SANGUINARIA.

The rhizome and roots of Sanguinaria canadensis, Linné (Nat. Ord. Papaveraceae), gathered in autumn after the leaves and scape have died to the ground. Found in woods and clearings and along old fences in North America from Canada to the Gulf of Mexico and from the Atlantic to the western boundary of the States bordering the west bank of the Mississippi. It is one of our most beautiful vernal flowers and is rapidly becoming scarce on account of the ravages of despoilers of our native flora. Dose, 1 to 5 grains (expectorant); 15 to 20 grains (emetic; not used).
Common Names: Bloodroot, Red Puccoon, Puccoon, Indian Paint, Tetterwort, etc.

Principal Constituents.—Chelerythrine (forming yellow salts with acids), sanguinarina (forming red salts with acids), gamma-homochelidilonine and protopine, all of which are alkaloids; alcohol soluble resin and sanguinarinic acid.
Preparations.—1. Specific Medicine Sanguinaria. Dose, 1 to 10 drops, well diluted. Usual form of Administration: Rx Specific Medicine Sanguinaria, 5-10 drops; Water, 4 fluidounces. Mix. Sig.: One teaspoonful every two or three hours.
2. Tinctura Sanguinaria Acetata Composita, Compound Acetated Tincture of Bloodroot (Acetous Emetic Tincture). An acetated tincture of Sanguinaria, Lobelia and Dracontium. Dose, 20 to 60 drops (expectorant); 1 to 4 fluidrachms (emetic).

Specific Indications.—"Burning and itching mucous membranes, especially of fauces, pharynx, Eustachian tubes, and ears; less frequently of larynx, trachea, and bronchi, occasionally of stomach and rectum, and rarely of vagina and urethra; mucous membrane looks red and irritable; nervousness, redness of nose, with acrid discharge, burning, and constriction in fauces or pharynx, with irritative cough and difficult respiration" (Scudder). "Feeble circulation, with coldness of extremities" (Locke).

Action.—The physiological action of sanguinaria is pronounced. The powder, when inhaled, is exceedingly irritating to the Schneiderian membrane, provoking violent sneezing, and free and somewhat prolonged secretion of mucus. To the taste, bloodroot is harsh, bitter, acrid, and persistent, and, when swallowed, leaves an acridity and sense of constriction in the fauces and pharynx, and induces a feeling of warmth in the stomach. In small doses, it stimulates the digestive organs, and increases the action of the heart and arteries, acting as a stimulant and tonic; in larger doses it acts as a sedative to the heart, reducing the pulse, causing nausea, and, consequently, diaphoresis, increased expectoration, and gentle diuresis, at the same time stimulating the liver to increased action. If the dose be large, it provokes nausea, with violent emesis, vertigo, disordered vision, and great prostration. It also increases the broncho-pulmonary, cutaneous, and menstrual secretions. It is a systemic emetic, very depressing, causing increased salivary and hepatic secretions, and hypercatharsis may result. When an emetic dose has been taken, the heart's action is at first accelerated, and then depressed. Poisonous doses produce violent gastralgia of a burning and racking character, which extends throughout the gastro-intestinal canal. The muscles relax, the skin becomes cold and clammy, the pupils dilate, there is great thirst and anxiety, and the heart's action becomes slower and irregular. Spinal reflexes are reduced and paralysis of the spinal nerve centers follows. Lethal doses produce death by paralysis of medullary, respiratory, and cardiac centers, death being sometimes preceded by convulsions.

Therapy.—External. Sanguinaria is sternutatory, but is no longer used, as formerly, in snuff to excite secretion or to reduce polypi and other nasal growths and turgescence; to alleviate headache, neuralgia, or chronic nasal catarrh. A cataplasm of slippery elm and blood root is a favorite domestic remedy for frozen feet and chilblains; and an acetated decoction has received professional endorsement for some forms of eczema, ringworm, and warts. An ointment has also been successfully used in tinea.

Internal. Sanguinaria fulfills a variety of uses according to the size of the dose administered. Minute doses relieve irritation, whereas large doses provoke such an effect. Though decidedly emetic it should never be used alone as such, but in combination, as in the acetous emetic tincture, it may, in rare cases, be used as a systemic evacuant where it is thought necessary to thoroughly cleanse the stomach, and to excite to activity sluggish hepatic and general glandular function. Such a course is one of the oft-neglected means once employed in prefebrile states, and was effectual sometimes in preventing the onset of continued and intermittent fevers. An occasional emetic of this type also acts well in chronic stomach disorders, with arrest of function and gaseous eructation, and succeeds in emptying the stomach of a great quantity of ropy mucus, thus preparing the way for the kindly reception of other needed remedies.

Sanguinaria has a gentle but reliable cholagogue action, and may be used in hepatic torpor, congestion of the liver, and subacute and chronic hepatitis. In hepatic debility, where the bile is deficient or vitiated and the general circulation feeble, with cold extremities and in sick headache, catarrhal jaundice, and duodenal catarrh depending upon a like condition, small doses of sanguinaria are efficient. Nor should it be overlooked for gastric catarrh and atonic dyspepsia associated with hepatic torpor and circulatory enfeeblement. Drop doses of the specific medicine (well diluted), every two or three hours, best meet these functional derangements. The alterative properties of sanguinaria are not to be underestimated.

Bloodroot is useful in amenorrhea in anemic and chlorotic patients who suffer with chills and headache, and in dysmenorrhea in debilitated subjects. When due to vicarious menstruation, hemorrhage from the lungs is said to have been controlled by it. It may be used also for sexual debility, seminal incontinence and impotence dependent upon such conditions and relaxed genital organs.

One of the most important fields for sanguinaria is in disorders of the respiratory organs. It resembles lobelia somewhat in action. It is a useful stimulating expectorant, but should be employed only after active inflammation has been subdued, and in atonic conditions. It favors normal secretory activity, restoring the bronchial secretions when scanty and restraining them when profuse. It is specifically indicated when chilliness is a dominant feature of respiratory disorders, and is further indicated by burning and itching of the naso-laryngeal tract, tickling or burning in the nasal passages, with super-abundant secretion, irritation and tickling provoking cough; and when secretions are checked it relieves dry cough by promoting normal moisture. Keeping the specific guides in mind it will be found exceedingly effective in acute and chronic bronchitis, laryngitis, sluggish types of pharyngitis and faucitis, with deep red and irritable dry membranes, and in acute and chronic nasal catarrh. Too much must not be hoped for from its use alone in the latter, for catarrh of the nose and throat is not readily amenable to medication, unless the patient has the courage to persist in treatment in the face of many conditions disturbing to the nasal tract. In all such cases the general systemic treatment is a most important desideratum, and it is almost certain that without such care local treatment seldom effects a cure. Bloodroot, in decoction, has served well in the sluggish form of scarlatinal angina with tendency to destruction of tissue. It has been advised in whooping cough, but is too harsh in the doses required to use upon young children, and in mucous croup the same objection holds good. Its use as an emetic, once popular, in pseudo-membranous croup is also inadvisable, such a condition now being recognized as almost always a laryngeal diphtheria, and it should, therefore, be treated by the more approved antidiphtheritic measures. After pneumonia, when debility persists and cough and viscid secretion continue and it is difficult to expectorate, specific medicine sanguinaria, with or without lycopus, wild cherry, or eucalyptus, in syrup, is one of the most efficient of medicines. The dose should be regulated so that the patient receives about one or two drops of the sanguinaria every two to four hours. It similarly benefits phthisical cough with difficult expectoration, but should be withheld if it provokes gastric irritation or nausea. It has no effect whatever upon the tubercular state.