VIBURNUM PRUNIFOLIUM.

The dried bark of the root of Viburnum prunifolium, Linné. The U.S.P. admits the dried bark of this and also of the Viburnum Lentago, Linné, or Wayfarer's Tree (Nat. Ord. Caprifoliaceae). Beautiful shrubs found in thickets of the eastern half of the United States. Dose, 5 to 60 grains.
Common Names: (1) Black Haw, Sloe, Sloe-leaved Viburnum, Stag Bush; (2) Wayfarer's Tree, Nanny Berry, Sheep Berry.

Principal Constituents.—A brown, bitter resin; greenish-yellow, bitter, viburnin, valeric acid, tannic acid, citrates, malates, oxalates, sulphates, and chlorides of calcium, magnesium potassium, and iron.
Preparations.—1. Specific Medicine Black Haw. Dose, 5 to 60 drops.
2. Black Haw Cordial (Howe's). (Contains Black Haw, Wild Cherry, Aromatics, Brandy and Syrup). Dose, 1/2 to 2 fluidrachms.
Specific Indications.—Uterine irritability and hyperaesthesia; uterine colic; threatened abortion; dysmenorrhea, with cramp-like pelvic pain, and scanty flow; severe lumbar and bearing-down pelvic pain; painful contraction of the pelvic tissues; false pains and after-pains; obstinate hiccough.

Action and Therapy.—Black haw is a remedy of Eclectic development and is praised by practitioners of all schools of medicine for its virtues in disorders of women. It is both tonic and antispasmodic, well-sustaining the time-honored meaning of those terms. While a tonic to the gastrointestinal tract and a good one, black haw is better adapted to atonic states of the female reproductive organs, and as a sedative for spasmodic pain and weakness in diseases of women. As a tonic it acts kindly and is pleasant to take. It causes no constitutional symptoms, such as sometimes come from the use of cinchona, nux vomica, and the more energetic tonics. It is agreeable to the stomach and tends to restrain unhealthy discharges. It allays the nervous unrest so commonly associated with pelvic weakness; and its effect upon cramp-like contraction of both the tubular organs and the voluntary musculature of the body is similar to that of cramp bark or Viburnum Opulus.

As a uterine sedative and tonic, black haw is used, perhaps, oftener than any other drug. It seems to improve the uterine and ovarian circulation, giving better innervation and more perfect functioning, and evidently promotes pelvic nutrition. In relaxation of pelvic tissues, with more or less congestion, or tendency to undue discharges and passive hemorrhage, it is one of the best of medicines. For painful menstruation, whether due to debility with relaxation, or to engorged tissues with cramp-like pain, the physician will find almost daily use for black haw. Sometimes the menstrual flow is scanty, but more often it is profuse and accompanied by severe bearing down, intermittent and expulsive pains. Few agents give greater relief in such conditions. In cases in which the menses are imperfect in function and pale in quality, and there is an associated cardiac disturbance, usually palpitation; and in some cases of amenorrhea, in anemic girls with pallor and subject to intermittent cramping pain, the action of the drug is very positive. It is equally valuable in chronic uterine inflammation, in subinvolution, in boggy, congested uterus, and for the associated leucorrheal discharges. As a remedy for passive hemorrhage its use will be governed largely by the cause. If due to polypi, fibroid or carcinomatous tumors, but little can be expected from it or any other medicine. But even here, in combination with cinnamon, it sometimes restrains the flow. Such cases are surgical and should be surgically treated. Many a good medicine, like black haw, has been brought into discredit because of its failure to do what a careless or faulty diagnosis has led one to hope for from its exhibition or to attempting physical impossibilities with such medication. Black haw is a good tonic during pregnancy, and through such action proves a fairly good partus praeparator. It is one of the most certain remedies for nocturnal cramping of the muscles of the leg. It does not act so well when due to pregnancy, as that is a pressure condition that can only be relieved by supporting the abdomen or a change of position in reclining.

Many practitioners, whose opinions we value and whose experience has been wide, report success with black haw in restraining the expulsion of the product of conception. Our own experience leads us to doubt its reputed value in that condition, but this in no way disparages the statements of others who may have been more successful with it. Rest in bed and quieting agents, I such as Dover's powder, may enable the product to be retained; perhaps black haw may aid. But we have utterly failed in every attempt to prevent miscarriage with the agent where there was any considerable hemorrhage or where enforced and prolonged rest was not insisted upon. If any results are to be expected from it in habitual abortion it must be in cases of functional debility of the reproductive organs, and not in those due to inherited taints or syphilitic infections, or criminal operative interference. We believe, however, that much may be done with black haw to strengthen conditions in cases having had a previous miscarriage, and in uneasy, cramp-like sensations occurring during pregnancy, but with no considerable hemorrhage. It will, however, be of service in controlling the nervous phenomena associated with such threatened accidents and aid psychologically in preventing that which undue nervous agitation might precipitate. It is a good agent for false pains and for ovarian irritation and congestion. Black haw cordial is an ideal sedative for spasmodic dysmenorrhea.

Black haw is of very great value in treating those having a craving for alcoholic drinks. The specific medicine black haw, with essence of cinnamon or of cloves, or preferably Howe's Black Haw Cordial may be given. It relieves the discomfort experienced in the throat and the gnawing distress in the stomach, from which these unfortunates suffer.

For most purposes the specific medicine black haw is given in doses ranging from five to sixty drops, two, three, or four times a day as indicated; the black haw cordial in doses of one half to two fluidrachms.