Leptandra virginica

Volume I — Special Symptomatology

(Black Root — "Culver's Physic.'")

Description. — This is the Veronica virginica of Linnaeus. It is an indigenous, perennial plant, with a simple, straight, smooth, herbaceous stem, from two to five feet high. The leaves are whorled in fours to sevens; short petioled, lanceolate, acuminate, finely serrate. The flowers are white, numerous, nearly sessile, in long, terminal, and verticillate, sub-terminal spikes. It grows in rich, moist places, thickets, and flowers in July. The root is perennial, horizontal, woody, about as thick as the finger, six to twelve inches long; black externally, brownish internally, with many long, slender, black fibres. It should be gathered in the fall of the second year. It has a bitter, nauseous taste. The active principle, Leptandrin, is a jet-black, resinous substance, resembling pure asphaltum; or, of a greyish-brown color, with a peculiar, faint cyanic smell and taste; somewhat bitter, nauseous and disagreeable. When powdered, it has a black, glistening, soot-like appearance, and coalesces in a warm and moist air. It is soluble in water and alcohol.

Officinal Preparations. — Tincture of the root; dilutions; triturations of the dry root; Leptandrin, and its triturations.

Analogues. — Arsenicum, Baptisia, Carbo veyetabilis, China, Iris versicolor, Mercurius, Myrica cerifera, Nitric acid, Podophyllum

Sensorium.

0 Gloomy; desponding; drowsiness, attending hepatic derangements.

Head.

• Constant, dull, frontal headache, worse in the temples, with

aching sensation in the umbilicus.

• Dull, frontal headache, with neuralgic pains in the right

temple.

0 Bilious headache, with constipation, bitter taste, indigestion, etc.

Eyes.

• Smarting and aching with or without secretion of tears.

Mouth and Throat.

• Tongue coated yellow along the centre, with pain in the submaxillary glands.

Gastric Symptoms. Nausea, with deathly faintness on rising in the night. Nausea followed by vomiting and diarrhoea. 0 Dyspepsia from disorder of the liver and stomach.

Stomach.

• Constant distress in lower part of the epigastrium. Constant, burning, aching sensation in the stomach and liver.

worse after drinking water.

• Great distress in the stomach and small intestines, with

immediate desire for stool.

• Weak, sinking sensation at the pit of the stomach.

Liver.

• Dull aching in the whole of the liver, pain worse near the

gall bladder.

• Constant, dull burning distress in the epigastric and hypochondriac regions.

• Great distress in the region of the liver following profuse,

black, undigested stool.

• Great burning distress in the back part of the liver and iD

the spine.

• Pain in the right shoulder and arm. ° Jaundice, with clay-colored stools.

0 Functional derangement of the liver.

• Yellow coated tongue, with vomiting of bile, shooting or

aching pains in the region of the liver, and black evacuations.

° Chronic congestion and other chronic disorders of the liver. Leptandra causes black, tarry, bilious stools {primary), followed by clay-colored stools with jaundice {secondary) Abdomen.

• Constant, dull, aching distress in the umbilical region.

• Great distress in the whole of the bowels, with rumbling and

desire for stool.

• Rumbling and distress in the hypogastric region, with a profuse, black, foetid stool, with pains in the bowels Pains aggravated by drinking cold water. Pain in the left inguinal region. ° Bilious colic, or a tendency to it.

the portal system.

Stool.

Hard, black, and lumpy evacuations.

• Stool soft and mushy, with weak feeling in the bowels.

• Distress in the hypogastrium, with profuse, black, foetid stool.

• Watery stool with mucus, followed by severe cutting pains

in the smaller intestines.

• Copious tar-like evacuations.

• Diarrhoea from chronic irritation of the mucous membrane. ° Diarrh(ea dependent on hepatic derangement. Diarrhoea, with great debility, sallow skin, and emaciation.

0 Camp-diarrhoea in soldiers, from exposure, improper diet, etc.

0 Chronic ulceration of the intestines, with hepatic disorder.

° Diarrhoea ; stools of greenish, muddy or dirty water; profuse, "like water running from a spout; " coming on in morning as soon as he moves; aggravated by meat, vegetables, and walking; before stool, rumbling, after stool, weak, faint, purging feeling at stomach; dull aching across umbilical region all the time; canine hunger, no thirst. (Cured in four days.) {Dr. It. R. Williams?) Urine.

Urine very red (neutral), with dull, aching pain in lumbar region.

0 Dropsy from hepatic derangement.

Generative Organs. ° Suppressed or retarded menses from disease of the liver.

Thorax. Soreness in the cardiac region.

Back.

Sore and lame feeling in the small of the back.

Fever.

Pulse diminished in frequency. Pulse slow and full.

° Infantile remittents, with black and tarry, or white foetid

stools.

Skin

• Hot and dry skin in bilious fevers.

Upper Extremities.

Both wrists are lame and ache severely.

0 Pain in the left shoulder and arm.

Chilly sensation at the shoulder and down the arm.

Lower Extremities. Feet and legs cold and numb.

General Symptoms. Languid, tired feeling, with great prostration. Physical and mental depression, with vertigo and drowsiness.

Volume II — Special Therapeutics

If you look in your recent textbooks on botany, you will not find “ Leptandra ,” because it has been changed to Veronica Virginia. This plant has a high reputation among eclectics, but I have of late years doubted its efficacy in many diseases in which it is recommended.

If the provings made by Burt, and the clinical experience of botanic, eclectic and homoeopathic physicians is trustworthy, then the sphere of action of Leptandra may be defined as follows :

It first arouses the secretory action of the liver, then the secretory glands of the intestinal canal, and finally the more distant glands of the body.

The eclectic school of medicine, and even the allopathic, claim for Leptandra that it possesses a specific affinity for the liver; that it profoundly modifies its functions in various ways. King says of Leptandra : “ It is a cholagogue. It causes the liver to act with great energy, and without active catharsis, and is employed with success in all hepatic affections . It is indicated

by an inactive state of the liver, and all functional diseases of that organ.” And of Leptandrin he says : “It is the only known medicine which efficiently stimulates and corrects the hepatic secretions and removes functional derangements of the liver, without debilitating the system by copious alvine evacuations.”* Other writers of that school reiterate the same statements, and all eclectic practitioners use it with unhesitating confidence. It is to that school what “blue mass” is to the allopathic, while the Podophyllin is considered to take the place of Calomel. But the wide reputation of Leptandra, in 11 all functional derangements of the liver,” is too sweeping, and resembles the assertions of the allopaths, that Mercury is the only remedy in “all hepatic derangements.” We are aware that the researches of Inman and Thudiehum seem to render it doubtful if Mercury acts directly upon the liver, but the great mass of the allopathic school still use it, and probably will for the next ten generations.

• Iridin and Euonymin are similar. — Hale.]

The following symptoms are from large doses of the fluid extract :

Dull aching pain in lower part of the right hypochondriac region, near the gall-bladder , with dull, aching pain in the umbilicus, and rumbling in the bowels; dull aching in the whole of the liver, the pain extends to the spine, but is worse near the gallbladder; constant, dull, burning distress in the epigastric and hypochondriac regions; dull, aching distress in the region of the gall-bladder, with frequent chilliness along the spine ; profuse, black, undigested stool, followed by great distress in the region of the liver, extending to the spine ; the pain is of a hot, aching character, with chilliness along the spine; sharp, cutting pains near the gall-bladder ; great burning distress in the back part of the liver, and in the spine; pain in the left shoulder and arm. Jaundice, with clay-colored stools.

These symptoms, from Burt’s proving of Leptandra, seem to establish the fact that this medicine does exercise an influence of no doubtful power over the liver and its secretions. The hepatic symptoms are well marked, both the subjective and objective, and the whole experiment goes to prove what I have so often asserted in my writings, viz., that all the remedies successfully used by the allopathic school, are used strictly in accordance with the homoeopathic law of cure, and being administered under that law, do effect cures, notwithstanding the large doses in which they are given — doses which very often produce needless and painful, and sometimes injurious, medicinal aggravations. In regard to the real action of Leptandra on the liver and secretions, I do not propose to hazard any decided opinion, inasmuch as the action of Mercury, even upon that organ, is involved in considerable mystery. The same may be said of such analogous medicines as Iris versicolor and Podophyllum. But I may throw out a few suggestions which may be taken for what they are worth.

“Calomel,” says Draper, in his “ Physiology,” “ increases the fluid, but diminishes the solid constituents of the bile.” It is my opinion that Podophyllin and Iris versicolor act in a similar manner. Leptandra, on the contrary, seems to increase the solid and decrease the fluid constituents of that secretion; or, in other words, Leptandra may have the power of facilitating the proper

elimination of the excrementitious portions of the bile, or an excess of the non-excrementitious portions. It is, at present, believed that the retention of cholesterin in the blood is very injurious. That substance acts somewhat after the manner of urea, namely, «as a direct poison to the nervous centres. Its non-elimination causes headache, vertigo, languor, depression of spirits, painful sensations in various portions of the body, etc. Nowit is highly probable that Leptandra increases, directly, the elimination of this substance, for under its action, when given in proper medicinal doses, the symptoms enumerated above are rapidly dissipated. The retention of other excrementitious constituents of the bile causes various morbid conditions, and the Leptandra, by its peculiar action, seems to be the remedy most likely to be of benefit when we wish to eliminate such substances through the liver. As it does not appear to increase the fluid constituents of the bile as does Podophyllum and Iris versicolor, its apparent tonic effect, even in material doses, may thus be accounted for. Mercury, however, seems to have, in some instances, a similar action with Leptandra. In minute doses, in certain states of the system, it acts as a tonic, i. e., it removes the morbid state by its homoeopathic action, and the vital powers resume their normal sway. Some further suggestions relating to the action of Leptandra may not be amiss.

Its primary pathogenetic action seems to be that of a stimulant, or irritant of the hepatic cells. Chambers states that “ Mercury, Nitro-muriatic acid, and Manganese cause an increase of yellow matter in the cells of the liver.” Podophyllum may have the same effect ; also Leptandra. As a consequence of this primary stimulation and irritation, we have the increased elimination before mentioned, and sometimes acute congestion and inflammation. Leptandra, therefore, is primarily homoeopathic to an irritable condition of the liver, in which the discharges are of the peculiar character described under “ stool,” and the pains and abnormal sensations are similar to those under “ liver.” The secondary effect of Leptandra is over-stimulation, or a condition of exhausted irritability, in which the hepatic cells refuse to perform their office (particularly that of eliminating the excrementitious substances from the

The size of the dose, let me remind the reader, will depend on its primary or secondary homoeopath icity.

Dr. H. M. Warren, of Jonesville, Mich., reports the following rapid and suggestive cure of a severe case of hepatic disease. Its effects in this case would seem to show that it has a powerful and rapid action on the liver:

Mrs. W aged 75, was one morning suddenly attacked with the following symptoms, her health up to the previous evening being good : Deliriousness, complete prostration, heat and dryness of the skin, coldness of the extremities ; fetid and tardy stools ; tongue thickly coated, with a black streak down the centre. I have seldom seen a patient attacked so suddenly, especially with these symptoms, and with such complete prostration. I gave her Rhus and Baptisia — the latter for her fever, which was high, the pulse being quick but weak. The next morning, Friday, I thought she appeared more conscious, and could understand questions put to her. I gave her five grains of Leptandrin 2d, in a tumbler half full of water. I never saw a more rapid recovery. The bowels became natural, tongue cleaned, consciousness and strength returned.

Dr. Neidhard writes me as follows in relation to the action of Leptandra on the liver :

I would draw the attention of my professional brethren to the admirable effect of Leptandra in certain cases of liver complaint. Four cases of this kind are now before me, characterized by the following symptoms : The states of the liver are quarterly, periodical, occurring every two or three months ; yellow-coated tongue ; constant nausea, with vomiting of bile ; shooting or aching pains in the region of the liver ; loss of appetite ; urine of a brownish color, or at any rate very dark ; there is also, often, pain in the transverse colon ; giddiness in the head. The most characteristic symptom consists in the presence of very dark, almost black, evacuations from the bowels.

It is a stereotyped phrase of eclectic writers that the Leptandra causes “copious, tarlike dejections from the bowels/’’ They teach that when this symptom occurs, after the administration of Leptandra in disease, it is a very favorable symptom, and recovery is confidently predicted. This assumption is based upon the wellknown fact, that similar evacuations do often occur during the course of bilious and other fevers, hepatic diseases, etc., and seem to be of a “ critical ” character, i. e., they relieve the system of certain morbid matters which had caused the malady. I have treated many malarious fevers of a pernicious character, when these tarlike discharges occurred under the homoeopathic use of Arsenicum

and Rhus, and when the peculiar evacuations were not due to the medicine, but to the vis rnedicatrix naturae. I have known them to occur during an attack of supposed portal congestion, when no medicine had been taken. But the pathogenesis of Leptandra proves that those peculiar dark discharges are not always the result of natural disease — in other words, this medicine is not alone an eliminative of such morbid matters, but actually causes such evacuations when given to a healthy person. Eclectic writers erroneously teach that when the Leptandra causes black evacuations, it shows that the system was being poisoned with u vitiated bile,” or some other morbid matters. It- is this belief that has led to the indiscriminate routine and injurious use of this remedy in many diseases. They do not stop to ask themselves the question, whether the tarlike discharges might not be due to the poisonous action of the drug ? I have known patients under eclectic treatment to be kept under the action of Leptandra day after day, until the third stage of poisoning — namely, that stage when watery, mucous, and bloody stools occur — because the physician supposed he must continue the administration of the medicine until the black discharges ceased. When they did cease, then the disease was said to “ run into dysentery but it was the dysentery of Leptandra. So much for the blind adherence to prevailing opinion, which is the curse of all medical schools. There are some peculiarities in relation to the symptomatology of the evacuations caused by Leptandra. The catharsis caused by it may be divided into four stages :

(1) Discharge of black, thick, tarlike, fetid substances.

(2) Thinner, brownish, often fetid evacuations.

(3) Stool of mixed mucus, flocculent, and watery matters, with yellow bile or blood.

(4) Mucous, bloody stool, mixed with shredlike substances; often pure blood is discharged.

Now, to prescribe a drug successfully, We should know the different stages of its pathogenetic action. This is just as important as to know the stages of disease. The catharsis of Podophyllum differs materially from that of Leptandra, and although it causes some of the varieties of stool, they occur in a different order. If we are called upon to prescribe for a diarrhoea, we should investigate its history ; if that history corresponds in order and nature with the Leptandra disease, then that drug is the specific remedy. In the treatment of a dysentery the same rule holds good ; dysentery occurs in the fourth stage of Leptandra poisoning, while it occurs in the second stage of Podophyllum intestinal irritation. With some drugs, scanty, bloody, and mucous stools occur as a primary symptom, as in cases where the rectum is the seat of inflammation.

Dr. P. P. Wells, of New York, has lately called the attention of the profession to the characteristic symptoms of drugs ; those symptoms which make it differ from all other drugs. Thus, there are many remedies for “black stools ,” but not all will remove that condition ; the collateral symptoms must correspond. This subject will be noticed in another place.

In the pathogenesis of Leptandra, it should not escape the notice of the physician, that the evacuations per anum are accompanied by some peculiar symptoms: the pains in the intestines usually occur after stool ; in the Podophyllum diarrhoea they occur before, while in the diarrhoea of Mercury, and many others, the pain is severe during the stool. It will also be noticed that the evacuations are not followed by tenesmus. The provings given do not mention it, nor do I find it mentioned in any article referring to its action. In practice I have not found it useful when there was marked tenesmus attending the disease. Such remedies as Podophyllum, Aloes, and Mercurius are more applicable.

I am inclined to believe that Leptandra does not have any direct specific effect upon the rectum. Its action on the liver and portal system undoubtedly causes it to affect the rectum and haemorrhoidal vessels, but this action is indirect. If we carefully study the symptoms of Leptandra, after the method proposed by Dr. P. P. Wells, we shall find it a drug possessing a distinct individuality, as much as any other drug in our Materia Medica.

In acute diarrhoea, we shall find this medicine often indicated, and it will prove a valuable specific when administered for the pathological conditions in which it is indicated; those, and the symptoms, are well shown by the provings.

In chronic diarrhoea, this drug is even more reliable for the general condition, which is shown by the following extracts from

my lecture on Leptandra, delivered before the class of Hahnemann Medical College, in the winter of 1864 :

The three principal varieties of chronic diarrhoea, in which Leptandra will be found useful, are :

(a) From chronic acute inflammation or irritation of the mucous membrane.

( b ) Dependent on hepatic derangement.

(c) Diarrhoea of debility.

Some of the indications for Leptandra in the first-named variety I have already given, but I will here call your attention to one form of this affection, which bears the common name of “ camp diarrhoea.” This disease is usually contracted in camp, where the soldiers are ill-protected from atmospheric changes, and are exposed to cold, dampness, and fetid exhalations from refuse matter, decaying vegetation, etc. These, together with improperly cooked food, and bad water, are the principal causes of this malady. Its onset is sometimes gradual, lasting for days and weeks before the surgeon’s attention is called to it by the patient ; but it often attacks its victims suddenly, and assumes the character of a cholera morbus or acute enteritis. It is one of the most intractable diseases with which our army had to contend. Under allopathic treatment it is almost incurable, and sometimes resists all medication, so long as the man remains in damp or barracks, exposed to the same influence which caused it, and obliged to subsist upon the usual hospital diet. In the acute stages the following treatment will be found the most applicable: If it is evidently caused by a cold or exposure to dampness, Dulcamara, Aconite, or Pulsatilla will be found most efficacious. When caused by bad diet, and improper food or water, Pulsatilla or Podophyllum will be most useful. If hepatic derangement is evidently present, Mercurius, Podophyllum, Leptandra, or Iris versicolor, will be indicated. If the attack is choleraic in its character, Arsenicum, Veratrum album, or Euphorbia corollata, and perhaps Aconite, should be selected. But when it assumes a chronic character, and persists in spite of altered diet, change of location, etc., then Leptandra will be found an invaluable remedy. In many cases its persevering use will alone effect a cure, although there are cases in which we may be obliged to resort to the auxiliary aid of Phosphoric acid, Nitric acid, Arsenicum, Sulphur, or Mercurius corrosivus.

It is in most cases absolutely necessary that the patient (the subject of camp diarrhoea) should be removed from camp, or barracks, as soon as possible, and transferred to some healthy locality. For obvious reasons, a return to the patient’s home is to be preferred. Here his military dress should be changed for his former civilian’s apparel, and his diet should consist of plain, nutritious, easily assimilable substances. My experience has been that patients do the best upon a milk diet, plain bread and milk being the best form of its use. In addition, he should have a certain amonnt of good fresh beef, mutton, or game, every day. Taking the hint from the practice of an eminent Russian military surgeon, who successfully adopted the treatment in the great military hospitals, I have advised the use of raw, or nearly raw, beef, and in most instances with the most satisfactory results. Tender lean steak should be selected and chopped very fine; a very small quantity of salt may be added if the patient insists. Of this an adult may eat one or two ounces three times a day with his bowl of bread and milk. Potatoes, salted meats, warm bread, raw fruit, pastry, coffee, preserves, and

liquors, should be prohibited. Moderate exercise will be of advantage; too much, injurious. If the chronic diarrhoea depends for its continuance on debility, and resembles the colliquative diarrhoea of phthisis, accompanied by hectic fever and colliquative sweats, the Leptandra is still useful, but should be given in alternation with Phosphorus, Arsenicum, China, or Nitric acid. The two latter are especially indicated if a lientery is developed and the food passes the bowels unchanged, or in a state of putrefactive fermentation.

In some cases such is the debility and relaxation of the mucous membrane that the serous and even fibrous parts of the blood escape, attended sometimes with more or less of the red coloring matter. An increased degree of the same affection constitutes passive haemorrhage. It is not unfrequently associated with a watery state of the blood, which becomes incapable of sustaining a due energy in the extreme vessels. In such conditions Leptandra is still useful, but should be aided by those remedies which are capable of bringing back the blood to a normal condition. First in importance stands Iron. The preparation I prefer is the Phosphate, given in the form of syrup or superphosphate of Iron, thirty drops after each meal, or a few grains of the first decimal trituration of the Pyro-phosphate. Next in value are Hydrastin, Ilelonin, Muriatic acid, and sometimes Nux vomica. The Citrate of iron and strychnine is often one of the most efficient remedies for chronic diarrhoea, when we have two conditions, namely, an impoverished state of the blood and an atonic state of the muscular tissues of the intestines. When these states obtain, we usually find alternate constipation and diarrhoea, deficient digestion, accumulations of flatulence, and haemorrhoids.

Chronic ulceration of the intestines often occurs during the course of a chronic diarrhoea. Dr. Chambers says : “ There is no disorder in which emaciation is so marked a feature throughout its whole course as chronic ulceration of the small intestines. Ulcerations of the coecum and colon, tubercular or not, produce as much, nay, often more, diarrhoea ; but they are not by any means so distinguished in their power of reducing the patient. In this lesion of the ilia, even the parts which are not the actual seat of disease seem incapacitated for absorbing nutriment, and the victuals pass through the alimentary canal in the same state as when they left the stomach, except being made putrid by chemical decomposition. All the stages of digestion are equally suspended.”

These lesions are more common during infantine life, and thousands of children are yearly carried off by this malady in every large city. In this affection Arsenicum, Mercurius corrosivus, Sulphur, Nitric acid, and Phytolacca are indicated. The Leptandrin has also been of use in my hands, when, with the usual symptoms, there was present a jaundiced hue of the skin, sallow complexion, pain in the region of the liver, lack of bile in the evacuations, and great debility. In such a condition I would advise you to use, for adults, the first decimal trituration ; for children, the third trituration .

When the ulceration is tubercular you will have to resort to a different class of remedies, prominent among which I would advise the Hypophosphite of lime (Calcis hypophosphis), which has all the curative properties of Calcarea carbonica, together with the recuperative qualities of Phosphorus. The second or third decimal trituration will prove the most satisfactory. Leptandra may be called for, even in this disease, if we find disorder of the liver complicating the case.

I believe it increases the absorbent action of the intestinal mucous membranes, and thus prevents the excessive emaciation. In respect to the action of Leptandra on the mucous membranes of the intestine, Dr. Coe gives a case which is quite interesting. He says: “No remedy with which we are acquainted is more to be relied upon in chronic affections of the mucous surfaces. Its value in this respect is peculiarly apparent in chronic dysentery and diarrhoea and other diseases of the bowels. When false membranous formations have occurred in the smaller intestines, produced by the gradual exudation of plastic lymph, the Leptandra may be relied upon for their removal with great confidence . We

have also used it with great success in the cure of constipation and piles. We recently treated a case of the latter complaint, accompanied with frequent haemorrhage from the rectum, of twelve years’ standing. A short time after commencing its use, the patient discharged considerable quantities of false membrane, in shreds and patches, and a number of pieces several inches in length, forming complete tubes. The evacuation of this matter was attended with amelioration of all the symptoms, and at the present time the patient declares himself well. The bowels are regular, appetite good, the haemorrhage has ceased, and the distressing pain so long experienced beneath the sacrum, entirely gone.”

This is quite an important clinical fact, and although the cases were treated with massive doses (two to four grains twice or thrice a day), we cannot doubt that the remedy was homoeopathic to the disease mentioned.

In Wood’s “Practice,” article Chronic Enteritis, we find that “occasionally false membranes are discharged, and, in some rare instances, tubes of considerable length, obviously the result of a plastic inflammation, throwing out coagulable lymph upon the surface of the mucous membrane.”

Dr. Cumming, of Edinburgh, has given an account of a peculiar variety of pseudo-membranous inflammation of the bowels (quoted by Wood). In this variety Dr. Simpson used Arsenic, a remedy homoeopathic to the disease; and Dr. Cumming used tar and “electro-galvanism” successfully.

Believing, as I do, that all medicinal remedies cure only under the law of similia, it seems highly probable to me that Leptandra, in the case given by Dr. Coe, caused the expulsion of the membrane, and effected the cure by virtue of its power to cause a similar pathological state.

Chronic, dysentery is often associated with chronic enteritis, and it is not always easy to determine how far the two portions of the bowels are severally involved in the inflammation, nor is the decision a matter of much importance. Chronic diarrhoea and dysentery are very nearly allied in their anatomical character, and we often find cases where the symptoms of both maladies are intimately blended. But chronic dysentery, when not thus combined, is distinguished from chronic diarrhoea by the frequency and comparatively small quantities of the evacuations, their character, and the tenesmus with which they are attended. The greater number of the stools consist chiefly of mucus, sometimes mixed with puslike matter or blood. Occasionally, however, feculent or bilious matter is mixed with the proper dysenteric discharge. When the disease occupies the rectum and lower portions of the colon, the frequent discharge is often consistent, and instead of being uniformly mixed with mucus, is either irregularly pervaded by it in layers or streaks, or enveloped in a thick coating of it, derived from the surface of the bowel with which the faeces lay in contact. There is usually more or less tormina and tenderness on pressure; the pulse, skin, and appetite are affected as in chronic diarrhoea, and there is nearly the same emaciation. Chronic dysentery is seldom an original disease; but when it occurs is almost always in consequence of an acute attack. “ Camp dysentery,” and even “camp diarrhoea,” may run into a chronic dysentery. In this disease we have in Leptandra a valuable and efficient remedy, but it is more applicable to those cases in which a chronic enteritis complicates the disorder.

In cholera infantum it has proved a very useful remedy. Dr. King (eclectic) says :

In cholera infantum, a disease which sometimes sets at defiance all the skill of the physician, I have met with excellent success by the following combination : Leptandra, six grains ; Quinia, three grains ; Camphor, one and one-half grains ; Ipecacuanha, three-fourths of a grain, mixed and divided into twelve powders, of which one may be given every two or three hours, and its use continued thus for several days. Its action at first is to increase the alvine passages, and apparently augment the disease ; but in a few days the character of the evacuations change, become more and more normal, as well as more regular in their appearance ; after which one or two powders per day for a week will render the cure permanent.

I have quoted the above to show that this mixture, absurd as it is, really cured the disease homoeopathically.

Leptandra, the main ingredient, is eminently homoeopathic to the disease in most cases, as the provings show.

Quinia, for which we substitute China, is indicated by the general condition (prostration from loss of fluids), and by the special symptom (copious, dark, or light watery stool).

Ipecac, is one of our best remedies when there occurs vomiting with the diarrhoea; and Camphor, as shown by Hahnemann, is quite homoeopathic to choleraic symptoms with considerable prostration. By the use of Leptandra, third trituration ; China, second dilution ; and Ipecac., first or second, with Camphor, one-tenth, as an intercurrent remedy, the homoeopathist can cure his patient, without the danger of doing the injury to the organism, especially in cases of children, that is apt to occur from such massive doses as is advised by King, who admits that the disease is apt to be aggravated at first by the medicines.

Hr. B. L. Hill, when an eclectic, wrote as follows concerning the action of Leptandra in dysentery :

In the epidemic dysentery which has prevailed for the last two seasons (1854- 55) in many parts of our country, it has been of great service. It was usually given with the best success after evacuating the bowels freely, with a combination of Podophyllin and Leptandra, or Rhubarb. For this purpose give from onehalf of a grain to a grain every hour, gradually lengthening the intervals as the discharges become darker. Though it may not be applicable in all cases of dysentery, it is doubtless one of the most useful articles in this dangerous disease.

The epidemic referred to was of an adynamic character, quickly prostrating the patient, and often ran into a typhoid condition. For the same epidemic Dr. Hill would now advise and use, with as good results, minute doses of Leptandra, Podophyllum, Arsenicum, and Baptisia. It may be remarked here that Podophyllum is indicated for a much higher grade of inflammation and irritation of the bowels than Leptandra. The following was Dr. Hill’s estimate of the action of Leptandrin :

It is not strictly cathartic. It is aperient, alterative, and tonic. In cases of children affected with summer complaint, where there is evidently a lack of the proper biliary secretions, but when, owing to the irritated condition of the bowels, the ordinary remedies for arousing the liver are inadmissible, this article seems to be the very thing needed. While it acts freely upon the liver, instead of purging, it seems to change the discharges from the light and watery, or slimy condition, to a darkened and apparently bilious state, rendering them more and more consistent, until they become perfectly natural, without having been arrested entirely, or at any time aggravated. At the same time it seems to act as a tonic, restoring the tone of the stomach, and increasing the strength and activity of digestion.

Dr. Hill, the homoeopathist, valued the Leptandra quite as highly as did Dr. Hill, the eclectic, but he accounted for its action in a more rational manner. As the latter, he gave from one-fourth to one grain every hour or two in acute cases, or one to two grains three times a day in chronic cases; as the former, he also finds y1^ or you °f a grain equally serviceable. In those severe cases of disease which clearly resemble the primary symptoms of poisoning with the fresh root of Leptandra, the 30th, if prepared from a good tincture, would doubtless act curatively.

Dr. William Fry, of Hew York, reports the following case of intestinal disease treated successfully with this remedy :

My first trial with this remedy was followed by the most prompt and satisfactory results. It was a case of dysentery of nearly a month’s standing, having been brought on after a sudden change of climate. The following were the most characteristic symptoms of the case at the time the Leptandra was prescribed : mental suffering ; dizziness and headache; chills, followed by fever; pain and uneasiness in the bowels ; nausea, and a constant profuse flow of saliva from the mouth during the chill ; great thirst, but inability to keep any food or drink upon the stomach ; constant desire to urinate during the chill ; urine high-colored, and passed in small quantities ; soreness of the rectum ; haemorrhoids ; painful dragging and stinging pains in the rectum ; bowels bound and alternated every three or four days by a setting-in of diarrhoea, the passages consisting of fecal matter resembling raw or boiled beef after having been pounded fine, with an admixture of mucus and an intolerable fetid smell. The desire to stool was in the morning, and continued about an hour, during which time there were four or five passages, followed by tenesmus of the rectum and a feeling as if something was passing out. These are some of the most prominent symptoms of the case, and I cured it with two doses of the Leptandra — one powder of the first centesimal trituration in the evening and another in the morning, after having failed to get any effects from such remedies as Arsenicum, Colocynth, Carbo veg., Mercurius, etc. I got the best results from this remedy in the lower forms of preparation.

Dr. G. W. Barnes, now of San Diego, Cal., communicates the following cases :

Case I. — During the progress of a tedious case of post-scarlatinal follicular entero-colitis, associated with a condition of general anasarca, occurring in a little boy of six years, the details of which I will not trouble you with, there occurred a condition of the alvine evacuations corresponding very beautifully with your proving of Leptandra. The stools, three or four a day, were profuse, dark-brown, almost black, of a mushy consistence, and highly offensive odor. There was difficulty in retaining the stool ; he must go immediately. There was sharp pain preceding the stool and relief afterwards, but increased weakness. He usually went to sleep soon after stool. Other remedies were required to complete the

cure ; but Leptandra, 3d trituration, very promptly changed the stool to a normal appearance and frequency, and produced a satisfactory amelioration generally.

Case II. — Captain H - , Ohio National Guards, had suffered nearly three

months with camp diarrhoea, and had been for the greater part of that time in hospital. During a tedious journey from Washington his case became aggravated, and on his arrival at home he was hardly able to stand upon his feet. He was emaciated, his features haggard and jaundiced ; his stools, previously mixed with undigested food, were now muco-purulent and bloody, quite frequent and attended with some tenesmus and cutting pains low down in the bowels. Cold water taken internally produced a sense of weight at the stomach, cutting in the bowels, and a disposition to stool. There was a state bordering on ulceration, and it was the opinion of his hospital surgeon that that condition existed.

Some amelioration followed the administration of Mercurius cor., 6th and 30th, but under the influence of Leptandra, 3d trituration, improvement was prompt and steady, and in two weeks his stools were natural in quality and frequency, and he was soon well.

You must not confound the black, tarry, fetid stools of the Leptandra diseases with melcena, a disease in which black, disorganized blood is passed by the bowels — a condition in which I doubt the applicability of Leptandra, but would prefer Sulphuric or Nitric acid, or Hamamelis.

It has been recommended as a remedy in dropsy. King says, “ It exerts a powerful influence upon the absorbent system, and in combination with Cream of tartar, has been successfully used in obstinate cases of dropsy.”

If Leptandra is homoeopathic to any variety of dropsy, it is probably that dependent on disease of the liver. In order to test its value in dropsy, or indeed any disease, it should be given alone. To combine medicines is to lose all data concerning the real action of any single agent.

It is doubtful if Leptandra exercises any specific action on the functions of the kidneys, yet a medicine may be useful in dropsy without being a diuretic. It may act curatively by a certain general restorative power. Thus, China, Iron, Helonias, etc., may remove dropsies, by bringing the organism up to a normal condition. Any cause which obstructs the circulation in the portal system of veins will induce dropsy. Chronic tumefaction of the liver, and organic diseases of that organ ; also inflammation of the

portal vein, are the principal causes of the varieties of hepatic dropsy.

You may find Leptandra useful in headaches.

With the knowledge we now possess of the action of this medicine, especially on the liver, we can very properly decide its headache to be the so-called “ bilious headache.” It somewhat resembles the cephalalgia caused by Nux and Bryonia. A bilious headache is usually accompanied by constipation, furred tongue, bitter taste, indigestion, yellow urine, languor, and depression of spirits. A free discharge from the bowels of dark-brown, or greenish, feculent matter, usually dissipates the pain. Such headaches are relieved, and even cured, by the use of Leptandrin, second or third trituration.

Aided by Nux vomica, it is one of our most efficient remedies against the peculiar, stupid, sleepy condition which attends portal congestion — “ biliousness ” — a state which often occurs during the summer months, and is often precursory of a bilious fever.

As a fever medicine, its only use is as an intercurrent remedy, or for the purpose of removing the cause of the fever.

Coe remarks that when the Leptandra is given in disease, and the patient is fairly brought under its constitutional influence, “the skin, which was before hot, dry, and constricted, becomes soft, moist, and flexible; expectoration becomes easy, the arterial excitement is lessened , and the patient, before restless, wakeful, and delirious, becomes calm, rational, and inclined to sleep.” He considers it a valuable remedy in typhoid fevers, and in his opinion King, Jones, Morrow, and others concur. Some homoeopathic practitioners, as Hill, Gatchell, and many of my correspondents, place the same high estimate upon its curative powers in typhoid states, when there is present great prostration, stupor, heat, and dryness of the skin ; calor mordax, or coldness of the extremities ; dark, fetid, tarry, or watery stools, mixed with bloody mucus; and an icterode condition.

In intermittent fever it is a favorite and much-used medicine by nearly all Western physicians of both schools, who combine it with Quinine. They assert that it renders the action of Quinine more certain, and prevents the liability to a return of the disease, at least for the season, and is useful in periodic diseases generally,

of an obstinate character, in which Quinine produces little or no result. In my experience, which at one time was very large in diseases of the character referred to, the Leptandra did really act in a very beneficial manner. My method was to use it in alternation with Quinine, China, Nux vomica, or any other medicine indicated, and always in accordance with what I considered to be its homoeopathic applicability. I do not consider that it has any real antiperiod ic power, as some drugs undoubtedly have, but it removes conditions of the liver which often tend to keep up a continuance of intermittent maladies. I usually gave it for the following symptoms : Considerable prostration, loss of appetite, heavily coated brown tongue, bitter taste in the mouth, constipation, or diarrhoea, with dark, fetid stools, jaundice, yellow, saturated urine.

In bilious fevers, I have given it for nearly the same symptoms, using Leptandrin, second or third decimal trituration.

In infantile remittent, I have had some excellent results from its use, administering the second or third dilution of the tincture, or the third and fourth trituration, as seemed most proper.

I do not see why it may not prove a good remedy in yellow fever. It corresponds to some of the symptoms. It may be good for the premonitory symptoms, or some of the sequelae.