Liquor Sedans, Saw Palmetto, Damiana, Pichi, and Stylosanthes Elatior. THEIR USES IN NERVOUS DISEASES—TIIEIR ME DICO-LEGAE REEATION—EPILOGUE. By JOHN J. CALDWELL, Neurologist, OF BALTIMORE, MD. [Reprinted from Virginia Medical Monthly, January, 1894.] After repeated trials, we have the pleasure of presenting to the profession our experience with the above-named new and valuable specialties. Like purgative and anodyne remedies, uterine tonics are often found to exert their influence on that much sooner, and often in a more satisfactory manner when com- bined, than when given in Galenic prescription. In the compound known as liquor sedans, we have the best ming- ling of ingredients known to the therapeutic world as espe- cially useful and favorites in affections of the genital or- gans. They all combine to impart to the mixture the effect so well illustrated in its name of “sedans,or soothing;” and we hope our selection of the following case will not be inappli- cable in our endeavor to give the good result of the remedy: Mrs. F., aged 47, had for eight years suffered with loss of The remedies mentioned are the products of the well-known house of Messrs. Parke, Davis & Co., manufacturing chemists. 2 appetite and indigestion, attended with rapid loss of weight and strength. She had been treated by several physicians and had tried various drugs to arrest the waste of flesh, with little or no good result. About a year ago she applied to me, I advised her to use the materials of which I after- wards learned through the Working Bulletin of Messrs. Parke, Davis & Co., the liquor sedans to be composed. She took these remedies regularly according to my directions, and after two weeks’ administration her skin, which had before been dry and husky, became soft and moist, and her com- plexion of a better color. Her appetite improved, and sev- eral articles of diet, which before she could not eat without causing decided uneasiness and diarrhoea, could now be taken with decided relish and good digestion. I continued to use the remedies for several weeks longer, and found her health greatly improved. She gained fifteen pounds in weight, while her spirits were much improved and her en- ergy renewed. I might mention, also, several cases to show the efficacy of these ingredients in troubles of digestion and nutrition, and how they exert a prompt action in restoring the inertia of the pelvic organs by their tonic effect on the genital cen- tres, and in allaying the pathological conditions which we so often find unduly exalted to such a degree as probably to have induced the great Sydenham to assert most positively “ that all women were hysterical.” The following are the ingredients entering into the liquor sedans—all vegetable, and all, when used, each for itself, capable of effecting, in a less degree, the purpose which the mixture accomplishes in less time and very effectively, showing, as we find on the motto seen on the Waterloo Monu- ment, “ V Union fait la force,” which is the motto on the shield of Belgium. We have the viburnum or the black haw; the golden seal, whose known amount of liydrastine is one of the most reliable alteratives in mucous troubles; and the Jamaica dogwood, or the piscidia erythrina, a sedative and anodyne agent of no mean power, besides possessing considerable hypnotic power—sufficient to make it only sec- ond to opium, and fully equal, in the experience of the writer, to the action of henbane, so great a favorite in Ger- 3 many, where opiates are far less frequently prescribed than in this country. Dr. J. M. Goss, of Georgia, in his “ New Remedies,” says of the black haw, or the viburnum prunifolium : “ It has many properties in common with the viburnum opulus, but differs somewhat in many respects also. Both of these plants have the smell of valerianic acid, and un- doubtedly contain it. Its most valuable therapeutic use is its preventive power over threatened abortion. For some twenty-five years I have used this article in cases of habitual miscarriage, and have never been disappointed in arresting the unhappy issue when I saw the case in time. It is a matter of general knowledge among farmers and breeders that animals which have dropped their offspring at a cer- tain period are prone to repeat the process at the same pe- riod of each future pregnancy; and these farmers use the black haw, given in the form of a strong tea mixed in with the feed, with the view of assisting the mother to go to full term and to prevent the premature ‘slinking’ or dropping of the offspring before its full time; and,per contra, it is said, however true I cannot assert, that the rinds given raw of the common Irish potato will conduce to produce abor- tion in the sow. Another species of haw is the viburnum santata, of European origin, and is thought to be analogous in its power to prevent abortion with the viburnum pruni- folium and the opulus. The viburnum is a very positive remedy in after pains, and is thought effective in antidoting the abortive action of the root of the gossypium, or com- mon cotton root, when taken to produce miscarriage, com- pletely neutralizing the effects of this abortive agent and compelling the would-be criminal mother to carry her off- spring to full term. “ As an antispasmodic to the uterus, it removes many of those harrassing nervous symptoms which so often torment, wear down and disqualify the pregnant woman for her final parturient effort. In dvsmenorrhoea, I have found no remedy so prompt and kindly acting as viburnum. In menor- rhagia, it is a very valuable remedy. The viburnum opulus has similar effects on the female reproductive organs.” Dr. Lane says in the Mississippi Medical Monthly, speaking of the two viburnums: “Their action is supposed to be somewhat similar, with a specific influence upon the uterus; a nervine, antispasmodic, diuretic, astringent and tonic.” 4 In dysinenorrluea, eitlier congestive or spasmodic, its ac- tion should be very satisfactory, affording that relief which, to our shame, we have in very many instances failed to se- cure with other and older agents. I believe it to be a direct uterine tonic and pelvic anodyne, and that the uterus, when in an atonic condition, is as susceptible of tonic influence as any other organ; and knowing that most of our thera- peutic agents are of but little value in the majority of uterine ailments, I accept, with pleasure, any remedy which is known to give good results and to supply a want long felt in treating female troubles. I can, from my own experience in its action, safely re- commend the compound to the profession at large, as I have not been disappointed in securing the desired results. I believe it is destined to produce a new era in gynaecology. In irregular, painful, suppressed and in excessive men- struation, it is almost a specific. In uterine or in ovarian neuralgia, in displacements of the uterus, which give phy- sicians so much trouble and patients so much suffering, this remedy will act like a thing of magic; and when the profession shall have become fully impressed, as it will the more we use it, with its remedial virtues, we believe that we shall hear much less of the many operations in gyrue- cology, and find, no doubt, that in the end the present fad of cutting and slashing at the cervix could have been well dispensed with in favor of more conservative therapeutic procedures. We venture to surmise that the pregnant woman would derive great comfort as an antinauseant from half doses of the liquor sedans—with or without one drop of Fowler’s solution, three times a day or oftener, as might be required. The writer remembers the case of a lady from a neigh- boring State who was nauseated the week after marriage until the day her babe was born. Nothing afforded satis- factory relief except champagne, which was objectionable for many reasons, but which had to be kept up. Now, he would combine with the liquor sedans a drop of Fowler’s solution, or a drop of beechwood creosote, with or without 5 a tablespoonful of lime water, expecting, with very fair prospect of success, to afford relief to the tortured woman. Should the stomach reject all remedies, the mixture in question could be given in free doses by enema, in either milk or in some form of broth, where there is danger of too great prostration from the continued nausea or the portracted loss of appetite. In cases of imperfect erectile power, or impotency, it ap- pears to exert a desirable tonic influence, like other restora- tive remedies acting on the same organs. Of equal merit, might be here cited, such remedies as the fluid extract ofpichi (fabiana imbricata),from Chili; the fluid extract of damiana; the saw palmetto; the yerba santa; the extract of the va- nilla bean; and last, but not least to be depended on in such cases, the stylosanthes elatior, which has lately ac- quired the reputation for a valuable uterine sedative during pregnancy, and a good permanent tonic to give strength to the muscles of the womb during the process of labor, and also for causing firm involution after that process All these agents make up the important role in the suc- cessful treatment of the genital organs of both sexes. Thus we find, from our own, as well as from the experi- ence of other medical men, the natural similitude of the therapeutic action of the similar drugs on kindred organs; and though agents which are supposed to exert their spe- cial action have been alone circumscribed to female affec- tions in formulating prescriptions directed to their troubles, it is a matter of wonder why the attention of the profession is not directed to the line of action in which we wish to se- cure the convalescence of our patients, and convince them- selves that, as a remedy, “what is sauce for the goose should also serve as sauce for the gander.” “ Medical Jurisprudence.”*—How very important the fore- going suggestions are from a medico-legal standpoint, may be seen when we reflect upon the sad mental troubles fre- quently accompanying the various phases of genito-urinary * Advanced Sheets of Dr. Caldwell’s coming book on “Nervous Dis- eases.” 6 disorders, viz: Diseases of the brain and nervous system, mental prostration, emotional insanity, alienation—tempo- rary or permanent, hysteria, hypochondriasis; indeed, all kinds of eccentricities may be found often playing some* fearful antics in criminology. Or, in the language of that original and fearless genius and eminent gymecologist, Lawson Tait, F. R. C. S., Surgeon-in-Charge of the Birming- ham Hospital for Women: “At the period of the appearance of menstruation, and at its decadence, special dangers await women—all of them due to their sexual functions, though some of them have only an indirect association with the pelvic organs Thus, on the accession of those feelings of vague uneasiness or positive pain, to which the name molimena has been given, we frequently find instances in which a dormant tendency to mental disease becomes aroused into action; and acute mania forms one of the risks through which young women have to pass at the period of puberty. In these diseases, the greatest distress is sometimes caused by the terrible form taken by the insanity—erotomania; and I have several times seen girls so affected indulge in gestures and language which puzzled us to guess how the patients became acquainted with them, the girls were so young and had been so well brought up.” As soon as any symptoms of sexual eccentricity display themselves in a girl at the molimenal period, she must be treated as insane; and I hold that this view is really the best and safest explanation of many cases of what look like mere lust, and what is usually and unfortunately punished as a moral offence. It must be borne in mind, as I have already said, that in the descent of the whole scheme of creation, the function of reproduction has been the field of the keenest and most unremitting struggle for existence; and at the time of the physiological change which enables the young animal to enter upon that dangerous battle field, the tendency of his or her ancestry is almost sure to evince itself in one form or another; and any error in this direction is to be held as not the fault of the individual, but his or her misfortune. The true preventive consists in what I believe to be the 7 duty of every parent to give to every child—instruction in the nature and purport of sexual functions, how they are to be used, and how easily they may be abused. If this were done, we should not only diminish sexual diseases, but we should greatly diminish sexual immoralities. At the climacteric period of life, women are subjected to another set of risks, some of which are directly, and others only indirectly associated with their sexual functionating organs. The general symptoms of climacteria are often severe enough to constitute a disease, even though they may have only a subjective existence. Most women cease to menstruate between the ages of forty-five and forty-eight, though they may have the change earlier as a result of certain conditions elsewhere described, or it may be delayed for some years by causes of an oppo- site nature. The general symptoms which accompany the change include headache, nervous depression, flushes of heat and chill, irregular and sometimes profuse menstrua- tion, pains in the back, dyspepsia, or other functional dis- turbances. Very few women pass the climacteric period without more or less suffering, and in some cases permanent damage is encountered. The nervous symptoms may be so severe as to result in mental derangement, and this often takes the form of incurable dementia. I have also noticed in several cases a specific form of climacteric epileptic ma- nia, which I believe to be entirely irremediable. But perhaps the most common, and I really think the most terrible form of mental disease which is developed at the climacteric, is a tendency to the abuse of alcohol. Here let me say, in defence of woman, and in opposition to much clap-trap which it has been of late the fashion to write about their drinking, that after a considerable experience of wo- men who have given themselves up to the habit of intem- perance, I have never yet had one as a patient in whom there was not some strong inducement to the indulgence. Women are always secret drinkers, in this differing greatly from men; for when a woman does give way to intemper- 8 ance, she knows how much more she has to lose than a man has, and how much more misery she will bring on others. The cause will generally be found to exist in some physical suffering, or in some mental distress, from which she seeks relief, or in a form of climacteric insanity. I have cured a drunken woman of her habit by a pessary for retroflexion. I have known many driven to the use of an alcohol anaes- thetic by the neglect or infidelity of their husbands; but bv far the larger number of these unfortunates have adopted the habit late in life as a relief from their climacteric dis- comfort. These are cases of insanity, and it would be a wise law which would enable us to place them in seclusion till the time of their trial is over. I do not believe that women ever take to drink from the mere love of it, or from con- vivial indulgence, as men do. When the inner secrets of the mind of a climacteric pa- tient, suffering from such depression as is likely to produce intemperance, can be reached, some delusion will generally be discovered which will guide us in the treatment. I cannot here enter into this subject without trenching on the province of the alienist, but I could give many illustra- tions of it. I have found women believing themselves pregnant by men not their husbands; but one of the most terrible was a case in which the poor woman believed that she was pregnant by a dog. We removed her from all home association without putting her under restraint, carefully regulated her mental occupation, and in twelve months her delusion left, and she gave up her intemperate habits com- pletely. The most essential treatment in all these cases is removal from all the former associations of the patient. In Conclusion.—Thus it may be noted that in this pre- sentment is to be found a description of the sad trouble often attending the approach of puberty, the molimena, the season of reproduction, its decline and climacteric, a fearful combat wherein vast holocaust have faded away through fearful tortures finally down to oblivion in former decades 9 with but little amelioration—believing, like the martyrs of old, that these trials and pains were necessary for the pro- pitiation of original sin. The light of science (the handmaid of religion), during the later decade, has so greatly illuminated religion and medicine that the dawn of truth and harmony point hap- pily to the millennium. Modern surgery, improved therapy and sanitation, have done more for humanity than the two thousand previous years. So that now the battle-field of regeneration and the fiat, “Thou shalt bring forth in tribulation,” is vastly ame- liorated, and our noble profession may proudly go forth free from the stigma of experiinentia docet, or guess-work and doubt. And now the Orient welcomes the lady doctress, espe- cially those who won diplomas from the medical department of Johns Hopkins, Yale, Harvard, London, Paris, Germany, and many other well-known medical schools, with open arms, in full faith of their ability and happiness to relieve the millions of heretofore suffering and martyred feminin- ity through the administration of advanced therapy, such as manufactured by Parke, Davis & Co., and many others of like reputation. And from Medico-Jurisprudence the motto of “ mens sana in corpore sano,” will be better appre- ciated, or that knowledge will make you free. “ And Medicine, till lately laggard, stands Brightest among the foremost bands ; On Science’s proud stage, In the lull sun burst of this wondrous age.” Epilogue.* Oh, if the law that governs every land Enforced the law that Genius hold aright, The work of Jenner and Pasteur would stand In all its majestic and all its might What forms now doomed to death would live! What rest would mind and heart receive! No longer terror and despair Would darken like the clouds the air, * Epilogue from the Pindaric Ode, “Genius Resistless.” Written for the International Medical Convention. London, 1882. ByJ.J. Cald- well, M. D. 10 Nor life be fearful lest the breath Which health requires should teem with death. Diseases, like mad serpent's foes to joy, With their own poisons would themselves destroy ; And foul contagion haste to hide its head Where it arose in fell Gehenna’s shade. Then would each lovely Christian grace— Faith, Hope and Charity embrace ; The Arts and Sciences and all unite With holy thought and feeling pure, To sing their songs of love and light * In praise of Jenner and Pasteur.