CASCARA CORDIAL 
:b ,0 "HE MEDICAL ’ROFESSION 
,'VITH. COfo%JMENTS t)F r a 
Histpry of__ 
the Introduction. Source, 
- Pnarhnaceutica! Composition' ar 
Therapeutic Application 
of 
Cascara-Cordial— 
The 
Most Eligible 
Preparation of Cascara Sagrada- 
for the Treatment 
of 
HABITUAL CONSTIPATION, DYSPEPSIA, H/£klORRHOIDST/ND 
/HIED 
Compiled from Medical and Pharmacal Literature, and Issued by 
THE SCIENTIFIC DEPARTMENT 
— OF — 
PARK E, DAVIS & CO., 
Manufacturing Chemists, 
DETROIT, MICHIGAN, 
60 Ma'den Lane, New York City 
- A N D - TN OFFERING this descriptive brochure on Cascara Cordia 
we desire especially to’call attention to the following facts, 
viz: 
The claims we make for its medicinal efficacy are 
thoroughly substantiated by eminent medical authorities of 
this country and Europe, as well as by the experience of the rank 
and file of the profession. 
The preparation is absolutely unprotected by patent, 
trade-mark or copyright. Its formula is published and its 
manufacture is open to the freest competition. From a scien- 
tific and ethical point of view, therefore, it is wholly unobjec- 
tionable, and may be prescribed by physicians with the same 
propriety as quinine or opium. 
The statements we shall advance, however, apply only 
to Cascara Cordial of our manufacture. We can not assume 
the responsibility for any lack of success physicians may meet 
with in perscribing the many imitations and spurious varieties 
of Cascara on the market, and would request that those 
wishing a genuine and reliable preparation specify “ P. D. & 
Co’s.” on their prescriptions. 
ESPECIAL. INTRODUCTION. 
IT IS the purpose of the following pages to submit 
Cascara Cordial to the medical and pharmaceutical 
professions as a preparation of peculiar value pharma- 
ceutically and therapeutically. We send it out for 
collective investigation, accompanied by our working 
formula, believing our claims with regard to it will be 
fully endorsed by the medical and pharmaceutical 
world, and that finally it may be accepted by the 
various pharmacopoeias as a contribution from our 
laboratory to scientific medicine. 
Our business, as pharmacists, is to cater to the 
wants of the medical profession. For this reason our 
policy is one compatible with their interests. 
It is too often the practice of our competitors to 
present to the profession pharmaceutical preparations 
protected by a system dangerous to progress in science 
and the arts. We refer to the proprietary medicine 
system. By it knowledge is locked up to a secret 
and everlasting monopoly, and a demand created by 
an advertising system of fraud, error, and humbug. 
We have introduced Cascara Cordial absolutely 
with no protection whatever, either by the scientific 
patent system, or the unscientific, secret monopoly, 
proprietary system, with its abuse of the trademark and copyright laws. And we have done this so that 
our policy may be compatible with professional re- 
quirements. 
SPURIOUS SUBSTITUTES. 
The manner in which we present Cascara Cordial 
wholly unprotected, opens the door to imitations and 
substitutions, injurious alike to the public, the profes- 
sion, and ourselves. It is a fraud on the public to 
imitate our labels or packages in such a manner as to 
deceive purchasers into the belief that they are using 
the genuine article, when an imitation has been pro- 
cured instead, and we propose to prosecute offenders 
in this direction to the full extent of the law; but any 
one can manufacture Cascara Cordial, and call it by 
that name; and, as we can truthfully testify, can man- 
ufacture a very poor article out of inferior drugs, and 
injure our reputation as originators of the preparation 
thereby. We, therefore, especially request our patrons 
to use care in specifying (P. D. & Co.), on every pre- 
scription where our brand of this article is desired, and 
we shall endeavor to protect the public, the profession, 
and ourselves, from fraudulent substitutions, in the 
proper manner. 
CASCARA CORDIAL PACKAGES. 
In view of comments which competitors have 
passed on the form of our Cascara Cordial packages, i. e., the shape of the bottle and the style of the wrap- 
per, we have been led to offer a few words of explana- 
tion. We have adopted the style purely to protect 
ourselves and our patrons against imposition. It is a 
fact, and that fact a sad commentary on the commer- 
cial methods of certain so-called pharmacists, not only 
that sundry of the brands of cascara sagrada in the 
market do not conform to the legitimate standard, but 
also that no proper pains are taken to secure such 
conformity. 
We are in a position to make this charge advisedly. 
There are, according to a botanist of repute, who has 
made the matter one of special study, no less than 
seven varieties of the rhamnus to be found on 
the Pacific slope. Many of these varieties are worth- 
less medicinally, yet all resemble each other so very 
closely in physical appearance as to require an expert 
to differentiate them. Following our introduction of 
the drug, competing firms, in order to supply the de- 
mand, sent to the habitat of the drug for the crude 
bark. Inasmuch as this was not kept in stock by the 
professional drug gatherers, the latter immediately 
advertised for a supply, and the country groceries of 
the sparsely settled country were made the purchasing 
depots. The natives, stimulated by the price offered, 
were active in gathering the bark, and, as might be 
expected, the care in the selection of the proper vari- 
ety, even had they possessed the necessary qualifica- 
tions, was very imperfect. It is from this source that 8 
the demand for cascara sagrada bark is supplied, and 
the result is just what would naturally be expected. 
Having introduced the drug, our name became very 
closely associated with it, and we were beset with 
complaints of its inefficacy and reports of its failures. 
In each instance of such complaints, we took especial 
pains to ascertain what preparation had been employed, 
and in the vast majority of instances it was other than 
ours. Under these circumstances we were driven to 
have some distinctive designation of our preparation, 
and we have adopted it by putting our Cascara Cordial 
on the market in this form. We have selected the 
Cordial for this distinction, from the fact that the 
demand for this eligible and palatable combination 
is so much more extensive than that for the other 
preparations. 
We should state in further explanation that there 
is no copyright or trade-mark protection on the name 
Cascara Cordial, nor a patent on the formula, and that 
it is intetided solely for use on the prescription of the 
physician. We neither advertise it to the public, nor 
accompany it with any literature calculated to intro- 
duce it into popular use. We simply avail ourselves 
of the protection legitimately due the superiority 
which our careful selection of the crude drug by ex- 
perts, and a thorough knowledge of the chemical and 
pharmaceutical peculiarities of the bark, ensure. THE PREVALENCE OF HABITUAL CONSTIPATION. 
WE can not perhaps more appropriately present the 
advantages of Cascara Cordial as a remedy for 
the treatment of constipation than by quoting briefly 
from medical writers a few facts regarding the preva- 
lence of this malady and the inadequacy of the reme- 
dial agents hitherto offered to effect its cure. 
We quote from a recent article on this subject the 
following: 
“Among the evils that have attended the progress 
of the race toward a higher state of civilization those 
resulting from increase of sedentary occupations and 
the inactivity of the luxurious classes have long been 
conspicuously apparent to physicians and sanitarians 
who have given this subject their especial attention. 
“Perhaps the chief of these evils from a medical 
point of view, as it is the most widely prevalent, and 
pernicious in its effects is Habitual Constipation and 
its attendant train of ills, dyspepsia, haemorrhoids, 
nervous prostration, and anaemia. 
“Alonzo B. Palmer, M. D., LL.D., in his recent 
work on the Science and Practice of Medicine in 
alluding to this important subject very pertinently 
remarks: “ ‘Many, even of the enlightened members of the 
profession, do not fully appreciate how injurious are 
the effects of habitual constipation. The long- 
continued retention of matter which should be ex- 
pelled, often undergoing putrefactive changes, is al- 
most certain to be followed by the absorption of 
materials which contaminate the blood and system. 
Moreover, the presence of mechanically or chemically 
irritating materials continually impressing and more 
or less irritating the intestinal nerves, affects very 
unfavorably the whole nervous system, especially in 
sensitive persons, and leads to a great variety of 
sensory, motor, nutritive, and even mental abnor- 
malties.’ ” 
Habitual Constipation has been a fruitful theme 
for the pen of medical writers, and no aspect of the 
question has proved more puzzling than that having 
to do with its successful treatment. The great desi- 
deratum in the treatment of chronic constipation has 
heretofore been a remedy which possessed not only a 
temporary specific action on the bowels but which would 
be followed by no reaction and no repression of secre- 
tion, and which could be administered for a sufficient 
length of time to permit of a restoration of normal 
function, a remedy which should not only alleviate 
temporarily the existing mal-condition but perma- 
nently remove the cause upon which it depended for 
its continuance, and thus effect a radical cure. HOW SHALL THE OBVIOUS INDICATIONS FOR 
TREATMENT BE MET? 
The various cathartics and laxatives have in the 
experience of every physician, signally failed to meet 
the indications presented. 
The discovery of the specific action of Cascara 
Sagrada on the muscular coat of the intestine, and its 
power of imparting tone and elasticity to the relaxed 
intestinal walls, and by this means restoring its natural 
vermicular movements and thus radically, and perma- 
nently relieving habitual constipation led to a very 
extensive trial of the drug in hospital and private 
practice, and has established its position in the materia 
medica as the most important remedy for the treatment 
of constipation which therapeutic research has given to 
medicine. 
The most eligible form forthe administration of the 
drug that has been presented is that offered under 
the name of Cascara Cordial, in which the medicinal 
action of the drug is fully preserved, while its inherent 
bitter qualities have been so skillfully disguised by 
carminatives and aromatics as to render it especially 
well adapted for administration to women and chil- 
dren averse to taking unpalatable medicines. CASCARA SAGRADA—ITS BOTANICAL ORIGIN- 
MICROSCOPICAL STRUCTURE—AND 
CHEMICAL COMPOSITION 
BEFORE proceeding to a consideration of the 
therapeutic application of Cascara Cordial it may 
be interesting to present a few facts regarding the 
botanical origin, microscopical structure, and chemical 
composition of Cascara Sagrada, the source of the 
medicinal properties of Cascara Cordial. 
BOTANICAL ORIGIN. 
Natural order—Rhamnaceae. Tribe—Rhamneae. 
Rhamnus Purshianus De C.(cascara sagrada) is a small 
tree indigenous to the Pacific coast of North America. 
Its name was given in honor of the renowned Prussian 
botanist, Frederick Pursh, who, in 1814, first gave it 
such a description as fixed its place in botany, his in- 
vestigations being made on specimens received by 
him directly from the habitat. The plants of this species of Rhamnus attain 
dimensions of from ten to twenty feet in height, 
measuring through their trunk from six to nine inches. 
The leaves are elliptical in shape, from three to five 
inches in length, by to 2 inches in their greatest 
width. They are borne on leaf-stalks about an inch 
in length. The margin of the leaf is regularly dentate 
with numerous minute teeth, except at the base. 
When young, the leaves are covered with a dense pu- 
bescence on the under surface, but when old they be- 
come glabrous and bright green. The flowers are 
small and white, and appear after the leaves have 
matured, being disposed in close, umbellar clusters, 
on pubescent peduncles, slightly longer than the leaf 
stalks. The fruit is a plain, round, black berry, about 
a quarter of an inch in diameter, and contains three 
seeds. 
Rhamnus Purshianus differs from other indigenous 
species of the Rhamnus family in that it is a larger tree 
and bears a larger fruit. The difference is peculiarly 
marked as between it and Rhamnus catharticus, with 
which species it has been often confounded. TRANSVERSE. 
LONGITUDINAL. 
Microscopical Structure of Cascara Sagrada Bark. Gross Appearance of the Crude Cascara Sagrada Bark. 16 
MICROSCOPICAL STRUCTURE 
Report from Albert B. Prescott, M. IX, Professor 
of Organic and Applied Chemistry and Pharmacy, 
University of Michigan. (New Preparations, Febru- 
ary, 1879, P- 27-) 
The corky layer (a) of the bark consists of 
the outer epidermis of dark brown withered cells, 
then several rows of cells filled with a dark red 
coloring matter (c), and in the more recent bark, 
a row or two of cells containing chlorophyll. The 
red color (c) is soluble in ether, alcohol, potassium, 
hydrate solution (with dark brown color), insoluble in 
acetic acid. 
The middle bark (b) is made of parenchy- 
matous cells, which are filled with small starch grains. 
There are visible, also, in the transverse section, sev- 
eral groups of cubical crystals (f), and, in the longi- 
tudinal section, groups of very thick-walled yellow 
cells (k). These cells (k) are not noticeably affected 
by the ordinary reagents. 
The inner bark (e) consists principally of yellow 
medullary rays (d), separated by bast parenchyma (g), 
through which are scattered numerous yellow bast 
fibres (h). As seen in longitudinal sections, these 
fibres (h) are frequently surrounded by small cubical crystals (f), which appeared not to be affected by 
hydrochloric acid. 
Almost the entire inner bark and parts of the 
middle bark are turned cherry-red color by contact 
with potassium hydrate solution. 
CHEMICAL COMPOSITION. 
The following report regarding the chemical 
composition of Cascara Sagrada was also made by 
Prof. Prescott (New Preparations, February, 1879, 
p. 28) : t. A brown resin, of strong, bitter taste, 
colored with vivid purple-red by potassium hy- 
drate solution. This resin is contained mostly in 
the middle and inner layers of the bark. It is 
sparingly soluble in water, freely soluble in alcohol 
and dilute alcohol, scarcely soluble at all in absolute 
ether, soluble in chloroform, soluble in benzole (of 
coal tar), and in carbon disulphide; soluble in caustic 
alkali solution, with splendid color above mentioned, 
and precipitated from this solution by acids. Con- 
centrated sulphuric acid colors it blood-red. It is 
removed from alcohol solution by animal charcoal. 
2. A red resin, nearly tasteless, colored rich 
brown by potassium hydrate solution. It is insoluble 
in water, soluble in alcohol and dilute alcohol, not 
freely soluble in ether, or chloroform, or carbon 
disulphide; soluble in caustic alkali solution, with the brown color above mentioned, this solution being pre- 
cipitated by acids. Concentrated sulphuric acid deep- 
ens its color, brownish-red. It is not removed from 
alcohol solution by animal charcoal. In the bark, it 
resides in the corky layer, (a) 
3. A light yellow resin, or natural body, taste- 
less, colored bright red-brown by sulphuric acid, not 
colored by potassium hydrate solution. It is insoluble 
in water, soluble in hot alcohol, sparingly soluble in 
cold alcohol of 70 per cent., soluble in chloroform, in 
carbon disulphide, and to some extent in benzole (of 
coal tar). In the concentration of its solution, it de- 
posits in pale orange yellow granules. Its alcoholic 
solution gives negative results with the general tests 
for alkaloids. 
4. A crystallizable body, obtained from absolute 
alcohol solution, in white double pyramids, and some 
other forms of the dimetric system. The crystals melt 
and then sublime, at a temperature a little above the 
water-bath, the sublimate being partly crystalline. 
This substance is not appreciably soluble in ether, 
chloroform, or petroleum ether; is slowly soluble in 
absolute alcohol, slightly soluble in 70 per cent, alco- 
hol, soluble in benzole (of coal tar). It is neutral to 
test-papers, and is not dissolved by potassium hydrate 
solution, by acetic acid, or dilute sulphuric acid. It 
is not colored by potassium hydrate solution, concen- 
trated sulphuric acid, nitric acid, Frcehde’s reagent, or 
sulphuric acid, followed by dichromate. The alcohol solution gives negative results with the general test for 
the alkaloids. 
5. A tannic acid, giving brownish-green color, 
with ferric salts. 
6. Oxalic acid. 
7. Malic acid. 
8. A fat oil, of yellow color. 
9. A volatile oil, not abundant, bearing the 
characteristic odor of the bark. 
10. Wax. 
11. Starch in abundant quantity. 
The proportional quantity of the resins, 1, 2, and 
3, is indicated pretty nearly by the quantity of resin 
extract obtained as follows: An acidulated alcohol 
solution of the bark was neutralized (with ammonia), 
and evaporated, the residue dissolved in dilute potas- 
sium hydrate solution, this solution precipitated by 
dilute hydrochloric acid, and the precipitate drained 
and dried at gentle heat. (The filtrate contained 
some resin, 1, and the precipitate retained, of course, 
the dissolved substances not washed out). This crude 
resin extract (chiefly bodies 1, 2 and 3), was about 10- 
per-cent. of the weight of the bark. 
The substances numbered 3 and 4 appear par- 
ticularly to deserve further chemical investigation, 
which I hope to be able to give them. The chemistry 
of the Rhamnaceae is of decided interest, especially 
within a few years past. Rhamnus Frangula, the European buckthorn, or black alder, has been re- 
ported by Lieberman and Waldstein (1876) to contain 
emodin, a well-determined constituent of rhubarb, 
allied to chrysophane, and chemically a derivative of 
anthracene. Further, the investigators just named 
find it nearly, or quite certain, that frangulin is capable 
of ready change to emodin, by glucosic fermentation. 
This may be associated with the well-known fact that 
the bark Rhamnus Frangula changes in therapeutic 
properties by storing. It has both emetic and pur- 
gative action in the first year after gathering, but 
when two years old, retains only the purgative power 
—one much like rhubarb—so that some authorities 
positively direct that it be not used until two years 
after gathering. The glucosic fermentation of frangu- 
lin into frangulic acid has been known for some time, 
but the like formation of emodin, a constituent of 
rhubarb, seems a step nearer some chemical explana- 
tion of the change of medicinal power characteristic 
of the bark. The material worked by Lieberman and 
Waldstein was a large quantity of residual extract of 
a large quantity of frangula bark worked by the manu- 
facturer, Merck. 
The chemical constituents of Rhamnus Purshianus, 
though not determined in this analysis to be, in any 
compound, identical with constituents of Rhamnus 
Frangula, yet show several similar reactions, especially 
in the case of “brown resin, 1.” The Rhamnacese very 
probably contain, in different species, allied bodies, some of them related to others as parent and product, 
but having practically distinct medicinal powers. 
These powers, of course, are known only by physio- 
logical and therapeutic trial. CASCARA CORDIAL (ELIXIR RHAMNUS PURSHI- 
ANUS).—DEFINITION, HISTORY, COM- 
POSITION, PHARMACY, AND 
THERAPY. 
DEFINITION. 
CASCARA Cordial is a preparation made from the 
barks of Cascara Sagrada (Rhamnus Purshianus) 
and Berberis Aquifolium, with addition of carminative 
aromatics and appropriate flavoring ingredients, for the 
treatment of habitual constipation, dyspepsia, indiges- 
tion and haemorrhoids. 
HISTORY. 
Cascara Cordial was introduced by Messrs. Parke, 
Davis & Co., manufacturing chemists, in 1879. Their 
observations were founded on the writings of Dr. J. 
H. Bundy, of Colusa, California, the introducer of Cas- 
cara sagrada, and Berberis aquifolium, its principal 
ingredients. 
Messrs. Parke, Davis & Co. also took a prominent 
part in the introduction of both of the drugs which 
give the cordial its large reputation. Acting in the 
line of their duty as pharmacists they obtained a large 
supply of the drugs, and had them extensively tested 
by the medical profession, at their own expense, the only pay for their work being a demand thereby 
created which they share in common with the phar- 
maceutical profession at large. 
COMPOSITION. 
Cascara Cordial combines the medicinal proper- 
ties of Cascara Sagrada (eccoprotic), and of Berberis 
Aquifolium (alterative) with those of aromatic (car- 
minative), and of small doses of an alcoholic stimu- 
lant. We have already explained the peculiar action, 
as a laxative tonic, of the first of these constituents. 
Berberis Aquifolium is said to be an alterative, by 
which we are to understand, an agent capable of 
hastening the processes of tissue metamorphosis, and 
the elimination of the waste products. In cases of 
chronic constipation, not only are the bowels torpid 
and inactive, but the absorbents throughout the body 
perform their work sluggishly and imperfectly, so 
that the whole system becomes poisoned by the accu- 
mulation of excrementitious materials. It is the 
peculiar property of alteratives to stimulate the ac- 
tivity of the eliminative apparatus, and therefore such 
an agent is a valuable adjuvant of the operation of a 
laxative. The effect of minute doses of alcohol, in 
aiding digestion adds, also, to the efficiency of the 
cordial, while its operation is rendered less harsh by 
the corrective influence of the aromatics which enter 
into its composition. The medicinal efficacy of the preparation is heightened also by the fact that the 
natural bitterness of the drugs employed is so effec- 
tually disguised by the use of flavoring ingredients, 
that the patient takes the cordial with none of the 
feeling of self compulsion with which he would swal- 
low a dose of ordinary medicine. At the same time 
the proportion of alcohol in the cordial is so small, 
and its medicinal character is so pronounced, that the 
patient runs no risk of acquiring a fatal fondness for 
an alcoholic stimulant. 
PHARMACY. 
Formula for Cascara Cordial : 
R Cascara sagrada bark (true Rhamnus 
Purshianus) ioo grms. 
Berberis Aquifolium root, true 37 “ 
Diluted alcohol 233 “ 
Coriander seed 17 “ 
Angelica root. 2 “ 
Oil of anise, 
“ orange aa 0.13 “ 
“ cassia 0.005 “ 
Granulated sugar 288 “ 
Fluid extract licorice 12 “ 
Tincture of cudbear q. s. 
Water, q. s. to make of finished preparation one litre. 
Directions.—Make a decoction of the cascara 
and water at 212° F. and filter, then dissolve the sugar 
in resulting liquid. Pack the coriander, angelica and berberis (in coarse powder) in a percolator, and dis- 
place with the alcohol, in which the oils have previ- 
ously been dissolved. Lastly, mix the cascara solution, 
the aromatic tincture and the tincture cudbear to- 
gether, and add the fluid extract licorice. 
THERAPY. 
The therapy of Cascara Cordial is founded 
on logical theories deduced from analyses of the 
drugs which form it, and the subsequent clinical 
experience gained by its use. As it is the 
purpose of this brochure to call special attention to 
this article as a compound peculiarly calculated to 
effect certain definite purposes, rather than to go into 
an elaborate description of the therapeutics of its in- 
gredients, the reader is referred to our working bulle- 
tins on Cascara sagrada, and on Berberis aquifolium— 
which will be sent on application—for a more extended 
description of their chemical composition and physio- 
logical action. 
Universal testimony seems to be that often when 
the whole list of aperients, cathartics, and intestinal 
tonics have been tried in vain, as far as perma- 
nent benefit is concerned, the use of Cascara sagrada 
has effected a cure. Habitual constipation, dyspepsia, 
indigestion, and haemorrhoids, depending, as they 
usually do, on the same causes, and being a set of 
symptoms indicating to a great extent the same gen- 26 
eral treatment, it is not surprising that cures of one or 
all of these distressing conditions should be reported. 
Our correspondents both in America and Europe are 
prolific in their praise of the pharmaceutical elegance 
and therapeutic efficacy of the cordial. 
Voluminous reports of physicians testifying to 
the efficacy of Cascara Cordial are in our posession, 
many of which have been printed in our Working 
Bulletin for the scientific investigation of this prepara- 
tion, which it will give us great pleasure to mail to 
those interested in the narration of clinical cases. 
The case reported by Dr. F. E. Stewart, M. I)., 
Ph. G., in the following extract from an article from 
the pen of this writer, entitled, “ Cascara Cordial in 
the Treatment of Habitual Constipation,” illustrates 
the tenor of the reports received: 
“ My observations concerning Cascara sagrada ex- 
tend over several years, and embrace more than sixty 
cases, treated in hospital and private practice in the 
cities of New York and Philadelphia. The following 
case is a typical one of a great many that are continu- 
ally brought to my notice. 
TYPICAL CASE OF HABITUAL CONST!PATION PER- 
MANENTLY RELIEVED BY CASCARA CORDIAL. 
Mr. E. S. came to me complaining of habitual 
constipation, with which he had been suffering for 
three years past. He complained at the same time that he experienced a sense of uneasiness during the 
digestive process, though, for a short time after taking 
food, this symptom disappeared. At other times he 
experienced a feeling “as though he had swallowed a 
small potato and couldn’t get it down.” Belchng 
of wind after meals, acid eructations, oppression and 
difficulty of breathing were frequent symptoms; also 
flatulency—the abdomen becoming sometimes greatly 
swollen, appetite variable, generally feeble, sometimes 
ravenous. Tongue somewhat enlarged, pale, and 
flabby, at other times coated, especially in the morn- 
ing, at which time a bad taste in the mouth 
was present on rising. Tonsils were enlarged, uvula re- 
laxed, and voice husky, with a tendency to continually 
clear the throat. Weak, excitable, compressible pulse. 
Palpitation of the heart on exertion. Extremities 
cold. Urine pale, of low specific gravity, loaded with 
phosphates. Memory very much impaired, mental ex- 
ertion attended with great fatigue. Marked nervous 
prostration. Drowsiness after meals, restlessness, 
temper irritable, patient easily worried though sanguine 
in disposition. To this was added constipation, which 
had now taken on a serious type, for the patient had 
finally got into such a condition that the bowels had 
apparently stopped all action, and added to this he 
found it impossible to force an injection beyond the 
fecal mass that had accumulated in the rectum. It 
was for relief from this distressing symptom that he 
appealed to me. A digital examination revealed a prolapsed rec- 
tum, which, owing to loss of tone, and pressure from 
superincumbent faeces and straining at stool, had been 
pressed down, forming a valve that completely occluded 
the bowel above the internal sphincter, allowing noth- 
ing to pass it from above, or an injection to penetrate 
it from below. The bowel was easily replaced by the 
finger, and the rectum thoroughly washed out with an 
enema of soap and water, and the patient directed to 
keep it clean by this means, returning the bowel when 
prolapsed by means of his own index finger, thoroughly 
oiled for that purpose. 
I found the rectum filled with small, hard, dry 
balls of faeces, very much reminding one of sheep- 
dung. This had to be removed by the finger before 
the bowel could be placed again in its proper position. 
Passing the finger further up into the rectum, after 
thoroughly cleaning it out as described, I found the 
tube very much narrowed by the folds caused by its 
prolapsed condition, adding another mechanical diffi- 
culty to the voiding of its contents. 
After this examination I inquired more fully into 
the history of the case, curious to know what had 
been the cause of bringing on such a complicated con- 
dition of affairs, and obtained the following very inter- 
esting account. 
At the time he presented himself his age was 
thirty years, and this complaint for which he came was first noticed five years previous to this. He was born 
in New York, by occupation a clerk, very closely con- 
fined to business. Constitution and general health 
good until then, though a hereditary predisposition to 
nervous diseases. Of a highly “ nervous ” excitable, 
and sanguine temperament. In his early youth had 
cerebral meningitis and hemiplegia, from which he 
had a good recovery, with a long, slow convalescence. 
Hygienic influences at present excellent, though for- 
merly exposed to, and a victim of, the ague. Habits 
and mode of life temperate; but he had been subjected 
to long-continued mental strain and business worry, 
which was evidently the exciting cause of the present 
trouble. 
His symptoms came on one by one,—were some- 
times better, and sometimes worse. He had appealed 
to physicians several times, and had been treated for 
dyspepsia by one, congestion of the brain by another, 
and malaria by several. Cathartics, aperients, tonics, 
quinine, etc., had been given him at various times and 
with various results. But the general tendency was to 
grow worse and worse, till, discouraged and wretched, 
recommended by other patients similarly troubled, that 
I had successfully treated, he appealed to me for help. 
I diagnosed his case as one of atonic dys- 
pepsia and habitual constipation brought on by worry 
and confinement. Ordered him to take a certain 
amount of out-door exercise daily, especially to walk 
whenever opportunity offered, and gave him the fol- lowing prescription: Before meals, a teaspoonful of 
Cascara Cordial (P., D. & Co.); and after meals, half a 
teaspoonful of dilute muriatic acid (U. S. P.), with 
three grains of pepsin (P., D. & Co.) in water. 
I was obliged to increase the dose of cordial before 
sufficient action on the bowels was obtained. The pa- 
tient commenced immediately to improve, the belching 
ceased, or nearly so, the tongue improved, eye bright- 
ened, and life became again worth living, and in a 
week he came back, perfectly delighted to report pro- 
gress. His bowels had moved daily under the in- 
creased dose, but not freely; and once, when he had 
neglected to go to stool, owing to being busily engaged 
at the usual time for this operation, he was obliged to 
remove the contents of the rectum with his finger be- 
fore he could effect a passage. But for all that, so 
marked was his improvement in feeling, that he was 
well satisfied with my treatment. 
Guided by my experience in other cases, however, 
I cautioned the patient not to be too sanguine, but to 
report again in a week. He did so, saying that for 
several days the improvement had continued, then he 
became so occupied in business that he forgot all 
about his medicine, and was now as bad off as ever. 
A purge of Rochelle salts was ordered, and another 
course of the medicine. For several weeks he now 
showed marked improvement, sometimes, however, 
deceived into the belief that no more medicine was needed, he omitted his customary doses, to find his 
mistake, and again improve on its renewal. 
I now dropped the use of the pepsin and hydro- 
chloric acid, giving in place of it the following tonic: 
Citrate of iron and quinine, one drachm; glycerine, one 
fluidounce; sherry wine, sufficient quantity to make 
eight fluidounces. One or two teaspoonfuls before 
meals. The cordial was continued in teaspoonful 
doses, three times daily,, with the other medicine. 
From now the improvement was most marked, and in 
about six months from the time of his first visit, the 
bowel had nearly regained its natural tone, the pro- 
lapsus had disappeared, and a regular habit established 
in place of the former constipation. 
It is my opinion that Cascara sagrada is the most 
valuable laxative in the materia medica. Properly 
employed, it is capable of yielding the most brilliant 
results. The cordial is an elegant form for adminis- 
tering it, and is easily borne by the most delicate 
stomachs. Again, the remedy is often effectual 
when other drugs have failed. One case in 
particular at my clinic, when one of my colleagues 
failed with various compounds of aloes, colocynth, 
etc., saline laxatives and the use of anti con- 
stipation pills of several varieties, yielded readily 
to the cordial given in teaspoonful doses three times 
daily. 
I have seen Cascara sagrada fail, but rarely, and 
the failures have been so exceedingly rare as not to qualify my opinion in regard to its great value in the 
least. I have seen it compared with the other species 
of Rhamnus, the Rhamnus catharticus, with results 
which prove its superiority. But before the drug 
should be set aside in any case, different doses should 
be employed, for it is certainly true that its effects 
differ with different individuals. This is very im- 
portant. 
A case in point occurred under my observation. 
I saw Cascara Cordial condemned by a physician at the 
New York hospital, because a certain patient took two 
ounces of it without effect, while at the same time I 
have had patients who were obliged to reduce the dose 
to five drops to prevent too much effect. I have seen 
physicians of high standing, both in Philadelphia and 
New York, who ought to know better, expect cures 
from Cascara Cordial without attention to exercise 
and hygiene—a thing they would not expect from any 
other drug. I claim that, from abundant experience, 
Cascara sagrada will do more to cure cases of ha- 
bitual constipation than any drug known, all things 
being equal, and the test being a fair one, and in this 
I am borne out by eminent authorities both in this 
country and abroad. DOSE OF CASCARA CORDIAL AND ELIGIBLE 
FORMULA FOR ITS ADMINISTRATION. 
The dose of the cordial as a laxative is from out- 
fourth to one teaspoonful, increased, if necessary, twice a 
day, night and ?norning. The minimum dose 
should be commenced with and gradually in- 
creased until the stools are softened by it, and 
then the administration should be continued in 
that dose for several months before it is discontinued, 
which should be done in gradually decreasing doses. 
In the treatment of constipation by means of Cascara 
Cordial, patience is an element of success. The pa- 
tient must be impressed with the fact that the object 
of treatment is rather to permanently remove the 
cause of the constipation than to temporarily remove 
the symptom. The remedy should never be increased 
to cause catharsis. When for any cause a cathartic 
may be deemed necessary or desirable, there are 
others, as, for instance, rhubarb, or some resinous 
cathartic, which are to be preferred. 
Some patients do not seem to be affected by the 
cordial even when taken in doses of a fluidounce. In 
such cases a few drops of the fluid extract added 
thereto will generally be sufficient to produce the de- 
sired results. In a few obstinate cases it may be nec- 
essary to abandon the cordial altogether and resort to the use of the fluid extract, either alone, or combined 
with some pleasant disguise. Dr. Rex, of Philadel- 
phia, is in the habit of prescribing the following: 
IJ FI, ext. cascara sagrada, 
Syr. sarsaparilla comp., 
Glycerine, aa§j. 
M. S. Teaspoonful three times daily. 
Dr. F. E. Stewart recommends the following 
formulae: 
IN CONSTIPATION WITH HEPATIC TORPOR. 
IJ Cascara cordial, § ij. 
Fluid extract wahoo, 3 j. 
M. Dose, two teaspoonfuls. 
IN CONSTIPATION WITH EXCESSIVE DRYNESS OF 
STOOLS. 
5 Cascara cordial, § jv. 
FI. ext. lobelia, 3 ij 
M. Dose, two teaspoonfuls. 
IN CONSTIPATION WITH GASTRIC DEBILITY. 
IJ Cascara cordial, § iijss. 
FI. ext. rhubarb. 
Dilute nitro-muriatic acid, aa 3 ij. 
M. Dose, two teaspoonfuls in infusion of quas- 
sia. Dr. J. H. Bundy, who first introduced Cascara 
sagrada, was accustomed to use, with gratifying suc- 
cess, the following formula, in which for the fl. ext. 
Cascara sagrada and syrup an equivalent amount of 
Cascara Cordial might be substituted with advantage: 
CONSTIPATION WITH DEFICIENT SECRETION. 
5 Fl. ext. cascara sagrada. 
Syrup. 
Water, aa | i. 
M. Sig. A teaspoonful three or four times daily. 
DYSPEPSIA WITH CONSTIPATION. 
5 Fl. ext. cascara sagrada, § i. 
Fl. ext. berberis aquifolium, § i. 
Syrup (or ext. malt), 1 ii, 
M. Sig. One teaspoonful three times daily. 
CONSTIPATION WITH GASTRIC IRRITABILITY. 
9 Fl. ext. cascara sagrada, § ss. 
Fl. ext. berberis aquifolium, § i. 
Acid, hydrocyanici dil., 3 i. 
Syrup (or ext. malt) q. s. ad. § iv. 
M. Sig. Teaspoonful after meals and at bed 
time. 
CONSTIPATION WITH DEFICIENT MUSCULAR TONE OF 
STOMACH AND BOWELS. 
Ext. cascara sagrada, 1 i. 
Ext. of malt, | ii. 
Syrup, 1 ii. 
M. Sig. Teaspoonful three or four times daily. The list of such combinations might be made very 
extensive, as Cascara Cordial has few incompatibles. 
These combinations, moreover, need not necessarily 
be confined to meeting the indications in constipation, 
the pleasant carminative nature of the cordial making 
the range of its applicability, particularly in affections 
of the alimentary tract, very extensive. While it 
should not be given in cathartic doses when its per- 
manent effects are aimed at in constipation, it may 
nevertheless be employed as an agreeable corrective, 
adjuvant and excipient for other cathartics. CASCARA CORDIAL AS A VEHICLE FOR OTHER 
REMEDIES, ESPECIALLY THOSE OF A 
NAUSEOUS CHARACTER. 
DURING the past couple of years we have received 
so many unsolicited testimonials to the efficiency 
of Cascara Cordial as a vehicle for the administration 
of drugs which are offensive to the palate, that we were 
induced to test the range of its applicability to this 
end. The result of our experiments has strongly 
corroborated the reports, and justifies us in asking for 
this preparation atrial in the prescriptions of nauseous 
medicines with special reference to quinine. 
It requires no argument to convince physicians of 
the desirability of palatability in mixtures, but the im- 
portant matter has been neglected, to the detriment of 
regular medicine in the regard of the public, chiefly 
because of the existence on the market of no agreea- 
ble and reliable excipient which could be ordered on 
prescription, and thus obviate the danger of changing 
the medical nature of the compound which exists when 
the druggist is given a carte blanche order to make 
the mixture agreeable. When the peculiar tonic lax- 
ative properties of Cascara Cordial are considered, its 
value as an excipient in a large number of cases, will 
be all the more apparent. CASCARA CORDIAL IN COMBINATION WITH 
OTHER LAXATIVES. 
The distinctive property of Cascara Sagrada is 
its tonic laxative action, and properly administered, 
in cases of constipation due to atony) of the muscular 
fibre of the intestines, it is beyond question the most 
valuable remedy of the materia medica. It is because 
such atony is the vastly preponderating cause of con- 
stipation that this drug, even when given empirically 
in this symptom, is so uniformly successful. But 
there are other causes of constipation,—causes some- 
times, though extremely rarely, existing alone, but 
usually associated with lack of tone in the non-striated 
muscular fibre. In such cases the mere restoration of 
tone will not be sufficient to cause normal defecation. 
The associate causes must be discovered and removed. 
Thus, hepatic torpor may be a complication, or the 
glands of the mucous membrane may fail to secrete the 
fluids necessary to normal solubility of the faecal mass, 
etc. While cascara sagrada has cholagogue properties 
and acts also as a tonic to the mucous tissue, its distinc- 
tive action is not in either of these directions, and in 
many cases adjuvants may be necessary to meet these 
complications. The intelligent physician will, before 
condemning Cascara because of its failure in such 
cases, review his diagnosis with a view to discovering 
to what other causes than atony of the muscular tissue 
of the intestines the constipation is due. He will find 
in Cascara Cordial a very agreeable excipient for the 
exhibition of his adjuvants to Cascara sagrada. HOW TO INSURE THE FULL EFFICACY OF 
CASCARA CORDIAL. 
THE failure of a remedy to produce its natural medi- 
cinal effect occasionally depends on the individual 
idiosyncrasy of the patient and his insusceptibility to 
its influence. More often, however, such failure de- 
pends on a lack of the proper recognition of existing 
causes interfering with the proper action of the drug— 
causes which, when intelligently appreciated are 
readily removable—or on the impurity or spuriousness 
of the preparation of the remedy used. 
A study of the responses elicited by the following 
queries which we quote from a well-known medical 
writer will afford the information necessary to suggest 
to the physician that combination of tonic and remedial 
agencies indicated in each individual case. 
Question i.— What is the cause of the constipation ? 
Habitual constipation is produced by various causes. 
It may be brought about by the peeuliar nature of 
the diet. It may depend upon a deficiency or a faulty 
composition of the intestinal secretions, or upon dis- 
orders of those neighboring glands which pour their 
secretions into the intestines. It may result from im- 
paired power of the bowel to propel its contents, the 
consequence either of some mechanical interference 
with its action, or of nervous influences, or of ex- posure to the poisonous effects of certain substances, 
as of lead. 
Question 2.— What are the patient's habits as to 
amount and quality of food and drink l Cases of con- 
stipation frequently occur from insufficient food or 
drink, or because of food deficient in the elements of 
waste. Proper attention should be paid to these im- 
portant points in the employment of Cascara Cordial 
in the treatment of habitual constipation. Cases are 
reported when the use of the Cordial taken in a glass 
of hot water at night, or before breakfast, has proved 
of benefit. 
Question j.—Does the patient take a proper amount 
of muscular exercise ? It is a well-known fact that 
when the voluntary part of the muscular system is 
inactive, the involuntary is apt to sympathize, and a 
general stagnation is apt to follow. 
Question 4.—Is the patient suffering f rom anaemia 
or general debilityl Impoverished blood is not capable 
of generating that amount of nervous energy sufficient 
to carry on the functions of the alimentary canal. 
Ansemia and general nervous debility will often ac- 
count for habitual torpidity of the bowels. 
Question 5.—Is the patient engaged in absorbing 
mental occupation ? It is a physiological law that the 
continuous employment of one organ will deprive 
other organs of their proper supply of blood and 
nervous energy, and thus result in impaired function. This is especially true with regard to the brain in its 
relation to the alimentary canal. 
Question 6.— What is the condition of the liver and 
its secretion ? So much stress has been laid on 
deficient bile as a cause of habitual constipation that 
a thorough investigation of this point is desirable. 
Question 7.— What is the habit of the patiet.t in 
regard to defecation ? A habitual neglect of the calls 
of nature is one of the most prolific causes of consti- 
pation, and a regular habit should be established if a 
cure of the condition is expected. 
Question 8.—Is the patient subject to profuse per- 
spiration, excessive urination, or other discharge of the 
fluids of the body in undue amount l Any cause de- 
priving the secretions of water will result in consti- 
pation 
Question 9.—Is the patient suffering from any 
organic disease, and if so state what ? Organic dis- 
eases of various kinds are prolific causes of constipation 
by their drain on blood and vital force. An organic 
disease of the stomach, resulting in impaired diges- 
tion is a cause to be carefully noted. 
Question 10.—Atonic dyspepsia is a freque?it cause 
of constipation. Is it in the case you are treating ? 
The facts elicited by these queries should be 
taken into consideration, and due allowance made for 
them in prescribing the cordial. 
Disappointment in the results of the administra- 
tion of Cascara Sagrada is due either to the employ- ment of inferior or spurious varieties, or to the im- 
proper use of the true drug and the non-observance 
of proper dietetic and hygienic rules. Constipation 
is essentially a symptom of a functional disease of the 
intestines, this disease consisting usually of a dimin- 
ished tonicity of the muscular coats, resulting directly 
in the impairment of the normal vermicular contrac- 
tion. As is the case with other diseases it is the 
result of a cause, and in its treatment, as in the treat- 
ment of other diseases, that cause must first be re- 
moved. This cause is very generally due to indis- 
cretion in diet, undue quantity and improper quality 
of food, irregularity in the habit of evacuation, and 
deficiency of systematic exercise. To secure the best 
results from Cascara these must be corrected. 
Cascara acts curatively in constipation by impart- 
ing tone to the muscular coats of the intestine, and is 
most effective to that end when administered in small 
doses. In large doses it acts as a cathartic, and thus 
like all other cathartics given in constipation, it de- 
feats the very end for which it is given, by weakening 
the bowels by its violent action. If, in prescribing 
Cascara, physicians will endeavor to remove the causes 
we have alluded to, which tend to render the drug in- 
operative, and will insist on a proper diet, abstinence 
from alcoholic liquors, which unfavorably influence 
the liver, regular habits of exercise, and the observ- 
ance of regularity in the time of seeking an evacua- 
tion, they will find this remedy entirely satisfactory. HOW TO OBTAIN A GENUINE PREPARATION. 
The only efficient way of guarding against the 
cause mentioned as being often responsible for 
failure to secure the medicinal effect of a remedy, 
viz., the impurity or lack of genuineness of the 
preparation prescribed, is for physicians to specify in 
prescribing the product of a manufacturer whose 
facilities for obtaining pure supplies, experience in 
manufacture, and reputation is a guarantee of the 
genuineness, purity and medicinal value of the pre- 
paration such an one places on the market. CLINICAL REPORTS FROM PRIVATE AND HOS- 
PITAL PRACTICE. 
Case i.*—I have tested Cascara Cordial in my 
own family, in a case of obstinate habitual constipa- 
tion which had resisted all other remedies. It gives 
me great pleasure to be able to state that it has met 
all the indications in the most satisfactory and agree- 
able manner. In my career as a student and physi- 
cian, a matter of twenty-seven years, I have never 
seen anything to equal it. Indeed, the satisfaction is 
so great that were it possible to use more forcible 
language I should certainly do it. I shall take pleas- 
ure in speaking of it to my professional brethren. 
Case 2.f—A sample of this elegant elixir, which I 
have been submitting to a test, has produced very ex- 
cellent results. A gentleman who has been one of my 
patrons for a number of years, has given me a consid- 
erable amount of trouble because of the chronic con- 
stipation with which he has been afflicted. The whole 
list of aperients, cathartics, and intestinal tonics had 
been tried in vain as far as regards permanent benefit. 
I placed him on cascara cordial, but the very pleasant 
* Thos. J. Wheeden, 53 Sands Street, Brooklyn, N. Y., 
in the Therapeutic Gazette, 1880, p. 195. 
f R. C. Kinnaman, M. D., Ashland, Ohio, Therapeutic 
Gazette, 1880, p. 226. taste of the mixture made it very difficult for me to 
induce him to persevere in its use. His was an aggra- 
vated case, and he thought that relief could only come 
through something “powerful;” that is, I suppose, 
something which by its taste and smell suggested 
“power.” The dose was gradually increased until 
laxation of the bowels was secured. It was continued 
at this dose until the evacuation became regularly 
diurnal, after which it was discontinued. No return 
to the cordial has thus far been necessary. 
Case 3.*—I received a sample of this elegant 
preparation some time since, with the request that I 
subject it to a trial. A few evenings afterwards a 
gentleman consulted me for chronic constipation. He 
had tried various remedies and combinations without 
satisfactory results. I handed him the sample of Cas- 
cara Cordial left with me, with, I confess, very little 
faith in the mild and pleasant mixture. Two weeks 
after, the patient called and assured me that he had 
followed my instructions for a few days—a teaspoonful 
before each meal and at bedtime—and had secured 
copious defecations without the griping and flatulency 
attendant on the use of the laxative or cathartic pills 
to which he had been accustomed; that he has had 
full and easy evacuations since stopping the medicine, 
and has had more relief from the little vial than he 
* J. Harvey Lyon, M. D., Mason, Mich., in the Thera- 
peutic Gazette, 1880, p. 331. ever secured from the abundance of medicine that had 
cost him many dollars. 
Case 4.*—Chas. Z., aged nine; U. S. From birth 
he appeared to be a strong healthy baby. When 
eighteen months old, he had summer trouble, which 
left him in a weakened condition. At the age of five 
years he had what the.doctors called typhoid fever; 
he was sick two months. Since that time he has had 
more or less trouble with his bowels. He would go a 
week without any movement; then after taking a 
cathartic, he would suffer from a diarrhoea, which 
would last a week or ten days, and would leave him in 
such a weak condition as to compel him to go to bed. 
March 3.—Present condition: loss of appetite, 
cachectic, with yellow, anaemic complexion; pain over 
abdomen; bowel* distended; has not had a movement 
since February 28, although the mother has given him 
several cathartic medicines. I told the mother to 
give the patient a sponge bath, night and morning; to 
commence with warm water, and gradually lower the 
temperature until the thermometer indicated 6o° F.; to 
give him milk and lime water. Ordered the fluid ex- 
tract of Cascara sagrada in fifteen minim doses, in a 
little coffee, every three hours, till the bowels moved 
freely; also to take thirty minims of dialyzed iron three 
times a day. 
* Herbert C. Rogers, M. D., Surgeon to the Long Island 
College Hospital Dispensary, in the Philadelphia News, Nov. 
io, 1883. 5th.—Mother reports that the boy’s bowels have 
moved three times since the morning of the 4th, the 
last time very freely. Told her to keep on as before, 
with the exception that she is to give the Cascara fif- 
teen minims night and morning, and report to me in 
one week. 
13.—Patient called with his mother this morning at 
my office. He looks better, and says he feels better. 
The bowels have moved two or three times a day since 
last note; appetite improved; sleeps better at night; 
complained of the bad taste of the medicine, and 
asked me if I could not give it in pill form. If 1 
could not he would try and take it. Will not give it 
up, as he says it is the only thing that has helped him 
since he began to suffer from his trouble. I gave the 
cordial in place of the fluid extract. 
April 2.—Met the patient on the street. His moth- 
er says he was never better; his bowels move once or 
twice each day; appetite is good; has not taken any 
of the medicine for the last week. I advised the 
mother to give him the medicine whenever he showed 
signs of a return of the old trouble. 
Here was a case of constipation in a boy, which 
had lasted nearly four years. He had taken various 
remedies and combinations with little or no success. 
I must confess that I had but little faith in the prepar 
ration. The result, however, has been most gratify- 
ing, both to the parents of the child and to myself. Case 5.*—Harry O., male, aged ten months; has 
suffered from constipation since birth. The mother 
has tried several domestic remedies, with but little 
success. I told the mother to give him thirty minims 
of the cordial Cascara sagrada, night and morning, 
every other day, until his bowels moved naturally. A 
few days later the mother called at my office, and said 
that the medicine not only helped baby, but herself 
also, who was troubled with constipation. 
Case 6.f—Frank B., aged 50, called at my office 
July 6. He had been on a spree for the last week. 
He has been unable to keep anything on his stomach 
for the last two days. Bowels have not moved for 
nearly a week; muscles flabby and tremulous. Or- 
dered fluid extract of Cascara for his constipation, and 
ten minims each of tr. capsicum and tr. of nux vomica 
in Vichy water three times daily—the Cascara to be 
taken night and morning. 
July 7.—Patient says he is better; vomited the 
first two doses of the capsicum and nux vomica; 
has been able to retain the Cascara. Bowels have not 
moved, although he has some pain. I told him to 
continue as before, and report to me in two or three 
days. 
10th.—Patient called at my office this morning. 
He said that his bowels had moved freely on the after- 
* Ibid, 
f Ibid. noon of the 7th. Has been taking one dose of Cascara 
daily since. I told him to omit the medicine as long 
as his bowels moved freely once a day, but to continue 
on with the nux vomica and capsicum for another 
week. Met patient a few days ago. He told me he 
had never taken such medicine; that both he and his 
wife had been great sufferers from constipation, but 
that the medicine had cured them completely. 
Case 7.*—Was sent for to see H. R., a young 
lady aged 24, suffering from obstinate constipation, 
which had continued for a period of over two weeks. 
She had been treated previously to my visiting her by 
purgatives, which produced pain and vomiting, and a 
feeling of general uneasiness, together with ineffectual 
efforts to have an evacuation. Ordered milk and 
lime-water and one teaspoonful of cordial of Cascara 
every three hours, until the bowels began to move. 
4th.—Patient’s bowels have moved once yester- 
day; is suffering some pain; has not vomited since 
last evening. Advised the same treatment to be con- 
tinued as was ordered yesterday. 
5th.—Patient says she feels better. Since the 
afternoon of the 4th her bowels have moved four 
times, the last time very freely. I told the patient to 
omit the Cascara as long as the bowels moved once 
daily, but to resume it whenever she went over one or 
two days without a movement. 
* Ibid Case 8.*—A family, consisting of father, mother, 
and two daughters, one 30, the other 17, all suffer- 
ers from constipation, took Cascara with the best results. 
I might go on naming case after case, but I think the 
few above quoted are sufficient. It is well to remem- 
ber that the medicine is to be used in small doses, 
and special attention should be given to see that the 
preparation is reliable. I have been disappointed two 
or three times in the use of what proved to be poor 
preparations. 
Case 9.*—A gentleman of about 50 years of age 
came under my care suffering from “biliousness,” bad 
taste in the mouth, coated and foul tongue, conjunc- 
tiva yellow, constipation, flatulency, and drowsiness, 
for which I had tried many medicines. Pil. cath. 
comp., muriatic acid, magnesia, phosphate of soda, 
podophyllin, and other remedies, only gave him tem- 
porary benefit. I gave him Cascara Cordial, which 
acted like magic. It immediately relieved all the 
distressing symptoms, and gave him natural alvine 
evacuations, with neither straining or griping, relieved 
an unnatural desire for sleeping, cleared the skin, and 
cured my patient. 
Case 10. f—A lady patient of mine, who had suf- 
fered from neuralgic headaches, to whom I had given 
*Edward F. Arnoux, M. D., New York City, in Thera- 
peutic Gazette, 1883, p. 467. 
flbid. arsenic, gelsemium, citr. of caffeine, purging pills, etc., 
without effect, was relieved in a short time by the 
Cascara Cordial, and what was of great importance in 
her case, the medicine did not taste nasty. 
Case ii.*—W. B., male, aged 53 years, was 
troubled with constipation for four years, which 
gradually became more and more obstinate in its 
nature. He is a carpenter by trade, and is rather 
thin in flesh, and of somewhat delicate constitution. 
This patient consulted me on the 21st of September 
last. He was considerably emaciated, and had an un- 
healthy and dirty yellowish color. The expression of 
his countenance was indicative of distress, mental and 
physical. The patient is slow to consult physicians; 
but he had, of his own volition, employed a variety of 
cathartic medicines, with little substantial relief. His 
own declaration was, that he had “dyspepsia,” and he 
complained of pain in the pit of his stomach. The 
skin was not only sallow, but it was quite dry. There 
was no probable kidney trouble, but sickness of the 
stomach, and distress in that neighborhood, were 
prominent symptoms. 
I prescribed for this gentleman Cascara Cordial, 
and furnished three ounces of the medicine; was sur- 
prised, as time passed, that I saw no more of my 
patient. Upon inquiry of other members of his family 
*T. L. Wright, M. D., Bellefontaine, O., in Therapeutic 
Gazette, 1883, p. 489. I was informed that he was better. On the ioth of 
November, inst., Mr. B again called upon me. 
Said he was greatly improved, and his appearance 
plainly justified his words. There was an evident 
increase of life and energy in his whole makeup, and 
there was light in his eyes. He wished to continue 
the treatment, and desired another supply of the 
cordial. He said, however, that the doses he had 
been compelled to take were larger than had been 
prescribed—which were fifteen drops twice a day. 
He declared that his improvement was remarkable to 
his own mind, and volunteered the statement that his 
evacuations had lately been perfectly efficient, easy, 
and in every way more satisfactory than they had 
been for a long time previously. This man has now 
taken only about four ounces of the preparation. 
And here I will make a suggestion or two, with 
reference to the adaptability of the Cascara Cordial to 
certain forms of physical condition. When the grand 
climax of life has been passed, both in women and in 
men, when the failing sight, the subsiding passions, 
the lapse of memory, and muscular inertia, tells the 
unwelcome story that the acuteness and alertness of 
nervous sensibility, in all its diversified phases, are 
being dulled by age and subdued by the reverses of 
time, it is the experience of physicians that the great 
conservator of life and energy, itself—the digestive 
and assimilative tract—sympathizes with the general 
decay, and constipation is a frequent, if not a com- mon coincident. It is in the treatment of such cases 
in particular, that our remedy appears to the greatest 
advantage. From the observations that I have been 
enabled to make, the Cascara sagrada, especially in 
the form of the cordial, seems to me to afford better 
results in the constipation of elderly people, than any 
other medicine that has come under my notice. 
Case 12.*—Mrs. H., aged 24 years, is a very 
light blonde. Her complexion is almost milky white; 
her hair is a very light flaxen; and her eyes are large 
and very light blue in color. The patient’s counten- 
ance was very melancholy and unfixed, and her eyes 
were weak and tearful. Her voice was tremulous and 
feeble, while her general manner was shrinking and 
timid. Mrs. H. was afflicted with constipation of a most 
obstinate character, which dated back four years. It 
seems to be impossible for her to secure an evacuation 
of the bowels without artificial aid—going without 
one often, from five to eight days. After trying sev- 
eral remedies with poor success, I furnished her with 
three ounces of the Cascara Cordial. She took one- 
half teaspoonful twice a day. After exhausting the 
first installment of the remedy, she applied for more, 
and said she felt better, although she obtained an 
alvine evacuation only about every second day. After 
consuming the second three ounces of the medicine, 
she again applied for an additional quantity. Her 
*Ibid. appearance was now materially changed for the better. 
Her features were expressive of a good deal more en- 
ergy than usual; her flesh seemed something fuller, 
her eye brighter and more expressive, her voice was 
stronger and firmer; and at this time she smiles and 
looks as though she enjoys life. Upon inquiry she 
said that the Cascara Cordial is the most efficacious of 
all the remedies she had ever taken; that she is feel- 
ing better in every way, but that she could not get 
along without continuing the treatment. She also in- 
forms me that her spirits are now good; whereas, 
before the treatment above described, she felt melan- 
choly, and often did not wish to live. Upon the 
whole, I believe the patient will ultimately recover 
her health, although (and so I informed her) it will 
probably take months of patient hygienic, and medi- 
cal assistance to accomplish a cure. 
Case 13.*—Another example that is instructive, 
is that of a child four years of age. This little boy 
has been troubled with constipation from birth. Such 
instances are by no means rare, and they are always 
the subjects of great anxiety and trouble. The child 
in question, was treated in the beginning by supposi- 
tories; first, of soap, until inflammation of the rectum 
almost ruined him. Afterwards, pieces of mutton 
tallow, or stearine were employed; and at last fre- 
quent injections of various kinds were used. But in 
* Ibid. spite of all, he would, every few weeks, exhibit such 
indications of distress as are seen in a sallow com- 
plexion, haggard countenance and fretful mind. Then 
resort was of necessity had to cathartics by the mouth. 
Of course, all this was attended by many untoward 
symptoms—as of nervous irritability, nettle-rash, and 
so on. Between two and three months ago, I pre- 
scribed for'this child the Cascara Cordial. Never was 
any medicine more pleasing in its effects. The dose 
employed was very large—from fifteen to twenty 
drops twice a day; but it was not necessary to give 
the medicine steadily. Two or three days of interval 
are now frequent between doses. The little fellow is 
fat and happy, and is willing and eager to take his 
medicine. But he is by no means cured. He will, no 
doubt, be compelled to continue the drug for some 
months, before he can forego it altogether. 
Case 14.*—A lady, aged 54 years. Constipation 
habit gradually increasing in obstinacy for five years. 
Ordinarily impossible to secure an evacuation without 
the assistance of medicine. In consequence of the 
unpleasant nature of purgative medicines in general, 
she is apt to delay until an increasing vertigo 
compels a resort to cathartics, in order to obtain 
temporary relief. The countenance is bloodless and 
corpse-like, with a tawny hue, and its expression 
* T. L. Wright, M. D., of Ballefontaine, O., in Cincin- 
nati Medical News, 1883, p. 651-3. is one of the utmost distress, almost of despair. The 
dizziness is so great that the patient is wholly unable 
to stand, or even sit erect; while violent palpitation 
of the heart contributes to the mental and corporeal 
uneasiness and incapacity. In this condition she is 
compelled to take for relief some one of the several 
active purgative remedies. 
It is proper to say that this lady, notwithstanding 
her periodical spells of constipation with vertigo, etc., 
has seldom failed to take daily, either some suitable 
article of diet or some lauded remedy for constipation,or 
both. And although this practice often seemed to be 
of benefit at times, the truth is that she has, in spite 
of pills and pellets and bitters and elixirs of every 
conceivable description, been growing gradually and 
steadily worse all the time. Very often she would be 
confined to the house and bed for several days at once, 
with nervous exhaustion, as seen in her pallid color, 
absence of appetite and dreadful dizziness. I may 
say here that this patient is a connection of my family, 
and has been under my daily observation for years. 
Thirty-five days ago I prescribed for her twenty 
drops of the Cascara Cordial, to be taken morning and 
evening. After the fourth dose she .had an easy and 
satisfactory evacuation of the bowels, without pain or 
sickness. After two more doses she had two good evac- 
uations in one day. She then took but one dose a day 
for four days. At this time she is taking 15 drops once 
a day, occasionally passing a day without taking any. Let us now trace the effect of the remedy a little 
more in detail. Very soon after the first few evacua- 
tions, as early probably as the fourth or fifth day, the 
patient declared with evident satisfaction that she felt 
better than she had for a very long time; that she felt 
“natural” and like herself once more. This patient 
visited the exposition in Cincinnati, involving 200 
miles of railroad travel, about two weeks after the 
commencement of her treatment. For once, the mo- 
tion of the cars did not make her dizzy or produce 
nervous headache; and she arrived home in good 
health. 
An early manifestation of the value of the 
Cascara sagrada, in the case of the patient, was the 
speedy and complete clearing up of the color and 
general expression of the countenance. This took 
place in a few days. The skin became healthy and 
clear in appearance, and still remains so; while the 
tone and elasticity of the organism are quite satis- 
factory. 
I am aware that a report of this kind should not 
be made too early. Nor can it be expected that the 
remedy will, as a rule, come into relation with cases so 
clearly adapted to a rapid display of its best powers, 
as the one cited. But the application of the Cascara 
sagrada in this case, where it immediately supplanted 
the habitual use of other highly praised drugs, has', by 
its remarkable operation, demonstrated through the 
contrast of its powers with the powers of other reme- 58 
dies, the fact that it does possess therapeutical prop- 
erties of great value and which are peculiar to itself. 
The remedy, as a matter of course, should not be 
wholly withdrawn from the case for a considerable 
period of time. 
Case 15.*—Also a lady, 51 years old. This patient 
has, like the former, been under my observation for 
many years. Her case is one of obstinate constipation. 
She has been in the habit of using certain “bitters” a 
good deal, to keep her bowels in a soluble condition. 
She declares that her remedies—pills, pellets, bitters, 
etc.— are no longer manufactured honestly. Upon the 
whole, she has been getting worse steadily for three 
years at least. For some months past she has com- 
plained of pain in the stomach, with giddiness and 
headache. But her principal complaint has been of 
weight in the stomach, belching and indigestion. The 
color of this patient was dirty looking and sallow, and 
the expression of her countenance was indicative of 
profound misery. 
After repeated attacks of “ biliousness,” as she 
called it, depending on constipation, which would 
yield only to powerful medication and which would 
return in a few days, or, at best, in a few weeks, she 
was seized five weeks ago with cramps about the stom- 
ach attended by constipation. Vomiting, which con- 
tinued all of one night and part of a day, was also 
* Ibid. present. Indigestion had been troubling the patient 
several days, and she ejected from her stomach food 
which she had swallowed two days previously. As 
soon as these symptoms were relieved, and the patient 
began to move about again, I prescribed for her (thirty- 
one days ago) the cascara cordial in 15 drop doses 
twice a day. The effect now is very great improve- 
ment in the health of this lady. Her color has im- 
proved in a remarkable manner, and she is greatly 
benefitted in every other particular. I am of opinion, 
however, that her improvement, while gratifying, is 
not yet so complete as in the first case reported. 
There are several chronic nervous maladies, which, 
by fair inference, we may presume would be benefitted 
by the prolonged use of cascara sagrada. I have some 
such now under treatment by that remedy, and when 
the proper time has come I will report the results, be 
they favorable or otherwise. CASCARA CORDIAL IN DYSPEPTIC DISORDERS * 
IN an article upon the subject of the therapeutic uses 
of Cascara Cordial, in the Medical and Surgical 
Reporter, I particularly urged that the efficiency of 
the preparation in the treatment of habitual constipa- 
tion marked it for great favor. A more extended ex- 
perience with it in this sphere of application has only 
added proof of its therapeutic value. By the test of 
experience every medicinal agent must either stand or 
fall. We are confident and glad, too, that this pre- 
paration will grow in favor and become one of the 
verities of the medicine chest. In our former publi- 
cations we also indicated the use of Cascara Cordial in 
the treatment of various forms of dyspeptic disorders. 
Added experience has shown that what was then stated 
and claimed for it embraced only a part of its great 
merit in these conditions. Here it meets a wide range 
of indications and certainly must become a favorite 
remedy with the practicing physician. All in all Cas- 
cara Cordial may be regarded a valuable addition to 
the physician’s armamentarium. Its authors builded 
better than they knew. In an unusual degree they 
have here made the refinements of scientific pharmacy 
subservient to the demands of the people and the 
* F. C. Herr, M. D., Philadelphia, Pa., in Therapeutie Gazette, 
1883, p, 490. times. The encroachments of homoeopathy upon 
regular medicine have only been made possible by the 
persistent refusal of the old school to accede to the 
demands of the sick public for tolerable medicines. 
For generations we were indifferent to the cry of our 
patrons for some alternative that would relieve them 
from the necessity of taking noisome drugs. In later 
times we slowly awakened to the reality of the situa- 
tion. To-day we recognize in its fullness the import- 
ance of bringing to our aid the elegancies and refine- 
ments of pharmacy. We are persuaded that these 
may be made potent levers to our advancement and 
elevation. It does not help us that we belong to the 
“old school.” Independent of schools each man in 
the profession must make his record. A palatable 
medicine is money in the doctor’s pocket. He cannot 
afford in the face of a growing sentiment against it, to 
trudge along in the well-worn path of our predeces- 
sors. We cannot afford to go backward. Let us then 
honestly endeavor to go foward in the path indicated 
by these pharmaceutical preparations. Pharmacy and 
medicine are not essentially antagonistic. They should 
always assist each other, for out of such united and 
harmonious work could come only that which would 
profit both equally. It is a step in the right direction, 
and deserves to be encouraged. If Messrs. Parke, 
Davis & Co. will exert themselves in the direction of 
improving the newer materia medica in just the way 
that they have surmounted the objections to Cascara sagrada, they will confer a blessing upon many suffer- 
ers and greatly aid the practicing physician. 
One use of Cascara sagrada not yet referred to 
here we shall briefly consider. It is its employment 
as an adjuvant. It has been highly spoken of in 
this connection and it is unquestioned that neither 
the older nor the newer materia medica afford 
an agent in any respect superior to Cascara Cordial 
in this specific use. Indeed, we doubt whether 
another preparation equals it in this application. For, 
in addition to its very agreeable taste, it possesses 
such decided therapeutic properties of its own that 
these make it valuable in many conditions of disor- 
dered function. The early reports on Cascara sagrada 
(the active cathartic or laxative ingredient of Cascara 
Cordial) indicate the desirability of permanently con- 
cealing the intensely bitter principle which develops 
with age. The efforts of Messrs. Parke, Davis & Co. 
were successfully exerted in this direction, and as the 
fruit of their labor we have the Cascara Cordial. An- 
other valuable ingredient of this preparation is Berberis 
Aquifolium. Clinical experience has shown this agent 
to be a powerful tonic and alterative. By some it is 
maintained that it is second to no representative of 
this class of remedies in power and efficiency. It pro- 
motes destructive and constructive metamorphosis— 
the former by exciting absorption, the latter by stimu- 
lating digestion and assimilation. It is shown by 
abundant experience that it is invaluable as an altera- tive in syphilitic disorder. It is per se an important 
addition to the materia medica. In combination with 
the various components of cascara cordial it is serv- 
iceable in a wide range of disorders. Take hepatic 
torpidity, for example, with its endless diversity of 
symptomatic expression. Try all the well-known 
cholagogues faithfully, and then as faithfully try Cas- 
cara Cordial, and your testimony will be against the 
former. This preparation in some strange way lifts 
the load of oppression and gloom which hangs over 
these people, and imparts life and ambition to them. 
I have very complete records of three cases of this 
form of affection most happily treated with Cascara 
Cordial. 
There is a condition which frequently obtains in 
infants and young children that necessitates a requisi- 
tion upon the “carminative bottle.” I refer to the 
flatulent distension of indigestion so common at these 
ages and so annoying to the little ones and their at- 
tendants. The domestic medicine chest always con- 
tains the weapon that will deal death to this foe of 
health and comfort, and alas ! it is too true that this 
same weapon may deal death to the suffering one. 
These “ baby mixtures ” too often are not safe, and 
should be given with a sparing hand. In Cascara 
Cordial we have a safe weapon to meet these troubles. 
It meets the indications amazing well—relieving the 
flatulence—producing comfort, and in some yet unex- 
plained manner, inducing quiet and refreshing slumber. 
63 It can be given in large doses with no apprehension of 
evil results. Upon theoretical grounds I am disposed 
to think that it would be an effective remedy in some 
forms of summer complaint in children. Its influence 
upon the functions of digestion is so unquestioned, its 
power in restoring normal secretion and correcting 
morbid action and imparting tonicity to the digestive 
and alimentary tracts is so decided, that I have no 
doubt the indications here would be met by its admin- 
istration. In all the conditions save the last named 
one, I have had considerable experience with Cascara 
Cordial, and have rarely found it disappointing, while 
I have never been met with that unwelcome saluta- 
tion: “ O, doctor, what an awful medicine you gave 
me ! ” 
In conclusion, it may be said that the extensive 
use of Cascara Cordial has demonstrated conclusively 
its great utility in every form of constipation, and in 
the manifold departures from normal health which 
may be traced to constipation as their source. 
We place the facts we have collated regarding its 
nature and therapeutic application before the medical 
profession, in the belief that they are eminently 
worthy careful consideration, and that further investi- 
gation of this laxative preparation will confirm the 
conclusions regarding its value already arrived at, and 
establish the place of Cascara Sagrada in the materia 
medica as the most valuable drug yet discovered for 
the treatment of habitual constipation. 
64 IJSTDEX 
Biliousness, Cascara in 
Cascara Cordial as an Adjuvant to Other Laxatives 3S 
as a Vehicle for Nauseous Medicines 37 
Composition of 23 
in Chronic Nervous Maladies . . 5g 
Definition of 22 
Dose of 2,2, 
in Dyspeptic Disorders 60 
Formula of 24 
Formula. '.'.■'.■.34, 35 
History of 22 
How to Insure the Efficacy of.... 3S 
How to Obtain a Genuine Preparation of, 43 
Packages 6 
Pharmacy of 24 
Spurious Substitutes for 6 
Therapy of , 25 
Sagrada Bark Gross Appearance of 15 
Microscopical Appearance of 14 
Botanical Origin of 12 
Chemical Composition of 17 
Microscopical Structure of 14, 16 
Clinical Reports of Therapeutic Application of Cascara 
Cordial ...44 to 50 
Constipaton of the Aged, Cascara in 53 
with Gastric Debility, Cascara Cordial in. .. . 34 
Hepatic Torpor, .... 34 
Prevalence of q 
Dyspepsia with Constipation, Cascara in .35, 60 
Flatulency, ’ 
Gastric Debility, Cascara in. . . 34 
Habitual Constipation, Prevalence of IO 
Treatment of u 
Hepatic Torpor, Cascara in ’ 34 
Obstinate Constipation, Cascara in ’ 44