The simple bitters increase secretion from the mucous membrane. In the mouth they promote the flow of saliva, and in the stomach they appear to stimulate the production of gastric juice, and also of gastric mucus. It follows that an increase of digestive capacity is one result of their administration. The increased appetite which is observed from the use of the bitters is probably due to two factors: the sense of bitterness which increases the 14 desire for food, and the improved digestive power which, enabling more food to be disposed of, postpones the sense of satiety. Furthermore, the bitters bv removing morbid states of the intestinal mucous membrane, favor assimilation. More food being taken and more thoroughly digested it is obvious that the bitters promote constructive metamorphosis.

The active constituents of some of them have been studied in detail. Berberine, which enters into the constitution of several bitters, is possessed of some antiseptic and antiperiodic power, but is not active from the physiological point of view. In animals it causes lowering of the blood pressure, and lessens body-heat (Curci). According to Kohler, it contracts the blood-vessels, and in the intestinal canal acts in a similar manner to the tannates. It is said, also, that when applied to the walls of the intestines they contract energetically. Quassin has recently been studied by Dr. Campardou, and his observations were published in a special memoir. There are, however, no new facts produced. Quassin, as might be supposed from its origin, acts after the manner of the bitter tonics; it increases the appetite, and promotes the digestive functions by stimulating the secretions of the gastro-intestinal mucous membrane, and the contractility of the muscular fiber of the intestine. In an overdose quassin causes the local and systemic symptoms of an irritant poison.

Although these remedies, used judiciously and for a short period, undoubtedly promote the constructive metamorphosis, yet their long- continued use will produce gastric catarrh, decrease the flow of healthy gastric juice, and impair digestion.

Therapy

An infusion of coptis has much reputation in New England as a remedy in aphthae, psoriasis of the mucous membrane, ulcers, and epithelioma, but it is probable that this supposed curative power is unfounded, and that it is no more useful than any bitter so applied.

A few drops of the tincture of calumba, or a teaspoonful of the infusion, will sometimes greatly relieve the vomiting of pregnancy, and is also occasionally efficacious in sea-sickness. The simple bitters are especially indicated in atonic dyspepsia, and in chronic gastric catarrh. They are useful in this state of things: pain after food, slow digestion, constipation, alternating with diarrhoea. Calumba is the mildest, and may be borne when quassia and gentian disagree. According to Wilson Fox, "calumba holds the chief place in point of therapeutic value as a remedy which can be safely employed when others of the class would be too irritating." When there are much relaxation and torpor, quassia is very useful as a stomachic tonic. Sometimes an extemporaneous cold infusion of quassia is used, made by filling overnight with cold water a quassia-cup—a goblet turned out of quassia-wood. When constipation exists in cases of atonic dyspepsia, good results are obtained by a combination of gentian with senna, as in the formula already given. The compound tincture of gentian is an excellent vehicle for the administration of cod-liver oil, and contributes to its digestion and assimilation.

The infusions of gentian, calumba, and quassia are usefully employed as vehicles for the administration of acids and alkalies in cases of acidity and deficient supply of gastric juice, under the rules given in the articles on acids and alkalies.

In convalescence from acute diseases, the simple bitters, especially gentian and calumba, are employed to promote the appetite and digestion, and thus to aid in the process of constructive metamorphosis.

In the diarrhoea which is due to relaxation of the mucous membrane, and is not dependent on inflammation, the tincture of calumba is often useful. The author has obtained good results from the use of tincture of calumba combined with opium in the treatment of an irritable state of the intestinal mucous membrane, indicated by these symptoms: Soon after taking food, the occurrence of pain referable to the small intestines, nausea, loose evacuations containing undigested aliments, and followed by weakness and depression. Rx Tinct. ca-lumbae, 3 xv; tinct. opii deodor., 3 j. M. Sig.: A teaspoonful in a wineglassful of water before meals. Calumba is also serviceable in the relaxation of the bowels succeeding to acute affections of the intestinal mucous membrane.

The infusion of quassia is one of the most effective injections for the destruction of the ascarides vermiculares which infest the rectum. The stomach administration of simple bitters undoubtedly hinders the development of intestinal worms, probably by correcting a morbid state of the mucous membrane. In the treatment of intestinal parasites much good, therefore, is derived from the use of bitters, administered with the view of restoring normal digestion.

According to Wood, the remedy most effective to remove and "permanently cure a disposition to the accumulation of flatus in the bowels is an infusion made with half an ounce of calumba, half an ounce of ginger, a drachm of senna, and a pint of boiling water, and given in the dose of a wineglassful three times a day."

The bitters are used as remedies in malarial fever. Although they exercise but little influence over the course of intermittent and remittent fever, they are useful in the form of infusion as vehicles for the administration of more active drugs. In the convalescence from malarial fever, and in chronic malarial poisoning, they are more actively beneficial as agents promoting constructive metamorphosis. Calendula is chiefly used as a topical application in chronic pharyngitis and suppurative affections of the throat and external auditory canal. It has also been applied to the treatment of chronic stomachal disorders, catarrh of the stomach, of the duodenum, and conjoint implication of the bile-ducts. It was first introduced into medical practice by Dr. Sexton, of New York, by whom it is employed in suppura: tive inflammation of the ear, and given internally in cases of suppuration to obviate septic infection. While the local application seems beneficial, there is little reason to suppose that it has any influence over a systemic septic state.