"The question arises, How far can the results of this work on the excised strips of uterus muscle be compared to the action in the intact animal and in the human uterus? There are no experimental data on the point at present, but judging by analogy to other drugs, notably pituitary extract and ergot, it may with perfect safety be assumed that the action would be the same on the uterus in situ as on the excised strips of uterus, provided the drug reached the uterus in a similar concentration; this refers to the action on the muscle directly and on the nerve endings; any action on the local circulation can be dismissed, as no known drug acts specifically on the circulation of any organ. The action on the human uterus would be the same, as a similar physiology implies a similar pharmacology. It is improbable, however, that the concentrations of the drug used in this work could be attained in the body in whatever way they were administered. From preliminary work on another form of smooth muscle (intestine) it seems highly probable that these drugs act in no sense specifically on the uterus, but on smooth muscle in general, so that, even granted that they could be taken in sufficient dosage to exhibit their characteristic action on the uterus, it is more probable that the action on the other forms of smooth muscle (intestine, blood vessels, etc.) would overbalance any favorable effect there might be on the uterus."

Of course opinions may differ regarding the conclusions here drawn. Indeed, this pharmacologic technic is somewhat open to question. Viburnum opulus is esteemed by many physicians as a uterine sedative and antispasmodic, though many doubtless used Acer spicata; but all pharmacologists agree with Pilcher. And it would seem that, whatever the drug (either viburnum or acer) may or may not do, valerian would be more active in the same direction.

"Cramp-bark," so-called, is a constituent of many proprietary preparations, and various official and semi-official formularies (as the N. F. IV) have included Viburnum opulus. It is hard to secure definite clinical data upon these agents. And it must be conceded that the valerian-like drugs, as well as valerian itself, are an unsolved problem. See "Valerian." So, then, let us not be dogmatic and so await further report.

The fl. is given in doses of 10 to 30 minims.

Black Haw, Viburnum prunifolium, is official in Austria, Great Britain, France, Mexico, the Netherlands, Servia, Spain, and in the U. S. P. IX. Viburnum cutago is more or less recognized. The new U. S. P. directs that the fluidextract be made from No. 30 powder instead of No. 40, as formerly, the menstruum being two volumes of alcohol and one volume of water and that extraction be without heat. This should produce a representative preparation.

It will be observed that Pilcher thinks no more favorably of Viburnum prunifolium than of the other drug; and it must be stated that most pharmacologists agree with him.

As long ago as 1884, Laurence Johnson definitely condemned Viburnum prunifolium as practically inert. Wilcox, however, while finding no scientific data in its support, regarded it favorably in practice. The following is a favorable report clipped from the editorial pages of The New York Medical Journal:

"While viburnum prunifolium is an American plant, it is less known than it should be; it is an agent which is efficacious without being toxic. We have used it in dysmenorrhea, and with advantageous effect. Naturally, therefore, we have read with more than usual interest the researches of Chistoni, of Professor Marfori's clinic, on the pharmacology of Viburnum prunifolium. This paper, published in Giornale Internazionale delle Scienze Mediche for June 30, 1914, is possibly the best piece of work that has been done on this subject; it is clear, complete, careful, strictly conservative. Chistoni remarks that while viburnum has been an object of much interest to clinicians, pharmacologists, on the other hand, have paid infrequent attention to it. Indeed, no regular experimental study of its effects exists. Medicinally, it is believed, Viburnum prunifolium has specific effects on the uterus, what is called a selective action on the uterine nerves and muscle. The effect is one of calm and arrest of hemorrhage. In his experiments, Chistoni used an extract; the ingredients, according to Wehmer, are valerianic acid, citric and oxalic acids, a bitter substance, viburnina, and an alkaloid of ill-defined composition. On the uterus the extract produces the effects specifically intended. Contractions succeed one another with increasing rapidity and a corresponding decrease in the amplitude of the wave. The tone of the muscle is not altered - a rather indefinite statement - and the action is essentially one of nervous impulses to muscular elements. The substance called viburnina reproduces these effects on the heart, which manifests rapid contractions. The breathing, on the other hand, is unaffected. Chistoni sums up his experiments by saying, 'We must look to the nervous system of the uterus for an explanation of the powers of viburnum. It excites within the uterus the nerves which govern the autonomous movements.' This explanation of the action of viburnum advanced by Chistoni is the most modern notion; fortunately, it does not tend to upset practical knowledge."

So, then, pharmacologists differ, as do clinicians. It would appear that Viburnum prunifolium is to be preferred over other species named here, and that the drugs of the valerian type are in need of serious and more extended study.

Therapeutics

A bitter aromatic causing nausea and vomiting in large doses. In smaller doses it is antispasmodic and nervine. It is classed as a uterine sedative, relieving irritable conditions of the womb, much as does valerian. It has little effect upon the menstrual flow. Dose of fl., 30 minims.