(Virginia Snakeroot.)

Origin. - The dried rhizome and root of Aristolochia Serpentaria L. (Virginia Serpentaria) or Aristolochia reticulata Nutt. (Texas Serpentaria), perennial herbs indigenous in the United States.

Description and Properties. - The rhizome of Virginia serpentaria is about I inch (25 Mm.) long, thin, curved; on the upper side with approximate, short stem-bases; on the lower side with numerous thin, branching roots about 4 inches (10 Cm) long; dull yellowish-brown, internally whitish; the wood-rays of the rhizome are longest on the lower side; odor aromatic, camphoraceous; taste warm, bitterish, and camphoraceous. It contains 1/2 per cent. of volatile oil, a bitterish principle aristo-lochin, tannin, resin, starch, etc. The roots of Aristolochia reticulata are coarser, longer, and less interlaced than those of Aristolochia Serpentaria.

Dose. - 10-30 grains (0.6-2.0 Gm.) [15 grains (1 Gm.), U. S. P.].

Official Preparations

Fluidextractum Serpentariae - Fluidextracti Serpentariae - Fluidextract of Serpentaria. - Dose, 10-30 minims (0.6-2.0 Cc.) [15 minims (1 Cc), U. S. P.].

Tinctura Cinchonas Composita - Tincturae Cinchonse Compositae - Compound Tincture of Cinchona. - Dose, 1-4 fluidrams (4.0-15.0 Cc.) (2 per cent. of serpentaria).

Tinctura Serpentariae - Tincturae Serpentariae - Tincture of Serpentaria (20 per cent.). - Dose, 1/2-2 fluidrams (2.0-8.0 Cc.) [1 dram (4 Cc), U. S. P.].

Antagonists and Incompatibles. - The salts of iron, lead, and silver are incompatible with gentian and the aromatic bitters, though preparations of iron can be given with quassia, calumba, and chirata. Boiling water impairs the virtues of wild cherry.

Synergists. - The digestants, mineral acids, and, under certain conditions, alkalies, and the restorative agents generally, aid the action of vegetable bitters.

Physiological Action. - Because of their action in augmenting the secretions from the salivary and gastric glands, they aid digestion and improve nutrition.

Pure bitters act immediately upon contact; that is, their efficiency is due to their local action upon the mucous membrane of the mouth, tongue, and esophagus.

Bitters increase the secretion from the salivary glands. This effect is produced by stimulating the ends of the nerves of taste distributed in the mucous membrane of the mouth, from which nerves the impression is conveyed to the center in the medulla, and from there transmitted to the vasomotor and secretory nerves supplying the salivary glands, increasing their blood-supply and activity and at once promoting the secretion of saliva.

Bitters increase the secretion from the gastric glands. The primary action is an augmented flow of gastric juice, caused by reflex stimulation from the mouth. It is well known that there is an intimate relationship between the stomach and the senses of taste and smell. The taste of victuals or the odor of a tempting dinner excites the appetite, and, reflexly, the flow of gastric juice, similar to the flow of saliva in a dog looking wistfully at a meat-stand. Bitters act in a similar manner. The nerves of taste are stimulated; the impression is conveyed to the medulla, and from it transmitted not only to the salivary glands, but through the fibers of the vagus, increasing the blood-supply to the gastric glands and thereby promoting their functional activity.

Bitters stimulate the peristaltic movements of the stomach by reflex action. The sensory nerves in the mucous membrane are irritated, and an impression is conveyed by them to Auerbach's plexus between the muscles in the walls of the stomach, from which plexus, or ganglion, the influence is transmitted to the muscles themselves, causing increased activity or peristalsis.

Another method by which peristalsis is stimulated occurs when the impression is conveyed by the sensory nerves directly to the center in the medulla, and from there through the motor fibers of the vagus to Auerbach's plexus, affecting the muscles in the manner just described.

Bitters augment absorption by increasing the blood-supply to the mucous membrane of the stomach. It is a physiological fact that the larger the blood-supply passing through the bloodvessels, and the greater the amount of lymph conveyed through the lymph-channels, the more rapid the absorption.

Bitters also induce leukocytosis. Their action as antiseptics is secondary to the increase of the gastric juice, digestion being a physiological fermentative process, forming a contraindication to the administration of bitters during active digestion.

Therapeutics. - Externally and Locally. - The tincture of calendula is recommended by many physicians as an external application for contusions, sprains, etc., although not so efficient as tincture of arnica. The drug has been used topically in chronic pharyngitis.

Internally. - The simple bitters are peculiarly useful in atonic and fermentative dyspepsia, chronic gastric catarrh, and as a tonic in convalescence from acute disease, in malarial fever, and in the anorexia following it.

Infusion of quassia is a most efficacious injection to destroy seat-worms (Oxyuris vermicularis), the infusion being injected into the rectum, which has been previously washed out with soap and water and cleared of mucus by salines.

The aromatic bitters are used to stimulate the appetite and improve the condition of the digestive apparatus. The simple bitters are similarly used, but the former possess more stimulating and tonic properties, owing to their volatile and astringent constituents. Chamomile, in addition to its action as a stimulant to the digestion, has been employed with benefit in delirium tremens and as an em-menagogue, while in the form of hot poultices chamomile flowers serve as an efficient application for local pains.

Wild cherry might not inaptly be called a sedative tonic, its peculiarly bitter, yet not unpleasant taste causing it to be well tolerated by the stomach, and rendering it one of the best stomachic tonics, especially during convalescence, when its sedative action upon the heart allays febrile and cardiac excitement. The syrup of wild cherry is a common ingredient of "cough-syrups." It is thought to quiet the cough and allay the irritability of the nervous system in broncliitis and phthisis - probably owing to the hydrocyanic acid which it contains.

Serpentaria is considered an efficient expectorant in pneumonia and capillary bronchitis. Next to its use as a stomachic its chief value seems to be as a stimulant in typhus and typhoid fevers, the compound tincture of cinchona being a most excellent remedy in the low forms of typhoid. Bitter orange is widely employed as a pleasant bitter. Cinchona and nux vomica make most efficient bitters.

Contraindications. - Bitters should not be given when the secretion of gastric juice is diminished as the result of organic disease. They are contraindicated as stomachics during the course of acute disease, as in fevers. When after a reasonable time they fail to improve the appetite, they should be discontinued. In convalescence from acute disease, when the appetite is voracious, they are contraindicated. Bitters find their chief usefulness in the depressed and hypochondriacal states of fatigue from a vast variety of sources, and in which there is loss of appetite.

Administration. - To improve the appetite bitters should be given from one-half to one hour before meals. When necessary to use them for a long time, one bitter should be substituted for another in the course of every week or two; otherwise the stomach may rebel at the monotony. Bitters may be given in the form of a powder or a solid extract. Ordinarily, however, it is preferable to administer a liquid preparation - fluidextract, tincture, or infusion. A pleasant method of giving the latter preparation in the case of quassia is to allow water to stand overnight or for a few hours in a quassia-cup - purchasable at almost any drug store - when the water will become impregnated with the bitter principle of the quassia.