Active Ingredients. - No perfectly satisfactory analysis of cimi cifuga has yet been made, but it seems probable that there is no alkaloidal principle contained in it; and, on the other hand, that there are a volatile oil and two resins. A resinoid extract can be obtained by precipitation of the alcoholic tincture with water.

Physiological Action. - This is not by any means well understood. Among the various accounts given by Chapman, Davis, Young, etc., there is nothing very clear, except that in large doses cimicifuga produces vertigo, dimness of vision, and a depression of the pulse, all of which symptoms are somewhat persistent. Dr. Young speaks rather of vague, uneasy feelings of the limbs than of these more positive symptoms, and says that it does not cause purging, vomiting, or diuresis.

1 Arch. Path. Anat., 1854; Husemann, op. oit.

Therapeutic Action. - Had only a portion of its reputed properties been proved to exist in cimicifuga, we should be justified in regarding it as a medicine of great energy and importance. That it is of service in the treatment of humoral asthma, catarrh, and similar affections, is indisputable; and, as stated by Stille, the success of cimicifuga as a popular remedy for chorea led to its being employed in the regular professional treatment of that disease. The last-named author goes on to say that it is one of the most valuable remedies which can be employed in chorea, the cases to which it is most peculiarly adapted being those in which the nervous derangement is independent of any definite disease in other parts of the body. Stille insists also upon the importance of the remedy being exhibited in doses sufficiently strong for its specific effects to be developed, such, for example, as vertigo and confusion of sight. This idea is fully corroborated by other practitioners, since, when the administration of cimicifuga is prescribed by them, we find large doses recommended, its effect upon the head being considered as the test of the extent to which the medicine should be given.

Many writers upon cimicifuga give as their experience that they found no increase caused by it in any of the secretions, and that it does not possess stimulating qualities. But these conclusions must not cause surprise, since, before one can rely with any certainty upon the accomplishment of wished-for results, we must satisfy ourselves that there is some kind of intelligible relation between the drug and the disease which we hope to efface by the use of it; and this may not have been done by the writers who seem inclined to deny the efficacy of cimicifuga. For instance, if we wish to observe the beneficial effects of this medicine in cardiac affections, it must be administered in those cases where the heart and the pulse beat intermittently. And if we desire to witness the so-called diuretic effects, it must be given in cases of irregular action of the heart accompanied by general anasarca, where the secretion of the kidneys is very scanty. Here I may remark that the action of cimicifuga upon the heart and kidneys forcibly reminds us of the power which, under similar circumstances, is exerted upon those organs by infusion of digitalis. That the action of cimicifuga upon the heart is strongly stimulating and tonic, there can be no doubt; though this may be partly attributable to the action being exerted through the medium of the nervous system, since we frequently observe this medicine to prove singularly efficacious when the pulse is quick, or even too slow, with frequent intermissions, and accompanied often by much dyspnoea, and cold and rather clammy perspirations. have frequently seen it relieve most distressing dyspnoea, when the heart has been weak and its action irregular, and this even when digitalis itself had failed to be serviceable.

In general anasarca, attending this same condition of the heart, when the urine is scanty, the pulse slow and irregular, and the breathing much oppressed, so that the patient is for nights together quite unable to lie down, I have prescribed cimicifuga with results most favorable in every way, the action of the heart becoming strengthened and quickened, the irregularity of the pulse being subdued, and a copious flow of urine being induced, with consequent early disappearance of the anasarca. It also appears to possess a powerful affinity for the muscular system. Hence, we may daily observe examples of its curative efficacy in removing localized rheumatic affections, such as wry-neck, lumbago, pleurodynia, and intercostal and abdominal rheumatism. It is valuable also in alleviating the pains which arise from rheumatism of the uterus.

Rheumatic Fever, etc. - In rheumatic fever I have, upon several occasions, found this drug very serviceable. It has quickly relieved the pain, and subsequently reduced the frequency of the pulse, causing profuse perspiration, and often changing the quality of the perspiration, which under the influence of cimicifuga has become less acid. In colds of a rheumatic and catarrhal kind, when the patient suffers from aching, or from severe pain in the upper or the lower jaw of a neuralgic character, and often attended with coryza or sore-throat, it is again to be regarded as an efficient means of relief. In rheumatic neuralgias generally, and in many of those nervous headaches familiarly termed "sick," and which baffle all the accustomed methods of treatment, it is also to be strongly recommended. Ordinary rheumatic headaches give way to it readily, and so do the headaches which occur during or about the menstrual period. Its utility in dispelling the pains attendant upon rheumatism of the uterus I have already mentioned.

Disorders of Females and Childbirth. - I wish to lay stress upon the influence which this medicine possesses in cases of spinal imitation, aggravated during the menstrual period, or very soon afterward, and which depends in all likelihood upon some sympathetic or rheumatic affection of the uterus. Several such cases have come under my personal observation, and I have had sincere pleasure in watching the salutary effects of the medicine as an alleviant of the symptoms most trying to the patient. Upon the uterus the effects of cimicifuga are truly remarkable, as also in puerperal mania and in peritonitis, especially in the rheumatic form of the last-named disease. I have known it check ordinary monorrhagia when the discharge was of a passive character, coagulated, and dark, the action again reminding us of that of digitalis in controlling this very troublesome disorder. My opinions in regard to its employment, in the class of disorders to which I am referring, are wholly borne out by Dr. Hale, of America, who tells us, in his work upon "New Remedies," that in the estimation of the Eclectic school of medicine no agent stands higher among those adapted to the treatment of diseases peculiar to women than cimicifuga, and its concentrated principle, cimicifugin. By the Eclectic physicians of North America it is constantly resorted to in uterine complaints, including some of the most opposite character. Dr. King, one of the best of the American (Eclectic) authorities, describes it as being useful in amenorrhoea, dysmenorrhoea, leucorrhoea, etc., and, as a partus accelerator, he asserts that it may wisely be substituted for ergot, bringing on the expulsive action of the uterus both speedily and energetically; and, lastly, he assures us that after labor it will be found effectual in allaying the general excitement of the nervous system, and in relieving the after-pains. These results have the advantage over those attained by the employment of ergot, in being unattended by the powerful and continuous contractions of the uterus which ergot occasions, and consequently there is less danger to the child. Ergot, moreover, lessens the susceptibility of the organ to subsequent doses, should they be needed; whereas with cimicifuga there is no such result - the action of the last-named medicine being to excite the uterus freely and normally, but neither imperiously nor in such a way as to interfere with renewed use. Like ergot, cimicifuga is again useful in checking the haemorrhage which follows parturition, especially when tediously prolonged, and either profuse or otherwise.