Description: Natural Order, Scrophulariaceae. Prof. A. Wood brings the genus Leptandra into the genus Veronica, (speedwell) and gives this plant the technical name VERONICA VIRGINICA. This is botanically correct; but the medical profession is so used to the name leptandra, (often incorrectly put leptandra,) that it will probably be best at present to retain the old generic title.
This is a conspicuous plant, perennial, with a smooth, straight and unbranched stem rising to the height of from three to seven feet, one to several from the same root-stock. The leaves are from three to five inches long by half or three-quarters of an inch broad, long tapering, finely serrate, smooth beneath, on short petioles, arranged in whorls of fours, fives, or sixes, at intervals of six to eight inches along the entire stem. Flowers small, numerous, in a dense and cylindrical spike (sometimes several spikes) from four to ten inches long, erect upon the top of the stem, calyx four-parted; corolla white, deeply four-cleft, united into a tubular claw, lower segments mostly narrow, pubescent within; stamens two, twice as long as the corolla, upon the tube of which they are inserted. Fruit a small, dark, compressed capsule. July.
The root is perennial, and possesses its full strength when two years old. It is several inches long, half an inch or more in thickness, blackish-brown externally, brownish internally, sending off numerous slender and dark fibers horizontally. It contains a resinous substance and extractive, which are medicinal, and a volatile principle that is lost by age. Water, diluted alcohol, and alcohol, extract its virtues.
Properties and Uses: This root, when fresh, is a somewhat acrid cathartic; but drying dissipates its harshness, and it is then an almost pure relaxant. Its action is mild and very slow the cathartic result rarely being obtained from a common dose in less than ten hours, and sometimes not for eighteen hours. In this respect it is the slowest of all agents of this class. Nearly its entire influence is expended upon the liver, in distinction from agents which influence the gall-ducts, (§172;) hence it directly favors the elimination of bile, but not its ejection from the gall-cyst, on which account it is not a suitable remedy for jaundiced conditions. The stomach as an organ feels its impression; as is made known by a slight sense of nausea it usually occasions, and which sometimes is quite unpleasant and continues for several hours. The small intestines feel its influence distinctly, as is shown by the thoroughness with which it dislodges scybala and tarry accumulations in dysenteric and typhoid cases; but the lower bowel scarcely feels its action, whence it may depurate the liver fairly and yet not secure the elimination of sufficient bile to move the colon and rectum at all times. Its relaxing impression on the stomach is sometimes extended through the sympathic system, and in rare instances to the circulation; but this is very mild, and not sought for.
The action on the liver is that for which leptandra is most valued; and its mildness, persistency, and reliability, make it superior to almost any agent of its class where hepatic relaxants are needed. In dysentery and diarrhea it is perhaps unequaled–not for any astringent action, as some suppose, but for removing the origin of the trouble by eliminating bile and dislodging alvine accumulations. In typhus and typhoid cases, it is almost indispensable, and it is a hepatic of the first class in bilious, remitting, synochal, rheumatic, and all other febrile cases, so long as the liver is deficient in activity. While it secures the full action of this organ, and obtains a thorough elimination of bile, its final cathartic effect is mainly due to the biliary stimulation of the alvine canal; hence leptandra is a physic not liable. to overwork the organism or induce any prostration. This fact renders it of peculiar value, both in the cases named, and in all other acute cases, so far as failure of the hepatic secretion is concerned. In chronic cases, it is equally useful in hepatic forms of habitual constipation for intermittents, dropsy dependent upon portal obstructions, biliousness other than actual jaundice, diarrhea and dysentery, and those skin diseases which so often have their origin in defective biliary secretion.
While the influence of leptandra is thus beneficial in so many cases, it must be employed with discrimination. Its impropriety in jaundice has already been named; and even when given for common biliousness, some such cholagogue as apocynum is nearly always required with it. Used in typhoid cases, it so thoroughly opens the one great emunctory as to seem almost a specific for such cases; yet then, in ague and all other conditions of much depression, it needs some capsicum, gentiana, or other stimulant or tonic associated with it. (§174.) In old persons, and those laboring under chronic difficulties which induce general and continuous laxity of the tissues, it should scarcely be used at all, or only in conjunction with a large excess of tonics and stimulants. In chronic watery diarrhea, it should be associated with some such astringent tonic as cornus florida–the leptandra effectually relieving the provocative obstructions at the liver, while the cornus gives firmness to the alvine structures. In chronic skin affections and dropsy, it is merely a help-meet (though a valuable one) of stimulating alterants and tonics. In cases requiring a prompt evacuant action on the bowels alone, it is not at all suitable; and persons with a "cold" stomach and a tendency to nausea, will find it a sickening agent.
The usual cathartic dose of leptandra is about twenty grains, which may be given in substance or infusion. A single full dose at bedtime usually secures defecation the following morning, and this is a good method for using this agent, (or any other that acts largely upon the liver.) In febrile cases, two medium doses may be given in twenty-four hours; but this is not a remedy that should bo repeated at intervals of two or three hours, as some authors advise and some physicians practice. In chronic cases, it is customary to use not more than five or six grains in some sirup, three times a day, for a slow "alterant" effect; but it should always be associated with the stimulant rather than the relaxant alterants, and even then I doubt if it is often proper to use this remedy for any length of time at short intervals–euonymus, fraxinus, or some similar laxative, being generally preferable in such sirups. The use of the root has of late years been almost superseded by leptandrin or the fluid extract, the leptandrin being usually preferred.
Pharmaceutical Preparations: I. Extract. This preparation is made with water and alcohol, after the usual manner for hydro-alcoholic extracts. To be of full strength, it should be prepared from roots that have been dried recently. It is usual to direct a boiling heat to the watery liquor, but this is not good practice. It represents the qualities of the root well; and may be used in pills in doses varying from three to six grains, once or twice a day.
II. Fluid Extract. Recently dried leptandra, well crushed, one pound, is to be macerated for twenty-four hours in seventy-five percent alcohol. Transfer to a percolator, and add the same strength of alcohol till six fluid ounces have passed; set this aside, and continue the percolation with warm water till exhausted; evaporate to ten fluid ounces, and mix with the first product. This is an active preparation, used in doses of from twenty to fifty drops.
III. Tincture. Three ounces of leptandra are treated with one pint of diluted alcohol, either by percolation or by maceration and filtration. It is rarely used.
IV. Leptandrin. This is a dark-brown resinoid principle, obtained by exhausting the roots with absolute alcohol, distilling off three-fourths of the alcohol from this tincture, and slowly mixing the remainder with three times its own bulk of water. The resinoid separates, and after several days is precipitated. This precipitate is washed with a small quantity of water, allowed to settle, and then slowly dried at a temperature not above 150 °F. If too much water is added to the reduced tincture, the resinoid will not separate fully; if too much heat is used in drying, the product will be injured. If the tincture is obtained with a weaker alcohol, a large portion of extractive is obtained, and the product is not a pure resinoid, and is liable to fall into a gummy mass. This seems to be the method pursued by Messrs. Tilden & Co., Lebanon, N. Y.; and by B. S. Keith & Co., New York city. The extractive is medicinal, but not equal to the resinoid; and the water that remains after the resin has been precipitated, may be evaporated into a fair extract. A good quality of leptandrin is one of the best of all the resinoids, is an excellent representative of the root, and may be used for all the purposes above named. It is not an article from which a vigorous cathartic action is to be expected, but one that is slow and reliable. As prepared by Tilden & Co., and B. S. Keith & Co., it has proven very uncertain in our hands; W. S. Merrill & Co. prepare it in one form that seems nearly inert, and in another that acts almost as harshly as podophyllin; .but that of Dr. H. H. Hill, and Dr. T. L. A. Greve, both of Cincinnati, I have found uniformly reliable. The usual dose is two grains. When used in dysentery, it is usually advisable to give a fair dose every six hours; and to combine it with a moderate portion of hydrastis, in order to secure the good. action of the latter agent upon the intestinal mucous membranes.
V. Compound Leptandrin Pills. Leptandrin, one drachm; podophyllin, half a drachm; made into three-grain pills with a sufficient quantity of softened extract of dandelion. This is much used by Eclectics, and is an active cathartic, suitable for sluggish conditions, but not admissible in typhoid or dysenteric cases. One or two at bedtime are usually sufficient. Their too frequent use is weakening to the bowels.
VI. Compound Antibilious Pills. Mix the powders of two drachms leptandrin, one drachm apocynin, and half a drachm caulophyllin. Shave a sufficient quantity of white castile soap, and add to it enough strong essence of peppermint to soften it. Use this soap as a basis into which to mix the powders to form a pill mass, and make into four-grain pills. This is a mild, unirritating, and very reliable cathartic, influencing the liver, gall-ducts, and bowels, and procuring thorough yet not drastic or weakening operations. They rarely gripe the bowels, though they may do so to a slight extent in very sensitive patients. I warmly commend them to the profession as a formula that I have employed for many years, and consider one of superior merits for all general cathartic purposes. Dose from two to four, which usually operate once or twice inside of ten hours. If desired, half a drachm of podophyllin may be added; but it is to be remembered that all cases will not admit this agent, and therefore this addendum should be made only for special cases. In the same way, ten grains of capsicum may be incorporated to meet conditions of unusual sluggishness; but this is suitable to only a limited number of cases, and the formula as above given will be found most widely applicable without either of these additions.
The Physiomedical Dispensatory, 1869, was written by William Cook, M.D.
It was scanned by Paul Bergner at http://medherb.com