Coto Bark.

We have, among our list of tried remedies, a number of excellent, intestinal astringents notable among which is geranium, a remedy of wide and effective influence. The addition of another will increase our resources, especially if the other be found as it is claimed to control pain present in diarrhea, cholera and dysentery.

The above remedy, coto bark, was introduced from Bolivia twenty-five years ago, and notwithstanding the fact, that very many have obtained excellent results from it, it has never come into general use. I used it in my practice with good results at that time, and was convinced then that it was a superior remedy. I am confident that we have done wrong in neglecting to thoroughly investigate it.

The remedy may be given in the form of a fluid extract, or the powdered bark. The fluid extract may be given in doses in from five to twenty minims; it is a good plan to combine, for children especially, two drams of the fluid extract, with six drams of simple syrup or glycerine. This may be given in sufficient doses to equal the above, but the best results will be obtained when the remedy is given every hour especially in severe cases.

The most of our astringents are advised when no acute inflammatory condition is present. The original investigators gave this remedy during the entire course of acute inflammatory disease. They claimed the best of results. While we have no definite, or thoroughly proved symptomatology, the following will serve as specific indications to guide the observations of those inexperienced, but it must be borne in mind that this remedy is not to be given to cover all the indications present, as that would deprive us of some specific remedies, which must not be overlooked.

It is indicated in attacks of epidemic diarrhea, those which occur suddenly in the night or in the early morning, where the stools are very large or frequent, where there are colloquative rice water stools, with nausea, vomiting and especially with great distress, sharp cutting pain in the bowels. Later there are involuntary evacuations, extreme prostration, cold and clammy perspiration with a tendency to collapse.

The remedy is also useful in typhoid fever, and in the diarrhea of other prostrating disease. There is no doubt that given with other indicated remedies, for the diarrhea of septic infections, septic fever, that it will in a majority of cases exercise a restraining influence.

A few of our writers have been very enthusiastic in the action of this remedy. I remember Dr. Edison of Indiana, in an article written some years ago, gave some very marked cases where the influence of this remedy was highly beneficial. He claimed then that there seemed to be a nerve sedative influence in conjunction with its astringent effect. That while controlling intestinal pain, it soothed the nervous system, and in one case, he thought it produced actual, temporary, paralysis.

I should like very much to have reports from any of our readers as to the peculiar action of this remedy to determine whether its influence is superior or different in any essential particular from those we have under observation.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.