Family Name: Pyrolaceae

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Chapter from my PhD Thesis
Notes from the Eclectic Physicians

Chapter from my PhD Thesis

Part used: Recent or dried leaves

Chemical Constituents: Significant phytochemicals include arbutin, Chimaphyllin, methyl salicylate, and tannin. (13)

History
This small woodland plant is indigenous to the northern parts of North America where it can be found growing flat to the ground in dry, shady woods. It was widely used as a medicine by the North American tribes (Algonquin, Penobscot, Montaignais,Mohegan, Delaware , Menomini, Ojibwe, Seneca, and Malecite) for nephritic, scrofulous, and rheumatic conditions. (12) The Colonials followed suit using it in
rheumatic and nephritic disease.

The western pioneers used it to treat tuberculosis, rheumatism, gonorrhoea, cancer, typhus, tumours, malignant ulcers, chronic indurated swellings, fevers, gravel, kidney disease, and kidney failure. Eventually it passed from domestic remedy to official medicine. It was first mentioned in the 1830 Philadelphia Pharmacopoeia, though it was not mentioned in the 1830 New York edition. It was official in the US Pharmacopoeia from that year until it was dropped from the 1910 edition. (10)

Eclectic uses (1–11)
Actions
Diuretic, tonic, alterative, astringent, tonic diuretic, diaphoretic, decreases lithic acid in urine, increases renal circulation, improves waste and nutrition, restores appetite and strengthens digestive powers.

Indications
“Atonic and debilitated states of the urinary organs, giving rise to lingering disorders, with scanty urine, but excessive voidings of mucus, muco-pus, or bloody muco-pus, offensive or non-offensive in character; smarting or burning pain with dysuria; chronic irritation of the urethra and prostate; chronic relaxation of the bladder walls; chronic prostatitis, with vesical catarrh .” (8)

General
Scrofula, scrofulous ulceration, scrofulous diathesis, atonic dropsy associated with scrofulous taint and loss of appetite, debility associated with a scrofulous taint, secondary syphilis, diffused stages of syphilis where the constitution has been greatly impaired, chronic rheumatic affections, ascites, dropsy, chronic disease associated with debility, dropsy with no obstruction to the circulation, atonic troubles, glandular disorders, general bubonic inflammation, dropsy after scarlatina and measles, dropsy with debility from any cause and enlarged glands, hectic fever with night sweats, later stages of typhoid with deficient excretion.

Digestive
Abdomen filled with nodules (diarrhoea or cholera infantum).

Endocrine
Enlargement of mammary glands or testicles, tumours of the mammary supposed to be cancerous.

Genito-urinary
Chronic nephritic conditions, chronic nephritis, strangury, chronic gonorrhoea, leucorrhea, catarrh of the bladder, conditions of the urinary tract with pronounced catarrh, urinary tract stones, dropsy, dropsy with loss of appetite, irritation of the entire urinary tract, poor circulation and nutrition to the urinary organs, chronic diseases of the urinary mucous membranes, chronic catarrh of the bladder, chronic urethritis attended with purulent or profuse mucous discharge, calculus and prostatic affections, diabetes, advanced stages of albuminuria, disorders of the urinary tract attended with local debility or chronic inflammation or irritation, chronic cystitis, relaxation of the kidneys followed by polyuria, genito-urinary fluxes due to debility or depending upon scrofulous diathesis, catarrh of the bladder with offensive urine, urine loaded with mucous, muco-pus, blood, urethritis with profuse and purulent discharge, chronic prostatic inflammation and prostatitis, mucous profluvia, uric acid diathesis with dropsy and loss of appetite, ulcerated cervix.

Lymphatic
Enlarged glands, either chronic or acute, bubo, ostitis, mastitis, enlarged glands of the skin, enlarged parotid glands from retained excrementious products, enlarged mesenteric glands.

Musculoskeletal
Chronic rheumatism, rheumatism where the patient is scrofulous.

Skin
Scrofulous ulceration, skin diseases with enlarged cervical glands in scrofulous subjects, obstinate and ill conditioned ulcers.

The drug from Selye’s perspective

State of Resistance
The drug was used to increase resistance to tuberculosis, rheumatism, syphilis, nephritis, gonorrhoea, urinary tract disease, scarlet fever, and malaria.

State of Exhaustion
The drug was used when chronic disease gave way to State of Exhaustion . When the body could no longer maintain resistance to tuberculosis, syphilis, rheumatism, kidney failure, typhoid fever, measles, scarlet fever, or any other cause, and the signs of State of Exhaustion presented themselves, the drug was used. Signs treated with the drug included obstinate and ill condition ulcers, debility, ulceration, skin disease, atony of the system, dropsy with appetite loss, kidney failure, constitutional impairment, and hectic fever with night sweats.

Adaptation Energy
From Selye’s perspective, the drug increased adaptation energy. Evidence supporting this includes the following. The Eclectics believed the drug increased vital force powerfully. Ellingwood said this of the drug; “ Chimaphylla is a tonic giving strength to the body .” The drug was used to raise resistance to chronic infectious disease (syphilis and tuberculosis) and to chronic debilitating diseases (rheumatoid arthritis and kidney disease). When the body was no long able to maintain resistance to stressors, and State of Exhaustion commenced, here too it was used. Lastly, the drug was used topically to stimulate healing in wounds and non-healing sores.

Brekhman’s Adaptogen Criterion
An adaptogen should be innocuous and cause minimal disorders in the physiological functions of an organism.

Eclectic and contemporary literature reports the drug is innocuous. (1–13)

The action of an adaptogen should be non-specific i.e. it should increase resistance to adverse influences of a wide range of factors of physical, chemical, and biological nature.

Clinically the drug was used to increase resistance to bacterial infection (syphilis and tuberculosis), autoimmune disease (kidney failure following scarlet fever, rheumatoid arthritis), autotoxaemia, and cancer. (1–11)

Experimentally, compounds it contains have been shown to increase resistance to bacterial (Streptococcus, Staphylococcus, tuberculosis,), viral (EBV, influenza, HIV), fungal infection (Candida), and protozoan infection (malaria, plasmodium). This effect is mediated through immune stimulation and antibiotic activity. They have also been shown to increase resistance to Carcinogenesis and cancer metastasis. Lastly, they have been shown to increase resistance to free radical damage and liver damage. (13)

An adaptogen may possess normalising action irrespective of the direction of the foregoing pathological changes.

Clinically the drug was used to reverse the abnormalities associated with State of Exhaustion . Specifically, it was when State of Exhaustion manifested in the systems of waste excretion. (1–11) “ Chimaphila is an alterative, stimulating waste, a tonic giving strength to the body, and a diuretic, removing dropsical accumulations. While it aids in restoring the excretory functions to a normal condition, it tends to remove irritation of the urinary tract and kidneys, lesions of the skin and lymphatic glands, and deterioration of the blood, caused by the presence of waste products, the result of defective catabolism .” (11)

Experimentally, compounds it contains have been shown to normalise diuresis, inflammation, temperature, immune dysregulation, blood pressure, capillary fragility, dermatitis, arthritis, histamine production, hyperlipidemia, ulceration, poor bile production, and blood sugar levels. (13)

Discussion
The drug exhibits properties consistent with Brekhman’s definition of an adaptogen. The drug is innocuous. Clinically, it was used to raise resistance to a collection of debilitating chronic disease, some of infectious origin (syphilis) and some of internal origin (autoimmune disease). Experimentally it has been shown to increases resistance to a wide assortment of biological threats. It was used to normalise physiological function, and there is experimental data supporting these uses.

It was used particularly when State of Exhaustion was manifest in the urinary tract. Kings’ Dispensatory said this of it, “The cases of all disease in which it is of most value are those of debility and particularly when a scrofulous taint is present. Its particular field is in genitourinary fluxes due to debility or depending upon a scrofulous diathesis.” (6)

However, it was also used when urinary tract disease was the source of stress causing State of Exhaustion . When urinary tract disease caused State of Exhaustion , or was merely a symptom of State of Exhaustion , Chimaphylla umbellata was the drug of choice.

Potential Clinical Applications
The drug was used when State of Exhaustion caused or was manifest in the urinary tract. Research has shown that the drug raised resistance to urinary tract infections. It may be useful in preventing urinary tract infections.

Future research
• Chimaphila umbellata and its effect on the GAS. The drug should be tested out in the animal model for its effects on the GAS.
• Chimaphila umbellata and autoimmune disease. This drug was used to increase resistance to autoimmune disease, including rheumatoid arthritis and kidney disease. The drugs’ role in raising resistance to autoimmune disease should be investigated.
• Chimaphila umbellata and urinary tract disease. The drug was used when State of Exhaustion manifest in the urinary tract and when urinary tract disease caused State of Exhaustion . The drugs’ ability to raise resistance urinary tract disease should be examined.

Eco-availability
The drug is abundant in the wild and is easily cultivated.

References
• King, John. The American Eclectic Dispensatory. Moore , Wilstach, and Keys. Cincinnati . 1854. P. 333.
• Scudder, J. M. Specific Medication and Specific Medicines. Revised. Fifth Edition. Wilstach, Baldwin and Company. Cincinnati . 1874. P. 107.
• Scudder, J. M. the American Eclectic Materia Medica and Therapeutics. Published by the Author. Cincinnati . 1883. P. 243, 490.
• Watkins, Lyman. An Eclectic Compendium of the Practice of Medicine. John M.Scudder’s Sons. Cincinnati . 1895. P. 430.
• Webster, HT. Dynamical Therapeutics—A work devoted to the Theory and Practice of Specific Medication with special references to the newer remedies. Webster Medical Publishing Company. Oakland . Second Edition. 1898. P. 427, 474.
• Felter, Harvey Wickes and Lloyd, John Uri. Kings’ American Dispensatory. Volume one and Volume two. Ohio Valley Company. Cincinnati . 1898. P. 495.
• Felter, Harvey. Syllabus of Eclectic Materia Medica and Therapeutics. Compiled from notes taken from the lectures of F.J.Locke. Edited with pharmacological additions by H.W.Felter. Second edition, with appendix. Scudder Brothers Company. Cincinnati.1901. P. 120.
• Ellingwood, Finley. A Systematic Treatise on Materia Medica and Therapeutics with reference to the most direct action of drugs. Fifth Edition thoroughly revised and greatly enlarged. Chicago Medical times Publishing Company. 1905. P. 464.
• Fyfe, John William. Pocket Essentials of Modern Materia Medica and Therapeutics. The Scudder Brothers Company. 1911. P. 86.
• Lloyd, JU. History of the Vegetable Drugs of the Pharmacopoeia of the United States . Bulletin number 18: pharmacy number 4. 1911. P. 16.
• Ellingwood, Finley. American Materia Medica, Therapeutics, and Pharmacognosy. Ellingwood’s Therapeutist. Chicago . 1919. P. 377.
• Erichson-Bronson, Charlotte . Medicinal and other uses of North American Plants. Dover Press. 1989. P. 315–316.
• Dr. Dukes Phytochemical and Ethnobotanical Databases. Agricultural Research Service. USDA.
• Lloyd Brothers. Desebook of Specific Medicines. Lloyd Brothers. Cincinatti. 1930.

Notes from the Eclectic Physicians

1854: JOHN KING – CHIMAPHILA UMBELLATA – PIPSISSEWA
Properties and Uses – Diuretic, tonic, alterative, and astringent. The fresh leaves when bruised and applied to the skin, act as vesicants and rubefacients. It is especially useful in scrofula, and chronic rheumatic and nephritic affections. The decoction alone has cured ascites, and has been advantageous in strangury, chronic gonorrhea, and catarrh of the bladder; and as an antilithic it is said to diminish lithie acid in the urine. In dropsy it cannot always be relied on to the exclusion of other more active measures, and is better adapted to cases accompanied with much debility and loss of apetite. In urinary disorders, it may be sued as a substitute for the uva ursi, to which it is preferable on account of being less offensive to the stomach. In many cutaneous diseases, it has proved very efficacious. Dose of the decoction, from one to four fluidounces three times a day; of the extract, from ten to twenty grains, three or four times a day; a syrup may be prepared, by macerating four ounces of the finely-bruised leaves in eight fluidounces of water for thirty-six hours, then subject the whole to percolation till a pint of fluid is obtained, evaporate to half of pint, and add twelve ounces of sugar. Dose one or two tablespoonfuls.

1874: Scudder
The chimaphilla has been used mostly in infusion or decoction; but for general use it may be prepared in the form of tincture, both of the recent and the dried leaves, though they will differ materially in strength and properties, the fresh leaves possessing a volatile principle which is lost in drying.

The Chimaphilla has been principally employed as a tonic diuretic, influencing the urinary apparatus in a similar manner to the buchu and uva ursi, though I think it preferable to either. It relieves irritation of the entire urinary tract, and improves the circulation and nutrition of these organs.

It also possesses of waste and nutrition, and possesses the properties termed alterative. In this respect it has not been thoroughly studied, though highly spoken of by some in the treatment of scrofula and secondary syphilis.

1883: Scudder(alterative)
The herb of chimaphila umbellata.

Preparations: A decoction. Tincture of Chimaphila.

Dose: Of the decoction 3j. Of the tincture gtt. x. to 3j.

Therapeutic Action: Chimaphila is diuretic, tonic, astringent and diaphoretic, and said by some authors to be alterative. It exercises a specific influence over the urinary apparatus, increasing the renal secretion, and at the same time it is thought by some to lessen the quantity of lithic acid or lithates secreted. It is especially serviceable in chronic diseases of the genito-urinary mucous membrane, as in chronic catarrhal affection of the bladder, chronic nephritis, or urethritis attended with purulent or profuse mucous discharge. It is also beneficial in calculous and prostatic affections, diabetes, in the advanced stages of albuminuria, and in other disorders of the urinary organs attended with local debility, or chronic irritation or inflammation. Its utility in the affections named, may undoubtedly be ascribed in part to its astringent and alterative action, and in part to its diuretic and tonic properties.

Chimaphilin, the concentrated principle of the Chimaphila umbellata, is a light yellowish-brown powder, having a faint not disagreeable odour, and a feeble taste. It is mildly diuretic, and is especially indicated where there is debility of the urinary organs, and a tonic is desirable. As an alterative it is highly recommended by some in the treatment of scrofula. It is also said to be an efficient remedy in the treatment of chronic rheumatism. Dose grs. ij. to grs. v.

1895: Watkins
Scanty urine, frequent urination with pain in the penis, vesical tenesmus, kidney problems. Kidney stones: scanty urine, mucopurulent sediment, vesical tenesmus, frequent micturition with smarting pain. Chronic cystitis: atonic conditions of the urinary passage, scanty secretion of urine, frequent and inefficient efforts to urinate,. Enuresis: chronic urethral irritation , muscular relaxation of the bladder, debility of urinary organs. Atony of urinary organs, scanty urine, frequent and ineffectual efforts to pass urine, smarting pain in urethra, chronic urethral irritation, muscular relaxation of the bladder, debility of urinary organs.

1898: Webster
Pipsisewa improves the recuperative powers of the urinary tract and is useful where chronic disease here has been followed by debility. It also relieves irritation and is useful in chronic cystitis, and relaxation of the kidneys attended by polyuria. Professor Goss write very enthusiastically of this agent as a remedy for the relief of dropsy, where there is no obstruction to the circulation. He asserts that the dose used is usually too small to give the remedy a fair chance to develop its full power. Hale recommends cimaphilla in dysuria with mucous sediment in the urine. Form for administration: the specific medicine, when the fresh plant is not obtainable. The decoction of the recent plant is certain to give the best satisfaction.

Dose: from five to twenty drops. The decoction may be given in teaspoonful doses.

1901: Locke
Hot water and alcohol extract its virtues. chimaphilla is diuretic, tonic, astringent, diaphoretic, and alterative. This agent is very valuable in the treatment of disease soft the genito-urinary organs. Use it in catarrh of the bladder with offensive urine and in urethritis with profuse mucous flow. in chronic affections of the kidneys and bladder, attended with purulent discharge of mucous, this is a very good remedy. In troubles of the prostate gland and calculous affection this remedy may be employed alone or with eupatorium purpureum.

Owing to its tonic and stimulating effects it is a very good remedy in atonic troubles. dr. white says: it is one of the best alteratives in our materia medica. Others speak of it very highly for this purpose, some claiming to have cured scrofula with it alone. in scrofulous ulceration use it both locally and internally. It is indicated in atonic conditions, especially if the patient is of a scrofulous diathesis. It is one of the best remedies we possess for atonic dropsy associated with a scrofulous taint and loss of appetite.

In some cases of rheumatism , when the patient is scrofulous, it acts very nicely. It may not cover the entire ground here, but is a very valuable aid. It is a good alterative in the diffused stage of syphilis, when the constitution has been greatly impaired. For this purpose give a wineglassful of the infusion, to which is added from five to twenty grains of potassium iodide. Here it restores the appetite and strengthens the digestive powers.

Make the infusion one ounce of pipsissewa to one pine of water. Dose, one to two ounces. Do not make a decoction of this drug, as boiling impairs its virtues; use an infusion. Use specific chimaphilla in doses of from one to ten drops.

1906: Ellingwood
Chimaphilla is an alterative, stimulating waste, a tonic giving strength to the body, and a diuretic, removing dropsical accumulations. While it aids in restoring the excretory functions to a normal condition, it tends to remove irritation of the urinary tract and kidneys, lesions of the skin and lymphatic glands, and deterioration of the blood, caused by the presence of waste products, the result of defective catabolism. …where there is inflamed and swollen prostate gland, with discharge of prostatic fluid, urine thick, ropy, with bloody sediment, itching and pain in the urethra and bladder, strangury, discharge, obstinate and ill conditioned ulcers. In dropsy associated with debility and enlarged glands it should be given freely.

1909: King
Diuretic, tonic, alterative, and astringent. The fresh leaves, bruised and applied to the skin, act as vesicants and rubefacients. Its alterative properties are marked, the processes of waste and nutrition being powerfully influenced by it. It is especially useful in scrofula and chronic rheumitic and nephritic affections. Irritation of any part of the urinary tract is relieved by it, and the circulion and nutrition of the part improved. The cases of all diseases in which it is of most value are those of debility, and particularly when a scrofulous taint is present. Its particular field is in genito-urinary fluxes, due to debility or depending upon scrofulous diatheses. The more pronounced the catarrhal character of the disorder, the more valuavle is the drug. Catarrh of the bladder, with offensive urine, or urine loaded with mucous, muco-pus, or even blood, are cases for its exhibition. Chronic affections of the kidneys, with muco-purelent disharges, are also conditions indicating it. The infusion is the best preparation. Do not make a decotion, as boiling impairs its cirtues. It is also a remedy for chronic prostatic irritation and chronic prostatitis. Used both locally and internally, it is a good remedy for scrofulous ulcerations. The infusion has cured ascites, an d has been advantageous in strangury, chronic gonorrhea, and other mucous prfoluvia; and as an antilithic it is said to diminish lithic acid in the urine. In dropsy it can not be depended upon wihtout the use of other more active measures, and is better adapted to cases accompanied with weakness and loss of appetite. In urinary disorders, it may be sued as a substitute for uva-ursi and buchu, to hwich it is preferable on account of being loess obnoxious to the stomach.

Specific indications and uses: Atonic and debilitated states of the urinary organs, giving rise to lingering disorders, with scanty urine, but excessive voiding of mucous, muco-pus, or bloody muco-pus, offensive or non-offensive in character;smarting or burning pain with dysuria;chronic irritation of the urethra and prostate;chronic relaxation of the bladder walls; chronic prostatitis, with vesical catarrh.

1909: Felter and Lloyd: CHIMAPHILA (U.S.P.) – CHIMAPHILA
History – This little herb is indigenous to the north temperate regions of both hemispheres, and is met with in the United States in dry, shady woods, flowering from May to August. The leaves have no odor when dried, but when fresh and rubbed they are rather fragrant; their taste is astringent, sweetish, and not disagreeably bitter. The whole herb is used. Boiling water or alcohol extracts the active properties.

Action, Medical Uses, and Dosage – Diuretic, tonic, alterative, and astringent. The fresh leaves, when bruised and applied to the skin, act as vesicants and rubefacients. Its alterative properties are marked, the processes of waste and nutrition being powerfully influenced by it. It is especially useful in scrofula and chronic rheumatic and nephritic affections. Irritation of any part of the urinary tact is relieved by it, and the circulation and nutrition of the part improved. The cases of all diseases in which it is of most value are those of debility, and particularly when a scrofulous taint is present. Its particular field is in genito-urinary fluxes, due to debility or depending upon a scrofulous diathesis. The more pronounced the catarrhal character of the disorder, the more valuable is the drug.

Catarrh of the bladder, with offensive urine, or urine loaded with mucus, muco-pus, or even blood, are cases for its exhibition. Chronic affections of the kidneys, with muco-purulent discharges, are also conditions indicating it. The infusion is the best preparation. Do not make a decoction, as boiling impairs its virtues. It is also a remedy for chronic prostatic irritation and chronic prostatitis. Used both locally and internally, it is a good remedy for scrofulous ulcerations. The infusion has cured ascites, and has been advantageous in strangury, chronic gonorrhoea, and other mucous profluvia; and as an antilithic it is said to diminish lithic acid in the urine. In dropsy it can not be depended upon without the use of other more active measures, and is better adapted to cases accompanied with weakness and loss of appetite. In urinary disorders, it may be used as a substitute for uva ursi and buchu, to which it is preferable on account of being less obnoxious to the stomach. In many cutaneous diseases it has proved very efficient.

Dose of the infusion, from 1 to 4 fluid ounces, 3 times a day; of the extract, from 10 to 20 grains, 3 or 4 times a day; a syrup may be prepared by macerating 4 ounces of the finely-bruised leaves in 8 fluid ounces of water for 36 hours, then subject the whole to percolation till a pint of fluid is obtained, evaporate to 1/2 pint, and add 12 ounces of sugar. Dose, 1 or 2 tablespoonfuls; fluid extract, 3ss to 3j, largely diluted; specific chimaphila, 5 drops to 1 drachm, every 3 or 4 hours.

Specific Indications and Uses -Atonic and debilitated states of the urinary organs, giving rise to lingering disorders, with scanty urine, but excessive voidings of mucus, muco-pus, or bloody muco-pus, offensive or non-offensive in character; smarting or burning pain with dysuria; chronic irritation of the urethra and prostate; chronic relaxation of the bladder walls; chronic prostatitis, with vesical catarrh.

1911: Fyfe
Chronic vesical and renal affections, with muco-purulent sediment; smarting pain and frequent urination. Chimaphilla umbellata is alterative, tonic, diuretic, and astringent.

1911: LLOYD
Wintergreen, or pipsissewa, Chimaphila umbellata, is a creeping evergreen vine native to northern latitudes of Europe, and Asia, and found in the United States in shady woods, where it prefers loose, sandy soil. The Indians of North America considered chimaphila of importance, using decoctions of it in nephritic, scrofulous, and rheumatic disorders. Mitchell (441), in his Inaugral Address, 1803, (University of Pennsylvania) gave the drug particular attention, whilst in domestic medicine it was in favor as a tea, in the sections of the country in which it was native, its use being especially in rheumatic and nephritic affections. In these directions it crept into some favor with the medical profession, and thus anticipated the uses of salicylic acid and the salicylates, which in structural form are constituents of this plant.

1919: Ellingwood
Synonym -Pipsissewa.

Constituents – Chimaphilin, arbutin, ericalin, ursone, tannin, sugar, gum, resin.

Preprations – Extractum Chimaphilae Fluidum, Fluid Extract of Chimaphila. Dose, from a half to two drams.

Specific Medicin Chimaphila. Dose, from five to sixty minims.

Syrupus Stillingiae Compositus, Compoun dSyrup of Stillingia. Dose, from one dram to one ounce.

Physiological Action – Chimaphila is an alterative, stimulating waste, a tonic giving strength to the body, and a diuretic, removing dropsical accumulations. While it aids in restoring the excretory functions to a normal condition, it tends to remove irritation of the urinary tract and kidneys, lesions of the skin and lymphatic glands, and deterioration of the blood, caused by the presence of waste products, the result of defective catabolism.

Therapy – Dr. Fox of New York recommended chimaphila in the treatment of glandular disorders. In 1905 he presented a very interesting paper to the New York Society on the influence of this agent in the treatment of general bubonic inflammation. He believes the remedy to be very valuable in leucorrhoea, and diseases where there is an excessive outpour of mucus. He gave it also when the abdomen seemed to be filled with nodules, when there was diarrhea or cholera infantum.

He claimed that it will reduce the mammary glands if taken too long by females, an din males it will reduce the size of the testicles. It does not cause derangement of the stomach nor produce free action of the kidneys.

When the glands are large or inflamed either in the acute or chronic form he believes that this remedy is superior to our other glandular remedies, even to phytolacca. With it he can determine whether an enlarged gland is simple, or whether a tumor is developing. He gives it in bubo, ostitis, and mastitis with excellent results; also when the glands of the skin are affected.

It can be correctly adjusted to the uric acid diathesis, in dropsy, with debility and loss of appetite. Also in cases where there are inflamed and ulcerated cervical glands, enlargement of the parotid glands from retained excrementitious products, dropsy after scarlatina an dmeasles, dropsy with debility from any cause, chronic rheumatism, skin diseases with enlarged cervical glands in scrofulous subjects, hectic fever with night sweats, enlargement of the mesenteric glands, also where there is an inflamed and swollen prostate gland, with discharge of prostatic fluid, urine thick, ropy, with bloody sediment, itching and pain in the urethra and bladder, strangury, chronic gonorrhoea, chronic nephritis, urethritis with profuse and purulent discharge, obstinate and ill-conditioned ulcers, in latter stages of typhoid fever with deficient excretion, tumors of the mammae supposed to be cancerous, this agent is used.

In dropsy associated with debility and enlarged glands it shoul dbe given freely.

In acute rheumatism a warm infusion should be given till it produces perspiration, while hot fomentations of the same should be applied to the swollen an dpainful joints.

In obstinate skin diseases in scrofulous subjects, the tincture from the fresh leaves should be applied to the diseased skin and taken internally.

1911: LLOYD: CHIMAPHILA (Chimaphila, Pipsissewa)
Mentioned first in the 1830 Pharmacopeia (Philadelphia). Not mentioned in the 1830 edition, New York. Dropped from the 1910 edition. Official in all other editions of the U.S.P.

Pipsissewa, Chimaphila umbellata, is a creeping, evergreen vine native to northern latitudes of Europe and Asia. It is found also in the United States in shady woods, where it prefers loose, sandy soil. The Indians of North America considered chimaphila of importance, and used decoctions of it in nephritis, scrofulous and rheumatic disorders. Mitchell (441), in his Inaugural Address, 1803, University of Pennsylvania, gave chimaphila particular attention, whilst in domestic medicine it was in favor as a tea, in the sections of country where it was native, its use being especially in the direction of rheumatic and nephritic affections.

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