Viburnum prunifolium. 

Research

Black Haw- Viburnum prunifolium, in abortion and miscarriage
John Henry Wilson  M. K. Q. C. P.,  M. R. C. S. E. (1886)
Fellow of the Obstetrical Society; Consulting Physician-Accoucheur to the Ladies' Charity and Lying-in Hospital, Liverpool.
I AM glad that the attention of the members of the British Medical Association has been drawn to the efficacy of this medicine in cases of abortion and miscarriage, by Dr. Macfie Campbell, and Dr. Leith Napier. ln the number of the Liverpool 3fedico-Cikirurgical Journal for
January, 1885, I reported six typical cases treated successfully by this medicine; and since then, after considerable experience, I have been more and more confirmed in its value. I cannot say it has always succeeded, but in those cases in which it failed, I have been able to account for its doing so. Either the medicine has not been commenced in time, and the ovum has been detached before the viburnum has been taken, or there has been some reason to suspect a syphilitic taint; and, in a case of fatty degeileratioin of the placenta, after not succeeding with the viburnum alone, chlorate of potash was taken in addition, with a good result.
Dr. Napier says, "some women abort on the slightest provocation," and they continue to do so, although every care may have been taken in the way of rest, medicine, etc., to preveait it. I have had many such cases, and have been greatly disappointed ; but when I have had the
opportunity of commencing the viburnum shortly before the antici- pated period, and continued it at intervals on the first appearance of threatening symptoms, these patients have invariably gone on to the full tirme, and done well, without being subjected to restrictions or debarred fromn active exercise.
In the next class of cases, where there may be reason to suspect even a partial separation of the ovum-l and a dilated external os, with severe pains and h morrhage going on for hours, anld the patient under the impression that she could not possibly go on to lher full time, and when I had almost despaired of any benefit from the medicine, I have been astonished at its etfect, more than three-fourths of these cases doing well.
The most sanguine adlvocate of vibuirnumu could not expect it to do impossibilities, or to prevent abortion when there is "a gaping os, and a detached ovum presenting." One might as well expect to resuscitate a dead body by galvanism.
I have never seen ill consequences follow the administration of the nedicine, however often the dose has been repeated. In two cases only has it been followed by slight headache. One patient inquired if she had not been taking quinine. The symptoms had been relieved;
therefore it was not continued. In the other case, the patient had taken fouir grains of the extract every two hours. The only change was to extend the interval to four hours, andl then gradually discontinue it.
Some patients have taken viburnum at intervals during the whole course of their pregnancy. It seems to act as an uterine tonic and sedative, anid to relieve the woman of those harassina nervous forebodings which often lead to abortion. The patient, after taking only a few doses, has quite a changed expression. From a drawn, desponding look, her countenance becomes cheerfuil and haplpy. Siince I have prescribed viburnuum, it has not been necessary to keep the women in the horizontal positioIl mnore than a few days; whereas, under the old treatnment, they occasionally spent weeks in Led, and, after all, abortion has taken place. On some of the planitations in America, it is the popular belief a womnan cannot abort if she be under the influence of black haw, although she may be taking melicine with a criminial intent. My experience would go far to confirm that opinion, for I have had patients in whom a succession of abortions have taken place, but, when uilder the influence of the medicine, they have been able to resist the severest tests-frights, falls, strainis, etc.-and no ill effects have followed.
With regard to the modle of administering the drug: at first, the liquid extract was or(dered, but the snmell was so strong, and objectionable, that the whole house became impregnated ; and in two cases, where the stomach could not retain it, the liquid was given as an enema.
I now order the extract in pills of four grains, and find it a convenient form; as usually made, they soon absorb moisture, and run into a mass; but I now advise theni gelatine-coated, as prepared by Parke, Davis, anid Co., of Detroit, who seem to have been the first to introduce this medicine to the profession. I have no doubt others would make them equally well. These pills keep any length of time, and I advise my patients to keep a supply by them. I have such confidence in viburnum prunifolium that I am anxious the profession should give it a trial, feeling assured they will not be disappointed.
The British Medical Journal April 3, 1886 ncbi.nlm.nih.gov


In vitro relaxant and spasmolytic effects of constituents from Viburnum prunifolium and HPLC quantification of the bioactive isolated iridoids.
Cometa MF, Parisi L, Palmery M, Meneguz A, Tomassini L.
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE:
Viburnum prunifolium is a North America shrub used in ethnomedicine because of its spasmolytic, sedative, and anti-asthmatic properties.
AIM OF THE STUDY:
Contrasting results were reported in past literature about the active principles of this plant. Our aim was to clarify this matter by evaluating the relaxant and spasmolytic activities of the main constituents obtained from the drug.
MATERIALS AND METHODS:
The pharmacological assays were carried out on rabbit jejunum spontaneous contractions and on guinea-pig carbachol-precontracted trachea.
RESULTS:
Cumulative concentration (1-100 microg/ml) of Viburnum prunifolium methanolic extract (MeOH extract), its purified fractions soluble in ethylacetate (EtOAc fraction) and in n-butanol (BuOH fraction), and the iridoid glucosides (2 x 10(-5) to 4 x 10(-4)M): 2'-O-acetyldihydropenstemide (1), 2'-O-trans-p-coumaroyldihydropenstemide (2), 2'-O-acetylpatrinoside (3), and patrinoside (4), isolated from EtOAc fraction (1 and 2) and BuOH fraction (3 and 4), induced both relaxant effect of rabbit jejunum spontaneous contractions and spasmolytic effect on guinea-pig carbachol (5.5 x 10(-7)M)-precontracted trachea. Propranolol (10(-6)M) antagonised all Viburnum prunifolium tested components relaxant and spasmolytic effects. At non-relaxing concentrations (0.5 microg/ml), MeOH extract and its fractions induced a potentiating effect of isoprenaline cumulative concentrations also in both isolated tissues.
CONCLUSION:
In both tissues, the order of potency was EtOAc fraction>BuOH fraction>MeOH extract and 1>2>3>4 suggesting that the major iridoids of EtOAc fraction may be considered among the most active compounds. HPLC analysis of the bioactive iridoids indicates that 1 and 2 are present for 7.38% and 14.90% in EtOAc fraction, and 3 and 4 for 18.47% and 8.86% in BuOH fraction. By comparing the values of EC(50) of the fractions and compounds isolated from them, we may assume that the iridoids play a significant role in the biological activity of the corresponding fractions.
PMID: 19429363 DOI: 10.1016/j.jep.2009.03.021 J Ethnopharmacol. 2009 Jun 22;123(2):201-7. doi: 10.1016/j.jep.2009.03.021. Epub 2009 Mar 26. ncbi.nlm.nih.gov

NOTE ON VIBURNUM PRUNIFOLIUM IN ABORTION.
By W. MACFIE CAMIPBELL, M.D., Liverpool.
SINCE the publication of Dr. Wilson's paper in the Liverpool Medico-Chirurgical Journal of January, 1885, I have had the opportunity of testing the use of viburnium prunifolium, so much vaunted in America, in several cascs of threatenied miscarriage, and I can entirely endorse the good opinion he has formed of it. Nothing, probably, in midwifery is more disappointing than the ordinary routinetreatment of miscarriage by opium or Indian hemp oni -the one haid, or ergot on the other. For these drugs as often act in the way contrary totheprescriber'sintention as in accordance with it. Howoftenhas a dose of Battlev's solution, administered to arrest uteriute actioni, and give rest aind ease from pain, been followed by immediate and severe expulsive pains, while the attempt to empty the uterus by a dose of ergot has resulted in a perfect calm, and a disappearance of symptoms.
It is a comfort thus to have some hope of success in dealing, with such a condition as miscarriage ; and although I have so far only the notes of six cases, of which five were successful, yet, these five being consecutive, and the effect exactly following the administration of the
remedy, I have no hesitation in my own mind in giving the credit to the viburnum. The case of failur e was my first.
CASE I.--Mrs. B., two months pregnant, had discharge of blood, wvith uterine action. She was treated in the usual manner, wilh opiium and rest for two davs, when extract of viburnlum, in two-grain doses, three times a day, was oldered. lThere seemed no effect upon
the pains, the os continued to dilate, and the uterus was soon empty. Perhaps the dose was too small' ; at any rate, I had lost two days, which I take to be the reason of the failure.
CASE II,-Mrs. H., pregnant for the seventh time, two mlonths and a half, was awakened by a gush of water early one morninug, followed by a bloody discharge. On examination, the os was soft anid dilatable. She was kept in bed, and given at once three grains of extract of
viburnum every four hours. There was no return of bright blood anid the discharge gradually ceased. The relief to the paini after the first dose was in this case very marked.
CASE iii.-Mrs. B., in her sixth pregnancy, one night during the fifth month was wakened by the "breaking of the waters," the escape being sufficient to saturate her night-dress and bedclothes. This was followed by pains. I saw her in the early forenoon, and gave three grains of the extract three times a day, and there were no further symptoms.
CASF iv. -Mrs. G., in the fifth month of her second pregnancy, had a bloody discharge, with uterine pains. The same dose was used, and with the same good result.
CASE v.-Mrs. W., in the second mouth of her sixth pregniancy, iacl already had two miscarriages. Two gr4ins of extract of viburnumi, three times a day, gave relief, as also a month afterwards, when the same threatening symptoms appeared.
CASE VI. -Mrs. S., first pregnancy, fourth month. This case was particularly interesting from the fact that, miscarriage had been imminent in her case at each montlily period. The first and second attacks occurred in America, when she. was given viburnum, and her medical man provided her with a large store of the liquid extract, which he told her was unknown in 'England. She had an attack at sea, and in due time in Liverpool, and was pleased to discover that the drug could be taken in pill, and was equally efficacious, as the liquid extract is very nauseous. While I was from home she had another attack, in which she was attended by Dr. Westby, who considers she was only saved from miscarriage by the viburnum. During this last attack, she took her pills five and six times a day; in fact, her faith was such, that she would have taken too many. Bromide of potassium was also given to allay her nervous excitement. Two other cases turned up during my absence, both of which completed their miscarriage and I cannot help feeling that, if they had been treated with viburinum, the result would have been different.
One sent for Dr. Westby on the third day; the other was treated by another doctor with opium and morphia hypodermically. It does not do to build too much upon the result of these few cases; but I have been so constantly foiled in my endeavours heretofore to prevent miscarriage, that I hope to have found in viburnum the sure arrester of uterine action, which we certainly at present do not possess.
As recommended by Dr. Wilson, I prescribe the solid extract prepared by Mlessrs. Clay and Abraham, of Liverpool, from the liquid extract.
Feb. 27, 1886. THE BRITISH MEDICAL JOURNAL. 391