Medicine Lake Volcano (MLV), located in the southern Cascades ∼ 55 km east-northeast of contemporaneous Mount Shasta, has been found by exploratory geothermal drilling to have a surprisingly silicic core mantled by mafic lavas. This unexpected result is very different from the long-held view derived from previous mapping of exposed geology that MLV is a dominantly basaltic shield volcano. Detailed mapping shows that < 6% of the ∼ 2000 km² of mapped MLV lavas on this southern Cascade Range shield-shaped edifice are rhyolitic and dacitic, but drill holes on the edifice penetrated more than 30% silicic lava. Argon dating yields ages in the range ∼ 475 to 300 ka for early rhyolites. Dates on the stratigraphically lowest mafic lavas at MLV fall into this time frame as well, indicating that volcanism at MLV began about half a million years ago. Mafic compositions apparently did not dominate until ∼ 300 ka. Rhyolite eruptions were scarce post-300 ka until late Holocene time. However, a dacite episode at ∼ 200 to ∼ 180 ka included the volcano's only ash-flow tuff, which was erupted from within the summit caldera. At ∼ 100 ka, compositionally distinctive high-Na andesite and minor dacite built most of the present caldera rim. Eruption of these lavas was followed soon after by several large basalt flows, such that the combined area covered by eruptions between 100 ka and postglacial time amounts to nearly two-thirds of the volcano's area. Postglacial eruptive activity was strongly episodic and also covered a disproportionate amount of area. The volcano has erupted 9 times in the past 5200 years, one of the highest rates of late Holocene eruptive activity in the Cascades. Estimated volume of MLV is ∼ 600 km³, giving an overall effusion rate of ∼ 1.2 km³ per thousand years, although the rate for the past 100 kyr may be only half that. During much of the volcano's history, both dry HAOT (high-alumina olivine tholeiite) and hydrous calcalkaline basalts erupted together in close temporal and spatial proximity. Petrologic studies indicate that the HAOT magmas were derived by dry melting of spinel peridotite mantle near the crust mantle boundary. Subduction-derived H₂O-rich fluids played an important role in the generation of calcalkaline magmas. Petrology, geochemistry and proximity indicate that MLV is part of the Cascades magmatic arc and not a Basin and Range volcano, although Basin and Range extension impinges on the volcano and strongly influences its eruptive style. MLV may be analogous to Mount Adams in southern Washington, but not, as sometimes proposed, to the older distributed back-arc Simcoe Mountains volcanic field.