By Carroll Dunham, M.D., New York

It happens that Aconite is frequently indicated at the very beginning of some acute diseases and that, if properly used in such cases, it will often cut short the career of the disease. From these facts, has arisen a fashion of giving Aconite almost as a routine prescription in the beginning of all acute cases indiscriminately; particularly if the cases are supposed to be characterized by that Protean phantom of the Pathologist inflammation.

Great mischief often results from this practice; negatively, inasmuch as it causes the loss of valuable time, during which the true specific remedy, which should have been given at the very first, might have been acting; and, positively, inasmuch as the Aconite often, when inappropriately administered, does real mischief, exhausting the nervous power of the patient and adding to a prostration which is already, probably, the great source of danger.

From experiments upon animals and men, systematic writers on Materia Medica draw the following conclusions:

Aconite is a “cerebro-spinant,” a “nervous sedative.” Its first action is to benumb the nerves of sensation. This it does when taken internally; producing first, a sensation of warmth in the fauces, then, a rough prickling or smarting, and then, a want of sensibility and an absence of the sense of taste. When applied externally, to the skin, it produces anaesthesia, without at first, impairing the motive power. It does not affect the consciousness and intelligence until its action is carried to a very considerable extent. [In this respect it is in direct opposition to Cocculus]. Preceding the anaesthesia are observed all the sensations which characterize incomplete anaesthesia, such as, tingling and prickling of the fingers and toes, numbness, etc.

A general feeling of warmth is diffused throughout the body. This soon becomes increased to a disagreeable sense of internal heat with distension of the brain, lips and face, along with a very profuse perspiration over the whole body, itching and a miliary eruption. (Pareira, Stible, Wood, Sturm.)

Dr. Fleming describes, in addition, nausea and oppression at the stomach and a peculiar tingling sensation at the roots of the teeth. The pulse and respiration which were at first markedly accelerated, become, after a time, retarded and enfeebled. When pushed to extremes, the cases of Aconite poisoning prove fatal with the usual symptoms of narcotic sedative poisoning. They furnish no distinctive characteristic symptoms.

Special Analysis - Sensorium. Aconite produces a well-marked vertigo, a sensation as of a swaying to and fro in the brain. This is increased by stooping and by motion generally, especially by suddenly rising from a recumbent posture. Sometimes vision is obscured by it. In connection with these symptoms, a bursting headache, accelerated pulse, and internal heat of the head, with, at the same time, perspiration of the head and thorax. This vertigo resembles that of Glonoine and Bryonia and is contrasted with that produced by China, Ferrum and Theridion.

The thoughts are confused. The head feels oppressed in the forehead with pressure in the temples.

Head. Heaviness and pressure in the forehead as if there were a load there, pressing outwards, and as if all would come out there. Headache as if the brain were pressed outwards. Throbbing and internal soreness. Sticking and pressing headache, involving the eyes; also extending down into the upper jaw-bone.

The headache is pressing from within outward; sometimes throbbing. Its location is the forehead and temples, involving the eyes and upper jaw. It is aggravated by motion, stooping and noise, and relieved by repose. Head and face are hot, especially internally, and covered with hot perspiration.

Eyes. A sharp, anxious expression. Sharp, darting pain in the supra-orbital region. The pupils are at first, dilated. The globe of the eye and the lids reel very dry. Subsequently, there is a feeling of pressure in the eye, and pain when the ball revolves in the orbit. Pressure and burning in the eye and over the brow. Moderate photophobia.

Ears. Indefinite pains and pressure.

Face. Tingling in the cheeks. Sweat covers the cheeks. The face is red and hot, cheeks glow. A sensation as if the face were growing large.

Mouth. The lips burn and feel swollen. Mouth dry, with thirst.

Teeth. Sensitive to cool air.

Tongue. Burning, tingling and pricking. Feels as if it were swollen.

Throat. Rough and scraped sensation.

Gastric Symptoms. Bitter, flat taste. Loss of appetite; discomfort after food, nausea and vomiting.

Stomach. Pressure in the stomach and both hypochondria as if a stone lay there (Bry. Arn.) extending through to the back.

Heaviness in stomach and hypochondria. After repeated vomitings there still remains a sensation as if a cold stone lay in the stomach. (Compare Colch.)

Burning in the stomach and umbilical region extending to the epigastrium with throbbing, at length a shivering, followed by heat.

Abdomen. Pinching pain, in various parts of the abdomen. Very sensitive to touch and pressure. Distended as in dropsy.

Stool. Fluid, rather watery. Sometimes greenish, with some pain and flatulence.

Anus. Sensation as of a discharge of a warm fluid from the anus.

Urine. High colored, strong in odor and scanty, without sediment. It is passed frequently.

Respiratory Organs. Sense of smell unnaturally acute. Nasal membrane dry and irritable. Sneezing frequent, and violent, though often restrained because of the pain which it produces in the walls of the abdomen or of the stitch in the left side of the thorax which it often provokes.

Larynx and Trachea. Larynx very painful. Sensitive to inhaled air, as if it were deprived of its outer covering. This is an intense degree of the sensation of rawness, etc., in the larynx, of which every prover complains.

Sensation as if the larynx were compressed from all sides. Sensation of dryness and roughness in the larynx and all along the trachea. This sensation often gives rise to a little hacking cough.

Irritation (provoking a cough) in the larynx, on coming from the open air into a warm room. (Ran. bulb., the same. Rumex, Squilla, Ipec. and Bry., have cough provoked by change from warm to cold air.)

Cough. Dry, hacking, from rawness in larynx and trachea. Or a forcible cough, producing a taste like that of blood.

Cough always dry, except when attended by clear bloody expectoration.

Cough accompanied by excoriated sore pains in the thorax.

Cough relieved when lying on the back, worse when lying on the s ides.

Expectoration bloody, or consisting of clear blood.

Thorax. Much dyspnea. Frequent deep sighing respiration. One prover, Zlatarovitch says:

“Frequent deep inspiration, not sighing, but like a desire to accelerate the course of the blood through the lungs.”

Heaviness and fullness upon the chest, as though one could not dilate the thorax, compelling deep inspirations conjoined with restlessness, anxiety and palpitation. Audible (subjectively) crepitation. Accelerated breathing.

Besides the heaviness, there are ill-defined stitches in the intercostal spaces, generally low on the right side, aggravated by deep inspiration.

Heat and burning in the lungs.

Heart. Movements irregular and inharmonious. Palpitation, which is worse when walking. Violent palpitation with great anxiety, during repose as well as motion. Anguish in the region of the heart with rapid and powerful action of that organ.

Oppression, especially in the region of the heart. A pressing in pain in the region of the heart.

The following remarkable symptom is reported by Zlatarovich, a keen and daring prover: Lancinating stitches in the region of the heart, feeling as if they were in the costal pleura, and which prevent the erect posture and deep inspiration, with disposition to cough; relieved by friction and by occasional deep inspiration; but the part remains sore.

Back. Pressive, drawing, tearing and numb sensations in various parts of the back. Sensitiveness in the region of the kidneys. Particularly, a weariness and soreness in the lumbar and sacral region.

Upper Extremities. The same creeping, tingling, paralytic sensations in these parts, as in the skin generally. Drawing, tearing pains in the joints of the hands and fingers.

Lower Extremities. Great lassitude of the legs and weariness and heaviness of the feet. They refuse to perform their function. Drawing pains in the hip-joint on motion. Drawing and tearing in the tendinous expansion of the legs and feet. Drawing and pain in the tendo Achillis.

Sleep. Great sleepiness as if from exhaustion, during the day. Nights are very restless. Patients sleep lightly; are too wide awake to sleep; restless and full of dreams.

Restless, alternating cold and heat, thirst and anguish.

Dreams terrifying and very vivid.

Skin. Itching, tingling, prickling and all degrees of commencing and incomplete anaesthesia.

Reddish papules, spots like flea bites on the hands, face, etc.

General Condition. Whole body sensitive to touch.

Sensibility as after a long tit of sickness.

Paralytic sensation and lassitude in the whole body, especially in the arms and feet, with trembling of the whole body, and especially of the extremities - one can hardly walk — with very pale face, dilated pupils, faintness, palpitation, cold sweat on the back and a bursting asunder headache in the temples. Soon after this comes burning heat in the face, with sensation of distension, redness of the face and sleepiness.

Joints. Pains in all the joints. Weakness and laxity of the ligaments of all the joints.

Fever . Chilliness, especially over the back and abdomen. Fugitive chills from the middle of the spine down the loins on each side.

Chilliness and formication between the shoulders and down the back. Shivering.

These symptoms at first alternate with heat and are, finally, followed, as the Austrian provings show, by general and constant heat; dry heat of the whole body; burning heat; heat with moderate sweat.

Heat with contracted, full, strong pulse about 100 per minute in the adult.

Copious sweat, especially at night. Special and general senses Unnaturally acute. Noise, light, odor and touch are unpleasant.

Disposition. Very anxious, restless, full of forebodings, either ill-defined forebodings, or, sometimes, a definite anticipation or prediction of the day of impending death.

If we now review the symptoms of Aconite, as they have been detailed, for the purpose of making a general analysis of the action of that drug upon the organism, we find,

1. The action of the vital power is of such a nature that while the nerves of sensation are more or less benumbed, the voluntary and involuntary muscles and the power of locomotion are but little affected. The action on the sensorium and on the special senses may, perhaps, be accounted for, by that which is the most marked effect of Aconite, viz.: the exalted activity which it produces in the arterial circulation.

The brain is congested; so are the lungs and the kidneys (as indeed the autopsies plainly show). The susceptibility of the special senses is greatly exalted.

2. Action on the Organic Substance. - Of very few drugs, so powerfully poisonous as Aconite is, even in moderate doses, can it be said, as of Aconite, that they produce hardly any appreciable effect upon the organic substance; hardly any change in the tissues or fluids of the body. The records of fatal cases of poisoning, as well as our provings, bear witness to this fact.

The complexion is affected only in so far as the capillary blood-vessels are contracted, producing paleness, and then congested, with redness and heat.

The evacuations can hardly be called abnormal - the urine being merely high colored, inasmuch as it is concentrated, It is a peculiarity of Aconite that urine secreted under its influence has no sediment,

The cutaneous eruption furnishes the only modification to the above statement. It is of such a character as led Hahnemann to recommend Aconite in some cases of measles and miliary rash. There is no resemblance in the symptoms of Aconite to the features of any dyscrasia.

3. Sphere of Action. - The head, the respiratory organs, the heart and the joints seem to be the parts most markedly the seat of the local action of Aconite. In all of these except perhaps the joints, the symptoms point rather to arterial excitement than to definite organic change, involving alteration of existing tissues or formation or deposit of new substances.

4. Sensations. - These are mostly drawing pains - or the various grades of anaesthesi-from sticking, prickling, tingling, etc., down to absolute default of sensation.

5. Periodicity. - None at all.

6. Peculiarities. - The symptoms of Aconite are generally aggravated by warmth and motion and, also, at night.

There is one group of symptoms so characteristic of Aconite that Hahnemann said, “Aconite should not be given in any case which does not present a similar group of symptoms.” These are the symptoms of the Mind and Disposition, viz.: Restlessness, anxiety and uneasiness of mind and body, causing tossing and Sighing and frequent change of posture; forebodings, anticipations of evil, anguish of mind, dread of death and, even, distinct anticipations of its occurrence.

Turning now to consider the kind of cases in which Aconite is most likely to be indicated by the similarity of its symptoms, we cannot do better than carefully ponder Hahnemann's most excellent cautions, contained in the introduction to the proving of Aconite. “In order to banish from our conscientious mode of treatment all of that quackery which is only too glad, in selecting its remedy, to be guided by the name of the disease, we must take care, that, whenever we give Aconite, the chief symptoms of the malady, that is, of the acute disease, shall be such as are to be found in the strongest similarity among those of Aconite!”

This is the whole secret of a successful prescription of any drug under any circumstances, viz.: that whatever name we may choose to give to the patient's malady we shall select for its cure, that drug which presents symptoms most similar, not to those which we regard as pathognomonic of the disease so named, but to those of that very patient, at the time of the prescription. “Then,” as Hahnemann truly says, “then, is the result most wonderful.”

Hahnemann speaks of Aconite as likely to be of service “in those cases, viz.: in which medicine has hitherto employed the most dangerous methods; for example, copious blood-letting, the entire antiphlogistic apparatus - and, too often, in vain and with the saddest results. I mean the so-called inflammatory fever in which the smallest dose of Aconite makes the entire antipathic methods of treatment altogether superfluous, and helps quickly and without sequelae. In measles and miliary fever and in the inflammatory pleuritic fevers, its power to help approaches the marvelous, when, the patient being kept somewhat cool, Aconite is given alone, all other medicinal substances being carefully avoided, even including vegetable acids.” He then cautions us to avoid prescribing Aconite for a patient simply because we have given to his malady one of the above names, and enjoins us to be sure that the patient's symptoms closely correspond with those of Aconite.

“Exactly in those cases,” he proceeds, “in which Allopathy is most accustomed to regard herself as the only possible saviour, in severe, acute, inflammatory fevers, in which she resorts to copious and frequent bleedings and thereby imagines she far surpasses all homoeopathic treatment in the help she affords - exactly here, is she most in the wrong. Precisely in this, is the infinite superiority of Homoeopathy displayed; that she has no need to spill a drop of blood, that precious vital fluid (which the Allopaths so ruthlessly set streaming) in order to convert this dangerous fever into health again in just as many hours, as the Allopathist's life-exhausting treatment often requires months for a complete restoration; if indeed death shall not have rendered this impossible or if it have not been supplanted by artificially-produced chronic sequelae.”

“Sometimes,” Hahnemann observes, “after Aconite has acted for several hours, a change in the symptoms may call for some other remedy; and,” he adds,“ it is extremely seldom that, after this, a second dose of Aconite is called for.” It is manifest that the too frequent practice of giving in alternation repeated doses of Aconite and Belladonna, or Aconite and Bryonia, or Aconite and some other remedy, did not originate, and would not have found favor, with Hahnemann.

Hahnemann continues,“ in as short a time as four hours after the first dose of Aconite, thus carefully administered in the above-named diseases, all danger to life will have passed and the excited circulation will then, hour by hour, gradually return to its wonted course.”

“So, likewise, Aconite, in the above-named small dose, is the first and chief remedy in the inflammation of the trachea (croup); in several kinds of inflammation of the throat and fauces; as well as in local acute inflammations of all other parts, especially where, in conjunction with thirst and a rapid pulse there are present an anxious impatience, a restlessness not to be quieted, distress and an agonized tossing about.”

“Aconite produces all the morbid symptoms, the like of which are wont to appear in persons who have had a fright, combined with vexation; and for these symptoms it is the best remedy.”

“Always, in choosing Aconite, as the homoeopathic remedy, especial regard must be paid to the symptoms of the disposition and mind, for these, above all, must be similar.”

“Hence, Aconite is indispensable in women after fright and vexation, during menstruation, which, without this soothing remedy, is often instantaneously suppressed by such moral shocks.”

If we add to these practical directions of Hahnemann, the conclusions to which our analysis of the sphere of action of Aconite has led us, we shall begin to comprehend a large variety, at least, of the cases which call for Aconite.

As we have seen, Aconite, when given in moderate doses, excites the circulation, increases the heat of the surface and produces perspiration; it affects the innervation, producing extreme sensitiveness of the surface of the body to contact and the correlative sensation of tingling, etc.; in short an incomplete anaesthesia. But it does not alter (in kind) the function of any organ; nor does it set up any new action in any organ or tissue.

Aconite produces, so far as we know, almost no localized diseased condition.

Even when given in large and fatal doses, it acts as a depressant, paralyzing the cerebro-spinal nervous system; but it produces death by this paralysis and without previously localizing its action in any organ or system. It gives evidence of no dyscrasia. Its action bears no resemblance to that of the poison which produces any of the miasmatic diseases - such as the exanthemata, or typhus or intermittent, remittent or continued fevers. Neither does its action, from beginning to end of a fatal case of poisoning, resemble the well defined course of any local acute inflammation - as of the brain, heart, lungs, pleura, etc.

For these reasons, Aconite can never come into requisition (save possibly (?) as a rare and temporary intermittent in some complication) for any of the miasmatic fevers or dyscratic diseases; because, in these, the dyscrasia precedes and gives its features to the acute manifestations of the disease (and, therefore, the symptoms cannot find their analogue in those of Aconite).

Moreover, Aconite can never be the single remedy by the influence of which a patient may be safely carried through a complete course of pure, acute inflammation of any organ or system; because, in the action of Aconite, that localization is lacking which is the essential feature of these diseases. Yet in all of these pure inflammations, there is a period in which Aconite may be indicated and may do a heroic work. For every one of these inflammations which eventually become localized, has a first stage which consists of arterial excitement; and which is prior to that stage that is characterized by change of function and of tissue and by local deposit. This stage is that, in which Aconite plays so important a part and in which, if promptly and judiciously employed, it may arrest and cut short the entire disease.

It is to such a use of Aconite in acute inflammations that Hahnemann undoubtedly refers when he speaks of its ability to restore to health in a few hours, saying: “In as short a time as a few hours, after the first dose of Aconite, thus carefully administered * * all danger to life will have passed and the excited circulation will then, hour by hour, gradually return to its wonted course.” So rapid a change as this would be very possible and easily conceivable in the first stage of acute pneumonia before hepatization has taken place; whereas, after hepatization has become established, it would not become conceivable and we have no reason to suppose it ever takes place. Hence the propriety of Hahnemann's caution, in the following words: “sometimes after the Aconite has acted for several hours, a change in the symptoms may call for some other drug; and it is extremely seldom that, after this, a second dose of Aconite is called for.” Why? Because, probably, the inflammation has passed from the stage of arterial excitement to that of organic localization and Aconite no longer corresponds. And, probably, that very “change in the symptoms” which called “for some other drug,” was a sign that localization had taken place.

This view is in entire harmony with Hahnemann's urgent admonition to heed what he regarded as the great characteristic indication of Aconite: “the anguish of mind and body, the restlessness, the disquiet not to be allayed.” This state of mind and body accords precisely with the general phenomena of that arterial excitement which attends the invasion of an acute inflammation; while the localization of the inflammation and the occurrence of exudation are marked by a subsidence of this general anguish, symptoms of local organic embarrassment being substituted for it and the general constitutional symptoms being, rather, those of exhaustion and a depressed condition. Whoever has closely watched a number of cases of pneumonia through the first and second stages will, I think, corroborate these views.

Here, then, we have, again, an example of what the student of Materia Medica so often meets; the entire coincidence of the teachings of a sound pathology with the results of an intelligent and discriminating application of the law of the selection of the drug by the correspondence of characteristic symptoms!

Though it is always hazardous to undertake the illustration of a scientific point by a rhetorical simile, we may venture to liken the action of Aconite and cognate remedies to the onset and effects of a tempest. Whoever is familiar with the general character of North America from the Alleghanies to the Atlantic, must have had opportunity to overlook some fertile valley in the luxuriance of its midsummer vegetation. As he enjoys the prospect, the breeze subsides, and the sunlight becomes obscured. The cattle cease to graze; they move uneasily through the field and snuff the air as if in dread. Soon the incongruous swayings of the foliage in different parts of the valley make it evident that the air is agitated by varying eddies and currents. To the same cause are due the variations in the sounds of the murmur of the brook and the hum of insects, and the chitter of birds that are brought to the ear at successive moments. Clouds of dust rise from portions of the winding road and are born whirling along and upwards. The cattle become more and more uneasy - they rush wildly to and fro through the meadows. A sound as of rushing waters comes up the valley, with a blast of cool air having an odor of freshly cut herbage, or faintly ammoniacal; clouds of dust envelope the spectator; the tempest breaks upon him and for a time he realizes nothing but wild confusion, and the crash and roaring of the elements in unrestrained collision.

After a short time the winds abate; the atmosphere becomes clear and quiet prevails again. All things have resumed their normal state. Nature, animate and inanimate, has come to her former condition of repose. The violence of the tempest has swept past - to spend itself in permanent effects elsewhere.

This represents, well enough, the action of Aconite, which raises an arterial and nervous storm which, though, in fatal cases, its fury may be great enough to induce chaos, that is death, yet does not localize itself in organic changes. Or, if the tempest be considered as representing disease, then Aconite is a happy influence (we know of none such in inanimate nature) which turns aside its force and sends it to expend its energies in material changes elsewhere.

But, the tempest does not always pass thus lightly over the valley. It too often happens, that, when the calm that follows its outbreak, permits the spectator again to survey the region, he looks upon a scene wholly changed. Trees have been prostrated perhaps, and buildings overturned. The mill has been carried away, the dam has failed to resist the sudden increase of the stream; where was once a broad expanse of tranquil water is now an oozing waste, threaded by a narrow creek. The cattle are scattered and the crops destroyed. Havoc has been made and desolation reigns. The processes of nature still go on, but in every condition how changed!

This represents, in some sort, the action of drugs which, like Aconite, produce a storm of general vascular and nervous excitement, but which, unlike Aconite, produce, after this storm: as a sort of sequel of it, a definite localization of pathogenetic action, viz., changes of function and tissue!

Such a remedy is Bryonia, in its action on the lungs and pleura, and Belladonna, in its action on the brain and lungs; such indeed are most of our remedies. For there are few storms which do not make more or less of local havoc!

With a few disconnected remarks, we may close these desultory observations.

It is clear that Aconite may be given in acute inflammation of every organ of the body - but only in a certain stage of a certain form of inflammation. How shall we know when this stage and form are before us? When, in addition to whatever signs they may be which designate the organ which is affected, the symptoms which have been called characteristic of Aconite are present; the heat of surface or external cold and internal heat, thirst, quick, excited but not hard pulse, copious sweat with burning heat; and, above all, anguish and restlessness of mind and body, tossing which will not be quieted, foreboding and anticipations of death.

So, then, after all this talk, involving the terms and speculations of Pathology, the selection of the remedy comes down again to a comparison of symptoms!

Yes! for the sagacity of the Master led him to see clearly that the symptoms of the patient are the only facts of which we have Absolute Knowledge as concerns the patient; and the symptoms of the drug are the only facts that we absolutely know respecting it - and the relation in which they must be placed to neutralize each other, if it be found, must be such as to satisfy every sound hypothesis constructed on these facts. It must consequently harmonize with sound Pathology. And many times this volume of talk will have been well bestowed, if it shall convince any thoughtful mind that, first and most important stands, the correspondence of symptoms according to their rank, and that to this same result all sound hypothesis must lead.

___the purpose, as is often alleged, of “controlling fever.” I___

Aconite should never be alternated with other drugs for the fever be such as to require Aconite, no other drug is needed. If other drugs seem indicated, one should be sought which meets the fever, as well; for many drugs, besides Aconite, produce “fever” each after his kind.

Aconite may be called for, if the symptoms correspond, in the first stage of every acute inflammation.

It is a remedy of unspeakable value in a vast many cases of acute hemoptysis, which present the general symptoms as above detailed, characteristic of Aconite, and yet the pathological origin of which and their ultimate nature, if not controlled, are involved in obscurity. The blood is florid. (Spitting of florid blood, without the restless anguish of Aconite, calls for Millefolium.)

Aconite should never be given “to save time” while the physician goes home to study up the case. This is slovenly practice; it were better to give nothing, because Aconite, if given in a case which does not call for it may do mischief: as, for example, in the commencement of typhoid fever, in which it will unfavorably influence the entire course of the disease.

Notwithstanding this fact, so wide-spread has the notion become, that “Aconite is the remedy for fever” that the Allopaths have adopted and are now using it, as the stock remedy for typhoid fever in Bellevue Hospital (1864). The death rate does not lessen.

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