An alkaloid contained in A. napellus, and also in all other species of Aconitum save the lycoctonum. The German and French preparations differ widely in strength, as seen in two of the cases of poisoning which follow; the former is amorphous, the later crystalline. What is commonly called “English Aconitine” is a secret preparation of Morson’s and is believed to be made from the A. ferox. The alkaloid most abundant in this plant differs somewhat from ordinary aconitine in chemical composition, and has been called “pseudo-aconitine;” and Schroff’s statement that the ferox causes much dyspnoea but no facial neuralgia is supported by the comparative results of the provings of Harley and Hottot respectively. The aconitine of Messrs. T and H. Smith, of Edinburgh, seems identical with that of Morson; but the preparation of the British Pharmacopoeia is made from the A. napellus, and would represent that of the French and German observers.
1. Dworzack. – Immediately after taking it, eructations and rumbling in bowels; head and face became suddenly warm; warmth extended over rest of body, was most intense in region of stomach, and was accompanied by sweat. Then arose peculiar drawing, pressing sensation in cheeks, upper jaws, forehead, in short through whole tract of trigeminus, increasing by degrees in intensity, through whole tract of trigeminus, increasing by degrees in intensity, alternating with actual pain, which, at first occasional and fugitive, finally became steady and severe. Pulse at beginning, coincidental with accession of warmth, was more frequent; but soon after sank below regular standard, was small, weak, and at times dicrotic. Pupil showed at first an unusual mobility, was at one movement greater, at another smaller, but finally became so much dilated that only a small ring of iris could be seen. Fulness of head becomes more marked; there sets in ringing in ears and feeling of pressure there, giddiness, and distraction. Flow of ideas is sluggish, long reflection impossible, and power of attention much impaired. After slightest mental exertion the head- and face-ache become very intense. There is a certain amount of relaxation in the limbs, and every muscular exertion-much amount of relaxation in the limbs, and every muscular exertion-such, for instance, as going upstairs-is accompanied by unusual fatigue and prostration, and by increase of pain in head and face. Flow of urine very much increased. As regards difference of symptoms according to different dosage, eructations, rumbling in bowels, drawing stretching feeling in trigeminal tract, and primary rise and subsequent fall of pulse, were always present. A dose of 0.004 gramme was always followed by heat, tightness, and pain in head, lasting only a few hours; while after 0.01 gramme the symptoms recurred the day following trial on any attempt at mental or bodily activity. After 0.02 and 0.03 grammes, pulse sank to two thirds of normal standard, and remained thus low for more than 24 hours, and for same length of time continued also pain in face and head, feeling of fatigue, weakness of memory, etc. Not until second day after experiment, when these doses were given, did condition become normal. (SCHROFF, Prager Viertelj, ii.) 2. HEINRICH.- 0.05 gramme. Taste disagreeable and disgustingly bitter; in 10 morning burning sensation on tip of tongue and on lips; pulse at first accelerated, but afterwards became slower, falling in 1.1/2 hours to 47-52; whole body warm, perspiration set in, head dull and heavy, and therewith exhaustion and weakness; crawling sensation in the face, and feeling as if epidermis were scaling off; on skin appeared red spots as if from punctures; pupils dilated, pain in head and face, roaring in ears, weakness of muscles, and difficulty of respiration. Eructations and rumblings in bowels did not set in till 2 hours after dose had been taken. After supper burning sensation all over mucous membrane of mouth. The head-and face- ache lasted all the evening, as did also the debility; sleep disturbed. Day after proving pain in head and face returned, together with forgetfulness and trembling of legs. Even from smaller doses these symptoms were constant, – acceleration of pulse at first and retardation afterwards, burning on tongue, and pain in face and head (particularly in the course the supra-orbital nerve). A dose of 0.01 gramme was followed besides by inclination to cough, cough with easy expectoration, dryness in throat, eructation and exhaustion. (Ibid.)
3. HOTTOT.- Effects (of preparation known by his name) on self and two others. 3a. When a. is applied to a sensitive part of skin, whether in solution in alcohol or as a pomade, it soon produces feeling of warmth, then of burning, accompanied with sharp pains and itchings; later on, one experiences weight and numbness in parts affected, they seem to be compressed by a heavy weight; at other times skin seems as though heaved up and contracted by muscles beneath; its colour is not modified; there is anaesthesia. These symptoms last several hours, sometimes a whole day; they are never followed by general disturbances. 3b. Almost immediately after taking 3 milligrammes internally one experiences all over buccal mucous membrane sensation of acridity and heat, which travels rapidly to throat an later to stomach. This feeling soon becomes more and more acute; there is burning and numbness of lips, tongue and pharynx; at same time occurs salivation, often very abundant. To these local effects general phenomena are soon super-added; one first experiences malaise, feebleness, weight about head; then nausea, frequent yawning, oppression, and very pronounced muscular enfeeblement. Pulse rise, but to a slight extent only. Skin is moist. One is sensible of creeping on various parts of the body, and more particularly on the face and extremities. After a variable space of time depression increases, there is headache, often darting pains in face, sometimes accompanied by vomiting. Muscular enfeeblement greater, creepings more palpable, especially during immobility; limbs are as though benumbed, face tense and swollen; pulse falls, respirations. Later on there is general prostration; bruised feeling in limbs; difficulty in grasping objects; the least effort exhausts, one feels enervated; respiration is slow and deep, pulse markedly lowered. Mind remains clear; rarely any tendency to sleep; pupils dilated, but far less energetically than by atropine, dilatation develops slowly and mostly ceases under influence of brilliant light. These symptoms last from 10 to 16 hours, little by little pulse rises, respiration becomes more free, strength rallies, suspended appetite revives, in a word everything gets into good order again. the symptoms which persist to the last are acridity of throat, weight about head, and prostration. 3c. Observation.- 8:30 a.m. Six granules of a. of 1/2 milligram each; pulse 68. 8:40. Feeling of heat in stomach. 8:50 General malaise, yawnings, eructations, turns of nausea. 9. Great heat of stomach; pulse 76; burning sensation at tip of tongue, general debility, muscular enfeeblement, turns of nausea. 9:10. Burning of lips, throat, and whole buccal mucous membrane. 9:15. Creeping in face and fore-arms; pulse 84. 9:30. Oppression, headache, feeling of acridity and burning of throat much more marked, salivation. 10. General depression, great muscular enfeeblement, sweats; pulse 68; turns of nausea, vomiting. 11. Creepings in face, which seems swollen and tense, also in fore- arms and hands, which are benumbed and heavy; pulse 60. 12. Breathing irksome; pain at temple and along course of supra orbital nerve abundant perspiration; pupil not dilated; burning sensation very painful in whole mouth and larynx; lips benumbed; abundant salivation, entire want of appetite, occasional nausea. 1 p.m. Same symptoms; complete prostration of strength, heavy gait, general enervation, slight tendency to sleep. 3 p.m. Head ache with constriction at the temples, pupil dilated, respiration difficult; pulse 52. 5 p.m. Same symptoms sensibility appears to diminish, especially in hands and cheeks; mind is clear, no drowsiness. 7 p.m. The symptoms appear to amend, the head clears, the creepings diminish, the depression is less; pulse 60. 8 p.m. There is marked improvement; respiration easier, acridity, dryness and burning of the throat less pronounced; there is, however, feebleness and general lassitude; pupil remains dilated; pulse 68. 8:30. Easy sleep without agitation or dreams. The following day on waking there remain no traces of the effects of
One notes in this observation that the irritant action of the a. upon the mucous membranes of the mouth and pharynx made itself felt only-gradually. This is owning to the fact that the a., having been conveyed directly into the stomach in the form of granules, could only exert its irritant action immediately; when, on the contrary, it is taken in solution, and is consequently in direct contact with the mucous membrane, its local effects make themselves felt almost instantly. (L’ Aconitine et ses effets, 1863.) 4. J. HARLEY. – Subject of following observations was a large but lethargic man, aged 54, lamed by chronic sciatica. Pupils were a little unequal; at a given light right was 1/8, 1.1/7. Pulse was 66, regular, of good volume and power; respiration 16 to 17. In order to test the value of the following observations, I watched the effect of complete rest of mind and body on the respiration and pulse during 2.1/2 hours as he sat still without once rising from his seat. After 1.1/4 hours pulse was 61, of initial volume and power, respirations 16; there was slight somnolency. After 2.1/2 hours pulse was 58, not changed appreciably in volume and power, and respirations were 15; pupils were unchanged. 4a. The 1/200th of a grain of a.,[ The pure crystalised aconitia of Mr. Morson, or of Messers. T. and H. Smith, of Edinburgh, was employed in every case.] taken by mouth at intervals of 3 days, always caused slight tingling in mouth and face, coming on with in 1 hour and lasting for 2 or 3 hours. On another occasion, after gr. 1/170, a faint glowing feeling in addition was perceptible throughout body, and there was a little somnolency. On another occasion, gr. 1/150 converted glowing feeling into a numbing glow-a comfortable feeling as if he were going off to sleep, and, if he did not move about, actual somnolency. These effects attained their maximum 2 hours after dose; he felt warmer while they continued, and there was at the time and afterwards some difficulty in voiding urine.
4b. Pulse being 66 and respirations 17, he took gr. 1/150, and did not rise from chair for 3 hours. After 40 morning, pulse 60, unchanged, respirations 17; somnolency coming on. After 1.1/4 hours, pulse 58, unchanged; respirations 16; pupils unchanged. Had slept for 20 morning; a general glow pervaded body. After 3 hours pulse 56, unchanged unaffected by deep inspirations; respirations 16, regular. The glow and somnolency continued, and he had dozed several times; tongue and pupils unchanged, and he felt comfortable throughout.
4c. On another occasion, after sitting still for 1.1/2 hours, at the end of which time pulse was 60, respirations 17 to 16, I gave him gr. 1/100. After 1.1/4 hours pulse 54, unchanged in volume and power; tongue and pupils unchanged. After 3 hours pulse 52, of initial volume and power; respirations 16, natural; pupils very slightly dilated (?). He felt warm and dozed much after the medicine.
4d. He then took gr. 1/5 0 repeatedly, at intervals of 3 days, at 9 a.m. The effects were uniform. The medicine “upset him” very much all days; he felt languid and sleepy; could not hold his head up or keep his days; he felt languid and sleepy; could not hold his head up or keep his eyes open. He was giddy, and could not walk across room without help; vision was hazy; erect position induced nausea. He could not eat much on the medicine days on account of a difficulty of swallowing and a pain in back of neck and behind jaws in parotid region, so that in eating he had to press back of neck with hand. A glowing, tingling feeling pervaded the body, and there was a burning feeling in the gullet, as if a hot coal were there. The tingling in mouth and face came on within 1/2 hours, the somnolency after 1.1/2 or 2 hours. At first he slept for 1 hour, but afterwards sleep was dreamy and broken. Giddiness, dimness of vision and muscular weakness were most marked within 6th and 10th hours. There was always some dysuria, and occasionally retention wit hypogastric pain. Nausea was generally a prominent symptom, and pain in neck often remained until next day.
I kept him under observation for 3 hours after one dose, but could detect no appreciable effect on either pulse, pupils, or breathing. At the end of this time pulse was 60, of good volume and power, a trifle more compressible perhaps than before the dose; but this will always be found the case after a long rest of mind and body, and with a tendency to sleep. The respiration 17, regular and easy; tongue and pupils unchanged.
4e. These observations were repeated on two other adult males with uniform results. Doses ranging from gr. 1/75 to gr. 1/50 always produce decided aconitism, general numbness and tingling, but most marked in face and throat; nausea, giddiness, somnolency, and muscular weakness. This latter is always a prominent effect, and strongly resembles the condition induced by hemlock.
4f. F. G.-, aged 12, a well-developed boy, affected with epilepsy. The 1/100th of a grain given repeatedly at intervals of 3 days produced following effects:
After 3/4 hour tingling pricking sensation running up legs to spine and head, and tingling of fingers; much giddiness and somnolency, but sleep disturbed by frequent awakings. After 2 hours unable to walk or even stand without great exertion, and on rising from recumbent posture was unable to see for a morning, and there was nausea. The effects lasted for 7 or 8 hours, after which he slept quite comfortably, and felt quite well the next day. I was unable to discover any influence on the breathing, pulse, pupils, or tongue, nor was there any diminution of temperature.
This observation was repeated with uniform results on another boy, aged 9. (St. Thomas’s Hosp. Reports, v. 146.)
5. Reil dissolved gr. 1.3/6 in 200 drops of alcohol, and took from 5 to 30 drops (gr. 1/25 to 1/4), diluted with water, in gradually increasing doses. He experienced feeling of fulness in cheeks and temples, which by degrees was exchanged for a painful sense of tension, formication, and prickling; the temples throbbed, the head ached, the yes felt strained, the pupils were dilated, the sight was obscure, there was oppressed and sighing breathing, ringing in the ears, and increased urination, and, for 3 days following, nocturnal pollutions to which the experimenter was not accustomed. (STILLE, Mat. Medorrhinum, ii. 311) [ Referred to ‘Mat. Medorrhinum d. rein. chem Pflanzenstoffe,’ p. 26, but this work not accessible. EDS.].
1. A gentleman took gr. 2.1/2. He must have fallen almost immediately, and struck his head against the furniture; either the poison or the blow must have caused violent vomiting, as the floor of his room was found flooded with vomited matter; in 8 hours; patient was fearfully collapsed, skin cold, sweating, and quite pale; heart’s action almost imperceptible; pupils acted; no paralysis; intellect unimpaired; he suffered from severe vomiting matter; in 8 hours patient was fearfully collapsed, skin cold, sweating, and quite pale; heart’s action almost imperceptible pupils acted; no paralysis; intellect unimpaired; he suffered from severe vomiting, which recurred every 2 or 3 morning, and was performed by a sudden jerking action of abdominal muscles, accompanied by a loud shout, probably dependent upon a sudden contraction of the diaphragm. Every attempt to swallow was followed by the spasmodic contractions so characteristic of hydrophobia, but they were not renewed by the sight of water. All these convulsive movements, however, were easily excited by simply touching him. Stimulants with opium were administered. He passed the night in spasms and exhaustion, but his intellect was perfect, even vivid; after a hard struggle seemed out of danger next day. (Golding Bird, Lancet, January first, 1848.)
2. H. L.-, labourer, was given for a periodical hemicrania (he being otherwise well), a solution of nitrate of a. in tincture of chenopodium, which he was to take in increasing doses. 2a. March 14th, at 7 p.m., took 5 drops (=0.0004). Complained immediately of constricting and burning sensation extending from mouth to stomach. Feeling chilly, went to bed. At 9 p.m. took 20 drops, and experienced same sensation more severely. 15 morning later felt very sick and complained of fear that he would die; ice-cold sensation creeps up from his feet; in praecordial region an oppressive anguish, and excessive bitter and burning anguish in throat. His whole body is bedewed with a cold, clammy sweat; he cannot see any more; is dizzy and deaf. 15 morning later he vomited copiously, with gradual decrease of all the symptoms, and sleep followed. During whole time felt fearfully exhausted as if paralysed, with great difficulty of breathing. His wife says that his breathing was audibly rattling, but that consciousness was undisturbed. No urination during night nor any inclination thereto. Next morning felt tolerably well, and took a cup of coffee and an egg without any inclination to vomit. At 8 a.m. took 20 drops, and shortly afterwards the same symptoms reappeared. He grew cold, had sensation of anguish in praecordial and gastric region, breathing oppressed, was deaf and blind, and felt great malaise. His wife says that twitchings and spasms over whole body set in, especially in face. 20 morning after taking dose spontaneous vomiting occurred, with relief of all the symptoms.
2b. At 11 a.m. 20 drops; same symptoms. With every dose state during intervals, became worse. He felt continually weaker and more exhausted, with all energy lost, and sense as if paralysed. In the afternoon again 290 drops, with same result. Increasing constriction of mouth and fauces after doses. At 9:30 p.m. again 20 drops. Though medicine was always diluted with water, he drank now in extra quantity of cold water to prevent vomiting, and did not throw up dose. He went to bed, and soon fell asleep. Sleep restless, rather a slumber only. Between 11 and 12 he felt very sick, and called out, full of anguish; “So chilly, my chest, my chest, I feel awfully chilly, what shall I do? I am poisoned.” Now genuine convulsions in hands, arms and face set in. He was totally blind and deaf. His eyes were closed, his lips dry and fissured, his tongue stiff, he could not open his mouth, he felt chilly and as if dying; breathing became rattling and moaning, quick. More severe convulsions alternated with quieter intervals. Draughts of strong hot tea were given half-hourly. His taste was entirely gone, so that he did not know whether the tea was hot or cold. 5 morning after drinking vomited copiously, with great rattling in chest. All this time he remained perfectly conscious. About 15 morning after having vomited felt some relief. With every subsequent vomiting, aided by copious draughts of hot tea, amelioration increased and chest felt more free. The symptoms gradually abated, and for an hour he enjoyed a quiet sleep with easy respiration. On waking he complained only of weakness. He passed no urine during the night, though he tried to do so towards morning.
2c. During 16th felt moderately well, but for pressure on chest, and sense of fatigue. At 66 p.m. 10 drops only. Immediately lost all taste; burning in mouth and stomach returned; felt chilly- in short, all the symptoms returned only in a more moderate degree, till vomiting 15-20 morning afterwards again brought relief. No more medicine.
2d. L- further affirms that he felt during the intoxication a heaviness as of lead all over the body, always relieved by vomiting. During entire poisoning his colour was cadaverous. On 17th still complained of burning constricting sensation in mouth and fauces, his taste altered, and his vision unusual. A few days later complained of unwonted difficulty of breathing; his taste is not as good as usual, and the teeth are more sensitive when biting. the urine also usual, and the teeth are more sensitive when biting. The urine also passes only in drops, and less easily. No more hemicrania. (BUSCHER, in Berl. klin. Wochenschrift, 1880.)
3. Dr. Meyer, the physician who prescribed for the foregoing, drank 50 or 60 drops of the mixture in the wife’s presence to assure her of its harmlessness. It seems that the alkaloid used was Petit’s, which is 170 times stronger than Friedlander’s, the latter being intended by the prescriber. Hence his patient’s peril and his own death. He was found dead 5 hours after taking dose. At the autopsy 43 hours later, the body was strikingly pale and the jaws firmly closed.
Internal Examination. – Diaphragm on both sides reaches fifth rib; muscles of bright red colour when cut; momentum pale and anaemic; colon partly filled with gas, partly with solid and fluid contents, its colour pale, no injected vessels visible. Duodenum from below upwards more injected, of darker colour as t approaches stomach, but mucous membrane intact. Interior of stomach strongly hyperaemic and bright red from intense vascular injection. Spleen of twice its size, of dark, nearly black-red colour: incised it is full of blood, soft and friable. Liver enlarged, exterior smooth, dark posterior part nearly black: incised seen to be full of blood, but otherwise normal. Kidneys equally hyperaemic. The fluid contents of the abdominal cavity thin fluid and of bright cherry red colour. Right ventricle holds much bright red thin fluid blood; coronary arteries full of blood; in pericardium much bloody serous fluid. The very voluminous brain, even in its membranes, very hyperaemic: sinuses full of thin bright red blood. In hemispheres sub-arachnoid extravasations here and there. The grey substance of brain shows on surface of section small red blood points, the whose very hyperaemic, less so in the medullary substance. [ The post- mortem examination of the lad Malcolm John, poisoned with a. by Lamson in 1881, disclosed a precisely similar state of stomach, duodenum, liver, spleen and kidneys.-EDS.] (Ibid.)