Aconitum napellus, monkshood, N.O. Ranunculaceae. A tincture is made from the whole plant (fresh if possible) in the spring time.
The physiological action of aconite (including its alkaloids) has received much attention and is decidedly complex.
A brief summary may be given to include the main points. (1) Massive doses rapidly produce death from paralysis of the cardiac and respiratory centres, time not being allowed for the development of effects produced by smaller doses.
(2) Smaller but still fatal quantities induce death preceded by irregular and slow pulse, laboured breathing, cyanosis, the pulse becoming feeble, imperceptible or very rapid as collapse comes on. Convulsions may arise. Sometimes the heart stops before the breathing. Arrhythmia passing on to fibrillation brings the circulation to a standstill.
(3) In still smaller amounts, burning in the mouth, throat, windpipe and stomach, and also in the skin, have time to attract notice; then tickling and pricking sensations occur soon to be replaced by diminished sensation-numbness of skin. The pricking and numbness are diagnostic, occurring only from aconitine and veratrine. Symptoms narrated above come on with weakness, cold sweat and nausea, with which is quickening of the pulse. Consciousness is not usually affected. When mental symptoms arise they are secondary to the physical effects of the poison.
Reflex symptoms occur, such as salivation, coughing, sneezing and vomiting.
(4) In substantial remedial doses, the pulse may be quickened; the slowing alluded to above is due to stimulation of the vagus, but smaller remedial doses seem to leave the heart unaffected.
Temperature is lowered by these doses, whether already raised or not. Perspiration, usually cold, is part of the nausea, or of the collapse of poisonous doses not due to independent sudorific action.
It will be noticed that very few of the effects of these material doses are utilizable therapeutically. The numbing effect on the sensory nerves of the skin is made use of in some cutaneous neuralgia-an ointment of one or two percent being used. As an antiseptic in physiological (antipathic) doses it is dangerous.
Pyrexia.-The question as to whether aconite produces fever has been much discussed. In the doses employed in ordinary laboratory experiments it does not. In the provings evidence that it does so is not abundant. Seeing that many of the provings were made before the clinical thermometer came into general use it may. Have been impossible to prove small rises, but it is equally impossible to disprove them. Some of the subjective effects can hardly be interpreted otherwise than as supporting the belief that aconite actually does induce a mild and transient but very uncomfortable febrile reaction. Associated symptoms of various kinds go with pyrexia and it was in cases where these symptoms corresponded with those of febrile cases that Hahnemann first administered his small doses of aconite and found that amongst the benefits induced, a reduction of the fever was one.
Sixty years ago and subsequently until the time of Ringer, aconite was abandoned as an antifebrile remedy on account of its dangerous effects, mainly on the circulation. Ringer reinstated it by adopting very small doses.
It has again fallen into disuse by orthodox medicine, partly it would seem, because the stigma of homoeopathy and its use in domestic practice attaches to it, and probably still more because, without the guidance of the rule of similars in its selection, its general use as an antipyretic has led to many disappointments.
The clinical sphere of aconite is well defined and decidedly limited, although there are within that sphere daily instances of its value.
It is more frequently useful in a certain type of febrile affections than in any other class of cases. The kind of fever calling for its use is that due to a mild infection against which the patient can make a good reaction. Thus it is most useful in healthy well-set up subjects, especially children and young adults whose vitality has been temporarily lowered by some agent such as a dry cold wind, notably if aching on a perspiring skin, or cold due to premature changes of garments; or by depressing emotions, serious bad news, fear or the like. Causes such as these lay the victim open to the influence of some microbe resulting in a complex of symptoms known as “a chill,” “simple fever,” “influenza” or some more specific disorder according to the prevalent micro-organism.
The features of such a febrile condition usually ephemeral, are chilliness or definite shivering, sensation or “cold chills” or cold water” up the back or else where: cold surface with or without “goes-skin,”headache, aching of the limbs, possibly sneezing and coryza, with a temperature already beginning to rise. The chills” soon give place to heat dry heat of face and body or heat alternating with chills, or even chills persisting in the midst of the heat, hard rapid pulse and fever.
In some cases the patient will experience the other symptoms so constantly (and correctly) recited as calling for aconite. They are “nervousness,” restlessness of body and mind, anxiety and fear. This anxiety will most often be lest the patients affairs are likely to be upset by an illness, lest he should not be able to fulfil an important engagement; or he may be kept awake turning these matters over in his mind and arranging how to circumvent them. He may have a fear of some impending misfortune connected or not with his illness; or there may be a definite fear of death not so much of the act of dying as of the upheaval of his plans, and the distress of his survivors. Patients, it is said, may predict the hour of their death and approach it with increasing alarm.
The minor degrees of restlessness and “anxiety” are common features of chills with a raised temperature; the extreme degrees just quoted are rare and are due to some inherent mental sensitiveness of the patient, rather than to the severity or specificity of the infection. In any case it is not necessary to wait for the development of the extreme mental symptoms emphasized as characteristic of aconite before prescribing it as a remedy.
Aconite is stated to be a short-acting drug. We do not know the length of action of a single poisonous dose that will depend partly on its size as do the phenomena induced. Clinically it is more useful to recognize that aconite is a superficially acting remedy than to regard it as of short action, for shortness could be made up by repetition. It is of short action as a homoeopathic remedy because the stage of an illness corresponding to the condition induced by aconite is short.
Aconite therefore may follow a mild general infection to its termination and may modify the initial stage of some more deep or specific infections, but a rule it still not follow to its focus or foci a disease which has become localized. It would be a waste of time to continue it as a homoeopathic remedy and it would be worse than useless it would be dangerous practice to give it as an antifebrile (antiphlogistic”) drug in antipathic (“physiological”) doses. The summary of the pharmacology of aconite give at the commencement of this article shows that in such doses it reduces temperature by reducing vitality through its action on the respiratory and circulatory centres.
A FEW EXCEPTIONS must be made to the above safe statement in those cases where aconite seems to possess a superficial and transient local action as well as the general erethistic one described. It has a congestive and irritative action on the ocular and respiratory mucous membranes. On the conjunctiva it produces vascular injection, dryness smarting, pricking with little or no discharge and with aching in one or both globes, worse on moving the eyes. Dread of light is common and swelling of conjunctiva (chemosis) is said to occur at any rate it will not contra-indicate aconite if other features of the case suggest
Respiratory system.Coryza, sneezing, a short, dry croupy cough with tickling in the nose and throat, shooting pains in the chest, pains in the ribs, sharp pains on breathing a sense of constriction in the larynx and chest one or both sides-indicate its local effects in the respiratory sphere. They denote an irritation of the mucous tract from the eye to the bronchial tubes.
Conformably with its power to influence these areas it may be useful in the early stages of measles, with its red eyes, sneezing dry or croupy cough. all these are present before the rash appears, and it is during this stage that aconite may be continued longer in measles than in most of the other zymotic diseases. It does not produce an eruption resembling the measles rash, nor does it cause bronchitis, broncho-pneumonia, or otorrhoea, so that its usefulness does not extend to these complications.
For non-diphtherial laryngitis (due to exposure to cold wind or cold draughts) with or without spasm of the vocal cords (“croupy or crowing breathing), aconite is an early and very valuable drug, usually cutting the condition short, relaxing the spasm, removing the distressing dyspnoea and strained anxious expression, &c., reducing the temperature, and ending the attack with free sweating and comfortable sleep.
Before leaving the respiratory system reference must be made to its use in pleurisy. It has been employed in the early stages on account of the sharp pain it produces in the chest, aggravated on inspiration and more especially by breathing cold air. In the days when a rheumatic pleurisy was described it was this variety for which aconite was exhibited. There does not appear to be much evidence that inflammation of the pleura is induced by drug, although the lungs have been found congested in cases of poisoning and there is some evidence that the endothelium of the mitral and tricuspid valves are thickened by prolonged slow poisoning. In tuberculous pleurisy or the acute septic (pneumococcic and streptococcic) varieties (e.g., after operations) aconite is not likely to be of use, save as a palliative.
In the early stages of endocarditis and pericarditis its use would be indicated by the mental and bodily symptoms first described. There is on record one case of ulcerative endocarditis cured by it.
On the nervous system, as already stated, the drug in large doses has a paralysing effect. Quite small doses develop a stimulating or irritant effect, shown by twitching of muscles, spasms in a variety of situations (the vocal cords have been referred to), trismus, stiffness and cramps in the back sometimes approaching opisthotonos, and cramps in the lower limbs. Administered early in acute anterior poliomyelitis aconite will lessen the area of the cord involved.
General convulsions in children, as during dentition, and in other sensitive subjects, may be relieved by the drug, but only when the general erethistic condition coexists. The paralysing effects are due to massive doses.
The provers of aconite experienced variety of shooting pains, tingling, numbness and burning, together with surface tenderness more or less general, the stress falling on the trigeminal nerve (of either side), on the intercostals and the sciatic nerve, suggesting neuritis. If such pains have been induced by cold in otherwise healthy subjects aconite will be of prompt assistance.
Muscular pains, frequently described as rheumatic, are even more common and more general. They may be burning, shooting, aching, bruised in character, or merely evidenced by stiffness. They occur more often on the left side-neck, chest, dorsal and lumbar muscles, sacral and hip-joints, shoulders, forearms, &c. The right side, however, by no means wholly escapes, even in the same regions. Movement is usually distasteful-whether walking, writing or otherwise using the part. In some cases of stiffness and weakness stronger movement brings relief. These muscular and articular pains, plus the sweats produced by aconite, have led to its use in acute rheumatism(rheumatic fever) with indifferent results. As a palliative to the restlessness and distress produced by the pain it may have a useful place.
Head.-As is usual with febrile conditions headache is common in cases requiring aconite. There are so many varieties that they are scarcely useful as indications, but some varieties are more frequently found than others. The so-called pressive or compressive headaches in which the head feels as if tied up with a string or compressed with a tight hat or band, is common. Throbbing and shooting are common. The forehead is the chief seat of any of the pains, especially outwards-pressure pain. Unilateral headache, e.g, in one temple, is frequent, especially on the left side. Heat of head, throbbing, a flushed face and tenderness of scalp, all may be found. Stooping and walking in the open air aggravate, and sitting relieves. Headaches with high-tension pulse and flushed face due to exposure to the heat of the sun may call for aconite-compare the symptoms. For sunstroke other remedies will be required. Sudden earache from dry cold winds generally requires aconite.
Epistaxis may occur, especially with high blood pressure.
Digestive disturbances are not prominent. Nausea, aching or pressure in the epigastrium or in the region of the liver, colicky pain in the hypogastrium aching and shooting in the rectum or anus, may occur and do not contra-indicate aconite. It is very serviceable in colic, diarrhoea and even dysentery brought on by exposure to wet and to cold winds, and if given early in the attack will abort it, or greatly modify its severity.
Bladder: Urging to urinate, with or without dysuria, is a common symptom. Rigors after passing catheters or sounds are checked by aconite or may be prevented.
(1) SIMPLE FEVER: Chills followed by or alternating with heat: shivering on every movement; full; hard pulse and palpitation. Ordinary fever symptoms, but especially if accompanied by certain-
(2) MENTAL AND NERVOUS SYMPTOMS : Restlessness of mind and body, tossing about, anxiety, nervousness, apprehensiveness. FEARS: fear of death, predicting the day; anxious, horrified facies. In the initial stage or independently of fever, fear of being in a crowd or crossing a street. Feeling of being in a hurry; ailments from fright.
ALTERNATION of moods with other symptoms.
(3) Hypersensitiveness: to pain (screaming and desperation), all ailments seem severe; to noises, especially to music, to smells; and, if crossed, with the highly strung condition, and high-tension pulse haemorrhages may occur, e.g, nose, lungs, &c.
(4) Muscular twitchings, even convulsions (children).
(5) Pressing pains in small spots, as if pressed either outwards or inwards, as with a finger.
(6) Aconite is useful for suddenly suppressed sweat, coryza, menstruation or other secretions.
(7) Hoarse and croupy coughs.
(8) Vertigo: Sudden giddiness or faintness on assuming the erect posture.
(9) DREAMS: Confused, nightmares; long dreams on a single subject, haunting prover when awake.
(10) Craving for bitter, pungent things.
(11) Dark-complexioned plethoric persons of firm muscular habit are especially sensitive to the influence of aconite.
From Movement, especially walking (muscular and rheumatic pains, teeth); breathing cold air or tobacco smoke (cough); touch and pressure, lying on painful parts; sudden or periodical aggravations of various symptoms; general aggravation at night; from dry cold winds, cold draughts (neuralgia); heat of sun (headache); hot weather (intestinal).
Perspiration, lying in bed and especially by lying on the back.
ACONITE is of interest to the student of or inquirer into homoeopathy. In physiological doses it is of little use except as a local application in neuralgias, and there are many sedatives and palliatives superior to it.
As a febrifuge its field has been defined by the application of the law of similars, and where that rule is not applied disappointment follows.
Experimentation with it in repeated small and infinitesimal doses has brought out the finer points of its action, which points serve as indications for its use remedially. These points are not brought out by experiments with massive doses.
A short testing of the remedy on these lines in general practice will soon establish its reputation and incidentally will furnish an important item of evidence of the validity of the homoeopathic rule.