Closely related to Veratrum Album, but of a fairly wider range of action, is Aconite, the physiological qualities of which I must suppose you are sufficiently acquainted with. Aconite is no haematic poison; it is so far inferior to Arsenic and even to Cuprum. It resembles in this respect Camphor and Veratrum. As a tissue irritant, its sphere of action goes as far as that of Arsenic; but it is in this respect far less destructive in its effect than Arsenic. The irritation set up by it tends towards catarrhal inflammation only, and the condition of the subject thus affected, maintains its ethenic character, while arsenical poisoning is invariably associated with an adynamic type. It irritates not only muscular tissue like Veratrum, but almost any tissue of the human frame, nerve tissue included. As such it may even produce violent tetanic convulsions, such convulsions being most likely associated with a rise of temperature. Of all these physiological effects we can hardly make use in the treatment of cholera. But over and above its poisonous effects as a tissue irritant it is a depressor of nerve-function, especially of the sympathetic nervous system; and when the toxic dose has been so large as to induce nerve-depression to its utmost, there is hardly room left for nerve tissue irritation, and the picture represented by the patient is that of total collapse, as described before, when speaking of Veratrum. But in Aconite it is not only the muscular tissue of the heart which is threatened with paralysis, but also its ganglia and nerves. Meantime Aconite appears to depress in a similar way the central nervous system.
Wherever, therefore, there is reason to believe that we re dealing with a paralytic form of cholera, brought on by depressing influences, otherwise than mere bodily fatigue, we shall derive far greater benefit, at the first onset of the disease, from the administration of a few doses of Aconite in rapid succession, than from Veratrum. We use in such cases the lowest dilutions of Aconite: a drop of the mother tincture in bout 3 or 4 ounces of water, of which teaspoonful is given every five or ten minutes. Aconite in such cases should be used in the same way as Camphor in the spasmodic variety of cholera till the patient feels relieved, or so long as there is no vomiting, no purging. Often the first dejections in cholera are more or less bilious; when such is the case, we may still go on with the administration of Aconite. Should the evacuations, however, in spite off our efforts to check them, go on increasing, assuming at the same time the choleraic character, then we may recur to Veratrum. Anyhow, the threatening cardiac and vaso-motor paralysis must here, from the very beginning, occupy our chief attention.
The gastric and intestinal irritation set up in the course of the evacuation period may bring on spasms of the severest kind; and the superficial observer might be inclined to consider the case as a variety of spasmodic cholera, while a single stethoscopic examination would reveal to us, often to our great surprise, that the heart’s action is weak out of all proportion to the stage patient is in. Cuprum is often here of great service; it not only ministers to the spasms but also to the heart. This is, however, not always the case. sometimes it would appear, as if muscular spasms go hand in hand with the gradual sinking of the heart. And here it is where Cuprum Arsenicosum will do more for us, than any of its components could ever achieve singly.
Of the further use of Aconite in the collapse of cholera, I intend speaking in my next lecture.
If a leaf or a small scraping of the root be chewed, writes Dr. Phillips, a sensation of numbness is quickly produced upon the lips and tongue, and this effect is still perceived after the lapse of many hours. A quantity sufficient to cause death, if received into the stomach, produces pungent heat in the palate and fauces, accompanied by a sensation of burning in the stomach itself. To these sensations are soon added a condition of painful numbness, which pervades the limbs, to the fingers and toes, and general tremor of the whole body. Severe vomiting, attended by pain in the abdomen, quickly follows, and along with it, an intermittent, weak, and irregular action of the heart. There is then an approach to suffocation, with great anxiety, restlessness and vertigo; the limbs become cold and clammy, the pulse is more and more irregular, and death soon puts an end to the patients sufferings. Neither convulsions, spasms, stupor, nor delirium can be reckoned upon as certain, though it is true that in several recorded cases one or more of these phenomena have been manifested, and it frequently happens that after full and poisonous doses the mind remains unclouded to the last.
From a large number of experiments on both cold and warm blooded animals, the following conclusions are drawn by Dr. Ascharumow:(* Virchow’s Archiv, 1866, p. 255*).
1.Aconite produces death from asphyxia by cardiac paralysis.
2.The medulla oblongata is, in the first place stimulated, the vagi are thereby affected in a similar manner, and this stimulation is succeeded by paralysis of these organs. Accordingly, Aconite primarily produces slowing of heart’s action, with spasmodic contraction of the arteries, and secondarily frequent beats of the heart, with dilatation of the arterioles and capillaries, in other words, vaso-motor paralysis. It has been observed, that under the influence of Aconite, the impulse of the heart is always weak, whether its action is quick or slow. The hard, strong pulse of Aconite, of which we hear so much in our school, as a homoeopathic indication of the drug in febrile disorders, is the pulse of reaction occurring in Aconite patients who are about to recover from the depressing action of the poison. The invariably weakening effect of the drug upon the heart’s impulse, is ascribed to its paralyzing effect upon the cardiac ganglia. So far Aconite distinguishes itself from Camphor, Hydrocyanic Acid and Arsenic; under the influence of all these poison, the heart’s impulse is primarily so much the stronger, the lower its beats. Such is also the case at the first stage of the spasmodic variety of cholera. It is, therefore, that Aconite is hardly indicated in that variety, although contraction of the arterioles and capillaries is a prominent toxic effect of that drug. Such a contraction often follows exposure to cold, or sudden inhalation of cold air, and may, under certain physiological conditions, combined with such influences as are known to be active during an epidemic, gives rise, either to a sudden choleraic attack of the type so often mentioned in this lecture or to a diarrhoea, which may ultimately lead to it. Aconite, in such cases may be just as useful, as we have seen Camphor to be in choleraic attacks of the spasmodic variety, and in the diarrhoea preceding them.
I cannot close this lecture on the paralytic variety of cholera without making mention of Nicotine, a drug which has altogether been neglected in our Materia Medica. The neglect chiefly arises, I Presume, from the fact that almost every body smokes tobacco. Under such circumstances it is supposed.. Nicotine would be quite inactive. We use, however, Coffea, in attenuation, with good effect in coffee drinkers. Hence there is then no reason why we should, on the ground before mentioned, discard Nicotine, without even submitting it to a therapeutic trial. There are besides women and children who do not smoke, and they represent at least three quarters of the number of our patients. Moreover recent researches have rendered it more than probable, that tobacco smoke owes very little of its potency to Nicotine; it is to the combustion products of the tobacco leaves, of which Pyridine is the most powerful, that all the mischief arising from smoking is owing.(* It is to be regretted that Allen in his Encyclopaedia of Pure Materia Medica, article Tabacum, has mixed up the effects of he drug as such, and those arising from smoking it.*)
Taylor relates a case of a girl who in half an hour after the administration complained of faintness, and of feeling sick, and, in another half hour became quite collapsed, with cold sweats; she vomited, was slightly convulsed, and died in an hour and a half after the first reception of the poison into her system. On post-mortem examination the heart was found flaccid; neither stomach nor intestines presented an trace of inflammation.
The profound nausea and vomiting caused by tobacco, seem to be purely cerebral in their nature; the drug is so far not homoeopathic to an acute stage of paralytic cholera. The convulsions occurring under the influence of its toxic action seem to be spinal in their origin; this would gain be an unfavorable indication of the drug in the disease under consideration. But as a cardiac paralyzer, tobacco and so much the more its alkaloid, Nicotine, takes a foremost rank, and should certainly not be neglected in certain cases of cholera collapse. Here again I must reserve what I have to say on the subject to my next lecture. Dr. Vassili of Naples employed in 1888 a small balloon which he lined internally with a layer of gelatine containing cholera bacilli. He found, by drawing through this balloon, the smoke of from one to four cigars–the number of cigars required, depending on their strength in nicotine-the gelatine was completely sterilised. To which the Lancet (February 20th, 1892) rightly observes, that this is no reason why tobacco should be considered, even on theoretical ground, as a cholera prophylactic. There is a great difference between the sterilising of microbes in nutritive gelatine and in the human being. Sulphurous Acid is also an antiseptic, but still remains to be proved that London fogs and London smokes save the metropolis from zymotic diseases.
