Ambra Grisea

Ambra grisea is supposed to be a disease-product derived from the whale. It has a decided medicinal action, and, like all substances having a strong odor, it acts prominently upon the nervous system. Unless there are some nervous symptoms present in the case, you can hardly expect it to do good service. Ambra affects the cerebro-spinal nervous system, causing spasmodic symptoms here and there over the body.

The muscles of the face twitch. It may also be used in sleep- lessness arising from worriment of mind, as from business troubles. The patient may, in these cases, retire to bed feeling tolerably tired, yet as soon as his head touches the pillow he becomes wakeful. Such a case as that frequently yields to Ambra.

This remedy is particu- larly indicated in thin, spare men, who have a decidedly nervous tem- perament, in whom nervousness predominates at the expense of nutri- tion. It is particularly indicated for the nervous complaints of old people, especially when the}7 are forgetful and cannot remember the simplest facts. Vertigo comes on when the patient moves about, and the legs are unsteady; he totters when he walks. He has numbness of the feet and tingling in the limbs.

The limbs go to sleep readily. These symptoms show you that there is either functional or organic weakness of the cerebro-spinal nervous system. We may use the drug in cases of softening of the brain and spinal cord, whether of senile origin or not.

There is another use we may make of Ambra grisea. It is a very quick-acting remedy. We may, therefore, give it in nervous diseases when there is defective reaction. We have already learned of a similar use of Psori?ium; under the latter remedy, the defective reac- tion arises from constitutional taint. But under Ambra grisea it arises from nervous weakness. We find many such cases, particularly among men.

We may use Ambra for cough which is worse when strangers are in the room, or under any other circumstances which would tend to excite the nervous system. It is then a cough that is reflex from mental influences. In these cases, it is exactly similar to Phosphorus.

152 A CUNICAI, MATERIA MKDICA.

Ambra is also indicated for cough, whether whooping-cough or not, when the cough is followed by eructations of wind from the stomach. There are not many remedies that will cure this symptom. Ambra grisea is one of the best; others are Sulphuric acidy Ar?iica} Sangui- naria and Veratrum album. Sometimes the eructations come during the cough, which is usually a very annoying and painful symptom.

Here Ambra coincides with Arsenicum, Cimex, Lachesis and Angustura. We may use Ambra in asthma when it is accompanied by cardiac symptoms, oppression of breathing, and a feeling as of a load or lump in the left chest and fluttering in the region of the heart. This comes probably from a constrictive feeling there, not as if a hand were grasp- ing the heart, but as if something in the left side of the chest were squeezed up in a lump. It is usually accompanied by palpitation of the heart.

Ambra grisea acts markedly on the female genital organs, its action here being important and quite unique. It causes atony of the uterus. The menses are regular as to time or they come a few days too early, but they are very profuse, and are accompanied by nosebleed and by an increase in the varicose veins on the legs, if such a condition is present. There is a discharge of blood between the periods.

Any little excitement or extra effort, such as straining at stool, brings on a vaginal discharge of blood, showing how engorged is the uterus and how relaxed and weak the tissues. The leucorrhcea consists princi- pally of mucus, which has a bluish or bluish-gray tinge to it.

You may also use Ambra during the lying-in period, especially when constipation is severe. It is suited to those nervous women who are thin and scrawny-looking, who have frequent ineffectual urging to stool accompanied by great anxiety and restlessness, and inability to pass stool while the nurse or any one else is in the room.

LECTURE XIII.

SECALE CORNUTUM.

Secale cornutum is commonly called "spurred rye." Ergot, a term borrowed from the French, is the name of the drug in the old school pharmacopoeia. The drug is not obtained from the rye itself, but from a fungous growth which attacks the grain, probably when it is very young.

Secale cornutum, or Ergot, has long been used in the dominant school on account of its well-known property of producing contraction of non-striated muscular fibres when given in appreciable doses. It exerts this action particularly on those involuntary muscular fibres which have a circular or transverse direction. I believe that it does this through an influence exerted over the vaso-motor nerves, and that all its symptoms are explainable on this ground. In the first place, the effects of Secale may be divided into two sets, those referable to the circulation, and those referable directly to the nervous system.

We shall consider the last-named first. We find Ergot producing a peculiar type of convulsions, which constitute a prominent symptom of Ergotism, a condition of chronic poisoning produced by Ergot. Ergotism is not at all uncommon on the continent of Europe, especial- ly in some of the provinces of Germany, where the farmers grow a great deal of rye. Rye is the principal grain, and thus Ergot poison- ing is frequent.

Of late years, by exercising more care, the number of cases of Ergotism has lessened. Eet us now return from this little digression and describe the character of the convulsions.

At times the body is rigid and at others the rigidity alternates with relaxation; particularly is this noticed in the fingers. The hands are clenched, or the fingers are spread wide apart. The facial muscles twitch. Twitching commences in the face and spreads over the whole body.

The abdomen is drawn in by the contraction of the musculi recti abdominales. There is suppression of urine, and at the same time retention from spasmodic contraction of the neck of the bladder. By the use of the catheter a small amount of prune- juice-like fluid may be obtained. There is a great deal of spasmodic retching, but not much real vomiting.

The stomach is violently contracted.

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Coming now to the action of Secale on the circulation, we find that the symptoms referred to disordered circulation are traceable to the action of the drug on the involuntary muscular fibres of the blood- vessels. The first effect is one of contraction, while the secondary action produces a dilatation. The fingers look bluish-black, as though the blood had settled there. The skin is wrinkled and dry.

After a time sloughing of the whole or part of the limb results. Now, the explanation of this is as follows: there has been a prolonged contrac- tion of the capillaries, interfering with the circulation, and bringing about a stasis of blood. Thus local nutrition is deranged and the part in consequence dies. This action of Secale has led to its use in dry gangrene, especially of the toes in old people.

Coming next to the uterus as a muscular organ containing non- striated muscular fibres, we find that Ergot produces marked contrac- tion of this viscus, acting more on the pregnant than on the non-preg- nant uterus, more upon the uterus of parous than of nulliparous women. The more the uterine muscular fibres are multiplied the more powerful is the action of Ergot. What symptoms does the drug produce ? You know that it has been used to bring on contraction of the uterus, to cause abortion, to hasten the expulsion of the foetus when abortion is inevitable, to increase labor-pains, to expel the after- birth, and in fact whenever it is desirable to create uterine contrac- tions.

One of its characteristic symptoms is prolonged but ineffectual uterine pains. Another, which you will sometimes notice in cases of retained placenta, is hour-glass contraction of the uterus. This peculiar contraction prevents the expulsion of the placenta. You may remove the after-birth by the aid of the hand, but the safer plan is to give a few doses of Secale.

Secale may also be used in thin and scrawny women, with dry, harsh, shrivelled skins, and sallow faces, who are very weak in labor. The labor-pains seem to be entirely wanting. The uterus is as flabby as though it were merely mucous membrane, instead of a muscular organ. At other times the woman will complain of a sort of prolonged bearing down feeling in the abdomen and the sacral region.

Ergot affects the blood itself; it seems to lessen the coagulating function of that fluid. Hence it will cause haemorrhages, which are dark, thin and persistent; haemorrhage from the uterus or from any of the cavities of the body. You may give it in uterine haemorrhage when the flow is passive, dark in color and, it may be, offensive. The

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woman may be reduced to such an extent that she is almost exsangui- nated and lies unconscious and cold. Before losing consciousness she complains of tingling all over the body, and requests the attendants to rub her limbs. Formication is the best word to describe this tingling sensation under Secale. She constantly holds her fingers spread asunder. This symptom seems to bother her even more than the haemorrhage itself. In such cases Secale is the remedy.

Again, we may use Secale in retained placenta, when it arises, not from hour-glass contraction of the uterus (although this condition may obtain), but after miscarriage, especially that occurring during the early months of pregnancy. The discharge corresponding to the lochia is offensive. The patient is cold and often almost pulseless, from loss of blood; the uterine contractions are very imperfect, or else there is prolonged tonic contraction. In such cases, Secale is further indicated by its mental symptoms.

The patient has mania, during which she laughs, claps her hands over her head, in fact, seems to be beside herself.

Secale acts very prominently on the gastro-enteric organs. It pro- duces a picture very much like that of cholera, and will be found use- ful whether it be cholera infantum, cholera morbus, or cholera Asiatica. It is indicated when the patient is cold and almost pulse- less, with spasmodic twitching of the muscles in various parts of the body; the spreading asunder of the fingers is especially noticeable. The eyes are sunken, and the features pinched.

There is a great deal of spasmodic retching, although not much vomiting. The surface of the body is harsh, shrivelled, and dry, as though there were no moist- ure left in the system. The urine is suppressed. There is tingling or formication all over the body.

The stools are profuse and watery, and are ejected with great violence. The patient, though cold, cannot bear to be covered.

In cholera infantum Secale is indicated more particularly by profuse undigested stools, which are watery and very offensive, are discharged by fits and starts, and are followed by intense prostration. Now, Secale must be separated from the remedies that are similar to it, or you cannot use it to the best advantage.

It has been observed in the case of a manufactory in which sub- stances containing arsenic were made, that the fumes of the arsenic destroyed all the surrounding vegetation with the exception of the rye, which grew more luxuriantly under the fumes of this factory

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thau it did in other localities. When we come to study the medici- nal effects of Secale and Arsenicum we ,find that they have many symptoms in common. Both produce shrivelling of the tissues, both produce gangrene, both produce choleraic symptoms, and they follow each other well. The following few distinctions are sufficient: in the first place, the Arse?iicum gangrene and almost all of its other symptoms are worse from cold and better from warmth.

The patient wants to be wrapped up warmly. The Secale patient finds relief from cold. The same is true of ulcers. If you have an indolent ulcer, with burning pains and discharge of an ichorous offensive pus, you almost always think of Arsenicum.

Yet Secale is the remedy if there is relief from cold.

In cholera, both remedies have profuse, offensive, watery stools, which are very exhausting. Arsenicum lacks the tingling which is al- most always present when Secale is the remedy. Arsenicum has more restlessness, anxiety, anxious tossing about and irritability of fibre. The patient wants to be warmly wrapped, while the Secale patient wants to be cool.

During the stage of collapse, Secale is indicated by the symptoms I have mentioned. Here, it is very similar to Carbo veg. The latter remedy is indicated when the prostration is so great that the patient lies quiet, too weak to move, with passive haemorrhage from the nose, and, perhaps, from the bowels as well. The body is cold, especially from the feet to the knees. The pulse is rapid, almost threadlike, and the breath is cold. In such alarming cases Carbo veg. may sometimes save the patient's life.

Another similar remedy, Camphor, is to be used in preference to Secale, Arsenicum, or Carbo veg. in cholera, when the system is over- whelmed by the suddenness or violence of the poison, before there is any vomiting or diarrhoea, and when the prostration is intense and the body is as cold as ice. The voice is squeaky or husky. Camphor is here used in the mother tincture, a few drops in water, and a dose given every fifteen minutes until the reaction takes place, when some other remedy may be needed.

Veratrum album resembles Secale in the coldness and blueness of the surface, with profuse watery stools; but it differs in one symptom, namely, the cold sweat on the forehead. None of the remedies just mentioned have this symptom except Arsenicum, and under this remedy the restlessness is greater than under Veratrum, while the cold sweat on the forehead is less marked.

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In the uterine symptoms, haemorrhages, etc. , we have to remember some remedies that are closely allied to Secale. I may incidentally mention Carbo veg. here as a remedy similar to Secale in persistent epistaxis. The bleeding continues day after day, apparently not de- creasing in the least, the blood being dark and non-coagulable. You must distinguish between the two remedies by their other character- istic symptoms.

Ustilago is to be remembered as a companion of Secale. It is a fungus which grows on corn and is similar in action to Ergot. Care- ful chemical analysis shows that it contains Ergotin just as does Secale. Ustilago may be used in haemorrhages somewhat different in character from those of Secale.

The haemorrhages in which it is most effective are those from the uterus, when the flow is bright red, partly fluid, and partly clotted. With this condition present you may use Ustilago, whether the haemorrhage occur at the climaxis or during labor, abortion, or menstruation. Unlike Secale, this remedy causes passive congestion of the uterus. It is especially indicated when the slight manipulation necessary for a digital examination causes oozing of blood.

Another condition for which it is the remedy is menorrhagia from retroflexion of the uterus. I have generally used it in the sixth potency. It seems to give tone to the uterus, so that the organ no longer feels soft and spongy to the examining finger. The circula- tion through the uterus is improved, and bleeding takes place less readily.

We have two or three other remedies useful in these cases of en- gorged uterus, and as this condition is so difficult to cure I will give them to you here.

One of them is Bovista, the puff-ball. When this plant is mature, the envelope of the ball bursts, and there is ejected from the cavity a brownish powder, which consists of the spores of the plant. This, when applied to the skin, produces an eruption resembling herpes, which bleeds readily. Bovista affects the circulation in a very peculiar way.

It seems to produce a relaxation of the entire capillary system, but whether it acts through the blood or through the nervous system, I am unable to state. This relaxation of the capillaries favors the haemorrhagic diathesis. On account of this unique action of Bovista, we find it useful in epistaxis, associated either with menstrual irregu- larity, or with traumatism.

Bovista is indicated in uterine haemorrhage when the uterus is

I58 A CLINICAL MATERIA MEDICA.

engorged, particularly when there is a flow of blood between the men- strual periods from any little over-exertion. Here it is exactly like Ambra grisea, but the menstrual flow of Bovista occurs chiefly or only at night or early in the morning. It would seem that the exercise during the day, by favoring the circulation, tends to diminish the uterine congestion.

Haemorrhage when the uterus is engorged is also found under Ustilago and Secale.

Another peculiarity of Bovista, which I might mention here, is a puffy condition of the surface of the body. A lady, for instance, after holding her scissors, notices that a deep crease has been made in the thumb and finger by the instrument, showing that there is a slight ©edematous condition produced by the sluggish passage of the blood through the veins.

Bovista also produces some symptoms of suffocation. It is used, in some countries, to stupefy bees in order to facilitate the collection of honey. The symptoms of asphyxia are very much like those pro- duced by the fumes of charcoal, and Bovista has proved useful as an antidote to the effects of charcoal fumes.

Other antidotes to charcoal fumes are Arnica and Opium.

In addition to these symptoms of Bovista, you should remember another group, likewise dependent upon the circulation. The heart feels enormously large, with oppression of the chest and palpitation after a meal and during menstruation. Associated with the heart dis- ease, and also with deranged menses, is a headache deep in the brain, with a feeling as though the head were enormously large or swollen.

Mitchella repens may be used in cases of engorged uterus when the flow is more active than in the case of the remedies already mentioned. The blood is brighter in color, and the haemorrhage is associated with dysuria.

The next remedy that I want to mention as similar to Secale in haemorrhages is Trillium pendulum. This remedy is useful in an en- tirely different type of haemorrhage from that calling for the former. It is indicated when the flow of blood is bright red and profuse, and is attended by a faint feeling in the epigastrium, pain in the back, coldness of the extremities, prostration, and rapid, feeble pulse. It is more closely allied to Cinchona than to any of the remedies thus far mentioned.

It is indicated more by the active acute haemorrhage

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than by the chronic slow oozing calling for Secale. There is gushing of bright red blood at every least motion. She feels as though the sacro-iliac synchondroses were falling apart and wants the pelvis tightly bound.

Hamaynelis is likewise indicated in haemorrhage. It acts as you know principally upon the veins. It is called for when there is ham- mering headache, especially about the temples. Strange to say the patient exhibits no alarm or anxiety concerning the haemorrhage. The flow is dark and rather passive and there is a feeling of soreness in the affected part. The patient is greatly exhausted by the flow of blood.

Erigeron Canade7isis is indicated in haemorrhages from the uterus associated with painful urination. How can you distinguish it from Mitchella ? The Erigero?i haemorrhage comes in fits and starts; it comes with a sudden gush and then stops again.

Sometimes the cavity remaining after the extraction of a tooth bleeds persistently. If you can clean out that cavity so as to remove the clot, and apply to it a piece of cotton soaked in tincture of Tril- lium, you will often check the haemorrhage even when other styptics fail. I have never used Erigeron in that way and cannot, therefore, tell what effect it would have. I have used Trillium in the same way in nosebleed.

I would like to mention here Ferrum phosphoricum. It acts upon the circulation very much as does Hamamelis. It is an excellent remedy in that stage of inflammation which we describe as ' ' dilatation of the blood-vessels." If administered then, it prevents further ex- tension of the disease. Thus in engorgement of the lungs, it prevents the subsequent pneumonia.

The chest feels sore and bruised, the pulse is full and round, but not rope-like as under Aco?iite. The ex- pectoration is scanty and blood-streaked. Whenever the discharge contains blood and you have not the sthenic fever that belongs to Aconite, you may depend upon Ferrum phos. Sometimes in the sum- mer diarrhoea of children, the bloodvessels of the intestinal tract be- come greatly distended.

The stools are watery and contain mucus and blood. There may be a little urging to stool but no tenesmus. If tenesmus appears, Ferrum phos. ceases to be the remedy. If your case advances to the production of pus or muco-pus, Ferrum phos. can do no good.

You may also use Ferrum phos. in the beginning of hydrocephaloid,

l6o A CLINICAL MATERIA MEDICA.

when, during a violent attack of summer complaint, the child be- comes drowsy and heavy, its ej^es are suffused with blood, and there is a full, soft pulse. It has not the hard, tense pulse of Aconite or Bella- donna.

LECTURE XIV.

THE VEGETABLE KINGDOM.

I have now reviewed the majority of the medicines derived from the animal kingdom, and also the most important of the nosodes. We come next to the second grand division in natural history, the vege- table kingdom. The vegetable kingdom offers us many varieties of medicinal substances, some of great practical utility and others having but a limited sphere of usefulness. Drugs obtained from this king- dom owe their medicinal effects to the juices which they contain, or to certain properties which reside in the roots, flowers, or seeds.

The medicinal qualities of a plant may be obtained from various parts of it, and these qualities may vary with the part. It is said of Belladonna, for instance, that one part of the plant gives us more of the acrid quali- ties of the drug, while another gives us more of the narcotic properties. We must be careful then in making a proving of a vegetable drug, that we are certain of the part of the plant we are using; and in pub- lishing our proving, we should state whether the whole plant was used, or only a single part of it.

If but a single part was utilized, we should state accurately which part, as the root, the flowers, the seeds, etc.

A study of the vegetable kingdom involves to some extent a study of the mineral kingdom, because many of the medicinal properties of vegetable remedies owe their existence to substances derived from the minerals in the soil in which they grow. The principal effects of some of the grasses are the result of the large quantity of Silica they contain. Xinet3T-nine one-hundred ths of the effects of Lata-ocerasus come from its Hydrocyanic or Prussic acid, which is commonly classed with the inorganic compounds.

The same may be said of Amygdala persica. Now these substances derived from the mineral kingdom and contained in the vegetable kingdom, become more active in their new environment; that is to say, a given chemical substance, if made synthetically in the laboratory, would possess less marked medicinal virtues than if it were obtained from a plant. The above remarks also apply to the animal and vegetable kingdoms. Substances existing in the animal kingdom and found also in the vegetable, are far more ii

l62 A CUNICAI, MATERIA MEDICA.

active in the former. Thus the Colorado potato bug, which feeds on potato-plants and derives from thence Solanine, presents more power- fully the symptoms of the latter than does the Solanine itself.

We shall study the remedies derived from the vegetable kingdom ac- cording to the classification of botanists. There are some incongru- ities in the botany of to-day; for instance, in the leguminous order of plants from which we get peas and beans, which are very nutritious, is also placed the I^athyrus, which has very poisonous properties. Be- cause there is an outward resemblance between the Lathyrus and sweet-pea, it seems not a little incongruous to put them together, when their effects are so different.

The five relations of drugs, which I have already mentioned, apply here as in the animal kingdom. There is this to be remembered, that substances having the same origin generally do not follow each other well. For example, if you have given Ignatia, it is not well to follow it with Nux vomica, and vice versa, because they both contain Strych- nia. Though they have many symptoms in common, they act too much in the same line.

Another example may be noted in Glonoin and wine. When Glonoin was proved, it was found to have a decided action on the pulse. All the symptoms wrere aggravated when the pro vers took wine. Wine produces an excitement very similar to that of Glonoin, but its action seems to be in the same direction, conse- quently it intensifies the effects of the latter.

But the different orders, sub-orders and classes into which botanists divide plants are so extensive and cover such vague resemblances, that we cannot confine ourselves strictly to the above rule regarding the sequence of drugs. Take for instance the Ranunculaceae, from which we obtain Pulsatilla, Aconite, Helleborus, and Staphisagria . Now the resemblances between these four drugs are not so close that they cannot follow each other without injury. If we find, then, from our study of symptomatology of the drugs that there are no marked resemblances between them, the rule does not apply.

In the Anacardi- aceae the rule does not apply with regard to Anacardium and Rhus tox. These drugs bear a family resemblance, but their points of divergence are so great that one drug may act as an antidote to the other. The rule, however, does apply to Ignatia and Nux vomica, and to Pulsatilla Nuttalliana and Pulsatilla pratensis. I will now take up the consider- ation of the individual drugs derived from the vegetable kingdom.

THE VEGETABLE KINGDOM. 1 63

Apocynace^E.

In the order of Apocynacece there are a number of plants which we use as medicines. Among these may be mentioned Apocynum can- nabinum and androscsmifolium, Gelsemium sempervire?is , Vinca minor, Olea?ider, Nux vomica, Ignatia. Curare, Alstonia scholaris, and Spigelia. By some authorities Gelsemium, Nux vomica, Ignatia, Curare, and Spigelia have been included in another order, the Loganiace<z.

This order of plants is very poisonous; they depress the nervous system, causing prostration, and even narcosis and paralysis; some of them cause death.