Ranunculus Sceleratus

Today we have on the board the Ranunculacece , an order of plants containing many medicines. It receives its name from the different varieties of the buttercup. As a whole, the order seems to be char- acterized by acridity, and some of its members are slightly narcotic. From this order we obtain Aconite , Actea racemosa, Actea spicata, Radix coptidis, Ranunculus bulbosus, Ranunculus sceleratus, Hepatica, Pulsa- tilla, Hydrastis Canadensis, Clematis erecta, Staphisagria, Helleborus and Pceonia.

Staphisagria contains Delphinine. Hydrastis Can. when fresh is said to be narcotic as well as acid. It is used for its tonic action, and it is said to cause, when abused, symptoms like those of Sulphate of Quinine, such as tight feeling, buzzing and ringing in the ears and reduction of the pulse. The Clematis vitalba is so caustic that it has been used as a substitute for Cantharides.

Similar proper- ties belong to Clematis crispi, on which the Spanish flies feed with avidity. The Clematis viorna whose tough shoots are made into paper, is also vesicant. We shall have time to study only the principal members of this order, and first of all let us consider Aconite.

Aconitum Napki^us.

Aconitum napellus is the monkshood. Aconite itself means "without dust." The plant has been so named from the botanical fact that it

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grows on dry rocks, with scarcely enough earth about to enable it to take root. This shows the hardiness of the plant. It is called the monkshood because of the shape of the flowers, which turn over and give the appearance of a hood thrown over the head.

Aconitum napellus contains a crystalline alkaloid called Aconitine. It is found in largest quantity in the root. Several other active prin- ciples occur with it. They are of uncertain composition and are diffi- cult to isolate.

In fact, commercial Aconitiiie practically always contains some of these substances. Aconitine and its related active principles are found in differing proportions in many of the members of the order. Aconitic acid is said to occur in some of them combined with calcium. I have heard that some of the inhabitants of Persia dry the tops of the Aconitum ferox, and eat them with impunity.

I cannot say how true this is, but it is known that this species of Acoiiite con- tains Pseudo-aconiti?ie , which is less toxic than true Aco7iiti?ie. It is also asserted (this, too, I cannot vouch for) that, in some parts of Switzerland, Aconite is grown in rows along the streets, and the tops are cut off and used as greens. Perhaps this illustrates the fact that plants alter their properties under domestication.

When taken in poisonous doses, Aconite acts as a depressant to the cerebro-spinal nervous system. It produces a sensation of numbness attended with pricking and tingling in the extremities, and even com- plete anaesthesia. It also affects the circulatory system. After the first sensation of diffused warmth is experienced, there follows an in- tense internal heat and profuse hot sweat.

At other times the skin becomes covered with a miliary rash which itches intensely. The pulse and respirations are greatly accelerated. Secondarily, the sur- face of the body becomes cool, with cold clammy sweat, the pulse grows feeble, and death ends the scene.

Aconite does not at first impair the intellect and the emotions. In its action on the nerves it thus differs from Cocculus Zndicus, which early disturbs consciousness. This drug, moreover, produces a complete motor and not sensory paralysis. It differs also from Geisemium, Coninm and Nux vomica, which early destroy motor rather than sen- sory activity.

As regards its symptoms of collapse, they resemble those of Camphor and Veratrum album. But only Veratrum has the characteristic purging and vomiting, with cold sweat on the forehead. Both Aconite and Nux vomica cause tetanic convulsions, but they are only partial in Aconite, and are accompanied by great muscular weakness.

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Aconite produces two different sets of symptoms, entirely distinct in their character, and as separate as though the drug were composed of two substances, each developing its own symptoms. The second set of symptoms, that which is most thoroughly known, is the tendency of Aconite to develop fever and inflammation. This it does through its action on the sympathetic nervous system. We find it indicated in genuine inflammatory fever of the type called synochal or sthenic fever.

These terms apply to a fever which has about it no quality of weakness or asthenia. The symptoms of the fevers calling for Aconite are these: there are usually dry heat of the skin, and full, hard, bounding pulse. This fever is always associated with anxiety. The mental symptoms and those which are local, Hahnemann has told us, are the true guiding symptoms in the selection of Aconite.

It cannot be the remedy unless there are present anxiety, restlessness and fear of death. The sweat which follows the fever is usually critical, and gives relief to all the symptoms; it is profuse, warm or even hot. It has been proved that Aco7iite does not produce any alteration in the quality of the blood; hence, you cannot expect it to be indicated in any form of fever in which there is a poison in the blood, destroying that fluid or impairing its corpuscles, altering its plasma, or in any way changing its quality.

The type of the Aconite fever is sthenic and continuous, and not intermittent or remittent. It has no symp- tom in its pathogenesis which points to intermittency. Beginning with the initial chill or chills, the dry heat follows and continues until sweat brings relief. Then the fever is over so far as Aconite is con- cerned.

It has no typical return of these febrile attacks. Hence, you cannot give Aconite in intermittent fever. Then, again, it must be borne in mind that sometimes the fever is not the disease itself, but a symptom which is necessary for the proper development of the dis- ease. You should no more attempt to remove this fever by the ad- ministration of Acoyiite than you would attempt to remove a single symptom in any other disease.

Hence when fever is only a symptom, Aconite should not be given to control it. Take scarlatina, for instance. The fever here may run high, the skin may be hot and dry, and the pulse hard. Superficially, Aconite appears to be indicated, yet you know, with the other symptoms present, backache, vomiting, sore- throat and the existence of other cases of the disease in the neighbor- hood, that scarlatina is developing.

You know, by removing this fever, you take away a symptom which is necessary for the proper

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development of the rash belonging to the disease. Therefore, Aconite is rarely to be thought of in scarlatina. There may be exceptional cases, when the fever is disproportionately severe and the characteristic men- tal symptoms are present, in which Aconite may be administered, but nine cases out of ten would only be spoiled by its administration.

Again, a mistake is made in giving Aconite in typhoid types of fever to diminish the pulse and control the temperature. Aconite has no relation whatever to typhoid fever. It is here given from mere symp- tom practice and not through any knowledge of pathology and symp- tomatology. Let me beg of you not to commence this practice; it will only lead you to alternation.

In traumatic or inflammatory fevers, Aconite must give way to other remedies unless this restlessness or anxiety is present. One of these remedies is Bryonia, which has full, hard pulse, increased action of the heart, dry skin and aggravation of all the symptoms by motion. The patient lies perfectly quiet. He is not at all restless.

It is important that you distinguish between Aconite, Gelsemium and Apis mellifica in febrile states. I will therefore give you in detail the symptoms and conditions which make the selection of one or the other of these remedies certain. If I repeat what has already been said, the repetition will only serve to impress the distinction between these remedies more firmly on your minds.

Aconite typifies the synochal fever; Gelsemium the remittent or inter- mittent; Apis the intermittent or typhoid. Aconite causes decided chill, followed by dry, hot skin and full, hard, bounding pulse, fol- lowed later by a warm, profuse, critical sweat, with relief.

Gelsemium causes partial chill, beginning in the hands or running up and down the spine, followed by general heat, most decided about the head and face. Sweat is gradual and moderate, but always gives relief. Apis causes a chill, which is followed by burning heat all over, or heat in some places and coolness in others. The heat is felt particularly in the ab- domen.

The skin is hot and dry, or alternately dry and moist. Sweat is absent or breaks out only in spells, soon drying off.

Under Aconite the pulse is, as stated, full, hard and bounding. Under Gelsemiu??i it is full and flowing, but not hard — the so-called " water- hammer pulse." Under Apis it is accelerated, full and strong, or fluttering, wiry and frequent. Aconite presupposes that the blood is not qualitatively altered. Gelsemium admits of any change which may favor depression. Apis tends towards toxaemia, with a typhoid type.

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Aconite, therefore, is the remedy only when the fever is sthenic, such as arises from exposure to dry, cold winds; from exposure after overheating; from cooling suddenly when warm and sweating, etc. In bilious fever it is indicated in the early stages when the fever is sthenic, especially because it acts on the liver. It is also the remedy in inflammatory fever, whether traumatic or not, the type agreeing; it is particularly applicable to full-blooded, robust individuals, who readily suffer from sudden active congestions.

It bears no relation to the intermitting type of fever, and, when given during such a fever, acts only by subduing the heart's action, and never curatively, hence never homceopathically. Neither does it hold any relation to typhoid fever. Gelsemium is the remedy when the fever develops under cir- cumstances which favor a paresis of motor nerves of both voluntary and involuntary muscles. It corresponds to that stage in which the blood-vessels are dilated and full, but lack the firmness and resistance of a fully developed sthenic inflammation.

Such a form of fever is accompanied by languor, muscular weakness, desire for absolute rest, and drowsiness. Under such conditions congestions might still be arterial, as under Aconite, but they exhibit a passivity which is sufficiently characteristic. The pulse is full, flowing, but not hard. So Gelsemium may be indicated in bilious fevers, the liver being pas- sively congested.

Again, it applies in typhoid forms, but never after the languor and drowsiness belonging to relaxation, and consequent passive congestion of the brain, pass into great prostration and stupor.

Apis has an apparent resemblance to the sthenic fever of Aconite in its hot skin, strong pulse, etc., and this is especially so in the begin- ning of erysipelatous inflammations, or, still more, in inflammation of serous or synovial membranes. But the tendency of Apis is toward typhoid or toward effusions; Aconite never develops either. Thus Aconite may suit the fever attending the initiation of a meningitis, pleuritis or synovitis; but its power ceases when the cri cephalique, the dyspnoea and dull percussion note, or the puffy, doughy swelling about the joint, announce the appearance of effusion.

In its inter- mittent form of fever, Apis bears no resemblance to either Aconite or Gelsemium. Even in a rheumatic type, in which Aconite and Apis both appear, the resemblance is only superficial; for Apis either de- velops an erysipelatous inflammation, or causes burning-stinging pain and an exquisite soreness, all referable to the blood-vessels.

In its lower forms Apis deserts Aconite and completely supersedes

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Gelsemium. It is indicated in genuine scarlatina, in diphtheria and in typhoid fever. There is a tendency to defibrination of the blood, and lastly to decomposition of the fluids. In such cases the anxious rest- lessness of Aconite and the irritability or drowsiness of Gelsemium are replaced by a fidgety restlessness and stupefaction.

The excitement and delirium of Aconite and the semi-conscious muttering of Gelsemium are changed into low muttering delirium and unconciousness. Ar- ranging the respective symptoms according to the requirements of the Organon, we have each remedy characterized as follows: Aco?iitey anguish; despair; restless tossing about during the fever; fears he will die; throws off the clothes; pulse full, hard, bounding; skin hot, dry; all symptoms end in copious sweat. Gelse??iium, irritable; sensitive; children sometimes wakeful; nervous; even threatened with convul- sions; or drowsy; eyelids heavy; look as if intoxicated; want to remain perfectly quiet.

Chill up and down the back, followed by fever with increased drowsiness; pulse full, flowing. Sweat moderate, gradual, but giving relief. Apis, fidgety restlessness; wants to sleep, but so. nervous, cannot; or low, muttering delirium; sopor. Chill begins in the knees or abdomen at three p. m.; heat, with dry skin or occasional transient spells of sweating; desire to uncover; great oppression of the chest; skin hot in some places and cool in others.

Pulse accelerated and strong; or, as debility shows itself, wiry and frequent, intermit- tent, or imperceptible.

Belladonna comes in as another concordant remedy to Aconite. This drug, as we shall see in the future, does not act primarily on the vaso- motor nerves or sympathetic ganglia; hence it does not control the calibre of the blood-vessels. It acts primarily on the cerebro-spinal nervous system, and we therefore find it indicated in fevers which be- gin with symptoms of the brain and spinal cord, or in fevers which have commenced with the Aconite type, but have, by extension, in- volved the brain.

Thus we often find Belladomia following Aconite well. Remember that Belladonna requires the presence of brain symptoms, such as starting from sleep, throbbing headache, hot head and cold body and extremities.

Veratrum viride takes the place of Aconite in fever marking the onset of pneumonia, when there is great arterial excitement and en- gorgement, as indicated by full rapid pulse; labored and difficult breathing; or later, nausea on rising, faintness, slow pulse and cold- ness.

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When synochal fever fails to yield to Aconite, the best remedy is Sulphur. The symptoms that will lead you to the selection of this remedy are these: despite the administration of Aco?iite, the dry heat persists; either no perspiration shows itself, or, if any, it is simply transient. The patient, at first sleepless and restless, becomes drowsy and answers questions slowly or permits an interval to elapse between your question and his reply, as if not fully comprehending. The tongue becomes dry and the speech a little thick.

The patient gives evidence of falling into a typhoid state owing to the continued ex- haustion from this heat.

Ferrum phosphoricum, of which I have already spoken more than once, should be distinguished from Aconite. It acts upon the blood- vessels, producing a sort of semi-paretic state, in which they become dilated as in the second stage of inflammation. The pulse is full and rather soft; not hard or tense, as with Aconite. It is indicated in con- gestions of any part of the body when the discharges from that part are blood-streaked. This may be applied to dysentery; to haemoptysis, or to secondary pneumonia.

Arsenicum album, like Aconite, causes intense fever, with anxiety, restlessness, and fear of death; but the fever and inflammation of Arsenic are such as belong to intense local disease, to inflammation progressing to the destruction of the part, to fever of a typhoid type with putrid discharges, etc.

Aconite may be used in inflammatory affections of the brain. You must, however, distinguish between an idiopathic cerebral inflamma- tion and one arising from deep-seated disease. Aconite can have but little influence over tuberculous meningitis. But in meningitis or cerebral congestion from lying with the head exposed to the direct rays of the sun, especially when asleep, it is the best remedy, being superior here to either Glonoi?i or Belladonna.

But Glo?win and Bella- donna are preferable in sunstroke from exposure under ordinary con- ditions. Aconite may further be indicated in sunstroke when the great heat has had a paralyzing effect on the circulation. At first the heart works harder. It then begins to lose its force and beat from 120 to 130 beats per minute.

Amy I nitrite causes a similar picture. The face is flushed; the eyes protruding; there are roaring in the ears, vaso-motor paralysis and paralysis of the heart secondary to reduced pressure in the capillaries. Aconite may also be used when cerebral congestion results from a fit of anger.

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You may use Aconite in affections of the eyes. It is of service in conjunctivitis following surgical operations, or resulting from a foreign body in the eye. It is also indicated in inflammatory affec- tions of the eyes, arising from exposure to dry cold winds. There is a great deal of heat, dryness and burning in the eye.

The eye feels as if full of sand, and is exceedingly sensitive. The pains are so in- tense that the patient wishes to die; he declares that he cannot stand them. The eye-ball feels as if forced out of the orbit, and aches; this aching is worse when the affected part is moved or touched. Photo- phobia is intense.

The pupils are contracted, and there is a blue circle around the cornea, and violent aching in the eye-balls as in episcleritis. Kven glaucoma may demand Aconite when, in addition to the symp- toms above enumerated, there are pains extending down the face, as in tic douloureux, especially after exposure to intense cold or to cold winds or in rheumatic patients. If, however, Aconite does not relieve promptly, you must resort to other measures at once, as this disease may destroy sight in an incredibly short time.

Sulphur is indicated in conjunctivitis from irritation of foreign bodies when Aconite fails.

Spigelia has many pains similar to those of Aconite, especially in the left eye; but its inflammation is less general than in the case of Aconite.

You will recall that I said Aconite had two distinct types of action. We have considered the second and better known type; let us now study the other, which is very different from the former. The symp- toms of this type belong more to the cerebro-spinal nervous system. First, we shall speak of the symptoms of the mind itself.

We find Aconite useful for mental disease or hysteria when there is particular aversion to excitement, especially to busy streets. The patient dare not cross these streets because of fear that something will happen to him. This symptom is perfectly normal under some circumstances, but when extreme, denotes over-excitement of the brain, common enough in hysterical patients. They are anxious.

They show an in- tolerance of music. They can bear no sounds, so sensitive are the ears. They imagine that some part of the body is deformed, e.g., a limb displaced, lips too thick, or features distorted. They imagine that they do all their thinking from the stomach.

Sometimes such patients, during attacks of illness, have "spells" in which they pre- dict the hour of death. You may note this symptom in puerperal

32 2 A CUNICAL MATERIA M^DICA.

Argentum nitricum and Coffea also have the symptom, predic- tion of the hour of death, the latter especially in child-bed.

Sulphur is the main antidote when paralysis results from overdoses of Aconite.

Cannabis Indica and Staphisagria should be remembered in paralysis, with tingling in the affected parts; Rhus to x., Sulphur and Causticum are preferable later, especially in paralysis from cold.

Colchicum is likewise indicated in left-sided prosopalgia. The pains are associated with a paralytic weakness of the muscles, but lack the severity of those of Spigelia, and the excitement and intolerance of pain which characterizes that remedy is wanting under Colchicum.

Amyl nitrite may be needed rather than Aconite in prosopalgia with much local congestion.

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Attacks of intense pain extend from the heart down the left arm, and are associated with numbness and tingling in the fingers. -

Veratrum viride, as already indicated, competes with Aconite in the incipiency of pneumonia. It acts admirably when the pneumonic en- gorgement is severe, with violent excitement of the heart, as indicated by rapid full pulse, nausea, faintuess on rising, tongue red down the centre.

Aconite may also be indicated in pleurisy, in the very beginning, be- fore there is any exudation; there are sharp stitches on either side of the chest, with chills followed by febrile action. Aconite is to be thought of here particularly when the trouble has arisen from a checked perspiration or confinement from the fresh air.

Spongia is to be used when the breathing becomes " sawing." The cough is still barking, harsh, and rasping. It is especially indicated in light-complexioned blue-eyed children, when the trouble is worse before midnight.

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Hepar should be given when the cough is worse toward morning,, and on uncovering, and is associated with rattling of mucus.

Sambiicus is called for when there is spasm of the glottis. The breathing is of a wheezing, crowing character, and is worse after mid- night and from lying with the head low.

Millefolium, which has haemoptysis, with profuse flow of bright red blood, but without fever.

Ledum for haemoptysis of drunkards or persons of a rheumatic con- stitution. The blood is bright red and foamy.

Cactus grandiflorus for haemoptysis with strong throbbing of the heart and a sensation of constriction, as of a band about the chest. It has, however, less anxiety and less fever than has Aconite.

Aconite may be used in dysentery, especially if the disease occurs in the autumn, when warm days are followed by cold nights; the stools are scanty, bloody and slimy, with much tenesmus. In this disease, Aconite is followed very well by Mercurius.

The diarrhoea of Aconite is of inflammatory origin. It usually ap- pears in summer, as the result of indulgence in cold drinks or from checked perspiration. • The stools are watery, slimy and bloody.

Cholera infantum calls for Aconite when the stools look like chopped spinach, and the inflammatory symptoms already mentioned are present.

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You should also remember Aconite in incarcerated hernia, when in- flammation has started in the strangulated bowel, with burning pain in the affected part. There are also vomiting of bile, great anxiety and cold sweat.

In incipient nephritis, whether true Bright' s disease or not, Aconite has relieved when the patient complains of sharp cutting pains going in a circle from the renal region around to the abdomen over each ilium.

Coming now to the genital organs, we find Aconite sometimes indi- cated in dysmenorrhea supposed to result from thickening of the peritoneum over the ovaries, and in suppression of the menses, due to anger or fright. The characteristic colic which I described a few minutes ago is present.

During pregnancy, Aconite may be administered for certain mental symptoms, such as fear of death, excitable temperament, etc. It may also be used for impending abortion caused by fright or anger.

In the so-called "milk-fever," Aconite is to be given when the mammary glands are hot and swollen, and the skin hot and dry. These symptoms are associated with restlessness and anxiety.

Suppression of the lochia is an indication for Aconite, when the trouble is caused by exposure or by some violent emotion, provided high fever, thirst and anxiety are present. The mammae are lax, and the abdomen is distended and sensitive to touch.

Aconite is not often indicated in puerperal fevers because they are generally of septic origin, but for one form of child-bed fever it is the only remedy capable of subduing the whole affair within a few hours. The nurse, perhaps, has carelessly exposed the patient after a hard labor, or she has bathed her with too cold water, or has thoughtlessly changed her clothing without the necessary precautions, and the fol- lowing symptoms result. High fever; thirst; eyes glaring and wild; sharp, anxious expression; abdomen distended and sensitive to touch; mammae lax and without milk. When you have this symptom-pic- ture, you may confidently give Aconite.

While Aconite is not called for in scarlatina, still it may be used dur- ing that disease, after the stage of desquamation, when the child

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Gelsemium differs in that it causes more drowsiness and desire to re- main quiet.

You may compare Nux vomica in colds caused by cold weather. The nose is stuffed and dry, and the throat feels rough as if scraped:.

Belladonna is to be given if the head is intensely hot, the throat red and the tonsils swollen.

China is useful if there is headache from suppressed coryza, with pains worse in the open air, instead of better, as under Aco?iite.

In skin diseases, Aconite is sometimes indicated. It is not a remedy for scarlatina, but you will sometimes find it useful in so-called scarlet- rash, with high fever, anxiety and other appropriate symptoms.

Sulphur is the proper remedy when Acoyiite has been abused.

LECTURE XXXII.

ACTEA RACEMOSA, RANUNCULUS BULBOSUS AND RANUNCULUS SCELERATUS.

ACTEA RACEMOSA.

Actea racemosa acts upon the cerebro-spinal nervous system, and especially on the motor nerves It seems to have a decided influence over the nerves distributed to muscles, producing a perfect picture of myalgia.

328 A CIvINICAIv MATERIA MKDICA.

Another remedy to be mentioned in this connection is Kalmia lati- folia, which has supra-orbital neuralgia, worse on the right side.

Aclea may also be used for headache attended with a feeling as if the patient were going crazy. Especially is it of value when uterine symptoms are present.

It is also called for when there is pain in the left infra-mammary region, dependent upon uterine disturbances.

When there is a great deal of soreness in the abdomen, the local ap- plication of a solution of Hamamelis is a good remedy.

The labor-pains of Actea seem to be associated with fainting spells or with crying out in agony, so severe are they.

In after-pains it is useful only when they are intense, when the patient is exceedingly sensitive and cannot tolerate them, and when they are worse in the groin.

Here you may compare Lachesis, which has " awakening from sleep and springing from bed, not only with superhuman strength, but in great terror. ' '

Arsenicum often follows Lachesis when the patient is afraid to be left alone.

Calcarea ostrearum has visions of rats and mice as soon as the patient closes her eyes.

Another symptom that we find indicating Actea in labor is ' ( rigors,

ACTEA RACEMOSA. 329

or nervous chills " in the first stage of labor. Gelsemium also is use- ful in this condition.

Actea racemosa does not cause phthisis, yet it may be one of the first remedies indicated when the disease is not of hereditary origin, especially if the trouble has been brought on hy exposure, or in any case in which the well-defined cough of Actea is present. This cough is dry, teasing, worse at night, with little or no sputum, and usually associated with pleurodynia.

In pleurodynia associated with tuberculosis, you will find Guaiacum to be a remedy that rarely fails.

You may use Actea in angina pectoris when the pains radiate over the chest, and are associated with cerebral congestion and unconscious- ness. The face is livid, and the left arm feels as if bound tightly to the body.

Agaricus muscarius also produces a perfect picture of spinal irrita- tion, with well-marked tingling or formication in the back, itching or burning of the skin as if frost-bitten, twitching of the muscles, espe- cially of the eyelids, and sensations in different parts of the body as if needles of ice were being thrust into the skin.

This spinal irritation may develop a partial paralysis, in which case

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Among men we do not find these symptoms present except as a re- sult of sexual excesses, in which case Nnx vomica is the remedy.

Cobalt is of use for spinal irritation from sexual excesses when there is backache, worse when sitting, with weakness in the legs.

Compare with Natrum mur., Arsenicum, Taraxacum, Rhus tox.

Like Ranunculus bulbosus, Ranunculus sceleratus may be indicated in ordinary catarrhs with sneezing, fluent coryza, pains in joints, and burning on urination.

LECTURE XXXIII.

HELLEBORUS NIGER AND STAPHISAGRIA.

HKIvIvKBORUS nigkr.

f Sweet spirits of nitre,

~" ""7' -I Phosphoric acid,

depression. ] .

Sensorial

Helleborus niger. <{