Aconitum napellus, monkshood, N.O. Ranunculaceae. A tincture is made from the whole plant (fresh if possible) in the spring time.
PATHOGENESIS.
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.
THERAPEUTICS.
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
it.
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.
Edwin Awdas Neatby founded the Missionary School of Homeopathy and the London Homeopathic Hospital in 1903, and run by the British Homeopathic Association. He died in East Grinstead, Sussex, on the 1st December 1933. Edwin Awdas Neatby wrote The place of operation in the treatment of uterine fibroids, Modern developments in medicine, Pleural effusions in children, Manual of Homoeo Therapeutics,