Santonica. Artemisia pauciflora.

Synonym—Levant Wormseed.

CONSTITUENTS—

Santonin, volatile oil, gum, resin.

PREPARATIONS—

Santonin is a crystalline neutral principle, derived from Santonica. it occurs in the form of shining, colorless, or slightly yellowish, flattened, prismatic crystals, odorless, and at first tasteless, but subsequently bitterish. Nearly soluble in cold water, soluble in 250 parts of boiling water, and in forty parts of alcohol. Slightly soluble in chloroform and ether.

Trochesci Santonine, Troches of Santonine. Dose, from one to six troches. Santonin. Dose, from one-fourth to two grains.

Physiological Action—Five grains of santonine given to a child caused pain in the stomach, convulsions, insensibility and death. Various phenomena are produced by even smaller doses, as everything appearing yellow or red throughout the field of vision; urine stained deep yellow; a punctiform rash or an eruption like that in measles; amaurosis, flushed face, hot head, twitching of the eyeballs, dilatation of the pupils, foaming at the mouth, clenching of the teeth, jerking of the arms, stertorous breathing. Two grains caused the death of a feeble child.

Generally, recovery takes place after these symptoms, but occasionally death follows.

Specific Symptomatology—The following indications, seldom all present at the same time, point to the presence of lumbricoid worms in the alimentary canal. They may also be present in part, induced by various other causes of intestinal irritation. There may be intense itching of the nose in children, the child rubbing or boring the nostrils, with bloated abdomen, restless sleep, crying out in affright, grinding of the teeth at night, groaning in sleep, complete loss of appetite, tongue deep red without coating, deficient saliva, nausea, vomiting, fetid breath depraved, erratic appetite with longings, great thirst, aversion to food, abdomen enlarged and hard, diarrhea with whitish, slimy stools, or bowels constipated followed by looseness, colicky pains in the bowels, vomiting and purging after meals, worms discharged with the stools, cramps in the bowels at night, itching at the arms, limbs wasted, face pale, skin sallow and unhealthy looking, constant urging to urinate, wetting the bed, urine whitish and cloudy, scalding, dry, hacking, constant cough, tickling in the larynx and trachea, convulsive movements of the hands and arms, sensitiveness to the touch over the whole body, twitching of the muscles, lividity of the face, arrested breath, severe choking sensations, convulsive contraction of the fingers, general convulsions with violent agitation of the limbs, chorea, haziness of sight, loss of consciousness, restlessness, not satisfied with anything, will not sleep, fever occurring daily, usually in the afternoon.

Therapy—The generally accepted influence of santonine is in the line of its anthelmintic properties. It is an excellent remedy for the long worm—ascaris lumbricoides. It is given in doses of from one-half to one grain, twice or three times daily. In the above symptomatology, however, I have named a long list of symptoms, which are due to intestinal or gastro-intestinal irritation. In a few cases they may be due to other reflex influences. Many of these symptoms should be treated with santonin, without regard to the presence of worms. In fact, if we properly study this remedy, we must put aside entirely the idea of its anthelmintic properties, and consider it as a nerve sedative, as an antispasmodic and as a positive and reliable agent with which to relieve, nerve irritations, especially those of a reflex character.

I have made some very conclusive observations in the past fifteen years that convince me that this remedy is the best remedy we have with which to relieve reflex irritation, when the cause of the irritation cannot be at once determined. This is an entirely new field for santonin. I was once treating a child who suffered from all the symptoms of nerve irritation which are present with worms. I gave santonin to remove the worms. Santonin relieved the nervous irritation in a most satisfactory manner, but subsequent observation proved that there were no worms present, but that the irritation was due to faulty digestion and decomposition of food. I was at once impressed that the agent had relieved the irritation by its influence upon the nervous system, independent of any action it might have had upon the worms.

From this observation, I began at once to administer it in all cases where there was reflex irritation. I was consulted concerning a child seven months old, who had a persistent hacking cough from its birth, which resisted all treatment. I allayed the cough in twenty-four hours with half grain doses of santonin, and the cure was permanent.

I was consulted concerning an irritable heart in an old lady, who was so enfeebled from the violent and irregular action of the organ that she had not been able to do anything whatever for over two years. The heart disorder did not seem to be sufficient to cause the extreme weakness, and I treated it with santonin, as a case of reflex irritation. The results were indeed most surprising. The patient was around the house and assisting with the work within less than a week.

A physician reported a case to me that was suffering from persistent protracted fever, with nervous phenomena, that showed it to be of reflex origin, as all other causes were excluded in the examination. After all known methods had failed, three doses of santonine, one grain each, reduced the temperature almost to normal, and that agent alone caused the permanent abatement of the fever.

I advise with full assurance of satisfactory results, that this remedy be used freely in the treatment of reflex irritations. I do not think it will be found necessary to give it in large doses. From one-half a grain to a grain and a half in an extreme case, will, I think, be sufficient.

I would suggest that it be carefully used in the reflex irritations of pregnancy, especially when there is scanty urine, or when there is deficiency of renal action, with much local irritation. Also in the beginning stages of the albuminuria of pregnancy. I am confident that it will do much towards preventing puerperal convulsions if given early. I think there are some cases of the vomiting of pregnancy that will be quickly allayed by it. I advise that it be given in hysterical conditions, and in those difficulties where there is irritation of the ovaries and irritation at the menstrual epoch, especially if accompanied with some pain.

Lydston advised the use of this remedy in large doses in the treatment of epilepsy. Its antispasmodic properties would suggest that it be used in cases where the spasms are due to reflex irritation; whether it possesses sufficient antispasmodic properties to control spasm, as gelsemium, chloral and other agents of that character do, remains to be proven.

Santonine at times is a positive remedy with which to increase the secretion of urine in children. It gently stimulates the functional action of the organs, promotes normal secretion and relieves irritation. It is without doubt, our best remedy with which to restore the secretion in post scarlatinal or post diphtheritic nephritis. In these cases it may be alternated with positive doses of belladonna. In conjunction with a persistent application of heat, it will be found useful in post puerperal nephritis, of an acute character, and probably in other cases, where sudden suppression has resulted from profound sepsis.

Where we find colic with loose, slimy stools, it points to intestinal disorders, while convulsive movements are reflex symptoms, consequent upon the intestinal disease. These are benefited by this agent.

Santonine influences these conditions by stimulating the great sympathetic and giving tone to the functions of digestion and nutrition.

It has been employed with advantage in nervous failure of sight, nervous vomiting and nervous diarrhea; but it is doubtful whether it has ever improved the sight in amaurosis or cataract, as has been claimed.

Santonine causes yellow vision and yellow urine, Where worms are demonstrated to exist in the bowels, it is a common practice to give santonine with a cathartic of podophyllin, or follow it with castor oil. The agent is toxic, as stated, and should not be given in material doses for the special purpose of destroying worms, when the child is constipated or suffering from fever.

The American Materia Medica, Therapeutics and Pharmacognosy, 1919, was written by Finley Ellingwood, M.D.
It was scanned by Michael Moore for the Southwest School of Botanical Medicine.