Cantharides: An Unsafe Remedy.
Selected writings of A. Jackson Howe.
So far as we are aware, this is the first signed article from the pen of Dr. Howe. It was in the year of his graduation in medicine, and he had been made an assistant editor of the college paper, "The Worcester Journal of Medicine." While some of the unsigned editorials may have been written by him, this paper is the first to bear his signature. It marks the beginning of a long and fruitful career of authorship, and true to his mission, he begins by attacking a common abuse in practice at that day. What he wrote is now commonly recognized as true, and all text-books on medicines give the cautions he penned concerning the dangerous effects of the cantharidal blister upon the urinary organs and the general system.—Ed. Gleaner.
CANTHARIDES: AN UNSAFE REMEDY.—One after another heroic remedies heroically administered go out of use. Many a bloodthirsty lancet now lies in its case in a state of inglorious rusting. Not, however, laid away on account of its unprofitableness, for it has "bled" many a victim in bygone days, as often at least as once a year, to relieve distended veins, and make plethoric the doctor's pockets. But its use has been discontinued, both on account of a popular prejudice having grown up against it, and the results of a thorough examination of its merits, which has blunted its point.
With the lancet, mercury, antimony, and arsenic are going out of use with the great body of practitioners, at least as leading remedies, being used by them only in particular cases, for the simple reason that substitutes of a more harmless character are now well known.
Another leading article of the old materia medica is cantharides, and their use is likely to be continued till a popular prejudice as strong as that against blood-letting shall arise against them. For the great body of physicians are too lazy to seek out a more harmless substitute, while the people do not shrink from the deformities of the old remedy.
Cantharides are used as a stimulant of the genital-urinary organs, and as a topical stimulant in low forms of fever; also to produce vesication. And if these indications alone were fulfilled by cantharides, and no injury produced, the remedy would deserve a eulogy next in power to that on antimony "by Basil Valentine, a Benedictine monk." But in numerous instances they prove a remedy worse than the disease—producing distressing symptoms of tenesmus and stranguary, even when taken in officinal doses. At times they aggravate the disease which they are intended to relieve. In other cases mischief arises from want of uniformity in the action of the remedy. When given as an emmenagogue it often only excites the kidneys and urinary passages; and when given as a diuretic or excitant of the urinary organs, it spends its force on the intestines. Also, when used for vesication, it performs not that alone, but the veins becoming absorbed, it brings on the most violent and distressing symptoms.
The external use of cantharides, under my observation, has oftener produced mischief than when administered internally; for the reason, I suppose, that they are exhibited thus with less regard for their poisonous effects. A blister can not be raised with cantharides without danger, especially if the blister surface be extended. Even death has taken place from the constitutional disturbance excited by extensive vesication. In low grades of fever, when cantharides are often used as a topical stimulant, their evil effects are not observed sometimes until days afterwards, when sloughing will commence, and not infrequently prove fatal. Several cases have come under my care after the fly blister had been improperly used. One was that of a lady who primarily was threatened with symptoms of pneumonia. Her physician, to relieve the lungs, which began to be oppressed, applied cantharides over the greater part of her chest, and allowed them to remain until enough of the poison had been absorbed to produce tenesmus and the most violent symptoms of stranguary. When I was called, the lady was suffering from nothing but the effects of cantharides, and her physician had been obliged to use the catheter for twenty days, with no apparent approach towards relief from this unpleasant situation, except that the urine had ceased to be bloody. I ordered slippery elm injections to the vagina, and prescribed carbonate of potassa and mucilaginous diuretics, to be taken several times a day. And so fortunate was the treatment that I was not obliged to use the catheter at all. Another case was that of a laboring man who had been treated with the fly blister over the abdomen to relieve him of colic. The catheter had been used for three days, and its introduction produced intense pain. He suffered from a constant desire to micturate and from obstinate priapism. Cooling mucilaginous diuretics, together with demulcent injections into the bladder and rectum—those into the latter allowed to remain near the neck of the bladder—soon afforded permanent relief. Other cases milder in their character have always yielded to a similar course of treatment.—HOWE, Worcester Journal of Medicine, Vol. X, No. 11, November, 1855.