Related entries: Pulsatilla in inefficient labor
H. C. SMITH, M.D., GLENDALE, CAL.
The members of the Eclectic school of practice pride themselves not only upon their general knowledge of drug therapy, but upon the unanimity of opinion within their ranks as to the application of drugs to disease conditions. In this they are like the Irishman's women. Pat said, "Mike, did yez iver notice how much women are aloike?" Mike said, "No, Pat, I niver did." Said Pat, "It don't make anny difference how many of thim yez git acquainted wit', they're all aloike in bein' different from one another. (As mentioned in another journal, Physicians shouldn't attempt dialects—MM.) And so with Eclectic unanimity. It rather seems to me that one of the chief pleasures of attending these meetings is in taking advantage of the opportunity to tell the other fellow he doesn't know what he is talking about—so here goes.
The March, 1915, issue of the NATIONAL QUARTERLY contains an article entitled, "Specific Medicine Pulsatilla," the paper having been read by Dr. Frank Webb, at the 1914 meeting of this Society. In the discussion of the paper which followed its reading, the amenities bandied about among the "discussions" were such as would elicit a cheerful snicker from any supposedly benighted allopath who chanced to hear or read them; about the only demonstrable unanimous opinion upon the subject being, "None of you knows what he is talking about, judging from my experience." Is this a fair sample of Eclectic unanimity? I believe that it is, as I could quote pages from the published transactions of this Society to prove the great diversity of opinion among its members upon the subject of drug therapy. I feel perfectly safe in making the assertion that were I to copy one of Dr. John M. Scudder's articles upon therapeutics, written some thirty-five or forty years ago, and reprint it as my own and over my own cognomen, that I would be assailed by many Eclectics as being ignorant of my subject in general, and of specific diagnosis and specific medication in particular. Such being the case, of what real value is our boast of exact therapeutic knowledge?
Dr. John M. Scudder was about fifty years ahead of the profession when he formulated and promulgated the principles of specific diagnosis and specific medication; but that fifty years have elapsed and the time has arrived when Eclecticism should shake off her smug complacency and begin to scramble for a seat in the van of progress, carrying forward and perfecting the work inaugurated by Dr. Scudder, instead of sitting back and shouting, "I am the great I am." "Call an Eclectic and be saved; call an Allopath and die."
This day and generation call for exact knowledge in drug therapeutics, just as they do in the other sciences and the other branches of medical science, and are not going to be satisfied with being told that a certain drug will relieve a certain set of symptoms, but demand to know how and why it does it.
Notwithstanding the fact that Leonard Keene Hirschburg is publishing articles in the daily press throughout the length and breadth of this country, that are manifest and successful efforts to undermine the confidence of the laity in true and legitimate practitioners of the healing art, the great mass of allopath practitioners are not satisfied with their present knowledge of drug therapy, nor are they satisfied to dispense with that form of therapy; consequently, they are awaiting a rational pharmacognosy based on scientific knowledge. At the same time the leaders of that school of practice, while outwardly emphasizing their therapeutic nihilism, are thoroughly studying the few drugs in which they do have confidence, and, in time, will outstrip us in our special line of study if we are not careful. While they are slowly yielding to a general demand for a more extensive and comprehensive drug therapeutics we may take advantage of our accumulated knowledge in this line and forge ahead to a pronounced and recognized lead, if we only will. The mote in the other fellow's eye and the beam in our own, both are entirely too prominent for the general good of the profession.
However, these aforementioned brethren are not alone in their lack of unanimity in regard to the virtues of the remedy which is the subject of this paper. Baron Stoerck, in 1672, employed pulsatilla for the relief of chronic diseases affecting the eye, particularly cataract, amaurosis and corneal opacities. He also used it for melancholy, palsy, suppressed menses, syphilitic nodes, caries, ulcers, nocturnal pains and indurated glands. It gradually declined in favor thereafter until the Homeopathic school was established.
Wooster Beach, the father of Eclecticism, in 1855, enumerated the uses of pulsatilla as employed by Stoerck and added, "None of the anemones is of much importance in a medicinal point of view, their uncertain and acrid properties preventing their use when better articles can be procured."
John King, in 1864 edition of The American Dispensatory, again repeated Stoerck's uses of pulsatilla and added, "It is very seldom employed in practice, except by the Homeopaths."
Stille and Maisch, in the 1879 edition of The National Dispensatory, stated, "Pulsatilla has been recommended in amaurosis, etc., but no sufficient ground exists for its use in therapeutics."
The United States Dispensatory of 1845 recounts the claims made for pulsatilla by Stoerck: that of 1875 adds: "It is, we believe, a favorite remedy with the Homeopathists." The 1907 edition still further adds: "Pulsatilla has been recommended for menstrual troubles and for affections of the epididymis and testicle. But to attain results it must be given in infinitesimal doses and with a great deal of ceremony." In brief, their conclusions were that its effects are wholly psychic.
Charles D. F. Phillips, lecturer on materia medica in the Westminster Hospital, London, in his Materia Medica and Therapeutics of the Vegetable Kingdom, 1879, recommended pulsatilla for practically the same affections as those for which modern Eclectics prescribe it, and directed by approximately the same symptomatology.
Roberts Bartholow, in his Materia Medica and Therapeutics, 1894, gives a very rational resume of the actions and therapeutics of pulsatilla.
Sam'l O. L. Potter, in his Therapeutics, Materia Medica and Pharmacy, 1910, gives rather complete pharmacological and therapeutic actions of the drug. (1902 version here - Henriette)
Henry H. Rushby, in the Reference Handbook of the Medical Sciences, states: "The clinical investigation of pulsatilla has been neglected by physicians, apparently with little better reason than that it is a favorite medicine with the Homeopaths and Eclectics." All Homeopathic authorities hold pulsatilla in great esteem, Hull's Jahr giving six or seven hundred items in the symptomatology.
Scudder, patterning after the Homeopaths, gave it in small doses for its primary effect and held it in esteem as a nerve tonic. Most modern Eclectics prescribe pulsatilla in doses sufficiently large to produce its secondary effects, consequently class it as a nerve sedative.
One or two of the physicians discussing Dr. Webb's paper, insinuated that his results were largely psychological; another said it was through its influence on the medulla; and Dr. Webb said it was through its influence upon the spinal and sensory nerve. While these opinions appear on the surface to be decidedly the reverse of unanimous, to a certain extent they all revolve around the same central idea, and I shall endeavor to elucidate what I mean by this central idea.
Pulsatilla belongs to the natural order ranunculaceae, to which also belong aconite, cimicifuga, staphisagria and some others, and all have a similar action upon the nervous system; but each has a selective action upon certain tissues.
Pulsatilla has a pharmacological action very similar to, and its toxic action is almost identical with that of aconite. Both produce the prickling and numbness of the tongue and fauces, both are rapidly absorbed, and both produce a primary irritation of nerve endings, which is often referred to as stimulation, but this irritation or stimulation is much more prolonged in the action of pulsatilla than is that of aconite, so that if the dose be kept small enough the primary or tonic action of the drug will be exhibited for a considerable period of time.
Both pharmacological studies and Homeopathic provings have shown the effects of the primary action of these drugs to be upon the circulation through the medium of the peripheral nerves. They have also shown that this action is more especially upon the afferent teledendrions, because beginning toxic doses next affect the sensory nerve-trunk, increasing doses affect the reflex mechanism of the spinal cord, and full toxic doses paralyze the motor nerve-trunks. While all these actions are readily demonstrable as regards aconite, and its effects upon the general circulation are so pronounced that the pharmacological action definitely outlines its therapeutic action, this is not the fact as to pulsatilla. Only the toxic action has proved of a definite nature, and empirical observations have been so glaringly contradictory as to seem wholly at variance and chimerical. However, I believe that we can apply pulsatilla as specifically to pathologic states of the system as we can apply aconite.
In the medulla of the adrenals, the ganglia of the abdominal sympathetic, the paraganglia along the abdominal aorta, the carotid ganglia, the coccygeal glands, the parovarium and the epididymis are certain cells staining brown with chromic acid, called chromaffin cells, and the entire group known as the chromaffin system. Free nerve and blood supplies are always to be found in connection therewith. Irritation of these cells in any part of this system will result in vascular disturbances which seem to stimulate the emotional centers, apparently at the expense of the volitional centers, producing an imbalance between them. The emotions reign supreme while volition and judgment become feeble and warped.
The individual is usually unduly exalted or unduly depressed—these moods having a marked tendency to alternate. The predominating symptoms in many instances are those of fear and worry; the patient being apprehensive of impending evil, often with the fear undefined. If a man, he is afraid to make business ventures, or fears he will lose customers or friends, while at the same time he may be so moody and irritable as to cause his fears to be realized. He is inclined to lack confidence in himself in everyday matters, while he may, at the same time, be over positive as to his ability to handle affairs entirely out of his line of work, and be extremely obstinate in his contentions. If it is a woman, she may be, and usually is, more irritable and erratic than is her wont, although this is less noticeable usually than the elements of fear and worry. The woman who ordinarily is very well balanced begins to fear some impending evil; fearful as to her husband's business success or personal safety, although there may be no known grounds for her apprehensiveness, or for the personal safety of the children if they are out of her sight, or that they may contract some disease—often without due regard to the fact that there is no such disease prevalent at the time. She may fear for her own safety, carefully examining and re-examining the locks upon the doors and windows. If she has a cut or scratch upon her person she fears blood-poisoning; or any lump in her breast is a cancer—whether she has ever seen Dr. and Mrs. Chamlee's advertisement or not. She is prone to fits of anger, and to weep upon the slightest provocation. In the case of either male or female, if the spinal cord is already irritable, then irritation of these cells will induce convulsive attacks, or the good, old-fashioned hysterical spasms.
I have a thin patient who has a floating right kidney, which carries the supra-renal gland with it in its excursions—persistently violating the Mann Act. Her kidney may prolapse until it occasions her considerable discomfort, but that is all she complains of unless there is pressure upon the supra-renal, when she immediately begins to develop hysterical symptoms—in fact, about every symptom that I have enumerated as likely to be manifested by a female sufferer. The uncertain temper and fits of weeping are particularly prone to manifest themselves at the menstrual period. I have experimented upon her when there were no hysterical symptoms present, by pressing upon the supra-renal and the abdominal aorta and have succeeded in developing a full quota of symptoms in a very few moments. Pressure sufficient to produce this train of symptoms also precipitates an attack of indigestion with gaseous distention and often colicky pains. Frequent attacks in a short space of time soon develop metrorrhagia. The fact that mammary extract more readily overcomes this than any other treatment directs our attention to the disturbing effect upon all the internal secretions.
Recapitulation.—We have a series of chromaffin cells in various parts radiating from the adrenals and abdominal sympathetic. All these cells are in intimate relation with rich peripheral nerve and blood supplies. Irritation of the parts where these cells are located induces a general imbalance of the autonomic nervous system which manifests itself in circulatory disturbances, erratic volition and unstable emotions. On the other hand, homeopathic provings of pulsatilla in minute doses have developed a great variety of symptoms that are almost identical with those produced by irritation of the chromaffin system. Pharmacological studies of investigators, such as Bartholow, have demonstrated that pulsatilla acts upon the circulation through the medium of the afferent teledendrions. Ample clinical experience has proven that a majority of cases presenting the symptomatology mentioned previously are benefited by the administration of pulsatilla. Consequently, I believe we are justified in concluding that pulsatilla has a specific influence upon the chromaffin system.
It has long been known that irritation of the adrenal will affect the pigmentation of the skin, producing leucodermic spots. Destruction of this structure by tuberculosis or other disease induces the peculiar pigmentation of the skin that is the characteristic feature of Addison's disease. Consequently, it is reasonable to suppose that a more active adrenal medulla will produce a fairer complexion; a less active adrenal medulla a darker skin or complexion. We also know that in diseases or derangements of some of the other abdominal organs there is an increased pigmentation of the skin; so, by putting two and two together, we may conclude that chromaffin cells outside the adrenal medulla also have to do with pigmentation of the skin. This being the case, an individual with a fair skin—a blonde, if you please—has a more active chromaffin system than a brunette has—the fundamental reason for their being blondes—and, in consequence, this system shows signs of irritation more readily in the blonde, and pulsatilla is more likely to be required as a remedial agent.
If this system is atonic it will respond more readily to direct tonic treatment in a blonde than in a brunette, but both pharmacological studies and homeopathic provings have shown that pulsatilla is ultimately a sedative, whatever the size of dose; so I prefer, in this instance, to administer some such remedy as ignatia, which is tonic first, last and all the time.
The principal reason why we recognize the influence of pulsatilla upon the sexual glands, and its specific application thereto, oftener than we do its influence upon the adrenals and digestive organs, is because of our greater ability to recognize disturbances of the sexual glands. In ovaritis, orchitis and epididymitis it is of value because of its influence upon the circulation, but it does not compare with aconite in these afflictions as a reducer of inflammation and temperature.
In administering pulsatilla an exact observation of the sex, color and condition of servitude is not a dire necessity, but the plain, unvarnished fact remains that we find the remedy oftenest indicated in fair complexioned people, and these oftenest of the female sex. If the patient is a male or a brunette, or both, larger doses will be required to accomplish results.
I am not insinuating that pulsatilla will restore a cystic or otherwise diseased ovary, or anchor a floating kidney—we know better. I wish, however, to emphasize the fact that pulsatilla is preventive of diseases of the ovary, adrenal and other such organs, by relieving irritation of the nerve supply and restoring a normal circulation to them before permanent damage has resulted.