Aconitum (U. S. P.)—Aconite.
Preparations: Tincture of Aconite - Extract of Aconite - Fluid Extract of Aconite - Aconite Plaster - Ointment of Aconite - Compound Pills of Aconite - Oleate of Veratrine - Aconite Liniment - Lotion of Hydrastis and Aconite
Related entries: Aconitum Fischeri.—Aconite - Aconitina.—Aconitine
The root and leaves of the Aconitum napellus, Linné. (Aconitum vulgare, De Candolle; Aconitum variabile, Hayne).
COMMON NAMES.—Monkshood, Wolfsbane.
ILLUSTRATION: Bentley and Trimen, Med. Plants, 5, 6, 7.
Botanical Source.—Aconite plant is a perennial herb, having a simple stem (usually growing from 2 to 4, sometimes 8 feet high), and bearing palmately-lobed leaves; those low on the stalk being from 5 to 7-cleft, those higher 3 to 5-cleft. Each of these lobes is, again, from 3 to 5-parted. They are alternate, petiolate (the lower ones having long foot-stalks), and are deeply divided, and vary from 2 to 4 inches in diameter. Each lobe is toothed in such a manner that each tooth terminates in a lance-linear point. The leaves are stiff and somewhat smooth and coriaceous, the under surface being light, while the face of the leaf is of a bright, shining, green color. The flowers are large, attractive, and of a dark-purple or violet-blue hue (sometimes white) and are borne in a terminal raceme, with occasional clusters below, in the axils of the leaf stalks. The upper sepal is helmet-shaped and pointed, and the lateral sepals hairy on the inner surface. The fruit consists of from 3 to 5 capsular pods, containing numerous angular, corrugated seeds.
Description.—ACONITUM (U. S. P.) Aconite. ACONITI RADIX.—The root is prolonged into a conical tap-root, tuberous, and though smaller, has some resemblance to the common horseradish root, for which it has been mistaken, and eaten with fatal consequences. At the top it seldom exceeds an inch in thickness, and is about 2 to 4 inches long. Externally, it is brown; internally white and fleshy. As found growing, there is usually a rhizome produced from a lateral bud from the tuber. At the extremity of this subterranean stem, another tuber, with a bud for the next year's plant, is developed. This second tuber, in the course of the year, develops a third tuber, so that when dug for commerce it is common to find at least two roots, connected by a short rhizome. Each root has several long, fleshy rootlets. The fresh root has a radish-like odor which is dissipated on drying. The dried root is thus described in the U. S. P.:
From 10 to 20 Mm. (⅖ to ⅘ inches) thick at the crown; conically contracted below; from 50 to 75 Mm. (2 to 3 inches) long, with scars or fragments of radicles; dark-brown externally, whitish internally; with a rather thick bark, the central axis about seven-rayed; without odor; taste at first sweetish, soon becoming acrid, and producing a sensation of tingling and numbness, which lasts for some time"—(U. S. P.).
If of recent growth, it is whitish, internally, and compact, breaking with a short, clean fracture. If, however, the root be of the previous year's growth, it may be porous and of a dark-brown color within, and consequently of less value as a drug.
ACONITI FOLIA.—Aconite leaves are often intermixed with some of the flowers, as well as leaves and blossoms of other blue-flowered species of the family. The leaves are smooth, coriaceous, somewhat rigid, glossy on the upper surface, having a sub-orbicular, or nearly cordate outline, which is deeply (3 to 5) cleft, producing long, narrow, cuneiform segments, deeply incised, and presenting lance-linear teeth. The taste is bitterish and acrid, and gives the well-known characteristic tingling sensation of aconite. They have but little, if any, odor.
History.—Aconite is abundant in the mountainous woodlands of various parts of Europe, especially in France, along the Pyrenees, and in the rocky heights in Germany and Austria, Denmark, and the Scandinavian peninsula, and is abundant in the Alps and the Himalayas, where, with other species, it is found at a height of from 10,000 to 16,000 feet (Pharmacographia). It is plentiful throughout Siberia, and is cultivated to some extent in gardens, both in the United States and Europe, for its floral beauty. It is said to have been naturalized in portions of the British isles.
Aconite tubers and leaves are frequently of very poor quality, and with foreign admixture as found in market, having been gathered without regard to season, species, or quality, by the poor peasants while engaged in watching the grazing herds. The shrivelled and decaying growth of the previous year is, as compared with the recent growth, relatively feebler. The aconites were well known to the ancient Greeks, Romans, and Chinese. It provided certain native tribes of the East with an active arrow poison. The root should be collected in winter or early spring; the leaves just before the blossoming period, or when the plant has but partially bloomed. The virtues of aconite remain intact upon drying, the whole plant being acrid and fully yielding its medicinal properties to alcohol. Various other plant species are present as admixtures, and especially, according to Holmes (Pharm. Jour., 1877), are substituted the roots of the Imperatoria Ostruthium, Linné. (European masterwort). As the latter tuber is aromatic, its detection is not difficult, though the roots somewhat resemble the aconite tubers. Good aconite is usually known by its characteristic benumbing taste. Aconite was introduced into modern medicine by Baron Störck, of Vienna, about 1762.
Chemical Composition.—Besides mannite, cane sugar, glucose, resin, and fats, aconite root contains aconitic acid (H3C6H3O6), usually combined with calcium in the form of calcium aconitate. This acid is also present in a number of other plants. It occurs in plate-like or warty crystals, soluble in alcohol, ether, and water. The most important constituent, however, is the alkaloid aconitine (napaconitine, benzoyl-acetyl-aconine) (C33H43NO12, Wright; C33H45NO12, Dunstan and Ince, 1891; C34H47NO11, Freund and Beck, 1894), for a description of which and other constituents of aconitum usually present in the commercial alkaloid, see Aconitine. Aconite leaves contain, besides aconitine, gum, albumen, sugar, tannin, aconitic acid, an amorphous alkaloid, bitter to the taste, called napelline, which Hübschmann found to be identical with a substance previously isolated by him from another species of aconite (Aconitum Lycoctonum, Linné), and named acolyctine, but considered by C. R. A. Wright to be a decomposition product of aconitine. The tubers also contain a small amount of napelline.
Action and Toxicology.—Aconite is an energetic, acro-narcotic poison in improper doses, occasioning symptoms of gastric irritation, with great depression of nervous energy and brain. The usual effects of an improper dose of either the tincture or powder, are a prickling, or slight thrilling in the mouth and limbs, accompanied with a benumbing sensation, but without, as a rule, coma or convulsions. Several of the following symptoms will soon manifest themselves: Vomiting, perhaps great thirst, sometimes violent purging with painful spasms of the stomach and bowels, sense of great exhaustion, pale face, impaired vision, scarcely perceptible pulse, coldness of feet and legs, and coma, or delirium; and, from paralysis of the respiratory muscles, death follows. These symptoms may vary in different cases, though several of them will always be present. Gastritis and enteritis, with pulmonary and cerebral congestion, are exhibited upon a post-mortem examination.
Locally, aconite and its alkaloid produce a prickling sensation and numbness, followed by an impairment of the sensory nerves, resulting in anaesthesia of the part. Both are very irritating to the Schneiderian membrane and conjunctiva. Aconitine produces the effects of aconite, though in a much more exalted degree. Taken internally, in small amounts, aconite occasions a tingling, pricking sensation of the buccal cavity, fauces, and tongue, followed by more or less numbness. If not too large a quantity has been swallowed, these effects are overcome by a swallow of vinegar (Scudder). The tincture, in non-lethal doses, gives rise to a sense of gastric warmth and a general glow of the surface. Perspiration may be induced and the renal secretions augmented. Pyrexia is reduced when the pulse is frequent and feeble, if the drug be administered in minute doses.
In maximum medicinal doses, it causes gastric heat, which extends throughout the general system, and occasionally the pricking sensations will be experienced, with, perhaps, benumbing feelings; or, these may pass over the whole system, with dizziness, more or less pain in the head, acute pains, excessive depression of the vital forces, with feeble circulation and respiration. Aconitum should never be given in sufficient quantity to produce these effects. A drop of a solution of aconitum in the eye causes the pupil to contract. Larger amounts induce toxic symptoms, the principal of which are increase of tingling and numbness, or thrilling of the mouth and extremities, excessive perspiration rapidly lowering the body temperature, pupillary dilatation, dimness of sight, loss of hearing and the sense of touch, and diminished action of the sensory filaments supplying the skin. Muscular weakness is marked; trembling, and occasionally convulsions may ensue. Excessive depression comes on, and the power of standing is early lost. The feet and legs become cold, the face pale, and the patient has a tendency to faint. There may be violent burning in the stomach, with great thirst and disphagia, and vomiting and diarrhoea may occur. The pulse is weak, rapid, and almost imperceptible; acute, lancinating pain may be felt, and more or less delirium may result, though as a rule the intellect remains unimpaired. The manner in which aconite affects the nervous system is not yet definitely known. That it is a heart paralyzer, seems to be an accepted fact. Death may result from syncope, though usually it occurs from respiratory paralysis. The action of a lethal dose is rapid—toxic symptoms showing themselves within a few moments. The treatment consists in keeping the patient in a recumbent position, with the feet slightly elevated. External heat should be applied, and stimulants (as brandy, ammonia, ether) administered. It is stated that digitalin previously administered, to animals, wholly prevented the toxic action of aconitine (Fothergill); hence digitalis is recommended to antidote aconite poisoning. Tannin (astringents) is said, also, to be an efficient antidote. Inhalations of nitrite of amyl were resorted to in one case with good results. Strychnine, atropine, or strophanthus may be cautiously administered. In no case allow the patient to arise from the recumbent posture, lest death suddenly take place from syncope. The stomach should, of course, be promptly evacuated with the stomach-pump, or emetics and artificial respiration resorted to, if necessary, for the prevention of respiratory paralysis.
Medical Action, Uses, and Dosage.—Therapeutically, aconite is a special sedative, and, according to Prof. J. M. Scudder, is the remedy when there is difficulty in the capillary circulation, a dilatation and want of tone in these vessels, as it moderates the force and frequency of the heart's action, increasing the power of the heart and the tone of the blood-vessels, and hence is advantageous in asthenia and extreme debility; it also has a tendency to lessen pain and nervous irritation. He considered it the remedy incases where there is a frequent but free circulation; where there is an active capillary circulation; and where there is a marked enfeeblement of the circulation, manifested by a frequent, small pulse, a hard and wiry pulse, a frequent, open, and easily compressed pulse, a rebounding pulse, or an irregular pulse. In congestion, especially of the nerve-centers, to relieve coma, and in diabetes insipidus, he associated its administration with belladonna; with the bitter tonics in phosphuria and oxaluria; and with the mineral acids in night-sweats. While it acts upon the excretory organs, increasing excretion, yet it controls excessive activity of these organs, whether of the skin, bowels, or kidneys, and hence its value in summer complaint of children (Ec. Med. Jour., 1868, p. 430).
With the small, frequent pulse, whether corded or easily compressed, aconite is a remedy of wide applicability in asthenic or adynamic states. Our old school competitors assert that aconite should never be given only in sthenic conditions, but their conclusions are evidently based upon the use of too large doses. Given in the minute dose, as employed by our physicians, it tends toward a restoration of normal action. With the characteristic pulse, its action in fevers is to reduce the temperature, generally in the proportion in which it controls the frequency of the heart-beat; if, on the other hand, the temperature be subnormal, as in the cold stage of fevers, congestive chill, or in Asiatic cholera, the minute dose increases the warmth of the body, giving volume and freedom to the pulse, and tending toward a normal circulation.
"If we note its action in active inflammation, we notice that it lessens determination of blood, quiets the irritation, checks the rapid circulation in the capillaries where it is too active, and increases the circulation where it is sluggish. If, as we think, it acts upon and through the ganglionic system of nerves, we can account for all this by saying that it gives right innervation. I have been in the habit of saying that aconite was a stimulant to the heart, arteries, and capillaries, because whilst it lessened the frequency, it increased the power of the apparatus engaged in the circulation" (Scudder, Dis. of Child., 42, 43). It must be remembered that our term sedative differs somewhat from that accepted by other schools. A remedy, such as aconite, which in minute doses will stimulate the vascular system to normal activity, and thereby reduce febrile states by correcting innervation, comes under our class of "special sedatives." As a special sedative, it is useful in all asthenic febrile and inflammatory diseases, and, indeed, in all affections in which there is an increase of nervous, vascular, or muscular action with determination of blood to the parts. In scarlatina, inflammatory fever, acute rheumatism, peritonitis, gastritis, and many other acute disorders, it has been used with the most decided advantage. Added to cimicifuga, it greatly increases the curative influence of this agent in acute rheumatism, and more especially where there is a tendency to muscular spasm. "In cases of pure inflammatory rheumatism, independent of any organic lesion, and with no septic processes going on in the blood, aconite is an absolute specific" (Locke). By its beneficial action upon the sensory nerves, it is a remedy of marked value in various forms of neuralgia. In facial neuralgia, not due to carious teeth, it may be aided by piper methysticum (Webster), and is especially applicable when febrile phenomena are present. In rectal neuralgia, it may be used with aesculus glabra, aesculus hippocastanum, collinsonia, or hamamelis, as indicated; in visceral neuralgia, with aesculus glabra. Its action in neuralgias is not pronounced in most instances when administered alone, but it greatly aids the other indicated remedies, particularly where fever is a concomitant condition. Peridental inflammation is allayed by it.
In simple fevers, aconite aids diagnosis. "If in twelve hours' treatment with aconite the patient is not well, or markedly improved, he has more than a case of simple fever" (Locke). In typhoid fever, it cannot arrest the disease, though it may be used, if clearly indicated, which we believe is rarely; baptisia is a much better remedy here. Rheumatic and intermittent fevers are benefited by it, especially when slight chilly sensations are repeatedly experienced. Gastric fever, with yellow-coated tongue, bad taste, and diarrhoea of undigested aliment, is controlled with aconite in small doses. Its action is marked in many inflammatory skin diseases. In erysipelas, when high fever is present, never omit aconite (Locke). In brain and meningeal disorders, it is frequently of marked advantage. Add to the characteristic pulse a hyperemic state of the superficial cerebral and meningeal vessels, and our case is one for aconite. If there be great excitation, gelsemium will aid its action; if congestion, belladonna. Insomnia, from nervous erethism, points to aconite for its relief. Such a state, bordering upon convulsions, sometimes depends upon teething and gastro-intestinal diseases. Mental perturbation, with fever, and a fear of impending disaster, with melancholia, is said to be relieved by aconite. Webster pronounces it "the pulsatilla of the febrile state."
By its control over the sympathetic nervous system, and its influence on the circulation and temperature, aconite becomes one of the most important remedies in the treatment of respiratory lesions. If the temperature is high, it reduces it; if it be abnormally low, it raises it to its normal standard. It is the remedy for all asthenic inflammatory and febrile conditions, especially in their earlier manifestations. It is the remedy for hyperemia; it is the remedy for loss of tone in the capillary structures resulting in inflammation. Loss of tone in a part causes capillary stasis, which, if allowed to go on, results in congestion, and, continuing, ends in inflammation. Here aconite controls the circulation, allays the irritation, lowers the temperature, and re-establishes the secretions. It acts as a gentle stimulant to the sympathetic system, consequently it has a good influence over irritation and inflammation in the parts supplied by it. Aconite is the remedy for irritation of the mucous surfaces. Acute catarrh, nasal and faucial, acute pharyngitis, and ulcerated tonsils, with elevated temperature, yield to aconite. It is the first remedy to be thought of in tonsillitis, spasmodic and mucous croup, and it is not without value in the pseudo-membranous form of croup. It may be used internally and locally. In spasmodic croup it allays the spasm, and the dyspnoea is quickly relieved. In tonsillitis it materially lessens the duration of the disease. It may be used early by spray, and given internally in small doses. Associated with gelsemium, it is of value in a large percentage of cases of "la grippe." In cases of acute coryza, it controls the febrile phenomena. In pneumonia, catarrhal or fibrinous, it is of signal value in the earlier stage to control the inflammatory process. It is good, though of less value, in the latter stage of the same malady, when bryonia is to be preferred. Its use in acute bronchitis and laryngitis gives good results. In pleurisy it should be associated with bryonia in the earlier stage, with sharp pain, marked chill and high temperature, and the use of the latter agent should be continued to remove the effusions after the acute pains have subsided. It is one of the best agents to prevent acute catarrhal pneumonitis, as a complication of measles, and one of the best to control it in case it does supervene. The remedy should be administered in phthisis, to regulate the temperature, and is very valuable when new portions of the lung tissue are being invaded by the inflammatory process. It is said to give relief in asthma, with high temperature. Give the drug in small doses, frequently repeated, in acute disease; 3 or 4 times a day in chronic conditions.
No remedies surpass aconite and belladonna in the exanthematous diseases, and very frequently no other remedy than aconite will be indicated in scarlatina and measles. Here the hot, dry skin, with vascular excitation, calls for the drug, the temperature falling as soon as the eruption appears, which aconite aids in bringing out. Recent amenorrhoea, due to cold, is amenable to aconite if the circulation and temperature be increased. Disorders of the menopause, with alternate chills and flushes of heat, "with rush of blood to the bead," cardiac palpitation, dyspnoea, gastric fullness, and sense of distension in the bladder, with frequent attempts to pass urine, are relieved by the usual dose of aconite every half hour (Locke). In uterine hemorrhage, as menorrhagia, with hot, dry face and excited circulation, aconite will relieve. In cardiac diseases, it has been employed with good results when there is palpitation, depending upon irritation; and for heart spasm, with a feeling of suffocation and as if the heart's action would cease, it is a prompt remedy.
Aconite is one of the first remedies for gastro-intestinal diseases, and especially the bowel troubles of children. All such disorders resulting from cold, or with inflammation, demand aconite as a part of the treatment. In aphthous conditions, with fever, associate it with phytolacca. It relieves gastric irritation, and may be associated with amygdalus, rhus, and ipecac. Diarrhoea, cholera infantum, cholera morbus and acute gastro-intestinal irritation, usually yield to aconite and ipecac; while in dysentery, aconite, associated with ipecac and magnesium sulphate, is very prompt in controlling the disease. It is often indicated in the diarrhoea of teething.
A hyperemic, oedematous conjunctiva, with a feeling of burning and dryness, are the indications for its use locally and internally in inflammatory affections of the eye and its appendages. It shortens the inflammatory stage and allays pain in acute catarrh of the middle ear, though suppuration can not always be averted. The same result is obtained by its internal and external use in mastoid disease. Locally, aconite has been used in painful and neuralgic states, but is not much employed in this manner by our physicians. The usual prescription is: Rx Specific aconite, gtt. ij to v; aqua, fl℥ iv. Mix. Sig. Dose, a teaspoonful every ½ to 1 hour. Dose: Tincture of aconite, 1 to 3 drops; extract of aconite, 1 to 2 grains; fluid extract of aconite, ¼ to 1 drop; specific aconite 1/20 to ½ drop. The larger doses should seldom be employed.
Specific Indications and Uses.—The small and frequent pulse, whether corded or compressible, is the direct indication; asthenic febrile state, with or without restlessness; chilly sensations; skin hot and dry, with small, frequent pulse; irritation of mucous membranes, with vascular excitation and determination of blood; hyperemia; tonsillitis and laryngitis, early stage; simple colitis.
Related Drugs and Species.—Aconitum Lycoctonum, Linné. This plant yielded Hübschmann two alkaloids, acolyctine (previously called by him napelline) in powdered form, and lycoctonine in crystalline needles. According to Flückiger, it is identical with neither aconitine nor pseudaconitine. Wright regards lycoctonine as identical with aconine, and acolyctine with pseudaconine. Dragendorff and Spohn, on the contrary, state the constituents of this plant to be lycaconitine (C27H34N2O6.2H2O), and myoctonine (C27H30N2O8.5H2O), the former of which, when boiled with water under pressure, splits into a volatile acid and lycoctonic acid (C17H18N2O7), and an alkaloid soluble in ether, lycaconine, and a second one, probably the acolyctine of Hübschmann, soluble in chloroform. Hübschmann's napelline is regarded by Mandel as a mixture of aconine and aconitine in variable amounts. The status of the constituents of the several aconites does not seem as yet to be well understood.
Other tomes: AJP1881
JAPANESE AND CHINESE ACONITE.—This drug consists of the tubers of several species of aconite variously preserved, sometimes, it is said, in child's or cow's urine, or in vinegar, or dried and salted. They are poisonous in varying degree, those of the Aconitum Fischeri, Reichenbach, being regarded as the most virulent. Aconitum Chinense, Siebold, and Aconitum Japonicum, Thunberg, as well as other species, amounting to seven altogether, are said to furnish this kind of aconite. An extremely poisonous principle, japaconitine (C66H88N2O21), has been isolated from Japanese aconite-tubers. It splits into benzoic acid and japaconine, when saponified (see Aconitum Fischeri).
ATIS, or ATIVISH.—Atees, Utees, etc. The tuberous roots of the Aconitum heterophyllum, Wallich, a species growing in the Himalayan country, constitute the atis of East Indian medicine. It is employed in its native country as a bitter tonic and antiperiodic, and is used as a vegetable (G. Watt). Atisine, discovered by Broughton, is the active constituent, and is a non-toxic, intensely bitter alkaloid. Broughton gave it the formula C46H74N2O5. Wright (1878) suggests C22H31NO2 as being more nearly correct. Wacowitz (1879) found besides atisine, probably another amorphous alkaloid, sugar, mucilage, pectin, aconitic acid, starch, and a soft fat, which he thought to be a mixture of oleic, stearic and palmitic glycerides, and an acid resembling tannic acid. Pure atisine is white, amorphous, and exists only in minute quantities in the drug (Dymock, Mat. Med. of Western India).
BISH, BIS, BIKH, BIKLI, or NEPAUL ACONITE.—This variety is chiefly made up of the tubers of Aconitum ferox, Wallich, though Aconitum napellus, Aconitum palmatum, and other species probably contribute a portion. This variety is intensely acrid and poisonous. Its chief active constituent is the extremely poisonous pseudaconitine [feraconitine] (C36H49NO12); and has also been termed, by Ludwig, acraconitine; by Wiggers, napelline; and by Flückiger, nepaline. F. Mandelin (Arch. der Pharm., 1885) believes aconitine and pseudaconitine pharmacologically the same, and regards them as the strongest of known poisons. He also regards japaconitine, aconitine, and benzoylaconine, as identical. Pseudaconine (C36H49NO12+H2O), a new base formed by the saponification of pseudaconitine, and aconine (C20H39NO11), one of the saponification products of aconitine, are regarded by the same investigator as either identical or homologous, and both poisonous, though less so than aconitine and pseudaconitine. Mandelin also believes that the difference in the poisonous effects of Aconitum ferox and Aconitum napellus depends wholly upon the relative amount of aconitine present in the two plants, and not upon any difference in virulence of the active principles of either. (See Dymock, Mat. Med. of Western India). Dymock states that Hindu authors mention "eighteen kinds of Bish, or poison," ten of which are too poisonous for medicinal use; also, that the word bish appears to have been applied "to any very poisonous root."