Aconitum Napellus. (Aconite)
Preparation.—A tincture of the root (imported from Germany) is the strongest and most uniform preparation. It should be prepared by percolation, the strength being ounce for ounce; though, if constantly made in the office, it will be easier to make it ℥viij. to the pint, the dose being proportionately increased.
The medium dose two-thirds of one drop, and the form of administration: Rx Tincture of Aconite Root, gtts. xx.; Water, ℥iv.; a teaspoonful every hour in acute disease, every two or three hours in chronic disease. To a child two years old the proportion is gtts. v. to Water ℥iv.
Aconite is a stimulant to the sympathetic system of nerves, and increases the power of the heart to move the blood, at the same time that it places the blood-vessels in better condition for its passage. It will be recollected that the same system of nerves governs the movements of the heart and of the entire system of blood-vessels. What will influence one, therefore, will influence the other in the same manner.
But Aconite is said to be a sedative; and by a sedative we are to understand a remedy that diminishes the frequency of the pulse. How can Aconite, therefore, be a stimulant and a sedative ?
There is no doubt but that Aconite is one of the most certain remedies we have to reduce the frequency of the pulse in certain conditions of disease. And the condition is that in which there is a want of power on the part of the heart, and a like want of innervation to the capillary system of blood-vessels. Aconite in small doses lessens the frequency of the pulse, because it removes obstruction to the free flow of blood in the vessels, and gives greater cardiac power.
We employ it in all forms of fever, to control the circulation, and diminish the temperature. Used in the doses named, it gives greater freedom to the circulation, at the same time that it diminishes the frequency of the pulse. It seems to remove obstruction to the free circulation of the blood, at the same time that it removes irritation of the cardiac nerves, and gives increased power to the heart.
Its action in inflammation is as pronounced as in fever. It directly antagonizes inflammatory action, and in the early stage will arrest it speedily—if this is the sedative indicated.
There are some diseases of an inflammatory character to which Aconite is specific, that deserve mention. The first of these is Tonsillitis, in which we employ it by internal administration, or better by the use of the steam atomizing apparatus. In some forms of mucous croup, with enfeebled circulation, in muco-enteritis, and in simple colitis or dysentery from cold, I never think of making any other prescription.
To point out the special indications for the use of Aconite I can not do better than reproduce the editorial in September Journal of 1868 on the "Differential Therapeutics of Veratrum and Aconite:"
To determine which of a class of remedies is applicable in a given case, is the most difficult task of the physician, and any information in this respect is of much value. I doubt whether any one using the two remedies named, would be willing to risk giving this estimate. Many may have an empirical intuition in regard to it, but most could venture nothing but a guess.
In general terms, Veratrum is the remedy in sthenia, Aconite in asthenia; but there are too many exceptions to this to make it a safe rule for our guidance.
Veratrum is the remedy where there is a frequent but free circulation. It is also the remedy where there is an active capillary circulation, both in fever and inflammation. A full and bounding pulse, a full and hard pulse, and a corded or wiry pulse, if associated with inflammation of serous tissues, call for this remedy.
Aconite is the remedy when there is difficulty in the capillary circulation, a dilatation and want of tonicity of these vessels, both in fever and inflammation.
It is the remedy for the frequent, small pulse, the hard and wiry pulse (except lit the cases above named), the frequent, open and easily compressed pulse, the rebounding pulse, the irregular pulse, and indeed wherever there is the evidence of marked enfeeblement of the circulation.
It is the sedative I associate with Belladonna in congestion, especially of the nerve centers, and to relieve coma. Whilst I would use Veratrum with Gelseminum in determination of blood to the brain, and in active delirium.
Veratrum acts more efficiently upon the excretory organs; indeed I believe it to he one of the most certain remedies we have to increase excretion. Hence it is employed with great advantage for those purposes usually called alterative.
Aconite controls excessive activity of the excretory organs, whether of the bowels, kidneys or skin. Thus it is our most certain remedy in the summer complaint of children, associated with Belladonna in diabetes insipidus, with the bitter tonics and Strychnia in Phosphuria and Oxaluria, and with the mineral acids in night sweats.