ON

#

THE MEDICAL PROPERTIES

OF

THE NATURAL ORDER

RANUNCULACER

e
?
AND MORE PARTICULARLY ON THE

USES OF SABADILLA SEEDS, DELPHINIUM STAPHISAGRIA,
AND ACONITUM NAPELLUS,

, AND THEIR ALCALOIDS,

VERATRIA, SABADILLINE, DELPHINIA, AND.
ACONITINE.

BY A. TURNBULL, M.D.

PHILADELPHIA: |
HASWELL, BARRINGTON, AND HASWELL.
1838.

PREFACE.

TuE greater part of the contents of the following pages
has been already laid before the profession, and the object
the author has in view at present, is to give a connected
account of the new medical properties, which he conceives
to reside in many of the plants belonging to the natural
order Ranunculacee, and more particularly as they are
found in Sabadilla seeds, in the seeds of the Delphinium
Staphisagria, and in the root of several species of the genus
Aconitum. The properties alluded to, are those possessed
by preparations of the plants above mentioned, when ad-
ministered internally, of exciting sensations of heat and
tingling on the surface of the body, and of producing similar
effects locally when rubbed upon the skin, without, in most
instances, giving rise to irritation of the vascular system;
_and when exhibited in either way in certain painful diseases,
as Neuralgia, Rheumatism, and Gout, of alleviating or
removing the pain, apparently by exerting a peculiar effect
upon the nervous system, unattended by any narcotic
influence. |

These effects are more certain and exist in a higher
degree of energy in the active principles obtained from the
plants, and on this account the author has bestowed more
attention on them, and, in most cases, would give them
the preference as medicinal agents. He has also dwelt
more fully upon the effects produced by them when ap-
plied to the surface, than when exhibited internally, because
experience has shown, that by the former method, a quan-

A . PREFACE. —

tity sufficient to remove disease may be introduced into
the system, whilst at the same time, in topical affections the
remedy may in this manner be applied over the seat of
the disease; but when the affection is more general 1m its
character, the internal use, or both methods combined,
will be found most advantageous. :

The author would caution the profession against expect-
ing too much from the employment of these remedies. In
some cases they have given only a temporary relief, whilst
in others they have had no effect: but generally speaking
he has found them of much more advantage in the treat-
ment of a very distressing class of affections, than any means
hitherto discovered, and on this account he would recom-
mend their use. |

Russell Square, June 1st, 1835.

CONTENTS.

PAGE

Introduction: 4.26.31) 9. ee, ee

CHAPTER I.

Medicinal Properties:of’ Sabadilla Seeds)... 592.2. 25.92
Breparation@oft V erairiay “0, ee ee LO
Internal Administration of Veratria and its Salts . .. .. . 21

External, Application offVeratria 2... . 9 9 LD
‘inc Affections: ofthe Heart): 2. =. 4 ba
in. Neuraleic: Affections’ =... « . ie 27
in Rheumatism . ... : = Wa ademas tad. : Riay BW
In GoOUb ee. ee Oe AER Meee oe cmmeg ae mer eA
in, Dropsy, and: Paralysis: .0).. 3. 9g. er a4
Properties of the Constituents of the Veratria of Commerce, viz:
Veratrine, Veratrin, Sabadilline, Mono-hydrate of Sabadilline . 47

CHAPTER IL.

Medicinal Employment of Delphinium Staphisagria, and its Active
Brinciples Delphiniaggri.. 5 -uivees oe Bod ce fod oko eens
Preparation ef Delphinia (ro (hh a re see A
Internal Administration of Delphinia and its Salts . . . . . . 50
External Application of Delphinia 3.) ee

6 | CONTENTS.

CHAPTER Ill.

3 PAGE
Medicinal Employment of the Genus Aconitum, and its Active
Marncinlem ACONIINC | eee ee 53
Processes for preparing Aoatiting fh REA Aa ae ea oie
External Application of Aconitine ©. . + + + + + +s + 56
| _ of Ammoniated Extract ofAconite . . - + + «+ ; 59
Severe Case of Neuralgia of the Finger, cured by Preparations of
INCOMILC Ny coe haat 60
St. Thomas’s Hospital Report . . . - - +--+ + + +--+ 866
Appendix—Cases communicaied to ie Author... 7... 69

ON THE MEDICAL PROPERTIES

oF THE NATURAL ORDER |
BAN UN CURE ae
AND OF THE ALCALOIDS,

VERATRIA, SABADILLINE, DELPHINIA, AND ACONITINE.

Or the three plants, whose medicinal properties it is intended to
give an account of in the following pages, two, the Delphinium
Staphisagria and the Aconitum Napellus, belong to the extensive
family ranunculacee ; and with regard to the third, the plant
which yields the Sabadilla seeds, little appears to be ‘known, by
which its precise character and situation in botanical arrangements
can be determined. It has been supposed to belong to the class
Colchicacex, but as in some of its medicinal properties it is much
more allied to the ranunculacez, it isintended, for the sake of con-
venience, to speak of it as belonging to this latter class, until our
knowledge of it becomes more definite.

The natural family ranunculacex, asa whole, exhibits consider-
able uniformity ; but nevertheless, some discrepancy occurs when
its parts are more minutely examined. Many of the individuals
are acrid and caustic in the highest degree, whilst others are aromatic,
as the Megella Sativa, which in consequence of its taste is some-
times used as a pepper. In some again, the properties they possess
are owing to an active principle which can be separated by che-
mical processes ; whilst in others, as for instance, in almost the
whole tribe of ranunculuses, these are destroyed by drying and
boiling, or even by simple infusion in water, whilst they are aug-
mented by acids, honey, sugar, wine, alcohol, &c.* The acrid @le-
matis Vitalba is used as an article of food after being boile , by
the country people in the north of Italy, and the Ranunculus
aquaticus is sometimes given to cattle after being deprived of its
acrimony by drying. The general properties of the family may be

* Decandolle Essai sur les Propriétés Médicales des Plantes.

§ TURNBULL ON RANUNCULACE,

thus stated ; Acrid and vesicatory, e. g. many of the ranunculuses,
Clematis recta, Knowltonia Vesicatoria, &c., which are used as
blisters. Acrid, stimulant, cathartic, emetic, e. g. the roots of dif-
ferent species of Hellebore, Delphinium Staphisagria, &c. Bit-
ter, tonic, antispasmodic, e.g. Zanthoriza apitfolia, Hydrastis
Canadensis, Pxonia officinalis. Along with the acrid prin-
ciple there exists a powerful narcotic property in the Aconites ;
some of the acrid plants, as the Ranunculus Glacialis, are sudorofic,
and others are diuretic and vermifuge.

In addition to these, there is another class of properties, which exists
in the Delphinium Staphisagria, some species of the Aconites, and
in the Sabadilla seeds, and in a more marked degree in the alca-
loids prepared from these plants; namely, the Delphinia, Aconi-
tine, and Veratria ; and there can be little doubt, that further inves-
tigation into the medicinal action of the ranunculaceex, will in-
crease the number of the individual plants which possess such
properties.

When preparations of the species above mentioned, or their alca-
loids, are exhibited internally in small and repeated doses, they give
rise to peculiar effects on the nervous system, but more particularly
upon the nerves of sensation. ‘These consist of heat, and tingling
on the surface of the skin, beginning generally in the extremities,
and extending themselves towards the trunk and head, and some-
times ending in perspiration ; and in rheumatic and other painful
affections, these sensations are attended by marked relief to the
patient. The same effects are produced, but more locally, when
the active principles and other preparations of the plants are applied
by friction over the seat of the disease ; heat and tingling are like-
wise induced ; at first only in the part where the friction has been
made, but afterwards extending itself over the skin. In affections
which are topical in their nature, these peculiar feelings are also

_ attended by great diminution in the severity of the symptoms, and
often by a removal of them after every other means have failed.

It would be an interesting question, to determine in what manner
such effects are produced : but as yet nothing has been made out,
that is calculated to throw light upon the subject. All that can be
said, is, that they are matters of observation, and it is quite sufficient
for the purpose of the practitioner that they are so, for it is upon
such evidence that a great part of our practice is founded. It is to
this latter class of properties, then, that it is the author’s wish to
direct the attention of the profession ; and in doing so he may be
allowed to express his conviction, that if the directions and illus-
trations to be given, be sufficiently explicit to enable the profession

to employ the remedies he recommends, the results will be satis-
factory,

USES OF SABADILLA SEEDS. 9

CHAPTER L
Medicinal Properties of Sabadilla Seeds.

ConsIDERABLE difference of opinion exists, as to the precise
plant which yields the Sabadilla seeds. Some authors are of opin-
ion that they are the produce of different species of Veratrum ;
the V. Sabadilla, V. Ovbilia, and V. Officinale—others, of the
Vellozia Squamata ; and lately the plant has been considered as a
species of Xerophyllum, the X. Sabadilla. It is a native of Mex-
ico; it has been placed amongst the Colchicacex, but in some of
its properties it appears more nearly allied to the Ranunculacee ;
very little that is certain, however, is known regarding its history.
The seeds are dark-coloured, rugous and slightly curved, and are
contained in a light brown capsule about half an inch in length.
They are without smell, but have an acrid burning taste. When
given to animals in sufficient quantities to produce poisoning, their
effects are marked by great irritation in all the mucous membranes, .
particularly in the intestinal canal, in the mucous membrane of
which they excite inflammation by whatever manner the poisonous
matter may have been introduced ; and along with this effect, great
disturbance of the nervous system comes on before death.

They have been used medicinally in the form of powder, ointment,
and infusion for destroying pediculi, and internally for removing
teenia, and for the cure of hydrophobia.* :

I have employed two preparations ; the tincture and extract,
made from Sabadilla seeds, with considerable advantage in some cases.
The tincture made use of is a saturated one, prepared by digesting
for ten days a quantity of the seeds, freed from their capsules and
bruised, in as much strong alcohol as will cover them. It forms a
useful rubefacient in chronic rheumatism and paralytic cases, and
has a tendency to bring outa slight eruption on the skin after it
has been rubbed for some days. It produces, in a very marked
degree, a tingling sensation, similar to that caused by Veratria; and
friction with it ought always to be continued until this effect is
brought about at each application. |
- When rubbed over the heart, this tincture has in some instances
the effect of reducing the frequency and force of the pulse, in a
marked degree, and has often appeared useful in cases of nervous
palpitation. 3 :
The extract is prepared by evaporating the saturated tincture made
as above directed, with a very gentle heat, to a proper consistence.
When given internally in small doses, it has nearly the same effects

* Hardy’s Travels in Mexico.
JANUARY, 1838.—B 2

{

10: TURNBULL ON RANUNCULACE,

as Veratria, and may be employed with advantage in painful rheu-
matic and neuralgic affections. One sixth part of a grain, made into
a pill, and given three or four times a day, appears to be the proper
dose, and it should be continued, and gradually increased in quantity
according to circumstances. This preparation alsoinduces sensations
of heat and tingling on the surface of the skin, and sometimes acts
as a diuretic.

Preparation of Veratria.

Veratria, the active principle of the Sabadilla seeds, was discover-
ed by MM. Pelletier and Caventou, in the year 1819,* and about
the same time in Germany by Meissner and Van Mons. In their
subsequent investigations, the two first-named chemists detected the
presence of asimilar principle in the bulb of the Colchicum Autum-
nale,and in the root of the Veratrum Album: the substance
obtained from the colchicum, however, has since been discovered by
MM. Geiger and Hesse, to differ from Veratria in several important
particulars, to be afterwards noticed, and they have in consequence
considered it as a new principle under the name of Colchicine.t
The true nature of the alcaloid extracted from the white hellebore,
- is still unknown ; so that the Veratria of commerce may be consi-
dered as being obtained entirely from the Sabadilla seeds.

Until very lately, Veratria, as obtained according to the processes
employed by its discoverers, was considered to be a simple body; but
from the recent investigations of M. Couerbe, it appears to consist of
four distinct substances, to which he has given the names Veratrine,
Veratrin, Sabadilline, and Mono-hydrate of Sabadilline; and these
are obtained separately in the following manner :—A_ concentrated
tincture, made by digesting Sabadilla seeds with boiling alcohol, is
slowly evaporated to the consistence of an extract, which is next
dissolved in water acidulated with sulphuric acid, and the solution
filtered, after being heated to the boiling temperature. The liquor
obtained, holds dissolved in it the four substances above-mentioned,
along with a quantity of colouring matter. By the addition of potass,
they are all precipitated, and the precipate is to be re-dissolved in
alcohol, and the tincture thus obtained is evaporated to the consis-
tence of an extract, and this again dissolved in acidulated water, as
before. ‘The addition of potass to this solution, throws down a
light-coloured precipitate, which, when dried, is nearly white, and
constitutes the Veratria of commerce. As thus obtained, it is acrid,
alcaline, and forms incrystallizable salts with acids.

This substance, however, is still in an impure state, and is again
to be dissolved in water acidulated with sulphuric acid. To this
solution nitric acid is to be added, so as to throw down an abundant
dark-coloured precipitate. The liquid is next poured cautiously off,
and a solution of potass or ammonia is added, drop by drop, as long

* Journal de Physique, 1819. ¢ Journal de Pharmacie, 1834.

PREPARATION OF VERATRIA. AEE

as any precipitate is formed. The precipitate is next to be washed
with cold water, and dissolved in alcohol, and the tincture evaporated
to the consistence of an extract. 2 |

_ By treating this extract with boiling water, the Sabadilline and
Mono-hydrate of Sabadilline are taken up, and the other two _ prin-
ciples left undissolved. The solution, on cooling, deposits the Sa-
badilline in crystals, and the Mono-hydrate is obtained by slowly
evaporating the remaining liquid in vacuo. The portion of the
extract left undissolved by the water, is next treated with ether,
which takes up the pure Veratrine, and leaves the Veratrin.

The Veratria of commerce is then a very complicated substance ;
but as it is the only form which has yet been introduced into medi-
cine, the remarks which are to follow are applicable, at least so far
as we yet know, to it alone. Itis prepared in the form of a fine
subtile powder, varying in colour from light brown to nearly white’;
it is very sparingly soluble in water, but sufficiently so to communi-
cate a sensibly acrid taste to the fluid. It is very soluble in alcohol
and ether. It is insoluble in alcalis, but combines readily with acids,
and forms incrystallizable salts. It restores the blue colour of litmus
paper, reddened by acid. When heated, it melts, and has the ap-+
pearance of wax; and on cooling, presents a mass of a brownish
transparent appearance.

It is destitute of smell, but when brought in contact with the mu-
cous membrane of the nose, it occasions violent sneezing ; when
applied to the conjunctiva, it excites considerable irritation, and
causes an abundant flow of tears. Its taste is extremely acrid, but
destitute of bitterness. : 3

According to the experiments of MM. Magendie and Andral,
Veratria acts on animalsas a powerful irritant, occasioning rapid in-
flammation in the lining membranes of the cavities into which it is in-.
troduced ; ending in tetanus and death.* There is some discrepancy,
however, betwixt its effects upon the intestinal canal, as observed
by M. Magendie, and those that have come under the author’s ob-
servation, and which shall now be noticed.

Internal Administration of Veratria and its Salts.

The acknowledged value of colchicum autumnale in the treat~
ment of a variety of diseases, appears to have given rise to consi-
derable expectations that the discovery of the active principle of the
plant would be of great advantage to medicine ; and accordingly
we find, that no sooner had MM. Pelletier and Caventou succeed-
ed in obtaining Veratria, than a number of experiments were in-
stituted, with a view to determine its action upon the animal econo-
my. These were principally conducted by MM. Andral and Ma-
gendie, and agreed in proving it to be possessed of most energetie
properties, and similar, though in a more exalted degree, to those

* Magendie, Journal de Physiologie, tom. 1.—Formulaire.

‘yg TURNBULL ON RANUNCULACES,
ascribed to white hellebore, sabadilla seeds, and colchicum, by Scha-
bel, Orfila, Sir Everard Home, and other observers. Unfortunately,
however, these properties appeared to be of such a nature as almost
to preclude the possibility of Veratria ever being employed in me-
dicine. From M. Andral’s experiments on animals, it was proved
‘that when applied directly to any of the tissues, it produced rapid
inflammation of the part ; and that when introduced in small doses
into the system, either through the medium of the veins or intes-
tines, it occasioned violent vomiting aud purging; and in larger
doses, tetanus and death.

M. Magendie administered it internally in the human subject, and

found that,in the dose of a quarter ofa grain, it acted powerfully upon
the intestines, and produced very copious dejections ; and he recom-
mends its employment on this account, as a convenient remedy in
‘cases requiring a speedy action upon the bowels, particularly in old
men, in whom he states his having used it with much advantage ;
he also advises its substitution for the preparations of colchicum, in
the treatment of those diseases in which they had been employed.
‘Such, however, was the dread inspired by the observed properties
of the new alealoid, that few practitioners ventured upon a trial of
it; and much surprise was expressed that, with these before his
eyes, M. Magendie should have ventured upon such a dangerous
recommendation. 7

Veratria has hitherto been little employed internally in this
country ; but where it has been used, the effects produced have
been nearly similar to those already recorded by practitioners on
the Continent ; and agree with them in proving it to be possessed
of great activity as a purgative and emetic : so much so, indeed, that
its administration appears to have been very generally abandoned,
as being fraught with greater danger, from this circumstance, than
_ could have been counterbalanced by any good effect that might have
arisen from it. This was also the author’s opinion at the time his
work on Veratria was published ; and as the impressions he had
received from the writings of others had to a certain extent been
confirmed by his own experience, he considered it his duty to lay
them before the public. Since then, however, he has employed
pure Veratria internally to a. considerable extent, in consequence of
having observed that its salts produced none of those effects which
_ had been ascribed to it, and in very few cases out of a great many in
which it has been employed, eyen when given to the extent of four
or SIX grains in twenty-four hours, has it produced the slightest
purgative effect : it has often occasioned a degree of nausea, but this
may easily be obviated by taking care that too large a dose be not
given at one time, .

To what are we to ascribe this great discrepancy in the operation
of so powerful a substance? It may arise from one of two causes,
or perhaps from both. Veratria, when first used, appears to have
been obtained in part from the colchicum autumnale, and on this,
account differed in some material points from the alcaloid, as it is,

INTERNAL ADMINISTRATION OF VERATRIA, ETC. 13

now prepared from the seeds of the Veratrum Sabadilla: so much
so, that it has been described as a new principle by MM. Geiger
and Hesse, under the name of Colchicine —one of the most
prominent properties of which, according to those gentlemen, is to
produce violent purging and then vomiting.

T'wo counter-experiments are related by them: in one of which
a small dose of Colchicine was given to a cat: at the end of an
hour it was violently purged ; vomiting next came on, and then
death ; and upon examination, it was found that violent inflamma-
tion had taken place in the stomach and intestinal canal, with san-
guineous infiltration throughout their whole extent. The second
experiment was made upon a younger cat, and a smaller dose of
Veratria was administered : the animal died very speedily, but
neither vomiting nor purging are mentioned as having been pro-
duced: and upon examination, it was observed that the superior
part of the cesophagus was the only portion of the alimentary tract
where inflammation had taken place ; and it was remarked that this
part had escaped injury in the animal which had been poisoned by
the Colchicine.* These facts might of themselves be sufficient to
account for the great difference in the observed action of Veratria
above alluded to; but it ought also to be kept in mind, that it is
very probable the alcaloid, from the large quantity which has been
lately brought into the market, may now be made ina state of
greater purity, from that dexterity in its manufacture which prac-
tice alone ean give. Whichever explanation of the circumstance
may be adopted, it certainly appears that pure Veratria, or any of
its salts, may be substituted for preparations of colchicum, not only
with perfect safety, but with considerable advantage, provided an
ordinary degree of caution be observed in its exhibition.

The best form of administering it is that of pill ; and the follow-
ing prescription is the one I generally make use of :—

R—Veratriz : : : 6 : : : : or. ii.
Pulv. Rad. Glycyrrh. . . ° : : ‘ pr. Xil.
Ext. Hyoscyam . - . : : : or. Vi.
M. fiat mass. in pilul. aequal. duodecim. divid. quarum sumat unam ter in die.

For the two last ingredients it will sometimes be found advan-
tageous to substitute a few grains of compound rhubarb pill, espe-
cially when there is a tendency to costiveness. ‘This prescription [
have found very useful in the treatment of painful spasmodic affec-
tions, rheumatism, gout, &c. It has also been used in diarrhoea with
considerable effect ; and in this disease one pill ought to be given
after each stool, until the relaxed state be removed. After a few
doses have been taken, the patient generally experiences a sensation.
of warmth in the stomach, which extends over the abdomen, chest,
and upper and lower extremities : this is succeeded by a feeling of |
tingling in various parts of the body, and frequently a degree of
perspiration is induced.

Veratria has been combined with several acids ; but the only

* Jour. de Pharmacie, Mars 19834. 7
Q%

14 TURNBULL ON RANUNCULACES.

products as yet obtained that are fit for administration, are the sul-
phate, tartrate, and acetate. | |

According to Professor Turner, and M. Courbe, they are crys-
tallizable, when prepared from pure Veratria ; but the difficulty in
obtaining them in this state must, for some time at Jeast, render it
necessary to make use of the more common and more easily pre-
pared form. In this condition they have, when solid, very much
the appearance of resins; they-are friable, and- can be reduced to a
fine powder, which is of a brownish aspect. They are all very
acrid when applied to the tongue, and leave a sensation of heat and
tingling in the part of the mucous membrane with which they may
have been brought in contact. |

When given in the doses to be presently mentioned, like Vera-
tria itself, they in general give rise to the following effects: a sen-
sation of warmth in the stomach, which gradually extends itself over
_ the abdomen and lower part of the chest: after the dose has been
repeated once or twice, the same feeling is experienced in the lower
extremities, and particularly in the feet ; the upper extremities and
head become also affected in the same manner : and if the medicines
be pushed further, a sensation of tingling, exactly similar to that
eaused by frictions with Veratria ointment manifests itself in vari-
ous parts of the body, and sometimes over the whole surface of
the skin ; this is generally accompanied by considerable perspira-
tion, and some feeling of oppression, and all these effects are aug-
mented by heat, or by the use of warm diluents. To this sueceeds
a sensation of coldness; and should their administration be still
continued, the stomach becomes affected, and a degree of nausea
takes place, followed by vomiting. In a few instances only have
they acted as diuretics, and in still fewer as purgatives. No nareotic
effect has been observed to arise from their use.

In their action upon disease, the salts of Veratria, when given
internally, are possessed of powers very similar to those exercised
by the base when rubbed upon the skin. The particular diseases in
which they appear to be of most service, are tic douloureux, gout,
and rheumatism, especially in the two first named. In the treat-
ment of these, any of the salts may be employed ; but the tartrate
1s upon the whole to be preferred, as it is less liable than the others
to give rise to irritation of the stomach ; either of them, however,
may be had recourse to with safety. The best method for exhibiting
them is the form of pill, made according to the following preserip-
fion 3 :

R—Tart. Veratrie . , ; Seteaenelt 6 5 on. li.
_ Pulv. Rad. Glycyrrhiz. Sie dit - - ‘pr, Xil.
Mucilag. Acaciae q- 8. Misce

bite et divide in pilulas equales duodecim, quarum sumat unam tertia quaque
ora,

The dose of the tartrate ordered above is sufficient to begin with,

and it may be augmented, until the quantity given amounts to a
grain and a half, or two grains in the course of the day : beyond

EXTERNAL APPLICATION OF VERATRIA. 15

which it will not be necessary to push the medicine, as its peculiar
effects in general show themselves before that quantity is used.
Should the sulphate or acetate be preferred, the doses administered
ought to be rather less, as these act more readily upon the stomach
than the tartrate. M. Magendie has suggested the form of solution
for the employment of the sulphate, but it is a very objectionable
one, both on account of its taste, and from the disagreeable sensations
left by it in the mouth and pharynx, which often are of such a na-
ture as to oceasion nausea and vomiting. | |

In any case in which it may be desired to make use of the salts of
Veratria, the plan that appears the best to be followed, is to adminis-
ter a pill every three hours, until the sensation of heat and tingling
manifests itself, and when this takes place, some alleviation of the
pain will in general be observed ; but should this not be the case,
the treatment ought to be persevered in, until it has had a fair trial,
the dose being at the same time augmented accordingly as the pa-
tient can bear it. In some instances, it has not been found necessary
to continue the pills above a few days, whilst in others, a week or
two has been required to produce their full effects ; and in almost
every case, it has been requisite to regulate the bowels, by means of
gentle aperients, to obviate the constipation which often comes on
during their use. When the disease occurs in regular paroxysms,
the pills ought to be resumed an hour or two before the expected
time of attack. | 7

External Appitcation of Veratria.

Veratria may be applied externally, either in solution, in alcohol,
or made into an ointment with hog’s lard: the latter form is the one
which has been: most generally employed; but where unctuous
applications are objected to, an embrocation made by dissolving from
ten to twenty or more grains of Veratria, in an ounce of boiling
alcohol, if applied in the same manner as the ointment, will prove
equally efficacious.* The ointment may be made with similar
proportions of the alcaloid to an ounce of lard, and of this, a piece,
the size of a large nut, may be rubbed with the hand from five to
fifteen minutes, night and morning, as nearly as possible, over the
seat of the disease, until relief from the urgent symptoms be expe-
rienced ; care being taken to observe that the skin over which the
friction is to be made, be free from injury, otherwise considerable
irritation of the part will ensue; and for reasons already given, the
person who applies either form, must be careful not to insert even the
smallest quantity under the eyelids.

M. Magendie appears to have been the first person who suggest-
ed the external application of Veratria in rheumatism, gout, and
anasarca ; but his proposition does not seem to have been complied

~* In cases where the skin is irritable, the proportions of Veratria employed,
must be smaller than those now given.

16 TURNBULL ON RANUNCULACE.

with, neither does he himself appear to have been fully aware of its
importance in a medicinal point of view ; and indeed, the weakness
of the preparations recommended by him, even had they been made
use of, must have prevented the striking effects produced upon cer-
tain diseases by the Veratria, when more freely employed, from
coming under his observation.

The skin over which the ointment has been rubbed, in general
shows no mark of irritation, even after the friction has been conti-
nued for some length of time: sometimes an evanescent blush per-
vades the surface, and in rare instances a quantity of eruption has
appeared upon the part, but these bear only a small proportion to
the cases in which no such effects are produced. When a small
quantity of the ointment is rubbed in, the patient generally experien-
ces a considerable degree of warmth and tingling in the part, and
until this takes place, the peculiar effects of the medicine never mani-
fest themselves; the circumstance, therefore, is one worthy of atten-
tion, and may serve as a criterion whereby to estimate the extent to
which the friction may be carried without producing inconvenience,
and also to judge of the degree of purity of the Veratria employed ;
for when, as is sometimes found to be the case, the medicine is mixed
with impurities, these sensations are not produced, and its action is
by no means either so certain or powerful as when it is free from
adulteration. This last observation appears necessary to prevent the -
practitioner from laying a charge of failure against it in cases where
the impure Veratria may have been made use of in compounding
the prescription.* :

After the ointment has been applied a sufficient length of time to
put the constitution completely under its influence, the feeting of
heat and tingling extends itself from the place where the friction
may have been made, over the whole surface of the body, and pro-
duces sensations similar to those which have been already described
as arising from the internal use of Veratria and its salts.

The sensibility of the parts over which the application has been
made, is increased so as to render them peculiarly susceptible of the
presence of certain stimuli, particularly electricity or galvanism ;
these agents have in some instances been applied along with the
Veratria ointment, but have given rise to sensations so acute as to
render their further employment almost insupportable, and that
without the slightest perceptible alteration of the surface.

Such are a few of the more remarkable effects resulting from the
application of the Veratria to an entire surface, and in the great ma-

Jority of cases these will be found sufficient for every purpose which

* Pure Veratria is entirely soluble in aleohol, and burn
residuum ; but, perhaps the simplest and. best test is t
drachm of alcohol, and to rub a small quantity of this
forehead ; when the Veratria is good, the heat and tin
after the friction has been continued for two or three

time required to produce this effect affords a tolerably
cacy of the medicine.

S without leaving any
o dissolve four erains ina
solution on the wrist or
gling manifest themselves
minutes, and the length of
correct estimate of the effi-

\

EXTERNAL APPLICATION OF VERATRIA, ETC. 17

they are intended to serve: in some affections, however, in which
the symptoms are more severe, or which are seated in parts only
thinly covered by integuments, the attempt has been made to apply
it directly to a part denuded of the cuticle, but although the effects
upon the disease were much greater than when the surface remained |
unbroken, yet the extreme irritation which followed the practice
rendered its repetition impossible.

External Application of Veratria in Affections of the Heart.

When any of the preparations of Sabadilla or Veratria are adminis-
tered in repeated small doses by the mouth ; besides exerting their
peculiar effects upon the nerves of sensation already mentioned, they
‘act also upon the circulating system. In many instances the force
and frequency of the pulse are remarkably diminished by them, and
the circulation is rendered more regular; whilst in others, a contrary
effect is produced. This appears to be the result of the influence
exerted by the medicine on the nervous system, for it takes place
chiefly in those whose nerves are easily excitable ; in some cases,
also, in which organic disease of the heart has been present, the
internal exhibition of one or other of the preparations has afforded
the patient considerable relief, but apparently, not so much by acting
upon the nervous system, as upon the kidneys, and thus removing
some effusion existing in the chest, and which was the immediate
cause of the aggravated syrnptoms.

Precisely the same effects are produced, when Veratria ointment,
or the tincture of Sabadilla, are rubbed over the region of the heart,
though perhaps not in so great a degree. This latter method,
however, of employing Veratria, is upon the whole the preferable
one, as in many cases the stomach might be incommoded by the
internal use of it, and in addition to its action on the heart, there 1s
also another exerted, when it is applied to the skin, namely, the
tingling, which of itself appears to have a beneficial effect, especially
in nervous cases, probably by acting as a counterstimulant, whilst
the quantity absorbed during the friction is sufficient to produce its
other effects on the system. | |

From the observations which I have made on the action of
Veratria in affections of the heart, I have been led to conclude, that
there are some cases in which the symptoms may be removed by
its use, though of a class that might have been considered as indiea-
ting confirmed organic disease; amongst the following, will be
found instances of this kind, and others could have been given;
these have occurred in patients in whom a gouty or rheumatic
diathesis has been present, and this fact may perhaps afford some
explanation of the effects of the remedy.

There are, then, three states of disease, in which the oimtment
may be tried: namely, simple nervous palpitation ; in the same
affection occurring in gouty subjects; and as a diuretic in eases of
organic disease, though of course in instances of this kind any

18 TURNBULL ON RANUNCULACE.

relief which it may give, can at best be only temporary; it has,
nevertheless, given relief, and if it should do no good it will at least
do no mischief. |

The application best adapted for this class of affections, consists
of fifteen or twenty grains of Veratria, made into an ointment with
an ounce of lard, and of this a piece the size of a nut, should be
rubbed over the region of the heart for five minutes every night,
and it may be continued according to the effect produced.

CASE I.

A apy, fifty-five years of age, was attacked seven years ago
with what her medical attendants considered to be an inflammatory
affection of the lungs, and for which she was profusely bled, and
otherwise actively treated. The violent symptoms were by these
means removed ; but there still remained a degree of weakness and
affection of the chest, sufficient to confine her almost constantly to
her room for nine months afterwards. Since that time, she has
_ recovered considerably, but has been under the necessity of remain-
ing in an apartment, kept at an equable temperature, during the
winter; and with the prospect of being obliged to continue the same
regimen for the remainder of her life. i

Throughout the whole seven years she has had constant cough,
attended with scanty mucous expectoration: a difficulty of breath-
ing so great, as to prevent her sleeping at night, or even remaining
in the recumbent posture for any length of time without bringing
on distressing fits of coughing: respiration very much hurried, and
the lips of a purplish hue: pulse so small, rapid, and irregular, as to
render it difficult to ascertain the number of its beats. Over the
region of the heart, and over a great part of the anterior surface of
the thorax, there was a very perceptible undulatory motion, al-
together different from ordinary pulsation; and the ear, applied to
the chest over the same region, distinguished the heart’s action to
be extended, indistinct, and undefined in character. Along the
whole length of the left arm, from the shoulder to the points of the
fingers, she complained of pain and a feeling of numbness, which
rendered the extremity almost useless: this symptom had lasted
about four years. There was no very marked derangement in the
digestive organs. The bowels were regular, the appetite pretty
good; but there existed a slight degree of flatulence, not however
$0 great as to occasion much inconvenience, and there was nothing
very particular in the appearance of the tongue.

The patient had previously been under almost every variety of
treatment, but without receiving any benefit. Upon the supposi-
tion that there might be some accumulation in the bowels sufficient
to aggravate the symptoms, she was directed to use aperient medi-
cine for a few days, but without producing any alleviation. She
was then put under the influence of small and repeated doses of the

EXTERNAL APPLICATION OF VERATRIA, ETC. 19

tartrate of antimony, and along with this treatment, frictions with
croton oil were applied over the chest and down the left arm, until
a pretty free eruption was brought out. Under this plan the patient,
for the first time from the commencement of her illness, experienced
decided relief; and it should certainly have been persevered in
until a fair trial had been given to it, had not such a degree of
debility supervened, as to give rise to considerable doubt whether
or not it could be continued with safety; the cough and difficulty
of breathing had very much diminished in severity, but the pain in
the arm remained unabated, and at the end of ten days she would
not consent to the further employment of the remedies, and they
were in consequence given up. |

Before the time at which this patient came under treatment, the
very striking effects which the Veratria, when applied externally,
exercises upon the pulse, in removing irregularities and intermissions,
and in diminishing its frequency, had presented themselves to
observation; and although it was not anticipated that very great
benefit could arise from its use in a case so apparently hopeless, it
nevertheless appeared probable that, at least, a temporary relief
from the violence of the symptoms might be procured, if the medi-
cine only acted upon the circulation, without inducing such a degree
of general debility as had resulted from the means previously had
recourse to. A piece, as large as a nut, of an ointment composed
of fifteen grains of Veratria and an ounce of hog’s lard, was ac-
cordingly directed to be rubbed twice a-day over the chest and
along the affected arm five minutes each time, and the result very
far exceeded the expectations formed. The first application re-
lieved the chest symptoms considerably. The cough and breath-
lessness, to a certain extent, subsided, and the pulse and action of
the heart were greatly improved: the most decidedly beneficial
effects however were produced upon the extremity; the pain and
numbness had not altogether disappeared, but these symptoms were
so much alleviated, as to induce the patient to state that, comparatively
speaking, she had recovered the entire use of her arm. From this
time the ointment was directed to be used every evening for about
ten days, and then only occasionally, as it might be found ne-
cessary. : .

In about a fortnight from the first application of the Veratria, the
patient was able to leave her room and walk up and down stairs
with facility; and the general improvement of her health was such,
that she ventured into the open air, but in consequence of incautious
exposure, the symptoms returned two or three times, though by no
means with the same severity as before; and when such an occur-
rence took place, one or two rubbings with the ointment afforded
complete relief. She is now in comparative health; her general
appearance 1s good, the pain and numbness of the arm have entirely
disappeared, the circulation is much more regular than it has been
for a great length of time, the cough and difficulty of respiration are
almost gone, and she can now remain in the recumbent position,

20 TURNBULL ON RANUNCULACES,.

and enjoy a good night’s rest ; and the last time I saw her, she had
walked about four miles without any inconvenience. _

CASE II.

. Mr. B., aged thirty-six, of sedentary habits, and by profession a
banker’s clerk, was seized about ten years ago, without any apparent
cause, with palpitation on the left side of the thorax, which was
followed by pain and a sensation of tightness and anxiety over the
region of the heart; his pulse became irregular and intermittent ;
his breathing, however, has not been to any great degree disturbed,
and he has been able to take free exercise, and with some benefit.
During the course of his illness he has had no cough, but has had
occasional sighing. eety

The digestive functions have been considerably impaired, the
appetite bad, the bowels disordered, and an almost constant tendency
to flatulence has been present. The nervous system has also been
for some time under much derangement, marked by tremors in the
hands, irritability of temper, disturbance of the mental powers,
particularly of the memory, which has suffered a good deal in its
integrity ; for some time past he has experienced a disinclination
for exertion, and has gone through his business more as a matter of
duty than of pleasure. His sleep has been disturbed and unrefresh-
ing; and he has laboured under great depression of spirits, from the
belief that his complaint, from the number of remedies he had tried
without advantage, was incurable.

Under these circumstances, and considering from the account he
had given, that to attempt. a cure by the means usually employed
in such cases, would only be a waste of time, and also in consequence
of the success which had attended the previous trials made with the
Veratria, it was determined at once to employ it in his case; and
with this view he was directed to take a little opening medicine, a
practice always necessary to be pursued during the time the Veratria
is in use; and an ointment of the same strength as that applied in
the preceding case, was ordered to be rubbed on, nightand morning,
over the region of the heart. As the patient lived at some distance
he did not present himself again until the end of a week, when he
returned to announce that he was quite well. The palpitation and
nervous symptoms had entirely vanished, and he was then in the
enjoyment of the best health and spirits. I have seen him once
nce that time, and he has not had the slightest return of his com-
plaint. | .

ue CASE III.
Mrs. L., a lady thirty-six years of age, and of a spare habit of
body, residing in Bristol, has been suffering for five years from
palpitation of the heart, attended by considerable difficulty of breath-

EXTERNAL APPLICATION OF VERATRIA, ETC. 21

ing. She dates the commencement of her disease from a severe
inflammatory affection of the chest, occasioned by cold caught
during her confinement. To relieve the chest symptoms, bleeding
and other antiphlogistic measures were had recourse to; but the
palpitation continued to such a degree, as to render her incapable
of taking any exercise without materially aggravating her symptoms.
She has had many exacerbations arising from slight causes, and yet
so severe as to render venesection necessary to alleviate the violent
throbbing in the left side of the thorax. Her eyes are suffused, her
memory impaired, and she has a considerable degree of nervous
Irritability. Her breathing is difficult, accompanied by slight
cough and a sense of partial suffocation, along with pain across the
region of the heart and down the left arm, and these feelings are
materially increased by walking or any other exertion. Her pulse
is irregular and quick; bowels costive; feet generally cold ; and her
sleep interrupted by the palpitation.

While labouring under these symptoms she was put under the
influence of small doses of tartrate of antimony and blue pill; and
at the same time an embrocation of croton oil was ordered to be
rubbed over the chest and down the affected arm, until a free erup-
tion was produced. So long as the patient continued this plan of
treatment, and remained quiet, she experienced great relief; but the
palpitation returned nearly as violent as ever, upon slight exertion,
and she now began to complain of a degree of debility which she
had not before been subject to. Under these circumstances, she
_ was ordered to have an ointment prepared with twenty grains of
Veratria to an ounce of lard, rubbed in the usual quantity over the
region of the heart for five minutes night and morning; and owing
to the severity of the pain in the arm, frictions with the croton oil
were ordered to be made along it, until a raw surface was obtained,
and over this the Veratria ointment was applied.

On the night after the first application the symptoms were very
much diminished in intensity, but the Veratria had occasioned a
degree of heat and tingling in the arm, so great as to prevent her
sleeping; the pain, however, never afterwards returned. In three
or four days she began to take exercise without inconvenience ;
from this time she gradually improved, and at the end of three
weeks left town, and returned home quite well. :

CASE IV.

Mr. J.,a clergyman, fifty years of age, has been affected with
severe palpitation for the last seven years, accompanied by quickness
and irregularity of the pulse, difficulty of breathing, loss of voice,
cough, expectoration, and a distressing sense of anxiety ; has some-
times been seized in the pulpit with giddiness, succeeded by throb-
bing in the neck and confusion of intellect, and these symptoms
have occasionally gone on to such an extent as to oblige him to de-

January, 1838.—C 3

22 TURNBULL ON RANUNCULACE&.,

sist from his duties for two or three months at a time: his bowels
are regular, and his digestion generally good.

He was ordered to take small doses of tartar emetic, and to have
a blister applied over the chest; and this treatment was pursued
with considerable advantage for the time, but when it was remitted
he soon returned to the same state as before. As this seemed a fair
case upon which to make trial of the Veratria, it was ordered to be
rubbed on in the manner already described. By making use of the
frictions once every night he became gradually better, and at the
end of a week considered himself quite well ; he was advised, how-
ever, to continue the ointment for a little longer, and then to leave
it off by degrees: this was accordingly done about a year and a
half ago, and he has remained ever since in excellent health, free
from his old complaints, and able for the discharge of the functions

of his office.
CASE V.

Mr. W., aged fifty-eight, has been affected for seventeen years
with palpitation, which, during the last seven of that period has been
attended by great difficulty of breathing, occurring in paroxysms,
and coming on especially whilst taking exercise on foot. The dysp-
noea at these times has been so severe, and has been accompanied
by such extreme pain across the chest, as to compel him to lay hold
on the nearest object for support. The pain, during the fit, extends
down the left arm ; and is of such intensity, that in the words of the -
patient, “no language can describe it.”

For these and other symptoms he has, during the last ten years,
applied to all sources for relief, and almost every possible remedy
has been tried without procuring for him any ease. At the time
he came under treatment, he had, besides the symptoms mentioned,
a purple blush upon his face, and more particularly over his nose
and lips ; his voice was weak and quivering. Upon applying the
ear over the region of the heart, a tremulous, confused, irregular pul-
sation was heard ; the pulse was irregular and very intermittent :
the left side of the chest appeared much larger than the right, and
the ribs over the cardiac region seemed pushed out as if to afford a
larger space for the heart’s action. There was considerable disten-
sion of the abdomen, along with a very evident degree of enlarge-
ment on the right side, immediately under the margins of the ribs;
his bowels had been for some time in a very torpid state, and re-
quired active medicines to operate upon them ; the lower extremi-
ties were a little swollen, and the urine deficient in quantity. His
sleep was unrefreshing, and often disturbed by fits of coughing, which
generally ended in great exhaustion. —

_ As it was evident, that in a case of such severity and duration,
little more could be done than merely to relieve the sufferings of
the patient, by endeavouring to mitigate the symptoms as much as
possible, the treatment followed was addressed to thatend. A course

EXTERNAL APPLICATION OF VERATRIA, ETC. 23

of medicine was prescribed, consisting of purgatives combined with
antacids, for the purpose of clearing out the bowels and removin
the distension of the abdomen. These means were employed alone,
for about a week, and then, with the addition of a little squill to the
pills previously ordered, it was persevered in for a fortnight longer ;
at the end of which time he felt considerably better. The swelling
_ In the legs had diminished, the digestion was improved, and, altoge-

gether, he was in a more favourable state of health than before.
During the previous treatment of this case, counter-irritation, b
means of blisters, issues, tartar emetic ointment, &c., had been freely
employed, and with so little effect, further than bringing about a
temporary alleviation, that the patient would, on no account, consent
to their repetition now, and he was therefore recommended to make
use of the Veratria ointment, but certainly without any great expec-
tations of its producing a beneficial effect. oe

An ointment of the usual proportions was ordered to be rubbed,
for five minutes, night and morning, over the region of the heart ;
and, in the course of three days, the feeling of pain and constriction
across the chest had disappeared. As the pain in the left arm still
remained, he was ordered to use frictions with the ointment to it
also, and almost immediate relief from that symptom followed the
application. _ In the course of a fortnight from the time the Veratria
was had recourse to, the most decidedly beneficial effects had been
produced upon the disease: the pulse and action of the heart had
become much more regular and natural, the difficulty of breathing
had very much diminished, the complexion was completely changed,
and exhibited signs of an unimpeded circulation: and this improve-
ment went on gradually, under the occasional use of the ointment,
along with a little medicine to act upon the bowels, so that, in about
six weeks he could walk about, and go up and down stairs without
inconvenience. As this case was one in which a cure could not be
expected, the patient was left to himself with directions to rub the
ointment whenever a return of pain. or uneasiness rendered its
employment necessary. This, he accordingly does, and by its means,
is enabled to pursue his avocations with ease and comfort. Before
taking leave of this case it is proper to state, that it was one of those
in which the Veratria exerted its peculiar diuretic effects; for,
during the first week it was used, no less than six pints of urine a
day were evacuated by the patient.

CASE VI.

Mrs. C., a lady betwixt fifty and sixty years of age, has been ill
about nine years. During the first three she suffered from dyspepsia
and irregularity of the bowels, and, for six years, she has been affec-
ted with almost constant palpitation and difficulty of breathing ;
which symptoms she describes as having been on the increase, until
at last she was obliged to confine herself to one floor of the house,

24 TURNBULL ON RANUNCULACES.
from inability to ascend or descend the stairs, and to refrain from
walking, under the impression that the exertion might prove fatal.
She has violent pulsation over the region of the heart, along with
an irregular and intermittent pulse, and complains, at times, of severe
pain across the chest, and stretching down the left arm: her lips are
of a purplish colour ; her eyes dull; her countenance sallow ; and
she labours under considerable nervous irritability, accompanied by
impairment of the memory ! she has a degree of fulness in the right
side, under the margin of the ribs, and her feet are generally cold,
and a little swollen. For these symptoms she had previously been
treated by bleeding, blistering, purgatives, and indeed, every thing
possible appeared to have been done, without procuring any abate-
ment of the disease. : |
From the disordered state in which the digestive organs evident-
ly were, she was put under a plan of treatment similar to the one
pursued in the preceding case, for about three weeks, but no diminu-
tion of the symptoms took place; and then the Veratria ointment
of the usual strength, was ordered to be rubbed over the left side
of the chest, and down the arm, every night. The first application
afforded great relief to the palpitation and difficulty of breathing,
and the pain in the arm was also considerably alleviated. In the
course of a few days all the symptoms were nearly gone; the oint-
ment was, however, directed to be applied occasionally, for about
a month: and at the end of that time, the patient could walk with
ease, three miles at a time, and returned home quite well, and has
had no return of the disease since.

CASE VII.

Tux following case is given for the purpose of showing the effect
which the Veratria has upon the circulation, in a disease attended
by symptoms of great development of the heart’s action, occasioned
by simple hypertrophy of the walls of fthe left ventricle. Every
one must have remarked the difficulty which there exists of modera-
ting the pulsation of the heart and arteries, in this disease, and that,
in consequence, it 1s no easy matter to procure even a temporary
relief from the distressing sensations experienced by those who are
affected by it. The cases of this kind, in which the ointment has
been resorted to, are not sufficiently numerous to warrant the as-
sertion, that decidedly beneficial effects will result from its applica-
tion In every instance; but it will, nevertheless, be allowed, that
the subject is worthy of attention, from the fact of its having al-
ready proved successful in doing so. ;

Mrs. S., a lady about sixty years of age, has, during the last five
years, suffered much from violent beating of the heart, attended by
Strong pulsation in the neck, throbbing and giddiness in the head,
and a continued whizzing noise in the left ear, along with feelings
of anxiety, and considerable nervous irritability.

INTERNAL APPLICATION OF VERATRIA, ETC. 25

The action of the heart is strong, constant, and concentrated in a
Space over the situation of the apex, and communicates a powerful
impulse to any thing placed on it; the pulse is very full, throbbing,
andj incompressible ; the carotid arteries beat violently, and the
patient complains much of the noise in her ear, and of giddiness;
she has also confusion of ideas, and a feeling of heat and fulness in
the head. She has considerable anxiety, and her sleep is interrupted
by palpitation. There is some pain in the region of the heart; and
all these symptoms are materially augmented by exertion ; but this,
from the sensation of lassitude which she almost constantly labours
under, cannot be made to any great extent.

The bowels are generally costive, and require the employment
of active purgatives, which are the only medicines capable of re-
moving the uneasy feelings of the patient, to any degree; the digestive
functions are very active, and the appetite preternaturally great.
She complains neither of difficulty of breathing, cough, nor pain in
the arm. In the previous treatment of this case nothing had been
found useful, and as it did not appear that any bad consequence
could arise from the external application of the Veratria, it was
ordered to be rubbed over the region of the heart, in the usual
manner, after purgatives had been administered, for a few days, to
regulate the bowels. :

After the first or second friction with the ointment, all the
symptoms were materially diminished in intensity ; the palpitation
had greatly subsided ; the pulse had become much softer and weaker ;
the anxiety, the pulsation in the head, the feeling of giddiness, the
confusion of intellect, and the sensation of whizzing in the ear, had |
all disappeared, and the general health and appearance of the patient
were much improved ; but still some of the symptoms remained, not,
however, to such a degree as to occasion inconvenience, and she is
now in a comfortable state, and able to follow her household em-
ployments; though exertion, to any great extent, cannot be used
without aggravating her complaints. From the manifest benefit
experienced from the Veratria ointment, she uses it herself when-
ever, from any cause, an increase in the symptoms takes place, and
with the effect of procuring immediate relief.

4

CASE VIII.

A GENTLEMAN, aged about sixty, of a weak constitution, of seden-
tary habits, and given to mental occupations, has laboured, for seven
years, under slight palpitation, accompanied by feelings of anxiety -
and general languor, coming on at intervals, and increased by exer-
tion; his pulse is feeble, rapid, and intermitting; palpitation over
the lower part of the left side, not excessive, but attended with a
painful sensation in the region of the heart, which is so augmented |
by walking, especially against the wind, as to compel him to stop
and support himself on the nea object. Respiration generally

6; TURNBULL ON RANUNCULACEA,.
unimpeded, except under these circumstances. The See a pleen
this patient is peculiarly languid, the face pallid, and the surface ol
the body cold. The nervous system is easily excitable, and he
finds that continued exertion of mind very much aggravates all his
symptoms, Appetite good, digestion easy, but occasonially ac-
companied by flatulence; bowels rather costive.

In the previous treatment of this case the same measures
were employed as in those already related, but without the least
eflect. He was ordered to takéa little opening medicine for a
week, and then to apply the Veratria ointment over the region of
the heart as usual. On the night after the first friction had been
used, the patient got no rest‘in bed from the excessive nervous
irritation which it had given rise to; his feelings of anxiety, and
palpitation were so much augmented, that he would on no account
repeat the application: these symptoms continued unabated for two
days, at the end of which however the disease began to decline, and
went. on afterwards to do so until every vestige of it had disappeared,
although no curative means whatever had been employed after the
first application, of the Veratria; and he still continues well.

CASE IX.

A xapy, about sixty years of age, was seized with a fit of fainting
about sixteen years ago, in which she continued for an hour anda
half, and ever since that occurrence she has been affected with pal.
pitation of the heart, accompanied by frequent returns of the syn-—
cope. She now complains of palpitation, and difficulty of respiration,
along with deep sighing, occasioned by a sensation of constriction,
which she describes as extending over the chest, but unattended by
cough; and the angles of the mouth are slightly bluish in appearance.
The action of the heart is violent and irregular, and she complains
of oppression and weight over the lower part of the left side of the
thorax. The pulse is intermittent and irregular, and does not at
all times correspond with the intensity of the heart’s pulsations. She
complains of occasional shooting pains in the arm, reaching to the
points of the fingers; she is sometimes nervous, and low-spirited,
and at intervals nearly free from all those symptoms; but not for
any length of time, for they return again from very slight causes.

The appetite in this patient is at all times pretty good, but the
digestion is not performed with a corresponding degree of facility,
which renders a careful selection of the articles of diet, as well as
attention to their quantity, necessary; and notwithstanding that
these precautions are attended to, there is considerable flatulence
and pain in the stomach during the process. ‘The bowels are
habitually costive, and require the employment of active purgatives
from time to time, to keep them easy; and the lower extremities
are generally cold.

‘Almost every form of treatment that could be devised, had in

EXTERNAL APPLICATION OF VERATRIA, ETC. 27

this case been resorted to, during the long continuance of the
disease; but the palpitations and faintings never ceased, although
the general health by great care had been preserved tolerably good.
To relieve the disordered state of the stomach and bowels, the
patient was now directed to take opening medicine, combined with
antacids, along with small doses of blue pill, for a week; and by
these means the dyspeptic symptoms were, to a certain extent,
removed, but the affection of the heart still remained nearly as
violent as ever. The Veratria ointment was then prescribed of the
usual strength, and ordered to be rubbed every night over the left
side of the thorax. She did not return till the end of a week from
this time, and from her own account, as well as from examination,
she then appeared very much better. During the interval the
palpitation and syncope had been much relieved, and indeed the
latter had not returned. The feeling of tightness and oppression
was quite gone; the pulse was materially improved in character,
but still rather irregular. She was directed to persevere in the
application of the ointment; her health and appearance became
gradually amended, and at the end of a month from the time at
which the Veratria was had recourse to, she was quite well.

External Application of Veratria in Neuralgic Affections.

In no class of diseases have the beneficial effects of the Veratria
ointment been more strikingly manifested than in that which it is_
now proposed to bring under consideration ; for in none are the
symptoms productive of more distress to the patients, and by no
other means can the same degree of relief be afforded in so short a
period. |

The external application of the Veratria has been made use of in
neuralgic affections situated in every part of the body ; it is, how-
ever, in tic-douloureux that the most remarkable and _ speedy
change is effected in the state of the patient, for sometimes during
the continuance of the first friction the paroxysm is brought to a
termination, and does not again return ; and if this be not the case,
the following interval is at least of greater length than any that
may have previously occurred, and the next accession of pain is
less severe, and more easily removed. 3

The principal considerations to be attended to in the employ-
ment of Veratria in tic-douloureux are connected with the part of
the face, and the extent of surface, in the which the pain is situated,
and the length of time the patient has laboured under the disease.
With regard to the first of these, it has been found that in cases
where the affection is not confined to one particular point, but has
extended itself along the ramifications of the nerve in which it has
its seat, the symptoms may be removed much more speedily, and
by means of an ointment containing a smaller quantity of the Vera-
tria than when the contrary is the case ; and this probably arises
from the circumstance of their intensity in such instances being

28 ‘TURNBULL ON RANUNCULACE2.

much less, and from the surface under which the disease is actually
situated being greater than where one spot only is affected, thereby
affording an opportunity of making the application over a number.
of affected points at the same time. : ; :

In cases, too, of long duration, there is more difficulty experi-
enced in performing a complete cure, than in those of a more recent
date ; but this does not appear to arise from the ointment having
less power in removing the existing paroxysm in these instances
than in others, for it almost always affords immediate relief, but
from the habit of recurrence at stated intervals which its previous
long continuance seems to have impressed upon the disease : even
this, however, may be broken through by a little perseverance ;
and a recovery be effected, if not as quickly, at least as certainly, as
in less obstinate cases.

For those forms of the disease which have been characterised as
occupying the branches of the affected nerve, an ointment, made
with twenty grains of Veratria to an ounce of lard, must be rubbed
during the paroxysm, over the whole seat of the pain for fifteen or
twenty minutes, or what is better, until the heat and tingling caused
by the friction have been so great as to produce an impression on
the feelings of the patient equal to that arising from the disease
itself ;* and when such an effect has been brought about, the fric-
tion may be discontinued for a short time, to allow the irritation
occasioned by it to subside, so as to enable the patient to form a
judgment of the relative intensity of the pain now, compared with
what it was before the ointment was had recourse to. In many
instances the paroxysm will be found to have been cut short ; but if
any degree of uneasiness remain, the part must be again rubbed with
the ointment until the peculiar sensations arising from its use again
show themselves, and this second application will, in general, be
succeeded by a remission of the pain. Should an instance, however,
occur of such obstinacy as to resist this repetition, the patient
should still persevere, until the paroxysm be subdued.

In the great majority of cases to which this form of treatment has
been applied, the removal of the paroxysm has been readily effect-
ed ; and those in which a continuance of the friction, in the manner
now recommended, is found necessary, are almost without excep-
tion cases in which the affection has been confined to one point.

For the purpose of obtaining the full effect of the Veratria as soon
as possible in such instances, it has been used in the proportion of
forty grains to an ounce of lard, and this may be done either from
the very beginning of the treatment, or the quantity of the alcaloid
may be augmented by five grains in each prescription until it attain
to that amount. The former method is upon the whole to be pre-
ferred, because by it an immediate check is put upon the paroxysm
in severe cases, without the necessity of continuing for a length of
time the employment of weaker applications.

* It is of the greatest importance to attend to this caution, as the ointment has
no ject whatever in removing the disease unless these sensations are induced.

EXTERNAL APPLICATION OF VERATRIA, ETC, 29

It may notbe out of place to repeat here the caution already given,
against allowing even the most minute quantity of the Veratria to
come into contact with the conjunctiva, an accident which may easily
happen during the application of the ointment in affections situated
in the face; as such a circumstance, although it may not be fol-
lowed by danger, is nevertheless productive of so much irritation
as to make it an object to guard against its occurrence.

_ The general instructions which have now been given regarding

the plan to be pursued in the treatment of tic-douloureux, are
equally applicable to cases of neuralgia, situated in other parts of
the body. These last, however, are not so difficult of removal ;
and do not, so far as has been hitherto observed, require the
ointment made use of to contain more than twenty grains to an
ounce of lard. There is a form of this affection occurring in the
loins, and extending down the thighs of women during the men-
strual period, in which the application of the Veratria is found of
great service, as affording an easy and expeditious means of re-
moving it, i

CASE I.

A apy, fifty-five years of age, has been affected for the last
thirty-six years with tic-douloureux in the cheek, and in the fore-
head above the eyebrow on the left side. From the commence-
ment of the disease, she has had a paroxysm generally once a week,
and at no time does she remember the interval to have been greater
than fourteen days. Her sufferings during the continuance of the
attack have been extreme, and have compelled her to confine her-
self to bed until its termination, and it has never lasted a shorter
time than two days. In the intervals, however, she has been per-
fectly free from pain, and her general health has all along been
tolerably good.

It appeared from the history of the case given by the patient, that
throughout the long course the disease had already run, almost every
kind of medical treatment had been put in practice without giving
rise to any permanently good result!; and in consequence of this cir-
cumstance, and as the symptoms appeared to admit of nothing but
slight alleviation, if even that could be procured, she was ordered to:
keep the bowels open by the use of an aperient pill, and at the com-
mencement of every paroxysm to take a small dose of acetate of
morphia, and to repeat it every hour until the pain abated. She
persevered in these means for two months, and experienced con-
siderable relief ; but although the violence of the symptoms was
moderated, neither any diminution of the length of the attack, nor
any change in the duration of the interval, could be observed.

Under these circumstances, and as the general health of the pa-
tient was beginning to suffer from the employment of the morphia,
it was ordered to be discontinued ; and she was directed to. take
small doses of strychnia, for the purpose of removing, if possible, a

rj

30. ~~ TURNBULL ON RANUNCULACES.

paralytic affection of the levator muscle of the upper eyelid, and of
the left side of the face, which had come on during the previous ex-
istence of the disease. ‘This course was persevered in, until the
convulsive twitchings, brought on by the medicine, became as strong
as the patient could bear them, but without producing any effect
upon the paralysis. | 7 :

Her health was now much weaker, but her sufferings continued
unabated ; and as it became a duty to call into use any means
which might afford even the slightest prospeet of relieving the
violence of the pain, she was directed, after the manner already
stated, to rub over the forehead and on the side of the face, a por-
tion of ointment, made with twenty grains of Veratria to an ounce
of lard, till every uneasy sensation was gone. In about fifteen
minutes this effect was produced ; but the paroxysm again made its
appearance within two hours, and by a renewal of the friction for a
few minutes it was again extinguished, instead of continuing two
days, as usual. :

To this there succeeded an interval of perfect ease for ten days,
when the attack again returned, but not by any means so violently
as before. On this occasion the same plan was pursued as in the
preceding paroxysm, and the relief afforded was still more marked,
for the pain was entirely removed by the first application. From
this time the patient had only one or two very slight accessions, but
these were at once cut short by the use of the ointment for a few
minutes, and the disease entirely left her. |

Not the least remarkable circumstance in this case was the change
which took place upon the paralysis, for immediately after the first
friction had been made use of, it was observed to have diminished
considerably ; and by the time the patient was cured of the tic-

douloureux, it had disappeared, and has not since in any degree
returned. |

CASE II.

Mr. C., aged forty, has laboured for sixteen years under tic-dou-
loureux over the right side of the face and forehead, but particularly
along the lower jaw as far as the mesial line, where it terminated ;
and when the paroxysms were severe, the pain also extended itself
to the same side of the tongue. During the whole course of the
disease, this patient has hardly ever been free from pain ; and when
an interval of ease did take place, his sufferings were renewed by
the slightest causes, and more especially by mastication, which
seldom failed to bring on an accession : his general health and appe-
tite have been good, so much so,.that he has frequently brought on
an attack by inattention to proper rules for regulating his diet and
regimen. : 3 |

In the previous management of this case, under the supposition
that the pain might depend upon decayed teeth, the patient had
had several extracted without affording any relief. He was then

EXTERNAL APPLICATION OF VERATRIA, ETC. 31

bled, generally and locally ; blisters and embrocations were repeat-
edly employed, but still no abatement in the severity of the symp-
tems took place. Along with these means he had also used large
doses of carbonate of iron, arsenic, mercury, Opium, morphia, sul-
phate of quinine, nux vomica, &c., without effect; and when he
came under treatment, he had been taking prussic acid in a quantity
sufficient to affect the nervous system, and with as little success as
from the measures which had before been resorted to.
_ Ass it appeared, from the history of the case, that the patient had
been in the habit of indulging his appetite for food and drink toa
considerable degree, and as his digestive organs appeared somewhat
deranged, he was directed to take small doses of blue pul with
Epsom salts ; and along with these means the Veratria ointment
was prescibed, of the same strength as in the preceding instance ;
and from the fact of there being no distinct interval observable
betwixt the paroxysms, he was directed to rub it over the seat of
the pain twice a day, and to renew the friction at any other time
should the attack come on. | : -
In the course of four or five days he returned very much improved
in every way. His general health appeared better ; the disease
had been greatly relieved, for instead of being almost always pre-
sent, as had been the case for so long a time, it had been broken up
into distinct accessions, and these were attended with comparatively
little pain: he was therefore directed to discontinue the regular
application of the ointment, and to employ it only when threatened
with a renewal of the paroxysm: soon after this, he gave up the
use of the internal medicines which had been prescribed for him,
and he went on gradually improving under the influence of the
Veratria alone ; the intervals became longer, and the fits less and less
paicful, until at the end of four weeks from the time he came under
treatment, he returned home perfectly free from pain, and I believe
has been so ever since.

CASE III.

_A apy, forty-eight years of age, has been affected with severe
tic-douloureux, situated in the middle of the left side of the face,
for a period of twenty-two years. She has made use of every
possible medicine, particularly of carbonate of iron, which she had
taken for three months in very large doses, but without experienc-
ing any benefit. :

The paroxysms are irregular in their duration, but never shorter
than twelve hours, and they return generally at the end of three
days, sometimes at the end of a week, but seldom longer ; and
during the interval she is not altogether free from pain.

A short time before this patient came under treatment she had
an attack of paralysis; from which, however, she had recovered,
with the exception of a slight palsied appearance of the countenance.
There were no very marked symptoms of derangement in the diges-

392 ~ TURNBULL ON RANUNCULACE.

tive organs, but it was thought advisable to put her under a course
of medicine for a few days, similar to that made use of in the last
case ; and the Veratria ointment, of the same strength, was ordered
to be rubbed on in the usual manner when the next paroxysm
occurred. This was accordingly done ; and after the friction had
been continued for a quarter of an hour, the pain ceased entirely,
and never came on afterwards in the shape of a regular attack.
During five weeks from this date, the disease appeared occasion-
ally in the form of slight twinges of pain in the part previously
affected, but these were at once removed by rubbing on a little of
the ointment, and at length completely disappeared.

CASE IV.

A apy, about thirty-five years of age, has suffered most severely
and almost without intermission for the last eighteen months, from
tic-douloureux in the cheek and side of the forehead. She has,
during ali that time, been put under the effects of nearly every
variety of medical treatment that could be suggested, without pro-
ducing any effect whatever upon the disease ; and the only remedy
which has in any degree alleviated her sufferings is galvanism, but
this also has failed in producing any permanent benefit.

This patient appeared to enjoy very good health: so that, with-
out any other treatment being put in practice, it was determined
upon at once to try the effects of the Veratria ointment. She was
therefore ordered to rub over the affected part in the usual manner
an ointment made with twenty grains of Veratria to an ounce of
Jard, which she accordingly did, and in ten minutes from the com-
mencement of the friction, every vestige of the pain had disappeared,
and it has never since returned.

CASE V.

A Lavy, twenty-five years of age, has been for the last seven years
affected with severe tic-douloureux, confined to one point, exactly
in the situation of the supra orbitary foramen of the right side.
The paroxysms have varied in duration, from sixteen hours to two
days ; and intervals, extending from ten days to three weeks, but
never longer, have intervened between the attacks of pain, and
these, when short, have generally been followed by a recurrence of
the symptoms in two or three days.

In this, as in the preceding cases, almost every means of cure
appeared to have been already had recourse to, but, as usual, with-
out procuring any permanent alleviation of the sufferings of the
patient, except that small doses of acetate of morphia administered
during the paroxysm, sometimes caused an immediate cessation ;
but it was attended with this inconvenience, that if it did not pro-

EXTERNAL APPLICATION OF VERATRIA, ETC, 33

duce the desired effect, all the symptoms were immediately aggra-
vated to a great degree.

‘The digestive functions in this patient appeared to be considera-
bly impaired, her circulation languid, and her extremities cold,
especially during the attack. On these accounts she was put under
a course of laxatives, combined with blue pill, for about a week,
which was the means of removing these symptoms, but without
producing any change on the disease itself. As it appeared that
carbonate of iron was almost the only medicine which she had not
previously made use of, it was prescribed in pretty large doses, and
persevered in until it evidently appeared to exercise no effect what-
ever upon the symptoms; it was then given up, and about six
weeks afterwards the Veratria was applied.

At the commencement of one of the accessions, she rubbed over
the eyebrow and forehead of the affected side, part of an ointment
made with twenty grains of the Veratria to an ounce of lard ; and
after the friction had been continued in the usual manner for about
twenty minutes, the paroxysm was cut short. During the interval
she was directed to apply, in the same way, an ointment made with
morphia and hog’s lard, in the same proportions as the other, twice
a day, in order to prevent a return of the attack, but without pro-
ducing the intended effect, for it again made its appearance in ten
days.

With the view of making a decided impression at once upon the
disease, an ounce of ointment containing forty grains of Veratria was
ordered to be employed as before, whenever a new accession of the
pain took place; and in a few minutes after its first application,
there followed a great increase of the symptoms, which continued
for about two hours, and then subsided, leaving no trace of the affec-
tion behind, neither has any renewal of it taken place.*

; CASE VI.

A apy, aged twenty-six years, who has been subject to occasional
attacks of hysteria since her fifteenth year, has also since that period
suffered from tic-douleureux, situated in the left eyebrow and extend-
ing itself up the forehead, in the course of the ramifications of the fron-
talnerve. The paroxysms in general take place once a month ; but
if the patient happen to expose herself to sudden alternations of tem-
perature, she is almost certain of experiencing a violent attack on
the following day, and in either instance it continues with unmitigated

* In this instance the Veratria has completely failed in giving permanent re-
lief. The case was drawn up about the beginning of 1834, and the patient was
at the time in the state above described; shortly afterwards, however, the disease
again showed itself, and has ever since continued to come onatintervals. After
repeated examinations, I have been unable to detect any organic disease ; and
although the other remedies mentioned in this volume have likewise been tried,
no permanent benefit has been derived from them. Poe eee

JANUARY, 1838.—D 4

34 TURNBULL ON RANUNCULACE:.

severity for about twelve hours, and not unfrequently terminates in
sickness and vomiting, occurring at intervals for two days after,
along with a considerable degree of intolerance of light. _

As no plan of treatment which she had hitherto made trial of, had
had any effect upon the disease, she was, without any other means being
employed, directed to rub at the beginning of one of the accessions,
part of an ointment of the usual strength, and in the manner already
described, over the seat of the pain, and to continue the friction until
relief was obtained. She did so, and in less than half an hour from
the time the ointment began to be used, the paroxysm entirely left
her.

On account of the presence, in this case, of considerable visceral
derangement, the patient was treated by gentle laxatives, for a short
time in the way recommended in those previously mentioned, and
she was ordered to repeat the friction with the Veratria whenever
the pain returned ; but it has, I believe, never since been found
necessary.

CASE VII.

A apy, thirty years of age, has been for several years labouring
under tic-douloureux, seated in the right orbit, and extending along
the course of the frontal nerve as far as the top of the head. The
paroxysms have been so violent as generally to confine her to bed
for a day or two at a time, and have made their appearance with the
greatest severity at the menstrual period, but in other respects she
has all along been in the enjoyment of good health. She was ordered

to rub the Veratria ointment, when the attack came on, over the
whole surface occupied by the pain until relief was experienced:
this she accordingly did on the first appearance of it: in a few
minutes it was cut short, and never afterwards returned.

CASE VIII.

A GENTLEMAN, aged thirty-five, of a spare habit of body, subject
to nervous feelings, and accustomed to sedentary occupations, has
for the last seven years been seized with excruciating fits of pain,
confined to the right half of the head, and returning by regular
paroxysms at the end of about every third week. A short time
before each attack comes on, he suffers much from restlessness and
irritability, his pulse becomes augmented in frequency, and he
complains much of impairment of memory ; and after it has ceased,
i does not return to his usual state of health for two or three

ays.

For this affection he was directed, during the paroxysm, to make
use of frictions with the Veratria ointment, of the usual strength,
over the seat of the pain ; he first applied it to the forehead, and one
rubbing was all that was requisite to remove the pain in that situa-

EXTERNAL APPLICATION OF VERATRIA, ETC. 85

tion, but it still continued unabated in violence in the remainder of
the affected region : to this part he was also ordered to apply the
ointment ; and the pain there, in like manner, yielded to one appli-
cation : no return of the symptoms has taken place, and he is now
in good health.

Along with the hemicrania, there existed in this patient a consi-
derable degree of irritability of the heart ; but a few frictions with
the same ointment, made over the left side for five minutes every
night, along with an occasional aperient pill, sufficed to remove this
symptom permanently.

CASE IX.

Mrs. F., about thirty-eight years of age, had for the period of
four years suffered from intense pain, confined to one spot in the
loins, and which was not increased by motion. It came on in
paroxysms, so frequent in occurrence, and of such duration, that she
never experienced a longer interval than two days betwixt them;
and her sufferings were augmented to such a degree during the

period of gestation, that she was compelled to confine herself to bed

for a great part of the time.

To bring about the removal of this affection, the patient had pre-
viously submitted to bleeding, generally and locally ; and blisters,
tartar emetic ointment, frictions with stimulating embrocations,
along with plasters of various kinds, but without in any degree allevi-
ating the pain: she had also taken internally almost every medicine
calculated in any way to procure an abatement of the disease, but
still no relief could be obtained. .

When this patient first put herself under treatment, several of
the remedies previously had recourse to were again employed ; and
along with these, frictions with croton oil were ordered over the
seat of the pain, until a free eruption came out, but without effect.
As a last resource, the Veratria ointment made with twenty grains
to an ounce of lard, was directed to be applied in the usual way,
and ina very few minutes every vestige of the pain had disappeared.
She has been since entirely free from it, and is now in the enjoy-
ment of the best health.

CASE X.

A youne lady, about twenty-four years of age, has been affected
with most violent pains in the loins and thighs, during the men-
strual period, for about eight years. The pain has in general con-
tinued, without intermission, for three days, and has then subsided
of its own accord. .

Many attempts have been made in this case to effect a cure; the
patient has taken opium, preparations of morphia, Dover’s powder,

36 TURNBULL ON RANUNCULACE,

and other sedative remedies, but without experiencing any permanent
benefit, for at each monthly period the pain has manifested itself
with the same severity as before. From the effects which the
Veratria had been already observed to have upon similar diseases,
an ointment made with twenty grains of the alcaloid to an ounce of
lard, was directed to be made use of over the loins, with the effect
of immediately removing the pain, and it has not again returned.

CASE XI.

Tux eleventh case happened ina lady about thirty-three years
of age; and except that the disease had in this instance continued
for nine years, its previous history, course, and termination, were
- so precisely similar to those of the preceding case, that any more
particular relation appears unnecessary.

CASE XI.

Aw elderly gentleman, rather corpulent, and of sedentary habits,
had suffered severely for nine months from a fixed pain seated in
the lower part of the spine. It had continued during the whole
time almost without intermission, and at last nearly prevented
him from remaining in the erect posture. The Veratria ointment
was directed to be rubbed over the affected part, and immediately
removed the pain ; the patient was, however, ordered to apply the
frictions, night and morning, for two weeks, to prevent a return,
and he has since had no symptoms of the complaint.

CASE XIII.

Mrs. A., a middle-aged lady, has suffered severely for about five
years from a painful affection in the situation of the os coccygis,
which is much increased by sitting, or riding on horseback. For
the cure of this disease, she has been under every variety of treat-
ment, both internal and external, and has spent much time at the
principal watering-places, but the pain has continued.

She was directed to make use of friction with the Veratria oint-
ment over the affected part, and the first application afforded com-
plete relief. At the end of twelve hours the pain again came on,
but was a second time as easily removed ; and as there seemed to
be a tendency to a recurrence of the symptom, the ointment was
ordered to be repeated night and morning, until the disease had
ceased again to appear. In the course of ten days the patient was
quite well, and has since continued to be so.

APPLICATION OF VERATRIA IN RHEUMATISM. sy

External Application of Veratriain Rheumatism. |

From what has been said in the foregoing chapter on the subject
of the external employment of Veratria in neuralgia, it will not be
requisite to introduce here any further remarks, except such as are
exclusively applicable to the effect produced by it upon rheumatism
in its various forms. —

In the acute form of the disease, the Veratria ought not to be
employed, if there be active inflammation going on in the affected
parts ; as it is much better to treat the acute symptoms in the usual
manner ; but when these are on the decline, the ointment may be
had recourse to with advantage. | |

From the extent of surface affected in acute rheumatism, and
from the quantity of ointment which is on that account required
for the friction, the proportion of Veratria ordered in the prescrip-
tion should not be so great as in the diseases already treated of; for
in this, as in other affections, the strength of the ointment should
always bear a certain relation to the space over which it is to be
applied.

In cases where the rheumatism is general, or where it is seated
in several joints at the same time, ten grains of Veratria to an ounce
of lard will make an ointment sufficiently powerful for every pur-
pose ;* but where it is confined to one or two joints, or where it
has assumed the chronic form, the quantity employed may be
varied according to circumstances, from ten to twenty or more
grains, and the friction may be continued in either case as long as
the patient can bear it ; or if it be requisite to specify a fixed portion
of time—as a general rule, it may be stated, that in the earlier
stages of the disease fifteen minutes, and in long standing examples
twenty, will be enough to remove the existing pain.

When the case to be treated is decidedly chronic in its nature,

much perseverance is requisite, particularly if extensive organic
changes in the parts have taken place ; the best directions are, to
rub the affected joints every night for the time specified, until the
pain has disappeared ; and at any future period, when from change
of weather, or other cause, it again returns. In slight acute affec-
tions, arising from cold, one or two applications, continued until
the heat and tingling manifest themselves, often effect a cure.
- The directions which have now been given will, in most cases,
prove sufficient to enable the practitioner to make use of the Veratria
ointment in the more topical forms of rheumatism, as well as in
those already pointed out: and little more appears requisite than
simply to enumerate such as it may be applied in with the most
evident advantage. , ,

In lumbago, sciatica, rheumatic affections of the muscles over the

«Tn this form of the disease, it will be found advantageous to administer some
one of the preparations of Veratria, already recommended, at the same time that

the frictions are used.
4*

38 TURNBULL ON RANUNCULACE.

chest, or in other parts, the symptoms may be relieved almost im-
mediately by the first friction ; and in more obstinate cases, a few
more will, in general, have the desired effect.

CASE I.

Mr. G., a gentleman about forty-eight years of age, had been for
some time subject to occasional severe attacks of acute rheumatism,
affecting chiefly the joints of the extremities, and attended with a
considerable degree of general fever. For several days before he
came under treatment he had been labouring under very acute
symptoms of the disease; he had had a good deal of fever, a quick
throbbing pulse, much heat of skin, and the joints of the elbows,
wrists, knees, and ankles were swollen red, and so very painful as
1o render motion to any extent impossible. ‘

In this case the most active measures had already been put into
practice. Venesection had been freely employed, he had used
large and repeated doses of purgatives, of various diaphoretic medi-
cines, and colchicum ; and along with these means the antiphlogistic
regimen had been carefully pursued since the commencement of the
attack, but no abatement in its violence had taken place. |

As everything likely to effect a cure in the usual way appeared
to have been resorted to, the previous internal treatment was ordered
to be persevered in, and at the same time an ointment, consisting of
ten grains of Veratria and an ounce of lard, was directed to be
rubbed upon the affected joints, for ten minutes at night, and again
the following morning. When the patient was visited next day, his
rheumatism was nearly gone. The ointment had occasioned a con-
siderable increase in the heat of the parts, but the inflammation and
swelling were greatly diminished, and the pain almost removed ;
he could now use the affected joints with perfect ease, and there
was no return of the symptoms for some days. He then experienced
a slight renewal of the complaint in one of the ankles ; and at the
very first appearance rubbed the ointment, of his own accord, over
the inflamed surface for the usual time, but although it produced
sensations of heat and tingling as usual, yet no amelioration of the
pain took place : the friction was therefore ordered not to be repeated
till twelve hours had elapsed, and at the end of that period one ap-
plication entirely removed it.

CASE II.

A. Boy, twelve years of age, and of a delicate habit of body, had
been labouring for three or four days under an attack of acute rheu-
matism, attended by a good deal of febrile excitement ; the pulse
was quick, the skin hot, and the tongue dry, and slightly furred ;
both his ankles and knees were swollen to a considerable degree,

APPLICATION OF VERATRIA IN RHEUMATISM. 39

had a red and inflamed appearance, and could not be moved, on ac-
count of the pain.

On the second day of the disease, leeches and fomentations had
been applied to the affected joints, and internally he had taken col-
chicum and diaphoretics, but with very little benefit. He was
therefore ordered to have an ointment made with twenty grains of
Veratria to an ounce of lard, freely rubbed over the seat of the
pain, for about fifteen minutes at bed time.

Next morning the patient was almost well. During the night
the pain and fever had disappeared, and he could walk about and
move his limbs with perfect ease ; “the inflammation and swelling
had toa great degree subsided, and the joints were restored to
nearly their natural appearance. In two days afterwards, although
the ointment had been only once applied, no trace of the affection
was left.

CASE III.

Mx. G., forty-five years of age, and of a robust constitution, was
in consequence of exposure to cold and wet seized with a rheu-
matic attack, which was confined to the knee and ankle of the right
side, and accompanied with some degree of fever ; he was ordered
on the evening following the accession of the disease to take anti-
mony combined with calomel ; but next day the symptoms did not
appear at all to have diminished. The affected joints were swollen,
inflamed, and painful, and the quickness of pulse, and heat of skin
still continued the same.

Part of an ointment made with twenty grains of Veratria to an
ounce of lard, was now directed to be rubbed over the seat of the
pain for the usual time; and on the morning after the first applica-
tion, the patient could walk about the house ; the pains, inflamma-
tion, and swelling had almost disappeared, and the febrile symp-
toms were gone: by continuing the same treatment for two days
lenger, he was able to follow his business, and no relapse afterwards
occurred. ;

CASE IV.

Mr. S., a stout gentleman, aged about fifty, had been in the early .
part of his life much exposed to cold and moisture, which brought
on an attack of lumbago, and since that time he has had many re-
turns of the disease. In addition to this, he has also been affected
with chronic rheumatism, confined principally to the joints of the
hip and knee of the left side. The motion in both is very much
impeded ; over the hip-joint there is an evident fullness, and when
any extensive movement is impressed upon it there is a distinct
crackling noise elicited, and a similar feeling is communicated to
_ the patient. i age
The knee is also the seat of considerable swelling, and pain which

40 | TURNBULL ON RANUNCULACEA.

- js increased by pressure, but particularly by attempts at motion, and
the same noise and sensation are present when it is bent and ex-
tended as in the hip-joint. The swelling in both situations is white
in appearance, puffy, and somewhat elastic. The sufferings of the
patient are much aggravated by change of weather ; and attempts |
at motion in the affected joints are attended with so much pain that
he is compelled, in walking, to lift the whole extremity without
bending it, by exerting the muscles of the opposite side. —

For the removal of the disease, he had proviously resorted to
most of the remedies in common use. Besides having taken inter-
nally every thing that appeared likely to afford relief, he had em-
ployed to the parts themselves, bleeding, counter-irritation by means
of blisters, &c., and embrocations of every kind ; all of which had
failed in procuring any other than a temporary abatement of the
symptoms.

Under these circumstances this case first presented itself, and
with the view of giving a fair trial to external applications, the af-
fected parts were ordered to be rubbed with croton oil twice a day,
until a very free eruption came out, and this plan was followed
with considerable success for about six weeks, during all of which
time the irritation was kept up by repeated frictions with the oil.
Kiven this, however, at last began to lose its effect ; and the pain,
which had at first diminished considerably, now appeared to be
rapidly on the increase, and as there was no objection to the appli-
cation of the Veratria, it was prescribed.

An ointment made with twenty grains of the alcaloid to an ounce
of lard, was ordered to be rubbed for twenty minutes twice a-day
over the knee and hip of the affected side ; and after it had been
made use of a few times, the troublesome symptoms began to de-
cline. ‘The pain went quite away, and the swelling and the rigidity
became rather less : so that at the end of ten days or a fortnight, the
patient could bend both the diseased joints, and could walk almost
without inconvenience. The disease itself is, of course, not re-
moved ; but he can now take exercise on foot, and move the articu-
lations with freedom. : ; :

In changeable weather a slight return of the pain sometimes takes
place, but this is at once removed by rubbing the part with the
ointment for a few minutes; and the patient is now in a comfort-
. able condition.

CASE V.

Mr. B.,a gentleman about forty-five years of age, was seized two
years ago with an attack of rheumatism which terminated in a
chronic affection of the joints of the right arm and hand. He expe-
renced great difficulty in making use of the muscles of the shoulder
from the pain which always attended upon any efforts at motion :
the elbow-joint was stiff and painful, and he was obliged to carry
the fore-arm in a sling. The articulations of the fingers were

‘APPLICATION OF VERATRIA IN RHEUMATISM. — 41

‘swollen, and also gave pain on motion, so that the patient could not
use them in writing; but had been, in consequence, in the habit
_ of employing the left hand for that purpose.
_ This patient had previously applied many remedies, without
obtaining benefit from them, and he was now ordered to rub the
affected joints twice a day with the Veratria ointment ; and in a
day or two all uneasiness had left the shoulder and elbow, and he
could now move the arm with facility. The disease in the joints
of the fingers was also much relieved, but the swelling appeared
nearly the same ; he was directed to continue the application of
the ointment to them occasionally, until it produced some effect. He
returned at the end of about six weeks, and at that time the pain
and swelling had disappeared, and he had recovered the entire use
of the hand. .

CASE VI.

Mrs. P., about fifty-two years of age, has been for the last twelve
years affected with chronic rheumatism in the joints of the inferior
extremities, but particularly in the hip and knee of the right side.
Her sufferings for a considerable time have been augmented by
variationsin the state of the weather ; and, for the last five years,
the joints in which the disease is situated have been so painful and
rigid, as to oblige her to make use of supports in walking; the
knee is much swollen, and gives a sensation of crepitus when
moved. :

In the previous treatment of this case also, remedies of every
description had failed to do good ; and in order to try the effects of
the Veratria, it was directed to be rubbed on twice a day in the
usual manner, and to be persevered in for some time. At the end
of a fortnight the symptoms were much relieved, and she could
move the limbs with some degree of ease ; she went on improving,
and after six weeks could walk three miles at a time with little
difficulty, and without support.

CASE VII.

Mr. K.,a gentleman thirty-five years of age, has been the sub-
ject of repeated attacks of lumbago, for several years, and the pain
has occasionally been such as to confine him to bed for a fortnight
at atime. When the disease first made its appearance the patient
was bled and blistered repeatedly, and took many remedies in-
ternally, but particularly colehicum, and these means were always
followed by relief.

During the two attacks which had occurred previously to that in
which the Veratria was used, he had supplied sinapisms to the seat
of the pain, and taken large doses of colchicum, with the effect of
removing the symptoms ; but not till the plan had been continued
for about three weeks.

42 TURNBULL ON RANUNCULACE,

One evening he had a return of the affection, and when visited
next day, he was lying in bed in great pain, and could not be
moved in any direction. An ointment, made with twenty grains
of Veratria to an ounce of lard, was immediately ordered to be
rubbed across the loins for fifteen or twenty minutes, and to be
repeated at night ; and in the event of the second friction failing to
procure relief, he was directed to take fifteen grains of Dover’s
powder, with thirty-eight drops of vinum colchici, at bed-time ;
this last prescription, however, he did not find it requisite to make
use of, and next day he could move himself about freely, and with-
out experiencing any pain. To guard against a recurrence, he
persevered in the use of frictions night and morning for a few days;
he then discontinued them, and has since been quite free from the
complaint.

CASE VIII. »

Tunis case was one of severe sciatica, occurring in a gentleman
about thirty years of age, and bearing a considerable resemblance
in its history to the foregoing : the previous treatment pursued was
much the same, and in like manner freed the patient from the
existing attack ; but did little towards establishing a permanent
cure. The Veratria ointment in one application removed the pain,
and in a few more completed the recovery of the patient.

CASE IX.

A GENTLEMAN, thirty-three years of age, had, about eight years
ago, an attack of acute rheumatism, during which the larger joints
became affected, and after the violence of the disease had been sub-
dued, there still remained a degree of pain and swelling around the
articulations of the tarsus and ankle, of both sides ; and to these symp-
toms there has latterly supervened so much rigidity as to disable
the patient almost entirely from walking. When an attempt at
motion is made, he is compelled to raise the feet from the ground
without bending the ankle joints, and he experiences great pain in
pressing upon the ball of the great toe.

In this case, the patient was directed to rub the Veratria ointment
over the diseased parts twice a day ; at the end of a fortnight the
pain was gone, and the attack’ completely removed.

External Application of Veratria in Gout.

In the treatment of gout, Veratria, both internally and in the
form of friction, is a remedy of considerable power. When ad-
ministered by the mouth, its action upon the disease is not at all
unlike that of colchicum, but rather more mild ; and in cases where

APPLICATION OF VERATRIA IN GOUT. 43

the affection appears to be more general in its nature, much benefit
will be found to arise from its exhibition in this manner, as well as
from the ointment. During the height of an acute attack, the
friction should not at once be resorted to; for in this disease, as in
rheumatism, the local remedy will be found most advantageous after
the violence of the constitutional symptoms has been removed, by
other treatment: in some instances, however, it has been of much
service when made use of at the time an attack was threatened, by
warding it off, or making the subsequent stages less severe.

The general directions for applying the Veratria ointment in
gout, are nearly the same as those already given for its use in rheu-
matism. Fifteen or twenty grains of Veratria to one ounce of lard,
will be sufficient to begin with, and the friction should be continued
until the tingling sensation be freely produced : indeed, the quantity
of ointment used, and the duration of the friction, are of little
moment without attention to this circumstance.

In a late work, Sir Charles Scudamore has made some very
judicious remarks on the effects of Veratria ointment, and on its
manner of application in gout. His experience, in most essential
particulars, confirms what I have myself observed, and as illustrations
of the utility of the remedy, I shall avail myself of three of the
eases he has given, and shall here insert them.”

CASE I.

“A apy, aged forty-four, subject to severe attacks of regular
gout, in an unusually severe paroxysm, derived great benefit from
the internal medicines which I prescribed; but she remained
entirely lame, from the tender, swollen, and rather painful state of
the ankle-joint and foot. I directed the Veratria ointment, in the
strength of ten grains to the ounce; and the good effects of the ap-
plication were very quickly shown. She described that she was in
considerable pain at the commencement of the friction, but that it
abated at the end of twenty minutes, and was exchanged for strong
prickings like those from electric sparks, and a remarkable warmth,
rather agreeable than the contrary. These sensations lasted about
an hour. On the following morning the swelling of the ankle and
foot was much reduced, and allowed of standing. A further per-
severance with the remedy proved very beneficial ; and this lady,
by means of it, and further general treatment, recovered in the most
favourable manner.’’

CASE ILI.

“ A GENTLEMAN, aged sixty, one of the greatest martyrs to gout
that I ever saw, was seized with sciatica and lumbago, at the same —

* Principles and Treatment of Gout, 1835.

44 . TURNBULL ON RANUNCULACE.

time that he was affected with sharp gout in the knee. There was
much error in the state of the biliary system. I prescribed mer-
curial evacuants, sudorifics, and sedatives. After six days of this
treatment, although improved in his general condition, he com-
plained of continued suffering from the sciatic nerve, and great,
though not equal, distress from the knee. The Veratria ointment
was rubbed in upon each affected part. It produced the sensations
of heat and electric-like prickings for nearly an hour, and very
decidedly relieved the complaint. It was repeated three or four
times with complete success. The skin became irritated, as if by a
strong rubefacient, but no sore followed. The patient was highly
gratified by the effects of the remedy.”’

CASE IIL.

“¢ ANoTHER patient, too anxious for the quickest relief, used the
remedy on the second day of an attack of acute gout in the foot, the
part not being so exquisitely tender as to prevent moderate friction.
Active evacuants had been taken at short intervals with full effect.
The proportion of the Veratria was ten grains to the ounce. No

articular sensations ensued from the friction, and no apparent
benefit resulted. Five grains of Veratria were added, and the
friction was followed up for a longer time. Now the patient be-
came very sensible of the peculiar sensations before mentioned. On
the following day, there was a very manifest abatement of the gout ;
and the patient acknowledged the improvement. In conjunction
with its further use, I prescribed the mild colchicum aperient draught
and alteratives. ‘The recovery was uninterrupted, and a favourable
convalescence was established in the course of a fortnight.”

External Application of Veratria in Dropsy and Paralysis.

Brsrpxs the diseases mentioned in the preceding chapters, I have
employed the Veratria ointment in two others, Dropsy and Paralysis.
In my account of Veratria, several cases of these are mentioned in
which friction with the ointment appeared to have been of great
service ; but although the Veratria most certainly acts as a diuretic,
as well as a powerful stimulant of the nervous system, subsequent
consideration has made it appear doubtful whether or not the amount
of effect produced, was not augmented by the other treatment
pursued at the same time. The subject, however, is open to in-
vestigation, and on this account I shall give such genernal directions
for the use of the ointment in these diseases, as may be sufficient
for such as may wish to try its effects, leaving it to future experience
to decide upon the utility of the treatment. :

In dropsical cases it is indispensably necessary before the Veratria
be applied, that every attention should be paid to all the organs,
upon a derangement of which, either in structure or friction, the

\

APPLICATION OF VERATRIA IN DROPSY, ETC. 45

effusion may depend, otherwise the anticipated effects may not be

roduced. 2 : euks |

_ If, after a careful examination, nothing wrong, of importance, can
be detected, the ointment may then be had recourse to ; but if the
contrary be the case, the diseased state, whatever that may be,
should, if possible, be first removed, and then the treatment may be
proceeded with. : : | .
The same rule before laid down, as to the relation which the
strength of the ointment ought to bear to the extent of surface
over which it has to be rubbed, and to the state of the patient, must
here be kept in mind. But as the frictions should, if possible, be
made over the whole surface under which the effusion exists, and
as this must vary with the situation and extent which it occupies,
‘it is evident that no prescription applicable in every instance can
be given, except that the quantity of the ointment rubbed in each
time, should not, in adults, contain less than two, nor more than
four or five grains of Veratria; and the friction should be continued
for about twenty minutes, and repeated once or twice a-day. If
the plan of treatment is to be of service, the diuretic effect will
probably show itself in a few hours, and the repetition of the friction
must be regulated by the effect produced. _ |

As an illustration, the following case may be introduced, leaving
it for others to judge whether the rapid disappearance of the watery
effusion was the result of the large quantity of diuretic medicine
the patient had previously taken, or whether it arose from the action
of the Veratria. : | 2 :

J. Burnell, Esq., of Theresa Lodge, Pocklington, near York, aged
thirty, came under treatment in the summer of 1830. About a year
previously, he was attacked with ascites, which proved so very
obstinate that, although he was put under almost every plan of treat-
ment which could be devised by his medical attendants, during nearly
the whole time, the disease suffered no abatement, but on the contrary
appeared to be increasing rapidly. At the time he presented him-
self, the dropsy had become general ; his lower extremities and
scrotum were swollen to an enormous size ; the abdomen was com-
pletely distended with fluid; and the organs within the chest were
much impeded in their functions. There was great difficulty of
breathing, attended with cough and slight watery expectoration ;
the pulse was small and intermittent, and the patient was unable to
remain inthe horizontal posture for one minute, without experiencing
the most distressing sense of suffocation ; the distension of the legs
increased to such a degree that serous fluid oozed from them; and
altogether, the case was one of the most severe ever witnessed.

The previous treatment of this case had been as active as possible ;
diuretics and drastic purgatives of almost every kind had been em-
ployed, without producing any other effect than weakening the
patient ; and a course of mercury, continued during some time, had
been equally unsuccessful. ‘The flow of urine was less than an Ein-

January, 1838.—£ ye

46. TURNBULL ON RANUNCULACE#,

glish pint in twenty-four hours; and could not by any means be made
to exceed that quantity. 2 : eo

For six weeks after he came under treatment, the plan pursued
was similar to the one already described. Mercury, squill, the ace-
tate and super-tartrate of potass, digitalis, colchicum, spirit of nitrous
ether, juniper, broom seed, &c. were all had recourse to without
the slightest benefit, and the same want of success attended the
exhibition of elaterium, gamboge, and other drastic purgatives ; these
last produced large watery stools, but without bringing about any
apparent diminution of the swelling. There now appeared no hope
of recovery : all the means likely to procure relief had been put in
force, and had only added to the distress and debility of the patient,
so that it became necessary to abandon them, and look out for some
other means of cure. ee | |

In this emergency it was resolved upon to make trial of the Ve-
ratria externally, and a box of ointment, made with four grains of
the alealoid and an ounce of lard, was accordingly directed to be
rubbed over the surface of the abdomen at bed-time. The whole
quantity was applied ; and in the course of the night, and following
morning, the patient evacuated no less than eight pints of urine,
which had caused a marked diminution of the swelling, both in the
abdemen and extremities, and was attended with considerable relief
to the breathing and circulation ; but, along with these effects, the
medicine had caused such an alarming prostration of strength as to
render the administration of stimulants absolutely necessary, for
three days before the ointment could be repeated ; at the end of that
time, when the patient appeared somewhat recovered from his weak-
ness, a fresh quantity was prescribed, in which, however, a less pro-
portion of the Veratria was used, owing to the violent constitutional
symptoms caused by the first. On this occasion, two grains only
were rubbed on, yet the diuretic effects were scarcely less marked
than before ; and these were again accompanied by a degree of
debility which, although not so great as in the preceding instance,
still made it a matter of necessity to repeat the stimulants, and to_
delay the third application for five or six days.

On both cecasions, after the first effects of the ointment. had
subsided, the quantity of urine diminished considerably, but the
swelling became daily less in magnitude, and the patient went on
improving ina manner that could not have been anticipated. On
the fifth or sixth day from the second rubbing, a third, with an ounce
of ointment containing two grains of Veratria, was directed to be
made use of, as before ; and from this time the dropsy rapidly dis-
appeared ; the patient gained strength sufficient to enable him to take
active exercise ; and at the end of three weeks from the first applica-
tion of the Veratria, he was completely cured, and has since had no
return of the disease. :

_ The only collateral treatment employed in this case, along with
the 'Veratria, consisted in the daily exhibitien of purgative medicine,
not with the view of producing any change upon the disease by its

PROPERTIES OF THE VERATRIA OF COMMERCE. 47

means, but only for the purpose of obviating the constipating effects
of the remedy. : j

fn paralysis, the Veratria is worthy of a further trial; but my late
experience with it does not warrant the assertion that it is a decid-
edly useful remedy. In partial paralytic cases it might be used, and
probably with some degree of advantage, but in severe cases it ap-
pears to be of as little service as other remedies.

The friction ought to be made along the course of theaffected nerves,
two or three times a day, until the tingling is produced ; but, as a
general direction, fifteen or twenty grains, to an ounce of lard, will
be strong enough ; and frictions of ten to twenty minutes’ duration
each, will be sufficient for the purpose of giving it a trial. The
tincture of Sabadilla, however, is a much better remedy and certainly
deserves the preference.

Properties of the Constituents of the Veratria of Commerce:

_ Ir has been already stated, that M. Couerbe has succeeded in ob-
taining four alcaloids from the Veratria of Commerce, viz., Veratrine,
Veratrin, Sabaditline, and the Mono-hydrate, or Gum Resin of
Sabadilline ; we have also described the processes by which these
substances may be procured separately, and shall now give a few fur-
ther particulars of their history and properties.

Veratrine.—M. Couerbe considers Veratrine as the pure active
principle upon which the properties of Sabadilla seeds depend. It
is white, solid, and friable ; insoluble in water, but very soluble in
aleahol and ether, and forms erystallizable salts with acids. Its
medical properties, may be considered precisely similar to those of
Veratria. one pe .

VeERATRIN.—This substance has a brown colour, it is insoluble
in water, and differs from the preceding in being insoluble in
ether. It is soluble in alcohol; with nitric acid, it forms oxalic acid.
Its medicinal action has not been tried, but may be inferred to be
similar to that of Veratria.

SABADILLINE.—When in a state of purity, Sabadilline is white
and crystalline ; it is very acrid to the taste, it is completely soluble
in water and in alcohol, but insoluble in ether ; it combines with
sulphuric acid, and formsa crystallizable sulphate. It is distinguish-
ed from Veratria by its solubility in water, by its insolubility in
ether, and by its forming crystals. ‘The Sabadilline which I have
employed, is in the form of a fine light brown powder, and not so
pure as that obtained by M. Couerbe. In this state it is very solu-_
ble in water and alcohol, but insoluble in ether, and has the following
properties. )

Its taste is acrid but not bitter, and it produces a slight sensation
of cold when first applied to the tongue ; when applied to the nos-
trils it irritates the mucous membrane and occasions sneezing, but
not so violently as Veratria. When administered internally in the
dose of one-sixth part of a grain, every two hours, it gives rise to
effects very similar to those produced from the administration of

48 TURNBULL ON RANUNCULACES.

Veratria and its salts, though ina much less degree. It excites a
little heat in the stomach, but does not act upon the bowels, and after
several doses have been taken it occasions sensations of tingling in
the extremities, but very slightly. Internally it has effects on dis-

ease similar to those of Veratria, but it is much inferior as a medicinal

agent. | 3 \

When used in the form of embrocation or ointment, Sabadilline
has more powerful effects. It excites a peculiar feeling of heat and

pulsation in the part where it is rubbed, and this is accompanied by

a sensation, as if the part had been severely bruised, which continues

often for some hours. | | | 7

The ointment employed may contain from fifteen to twenty grains
to an ounce of lard, and may be rubbed for fifteen or twenty minutes,
or until the heat and pulsation show themselves; sometimes a slight
eruption comes out on the skin where it is rubbed, but it is not at-.
tended with an inconvenience. I have used the ointment of Saba-
dilla in friction, in neuralgic affections, and in rheumatism, gout, &c.
~ Its effects are similar to those of Veratria, but not so beneficial. It
cannot, however, be said that the remedy has had a fair trail, as very
little of it has as yet been made, and what I have used has not been
in a state of purity. : ines ve

Mono-HypraTE OF SABADILLINE differs nothing in general cha-
racter from Sabadilline, except that it has a yellowish colour, and is
incrystallizable ; it has nearly the same chemical constitution, and
indeed M. Couerbe considers the two substances as differing in
nothing, except that Sabadilline has two atoms of water of erystalli-
zation, whilst the mono-hydrate has only one. From their similari-
ty in these respects it may be inferred that they have similar
oe properties, although the mono-hydrate has not hitherto been
used. aie) | .

The only thing connected with this part of the subject which
remains to be noticed, is the use of the salts of Veratria externally.
Several of these have been employed, and appear to be possessed of
effects very similar to those of the base itself. Hither the sulphate,
acetate, or tartrate, may be used, in the proportion of from ten to
fifteen grains to an ounce of lard ; they make an ointment that oc-
casions a powerful sensation of heat and tingling, when rubbed upon
the skin, and may be resorted to, and perhaps with advantage, when
Veratria, as sometimes happens, has become less efficacious from
continued use. , |

ee es

CHAP a Rr.
Medicinal Employment of Delphinium Staphisagria, and its
| victive Principle, Delphinia. ;

STavEsacrE, a biennial, Polyandria Trigynia, Linn. Ranun-
culacez, J uss. Maltisilique, Linn. a native of the south of Europe.

- PREPARATION OF DELPHINIA. 49

~The Delphinium Staphisagria,and its active principle Delphinia,
are the next substances possessed of properties similar to those of
Veratria, of which J shall give an account. The seeds of the plant
are the part used in medicine ; they are of the size of small peas,
triangular, and sometimes four sided; they are rough, wrinkled, and
slightly curved, dark coloured. externally, and yellowish white
within; their smell is disagreeable, and their taste bitter, acrid, and
burning. | |

Stavesacre seeds in some quantity, act upon animals.as an acrid

irritating poison ; their effects are chiefly confined to the mucous
membrane of the stomach, in which they sometimes excite inflam-
mation ; but the nervous system appears to suffer most, especially if
death come on soon after the poison has been administered. In the
human subject, when taken internally, they excite vomiting and pur-
ging, and act also as general irritants and sialogogues.

Stavesacre was at one time employed as a cathartic and anthel-
mintic, but is now laid aside, on account of the violence of its effects.
It is still, however, used externally in infusion for the treatment of
skin diseases, particularly scabies, and, in powder or ointment for
destroying pediculi. Inthe form of a concentrated tincture, I have
employed it as anembrocation in the treatmentof rheumatic affections,
with considerable advantage. It causes sensations of heat and ting-
ling, very similar to thosearising from the useof Veratria, and should
be rubbed until these effects show themselves. }

Preparation of Delphinia.

Dex.rutnra was discovered in the seeds of the Delphinzaum Sta-
phisagria, by MM. Lassaigne and Feneulle, in the year 1819.* It
‘may be obtained by several processes, but thatrecently given by M.
Couerbe appears to afford the purest result. It is as follows. A
saturated tincture of Stavesacre seeds is to be evaporated to the
consistence of a thin extract, and treated with water, acidulated by
sulphuric acid : this solution, when filtered, is to be precipitated by
‘ammonia. The precipitate, after being freed from its water; is to be
taken up with alcohol, and again reduced to the consistence of extract,
which is likewise to be dissolved in acidulated water ; to this solu-
tion, when filtered, a small quantity of nitric acid is to be added, as
long as any precipitate falls: the liquid freed from this precipitate is
again to be thrown down by ammonia, and the powder dried. This
is the Delphine of Commerce ; but, like Veratria, it isa compound
substance, and consists of resinous matter, Staphisaire, and Del-
phine: the Delphine is separated by treating the powder with ether,
which takes it up and leaves the Sfaphisaire.

When ina state of purity, Delphinia is white, pulverulent, and
without smell; but, like Veratria, when applied to the mucous
membrane of the nose, it occasions sneezing, along with an abun-

* Annales de Chimie, tom. Xi. XI. »

5*

50 | TURNBULL ON RANUNCULACES.

dant secretion of mucous ; its taste is at first bitter, and afterwards
acrid ; and it acts upon animals inthe same manner, but more ener-
getically than the seeds from which it is prepared. | ‘f

_When heated it melts, and somewhat resembles wax in appear-
ance ; and on cooling, it becomes brittle like resin. It is very
sparingly soluble in water, but yet in sufficient quantity to commu-
nicate a bitter taste to the fluid. In alcohol and ether it dissolves
readily, and these solutions have the property of rendering syrup
of violets green, and of restoring the blue colour of litmus, when
reddened by the addition of a portion of acid. It combines readily
with acids, and forms neutral salts, which are possessed of much
bitterness and acridity, and it may be precipitated from solutions
of these in the form of a jelly, by the addition of an alkali.

Internal Administration of Delphinia and tts Salts.

Pore Delphinia has little effect upon the mucous membranes of
the stomach and bowels. It may be administered in some cases to
the extent of three or four grains a day, in doses of half a grain
each, without exciting vomiting ; in this quantity, however, it
sometimes operates upon the bowels, but causes very little irrita-
tion. In most instances it acts as a diuretic, and occasions a con-
siderable flow of pale urine. When taken to the extent of a few
grains, it gives rise to sensations of heat and tingling in various
parts of the body, similar to those which are produced by rubbing
it upon the skin, and its other effects are very nearly the same as
those of the salts of Veratria. The salts of Delphinia act much in
the same manner, but there is nothing to give them a preference to
the alcaloid itself: both have been used in the same diseases as the.
. preparations of Veratria, and appear to exercise a similar action. ~

External Application of Delphinia.

Dz.rurntA, when in a state of purity, is entirely soluble in al-
cohol and ether; but neither of these circumstances can be relied
upon as a test of the efficacy of the medicine ; for, like Veratria, it
may have the appearance of being almost chemically pure, and yet
be possessed of little activity in the removal of the affection, for
which we may wish to apply it. The test already laid down, with
regard to Veratria, is the one which should in this instance be re-
sorted to; namely, that unless a solution of Delphinia in alcohol, in
the proportion of four grains toa drachm, occasion a distinct sensa-
tion of heat and prickling, when rubbed for three or four minutes
upon the forehead, the specimen ought not to be used, for if this be
not attended to, no beneficial effect will arise from its application.

There are a few points in which Delphinia differs from Veratria,
in its action upon the skin, which require to be shortly noticed. |
Veratria, when rubbed upon the cuticle, produces a strong sensa-
tion of tingling, or rather a feeling similar to that produced by re-

EXTERNAL APPLICATION OF DELPHINIA. 5]

ceiving a succession of small electric sparks on an uncovered part of
the body ; whilst Delphinia gives rise to a sensation of burning, not
unlike that which manifests itself a short time after the application —
ofa blister; but not to an unpleasant degree, unless the friction have
been carried too far. They differ also in the duration of the effect
produced, as that caused by Delphinia is generally more powerful
and durable than when Veratria is used. i330

In the great majority of instances, Veratria may be rubbed upon
the skin for the usual time, without causing any great degree of
redness on the part ; but in almost every casé,a blush pervades the
surface, over which the Delphinia has been applied, and this con-
tinues during a length of time, varying from a few minutes to an
hour or two, but in no instance, as yet observed, has it gone on to
eruption. This property of stimulating the capillaries of the sur-
_ face of the skin, may add much to the power of Delphinia, particu-

Jarly in paralytic cases. |

So far as the comparative merits of the two substances have been
examined, they appear to be of nearly equal value as medicinal
agents, for in most instances they seem to have the same power in
removing similar diseases. There are one or two particulars, how-
ever, in which they differ, and which in certain instances may give
a preference to the Delphinia. The diseases in which it has been
chiefly employed, are tic-douloureux, paralysis, and rheumatism.
In the first of these, when the affection is seated in the tongue, or
at the point where the infra-orbitary nerve escapes from its fora-
men, the use of the Delphinia is to be preferred, because it can be
applied to the tongue, or rubbed on the gums without occasioning
irritation ‘of the mucous membrane, a circumstance of great import-
ance in the treatment of these forms of the disease. It appears also,
upon the whole, better adapted to the treatment of paralytic cases
than the Veratria, but principally on account of the property just
mentioned, which it possesses, of exciting the circulation in the dis-
eased part. i .

The manner of applying Delphinia is the same as that already
recommended for Veratria. It may be used either in the form of
ointment, or in solution in alcohol, and the proportions to be em-
ployed in either case, may vary from ten to thirty or more grains
to the ounce, according to the severity of the affection, in the treat-
ment of which it is to be prescribed. The duration of the frictions,
also; should be nearly the same ; that is to say, from ten to twenty
or more minutes, or what is better, until the pungent sensation
produced by the rubbing shows itself. In short, the two substances
are so nearly alike to each other in their effects upon the system,
and in the manner of their application, that the instructions which
have been already given in regard to Veratria, are equally appli-
cable to Delphinia, except that the latter may be with safety applied
in affections seated in the parts within the cavity of the mouth.
For this purpose a solution in alcohol is preferable, as being less
objectionable on the part of the patient, and it ought to be rubbed

52 TURNBULL ON RANUNCULACEA.

upon the mucous membrane, over the seat of the pain, until this
be removed, or at least until the peculiar sensation produced. by it
be as powerful as can be borne ; and the friction should be repeated
two or three times a-day, according to circumstances. ©

As an illustration of the action of Delphinia in removing disease
the following case has been selected. It is also interesting, as in its
treatment both remedies were resorted to ; and because it proves
the utility of frictions with Delphinia when employed within the

mouth.
CASE. .

Feb. Sth, 1834.—Mr. J. Sears, Bride Terrace, Liverpool Road,
Islington, aged 60, was about seven years ago seized with an acute
pain seated in the course of the frontal nerve, on the left side ;
about four years since the affection extended itself to the infra-or-
bital nerve, and for the last twelve months the portio-dura has also
become the seat of the disease. Since the commencement of the
attack the pain has continued with great severity, and with oeca-
sional itermissions of a day or two, but the sum of these has not
amounted to above a month in the year. .

All attempts which had been made to give him relief had failed,
and for three years he had been compelled to relinquish his occupa-
tions, on account of the severity of. his sufferings. For three
weeks before he came under treatment, he had of his own accord
made use of frictions with the Veratria ointment over the seat of
the pain, and he states that under its influence he has experi-
enced considerable relief, and that at times he is: quite free |
from pain, although the disease is not yet subdued. He was or-
dered to continue the frictions whenever the pain showed a ten-
dency to return, with the following ointment :

R.—Veratriz, . =. . or. xvi. |
AKO Se Nice ie a SSS. M. ut fiat unguent.

13th.—The patient has made use of the ointment as directed, and
the pain has now disappeared from the temple, eyebrow, and side of
the face, with the exception of a point exactly over the infra-orbi-
tary foramen, where tit still continues severe, and from whence
it occasionally darts to the other parts which were previously af-
fected.

As the progress made since he was last seen was so far satisfac-
tory, in order to try the comparative effects of the Veratria and
Delphinia, he was ordered to discontinue the former, and to use in
the same manner the following :

R.—Delphinie : oe Se OTee SVE
AXUNG. 85079 1 oo 8 8. M. ut fiat unguent.

EMPLOYMENT OF THE GENUS ACONITUM. 53

17th.—Since last report he has been improving, the pain in the
seat of the infra- orbitary foramen has become less and. less severe;
and he is at present quite free from it. He was ordered to use the
Delphinia ointment if the pain should return.

20th.—The pain has never appeared except at the point already
mentioned. The same prescription to be continued, with this
difference, that the frictions are to be confined as nearly as possible
to the skin over the seat of the pain. |

_23d.—The patient is better to-day than he has yet began ; there
is still, however, a tendency to a recurrence of the pain; he was
directed to discontinue the external use of the Delphinia, and in-
stead of it, to rub a portion of the same ointment inside of the
mouth, along the angle formed by the gum and cheek, as nearly as.
possible to the situation of the infra-orbitary foramen, and to con-
tinue the friction until the pain was removed, or as ‘long as the
application could be borne.

25th.—The friction occasioned no irritation in the mucous mem-
brane; it gave rise, however, to a sensation of tingling, accom-
panied with some degree of salivation, and the pain has almost dis-
appeared. Yesterday the patient had no attack, but to-day it has
slightly returned. He was ordered to use the frictions to the inside
of the cheek and gum, when the pain showed itself, with the follow-
_ ing ointment :

K.—Delphinie OT. Xo.
Axung. : - gi. M.ut fiat unguent. |

March 11th. —The last prescription was not made use of, as the
patient has continued to be quite well. The slight pain he experl-
enced when last seen, disappeared of itself ; and with the exception
of a little feeling of uneasiness, which lasted only a minute or two,
he has had no symptom of his former disease. He has resumed
his employment after an interval of three years —has exposed
himself to drafts of cold air, and to all those causes which used
formerly to bring on severe paroxysnis of pain, but up to this date
(June 1835) he has not had the slightest appearance of a return.

CHAPTER PEt.

Medicinal Biagtoiymens of the Genus Aconitum, and its ‘lective
Principle /Alconitine.

Aconitum, Polyandria Trigynia, Linn. Ranunculaceex, Luss.
Multisiliquex, Linn. Europe.
The gras Jiconitum has been divided by De Candolle into four

54 “TURNBULL ON RANUNCULACE.

sections,—Anthora, Lycoctonum, Cammarum, and Napellus.
Several species have been introduced into medicine in different
countries, and at various periods. An unknown species appears to
have been used by Avicenna, the celebrated Arabian physician, in
the treatment of skin diseases ; but since his time, down to a com-
paratively recent period, no further notice seems to have been taken
of it. The person who may be said to have introduced Aconite
into practice, was Dr. Stork ; and he recommended its employment
in the form of inspissated juice, prepared from the fresh plant,
in the treatment of Gout, Chronic Rheumatism, Amaurosis, Syphi-
lis, &c.* | | : 3 ; |
Considerable difference of opinion has prevailed as to the precise
species made use of by Stérk. He himself names two :—the co-
nitum Napellus and 4. Neomontanum. The latter of these is
the one determined by Willdenow ; but De Candolle is of opinion
that it is a variety of 4. Paniculatum, to which he has given the
name Stérkianum, to distinguish it as the species employed by
Stork. Besides these, however, the 4. Cammarum and 2. 2n-
thora have found a place in several continental ‘Pharmacopeeias.
Kach of our Colleges has given a formula for the preparation of
an inspissated juice from the fresh leaves of the monkshood ; but
‘in addition to this, the powder of the leaves, the wine and an alco-
holic and two ethereal tinctures, are made use of on the Continent :
all of these are employed internally, but are very inconstant in their
operation, as might easily have been anticipated from their manner
of preparation ; and this circumstance shall be presently noticed.
Very recently, M. Lombard, of Geneva, has recommended the use
of an alcoholic extract of Aconite in the treatment of acute rheuma-
tism, and has given a process for obtaining it. This, though a much
less objectionable one than any of those above-mentioned, gives a
product that is still inconstant in its effects ; for he states that he has
given with success from half a grain three times a-day,to a drachm and
a half in the twenty-four hours.t It appears that there are several
causes why the preparations of Aconite at present in use are liable to
inconstancy ; they are all prepared either from the fresh plant or from
the expressed juice : in the first instance they must vary in power,
according to the state of the plant, and the time when it is gathered ;
and the extracts made by evaporating the expressed juice must also
vary, a8 in the very act of expression a change in the activity of
the product appears to take place, and a still further alteration must
ensue during the process of evaporation. I have tried several dif-
ferent extracts made in this way, and have found them almost inert.
lhe process employed by M. Lombard consists in carefully evapo-
rating the expressed juice of the plant, and treating the extract with
aleohol ; then filtering and evaporating the tincture with a very
gentle heat. In this way, the active matter contained in the inspis-

* Stork, Spicilegium Observationum de Aconito, 1788.
{ Gazette Médicale, Juin, 1834.

PROCESSES FOR PREPARING ACONITINE. 55

sated juice may be procured in a more concentrated form, but still
the process is liable to some of the objections already stated. —

Another objection to these preparations is, that they are all
obtained from the least active part of the plant, for the root certainly
contains a much greater proportion of the peculiar properties of the
Aconite than any other part, and is consequently that which should
be used. From these considerations, and from the difficulty of pro-
curing the active principle, I was led to employ a tincture and al-
coholic extract, prepared from the powder of the root carefully dried.
The tincture is made by digesting one part by weight of the powder,
in six parts by measure of strong alcohol, for seven days, and filtering
through paper; and the dose for an adult ought not to be more than
eight or ten drops three times a-day to commence with, but it may be
augmented to twenty ; beyond which, however, few patients will
bear it to be carried. With regard to the extract, I have never
exhibited it internally, but have employed it with great benefit in
the manner-I shall immediately mention. ),

When Aconite is administered internally, in any form, and in a
small dose, it acts as a diuretic and diaphoretic, and accelerates the
pulse: if it be pushed still farther, it begins to affect the nervous
system, and occasions headache, nausea, weakness of the joints and
muscles, slight confusion of intellect, and a remarkable sensation of
tingling in various parts of the body, particularly in the head, face,
and extremities. This latter circumstance was remarked by Dr.
Dunean, jun., as always accompanying the relief afforded by the
internal exhibition of extract of Aconite in cases of Sciatica.* If
the dose be still augmented, aberration of mind, dimness of vision,
and convulsive movements, come.on. A few cases are on record,
_ where such symptoms have shown themselves when the Aconite
had been swallowed accidentally ; and they have, in some of these,
been followed by fainting, vomiting, stupor, and death.

The diseases in which Aconite has been administered, are chiefly
those already enumerated ; and I have also found much benefit from
its employment in tic-douloureux, and other painful nervous affec-
tions; but from all that is unknown of its internal use, it does not
appear that the benefit to be derived from this method of exhibition
is at all to be compared with that which arises from its administra-
tion by the Endermic Method, either as regards the amount of effect
produced, or the perfect safety with which, in this latter mode, it
may. berused. 4) G2 ee

Processes for preparing /Iconitine.

Tuure are three forms in which the Aconite may be employed
externally, namely,—the active principle Aconitine ; impure Aco-
nitine, as contained in the ammoniated extract ; and, thirdly, in the

* Edin. New Dispensatory, 1830.

56 ‘TURNBULL ON RANUNCULACE.

form of tincture, or solution of the active principle in alcohol ; and
of these it is now proposed to give a short account. |

_M. Peschier, of Geneva, appears to have been the first experi-
menter who detected the presence of Aconitine, during a chemical
examination of the Aconitum Napellus and 4. Paniculatum :
he describes it as a peculiar alkaline substance, capable of forming
erystallizable salts with acids.* It appears again to have been detected
by M. Brandes, in the 2. Neomontanum ; but no’ particulars.
regarding it are mentioned. In 1825, M. Pallas described the
Aconitine as an alkaline substance, which he had obtained in scales
of a yellowish colour.t 3 | yes

In the year 1832, M. Geiger, from the result of his physiological
experiments with different Aconites, came to the conclusion, that
the acrid Aconites contained a narcotic substance different from
their acrid principle ; and this opinion led M. Hesse to analyse the
Aconitum Napellus ; and from this he obtained a peculiar body,
to which he has given the name Aconitina. The process for ob-
taining it consists in precipitating a decoction of the dried leaves
by hydrated magnesia, washing the precipitate with water, drying
it, and then treating it with boiling alcohol, which dissolves the -
Aconitine and deposits it on cooling.} :

It is described as being incrystallizable, white and granular, or
in a colourless mass, .transparent, and having the lustre of glass. It
is alkaline, inodorous, and has a bitter acrid taste. This acridity,
however, does not belong to the Aconitine, but disappears if the
base be several times combined with acids, and the salt formed de-
composed. When deprived of this acrid principle, it is poisonous
in the highest degree, a twelfth part of a grain being sufficient to
destroy a little bird with the rapidity of lightning. Aconitine is
very fusible: it is little soluble in water, but very much so in
alcohol and ether. Its solutions are alkaline, and it neutralizes
acids; but its salts are not capable of being crystallized. Such is
the account of the substance obtained by MM. Geiger and Hesse;
but the elementary analysis has not yet been accomplished.

I have made seyeral attempts to obtain Aconitine from the
Parisian chemists, for the purpose of employing it in medicine, but
have never hitherto succeeded. It is now, however, prepared in
town, and may be had in sufficient quantity for present use, by
those practitioners who may wish to make trial of its properties.§
Either of the following processes will yield it: the first is the easier
to manipulate, but the second yieldsa much purer result, and is upon
the whole to be preferred. | , ge

A quantity of the fresh root of the Aconitum Napellus must be
procured, and care should be taken that it be sound, and that the

“Trommsdorff Neues Journal der Pharmacie, vol. 84,

T Journal de Chimie Médicale, tom. 1—193. :

+ Journal de Chimie Médicale, Aout, 1834.

§ Aconitine is at present prepared by Mr. Morson, chemist, Southampton Row.

PROCESS FOR PREPARING ACONITINE. 57

root be that of monkshood; for sometimes other roots are sold for
it. Let it be carefully and cautiously dried, and then reduced.to
powder; this latter operation is not unattended by danger, especially
if a part of the fine dust which rises from it be inhaled. One part
by weight of the powder, and two parts by measure of strong
alcohol, are to be digested together in a gentle heat for seven days,
and the tincture, while warm, is to be filtered. It is then to be
reduced to the consistence of an extract, by careful evaporation, at
a low and well-regulated temperature ; the object of this is to prevent
the destruction or expulsion of the active principle, which would
very probably ensue, if the temperature employed were higher than
barely sufficient to carry off the alcohol. To the extract thus pre-
pared, liquid ammonia is to be added, drop by drop, and mixed
well with it, to precipitate the alealoid; and in this part of the process
care must be taken that too much be not added, as in some instances
the product appears to have been decomposed by inattention to this
circumstance. It is difficult to give a precise rule as to the quantity ;
but enough will have been added, if the extract give out the odour
of ammonia, when stirred. ‘ |

The mass now consists of impure Aconitine, mixed up with a
quantity of extractive and other matters, soluble in water; and it
may be taken up either with boiling alcohol, or sulphuric ether; or
the soluble matter may be removed, by repeated washings with
small quantities of cold water, which will leave the Aconitine. This
latter process is the one we have generally employed, and is per-
formed by pouring a little water on the extract, and mixing them
carefully together, then allowing the undissolved part to subside,
pouring off the fluid, and repeating the operation, as long as any
soluble matter is taken up, a quantity of light brown or grey powder
is left, which may be purified by subsequent solution in alcohol.
This powder contains the active properties of the Aconite, in a high
degree of concentration. A grain of it was dissolved in a drachm
of alcohol; and twenty drops of the solution put into the mouth of a
guinea-pig occasioned death in a few minutes. Other experiments
have been performed, all of which prove the extreme energy of the
substance. 3 OES

The second process consists in dissolving the alcoholic extract,
prepared as before, without the addition of the ammonia, in as much
cold water as will take it up, and carefully decanting the solution
from the insoluble part, and then filtering it. To the filtered solu-
tion liquid ammonia is to be added, drop by drop, as long as it
occasions any precipitation. When the precipitate has subsided, the
supernatant fluid should be carefully poured away, or drawn off by —
means of a syphon; and after the precipitate has been deprived of
as much of the fluid as possible, it should be purified by a sufficient
number of washings with small quantities of cold water, or, what is
better, it may be dissolved in as much alcohol as will take it up,
and the solution thrown into cold water; and the precipitate thus

JANUARY, 1838.—/" 6

58 | TURNBULL ON RANUNCULACE.

formed is to be carefully dried. The product obtained by this
process is white. 3 . 3

External Application of Aconitine.

Ir has already been stated, that if a grain or two of Veratria or
Delphinia be mixed up with a little lard, or dissolved in a drachm
of alcohol, and a small quantity be rubbed upon the skin of the
forehead or other tender part, a sensation of heat and tingling will
be experienced, after the friction has been continued for a minute or
two. If the same procedure be followed with the Aconitine, a
similar result will be obtained. The sensations produced by the
three substances differ, however, in a few particulars. When Vera-
tria is employed, it produces a strong sensation of tingling or rather
a sharp feeling, similar to that produced by receiving a succession
of electric sparks on an uncovered part of the body ; whilst the
Delphinia gives rise to a sensation of.burning, not unlike that which
manifests itself a short time after the application of a blister, but not
to an unpleasant degree. 3

The Aconitine is possessed of an action similar, in some respects
at least, to that of Delphinia. When a small quantity of it, either
made into an ointment, or dissolved in alcohol, is rubbed fora
minute or two upon the skin, a sensation of heat and prickling is
experienced ; to this, succeeds a feeling of numbness and constric-
tion in the part, as if a heavy weight were laid upon it, or as if the
skin were drawn together, by the powerful and involuntary contrac-
tion of the muscles beneath. This effect lasts from two or three,
to twelve or more hours, according to the quantity rubbed in. So
small a portion as the one-hundreth part of a grain has produced a
_ Sensation that has continued a whole day; but the alcoloid, in this
instance, was in a high degree of purity.

The action of the Aconitine upon the cutaneous vessels, appears
to be less than that of either Veratria or Delphinia ; for in no case
hitherto observed, has it produced a greater degree of vascular ex-
citement than might easily be accounted for by the friction itself ;
and in one instance where the Veratria ointment did occasion irrita-
tion, the Aconitine has been employed without giving rise to any.

The diseases in which I have chiefly employed the Aconitine
externally, are Tic-Douloureux and Neuralgic affections generally,
and in gouty and rheumatic cases; and its success has fully answered
the anticipations that had been formed of its utility. It may be
employed in the form of solution in alcohol, in the proportion of
one or more grains to the drachm, and in ointment, made according
to the following prescription :—

R. Aconitinz, gr. ii. |
Alcohol, gtt. vi. tere optime
et adde, Axung, 3 i. ut fiat unguent.

The object of adding the alcohol, is to prevent the Aconitine from

_ EXTERNAL APPLICATION OF ACONITE. 59

forming a thick compound with part of the lard, which renders it
difficult to make a proper ointment.

The proportion of the alcaloid in this prescription will, in general,
be sufficient to begin with, but it may be augmented to four or five
grains to the drachm, if necessary ; and in one case of Tic-Douloureux
of unusual severity, as much as eight grains to the drachm were
prescribed with the most marked benefit. The best manner of
applying the ointment, is simply to rub a small part of it over the
whole seat of the affection, till the pain be either for the time re-
moved, or until the full effect upon the cutaneous nerves above
described be brought about; and the friction should be repeated
three or four times, or more frequently in the day, according to the
effect produced upon the disease. The proportion of the Aconitine
ought to be increased at every second or third friction; and the
same rule elsewhere laid down, in regard to the action of Veratria
and Delphinia, also holds good in the present instance,—namely,
that unless the friction occasion a full development of the peculiar
impressions caused by the Aconitine when rubbed on the skin, no
benefit whatever is to be looked for from its employment. It is
almost needless to remark, that an application of such activity should
not be resorted to, if there be the slightest abrasion of the surface
of the skin, and that it should be carefully kept from coming in
contact with any of the mucous membranes.

External Application of the Ammoniated Extract of Aconite, &c.

Tur next preparation that requires notice, is the ammoniated
extract of Aconite; this is probably the best appellation for the sub-
stance, although it bein reality a mixture of all the active principles,
along with extractive and other matters. It is made by evaporating
_ very carefully, and at a low temperature, the tincture of the dried
root of the plant, prepared as already directed in the process for
obtaining the Aconitine, to the consistence of an extract. To every.
drachm of this, eight or ten drops of liquor ammoniz should be added ;
and after the mixture has stood a short time in a very gentle heat,
to drive off the excess of ammonia, it is to be used in the form of oint-

ment, according to the following prescription :—

hk. Extract. Aconit. Ammon. 4 i.
Axung, 3 iil. M. ut fiat unguent.

This, from its dark colour, may be a less agreeable application
than the Aconitine ointment: but it appears to me, to be at least as
efficacious, and it has the advantage of being easily and cheaply
prepared: and on these accounts it is better suited for hospital
yractice. The proportion of the extract may be increased two or
three-fold, according to circumstances. sip.

When this ointment is rubbed upon the skin, it occasions sensa-
tions in the part, similar to those which are produced by the Aco-
nitine ointment; they are, however, rather more pungent in their

60 - TURNBULL ON RANUNCULACES.

character ; and this probably arises from the extract containing
what is called the acrid principle of the plant, as well as the alcaloid
itself ; and it is absolutely necessary that with this preparation also,
these sensations should be induced, in order to its having a full
effect on the disease for which it is applied.

_ In less severe cases, the simple saturated tincture of the dried
root, with or without the addition of a little ammonia, may be used ;
it has similar properties, but in a much smaller degree of develop-
ment, with the two preparations above mentioned, and the same
instruction as to its use ought to be attended to.

Severe Case of Neuralgia in the Finger, treated by Prepara-
tions of Aconite.

Tux following case has been selected as affording the most con-
clusive evidence possible of the efficacy of preparations of Aconite
in removing Neuralgia. It is one of the most severe and obstinate
on record ; and during a period of above two years, had resisted
every means that could be devised for its removal. The previous

history and treatment are taken from a very able lecture on Neu-
ralgia by Dr. Elliotson, which was published in the Lancet of De-
cember Sth, 1832.

Samuel Best, residing No. 7, Somers Street, Liquorpond Street.

“This man was a journeyman printer, aged 32, and had been ill
two years. He first of all had pain of the legs, arms, and wrists,
and when he came in, the pain was confined to the middle-finger
of the left-hand, on each side, along the course of the nerve. The
other fingers of the same hand were benumbed—were without any
great degree of feeling, but the thumb was unaffected. Originally
he had had pain on the right side of the face—that is on the oppo-
site side of the body, and the pain then commenced in the sub-
maxillary nerve, and extended upwards, so as partly to affect the
second branch of the fifth pair, as well as the third. It is there-
fore to be recollected, that he had had Neuralgia in another part of
the body. All this, however, had ceased a month before admission,
at which time he had only pain on each side of the middle-finger,
and after that had existed some time, the other fingers had heecame |
benumbed. ae :

“The pain was of a very agonising character ; a plunging. stab-
bing pain, as though you were running a penknife along the finger.
Patients usually describe the pain in neuralgia as stabbing and
plunging. The least touch gave him violent pain, like an electrie
shock. As the least touch produced such: violent pain, he could
not bear his nails to be cut, and the consequence was, that the nails
of that hand had grown to a great length. He could not sustain
the motion of the hand which the cutting of the nails necessarily
produced, and the agony of the pain was such, that he bit the
nails of the fingers of the other hand, so that the nails on
the fingers of it were eaten down by him in his agony,as far as they

NEURALGIA IN THE FINGER. 61

could be. ‘The appearance was certainly very remarkable ; for on
one hand the nails were, as I have just said, as short as they could
be ; and on the other hand, though they were not so Jong as they
might be, yet they were of very great length. I believe whenever
he had a very violent attack of pain, the nails of the affected hand
became discoloured, and remained so for some time. —

T ecould detect no cause for this at all. I could connect it with
no obvious morbid state, and therefore, what produced the pain I
could not tell. I could only say there was a pain, and that the pain
was clearly situated in the nerves—following the course of nerves,
affecting other parts also exactly in the situation of branches of
known nerves, and having the usual character of pain of the nerves,
or at least, what it very frequently is, stabbing and plunging.
There was no heat or inflammation of the fingers ; nothing what-
ever to beseen ; but yet there was agonising pain, and the slightest
touch aggravated the pain when present, or brought it on at a mo-
ment when he scarcely felt any. |

“ Treatment.—One of the best remedies in this disease, but by
no means a specific, and by no means so successful I think as in
some other nervous complaints, is carbonate of iron. Its efficacy
in this disease, so far as 1 know, was first pointed out by Mr. Hutch-
inson, a surgeon in the country, who, I believe, is now dead. * *

‘This man’s complaint having lasted two years, and carbonate
of iron being an innocent remedy, provided you keep the bowels
regularly open, he took half an ounce three times a day ; and when
he had taken that for five days without any benefit whatever, he
took the same quantity every four hours.

“ Now this did him a certain degree of good. He was better.
Still he had pain sufficient to keep him awake at night ; and I gave
him, in addition, a quarter of a grain of muriate of morphia. The
benefit was but temporary ; and I applied to the finger a solution
of the cyanuret of potassium, which has been so much praised by
the French. But it did not relieve him materially, and the solution
was then made stronger than the French have recommended it. It
was carried as far as twenty-four grains to an ounce of water. After
a time it was suggested, that it was merely the cold which did him
good, and I applied ether, to see if that would relieve him, and it
did so, much more than the solution of cyanuret of potassium had
done. Still, however, he was very little better. The amend-
ment which he at first experienced on taking the iron ceased, and |
was obliged to increase the dose of medicine, and likewise the mu-
riate of morphia, for he obtained’no sleep. He took a whole grain
of the latter every night. The iron was then increased to the
quantity of an ounce, and it was given every four hours. His
health improved under it, and from being pale and thin, he ae
great paleness, and gained flesh, and thought himself quite another

man, so far as his general health was concerned. ‘The quantity of

eyanuret of potassium was increased now, to a drachm in an ounce

of water; but it afforded no relief, He still found more benefit
| 6

62 TURNBULL ON RANUNCULACE.

from ether. One could not expect a man to continue swallowing
more than an ounce of iron every four hours. He would have taken
itin any quantity, but it was necessary to consider his stomach, not-
withstanding his good will to take the medicine. I therefore gave
him another form of iron also, the sulphate. Ido not know that
the carbonate is superior to the sulphate in this disease, or in cho-
rea, and the latter may frequently be taken the most easily. He
began with five grains, in conjunction with the carbonate of iron,
and took both every three hours. His agony was still extreme, and
the sulphate was, therefore, increased to ten grains, and afterwards —
to fifteen. He received some degree of benefit, but it was only
temporary. |

66 thought now that the iron had had a very fair trial, and it was
only relinquished on the 26th of July, he having begun to take it
on the 8th of March, so that he had continued it for three months.
This was a very fair trial, both with respect to the quantity of the
dose, and the long continuance of its exhibition. * * *

“J then relinquished the iron altogether, and endeavoured to
apply strychnine to the finger. We attempted to blister the finger,
and then sprinkled half a grain of the strychnine upon it. It was,
however, with very great difficulty that we produced vesication ;
very imperfect vesication was effected, and therefore it was not
very well managed. I still determined on trying whether. the
strychnine would do him good or not, and I therefore exhibited the
twelfth of a{grain internally. As strychnine is so powerful an
agent, I never like to begin with a larger quantity than that. It
was then increased gradually to the eleventh, tenth, ninth, eighth,
and so on, of a grain. Still he was no better, and I was obliged to
increasé the muriate of morphia.to two grains every night, one grain
being said to be equal to four grains of opium. The man told me,
with tears in his eyes, that the agony was such that he never slept.

“The strychnine was increased now to half a grain three times
a-day, and I had the finger smeared with croton oil. He could not
bear to have it rubbed in, and therefore it was gently smeared on
the part, but produced no great irritation. His health now began to
decline. He was taking on the 7th of August three-fifths of a grain
of strychnine three times a-day, and two grains and a half of mu-
riate of morphia, but he began to take the iron again. I gave it
him without any hopes of its producing benefit, but for the purpose
of improving his general health. He began with half an ounce
three times a-day, which was increased to an ounce, and then to
four times a-day. His health soon improved again, but the pain
continued unabated, and the muriate of morphia was increased to
three grains twice a-day. His pain was such, that I was obliged to
give him an opiate in the day time as well as at night. The strych-
nine was not increased beyond three-fifths of a grain three times
Arday, and as it did him no good, merely produced some twitching
of the limbs, it was relinquished on the 21st of August, never
having been of the slightest service. Arsenic has been known to

- NEURALGIA IN THE FINGER. 63
‘be serviceable in some cases combined with an alkali as in the
liquor arsenicalis. He commenced with this on the 21st of August,
and began with small doses three minims three times a-day, not
taking it on an empty stomach. ‘This was increased gradually to
nine minims, but without any effect on the disease, though it
began to make him sick. Nine minims I consider a very full dose.
It, however, disturbed his stomach, and to prevent the sickness he
took two minims of hydrocyanic acid three times a-day, half an
hour before the arsenic. ‘This did not lessen the sickness, and I
therefore was obliged to increase it to three minims, and went gra-
dually on till I arrived at a dose of nine minims three times a-day.
This entirely prevented the sickness arising from the arsenic. Hy-
drocyanic acid has the very valuable property of stopping vomiting,
provided this does not depend on inflammation. Knowing the
power that it has of tranquillizing the stomach generally, though it
does not invariably produce relief in gastrodinia, 1 thought it would
stop vomiting. I never heard that it had been used in such cases,
but I thought it must do good. After employing it for two or
three years, I thought it might prevent medicines from causing
further vomiting. I tried it, and I found that it had that power in
a very marked degree. Finding in this case that two minims had
no effect, I gradually increased it, as I have before mentioned, to
nine minims, and it then entirely stopped the sickness caused by
the arsenic. | |

‘All this time the arsenic did no good ; he bore it very well, but
it was of no service to him, and I therefore gradually increased it
to the largest dose that I ever gave—viz. twenty minims three
times a-day. He now began to look thin again—did not look so
well as before. I could not, however, tell whether it was the result
of the arsenic. It might merely have arisen from his extreme suf-
fering, but.still it was right that J should discontinue the medicine,
and I did so without his having derived the slightest benefit from it
during the whole period of its exhibition. As it was necessary to
procure sleep, the muriate of morphia was gradually increased up to
six, and at last to eight grains twice a-day. His agony was such,
that the begged to have the opiate, and he also begged to have it
increased, otherwise he said he could scarcely exist.

“He was taking, therefore, at last, eight grains of muriate of
morphia, twice a-day, which gave him ease, (1 got him to omit it
once or twice, hut he suffered so much, that he begged to -have it
again), and twenty minims of liquor arsenicalis, always taking
before it nine minims of hydrocyanic acid. This he bore perfectly
well, with the exception that he looked as il] as he did when he first
came in, not worse, but just as he did before I gave him the iron,

“He now wished to go out of the hospital for a fortnight for a
change, and he was supplied with a quantity of muriate of morphia
to take with him till he came again.

‘‘T attempted, during the time, other local measures. He once

-pubbed the extract of stramonium on his finger frequently every

64 TURNBULL ON RANUNCULACE.

day, and it relieved him for a time. He rubbed also the extract of
belladonna, two or three times a-day, and this, he said, certainly
produced relief for some time; but I am sorry to say, that at the —
very last he was nearly as bad as at first. He himself maintained that
he was a great deal better ; he did not allow it, but maintained
it. I was afraid that he was not improved, but he assured me that
he was better after he took the iron; that altogether his sufferings
were not such as they were before he came to the hospital ; but still
they were dreadful. He appeared to be an excellent man, a man of
a strong mind, but in his agony the tears were seen running down
his cheeks.

“ He will return, but I have no idea of medicine doing him any
further good. We have given him the most powerful remedies, and
these have been used in the most powerful manner, although with
great care, but he is not materially better, and therefore, when he
comes back it is to be considered whether or not he shall have his
finger amputated. JI have very little hope, however, in the opera-
tion, and for this reason—cases have occurred in which the opera-
tion has failed, the disease having reappeared in the corresponding
nerves of the other hand, and in the trunk of the nerves the branches
of which have suffered amputation. Still it may be right to make
the trial. I have little hope of success, however, for another reason,
because he has had the affection before in the nerves of the face.’

This patient came under treatment, about the end of October, 1834,
and in detailing his subsequent progress, I shall confine myself to a
weekly report, in order to avoid repetition. ‘The history which he
gave of his case was substantially the same as that quoted above.
He stated, that since December 1832, he had been suffering in an
extreme degree, that he had been in the hospital about eighteen
months subsequent to that date, and had been using every remedy |
that was likely to afford relief, butin vain. He stated, that the only
ease he had, was from taking large doses of morphia, to the extent
of from ten to twenty grains a-day ; but that even these procured
him only a few hours of broken rest.

The pain was seated in the fingers and wrist of the left hand, but
particularly in the middle finger, through which, and along the wrist,
it darted like a stab with a knife. He could not bear the slightest
degree of motion in any of the joints, either of the fingers or wrist,
without bringing on a violent paroxysm of pain, and for the same
reason he could not suffer the middle finger to be touched. His nails
were long and curved. The ring and little fingers were benumbed
and painful, and a similar feeling extended up the arm as far as the
shoulder. He had had no pain in his face for three months, but he
stated that the pain in the hand, at times, almost deprived him of his
senses. His appearance was wretched, and indicated the sufferings
he endured. , : |

First Week. Under these circumstances, he was ordered to rub
the saturatedt incture of the root of the 4conitum Napellus, pre-

_ NEURALGIA IN THE FINGER. 65
pared as already directed, for twenty minutes, along the back of the
hand and fingers. The friction at first gave him extreme pain, but
towards the end of the time he could bear it better, and it gave rise -
to a sensation of heat in the affected finger, which was attended bya
marked diminution of the pain. He was ordered to repeat the fric-
tion for ten minutes, twice a day, and to take six drops of tincture
of Aconite, prepared for internal use,* every four hours, in water.
The immediate effect of this treatment was, to enable the patient to
do without his daily dose of twelve grains of acetate of morphia,
which he had been in the habit of taking for many months before.
The friction excited sensations of heat and numbness in the hand,
and could be borne with greater ease at each successive application,
and he could sleep three or four hours ata time without interruption.
The dose of the tincture was gradually augmented in the course of
this week, to ten drops every four hours, and the frietion was ordered
to be used till heat and tingling were produced, whenever the pain
came on.

The pain was removed every time the tincture was applied, and
the quantity taken internally occasioned tingling and numbness in
the extremities, and acted as a diuretic. The patient slept six or
seven hours at a time: he had intervals of perfect freedom from pain,
with distinct paroxysms, varying in intensity: and on the seventh
day, from the commencement of the treatment, he was so far reco-
vered, that he could bear to have his nails cut, which had not been
the case for nine months previously.

Second Week. During the next seven days the same treatment
was continued. He took the tincture internally, in nearly the same
dose, and rubbed it on the affected joints, whenever the pain came on.
Under these means, the accessions of pain gradually diminished in
intensity, and the intervals of complete relief became longer, so
that at the end of this week he had little pain except on motion.

Third Week. This week he was directed to continue the same
treatment, to use the affected joints as much as he could : this, how-
ever, brought on attacks of pain, but these were at once removed by
frictions, continued until tingling was produced.

Fourth Week. On the first day of this week he was directed to
substitute for the tincture the following ointment :—

R. Aconitine. gr. ii.
Adipis, 4 1. ut fiat unguent.

and to rub with it whenever he had pain.

The tingling caused by this ointment was very considerable, and
generally lasted three or four hours afterwards. He had occasion to
use it three times a-day, and one grain of Aconitine was added to the
second prescription, as the first began to lose its effect. In a day
or two he discontinued the tincture internally, and was directed to
use the ointment of the ammoniated extract of Aconite, made ac-

* Vide page 55.

66 TURNBULL ON RANUNCULACE.

cording to the formula already given, in order to try the comparative
effect of this application. In this case it was found to produce a
more powerful sensation in the parts than the Aconitine itself, and
to be very useful in removing attacks of pain when they came on.
He used nothing except the remedies mentioned above, and at the
end of four weeks and three days from the commencement of the
treatment, he was totally free of pain, and has continued to be so
ever since. He can use his hand with perfect freedom, but complains
of its not being so strong as the other, probably on account of his
having been obliged to keep it for four years almost in the same
position. : 3 ; |

On the 6th of January last, he had an attack of pain in the right
cheek, on account of his having been exposed to the effects of cold,
this was, however, immediately removed by the Aconitine ointment ;
he has had no return of it, and is at present in excellent health.

ST. THOMAS’S HOSPITAL REPORT.
(From the London Medical and Surgical Journal of Saturday, Deeémber 13, 1834.)

«“M. A. Huntingford, et. 28, admitted into St. Thomas’s Hospital,
under the care of Dr. Roots, April 3d, 1834. She then stated
that she had been subject to paroxysms of pain in the loins, thighs,
and legs, for more than two years, which had gradually increased.
She had been in the hospital, under Dr. Elliotson, in January last,
by whom she was at first freely depleted ; after which the disease
assumed an intermittent form, and she then took large doses of qui-
nine, and was slightly relieved by it, but left the hospital before she
was well, and soon became worse. | 3 :

“¢ At the time of her second admission, her general health was not
impaired. Shewas subject to paroxysms of pain, generally two every
day, in the loins, hips, thighs, and legs, following the course of the
sciatic nerve. The pain was of a severe, cutting kind, and attended
by some twitching of the muscles. There was a tenderness on pres-
sure of the lumbar vertebra, and along the whole course of the scia-
tic nerve. The paroxysms of pain came on and ceased suddenly,
and without any warning: they did not observe any regular intervals,
and were of variable duration, often continuing for several hours; and
in the intervals she was seldom free from uneasiness. Has no symp-
toms of hysteria; menstruation regular. |

‘6 Quine sulph. gr. v.

Ferri sub-carb. 4 ij.—6 ta. quaque hora,
_Emp!l. canth. sacro.

* April 9th. No change.

\

‘Ferri. carb. 4 iij. extr. stramonii. gr. ss. 6 tis horis.

“On the 12th, the paroxysms were of rather shorter duration,
but returned as frequently, and were quite as severe as ever. The

ST. THOMAS’S HOSPITAL REPORT. 67
quinine was increased to gr. vij. and the iron to 3 iv. in each dose.
On the 14th she had no pain, and only a little on the evening of
the 16th. Quinine increased to gr. x. in each dose. The inter-
mittent character of the pain continued to the 30th, and the paroxysms
had gradually become less severe and of shorter duration. The
stramonium was omitted on this day, as the sight had become affect-
ed by it. |

“May 3d. The improvement had continued, and the quinine
was increased to gr. xv. From the 9th to the 24th, she suffered
from head-achefand sickness ; but the medicine was continued, and
the pain abated. On the 24th, the iron was increased to 3 vi. ; and
on the 28th, gr. ¢ of muriate of morphia was ordered with each
dose. © Seo

“June 11th. The pain still better and intermitting ; but, in con-

sequence of continued headache and sickness, all the medicines were
omitted. 3 : | : |

“Ung. veratri (D i.ad. 3. i.?) 3 i. ter. die. lumbis.

“On the 14th, the pain had become more severe, and the quinine,
carbonate of iron, and muriate of morphia, were gradually resumed,
and increased up to August 23d ; at which time she was taking

| *¢ Quine sulph. 5 i.
Ferri subcarb. 3 i. :
Morphie muriat. gr. 3, 6 tis horis.

‘“‘ These medicines were omitted for four days, during which she
took some creosote ; but the pains returned immediately after the
medicine was changed, and continued to increase. The old medi-
cines were resumed, and she quickly improved, as before. She
left the hospital on the 22d of September, of her own accord ; the
pain had diminished much in severity,—returned much less fre-
quently, and not at any regular intervals. The pain soon increased,
but never attained its original severity. She was again admitted
into the hospital, under Dr. Roots, Nov. 21st. The pain was of the
same character, and-in the same situation’as before ; commencing
in the loins, and afterwards affecting the gluteal muscles, and
extending down the back part of |the thighs to the hams and
heels. The paroxysms usually came on about 7, p. m., and: con-
tinued four or five hours. During the attack the muscles were
firm and contracted. There was some tenderness of the gluteal
muscles at all times. General health, good ; pulse, seventy-five, —
feeble. On the 25th, the following ointment was ordered :—
6 Aconite, pr. ij. !
Ung. cetacei. 4 i. ft. ung. et infricet pars sexta part.
: dolent. nocte maneq.

“On the 28th, she stated that after each application of the oint-
ment, the parts rubbed became hot, and smarted ; but this was
quickly followed by numbness. After the third application, the
pain was a little relieved ; and after the fifth, the amendment was

68 TURNBULL ON RANUNCULACES.

very remarkable. The paroxysms were much diminished in
severity, and did not continue more than one or two hours. The
pain, which had formerly been very acute, she described as being
much less severe, and called it a “burning twitching.”’? The parts
were less tender on pressure, and she could sit up without causing
pain in the gluteal muscles, which she could not do three days
since. |
“Infricet. unguent ter die.

“Dec. 2d. Two days-since,in the morning, she had a more
violent paroxysm of pain than she has had since her admission.
After it had continued an hour and a half, the ointment was applied,
and in ten minutes she was much relieved. The paroxysms do not
now last more than twenty minutes, and she says they have never
been so slight before. _ |

“6th. The pain has now resumed its intermittent character.
On the 3d, 5th, and 7th, she had a short and slight paroxysm in the
evening ; each being less severe than that preceding it.

‘¢ Quine. sulph. gr. v. 6 tis horis.

“9th. The pain returns every other night, but is gradually de-
creasing in duration and severity. : |

“There is a man in Luke’s Ward, under Dr.. Roots, who has a
painful affection of the sciatic nerve, for which he used Veratrine
ointment for some time without any benefit. He has used the
Aconitine for a week, and a very decided mitigation of the pain
followed its application. 3 : |

“Dr. Roots informs me that he has used the same remedy in
private practice, in three cases, with similar success.”’

In conclusion, these are the principal circumstances which occur
to me at present, as worthy of mention in regard to this new class
of remedies. The facts which have been adduced, appear to bear
out the position advanced at the commencement—that there exists
a class of active principles in the Ranunculacex possessed of
similar properties when applied to the surface of the skin, and
acting in a similar manner in the same diseases ; and if I succeed in
calling the attention of the profession to them by what has been
stated, my object in making this communication will haye been
answered. ay

APPENDIX, 6y

APPENDIX.

CASES COMMUNICATED TO THE AUTHOR.

Case of Tic-Douloureux cured by Veratria Ointment,communi-
cated by J. Holme, Esq., Surgeon, Linton, Cambridgeshire.

Miss L., a young lady ten years of age, has suffered from tic-
doulovreux for about four years. In the winter of 1829-30, she
first complained of frequent pains in the face, in the situation of the
infra-orbitary foramen, attended by intermissions, and which at
first were considered as probably connected with the teeth. In the
winter of 1830-1831, her sutferings became much greater ; and on
account of the intermitting nature of the pain, she was then treated
with quinine; but having experienced no relief from it, she had
three teeth extracted, yet without benefit. During the summer of
this year (1831), she was not free from suffering, especially when
exposed to chilly weather ; and if she happened to be out after sun-
set the pain was brought on.

In the commencement of the next winter I first saw her ; at that
time she was under active medical treatment, and had taken carbonate
of iron, arsenic, morphia, belladonna, quinine largely, purgatives,
mercury, and had made use of topical applications, but all without
advantage. The paroxysms of pain came on at regular periods, two
and three times a-day, for the space of from two to five hours at
each accession. |

In February 1832, she was taken to London, and put under the
eare of several eminent practitioners, but derived no benefit, except
for three weeks in July, after which the pain returned with increased
violence. Baths of various kinds were also tried, but without effect.
She returned home, and six weeks since the Veratria ointment was
first tried, and in about five days she experienced much relief.
Within that time she had no attack of pain during the night, and in
three days more, the daily paroxysms nearly ceased. We continued
to rub the ointment for about twenty minutes before the expected
time of the attack, and in one day, less than a fortnight from begin-
ning to use the frictions, all recurrence of pain had left her, and she
now continues quite free from any inconvenience. The only medi-
cine she took during the use of the ointment, was four grains of pad.

aloes et myrrhex, at bed-time.
April 21, 1834.

JANUARY, 1838.—G 7

HO TURNBULL-ON RANUNCULACES.

Cases in which the Veratria Ointment has been employed, com-
municated by Edward MacGowan, Esq., M.D., Exeter.

CASE I.

Tux first case happened in a farmer, about thirty years of age,
who had been many weeks suffering from severe rheumatism in the
articulations generally, but especially of the knees and feet. He
presented the rheumatic diathesis in a marked degree, and there was ©
a great tendency to leuco-phlegmatic anasarca. I gave him the sub-
carb. ammon. internally, with guaiacum, and ordered frictions on the
joints to be made with the ointment of Veratria. In the course of
a week, he rode into Exeter, a distance of five miles, and told me
he was quite recovered. | 3
_ To my surprise the swellings and pain in the joints had subsided,
and the general health was much restored. He had been almost a
cripple previously ; and has not had since, to my knowledge, any
return of his former complaint. :

CASE If.

Aw elderly lady of gouty diathesis, and subject to frequent attacks
of gout in the feet, suffered much from a swelled leg and foot, which
presented an appearance precisely similar to the Barbadoes leg.
There was besides, a chronic inflammation in the toes of the same
limb, around the nail of the large toe particularly, which had often
been attacked by gout, and which was accompanied with a fungous
kind of ulceration. The whole limb was greatly enlarged, and the
cellular tissue extremely hard, with now and then an erythematous
inflammation over the surface. After poppy-head fomentations, &c.,
T used the Veratria ointment, which reduced the swelling, and
abated the pain beyond my hopes. At first it produced a slight
irritation, which obliged me occasionally to suspend the frictions,
but that was the only inconvenience that resulted from it. The
limb is still considerably enlarged but much reduced and less pain-
ful than before, which I certainly think is owing to the Veratria.

I have some other instances of the advantageous exhibition of
Veratria externally, which confirm me in the persuasion of its effi-
cacy in rheumatic and gouty swellings, particularly in debilitated
constitutions. In such cases, it seems to stimulate the capillary and
absorbent systems, and bring back a vigorous and healthy action.

April 12th, 1834.

Case of Tic-Douloureux cured by Frictions with Veratria Oint-

ment, communicated by John Spence, Esqg., Surgeon, Otley,
Yorkshire.

A LApy, about twenty-four years of age, has been affected for the
-ast eight or ten years with a most painful neuralgic affection, situ-

APPENDIX. | al

ated in the cheek and temple of the right side. The pain makes
its appearance in regular paroxysms, varying in length from a few
days to several weeks, and -is succeeded by intervals of partial
relief, The state of the patient has been very distressing, and
during the continuance of the attack her sufferings have been so.
extreme, as to bring her into a condition almost bordering on dis-
traction. 3
Before she came under my care, she had been treated by active
depleting measures ; she had been bled generally and locally, and
had applied topical remedies of almost every description, including
repeated blistering, but without experiencing any cessation of the
pain. For some time I continued a similar course of treatment,
along with the internal administration of various medicines, none
of which, however, had a good effect, except preparations of iron ;
these succeeded for a time in diminishing the severity of the affec-
tion, but appeared to have no power in removing it. I now
ordered the patient to rub the affected part of the face, for twenty
minutes, with a portion of ointment made with a scruple of Vera-
‘tria to one ounce of lard, when the paroxysm came on. Next time
I saw her, she told me that when the pain made its appearance, she
applied the ointment as directed, and that the attack was cut short
immediately. After this period the paroxysms returned two or
three times ; but were removed by the same means. I saw her a
day or two ago; she was quite well, and is now free from the
disease. | :

June 10th, 1834.

Notices of Cases in which the Veratria Ointment has been em--
ployed, communicated by S. Hood, Esq., M. D., Brighton.

Tue first case in which I tried Veratrine, was in that of a lady
who had laboured some considerable time under tic-douloureux,
seated in the second branch of the fifth pair of nerves, on the left
side of the face. Many remedies had been previously tried without
effect, and it was at last determined upon to attempt the removal of
the pain by means of friction over the affected part with the Vera-
trine ointment of the usual strength. After this treatment had been
continued for three days, the disease was apparently cured, but
again returned with considerable violence ; the ointment was again
had recourse to, and the patient is now quite well. It may be pro-
per to state that latterly she had been in the habit of taking three
grains of sulphate of quinine a-day ; I do not think, however, from
previous trials of it in this case, that it would have been of the least
benefit without the ointment. ae

In two other cases of tic-douloureux, in the first branch of the
fifth pair, the Veratrine was most efficacious: in one, the disease
was removed by itin a single night; the other was relieved on the

79 TURNBULL ON RANUNCULACE.

third day after the first application of the ointment; there was,
however, a relapse in- about a week afterwards, but the pain was
again removed by the friction, and the patient is now quite well.

In addition to these, I have prescribed the Veratrine ointment in
three cases of painful affections in the course of the sciatic nerve ;
they went on gradually improving and are now removed.

About the diuretic effects of the Veratria there can be no doubt ;
in every instance in which I have employed it, the application has
been followed by an increased discharge of straw-coloured urine.
In dropsical cases occurring in old persons, after. the diuretics in
common use have been carried as far as the stomach can bear them,
it will be of great utility while the use of internal remedies is
suspended. I have three such cases at present under its influence,
and all of them are going on favourably, and likely to terminate
well.

April 27th, 1834.

Case illustrative of the effect of Frictions with Veratria Oint-
ment in Palpitation, communicated by William Porter,
Eisq., Surgeon, Gower Street.

A LADY, about twenty-eight years of age, has suffered from a_
dropsical affection for about eighteen months, accompanied with a
considerable degree of palpitation of the heart and irregularity of
the pulse, and these symptoms appeared to be connected with irre-
gular menstruation, from which the patient had suffered for some
time. The lower extremities were cedematous, and there was dif-
ficulty of respiration and general nervous excitement. In the
treatment of the disease various measures were employed without
much benefit, until about two months ago, when the cedematous
state of the extremities was much relieved by the use of diuretics
and drastic purgatives; the palpitation, however, continued the
same as before. As this latter symptom was peculiarly annoying
to the patient, the attempt was made to remove it by means of an
ointment made with twenty grains of Veratria to one drachm of
lard, and a small part of this was ordered to be rubbed over the
region of the heart for ten minutes night and morning. After the

second or third friction the palpitation disappeared along with the
irregularity in the pulse; this took place about eight weeks ago,
and although the patient is still unwell, it has not returned.

June 20th, 1835.

THE END.