it will fail. This much, however, is ascertained, that those neuralgias which depend on decayed teeth or diseased bone, or on tumours pressing on the nerves, are beyond the control of aconite. But these are not the only forms of neuralgia over which aconite cannot prevail. No doubt in some instances the failure can be explained by the badness of the preparation; but even when this is excellent, it is not uncommon for the pain to remain unabated after the application. As, however, no harm can possibly follow their employment, they should always be tried; and if unsuccessful, then resource can be had to other modes of treatment. If aconite succeeds at all, it will succeed at once; and hence, if no relief is speedily obtained, it is useless to continue its employment. The preparation should be sufficiently strong to produce decided numbness and tingling in the skin over which it is rubbed; and, where of service, these sensations replace the pain, which does not return when the effects of the aconite have worn off.

The ointment and liniment should be applied with friction, which very greatly heightens their activity. Of the ointment, a piece the size of a pea or bean should be rubbed into the skin till it has disappeared. Care should be taken while using these powerful and poisonous applications that they are not rubbed into wounds or cracks of the skin, nor brought into contact with absorbent tissues, such as mucuous membranes and the conjunctiva of the eye. Spinal irritation and intercostal neuralgia may in many instances be removed by aconite ointment, and sciatica sometimes yields to the same remedy. The former complaints are better treated by the belladonna prepa

rations.

When employed internally, the following sensations are experienced, the graver appearances and symptoms occurring only when a considerable dose has been taken. There is first a feeling of warmth at the pit of the stomach, with sometimes nausea and vomiting. The feeling of warmth spreads over the body, and there is soon perceived tingling of the lips and tongue and adjoining parts; the uvula with the tongue feels as if it were swollen, and too large for the mouth, and deglutition is frequent. If the dose has been a large one, the tingling and numbness are felt in the tips of the fingers, and thence spread over the whole body, and are accompanied by diminished sensibility and some muscular weakness, which, if the dose is a considerable one, becomes extreme, and is one of the most prominent and important symptoms of the drug.

On the circulation and organs of respiration its action is most noteworthy. With moderate doses the number of the heart's beats are much lessened, and may sink to 40 or 36 in the minute. After a larger and dangerous dose, the pulse rises in frequency, and may become irregular. With some persons such irregularity follows even a small quantity of the medicine. Whether the frequency be increased or lessened, the pulse always loses strength, and hence the circulation is retarded. The effects on respiration are very similar. By moderate doses the breathing grows slower; but after large and poisonous quantities it is often short and hurried.

During the administration of aconite cutting pains are often complained of in the joints and other parts of the body, and there sometimes breaks out on the skin an eruption of itching vesicles. Delirium occurs in some cases, but often after fatal doses the mind remains clear to the last. In some cases which have ended in death there has been found blindness, and deafness, with loss of speech.

When death is produced by this drug, the muscular weakness is extreme, and frequent faintings occur. Death from aconite appears to be due to syncope. On account of its power to diminish sensibility, aconite has been used internally in various painful diseases; but other remedies have, for the most part, superseded it for the relief of pain.

It is on account of its power to control inflammation and subdue the accompanying fever that aconite is to be most esteemed. The power of this drug over inflammation is little less than marvellous. It can sometimes at once cut short the inflammation. It does not remove the products of inflammation when these are formed, but by controlling the disease, it prevents the

formation of these, and so saves the tissues from further injury. It is, therefore, in the early stage of inflammation that the good effects of this plant are most conspicuous; still, although the disease may have progressed to some extent, and have injured the organs by the formation of new and diseased products, while the inflammation is extending aconite does good. It is useful wherever there is acute inflammation of any tissues of the body. The good it accomplishes can be shown both by the amelioration of the symptoms, and, still better, by the changes it effects in the inflamed tissues when these are visible, as in pharyngitis, tonsillitis, &c.

As might be expected, the results of aconite are most apparent when the inflammation is not extensive, or not very severe, as in the catarrh of children, or in tonsillitis, or in acute sore-throat. In these comparatively mild diseases, especially if the aconite be given in the earliest stage of the inflammation, when the chill is still on the patient, the following consequences will very generally be witnessed:-In a few hours the skin, which before was dry, hot, and burning, becomes comfortably moist; and in a little time longer, it is bathed in a profuse perspiration, which may be so great that drops of sweat run down the face and chest. With this appearance of sweat many of the distressing sensations--such as the restlessness, chilliness, or heat and dryness of the skin-are removed. At the same time the quickened pulse is much reduced in frequency, and in a period of twenty-four to fortyeight hours, it and the temperature have reached their natural state. It is rare that a quinsy or acute sore-throat, if caught at the commencement, cannot be disposed of in twenty-four to forty-eight hours. The sweating may continue for a few days after the decline of the fever on slight provocations; but it then ceases.

The appearance of the inflamed part also exhibits, in a striking degree, the beneficial effects of the drug. Thus large livid, red, glazed, and dry tonsils may often in twenty-four hours have their appearance completely altered. If the medicine has been given before much lymph has been formed in these organs, in the time named the swelling and most of the redness will have disappeared, and the mucous membrane will have that look which proves the acute inflammation to have subsided-namely, it has become moist, and is bathed with mucus or pus. If just at this stage some strong astringentsuch as glycerine of tannin-be applied, most of the remaining diseased appearance and the pain, if it continues, will be removed. Such are the visible effects of aconite on inflamed tonsils, &c.

These statements are not exaggerations; but the simple truth, as may be witnessed by those who will employ the aconite in the way to be immediately mentioned.

Its effects on catarrhal croup are as conspicuous. In a few hours the urgent dyspnoea is removed; and in a short time longer the fever is subdued. Severe colds, in which there is much chilliness with great aching of the limbs, with a hot, dry skin, and quick pulse, may be equally well treated by aconite. So, indeed, may all the slighter forms of inflammation.

The effects of this valuable drug, though not so rapid, are equally important on pneumonia, pleurisy, and the graver inflammations. These diseases may be considerably curtailed, and made much milder, if aconite is employed.

As

Its influence on inflammation has been ascribed by most observers to its power over the heart; and, as they truly point out, the remedy is found to be of most use in the sthenic forms of the disease; and where there is great weakness and the heart beats feebly, unless care is taken, it may do harm. The method of employing the drug has much to do with its success. already said, it should, where possible, be given at the very beginning of the disease. Every hour is of importance; the use of the medicine should never be delayed. Of the tincture, half a drop, or a drop in a teaspoonful of water, should be given every ten minutes or quarter of an hour for two hours, and afterwards be continued every hour. If there be much prostration, and the pulse be feeble and weak, a still smaller dose will best be given.

It is not inappropriate to mention here what signal service the thermome

ter may render in enabling us to decide whether aconite should be given or not. When called to see a patient, and when the symptoms and physical signs are not sufficiently developed to decide whether an acute inflammation of some deep-seated part has set in or not, this instrument will often decide the doubt. No acute inflammation can exist without preternatural heat of the body. Hence, if in a doubtful case the temperature, after a careful investigation, be found natural, the case is not one for aconite; while, on the other hand, if the symptoms, although doubtful, indicate an inflammation, the presence of an increased heat of the body will very considerably add to the probability of its existence, and will so indicate the advisability of employing aconite.

Another instance may be mentioned. After scarlet fever, as is well known, acute inflammation of the kidneys is very liable to occur. This would at once be indicated by a rise in the temperature of the body. It is therefore desirable to direct the friends of such patients to observe, night and morning, the temperature; and if this should rise beyond limits of health, they should at once commence the administration of aconite, and not allow some hours to pass before the patient can be seen by the medical attendant. It is true the fever may depend on some other complaint than inflammation of the kidney; but it will even then probably be inflammatory in character, as from gastric catarrh, over-feeding, and the like, in all which cases the aconite will be equally efficacious.

Whether aconite is of use in the fever of acute specific disease, as scarlet fever, measles, &c., is not so certain as its power over inflammation. But although there may be some doubt whether this remedy can lessen the severity of the fever of the acute specific diseases, there is no doubt it can control and subdue the inflammatory affections which often accompany them, and which may by their severity endanger life. Thus aconite will moderate the inflammation of the throat in scarlet fever, and the catarrh and bronchitis in measles, and in this indirect manner lessen the height of the fever. It appears to be unable to shorten the course of these acute specific diseases. In the treatment both of simple inflammations and acute specific diseases, aconite may be appropriately administered in conjunction with some other remedy which may be indicated.

The treatment which has just been described will be found of value in erysipelas, in which disease belladonna may also with advantage be given. In the treatment of acute rheumatism aconite has been much praised, and from the eminence of the authorities by which it has been recommended there can be no doubt of its usefulness. Still in this complaint its good services are not so apparent as in acute inflammation. This disease has no regular course of duration, but may, untreated, last only a few days or many months. It is difficult, therefore, to decide whether the speedy decline of the fever in some cases is a natural decline, or has been accomplished by the aconite. It is certainly ineffectual in many cases, which appear to run their course uncontrolled by this remedy. So that it is still required to determine in what class of cases it is useful, and in what cases it is without effect. In one respect it often appears to be of service-namely, in removing the pain from inflamed and swollen joints.

Gouty pains are said by some to yield to this remedy, and it has in many instances apparently with good results, been given to persons suffering from neuralgia.

The effect of this remedy on the heart has been mentioned. There it was shown to lessen the rapidity of the circulation. Aconite may thus be used in all cases where there is vascular excitement which it is desired to suppress, and also when it is desirable to diminish the force of the circulation. In fact it may be given in precisely those cases which were formerly treated by bleeding.

This remedy may be employed with advantage when the menses are suddenly checked, as by cold, on account of its power to restore the flux, and so remove the distressing and peculiar symptoms which not unfrequently oc cur when such a disease is produced.

The "fluttering at the heart" of nervous persons, and also nervous palpitations generally yield to this remedy. Usually when such disturbances occur, more general treatment is required, but when the conditions causing the palpitation cannot be discovered or cannot be removed, then aconite may be usefully employed.

The acute stage of gonorrhoea may be well treated by a drop of the tincture of aconite each hour, and the same treatment will often remove cordee.Lancet, Jan. 9, 1869, p. 42.

111.-ON POISONING BY STRYCHNIA.

By Dr. CHAUNCEY PUZEY, House-Surgeon to the Liverpool Royal Infirmary.

[A man, 24 years of age, was admitted into the Liverpool Royal Infirmary, on Tuesday, Feb. 18th, 1868, at 2 a.m., suffering from acute tetanic symptoms said to be the result of poisoning by strychnia. He had taken sixpennyworth of Hunter's vermin powder by mistake.]

On admission, at 2 a.m., he was cold, with feeble rapid pulse, face congested, and skin clammy; breathing short and hurried. At intervals of every three or four minutes, a spasm came on, in the form of well marked opisthotonos. During the spasms the respiration became hissing, jaws fixed, eyes very prominent, face congested and livid, and the man appeared as if he would die of asphyxia.

Each spasm lasted not quite two minutes, then there was about two minutes' interval, during which intervals the man was quite conscious, and described his sensations after taking the poison. Thirty minutes after admission he vomited again. (In the vomited matter, a trace of strychnia was found.) The act of vomiting was accompanied by great pain, and was of a peculiar spasmodic, jerking character. He could swallow nothing, so it was determined to try subcutaneous injection. At 2.30 a.m., one third of a grain of morphia was injected into the calf of one leg. The introduction of the needle brought on violent spasm, but in five minutes the man expressed himself as being easier than he had been for the last two hours, and the attacks became less frequent and less severe. About 3.15 they began to increase again, and a third of a grain of morphia was injected into the other leg, with renewed benefit. Shortly before this, the patient seemed so exhausted, and the pulse so feeble.-in fact hardly perceptible during the spasm,-that small quantities of brandy and water were frequently given, at first with considerable difficulty.

At 5.30 a.m., he had been dozing a little, and the spasms had been much less violent, but they appeared to be returning a little more frequently. Their character was, however, much altered, as they came on with sudden jerks that nearly threw the patient out of bed, causing him sudden acute pain, but unattended by trismus. A quarter of a grain of morphia was injected, and the brandy stopped, as his skin was much warmer, and pulse bet

ter.

At 7 a.m. he was again seen, and was so much better that nothing further in the way of treatment was thought necessary; but every now and then a sudden jerking spasm would seize him. These gradually became less violent, and by the afternoon had altogether ceased. He suffered from considerable pain and tenderness for several days afterwards, and slight ecchymoses appeared about the legs and arms, where the spasms had been most severe. He went out quite well in less than a week.

It appears to me that there are two or three points in this case worthy of

notice.

There seems to be no doubt that the man swallowed the whole powder. Mr. J. C. Brown, B. Sc., the lecturer on Chemistry and Toxicology at the Infirmary School of Medicine analysed a similar powder for me, and found that it contained exactly three grains of strychnia. (This according to Taylor is usually a rapidly fatal dose.) He voinited a little about an hour after taking the poison, but it must have been nearly two hours before the con

tents of his stomach were evacuated, for the emetic given him by the surgeon who was called to see him did not take effect until he was being brought in a cab to the Infirmary, at 2 a.m.

But after this a considerable quantity of strychnia remained in his stomach, for at 2.30 he vomited again, and in a small quantity of the vomited matter, collected and analyzed by Mr. Brown, there was found 1-10 of a grain. It appears probable that the absorption of the poison had been retarded to a certain extent by the state of the man's stomach, he having been drinking spirits freely that night, and that to this fact he owed his escape from speedy death within an hour.

As regards the treatment adopted, it consisted of three things1st, An emetic to remove the poison remaining in the stomach;

2nd, The injection of morphia, to put a stop to the convulsions, the result of the poison already absorbed; and

3rd, Stimulants to overcome the exhaustion due to the spasms.

Neither the first nor the second part of the treatment would per se have been sufficient. Of course, it would have been unreasonable to trust to the morphia whilst any poison might still be in the stomach; and it was evident to bystanders that the emetic alone would not have saved the man's life, as he must almost have certainly have died from exhaustion if the tetanic symptoms could not have been relieved, and his strength at the same time supported; and in no way could this so soon be effected as by the hypodermic method.

Probably many would suggest that the administration of chloroform would have succeeded as well. But, in the first place, it appeared to me that it would be difficult to combine this with the administration of stimulants and support to the patient; and again, I thought it a less safe method of treatment. For it seemed so likely that the man would die, during, or immediately, after one of the convulsions, that I was fearful, lest, supposing such a thing occurred whilst he was inhaling chloroform, death might be attributed to it. In the Medical Times and Gazette of May 9th, of this year, and in that of the 27th of June, 1867, cases of recovery after strychnine poisoning are related where chloroform was found to act in the most satisfactory manner. But even supposing each mode of treatment to be equally safe, there can be no doubt, I think, which is the more convenient, where there is not a staff of assistants to relieve each other in the administration of the remedy.

The effect of the hypodermic injection was manifest almost immediately. In five minutes the patient expressed himself as being easier than he had been for two hours before, and in half an hour he was able to swallow frequently small quantities of brandy, without which it appeared likely that he would sink from exhaustion. To the necessity for the administration of stimulants in such cases, Mr. Phelps draws attention in his observations on one which he treated at the Northern Hospital in this town, five years ago, and which is the second of those I alluded to above. In his case, beef tea and brandy were injected into the stomach whilst the patient was under the influence of chloroform.

The effect of the morphia was only temporary, for the injection had to be repeated in three-quarters of an hour, and again in two hours more.

The change in the character of the symptoms, as the effects of the poison were passing off, was peculiar, the violent tetanic spasms gradually becoming weaker and weaker, and then being replaced by short sudden jerks or starts of apparently every muscle, occurring at uncertain intervals, and calling to the mind of the observer the slight and interrupted shocks given off by an electro-galvanic machine after it has been worked for a considerable time.Liverpool Medical and Surgical Reports, Oct. 1868, p. 89.