The treatment of acute rheumatism with aconite was first prominently brought into notice by Dr. Lombard, of Geneva, whose very favorable statements were subsequently corroborated by Dr. Fleming, the inventor of the saturated tincture which bears his name. In the practice of the majority of English physicians,1 however, the drug has not established a permanent reputation, either for efficacy or manageableness in rheumatic fever; and I cannot but suppose that this has been largely owing to the use of too high doses, which, by their nauseating and even dangerously depressing effects, rendered it difficult or impossible to carry out the treatment with that persistent regularity which is essential to a good result. It is highly important here to adopt the system of small doses, frequently repeated. No doubt also much undeserved discredit has been thrown upon aconite by the use of feeble and inefficient preparations (for example, the old extract of the London Pharmacopoeia), as was remarked by Neli-gan, who had himself obtained excellent results, from the use of the drug in rheumatic fever.

The extract of aconite, applied as a plaster to the joints in the form usually employed for belladonna, though less energetic than the last-named drug, is unquestionably very useful in rheumatic affections. But it will be more convenient to treat of these matters in connection with our general remarks on the use of aconite for relieving pain.

Erysipelas. - Erysipelas is a complaint which will frequently yield to aconite. I have now before me in my diary thirteen cases of erysipelas, or acute inflammation of the skin, some of them implicating the subcutaneous areolar tissue, and all attended by high fever. The temperature taken in all the thirteen cases varied from 102° to 105°; yet, although the only remedy employed was aconite, with an occasional dose of castor-oil, the whole number recovered in five days after being attacked. It is proper that I should add that these thirteen cases were all of a purely sthenic kind, as I do not believe that there is any virtue in aconite as a remedy for the low or asthenic description of erysipelas, equally common in our experience.

The mortality from erysipelas is in England very considerable, the deaths amounting to over 2,000 annually. If aconite were used early in this disease and persevered with, I believe, from my own observation, that the deaths would not exceed one-fifth of that high number; and that it only needs to be fairly tried, in the treatment of acute erysipelas, to be found worthy of very extensive adoption.

In confirmation of the favorable action of aconite in erysipelas, I may cite Dr. J. le Coeur ( Union Medicale, 92,1861), who employed the alcoholic tincture of the root. It is obvious, however, from the large doses that were given, that this cannot have been a very powerful preparation; but as it was, it seems that rather awkward and probably quite needless physiological phenomena were evoked.

Continued and Exanthematous Fevers. - In typhus and typhoid fever aconite is of little use, since it neither reduces the temperature nor diminishes the frequency of the pulse. I have tried it upon various occasions, and have always found it injurious rather than beneficial.

In scarlet fever and measles it is valuable, since it moistens the skin, and certainly helps the emergence and development of the eruption when due, though it seldom reduces the temperature before the eruption comes out. In four cases of measles recently attended by me, aconite reduced the pulsation in every instance to about 72 in the early part of the second day of the eruption, and at this point the pulse remained during the eruptive stage, but the temperature stood at from 101 3/5° to 103° till decided defervescence set in.

1 See also Nothnagel (Arzneimittellehre), who says that neither its power to shorten the disease nor to avert heart complications has as yet been distinctly established.

Apoplexy. - In simple apoplexy, especially when occurring in stout and plethoric persons in whom the vessels of the brain are congested, but not ruptured, accompanied by a full, strong pulse, a hot, dry skin, a flushed and turgid face, and a tendency more or less to coma, aconite is decidedly the best remedy that can be employed. But in cases of apoplexy where there is a tendency to syncope, a pale face, a feeble and perhaps an intermittent pulse, and a cold and clammy skin, aconite should as decidedly be avoided, since the effect of this medicine upon the heart is certainly most depressing, and in some instances almost paralyzing.

Should a marked reaction take place, and we find it necessary to reduce the action of the heart, and to diminish the force of the circulation through the brain, then, however, we may wisely resort to aconite as a medicine pretty certain to render the most speedy and effective aid.

Palpitation. - Aconite is also of great use in those cases of palpitation of the heart which depend upon simple hypertrophy of the left ventricle. On the other hand, in hypertrophy of the left side of the heart, with diseased valves, admitting of regurgitation, aconite is dangerous.

Retention of Urine. - Aconite is of great service in cases of retention of urine, with spasmodic stricture, which have been caused by a chill (sub-inflammatory). It is also a most effective remedy in the febrile excitement sometimes produced by worms, used alternately with santonine.

Diarrhoea. - In non-tropical dysentery and dysenteric diarrhoea, when the patient suffers from high fever and pain in the abdomen of a griping and cutting character, these latter symptoms preceding a frequent inclination to stool, aconite will at once reduce the fever and remove the cutting pains. It is also of use in diarrhoea caused by a chill, especially in the young; and, on the other hand, we find it useful sometimes as a remedy for constipation in persons of plethoric habit, and when there is a dry skin and a feverish tendency.