This section is from the book "Materia Medica And Therapeutics - Vegetable Kingdom", by Charles D. F. Phillips. Also available from Amazon: Materia Medica And Therapeutics: Vegetable Kingdom.
1 Union Med., 1861. pp. 132-184.
In Myalgia, or so-called "muscular rheumatism," and in various forms of non-inflammatory aching pain in tendons, ligaments, and other fibrous structures, aconite may be of considerable service, though somewhat pushed out of the field by other remedies, and especially by the hypodermic injection of morphia and atropia. In tetanus we should as yet be chary of receiving with perfect faith the appearance of cure by any remedy whatever. Paget and others formerly recounted instances in which the pulse came rapidly down, and the spasms much subsided; but I believe their recent experience has not supported the pretensions of aconite in this direction. It was thought that this drug exerted a sedative influence upon the nerve-centres, and might thus control reflex action; but upon this point all that we accurately know of the physiological action suggests the contrary; for example, the above-quoted experiments of Achscharumow l seem distinctly to show that the reflex irritability of the cord remains intact even in fatal poisoning with aconite, while the centres of the voluntary movement are progressively paralyzed.
It is at any rate certain that aconite may relieve pain. Handfield Jones speaks of it as especially appropriate to the relief of superficial pains,8 and of spasms which are not of too severe a type, both by internal and external administration. But it is the latter mode of employment which is by far the most frequently efficacious. Local pain of a nerve, or local spasm of a muscle, if not too severe and of too long standing, may often be relieved by liniments containing aconite, or by painting the simple tincture on the skin over the part, or by rubbing in a small piece of the ointment of the alkaloid aconitia. Dr. Ringer remarks, very correctly, that if aconite be likely to give relief to pain it will do so quickly. Dr. Anstie 3 places it among those remedies for neuralgia which act by locally interrupting the conductivity of a sensory nerve, and thus giving the nerve-centre time for rest and self-recovery; he does not think it can ever be more than a subordinate agent, except in mild cases. In connection with the external use of aconitia it is important to remark that the German specimens of that alkaloid, as admitted by German experimenters, are totally inoperative when applied to the skin.4 The external application of aconitia ointment has been tried not only in the milder local spasmodic affections, but in those severe and intractable maladies which belong to the same group with torticollis; but so far as I know it has not proved more successful in the latter terrible maladies than other remedies.
1 Virchow's Archiv, loc. cit.
2 Med. Times and Gazette, vol. i., 1863.
3 Neuralgia and Diseases that resemble it, 1871.
4 Nothnagel, op. cit.; Achscharumow, loc. cit.
It is right to state that certain eminent authors give a much wider scope than is above assigned to the therapeutic action of aconitia in painful and spasmodic disorders. M. Gubler, in particular,1 assigns it an important role in the treatment of a class of neuralgic affections which he calls congestive, and also in that of the neuralgias which he calls acrodynic, which have their seat in the extremities of the limbs, in which situation the Pacinian corpuscles are numerous. In the latter cases he declares that it has succeeded where large doses of morphia and of atropia had failed. He also believes it to be appropriate to the treatment of angina pectoris, spasmodic asthma, convulsive cough, etc. But indeed, in France, aconitia is freely employed internally, which is not the case in England The granules de Hottot (made from an aconitia which is said to be nearly as powerful as the best English aconitine of Morson) are the usual form in which it is administered and in this way doses of 1/80 grain of the alkaloid are given, at first twice a day, and afterwards more frequently. In England the majority of physicians distrust this exceedingly powerful agent as an internal medicine. (Much of the commercial aconitia is an impure mixture of alkaloids, and is believed to be largely derived from the A. ferox. Its composition and energy therefore are so uncertain that the commencing dose should be quite small until the sample has been fairly tested.)
For practical purposes we may fairly say that all the benefits that are to be expected from aconite may be obtained from its internal use in the form of the tincture of the British Pharmacopoeia (which is the tincture uniformly referred to above and the external use of aconitia in the form of the pharmacoposial ointment, or of the tincture of aconite, simply painted on the skin, or diluted with soap liniment, etc., and applied by friction. An advantageous combination can sometimes be made by adding chloroform, or laudanum, or both, to such a liniment. It is scarcely necessary to add that in applying aconite, or still more aconitia, externally, we must avoid all abraded or wounded portions of the skin.
Besides the well-established efficacy of aconite in relieving congestions and inflammations on the one hand, and pains and spasms on the other, there are sundry other actions that have been attributed to it on more doubtful evidence. Among these one of the most important, if it were established, would be its alleged diuretic effects. Fouquier is the strongest advocate of this power of the drug, which however has been denied by several good authorities, and of which there cannot be said to be any certainty at present.
Preparations And Dose. - The officinal preparations (U. S.) are extractum aconiti, tinctura aconiti radicis, linimentum aconiti, em-plastrum aconiti, and aconitia. The properties of the root are similar to those of the leaves, but stronger. On this point Hirtz, among others, gives strong testimony.2 He administered the extract of the leaf, in large doses, in various cases of lung and bronchial affections; but no effect, either physiological or therapeutic, was produced unless as much as 15 or 16 grains were given at once. The extract of the root, on the contrary, in doses of only 1/8 grain, produced prompt physiological effects; and smaller quantities than these were found to act best medicinally. Aconite leaves dried and powdered may be prescribed in doses of gr. 1/2 - gr. ij.
1 Commentaires Therapeutiques, Paris, 1868. 1 Gaz. med. de Strasbourg, 1861, No. 1.
In all acute pyrexial affections of adults, one minim of the tincture every half-hour or hour, up to a total of 5 to 10 minims, or until the pulse or temperature sensibly falls; after this, about 2 or 3 minims every four hours. In children under two years of age, not more than one-fourth or one-sixth of these doses should be given; and from two years old to ten, one-fourth to one-half of the adult dose, according to the susceptibility of the child to the influence of the medicine.
In non-febrile pain or spasm, 5 to 10 minim doses of the tincture at long intervals.
Linimentum aconiti is a very strong preparation for external use, and should not be applied where there is any sore or abrasion of the skin, nor should it be used near the mouth. It should be applied with a sponge or soft brush, but this should not be continued long after numbness is produced.
Unguentum aconitiae (B. Ph.) should be used with caution. It contains 8 grains of aconitia to one ounce of prepared lard. This external application is highly beneficial in neuralgia, especially facial neuralgia, also in sciatica and muscular pains.
Aconitia is rarely prescribed internally, as the one-fiftieth part of a grain, if of good quality, produces poisonous symptoms of a dangerous character.