Therapeutic Applications. Assafetida is a highly important medicine, and there is reason to apprehend that it may be too much neglected in consequence of its extreme offensiveness. The probability is that it was employed by the ancient Greek physicians; though some doubt has been entertained upon that point. It was certainly known to the Arabians, and appears to have been introduced by them into modern Europe, through the school of Salernum.

It may be employed in almost all cases of nervous disease calling for medicines of this class, and, upon the whole, may be regarded as the most useful of them. Less powerful than musk in overcoming obstinate hiccough, in relaxing those painful spasms of the involuntary muscles which have a deeper source than mere hysteria, and in rousing up the nervous centres from profound torpor or prostration, it is superior to it in hysteria, and in certain other nervous affections which will be noticed immediately, and probably quite equal in general efficiency.

In hysteria, in almost all its forms, assafetida is a most valuable remedy. Even the convulsions of this disease will often yield to it, or undergo favourable modification under its use. In such cases, as it is often impossible for the patient to swallow, it should be exhibited by enema. In the same form, also, it may be employed in general hysterical insensibility simulating coma, and in dysphagia arising from hysterical spasm of the oesophagus.

In the allied disease of hypochondriasis in males, it is among the remedies which afford most relief to the various nervous disorders, though it may be inadequate to the cure.

In all convulsive affections, purely functional, that is, unconnected with active congestion, inflammation, or other form of organic disease, it may be used with reasonable hope of benefit. The particular form, besides the hysterical, in which most good may be expected from it is that of infantile convulsions, arising from spasm in the intestinal tube. It should be given, in cases of this kind, by enema during the convulsion, and by the mouth, at regular periods, every hour, two, or three hours, in the interval. Epilepsy is quite beyond its unaided powers; though the medicine may sometimes relieve it, and, in connection with other medicines, may even contribute to its cure when purely functional. In chorea it is occasionally adequate to the cure, if employed in association with cathartics; the patient being kept steadily under the use of the assafetida, while a purgative is given every second or third day.

Hooping-cough is one of the complaints in which assafetida is most useful. After the subsidence of the initial catarrhal symptoms, and when those of a spasmodic character have become fully established, it should be given regularly, every two or three hours, until the violence of the paroxysms has begun to abate. The child receives so much relief from the medicine, that, after having become accustomed to its taste, he will often call for it, even by cries, if too young to speak. This I have seen repeatedly.

Nervous coughs sometimes occur, which, after obstinately resisting measures addressed to them as catarrhal, will yield at once to a few doses of assafetida. They are most frequent in women, though I have seen them when there was no reason to suppose them hysterical, and have found them to yield as promptly as if they had been merely a phase of that disease. In some of these cases, the cough may be a form of nervous gout or rheumatism. I would urge upon the inexperienced practitioner to be on the watch for these cases. When he encounters a severe and harassing cough, which can be traced to no special source, and which, he is satisfied, cannot depend on inflammation of any part of the air-passages, let him try assafetida, and I feel quite sure that he will often find it successful. The nervous element may even complicate ordinary coughs, and give them an unusual obstinacy, which will yield by combining the use of assafetida with the other measures indicated.

The medicine may be employed in the paroxysms of spasmodic asthma, but cannot be relied on in that affection. In complicated cases, however, in which the dyspnoea is associated with chronic catarrh, the system being feeble, and the circulation and skin relaxed, it may be of much service by its combined expectorant and antispasmodic powers.

Laryngismus stridulus, or pure spasm of the glottis occurring in infants, is said to have been beneficially treated with it, but I have not used it in that complaint.

I would particularly call attention to a certain condition in the advanced stage of pectoral inflammation in infants and young children, whether bronchial or parenchymatous, in which assafetida is an admirable remedy. In patients of this age, the nervous system is very apt to suffer, whatever may be the nature of the case, if in any degree severe. Even in their inflammations, the nervous centres seem to become exhausted before the disease has run its course, and alarming symptoms from this cause not unfrequently complicate the case. In the pectoral inflammations, this condition may be readily, and, I believe, often has been fatally overlooked. This is probably one of the reasons of the great mortality of infantile bronchitis and pneumonia. The nervous exhaustion shows itself by symptoms which may be readily mistaken for an aggravation of the original affection. The respiration is much hurried, the alae nasi visibly expand and contract, the child is sometimes anxious and restless when not stupid, and the pulse is very frequent and feeble. Under such circumstances, if the patient is at a somewhat advanced period of the disease, and, upon application of the hand, it should be found that the ears, tip of the nose, cheek, or fingers feel cold, or even cool, it may be taken for granted that the system, and especially the nervous centres of respiration, need support; and this support assafetida, freely used, and repeated every hour or two, will often yield, to the vast relief of the patient. I am quite confident that I have seen lives saved, mainly by this remedy, in the condition referred to. While useful as an expectorant, it operates, I believe, chiefly by stimulating the exhausted nervous centres. My attention was first called to such cases by my pre-ceptor, the late Dr. Jos. Parrish, and I have since had frequent occasion to thank him for the valuable practical lesson.

In low sates of fever, assafetida is sometimes useful in obviating nervous symptoms, such as subsullus, general tremors, restlessness, hiccough, etc.; but it is not more efficacious than other much less disagreeable remedies, and is, therefore, little used. In the tympanites, however, of these complaints, given as an injection, it is a valuable remedy, second only to the oil of turpentine in efficiency.

In constipation with flatulence in old people or hysterical women, and in the colicky affections of the latter class, assafetida may often be advantageously combined with laxatives, such as aloes and rhubarb. If amenorrhoea be superadded, myrrh may be combined with the other ingredients; and, if anaemia, one of the preparations of iron.

The laxative properties of the gum-resin often add to its advantages as a nervous stimulant; but sometimes it is necessary to counteract them with a little laudanum.

Of the special uses of this gum-resin as a stimulating expectorant there will be occasion to treat hereafter.

Assafetida is contraindicated in acute inflammation, and in fever with hot skin, and a full, strong pulse; and especially so when the nervous centres themselves are the seat of high vascular irritation, inflammation, or organic disease, even though convulsions, spasm, or other nervous disorder should appear to indicate the use of this class of medicines.