292 THE INDIAN MEDICAL GAZETTE. [Oct., 1886.

ON ACONITE IN THE TREATMENT OF

PNEUMONIA.

BY JOHN D. T. RECKETT,

Surgeon, Army Medical Staff.

During the last six years I have, with very few exceptions, treated every case of pneumonia with Tinctura Aconiti B. P., and from the numerous patients so treated and recorded in

my notes I can only find one death. Aconite was employed in this case, and the absence of its almost uniform good results I attributed to

the advanced stage of red hepatization of the right lung, Avhen the patient first came under notice, a condition for which, if extensive, the

remedy will fail to produce its characteristic effects.

I remember in my student days, that the remedies used in the treatment of pneumonia were antimony, vinum ipecac, bleeding and

poultices, and often the application of large blisters, particularly if much pain were present. These 110 doubt did much good, but, neverthe- less, the great anxiety of the medical attend- juit at what was always considered a grave disease to contend with was rarely absent. As regards my own responsibility in dealing

with pneumonia, I can truly say that I place such great faith in the efficacy of aconite, that this responsibility?before so great?has become so much diminished that, when the disease comes before me in its first or congestive stage (when the drug exercises its most powerful influ- ence for good), I feel little anxiety as to the result.

It is for this reason, and the belief I have in the beneficial action of aconite, that I think

every prominence should be given to the virtues of the drug; as it is, of all the remedies in the Pharmacopoeia good, harmless or uncertain, entitled to every possible respect; a remedy which in careful hands is an almost certain

specific, and which for pneumonia seems to have been particularly adapted. It is indeed in this

disease especially, as a vascular depressant and in reducing the often very high temperature, that the usefulness of acouite is noticed.

It would of course be presumptuous for me to set forth here the mode of prescribing the drug, inasmuch as Dr. Ringer has given generally its therapeutic doses, uses and physiological action, but I may perhaps with interest mention

the manner in which I make use of it in this

particular disease. In adult men of a florid

complexion, high temperature, rapid and full

pulse, and in whom dyspnoea and acute pain of the affected side are generally present, I give aconite freely, commencing with M. v of the tiucture every two hours in half ail ounce of

water, and continuing it until the urgent symp- toms are relieved. Iu such a class of the

disease relief invariably follows its use in this

way; the most marked effects of the drug being profuse diaphoresis and consequent reduction of temperature, great reliet of and often dis-

appearance of acute pain and dyspnoea, and, very important to the sufferer, a sound sleep. The temperature of course is the guide in

the further use of aconite in pneumonia. This

quickly reduced from 104? or 105? F.' to

normal, or nearly so, I diminish the dose to m. iij every two hours and continue the remedy till the temperature and condition of patient show signs of remaining normal. Subsequent- ly, as regards medicine, I substitute Vinum

Ipecac and Liq. Ammonia) Acetatis, uutil the cure is complete. As aids to treatment, hot linseed poultices are applied to the affected

side, and low diet given. I never find it necessary to resort to other

drugs in this disease. Those who use aconite in the treatment of pneumonia must have been as forcibly impressed as I have with the rapid and remarkable direct effects of its use, and not less with the indirect good result; for I have often been astonished to see the rapid change from a picture of the greatest distress, attendant upon the combined effects of high temperature, parched lips, dry and irritable tongue, acute pain and general restlessness, to one of compa- rative calm and comfort?the skin and tongue becoming moist, the acute pain and dyspnoea passing off, and the previously painful cough altered to one that goes on freely, because it gives little pain, and as a consequence the air

passages liberated from the mucus, which with- out cough must accumulate and increase dis-

tress; and then the indirect good result appears in the affected lung being rarely left in an

extensively consolidated state ; but, on the con- trary, by attacking the disease in its congestive stage, and rapidly unloading the hyperaemic organ, as I believe aconite does, the disease rarely progresses far into the second stage of red hepatization or consolidation. The unloading of the hyperremic luno- to

which I have alluded is evidently produced by the power of aconite in reducing the volume of the circulation by depression, and by its

powerful diaphoretic action; and both these effects are attended with diminution of tension and pain.

I am aware that aconite is a very popular remedy of Homoeopaths and their patieuts, but know nothing of their general practices and

their uses of drugs : beyond this, I only know that the tincture of aconite of the Pharma-

copoeia is a remedy which, in the treatment of pneumonia, I have long since learned to regard as a powerful friend, and without which I fear

should have a different tale to tell concerning my experience in this branch of the practice of medicine.

Oct., 1886.] ACONITE IN PNEUMONIA. 293

A few cases extracted from my own notes inay serve to lend an interest to this paper. Case 1.?Private J. McC., at. 28, a robust

and otherwise healthy-looking soldier, was ad- mitted into the Station Hospital, Poonamallee, on January 13th, 1884, with double pneumonia contracted on the voyage from Burma to

Madras. When seen, he looked flushed and

anxious, complaining of pain in both sides, but particularly the right. Temperature 105? F. and much dyspnoea. Lungs much congested, as evidenced by haemoptysis and fiue crepitant rales.

Ordered to bed on milk diet and to have

Tinct. Aconiti ... mm. v

Aq. ... oz. ^

every two hours; which he continued through- out the day and night, taking about 9 doses.

Jany. 14th.?Much better. Free diaphoresis throughout the night, and sound sleep. Very little pain and temperature normal. To have

Tinct. Aconiti ... mm. iij Aq. ... oz. ?

every two hours; linseed poultices to both sides every three hours.

J any. 15 th.?Temperature?morning, normal; evening, 99?. Very little pain, expectoration free from blood, and no dyspnoea. To continue medicine every four hours. From this date he continued to progress.

Medicine changed to Liq. Ammonite Acet. and Vinum Ipecac, which he took for a few days.

Jany. 2 Is*.?Examined lungs carefully. Right lung a little dull over lower lobe, with

a few moist rales over both iufrascapular regions. Jany. 27th.?Ordered up. No pain. Slight

cough. Respiration and temperature normal. He continued up and seemed quite well, but

I kept him under observation and discharged him cured on February 8th. This was un-

doubtedly a very acute and severe case, and liad been aggravated by a march from Madras to Poonamallee, a distance of 12 miles, but the high temperature was quickly reduced and all urgentsymptomsreadily controlled by the aconite. Case 2.? Octr. 20th, 1883.?Private James

W.?on board Serapis, got cold by sleeping on deck, and was admitted to hospital with ex- tensive right pneumonia, complaining of severe pain in right side, catching and difficult res- piration, and very painful cough. Temp. 105? F. He was given a saline mixture with Vinum

Ipecac., and hot linseed poultices'ordered to be continually applied by the surgeon iu charge of the case.

Octr. 21 st. lemp. 104-6?. Great pain of

right side, and cannot take a deep inspiration. Surgeon Addison, A.,M.D., ut my suggestion, then gave

Tinct. Aconiti ... mm. v

Aq. ??? ... oz. a

every two hours.

Evening temperature after five doses came down to 101*4? F., free diaphoresis and the

patient expressed himself much easier in all res-

pects. To continue medicine throughout night every four hours instead of every two hours.

Octr. 22nd.?Expresses himself quite easy. Morning temperature 100*6?. To continue medicine. Evening temperature 102?.

Octr. 23rd.?Morning temp. 99*4?. No pain. Free expectoration with no rusty tinge. To con- tinue linseed poultices every four hours, and to have

Liq. Ammon, Acet. ... oz. J Vin. Ipecac. ... mm. x

Aq. Cam ph. ad ... oz. i

every four hours. Octr. 24th.?Morning temperature normal ;

evening 99*4?. No pain. Grey expectoration. From this date he went on progressing, and

was discharged from hospital a week later, with only very slight dulness remaining.

In this soldier it was very noticeable how

great was his relief after a few doses of aconite, and it will be seen that the temperature was

kept down by the continued administration of small doses of the drug, and that from the first all the urgent symptoms disappeared, when the temperature was reduced.

Octr. 15th, 1883.?Private S., at. 22, was

admitted to hospital on board H. M. S. Serapis, complaining of great pain in right side, cough, and rusty expectoration. A pale and delicate- looking soldier. Temperature 105?. Pulse

quick and weak, 120. Respiration 40. Ordered to bed ; to have milk diet and beeftea.

Tinct. Aconiti ... mm. iij Aq. ad ... ... oz. ?

every hour. Jacket poultice of linseed, sprinkled with

mustard. Octr. 16th.?Temperature 100?. Painless and

free diaphoresis. Says he had a fair night. Pulse 100. Respiration 30. To have medicine

every two hours. Temperature, evening, 102?. Octr. 17th.?Good night. No pain except

on coughing. Temperature, morning, 99*8?.

To continue medicine every four hours. Octr. 18th.?Temperature, morning, 99?.

Says he feels all right but weak. To have

Liq. Ammon. Acet. ... oz. j

Yin. Ipecac. ... ... mm. x

every four hours. To continue poultices at night only. He continued to progress satisfactorily, the

temperature never rising above 99?, and he was

discharged just before our arrival at Bombay on November 6th.

It is obviously unnecessary to mention all the symptoms and physical signs of the above cases. They were all pueumonia of a severe form.

1 might adduce innumerable instances both of civil experience as House Surgeon and in the

Army where aconite has thus acted quickly,

294 THE- INDIAN MEDICAL GAZETTE. [Oct., 1886.

safely, and effectually, but this would unneces- sarily take uptoomuch space, and though the rela- tion of numerous cases might give more empha- sis to the usefulness of the drug, it would none the more prove its undoubted value as an almost certain specific for this grave disease, at least in my own mind; and I feel convinced that if aconite were more generally used in the treat- ment of pneumonia, our mortality list from this cause would be still more reduced, and that

every practitioner thus using it would be as

thankful as I am in being able to avail myself of such a drug?the remedy I myself would take if the subject of this disease.

Bellary, July, 1886.