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With those alone do we refuse to associate who knowingly parade our doctrines as discoveries of their own, and for the sake of money, position, or fame consent to vilify or ignore the real author. Such among our opponents can expect nothing at our hands save indignant exposure and richly merited contempt.
ON THE PATHOGENESY OF ACONITE, WITH CLINICAL OBSERVATIONS.
By J. H. Nankivell, M.R.C.S., York.
(Continuedfrom Vol. XXXI, p. 427.)
Upper Extremities. "Trembling of the hands and arms; pains in the arms and fingers; numbness and lameness of the left arm, which scarcely permits the hand to stir. The arms hang down powerless as if paralysed by blows. The arms feel chilly and insensible."
Trembling, numbness, lameness, as if paralysed; these terms seem to fall naturally into one category and mark the depressing power of the drug when large or often repeated small doses of it have been taken. In such a state of things the muscles lose their tone, and are in the first stage of automatic uncontrolled action. The vasomotor nerves have failed to keep up their full influence on the arteries they supply, and thus in a morbid circle the nerves themselves cease to receive that quantum of blood which is required for the exercise of normal healthy functions: hence we arrive at a stage when a form of anaesthesia obtains and but little power is left in the affected extremities. The " clinical observations " of Aconite do not afford us any confirmation of the above signs or symptoms, but doubtless theyhave been met with in practice, and been combated with Aconite. I have not any case in point to record from my own experience.
"Tearing in the arms from the shoulders to the wristjoints and the fingers, scarcely even felt except during movement, with blueness of the hand during the paroxysm of pain. Pain as if contused in the shoulder-joint (also the hip-joint) after sleep, as if he had been lying on too hard a couch; the pain is felt only during movement. Pain in the shoulder, it feels as if it would drop. Swelling of the deltoid muscle, which when touched feels painful as if bruised. Stitches in the shoulder and the upper arm (they are sometimes drawing)."
In the first sentence we have a remarkable symptom, viz. venous engorgement accompanying acute pain; an opinion of Rau's may throw some light upon this point: he maintained that Aconite influenced the arterial but had no direct action on the venous system, and that the result was a stasis in this portion of the circulating vessels and hence a passive engorgement of the capillaries. Aconite seems to elect the upper extremity for some of its most marked effects ; thus we find "Sense of contusion of shoulder-joint and even swelling of deltoid," but Bonninghausen has recorded "a laming pain in the arms and bones without swelling." The symptoms in their entirety bear a close resemblance to those of chronic rheumatism as affecting aged people.
"Drawing pains in elbow-joints, weight and debility of the forearms as far as the fingers, which feel as if gone to sleep when taking hold of anything. Pain in the forearm as after a violent blow. Drawing (with sense of tearing and sticking) in the forearms and their bones; movement excites the pains. Feeling of lameness in the right forearm and hand, especially when writing, going off by moving the part strongly."
It has been before remarked, that the expression " as if gone to sleep" or " numb tingling" is one of the most characteristic symptoms of Aconite, and the expression "compare with Arnica " is constantly suggested during our study by such phrases as" after a blow." We may be pretty sure if this description of a pain by a patient had led us into the routine of giving Arnica and the effect if any had disappointed us that we might with every propriety give Aconite.
It is perhaps worthy of notice that the last two sentences are antagonistic in one of their conditions as to the effect of movement; in the first pain is caused, in the other it is allayed. The last sentence is well worth bearing in mind, as the lameness complained of is by no means rare amongst persons much engaged in literary composition.
"Crampy contractive pain in the hand and fingers, sometimes accompanied with stitches. Tearing and paralysing drawing in the wrists. Numbness, icy coldness, and insensibility (deadness) of one hand. Cool sweat of the palms of the hands. Swelling of the hands, with frequent paroxysm of cough, and good appetite. Drawing, jerking pain in the thumbs; pain in the thumbs as if sprained and lame. When bending the fingers, violent stitches dart through the wrist-joint to the elbow-joint. Tingling pain in the fingers even while writing."
It will not be necessary to make much comment on this quotation because most of the troubles are like those before glanced at, the site and sphere of them only being different. We may conclude for the most part that the same provers who had stitches in the fingers, tingling, tearing, &c., had also like affection in the region of the humerus. "Icy coldness of one hand '' is backed by "Icy coldness of both hands" in the Oest. Zeitschrift, but Bonninghausen in the three (only) symptoms he records respecting the upper extremity has *" Hot hands with cold feet." Were it not impious and disloyal to say so or think so, the sentence beginning "Swelling of the hands" might be reckoned an incongruous one, the pathological relations being not very evident.
(From the Oest. Zeitschrift.) "Stinging and pricking in the arms and fingers. Jactitation of the arms. Shooting stitches in the left shoulder. *Drawing, tearing pain in the shoulder-joint. Violent drawing and tearing, with a feeling of lameness in the head of the left humerus. Lameness and stiffness of the outer side of the right upper arm. Frequently recurring pinching as with dull pincers in some parts of the left arm."
It is highly probable that the stinging and stitching sensations have their seat in minute fibres of nerves, not in the larger trunks and main branches, and for the most part are subcutaneous. Jactitation is trembling in a magnified degree. The sentences describing acute pain about the shoulder-joint seem to mark deep-seated lesion, and it would appear from the asterisk and italics have been notably cured by Aconite. With regard to lameness and stiffness of the limb, the cases which most commonly have been treated by me with these features have been those of pseudo-paralysis in women, about the age of fifty, in whom the catameuial periods have become very irregular in their return or have ceased altogether. Aconite and Lachesis help this form of disease.
*" Drawing, tearing pain in the elbow-joint. Acute pain in the right forearm along the tendon of the flexor digiti minimi, increased by movement. Drawing, tearing pain in the forearm. Prickings in the joints of the forearm. Insensibility of the palms of the hands. Icy coldness of the hands. Drawing, tearing pain in the wrist-joint and fingers. Hot pricking in the tips of the fingers at night."
With the exception of ordinary rheumatic pains, especially in elderly people who have worked hard for many years whilst exposed to cold and wet, I do not remember many cases of disease which were at all parallel to the above. But of such as I allude to a few might be described were they not so miserably common. The effects produced have been some stiffness and immobility of the shoulder-joint, likewise of the elbow, rarely with deformity. But in the wrist and fingers one often is called upon to prescribe for tendons glued to their sheaths, bursal and other enlargements, lamentable distortion in the joints of the fingers which have become twisted hither and thither; and unhappily the pains which caused or accompanied these lesions have not ceased when the laming effect has been produced. Neither with Aconite nor any other remedy are we able, in this chronic condition of things, to effect anything better than slight palliation.
It boots little to say that had these patients been at an earlier period subjected to common sense or, as we call it, homoeopathic treatment, our blessed drug Aconite would have helped them very much.
Lower Limbs. "After sitting the thighs and legs feel lame and weak. Tensive pressure in the thighs as if a tight bandage were drawn around them, with great weakness when walking. Weakness in the region of the head of the femur and inability to walk, owing to an indescribable intolerable pain as if the head of the femur had been crushed, particularly after lying down and sleeping. Numbness and lameness in the left thigh."
The two first sentences of the above quotation are not very suggestive of clinical comment, the tight-bandage sensation being one of rare occurrence, albeit well deserving to be kept in mind. For the rest, although the passages do not point clearly and unmistakeably to what we understand by the expression hip-joint disease, I shall take this opportunity of subjoining a few remarks on that subject, and though when one sees in every town of any importance strumous children in whom one of the lower extremities has been dislocated at the hip-joint by the slow process of scrofulous inflammation and suppuration, the question naturally arises, Are there no means hitherto discovered, in allopathic or homoeopathic modes of treatment, whereby such a direful calamity might be more frequently averted than it hitherto has been? And there is also -another interesting question connected with it, viz. By what strange cause does it befal that double hip-joint disease is unknown? It might have been reasonably presupposed that, when one joint has been destroyed, and the limb of which it formed a part has become suspended, and doomed to be a mere pendulous crippled extremity, the other limb, having to bear the whole weight of the body almost constantly, and at a great disadvantage, would soon become hors de combat also. For whoever has noticed a case of this sort with single crutch, or crutch and stick, may well