2. Mode Of Operating

Though locally irritant to the vascular tissue, the primary effect on the nervous extremities themselves seems to be sedative; for a feeling of numbness attends the prickling sensation; and the effect altogether is that often felt in cases of commencing or partial paralysis. The feeling of warmth is probably the result of the vascular excitement. I have already expressed my belief, that the general but evanescent phenomena of excitement, sometimes produced, are the result of a sympathetic extension of the local excitant impression. The first direct effects upon the system are probably produced through absorption; for they are the same whether the medicine is taken into the stomach, or applied to the rectum, the areolar tissue, one of the serous membranes, the abraded skin, or a wounded surface. These effects are directly sedative to the nervous system, and apparently so to the circulation and respiration. The probability, however, is that it affects these functions, not by acting immediately upon the heart and lungs, but by first depressing the nervous centres which control the movements of these organs. The circumstance that the heart is sometimes found active, and sometimes quiescent after the suspension of respiration, shows that the influence of the poison is occasionally predominant in the nervous centre of respiration, and occasionally in that which regulates the heart. The increased frequency, weakness, and irregularity of the pulse which follows the first depression, in cases of excessive action from the medicine, may be ascribed to the complete paralysis of the nervous centre in the medulla oblongata, so that the heart is now left to the operation of the blood upon its own inherent susceptibility, and acts therefore hastily and irregularly, because not duly supported from the great centre of influence. So long as this centre remains unparalyzed, the operation of the medicine, through it, is to diminish the frequency of the pulsations.

3. Therapeutic Application

Aconite was known to the ancients as a poison; but they do not seem to have been aware of its medicinal powers. in reference to these, it was first brought into notice by Baron Storck, of Vienna, in 1762. The general indication which it is suited, through its sedative properties, to fulfil, is to reduce morbid excitement of the nervous and circulatory systems. Hence it may be inferred to be useful as an anodyne, antispasmodic, and antiphlogistic remedy. in the two former capacities, however, it should be employed only when the pain and spasm to be relieved are dependent on nervous irritation. To these conditions, when the result, as often happens, of a depressed state of the nervous centres, the remedy is wholly inapplicable; differing in this respect from the nervous stimulants, which often operate favourably in both conditions. Aconite is also contraindicated in gastric and intestinal inflammation, in consequence of its local irritant property, and in cases of great general debility, even when alternated with morbid excitement, from its powerfully depressing effects.

Inflammations. The sedative powers of aconite naturally suggested its use in inflammations; and, so far as mere reduction of the heart's action and of nervous force can prove curative in these diseases, benefit may be expected from the medicine. it was recommended by Dr. Fleming especially in inflammation of the brain. it has also been employed in angina, bronchitis, pneumonia, various cutaneous eruptions, and the inflammatory conditions of scrofula and phthisis.

But the disease in which it has enjoyed most reputation as an antiphlogistic is inflammatory rheumatism. As a nervous element of excitement enters largely into the constitution of this disease, aconite would seem to be peculiarly appropriate. Recommended originally in acute rheumatism by Storck, it has been much used in Germany and other parts of Continental Europe, and has at a comparatively recent date enjoyed some credit in Great Britain and this country. By M. Lombard, of Geneva, Switzerland, it has been strongly recommended as having a specific influence over the disease. Of 21 cases of acute rheumatism reported by Dr. Fleming, in which aconite was used, all were cured; the shortest duration of treatment being 2 days, the longest 17 days, and the average between 5 and 6. Upon the same authority, the improvement is often very speedy; "some alleviation of the pain being occasionally experienced in the course of an hour after the first dose has been taken; whilst there are few cases in which decided relief, with abatement of the redness, tension, and tenderness, is not obtained in a few hours. A longer period seems to be required to disperse the inflammation in the smaller joints than in the larger ones." A peculiar advantage of the treatment, judging from the results in the cases alluded to, is the infre-quency of the supervention of cardiac affection; two only of the cases having offered this complication. The convalescence too was extremely short; and there was less stiffness in the joints than is ordinarily left in this affection. This is great success, and, had the remedy proved equally efficacious in other hands, would authorize its universal adoption. But this has not been the general experience. Still, I have no doubt that aconite, like most of the articles of this class of medicines, has considerable efficacy in acute rheumatism; and it may be appropriately employed as an adjuvant of the lancet, or as a substitute for it when circumstances forbid its use.

In chronic rheumatism it has also been recommended, but, though I have frequently employed it in that affection, I do not remember to have effected a cure with it in one case; and the chief benefit which has accrued, has been from the relief of pain through its local application to the affected part. it is more especially applicable to those cases in which the disease approaches the neuralgic or nervous form.