A therapeutic guide to alkaloidal-dosimetric-medication

Front matter

FROM

THE ABBOTT ALKALOIDAL CO., CHICAGO.

LIBRARY OF CONGRESS.

Dedication

I dedicate this book to my wife, whose assistance and advice have always been valuable to me.

The Author.

PUBLISHER'S STATEMENT.

Contents

Chapter. Page.

Introduction n

I. ACONITINE 23

Introduction

About fifty years ago, Professor Adolph Burggraeve, of the University of Ghent, conceived the idea of administering in disease, according to certain simple rules, the active principles of plants prepared in granules.

Because the medicines were "mathematically measured " in small doses, the name "Dosimetry" was applied, to distinguish this method of prescribing from others then in vogue.

It is not claimed that dosimetry is a new system or that it is a complete practice. The active principles of plants, which have been used for ages in cruder form, are prepared in granules. This is done for the purpose of convenient dispensing and of assuring accurate dosage. That granules contain accurate doses is evidenced by the fact that uniform results are always obtained, and fatal effects have never been observed.

One of the precepts of dosimetry, or alkaloidal medication, is: "To acute diseases oppose acute treatment, to chronic diseases chronic treatment. ." — Burggraeve.

These granules represent a minimum adult dose and, in acute diseases, they may be administered every fifteen minutes, every half hour or every hour, according to the severity of the attack, until some improvement is manifested. The medicine should then be given at greater intervals. By pursuing this method closely it is simply impossible to overdose the patient. On this account the use of the alkaloids and other active principles and powerful drugs are perfectly free from danger. To insure better absorption of the granules, treatment is usually begun by giving a dose of seidlitz salt to clear and freshen the alimentary canal.

In cases in which the mucous membrane of the mouth is very dry, indicating that stomach solution will be slow, it is best to prepare a solution of the granules in water. Combinations may be made with different granules without the fear of chemical incompatibility except in the case of tannin. This granule should never be given with any alkaloid, as it forms an insoluble tannate.

Another advantage of the alkaloidal method is that in acute diseases, active treatment is begun immediately, even before a positive diagnosis can be made. This is done with the hope of checking the progress of the impending disease and of aborting fever.

Physicians who have tried this method testify to its wonderful efficacy in jugulating many acute febrile diseases, a thing comparatively easy to do at the beginning of the attack. The medicines used for this purpose, are aconitine, digitalin ; and veratrine.

There is no recognized dose, for no one can possible say how much of a given remedy will be required to relieve a symptom, therefore minimum doses should always be given and repeated frequently until the desired effect is obtained. Those physicians who use dosimetric granules are constantly upon the alert in order that harmful tendencies of disease may be anticipated. In capillary bronchitis, in peritonitis and in diphtheria, paralysis frequently occurs. Now, we do not wait until there are evidences of paralysis, but we apply our remedy before paralysis makes its appearance; that is, we anticipate it.

All schools of physicians use but one medicine to stimulate paralyzed nerves and to restore paralyzed muscles; and that remedy is strychnine. There is no other medicine but strychnine that can so effectually stimulate the vital functions and arouse nerve force.

If strychnine is a proper remedy to use to cure paralysis, it is also a proper remedy to use to prevent paralysis. Whether paralysis is actually threatened or not, the administration of strychnine cannot harm the patient but, on the contrary, it must greatly benefit him, for it is the best general tonic we possess. There is hardly i 4 INTRODUCTION.

a disease in which strychnine may not be given to good advantage to the patient.

In the treatment of infectious diseases, the materies morbi is never lost sight of and every endeavor is made to elimina^ and to neutralize it; first by the action of the seidlitz salt upon the intestines, kidney and skin, then by the administration of calcium sulphide throughout the entire course of the disease. In the blood, the sulphuretted hydrogen evolved from calcium sulphide may neutralize the products of germ activity, but it also acts upon the secretions.

The cause of disease always should be sedulously sought for, with the object of applying treatment directly to it. In typhoid fever a specific germ inhabits Peyer's patches. These germs and the absorption of their products cause the fever. Every endeavor should be made to clear the intestines of the fermenting germ products and to prevent their absorption. Calomel and sulpho-carbolate of zinc are probably the best remedies for this purpose and the latter should be given throughout the entire course of typhoid fever.

This is called dominant treatment, which means treatment directed against the cause of the disease, and if the cause is unknown, treatment must be directed against the most prominent symptom. Rachitis requires salts of lime. Inflammation requires aconitine. Paludal infection requires quinine, etc.. Whatever concomitant symptoms arise during the course of disease, as pain, diarrhoea, vomiting or insomnia, require what is called variant treatment. This treatment is limited to the symptom and is discontinued as soon as relief is obtained, while the dominant treatment is continued as long as the disease lasts.

DISPENSING GRANULES.

Granules are most conveniently dispensed in one-half drachm glass vials, or in wooden bottles, number"oo." The former hold about one hundred granules and the latter about fifty granules. It is best to have the bottles labled with the directions for the administration of the granules and the first two or three letters of the name of the remedy employed written thereon. If arsenite of strychnine is given, ar. st. is written; if aconitine, aeon.; if atropine, at., and so on. When prescribing for young children, a solution is needed. In the office, three-ounce vials filled with water should always be at hand. The granules should be crushed in a mortar and dissolved in water.

If the granules contain bitter medicine, a little saccharine may be added. When visiting patients at their houses, a three ounce vial may be used, or twenty-four teaspoonfuls of water may be measured into a tumbler, and the proper number of granules dissolved in this.

Always be accurate, and know how many granules are given, and in how much water they are dissolved. To throw an unknown number of granules into an unknown quantity of water, with the directions to take a teaspoonful, is criminal carelessness, and shows rank ignorance of the potency of the granules. From such carelessness, harm to the patient must certainly follow.

Where patients, especially infants, require larger quantities of medicine than usual to afford relief, a note should be made of it and thus, by accurately observing the dose and its effect, a large amount of useful information can be obtained, which cannot possibly be had in any other way.

Each standard granule represents, as a rule, a minimum dose for an aduit, which may be repeated every half hour or oftener. Most of the granules are not poisonous, and two or three may frequently be given at a dose. Aconitine. cicutine, gelsemin, and veratrine should be given only in doses of one granule.

In prescribing for children, the writer has found it convenient to use a three-ounce vial or to measure twenty-four teaspoonfuls of water into a tumbler. Any other quantity of water can be used, of course, but it will be found advantageous to use a certain quantity, in order that doses may be easily calculated.

If twenty-four granules were dissolved in a three ounce vial, one teaspoonful would represent one granule, which is ordinarily a dose for an adult.

The following rule has been formulated by the writer for administering aconitine to children and it has proved a perfectly safe rule to follow when standard granules of any of the active principles are to be given, as veratrine, cicutine, gelsemin, hyoscine, etc.

Dissolve in twenty-four teaspoonfuls of water, one granule for each year of the patient' 's age together with one additional granule. For a child of two years, dissolve three granules, for a child of one year two granules in twenty-four teaspoonfuls of water. An infant of six months requires only one granule in twenty-four teaspoonfuls of water, while one of three months requires one granule in forty-eight teaspoonfuls of water.

Ateaspoonful of the solution may be given, usually, every hour but, in severe cases, a teaspoonful of the solution may be given every half hour until improvement is manifested. This rule applies only to those medicines which are considered actively poisonous, as aconitine, veratrine, gelsemin, atropine, morphine, codeine, and hyoscyamine. There are many granules, as asparagin, calcium sulphide, emetine, iron, scillitin and zinc sulpho-carbolate, which require larger doses and are not poisonous medicines.

There is absolutely no reason to fear evil results from administering alkaloids according to Burggraeve's method. There is no safer method known and why physicians hestitate to use alkaloids in known quantities is difficult to comprehend. If the writer were compelled to give a prescription for active principles, to 'be filled by some druggist who has obtained his medicines from various manufacturers, there would necessarily be hesitancy on his part, but, when he is supplied by a reliable firm, as " The Abbott Alkaloidal Company," of Chicago, whose granules are uniform in action, and consequently must be accurate and pure, he feels no hesitancy in giving aconitine, hyoscyamine and strychnine even to the youngest infant.

The granules are even pure enough to use hypodermically, as the writer has done with glonoin, aconitine, morphine, atropine, pilocarpine and others.

When rapid effects are desired, they may be dissolved in hot water and administered.

Of course there are objections raised against dosimetry. In the first place, because it is assumed by some to be a new system of medicine. But it is not a new system of medicine. It is stated by the late Dr. Marchal " a great fact." It is simply a method of administering active principles in a perfectly safe and effective manner according to certain rules laid down by Professor Burggraeve.

Some declare that dosimetry borders on homeopathy, because little pills are used, and because the physician dispenses his own medicine in a way similar to that of a homeopathic practitioner. This is rather puerile, as chewing a few granules of quassin is sufficient to show.

Others affirm that alkaloids are dangerous medicines. So they are in the hands of the unenlightened and so is any medicine, except homeopathic medicine. The danger is removed by knowledge sufficient for a proper diagnosis and by an understanding of the physiological action of remedies.

Those physicians who object to alkaloidal granules which contain known quantities, do not object to giving infusions, tinctures, fluid and solid extracts, all of which must contain alkaloids, and in unknown quantities.

A physician cannot take a bottle of the tinc- Ture of aconite root, ordinarily found in drug stores, and tell exactly how much aconitine there is in a single dose. It must be that he does not want to know how much active principle he is using and, therefore, gives the cruder preparation.

It is urged as another objection that all of the alkaloids or active principles are not simple bodies; and this is true. But those who prescribe them are aware of the fact. They know that veratrine, digitalin, and it may be some others, contain several active principles. While this is true, the important question in the treatment of the sick nevertheless remains, " What results are produced by the use of these medicines?" These results are known and are all that can be desired. Besides, the purest active medicinal substances which chemistry can separate from plants are always used and, as soon as chemists can isolate simple active principles, they will replace the compound ones now in use.

Some objection has been very properly made to the common names given to the granules, as calomel, iron, mercury and sugar of lead, instead of the chemical names as found in the United States Dispensatory. Why these common names have been adhered to, I do not now know and I have no hesitancy in saying that it would appear more in accord with scientific knowledge, to use the recognized nomenclature of the United States Dispensatory.

It has always appeared to me strange that physicians should ask if patients do not object to the change from the usual method of prescription writing to the use of the granules. On the contrary it is the experience of the writer that patients always express themselves as highly pleased with the change; not only are the granules more palatable, but patients very quickly observe that the results obtained are better and follow more speedily than before, and they absolutely refuse to go back to the older ways. And not only does the patient learn of the wonderful potency and efficacy of the granules, but the physician himself is often astonished at the excellent results obtained, becomes inspired with a new enthusiasm and awakens to the fact that he can better alleviate and cure than formerly. The writer has had years of experience in writing prescriptions and also in dosimetry, and he has no hesitancy in saying that his results with dosimetric granules have far surpassed what he was able to do while using cruder preparations of drugs.

A THERAPEUTTC QCJIDE

TO

Chapter I. Aconitine (alk>

Standard granule — Gr. 1-134 of the amorphous.

Dose — One every % to %. or 1 or 2 hours, according to the conditions.

Aconitine is an alkaloid, and is the active principle of the leaves and root of Aconitine Napellus. According to Wright the yield of aconitine from the root is 0.07 per cent.

In dosimetric medicine two forms of aconitine are used, the amorphous and the crystalline. The amorphous is prepared in granules which contain different amounts of the active principle. There are granules containing gr. 1-134, grm. .0005, and others containing gr. 1-500, grm. .000125. The crystalline is prepared only in granules which contain gr. 1-500, grm. .000125. If a granule of aconitine is held in the mouth and allowed to dissolve, within ten. minutes a tingling sensation is perceived in the lips, tongue and fauces. If aconitine is taken in larger doses, or if smaller doses are repeated very frequently, tingling is felt in the fingers and toes, then in the hands and feet, and finally in all parts of the body. The tingling or numbness is the first physiological manifestation which shows that the system is fully under the influence of aconitine. Numbness is rarely produced while treating fever with aconitine. Probably the presence of fever prevents this action; at any rate it is not necessary in order to reduce fever that tingling should be manifest. Harm cannot result until the patient first feels this numbness.

In treatment of adults, therefore, no danger can arise from medicinal doses of aconitine, if the medicine is withdrawn when the patient perceives the sensation of numbness When aconitine is indicated we are justified in pushing its use, if relief is not obtained, until tingling, the one physiological effect described above, is manifested. The tingling is produced by paralysis of the end-organs of the sensory nerve-fibres. This physiological effect is utilized in the treatment of neuralgia, hyperesthesia, sprains and contusions. The first two may be treated by the internal administration of aconitine or by the local application of aconitine in the form of an ointment, in the proportion of two grains to the drachm of lard. Sprains and contusions may be treated by a liniment composed of tincture of aconite root one part, ext hamamelis distilled five parts. In the treatment of many stubborn neuralgias, especially of the facial nerve, it is absolutely necessary before relief can be obtained, to give aconitine in increasing doses until its full physiological effects are produced. A cure is more easily affected in the treatment of neuralgia, by combining aconitine with arseniate of quinine, with gelsemin or with morphine.

With reference to the tingling, the question might be asked, "How is it in regard to little children and infants who cannot express themselves or indicate their sensations?" In the first place, it should be remembered that tingling of the extremities is rarely produced by aconitine in dosimetric treatment of fevers. Further, as prominent symptoms subside, aconitine should be withdrawn and too much of the remedy is therefore not likely to be given. Lastly, the writer has never seen a case which was treated with aconitine, according to Burggraeve's method, in which an untoward or alarming symptom, danger, or death has been produced.

This may appear to be a bold statement to make in the face of warnings uttered by various writers of prominence who say that aconitine should never be used internally, and that it is unsafe. If the physicians who made the above remarks had ever used aconitine in small doses frequently repeated in the treatment of fevers, it would have been impossible for them to have made such statements.

It seems strange to read such adverse comments about a remedy which physicians use daily and know from experience that it is the most effective, the most reliable, and the safest of all the alkaloids of dosimetric medicine.

When one granule of aconitine amorphous, gr. 1-134, grm. .0005, is taken every half hour, the number of pulsations and respirations is reduced, the arterioles are dilated, the capillaries are flushed wiA blood, the blood pressure is lowered through the action of vaso-motor nerves and all of the secretions are augmented. The effect of aconitine upon the secretions is shown by the moistened tongue and skin, the increased flow of urine, and if the dose has been excessive, by the diarrhoea, and sometimes by the vomiting of mucus.

In disease, the effect of aconitine upon the glandular structure is more marked than in health. During high fever the skin is hot and dry, the urine is scanty, the bowels are constipated and the tongue is dry, heavily coated, brown or glazed. The patient may be comatosed and may breath heavily or he may be restless and delirious; he ma)' suffer also from great thirst, from general soreness and pain and the pulse may be rapid. Under these conditions if one granule of aconitine amorphous, gr. 1-134, grm. .0005, is given every half hour, great changes are soon produced. The skin is covered with perspiration, the quantity of urine is augmented, the bowels are moved, the tongue grows moist, the patient is aroused from his coma, or is relieved of his restlessness and delirium; his thirst and pain disappear, his pulse, respiration and temperature are reduced to normal.

By closely observing the tongue in fevers, we are able to judge of the progress of the action of aconitine. As long as the tongue remains dry, no impression has been made upon the general secretions and no progress has been made in the case but, as soon as the tongue grows moist, general improvement follows.

In the use of aconitine, no question need be asked concerning the kind of fever for which it is suited. It may be used in all kinds of fevers, from those occurring during the first days of infancy, throughout life, to extreme old age, irrespective of the cause. Wherever there is fever aconitine is indicated. Aconitine is not only the febrifuge of dosimetry, but without doubt, it is the best antipyretic known.

Aconitine is the great jugulator of fevers. Every endeavor should be made to administer it as early as possible in the course of an acute disease. While it is always easy to detect fever, provided a thermometer is used, it is not always easy to detect the cause '

Active treatment should, however, be begun at once. To give a placebo and wait until tomorrow in order to make a positive diagnosis before beginning active treatment, is an unnecessary loss of very valuable time. Fever is present and that is a sufficient indication for treatment, without waiting to make a positive diagnosis. The fever, indicated by a rise in temperature, is ominous and may prove serious. When the human body is plainly showing, by many signs, as an abnormal temperature, chilliness or rigor, headache, backache, general lassitude, a quickened pulse and respiration, that an inflammatory disease is threatening to attack some organ or structure, experience is powerless to indicate where the general storm which seems to be gathering throughout all parts of the organism will finally localize its entire force. If this force is localized, it will produce congestion and congestion usually leads to inflammation. It is our duty to attempt to prevent the general storm from making headway and attacking a single organ or, if too late for this, to jugulate the congestion or even to strive to hold in check the inflammation, if it has occurred; and, notwithstanding the preponderance of opinion against it, this can frequently be done.

Every case which presents itself with prodromal febrile symptoms, if unchecked by nature or art, will terminate in fever. This should be fully realized and, as soon as the case is seen, whether fever is present or not, aconitine should be given every hour and continued until improvement is manifested. The result will be that in many cases the various symptoms will soon disappear. If fever has been present the temperature may be restored to the normal within twenty-four hours. Some cases may run their course but the probabilities are that the course will be much shorter under treatment with aconitine than with any other medicine. This has been the writer's experience and this is his chief reason for using aconitine in the treatment of fevers.

Not all cases can be jugulated, chiefly because their incipiency does not always come under the observation of the physician. Frequently I have seen temperatures of 101 to 105 degrees restored to the normal within twenty-four hours. Without positive evidence, of course, I nevertheless believe that, if treatment had been delayed one day, the termination could not have been so favorable. When first seen, some of these cases were in their early congestive, others in their early inflammatory stages. Marked inflammatory changes had not as yet occurred. Whatever organ or structure was threatened it contained an increased supply of blood. The vaso-motor nerves were paralysed- and allowed an afflux of blood into the threatened structure, while all of the remaining structures of the body were drained and their arterioles were probably contracted.

3 o ACONITINE.

The equilibrium of the blood supply was destroyed through inharmonious action of the vaso-motor centres. A hyperaemia was produced in one part, an anemia in all other parts of the body.

When aconitine is administered to patients whose blood-supply is thus disturbed, an harmonious action of the vaso-motor centers is soon produced. The contracted arterioles dilate and the blood is withdrawn from the congested area. A large amount of blood being thus drained off, the congestion is relieved, an inflammation is prevented, a disease is aborted.

The following plan for the administration of aconitine in fevers, which has been founded upon an extended personal experience of the writer, can be recommended as being perfectly safe and highly effective.

One granule of aconitine amorphous, gr. i- 134, is the dose for an adult and may be given every fifteen minutes, every half hour, or every hour according to the degree of fever. If the temperature ranges between 100 degrees and 103 degrees, a granule of aconitine amorphous, gr. 1 -134, grm. .0005, should be given every half hour. If, however, the thermometer registers from 103 degrees to 105 degrees the same dose should be given every fifteen minutes. In both cases, the medicine must be continued until some improvement is manifested; the same dose can then be administered every one or two hours. If the patient is comatosed, one granule of aconitine may be injected subcutaneously every half hour until the fever declines or until he is able to swallow. To children only a fraction of a granule can be given as a dose and this should always be administered in a solution, which is made as follows: Measure into a glass twenty-four teaspoonfuls of water, or use a three-ounce vial of water. Drop into the water one granule of aconitine amorphous, gr. 1-134, for each year of patient's age, together with one additional granule; that is, for a child one year old, two granules; for a child five years old, six granules, etc. ; for infants of six months, one granule. Of this solution, one teaspoonful may. be given every fifteen minutes, every half hour or every hour, according to the degree of fever or the urgency of the case. In the treatment of children, as in the treatment of adults, as soon as improvement is observed, the medicine should be given less frequently. For infants under six months of age, the dose prepared for a child of six months should be administered as follows: If the child is under one month of age, fifteen drops of the solution may be given. If the child is one, two or three months old, one-half teaspoonful of the solution will be a sufficient and safe dose. If no improvement in the patient's condition follows within twelve hours, the dose may be gradually increased to one teaspoonful. The writer has frequently given aconitine to infants a few days old, and he has never known of harm resulting to the patient. The great safe-guard in the use of an alkaloid, according to the rules laid down by Burggraeve, is that as soon as improvement is manifested the medicine should be withdrawn either gradually or entirely. Gradual withdrawal is best as it prevents a return of fever. How can the attendant know when to withdraw the medicine gradually and to begin giving it at greater intervals ? If the patient has been restless and delirious and becomes quiet, if thirst, lassitude and soreness disappear, if the dry skin and tongue becomes moist, then, instead of giving aconitine so often, it should be given every one or two hours.

If after a time fever returns, aconitine may be given as frequently as at the beginning of the treatment.

It should be remembered that generally the pulse is restored to the normal before the fever has been reduced.

How long may aconitine be administered? It may be administered continuously for weeks but it is best to combine it with strychnine and digitalin, as it is in the preparation of the granule known as "Dosimetric Trinity."

Aside from its systemic use in the treatment of fevers, aconitine may be used to advantage in inflammations of the mucous membrane of the mouth and pharynx. For this purpose it should be given in solution and, when thus frequently administered, aconitine acts as a local anesthetic and relieves the pain which usually accompanies these diseases.

Aconitine reduces the number of respirations and should be used, therefore, in all inflammatory diseases of the lungs, in which there is always increased respiration. There is no remedy that can cure acute diseases of the entire respiratory tract so quickly and so thoroughly as aconitine. These are also among the diseases which can be aborted. In the treatment of bronchitis, emetine and scillitin may be combined with aconitine, to modify the character of the sputum and to make expectoration easier.

In cases of hypertrophy of the heart, in which the contractions have become too vigorous, one granule of aconitine given every two hours will reduce the force of the beat.

While aconitine may produce vomiting and diarrhoea when given in small doses to susceptible patients, and while large doses usually produce irritation of the stomach and intestines, still it is not contra-indicated in inflammatory diseases of the gastro-intestinal canal; because it may be administered with codeine, which prevents the irritant action of aconitine.

In all inflammatory diseases of the puerperal state, as pelvic peritonitis and metritis, aconitine reduces fever with remarkable rapidity.

If adynamia is present, strychnine and digitalin must be added to the aconitine. It should be remembered, that there is no disease accompanied by fever in which aconitine may not be given with advantage. In scarlet fever, measles, diphtheria and in small-pox, aconitine and calcium sulphide are among our best remedies. In acute articular and in muscular rheumatism, in erysipelas and in meningitis, aconitine will give better satisfaction in the reduction of fever, and consequently in the relief of pain, than any other antipyretic.

In the treatment of asthenic cases with aconitine, Burggraeve uses the combination of aconitine amorphous gr. 1-134, grm. .0005, digitalin gr. 1-67, grm. 001, and strychnine arseniate gr. 1-134, grm. 0005. These three active principles are prepared in a granule known as Dosimetric Trinity No. 1. Another granule is prepared containing one-fourth of the quantity of the active principles found in No. 1. and called Dosimetric Trinity No. 2*. This latter granule may be used in the treatment of diseases of children. When Dosimetric Trinity No. 1 is used in the treatment of adults, or of children, it should be given in the same dose, and according to the same method, laid down for the administration of aconitine. This granule may be given in all cases of fever, especially cases in which the patient is delicate, and the heart is feeble. When preparing Dosimetric Trinity

*These compound granules were first prepared and introduced by The Abbott Alkaloidal Company of Chicago.

in solution for administration to children, saccharine should be added to correct the bitterness.

In the granule known as Dosimetric Trinity, aconitine is an antipyretic, digitalin a heart tonic and antipyretic, while strychnine is a heart, lung and nerve stimulant. The slight antagonism which exists between aconitine and digitalin is not sufficient to destroy the property of aconitine as a febrifuge, and it also aids aconitine in reducing fever. The combined action of digitalin and strychnine in sustaining the heart, and particularly the action of strychnine as a respiratory stimulant, prevents pulmonary depression by the action of aconitine.