Continued from previous page.
Hale: The Homoeopathic Uses of Hydrastis - Scudder: The Uses of Hydrastis in the Eclectic School- King: The Uses of Hydrastis Canadensis in the Eclectic School - Remarks - Sattler: The Physiological Effects and Therapeutic Uses of Berberine and Hydrastine in Ophthalmic and Aural Practice
THE HOMOEOPATHIC USES OF HYDRASTIS CANADENSIS.—(Written for this publication by Edwin M. Hale, M. D., Emeritus Professor of Materia Medica and Therapeutics in the Chicago Homoeopathic College.)—This indigenous drug, first introduced into our school by myself in 1856, has since obtained a great popularity. Many provings and physiological experiments have been made with it, which, combined with an extensive clinical experience, have pretty clearly defined its sphere of action and its place in homoeopathic therapeutics.
Its sphere of action, although not wide, is yet very important. It appears to me to have a decided and specific affinity for
- (1) The mucous surfaces—especially those with which it may come in contact.
- (2) The mucous glandular system.
- (3) The nutritive system.
- (4) The circulatory system.
Action on the Mucous Surfaces.—The natural secretion is at first increased; then it becomes abnormal in quantity and quality. At first clear, white, tenacious and transparent, it becomes yellow, thick, green and even bloody, but always tenacious, capable of being drawn out in long strings. In this respect it resembles the mucus discharge caused by kali bichromicum, ammonii bromidum and cubebs. It differs from the mucus flux of stannum, copaiva and ammonii chloridum, which is thick, lumpy and falls in masses. This primary mucous flux of hydrastis may pass on to erosion, muco-purulent discharge and ulceration. It probably causes this condition by inducing a primary capillary hyperaemia; next a passie stasis, together with a stimulation of the mucous glands. Finally, from exhaustion or atrophy, the sources of the secretion are cut off, and the mucous membrane becomes dry, glazed, ulcerated and its functions destroyed. Pathologically, this disease of the mucous membranes may be called catarrh, or blenorrhoea. Other medicines cause similar conditions when taken internally, not only in the mucous surfaces with which they come in contact, but through which they may be eliminated (copaiva, kali iodidum, cubebs, grindelia, etc.); but we have as yet no proof that hydrastis is eliminated through any mucous surface, such as the bronchii, urinary or generative tract. If it acts on these surfaces at all when taken internally, it must act on them by disturbing the circulation in the capillaries. I have never been able to cure blenorrhoeas of the above named surfaces by its internal administration,. unless it was used at the same time topically; but I do not mean to dispute its ability to do so. Certain it is that we get the best curative effects when it is locally applied to diseased mucous membranes. We have used it successfully in mucous conjunctivitis; otorrhoea; diseases of the eustachian tubes; catarrh of the nasal passages, pharynx, fauces, stomach, intestines, part of the gall duct, urethra, vagina, uterus (leucorrhoea, gonorrhoea, etc.). These catarrhal affections may be simple, or severe, and may extend to erosions or ulceration. If they begin in simple blenorrhoea, they are all amenable to the curative action of hydrastis.
Method of Application.—When topically applied we use the tincture, or the muriate of hydrastine. The so-called "liquid hydrastis" is probably the best preparation. The infusion of the powdered root, when strained or filtered, is very efficacious. The strength of the lotion should vary according to the nature of the disorder, and the amount of the irritability of the surface. When the mucous membrane is red and irritable, a few drops of the tincture, or "liquid hydrastis," or gr. i of the muriate, to the ounce of water is sufficient. In chronic or torpid conditions the strength may be increased to ℨi of the fluid preparations, or gr.v of the muriate, to ℥i of water. It may be applied with a syringe, atomizer, or as a simple wash, or on bougies (in urethra or uterus), or with a brush (in pharyngitis or conjunctivitis).
Action on the Skin.—The skin being analogous to mucous membrane, it has been supposed that a drug which acts on the one would act simularly on the other. One of our provers records that it caused an erysipelatous rash on the face, neck, hands and fingers, with great heat and irritation, which continued for six days, when the skin exfoliated; others that it caused pustular eruptions. Now the cutaneous analogues of a mucous catarrh, are erythema, moist eruptions, eczema, and even ulcers. In domestic as well as homoeopathic practice it has been used successfully in similar skin affections. We have recorded cures of lupus, psoriasis, excoriations, rhagades, ulcers, boils, and even variola.
It was once highly praised as a remedy for cancer, but I can not find any authentic reports of its successful use when used alone. It was generally mixed with chloride of zinc, or some other escharotic.
Action on the Nutritive System.—The Eclectics have always believed hydrastis to be a general tonic. Our experiments seem to show that it acts similarly to cinchona, columbo, gentian, berberis, and others of that class. When given in medicinal doses of the crude drug, it seems to increase the general tone of the organs of nutrition and assimilation. The appetite is increased, digestion is more vigorous, and the bodily weight and strength increases. But if the drug is continued too long, the improvement ceases, and retrograde processes set in. A gastro-intestinal catarrh obtains, digestion fails, assimilation is deficient, constipation and hepatic torpor are present. All tonics, even iron, act similarly when the doses are too large or are continued too long. In these facts we see that hydrastis and its analogues are homoeopathic to debility, atony, retrograde metamorphosis, and that the drug should be used in small (not infinitesimal) doses, and not continued too long even in small doses.
It is curative in all disorders depending on the above conditions: namely, generally impoverished blood, emaciation, stomatitis, dyspepsia, indigestion either in the stomach or intestines, biliousness, constipation, etc. The action of hydrastine on the liver was established by the experiments of Rutherford, who calls it "a hepatic stimulant of considerable power, and but a feeble intestinal stimulant." He refers to its purgative power. Hydrastis is not a purgative in any sense. It may cause during its first effects some looseness of the bowels, owing to the increase of mucus, but as the catarrh increases the intestines become sluggish, obstructed and very constipated. English Homoeopaths value it more highly than do those of America as a remedy in hepatic torpor and constipation. They find it very useful for haemorrhoids, congestion of the liver and portal system, sallow, dirty skin, and jaundice. I have found it useful for -mucous piles," as well as "bleeding piles." In large doses it first causes acute hyperaemia of the liver, but this is followed by passive venous stasis of that organ and of the whole portal system.
On the lymphatic glandular system its action is not yet proven. I doubt if it has any.
Action on the Muscular System.—Hydrastis acts as a tonic. I do not think this acts through the nervous system, as does nux vomica, but through the blood. The increased assimilation of well-digested food allows the muscles to be better fed and better nourished. If the theory of Prof. Schatz, hereafter referred to, be true-that hydrastis acts directly on the muscular coats of the blood-vessels, contracting them-why should it not act on each and every muscular fibre in the body? Not, perhaps, to contract them, but by imparting a peculiar form of tonicity.
But in whatever way it may act, it has been the observation of all practitioners who have used hydrastis, and particularly the muriate of hydrastine (salt of white alkaloid), that the first signs of improvement mentioned by patients is the increase of muscular strength and powers of endurance, and this, too, in chronic, incurable diseases.
While I believe hydrastis to be a powerful tonic and restorative, I am obliged to deny it any specific anti-periodic (anti-malarial) properties. I tested it thoroughly during a practice of fifteen years in a malarious district. It is not and can never be a rival or substitute for cinchona. The practical physician knows that all bitter tonics have some reputation in ague, e. g., chelone, ostrya, euonymus, and others; but they are not anti-malarial medicines. They may be, and doubtless are, capable of removing the malarial cachexia, in which the recuperative forces of the system are too feeble to resist the habit of recurring paroxysms, which are not true ague paroxysms. All these bitter tonics, particularly hydrastis and its active principles, berberine and hydrastine, have the power of restoring the vital forces sufficient to overcome this habit. In this respect hydrastis is more than a rival of cinchona (which is worse than useless in the cachexia)-it is a most valuable substitute. In all cachexias hydrastis is an indispensable remedy. Even in anaemia and chlorosis, it greatly aids iron in restoring the integrity of the blood.
In the debility after wasting diseases, fevers-typhoid or gastric; after losses of blood, or due to depressing emotions, also in neurasthenia, the hydrastia berberine phosphate or hypophosphite have done me excellent service. We have found it very useful in gall-stones, not so much for the colic caused by their passage as to remove the tendency to their formation. It may dissolve the biliary concretions by causing a flow of thinner bile, or aid in their expulsion by removing (as in jaundice) the catarrh of the gall duct. Several German Homoeopathists have reported cases of tumors of the stomach and pylorus which disappeared under the careful and protracted use of hydrastis.
It is a curious fact in the history of our indigenous remedies that just about the time we think we understand all their qualities, and know all their uses, some foreign physician discovers new qualities and new uses for them.
This is partly true of hydrastis. I have recently read a lecture delivered before the Gynaecological Section of the Congress of German Philosophers and Physicians, held at Freiburg, in 1883, by Prof. Schatz, of Rostock, Germany. He gives as a result of his investigations that hydrastis acts on the mucous membranes by contracting the vascular system.
But such a condition must be due to its action in large doses, and must be followed by its secondary effects, which would be of an opposite character, namely: passive congestion of these tissues. This action can not, however, account fully for its blenorrhagic effects. It must have some other action, especially when locally applied, and this action I am sure is that of an irritant to the glands of the mucous membranes. It probably has, in crude quantities, a double and simultaneous primary action, namely: contraction of the vascular supply, and irritation of the glandular supply. This vascular tension will after a time be followed by vascular relaxation; and the acute primary blenorrhagia by a chronic blenorrhoea with tissue paresis.
Further, Prof. Schatz says that "in many particulars, hydrastis and ergot are not unlike, but not infrequently hydrastis is efficient in cases of haemorrhage where ergot is powerless, or even of positive injury, as also in some cases of myoma. It appears to me that we can attribute the action of hydrastis to the contraction, pure and simple, of the blood-vessel-wall, thereby lessening the congestion of the genital organs, while ergot spends its action on the muscular fibres of the uterus." "In the non-gravid uterus," he says, "the continuous administration of hydrastis causes a retardation of the menstrual period, with a diminution of the amount; it causes the pain to be less; even in menorrhagia and dysmenorrhoea of virgins, without any local causes, when pain is absent. Its action in myoma is often quite remarkable. Haemorrhages caused in this manner diminish very much, or disappear entirely, after the use of hydrastis, even where Bombelin's ergotine has been employed most energetically; I have observed a number of times that where hydrastis had been administered to virgins for menorrhagia, normal menstruation set in, and occasionally the catamenia did not make their appearance for one, two or three months." This result was caused by massive doses. Prof. Schatz gives twenty drops of the fluid extract four times a day, causing, we may presume, the extreme primary effects of the drug. He does not give a differential comparison of the effects of hydrastis and ergot, which would be of great value and interest, but he admits, or implies, that he is not yet able to make such a comparison.
The best authorities describe the action of ergot to be as follows. "The action of the heart becomes slower, and an enormous rise takes place in the blood-pressure. This influence on the circulatory system modern research has shown to be due to the action of ergot on the vaso-motor system; it increases the action of this system, and causes a contraction of the aterioles."
Again, it is said to diminish the blood-supply to the cerebro-spinal axis, to the vegetative organs, the skin and muscular system. It is therefore difficult to explain the difference in the action of the two drugs, unless we suppose that hydrastis acts directly on the blood-vessel walls and not through the vasomotor centers. But we doubt if this can be the case. There are many symptoms of hydrastis, in our meager provings of it, which indicate that it also diminishes the blood-supply of the brain—as witness the "tinnitus aurium, vertigo, dimness of vision, roaring in the head, with dull headache; a 'narcotized' feeling in the brain, feeling as if intoxicated; terrible headache and vertigo, horrible dreams."—Hale's New Remedies, third edition.
It is possible that a more heroic series of provings would evolve more vaso-motor symptoms, but when we consider the large quantities, continued for a long time, used in Eclectic and domestic practice, such a supposition does not seem probable.
But, while its full and true action is yet unexplained, we may take advantage of clinical experience to teach us the action of the drug and its value in certain diseases.
Prof. Schatz, in his memorable lecture, fortifies his statements by the narration of six cases of fibroid tumors of the uterus (myoma), in which he used hydrastis successfully in controlling and curing the haemorrhages, but he does not say what became of the tumors. We know that not all cases of uterine fibroids are attended by haemorrhage. If hydrastis acts by diminishing the vascular supply, it ought to arrest the growth of the myoma, or other non-malignant tumors. Now this brings us back to the alleged curative power of hydrastis in cancer, I have carefully examined all the records of our school relating to the use of hydrastis in tumors and cancer, and I can not find a single case where it entirely removed a cancer, or scirrous growth, before or after the stage of ulceration. But there are cases reported where hard, movable tumors appearing in the breast, stomach and uterus, have decreased in size, or disappeared altogether, after the internal and topical use of hydrastis.
It is my belief, based on a large personal experience and observation, that all the tumors benefited by this drug were fibroid in character, and the result was brought about, not by any "absorbent" action, but by diminishing the supply of blood, and thus cutting off the nutrition of the growth.
Ergot has certainly arrested and diminished the growth of myoma in the uterus, but we do not know that it has acted as well in fibroid tumors elsewhere.
Strychnine has the same action as ergot on the muscular structure of the uterus; so has caulophyllum, cimicifuga, and other drugs, but we do not hear of them as being of value in fibroid and other growths in the uterus.
Hamamelis, trillium, turpentine, phoradendron, millefoil, and others, act as well as ergot in controlling haemorrhages, but we do not know them to be useful in any kind of tumor.
These are mysteries of drug action which yet remain unsolved.
It would appear from the foregoing that if the modus operandi of hydrastis is as stated, its analogues are viburnum, ammonium bromide, ammonium chloride, and a few others.
Viburnum arrests and prevents the pain of dysmenorrhoea and haemorrhages. It is supposed to act on the motor nerves of the uterus, relaxing contractions of muscular tissue. If so, it must act opposite to ergot. How, then, does it arrest haemorrhage? It would seem that it could not affect the coats of the blood-vessels in a manner opposite to its action on the muscles.
Here is an anomaly which can only be explained by accepting the theory advanced by some Scotch obstetrician, that haemorrhage from the uterus often arises from undue contraction of the muscles of that organ.
The bromide of ammonium has been found curative in ovarian and uterine tumors. It is capable of arresting haemorrhage, and acts on the muscular structure of the uterus and its vessels similarly to hydrastis.
Muriate of ammonium has the same specific action on morbid growths, but is not known to arrest uterine haemorrhage.
The action of hydrastis on the uterus may be said to be unique; it has no close analogue. It is not alone in haemorrhage from uterine fibroids or myoma that hydrastis is useful. Prof. Schatz reports one case of congestive dysmenorrhoea; six cases of haemorrhage in virgins, where the bleeding continued after the use of the curette; three cases due to parametritis, cicatrices and contractions; two from incomplete involution of the puerperal uterus; three cases from endometritis and metritis; and five cases of climacteric haemorrhage. In all these cases various other means, drugs and operations had been used, and failed, but hydrastis performed a cure.
Dr. Schatz warns us to use the proper dose. Too small doses have no action; too large too much effect. The quantity he found generally useful was 20 gtts of the tincture three times a day.
I mention this because the illogical custom of many of our school is to select the dose in accordance with some arbitrary notion or preconceived theory. It is absurd to prescribe ergot in a middle or high attenuation for non-contractility of the uterus; and it would be just as absurd to give 20 gtts of the crude in uterine spasms. The dosage in these cases must be reversed, or it is not curative.
By Dr. Schatz's observations we learn that the sphere of curative action of hydrastis, already wider than we supposed, bids fair to become more and more enlarged, especially in the direction of its action on the circulatory system. If hydrastis increases the tonicity of the muscular fibres of the terminal blood-vessels, it must also increase that of the large arterial and venous trunks, and even of the heart itself. And if it does this without acting on the vaso-motor centers, it must prove far more valuable than ergot, for its effects must be more lasting. It follows that it may prove to be one of the chief remedies, if not the remedy, for chronic congestion, or more properly, stasis of the various organs of the body. It may prove to be to the arteries what hamamelis is to the veins, or it may rival the latter in its own sphere of usefulness. Further experiments and clinical observations are needed to substantiate this theory, but I can safely say that it is my conviction, based on many years' experience in its use, that it is of veritable value in chronic blood stasis in the liver, spleen, uterus, abdomen and portal system. I believe too that I have seen proofs of its value in passive stasis of the brain and lungs, for within the last year or two I have observed excellent results from the use of the hypophosphite of hydrastine in affections of the latter organs. I am sure I have seen its good effects in weakness of the muscular structure of the heart, with tendency to dilatation. It seems to build up the muscular tissue, while digitalis or convallaria regulates the rhythm.
I will close this paper by giving an excellent pen picture of the gastro-intestinal troubles, for which hydrastis is specific. It is copied from an article written by Dr. Clifton, of Northampton, England:
"The Facial Expression is dull, heavy, of a yellowish white color, sodden looking, not unlike that in which mercurious is indicated, but whiter, and having less animation. Though there is in its provings no reference to the expression or complexion, as affording reasons for selecting hydrastis, I have frequently found that when the gastric symptoms calling for this medicine have been present, the character of the face has been as I have described.
"The Tongue is large, flabby and slimy-looking. Underneath the fur the tongue is of a bluish white color, having in its edges the imprints of the teeth. So far it is like the mercurius tongue, but lacks the tremulous character of this organ, so often seen in cases benefited by mercurius. The coating is of a yellow, slimy, sticky fur.
"There are morbid states occurring in other organs, to which hydrastis is Homoeopathic, but where the appearances of the face and tongue I have described are not present. In the dyspepsia it relieves. Both are met with.
"The Eructations are generally sour or putrid, more commonly the former than the latter.
"The Appetite is generally bad; the power of digesting bread and vegetables being especially weak. Both are followed by eructations.
"The Stomach has a sensation of weight (not as after nux and bryonia, weight like a 'stone'), and with the weight and fullness, an empty, aching, 'gone' feeling, more or less constant, but aggravated by taking a meal. The aching, 'gone' feeling is something like that produced by gelsemium, but is attended by more general fullness of the stomach, and more sour eructations. Further, although the gelsemium tongue is sometimes coated white or yellow, it is not so large and flabby as is the hydrastis tongue. This symptom is, I am aware, produced by many other medicines besides gelsemium, especially by ignatia and cimicifuga, but ignatia and cimicifuga do not give rise to the other symptoms peculiar to hydrastis. In tea-drinkers this symptom occurs frequently, but with them the tongue is generally white (except when colored by the tea), and in their dyspepsia cinchona is often found to answer better than other medicines, especially in removing the flatulence with which they are commonly troubled.
"The Action of the Bowels may be either infrequent and constipated, or frequent, with the stools loose, soft, light colored, and with flatus. But as a rule the bowels are constipated, and stools lumpy and covered with slimy mucus, in cases indicating hydrastis."
THE USES OF HYDRASTIS IN THE ECLECTIC SCHOOL.—(Written for this publication by Prof. John M. Scudder, M. D., Professor of the Practice of Medicine in the Eclectic Medical Institute, Cincinnati.)—In some respects the hydrastis has been much over-estimated. It has been recommended as an antiperiodic, but it has but a feeble influence either as a prophylactic or a remedy opposed to malarial disease. It has been recommended as one of the best if not the best of bitter "tonics"—meaning a remedy to increase the appetite, digestion, blood-making and nutrition. But in this it is much overrated, and will not give satisfaction unless a special pathological condition exists.
This brings us to the consideration of the indications for its use, and its contra-indications. It is a remedy in atony of mucous tissues, with increased secretion; it is a remedy in irritation or inflammation of mucous tissues if secretion is free, whether it be mucus or pus. In this case it is a tonic, and improves nutrition, giving a better circulation and innervation. It has been claimed that it relieves irritation and gives tone to the parts, and with the conditions named this is a fact.
In catarrhal gastritis it is tonic and peptic, as it is in intestinal catarrh or catarrhal dyspepsia. It is a good remedy in stomatitis with increased secretion, in acute or chronic pharyngitis, and in some cases of nasal catarrh.
A solution of the soluble salts has proven very useful as an injection in the second stage of gonorrhoea, and in gleet. It is an excellent remedy in disease of the cervix uteri, and in cervical metritis, with profuse secretion from the cervical canal. In these cases the application should be thorough. In ulceration of the rectum it will sometimes prove a most efficient remedy.
In the second stage of purulent conjunctivitis a solution of these salts will give good results, and in some cases of chronic conjunctivitis the effect will be beneficial.
The salts of berberine (sulphate or phosphate), as well as the alkaloid itself are very convenient for dispensing, especially when the physician carries his own medicine. One to four grains to a half glass (℥iv) of water makes an excellent bitter, and with three or four drops of tincture of nux vomica, a good peptic. A collyrium or an injection for the purposes named is as readily prepared.
One use of hydrastis is yet to be named. In some cases of cancer with sloughing of tissues, and in malignant ulceration, no application will do more to retard the progress of the disease than an infusion of the crude article or a solution of the alkaloid. It has been claimed that the internal administration of the remedy will prove curative. I am satisfied that in some cases this use of hydrastis will do much to relieve pain and to lengthen life even if it does not prove curative.
THE USES OF HYDRASTIS CANADENSIS IN THE ECLECTIC SCHOOL.—(Written for this publication by Prof. John King, M. D., Professor of Obstetrics and Diseases of Women, in the Eclectic Medical Institute, Cincinnati). While as a general vegetable tonic, hydrastis is inferior to certain other bitter tonics, as, gentian, colombo, etc., it will be found superior to them in the treatment of subacute and chronic inflammation of mucous membranes, upon which it exerts a peculiar tonic and slightly astringent effect, whether taken internally, or applied locally. In the majority of cases, its local application is followed by more prompt and positive action than its internal administration. Whether its power of contracting vessels be owing to a tannic acid, or to a principle similar to that in ergot which causes a like effect, has yet to be determined. [Do not confound this with the yellow alkaloid berberine. (My guess is that the real footnote got lost somewhere between manuscript and printing press. This one properly belongs two spots down -- where it is also found. -Henriette)] Administered internally, it has proved efficacious as a tonic, in enfeebled conditions of the alimentary canal with infants and children; in restoring tone to the intestinal mucous coat after severe attacks of diarrhea, dysentery, and other debilitating maladies; and in removing the indigestion, and restoring the appetite in those cases of indigestion and anorexia of adults due to an abnormal condition of the mucous coat of the stomach. As a local application it has proved valuable in conjunctivitis, in ulcerations of the mouth and fauces, in vaginal and uterine leucorrhea, and in all cases of enfeebled mucous tissues. In the chronic forms of cervical and corporeal endometritis, it has acted with success, being applied in the form of powder, made by evaporation of a decoction of the root, rubbed up with simple cerate or vaseline, and introduced into the uterine cavity by means of a tube made for such a purpose. In combination with other agents, it exerts beneficial influences that can not be had by the employment of either of the articles separately. Thus, a strong decoction of the root, to which has been added one-third or one-fourth its volume of tincture of capsicum forms a successful application to corneal ulcerations, and to all atonic ulcerations of mucous tissues. In ulceration of the bladder, the decoction mixed with an equal volume of decoction of geranium, and injected into the bladder, has effected cures even in cases where all previous treatment had failed. This same decoction has never failed me yet, as a local application in ophthalmia neonatorum. The decoction, employed in combination with decoction of caulophyllum, has been found efficacious in thrush, and aphthae of infants and children. Berberine, or muriate of berberin, does not appear to posses the positive action upon abnormal mucous tissues that is manifested by the root in decoction, fluid extracts, or a powder made by evaporating the decoction to dryness."
The preceding statement was written some four or five months ago, and placed in the hands of Prof. J. U. Lloyd. To my great pleasure and surprise I have just noticed that in the section of Gynaecology in the Congress of naturalists and German physicians, held at Fribourg, in Brigau, Dr. Schatz, of Rostock, invited the attention of his colleagues to the American Hydrastis Canadensis, the therapeutical effects of which rather astonished him. He found this agent efficacious in hemorrhages from myoma, from congestive dysmenorrhea, from subinvolution, also in those attending metritis and endometritis, as well as those occurring at the period of the menopause. He supposes the medicine acts upon the uterine mucous membrane, exciting vascular contractions, through which mechanism it diminishes congestion of the genital organs, thus acting very differently from ergot, the influence of which is exerted upon the uterine muscular tissue. [The balance of this statement as to the form employed, doses, etc., of this medicine, are so nearly similar to those related by Dr. Hale, that we have with Dr. King's consent, omitted them, and refer our readers to the article by Dr. Hale, for further information concerning Dr. Schatz's investigations.—ED.]
REMARKS.—The foregoing independent papers on the therapy of hydrastis and its products, will be of general interest to the medical profession of America. To us, one feature is unexpected, namely, the announcement of Prof. Bartholow that "the alkaloid hydrastine [Do not confound this with the yellow alkaloid berberine.] is the true active principle."
The physiological action of hydrochlorate of hydrastine as demonstrated by Prof. Bartholow is such as to warrant a close clinical study of this salt, which has been heretofore generally neglected. The negative results that followed the investigations of early experimentors, were doubtless owing to the use of the insoluble alkaloid, or impure hydrastine, for the active nature of the salt, as shown by the investigations of Prof. Bartholow, would lead us to infer that the popularity of hydrastis and its pharmaceutical preparations is largely owing to a natural salt of hydrastine, modified, perhaps, by the berberine with which it is intimately associated, rather than the reverse. In the plant, this alkaloid, and berberine exist in the, form of very soluble salts, and the long accepted uses of hydrastis in diseases of mucous surfaces, instead of as a mere tonic, like other berberine yielding plants, would alone indicate that berberine is not the prime factor. Indeed, it has long been known that solutions of berberine were not, in eye diseases of the value of infusion of hydrastis. This has always been accepted by Prof. King. This new light would lead to the opinion that, the estimation of the value of hydrastis by our berberine process was fallacious, and that we should rather estimate the hydrastine of the drug.
Acting, therefore, on the information conveyed by Prof. Bartholow, we placed the hydrochlorate of hydrastine in the hands of several acknowledged authorities of the medical profession, and as a result we are enabled to present the following clinical contributions. It will be noticed that Prof. Sattler, having examined both berberine and hydrastine, also reports that hydrastine is the active agent.
THE PHYSIOLOGICAL EFFECTS AND THERAPEUTIC USES OF BERBERINE AND HYDRASTINE IN OPHTHALMIC AND AURAL PRACTICE.—(Written for this publication by Prof. Robert Sattler, M. D., Ophthalmic Surgeon to the Cincinnati Hospital, etc).—The want of a satisfactory preparation of Hydrastis Canadensis, perfectly soluble and free from the well-known objectionable features of the drug, has until recently prevented its more general and extensive use and application in the management of the various catarrhal affections of the eye and ear.
At the request of Prof. J. U. Lloyd, I commenced a series of observations to test the physiological properties and therapeutic uses of two soluble salts of hydrastis, i. e., diberberine sulphate and hydrochlorate of hydrastine, which he kindly furnished me, in powder form and in one, two and four per cent. solutions.
The investigations were conducted at my clinic and the records of the progress and results of the cases in which either remedy was resorted to, were carefully compiled by the clinical assistants, Drs. C. H. Castle and C. R. Holmes.
BERBERINE DISULPHATE.—Physiological Action.—Observations were begun with the berberine solutions. Two or three drops of a two per cent. solution dropped into the conjunctival sac caused slight irritation and injection of the palpebral and ocular conjunctiva. The objective and subjective disturbance, however, subsided quickly.
A four per cent. solution excited greater local irritation, more profuse flow of tears and mucous and also more pronounced subjective discomfort. The duration, however, of these symptoms was brief.
Therapeutic Application of Berberine.—To test its efficacy to relieve or modify catarrhal alterations of the conjunctiva (conjunctivitis simplex, acute catarrhal conjunctivitis, etc.), two and four per cent. solutions were resorted to, but in every case the results were negative, or at least, unattended by appreciable good effects, even after prolonged and systematic use.
The principal objection to the disulphate of berberine solution was, not so much the discomfort and irritation it induced, but principally on account of the deep staining (yellow) of the adjacent parts.
The hyperaemia of the conjunctiva, produced by the instillation was too transitory and was not effectual in modifying, after repeated trials, the local symptoms; or in bringing about relief from the scratching and burning sensations produced by the disease. Owing to almost uniformly negative results, additional observations were not made.
If the use of the berberine solutions proved of little or no value in the treatment of catarrhal affections of the eye, the use of both strong solutions and the powder in substance proved absolutely ineffectual when resorted to for the purpose of modifying or arresting catarrhal or purulent discharges from the middle ear.
In the following cases it was applied,-a four per cent. solution dropped into the ear twice a day, after syringing and the insufflation of the powder was resorted to once a day.
Case 1. R. H. aet 4. Acute catarrhal otitis media, perforation of membrana tympani, slight discharge. Applied powder and solutions Nov, 2, 3, 4, and 5. The discharge became very profuse during this time, the powder incrustated and caused pain and suffering. Nov. 6, discontinued berberine, and used powdered boric acid, and discharge stopped in two days.
Case II. K. F. aet 16. Chronic otitis media purulenta. First application Oct. 15, continued until Oct, 28. No change of symptoms. Oct. 29, complained of pain in the ear, discharge more profuse. In spite of great care in the introduction of the powder, and the daily cleansing, it underwent incrustation.
Case III. G. B. aet 13, Chronic purulent otitis media. Oct. 26, First application, continued until Nov. 7. No favorable change, incrustation also troublesome.
Case IV. Subacute purulent otitis media. First application Oct. 24. Continued to Nov. 7. In this case there occurred considerable improvement. Incrustation also troublesome.
Case V. Chronic otitis media purulent, was tried for ten days. symptoms became worse.
In a number of other cases the remedy was used, but after several days was abandoned, for the reason that no improvement or change occurred to warrant its continuance.
When resorted to in solution, coagulation or precipitation occurred at once but no pain attended its use. The principal objection to its use in this locality, and this applies particularly to the powder, is, that rapid incrustation, due to chemical transformation from contact with the discharge occurs. The staining of the parts also constituted an objectionable feature. The removal of the incrustated masses from the external canal became necessary, on account of discomfort and pain produced. In some of the cases the removal was tedious, difficult and painful.
HYDRASTINE.—The Physiological Action and Effects of Instillations of Hydrochlorate of Hydrastine.—Two or three drops of a two per cent. solution dropped into the conjunctival sac of a healthy eye, causes at once active stimulation of the palpebral and ocular divisions, attended by the usual reflex symptoms-lachrymation, blepharo-spasm, and a pungent and burning pain, which, however, is of short duration, rarely lasting longer than two or three minutes. With the subsidence of the pain, more or less moisture of the eye remains, and a watery mucus secretion often accumulates at the outer and inner canthus. After the expiration of one hour, all evidences of the instillation have disappeared.
A four per cent. solution causes more marked subjective discomfort, more active and persistent hyperaemia of the conjunctival area, more pronounced reflex symptoms, together with increased stimulation of the secretory apparatus. Stronger solutions cause an intensification of all these symptoms, and in addition, probably in consequence of the irritation to the sensory nerves of the cornea, contraction of the pupil. The myosis is most probably the immediate result of the irritation of the superficial sensory nerves of the globe, and is not due to a direct action upon the sensory and muscular structures of the iris.
Cold applications to the lids modify greatly the local symptoms, and also the discomfort attending instillations of weaker solutions; and the application of stronger solutions is greatly mitigated by immediate washing off the conjunctival surfaces with camels hair brush and tepid water. The inferences from a number of trials establishes that in mild solutions, hydrochlorate of hydrastine is a tonic and stimulant to the conjunctiva, increasing for the time being, its functional activity. It can also be inferred that the remedy exerts its beneficial effects, by its action in arousing and stimulating the functional activity of the complex glandular structures, by the active hyperaemia produced by its instillation. This was corroborated by numerous trials in those cases, in which the remedy was resorted to in variable strength of solution, to accomplish such effects, in diseased states of the conjunctiva, which the instillation into the normal eye rendered probable. It appeared therefore of probable value in those pathological processes of the mucous membrane attended by more or less pronounced passive congestion, relaxation of structure, and altered or suspended functional activity of its glandular apparatus.
In all catarrhal forms of conjunctivitis and in the first or catarrhal stage of more serious lesions, one and two per cent. solutions exerted a beneficial influence on the local symptoms. The secretions appeared less acrid and were reduced in quantity and perhaps altered also in composition; particularly was this observed, if in addition to frequent instillations of weaker solution, an application of a stronger solution five per cent. was made once a day to the conjunctival surfaces of the everted lids, by the aid of a camel's hair brush and the surfaces immediately washed off with water.
In follicular conjunctivitis, an affection quite common among anemic and scrofulous children, and also among adults living amidst unfavorable hygienic surroundings, it was found to possess decided advantages over the customary astringents and local stimulants ordinarily resorted to. The disease is eminently chronic and contagious. In many cases it exists in a latent form and gives rise to little annoyance, or the discomfort is ignored by the patients, until vision is interfered with by the accumulation of mucus and irritation of the lid borders, due to the acrid or irritating character of the discharges. Often it appears in an endemic form in certain localities, and in other instances it affects all the members of one or more families. Lack of cleanliness on the part of the person or persons affected, and the careless use of towels and handkerchiefs by the other members of the family constitute the principal channels of contagion. On account of its chronic course and the general or frequent vitiated state of the constitution of persons affected, it is a most troublesome affection to manage. The use of hydrochlorate of hydrastine solutions in this annoying affection has been particularly satisfactory, and local and subjective symptoms have been effectually modified and the course of this always tedious affection, has been altered and shortened. Compared with other remedies, the subjective discomfort attending its use was less annoying and subsided more rapidly, and the improvement was more lasting.
Therapeutic Application of Hydrochlorate of Hydrastine.—Bearing in mind its local action when instilled into the healthy eye, it was resorted to in a large number of cases in which this action would appear desirable in order to promote, modify, or arrest those local symptoms, which are the common and frequent attendants of acute, subacute and chronic catarrhal, follicular, granular, blennorrhoeral, etc., inflammations of the conjunctiva.
In the treatment of chronic catarrhal conjunctivitis, and particularly that variety known as conjunctivitis siccus, it was found of great service. This affection is eminently tedious and annoying, to both physician and patient. Among the most distressing symptoms, is a sensation of dryness and scratching, attended by a feeling of weight and heaviness of the upper lids. A perceptible reduction in the quantity, and also an alteration of the quality of the secretions of the conjunctiva can be observed. In the majority of instances anaemia, physical exhaustion, or other disturbances which depress the general health, are present, and to the local and general symptoms are added, failure of the accommodative power of the eyes and most annoying asthenopic symptoms. In those cases in which an optical error of the eyes co-exists, these symptoms appear in a most pronounced form and defy or effectually prevent all application of the eyes for close work. In the management of this variety of conjunctivitis, ordinarily so troublesome and tedious, hydrochlorate of hydrastine, in 1 and 2 per cent. and even stronger solutions, was found of particular advantage. The favorable influence exerted upon the progress of the disease, and also in modifying the annoying subjective symptoms, was probably assignable to the quick and decided stimulation of the vascular and secretory apparatus of the conjunctiva.
In chronic granular conjunctivitis, it was also found of benefit. In a large number of cases it was resorted to systematically during the second or stage of granular infiltration. In these cases daily applications of a stronger solution (5 per cent.) were made to the everted surfaces of the conjunctiva and immediately washed off with water. Both the use of weak collyria and the topical application of a stronger solution exerted a beneficial local and subjective influence, and effectually modified the protracted course of this most troublesome and chronic affection. In the transition or third stage of the disease, weaker solutions were used, and occasionally an application of a stronger solution. In the treatment of this extremely chronic and intractable affection it was not found to possess advantages over the customary remedies resorted to, and in several cases its use had to be discontinued, on account of the severe reaction and suffering which followed the application. In blepharitis marginalis it was applied in solution (2 per cent.) to the eroded and ulcerated margin of the lid. These cases progressed favorably and the improvement was assignable without doubt to the local stimulating effect of the remedy.
Reviewing briefly the advantages of this remedy in the management of the various diseases of the conjunctiva and its value as a therapeutic agent, it can be stated, that it is of principal advantage in catarrhal conjunctivitis, and especially in the chronic forms. It is of particular benefit in follicular conjunctivitis, and also an efficient remedy in granular conjunctivitis, blepharitis marginalis, etc. It appears to exert its specific local effect by exciting a temporary more or less pronounced hyperaemia of the conjunctiva, and, in consequence, active stimulation of its vascular and secretory structures. The action of hydrochlorate of hydrastine is prompt and decided. In weak solutions it is a tonic to the mucous membrane; in stronger solutions a more or less pronounced irritant effect is added, and in still stronger solutions it is a powerful irritant. As a choice of remedy, it deserves attention and preference, in all the various affections of the conjunctiva attended by a disturbance of its functional activity, due to an acute, sub-acute or chronic process of inflammation. On account of its active stimulant properties, it modifies and aids in correcting the secretions and relieves in this way the annoying symptoms and almost invariable concomitants of catarrhal inflammations. It is, therefore, a valuable tonic, stimulant or irritant to the mucous membrane. In those cases where the remedy has not been the first choice it may prove a valuable substitute for other astringents or stimulants, which may have been unsuccessfully resorted to. In other cases it will prove a serviceable agent, occasionally resorted to in conjunction with other remedies.
Hydrochlorate of hydrastine is contra-indicated in all affections of the cornea or iris, either primary or occurring as complications in connection with or the result of conjunctivitis. It is also of no value, and, therefore, contra-indicated in all deep-seated affections of the eye. It is primarily and principally a tonic, stimulant or irritant to the mucous lining of the lids or conjunctiva, and its scope and efficiency of action is limited to functional or structural alterations of this important membrane.
In the car, the use of solutions of hydrochlorate of hydrastine was also resorted to, but the number of observations was more limited. It was used, to modify or arrest irritating catarrhal and purulent discharges from the external auditory meatus, and its use was attended and followed by the same good, and in some instances even better results, than after instillations of the customary mineral astringents, or iodoform, boric acid, etc. In two cases of acute and five of chronic purulent otitis media the results were carefully noted. After thoroughly syringing the external auditory canal and middle ear, inflation by Politzer's method was practiced. This accomplished, the bottom of the meatus and those parts of the middle car which were accessible through the perforation of the membrana tympani were carefully cleansed and dried, by means of absorbent cotton attached to a holder, and the powder applied to the eroded and exhuberant mucous membrane. (In three out of the five cases this was an easy task, as the membrana tympani had been almost completely destroyed.) The results of systematic applications in these chronic cases were certainly favorable; in two of the five cases a marked reduction in the quantity and quality of the discharge occurred. All the cases had been under treatment and hydrochlorate of hydrastine solutions were substituted. All were apparently benefited; the discharge was reduced in quantity and lost its irritant and offensive characteristics. It can safely be said, that in many cases, carefully selected, the remedy is of advantage and deserves a trial either as a substitute or as a first choice. In several cases of granulations and polypoid formations, the result of otitis media purulenta, it was applied in substance, and, although it caused severe pain, it effected by systematic application a disappearance of the exhuberant growths.
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Drugs and Medicines of North America, 1884-1887, was written by John Uri Lloyd and Curtis G. Lloyd.