By GEORGE WILLIAM WINTERBURN, PH. D., M. D.
Of Sanguinaria, to which I invite your attention to-day, it may well be said that it is one of the most important remedies in our Materia Medica. Its common name is blood-root.
The poppy-worts (Papaveraceae), to which blood-root belongs, are a singular, as well as a notable family. The fifteen genera composing it are characterised by active narcotic properties, principally resident in a turbid juice; but this juice varies in appearance in the different members of the family. In Sanguinaria it is red; in Chelidonium, yellow; in poppy, white; and, in Eschscholtzia, transparent (The juice of Eschscholzia looks extremely orange to me. -Henriette). The same thread of analogy runs through their therapeutic natures, alike yet different.
Sanguinaria, from the Latin sanguis, signifying blood, is a curious little plant, springing stemless from a tuberous root, in a series of large sea-green, smooth-surfaced leaves, and bearing in early Spring a handsome, white, eight-petalled but odorless flower. This rhizoma is especially rich in the acrid, blood-like juice which pervades the entire plant; and is the part used in medicine. When fresh it is exceedingly acrid to touch, taste and smell, but rapidly loses this quality by exposure to the air. The official preparations are an infusion, a fluid-extract, a tincture, and a vinegar; and to be reliable should be made from the green root.
Sanguinaria grows in all parts of the United States, rejoicing in rich soils, and in umbrageous retreats, and presenting a very elegant appearance from March to June. Its chemical constituents are sanguinarina, an active alkaline principle, with the formula C37H64N4O8; porphyroxin; puccine; chelidonic acid; an orange-colored resin; and a yellowish fixed oil. Sanguinarina exists in the root in the form of a salt, the chelidonate of sanguinarina. It is in minute garnet-colored crystals, with shining facets, like a precious stone. Parphyroxin is found in tabular crystals, resembling that discovered in opium. The resin is analogous to amber in appearance. Chelidonic acid is found also in guaiacum and chelidonium.
The action of Sanguinaria depends largely on the size of the dose. Unlike many other drugs, Chamomilla for instance, whose influence lies always along the same plane and is only intensified by increasing the dose, Sanguinaria alters its mode of action, in quality as well as degree, when given in varying doses. In small physiological doses it stimulates the action of the heart; in large doses it is a potent cardiac sedative; in small doses it is a gastric tonic, in large, it causes distressing gastralgia and severe emesis; in small doses it energises the respiratory centre and causes an increase in the number of respiratory movements, in large it paralyses the same, prolongs the pause after respiration, and consequently slows the movement; in small doses it induces a hopeful, sanguine state of mind, and in large, lethargy and narcosis.
When the dose is very large death follows quickly, from paralysis of respiration, preceded by intense gastric symptoms. ("Four men who had been employed to clean out and whitewash the apothecary shop of Bellevue Hospital found a demijohn containing what they thought to be brandy or some other spirit, and they each took a good drink of it. They were all soon seized with severe racking and burning pains in the stomach and bowels, with intense thirst. They all died."—MITCHELL)
Such large doses do not cause vomiting. In doses of fifteen or twenty grains of the powdered root very free emesis takes place, followed by alarming prostration.
It has a marked influence upon the respiratory mucous membrane. In doses of less than a grain it is simply a mild expectorant; increasing the dose causes bronchial irritation, with loose, rattling cough and rather profuse expectoration. A still larger dose causes bronchial congestion with harsh, spasmodic cough, and scanty, tenacious sputa. Pushed still further we have stridulous breathing and sighing respiration.
The sensation excited is one of heat, followed at last by intense burning If the doses be moderate and repeated at intervals the person suffers from paroyxsmal cramps in the abdomen, wandering from place to place, increased by pressure or outward applications, and relieved by walking about. These severe pains are accompanied with vertigo, and followed by diarrhea. The stools are watery, undigested, and are evacuated with a great quantity of offensive flatus.
Sanguinaria has considerable effect on the female generative organs, causing abortion in the pregnant, and congestion in the unimpregnated uterus. The menses are too early, too profuse, and consist of very dark blood. The breasts also are swollen and sore to the touch. Pain, stiffness, and soreness is felt in various parts of the body, probably caused by the hepatic disturbance induced by the drug.
Dr. Rutherford has shown that Sanguinaria is a powerful biliary stimulant, increasing both the solid and watery constituents of the bile.
Its action upon the salivary glands is analogous, causing copious salivation. In continuous doses it causes great irregularity of the heart's action, with stitching pains in the cardiac region. It eventually paralyses the heart if artificial respiration be maintained; in this resembling Veratrum. Pulse and blood-pressure fall together, although just at first there may be a rise of the latter. In physiological doses Sanguinaria always lowers the temperature.
Sanguinaria is one of the most powerful drugs in our pharmacopoeia, and deserves the most minute study. It has a therapeutic relation to the skin and mucous membrane; to the digestive, generative, and respiratory organs; to glandular structures; to the cerebro-spinal system; and to muscular tissue.
I. The action of blood-root upon the skin is limited but peculiar. Applied in the form of the powdered root or acetum to fungous growths, fleshy excrescencies, or warts, it is escharotic. An ounce of the tincture in a pint of hot water makes a stimulating wash for old, indolent ulcers, with hard unhealthy-looking edges, and exuding dirty, sanious, or watery pus. Given internally Sanguinaria is useful in eruptions caused by amenorrhea; and in psoriasis and pityriasis, and other scaly eruptions; and in carbuncles. In the diseases of internal organs in which Sanguinaria is most useful the skin is apt to be dry and feverish, and the gastric disorders are often associated with pruritus and nettle-rash. Sanguinaria antidotes the eruption caused by Rhus venenata and toxicodendron. It is an excellent diaphoretic administered in small doses well diffused in a cup of hot water. In scarlatina it has been used advantageously by Dr. Coe and others, but I give you no special indications for it. It is said to have cured cases after belladonna had failed. In none of these conditions have I had any personal experience with it.
II. In catarrhal affections of the eye, Sanguinaria is a remedy of moderate importance. It has proved useful as a collyrium in ophthalmia tarsi, in conjunctivitis, in catarrhal inflammation associated with coryza, and in ulceration of the cornea.
The case which I now show you of inflammation of the eyelid is illustrative of its use in the first of these conditions. This little girl, eighteen months old, has suffered from inflamed lids for several months. The origin of the condition was probably a cold, and its present severity is undoubtedly the result of lack of cleanliness. The whole margin of the upper lid is hardened and the lashes have to a large extent fallen out. There is enough exudation to gum the lids together in the morning, but hardly sufficient inflammation to cause any serious damage to the eyes. As to treatment the eyes must be washed carefully with warm milk twice a day, after which they will be wet with this lotion of Sanguinaria, containing ten drops of the tincture to half an ounce of rosewater. The child will also be given internally the one-hundredth of a grain every six hours. (This case was cured in two weeks.) I have treated similar cases at the hospital by spraying the lotion over the eyes two or three times a day.
The following case of croupous conjunctivitis is interesting: A. S. B., a little boy aged six years, was seized with inflammation of the eyes in March, 1879. The lids became very edematous, and on the palpebral conjunctiva were found small patches of membrane, loosely attached, but tenacious if effort was made to loosen them. There was severe supraorbital pain, considerable fever, and great irritability. The same treatment was given as in the previous case, but great care was taken in using a syringe to bring the lotion in direct contact with all portions of the inner palpebral surface. If the lotion is too strong the inflammation will be greatly increased. This case was cured in six days.
In cases where coryzal colds extend to the eye, and cause profuse lachrymation, I have in three instances seen Sanguinaria remove the whole trouble.
It has likewise proved beneficial in the catarrhal disorders of the ears, especially when affecting the Eustachian tube.
Sanguinaria has an important influence on the nasal mucous membrane. I have seen it cure a number of fluent coryzas. It seems to act best in cases which affect particularly the right nostril and are accompanied by much sneezing. Such cases often yield quickly to inhalation through the nose of the dust arising from shaking a small quantity of sanguinarin in a bottle; the inhalation to be repeated at intervals of three or four hours.
Periodic coryzas of all sorts, from nose-cold to autumnal catarrh, if possessing the characteristic conditions for Sanguinaria, will be cured by it. These are copious, acrid, burning, watery discharge from the nose, causing an indescribable rawness of the schneiderian membrane, with loss of sense of smell, frequent sneezing, all the symptoms worse on the right side. If the conjunctiva be similarly affected, or if intestinal disorders alternate with the nasal symptoms, Sanguinaria is specifically denoted.
Non-syphilitic ozoena will often yield readily to Sanguinaria. In these cases it is always necessary to cleanse the nose thoroughly at least once a day, in order that the medicine may come in direct contact with the ulcerated tissue. When possible to command the regular attendance of the patient, I prefer to apply the medicine personally, by means of a spray-producer.
Nasal polypi are either hyperplasiae of the mucous lining (mucous polypi), or a proliferation of connective tissue (fibrous polypi), or a growth of a jelly-like substance (gelatinous polypi); and they occur in frequency in the order named. In the first and last varieties Sanguinaria is an excellent remedy, especially in the former. The freshly powdered root, or sanguinarin, may be used as a snuff, several times a day; but I much prefer the nitrate of sanguinaria. This substance is too pungent if used in full strength; and it should be thoroughly triturated with nine parts of granulated sugar. Even then it is apt to cause unpleasant burning in the nostrils. The following case nicely shows its usefulness:
Miss M. R. B., aged nineteen, a healthy, apple-cheeked, English girl, had been troubled with an uncomfortable feeling in her nose for more than a year. There was at all times a sense of fullness in the right nostril, but in damp weather it seemed completely occluded. An examination showed a mucous polypus adherent to the septal membrane, nearly filling the arch of the passage, and hanging downward into the posterior nares. The internal administration of Teucrium and the iodide of lime produced no apparent effect. She was then given an ounce of the nitrate of sanguinaria, first decimal trituration, in a two-ounce bottle, with orders to shake the bottle and snuff the dust thoroughly up the right nostril, every three hours. The effect was slow, but in the end most gratifying. In two months the polypus had entirely disappeared, and the nasal membrane was healthy and has remained so.
I have never had a case of polypus in the ear to treat but in the mucous variety I should certainly begin with the nitrate of sanguinaria. There is no question that this remedy not only removes the growth but cures the tendency (dyscrasia) that produced it. How much better this is than rudely tearing the tumor off, by means of forceps, leaving a lacerated and diseased membrane as the basis for a new growth. Better certainly for the patient; although the physician will not receive so much praise from the patient's friends for skillful therapeutics as the surgeon would for dextrous manipulation. There may be even doubts whether there was any polypus, unless it can be shown in a little bottle.
It may be merely a curious coincidence, but I have never been able to cure polypi in the left nostril with Sanguinaria. There is a peculiar right-sidedness running through the pathogenesis of this remedy and its analogue, Chelidonium. Both affect the right side of the head, the right nostril, the right lung, the liver, the muscles on the right side of the back, and the right heart.
In diseases of the buccal cavity you will occasionally have use for Sanguinaria. Epulis, from its analogy to polypus, will be easily remembered in this connection. That simple but annoying trouble, gum-boil, when not caused by caries is controlled by this remedy; as is also general inflammation of the gums (gingivitis), when they become swollen and spongy, bleed easily. Toothache, when the pain is aggravated by cold drinks and mitigated by warm, may be relieved by this remedy. In all these conditions I use the first decimal trituration of the nitrate of sanguinaria, varying the dose from a grain in an ounce of rose-water, used as a gargle or taken internally, up to insufflations of the dry powder directly on the diseased surface, pro re nata.
Passing back to the softer tissues of the pharyngeal cavity we meet a similar ulcerative condition, which yields to the same treatment. I shall reserve what I have to say in regard to the tonsils until I come to speak of the action of Sanguinaria on glandular structures, confining my present remarks to its influence on mucous congestion and diphtheria.
The ordinary idiopathic catarrhal sore-throat, involving frequently the entire mucous membrane of the pharyngeal cavity, is without doubt often mistakenly diagnosticated as diphtheria, on account of the tough whiteish exudation that sometimes appears on various parts of the fauces, especially about the tonsils. Even epidemics of simple sore-throat occur, and these are still more likely to confound the inexperienced or careless physician; but the fact that these cases are not followed by paresis and albuminuria is a sufficient index of their true character. There are many remedies for this condition, and among them Sanguinaria. This remedy is specifically indicated when the throat feels as if it had been scalded by drinking something hot. The throat is dry and tense; the dryness is unrelieved by drinking, and the tension causes a sensation as if the throat was about to split. Drawing cool air over the heated membrane (breathing with the mouth open) gives the patient great satisfaction. These disagreeable feelings are all worse on the right side. In cases of this sort I have seen a mild gargle of sanguinarin, one grain to the ounce, rapidly disperse all the uncomfortable sensations.
Follicular sore-throat, the form so common among clergymen and others who use the voice unduly, is more frequently a pharyngeal than a laryngeal complaint, although old cases are apt to involve both organs in a common misery, no matter which was the seat of the original lesion. Although by no means so frequently called for as some other remedies, Sanguinaria will cure this condition when the membrane is red and shining, and the burning pain seems to extend backward and downward from the pharynx into the stomach. The presence of the symptoms indicated just now when speaking of ordinary sore throat will also confirm the propriety of using it in this instance. If possible I like to apply it by means of a spray-producer, and I have a particular preference for the nitrate of sanguinaria, rather than sanguinarin; although either will answer.
Chronic catarrh of the throat is apt to run on to ulceration if neglected; but all ulcerations of the throat are by no means catarrhal. Speaking generally, we meet three forms of chronic ulceration of the throat: the superficial catarrhal ulcer, the deep, flabby, scrofulous ulcer, and the well-defined syphilitic ulcer with elevated, serpiginous edges. Baptisia, Hydrastis, Stillingia, and Sanguinaria cover, I think, all the variety of condition likely to occur. The general symptoms of the patient will determine the adaptability of either in any given case. The following case of the catarrhal form shows the action of Sanguinaria and the symptoms indicating it:
Miss S. M. A., aged twenty-seven, a school-teacher, had been troubled with catarrhal pharyngitis for some years. Her throat, when she applied for treatment, contained six or seven superficial ulcers, the largest about the size of a silver five-cent piece. She complained of great dryness in the throat, which was actual and not merely sensational, as the tissues were brighter in color than natural and glistening. Although she was not thirsty, nevertheless the burning feeling made her desire to drink frequently; hot drinks relieved the sensation for a few minutes, but cold water intensified it. The tongue also felt as if burnt, and was covered with a whitish slime. She remembered that at first the throat had been sore only on the right side; and now the majority of the ulcers were on that side of the median line. She was subject to periodic sick-headaches, which always began in the nape of the neck, extended over the head, and finally settled in the frontal sinuses. I gave her a mild lotion of nitrate of sanguinaria with which to gargle her throat; and some powders containing the one-hundredth of a grain of sanguinarin, of which she took two each day. The medicine not only cured her sore-throat but her headaches also.
I do not think that Sanguinaria is ever indicated in malignant diphtheria; but in some of the milder forms it will, like Phytolacca, prove to be the true remedy. The subjective symptoms have been already stated; the diphtheritic membrane is semi-translucent and grayish.
III. In acute gastritis Sanguinaria is likely to do harm if given in appreciable doses. Dr. Coe says:
"The sanguinarin possesses a considerable degree of escharotic power, hence its use is contra-indicated in gastritis and enteritis, and whenever we have occasion to suspect abrasion or ulceration of the mucous surfaces of the stomach or bowels."
The "use" here meant is the eighth to a half-grain every three or four hours; but thoroughly triturated, and given in minute doses, (that is, in the third decimal trituration), I have learned to depend upon it in certain acute stomach-troubles. The burning epigastric pain, aggravated by taking food, unrelieved by vomiting, and increased by pressure; the unquenchable thirst, with longing for piquant articles of food; and the great prostration of acute gastritis, call unmistakably for Sanguinaria. The following case presents the condition for which I prescribe this remedy:
Mr. R. H., aged forty-seven, a prosperous provision dealer, was taken ill in June, 1878, after drinking a large quantity of iced milk. The symptoms were first slight rigors, followed by a feeling of heat and depression. He lost his appetite, became apathetic, neglected his business, but not being used to being sick hardly realised that he was so, and did not send for a physician. Matters had gone on in this way for nine or ten days when I first saw him. He then complained of an acute burning pain in his stomach, as if that organ was on fire. Vomiting was frequent; preceded by intense nausea and followed by great exhaustion. After vomiting he craved food, but eating the slightest quantity increased the burning distress in the epigastrium. His thirst was prodigious, and it was only by the most constant watchfulness that he was prevented from drinking enormous quantities of water. He had considerable vertigo, worse when stooping or lying down. He was very irritable and objected to the slightest noise; even his children talking in the next room made him very angry. His face was pale; lips dry; tongue very red, especially at the tip, and felt as if burned by drinking some hot liquor; breath foul; bowels constipated; urine normal; pulse eighty-five; temperature 100° F. He was given Sanguinaria, third decimal trituration, two grains every three hours, and in four days he was quite well; appetite, digestion and bowels all normal.
In that common form of indigestion which proceeds from a deficient secretion of gastric juice, (gasterasthenia) and consists of loss of appetite, heartburn, and periodic vomiting, Sanguinaria is a most efficient remedy.
"When the food undergoes chemical decomposition, and gas is evolved in large quantities, Sanguinaria will generally change the action of the stomach, and digestion becomes more complete. When the mucous membrane is congested, the flatus formed by fermentation is retained by a spasmodic constriction of the cardia. Its irritation is reflected upon the lungs, through the pneumogastric nerve, exciting a feeling of tickling in the entrance of the trachea, with sympathetic cough. This peculiar, dry cough does not yield to expectorants, but often persists for hours, and is only relieved by eructations. Aromatics and stimulants fail to expel the gas; they only increase the erethism of the coats of the stomach. The Sanguinaria affords a better resource. It not only relaxes the constricted cardia, permitting the flatus to escape, but excites a healthy reaction on the whole surface of the fauces, esophagus and stomach, superseding the morbid state of a healthy one."—HUNT.
In this condition, where so many physicians resort to pepsin preparations, I find Sanguinaria almost specific, and use it with increasing confidence and pleasure year by year.
Chronic catarrh of the stomach, otherwise known as chronic gastritis, and cramps of the stomach (gastrodynia), especially when these occur at stated intervals, and other gastroses, are often cured by Sanguinaria, when the subjective symptoms resemble those already denoted; but I have never had any success with it in simple vomiting, the wine of ipecac, or the tincture of nux vomica, or the fluid extract of Cocculus palmatus generally succeeding when it fails.
The following case was diagnosed by several physicians as ulcus ventriculi perforans rotundum chronicum, (round perforating ulcer of the stomach) before it came under my observation. I believed it to be the same, but as he is now cured, only a necropsy will ever reveal what was the matter. M. J. T., aged thirty-four, a paper-hanger by trade, applied at Manhattan Hospital for treatment, in January, 1882, for relief from the following condition: He had suffered for more than a year from burning pains in the epigastrium. These were worse when lying on the right side, or even if when sitting he leaned toward that side. In fact they had become unendurable. Pressure on the stomach always mitigated them, although it never entirely relieved him. Although these pains were always spoken of as being in the pyloric region, yet they were also apparently in some way connected with the spine. Eating partially relieved the distress, although it was frequently followed by vomiting. The vomited matters consisted of soured ingesta, slimy mucus, and at intervals of dark, decomposed blood, and were generally ejected without much muscular effort. His appetite was good; in fact he ate too much, and many things that did not agree with him. He had a great relish for milk, but could not digest it. His bowels were usually constipated, although occasionally he would have a diarrhetic stool, the nature of which I did not learn. He had lost much flesh; his spirits were depressed; his face was sallow and sunken; his tongue was clean, but of too bright a color; respiration was rather rapid; pulse eighty; and temperature (evening) 99 7/10 °F.; his general appearance resembled marasmus. As though to make the diagnosis of ulcer of the stomach more probable, the history of the case showed that previous to the appearance of these symptoms he had been badly burned, on the arms, face and chest, by the firing of some alcohol which he was using. Sanguinaria, third decimal trituration, slightly aggravated some of the symptoms and partially relieved others from the first. Its steady use proved the prescription a good one, and he was discharged cured in about two months.
Pyrosis, when occurring as a solitary symptom, will generally yield to small doses of sanguinarin, although it in some cases merely proves palliative, arresting a paroxysm, but not preventing a recurrence of the trouble.
I have never used it in constipation, although Coe recommends it. It would seem to be indicated in that form of rectal inertia, for which nux vomica is so valuable a remedy: where there is a feeling of pressure upon the sphincters, with continual urging, but inability to evacuate anything except offensive flatus.
In cases where constipation alternates with diarrhea, and is associated with bronchial difficulties, Sanguinaria is useful, and will generally remove the whole train of symptoms. The following peculiar case is so suggestive of Sanguinaria, and was so admirably covered by it, that I give it here. J. Q. S., aged twenty-three years, had suffered all the spring months with a peculiar catarrhal attack. The coryzal flow was very acrid and excoriating; causing violent sneezing. At that time the bowels were constipated, with noisy rumbling of incarcerated flatus. After about two weeks diarrhea suddenly set in, the coryzal symptoms disappearing as suddenly. The stools were thin, hot, foetid, and accompanied by much wind. There was considerable pain before stool, and a sense of weakness after stool. This lasted three or four days, when the bowels became constipated (possibly through some cholera drops that he had taken), and in a few days the coryza was again in full blast. These alternations occurred several times during the months of April and May, and when I saw him in June (1881). he was greatly prostrated. I gave at first nitrate of silver. The diarrhoea stopped, as it had before, and in a few days the coryza again set in. The peculiar discharge suggested sanguinarin to my mind, and I prescribed it in the one-hundredth grain-doses, every six hours. In a few days the coryza disappeared and was not followed by diarrhea. The patient was well and remained so.
IV. Sanguinaria is said to have been used in seminal emissions caused by indigestion, and accompanied by much irritability, and in old chronic gleets associated with great prostration and despondency. I hardly think it has any direct action here, and if useful at all, it must be in those cases that depend for their continuance upon gastro-hepatic disorders. In secondary syphilis it probably has a wider application, but I know of no special indication for it, and am inclined to believe that it is far inferior to Podophyllum and Stillingia.
Amenorrhea, either partial or complete, occurring in women suffering from pulmonary disease, may be treated successfully with this remedy. It should be given for some days previous to the expected period, and may be used continuously if the pulmonary symptoms are active. I have seen it act promptly in one-tenth grain-doses, three or four times a day; and this dose is too large if it cause nausea or burning in the stomach.
In that distressing condition of the uterus when gas is generated within it (physometra) and discharged through the vagina, Sanguinaria can be used successfully. A case of this kind where the woman through timidity had failed to secure treatment, and the trouble had lasted for more than a year, was cured permanently, in a few days, by Sanguinaria in one-hundredth grain-doses.
It is useful in dysmenorrhea, with congestion to the head and lungs, especially at the climacteric, or when the menstrual flow beginning natural in appearance becomes later dark, clotted and very offensive.
What I have said in regard to polypi in the nose is applicable to these growths in the uterus or vagina. The remedy must be brought directly in contact with the polypus, and this is best done with the dry powder if possible. It reaches ulceration here, also, as in the pharynx, and may be applied in the same manner. A mild wash is useful in corrosive and fetid leucorrhoea.
Dr. Coe says that few remedies exercise a more decided influence upon the urinary apparatus, upon which it displays its peculiar power as an alterative. In obstinate gravelly affections, and in functional inactivity of the kidneys it is very serviceable. I have never used Sanguinaria in any form of urinary disorder.
V. We come now to the most important sphere of Sanguinaria. In the second and third stages of pneumonia Sanguinaria is our best remedy. You will remember what I said in regard to the use of Veratrum viride in the first or inflammatory period of this disease. When Veratrum has for any reason failed to abort the disease during the first stage, or if you have been called to the case too late to make its use desirable, and the dullness or percussion, bronchial respiration, extreme dyspnea, rust-colored, tenacious sputa, indicate the presence of hepatisation, then Sanguinaria may be used to great advantage. Even when the symptoms point to purulent infiltration of the pulmonary parenchyma Sanguinaria will do good, although here Eucalyputus is usually a far better remedy.
Sanguinaria has helped me so many times in this serious sickness that I hardly know which case to select as illustrative. Perhaps this one will do as well as another: J. McC., aged forty-five years, a laboring man, had taken a severe cold which settled on his lungs. He had neglected treatment, and had been ill an entire week when I first saw him. He was lying propped up in bed, being unable to breathe in a recumbent position. The cough was not very severe, nor very painful, but he had an agonising feeling of lightness and immobility over the entire right side of the thorax. The sputa had been rust-colored and thick, but were now becoming thinner, more easily expectorated, and of the well-known prune-juice tint. The features were sunken and pallid, and the forehead covered with a cold, dewy perspiration. The stomach was much disturbed, with frequent nausea, but no vomiting; bowels constipated. The temperature was not high, 103 2/10 °F. I gave him sanguinarin in the one-hundredth grain-doses every two hours. The only change the first day was a slight decrease in the dyspnea and relief from nausea; but on the second day the signs of improvement were various and satisfactory. The sputa became thicker, and of a yellowish tinge; he could lie down without much discomfort, and the bowels moved naturally. The improvement continued steadily, and in ten days he was completely convalescent.
Dr. Morrow and others speak of it very highly in hemoptysis, and it will often cure cases that have resisted other means. It is not, however, an important antihemorrhagic remedy.
That it will cure incipient phthisis pulmonalis there is a very general consensus of practical testimony. In persons of languid circulation, troubled with cold extremities, who are sensitive to atmospheric changes, whose skin is pallid, and who have a tickling cough, Sanguinaria in one-tenth grain-doses will often work wonders. The cough is more in the evening and on lying down; it sounds loose, but the secretion of mucus is expectorated with great difficulty. The sputum is offensive to the taste, and seems to come from the right side of the chest. If there is any pain it is in the right side, or in the right shoulder. There is considerable gastric disturbance, with belching of acrid flatus. He feels great lassitude, especially toward evening, and there is a hectic condition, with flashes of heat, and circumscribed redness of the cheeks.
In those chronic coughs in which it is well-nigh impossible to determine whether we are dealing with a chronic bronchitis or an incipient tuberculosis, Sanguinaria, in one-twentieth grain-doses, three times a day, will often prove curative.
Dr. Tom Nichol, of Montreal, writing of the beneficial action of Sanguinaria, reports the following case of acute edematous laryngitis:
"At six o'clock of Sunday morning, April 19, I received an urgent call to the patient, who, I was told, had hardly been able to breathe all night. I found her sitting up in bed, with a characteristic sawing and rasping sound issuing from the larynx—a sound somewhat difficult of description, but which once recognised can never be forgotten. The tonsils and pharynx were swollen, but auscultation showed that the sawing and rasping sound issued from the larynx. The cough was dry and hard, relieved by sitting up in bed, aggravated by eating and lying down, and it was accompanied by difficult expectoration of tough and glairy mucus. The voice was low and suppressed, and it was with difficulty that I could make out the hurried, whispered sentences. The pulse was feeble and fluttering, and the lips were pale; but on both sides of the cheeks there was a circumscribed redness. The pathognomonic symptom which made the pathological state quite clear to me was the fact that expiration was performed more readily than inspiration. M. Thuillier's test was decisive as to the diagnosis, for when the forefinger was passed into the larynx there is a perception of a cushion formed by the tumefaction of the sides of the glottis, a soft, pulpy body, quite distinct from the ordinary hard feel of the parts. The diagnosis was acute edematous laryngitis of the supra-glottis variety, and the peculiar respiration arose from the fact that the edematous membrane which fills the glottis closes like a valve against the entrance of air, but readily permits it to pass out. I prescribed Sanguinaria, first decimal trituration, a dose every half-hour.
"At 1 P. M. I found that improvement had commenced almost as soon as the medicine was given. The sawing and rasping sound was now much diminished, the respiration was comparatively easy, inspiration and expiration were performed with the same facility, the cough was less frequent and less severe, the voice was quite audible, and the patient had slept much of the time since morning. The tonsils and pharynx were still red and swollen, but the glottis was clear of the tense and rounded swelling present in the morning. The Sanguinaria was continued in the same dose.
"At 7 P. M. I again saw the patient, and found that the very serious pathological state had almost wholly disappeared. The Sanguinaria was continued all night, and in the morning the condition was entirely gone."
In June, 1881, I was called to a very similar case in a man about forty-six years of age, an iron worker, and remembering the above case of Dr. Nichol's, I gave Sanguinaria and quickly cured the case.
Croup is another disease in which Sanguinaria is very efficient. I think it is never indicated in the spasmodic variety, where Gelsemium, Aconite, Lobelia, ipecac, or iodine, cover the varied condition; but in membranous croup it is our chief remedy.
"The sanguinarin is one of the most valuable remedies known in the treatment of pseudo-membranous croup. It has proved as much of a specific for that disease as quinine has for ague. I have seen it used in a great number of cases, and have never known a single failure. It should be made into an acetic syrup, by adding twenty grains of sanguinarin to four ounces of vinegar; steep and add one ounce of sugar to form a syrup. Dose, one teaspoonful as often as indicated."—PAINE.
I have used the acetous syrup, sanguinarin, and the powdered root in cases of membranous croup, and I do not know that there is any particular choice between them; if so it is in favor of the preparation in vinegar. But Prof. Paine's dose is too large, and causes vomiting, which is unnecessary. A grain to an ounce answers very well, and produces no physiological symptoms. The following case is a fair sample of what it will do:
V. H., a little boy aged six years, had a croupous cough which continued to get worse each night for three successive days, although receiving the careful attention of the family physician. All the well-known expedients had been tried, including emetics, alum and inhalations of steam from hot water poured upon unslaked lime. At eleven o'clock on the fourth night, several other physicians being in attendance, I was sent for to perform tracheotomy. On arriving at the house I found that the parents had been assured that if the operation was performed the child would get well. The mother at once demanded of me a promise that the operation would save the child's life. As tracheotomy is a very uncertain remedy for croup, three out of every five operated upon dying, I was unable to give such an assurance, and thereupon the consent of the parents to the operation was withdrawn. I now had time to give some attention to the little patient. He was lying in his crib panting for breath. In a few minutes one of the paroxysms recurred. The struggle for breath was terrible. He rose up on his knees, his head went backward as far as possible, and the alae nasi moving up and down like the flapping of sails. His face was turgid with blood, and exhalation and inhalation seemed equally difficult. I sent at once for tincture of iodine and for sanguinarin. The iodine arriving first I used it as an inhalation, but without any effect. I then dropped a few grains of sanguinarin in a cruet of vinegar, and placed a few drops on his tongue, repeating the dose every three to five minutes; giving him a tablespoonful in the course of an hour. The use of Sanguinaria was begun about midnight, and at two o'clock a slight improvement was manifest, the paroxysms being shorter and less severe. I ordered that he have ten drops of the vinegar every fifteen minutes. In the morning I found the paroxysms had entirely ceased, the metallic whistling cough had given place to a catarrhal one, and although the voice was hoarse, and the child dull and stupid, all danger was past.
In these cases if the face is livid and swollen, the lips blue and the dyspnea extreme, Sanguinaria will cure; but if the face is pale, the lips and extremities cold, the pulse feeble, and the dyspnea although considerable, yet not intense, it will fail. (The Sanguinaria case begins with a loose, rattling cough, which becomes dry, spasmodic, and then croupous; and if Sanguinaria be used the order is reversed and from croupous it becomes first merely spasmodic and then catarrhal.)
Tracheitis and bronchitis, when associated with gastro-hepatic or gastro-intestinal complaints, will nearly always yield to the administration of Sanguinaria; ten drops of the tincture in half a goblet of water, teaspoonful doses every three or four hours.
VI. Drs. Rutherford and Vignal have shown the specific action of Sanguinaria upon the liver; but long before they began their valuable experiments upon curavised animals with Keith's educts, it was a familiar remedy in liver complaints. Unfortunately most of the experience which has been had with it was in combination with leptandrin, podophyllin, myricin, or cimicifugin, and so it is impossible to make nice discriminations as to the peculiar conditions under which the remedy is most useful. That it is valuable in atony of the liver, in hepatic torpor, in jaundice caused by malaria, and that it will remove biliary concretions we know; but we do not know just when to give it the preference over all other remedies in these conditions.
Next to the liver, of all the glandular structures, the tonsils are the most under the control of this remedy; and in tonsillitis, both recent and chronic, it is frequently a useful therapeutic agent. Used early it will abort the inflammation and prevent suppuration; used later it conducts the suppurative process to a healthy close; and in those who are subject to attacks of quinsy its continued use so alters the local dyscrasia as to prevent a return of the trouble. In several cases of enlarged tonsils I have seen the persistent use of a mild gargle of the tincture of Sanguinaria entirely remove the trouble in a month or two. One of these cases was a girl twelve years of age, whose tonsils had been indurated for six or seven years. Each Winter they would become greatly swollen and deglutition painful, this condition lasting until warm weather. Now the tonsils are of normal size, and she has had no trouble with them for three years.
Sanguinaria also affects the salivary glands, the spleen, the mammae, the testes and ovaries, and probably other glandular structures.
VII. Sanguinaria is a notable remedy in headache. The cephalaegia in which Sanguinaria is curative is peculiar and easily remembered. The pain commences in the back part of the head, and rising upwards spreads over the head and finally settles in the brow above the right eye. There is great intolerance to light and noise. The patient is obliged to remain in a dark room and to lie perfectly still. There is nausea and vomiting, accompanied sometimes with chilliness. If there are flashes of heat through the body, or if the palms of the hands and soles of the feet burn, or if the urine is scanty and dark at first, becomes later profuse and clear, Sanguinaria is the more specifically indicated.
This headache differs from that calling for Rhus radicans, that while both begin in the occiput and spread over the head, the Rhus headache stiffens the muscles of the nape of the neck, is better while moving about, and is caused by exposure to damp and cold; this does not affect the neck, is better when the patient keeps quiet, and is brought on by gastric disturbance. The Iris hemicrania, which is also mainly on the right side and of gastric origin, is accompanied with blurring of the eyes, is worse when at rest, and recurs periodically, often on the same day of the week. In Sanguinaria the vomited matters are bitter, but in iris they are intensely sour. The Cereus hemicrania is also right-sided, compels the patient to avoid all noise, light, or exertion, but it is rarely connected with any gastric disturbance, it is usually caused by mental excitement or worry, and is often associated with cardiac complications. Right-sidedness also characterises the Pulsatilla cephalaegia, but this usually begins in the afternoon and is always worse during the night, whereas the Sanguinaria headache begins in the morning, increases through the day and is better at night. The pulsatilla pain is relieved in the open air, and generally arises from uterine disturbance. (The Chelidonium and Sanguinaria hemicraniae are very similar. Both extend from the occiput to the forehead over the right eye; both are aggravated by moving about; both are periodical; and both cause great irritability. In Chelidonium the patient is better from eating, in Sanguinaria worse; in Chelidonium the patient is low-spirited, in Sanguinaria cross; in Chelidonium the food tastes natural, in Sanguinaria bitter; in both there is a disrelish for nitrogenous food, but the Chelidonium patient longs for acids.)
Sanguinaria is of value in the neuralgia of the trigemini, when the pain is shooting and burning in character, and pressure over the pain gives relief. It is of value in various myalgic pains when accompanied by distension of the temporal veins, and Dr. Hale suggests it as a remedy in sanguineous apoplexia.
VIII. When in acute rheumatism the poison attacks both the muscular and serous tissues at the same time Sanguinaria is an excellent remedy. These pains are apt to be felt in the right arm and shoulder, and in the right hip, extending down to the knee. The pain is worse where the bone is least covered by flesh, and is of a burning, bruised nature. Rubbing the affected part temporarily eases the patient's suffering, but the pain is apt to appear elsewhere. When metastasis to the heart is caused by the use of topical applications, and rheumatic pericarditis sets in, Sanguinaria acts promptly.
Transactions of the National Eclectic Medical Association, Vol. X, 1882-83, edited by Alexander Wilder.