Arnica montana

Lecture XXII — Compositae — Arnica montana, Artemisia vulgaris, Absinthium, Millefolium, Taraxacum, Eupatorium perfoliatum, Artemisia abrotanum

The next order of plants to be considered is the Composites, a verylarge order, from which we obtain a number of drugs ; namely, Arnica, Chamomilla, Cina, Eupatorium perfoliatum and purpureum, Artemisia vulgaris, Artemisia abrotanum, Artemisia tridentata, Absi?itkium, Millefolium, Taraxacum, and Calendula.

Composite.

Arnica.

Chamomilla.

f Capillaries.

| Typhoid.

I Injuries.

[ Organs.

Abdomen.

Brain and spine, j Fever.

(^ Organs.

Brain and medulla.

Cina.

Artemisia vulgaris.

Absinthium.

Millefolium.

Eupatorium perf. ^ -,-a • [ Fever.

Eupatorium purp. J Taraxacum. Liver.

We shall now proceed to study the first one of these.

Arnica Montana.

Arnica montana is commonly called leopard's bane. The tincture of the drug should be prepared from the roots of the plant rather than from the flowers, because the latter are infested by little insects, the bodies of which, together with the eggs, considerably modify the action of the pure drug, and, of course, add symptoms which are foreign to the genuine effects of Arnica. We also find an essential oil in the flowers differing somewhat from that found in the roots. I do not know why the plant has been called the leopard's bane, for it is hardly poisonous. While there have been a few cases of death resulting from its extravagant use, most of them have been traced to preparations in which the flowers were used, so that it is not unlikely that the fatal result was due to the insects. The species which is officinal in our materia medica, the Arnica montana, does not grow in this country, but is indigenous to Europe. Its essential oil contains an imperfectly known alkaloid called Arnicin, and a starchy substance known as Inulin.

To understand Arnica properly as a whole you must know that it affects the blood-vessels. Bxactly how it does this, I can hardly tell you, for it is not clearly defined in my own mind ; but the results I can tell you. It so affects the walls of the blood-vessels, particularly of the capillaries, that dilatation of the small vessels and extravasation of blood becomes possible. This weakening of the capillary wall, which admits of extravasation of blood, explains the applicability of Arnica to trauma. It also explains the relation of the drug to typhoid conditions. Now if you will keep before your minds this fact, that Arnica so alters the capillaries that blood may ooze through their walls, you will understand its symptoms. There seems to be a venous stasis producing an extravasation of blood. This form of oozing cannot occur from a healthy vessel.

Arnica is applicable to both the acute and the chronic effects of injuries. The acute injuries for which it is useful are the following: simple bruises in which there are well-marked ecchymoses ; concussions of the brain or spine or of both. We have no remedy which equals Arnica in these last-named cases. Even compression of the brain comes within the range of Arnica, whether this compression be the result of a displaced fragment of bone in cranial fracture, or the result of effusion of blood within the cranial cavity. Arnica cannot, of course, cure in the former of these cases ; an operation is demanded in order to obtain permanent relief.

You may use Arnica in injuries of the muscles from a strain or from a sudden wrench, as in case of heavy lifting, and in haemorrhages of mechanical origin. Fractures of the bones may call for the use of Arnica, both externally and internally, to relieve the swelling and tumefaction of the limb, and also to relieve the twitching of muscles, a reflex symptom of the fracture.

In the chronic effects of injury we may use Arnica when diseases (which may even be entirely foreign in their appearance to the ordinary symptomatology of the drug) may be traced to a traumatic origin. No matter what that disease may be, whether of the brain, eyes, lungs or nerves, if the injury is the exciting cause, the administration of Arnica is proper.

Again, as Arnica undoubtedly acts on the muscular tissue itself, we may use it for the consequences of diseases in the muscle ; for instance, when one has been working very laboriously, and in consequence the whole body feels sore and bruised, as if pounded ; or again, when heavy work may have caused hypertrophy of the heart. This lastnamed is not strictly a disease, but it ends in disease. The heart is a muscle that grows under the stimulus of exercise as much as does the biceps of the arm. As a result of the cardiac hypertrophy, the patient complains of swelling of the hands on any exertion. They become redder than usual, and swell when the arm is permitted to hang down. The pulse you will find to be full and strong. When the heart has reached this stage of hypertrophy, there are local symptoms in addition to those mentioned. The heart feels as though tightly grasped by the hand. The whole chest feels sore and bruised, and he cannot bear his clothing to touch it.

This will at once suggest to you Cactus, which has that constriction about the heart. Cactus, however, does not have a traumatic origin for its symptoms.

The sensitiveness of the chest suggests Lachesis, but is a different symptom under Arnica, which lacks the sensitiveness of the peripheries of the nerves that Lachesis has ; but has a genuine soreness from fulness of the bloodvessels.

Other remedies to be compared with Arnica in this hypertrophy of the heart are :

Rhus tox., especially if there is rheumatic diathesis.

Arsenicum, if it has resulted from climbing high places. Bromine has also been successfully used in this condition. Now let me give you the typhoid symptoms of Arnica, which, although very different from those just mentioned, depend upon a similar condition of the bloodvessels.

The changes in the bloodvessels due to the typhoid poison favor the formation of ecchymoses here and there over the body. There is also a passive congestion of the brain. This is shown by drowsiness and indifference to those about him and to his condition. The patient falls asleep while answering questions, just as we find in Baptisia. With these symptoms you almost always find the head hot and the body not hot. The symptom in the materia medica reads, " the head is hot and the body cool, or at least not hot," implying that there is a difference in temperature between the head and the rest of the body, and this has been so often confirmed that it is well for you to remember it. The patient complains of a bruised feeling all over the body, so that the bed feels too hard to him. He is restless and tosses about the bed to find a soft spot on which to rest ; and yet the fault is not with the bed, but with himself. Sugillations from hypostasis appear on the back. The lungs become affected—and here, too, the same character of Arnica shows itself. There is a cough, with expectoration of mucus and blood. If the patient is still sufficiently conscious he will complain of sore bruised feeling in the walls of the chest. There is a brown streak down the centre of the tongue. As the case progresses still further, Arnica may yet be called for, when the pressure of the blood in the brain is sufficient to cause apoplectic symptoms. The breathing becomes heavy, and even stertorous. The lower jaw drops. Petechise appear on the skin, and both stool and urine are passed involuntarily, the patient, of course, being in a stupor. These are the

typhoid symptoms of Arnica.

Now for the muscular symptoms. Arnica develops a true myalgia. The pains occur in the muscles of any part of the body. They are of traumatic origin, or they come from over-exertion, and are accompanied by this sore, bruised feeling, which is so necessary to the choice of the drug.

In rheumatism, you may employ Arnica, not for true inflammatory rheumatism, but for the local rheumatism which occurs in winter weather, and which seems often to be the combined effect of exposure to dampness and of cold and strain on the muscles from over-exertion. The affected parts feel sore and bruised. Any motion, of course, aggravates this sensation. There are sharp, shooting pains, which run down from the elbow to the forearm, or which shoot through the legs and feet. The feet often swell and feel sore and bruised. In cases of injury, the drugs to be thought of in connection with Arnica are these : first, Rhus tox., which, as I have already told you more than once, is preferable to Arnica when the ligaments of a joint, rather than the soft parts, are involved in an injury. It acts on the fibrous structures. Arnica is suited more to tumefaction of the other tissues.

Calendula is to be thought of when the injury causes a torn or ragged wound, possibly with loss of substance. Calendula removes the inflammatory condition of the part, and so permits of healthy granulation.

Hypericum is to be substituted for Aynica when the nerves have been injured along with the other soft parts. Nothing equals Hypericum in cases of mashed finger. It relieves the pain and promotes healing. It often follows Arnica in concussion of the spine. Dr. Ludlam, of Chicago, was very partial to Hypericum in this trouble of the spinal cord, and with good reason, for not only has he relieved some severe cases with it, but the provings show a perfect picture of the results of spinal injury.

Another drug is Staphisagria. This is the remedy for smooth clean cuts, such as are made by the surgeon's knife, and hence it is called for in symptoms which are traceable to surgical operations. Even if the symptoms which follow are not apparently connected with the symptomatology of Staphisagria, you may expect, when they arise from this cause, to obtain relief by its administration. Ledum is useful after Arnica when the latter remedy fails to relieve the soreness. It is also suited to injuries inflicted by pointed instruments, therefore in punctured wounds.

Symphytum officinale is the proper remedy for bone injuries. For example, when a blow on the eyes injures the orbital plates of the frontal bone. It may also be administered in case of irritable stump after amputation ; and also for irritability of bone at the point of fracture.

If the latter condition is the result of impaired nutrition, Calcarea phos. should be prescribed.

For violent burning, stinging pains in a stump after operation, Allium cepa is the remedy.

Arnica may be used as a preventive of pyaemia. It is thought by some physicians that this remedy promotes the evacuation of pus, that it promotes the appearance of pus on the surface of a sore. With the object of preventing pyaemia, some surgeons use Arnica after operations, applying it locally and giving it internally at the same time. This property of Arnica, to prevent pyaemia, lies at the foundation of the routine practice among physicians of giving this drug to women after delivery. It tends to relieve the soreness following parturition and promotes proper contraction of the uterus and expulsion of coagula and of any portions of the membranes that may have been retained.

Arnica has an action on the skin, producing crops of boils all over the body. They begin with soreness and go on to suppuration, and are followed by another crop. It may also be used in boils and abscesses which have partially matured but which, instead of discharging, shrivel up by reason of absorption of the contained pus. Arnica given internally and applied externally redevelops the abscess. Further, in connection with the action of Arnica, I would call your attention to the effects of the drug on the gastro-intestinal tract. We find it indicated in dyspepsia, when, after a meal, there is impending apoplectic congestion of the brain with throbbing headache and drowsiness ; and also, when there is some difficulty in the digestion of food ; there are foul breath, slimy yellow coating of the tongue, eructation of gas tasting like rotten eggs, tympanitic distension of the abdomen and foul-smelling stools.

Arnica may be called for in cholera infantum, diarrhoea or dysentery ; the stools have a foul odor and are slimy, bloody, and even purulent, and are accompanied by great urging and straining to stool. The dyspeptic symptoms just mentioned will be present, and there are sharp, stitching pains through the abdominal walls. The patient is thirsty, and yet he does not know what he wants to drink. I should like, in closing my remarks on Arnica, to mention its use in whooping-cough. It is indicated in children who have a violent tickling cough, which seems to be excited whenever the child becomes angry. The child loses its breath when it cries. Before a paroxysm it begins to cry. Why ? The lungs and trachea are sore. The little sufferer knows what is coming and dreads it ; that is the interpretation of the symptom. The expectoration is frothy, slimy and always mixed with blood.

In compression of the brain from apoplectic extravasation of blood, Arnica may be used when associated with the hemiplegia ; there is an aching soreness all over the body. Bed-sores form very readily.