Euonyminum

Volume I — Appendix

Description. — Euonymin is the active principle of Euonymus Atropurpureus, which is described in the " Symptomatology," page 293. Preparation. — Triturations.

No systematic proving of Euonymin has yet been made, and in lien of a proving I submit an article, which appeared in the New York Medical Times for September, 1881.

A proving of Euonymus Europseus can be found in Volume X, of Allen's Encyclopaedia of Materia Medica.

" Before entering upon the subject-matter of this paper, the writer desires to call attention to the valuable work recently issued, entitled ' An Experimental Research on the Physiological Action of Drugs on the Secretion of Bile,' by William Rutherford, M.D., F.R.S. Edinburgh : 1880. Dr. Rutherford, aided by his two pupils, Vignal and Dodds, entered upon the experiments which are detailed in this volume, with a determination to ascertain the exact value of certain drugs supposed to influence the secretion of bile. After showing that clinical experience is very untrustworthy, and previous experiments not wholly reliable, they decided to adopt the following improved plan of experimentation. Briefly, it was as follows :

" ' The dog was selected. 1. Because the size of the common bile duct renders it possible to introduce a canula with an orifice sufficiently large to prevent its being blocked up by particles of inspissated mucus from the gall-bladder. 2. For the reason that its digestion resembles that of man, inasmuch as its stomach becomes empty when the process is completed

" ' The selection of the dog has proved fortunate, for the results of our experiments are in complete harmony with every perfectly ascertained fact regarding the action of medicinal agents on the human liver, and prove that the liver of this animal is affected in the same sense — although it may not be in the same degree — by substances that act on the human liver. All the experiments have been performed on animals of the same species, placed as nearly as possible under similar conditions ; the results are fairly comparable ; although it must be borne in mind that, just as no two members of the human species can, even in their normal condition, be regarded as equally susceptible to the influence of any medicinal agent, neither can any two members of the canine species be held to possess identical susceptibilities. All the animals had a full meal of lean meat at three or four o'clock in the afternoon, and the experiment was begun between nine and ten o'clock on the following morning, so that the digestion and absorption of the food was completed, and the animal was therefore in a fasting condition.

"'This was an essential preliminary; for, as is well known, the secretion of bile is accelerated during the process of digestion ; and had we taken the amount of bile secreted per hour during digestion, as an index of the activity of the liver previous to the administration of a drug, our experiments would necessarily have been worthless. The disturbing effect of irregular muscular movements upon the biliary flow was prevented by injecting into a vein small

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doses of Curare, repeated at intervals, when the motor paralysis which it induces became too slight. In consequence of the Curare palsy, artificial respiration was had recourse to, and maintained at regular intervals throughout the whole experiment. Chloroform was used during the preliminary operation in two cases, but the stimulation of the liver which it induced rendered the experiments worthless. On the other hand, we have abundantly proved that the doses of Curare, administered in the following experiments, have no influence on the biliary secretion, and do not interfere with the effects of hepatic stimulants. It is therefore an exceedingly valuable auxiliary in a research of this nature.

"'The method of experiment we adopted was always that of a temporary biliary fistula. Through an opening in the linea alba, a glass canula was inserted into the common bile duct, near its junction with the duodenum, and tied therein. To the end of the canula projecting from the abdomen a short caoutchouc tube was attached, and to the free end of this a short glass tube, drawn to a narrow aperture, so that the bile might drop«from it, as Rohrig (Op. VI.) had recommended. The gall-bladder was then compressed, in order to fill the whole tubing with bile, and the cystic duct was clamped to prevent its return to the gall-bladder, and so compel all the bile secreted by the liver to flow through the canula. The wound in the abdominal wall was then carefully closed, and in all save the earliest experiments the animal was thoroughly covered with cotton-wool, in order to quickly restore it to its normal temperature; and, guided by a thermometer in the abdominal cavity, great care was taken to keep the temperature normal — a matter of no small importance ; for if the temperature fall several degrees, the liver secretes more slowly.

" ' The respiration requires to be maintained with regularity, otherwise the biliary flow is rendered somewhat unequal by irregular diaphragmatic compression of the liver. Moreover, if the respiration be deficient, the secretion of bile is always diminished. Some of the slight oscillations observable in the charts of the biliary secretion in these experiments are probably owing to variations in the respiration ; for in the earlier experiments we were obliged to have the respiratory bellows moved by hand, and this is never so regular as a machine. Notwithstanding this, however, the main results of these experiments are per fectly clear.

" ' Until it is attempted, one might suppose that this mode of experiment is extremely simple, but it is by no means so simple as it appears. It is needful to manipulate the abdominal viscera with great care, and to avoid all dragging at the bile-duct; otherwise the secretion of bile becomes so irregular that the experiment may be useless. The canula must be very carefully retained in a position which will permit its moving with the diaphragm, but will prevent it from twisting the duct, and thus impeding the exit of the bile by forming a valve at its orifice.

"'Eohrig estimated the velocity of the biliary secretion by counting the seconds-that elapsed between the fall of the drops from the orifice of the tube. A single trial convinced us that this method is extremely laborious, and leads to inaccurate results, because it does not permit of continuous observations for any

length of time. Variations in secretion often occur independently of the administration of any substance, and it is impossible to estimate their significance and make due allowance for them, unlers the method of continuous collection of the bile be adopted. Moreover, we soon found that the degree of viscosity of the bile caused a variation in the size of the drops, and, therefore, in the intervals between their fall. We therefore abandoned this for the more accurate method of allowing the bile to flow into a fine cubic centimeter measure and recording the quantity secreted every quarter of an hour. In addition to constant collection of the bile, this method has the great advantage of permitting a graphic representation of the results.'

"The experiments are illustrated by cuts showing the rise or fall of the bile current. They are similar to those cuts used to illustrate the rise and fall of human temperature in fevers. I append one of the cuts— showing the tracings, —illustrating the action of Euonymin on the liver, also the text explaining the experiment.

" Secretion of bile before and after ' Euonymin.' 1.1 cc. bile and 3 cc. water injected into the duodenum at b. The same five grains 'Euonymin ' injected at e.

" ' Experiment 28. — Dog that had fasted twenty-four hours. Weight, 23. 3 kilogrammes. The unusually long fast resulted from the animal having refused to take food on the afternoon of the day preceding the experiment. It was probably owing to this circumstance that the secretion of bile was so low at the beginning of the experiment.

"'Autopsy. — Stomach contracted, mucous membrane normal. The " Euonymin " had extended along about a third of the small intestine. The mucous membrane of the upper third was extremely vascular. Mucous flakes were scattered over the surface, and the whole appearance of the membrane reminded us of the effects of Podophyllin. But notwithstanding the very obvious irritation, the intestine at this part contained only a small quantity of watery fluid. The remainder of the intestine was dry and contracted, without any signs of irritation.

" ' Results of Experiments with " Euonymin." — 1. Five grains of " Euonymin," when mixed with a small quantity of boiling water and placed in the duodenum, powerfully stimulated the liver. The analysis of the bile secreted before and after " Euonymin" was lost. 2. Coincident with the marked action of the liver there was only slight increase of intestinal secretion. Seeing that Mr. Clothier found " Euonymin" to be an active purgative in the human subject, these experiments suggest that the purgative effect may be chiefly due to increased secretion of bile. At any rate these experiments clearly show that this substance is worthy of receiving far greater attention in practical medicine than it has done hitherto.'

"These experiments, which were carried out with great labor and scientific exactness, will be of infinite value to physicians of all schools, but more especially to those who recognize the law of Similia as the universal law of cure. Those also who understand the true ' Law of Dose,' as deduced from the primary and secondary actions of drugs, will be greatly aided in their prescriptions of these hepatic remedies.

"Rutherford records some facts which prove conclusively that these hepatic drugs have a double action, the one exactly opposed to the other, namely: (1) That, whereas small, or medium doses always produced a physiological increase of bile-llow, massive doses decreased or completely arrested the secretion of bile. (2) That when a drug produced active increase of the intestinal secretions, it decreased the secretion of bile. (3) That the primary increase of bile was often followed by a 'corresponding suspension of the secretion for a longer or shorter period. These observations are in accordance with my teachings regarding the pathogenetic actions of medicines, and from which 1 deduce the following axiom relating to the selection of the dose: (1) When the symptoms of a disorder resemble the primary action of a drug, prescribe that drug in the smallest rational dose.

"Illustration. — The primary action of Podophyllin was found to cause an increase of the secretion and flow of bile of a thin character, with colic, nausea, and irritation of the intestinal mucous membrane, especially the colon and rectum, with congestion and inflammation of the liver. For this condition the dose should not be below the 3x trit. or dil., if we desire prompt curative action. The secondary action of Podophyllin causes constipation, with arrested or retarded secretion of bile, with jaundice, hepatic enlargement, etc., or profuse choleraic discharges, with suppressed biliary secretion. For this condition the drug must be prescribed in more appreciable, yet small doses, as the T^, ^ sVi 23' or 1V °f a grain (I mean enough of the Ix or 2x trit. to make either of the above-mentioned doses), repeated at suitable intervals.

"The law of dose will apply to all the hepatic remedies whose primary and secondary action is similar to that mentioned above. There are some drugs which cause hepatic symptoms in a reverse order.

" As regards the relative power of the drugs experimented with by Dr. Rutherford, it is exceedingly interesting to compare their action by consulting the following list of indigenous drugs, which I copy from the monograph. The drugs are mentioned in the order of their relative inherent power:

• " Podophyllin, per cent, of bile above normal, . . . 0.47

Iridin, " " " " ... 0.39

Euonymin, " " mm ... 0 30

iSanguinarin, " " mm ... 0.42

Baptisin, " " « « ... 0.33

Phytolaecin, " " " " ... 0.16

Hydrastin, " " m m ... 0.38

Juglandin, " " « « ... 0.40

Leptandra, " " mm ... 0.31

" The table shows that Podophyllin caused the greatest amount of bile discharged during a given time ; but the doses were larger than the doses of Euonymin, although the former is a very much more powerful drug. So with other drugs; they seem to show a higher degree of power, but, considering the relative potency of all the drugs (I mean the inherent power per grain) as disturbers of the general system, the Euonymin may be considered the most powerful in its pure, specific action, and in its influence over the secretion and expulsion of bile from the liver.

" It is interesting to note the different behavior of the discharge of bile under the influence of these drugs. Some cause a steady, continuous flow ; others a rapid powerful ' spurt,' or high rise in the tracing ; while a few cause an intermittent discharge. The latter two peculiarities are especially noticeable in the case of Euonymin. The above tracing beautifully illustrates the effect of Euonymin on the secretion of bile. Note the sudden high rise, then the slight arrest, followed by the still higher rise, and the intermittent flow during the gradual decrease. Another interesting feature in this proving is, that, on postmortem, the upper third of the mucous membrane of the small intestines — in the two experiments — was found to be highly vascular, and covered with flakes of mucus, while the lower two-thirds was dry. In the experiments with Podophyllin, ' the mucous membrane of the stomach and whole length of the small intestines was intensely red, and contained a large quantity of fluid ; in another case the mucous membrane of the duodenum was intensely vascular.' This is what we might deduce from the provings of that drug, judging from the symptoms in our Materia Medica.

CLINICAL OBSERVATIONS.

"We have no provings of Euonymin made in the usual manner of our school. Eclectic authorities have recorded that in doses of one-half drachm (^ss) it causes 'nausea, vomiting, and purging.' Dr. Payne says the same dose taken by him caused ' all the symptoms of cholera morbus.' In the Encyclopaedia of

Materia Medico, is a case reported of a man who took 18 seeds of the Euonymus Europeus one evening, and 18 the following morning. 'He was seized with frightful abdominal pains and profuse diarrhoea, eventually bloody. He was not seen till evening, when he was in a state of profound collapse, with involuntary evacuations of blood and mucus. On lifting him up, tetanic convulsions were induced, which immediately preceded death.' King's Disp. records that the seeds of the Euonymus Americanus are a violent emetic and purgative. The seeds are doubtless more powerful than the bark, but the crude tincture or infusion of the bark is a powerful drug, for the following symptoms are recorded in my Symptomatology of New Remedies, and were collected from various sources, namely: ' Deathly sickness of the stomach, with perspiration and heat in face; violent catharsis with deathlike nausea ; excessive tormina, prostration and cold sweats; evacuations violent, profuse, with much flatus.' It is true that large doses of the Euonymin would cause all these violent symptoms, but I think that in the process of separating the so-called active principle, from the crude bark, much of the acrid and irritating property is eliminated. The same occurs with other drugs, e. g., Quinine. The taste of Euonymin has nothing about it reminding one of the pungent, acrid, and burning taste of the mother tinctures or the powdered bark. Rutherford suggests that if Euonymin causes purgation, it does so by causing a profuse flow of bile, which is a powerful purgative. This may be true of Euonymin, but I believe the crude bark or tincture has, aside from its cholagogue effect, an irritant action on the small intestines of the same nature as Podophyllum, but not in the same degree. I have used the 2x and 3x dilution of tincture of Euonymin in profuse and painful diarrhoea and cholera morbus and cholera infantum, and find it equal to Podoph. or Verat. alb. Eclectic authorities claim that Euonymin is very useful and efficient in the same affection, but my experience with it in such conditions is limited to a few cases. In another class of disorders, however, I have, during the last few years, used the lower triturations of Euonymin, with unqualified success, and I have selected it homceopathically, basing my selection on its one physio-pathological symptom, namely, a profuse and irregular flow of bile (primary) followed by its natural sequence — a scanty or suppressed secretion of bile.

" Biliousness. — This condition, so well known to the laity as well as the physician, is characterized by such symptoms as general malaise, a yellow or brown tongue, bitter or coppery taste in the mouth, headache, generally frontal, worse in the morning, or sometimes occipital, vertigo, dark spots before the eyes, disinclination for mental or physical labor, dark urine, constipation, or loose fecal, offensive evacuations, and muddy complexion. These symptoms are usually treated by homceopathists with Nux vom., Bry., Merc, or Podoph. By the allopathic school with Blue Mass, or Calomel, followed by bitter-water, or some saline purge. Both methods are palliative, but not completely curative. The former method is by far the best. But I have had better success with Euonymin than with any other remedy. I find a few grains of the lx trit. three times a day amply sufficient. After forty-eight hours, if the bowels do not move normally and the tongue is cleaning, I advise two or three ounces of bitter-water in the morning before breakfast. I use the lx trit. because this condition simulates the secondary effects of Euonymin. Per contra, if the patient has a yellowish-white tongue, some nausea and griping in the bowels, with loose yellow or greenish stools, which burn the rectum, the 5x or 6x is prescribed, because these symptoms show an increased secretion and expulsion of bile, thus simulating the primary effect of Euonymin. In children of all ages, who are especially prone to this form of biliousness, or bilious diarrhoea with congestion and irritation of the small intestines, Euonymin 6x trit. acts more promptly and happily than any other drug, unless some special symptoms indicate Merc, Pule, Iris, or Podoph. It is a notable fact, which any physician can verify, that if he prescribes Euonymin to his bilious patients to whom he has usually given Nux, Bry., Merc, Podoph., or Iris, he will find that nearly all will testify that they prefer Euonymin to any of the above, for they soon recognize its prompt, happy action, and its excellent effect upon their condition, especially in its power of restoring normal appetite and digestion. Many of my readers will recollect the cases of Albuminuria reported by Dr. W. H. Holcornbe, and incorporated in the last edition of Therapeutics of New Remedies. The curative effects were brilliant, and the drug selected solely on account of its power over the secretion of bile.

" Referring to the hepatic and intestinal disorders of children, it must be remembered that the liver is much larger and more irritable in the very young than at any other age. Euonymin is, par excellence, the panacea of these disorders in children. But it must be used intelligently and in accordance with my law of dose, when it will act most happily. There are three conditions characterized by peculiar symptoms in which it is indicated.

"1. In children, especially in summer, when the bowels are disordered — the passages green, yellow, or olive-colored, colic, nausea, vomiting of bile, or food mixed with bile, some fever, loss of appetite, indigestion, especially of milk, languor and stupor, with pale, yellow, or earthy complexion — no remedy with which I am acquainted acts so favorably on this state as Euonymin, from the 3x to the 6x trituration, frequently repeated. It is possible the higher triturations may be efficacious, but I have never tried them.

" 2. Every one who has had much to do with gastro-intestinal diseases of children have observed the peculiarly variable appearance of the stools and vomit. 'No two passages are alike' is the common report of the nurse. At one time they are green, then white, then watery or yellow, and the vomit just the same. Pulsatilla, is said to be indicated for this, but I have succeeded better with Euonymin 3xtrit. I believe this variability to be due to an irregular secretion and expulsion of bile, and for this Rutherford's experiments show Euonymin to be the similimum. In very young children the 3x trit. repeated in one grain doses every three hours, changes the character of the stools to a normal color and consistency. In older patients the 2x is required.

" 3. In children or adults there often occurs the following group of symptoms : After a sudden attack of vomiting and purging of bilious matters— sometimes, however, without this first stage— we find the stools clay-colored, white, gray or watery and colorless, and T3ry offensive ; there is some gagging or nausea, the urine is high-colored, strong-smelling and contains bile ; the food is not digested;

there is great prostration ; the complexion is sallow or jaundiced, and the expression dull and listless. Here the hepatic cells fail to eliminate biliary matters from the blood, and it seeks outlets through the skin and kidneys. Often the brain is poisoned and we have marked bilsemia. Benzoic acid has often done me good service in these cases, but I have found the lx trit. of Euonymin to act more satisfactorily. This condition is such a one as we might expect would arise from an overstimulation of the liver with large doses of Euonymin, a reaction or secondary effect. Consequently the law of dose calls for the lowest trituration or material doses. In the jaundice of adults due to

"4. Biliary Calculi or Concretions, the solid constituents of the bile are in excess. If such constituents are crystallizable we have Calculi, if not, we have concretions in the form of tarry, tough balls, often in great numbers. The indications of treatment are to increase the fluid portion of the bile, making it thinner, and thus dissolving the solid mattters, or washing them out of the gallbladder. After they have formed, and obstruct the gall-duct, the use of large doses of Olive Oil will aid in their expulsion ; but we should at the same time give hepatic remedies which thin the bile. Chelidonium is the chief remedy for this condition, although Rutherford says Podoph., Iridin, and nearly all the drugs he experimented with have this effect. I believe Euonymin has this effect equally with Chelid., although, unfortunately, the analysis of the bile, after the use of Euonymin, was lost. I think I have prevented the formation of biliary calculi in many cases, by the use of both Chelid., and Euonymin, with greater certainty than any other medicine. But we do not get good effects with doses higher than the lx or \ trituration in material quantities repeated every three hours.

"5. Malarious Diseases. — In true malarious disorders, notably those which cause intermittents, the poison in the blood paralyzes the hepatic cells. It often primarily irritates them, causing them to secrete an abnormally acrid bile, which results in bilious vomiting and catharsis. After this always comes paresis, with a whole train of symptoms, such as occur under bilsemia. Careful observers are aware that so long as this ' bilious' condition exists it is impossible to cure the ague or fever, but as soon as the tongue clears, and the stools become normal, the fever is easily subdued or the paroxysm arrested. This fact accounts for the ill success of the unscientific treatment of both schools ; the old with their routine of Quinine; the new with the fruitless chase for* the specific in each case. While engaged in practice in the State of Michigan, when fourfifths of all my cases were malarious fever, I observed that the country people used an infusion or a maceration of the bark of the " Wahoo" (Euonymus) in whiskey as a remedy for ague. It certainly succeeded after all other drugs failed, especially after the abuse of Quinine, for Quinine injures the liver as seriously and in a similar manner to malaria. Taking the hint from this domestic practice I used to give the tincture of the bark in appreciable doses, in alternation with homoeopathic anti-periodic remedies, and with satisfactory results. I would advise those who have to deal with miasmatic, intermittent, or remittent fevers, that they give Euonymin lx trit. doses of 2 grs every two hours, until the tongue cleans and the secretions become normal. Then and not till then, select the similimum for the paroxysms, namely: Quinine, Arsenicum, Cedron.

Gelseminum, Alstonia, or one of the few antiperiodic remedies in our Materia Medica.

"This plan will insure success, and we shall escape the opprobrium of allowing our patients to pass out of our hands into those of the Philistines, or their own resort to the abuse of Quinine.

" 6. Dyspepsia. — This protean disorder, depending as it does upon a great many pathological conditions of the stomach, liver, md nervous system, needs for its successful treatment a host of medicines. '"'When, however, it depends upon hepatic disorders, as it does in this country in very many cases, we find in Euonymin its most powerful remedy. The symptoms for which I have found it most useful, are those which usually accompany slow and imperfect digestion, namely : sense of unnatural satiety, bloat of the stomach, sour, acrid, or bitter eructations, vomiting or regurgitation of food, headache after eating, sluggish or irregular action of the bowels, foul coated tongue, and bad breath. I usually prescribe two or three grains of a low trituration one hour before each meal. Its curative action is often generally aided by giving a few grains of Pepsin just before meals. If the digestion is painful — a hard, pressing, aching pain soon after meals — Bismuth lx, a few grains, instead of Pepsin. If the pain comes on three or four hours after eating give Nux or Lycop.

"Finally, I use Euonymin in many other affections due directly or indirectly to hepatic disorder, but the limits of this paper will not allow further experience."