Chelidonium majus.

By GEORGE WILLIAM WINTERBURN, PH. D., M. D., New York.

We will occupy the hour to-day considering the estimable virtues of a remedy for which I must confess an especial penchant, because it has so often in my hands proved its quality; and which, I doubt not, you will share with me on a more intimate acquaintance. It is, to be sure, not strictly speaking an American shrub, but it grows so freely here, now it has lodgment, that the story of its healing virtue should be heralded wherever it shows its dainty head. I mean the greater celandine.

Chelidonium, so-called because it was supposed to flower with the arrival of the swallow, and to perish with its departure, is a pale-green herb, imported from Europe, but now naturalised in this country, and growing in waste places and on waysides. It belongs to the natural order Papaveraceae, the same as the poppy and the blood-root. The WHOLE PLANT contains an abundant bright-yellow juice, which exudes when any part is broken. The tincture should always be prepared from the green plant, including the root.

Chemical Constituents.

It contains chelidonic acid C₁₄H₅O₃; a narcotic alkaline principle chelerythrin C₃₇H₁₆NO₈; a bitter alkaline principle chelidonin C₄₀H₂₀N₃O₆; a neutral crystallisable principle chelidoxanthin C₂₀H₉NO₄; beside resin, malic acid, silica, and various salts. Chelerythrin also occurs in Sanguinaria Canadensis and Glaucium luteum.

Physiological Effects.

Four dogs poisoned with moderate doses, upon necropsy the mucous membranes were found of a lively red; and the lungs brownish blue, congested with blood, and slightly crepitant. The same phenomena were noticed in a horse. Two goats fed with the herb were soon seized with severe diarrhea, which continued until their death on the third day.

The fresh juice of the plant applied to the skin produces inflammation and redness. Of the effects of its internal use, Schallern says in Latin, thus translated:

"Taken internally, it penetrates the inmost vessels, resolves and attenuates (the fluids). It drives out the perspirable moisture, the sweat, and urine; also, as I have experienced more than once after taking the extract at different times of the day or year, it relieves the bowels without inconvenience. It strengthens not only the primeae viae, but also the secundae, and extends its tonic influence throughout the whole frame."

According to Voigt:

"The fresh juice in strong doses affects powerfully the abdominal organs, causing vomiting and purging, followed by diminution and strength of the pulse, great depression of muscular power, laborious and difficult breathing, beclouding of the senses, stupefaction of the head, severe perspiration and salivation, sparkling and darkness before the eyes."—Lehrbuch der Pharmarodynamik, II., 243.

Rademacher, a close observer and scientific prescriber, says that it acts on the internal structure of the liver, and he believes that all its general effects are due to this specific action. Dr. Buchmann, of Germany, has made a splendid proving of this drug on eighteen persons, extending over a period of nine months, with doses of the tincture varying from five drops to three drachms. In his summing up of its physiological effects he says:

"The power of exciting the whole arterial and capillary system is possessed by Chelidonium, in common with aconite, as appears from the great similarity of the febrile symptoms, but it does not agree with the transient character of the action of aconite on the vascular system. This is especially evident from its effects on the vena porta and its functions, inasmuch as it calls forth all the phenomena of fully developed abdominal plethora. This effect is always, for the most part, produced by defective circulation in the liver, and continual catarrhal excitement of the mucous membrane of the abdominal viscera. There is no room to doubt that the attacks of palpitation, slowness of the pulse (50), the distension of the veins of the hands, the paralysis, weight and stiffness of the limbs, the coldness of the extremities, the edematous swelling of the legs, dull pains in head, vertigo, pressure in the occiput, pains in the back and sacrum, weakness, indolence, irritability, ill-humor, alternation of diarrhea with costiveness, fits of colic, yellow-gray color of the skin, renewal of the symptoms on change of weather, etc., are to be referred to a congested retention of blood in the portal system, and the hyperemia thereby determined in the abdominal organs."

Chelidonium primarily acts upon the mucous membrane, exciting catarrhal inflammation in the esophagus, stomach and intestines, in the nostrils and respiratory tract, in the mucous lining of the gall-ducts, as well as in that of the urethra and ureters, and the female sexual apparatus. The skin was covered, more or less, with elevated exanthematous eruptions, which appeared more commonly on the face and genitals.

Pain of a severe neuralgic nature was experienced in various parts of the body, with restlessness, anxiety, and desire for fresh air (see Baptisia). Also myalgic pain, as if the muscles were strained, bruised, torn, or as if the bones were mashed or dislocated. From no other medicine does the feeling of constriction occur in so many parts of the body; we find it in the forehead, temples, muscles of the nape of the neck, larynx, esophagus, thorax, navel and anus.

There was one notable cardiac symptom. The heartbeat was steady and less frequent than normal, but so strong that the clothes were lifted by the movement, communicated to the thoracic parietes, and sounded so plainly to the prover that she fancied others must hear it also.

The fever-symptoms were well marked in all the trials; cold rigors, with chattering teeth and goose-skin, glowing heat, full, bounding pulse (90), followed by warm perspiration and pale countenance.

Forgetfulness, quarrelsomeness, extreme lowness of spirits, and horrible dreams characterise the mental state.

Pain in the kidneys occurred in most of the cases with great sensitiveness to pressure, frequent urging to urinate, urine intensely acid (uric and hippuric), deficient in chlorides, and in one case containing mucous epithelium and compact urinary cylinders. The impression of the drug in this case was so considerable that edematous swelling of the extremities occurred.

Small, thin, bright-yellow stools characterise its primary action, followed after from four to eight days with white, clay-colored stools, destitute of bile, very hard and difficult, causing a painful nodule on the margin of the anus.

Three different conditions of the secretion of the bile were caused by Chelidonium.

1. —Diminished secretion, with light-gray or yellowish-white stools, without deposit of biliary coloring matter in the skin, and without separation by the urine.
2. —Suppressed secretion, with lemon-colored skin all over, as in jaundice.
3. —Absorption, without stopping its escape into the intestinal canal.

The Chelidonium catarrh in the air-passages manifested itself by dry cough, with expectoration as if from the depths of the lungs; with dyspnea, sudden lancinating pains on the right side, aggravated by movement. Extravasations apparently took place in the lung tissue (as proved by necropsy in animals), as soreness occurred at various points as from a wound, increased by breathing deeply, which always seems to cause coughing and choking. It appears to exert a special influence upon the diaphragm.

All the provers had great desire for acids (vinegar, sour wine), and disrelish for cheese, etc. (alkaline food).

Chelidonium is analogous to Arnica, Bryonia, Podophyllum, Leptandra, Baptisia, Sanguinaria and Chionanthus.

Therapeutics.

The great celandine has been used, both externally and internally, from the remotest antiquity. The fresh juice was used by the ancient Greeks as an external application in affections of the eye. Fabricius, of Hilden, attributes to it the power of removing incipient cataract. Schallern mentions the cure of several cases of amaurosis. Biett says it has arrested the progress of a pterygium. Blankard has dissipated with it specks on the cornea. Galen and Dioscorides used a vinous decoction in jaundice. Creuzbauer used it to dissolve biliary calculi. Gilibert and Recamier have seen good effects from it in indolent engorgement of the liver and spleen, with or without intermittent fever. Lange has seen it successful in pulmonary catarrh and chlorosis, Lisdenfort in caries, Hufeland in glandular affections, Boniface in pulmonary phthisis, and Riviere in biliary complaints.

I need hardly mention the well-known power of the fresh juice to remove warts, fungous growths and cancerous excresences.

How is it possible that in spite of such precious traditions, celandine should have fallen into such complete disuse, that it is no longer even mentioned in but few works on materia medica? Is it not strange that facts can be thus blotted out? It is not because other and better remedies have been found to take its place; because, as I shall show you, celandine is unequalled in the treatment of various important affections.

I.—In the first place, celandine is superior to arnica as a vulnerary. In all painful conditions of the cutis vera, and subcutaneous cellular tissue, of traumatic origin, characterised by inflammation, and extreme painfulness on pressure, you will find celandine of the utmost value. In all lesions caused by bruises, falls, or sprains; in the myalgia and exhaustion of over-exercise; in traumatic pleuro-pneumonia; and even in tetanus caused by traumatic lesions, the local and internal use of celandine will prove its splendid curative power. From indications in the provings, but of this I know of no clinical confirmation, I believe it will go beyond this, and follow up the remoter consequences of mechanical injuries and the results of over-exertion, even after all local evidence of the mischief has subsided.

II.—Then you will find it valuable in many forms of cutaneous disorder; in simple erythema, in herpetic or eczematous eruptions, in falling out of the hair or beard, in warts, and in ulcers, even when inveterate, foul and phagedenic. Diseases occurring from suppressed eruptions are frequently benefitted by a course of celandine in moderate dosage.

In diseases of the eye celandine has always had a reputation. Dioscorides gives the swallows the credit of curing blindness in their young by feeding them with bits of the leaf. You will probably find it of value in some cases of catarrhal ophthalmia; in amblyopia or amaurosis, especially when traumatic; in traumatic iritis; in muscae volitantes, when they are flickering, sparkling or black; and in absence of better treatment, you might try it in cataract and pterygium, as an alleviative measure.

"I have often proved its efficacy in acute inflammation of the eyes, where they are swollen, injected, with a sensation of burning, as if from the presence of a foreign body. When there is excessive photophobia, lachrymation, abundant sebaceous secretion, agglutination of the eyelids in the morning; shiverings from time to time; pain which generally extends not only to the forehead, but sometimes all over the head; this pain, beginning to be felt towards 2 or 3 P. M., is at its height about 8 or 9, and prevents sleep, or even lying down, till nearly daybreak."—Ferrivat.

III.—In the digestive tract, omitting, for the present, consideration of the liver, you will find it of service in esophagitis, indicated by heat and burning from the pharynx to the stomach, and constriction of contractive spasm low down behind the larynx: in dyspepsia, evinced by disrelish for cheese, meat and other nitrogenous foods, and cold drinks, with keen desire for hot drinks and sour things, such as lemons, pickles, wine; in intestinal catarrh, painless, nocturnal, yellowish and slimy; and bilious diarrhea, with rumbling in the abdomen, before, during and after stool, not much pain, but great feeling of debility and weakness.

In the summer diarrhea of children, especially when associated with laryngeal, bronchial, or lung troubles, it often acts better than any other remedy.

Every case of gastro-intestinal catarrh in children, occurring at any season of the year, and showing itself by bright colored diarrhea, loss of appetite, feverish symptoms, and causing great emaciation and feebleness, will yield quickly to the exhibition of Chelidonium.

Chelidonium will often be of service to children afflicted with worms, when they complain of crawling, pricking and itching within the rectum, or on the perineum, associated with costiveness. Schallern testifies to its good effects against round worms.

Constipation, with white, clay-like stools, or resembling sheep-dung, is often removed by gentle purgation with this drug.

IV.—But, it is in diseases of the liver that we find the real value of celandine. You will find no better remedy, and none so often indicated in general practice, in the disorders of the liver. Valuable as Podophyllum, Leptandra and Iris are, yet, I believe, Chelidonium is oftener indicated than either of them. Pain under the right scapula, with constipation of whitish stool, or bright, yellow diarrhoetic stool, with acid urine, is diagnostic for it. You will find it of value in the treatment of acute inflammation of the liver, induration of the liver, catarrh of the gall-ducts, cholesteraemia, jaundice of every grade, biliary calculi.

Dr. Hale details a case of biliary obstruction in which the prompt curative action of the medicine was unmistakable:

"The patient was a gentleman, an old resident of Chicago. He had been jaundiced nearly two years, and during that time had suffered intolerably with congestive chills, terrible cardialgia, periodic intense hepatic pains, and his appearance when I first saw him was frightful. He was bronze-yellow; emaciated in the extreme; urine scanty and nearly black; stools hard and white; total inability to retain food; pulse intermittent and almost imperceptible. Like the case above alluded to, he had been drugged constantly for the two years, without the slightest benefit. I began with two drops tinct. Chelid. every three hours, increasing it a drop each dose every day, until he took ten drops, when he was seized with intense pains in the gall-bladder, followed by the expulsion from the bowels of a stone, dumb-bell shaped, nearly an inch long, and half an inch in diameter. He rapidly recovered—New Remedies, p. 138.

Many other cases of similar import come to us from Germany and England, showing its wide acceptance. In two cases of gall-stones and black jaundice fifteen drops of the juice of celandine four times a day removed fifty-three stones in one case and three hundred in the other. In all or nearly all diseases in which you will get rapid curative effects from celandine there will be some connection between the disorder and the state of the hepatic system.

V.—It is probable that celandine may yet prove of value in renal troubles, especially those that date back to pre-existing hepatic derangements. It has the power of setting up a condition analogous to Bright's disease, and although clinical experience has not yet confirmed the hypothesis, I would suggest that you give it a trial, and watch carefully the results. If, as I hope, it can make a place for itself here, it will be a treasure of priceless value.

VI.—In the treatment of diseases of the respiratory organs, it is a remedy of considerable importance. Influenza, with frequent sneezing, soreness in the nostrils, and associated with more or less irritation of the vagi, comes within its influence. Whooping-cough is sometimes relieved by it, especially the epidemic form, with hepatic torpor. Laryngitis, bronchitis, pneumonitis and pleuritis, when the liver is implicated, and particularly if there be a yellow, slimy diarrhea, with the peculiar dietetic desires and dislikes that I have mentioned, will yield to its influence. Even nervous affections, such as asthma, hay-asthma, spasm of the glottis, prosopalgia and chorea, with the above concomitants, are benefitted by it.

Kissel gives the following sample cases of cough, with emaciation and fever in the evening, that come within the province of celandine.

1. A boy, aet. 4, had had a cough for a week, and in the evening a hot fit, with perfect intermission, when I undertook his case, March 19, 1849. The boy, who was previously stout, had become strikingly thin, with a dirty-gray complexion. He complained of nothing, but coughed up a little phlegm. Auscultation showed nothing abnormal; stool bright-yellow and consistent; urine bright-yellow, clear and acid. The pulse in the morning soft, not frequent; skin of normal temperature.

Gave twelve drops of tinct. Chelid. per day.

On the second day the fever was gone, and in a few days the child was quite well.

2. A girl, aet. 4, had suffered for ten days with cough and loss of appetite, and had several times had transient pain in the bowels when I saw her March 29, 1849. She had fallen away rapidly, had a dingy-gray complexion, and coughed hard without much expectoration. Auscultation discovered mucous rale on both sides. Her tongue was clean; urine bright-yellow, clear and natural; pulse 110 and small; skin of normal temperature and rather moist; stool quite white, like thick pap; conjuctiva clear white, without any trace of bilious tinge.

By March 31 the cough was more moderate; stool once brownish, but then white again. April 2 it was brown, and continued so; the mucous rale could scarcely be heard; pulse 80. The child was playing again. Quite well by April 5.

Chelidonium will materially alleviate whooping-cough, when the catarrhal symptoms are prominent (or catarrhal diarrhea); the cough, which is violent and straining, with lachrymation, alternates with burning, shooting and constrictive pains in the larynx, and expectoration.

The following case is mentioned as typical of its use in spasm of the glottis:

A child one year old, grown rather thin, was ill for ten weeks. Always on waking it had a fit of laryngeal spasm, which had become gradually more severe till at last the respiration ceased for sometime at each fit. The tongue was thickly coated yellow, stool greenish-yellow, urine bright-yellow, clear and strongly acid.

Well in four days.

VII.—Sometimes, hepatic derangements involve the cardiac structure and set up an inflammatory action resulting in pericarditis, or endocarditis and here also Chelidonium will come to our assistance; just as we saw Digitalis, when we studied that drug, wiping out hepatic disorders arising from cardiac affections. Analogous to aconite and Bryonia, it will sometimes replace both of these in the treatment of measles—the gastro-hepatic symptoms will be diagnostic. It will replace Arnica in treatment of erysipelas of the face, traumatic or otherwise; the and Baptisia and Rhus, in typhoid fever. Dommes relates a severe case of vesicular erysipelas of the face cured by the tincture of Chelidonium in six days. Rademacher, Loffler, Bernhardi, Kissel and Thienemann all found it efficacious in epidemics of typhus, characterised by rapid general emaciation, sense of being bruised all over, dizziness and confusion of head, and incoherent speech. The loose stools numbered six or twelve per day, and were bright-yellow or green, watery, slimy, and parted into two portions, one of which was thinner and stood uppermost, whilst the other covered the bottom of the vessel. In children they were often quite white, as in the last stage of jaundice. The urine was at first jumentous and very acid, then turned deep-yellow and turbid afterwards bright-yellow and clear. The normal duration of the disease was eight weeks, and death was preceded by hemorrhage from the bowels. The tincture of chelidonium was found to be the remedy. Twenty drops per day were given in divided doses, and complete recovery took place in from two to three weeks. Death occurred in no instance where it was employed.

It has already been stated that obstinate intermittents were formerly cured by Chelidonium. It will be found useful in those cases where the fever sets in daily, in the afternoon or evening. The chill lasts fifteen or twenty minutes, followed by fever for two hours, with thirst.

When you meet with a case of rheumatism or rheumatic gout, characterized by intense pain on the part being touched ever so gently, particularly if the functions of the pneumo-gastric nerve are more or less perverted, give a trial to Chelidonium.

VIII.—In certain forms of headache it is indispensable. These are mainly bilious or sick headaches, but it will also be useful occasionally in neuralgic headache. The Chelidonium headache is periodic; the pain is acute, and presses in the direction of the forehead (Bry.); it seems as if the head was compressed with a bandage, close over the eyebrows (Cactus); when she wants to sit up in bed, she has to raise her head with her hand, for fear the occiput will break off from the rest of the skull (Eupat. perf.); violent throbbing pains from nape, coming over the occiput to the temple (Sanguin.); pains in the root of the hair when combed (nux vomica); vertigo when sitting up in bed (Arnica), when closing the eyes (contra acon. Puls. Sang.), with tendency to fall forwards (Rhus tox). The pain is relieved by eating (contra nux), agravated by fresh air (contra Puls.), by lying down (contra nux) by cough (nux vom.), by blowing the nose (Rhus tox.), by stooping (Bry.)

IX.—And lastly, in some cases of mental alienation, or suicidal mania, when the person is restless, forgetful, quarrelsome, and imagines she has committed some great or unpardonable crime; you will relieve this condition, arising reflexly from long-continued hepatic and gastric disorder, and cure its hepatic causator, by administering a course of celandine.

In diseases calling for Chelidonium, the following symptoms are diagnostic:

Forgets easily. Sleepy, but cannot sleep. Dread of motion. Tongue narrow, pointed, white. Redness of the left cheek. Longing for milk, wine, acids. Urine intensely sour. Stools bright-yellow. Skin lemon color.

Chelidonium is best suited to blonde persons, Bryonia to those with dark hair and eyes.

Now, as to dose. We may take a leaf out of Rademacher's experience, who first used it in massive doses, but, finding many disappointments, reduced his doses to a few drops, or fractions of a drop, with manifest good results. The best results follow the smallest doses. Give five drops of the fluid-extract in an ounce of water, a teaspoonful every hour or two; increase if effects are not observed, decrease when it causes aggravation of the complaint. The maximum dose is a half drachm.

Transactions of the National Eclectic Medical Association, Vol. X, 1882-83, edited by Alexander Wilder.