ECHINACEA-SOME OF ITS USES IN MODERN

SURGERY.

BY A. B. MATHEWS, M.D, ELBERTON.

My object in bringing this single remedy to your attention in preference to many other remedial agents employed to correct conditions commonly termed septic is the fact that I believe it to be the best of its class and that it seems to be so little known to the profession. In reporting the few surgical cases which will follow, I do not do so on account of any original research, but because of the fact that they have been of special interest to me. On account of the uniqueness of some of them and the extreme severity and seemingly utterly hopelessness of all which was intercepted by the free use of echinacea. Echinacea augustifolia, purple cone-flower, was brought to the attention of the medical profession by Dr. Myer, of Nebraska, in which State the plant grows wild, as well as in other States on the Western plains, and was first used by the Indians, who used the bruised root locally and a decoction internally for snakebites. That this plant possessed antidotal properties for the venom of the rattlesnake-bite can not be doubted, and led to a long series of experiments in other conditions of toxemia, and the result has been so satisfactory in the treatment of septic conditions as to be termed by other writers "A corrector of blood dyscrasia." By so broad a statement as the above many conditions of the blood would be thought of, the result of many kinds of infection and the thousands of ways by which they occur, whether it be a slight abrasion of the skin through which a mild infection takes plac›

or through some internal source the introduction of extremely virulent bacilli. Echinacea does play a part so marked in its influence upon the character of the blood to be well worthy of the title, "A corrector of blood dyserasia." The physiological action of this drug I am unable to give. I know some of its virtues nor need the mode of operation worry us or detract any of our faith in its influence without giving the reason how it acts as a blood-corrector. So we need not worry if an explanation as to how this remedy acts is not forthcoming, so long as we are familiar with the result obtained by its use. My experience with echinacea began in the spring of 1902, and the best results obtained was from the fluid extract prepared by Merrell, dose five to twenty gtt., locally applied twenty-five per cent. dilution. When taken by the mouth in twenty-drop doses of the fluid extract a pungent warmth is at once experienced, which decreases to a tingling, and remains for at least an hour after the agent is rejected. It resembles very closely the sensation produced by aconite, but more of a nerve irritant. If a small quantity be swallowed there is an apparent constriction of the throat, a very marked sensation of irritation much greater in some patients than in others, and always disagreeable. Experience teaches ma that it promotes the flow of saliva, a warmth of feeling of well-being in the stomach, slightly diaphoretic, increases if continued. The action of the kidneys, the whole glandular system seems to be stimulated under its influence. The stomach is improved in its function, the appetite increases, food is more perfectly digested, the bowels operate better and absorbtion and assimilation and general nutrition is in every way improved. It encourages secretions and excretions and in this manner prevents any further autoinfection and quickly relieves the system of any that is present. It stimulates retrograde metabolism probably better than any single remedy known, save phosphorus. Its in

fluence is marked upon the whole lymphatic system, and the condition of the blood suggests that the patient has been taking stimulants. So far as known no toxic symptoms have been observed, and aside from the apparent irritation no unpleasantness has been occasioned by its use. The writer has used the remedy with infants only a few days old, and in every stage of life to extreme old age, and so far has observed no deleterious results that could be traced to toxic influence of this particular drug, and in view of this fact with the gratifying experiences in relieving many almost helpless conditions of the various forms of blood poison, leads me to believe that in echinacea we have the best and at the same time the safest of all the remedies of its class. In the treatment of typhoid fever it seems especially valuable and can be given without interruption from the start to the close of the disease with any kind of temperature without any fear of doing the patient any irreparable damage, but with an assurance that if properly administered the severity of the disease will be modified and less liable to have complications, and shorten its duration. In a series of twenty cases treated with echinacea, I have never seen tympanites or a hemorrhage. Given in smallpox it lessens aching and shortens the febrial period, and beyond question robs the stage of pustulation of its frightful consequences. As a remedy for anthrax it exerts such an influence that the formation of new colonies of boils can almost with certainty be stopped, and those already in process of formation often cease to be painful, redness and swelling subside, and in short, a very painful process avoided. To accomplish the best results in this last case the dose should be quite large and repeated every hour until from twenty-four to thirty-six doses have been taken, or until fever begins to subside when the administration interval should be lengthened two, three or four hours, and

kept at four hours, for at least twelve days after the last boil has disappeared.

As a remedy for burns I have never seen its equal. It relieves the pain and burning sensation almost instantly, less cicatricial tissue follows its use than any other remedy or combination of remedies used by the writer. The burned surface should be prepared by replacing the loose skin, if any, removing foreign substances that lie loose upon the surface, sterilized gauze evenly applied should cover the whole burned surface, care being taken if the hands or feet be involved to wrap each toe or finger separately and keep this dressing moist with a solution composed of twenty-five per cent. dilution with sterilized water, and allowed to remain until the healing process separates the gauze from the contact with part. Covering for this dressing should be made by some impervious material that can easily be removed to allow making the application to the gauze. If any rise of temperature occur, which is not likely to be expected if proper local application is made, the remedy should be given internally in small and often-repeated doses. If the solution be properly applied, little or no suppuration takes place. It seems to counteract shock; whether this be due to its effect in relieving pain or its similar action spoken of in the description of the drug, I am unable to say, but am of the opinion that it is a combination of both.

Gangrene. While my experience in the treatment of senile gangrene has been limited to a few cases in which echinacea has been the chief remedy, and in two cases the only remedy employed, my confidence in its usefulness has not been shaken, but each case seems more convincing that we have in this remedy something by which we can influence the course of the malady and change into many recoveries what not many generations past was considered always fatal in its course. When we consider the pathology of gangrene, the, febrile circulation and very often but little

arterial blood at all going to the part affected (hence its death), with the rather active absorption and resultant septic material thrown into the general circulation, pain, loss of sleep, disturbed nutrition, and since the surgeon can offer little assurance of recovery by amputation of the part, however early in the course of the disease he may see the case, any remedy that promotes fifty per cent. of recoveries should be given a fair trial at least. Echinacea applied locally in the proper strength stops the sloughing, the stench of dead flesh soon passes away, and a line of demarcation is soon pointed out when amputation should be done to shorten the process of recovery. I believe the remedy should he administered internally in every case of senile gangrene, especially if any symptoms be present of sepsis, for its influence on the process of nutrition to the parts. In snakebites my experience is nil, but in those localities where the crotalus is found, many cases are reported, by men whose integrity is beyond question, of recoveries which are believed to have been done by the free use of echinacea locally and internally. This drug promises much to the surgeon, in that by its use he may render disease of injured parts more favorable for operation, particularly so in senile gangrene and a host of other conditions where an immediate operation not only promises little good, but absolute harm. No surgeon will from choice operate on any part in the stage of acute inflammation, no matter how trivial it may seem, without first making an effort to remove the septic condition, and until recently in a haphazard indefi-nite manner with such remedies that not only destroy infectious material but often cause destruction of the very part that the effort was made to save. The first case I wish to mention is a case of empyema, a purulent effusion into the left plural sac, the sequelae of pneumonia.

History. The patient was a hard drinker, contracting pneumonia about August 1, 1903. He was in another