The ALOE SPICATA, the inspissated juice of the leaves of which is the part used in medicine. It has various names denoting the origin of the specimen.
1. Socotrina, the finest kind, called also Turkish or Indian Aloes, of a garnet red color with a golden or yellow red when powdered.
2. Hepatic, similar but less brilliant.
3. Cape Aloes, the most abundant, derived from the Cape of Good Hope, greenish and dull.
4. Barbadoes Aloes, strong, dark brown, used for horses.
Aloe has been used in medicine since very early days. Its great bitterness has given it reputation as a tonic, but its chief use has been as a cathartic.
The ancients ascribed to it a special power to purge off the bile, and to cure affections of the abdomen and of the head, supposed to depend on a disordered state of the biliary secretion.
Aloe is a drug in very frequent use in our day. Very few purgative pills are ordered by practitioners which do not contain a portion of Aloes. It is the standing ingredient of the so-called anti-bilious vegetable purgative and other pills known as "patent medicines." Likewise of certain officinal mixtures, about the names of which there has gathered from the days of our childhood a certain odor of antique sanctity, to wit, the tincture of aloes and canella, known as hiera picra (or sacred bitters), and the tincture of aloes and myrrh, known as the elixir proprietatis (or, more commonly, elixir pro).
Trousseau and Pidoux give an excellent summary of the action of Aloe :
Administered in small doses (one-half grain to one grain) once or twice a day, it provokes moderate colics, followed by the expulsion of one or more diarrhoeic stools. It is remarkable that the action of this purgative is very slow, the stool rarely follows within six or seven hours after the dose, and often not till twenty-four hours after it. The first effect, then, is to augment the number of the stools, or simply to facilitate their evacuation, and it likewise stimulates the functions of the stomach, but only where the slowness of digestion is not accompanied by symptoms of chronic gastritis. If the use of Aloes be continued for a long time, there soon ensue symptoms of sanguineous congestion of the pelvic organs, such as heat, itching, sensation of weight toward the extremity of the intestine, excitation of the genital organs, and frequent need to evacuate the bladder. In women, pain and heaviness in the uterus, in the groins and in the loins, increase of the leucorrhoea, uterine colics, more painful during the menses, increase of the menstrual flow.
Aloe has been known, in numberless cases, to produce congestion of the lower part of the rectum, with haemorrhage from the haemorrhoidal veins. And the tendency to this action is a great objection to the customary long-continued use of this drug as an habitual palliative in constipation. Nevertheless, Aloe has been successfully used by Eberle in the treatment of haemorrhoids.
By reason of its power to cause congestion of the pelvic organs, Aloe has been used by the old school as a derivative in cases of severe cerebral congestion, also in amenorrhoea (particularly the tincture aloes et myrrhae or elixir pro).
Our direct knowledge of Aloes is derived from a proving conducted by Dr. Hering (and published in his "Amerikanische Arzneipriifungen," vol. i.).
A most excellent, accurate and spirited translation of this admirable proving will be found in the appendix to vol. v. of the " American Homeopathic Review." It was executed by Prof. T. F. Allen, A. M., M. D., of New York, and is a model of philological discrimination, avoiding at once the indefinite and flippant gracefulness of modern English, and the corduroy roughness of colloquial German; combining the acerb crispness of rugged Yorkshire with the Amherst softness of highly civilized southern Saxony.
As already stated, the action of Aloes is chiefly exerted upon the pelvic organs, in which it produces functional changes (in so far as the secretions are concerned in frequency and manner), and organic in this that the organs are gorged with blood.
The action upon the head I believe to be secondary upon the action on the pelvis. I have never seen it disassociated therefrom.
The peculiarities of Aloes will appear in the special analysis.
On the sensorium Aloe produces a singular combination of anxious restlessness, despondency, indisposition to mental or bodily exertion, and confusion of the intelligence. These conditions alternate, but the depression is predominant.
Considerable vertigo is produced, which, however, coincides with constipation or other disordered condition of the intestine and its functions.
It resembles the vertigo of Chelidonium, which coincides with pain in the right hypochondrium and at the angle of the scapula, and with icteric complexion and bilious urine.
The headache of Aloes is chiefly a confused feeling of heaviness or pressure in the anterior part of the head, a weight pressing down the middle of the forehead to the root of the nose. The pressure sometimes extends to the vertex, sometimes to the temples. Sometimes throbbing. Most provers note that this headache accompanies or alternates with colic or constipation, or with the kind of diarrhoea peculiar to Aloes.
The scalp becomes sensitive to touch. Respecting the eyes, we note here only a symptom which often accompanies the pressing frontal headache, viz., pressure on the eyes from above and a feeling as if it were necessary to contract the eyes and make them very small in order to see (symptom 172). I have prescribed on the authority of this symptom Aloes for a patient whose other symptoms were not very clearly indicative of Aloes, and thereby succeeded in permanently curing a chronic headache.
I call attention to the ear symptoms in the published proving, because Dr. Hering has found Aloes to be a good ear remedy. I have no experience with it as such.
HYPOCHONDRIA. In the hepatic region we find pressure and tension, discomfort, a sensation of heat, pressure, and single not severe stitches. These symptoms, along with the sickly expression of face and the bitter taste, point to some derangement of the liver, though, from the absence of fever in the Aloes proving, it cannot be acute inflammation. Eberle signalizes the efficacy of Aloes in certain forms of jaundice.
(Lycopodium has tension and pressure, but these are felt in the left as well as in the right hypochondrium, and are aggravated by pressure on the epigastrium. China has symptoms in the right hypochondrium, similar to those of Aloes, but is distinguished by the fever symptoms and others. The Chelidonium liver symptoms are accompanied by pain under the right scapula, and generally by cough.)
The abdomen is somewhat distended with flatus. There is head fullness, a sense of weight and dragging, particularly in the hypogastrium, and the abdomen is tender on pressure.
The heaviness extends into the rectum and into the region of the bladder. Flatulent colic accompanies the pelvic congestion.
As regards stool, it is first, by very small doses, retarded and diminished. Then it is more free; finally there ensues a half-fluid, light yellow, moderately offensive stool, and at last a yellow watery diarrhoea.
The peculiarities of the evacuation characterize this drug. The diarrhoea comes on early in the morning, say at five A. M. The desire for stool wakens the patient, and he can hardly rise with sufficient rapidity. In this respect Aloe resembles Sulphur, Thuja (and Bryonia).
Croton tiglium has a morning diarrhoea, light yellow, watery, almost painless, very abundant, gushing out in an instant, imperative, leaving prostration.
Sulphur diarrhoea is white mucus, watery, painless, containing undigested food; the patient has to get up to go to stool.
Thuja, pale yellow, forcibly expelled, with much wind. It returns at the same hour but is not imperative.
Bryonia, dark and putrid, smelling like old cheese. Only A. M.
But with Aloes there is throughout a peculiar sensation of weakness in the rectum, and particularly in the sphincter ani, as if the latter would be suddenly relaxed in spite of the patient's will, and would permit the escape of faeces.
The diarrhoea rarely continues later than ten A. M. The disposition is always brought on by eating, E. G., at the breakfast table.
So treacherous does the sphincter ani seem to be that the emission of flatus is dreaded as sure to be accompanied by the escape of faeces. (Similar to Phosphoric acid.) So likewise the patient dreads to pass water lest the slight exertion and bearing down involved in that act should also move the bowels.
A very similar state of things obtains with regard to the sphincter of the bladder.
At the same time there is a frequent disposition (as with Nux vomica) to evacute the bladder and rectum.
At the extremity of the rectum, burning, itching. Bleeding from the rectum.
In the perinaeum, a sensation of weight and a feeling as if a plug were wedged in between the symphisis pubis and the os coccygis.
Hepar sulphuris, Thuja and Causticum have similar sensations pointing to affections of the prostate gland.
In the pelvis, heat, weight, pressure and dragging downward.
The menstrual flow is augmented and hastened.
The practical applications of Aloes follow clearly from the statement of symptoms. Experience has thus far established its value in the treatment of diarrhoea, headache and vertigo depending on pelvic congestion, haemorrhoids, prolapsus uteri and menorrhagia.
The symptoms which have seemed to me the most characteristic are those of the head and of the abdomen, stool and urine. They are those on which my use of Aloes in practice has been based. Chief among these are those of the stool.
From symptoms 512 to 860, we gather that Aloes produce a diarrhoea consisting of light-colored semi-liquid faeces, preceded and accompanied by much gurgling and flatus in the abdomen; that the diarrhoea occurs especially in the morning, say from two A.M. to ten A.M. ; that the desire for stool is sudden and extremely urgent, being felt in the hypogastrium and in the rectum, and being so urgent that the patient can scarcely retain the faeces long enough to effect the necessary strategic "change of base;" that, during this brief interval, he fears to evacuate wind by the anus or to make any physical exertion, or even to strain to pass water, lest he should have an involuntary evacuation of the bowels. This sensation of the uncertain tenure by which the faeces are held in the rectum is a very well marked characteristic of Aloes, as shown by the following symptoms:
The evacuation takes place without any exertion on the part of the patient; it seems, as it were, to fall out of the rectum (765). At stool a constant feeling as if there were more faeces to be passed (769). Involuntary passage of faeces when emitting flatus (824). Disposition to stool when passing water (826). Faeces and urine seem inclined to pass and do pass simultaneously (827). When passing water feeling as if a thin stool were about to pass (828). When standing, sensation as if faeces would pass (833).
There is also a similar frequency or urgency of the desire to pass urine, with a similar uncertainty in the tenure of that excretion, as we perceive from the following symptoms:
Frequent desire to urinate (990). Increased desire—quantity not increased (992). So urgent a desire he can hardly retain the urine (993). On rising he was obliged to run quickly to urinate (996).
And the similarity of the affection of the urinary organs and the intestines is shown in symptom 1001:
At stool, urination; when urinating, desire for stool.
In connection with these two series of symptoms, those of the pelvis deserve notice. Among them we find, " heaviness, pressure downward (865, 861). Feeling as if a plug were wedged in between the symphysis pubis and the os coccygis (860)." This is equivalent to a weight upon the perinaeum. Viewing it in combination with the symptoms of stool and urine above referred to, we are justified in saying of Aloe, in regard to this portion of its sphere of action, that it strikes the patient equally "between wind and water."
It is understood, of course, that this is not the only action of Aloes upon the abdominal organs. It is believed, however, to be that variety of action which is most characteristic of the remedy and least likely to be confounded with the effect of any other drug. In the frequent desire for stool; in the frequent, pappy, not very abundant stool; in the pressure downward in the back and pelvis; in the abundant formation of flatus in the abdomen, which rumbles and gurgles, producing pinching pain in the lower part of the abdomen just before the stool, the action of Aloes very closely resembles that of Nux vomica, a remedy so useful in diarrhoea and dysentery. It is distinguished, however, by the peculiarities of the evacuation of stool. Nux vomica produces very frequent desire for stool, with inability to evacuate the faeces. Under Aloes, on the contrary, the difficulty is to retain the faeces as long as the patient desires to do so. Aloes seem to paralyze the sphincter ani to a certain extent, Nux vomica to excite in it a spasmodic action of exalted power. In this action on the sphincter, Aloes resemble Hyoscyamus.
Among the symptoms of the head I am inclined to regard as characteristic of Aloes, those which describe a heavy, confused dullness in the . front part of the head extending to the root of the nose, with inability to think; a pain in the forehead which compels the patient to close the eyes or, if he wishes to look at anything, to constringe the eyes, making the aperture of the lids very small. It must be admitted, however, that symptoms so similar to these are found under other remedies, that these symptoms alone could not be regarded as a sure indication for Aloes.
The following cases will show how I have prescribed Aloes, and will suggest some reflections upon the mode of selecting remedies in practice.
Within the last three years I have treated about thirty-five cases which so closely resemble each other in their characteristic elements, that the description of all may be given in that of the last of the series, which came under my care a month ago.
A young man applied for relief from a diarrhoea which had persisted about two weeks in spite of various remedies which had been prescribed for it, and among which were Calcarea, Nux vomica, Bryonia, and the inevitable Arsenicum. He described his stools as being light yellow, pappy, somewhat frothy, and tolerably abundant. They were preceded by flatulent rumbling in the abdomen and by pinching pain in the hypogastrium. The necessity for a stool awakened him from a sound sleep about three A. M. From this hour to nine A. M. he had from four to six stools of the character above described. None at any other period of day or night. When the desire for stool was felt, the urgency became instantly so great that he was compelled to spring from the bed and hasten to the water-closet. Yet this urgency was not of the nature of tenesmus, but rather a sensation of weakness in the sphincter, as though he could not prevent the faeces from falling out. During stool, which passed freely in a mass the instant the restraint of the patient's volition was withdrawn from the sphincter ani, there was a slight burning in the rectum. After stool, cessation of pain, but a very slight general sensation of weakness and lassitude.
During this period, from three to nine A.M., the patient was compelled to avoid all rapid or severe exertion of body, and especially straining to pass water. The penalty of such exertion or straining was sure to be an involuntary evacuation of faeces.
I prescribed one powder of Saccharum lactis containing two globules of Aloes 200 to be taken dry on the tongue at ten A. M. (the hour at which he called on me). From this time he had no diarrhoea. The next morning he slept until seven A. M., and at nine had a natural stool as was his habit in health.
During the winter season, a gentleman about seventy years of age applied for relief from a dull, heavy, frontal headache, which incapacitated him from mental labor. He could give me no more definite nor characteristic description of his ailment. It was felt as soon as he waked and lasted all day. From such a description as the above, it would be impossible to prescribe with any certainty of selecting the right remedy. I set myself, therefore, to investigate the patient's previous history, in the hope of getting some help from the Anamnesis to which Hahnemann and Bïenninghausen attach so much importance. I learned that this headache was no new affliction. It had for years annoyed this gentleman, rather more during the winter season, whereas during the summer he was comparatively free from it. No peculiarity of diet or regimen could explain this fact.
On the other hand, I learned that during the summer season my patient was very frequently attacked with diarrhoea, the disease coming on suddenly, waking him at two A. M., with a pinching, flatulent colic, and so urgent a call to evacuate the bowels that he would be compelled to seek the water-closet instantly, experiencing, meanwhile, the greatest difficulty in retaining the faeces. From this time till ten A. M., he would have four or five stools, pappy, copious, light yellow, great difficulty in retaining the faeces for even a moment after the desire for stool was first experienced. Desire for stool provoked by eating, so that he was compelled to leave the breakfast table. Involuntary stool when straining to pass water. When comparatively free from headache he was inclined to diarrhoea, and VICE VERSA.
I have long been persuaded that a most important condition of success in the treatment of chronic diseases, consists in the practitioner taking such a view of the case as shall combine the various ailments of which a chronic patient may complain at different periods of time and in different organs, even though these periods and organs be remote from each other and apparently disconnected. In no other way, it has sometimes seemed to me, could the characteristic indications of the remedy for such a case be found.
Acting upon this persuasion in the case in question, I regarded the headache which predominated in winter, and the diarrhoeas which predominated in summer, as in some sort complementary series of symptoms, and as making up, both together, the " totality of symptoms" for which I was to seek, in the materia medica, the SIMILIMUM.
The symptoms of the headache—indeed of the entire winter affection—presented nothing that was characteristic of any one remedy to the exclusion of all others. Carbo vegetabilis, Sabadilla, Sulphur, Aloes, Nux vomica, and several others, might be regarded as about equally well indicated.
When, however, to the head symptoms of the winter I came to add the diarrhoea symptoms of the summer, regarding the sum total as one disease, it was then impossible to avoid perceiving that the diarrhoea symptoms were strikingly characteristic of Aloes, and could not indicate any other remedy. This furnished the clue to the prescription. On studying the head symptoms of Aloes, it was seen that they corresponded to the head symptoms of my patient quite as well as the symptoms of any other drug. Aloe 200 was given, and it afforded a relief which my patient had sought in vain from other remedies taken on the strength of the head symptoms alone. The headache returned a few times afterward with very much diminished severity, but yielded at once to Aloes. Latterly, my patient has been entirely free from it, nor did the diarrhoea return as it used formerly to do whenever the headache ceased to prevail.
In a third case I have given Aloes for incontinence of urine in an old gentleman who has enlarged prostate. The prescription was based on the fact that he is very subject to a diarrhoea, presenting all the characteristics of the Aloes diarrhoea. The peculiarities of the incontinence, moreover, correspond to those of the Aloes urine symptoms. Thus far, the success of the treatment leaves nothing to desire. But as the patient has been but a few weeks under the treatment, it is too soon to express a decided judgment or to entertain sanguine expectations of a cure.