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Action, Medical Uses, and Dosage.—Santonin is an active agent, and, in improper doses, is capable of producing serious symptoms, and even death. As small a dose as 2 grains is said to have killed a weakly child of 5 years, and 5 grains produced death in about 1/2 hour in a child of the same age. Among the toxic effects may be mentioned gastric pain, pallor and coldness of the surface, followed by heat and injection of the head, tremors, dizziness, pupillary dilatation, twitching of the eyes, stertor, copious sweating, hematuria, convulsive movements, tetanic cramps stupor, and insensibility. Occasionally symptoms resembling cholera morbus have been produced, and in all cases the urine presents a characteristic yellowish or greenish-yellow hue. We have observed convulsions caused by the administration of "worm lozenges." Death from santonin is due to respiratory paralysis, and post-mortem examination revealed in one instance a contracted and empty right ventricle, and about an ounce of liquid, black blood in the left heart, an inflamed duodenum, and inflamed patches in the stomach (Kilner). The chief form of treatment of poisoning by santonin is by artificial respiration. Internal and external stimulation should also be resorted to, inhalations of ether or chloroform, to control the convulsions, should be given, and a purgative administered to remove remaining traces of the poison from the bowels. Santonin often produces a singular effect upon the vision, causing surrounding objects to appear discolored, as if they were yellow or green, and occasionally blue or red; it also imparts a yellow or green color to the urine, and a reddish-purple color if that fluid be alkaline. Prof. Giovanni was led to believe that the apparent yellow color of objects observed by the eye, when under the influence of santonin, did not depend upon an elective action on the optic nerves, but rather to the yellow color which the drug itself takes when exposed to the air. Santonin colored by the air does not produce this effect, which only follows the white article. The air gives the yellow color to santonin, to passed urine containing it, and to the serum of the blood when drawn from a vein, and, according to Giovanni, it is owing to its direct action upon the aqueous humor, where it is carried by absorption, that objects present this color. The view now held, however, is that of Rose, that the alkaline serum dissolves the santonin, which then acts upon the perspective centers of the brain, producing the chromatopsia or xanthopsia. Santonin has been advantageously given in amaurosis following acute inflammation of some of the internal parts of the eye; also in subacute and chronic retinitis and choroiditis. It is said to have materially benefited cases of noncongenital color-blindness, being administered in 1/20 or 1/10 grain doses (Foltz).
Santonin is the chief remedy now used for the expulsion of the roundworm or ascaris lumbricoides. It acts less effectually upon rectal ascarides, and not at all upon the tapeworm. As a rule, when a single dose is to be given, it should be administered upon an empty stomach, and the patient should refrain from eating for a short time afterward. A purgative should precede and follow its use. Another method, which has found much favor in the Eclectic school, is that of giving santonin, in divided doses, as follows: Rx Santonin, grs. v; podophyllin, grs. j; milk-sugar, i. Mix. Divide into 10 powders, and administer 1 powder 3 times a day.
Santonin is an important nerve stimulant. It relieves many of those nervous phenomena which simulate the conditions produced by worms—picking at the nose, starting in sleep, intestinal irritation, etc. Its effects upon troubles of the urinary apparatus, due to disordered or deficient innervation, make it one of our best specific remedies. In retention of urine, due to atony of the bladder, no remedy surpasses it, and when this occurs as a symptom of the advanced stage of acute diseases of children, indicating an unfavorable prognosis, unless the urinary function can be restored, santonin may be given in 1/4 to 1/2-grain doses (triturated with sugar), every hour, until a free urinary flow is established. Retention of urine, caused by opium preparations, is corrected by it. Being strongly diuretic, it may be administered in in renal colic. It relieves urethral irritation, dysuria, strangury, nocturnal enuresis, chronic vesical catarrh, and vesical tenesmus. It acts promptly in the urethral irritation, with pain and scalding, associated with uterine disorders, and in large, but unsafe, doses (10 grains), it has been recommended in uterine colic and amenorrhoea (Berthey). It relieves the difficult micturition and urinal retention following parturition, when not due to long-continued pressure of the child's head upon the parts. Many of the unpleasant urinary symptoms of albuminuria and chronic nephritis are relieved by santonin, and it is a remedy for impaired breathing and tympanitis due to deficient spinal innervation. The dose of santonin for an adult ranges from 1/10 to 4 grains; for a child, 1/20 to 2 grains, always avoiding the larger dose when possible; 2 x trituration, 2 or 3 grains, for its effects upon the urinary apparatus.
Physiological Action. - This agent acts as an anthelmintic to the round worm and to a less degree on the thread worm. IT has no action on the tape worm.
Many cases of poisoning and death have been reported from its use.
A boy three years old was given 1/3 of a grain till fifteen tablets were taken in three days, at which time the child was vomiting; the pupils dilated; collapse, cyanosis, dyspnoea and finally convulsions developed. The temperature was 103. 5; epistaxis and haemoglobinuria developed, and a rash similar to scarlatina.
Prostration, convulsions, cramps, icterus, salivation and uncertain of the gums have been reported from other toxic doses.
It affects the cerebral circulation and vision so that objects appear at first blue, then green or red, and at last they are yellow. This may be followed by temporary blindness.
It is excreted by the kidneys, coloring the urine greenish - yellow if it is acid and reddish - purple if it is alkaline.
It should never be given to a child in physiological doses, while suffering from a fever or while the bowels are constipated.