Part IV
ADONIS VERNALIS.
This remedy, like Convallaria, comes to us from Russia, and, like many of our best remedies, was first used by the common people as a remedy in dropsy and heart disease. Experiments were first made by Dr. Botken, the results of which were described by Dr. Butnon in a graduating thesis. The experiments made on both cold-blooded and warm-blooded animals with different preparations of Adonis (infusion and both aqueous and alcoholic extracts) showed that its action is to stimulate both the inhibitory apparatus and motor ganglia of the heart, to increase the contractility of the cardiac muscle, and to cause the contraction of small arteries in different parts of the organism without affecting the vaso-motor centre.
Under its influence in cases of dropsy the cardiac contractions increase in force, the pulse become less frequent, more regular and full, the urinary secretion increases from 200 to 2,000 or 3,000 cubic centimetres, and albumen and casts disappear from the urine.
In cases where the dropsy was due to a disturbance in the compensation and activity of the heart this remedy acted very satisfactorily. The heart-beat increases in force, and the size of the heart rapidly diminishes; the heart-sounds and murmurs, especially the presystolic and systolic in stenosis, are more marked and distinct. The heart-rhythm is more regular and somewhat slower; therefore the pulse is slower, and in most cases the pulse-wave fuller and slower. The urine increases from 300 to 3,000 cubic centimetres, a tenfold increase of the watery element. All deposits disappear, the specific gravity diminishes, and the urine has a very pale color. There is an absolute increase of the chlorides and urates, the body weight diminishes, and the oedema decreases rapidly; the dimensions of the liver increase, cyanosis and dyspnoea disappear, and respiration becomes full and regular.
In the largest number of cases great relief was experienced at the end of the first day. Complaints were less frequent, and in the course of a few days disappeared entirely.
These clinical results were obtained in hospital practice, where the cases were closely and carefully watched.
It is indicated in cases of (a) endocarditis, with valvulitis, when the heart-muscles are endeavoring to overcome the valvular obstruction and need the aid of specific remedies to increase the tonicity of those
14 tissues; or (b) when there is impending or actual dilatation of the heart from a giving way of muscular fibres. This condition is marked by diminished force of the heart’s action, with lowered blood-pressure everywhere, especially in the kidneys, decreasing their functional activity.
It has been found equally potent in secondary heart disease, following Bright’s disease, when we find a diminished action of the heart, pulse irregular or intermitting, passive venous stasis, dropsy, etc. A typical case from these hospital records is as follows: A common laborer, with chronic valvular disease, with dilatation. After the use of Adonis the heart diminished in size, the congestion of the lungs, well marked, almost disappeared, the oedema of the legs and the ascites disappeared entirely, palpitation of the heart and dyspnoea diminished so much that the patient was discharged from the hospital and returned to work.
The dose of Adonis, when given in infusion (13 of the herb to 123 of water), is a tablespoonful every two hours in severe cases; in chronic cases every four hours. Of the fluid extract the dose is one to two minims, or increasing from 5 to 10 drops.
By the above it is seen that Adonis is quite similar, if not identical, in its action on the heart to Digitalis and Convallaria. The symptomatic differences have not yet been brought out by any physiological provings. We can resort to it when, as is often the case, the two medicines above named fail to act favorably, or cease to give the patient relief. It is said to be more liable (than Digitalis) to cause gastro-intestinal irritation, nausea, vomiting and diarrhoea, in large doses.
In experiments made on frogs, in both the isolated heart and the heart in situ, diastole ends the scene. Two questions now arise, namely: What is the cause of this stoppage in diastole, and what produces the slowing of the cardiac rate occurring in the heart when lying in its sac?
The diastolic arrest of the isolated heart can only be due to one of two things – either the inhibitory cardiac apparatus is stimulated, or the heart-muscle and its motor ganglia are depressed. The latter seems far more likely, not only from analogy, but from the fact that in the experiments performed on the non-eviscerated heart of frogs the inhibitory nervous apparatus was found to be stimulated centrally and not peripherally; and, furthermore, the very character of the slowing of the isolated heart showed it to be due to stimulation, but to increasing depression.
That the vagi are not stimulated peripherally by this drug at any time was proved by the following experiments, and also by the results of the observations on the action of the drug upon dogs, which will be described farther on.
If the inhibitory nerves be cut before the Adonidin is placed in the pericardial sac, the usual increase in rate under such circumstances takes place, and the addition of a small quantity of the drug now immediately increases the rate still further, without the appearance of any primary stage of slowing of rate. This proves that the primary slowing occurring when the vagi are intact must be due to exaltation of their function, and also proves that the drug must directly stimulate the heart-muscle; for the rapid rate under these circumstances is not one of weakness, but of power. It should not be forgotten that this drug in large quantities finally stops the heart in diastole, whether the vagi are intact or divided. In small quantities it does not produce the primary slowing of the pulse, nor does it bring on the peculiarly weak and imperfect movements which have already been described as occurring before death. In other words, it requires large doses to affect the pneumogastric, and large doses to depress the heart-muscle.
One more point is to be decided. Is the rapid stage following the primary slow stage in the viscus in situ due to paralysis of vagi, to direct stimulation of the heart which overcomes inhibition, or to both? While I am unable to state whether overstimulation takes place, it is a fact that the pneumogastric nerves are certainly in this second stage depressed by the drug, for galvanization of these nerve-trunks during this stage failed to produce as marked a slowing of rate as should have occurred, provided the inhibitory pathway was open. From this point we may conclude that although the stimulation of inhibition in the first stage is centric, the paresis of inhibition in the second stage is peripheral.
The same changes are present when the drug is injected into the posterior lymph-sac of a frog. The animal soon becomes passive and immovable, and dies shortly so quietly that its death is not noted until he is handled. That the high arterial pressure produced by this drug is due in part to centric stimulation of the vaso-motor system is proved by the fact that the mesenteric bloodvessels are seen to dilate after section of the spinal cord.
Further evidence of this fact was adduced when studying the influence of the glucoside on the circulation of mammals; for there is but little, if any, difference in the action of Adonidin on the dog and frog. The injection of the quarter of a grain of Adonidin into the jugular vein of a dog, weighing twenty-five pounds, causes a great increase of cardiac force and arterial pressure and a marked decrease in pulse-rate. Following this stage of exaltation of force and pressure come a marked fall of arterial tension and, as is usual, a decrease of pulse-force, with an increase of pulse-rate. This condition remains the same for some time, until at last the heart beats irregularly, and stops in diastole, just as did the heart of the lower animals. We have, therefore, several stages to be accounted for in the action of this drug in the dig, viz., the increase in arterial pressure, in cardiac force, and decrease in pulse-rate in the first stage; the fall of arterial pressure and force and increase of pulse-rate in the second stage, and the arrest of the heart in diastole at the end of the third stage. Turning attention to the rise in arterial pressure, the writer eliminated all danger of a rise due to asphyxia by curarizing the dog, artificial respiration being maintained. Under these circumstances arterial pressure was increased as greatly as when the animal was not curarized. What, then, is the cause for this rise in arterial pressure? Probably two factors lie at the bottom of this condition, namely, centric vaso-motor stimulation, aided by increased cardiac force; for when the spinal cord was divided high up in the cervical region, thereby producing vaso-motor palsy, the rise in pressure under the influence of Adonidin was of course less marked, and the rise which did occur must have been due to increased cardiac force. The experiment on the fourth dog was made to discover how the slowing of the pulse was produced in the first stage. One-fourth grain of the drug was administered in the same manner as before, the animal having first been curarized. No sooner was the slowing of the heart-beat most marked than the vagi were divided, and instantly the pulse was increased from 102 to 192 per minute, proving that the slowing was due to stimulation of inhibition, and that this stimulation was centric. The increase in force has already been shown to be due to a direct stimulant action of the drug on the heart itself. In regard to the symptoms of the second stage, we find that the fall of arterial pressure is due to palsy of the vaso-motor system, since, when the cord is intact, galvanization of the sciatic nerve or asphyxia did not bring about increased pressure.
Hale wrote Lectures On Diseases Of The Heart, Materia medica and special therapeutics of the new remedies Volume 1, Materia Medica And Special Therapeutics Of The New Remedies Volume 2, Saw Palmetto: (Sabal Serrulata. Serenoa Serrulata), The Medical, Surgical, and Hygienic Treatment of Diseases of Women, New Remedies: Their Pathogenetic Effects and Therapeutic Application, Ilex Cassine : the aboriginal North American tea, Repertory to the New Remedies with Charles Porter Hart, The Characteristics of the New Remedies, Materia Medica and Special Therapeutics of the New Remedies, The Practice of Medicine, Homoeopathic Materia Medica of the New Remedies: Their Botanical Description etc.