GLONOIN WITH STROPHANTHUS.
The new cardiac remedy, Strophanthus, does not contract the systemic arteries nearly as much as does Digitalis. But Dr. Thomson finds that alternating Glonoin with Strophanthus greatly increases the value of the latter in weak heart combined with contracted arteries. He gives several interesting cases illustrating the combined action of Glonoin and Digitalis, and Glonoin and Strophanthus, and the results were very happy. His usual doses were three to five drops of Digitalis or Strophanthus, continued with one to two drops of the one per cent. solution of Glonoin (our 1c dilution). Since reading Dr. Thomson’s paper, I have had an opportunity of testing his practice. It was in a case of cardiac dilatation, with enormous anasarca, in an old man. The arteries were very tense and rigid, due to atheroma. There were great dyspnoea and quick, intermittent pulse. Digitalis had been given alone by a former attendant, in ten to fifteen-drop doses three times a day – rather aggravating the symptoms. I prescribed three drops of Digitalis tincture every four hours, alternated with one drop Glonoin, 1c, every four hours. In less than twelve hours the beneficial effect of this method was manifest. The dyspnoea was relieved, the cold extremities became warmer, the urine increased greatly, and the pulse and heart action became nearly regular. The dropsy disappeared in a week.
I have for several years used Aurum in such cases; it has about the same effect on the arterial system as Glonoin, but is not so prompt. Aurum mur. et sodii in doses of one-hundredth or one- fiftieth grain is the best preparation.
The Nitrite of Soda is quite as active as Glonoin, and has been used as a substitute for that medicine. Neither is as rapid in its action as the Nitrite of Amyl.
In a Nitrite could be found that would lower arterial tension without
18 causing the unpleasant throbbing and flushing, it would be very desirable.
Such a remedy, perhaps, is the
COBALTO-NITRITE OF POTASSIUM.
In the New York Medical Journal for August 25, 1888, in a preliminary note, Dr. J. West Roosevelt calls attention to a drug which seems likely to prove of some value in cases where it is desirable to lower arterial tension, or to produce any of the physiological effects of the various Nitrites now in use, and to sustain these effects for some time.
Dr. Walcott Gibbs suggested to the author that Cobalto-nitrite of Potassium might be of value in certain causes, on the ground that its stability and relative insolubility would probably cause a slower, more uniform and more easily controlled action than that of Nitro-glycerine Sodium Nitrite, Amyl Nitrite, or Ethyl Nitrite.
He further stated that the salt could easily be prepared in a state of absolute purity, and would have the advantage of not being deliquescent or subject to chemical change.
When a solution of Potassic Nitrite is mixed with a solution of a salt of Cobalt, previously acidulated with Acetic Acid, a crystalline precipitate is formed, varying in color from bright yellow to a dull olive shade. This salt was discovered many years ago by Fischer, and, according to Sadtler, has the formula Co2(NO2)12 K6 plus 2 Aq. The salt may be considered as derived from the acid Co2(NO2)12H6.
Acting upon the suggestion of Dr. Gibbs, the writer gave the salt to a dog, weighing about eight pounds, in a dose of five grains. No other effects than drowsiness and probably lowered tension and more rapid pulse were produced. The dose was repeated several times on different days. As there was no apparatus to measure blood-pressure at hand, no attempt was made to ascertain anything save whether the salt was actively poisonous or not. A dose of seven grains produced no symptoms in another dog of about the same size. A pregnant cat took about five grains without toxic effect. In the dog examined there seemed to be increased speed in the pulse and a fall in tension as appreciated by the finger. The temperature also fell from 2 to 4 degree F. In the absence of precise observations the experiments are of little value.
Three cases of uraemia, with high arterial tension and dyspnoea, with and without signs of oedema of the lungs, were selected. In two an attempt was made to compare the action of Nitro-glycerine and the new salt administered alternately in the same case. The tension, as shown by the sphygmograph or finger, fell in from fifteen minutes to an hour. The dyspnoea was wonderfully relieved in two of the cases and in one of these, where Nitro-glycerine was given alternately with cobalto-nitrite, there was no doubt (in the patient’s mind at least) that the effects were more lasting as regards the relief from dyspnoea with the latter, and that it produced no fulness, throbbing nor pain in the head, while Nitro-glycerine had caused a great deal. In the other case in which the two drugs were given alternately, neither seemed to give much relief to the symptoms, and after use of Cobalto-nitrite was begun there was vomiting. Whether this was caused by the salt or the uraemia cannot be told. In the third case the salt gave absolute relief from the dyspnoea and produced neither headache nor vomiting. A fourth case of uraemia presented head symptoms without dyspnoea. Here the patient became better after taking the drug, but it is very doubtful whether this result was post or propter hoc. The improvement continued after the salt was stopped, and the patient passed from under observation.
A case of emphysema of long standing, with severe asthmatic seizures, was completely relieved of the dyspnoea by the drug, so far as the subjective symptoms or chest signs are concerned. In this case also Nitro-glycerine was tried. The relief obtained by the latter was the same, but there was headache with it, while the Cobalto-nitrite did not seem to cause any.
Since then the patient again came under the writer’s care in Bellevue. The Cobalto-nitrite relieved in great measure the dyspnoea, and completely abolished the sibilant and sonorous rales which at first were audible.
Nitro-glycerine, in doses of 1/100 of a grain, failed to produce any effect. Cobalto-nitrite, in doses of one-half grain every hour, caused headache, but one-half grain every two hours decidedly improved the subjective and objective signs, and caused no head symptoms.
In a case of cardiac valvular disease, in which there were dyspnoea and oedema of the lungs and very pronounced albuminuria (the urine also containing hyaline and granular casts) the tension was lowered, but no positive good results were obtained. In this case the patient had vomited before taking the drug, and continued to do so afterwards. Possibly the vomiting was more severe after than before. In the case of a woman, 70 years old, with somewhat thickened vessels, an attack characterized by severe headache, nausea and vomiting, very high arterial tension, restlessness, slight albuminuria, with urine of normal specific gravity, containing a few hyaline casts and rather numerous leucocytes, was relieved by chloral.
This drug, when given in efficient doses, caused drowsiness. The Cobalto-nitrite was substituted, tablet triturates of one-fourth grain each being administered every three hours, and the same relief without any drowsiness was obtained. When the drug was discontinued, the headache, etc., returned, and relief again followed its use.
In a case of lead colic, with high arterial tension, the drug lowered this, but did not relieve the pain.
A case of mitral stenosis, with marked albuminuria, improved under the use of this salt with Digitalis; but it is not possible to say what share the Cobalto-nitrite had in this result.
It seems to the writer that this salt is worthy of trial in all cases where Nitrites are now used. Besides the cases mentioned, he has a number of others under observation, and it is his intention to publish a detailed statement of his studies as soon as a sufficient number of cases have been observed and satisfactory experiments have been made upon animals. The experience with it so far has been encouraging. It is easily prepared, cheap, stable and safe. It seems probable that we shall find that it lowers arterial tension, and that it does not produce so much discomfort as the other Nitrites.
The effect of the drug seems to begin in about fifteen minutes to one hour after its administration, and to last (in some cases at least) for three or four hours. The average dose given has been half a grain every two or three hours. It is possible that this may be largely increased, but the fact has not been proved. It is also possible that vomiting may have resulted from its use in two cases mentioned. It seems to relieve more or less the dyspnoea of uraemia and of asthma. A grain or two of the 1st trituration, frequently repeated, might give better results.
OLEANDER AND ITS ALKALOID, OLEANDRINE.
Oleander was introduced into Homoeopathic practice by Hahnemann, but Galen and some of the ancient physicians used it. Its active principle, “Neirin,” or “Oleandrine,” has been found to act as a heart-poison.
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.