Oleander affects the brain like a narcotic, causing loss of memory and the power of concentration, also stupor and coma. It causes pressing-out pains in the forehead and vertex like Cimicifuga. It causes dilated pupils, blackness before the eyes etc. It paralyzes the tongue, causing loss of speech. Its heart symptoms are “dull-drawing pains about the heart, more violent on stooping (Spigelia), and lasting during expiration. Distress at the heart and anxiety; anxiety about the heart, without anxious thought, with trembling of the whole body. Quick pulse, sinking to a thread. Pulse small, irregular, periodically intermitting. Pulse weak and very slow. Intermission every four or five beats. Pulse very irregular, at one time rapid, another very slow; at one time full, another very soft and weak. Perceptibly violent and full, but slow pulsations in the carotids. A pressure seeming to press from below upward in the anterior cervical muscles, so that he was obliged to loosen the neckband – a suffocating, choking sensation.”
The above symptoms would seem to indicate it is some functional disorders of the heart, as well as organic. A study of its most characteristic symptoms, as well as the observations below collected from various sources, will enable us to prescribe it intelligibly. The doses of the active principle is about the same as of Digitaline.
It has long been known that the ordinary Oleander, or Nerium odorum, is a poisonous plant, and it is asserted that almost from time immemorial the root has been employed in some portions of Southern Europe for the purpose of destroying rats.
Cases of poisoning of the human being by it have been infrequent, but have occurred. In the Journ. de Chem. Medorrhinum, 1843, Professor Richard gives an account of the poisoning of a troop of French soldiers as the result of eating meats, which had been roasted before an open fire, composed of Oleander blossoms. Seven died and five others were dangerously sick.
According to M. Julien Larue du Barry, in 1841, five French soldiers in Algeria ate food which had been cooked with the wood of the Oleander. Three hours afterwards they were all taken to the hospital in a condition of poisoning. The symptoms were dilatation of the pupils, vomiting, frequent cries, apparently the result of abdominal pain, convulsive movements of the limbs, vertigo, and in two cases insensibility. All recovered. In 1859 (Ztschr. d.k.k. Gesellsch. d. Aerzte zu Wien, 1859, xv. 690, 785, 801), Dr. Kurzak published quite a long article upon the poison, in which he cites a number of cases. In one of these 11/10 gramme (161/2 grs.) of the extract is said to have produced violent vomiting and cold sweats, fainting and other symptoms; in another 51/5 grammes (78 grs.) of the extract caused death. At the autopsy the blood was found dark and imperfectly coagulable, while there was much injection as well as inflammation of the gastro-intestinal mucous membrane. In still another case, a child, 31/2 years old, swallowed two of its little handfuls of the blossoms. In ten minutes restlessness came on, followed almost immediately by vomiting and apparent recovery of the normal condition. Some hours afterwards the boy was put to bed, and when, still later, his father went to him, he found him unconscious, motionless, excessively pale with very small (?) pupils and cold extremities.
The child remained for some hours in a condition of unconsciousness, with an intermittent pulse, but finally recovered. In these various cases the symptoms are stated so imperfectly that they throw little or no light upon the action of the drug. More recently better observed cases have been reported, the most satisfactory being that recorded by Dr. C. Sibthorpe (Indian Medorrhinum Gaz.), 1881, the case of an adult Hindoo, who took the root of the Nerium odorum in unknown amount for the purpose of suicide. Before going to the hospital he had vomited. At the time of the entrance the pupils were dilated and fixed, the pulse small, very slow – 36 per minute -the respiration unaffected, the skin normal, the gait staggering, the mental condition dazed. Two hours later epileptiform convulsions came on; the temperature fell in the axilla to 97.4, and semi-coma developed. After this, violent convulsions similar to those of hystero-epilepsy occurred about every half hour, lasting each one and a half minutes. The temperature rose to 101, the pulse to 120. Twelve hours later the patient was still semi-unconscious, the pulse slow – 40 a minute – the respirations 18, the temperature 98. Thirty six hours afterwards the pulse was still 40 per minute. Five days afterwards the pulse was 44 per minute, and the patient showed evidences of mild mania, in rest, lessness, singing, etc., and said that he had got a god in his abdomen and wanted a piece of glass to cut him out. He finally recovered. In a case reported by Dr. D. Murray (Indian Medorrhinum Gaz., 1887, p. 389), an infusion made from four ounces of the Oleander root was taken at 8 o’clock in the morning. In about an hour the man was seized with vomiting and severe cramps in the abdomen and extremities. About an hour later he became insensible, but was first seen by the doctor near 4 p.m. He was then unconscious, with cold, clammy skin, weak, thready pulse, stiffness of the jaw muscles, and rigid fingers. There were also frequent convulsive spasms.
He was under treatment for two nights and one day, when he was removed to his home still unconscious, with increasing collapse. He died five days after taking the poison.
It has been asserted that the Oleander is capable of acting as a violent local irritant, and Dr. J.A. Wessinger attributes an extensive eruption on the face, with blebs and large papules, accompanied by intolerable itching and burning, to the local effect of the Oleander bush (Detroit Lancet, 1882). At present it is not clear, however, that the drug has such influence. Animals have occasionally been accidentally poisoned by Oleander.
Thus Dr. Kohlmann gives an account of a cow and two goats, which were given leaves from two Oleanders along with other food. Both animals were affected with coldness of the nose and extremities, marked tremors in the posterior extremities, and cramp-like contractions of all the muscles. The goat finally passed into a general paralytic condition, and died about eleven hours after feeding. Twenty-four hours after feeding, the cow also died paralyzed (Central. f. Klin Medorrhinum, vol. i., 161).
Orfila made experiments upon dogs with the aqueous extract of the leaves of the Oleander, and found it to be locally irritant and an active general poison, whether thrown into the stomach or into the veins, especially influencing the nerve-centres and causing stupefaction with paralysis, and in most cases vomiting. He noted that immediately after death the heart was usually found in a condition of rigid contraction. The first person, however, to make experiments with Oleander, according to the modern method, was M.E. Pelikan (Compt. Rend., 1866, p. 239). He found that in the frog the extract of Oleander causes immediate increase in the number of the heart-beats, followed after a little by slowing of the cardiac movements, and later by irregularity of contraction, ending in systolic arrest of the ventricles at a time when the auricles continue to beat and the frog is still able to jump about freely. Pelikan’s experiments upon dogs have not, we believe, been published in detail, but he states that they led him to the conclusion that the Oleander acts in the mammal upon the heart in the same way as does Digitalis. He also convinced himself that the active principle was a yellow resinous principle, insoluble in water, easily soluble in amylic alcohol and chloroform, previously discovered by M. Latour (Journ. de Pharm. etc., xxxii., p.32).
M. Leukowski claims to have discovered (Journ. de Pharm., 3d series, vol. xivi., p. 397) two alkaloids, one named Pseudocurarine, and the other Oleandrine.
In the Archiv fur Exper., Path. und Pharm., 1883, vol. xvi., p. 149, Professor Schmiedeberg published the result of an elaborate chemical study of the Oleander leaf. He found that the leaf contains two active substances, to one of which he gave the name Neirin. He believes it to be identical with or very closely allied to Digitaline. The second substance, Oleandrine, had been previously described by Leukowski and by Betelli.
Schmiedeberg also obtained from African leaves another glucoside, Neriantin, which he surmises to be and educt from Oleandrine.
Schmiedeberg found Oleandrine to be a very powerful cardiac poison, 25 milligrammes being sufficient to cause systolic arrest of the frog’s heart. The glucoside, Neriantin, was not able to arrest the heart of the frog, although it had some influence upon it, possibly, as Schmiedeberg surmises, through contaminating Oleandrine.
Very recently (Bull. de Therap., May 15th, 1888) a partial study of the physiological action of Oleander has been made by Dr. Pouloux. He has found that in doses of 5 centigrammes (3/4 gr.) the extract produces in the frog paralysis, and death occurs in from thirty-five to forty minutes; that the ventricle is thrown into a state of tetanus, so that the diastole is incomplete, at a time when the number of cardiac beats are neither augmented nor diminished, and that in five minutes after the injection the tetanus of the ventricle is complete, the auricles continuing to contract over a considerable length of time. The mortal dose for the rabbit is about 50 centigrammes (71/2 grs.) of the hydro- alcoholic extract, death occurring usually in about forty minutes. The heart continued to beat in all cases some minutes after death, but the aorta was found full of blood, the venous system engorged, and the movements of the heart exceedingly feeble, so that the death was attributed by Dr. Pouloux to the cardiac action of the drug.
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.