Fraser has used Strophanthus in the form of a tincture, in doses varying from three to twenty minims, twice or three times daily; but, in a recent article, he speaks of the dose as varying from five to ten minims. He has also experimented most successfully with the subcutaneous injection of the active principle, Strophanthin, a glucoside, in doses of 1/50 of a grain, and by this means has noticed much more lasting effects from one dose than with the tincture. In one case, with severe symptoms from mitral regurgitation, the marked beneficial effect upon the heart’s action by a single subcutaneous injection of 1/50 of a grain of Strophanthin was noticed for eight days.
In the New York Medical Record of December 18th, 1886, among the “Transactions of the Practitioners’ Society of New York” are reports of cases by Dr. C.L. Dana, the only ones yet made public, so far as I know, in America. Dr. Dana’s results, in a comparatively small number of cases, are such as to make him believe that Strophanthus, as now used here, is a valuable addition to our pharmacopoeia, and can be often used in cases where Digitalis is not so efficacious. The testimony of other observers seems to point towards the favorable action of Strophanthus, some believing that, eventually, it will supersede Digitalis in the treatment of heart disease. My attention was especially called to the drug by a well-known lady physician, of this city, who is enthusiastic over its action in her own case, and has kindly allowed me to quote her experience with it.
During the previous year this lady, a sufferer from mitral lesion, was very ill, in the South of France, with pneumonia, during the progress of which the heart became very troublesome. At the suggestion of her physician, during her convalescence she began taking Strophanthus, and, before twenty-four hours had passed, experienced the greatest relief from the breathlessness upon the least exertion, which had been one of her most distressing symptoms. The improvement continued steadily, until, by the advice of a physician in another part of France, she ceased to take Strophanthus, when the former symptoms returned. Repeated experiments have shown her conclusively that the drug gives her great relief from dyspnoea, and its effects are always more pleasant than those of Digitalis. In the use of the latter she had always experienced a depressing effect, coupled with gastric disturbance; with Strophanthus, however, the effect is always rather exhilarating, and it has never caused the slightest trouble with the digestion. Its action is always markedly diuretic, and although she has never taken it in doses sufficiently large to carry the pulse below the normal rate, it has always had a distinctly calming effect upon the heart.
She continues to use the drug, omitting it at times for a few days, and always experiences the same sensations upon resuming it again. Her testimony, therefore, is distinctly in favor of Strophanthus as a substitute for Digitalis.
Acting upon these suggestions, I was fortunately able to try the drug in a case of severe heart disease, transferred to me by Dr. F.J. Knight, in which a slight mitral systolic murmur, great dilatation of the left ventricle, pulmonary oedema, a very rapid, irregular, intermittent pulse and almost constant orthopnoea were the chief symptoms. For several weeks almost constant use of the tincture of Digitalis and trials of Sparteine and Caffeine had failed to effect the action of the heart muscle, the pulse varying from 140 to 110 to the minute most of the time. Tincture of Strophanthus, in doses of about three or four minims three or four times a day, was tried; but, owing to some rather obscure symptoms which I then thought might arise from the drug, it was discontinued after the third or fourth day; and although the patient insisted that she liked the medicine and that she breathed more freely, I noticed no special action upon the heart or pulse.
Soon after this the patient developed signs of congestion in the lower part of the left lung, namely, dulness and slightly bronchial breathing; rales from rapidly increasing pulmonary oedema were heard on both sides; the legs, arms and face were swollen, the dilatation of the heart increased, and relief from great dyspnoea was obtained only by subcutaneous injections of morphine.
The husband of the patient having heard that Dr. M.L. Chamberlain, of this city, had had experience with Strophanthus, suggested a consultation, to which I gladly assented, and at his advice the Strophanthus was again tried and gradually pushed. It was given finally in doses from fifteen to twenty-three drops by the ordinary glass dropper (about equivalent to ten or twelve minims) three or four times in the twenty-four hours; Digitaline, in doses varying from gr. 1/100 to gr. 1/75, being given between the doses of Strophanthus when the patient was awake. It would be quite unfair to attribute all the gain which immediately followed to Strophanthus, for, although Digitalis as used before in the tincture had not had the slightest apparent effect upon the pulse, yet the use of Digitaline naturally makes it impossible to say which was the larger factor in the improved condition of the patient, but the following facts were noticed: rapid decrease of the dulness and bronchial breathing over the congested portion of the left lung, great diminution in the number of rales throughout the chest; the swelling of the arms and legs diminished; the dyspnoea was less marked; the action of the heart became much less feeble, while the pulse slowly dropped from 120 to 88, became perfectly regular and lost its intermittent character. This improvement continued for about a week, when a curious friction sound appeared near the angle of the left scapula, the exact nature of which it was impossible to determine, and that night the patient, while sitting up during a movement from the bowels, suddenly fell back and expired. No autopsy was allowed.
Synopsis of Case. – Patient suffering intensely in the last stages of mitral disease, after receiving no apparent benefit from the tincture of Digitalis, Sparteine or Caffeine, obtains very great relief from somewhat large doses of tincture of Strophanthus alternating with Digitaline. Another case in which I have noticed a markedly beneficial effect from Strophanthus is a lady, 63 years of age, for years a sufferer from valvular disease, in which dyspnoea and great irregularity of the heart’s action are the chief symptoms. During a severe illness last November, from which I never expected her to recover, all the most serious symptoms were greatly relieved by three or four minims of Strophanthus, given three times a day. General oedema of the legs disappeared; the action of the heart and pulse steadily improved, and the latter, which by the use of Digitalis had fallen to about 45, rose again to about 60, and although occasionally intermittent was more regular than I had ever known it under the previous use of Digitalis. the patient is now vastly improved in health, moves about the house, is able to go out to drive or walk, and still takes about three minims of the Strophanthus three times a day, and although the pulse still intermits and is somewhat irregular, the action of the heart is much less tumultuous than before, and varies from 60 to 80 beats in the minute. The last case in which I have used the drug is a man about 58 years of age who has had symptoms which point to fatty degeneration of the heart, namely, a weak, rather irregular and rapid pulse, with occasional attacks of faintness. This patient seems not at all sensitive to the drug, and I have gradually increased the dose to fifteen minims four times in the twenty-four hours. Although the pulse has never fallen below 86 and usually is about 94 or 96 to the minute, it is now of very good strength, and perfectly regular since he began to take the tincture about five or six weeks ago. Previously the pulse had often been about 100, and at times very weak. The general condition has slowly improved; there has been no recurrence of the attacks of faintness; and as the patient tells me he has always had a rapid pulse, I have not attempted to reduce its action further, and am at present diminishing the dose again to see how far the drug has a controlling action upon his heart.
Dr. J. Lindsay Porteous concludes an article on the use of Strophanthus as follows: “It decidedly increases the flow of urine; it causes a certain amount of moisture over the surface of the body; it relaxes the bowels; it markedly makes the pulse stronger, although it may raise it for a short time after it is taken. If carefully used, it is destined to hold a foremost place among remedies for controlling the heart’s action, but, like other remedies, will not suit every patient.”
J. Higham Hill, M.D., gives the case of Dr. R., who had for many years been the subject of mitral regurgitant disease of the heart. There was considerable oedema, extending to the upper part of the thighs, scrotum, etc. He had twice been aspirated during the last few months for hydrothorax of the right pleura, a large quantity of fluid being withdrawn each time. He had also suffered greatly form very painful and intractable flatulent distension of the abdomen, arising apparently from atonic dyspepsia. Strophanthus was given in doses of five minims of the tincture three times a day in half an ounce of water. Improvement rapidly followed; the pulse on the second day fell from 96 to 80 and became much fuller and stronger; the renal secretion increased on the third day from thirty ozs. to eighty ozs. and the oedema rapidly decreased.
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.