Mr. Zerner and Loerr (Wiener Medizinisch Wochenschrift, Nos. 36 to 40, 1887) have recorded the results obtained in the service of Professor Bamberger, of Vienna, in using Strophanthus in cardiac affections.
They affirm that it is equal in efficacy to Digitalis, and that they have only seen it fail when the degeneration of the heart- muscle has gone to the last degree. The indications and contra- indications for its use, they think, are identical with those controlling the employment of Digitalis. In one mild case of Basedow’s disease the pulse, which at the moment of administration was 100, half an hour later it had regained its original frequency. In seven our of eleven cases of Bright’s disease they achieved very good results from its administration. It is especially indicated when there are evidences of secondary failure of the heart in renal disease. In several healthy subjects no diuretic action at all followed the use of Strophanthus. This, if it be confirmed, proves that the diuretic action of the drug in disease is dependent, not upon any influence upon the secreting structure of the kidney, but is the result of the increased blood-supply to the organ.
Zerner and Loerr also confirm the statements of Drasche, that in large doses the remedy produces nausea and vomiting.
Dr. William Budd reports in the Lancet, September 10th, 1887, two cases of mitral cardiac disease, with albuminuria and excessive and other very severe symptoms, in which Strophanthus was entirely successful after the failure of Digitalis. The effect of the drug upon the secretion of the urine was extraordinary. He used five minims of the tincture three times a day.
A new use for this remedy, which, more than its properties as a cardiac tonic, will serve to render it popular, is its employment as a diuretic in renal colic. Dr. Hutchinson reports, in the Provincial Medical Journal, October 1st, 1887, a case of marked uric acid diathesis occurring in a man, aged 52, who, since 20 years of age, had been subject to periodical attacks of gravel. When Dr. Hutchinson was called to see the case the patient was then suffering from a violent attack of colic from the passage of a calculus through the ureter. There were severe lumbar pains, scanty urine and difficulty in micturition. At the onset of the attack the urine was high colored, was then smoky, and finally contained blood. The bowels were confined; there was no nausea, but total anorexia. Dr. Hutchinson ordered him turpentine stupes across the loins, plenty of fluid to drink, a seidlitz powder in the morning and a tincture of Strophanthus in five-minim doses three times a day. The result of this treatment was to produce copious diuresis and a rapid relief of the pain.
In the absence of any officinal standard the tincture of Strophanthus, as sold in various drug stores, must vary in strength, and the important question as to the proper dose to employed must remain unsettled. The only recourse that the practitioner has, who does not know exactly the method in which the tincture that he is using has been prepared, is to commence with a minimum dose and increase until the effects are obtained. The tincture should be prepared according to the method of Professor Fraser, as given in the first volume of the British Medical Journal for this year. The dose of this tincture may be set down as five drops, carefully increased if necessary.
Dr. Hochhaus thus summarizes his observations of the effects of tincture of Strophanthus:
1. For a valvular weakness in the stage of compensation disturbance, tincture of Strophanthus is an excellent remedy in certain cases to retard, strengthen and regulate the cardiac action. the retardation occurs first, while the regulating effect only takes place, as a rule, after a few days. Dyspnoea and oedema are promptly relieved. But the favorable effects, in about one-half the cases, do not appear with the regularity and safety peculiar to Digitalis; and in most cases in which Strophanthus failed, Digitalis was effective. Digitalis has, generally, a quicker and more thorough effect, especially in causing diuresis, while Strophanthus failed, Digitalis was effective. Digitalis has, generally, a quicker and more thorough effect, especially in causing diuresis, while Strophanthus affects a disturbed respiration far more favorably. It is more difficult to indicate Strophanthus than Digitalis in cases of valvular weakness, so that it is almost impossible to say beforehand in what cases Strophanthus will be successful.
2. In chronic degeneration of the cardiac muscle, with usually a small, frequent and irregular pulse, great difficulty in breathing and oedemas, tincture of Strophanthus may be relied upon.
3. In acute and chronic nephritis the effect of Strophanthus is not so marked as in the above mentioned affections. The dyspnoea often yields to its influence as in the other diseases, but the diuresis and oedemas are not favorably affected by it.
4. In cases of palpitation and apnoea of nervous origin, Strophanthus often gives marked relief.
5. OEdemas of a Cachectic character may be also favorably affected by tincture of Strophanthus.
6. In some cases the drug has secondary effects on the digestive track, causing a loathing of food, followed by choking and vomiting after eating, and sometimes by severe diarrhoea. But, as a rule, the aversion to food is the only disturbance, and this passes off when the stomach becomes used to the drug.
7. Hochhaus advises to begin with doses of gtt. vj. i.d., in a tablespoonful of water or wine, and to add gtt. ij daily to the dose until the effect is obtained, though it is not advisable to give more than gtt. xx t.i.d. Gtt. iij t. i.d. is the proper dose to begin with for children, but the dose should not exceed gtt. v.t.i.d.
8. The effect usually appears on the second or third day, and generally lasts a week or two weeks, though there is considerable variation. hochhaus has never seen a cumulative effect, even after long use of the drug.
9. While Strophanthus cannot lay just claim to all the praise bestowed upon it, it is valuable as an occasional substitute or an ally of Digitalis.
While on the subject of Strophanthus, it may be stated that further investigations have been made on Onabaine, the African arrow-poison principle which was recently alluded to in this correspondence. The substance having proved to be of nearly the same chemical composition as Strophanthin, also a glucoside, Dr. E. Gley has undertaken to compare the physiological effects of the two poisons, and found them to be also very similar. Both act upon the bulbo-medullary nervous system, causing breathing troubles and vomitings, and the cardio-vascular apparatus (acceleration and increase of cardiac contractions first, and, finally, stoppage of the heart). When injected hypodermically, 1/40 of a milligramme (1/2400 of a grain) of Onabaine will in six minutes cause the heart of a frog to stop in systole. Strophanthin will not do as much in the same dose, but requires twelve minutes. Guinea pigs weighing one-half a kilogram (eighteen ounces) are killed in twenty five minutes with 1/20 of a milligramme of Onabaine, while twice as much Strophanthin is necessary to bring on the same result. Dogs and rabbits were also experimented with; but not to occupy too much space with details, suffice it to say that both Onabaine and Strophanthin were found to be much less poisonous when taken through the stomach than when injected into the veins, and that, as a rule, Onabaine proved twice as poisonous and twice as rapid in its effects as Strophanthin. As both glucosides are produced by African plants of the Apocyneae family, Strophanthin from a seed and Onabaine from the wood of a tree, the Dark Continent must be admitted to be well provided with fine specimens of poisonous plants.
The question very naturally comes up here as to the modus operandi of this remedy acting as a diuretic, when it has all along been supposed, and by many the question was regarded as settled beyond a doubt, that Digitalis acted as a diuretic by reason of its increasing blood-pressure.
Here we have a remedy which acts as a diuretic, and yet when compared with Digitalis in this respect its action on the bloodvessels is comparatively nil.
According to the observations of those who have had the most perfect facilities for determining the matter, this diuretic effect is one of its marked characteristics, and it is recommended in cases of cardiac disease where the diuretic action is desired.
Can it be that our teachings have been at fault in this important particular, and that Digitalis does not act as a diuretic coeteris paribus, with the increase of blood-pressure?
I think this supposition can be satisfactorily explained by granting that both Digitalis and Strophanthus give increased power to the heart’s action, and consequently that there is increased activity in the vascular system, the result being that all glandular function is more perfectly carried on. This, of course, leaves out of the question all consideration of the effects of blood-pressure in the structure of the kidney.
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.