I have verified this assertion in many desperate cases in my own practice and in consultation. I have seen patients whose hearts were near the point of irrecoverable paralysis, when general dropsy was fast wearing out the little left, rapidly improve under the use of Caffeine, one to three grains every four hours. The terrible dyspnoea which accompanies such cases is magically relieved, and patients who have passed agonized nights sitting upright have been enabled to lie down with comfort. The methods of administration in such cases are various. Usually the coated pill is most convenient, but when the stomach is irritable, it had best be given hypodermically. If we desire to give less than one grain by the stomach, the first trit. is the best preparation, for trituration gives greater power than the crude drug, and 1/10 gr. in trituration seems often equal to one grain in a pill.
In very urgent cases it has been recommended to give it largely diluted, so as to not offend the stomach. The following formula is best: Caffeine, 100 gr.; Benzoate of Soda, 100 gr.; water, 3 viiiij; each teaspoonful of this contains about 7 grains, which can be given three times a day. My favorite formula is Caffeine, gr. 60; Detannated fl. ext. wild cherry, 3 viij, each 3j containing one grain; one or two teaspoonfuls every two or four hours.
For hypodermic use a solution containing 60 grs. of Caffeine to 3j of water is best. Inject 10 drops every two hours till improvement is seen. It will require heat to dissolve it, and it must be injected at a temperature of 90 degree F.
When the patient is helped over the critical period, when the kidneys have acted sufficiently to run off the dropsical accumulations and the heart’s action has become more regular, then some other cardiac tonic should be used, in order that the action of Caffeine may not “wear out, for it may be necessary to resort to it again. The following may be considered the latest views regarding the action of Caffeine: As to its medicinal influence over both heart and circulation there is no further doubt, nor can the complete absence of all cumulative action be questioned. Of paramount interest, of course, is the question: How does this drug compare therapeutically with Digitalis? Does it meet the same indications? Is it equally powerful, constant and prominent in its effects? It was with special reference to these important questions that Kurschmann, of Hamburg, investigated Caffeine (Central blatt f. kl. Medorrhinum, April 11th, 1885).
Caffeine cannot, according to Kurschmann’s observations, be credited with the same amount of constancy of action on the circulation and the secretion of urine as Digitalis.
In diuretic effects appear no sooner and remit far earlier than after the use of Digitalis. While in Digitalis heightened renal pressure and slowing of pulse are coincident, the pulse does not slacken at all, or but very little, after Caffeine, even when increased diuresis is very marked. It seems probable that the two drugs act differently, on account of influencing the central nervous system differently; often Caffeine is efficient when Digitalis is powerless, and vice versa. No cumulative action, as intimated above, and no traceable permanent injury to the system can be made out in Caffeine, though occasional vomiting, nausea and headaches have been noted, forbidding its employment with certain individuals.
Kurschmann’s general conclusions may be summarized as follows: 1. Caffeine and its double salts are usually borne well, even in large doses (up to 30 gr. pr die).
2. Its diuretic effects depend upon an increase of the arterial pressure. Though cardiac action grows often more regular, an appreciable slowing of the pulse is but rarely observable.
3. Caffeine cannot justly be called a heart-regulator in the sense of Digitalis (as taught by Reigel), as the absence of any coincidence between rise of renal (i.e., aortic) pressure and slowing of the pulse.
Leblond thus sums up the views of physiologists respecting the action of Caffeine on the heart and circulation:
Londe, Nysten, Murray, A. Richard, etc., affirm that Coffee excites the action of the heart. According to Prompt, it accelerates the pulse.
According to Trousseau, infusion of Coffee increases the beatings of the heart. Rognetta says that the pulse is not quickened under the influence of Coffee, or, if it be quickened, this is due simply to the fact of taking a hot drink.
The pulse, he says, becomes slower, fuller and softer, indicating a depressant effect on the circulatory vessels. He adds, moreover, that Coffee has an elective action on the vessels of the brain, which it tends to deplete.
The tetanic state provoked by Caffeine, says Albert, does not limit itself to the external parts, to the peripheral muscles, but invades the heart as well; for as soon as the contractions manifest themselves in the members, the heart is spasmodically affected, labors and becomes sensibly smaller. It is in this way that Caffeine differs from the powerfully toxic narcotics: With whatever violence and rapidity (for example) nicotine may act on the heart of an animal, this organ preserves the regularity of its movements an hour and even more after the appearance of the paralysis or spasmodic contractions of the members, which
15 is not the case with Caffeine, whose action, as before stated, when given in toxic doses, is unique.
Penilleau and Dettel call Coffee an accelerator of the heart.
Caron, who, in an experiment on himself, took 71/2 grains of Caffeine in one dose after breakfast, experienced at the end of two hours: First a general prostration of the forces, a vague headache, with trembling of the limbs, which staggered and could hardly support the body. Later still, a strange sense of nausea, a fulness of the stomach, continual somnolence, with prolonged want of appetite; and he remained until 11 o’clock at night without desire for food. His pulse gradually fell from 80 to 56 beats per minute.
Meplain, after having ingested 50 centigrammes of Caffeine, also found his pulse to fall from 72 to 51 beats.
According to Jourand, the action of Caffeine on the heart is one of slowing. Sabarthez, on the other hand, has recently noted that the infusion of Coffee produces an acceleration of the cardiac contractions, whether taken cold or hot, on an empty stomach, or after a full meal.
“It is necessary to bear in mind,” says M. Leven, “that in toxic doses Caffeine always begins by augmenting the number of heart- beats; it is not till the second phase of its action that it slows them.”
Voit, Stuhlman and Falk have arrived at the same conclusions.
According to Binz, Caffeine in moderate doses increases the action of the heart by directly stimulating this organ and exciting the arterial contractility. The blood-pressure and the frequency of the pulse are augmented; the temperature also rises one degree or more, and more urea and CO2 are eliminated than in the normal state.
All the symptoms are relatively short duration, for a part of the Caffeine is eliminated by the urine almost immediately after its absorption.
Gentilhomme, in his researches, affirms that Caffeine is without action on the heart.
Hoppe, Schmiedeberg, Johannsen and others fail to notice the action of Caffeine on the heart and circulation.
Henneguy, on the other hand, has observed that Caffeine slows and then enfeebles the movements of the heart, which is arrested in systole.
According to Foussagrives, Caffeine augments the arterial tension, and with it the frequency of the pulse diminishes. There are excitation of the vaso-motors and augmentations of contractility in the small vessels. The heart is stimulated in a peculiar manner by it, and its movements become more energetic. Bennet, in his experiments, has always observed contraction, then dilatation, of the capillaries, with blood-stasis.
The increase of vascular tension had been previously noted by Magendie, who, on injecting 8 grammes of infusion of Coffee into the jugular vein of a dog, saw the liquid rise in the haemadynamometer from 30 to 70.
According to Aubert and Dehn, Caffeine in larger doses is without action on the heart of the frog, while in the dog and cat there are always seen extreme frequency of the pulse and diminution of the blood-pressure, followed by augmentation of tension, with slowing of the pulsations.
Meplain, in his experiments on man, arrives at the conclusion that there is augmentation of arterial tension. Sphygmographic tracings obtained upon the right radial have shown him that under the influence of Coffee the line of ascent was less vertical and less high; the amplitude of the rebound was much more feeble; the summit of the pulsation was less acute, and even transformed, in some cases, into veritable “plateau.”
Dr. Giraud, studying on himself the action of infusion of Coffee and Tea, has come to the following conclusions:
In therapeutic doses, Caffeine –
1. Diminishes the frequency of the pulse.
2. Augments the arterial tension as well as the energy of the heart-beats.
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.