3. Coffee and Tea appear to act only by virtue of the Caffeine which they contain.
According to experiments on animals, in toxic doses:
1. It accelerates, then slows, the respiration and circulation, by nervous exhaustion.
2. It diminishes considerably the blood-pressure.
3. It paralyzes completely the vaso-motors.
According to Stewart, Caffeine produces first a stimulant action on the heart, and augments the arterial tension, but consecutively it determines enfeeblement of the cardiac muscular power and diminution of the blood-pressure. It acts probably on the cardiac ganglia, which it paralyzes. In animals poisoned by Caffeine the respiration ceases before arrest on the heart.
Leblond has made a great many experiments to ascertain the action of Caffeine on the circulation, and these are his conclusions:
In physiological doses:
1. Caffeine is an excitant of the nerves and muscular system.
2. It diminishes the frequency of the pulse by augmenting the energy of the cardiac contractions and the blood-pressure through vaso-motor constriction.
3. It lowers the peripheral temperature.
4. It is no way influences the formation and excretion of urea.
In toxic doses:
1. Caffeine increases the excito-motor power of the cord, paralyzes the peripheral sensory nerves and acts on the vagus, whose excitability it diminishes.
2. It lowers the blood-pressure by paralysis of the vaso-motors.
3. The heart in cold-blooded animals slows more and more, and is arrested in systole; in warm-blooded animals it is quickened at the termination of the toxic action, and is arrested in diastole.
4. It produces a tetanic action on the muscles.
5. It causes a rapid fall of the temperature.
6. It augments denutrition.
Writing of the diuretic effects of Caffeine, Dujardin BEaumetz says:
“If Convallaria and Convallamarin are uncertain diuretics, it is not so with Caffeine, which renders us important service, almost equal to that of Digitalis, in affections of the heart. it is above all in the last stage of the malady, in the asystolic period, and when the other heart tonics have lost their effects, that Caffeine will render you the most signal service.”
I shall not here take up your time with details of the physiological action of Caffeine on the circulation. When you take a general view of all which has been written concerning the effects of Coffee and Caffeine, you find that the theories which have been put forth on this subject may be arranged in three distinct groups. Some, as Gentill homme, of Rheims, others, as Trosseau, Rognetta, Penilleau, Delte. and Sabarthez, claim that it accelerates the beatings of the heart. Others, still, as Caron, Meplain and Foussagrives, believe that it slows the heart.
Whence come these differences of opinion? They are due to the fact that the toxic effects of the heart-tonics are the opposite of the therapeutic, and while Caffeine, in moderate doses, as the researches of Giraud and Leblond have shown, diminishes the pulsations by augmenting the vascular tension (i.e., by acting as a cardiac tonic), in higher doses it increases the beatings of the heart and perturbs them. You easily understand, then, how, and according to the doses employed, exactly opposite results have been obtained.
It was 1839 that an anonymous writer (M. S.), in the Bulletin General de Therapeutique, called attention to the diuretic action of Coffee, and its applications to the treatment of dropsy. Note, however, that in 1825 a Dutch physician had preceded this writer in extolling Coffee as a remedy in serious effusions.
In 1846, Honore, physician to the Hotel Dieu, signalized the favorable effects which he had obtained from the infusion of Coffee in albuminuria and dropsy.
But it was in 1863 that the first important work appeared on the therapeutic action of Caffeine in diseases of the heart. This was the production of Koschlakoff, an assistant of Botkin, of St. Petersburg. In 1866 Jaccoud introduced Caffeine into France as a remedy for diseases of the heart, and in 1877 Gubler spoke of it as the ideal diuretic.
Nevertheless, despite a very important practical treatise of Bracken-bridge pointing out the necessity of large doses, Caffeine was administered thus far in but feeble doses, scarcely 50 centigrammes a day. the trials simultaneously made at Lyons by Lepine, and in Paris by Huchard, showed that these doses were insufficient, and that one should not hesitate to give two grammes (3 ss) a day of this medicament, in order to obtain its desired effects.
This is the rule which you ought to follow, and when you prescribe Caffeine you will do well to make use of one of the most stable preparations of this alkaloid, which consists of its combination with Benzoate of Soda, according to Tanret’s formula:
Take of Caffeine, 7 grammes (gr. cv.).
Benzoate of Soda, 7 grammes (gr. cv.)
Water, 250 grammes (f3viij and 3ijss). M.
Dose, a tablespoonful three times a day, each dose containing 50 centigrammes (71/2 grs.) of Caffeine.
I discard as untrustworthy the preparations of Caffeine in pill form or in capsules. The capsules, in fact, often determine severe pains in the stomach, and sometimes vomiting. When you cannot administer Caffeine by mouth, you may make use of the hypodermic method, in which event the following solution will be found convenient:
Rx. Benzoate of Sodium, 3 grammes (gr. xiv).
Caffeine, 2 grammes (3 ss).
Distilled water, 6 grammes (f3jss). M.
Each cubic centimetre (syringeful) contains 25 centigrammes of Caffeine (about 5 grains). Whenever, then, you have a patient in the last stages of heart disease, where everything has been tried and everything has failed, you may resort with confidence to Caffeine, and administer it in the dose of 20 to 30 grains a day, and you will often obtain effects truly marvelous.
The necessity under which we find ourselves of giving pretty large doses of Caffeine has caused Coffee and its infusion to occupy but a secondary place in cardiac therapeutics, and hence Coffee comes in only as an adjuvant medicine, under the form of ptisan. By this roasted Coffee is meant. Certain authorities have vaunted the properties of green Coffee, not only as a remedy for gout and its manifestations, but also for hypertrophy of the heart.
Pelletan, who was much in the habit of prescribing this medicine, gave these directions: “Take twenty of the berries, bruise and pour on them a cupful of boiling water; this is to be rejected; then pour over them another cupful, in which they are to be allowed to macerate, and the whole is to be drunk by the patient.”
I desire it to be understood that in the above I refer only to the use of Caffeine in physiological doses. I have not mentioned the strictly homoeopathic uses of Coffea based on its primary effects – as recorded by Hahnemann – namely, in cardiac irritability, from nervous or emotional causes, for I have already treated of its value in such cases in the body of this volume.
I also desire to assert positively that the action of Theine, when obtained from tea, is very different from Caffeine, as much so as the physiological effects of Tea and Coffee. The two alkaloids should not be substituted for each other. I believe in cases where Caffeine has disappointed us in cardiac failure, it has been because Theine was used. It is well known that chemists use damaged Tea for the purpose of manufacturing the substance they call Caffeine.
As Prof. Mays has recently shown, such substitution is unjustifiable.
NOTE. – Mercurius has announced a new preparation of Caffeine, the boro-citrate, which he says is soluble in water. This would seem a very desirable form in which to use it, internally or hypodermatically.
ON CONVALLARIA MAJALIS
(Lily of the Valley).
Habitat. – This charming little flower is a native of Europe and of the United States. It is found growing wild upon the highest mountains of Virginia and North Carolina. It is cultivated in gardens and conservatories in all countries where the people possess any claims to civilization and refinement. It has always been associated with sentiment and romance, and now bids fair to occupy a prominent place as an agent to alleviate the ills of the human organism. The flowers are noted for their purity and delicacy and for their delightfully fragrant odor, somewhat similar to orange flowers, although they have a bitter and acrid taste.
History. – I think it a little singular that there is no mention of the lily of the valley in any of the botanic or eclectic medical works, or in the domestic practice of the common people in America, but Dr. Ralph D’Ary, Romeo, Mich., says:
“The Russian country folks, like the Indians of this country, are a very primitive people, and being almost beyond the reach of civilization and the medical advantages it offers, they have learned to help themselves in case of emergency. But whilst everybody is more or less of a herbalist or nurse, each village has its znaharka or wise-woman, who occupies about the same position as the Indian medicine-man.
“While on a summer tour through Russia – my native country – some year ago, I took special pains to obtain information concerning their methods and means of treating disease. As may be expected, it was difficult to gain the confidence and good will of the jealous and suspicious women, but whenever successful in that respect – with the aid of alcohol and flaming dress-goods – a very curious insight into popular medicine and pharmacy was afforded me. The revelations in the majority of the cases consisted of unmitigated trash, but here and there I obtained ideas, hints and positive knowledge, which were well worth retaining. Among the latter I class what I learned of the uses of that beautiful fragrant little wild flower, the lily of the valley (Convallaria majalis). I pass over the uses made of the rot or leaves, since they are recorded in almost every dispensatory (the eclectic one of this country alone excepted, strange to say), and since their properties are not of the nature to make those parts of the plant a desirable remedy. the fragrant flower, however, deserves the closest study of the therapeutist. My attention was first called to it by witnessing the relief derived from it by an old man in the last stages of chronic dropsy. He used it as a diuretic and tonic for the heart, and it seemed to be so very efficient that I made his case an object of special observation, he willingly lending himself to my experiments. Since that time I have used a tincture in my practice, and have cautiously experimented with it, but, not being aware that the plant had ever been brought before the profession, and that physiological experiments had been made with it, I thought it premature to call attention to it until I should be able to give more than clinical observation to the medical press. Circumstances, however, have prevented me from making any systematic physiological experiments, and even at this day I should hesitate about submitting the present article to the medical world, if I had not found since that the ground had been fully prepared by the experiments of Waltz, Marme and others (See New York Medical Journal, November, 1867, and Schmidt’s Jahrbuch, 1867, vol. 166), and especially those of Drs. Bogoyavlenski and Troitsky, of St. Petersburg, whose articles on the subject, in translation, I have furnished to the editors of the Therapeutic Gazette.”
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.