The following is translated from the Russian by R. D’Ary, M.D. (Therapeutic Gazette, October, 1881, p. 374): In May, 1880, Prof. S.P. Botkin requested me to repeat the investigations of Marme, Waltz, Brandt and others concerning the physiological effects of the above drug, in order to replenish the gaps left by them in the subject. Besides making experimental investigations, I was especially to try the remedy clinically (in cases of patients suffering from insufficient compensation), in order to determine the clinical indications for its use and the best mode of administration. Since that time to the present day (December) I have continued my physiological experiments in Prof. Botkin’s laboratory, and am trying the remedy clinically in St. George’s Hospital. The following are the results so far of my labors:
A. Experiments on Frogs. – Upon introduction of the infusion, the tincture or extract of the flowers of Convallaria majalis, into the lymphatic system of the frog, the following results are noticeable:
1. Retardation of the cardiac contractions, with an increase in their energy.
2. Irregularity in the diastole of the ventricle, some of its divisions remaining partially systolic.
3. Complete arrest of the heart-beat, with tetanic contraction of the ventricle, and distended throbbing auricle and venous sac.
4. The heart, after assuming this characteristic condition, does not change in response to electrical, mechanical or chemical irritation, nor upon application of Stannius’ ligatures, nor upon division and irritation of the vagi, nor in consequence of destruction of the nerve-centres.
5. During the first and second stages of the intoxication the usual effects are obtained by electrical stimulation of the vagi.
6. If the vagi are divided previously to the introduction of the Convallaria, or if atropine is first introduced, the effects of the Convallaria are still the same.
7. If the nerve-centres are destroyed, a larger dose of convallaria is required to produce the above results.
8. In all these experiments there were no abnormal deviations in the other organs of the muscular or nervous systems.
B. Experiments on Warm-blooded Animals. – The same preparations of Convallaria were used, with the following results:
1. A sudden retardation of the cardiac contractions, with increase of blood-pressure.
2. After the period of retardation there follows a strongly pronounced acceleration of the contractions, with still greater increase of blood-pressure.
3. Arrest of the heart-beat, with diminution of blood-pressure.
4. When the vagi are previously divided, the precursory retardation does not take place.
5. If during the period of acceleration of the contractions the peripheral ends of the vagi are irritated, the usual effect on the heart is not observable, but the following strange circumstance takes place: Those variations of pressure which are caused by the breathing movements of the animal, forming a wavy line on the indicator, very suddenly disappear, and remain the abeyance during all the time that the electrode is kept in contact with the nerve. (I am at present engaged in a closer investigation of the circumstance.)
6. In the left and right ventricles there is always found an extravasation of blood under the endocardium.
Dr. E.P. Hurd, of Newburyport, Mass., in the Medical Record of Feb. 17, 1883, states:
“From experiments on animals it is proved that Convallaria is a powerful toxic agent not inferior to Digitalis in its power to cause speedy death. Therefore, in its clinical application to human patients, it is well to be a little careful about the dose prescribed.”
7. This effect is equally manifest, whether there be valvular deficiency or a narrowing of the cardiac openings.
8. The remedy does not seem to possess any cumulative properties.
9. The diuresis induced by the remedy continues long after the cessation of its administration.
One of the cases of heart disease which I treated with Convallaria majalis was complicated with chronic nephritis, but nevertheless the diuretic effect of the remedy was strongly manifested, though not quite in the same degree as in patients with healthy kidneys.
Troitzki and Bogoyavlenski, of Russia, says: “This common plant is a veritable substitute for Digitalis. It was formerly much employed, especially in Germany, and Matthiole has enumerated, at length, its properties, which at this time were attributed to the flowers of the plant. If we are to credit his statements, there are few diseases which were not happily modified by its use. Among their number he mentions palpitation of the heart, which it is claimed can be relieved by Convallaria majalis. This remedy, however, had entirely fallen into oblivion when the authors of this pamphlet endeavored to bring it forth anew, basing their claims on the results furnished by experimental physiology.
“Injected into the veins of warm-blooded animals, the infusion of the lily of the valley produces a diminution of the number of the heart’s contractions, with elevation of arterial pressure. A little alter the contractions become more frequent, and the pressure is further elevated; then the contractions cease and the pressure falls. In such cases, also, the section and excitation of the peripheric end of the pneumogastric produce no change. Besides these results obtained on animals, Bogoyavlenski treated with the lily of the valley six patients suffering with valvular non-compensated lesions. He administered an infusion of 3.06 grammes to 7.02 grammes of the plant in 120 grammes of water. Under its influence the quantity of urine increased pari passu with the disappearance of the oedema. The heart contractions became clearer, slower and more regular; the stasis in the small and large circulation began soon to disappear. The diuresis kept on even after stopping the use of the remedy.
“Nephritis in one of the patients suffered no change, the improvement in the general symptoms being merely less marked. Troitzki has noticed the happy effects of this remedy, especially in such cases where the asystole is caused by a nervous state which stops or hinders the compensation. He has used a less concentrated infusion of from 3.06 grammes to 7.02 grammes in 180 grammes of water, and has given of this infusion three or four spoonfuls per day in nervous palpitation of the heart. The effects obtained have always been very marked and singular. They have persisted for nine days after suspension of the administration of the remedy. The general excitation, the dyspnoea and the intensity of the palpitations disappeared completely. According to the same author, the Convallaria did not, like the Digitalis, give as favorable results in aortic as in mitral insufficiency, but it is much superior to Digitalis in nervous palpitation. Such is the resurrection of an old remedy, which had only been employed in sternutatory powders.”
Dr. Troitzki also says: “The use of infusion of Convallaria majalis by persons suffering from heart disease, in any form, has generally produced good results in my hands, but is most striking in cases of insufficiency of the mitral valves. In affections of the aortic valves, and also in cases of mitral insufficiency complicated with stenosis, its efficiency is comparatively less. This, as is well known, is also characteristic of Digitalis. The cause of this unequal effect, on the diseases of the several parts of the heart, lies in the very nature of the physiological action of these remedies, which increase the arterial blood- pressure.”
A great number of patients (suffering from mitral insufficiency, either with or without stenosis) have consulted me either during the period of complete compensation, or after its cessation, when symptoms dangerous to life set in. During the period of compensation the patients consulted me because they were unable to take even the least bodily exertion without troublesome palpitation and dyspnoea, which would compel them at once to desist, and necessitate a more or less prolonged period of rest. This class of patients, who, moreover, are irritable in temper, through the effects of their affliction, generally beg of the physician to prescribe something that would lessen their irritability, and eo ipso prevent the occurrence of those torturing attacks of dyspnoea. Valvular disease in all, and which is so frequently the sequence of acute articular rheumatic cases, without exception, is productive of great irritability and peevishness. Even when it affects persons with fully developed moral character, this disease will so much change it as to render the sufferer almost unrecognizable as the person to his nearest friends, sometimes leaving him of his former temperament and disposition only a vague general habitus. To these patients I have been in the habit of prescribing an infusion of the flowers of Convallaria majalis (gr. x – f3vj) in doses of one tablespoonful twice a day, and in two or three days it so far soothes their organism that it enables them to discontinue their enforced and irksome idleness, or even to undertake considerable exercise without producing palpitation and dyspnoea. The effect of the medicine, without producing palpitation and dyspnoea. The effect of the medicine, without repetition of the dose, continues from five to nine days, after which, if necessary, it may be taken again, and the same result will follow. Especial attention is invited to this sedative effect of the remedy, because the patients during the period of full compensation and apparent health apply to the physician with the special object of obtaining relief from their excessive irritability, and are not contented with the advice that in such cases is generally given them. We must give them something to lessen the reflex functions of the nervous system, and this is accomplished by the infusion of Convallaria majalis. The patient should be instructed to take the medicine only during the continuation of the highest degree of irritability, and discontinue it as soon as his condition becomes at all tolerable, for it is not known to me, as yet, whether the flowers of Convallaria majalis do not, like Digitalis, possess a cumulative action. The infusion of Digitalis, although given in stronger doses (gr. xxf3vj) was much less effective than the infusion Convallaria majalis, made of gr. vij-x to water f3vj.
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.