The influence of the latter, if taken during a paroxysm of palpitation and dyspnoea, is felt at once.
When compensation is no longer able to correct the consequences of valvular disease, the remedy still acts satisfactorily, and it has great advantages over Digitalis, as the latter, in order to remove symptoms immediately dangerous, has to be used in such large doses that not many physicians, remembering the dangers from the remedy itself, dare repeat it. Instead, therefore, of giving heroic doses of Digitalis, I have repeatedly prescribed infus. flor. Convallariae (gr. x – xij: 3vj), 3/4 tablespoonfuls, in a day, and with excellent results, the severe dyspnoea, oedema of the feet, and rales in the lower lobes of the lungs disappearing, so that in seven or eight days, after having taken the six ounces of infusion, the patient would feel tolerably well. In cases of severe dropsy through arrest of compensation I have not yet tested the remedy; consequently I cannot say anything about its diuretic effects, although I expect it will be found very valuable.
The following clinical indications for the use of Convallaria majalis are from Dr. E.C. Trudeau, of Saranac Lake, N.Y., who writes to the Medical Record his experience with the use of this remedy for a year past and expresses his belief that it is most successful in all cases where it is imperative to restore the balance of the right side of the heart, while it is much less active when increased energy on the part of the ventricle is called for. Its striking power in controlling dyspnoea in cases of emphysema, fibrous and chronic phthisis (cases in which Digitalis frequently fails), in relieving the orthopnoea of mitral disease, increasing at the same time the flow of urine, and its failure to mitigate the symptoms of aortic mischief or to increase the flow of urine in such cases, are clinical facts which tend to confirm this suggestion. It is in relieving dyspnoea that Convallaria attains its most brilliant results, while it has only an uncertain and trifling power over oedema and dropsy, and it succeeds often in precisely the cases in which Digitalis fails. Another indication for its use, not hitherto dwelt upon, is in controlling the symptoms of purely functional heart disorder.
Paroxysmal palpitation and dyspnoea, due to nervous causes, rapid and irregular heart action dependent upon debility, are symptoms almost always benefited by it, and which often entirely disappear during its exhibition.
[I can agree perfectly with Dr. Trudeau, who has more clearly defined the sphere of curation of this remedy than any other writer. In his original paper Dr. Trudeau says he prescribes it in doses from gtt. x to 3j of the fluid extract. In the same class of cases I have succeeded just as well with five to ten drops of the tincture, made from the fluid extract of the flowers. My dose only represents one-fifth that of Dr. Trudeau’s. In inflammatory cases I use only one one-hundred as much as he, and yet get prompt results. – Hale.]
In the Medical Record for February 7th and 15th, 1883, are reported twenty cases of cardiac, renal and pulmonary diseases, treated in hospital with Convallaria. But the report is unsatisfactory, for a majority of the cases were almost “in extremis;” others incurable; but even in these cases a few received marked benefit; and a study of the report is not without value.
At Dr. Botkin’s Military Hospital, St. Petersburg, a woman applied for medical aid. She was 30 years old, of medium size, thin and anaemic. She complained of constant dyspnoea, palpitation and pain about the heart, radiating into the left arm, and down, along its internal aspect, into the fingers. Exacerbations of these symptoms took place several times a day, and sometimes in the night. She was unable to work, and was losing flesh; could sleep but little, and only in a sitting posture; had suffered for ten months, although she had been constantly treated by physicians. The cause of her illness was unknown to her. Her thorax was normal, breathing superficial, 48. Radial pulse small, 116, whilst the carotids and aorta pulsated violently. Her hands trembled very much. Immediately below the left clavicle there is a very noticeable dulness, which extends along the left parasternal line, and which over the third rib merges completely into the absolute dulness of the cardiac region, the latter extending toward the right as far as the median line. The heart impulse is vigorous and in the normal situation. The second heart-sound is more pronounced. The respiratory murmur along the parasternal line is weak and short, but improves after deep breathing. On palpation of the abdomen the right kidney was discovered to be painful and movable.
He pronounced the case one of neurosis of the cardiac apparatus, taking the form of angina pectoris, and which had already caused a change in the dimensions of the heart. Thus, its diameter was increased so as to reach the median line, and increase in the size of the left auricle was indicated by the dulness along the left parasternal line. In consequence of the insufficient evacuation of these parts of the heart, there were abnormal blood-supply to the lungs and dyspnoea. The cardiac neurosis in this case is probably due to reflex influence from the abnormal situation of the right kidney, which not only was irritated itself, but kept up an irritation of the adjacent organs.
The patient was ordered to apply clay poultices to the cardiac region, to take two or three warm baths a week, and to wear a special belt to retain the kidney in its proper position. Internally she received:
16
Rx – Camp. monobrom, 3j
Chloral hydrat. 3ss.
Pulv. acaciae.
Sacch. alb, aa 3j.
F. Pill. No. 60. Two pills three times a day.
On the 10th there was no improvement. Examinations showed only slight sensitiveness of one kidney. The patient was now given tinct. Convallariae majalis, 10 drops, four times a day. The baths and belt were continued.
On the 17th patient reported that she obtained relief from the very first dose of the medicine, and now feels well. She can sleep in the recumbent position; has no more palpitation or dyspnoea. Pulse 80 – 90; respiration 22. The parasternal dulness is less marked. Cardiac dulness now extends only as far as the left parasternal line. Pulsation of the aorta is still too violent, but less than before. Heart-tones clear, with slight accentuation of the second sound. When breathing deeply there is a vascular murmur, though rather weak, along the parasternal line, where the dulness was. The right kidney is less sensitive. The whole success in this case of rather complicated cardiac neurosis is evidently due to the tincture of Convallaria, since the remedies previously employed had no effect.
We believe the relation of this case to have some practical value, since cardiac neuroses are frequently met with in practice, and we have hitherto had no certain and reliable remedy for their treatment.
Our usual cardiac remedies – Digitals and Adonis vernalis – says Professor Botkin, in the vast majority of cases of cardiac neurosis, have no effect whatever, whilst Convallaria generally acts like a specific. But in these cases it should be used in form of an alcoholic tincture, not in infusion.
It is probably more largely used in Russia than in any other country. I am not aware that it has been used to any extend in England. In France, however, we have some excellent reports from the “Clinique” of Prof. See. In this country it is being largely used by both schools of practice.
HOMOEOPATHIC PROVINGS OF CONVALLARIA.
We, who believe that the law Similia Similibus Curantur is the chief or only scientific law of cure, know that a proving, or series of provings, of a drug on the healthy, will always confirm the cures or remedial effects of a drug which has been used successfully in an empirical manner.
The use of Convallaria has not been solely empirical. Its only purely empirical uses have been by the aboriginal inhabitants of Russia, who gave it in a crude manner in hysteria, epilepsy, dropsy, etc. They had no idea of its specific relation to any particular organ. But such crude uses served as a hint to scientific physicians, and they have ascertained from experiments on animals that it caused pathological conditions in the healthy heart. Experiments on healthy men they did not make. But they reasoned that if Convallaria caused the healthy heart of an animal to beat slower and stronger, and finally cease to beat from a firm contraction in systole, it would act as a tonic and regulator to a disordered heart, rendered weak and flaccid, and with irregular, feeble action. Its administration in such cases proved the deduction to be true. But they did not possess a knowledge of the special symptoms produced on men and women by the drug. It remained for us to supply this want by our systematic provings. Dr. Irving J. Lane gives us his thesis in the May number of the North American Journal of Homoeopathy, which contains three provings of Convallaria. Two of these are on men, and one on a woman.
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.