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cases it is a diuretic. The reasons for these discrepancies are
that if the arterial vessels are, like the rest of the vessels in the
body, tightly contracted by the drug, very little blood will come
to the kidney, and very little urine will be secreted ; but if the
digitalis does not constrict the renal vessels markedly, the in-
creased cardiac force and the general rise of blood-pressure will
send more blood through the kidney and more urine will be ex-
creted. Some observers have, probably incorrectly, stated that
digitalin and digitoxin have a special effect in relaxing the ves-
sels of the kidney. We have no certain knowledge of the effect
of digitalis on the constitution of the urine.

Temperature. Moderate doses have no influence on the tem-
perature, but toxic doses cause it to fail even in health. The
reason of this is unknown.

Respiration. This is unaffected by digitalis unless poisonous
doses have been given, when it begins to fail from the imperfect
circulation through the respiratory mechanism.

Nervous system and Muscles. Medicinal doses have no
marked influence. Large doses will, because of the alterations
in the cerebral circulation, cause headache, giddiness, and dis-
turbances of sight and hearing. In many cases of poisoning all



DRUGS ACTING CHIEFLY ON THE HEART. 425

objects have appeared blue. [In acute poisoning there is a
peculiar blue color of the sclerotic.]

The reflex activity of the cord and motor nerves is depressed
independently of the action on the circulation ; sensory nerves
are unaffected. Digitalis directly paralyzes muscles if given in
toxic doses.

Uterus. This organ is said to be stimulated to contract by
digitalis.

THERAPEUTICS OF DIGITALIS.

External. Digitalis is [sometimes] used externally [in the
form of a poultice made from the leaves, and placed over the
loins in case of renal congestion] .

Internal. It is one of the most valuable drugs we have. It
is chiefly given in cases of cardiac disorder.

Mitral regurgitation. If in any case of this variety of heart
disease the organ is beating feebly, irregularly, and rapidly,
digitalis in moderate doses will probably strengthen, regulate,
and slow the beat. It will cause the left ventricle to contract
more forcibly and to act synchronously in all its parts ; hence
the mitral flaps will be better approximated, the regurgitation
will be less, and more blood will be sent on into the arterial cir-
culation. The prolonged diastole will also be of great advan-
tage, for it will allow more time for the blood to flow from the
dilated auricle, and from the right side of the heart and venous
system generally, into the left ventricle. In mitral regurgitation,
as is well known, venous engorgement and oedema of the lungs,
of the right side of the heart, of the liver, the kidneys, and sub-
cutaneous tissues is very common. Digitalis, by improving the
venous flow towards the heart, will ameliorate all these symptoms.
It might be supposed that by constricting all the peripheral arte-
rioles it would impede the arterial flow, because the heart will
have to contract against a greater peripheral resistance, but this
disadvantage is never enough seriously to hamper the increased
cardiac power ; and it must be remembered that it is a great
advantage to the circulation to have a proper peripheral arterial
resistance, for without that, the elastic coat of the arteries cannot
aid the arterial flow. If, as it usually does in these cases, digi-



426 ORGANIC MATERIA MEDICA.

talis acts as a diuretic, this will be of great value in removing the
cedema, and in causing the scanty high-colored urine to become
pale and abundant. The improvement in the circulation relieves
the cardiac pain and distress which so commonly accompany
mitral regurgitation, the lividity passes off, the dyspnoea de-
creases, and usually in a day or two a wonderful improvement in
the patient's condition takes place. The more any case of mitral
regurgitation deviates from the above [cedematous] type, the less
good, as a rule, will digitalis do. Thus cases in which there is
much pain and distress, and but little regurgitation, are not so
often benefited, although even of such cases many are improved.
Sometimes the vomiting caused by digitalis prohibits its use.
Fatal syncope may occur in those taking digitalis if they are too
suddenly raised from the prone to the upright posture.

Mitral constriction. In this condition it is obvious that it
will be a great advantage to lengthen the diastole, for then there
will be a greater chance that the diastole will be long enough to
allow the normal amount of blood to pass through the constricted
orifice. In proportion as this end is attained, the oedema,
lividity, and other signs of backward venous congestion will be
relieved, and if the digitalis induces diuresis, this is very valu-
able in aiding the reduction of the oedema.

Diseases of the tricuspid valve, In both tricuspid constriction
and tricuspid regurgitation, digitalis will be beneficial in the
same way as in similar affections of the mitral valve. As a rule,
however, it does less good when the disease is on the right side
of the heart.

Aortic regurgitation. Often digitalis is harmful, for by pro-
longing the diastole more time is allowed for the blood to flow
back through the imperfectly closed aortic orifice, and hence
there is great danger of fatal syncope. The drug should only be
given in cases of aortic regurgitation, when the heart is very
rapid, or when there is evidence that not much blood regurgi-
tates, or when there are reasons, such as the coincident presence
of aortic obstruction, for wishing to strengthen and regulate the
contraction. The dose must be small and the effects must be
lv watched



DRUGS ACTING CHIEFLY ON THE HEART. 427

Aortic constriction. This, unfortunately, is usually accom-
panied by aortic regurgitation ; but sometimes when it is wished
to increase the force of the beat, and so to drive more blood
through the constricted aortic orifice, digitalis is useful, or when,
as a result of the obstruction, mitral dilatation and consequent
regurgitation, with much pulmonary and venous engorgement,
have set in. Many cases of pure aortic obstruction do not re-
quire drugs, for the heart hypertrophies sufficiently to overcome
the obstruction.

Bright 's disease. In cases of contracted granular kidney in
which the cardiac hypertrophy has been unable to overcome the
peripheral resistance, and consequently the left ventricle and with
it the auriculo-ventricular orifice has dilated, and mitral regurgi-
tation has therefore ensued, digitalis may be of service for the
reasons given elsewhere (see^. 425). A diuretic pill, often used
for this condition, consists of [calomel] , digitalis, and squill a
grain of each ; [.06 gm.] made up with extract of [hyoscyamus].
Otherwise, in chronic Bright' s disease, digitalis is not a suitable
diuretic, for it raises the tension of the pulse, which is already
high. In the earlier stages of acute Bright' s disease it has been
given as a diuretic, but it is questionable whether it is right to
dilate the vessels of an acutely inflamed organ ; further, digitalis
is always, unless the heart is diseased, an uncertain diuretic, and
even in the early stage of acute Bright' s disease the arterial ten-
sion is somewhat raised. In chronic tubal nephritis, uncompli-
cated by cardiac disease, it is worse than useless, for it has no
effect on the renal cells, and it raises the blood-pressure.

Diseases of the cardiac muscle. If the heart be fatty, or other-
wise degenerated, digitalis rarely does good, for it is harmful for
the diseased heart to have to work against the increased arterial
tension, and it is said that there is danger of rupture of some
of the degenerated fatty fibres. The weakly acting heart that
is met with after pericarditis, typhoid fever, scarlet fever, rheu-
matism, and other acute diseases, even if no valvular defects are
present, is markedly strengthened by digitalis. For this purpose
it may be combined with caffeine, or two drachms [8. c.c.] of
the infusion may be given, with three minims [.20 c.c.] of



428 ORGANIC MATERIA MEDICA.

stronger ammonia [water], in a little water. Each contraction
is more efficient, and the prolonged diastole allows more time
for the muscle to rest. It is clear that in the course of twenty-
four hours this additional repose, although but little in each
cycle, will amount to a considerable time. Many men who have
practiced rowing or other hard exercise to excess, suffer from
shortness of breath, and the apex of the heart is found to be a
little outside the normal position, but there is no demonstrable
valvular lesion. This condition, which also occurs in soldiers
after a long campaign, is much benefited by digitalis. The
dilatation of the right side of the heart that so frequently accom-
panies chronic disease of the lungs may be, but usually is not,
improved by digitalis.

Functional diseases of the heart. The irregular, palpitating
beat, often seen apart from any organic disease, may be benefited
markedly by digitalis ; but it must be remembered that this con-
dition is commonly a result of indigestion, in which case the
right treatment is, if possible, to cure the dyspepsia, and if
digitalis is given at all, to do so cautiously, for it may excite
indigestion. The functional affections of the heart met with in
highly neurotic subjects may be, but are not often, benefited by
digitalis.

Exophthalmic goitre may improve under a long course of
digitalis ; but generally this treatment fails.

Htzmorrhage. Although digitalis contracts the arterioles, it
is not often given as a haemostatic, for the increased blood-pres-
sure may lead to greater haemorrhage, but it may be useful in the
pulmonary haemorrhage due to disease of the mitral valve.

Alcoholism. Moderate doses of digitalis have been said to be
serviceable in chronic alcoholism on account of their stimulating
effect on the circulation. Enormous doses have been given em-
pirically in delirium tremens, but generally without any good
result.

Uterus. Because of its power to contract the uterus, digitalis
may be useful in menorrhagia.

[Digitalis is said to be useless if the patient suffers from high
fever. J



DRUGS ACTING CHIEFLY ON THE HEART. 429

It is often desirable to combine fluid preparations of digitalis
with iron salts, the resulting mixture, which is usually inky from
the action of the iron on the tannic acid in the digitalis, can be
clarified by the addition of a little diluted [phosphoric] acid.
Because of this difficulty the powdered digitalis leaves are often
made into a pill with dried [ferrdus] sulphate.

ANTAGONISM.

Antagonism between Digitalis and Aconite. Aconite is a cardiac poison,
weakening instead of strengthening the beat ; it dilates the peripheral vessels,
it lowers the blood-pressure, and after death the heart is always found in a
condition of diastole. In all these points it is antagonistic to digitalis, but the
action of aconite is very rapid, that of digitalis very slow. Therefore these
drugs are not practical antidotes to each other in poisoning. [Saponin and
senegin are considered to be the most complete physiological antidotes.]

Digitalis is cumulative. Patients who have taken it for a long while
sometimes suddenly show symptoms of poisoning without any increase in the
dose. This is because the drug is not excreted by the kidneys so fast as it is
absorbed, therefore it accumulates in the body. [Digitalis should be stopped
so soon as symptoms of gastro-intestinal irritation supervene, or the pulse be-
comes abnormally slow.]

STROPHANTHUS.

STROPHANTHUS. [The seed of Strophanthus hispidus De Can-
dolle (nat. ord. Apocynacece], deprived of its long awn. Habitat. Tropical
Africa.

CHARACTERS. About 15 mm. long and 4 or 5 mm. broad, oblong-lance-
olate, flattened and obtusely edged, grayish-green, covered with appressed,
silky hairs, one side with a ridge extending into the attenuated, pointed end;
kernel white and oily, consisting of a straight embryo, having two thin cotyle-
dons, and surrounded by a thin layer of perisperm ; nearly inodorous ; taste
very bitter.]

COMPOSITION. The chief constituents are (l) Strophanthin, [C^H^O^].
It exists in all parts of the plant, but mostly in the seeds (8 to 10 per cent.).
This is in all probability the same as, or closely allied to, the active principle
Ouabain [see p. 416] which has been isolated from [another species of] Stro-
phanthus. It is a transparent, white, imperfectly crystalline, bitter glucoside,
(being split up by acids into glucose and Strophanth idin). [Very] soluble in
water ; insoluble in Chloroform and Ether. \_Strophanthin, according to
recent investigation, can be isolated from Strophanthus Kombe, and many
other species of Strophanthus. (2) Kombic Acid, which is not identical in all
varieties of Strophanthus. (3) Ineine, an Alkaloid. (4) Tanghinin, C-^H^Og.
in rhombic prisms.



ORGANIC MATERIA MEDICA.

Preparation.

Tinctura Strophanthi. Tincture of Strophanthus. Strophan-
thus, 50. By digestion and percolation with Alcohol and Water to
1000.

Dose, 2 to 10 m. ; .12 to .60 c.c.

Tincture of Strophanthus Kombe, from which the oil has been extracted
and made from assayed material, is far more reliable. Of this the maximum
dose is 5 m. ; .30 c.c.]

ACTION OF STROPHANTHUS.

External. None.

Internal. G astro-intestinal tract. Like digitalis, Strophan-
thus is liable to cause vomiting and diarrhoea, especially if
the dose be large. [Generally these disturbances result from
preparations from which the volatile oil contained in the seeds has
not been extracted.] In small doses its bitter action may come
into play, and then it will aid digestion like any other bitter
stomachic.

Heart. Strophanthus acts on the heart exactly like digi-
talis, for it strengthens the force without altering the duration
of the systole, slows the rate of the beat, and consequently pro-
longs the diastole, and makes an irregular heart regular. In fatal
cases of poisoning by Strophanthus, the heart may be arrested
either in diastole or systole. The details of its cardiac action are
the same as those of digitalis.

Vessels. It does not constrict the peripheral vessels,
or at any rate very slightly ; therefore, the slow rise of blood-
pressure is almost entirely due to the action of the drug on the
heart. This is the most important difference between it and
digitalis, which contracts the vessels powerfully and consequently
gives a greater rise of blood -pressure, [and is the reason for the
greater safety of the former.]

Kidneys. It is diuretic, [more] powerfully than digitalis.
Probably the diuresis is entirely due to the increased cardiac
action. No special alteration in the size of the renal vessels takes
place under Strophanthus.

Nervous system. This is not affected. In toxic doses it is



DRUGS ACTING CHIEFLY ON THE HEART. 43 1

a direct poison to the voluntary muscles. Strophanthin is a
powerful local anaesthetic when dropped on the conjunctive [of
dogs].

Respiration. No particular effect is produced. The African
Kombe arrow poison is made from strophanthus.

THERAPEUTICS OF STROPHANTHUS.

Strophanthus is used in the same varieties of cardiac disease as
digitalis ; that is to say, when it is desirable to slow the heart, to
increase its force, to make it regular, and to prolong the diastole.
It is clear, therefore, that it will be chiefly valuable in cases of
mitral disease. A priori, it might be thought that as strophanthus
does not contract the peripheral vessels and so increase the car-
diac resistance, consequently it would be the more useful drug,
[and] experience has confirmed this [for certain cases] ; it will
generally happen that strophanthus will not produce vomiting
when digitalis does. [The advantages which strophanthus possesses
over digitalis may be summed up as (i) greater rapidity, modi-
fying pulse rate within an hour ; (2) absence of vaso -constrictor
effects ; (3) greater diuretic powers ; (4) no disturbance of diges-
tion from properly made preparations ; (5) absence of so-called
cumulation ; (6) greater value in children ; and (7) greater safety
in the aged.

It should be the remedy of choice in all cases, (i) in which
we wish to establish compensation ; ( 2 ) of arterial degeneration
in which a remedy which causes more energetic cardiac contrac-
tion is required ; (3) of cardiac disease when a diuretic is neces-
sary ; (4) of weak or irritable hearts ; (5) of cardiac disease in
childhood or old age.] Strophanthus is preferable to digitalis
when it is wished to give one of these drugs in Bright's disease.

CONVALLARIA.

CONVALLARIA. [The rhizome and roots of Convallaria majalis
Linne (nat. ord. Liliacea). Synonym. Lily of the Valley. Habitat.
United States, in the Allegheny Mountains ; Europe and Northern Asia.

CHARACTERS. Of horizontal growth and somewhat branched, about 3
mm. thick, cylindrical, wrinkled, whitish, marked with few circular scars; at
the annulate joint are about eight or ten, long, thin roots ; fracture somewhat



432 ORGANIC MATERIA MEDICA.

fibrous, white ; odor peculiar, pleasant ; taste sweetish, bitter, and somewhat
acrid. ]

COMPOSITION. The chief constituents are (i) Convallamarin, [C^H^
O M ], a glucoside the active principle ; [a white, bitter-sweet powder, soluble
in water and Alcohol. (2) Convallarin, C 34 H 31 O n , a glucoside, in acrid
prisms, sparingly soluble in, but foaming with water, soluble in Alcohol, but
not in Ether.] This is said only to purge.

Preparation.

[Extractum Convallariae Fluidum. Fluid Extract of Con-
vallaria. By maceration and percolation with Diluted Alcohol, and
evaporation.

Dose, 5 to 30 m. ; .30 to 2.00 c.c.]

ACTION AND THERAPEUTICS OF CONVALLARIA.

The action of convallaria is precisely that of digitalis, and it
may be given in exactly the same varieties of heart disease. It
is sometimes successful when digitalis has failed. It is not so
powerful as digitalis, but some find it less likely to produce sick-
ness. [It is said to act more powerfully upon the right heart,
but this is probably not true. A more extended experience
seems to indicate that this drug is very unreliable.]

SCILLA.

SQUILL. [Synonym. Sea Onion. The bulb of Urginea maritima
(Linne) Baker (nat. ord. Liliacete), deprived of its dry, membranaceous outer
scales, and cut into thin slices, the central portions being rejected. Habitat.
Basin of the Mediterranean near the sea.

CHARACTERS. In narrow segments, about 5 cm. long, slightly translucent,
yellowish-white or reddish, brittle and pulverizable when dry, tough and flexi-
ble after exposure to damp air ; inodorous ; taste mucilaginous, bitter and
acrid. ]

COMPOSITION. The chief constituents are (l) Scillitoxin, the most
active principle; (2) [Scillipicrin, acting upon the heart; (3) Scillin, pro-
ducing numbness and vomiting ; (4) Mucilage.

Dose, i to 5 gr. ; .06 to .30 gm.]

Preparations.

i. Acetum Scillse. [Vinegar of Squill. Squill, loo ; Diluted
Acetic Acid, by maceration and percolation, to 1000.
Vinegar of Squill is used to prepare Synipus Scillse.
10 to 45 m. ; .60 to 3.00 c.c.



DRUGS ACTING CHIEFLY ON THE HEART. 433

2. Extractum Scillae Fluidum. Fluid Extract of Squill. By
maceration and percolation with Alcohol and Water, and evaporation.

Fluid Extract of Squill is used to prepare Syrupus Scillse Com-
positus.

Dose, i to 5 m. ; .06 to .30 c.c.

3. Tinctura Scillse. Tincture of Squill. Squill, 150. By ma-
ceration and percolation with Alcohol and Water, to 1000.

Dose, 5 to 30 m. ; .30 to 2.00 c.c.

4. Syrupus Scillae. Syrup of Squill. Vinegar of Squill, 450;
Sugar, 800 ; water to 1000. By solution and straining.

Dose, y 2 to i fl. dr. ; 2. to 4. c.c.

5. Syrupus Scillse Compositus. Compound Syrup of Squill.
Synonym. Hive Syrup. See Antimony, p. 230.]

ACTION OF SQUILL.

Squill so closely resembles digitalis in its action that the
account of that drug will apply to squill, with the following ad-
ditions : Squill is a much more powerful gastro-intestinal
irritant ; vomiting and purging result from even moderate doses,
and after death, if animals are killed with it, much gastro-enteritis
is found. In the second place, some constituent of squill is
excreted by the bronchial mucous membrane, and in passing
through it irritates it. The vascularity and the amount of secre-
tion are thereby increased. Squill is, therefore, a powerful ex-
pectorant. Thirdly, squill in the course of its excretion
through the kidneys stimulates them ; it is, therefore, a more
energetic diuretic than digitalis, and it may irritate the
kidneys excessively.

THERAPEUTICS OF SQUILL.

Because of its irritating properties, squill is not given alone,
but it is frequently combined with digitalis when that drug is
administered for heart disease or as a diuretic. A very favorite
diuretic pill is composed of squill, digitalis and calomel, i gr.
[.06 gm.] of each, made up [with extract of hyoscyamus,
i^ gr. ; .09 gm. This is sometimes known as Guy's triplex
pill.]

Squill is much used as an expectorant. Here also it is always

28



434 ORGANIC MATERIA MEDICA.

prescribed in combination ; it is too irritating to the bronchial
mucous membrane for it to be advisable to give it in acute bron-
chitis ; nor should it be chosen in phthisis, lest it should cause
dyspepsia ; but it is valuable in chronic bronchitis if the secre-
tion is scanty.

Squill should not be given in acute Bright' s disease, for it is
too irritating to the kidneys. [Vinegar of squill should not be
prescribed with ammonium carbonate.]

SCOPARIUS.

SCOPARIUS. Synonym. Broom. The tops of Cytisus Scoparius
[(Linne) Link (nat. ord. Leguminostz). Habitat. Western Asia, Southern
and Western Europe ; naturalized in some localities in the United States.

CHARACTERS. In thin, flexible, branched twigs, pentangular, winged,
dark green, nearly smooth, tough, usually free from leaves ; odor peculiar
when bruised ; taste disagreeably bitter.]

COMPOSITION. The chief constituents are (i) Scoparin, C^H^O^, a
[tasteless, amorphous, neutral principle. (2) Sparleine, C 15 H 26 N 2 , a color-
less, oily, very bitter alkaloid. (3) Tannic Acid.

Dose, ]^ to i dr. ; i. to 4. gm.]

Preparation.

[Extractum Scoparii Fluidum. Fluid Extract of Scoparius.
By maceration and percolation with Diluted Alcohol, and evaporation.
Dose, i^ to i fl. dr. ; i. to 4. c.c.

SPARTEIN^E SULPHAS. Sparteine Sulphate. C 15 H 26 N 2 H 2 SO 4 -f

4H 2 0=4<>3-23-

SOURCE. The neutral sulphate of an alkaloid obtained from Scoparius.
It is obtained by extracting the plant with water acidulated with Sulphuric
Acid, concentrating, decomposing with Sodium Hydroxide, and distilling. The
Sulphate is prepared from the Alkaloid by neutralization with Sulphuric Acid,
and crystallization.

CHARACTERS. Colorless, white, prismatic crystals, or a granular powder,
odorless, and having a slight saline and somewhat bitter taste. Liable to
attract moisture when exposed to damp air. Solubility. Very soluble in
water and Alcohol.

Dose, y'j to 2 gr. ; .006 to .12 gm.]

ACTION OF BROOM.

External. Broom has no external action.

Internal. Nervous system. [Its alkaloid sparteine sulphate



DRUGS ACTING CHIEFLY ON THE HEART. 435

in poisonous doses causes, in the lower animals, tremblings, inco-
ordination, increase of reflexes, clonic and tonic convulsions,
followed by enfeeblement of all the functions, convulsions, and
death from asphyxia.

Respiration. It paralyzes the respiratory centres, causes em-
barrassment of the respiration and paralyzes the motor centres
of the spinal cord, but has a very feeble influence upon the
muscles, lessening, though not destroying, their excitability.

Circulation. According to Laborde, under the influence of
this alkaloid there is a very great increase in the size and height
of the cardiac wave. If the dose has been a small one, the
pulse is at first accelerated ; after large doses there is a slowing
followed by enfeeblement of the heart. The arterial pressure is
not materially changed unless the dose is toxic, when it falls.
Small doses weaken, and large ones paralyze the pneumogastric ;
upon the vaso-motor system it appears to have no influence,
unless in very large toxic doses, when it, perhaps, acts as a
paralyzant.

Kidneys. Broom is of value as a diuretic. Scoparin prob-
ably represents the diuretic principles of the plant.]

THERAPEUTICS OF BROOM.

Broom is a very useful diuretic. It is usually given in com-
bination with other diuretics in cases of dropsy from heart dis-



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