Apocynum. Apocynum cannabinum.

Synonym—Canadian Hemp.

CONSTITUENTS—

Apocynin, apocynein, tannin, gallic acid, gum, starch, resin, wax.

PREPARATIONS—

Decoctum Apocyni, Decoction of Apocynum. Dose, from half a dram to one dram.

Specific Medicine Apocynum. Dose, from half of a minim to twenty minims.

Administration—It may be necessary to vary the form of the remedy in its administration in certain cases before a marked result occurs. The specific apocynum seldom fails. It may act promptly in doses of from one-half to one drop frequently repeated, and it may be necessary to give five drops or more at a dose, but close watch must be kept on its action upon the bowels that it be not too severe and prostrating. The agent has a general tonic influence which so sustains the body forces that considerable violence of cathartic action can be obtained in some cases, without marked depression, but usually this violent action should be avoided.

Fluid extracts are usually unreliable and uncertain in their action, some acting promptly, others producing marked irritation and depression, and still others being inert. If the fresh root of the apocynum can be obtained, an infusion of one ounce to the pint of water may be made, and from a teaspoonful to a tablespoonful of this infusion given often and increased or diminished as indicated. In some cases very small closes are very efficient. A tincture carefully prepared from the fresh root sometimes is the superior preparation.

While specific medicine apocynum and the normal tincture of apocynum are both excellent forms of this remedy for administration, there are some cases in which these produce considerable irritation of the stomach and intestinal canal. A distilled extract of apocynum is now supplied, which is nearly tasteless; can be administered in larger closes, and in many cases produces more satisfactory results than any other form, as it has less irritating properties. This fact is indeed important.

Physiological Action—Whether this agent acts most directly upon the heart or upon the kidneys has been an unsettled question except to those who have used it in cases where the heart was greatly enfeebled and relaxed, and when dropsy resulted from that condition.

It is certainly an excellent heart tonic in such cases, improving the strength of the heart muscle, the character and force of the pulse, and increasing to a most marked extent the arterial tonus. We have taken the initiative in introducing it among the specific heart remedies. It strengthens the nerve force, improves the respiration, and facilitates oxidation of the blood. Its influence is similar to convallaria or digitalis, and it acts in harmony with cactus, the influence of both being increased.

This agent is a violent cardiac poison. Given in large doses, it stops the heart in complete systole, and in small doses slows the beats and strengthens their force. It contains an active principle which acts as does digitalis, with, however, these differences, that it is not cumulative, and when administered in a medicinal dose it does not give rise to any inconvenience excepting some headache. Froment has reported ten instances of diverse cardiac disease in which the pulse was slowed, the rhythm was made regular, the arterial tension was raised, and edema disappeared; in certain cases it acted when strophanthus and tincture of convallaria had failed. It seems to be useful in certain febrile conditions where the frequency of the pulse gives rise to anxiety, notably so in pulmonary tuberculosis, although a large dose may increase the diarrhea if present.

Horatio C. Wood conducted independent experiments to determine the physiological action of this remedy, under the auspices of the National Academy of Science. His observations have confirmed my early and later statements concerning the direct influence of apocynum upon the heart. He states that, notwithstanding all early observations were made with reference to the action of this drug upon the kidneys, his experiments prove that its influence is directly upon the circulation. Injected into the veins of a dog, there was a marked slowing of the pulse with a rise in the blood pressure, usually, but in some cases the slowing of the pulse was so great and so immediate as to prevent any rise of blood pressure. These effects, he asserts, are in every way similar to the action of digitalis, and he is impressed that there is a marked similarity between the action of this drug and digitalis.

His experiments made to determine whether the stimulation was directly upon the heart, or upon the circulation, through the vaso-motor mechanism, convinced him that the drug stimulated the cardiac muscle directly, bringing about a cessation of cardiac action, if persisted in, to over-stimulation, the contractions of the heart ceasing in permanent systolic spasms. He believes the remedy acts also upon the arterial walls. His studies further show that despite the enormous stimulation of the heart, the circulation through the kidneys is diminished rather than increased. This he attributes to a narrowing of the lumen of the blood vessels of the kidney.

He believes that the increased flow of urine under apocynum is due to the regulation of the circulation at large, a condition similar to that induced by digitalis. The pulse is slowed by the action of the remedy through stimulation of the cardiac inhibitory centers of the medulla.

His final conclusions are that apocynum is a powerful stimulant to the circulation, and one of which great practical use can be made. However, because of its irritating action upon the stomach, he thinks its use will be limited, but we do away with this objection entirely, first by the administration of the specific medicine in small doses and, second, by the use of the distilled extract, as stated, which is devoid of irritating properties.

Felix-Kramer of Germany has made the following statements:

"The active principle of apocynum, according to Liebreich and Langaard, is a glucoside called apocynin, the action of which is, like that of digitalis, a cardiac poison. Like strophanthus, nereum oleander, and vinca minor, the plant belongs to the Apocynaceae family.

The reports on this remedy so far as I have been able to follow them are unanimous in designating it as a cardiac tonic and diuretic. According to Gwovdinski, of Kiev, apocynum cannabinum is known in Virginia as a household remedy and is used by some American physicians by preference as a diuretic. The dose according to this report is 15 drops, t. i. d., and given during the period of compensatory disturbance it caused no unpleasant side-effects.

According to Alesejew the effect of the remedy appears, in proper cases, in two or three days. If no remedial action appeared in five days Alesejew made no further use of the remedy. He prescribed small doses (from three to five drops) three to four times a day. After larger doses he met at times gastric disturbances and pains in the cardiac region. Cumulative effects he did not encounter. The dosage, according to Golubin, is five drops three or four times daily.

In Pawinsky's (of Warsaw) notices about apocynum cannabinum the observations he made of the different effects of this remedy from those of digitalis on the vagus are interesting. He found that apocynum cannabinum acts more readily and energetically on the innervation of the heart than digitalis, but the effect of the latter is a more persistent one. He would, therefore, use the remedy at shorter intervals, especially in cases of arrhythmia.

His dosage is somewhat higher: Eight to ten drops of the fluid extract two to three times a day. However, one should always begin with small doses. Pawinsky rarely met with unfavorable effects on the digestion from this remedy, of which effects some authors speak very extensively. Cumulative effects he found none.

The indications for the remedy, according to the writer mentioned, are valvular lesions and affections of the heart muscle at the time of disturbance of compensation. A. Robin gave thirty drops of this remedy three times daily.

Its influence upon the kidneys is exercised, however, when heart symptoms are not conspicuous. It produces a greatly increased flow of limpid urine without irritating the kidneys. There is no hematuria or other evidence of forced action or marked renal congestion. In profound doses it has caused suppression of the urine.

The agent exercises a hydragogue influence both upon the kidneys and bowels. In large doses it irritates the stomach, producing violent prostrating emesis. As an emetic or cathartic it is too harsh and should not be used. We have more efficient and milder remedies.

Dr. Gregory believes apocynum acts directly on the kidneys and when they are acting insufficiently he uses it as a stimulant, believing that it increases the solid matter thrown off. Dr. Moercke, of Burlington, believes that the remedy will not act when dropsy is induced by malignant diseases, but may perform miracles where the patient is dying from incurable heart lesions with general dropsy. He finds it of great value in articular rheumatism when the tissues are filled with serum, and the heart weak but sound.

The following conclusions were drawn by a writer in the Medical Century:

The drug may be given in large doses for a long time—several years in a few cases—without injury to the patient.

Improvement soon manifests itself in the majority of cases, but if improvement does not appear soon after taking the drug its further administration will be of no avail.

The best way to give the drug is by starting in with small doses of the tincture—three drops—and gradually increasing the dose so that the patient is taking ten drops three times a day within three days.

Curative results have not been seen from its use, but the patient is made comfortable and the amount of dropsy greatly diminished.

The only evil consequence from the use of the drug is a slight amount of gastric irritation which is sometimes the result of its taking. This effect gradually wears off as the patient becomes accustomed to its use.

Many failures have been reported, but the writer is inclined to believe that they are mostly due to the use of poor preparation. Beneficial results have not been obtained from the use of the various homeopathic tinctures; many of them seem to be inert. The best results have been obtained from the use of the eclectic specific medicine.

Specific Symptomatology—Dropsy is the condition for which this agent should be used, with puffiness of the face beginning in the cellular tissues around or under the eyes, puffiness of the hands and feet, followed by general dropsical effusion. Dropsy caused by defective kidney action yields first, provided too much structural change of the kidneys has not occurred.

We would add, as specific symptoms, local edema; edema of the feet and lower legs, pitting upon pressure; edema occurring suddenly from unexplained causes, especially when there is general atonicity, with more or less feebleness of the heart's action.

In acute inflammation of the kidneys, where dropsy appears before the kidney lesion has been diagnosed, as often occurs in post-scarlatinal nephritis, it is prompt in its action, but the kidney inflammation must be combated with other remedies. In dropsy depending upon feeble heart, with impaired blood pressure and deficient capillary action, the influence of apocynum is fully as marked as in the above condition.

Therapy—The statements made in my first editions concerning the therapeutic action of this remedy upon the heart have been more than confirmed by subsequent reports other than those of Wood. It acts in harmony with cactus, which is the superior remedy, however, in its tonic effects upon the nervous control of the heart and in improving its muscular power.

Apocynum improves the functional operation of the heart. Dr. Best reports two cases, where the heart was laboring tumultuously, with great irregularity. The radial pulse was almost imperceptible, except upon the every third or fourth beat. All other heart remedies had been tried and failed. This remedy accomplished all that could be desired. There was a very great increase in the flow of urine, the pulse became stronger, the heart turbulence and the dyspnea disappeared, and the patient recovered. Another patient, seventy-five years of age, with very irritable heart and constant cough, was relieved by the action of this remedy, in small, frequent doses.

Apocynum strengthens the heart's action, producing an increased tonicity and a regularity of movement, and stimulates the excretion of the watery portion of the urine, changing this fluid from a scanty, thick, turbid liquid to one normal, clear and free, rapidly reducing edema.

In the latter stages of heart diseases where hydropericardium is present, with other local or general effusions, it is prompt and efficient in its action, as it most materially strengthens the heart and improves the character of the circulation, while it removes the effusion and consequent oppression.

In the later stages of pneumonia where cyanosis and difficult breathing, with increased weakness of the heart, are threatening complications, Dr. Wilkenloh depends upon apocynum. It increases the power of the heart, improves capillary circulation, assists in overcoming hepatization, and acts upon the kidneys at the same time. She gives from five to ten drops until it loosens the action of the bowels. Then she reduces it to half a drop every half hour or hour. She has confidence in it in cardiac dropsy. She gives it for dropsy from arteriosclerosis, giving it in small doses with hypodermics of strychnine. She thinks we have much yet to learn of its influence.

It has been used in all local dropsies. It has cured several cases of hydrocephalus, and should be tried in these cases.

Edema, accompanying a mild form of asthmatic breathing, with irregular heart's action, has been cured, with all the symptoms, with this remedy. The recent reports of the action of apocynum include the influence of the remedy upon the heart. Dr. Winter believes that apocynum should be used in cerebrospinal meningitis, especially after the stage of effusion. He believes if to be the rational remedy. It may be combined with the other indicated remedies and echinacea. Dr. Shafer and other observer's have used it to settle the stomach and strengthen the heart during an attack of delirium tremens, or following a debauch. Its influence in the cases used was very prompt and satisfactory. Dr. Keys confirms this observation.

In the nephritis of pregnancy with albuminuria, apocynum lessens arterial tension while it overcomes the dropsy and assists in the reduction of blood pressure which in itself abates the quantity of albumin. If the pulse is strong and rapid, this influence is enhanced by the careful use of veratrum.

In females where there are greatly relaxed or flabby tissues, anemia, and a tendency to metrorrhagia or menorrhagia, with some little effusion in the ankles, with feeble kidney action, apocynum influences all the conditions. If iron be added for the anemia the influence will be prompt and satisfactory. It has considerable reputation in the control of passive hemorrhage among certain physicians.

Apocynum has cured many stubborn, intractable and very severe cases of sciatica. We do not undertake to explain its action in this disease. Half a dram of the specific apocynum added to four ounces of water, a teaspoonful every half hour, resulted in relief after a few doses. In the treatment of this disorder Webb and others use five drops over the sheath of the nerve, sometimes giving it from four to six times in a day, often with rapid results. Any toxic effect must be watched for.

Harvey Brown adds three drams of apocynum to four ounces of water and gives a teaspoonful every four hours for sciatica.

Trowbridge has used apocynum in doses of two drops four times a day where there is irregular and too frequent menstruation. In one case in his special work as an oculist where there was exophthalmic goiter with nervous irritability and irritable heart, he gave apocynum and this corrected all the conditions as well as the irregular menstruation, which he thinks is present in every female patient with this disorder. This suggestion should have attention.

From severe injury to the thigh, a patient of Dr. Neiderkorn developed a condition closely resembling dropsy of the extremities, but described by him with symptoms similar to acute traumatic phlebitis. The appearances so closely resembled the indications for apocynum that he gave this remedy in drop doses every two hours. There was a gradual reduction in the swelling, and a satisfactory abatement of the inflammatory symptoms with early recovery.

The Removal of Dropsical Accumulations.

In the treatment of dropsy I am convinced that the physiological processes involved have been misunderstood and therefore often wrongly treated. Failures have been attributed to the remedy, when they have been due to its improper administration. That this is too often the case in the use of remedies for other conditions, I am assured.

To illustrate: Cathartics are administered for their hydrogogue action in dropsy, either to directly reduce the quantity of the fluid within the tissues or to reduce the quantity of serum directly from the blood and thus induce a reabsorption, perhaps, of the serum which has been diffused outside the capillaries throughout the tissues.

It is well known that apocynum, elaterium, and hair cap moss, when given in proper dosage, will so influence the process of absorption that the diffused serum will be taken back through the medium of the capillaries, into the circulation and the dropsy will disappear without any active hydrogogue or diuretic action.

I first made this observation in 1882, of the action of hair cap moss. Both my own observations and those of other more recent writers will confirm this influence as being possible from the use of apocynum, elaterium, magnesium sulphate in small and frequently repeated doses, and one or two other remedies to a limited extent. Whether the remedy acts through its direct influence upon the heart, and the circulation of the blood, or upon the secretory or excretory glands of the intestinal canal, as elaterium is supposed to act, or upon both these processes, as apocynum acts, or primarily upon the kidneys, there is no doubt in my mind that an influence is exercised upon the blood pressure-upon arterial tension and perhaps also upon the specific gravity of the blood which influences absorption and the osmotic processes, promoting a reabsorption of the diffused serum into the capillaries without any apparent loss of fluid by increased intestinal, renal, or other eliminative action.

If it were possible to know how this reabsorption could be always induced, it would be of great advantage, as it at once restores the quantity of fluid to the circulation, and prevents the prostration and debilitation of the patient, present, often after the removal of so great a quantity of fluid, which sometimes results in the death of the patient, before the influence of restoratives can be administered. I regret that I cannot give the dosage, exact in each case, but it is small always, usually much less than the commonly prescribed dose, and the dose should be frequently repeated. With apocynum this may be observed with twenty drops of the specific medicine in four ounces of water, a teaspoonful given every hour. With elaterium from one-thirtieth to one-fortieth of a grain should be given every hour. The fact that there is no prostration, that the patient's strength and vital forces are. retained by this process, is a strong argument in favor of a knowledge of it, and of its adoption. We must look for this influence with other remedies.

The American Materia Medica, Therapeutics and Pharmacognosy, 1919, was written by Finley Ellingwood, M.D.
It was scanned by Michael Moore for the Southwest School of Botanical Medicine.