Lobelia. Lobelia inflata.

Note—In the early editions of my work on Materia Medica, this agent was classed from our knowledge of its action per os, as a nauseating expectorant and respiratory sedative. Since that time, the very wide observations made of its action hypodermically have changed the most of our ideas concerning it, and have placed it in an entirely different class. Given hypodermically but very few patients are nauseated by it, and almost the whole number, notwithstanding its sedative and anti-spasmodic influence, experience a physical uplift from its action. It would seem therefore to be more properly classed among stimulants. I have thought best, however, to leave this agent in its original class, until laboratory experiments have proven its exact influence upon the nervous and circulatory systems.

Synonym—Indian Tobacco.

Part Employed—The whole plant.

CONSTITUENTS—

Lobeline, Lobelachrin, Lobelia acid.

PREPARATIONS—

Extractum Lobeliae Fluidum, Fluid Extract of Lobelia; dose, from one to ten minims.

Tinctura Lobeliae, Tincture of Lobelia; dose, from five to thirty

Specific Medicine Lobelia; dose, from one to twenty minims.

Subculoid (hypodermic) Lobelia; dose, from two to sixty minims; usually from ten or thirty minims repeated as occasion demands.

The preparation of lobelia which is to be used hypodermically, must be selected with great care. If the agent be given internally, any good fluid preparation is effective, but in its hypodermic use, local irritation, nausea, severe vomiting, even general prostration occur more frequently from the ordinary fluid preparations. If depression with the above complications can be properly antagonized, and is not objectional in a sthenic patient. and the case immediately demands the remedy when only these are at hand, much the same results will occur as from the perfected preparations.

Extended and persistent experimentation has been made nearly as possible a perfect fluid preparation for hypodermic use. The nearest to this at the present time is the so-called Subculoid lobelia. This is devoid to a very large extent of the objectionable features of the other preparations, and so nearly devoid of emetic properties that this is now considered a negligible quality. It is always best however to use any preparation hypodermically warmed, the parts aseptic, and to apply a hot compress over the seat of the application immediately for a few minutes. Except for its local effects, there is but little difference between the Subculoid lobelia and the specific medicine lobelia.

Administration—Given by mouth for the various purposes for which it has long been used, the dosage of the specific medicine should be small, and frequently repeated. As an emetic or antispasmodic, the dose is from fifteen to thirty minims. Given hypodermically, from five to fifteen drops is usually sufficient in all children's cases, and from ten to thirty drops in adult cases. If no untoward results occur after the first dose, and the condition demands it, a more or less frequent dose and an increase in the size of the dose is justified by the severity of the symptoms, and by the demand for its influence.

Every prescriber will soon learn to make these adjustments correctly. In an occasional case a very small dose is sufficient.

Physiological Action—Lobelia relieves pain due to spasm of any character. But in its antispasmodic and relaxing influence it is not narcotic in the same sense as opium. It exercises a soothing influence over nerve irritability, and a distinct anodyne result ensues. General relief from pain often follows when other measures have failed. The pain from renal or hepatic stone is more quickly relieved by it and more permanently, often, than by morphine because of the general relaxation.

As used by the mouth, prior to our knowledge of its peculiar action hypodermically, it was determined that lobelia in toxic doses causes extreme prostration, burning pain in the esophagus, rapid, feeble pulse, fall of temperature, collapse, coma or convulsions and death from respiratory failure. Moderate doses cause dizziness, nausea, vomiting, headache and general tremors. In doses of twenty grains it is a prompt emetic, but emesis is accompanied by excessive prostration, relaxation and a feeble pulse. In small doses it causes increased expectoration and diaphoresis. Like other narcotics, a small dose stimulates, while a large dose depresses the nervous system.

Although usually classed among emetics, lobelia is a nerve sedative of great power, and in this influence as an antispasmodic it is exceeded by but few remedies.

Death has occurred in a very few cases from excessive doses of the remedy, but toxic effects are not apparent where the medicinal dose is prescribed. Where death has occurred, its influence as a nerve depressant has been plainly shown in the profound, general muscular relaxation, with greatly impaired muscular power, general trembling, shallow respiration, cold, clammy skin, feeble and depressed heart action. It acts like tobacco and physostigma upon the respiration, the heart's action continuing after the respiration has ceased. Paralysis of the respiratory nerves is its prominent influence.

The observations made of its physiological action when the remedy is used hypodermically are, that so used, the direct local influence of the agent upon the stomach is avoided and if the remedy is properly prepared, emesis, violent vomiting, profound relaxation, with prostration and depression, which were found present from that local influence are all absent. A total of less than five per cent of the cases will show emesis or even nausea.

Used in a medicinal dose, it softens the pulse, slows the respiration, quiets the nervous system, and produces a freedom of the respiration and circulation. One of our writers claims that he believes that the agent introduced by the stomach acts upon the pneumogastric nerve, while, when introduced hypodermically and absorbed, it acts more directly upon the sympathetic nervous system.

Lobelia acts directly upon the regulating centers of the system; those of heat, of the circulation, of nerve influences, both motor and sensory. It supports the heart; it overcomes excessive blood pressure, and restores normal tension. It is directly indicated in depression as well as in over-stimulation. It also controls hyperemia. Whatever the cause of any great depression, we cannot yet define the marvelous improvement observed from this agent. We hardly call it stimulation, and yet the improved condition is such as would ultimately follow the action of the very best, most natural stimulants or tonics.

It is hard indeed to express the apparently contradictory influence exercised on the above named depression, which has been overcome in its most extreme form—(in fact, in some cases where the skin was so cold and the process of life so feeble as to cause one to think that death had occurred and yet the reaction appears very promptly)—between this condition and its influence in profound heat stroke, as one doctor reports, where the temperature was 110 degrees, and others have reported from 106 degrees and up. Dr. Jentzsch who is enthusiastic about the action of this remedy in heat stroke, hesitates in claiming that lobelia is a stimulant, pure and simple, as we understand the action of stimulants. Unlike brandy or strychnine or digitalis, the immediate and sharp, stimulating, or whipping-up effects do not appear in the same way to be lost when the effect of the medicine is gone.

The improvement on all conditions is plainly marked, but the restoration is nearly that of a full normal condition obtained in a smooth and satisfactory manner. It is more like an increase of vital force, which remains to a large extent, in the improved condition of all the functions after the remedy has had time to be fully eliminated.

From my own personal observations and from the conclusions I have drawn from the observations of others, I would say that lobelia seems at once to supply a subtle but wholly sufficient force, power, or renewed vital influence, by which the nervous system and the essential vital force within the system again reassert themselves and obtain complete control of the functional action of every organ. From this influence, in a natural and sufficient manner, a complete harmonious operation of the whole combined forces is at once resumed, in some cases in an almost startling manner. Other agents stimulate, prop up, whip up or temporarily increase the force and power of one or another function, while this remedy with this peculiar power at once assumes control of the whole, and succeeds against all the opposing influences.

Specific Symptomatology—This remedy is specific given in irritable, spasmodic and oppressed breathing, and in respiratory disorders from exalted nerve force and nerve irritation.

It is contraindicated in general relaxation and in dyspnea from enlarged or fatty heart, or from hydropericardium, or enfeebled heart, with valvular incompetence. It is specific in threatened spasm with exalted nerve action—a high degree of nerve tension with great restlessness and excitability, flushed face and contracted pupils. It is a prompt emetic in full doses. The following observations are made almost entirely from its hypodermic use.

Therapy—In spasmodic asthma, if given in a dose of from thirty minims to one dram during the paroxysm, the benefit is apparent almost immediately. Small doses are of but little or no benefit in such a case. This full dose may be once repeated, but this is seldom necessary, and a single dose seldom produces vomiting. It is useful in asthmatic breathing. When continued with other agents it must be given in doses not to exceed ten minims three or four times a day.

Lobelia is of value in whooping-cough. It is a reliable expectorant, and either alone or in combination with other indicated remedies, is useful in all cases of dry, hard, barking cough, or where the expectoration is difficult to raise, in spasmodic croup, and in membranous croup without depression.

Children are less liable to be unpleasantly affected with Lobelia than adults.

Its action as an emetic is most profound. It is not so commonly used at the present time for that purpose as ipecac, as the irritation, nausea and general depression are usually greater than is necessary.

It resembles tobacco in this and in many other particulars, producing a burning sensation in the fauces which is persistent and unpleasant.

Either alone or combined with tincture of capsicum, it has long been used to overcome spasms of all characters, from infantile convulsions to puerperal eclampsia and epilepsy.

It has been given in tetanus with benefit, and with success in the spasm of hydrophobia and of strychnia poisoning.

Because of the great importance placed upon this remedy by Thompson, and the violent opposition which followed his endorsement, it has been openly decried by the profession at large, and denounced because of its inactivity in small doses, and declared to be a profound poison in full doses. If it had been given fearlessly in full, large, single doses, the best of results would have occurred.

As a remedy for hysteria, hysterical paroxysms and hysterical convulsions, the combined tinctures of this remedy and capsicum have no superior. It will immediately terminate many paroxysms and quickly control convulsive attacks.

This agent has in the past been exceedingly popular as a relaxant in rigid os uteri. Very many cases are on record of almost immediate relaxation and rapid termination of labor.

Ten years ago Dr. Ernst Jentzsch, sitting one night at the bedside of his only son in the throes of death, from fulminating diphtheria, after antitoxin to the extreme limit had been used, and all other available measures, claims that in answer to prayer, with a peculiar confidence that he could not account for, gave the boy, without any precedent, a hypodermic injection of one-half dram of specific medicine, lobelia. He made the following statement as to results:

"All the fatal symptoms gave way to those of returning health, the patient passing from a death struggle into a peaceful slumber, from which he awoke after three hours, somewhat weak. Another dose was given, which was followed by a still more pronounced reaction for the better. The patient from that time continued to convalesce, and, with the exception of a post-diphtheritic pharyngeal paralysis, he made a rapid recovery. Later, the paralysis yielded to smaller doses of the same remedy."

"In any case where there is the least suspicion of diphtheria not always waiting for a test, I give a half dram dose of the specific medicine lobelia hypodermically, and repeat it from two to twelve hours once or oftener, as indicated, until reaction sets in, which means a return to health."

In Diphtheria, lobelia has now been tested in several thousand cases. At first there was some doubt from the reports received, but later and more recently reports are quite uniformly favorable in encouraging the belief that it will be found to be fully as useful a remedy as the serum antitoxin. It has several advantages. It not only removes the membranes, but it destroys the germs of disease, and at once puts the patient in the best possible physical condition to resist its inroads. It preserves intact the functions of the body, and preserves or restores the functions of the nervous system. It is nontoxic, has not only no anaphylaxis following, but a single dose restores a patient suffering from anaphylaxis from the serum antitoxin. The latest report at this writing received found nine children in a hovel with no care, all with diphtheria and only one with the disease mildly. Using nothing whatever except lobelia, the physician lost one case out of the nine, putting them, however, into as good condition as possible in their surroundings from the beginning of his treatment.

The dose for diphtheria varies from ten minims to forty, and is administered according to the demands of the patient from one hour at first to six hour intervals, with one or two injections a day for any subsequent paralysis.

Lobelia has long been used in asthma. Taken by the mouth severe spasmodic cases are relieved. Hypodermically the same results are obtained. An occasional case however will show unfavorable results, and in some cases where there are serious heart lesions, there has been prostration, depression, and threatened death which were combated only by vigorous measures. The smaller dose should be used in these cases until no evidence of idiosyncrasy or susceptibility are known to occur. In the absence of these indication's then the agent can be used fearlessly and in increasing doses if necessary.

This agent is equally satisfactorily in the treatment of diphtheritic-membranous croup. The observations have been universally favorable. Simple spasmodic croup yields to it promptly. As yet no undesirable results are reported. The dose is from five to fifteen minims, repeated as needed.

In the treatment of tonsillitis, it will not be needed except in the severer forms, in which it will promote satisfactory results.

In the treatment of coughs, those due to pneumogastric irritation, are quickly relieved as well as the pain accompanying. It promotes normal expectoration and respiratory freedom.

In the treatment of whooping cough, but few cases are reported at this time, but the suggestion is that it be given just preceding the attack of cough and repeated if possible on two or three consecutive attacks.

In the treatment of bronchial coughs and acute bronchitis, especially if the bronchial tubes are loaded with mucus and there is a sense of tightness with some difficulty in breathing, the agent is directly indicated.

If with pneumonia or broncho-pneumonia there should be rapid shallow breathing with anxious expression of the countenance and a tendency to cyanosis, this agent is clearly indicated. It improves the heart's action; relieves the capillary circulation, and dissipates cyanosis, more quickly than any other remedy.

It is well known that in the treatment of pneumonia in the later stages, symptoms occur frequently which seem to threaten an almost immediate fatal termination. This group of symptoms is promptly met with a single hypodermic dose of lobelia. This is especially true with children. I have many reports where the agent snatched the little patient as it were, from the grave, just as death's door seemed to be closing upon it.

When from any cause, usually from heart complications, the patient complains of shortness of breath, especially if there be any sense of oppression in the chest, or tightness around the chest, a medium dose of lobelia hypodermically will give full freedom and in many cases a careful properly timed repetition of the injection will give permanent relief.

In the treatment of nausea, persistent vomiting, and a generally disturbed condition of the stomach, if ten drops of lobelia be added to half a glass of water and a teaspoonful be given by the mouth every ten or fifteen minutes, it will often give prompt relief.

It is also useful adjusted in the same manner as the above for sick headaches and given over a period of time with reference to the conditions that induce the disease and also to any possible periodical recurrence of the disease, it will be found curative.

It was used successfully in one case of persistent hiccough. One-half dram repeated in half an hour cured the case.

In the treatment of acute spasm in the stomach, in the pylorus or cardiospasm, this agent is of immediate benefit. It is exceedingly beneficial in spasms of any kind within the abdomen. Some obstinate cases having been cured with it. It quickly relieves certain cases of chronic constipation, and is positively indicated in obstipation and where the obstruction of the bowels seem certain. It thoroughly relaxes muscular spasm and encourages peristalsis.

Used in acute heart failure with imminent danger, a full injection is demanded. Many lives have been saved by its peculiar sustaining influence. No depression is observed, no erratic action, even when what would seem to be unnecessarily large doses have been given. One to two drams have been frequently given and repeated with only good results. In these cases indications for other remedies should be looked for and met.

Heart conditions depending upon feebleness or lack of tone or of muscular power should have occasional regular doses of this agent. It can be given with more freedom than any other heart stimulant. A case of tachycardia is reported where it was used with temporary benefit only.

In chronic heart disease with dilatation—hypertrophy—the consequent valvular deficiency and other structural defects, the agent must be given with caution as in a few cases untoward results have been seen.

The prompt and satisfactory effect of lobelia upon angina pectoris has been known for fifty years or more, the old prescribers giving it by the mouth freely and with positiveness for this disorder. Hypodermically the agent is given in about thirty drop doses but in many cases fifteen drops have been sufficient. Usually the larger the dose the more satisfactory the result.

In precordial oppression, where the patient complains of a sensation of tightness over the chest with sighing respiration—a sensation of weight, heaviness and tightness, often accompanied with considerable pain, it is indicated.

In the treatment of any form of hysteria, especially if there be violent hysterical excitement or convulsions, this agent will be found of immediate benefit.

Its natural antispasmodic properties make it a most reliable remedy for convulsions of any form and by proper adjustment, it is the safest probably of our agents for the convulsions of childhood. In babes, a small dose only is required and there is little danger of nausea or other unpleasant effects. The dose should be repeated as needed.

Spasm of the glottis has been controlled in several cases promptly with ten drop doses, though a larger dose may be needed.

A case of tonic spasm with deep coma following a fifth laparotomy was most satisfactorily cured by dram doses every fifteen or twenty minutes until two ounces were used.

The convulsions of cerebrospinal meningitis have no more active antidote than hypodermic lobelia. Given with echinacea, calcium sulphide or hexymethylenamine, it will prove curative, although some doctors will prefer to combine it, for sedative influence with gelsemium.

Dr. Wilkenloh has observed that she gets best results in this disease when the face is ashy pale, when the muscular pains are extremely severe, and where there is some paralysis following the convulsive attack. Even in children with these conditions she gives full doses in most cases though usually smaller doses will accomplish the same result.

Five cases of epidemic spinal meningitis were treated with recovery in every case with ten drop doses given every hour.

Epilepsy should be treated with this remedy and careful observations made. If given during the aura in sufficiently large doses and the dose repeated as indicated, it will probably be found to exercise an efficient control. It was satisfactory in a few cases that are reported, but observations are insufficient.

In the treatment of tetanus, it has controlled the convulsions in a number of cases, especially if an anti-toxic agent was injected at the same time.

In the treatment of eclampsia, while our present anti-spasmodics are efficient their influence is enforced by hypodermics of lobelia. It is the most active of this class in promoting dilatation of a rigid os, which is often immediately essential, permitting the completion of the labor. It can be used in conjunction or alternation with veratrum or gelsemium, and dram doses of echinacea should be given by the mouth every two hours to antagonize the toxins. One extreme case is reported with every condition aggravated and these complicated with placenta previae. The child was removed by Caesarian section. After veratrine, pilocarpine, elaterium, and magnesium sulphate were given fully for the dropsy, the convulsions persisted even in spite of prolonged anesthesia until thirty drop doses of lobelia were repeated, frequently, when the whole was controlled, and the patient saved. Echinacea was given for the extreme infection.

For rigidity of the os uteri at any time, it may be used. It promotes normal uterine contraction after the os is dilated. A case of persistent absolute rigidity for thirty-six hours was dilated fully in four hours with this agent.

A child thoroughly poisoned with strychnine was saved by thirty drop doses repeated every half hour. He had eaten one-third of a grain. Another case is reported where the agent successfully antagonized over-doses of strychnine.

In every case of ptomaine poisoning, in which the agent has been used, it has covered all the indications and has proved fully successful. It has been used in many instances.

In one case where toad stools were eaten instead of mushrooms seven individuals were thoroughly poisoned. One woman was very near death when the first injection was given. All were saved very promptly by the persistent and repeated use of full doses of this remedy. In many instances when the dose was given, the immediate effect was plainly apparent.

Three or four cases of cerebral concussion have been reported where the patients were unconscious. In one case consciousness was restored three consecutive times, the patient and friends refusing an operation which was plainly demanded for the compression made by the broken skull.

A number of cases of syncope from apoplexy were satisfactorily relieved and the paralysis when present was benefited, to an extent, by the use of this remedy.

Asphyxia from any cause indicates Subculoid Lobelia. It should prove of excellent benefit in restoring patients from drowning. Those who have used it to restore patients from the dangerous effects of anesthetics keep it constantly at hand for this purpose.

Favorable results are reported in two cases where patients were threatened with hydrophobia. There was one test case in which the patient bitten treated as above, showed no signs of hydrophobia while all the animals bitten by the same dog, developed the disease in fatal form.

A remarkable case is reported where a patient would indulge in an occasional alcoholic debauch. At such a time he became unconscious and remained so for four hours. This case was threatened with heart complications of a serious character. The condition was relieved in half an hour by an injection of lobelia. In another case consciousness was restored by this agent.

In all forms of calculi where the pain is extreme, lobelia must be given in full free doses. One or two repetitions will be all that are necessary.

In strangulated hernia, it is used with superior results. One case of umbilical hernia yielded to it quickly.

In the treatment of malaria, it can be adjusted to assist the antiperiodics if given before the expected paroxysm. Several cases of pernicious congestive chill have been restored by its prompt and sufficient use.

In general uremic poisoning, it should be given. In scarlet fever, especially severe cases, it acts promptly and in line with its indications will meet the expectation of the prescriber.

In cases of obstinate constipation or obstipation, it has produced such relaxation that the obstacles were quickly removed.

It has been given where there was extreme albuminaria in which it supported the strength of the patient until other measures could be used.

Lobelia has been given in full doses in cases of profound anuria three doses of from twenty to forty minim having been sufficient.

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.