Strophanthus. Strophanthus hispidus.

CONSTITUENTS—

Strophanthin. The active principle of the plant, a glucoside, a white crystalline powder, neutral, bitter, insoluble in water, insoluble in ether and chloroform. Dose, 1/600 to 1/200 of a grain.

Strophanthidin and kombic acid.

PREPARATIONS—

Tincture Strophanthus is prepared from the seeds alone. Dose, 1 to 10 minims administered cautiously .

Specific Medicine Strophanthus is made from the seeds is of full strength, and should be given in smaller doses than the official tincture. The dose is from one-half to five minims.

Granules of Strophanthin containing 1/500 of a grain are prepared and may be given, two or three granules every half-hour in extreme cases, until the force and power of the heart are improved, then every two hours.

Administration—In administering the alcoholic tinctures of strophanthus it should not be prescribed in an aqueous or syrupy menstruum, as the agent precipitates in these solutions. It should be dropped from the bottle into the menstruum at the moment of administration.

Physiological Action—Strophanthus is the Kombe arrow poison, acting vigorously upon all muscular structure and specifically upon the muscular structure of the heart.

Its action on unstriped muscular fiber is similar to that of ergot. In some cases it affects the respiratory muscles so profoundly as to produce respiratory paralysis and death.

Strophanthus, in small doses, renders the pulse stronger and less frequent; arterial tension is increased. In toxic doses the systolic contractions become very frequent and very brief, followed, consequently, by enormous increase of blood pressure, to which is added sudden cessation of the heart in systole. Respiration ceases last. It exercises an irritating influence directly on the muscle fibers of the heart. Its action on the heart is the same as that of muscarine. It does not act on the vaso-constrictors.

Under physiological conditions, the diuretic action is uncertain. Under pathological conditions, it renders the pulse less frequent, more vigorous and more regular; it promotes diuresis, causes the disappearance of dropsical swellings, and improves the subjective condition of the patient.

Unlike the most of the heart remedies, the effects of strophanthus seem to be caused by the agent being brought into direct contact with the muscular structure of the heart itself, after absorption into the blood. There is excellent authority for the belief that it neither acts through the medulla nor through the inherent ganglionic heart centers. It acts, by contact. It causes violent contraction of the heart muscle in extreme cases, being the only one of the heart poisons to leave the heart in systole after death from its use. It does not influence the vascular system.

The diuretic influence of the agent, if observed, is quite permanent. It increases the blood pressure in the kidneys to a great degree through its influence on the heart muscles, and thus directly upon the capillary circulation. It is also direct in its action upon the secreting and excreting mechanism of the kidney; by this influence its diuretic action is explained.

Specific Symptomatology—The direct indications for this agent are a weak and rapid heart from muscular weakness, inactivity or lack of contractile power. Apparently strophanthus acts similarly to digitalis, but it is not a cumulative poison. Pius, of Vienna, says in disturbances of compensation, strophanthus acts well. The pulse becomes stronger and diminishes in frequency, respiration becomes normal and dyspnea less marked.

Therapy—In rapid and feeble heart strophanthus reduces the pulse and increases the power. In some cases it also reduces the temperature.

Dyspnea is relieved in a few minutes after its administration, and the pulse becomes stronger and more regular in less than an hour. Its influence is exceedingly persistent and can be depended upon sometimes for weeks after the agent is discontinued.

In asthma the paroxysm is shortened and prevented, diuresis begins, and edema, disappears, not to reappear save in exceptional cases. The patient experiences a general relief.

It has been employed in fatty degeneration of the heart, in acute endocarditis, in atheroma of the arteries, in chronic Bright's disease, in ascites produced by cirrhosis of the liver, and certain pelvic tumors, in the enfeebled heart after acute and chronic fevers, in acceleration of the pulse, and reflex palpitation of neurasthenia, hysteria and chlorosis.

Strophanthus is contraindicated in ascites of tumors, hepatic, splenic and pelvic, in respiratory and circulatory troubles of vasomotor origin, in active hyperemia, and in cases in which there is a tendency to visceral hemorrhages.

In its influence upon the stomach it improves the digestion and increases the appetite. Like digitalis it may induce gastric irritation if given too long or too frequently, but this effect rarely occurs. It does not increase nerve tone.

In the Indian Medical Gazette, Dr. Sanders reported seventeen cases of cholera treated with tincture of strophanthus, all successfully. The results were quick recovery from collapse and a gradual rise of temperature.

Vacci claimed that in cases of persistent anemia of a chronic character, in acute anemia from flooding, especially where the heart's action is feeble and imperfect, he has found strophanthus to materially assist the appropriation of iron. In some cases where iron had been given a long time, causing insomnia, general nervousness and palpitation with indigestion where it seemed necessary to stop the iron entirely, he has used Blaud's pill with tincture of strophanthus with excellent results. Other forms of iron would probably act equally well.

Strophanthus has been prescribed in many cases of goitre, two drops of the tincture three times daily were given with a rapid reduction in the size of the enlargements, and in some cases a cure. In exophthalmic goitre it has accomplished marked results and has become a permanent addition to the therapeutics of this disorder. The dose in these cases is from five to ten drops three or four times daily.

Urticaria is reported as having, been cured with strophanthus given in full doses. It is credited with the cure of several cases of tetanus. Clapp, in the London Lancet, reported a cure of traumatic tetanus after antispasmodics had entirely failed. In this case it had a marked diuretic effect.

Strophanthin is a mild local anesthetic. It is only of service in operations upon the eye and not of great service here. Its effects are slow in appearing and remain long. In animals a cloudiness of the cornea is apt to appear after its use.

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.