Cactus Grandiflorus.

FINLEY ELLINGWOOD, M. D., CHICAGO

This remedy has been brought conspicuously before the profession at large during the past few months, by statements made in the Journal of the American Medical Association by the Council of Pharmacy and Chemistry concerning the concentration known as cactin.

These gentlemen, who stand high in the regular profession, but who have had no clinical experience whatever, with the use of cactus, have conveyed the idea that this valuable remedy occupies an inferior place in therapeutics. By so doing, they have done the profession and the people themselves an incalculable amount of harm.

Probably twenty thousand physicians have been using this remedy for many years, with results that are impossible with any other single heart remedy, or I believe I am safe in saying, any combination of heart remedies; but these have not belonged to the faculty of the regular school and have been ostracized through the prejudices of that school, and their observations have not been given the credit they deserve.

On the other hand, persons whose names are conspicuous in the profession, have ventured statements on this remedy when they too have had no practical experience with it, and these statements are quoted as authoritative. This is certainly unjust and misleading.

The plant is known under the various names of night blooming cereus, large flowering cactus, vanilla or sweet smelling cactus. The flower is from eight to ten inches in diameter, opens after sundown and fades the next morning after sunrise.

During its existence, there is hardly any flower of greater beauty or one that makes a more attractive display. The calix is dark brown on its exterior, inside it is of a splendid yellow color, and when open appears like the rays of a star.

The cactus is mucilaginous and yields a sticky juice when pounded in a mortar. The stems form a viscid pulp. It yields its medicinal properties to alcohol alone. The dose of the fluid extract is from one to twenty minims. A tincture, of a light green color, is prepared also. Of this, from five to thirty minims is the dose.

Because Lloyd Bros. have made a specialty of the fluid medicine from cactus, we have learned to use this preparation—Specific Cactus—in preference to any other, as it is invariable in its action and positively reliable. Those who have used the concentration which is called cactin, claim to have obtained results uniform with those obtained from the fluid preparation. Those who have used cactus in the fluid form are confident of the superior activity of the remedy in any form.

In the use of this remedy, if good results are obtained, a good preparation must be used. It is difficult to get the true species of cactus and others have been substituted for it. Often a tincture recommended as of cactus grandiflorus has been prepared from some of the inferior or inert cacti.

The dose of specific cactus varies from a half minim to two or three minims. However, no toxic effects have been reported, and there are observers who claim to have obtained results from doses of from five to thirty minims of cactus, which have not been obtained from a smaller dosage.

A foreign writer has made some observations in aortic lesions with faulty compensation. He prescribed this remedy in much larger doses than are usually given. One-half dram, three times a day, demonstrated to him a recession of the cardiac dilatation.

The conspicuous symptoms were dyspnea, arrhythmia and ascites. In my own experience, I have obtained desirable results always from a maximum dose of from two to three minims.

While we claim that there is but little, if any, toxic effect from the remedy, if this agent is prescribed when there is violent action of the heart, from a temporary increase of the nerve force, inducing irritation or palpitation, these symptoms may be increased by the use of this remedy. It must be prescribed in accordance with its indications and with some care as to the proper dosage.

In its physiological action, this agent stimulates the vasomotor system, the ganglia of the sympathetic, and directly influences the nutrition of the heart muscle. It increases the musculomotor energy, elevates arterial tension, increases the height and force of the pulse wave. This is accompanied by increased heart action through stimulation of the spinal motor centers, the activity and general tone of which is permanently improved.

It has a direct influence upon the central nervous system, regulating the action of the sympathetics, whatever the perversion. Acting directly upon the cardiac plexus, it regulates the functional activity of the heart. It is the heart tonic, par excellence, as it produces stimulation and actually increases nerve tone through improved nutrition of the nervous system and of the muscular structure of the heart.

It produces no irritation of the heart muscle as strophanthus does, nor, in proper doses, does it produce gastric irritation or a cumulative influence as digitalis does. It increases the contractile power and energy of the heart muscle through the cardiac ganglia and accelerator nerves.

It directly, and with much positiveness, improves the nutrition of the heart, strengthening the muscular power and improving the condition of the valves. On very many occasions I have been able to watch the progressive disappearance of valvular murmurs, from the action of this remedy.

Specific Symptomatology:—Scudder gave as the directest indication for cactus, pain in the heart of a restrictive character, as if the patient were bound with an inflexible bandage. Feebleness is the first, strong, suggestive point; impaired action with insufficient force; irregular or intermittent pulse with feebleness and violent action from functional disorder.

These symptoms are accompanied with dyspnea, weight, oppression in the chest, a sensation of restriction around the chest, or perhaps around the heart, with anxiety and apprehension of danger or death, nervous disorders with heart complications, hysterical phenomena, an over-strained or over-worked heart and tobacco heart.

It is promptly and directly serviceable in the treatment of the feeble heart of the aged. With these, it temporarily restores tone, promotes normal functional activity, does away with the symptoms of oppression, and increases the general nerve tone and materially promotes the action of the remedies which are prescribed conjointly with it as a nerve tonic.

It is useful in functional irregularities from any cause. Unlike digitalis, it reduces gastric irritation and relieves heart symptoms dependent upon this as a cause, or upon faults of digestion.

In its general influence, for breadth of action, for specific directness, for reliability, smoothness and general trustworthiness of action, this agent takes precedence over other heart remedies. Given during the progress of protracted fevers which show a tendency to induce heart feebleness, with, perhaps, ultimate failure this agent certainly exercises a splendid, sedative influence. I made this observation twenty-five years ago, and during the years that have passed, I have noted a number of writers who have made the same claims.

Rubini, of Naples, claims that it is almost the counterpart of aconite, differing from that remedy in that it increases the strength and tone of the nervous system, instead of inducing the paralyzing influence of the latter remedy. Whenever there is a rapid and feeble pulse, a fluttering pulse, regular or irregular, which points to a weak and exhausted nervous system, it makes no difference what has induced that condition, this remedy should be given in frequent small doses of, perhaps, one minim.

Under these circumstances, where there is a high temperature, the influence of the remedy in reducing the temperature is unquestionably apparent. None of our older writers attribute active, stimulating properties to this remedy. My observation is that it enforces the action of the heart at once, in a manner highly sufficient and satisfactory, and yet unlike that influence induced by strychnin or digitalis.

It brings about a condition in which the actual strength of the heart is apparent in the pulse wave and in the pulse beat. There is no doubt but that it is a most dependable remedy when shock, anesthesia or asphyxia from any cause, has induced sudden heart failure.

In organic heart disease, where there is threatened failure of compensation with valvular lesions, where the heart is irregular and intermittent in its action, and where regurgitation murmurs are distinct, this remedy will accomplish a great deal of good. It gives the patient a sensation of improved health and strength, and removes the unpleasant heart symptoms.

It may be given in nerve exhaustion and in simple forms of paralysis. Also where, from nervousness, there is a headache on the top of the head or in the occipital region. It is of value in endocarditis and pericarditis, especially where from deficient oxygenation, the respiration is labored and the face has a purplish hue.

I have urged its use in heart weakness following the use of tobacco and cigarettes, especially in those cases where the symptoms have developed rather suddenly in young men; also where heart feebleness resulted from over-muscular action or from masturbation.

Dr. Lydia Ross, of Massachusetts, urges this remedy in certain forms of oppressive headache occurring upon the top of the head, not uncommon at the menopause, resulting also from uterine malposition and congestion. It is especially valuable in the hot flashes which are so disagreeable during the climacteric. Small doses are advisable at that time and their influence is often a surprise in controlling this otherwise intractable condition.

Helleborus niger is an excellent remedy for this condition and they may sometimes be given in conjunction or alternation. The melancholia, nervousness, irritability of temper, hypersensitiveness, neuralgia, vague fears and fancies present during the menopause, are all influenced favorably by cactus. Its direct influence in strengthening the nervous system and in toning the heart and circulatory organs, underlie its influence upon these conditions.

Other conditions common to women, relieved by this remedy, are cerebral congestion with weight and pain in the occiput or in the vertex, numbness of the limbs, cough at the supra sternal notch, pain behind the sternum, fear of death, general plethora and congestion, irregularity of the menses consisting of a flow too early, too dark and thick, too abundant—a flow which ceases upon lying down, with an inability to lie upon the left side, demand its use.

Dr. Lyman Watkins confirms most of the statements made by Dr. Lydia Ross on its action in hysterical conditions, and as a remedy to relieve the functional disturbances which the heart exhibits from menstrual disorders. He believes it to be a most valuable remedy in the rapid and feeble heart-beat of anemia and chlorosis, greatly facilitating the influence of other indicated remedies.

I have for five years been observing the action of this remedy in the treatment of subnormal temperature. In every case that I have used it I have obtained some results, in some cases very excellent results. It may be given in doses of two minims every two or three hours if there is no excess of heart action, and it will not only improve the action of the heart, but it will improve the functional operations of the nervous system, the stomach and the intestinal tract.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.