Leading articles.

Calendula Officinalis—A Study, Comparison, and Local Uses.

(From Transactions National Association.)

DR. R. D. HOMSHER, DENVER, COLO.

Calendula officinalis belongs to the composite family, the hardiest of flowers. Dunglison mentions three varieties as very useful, viz.:

Single and double, which he calls calendula officinalis, and wild or calendula arvensis. The single corolla is sometimes variegated, while the leaves appear darker and richer in color than the double or old fashioned yellow marigold. The single makes as good if not a better medicine than the double. I consider the single richer in gum than the double. The leaves and flowers are the parts used. The green tincture should be the best; in my opinion it is the best. The dried leaves must lose some of the aromatic or volatile properties when long kept, but a very satisfactory tincture from the dried plant one and one-half years old has been obtained.

My investigations of marigold for thirty years have led me to believe that it is non-toxic when used locally. I have not used it internally very much, as so little has been said of it, as an internal remedy. I used it for a pain, in the region of the liver, but it seemed to produce an astringent effect on the bowels, causing slight constipation. I have applied it in two cases to the base of the skull in cases of apoplexy, where hemorrhage into the brain was suspected. The cases improved, but as other remedies were used, I cannot say what effect it had. I am of the opinion, that absorption, through the skin, permits the remedy to act similarly to its application to exposed bleeding vessels, and is an indirect way of giving it internally.

I would be pleased to read the results of calendula as an internal remedy, for I am convinced from its effects upon certain local conditions, some marvelous results may be obtained, some missing link in our materia medica may be discovered, in this old, but little understood plant. I sometimes think I have reached the limit with it as a local application, then shortly afterwards I get a happy effect in an extended use of it.

But there is another genus of the same family with leaf arrangement opposite, which is poisonous, and decidedly so to some individuals, when used topically, and to all individuals when used internally. I refer to calendula montana, or alpine. It is commonly known as arnica, and is extensively used as a liniment. Some people are so idiosyncratic to arnica, that whenever it is applied it affects them worse apparently than poison oak or ivy. One such case came under my care.

Dunglison says, "arnica in large doses is deleterious." King says, "arnica in large doses causes heat in the throat, nausea, vomiting, spasmodic contraction of the limbs, difficulty of respiration, and sometimes inflammation of the alimentary canal, and coma. There is no known antidote to its poisonous influences."

If large doses of arnica do all these things, why would not the absorption of the drug, when locally applied, do the same thing. Every drug has its peculiar action. We are everlastingly getting such undesirable, unknown, unexpected and unthought of results from drugs, owing to our ignorance, that when we have found something positive and safe, we should cling to it. Calendula may be not quite so narcotic, but it is more reliable and safe in every way as a lotion than arnica. Then, again, arnica is not classed as an antiseptic.

Hamamelis, as a lotion and as an internal remedy, parallels marigold in many ways. Ellingwood gives its symptomatology as follows: "Soreness of muscles, muscular aching, a bruised sensation, soreness from violent muscular exercise, soreness from muscular strains and bruises, soreness and muscular aching from cold and exposure, relaxed mucous membranes, dark blue membranes from venous stasis, veins dilated, relaxed, enlarged and full —varicosis."

Hamamelis is not classed as an antiseptic. It is a very safe and pleasant remedy and the best substitute for marigold I know. If it was antiseptic it would be nearly, but not quite, a substitute for calendula.

Arnica is a perennial, hamamelis is a small tree, while marigold is an annual. Arnica contains volatile oil, an acrid resin, yellow coloring matter, albumen, gum, muriate and phosphate of potassa, sulphate and carbonate of lime, and silica. Hamamelis contains tannin, a volatile oil and a bitter principle.

Marigold contains volatile oil, an amorphous bitter principle, gum, sugar and calendulin. Calendulin contains a yellow coloring matter and a substance analogous to wax, which treated first by ether and then by hot water, yields a gelatinous substance. I would like to know if the gum of this plant resembles opium in its effects?

As you are aware, some drugs are of common and extensive use, others are used occasionally, while others are used and called for rarely. Calendula is the most in demand in my office. Wonderful claims have been made for it, time and again, but book writers, as a rule, give little credence to the reports except, perhaps, the homeopaths, who use it quite extensively, and the Eclectics who say more about it than any other class.

Dr. O. L. Potter's Materia Medica, Pharmacy and Therapeutics, Ninth Edition, London, says this of it: "The tincture 20 per cent alcohol, is also official, and is exclusively used as a local application to promote the healing process in wounds, ulcers, burns, and other breaches of tissue. Extravagant views of its powers as a vulnerary are promulgated by the so-called homeopathic surgeons, and serve as one of their excuses for proficiency, an exclusive position in surgery." That is all he says about it.

King's American Dispensatory, 10th edition, (18th edition here) says of marigold: "Slightly stimulant, a diaphoretic. Used for similar purposes with saffron, but less active. Has been reputed useful in spasmodic affections, strenuous maladies, icterus, suppressed menstruation, typhoid febrile conditions, cancer, etc. Used in infusion, in form of an extract, from four to six grains, three or four times a day; also applied locally to cancerous and other ulcers. Probably overestimated.'"

Dr. J. W. Clary, of Monroeville, Ohio, writes me as follows in relation to this plant:

"As a local remedy after surgical operations is has no equal in the materia medica. Its forte is its influence on lacerated wounds, without regard to the general health of the patient, or the weather. If applied constantly, gangrene will not follow, and I might say, there will be but little, if any, danger of tetanus. When applied to a wound it is seldom that any suppuration follows, the wound healing by first intention. It has been tested by several practitioners, and by one is used after every operation with the happiest effect. You need not fear to use it in wounds, and I would not be without it for a hundred times its cost. It is to be made into a saturated tincture with whisky diluted with one-third quantity of water. Lint is saturated with this, applied to the parts and renewed as often as it becomes dry."

So King did not know much about this remedy, but Dr. Clary knew a great deal as a local application, and what he said in 1875 will be substantiated by a greater number today.

Lloyd's Chemistry of Medicine, 2d edition, 1881, does not mention calendula.

Ellingwood's Materia Medica, Therapeutics and Pharmacognosy says more about it than any author I have been able to consult. I here give verbatim what he puts down:

"This agent is used principally for its local influence. Internally it is given to assist its local action and to prevent suppuration in cases where there is a chronic tendency to such action. It is useful in varicose veins, chronic ulcers, capillary engorgements, and in hepatic and splenic congestions.

As arnica is applied to bruises and sprains, this agent is also applicable; and in addition it is of much service applied to recent wounds, cuts and open sores. It is antiseptic, preventing the formation of pus. It causes the scar or cicatrix to form without contraction of tissues, and in the simplest possible manner. It hastens the healing of wounds, and materially favors union of coated surfaces by first intention. It relieves the pain in wounds, and if there are bad bruises it quickly relieves the soreness and favors the healing process. It is also applicable to catarrhal mucous surfaces, to festering sores, local swellings, glandular inflammations and to epithelioma and carcinoma, to correct the fetor. It is especially applicable to severe burns, to promote healing and to prevent the formation of a contracting scar."

Ellingwood classes marigold as a "specific alterative" along with hamamelis. I would like this explained. It does reduce enlarged glands by local application. I do not think it will act on the bowels to move them. I have not tested its internal administration. Applied on inflamed glands it reduces them. I want to make one more quotation because of the viewpoint; it approaches the scientific or physiological action of calendula. I think it is, in the main, correct. Anyhow it is interesting. The quotation is from Dr. Wm. H. Burt, 4th edition, 1888, Homeopathic Materia Medica:

"Through the cerebro-spinal vaso-motor nervous system, calendula has one special action, inducing paralysis in the arterial capillary vessels. Through it the vaso motor nerves, the capillary vessels, become partially paralyzed and consequently receive mere bleed than usual. From this increased irritation, which attracts a large amount of colorless corpuscles, together with the viscosity or adhesive qualities of these corpuscles, we get adhesive inflammation, that is most beautifully shown us in lacerated wounds, in which, when calendula is used, we get union by first intention without suppuration.

Cuts and lacerated wounds heal by first intention, in a most wonderful manner, when the remedy is used locally and internally. Locally, the cerate will be found of great value when calendula is indicated.

I do not think calendula could produce inflammation per se, but it may by its stimulating effect upon the nerve ends cause an extra deposit of plasma sufficient to cover up and unite the parts by first intention, which surely does occur. While it does this it as surely prevents true inflammation by its antiseptic properties and secondary sedative action, similarly to belladonna, the action of which it seems to simulate in several ways.

Burt makes two points to which I would like to call your attention, viz.: The effect upon the vaso motor nervous system and one of the best means of applying calendula; that is as a cerate. These points will be referred to hereafter.

I will now try to give the results of my inquiries, investigations and experiments with marigold. In the first place I generally make my own tincture by filling any desired bottle with the leaves and flowers, green plant when I can get it. When the vessel is packed, the bottle is filled, one part alcohol to four parts water, distilled water if handy. I let this set for two or three days. The tincture is then filtered into a stock bottle. After filtering off the first tincture I cover the same plant the second time with the same menstruum and set aside five or six days, when this is filtered into the stock bottle with the first filtration or tincture. For the third time I cover the plant, but not with alcohol. I cover it with water, preferably distilled. This gives me what I call a non-alcoholic extract, or an extract with but little alcohol and little calendula.

The cases in which I use this are those where much alcohol might be deemed too irritating and cause smarting, as about the eyes. The smarting of calendula is transitory and generally comes from the alcohol in it. You will learn by use what strength will be proper. It will surprise you how little is required in some cases. I cannot recall any bad effects from calendula used in any strength. If bad effects occurred, I never knew it. Alcohol, while an antiseptic, if too often and too strongly used, causes irritation.

Calendula as a Hemostatic

Calendula is a hemostatic of pronounced efficiency in all those cases involving a division or exposure of the integrity of the capillaries. If you use a dram or two to the pint of cleansing water, you will find the bleeding checked by the time the wound is cleaned, and have in addition a healthy condition, without the toxic effects you get from carbolic acid or bichloride solutions, when improperly used. This last effect is much desired and pleasant to contemplate. If the wound bleeds from a depth you can inject the tincture or dilution by any small or properly proportioned syringe into the deep cavity, always assured you will do no harm, but on the contrary will most always, if not always, get what you want and end the blood flow.

The most persistent office case of bleeding coming under my care was a broken matrix of a finger nail. As the vessels in the matrix fill the canaliculi of the matrix, and seem to be more or less adherent to their walls, there is not that opportunity to contraction of the capillaries as in the soft tissues. This case had been bleeding for half a day. Some of his friends stood by him valiantly with their sympathy as the life blood trickled away, drop by drop. The crimson went through wrappings without stopping. Washing the wound with tincture calendula did not stop this hemorrhage, but an injection by means of a hypodermic needle into the deep part of the broken matrix stopped it readily.

Used as a spray by a nebulizer or atomizer in epistaxis from habit or from a bump on the nose, it is effective. Used in a vaginal or uterine hotwater douche for post operative hemorrhage, it is hemostatic and" antiseptic at the same time. I have used it in postpartum hemorrhage, always with success. This hemostatic effect of calendula is brought about through its influence on the vaso-motor nervous system, causing contraction of both longitudinal and circular muscular fibres of the arterioles and capillaries, and not by the formation of a clot. It seems to close the smaller vessels as effectually as a ligature and in a physiological manner.

Now as to calendula's modis operandi in procuring healing by first intention, let me relate the best I can, the history of one of the most anxious cases that falls to the lot of medical humanity. It was a boy of eighteen years. He was run over, knocked down, caught-by the gear of an automobile and dragged at good speed across the street over two street railway lines in such a manner that his left knee had to stand the continuous impact of constant bumping and dragging. The resultant wound was a lacerated one of about three and one-half inches long above and diagonal to the transverse diameter of the knee. The derma had been stripped downward and half off the knee cap. The capsule of the joint was partly torn up and into shreds, and I think the capsule was ruptured, although the bulb of a probe one-sixteenth of an inch in diameter would not enter the capsule without using more force than I cared to exert for fear of tearing the synovial membrane, providing it was intact. Beside the torn ligament of the capsule the dermal wound was a fringe of shreds. The wound was thoroughly cleaned with calendula and water and when cleaned the hemorrhage had ceased. I attempted to trim the wound but it was so painful to the suffering and shocked boy, I desisted. Two stitches were put in and the wound dressed with—

Mix.

Besides saturating the wound with this, cotton spread out sufficiently large to cover the wound was wet with the medicine and laid over the parts. This was held in place by a cotton bandage. It was ordered the coverings be watched closely and when approaching dryness that they be moistened by carefully rubbing the medicine in until again wet. It was only necessary to do this three times a day, as the glycerin in the prescription prevented rapid evaporation. The drawback to the tincture is the rapid evaporation and this alone may account for its neglect. The wound would soon be unprotected. The addition of glycerin overcomes this objection so thoroughly that I predict calendula will become a very common and favorite drug. The cerate would not have been so handy in this case as the solution for obvious reasons. As soon as the inflammatory tendency was reduced or controlled, the glycerin was reduced one-half and water substituted, because I find at certain stages glycerin becomes as unsuitable as boracic acid, that is irritating. The final prescription was something like this:

Mix.

I dressed the injury every day for ten days, after that lengthened the time between visits. The second visit, which was the third day of the injury, I found the wound where it gaped between the stitches was filled with gelatinous plasma and the shreds standing out in it like flowers in a cake of ice. The sides of the wound were held together by this substance. Underneath this provisional membrane, was what I took to be a body of synovial fluid. The patella was raised above the joint and the capsule distended with the fluid, all showing the joint and parts to be badly bruised and the synovial membrane injured and perforated as well, thus permitting communication between the capsule and the cavity formed by the provisional membrane uniting the edges of the wound. For fear there might be some foreign substance overlooked in the wound, and that the fluid might be infected by it, drainage was desirable.

By the use of the flat end of the probe the edges of the wound were carefully separated to the extent of about one-eighth of an inch, as one would separate the parts of an orange. Drainage occurred slowly and the excess of the fluid was discharged. But this first intention effect of calendula was so persistent that it closed the gap again. The force of the accumulation consequent upon this second closure and good intention of calendula was such that the wound was burst open by it, so the frequent companion of calendula, boric acid, was called in to curb the work of calendula. Boric acid is a mild escharotic and by dusting it sparingly over the edges of the wound, it was kept open and regular progress was made to the end of the case which was of six weeks duration.

Calendula kept up its antiseptic, healing and contra-inflammatory effect, without reverses. There was no pus in the case. The parts were somewhat swollen and had a pale color, the skin seemed thickened with serum, rather than blood. After the reaction fever which lasted probably a week or ten days the parts were so cool that I recommended a warm pack or sitting with the knee next to the stove, to stimulate healing. The leg was supported by a splint underneath and not permitted to be bent until the parts were nearly normal. I am inclined to think the parts were narcotized to some extent but not paralyzed. Narcosis simulates paralysis.

Calendula as a local anodyne is as positive as opium, if not more effectual. It apparently does not affect the sympathetic like opium. In this respect it resembles aconite, the most powerful local anodyne we have of that class. It also resembles belladonna in relieving pain, local congestion and inflammation, but not so dangerous.

One nice and quickly prepared cerate is made by incorporating one dram tincture calendula in one ounce of vaseline, thoroughly mixing the two. This is useful for sores and painful conditions where lotions would not be so handy. In painful piles it is prompt, relieving pain and removing the piles in many cases. It is also ideal in rectal ulcers, relieving and curing them. In burns, if you will add a little boric acid you will find it satisfactory. Or by adding a dram or two of tincture calendula to four ounces of carron oil, you have a lotion for burns that cannot be excelled. The scars will be soft if you have scars at all. Calendula covers all the demands for hamamelis, except the color. But it more than makes up for this as an antiseptic. It guards against infection and suppuration, besides relieving the pain of bruises, cuts, sprains, contusions, extraction of teeth, and surgical operations. More than once have I relieved the bleeding and stopped the infection in a tooth cavity with tincture of calendula. Bleeding and painful gums it has always relieved promptly. I have used it in all painful conditions from a bruise to articular rheumatism, with good effect. It always helps. For gonorrheal rheumatism try tincture calendula, salicylate of soda and water and you will be surprised at the result. It is scientific. Try the same for bromidrosis of the feet with soreness of the joints, or seat disease and you will be equally pleased. As a collyrium for an injured conjunctiva from a mote or scratch, what is handier and better than five to ten drops. of tincture of calendula to the ounce of water ? Nothing that I know of is better or safer.

As a catarrhal remedy for mucous membranes, reached by hand or swab, or nebulizer, it is a most appreciated remedy.

In a three branched fractured cornea, discharging pus, lachrymal fluid, aqueous humor, all the contents of orbicular cavity inflamed and the mass bulging beyond the orbit, pronounced irremediable, and enucleation advised, calendula removed the unpleasant train of symptoms, healed the cornea, restored some vision and saved the eyeball. It proved to me the antiseptic local anodyne and healing virtues of calendula. Calendula is an antiseptic of great efficiency, working in harmony with the natural laws of life, that one is constrained to call it a physiological antiseptic so compounded by the Almighty that given a proper vehicle and timely application, it seems complete. No suppuration occurs when promptly used. It holds in abeyance the sensory nerves; it stimulates the vase-motor nervous system to clear the way and bring on reparative materials; it stands guard over the injured part to destroy the septic enemy if it should threaten to interfere, while the great sympathetic with God-like omniscience, hastily closes the breach and restores the citadel to safety, comfort and peace.

"And the leaves shall be for the healing of the nations."

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