Lobelia (U. S. P.)—Lobelia.

Preparations: Vinegar of Lobelia - Lobelia Poultice - Fluid Extract of Lobelia - Compound Fluid Extract of Lobelia - Compound Powder of Lobelia - Syrup of Lobelia - Tincture of Lobelia - Compound Tincture of Lobelia - Compound Tincture of Lobelia and Capsicum - Compound Lobelia Lotion - Troches of Capsicum and Lobelia - Compound Tincture of Hydrastis - Compound Acetated Tincture of Sanguinaria

The leaves and tops of Lobelia inflata, Linné, collected after a portion of the capsules have become inflated"—(U. S. P.).
Nat. Ord.—Lobeliaceae.
COMMON NAMES: Lobelia, Indian tobacco, etc. (see History).
ILLUSTRATIONS: Lloyd's Drugs and Med. of N. A., Plate 34; Bentley and Trimen, Med. Plants, 295.

Botanical Source.—This plant, generally known as Wild, or Indian tobacco, is an annual or biennial indigenous plant, more commonly the latter, with a fibrous, yellowish-white root, and an erect, angular, very hairy stem, in the full-sized plant much branched, and from 6 inches to 3 feet in height. The leaves are alternate, scattered, sessile, ovate-lanceolate, serrate, veiny, and hairy. The flowers are small, numerous, pale-blue, on short peduncles, each originating from the axil of a small leaf. The calyx consists of 5 subulate segments. The corolla is tubular, small, slit on the upper side, ventricose at the base; the limb bilabiate; tube prismatic; segments spreading, acute; two upper ones lanceolate, three lower ones oval. The anthers are united into an oblong, curved body, and of a purple color; filaments white. Style filiform; stigma curved, 2-lobed, inclosed by the anthers. The capsule is 2-celled, ovoid, inflated, striated, 10-angled, crowned with the persistent calyx. The seeds are numerous, small, oblong, and brown (L.—B.—W.).

Ɣ History.—Lobelia is very plentiful throughout the United States, and is usually found thriving in dry soil along roadsides, in dry fields, and old pastures, as well as in woodland grazing grounds. It flowers from July to September, or until frost cheeks its blooming. It grows from a few inches to 2 feet in height, and is peculiar in that it will blossom when the flowering time arrives, even if it be but an inch in height. The plant has alternate leaves, and flowers of a light-blue color, inconspicuous, yet very pretty when closely examined, having the characteristic split corolla tube (along the upper side) of the Lobelias. The fruit is an inflated pod, resembling a small balloon, easily compressible, and contains an innumerable number of minute brown seeds. The plant, when broken or cut, exudes an acrid, milky juice, imparting a taste very much resembling that of tobacco. The whole plant is active, but the leaves and seeds are more usually employed. The root is supposed to be more energetic, medicinally, than any other part of the plant. The proper time for gathering the plant is from the last of July to the middle of October, during which period the seed-vessels are in great abundance. The plant should be dried in the shade, and then be preserved in packages, or covered vessels, more especially if it be reduced to powder. When dried, it has a faint, nauseous, rather disagreeable odor, and a strong, acrid, nauseous taste developed by chewing, somewhat similar to that of tobacco, which powerfully affects the throat and fauces, occasioning ptyalism and sickness at stomach. The leaves form a greenish powder; the seeds a brownish. Hot water, vinegar, ether, or alcohol take up its medicinal principles, but boiling dissipates them.

Few drugs are more favored among Eclectic physicians than lobelia, and certainly none others have so interesting a history. This plant is vulgarly known as Indian tobacco, though why it should have this name is difficult to say, as there is no distinct record as is the case with other plants (unless we accept the statements made that it was known to the Penobscot tribes), that it was ever employed as a medicine by the natives. As the plant resembles somewhat in taste the common tobacco (Nicotiana Tabacum), and was for this reason called Wild tobacco, the authors of "Drugs and Medicines of North America" advance the opinion that if known as Wild tobacco it was but a step farther to call it Indian tobacco, on the presumption that a tobacco that was wild would be used by the Indians. The earliest botanists did not use a common name for lobelia, and it was not until 1810 that we find the first popular name—Bladder-pod—given it by Aiton. Following this came Inflated lobelia and Bladder-pod lobelia for obvious reasons. So much for names suggested by the plant itself. When it came to be used in medicine a new set of popular names having reference to its properties, were applied. Thomson and Cutler called it Emetic weed and Emetic herb. These names suggested those to follow—Puke weed, Vomit weed, and Gag root. Although the term gag root was employed, the root was never used in medicine, statements to the contrary notwithstanding. One of its very old names is Eye-bright—a name properly belonging to Euphrasia officinalis, and, from its use as an anti-asthmatic, some writers have referred to it as Asthma weed. Its generic name—lobelia—was given it in honor of Matthias de Lobel (de l'Obel), a distinguished botanist of the sixteenth century; its specific name—inflata—on account of its inflated seed pods.

Though lobelia grows nearly all over this country, much of the drug supply of commerce comes from the mountainous districts of North Carolina. Lobelia was known to the Penobscot Indians, and was also extensively used by the people in New England in domestic practice, long before the time of Samuel Thomson, its assumed discoverer. Though used by a few in domestic practice, the credit for the introduction of lobelia into medical practice is due to Drs. Manasseh Cutler and Samuel Thomson. The latter claims to have been the first to employ it and, indeed, it would seem probable that Cutler learned the use of it from Thomson. As before stated, few drugs have been so notoriously historical as the one under consideration. It became widely known to the people during the early part of the present century, through the famous trials of Drs. Thomson and Frost. The name of lobelia became so odious, that to be known as a "lobelia doctor" was sufficient to subject the physician to all manner of ridicule. The prosecution of Thomson was brought at the instigation of a jealous physician—Dr. French—backed by a jealous profession. While under treatment by Dr. Thomson, one Ezra Lovett, of Beverly, Mass., died after a tedious course of medicine applied after the peculiar method of Thomson. The prosecutors charged the latter with killing Lovett with lobelia. Thomson denied it, claiming the drug employed to be marsh rosemary. The prosecutors showed their ignorance by exhibiting to the court some of the powder alleged to have been employed, which powder actually proved to be marsh rosemary. Judge Parsons instructed the jury to acquit Thomson. The memory of lobelia was again revived, in 1837, by the trial of Dr. R. K. Frost, of New York City, for the alleged killing of T. G. French. The charge against Frost was that be put French into a "vapor bath" and "administered to him poisonous decoctions of lobelia, and giving deleterious herbs which no reasonable man would administer to a dog." He was tried for manslaughter, the trial lasting ten days, and the jury found him guilty (in the fourth degree), but recommended him to the mercy of the court. The court sentenced him to three months' imprisonment.

The first published account of the use of lobelia in regular medicine, is by the Rev. Manasseh Cutler, LL. D., in his "Account of Indigenous Vegetables" (1785), stating that the leaves, if chewed, "produce a giddiness and pain in the head, with a trembling agitation of the whole body." Cutler was a great sufferer from asthma and found this drug to give him more relief than any other, and as Thomson had been in the habit of using lobelia for this complaint, and practicing so near to the home of Cutler, in Massachusetts, it is fair to presume that the latter derived his knowledge of the drug from Thomson. As early as 1820, the first edition of the U. S. P. recognized lobelia and it has continued official until the present time.

Description.—The U. S. P. officially describes lobelia as follows: "Leaves alternate, petiolate, the upper ones sessile, ovate or oblong, about 5 Cm. (2 inches) long, irregularly toothed, pubescent, pale-green; branches hairy, terminating in long racemes of small, pale-blue flowers, having an adherent, 5-toothed calyx, which is inflated in fruit, a bilabiate corolla, and 5 united stamens; odor slight, irritating; taste mild, afterward burning and acrid"—(U. S. P.).

LOBELIA SEED.—Lobelia seeds are not official, excepting as included in the inflated pods of the plant. Lobelia seeds, viewed under the microscope, are about 1/33 of an inch in length, 1/85 of an inch in breadth, of a dark-brown color, oblong, with ridges and furrows, somewhat resembling basket-work; the only seeds which resemble them are those of the L. cardinalis, which are not so dark-colored, but are oval, or almond-shaped, reticulated with irregular, oblong-square, or rectangular reticulations not so well defined, and are of larger size (P.—F. Curtis).

Lobelia in the powdered form enters into the composition of the compound emetic powder , and is a constituent of the compound tincture of lobelia and capsicum (King's Antispasmodic), and the acetous emetic tincture. The oil, as before stated, is contained in the stillingia liniment. Specific lobelia, the preferred preparation of this plant, has a deep wine color and a peculiar fatty odor. When dropped into water it produces a white turbidity, forming a yellowish-white, milky liquid, when viewed by reflected light. It mixes with alcohol without change. The taste is peppery and persistent, leaving a disagreeable acrid impression in the throat and fauces. A few drops only will sicken some persons and even produce emesis. Specific lobelia contains a large amount of oil of lobelia, which preserves the alkaloid in the preparation. Investigations made by Prof. Lloyd demonstrated that solutions devoid of the oil were inferior, being altered by age. Specific lobelia retains its energies indefinitely.

Chemical Composition.—The active principle of lobelia is an acrid, irritating, unstable alkaloid, called lobeline, first obtained by Wm. Procter, Jr. (Amer. Jour. Pharm., 1838, p. 98, and 1841, p. 1), as a yellowish liquid of faintly aromatic taste, soluble in water and exhibiting an alkaline reaction. It exists in combination with a vegetable acid—lobelic acid—forming precipitates with solutions of metallic salts (Pereira, 1842). Lobeline and its salts are exceedingly active emetics. Though stable when thus combined, it readily decomposes when freed from contact with the other constituents of the plant. Heat applied to either an aqueous preparation or an alcoholic tincture of lobelia, destroys this alkaloid, hence a decoction or hot infusion of this plant is irrational. Lobeline was obtained by Prof. Lloyd (see D. and M. of N. A., by J. U. and C. G. Lloyd, Vol. II, pp. 75 and 76), by depriving lobelia seeds of fat by means of benzin, abstracting the seeds with alcohol acidulated with acetic acid in a percolator, and evaporating and extracting the alkaloid with ammoniated ether. As thus obtained, lobeline, after further purification, is a colorless, odorless, amorphous, and non-hygroscopic alkaloid, of an alkaline reaction, soluble in alcohol, chloroform, benzol, ether, and carbon bisulphide. It is also somewhat soluble in water and exhibits in solution alkaloidal reactions. No crystallizable salts could be obtained, though Prof. Procter (loc. cit.) alludes to a crystallizable muriate, sulphate, nitrate, and oxalate of lobeline. Paschkis and Smita obtained from lobeline benzoic acid by oxidation with potassium permanganate (Amer. Jour. Pharm., 1890, p. 339). H. von Rosen (Amer. Jour. Pharm., 1889, p. 393), isolated two alkaloids, one liquid (lobeline) and another solid.

According to Prof. Lloyd, the plant also contains a crystallizable, non-basic substance, to which he gave the name inflatin. This body exists in the plant, intimately associated with the alkaloid and some volatile oil (see below). Inflatin is tasteless and odorless, "insoluble in water, or glycerin, but soluble in carbon disulphide, benzol, chloroform, ether, and alcohol, in the order given" (Lloyd, D. and M. of N. A., Vol. II, p. 78). It is not important in a medical sense.

The lobelacrin of Enders (1871), which was obtained in warty tufts of a brown color, was regarded by W. H. D. Leurs (Pharm. Jour. Trans., Vol. VIII, 1878, p. 562), as probably lobeliate of lobeline. Lobelia contains a non-acrid, volatile oil of a pungent odor, possessing but little taste and no acridity. It was named lobelianin by Pareira in 1840. In addition, the plant contains about 30 per cent of nonvolatile oil matters. The impure oil (so-called) of lobelia, so extensively employed by Eclectic doctors, is simply a syrupy extract of lobelia made with stronger alcohol, preferably acidulated with acetic acid. This so-called oil is the active constituent of that favorite Eclectic preparation, the compound stillingia liniment. The pure or true fixed oil of lobelia is non-acrid and bland, but as usually obtained (impure), is acrid and of a green color. The fixed oil of lobelia (impure) may be obtained by bruising the seeds between heated rollers, and pressing while hot in a strong linen cloth, between proper iron plates. Its consistence is nearly like that of linseed oil, and eminently possesses the drying qualities common to many fixed oils. It possesses all the medicinal properties of the seeds.

Action, Medical Uses, and Dosage.—Lobelia, in the ordinary sense of the term, is not a poison. Undoubtedly, its injudicious use has, and might produce death, but the same is true of many other drugs that are not ordinarily considered as poisons. That the alkaloid lobeline will kill animals, has been fully demonstrated. A drop of the alkaloidal solution placed upon the tongue of a strong, healthy man, instantly vomited him. To this property of its alkaloid, is undoubtedly due the failure of lobelia to act as a toxic agent. Its emetic action is so prompt and decided, that the contained alkaloid could not, under ordinary circumstances, produce fatal results. Given in cases in extremis, the resulting exhaustion from repeated emesis would very likely hasten death, but death would be more likely due to the act of vomiting exhausting the patient, than to any poisonous effect of the medicine.

If lobelia be chewed, it gives rise to an acrid, prickling, and persistently pungent sensation in the throat and fauces, accompanied by slight nausea and a feeling of warmth and distension along the esophageal tract and in the stomach. The sensation is not very unlike that produced by tobacco. The salivary and buccal glands are impressed, pouring out saliva and mucus in abundance. A sense of epigastric depression succeeds, followed by profound nausea, and if the amount chewed be large enough, severe and thorough emesis results. The gastric mucus is secreted in great abundance and ejected with the contents of the stomach. The emetic action of lobelia is extremely depressing, and is usually accompanied by profuse perspiration. Oppressive prostration, relaxation of the muscular system, and a languid pulse accompany the emetic stage. The depression, however, is of short duration, and is immediately followed by a sense of extreme satisfaction and repose. Under its action the mental powers are unusually acute, and the muscles are powerfully relaxed. The circulation is enfeebled by large and strengthened by small doses, and the bronchial secretions are augmented. When the drug does not prove emetic, it is said that it usually purges. Death, when due to lobeline, is said to result from respiratory paralysis.

Lobelia is nauseant, emetic, expectorant, relaxant, antispasmodic, diaphoretic, sialagogue, sedative, and, secondarily, occasionally cathartic and diuretic and astringent. It is in no sense a narcotic. The earliest use of lobelia, as will be seen from its history, was that of an emetic, and for this purpose it is still employed when we desire the action of a systemic emetic. Though momentarily depressing, its beneficial after-effects cause it to be preferred above other agents, ipecac not excepted, when such an agent is required. Its action is somewhat modified by combination with ipecacuanha, and other vegetable emetics, and rendered safer and more effectual. Such a combination is the emetic powder. It may be used in forming stages of febrile affections, and is especially indicated by a general sluggishness of the whole system with an oppressive feeling, and the tongue is heavily and foully coated at the base. In some chronic diseases its emetic action is salutary in arousing the system from its atonic state. When its emetic action is desired, small doses should be frequently administered until profound nausea is induced, and then the drug should rapidly be pushed to emesis. Copious draughts of warm water will hasten its action and render the act of emesis much easier. Spasmodic movement is incompatible with nervous and muscular relaxation, hence we find prompt relief in many spasmodic conditions by the use of this drug.

The powerfully relaxant properties of lobelia render it a very efficient agent in several conditions, whose chief feature is the spasmodic element. For its control over spasmodic movement, nauseant or emetic doses must be given. For this purpose it may be exhibited in chorea, tetanus, "worm fits" of children, hysteric and infantile convulsions, epileptiform and other convulsive disorders. For puerperal eclampsia, chloroform by inhalation, and morphine subcutaneously injected, give better results than lobelia, though the latter drug has been used with success in some cases. Lobelia is of value in obstetrical practice. It powerfully subdues muscular rigidity. It is the remedy to overcome a rigid os uteri during parturition, and at the same time it relaxes the perineal tissues. This it does when there is fullness of tissue—a thick, doughy, yet unyielding, os uteri; when, however, the edge of the os is thin and closely drawn, sharp like a knife edge, full doses of gelsemium are indicated. For its antispasmodic action it may be given by mouth and by rectum. Intestinal obstructions have been overcome by lobelia when other agents would have been inadmissible, hence it is of value in the reduction of strangulated hernia, an enema being employed. Intussusception and fecal impaction may be treated with this drug when cathartics would result fatally. It is for its antispasmodic effects that it is given in asthmatic paroxysms, spasmodic croup, and whooping-cough. It has been successfully used to overcome the violent convulsions resulting from strychnine poisoning. Chloroform and ether excepted, it is the best antispasmodic drug in the materia medica, and much safer than either of these. In the so-called "worm fits" it should be carried to nausea and then followed by santonin, after which a mild purgative may be given.

Lobelia is a stimulant to the sympathetic system. It improves the innervation of the parts supplied by both the pneumogastric and sympathetic nerves. The appetite and digestion are improved by small doses of the drug. It will frequently be found indicated in indigestion and dyspepsia. We have frequently used it in small doses for sick headache due to gastric derangement. It is indicated by the feeling of "qualmishness" and nausea present. Though frequently overlooked when we are looking for a drug to overcome intestinal atony, lobelia will be found one of the best drugs at our command for the relief of habitual constipation. Rx Specific lobelia, gtt. i-ij, every 2 hours. Administered with podophyllin it tends to prevent the costiveness so frequently the result after using a "bowel persuader" in cathartic doses. It increases peristalsis. Small doses of it relieve infantile colic.

Lobelia is the drug for angina pectoris, neuralgia of the heart, and pulmonary apoplexy. Though evanescent in its action, large doses of specific lobelia (about 20 drops), may be administered with the expectation of relieving the patient. The dose may be repeated if necessary. Lobelia is a cardiac stimulant, thus we class it with the sedatives, for all sedatives in medicinal (small) doses are heart stimulants. When the circulation exhibits a markedly slow pulse-wave it will be better corrected by lobelia than by any other drug we possess. In fact the most prominent indication for the drug is the full, oppressed, sluggish, doughy pulse. Associate this with praecordial oppression, thoracic pain, difficult breathing, soreness or bruised feeling within the chest, nausea with tongue heavily coated at base, fullness of tissue, and we have before us a fair range of the action of lobelia. It is a good remedy in cardiac congestion.

Perhaps the most important use for this drug will be in the treatment of respiratory affections. For this class of diseases no remedy is more highly valued by physicians of our school. "Lobelia is an admirable pectoral remedy. As a nauseant expectorant it has no equal. When an emetic is desired in pulmonary complaints it is one of the most efficient that can be employed. It has come to be the first of remedies for spasmodic asthma, and is not without utility in whooping cough. It improves innervation and the circulation, and is one of the best remedies to employ in congestive conditions. It is frequently indicated in pleurisy and pleuro-pneumonia. As a sedative it ranks between veratrum and aconite. Acute pneumonia, with, tendency to congestion, the breathing being oppressed, is quickly relieved by lobelia. All chronic forms of sore throat, especially when ulcerated, are benefited by it. Chronic pneumonia, bronchitis, and laryngitis are all conditions in which lobelia will be of great service. In asthenic laryngitis of children it is exceedingly useful. It is a remedy of great value in chronic catarrh, dry, hard, or barking coughs, colds, and all forms of irritation of the respiratory tract, with oppression. It relaxes the tissues, favors expectoration when a large quantity of mucus is secreted and there is want of power to remove it. The indications for this drug are the full, oppressed, or small, feeble pulse, praecordial oppression, with difficult respiration, oppression anywhere in the chest, with accumulation of the bronchial secretions, cough with loud mucous rates within the chest. The "acetous emetic tincture," which contains this agent, may be used to fulfil most of the indications for this drug. Powdered lobelia seeds or leaves, or the "compound powder of lobelia and capsicum," are the best local applications that can be employed in acute pulmonary complaints, and give great relief in chronic cases with a sense of suffocation and fullness, accompanied by soreness within the chest" (Felter).

When in the eruptive diseases retrocession takes place, lobelia, by promoting determination of blood to the skin, will promptly bring the eruption to the surface. It is also indicated in scarlatina and measles when the eruption is tardy in making its appearance.

Lobelia was formerly used to a considerable extent in the eruptive skin diseases. In the Western Medical Reformer for 1838, we find it lauded as a local wash for "herpes, lichen, eczema, nettlerash, and erysipelas." There is one condition in which its use should not be overlooked, and that is in poisoning by Rhus Toxicodendron. An aqueous solution of specific lobelia, or an infusion of the plant should be freely used by wetting the cloths in the lotion and applying frequently to the affected parts. Externally, the infusion has been found useful in ophthalmic affections; and the tincture is a valuable local application to sprains, bruises, rheumatic pains, erysipelas, and erysipetalous inflammations, tetter, and other forms of cutaneous diseases. A poultice of powdered lobelia and slippery-elm bark, with a weak lye-water, will be found valuable in erysipelatous diseases, bites, and stings of poisonous insects, spasmodic affections of the limbs, pains, and to produce muscular relaxation. Tincture of lobelia, painted upon the parts before suppuration has begun, is said to abort felons.

The oil of lobelia is valuable in tetanus and some other extreme cases, as it is easy to introduce enough upon the tongue to relax the whole system immediately. On account of the tendency to produce inflammation of the stomach, it should not be employed alone as a common emetic, but a few drops of it should be triturated with sugar, and diffused in chamomile, boneset, or other emetic infusion. One drop of the oil, triturated with 20 grains of sugar, and divided into from 6 to 12 doses will be found highly useful as an expectorant, nauseant, sedative, and diaphoretic, when given every 1 or 2 hours, as may be required. As a local application, much benefit may be derived from it, where a particular nerve is to be quieted, or a muscle to be relaxed. An excellent liniment may be made of a mixture of ½ ounce, each, of oils of amber and sassafras, 1 drachm of oil of lobelia, and ½ drachm of ethereal oil of capsicum. To be used in painful neuralgic and rheumatic affections. That lobelia is a valuable remedy will be conceded by all, and that it has been notoriously misrepresented is apparent to all. Carefully used according to its specific indications, it will be better appreciated the more it is used. As an emetic, dose of the powder, from 20 to 60 grains; of the tincture, from 2 to 4 fluid drachms; as a nauseant and expectorant, from 5 to 20 grains. The dose of specific lobelia ranges from 1 to 40 drops, according to use, taken in a little water. When lobelia does not act as an emetic, it is very apt to purge. The relaxation caused by lobelia may be counteracted by the stimulating and tonic influence of capsicum.

Specific Indications and Uses.—Lobelia is specifically indicated by the full, labored, doughy pulse; the blood moves with difficulty; pain in chest of a heavy, sore, or oppressive character; angina pectoris; cardiac neuralgia; pulmonary apoplexy; mucus accumulation in bronchiae; convulsive movements; rigidity of muscular tissues; rigid os uteri, with thick doughy edges; rigid perineum, or vaginal walls; nausea; oppressive sick headache, with nausea. As an emetic when tongue is heavily coated at base.

Related Species.—There are other species of Lobelia, as the Blue lobelia (Lobelia syphilitica, Linné), and the Red lobelia (L. cardinalis, Linné). The first is diaphoretic, emetic, and cathartic; also diuretic and antisyphilitic, and a strong infusion of it has cured gonorrhoea. It has likewise been used in dropsy, diarrhoea, and dysentery. The root is the part used; dose, from 20 to 60 grains of the powder. The L. cardinalis is said to be anthelmintic, nervine, and antispasmodic. These two varieties are seldom, if ever, used in medicine. Wm. Procter, Jr. (1839) obtained a bitter, acrid, aromatic, oily, liquid alkaloidal body from this plant. It was probably a mixture of the alkaloid with impurities (see D. and M. of N. A., Vol. II, p. 106).

Lobelia Kalmii is the plant shown to Mr. Kalm by Col. Johnson, as the one used by the Indians of some parts of North America to cure syphilis; and he was likewise informed that syphilis was known among them previous to their acquaintance with the Europeans, and that they cured it very readily, even when "the patient is half rotten and insupportable to be approached" (General Practice of Physic, by R. Brookes, M. D., 7th ed., 1777, Vol. II, pp. 67-71).

King's American Dispensatory, 1898, was written by Harvey Wickes Felter, M.D., and John Uri Lloyd, Phr. M., Ph. D.