Convallaria. Convallaria majalis.

Synonym—Lily of the Valley.

CONSTITUENTS—

Convallarin, Convallamarin, both Glucosides.

PREPARATIONS—

Extractum Convallariae Fluidum, Fluid Extract of Convallaria. Dose, from five to twenty drops.

Tinctura Convallariae. Dose, from five to thirty minims.

Specific Medicine Convallaria is always made from the fresh root. It may be given in doses of from one to five minims in water, frequently repeated, giving good results, prescribed from one-half to two and one-half drams, in four ounces of water.

All the preparations are stable in water except the fluid extract of the root. An infusion of the entire plant was used in the most of the original investigations made. It yields good results.

The Glucoside Convallamarin is given in doses varying from 1/12 of a grain to one grain. The granules of 1/6 grain- afford an excellent form, as they may be dissolved in water if a smaller dose is desired, or one or more granules may be given at a dose.

Physiological Action—A poisonous dose to a child produced great restlessness, rolling and tossing, continuous trembling of the arms and legs, and one attack of general convulsions. There was stupor, from which the child was roused by the greatest effort, to immediately relapse into it again on being left quiet. The pupils were moderately dilated, the temperature became subnormal, the pulse rapid and exceedingly irregular. The respiration was very regular but rapid, shallow or superficial. The face was flushed. The agent induced no diuretic or diaphoretic influence in this case and no gastro-intestinal irritation. Bogoyavlenski's extensive observations of the action of convallaria upon warm-blooded animals were as follows: It induces a sudden retardation of the cardiac contractions, with increase of blood pressure. After the period of retardation there follows a strongly pronounced acceleration of the contractions with still greater increase of blood pressure, arrest of heart beat with diminution of blood pressure. When the vagi are previously divided the precursory retardation does not take place. If, during the period of acceleration of the contractions, the peripheral ends of the vagi are irritated, the usual effect on the heart is not observable.

In the left and right ventricles there was found an extravasation of blood under the endocardium. Under its influence the quantity of urine is much increased, and dropsical exudates are promptly absorbed and the weight of the patient lessened. The diuresis induced by the remedy continues long after cessation of its administration. The pulse grows fuller, more regular, and in some cases slower. It is not poisonous and has no cumulative action.

Specific Symptomatology—The direct therapeutic indications are organic heart weakness with valvular inefficiency, especially if accompanied with dropsy. It is probably an efficient remedy for dropsical infiltration wherever located, if due to inefficient heart.

Therapy—It strengthens the heart's action, slows a rapid and feeble pulse, corrects the rhyme and rhythm, improves the tone and increases the power of the heart, as evidenced by increased tonicity throughout the entire capillary circulation. It may be given for a few days and then discontinued for as many days when its influence remains. Its influence is exercised in a regular, steady and permanent manner.

Its efficiency in dropsy is evidenced when there is sluggishness of the general circulation, with extreme inefficiency of the capillary circulation and greatly diminished blood pressure. In these cases, if the kidneys are not seriously diseased, it can be made to induce extreme diuresis and give prompt relief.

It can be given with impunity and small doses should not be relied upon in extreme cases. If prompt effects are desired the tincture in full doses can be given in hot water, or an infusion of the entire herb will yield the best results.

In some cases of chronic nephritis the kidneys will fail to respond to the action of the agent. But these cases are necessarily extreme ones, as in many cases of Bright's disease most beneficial results are obtained from the use of this agent.

It overcomes general depression, favors elimination, adds power and regularity of action to the heart, overcomes distress of breathing, conduces to rest and sleep, and induces a general sense of improved well-being. It is an excellent remedy with which to improve the tone and vigor of the heart after the depressing effects of protracted fevers or violent acute inflammation, especially of the lungs and bronchi. It is useful also in the enfeebled heart of phthisis pulmonalis.

It is of much value in rheumatism, especially when the heart is involved. In rheumatic carditis or pericarditis it serves a double purpose. It strengthens and improves the tone of the heart, and favors the elimination of morbific products which cause the inflammation. But few remedies will act more efficiently. If there is effusion within the pericardium its influence will be quickly observed.

To sum up the influences of convallaria: It is used to excellent advantage in the tobacco heart from cigarette smoking; in the bicycle heart from overstrain; in asthmatic breathing from enfeebled heart, especially in chronic asthma. It does not, like digitalis, irritate the stomach unpleasantly. On the contrary, it is of much service in that form of dyspepsia in which there is extreme torpor of the stomach, with pale, flabby mucous membranes of the mouth, broad, thick tongue, with a heavy, dirty white coating. In conditions where the tongue is red and thin, with elongated papillae, redness of the tip and edges, it is contraindicated. It is contraindicated also in fatty degeneration of the heart.

Germaine mentions the following therapeutic indications:

In palpitation resulting from a state of exhaustion of the pneumogastric nerves—cardiac paresis, the most frequent source of palpitations.

In simple cardiac arrhythmia, with or without hypertrophy of the heart, with or without lesions of the orifices or valves of the heart.

In mitral constriction, especially when it is accompanied by failure of compensation on the part of the left auricle and right ventricle, the contractile force augments visibly under the convallaria, as the sphygmograph testifies.

In mitral insufficiency, especially where there are pulmonary congestions, and when, as a consequence, there is dyspnea, with or without nervous trouble of the respiration.

In dilatation of the left ventricle, without compensatory hypertrophy, it restores energy of the heart, which tends to become more and more feeble and dilated. In dilatations of the heart, with or without fatty degeneration, with or without sclerosis of muscular tissue, the indications for convallaria majalis are clear.

In all cardiac affections indifferently, from the moment that watery infiltrations appear, convallaria has an action evident, prompt and certain.

In lesions with dyspnea the effect is less marked. To combat cardiac dyspnea, convallaria is inferior to Quebracho. The combination of convallaria majalis with iodide of potassium in the treatment of cardiac asthma constitutes one of the most useful methods of treatment. One is often obliged to suspend the employment of digitalis on account of vomiting, digestive disturbances, cerebral excitation, the dilatation of the pupil, which it so often produces after prolonged use. No such results obtain from the use of convallaria.

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.