Leading Articles.
Specific Indications for Lobelia Inflata Used Hypodermically and a Study of its Action when so Used
E. JENTZSCH, M. D. C., M. D., CHICAGO
It is quite certain that the drug is non-poisonous when so given. In a series of experiments performed by me on dogs ranging in ages from a few weeks to twelve years, I failed to elicit any poisonous symptoms, giving it in two dram doses every three hours to the number of six injections. With these animals the first dose caused emesis, but it was not subsequently induced, and they were all well and hearty after thirty-six hours. During the period of lobelia administration, the only symptoms noted, besides the emesis after the first dose, were moderate increase in salivation, a slight reduction and softening of the pulse, likewise a slowing of respiration. The animals were listless, bordering on hypnosis, but alert and conscious when spoken to.
This experiment was undertaken principally for the purpose of establishing the poisonous or nonpoisonous properties of the drug when so given. I am entirely satisfied that it is nonpoisonous. I give this information in good faith as I did the former in regard to lobelia in diphtheria, with a desire to benefit all who may be inclined to profit by it. Bearing in mind that I am only speaking of its hypodermic use.
The principal action of this drug so used is that of a restorative to the centers of circulation and enervation, primarily, and secondarily it acts as a cardiac and respiratory tonic. It quickly restores the powers of control to these centers, thereby equalizing the entire nervous and circulatory system. Especially is this liable to be found so in those conditions, or diseases, where the cerebral circulation is notably affected. It is a mild hypnotic, which is ascribable to its power of relieving both cerebral congestion and anemia. Strictly speaking, it cannot be classed as a stimulant or as a sedative, but it will promptly act as either, according to whether sthenia or asthenia is present. It is an anodyne. This action is caused by the same phenomena as mentioned before; likewise its exhilarating and tonic effect. It is a relaxant only in so far as this influence is permitted by its equalizing action upon the circulation. In doses varying from one-half dram to one dram respectively, either for a child or adult, I have not found it either a depressant or an emetic. This I conclude from my personal, clinical observations of at least eight hundred injections.
So used this agent is a powerful antidote to poisoning of any sort, bacterial or otherwise, but especially to diphtheria. I have just now concluded the treatment of four cases of diphtheria in one family, where the mother and three children were affected. The history of this family affliction is interesting and deserves mention, because I am quite positive that without this lobelia treatment, it would have proven a calamity to that family. While on account of this treatment it can only be considered an inconvenience.
On October the fourteenth, last, Mr. Warner, the father of the child first affected came to my office inquiring if I was the doctor that wrote about lobelia for diphtheria, to which I answered "Yes." He then told me that his little girl was sick with diphtheria. Another doctor having made the diagnosis and because I was so sure of curing diphtheria he would like to have me treat the child. I promptly consented, went to see the patient, a little girl 7 years old, and confirmed the diagnosis, which was unmistakable. I gave her one injection of lobelia and with the treatment mentioned before in a paper on the subject the child was well in four days. I so reported the case to the Health Department and all quarantine restrictions were removed within two weeks from the time the child was taken sick.
On Nov. 1st was again called and found the older child, a girl aged 13, affected. This proved to be one of my most virulent cases, from an objective point of view. This patient has a goitre which caused alarming tachycardia, that is alarming to me alone, because she did not complain much of anything, such as pain in the throat or dyspnea.
This is true of all patients in my experience, treated by this method. It not only saves the patient, but it spares the patient distressing pain, dyspnea and to a great extent post diphtheretic sequelae.
Although there was extensive membranous involvement of the nose and throat she got along well at first, the deposits beginning to disappear on the third day, but they lingered until the fifth day when the edema and deposit again became progressive with even greater virulence than before, to such an extent that the air passage was almost entirely occluded. In addition bloody serum dozed from her nose almost continuously, making it necessary to change the bed linen several times a day, besides she had several quite severe epistaxes. This was a genuine hemorrhagic case of diphtheria.
Here I might say, that although outwardly I was as confident as a confirmed republican was of the country's safety at the last election, inwardly I entertained the gravest misgivings that this might prove my first failure with lobelia. Not so much because it was a severe case of diphtheria, but because the goitre with the tachycardia was a dangerous complication. Several times I found myself arguing that it would be better for me to ask for consultation, with the view of dividing responsibility, but I knew that it would mean the cessation of my treatment and the administration of a big dose of serum-antitoxin, with the consequence that in this case, with the serious complications, death would have naturally followed. Likewise did I know that at this stage no matter whether the patient would have died with or without the serum-antitoxin, I was sure of the official and unofficial censure and criticism in whispers and shouts for daring to treat contrary to the official dictum. Besides. I was determined to give this patient the full benefit of the lobelia treatment, therefore, I stuck to the ship and landed her safely in the harbor of health, and in such a short time that one not familiar with the usual outcome of this treatment might be prone to doubt. The girl was well within two weeks from the time she was taken sick.
This result was brought about by simply increasing the dose and frequency of the vegetable diphtheria antidote (sp. lobelia inflata.) This patient bears the distinction of receiving the most injections I have ever given in a single case. She received, within nine days, fourteen injections of seventy-five minims each, besides a few smaller doses. While this girl was sick the mother contracted the disease, in a moderately severe form and another boy with a mild form. They now are all well and none the worse for their experiences. I am citing the history of these cases on account of their recent occurrence and as part proof of my assertions.
The antidotal action of this remedy differs in many respects from the serum as follows:
It gives results quicker and with much greater certainty than the serum; its administration is not followed by a negative opsonic stage. (In other words by a depression.) It is a steady and reliable supportive. It prevents pain, and dyspnea, consistently, and to a large extent post diphtheritic sequelae. It causes no unpleasant symptoms, ascribable to the drug action, and last, but not least, it has in my hands saved every diphtheria patient treated within the last four years.
As alluded to before the indications are principally where the vital centers (the governing centers) of enervation and circulation are impaired, in other words where these centers are losing control. This leads me to believe that diphtheria as it is now classified and considered is preceded by a pre-diphtheritic stage. A condition in which the system is a suitable culture medium for these bacteria, and that the development of these bacteria is a secondary stage of the disease. The primary stage is a disordered condition of the centers of enervation and circulation, whereby these centers are unable to properly perform their functions. That this is probably so is demonstrated by the fact that just as soon as this primary condition is treated, with a view to restoring the functions of these centers (which lobelia will do), the bacteria complication will yield and disappear.
In the infectious character of diphtheria the bacteria, being the primary cause of the disease, which statement, when qualified, I have no intention to dispute, I contend that only bacteria recently derived from suitable media are able to produce this result. To be plain only germs recently coming from diphtheria patients (or from the artificial culture media) act as contagion, and why? Because they are then immersed and carry with them the substance on which they nourish and which is necessary for their propagation. I doubt if the impairment and death of bacteria is due so much to the excretion of an antitoxin emanated by these bacteria as to the exhaustion of the substance from which they nourish. It is not very likely that an immunizing antitoxin circulates throughout the system for seven years after an individual had the smallpox or cowpox, which is said to protect them for this length of time, but it is to me more rational to believe that the substance necessary for bacterial growth is exhausted.
Pronounced and acute loss of enervation by itself evidenced by cerebral disturbances is an important indication for this remedy. It is difficult to determine which of the two is primary. It is however certain that the remedy has a powerful and pronounced remedial action upon disorders of the centers of enervation, which I have observed in many such cases, particularly in the following which I have selected: First case, apoplexy. A man aged 61. Hemiplegia of the right side unconscious, unequal pupils, stertorous, breathing, inability to swallow, rectal temp. 103°. He was given half of a dram of specific lobelia every 10 minutes. The patient regained consciousness, was able to talk and swallow within an hour after receiving four doses. He made a complete recovery in about one year.
The second case was one of five cases of insulation, all recovering in a similar manner by the same treatment. Mr. C., aged 35, was overcome in the shop, but was prostrated in the street car, where he completely collapsed. After an hour's ride he was carried into a drug store and I was called. I found him literally in a dying condition, radial and carotid pulse, imperceptible, cardiac beat, elicited by the stethoscope about 30 per minute. No pupillary or ophthalmic reflex; no irritation reflex; respiration about ten per minute, cold sweat in patches, deathly pallor. I gave forty-five minims of specific lobelia with 1/30 of strychnine. The man was able to talk and gave his name and address in 30 minutes, when the ambulance arrived.
Third case. Man aged 33. A carpenter, fell off a building and sustained a fracture of the vault of the cranium, producing extensive bone compression, which I so diagnosed at my arrival. He was unconscious, bleeding from right ear, slight response to irritation. I gave one dram of lobelia, ordered him to be taken to the hospital and prepared for an immediate operation. There he was examined by several doctors, including the family physician, who then doubted my diagnosis, as the patient had regained almost complete consciousness from the lobelia, besides the pulse and respiration were nearly normal. However I knew this to be due to the action of lobelia, therefore I maintained my original diagnosis. I was retained in the case with the family doctor and advised operation as soon as pressure symptoms returned, which I knew would not be long in coming.
This happened in the morning. Towards evening I was called up from the hospital and informed that the patient was in a precarious condition. Responding to the call I found the patient unconscious, temperature 103°, stertrous breathing, etc. This time the interne agreed with my diagnosis. We decided that an immediation operation was imperative and so informed the family. While waiting for the family I gave another dose of lobelia, with the result that the patient again improved to such an extent that when the family doctor arrived it caused him to be still doubtful, counseling further delay. This time I made it plain that if I was not permitted to operate immediately I would not assume further responsibility. Thereupon I was dismissed from the case. After another twenty-four hours' delay the patient was operated upon by some other surgeon who confirmed my diagnosis. The patient died shortly after the operation. This last case seems to me to be an exceptionally interesting one in so far as it shows the powerful actions of the drug.
Fearing to be too lengthy I will conclude by mentioning the diseases in which I have successfully used this remedy, and others where the indications for others were present and where this remedy should be remembered: Diphtheria, apoplexy, acute alcoholism, shock, emphysema, pneumonia, insolation, tetanus and embolism. I suggest this use of the remedy in acute insanity, hysteria, hydrophobia and meningitis. As a precautionary measure, as a parturient in obstetrical practice, in conjunction with Abbott's H-M-C tablets, with the view of avoiding any unpleasant symptoms from this anesthesia. I use it when indicated in every case of obstetrics with the H-M-C tablets in ten drops with the best results. I am writing this treatise at this time with a desire to aid those that are contemplating its use, and to save the lives of those who will be saved by it, because I believe there is no other remedy known which will do as much in this respect. I have not mentioned contra-indications for the simple reason that I have not discovered any as yet. This I think is not due to a lack of observation on my part, but because the remedy is so very harmless. Please take note of this last fact mentioned. The remedy is nonpoisonous, nonemetic, non-depressant of course, when given in rational doses as indicated. This is true, no matter what may be said about the action of this drug when given otherwise, whether you read it in the U. S. P. or any other book of authority. It is the peer of life savers and if the reader will bear this in mind it will, I am sure, often prove the means of rescuing a patient who would otherwise die. It is safe to say that where there is danger of impending death from acute conditions the remedy is indicated whether you think of it first or last.
Ellingwood's Therapeutist, Vol. 3, 1909, was edited by Finley Ellingwood M.D.
