Night-blooming Cereus, Cactus grandiflorus or Cereus grandiflorus. Not official, but listed in the National Formulary. The cacti have been inadequately investigated. Some species are used as food for cattle. I have personally investigated, though in a superficial way, a number of species, using fresh material. The common opuntia is mucilaginous and its tincture, sometimes sold as "tr. cactus," is inert. Cereus fimbriatus possesses acrid principles of undetermined action. Anhalonium Lewinii, Mescal Button, carries anhalonine, a toxic agent especially impressing the nervous system. It is stated that mescale, an intoxicating drink, is made from it. Certainly, from my own observation, mescale does not, at least as ordinarily made, give rise to the same symptoms as does anhalonium. Little anhalonium is to be found in the desert. Other species of cacti, including some varieties of maguey, from which the relatively mild pulque is made, yield "buttons" at certain periods of their growth; and the Indians gather certain cactus products to use in drinks and in smoking, which produce symptoms resembling insanity.

My own tests of anhalonium gave symptoms akin to those produced by cannabis indica. This data, for which I feel in position to stand sponsor, proves that there are certain cacti possessed of active properties. But the lack of critical data makes it impossible to give a definite pharmacology of any of the cacti.

Cactus grandiflorus was studied by Scheele and, later, by Rubini. Neither claimed a digitalis action for it, as has been erroneously stated. Their somewhat involved statements showed it, in their opinions, to influence the heart muscle and the sphincters in medicinal doses; but they made no claims based on animal experimentation. Hosts of clinicians have agreed with them.

From the animal side, Gordon Sharp (Practitioner, Sept., 1894) found no active principle and determined no action except mild diuresis. Hatcher, more recently, definitely proved the commercially marketed so-called "active principle" to be practically inert. His later tests of cactus itself were less convincing, since he did not prove identity or origin of material used. But he proved, as was long suspected, that cactus does not possess a digitalis action. I have taken large doses of a reliable tincture, and noted no toxic symptoms therefrom; but the pulse was quickened and there was gastric irritation, with a feeling of general discomfort. Blood-pressure was not raised. Also I have taken vastly excessive doses of the "active principle" with no demonstrable effect. And I have made concentrations of cactus, which I believe the commercial "active principle" to be, and the product was wholly unstable, the mucilage therein soon proliferating microorganisms. Furthermore, microscopical examination of the commercial product shows the presence of numerous microorganisms. From the practical standpoint, I believe the "active principle" to be of little or no value.

Various specimens of the tincture have, in my hands, varied largely in effectiveness, as judged clinically. From tests of the conservatory-grown cactus, I believe it to be inferior to the cactus gathered in a wild state in Mexico.

There has not been, so far as I have been able to learn, any satisfactory pharmacologic study of the green stems gathered in Mexico and immediately immersed in alcohol. Only such study would be convincing.

Wilcox, in 1905, asserted that "The action of cactus is upon the intra-cardiac ganglia and accelerator nerves, through the cardiac plexus of the sympathetic, and there is not any interference with the inhibitory nerves." This may well be taken as academically probable, though not confirmed by other observers. The thought suggested is that cactus is a cardiac anti-spasmodic; and clinical experience gives some support.

The property of being antispasmodic is hard to prove or disprove by pharmacologic investigation, as spasm is not a normal biologic phenomenon.

Indeed, there are few true antispasmodics; and the actions of these are not the same. Some reduce the irritability of the nerve centers; others are terminal in influence; some are antispasmodic because also anesthetic, and yet others cause muscular relaxation.

Among botanic antispasmodics (not mere "nervines") are opium, belladonna, cannabis indica, conium, aconite, lobelia, and hyoscyamus. Now opium acts in intestinal and urethral spasm; belladonna is the most effective in anal spasm; cannabis indica is a vesical antispasmodic; conium is effective in spasm from irritative lesions of nerve trunks; aconite is a terminal antispasmodic, acting best when locally applied; lobelia is effective in spasmodic asthma and spasm of the uterine os; hyos-cyamus is antispasmodic in several more or less diverse states.

Now these various antispasmodic actions were proven by clinical experience, not largely by animal experimentation; and the pharmacology of abnormal function, which is proven clinically, is just as valuable and important as is the pharmacology of normal function, which is proven by animal experimentation. As an illustration of the pharmacology of abnormal function, see "Camphor."

An analysis of the better sustained claims made for cactus showed its dominant role to be antispasmodic in effect upon involuntary muscle. A tobacco smoker can, by excess, produce the well-proven spasm of involuntary muscle, especially of the heart muscle and intestine. I have experienced this spasm in myself, and very promptly relieved it with medicinal doses of cactus. Also I have carefully observed its action in mild anginal or pseudo-anginal cases, cardiac spasm, spasmodic asthma, sphincter spasm, etc., and am much inclined to credit antispasmodic properties to the drug, more especially as regards the heart muscle, the relief of sphincter spasm not being marked, although the vessel walls seem to respond.

I believe the future will develop more definite data than I am able to record here; but in no sense of the word does cactus take the place of the drugs of the digitalis group.

Therapeutics

Many functional cardiac derangements respond in varying degrees, especially those induced by excesses in habit-inducing agents like coffee and tobacco and, to a less degree, alcohol, which slows the heart. The slow heart is frequently aided by long-continued administration of the drug. Pseudo-angina and mild angina are relieved. Some cases of cardiac pain and spasm respond promptly. Tachycardia is relieved only by full dosage.

Administration

No preparations except those of the green drug in concentrated alcohol should be used. I give "Normal" or "Specific Medicine" in doses of from 1 to 5 minims, and sometimes 10 minims.