Definition. - A glucoside, or mixture of glucosides, obtained from strophanthus.

Description and Properties. - Strophanthin is a white or faintly yellowish crystalline powder. It is permanent in the air and has an intensely bitter taste. It is very soluble in water and diluted alcohol. Its solutions decompose very readily.

Dose. - Average dose: 1/200 grain = 0.0003 Gm. (0.3 milligramme), U. S. P.

Antagonists, Incompatibles, and Synergists. - The same as for digitalis.

Physiological Action. - Externally and Locally. - The tincture of strophanthus has no local action of importance. Strophanthin and ouabain, however, possess marked sedative properties, the latter being much the stronger. They paralyze the ends of the sensory nerves and are active local anesthetics.

Internally. - Digestive System. - Strophanthus is similar in its action to digitalis, though less apt to disturb digestion in small doses; on the contrary, its bitter taste tends to improve the appetite.

Circulatory System. - Upon the heart its action is identical with that of digitalis, though differing from the latter drug in its effect upon arterial tension and the arterioles. Strophanthus does not contract the arterioles so markedly, and the arterial pressure is but slightly raised, the elevation being due to the increased force of the heart. Its action is more rapid than that of digitalis, results being produced in fifteen to twenty minutes after taking.

Nervous System. - Strophanthus affects the nervous system even less than digitalis. Kobert claims that it is a slight sedative to the brain and spinal cord.

Respiratory System. - It has no important action.

Absorption and Elimination. - Strophanthus is rapidly absorbed, and more readily eliminated than digitalis, possessing less cumulative action. It is principally excreted by the kidneys, increasing the amount of urine by the strengthened heart's action. Unlike digitalis, the drug has little influence upon the caliber of the renal vessels.

Temperature. - Very large doses of strophanthus cause a slight reduction of temperature, not, however, as marked as digitalis.

Eye. - Excessive doses contract the pupil and increase intraocular tension.

Uterus. - It resembles digitalis, though more feeble in its action upon the uterus.

The symptoms and treatment of poisoning are similar to those described under Digitalis, although strophanthus is more apt to occasion diarrhea. Cases of poisoning are rare. The symptoms observed have been those of severe digitalis poisoning with unconsciousness, tonic and clonic convulsions, hallucinations, diarrhea, analgesia, myosis, Cheyne-Stokes respiration, and death after four days. The toxic dose has not been determined.

Therapeutics. - Externally and Locally. - Strophanthin has been occasionally employed as a local anesthetic, but the testimony in its favor is hardly sufficient to encourage its use.

Internally. - Strophanthus is a cardiac remedy, being indicated in the same varieties of heart disease as digitalis. It is of particular value in stenosis of the mitral orifice, having a happy influence in controlling the irregular rhythm, nervous dyspnea, and intermittent pains distinctive of this lesion. The drug is also well adapted in subduing functional irregularities of rhythm in cases of irritable or tobacco heart.

Hypothetically, strophanthus is superior to digitalis in certain stages of Brights disease and heart failure of elderly people with slightly degenerated arteries, especially in those patients with preexisting high arterial tension. It is also hypothetically of greater value in pneumonia than digitalis.

Shoemaker advocates the use of strophanthus in the treatment of psoriasis.

While in the majority of cardiac diseases digitalis should be first tried, where it fails strophanthus is the proper recourse. It is a peculiarly efficient drug in the cardiac diseases of children, according to the majority of observers being safer than digitalis for young patients.

Contraindications. - The same as for digitalis.

Administration. - Of the preparations of strophanthus, the tincture is preferable, both for convenience and safety. It should not be forgotten, however, that the seeds of strophanthus that come into the American market are very much mixed, and that many preparations are not as reliable as one would hope for. Should strophanthin or ouabain be desirable, a fresh solution is to be preferred.