The rhizoma and roots of Convallaria majalis (Nat. Ord. Liliaceae).

The Preparations

It is a remarkable fact that different properties are possessed by extracts made from the various parts of the plant. An extract made from the root has very powerful emeto-cathartic property, while it but little affects the action of the heart. The same fact is true, to a less or greater extent, of extracts from the whole plant. This emeto-cathartic action is due to the presence of a rather acrid resin, and hence for the purpose now intended to be subserved by the administration of convallaria the preparation used must be freed from this resin. An extract prepared from the flowers and stalks, mixed with a third of their weight of leaves and root, is, according to Langlebert, the best preparation, when deprived of the resin. In this shape it is a solid extract, has a shining black color and a bitter taste, and is freely soluble in water and alcohol.

Extractum Convallariae Fluidum

Fluid extract of convallaria. Dose, τηv— 3 ss.

An infusion of the flowers, leaves, and stems is also used. Troitzky employed several formulas in his trials—from two to four scruples of convallaria to four ounces of water.

Infusum Convallariae

Infusion of convallaria (convallaria, 50 parts; water, 200 parts). Dose, a table spoonful. Another formula is eight ounces of convallaria to a pint of boiling water, which is twice the strength of the above.

As the active principle presents many advantages, this will probably be preferred for administration in cardiac affections.

Composition

In 1858 Walz announced the presence in this plant of two glucosides—convallarin and convallamarin. There are important differences in the qualities of these substances. The former, convallarin, occurs in colorless, rectangular prisms, is slightly soluble in water, but freely so in alcohol. Convallarin, as Marmé first ascertained, is a purgative in doses of three or four grains (Husemann). It is probable that the presence of this glucoside in the resin is the secret of the cathartic property of this substance, in part at least. Convallamarin is not crystallizable, is a white powder, bitter, and freely soluble in water and alcohol, but not in ether. The dose when administered by the stomach will range from one fourth of a grain to two grains; but further investigations are needed to decide this point. This is the principle of convallaria, to which its cardiac actions are due. It is probable that the perfectly pure alkaloid possesses much greater activity than the dose above stated indicates.

Physiological Actions

For some time no other powers were attributed to convallaria than those of a cathartic intermediate in action between scammony and aloes. In Russia it has long been known as a remedy for dropsy. This fact finally induced Troitzky and Bojojawlensky to study its action more closely, and Prof. Bot-kin, of St. Petersburg, subsequently confirmed their researches.

It was not, however, until Prof. See undertook the study of its powers and actions, that general interest was aroused, although Marmé had, as is stated above, some time before, given an accurate account of the physiological actions of convallaria. Since the publication of See's observations, the actions of this medicament have been investigated by various English and American observers. From these sources, and some personal studies, the author makes up the following account:

Notwithstanding the emeto-cathartic action, if the extract freed from the resin, or convallamarin, the active principle, is given, no disturbance of the stomach occurs. It stimulates the appetite somewhat, and digestion is not impaired. An increase of peristalsis occurs, and the evacuations, without being loose, become easy. In warm-blooded animals it slows the heart and raises the arterial tension. At the same time the respiratory movements are rendered more full and somewhat less frequent. These effects are due to stimulation of the vagus, but the nerve does not lose its irritability. If the dose be lethal, after this first stage, the heart becomes irregular in rhythm, the force of the cardiac contractions varies, and the respirations are disturbed, inspiration growing deep and prolonged, owing to spasm of the inspiratory group of muscles (See). In the third period of the action, just before death, the arterial tension rises very high, but the pulse is exceedingly rapid; then the pressure falls, the respiration growing deeper and very slow, and the heart stops in systole, before the breathing finally ceases. The vagus does not wholly lose its irritability, but near the end a strong faradic current does not stop the heart. The irritability of the motor and sensory nerves remains unaffected, and the muscles preserve their contractility. The pupil is unaffected and the functions of the brain are undisturbed.

The diuretic effect of convallaria is very constant and decided, a fact long known in Russia, but no change occurs in the composition of the urine.

Therapy

In suitable doses—15 to 25 grains of the extract—convallaria slows the heart-beats, and often restores the normal rhythm of the heart when disturbed, increases the energy of the cardiac contractions, raises the arterial tension, and at the same time the respiratory movements acquire increased force and volume. These important therapeutical effects are wrought without affecting the functions of the brain and spinal cord. It is also a prompt and certain diuretic, increasing the discharge of all the urinary constituents. The therapeutical indications based on these physiological actions are the following: Palpitation, disordered rhythm, or vehement action, dependent on impaired function of the pneumogastric, or on hypertrophy of the muscular walls; narrowing of the mitral orifice (mitral stenosis) or insufficiency of the mitral valves, with stasis in the venous circulation, with or without spasmodic breathing; dilated heart, with or without fatty change or sclerosis; in all cardiac affections accompanied by dropsy (See). The signal advantage which it offers over digitalis is the absence of danger from its administration, and the freedom of the cerebro-spinal axis and the digestive organs from disturbance. It has now been used in the maladies above mentioned by numerous observers in various parts of the world; and, although the reports are not uniformly favorable, there can be no doubt that we have in con* vallaria an important addition to our resources.

Authorities referred to:

Ferrand, Dr. G. Sur le Muguet [convallaria]. Annuaire de Thérapeutique, Bouchar-dat, 1883, p. 135.

Juk, Dr. London Medical Record, June 15, 1883.

Langlebert, M. Adolphe. Note sur le Convallaria Mdialis. Bull. Gén, de Thvrap., vol. ciii, p. 74.

Moutard-Martin, Dr. Sur la valeur de l'extrait de Muguet comme médicament diurétique. Bouchardats Annuaire for 1883, p. 132.

SÉe, Prof. Germain. Recherches experimentales sur le Muguet (Convallaria Maialis). Bull. Gén. de Thérapeutique, vol. ciii, p. 49.

Tanret, C. Ibid., vol. cii. Convallamarine, principe actif de Muguet (Convallaria Maialis).

Troitzky and Bojojawlensky. Wratch 47 and 49. Annuaire de Thérapeutique, 1883, p. 127.