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Lobelia.

The leaves, tops, and seeds of Lobelia inflata, Linné (Nat. Ord. Lobeliaceae). Abundant in the United States. Dose, 1 to 60 grains.
Common Names.—Lobelia, Indian Tobacco, Wild Tobacco, Puke Weed, Emetic Weed, Emetic Herb, Vomit Weed, etc.

Principal Constituents.—The unstable liquid alkaloid lobeline, combined with lobelic acid; fixed and volatile oil, and an unimportant nonbasic substance, inflatin. The so-called lobelacrin of Enders is probably lobeline lobeliate.
Preparations.—1. Specific Medicine Lobelia. Dose, 1/10 to 60 drops. (Usual form of administration: Rx Specific Medicine Lobelia, 5-30 drops; Water, enough to make 4 fluidounces. Mix. Sig.: One teaspoonful every 1 to 3 hours.)
2. Subculoyd Lobelia. Dose, 1 to 30 drops. Designed chiefly for hypodermatic use.
3. Pulvis Lobelia Compositus, Compound Powder of Lobelia (Emetic Powder). Contains Lobelia (6), bloodroot (3), skunk cabbage (3), ipecac (4), capsicum (1). Dose, as an emetic, 2 drachms in broken doses of 1/4 to 1/2 drachm, in warm water, every 15 minutes. Used chiefly locally.
4. Tinctura Lobelia Composita, Compound Tincture of Lobelia, (Acetous Emetic Tincture, Expectorant Tincture). Dose, 1/2 to 3 fluidrachms.
5. Libradol. For external use.

Specific Indications.—Fullness of tissue, with full veins and full arterial flow; full labored and doughy pulse, the blood current moving with difficulty; short, labored breathing; sense of suffocation; dyspnea with praecordial oppression; pain in chest of a heavy, sore, or oppressive character; pulmonary apoplexy (full dose); mucous accumulations in the bronchi; dry croupal cough, with scant or oversecretion; asthmatic seizures; short, lancinating pain radiating from heart to left shoulder and arm; spasmodic muscular contraction; muscular rigidity; infantile convulsions from irritation of the bowels, or from respiratory obstruction; hysterical convulsions; rigid os uteri with thick doughy and unyielding rim; perineal and vaginal rigidity during labor; angina pectoris (full doses).

Action.—Lobelia apparently acts upon the central nervous system, the myoneural junction of the muscles of volition, and the sympathetic nerve ganglia, and by some is classed with the nicotine group in pharmacological effects. It is a powerful gastro-intestinal irritant, producing emesis. Should it fail to vomit, which is rare, purgation may result. In large doses a state of near-collapse is induced. Small doses act upon the cardiac inhibitory apparatus, slowing the heart action, but this is followed by a more or less accelerated pulse. During the depressive stage blood-pressure is lowered, but subsequently becomes increased. Small doses stimulate, and large doses paralyze the respiratory centers and the vagal terminals and ganglia in the bronchi and lungs, death, when it occurs (in animals), resulting from respiratory paralysis (asphyxia). Lobelia is most largely eliminated by the kidney, though some is thought to be excreted by the skin.

If lobelia be chewed it causes an acrid, prickling, and persistently pungent sensation in the throat and fauces, accompanied by slight nausea and a feeling of warmth and distention along the esophageal tract and in the stomach. The sensation is not very unlike that produced by tobacco. The salivary glands and those of the mouth are impressed, pouring out saliva and mucus in abundance. A sense of epigastric depression succeeds, followed by profound nausea, and if the amount chewed be large enough, severe and thorough emesis results. The gastric mucus is secreted in great abundance and ejected with the contents of the stomach. The emetic action of lobelia is extremely depressing, and is usually accompanied by profuse perspiration. Oppressive prostration, relaxation of the muscular system, and a languid pulse accompany the emetic stage. The depression, however, is of short duration, and is immediately followed by a sense of extreme satisfaction and repose. Under its action the mental powers are unusually acute, and the muscles are powerfully relaxed. The circulation is enfeebled by large and strengthened by small doses, and the bronchial secretions are augmented.

Lobelia, in the ordinary sense of the term, is not a lethal poison. Undoubtedly its injudicious use has and might produce death, but the same is true of many other drugs that are not ordinarily considered as poisons. That the alkaloid lobeline will kill animals has been fully demonstrated. A drop of the alkaloidal solution placed upon the tongue of a strong, healthy man instantly vomited him. To this property of its alkaloid is undoubtedly due the failure of lobelia to act upon man as a lethal agent. Its emetic action is so prompt and decided that the contained alkaloid does not, under ordinary circumstances, produce fatal results. Given in cases in extremis, the resulting exhaustion from repeated emesis would very likely hasten death, but death would be more likely due to the act of vomiting exhausting the patient than to any poisonous effect of the lobelia.

Therapy.—External. Infusion of lobelia, or the alcoholic preparations diluted and constantly applied by means of compresses, are among the most efficient applications in rhus poisoning. A lotion or a poultice (with flaxseed or elm) often relieves insect bites and stings, articular pain, the pain of bruises and sprains, and sometimes causes relaxation in strangulated hernia, and relieves the discomfort of erysipelatous inflammation. Powdered lobelia sprinkled upon a larded cloth and applied warm, or the compound emetic powder similarly used, is an invaluable local application to the chest in acute thoracic diseases, and gives marked relief from pleural and muscular pains and alleviates the sense of suffocation and fullness accompanied by a feeling of soreness within the chest. Libradol is a more cleanly application and owing to the presence of glycerin is more or less dehydrating, thus making it a preferable application in swellings, bunions, and inflammatory affections of the joints. Libradol, or a lotion of equal parts of glycerin and the specific medicine, provides a grateful application to relieve pain and reduce tumefaction in orchitis and epididymitis; the lotion is the more easily applied.

Libradol is an exceedingly efficient local application in many disorders, to relieve pain and reduce local inflammations. It is not a cure-all, but covers two definite fields of action-the relief of disease conditions presenting:

(1) Pain and inflammation, with or without exudation, as occur in pneumonia, broncho-pneumonia, bronchitis, croup, pleurisy, acute pharyngitis, tonsillitis, orchitis, ovaritis, arthritis, synovitis, inflammatory rheumatism, boils, and bunions.

(2) Localized pain, along nerve courses, in joints, and in the muscular structures, as in some forms of rheumatism (subacute, non-inflammatory, articular, etc.), lumbago, facial, subscapular, and intercostal neuralgia, pleurodynia, and neuritis.

The specific indications for Libradol are: Pain with or without swelling or inflammation; inflammation with serous or mucous exudation; sharp, lancinating pain in the chest, aggravated by respiratory or other movements; congestion and engorgement of parts; dyspnea; soreness in the pectoral region; dull, aching pain; subcutaneous and thecal inflammations; pain of syphilitic nodes and lymphatic swellings.

Pulvis Lobeliae Compositus or Compound Emetic Powder is seldom used for the purpose indicated by its name a purpose for which it was originally intended and which it admirably fulfills. It is for its effects when applied locally in broncho-pulmonic affections that it is so highly valued and that has caused it to outlive many other old Eclectic compounds. How it acts—how it can produce the results it does—remains yet a mystery and can not easily be explained scientifically, but that it does act, and very decidedly, is a well attested clinical fact, and its certainty makes it a remedy that we will not be likely to part with. It is the first application thought of by many when desiring an outward application in acute bronchitis, pleurisy, pneumonia, pleurodynia, and soreness of the pectoral walls. A well-larded cloth is sprinkled with the powder. This is then well warmed and applied directly to the chest. Goose fat probably is the best penetrating medium for its exhibition, and singularly recent scientific tests of the penetrability of fatty bodies has yielded the highest place to goose fat. Once more has science recognized the wisdom of the domestic medicationists, whose only claim to skill rested on their discriminatory clinical observation. The emetic powder may be freely used without danger of unpleasant consequences. It takes the place of the heavy poultices and thus gives little or no discomfort to the patient. If a cotton jacket (best prepared by lining an undershirt or waist with a uniform layer of cotton) be worn over the larded cloth the effects are all that can be desired from external applications. Petrolatum is substituted for other greases by some physicians.

Internal. From the early days of Eclecticism lobelia, through Thomsonian introduction, has been a valued medicine. Many properties were once ascribed it of which little note is now taken. Its chief uses, however, were as an emetic, expectorant, and antispasmodic, fulfilling all of these offices to the admiration of its prescribers. As an emetic it was regarded as not only prompt but efficient, but in order to render it safer and more efficacious, it was often combined with other substances, notably capsicum and ipecacuanha. Either as an expectorant or emetic, as the urgency of cases required, it was in free use in croup, whooping cough, asthma, dyspnea simulating asthma, and pneumonia. In fevers it was used as a relaxant and to modify the circulation. When used as an expectorant it was usually combined with tincture of bloodroot, syrup of senega, wine of ipecac, or oxymel of squill. Doses of lobelia sufficient to excite nausea and relaxation were employed in epilepsy, chorea, cramps, hysteria, tetanus, strychnine poisoning, and other convulsive attacks. Internally, or by enema, it was largely employed to overcome rigidity of the uterus during labor, but its specific applicability, as now known, was not then differentiated. As a relaxant, when employed by rectal enema and in fomentations, it was highly regarded in treating strangulated hernia and other intestinal obstructions; and to release muscular contracture in tedious labors, and to facilitate the setting of fractures and reducing of dislocations. In extreme cases, oil of lobelia was employed and entered into liniments for severe neuralgic and rheumatic complaints. The infusion was used in ophthalmia; the tincture locally in sprains, bruises, rheumatic pains, erysipelatous and similar inflammations, eczema and other cutaneous diseases, and in poisoning by ivy. Poultices of lobelia were similarly employed. These were the days prior to the advent of specific medication through which a better understanding of the use of lobelia was acquired. Of these uses only the occasional employment still survives for the same purposes in croup, asthma, whooping cough, dyspnea, children's convulsions, rigid os, and the local surface disorders named.

Lobelia is nauseant, emetic, expectorant, relaxant, antispasmodic, diaphoretic, sialagogue, sedative, and, secondarily, occasionally cathartic and diuretic and astringent. It is in no sense a narcotic. As an emetic lobelia is now seldom employed. In selected cases where a systemic emetic effect is desired it may still be employed with benefit. By a systemic emetic we mean one which, like lobelia, not only causes emesis, but reacts profoundly upon the nervous, circulatory, and secretory apparatus of the whole body, so that marked relaxation takes place and the stomach yields up a great quantity of thick, ropy mucus. Such an effect is sometimes desirable as a preparatory treatment for the better receptivity of medicines that would otherwise remain unabsorbed by the stomach, or when antiperiodics act indifferently or irritatingly unless a good cleaning of the stomach and relaxation of nervous tension are first insured. This is notably true of quinine, and often of the special or arterial sedatives. Though momentarily depressing, the reaction is decidedly beneficial, and it may well be used when depression is not too great to begin with, and the tongue is expressionless and foully coated at the base. In such instances we believe it should still be used in emetic doses in some chronic disorders of the stomach, and especially in the incipient stage of intermittent and other allied fevers. We have seen it arouse from a general sluggish condition of atony those who have been ill for months and start them on the way to better health. When the emetic action of lobelia is desired, small doses of specific medicine lobelia, or of the powder in warm water, should be frequently administered until profound nausea is induced; then the medicine should be pushed rapidly to emesis. Large draughts of warm (not hot) water will hasten its action and render the act of vomiting easier. Lobelia should never be given to children or the old and feeble as an emetic; nor is it admissible in ordinary cases of poisoning, where depression may be increased by it. Such are to be treated with stimulating emetics.

The powerfully relaxant properties of lobelia make it an efficient drug where the spasmodic element is a factor. As of old, nauseant doses may be given to relax hysterical convulsions, worm convulsions, the convulsions of dentition, and other convulsive disorders of children. When mildly asthenic, lobelia may be used alone; when sthenic, bromide of potassium or gelsemium may be given with it. Usually, however, the indications are present for all three medicines. The best combination of drugs we have personal knowledge of for the relief of convulsions of childhood caused by errors of diet, such as the ingestion of half-comminuted bananas, nuts, or shredded cocoanut cakes, or of fresh flour dough, is the following: Rx Specific Medicine Lobelia, and Specific Medicine Gelsemium, 1 fluidrachm each; Potassium Bromide, 1 drachm; Water, enough for 4 fluidounces. Mix. Sig.: One teaspoonful every five minutes until complete relaxation is insured; then every two hours for a day. The warm bath and the enema should not be neglected. If convulsions are due to dentition or to the onset of infectious diseases, good will have been accomplished by placing the system in repose and giving a better receptibility for other medication. Lobelia is of little value in epileptic convulsions, and is rarely of service in tetanus. It has been used in strychnine poisoning, but is not to be commended, especially if given late, lest attempts at emesis provoke the already greatly excited reflexes and precipitate repeated paroxysms; and less than emetic doses would have absolutely no value. In puerperal eclampsia, in which it has also been advised, it is not to be compared with veratrum, gelsemium and chloroform in efficiency. When intestinal obstructions are due to a spasmodic state of the intestines it may be of service, as in intussusception and fecal impaction; and it may relax and relieve a strangulated hernia. Too much time must not be consumed in attempts at medication in these serious disorders, and an early resort to surgery is advisable. Spasmodic colic in both adults and children is sometimes quickly relieved by lobelia. In fact very small doses prove the very best treatment in colic of very young infants. For spasmodic croup and spasmodic asthma lobelia in nauseant doses is without a peer in drug therapeutics.

Lobelia is the drug for angina pectoris, neuralgia of the heart, and pulmonary apoplexy. Though evanescent in its action, large doses of specific medicine lobelia (about 20 drops) may be administered with the expectation of relieving the patient. The dose may be repeated as necessary. Lobelia is a cardiac stimulant, therefore we class it with the sedatives, for all arterial or special sedatives in medicinal (small) doses are heart stimulants. When the circulation exhibits a markedly slow pulse-wave it will be better corrected by lobelia than by any other drug. In fact the most prominent indication for lobelia is the full, oppressed, sluggish, doughy pulse. Associate this with praecordial oppression, thoracic pain, difficult breathing, soreness or bruised feeling within the chest, nausea with tongue heavily coated at the base, fullness of tissue, and we have before us a fair range of the action of the drug. It is a good remedy in cardiac congestion.

Lobelia is of specific value in obstetrical practice. It powerfully subdues muscular rigidity. It is one of the remedies to overcome a rigid os, during parturition, and at the same time it relaxes the perineal tissues, thus defending the parts against lacerations. This specific effect of lobelia has won many converts to specific medication. This it does when there is fullness of tissue—a thick, doughy, yet unyielding os uteri; when, however, the edge of the os is thin and closely drawn, sharp like a knife edge, full doses of gelsemium are indicated. For this antispasmodic action lobelia may be given in nauseant doses, preferably in hot water, by mouth and by rectum.

Lobelia is a stimulant to the sympathetic nervous system. It improves innervation of the parts supplied by both the pneumogastric and sympathetic nerves. The appetite and digestion are augmented by it and peristalsis of the whole gastro-intestinal tube greatly stimulated. All this it does best in small and repeated doses; and for these specific purposes it should be so employed and not for its nauseating and emetic effects, which it causes by pushing this stimulation to its limit. The conditions in which such violent and disturbing action is desired are sufficiently set forth above. Specific medication has proved that lobelia is indicated by the full, slow, labored, and doughy pulse, showing that the blood current moves with difficulty. Over the chest, and particularly in the praecordium there is a sense of oppression and weight and often a dull, heavy pain or soreness of an oppressive character and always associated with difficulty in breathing. Mucous rales in the bronchi are prominent and the cough is aggravating, but followed by free and full expectoration. The tongue is full, pallid, broad and flabby-expressionless, nausea is a common indication, and sick headache with nausea frequently encountered. The sympathetic and the vagus are always below par when lobelia is indicated. With any or several of these indications lobelia proves most valuable in the gastric and respiratory disorders named below. Even in this specific field comes partly its beneficent action in angina pectoris, though relaxation even to nausea apparently intensifies its ameliorating effects.

The small dose of lobelia is of distinct value in atonic types of indigestion and dyspepsia. In similar doses it may relieve sick headache due to gastric derangement, and is then indicated by a feeling of "qualmishness" and nausea. Though sometimes overlooked when we are seeking a drug to overcome intestinal atony, experience has proved lobelia, continued for some time in moderately small doses, to be one of the best agents at our command to gradually relieve habitual constipation. Rx Specific Medicine Lobelia, 1 or 2 drops, every 2 or 3 hours. This is accomplished by improving the innervation and peristalsis, and stimulating the secretions of the intestinal glands, as lobelia is in no sense a laxative in such doses. Administered with podophyllin and other cathartics it tends to prevent the after-constipative results that frequently follow the use of "bowel persuaders" when given in purgative amounts.

Lobelia is of value in common colds with a dry, irritative cough. It ranks with the best of antiasthmatics, and is equally serviceable in spasmodic asthma and in humid asthma, with scanty secretion in the first and over-secretion in the latter. In asthma, which is but a symptom of some grave body wrong, the urine should be examined for albumin, which, together with the asthmatic paroxysms, are sometimes the only early evidence pointing to nephritis. Nasal obstructions and deformities requiring removal by the nasal specialist should also be taken into account, as well as other causes for reflex excitation. With these absent lobelia is signally effective; it often fails in part or altogether when these abnormalities remain uncorrected. Lobelia is an equally certain remedy for the relief of spasmodic croup and the asthmatic form of acute laryngitis in children. In lobar pneumonia and in broncho-pneumonia it renders good service when there is much congestion and breathing is greatly oppressed. In chronic respiratory disorders it is valuable either to increase or decrease secretion, accordingly as the fuller or lesser doses are used, and to relieve cough. For coughs, when dry, barking, or hacking, or when loud mucous rales are heard, but there is difficulty in raising the sputum, lobelia may be employed alone, or in mixtures or syrups as indicated. For chronic coughs requiring lobelia a good form is the compound liniment of stillingia (which see), which contains the so-called oil of lobelia. For the cough of measles, when a sluggish circulation and imperfect eruption are factors, it proves useful in quieting the laryngeal irritation, controlling the catarrhal features, and more perfectly bringing out a tardy efflorescence. In both scarlet fever and measles, lobelia, by causing determination of blood to the skin, promotes the eruption when tardy and re-establishes it when retrocession occurs. It modifies many cases of whooping cough where abundant secretions of a stringy character almost strangle the sufferer. In short lobelia is a most admirable respiratory stimulant when the mucous membranes are dry, or when relaxed and secretion is free but difficult of expectoration. It should not be forgotten as one of the most valuable medicines in all stages of la grippe and epidemic influenza, as a vital stimulant, to regulate an imperfect circulation, and to control cough and expectoration. It is an admirable drug in post-grippal catarrhs, following the specific indications as given. Lobelia is seldom indicated, nor is it well borne, in advanced pulmonary tuberculosis.

It has been assumed by some that lobelia possesses the properties of an antitoxin in the sense that that term is now employed in biologic medication. This assumption we believe to be unwarranted without definite and exact biological experimentation. Such unsupported vagaries bring into discredit otherwise good and efficient drugs. That quite remarkable results have been obtained from its use in grave blood -disorganizing and specific diseases seem probable. But lobelia is essentially a vital stimulant, and this property, more than an antitoxic action as now understood, better explains its beneficent effect in diphtheria and other depressing septicaemic diseases.

Hypodermatic Use. For the so-called antitoxic and other general action, lobelia, hypodermatically administered, has come into prominent use in late years in many of the disorders for which the drug is given internally. In this manner the probability of nausea and vomiting is lessened, while its relaxant properties seem not to be diminished. In spasmodic asthma it sometimes gives prompt relief, and we have observed its effects most beneficially in gall-stone colic of a continuously nagging, though not very severe, type. We have also observed a remarkable increase of urine from the drug used in this way. To catalogue the conditions in which many have obtained asserted good effects would be to restate all the uses of lobelia given in this article, except that of emesis.

The subject of hypodermatic medication, involving a large number of vegetable medicines, has been purposely omitted from this work. The author is unalterably opposed to this too general practice because of the dangerous reactions that occur often enough to make one cautious. Thoughtless, and often unscrupulous, commercialism in medicine on the part of a few has brought about a demand from physicians for these hypodermatic forms of medicines, and to meet this demand reputable manufacturers of drugs have unwillingly yielded and have supplied a score or more of such preparations. Realizing that such preparations under the best of pharmacal care are liable to deleterious change or disintegration, or to the development of toxic material, the thoughtful manufacturer is unwilling to continue the supply of such drugs. Certain vegetable proteins may, and often do, become as obnoxious and dangerous as some animal proteins, and may produce allergic, or anaphylactic effects, as well as direct poisoning; and occasionally the most unhappy and near fatal consequences have resulted. Apparently lobelia and ergot are the safest of these preparations and they should not be recklessly or unnecessarily used, when other methods of medication may be just as effectually employed.

Acetous Emetic Tincture. Like the Compound Emetic Powder, this agent is now seldom employed as an emetic. On the contrary its reputation rests on its value as a remedy in coughs, colds, and broncho-pulmonic complaints. It is of service when the indications are present for both lobelia and sanguinaria. These drugs are more effective when tinctured with a certain proportion of vinegar, hence the superiority of this compound over the plain tinctures. Emetic tincture added to syrup will often render good service when a cough mixture for irritative cough, with deficient secretion, is desired. The dose of the tincture is from 20 to 60 drops.

RELATED MEDICINE.

Tobacco (Nicotiana Tabacum, Linné. and Nicotine. Tobacco was once used to a considerable extent upon painful inflammatory swellings and to relax strangulated hernia. It is seldom employed as a drug at the present day. When unaccustomed to its use in chewing and smoking it acts profoundly, causing vomiting and great depression; toleration is soon established. Nicotine is of toxicological interest chiefly, but rarely it is used to subdue pain. A solution of the combined alkaloids of tobacco, containing 1 per cent of nicotine, is on the market as Dynamyne, a preparation devised by Lloyd and Howe. It is a green-colored hydro-alcoholic liquid designed for external use only, a solution of 1 to 4 fluidrachms in a pint of water being applied by means of a compress upon localized inflammations, and to relieve the pains of neuralgia, pleurodynia, rheumatism, felons, abscesses, etc. Some persons are very susceptible to nicotine, hence this preparation must be used with great caution, and care should be had in handling or inhaling it. A combination of tobacco alkaloids is an ingredient of Libradol.


The Eclectic Materia Medica, Pharmacology and Therapeutics, 1922, was written by Harvey Wickes Felter, M.D.



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