A. W. JERNIGAN, M. D., EVENING SHADE, ARK.
Although we are all familiar with the history of the introduction of this drug into this country, and with the reports of the wonderful cures effected by it in the practice of Eclectics, I am sure that Crataegus has not received the attention it deserves from the profession.
The majority of the profession is still ignorant of the qualities of this remedy, and many whom I meet, socially and professionally, have never heard of it. The Eclectic materia medica is.rich in the abundance and variety of its resources. But while there are very few of our remedies that do not repay us for restudying them, I give it as my opinion that no remedy will more surely repay the observer for a careful, systematic study of its actions and uses, than Crataegus.
For the past three years I have used this drug extensively in many forms of cardiac troubles, functional and organic, acute and chronic, and with such gratifying results in most cases that I take this opportunity of presenting the conclusions formed from my observation of its action in my practice.
Clinical experience has convinced me that Crataegus is the peer of many so-called heart remedies, because:
- Its field of action is much broader than that of any other agent of this class.
- It has no cumulative effect.
- It is non-toxic.
- It acts in harmony with any other indicated heart remedy.
- It has no contra-indications.
In the study of drugs, we have always endeavored to ascertain as far as possible their specific action upon certain organs or parts of the body, and following this line of thought, to associate certain drugs with certain conditions.
Pursuing this method of study, we find that while Crataegus acts powerfully upon the heart, this is not its only field of usefulness.
My studies lead me to believe that Crataegus has a beneficial influence:
- Upon every part of the circulatory apparatus, from the heart to the smallest capillary.
- Upon the sympathetic nervous system.
- Upon the central nervous system, especially upon the pneumogastric nerve.
- Upon the urinary organs.
- Upon the processes of metabolism.
Upon the administration of Crataegus, the pulse is noticeably lessened, and the impulse strengthened. The lack of equilibrium between the heart beat and the blood pressure is restored, and there is no doubt of the importance of the relation of the action of the heart to vascular pressure. This is exemplified when the characteristic, rapid, feeble heart action is present which follows hemorrhage and shock, the heart being over-worked in its efforts to fill the depleted vessels.
Soon after beginning the use of Crataegus, the patient invariably experiences what has been described as a sense of well-being. All his gloomy forebodings are gone, and he feels that he has a new lease of life. And allow me to insist that this is not the least important action of the drug. If your patient would get well, he must think healthy thoughts. We are all familiar with the mischief wrought in our heart cases, by the patient's mental condition. Have you not seen one, when he thought no one saw, counting his own pulse, with an expression of despair upon his face? But all this is soon overcome by the action of Crataegus, which is due, I believe, to the influence of the drug upon the central and sympathetic nervous systems, as well as to the actual improvement in the condition of the circulatory apparatus.
In this respect, Crataegus acts much as does Pulsatilla, and the two agents may be prescribed in combination, with very good results. Especially is this combination valuable with neurasthenic girls with a functional heart trouble, and menstrual irregularities, where the influence of Crataegus is not to be overlooked by the observing physician. Whether the heart be feeble from organic lesion or functional distress, with or without effusion, its wonderful curative properties are apparent. The improved circulation, the unmistakable improvement in the condition of the blood vessels, show that the heart is not the only part of the circulatory system acted upon by the remedy. The appetite increases, assimilation and nutrition improve, showing its influence upon the sympathetic and upon the pneumogastric nerve; the diseased valves are repaired, the flabby, anemic heart is renewed, testifying to its influence upon waste and repair, and to the fact that the cells themselves feel its presence.
In all dropsical conditions, whether due to cardiac weakness or to some wrong of the kidneys, I have come to use Crataegus, associated with any other indicated remedy. It facilitates the action of Apocynum cannabinum in the albuminuria of pregnancy, with the consequent edema. Here I prescribe:
Sp. med. Apocynum cannabinum,
Sp. med. crataegus oxyacantha, aa fl. dr. ii
Syrup squills, q. s. ad fl. oz. iv
M. Sig. Take one teaspoonful every four hours during the day.
I have found Crataegus a valuable adjunct to the treatment of diabetes insipidus, especially when occurring in children.
Again, I believe that we have in this agent a most dependable remedy in the treatment of exophthalmic goitre. I am now treating a case of this malady which developed about one year ago. At the time the patient, a young woman of 23, very anemic, came to me, about three months ago, the symptoms were alarming. The pulse rate I40, vascular disturbance great, and dyspnea so great that the patient could not walk one hundred yards without great distress; the eyes were bright and bulging, and the thyroid enlarged to several times its normal size. About six months before coming to me, periodic seizures had developed, resembling those of epilepsy. During these convulsions, she would lose consciousness for several hours.
I gave her 10-drop doses of sp. med. Crataegus, two hours apart, for several days, with appropriate tonic treatment. I then increased the interval to four hours.
Since she came under my care she has not had a convulsion, and her general condition is greatly improved. Pulse rate is now about 90, quality good. The eyes seem to have regained their normal position. There is no dyspnea, and the thyroid itself is greatly reduced in size. It is of course too early to be sure of a cure in this case, but I believe that the results obtained will be permanent. A similar case, excepting the convulsions, treated two years ago, has had no return of the trouble.
In my practice I have found Crataegus to be a sheet anchor in the treatment of angina pectoris.
A case of the nocturnal form of this disease, of five years' standing, was cured by the use of this drug. This patient's condition was pitiable. He was 53 years of age, and a neurasthenic. He lived in constant fear that he would not live through another paroxysm. During the first day, I gave him 10-drop doses of specific medicine Crataegus every hour. The paroxysm that night was not so severe, and was soon relieved by full doses of specific medicine Lobelia.
I continued the Crataegus, gradually lengthening the interval. The patient's condition continued to improve, and at the end of the second week, the heart pang seemed to be gone for good. But I had him continue the remedy in 10-drop doses, three times per day, for three months. Two years have now elapsed since the treatment was discontinued, and there has been no return of the difficulty.
I would not neglect to mention, however, that in this case, as should be done in every case, careful attention was given to the habits of the patient, and that other indicated remedies were not forgotten.
Here again, let me emphasize the fact that any other indicated remedy may be prescribed in conjunction or alternation with Crataegus. The indications should all be studied, and our medication directed toward the relief of the abnormal condition of which the symptoms are but the expression.
If there is any division of cardiac difficulties in which Crataegus acts more powerfully or promptly than another remedy, it is in endocarditis, and the subsequent valvular incompetency. To be able to appreciate fully the remarkable results following its administration in these conditions, you must have watched a patient whom YOU would expect to fill an early grave, under any other treatment, coming back to health with the cleaning up of the entire pathological condition. The following case in practice illustrates the action of Crataegus in the conditions just named.
On Jan. 17, 1906, I was called seven miles into the country by a farmer, to attend his daughter, aged 14. I found the patient suffering from inflammatory rheumatism, complicated with a severe case of chorea. The rheumatism affected the right hip, knees and ankles. There was great tenderness and swelling in these joints, and the pain occasioned by the spasmodic action of the limbs, induced by the chorea, was distressing. The patient was anemic and restless, temperature 103.8° F., pulse rate 135. There was considerable dyspnea, and she preferred to lie with head and shoulders elevated. The lower limbs were edematous.
The family history showed tuberculosis, a maternal uncle and an aunt having died with this disease. No history of venereal complications. Upon questioning the family, I learned that the patient had had two previous attacks of inflammatory rheumatism, and one of chorea, all within the past three years.
The strained, frightened expression of countenance caused me to think of cardiac lesion, even before I had felt the pulse. After examination I diagnosed an endocarditis with mitral incompetency and regurgitation, the mitral sound being very distinct. The bowels were constipated, the urine scant and highly acid. I gave:
Sodium salicylate, oz. ss
Sp. med. Apocynum cannabinum, fl. drs. ii
Aromatic elixir, q. s., ad. fl. ozs. iv
M. et Sig. One teaspoonful every four hours.
Also the following:
Sp. med Gelsemium, gtt. xx
Sp. med. Macrotys, fl. dr. i
Sp. med. Crataegus, fl. drs. ii
Sp. med. Pulsatilla, fl. dr. ss
Aqua, q. s. ad. fl. ozs. iv
M. et Sig. One teaspoonful every hour
For the constipation I gave small doses of Rhamnus purshiana, three times per day. I applied libradol to the affected joints, and gave directions concerning the diet.
On the 19th, her condition was greatly improved. The spasmodic action of the muscles was much less severe, and the patient was resting well, with kidneys acting freely, and bowels loose, but no diarrhea. Temperature 100.2° F.; pulse rate 110. With some slight alterations I continued this treatment until the 21st, when I found the patient still improving, with temperature normal, pulse go, no pain and but little swelling in the joints, and but little evidence of the St. Vitus's dance. I then gave the following:
Sp. med. Crataegus oxyacantha, fl. drs. iii
Sp. med. Macrotys, fl. drs. ii
Sp. med. Pulsatilla, fl. dr. i
Aqua, q. s. ad fl. oz. iv
M. et Sig. One teaspoonful every three hours. Also:
Iron by hydrogen, fl. dr. i
Ft. capsules, No. xx
Sig. One capsule every four hours.
Not thinking it necessary to see her again, I explained to the father the condition of the heart, instructing him to come for more medicine as soon as the supply on hand was used. But by the time the medicine was taken, she had improved so much that he failed to return, and I heard nothing from her until March 29, when I was again summoned.
I found great dyspnea, lower limbs very edematous, pulse rate 145 and very feeble, irregular and tremulous, temperature 100, with mitral sound distinct, though the other heart sounds were muffled by a hydropericardium which was now present. The evidence of pulmonary congestion had increased apace, and a troublesome cough, with an expectoration of thick mucus streaked with blood, was now present.
The patient could remain in the recumbent position but a few moments at a time. She was hysterical, the voice shrill and bleating, and the expression of the face and eyes was one of fear and distress.
The evidences of sepsis present led me to believe that the endocarditis had now reached a suppurative stage, and for this reason I incorporated Echinacea and calcium sulphide into my treatment, which was, now as follows:
Sp. med. Echinacea angustifolium,
Sp. med. Crataegus oxyacantha, aa fl. drs. ii
Sp. med. Aconite, gtt. vi
Sp. med. Pulsatilla, fl. dr. ss
Aqua pura, q. s. ad fl. ozs. iv
M. et Sig. One teaspoonful every hour. Also:
Sp. med. Convallaria, fl. dr. i
Sp. med. Apocynum, fl. dr. i
Syrup Scillae, fl. ozs. iv
M. et Sig. One teaspoonful every three hours. Then:
Calcium sulphide, dr. ss
Iron by hydrogen, fl. drs. ii
Ft. capsules, No. xx
Sig. One capsule every four hours.
I saw her again on March 31, when I found her more comfortable, with condition seemingly improved. My prognosis was unfavorable, however, and on April 3 the family called a regular physician of some years' experience, to meet me in consultation.
I could see still further improvement in her condition, but the consulting physician told the family there was no possible chance for her recovery, that no doctor could do her any good. This of course greatly distressed them, and on the next morning, April 4, I was notified that the case had been turned over to another physician. On the evening of this date I saw at the local drug store two prescriptions for the girl, one calling for strychnine and atropine, and the other for digitalis. I made a mental note of this, and waited.
I heard nothing more until April 16, when the father telephoned me to come at once. The physician who had been called in my stead had given up the case, and the girl was now dying.
There was no perceptible, radial impulse, and there was a faint flutter instead of a heart beat. The breathing was labored and very shallow, owing to the extreme anasarca now present. The skin was greatly cyanosed, and the extremities cold.
I gave immediately a hypodermic injection of 10 drops of specific medicine Crataegus, and repeated it every thirty minutes until four doses had been given. I could then feel the pulse at the wrist, and she began to show signs of returning consciousness. I lengthened the intervals of the injection to one hour, for three hours, when she was able to swallow. I then gave the following:
Sp. med. Crataegus, fl. oz. ss
Sp. med. Convallaria, fl. drs. ii
Sp. med. Apocynum, fl. dr. i
Aqua, q. s. ad, fl. ozs. iv
M. et Sig. One teaspoonful every three hours.
The patient's improvement was indeed remarkable, and, to the family, seemed little less than miraculous.
After a few days, I discontinued the Apocynum, and added Echinacea to the treatment. I also gave the combination of iron and calcium sulphide given above. I administered the Apocynum at intervals, as the gastro-intestinal irritation admitted, for three weeks, at which time there was no edema or anasarca present. At this time I discontinued all the medication except Crataegus and the above mentioned combination of iron and calcium sulphide, which was continued for one month.
On April 28 she could walk about the premises. She continued taking Crataegus in 10-drop doses, before meals and at bed time, until some time in the month of September. Today, the girl is strong and well, with no signs of valvular disease, or of other cardiac lesion. As far as I am able to discover, she has a perfectly sound heart—thanks to specific medication, and to the wonderful curative properties of Crataegus oxyacantha.
It is results that we seek, and one clinical fact is more valuable than ninety and nine fine-spun theories.
COMMENT: This is the first case in which I have known Crataegus to be given hypodermically and although other remedies were afterward given the immediate restorative effect must be attributed to this remedy, and it looks as if the general improvement was due to its influence. This is certainly an important report and adds some important facts to our rather meager knowledge of this remedy. I have always felt that it had an important place when that place was determined.
Ellingwood's Therapeutist, Vol. 3, 1909, was edited by Finley Ellingwood M.D.