Strophanthus: A Clinical Study. 
BY 
REYNOLD W. WILCOX, M D., LL.D., 
PROFESSOR OF MEDICINE AND THERAPEUTICS AT THE NEW YORK POST-GRADUATE 
MEDICAL SCHOOL AND HOSPITAL ; PHYSICIAN TO ST. MARK’S HOSPITAL. 
FROM 
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 
May, 1897. Extracted from The American Journal of the Medical Sciences, May, 1897. 
STROPHANTHUS: A CLINICAL STUDY.1 
By Reynold W. Wilcox, M.D., LL.D., 
PROFESSOR OF MEDICINE AND THERAPEUTICS AT THE NEW YORK POST-GRADUATE MEDICAL. 
SCHOOL AND HOSPITAL ; PHYSICIAN TO ST. MARK’S HOSPITAL. 
During the years in which I have made use of the tincture of stro- 
phanthus I have frequently noticed that failures to obtain clinical 
results have repeatedly occurred. This experience is similar to that of 
other practitioners if we may accept the reports to be true which are 
found in current medical literature. In addition I have observed the 
very large doses which have been given without appreciable effect; these 
doses were certainly improper, in view of the brilliant results which 
often follow the administration of small or even moderate ones. Some 
months ago, on reviewing the literature, I was very strongly impressed 
by the discordant reports of observers whose position and training 
entitle their published observations to be seriously considered. In view 
of these facts the conclusion seems to be unavoidable that the source of 
the pharmaceutical preparations must be various. Faulty methods in 
drug preparation can be excluded, for in my earlier studies care was 
exercised that reliable tinctures only should be employed. With the 
intention of clearing up some of the inconsistencies, to say nothing of 
the contradictions, I have undertaken this study from the standpoint 
of the clinician, hoping to establish for the tincture, from a particular 
drug source, a practical working basis. From what I can learn I have 
come to the opinion that the so-called Strophanthus hispidus, variety 
Kombe, of the Pharmacopoeia is not a variety, but a distinct species. 
In the following observations I have made use of a 5 per cent, tincture, 
prepared according to the United States Pharmacopoeia from stro- 
phanthus (Kombe). In order that I might eliminate errors of pharma- 
ceutical manipulation I have employed the tincture of strophanthus 
(Kombe) made especially for me by Parke, Davis & Company. For 
the drug which I have used I claim nothing further than that it is 
made from selected material by an expert pharmaceutical chemist. I 
have chosen clinical observation because of the rather scanty litera- 
ture based upon sphygmographic work. Upon this species (Kombe) 
alone it is my intention to report, reserving for another occasion the 
presentation of similar studies upon what I believe to be four abso- 
lutely independent species of strophanthus. 
After considerable experience with both Marey’s and Pond’s sphyg- 
1 Read before the Medical Society of the State of New York, at Albany, January 27, 1897. 2 
WILCOX: STEOPHAXTHUS. 
mograph I have finally settled upon the use of Dudgeon’s instrument 
as the one most practicable for the practitioner, and this has been 
exclusively employed in making the tracings for this study. The least 
pressure consistent with the production of a characteristic tracing has 
been used, and tracings presenting any suspicion of undue weighting, 
as rounded apices, have been rejected and a second tracing made. It 
is only fair to state that many of the patients had been treated, some 
for many years, with digitalis and similar drugs, and that all presented 
lesions giving rise to symptoms of marked severity. My purpose has 
been not to demonstrate that this particular preparation is one to be 
administered as a routine prescription, but rather to ascertain the 
dosage, to find out the real effects of administration, and to point out 
the advantages of its use when employed in a judicious manner. Inci- 
dentally, as will appear later, it will be shown to possess certain 
advantages over other drugs in relieving positive, well-marked patho- 
logical conditions. 
The physiological action of strophanthus has been thoroughly worked 
out by Fraser and Delsaux. Its field of action is especially upon car- 
diac muscular fibre, and this action is marked. Therefore we should 
expect an energetic cardiac systole, and secondarily a slower pulse-rate. 
As a consequence of a slower and more perfect systole, an irregularity 
of rhythm previously existing becomes lessened. There is but little 
change in the calibre of the bloodvessels. It possesses a diuretic action 
under limitations; that is to say, it is diuretic so far as increased blood- 
tension causes a larger amount of urine to be excreted. 
Clinically its action has been reported upon by many observers, and 
with a great lack of uniformity as to their conclusions. To mention 
only those whose published records are readily accessible, I would cite 
Fraser, Paschkis and Zerner, Corville, Egasse, Porteous, Lemoine, 
Drasche, Frankel, Purdy, Helbing, Bahadhurje, Dana, Denian, Ham- 
mond, Gley, Quinlan, Aulde, Mays, Budd, Pins, Hochaus, Wadleigh, 
Evans, Robinson, Hutchinson, Ferguson, and Yount. 
Its therapeutic field of usefulness can be ascertained from the follow- 
ing facts : (1) it acts directly upon cardiac muscle (Fraser, Yeo, Biddle, 
Potter) ; (2) it has little or no influence upon the calibre of the blood- 
vessels (Fraser, Delsaux, Yeo) ; (3) it acts but temporarily upon the 
innervation of the heart (Hayem), if at all; (4) it is diuretic (Fraser, 
Delsaux, Porteous) in certain cases (Yeo), particularly those in which 
the previously existing blood-pressure is low (Budd) ; (5) it is a bitter 
stomachic (White), and in moderate doses does not disturb digestion 
(Budd), and it relaxes the bowels (Porteous); (6) it is antipyretic (Pot- 
ter, Rovighi, but denied by Martini) within limited range, because 
under its administration the consumption of oxygen is smaller and the 
processes of combustion are depressed (Bartholow); (7) since its active WILCOX: STROPHAXTHUS. 
3 
principle is soluble in less than its own weight of water, it possesses the 
diffusibility of a soluble crystalloid (Fraser), hence the prompt results 
from its administration; its active principle escapes with the urine 
(Wood), so that we have also ready elimination (Butler), although 
somewhat slower than its absorption, and therefore an overlapping of 
effect from too frequently repeated doses (Bartholow) ; (8) habit does not 
seem to impair the therapeutic usefulness of the drug (Farquaharson). 
The therapeutic indications are, then : (1) Rapidly recurring cardiac 
systoles of lessened force and irregular rhythm. We get then, first, a 
more vigorous contraction of the ventricle, with a slowing of the pulse- 
rate and consequently a lengthening of the diastole, which is the period 
of rest for the heart; next comes the disappearance of irregularity of 
rhythm; and lastly, from improved intracardiac nutrition, a permanent 
strengthening of the heart-muscle. (2) The absence of vasomotor effects 
enables us to use this remedy in those instances of permanent high ten- 
sion which are met with in some forms of Bright’s disease, in arterio- 
sclerosis, and in the rigid arteries of the aged. (3) Whenever diuresis 
can be promoted by increased blood-tension resulting from more vig- 
orous cardiac contractions this may be expected from the use of this 
remedy. (4) The rapidly appearing effects of its administration, together 
with its regular elimination, make it the drug of choice when the symp- 
toms are urgent. (5) The absence of digestive disturbances from thera- 
peutic doses and slight likelihood of habituation to its administration 
make it important when long-continued use is necessary. 
The instances in which failure will follow its administration are those 
of (1) advanced degeneration of the myocardium (Fraser, Quinlan) ; 
(2) extreme mechanical obstruction to the circulation from valvular in- 
competency or obstruction; and (3) a combination of these. Balfour 
does not find the remedy useful in the aged. When we remember that 
arterial degenerations are extremely common in advanced life, I am of 
the opinion that Balfour is in error, at least so far as the use of moder- 
ate doses is concerned. It goes without saying that in fully compen- 
sated hearts this—as well as other drugs of the same type—is unneces- 
sary, and when over-compensation exists it will likely aggravate the 
condition. I am thoroughly in accord with Hare in acknowledging 
its great value in the cardiac diseases of children. In addition, in cor- 
pulent individuals we obtain most excellent results. Of especial impor- 
tance we should consider its administration for the weak hearts of anaemia 
and chlorosis, in order that nutrition may be improved ; for the so-called 
irritable hearts, where the pain and palpitation are relieved; for the 
debilitated hearts, associated with dyspeptic symptoms and particularly 
flatulence, which usually disappears; and in the aged, where vertigo is 
the result of cerebral anaemia. 
Sphygmographic tracings have been used to demonstrate the results 4 
WILCOX: STROPHANTHUS. 
of the administration of this drug by but comparatively few observers, 
among whom may be cited See and Gley, Paschkis and Zerner (two 
cases), Denian (six cases), and Fraser (five cases). 
In general, it may be stated that within an hour the pulse visibly 
strengthened, the line of ascension, from being nearly horizontal, 
approached the vertical, the line of descent suddenly fell, the dicrotic 
wave disappeared, and the irregularities and inequalities were almost 
always overcome. Nor is this a temporary effect, as is shown by the 
permanence of the results upon continuation of the same or lessened 
dose, as may be seen in the following tracings made at intervals and 
extended over a considerable period of time. 
Case I.—Mrs. H., aged thirty-five years, married eight years, the 
mother of two children, came to me October 27, 1896, complaining of 
constant dyspnoea, severe pain in left chest, fainting upon several occa- 
sions, and distress after eating. She had had all of the infantile dis- 
eases, but no severe illness excepting severe polyarticular rheumatism 
ten years ago, from which she had practically recovered. For the past 
two years she had been failing in health, and in addition to the above 
symptoms she had complained of severe backache, bearing-down pains, 
vaginal discharge, irritability of the bladder, profuse and painful men- 
struation, for which she had been treated by a gynecologist of promi- 
nence for many months with but slight relief. On physical examination 
a rather obese woman with dusky skin and cyanotic lips presented herself. 
The apex-beat was in the sixth interspace, diffuse, and only located by 
the stethoscope in the mammillary line. At the apex was heard a soft, 
blowing murmur, coincident with the ventricular systole; at the second 
right costal cartilage were heard two murmurs : one harsh, with the ven- 
tricular systole, the other soft, replacing in part the aortic second sound, 
occurring with the ventricular diastole. The first cardiac sound as heard 
at the apex was of higher pitch, shortened, and distinctly weakened ; 
the pulmonic second sound was accentuated. The liver was sensitive 
to the touch and distinctly below the free border of the ribs. At both 
bases of the lungs posteriorly there were a dull percussion-note and many 
crepitant rales. The urine was of a specific gravity of 1025, containing 
a trace of albumin, a few hyaline casts, and increased earthy phosphates. 
The abdomen was distended, tympanitic on percussion, and sensitive on 
palpation. The diagnosis of the cardiac condition was mitral insuffi- 
ciency, aortic obstruction and insufficiency, with dilatation of the left 
ventricle. The pulse-tracing is as follows : 
Fir. 1. 
The tincture of strophanthus, hereafter in this paper simply termed 
“ strophanthus,” in dose of four drops dissolved in a wineglass of water, 
was directed to be taken after each meal. WILCOX! STROPHANTHUS. 
5 
November 3. The patient states that the dyspnoea has been markedly 
relieved during the past four days, and that the dyspeptic symptoms 
have improved. 
One week later improvement in the symptoms referable to the genital 
organs was marked, although no local treatment had been carried out. 
17th. She reports that for the first week in two years she has been 
free from chest-pain and that her appetite is excellent. The passive 
renal congestion had disappeared, and the liver was no longer sensitive. 
24th. The abdominal symptoms were much benefited and dyspnoea 
appears only on ascending stairs. 
December 1. As the patient was on her way to my office she became 
very much alarmed at a street accident, but was positive that the palpi- 
tation was much less than on former occasions with less cause. 
12th. All symptoms were so much improved that the patient again 
had resumed her social duties. 
Fig. 2. 
22d. Owing to the fact that the patient has been busily engaged in 
going about town, she has not improved, but has at least retained her 
previous improvement. 
29th. To-day the report is decidedly favorable, there having been less 
backache and no dyspeptic symptoms. 
January 5, 1897. Owing to mistake, the patient has received ten 
drops of tincture of digitalis in place of the strophanthus. The old 
symptoms have returned, especially the dyspnoea. Four drops of stro- 
phanthus are now to be taken thrice daily. 
12th. The patient is in excellent condition. The signs of ventricular 
dilatation have now disappeared, and the first sound is now loud. 
The pulmonic second sound is normal and compensation is now estab- 
lished. 
Case II.—Mr. INI., merchant, aged fifty-two years, consulted me on 
October 27 for increasing weakness, fatigue on slight exertion, with 
breathlessness and prsecordial distress, of six months’ duration. He 
was a small, pale, and slightly built man of quick, nervous move- 
ments. On examination I found that the percussion outlines of the 
heart were increased by two finger-breadths downward and to the left, and 
that there was marked intercostal retraction on cardiac systole. Over 
the whole of the cardiac area was heard a rough crepitation with both 
ventricular systole and diastole. At the apex, coincidentally with the 
impact of the apex against the chest-wall and at its site, was heard a 
soft, blowing murmur. At the aortic cartilage was heard a ventricular 
systolic murmur, somewhat harsh in character, which was transmitted 
upward to the root of the neck. The condition was believed to be an 
adhesive pericarditis, with secondary ventricular dilatation and thick- 
ened aortic valves consecutive to degeneration of the aortic intima. ' 
Five drops of strophanthus, thrice daily, were administered, with the 6 
WILCOX: STROPHANTHUS. 
result that the dyspnoea was markedly relieved when he reported on the 
6th of the following month. 
21tli. He stated that he had been able to perform much more work 
without fatigue, and that this pain in the chest was entirely relieved. 
December 10. In addition to his treatment, which had been faith- 
fully carried out, he was directed to make use of a claret-glass of Bur- 
gundy with each meal. His color was good, his eyes bright, and he felt 
as well as before his illness. 
Fig. 3. 
Fig. 4. 
January 10, 1897. The patient is no longer troubled with dyspnoea, 
and since the last report has attended to his business without unusual 
fatigue. The cardiac area is but a finger’s-breadth lower than normal 
and the heart-sounds are of good volume. 
Case III.—Miss A., aged thirty-eight years, suffered from rheumatic 
fever thirty years ago. For many years she had been prostrated by 
headaches, which occurred at intervals varying from one to six weeks, 
which often kept her in bed for twelve to thirty-six hours. She had 
always suffered from palpitation, dyspnoea, various dyspeptic symptoms, 
and general nervousness, which had been treated by various physicians, 
some of prominence, with but temporary relief. Three years ago hyper- 
opic astigmatism was discovered and corrected, and rest in bed with 
appropriate medication and diet for four months insisted upon. As a 
result, compensation was established, and for the first time in her life 
she was able to perform her social duties without headaches or other 
annoying symptoms. On November 20th, after a series of visits to 
various summer-resorts, she consulted me for the relief of intestinal 
symptoms which had persisted for several months. Of the marked 
physical signs which were present before her treatment three years ago 
none remained save the enlargement of the area of cardiac dulness to 
the left and downward for one and one-half inches, and a harsh, ven- 
tricular systolic murmur at the aortic cartilage, and at the same place 
a ventricular diastolic murmur, which, although not replacing the 
dulled second sound, was fairly rough in character. The first sound 
was by no means so loud, prolonged, or booming in quality as at the 
close of her prolonged stay in bed. Beyond abdominal tenderness and 
distention there were no physical signs in connection with the diarrhoea. 
Fig. 5. 
Four drops of strophanthus, thrice daily, were ordered and five grains 
of bismuth naphtolate after meals. WILCOX: STROPHANTHUS. 
7 
November 28. The intestinal symptoms have entirely disappeared 
and the patient can endure more fatigue. 
December 6. On coming to my office after a fatiguing morning of 
shopping she said that she felt dizzy, nauseated, and that her heart 
palpitated. 
The dose of strophanthus was now increased to five drops and caution 
as to overfatigue enjoined. 
16th. Since the last report, although shopping has been persisted 
in, the patient feels well. 
20th. The improvement still continues, the only complaint being dys- 
peptic symptoms following too frequent and elaborate dinners. 
2Oth. The dyspeptic symptoms are now relieved. The first sound is 
lengthened, louder, and booming in character. The apex-beat is now 
vigorous and the first sound has regained its former loudness. 
Fig. 6. 
Case IV.—Miss D., aged twenty-two years, was under my care for 
several months at the age of sixteen, suffering from diabetes mellitus, 
which had persisted for three months before coming under my treatment. 
Although at the outset the sugar was from 4 to 6 per cent, in amount 
and the patient markedly emaciated, yet it disappeared within ten 
months, and, with the exception of two occasions of unusual dietary 
indiscretion, it has never since been found. The patient has regained 
her flesh and spirits, and indulges in a fair amount of starchy and a 
limited quantity of sweet food. At times, however, she has suffered 
from palpitation, cardiac distress, and suffocation, and these attacks are 
generally justly attributable to fatigue, mental disturbance, or dietary 
follies. The underlying physical cause is undoubtedly the degeneration 
of myocardium, which so generally accompanies saccharine diabetes and 
so frequently contributes to the fatal termination. On November 5th 
Fig. 7. 
the patient complained of the above symptoms, due on this occasion to 
excessive fatigue. Beyond tenderness on pressure over the right hypo- 
chondrium, and a slight, soft, blowing, ventricular systolic murmur, 
heard loudest at the apex, nothing definite was found. This tracing is 
unsatisfactory, as are the others, because of a deep-lying radial artery in 
a small wrist. 8 
WILCOX: STROPHANTHUS. 
Two drops of strophanthus, thrice daily, were ordered and a moder- 
ately strict diet, with confinement to the house, was recommended. 
One week later the amount of the drug was increased to three drops 
at each dose and considerable improvement noticed. 
December 7. The patient is again in her usual health and attends 
to her numerous social duties. 
loth. The strophanthus is now diminished to two drops, and there has 
been no palpitation nor suffocative sensations. 
Fig. 8. 
January 4, 1897. There has been no cardiac distress since last report. 
The murmur has now entirely disappeared, and the dilatation of the 
left ventricle relieved. The patient is in excellent spirits and claims to 
be entirely relieved of her symptoms. 
Case V.—Mrs. B., aged sixty-five years, has been dyspnceic on exer- 
tion for several years and unable to walk but a short distance and not 
at all in a strong wind. On November 25, 1896, when I first saw her, 
she was confined to her bed, unable to lie down, coughing almost inces- 
santly and panting for breath. On physical examination I found cyan- 
otic lips, swollen feet and ankles, and general emaciation. At the apex, 
which was displaced downward and to the left, was heard a loud, blow- 
ing murmur, synchronous with the impact of the apex against the chest- 
wall ; the pulmonic second sound was accentuated ; besides dulness from 
the angle of the scapula downward there was a large number of moist 
rales of various sorts and sizes. The tongue was extremely foul and 
heavily coated. The expectoration was profuse, in yellowish, discrete 
masses and in much liquid. 
Fig. 9. 
I administered six drops of strophanthus every six hours and one 
one-hundredth of a grain of glonoin every two hours. Great relief 
followed, and after a few nights she was able to lie down. 
December 1. The general condition has markedly improved; sleep 
is possible for two or three hours at a time, and the appetite has 
increased slightly. 
The glonoin is now omitted and the strophanthus diminished to three 
doses per diem. 
7th. It was noted that the amount of expectoration had still further WILCOX: STROPHANTHUS. 
9 
diminished and that it was less purulent. The tongue still remains 
coated in spite of various local treatment. Aqua chlori (U. S. Ph., 
1890), in drachm doses ivell diluted, every two hours was now ordered. 
Fig. 10. 
25th. The tongue is now clean; all symptoms of oedema have disap- 
peared. The chlorine-water is now omitted. The patient sleeps for 
four or five hours without cough and the expectoration has become less 
in amount. 
January 12,1897. The dyspnoea is noticeable only on ascending stairs 
and all symptoms of pulmonary and alimentary congestion have disap- 
peared. The apex is still displaced to the left, but the heart-sounds are 
distinctly louder. 
Fig. 11. 
Case VI.—Mrs. H. B., aged thirty-five years, during the past year 
has undergone great mental and physical strain. She complains of feel- 
ings of suffocation, stabbing pains in the left chest, shortness of breath, 
palpitation on exertion, and general nervousness. Within the past 
two years she has grown quite stout. Further questioning elicited the 
history of various dyspeptic symptoms and that profuse menstruation 
had resulted in considerable prostration at the time of her periods. 
December 1st it was found that the apex-beat was slightly moved to the 
left; at its site was distinctly heard a ventricular systolic murmur ; there 
was also a faint murmur heard, at the same period of the cardiac revo- 
lution, at the aortic cartilage, and there was an accentuation of the 
pulmonic second sound. The feet were slightly oedematous, the lips of 
good color, but there are no pulmonary signs. 
Fig. 12. 
Four drops of strophanthus were ordered and the patient enjoined to 
remain recumbent during the menstrual epoch. 
December 8. There has been considerable improvement in the palpi- 
tation and general nervousness, the thoracic pain is less, but the breath- 10 
WILCOX: STROPHANTHUS. 
lessness still continues. For the past three days, during menstruation, 
she has remained in bed, and the flow is diminished. 
29th. The dyspnoea still continues, although the palpitation and 
nervousness are better than at last report. 
January 6, 1897. The dyspnoea has markedly improved and the pal- 
pitation and nervousness have disappeared. The murmur at the apex 
is no longer heard and the pulmonic second sound is normal. 
Fig. 13. 
Case VII.—Miss A., aged twenty-four years, a subject of chronic 
bronchitis with acute exacerbations ; there is also found a pleuritic adhe- 
sion at the right base behind. She has suffered for several years from 
palpitation on excitement or on exertion, faintness and excessive ner- 
vousness and fatigue easily induced. On November 19 she was exces- 
sively pale as to lips and tongue. Her fingers showed enlarged joints. 
The abdomen was tympanitic, tender to pressure over stomach, and she 
then spoke of the distress and expulsion of gas, which generally occurred 
about two hours after each meal. There was found no increase of car- 
diac dulness. At the aortic cartilage, coincident with the ventricular 
systole, there was heard a short but harsh murmur; at the apex at the 
same time was found a faint, dull murmur transmitted upward into the 
third interspace. The examination of the urine showed a specific gravity 
of 1026, excess of urates and chlorides, but no sugar, albumin, peptones, 
nor bile. 
Fig. 14. 
Three drops of strophanthus were ordered to be taken after each meal 
and two drachms of sodium phosphate on rising in the morning. 
Fig. 15. 
December 6. The palpitation and nervousness have improved. The 
dyspeptic symptoms have lessened, and she has borne more than usual 
fatigue without lasting exhaustion. WILCOX: STROPHANTHUS. 
11 
16th. There are no longer dyspeptic symptoms or signs. The apicial 
murmur is not heard, while in addition the heart-sounds are louder and 
approaching the normal in quality. 
30th. The improvement continues, and it seems fair to conclude that 
the amemia was consequent to the circulatory disturbances. 
Case VIII.—Mrs. T., aged forty-five years, has suffered from dysp- 
noea for about ten years. She also complains of palpitation, pain in 
back of head, swelling of feet, belching of gas, distention of stomach, 
and wandering abdominal pains about two hours after eating. During 
the past year she gained considerably while at rest and under a meat 
diet and appropriate treatment. This gain, however, was lost during 
a month’s sojourn in Switzerland last summer. When seen on No- 
vember 2, shortly after her return from Europe, she was intensely 
dyspnoeic, lips purplish, and suffering from palpitation with considerable 
prsecordial distress. The apex-beat was indistinct, and, on account of 
adipose tissue, difficult to locate. There was heard at its supposed site, 
coincident with the first sound, a very faint murmur. The sound pro- 
duced by closure of the aortic valves was not sharp nor distinct. There 
was distinct tenderness upon pressure over the liver, which was appar- 
ently enlarged. The feet and ankles were swollen, especially on the left 
side. The urine contained a trace of albumin and peptones, was of a 
specific gravity of 1026, with increased phosphates. 
Fig. 16. 
Four drops of strophanthus were ordered to be taken after each meal, 
a meat-diet prescribed, two drachms of sodium phosphate to be given 
upon rising, and freedom from her social duties enjoined. 
17 th. It was reported that headache at base of brain was severe on 
rising in the morning, but that the swelling of the feet had disappeared. 
The strophanthus was now increased to five drops, thrice daily. 
22d. The tenderness over the liver was absent, the dyspeptic symp- 
toms markedly ameliorated, and palpitation has only been present upon 
unusual exertion. 
December 15. The dyspnoea is steadily improving and the cyanotic 
lips are now normal. The apex-beat is more distinct and felt with less 
difficulty. 
Fro. 17. 
18th. Within the past three days unusual demands upon the patient’s 
strength have been made and have been met without losing ground. 12 
WILCOX: STROPHANTHUS. 
January 6, 1897. The improvement still continues and the dyspeptic 
symptoms are completely relieved. The headache has entirely disap- 
peared. The murmur formerly heard at the apex is absent and the 
aortic second sound sharp and distinct. 
Case IX.—Mr. H., superintendent, aged forty-five years, generally 
well, began to lose flesh rapidly as early as February of this year. With 
this he became breathless, suffered from fainting sensations, headaches, 
trembling, and generally was unable to attend to his responsible duties. 
During the summer he took a five months’ complete rest in the country, 
regained about one-half of the flesh lost, and became more cheerful. 
On November 1 he was noticeably thin in flesh, but with excellent 
digestion. There was no swelling of the feet or signs referable to 
the digestive tract. The apex-beat was diffused, displaced outward 
and in the sixth intercostal space. At the apex and synchronously 
with its impact is heard a loud, rough murmur; at the same point is 
heard, with the auricular systole, a harsh murmur shading into the 
former. The pulmonic second sound is somewhat accentuated; there 
is nothing noticeable about the aortic. 
Fig. 18. 
Three drops of strophanthus are directed to be taken after each meal 
and the importance of a full diet insisted upon. Care in ascending 
stairs and the avoidance of undue exertion were regarded as important. 
November 14. There is a fair gain of weight, and faintness has not 
been noticed. The headaches and trembling are lessened. 
December 13. He has attended to all of his daily duties during the 
past month and declares that the palpitation is absent. The pulmonic 
second sound is less accentuated, while the first sound has much im- 
proved. 
January 3, 1897. The patient is now able to ascend stairs with com- 
fort, attend to his daily duties, and is steadily regaining his customary 
weight. The murmurs still persist and the first sound is now loud, pro- 
longed, and booming. 
Fig. 19. 
Case X.—Mrs. C., aged fifty-two years, has been increasing in weight 
for six years. With this she has found difficulty in getting sufficient 
exercise, and for the past year her feet have been constantly swollen. 
Besides she complains of gaseous eructations, obstinate constipation, 
and that she no longer has any ambition. On November 7th the apex- WILCOX: STROPHANTHUS. 
13 
beat was found to be in the sixth interspace, diffused, and weak. At 
this point was heard a rough, blowing, auricular systolic murmur. At 
the aortic cartilage the valve closure was indistinct; the pulmonic second 
sound is accentuated. In addition to the oedema of the feet there 
was marked swelling of the hands and face. The urine was thirty-four 
ounces in quantity, of a specific gravity of 1027, with increased urea, 
alkaline phosphates and sulphates. 
Fig. 20. 
Foul' drops of strophanthus were directed to be taken three times 
daily, with live grains of taka-diastase after each meal. 
16th. It was noted that the oedema had entirely disappeared, the dys- 
peptic symptoms were noticeably better, and the patient was enabled to 
take some exercise. 
December 16. The intestinal symptoms having disappeared, the diastase 
was omitted. The strophanthus was reduced to three drops, and the 
patient is more energetic. 
Fig. 21. 
January 11, 1897. The apex-beat is stronger and the pulmonic second 
sound no longer accentuated. She asserts that she is in her former 
health and accustomed spirits. 
Case XI.—Miss E. F., aged forty-two years, has suffered from vague 
thoracic pains for several years, persistent headaches, palpitation on 
exertion, and attacks of unconsciousness. She is pale, of slight build, 
and thin. Upon physical examination, October 7, there was but little 
to be found excepting trembling on exertion, apex-beat weak, but in 
normal position, and a soft, ventricular systolic murmur, heard loudest 
at the apex. 
Fig. 22. 
Two drops of strophanthus were directed to be taken thrice daily, a 
generous diet, and moderate outdoor exercise each day. 14 
WILCOX: STROPHANTHUS. 
17th. There was less complaint of palpitation, lessened headaches, and 
an improved appetite. The outdoor exercise has been continued every 
fair day, and there has been no attack of unconsciousness. 
November 26. The murmur has now disappeared and there is marked 
general improvement. 
December 15. The trembling has become less and the apex-beat strong, 
with a coincident improvement in the first cardiac sound. 
Fig. 23. 
Case XII.—Mrs. E., aged forty-seven years, suffered from acute poly- 
articular rheumatism about fifteen years ago. Since then she has been 
subject to palpitation, extreme breathlessness on exertion, occasional 
attacks of fainting, and almost every night to tormenting dreams. She 
has lost much flesh and her feet are considerably swollen at night. On 
October 2d the apex-impulse was found well out in the mammillary line, 
one and one-half inches below its normal position. At the apex is heard 
both an auricular and a ventricular systolic murmur, the former harsh, 
the latter soft and somewhat musical. At the second right aortic carti- 
lage is a ventricular systolic murmur, but neither loud nor rough. The 
first sound is shortened, higher pitched, and metallic in character. The 
pulmonic second sound is markedly accentuated. 
Fig. 24. 
Four drops of strophanthus was given after each meal, two d rops’at 
bedtime, and quiet insisted upon. 
27th. It was found that the dyspnoea had been greatly benefited and 
the sleep more peaceful. There had been but one attack of fainting. 
Fig. 25. 
November 2. The palpitation wa? much lessened and general improve- 
ment continued. The first sound is of lower pitch, longer in duration, 
and approaches the normal in character. 
December 25. The palpitation is no longer complained of and dyspnoea WILCOX: STROPHANTHUS. 
15 
is noticed only on violent exertion, There has been no fainting during 
the past month and her sleep has been more free from dreams. 
January 6, 1897. The patient now sleeps well at night and all symp- 
toms are markedly better. She is gaining in flesh. The apex-beat is 
still one inch below its normal position, but the first sound is booming 
in quality. 
The careful study of these cases, which present the different varieties 
of cardiac disease, leads me to believe that in them was obtained a more 
speedy relief of the symptoms than can ordinarily be expected from the 
use of digitalis or of other drugs commonly used. 
Fraser presents a most interesting study of the action of strophanthus 
upon the heart, finding it eight times more powerful than adonidin, scil- 
litoxin, or erythrophlcein; twenty times more than helleborein, thirty 
times more than convallamarin, three hundred times more than some 
specimens of digitalis, and thirty thousand times more powerful than 
caffein. On the contrary, upon the bloodvessels digitalis acted fifty times 
stronger than strophanthus. 
The advantages which strophanthus possesses over digitalis may be 
summed up as (1) greater rapidity, modifying pulse-rate within an hour 
(Potter); (2) absence of vasoconstrictor effects; (3) greater diuretic 
power; (4) no disturbance of digestion; (5) absence of cumulation; 
(6) greater value in children; and (7) greater safety in the aged. 
When we consider that although digitalis has been in use since 1785 in 
the treatment of cardiac disease, it is only within the past ten years that 
it may be truly said that its administration was productive of uniformly 
excellent results. That this is so is undoubtedly due to the fact that 
the greatest danger from its use—namely, the marked vaso-constriction 
—has been to a considerable degree obviated by the common practice 
of the coincident administration of a nitrite. Strophanthus was first 
brought to the notice of the French Academy of Medicine in 1865, but 
its first practical demonstration as a valuable heart-remedy came twenty 
years later, when Fraser published the results of his long-continued and 
patient researches. With the wider and more rapid dissemination of 
knowledge which obtains at the present day we may hope that within 
a comparatively few years we may have strophanthus used as carefully 
as is digitalis today. That it possesses distinct advantages over the 
latter drug is undoubted, and it is equally certain that it is free from 
the greatest danger which the use of digitalis entails—namely, vaso- 
constriction. 
We may say that success in the administration of strophanthus 
requires: 1. An active, well-made preparation from a reliable source. 
2. Avoidance of its use in fully or over-compensated hearts, in those 
which present advanced muscular degeneration or mechanical defects 
of high degree. 3. The use of not too large or too frequently repeated 16 
WILCOX: STEOPHANTHUS. 
doses. From my own observations, the dose of five drops of a reliable 
tincture three or possibly four times a day is sufficient. 
In conclusion, I believe that, considering the limitations just enumer- 
ated, strophanthus is the drug of choice in : 
1. All cases in which we wish to establish compensation. 
2. All case of arterial degeneration in which a remedy which causes 
more energetic cardiac contractions is required. 
3. All cases of cardiac disease where diuresis is necessary. 
4. All cases of weak or irritable hearts. 
5. All cases of cardiac disease in childhood or old age. 
749 Madison Aye., January 14,1897.  Journal 
ofthe MEDICAL SCIENCES. 
MONTHLY, $4.00 PER ANNUM. 
WITH 1897 The American Journal of the Medical Sciences enters upon its seventy- 
eighth year, still the leader of American medical magazines. In its long career it has 
developed to perfection the features of usefulness in its department of literature, and 
presents them in unrivalled attractiveness. It is the medium chosen by the leading minds 
of the profession on both sides of the Atlantic for the presentation of elaborate Original Articles; 
its Reviews are noted for discernment and absolute candor, and its Classified Summaries of 
Progress each month present an epitome of medical advances gleaned by specialists in the 
various departments. According to unquestionable authority, “ It contains many original papers 
of the highest value; nearly all the real criticisms and reviews which we possess, and such 
carefully prepared summaries of the progress of medical science and notices of foreign works that 
from this file alone, were all other publications of the press for the last fifty years destroyed, it 
would be possible to reproduce the great majority of the real contributions of the world to medical 
science during that period.” 
JFIje Medical NeWs. 
WEEKLY, $4.00 PER ANNUM. 
BY KEEPING closely in touch with the needs of the active practitioner, The News has 
achieved a reputation for utility so extensive as to render practicable its reduction in 
price from five to Four Dollars per annum. It is now by far the cheapest as well as 
the best large weekly medical journal published in America. Employing all the recognized 
resources of modern journalism, such as the cable, telegraph, resident correspondents, special 
reporters, etc., The News furnishes in the 28 quarto pages of each issue the latest and best infor- 
mation on subjects of importance and value to practitioners in all branches of medicine. Its 
numerous departments are designed to subdivide and present its material in the most attractive 
and convenient manner. 
In a word The Medical News is a crisp, fresh, weekly newspaper, and as such occupies a 
well-marked sphere of usefulness, distinct and complementary to the ideal monthly magazine, 
The American Journal of the Medical Sciences. 
The Year-Book of Treatment for 1897 
Gives a classified summary and review of the real advances in treatment made during 1894 in all 
departments of the science of medicine. Price, $1.50; or in combination with either or both the 
above journals, 75 cents. Ready early in 1897. 
The Medical News Visiting- List for 1897 
Published in four styles: Weekly, dated, for 30 patients; Monthly, undated, for 120 patients per 
month; Perpetual, undated, for 30 patients weekly per year; Perpetual, for 60 patients weekly 
per year. The first three styles contain 32 pages of important data and 160 pages of assorted 
blanks; the 60-patient perpetual consists of 256 pages of blanks. Price, each, $1.25. In com- 
bination with either or both above periodicals, 75 cents. Or, Journal, News, Visiting List 
and Year-Book, $8.50. Thumb-letter index for Visiting List, 25 cents extra. 
LEA MOTHERS & CO., Publisher,, {%Tr.