STRYCHXOS NUX-VOMICA. 



STRYCHNOS NUX-VOMICA. 



851 



pletely prevents its peculiar agency, even though artificial respiration 

 be maintained. " From some experiments of Segalas, it appears also 

 to exhaust the irritability of the heart ; for in animals he found that 

 organ could not be stimulated to contract after death, and life could 

 not be prolonged by artificial breathing. Nux-romim differs from all 

 narcotic poisons, by not exhausting the sensibility. During the inter- 

 vals of the fits the sensibility is on the contrary heightened, and the 

 faculties acute." (Christison.) 



Three distinct degrees of action may be observed from the use of 

 niuc-r'anica. In small doses the ganglionic system appears chiefly to 

 be affected, and this so slightly, that any phenomena are observed only 

 in cases of disease, particularly in hysterical and weak persona. The 

 secretions are increased, both of the intestinal canal, the liver, the 

 kidneys, and of the skin, accompanied with an increase of appetite and 

 improved digestion. Hence, in small doses it is a useful adjunct to 

 aperient and diuretic medicines. 



It is in the second degree of action that the characteristic effects of 

 mini begin to appear. The patient experiences a feeling of 

 weight and weakness in the movements of the limbs, inducing him to 

 remain at rest ; while his mind is restless, sad, depressed, and anxious 

 for solitude and darkness, as he is peculiarly sensitive to light, noise, 

 or the movement of the surrounding objects. With an augmentation 

 of the dose, these phenomena are increased, and the contact of any 

 external body causes a feeling like an electric shock, the voluntary 

 muscles are no longer under the control of the will, and the individual 

 staggers on the least attempt at walking. At the beginning of these 

 occurrences the pulse is hard and quickened ; the gums, cheeks, and 

 eyes reddened, and the respiration more frequent; but when the 

 nervous system is more affected, the hardness of the pulse subsides, 

 the countenance becomes of an ashy paleness, the eyes appear sunken, 

 articulation is difficult and indistinct, breathing is laborious, and 

 accompanied with violent spasms of the larynx, and the other muscles 

 of respiration are irregular in their action. After these symptoms 

 have lasted six or twelve hours, they subside, and a great increase of 

 the secretions in observed to follow ; itching of the akin, with much 

 perspiration, even accompanied with an eruption of vesicles or large 

 blebs ; the secretions of the serous membranes, of the kidneys, and of 

 the mucous membranes, are sensibly increased, those of the latter some- 

 times becoming bloody. During this period the patient complains of 

 heat in the stomach and throat, of thirst, of foul taste, and rancid 

 eructation*, with nausea, and occasionally even vomiting. While the 

 augmented secretions are taking place, the more prominent nervous 

 symptoms disappear ; and in a few days the sufferer recovers entirely 

 from the debility and excessive sensibility. 



The third degree of action manifests itself by tetanus and asphyxia, 

 occurring in single paroxysms, alternating with paralytic torpor. The 

 paroxysm become longer, and the remissions shorter, in which how- 

 ever, till denth close the scene, the intellect remains unaffected. While 

 the voluntary muscles are entirely withdrawn from the control of the 

 will, the pulse sinks and becomes slower, the breathing more and more 

 laborious (' the external muscles of the chest may be felt during the 

 fits as hard almost as bone ; and, according to an experiment of 

 Wepfer, the diaphragm partakes of the spasm of the external muscles : " 

 Christison). The belly swells and exhibits blue marks, the countenance 

 is livid, and in a paroxysm of tetanic rigidity the breathing ceases, 

 though the heart's action and the peristaltic motion of the intestines 

 continue for some time ; and, if an artery be opened, black carbonaceous 

 blood issues. " Death, however, does not always take place by tetanus : 

 in some cases the departure of the convulsions has been followed by a 

 fatal state of general and indescribable exhaustion." (Christison.) Thus, 

 after the spasms have lasted twelve, sixteen, or twenty-four hours, and 

 completely disappeared, the individual has nevertheless died, after 

 being apparently in a state of safety. This has been ascribed to the 

 depressing effect on the heart's action, through the medium of the 

 nervous system, of long-continued pain. Or the individual may suffer 

 an attack, after the primary symptoms have subsided, of inflammation 

 of the stomach and intestines, which may or may not prove fatal. 



Vomiting does not always occur, though the name would seem to 

 imply the frequency of this symptom. 



.\'u.r-romica is important not only for its formidable properties, but 

 for the illustrations it furnishes to certain physiological doctrines. 

 Thus, when used hi cases where a portion only of the body is paralysed, 

 it excites convulsions in the paralysed part before any action be observed 

 in the sound parts. " The paralysed parts are the seat of tetanic 

 shocks, of a prickly sensation, and of a perspiration, which is not 

 observed elsewhere. In hemiplegia the sound side of the body remains 

 tranquil, while the affected one is the seat of extreme agitation ; the 

 tetanic attacks succeed each other rapidly, and an abundant exudation 

 take* place. Even an anomalous eruption has been observed, while 

 the healthy side has been perfectly free. One side of the tongue in 

 sometimes sensible of a decidedly bitter taste, which is not perceptible 

 on the other. If the dose be augmented, both sides become the seat 

 of tetanic action, though not equally so." (Magendie.) It is also very 

 remarkable that the contact of any external body with any part of the 

 frame of an individual under the influence of nu.t-r<n!ra which is 

 supplied with nerves originating from the spinal cord, immediately 

 excites convulsive actions. In persons poisoned by nux-romica, whether 

 the seed* or bark (false Angustura bark), the mere act of touching the 



skin to feel the pulse has excited again the convulsive motions. Of 

 these two phenomena, namely, the action of strychnia on the paralysed 

 limbs previous to causing any obvious effect on the sound organs, and 

 of the contact of an extraneous body exciting the tetanic throes, the 

 following explanation has been given by Mr. Grainger : " Strychnia 

 acts by preference on the paralytic limb or limbs, because the cerebral 

 control is removed from the paralysed limb. If the cord be divided, 

 the pure spinal power remaining, when the skin is touched the limb is 

 retracted, and must be retracted, because the cerebral control is wanting. 

 So when the spinal cord is stimulated by strychnia, it must act on the 

 lirnb or limbs from which the cerebral power is withdrawn." 



X'ux-romica acts most rapidly when introduced into a vein, and in 

 other instances in the ratio of the absorbing power of the part ; but it 

 produces no effect when applied directly to a nerve or to the brain. 



In fatal cases the morbid appearances vary according to the period 

 at which death occurs. When death results from asphyxia, the brain 

 is gorged with blood, and the texture softer than natural. When 

 death takes place at a late period, sometimes appearances of inflamma- 

 tion are found in the stomach and intestines ; but frequently these are 

 absent. A tetanic stiffness remains in the corpse till decay commences : 

 this state of rigidity, however, does not invariably occur. 



The powerful properties of nitx-romica, and the rapidity of its action 

 when administered in the state of a pure alkaloid, strychnia, or its 

 salts, have deterred medical men from making so extensive a use of it 

 as its therapeutic qualities entitle it to. The necessity for care in its 

 administration is manifest from the facts, that death resulted in one 

 instance merely from a woman grating cheese with a file which had 

 been previously used to rasp seeds of ntuc-romica ; and in another 

 instance death ensued from three grains of the alcoholic extract being 

 taken at once. The consequence of a salutary dread of it being enter- 

 tained has been that it is generally employed only as a last resource, 

 instead of being used at an earlier period. It might, however, be bene- 

 ficially used, with due caution and careful superintendence, in many 

 cases of hysteria and hypochondriasis, dependent on irregular action of 

 the nerves of the ganglionic system. In cases of hysterical paralysis, 

 accompanied with greatly impaired sensibility, it would be more 

 influential than any other agent in a disease at once tedious and 

 distressing. 



In paralysis it has been found more uniformly beneficial than most 

 other remedies, though success has not always attended its employ- 

 ment. It is certainly better suited for some forms of paralysis than 

 for others. 



It is most serviceable in cases of paralysis of parts which derive their 

 nerves from the ganglionic system or spinal cord. Hence it is more 

 serviceable in paraplerfia than in hemipleyia, in palsy of the bladder, of 

 the rectum, and even in some cases of chronic diarrhoea dependent on 

 atony of the intestines. It is more serviceable in the palsies which 

 follow fevers, rheumatisms, repelled eruptions, habitual drunkenness, 

 and exposure to noxious metals, such as lead or mercury, and merely 

 depressed nervous power, than in those which result from effusion of 

 blood. Its use is altogether improper immediately after an apoplectic 

 seizure, and indeed whenever vascular fulness or organic disease of the 

 brain is supposed to exist. Though less useful in affections of the 

 nerves which arise from the brain, it has nevertheless proved beneficial 

 in some cases of amaurosis, in which the endermic method of applica- 

 tion has been employed, rather than the internal administration of it. 

 Deafness has also been cured by it. When employed in paralysis of 

 any of the limbs, an auspicious sign of its beneficial influence is a 

 feeling of formication, and often of sweating, with or without an erup- 

 tion, and spasmodic twitchings in the limb, while the rest of the body 

 is unaffected. 



It was conjectured by Batka, and it has since been proved by Dr. 

 O'Shaughnessy, that the false Angustura bark [GALIPEA] was the bark 

 of the Slrycknos nuz-romica ; so that in case of poisoning by that 

 article, the same mode of treatment is to be pursued as in poisoning by 

 nux-vomica or strychnia. " Nux-vomica bark (kuchila) is commonly 

 sold in Calcutta for rohun, the harmless bark of Koymida febrifuya a 

 most dangerous substitution." (Pereira.) 



Notwithstanding the " Act to regulate the Sale of Poisons " in this 

 country, nttz-vomica, compounded in various ways, is too freely sold, 

 and used for nefarious purposes. 



In cases of poisoning by nttx-romica, the moat prompt treatment is 

 necessary, and still more so if any of the soluble salts of strychnia 

 have been taken. " Nux-vomioa is occasionally made the instru- 

 ment of voluntary death, although no poison causes such torture." 

 (Christison.) The stomach-pump should instantly be had recourse to, 

 when nux-vomica has been taken in powder ; and as it adheres very 

 obstinately to the coat of the stomach, it must be perseveringly <ued, 

 with plenty of water. Emetics are too tedious in their action to be 

 depended upon. M. Donne! has recommended, when strychnia or any 

 of its salts have been taken, to endeavour to form an insoluble salt ; 

 and for thia purpose proposes chlorine, bromine, or iodine. Tho 

 tincture of iodine may be procured promptly, but if ten minutes 

 elapse before it be administered, it is unavailing. When the quan- 

 tity of strychnia taken is not large, nor the symptoms very 

 urgent, vital stimulants or sedatives are often sufficient; and for 

 this purpose, wine, brandy, or a mixture of acetous ether and laudanum, 

 or laudanum alone, will remove the present danger. Chloroform in 



