Am.  Jour.  Pharm. ) 
May,  1881.  J 
The  Dose  of  ExtrciGt.  Physostigmatis. 
231 
that  he  did  not  refuse  to  put  up  the  prescription,  after  the  physi- 
cian liad  assumed  the  responsibility  incurred  by  the  dose,  we  think 
that  he  was  not  at  fault.  The  German  Pharmacopoeia,  which  in  its 
table  of  maximum  doses  always  remains  on  the  safe  side,  permits  the 
dispensing  of  0*02  gm.  =  -^-^  gr.  pro  dose,  and  of  0*06  gm.  =  -f^  gr» 
within  a  day ;  but  larger  doses,  if  found  necessary  by  the  attending 
physician,  are  not  prohibited. 
Professor  Stille,  in  the  National  Dispensatory,  gives  the  average  dose 
of  the  extract  of  Calabar  bean  as  one-tenth  of  a  grain;  but  under 
Physostigma,''  speaking  of  its  use  in  tetanus,  he  says:  "The  minimum 
dose  of  extract  of  physostigma  which  should  first  be  administered  is 
one-third  of  a  grain.  It  should  be  rej^eated  every  quarter  of  an  hour 
until  its  specific  action  is  developed  and  the  spasms  are  completely 
overcome.  This  effect  should  be  steadily  maintained  and  then  repro- 
duced as  often  as  the  spasms  occur.  It  is  usually  necessary  to  increase 
the  dose  in  order  to  maintain  its  original  impression.'^ 
Dr.  Harley,  in  Royle's  Materia  Medica,  reports  that  "Dr.  O'Leary 
took  140  grains  of  the  extract  in  86  hours,  and  for  a  short  time  four 
grains  every  hour  during  an  attrck  of  traumatic  tetanus,  and  Dr. 
Eben.  Watson  has  given  even  larger  doses  to  patients  suffering  from 
the  same  affection. Dr.  Harley  is  inclined  to  attribute  these  large 
doses  in  a  measure  to  the  variability  of  the  extract;  but  he  mentions 
the  ordinary  dose  to  be  from  yw  to  ^  grain. 
Dr.  Farquharson  (Guide  to  therapeutics  and  materia  medica,  Amer. 
edit,  by  F.  Woodbury,  M.D.,  p.  344)  says :  "  It  is  seldom  used  intern- 
ally, for  in  tetanus  the  functions  of  the  stomach  are  suspended  in 
great  measure,  and  drugs  are  probably  only  very  partially  absorbed; 
subcutaneous  injection  is  therefore  our  best  method,  and  we  use  a  solu- 
tion of  the  extract  (from  ^  to  J  grain),  neutralizing  its  irritating  acidity 
by  the  addition  of  a  little  soda." 
There  are  but  few  deaths  on  record  produced  by  Calabar  bean, 
although  the  cases  of  intoxication  are  rather  numerous.  A.  S.  Taylor 
(On  Poisons)  reports  from  fifty  to  sixty  children  poisoned  at  Liverpool 
from  eating  the  seeds  from  a  heap  of  rubbish,  where  they  had  been 
thrown  with  the  sweepings  of  a  ship  from  the  west  coast  of  Africa; 
only  one  of  the  children,  aged  six  years,  who  had  eaten  six  seeds,  died. 
It  is  evident  from  the  above  quotations  that  physostigma  is  a  very 
active  and  even  dangerous  medicine ;  that  it  should  be  used  with  great 
caution;  but  that  in  certain  morbid  conditions  it  is  borne  in  relatively 
