Strychninum purum

Volume I — Special Symptomatology

Strychnia. — An alkaloid obtained from the Nux Vomica and the Ignatia Bean.

It is a white or grayish-white powder. When rapidly crystal ized from its alcoholic solution, it has the form of a white granular powder; when slowly crystalized, that of elongated octahedra, or quadrilateral prisms, with quadrilateral terminations.

It is permanent in the air, inodorous, but excessively bitter, with a metallic after-taste.

This bitterness is so intense that one part of it will impart a sensible taste to 600,000 parts of water.

It is soluble in 6667 parts of water at 50°, in 2000 parts at boiling point. In absolute alcohol and ether it is very sparingly soluble. Boiling officinal alcohol dissolves it without difficulty, and deposits it on cooling.

The Sulphate occurs in colorless prismatic crystals, efflorescent on exposure, inodorous, extremely bitter, fully soluble in water, sparingly soluble in alcohol.

Phosphate of Strychnia occurs in a white, amorphous powder, almost entirely insoluble in water, sparsely soluble in alcohol.

Officinal Preparations. — Triturations (centesimal).

Citrate of Iron and Strychnia occurs in garnet red amorphous scales. Is soluble in water, insoluble in alcohol. It has an acid and ferriginous, and persistently bitter taste, and is deliquescent. It contains 1% strychnine.

Officinal Preparations. — Triturations (decimal).

(See Therapeutics, Vol. II.)

Volume II — Special Therapeutics

The following paper on the use of Strychnia was read before the Wisconsin State Homoeopathic Medical Society, and was listened to with great interest. I have therefore ventured to reproduce it in this work.

Strychnia is one of the alkaloids of Nux vomica. The other alkaloid, Brucia, is not used to any extent, and is not considered officinal.

Homoeopathic physicians universally use Nux vomica, and very rarely use Strychnia, probably for the reason that Hahnemann gave such a thorough and extensive pathogenesis of the former and said nothing about the latter.

Strychnia bears the same relation to Nux vomica that Atropia bears to Belladonna. It seizes upon the nervous system exclusively, and has no direct effect upon the vegetative system. If we were in possession of the most exhaustive provings of Strychnia, I do not suppose we should find anything like a majority of Nux symptoms in them. We should miss the hepatic, intestinal, gastric, and many of the mental symptoms, and find only those due to irritation and spasms (primary) or paralysis (secondary) of the spinal nerves.

Before entering upon a consideration of the therapeutical application of Strychnia according to the law of similia, it will be proper and important to study its general physiological and toxical action on the human organization, and, to a certain degree, upon the animals.

When taken in quantities just sufficient to produce sensible 'physiological effects, Strychnia induces a feeling of restlessness, perhaps accompanied by trembling in the limbs, and some stiffness in the neck and jaws. When a somewhat larger amount has been given, there may be general muscular twitchings and startings, with stiffness and stricture of the throat and chest ; formications or other abnormal sensations under the skin may or may not be present.

After poisonous doses the symptoms usually come on in from fifteen to twenty minutes — rarely after the hour — with great suddenness. Sometimes the convulsions are preceded by partial spasms of the muscles of the extremities, but more often the patient is thrown down by the general tetanic spasm. In this the body is bent backward, and rests upon the heels and head, in a condition of profound opisthotonos, the legs are rigidly extended and the feet everted, the arms bent and the hands clenched, the eyes staring wide open, the corners of the mouth often drawn up so as to produce the risus sardonicus. Sometimes previous to the attack there is a feeling of restlessness and soreness of the limbs, shooting pains like electric shocks occur in various parts of the body, often first in the back, and down the arms and legs. After the tetanic and paroxysmal contractions of the muscles set in they rapidly grow worse until the respiratory movements are arrested. In this condition the face becomes bloated and livid, the jugular veins

stand out in the neck, the eyes are staring and prominent, the jaws firmly clenched, and the pupils dilated.

Each spasmodic attack lasts from a few seconds to a minute or more, and then generally ceases altogether for a time. Throughout the paroxysm the mind is quite unaffected, and the patient’s sufferings are agonizing. A breath of air, a slight noise, movement of the bedclothes, the most trivial cause, will excite tetanic spasms. Sometimes, however, a firm grasp or hard rubbing of the muscles is grateful. All the senses are sharpened to an intense degree, and even the mental operations are more vivid.

In a fatal case death is rapid, and if the patient survives two or three hours hope of his recovery may be entertained.

If the case terminates favorably, the convulsions gradually lessen in intensity and fade away.

Death occurs from asphyxia, or spasms of the muscles of the chest, or from exhaustion from repeated convulsions.

I have given you a brief but clear picture of the extreme 'primary action of Strychnia. A series of provings would show a multitude of symptoms affecting the nervous system directly, and showing perversion of the various functions of the organs largely supplied with motor and sensory nerves, and causing a large variety of pains and abnormal sensations.

The question now arises : Are there no secondary effects of Strychnia ?

This is a very important question, for upon its solution rests the truth of the homoeopathic law ; for, if Strychnia does not cause motor paralysis, we cannot prescribe it in such cases without violating that law, i. e., without using it antipathically. Let us carefully examine the records of cases of Strychnia poisoning, and see if we cannot find proof of secondary action.

We find that during the intervals between the spasms, “ the jaw drops, the muscles relax, insensibility obtains, and faeces and urine are passed involuntarily.” These are the first indications of its secondary paralyzing effects. We also find that after recovery from poisoning by Strychnia, the senses are apt to he obtuse for some time. The muscles are sore, and respond feebly to the will. Motion is slow and difficult. The eyes are dim, there is ringing in the ears, the mind is sluggish, speech is thick and difficult, taste and smell are altered, and all the symptoms of nervous exhaustion show themselves unmistakably.

Strychnia is no exception to the rule I have often mentioned in my writings, ■namely, that a massive dose will often develop secondary effects not preceded by the primary.

Immense doses of Strychnia have often caused insensibility, with loss of sight and hearing, followed by sudden death in the first attack of spasms. This was due to its sudden, overwhelming secondary action.

Moreover, the investigations of Matteachi, Kolliker, and others have proved that “ after death from Strychnia the functions of the motor nerves are always found to be more or less destroyed, so that galvanization of the nerve trunk either produces only very feeble contractions in the tributary muscles, or else none at all.” Wood considers it proven that the functional power of the motor nerves is destroyed in Strychnia poisoning, but he asks : “ Is this destruction a direct action of the poison, ■or is it simply the exhaustion of over use, due to the intense activity of the nerve

during the stage of spasm ?” Kolliker thinks the latter is the sole cause of the nerve paralysis, but Vulpian and other observers controvert his theory by experiments which prove that “ enormous doses of Strychnia kill the frog without the induction of spasms, by general paralysis with total loss of power in the nerve trunks.” Evidently, in such case, the paralyzing action of the poison on the nerves must be direct.

There is another peculiarity of secondary Strychnia action which is of great diagnostic importance, namely : It paralyzes the efferent but not the afferent nerves. This it appears to do before it paralyzes the spinal nerve-centres. In other words, the peripheral portions of efferent nerves die before their roots, or before the nerve-centres from which they spring are completely exhausted. Wood’s assertion, that “the general collapse (paralysis) of frogs from Strychnia poisoning is largely due to the affection of motor trunks and not to exhaustion of the spinal cord,” is only partly true. Its ultimate secondary action is spinal exhaustion, and is as much a Strychnia effect as its ultimate primary excitation and congestion.

Harley’s experiments show that Strychnia acts on all parts of the spinal cord. “ Its effect on this organ,” he says, “ appears to be twofold. It dilates the vessels, and thus increasing the supply of blood augments the activity of the functions of the cord.” But apart from this property of dilating the vessels, it is supposed that Strychnia exerts a direct stimulating influence on the spinal cord, although, as Harley has shown, it can act only through the blood, and does not, as was formerly supposed, exalt the functions of the cord when divested of all its vessels, and when a solution of Strychnia is brought into direct contact with its elements.

The experiments of Spence seem to prove just the opposite of this ; for when he supposed he had drained all the blood from the body of a frog, and placed a piece of Nux vomica upon the exposed brain, convulsions occurred from above downward, as fast as the poison permeated the substance of the cord.

Strychnia differs from many other poisons in this, — that it is only in increasing the reflex faculty of the spinal cord that it causes convulsions. This vital property of the cord reaches such a very high degree that any external or internal excitation brings on a reflex tetanic contraction, the violence of which, according to a wellknown law, is in proportion to the degree of the reflex faculty. So long as the spinal cord does not receive some kind of excitation, however powerfully poisoned by Strychnia it may be, there is no convulsion.

In other words, the cord may be ever so much congested, but the abnormal reflex irritability is not shown, unless it is excited by the touch, or some other form of irritation.

There are many other drugs which cause spinal congestion, but none which cause this peculiar abnormal condition in the tissue of the cord. If Strychnia causes this twofold condition of the spinal cord by its primary action, it causes, as the results of poisoning in animals show, a secondary action just the opposite, namely, an anaemia of the cord, with paralysis, from exhaustion, of the faculty of the reflex motor nerve-cells. Not only this, but it causes a paresis of the trophic (nutrient) nerve-cells, and as Hanfield Jones believes, may cause paresis of the cerebral nerve-centres.

Therapeutically considered, the action of Nux vomica and Strychnia differ

only in degree. Nux will cause all the symptoms of Strychnia, but Strychnia will not cause all the effects of Nux. As I stated in treating of Atropia, an alkaloid is but one constituent of a drug, and only represents a part of its power.

But in its sphere an alkaloid is often better than the drug from which it is isolated, because its action is more direct and intense.

The therapeutics of Strychnia, without being absolutely confined to disorders of the nervous system, is certainly best manifested in that system.

The question which meets us at the onset is a momentous one, namely : What are the diseases and symptoms for which Strychnia is primarily indicated ?

Among the most prominent I must name tetanus. As Baehr says: “If there is any truth in the homoeopathic law, Nnx vomica ought to cure tetanus.” So I assert in relation to Strychnia. Baehr says he cannot find any record in homeopathic literature of cases of tetanus treated with Nux vomica, nor have I been more successful in my researches.

Our literature is particularly barren of cases of tetanus. Baehr, in commenting on this fact, suggests that homeopathists rarely treat the disease.

One would suppose that the treatment of tetanic spasms with Nux would be published with considerable flourish of trumpets, as a brilliant illustration of the truth of the homeopathic law.

On examination of our works on practice, I find that Nux is recommended theoretically, but no cases illustrative of its efficacy are reported. Marcy and Hunt recommend Nux, Belladonna, Arnica, Stramonium, Cicuta, Hyoscyamus, Pulsatilla, and Sulphur.

Of these none have the slightest positive value except Arnica, and perhaps Cicuta ; and the recommendation of Pulsatilla and Sulphur is absurd.

The same authors mention the following as having cured individual cases : “ Tobacco, Nicotin, Aconite, Atropia, Belladonna, Conium, Henbane, Cannabis indica, Opium, Camphor, etc.” But these are all secondarily homoeopathic to tetanus, or, according to some, antipathic.

Now, until we can cure true tetanus and trismus with Strychnia, we should be careful about boasting of the universality of the law of similia.

The value of Strychnia in tetanus, singularly enough, received its confirmation, not from the homoeopathic, but from the allopathic school.

In Stilly’s “ Materia Medica,” I find that Strychnia has been used successfully in tetanus. Stills says :

“ The diseases characterized by excessive, or rather, disordered action, in which Strychnia has been employed with benefit, are more numerous than those which have been noticed. Even in tetanus its power has been unequivocally displayed. In 1847, Dr. Fell, of New York, published seven cases of tetanus, six of which were of the traumatic variety, and all recovered under its use. His plan of administering it was to give one-eighth or one-tenth of a grain, and in two hours one-sixteenth of a grain, then reducing the dose still further, and only to the extent of producing specific signs of its influence after each one. Dr. Kalloch, also, relates a case of traumatic tetanus, occurring in a negro girl, which was cured by Strychnia, given in doses of one-twelfth of a grain every two hours.”

Hammond, in his work on “ Diseases of the Nervous System,” does not allude to these cases. We can hardly account for this omission on the part of such a

thorough investigator, except on the theory that he doubted their trustworthiness. It cannot be possible that he omitted them for fear of giving testimony that would prove the truth of the fundamental law of homoeopathy.

I cannot believe that in these cases the condition of the spinal cord was the same or similar to that caused by Strychnia. Hammond says nothing about any difference in the pathological appearance in the cord, occurring in traumatic and Strychnia tetanus. But there must be a difference, and in that difference we must look for the reason of the cures by Strychnia in doses of one-tenth or one-sixteenth of a grain. Dr. Fell admits that each dose caused aggravations, and those who are familiar with the action of homceopathically indicated medicines know that quite appreciable doses will cure 'primary symptoms, but in so doing they always cause aggravations. My belief is that traumatic tetanus, while it presents many of the outward symptoms of Strychnia tetanus, does not arise from the same pathological conditions in the cord. A careful study of the different diagnosis of the symptoms forces one to this conclusion. The fact that the dose used by Dr. Fell did not kill, is also proof of the same conclusion. It is absolutely certain that if the identical condition existed in Dr. Fell’s cases which obtain in Strychnia tetanus, a dose of one-thousandth of a grain would have caused terrible if not fatal aggravations.

I should not dare to prescribe Strychnia under the 6th centesimal attenuation in true tetanus, if I believed there was intense congestion of the cord, together with the peculiar excitation of the reflex motor nerve-cells so characteristic of Strychnia tetanus.

Idiopathic tetanus has its origin in the cord or its membranes. Traumatic tetanus commences at the periphery of the body. Now it is difficult to imagine that tetanus of a central origin is the same as tetanus of a peripheral origin. No record has been found of the treatment of idiopathic tetanus by Strychnia, and the treatment of Strychnia tetanus by Strychnia is out of the question. This narrows the use of appreciable doses of Strychnia in tetanus to the traumatic variety (possibly the hysterical).

I have frequently prescribed the 6C of Strychnia in the tetanic spasms of cerebro-spinal meningitis (which is an idiopathic tetanus) with the best results, and I should have equal confidence in the higher attenuations.

In chorea, when the convulsive motions are due to perverted action of the motor portion of the spinal cord, and when the convulsions do not cease during sleep, Strychnia is primarily indicated, and should not be prescribed lower than the 12th or 30th attenuations.

If the chorea is due to disease of the heart, to rheumatism, or from mental emotion, or from cerebral irritation, it corresponds to the secondary action of Strychnia, and that remedy may be given in the doses used by Trousseau and Hammond. The former gives one- twenty-fifth of a grain, one or two doses a day ; the latter- gives one-fiftieth of a grain three times a day. Trousseau considers it necessary to cause slight stiffness of the jaws and neck, and some jerking in the limbs. Hammond does not think it necessary to cause such symptoms. It is not only unnecessary, but criminal to give a drug to the extent of causing toxic symptoms, especially such a poison as Strychnia.

Under no circumstances is it necessary to give Strychnia lower than the 3C trit. in the treatment of functional chorea.

The primary Strychnia constipation is due to spasmodic contraction of the circular fibres of the intestines. Strychnia 30th will promptly cure this variety after Nux vomica has been used unavailingly.

Acute myelitis and spinal meningitis , although not usually caused by Strychnia, may come under its primary curative power.

It causes intense congestion of the cord and its meninges, which, if persistent, results in inflammation and softening. As an intercurrent remedy it will be of value in alternation with Veratrum viride or Belladonna, even in the acute stage.

In the later stages it alternates well with Cannabis indica or Ergot, but I would not advise it to be given lower than the 6th or 12th centesimal.

The same may be said of paralysis when caused by any organic disease of the cord or brain, such as effusion (sanguineous), congestion, softening, etc. Allopathic authorities are particular to caution their readers never to give Strychnia in paralysis from actual lesions of the cord and brain until after all signs of irritation have disappeared, or unless the paralysis is of reflex origin. This is a very proper caution from the allopathic standpoint. But the homoeopathist is not confined to such narrow limits.

Strychnia is primarily homoeopathic to paralysis, from the causes enumerated by Brown-Sequard, as contraindicating Strychnia, namely, myelitis, meningitis, pressure on the cord, haemorrhage in the spinal cord, congestion of the cord, softening of the cord. In all of these conditions Brown-Sequard says Strychnia ought to be avoided, because it increases the flow of blood to the cord and aggravates the paralysis. It is evident that it did not occur to Brown-Sequard to give the Strychnia in minute doses ; the dread of, or utter disbelief in, the value of attenuated doses, prevents such men from attaining all scientific truth.

I have treated many cases of paralysis from the conditions above mentioned, and have seen the best results from Strychnia 6th cent. The presence of congestion or extravasation is an excellent indication for the use of Strychnia in the highest attenuations. I prefer the Phosphate of strychnia in these cases.

Strychnia is secondarily indicated in all cases of paralysis (paraplegia) from exhaustion of the spinal cord, spinal anaemia, reflex paraplegia or hemiplegia, or white softening ; also in cases where it was primarily indicated, but after all signs of irritation have passed away, leaving a paresis of the motor nerve-centres.

Allopathists are very successful with Strychnia in such conditions — if they are correct in their diagnosis — for it is only in such cases that they can use large (appreciable) doses with safety.

Brown-Sequard, in his admirable work on “ Paralysis of the Lower Extremities,” gives the differential diagnosis of the two grand divisions of paralysis — the reflex and direct — and I advise every homoeopathic physician to procure and consult that work in order to enable him to attain a certainty in diagnosis, such as he cannot otherwise attain.

The doses of Strychnia most applicable in cases of reflex paralysis, or cases of a secondary nature, depend on the age of the patient and the duration and intensity of the disease.

Careful physicians, like Hammond, Brown-Sequard, and Trousseau, who have

made the subject of paralysis a life-study, advise Strychnia to be given in quantities just sufficient to cause slight drawings and jerkings in the affected parts.

As this effect of Strychnia is always first manifested in the paralyzed limb, the danger is not as great as might be supposed. In fact, there is no danger at all if this effect is watched for and the dose decreased as soon as observed.

This method of using Strychnia is sanctioned by the most practical men of all schools. You will rarely be able to cure paralysis with this remedy unless you follow these rules.

The dose for an adult will range from the one-fiftieth to the one-twentieth of a grain, repeated three times a day, until its action on the paralyzed portion is observed, when it should be decreased gradually.

For a child under twelve years, one-fiftieth to one two-hundredth of a grain may safely be prescribed.

The homoeopathic preparations of tincture and trituration afford us a ready method of prescribing the dose with sufficient precision.

Many physicians and surgeons prefer to administer the Strychnia by hypodermic injection, as its action is more certain when introduced into the system in this manner. The quantity injected must be much less than when taken by the mouth (one-tenth as much in most cases).

Amaurosis, when it is of a paralytic nature, is frequently cured by small doses of Strychnia. It should only be used when the disorder is caused by atony of the retina from some cause acting directly upon its texture through the medium of general debility, or when caused by using the eyes by very feeble light. An aqueous solution of one grain to one ounce of water, a few drops placed in the eye, and the region of the eye bathed with the same, is the best method of application in such cases.

Diplopia with amaurosis has been cured by the same method. Night-blindness has been promptly cured in the same manner.

Griffin cured a case of congestive amaurosis by means of one-twelfth grain once or twice a day for eight weeks. It must have been a passive congestion, or the Strychnia would have made it worse.

In homoeopathic treatises on diseases of the eye, Nux vomica is recommended for the above conditions, but I am satisfied that the alkaloid will act more promptly, especially when secondarily indicated.

Facial neuralgia and neuralgic headache will often refuse to be benefited by the ordinary doses of Nux in use by our school, but will promptly disappear under the use of the 3X of Strychnia sulph. In one very obstinate case the Valerianate of strychnia cured after other preparations failed.

Mathieu relates a singular case of spasm of the oesophagus in an hysterical woman, who was afflicted to such a degree that she was rapidly becoming emaciated and exhausted. Strychnia was resorted to, “ and as soon as it developed its specific effect, the oesophageal spasm ceased altogether.” The dose is not mentioned. Homoeopathists have cured similar cases with Ignatia and Cocculus.

Among the secondary affections which Strychnia cures may be named prolapsus recti. It has cured cases of years’ standing. Nux and Ignatia have a great reputation in this trouble, but in very old cases they fail. Then the Strychnia is

of great value, for it can be injected into the cellular tissue near the anus (one one-thousandth of a grain), and a brilliant cure often ensues from a single application. In other cases small injections, each containing the same quantity of the drug, are very successful.

Incontinence of urine or retention of urine , when both conditions depend on impaired power in the muscular coat of the bladder, from habitual distension or pressure of the uterus, is often cured promptly by a few doses of the 3X, or even the 6*.

Sexual impotence is treated very successfully by our school with Nux vomica ; but there are cases, especially when the condition is purely from spinal exhaustion, in which Strychnia is more useful.

Usually the impotency cured by Strychnia is attended by more or less paralysis of the lower extremities ; but cases are on record where the paralysis appeared to be confined to the penis alone. In the latter instance Strychnia does not perform a cure, it only removes the disability for the time. This power, however, even if limited, may be of great importance, as in cases where the possession of an heir is necessary to the perpetuation of a family or the retention of an entailed estate.

If I should be called upon to mention any particular class of disorders in which the Strychnia was most important, I should name those dependent on perverted or excessive reflex action. We have seen how it exalted to an abnormal condition the functions of the reflex motor nerve-cells, and I have mentioned its value in reflex paralysis. There are many serious and troublesome reflex disorders which are more successfully treated by Strychnia than by any other remedy, but these disorders are primary, and the medicine must, therefore, be used in the smallest doses. Of these affections I will mention particularly headache, prosopalgia, cardialgia, vomiting, dyspepsia, cough, etc.

No other drug so uniformly causes hypercesthesia of the reflex faculty by its primary action. Consequently no drug is so homoeopathic (primarily) to reflex neuroses. To be successful in the treatment of these affections with Strychnia, all the modalities and concomitants of its action must be studied, and it must be prescribed in the most attenuated doses. Then we shall make very brilliant cures.

Bromide of potassa is just the opposite of Strychnia in this respect. It is secondarily indicated. But it will make as brilliant cures in the same reflex affections if given in appreciable doses.

In some of the cardiac neuroses, which depend on paresis of the motor nerves, you will find Strychnia a potent remedy. These neuroses are either spinal, direct, or reflex. In either case there is always a constitutional debility, attended with poor circulation, feeble cardiac action, and a quick, small, and feeble pulse. The slightest emotion, physical exercise, or derangement of digestion causes oppressed action of the heart, with great nervousness and prostration. It acts in these cases in a manner apparently similar to Digitalis. I say apparently, because both increase cardiac power, but the Digitalis acts from the centre, i. e., on the cardiac ganglia, while Strychnia acts through the cord. In special cases they can be alternated with excellent results.

Some cases of asthma are said to have been cured by Strychnia. I imagine

the asthmatic symptoms were probably due to a kind of paralysis of the muscles concerned in respiration, more than to any affection of the lungs.

In addition to these special indications for the use of Strychnia, there are some general indications which you should fix in your memory.

(1.) Strychnia is primarily indicated whenever the reflex nervous system is in an excessively irritable condition ; when all the senses are in a state of hypercesthesia; and when the mental sphere partakes of the same abnormal sensitiveness. In this condition the 30th attenuation will be found to be most appropriate.

[Hahnemann gives the same indications for Nux (also for China and Phosphorus). This condition may occur in chronic as well as acute diseases, and Strychnia will be found to be better than Nux in cases specially involving the reflex nervous system.]

(2.) Strychnia is secondarily indicated in spinal exhaustion, when the reflex nervous system, the cerebro-spinal nerve-centres, and even the trophic nerves are in a condition of paresis.

[In this condition the whole organism or a portion of it may be paralyzed, or in a state of paresis in which the functional activity is far below its normal condition. There may be present cerebral paresis, with resulting dementia, idiocy, melancholy, and even softening of the brain; or spinal paresis, with paraplegia, hemiplegia, chorea, cardiac weaknesses, dyspeptic states, constipation, chronic diarrhoea (often involuntary), enuresis, impotence, etc. When the nutrient nerves are affected there is marasmus from deficiency of assimilation. The nerves may lack nutrition, and then will occur the various forms of neuralgice, spasmodic disorders, such as epileptiform fits, catalepsy, masked ague, and many other neuroses kept up from force of habit, a condition always present in spinal paresis. In these conditions and disorders the lower attenuations are required, and sometimes appreciable doses, even as low as the one-tenth of a grain.]

A few words as to the antidotes of acute Strychnia poisoning. If the patient is seen immediately make him drink large quantities of melted lard, Olive oil, or milk. These seem to prevent absorption.

As special antidotes, Tobacco, Nicotin, Opium, Morphia, Curare, Wourali, Chloroform, Camphor, Aconite, and Chloral have all been recommended. Of these all but Chloral are very objectionable on account of their depressing effect on the heart and other organs. Chloral is the least objectionable, but I would not give that alone. It is more efficient when combined with the Bromides. Doses of 30 to 50 grains of Chloral, with the same quantity of Bromide of soda or Potassa, repeated every three or four hours, has saved many desperate cases.

The Bromides are, on the whole, the safest and most efficacious antidotes. Of the Potassium, or Sodium salt, two or four drachms, in severe cases, can be given every twenty minutes for an hour ; after which smaller doses should be frequently administered.

In cases where persistent trismus exists it may have to be administered by injection. Generally, however, there are intermissions between the paroxysms sufficient to allow of a dose being swallowed (3j of water will dissolve 3j of the Bromide of soda, or Potassa).

If the Passiflora should prove upon full investigation to possess the virtues claimed for it by Dr. Phares, it will be an excellent antidote to Strychnia.

Nitrate of amyl may be found to be an antidote in some cases, but it should be used cautiously.

Of course all these antidotes to toxic doses act by antagonizing the specific poisonous effect of Strychnia on the spinal cord. They paralyze the nerve-centres which are irritated by that poison. This paralysis must be kept up until the danger is over.

Of the various preparations of Strychnia the Sulphate is generally used. It is probably the most certain of all.

I often use the Phosphate when the cerebral functions are involved, or when the symptoms seem to call for Phosphoric acid or Phosphorus.

The Citrate of iron and Strychnia is a favorite preparation with many of our school. It is perhaps the best in all cases where anaemia is a predominant symptom. The use of this double salt obviates the alternation of Strychnia with Iron. I usually prescribe it in the 1* trituration.

In many cases of exhaustion of brain power, or in women in whom a high state of nervous erethism exists, I have seen brilliant curative results attend the use of the Valerianate of Strychnia, in the 2X trituration or dilution.