Nux vomica

Volume III — Main text

NUX VOMICA.

Seeds of StrycAnos Nux vomicoj L. Poison-nut. Nat. Ord., Legaaiaeta,

I. Provings. — I. Hahnemakk, Mat, Med, Ptfr<i, part i of original^ vol. ii of English translation. Contains 1200 symptoms from self^ and 300 from three fellow-provers and thirteen authors.

II. Poisonings, — i. a» Pierre Duste, set. 45, of bilious tempera* ment and vigorous constitution, resolved in a fit of Jealousy to poison himself. With this intention he took, June 13th, 1820, a considerable quantity of powdered Nux v., which he dusted over his food. Almost immediately after swallowing this he was attacked with violent convulsions. A medical man who was called excited vomiting by giving hot water and milk ; the patient was then carried to the Hopital St. Louis,' where he arrived about 6 p.m. His features were very much altered ; he felt completely prostrated. Convulsive paroxysms closely followed one another, marked by rigidity of all muscles, jaws strongly closed^ trunk and limbs forcibly extended, lasting i — 2 m. Patient was extremely agitated, uttered inarticulate cries, and called for help. Pulse remained normal. An emetic excited copious vomiting ; an enema was also administered. During n. the senses of sight and hearing acquired an excessive sensibility ; such was theirritability of the muscles that touching the patient is sufficient to excite convulsive movement; even a slight noise produces the same effect. During the convulsions the pulse is quick and agitated, and the body is bathed in perspiration. 14th. — 7 a.m., the patient is calmer, the convulsions are shorter, less violent and less frequent, but are still liable to be excited by the causes

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previously mentioned. The pulse is normal, sensation of lassitude and of being bruised throughout the whole body, no pain in abdomen (a weak opiate draught was given). 9 a.m , the convulsions have ceased, and hopes are now entertained of his recovery. He continued in this calm state during d. and n., complaining, however, of weakness and general pains. In c. of 15th the pain is concentrated in ihe epigastric region, skin is dry, and the pulse frequent. i6th. — 6 a.m., pulse small, almost imperceptible, dryness and heat of skin^ redness of margins of tongue, acute pain in epigastric region, also pulsations there, feebleness, extreme prostration, alteration of features, eyes staring ; intellectual faculties entire. Death at 10 a.m.

b. Examination 48 A. after death. — About 4 oz. of serum in the lateral ventricles of brain, no appreciable alteration in meninges or cerebrum, considerable serous effusion under arachnoid membrane of the spine. Liver large. The stomach contains some tablespoonfuls of a muco-sanguineous brownish liquid ^ the internal surface presents at various points a discoloration varying from red to a deep black ; it is impossible to say whether this is owing to ecchymosis or to inflammatory action. The duodenum is filled with yellowish mucous fluid and is inflamed ; the redness and injection of the mucous membrane extends, gradually decreasing, to the small intestine; the middle portion of this is contracted and thickened, the mucous membrane at the contracted portions being ulcerated. Bladder is small, contracted, empty, and slightly inflamed, containing about a spoonful of a puriform liquid. Congestion of lungs, especially towards their base, which is reddish. Heart normal. Considerable rigidity of muscles (although immediately after death they were quite pliant); ecchymosis of skin, especially at the dependent parts of the body. CCloquet, in Orfila, op. cit.)

1. A young woman swallowed purposely \ drni. of Nux v. mixed in a glass of wine. In 15 m. she was seized with pain and heat in stomach, burning in gullet, sense of rending and weariness iw limbs, succeeded by stiffness in joints, convulsive tremors, tottering gait, and at length violent and frequent fits of tetanus. Milk given after the tetanus began excited vomiting. She was further affected with redness of gums, inflammation of tongue, burning thirst, and pain in stomach. The pulse also became quick and the skin hot. Next d., though the fits had ceased, the muscles were very painful, especially on motion. Tongue and palate were inflamed, and there was thirst, pain in stomach, vomiting, colic, and diarrhoea. These symptoms, however, abated, and on the fourth day disappeared, leaving her exceedingly weak. (Tacheron, Lond* Med. Repository^ xix,4s6.)

3, A young woman swallowed between 3 and 4 drachms in powder, and in \ h. was seen by Mr. Oilier. She was sitting by the fire, quite collected and tranquil ; her pulse about 80 and regular. He left her for about 10 m. to procure an emetic, and on his return found that she had thrown herself back in her chair, and that her legs were extended and considerably separated. She was perfectly sensible and without pain, but seemed in alarm, laid hold of her husband's coat, and entreated him not to leave her. A perspiration had broken out on her skin, her pulse had become faint and much quicker, and she called frequently for

drink. She then had a slight and transient convulsion. Recovering from it, she was in great trepidation, kept fast hold of her husband, and refused to let him go, even for the alleged purpose of getting her drink. In a few m. after she had another and more violent attack, and shortly afterwards a third ; the duration of these was from li to 2 m. In them she retained her grasp ; her whole body* was straightened and stiffened, the legs pushed out and forced apart. I could not (says Mr. Ollier) perceive either pulse or respiration ; the face and hands were livid, the muscles of the former, especially of the lips, violently agitated, and she made constantly a moaning chattering noise. She was not unlike one in an epileptic fit, but did not struggle, though, as she was forced out, it was difficult to keep her from falling on the floor. In the short intervals of these attacks she was quite sensible, was tormented with incessant thirst, perspired^ had a very quick and faint pulse, complained of being sick, and made many attempts to vomit (I should state she had swallowed some ipecacuanha powder to evacuate the poison) . She continued to refuse to let her husband move, and to the question whether she was in pain, replied " No, no, no ! " A fourth and most vehement attack soon followed, in which the whole body was extended to the utmost, and she was rigidly stiff from head to foot, insomuch that, with all the force of the surgeon, he could not bend her thighs on the pelvis to replace her on her seat. From this she never recovered j she fell into a state of asphyxia, and never breathed again. She now relaxed her grasp ; her discoloured hands dropped upon her knees ; her face, too, was livid ; the brows contracted ; the lips wide apart, showing the whole of the closed teeth, and a salivary foam issued plentifully from the corners of her mouth. The expression of the whole countenance was at this time very frightful. On removal of the body, it was discovered that the urine had been discharged. She died in about an h. after taking the poison. Five h. afterwards she was still as straight and stiff as a statue j if you lifted one of her hands, the whole body moved with it, but the face had become pale in comparison, and its expression more placid. (Ollier, Ibid,^ p. 448.)

1. A. D — , Bet. 20, a healthy labourer, was admitted into the Royal F>ee Hospital, having j h. previously taken about 5is8 of powdered Nux v. When admitted he was in profuse perspiration, the skin of the face, neck, and chest was greatly congested, the eyes suffused, the pupils slightly contracted, the pulse hard and excited. The patient was greatly agitated, and on moving he grasped firmly the nearest object for fear of falling. A few m. after admission a tetanic paroxysm came on suddenly, the man was thrown into a state of opisthotonos, all his muscles becoming rigid and respiration for the time suspended. This fit lasted about half a m., when the muscles became relaxed and he was again able to answer questions. He states he swallowed nearly all the powder. Soon after he felt a little drowsy, and the first paroxysm of tetanic spasm came on about 10 m. afterwards. He had several of these fits before he was brought to the hospital, and five after his admission into the ward. They went on decreasing in severity, and none were observed after the fifth was over. The n, following the patient slept well j next d. he complained of cramping pains in the

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w when he moved them j tongue dry, much thirst, bowels confined.

Next d. patient was dismissed well Stomach-pump was used. (Lancet^

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1. A. C — , aet, 16, A h, before admission into the Liverpool Hospital had swallowed some of Gibson's Vermin Killer. When admitted she was much excited and hysterical, and complained that her back felt stifFand her throat hot. An emetic of sulph. zinc, was administered, causing her to vomit. About 10 m. after admission twitching of the muscles, which was aggravated by touching the patient, even when she did not know she had been touched, commenced in the limbs and back and rapidly extended over the body, increasing in violence and rapidity, until about 20 m. after admission the whole body was violently convulsed, the back being slightly arched, the jaws firmly clenched, and the face livid, apparently from interference with the respiration in consequence of spasm of the muscles of the chest. The respirations were very slow and laboured, ceasing entirely when the patient was moved or touched. Pulse quick and strong. A hypodermic injection of 5jiss of solution of hydrate of chloral (3J to ^]), When half an ounce had been injected the spasm of the muscles of chest and jaws relaxed, the patient being able to breathe freely and speak, the face resuming its natural colour; gradually other symptoms disappeared. Next morning she seemed well. (Ihid,^ 1873, i, p. 698.)

2. a. A somewhat stout maidservant, who had always been in good health, took the desperate resolution, on account of some disagreeable circumstances she had encountered, to deprive herself of life. She asked an apothecary for threepence worth of rat poison (rattenkraut) — by which arsenic is here understood — instead of which the apothecary gave her about two drachms of grated Nux v. About 10 a.m., lOth May, 1796, she took the whole of this quantity in a little water. \x\ \ h. she complained of severe pains in the bowels, which increased every moment and soon reached an indescribable degree of severity. I was called to see her about noon, and found her in bed suffering the most dreadful convulsions, especially opisthotonos, which abated and returned several times in a m. The face was strongly suffused with blood, scarlet, the eyes fixed and glistening, the hands cold, the pulse almost gone All this time she was perfectly conscious and told me she had taken three pennyworth of rat poison, upon which she soon felt pain in the bowels and then an indescribable anxiety, which still continued. She had drunk a quantity of lukewarm milk without the smallest relief. Under the certain belief that she had taken arsenic, in addition to the ordinary external applications I made her take a solution of the liver of sulphur, gave her a clyster, and opened a vein. But all in vain ! The pains went ofi', a cold sweat broke out, and she died a little after I 2 at n.

b. An examination of the body took place the following d, in the presence of several witnesses. Externally the whole r. side was purple, the abdomen dreadfully distended, the hands convulsively clenched, the head pale and collapsed, the mouth shut, the lips blue with traces of blood having run our of them, the nails natural and firm, but the hair was easily pulled out. In the abdomen, the liver, spleen, kidneys and

womb were perfectly sound. The intestines strongly distended with air. The stomach violently inflamed and in the neighbourhood of the pylorus almost mortified (brandig). The inflammation extended to the middle of the jejunum. The ileum was quite healthy. In the stomach a large worm (spulwurm) was found eaten through into three different portions, and about six ounces of pulpy matter, which I carefully collected into an iron pot for examination. The head and chest were not opened. The examination of this pulp revealed the presence of a quantity of grated Nux v. but no trace of arsenic. (Consbruch, Hufeland's Journal, v, 42.)

1. A lady, ait 50, affected with some abdominal complaint, took by mistake a teaspoonful of a sol. of gij of the alcoholic extract in 3u of menstruum. Almost immediately after taking the medicine she was attacked with rigor and vomiting, and got worse every m. Her face, previously pale, became of a very red colour ; her cheeks were burning hot ; eyes were fixed^ and often so strongly drawn upwards that the (contracted] pupil could not be seen \ features were distorted ; mouth fast closed ; grinding of teeth ; rapid, grunting, interrupted breathing; great anxiety ; violent palpitation ; and involuntary loud crying out. When she screamed out her head was drawn backwards, whereupon the mouth was opened wide and gave her countenance a horrible expression ; the tongue was at same time protruded, and was several times severely wounded by the jaws closing suddenly upon it. She had great aversion to fluids, which she was sometimes utterly unable to swallow. She trembled all over, and could only keep seated for a few m. at a time ; was then compelled, as by an electric shock, to rise up and totter about room. Speech was continually interrupted by hiccup \ it was weak, monosyllabic, and often quite unintelligible, so that her wishes could only be guessed at from signs. Pulse small, hardish and quick. These symptoms lasted about 3 h. : they were followed by great exhaustion for several d., and an eruption (kind not stated) over whole body.* (Leonhard, Med, Xeit.^ 11 Jahrg., p. 225.)

2. a. E. S — , xt. 16, was low-spirited in her situation, and left her mistress's house about 10.30 a.m., Jan. 25th, i8$6. About noon she reached her home, about 2 miles off ; and rushed into a room in a state of great mental excitement, exclaiming that her mother had been murdered, seating herself suddenly on a chair, and then being seized with convulsions. iVlr. Slceman was sent for, and 2 more fits supervened before his arrival at 12.30. He found her lying down in violent

• " A young man, xt. 20, whose 1. arm was completely and r. partially paralysed, wa<< givt:n nills of equal parts of extr. and powder of Nux v., weighing a gr. each. Gradually mcreasing dose, he finally took 6 pills m. and e. On tne lath u. he wax seized with raging pain and shuddering in r. arm, with violent redness and swelling of limb and breaking out of pustules, wnich seemed to form an almost confluent eruption and gradually spread over wliole body, — the paralysis improving in proportion. Six d. after eruption had appeared it dried up and fell off in large whitish scales. Patient contin\K-d his pilN, and eruprion broke out a second time, preceded by rigidity of limb. From 1 6 pilU daily he now came tlown to 8 j the former had caused shocks and tetanic rigidity, the 8 produced heavines^ of tongue and hurriedness in all his motions. At last he only took j pill a d. The eruption broke out twice more, but only in the shape of small vesicUs, which dried up and left patient perfectly cured '* (DiERBACM, in Hempel, op. cit.).

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tetanic spjsms. Her head was drawn back, arms extended, fingers flexed to palms, jaws firmly contracted, countenance somewhat livid, eyes open, fixed, and somewhat protruding, trunk stiff, legs extended, feet turned outward, toes flexed to plantar surface, skin dry and warm i respiration loud, almost amounting to stertor ; pulse cuuld not be counted. This paroxysm lasted about 2 m. An interval of perfect sensibility ensued, during which she admitted having taken the poison (about i oz.), expressed her sorrow for it, and said that during the fits she suffered much pain.

h, A full dose of sulphate of copper was administered as an emetic, but did not produce vomiting. The stomach pump was about to be used, but a fresh paroxysm prevented it. During the interval between the paroxysms all the limbs were perfectly relaxed, the body pliant, and she was much exhausted : occasionally, after one of more than usual severity, there was a slight tendency to coma. Countenance was pallid, eyes and breathing natural ; pulse about 80, moderately full ; skin warm and dry. The paroxysms lasted about 2 m., the intermissions about 5 m., when patient 'vas first seen ; former gradually increased in severity, and latter became shorter, but always allowing of consciousness even to that before the last paroxysm, which occurred a few ni. before 2. During the last ^ h. the slightest movement caused a paroxysm, even an attempt to speak or drink : she begged to be left alone because of the pain she suffered "when in a fit. The P,Af, examination presented no feature of interest, {Mid, Timrs and Gazette^ Feb. gth, 1856.)

1. A lady affected by rheumatism took, at 7 a.m.j 60 dr. of tinct. She remained quite well for 2 h., then she suddenly became convulsed, and in a few m. was quite tetanic. The lower jaw moved in a jerking way from side to side, but could not be opened. The arms were drawn spasmodically up close to the chest thighs upon abdomen ; fingers and toes were strongly flexed. It was with great difficulty that the bent limbs could be extended. The patient whined and groaned, but could not speak a word. Her skin was perfectly insensible, and she felt neither pinching nor pricking. These symptoms lasted \ h. and then went o9i. (Horns Archiv^ xx, 2, 245.)

2. A chemist, by way of bravado, took one n. 3 or 4 dr of the homccopathic mother tincture of Nux v. He awoke early next m. with feeling as if head would burst. He was so giddy that he could neither sit nor stand \ he had rushing sounds in his ears, intolerance of tight and sound, and could not see. His face was tumid, and he looked besotted, like a man reeling drunk. (Chapman, JnnaU of Brit. Hotn. SoCy i, 380.)

1 1. On August 14th I was suddenly called to attend a lady who, I was told, had just had a stroke of paralysis. I found a young woman lying upon a bed, where she had been laid fainting a few m, before. She had regained consciousness as I entered the room, and was much alarmed, complaining that she had suddenly lost all power over her hands and feet, and was unable to move them. Her fingers were extended, and she could not flex them j close inspection detected almost continuous twitchings of the small muscles of the hand. The condi-

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tion was evidently one of tonic spasm, and not of paralysis. The face was pale, and the pupils were equal and widely dilated ; the patient complained that she could not see distinctly, and that everything looked far away and blurred. The respirations, although disturbed in rhythm by nervousness and excitement^ were, nevertheless, evidently efficient j a moment's auscultation showed the heart beating clearly and forcibly about 100 times per m. The patient's mind was even abnormally sensitive, and she herself keenly apprehensive ; despite her alarm, natural under the circumstances, there was a certain dignity and apparent effort to keep calm — an absence of the dramatic element in her manner, which silenced any suspicion of hysteria which might have been suggested by symptoms somewhat difficult to account for in any other way under the circumstances. In addition to this, the dilatation of the pupils was so conspicuous as to call for some other explanation. The mental clearness, associated with marked disturbance of the functions of the spinal cord, at once suggested strychnia, and I asked if she had not taken something— a medicine for her eyes, the last teaspoonful of a tonic mixture, &c. The members of the family denied that she had taken any medicine for a long while, and, being wedded to the opinion that the trouble was paralysis {of which they said many of their relatives had died), almost resented my persisting in asking questions. Suddenly the patient herself remembered that she had taken some homoeopathic granules which she had long been in the habit of prescribing for herself when threatened with a sick headache. The dose had origmally been five granules, taken two or three times ; but that m., feeling very badly, and fearing that the medicine might have lost its strength by having been kept for a year or so, she increased the dose to 14 granules, and took it five times — 70 granules in all — in the course of i ^ A. This occurred about an h. before the alarming symptoms presented themselves i she had for the time forgotten that she had taken the medicine, not dreaming that it was the cause of her sickness, and, indeed, considering that " homoeopathic medicine was in any case harmless, since it affected merely the disease, and not the patient.' The vial of granules was given me, and on the cork I read " Nux." During the few m. required for diagnosis, the symptoms became more marked; a slight convulsion occurred, with suspension of respiration and a suggestion of opisthotonos. The face became deathly pale, the pupils even more widely dilated, and the patient fainted — apparently from cerebral ansemia. The inhalation of a few drops of nitrite of amy! (a bottle of which I was fortunate enough to have with me) rapidly restored her. Some chloroform was obtained just in time to be administered during a second convulsion, which was a little more marked than the first had been j 2 drachms of bromide of potassium were given as soon as the patient was able to swallow. The room was darkened and kept quiet, and slight inhalations of chloroform were continued for about 20 m. until the bromide of potassium could be absorbed and produce its effects. No further convulsions occurred ; in an h. the danger had passed, and very soon afterward the symptoms had all disappeared. I have been unable to discover the strength of the granules ; they were obtained while the patient was travelling in the West, and the circum-

stances attending their purchase have been forgotten. One of them, which I allowed to dissolve in my mouthy had a distinctly bitter taste, and the symptoms above recorded undoubtedly attest the presence of a larger proportion of the original drug than is sustained by any tenet which survives the visionary Hahnemann. (M T. Med. Record^ 1880.)

1. A man, art. 56, toolc by mistake, April 29th, 3 p.m., a teaspoonful of tinct. nuc'n vom. Rademachcri^ which is only half as strong as the ordinary tinct. At 12.30 a.m. inother teaspoonful. He had a restless n. and peculiar drawing on dorsum of feet and in soles. — 30th, 8 a.m., a teaspoonful. 8.15 a.m., alternate heat and chills, head hot. On trying to rise from chair, he could only stand, but could not raise his feet to take a step; next drawing and stiffness of masticating muscles and nuchal muscles j the movements of eyes are difficult from stiffness of the ocular muscles ; drawing and pricking as with needles on dorsum and soles of feet and in toes \ a similar sensation in arms and hands. He looked somewhat heated, skin rather moist j tegs could be moved when seated, hut could not sustain body. He ^ot cotFee and camphor. 9.30 a.m., better, with assistance could walk into next room. Urine passed in a stronger stream than for years. 2 p.m., quite well. (Lembke, A^. Ze'ttsch.f. hem. K/ini^.yXiw, 152.)

2. Posi-morUm examination of a woman, «t, 26, who had committed suicide with 3j pulv. nucis vom. 13ody very stiff, head drawn forwards and to 1., flexed and contracted arms and fingers of both hands, jaws firmly closed, dark violet spots on face and upper part of chest, and traces of vomited greyish mucous masses. P.m. sugillations in various parts, flow of bloody mucus from nose. Meningospinal vessels slightly congested ; vessels of arachnoid not perceptibly injected, in its cavities a little reddish serum, where it covers the I. lobe a reddish-black serous infiltration. Brain substance soft, grey and white substance well defined. On cutting through it many bloody points seen ; in lateral ventricles half tablespoonful of reddish serum; lobes of cerebellum covered with red and gelatinous exudation, especially on their upper surface ; pia mater very red and injected ; cortical substance very soft and verv dark, white substance injected. The cavity of the arachnoidca mcdullse filled with copious, clear, dark red fluid ; vessels of dura mater slightly injected ; the thoracic portion of spinal cord very soft compared with the other parts i the grey central parts traversed by visible blood-vessels. Larynx, trachea, ana bronchi filled with blackish-violet, slimy, viscid fluid ; their m.m. blackish-violet, their capillaries not injected ; posterior parts of lungs almost black, crepitating strongly, and on being cut through a large quantity of black fluid blood escaped. Heart flabby and very large j on its surface near r. border 8 to 10 ecchymosed points like flea-bites irregularly grouped and close together ; one isolated spot near 1. border ^ inch from apex ; its cavities contained black fluid blood, as also the large arterial and venous trunks. In pharynx blackish blood nlightly staining its walls. Stomach and intestines distended with gas ; m former a blackish-brown spot towards the inner surface of spleen ; several injected venous trunks under serous membrane. In stomach a clear, beef-tea-like, greyish liquid. Its m.m. throughout whitish, with some brownish-red marbled marks.

In the part of the saccus caecus ventriculi corresponding to the external brown spot the same venous clusters in the m.m., which showed a red spot as big as a florin, very dark and punctated, growing paler towards circumference. Throughout the intestinal canal m.m. whitish i some of the greyish fluid seen in stomach was found in the duodenum, none in jejunum. Liver healthy ; spleen very soft, very easily' broken up, and containing much black fluid blood. A cyst as large as a pigeon's egg in 1. ovary, filled with clear colourless serosity. (Ollivier, Arch, gen, dt Med.^ viii, pt. i, 17 j also in Frank's ^^''jfO

1. A man, aet. 45, of nervous-bilious temperament, took June 13th, 9 p.m., a considerable quantity (12 sous' worth) of coarsely triturated Nux v. Almost immediately violent convulsions. When brought to the hospital his features were altered, general bruised feeling, strength much diminished ; convulsive fits of 1 to 2 m. duration at frequent intervals, extremely pronounced stiffening of all muscles, jaws fast closed, great restlessness, uninterrupted cries and requests for speedy relief, pulse not altered (emetics and purgatives given). At n. hearing and sight extremely sensitive, the convulsive fits were renewed by touching him and by the slightest noise j during fits pulse frequent and agitated ; he is bathed in perspiration, — H^h, 7 a.m., quieter, the convulsive fits rarer, shorter, and slighter, but still excitable in the same way, a feeling of relaxation and prostration in limbs (Pot. calm, 31^1 Op. gr. vi). 9 a.m., cessation of convulsions. This state of quiet continued all d., also next n., and on the 15th there only remained a general feeling of pain and weakness. E., complained of pain in epigastrium, akin dry, pulse quick. — i6th, 6 a.m.^ pulse small, almost imperceptible, dryness of skin, redness of border of tongue, acute pain in epigastrium, extreme prostration, with unimpaired mental faculties. Died at 10 a.m. in a state of general clammy sweat but no stifl'ness of limbs. P,M. (after 48 h). — In lateral ventricles of brain about 3j fluid, in cavo arachnoidex of spinal cord a considerable quantity ; the posterior part of that membrane studded with numerous irregular cartilaginous plaques. Liver large. Gastric m.m. has several red and black spots, contains some spoonfuls of slimy, bloody, brownish fluid ; duodenum filled with a yellow slimy fluid, without a trace of inflammation, the redness and injection of its m.m. goes off* towards jejunum. Its middle part contracted, its walls thickened, and ulcers on the m.m. corresponding to the contracted part. Bladder small, contracted, slightly injected, and containing a spoonful of purifoim fluid. Some adhesions betwixt pleura pulmonalis and costalis, lungs full of blood, especially at the base. Heart normal. Considerable stiffness of limbs; almost all the skin violet, especially in depending parts. (Bouillaud, youm. univ. et htbd.^ xiv, 396; Prank*! Mag.y iv, 629,)

2. A young woman took by mistake a quantity of rat poison consisting of coarse powdered Nux v. She was soon unable to walk, and fell down without losing consciousness. When seen was lying in bed with pale face, expression of indifference, anxiety, alternately laughing and crying, eyes wide open, pupils contracted. Breathing irregular, superficial, pulse irregular, small, not hard or quick, skin cool, forearms half flexed, hands and fingers moving convulsively, lower

-•xtremitics immovable, stiff, all the muscles hard, tetanically contracted. No pain, no nausea. Respiration became every instant more difficult, and she complained she was suffocating. She got 5 gr. tart. em. After 10 m. no feeling of nausea, a cup of tea was given, and throat irritated with a feather until vomiting ensued. She then got various medicines. The symptoms gradually subsided, bur the sight continued dim for 3 d., and she had a bruised sensation and tired and painful feeling in thighs as though she had had a long walk. (Basedow, Hufelancti Journ^^ Ivii, i, 86. 1 8 28.)

1. A man for suicidal purpose took, Feb. 7th., 9 a.m., about f of an oz. of powdered Nux v. After i h. he felt his feet and soon afterwards his legs and thighs growing cold and stiff. He went to bed ; then there came on an indescribable pain in back and loins, soon followed by tetanic convulsions. At same time nausea, inclination to vomit, but without vomiting. After being r h, in bed his body was covered with profuse warm perspiration, though the legs remained cold, damp, and stiff. When seen at 4 p.m. was bathed in sweat, very anxious and repentant of his foolish act. The legs were stretched out and stiff. The arms also felt cold and crampy, but were still at patient's command, Breathing oppressed. Pulse very quick, 65 to 70, full. On touching him he had immediately a convulsive fit. He could with difficulty put out his tongue, which was furred white. His expression was anxious, his speech stammering and interrupted by convulsions in extremities and back (opisthotonos). After a clyster of Glauber salts the violence of the fits subsided somewhat. He remained perfectly conscious. He slept restlessly, and next m. felt very exhausted, but he could get up and move slowly about the room. He complained of paiti and prostration in back and sacrum, fetid odour from mouth, the sensibility of the lower extremities somewhat dulled. Urine turbid, with dirty yellow sediment. — 9th. Convulsive movements quite gone, only painful feeling in back and loins remains. Tongue still loaded, no appetite. — nth. Quite well. (Levib, Schmidt*s Jahrb,^ xxx, 296. 1841.)

2. A few d. ago I received an urgent call to go and sec a patient who had been suddenly seized with cramp, and who appeared to be in a dying state. This was about 4 p.m., and he had been attacked about 4 h. before that. On reaching the patient I found him labouring under the following tetanic symptoms, viz. drawing, crampy pains in back of neck, with paroxysms of internal stiffness and rigidity from nape downwards. The paroxysms varied in intensity. During the mild attacks the muscles of the neck alone were affected, when he could walk about and speak freely. During the more severe attacks not only the muscles of the neck but those of the chest and throat were affected, causing great difficulty of breathing and choking sensation, especially when attempting to swallow anything, also the muscles of the head, and especially of the forehead, causing a contraction of the eyebrows, and giving him a peculiarly sullen expression of countenance. During the most severe attacks all the muscles of the back and legs were affected, and the entire body became rigid and curved backwards \ at times he was unable to keep his seat on the chair, and when he attempted to get on his feet he could scarcely stand or move his legs, his muscles were so

rigid. Each paroxysm lasted I — 2 m. He always made an effort to move about when the attacks came on, and to rest the affected parts. Having learned the cause of the complaint I at once gave him camphor every few m. In the course of h h. the spasms gradually lessened in severity, and disappeared altogether in about 3 h. Shortly after he wis suddenly seized with violent strangury. The efforts to urinate were constant and most painful, without being able to pass a drop. For this he got opium, which speedily gave him relief. Next d., urith the exception of a little fatigue and shakiness, he was quite well. This patient had been labouring under some slight nervous affection, for which he applied to a well-known orthodox professor in Edinburgh, who sent him a prescription for 60 (!) pills, each containing i^ gr. Nux v. Of these, one was to be taken 3 times a d. The tetanic symptoms came on after taking the second pill. The first was taken in the m., the second at 3 p.m., and in 10 m. after that the cramps in neck and back came on. (Cockburn, Month. Horn. Rnv.y ii, 49.)

1. in the larger medicinal doses the effects of Nux v. manifest themselves by a disordered state of the muscular system. A feeling of weight and weakness in the limbs, and increased sensibility to external impressions (of light, sound, touch, and variations of temperature), with depression of spirits and anxiety, are usually the precursory symptoms. The limbs tremble, and a slight rigidity or stiffness is experienced when an attempt is made to put the muscles into action. The patient experiences a difficulty in keeping the erect posture, and, in walking, frequently staggers. If, when this effect is beginning to be observed, he be tapped suddenly on the ham while standing, a slight convulsive paroxysm is frequently brought on, so that he will have some difficulty to prevent himself from falling. I have often in this way been able to recognise the effects of Nux v. upon the muscular system, before the patient had experienced any particular symptoms. If the use of the medicine be still persevered in, these effects increase in intensity, and the voluntary muscles are thrown into a convulsed state by very slight causes. Thus, when the patient inspires more deeply than usual, or attempts to walk, or even to turn in bed, a convulsive paroxysm is brought on. The sudden contact of external bodies also acts like an electric shock on the patient. The further employment of the drug increases the severity of the symptoms ; the paroxysms now occur without the agency of any evident exciting cause, and affect him even while lying perfectly quiet and still in bed. The muscular fibres of the pharynx, larynx, oesophagus, and bladder also become affected j I am acquainted with two cases of paralysis, in which the use of Nux v. caused almost constant nocturnal erection. The pulse does not appear to be uniformly affected. Previous to the production of the affection of the muscles, various painful sensations are oftentimes experienced in the skin, which patients have compared to the creeping of insects (formication) or the passage of an electric shock ; and occasionally an eruption makes its appearance. (Pereira, op. cit.)

2. The first effects of the drug are a drawing in the temples and nape, which patients call headache, but which they know to be quite difi'eicnt from any trouble of this kind they have hitherto experienced.

The jaws are a little drawn, or rather they become stiff, as if the play of the articulations were a little less free. It is not long before the stiffness invades all the muscles of the trunk and limbs. The patients cannot completely dilate the chest, and their great efforts at inspiration are cut short by a sort of general muscular spasm. This stiffness, however, is not constant, or rather it becomes aggravated at intervals. The spasms are often preceded by horripilation, accompanied by marked shivering » tingling then comes on along the course of the peripheral nerves, sometimes with painful sensations described as like the passage of electric sparks. The more marked these precursory phenomena the more severe the subsequent spasms. Other muscles, which are usually less under the control of the will, become affected j such are chose of the pharynx and oesophagus, and the erectors of the penis, so that swallowing becomes difficult, and nocturnal and diurnal erections trouble persons who have long lost their virile power. Women even experience increased sexual desire. I'he tinglings which have been mentioned are at first deep, but afterwards become superficial, and when all the spasmodic phenomena have passed off there sometimes remains an almost intolerable itching. The itching is often the first effect noticed ; it occurs chiefly on the parts covered with hair. It is only later that the rest of the skin becomes involved. When the dose of Nux v. is A little larger, the electric shocks resemble a veritable tetanic convulsion, which though not dangerous is decidedly painful, and may be followed by such stiffness of the limbs that walking is impossible. When the shocks surprise the patient standing, he has difficulty in maintaining his equilibrium, and sometimes he falls ; in some cases he is thrown as if from a spring and falls. The intellect is in no way affected ; some swimming and ringing in the head and flashes before the eyes, and a certain nervous excitement like hysteria may appear, but they pass off as soon as the drug is discontinued. The symptoms do not all come on at once, nor do they all last equally long. Rigidity is the first symptom, then the ""electric sparks," then the shivering and the spasms. The tingling and itching only supervene after the drug has been given several days. When examined by means of the galvano-forceps it is found that the excitability of the muscles, motor nerves, and spinal cord is preserved, while that of the sensory nerves is abolished. In animals it has been found by experiment that strychnine has an elective action on the extensor muscles, the flexors remaining at rest, except a few fibrillary contractions. Jn healthy eyes strychnine docs not increase the perception of colours in general, but augments the sensibility of the periphery of the retind for blue rays. The field of vision is temporarily enlarged and acuteness of vision mcreased, so that objects situated at the periphery of the visual field can be distinguished at a greater distance than usual. (Trousseau et Pjdoux, op, cit,^ sub voce.)