Nux Vomica. Strychnos nux vomica.

Synonym—Vomit nut.

CONSTITUENTS—

Strychnine, brucine united with igasuric acid and loganin.

PREPARATIONS—

Extractum Nucis Vomicae, Extract of Nux Vomica. Dose, from one-eighth to one grain.

Tinctura Nucis Vomicae. Dose, from two to fifteen minims.

Extractum Nucis Vomicae Fluidum, Fluid Extract of Nux Vomica. Dose, from one to five minims.

Specific Medicine Nux Vomica. Dose, from one-tenth to two minims.

Physiological Action—Nux Vomica and its alkaloid, strychnine, act on the spinal cord and the medulla oblongata, a non-poisonous dose stimulating, and a toxic dose paralyzing them. There is contraction of the arterioles, while the heart is stimulated by a moderate dose.

A poisonous dose causes spasm of the muscles of the chest and prevents the respiratory act, with resulting asphyxia. According to the quantity taken, there may be weariness, stiffness in the muscles, soreness and heaviness in the limbs, stiffness of joints and the muscles of the chest and of the lower jaw. A larger dose causes violent tetanic convulsions, with brief intermissions, acute sensibility, and death may result in five minutes and usually within six hours. There is contraction of the muscles, resembling trismus, with constriction in the throat, headache, dizziness, with symptoms of asphyxia. There is a leaden color of the skin; breathing is laborious; the pulse is rapid and fluttering, pupils dilated, while the face has a staring expression, with an appearance of fright.

The spasms grow less violent as the system becomes exhausted. During the intermission in the spasms the slightest stimulus will renew them. In some cases there is pain—a neuralgia of the spinal nerves—when an attack is accompanied with shrieks of pain, or with dizziness, insensibility and convulsions. Small doses in the corpulent may cause slight creeping sensations in the skin like electric shocks, with involuntary contraction of muscles, with headache, a disagreeable sensation in the head and dizziness. The influence of strychnine upon the great sympathetic is shown in many ways. There is an elevation of arterial blood pressure, an increased vigor to the heart's action, increased action of the sudoriparous glands, with dilatation of the pupils.

In some particulars it resembles the action of electricity in its effect upon the nervous system. There is often a sensation of tingling, a temporary stimulation, a sensation of increased nerve force, a renewed energy imparted to both voluntary and involuntary muscles.

Specific Symptomatology—The indications for nux vomica are sallow skin, a sallow circle around the mouth, yellowness of the conjunctivae. A thick yellow, pasty coat on the tongue, fullness, soreness or pain in the region of the liver, suggest the use of nux vomica in medicinal doses. It is also suggested by colic due to atonicity characterized by abdominal fullness, sharp pain at the umbilicus and a general torpor of the system. These symptoms are more quickly relieved by small doses of specific nux vomica than by powerful anodynes, and the relief by this agent is a cure. The indications are directly in the line of its physiological influence in small doses, especially when there is an impairment of tone of the gastro-intestinal apparatus, a general or local atonicity of the digestive organs or organs concerned in these processes.

Therapy—This condition is sometimes induced by reflex influence, apparent in the persistent vomiting of pregnancy, the vomiting or regurgitation of food present in hysteria, and in the vomiting of phthisis pulmonalis, especially occurring in these latter cases after coughing.

Dr. Perry advises nux vomica, ten drops in four ounces of port wine, giving a teaspoonful every three or four hours when sea-sickness threatens, or when it may be anticipated. He believes it is a very reliable remedy. A small quantity of the mixture may be taken on the tongue every few minutes, sometimes with better results.

The same atonic condition is present with infantile diarrhea of hot weather, in cholera infantum, in cholera morbus and in cholera. In the vomiting of these conditions small doses of nux vomica frequently repeated are specific.

In atonic congestion of the spleen or of the liver, existing from malarial influences, with whatever disease manifested, this agent is directly indicated.

It stimulates the digestion and increases the appetite. It is one of the very best, if indeed it is not the best, of our restorative tonics. In all debilitated conditions, in convalescence from exhausting disease and protracted fevers, wherever there has been depression or exhaustion of nerve force, it is the remedy.

In chronic stomach disorder, with deficient digestive power and general malnutrition, this agent arouses the nervous system and increases the functional activity of the digestive and assimilative apparatus more satisfactorily than any other known agent.

Cases of vomiting in pregnancy have been controlled by frequently repeated doses of the tincture of nux vomica, and the weakness of the stomach in dipsomaniacs with vomiting and anorexia are controlled with the agent, which is often rendered more efficient by combination with capsicum.

Strychnine.

Description—This most important of the alkaloids of nux vomica occurs in the form of colorless prismatic crystals, or as a white crystalline powder. it is odorless, but intensely bitter. It can be tasted in 750,000 parts of water. It is permanent in the air, very sparingly soluble in water, soluble in one hundred and ten parts of alcohol and in seven parts of chloroform. Its salts, named below, are in more common use than the uncombined alkaloid, largely because of its insolubility, but it may be given in doses of from one-eightieth to the one-twentieth of a grain. The more soluble salts are in every way preferable.

Strychnine Sulphate. Dose, from 1/120 to 1/15 of a grain.

Strychnine Nitrate. Dose, from 1/120 to 1/20 of a grain.

Strychnine Phosphate. Dose, 1/180 to 1/80 of a grain.

Strychnine Arseniate. Dose, 1/200 to 1/50 of a grain.

Specific Symptomatology—In acute heart failure from any prostrating cause, strychnine is given hypodermically or in conjunction with digitalis. In the prostration following any inflammatory disease of a severe and protracted character this combination is specific, but it seems to be particularly beneficial in the prostration of beginning convalescence after pneumonia, especially if there has been abscess or other exhausting complications. Often in these cases there is a tendency to sub-normal temperature and slow pulse; when this is the case there are but few remedies that will act as strychnine, and none will excel it.

Therapy—In impotence due to exhaustion, to relaxation or atony of the erectile tissue of the sexual apparatus, strychnine in small doses persistently used is an advantageous remedy. The extract of nux vomica may be given, but will not work as promptly as the alkaloid. In the incontinence of urine of the feeble and aged, and in nocturnal enuresis in childhood from atonicity without local irritation, minute doses of strychnia sulphate will often cure after repeated failure with other remedies. These facts are especially true in plethoric and relaxed cases and in inactive patients.

In uterine inertia from exhaustion or lack of nerve force, this agent excels all others. It increases nerve force, restores the normal contractility of the uterine muscular fibrillae, and increases the power and number of contractions in a normal manner. It also anticipates and prevents post-partum hemorrhage. In cases where hemorrhage has previously occurred it should be given in advance and for a short time subsequently to the birth of the child.

The influence of the sulphate or nitrate of strychnia is that of a spinal stimulant, pure and simple, with the power of augmenting nerve force to a most desirable extent by increasing the nutrition of the nervous system entire.

Its effects are not alone upon the motor nervous system and voluntary muscles, but upon the sympathetic nervous system as well. For this influence it is best administered hypodermically in doses of from the one one-hundredth to the one-twentieth of a grain.

In paralysis of the aged, without active inflammation, it is of value, especially if injected deeply into the paralyzed muscles. Wherever paralysis occurs, without inflammatory action, it may be used if there be no structural changes in the nerve centers.

In the early stage of paralysis where rigidity or muscular spasm is present the agent is contraindicated. In fact, it is not to be administered in paralysis, except where absence of central irritation is evidenced by complete relaxation, flaccidity and perhaps tumidity. The more perfect the relaxation the more satisfactory the action of the agent. In these cases the agent should be injected directly into the paralyzed muscles.

In lead poisoning, with wrist drop and other evidence of suspension of nerve influence, with or without lead colic and constipation, this agent exercises a direct influence.

The influence of strychnine to relieve, modify or cure alcoholism is now almost universally acknowledged. It has been but a short time that dipsomania has been considered, as it now is, to be an actual nervous disease of the central nervous system with concomitant phenomena—a long train of disagreeable or dangerous symptoms. But since this fact has been recognized, there has been a universal effort made to discover the most satisfactory method of cure.

In 1891 Yarochewski reported a series of experiments on dogs, conducted to determine the antagonistic power of strychnia over alcohol. He gave them alcohol of a strength of 42 to 65 per cent and produced a staggering gait by the injection of 60 grams and complete intoxication with 90 grams. The alcohol was given for a week and produced considerable emaciation, followed by death. If, however, a hypodermic injection of two milligrams of strychnine was administered with each dose of 30 grams of alcohol, the latter could be run up to 180 grams without the development of intoxication or symptoms of strychnine poisoning.

On the ground of these experiments the author formulated the following conclusions: Strychnine suppresses the toxic action of alcohol; it enables persons to ingest large quantities of alcohol for a long time without appreciable injurious effects on the organs. The increased doses of alcohol which may be given with impunity, if associated with strychnine, have a limit—i.e., as soon as the quantity of strychnine necessary to counteract the effects of the alcohol commences to give rise to toxic symptoms. Strychnine is applicable as an antidote in all forms of alcoholism.

Portugalow, of Samaria, reported in 1891 that lie cured 4-5 cases of dipsomania with hypodermic injections of strychnine nitrate. He knew of reliable and specific remedies for two affections only: strychnine for the various forms of alcoholism and quinine for malarial fever.

He prescribed a solution of the nitrate, two grains to the ounce of distilled water, for subcutaneous injection. He gave one or two injections daily of from four to eight minims of the solution. Usually ten to sixteen injections sufficed for a complete cure. This agent has now become of first importance in the cure of this condition.

Baines investigated the action of the nitrate of strychnine in surgical shock. In thirty cases lie injected the remedy hypodermically in one-thirtieth grain (loses for from two to six days previous to the operation, where its general influence was not contraindicated by irritation of the nerve centers. On the day preceding the operation it was injected every three hours. It was injected before beginning the operation every two hours, and for two or three days afterward. In sonic of the cases be claimed an entire absence of shock. In all others the shock was very mild, and in no case was it severe, and con. valescence was short and satisfactory. In all cases there was no collapse from the anesthesia lies and but little reduction of the force and strength of the heart and no respiratory failure.

Hare advises one-twentieth of a grain of the sulphate of strychnia at the time of the operation, just preceding and subsequently every half hour, treating the conditions induces by the agent symptomatically. We believe it to better to begin earlier, in order to have the system previously braced and not be obliged to administer the agent to toxicity just at the time.

It is a direct antidote to chloral and is used to great advantage in the earlier stages of opium poisoning, poisoning or asphyxia from gas inhalation and chloroform narcosis, and as a restorative to those apparently drowned.

Antidotes—In the treatment of strychnine poisoning, the stomach should be immediately irrigated. The spasms should be met promptly with inhalations of chloroform or amyl nitrate. A strong infusion of white oak bark or tannic acid in water should be given, or the substances can be used in the irrigating fluid. After the stomach is thoroughly evacuated, chloral in doses of from fifteen to thirty grains, with as much sodium bromide, may be given, or passiflora in from two to four dram doses, or large doses of the fluidextract of gelsemium. We have assurance now that full hypodermic doses, thirty to sixty minims of subculoid lobelia, repeated as needed, will prove to be a most dependable antidote for the action of this agent.

If the patient cannot swallow, the passiflora or chloral in solution may be injected into the rectum, or veratrum may be injected hypodermically in doses of from ten to fifteen minims. If the spasms increase in severity and in frequency, the result will be fatal. If they decrease in severity, are of shorter duration and occur after increasing intervals, the prognosis is hopeful.

Strychnine Phosphate.

Therapy—The phosphate of strychnine given in doses of from 1/180 to the 1/80 of a grain combines the stimulating properties of the strychnine with the nerve building properties of the phosphorus. It is a combination that should be of much value in conditions where it is desired to retain the high point gained by a nerve stimulant, and make the condition thus gained permanent. The use of phosphorus and the phosphates during pregnancy, where anemia is present or where the nervous system is seriously drawn upon by the nutrition of the fetus, has been observed by many. The use of the phosphate of strychnine in doses of one one-hundredth of a grain is commented upon by Dorset. (Annals of Gynecology, Nov., 1897.)

He says a good appetite and a good assimilation are obtained in the general weakness and debility of the anemic constipation is relieved, and, in short, the patient is built up and placed in a good condition to pass through the ordeal of labor. It improves the appetite and digestion, overcomes despondency, relieves constipation and materially builds the patient up, placing her in an excellent condition to pass through the labor with full strength. The uterus contracts promptly after the second and third stages, and the use of ergot is entirely dispensed with. The often observed chilliness or rigors which, in the majority of cases immediately follow labor, have been noticed in but few cases. These rigors, little account of which can be found in textbooks, are nothing more or less than surgical shock. This is obviated by the prophylactic—strychnine. He believes that as phosphorus and strychnine are remedies used in the treatment of rachitis with good results they are indicated during the gestation of the rachitic fetus.

A wide field of action is open to this compound, as prostration from real deficiency of the nerve elements, prominent among which is phosphorus, is a common condition among very many, especially among brain workers. The strychnia lifts the forces up to the normal point, and the phosphorus permanently holds them there by its restorative influence.

Strychnine Arsenate.

Administration— The dose is from the 1/200 to 1/50 of a grain, usually administered in pill form. In granules of 1/120 of a grain the agent is convenient of administration and prompt in its action.

Specific Symptomatology—Hale says arsenic acts upon the glandular system, and fluids of the body, while strychnine acts upon the nervous system. He advises it where the nutritive and glandular systems are involved to any great extent, with implication of the nervous system at the same time. This is found in paresis or mild forms of paralysis with edemic tissues, sodden, relaxed muscular structures, with anemia and tendency to dropsical conditions; great nervous weakness or prostration, with marked blood dyscrasia, chronic glandular induration, chronic ulceration, and the conditions of the mucous surfaces of the intestinal canal following typhus or typhoid fever and dysentery.

It is specifically indicated in the debility or nerve failure of the aged, and in the prostrating influence of severe disease in children. During severe fevers it will not antagonize the sedative influence of the antipyretics, but will brace the nervous system against the prostration that will follow when the fever is gone.

It antagonizes vasomotor paralysis in all cases. In spasmodic affections it is valuable. The author has given it persistently with sedative remedies in severe chronic cases of asthmatic bronchitis, especially in the aged, and cured them both permanently. It is indicated in a general way where strychnine is demanded, but has a special characteristic tonic influence.

It may be given in the asthenic stage of all prostrating diseases, except during the hours of the day when the temperature is increasing or stationary at its highest point. It strengthens the heart's action, and, like quinine, if given in the intermission of the temperature, or at the time of the greatest remission, it often prevents an increase of the fever and determines a continued lower temperature. It increases or intensifies the action of many stimulating, restorative or antiperiodic remedies.

The American Materia Medica, Therapeutics and Pharmacognosy, 1919, was written by Finley Ellingwood, M.D.
It was scanned by Michael Moore for the Southwest School of Botanical Medicine.