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Nux Vomica (U. S. P.)—Nux Vomica.

[image:12735 align=left hspace=1][image:25869 align=left hspace=1]Preparations: Extract of Nux Vomica - Fluid Extract of Nux Vomica - Tincture of Nux Vomica
Related entries: Ignatia.—Ignatia - Strychnina (U. S. P.)—Strychnine - Strychninae Sulphas (U. S. P.)—Strychnine Sulphate - Curare.—Woorari - Physostigma (U. S. P.)—Physostigma: arrow poison - Strophanthus (U. S. P.)—Strophanthus

"The seed of Strychnos Nux vomica, Linné"—(U. S. P.).
Nat. Ord.—Loganiaceae.
COMMON NAMES: Nux vomica, Nux vomica seed, Quaker buttons, Poison nut (Semen nucis vomicae).
ILLUSTRATION: Bentley and Trimen, Med. Plants, 178.

Botanical Source.—This is a moderate-sized tree, with a short, pretty thick, often crooked trunk. The branches are irregular, covered with smooth, ash-colored bark; the young shoots deep-green and highly polished. The wood is white, hard, close-grained, and bitter. The leaves are opposite, short-stalked, oval, shining, smooth on both sides, 3 to 5-nerved, or rather between that and triple, or quintuple, differing in size from 1 1/2 to 4 inches long, and from 1 to 3 broad. The flowers are small, greenish-white, funnel-shaped, in small, terminal cymes, with a disagreeable odor. Calyx 5-toothed; corolla also 5-parted. Filaments scarcely any, or exceedingly short, inserted over the bottom of the divisions of the corolla; anthers oblong, half within the tube, and half without. Ovary superior, roundish, 2-celled, with many ovules in each cell, attached to the thickened center of the partition. Style as long as the tube of the corolla; stigma capitate. The fruit is a berry, round, about the size of a large apple, covered with a smooth, hard rind, of a rich-orange color when ripe, and filled with a white, soft, gelatinous pulp. The seeds are 5, nidulant, discoidal, with a central prominence, covered with a fine woolly substance, but whitish and hard like horn internally (L.).

[image:12737 align=left hspace=1]History and Description.—The nux vomica tree inhabits India, along the Coromandel coast, Ceylon, and other parts of the East Indies. The wood is exceedingly bitter, especially that of the root, which is said to cure intermittent fevers and bites of venomous snakes. The pulp of the fruit is greedily eaten by various birds. The Lignum colubrinum, or Snake-wood, which is generally referred to the Strychnos colubrina, is also derived from the nux vomica wood. The bark contains a large proportion of brucine and some strychnine, and is said to be identical with the false angustura bark, which at one time appeared on the market. The characteristic seeds are the parts used in medicine, the Bombay variety being considered the best commercial sort. As described by the U. S. P., nux vomica is "about 25 Mm. (1 inch) in diameter, orbicular, grayish or greenish-gray; soft-hairy, of a silky lustre, with a slight ridge extending from the center of one side to the edge; internally horny, somewhat translucent, very tough, with a large circular cavity, into which the heart-shaped, nerved cotyledons project. It is inodorous and persistently bitter"—(U. S. P.). The seeds are with difficulty reduced to a powder. An efficient method is that of the former Edinburgh Pharmacopoeia, which directs them to be softened well with steam, and then sliced, dried, and ground. By another process the seeds may be dried whole for a few days in a drying oven, and, after breaking them into fragments, dried again by the action of warm air, and lastly powdered. The powder has a fallow-gray color, a bitter taste, and a peculiar odor, similar to that of liquorice. Concentrated sulphuric acid blackens it; nitric acid renders it a deep, orange-yellow color. Hot water and diluted alcohol dissolve the bitter, active ingredients; the last solvent acts most energetically. Ether takes up a concrete oil and some wax. The aqueous decoction is of a pale, grayish-yellow color, and intensely bitter, and becomes orange-yellow on the addition of nitric acid, and emerald-green by sesquioxide of iron, the color disappearing on the addition of hydrochloric acid. Tannic acid, or infusion of nutgalls, produces in the aqueous decoction a copious precipitate.

Chemical Composition.—The chief constituents of nux vomica are strychnine (see Strychnina) and brucine, both existing in combination with igasuric acid (Pelletier and Caventou), a tannic principle identical with caffeo-tannic acid (G. Sander, 1897). A crystallizable glucosid (loganin, C25H34O14) was discovered by Dunstan and Short (Pharm. Jour. Trans., 1884, Vol. XIV, p. 1025), in the pulp surrounding the seeds, the dried pulp containing between 4 and 5 per cent. Loganin was also found in the seeds in small amounts. When gently heated with a few drops of strong sulphuric acid, a handsome red color is developed, changing to purple on standing. When boiled with diluted acids, it splits into glucose and loganetin. Loganin is readily dissolved by alcohol or water, but is less soluble in ether, chloroform, and benzene. A supposed third alkaloid, igasurin (Desnoix, Amer. Jour. Pharm., 1854, p. 31), according to Shenstone (ibid., 1881, p. 610) is probably nothing but impure brucine. The seeds also contain a fatty substance (3 to 4 per cent), yellow coloring matter, nitrogenous matter (11 per cent), gum, sugar, and about 1.5 per cent of ash. The amount of total alkaloids in the seeds, usually containing strychnine and brucine in about equal proportions, has been found to vary from about 2 to 5 per cent. Dunstan and Short (Pharm. Jour. Trans., 1884, Vol. XV, p. 6) found specimens of Ceylon nux vomica especially rich in alkaloids, the latter amounting on an average to 1.7 per cent of strychnine and 3.2 per cent of brucine; the total amount in one instance was 5.34 per cent.

Ɣ BRUCINE (C23H26N2O4+4H2O) was discovered by Pelletier and Caventou in 1819. It exists in the bark and seeds of nux vomica, and in St. Ignatius' bean (see Ignatia). It was obtained by its discoverers from false angustura bark (formerly thought to be the bark of Brucea antidysenterica, Miller—hence the term brucine), but is now obtained as a by-product in the preparation of strychnine from nux vomica (see Strychnina). Shenstone (loc. cit.) prepared it pure by converting the base (contaminated with small amounts of strychnine) into the hydriodide, and recrystallizing the latter from alcohol repeatedly. Brucine slowly crystallizes in colorless, transparent, oblique, 4-sided prisms, or by rapid evaporation in pearly scales. It is odorless, intensely and persistently bitter, slightly efflorescing in the air, and fusible a little above 100° C. (212° F.). When anhydrous, it is soluble in alcohol (1.5 parts), chloroform (7 parts), and glycerin (70 parts), in 850 parts of cold water, and 500 parts of boiling water; the hydrous alkaloid (4H2O) is soluble in 320 parts of cold and 150 parts of hot water and in aqua ammoniae; sparingly soluble in fixed and volatile oils, and insoluble in ether. Brucine forms crystallizable salts with acids. In chlorine water brucine entirely dissolves, assuming a rose color, which ammonia converts to a dirty yellow. Nitric acid dissolves it, also with decomposition, forming a deep rose-scarlet or blood-red color, which, on warming, becomes yellow; if stannous chloride is now added a purple-violet color and precipitate is formed. This behavior toward stannous chloride distinguishes brucine from morphine. Strychnine can be quantitatively separated from brucine by Gerock's process, which consists in converting the mixture of strychnine and brucine into picrates, and warming with nitric acid of specific gravity 1.056, which destroys the picrate of brucine only. Brucine may likewise be destroyed in its mixture with strychnine by merely warming it for half an hour with nitric acid of the strength mentioned (see J. B. Nagelvoort-Flückiger, Reactions, Detroit, 1893, p. 137; and Proc. Amer. Pharm. Assoc., 1893, p. 165).

Action, Medical Uses, and Dosage.—Nux vomica is an energetic poison, exerting its influence chiefly upon the cerebro-spinal system; it affects the spinal cord principally, because the division of this cord does not prevent its poisonous influence, and, again, because when the cord is destroyed by the introduction of a piece of whalebone into the spinal canal, the convulsions immediately cease. In poisonous doses, nux vomica produces violent tetanic convulsions, without impairing the functions of the brain, with asphyxia and death. When given in doses sufficiently large to influence the system, a sensation of debility and heaviness is experienced, the spirits become depressed, the limbs tremble, and a slight rigidity or stiffness comes on when it is attempted to move. Frequently, the person can not stand erect; he staggers, and if at this time he be suddenly tapped on the ham while standing, a slight convulsive attack will often ensue, with an inability to stand. In the most severe paroxysms caused by this medicine, the patient retains his mental faculties, and the slightest motion, noise, or even a breath of wind passing over him, will excite convulsions anew, every time these occur. Sometimes, even with small doses, there will be sudden starts resembling shocks of electricity, which will be more or less severe, occasioning him to jerk the muscles acted on in this manner. It frequently occasions priapism. Of course, these symptoms vary with different persons, in proportion to their susceptibility to the influence of the medicine, and to the quantity swallowed. The usual effects of nux vomica are about as follows: in poisonous doses, stiffness, weariness, pain or rending in the limbs, violent tetanic convulsions, with short intervals of repose, acute sensibility, dreadful alarm, and finally death; in small doses, twitching of the muscles, restlessness, anxiety, and increase of urine, perspiration, etc.; when the doses are rather large, there will be more active spasm of the muscles, a tendency to lockjaw, with the preceding symptoms more or less severe. Heat in the epigastric region, constriction of the throat, headache, dizziness, and impairment of vision with closely contracted pupils, are often caused by small doses; and more especially with the corpulent and apoplectic, there will be painful sensations in the skin compared to an electric shock, or to the creeping of insects over the surface, with more or less perspiration, slight involuntary spasms of the muscles, and a very disagreeable, dreamy or vague condition of the brain. The pulse may or may not be increased in frequency. Chloroform is beneficial in poisoning by nux vomica. (For other effects, and treatment of poisoning by nux vomica and strychnine, see also Strychninae Sulphas.)

In medicinal doses, nux vomica is tonic, and increases the action of the various excretory organs; it should always be given, as well as its alkaloids, in doses to fall short of any immediate sensible effects upon the system. The keynote to its use is atony. It was formerly employed in cases where there is a want of nervous energy, as in the treatment of paralysis, especially when this has been of some standing, and not occasioned by hemorrhage in the nervous centers, or inflammatory conditions of them. Strychnine is now generally used in its stead. It must not be used in recent cases, or while reaction prevails, or when signs exist either of local irritation in the brain or spinal cord, or of determination of blood toward the head. Congestion or inflammation must always be removed before employing it. It is said to be more beneficial in general paralysis and paraplegia than in hemiplegia, and also in local paralyses, as of the bladder, in amaurosis, impotence, spermatorrhoea, tremor of the muscles produced by habitual intoxication, etc. It has also been beneficially employed in neuralgia, chorea, prolapsus of the rectum, borborygmi of females, colica pictonum, etc. A small quantity added to cathartics frequently increases their energy. Rheumatism, hysteria, mania, and worms have been successfully treated by the use of this agent.

As a remedy for atony of the gastro-intestinal tract, few agents equal, and none exceed nux vomica in value. The condition must not be one of irritation or inflammation, though it may be one of irritability due to atony. Often there is an enfeebled spinal innervation. The tongue is pallid and expressionless, there is nausea or vomiting, a yellow or sallow circle is about the month, and there is evidence of a disordered liver. There may be a yellow, pasty coating upon the tongue, yellowness of the conjunctiva, pain or fullness in the hepatic region, pain in shoulder, and colicky pains pointing to the umbilicus. With any or all of these symptoms it becomes a remedy of first importance, both for the ailments of adults and children. When nausea is due to irritating material in the stomach, nux will not be apt to relieve, but if due to simple atony, it is a positive agent. Used as above indicated, it is very valuable in cholera infantum, cholera morbus, Asiatic cholera, constipation, chronic dysentery, diarrhoea of atony, nervous debility of the stomach, the gastric irritability of the dipsomaniac (with good food and capsicum), and in chronic non-inflammatory infantile diarrhoea. It is especially used in obstinate and habitual constipation due to atony. A drop of nux vomica should be taken in a glass of cold water upon rising in the morning, and a regular habit of going to stool be encouraged. Nux relieves constipation due to spasmodic conditions of the bowels, and to some extent, that arising from the effects of lead. Nux is a remedy for heartburn, flatulent colic, colic of atony in infants, in all of which the pain centers near the umbilicus. It relieves the vomiting of pregnancy, of hysteria, and of phthisis pulmonalis. In chronic dyspepsia of an atonic character, or associated with dilatation, or flatulent distension, it is one of our best remedies. Drop doses are of great benefit in the dyspepsia of inebriates. Though usually contraindicated by congestion, it is nevertheless a remedy for hepatic and splenic congestion, or other parts supplied by the coeliac axis. It stimulates the sluggish portal circulation and thereby relieves the congestion dependent thereon. It is the remedy for "biliousness," for hepatic colic, when not due to calculi, and for chronic jaundice due to atony.

In stomach and liver disorders requiring nux, there is always a feeble and sluggish circulation, and enfeebled spinal and sympathetic innervation. These conditions are overcome by nux vomica more quickly than by any other agent. Nux vomica is more largely used in disorders of the gastro-hepatic tract than strychnine, while strychnine is generally preferred in nervous, sexual, and bladder disorders. Nux vomica frequently acts as a sedative and antiperiodic. This it does when the conditions above referred to are present. Thus it has proved exceedingly useful when nerve force was low, as in typhoid fever, and in asthmatic seizures, in both of which there was impaired spinal innervation and difficulty in breathing. It is adapted to cases where the patient awakens suddenly from sleep, with a sense of suffocation; where breathing seems to depend largely on the will power. Here strychnine is valuable. When respiration flags in pneumonia, nux or strychnine is demanded.

Nux and strychnine are of great value in the urinal incontinence of children, when not due to irritation, and the same in the aged when due to a relaxed or paralyzed sphincter with feeble circulation. It is also a remedy for paralytic retention of urine. It is often of value in catarrh of the bladder. It is a remedy for uterine inertia, and is said to lessen the liability to post partum hemorrhage. Nux has long been used in sexual atony, as a remedy for impotence, spermatorrhoea, sexual frigidity in the female, etc. In amenorrhoea it serves well with iron if there is weakness, constipation, anemia and torpor. When in dysmenorrhoea, the discharges are premature and associated with cramps and chilliness, or in menstrual colic with sharp, cramp-like pain and marked atony, nux vomica is the remedy to be used. Small doses benefit leucorrhoea with a heavy, yellow discharge, and great torpor of the system.

Nux vomica has been praised in amblyopia when due to excessive use of tobacco or alcoholics, in nervous affections of the lids, and in muscular asthenopia (Foltz). Where atony of the general system contributes toward the aggravation of eye and ear disorders, nux should be administered. It often aids in the cure of conjunctivitis and phlyctenular keratitis. It is of some value in choroiditis. In purulent otitis media with general lack of tone, nux is the best remedy (Foltz).

Nux vomica and its alkaloids should always be given with great care, the physician closely observing its effects. The dose of powdered nux vomica is from 1/2 grain to 5 grains, three or four times a day, and gradually increased to 10, or until a slight influence is observed as indicated. Specific nux vomica, tincture, or alcoholic extract, are the best forms of administration. The extract may be given in doses of from 1/15 to 1/20 of a grain as a tonic; and in paralytic affections from 1/2 grain to 2 grains in the form of a pill, and, as with the powder, gradually increased. The saturated tincture may be given in doses of from 5 to 30 drops, likewise gradually increased. For specific uses, the usual prescription is: Rx Specific nux vomica, gtt. v to xv; aqua, fl℥iv. Mix. Sig. One teaspoonful every 1 to 3 hours, as indicated. (For further consideration, see Strychninae Sulphas.)

Specific Indications and Uses.—Atonic states; tongue pallid and expressionless, uncoated, or coated with a pasty-yellowish coat; yellowness of the conjunctiva; yellow or sallow countenance, and yellowish or sallow line around the mouth; fullness and dull pain in the right hypochondrium; pain in shoulder, colicky pains pointing to the umbilicus; menstrual colic; constipation; diarrhoea of atony; functional forms of paralysis.

Related Species.Strychnos malaccensis, Bentham (Strychnos Gaultheriana, Pierre), Hoàng-Nàn, Tropical bindweed. A climber of Malacca and neighboring isles, also of China. Its bark contains brucine and strychnine, the former preponderating. The drug closely resembles the latter alkaloid in action, producing in the inferior animals violent tetanic convulsions. In doses of 3 grains of the powdered bark, it has been employed in cases in which nux vomica is applicable.

Strychnos colubrina, Linné, yields true lignum colubrinum, often substituted in India for nux vomica branches. It contains strychnine and brucine.

Strychnos potatorum, Linné, Clearing nuts, Indian gum nuts, Chilbinz.—India. The seeds of this species are subglobular, and of a brown-gray color. They are insipid in taste, and do not contain any alkaloid (Proc. Amer. Pharm. Assoc., 1893, p. 865), but an abundance of an albuminous body upon the presence of which their properties most likely depend. They are used in India to clear muddy water, and as an emetic, and in dysenteric disorders.

Related entries: Curare

Strychnos Tieute, Leschenault.—A climbing plant of Java. A decoction of the root-bark, mixed with onions, garlic, pepper, and other substances, constitutes the arrow poison upas tieute. Strychnine (about 1.5 percent) and very little brucine are the toxic principles contained in it. The seeds are lighter in color, and smaller than those of nux vomica. The seeds and the leaves, according to Boorsma, also contain 1.4 per cent of strychnine.

Akazga, Raja, M'Boundou, Quai, Ikaju, Icaja, Boundou.—According to Pecholier and Saint-Pierre, of France, this is believed to be a shrub of the family of Apocynaceae, which, as with some other plants of the same family (Nerium Oleander, Inee, etc.), is used in the preparation of a violent arrow poison. More recently, however, it was ascertained to be a Strychnos species, and the poison is now accepted to be derived from Strychnos Icaja, Baillon (1879). The root-bark is employed. It is intensely bitter, and feebly aromatic, and contains, according to Prof. T. R. Fraser, of Edinburgh, a crystallizable alkaloid which he has named akazgine. Heckel and Schlagdenhauffen, in 1881, established the absence of brucine and the presence of strychnine, in Icaja poison. This is confirmed by the more recent researches of Gautret and Lautier (Jour. Pharm. Chim., 1896, p. 418), who also found that the active principle is chiefly contained in the bark of the root, and is also found in much smaller quantity in the leaves and the stems.

According to Pecholier and Saint-Pierre, the bark of this shrub (Strychnos Icaja) is employed in infusion among the Africans on the Gabon as an ordeal liquid under the name of M'Boundou. The bark is macerated and the infusion given to the accused to drink, followed by certain proceedings; and if the accused can successfully pass the ordeal, he is deemed innocent of the charge against him. Its effect is to determine tetanic convulsions, with rapid death. Sometimes profuse urination occurs, and the person gradually returns to health and life. From experiments on frogs, a dog, and rabbits, these gentlemen have concluded that the boundou contains a poisonous principle, soluble in water and in alcohol, which exerts an action upon the sensitive nervous system analogous to that caused by nux vomica. Administered by the stomach, or used endermically, this poison increases the number of inspirations and cardiac pulsations, succeeded by a great diminution of these movements; at the same time it causes an exaggeration of sensibility, followed by tetanic convulsions, and, finally, insensibility, paralysis, and death. Its action on the motor nervous system is only secondary, and it does not affect the contractility of the muscular system. It is not a poison to the heart, which, on the contrary, continues to pulsate for a long time after death (Montpelier Medical).

IPOH.—At one time believed to be derived from Terris elliptica or Tuba root. The arrow-poison of the Malays and fish poison of Java. Its active constituent, an acid resin, dervid, is reputed intensely poisonous, gold-fish being stupefied by 1/5000000 part, death following in 30 minutes. Recently (1892), Ipoh has been ascertained to be identical with Upas antiar, from Antiaris toxicaria (see Wray, Pharm. Jour. Trans., 1892, p. 613). The pygmies of Central Africa use an arrow-poison containing both strychnine and erythrophloeine (also see Arrow-poisons under Strophanthus).

Ɣ Hedwigia balsamifera.—Habitat, the Antilles. Contains a resin and an alkaloid. The extract from root and stems acts powerfully upon the nervous system. The alkaloid acts upon the spinal cord, inducing convulsions; the resin is a paralyzer.

Hyaenanche globosa (Toxicodendron capense).—South Africa. Contains a powerfully poisonous, bitter, neutral principle hyananchine, acting much like strychnine, except that it markedly affects the cerebrum, the convulsions being of centric origin (see Engelhardt, Jahresb. der Pharm., 1892, p. 55).

King's American Dispensatory, 1898, was written by Harvey Wickes Felter, M.D., and John Uri Lloyd, Phr. M., Ph. D.

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