Source and Composition. The seeds of Strychnos Nux-vomica, an East Indian tree of the order Loganiaceae. It contains 2 alkaloids,—Strychnine and Brucine, which in the plant are combined with Igasuric Acid. Brucine has only 1/12th the strength of Strychnine, but otherwise corresponds with it physiologically and therapeutically. A third alkaloid, Igasurine, is claimed by some authorities, and denied by others.
- Extractum Nucis Vomicae, Extract of Nux Vomica,—Dose, gr. ⅛-j.
- Extractum Nucis Vomicae Fluidum, —Dose, ♏j-v.
- Tinctura Nucis Vomicae,—Dose, ♏j-xxx, according to the effect desired.
- Strychnina Sulphas, Strychnine Sulphate,—Dose, gr. 1/60-1/20.
- Ferri et Strychninae Citras, Iron and Strychnine Citrate,—Dose, gr. j-iij.
- Syrupus Ferri, Quininae et Strychninae Phosphatum,—each ʒ contains about gr. 1/90 of Strychnine, gr. j of Ferric Phosphate, and gr. j ¾ of Quinine. Dose, ʒj-ij.
Physiological Action. In small doses Nux Vomica acts as a bitter tonic, stimulates respiration, secretion, appetite and digestion, and sharpens the vision. It increases peristalsis, stimulates both the motor and inhibitory apparatus of the heart, and raises arterial tension by stimulating the vaso- motor centres, thus contracting the arterioles; though by full doses the arterioles are relaxed, and the blood-pressure lowered.
By a full dose (Strychnine gr. 1/10), the pupils are dilated, the limbs jerk, respiration becomes spasmodic, the lower jaw stiff; a sensation of cerebral tension, shuddering and anxiety; the face wearing an unmeaning smile.
A Toxic Dose (gr. ½ for an adult), on an empty stomach quickly produces heightened reflexes; tonic spasms, especially of the extensor muscles, on the least irritation, quickly succeed each other, with intervals of repose; resulting, after two or three hours at most, in death by asphyxia, from tetanic fixation of the muscles of respiration; consciousness being preserved until CO2 narcosis sets in.
Strychnine exalts all the functions of the spinal cord, reflex, motor, vasomotor, and sensory,—the latter being least affected. It has selective action on the large multipolar ganglia in the anterior columns, which it stimulates, and then paralyzes by over-stimulation A large dose destroys the spinal functions as by one blow. It does not affect the brain directly.
Thebaine, the tetanizing alkaloid of Opium, has an action very similar to that of Strychnine, being a powerful spinal exaltant.
Strychnine-Spasms are differentiated from Tetanus-Spasms—by remembering that the former are intermittent, the latter constant. Furthermore, the meaningless smile, the less marked trismus, the absence of a wound, the rapid course of the symptoms, all point to the action of Strychnine.
Treatment of Strychnine-Poisoning. The Antidote is Tannic Acid, to form the insoluble tannate. Then emetics or the stomach-pump, followed by perfect quiet, which is very important. Antagonists are Chloral, Chloroform, Chamomile Oil, Physostigma, Tobacco and Potassium Bromide, the latter being so slow of action that it is rarely available. The bladder must be frequently evacuated, to prevent re-absorption.
Therapeutics. Nux Vomica and its chief alkaloid hold high rank as respiratory, cardiac, muscular and nervous stimulants and stomachic tonics. These powerful poisons are equally powerful remedies in—
- Atonic Dyspepsia,—Tincture of Nux Vomica, gtt. v ter die, before meals.
- Gastric Catarrh, especially that of drunkards,—the Tincture is excellent, and gives therein entire satisfaction if a little Capsicum is given with it.
- Opium poisoning,—Strychnine is powerfully antagonistic to Morphine.
- Constipation, when atony of the bowels,—the Tincture in 10-drop doses is very efficient; not as a purgative, but by increasing peristalsis.
- Diarrhoeas and Dysentery of epidemic type ,—are well treated by Strychnine.
- Vomiting of Phthisis,—Nux Vomica is generally one of the best remedies.
- Anaemia and Chlorosis,—Strychnine with Iron and Quinine, is invaluable.
- Tetanus, especially the idiopathic type—has been often cured by Strychnine.
- Neuralgias, especially the visceral ,—Strychnine in very small doses.
- Local Paralyses of various types—are well treated by injecting Strychnine hypodermically into the affected muscles, about once a week.
- Hemiplegia, not when recent, nor when the muscles have lost their electrical contractility, but when degeneration is about to set in,—Strychnine is an excellent remedy in most cases.
- Diphtheritic Paralyses,—are almost invariably cured by Strychnine.
- Amaurosis, from lead, tobacco or alcohol,—Strychnine has proved useful.
- Cardiac Failure from any cause,—Nux Vomica in very small doses, frequently.
- Dyspnoea from pulmonic affections,—Nux Vomica as a respiratory stimulant.
- Intermittents,—as adjunct to Quinine, Strychnine is used advantageously.
- Nervous Cough, and the cough of habit,—Nux Vomica is curative.
- Chronic Alcoholism,—Strychnine in full doses, hypodermically, thrice daily, has been successfully used for many years, and is the basis of the so—called "Bichloride-of-Gold" cures.
A Compend of Materia Medica, Therapeutics, and Prescription Writing, 1902, by Sam'l O. L. Potter, M.D., M.R.C.P.L.