This drug owes its activity to strychnin, a most toxic alkaloid. Practically the entire action of Nux vomica or of strychnin is exerted upon the nervous system: the irritability of the spinal cord and the central nervous system becomes greatly increased. There is an increase in the susceptibility to ordinary stimuli, and after larger doses, convulsions, due to the stimulation of the cord, very quickly make their appearance. Consciousness is retained until death takes place, due to asphyxia.

That the convulsions are of spinal origin is proved by removing the brain, when it is found that they still continue. In animal experiments, artificial respiration may cause a cessation of the spasms caused by strychnin. The convulsions are opisthot-onoid in character, because the extensor muscles contract simultaneously with and are stronger than the flexors.

Irritation of sensory nerves is necessary in order to produce strychnin convulsions, since the spasms do not occur after the skin has been cocainized, or after complete blocking of all the sensory nerves.

Nux vomica stimulates the medullary centers, with a subsequent increased strength of respiration and a rise of blood pressure. The rise of blood pressure is due to some effect upon the vasomotor centers and also to a direct action on the vessel walls.

There is produced by strychnin a decided increase in the acuteness of all the special senses. The field of vision, the acuteness of hearing and the sense of smell are all increased. These phenomena precede those resulting from stimulation of the cord. The abnormal acuteness of vision owes its origin to the direct action of the alkaloid upon the retinal cells. These effects, except those of vision, are the result of an action on the central sensory tracts in the cerebrum.

The heart rate becomes slower, through stimulation of the vagus. The heart muscle is not stimulated by strychnin; in fact, the amplitude and rate are decidedly depressed. By an increase in the irritability of the cardiac inhibitory and ac-celeratory centers, normal stimuli may produce more profound and beneficial changes in the musculature of the cardiac apparatus. It must be remembered, however, that even this favorable cardiac response to strychnin is somewhat antagonized by the depression of the cardiac muscle tissues?

Therapeutic doses cause striated muscle to perform a greater amount of work than otherwise. The "receptive substance" is presumably the point stimulated by strychnin in producing this result. When strychnin is absorbed even in extremely small quantity, the secretory and gastric motor mechanisms of the central nervous system are rendered more susceptible to stimuli, hence an increase in tone results.

Heat production is augmented because Nux vomica increases the general metabolism. This is a secondary, rather than a primary effect. Any rise in temperature which might otherwise occur, is prevented by increased heat dissipation

The excretion of sweat may be somewhat increased, an effect which is produced by anything which stimulates the spinal centers.

While Nux vomica and strychnin may be considered pharmacologically as identical in action, yet differences exist when each is studied in regard to its finer action. From this latter standpoint, and when close therapeutic distinctions are made, it is quite apparent that the one does not have exactly the same effects as the other and that they should not be used interchangeably.

Therapeutics

Nux vomica suggests overdosing with patent and other medicines, particularly those containing laxative ingredients or embodying various narcotic preparations, such as opium and its derivatives. Overindulgence in rich and spicy food, especially when washed down with copious libations of strong alcoholic wines or liquors and accompanied by the smoking of strong cigars, will frequently bring about a disordered state of gastric and mental irritability, for which this medicine is eminently suitable.

The Nux vomica patient represents, in short, a certain distinctive type - the keen, active, overworked, hurried and nervous professional or business man, who seeks distraction from the daily cares and annoyances of life in late hours and the pleasures of the table. Taking little or no exercise, leading sedentary indoor lives, such patients are quite likely to be chilly, constipated and irritable. Sleep is apt to be broken, especially in the early morning hours, when, at about three o'clock, the Nux patient is apt to find himself awake and unable to fall asleep again.

He is wide awake, but after much restless tossing, finally drowses off, only to waken at the usual rising time, feeling dull and miserable, with frontal or occipital headache and disagreeable bad, bitter or sour taste in the mouth.

Hypochondriacs often need Nux, especially when they are at the same time quarrelsome, spiteful, hypersensitive to external impressions, to bright light and to noises. Difficulty in thinking is characteristic, with dread of attempting any literary or similar mental work.

Vertigo is common, as though the brain were whirling in a circle, worse after eating, particularly after dinner. A sense of intoxicated confusion in the head, is common. Headache in the morning in bed, gradually improving after rising. Headaches which are caused by drinking alcoholic liquors or from coffee, but relieved by remaining quiet* and in a warm room, will often need Nux vomica.

Coryzas with thin, excoriating, watery discharge, sneezing, chilliness and scraping soreness of the throat, all aggravated in the morning, will require this medicine. In these conditions there is likely to be present frontal headache and relief to the nasal obstruction in the open air.

Functional disorders of the stomach, embracing the numerous complaints commonly included by the term dyspepsia, need Nux vomica when these disorders occur in the type of patient already described and the latter complains of a sensation of a lump or stone in the stomach, coming on an hour or so after eating. Constipation is present, with much fruitless urging to stool, due to irregular, fitful peristaltic action, especially of the small intestine. The tongue is coated brownish, yellow or white, with bitter or sour taste, nausea and a feeling that if he could only vomit, the patient would feel so much better. Headache, either frontal or occipital is present, with a general aggravation of the condition in the morning.

Nux vomica is at times extremely useful in acute diarrhea for which "cholera" or other mixtures have been unsuccessfully given, when the patient has a frequent, often entirely ineffectual desire for stool, with temporary, immediate relief after stool. Chilliness is commonly present, and this is decidedly accentuated, if the patient uncovers, or if the least air strikes him. The latter symptom is very characteristic of Nux.

In incipient spinal diseases Nux may be of distinct aid, especially when a history of sexual and alcoholic excess is present, which has led to paralysis, trembling and numbness of the extremities. Convulsive seizures, aggravated by the least noise or by a draft of air, with tetanic muscular rigidity or with the presence of opisthotonos, may be relieved by Nux vomica.

A simple backache or lumbago will be helped by Nux, when the patient is unable to turn over in bed without first sitting up. Backache caused by sexual excess and which is worse in the morning in bed, or on first rising, will often need the remedy.

Hemorrhoidal affections, when present with the typical constipation, are likely to be helped by Nux vomica. The hemorrhoids may be blind or bleeding, with a sensation of rectal constriction and a feeling after stool, as though more stool could be evacuated by continued pressing and straining.

In the gastric disturbances which need this remedy there is often a peculiar abnormal appetite or hunger, which precedes the attack by twenty-four, or even thirty-six hours.

Nux is at times useful in a dry, tickling cough, which is especially annoying from midnight until morning, accompanied at times by soreness in the chest, or by scraping soreness in the throat. Coughs which have been treated with cough mixtures, especially those containing opium or codein, will frequently need Nux vomica.

The remedy is a valuable one in everyday practice, suiting many common ail-ments, but must only be prescribed when the peculiar type of irritable, nervous, sensitive temperament is evident.

Characteristic Symptoms Of Nux Vomica

1. Careful, jealous persons, inclined to get excited and angry, or of a spiteful, malicious disposition.

2. Hypochondriac mood; worse after eating, especially in those of sedentary habits or in those who dissipate; with abdominal sufferings, constipation and hemorrhoids.

3. Coryza; fluent during the day, and stopped up at night.

4. Constipation, with frequent and ineffectual desire for stool, and sensation of constriction of rectum.

5. After stool, sensation as if more remained but could not be evacuated.

6. Menses a few days before the time, and rather too copious, or keeping on for several days longer, with complaints at the onset and remaining after the period is over.

7. Dry, fatiguing cough in the evening after lying down, or very early in the morning, also with roughness, rawness and scraping of chest.

8. Awakes at 3 A. M., lies awake for hours with a rush of thoughts, falls into a dreamy sleep at daybreak, from which he is hard to arouse, and then feels tired and weak, and averse to rising.

9. Sleepy in the early evening and sleepless at night.

10. Ailments from continued mental labor.

11. After aromatics in food, or as medicine, especially ginger, pepper, etc., and after almost any kind of so-called hot medicines.

12. Feels worse in the morning, soon after waking, also worse after mental exertion and after eating.