In nervous disease strychnine is extensively employed, but its use requires careful discrimination. Its application is as follows:

(a) In the postoperative paralysis of stomach or intestine the drug would seem to be the best that we have.

(b) In paralysis from disease of the anterior horn cells (anterior poliomyelitis, progressive muscular atrophy, amyotrophic lateral sclerosis) moderate improvement may come from increased transmission of the regular afferent impulses.

(c) In lesions involving the posterior columns of the cord (e. g., locomotor ataxia) the result is problematic. Large doses may bring about improvement in some of the functions, but often are of no value at all.

(d) In sexual feebleness without evidence of an organic lesion the effect on the reflexes may be of value.

(e) In paralysis due to lesions of the motor area of the brain, or of the motor tract of brain or cord, the tendency of the drug is harmful; for the reflexes of the cord below the lesion are cut off from the normal cerebral control. As a result, they are so heightened in activity that they approach the incoordinated type. The muscles are in a state of overtone, and in voluntary motion the opposing muscles do not readily relax; so it requires but slight provocation to bring the limb into a state of spasticity or rigidity with perhaps clonic contraction of the muscles (as in the spastic gait). Therefore in hemiplegia, multiple sclerosis, transverse myelitis, and other conditions with spastic paralysis, strychnine would tend to increase the already bad condition. The writer found a man with multiple sclerosis who was being given two pills of aloin, belladonna, and strychnine, 1/60 grain (0.001 gm.) in each three times a day, together with strychnine sulphate, 1/30 grain (0.002 gm.), and a dose of Bright's tonic, containing strychnine sulphate, 1/60 grain (0.001 gm.). The amount of strychnine sulphate being administered was thus 1/12 grain (0.005 gm.) three times a day. He was in such a spastic condition that he could not walk, and could scarcely use his hands to button his clothes. The substitution of bromides for the strychnine resulted in a marked improvement in two days.

(/) In diminished vision, whether functional or from retinitis or partial optic nerve atrophy, large doses sometimes give good results. In these cases the drug may be given internally in the usual way; or, if the eye only is to be treated, may be injected into the neighborhood of the affected eye, or even in 1 per cent. solution dropped into the eye.

Contraindications

Spasmodic conditions of all kinds, as - (a) Of smooth muscle - spasmodic asthma and biliary, renal, or intestinal colic, or spastic constipation; (b) of voluntary muscle - hiccup, convulsive tic, epilepsy, and any spastic condition, as from a lesion involving the motor area or tract. Strychnine or nux vomica should not be given if the reflexes are already overactive.

Administration

For a bitter effect, the tincture of nux vomica is preferred (10 minims = 1/100 grain of strychnine, or about 1/80 grain of strychnine sulphate). It is given about ten minutes before meals, diluted with water to make a bitter drink. For the purposes of a bitter it is useless if given in capsules or coated pills. For a tonic effect any of the preparations may be employed, the strychnine salts being frequently prescribed by themselves in the form of tablet triturates. For hypodermatic use, the strychnine salts alone are suitable.

As camphor has already been considered, and the other central stimulants, atropine and cocaine, are at the same time pronounced peripheral depressants, we shall defer their consideration for the present.