Curara, as has been stated, produces an obvious rise of temperature in the extremities. This is supposed to be due to paralysis of the peripheral vessels. In the interior of the body, however, there ensues an equally constant decline of body-heat (Tscheschichin, Röhrig und Zuntz). This lowering of the central temperature is due to the loss of heat at the periphery by the cooling of the blood detained in the superficial vessels.

Bernard long ago ascertained that curarized animals became diabetic. It seems probable that this result is due to the paralysis of the vessels of the liver. On the other hand, Bock and Hoffmann have apparently demonstrated that the production of glycosuria is the result of increased activity of the liver. It may be due to the fact that the sugar formed does not undergo oxidation, for Jolyet has ascertained that in curarized animals the excretion of carbonic acid is much below the amount in health. By reason of the changes in the vascular supply, curara affects the functional activity of various organs. The increased production of saliva, and of the nasal and intestinal secretions noted at the outset, is due, there is little doubt, to this fact.

The elimination of curara takes place chiefly by the kidneys, but some escapes with the faeces (Koch). The urine of a curarized animal will poison another animal, and this may be repeated to several subjects. The retention of the urine charged with curara, in the bladder, will continue the effects of the poison by reabsorption. This statement has been the subject of considerable controversy. It has been denied that the mucous membrane of the bladder possesses the power to absorb again into the circulation poisons dissolved in the urine in the process of excretion. Brown-Séquard appears to have been the first to prove, by direct experiment, that alkaloids could be thus absorbed, and some recent observations have confirmed the accuracy of his experiments. In respect to curara, as to other organic alkaloids, when poisoning occurs, it is an obviously proper expedient to keep the bladder empty, if necessary, by catheterization.

Curara Therapy

The applications of curara to the treatment of disease follow from the results of the physiological study. Being a motor and not a sensory paralyzer, it is adapted to the treatment of muscular cramp and spasm. It is one of the remedies employed against strychnine-poisoning, and although from the theoretical standpoint such treatment may seem proper, yet in actual practice it has not succeeded. That a remedy obtained from members of the strychnos family, and a paralyzer in action, should antagonize strychnine, is a remarkable fact. In the process of preparation employed by the Indians, it is in a high degree probable that methyl strychnium is formed, and this substance, as was originally shown by Crum-Brown and Fraser, is a paralyzer, and acts precisely like curara. Curara has been used with a limited measure of success in tetanus. In the successful cases—for example, that narrated by Mr. Spencer Wells—large doses were administered. According to the statistics of Demme, of twenty-two cases of tetanus treated by this agent, eight recovered. Other methods have certainly succeeded better. Two cases of hydrophobia have been reported in which a cure followed the use of curara. One of these, reported by Dr. Watson, was examined, and the diagnosis confirmed by Dr. Flint, of New York. The first dose was 1/16 gr., and subsequently 1/9 gr. and 1/6 gr. were given. The value of this statement is impaired by the fact that the different specimens vary so much in activity. M. Vella has successfully treated a case of tetanus by cutaneous absorption of the agent; but the usual mode of administration has consisted in the subcutaneous injection. This subject, as M. Vulpian has well said, has lost its interest since the discovery of the utility of chloral. It is in a high degree probable, however, that curara would be greatly more successful if it were pushed in these cases to obtain its full physiological influence, and the complete suspension of the spasms.

By Voisin and Liouville curara has been extensively employed as a remedy for epilepsy. The facts already mentioned in regard to the action of this agent in producing febrile phenomena were obtained from the experiences with epileptics. They find that attacks may be prevented, and the condition of epileptics much improved, by the timely administration of this remedy.

It has proved useful in chorea, in tic-douloureux (Beigel, Du Cazal), but other remedies are doubtless better.

Authorities referred to:

Beigel, Dr. H. Journal of Anatomy and Physiology, vol. ii, p. 329.

Bernard, Cl. Lecons sur les Effets des Substances Toxiques et Médicamenteuses, Paris, 1857, p. 238.

Bohh, Dr. R. Beiträge zur Physiologie, 1886, p. 173. Quoted by Virchow und Hirsch's Jahresbericht for 1886.

Hammond and Mitchell. The American Journal of the Medical Sciences, July, 1859. Experimental Researches regarding Carroval and Vao.

Kolliker, A. Virchow's Archiv, Band x, p. 3. Physiologische Untersuchungen über die Wirkung einiger Gifle.

Riegel, Dr. Franz. Centralblatt f. d. med. Wiss., 1871, p. 401. Ueber den Einfluss des Curare auf die Körpertemperatur.

Tarchanoff, M. J. Archives de Physiol. Norm, et Path., January and February, 1878. De l'Influence du Curare sur la Formation de la Lymphe et l'Émigration des Globules blancs du Sang.

Voisin et Liouville. Gaz. Hebdom., Nos. 32-37, 1866.

Vulpian, A. Lecons sur l'Action Physiol, des Substances Toxiques et Medicamenteuses Paris, 1881, pp. 193-422.

Watson, Dr. American Journal of the Medical Sciences, July, 1876.

Zeleuski, Dr. Virchow'ss Archiv, Band xxiv, p. 362. Zur Frage von der Muskel irritabilität.