This section is from the "A Practical Treatise On Materia Medica And Therapeutics" book, by Roberts Bartholow. Also available from Amazon: A Practical Treatise On Materia Medica And Therapeutics
This important therapeutical measure needs to be separately discussed. The solution which the author advises is as follows: Rx Strychninae sulphat., gr. j; aquae destil. vel aquae lauro-cerasi, oz j. M. Sig.: Ten minims contain one-forty-eighth of a grain. Some heat is usually necessary to procure a perfect solution.
"The effects of strychnine," as has been well remarked (Echeverria), "are widely different when administered hypodermically or by the mouth. By the latter method the quantity may be repeated and increased, unsuccessfully, . . . and yet a smaller dose of the substance, exhibited hypodermically, be capable of regenerating at once the lost muscular power."
The indications for the subcutaneous use of strychnine are precisely as those given above for its stomach administration: it is contraindi-cated in cases of hemiplegia when the injury to the brain has been recent. It generally does no good, but harm, when the paralyzed muscles are rigid. It is most useful in old cases of hemiplegia, the subjects not being advanced in life, the paralysis incomplete, the muscles flaccid but not wasted, and having preserved their electro-contractility. Very remarkable improvement not infrequently follows from this mode of treatment in suitable cases.
The hypodermatic injection of strychnine sometimes is entirely successful in curing paraplegia, but the limits of its utility are well defined. It is not proper, and is in every way injurious, in acute cases involving structural alterations of the spinal cord. In doubtful cases, a strychnine injection may be used as a means of diagnosis between structural and functional diseases of the cord: in the former, the symptoms are increased in definition; in the latter, they are ameliorated by the injection. This mode of using strychnine is curative in reflex paraplegia, in paraplegia due to anaemia of the cord, in hysterical paraplegia, and in those cases of paresis of the muscles of the inferior extremities due to concussion of the cord, to rheumatism of the meninges, and to syphiloma, after the local morbid process has • ceased.
In infantile paralysis, the hypodermatic injection of strychnine is an important addition to other means of treatment. If the electro- contractility of the affected muscles is not lost, very beneficial results may be expected: the injection promotes the capillary circulation, and increases the growth and power of the muscles.
In no form of paralysis is the use of strychnine more conspicuous for good than in diphtheritic paralysis. Few cases are not promptly benefited and most are quickly cured. The utility of the subcutaneous injection of strychnine has been most signally exhibited in the local paralyses; e. g., facial paralysis, aphonia from paralysis of the vocal cords; paralysis of the extensors by lead; paralysis of the sphincter vesicae, of the sphincter ani, etc.
The mode of practicing the injection is of considerable importance. The solution should be thrown into the substance of the paralyzed muscles. For example, in hemiplegia, the muscles in turn, of the paralyzed side, should be pierced by the needle, and the solution discharged into them. In drop-wrist the extensors should be grasped, made tense, and the needle of the syringe be thrust well into them. In paralysis of the sphincter ani and prolapse of the bowel, the muscle affected should be penetrated by the needle. When the affected muscles are beyond reach, the injection may be practiced at any indifferent point.
Next to the treatment of paralyses, the most frequent application of strychnine by the hypodermatic method is in certain ocular maladies. In the normal condition, strychnine affects the visual functions. Hippel first studied these effects, afterward Sandi and Cohn, and subsequently, in France, Coumétou and Rouire. According to Coumétou, strychnine augments the excitability of the retinal elements, increasing the sharpness of vision, central and peripheral, and also enlarging the visual field. He advises its use in amblyopia without lesions, dependent on functional disorder of the retina, and says it may also, if the lesions are not too far advanced, effect favorable changes in chronic diseases of the optic nerve and retina. Rouire also agrees with previous observers in stating that strychnine affects the optic nerve-fibers, increasing the normal acuity of vision and enlarging the visual field. He advocates its use in tabetic atrophy, and calls attention to the fact that in certain atrophies good results are obtained only by a progressive increase in the amount administered. In these ocular maladies the solution may be injected in the temple, or in the nape of the neck, taking the usual precautions against accident.
In infra-orbital neuralgia, good results have been obtained from the subcutaneous injection of strychnine. This practice may be very useful in neuralgia characterized by anaemia and depression. It may also be highly serviceable in epilepsy, the cases selected according to the rules already defined.
Authorities referred to:
Bernard, Cl. Lecons sur les Effets des Substances Toxiques et Médicamenteuses, Paris, 1857.
Brunton, Dr. T. L. St. Bartholomew's Hospital Reports, vols, xii and xv.
Busch, Dr. Berliner klin. Wochenschrift, No. 37, 1874.
CoumÉtou, Dr. Thése de Paris. Strychnia dans la Chirurgie Oculaire.
Delioux de Savignac, Dr. Bull. Général de Thérap., 1871, January, February, and March.
Echeverria, Dr. M. Gonz. Treatment of Paralysis by the Hypodermic Injection of Strychnine. Connecticut Med. Society, Trans, for 1868.
Eulenburg, Dr. Albert. Lehrbuch der functionellen Nervenkrankheiten, Berlin, 1871, p. 450. Also, Hypodermatische Injectionen.
Falck, F. A. Archiv für experimentelle Pathologie und Pharmacologie, Band iii, p. 77.
Freusberg, A. Ibid., Band iii, p. 204 u. 308. Ueber die Wirkung des Strychnins und Bermerkungen über die reflectorische Erregung der Nervencentren.
Gorochofzeff, N. Deutsche Klinik, xl, 1874, p. 316. Versuche mit Strychnin.
Holtenhof, Dr. Lyon Medicate. Quoted by Annuaire de Thérapeutique, 1877, p. 65, et seq.
Haughton, Dr. Samuel. The British Medical Journal, June 22, 1872, p. 660. Poisoning by Strychnine treated by Nicotine.
Heinemann, Dr. Carl. Virchow's Archiv, vol. xxxiii, p. 394.
Hunter, Mr. Charles. Pamphlet containing reprints of various papers on Hypodermic Injections.
Jochelsohn, Dr. On the Influence of Artificial Respiration over Poisoning by Strych-nine. London Medical Record, vol. i, p. 82.
Klapp, Dr. W. H. The Journal of Nervous and Mental Diseases, vol. v, 1878, p. 619,
Leube, Dr. William. Archiv für Anat. und Physiologie, 1867, p. 629.
Kolliker, Prof. Dr. Virchow's Archiv, Band x, p. 239.
Mayer, Dr. S. Archiv für experimentelle Pathologic und Pharmacologie, Band ii, p. 458,
Nagel, Prof. Dr. Berliner klinische Wochenschrift, vol. viii, p. 6, 1861
Schlesinger, Dr. London Medical Record, vol. ii, p. 35. Spitzka, Dr. E. C. Journal of Nervous and Mental Diseases, vol. vi, 1879. Vulpian, Dr. Archives de Physiologie, Normale et Pathologique, 1870, p. 116 et seq.