Influenced by theoretical considerations, physostigma has been prescribed in chorea and epilepsy, but the results have not been encouraging. It is true, successful cases of chorea have been reported, but the influence of favorable hygienic surroundings and time is so great in uncomplicated chorea, that we may well doubt whether physostigma has any real influence. Of twelve cases of epilepsy treated by this agent, six were improved, and in the other six a notable increase in the number of the epileptic paroxysms took place (Williams).

In progressive paralysis of the insane, remarkable improvement has occurred under the use of physostigma in a few cases (Browne), but in others the results have been entirely negative (Williams). As in this melancholy disorder no remedies have hitherto been of any avail, it is a gratifying fact that in some cases Calabar bean has seemed to stay its progress.

Since it has been shown that physostigma lessens the activity of the respiratory function, lowers the action of the heart, and depresses the temperature, it has been used in bronchitis, congestion of the lungs, and pneumonia, with a degree of success which warrants more extended and systematic use.

Besides the various applications in ophthalmic practice growing out of the myosis produced by physostigma, it has been used with success in certain paralytic and convulsive states of the ocular muscles. In a case of paralysis of the third nerve, with ptosis, double vision, and immobile pupil, Wharton Jones effected a cure by the instillation of physostigma into the eye, whence he concludes that the myosis caused by this agent is due to the stimulation of the third nerve. Galezowski recommends the instillation of physostigma into the eye in cases of suppuration of the cornea and in amblyopia. Eserine disks (of gelatin) have been successfully employed in tic.

The experiments—thirty in number—of the British Medical Association Committee, with regard to the antagonism between physostigma and strychnine, have led them to the following conclusion:

"Although the symptoms produced by either substance were modified considerably by the action of the other, there was no instance of recovery from a fatal dose."

The antagonism between atropine and physostigma, at least to a considerable extent, has been well established, especially by the labors of Fraser. In 1864 Kleinwächter, influenced probably by the marked antagonism of the two agents on the pupil, employed physostigma with success in a case of poisoning by atropine. The British Association Committee, however, conclude as the result of their investigations that—" 1. Sulphate of atropine antagonizes to a slight extent the fatal action of extract of Calabar bean; 2. The area of antagonism is more limited than even Dr. Fraser has indicated in his paper on the subject.

"Thirty-one experiments, performed by the committee with hydrate of chloral and Calabar bean, have shown that—

"1. Hydrate of chloral modifies to a great extent the action of a fatal dose of extract of Calabar bean, mitigating symptoms and prolonging life.

"2. Hydrate of chloral, in some cases, saves life from a fatal dose of Calabar bean.

"3. If hydrate of chloral be given before extract of Calabar bean, so that the animal is deeply under the influence of hydrate of chloral before it receives the extract of Calabar bean, the symptoms produced by the latter are much modified, and life is saved from the effects of what would otherwise be a fatal dose.

"4. Chloral hydrate is of little service as an antagonist to extract of Calabar bean, if given some time after the latter. If the symptoms of the action of Calabar bean be in full operation, it will not save life, however it may modify symptoms."

Uses of Eserine

This alkaloid represents the powers of the plant, and is the most eligible form for internal administration, and for local use in ophthalmic therapeutics. Merck, however, maintains that the salicylate of physostigmine is the best preparation of the alkaloids, and it has been made official. The dose for internal and hypodermatic use ranges from -fa to fa of a grain. Gelatin disks of eserine are now most frequently employed for instillation into the eye, but a neutral solution of any of its salts is convenient for this purpose. It is now largely used to counteract the effects of atropine on the pupil; in iritis, to break away or prevent the formation of adhesions; in ulceration and suppuration of the cornea; after extraction of cataract, to prevent suppuration (Wecker); in the operation of iridectomy. The curative influence of eserine in these cases is due to its action in lowering the intra-ocular tension, in diminishing the conjunctival secretions by contracting the blood-vessels, and in checking the migration of the white blood-corpuscles (Wecker). Eserine may be substituted for physostigma for all purposes, by the stomach or hypodermatically

Authorities referred to:

Arnstein und Sustchinsky. Schmidt's Jahrbücher der gesammten Medicin, Band cxlii, p. 286.

Bennett, Dr. J. Hughes. Report of the Committee of the British Medical Association to investigate the Antagonism of Medicines. British Medical Journal, January 23, 1875.

Browne, Dr. J. Crichton. British Medical Journal, p. 60, January 10, 1874.

Fraser, Dr. Thomas It. An Experimental Research on the Antagonism between the Actions of Physostigma and Atropia, Edinburgh, 1872. (I am indebted to the courtesy of Dr. Fraser for a copy of this important memoir.)

Galezowski, Dr. Xavier. Gazette des Hộpitaux, 124, 1869.

Grunhagen, Dr. Virchow's Archiv, Band xxx, p. 521.

Hermann, Prof. Dr. L. Lehrbuch der experimentellen Toxicologie, Berlin, 1874, p. 337.

Jones, T, Wharton. The Practitioner, vol. iii, and vol. vii, p. 345.

Kohler, Dr. H. Experimentelle Beiträge zur Kenntniss der Herzwirkung des Calabart etc. Archiv für experimentelle Pathologie und Pharmacologie, 1873, p. 276.

Laschkewich, Dr. Virchow's Archiv, vol. xxxv, p. 294.

Laborde et Leven, MM. Gazette de Paris, 3, 6, 1870.

Papi, Clementi. (Gaz. Lomb.) Schmidfs Jahrbücher, vol cxlii,p. 286.

Roemer, Dr. B. St. Louis Medical Journal, 1873, p. 367.

Subbotin, Dr. Victor. Ext. sem. Physostigmatis venen. bei atonischem Zustande da Darmkanals. Archiv für klin. Medicin, vi, 2, 3, p. 285, 1869.

Watson, Dr. Eben. The Practitioner, vol. iii, p. 146, and Edinburgh Medical Journal, May, 1867, p. 999.