The only other symptom that requires mention is the protrusion of the eyeballs, as observed by Voisin and Lionville. On the whole, the position of curara among narcotic poisons must be considered as very peculiar; and it is certain that only a few closely resemble it in action, - conia, for instance, and some of the methyl-bases, of which Drs. Fraser and Crum Brown have made such interesting experimental trials.

Therapeutic Action. - The medicinal properties of curara have as yet scarcely been investigated.

In Tetanus, as might be expected, it has received considerable attention, and the results obtained have undoubtedly been encouraging. Four cases under Italian physicians are mentioned in the Union Medicale, 1869. The first was one of idiopathic tetanus, treated by Dr. Capozzi. Here the curara was injected subcutaneously in doses of 1/6 grain, increased to 1/2 grain, twice daily; about five grains in all completed the cure. A case under Dr. Merra was treated by injection with 1/6 grain doses, and the patient recovered in a fortnight. A third patient was under Dr. Nobis, in whose hands about 12 grains, administered in small doses, proved successful. A fourth was a traumatic case, under Dr. Gherion. Sixty-four injections, varying from 1/6 grain to 1/2 grain of curara, quite cured the patient. An important case occurred also under Chassaignac.1 A young man had a gunshot wound of the foot; at the end of a fortnight trismus and opisthotonos set in. Chassaignac gave 1 1/2 grains of curara by the mouth, and ordered the wound to be syringed with an aqueous solution of curara, 1 part in 1,000. This produced a diminution of the spasms; the strength of the solution was then increased by 50 per cent. On the sixth day of tetanus there was a relapse; the internal doses were increased, and the curara lotion was raised to double its original strength. On the following day there was much improvement, and on the sixteenth day the tetanus had altogether disappeared. This case has been criticised as being probably an example of chronic tetanus spontaneously subsiding; but for this to be true, the connection between remedy and effect seems too close.

One of the most important papers on the use of curara in tetanus is that of Professor Busch, of Bonn; it is drawn from Busch's experience of the war in Bohemia in 1866. Busch had 21 cases of tetanus in the field hospitals, 14 of which were fatal. Out of these 21, he treated 11 with curara, the patients recovering in 6 of them; though one of these last seems to have owed his escape rather to the repeated use of hypodermic morphia than to the curara with which the treatment was commenced. Busch administered the curara hypodermically in doses of from 1/10 to 1/4 grain. His own conclusion was, that in the very severest cases of all, curara was inferior in power to hypodermic morphia.

The testimony of Demme is also very striking: he obtained his experience in the Italian war of 1859, in which there were 86 cases of tetanus on the Austrian side, and 140 on the Italian. He treated 22 cases with curara, and out of these obtained 8 cures. In order to appreciate the value of such facts as those of Busch and Demme, it is well to call to mind what is the usual mortality of traumatic tetanus in war: this, it is needless to say, is enormous - greater than that which occurred under curara-treat-ment in the hands quoted. Thus Demme, out of the whole number of cases which he treated, only saved 7 per cent.

There is no doubt that the subcutaneous plan is far preferable to any other mode of administration, and that curara by the mouth is unnecessary and untrustworthy. On the whole there is a very encouraging amount of evidence in favor of curara in tetanus, if we look at the matter with sober and reasonable expectations. Certain cases of tetanus will, it may be feared, always remain among the list of necessarily fatal maladies; the personal or inherited nervous constitution of the patients rendering them peculiarly easy victims to the kind of influence which sets up fatal tetanus. It ought to be no serious discouragement to the use of curara that it has failed in such exceptionally severe and rapid cases as those recorded by Vulpian.1 Some other instances that have been cited against curara in tetanus are equally inconclusive: thus, a case (from Professor Schuh's Clinic2) of traumatic tetanus was fatal; but it was one of extreme severity, as attested not only by the rapid course, but by the unusual amount of positive material lesion found after death in the cord; yet even here the curara produced very striking temporary amendment.

1 Journal de Med. et de Chir. pratiques, 2 serie, ¶ 5722.

On the whole, it would appear very desirable that curarine should be exclusively employed in order to insure uniformity of effects; but it appears that at present there is much difficulty in obtaining this alkaloid, which is not easily prepared. In the meantime, curara can now be obtained of one or two of our best pharmaceutical chemists, of a considerably more uniform strength than formerly.

In Strychnia-poisoning, curara has also been warmly recommended; but its claims to confidence are very doubtful. It would appear that against the violent spasms of the respiratory muscles which strychnia produces, the doses of curara, to be effective, would have to be so large that there would be very great probability of inducing complete curar-ism, during the maintenance of which it would be necessary to keep up constant artificial respiration. Considering the apparently much greater benefits which are offered by nicotine (without these disadvantages) in strychnia-poisoning, it can scarcely be worth while to use curara for this urpose.

In Chorea, curara has been tried with very different results in different hands; and, on the whole, nothing can be said to be definitely established in its favor.

In Epilepsy, also, curara was loudly vaunted at first; but the comparatively recent experiments of Beigel give little encouragement to the idea that it is really effective. He employed it in both large and small doses.

In Facial Spasm, Gualla found curara effective when other remedies had failed.

Preparations and Dose. - Non-officinal. A solution should be given subcutaneously in the commencing dose of 1/10 grain, repeated as may be necessary. As different samples of curara vary in quality, the first few doses should be administered with caution.

Of curarine it is unfortunately impossible at present to state the proper dose with any precision. Preyer considered that the alkaloid has twenty times the power of curara, but Beigel's researches with Preyer's own curarine make it very doubtful whether the proportion is so high as this. Subcutaneous injection is, of course, the only mode of administration to be thought of in the case of curarine. The dose can at present be only stated with reserve, as probably ranging from the 1/60 to 1/30 grain. Mar-quart of Bonn is the best maker.

1 Union Med., No. 7, 1857.

2 Schmidt's Jahrbuch, 118, p. 292.