This section is from the book "Materia Medica And Therapeutics - Vegetable Kingdom", by Charles D. F. Phillips. Also available from Amazon: Materia Medica And Therapeutics: Vegetable Kingdom.
There is one form of paralysis - that, namely which is limited to one or two groups of muscles - in which a remarkable and very effective employment of strychnia has been devised by Mr. Barwell. He adopted it chiefly in cases of infantile paralysis of old standing, when the atrophic process had gone so far as to much impair the electric sensibility, even to a constant current. He employed a 2 per cent. solution of hydrochlorate of strychnia, and in some instances injected as much as 1/6 grain. When Mr. Barwell first brought forward these cases, it was suspected by most persons that there must be some mistake, since very much smaller quantities, subcutaneously injected, had several times been known to induce alarming symptoms. But the solution, being examined, was found to be exactly of the represented strength; and as Mr. Barwell made a point of injecting quite into the substance of the paralyzed muscles, it was certain there was no waste of the fluid. After Mr. Barwell had brought forward a number of such cases in which great good had been effected by the strychnia injections, other persons ventured to try it; and the success has proved remarkable, while not a single accident has occurred. It is now conceded, by all who have studied the matter, that the high concentration of Mr. Barwell's solution is what localizes its action; such a solution as the one described is highly irritant, and, when injected into the belly of a muscle, it at once sets up inflammation around, and becomes enclosed, instead of mingling with the general circulation. A weaker solution would be far more dangerous to life. The local injection has been practised in France with much success for the treatment of prolapsus ani, only here the solution has been much weaker (1 in 1,000). Of such a solution 10 or 15 drops were used by Dolfear and Foucher. This operation would probably be far safer if performed with the concentrated fluid used by Barwell.
In Anaesthesia of functional character, the good effects of strychnia are often very marked - a circumstance which illustrates the difference between the poisonous and the therapeutic actions of the drug, since among the former we scarcely find any direct and evident effects upon common sensation.
In Tremors and Atactic Movements of many kinds (though not in true locomotor ataxy, which is an organic disease), strychnia has proved very useful. It is of much value, for instance, in the tremor of chronic alcoholism; here it is probable that a part of the beneficial action is due to its influence in removing the catarrhal condition of the stomach, an organ upon which we shall see that strychnia has a powerful influence. In chorea, particularly in those cases where fright, or the disturbing effect of commencing puberty, rather than rheumatism, is the principal cause, strychnia in minute doses (1/80 grain ter die for a child of ten years, 1/60 to 1/40 grain after puberty) has often been found of much use. In some cases of hysteric tremor, where the hysteria is merely the product of great bodily weakness, induced by illness or exhausting fatigue, it is similarly beneficial.
In Dyspepsia of the simple atonic form, strychnia, or tincture of nux-vomica, is often of the highest possible value; it is best alone, but an excellent combination is tincture of nux-vomica and diluted nitric acid, 5 or 10 minim doses of the first and 15 of the latter. I have already mentioned its good influence upon the irritated stomachs of drunkards; it may be added that heartburn, hiccough, regurgitation, and even pyrosis, when the origin is chiefly due to an atonic condition of the muscular walls of the stomach and functional languor, may frequently be cured by a short course of this medicine. It is often very useful in the morning-sickness of pregnant women. Abdominal cramps and spasm are quickly overcome by it.
In Atonic Conditions of the Bowels, also, strychnia is of great service, especially in that almost hopeless-looking form of constipation in which the large bowel almost ceases to contract, and becomes passively loaded with more and more faeces day after day. In prolapsus ani, arising from such a state of the rectum and sphincter, Dr. Schwarz strongly recommends nux-vomica; and I agree with him, and can speak with equal emphasis of its benefit in haemorrhoidal tumors of the anus. Five to ten drops of the tincture of nux-vomica, taken in a tumbler of cold water before breakfast and dinner, act as a laxative, and often overcome most obstinate constipation.
In Epidemic Dysentery and Diarrhoea, nux-vomica is often of much service, especially when given in conjunction with mineral acids.
In Coldness of the Feet, from languid capillary circulation, Dr. Anstie has seen much benefit induced by minute doses of strychnia.
In Neuralgias of various kinds, strychnia has often proved most useful. Probably its utility is greatest in cases where the pain is visceral rather than superficial; in hepatalgia, for instance, and in the milder forms of angina pectoris, and in gastralgia, it has been found of much benefit. In the latter disease the use of tincture of nux-vomica has long been a favorite and very successful remedy, though there are intractable cases, of course, where this, like every other medicine, will fail. In all forms of neuralgia the dose of nux-vomica or of strychnia should be very small; there is seldom occasion to use more than 1/100 or at most 1/32 of a grain twice or three times a day.
In Cases of the Impairment of the Nervous Apparatus of Sight and Hearing, strychnia is believed by some authors to be very useful. As regards vision, no one, of course, expects it to do good in those diseases in which the nutrition of the retina is destroyed by complicated inflammatory or degenerative processes; but it has been rightly expected that cases of simple atrophy might be really improved, and there is reason to think that this sometimes takes place. The supposed improvement of nervous deafness by strychnia is more than doubtful.
In Spasmodic Asthma and in Dry Cold in the Head, nux-vom. ica and strychnia have often been used with great effect.
In Heart Weakness, strychnia may be spoken of as an excellent tonic; it is sometimes the first remedy which begins to do good in cases of fatty heart, when everything else that could be thought of has been tried. One caution must be added, however - namely, that any undue pushing of the remedy will produce, even more seriously than in other subjects, a state of nervous worry and restlessness, in which sleep is broken or even destroyed by a tendency to perpetual muscular movement. To the subjects of fatty heart this condition is not merely fatiguing and annoying, but positively dangerous; and we are therefore bound to inquire for the first symptoms of its appearance when administering strychnia to such persons.
In Intermittent Fevers, it has been proposed to substitute the use of strychnia for that of quinine; but so far as concerns the acute stages, there is no satisfactory evidence of its efficiency. In the stage of convalescence, however, the combination of strychnia with quinine and iron, in the shape of Easton's syrup, is spoken of with much approval by Dr. Maclean and other good authorities. (Strychnia has also been found of decided service in tetanus, chorea, and epilepsy.
"In 1847 Dr. Fell, of New York, published seven cases of tetanus, six of which were certainly of the traumatic variety, and which all recovered under its use. ... In chorea there is strong evidence of its antispasmodic virtues. Attention was first attracted to its power in this affection by Rougier and Trousseau. The former published ten cases of boys, between the ages of six and sixteen, who had suffered from the disease during various periods of from one month to four years. The duration of treatment varied between one and eight weeks. Only one of the cases relapsed, and that was cured by the same means. ... In epilepsy nux vomica was asserted even at the time of Murray to be a valuable remedy; and in 1838 Chrestien, of Montpelier, alleged that out of thirty cases treated by it, eight were entirely cured, and the remainder benefited. Since then nearly all who have written concerning the disease have either made no mention of strychnia, or have only done so to condemn it. But in 1867 Mr. W. Tyrrell, apparently unacquainted with the precedents to which we have referred, was led by the fact that conia, which controls the convulsions of strychnia, increased those of epilepsy, to conjecture that strychnia might be antidotal to epilepsy. Having treated sixty-nine cases with the medicine thus suggested to his mind, he found that in every case it exhibited a marked power in controlling and altering the convulsive attacks." (Stille.))
Preparations and Dose. - Tinct. Nucis Vomicae, m v. - xx. (.30 - 1.20); Extr. Nucis Vom., gr. 1/6 - 1/2 (.01 - .03); Strychniae Sulphas, gr. 1/100 - 1/20 (.0006 - .012).