This section is from the book "A Treatise On Therapeutics, And Pharmacology Or Materia Medica Vol1", by George B. Wood. Also available from Amazon: Part 1 and Part 2.
M. Fouquier, a French physician, was the first who regularly employed nux vomica in the treatment of palsy. He was very naturally led to this application of the medicine by the consideration of its physiological operation, as shown by its effects as a poison, and fully developed and established by the experiments of Magendie and others on inferior animals. In palsy there is a loss of the power of voluntary motion. One of the most striking effects of nux vomica is muscular contraction. It seemed a very fair inference that the medicine would prove useful in the disease. On trial it was found to be so in many instances, and nux vomica is now an established remedy in paralytic affections.
A curious circumstance in the treatment of paralysis by nux vomica is, that the first effects of the medicine are felt in the paralyzed part. It is in this that the muscular twitching, the electric-like shocks, the formication, tingling, etc., characteristic of its action, are in general first experienced, especially in cases which are to end favourably. I know not how better to explain this curious fact than by supposing that each portion of the system, when under its ordinary healthful influences, is best able to resist disturbing causes; and that consequently the nervous centres which preside over the unparalyzed parts, being in the healthy state, are less readily thrown into disorder by contact with the medicine circulating with the blood, than the diseased nervous centres corresponding with the external seat of paralysis. Of course, this explanation implies that the diseased centres are only functionally affected; for, if disorganized, they become either insensible, or sensible only in an abnormal way, to the action of the medicine; and the fact is that, in cases of the latter kind, that is, when the nervous centres are organically affected, the paralyzed limb is not apt to exhibit this peculiarity, and the disease is not likely to yield to the remedy. It may, therefore, be regarded as an unfavourable sign, in reference to the remedial influence of nux vomica in palsy, when the effects referred to are displayed first in the sound parts, and little or not at all in the diseased.
But, though nux vomica was found to possess unquestionable powers over many cases of palsy, experience soon demonstrated that there were also many which were in no degree benefited by it. and that it sometimes proved positively injurious. This is what might have been anticipated from a consideration of the ordinary causes of palsy, and the mode of action of the medicine. In most paralytic affections the real seat of disease is in the nervous centres of the paralyzed part, or in the course of the connecting nerves; and this disease is very often of an organic character, that is, such as deranges or destroys the structure of the part affected. Most frequently it is hemorrhagic or inflammatory. Now to expect to restore to its healthy function, by the stimulant influence of nux vomica, a nerve or a nervous centre, already actively congested, or positively inflamed, or lacerated by effused blood, would be in the highest degree unreasonable. What might rationally be expected, under such circumstances, would be an increase of the inflammation or of the hemorrhage, and consequently a confirmation of the paralysis. When palsy, therefore, follows hemorrhage within the encephalon or spinal column, or attends inflammation of the cerebral substance or the medulla spinalis, nux vomica and its preparations should be scrupulously avoided, until the immediate effects of the injury shall have been remedied, and the nervous tissue have been restored as nearly as possible to its normal organic condition. Being now merely enfeebled, and unable to perform its function in consequence of this feebleness, all that is needed is a stimulus calculated to rouse it into action; and such a stimulus is happily afforded in the nux vomica. In the palsies, whether hemiplegic, paraplegic, or local, which are believed to originate in inflammation or hemorrhage, or other organic mischief, ample time should be allowed for the subsidence of the inflammation under suitable appliances, or for the absorption or isolation of the effused blood, and the repair of the injury inflicted by it, or for the removal of whatever other disorganizing condition may exist, before recourse is had to nux vomica. There can be no doubt that injury has often accrued from a neglect of this caution. Weeks or months, and sometimes many months, must be allowed to pass before the remedy is used. Hemorrhage generally requires a longer delay than acute inflammation, because a longer time is requisite to repair the mischief done. In hemiplegia following hemorrhagic apoplexy, it will in most cases be prudent to wait from four to six months, or even longer. When, moreover, under these circumstances, the medicine is begun with, the smallest doses should be first prescribed, and a careful watch kept so as to note the first sign of injury, and when it is presented, to suspend the remedy for a time. How far a complete restoration of the palsied part is to be accomplished in these cases of organic affection, depends upon the degree of permanent injury which the nervous tissue has suffered. When it recovers without injury, but merely debilitated, the palsy may be cured; but in very many instances there is only a partial restoration, and consequently only a partial relief of the paralysed part.
Hemiplegia yields much less frequently and less completely to nux vomica than paraplegia; chiefly, in all probability, because the former, connected as it generally is with disease of the brain, is much more frequently dependent on a destructive, and often irreparable hemorrhage, than the latter, which, proceeding usually from disease of the spinal marrow, where hemorrhage is less common, is more apt to be a result of inflammation, or other curable affection. There is, however, another reason why cerebral palsy yields less readily to nux vomica than spinal. It is upon the spinal medulla that the remedy specially acts; and, even when the cerebral centres are sound, though debilitated, they may be without the circle of its influence, and thus remain unaffected by it. But even in paraplegia, though, when suitably employed, it often does much good, it often also fails altogether, in consequence of the disorganized condition of the spinal marrow, from inflammation, degeneration, softening, etc., or irremovable pressure upon it, as by displaced bone, aneurisms, organized tumours, etc.
Though nux vomica acts most powerfully as a stimulus to the motor power, it is by no means without influence over the sensibility or impressibility of the nervous centres, and therefore proves useful in palsy of sensation as well as in that of motion, though perhaps in an inferior degree. When the loss of sensibility depends upon a want of due power of action in the conducting fibres of the spinal marrow, it is highly probable that these are stimulated in like manner with the spinal centres by the direct influence of the medicine. Hence in paraplegia there is very generally a restoration jointly of sensibility and the power of motion. When the cause of the palsy of sensation is in the sensorial centres at the base of the brain, there is still hope of benefit from the remedy, which, as before stated, acts often with considerable energy on these centres, cither directly or through emanation from the medulla oblongata. Hence, nux vomica may be used, with reasonable prospect of advantage, in exclusive palsy of sensation, whether the general sensibility is affected, or only the special senses, as of tact, taste, smell, hearing, and sight.
But the kind of palsies to which nux vomica is most appropriate are those of function merely, without organic injury of the nervous fibrils or centres. It may be very difficult to decide during life upon the nature of such cases; but when, upon the most careful examination, no source of organic mischief can be discovered or reasonably suspected, the practitioner will be quite justifiable in presuming upon its absence, and in giving at least a trial to nux vomica. Palsy commencing with hysterical phenomena, or of rheumatic origin, if persistent, may be treated in this way; and in the various forms of lead-palsy nux vomica is among the most efficient agents. It has also proved especially useful in diphtheric paralysis.
Of the varieties of palsy, as connected with the seat of the affection, little need be said. Of hemiplegia and paraplegia enough has been said in the preceding general remarks. General palsy too often fails to yield to any remedy; but it is among those in which nux vomica is particularly indicated; for, if obscure in its origin, it would obviously call for a trial of means calculated to stimulate the defective function; and if traceable, as it often is, to degeneration of the nervous tissue under depressing influences, it is to be remedied, if at all, by the joint influence of a tonic and of a stimulant to the enfeebled tissue, such as is exerted by the medicine under examination. In local palsies, such as those dependent on injuries, the use of the remedy is to be governed by the same principles as in the other forms. There are a few of these local affections which require particular notice.
Retention of urine from palsy of the bladder, and incontinence of urine from a similar condition of the sphincter muscles, are frequently treated with advantage by nux vomica or its preparations; and it is among the most efficacious remedies in the nocturnal incontinence of children, which frequently depends upon debility of these muscles.
In prolapsus ani in children, depending on debility of the sphincter ani, it would seem to be indicated. M. Duchaussoy reports a very obstinate case, in a child of eleven years, in which a complete cure was effected, in less than a week, by the daily application of about one-fourth of a grain of strychnia upon blistered surfaces near the anus (Archives Gen. de Med., Septemb. 1853, p. 328); and a somewhat similar case is recorded in the London Medical Times and Gazette (Nov. 1854, p. 521), Might not the remedy be prescribed with equal effect by the stomach, or in the form of injection with or without a little laudanum? Of course, if given in this way, the dose must be diminished. It has been used successfully by the injection of the solution into the subcutaneous tissue near the anus.
Functional aphonia is another example of muscular relaxation or paralysis in which nux vomica is clearly indicated.
Loss of taste, or of smell, deafness, and amaurosis, when purely nervous or functional, may possibly be benefited by the medicine; and the practitioner would always be justified in employing it in these affections: nor, even when they may have originated in active congestion, hemorrhage, or inflammation, provided that all acute symptoms have ceased, and time has been allowed for the repair of the injury inflicted, need the remedy be withheld, though it would probably prove less efficacious than in the functional cases. In amaurosis it has been used locally with great supposed advantage, being sprinkled, in the form of powdered strychnia, upon blistered surfaces upon the temples, as near the seat of the complaint as possible. Experience has not fully confirmed the sanguine hopes that were at one time entertained of its efficacy; but, with the caution above given, in relation to any possibly existing organic disorder, it may be used with great propriety either endermically, or by the stomach. Used hypodermically. by injection into the supra-orbital areolar tissue, the solution has proved successful in a case under the care of M. Freminau. (Med. T. and Gaz., Jan. 21, 1865).