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As the drug acts directly on the kidney, it should be given
cautiously in renal disease. Many patients so soon become used
to it that at the end of a week it has lost its power of producing
diuresis.

Nervous system. Occasionally it cures migraine, but it is not
so useful as [antipyrin] or exalgin.

It may be rendered sufficiently soluble for subcutaneous ad-
ministration by mixing it with a solution of sodium salicylate.

GUARANA.

GUARANA.^ Synonym. Brazilian Cocoa. [A dried paste chiefly
consisting of the crushed or pounded seeds of Paullinia Cupana, Kunth
(Paullinia sorbilis, Martius ; nat. ord., Sapindaceez. ) Habitat. Northern
and Western Brazil.

CHARACTERS. Subglobular or elliptic cakes, or cylindrical sticks, hard,
dark reddish-brown ; fracture uneven, somewhat glossy, pale reddish-brown,
showing fragments of seeds invested with blackish-brown integuments ; odor
slight, peculiar, resembling that of chocolate ; taste, astringent and bitter.
Solubility. It is partly soluble in water, and in Alcohol.



39 2 ORGANIC MATERIA MEDICA.

COMPOSITION. The chief constituents are (l) Guarantee, identical with
Caffeine, 4 to 5 per cent, (see p 388); (2) Volatile Oil, a trace ; (3) Saponin;
(4) Tannic acid.

Dose, ^ to i dr. ; i. to 4. gm.

Preparation.

Extractum Guaranae Fluidum. Fluid Extract of Guarana. By
maceration and percolation with Alcohol and water, and evaporation.
Dose, ^ to i fl. dr. ; i. to 4. c.c.]



ACTION AND THERAPEUTICS OF GUARANA.

Although there is no reason to believe that guaranine does not
produce the same action on the nervous system, heart and kid-
neys as caffeine, yet it is rarely used except for sick headaches ;
but in these cases it is sometimes of the greatest service.

[THEOBROMINjE SODIO-SALICYLAS.

THEOBROMINE SODIO-SALICYLATE. (Not official).
C 7 H 7 NaN 4 O i -fNaC 7 H 5 O 3 =36i.42. Synonym. Diuretin.

SOURCE. By the interaction of Sodium Theobromine and Sodium Sali-
cylate. It contains 49.7 per cent, of Theobromine.] It corresponds to the
Caffeine Sodio-Salicylate, the salt of Caffeine most used in Germany.

[CHARACTERS. A white powder, soluble in half its weight of warm
water, the solution remaining perfect when cooled.

Dose, 15 to 30 gr. ; i. to 2. gm.

ACTION AND USES OF THEOBROMINE SODIO-SALICYLATE.

This is a pure diuretic acting upon the renal epithelium,
without action upon the heart, and it is believed that it does not
irritate the kidneys. The daily dose is from one to two drachms ;
4. to 8. gm., best administered in solution with aromatic water.
It has been administered with benefit in cases of severe cardiac
or hepatic dropsy.] It is said that it does not produce depres-
sion, but it has occasionally given rise to severe symptoms,
[which may have been due to impurities.]



DRUGS ACTING CHIEFLY ON THE NERVOUS SYSTEM. 393

CLASS II. DRUGS ACTING CHIEFLY ON THE SPINAL CORD.
[A. The following excite the cells of the anterior cornua.]

NUX VOMICA.

NUX VOMICA. Synonyms. Poison Nut. [Dog Button. Quaker
Button. The seed of Strychnos Nux-vomica Linn6 (nat. ord. Loganiacece).
Habitat. India and East Indian Islands.

CHARACTERS. About 25 mm. in diameter, orbicular, grayish or greenish-
gray ; soft-hairy, of a silky lustre, with a slight ridge extending from the
centre of one side to the edge ; internally horny, somewhat translucent, very
tough, with a large, circular cavity, into which the heart-shaped, nerved coty-
ledons project. It is inodorous and persistently bitter.]

COMPOSITION. The chief constituents are (i) Strychnine (see below),
0.9 to 1.9 per cent. ; (2) Brucine, which is dimethyl oxylstrychnine, C^H^
N 2 O 4 , 0.9 to 1.5 per cent, in colorless prismatic crystals or pearly flakes. Very
bitter, but less so than Strychnine. [Brucine is found in Hoang-Nan. ] Solu-
bility. Freely in Alcohol, and in 7 parts of Chloroform. It has the same
action as Strychnine, but is considerably less powerful and slower in its effects.
Strong Sulphuric or Nitric Acid gives a blood-red color. (3) Igasuric Acid,
with which the Strychnine and Brucine are united. (4) Loganin, \^yf^-zf^\v\
in colorless prisms, an inert glucoside.

Dose, i to 4 gr. ; [.06 to .24 gm.]

Preparations.

1. Extractum Nucis Vomicae. [Extract of Nux Vomica. By
maceration with Acetic Acid, Alcohol and Water, percolation with
Alcohol and Water, and distillation ; treat with Ether, filter, evaporate
and add Sugar of Milk.

Extract of Nux Vomica is used to make Tinctura Nucis Vomicse.
Dose, y% to i gr. ; .008 to .06 gm.

2. Extractum Nucis Vomicae Fluidum. Fluid Extract of Nux
Vomica. By digestion with Acetic Acid, Alcohol and Water, and per-
colation with Alcohol and Water. Distil off the Alcohol and evaporate.

Dose, i to 4 m. ; .06 to .25 c.c.

3. Tinctura Nucis Vomicae. Tincture of Nux Vomica. Ex-
tract of Nux Vomica, 20 ; Alcohol and Water to 1000. By solution.

Dose, 5 to 20 m. ; .30 to 1.20 c.c.] - 9 O

STRYCHNINA. Strychnine. C 21 H 22 N 2 O 2 [=333.3i. An alkaloid
obtained from Nux Vomica, and also obtainable from other plants of the
natural order Loganiacetz, especially from the Strychnos Ignalia.

SOURCE. (i) Comminute the Nux Vomica ; (2) Extract the Strychnine
with water acidulated with Hydrochloric Acid; (3) Concentrate the infusion,
decompose the Strychnine with Lime ; (4) Extract the Strychnine from the



/



394 ORGANIC MATERIA MEDICA.

precipitate with boiling Alcohol ; (5 ) Concentrate the solution to obtain the
crystals.

CHARACTERS. Colorless, transparent, octahedral or prismatic crystals, or
a white crystalline powder, odorless, and having an intensely bitter taste per-
ceptible even in highly dilute ( I in 700,000) solution. Only extremely diluted
solutions should be tasted. Permanent in the air. Solubility. In 6700 parts
of water ; in no parts of Alcohol ; in 2500 parts of boiling water ; and in 12
parts of boiling Alcohol. Also soluble in 7 parts of Chloroform, but almost
insoluble in Ether.] Gives no color with Nitric or Sulphuric Acids. Add to
a crystal strong Sulphuric Acid, and then add a particle of Potassium Bichro-
mate, a beautiful violet color, passing to brown and green, is formed. Re-
sembling Strychnine. Salicylic Acid (y. v.)

INCOMPATIBLE^. Alkalies, Iodides and Bromides ; the last are especially
dangerous, for the precipitated strychnine bromide falls slowly.

IMPURITY. Brucine, distinguished by tests.

[Strychnine is used to prepare Fern et Strychninae Citras and Syrupus
Ferri, Quininae et Strychninae Phosphatum.

Dose, ^ to ^ gr. ; .001 to .003 gm. in solution, or made in a pill with
Sugar of Milk (thoroughly to divide it) and Glycerin of Tragacanth ; or hypo-
dermatically. The Nitrate (not official), soluble in I in 60 of water, may be
used.

STRYCHNINE SULPHAS. Strychnine Sulphate. (C^H^N/),),
H 2 S0 4 +5H 2 0=8 54 .24.

SOURCE. By the action of Diluted Sulphuric Acid on Strychnine, filtra-
tion and evaporation.

CHARACTERS. Colorless or white, prismatic crystals, odorless and having
an intensely bitter taste perceptible even in highly dilute ( I in 700,000) solu-
tion. Efflorescent in dry air. Solubility. In 50 parts of water, and in 109
parts of Alcohol ; almost insoluble in Ether.

Dose, fa to fa gr. ; .001 to .005 gm.]

ACTION OF Nux VOMICA.

External. Strychnine is a very powerful antiseptic.
Brucine is a local anaesthetic.

Internal. Gastro-intestinal tract. Being intensely bitter,
nux vomica is a good stomachic, increasing the vascularity of
the gastric mucous membrane, the secretion of gastric juice, and
the movements of the stomach, just like calumba, gentian, or
any other bitter ; consequently it aids digestion and sharpens the
appetite. In the intestine it is a direct stimulant to the intestinal
muscular coat, and by this means it increases peristalsis, and
is therefore purgative.



DRUGS ACTING CHIEFLY ON THE NERVOUS SYSTEM. 395

Blood. Strychnine is absorbed into the blood, and circulates
as such. If blood is mixed with strychnine and shaken with air,
it contains more oxygen and less carbon [dioxide] than it would
have done had the strychnine been absent ; but there is no evi-
dence that strychnine in small doses alters the oxidizing power
of living blood.

Spinal cord. Strychnine causes convulsions. They are
not cerebral, for they occur if the spinal cord is separated from
the brain. They do not depend upon excitation of the motor
nerves or muscles, for they are absent in a limb the spinal ante-
rior nerve-roots of which are cut. They occur if the posterior
nerve-roots are cut, provided the proximal end is stimulated.
Therefore they must be spinal ; and this is proved by the fact
that if all the vessels of the lower part of the spinal cord are
[ligated] just at their entry into the cord, so that this is the only
part of the body deprived of its blood supply, and strychnine is
injected into the blood, convulsions occur in all the muscles ex-
cept those the nerves of which spring from the part of the cord
which the strychnine cannot reach. Again, if an animal be
convulsed by strychnine, and a probe be slowly passed down the
spinal canal, the convulsions will gradually cease from above
downwards. But a peripheral stimulus, particularly if sharp and
sudden, so easily excites convulsions when strychnine has been
given that we are justified in assuming that every convulsion is
excited by a peripheral stimulus, and often so slight as not to be
evident. Further, strychnine enormously exaggerates the con-
duction power of the cord in such a way that general convul-
sions reflexly follow a very slight local stimulus. It is believed
that the precise part of the spinal cord stimulated to increased
excitability by strychnine is that immediately on the afferent side
of the anterior cornual cells.

Muscles and nerves. Even with enormous doses the muscles
and afferent nerves are unaffected. Towards the end of a case of
poisoning the functional activity of the motor end-organs is de-
pressed. This is due to direct action on them, and occurs readily
in some species of frogs.

Brain. The convolutions are quite unaffected. The



396 ORGANIC MATERIA MEDICA.

centres in the medulla, which are really the continuation upwards
of the anterior cornua of the cord, are powerfully stimulated,
especially the respiratory centre. The vaso-motor centre
is also considerably excited, and chiefly for this reason the
blood-pressure rises from the very first. The cardiac centre is
but slightly affected [although the clinical evidence is in favor
of its being strongly influenced].

Circulation. Strychnine stimulates the heart directly,
either by its action on the cardiac muscles or, as most authorities
think, by stimulating the motor ganglia. The blood-pressure
is raised, partly no doubt by the action on the heart, but also
by the contraction of the vessels all over the body, which is
brought about first by the direct excitation, by the strychnine, of
the medullary vaso-motor centre, and subsequently by its asphyx-
ial stimulation, and also by the increased peripheral resistance
which must occur from the frequent contraction of all the muscles.
[The result is that the force of the heart is increased and the
diastole lengthened.]

Respiration. Respiration is rendered quicker and deeper
because strychnine excites the spinal and medullary respiratory
centres. The respiratory muscles are implicated in the general
convulsions with the result that the patient ultimately becomes
asphyxiated owing to exhaustion of them, and to their prolonged
contraction during the convulsive spasms. The heart continues
to beat after death which is entirely due to failure of respiration.
The excessive muscular contractions occasionally cause a rise of
temperature, but so rarely that often the loss of heat must be
greatly increased.

Special senses. Smell, hearing, touch and sight are sharpened
by strychnine. The field of vision, especially for blue, is said to
be enlarged.

Elimination. Strychnine is eliminated unchanged in the
urine. It is excreted very slowly, and therefore accumulates in
the system. Tolerance is never established. For a clinical ac-
count of strychnine poisoning see Toxicology.

Brucine and thebaine act like strychnine, but methyl-bru-
cine, methyl-thebaine, and methyl-strychnine do not influ-



DRUGS ACTING CHIEFLY ON THE NERVOUS SYSTEM. 397

ence the cord, but paralyze the ends of the motor nerves like
curare.

Strychnine acts on all animals in the main as on man ; but
some birds and guinea-pigs are less susceptible to it, for they
absorb it slowly.

THERAPEUTICS OF Nux VOMICA.

External. Strychnine is so posionous that its use as an
antiseptic would not be safe.

Internal. Gastro-intestinal tract. Tincture of nux vomica
is very largely given with excellent results as a bitter stomachic
and carminative, especially in cases in which the feebleness of
digestion is merely part of generally feeble health. [Twenty
drops of tincture of nux vomica in a wineglass of hot water will
frequently at once check gastro-intestinal fermentation.] A mix-
ture of diluted hydrochloric acid, gentian and nux vomica is of
great service in these cases. As the digestion improves, the
general health improves. Because of its power to stimulate
peristalsis nux vomica is a valuable drug for cases of constipation
in which the contractile strength of the muscular coat of the in-
testine is weak ; usually this is a part of a general weakness of the
whole body. The constipation of anaemia, which can be very
successfully treated by a pill of extract of nux vomica and ferrous
sulphate, is a good instance of this variety of constipation.

Circulation. In cases of heart disease in which digitalis is
inadmissible, nux vomica and strychnine are excellent cardiac
stimulants, and for this purpose they may be combined with
caffeine. Patients almost dead from failure of the heart in the
course of chronic .cardiac disease may sometimes be brought
around by the subcutaneous injection of strychnine.

Respiration. Strychnine may be combined with expectorants,
because it stimulates the respiratory centre ; and it is extremely
serviceable when from any cause, such as severe bronchitis, the
respirations are feeble and shallow. [It is also useful in pneumo-
nia when death is imminent from dilatation of the right heart.
In this condition it should be administered hypodermatically and
at frequent intervals.]



39$ ORGANIC MATERIA MEDICA.

Nervous system. It has been given for a number of nervous
diseases, but with no constantly good results, for when the disease
is not in the anterior cornua, strychnine is hardly indicated ; and
if it is in this part of the cord, it is doubtful whether it is advisa-
ble to stimulate the part of the body which is diseased.

TOXICOLOGY.

Symptoms. In about an hour after a poisonous dose the patient begins to
feel uneasy from a sensation of impending suffocation. The tetanic convulsions
then commence with great violence, nearly all the muscles of the body being
affected at once. The limbs are thrown out, the hands are clenched, the head
is jerked forwards and then bent backwards, and the whole body is perfectly stiff
from the violence of the contractions. The pulse is very rapid ; the temperature
may rise. Hearing and sight are acute. The convulsion lasts a minute or two,
then the muscles relax, and the patient feels exhausted and sweats all over. The
intermission is short, convulsions soon come on again, and again there is a
relapse to the state of muscular relaxation. The convulsions now rapidly
increase in severity, and owing to the violent contractions of the muscles of the
back, the patient is in the position of opisthot^nos, resting on his head and his
heels. The abdominal muscles are as hard as a board, the chest is fixed, the
face becomes livid, the eyeballs are staring. The contraction of the muscles
of the face causes a risus sardonicus ; but those of the jaw are not affected till
near the end ; [this aids in distinguishing strychnine poisoning from tetanus.]
Consciousness is retained till the last. The slightest noise or even a bright light
will reflexly bring on the convulsions, which may jerk the patient out of bed.
Ultimately he dies from exhaustion and asphyxia. The smallest dose of strych-
nine known to have killed is half a grain ; [.03 gm.] Post-mortem. The usual
appearances of death by asphyxia are seen.

Strychnine poisoning is liable to be confounded with tetanus, but in this
disease symptoms come on more slowly, the muscles of the jaw are implicated
very early, and there is continuous muscular rigidity with paroxysmal exacer-
bations, but never complete muscular relaxation.

Treatment. [Give emetics (see p. 139), particularly apomorphine hydro-
chlorate hypodermatically, or wash out the stomach if the patient is seen early
enough for the passing of the tube not to cause spasm]. The stomach [may
be] washed with solution of potassium permanganate as for opium [poisoning,
but it is not so effective]. Inject large doses of potassium bromide and chloral
per rectum. Use amyl nitrite inhalations, and if possible artificial respiration.

ANTAGONISM.

In a sense strychnine is antidotal to chloral and morphine, but it is not a
strict antidote, for they act chiefly on the cerebrum. Still chloral is valuable
in strychnine poisoning, and although the antagonism with Calabar bean and



DRUGS ACTING CHIEFLY ON THE NERVOUS SYSTEM. 399

gelsemium is more accurate, as both depress the anterior cornua, yet they are
of very little use in strychnine poisoning. [Chloroform is the most practical
antidote to strychnine.

B. The following depress the cells of the anterior
cornua.]

PHYSOSTIGMA.]

PHYSOSTIGMA. [Synonyms. Calabar bean. Ordeal bean. The
seed of Physostigma venenosum Balfour (nat. ord. Leguminosai). Habitat.
Tropical Western Africa, near the mouth of the Niger and old Calabar.

CHARACTERS. About 25 to 30 mm. long, 15 to 20 mm. broad, and 10 to
15 mm. thick; oblong, and somewhat reniform ; testa granular, chocolate-
brown, with a broad, black groove extending over the entire length of the con-
vex edge ; embryo with a short, curved radicle, and two large, white, concavo-
convex cotyledons ; inodorous ; taste, bean-like.

COMPOSITION. The chief constituents are : (l) Physostigmine or Eserine
(see below) ; (2) Calabarine, a derivative of Physostigmine ; (3) Eseridine ;
and (4) Physosterin a neutral principle closely related to cholesterine.

Dose, }/z to 2 gr. ; .03 to .12 gm. of the powdered seeds.]

Preparations.

1. Extractum Physostigmatis. [Extract of Physostigma. By
maceration, percolation with Alcohol and evaporation.

Dose, ^j to y 2 gr. .006 to .03 gm., internally, or rather less dis-
solved in 10 m. ; .60 c.c. of water and given subcutaneously.

2. Tinctura Physostigmatis. Tincture of Physostigma. Phy-
sostigma, 150. By maceration and percolation with Alcohol to 1000.

Dose, 10 to 30 m. ; .60 to 2.00 c.c.

PHYSOSTIGMINE SALICYLAS. Physostigmine Salicylate
C 15 H 21 N S O 2 C 7 H 6 O 3 =4I2. 17. Synonym. Eserine Salicylate. The Salicy-
late of an Alkaloid obtained from Physostigma.

SOURCE. By adding Physostigmine to a solution of Salicylic Acid in
boiling Distilled Water, and allowing the salt to crystallize on cooling.

CHARACTERS. Colorless or faintly yellowish, shining, acicular, or short,
columnar crystals, odorless, and having a bitter taste. It acquires a reddish
tint when long exposed to light and air. Solubility. In 150 parts of water,
and in 12 parts of Alcohol.

Dose, y^ to JQ gr. ; .0006 to .002 gm.

PHYSOSTIGMINE SULPHAS. Physostigmine Sulphate. C 15 H 2 ,
N S O 2 ) 2 H 2 SO 4 =D46.82. Synonym. Eserine Sulphate. The Sulphate of an
Alkaloid obtained from Physostigma.

CHARACTERS. A white or yellowish-white, micro-crystalline powder ;



4OO ORGANIC MATERIA MEDICA.

odorless, and having a bitter taste. It is very deliquescent when exposed tc
moist air, and gradually turns reddish by exposure to air and light. Solubility.
Very soluble in water and in Alcohol.
Dose, T^ to ^ gr. ; .0006 to .002 gm.]

ACTION OF CALABAR BEAN.

External. None.

Internal. Mouth. After physostigmine is absorbed it in-
creases the salivary secretion ; and this has been shown to
be due to stimulation of the terminations of the secretory nerves
in the glands. Other secretions are increased, probably in the
same way. After a time the flow of saliva ceases, because the
drug has so acted on the circulation as to constrict the vessels,
and consequently the flow of blood through the salivary glands
is diminished.

Stomach and intestines. The muscular coat of the stomach
and intestines is stimulated by the direct action of the drug
circulating through it. The result is that after a large dose
vomiting and purging occur. Physostigmine is quickly ab-
sorbed.

Circulation. No influence on the blood is known. The
effect on the heart is obscure, but it appears that the irritability
of the peripheral terminations of the vagus is at first increased,
and that consequently the heart is slowed. Very large doses
are said to decrease the irritability of the vagus. In addition to
its effects on the vagus, physostigmine powerfully stimulates the
contractile force of the heart. The beat is therefore both more
forcible and slower. Ultimately the organ is paralyzed and
stops in diastole.

The blood-pressure rises very much ; this is largely due
to the increased force of the cardiac beat, and partly to contrac-
tion of all unstriped muscle of the abdominal viscera, driving
much blood out of the abdomen. It is not known for certain
if the unstriped muscle of the arteries is stimulated. Analogy
would leave us to suppose that it is.

Respiration. This is first quickened, but soon retarded, and
death takes place from asphyxia. Three factors at least are
probably concerned in bringing about these results. The ends



DRUGS ACTING CHIEFLY ON THE NERVOUS SYSTEM. 40!

of the vagi in the lungs are stimulated, for if these nerves are cut
and physostigmine is administered there is no primary quicken-
ing of respiration. Physostigmine, from its action on involun-
tary muscular fibre, causes contraction of that in the bronchial
tubes, with consequent constriction of them. Lastly and the
most important, the activity of the respiratory centres in the
medulla and cord is depressed.

Nenwus system. Brain. Even in fatal doses consciousness
is unimpaired. The only part of the brain known to be affected
is the respiratory centre.

Spinal cord. It is here that physostigmine produces its most
characteristic effects. Reflex activity is inhibited; by ex-
clusion it can be shown that this is not owing to any influence
on the nerves or voluntary muscles, therefore it is due to depres-
sion of the anterior cornua of the spinal cord. The most
conclusive proof of this is the direct application of the drug to
the cord. There is then, at first, from the irritation, which is
caused by almost any substance, a slight increase of reflex ex-
citability, but this soon gives way to complete abolition of it.
Later on the posterior part of the cord is also paralyzed, so that
there is a diminution of cutaneous sensibility.

Voluntary muscles and their nerves. Muscular twitchings fol-
low large doses in many animals. These appear to be due to the
action on the motor nerve terminations ; sensory nerves are un-
affected.

Involuntary muscles. We have already seen that the involun-
tary muscles of the intestines, stomach, and bronchial tubes are
stimulated by physostigmine ; so also are those of the spleen,
uterus, bladder, and iris. Probably in all these instances it is
the terminations of the motor nerves that are affected.

Eye. Physostigmine applied locally to the conjunctiva or
introduced into the circulation causes contraction of the
pupil, spasm of accommodation from direct stimulation of
the ends of the motor nerves of the iris and the ciliary muscle.
There is a diminution of intra-ocular tension. Thus, as
regards both secretions and the eye, physostigmine is antagonistic
to atropine.

26



4O2 ORGANIC MATERIA MEDICA.

The action of physostigmine is much more constant than that
of Calabar bean, perhaps because the other active principles in
the bean interfere with the action of physostigmine.

THERAPEUTICS OF CALABAR BEAN.

Involuntary muscles. Because of its stimulating power on
unstriped muscle Calabar bean has been recommended for chronic
constipation, atony of the bladder, and chronic bronchitis with
deficient power of expectoration, but it is rarely given for these
purposes.

Spinal cord. Calabar bean has been largely used for tetanus,
and some cases of recovery have been reported. It must be



Online LibraryWilliam Hale-WhiteMateria medica, pharmacy, pharmacology and therapeutics → online text (page 35 of 67)