Nux vomica

Lecture XVI — Nux vomica

Nux vomica, another member of the Loganiaceae, is a drug that was known as early as 1540, A. D., in which year, one Valerius Cordus wrote a remarkably accurate description of it. The fruit of the tree is about the size of an orange and contains a bitter, gelatinous pulp. This pulp, it is said, is eaten by some of the birds of India, although it is well known to contain Strychnine. The Nux itself is the seed deprived of the pulp and shell. This seed is disk-shaped, and about one inch in diameter and one-quarter of an inch thick. Its surface is satiny by reason of a thick covering of adpressed radiating hairs. You will recall that I have already mentioned that Ignatia and Nux vomica both contain as active principles two alkaloids known as Strychnia and Brucia. The Brucia occurs in much smaller quantities than the other, and is present more in the bark of the tree than in the nut itself. Its properties are somewhat similar to those of Strychnia. Both alkaloids are combined with an acid known as Igasuric acid, which is identical with the malic acid found in apples and pears. Strychnia, the principal alkaloid of Ignatia and Nux vomica, has a well-described symptomatology, being a poison not uncommonly used for suicidal and homicidal purposes, and also for the extermination of the lower animals, cats, rats, etc. Strychnia causes restlessness, trembling of the limbs, stiffness of the neck and jaws, constriction of the throat and tetanic convulsions with opisthotonos. These tetanic convulsions differ from those of true tetanus only in the fact that the muscles relax between the paroxysms. The temperature of the body is not so high as in true tetanus, and trismus comes late in Strychnia poisoning. These Strychnia convulsions are re-excited by impressions made on the senses, particularly by the slightest touch, while rubbing relieves; the patient is conscious throughout the attack. In very large or in oft-repeated doses, Strychnia causes paralysis of afferent nerves. Finally, collapse ensues as the result of exhaustion of the motor centres. I give you these symptoms of Strychnia for two purposes. One is that you may be familiar with them in order to recognize them in case one of your patients is unfortunate enough to be poisoned with the drug. The other is that you may the better understand the action of Nux vomica, for Strychnia being its principal ingredient, you will find running all through its symptomatology this over-impressibility; by this I mean that everything impresses the patient excessively. External impressions, such as sounds, odors and noises, excite him, and this symptom, I say, is characteristic of the drug.

The smallest fatal dose of Nux vomica is said to be three grains; that of Strychnia, one-half a grain.

Strychnia resembles Picrotoxine, Veratria, Cicuta virosa, Thebaine, Hydrocya?iic acid, Belladonna, Stramonium, Aconite, Physostigma, Passiflora, Curare, Camphor, and Phytolacca; but especially are its effects like traumatic tetanus.

Picrotoxine , according to Bartholow, is synergistic with Strychnia; but respiration is accelerated, not so much from spasm of the respiratory muscles as from spasm of the glottis; and there is less susceptibility to slight touch. Gubler asserts that Picrotoxi?ie produces more choreic symptoms.

Veratria causes incoordination by producing relaxation of some fibres with contraction of others; that is, following prolonged contraction of muscles comes a state of partial relaxation with fibrillary contractions. Herein it somewhat resembles Strychnia; but it differs widely in purging and vomiting, and in general paralysis occurring, not from exhaustion, but from direct devitalizing of the muscles. Thebaine causes tetanus, but may be distinguished by its hypnotic symptoms. It is said to be the most poisonous of the active principles of Opium.

Physostigma, which contains the alkaloid Eserine, can be confused with Strychnia only in a limited range of symptoms. It increases the irritability of the sensory nerves and also causes tetanic spasms of involuntary muscles. But in the main, it differs widely from Strychnia, causing spinal paralysis and diminished reflex action. Hence, when such symptoms as constriction of the throat, cramps in the stomach and bowels, tenesmus recti, stiff spine and legs, tight feeling in and about the eyeballs, etc., suggest a similarity to Strychnia, such consentaneous evidences of spinal paralysis as the following will serve for differentiation: trembling; so feeble he can hardly walk; finds difficulty in making the muscles obey the will (like Gelse??tium and Conium)\ unsteady when walking with the eyes closed. In Strychnia, death results from asphyxia caused by tetanic spasm of the respiratory muscles; in Physostigma, from paralysis. The pupils, too, differ; the former causes dilatation during the convulsions, with contraction during the interim; the latter causes contraction with defective accommodation and twitching of the eyelids.

If, now, the remote effects of Strychnia are to be considered—such effects as follow severe but not fatal poisoning, or such symptoms as are frequently produced by potencies—we may still discriminate by the characteristic irritability, which is more marked in Strychnia; everything makes too strong an impression; odors cause fainting; there are muscular tremors with excitement; desire for coitus, but during the act the penis becomes flaccid.

Curare, although it contains Strychnia, acts quite differently from the latter on account of the presence of the alkaloid Ctirarine. This substance destroys the irritability of the end-organs of the motor nerves, leaving the muscles themselves intact. Reflex action is diminished or destroyed, and respiration is paralyzed. Sensation is not materially altered. Owing to paralysis of the vagus, the heart's action is accelerated, bat blood-pressure is not increased. In fact, from paralysis of vaso-motor termini, the bloodvessels dilate, lessening resistance to the blood currents. Increased peristalsis is not due to spasm, but to paralysis of the inhibitory splanchnic fibres. We have no very trustworthy provings of Curare. Baruch has used it for so-called " liver-spots;" and Dr. Paul Pitet records several interesting cures of muscular weakness, embarrassed respiration from deficient power, immobility with fixed gaze on awakening, and eczema of infants, worse on the face and behind the ears, especially in scrofulous children ( World" s Homceopathic Convention, vol. i). It has also been used by Baruch, I think, for catalepsy, with spasms of the lower jaw, and for paralytic weakness in the hands and fingers of pianists.

Phytolacca differs essentially from Strychnia in its acrid-narcotic properties, as well as in its tardy gastro-intestinal irritation and collapse. Still the convulsive symptoms are somewhat similar; the limbs are stiff, the hands firmly shut, the feet extended and the toes flexed; the jaws are clenched and the lips everted showing the teeth; opisthotonos is present; the chin is drawn down to the sternum; there is alternate relaxation and spasm of the facial muscles.

Passiflora incarnata has cured cases of tetanus in hot countries, where, unhappily, they are but too common. Dr. Archibald Ba}me, of Barbadoes, W. I., reports two cures with the tincture and the ix {Hahnemannian Monthly , May, 1881).

Angustura is placed among aromatic bitters and is called a tonic. But it is more than this. It causes drawing, tension, and stiffness of the muscles and joints, with a bruised, sore feeling, as after a blow. This tension is marked enough in the temporal and masseter muscles to suggest trismus. The drug also affects the bones. There are points of resemblance between Angustura and another of the Rutaceae, the Ruta graveolens. Injury to periosteum frequently suggests the latter; and it is very probable that injury with incipient muscular contractions may need the former.

Dr. Hering, who was fully aware of the confusion of Angustura with Strychnia, nevertheless reported a cure of tetanus with the former, and printed the symptoms thereof in his Guiding Symptoms. Dr. Hubbard reports a cure made with Angustura {Medical Investigator, April, 1870).

That Angustura vera acts on the bones has been fully confirmed. iE^gidi used it when the long bones were affected (see Raue' s Pathology} . Dr. C. G. Raue writes me that the preparation with which he cured podarthrocace was unquestionably the vera. It was Jenichen's, and this manufacturer carefully distinguished between Angustura vera and Angustura falsa, or Nucis vomica cortex seu Brucea antidysenterica. Dr. Aug. Korndoerfer, Sr.,used Jenichen's 200th for necrosis of the lower jaw. One side of the jaw had been successfully excised; but the disease made its appearance on the other side; the cure was complete.

Among the general characteristics of Angustura we may refer to irritation from a slight offence (with caries). Craving for coffee (clinical, but confirmed by Dunham, Boenninghausen, and iEgidi). Tenesmus recti, with soft stool; urging to urinate, with copious flow (see Dr. Edmundson's case, Hahnemannian Monthly, October, 1876). I cannot, then, quite agree with Dr. Hughes, who asserts that A?igtcstura has no recognized therapeutic place.

Aconite in one of its manifestations, causes a general tension of nerves and vessels, characterized by the w Tell-known anxiety, heat, etc. (see Hughes's Pharmacodynamics) . It also induces trismus, stiffness of the limbs, and even opisthotonos. We see now why Reynol could use it successfully in trismus of horses (Trousseau's Therapeutics, vol. ii); and, further, why it is recommended in the beginning of trau matic tetanus.

It does not, however, like Strychnia, cause increased reflex excitability. There is present rather a diminution or perversion of sensibility, expressed by tingling numbness.

In impending tetanus we certainly have efficient preventives of the full-fledged disease. Aconite, with fever, anxiety, tension of muscles, tingling and numbness; Veratrum viride, Hypericum, with excruciating pain in the wound; Belladonna, Cicuta, Silicea, and possibly Angustura, if the wound is suppurating or has suddenly ceased to discharge pus.

Hydrocyanic acid was first recommended in tetanus by Begin; and Dr. Hughes, in his paper on that acid, read at the World's Convention in 1876, cited poisoning cases which prove its homceopathicity to epilepsy and to tetanus. The relation of this acid to the latter disease is more fully brought out in Dr. Hughes's Pharmacodynamics , where we read: "Hydrocyanic acid causes tetanus; there is not, as with Strychnia, evidence of increased reflex excitability; but, as with Acojiite and Cicuta, persistent tonic spasm; this it produces by direct action upon the spinal cord."

It seems especially useful when the tetanic symptoms show themselves mostly in the muscles of face, jaws, and back; there are trismus, risus sardonicus and embarrassed respiration, with lividity and frothing at the mouth. Dr. Charles A. Barnard reports two cases of traumatic tetanus relieved with this acid. In each instance only the spasms of face, jaws, and chest were ameliorated, other remedies being needed for the remaining symptoms (see New England Medical Gazette, October, 1882). This affinity of Hydrocyanic acid for the upper part of the body does not contra-indicate the medicine in opisthotonos and general tetanic rigidity, for under its baneful influence both trunk and extremities are thrown into spasm. In one case, spasms commenced in the toes and spread over the body. But the acid undoubtedly affects the medulla oblongata most powerfully, and consequently lungs, heart, and larynx suffer through thepneumogastric nerve. It bears but little resemblance to Strychnia, but is similar to Cicuta, Lachesis, and Nicotine.

Lachesis has relieved when, with trismus and spasm of the larynx, there is blueness from asphyxia and the patient sleeps into the paroxysm.

Cicuta virosa contains a volatile alkaloid termed Cicutine, which is chemically identical with Coniine. According to Boehm, this plant causes vomiting, diarrhoea, and tetanoid convulsions, and in man also syncope and strabismus. Cicutoxine is another alkaloid derived from Cicuta. It is the most powerful of the Cicuta derivatives, causing in frogs, alternate tonic and clonic spasms. The respiration is hurried, the inspiratory so far exceeding the expiratory act that the animal becomes distended with air. In mammals, the first effect is profuse salivation, quivering of the muscles, and then spasms. The breathing grows very rapid, and then suddenly convulsions develop. Respiration, as with Strychnia, is suspended by contraction of the respiratory muscles. If irritated, spasms return; after the paroxysms subside, the animal lies completely exhausted.

Now these views of the action of Cicuta embody characteristics which have for years guided the homoeopathist in the choice of this powerful remedy; sudden rigidity; then jerking and violent distortion, followed by utter prostration; tonic spasm renewed by touch; great oppression of breathing; lock-jaw; face dark red; froth at the mouth; opisthotonos; loss of consciousness .

The seizure in the Cicuta case is more epileptiform than in Strychnia and there is generally loss of consciousness. Reflex excitability is less marked in the former. The exhaustion of Cicuta is equalled only by Chininum arsenicosum.

Tabacum and its alkaloid Nicotine, which is also closely related to Coniine, cause drawing back of the head, with rigidity of the muscles of the neck and back; contraction of the eyelids and the masseter muscles; hissing respiration from spasm of the laryngeal and bronchial muscles; alternate tonic and clonic spasms, followed by general relaxation and trembling; retraction of the abdominal muscles; contractions of parts supplied with involuntary muscle-fibres, as the intestines, ureters, etc. ; these contractions are accompanied by intense pain, nausea, cold sweat and speedy collapse, with asphyxia.

Tobacco, then, acts upon the spine, especially upon the medulla oblongata, and also upon the abdominal ganglia. Its tetanic symptoms with asphyxia resemble those of Hydrocyanic acid rather than those of Strychnia. A characteristic difference between Tobacco and Nux vomica is well brought out in their respective applications to renal colic. In Nux there is pain down the right ureter into the genitals and leg, nausea and vomiting; in Tabacum, pains down the ureter, with deathly sickness and cold sweat.

Veratriun album causes trismus with spasm of the glottis and constriction of the chest, amounting almost to suffocation; the hands and feet are drawn inward, and the pupils are contracted. It may be distinguished from Strychnia by the fact that under Veratrum album the convulsions are secondary to exhausting diseases and are never primary, as under Strychnia.

Stramonium, like Strychnia, causes tetanic convulsions, which are worse from touch or from light. The chief distinction is that with St?

ramonium mania is almost always present, while under Strychnia the mind is clear to the last hours of life.

Camphor is similar to Strychnia in tetanic spasms. It has showing of the teeth from drawing up of the corners of the mouth, but when Camphor is indicated in tetanic spasms, we find the ever-present deathly coldness.

In studying Nux vomica, you should remember these prefatory remarks.

Next let me say that Nux vomica is complementary to Sulphur. By that I mean that after Nux vomica has done as much as its symptoms will allow it to do, very frequently the remaining symptoms find in Sulphur the remedy that will complete the cure.

Now, let me give you the Nux vomica temperament. It does not necessarily follow that you must not use Nux if the constitution is not what I am going to describe; but it does follow that it acts better in the constitution about to be mentioned. Nux vomica is best adapted to rather thin, spare patients. It does not seem to act so well on the fleshy. Especially is it indicated if the patient is rather irascible and is quick and active in his motions. He has a nervous temperament. He is extremely susceptible to external impressions and hence cannot tolerate noise, odors or light. The face is rather sallow or yellowish. There is a sort of false plethora that gives the patient at times red cheeks on the yellow background. Generally, too, you will find that he suffers from any strain on the mind, particularly if this overtaxing of the mental powers is intensified or rendered more injurious by sedentary habits. Thus you will find the drug of great value for those who deprive themselves of sleep and exercise in pursuance of their studies. You will find it frequently indicated in ministers who take very little exercise and who have become dyspeptic. They have headache and are tired in the morning when they awake. The Nux patient frequently lies awake at night; the mind is so wrought up that he cannot sleep. Thoughts run through the mind in confusion. He does not fall asleep until long after midnight, and then awakes in the early morning, perhaps at four or five o'clock. Falling asleep again, he awakes once more, feeling as if he had been on a spree, and his sleep had done him no good. He has a bitter taste in the mouth; the tongue is coated; he complains of dull headache, and, in fact, of every symptom that points to wearing out of the system from overwork. This, then, is the kind of patient in which you will find Nux vomica most effective.

Nux may avert an oncoming cerebral softening especially when sedentary habits and severe mental strain have preceded it, as well as in cases where intemperance antedates the disease. The patient complains of headache when he exerts his mind. His memory is fickle, he is dizzy and his walk grows unsteady. The remedy may be followed by Phosphorus, Picric acid or Sulphur.

The Nux patient, you will find, has a great deal of trouble with the digestive organs. He suffers from headache, situated either in the occiput or over one eye, usually the left. When the pain settles over the eye, it usually begins in the morning, and increases until night, and is accompanied generally by a sour taste in the mouth (less frequently by a bitter taste), by accumulation of flatus, and by annoying retching. This may be associated with vomiting of food and of sour matter, but the prominent feature of the vomiting is the violent retching, often more or less ineffectual, showing the irritated condition of the stomach. He has the characteristic peculiarity of waking in the early morning and then falling asleep, only to awake again feeling worse than at first. The bowels are constipated; and this constipation consists, characteristically, in ineffectual urging to stool. Thus you see that it is not due to atony of the rectum, but to irregular, fitful action. He suffers, also, from gastralgia, which is usually made worse by eating. It is sometimes worse, however, when the stomach is empty- The pain starts in the epigastrium, and radiates in various directions, into the back, etc. The paroxysms are very apt to recur periodically every morning, and are often associated with vomiting of sour matter and ineffectual urging to stool. The pains themselves are of a griping, clawing character, as though a hand were scraping the inside of the stomach; they are often relieved by hot drinks. Now, you will notice that the symptoms I have mentioned for Nux vomica, if mentioned in pathological language, would have to be put under the term gastric irritability. The nerves are in such a state of hypersesthesia that the ingestion of food causes spasmodic action of the stomach and ejection of its contents. This, you will notice, is pathologically similar to the condition of the rectum.

In this extreme gastric irritability, we find Nux vomica a remedy without which we cannot well get along. You are treating a patient who has been prostrated by disease; as soon as he swallows food, up it comes. Nux is here one of the remedies to be thought of, particularly in children who are very excitable, and in men when they have indulged in excessive eating or in debauchery.

In other cases, where there is much burning in the stomach with the violent ejection of food, Bismuth is the remedy. The Subnitrate of Bismuth is the remedy for pure gastralgia, that which is not associated with any catarrh, or with any of the symptoms of indigestion. The epigastric pains may be burning, griping, or lancinating, extending into the adjacent spine Pressure, heaviness and burning in the stomach, convulsive gagging. The patient vomits at intervals when the stomach becomes full, and then the amount of vomited matter is enormous. Water is vomited as soon as it reaches the stomach. But unlike Nux, the pains are usually relieved by cold drinks, and, though the patient is greatly prostrated, the surface of the body is warm.

In still other cases, we find Arsenicum the remedy, when, in addition to the burning pains, we have the intolerable restlessness and anxiety, thirst, etc. It produces a perfect picture of subacute gastritis. A remedy more valuable than any yet mentioned is Kreosote. Kreosote is excellent for this irritable weakness of the stomach. Food cannot be digested. But its distinctive character lies in the fact that, though the stomach retains the food several hours, it finally ejects it undigested.

Another form of stomach trouble to which Nux is applicable is a dyspepsia in which there is marked aggravation an hour or so after eating. About twenty-four hours before the attack comes on, the patient complains of great hunger. He craves meats, gravies, and fat foods, and is averse to coffee. He has violent thirst, but water distresses the stomach and causes distension; after even a light meal; he is obliged to loosen his clothing. He is troubled with sour and bitter eructations, and hiccough.

In gastric symptoms following debauchery, when Nux fails, Carbo veg. is a good remedy, although Sulphur may be required. Pulsatilla is preferable to Nux vomica when the symptoms have resulted from a mixed diet, such as meats, pastry, nuts, ice cream, etc., especially if the temperament agrees.

In constipation, Nux is similar to several other remedies. Lycopodium has constipation with ineffectual urging to stool, but under this remedy the ineffectual urging is caused by constriction of the rectum and anus.

Carbo veg. has an urging to stool similar to that of Nux, but it is relieved by the passage of flatus, showing at once the cause of the urging.

Under Opium, Bryonia, and Alumina the constipation is unattended by urging to stool. Opium has constipation from inactivity of the bowels; the stool consists of hard, round, black balls. The Bryonia constipation results from dryness of the alimentary tract. The stools are large, dry, and hard.

Marked inactivity of the rectum characterizes Alumina. The evacuation of even a soft stool requires great effort.

Nux vo7nica has a marked action on the liver. It is particularly indicated in liver affections in those who have indulged to excess in alcoholic liquors and highly-seasoned food, or who have abused themselves with drastic purgatives. Nux is one of the best remedies we have to counteract the effects of allopathic dosing. In taking charge of a case that has been under old-school treatment you will frequently find it necessary to administer Nux before you can get a clear picture of the symptoms. In these cases you will often find the liver swollen, hard and sensitive to the pressure of the clothing. Colic is frequently present, and may come from an accumulation of flatus, which presses either upward toward the chest, producing inconvenience in breathing, or downward toward the rectum and bladder, developing both urging to stool and desire to urinate. Or it may be a hemorrhoidal colic. By this I mean abdominal pains which follow the sudden stoppage of hemorrhoidal flow. The patient has perhaps been subject for years to piles, with bleeding at stool. If from some cause, this flow is suddenly checked and headache or colic results, Nux will help him. If the liver is enlarged, you should give Nux in repeated doses, and you will often be gratified to find the liver resume its natural proportions. If it does not, then you must fall back on Sulphur, Sepia or Magnesia mur.

Nux may also be indicated in the enlarged liver of drunkards. Here you may compare it with Sulphur, Lachesis, Fluoric acid, Arsenicum and Ammonium mur.

Nux vomica is also useful in jaundice provoked by violent anger, by abuse of quinine, or by too high living. The patient has attacks of faintness, after which he feels very weak.

Chamomilla may be employed in jaundice resulting from a fit of anger, as also may Bryonia, Natrum sulph. and Aconite.

Bryonia is especially useful in jaundice when the case has been spoiled by the abuse of calomel or blue mass.

In jaundice from the effects of quinine you should compare Hepar, Mercurius, Pulsatilla and Arsenicum.

Carduus ?narianus is indicated in jaundice with dull headache, bitter taste in the mouth, and white-coated tongue, especially in the middle, with the tips and edges red. There is nausea with vomiting of an acid green fluid. The stools are bilious, and the urine goldenyellow. There is an uncomfortable fulness in the region of the liver. In haemorrhoids, Nux may be useful when there is itching, keeping the patient awake at night, and frequently so severe as to compel him to sit in a tub of cold water for relief. There is frequent ineffectual urging to stool, and the piles are apt to bleed. But unless Nux is thoroughly indicated in such cases, it should not be prescribed, for while it may cure the piles, it is likely to excite some other trouble more unbearable than the one it has relieved.

The analogues of Nux in haemorrhoids are several. SEsculus hippocastanum is a wonderful remedy in abdominal plethora. You will find it indicated when there is throbbing deep in the abdomen, particularly in the hypogastric region. The haemorrhoids, which may or may not bleed, are accompanied by a feeling of dryness in the rectum, as though little sticks or splinters were pricking the folds of the mucous membrane. This is the keynote for sEsculus. sEsculus also has weak feeling at the sacro-iliac symphysis, as though the back were about to give out at this point.

The next remedy to be mentioned in this connection is Aloe. This drug has abdominal plethora and flatulence, like Nux and Sulphur, and haemorrhoids like Nux, Sulphur and Aisculus. But it differs from these remedies in that it acts almost entirely on the rectum, producing catarrh of its mucous lining. The stools are accompanied by an expulsion of copious flatus. The haemorrhoids protrude like a bunch of grapes and are greatly relieved by cold water. There is also a sort of uncertainty about the rectum, shown in a feeling as if the bowels were about to move. Aloe also cures a headache which, like that of Nux vomica, is situated over the eyes. It is attended by a sensation as though a weight were pressing the eyelids down. Relief comes from partially closing the eyes.

Collinsonia is indicated in haemorrhoids when there is a sensation of sticks in the rectum. Constipation is usual. The bowel symptoms are worse in the evening and at night. Collinsonia is also useful in prolapsus uteri complicated with haemorrhoids. It is just as frequently indicated in this condition as is Podophyllum in prolapsus uteri with diarrhoea and prolapsus recti. Collinsonia has a symptom found also under Opium, namely, dry balls of faecal matter are passed from the rectum; but they differ from those of Opium in that they are of a light color.

Hamamelis is called for in haemorrhoids when there is considerable haemorrhage with marked soreness of the affected parts. The back feels as if it would break.

Nux vomica may be used in diarrhoea coming on after a debauch. The patient is usually worse in the morning. The stools are papescent or watery, and are scanty and accompanied by urging, thus keeping up the character of the remedy. The patient retches in the morning, vomiting perhaps a little froth or sour fluid. He craves liquor, of course, but his stomach is so irritable that he vomits the stimulant as soon as it is taken. Such persons seem to be particularly intolerant of milk.

We may give Nux in dysentery when there is frequent ineffectual urging to stool, ceasing as soon as the bowels move. The stools are bloody, slimy, watery and scanty. The patient is worse in the morning. Nux is indicated by these symptoms whether the disease is the result of cold, or whether it comes from the suppression of an excretion, such as the perspiration.

Mercurius is distinguished from Nux in dysentery by the fact that in the former the urging to stool does not cease with the evacuation, no matter how free the latter may be.

Another concordant remedy in dysentery is Aloe. This drug is useful in dysentery when there is griping pain in the hypogastrium before stool, resembling Nux vomica very closely here. The stool consists of blood and mucus, coming out in jelly-like masses. The griping may or may not cease after stool. In addition, an extraordinary amount of mucus must be expelled.

Nux is a valuable remedy in hernia, whether inguinal or umbilical. It is indicated when, on rising in the morning, the patient complains of a feeling of weakness in the abdomen, particularly in the region of the inguinal canal. It affects especially the left side. Lycopodium may be used for right-sided inguinal hernia. Cocculus Indicus comes into play in umbilical hernia after Nux vomica has failed.

Let us now study the action of Nux on the eyes. We find it indicated in many eye diseases. You may give Nux in ordinary conjunctivitis, particularly when it is worse in the morning. This period of aggravation is so well marked that it becomes characteristic of the drug. There is agglutination of the lids and photophobia in the morning. For instance the child buries its head in the pillow in the morning and forenoon, while in the afternoon it uses its eyes freely. These symptoms may also indicate the drug in scrofulous ophthalmia and in blepharospasmus.

In inflamed eyes Euphrasia should be compared. It has the morning agglutination but the photophobia is especially noticeable in artificial light. The tears are profuse and acrid, causing the lids to smart, while with Nux the lid-edges itch and burn without discharge. In spasms of the eyelids Agariais is generally the best remedy, but you should consult also Belladonna, Natrum mur., Euphrasia, Pulsatilla, etc.

Nux may also be indicated when the deeper structures of the eye are involved. For instance, it may be given in that dread disease, atrophy of the retina, whether it comes from choroido-retinitis or not. We find it indicated, too, in another condition of the retina, namely, retinal hyperesthesia. It is indicated by intolerance of light, worse in the morning ; the least attempt to use the eyes is followed by intense pains and spasmodic motion of the ocular muscles; with this there may be excoriating lachrymation and frequent pains in the top of the head.

In amblyopia or impairment of vision due to the effects of tobacco and intoxicating liquors or of debauchery, no remedy will do more toward restoring the power of the weakened optic nerve. Even when atrophy has commenced, Nux will palliate if it does not entirely cure. Another condition in which you find Nux indicated is in ccchymoses of the sclerotic coat, when a certain amount of blood is effused beneath the conjunctiva. These often follow debauchery or sitting up late at night to study, in persons subject to dyspepsia.

If these ecchymoses are of traumatic origin, you should study Ledum, Arnica and Hamamelis.

Now for Nux vomica in catarrhs. Nux is suited to the initial stages of the ordinary coryza, particularly when it has been caused by dry, cold weather, or by sitting in cold places, especially by sitting on cold steps. The trouble is associated with sneezing, and a stuffed-up sensation in the nose at night and in the open air, with fluent coryza in a warm room and during the day. The eyes water, and there is a scraping rawness in the throat. These symptoms are associated with aching all over and chilliness, worse from moving, even when covered up warmly in bed.

The rawness of Nux differs from that of Mercurius. It is not a sore, raw feeling as if the skin were off, so much as it is a rough, scraping sensation. Mercurius is useful in coryza, with rawness and soreness of the nose and throat, with aggravation in damp weather. Pulsatilla is the remedy for a " ripe" cold, in which the discharge is green and bland. If Pulsatilla is prescribed in the beginning, it usually spoils the case.

If, despite the use of Nux, the cold travels downward and involves the chest, I have found Phosphorus to follow well.

There is an epistaxis curable by Nux vomica. It occurs in persons, of a hsemorrhoidal disposition, and is preceded by headache or red cheeks. It usually comes on at night during sleep, although it may occur at any time.

Nux may also be used in Eustachian catarrh, when there is itching and tingling along the Eustachian tube, inducing a frequent desire to swallow.

You will sometimes find symptoms of the mouth suggesting Nux as a remed}r. Ulcers form on the lips, accompanied by burning and sticking pains. Ulcers also appear on the gums. The stomacace of Nux vomica is of gastric origin.

Cough is not a prominent symptom of Nux vomica. You may employ it in coughs of nervous origin: for instance, in coughs which are provoked by mental work. It may also be used in coughs of gastric origin. The patient suffers from cough after eating and in the morning. There is usually severe headache and soreness in the stomach and bowels.

In diseases of the chest we do not find Nux indicated very frequently. It is sometimes useful in asthma, not often in the purely nervous type, but commonly in that arising from gastric disturbance. It is associated with a feeling of fulness and oppression in the stomach, particularly manifested after a hearty meal, during which the patient must loosen all the clothing about the hypochondria in order to obtain relief. The abdomen is distended with flatus. The asthmatic symptoms are worse after a meal, after 12 o'clock at night, in the morning, and are always increased by cold air or any exertion, particularly ascending a height. Belching relieves.

There is a drug analogous to Nux vomica which is often overlooked by members of our school, and that is Zingiber. Zingiber or ginger, unless given too frequently, has a tonic effect on the stomach. It is not a safe article of food for children, or for those who have any kidney affection, as it rather favors the development of morbus Brightii. As a medicine, Zingiber may be used in asthma of gastric origin. The attacks come on in the night toward morning. The patient has to sit up to breathe, but despite the severity of the paroxysms, there seems to be no anxiety.

Carbo veg. and Lycopodium are similar to Nux in asthma from abdominal irritation with marked flatulence.

In haeinopt3^sis or blood-spitting, Nux vomica is indicated when the trouble results from debauchery. The attack usually appears after a drunken spree or after some violent emotion, such as anger, but it may also result from suppressed haemorrhoidal flow.

Nux vomica is a useful remedy in diseases of the genito-urinary organs. It is indicated in renal colic, when one kidney, usually the right, is the seat of the disease. The pains extend into the genital organs and down the leg, and they are usually associated with intense backache. We must here differentiate Nux from Lycopodium, Cantharis, Belladonna and Berberis.

Lycopodium, like Nux, usually chooses the right side, but the pains extend along the course of the ureter and end in the bladder; they do not descend the leg. The backache is relieved by urination. It may be given after Nux.

One of the best remedies during the parox3 rsms of renal colic is Cantharis , which relieves the patient by lessening the amount of local irritation and thus permitting nature to get rid of the stone with less suffering to the patient.

Belladonna is another remedy for renal calculi. The pains are of a sharp, shooting character and differ from those of Nux in the fact that they come suddenly and radiate in various directions from the central point of irritation. The patient grows feverish and excitable. Belladonna relaxes the spasmodic constriction caused by the stone and allows it to pass more readily.

Berberis is an excellent remedy for renal calculi. The pains are of a shooting character. The patient cannot make the slightest motion, and must sit bent over toward the painful side to obtain relief. If, in addition, he complains of sharp, darting pains following the direction of the ureter and extending into the legs, there is no remedy like Berberis. You find in the urine a reddish deposit, consisting of mucus, epithelium, and amorphous urates.

Berberis sometimes has biliary calculi associated with the renal disease. Belladonna is also useful in cholelithiasis, but the remedy to cure the condition permanently is Cinchona. This has been highly recommended by Dr. Thayer, of Boston. Unless some symptom or symptoms call specifically for another drug, put your patient on a course of Cinchona and have him continue it for a number of months. In the passage of gall-stones, when remedies fail to relieve, I find that ether, externally and internally, is very good, acting better here than chloroform.

We find Nux indicated in hematuria, when it is traceable to the same cause as the haemoptysis described above, namely, to debauchery. Nux vomica is indicated also in affections of the bladder, particularly in strangury accompanied by painful urging to urinate, with the passage of only a few drops at a time, causing burning and scalding and other uncomfortable sensations. With this urging to urinate there is also urging to stool.

In gonorrhoea Nux is useful after the abuse of cubebs or copaiva, when the discharge is thin. Sometimes I have noticed that after gonorrhoea has been cured so far as the discharge is concerned, the patient still complains of irritation far back in the urethra, probably in the prostate, causing an uncomfortable feeling which the patient refers to the root of the penis. Nux often relieves this condition. Nux is useful in sexual excesses, especially for the bad effects of early masturbation. It is one of a group of remedies used in these cases ever since the days of Hahnemann. This group consists of Nux vomica, Sulphur, Calcarea carb. and Lycopodium. Nux is to be given when the patient has headache, frequent involuntary emissions at night, especially towards morning; he complains of backache and difficulty in walking. Do not repeat your medicine too often, and when improvement ceases under Nux, Sulphur will almost always be the next remedy indicated.

Calcarea carb. usually follows Nux and Sulphur, particularly when night sweats follow every emission; or, after marriage, every coitus is followed by weakness of mind and body.

Lycopodiu?n is indicated still later, when the case has gone on to complete impotency. The erections are either absent or imperfect. The genitals are cold and somewhat shrivelled.

Staphisagria is called for in the bad effects of masturbation, particularly if there is great emaciation, with dark rings about the eyes, sallow face, and well-marked peevishness and shyness.

There is still another remedy which I would mention in this connection, and this is Cobalt. This is an excellent remedy for backache in the lumbar region, following seminal emissions, whether voluntary or involuntary; the backache is particularly worse while sitting. Nux is indicated in a variety of diseases of the female sexual organs. We find that it has caused and therefore can cure prolapsus uteri. It is to be used when the disease is of recent origin, and has resulted from a sudden wrenching of the body. These symptoms are often associated with constipation accompanied by ineffectual urging to stool. If Nux does not entirely cure, the best remedy to follow it is Sepia.

The menses, under Nux vomica, are almost always profuse, are generally dark in color and are accompanied by retching and cramps in the abdomen. The patient has frequent fainting spells about the time of the menses, especially when in a warm room.

During pregnancy, Nux is a useful remedy for the morning sickness. The patient rises in the morning feeling haggard and sick at the stomach. The more retching predominates over vomiting, the more can we expect of Nux vomica. Jaundice, even, may be present. The skin is sallow, the bowels are constipated, and the appetite is lost. Still later, the patient complains of great pressure upward, as though she could not breathe.

During labor, Nux is the remedy when the constipation calls for it. The labor pains may be very spasmodic and severe; the woman has a constant inclination to stool and urine. This symptom, when Nux is the remedy, is not due to mechanical causes, such as the pressure of the child's head, but it is purely of reflex origin. Frequently, you will find fainting during the pains, or the pains begin in the back and descend thence to the buttocks and thighs. We may also give Nux when the labor pains nearly or entirely cease, exactly as in Pulsatilla. The temperament of the patient will enable you to decide between the two.

Nux is often useful to prevent the return of metrorrhagia, preceding the climaxis or during labor. There are the urging to stool, faintness, etc., already mentioned.

Now let us take up the action of Nux vomica on the spine. It produces, as we have seen when speaking of Strychnia, irritation of the motor centres and efferent nerves. The backache cured by Nux is that located in the lumbar region. It is usually worse at night when lying in bed, and the patient cannot turn over without sitting up. It is thus useful in lumbago. The longer he lies in bed in the morning the more does his back ache.

Picric acid should be mentioned here. This substance is known chemically as trinitrophenol, and is a violent poison. It is to be thought of when, after every severe mental effort, the patient suffers from intense headache of a throbbing character, felt more particularly at the base of the brain. There is often an accompanying congestion of the spine, with an increase of sexual excitement, so that erections, become violent enough to be termed priapism.

Nux vomica is indicated in torticollis, arising from cold or due to spinal disease.

Belladonna is the best remedy for stiff neck of rheumatic origin or from cold. The stiffness is apt to be on the left side. Causticum has stiffness of the sterno-cleido-mastoid muscle of the right side, with drawing. The torticollis may be due to paralytic weakness, as in affections involving the spinal accessory nerve. Here Agaricus and Lachnanthes are also to be compared.

In spinal irritation you must use Nux when the backache just described is present in association with the following symptoms. Sudden loss of power in the legs in the morning; the hands and feet go to sleep easily; stiffness and tension in the hollow of the knees; the clothing about the waist feels too tight; sensation as of a band about the waist; desire to lie down; numbness and formication along the spine and in* the extremities. These symptoms also indicate Nux in myelitis, and in the early stages of locomotor ataxia, especially when the trouble has occurred from exposure to cold or from sexual excesses.

Phosphorus is in many respects very similar to Nux. Both cause an increase in impressionability; both cause spinal anaemia. But Phosphorus tends toward complete paralysis, Nux generally toward partial paralysis dependent upon exhaustion. Both have proved useful in spinal softening.

Physostigma has a symptomatology almost typical of spinal irritation. Under this drug every nerve of spinal origin is irritated. Pressure of the finger between the vertebrae causes the patient to wince. Physostigma causes rigidity of the muscles from meningeal irritation. It finally develops trismus and tetanus.

Ambra grisea, like Nux vomica, is suited to thin, " dried up," nervous subjects. It has marked numbness of the skin. Various parts of the body go to sleep readily. There are also stiffness in the small of the back after sitting and tension in the lumbar muscles, worse on awaking. Even the scrotum and penis feel numb. Patients who complain of these symptoms are apt to be excessively nervous and weak. In company they are easily embarrassed and speak and act hastily. They are driven by nervousness to an impetuous desire to talk, but quickly give out (like Cocculus, Veratrum album, Calcarea ostrearum, Alumina, Sulphur, and Kali carb.). Conversation and exercise quickly cause fatigue.

Asarum Europoeum is suited to still another style of nervousness. It is especially adapted to irritable females, who are so exceedingly sensitive that even the thought of any one scratching silk or making some similar noise causes an aggravation of their symptoms.

Castoreum is indicated when females are nervous and do not react after sickness. Hence, it may be used after typhoid, especially when the patients are subject to headaches which leave the head very sensitive to touch. These are attended by tingling, creeping sensations which are relieved by sleep.

Nux is useful in rheumatism when it involves the larger joints and muscles. It is especially indicated in rheumatism of the trunk. The swelling in the joints is usually rather pale. The symptoms are almost always worse towards morning.

Nux has been recommended for the acne of drunkards and also for acne from eating too much cheese. Constipation from eating cheese requires Colocynth.

Sulphur should be preferred when, with other symptoms, the face is red in blotches, and Ledum when there are red blotches and pimples in which sticking is induced by every least touch. Kreosote and Lachesis are also to be compared with Nux in this condition. Next we shall look at Nux vomica in typhoid fevers. In the selection of Nux in such cases, you are guided by the gastric and bilious symptoms, bitter taste in the mouth, especially in the morning, nausea, vomiting of bile, and characteristic constipation of the drug. The weakness which necessarily belongs to the typhoid state is expressed under Nux by a strong inclination to lie down. The nights are passed in nervous, excited sleep; slight noises cause him to start. He moans and whimpers in his slumber and his dreams are full of bustle and hurry. He may even be delirious.

Nux vomica is useful in intermittent types of fever, when the chill is preceded or accompanied by blueness of the finger-nails; gaping and yawning are well marked. There is always aching in the limbs and in the back; this is followed by fever, and that by sweat. During the apyrexia we have prominent gastric and bilious symptoms. A peculiarity of Nux well worthy of mention is that it seems to intensify the action of Sepia. The same relation exists between Sepia and Lilium tigrinum, and between Sulphur and Mercury. Nux vomica is inimical to Zincum.

The Nux patient is always better after an uninterrupted sleep. Led: by this symptom, Dr. P. P. Wells cured his friend, Dr. Dunham, of diphtheria with Nux, a characteristic symptom of the case being marked relief from a nap. When the sleep is disturbed, the Nux patient is always worse. Early in the evening he is irresistibly drowsy.

Nux acts best when given in the evening. According to Hahnemann, sensitive persons should not take it fasting in the morning or on first awaking, because its most powerful symptoms are then called out. Neither should it be taken just before or after a meal, or when the mind is on a strain.