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Homeopathic Materia Medica by Farrington



NUX VOMICA

(nux-v)

Nux VOMICA 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 Strychnia. The Nux itself is the seed deprived of the pulp and shell. These seeds are disk-shaped, and are about one inch in diameter and one-quarter of an inch thick. Their 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 being in, much smaller quantities than the other and 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 IGASYRIC 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. The throat is constricted similar to what we find under BELLADONNA. Sometimes there are 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 any impressions made on the senses, particularly by the slightest touch, while rubbing relieves the patient. 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-impressionability; by this I mean that everything impresses the patient excessively. External impressions, as sounds, odors and noises, excite him, and that over-irritability, I say, is characteristic of the drug.

Strychnine resembles PICROTOXINE, VERATRIA, CICUTA VIROSA, THEBAINE, HYDROCYANIC 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 Picrotoxine 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 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 varies widely from Strychnia, causing spinal paralysis and diminished reflex action. When, therefore, such symptoms as constriction of the throat, cramps in stomach and bowels, tenesmus recti, stiff spine and legs, tight feeling in and about the eyeballs, suggest a similarity with Strychnia, such consentaneous evidences of spinal paralysis as the following will serve for differentiation : trembling, feeble, can hardly walk, can with difficulty make the muscles obey the will (hence like GELSEMIUM, 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; the latter contraction with defective accommodatiou 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; faints from odors; muscular tremors with excitement; desire for coitus, but during an emission he becomes impotent, etc.

CURARE, even if it does contain Strychnia, acts quite differently from the latter. It destroys the irritability of the end-organs of the nerves of muscles, 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 extremities of the vagus, the heart's action is accelerated, but 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.

We have no very trustworthy provings of Curare. Still 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 awaking, and in eczema of infants, worse on the face and behind the ears; scrofulous children (WORLD'S HOMEOPATHIC CONVENTION, vol. i.).

It has also been used for catalepsy, with spasms of the lower jaw, by Baruch, I think.

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; limbs stiff, hands firmly shut, feet extended and toes flexed, teeth clenched and lips everted, opisthotonos; chin drawn to sternum.

PASSIFLORA INCARNATA has not been proved, but it has cured cases of tetanus in hot countries, where, unhappily, they are but too common. Dr. Archibald Bayne, of Barbadoes, W. I., reports two cures with the è and lx (HAHN. MONTHLY, May, 1881).

ANGUSTURA is placed among aromatic bitters and called a tonic. But it is more than this. It causes drawing, tension, and stiffness of muscles and joints', with 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 Rutacease, the RUTA GRAVEOLENS. Injury to periosteum frequently suggests the latter; and it is quite probable that injury with incipient muscular contraction's 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. Aegidi 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 VOMICAOE CORTEX SEU BRUCEA ANTIDYSENTERICA.

Dr. Aug. Korndoerfer used Jenichen's 2° for necrosis of the lower jaw. One side of the jaw had been successfully excised; but the disease made its appearance in the other side; the cure was complete.

Of 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 Aegidi). Tenesmus recti, with soft stool; urging to urinate, with copious flow (see case of Dr. Edmundson's, HAHN. MONTHLY, October, 1876). I cannot, then, quite agree with Dr. Hughes, who asserts that Angustura has no recognized therapeutical place.

ACONITE, in one of its manifestations, causes a general tension of nerves and vessels, characterized by the well-known anxiety, heat, etc. (see Hughes' 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 traumatic tetanus.

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

In impending tetanus, we certainly have efficient preventives of the full-fledged disease: ACONITE, fever, anxiety, tension of muscles, tingling and numbness; VERATRUM VIRIDE, HYPERICUM, excruciating pain in the wound; BELLADONNA, OICUTA, 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, cites poisoning cases which prove its homceopathicity to epilepsy and to tetanus. The relation of the acid to this 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 Aconite 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. I)r. Charles A. Barnard reports two cases of traumatic tetanus relieved with this acid. In each instance only the spasms of face, jaws, and chest lessened, other remedies being needed for the remaining symptoms (see N E. MED. GAZETTE, October, 1882). This affinity of Hydrocyanic acid for the upper part of the body does not contraindicate 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 though the par vaga. 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 CICUTINA, which as yet has not been isolated. According to Boehm, this plant causes vomiting, diarrhoea, and tetanoid convulsions, and in man also syncope and strabismus. The volatile oil which it contains is said to be identical with oil of cumin, and is non-poisonous. But an alcoholic resinous extract containing, according to Trojanowski, Cicutoxin, causes 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 muscles, and then spasms. The breathing grows very rapid, and then suddenly convulsions develop. Respiration, as with Strychnia, is suspended by contractions 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 homeopathist in the choice of this powerful remedy; sudden rigidity, then jerks 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 the 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 ARS.

TABACUM and NICOTINUM cause: Head drawn back, with rigidity of muscles of neck and back; contraction of eyelids and masseter muscles; hissing respiration from spasm of 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 muscles, as intestines, ureters, etc.; thege contractions are accompanied with intense pains, 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 Prussic acid rather than those of Strychnia. A characteristic difference between Tobacco and Nux is well brought out in their respective applications to renal colic: Pain down the right ureter into the genitals and leg, nausea, vomiting, Nux. Pains down the ureter with DEATHLY SICKNESS AND COLD, SWEAT, Tabacum.

VERATRUM ALBUM causes convulsions, 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. You distinguish it from Strychnia in this; under Veratrum album it is secondary to exhausting diseases and never primary, as under Strychnia.

STRAMONIUM, like Strychnia, causes tetanic convulsions which are worse from touch or from light; the distinction lies principally here: With Stramonium there is almost always mania present, while under Strychnia the mind is clear to the last hours of life.

CAMPHOR and PHYTOLACCA are very similar to Strychnia in tetanic spasms. Both of these have showing of the teeth from drawing-up of the corners of the mouth. Camphor is indicated in tetanic spasms with the ever-present deathly coldness.

PHYTOLACCA is called for when there are clenching of the hands and flexing of the toes; the lips are everted, and there is alternate spasm and relaxation of the facial muscles.

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

 

 

Next let me say that Nux vomica is complementary to SULPHUR. By that I mean, that very frequently after Nux vomica has done as much as its symptoms will allow it to do, the remaining symptoms often 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 suits best for 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 quick and active in his motions. He has a nervous temperament. 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 the patient 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 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, apd who have become dyspeptic. They have headache and are tired in the morning when they awake. The Nux patient frequently lies awake at night; his mind is so wrought up that he cannot sleep. Thoughts run through the mind in confusion. He falls asleep long after midnight, and then awakes in the early morning, at four or five o'clock perhaps. He falls asleep again, and when he awakes once more, he feels terribly used up, as if he had been on a spree, and his sleep had done him no good. He has 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 the most effective.

The Nux patient, you will find, has a great deal of trouble with the digestive organs. He suffers from headache. This headache is situated either in the occiput or over one or the other eye, usually the left. When it is situated over the eye, it begins usually in the morning, and increases all day until night, and is accompanied generally by 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 matters; but the prominent feature of the vomiting is the violent retching, often more or less ineffectual, showing you the irritated condition of the stomach. He has this peculiarity of sleep, awaking early, at three or four o'clock in the morning, and then falling asleep once more, awakes 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 matters 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 ; and 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 hyperirritation that 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 and two or three other remedies which we cannot get along well without. You are treating a patient who has been prostrated by disease; as soon as he swallows food, up it comes again. Nux is here one of the remedies, 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, and associated with dull pain in the back, and spasmodic vomiting.

Another form of stomach trouble to which Nux is applicable is a dyspepsia in which there is marked aggravation about an hour or so after eating. The patient complains of great hunger about twenty-four hours or so before the attack comes on. In these cases, he craves meats, gravies, and fat foods. He has violent thirst, and water distresses the stomach and causes distension of that organ; the patient, after even a light meal, is obliged to loosen his clothing.

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.

 

 

Still another remedy more valuable than any yet mentioned is KREOSOTE. Kreosote is a remedy for this irritable weakness of the stomach. Food cannot be digested. But I think its distinctive character lies in this fact, that though the stomach retain the food several hours, it finally ejects it undigested.

In gastric symptoms following debauchery, Nux sometimes fails and sometimes is contraindicated by temperament. In the former case CARBO VEG. is a good remedy.

PULSATILLA is preferable to Nux vomica when the symptoms have resulted from a mixed diet, such as meats, pastry, ice cream, etc., especially if the temperament agrees.

In constipation, Nux is similar to several 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 urging to stool similar to Nux vomica, but it is relieved, by the passage of flatus, showing that that was 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. Even a soft stool requires great effort for its evacuation.

Nux vomica has a marked action on the liver. It is particularly indicated in liver affections in those who have indulged to excess in alcoholic liquors, highly-seasoned food, or have abused themselves with drastic purgatives. Nux is one of the best remedies we have to counteract the effect of allopathic dosing. You will frequently find it necessary in taking charge of a case that has been under old school treatment to administer Nux before you can make head and tail of the case. The liver you will often find in these cases swollen and hard and sensitive to the pressure of the clothing. There is often colic attending these gastric and bilious troubles. This colic may come from accumulation of flatus which presses up towards the chest, producing inconvenience in breathing ; or downward upon the rectum and bladder, developing both urging to stool and urination. Or it may be haemorrhoidal colic. By this I mean, abdominal pains which follow the sudden stoppage of a haemorrhoidal flow. The patient has been for years subject 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 must give Nux in repeated doses, and you will often be gratified at finding the liver resume its natural proportions. If it does not, then you have to fall back on SULPHUR, SEPIA or MAGNESIA 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 sick or weak.

Nux may also be indicated in the enlarged liver of drunkards.

CHAMOMILLA may be employed in jaundice resulting from a fit of anger.

BRYONIA is useful in jaundice when the case has been spoiled by the abuse of calomel.

CARDUUS MARIANUS is indicated in jaundice with dull headache, bitter taste in the mouth, tongue white, 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 golden yellow. 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 the patient to sit in a tub of cold water for relief. There is frequent ineffectual urging to stool. There is bleeding from the piles. Unless Nux is thoroughly indicated, it should not be prescribed, for while, in such cases, it may cure the piles, it will excite some other trouble more unbearable than the one it has relieved.

The analogues of Nux in haemorrhoids are several; First, Aesculus HIPPOCASTANUM. This 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. That is the keynote for Aesculus. Aesculus also has weak feeling at the sacro-iliac symphysis, as though the legs were about to .give out.

The next remedy that I will mention in this connection is ALOE. This remedy has abdominal plethora and flatulence like NUX and SULPHUR, and haemorrhoids like NUX, SULPHUR and AeSCULUS. But it differs from these remedies in that it acts almost entirely on the rectum, producing catarrh of the rectum. The stools are accompanied by an immense expulsion of 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 be moved. 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 eyelids.

COLLINSONIA is indicated in haemorrhoids when there is a sensation as of sticks in the rectum. Constipation is usual. The bowels are more apt to move in the evening. 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. We find that Collinsonia has a symptom like one of OPIUM ; 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 characterized by being scanty and often accompanied by urging, thus keeping up the character of Nux vomica. The patient retches in the morning, vomiting perhaps a little froth or sour fluid. He craves liquor, of course, but so irritable is his stomach that he vomits it 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 urging to stool, this urging ceasing as soon as the bowels move. The stools are bloody, slimy and watery and also 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 a secretion, as the perspiration.

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

Another concordant remedy in dysentery is ALOES. This drug is useful in dysentery when there is griping pain in the hypogastrium before stool, being here Very much like Nux vomica. The stool consists of blood and mucus coming out in jelly-like masses. The griping may or may not cease after stool. In addition, we may have an extraordinary amount of mucus expelled.

 

 

Let me speak of the use of Nux in incarcerated hernia, whether inguinal or umbilical, and I will have done with its abdominal symptoms. Nux is indicated when the patient complains of a feeling of weakness in the abdomen on rising in the morning.

LYCOPODIUM may be used for right-sided inguinal hernia.

COCCULUS INDICUS comes into play in umbilical hernia after Nux vomica has failed.

Now let us look at the action of Nux on the different organs, for instance, the eyes,—we find it indicated in many eye diseases. In the first place, you may give it 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 rhorning. These symptoms may also indicate the drug in scrofulous ophthalmia and in blepharospasmus.

In spasms of the eyelids, AGARICUS is generally the best remedy.

It 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 come from choroido-retinitis or not.

We find it indicated, too, in another condition of the retina, that is hyperaesthesia of the retina. It is indicated by the intolerance of light, worse in the morning; the least attempt to use the eyes is followed by intense pains and spasmodic motion of the different ocular muscles; with this, there may be excoriating lachrymation.

Another condition in which you find it indicated is, in ecchymoses of the sclerotic, when a certain amount of blood is effused beneath the conjunctiva. Tliese often follow debauchery or sitting up late at night to study, in persons subject to dyspepsia.

If these ecchymoses are of traumatic origin, then we are to think of 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 from sitting on cold steps. The trouble is associated with sneezing, and stuffed-up sensation in the nose. The nose seems to be dry, there being no discharge to speak of; the eyes water, and there is a scraping rawness in the throat. Sometimes these catarrhal symptoms seem to be worse in a warm room and are relieved by the open air.

Now this rawness 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 then 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 downwards 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 haemorrhoidal disposition. It is usually preceded by headache with 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. There is itching and tingling along the Eustachian tube, and this induces a frequent desire to swallow.

You will sometimes find symptoms of the mouth suggesting Nux as a remedy. Ulcers form on the lips, which burn and have sticking pains in them. Ulcers also appear in the mouth. The stomacace of Nux vomica is of gastric origin.

The cough of Nux vomica is not very characteristic; but you may employ it in cough of nervous origin, for instance in coughs which are provoked by mental work. It may also be used in coughs of gastric origin; after eating, the patient suffers from cough. This is usually accompanied by soreness in the hypogastrium.

In diseases of the chest, we do not find Nux indicated very often; still it is sometimes useful in asthma. This asthma is usually not the pure nervous asthma, but it is that which arises 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. The abdomen is distended with flatus. Belching relieves this asthmatic state. The symptoms are always increased by cold air or any exertion, particularly ascending a height.

There is a drug analogous to Nux vomica which is often overlooked by members of our school, and that is ZINGIBER. Zingiber or ginger has a tonic effect on the stomach unless it is overused. It is not a safe article of food to be indulged in by children, or by 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 towards morning. The patient has to sit up to breathe. Despite the severity of the paroxysms, there seems to be no anxiety.

CARBO VEG. and LYCOPODIUM may be used in asthma from abdominal irritation with marked flatulence.

In haemoptysis or blood-spitting, Nux vomica is indicated when the trouble results from debauchery. The attack appears after a drunken spree or after some violent emotion, as anger. 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 or the other kidney, usually the right, however, is the seat of the disease. The pains extend into the genital organs and down the leg. They are usually associated with intense backache. We must here differentiate Nux from a few other remedies, LYCOPODIUM, CANTHARIS, and BERBERIS.

One of the best remedies during the paroxysms is Cantharis, which relieves the patient by lessening the amount of local irritation and so permits nature to get rid of the stone with less suffering to the patient.

In the passage of gall-stones, I find that ETHER, externally and internally, is very good. It here acts better than CHLOROFORM.

BELLADONNA is another remedy for biliary calculi. The pains are of a sharp, shooting character; they come suddenly and radiate in various directions from the central point of irritation. The patient becomes feverish and excitable.

BERBERIS is an excellent remedy for biliary as well as renal calculi. The pains are of a shooting character. The patient cannot make the slightest motion, and must sit bent over to the right side to take the pain from the sore region. 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 lithates.

The remedy to permanently cure biliary calculi is CINCHONA. This has been highly recommended by Dr. Thayer, of Boston. Unless some symptom or symptoms call you specifically to another drug, put your patient on a course of Cinchona and have him continue it for a number of months.

We find Nux indicated in haematuria, when it is traceable to the same causes as the haemoptysis.

Nux vomica is indicated also in affections of the bladder, particularly in strangury with painful urging to urinate, with passage of only a few drops at a time, causing burning and scalding and other uncomfortable sensations.

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. With this urging to urinate, there is urging to stool. In gonorrhoea, Nux is useful after the abuse of Cubebs or Copaiva, when the discharge is thin.

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 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 the improvement ceases under Nux, you will almost always find that SULPHUR will be the next remedy which will give the patient any relief.

CALCAREA 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.

LYCOPODIUM is indicated still later, when the case has gone on to complete impotency; when 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 that is KOBALT. This is an excellent remedy for backache in the lumbar region, following seminal emissions whether voluntary or involuntary; this backache being particularly worse while sitting. Nux is indicated in quite a variety of diseases of the female sexual organs. We find that it is a remedy which 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 with 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, and generally dark in color. 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 upwards, 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 are 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.

Now, 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.

It is also indicated in torticollis, arising from cold and due to spinal disease.

In spinal irritation, you may 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.

PHYSOSTIGMA has a symptomatology almost typical of spinal irritation. Every nerve of spinal origin is irritated under this drug. The 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.

BELLADONNA is the best remedy for stiff-neck of rheumatic or catarrhal origin.

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. Such patients as 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 fatigue quickly.

ASARUM EUROPEUM is suited to yet another style of nervousness. It is especially suited 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.

Cerebral softening may be averted by Nux vomica. Especially is this remedy to be thought of, when sedentary habits and mental effort have operated as well as intemperance to produce the disease; especially, too, in persons who have been living too high. The memory is fickle, headache comes with every attempt to exert the mind. He has vertigo when he awakens in the morning, and his gait is vacillating.

PHOSPHORUS is the remedy which most frequently follows Nux in this condition.

There is a new remedy which I would here like to mention, and that is PICRIC ACID. This is a violent poison. It is to be thought of when, after every severe mental effort, the patient suffers from intense headache of throbbing character, and felt more particularly at the base of the brain. Often, too, there is congestion of the spine with increase of sexual excitement, so that erections become almost violent enough to be termed priapism.

Next, we will 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 strong inclination to lie down. The nights are passed in nervous, excited sleep; slight noises cause him to start. He dreams a great deal at night. 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 SULPHUR and MERCURY. NUX VOMICA IS INIMICAL TO ZINC.

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.