Cocculus indicus owes its properties to an active principle called PICROTOXINE, this term being derived from two words meaning when combined, "bitter poison." You will notice by the schedule on the board that I have arranged the symptomatology of the remedy under two heads, first the nerves, and secondly, the organs in general.
Now, whatever individual characteristics you may have for a drug in an individual case, these characteristics should agree with the general effects of the drug ; otherwise, you are making a partial selection. To illustrate : Under BELLADONNA, you know of the symptom, "sleepy, but cannot get to sleep ;" that is characteristic of the remedy. But we find the same symptom under CINCHONA, FERRUM, and APIS. How are you to distinguish between them ? By taking the general effect of Belladonna as a groundwork, into which the particulars must fit.
Now, we shall find under Cocculus symptoms that are under many other drugs, but in no other drug do they hold the same relation as they do here. What, then, is the general effect of Cocculus indicus ? This effect is the well-known action of the drug on the cerebro-spinal system, it having very little influence on the nerves and the ganglionic system. How can you find this out? Not very easily, I confess, but yet this has been done, by studying the drug as a whole, by endeavoring to discover, by means of physiology, pathology, or any other science that bears on the subject, on what portions of the body it acts, what functions it alters, and what tissues it changes. Then you have a strong basis on which to build your symptomatology.
Cocculus acts on the cerebro-spinal system, producing great debility of these organs; the action of the drug on the brain itself I will explain to you when I come to speak of its use in typhoid fever. We will now consider the remedy as it affects the spinal cord. It causes a paralytic weakness of the spine, and especially of its motor nerves ;' thus we find it a certain or frequent remedy in paralysis originating in disease of the spinal cord. Especially is it indicated in the beginning of the trouble, whether it results from functional or from severe organic disease of the cord ; whether the disease be spinal irritation from loss of seminal fluid, softening of the spinal cord, or locomotor ataxia. It is especially indicated in these cases when the lumbar region of the spine is affected; there is weakness in the small of the back, as if paralyzed ; the small of the back gives out when walking. There is weakness of the legs; and by legs I mean the entire lower extremities; the knees give out when walking; the soles of the feet feel as if they were asleep ; the thighs ache as if they had been pounded; first one hand then the other goes to sleep; sometimes the whole arm falls asleep, and the hand feels as if swollen. These symptoms lie at the foundation of the symptomatology of the whole drug; they all seem to depend upon spinal weakness. We find these symptoms common enough in women with menstrual difficulties, when the back gives out in the morning, after venereal excesses, and also from loss of sleep. There is a concomitant symptom which you almost always find associated with those just mentioned, and that is a feeling of hollowness in some one of the cavities of the body, either in the head, chest, or abdomen. It is more than a weakness; it is an absolute feeling as though the parts were hollow. Talking tires these patients very much.
The debility of Cocculus is of spinal origin. Especially is it apt to follow loss of sleep; the patient cannot sit up even one or two hours later than usual in the evening without feeling languid and exhausted throughout the entire day following.
Let me next enumerate the typhoid symptoms of Cocculus; under this heading I shall speak of those of the brain. You would not expect Cocculus to be indicated in a case of typhoid fever when the changes in or ulceration of Peyer's patches were marked, or where there were profuse diarrhoea, pneumonia, and similar complications. But in the nervous type of the fever, when the cerebro-spinal system is bearing the brunt of the disease, Cocculus becomes one of the remedies that will help us through the case. The symptoms indicating it are the following: The patient complains of great vertigo, and this is made worse when sitting, or when attempting to change from a reclining to a sitting posture. It is often associated with nausea, inclination to vomit, and even fainting. BRYONIA also has this symptom. So far as the symptom itself is concerned, there is no difference between Bryonia and Cocculus, yet, if you examine the case thoroughly, you will find that in Cocculus it is weakness of the cerebro-spinal nerves that gives origin to the symptom. There is great confusion of the mind ; a sort of bewildered, heavy state might better explain what I mean. It requires a great effort to speak plainly. In some cases they cannot find the words they wish, to convey their meaning. Generally, such patients lie quietly wrapped in thought; the eyelids are heavy, as though they could hardly be lifted. Here is a symptom reminding you of Gelsemium. If the patient is still conscious enough to describe to you his condition, he will complain of a feeling of tightness of the brain, as though every nerve in the head were being drawn up tightly. At other times, he has this empty, hollow, vacant feeling in the head. Any attempt to move the patient produces faintness or even fainting away. The tongue is usually coated white or yellow; there is bitter taste in the mouth. The abdomen is greatly distended and tympanitic; this tympanites under Cocculus is not the same as under CINCHONA, CARBO VEG., COLCHICUM, SULPHUR, or even LYCOPODIUM.
There are several origins of tympanites. It may come from the bloodvessels, from the air swallowed with the food, from changes in the food itself, and also from its retention. The latter condition is the cause of the tympany under Cocculus indicus. It is not to be thought of as a remedy when flatus results from decomposition of food. That calls for CARBO VEG. Cocculus has considerable oppression of the lungs, this being of nervous origin. It is usually referred by the patient to the walls of the chest. The patients are sleepless, or at least business thoughts crowd on the mind and keep them in a half-waking state, here again resembling BRYONIA. These are the symptoms which lead you to Cocculus indicus in typhoid states.
The next division for consideration is "Spasms." COCCULUS INDICUS is useful in spasmodic affections when the patient is greatly debilitated as to the cerebro-spinal nervous system. Irritable weakness is the condition which gives rise to the spasms, for which Cocculus is the remedy. It is especially useful when spasmodic symptoms ensue as a result of prolonged loss of sleep. This condition we meet with more frequently in women than we do with men. The former are also more subject to spinal weakness. You may also use Cocculus for spasms after suppressed menses. The eyes are usually closed during these convulsions, and there is rapid oscillation of the eyeballs beneath the closed lids. But the woman must be of a weak, nervous temperament, or Cocculus is decreasingly indicated.
Under the heading "Organs" we still have a word to say about Cocculus. First, as to the headache. Some years ago there was an epidemic of spotted fever in this city. During that epidemic many children died, especially in its earlier days. After a while there was discovered a symptom characteristic of the epidemic, and that was intense headache in the occipital region, in the lower part of the back of the head, and in the nape of the neck. The intense headache was manifested in various ways. Children in a stupor would manifest it by turning the head back, so as to relieve the tension on the membranes of the brain; others, who were conscious, would put their hands to the back of the head; while still others complained of pain in the back of the head, as if the part were alternately opening and closing. That symptom was under Cocculus. There were very few fatal cases after Cocculus was used. Occipital headaches are hard to cure. Cocculus is a good remedy. GELSEMIUM is another. In the latter there is passive arterial congestion, by which I mean that the arterial blood flows freely to a part, the pulse being full and round, and not hard and tense, as under BELLADONNA or ACONITE. There is often thick speech, too, with Gelsemium.
Still another remedy for occipital headache is the JUGLANS CATHARTICA, sometimes called JUGLANS CINEREA, or the butternut. This I consider to be the best remedy for sharp pains in the occipital region.
We have already anticipated some of the symptoms of Cocculus pertaining to the female genital organs. Still there are others. The menses are either profuse, and coming too often and with a gush, and very debilitating, or they are tardy in their appearance, and the patient suffers each month from what has been termed menstrual colic. We have a little group of remedies, of which Cocculus is one, for this condition. The others are PULSATILLA and CHAMOMILLA. First let me describe the symptoms of Cocculus. This remedy is indicated by a colic, in which the pain is as if there were sharp stones rubbing against each other in the abdomen. There is very often with this colic excessive distension of the abdomen from accumulation of flatus. The colic is especially liable to come on at night and awaken the patient. It is relieved by belching, but returns again from the reaccumulation of flatus. The patient is, of course, irritable.
Under CHAMOMILLA the menstrual flow is very dark. The mental symptoms described to you in my lecture on that drug are necessarily present.
PULSATILLA has scanty menstrual flow, coming by fits and starts, griping pains doubling the patient up; but the disposition is mild and tearful.
CYCLAMEN is similar to Pulsatilla. It has chilliness with the pains ; crying, tearful mood; dyspepsia, made worse by eating fat food and pastry ; scanty menses ; menstrual colic. But we make the distinction here: Cyclamen does not have relief in the cool air or in a cool room, and in many cases Cyclamen has thirst. The resemblance between Cocculus and Cyclamen is that both remedies suit a depressed condition of the cerebro-spinal nervous system. Those of Cyclamen are these: The patient feels dizzy; is weak from any motion ; is highly anaemic; and usually worse when sitting up. These symptoms are usually associated with dimness of vision. We also find under Cyclamen this flatulent colic, arising of wind in the bowels, coming on at night, and only relieved by getting up and walking about. Compare also, in menstrual colic, IGNATIA and NUX VOMICA.