K. A. MCLAREN, M. B.
The proving of the acid phosphate of strychnine, quoted by J.H. Clarke, M.D. in his Dictionary of Materia Medica, produced a sense of constriction in the throat and violent headache over the eyes after eating. The choking sensations were a constant feature in provings and poisonings. He quotes a tabetic case with alarming laryngeal crises with choking attacks relieved by injections of strychnine.
The provings of Strychninum are full of sudden jerks, shocks, twitching and stiffness. There is dread of touch, noise, motion, and aggravation from drafts of cold air. Symptoms are worse in the morning, worse after meals, and better lying on the back.
The senior class at Iowa City in 1907 proved Strychninum phos. I have not been able to find this proving, but Boericke in his Materia Medica, page 712, gives a condensed report. “This drug acts through the cerebro-spinal system upon muscles, causing twitching, stiffness, weakness and and loss of power; upon circulation, producing irregularity of pulse; upon the mind, producing lack of control, disinclination to use the brain, desire to laugh,” etc.
It is not a widely used remedy, but coming as it does from two such gigantic polychrests as Nux Vomica and Phosphorus, one wonders if it is being overlooked.
The majority of the symptoms are found under the parent alkaloid Strychninum. It is with interest then that we look to the Phosphorus element, which also acts in force upon the central nervous system where it produces lack of stamina, fears, and sensitiveness to external stimuli. The cardio-vascular system is also acted upon and we get flushings, rapid heart, and irregular pulse.
I am informed that during the waking hours the centre for respiration lies in the cerebrum, and that with the advent of sleep it is translated to the cerebellum where its action during that time is wholly automatic. During the time which elapses while one is dreaming, it is quite possible that this action is reversed. It is certain that during the process of a frightening dream both respiration and pulse-rate are markedly accelerated.
Whether the emotional disturbances causes the change in pulse and respiration, or whether some other stimulus, such as pressure of intestinal flatus, acts reflexly upon the vagus terminals and these start the rapid heart and breathing which lead to the dream, I do not know. It is true that the chain may be broken by the passage of flatus. It is also true that patients who have attacks like this should not eat before retiring, or if they do, sparingly of plain food.
In the Strychninum phosphoricum patients we get a combination of these Phosphorus ebullitions and of the sudden, violent, muscular contractions of the Strychninum element. These are not the little jerks which affect the hand, arm or foot, but they are sudden, violent, muscular contractions which come like lightening and are gone as fast. They come in the larynx but more often in the lower thorax, and are probably seated in the diaphragm. The patient often thinks it is his heart which jumps violently.
They are frightening to a degree, occur only at night, and generally at the moment of falling into deep sleep. At once following come tachycardia and a hot flush. This is accompanied by coldness of the feet, which is in reality more of a numbness. There may be numbness in one or both arms but no pain. If the patient lies quietly on the back and takes long regular breaths, the rapid heart action and flush soon vanish. This sequence of symptoms may be repeated several times in the same night but is at its height between one and two a.m. The rest of the night is normal. These attacks are accompanied by fear. In the morning the patient is weak, shaken and fatigued.
Such a patient, if sent to a cardiologist, will have a clean slate, will be told he is nervous be directed to exercise more and to take a nightly sedative. If he should happen to consult the specialist during one of the flushes the diagnosis is “Paroxysmal Tachycardia” and he is directed to take quinidine daily.
This remedy is more frequently indicated in males than in females. You will be led to its selection more often by its Phosphorus symptoms than by the Strychnine ones. These latter symptoms are brought out by questioning.
It is most easily confused with Lachesis, which also has the flushings, throat constriction and aggravation after sleep, but does not have the lightning-like muscular contractions. Grindelia also has the sudden cessation of breathing on falling asleep but not the contractions Nux and Strychninum have the contractions but not the fear and flushing and tachycardia.