Physostigma Venenosum
Physostigma · Clarke - Dictionary of Practical Materia Medica · John Henry Clarke · 24,032 chars · source ↗
General
Physostigma.
Physostigma venenosum. Calabar Bean. Eséré. N. O. Leguminosae. Trituration of the bean.
Clinical
Astigmatism. Bathing, effects of. Blepharospasm. Chorea.
Ciliary spasm. Climacteric. Constipation. Coccygodynia.
Dentition. Diarrhoea. Dyspepsia. Epilepsy.
Eyes, affections of; injuries of; strain of. General paralysis. Glaucoma. Haemorrhoids.
Headache. Heart, affections of. Hemiplegia (l.) Herpes, preputialis. Hiccough.
Hysteria. Iris, prolapsed. Leucorrhoea. Levitation.
Locomotor ataxy. Myopia. Navel, inflammation of. Paralysis, local; agitans; spinal.
Paraplegia. Progressive muscular atrophy. Prostration; muscular. Sleeplessness.
Spinal irritation. Spinal sclerosis. Stiff neck. Tetanus.
Throat, sore; fish-bone sensation. Water, effects of. Wounds.
Characteristics
"The Ordeal-bean" of Old Calabar, the Eséré of the natives, is the type of a genus of Leguminosae of the tribe Phaseoleae, with flowers very like Phaseolus, except that its bearded style is terminated by a great oblique hood, covering the blunt stigma." It is this hood which distinguishes the genus and gives it its name. P. ven. is a great twining climber, and has purplish flowers. Its seeds are very poisonous, and are used by the Calabari as an ordeal, suspected persons being compelled to eat them until they either vomit or die.
In the latter case they are considered guilty, in the former innocent. In cases observed in Calabar convulsions have been noted, and twitchings, especially in the back, and death in thirty minutes. A number of cases of poisoning have occurred in this country, and in these the most notable feature was complete muscular prostration. According to Brunton, the tetanising properties of the bean belong to an alkaloid, Calabarine, and the paralysis to Eserine (or Physostigmine, as it is now called).
In animals poisoned by it speedy general paralysis is set up, and death occurs from failure of respiration; though the heart may be poisoned both directly and through its nerves. The paralysis is seated in the spinal cord itself. The muscles are affected by fluttering tremors; involuntary muscles are excited to active movements and expulsive efforts. The intestines are often twisted up in knots.
All the secretions are somewhat increased (C. D. P.). A crowd of children in Liverpool ate beans which they found among the sweepings of a ship from Africa.
Forty-six were admitted to hospital with loss of muscular power, prostration, feeble, slow pulse, cold, perspiring skin, cold extremities; vomiting in nearly all cases, diarrhoea in one-third of them. At first there was colic, but later on remarkable freedom from pain. Pupils contracted in many; in one contracted during sleep, dilated when aroused. Only one (a phthisical boy) succumbed.
He staggered as he walked, then fell, kicking and rolling as if in pain, but afterwards became quiet; much purged; pulse hardly perceptible; skin cold, face livid; quite conscious and able to swallow water. Directly after drinking he died without a struggle, some froth issuing from nose and mouth. After death the blood was found to be fluid; the heart distended with it, and its muscular substance very flaccid (C. D.
P.). Many excellent provings have been made with Physo., among which one made by Christison on himself is remarkable. Simpson and Douglas MacLagan were sent for to attend him in his collapsed state, which Simpson could only compare to that produced by severe flooding, though Christison's only sensation was one of "extreme but not unpleasant faintness." MacLagan thought it like Aconite poisoning. Christison could not get his will into his muscles except by a tremendous effort.
Warmth to feet and a sinapism to whole abdomen gave great relief, and he was then able to turn on his left side; but only remained there a very short time on account of the tumultuous action of the heart it set up. He became drowsy and slept; but his mind was so active in sleep that on awaking he did not know that he had slept. The tumultuous action of the heart continued on waking, but strong coffee quickly restored the whole condition and made the heart regular. A symptom observed by Christison and many other provers was one of indigestion, "as if large pieces of food had been suddenly swallowed." It began under upper sternum, descending and increasing in intensity till it reached the epigastrium; eructations then occurred, and a reversal of direction followed, the sensation ending where it began.
With other provers there was a sensation of weight and hardness. Christison also had very much giddiness and dimness of vision. It is for its action on the eye, especially for its power of contracting the pupil, and thereby antagonising Atropine, that Physo. and its alkaloid Eserine are best known in old-school practice. The effects are more definite when the drug (tincture, extract, or solution of alkaloid) is applied to the eye direct; but one myopic prover had his myopia much diminished.
In glaucoma it has been used with signal success to diminish intra-ocular tension; and especially when glaucoma has been the result of injury. Dudgeon (B. J. H., xxxviii. 60) relates the case of A.
E., 26, struck by the cork of a soda-water bottle on inferior and outer part of left eyeball. Intense burning pain and effusion into the eyeball followed. Under Arn., prescribed by Mr. Engall, the effusion disappeared, and later the pain and inflammation subsided under Aco. and Merc. c.
The pupil was now egg-shaped, the long diameter perpendicular, smaller end downwards; vision extremely myopic. Bell. dilated the pupil, but had no effect on the vision. Engall sent the patient to Dudgeon, who found the pupil was sluggish, and a book had to be held within four inches of the eye to be read. Physo. 3x, every three hours, was given.
After the first dose objects could be seen at a considerable distance, and next day sight was nearly as good as ever. Dudgeon considers that the lens was tilted by the blow, and that Physo. restored the over-stretched or paralysed portion of the ciliary muscle. Woodyatt (Org. iii. 99) states that Physo. has produced corneal astigmatism in a young lady, who found any attempt at close work caused redness of tarsal edges and a hot, sandy feeling in conjunctiva. Lil. t. 30 cured.
Paralysis and tremors predominate over the cramps, twitchings, stiffnesses, and tension of Physo., but these are also characteristic, and tetanus has been cured by Physo. Paralysis of left side is very proeminent, and the numbness is more apparent on left side, especially in left arm; which may be associated with heart symptoms. The apex of the left lung is also affected. A feeling of levitation was observed in one prover on stepping.
Ataxic gait and shooting pains down limbs show its appropriateness in locomotor ataxy. The inability to get the will into the muscles is a striking feature of many paralyses. Spinal, sacral, and coccygeal pains were experienced, and associated with some of them, numbness of the womb. The association of muscular prostration (in any form, of which laboured respiration is one) with any affection is a keynote of Physo.
This case was cured: Great muscular prostration with continual inclination to sigh; leucorrhoea < by exercising during the day, especially 4 p.m.; sighing < when leucorrhoea is <; dread of cold water. This dread of cold water is a grand keynote of Physo. One of the provers (a water drinker) developed a perfect disgust for cold water and cold drinks; and though used to a cold morning plunge, was obliged to omit it on account of his horror. Other provers felt uncomfortable after bathing, and had great reluctance to their bath.
Weakness was felt on change of weather, and on cold, bracing days. A paralytic state of mind and body from grief has been cured with Physo. Sleeplessness of a peculiar kind occurs in Physo. Nash (Med.
Adv., xx. 258) cured with Physo. 12 and 30 persistent sleeplessness in a patient who had been in an insane asylum, and feared she would have to go again. Her symptom was: "If she chanced to get a nap she awoke suddenly as if in a fright, and felt no > from what she had slept." Peculiar sensations are: As if stomach were full. As if she must lose her mind. As if a ball were coming up throat.
Lower limbs as if asleep. Back as if paralysed. Tongue as if burnt (left margin); as if swollen and paralysed. Sensations of contraction and tension.
Wavering in brain. Weak feeling in stomach. H. L.
Chase, one of the provers, had a "very severe pain in the right popliteal space," and he afterwards cured a patient who came to him with pain in the same region two years later (H. R., xiii. 117). (Allen gives the symptom as in the left popliteal space.) The symptoms are < by pressure (of finger between vertebrae causing wincing); by falls and blows. < Motion; descending stairs (wavering in brain).
< Walking; stepping; jar of misstep. > Lying supine. < Lying l. side; > lying on r. side.
< 4 p.m. < Night (headache unbearable). If pain began at any hour it always continued till 12 o'clock following, either noon or midnight. < Cold water; perfect horror of cold drink; cold bath.
< From bathing; from change in weather; on bracing days. < In church. > In cool open air. < On waking.
> Closing eyes. > By sleep (hiccough). > Warmth to feet; sinapisms to abdomen.
Relations
Antidoted by: Coffee; Sinapisms; Arn.; (emetics are of the first importance.
Injection of Atropine antagonises its effects). Lil. t. cured astigmatism of Physo. Compare: Eserin. In paralyses, Lathyr., Oxyt., Strych., Ciner., Con., Gels.
Heart, Phaseol., Phos. Eyes, Onos., Lil. t., Rut., jabor., Bell. Headache with drowsiness, Brucea, Gins., Herac. Spinal irritation, hungry sensation, numbness, muscles of back rigid, wavering in brain, Act. r.
Headache < by music, Phos., Phos. ac. (Physo. of organ.). Levitation, Phos., Phos. ac. Headache with inability to stop thinking (Phos. with increased mental power), Globus, Ign., Asaf.
< Descending stairs, Borax. Increased irritability, tetanic spasms, cramp, tenesmus recti, stiff spine and legs, Strych. and Nux (Physo. has diminished reflexes, spinal paralysis; unsteady gait with eyes closed; death by paralysis, Strych. has death from respiratory spasm dilated pupils). Tetanus, Passif. Tongue as if scalded, Sang.
Causation
Emotions. Grief. Bathing. Injuries. Blows.
Mind
Uncommon mental activity
Foolish actions, said it made him crazy
Exhilarated in morning, gloomy towards noon
Nothing was right, too many things in room; continually counting them
Irritable
Nervous, cannot endure pain
Exhaustion, cannot remember anything
Disinclined to work
Difficult thinking; cannot concentrate the mind.
Head
Vertigo: on moving, with fainting and muscae volitantes; with nausea; in evening, if people stepped in front of tier in the doorway; at night; when reading; on getting up after dinner; when walking; on descending stairs, with dim vision and unsteady gait; wavering in brain; as if drunk; with sensation of wavering in brain
Confusion and dizziness; dull, heavy, oppressive headache
Intolerable pain over both eyes
Head drooping listlessly
Darting pain in various parts, < motion
Aching in morning with epistaxis l. side
Bruised pain in brain all day, < a heavy step;
< l. temple, with general fatigue and sensitiveness to cold or change of temperature
Pressure encircling head, with sleepiness
Constriction as from a bandage or tight cap pressed down as far as temples
Severe, dull, frontal headache, esp. in the morning
Darting pain in forehead, < motion, and in temples
Sharp pain in supra-orbital region, running off towards nose
Pain: over r. eye, in morning on waking, by noon pain in whole cerebrum, fulness of blood-vessels of brain, and contracted feeling in forehead, which extended to eyelids, causing an effort to open or close them; in l. side at 10 a.m., with heat in abdomen and nausea, the pain is heavy at 11, pain over whole head from 4 till 10 p.m., with nausea and general sweat, headache next day with lame, bruised feeling in region of kidneys
Pain in temples; showing from r. temple to 2nd bicuspid
In evening sound of the organ caused headache, < forehead and temples
One-sided headache with fear of opening eyes lest it should < the pain
Inability to stop thinking with headache
Sensation of rush of blood to frontal and temporal regions
Sharp, shooting pains in temples
Throbbing of temporal and carotid arteries; heart beats felt in head on lying down
Intense, painful pressure in vertex and both temples, the pressure in vertex extending over to occiput.
Eyes
Eyes inflamed, first r., then l.; sclerotic dry, red, and swollen; eyeballs pain and smart; lids feel sore
Eyes bloodshot all the forenoon, with burning in them
Pain on attempting to use binocular vision, as in reading, so that one eye must be closed, > by a weak concave glass
Pressure; with muscae volitantes, dark and light long worms or snakes, also tremulous vision
Bright marks when looking at an object; dark yellowish spots covering one or two letters when reading
Sharp, shooting pains, and drawing, twisting sensation in eyes
Eyes sore and painful when moved from side to side
Pain deep in, over top of eyeball, running up from inner canthus to r. frontal eminence, then down obliquely outward into temple
Sharp stitches in r. eyeball, > by motion in open air
The muscularis internus seems not to do its work rightly, and the axis of the eyes differs in each; eyes feel weak, with lachrymation
Eyes convulsed
Sight blurred, hazy, or misty, film over eyes; objects mixed; after which dull pain over the eyes and between the eyes
Aching in posterior part of orbit, extending back into the brain;
< on reading, causing nausea
Lids (esp. l.) heavy; cannot bear to raise them; twitching of lids (upper, < l.)
Contracted sensation in lids with difficulty in opening them and lachrymation when wide open, difficulty in keeping l. eye open
Lids immovable
Tight feeling in ciliary region as if something were creeping about in it, with sharp pain, < reading
Contraction of pupils; in morning; by small and rapid jerks, with sensitiveness to light; then mydriasis, < morning, seeming to depend on fatigue of sphincter, which was > during day by reflex stimulus of light
Pupils dilated
Pupils contracted when asleep, dilated when aroused
Disturbed accommodation; approximation of far point (myopia) and also of near point (the accommodation recovers before the pupil)
Vision abnormally acute; double; dim and indistinct; blurred, hazy, misty.—(Lens dislocated by blow.)
Ears
Sharp, shooting pains in the ears
Shooting in l. ear; in r
Pain in r. ear when writing
Hammering in r. in evening, with feeling in external ear as from a hot wind
Painful pressure on tympani
Discomfort in r., with inclination to bore in with finger; after removal of wax some pain; with eructation a sudden pain from throat along Eustachian tube to middle ear
Crawling in l. ear
Fulness
Stopped feeling
Partial deafness of r
Sensitive to every sound
Singing or tuning like escaping steam, at night after lying down
Hissing, buzzing, ringing in the ears.
Nose
Fluent coryza, sneezing; burning, smarting, itching, and tingling of nostrils; nose stuffed and hot
Twitchings in nose and involuntary expansion of nostrils
Small boil inside r. nostril
Epistaxis while at supper
Smarting at end of nose, it feels as if burnt by hot liquid
Tension in skin of nose and forehead.
Face
Face pale; flushings of the face; heat
Neuralgic pain in r. side of face
Sensation of cramps or spasms in face extending to neck; with numbness of l. hand
Sensation of contraction of l. side of face, with numbness
Severe pain in r. upper jaw like toothache (though all teeth on that side had been extracted)
Numbness of lips.
Teeth
Dentition: nervous children with vacillating pupils who have trouble when nursing or taking food; pain in stomach as soon as they begin, but going off if they continue to nurse.
Mouth
Tongue sore on tip and rough
Smarting of end of tongue; feels as if burnt
Scalding sensation l. side
Tongue coated, more heavily at root
Numbness and tingling of tongue and lips, with constant desire to moisten them
Bad taste in mouth
Profuse salivation; thick, leathery saliva
Difficult speech
Power of speech retained long after inability to swallow.
Throat
Sore throat, painful swallowing
Tonsils and soft palate dark red
Burning, scraping, raw feeling in throat
Tonsils enlarged; swollen, elongated uvula
Small ulcers, with yellow centres in pharynx
Feeling as of a fish-bone in throat; swallowing saliva very painful
Constriction of throat and dysphagia
Pain extending from throat to l. ear when swallowing
Feeling as if a ball were coming up in throat
Submaxillary gland tender and tumefied.
Appetite
Hunger but can find nothing to satisfy it; food has a flat taste.—No appetite, disgust for food, tobacco, and coffee; and esp. for cold drinks.
Stomach
Tasteless eructations
Burning in stomach with hot eructations
Violent hiccough
Nausea and vomiting
In stomach: prickling, sharp pains; darting pains, with paralysed feeling of l. side; heaviness and weight, as if undigested food were lying there; hard pain; griping; emptiness and weakness; sensation of nervousness and trembling
Soreness in region of stomach
Sensation at epigastrium as when large pieces of food are suddenly swallowed.
Abdomen
Lancinating pains in hypochondria
Hard, sore pain in splenic region; descending to groin and across hypogastrium, < by motion
Soreness and pain at navel, which was found much inflamed
Severe pain in umbilical region
Pain and soreness in umbilical region
Stitches in l. side of abdomen
Much rumbling and distension in abdomen, with discharge of large quantities of flatus
Dull pain in transverse and descending colon
Colicky pains, with feeling as if diarrhoea would occur
Shooting pains in l. iliac region and down thigh
Sharp, cutting pains in lower part of abdomen
Dull pain in groins.
Stool And Anus
Stools: copious; soft, thin; watery; yellowish; bilious; part natural, part black like tar; lumpy, mixed with watery discharge; dark and offensive
Constipation; from atony
Sphincter ani swollen and rigid; evacuation painful; rectum protruding, swollen and very sensitive
Tenesmus and burning, with diarrhoea; also tenesmus of bladder
Stool irregular and loose, anus sore and inclined to protrude; piles (absent for three years) return
Severe piles following childbirth.
Urinary Organs
Bruised, sore feeling in region of kidneys
Bladder feels distended
Frequent desire to urinate, often ineffectual
Frequent and copious urination
Urine: yellow; high coloured; strong-smelling; clear; muddy; pale and copious.
Male Sexual Organs
Frequent erections with but slight desire
Two emissions without dreams or excitement
Strong-smelling sweat about genitals, prepuce tender and swollen, many small vesicles on glans with burning itching.
Female Sexual Organs
Leucorrhoea;
< exercising during day, esp. about 4 p.m.; with inclination to sigh; sighing < when leucorrhoea is worse; dread of cold water
Menses irregular
Numbness of womb with pain in back
Condition like that produced by flooding after delivery
Metrorrhagia
Pain as if menses were coming on
Menstruation, with palpitation; congestion of the eyes, with tonic spasms, rigidity, sighing respiration, consciousness retained.
Respiratory Organs
Cough from tickling in throat
Slight constant inclination to cough from filling lungs
Laboured, sighing respiration; yawning.
Chest
Stitches in the chest
Cannot fill l. lung as inspiration = dull pain at l. apex, > by pressure
Stitches under inferior angles of scapulae during expiration
Heavy weight at chest
Twitches across pectoral muscles
Stitches in l. breast, and unable to draw long breath.
Heart And Pulse
Dull pain, uneasiness and distress about the heart
Violent palpitation of the heart, with feeling of pulsation through whole body
As the fresh, bracing air strikes me, a choking sensation with fluttering of heart
Heart's action irregular and tumultuous, when lying on l. side, > when lying on the back
Pulse: variable; accelerated; small, frequent, slow, feeble, intermittent.
Neck And Back
Inclination to stretch out the neck
Pain at base of brain as if it were cutting off body from head; going through to back part of throat, which is stiff and sore
Stiffness in neck
On waking, pain in r. head and neck as if latter was stiff
While taking morning bath suddenly stiff neck (r.)
Drawing on turning head
Rheumatic pains in l. neck and shoulder
Feeling of weakness passed down from occiput through back to lower limbs
Cramp-like stitches up and down spine; stiffness of l. neck
Chilly, creeping sensations up back, 7 p.m
Back very weak, unable to stand erect
Dull pain in back
Backache (in renal region) kept him restless all night; no > in any position; passed copious colourless urine
Creeping numbness from back of head down spine
Cramp-like stitches up and down the spine
Pain under r. shoulder-blade
Dull, heavy pain in lumbar region; also over l. hip, extending to back
Pain in back between hips, with numbness of womb
Pain in (l.) sacral region, as if strained by lifting, < on motion
Contractive pain of anterior surface of coccyx; as if dysentery coming on;
(since verified).
Limbs
Limbs feel weary, as after great fatigue.—(Pleasant) numbness in all the limbs; and paralytic feeling
Neuralgic pains in the limbs
Stiffness or bruised feeling in the joints
Staggering gait
Cold extremities.
Upper Limbs
Wrists feel weak; dull aching pain in them
Sharp, shooting pain in l. shoulder
Itching of l. palm
Paroxysms of burning in palms
Hands feel cold, then hot and red
Pain in r. deltoid > only by violent motion
Numbness in l. arm
Sharp pain in l., then r. arm.
Lower Limbs
Unsteadiness from knee downward when walking, esp. with eyes shut
Dragging pain in l. hip towards back
Thrusts with aching down l. thigh from iliac region
Stiffness in hip and knee
Cramp-like pain in l.
(and r.) popliteal space
Sensation of a drawing cord behind leg and knee, impeding walking
Gnawing in l. tibia
Legs feel asleep
Numbness in l. foot.
Generalities
Indescribable torpidity as from opium; "this is not debility but volition is inoperative" (Christison's experiment) Great sense of fatigue and weariness; weakness Convulsive twitchings
Constant fibrillary twitchings of the muscles Violent trembling all over the body Great prostration of the muscular system Diminished reflex action
Omits bath on account of horror for cold water Sore and stiff all over, as from a cold Severe, sharp pains in various parts of the body In nerves in front of body waves like tremblings going up and down; at back nerves paralysed and numbed with pain as when the nerve of a tooth is being killed
Stiff all over as after taking cold Paralysed feeling in l. side On raising foot in walking, momentary feeling as if he were floating upwards, and on foot touching ground an unpleasant feeling making a shuddering sensation pass all over him.
Sleep
Irresistible desire to sleep; soporific sleep
Restless sleep with dreams
During sleep mind so active was unaware he had been asleep
Falls asleep frequently, but awakes suddenly without relief; following night scarcely closed eyes in sleep; thoughts very active; an idea once started kept on with unusual persistence.
Fever
Creeping, chilly sensation in back; yawning; every movement and draught = shuddering
Hands and feet cold
Cold, clammy skin
Heat in head and face; flushed and hot
Heat in face and down back with chilliness of legs
Dry burning in hands
Perspires very easily
Cold sweat in drops over whole body
Strong-smelling sweat around genitals
Copious sweat all over body.