Physostigma - General symptoms - Clarke

GENERAL

General

Physostigma venenosum. Calabar Bean. Eséré. N. O. Leguminosae. Trituration of the bean.

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 Versicolor ^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.

"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.

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).

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.

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 ^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 Arnica ^Arn., prescribed by Mr.

Engall, the effusion disappeared, and later the pain and inflammation subsided under Aconite ^Aco. and Merc Viv ^Merc. c. The pupil was now egg-shaped, the long diameter perpendicular, smaller end downwards.

vision extremely myopic. Belladonna ^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.

Physostigma case was cured Great muscular prostration with continual inclination to sigh; leucorrhoea agg. by exercising during the day, especially 4 p.m.; sighing agg. when leucorrhoea is agg.; dread of cold water.

Physostigma 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 amel. 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 agg. by pressure (of finger between vertebrae causing wincing).

by falls and blows. agg.

Motion; descending stairs (wavering in brain). agg.

Walking; stepping; jar of misstep. amel.

Lying supine. agg. Lying l. side; amel. lying on r. side. agg. 4 p.m. agg.

Night (headache unbearable).

If pain began at any hour it always continued till 12 o'clock following, either noon or midnight. agg.

Cold water; perfect horror of cold drink; cold bath. agg.

From bathing; from change in weather; on bracing days. agg.

In church. amel. In cool open air. agg.

On waking. amel. Closing eyes. amel.

By sleep (hiccough). amel.

Warmth to feet; sinapisms to abdomen.

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.