Poisoning by Physostigma.—In toxic doses physostigma is a powerful poison, producing extreme muscular debility, vomiting (may be absent), and giddiness, followed by paralysis of the voluntary muscles, convulsive muscular twitch ings, and invariably a contraction of the pupil. The respirations become slow and irregular, the pulse slow and weak, and there is an abolition of all the re flexes. Death may occur either by car diac syncope, or, if taken in smaller quantity, by paralysis of the respiratory centre and asphyxia. The mind is usually clear to the end. Death has oc curred from 19 beans in the adult, 6 beans in a boy, and an extreme degree of collapse resulted from the hypodermic injection of V.,,, grain of physostigmine into a child nine years of age: profuse diaphoresis, vomiting and collapse, with pulse 54, and scarcely perceptible and greatly diminished papillary reflex (Lod derst5dt).
Treatment of Poisoning by Physos the crude drug (powdered beaus) or extract have been swallowed, evacuation (by emetic or stomach siphon) and lavage of the stomach are indicated. Atropine is the physiological antidote. It should be promptly ad ministered, 1/64 to V„ grain being hypo dermically injected in a severe case, re peated, as need be, until the pupils are dilated. Chloral is also antidotal to
physostigmine. External heat to the body and respiratory and cardiac stimu lants—such as digitalis, alcohol, and ammonia—will be found useful. Arti ficial respiration may be necessary.
Therapeutics. — SPASMODIC DIS ORDERS.—Physostigma is a useful rem edy in all spasmodic disorders. In tet anus recovery has followed its use in more than 50 per cent. of reported cases. Fraser recommends it to be given until decided physiological effects are pro duced. He advises 1 grain of a good ex tract by the mouth (V, grain hypoder mically), repeated every two hours, and increased or diminished according to the effect produced. In other nerve affections great improvement has been noted, especially in chorea, in epilepsy, in locomotor ataxia, and in progressive paralysis. Trismus neonatorum is amen able to its action. In convulsive dis orders of individual muscles (tic, twitch ing of the orbicularis, histrionic spasm, etc.) its action is satisfactory. In writers' cramp and in hiccough its use has been successful.