PHYSIOLOGICAL ACTION. — According to D. W. Prentiss, muscarine first pro d aces increased excitability of the brain, and later reduced excitability, merging, in cases of poisoning, into paralysis of the brain-cells. The action on the heart is similar to that upon the brain-centres: first, increased frequency, followed by slow, feeble pulse. The action upon man and the lower animals is identical. In the latter, poisoning by muscarine is followed by stoppage of the heart,— in relaxation or diastole due to paralysis of the inhibitory nerve. Application of muscarine to the heart-muscle produces the same effect. This condition is re lieved and the heart again begins to beat upon the administration of atropine.
Experiments on animals poisoned by the fly-amanita and with pure mus earine show very clearly that when the heart has nearly ceased to beat it may he stimulated to strong action almost con stantly by the use of atropine. In such eases of poisoning its use should be pushed as heroically as the symptoms of the case will warrant. V. K. Chestnut (Circ. No. 13, Division of Botany, U. S.
Dept. of Agriculture, '9S).
Treatment of Muscarine Poisoning.— The patient should be kept in the re cumbent position and as quiet as prac ticable, and the gastro-intestinal tract re lieved at the earliest possible moment. The emetic to be employed should be selected so as to avoid depression, heart failure being the chief danger, while the purgative should not be of a kind capa ble of encouraging, by the copious pro duction of fluid, the absorption of the toxin. Thus, tartar emetic and salines become dangerous agents.
A tablespoonful of mustard in a turn blerful of lukewarm water usually acts .promptly and may be administered if apomorphine is not at hand and while it is sent for. Unless copious emesis be obtained, the latter emetic grain) should be administered hypodermically. Sulphate of zinc is also effective.
As purgative, an oleaginous agent is to he preferred. Croton-oil, 1 drop, may be given, or if there is not much gen eral torpor, a tablespoonful of castor-oil. Half an ounce of glycerin, in as much water, injected into the rectum some times produces a rapid evacuation.
Atropine being the physiological anti dote of muscarine, it should be given at once hypodermically, the dose ranging from '/,„ grain to grain, according to age. The pupil acts as a reliable guide if the ease is not seen too late; the atro pine causes dilatation of the pin-head pupil as soon as its physiological effects are produced.
To further sustain cardiac action, digitalis is given at fixed intervals, strychnine or nitroglycerin, and all the methods applicable in chloroform cosis are indicated. The poisonous ac tion reaches its crisis, then gradually cedes. The aim, therefore, should be to maintain life by sustaining the action of the heart throughout the dangerous period.
Strychnine used as an antidote in mushroom poisoning, twelve injections of grain each causing complete re covery. Koenigsdorfer (Pharm. Zeit. f. Russland, No. 7, '94).
The physiological antidote of mus carine is atropine, which should be given in full dose, say V„ grain, and repeated if the pupils are not dilated by the first dose. With this should be given strych nine and such other stimulants and heart tonics as are usual in the treatment of poisoning by depressants. Editorial (Northwestern Laneet, Jan. I, '98).
First of all in importance is absolute rest in the recumbent posture; then the tincture of digitalis, 10 drops, should be given every two or three hours, according to the effect. If there should be blanched skin, pale face, and cold extremities, nitroglycerin, grain, should be given hypodermically as frequently as required, instead of the digitalis. If the heart still continues weak and the vita] powers are sinking, galvanism to the cardiac region and inhalations of oxygen may be em ployed. Efforts to keep the patient alive should be unremitting; if the crisis can be tided over, nature will eliminate the poison and recovery be assured. For nourishment, concentrated foods are pref erable, such as the meat-extracts, egg albumin, milk, and the like. Nourish ment is best given in small quantity at frequent intervals. D. W. Prentiss (Phila. Med. Jour., Sept. 24, '98).