When immediate relief from severe pain is sought to be obtained, and that opium does not materially disagree with the patient, a preference is due to the tincture of opium, as being a more powerful anodyne than any of the other preparations which I have mentioned. I have found, by experiment, that the resin, separated from the other parts of opium, has an anodyne power, not inconsiderable.
The hydrocyanic (prussic) acid is a valuable medicine, but requires, according to my observation, more care in the administration of full doses, than any other medicine. It may be given in small doses, usually, without any inconvenience. When its qualities were first proclaimed, it was too highly extolled as a remedy in phthisis pulmonalis; and, from consequent disappointment, I conceive that its just merits are not sufficiently appreciated. In some cases of hectic fever, attended with urgent cough, I have procured the happiest effects from the use of this medicine. I have not, with the adult patient, in any instance, prescribed more than twenty-four minims as the total quantity, in twenty-four hours; and usually have confined myself to the extent of fifteen, always commencing with small doses.
In order that this medicine may be given with reliance on its properties, it is necessary that it should be kept in the dark, in a cool situation, and that the vial should be accurately stopped. I proceed to offer a cursory account of several of the other new medicines.
The alcoholic extract of nux vomica exerts a special and powerful influence on the spinal marrow, and has produced very beneficial effects in some urgent cases of paralysis. It may be given either in general or local palsy, provided that inflammatory action be not present; that there be no indications threatening apoplexy; and that due care be taken in its administration.
In order to obtain the beneficial effects of the medicine in very confirmed cases of paralysis, we are informed by M. Magendie, that the paralytic limbs should experience some convulsive action; and this, he says, usually takes place in the course of a few days. Then the dose of the medicine is to be lessened. It is administered with most advantage in the form of a pill. A quarter of a grain is the least dose which need be used in the beginning for an adult; and it may be given twice or thrice in the day. The dose is to be increased according to its effects: and it is stated by M. Magendie, that some persons have borne the augmented quantity of thirty grains in the day: but from four to six grains per diem, is the maximum amount usually required. This distinguished physiologist mentions that, in Italy, the following tincture is very much employed for the treatment of paralytic limbs, by means of friction:
Alcohol, one ounce,
Dry extract of nux vomica, three grains.
Dr. Edwards, at Paris, was successful with nux vomica in a case of amaurosis, or gutta serena, accompanied with a paralysis of the upper eye-lid. It has afforded great benefit in many cases of local paralysis, affecting different parts of the body in different examples.
A medical friend informs me, that he obtained very great advantage from this medicine in the treatment of a severe case of tic douloureux, after various other medicines had failed to give relief.
In a case of long standing paralysis of one of the lower extremities, I have had great cause to be gratified with the useful agency of the alcoholic extract, in relieving the symptoms of neuralgia. The patient, a gentleman between thirty and forty years of age, had been afflicted with occasional pains of great severity coming on suddenly, causing complete disability, lasting about twelve hours, and during such period, producing exquisite tenderness of the limb. With the abatement of pain, sleep followed; and, on awaking, this tenderness had so completely passed away, that he could bear a free handling of the parts; but the muscular power of the limb was weakened during the day, it was frequently affected with convulsive action, and its usual debility became much increased.
The case is in progress; but up to the present time the medicine has evidently produced good effects, and without causing any tetanic action of the muscles, which I have mentioned as being considered desirable in some cases; although an unusual sense of tightness was produced. Not the least pain has returned, and the limb is stronger. When I had increased the dose to a grain and a quarter during two days, the sense of tightness, joined with much feeling of weight, became troublesome, and I suspended the use of the extract. In forty-eight hours these symptoms disappeared, and the medicine has been resumed without any kind of disagreement. I may add, with satisfaction, that the retentive power of the bladder, which had been for a long time affected, became materially improved.