EDITORIAL.

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EDITOR-IN-CHIEF:

F. W. COLBURN, M.D.

JOHN P. SUTHERLAND, M.D.

ASSOCIATE EDITORS:

C. T. HOWARD, M.D.

W. H. WATters, M.D

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NUX VOMICA IN EPILEPSY AND CHOREA.

Satisfaction of a deep and encouraging sort may be found in the fact of an old school physician naively and apparently unconsciously urging a line of treatment which is homœopathic, and of arguing strenuously for small doses, basing his claims and arguments upon the results of personal investigations. Such satisfaction may not be an everyday experience, but perhaps for that reason it may be more than excusable to call the attention of our readers to the following quotation from the London Daily Mail which was printed in the Boston Transcript for March 24, 1906. One cannot read the clipping without noticing the statement attributed to van der Kolk that there is "marked similarity between the progress of an attack of epilepsy and cases of strychnine poisoning," or being impressed with Dr. Tyrrell's convictions that larger doses than are needed aggravate the condition under treatment; and that not only do small doses benefit the patient but "the smaller the dose the better the results." The word "small" evidently is used here in a very relative sense to mean smaller than the doses recommended in the "Pharmacopoeia," and not the high "attenuations" of the homoeopathic pharmacopoeia. The article referred to reads as follows:

"Some forty years ago the attention of Dr. Tyrrell of Harley street, London, was drawn to the work of van der Kolk of Utrecht, who had pointed out the marked similarity between the progress of an attack of epilepsy and cases of strychnine poisoning. It was this little fact that gave Dr. Tyrrell a hint as to that line of treatment in epilepsy.

Conium is markedly antagonistic to strychnine, and Dr. Tyrrell was led to give this drug a trial in his cases of epilepsy. He found that the conditions and all the symptoms were aggravated under treatment with conium, and following on this asked himself if conium is antagonistic to strychnine and aggravates epilepsy, why should not strychnine improve and modify the condition?

Dr. Tyrrell immediately experimented with strychnine. Large doses were given, with the result that the epileptic attacks were modified and in many cases inhibited, but only disappeared to recur later. He argued that as large doses gave only temporary relief, probably small doses continued over a longer period would lead to permanent cure.

The dose of strychnine was accordingly reduced, and reduced again and again, with increased benefit to the patient and marked and continued improvement. When the dose had been reduced to almost a minimum it occurred to Dr. Tyrrell that a milder form of the drug might be substituted, and in searching for this form he fixed on nux vomica.

Commencing with a moderate dose this was reduced again and again until a very minute quantity sufficed. Dr. Tyrrell found that the smaller the dose the better the results, and he now uses nux vomica purely as a form of food and tonic.

It is this minute dose which does not find favor with the profession; but Dr. Tyrrell suggests that because his dose is not mentioned in the Pharmacopoeia it should not be argued that a small dose will not suffice. He has every justification for his belief, because the small dose has in his hands cured many epileptics, and led to great improvement in others.

One case will illustrate Dr. Tyrrell's point. A man whom he was treating was given a slightly increased dose of nux vomica, which was followed shortly by irritation and twitching of the muscles of the wrist. On going back to the small dose this condition disappeared, and did not return. Dr. Tyrrell finds that all forms of irritability of the brain caused by nervous exhaustion can be cured by his method. Insomnia, neuralgia and chorea come under this head."

It is not our purpose in referring to this subject to advocate the use of strychnine or nux vomica in the treatment of epilepsy or chorea but to urge a close analysis of the pathogenesy of

strychnia; to emphasize the fact that to be effective curatively a drug need not always be administered in massive or ponderable doses; and to show that occasionally testimony to the usefulness of the law of similars may be found in the utterances of physicians who are not homoeopathic.

Confirmation of Dr. Tyrrell's belief that strychnine and nux vomica are curative of epilepsy has been sought for but very little is found in homoeopathic literature. In a very instructive analytical and therapeutical study of strychnine by Dr. Thomas D. Nicholson, which is to be found in the Journal of the British Homœopathic Society for January 1905, it is stated that "considerable success has been recorded of the administration of strychnine in other spasmodic diseases. Trousseau lauds it in chorea, and gave largish doses. Eustace Smith recommends it in chorea, as well as for the reflex convulsions in growing boys and girls (1 or 2 mins, of liquid strychnine with ergot), and it has been given with curative results in idiopathic epilepsy and in writer's cramp. Laura says, in his 'Pharmacotherapie Dosimétrique,' that its effects are marvellous in the latter disease, and I think the resemblance of the symptoms to those produced by strychnine is very close."

In a scholarly paper on "Epilepsy" by Dr. Giles F. Goldsborough (vide Journal of the British Homœopathic Society, for October, 1905) in which records of twenty-four cases were presented, nux vomica was referred to in connection with two cases (Nos. 21 and 24) but no cures or marked ameliorations were reported from its use. In the discussion of the paper, however, Dr. Speirs Alexander spoke of having given to a patient nux vomica 12, which immediately began to control the fits, which had been getting pretty frequent, perhaps two or three a week. The patient now never had a fit more than once in four months. Dr. Richards Hughes in his "Principles and Practice of Homœopathy," page 382, includes strychnina and nux vomica in "our antiepileptic armory," saying, "Lastly, there are drugs which, though never causing epileptiform paroxysms, have an ascertained relation either to over-excitability of nervous centres or to their imperfect nutrition. In the first class are strychnia and its ores (as they may be called)-nux vomica and ignatia."

Dr. Hughes, also, more than twenty-five years ago, in his