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Caffein is indicated if digitalis is contraindicated or does not act satisfactorily, and the patient is not nervously excited, but perhaps is stupid or apathetic, and also when diuresis is desired. Strychnin: This is a valuable stimulator and heart tonic when properly used. It promotes muscular activity of the heart much as it promotes all muscular activities.
Caffein or coffee is here indicated, and the patient should be kept warm lest he lose necessary heat. The stomach should be emptied by an emetic, often best by apomorphin hypodermically, unless the pulse is excessively weak. Strychnin may also be given, and digitalis, hypodermically, if it seems indicated. Camphor is another cardiac and cerebral stimulant that is valuable in these cases.
If it makes a nervous patient more nervous, or a quiet patient restless and irritable, it is acting for harm and should be stopped, just as caffein under the same conditions should be stopped. Strychnin may cause diminished secretion of the skin. This is not frequent, but it does occur. It may prevent the patient from sleeping.
A brisk purge should be admintered at the onset and strychnin, because of its indirect stimulative effect upon the circulation together with its tonic effect upon the musculature, is beneficial. In all such cases rational treatment, good hygiene and careful nursing are the principal factors which stimulate recovery.
Our experiments have shown that the brain-cell changes induced by drugs of the first class are precisely the same as the cycle of changes produced by the emotions and by physical activity. We have found that strychnin, according to the dosage, causes convulsions ending in exhaustion and death; excitation followed by lassitude; stimulation without notable after-results; or
"He was put on light, nourishing diet, iron and strychnin were given internally, and electricity was applied to the lower extremities every other day; the cystitis was treated by irrigating the bladder each day with Thiersch's solution.
There is a great difference in the belief of clinicians as to the best treatment for this condition. It would seem to be a positive indication for digitalis, and good-sized doses of digitalis given correctly, provided always that the preparation of the drug used is active, are good and, many times, efficient treatment. Small doses of strychnin may be of advantage, and camphor may be of value.
It could not be ascertained whether any medicine containing strychnin had been taken, but surely, from the symptoms, such must have been the case. Tobacco. O'Neill a gives the history of a farmer's wife, aged forty, who wounded her leg against a sewing-machine, and by lay advice applied a handful of chopped wet tobacco to it, from which procedure, strange to say, serious nicotin-poisoning ensued.
It should be remembered that atropin is not a sleep-producer; it may stimulate the cerebrum. Therefore at night it might well be combined with a possible necessary hypodermic injection of morphin. The question of the advisability of strychnin is a constant subject for discussion. Strychnin is overused in the cases of most patients who are seriously ill.
This is undoubtedly the reason why a severe case of exophthalmic goiter sustains a permanent loss of brain power. Insomnia. The brains of rabbits which had been kept awake for one hundred hours showed precisely the same changes as those shown in physical fatigue, strychnin poisoning, and exhaustion from emotional stimulation.
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