TII E TREATMENT 
% OF 
IJ A E A L YSIS 
BY 
HYPODERMIC INJECTIONS OF STRYCHNIA. 
BY 
REUBEN A. VANCE, M. I)., 
ASSISTANT TO TIIE (HAIR OF DISEASES OF THE MIND AND NERVOUS SYSTEM IN THE 
BEI.LKVUE HOSPITAL MEDICAL COLLEGE, AND ATTENDING PHYSICIAN 
FOR DISEASES OF THE NERVOUS SYSTEM AT THE OUT- 
DOOR DEPARTMENT OF BELLEVUE HOSPITAL. 
{FROM THE JOURNAL OF PSYCHOLOGICAL MEDICINE, APRIL, 1870.) 
NEW YORK: 
J>. A l* V L K T O N & C O M P A N Y , 
9 0, 9 2 k 9 4 (3 R A S I) ST R E E T . 
1870. TWO IMPORTANT NEW MEDICAL BOOKS. 
D. APPLETON & CO., New York, 
Have just Published, 
I. 
A Text-Book of Practical Medicine, 
WITH PARTICULAR REFERENCE TO 
PHYSIOLOGY AND PATHOLOGICAL ANATOMY. 
By Dr. FELIX YON NIEMEYER, 
Professor of Pathology and Therapeutics ; Director of the Medical Clinic of the University of Tubingen, 
TRANSLATED FROM THE SEVENTH GERMAN EDITION, BY SPECIAL PERMISSION OF THE AUTHOR, 
By GEORGE H. HUMPHREYS, M. D., and CHARLES E. HACKLEY, M. D. 
In two volumes, octavo. 1,500 pp. Price, in cloth, $9.00 ; in sheep, $10.50. 
“ The sciences of Pathology and Therapeutics have made vast strides within the last ten years ; and, 
for very many important researches and discoveries in both these branches of medicine, we'are indebt- 
ed to Germany. Professor Niemever’s volumes present a concise and well-digested epitome of tbe re- 
sults of ten years of carefully-recorded clinical observation by the most illustrious medical authorities 
of Europe, together with many valuable and practical deductions regarding the causes of disease and the 
application of remedies, such as we believe have not yet been assembled in any single work. 
“ The rapidity with which it has passed through seven German editions, the last two of triple size, 
and the fact that it has been translated into most of the principal languages of the old continent, afford 
ample proof of its appreciation in Europe.” 
Extract from the Author's Preface to the Seventh German Edition. 
“Nearly ten years have elapsed since the first appearance of my text-book. Meanwhile, clinical medi 
cine owes a rich accession of knowledge to investigations made, not only in her own province, but in tho 
provinces of physiology, pathological anatomy, and physiological and pathological chemistry. Impor- 
tant questions have been settled; obscure points rendered clear; false theories corrected, and errors 
recognized. ... In the present edition, but few portions of the work remain unaltered ; and even 
those few have nearly all undergone revision on previous occasions. Most parts of it have received valu- 
able emendations, and have been enriched by copious additions. I have everywhere paid particular 
attention to the important results obtained iu the domain of therapeutics by recent investigations, partly 
because I wish my book to maintain the honorable confidence which it has won for itself among practical 
physicians ; partly because I regard the happy progress which therapeutics has made as the most iinpor 
taut acquisition of the last ten years.” 
From the New YorJc Evening Post. 
' “Messrs. D. Appleton & Co. have done an important service to the medical profession by publishing 
an admirable translation of the last improved edition of this important work. A general view, so com- 
prehensive in scope, so thoroughly scientific in spirit, of the whole science of medicine as it now exists 
in the foremost minds devoted to it, is scarcely to be found elsewhere in so convenient a form. Pro- 
fessor Von Niemeyer writes for special students; and neither an analysis of his work, nor extracts from 
it, would be of interest to the general reader. It is enough in this place to point out its general charac- 
teristics. It is founded on the conviction that “ therapensis,” or the art of healing diseases, is to bo 
studied independently, by the same methods of experiment and observation by which all the natural 
sciences are built up; and that it cannot be reduced to a series of corollaries from other branches ol 
learning, such as pathological anatomy or physiological chemistry. But in the pursuit of this study lie 
insists upon the most rigid adherence to scientific method, aDd pays little regard to unverified impres- 
sions, or the mere dicta of authority. His book is, therefore, in harmony with the prevailing sentiment 
of the medical profession at this time, and especially with that of the most zealous and successful pro- 
moters of their art. One of its pleasing features is that truly catholic spirit which marks the genuine 
scientific mind ; but which, for some reason, is not always found iu the text-books of physicians. Dr. 
Von Niemeyer welcomes facts from all quarters ; and does not disdain suggestions even from schools 
of practice which many medical men will not name with toleration. On the whole, the adoption of this 
book as the outline of a medical course, around which the student may gradually group his fuller acqui- 
sitions, cannot fail to aid the cause of sound, sensible, and efficient healing art.” 
From the Medical and Surgical Reporter. 
“ Professor Niemeyer is one of the most distinguished of the medecins pensevrs d'outre Rhin. as the 
French jealously style their rivals across the Rhine. He lias long been known for his advanced views 
In pathology, his ability as a lecturer, and his profound acquaintance with every department of medi- 
cine, as well as the liberality of bis views. The fact that, in less than ten years, a large work on prac- 
tice passes through seven editions in Germany, stamps it at once as one of unusual merit. But this is 
guaranteed by the name of the author alone. . . . This work of Niemeyer will go far to bring about 
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and print are good. The volumes are worth their price, and we repeat our hope that they will deal a 
.severe blow at nihilism in this country.” 
New York: D. APPLETON k CO., Publishers. THE TREATMENT 
OF 
PARALYSIS 
BY 
HYPODERMIC INJECTIONS OF STRYCHNIA. 
BY \ / 
REUBEN A. VANCE, M. D., 
ASSISTANT TO THE CHAIR OP DISEASES OF THE MIND AND NERVOUS SYSTEM IN THE 
BELLEVUE HOSPITAL MEDICAL COLLEGE, AND ATTENDING PHYSICIAN 
FOR DISEASES OF THE NERVOUS SYSTEM AT THE OUT- 
DOOR DEPARTMENT OF BELLEVUE HOSPITAL. 
[[FROM THE JOURNAL OF PSYCHOLOGICAL MEDICINE\ APRIL, 1870.] 
NEW YORK: 
D. APPLETON & COMPANY, 
90, 92 & 94 GRAND STREET. 
1870. THE 
TREATMENT OF PARALYSIS 
BY 
HYPODERMIC INJECTIONS OF STRYCHNIA. 
The preparations of mix vomica, especially its 
principal alkaloid, strychnia, have occupied a high posi- 
tion among the recognized remedies for paralysis, since 
M. Foquier, reflecting upon the physiological demon- 
strations of Magendie, first ventured to test their 
therapeutical efficacy in cases of this description. In 
modern treatises on the practice of medicine, as well as 
in the more special contributions to nervous diseases, 
rules will be found to regulate their administration, 
and cautions are given to prevent their use in unsuita- 
ble cases. 
The first reference to the employment of strychnia 4 
THE TREATMENT OF PARALYSIS BY 
by means of hypodermic injection, was made by Dr. 
Beliier, of Paris, in a paper read before the Imperial 
Academy of Medicine in 1859, in which lie referred to 
its use in seven cases of paralysis, four of which 'were 
cured, and three improved. 
In 1863, Prof. Courty, of Montpellier, reported 
three cases of facial paralysis, and one of paraplegia 
cured by strychnia administered in this manner. 
The article of Mr. Charles Hunter, late surgeon to 
the Royal Pimlico Dispensary, which appeared in the 
British and Foreign Medico- Chirurgical lievieio for 
April, 1868, was the most valuable, as well as the 
most accessible, of all the contributions to our knowl- 
edge of this subject made to that date. In this paper, 
Mr. Hunter pointed out the advantages and disadvan- 
tages of administering strychnia by the cellular tissue, 
and, from his practical experience, indicated tlie differ- 
ent action to be when used in the former 
manner, from its usual effect when given by the stom- 
ach. Reasoning from the difference in action of cer- 
tain other remedies, as morphia and quinia, according 
as they are given in one or the other of these ways, 
he stated that we might fairly anticipate a beneficial 
result in a shorter time, and from smaller doses, when 
strychnia was administered hypodermically, than when 
given by the stomach, and that benefit might be ex- 
pected, even in cases where it had been taken inter- 
nally without effect. 
These a priori inferences he submitted to practical 
demonstration, in the seven cases forming the basis of 
his communication. Four of these were examples of 
hemiplegia; one of local paralysis, from injury of arm, 
and one case of paraplegia, with symptoms seemingly of 
myelitis. The other case occurred in the person of a HYPODERMIC INJECTIONS OF STKYCIINIA. 
5 
young female, complaining of gastric irritation, weak- 
ness, and debility of the spine, and muscular jactita- 
tion, who was greatly relieved by several injections. 
Dr. M. Gonzales Echeverria, of this city, read a 
paper on the “ Treatment of Paralysis by Hypodermic 
Injections of Strychnine, with remarks on Infantile 
Palsy,” before the Annual Convention of the Connec- 
ticut State Medical Society, held at New Haven, in 
May, 18G8. This paper was published in the proceed- 
ings of the Society for that year, and, in addition to 
the cases in which he details the effects of strychnine 
injections, contains references to the early use of this 
remedy by the hypodermic method, to which I am in- 
debted for an account of the researches of the two 
French physicians before referred to. 
In Dr. Bartholow’s recently-published “ Manual 
of Hypodermic Medication” will be found an excel- 
lent resume of the whole subject, in the section de- 
voted to strychnia. 
Having had occasion to use hypodermic injections 
of strychnia very extensively, during the past fifteen 
months, in the treatment of the various forms of para- 
lytic affections that have come under my care at the 
Out-door Department, Bellevue Hospital, I have se- 
lected a series of cases which illustrate the phenomena 
that attend their administration, and indicate the class 
of cases in which they are likely to prove efficacious. 
I could have added a much larger number of cases, il- 
lustrating a greater variety of diseases, in which the 
hypodermic injection of strychnia has been employed, 
either as an adjunct to other methods of treatment, or 
as the only remedy used, but I have restricted myself 
to cases in which treatment has been suspended, and 
in which definite results have been obtained solely by 
this method of treatment. 6 
THE TREATMENT OF PARALYSIS BY 
As tlie three prominent divisions of paralytic affec- 
tions—hemiplegia, paraplegia, and local paralysis—are 
each represented by several examples, the following 
cases will be grouped together according to the region 
of the body affected, and without regard to the date at 
which they came under treatment: 
Case I.—J. V., Ireland, laborer, aged forty-two. 
On the 14tli day of September, 1809, while working 
in 75th Street, noticed a weakness and dragging in his 
right leg, accompanied by more or less vertigo. These 
symptoms passed away upon taking a drink of water. 
He then drove his cart to the river, unloaded it, but 
was unable to drive back on account of a return of the 
previous feelings of weakness and vertigo. The right 
arm was now affected, and, upon attempting to call for 
assistance, he discovered that he could not speak dis- 
tinctly. The workmen carried him a short distance and 
laid him on the ground; but in a few minutes these 
unpleasant feelings disappeared, and he was able to re- 
sume work. These two attacks came on and passed 
off within half an hour, and in neither instance was 
there any impairment of consciousness. He had not 
worked long before an unpleasant sense of general un- 
easiness compelled him to again leave off and withdraw 
for air. He retired to a shady place and sat down, 
but in a few moments the same sensation of weakness 
returned in the right side, and he fell to the ground. 
This attack lasted an hour, and during its continuance 
he was unable to move his right arm or leg, or to artic- 
ulate distinctly, although he was conscious of all go- 
ing on around him. Afterward his strength returned 
completely, as also did his speech, and he was able to 
give an account of what had befallen him, and to walk 
to his house, a distance of a quarter of a mile, and as- HYPODERMIC INJECTIONS OF STRYCHNIA. 
7 
cend two flights of stairs to liis room. Upon arriving 
there, was again seized as on the second occasion, with 
paralysis of the right arm, leg, and organs of speech, 
and fell to the floor, but without losing consciousness. 
For four weeks was confined to his bed ; had complete 
motor paralysis of the right arm and leg, some distor- 
tion of the face, and so much difficulty in articulation, 
that it was with the greatest effort he could make him- 
self understood. About the middle of October had re- 
covered sufficiently to get out of bed and walk with 
the aid of a cane ; but, since then, although his general 
health has been excellent, his paralysis has remained 
stationary. The leg is more supple, and has regained 
more power than the arm. 
In 18G1 had a sore, followed by secondary symp- 
toms. In 18G7, was accidentally struck on the nose 
and severely injured by a hand-ball; soon afterward 
the soft parts of that organ were destroyed by an ulcer, 
which was undoubtedly specific. 
November 27, 18G9, came under my observation 
at Dr. Hammond’s Clinic for Nervous Diseases at the 
Bellevue Hospital Medical College, where he had been 
directed to apply for treatment. At that time there 
was a little distortion of the face, the angle of the 
mouth drooping on the right, and being drawn beyond 
its proper position on the left side. No trouble with 
the eye. The tongue pointed to the right side and was 
very tremulous. He said that the paralysis of the face, 
as well as the difficulty in articulation, had undergone 
marked improvement during the preceding six weeks. 
The shoulders were on the same line, but the right arm 
was adducted and rotated inward, the elbow semi- 
flexed, and the forearm rested on the abdomen. The 
wrist and fingers were slightly flexed, and the hand 8 
THE TREATMENT OF PARALYSIS BY 
was lield midway between pronation and supination. 
Quite an appreciable resistance was met with in at- 
tempting to straighten the arm, and he said that this 
limb had been more or less stiff since he was able to 
get out of bed, about the 15th of October. The right 
leg had improved a little since he began to walk, but 
was still quite weak and numb. lie could ilex the 
thigh upon the abdomen when lying on his back, but 
the power of moving the foot in any direction was com- 
pletely lost. In walking, he would throw the weight 
of the body on the left leg, tilt the pelvis, and carry 
the right foot forward by a movement of circumduction 
—a manoeuvre quite common with liemiplegics. The 
right toe dragged on the ground at the beginning and 
end of each step, and he said that the corresponding 
part of that shoe required cobbling almost every week. 
The paralyzed limbs were as warm as the healthy ones, 
and their muscles responded as readily to the induced 
current. No difference in tactile sensibility between 
the two sides, and pinching or pricking the skin caused 
as much pain in the paralyzed as in the healthy arm. 
He complained of an occasional unpleasant sensation of 
heat, which manifested itself in the diseased side. No 
implication of thoracic or abdominal muscles. 
The amount of muscular power he possessed in his 
right hand, at that time, was insignificant when com- 
pared with that of his left; and, in making pressure, it 
was impossible for him to keep up the same degree of 
force from moment to moment. This defect, combined 
with his inability to extend, abduct, or elevate the right 
arm, rendered him almost helpless. Such little things 
as cutting his food, dressing or undressing himself, 
could not be performed without assistance. He had 
the greatest difficulty in walking, from his liability to HYPODERMIC INJECTIONS OF STRYCHNIA. 
9 
trip, and getting up and down stairs was almost an im- 
possibility. lie could not walk at all after niglit, or 
in a darkened room. 
In this case no treatment other than the hypoder- 
mic injection of strychnia was resorted to, and the pa- 
tient was under my care from November 27, 1809, 
until January 2G, 1870. During this time he called 
at my oflice every Monday, Wednesday, and Friday, 
and received a hypodermic injection. The amount of 
strychnia administered each time varied from the for 
tieth to the twentieth of a grain, and, as he received 
twenty-four injections, he took about one grain in all. 
No sudden change for the better was manifested 
during the progress of the case; but the improvement 
was evident from week to week. Once or twice he 
thought the medicine produced a little headache, but, 
as this symptom did not appear for hours after the in- 
jection, and occurred very infrequently, it was plain 
that there was no causative relation between the two. 
The most constant of the symptoms referable to the 
remedy was a sense of tingling and smarting, which 
would last for hours, at the point where the needle of 
the syringe was passed through the skin, when the 
puncture happened to be in the diseased arm. All the 
injections were passed into the loose cellular tissue be- 
neath the thin integument of the anterior surface of the 
forearms, and were alternately given in the right and 
left sides. No such sensations followed the injections 
into the healthy limb. 
On several occasions, especially after the maximum 
quantity was injected, he would experience peculiar 
feelings about the knee of the affected side, and slight 
jerkings of the muscles of the right arm. 
• The first signs of amendment were manifested in the 10 
THE TREATMENT OF PARALYSIS BY 
muscles of tlie thenar eminence, and were described by 
the patient as an increased facility in moving the thumb 
so as to grasp objects. The extensor muscles of the 
forearm and hand regained power a little later; and 
last of all came the deltoid, and the muscles of the liy- 
pothenar eminence. Along with restoration of the 
ability to straighten the arm and wrist, he obtained 
more control over his foot; but power in the lower ex- 
tremity never returned to the same extent as in the 
upper, and, when last seen, his mode of progression was 
much the same as at first; yet, when his attention was 
directed to it, he could lift the toe and carry the foot 
forward in a natural manner. He had become so ac- 
customed to swinging liis leg when walking, that the 
movement was executed from preference. Late in De- 
cember he endeavored to do something at his former 
business, but had to abandon the attempt. In Janu- 
ary he was more successful, and, after working half of 
each day for two weeks, was able on the 26tli, the date 
of his discharge from treatment, to resume his usual 
work, and earn full wages. 
Case II.—Mrs. J., forty-two, widow, seamstress. 
While working at her sewing-machine on the afternoon 
of the 10th of August, 1868, she suddenly lost the 
power of moving her left leg, and at the same time ex- 
perienced a very disagreeable feeling of prickling and 
tingling in the foot of that side. Imagining that the 
limb had “ gone to sleep,” she arranged her work so as 
to walk about until the unpleasant sensation would 
disappear, but, upon attempting to rise from her chair, 
fell to the floor. During the remainder of the day she 
lay on the sofa, and had some vertiginous sensations and 
confusion of thought, but no loss of consciousness. The 
next morning she discovered the left side of her body HYPODERMIC INJECTIONS OF STRYCHNIA. 
11 
and face was paralyzed, and had great trouble in talk- 
ing. By the end of a fortnight she improved so as to 
be able to walk with the aid of a cane, but the paral- 
ysis has remained stationary, and she has done no 
work since August, 18G8. 
On the 11th of June, 18G9, she came to the Out- 
door Department of Bellevue Hospital, and related the 
foregoing facts. There is but little facial paralysis re- 
maining ; protrudes her tongue in a straight line, and 
talks fluently. In walking, swings her left foot around 
the right. Left arm hangs loosely and dangles when 
she walks. No rigidity of any muscles. The upper 
extremity much more paralyzed than the lower. AVell- 
marked anaesthesia in the arm—very little in the leg. 
Electro-muscular contractility normal. Her mental 
powers, according to her own statement, are much 
weakened, and she is easily moved to tears. She re- 
quires her sister’s aid in performing the simplest acts, 
such as combing her hair, fastening her clothing, etc. 
Iler food has to be cut into suitable fragments before 
she can feed herself, and all movements are accom- 
plished without aid from her left hand. Instead of 
being able to earn her living as before, she is com- 
pletely dependent on her friends, and in many respects 
requires as much care as a child. 
She has been a patient at several dispensaries, and 
says she has taken strychnine and iodide of potassium 
in large doses. 
This patient received no treatment other than the 
hypodermic injection of strychnia, the first of which 
was given June 11, 18G9. Each injection was the 
thirtieth of a grain, and six in all were administered. 
After the first injection she experienced a general feel- 
ing of warmth, more marked in the paralyzed than the 12 
THE TREATMENT OF PARALYSIS BY 
healthy limbs, and a little rigidity of the lower jaw. 
Strength soon began to return to the muscles of the left 
hand, and increased power was plainly exhibited by 
the third injection. She stated that the feeling of 
warmth, which was especially plain after the first injec- 
tion, remained in the ball of her thumb after it had 
disappeared from the balance of her person. She was 
also conscious of slight jerldngs and a tremulous mo- 
tion in the muscles of the back of her left forearm. 
Sensibility returned completely by the last injection. 
Improvement was rapid from this time forward, 
and more marked in the upper than the lower extrem- 
ity. The ability to grasp objects between the thumb 
and fingers was among the first motions regained; soon 
afterward she could move the forearm and hand with 
greater freedom, and, by the time she had received the 
sixth injection, could perform all the movements with 
her left hand that were possible with her right, but of 
course with much less strength and precision. She was 
discharged June 25th, finding herself able to work her 
sewing-machine, and thereby gain a livelihood. 
Case III.—M. O’B., Ireland, laborer, aged fifty- 
six. In August, 1868, was attacked with paralysis, 
under the following circumstances : After working as 
usual until noon of the 16th, discovered a loss of power 
in the right arm, and a sense of numbness in the right 
leg. This passed away in a short time, and did not 
interfere with his duties. An hour subsequently, the 
same feelings returned, but with much greater sever- 
ity, and he left work and sat down. A short time 
afterward he was found in an insensible condition, and 
removed home. He regained consciousness late at 
night, and found he had no power over his right side. 
His face was paralyzed on the corresponding side ; the HYPODERMIC INJECTIONS OF STRYCHNIA. 
13 
eye turned outward, and was partially closed. lie said 
that the right side of his face was numb, for he was 
not conscious of any sensation when flies were crawl- 
ing over it. There was trouble in pronouncing certain 
words, but no other difficulty of speech. 
In September, 18G9, he came under my observa- 
tion, at the Out-door Department of Bellevue Hos- 
pital, and at that time there was no difficulty in articu- 
lation, no strabismus, and no facial paralysis. The 
right shoulder was elevated, the arm adducted and 
rotated inward, the hand pronated, and, as also the 
Angers, completely flexed. The elbow was semiflexed, 
and the forearm rested against the abdomen. lie 
was unable to lift the right toe, and, in walking, he 
swung the right foot forward, in the manner usual 
with hemiplegics. lie managed to get along without 
a cane, and said that the foot and leg speedily re- 
gained the amount of power they then possessed, while 
the arm has been steadily growing worse. The sensi- 
bility, as determined by the pesthesiometer, was normal, 
and no difference in temperature was perceptible be- 
tween the two sides. The power of grasping with the 
right hand was quite considerable, but it was necessary 
to place the object to be compressed, completely in 
the palm of the hand. lie could not straighten the 
arm voluntarily, and the limb was of very little use. 
The muscles responded readily to electricity. 
At the suggestion of an acquaintance, he procured 
a small electrical machine, which he used by placing 
one pole in the axilla of the diseased side, while he 
held the other in the right hand, and turned the crank 
with his left hand. After proceeding in this manner 
for several months, he became disgusted with electri- 
city, and disposed of his battery. 14 
THE TREATMENT OF PARALYSIS BY 
For thirteen months his paralysis prevented him 
from working, and during that time he sought relief 
from all imaginable sources. 
The deformity of the right arm was veiy easily 
overcome by manipulation, and appeared to be owing 
simply to the preponderating power of the flexors, 
which had undergone less change than the extensors. 
The induced current caused the muscles to contract, 
and, when they did so, the limb weuld resume its nat- 
ural state. They did not appear to have atrophied to 
any appreciable extent. 
The treatment determined upon was daily frictions 
of the upper extremity with a coarse towel, shampoo- 
ing of the muscles, and the hypodermic injections of 
strychnia. The latter was administered on alternate 
days for five weeks. During the progress of the case, 
the patient was exhibited to the class attending the 
preliminary course of lectures at the Bellevue Hos- 
pital Medical College, and Dr. Hammond approved 
the treatment adopted, and prognosticated a successful 
result. 
Fifteen injections were given, and the patient was 
discharged November 1, 1869. When last seen, the 
arm had lost the deformity that formerly existed, and, 
although its movements were weaker and less free 
than those of the opposite limb, yet he said he experi- 
enced no difficulty in performing the arduous labors of 
his business. 
In this case, each injection was the thirtieth of a 
grain in strength, and the total amount administered 
was one-lialf grain. After the first two or three injec- 
tions, the patient had marked improvement in the 
power of moving the hand and forearm, but he per- 
sistently denied that any sensations were excited by HYPODERMIC INJECTIONS OF STRYCHNIA. 
15 
the drug. I inquired in vain for any tiling correspond- 
ing to the feeling of heat, the fibrillary contractions, 
diaphoresis, or stiffness about the joints, mentioned 
by others who had undergone this treatment. lie said 
the only thing he noticed was that his arm was grad- 
ually getting better. 
Case IV.—A. H., widow, Ireland, laundress, aged 
fifty. After performing an unusually large amount of 
work on the 10th pf June, 1809, she was seized with 
paralysis affecting the right arm, leg, face, and organs 
of speech. There were no premonitory symptoms, and 
the attack was accompanied by a slight amount of 
vertigo only—no loss of consciousness. After resting 
for about an hour, all these symptoms disappeared, ex- 
cept a little weakness in the leg, manifested by stag- 
gering when she attempted to walk. At the supper- 
table she fed herself as usual, but, before the meal was 
finished, the paralysis returned with greater severity 
than before. ' She was confined to her room for two 
months, and during this time the right arm and leg 
were completely useless, the facial paralysis well 
marked, and considerable difficulty experienced in 
articulating distinctly. 
When she first, came under my observation, Octo- 
ber 18, 18G9, her daughter’s assistance was necessary 
to enable her to walk in the street. The right side of 
the face was flatter than the left, the cheek hung, the 
angle ,pf the mouth drooped, and it was impossible for 
her to inflate the cheeks, or purse up the lips, as in the 
act of whistling. The tongue deviated to the right, 
and there was some thickness of speech. The right 
arm hung motionless by the side, and in walking she 
carried the right foot forward by a swinging motion. 
It was impossible for her to pick up small objects, to 16 
TIIE TREATMENT OF PARALYSIS BY 
grasp with any force, bend the elbow, or perform any 
manoeuvre with the right arm. The power over the 
leg was more complete; but she could not raise the 
toes, or bear the weight of the body on that limb 
alone. The tactile sensibility was greatly diminished— 
she could not recognize the two points of the testhe- 
siometer applied to the right forearm, when, separated 
four inches. The sensibility to contact, temperature, 
and painful impressions, was also very obtuse. The 
muscles responded readily to electricity, but the con. 
tractions were neither energetic nor complete. Her 
mental powers were greatly enfeebled—loss of control 
over emotional manifestations especially marked. 
She was under treatment one week, and received 
three hypodermic injections, each containing the one- 
thirtieth of a grain of strychnia. The improvement 
was marked from the reception of the first injection, 
and, after the third, she was in a condition to resume 
work. The rapidity with which the aim regained 
power was surprising. After the third injection, she 
volunteered the statement that on the previous day 
she had been able to thread a needle and sew; and, to 
exhibit her newly-acquired strength and dexterity, she 
performed several manoeuvres that were utterly im- 
possible to her a week before. 
February 14,1870. Mrs. H. called at my office this 
morning. The right arm is as well as it was before 
her paralytic stroke. In walking, she complains of 
stiffness in the right lower extremity, but she experi- 
ences no trouble in standing, or bearing the weight of 
the body, on that limb alone. Has worked in the 
laundry since October 25, 1869. 
Case V.—M. II., Ireland, mason, aged thirty. 
During the latter half of September, I860, was con- HYPODERMIC INJECTIONS OF STRYCHNIA. 
17 
scions of a gradually-increasing weakness in his lower 
extremities, which finally became so severe as to com- 
pel him to give up work the 1st of October. At this 
time his general health was good, his habits regular, 
and nothing indicated the cause of his trouble. After 
visiting several dispensaries, and at least one college 
clinic, he came to the Out-door Department of Bellevue 
Hospital on the 20th of October, 1800. 
At that time the following notes were taken of his 
case : The motor paralysis affects chiefly the extensors 
of the legs and feet; the flexors still retain consider- 
able power, as is easily demonstrated by holding his 
ankle while he endeavors to extend and flex the leg. 
Tactile sensibility alike on the two sides, and the sen- 
sibility to pain and temperature very slightly, if at all, 
diminished. The fact that both lower extremities are 
affected with motor paralysis, and that, if there is any 
diminution of sensibility, it is so evenly distributed 
over both legs as to render its recognition impossible 
by comparing the results obtained by using the festlie- 
siometer at corresponding points on the two sides, 
renders it difficult to clearly determine, or completely 
exclude, the existence of a certain amount of ana3sthe- 
sia. There is no pain referred to the back, and none 
can be elicited by forcibly percussing the spine. No 
sense of constriction about the chest or abdomen, no 
implication of bladder or rectum, and no alkalinity of 
the urine. No referred sensations, such as formication, 
tingling in the toes, feelings of heat or cold, etc. No 
cramps in the legs. Heart and lungs normal. An 
ophthalmoscopic examination, made that evening, re- 
vealed nothing abnormal about the optic nerve or 
retina. Upon the application of electricity, a certain 
amount of diminution in the electro-muscular contrac- 
tility and sensibility was very apparent. 18 
THE TREATMENT OF PARALYSIS BY 
When he is directed to walk with his eyes closed, 
he staggers from side to side, keeps his feet wide ajwt, 
and his arms extended as balancing-poles. He can 
stand perfectly well with his heels and toes together 
and his eyes shut; for, as he says, when he goes to fall 
his knees mb together, and he appreciates his loss of 
balance, and rights himself. 
Three hypodermic injections, each of the sixtieth 
of a grain of strychnia, were given during the ensuing 
week, and, as none of the peculiar symptoms were ex- 
cited that would have indicated an organic disease of 
the cord, the patient was brought before the class in 
attendance at the Bellevue Hospital Medical College, 
and lectured upon by Dr. Hammond, as an example of 
reflex paraplegia. Dr. II. also coincided in the treat- 
ment adopted, and suggested that it be given a full 
and fair trial. 
The fourth and all subsequent injections were in- 
creased to the thirtieth of a grain. There was a well- 
marked feeling of heat excited in both lower extremi- 
ties by each dose, and fibrillary contractions were occa- 
sionally produced in the muscles on the front of the 
thigh. No decided improvement was observed until 
the 10th of November, after eight injections had been 
given. He then said that he could walk without 
having to keep his eyes fixed on the ground, that he 
did not trip as much as formerly, and that he could 
get his toes over slight impediments on the pavement 
with greater ease. He remained under treatment until 
the 17th, and received four more injections. Novem- 
ber 20th, was again brought before the medical class, 
to show the effects of treatment, and then discharged 
perfectly well, and able to resume his business. 
Case VI. — J. W., Ireland, blacksmith, aged thirty- HYPODERMIC INJECTIONS OF STRYCHNIA. 
19 
four. In August, 1808, fell and cut liis head. This 
healed readily, but in September lie was attacked with 
erysipelas, making its appearance first at the cicatrix 
of the wound. After this disappeared, a scaly skin- 
disease came out over his body and extremities, and at 
the same time he became subject to attacks of vertigo, 
which would come on several times a day. In April, 
1800, the skin-disease was cured, but the vertiginous 
symptoms grew worse. In August, a sense of simple 
muscular weakness came in the right leg, and the ver- 
tigo disappeared. The weakness in the leg gradually 
increased, and in November extended to the muscles 
of the thigh. At the same time he became conscious 
of prickling sensations in the right foot, and, from his 
inability to lift the toes, experienced considerable 
trouble in walking. 
December 7, 18G9, he came under my care in the 
following condition: He cannot walk without a cane, 
and when sitting down cannot extend or flex the right 
leg without assisting its movements with his hand. 
The muscles have not atrophied perceptibly, and re- 
spond readily to the induced current, but with less 
force than the corresponding ones of the other limb. 
The tactile sensibility is considerably impaired, but 
painful impressions are recognized as easily as on the 
other leg. The urine is acid in reaction. lie states 
that he has had no unusual sensation about the abdo- 
men, no cramps in the leg, and no feeling of heat in 
the ball of the foot. Of late there has been some 
trouble in retaining the urine. 
December 14tli, one-sixtieth of a grain of strychnia 
administered hypodermically. 
This injection was followed by symptoms that left 
no doubt as to the diagnosis. During the night fol- 20 
THE TREATMENT OF PARALYSIS BY 
lowing lie was attacked with pain in the back, cramps in 
the calves of both legs, burning sensations in the soles 
of both feet, and upon falling asleep was awakened by 
the jumping of his legs. When I next saw him, the 
feeling of weakness had extended to the previously- 
sound limb; there was a sense of constriction about the 
abdomen, and the urine alkaline. Both lower extremi- 
ties were the seat of formication and other referred 
sensations, and pain in the back and cramps in the 
legs were prominent symptoms. No more strychnia 
was given, but he was ordered tr. ergot, in draclim- 
doses, with ten minims tr. belladonna three times a 
day. 
February 14,1870.—Since last date, has continued 
the ergot and belladonna treatment, with the effect of 
dissipating the symptoms excited by the strychnia. 
He is able to work at his business, and his paralysis is 
less marked than at the time he first came under my 
observation. 
Case YII.—H. lb, Oswego County, N. Y., farmer, 
aged forty-nine, came under treatment in April, 1869. 
At that time he stated that his lower extremi- 
ties had been weak and numb for three years, and 
that these feelings came on shortly after an attack of 
urethral inflammation. The only positive symptoms 
present were muscular weakness, slight anaesthesia, and 
tremulousness of the muscles. In walking, the toes 
dragged, and he required the assistance of two canes. 
Could walk short distances only, and then complained 
of great fatigue. No pain in back. Urine, alkaline. 
The degree of paralysis varies from month to month, 
and these fluctuations are accompanied by changes in 
the urine, which, during the intervals of improvement, 
loses its strong odor and becomes clear. HYPODERMIC INJECTIONS OF STRYCHNIA. 
21 
An injection of one-sixtieth of a grain of strychnia 
was administered as a diagnostic test. The phenomena 
it excited were incontinence of urine, pain in the hack, 
spasms of the legs, especially at night, feeling of con- 
striction about the abdomen, burning in the feet, and 
increased anaesthesia. These symptoms persisted for 
several days, and then gradually yielded to the ergot 
and belladonna treatment to which he was subjected. 
He remained in the city one month, and at the end of 
that time was able to walk from Twenty-second to 
Fifty-first Street, without unusual fatigue. When last 
seen he still used his canes, but his power of walking 
had greatly improved; he was able to retain his urine, 
and the unpleasant symptoms excited by the strychnia- 
injections, four weeks previously, had entirely sub- 
sided. 
Case VIII.—M. H., Ireland, laborer, aged thirty- 
five. Presented himself at the Out-door Department 
of Bellevue Hospital, July 30, I860, complaining of 
loss of power in right wrist, of six weeks’ duration, 
which had been steadily growing worse. The arm 
was as well as its fellow until about the middle of 
June, when something happened to it one night, and 
since then it has been in its present condition, lie 
cannot fix the exact'date of its occurrence, having been 
on a prolonged spree about that time, but, as nearly as 
he remembers, on waking in the morning, after passing 
the night in a lumber-yard, at the eastern foot of 
Thirty-first Street, he found the arm numb and power- 
less. He paid little attention to the'circumstance, and 
continued his debauch. He has been unable to work 
since. Liniment and other external applications have 
been freely used, and he is cpiite anxious to get well. 
He cannot extend the hand, fingers, or thumb, or 22 
TIIE TREATMENT OF PARALYSIS 13Y 
move the wrist laterally. The power of making firm 
pressure is unimpaired, but he experiences considerable 
trouble in picking up small objects, or in using his 
tools, from his inability to completely open the hand. 
The sensibility to pain and tactile impressions appears 
to be somewhat impaired on the dorsal surface of the 
thumb and first two fingers. Electro-muscular con- 
tractility is much reduced in the extensor communis 
digitorum and extensor carpi ulnaris, and, upon com- 
paring the two arms, it is evident that those muscles 
have become somewhat atrophied. 
This patient not only received hypodermic injec- 
tions of strychnia, but had the induced current applied 
to the affected muscles three times a week. It is, of 
course, impossible to say what was the therapeutical 
efficacy of the strychnia, with as much precision as if 
the electricity had not been employed, but certain 
features of the case are interesting as showing the 
physiological action of this drug, when used in the 
manner indicated. 
Nine injections, each of the thirtieth of a grain, 
were given. He called at my office three times a week, 
on Monday, Wednesday, and Friday; received a hypo- 
dermic injection, and had the induced current applied 
to the wasted muscles. The electricity was never used 
to exceed five minutes at one sitting. 
The first injection was followed by no well-defined 
symptoms. After the second, he said that, during the 
afternoon of the day on which it was given, his face 
became so flushed that an acquaintance accused him of 
drinking, and that the paralyzed limb was the seat of 
a burning sensation, especially marked on the back 
of the index-finger. Slight exertion was followed by 
profuse perspirations, and he imagined that the medi- HYPODERMIC INJECTIONS OF STRYCHNIA. 
23 
cine was going to weaken him greatly. About the 
time lie received the fifth injection, the lower jaw be- 
came tremulous, and he complained very much of neu- 
ralgic pains in the right forearm. The affection of the 
jaw would come on in a few moments after the injec- 
tion, and last about an hour. The electricity, appear- 
ing to aggravate the neuralgic pains, was suspended 
after six applications, and the strychnia alone used. 
Decided jerkings of extensor communis dhjitorum made 
their appearance early in the treatment, and could be 
easily excited by pressing the body of the muscle be- 
tween the fingers. The extensor muscles gradually 
resumed their functions, and after the ninth injection 
he returned to liis ordinary occupation—that of a day- 
laborer. 
The muscles had not regained their normal size at 
this time, but, as I was compelled to leave the city for 
several weeks, the treatment was necessarily suspended 
When I next saw him in October, 18G9, he stated that 
he had been constantly at work, and had experienced 
no trouble from the arm. The hollow formerly ap- 
parent at the site of the atrophied muscles was no 
longer perceptible, and the right arm was as powerful 
as ever. No other or further treatment was resorted 
to after he passed from under my observation. 
Case IX.—J. C., Ireland, teamster, aged twenty-nine. 
Fell from his wagon one morning during holiday-week, 
18G9, and struck upon the point of his left shoulder. 
The whole limb was stiff and painful during the re- 
mainder of the day, but he still had sufficient control 
over its movements to attend to his business. The 
next morning, however, he found that the shoulder- 
joint was exceedingly tender, and that the least motion 
of the arm caused him great pain. For the ensuing 24 
TIIE TREATMENT OF PARALYSIS BY 
week lie remained in liis room and applied liniments 
to the part. January 5, 1870, applied at the Out-door 
Department of Bellevue Hospital. No evidences of 
synovitis; the arm could he carried backward or for- 
ward, but could not be abducted; no anaesthesia, and 
no subcutaneous ecchymosis; manipulation of the part 
did not cause pain. January 7th.—The deltoid responds 
to electricity, but not so readily as its fellow. A hy- 
podermic injection of one-thirtietli of a grain of strych- 
nia administered to-day. January lOtli. — Says that 
he is confident there is less stiffness and more power in 
the left shoulder. The injection caused no unpleasant 
feelings. Injection repeated. 
The patient passed from under my observation at 
this time, and was not again seen for several weeks. 
He then said that, immediately after the last injection 
was received, he felt well-marked jerkings in the left 
arm, and some stiffness of the jaws, but that these 
symptoms passed away in an hour or so. An oppor- 
tunity offering, he resumed work, and experienced but 
little inconvenience from his arm. At the present time 
(February 11th), the left shoulder is as sound as the 
right, and he can abduct the arm with ease. 
Case X.—F. B., U. S., laundress, aged thirty four. 
After working unusually hard in the hot, moist air of the 
laundry-room, she was exposed for a length of time to 
a cold wind while hanging out the clothes. That night 
she was restless, and had something like neuralgia of 
the face; in the morning she noticed a queer expression 
about her countenance, which attracted so many com- 
ments from her acquaintances that she became alarmed, 
and came to the Out-door Department of Bellevue Hos- 
pital that same afternoon. 
January 14, 1870.—The right eye remains partly HYPODERMIC INJECTIONS OF STRYCHNIA. 
25 
open, even during forcible efforts at winking; the up- 
per lid is drawn up, the lower depressed and everted. 
She cannot laugh or frown on the right side of her 
face; the muscles of expression are all implicated. The 
angle of the mouth droops on the right side, and is 
somewhat elevated on the left. The whole right side 
is smooth and devoid of expression, while the left ap- 
pears unusually corrugated. She cannot purse up her 
lips in the manner required for whistling; the right 
cheek flaps in and out with forced respiratory move- 
ments. The tongue can be protruded in a straight 
line, and the eye can be made to perform all its natural 
motions. All the facial muscles responded naturally 
to the induced current; no amestliesia; no trouble 
with speech. 
A hypodermic injection of one-twentieth of a grain 
of strychnia was given on the 17th, and repeated on 
the 19th and 21st of January. Each injection was fol- 
lowed by twitching of the paralyzed side of the face, 
and well-marked rigidity of the masseter muscles. By 
the end of a week, the paralysis had disappeared. 
The phenomena which result from the immediate 
effects of the strychnia upon the system, when intro- 
duced directly into the circulating fluid by hypoder- 
mic injection, have been dwelt upon at length in the 
articles of Mr. Hunter and I)r. Echeverria. In the 
cases recorded by the former, the most prominent 
effects were a general glow and warmth of the cuta- 
neous surface, with temporary accession of power in 
the weakened muscles. In some cases, diaphoresis 
accompanied the feeling of warmth; and, like the lat- 
ter, was most marked in the paralyzed limbs. In each 
of I)r. Echeverria’s carefully-observed cases, some of the 26 
TIIE TREATMENT OF PARALYSIS BY 
following phenomena were noticed: increased power 
and sensibility in the diseased parts; acceleration of 
pnlse and respiration, and augmentation of tempera- 
ture ; giddiness ; dilatation of pupils ; gurgling of the 
bowels; fibrillary contractions; trismus; peculiar coun- 
tenance ; sighing, and congestion of the face. 
In the foregoing cases, all the symptoms noticed 
by the patients were carefully recorded, and they differ 
widely on the three divisions of hemiplegia, paraplegia, 
and local paralysis. 
In all the cases of hemiplegia there was progres- 
sive improvement in the muscular power. 
In two cases, a feeling of warmth in the paralyzed 
limbs was especially marked. In both cases, in addi- 
tion to loss of muscular power, there was anaesthesia. 
Jerking of the muscles and fibrillary contractions 
were excited in two cases; and in one case, rigidity of 
the lower jaw. 
In one case a sensation of tingling and smarting 
was observed whenever the needle was inserted be- 
neath the skin of the diseased side. 
In Case III., there was gradual improvement and 
ultimate cure, without any other symptom that coud 
be ascribed to the effects of the strychnia. 
The phenomena produced in the cases of para- 
plegia could doubtless have been excited by the inter- 
nal administration of the drug, had it been given in 
sufficiently large doses, and for a length of time. This 
is certainly true as regards two cases, in which the 
symptoms of organic disease of the cord were excited 
in each instance by a single hypodermic injection. In 
the case of functional disorder, a feeling of heat, cor- 
responding in situation to the extent of the preceding 
anaesthesia, together with fibrillary contraction of the 
paralyzed muscles, were the only symptoms noticed. HYPODERMIC INJECTIONS OF STRYCHNIA. 
27 
The cases of local paralysis exhibited certain phe- 
nomena that were not presented by either of the other 
forms of paralysis. The tremulousness of the lower 
jaw and spasm of the masseter muscles were doubtless 
effects of the same cause, operating with greater inten- 
sity in one case than in the other. The increased toni- 
city of the muscles, due to the immediate effects of 
the remedy, was manifested by contraction, more or 
less persistent, thus giving rise to spasm, or by irregu- 
lar muscular action producing the peculiar phenomena 
of tremor. The flushing of the face and diaphoresis, 
in Case VIII.. if due to the strychnia, are to be 
ascribed to its implication of the sympathetic nervous 
system, and are among the rarer manifestations of the 
action of this remedy. 
Before considering the results obtained in the fore- 
going cases, I will introduce brief notes of thirteen 
cases of hemiplegia, treated by the hypodermic injec- 
tion of strychnia, occurring in the private practice of 
Dr. William A. Ilammond in 18G5, and to whom I am 
indebted for permission to use them in this connection. 
The date affixed to each case indicates the time it came 
under treatment; and it will be seen that Dr. Ham- 
mond was in the habit of employing this method of 
administering strychnia several years before the ap- 
pearance of Mr. Hunter’s paper: 
Case I.—II. A., fifty ; male : right hemiplegia; 
January, 1805; strychnia ineffectual by the stomach; 
thirteen injections; much improved. 
Case II.—J. S., forty-two; male: left hemiplegia; 
February, 1805; thirteen injections; much improved. 
Case III.—S. T., sixty; female: right hemiplegia; 
February, 1805; strychnia ineffectual by the stomach ; 
nine injections; much improved. 28 
THE TREATMENT OF PARALYSIS BY 
Case IV.—J. S., sixty; female: riglit hemiplegia; 
April, 1865 ; five injections; much improved. 
Case V.—M. T., fifty-two; male: right hemiplegia; 
April 21, 1865 ; strychnia ineffectual by the stomach; 
eleven injections; cured. 
Case VI.—O. S., sixty-tliree, female: left hemiple- 
gia; April 30, 1865; secondary contractions; twenty- 
two injections; no improvement. 
Case VII.—B. B., forty-seven ; male: left hemi- 
plegia ; June 11, 1865; strychnia ineffectual by the 
stomach; seven injections ; much improved. 
Case VIII.—B. F., fifty; male: left hemiplegia; 
July 17, 1865; strychnia, ineffectual by the stomach; 
eight injections; cured. 
Case IX.—T. W., forty-eight; male: left hemi- 
plegia; September 5, 1865; eight injections; much im- 
proved. 
Case X.—T. S., forty-nine; male: left hemiplegia; 
September 7, 1865 ; secondary contractions, five in- 
jections ; no improvement. 
Case XL—J. J., fifty-seven; male: left hemiplegia; 
September 10, 1865; secondary contractions; no im- 
provement. 
Case XII.—J. W., fifty-two; male: right hemiple- 
gia; affecting arm only at the time treatment com- 
menced; September 27, 1865; strychnia ineffectual 
internally; six injections; cured. 
Case XIII.—W. M., forty-five; male; left hemiple- 
gia ; October 19,1865 ; strychnia ineffectual internally; 
seven injections; cured. 
All but three of the above thirteen cases were either 
greatly improved or completely cured. 
Of the ten cases greatly improved or completely 
cured, seven had previously taken strychnia internally HYPODERMIC INJECTIONS OF STRYCHNIA. 
29 
without effect Of this number, four were completely 
cured. 
In three cases in which no improvement was mani- 
fested, the muscles had undergone the change known 
as “ secondary contraction.” 
The conclusion to be drawn from a consideration 
of the foregoing examples of hemiplegia is, that in the 
hypodermic injection of strychnia we possess a remedy 
of great power and usefulness, and that no case should 
lie pronounced incurable until it has been fully and 
fairly tested. The only instances in which no result 
of a favorable character was obtained, were those cases 
in which the muscles became permanently contracted 
and shortened at a late period after the first mani- 
festation of the disease—that variety designated by 
Todd as hemiplegia with late rigidity, in contradis- 
tinction to those in which this phenomenon was an 
early manifestation. The former, he imagined to de- 
pend upon the contraction of the cicatrix resulting 
from reunion of cerebral fibres ruptured by a former 
apoplectic extravasation; the latter, from an irritated 
condition of the motor filaments in the immediate 
vicinity of a cerebral lesion. However correct lie may 
have been in the latter surmise, modem investigation 
(especially the researches of M. Charles Bouchard, 
whose monograph on that subject has recently been 
translated by Dr. Ilun, of Albany) would appear to 
indicate that the sclerosis following secondary degen- 
eration of the spinal cord, subsequent to cerebral 
lesions, is an important, if not the sole cause of those 
muscular changes that form the basis of this classifica- 
tion. 
Cases of hemiplegia present themselves in one of 
three conditions as regards the state of the muscles of 
O 30 
TIIE TREATMENT OF PARALYSIS BY 
tlie paralyzed limbs; and these conditions are valuable 
aids to a correct prognosis. In one class of cases, of 
which Case II. is an example, there may simply be 
motor paralysis, and the character of the deformity and 
mode of progression is such as results from a want of 
voluntary muscular power. In these cases, the patient 
is unable to dress or feed himself; or, depending upon 
the extent of the paralysis, to perform any of the sim- 
ple movements so constantly used in executing the 
ordinary offices of daily life. lie cannot bend his arm, 
ilex his fingers, or elevate his toes, simply because his 
volitional impulses cannot act upon the muscles, the 
contraction of which is essential to the execution of 
these movements, and a process of atrophy is the result 
of their forced inaction. In these cases the arm hangs 
uselessly by the side, and the lower extremity is of but 
little aid in walking. 
In another variety of cases, the arm and leg are par- 
alyzed, and, from the preponderating influence of the 
flexor muscles, assume certain positions that are com- 
mon to this and the remaining class. In these cases, 
however, although the fingers, wrist, and forearm, are 
flexed, yet they can be readily straightened by the ap- 
plication of a slight amount of power, and this circum- 
stance is the diagnostic mark between the two divisions. 
Case I. is an example. 
The third class of cases are examples of what is 
known as “ secondary contractions.” The extensor 
muscles, especially of the arm, are completely para- 
lyzed, and the flexors are shortened and rigid. Tlie 
shoulder is elevated from changes in the levator anguli 
scapulae ; the arm is adducted and rotated inward; the 
forearm midway between pronation and supination and 
the hand and fingers strongly flexed—the latter in HYPODERMIC INJECTIONS OF STRYCHNIA. 
31 
some cases to such a degree as to cause injury to the 
palm from pressure of the nails. The hamstring mus- 
cles may he the only ones affected in the lower ex- 
tremity, and can be felt as hard cords beneath the 
integument, extending from their origin to their inser- 
tion. The diagnostic mark between this and the pre- 
ceding variety is, that no reasonable amount of force is 
sufficient to overcome these contractions, and restore 
the limbs to their normal position. The three cases in 
Dr. Hammond’s series, which were not benefited by 
treatment, belonged to this class. 
Cases of hemiplegia, belonging to either of the first 
two classes, are susceptible of relief from the hypo- 
dermic injection of strychnia. A favorable prognosis 
can be given in any case in which the limbs have not 
undergone these secondary contractions, and, as is evi- 
dent from the foregoing examples, the fact that strych- 
nia internally has been of no avail, does not argue 
against its efficacy when administered hypodermically. 
Cases of paraplegia which do not present evi- 
dences of organic disease of the cord, of which Case V. 
is an example, are very favorable for this method of 
treatment. It is not too much to say that any case of 
paralysis of the lower extremities, in which the diag- 
nosis between organic and functional disease is doubt- 
ful, should be subjected to the test of a hypodermic 
nijection of strychnia. The amount of the remedy 
used should be small, and its effects closely watched. 
If there is any organic disease existing, its presence 
will be manifested by some of the symptoms detailed 
in Cases VI. and VII., and their advent will indicate 
the necessity for a different course of treatment. 
Should nothing of the kind be elicited, then the hypo- 
dermic injections can be proceeded with either alone, 
or as an adjunct to other therapeutical measures. 32 
THE TREATMENT OF PARALYSIS BY 
Iii tlie cases of local paralysis above related, the 
hypodermic injections were certainly of benefit. In 
the greater number of instances, however, the use of 
electricity is equally efficacious in its results, and is 
free from many of the objections which can be urged 
against the former method. In those cases in which, 
from any cause, electricity is contraindicated, hypoder- 
mic injection of strychnia is the next best resource. 
The advantages of this method of administering 
strychnia are: 
1. Quantity required. 
A reference to the details of the preceding cases 
will show that an amount of the remedy which would 
be considered insignificant, administered internally, has 
been sufficient to produce the best results. 
2. Speed of action. 
In Case IY. this was very evident; but it is not 
usual to see such rapid improvement. In this respect 
Case I. is a better example. As has been remarked 
by Mr. Hunter, a case that is susceptible of relief will 
respond readily to this method of treatment, and but 
a small number of injections are requisite to determine 
whether any improvement can be effected in a given 
case. This is not an absolute rule, however; for, in 
Case V., treatment was continued three weeks, and 
eight hypodermic injections administered, before any 
amendment was manifested. 
3. Greater efficacy. 
In Case II., the patient had previously taken 
strychnia internally, without effect. The same fact is 
noted in seven of Dr. Hammond’s cases; yet four of 
these eight cases were completely cured, and four 
greatly improved. 
In addition to the advantages arising from the HYPODERMIC INJECTIONS OF STRYCHNIA. 
33 
small quantity required, its speedy action and greater 
efficacy, the power it possesses of unmasking organic 
disease of the cord, in doubtful cases, makes it a val- 
uable diagnostic aid in certain cases of paraplegia. 
Too great care cannot be exercised upon the solu- 
tion intended for subcutaneous injection. Aside from 
securing a trustworthy article, strict attention should 
be given to the strength of the solution, so that a 
given number of drops shall correspond to a definite 
amount of strychnia. Unfortunately, the hypodermic 
syringes in general use are not graduated alike, so that 
a standard solution, applicable to all cases, is not prac- 
ticable. However, if the following plan is adopted, 
the inconveniences, otherwise unavoidable, are done 
away with: Each physician should make his own so- 
lution. This is readily and accurately done by tkiang 
a certain quantity of water, enough to fill the syringe 
twenty times, and adding to it four grains of strychnia 
dissolved in two drops of dilute phosphoric acid. Each 
syringe full will then contain one-fifth of a grain; one- 
half full, one-tenth of a grain; one-quarter full, one- 
twentieth of a grain ; one-eighth full, one-fortieth of a 
grain, etc. In this manner a reliable solution is formed 
—one, the strength of which can never be mistaken. 
The only objection is, that it must be administered 
with the instrument for which it was calculated. 
The solution made with dilute phosphoric acid is 
better than with sulphuric acid. With the former, a 
smaller quantity is required to dissolve the strychnia, 
and the solution, upon standing, does not become filled 
with flocculi, as in the latter case. 
No stated quantity will serve as a dose in all in- 
stances, and in this respect each case will require sepa- 
rate study. For an adult, it is perfectly safe to admin- 34 
THE TREATMENT OF PARALYSIS, ETC. 
ister as much as the one-tenth of a grain; but so large 
a dose is rarely necessary. The safest plan is to com- 
mence with a minimum quantity—say, the sixtieth of a 
grain—and increase it gradually as the patient becomes 
accustomed to the effects of the drug and the necessi- 
ties of the case require. 
A grave objection to hypodermic medication, and 
one that is of great weight with many practitioners, is 
the danger of abscesses forming at the point where the 
solution is thrown into the cellular tissue. I have seen 
this accident follow the use of morphia, and have 
known of its occurrence after hypodermic injections of 
chloral; yet, although my experience with stryhnia 
employed in this manner has been quite extensive, I 
have never seen any thing of the kind result from its 
use. I am of the opinion that a concentrated solution, 
of which it is necessary to use but a small quantity, is 
less liable to cause this accident than one requiring the 
introduction of a larger amount of liquid. 
This method of treatment is far from being appli- 
cable to all forms of paralysis. Its employment in 
cases of organic disease of the spinal cord, such as me- 
ningitis, myelitis, congestion of the cord or tumors, is 
radically wrong, and can result in nothing but injury 
to the patient. Cases of paraplegia not due to organic 
disease are the only examples of that form of paralysis 
in which strychnia should be used in any form; and 
in such cases, if the hypodermic injections are not suf- 
ficient for a cure, they will always be found a useful 
adjunct to other methods of treatment. ADVERTIShMfESTS. 
ELECTRICITY 
In its Isolations to [Practical Medicine. 
By Dr. MORITZ MEYER, Royal Counsellor of Health, eto. 
First English, from the Third German Edition ; translated, with Notes and Additions, by 
WILLIAM A. HAMMOND, M. D., Professor of Diseases of the Mind and Nervous Sys- 
tem. and of Clinical Medicine, in the Bellevue Hospital Mediral College; Vice-President 
of the Academy ol Medicai Science.-*; late Surgeon-General of the if. S. Army, etc., etc. 
lit one volume, octavo. 600 pp. In cloth. Price, $4.50. 
“ The general practitioner must have this ltook. . . . Prof. Hammond, by this faith- 
ful translation, with additions, has conferred a blessing on hi- professional countrymen, 
and through them upon the American people; indeed, upon those everywhere who speak 
the English language. The translation, we are assured, is faithful, and the paper, type, and 
binding are all beautiful, mukiiig the volume sightly aud elegant."—Xa*Kcitle Medical Jour- 
nal, OH., lNttu. 
“ A complete, concise, and practical treatise upon this subject ha« long been a desidera- 
tum. ami we an* much mistaken if the work before ns is not just the one the profession 
needs. It Is by fitr the best wo have yet seen upon the subject, and we can cordially recom- 
mend it to any who wish to he up In the latest udvauces fu medical electricity.”—Leaven- 
worth Medical Herald, Oct., lMiU. 
“On the intricate subject of Electro-therapcutics. no higher authority exists than Dr. 
Morlla Meyer, nor could a better exponent of his researches and views he found tliuu Dr. 
Hammond, whose own investigations in this field have developed many valuable results. 
Tin* product of their joint labor, now bel'oie us, i- an exhnu-ti'e i realise, the importance of 
widen, to every practitioner who would deal intelligently witli what is in many cases the 
niosi potent, if not the only, remedial agent, can hardly be overestimated. . . . Of 
especial interest is the section on ■ Electricity in its application to Anatomy, Physiology, 
and Pathology,’ In which the beautiful experiments of Duchenno are cited : and that on the 
aid afforded by electricity in ttie diagnosis and prognosis of paralytic affections. The most 
important addition made by the editor is an elaborate article on ’Organic Infantile Paraly- 
sis,’ as careful and complete as are most of his productions As a whole, the work is one 
w lilch no one who wishes to do his duty to patients suffering front nervous maladies can 
atford to ho without, and one which will lie referred to oftener than most books in a physi- 
cian's library."—Medical Gazette {New York), He/jt. IS, IMiVl. 
“ Dr. Meyer ha- made electricity it subject of especial study for a long series of years, 
and in this volume sums up the results of his experience. He is a care At I clinical observer, 
aud intimately acquainted with the medical applications of the various forms of the elec- 
trical current. Hence his work is superior in many respects to any now in the market, and 
deserves the encomium which the translator gives it—that of being * the best in the mar- 
ket.’ After a short introduction descriptive of the different forms of electricity, lie con- 
siders the action of the currents on the organs aud tissues of the body, the different appa- 
ratus used, the importance of electricity in the diagnosis and prognosis of paralytic affec- 
tions. and its use a- a curative agent in medicine, midwifery, ami surgery. The translator, 
who lias done hi- work witli that thoroughness which characterizes whatever comes from 
liis pen, lias added some vain title notes on the treatment of Infantile Paralysis, which adu 
to the value ol the book." — M-dlcal mi l Surejicnl Reporter, Se/et. 18, 1809. 
*• Probably two-thirls of the book is devoted to the therapeutic nses and applications of 
electricity in the treatment of ili-ea-e. In general medicine, of course the most imporiai t 
consideration Is the use of this agent in nervous affections, paralysis, and like diseases; 
we think our renders will find litis volume in all those respects tlie most valuable and reli- 
able that has appeared in the consideration of these topics. The chapter treating of the 
einpl -yment of electricity in ob-tetrios and diseases of women is also a very instructive 
one."—Cincinnati Lancet and Otmerrer, Nov., lssi'.l. 
“ The scope of the work is complete, embracing an historical sketch of tiie applications 
of electricity in medicine; the action of the electric current in general—friction, contact, 
and induction electricity ; of the electro-motor properties of the annual body ; the action of 
file currents on its organs and tissues; a description of the various kinds of appamtu- 
lon-iructed for therapeutical pupoees, and the incthoda of using them; the application of 
cleoirlciiy to anatomy, physiology, and pathology; its importance in Die diagnosis anil 
p ognosis of paralytic affections ; and u-e in medicine, surgery, uimI obstetrics. Including 
gynaecology, with fitustralive cases. We believe it to be unquestionably tne best and most 
complete work on the subject which tias vet appeared, and rrof. Hammond veil deserve- 
the thanks of the profession for making it accessible to tlie English reader."—HI. Louie 
Medical Arc/dre*. Xov.. lNiU. 
"There cannot he a doubt that the work now before us is tin- most systematic, the 
most scientific, and the most complete, which has \et issued from the American press, on 
the practical applications of electricity. It treats of the ac'ion ol the elec!ric current, both 
constant ami interrupted, on the tissues an i organs severaby, aud on the various forms of 
disease, and • n mldwlferv amt surgery. Nninero.i-cases are given in i I In •• ration."—i'ucijtc 
Medical wd Surejtcal Journal, Xrr., lsflU. I. 
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