Cicuta virosa: Water hemlock, Cowbane N.O. Umbelliferae. Tincture of the fresh root gathered at the time of flowing.
CICUTA VIROSA contains a non-nitrogenous poison called cicutoxin which is closely allied to picrotoxin. The latter is a convulsive poison and is the best know of the group of which it is the head and to which cicutoxin belongs. Cicutoxin itself has not been studied in detail but its action is very similar itself has not been studied in detail but its action is very similar to that of picrotoxin.
Poisonous doses of picrotoxin in man cause first, salivation, vomiting, acceleration of respiration and slowness and palpitation of the heart. These symptoms are followed b stupor and unconsciousness and then arises a series of convulsions which commence as tonic spasms but soon change to colic movements. During the convulsion respiration is arrested and the patient may die from asphyxia during a spasm. If he survives the convulsion, respiration is re-established and a period of quiet and prostration follows, but after a sort time convulsions return. Spasms and quietness may continue to alternate for some time, but sooner or later asphyxia during a paroxysm causes death. An increase in reflex excitability is noticed in animals during the quite intervals and must be present also in man, as a touch or draught of air or a loud noise os sufficient to induce a convulsion.
The action of picrotoxin is on the central nervous system and it is interesting to observe that the part of the nervous system most affected moves upwards with the higher development of the brain. Thus in the frog the chief effects arise from the spinal cord, medulla and optic lobes; in mammals from the mid- brain and cerebrum. Probably in man the cerebrum is involved to to a greater extent than in mammals, as a confused mental condition and impaired memory are present for some days after an attack of convulsions brought on by the drug.
Of cicuta virosa hear out the contention that its action is practically the same as that of picrotoxin and show that it affects the central nervous system and particularly the cerebrum. In post-mortems on animals poisoned by cicuta there are found great hyperaemia and oedematous infiltration of the brain and cord and no distinctive pathological results in other organs.
Cerebral and Spinal Symptoms.-In the provers cicuta produces violent epileptic attacks, commencing with tonic spasm of the jaws and the muscles of the back of the neck, causing trismus and opisthotonos, followed by clonic convulsions of the limbs. The attacks are accompanied by unconsciousness, foaming at the mouth, protruding eyes turned upward or to one side, and twisting of the neck backwards and to one side, usually to the left. An aura from the stomach often precedes the attack. Evidence of the milder influence of cicuta on the cerebro-spinal nervous system is afforded by the symptoms, short of convulsions, elicited by the powers.
They are tension and drawing pains in the neck, back and limbs, jerkings in the limbs (especially the left arm), hot and cold sensations in the back, head or limbs, a great sense of weariness and powerlessness, felt chiefly in the legs, heaviness and severe pain in the occiput, a dull, stupefying pain in the forehead and tearing pains on one side of the head.
The convulsions are distinguished by their violence, their initial tetanic character followed by clonic movements, and by the patient being unconscious, differing in these last respects from the convulsions caused by nux vomica, which are more purely tetanic and in which the patient retains his consciousness. They usually begin about the head, face, eyes and neck and pass downwards. The face and limbs are often much contorted. There is fear and horror before the convulsion, but after it the patient is placid and quiet and does not remember his fear.
In the eyes there is evidence of spasms of the extrinsic and intrinsic muscles, shown by mistiness of vision, difficulty in focusing objects and diplopia. The pupils are first contracted and then dilated, the yes are sensitive to light.
There is everywhere great sensitiveness to touch and pressure and in many parts there is a sensation as if bruised. The nose is hypersensitive and hyperaemic, so that a slight touch will bring on epistaxis; there is sensitiveness of hearing; swallowing anything sharp, like a piece of bone or a fish bone, will set up spasm of the oesophagus. A dull, shooting pain in the urethra and fossa navicularis causes a violent desire to urinate; stool is immediately followed by tenesmus and forcible micturition; friction of the clothing causes the testicles to be tightly drawn up against the abdominal rings and is the source of frequent erections in the daytime without lascivious thoughts; a splinter beneath the nails or skin may set up tetanic spasms-in fact, everything about the patient denotes that his nervous system is in a state of intense reflex excitability.
Digestive System.-The tongue is swollen and speech is difficult, as when speaking there is feeling of a jerk in the head from before backwards, as if he had to swallow the word, which may be compared to the catch in the breathe of hiccough. Salivation occurs, or the throat may be dry and swallowing difficult or impossible from spasm of the oesophagus. The patient is thirsty; he longs for strange things like coal, he is hungry but quickly satisfied, in a short time he becomes hungry again. A sudden shock, felt deep in the stomach area (probably spasm of the diaphragm), is sometimes the starting point of a convulsive opisthotonos. Swelling and throbbing take place in the pit of the stomach, the abdomen is distended and painful, rumbling and splashing noises occur, and there are frequent liquid stools which are forcibly expelled, are accompanied by an irresistible desire to urinate, and are followed by tenesmus.
The menses are delayed and are associated with tearing and drawing in the os coccygis.
Respiration.-The breathing is oppressed and the chest feels tight from spasm of the pectoral muscles; both hot and cold sensations are felt in the chest.
Circulation.-The pulse is usually slow, large and full. Hear and strong beating are felt in the heart, or there may be a sudden sensation while walking as if the heart stopped beating.
On the skin eruptions of fine vesicles appear on the back of the hands and on the face, especially round the mouth, sides of the face and on the chin; the vesicles to on to pustulation. The extremities are cold and the nails bluish.
Sleep.-There is frequent awakening from sleep in perspiration, mostly on the abdomen.
Mind.-The mind is a good deal affected by cicuta; the patient is given to dismal reflections, is much affected by sad stories, his thoughts are confused and disconnected, he wants to be alone and has fear and mistrust of strangers and strange places. There may be aberration of mind in which the patient forgets his own name, confuses the present with the past, thinks himself a child, is childish in his ways, sings, shouts and makes grotesque gestures.
Nervous Diseases.-Cicuta has important therapeutic applications, but they are limited almost entirely to affections of the nervous system and skin, both, it may be noted, of epiblastic origin. It is a valuable medicine for convulsions, whatever may be the cause, when there is loss of consciousness. It is one of the best remedies for epilepsy, for epileptic fits resulting from indigestion, worms, repercussed eruptions, hysteria, injuries to the skull, fright, and when convulsions take the place of the ecstatic or cataleptic condition. It is the most often indicated remedy for cerebro-spinal meningitis when opisthotonos is present. It is useful in spasmodic affections resulting from falls or blows on the head, ex. gr. convergent strabismus when it arises from that cause. Reflex spasms of all kinds come within its sphere of influence, as also does spasmodic jerking of the limbs. Traumatic tetanus, lockjaw and epileptiform attacks from reflex irritation are suitably treated with it. Convulsions in which this drug is indicated often have an aura and are always followed by great exhaustion. The mental symptoms of cicuta suggest that it might be useful in encephalitis lethargica, in the catatonic form of dementia praecox, in the convulsions of general paralysis of the insane and when in that disease there is “over-estimation of self,” for the convulsions of brain tumours and in epileptic insanity.
Skin Diseases.-With regard to the skin it has been found very useful for eczema capitis, in which the entire scalp in covered with a solid mass of crusts, for eczema barbis, or barber’s itch, for eczema of the chin and for chronic confluent impetigo o the face. The eruptions are vesicular, they then become pustular and exude a fluid which forms honey-yellow, adherent scabs. It is said to have cured epithelioma of the lip, and was given on the indication that a small amount of pressure is apt to lead to induration (Kent, loc. cit.).
Headache.-Cicuta has cured some unilateral headaches in which the patient is forced to sit erect and perfectly still.
It has been used for deafness in old people with sudden detonation in the ears, especially on swallowing, for neuralgia of the coccyx menstruation, and for violent hiccough with screaming.
(1) Excessive reflex nervous irritability whereby slight impressions start a convulsion.
(2) Convulsions, accompanied by loss of consciousness.
(3) Convulsions that are tetanic at the outset, but soon followed by clonic movements, are violent and with much distortion.
(4) Epileptic convulsions. Spasmodic jerks.
(5) Pustular eruptions, with yellowish honey-coloured scabs, becoming confluent, mainly on head and face.
(6) Spasmodic, nervous complaints of children and old people.
(7) Cerebro-spinal meningitis when there is opisthotonos.
(8) Effects of concussion and other injuries to the head.
From touch, pressure, noise, jars concussions, cold, wet.
From rest, a dark room, quiet, warmth.