[430] De l’Action de la Strychnine à très forte dose sur les Mammifères. Comptes Rend., t. xcl. p. 131.

§ 392. Effects on Man: Symptoms.—The commencement of symptoms may be extremely rapid, the rapidity being mainly dependent on the form of the poison and the manner of application. A soluble salt of strychnine injected subcutaneously will act within a few seconds;[431] in a case of amaurosis, related by Schuler,[432] 5·4 mgrms. of a soluble strychnine salt were introduced into the punctum lachrymale;—in less than four minutes there were violent tetanic convulsions. In a case related by Barker, the symptoms commenced in three minutes from a dose of ·37 grm. (5·71 grains).[433] Here the poison was not administered subcutaneously. Such short periods, to a witness whose mind was occupied during the time, might seem immediate. On the other hand, when nux vomica powder has been taken, and when strychnine has been given in the form of pill, no such rapid course has been observed, or is likely to occur, the usual course being for the symptoms to commence within half an hour. It is, however, also possible for them to be delayed from one to two hours, and under certain circumstances (as in the case related by Macredy) for eight hours. In a few cases, there is first a feeling of uneasiness and heightened sensibility to external stimuli, a strange feeling in the muscles of the jaw, and a catching of the respiration; but generally the onset of the symptoms is as sudden as epilepsy, and previous to their appearance the person may be pursuing his ordinary vocation, when, without preliminary warning, there is a shuddering of the whole frame, and a convulsive seizure. The convulsions take the form of violent general tetanus; the limbs are stretched out involuntarily, the hands are clenched, the soles of the feet incurved, and, in the height of the paroxysm, the back may be arched and rigid as a board, the sufferer resting on head and heels, and the abdomen tense. In the grasp of the thoracic muscles the walls of the chest are set immovable, and from the impending suffocation the face becomes congested, the eyes prominent and staring. The muscles of the lower jaw—in “disease tetanus” the first to be affected—are in “strychnos tetanus,” as a rule, the last; a distinction, if it were more constant, of great clinical value. The convulsions and remissions recur until death or recovery, and, as a rule, within two hours from the commencement of the symptoms the case in some way or other terminates. The number of the tetanic seizures noted has varied—in a few cases the third spasm has passed into death, in others there have been a great number. The duration of the spasm is also very different, and varies from thirty seconds to five or even eight minutes, the interval between lasting from forty-five seconds[434] to one or even one and a half hours.[435]

[431] In one of M. Richet’s experiments, a soluble strychnine salt injected into a dog subcutaneously acted in fourteen seconds.

[432] Quoted by Taylor from Med. Times and Gazette, July, 1861.

[433] A non-fatal dose may show its effects rapidly, e.g., there is a curious case of symptoms of poisoning caused by the last dose of a mixture which is recorded in Pharm. Journ., 1893, 799. A medical practitioner prescribed the following mixture:—

℞.Tr. strophanthi,ʒi.
Liq. strychni hydrochlorici,ʒiiss.
Sol. bismuthi et pepsin. (Richardson’s),℥iss.
Sp. ammon. aromat.,...
Sp. chloroformi,aa.℥iss.
Aquam ad,℥vi.
ft. mist.
Shake the bottle.
Two teaspoonfuls when the attack threatens, and repeat in an hour if necessary.

Richardson’s liquor bismuth contains 1⁄20 grain of strychnine in each drachm. The mixture was alkaline; it contained 1·7 grain of strychnine and 38·25 minims of chloroform.

The patient, a woman, 54 years of age, had taken the previous doses with considerable relief; but ten minutes after the last dose, which she described as far more bitter than those she had taken previously, she was seized with the usual symptoms of strychnine poisoning, but recovered after five hours.