The symptoms of strychnia poisoning have been explained away by the defence as “hysteria,” “idiopathic tetanus,” “epileptic convulsions with tetanic complications” (Dr. Macdonald in Palmer’s trial), “angina pectoris” (Dr. Richardson), “apoplexy” (Dr. Bamford’s certificate). Gritty granules on the spinal cord, sexual or other excitement, cold and damp, drink, &c., were in that trial assigned as causes. As to “gritty granules,” the expression is not clear; such granules as occurred in Cook have been found in many post-mortems, where they certainly did not cause the death. Sexual excitement was out of the question in this case. Drink does not cause tetanus. The cold and damp were hardly sufficient reasons, as no symptoms of chill were noticed. Apoplexy is distinct, as in this the brain would show the disease.
Hysteria, epilepsy, and idiopathic tetanus (tetanus which is “constitutional,” or not occasioned by external injury) produce in some cases insensibility; strychnia, as a rule, does not. They are also continuous in symptoms. Traumatic tetanus is caused by a wound or injury, rarely by ulcers or syphilitic sores (see p. 113). If there be none of these it cannot, of course, be traumatic tetanus. Hysteria is exceedingly variable, and simulates many other diseases: it is generally the result of excitement. But it does not produce opisthotonos. Epilepsy has never such symptoms as strychnia occasions: it rarely supervenes without some history of hereditary tendency, and it is always attended by unconsciousness (p. 151). Idiopathic tetanus may occur from a cold (see a case of Dr. Todd’s, Lond. Med. Gaz., Nov., 1850), or from no assignable cause. It is very close to strychnia in symptoms, but the latter is much more rapid: the shortest recorded fatal period for natural tetanus being twelve hours —“even here the early symptoms had been probably overlooked”—Sir B. Brodie), the usual about eight days. In both kinds of tetanus the jaw is usually the first, in strychnia the last part to be affected. Angina pectoris Dr. Richardson himself disposed of, as in the case he mentions he says that had he known more at the time he would have suspected strychnia (see Palmer’s trial, p. 176). The symptoms of this disease, as given in the leading works, differ much from strychnia poisoning.
Post-Mortem Appearances.—Neither characteristic nor uniform (Guy and Ferrier). As a rule, the body is relaxed at death, and stiffens afterwards (Taylor), but occasionally the reverse is the case (Reg. v. Vyse, Central Criminal Court, 1862).[99] Sometimes the rigidity, as in Cook’s case, remains for months. Clinching of the hands, arching of the feet, are nearly always present, but they may likewise be noticed in cases of natural death (Casper, quoted by Taylor, Med. Jur., p. 406; also Prof. Partridge’s evidence in the Palmer trial, p. 172—“half-bent hands and fingers, not uncommon after natural death”). Brain, spinal cord, and lungs almost invariably congested. Blood dark and fluid. In some cases the heart is full of blood, especially on the right side, but occasionally it is empty and contracted. Stomach generally healthy, rarely congested. Casper found a dark violet colour of the muscles of the throat and gullet; this was the only peculiarity he noticed, and even this has not occurred in other cases. On the whole, the diagnosis must depend mainly on the symptoms during life, though the congestion mentioned above is a valuable corroborative from the post-mortem. Involuntary evacuation of urine and fæces generally occurs, but is usual in all painful deaths.
Treatment and Antidotes.—The question will often arise in a trial whether the best means were taken of saving the patient. In Tawell’s trial it was actually suggested that the water poured down the throat may have caused the death by choking! If emetics are used, they are all more or less poisons. If the stomach-pump be employed, it will cause irritation and exhaustion. Nevertheless, where a violent poison has been given, the only hope is in strong remedies—to empty the stomach by emetics or the pump, to give tannin or animal charcoal, and to generally sustain nature during the operations. As the inquiry is, “What caused death?” the defence will frequently endeavour to fasten the responsibility on the remedial measures. These would not of themselves be fatal, unless disease or poison had previously brought the patient to a nearly dying state; whether it be disease or poison will be otherwise determined.
The direct antidote to strychnia is chloroform. In animals I have noticed a large percentage of recoveries. Woodman and Tidy (Forens. Med., p. 332) give the majority of recoveries to this agent.[100] I believe that most cases could be saved if, on the approach of the convulsions, they could be put vigorously under the action of chloroform. Chloral hydrate, nicotine, opium, &c., have been also tried with scanty success. Tannin precipitates strychnia, as well as most other alkaloids; hence may be useful as an adjunct. When the jaw is fixed, liquids can only be given through a tube; even teeth have been taken out to effect this. Enemata may also be used. Artificial respiration should be cautiously tried. Curara and Calabar Bean are dangerous and not effective.
Death or recovery is always rapid; if a person lives over five or six hours, the case is hopeful (Woodman and Tidy).
One or two considerations remain. Dr. Taylor’s evidence in the Palmer trial, though in most points it has been corroborated by subsequent authorities, contained the following statements that require rectifying:—
(1.) “The colour tests are fallacious” (pp. 144 and 147). They are quite decisive if properly performed, and the precautions remembered.
(2.) “I know of no process which can detect strychnia in the tissues” (p. 133). This has been repeatedly done by the same method as is used for the stomach. Dr. Taylor himself admits it in his later works (see Med. Juris., 1873, p. 415). No operator now neglects the tissues. They should always be forwarded for analysis at the same time as the stomach, but in separate jars.
If indications be obtained, the question will occur—“Could they be due to Selmi’s ptomaine, resembling strychnia?” If we consider that in an immense multitude of cases of suspicion, where there is no clue, strychnia is tested for but not found, it is evident that this natural imitation of the alkaloid must be decidedly rare. So that the overwhelming probability, if the colour test has been obtained, is that strychnia itself is present.