Its Mode of Action and Symptoms in Man.—The poisonous properties of nux vomica are now well known to the vulgar; and in consequence it is occasionally made the instrument of voluntary death, although no poison causes such torture. It is difficult to conceive, considering its intensely bitter taste, how any one could make it the instrument of murder. But a fact is stated in Rust’s Journal, which shows that it may be used for that purpose. At a drinking party one man wagered with another, that if he took a little Cocculus indicus in beer, he would be compelled to walk home on his head. The wager was taken and the potion drunk; but nux vomica was substituted for the Cocculus indicus, itself too a virulent poison; and the man went home and died in convulsions fifteen minutes afterwards.[[2337]]
Many experiments have been made on animals with nux vomica; but the first accurate inquiry was that of Magendie and Delille read before the French Institute in 1809. The symptoms they remarked were precisely the same with those produced by strychnia. Half a drachm of the powder killed a dog in forty-five minutes, and a grain and a half of the alcoholic extract thrust into a wound killed another in seven minutes. The animals uniformly experienced dreadful fits of tetanic spasm, with intervals of relaxation and sensibility, and were carried off during a paroxysm.
The cause of death appears to be prolonged spasm of the thoracic muscles of respiration. The spasm of these muscles is apparent in the unavailing efforts which the animals make to inspire. The external muscles of the chest may be felt during the fits as hard almost as bone; and, according to an experiment of Wepfer, the diaphragm partakes in the spasm of the external muscles.[[2338]]
On account of the singular symptoms of irritation of the spinal cord, uncombined with any injury of the brain, this poison is believed to act on the spinal marrow alone. This is farther shown by the experiments of Mr. Blake with strychnia alluded to above. But from some experiments by Segalas it appears also to exhaust the irritability of the heart: for in animals he found that organ could not be stimulated to contract after death, and life could not be prolonged by artificial breathing.[[2339]] A similar observation was made long ago by Wepfer, who found the heart motionless and distended with arterial blood in its left cavities;[[2340]] and a case of poisoning in the human subject to the same effect will be presently related. The pulse is always very weak, often wholly suppressed during a paroxysm; and in the case alluded to it was found on dissection pale, flaccid and empty, having been apparently affected with spasm. The action exerted through the medium of the spinal cord on the muscles is wholly independent of the brain; for Stannius found that in frogs the removal of the brain does not interfere with the effects.[[2341]]
Of late poisoning with nux vomica has been common. The most characteristic example yet published is a case related by Mr. Ollier, of a young woman, who in a fit of melancholy, took between two and three drachms of the powder in water. When the surgeon first saw her, half an hour afterwards, she was quite well. But going away in search of an emetic, and returning in ten minutes, he found her in a state of great alarm, with the limbs extended and separated, and the pulse faint and quick. She then had a slight and transient convulsion succeeded by much agitation and anxiety. In a few minutes she had another, and not long afterwards a third, each about two minutes in duration. During these fits, “the whole body was stiffened and straightened, the legs pushed out and forced wide apart; no pulse or breathing could be perceived; the face and hands were livid, and the muscles of the former violently convulsed.” In the short intervals between the fits she was quite sensible, had a feeble rapid pulse, complained of sickness with great thirst, and perspired freely. “A fourth and most violent fit soon succeeded, in which the whole body was extended to the utmost from head to foot. From this she never recovered: she seemed to fall into a state of asphyxia, relaxed her grasp, and dropped her hands on her knees. Her brows, however, remained contracted, her lips drawn apart, salivary foam issued from the corners of the mouth, and the expression of the countenance was altogether most horrific.” She died an hour after swallowing the poison.[[2342]]—A case precisely similar, produced by three pence worth of the powder, and fatal in little more than an hour, is related by Mr. Watt of Glasgow.[[2343]]—Another apparently also similar but fatal in three hours, is related by Dr. R. D. Thomson.[[2344]] There is in fact very little variety of symptoms in different cases, where death occurs in the primary stage.—Occasionally even in such rapid cases there is a little vomiting in the first instance. This was remarked in Mr. Watt’s case, and also in another described by MM. Orfila and Ollivier.[[2345]]
When death does not take place thus suddenly in a fit of spasm, the person continues to be affected for twelve or sixteen hours with similar, but milder paroxysms; and afterwards he may either recover without farther symptoms, or expire in a short time apparently from exhaustion, or suffer an attack of inflammation of the stomach and intestines, which may or may not prove fatal.
M. Jules Cloquet has described a case, where the patient seemed to die of the excessive exhaustion produced by the violent, long continued spasms. The tetanic fits lasted about twenty-four hours, the sensibility in the intervals being acute. Slight signs of irritation in the stomach succeeded; and death ensued on the fourth morning.[[2346]]
In the Bulletins of the Medical Society of Emulation another case is related, which arose from an over-dose of the alcoholic extract being taken by an old woman who was using it for palsy. She took three grains at once. Violent tetanus was soon produced; and afterwards she had a regular attack of inflammation of the stomach and intestines, which proved fatal in three days.
The last instance to be noticed exemplifies very well the effects of the poison when the quantity is insufficient to cause death. A young woman swallowed purposely a drachm mixed in a glass of wine. In fifteen minutes she was seized with pain and heat in the stomach, burning in the gullet, a sense of rending and weariness in the limbs succeeded by stiffness of the joints, convulsive tremors, tottering in her gait, and at length violent and frequent fits of tetanus. Milk given after the tetanus began excited vomiting. She was farther affected with redness of the gums, inflammation of the tongue, burning thirst, and pain in the stomach. The pulse also became quick, and the skin hot. Next day, though the fits had ceased, the muscles were very sore, especially on motion. The tongue and palate were inflamed, and there was thirst, pain in the stomach, vomiting, colic and diarrhœa. These symptoms, however, abated, and on the fourth day disappeared, leaving her exceedingly weak.[[2347]]
This and the previous case show clearly the double narcotico-acrid properties of the poison.