With regard to the dose requisite to prove fatal, the smallest fatal dose of the alcoholic extract yet recorded is three grains, which was the quantity taken in the case from the Parisian bulletins: Hoffmann mentions a fatal case caused by two fifteen grain doses of the powder;[[2348]] and in Hufeland’s Journal there is another caused by two drachms, which was fatal in two hours.[[2349]]—A dog has been killed by eight grains of the powder, and a cat by five.[[2350]] It is even said that a dog has been killed by two grains.[[2351]]
It has been thought, from some observations by Mr. Baker on the medicinal use of nux vomica in Hindostan that, by the force of habit, the constitution may become to a certain extent accustomed to large doses of this poison, in the same manner as it acquires the power of enduring large doses of opium. The natives of Hindostan, often take it morning and evening for many months continuously, beginning with an eighth part of a nut, and gradually increasing the dose to an entire nut, or about twenty grains. If it is taken either immediately before or after meals, it never occasions any unpleasant effects; but if this precaution be neglected, spasms are apt to ensue.[[2352]] As it is found unsafe, however, to increase the dose beyond one nut, and the poison is taken in the form of coarse powder, in which state it must be slowly acted on by the fluid in the stomach, it is probable that the modifying influence of habit is inconsiderable. Habit certainly does not familiarize the system to strychnia used medicinally. The same dose, which has once excited its peculiar physiological action, will for the most part suffice to excite it again, however frequently the dose may be repeated.—The facts mentioned by Mr. Baker show that nux vomica is not a cumulative poison; and European experience, in the instance of strychnia, is to the same effect.
Morbid Appearances.—The morbid appearances differ according to the period at which death occurs. In Mr. Ollier’s case, where death took place in an hour, the appearances were insignificant. The stomach was almost natural, the vessels of the brain somewhat congested, the heart flaccid, empty, and pale. In the case in Hufeland’s Journal there was general inflammation of the stomach, duodenum and part of the jejunum. In Cloquet’s case, a slower one, there was very little appearance of inflammation. In that from the Parisian bulletins, on the contrary, the stomach was highly inflamed, the intestines violet-coloured, in many places easily lacerated and apparently gangrenous. In an interesting dissection of a case, which was quickly fatal,—that related by Orfila and Ollivier, there was found much serous effusion on the surface of the cerebellum, and softening of the whole cortical substance of the brain, but especially of the cerebellum. Blumhardt too, found softening of the cerebellum and congestion of the cerebral vessels, together with softening of the spinal cord and general gorging of the spinal veins. This is some confirmation of an opinion advanced not long ago in France by Flourence and others, that nux vomica acts particularly on the cerebellum.[[2353]] In Dr. R. D. Thomson’s case, which was examined by Mr. Taylor, there was found much congestion of the whole membranes and substance of the brain and cerebellum, and even some extravasation of blood within the cavity of the arachnoid over the upper surface of the former. Mr. Watt remarked in his case (sixty hours, however, after death in summer) softening of the substance of the brain and the lumbar part of the spinal cord.—In Orfila and Ollivier’s case the lungs were found much gorged with black fluid blood.—In Blumhardt’s case the heart and great vessels were entirely destitute of blood.—There is sometimes seen, as in Dr. R. D. Thomson’s case, a brown powder lining the stomach, even although vomiting may have occurred.
The body appears sometimes to retain for a certain period after death the attitude and expression impressed on it by the convulsions during life. In the instance mentioned by Orfila and Ollivier the muscles immediately after death remained contracted, the head bent back, the arms bent, and the jaws locked. This state may even continue for some hours, so that the body appears to pass into the state of rigidity which precedes decay, without also passing through the preliminary stage of flaccidity immediately after death. In the case related by Mr. Ollier, the body five hours after death “was still as stiff and straight as a statue, so that if one of the hands was moved the whole body moved along with it;” and in Blumhardt’s case the rigidity twenty hours after death was unusually great. This state of rigidity, however, does not invariably occur. On the contrary, in animals the limbs become very flaccid immediately after death; but the usual rigidity supervenes at an early period.[[2354]] In Dr. R. D. Thomson’s case flaccidity immediately followed death.
Treatment.—Little is known of the treatment in this kind of poisoning. But it is of the greatest moment to evacuate the stomach thoroughly, and without loss of time. Hence emetics are useful; but if the stomach-pump is at hand it ought to be resorted to without waiting for the operation of emetics. Torosiewicz describes the case of a young woman who, after the usual symptoms had begun to appear in consequence of the administration of a tea-spoonful of powder, recovered under the action of an emetic followed by rhatany-root.[[2355]] When nux vomica is taken in powder,—the most frequent form in which it has been used,—it adheres with great obstinacy to the inside of the stomach. Consequently whatever means are employed for evacuating the stomach, they must be continued assiduously for a considerable time. If the patient is not attacked with spasms in two hours, he will generally be safe.
M. Donné of Paris has stated that he has found iodine, bromine, and chlorine to be antidotes for poisoning with the alkaloid of nux vomica, as well as for the other vegetable alkaloids. Iodine, chlorine, and bromine, he says, form with the alkaloid compounds which are not deleterious,—two grains and a half of the iodide, bromide, and chloride of strychnia, having produced no effect on a dog. Animals which had taken one grain of strychnia or two grains of veratria, did not sustain any harm, when tincture of iodine was administered immediately afterwards. But the delay of ten minutes in the administration of the antidote rendered it useless. In the compounds formed by these antidotes with the alkaloids, the latter are in a state of chemical union, and not decomposed. Sulphuric acid separates strychnia, for example, from its state of combination with chlorine, iodine, or bromine, and forms sulphate of strychnia, with its usual poisonous qualities.[[2356]] It remains to be proved that the same advantages will be derived from the administration of these antidotes in the instance of poisoning with the crude drug, nux vomica, as in poisoning with its alkaloid.
In general little difficulty will be encountered in recognizing a case of poisoning with nux vomica. Tetanus or locked-jaw is the only disease which produces similar effects. But that disease never proves so quickly fatal as the rapid cases of poisoning with nux vomica; and it never produces the symptoms of irritation observed in the slower cases. Besides, the fits of natural tetanus are almost always slow in being formed; while nux vomica brings on perfect fits in an hour or less. It is right to remember, however, that nux vomica may be given in small doses, frequently repeated, and gradually increased, so as to imitate exactly the phenomena of tetanus from natural causes. Medical men will be at no loss to discover, on reflection, how the preparations of this drug may be rendered formidable secret poisons.
Of Poisoning with the St. Ignatius Bean and Upas Tieuté.
The Strychnos Sancti Ignatii, or St. Ignatius bean, contains about three times as much strychnia as nux vomica, namely, from twelve to eighteen parts in the 1000. It is very energetic. Dr. Hopf has mentioned an instance of a man, who was attacked with tetanus of several hours’ duration after taking the powder of half a bean in brandy, and who seems to have made a narrow escape.[[2357]]
The Strychnos tieuté is the plant which yields the Upas tieuté, one of the Javanese poisons. This substance has been analyzed by Pelletier and Caventou, and found to contain strychnia.[[2358]] From the experiments of Magendie and Delille, the Upas tieuté appears to be almost as energetic as strychnia itself.[[2359]] Mayer found that the bark of the plant which yields it, when applied in the dose of fifty grains to a wound, killed a rabbit in two hours and a half.[[2360]] Dr. Darwin has given an account of its effects on the Javanese criminals, who used formerly to be executed by darts poisoned with the tieuté. The account quoted by him is not very authentic; yet it accords precisely with what would be expected from the known properties of the poison. He says, that a few minutes after the criminals are wounded with the instrument of the executioner, they tremble violently, utter piercing cries, and perish amidst frightful convulsions in ten or fifteen minutes.[[2361]]