Symptoms.—The time at which the symptoms commence varies according as the strychnia has been taken in solution or in a pill. In the first case a very bitter taste is experienced during swallowing, usually followed in a few minutes by a sense of suffocation and difficulty of breathing. Then there are twitchings of the muscles, jerking movements of the limbs, and a quivering of the whole frame. The limbs become rigid, the head is bent back, while the body is stiffened and arched, so that it rests on the head and heels (opisthotonos). The difficulty of breathing causes the face to become dusky, the eyeballs prominent, and the lips livid. The features assume a peculiar grin (risus sardonicus); there is much thirst, but perhaps inability to drink from spasm of the jaws; while the sufferer is quite conscious, is much alarmed, and is impressed with the idea that death is surely stealing upon him. As the attacks of spasms are commencing the patient cries out, and warns those about him of the approach of the seizure; he begs for help, and perhaps asks to be held, or rubbed, or turned over; and when the seizure passes off, at the end of forty or sixty seconds, he is exhausted, and bathed in sweat. The more he is disturbed or excited the shorter is the intervals between the attacks; and though a firm grasp seems to afford relief, yet a slight touch, a gust of air, or opening a door, will increase the suffering. As death approaches the tetanic spasms rapidly succeed each other; and the patient sinks, suffocated during an attack, or exhausted during an interval, in about two hours from the beginning of the symptoms.
When the strychnia has been taken in a pill two hours have elapsed before any effects have been produced. A case is also reported (Glasgow Medical Journal, July, 1856) where a medical man took three grains of strychnia dissolved in spirits of wine and diluted sulphuric acid. He went to bed and slept for an hour and a half, and then awoke with a spasm. Under treatment he recovered.
There is commonly a wide difference between tetanus arising from a wound or from disease and that provoked by strychnia. In the former case some exciting cause can be detected; the symptoms come on gradually, and only attain their full development at the end of several hours; the rigidity of the muscles is more or less permanent, there being no intervals of relaxation as there are in poisoning; and death has hardly been known to occur in less than twenty-four hours, while frequently it is deferred for two or three days.
Post-mortem Appearances.—Although the body may be relaxed at the time of death it usually quickly stiffens—frequently in the course of ten or fifteen minutes. The rigor mortis is persistent for some time: in the case of Cook, poisoned by Palmer, the rigidity of the body and limbs was said not to have passed off after two months’ interment. This is not however invariable, as a body may be flaccid or stiff after death from this cause as from any other. The hands are often clenched, and the soles of the feet arched and inverted. The membranes of the brain and of the upper part of the spinal cord are congested; and there is often considerable serous effusions under the spinal arachnoid. The lungs are generally loaded with dark fluid blood. The heart is usually contracted, but sometimes the right cavities are distended like the pulmonary vessels. The blood has been found black and liquid.
Treatment.—Emetics are to be given at once, and repeated until very free vomiting is induced. If the tetanic spasms have not commenced, the stomach-pump ought to be used. Chloroform is to be given to relieve spasm and pain, but the patient should be disturbed as little as possible, as the least thing induces the tetanic attack. There is no very suitable antidote, but tannic acid, in the form of green or black tea, &c., might be given.
Iodine forms a crystallizable compound with strychnia. Dr. Bennett, of Sydney, has recorded an instance in which he attributed recovery to the employment of tincture of iodine. Hence from thirty minims to a drachm of this tincture combined with the iodide of potassium may be exhibited. In its absence, three or four ounces of animal charcoal, diffused through water, ought to be given.
To prevent the spasms by paralyzing the motor nerves, a solution of curare has been recommended by Dr. George Harley to be injected under the skin; or, if it could be obtained, the active principle of this substance, curarina, would perhaps be deserving of trial.
The patient is to be kept warm and quiet.
To separate strychnia from organic admixture the process modified from Stas, given in the beginning of this book, is the most useful.