STRYCHNIA AND BRUCIA.
Contained in St. Ignatius’s bean—False Angostura bark—_Nux
Vomica_, &c.—Properties of strychnia—Facility of detection.
_Tests_: (1) Microscope—(2) Taste—(3) Color test; ditto
in other alkaloids, in bile, and in resinous and saccharine
matters—(4) Physiological test (Marshall Hall)—(5) Bichromate
of potash—(6) Picric acid—(7) Sulphuric acid and sodium
nitrite—(8) Mercuric chloride. Preparations of strychnia: _Vermin
killers_—Battle’s, Gibson’s, Miller’s, Marsden’s, Barber’s,
Hunter’s, Keating’s—_Brucia_—_Igasuria_—_Igasuric acid_. _Doses of
strychnia_: medicinal, fatal, recovery—_Nux vomica_. _Fatal period_
for strychnia—_Symptoms_ in man, commencement of symptoms, if given
in powder, in solution, in pills. _Explanation of symptoms_: by
hysteria, tetanus, epilepsy, gritty granules on spinal cord—Angina
pectoris. _Post-mortem_ appearances—Treatment—Antidotes—Dr.
Taylor’s evidence—Ptomaine—Did Cook die from morphia?—_Granular
preparations_ at St. Thomas’s Hospital.
SEVERAL species of Strychnos, of the natural order Loganiaceæ, contain,
mainly in their seeds, the alkaloids Strychnia and Brucia in the
proportion of one to one and a half per cent. The plants yet proved
to contain these two alkaloids are:—_Strychnos nux-vomica_ (bark and
seeds), _Strychnos Ignatia_ (Faba amara, or St. Ignatius’s bean),
_Strychnos Tieute_ (the Upas tree of Java), _Strychnos toxifera_ (main
source of woorara or curare, the arrow poison of the South American
Indians), and _Strychnos Ligustrina_ and _Colubrina_ —“snakewood”), a
tree of Asia. _S. potatorum_ —“clearing nut”) and _S. pseudokina_ are
not poisonous.
In commerce, “Nux vomica,” “Faba amara, or St. Ignatius’s bean,” “false
Angostura bark” (the bark of Strychnos nux-vomica), and an extract
called “curare,” are met with. The last is made by mixing the juice
of the bark of Strychnos toxifera and another species with pepper
and acrid plants; as its effects depend upon “_curarine_,” another
alkaloid, and not upon strychnia, it will not enter much into our
subject.
“_Faba Amara_,” St. Ignatius’s bean, contains 1·2 per cent. Strychnia
and some Brucia.
“_False Angostura Bark_” contains Strychnia and Brucia, gives a light
yellow powder, intensely bitter, and turned red by nitric acid.
_Nux Vomica_, a flattened circular seed, from half to one inch
diameter, generally concavo-convex, with a slight central prominence.
Colour greyish-brown; silky from radiating hairs. Substance tough
and horny; powder light brown, with an odour like liquorice, and an
intense and persistent bitter taste. Nitric acid gives with the powder
and with the extract an orange-red colour, owing to the presence of
_brucia_. The aqueous infusion gives a precipitate with tannin, and an
olive-green tint with neutral ferric chloride.
STRYCHNIA, C_{21}H_{22}N_{2}O_{2}, occurs in commerce in opaque
white rhombic prisms (the “right square octahedra” of the British
Pharmacopœia are not met with), inodorous, having a sp. gr. of 1·36.
One part of strychnia dissolves in 7000 parts of cold, in 2500 parts of
boiling, water; in 1250 parts of ether; in 1000 of carbon disulphide;
in 200 of _absolute_ alcohol; in 120 parts of cold, and 10 parts of
hot, rectified spirit; in 181 parts of amylic alcohol; in 164 of
benzene; and 7 of chloroform. Creasote and essential and fixed oils
also dissolve strychnia (Blyth).
It sublimes in needle shaped crystals, or sometimes, if too quickly
heated, in drops, at 169° C.; melts at 221° C., finally darkening and
carbonizing.
Its bitter taste is its most prominent physical characteristic. I have
verified the statement that one grain of strychnia in a gallon (70,000
grains) of water is distinctly perceptible. One grain in 30,000 is
markedly bitter.
Its salts are crystallizable, and also bitter, lævo-rotatory in
solution, mostly colourless, neutral to test-paper, generally
soluble with facility in water, hence more rapidly poisonous than
the free alkaloid. _Strychnia sulphates_ occur in large four-sided
prisms, octahedrons, or needles, according to the amount of water of
crystallization. _Strychnia nitrate_ crystallizes in silky needles,
easily soluble in water. The _sulphate_ is officinal in the French,
the _nitrate_ in the German, Austrian, Swiss, Norwegian, and Dutch
Pharmacopœias. The acetate and hydrochloride are met with in commerce,
but are not officinal. _Strychnia_ itself, the free alkaloid, is
prescribed in the British Pharmacopœia. _Liquor strychniæ_ is a
solution of the hydrochloride.
_Separation._—Strychnia is probably the easiest of the alkaloids to
detect, on account of its stability and the delicacy of its reactions.
One half-millionth of a grain in the pure state is discoverable by the
colour tests (Pharm. Journ., July, 1856). Putrefaction does not change
it, for Richter detected it in tissues after _eleven years_ (Sammlung
Klin. Vorträge, 69, 562), and other observers in decomposed or buried
bodies after five to eight weeks. And yet there are few analysts who
have not on some occasion failed to find it (see p. 147.) A very
small quantity, about a grain, may destroy life. Even of this, only
a portion is absorbed; the rest is eliminated by vomiting (when it
occurs), and by the urine and fæces; the absorbed portion is diffused
with great rapidity through a large mass of blood and tissue; the
result is that we are looking for _one part_ of the poison in about a
_million times_ its weight of impurities—almost worse than the needle
in the haystack. Matters are still more difficult if the theory be true
that an alkaloid, in killing, itself suffers change (see pp. 128 and
133)—an idea that Dr. Letheby and Mr. Nunneley strongly repudiated
in the Palmer defence, though the latter witness had to admit that
he himself had once failed to detect strychnia in an animal to which
he had administered it. Dragendorff records several negative results
without apparent cause. Taylor (Med. Jur., 1873, Vol. I., 414) mentions
cases of non-discovery by Dr. Reese of Philadelphia, Mr. Horsley of
Cheltenham, by himself in the organs of an animal hypodermically
poisoned; and also a case in which _five grains_ had been taken, and
only a little over a grain was found. Sonnenschein (Casper’s Handbook)
in one case found a quantity in the stomach, but none in the tissues;
yet it had caused death. All these facts greatly support the theory
that the alkaloid is itself changed in causing death.
However this be, if the stomach has failed to yield strychnia, the
whole of the rest of the organs, the blood, and the muscles—in fact,
as much of the body as can be managed—should be extracted with hot
redistilled methylated spirit acidified with a little acetic acid. It
is easy to fit up an arrangement with a stoneware pan, a wooden cover,
and a coil of tin pipe, through which steam can be passed, and thus
the alcohol can be kept warm for two or three hours without much loss.
Strain the whole through a cloth, distil off most of the alcohol,
evaporate on a water bath at about 70° C., and treat the extract as
described in the general process for alkaloids. To facilitate the
purification, the alcoholic solution may be precipitated by acetate
of lead (_avoiding much excess_), filtered, the lead removed from
the filtrate by adding sufficient sulphate of potash in solution and
allowing it to settle, and the clear liquid evaporated as before. Much
syrupy matter, which occasions trouble, is thus removed.
The ether-chloroform solution (p. 5), by spontaneous evaporation,
leaves the strychnia in “rosettes, veined leaves, stellate dotted
needles, circles with broken radii, and branched and reticulated forms”
(Guy and Ferrier, Forens. Med., 1881, 568). If not yet pure enough to
crystallize, advantage may be taken of the fact that while most of the
impurities are charred by warm concentrated sulphuric acid, strychnia
is very little affected. A few drops of this acid are therefore added
to the residue, then it is warmed for ten or fifteen minutes on the
water-bath, finally diluted to about ten cubic centimetres, filtered,
the filter washed with water, and the filtrate treated again with
ammonia and ether-chloroform. The residue left by the latter, on
spontaneous evaporation, will now be pure enough for the following
TESTS.—1. The microscopic appearances are so various as to be
somewhat indefinite; Guy’s description has been already given. If _no_
crystals are found, strychnia and most other alkaloids are unlikely to
be present. But if crystals _are_ obtained, they frequently, on further
examination, prove to be some inorganic salt or an ammonium compound,
leading to wrong conclusions, if the microscope be trusted too much.
2. Dissolve in water with a trace of acid, and divide on several
watch-glasses, as described in the introduction. If one portion be
cautiously _tasted_, and there be no bitterness, strychnia is very
improbable.
3. Proceed at once to the _colour test_. Transfer a portion of the
residue, dissolved in a drop of acetic acid, to a white porcelain dish
or plate; dry gently on the water-bath; moisten it with about two drops
of pure concentrated sulphuric acid; _strychnia gives no coloration_;
with the point of a knife place a minute quantity of finely-powdered
peroxide of manganese (the precipitated hydrate is often recommended,
but the natural peroxide answers better, being more gradual in its
action) on the side of the dish; slant the dish so as to allow the
liquid to come in contact with the powder. At the moment of contact
a _deep rich blue_ colour is produced if 1/20000th of a grain of
strychnia be present. The blue colour rapidly changes into _purple_,
_crimson_, _rich red-brown_, then fades into _bright orange-red_, which
last tint remains for some hours. By cautiously stirring with a glass
rod, the succession of colours can be brought out again at another
spot. One or two other qualified observers should always be summoned
to witness the experiment, for two reasons; _first_, that they may
testify at the trial, if necessary, to the certainty of the conclusion;
_secondly_, because the sense of colour is differently developed in
different people, and, if the hues are faint, one is apt to imagine
what one expects to find. But if two or three, without prompting, see
the same appearances, the chance of error is removed.
Applied in this way, the succession of colours is _absolutely peculiar
to strychnia_. But, as objections have been made that these can be
produced from other substances, they may as well be discussed and
disposed of.
(_a_) _Curarine_ (from Strychnos toxifera) has a bitter taste, is
almost insoluble in ether and chloroform; hence it is not usually
extracted by the above alkaloidal process, but remains behind in the
aqueous liquid. With sulphuric acid and peroxide of manganese it gives
the same colours as strychnia, but the changes are slower. _With
sulphuric acid alone_, it yields a pale violet colour, changing to
dirty red, and finally to rose. Its physiological effects are opposite
to those of strychnia—so much so that it has been proposed as an
antidote.
(_b_) _Pyroxanthine_ (a rare substance, obtained in very small quantity
from wood spirit), _salicine_ (from the willow), and _piperine_ (from
pepper), give _with sulphuric acid alone_ a deep-red colour, destroyed
or spoilt by peroxide of manganese. (Nunneley, in Palmer’s trial.)
(_c_) If sugar and bile should be present together, sulphuric acid will
develope a purple colour very like the strychnia test. Bile would also
give bitterness. But it must be remembered that bile, without sugar,
will not give the colour, that sugar will not be extracted by the
ether-chloroform, and that the colour will appear immediately on the
addition of the acid alone, whereas strychnia remains then uncoloured.
(_d_) Many resinous and saccharine matters are coloured by sulphuric
acid, but can be got rid of by warming with the acid as described above.
So that none of these can be mistaken for strychnia. This important
test depends upon the action of nascent oxygen; hence any substance
which yields oxygen will give the colours more or less satisfactorily.
Bichromate of potash, potassium ferricyanide, peroxide of lead,
peroxide of cerium (Sonnenschein), have been employed, but most of
them give colours of their own, and none are so good as peroxide of
manganese. It is only necessary that the manganese should be finely
pounded and not too much added. The action is slower and more lasting
than with bichromate.
Letheby’s galvanic test is interesting, and has the advantage of not
introducing any extraneous substance into the matter under examination,
so that another alkaloid can be tested for afterwards. I have found
it better to place the drop of supposed strychnia solution, acidified
with a drop of dilute sulphuric acid (10 per cent. strength) on a
white plate, to place on its opposite sides two small pieces of
platinum foil pressed closely against the plate, touching the drop,
and approaching within a quarter of an inch of one another, and to
touch them simultaneously with the terminals of a battery of _two_
Grove’s or other cells. In the region of the positive terminal the same
colours manifest themselves as with peroxide of manganese. If no colour
is shown at once, the battery should be removed, as further galvanic
action may decompose any other alkaloid that may be present. The test
is not so delicate as sulphuric acid and peroxide of manganese.
It is said that the presence of much _morphia_ will interfere with the
above test. But morphia, again, is not extracted completely by the
ether-chloroform; and I have not found it to hinder the reaction if
performed carefully.
Brucia in ordinary quantities, quinine, cinchonine, veratrine, and
santonine do not interfere. In strychnia poisoning, morphia should
always be sought for, as it is used as an antidote. If found, its
interference may be obviated thus. Dissolve the supposed strychnia
in water with a little acetic acid, add an equal volume of _ether_,
and then ammonia in slight excess, and shake well. The strychnia will
dissolve in the ether, the morphia will remain in the aqueous liquid.
On evaporating the ether, the strychnia will be isolated.
4. Dr. Marshall Hall’s _physiological test_ is very delicate. With
some small animal—preferably a frog—proceed as mentioned in the
introduction (p. 6). Tetanic spasms are caused. But other poisons,
ptomaines, and even the mechanical injury, may produce irritation
and perhaps convulsions, so that the test is dangerous, except as
confirmatory or negative.
5. _Bichromate of potash_ solution gives with strychnia, at once or
on standing, a yellow precipitate, appearing under the microscope
as rectangular plates and prisms. (See Guy and Ferrier’s Forensic
Medicine, p. 567.)
6. A sublimate of strychnia touched with a drop of dilute _picric
acid_ solution, strength 1 in 250, gives microscopic arborescent
crystallizations of peculiar _curved_ forms. (_Ibid._)
7. Treated with concentrated sulphuric acid and then with a crystal
of sodium nitrite, strychnia gives a dirty yellow colour, changed by
an alcoholic solution of potash to a fine orange-red, by an aqueous
solution to brownish green, and finally to dirty red-brown. (Arnold,
Arch. d. Pharm. 3, 20, 561.)
8. Mercuric chloride produces a white precipitate, as also does
potassium sulphocyanide. All the general reagents for alkaloids
precipitate strychnia. If, however, the reaction with sulphuric
acid and manganese have come out properly, all the other tests are
superfluous; if it has _not_ been obtained, none of the other tests
will be of use.
_Preparations._
┌—─—─—─────—──┬—─—─────—─—─—─┬—─—─—───────—─—─—─┬—─—─—──────—─—─—──┐
│ │ │ Approximate │ Approximate │
│ Name. │ Composition. │ Amount of │ Amount of │
│ │ │ Strychnia. │ Brucia. │
├—─—─—─—──────┼—─—───────—─—─┼—─—─—─—─—───────—─v—─—──────—─—─—─—──┤
│ │ │ │ │
│ {│ Aqueous }│ │ │
│ Liquor {│ solution }│ 4 grs. in │ None. │
│ Strychniæ, {│ of strychnia}│ 1 fl. oz. │ │
│ B.P. {│hydrochloride}│ │ │
│ │ │ │ │
│ Tinct. {│Nut extracted}│ 0·15 per cent. │ 0·15 per cent. │
│ Nucis Vom. {│ with spirit }│ │ │
│ │ │ │ │
│ Extractum {│ Spirituous }│ │ │
│ Nuc. Vom., {│ extract }│ │ │
│ English {│ evaporated }│ 3 to 4 per cent. │ 3 to 4 per cent. │
│ Pharm., &c.{│ }│ │ │
│ │ │ │ │
│ Extr. Nuc. {│ Aqueous }│ │ │
│ Vom., Germ.{│ extract }│ ½ to 1 per cent. │ 2½ to │
│ Pharm. {│ evaporated }│ │ 3 per cent. │
│ │ │ │ │
│ Extr. Fab. {│From St. }│ │ │
│ Ignatiæ, {│Ignatius’s }│ 5 per cent. │ Very little. │
│ American. {│bean }│ │ │
│ │ │ │ │
└—─—─—─────—──┴—─—─—─────—─—─┴—─—─—─—───────—─—─┴—─—──────—─—─—─—──┘
_Vermin Killers._
1. _Battle’s_ seems to vary in composition. Tardieu found in a packet
of 19 grains, 1½ grain of strychnia, or 7·7 per cent., the rest being
_Potato_ starch and Prussian blue. Woodman and Tidy (For. Med. p. 329)
found 23 per cent. strychnia, with sugar, flour, and Prussian blue.
Bernays found 10·7 per cent. of strychnia, with flour and Prussian
blue. (Barlow’s case.)
2. _Butler’s_ contains flour, soot, and about 5 per cent. strychnia.
Sometimes it contains Prussian blue, and sometimes carbonate of barium
in place of strychnia.
3. _Gibson’s_ contains half a grain of strychnia in each powder.
4. _Miller’s Rat Powder_ contains oatmeal, and about 6 per cent. of nux
vomica (equal to 0·023 strychnia and 0·067 brucia). (Blyth, Man. of
Prac. Chem. p. 317.)
5. _Marsden’s Vermin and Insect Killer_: one packet contains ¾ grain
strychnia. (Lancet, April 19, 1856.)
6. _Barber’s_ “_Magic Vermin Killer Powders_” weigh 28 grains and
contain 10 per cent. of strychnia. “Hunter’s Infallible” also contains
it.
In _Keating’s Insect Powder_ I have found no strychnia nor arsenic.
BRUCIA.
C_{23} H_{26} N_{2} O_{4}, 4 H_{2} O, is probably derived from
strychnia by the substitution of two molecules of methoxyl (CH_{3} O)
for two atoms of hydrogen (Shenstone, Chem. Soc. Journal, Feb., 1883),
hence might be named _dimethoxystrychnia_. But efforts to change it
into strychnia have, as yet, been unsuccessful. All plants containing
strychnia contain also brucia. In _false Angostura bark_ the latter
much predominates. It occurs in needles or 4-sided monoclinic prisms
(rarely in tables), colourless, intensely bitter, lævo-rotatory to a
less extent than strychnia, but more soluble in water, alcohol, &c.,
hence remaining in the mother liquors in the preparation of strychnia.
Insoluble in pure ether. It melts at 151° C. (Blyth), and produces a
scanty amorphous sublimate near its temperature of decomposition. The
salts are neutral, easily soluble in water, and crystallize in needles
(the acetate with difficulty). Its physiological action is the same as
strychnia, but six or seven times weaker.
With the general reagents for alkaloids brucia gives precipitates. With
_concent. nitric acid_ it gives a deep-red colour, changing to orange,
and finally to yellow. A trace of stannous chloride (protochloride of
tin) turns the red solution purple: excess bleaches it.[98] This test
is very delicate. In former times commercial strychnia always contained
brucia, hence the coloration by nitric acid was even looked upon as
a test for strychnia (see p. 125, and p. 156). But, as the strychnia
now sold is generally pure, it gives no colour with nitric acid in the
cold. Therefore, if both strychnia and brucia are found in a product
extracted from the animal tissues, it follows that _Nux Vomica_, or one
of the plants, or their preparations, has been used, and not the pure
alkaloid. The microscope in this case will generally detect some of the
vegetal tissue or hairs in the stomach.
Concent. sulphuric acid, followed by bichromate of potash, gives with
brucia a red-brown colour passing to green and yellow (Guy).
Whenever strychnia is found, brucia should also be looked for.
IGASURIA, a supposed third alkaloid of the Strychnos tribe, has been
shown by Shenstone to be a mixture of strychnia and brucia (Chem. Soc.
Journal, Sept. 1881, p. 457).
_Strychnic or Igasuric Acid_, obtained by Pelletier and Caventun from
Nux Vomica and from St. Ignatius’ Bean, is probably identical with
malic acid.
DOSES.
_Medicinal dose_ of strychnia 1/30 to 1/12 grain. _Fatal dose_:
smallest recorded ½ grain (Dr. Warner, “Poisoning by Strychnia,” p.
138), ¼ grain (Guy; also case of Agnes Sennett, p. 121, _ante_), but
a child of two or three years was killed by 1/16 grain (Christison):
average for adults, ½ to 2 grains (Taylor).
_Recovery_ has taken place after 3 grains (Taylor), 4 grains (Lancet,
1863, i. 54), 3 to 7 grains (Husemann), 7 grains (Med. Gaz., xli.,
305), “20 grains or more” (? Guy and Ferrier’s Forens. Med., 1881,
p. 574), 40 grains (Med. Times and Gaz., 1865, p. 267). If these
statements are correct, they must be accounted for either by vomiting,
early and vigorous treatment, or impurity of the alkaloid.
Poisonous symptoms have sometimes occurred in adults, and frequently in
children, from medicinal doses.
_Fatal close of nux vomica_: of the powder, 30 grains is the smallest
(= ⅓ grain strychnia), (Hoffmann, Med. Rat. System, 2, 175), of the
alcoholic extract, 3 grains (Christison on Poisons, p. 642).
_Brucia_ is not used in medicine. _Fatal dose_ rather uncertain,
probably three to ten grains.
FATAL PERIOD FOR STRYCHNIA:—Shortest, five minutes (Dr. Gray on
Strychnia, 1872, p. 55); longest, six hours after three grains (Taylor,
Guy’s Hosp. Reports, Oct., 1857, p. 483); average, two hours. _For
nux vomica_:—Shortest, fifteen minutes; longest, three hours or more
(Guy); average, two hours (Taylor), one hour (Guy).
_Symptoms commence_ at various intervals after taking, according to
dose, form, and constitution. The beginning may be (1) almost immediate
(Mad. Merghelynk, 1870, Taylor’s Med. Juris., p. 408), (2) in five
minutes (case of Dr. Warner, also Dr. Gray on Strychnia, 1872, p. 55),
(3) in fifteen minutes (trial of Dove, p. 242), (4) about an hour
(Palmer’s trial, p. 102), (5) forty minutes (Lond. Med. Repository,
xix., 448), up to two and a half hours (Wormley, Microchemistry of
Poisons, p. 538). Hence no conclusion can safely be drawn from this
feature (see Dr. Letheby’s evidence in the Palmer trial, p. 166).
Probably Dr. Todd’s statement in the same trial is the most correct
average:—“Symptoms in ten minutes, if in solution and a large dose;
otherwise in a half to one hour.”
The different action of powder and solution is shown in the following
experiments on two full-grown rats:—
1. Half a grain of _powdered_ strychnia—First convulsion in twenty
minutes, death in two and a half hours.
2. Same quantity _dissolved_ in sufficient acid—Effect almost
immediate; death in half an hour. In the stomach, liver, and brain,
strychnia was separately detected.
Pills, especially if hard, would be very slow in action. The most
intense effect is produced by hypodermic injection.
SYMPTOMS IN MAN:—Bitter taste in the mouth, feeling of suffocation,
jerkings and twitchings of head and limbs, then tetanic convulsions
of nearly all the muscles. Body stretched out stiff, finally arched
back so as to rest on the head and the heels (opisthotonos), spasmodic
and difficult breathing, usually a peculiar grin (risus sardonicus).
_After a time the jaw becomes tightly fixed_ (trismus or lockjaw), the
fingers are clenched, the feet arched inwards (incurvated), the eyes
prominent and staring. The spasm lasts from a half to two minutes, then
there is an interval of comparative rest. The pupils are generally
_dilated_ during the fit, _contracted_ in the interval. A touch, a
change of position, or a sudden noise, will usually cause a renewal
of the spasm. In severe cases the convulsions recur at diminishing
intervals, increasing in violence till death occurs from exhaustion or
suffocation. Vomiting is very rare. Taylor says “the jaw is not always
fixed during a paroxysm: the patient can frequently speak and swallow”
(Med. Juris., 1873, p. 404). Woodman and Tidy (Forens. Med., 1877, p.
330) say that this symptom is invariably present. Guy and Ferrier are
cautious, and state that the effort to drink often causes rigid spasms
of the jaw, but that the “jaw is not always fixed, even in the fit”
(Guy and Ferrier’s Forens. Med., 1881, p. 573). On the whole, fixing of
the jaw is usual but not invariable. In the Palmer and Dove trials the
patients spoke or shrieked during the paroxysms.
As to impatience of touch, Mr. Morley’s dictum in the Dove trial
expresses the truth: “_Not_ shrinking from touch is _consistent_ with
strychnia, but a desire not to be touched is an _indication_ of it.
Several cases of strychnia had desired to be rubbed.” See also the
cases of Mrs. Smyth and Mr. Clutterbuck, pp. 122 and 123.
Consciousness, in the immense majority of cases, is preserved to the
last. If, as in Mrs. Dove, insensibility occurs, it is due to the
exhaustion. In this trial Dr. Christison said “it is unusual to be
insensible before death from strychnia.” Farquharson (Therapeutics, p.
264) states that “the cerebral functions remain unimpaired almost up to
the close.” This is agreed to by all authorities.
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.
In conclusion, Palmer afterwards is said to have more or less admitted
that he poisoned Cook, “_but not with strychnia_.” Though the word
of such a man is of little value, there are others who have been of
this opinion. Mr. Justice Grove is reported to have expressed some
hesitation afterwards on this point. Mr. Nunneley, who, although he
showed too much partizanship in the trial, yet may be said to have
certainly had great experience with animals, asserted that the symptoms
did not quite coincide with strychnia. Others followed in this train.
The assertion is certainly wrong, but Dr. Guy (Forens. Med. 1881, p.
525) has made a suggestion that may be noticed. After quoting Dr.
Shearman’s case of a patient who had taken one and a-half grain of
_morphia_ acetate, and who was seized with “twitching of the limbs and
face, difficulty in swallowing, spasms of the arms, legs, and abdomen,
partial opisthotonos, and great activity of the reflex function”
(Med. Times and Gazette, March 7, 1857); another case from orfila,
when _twenty-two_ grains of morphia hydrochloride had caused lockjaw,
tension of the abdomen, and occasional convulsions; and Castaing’s
case, when twenty-six grains of morphia acetate, and twelve grains
of tartar emetic, had been purchased, and the victim had “vomiting,
purging, convulsions, lockjaw, rigid spasms of the neck and abdomen,
inability to swallow, loss of sensibility in the legs, contracted
pupils, and stertorous breathing,” Dr. Guy goes on to say that as Cook
had probably three grains of morphia acetate within seventy-two hours,
and had previously been reduced by tartar emetic, his death may have
been due to _morphia_ and not to strychnia. But setting aside the
second and third cases where the dose was so large, Cook’s symptoms
did not on the whole agree with those of Dr. Shearman’s patient. The
dose in the time was not larger, but the effects on Cook were immensely
more severe. If these be examples of morphia in its worst and most
anomalous aspect, it certainly cannot dispute with strychnia for the
responsibility of Cook’s death.[101] See also Dr. Todd’s remark, p. 117.
The three preparations of “gritty granules” on the spinal cord in the
museum of St. Thomas’s Hospital, “in which the patients are said to
have died from tetanus” (Mr. Nunneley’s evidence, p. 152, also Dr.
Macdonald’s evidence, p. 180), are in section N, numbers 113, 114, and
115. They are described in the catalogue as—
“113. Several small patches of earthy matter on the arachnoid of the
medulla spinalis.”
“114. A spinal cord. There are numerous large plates of bone on the
arachnoid of the lumbar portion, and of the cauda equina.”
“115. A similar preparation. The plates of bone extend as high as the
upper dorsal vertebræ.”
Mr. Charles Stewart, professor of comparative anatomy and curator of
the museum at St. Thomas’s, tells me that these are calcareous, but
not true bone, that they are not uncommon in post-mortems where they
have had nothing to do with death, and that if the above had died from
tetanus it would probably have been recorded in the catalogue. As there
is no mention of the cause of death, it is certain that it had no
reference to the so-called “granules.”
The assertion of Mr. Morley (Dove’s Case, p. 245), that strychnia is
decomposed into its elements, is obviously incorrect, probably an error
of the reporter.
See also an interesting case lately reported (J. de Pharm. et de
Chimie, November 1882), where strychnia was found, and also arsenic, in
the stomach, liver, and brain.
Dr. John Harley tells me that he finds _hemlock juice_ the best
antidote to the convulsions of all kinds of _tetanus_. He has had many
successful cases. Messrs. Mavor, veterinary surgeons, find this remedy
most efficacious with horses, in which animal _tetanus_ is very common.