CONVULSIVES.
NEUROTICS PRODUCING CONVULSIONS.
NUX VOMICA--BRUCIA--STRYCHNIA.
The plants which yield the alkaloid Strychnia are, the _Strychnos nux
vomica_, a native tree of Coromandel, Ceylon and Bengal: the _Strychnos
Ignatii_, which abounds in the Philippine Islands, and furnishes the
hard seed, about the size of a filbert, known as the bean of St.
Ignatius; the _Strychnos tieute_, a large climbing shrub of Java; the
_Strychnos toxifera_, of Guiana; and the _Strychnos colubrina_, or
_Snakewood_, of the East Indies. The effects of these plants are exerted
upon the spinal cord; as is manifest by the violent convulsions and the
tetanic contractions of the muscles which they produce. They have no
effect on the brain, consciousness remaining intact until death.
A powerful juice, used by the Indians of Guiana as an arrow poison, and
variously designated as _curare_, _woorara_, &c., is in all probability
obtained from the Strychnos toxifera. The composition of the arrow
poison varies in different tribes; in some it is a mysterious compound
of many substances, obtained from plants, red and black ants, and the
fangs of venomous snakes; but in all the active ingredient would seem to
be the Strychnos toxifera. It destroys the power of the motor nerves--an
action the reverse of that possessed by strychnia.
NUX VOMICA.--A powder, a tincture, and an extract, obtained from the
seeds of the Strychnos nux vomica, or koochla tree, are used in medical
practice. Thirty grains of the powder have proved fatal, and so have
three grains of the alcoholic extract. Death may occur in from fifteen
minutes to twelve hours. It is possible that nux vomica may accumulate
in the system, as serious symptoms have arisen from the long-continued
use of small doses. Thus a lady took nine grains of the powder daily, in
divided doses, for sixteen days. As purging then set in with colic, the
medicine was withdrawn. Five days after the withdrawal there was ringing
in the ears, with drowsiness, impairment of speech, &c.; on the ninth
day tetanic symptoms set in, with trismus; and on the twelfth day, after
several tetanic convulsions, death took place from exhaustion.
BRUCIA.--The seeds of the nux vomica not only yield strychnia but
brucia, an alkaloid which has the same properties, and causes the same
symptoms as strychnia, though it is much less powerful.
STRYCHNIA.--This alkaloid may very justly be termed a deadly poison. It
is unfortunately the active ingredient of some preparations sold to the
public for destroying vermin: a circumstance which has now led to the
death of several individuals. "Battle's Vermin Killer" is said by Dr.
Letheby to consist of flour, Prussian blue, sugar, and strychnia in the
proportion of twenty-three per cent. Since the use of strychnia by those
notorious criminals Palmer and Dove, this formidable agent has been
employed by other murderers.
The medicinal dose of strychnia is from the 1/30th to the 1/12th of a
grain twice a day. Dr. Christison communicated a case to Dr. Taylor in
which the 1/16th of a grain caused the death in four hours of a child
between two and three years of age. One quarter of a grain has nearly
proved fatal to adults. A woman twenty-two years of age died in the
Jersey Hospital, from the accidental administration of half a grain.
Death has occurred in twenty minutes from this poison. In eleven cases
analyzed by Dr. Guy two hours and three-quarters were the limits
respectively.
_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.
_Tests._--Strychnia is a white crystalline solid, very insoluble in
water, soluble in alcohol or chloroform or weak acids, and having an
intensely bitter taste.
1. Pure strychnia is not changed in color when treated with iodic acid
or with either of the strong mineral acids; but as this alkaloid
generally contains brucia, nitric acid reddens it.
2. Dissolved in sulphuric acid no change ensues; but on adding a
fragment of bichromate of potass to the solution a series of blue,
violet, purple and red tints are produced. The same result is brought
about by using ferricyanide of potassium, permanganate of potassium, the
peroxide of lead, or the black oxide of manganese.
3. If the skin of a frog be dried, and a few drops of a solution
containing strychnia applied to it, strong tetanic convulsions will
ensue, and be reproduced every time the animal is touched or irritated.
According to Dr. Marshall Hall this strychnoscopic test will detect the
1/5000th of a grain, or even less.
4. An exceedingly useful class of tests for many poisons has been
introduced by Dr. Guy; we mean the crystalline appearances presented on
subliming the substance and condensing it on a cool microscopic slide,
or the crystalline form observed as modified by various reagents. Thus
the strychnine sublimate, touched with a drop of carbazotic acid, forms
groups of arborescent crystals, each branch forming part of a circle,
when seen under the microscope.