Strychninum purum

Volume III — Main text

StrychninUIU. — Alkaloid derived from Nux vomica (also from Ignatia). CgiH^NjOj.

I. Provings, — i. R- R — , ast. 29, bilious-sanguine temp., robust and very healthy, proved the liquor strychnix of the British Pharma.

copccia. — J. gr. to the oz., under Mr. Robinson's superintendence. J&iiuary 3rd, Ibb8, took 10 dr. m. and e. Tense pain in r. hrpochoncrium and sleepless n. 4th. — Same m., noon, and e. About i b. ^i'ter 1st coic considerable stirtness of muscles of mastication, and difficuicy in open.ng and shutting mouth; during d. flushing and heat of face, slight confusion of ideas, stitFness of extensor muscles of tbighs,u if thev were made of wood. Sleepless n. 5th. — 3 doses of 12, 15, and ic dr. respectivelr. Slight trembling of knees ; considerable confusion of ideas (after 2nd dose) ; general drowsiness, lasting for some h. 6th. — 4 doses of lo dr. each. Slight stilFness of muscles of jaw and hands ;after 3rd dose) ; during d., dull pain shifting along line of aortic arch. 7th. — Same doses. After 4th, scitFness of extensors o( thighs, and of muscles of back of neck and hands, causing inability to write. 8th. — Same. No symptoms. 9th. — Same. Occasionally spasmodic explosi%'e cough. 15th, T6th, 17th. — Each d. 48 dr. in 4 doses. No symptoms. i8ch. — 6o dr. in 4do5CS. Troublesome itching of skin for about 2 h. 19th. — 60 dr. in 3 doses. Involuntazy idiotic-like chuckle; on raising hand to take hold of a cup, it was drawn back suddenly as if it had been burned, and there came on spasmodic twitchings of both arms — he was obliged to eat with elbows resting on table, muscles of forearm being under control, but not those higher up (after 2nd dose) ; in bed twitchings of limbs, and spasms as if heart was being firmly grasped ; slight confusion of ideas. 20th. — 60 dr. in 4 doses — last 3 largely diluted and sipped at intervals of about 10 m. No symptoms. 21st. — Same. Rheumatoid pains, especially in articulations of lower jaw and extensors of thighs. 22nd. — Same. Similar pains in front of thighs, and in forearms and fingers. 23rd. — Same. No symptoms. 24th. — Same. Bad taste in mouth ; slight shivering. 25th. — Dizziness, humming in ears, general coldness, especially in sacral region, which feels as if it were iced. These symptoms proved the precursors of a ^^ fever of an adynamic intermittent type," such as the prover had frequently witnessed at Peshawur in India, with considerable prostration. Upon this, after 7 d., supervened uneasiness increasing to pain in bladder and urethra, with constant urgency to pass water, pain (shooting) involving rectum, and attack culminating in inflammation of r. spermatic cord and testicle. From Feb. i6th, profuse perspiration set in at n., and general condition improved. Testicle^ however, remained hard and swollen, and eventually there came on burning pain of I. side of scrotum, where skin was tense over testicle, and a large abscess formed in dartos and cellular tissue. This was opened, and yielded a great quantity of semi-transparent fluid, partly mixed with blood ; after discharge of which size of testicle became somewhat less, though there seemed no connection between it and the abscess. Soon after this spasms of darting pain in rectum, with gurgling sounds, which had never left him, became more frequent and severe ; stools throughout being lumpy, either dry or covered with mucus. Therewith was constant headache, sleeplessness, and slight fever. Sulphur 30, ter die^ caused rapid and almost complete relief. [We have summarised these phenomena subsequent to Jan. 23rd, as it is very doubtful whether they were effects of the S. They can only

be noted for confirmation. — £ds.] {Monthly Horn, Riv^, xii^ 251, 560.)

1. a. A. F — , «t. 34, an unmarried woman, in good health, active and temperate, proved same preparation. March 17th, 1868, at 3.45 p.m., took 15 dr. in water. 4.15, sharp momentary pains at bottom of r. heel, and then in r. thumb and r. hip-Joint ; peculiar creeping chilliness, with heat, in r. side of head and face. 5 30, sore contracted feeling in muscles of abdomen generally ; strange darting sensation in calf of 1. leg and muscles of 1. upper arm j sharp contractive pains in muscles of chest ; peculiar muddled vacant feeling, forgetfulness, she felt disposed to sit still and sleep ; dull aching pains at nape and up behind ears ; stiff^' sensation in legs on going downstairs, especially in knees; fixed deep-seated pains in lower abdomen ; intense aching \n small of back. 10, while sitting, suddenly a kind of spasmodic jumpin^r in lower part of trunk, and now and then in 1. arm \ when falling asleep at n., several convulsive jerks of entire body. Sleepless at n. ; visions of dead persons. 18th. — On rising severe headache, with sensation on stooping as if head would burst ; feeling of intense fulness in cars ; extreme chilliness and drowsiness ; shooting pains under jaws, and in muscles generally -, transient crampy feeling in toes of 1. foot at intervals ; dull shooting pains in glands of neck and behind ears ; intense itching of nose, as if in bone, lasting entire d. j sharp pains Hying about head, at times fixed pain in vertex ; creeping, tingling sensation in auricles. Afternoon, burning in I. car and eye j vacant feeling, forgetfulness ; tight stiff sensation up spine when bending head down ; hot pains und dry sensation in throat, coming on at intervals and lasting a short time; griping pains in bowels ; sharp darting pains in I. calf. 8 p.m., severe pains in head generally, in 1. eye, and behind ears, with feeling of stupor and drowsiness ; sharp pains in r. wrist, and then in 1. arm from shoulder to wrist. 19th. — On rising felt much better. 9 a.m., sharp cutting in I. ankle, I. arm, r. lower half and 1. upper half ot abdomen, in succession \ momentary darting pains in head and under 1. jaw ; unusually good appetite. 10, sharp pain in r. little Bnger, and at same time such intense aching in ankles that she must sit down \ momentary griping pains in bowels. 4 p.m., headache coming on suddenly, especially in J. side (including eye) ; peculiar creeping chilliness all over, with tremulous sensation in jaws. 7 p.m., severe sharp pains in shoulder-joints and muscles of chest \ severe hxed pain in upper I. chest ; a single cold chill down entire length of spine, afterwards she feels deathly cold \ dimness of eyes \ giddiness and nausea ; sensation as if brain had been overworked, with great weariness ; dry, hot feeling in throat; darting pains in muscles of arms and in r. calf; dull pains in glands of neck and behind ears. At n. when falling asleep peculiar spasmodic jumping, at times in 1. arm only, and afterwards in r. hand ; severe toothache at midnight. 20th. — On rising, slight sensation of sore-throat, I. side, wiih general dry feeling in throat ; dull pains in head and eyes, with feeling of stupor and great weariness; griping pains in bowels and constipation ; sharp cutting pains in muscles of 1. thigh and in both arms. 3 p.m., darting pains and contracted feeling in back of neck and head and behind ears ; feeling of weariness in brain, great

desire to lie down and sleep ; loss of memory ; sharp pains in upper rchest and in top of shoulders, at short intervals ; extreme chilliness, even in warm room ; sharp pains in back teeth and jaws. 53^ p.m>^ sharp pain in r. thumb and r. great toe ; stiff hard feeling of muscles o neck. (All the pains are more cramp-like than rheumatic ; they make her feel as though she would be stiffened.)

b. 2ist. — At 3.45 p.m., 20 dr. 5.45, slight dull pain in hc«d, behind r. ear ; severe sharp pain in muscles of abdomen. 7, peculiar sudden faint sensation, with sense of extreme brilliancy of vision ; jaws were suddenly stiffened for a few m., and then in a moment became relaxed. 9, pains in 1. knee, palms, and 1. thumb, as if they would be stiffened. Spasmodic jumping in arms at n. 22nd. — Shortly after rising, feeling of contraction in throat, 1. side. 10, contractive pains io palms. 11.30, sudden drowsy sensation ; hard stiffness of muscles of face; stiffening sensation in jaws ; sharp darting pains in 1. temple and round to back of I. ear; spasmodic jumping of muscles of arms, passing oft' suddenly. 5 p.m., sharp pains in r. elbow, at short intervals ; great weariness and prostration. At n., disagreeable dreams i strange wanderings of the imagination. 23rd. — M., muddled, confused feeling ; stiff sensation in eyes, she felt unable to look up; soreness in I. side of throat; tongue much coated, bad taste. lO a.m, feeling of extreme stupor; weight in eyes, with sharp pains in I. head and eye ; pains in back of head extendmgdown whole length of spine ; extreme chilliness. 3.30 p.m., painful coldness of head; feeling as if eyes were suddenly stiffened and drawn back, lasting a few m. ; prickly numbed sensation in 1. hand at intervals during d. 8, throat began to feel much worse, hot pains shooting from its I. side into ear and eye; cramp-like pains in palms, she can scarcely extend them. Sudden spasmodic jumping or starting of entire body when falling asleep ; intense gnawing pain in 1. half of neck at n. ; peculiar paralysed feeling in 1. head and face ; tremulous feeling in muscles of face ; noise in 1. ear, like wind. (Menstruation came on on 2lst, and was quite normal.) 24ch. — M., same soreness in throat. Forenoon, intense gnawing pain in 1. half of back from shoulders to waist ; exceedingly low-spirited, 2 p.m., deep spasmodic pains in chest and back ; feeling of extreme stupor; sharp pains in back of head, extending to 1. eye and to back of r. ear ; cutting pains in 1. calf and I. wrist ; digging pains deep in I. ear. 10, sudden burning heat in 1. car and along lower jaw of same side ; throat painful and sore, with redness and slight swelling ; crampy pains in r. foot and leg. 25ih. — 10 a.m., violent headache, with bursting pains in forehead, especially 1. ; at times great nausea ; eyes very hot and painful ; extreme chilliness ; throat painful and sore entire d. \ tender bruised feeling over 1. eye, with fixed pain towards e. ; stiff pains in r. knee when sitting. 26th. — Deep pain in 1. lower abdomen, at intervals during d,, also occasionally pains of same kind at pit of stomach ; sharp cramp-pains in 1. palm and sole, also in muscles of neck ; slight giddiness at intervals. c. 27th. — 25 dr. at 3.50 p.m. After 1 h., sudden giddiness and extreme drowsiness while walking in street, she felt as if a cloud was coming over her ; stiffening heavy sensation in jaws and facial muscles, also stiffening in muscles generally, especially of knees and 1. band

trembling in legs, with sensation of falling ; icy coldness all over, with shivering and yawning. 7, rumbling in bowels, with feeling of diarrhoea, also deep pains in abdomen generally ; severe darting pains in back of neck and head, and through head from back to front ; burning heat in eyes ; painful dryness and contracted feeling in throat. 28th. — M., stiffness in back of legs ; painful dryness of throat ; sore pains in scalp, as if hair had been pulled ; rheumatic pains in various muscles and joints, at short intervals ; burning heat in eyes and lids. Afternoon, spasmodic pain about pit of stomach, extending to heart at intervals, also at times similar pain in hypogastrium ; extreme chilliness ; sudden pain and pressure at top of head and in 1. eye ; numbed prickly sensation in I. hand forshort time at intervals ; sharp cutiing pains in 1. hypochondrium and at times in 1. half of back ; sharp pain deep in upper part of chest. 8, sharp needlc-likc pains under jaws> especially 1. side. 29th. — Severe dull pains in muscles and glands of neck, at times shooting up into head ; pains in maxillary joints and back teeth \ sharp needle-like pains in cheek-bone and under jaw, 1. side ; rheumatic pains in legs from knees upwards, at times in joints of knees and hips, especially 1. ; confused giddy feeling at intervals, with loss of memory ; intense aching and icy coldness of entire back ; rheumatic pain in 1. back about waist j peculiar Slinging in nostrils, as if a cold was coming on ; very low-spirited and gloomy -y deep pains in abdomen at intervals, generally from below upwards ; soreness of tongue and roof of mouth.

d, 30th. — At 2.45 p.m., 30 dr. 3.30, intense aching in soles and outer sides of feet ; stiffening of muscles of legs, later also of back and neck ; tremulous and powerless, also rigid, feeling in legs ; giddiness ; hot fixed sensation in eyes ; sharp pains at pit of stomach, extending round to region of liver. 6, stiffening of hands, she fears to take hold of anything, and when she did she could not grasp it firmly; when stretching out arms, hands became involuntarily clenched ; agonising gnawing pain in muscles of legs above knees, and in back and neck ; intense itching of skin of entire body., even of scalp i icy coldness down spine, accompanied by a kind of nervous shuddering; bitter greasy risings with bad taste. 3(st. — On rising, intense soreness in muscles generally, especially of legs and back ; sharp pains in back teeth and maxillary joints ; rheumatic pains behind 1. shoulder, and in muscles of arms and legs ; dull pains in occiput and temples ; giddiness at intervals; deep boring pains in r. lower half of abdomen, changing suddenly from one part to another. By e. soreness and aching of whole body had become much worse, with intense aching in back, especially I. half about waist, and behind ears i dry contracted feeling in throat ; sharp nccdlc-likc pains under jaw, 1. side ; icy coldness down spine; extreme drowsiness, with stupid headache. AprtJ ist. — M., violent bursting headache, with stiff contracted feeling in- eyes ; burning heat in eyes ; contracted feeling in muscles of neck ; icy coldness down head and spine ; feverish thirst, nausea, and bad taste ; sure pains in bowels, with sensation of threatening diarrhoea ; rheumatic pains and stiffness of knees and hips ; sore pains and stiffness of back ; sharp needle-like pains in ends of fingers and toes ; intense aching of feet when walking ; a kind of internal twitching and nervous feeling, radiating as it were

from pit of stomach. E., sharp sore pains in eyeballs ; sharp darting pains in shoulders and elbows.

r. 2nd. — At 4 p.m., 30 dr. After i h., sharp momentary pain in top of 1. shoulder, shooting down to breast ; needle-IiJce pains in r. knee 5 extreme giddiness, with loss of memory ajid drowsiness i shaking of legs, especially knees; stiffening of jaws and down back convulsed, stiffened and twisted feeling at one moment in arms and hands, at another in muscles of face, arms felt snatched back when taking hold of anything, — lasting about 3 h.,and then suddenly passing off"; sharp pains at pit of stomach. N.j sudden heat down spine, with trembling faint feeling; sharp pains in back of head and glands of neck ; occasional jerking of whole body ; choking sensation, as if something were tied tightly round throat ; violent itching and tingling in soles and palms. 3rd. — M., felt much better, head and eyes free, which they had not been for a week. Forenoon, rumbling in bowels, with feeling of threatening diarrhoea; stiffness down spine and in knees j spasmodic feeling of contraction in throat. Afternoon, keen sharp pains behind 1. upper arm and in front of thighs, also in r. upper chest. N., sudden jerking of legs. 4th. — M., sharp pain in I. hypochondrium, at times shooting to pit of stomach- Noon, rheumatic pains in thighs. Afternoon, giddiness at intervals, with tremulous feeling; sore stiff'ness in knees and r. calf; violent sharp pains in r. hand ; extreme stiffriess of back ; pains in back teeth and maxillary joints. E., violent thumping pains in head, especially r. half, and over I, eye, lasting about 2 h. ; intense aching in soles. N., violent cramplike pain in lower r. abdomen, sth. — M., same pain in abdomen, also^ severe cutting in bowels, with feeling of impending diarrhcca. Noon, intense aching in shins when walking; sharp darting pains behind r. ear ; rheumatic pains and momentary stiffness in hands. £., dull pains in maxillary joints, shooting into temples. N., extreme restlessness and talking in sleep, with peculiar sense of" working " at back of brain. 6th. — Sharp tearing pains down entire length of spine, also in muscles of arms, and in r. knee, with tremulous feeling.

f, 6th. — At 4.15 p.m., 30 dr. From this there was a speedy recurrence of the symptoms previously noted, giddiness, tremulous feeling, stiffening of muscles, convulsive shocks, cold chills down back, pains and itching in legs. There was intense burning in eyes at n., with nervous agitated feeling and sense of stupor and aching in head ; next d. feeling as if bad headache were coming on, with extreme fulness of head and ears, and burning and bruised feeling of latter ; also (for this and following d.) intense pain down neck and spine, and sharp darting pains in various parts.

g, 9th. — At 4.30 p.m., 30 dr., with similar result ; tremor and giddiness being very marked. In addition, there was sensation as if a cold iron cap was on head, and rolling of eyes, which felt like cold bullets ; sudden cold perspiration and icy coldness of entire body ; at n,, intense burning and itching of cars, nose, and eyes ; next d., burning and tingling in nose, ears, and lips \ scanty urine, with constant urging ; constipation for 2 d., diarrhoea on 3rd, bowels uneasy with either, nausea and bad taste with latter. On 4th d., low spirits

and feeling of intense stupor. Throughout restless nights, with profuse perspiration.

h, 13th. — 30 dr., with similar effects. Also, sudden burning heat in face, and extreme sensitiveness to slightest touch ; if foot was touched it jumped as though it was shot. Very sleepless n., with extreme nervous excitability, palpitation, ugly faces passing before eyes; while falling asleep, quite suddenly, several jerks as from womb, with burning irritating heat and violent pulsation in vagina, also feeling of great pressure and bearing down. On 2nd d. felt very much shaken ; usual pains prevailed, with intense aching in lower back and over hips, and extreme lowness and gloom. On 3rd d. violent cutting pains in abdomen, with feeling of diarrhoea, distressing flatulence, coated tongue, bad taste, and headache in forehead and eyes. On 4th d., with headache and sharp pains here and there, sensation as though cold water fell from elbow or shoulder at intervals.

/'. 17th. —30 dr. With usual immediate symptoms, rapid pulsation in 1. upper eyelid, lasting several h., and darting pain and thrilling in vagina, with momentary pulsation at short intervals ; also extreme sensitiveness to slightest touch or noise — every sound appeared to beat at back of brain. On 2nd d. same pulsation in lid, with weakness and watery discharge from eye for 8 h. On 3rd d. violent pains in head, especially in forehead and over I. eye, and same pains in r. ankle, making it painful to walk. While at dinner sudden violent attack of spasm at stomach, lasting about i h., attended with very severe pain and feeling of suffocation, so that she had to loosen her clothes. On 4th, same pains in head, and dimness and aching of eyes. Restless nights and profuse perspiration throughout.

1. A. F — continued the proving some time longer, taking 30 dr. April 20th and 23rd, 35 dr. on the 27th, and 30 dr. April 30th and May 4th. The immediate effects were always those already noted, and those of the subsequent days showed the stiffness and soreness, the darting and shooting pains here and there, which have been so often seen. The following fresh symptoms may be mentioned. On 1st d. (doses being taken about 4 p.m.) immoderate fits of laughter ; sudden jerks in stomach, especially on opening mouth ; frequent fits of sneezing, with itching and stinging of nose. On 2nd d. short breathing, with dry cough ; hoarseness, with feeling as of a cold on chest, lasting 2 h. ; peculiar pulsation in chin, as if in nerves of lower front teeth, at short intervals. On 3rd d. violent tearing pains in womb and I. breast, coming on at intervals and lasting a few m. j irritability of temper ; sudden violent cutting pain in hack about waist, as though she were chopped in half, extending r. and I. to stomach. On 4th d. rapid pulsation in I. temple and 1. hypochondrium ; prickly sensation in feet at intervals ; intense pain in back, aggravated by least exertion ; constant aching round waist. No cumulative effects appeared, and after dose of 23rd (making 300 dr. in all) she felt much better in herself. {Ibid,^ vols, xii and xiii.)

II. Poisonings. — I. tf. G. S — , seen to stagger in the streets (of Milan), was taken in a carriage to Moro's pharmacy. He was visited there by Drs. Casanova and Cavalleri, and by the surgeon Gonzales*

Seated, and perspiring, he called out in a strong natural voice that be was seized with the cholera, then prevalent in the city. He complained of formication in legs and arms, and of a feeling of spasm in his throat and stomach, with vain attempts to vomit. No choleraic physiogaomy. Dr. Casanova tried to calm his fears, and prescribed ^'j of peppcrmiot water with 5J of anodyne liquor and one of laudanum, which the patient took by degrees. Flatus came away, and the spasm of the stomach appeared to subside. Then he rose of his own accord and lay doira on the bed, but his cries and fear of cholera did not cease, notwithstanding the assurances of all the doctors who came to see him. The above symptoms, whilst increasing, were accompanied by spasmodic contractions and opisthotonos ; the formication in the extremities changed into cramp ; the spasm of the stomach reappeared alternately with that of the throat, and was complicated by painful jerks as if from electric shocks every time the extremities or any part of the body was touched. Dr. Casanova thought there was an acute affection of the spine, and bled him, with the approval of the other physicians. The blood gushed out as if from an artery, and coagulated in the usual manner, without any special appearance of the serum, either in quantity or quality. Towards 4. o^clock, G. S — seemed quieter, the spasmodic contractions appeared at longer intervals, but the general jerkings increased in violence ; the slightest touch provoked them. The patient still insisted on his fears of cholera, and desired to be taken to the hospital. As much to humour him as to rid the Moro family of such an inconvenient guest; his request was granted, and he was taken there about 7 o'clock j but on the way from the surgery to the hospital the patient died.

h. The post-mortem examination required by law was made by Drs. Antonio Tarchini-Bonfanti and G. Martinelli about 24 h. after death. Exterior appearance : G. S — , apparently about 45 years of age, was tall, well made, and finely proportioned, robust, and of embonpoint. The face of the corpse is calm, the pupil moderately dilated, the mouth closed but not contracted. The neck is a little large ; the chest ample, dilated, and very sonorous, the abdomen slightly swollen } the upper extremities are very flexible, the lower extremities rather rigid, the fingers clenched, but not quite closed. The corpse lies on its back the front of the body is pale, but the posterior is entirely of a violet colour, as if cyanic ; this colour is also seen in the fingers, and is strongly marked in the scrotum. The cadaveric odour is slight. No trace of lesion exists on the exterior.

Head : Infiltrated blood in posterior portion of scalp ; skull of normal thickness. The dura mater, of a white pearly colour, adheres strongly to the level of the sinus, which contains a little darkish blood, rather fluid than thick. The arachnoid and pia mater are thin and transparent, showing a very few bluish vascular ramifications. The grey substance of brain is pale and a little dense, the medullary portion is milk-white and firm. The plexus choroideus is of a rose colour. The pineal gland is ash-coloured and soft. The venous sinuses at the base of the brain retain a small quantity of thick blood. The cerebellum is in the same condition as the brain.

Spine : On opening the vertebral canal there is an abundant sanguineous effusion, and here and there circumscribed collections of black blood. The dura mater lining the canal is red, dull, giving the appearance as if the whole cord were made of red wax ; the arachnoid is transparent ; the pia mater strongly injected j the substance of the cord normal.

Neck : Some of the cervical glands are of the size of a filbert ; the thyroid gland is a little larger than normal, reddish, but healthy in its texture.

Chest : The mucous membrane of larynx, trachea, and bronchi is rose coloured, covered with a little mucus ; the bronchial ganglia are blackish and a little swollen. The lungs are pressed back from the sternum to the extent of three fingers' breadth j they are ashy, with large black spots, light, feebly crepitant, and congested with blood. No serous effusion cither in pleura or pericardium.

Heart is flaccid and so softened that it is most easily torn ; it is filled with red blood. Its volume is one fourth larger than the fist of the corpse. On the anterior and external surface there is a strong and resistant cartilaginous patch. Its various cavities contain a small quantity of dark, thick, viscid, coagulated blood ; valves normal. The arteries and veins contain a certain amount of blackish pitchy blood.

Abdomen : No serous efi^usion. The liver of moderate size, dull red, dense, granulous, presents an engorgement of blackish, thick blood in the principal branch of the portal vein. Gall-bladder is full of viscid, greenish bile. The spleen is small, pale red ; the pancreas is pale and hard, enveloped in a thick coating of fat ; the kidneys are of a dull red colour, and the tissue very dense.

The mucous membrane of mouth, of pharynx, of oesophagus, is rose-coloured and normal, that of the stomach is pale rose colour without any partial injection, and covered with whitish mucus -, the cardiac and pyloric orifices normal. The intestines are rather pale and distended with gas, otherwise normal. Strychnia was found in contents of stomach. (Tardieit, Empoisonnement.)

1. a. A lad of 1 7 swallowed, immediately after dinner, about 40 gr. of pure S., and washed it down with a glass of wine and water. Immediately afterwards he began to feel uncomfortable, ran about the room, and experienced much anxiety and restlessness, 4 gr. of tart, em. were given without causing much vomiting, and the reporter saw him \ h. after the poison had been swallowed. He lay stifi'and unable to move on his back in bed, the head drawn forcibly backwards ; he showed an inclination to turn on the r. side ; he could still freely use his arms. His countenance was pale and altered ; temperature of the skin normal \ pulse quick and wiry. His consciousness was perfect, he spoke in his natural voice about his state \ he was occasionallv interrupted by a transient stiffness of the lower jaw, but not to such an extent to prevent him speaking quickly and easily. This stiffness did not prevent him opening his mouth to take liquids, which he swallowed easily. The trismus gradually increased, and the spasms soon involved the muscles of respiration. The chest was oppressed, the breathing irregular and interrupted, and occasionally there was a rapid succession

of short respirations, wich smatlj contracted and rapid pulse. Every effort to excite vomiting was unsuccessful. While stiJl retaining consciousness, there occurred a succession of attacks of trismus and oppression of the chest, with a few m. interval between each, which continued to increase in violence, soon extending all over the body ; and all of a 6uddcn the patient experienced a series of almost electrical shocks throughout the body, and after a short pause opisthotonos followed, whereby the body, though not much bent backwards, was, throughout its whole extent, as stiff as a statue, and was raised a few inches from the bed in the middle. This state was accompanied by the most violent suffocative symptoms. During this attack, wherein the trismus was extreme, but without any distortion of the muscles of the face, he uttered bleating noises, and seemed to be trying to speak. 7"he upper extremities were firmly drawn over the chest, the forearm immovably flexed at the elbow j the lower extremities were stiff and immovable, the feet were bent in such a manner that the soles were opposed to one another. The skin assumed a bluish colour, the face was puffed, of a dark violet hue, the lips dark blue, the neck swollen, the jugulars dis* tended, the eyes projecting and turned immovably towards the r. side, the pupils dilated and unaffected by light, the conjunctiva red. He now ceased to utter any sound ; he became unconscious as if suffocated, and the body lay still and stiff. All at once the spasm ceased ; the arms fell by the side of the body, the mouth opened, and he drew a deep breath, whereby beseemed to revive and resume his senses, speech, and power of swallowing. The dark coloration of the skin likewise went off. The contraction, however, continued in the muscles of the back, neck, and legs, but he could move his arms freely. Even after the third attack of this sort, the patient recognised the bystander^ and seemed to understand questions put to him, though he was unable to answer them intelligibly. In the fourth paroxysm he died, i j h. after the poison had been swallowed.

A, Post-mortem^ 20 h. after death. Surface of body blue ; abdomen tense, hard, but not swollen. The whole corpse uncommonly stiff; all the muscles rigid, especially those of the lower extremities ; the feet still distorted. 'Fhe flesh of the muscles, notwithstanding their stiffness, was uncommonly soft and doughy, and of a brownish colour like smoked meat. On opening the spinal canal there flowed out about 2 lbs. of viscid, not coagulated, black, tar-like blood. The plexus venosi spinales, which are in ordinary states unnoticeable, were distended with dark blood ; and between the fourth cervical and fourth dorsal, and again between the tenth dorsal and fourth lumbar vertebra, they had the appearance of a thick black venous net, some of the veins being as thick as a crowquill. The vessels of the pia mater of the cord showed the same congested appearance, especially at the corresponding points. Within the membranes some exudation was observed, more particularly about the cervical portion. The cord, when cut across, was at its iK)per parts soft, in some parts even pappy ; lower down it was harder. The cranial cavity was also congested; all the vessels of tne dura and pia mater, especially the choroid plexus, and even the cerebral substance, were full of blood, whereby the cortical substance appeared of a bluish

colour. The cerebellum was rather softer than usual. The organs of the chest and abdomen were, on the contrary, very destitute of blood ; the heart was flaccid, and its cavities and large vessels so empty that scarcely any blood could be obtained from them, The stomach was distended with solid food, which had quite a fresh appearance. The mucous membrane of the stomach was much reddened, that of the small intestines slightly so. Liver full and distended, more full of blood than the other viscera, otherwise nothing abnormal. (Blumhardt, Frame's AIag,y ii, 234.)

1. Mr. B — has been afflicted, for a considerable period, with tic douloureux, occurring at regular intervals and in paroxysms of excessive violence. For the relief of the pain of these attacks he has been in the habit of making use of the muriate of morphia, at firsi in smalt quantities, and afterwards in gradually increased doses, until 3^ gr. were necessary to produce its effect. At this time he went into the shop of a druggist in the town in which he resided, for the purpose of obtaining some muriate of morphia, and received a quantity of a powder, slightly yellowish in colour, which was stated to be that substance. On the same d., having occasion to go a short distance into the country on business, he took, previous to going out, his usual 3 J gr. of the powder, which was simply placed on the tongue and swallowed, and he remarked at the time that it was extremely bitter, and that the taste was more than usually persistent ; but it did not occur to him that anything was wrong. Shortly after, however, while walking along the street, he felt slightly indisposed, the most prominent symptom being a sense of numbness in the back and legs, which he attributed to the effects of cold, to which he had been exposed in the early part of the m. As these symptoms did not appear of any importance, he proceeded by a public conveyance to the village where his business lay, and returned by the next opportunity. During the whole of this time the symptoms remained precisely as they were the moment he first observed them; but as he was walking along, on his return, they suddenly increased, the numbness being accompanied by a sense of want of power, and a sort of dragging of the muscles of the legs, which soon became so great that, as he described it, he had to put his hands at the back of his thighs in order to push his legs along. This occurred nearly 2| h, after he had taken the dose of the supposed muriate of morphia, and at this time there could have been nothing remarkable or unusual in his appearance, for on his way home he met a friend to whom he communicated his sensations, and who laughed at his evident apprehensions and assured him that it was all imagination. As he was in the midst of describing the effect upon his muscles, and bending himself so as to show how it occurred, he suddenly overbalanced and fell heavily backwards. He was immediately raised, and on attaining the upright position he felt himself much in the same state as before, except that he was excessively nervous and alarmed. The want of power in the legs did not at all increase in intensity, and no spasmodic affection was observed, although the patient was himself under the impression that his fall was somewhat connected with the previous symptoms. The patient's fall and the nervous state into which he had got now fairly

VOL. Hi. 29

alarmed his friend, who begged him to get home as fast as he could, and accompanied him on his way, as he experienced considerable difficulty in walking, and could not get on without support. On reaching home he felt somewhat better, and remained sitting for some time, and at length retired to bed, about 5 h. after the first appearance of the symptoms. Just previous to stepping into bed, in order to ensure a good night's rest, of which the recent symptoms rendered him somewhat doubtful, he cook a second dose of the powder equal in amount to the first. In less than 10 m. after he was seized with a violent tetanic spasm, affecting the legs and muscles of respiration, and bad only time to call for assistance before the sensation amounted to absolute suffocation. Fortunately assistance was close at hand, and he wu immediately raised up in bed, with the effect of entirely relieving the sense of suffocation, and a medical man was sent for. Spasms now followed each other in rapid succession, the intervals being about \ h. or 20 m., and the affection was confined principally to the legs, back, and respiratory muscles, thp arms being comparatively unaffected. The numbness and dragging of the muscles, which had been continuous during the first 5 h., disappeared entirely during the intervals of the spasms, and the patient was left without any uneasy sensation, excepting the exhaustion of the previous fit and the apprehension of its successor. During the whole of this time he was not only perfectly conscious, but his senses were preternaturally exalted, and he distinctly heard a variety of whispered observations of the physician and his friends, which from their tenor were obviously not intended to reach the cars of the patient. The paroxysms, after continuing for some time, began gradually to diminish, the intervals becoming longer and duration of each spasm shorter, and it was hoped that they were about to pass off^, when all at once they returned to all their original violence. This proved, however, to be the last expiring effort of the poison, for the symptoms now entirely ceased, about 13 h. after the first dose was taken. At the conclusion of the spasms the patient was left in an excessively exhausted state, and was unable to turn himself in bed. From this, however, he recruited with great rapidity, as he was able to get up on the c. of the next d., and on the second he walked out and went about his usual business. The most remarkable fact connected with the case is, that from that time the attacks of lie douloureux entirely ceased, and he has not since had any return of it. The medical treatment employed in this case was unimportant and had not any eff^ect on the progress of the symptoms. Chemical analysis proved the drug to be S., and not morphia. (Anderson, Monthly Journ. of Med. Scy 184H.)

1. A man, xt. 34, paralysed on r. side, had i\ gr. sprinkled on raw surface of powerless leg. In less than an h. he had twitchings in it, which increased in intensity every m., boring pain in occiput, slight vertigo, and noise in ears. The twitchings spread to r, arm, and then over whole I. side, with increase of headache, and at last unconscioui ne&s, with rattling difficult breathing. Pulse was very full, hard, slow, and intermitting ; face bluish red, puffed ; eyes projecting, pupils very much dilated, mouth open. He tossed about in bed for the violent convulsions and difficult breathing. Skin of r. leg had a blue marbled

appearance. This patient recovered under the use of morphia cndermically adininiscered. (Richter, 5. A man, a:C. 60, took about

Frank^s Mag.^ i, 104.]

75 dr. of a solution of 3 gr. of the

had vertigo, and in

drinki

acetate in ^^j of water. In h h. he had vertigo, and in drinking a cup of coffee his hands trembled and he was forced to rise from his chair, when he was led to bed. He then had general trembling and dyspnoea. His look was wild ; pupils dilated ; face red ; tongue dry in middle, red at edges ; very rapid breathing ; full, hard, quick pulse. The least noise, the slightest touch produced tetanic convulsions accompanied by frightful cries. Patient continued to get worse, preserving, however, perfect consciousness. The cry was forced from him involuntarily, and was not occasioned by pain. The most disagreeable symptom he experienced was the oppression of the chest. The symptoms lasted altogether 2| h., and then went off, leaving only thirst and exhaustion. (FoHR, Ibid., iii, 8gg.)

6, In May, 1850, Dr. Bartlett was called to see a young man, act. 22, suffering from "spasms." He had red hair, blue eyes, fair skin, and had previously suffered from dyspe{>sia. He complained of a singular indescribable sensation all over, quickly followed by general tonic spasm. The extremities were held in a convulsive movement (both flexors and extensors being rigidly contracted), and he looked like one in an ague fit. His countenance was extremely sad and despondent; he was morose and indisposed to answer questions. 8 p.m., patient on back breathing heavily, dysphagia, eyes closed, pulse 120 and full, continued tetanic spasms of all the muscles, spasm lasted

4 m., attacking chiefly back and throat. As he lies, legs are wide apart, toes strongly flexed ; wide awake, mind active and anxious, intense thirst, dry mouth and tongue, burning heat and great fulness and throbbing in head (a little pain in forehead). Starts every 15 or 20 seconds ; least noise or slightest touch starts spasms, which are all alike, differing only in severity and duration, lasting from 10 seconds to

5 m. One description will suffice : He starts very suddenly, his legs are immediately drawn asunder as far as possible, his body curved so that head and heels only touched floor, muscles of arms and legs rigid, respiratory muscles frightfully affected, so that it is with great difficulty he breathes at all ; his face becomes blue and then black ; jaws tightly closed ; vomiting occurs. During this spasm he has not breathed at all for 3 m. and has lost consciousness, looking like a suffocated man. l^ongue protrudes, eyes stand out from sockets, and no action of pulse or heart, yet the paroxysm holds on. Mind harassed with dread, and he weeps, but cannot tell why. After a spasm, sighing, aching of insteps, and a dead numbness all through body. At midnight, nausea, burning heat all over; hot sweat, followed by a dried-up feeling all over surface of body i feels warmth in bowels; eructations of bitter and tasteless wind before vomiting ; bitter taste in mouth. By 5 a.m. he was much better ; only slight twitchings ; other symptoms present, but slight. This patient had taken 3 gr. of S. in ignorance of the proper dose. {N. Jmtr. Jount. of Horn. ^ i, 469.)

1. H — took 3 or 4 gr, of S, When first seen about 15 m, after he was only partially conscious and unable to answer questions intcl-

igibly. He soon became quite unconscious and quite stiff". During the h. and half that followed the spasms were severe; he would throw himself about, snap at a hand that touched him, strike and kick. Suddenly his body would curve backwards and rest on the head and heels, with the elbows on the bed at the sides. The muscles would continue to contract, drawing the head back, until the occiput nearly touched the spine and the face became buried in the pillow. Occasionally he would extend his arms at his side with the fingers straight and separated, and rising to the sitting posture would stare wildly about the room as if in fear. Breathing was only maintained by the aid of artificial respiration. (H. P. Cole, V. S. Aled, Jnvea.y ii, 432.)

1. Dr. HippEL says that he has found by personal experience that when given in doses of 2 to 4 milHgr. S. produces the following effects, viz. I, increased peripheric sensibility for blue ; 2, temporary increase of visual power \ 3, more distinct perception of peripheric points ; 4, lasting enlargement of the field of vision. (Horn. Tirms^ iv, 86.)

2. A man, it. 59, applied for relief from an intense feeling of cold, attended with visible sluggishness of the capillary circulation, especially in the hands and feet (the remnants of an attack of hemiplegic paralysis from which he had suffered 12 mos. previously), and from an extraordinary enlargement of the abdomen, which he had been led to believe was dropsical. The abdominal distension turned out on examination to be mere tympanitis, from partial paralysis of the muscular coat of the bowels, and strychnia was ordered, gr. -^ three limes a d. On the occasion of the man's next visit I thought at first that he was drunk, as he had the uncertain gait, meaningless smile, and flushed perspiring cheeks characteristic of intoxication. To my surprise, however, I found that this effect had been produced by a dose of the S. taken J h. previously, and he had come to me to complain of the medicine because it '^ made him drunk ;" this I ascertained subsequently by personal] observation was really the fact. He also complained that all sounds caused a " deafening noise" in his cars. The dose was decreased to gr. ^, and the disagreeable effects upon consciousness and co-ordination of movements were no longer observed ; but a very

[remarkable increase of temperature of the surface was still produced )y each dose, and by degrees became constant. (ANSTIE, Stimulants and Narcotics^ p. 151.)

1. M. T — , a man of 40, a great drinker, had become a teetotaler lately, because he had had one or two attacks of delirium tremens -, but this had not saved him from sinking into a state of chronic "horrors," so that he feared he should be driven to suicide. He was ordered to take S., gr. ^^ ter die. He came on the 3rd d., complaining of decided stiffness in lower jaw muscles, copious flow of saliva, and " flashes of fire before his eyes." His eyesight was much weakened ; he could only read the very largest type at any distance, and said that even this looked dim and misty. The flashes complained of always occurred if he looked towards a bright light, and even in comparative darkness soon after each dose of the medicine. The sensibility of the skin did not seem notably raised. (Ibid.y p. 311.)

2. A woman, zt. 33* was suffering from a peculiar numbneu

attended with partial paralysis and some wasting of the muscles of the forearm. S. was administered in gr. 7^ doses, with the most manifest good effects. On dose, however, being raised to gr. ^, skin of both arras and forearms, of palms and of soles became exquisitely tender to the touch, so that she could not bear to walk, and a considerable tendency to reflex muscular contraction developed itself. But the most distressing symptom was the painful effect which any sound made upon the ear j it was not that sounds were heard at all more distinctly, but that the slightest sound occupied the woman's whole hearing faculty, so to speak, and anything like a multiplicity of impressions on the auditory nerve became positively painful, [Ib'td,^ p. 212.)

1. A young man, x.t. 19, suffering from enuresis, took S. in doses gradually increased up to gr, -f^. The first dose of this immediately produced impairment of sight and distressing sensibility of the eyes to the dazzling influence of light, and even " flashes " after the eyes had been shut, or sometimes in a dark room, [Ibid^ p, 213.)

2. a. S., even in permissible doses, may produce a chain of threatening symptoms, differing only in degree from true S. poisoning. After gr, -^ — ]^ there may appear nausea, redness of eyes, formication, exalted sensibility to external impressions, feeling of weight in feet, and stiffness in limbs. With these symptoms are occasionally associated disagreeable tension of certain groups of muscles, and painful erections. Girl several times observed, after the repeated internal administration of S., the occurrence of periodic spasmodic attacks, reappearing during the course of several weeks, of a tertian type, resembling an intermittent fever, and ending with sweating. After they had ceased, they could be reproduced by b.

b. In the case of a woman who took gr. -j-J^ of the drug, Skinner saw a scarlatinous exanthema, which disappeared after it was discontinued. (Lewin, op. cit.)

1. In a case of amaurosis, a small powder = about 3 milligrammes was applied to the lachrymal orifice of one eye. Scarcely 3 or 4 m. had elapsed before patient's face assumed a livid colour, and he yawned spasmodically i then followed vertigo, which made him fall into an armchair. Windows were opened, the powder removed, cold affusion, &c., practised ; but in spite of this toxic symptoms of graver kind came

rapidly on, — complete loss of speech, absence of pulse, respiration laboured and interrupted, then tetanic shocks of extreme violence. From 10 to 12 of these occurred, their force increasing up to the 5th, when they became feebler. As patient improved, he felt painful pressure on bladder and rectum, and a copious evacuation ensued. In less than ^ h. he had completely recovered. {Gaz, Med, de Paris^ 1861, p. 98.)

1. In addition to the violent spasmodic contractions produced by S., Bally has observed an appearance of stupor, vertigo, tinnitus aurium, sleeplessness, and turgescence of the capillaries of the face. {Bu/Ldf 7/j/r., Feb., 1838.)

III. Expmmenti 9n animals. — I. a. Dr. Brown-Sequard has proved that the action of S. consists in an increased nutrition of the spinal marrow, by which excess of nutrition the reflex faculty becomes inten-

siRedi and also in a special power of stimulating this nervous centre independently of the quantity of blood it contains. Kollikcr's experiments demonstrate that in whatever manner the drug acts, it does so upon the nervous centres alone, and not upon the nerves themselves or on the muscles. His experiments also prove that during the action of S. spasms may be excited by a stimulus proceeding directly from without, or transmitted through the brain. Dr, Marshall Hall states that if a dog under the milder form of strychnism be allowed to remain quiet, it will recover; while, if continually excited, it will ti certainly die.

h. The experiments of Dr. Spence (Ed, Med. Journ,^ xii, 44) confirm these conclusions. He showed that S. applied directly to the nerves of frogs produces no effects whatever, but that its application to the medulla oblongata and spinalis immediately develops specific phenomena. He also proved that even when injected into the abdominal veins it remained ineffectual if the ventricle of the heart was cut away so as to prevent the poison from being thrown through the arteries into the nervous centres. On the other hand, his experiments demonstrated that the poison, if taken into the stomach, acts only when its access to those centres is not prevented. Its mode of action, he concludes, consists in stimulating the nerve-cells to excessive action, and keeping them in that condition until they perish from exhaustion. But before this process is completed, death may take place from asphyxia brought on by spasm of the respiratory muscles. (Still£, op, ciL)

1. a. Dr. Brown-Sequard found that when the spinal cord was cut just below the origin of the nerves supplying the forelegs of a frog, ind all the blood-vessels going to the lower section of the cord were also severed so as to isolate the latter, on the exhibition of S. convulsions occurred in the anterior part of the body, while in the posterior segment quiet and a normal reflex activity were maintained, although the blood was carrying the poison to every part of it save the spinal cord. This experiment has been repeated a great number of times by MM. Martin- Magron and Buisson with similar results.

h. Richter and Mayer have ascertained that S — causes a very decided rise in the arterial pressure, and the former has seen contraction of the vessels of the frog's web under its action. (H. C. Wood, 9p, cit.)

1. After the death of a dog poisoned with S. I examined spinal cord and brain, chiefly with a view to discover any congestion which might have existed in the several parts. In the brain I met with no unusual degree of congestion, but I was particularly struck by a remarkable condition of the grey matter of the lumbar bulb ; it presented, in fact, numerous small effusions of blood, while in the medullary portion no abnormity was found. In another dog, similarly killed, I found in the grey matter of the lumbar portion aneurismal dilatations of the capillary vessels, which were in consequence on the verge of bursting. In both cases the two horns of grey matter were most beautifully injected with blood. (Vav der Kolk, Sptnal Cord, ^c, New Syd. Soc., p. 78.)

2. Arnold (of Heidelberg) found that if gr. \ is administered to a

4 4

n

frog, tetanus comes on in not more than 5 m., and death ensues in 45 — 90 m. After gr. ^ it supervenes at about same time, but death comes later. After gr. -^ it took 10 — 20 m. to develop, but continued in one case for 48 h,, frog being found dead after 54 h. In young frogs, gr. iqIq^^ brought it on in 7 — 12 m., and it lasted 7 h. On giving gr. mo juuo* affcr J h. or so irritability was somewhat increased, but no spasm ensued in strong, full-grown animals. But in one frog, which the d, before was tetanic for some h. after gr. ,,, jt.^, but which had quite recovered, a slight attack came on } h. alter gr. n,<tJot)Oi ending in the death of the animal after some h. (Hygta^ xvii, i, 56.)

Volume IV — Appendix

STRYCHNINUM.

(Gee vol fii, p. 439.)

1. [have experimented with this alkaloid on myself and on two other persons, one of whom was a woman of lymphatic temperament. Ir always brought on electric shocks, occurring whenever the prover was touched, or whenever any one lightly shook the bed on which he or she was lying. This happened to all of us, only the lymphatic (and feeble) woman needed a stronger dose. (The ty dil. was used, and carried up to 6 dr. a d,) Trismus was alto very marked, and even opisthotonos to some extent, but I arrested the experiment at this point, The female prover noticed a curious fact, viz. that any touch on the body, it mattered not where, excited a’ voluptuous sensation, (Mevuorrer, Bull. de la Soc, Méd. Hom, de France, ji, 209.)

Volume IV — Supplement

STRYCHNINUM.

(See vol. iii, p. 439 ; vol. iv, p. 714.)

I. 4. The effect of nitrate of strychnia on the functional activity of the stomach has recently been made the subject of careful research by Dr. Gamper of St. Petersburgh, who employed for his experiments four healthy young hospital assistants. He found that S. increased the amount of gastric juice secreted, the general acidity, and the quantity of free acid in the secretion. It also hastened the absorption from the stomach, and strengthened the mechanical movements. Its effects, too, continued for some time after its administration had been stopped. {Lancet, 1891, i, 897.)