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STRYCHNOS  NUX  VOMICA                                             701

Pharmacopceial Preparations.—The pharmacopoeia! preparations of mix
vomica and strychnine are—

1.    Extractum Nuds Vomicce Siccum.—Standardized to contain 5 per cent of strych-
nine.   Dose, ^ to 1 grain.

2.    Extractum Nucis  Vomicce  Liguidum.—Standardized to  contain 1.5  per  cent of
strychnine.   Dose, 1 to 3 minims.

3.    Tinctura Nucis Vomicce,—Standardized to contain 0.125 per cent of strychnine.
Dose, 10 to 30 minims.

4.   Nux Vomica Prazparata.—This is also known as Nux Vomica Pulverata.    Dose,
1 to 4 grains.

5.    Strychnines Hydrochloridum^.—Dose, 1/30 to J grain and 1/30 to 1/16 grain sufo-

6.   Liquor   Strychnine**   Hydrochloridi,—It   contains   0.82   per   cent   of   strychnine
hydrochloride.   Dose, 3 to 12 minims.

7.   Injectio  Strychnine  Hydrochloridi,—Dose,   subcutaneously  1/30  to 1/16  gr.    If
no strength is stated, a solution containing 1/16 grain in 15 ms. shall be dispensed.

Symptoms.—These supervene immediately after, or within five or ten
minutes after, swallowing the poison ; in rare cases they may be delayed for
an hour or more.   An intensely bitter taste is experienced during the act of
swallowing if it happens to be in solution.    This is followed by a choking
sensation in the throat.   The most marked effects due to its direct action on
the spinal cord are the convulsions affecting all the muscles at a time.   These
are at first clonic, but eventually become tonic, as the intervals become
shorter and the paroxysms longer.    During the paroxysms the face becomes
cyanosed, and wears an anxious look, the eyes are staring, the eye-balls
prominent and the pupils are dilated*   The features are drawn into a grin
(the risus sardonicus), and the mouth is  covered with froth, frequently
stained with blood.    The body is arched back in the position of opisthotonos,
the unfortunate patient resting on his heels and occiput.   The spasms of the
diaphragm,   drawing  upon  the  ensiform cartilage,   cause   epigastric pains.
The contractions of the respiratory muscles produce a sense of suffocation,
which  may   end  in   asphyxia.   Sometimes,  the  spasms   of  the  abdominal
muscles  may bend  the  body forward   (emprostbotonos)   while,  less  fre-
quently, the body may be flexed to the side  (pleiirosfhotonos).   The mind
usually remains clear to the end of life, and the patient is conscious of the
pain and impending danger of death.   The reflex excitability is so great that
the slightest movement of the patient, a sudden noise or the touch of a glass
of water to the lips or even a flash of light is enough to induce the convul-
sions.   Vomiting is readily induced, and persists when once excited.   Death
may occur from asphyxia during the first paroxysm,  or any subsequent
attack, or from exhaustion during the intervals as a result of painful spasms.

In cases ending in recovery, the convulsions become shorter and less
active, and the period of intermissions is much longer.

Fatal Dose.—The usual fatal dose for an adult is J to 2 grains of strych-
nine. The smallest amount of strychnine known to have proved fatal is
J grain. Half-a-grain of sulphate of strychnine h$s proved fatal. One
drachm of liquor strychninse hydrochloridi containing 0.52 grain of strych-
nine killed a naval officer in 45 minutes.1 One or two of tabloids2 of Easton's
syrup killed a child, 19 months old, while two, possibly three, of the tab-
loids, equal to 1/32 and 1/20 grain of strychnine respectively, proved fatal
to a boy, three-and-a-half years old, in about one-and-half hours.8 On the
other hand, recoveries after prompt treatment have ensued from large doses
of 10 to 40 grains.

1,   Littlejohn, Transaction Med.-Leg. Soc.t Vol. XIX, p. 13,

2.   PTiar. Jour., June 9, 1945, p. 284.

3." Littlejohn, Transactions, Med.-Leg Soc.t Vol. XIX, p, 14