THE
MEDICAL EXAMINER,
AND
RECORD OF MEDICAL SCIENCE.
NEW SERIES.— NO. Oil.—JUNE, 1853.
ORIGINAL COMMUNICATIONS.
A Case of Poisoning with Strychnine relieved by Chloroform.
By Geo. L. Upshur, A. M., M. D., Surgeon to U. S. Marine
Hospital, Norfolk, Member of Am. Med. Association, &c., &e..
On the 30th of March, 1853, I was called to see the child of
Mr. F., sick with chronic diarrhoea. It was born on the 2d of
January, and consequently was not quite three months old.
When less than two weeks old, its bowels became disordered^ and
I had frequently prescribed medicine for it from the description
given of the case by the father. It took first one simple astrin-
gent and then another, with now and then an alterative dose of
calomel, but nothing seemed to exercise any permanent control
over the affection. The child thus became, in a short time, much
emaciated and enfeebled, and I was requested to visit it on 30th
of March. Found it feverish, thirsty and restless, with a move-
ment of the bowels every hour or two, and scarcely any diges-
tive power left. The milk was passed from the bowels in. the
same state as it left the stomach, and there were frequent nau-
sea and vomiting. I ordered one of the following powders three
times a day:
B. Ext. Krameriae	gr.	xv.
Pulv. Dover.	gr.	xii.
Pulv. Rhei	gr.	vj.
Strychnine	gr.	l-5th.
M. Chart. 12.
In the course of two or three days there was a manifest im-
provement in the condition of the patient; the nausea ceased,
the dejections became less frequent and more natural, and the
mother’s milk seemed to agree as it never had done before. The
powders were continued until 24 had been taken, when they were
discontinued, and I left the child fairly convalescent.
On the 14th of April the father came to my office to say that
the child’s bowels had again become disordered, but there was
no fever, and it was very sprightly. I ordered a tea-spoonful of
infusion of rhubarb with six drops of paregoric to be given three
times a day. On the 20th there had been no improvement, and
1 was requested to visit it. Finding it in nearly the same con-
dition that it was on the 30th of March, I determined to give the
strychnia again, and in larger doses. The following is the pre-
scription :
B. Pulv. Dover, gr. xv.
Cretae Prep. gr. xxx.
Pulv. Rhei gr. viii.
Strychniae gr. |.
M. Chart. 15. S. A powder three times a day.
The child took the first dose at one o’clock ; at two the mothci*
discovered that it was becoming very restless—frequently start-
ing, as it were involuntarily, and, now and then, becoming quite
rigid. These symptoms gradually increased in violence until 4
o’clock, when I was sent for, the messenger informing me that
the child had strong convulsions. Arriving in a few minutes, I
found the patient lying in the lap with almost every muscle in
the body acting spasmodically. The spasms were tetanic, with
very short intervals between the paroxysms. There was no heat
about the head, nor, indeed, any feverish action, and the child’s
intellect was perfectly clear, as was evinced by the cry of suffer-
ing which was uttered between the paroxysms, and the earnest
look for relief cast upon every person around it. The spasms
resembled more nearly than anything else a violent shuddering,
or agitation of the whole frame—the hands being tightly
clenched, the body bent backwards, and the limbs immoveably
rigid.
I immediately ordered a mustard plaster to be applied down
the spine, and, while I went for some chloroform, directed equal
parts of brandy and water to be freely given. I was absent half
an hour, and on my return found the convulsions more violent,
if possible, than ever. Fifteen drops of chloroform were sprinkled
on a towel, folded in the shape of a funnel, and applied over the
patient’s mouth and nose. In four minutes she was fully under
the influence of the remedy, and snored aloud. The towel was
removed, and as soon as consciousness began to return the spasms
also began to re-appear, when it was again applied. The child
was thus kept fully under the influence of the chloroform for
four hours, at the end of which time, there being no tendency to
a recurrence of the convulsive movement, the remedy was dis-
continued, the entire quantity inhaled being fjss.
For’two days afterwards the child had frequent bloody, slimy
stools, accompanied by a good deal of pain and fever; but these
symptoms yielded readily to a blister on the abdomen, and ni-
trate of silver enemata, with laudanum. The child is now in
better health than she has been since her birth, being four
months old on the 2d inst.
Remarks.—This case presents some exceedingly interesting
points. The tender age of the patient, the very small dose of
strychnia—only l-30th of a grain—the length of time that the
chloroform impression was maintained, and the perfectly satis-
factory result of the treatment, are all matters of great interest
to the medical man. At first I was disposed to doubt the possi-
bility of so minute a dose of strychnia producing such violent
symptoms, and began to think that some mistake had been com-
mitted by the apothecary ; but, upon inquiry, I learned that the
prescription had been put up by one of our most careful apothe-
caries, whose attention wTas called at the moment to the necessity
of being careful in weighing the strychnia, by an older member
of the firm. I do not think it probable that more than half a
grain was put in the fifteen powders, so that the child could not
have taken more than a thirtieth of a grain. When it is remem-
bered, that one twentieth of a grain had, but a few days before,
been given every day for eight days, without any unpleasant ef-
fects, it seems almost incredible that a thirtieth of a grain should
produce such alarming symptoms.
Is it possible, that the action of strychnia, like that of digitalis,
is cumulative ? If so, then the convulsions in this case may have
resulted from the whole amount of the poison which the child
had taken from the 30th of March to the 14th of April, instead
of from the simple dose of one thirtieth of a grain. But the
best writers on Materia Medica do not consider strychnia to be
cumulative in its action—certainly not to the same extent as
digitalis—for Taylor, in his work on Poisons, says, “ when the
dose is gradually raised, the system may become habituated to
the poison, so as to resist the effects of a very large dose
and Pereira has seen the dose gradually increased, until one
grain and a half was taken three times a day, without dangerous
consequences. Boyle, however, remarks, that some cases show
a tendency to its becoming cumulative in its action.”
I am not disposed to believe, however, that the symptoms in
this case wrere due to the cumulative action of the poison. The
medicine was entirely discontinued on the 6th of April, and was
not resumed until the 14th, eight days after. The symptoms,
too, followed the administration of the powder on the 14th too
quickly, and were too marked in their character, to be attributed
to any other cause than the powder ; so, that after a careful re-
view of all the attending circumstances, and without a desire to
give undue weight to any one of them, I am satisfied that the
child was poisoned by only the thirtieth of a grain of strychnia,
and that the dose would havh been fatal but for the chloroform.
This is probably the smallest dose of strychnia that ever pro-
duced symptoms which threatened to destroy life. Taylor quotes
from the Brit. Amer. Journ. for Aug., 1847, the case of Dr.
Warner, who was killed in fourteen minutes by taking half a
grain; and Dr. Watson reported a case, in the Med. (faz., for
1845, of a girl, set. 13, who died from taking three quarters of a
grain ; but in both these cases the dose was larger, in proportion
to the age of the patient, than in the case herein reported.
The magic effect of the chloroform deserves some notice. Its
impression was maintained for four hours with the happiest re-
sults. In less than five minutes the child became perfectly com-
posed, and soon was in a profound sleep. At every recurrence
of the convulsive movement, two or three inspirations were suf-
ficient to produce perfect composure, until the force of the
poison had expended itself, when the chloroform was discontinued,
and the patient recovered without further serious symptoms.
In conclusion, I may be permitted to say, that I report this
case only for what it is worth. As I have said elsewhere in the
pages of this Journal, it is very unphilosophical to deduce any
general principle in therapeutics from a solitary observation, and,
therefore, in giving this case to the public I do not intend to
commit the error which is so often committed—that of seeking
to establish a permanent law from the treatment of a single case.
I merely give the facts, viz : that I administered the thirtieth of
a grain of strychnia to a child three months and twelve days
old; that, in a short time, the child had all the serious symptoms
that are attributed to a poisonous dose of strychnia, and which,
to all appearance, would have destroyed life had they continued ;
and that it was kept under the influence of chloroform for four
hours, and recovered without having any return of spasm or
other serious symptom. I believe the recovery was due to the
chloroform.
Norfolk, Va., May 1th, 1853.