STRYCHNINE. 
§ 4 oi-] 
339 
tetanus ” the first to be affected—are in “ strychnos tetanus,” as a rule, 
the last—a distinction, if it were more constant, of great clinical value. 
The convulsions and remissions recur until death or recovery, and, as a 
rule, within two hours from the commencement of the symptoms the 
case in some way or other terminates. The number of the tetanic 
seizures noted has varied—in a few cases the third spasm has passed 
into death, in others there have been a great number. The duration of 
the spasm is also very different, and varies from thirty seconds to five or 
even eight minutes, the interval between lasting from forty-five seconds 1 
to one or even one and a half hours. 2 
§ 401. Diagnosis of Strychnine Poisoning. —However striking and 
well defined the picture of strychnine tetanus may be, mistakes in 
diagnosis are rather frequent, especially when a medical man is hastily 
summoned, has never seen a case of similar poisoning, and has no 
suspicion of the possible nature of the seizure. If a young woman, for 
instance, is the subject, he may put it down to hysteria, and certainly 
hysteria not infrequently affects somewhat similar convulsions. In a 
painful case in which the senior author was engaged, a young woman 
either took or was given (for the mystery was never cleared up fully) a 
fatal dose of strychnine, and though the symptoms were well marked, the 
medical attendant was so possessed with the view that the case was due 
to hysteria, that, even after making the post-mortem examination, and 
finding no adequate lesion, he theorised as to the possibility of some 
fatal hysteric spasm of the glottis, while there was ample chemical 
evidence of strychnine, and a weighable quantity of the alkaloid was 
actually separated from the contents of the stomach. The medical 
attendant of Matilda Clover, one of Neill’s victims, certified that the 
girl died from delirium tremens and syncope, although the symptoms 
were typically those produced by strychnine. Such cases are particularly 
sad, for we now know that, with judicious treatment, a rather large 
dose may be recovered from. 
If the case be a male, a confusion with epilepsy is possible, though 
hardly to be explained or excused ; while in both sexes idiopathic 
tetanus is so extremely similar as to give rise to the idea that all cases 
of idiopathic tenanus are produced by poison, perhaps secreted by the 
body itself. As for the distinction between idiopathic and strychnine 
tetanus, it is usually laid down (1) that the intervals in the former are 
characterised by no relaxation of the muscles, but that they continue 
contracted and hard ; and (2) that there is a notable rise of temperature 
in disease tetanus proper, but not in strychnine tetanus. Both state¬ 
ments are misleading, and the latter is not true, for in strychnic poisoning 
the relaxation is not constant, and very high temperatures in animals 
have been observed. 
1 White, Brit. Med. Journ., 1807. 
2 Folkcs, Med. Times, 1809. 
