of MEDICAL J ^ grains of powdered nux -TBJLCI^ ^ strychnine) given in two c Recoveries have, however, followec the hard insoluble testa, the entire producing poisonous symptoms. Three and 6 drachms of the tincture have' Thirty drops of extract nux vomica 1: nine administered in mistake for extract pean woman of Calcutta in 2 hours Fatal Period.—The usual fatal period is one to two hours. In a few cases death has occurred within five to thirty minutes after swallowing the poison, and in rare cases death has been delayed six to eighteen hours. If a narcotic preparation has been taken together with strychnine, death may not occur for several hours. Diagnosis.—Strychnine poisoning has to be diagnosed from tetanus. The chief distinguishing points between the two are as follows : — vomica .ely produced ratal'* results, lalent to J grain, ofjstrych- __j^uid proved fatal to a Euro- minutes on April 28, 1923. STRYCHNINE POISONING 1. Onset, sudden. f r 2. All the muscles are affected at a time. 3. During the intervals the muscles are re- . laxed. 4. Death takes place within a few hours, If death does not occur within four to six hours, the probability of recovery is great. TETANUS 1. Onset, gradual. 2. The muscles of the nock and lower jaw are affected first (Lock-jaw). 3. During the intervals the muscles are rigid. 4. Death rarely takes place within 24 hours and may be delayed for several days. Treatment—Give chloroform inhalation to check the spasms, and thep introduce the stomach tube to wash out the stomach with warm water con- taining potassium permanganate, animal charcoal, tannic acid or tannin, In the absence of the tube, evacuate the stomach contents by the hypodermic administration of 1/10 to 1/5 grain of apomorphine hydi&chloride,, It al$o tends actually to quiet and prevent the convulsions. Three cases are reported in which the hypodermic use of apomorphine hydro chloride was followed by recovery in human beings who had taken presumably lethal quantities of strychnine.4 Short-acting barbiturates like pentobarbital sodium, sodium amytal and other barbituric acid derivatives are considered as valuable antidotes to strychnine, and should be administered immediately intravenously in doses of 5 to 10 grains dissolved in 10 cc. of distilled water or in sufficient quanti- ties to induce sleep or to stop convulsions." Large doses of potassium bromide and chloral hydrate should be given internally at frequent intervals. Chloral hydrate may be given in 30-grain doses by the rectum or in 5-grain doses hvpodermically. Urethane (dos.e, 1 to 4 drachms) is considered useful in controlling convulsions. Gentle narcosis, perfect quiet and dark surroundings are very essential. Nitrite of amyl and oxygen may be administered by inhalation. Artificial respiration may be attempted, if respiratory paralysis supervenes. J*i?iiMartin' dted by Haggard and Greenberg* Jour. Awer. Med. A«*oc., April 2, p. .L.Lo4.