The wonder drug strychnine
One of the most significant changes to prehospital practice in the last few decades has been the introduction of drug therapies. Such medicines have of course been an integral part of established medicine for hundreds of years with many of them tracing their ancestry back even to ancient civilisations. Some have remained, refined perhaps, into current practice.
Then there are those such as strychnine. To set the scene, consider the Wikipedia description of strychnine. “a highly toxic, colourless, bitter crystalline alkaloid used as a pesticide, particularly for killing small vertebrates such as birds and rodents. When inhaled, swallowed or absorbed through the eyes or mouth causes a poisoning which results in muscular convulsions and eventually death through asphyxia.’ The Wikipedia doesn’t really create a medicinal impression.
Wind the clock back though and this was not always the case. Over a hundred years ago it was ahead of its time amongst athletes given that, as long as you didn’t take too much, could have a stimulant effect on muscles. It was credited with winning at least one event in the Olympic Games. It seems this sort of thing isn’t such a new problem after all.
It is said that money doesn’t grow on trees. However like seemingly everything of old, strychnine did. It was identified properly in the 1700s based on local medical practice long established before that. Ironically the first uses for the substance was as a poison to kill off unwanted little animals like rats and mice.
Medicine though wasn’t to be constrained by a little thing like not being able to harness a proven killer somehow as a life saver. Medicine for nurses 4th edition by W Gordon Sears, straight from 1944, still held the virtues of strychnine as having therapeutic value. Small doses by mouth provided a tonic to increase appetite and stomach movement. The alternative name for strychnine, Nux Vomica, appears clearly from a time before marketing experts advised on such matters. For the more serious practitioner, injections stimulated the medulla and breathing and the circulation.
Interestingly, the ability to stimulate the awareness made it also a favoured antidote in cases of excess morphia administration. This medicine must have been so very close to finding its way onto early twentieth century ambulances.
The British Red Cross Society Nursing Manual 5th edition by Hester Parsons, slightly earlier in 1941, advised that 1/60 to 1/80 grains of strychnine could be administered hypodermically for patients in heart failure. Medicine for nurses was a little more aggressive stepping up the dose to as much as 1/8 of a grain. If you don’t know what a grain is, a tincture could be prepared of 10-30 minims. Whatever amounts these are.
Get the dose wrong though, and strychnine showed its one or two down sides. Again Medicine for nurses covered it well. Suffocation, muscle twitching, tetanic convulsions and severe uncontrolled back arching (which had the brilliant medical name of opisthotonos). A rapid pulse and rising body temperature might have seemed problematic yet spasm of facial muscles held the victim trapped in a wild grin. Death could follow from either asphyxia or exhaustion. Modern words that might be added include lactic acidosis and rhabdomyalosis. The greater the drug dose, the faster and more severe the problems.
Despite the falling out of strychnine in modern medicine, it still manages to find its way into some herbal medicine practices. It also presents itself in poisoning to emergency departments through such accidents as ingestion of rat poisons.
Jeff Kenneally www.prehemt.com
prehospital emergency ambulance paramedic historic