Strychnine poisoning is poisoning induced by strychnine. It can be fatal to humans and other animals and can occur by inhalation, swallowing or absorption through eyes or mouth. It produces some of the most dramatic and painful symptoms of any known toxic reaction, making it quite noticeable and a common choice for assassinations and poison attacks. For this reason, strychnine poisoning is often portrayed in literature and film, such as the murder mysteries written by Agatha Christie.
The probable lethal oral dose in humans is 1.5 to 2 mg/kg. Similarly, the median lethal dose for dogs, cats, and rats ranges from 0.5 to 2.35 mg/kg.
Presentation in humans Ten to twenty minutes after exposure, the body's muscles begin to spasm, starting with the head and neck in the form of trismus and risus sardonicus. The spasms then spread to every muscle in the body, with nearly continuous convulsions, and get worse at the slightest stimulus. The convulsions progress, increasing in intensity and frequency until the backbone arches continually. Convulsions lead to lactic acidosis, hyperthermia and rhabdomyolysis. These are followed by postictal depression. Death comes from asphyxiation caused by paralysis of the neural pathways that control breathing, or by exhaustion from the convulsions. The subject usually dies within two to three hours after exposure.
One medical student in 1896 described the experience in a letter to The Lancet:
Three years ago I was reading for an examination, and feeling "run down". I took 10 minims of strychnia solution (B.P.) with the same quantity of dilute phosphoric acid well diluted twice a day. On the second day of taking it, towards the evening, I felt a tightness in the "facial muscles" and a peculiar metallic taste in the mouth. There was great uneasiness and restlessness, and I felt a desire to walk about and do something rather than sit still and read. I lay on the bed and the calf muscles began to stiffen and jerk. My toes drew up under my feet, and as I moved or turned my head flashes of light kept darting across my eyes. I then knew something serious was developing, so I crawled off the bed and scrambled to a case in my room and got out (fortunately) the bromide of potassium and the chloral. I had no confidence or courage to weigh them, so I guessed the quantity—about 30 gr. [30 grains, about 2 grams] bromide of potassium and 10 gr. chloral—put them in a tumbler with some water, and drank it off. My whole body was in a cold sweat, with anginous attacks in the precordial region, and a feeling of "going off." I did not call for medical aid, as I thought that the symptoms were declining. I felt better, but my lower limbs were as cold as ice, and the calf muscles kept tense and were jerking. There was no opisthotonos, only a slight stiffness at the back of the neck. Half an hour later, as I could judge, I took the same quantity of bromide, potassium and chloral—and a little time after I lost consciousness and fell into a "profound sleep," awaking in the morning with no unpleasant symptoms, no headache, &c., but a desire "to be on the move" and a slight feeling of stiffness in the jaw. These worked off during the day.Sandall, Leondard, (28 March 1896). "An Overdose of Strychnine". The Lancet, 147(3787):887.
Treatment There is no antidote for strychnine poisoning. Strychnine poisoning demands aggressive management with early control of muscle spasms, intubation for loss of airway control, toxin removal (decontamination), intravenous hydration and potentially active cooling efforts in the context of hyperthermia as well as hemodialysis in kidney failure (strychnine has not been shown to be removed by hemodialysis). Treatment involves oral administration of activated charcoal, which adsorbs strychnine within the digestive tract; unabsorbed strychnine is removed from the stomach by gastric lavage, along with tannic acid or potassium permanganate solutions to oxidize strychnine.
Activated charcoal Activated charcoal is a substance that can bind to certain toxins in the digestive tract and prevent their absorption into the bloodstream. The effectiveness of this treatment, as well as how long it is effective after ingestion, are subject to debate. According to one source, activated charcoal is only effective within one hour of poison being ingested, although the source does not regard strychnine specifically. Other sources specific to strychnine state that activated charcoal may be used after one hour of ingestion, depending on dose and type of strychnine-containing product. Therefore, other treatment options are generally favoured over activated charcoal.
The use of activated charcoal is considered dangerous in patients with tenuous airways or altered mental states.
Other treatments Most other treatment options focus on controlling the convulsions that arise from strychnine poisoning. These treatments involve keeping the patient in a quiet and darkened room, anticonvulsants such as phenobarbital or diazepam, muscle relaxants such as dantrolene, barbiturates and propofol, and chloroform or heavy doses of chloral, bromide, urethane or amyl nitrite. If a poisoned person is able to survive for 6 to 12 hours subsequent to initial dose, they have a good prognosis.
The sine qua non of strychnine toxicity is the "awake" seizure, in which tonic-clonic activity occurs but the patient is alert and oriented throughout and afterwards. Accordingly, George Harley (1829–1896) showed in 1850 that curare (wourali) was effective for the treatment of tetanus and strychnine poisoning.
Detection in biological specimens Strychnine is easily quantitated in body fluids and tissues using instrumental methods in order to confirm a diagnosis of poisoning in hospitalized victims or to assist in the forensic investigation of a case of fatal overdosage. The concentrations in blood or urine of those with symptoms are often in the 1–30 mg/L range.R. Baselt, Disposition of Toxic Drugs and Chemicals in Man, 8th edition, Biomedical Publications, Foster City, CA, 2008, pp. 1448–1450.
Strychnine toxicity in animals Strychnine poisoning in animals occurs usually from ingestion of baits designed for use against rodents (especially gophers and moles) and coyotes. Rodent baits are commonly available over-the-counter, but coyote baits are illegal in the United States. However, since 1990 in the United States most baits containing strychnine have been replaced with zinc phosphide baits. The most common domestic animal to be affected is the dog, either through accidental ingestion or intentional poisoning. The onset of symptoms is 10 to 120 minutes after ingestion. Symptoms include seizures, a "sawhorse" stance, and opisthotonus (rigid extension of all four limbs). Death is usually secondary to respiratory paralysis. Treatment is by detoxification using activated charcoal, pentobarbital for the symptoms, and artificial respiration for apnea.
In most western nations a special license is needed to use and possess strychnine for agricultural use.
Notable instances The most notable incidents which probably involved strychnine poisoning, are listed here. Alexander the Great may have been poisoned by strychnine in contaminated wine in 323 BC. Christiana Edmunds, the "Chocolate Cream Poisoner", laced chocolates with strychnine. She poisoned a number of people and murdered a four-year-old boy in Brighton in the 1870s. Emeline Meaker murdered her husband's eight-year-old half-sister Alice by lacing her drink with strychnine. As Alice convulsed from the effects of the poison, Meaker held her hand over Alice's mouth to muffle her cries until the girl was dead. Emeline Meaker was executed for Alice's murder in 1883. Margot Begemann, a friend of Vincent van Gogh, attempted suicide by ingesting strychnine in 1884. In the late 19th century, serial killer Thomas Neill Cream used strychnine to murder several prostitutes on the streets of London. Walter Horsford was hanged in 1898 for murdering his cousin with strychnine, to whom he had sent it on the pretense it was an otherwise harmless abortifacient. He was implicated in two other murders which also involved mailing it to women who suspected they were pregnant by him. Belle Gunness of La Porte, Indiana, also known as "Lady Bluebeard", allegedly used strychnine to murder some of her victims at the turn of the 20th century. Jane Stanford, co-founder of Stanford University and wife of California governor Leland Stanford, died from strychnine poisoning in 1905. Her last recorded words were "My jaws are stiff. This is a horrible death to die." Her murderer was never identified. Early 20th-century Portuguese poet and novelist Mário de Sá-Carneiro committed suicide via strychnine poisoning in 1916 aged 25. French inventor Jean-Pierre Vaquier poisoned Alfred Jones, the husband of his lover Mabel Jones, by putting strychnine in his hangover cure in Byfleet, Surrey, in 1924. Vaquier was hanged for the crime. Hubert Chevis, a lieutenant in the British Army, died in suspicious circumstances after eating partridge laced with strychnine at Blackdown Camp, Surrey, in 1931. The poisoner was never identified. Yoshio Nishimura, a prominent Japanese expatriate and president of the Japanese Association, died of strychnine poisoning shortly after arriving at police headquarters in Singapore for questioning by Special Branch in 1934. The coroner rendered an open verdict. The incident was speculated to be connected to espionage. In 1938, blues musician Robert Johnson died after drinking a bottle of whiskey which was allegedly laced with strychnine. This account of Johnson's death is disputed, as he died several days after the alleged poisoning. Oskar Dirlewanger, the commander of the SS-Sonderkommando Dirlewanger, was known to have tortured several Jewish women by stripping them naked and having them injected with strychnine. Dirlewanger and a few Wehrmacht logistic officers then watched them convulse until death. Irene Bates, mother of possible Zodiac Killer victim Cheri Jo Bates, died of strychnine poisoning in July 1969.Death certificate for Irene Margaret Bates. Registration district: 3318. Certificate number: 2234. Recorded July 8, 1969. Riverside City, Riverside County. She had been living in the city of Riverside, California. Turgut Özal, the 8th president of the Republic of Turkey, died in 1993 while in office and is theorized to have been assassinated via strychnine poisoning. In 2012, Özal's body was exhumed for testing, but the results were inconclusive.Today's Zaman, 20 June 2013, Independent expert evaluation casts doubt on Özal report In 2008, Hannes Hirtzberger, the Mayor of Spitz in Lower Austria, was reported to have been poisoned by local wine producer Helmut Osberger using strychnine. Hirtzberger barely survived and suffered permanent disability. The body of David Lytton was found on Saddleworth Moor, northwest England, in December 2015 after he consumed a lethal dose of strychnine. His identity remained a mystery until January 2017.
In culture
Strychnine has also served as an inspiration in several books, movies and TV series.
In literature In William S. Burroughs novel Naked Lunch, strychnine is described as a "hot shot", a poisonous shot of heroin sold to informants. In Anne of Green Gables Miss Cuthbert is warned against adopting an orphan girl with a story about a girl who poisoned her entire adopted family by putting strychnine in the well. In Agatha Christie's novel The Mysterious Affair at Styles, Mrs. Emily Inglethorp was killed by strychnine poisoning. In Agatha Christie's short story The Coming of Mr Quin, Mr Appleton died of strychnine poisoning. In Agatha Christie's story How Does Your Garden Grow?, Miss Amelia Barrowby was killed by strychnine poisoning.