Absorption and Elimination. - Strychnine is rapidly absorbed and slowly excreted. It is eliminated mainly by the kidneys, appearing in the urine as strychnine, and is also slightly excreted by the skin and the salivary glands. It has been detected in the urine as late as eight days after ingestion.

Metabolism. - From its marked action in increasing muscular activity metabolism is greatly hastened. Carbon dioxide is increased and there is heightened oxidation.

Temperature. - Under therapeutic doses the temperature is slightly raised, owing to increased oxidation, as shown by the increase of urea and carbon dioxide eliminated, and of oxygen taken in. During the tetanic convulsions the body temperature is markedly raised, though it is generally greatly reduced during the stage of exhaustion immediately preceding death.

Eye. -The general nervous stimulation produced by strychnine affects the mechanism of the eye; vision, as has been remarked, being rendered more acute.

Untoward Action. - Certain peculiar manifestations, having but slight resemblance, or none whatever, to the characteristic symptoms of poisoning, have followed the ingestion of small doses of strychnine, such as scarlatiniform eruption; cramps followed by perspiration, resembling in some respects the tertian type of intermittent fever; redness of the eyes; formication; a peculiar heaviness and stiffness of the limbs; persistent and painful priapism; and gastric uneasiness.

Poisoning. - As is the case with other active poisons, strychnine in lethal doses produces varying effects, dependent upon temperament, idiosyncrasy, and physiological conditions. Generally speaking, the absorption of large doses is followed by rigidity of the lower maxillary, dilatation of the pupils, increased action of the reflexes, and spasmodic and distressing muscular contraction, affecting the extensors particularly. Finally, the respiratory muscles are affected with tetanic rigidity, death resulting from asphyxia. In many cases the earliest symptoms of poisoning are restlessness and anxiety, twitching of the muscles, and stiffness of the neck. Spinal convulsions are manifested, the patient assuming the position of opisthotonos, so that he rests upon his head and his heels.

The slightest external irritation at this stage, even a movement of the bedclothes, is sufficient to cause a recurrence of convulsions. Notwithstanding these grave symptoms, the mind remains unaffected until carbonic-acid poisoning sets in, and the stomach is usually retentive. Accompanying the usual symptoms in cases of acute poisoning is the distortion of the features, which assume a ghastly grin (risus sardonicus). The action upon the genitourinary tract is quite marked, involuntary ejaculations of semen frequently taking place, together with incontinence of urine.

The earlier paroxysms attendant upon the effects of the drug are seldom fatal, but in the intervals of repose the patient's mind is oppressed with a sense of impending dissolution, intensified by each renewed access of spasm and increasing severity of pain.

Symptoms from 1/3 grain usually begin 1/2 hour after taking. Patients have been known to die from fatal dose in 15 minutes. Two hours is more often - 6 to 8 hours also. Minimum lethal dose lies between 1/2 to 1/6 grain (.030-.010 Gm.). Birds are usually immune to strychnine.

Treatment of Poisoning. - Emetics and cleansing of the stomach are naturally of the first importance. Animal charcoal and tannic acid should be freely administered, while copious anal injections containing potassium bromide and chloral are often efficacious in relieving the spasms. Chloroform may be needed. Artificial respiration is imperative, but must be continued for a long time, as the drug is so slowly eliminated.

Therapeutics. - The chief local action of strychnine is that of a bitter. There is no more efficient remedy in atonic dyspepsia than nux vomica or strychnine. Both possess all the properties of the simple bitters, besides stimulating the nerve-centers, rendering the coordination of the digestive process more perfect and enabling the stomach to respond more readily when the stimulus of food is applied to it. Small doses, 5 to 10 minims of the tincture, frequently repeated - intermitting.

The gastric catarrh of inebriates is especially benefited by this drug, which also serves a useful purpose in the vomiting of pregnancy and of phthisis.

Its tonic action upon the intestinal muscles renders it an invaluable remedy in habitual constipation, atonic diarrhea, and prolapsus of the rectum.

Strychnine is a most valuable cardiac tonic, having a marked action on the cardiac nervous system and also upon the heart-muscle. In pneumonia, typhoid fever, and other diseases accompanied by dyspnea and feeble heart-action, it is very beneficial. It is particularly valuable in failing blood-pressure. The hypodermic injection of full doses of strychnine ordinarily renders the pulse full and strong, even when it is scarcely perceptible, and death appears imminent. Many clinicians believe that they have tided pneumonic patients over the critical period by the heroic use of strychnine. The functional irregularity of the heart's action accompanying hysteria, hypochondriasis, and pregnancy is greatly relieved by moderate doses of tincture of nux vomica.

As a tonic in chlorosis and anemia strychnine is an esteemed remedy, particularly in combination with iron and arsenic.

In bronchial and neurotic asthma, as well as in many forms of neuralgia, particularly the visceral variety, the drug is an efficient remedy. In bronchitis also, and to relieve the coughs, of neurotic origin, it is of great value.

Strychnine is particularly valuable in all of the affections of the spinal-peripheral motor neuron. Anterior poliomyelitis, and the various neuritides. Lead, alcohol, tobacco, diphtheria, typhoid, grippe, pressure neuritides are much benefited by large doses.

Strychnine is exceedingly efficacious in amaurosis due to excessive use of alcohol or tobacco, being also valuable in paresis of the ocular muscle's: Night-blindness is also greatly benefited by this drug.

The weak and semiparalytic condition sometimes induced by bromides is improved by strychnine.

Hammond has obtained excellent functional results in tabes from massive doses of strychnine.

It is of undoubted merit in delirium tremens, as well as in preventing the usual effects of alcoholic intoxication; in fact, the drug is one of the best remedies in the treatment of alcoholism, the strychnine nitrate being usually employed - hypodermically. According to the best authorities on dipsomania, strychnine seems to be a true antagonist to the untoward action of alcohol, and it is probably the important constituent of the numerous "cures" for the alcohol habit.

No less valuable is strychnine in the treatment of acute poisoning by chloral, morphine, and physostigmine.

As an aphrodisiac it is of unquestioned value in functional spermatorrhea, and it is thought to produce contractions of the gravid uterus and cause abortion or premature delivery. When a predisposition to post-partum hemorrhage exists, the administration of strychnine may prove of great service.

Finally, strychnine has been highly recommended in the night-sweats of phthisis and in diabetes mellitus.

Contraindications. - Strychnine is contraindicated in acute inflammatory conditions of the spinal cord and excessive reflex irritability.

Administration. - The extract of nux vomica, the tincture, the fluidextract, or the alkaloid strychnine may be given and gradually increased. Better results are usually obtained if the drug is withheld for a time after its gradual use. The salts of strychnine are preferable to other preparations, the crude drug and its preparations varying greatly in strength, 10 minims (0.6 Cc.) of one tincture sometimes containing as large a percentage of strychnine as 20 minims (1.2 Cc.) of another.

The drug should be cautiously administered to children, the initial dose for a child five or six years of age not exceeding 1/100 grain (0.0006 Gm.).

In using strychnine hypodermically the soluble hypodermic tablets should be freshly dissolved in distilled water.

The solution of strychnine and of the other alkaloids should not be kept in stock, as they become contaminated with microscopic plants.