This section is from the book "A Treatise On Therapeutics, And Pharmacology Or Materia Medica Vol1", by George B. Wood. Also available from Amazon: Part 1 and Part 2.
Treatment of Poisoning. The most important point of treatment in poisoning from nux vomica, bean of St. Ignatius, or any of their preparations, is to empty the stomach as speedily and as thoroughly as possible. An active and prompt emetic should be administered immediately. Sulphate of zinc, tartar emetic, or ipecacuanha may be given severally or combined; and their influence may be aided, if necessary, by powdered mustard. During the spasmodic paroxysms, it is usually impossible for the patient to swallow, and the jaws are often so firmly closed that medicines cannot be readily introduced into the mouth; but relaxation in general takes place in a short time, and the opportunity thus afforded should be instantly seized for the exhibition of the emetic Should it be impracticable to introduce the medicine into the mouth, it might possibly be injected through a catheter or other small tube inserted into one of the nostrils. When the stomach pump can be employed, it should be brought in aid of the emetic, so as thoroughly to wash out the poison; but it should not be relied on to the exclusion of the latter remedy, which has often proved efficient, I have been informed of a case in which, after the strongest emetics had been taken without effect, a current of electricity directed through the body at the epigastrium was-quiekly followed by vomiting, probably in consequence of the susceptibility of the stomach being aroused by the measure. The patient was saved. Unfortunately there is no antidote to strychnia which has thus far been sufficiently tried to be confidently relied on; yet the experiments of Dr. Garrod with animal charcoal would seem to prove, that the power which this substance has of absorbing the vegetable alkaloids, and even of separating them from their combinations, may be made available in obviating the poisonous effects of strychnia, if brought into contact with it in the stomach before enough has been absorbed to cause death. In these experiments of Dr. Garrod, when strychnia previously mixed with animal charcoal was administered to animals, they were not in the least affected by it; and a case is recorded by Mr. W. Chippendale, in which, an hour after four grains of strychnia had been taken, three or four ounces of animal charcoal, mixed with water, were injected by means of the stomach-pump, and the stomach thoroughly washed out, with the effect of saving the life of the patient, which appeared to be in imminent danger. (Lond. Med. Times and Gaz., April, 1855, p. 423.) Other sub-stances have been proposed as antidotes, on the ground that they render strychnia insoluble; but none has sufficient experience in its favour to justify a reliance on it. For an account of them the reader is referred to the U. S. Dispensatory (12th ed., p. 1356.) Among them is tannic acid, which Prof. Kurzak infers, from experiments on dogs, to be an excellent antidote, requiring, however, to be given in very large proportion, at least from 20 to 25 times as much as of the poison taken. (Am. J. of Med. Sci., Jan. 1863, p. 258.) Perhaps the best emetic would be sulphate of zinc or tartar emetic, in connection with ipecacuanha.
But the evacuation of the stomach will not obviate the effects of the portion of the poison absorbed. For this purpose medicines must be resorted to calculated to diminish irritation of the spinal nervous centres. Opium, conium, camphor, chloroform, ether, and alcohol have been employed, and each with asserted advantage. Considerable doses are required; as the susceptibility to the narcotic influence seems to be diminished, as in tetanus, by the violence of the nervous derangement. One of these medicines, or some combination of them should be exhibited after the stomach has been emptied; and they may even be exhib-ited by the rectum during the use of emetic measures, with the exception perhaps of opium, which might tend to retard or prevent vomiting. In the Boston Medical and Surgical Journal (li. 476), Dr. J. II. Tewks-bury, of Portland, Maine, records two cases in which camphor appears to have been employed successfully without other measures, two flui-drachms of the saturated tincture having been given by the stomach in one case; while in the other, in which the patient could not swallow, the same preparation was injected into the rectum, and the patient at the same time immersed in a warm camphor bath. It is probable, however, that, in these cases, the camphor merely moderated symptoms which would not have proved fatal; for Dr. J. E. Thompson, in repeated experiments with dogs, found that the tincture of camphor was quite unavailing to obviate the fatal effects of the poison. (Ibid., liii. 163.) Subsequently, however, Prof. Rochester, of Buffalo, N. Y., has reported two successful cases, in which he ascribes the result to the camphor used.
(Buffalo Med. Journ., March, 1850.) In the Medical and Surgical Reporter (Nov. 18, 1865, p. 339), a case is recorded in which severe poisoning from strychnia yielded to half a pint of strong gin, exhibited in divided, but quickly repeated doses. Dr. Dresbach, of Tiffin, Ohio, relates a case in the Western Lancet for February, 1850, in which the most alarming symptoms, caused by swallowing three grains of strychnia, were completely relieved in fifteen minutes by two drachms of chloroform administered by the mouth Within a few years, inhalation of chloroform has been much used in poisoning by this alkaloid, and with encouraging success; many cases having recovered under its use. It very much relieves the pain and spasm, and to a considerable extent counteracts the effects of the poison, often preventing a fatal issue, until time has been allowed for the elimination of the strychnia by the kidneys. It should never be permitted to supersede the evacuation of the stomach by emetics or the stomach-pump, or the use of any substance which may be supposed to act as a proper antidote to the strychnia. The inhalation of ether, however, would be preferable, if found to produce the same effect, as it is not liable, like chloroform, to act as a fatal poison. Tobacco has also been employed with supposed success. The infusion should be given by enema. One instance, however, is recorded, in which it was exhibited by the stomach, so as to produce excessive vomiting, and with complete success. (Braithwaite's Retrospect, No. 4G, p. 185.) M. CI. Bernard recommends the use of woorari, which, besides contributing to relieve the spasms, favours the elimination of the poison by its stimulant influence on the various emunctories, especially the kidneys. (Arch. Gen., A out, 1865, p. 203.) Aconite also is thought to be antagonistic to strychnia, and has acted successfully as an antidote in experiments on dogs. (Dr. Woaks, British Med. Journ., Oct. 26, 1861, quoted in Am. J. of Med. Set., Jan. 1862, p. 276).