Consciousness, in the immense majority of cases, is preserved to the last. If, as in Mrs. Dove, insensibility occurs, it is due to the exhaustion. In this trial Dr. Christison said “it is unusual to be insensible before death from strychnia.” Farquharson (Therapeutics, p. 264) states that “the cerebral functions remain unimpaired almost up to the close.” This is agreed to by all authorities.
The symptoms of strychnia poisoning have been explained away by the defence as “hysteria,” “idiopathic tetanus,” “epileptic convulsions with tetanic complications” (Dr. Macdonald in Palmer’s trial), “angina pectoris” (Dr. Richardson), “apoplexy” (Dr. Bamford’s certificate). Gritty granules on the spinal cord, sexual or other excitement, cold and damp, drink, &c., were in that trial assigned as causes. As to “gritty granules,” the expression is not clear; such granules as occurred in Cook have been found in many _post-mortems_, where they certainly did not cause the death. Sexual excitement was out of the question in this case. Drink does not cause tetanus. The cold and damp were hardly sufficient reasons, as no symptoms of chill were noticed. Apoplexy is distinct, as in this the _brain_ would show the disease.
_Hysteria_, _epilepsy_, and _idiopathic tetanus_ (tetanus which is “constitutional,” or not occasioned by external injury) produce in some cases insensibility; strychnia, as a rule, does not. They are also _continuous_ in symptoms. _Traumatic tetanus_ is caused by a wound or injury, rarely by ulcers or syphilitic sores (see p. 113). If there be none of these it cannot, of course, be traumatic tetanus. _Hysteria_ is exceedingly variable, and simulates many other diseases: it is generally the result of excitement. But it does not produce opisthotonos. _Epilepsy_ has never such symptoms as strychnia occasions: it rarely supervenes without some history of hereditary tendency, and it is always attended by unconsciousness (p. 151). _Idiopathic tetanus_ may occur from a cold (see a case of Dr. Todd’s, Lond. Med. Gaz., Nov., 1850), or from no assignable cause. It is very close to strychnia in symptoms, but the latter is much more rapid: the shortest recorded fatal period for natural tetanus being twelve hours —“even here the early symptoms had been probably overlooked”—Sir B. Brodie), the usual about eight days. In both kinds of tetanus the jaw is usually the _first_, in strychnia the _last_ part to be affected. _Angina pectoris_ Dr. Richardson himself disposed of, as in the case he mentions he says that had he known more at the time he would have suspected strychnia (see Palmer’s trial, p. 176). The symptoms of this disease, as given in the leading works, differ much from strychnia poisoning.