The effects of strychnine usually appear rapidly, within ten to fifteen minutes. As with most poisoning cases, the victim appears to be well and in good health, and then suddenly falls ill following the eating or drinking of something or the taking of a preparation or medication. Within minutes the victim will complain of stiffness, often in the back of the neck. Tremor and twitching start, followed by convulsions. Occasionally there is only one massive convulsion before death, but usually there are five or more. They are painful and last about a minute, and the contortions of the body are extreme. The body is arched as the muscles contract excessively, so much so that the head may touch the heels (as in the case of one of Palmer's victims). The muscles that control breathing are also affected and may stop, leading to temporary asphyxia. After each convulsion there is a relaxation period of about fifteen minutes during which the victim is not only exhausted but terrified, as strychnine causes heightened awareness. Stimulation of the senses can precipitate a convulsion and so treatment involves keeping the patient in a darkened room, sedated, and sometimes even under anaesthesia. This may not be available quickly enough, however, as death may occur after five or so convulsions. The effects can be reduced by removing some of the strychnine from the stomach by washing it out, if the patient is lightly anaesthetized.
Detection of poisoning relies on toxicological analysis—detection of strychnine in the body—which is possible for a long time after death, for which there are methods available. There are often no signs at postmortem other than possible signs of asphyxia. The jaw is sometimes twisted by muscular contraction to give the victim's mouth what appears to be a sardonic grin at the time of death. For further details and the way in which strychnine works, see pp. 155-6.
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