In India the day of the new moon (Amavasya) in the month of July is considered to be highly auspicious. Various ancient rituals are practised on that day, one of which is drinking a herbal concoction prepared from the bark of the tree Alstonia scholaris (dita bark, devil tree, pale mara) early in the morning on an empty stomach. The bark of this tree is collected fresh, well before the sunrise, and is ground up to make a herbal preparation called kashaya. This preparation is believed to cure and prevent bowel related disorders. Clinical uses of this tree have been well described in homoeopathic and ayurvedic literature.
As they usually did, six members of a family prepared kashaya, but this year making it from the bark of a relatively young tree. Within a few minutes, all of them had severe muscle spasms and started having convulsive movements. They were rushed to hospital, but the two children, aged between 6 and 8 years, were dead on arrival. The four adult members of the family were conscious but had muscle stiffness with periodic convulsive movements of the limbs and opisthotonos. The clinical picture was consistent with strychnine poisoning, and it was later confirmed that, in the dark, the family had taken the bark from Strychnos nux-vomica (strychnine tree) instead of Alstonia.
Ancient traditions and rituals tend to abound with precepts and injunctions. To modern eyes, these can seem meaningless superstition, but much ancient wisdom can be hidden amidst such rituals. This family had blindly followed the ritual of taking kashaya but had neglected to follow the golden rule, to “Select only those trees with old scars on their trunk.” This practice of selecting trees with scars on the trunk is the only sure and safe way to identify the correct tree in darkness; old scars on the trunk affirm the tree's use in the previous year. Had our patients followed this tip, identification of the right tree would not have been difficult, and the tragedy could have been averted.