A CASE OF SNAKE-BITE: CURE.
By
Shih Chunder
Bhuttacharjea, L.M.S.,
Sub-Assistant Surgeon, Oraie. Kassee, a Hindu girl. 12 years old. was bitten on her left great' toe by a full-grown cobra, called by the natives kerait, at 3 p.m. 9th July 1872.?This happened while she was going to turn an ordinary flour-mill behind which the snake lay hidden from view. No effort was made by the parents to kill the animal, which was allowed to run put in their presence and enter into the rubbish heaps about the house; such deadly snakes being held sacred, and worshipped by the ignorant and superstitious Hindus, and not unfrequently cherished with milk and bread put in the holes in which they are known to lodge. The usual munturs or charms having failed to rouse the patient, she was brought to the dispensary two hours after the accident with the following symptoms:?Drowsiness and paralysis of the limbs, with incoherence of speech; eyes con-
264
THE INDIAN MEDICAL G-AZETTE.
gested; pupils widely dilated; breathing difficult, and attended with a gurgling noise in the throat; pulse full and accelerated. The bite was indicated by a livid puncture on the great toe with spots of dried blood, said to have escaped after infliction. To test the efficacy of Mr. Richardson's antidote long kept in the dispensary for trial, half a dose of the powder was administered, but it was instantly rejected with a spasmodic effort followed by foaming in the mouth ; and as human life was in question, the experiment was abandoned, and the ordinary recognized treatment adopted. A sheet of cloth was already firmly tied round above the ankle, and it was thought necessary to have the bitten part incised, and touched with strong solution of ammonia. Ordered the head to be shaved, and cold douche from a height of 3 or 4 feet to be continued for 10 or 15 minutes at a time. Ammonia) carbonas gr. v, rum ?i, as an euema every second hour. 6-30p. in. ?Is quite insensible; breathing stertorous; foaming at the mouth ; pulse depressed and small. Continue cold douche to the head ; stimulant enema; sinapism to back of neck, chest, and calves of legs. 1 a. m.?Is partially sensible ; breathing easier; pupils almost natural; conjunctiva) red; pulse feeble and frequent. Continue cold to the head; stimulant mixture by the mouth every three
hours.
10M.?Has got fever; skin hot; tongue furred and dry; thirst urgent; urine scanty and high colored ; pulse rapid and small; complains of violent throbbing; pain in the whole foot, which is swollen and tense. Ordered liquor ammonia) acet. ji, spt. ether, nitros. in xv, aqua), camphor, ji, every second hour. Milk and sago diet. 12th.?Fever not abated ; had two stcols by a dose of castoroil yesterday; pain in the foot almost the same; the swelling extends above the ankle; looks dark and inclined to slough. The dorsum and sides of the foot freely incised and dressed with carbolic acid oil and poultice. Continue mixture. Milk, sago, and soup. 13th.?Pain much less; the skin and cellular tissue from the toes to the ankle sloughing away; sole of the foot not affected, Is very low; body cool; pulse feeble and frequent; tongue covered with a thick white fur; no stool; urine free. Ordered spt. ammonia) arom. tn. xv, rum ?ss, thrice daily. Milk, sago, and kid soup frequently in small quantities. Carbolic acid oil dressing, and charcoal poultice to the sore. 17th.?Sloughs cleared off, muscles and tendons exposed; granulations springing at the edges ; pulse fair; appetite good. Ordered quinine'gr i, acid nitro-hydrochlor, dil v. and decoct, cinchon. ?i thrice daily. Continue carbolic acid oil dressing; omit poultice. Without further details, suffice it to note here, in short, that from this date the patient began to improve in general health ; the sore which was an extensive one gradually healed, and sho was pronounced cured, and discharged on the 20th August 1872 after a lengthened period of 42 days. , which shows the virulence of the poison Remarks.?This case local actions is interesting and worthy in both its immediate and of record, as it serves to illustrate some points in the pathology of snake-poisoning generally. The primary effect of the virus was depression of the nervous system, causing loss of muscular and of contractile force of the blood-vessels, ultimately leading to venous engorgement, especially of the brain and the lungs as was well indicated by hurried and difficult breathing, congestion of the eyes, dilatation of the pupils, and insensibility. The treatment of the above case in the beginning was simply with stimulant enemata, and heavy cold douche to the head; and I have every reason to believe the latter had the most beneficial effect in relieving cerebral congestion, and thu3 saving the patient from coma and impending death.
power,*
[October 1,
1873.
By
Shih Chunder
Bhuttacharjea, L.M.S.,
Sub-Assistant Surgeon, Oraie. Kassee, a Hindu girl. 12 years old. was bitten on her left great' toe by a full-grown cobra, called by the natives kerait, at 3 p.m. 9th July 1872.?This happened while she was going to turn an ordinary flour-mill behind which the snake lay hidden from view. No effort was made by the parents to kill the animal, which was allowed to run put in their presence and enter into the rubbish heaps about the house; such deadly snakes being held sacred, and worshipped by the ignorant and superstitious Hindus, and not unfrequently cherished with milk and bread put in the holes in which they are known to lodge. The usual munturs or charms having failed to rouse the patient, she was brought to the dispensary two hours after the accident with the following symptoms:?Drowsiness and paralysis of the limbs, with incoherence of speech; eyes con-
264
THE INDIAN MEDICAL G-AZETTE.
gested; pupils widely dilated; breathing difficult, and attended with a gurgling noise in the throat; pulse full and accelerated. The bite was indicated by a livid puncture on the great toe with spots of dried blood, said to have escaped after infliction. To test the efficacy of Mr. Richardson's antidote long kept in the dispensary for trial, half a dose of the powder was administered, but it was instantly rejected with a spasmodic effort followed by foaming in the mouth ; and as human life was in question, the experiment was abandoned, and the ordinary recognized treatment adopted. A sheet of cloth was already firmly tied round above the ankle, and it was thought necessary to have the bitten part incised, and touched with strong solution of ammonia. Ordered the head to be shaved, and cold douche from a height of 3 or 4 feet to be continued for 10 or 15 minutes at a time. Ammonia) carbonas gr. v, rum ?i, as an euema every second hour. 6-30p. in. ?Is quite insensible; breathing stertorous; foaming at the mouth ; pulse depressed and small. Continue cold douche to the head ; stimulant enema; sinapism to back of neck, chest, and calves of legs. 1 a. m.?Is partially sensible ; breathing easier; pupils almost natural; conjunctiva) red; pulse feeble and frequent. Continue cold to the head; stimulant mixture by the mouth every three
hours.
10M.?Has got fever; skin hot; tongue furred and dry; thirst urgent; urine scanty and high colored ; pulse rapid and small; complains of violent throbbing; pain in the whole foot, which is swollen and tense. Ordered liquor ammonia) acet. ji, spt. ether, nitros. in xv, aqua), camphor, ji, every second hour. Milk and sago diet. 12th.?Fever not abated ; had two stcols by a dose of castoroil yesterday; pain in the foot almost the same; the swelling extends above the ankle; looks dark and inclined to slough. The dorsum and sides of the foot freely incised and dressed with carbolic acid oil and poultice. Continue mixture. Milk, sago, and soup. 13th.?Pain much less; the skin and cellular tissue from the toes to the ankle sloughing away; sole of the foot not affected, Is very low; body cool; pulse feeble and frequent; tongue covered with a thick white fur; no stool; urine free. Ordered spt. ammonia) arom. tn. xv, rum ?ss, thrice daily. Milk, sago, and kid soup frequently in small quantities. Carbolic acid oil dressing, and charcoal poultice to the sore. 17th.?Sloughs cleared off, muscles and tendons exposed; granulations springing at the edges ; pulse fair; appetite good. Ordered quinine'gr i, acid nitro-hydrochlor, dil v. and decoct, cinchon. ?i thrice daily. Continue carbolic acid oil dressing; omit poultice. Without further details, suffice it to note here, in short, that from this date the patient began to improve in general health ; the sore which was an extensive one gradually healed, and sho was pronounced cured, and discharged on the 20th August 1872 after a lengthened period of 42 days. , which shows the virulence of the poison Remarks.?This case local actions is interesting and worthy in both its immediate and of record, as it serves to illustrate some points in the pathology of snake-poisoning generally. The primary effect of the virus was depression of the nervous system, causing loss of muscular and of contractile force of the blood-vessels, ultimately leading to venous engorgement, especially of the brain and the lungs as was well indicated by hurried and difficult breathing, congestion of the eyes, dilatation of the pupils, and insensibility. The treatment of the above case in the beginning was simply with stimulant enemata, and heavy cold douche to the head; and I have every reason to believe the latter had the most beneficial effect in relieving cerebral congestion, and thu3 saving the patient from coma and impending death.
power,*
[October 1,
1873.
