form of treatment, once for all; and place before the profession our individual experiences in the treatment of this terribly fatal condition, as being our small scientific contribution towards the fathoming of this, hitherto, mystery. It is with such sentiments as the foregoing that I feel prompted to make a report of the following case, which, though incomplete iu a few minor details, is, nevertheless, none the less interesting. The facts of the case are briefly as follow :?A police recruit was admitted into the police hospital here on the eveuing of the 14th September stating that he had been, just a few minutes previously, bitten by a cobra. It appears from the statemeut made at the time ( and subsequently by the man himself to me 011 his recovery), to the Hospital Assistant that he was going his round, being at the house of the District Superintendent of Police on orderly duty at dusk, and was in the act of stepping out of the verandah on tosomegross, when suddenlyhe feltasharpprick on his left foot, and then something very quickly twining itself up his leg, he saw instantly that it was a cobra (being avery intelligent youngfellow), smd as instantly seized the reptile and threw it with force into the verandah ; he states that 110 sooner had he done this, then the reptile got up and made for him again ! but lie prudently retreated, and at once had the presence of mind to tie a ligature tightly round his leg, above his ankle, and was taken off at once to the hospital, at which he arrived within half an hour of the time of infliction of the bite. He was at once attended to by the in charge, who did the usual Assistant Hospital things, such as adjusting ligatures, incising the wound (but not nearly sufficiently enough iu tins case ),&c., states that, notwithstanding all he did,the man rapidly became comatose, and that his breathing became soon markedly affected. About this time I happened to be passing 011 my way home, and heard of the occurrence, and at once ordered the man to be brought over to my house, which was very close; at which he arrived 011 an ekka ill three minutes, and altogether about one hour and a quarter after the infliction of the bite. Here I at once tackled him. I found him almost pulseless, respiration almost completely paralyzed, only the intercostal muscles apparently were acting,and that very feebly,foamingat the mouth, pupils dilated, and quite comatose, in fact the mau was to all intents and purpose, dead : though the case appeared so desperate and hopeless I determined to try. I quickly examined the puncture a
recognized
moreover, to
% (ptitinoii of Sjoiipital ?i|acti(i}. A CASE
OF
SNAIvE-BITE?TREATMENT: RECOVERY.
By H. E.
Drake-Brockman, f.r.c.s.e., Surgn.-Capt., l.M. S., Civil SurgnMirzapur, N.- W. P. As this is a time at which the treatment of snake-bite by the administration of strychnia is still a matter more or less of experiment, it becomes incumbent upon those of us who ?-et the opportunities, which are,alas,a great deal too few, to carefully and rigidly put this treatment to the teet, and thereby confirm or reject this method, as
marks,
to
satisfy myself
that
they
were
real,
and found them present; and as they had not been freely scarified, I very quickly cut through them right down to the bone, but little or no flow of blood ensued, owing to the moribund conditiou of the man, who did not even evince the least feeling when I deeply incised the parts. I then at once gave him an hypodermic injection of l/24th of strychnia nitras in left arm, and waited 48
374
INDIAN MEDICAL GAZETTE.
the result; five minutes elapsed, and no change whatever. I at once gave him a similar quautity in the right arm hypodermically. Meanwhile, I tried in every way to iuduce respiration, but without any apparent benefit, so I decided, as the case seemed practically beyoud hope, to give him another dose, which I did 20 minutes after the last, and still kept trying to induce respiAfter the lapse, of a very ration in every way. few minutes from the last dose, to my intense satisfaction, and to the utter amazement of the crowd, which had collected at my house on hearing the news that a man was uuder treatment for cobra-bite, the patient took one or two sighing inspirations, and very soon after began to show the toxic symptoms of the drug; his respiration, with aid in other ways, began to slowly get stronger and better, but he did not seem to regain consciousness, so after a little consideration, 1 settled upon giving him yet another dose of 1 /24th grain, which I did with a most cheering result; not fiveminuteshad elapsed,when he opened his eyes, and after a dose of stimulant mixture (consisting of ammonia, ether and a little brandy iced) he spoke to, and saluted me, having recognized who I was ; and at the same time said to me how relieved he felt as regards his respiration, and that he had not recollected a single thing since he first went to the hospital, 20 minutes after being bitten ! The toxic effects of the strychnia became now very marked, besides the facial signs, his abdominal muscles had become as hard as wood, so I administered stimulants to him freely, with the hope that it would neutralize the effects of the drug somewhat, and this it did in a marked manner. The good effects of the I sat up with him treatment were maintained. till midnight, and when I saw that there were not likely to be any return of the symptoms, I left him, in the charge of a medical subordinate, for The ligatures were removed at 4 the night. A.M., that is, about 10 hours after the bite, and the man made an uninterrupted recovery. It is a matter of regret that the snake should have escaped, but as the man was unarmed at the time, even with a stick, having been bitten once, and owing to the ferocious behaviour of the reptile it could hardly be expected that he should give chase and kili it, especially as it was dusk. That this was a case ot pure snake-bite, and that of a colubrine reptile, I have not the least doubt; and from the man's description of it, its mode of attack, and its ferocity, the reptile must have been a cobra; and this conjecture is enhanced by the fact of the distance apart of the fangs as evidenced by the puncture marks. It will be noticed from the history of the case, that in all, about l/6th grain was given in the course of one
to see
hour
or
so; not
an
extraordinarily large
amount
when we take iuto account the state ot the man, when the treatment was commenced ; as it will be naturally thought, from the extremely sutldeu
and
severe
symptoms which ensued,
fNov. that
1893. a
very
fairly large amount of the venom must havo been injected at the time of the bite, and further borne out by the fact that the man had to tear the reptile off by pulling at it before it would
release its hold ! Another point of interest in this case is, that in order to derive any benefit from this treatment the administration of this drug had to be pushed till its toxic effects were well marked, as that appears to be the only way by which the toxic effects of the snake venom can be prevented from asserting themselves. This opinion is certainly supported by the facts of this case, and, as far as I can recollect, at the present moment, in those interesting cases published by SurgeonMajor Cadge at Fyzabad, and Surgeon-Captain Vaughan in Bengal, in your valuable paper a In conclusion, I hope no opporshort time ago. tunities of testing and reporting the effects of this treatment for the benefit of the profession,, as well as for that of suffering humanity, will ever be lost, till the matter is thoroughly settled one way or the other.
recognized
moreover, to
% (ptitinoii of Sjoiipital ?i|acti(i}. A CASE
OF
SNAIvE-BITE?TREATMENT: RECOVERY.
By H. E.
Drake-Brockman, f.r.c.s.e., Surgn.-Capt., l.M. S., Civil SurgnMirzapur, N.- W. P. As this is a time at which the treatment of snake-bite by the administration of strychnia is still a matter more or less of experiment, it becomes incumbent upon those of us who ?-et the opportunities, which are,alas,a great deal too few, to carefully and rigidly put this treatment to the teet, and thereby confirm or reject this method, as
marks,
to
satisfy myself
that
they
were
real,
and found them present; and as they had not been freely scarified, I very quickly cut through them right down to the bone, but little or no flow of blood ensued, owing to the moribund conditiou of the man, who did not even evince the least feeling when I deeply incised the parts. I then at once gave him an hypodermic injection of l/24th of strychnia nitras in left arm, and waited 48
374
INDIAN MEDICAL GAZETTE.
the result; five minutes elapsed, and no change whatever. I at once gave him a similar quautity in the right arm hypodermically. Meanwhile, I tried in every way to iuduce respiration, but without any apparent benefit, so I decided, as the case seemed practically beyoud hope, to give him another dose, which I did 20 minutes after the last, and still kept trying to induce respiAfter the lapse, of a very ration in every way. few minutes from the last dose, to my intense satisfaction, and to the utter amazement of the crowd, which had collected at my house on hearing the news that a man was uuder treatment for cobra-bite, the patient took one or two sighing inspirations, and very soon after began to show the toxic symptoms of the drug; his respiration, with aid in other ways, began to slowly get stronger and better, but he did not seem to regain consciousness, so after a little consideration, 1 settled upon giving him yet another dose of 1 /24th grain, which I did with a most cheering result; not fiveminuteshad elapsed,when he opened his eyes, and after a dose of stimulant mixture (consisting of ammonia, ether and a little brandy iced) he spoke to, and saluted me, having recognized who I was ; and at the same time said to me how relieved he felt as regards his respiration, and that he had not recollected a single thing since he first went to the hospital, 20 minutes after being bitten ! The toxic effects of the strychnia became now very marked, besides the facial signs, his abdominal muscles had become as hard as wood, so I administered stimulants to him freely, with the hope that it would neutralize the effects of the drug somewhat, and this it did in a marked manner. The good effects of the I sat up with him treatment were maintained. till midnight, and when I saw that there were not likely to be any return of the symptoms, I left him, in the charge of a medical subordinate, for The ligatures were removed at 4 the night. A.M., that is, about 10 hours after the bite, and the man made an uninterrupted recovery. It is a matter of regret that the snake should have escaped, but as the man was unarmed at the time, even with a stick, having been bitten once, and owing to the ferocious behaviour of the reptile it could hardly be expected that he should give chase and kili it, especially as it was dusk. That this was a case ot pure snake-bite, and that of a colubrine reptile, I have not the least doubt; and from the man's description of it, its mode of attack, and its ferocity, the reptile must have been a cobra; and this conjecture is enhanced by the fact of the distance apart of the fangs as evidenced by the puncture marks. It will be noticed from the history of the case, that in all, about l/6th grain was given in the course of one
to see
hour
or
so; not
an
extraordinarily large
amount
when we take iuto account the state ot the man, when the treatment was commenced ; as it will be naturally thought, from the extremely sutldeu
and
severe
symptoms which ensued,
fNov. that
1893. a
very
fairly large amount of the venom must havo been injected at the time of the bite, and further borne out by the fact that the man had to tear the reptile off by pulling at it before it would
release its hold ! Another point of interest in this case is, that in order to derive any benefit from this treatment the administration of this drug had to be pushed till its toxic effects were well marked, as that appears to be the only way by which the toxic effects of the snake venom can be prevented from asserting themselves. This opinion is certainly supported by the facts of this case, and, as far as I can recollect, at the present moment, in those interesting cases published by SurgeonMajor Cadge at Fyzabad, and Surgeon-Captain Vaughan in Bengal, in your valuable paper a In conclusion, I hope no opporshort time ago. tunities of testing and reporting the effects of this treatment for the benefit of the profession,, as well as for that of suffering humanity, will ever be lost, till the matter is thoroughly settled one way or the other.
