A CASE OF
SNAKE-BITE.
By W. J. Moore, L.R.C.r., Surgeon, Rajpootana Political Agency. As with most ailments not readily curable, empirical treatment and pseudo-specifics have been applied, to a very great extent, in the condition resulting from the bites of poisonous snakes. To enumerate all the substances which have from time to time been imposed on the credulity of mankind as remedies, would indeed be an endless task. The ancient physi-
preparations of the serpent itself. Both Seneca Pliny inform us that human saliva was believed to be a powerful remedy. A great variety of vegetables have been celebrated, the principal one being the nagliawullee ramentce, or ophirrhiza In Australia mungos, called by Sir "William Jones chandraca. the root of the common male fern, polypodium filiic mas, has long been used as a secret cure.* Waringf gives a list, of fifty-five plants, of reputed efficacy in snake-bites. The famous Tanjore pill contains several vegetable materials, among others croton oil. The people of Scinde use a mixture of various vegetable substances, into the composition of which chopp3d onions enter largely. Among minerals, the oxides of metals have been especially reputed, under the idea that the poison of serpents acts upon the blood by attracting oxygen, cians extolled
and
*
Underwood on"Snate-bite." Brathwaite's
1859. " f Waring on Medical Plants of India." January 7th, 1862.
Retrospect,page
370, July
JIadras 2Iedical Journal,
THE. INDIAN MEDICAL GAZETTE.
104
upon -which the vitality of that fluid depends. Fontana, the Italian naturalist, conceived he had found a specific in nitrate of silver. Arsenic is a component part of the Tanjore pill ahove
mentioned.* This mineral has also been strongly recommended given alone, or in the form of " Fowler's solution."+ A stimulating treatment has long been practised. The outward
application of eau de luce, and a quantity of warm madeira taken inwardly, were stated ty Forbes J to be generally" effectual in curing the bite of the most venomous snake." After the fatal case of cobra bite occurring in the Zoological Gardens in London, 1852, much discussion on the subject ensued, the result being a general concord, that scarifications, suction of the wound, if possible a tight ligature, combined with every means to combat torpor, ought to form the bases of treatment. More recently the ligature, incisions, sucking the wound, cupping-glass, washing the wound with liquor ammonia, cauterization with nitrate of silver, with butter of antimony, or with red-hot iron, and the internal administration of eau de luce and brandy, were the remedial agencies recommended by Gunther.? It has also been proposed to maintain the flagging powers of the heart and circulatory system by enforced exercise. It i3 stated that Dr. Spilsbury, formerly Physician General, Calcutta, tied a man bitten by a snake behind his buggy, making the man run several miles. The narrator|| remarks:?"This man's life was doubtless saved by maintaining, by continuous and forced exercise, the action of the heart and lungs, and thus preventing the paralysing influence of the poison on those organs, at the same time causing the skin to act so profusely as to make it the eliminating channel for discharging the poison from the system." As in poisoning by opium, a certain amount of exercise, not to fatigue, but to combat torpor, would appear desirable. Dr. Hood observes :?"So long as we maintain the action of the heart and lungs, the patient cannot die." "
"
It will at once be admitted that none of the methods of treat-
enumerated present anything really specific. And yet, persons have recovered after all, as indeed after the use of various nostrums, thus affording the latter an undeserved reputation. And the explanation is that, from one or more of the causes afterwards referred to, such patients did not receive
ment
undoubtedly,
system a fatal amount of the poison. But doubtless the tendency to death has been frequently stayed by action based on the only rational principles of treatment, viz., destruction or removal of the poison, support by stimulation, and prevention of torpor. I believe the chances of recovery from snake-bite, notwithstanding the rapid absorption of the poison, will be materially increased by the immediate application of some liquid escharotic agent to the wound. And the following case is a striking ininto their
stance of the correctness of the above remark. Some months back I was called up in the night
to
a
case
of
cut-throat, and, on returning, had put the candle out and lain down, when the puggee or chokedar in the outer verandah called out that he was bitten by a snake. The candle and matches being on a chair by the bedside, I was with the man in half a minute, only delaying to strike a match and light the candle. When passing the dressing table, my eye caught a' bottle of fuming nitric acid used the previous day for some chemical process, and snatching this up, a drop was applied, and by manipulation caused to pass into the wound within at least forty seconds after the injury. The leg above the ankle was the part bitten, presenting two small marks, the usual indication *
"
Russel on the Serpents of India," Vol. I, p. 67. t "VVeston. Lancet, May 21st, 1859. Oriental J Memoirs, Vol. I, p. 45. ? Reptiles of British India, p. 168. on Hood the "Treatment of |j Poisoning by the Cobra." Lancet, February 15th, 1808.
[Mat 1,
18GS.
of which a little blood a venomous snake,* from one oozed. It appeared that the man, lying in the outer verandah, stretched his leg, and placed it upon the snake ; on feeling which, he immediately struck at the reptile with his stick. The serpent, of
cobra, nearly three feet long, was found close by, with broken back, and must have been thus injured at the very moment of inflicting the bite. On being bitten, the man had assumed the erect posture, but immediately sat down again. After applying the acid and a ligature above, the general condition was examined. Although so short a period had elapsed, the pulse was feeble and intermittent, the countenance anxious, and the whole appearance suggesting both syncope and fright. A glass of brandy was immediately administered, and in the course of five minutes liquor ammonia. During two hours, faintness, sickness, sighing respiration, feeble, quick intermittent pulse,caused anxiety regarding the result, after which a satisfactory reaction occurred, but some days elapsed before the man thoroughly recovered. The acid caused a slight sore, which rapidly healed; but there was no swelling, tenderness, or discoloration, either about the part or in the neighbouring glands. From the days of Virgilf it has been matter of observation that the same serpent possesses very different degrees of venomous
a
power at various seasons of the that* snakes are more savage and
year.
It is
also
stated
dangerous in the hot part of the day.J The temperament, state of health, and bulk of the person bitten, and the question if the snake had shortly before bitten something else, are, moreover, all matters affecting the result. But as the man whose case is detailed was injured by a cobra, without the intervention of clothing, as he was of averit may be reasonage strength, and in fair health, I think that his life was saved by the immediate applithat concluded ably cation of the nitric acid, consequent on the accident of this powerful agont being at hand. Professor Halford, of Melbourne, states, as the result of recent investigations, that when u person is bitten by the cobra, molecules of living germinal matter are thrown into the wound, speedily grow into cells, and as rapidly multiply; so that, in the course of a few hours, millions upon millions are produced at the expense, as Dr. Halford believes, of the oxygen of the blood. Hence the gradual decrease and ultimate extinction of combustion, and chemical change in various parts of the system, with the consequent cold, sleepiness, and insensibility. However this may be, the immediats introduction into the wound of some escharotic, more searching and powerful than nitrate of silver, causing destruction of the poison before it can all be absorbed, is doubtless the only " specific" treatment,?a fact which, to prevent recourse to worse than useless nostrums, cannot be too widely known. It would also appear essential, that the agent applied should be a fluid which will easily gravitate to the bottom of the wound. Although Fontana has shown that
a mixture of nitrate of silver and venom desthe power of the latter, it does not follow that a similar effect would be produced by the application of caustic to a
troys
bitten part. However firmiy on the surface, and as its
applied, nitrate of silver only acts corroding action, equally with other escharotics, stays the flow of blood, it appears as likely to do harm by the latter action as the reverse by its chemical power. And these remarks are equally applicable to all other solid escharotics, not excepting the actual cautery. ? * When there are more than two that the snake is not venomous.
t Georg., lib. iii. ? II Mr. Moore would make
marks, it may be safely assumed
J Gunther, Reptiles of British India. some experiments with cobras, similar lo what are being made by Dr. Fayrer in Calcutta, he would be a valuable coadjutor in the field of enquiry. We should be glad to have Dr. Francis' statements corroborated, moreover. Again* is the condition of the blood, after the bite of a cobra, uniformly such as Mr. Halford describes ii ? Cobras used to abound in our time in llajpootana : and we imagine that our author would have abundant opportunities fur instituting a series uf interesting experiments.?tu., I. Si, Ct>
SNAKE-BITE.
By W. J. Moore, L.R.C.r., Surgeon, Rajpootana Political Agency. As with most ailments not readily curable, empirical treatment and pseudo-specifics have been applied, to a very great extent, in the condition resulting from the bites of poisonous snakes. To enumerate all the substances which have from time to time been imposed on the credulity of mankind as remedies, would indeed be an endless task. The ancient physi-
preparations of the serpent itself. Both Seneca Pliny inform us that human saliva was believed to be a powerful remedy. A great variety of vegetables have been celebrated, the principal one being the nagliawullee ramentce, or ophirrhiza In Australia mungos, called by Sir "William Jones chandraca. the root of the common male fern, polypodium filiic mas, has long been used as a secret cure.* Waringf gives a list, of fifty-five plants, of reputed efficacy in snake-bites. The famous Tanjore pill contains several vegetable materials, among others croton oil. The people of Scinde use a mixture of various vegetable substances, into the composition of which chopp3d onions enter largely. Among minerals, the oxides of metals have been especially reputed, under the idea that the poison of serpents acts upon the blood by attracting oxygen, cians extolled
and
*
Underwood on"Snate-bite." Brathwaite's
1859. " f Waring on Medical Plants of India." January 7th, 1862.
Retrospect,page
370, July
JIadras 2Iedical Journal,
THE. INDIAN MEDICAL GAZETTE.
104
upon -which the vitality of that fluid depends. Fontana, the Italian naturalist, conceived he had found a specific in nitrate of silver. Arsenic is a component part of the Tanjore pill ahove
mentioned.* This mineral has also been strongly recommended given alone, or in the form of " Fowler's solution."+ A stimulating treatment has long been practised. The outward
application of eau de luce, and a quantity of warm madeira taken inwardly, were stated ty Forbes J to be generally" effectual in curing the bite of the most venomous snake." After the fatal case of cobra bite occurring in the Zoological Gardens in London, 1852, much discussion on the subject ensued, the result being a general concord, that scarifications, suction of the wound, if possible a tight ligature, combined with every means to combat torpor, ought to form the bases of treatment. More recently the ligature, incisions, sucking the wound, cupping-glass, washing the wound with liquor ammonia, cauterization with nitrate of silver, with butter of antimony, or with red-hot iron, and the internal administration of eau de luce and brandy, were the remedial agencies recommended by Gunther.? It has also been proposed to maintain the flagging powers of the heart and circulatory system by enforced exercise. It i3 stated that Dr. Spilsbury, formerly Physician General, Calcutta, tied a man bitten by a snake behind his buggy, making the man run several miles. The narrator|| remarks:?"This man's life was doubtless saved by maintaining, by continuous and forced exercise, the action of the heart and lungs, and thus preventing the paralysing influence of the poison on those organs, at the same time causing the skin to act so profusely as to make it the eliminating channel for discharging the poison from the system." As in poisoning by opium, a certain amount of exercise, not to fatigue, but to combat torpor, would appear desirable. Dr. Hood observes :?"So long as we maintain the action of the heart and lungs, the patient cannot die." "
"
It will at once be admitted that none of the methods of treat-
enumerated present anything really specific. And yet, persons have recovered after all, as indeed after the use of various nostrums, thus affording the latter an undeserved reputation. And the explanation is that, from one or more of the causes afterwards referred to, such patients did not receive
ment
undoubtedly,
system a fatal amount of the poison. But doubtless the tendency to death has been frequently stayed by action based on the only rational principles of treatment, viz., destruction or removal of the poison, support by stimulation, and prevention of torpor. I believe the chances of recovery from snake-bite, notwithstanding the rapid absorption of the poison, will be materially increased by the immediate application of some liquid escharotic agent to the wound. And the following case is a striking ininto their
stance of the correctness of the above remark. Some months back I was called up in the night
to
a
case
of
cut-throat, and, on returning, had put the candle out and lain down, when the puggee or chokedar in the outer verandah called out that he was bitten by a snake. The candle and matches being on a chair by the bedside, I was with the man in half a minute, only delaying to strike a match and light the candle. When passing the dressing table, my eye caught a' bottle of fuming nitric acid used the previous day for some chemical process, and snatching this up, a drop was applied, and by manipulation caused to pass into the wound within at least forty seconds after the injury. The leg above the ankle was the part bitten, presenting two small marks, the usual indication *
"
Russel on the Serpents of India," Vol. I, p. 67. t "VVeston. Lancet, May 21st, 1859. Oriental J Memoirs, Vol. I, p. 45. ? Reptiles of British India, p. 168. on Hood the "Treatment of |j Poisoning by the Cobra." Lancet, February 15th, 1808.
[Mat 1,
18GS.
of which a little blood a venomous snake,* from one oozed. It appeared that the man, lying in the outer verandah, stretched his leg, and placed it upon the snake ; on feeling which, he immediately struck at the reptile with his stick. The serpent, of
cobra, nearly three feet long, was found close by, with broken back, and must have been thus injured at the very moment of inflicting the bite. On being bitten, the man had assumed the erect posture, but immediately sat down again. After applying the acid and a ligature above, the general condition was examined. Although so short a period had elapsed, the pulse was feeble and intermittent, the countenance anxious, and the whole appearance suggesting both syncope and fright. A glass of brandy was immediately administered, and in the course of five minutes liquor ammonia. During two hours, faintness, sickness, sighing respiration, feeble, quick intermittent pulse,caused anxiety regarding the result, after which a satisfactory reaction occurred, but some days elapsed before the man thoroughly recovered. The acid caused a slight sore, which rapidly healed; but there was no swelling, tenderness, or discoloration, either about the part or in the neighbouring glands. From the days of Virgilf it has been matter of observation that the same serpent possesses very different degrees of venomous
a
power at various seasons of the that* snakes are more savage and
year.
It is
also
stated
dangerous in the hot part of the day.J The temperament, state of health, and bulk of the person bitten, and the question if the snake had shortly before bitten something else, are, moreover, all matters affecting the result. But as the man whose case is detailed was injured by a cobra, without the intervention of clothing, as he was of averit may be reasonage strength, and in fair health, I think that his life was saved by the immediate applithat concluded ably cation of the nitric acid, consequent on the accident of this powerful agont being at hand. Professor Halford, of Melbourne, states, as the result of recent investigations, that when u person is bitten by the cobra, molecules of living germinal matter are thrown into the wound, speedily grow into cells, and as rapidly multiply; so that, in the course of a few hours, millions upon millions are produced at the expense, as Dr. Halford believes, of the oxygen of the blood. Hence the gradual decrease and ultimate extinction of combustion, and chemical change in various parts of the system, with the consequent cold, sleepiness, and insensibility. However this may be, the immediats introduction into the wound of some escharotic, more searching and powerful than nitrate of silver, causing destruction of the poison before it can all be absorbed, is doubtless the only " specific" treatment,?a fact which, to prevent recourse to worse than useless nostrums, cannot be too widely known. It would also appear essential, that the agent applied should be a fluid which will easily gravitate to the bottom of the wound. Although Fontana has shown that
a mixture of nitrate of silver and venom desthe power of the latter, it does not follow that a similar effect would be produced by the application of caustic to a
troys
bitten part. However firmiy on the surface, and as its
applied, nitrate of silver only acts corroding action, equally with other escharotics, stays the flow of blood, it appears as likely to do harm by the latter action as the reverse by its chemical power. And these remarks are equally applicable to all other solid escharotics, not excepting the actual cautery. ? * When there are more than two that the snake is not venomous.
t Georg., lib. iii. ? II Mr. Moore would make
marks, it may be safely assumed
J Gunther, Reptiles of British India. some experiments with cobras, similar lo what are being made by Dr. Fayrer in Calcutta, he would be a valuable coadjutor in the field of enquiry. We should be glad to have Dr. Francis' statements corroborated, moreover. Again* is the condition of the blood, after the bite of a cobra, uniformly such as Mr. Halford describes ii ? Cobras used to abound in our time in llajpootana : and we imagine that our author would have abundant opportunities fur instituting a series uf interesting experiments.?tu., I. Si, Ct>
