of a customs peon, was brought into the dispensary at about 8-30 a.m. for treatment for

son

snake-bite.

History.?Apparently in the morning at 7 a. m. the boy tried to fetch out a certain book. As he was repairing to go to his tutor, passing over a certain collections of rags, &c.> he trampled a snake, a foot and a half long, and about the size of the little finger in thickness, of greyish or dull brown color. The reptile curled round the foot, and bit it on the part just below The relatives of the the right inner malleolus. the on a scratch made part bitten, and boy tried to burn it with burning charcoal, and applied a moderately tight ligature round the leg just below the right knee-joint. But when they found that irrespective of all their attempts the child became drowsy, they took the child to Assistant Commissioner's place ; and thence brought the child to the Hospital, and during further treatment the Assistant Commissioner was also present in the Hospital. well made, half sleepy state; no kind of irritability was noticed about Two punctures, about f inch apart were him. seen horizontally placed below the right inner The edges were black. Another malleolus. small puncture, but red in color, was seen to the Blood was inner side of the front puncture. oozing very scantily out of the scratch already made near it, and the leg was swelling out by the ligature applied. The boy could answer questions, but was drowsy, and mind not very clear, and he often complained of intense thirst, and asked frequently for water. Present

symptoms.?The boy square-built, plump, and in

was a

Treatment. First of all, in spite of the scratches made, a deep and free incision was made over the punctures; and it was not cauterized, considering that the poison had already found its way into the circulation ; so burning was here really useless. ?

Secondly.?The wound was washed and dressed with strong solution of potassium permanganate (gr, v?5ii of water).

Thirdly.?10% solution,2 drachms, in

drachms into the left arm hypodermically, but half-an-hour after such the drowsiness began to increase, and the boy felt general weakness, and his faculties more dulled. Then solution of strychnine with glycerine was injected into the other arm hypoderrnically, and this continued after each half-an-hour; and the total quantity of strychnine so injected amounted to \ a grain, and then symptoms of slight twitching appeared about the limbs and When this was discontinued, soluneck. tion of ammonia in 20 min. doses was given every 15 minutes, until the strength was fully restored, and the patient was discharged at 12-30 p.m. from the Hospital, but was treated

doses

CASE OF SNAKE-BITE. By R. P. BANERJEE, B.A., g.b.m.s.l., hledical Officer in charge, North India Salt Revenue Department Hospital, Pachbadra, Rajputana. On the morning of the 6th instant, a boy named Sadiq Hossein, Mussalman, at,. 11 years,

were

injected

Dec.

A MIRROR OP HOSPITAL PRACTICE.

1891.]

with medicine, if anything was complained of. Before bringing him to tlto Hospital?and immediately after admission in accordance with popular prejudice?some quan* tity of melted ghee was given to him to drink. home

?it

Inferences.?In

dies

were

1.

only

tried

:

this

case

four different

reme-

?

ghee was given, but this can mechanically on certain poisons in

Melted act

the stomach with which it comes into contact, find it can by no means act on virus introduced directly into the circulation; however it may act as a slight stimulant; so the remedial value of ghee so lauded by some may safely be rejected. 2. Liquor ammonia given by mouth, but in almost all cases this was tried and failed ; excepting to excite the respiration, it is of no value ns an antidote. 3. Solution of permanganate of potash ; it is not a diffusible substance, and cannot easily find its way into the circulation, and if it really possessed any good effects, it did not do so in this case, because the case changed from bad to worse, so it cannot be much relied upon. Solution of strychnine in glycerine was and this brought on a low form of the poisonous signs soon passed off, but trismus, shewing the food effects of the drug, and subsequently the boy fully recovered. 4.

injected

O

O

o"

t

Note.?The description of fche snake by the relatives and the boy himself, agreed to indicate that snake was one of the ecliidce, which are so rife down here. I cannot agree with Dr. Miiller, of Australia, to inject strychnine lotion near the puncture, because in the first place patients cannot have this remedy for some time after the wound has been inflicted. Secondly, if the poison is once introduced into the circulation, it so rapidly spreads itself, that it is quite useless to confine a certain remedy to a certain part only. In case of a bite on the foot where the circulation is usually languid, the remedy could not soon mix itself with the blood circulation. By all means it ought to be near In my the heart, the centre of circulation, as possible. hands in two cases of decided^ snake-bites, strychnine has if my professional brethren proved useful, and I promise take the trouble of experimenting with it, they will obtain \ / satisfactory results.

and?general

367

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