This
lie
the
terras
snake-bite
urgency treatment of The curative treatment
poisoning.
requires? Free incisions into all the
4.
inflamed
and the
tissues,
into these tissues of
15 per cent, solution of
a
of
potassium. Multiple injections of
permanganate 5.
into all the inflamed the
region
6.
The
the
but
regions,
of all the inof
by permanganate from half
potassium
inch to
an
an
the needle to be driven into the
tissues
just beyond the point being carried into
line of
border of the indurated
area.
The involved
permanganate
inch
healthy
demarcation, its deepest part of the
the
should be dressed
area
of lint saturated
means
in
particularly
complete surrounding
injections placed
7.
solution
same
of the wound.
volved tissues
apart,
of the
portions
thorough kneading
by
15 per cent, of
with
potassium solution.
of
Dr. Barber recommends that the permanganate of potassium should be used freely without and he has used
stint,
much
as
half drachms of the pure would not hesitate to use
one
as
and
drug diluted, four
times
a
and that
if necessary, as it seems to exert no deleterious effect either locally or generally. Stimulants should be given according to the
quantity
condition of the
diaphoretics
Laxatives, diuretics, and
pulse.
should also be administered to aid
in the elimination of the He records
poison.
and has had in all nine, single death. He began the
four,
without a treatment 24 hours after the patient was struck in the first case, 20 hours in the second case, cases
and 14 hours in the third case; and it is evident from this that the poison of the rattlesnake is
much slower in its action than that of the cobra, and gives more time for the application
SNAKE-BITES. Dr.
Barber,
of
a
rattlesnake
Wyoming, formupoisoning by the bite
Governor of
lates the treatment for as
Richards
remedy, pointed
made
was ?
and immediate cauterization; or, if this is not practicable, sucking the wound. 2. The immediate application of an intermittent for may
tourniquet,?that is, a
moment at
a
gain admission
one
time,?so
which is relaxed that the
poison
to the circulation in small
3.
The free administration of alcohol
bonate of
ammonium.
or car-
than
more
was
application 20
Vincent
Dr.
late
of little avail
of the
minutes
was
ly
.)
advocated in Australia.
Mueller,
lays
It
was
strong-
introduced
by
and received
the Editor of the who
the
bitten.
Another method of treatment has been
Dr.
remedy
after
?
patient
ment
doses.
the
for
out that it
in cobra bite if the
follows:?
Free incision to the bottom of the wound
1.
of this
strong support from Australian Medical Gazette,
down the
following principles
of treat-
:?
Endeavours should be made to eliminate the venom
previous
to its
absorption
at the incision
Oct. or
be
Neither alcohol nor ammonia should either by the mouth or beneath the
bite.
given,
skin,
by
of toxic
should not be
patient's strength
and the
exhausted ance
SNAKE-BITES.
1894.]
violent exercise. On the appearsymptoms the treatment by hypo-
dermic injections of strychnine should be begun. At least one-tenth of a grain should be in-
jected
skin,
under the
sixth if the
or even a
insensibility is very marked. be repeated in 20 minutes
successfully
The number of manner
the
coma
in which he
cases
has led other
satisfactory. three injections at another
patient,
One
woman
recovered with
intervals of 15 minutes,,? who had been taken seventy
of the arm by an Esmarch bandage; to effectual local depletion; and to the employment of
strychnia.
These were all cases of tiger-snake bite. But Hunt of Queensland reported the case of a child, aged sixteen months, who had been bitten by a death adder. Three hours previous to the treatment, immediately after the bite, the finger of
the child was cut off and the stump sucked by its relatives, who also drenched it with ammonia and applied ligatures to the arm. The child when seen was almost comatose ; the pupils were dilated and insensible to light; the pulse feeble and irregular, and the face pinched and cyanotic. One thirtieth of a grain of strychnia was injected into the arm, the ligatures removed a
Faradic current
neck and after the
spine.
applied
A second
to the nape of the
dose,
15 minutes and then the child
injected, began to improve; slight twitches occurred, the child made a perfect recovery. first,
was
boy was a symptoms
little
drowsy,
but he had
spasm and vomited.
a steamer for medical aid, and was almost comatose, recovered with a single injection. In a third case reported by Dr. Stoker, recovery was attributed by him to effective ligaturing
and
marked
practi-
miles in
full doses of
constable. The snake was a cobra of dark grey colour, 3ft. 3ins. long. The lad was brought to the Fyzabad Sudder Dispensary at 7 A.M. On ad-
treated
employed strychnia the results
were
on
The father seized the snake and dashed it some distance away, where it was killed by a police
incised, washed with a strong solution of permanganate of potassium, and a bandage was applied tightly above the ankle. Five minims of the ordinary pharmacopceial solution of strychnia were injected every five minutes with the seventh injection the boy had a tetanic
tioners to adopt it, and McDonald reports a case of snake-bite followed by intestinal haemorrhage and death, which was treated in this way without effect; but states that in two other cases
A.M.
Surgeon-Captain
Hindoo lad who was the great toe by a cobra. a
of any kind. There was no on the great toe and the a mark of the tooth skin was ecchymosed and swollen. The wound
administration should
in this
bitten at 6-30
of
case
mission the
or
until it
patient's safety.
reported
a
if
be suspenThis ded, disappears. may be renewed if the symptoms come on again, when a repetition of the remedy is required to assure the the
and
Surgeon-Major Cadge Pratt
This dose should
collapse continues and if necessary it should be repeated until the twitching of the muscles show the physiological action of strychnia, when
383
but
was
on
at
once
about half
renewed 12
a.m.
at
the
an
hour
When
drowsiness
later the
injections
came were
and between 11 and succession of severe tetanic
longer intervals, boy
had
a
spasms, when the strychnia was discontinued. At 6-30 P.M. the ligature was removed and the
patient made a good recovery. We give in another column a summary of 11 cases which have been treated by hypodermic injection of strychnine. Two were ascertained to
be srenuine cases of cobra-bite, and both recovered; half an hour had elapsed between the time of the bite and the commencement of the treat-
ment; 65 minims in 13 doses
were given in the 4 in doses in the second. minims 60 and first case which recovered cases the kind of In two other
snake
was
Russell's
maining nosis
definitely ascertained,?one being
viper,
the other
a
krait.
In the
a
re-
five which ended in recovery the diaguncertain; while in regard to the two
was
which ended in death nothing was known as to the kind of snake which had inflicted the bite, and an interval of one and-a-half and three
hours,
respectively, elapsed before the commence-
ment of the treatment. The result is undoubtedly encouraging and justifies an extensive trial.
In the Therapeutic Gazette of August 1894) we notice a communication from Dr. Mueller in which he recommends in bad cases an injection of 16 minims of the liquor strych. to be repeated after 15 minutes if the does not
improve,
and
a
continuance
(B. P.), patient5 of injec-
tions of 8 minims about every 15 minutes until, all symptoms have disappeared or until the
.
INDIAN MEDICAL GAZETTE.
384
physiological effects of the strychnine begins develop. In the worst cases one-fifth to onethird of a grain has been necessary. Dr. Mueller believes that four things are proved: 1. That strychnine acts regularly and promptly. 2. Its to
action
poison
stops entirely after a time. like the poison of fungi,
mussels develops
regularly.
4. The
sometimes remains latent in the
considerable time,
so
parently conquered start
a new course
3. The snakeof fishes
and
snake-poison
system
for
a
that, when it has been apfor a time; it may suddenly
of
symptoms.
recommended that the
It is therefore of
strychnine injections employed until unmistakable symptoms of the snake-poison are perceptible, as the pioison may act so slowly that the patient succumbs to the strychnine before the state which requires and neutralises its action has developed; and secondly, it is recommended that the patient should be watched after the disshould not
be
appearance of the last symptoms for another 24 hours in order to be able to combat in time a sudden
relapse.
[Oct.
1894.
lie
the
terras
snake-bite
urgency treatment of The curative treatment
poisoning.
requires? Free incisions into all the
4.
inflamed
and the
tissues,
into these tissues of
15 per cent, solution of
a
of
potassium. Multiple injections of
permanganate 5.
into all the inflamed the
region
6.
The
the
but
regions,
of all the inof
by permanganate from half
potassium
inch to
an
an
the needle to be driven into the
tissues
just beyond the point being carried into
line of
border of the indurated
area.
The involved
permanganate
inch
healthy
demarcation, its deepest part of the
the
should be dressed
area
of lint saturated
means
in
particularly
complete surrounding
injections placed
7.
solution
same
of the wound.
volved tissues
apart,
of the
portions
thorough kneading
by
15 per cent, of
with
potassium solution.
of
Dr. Barber recommends that the permanganate of potassium should be used freely without and he has used
stint,
much
as
half drachms of the pure would not hesitate to use
one
as
and
drug diluted, four
times
a
and that
if necessary, as it seems to exert no deleterious effect either locally or generally. Stimulants should be given according to the
quantity
condition of the
diaphoretics
Laxatives, diuretics, and
pulse.
should also be administered to aid
in the elimination of the He records
poison.
and has had in all nine, single death. He began the
four,
without a treatment 24 hours after the patient was struck in the first case, 20 hours in the second case, cases
and 14 hours in the third case; and it is evident from this that the poison of the rattlesnake is
much slower in its action than that of the cobra, and gives more time for the application
SNAKE-BITES. Dr.
Barber,
of
a
rattlesnake
Wyoming, formupoisoning by the bite
Governor of
lates the treatment for as
Richards
remedy, pointed
made
was ?
and immediate cauterization; or, if this is not practicable, sucking the wound. 2. The immediate application of an intermittent for may
tourniquet,?that is, a
moment at
a
gain admission
one
time,?so
which is relaxed that the
poison
to the circulation in small
3.
The free administration of alcohol
bonate of
ammonium.
or car-
than
more
was
application 20
Vincent
Dr.
late
of little avail
of the
minutes
was
ly
.)
advocated in Australia.
Mueller,
lays
It
was
strong-
introduced
by
and received
the Editor of the who
the
bitten.
Another method of treatment has been
Dr.
remedy
after
?
patient
ment
doses.
the
for
out that it
in cobra bite if the
follows:?
Free incision to the bottom of the wound
1.
of this
strong support from Australian Medical Gazette,
down the
following principles
of treat-
:?
Endeavours should be made to eliminate the venom
previous
to its
absorption
at the incision
Oct. or
be
Neither alcohol nor ammonia should either by the mouth or beneath the
bite.
given,
skin,
by
of toxic
should not be
patient's strength
and the
exhausted ance
SNAKE-BITES.
1894.]
violent exercise. On the appearsymptoms the treatment by hypo-
dermic injections of strychnine should be begun. At least one-tenth of a grain should be in-
jected
skin,
under the
sixth if the
or even a
insensibility is very marked. be repeated in 20 minutes
successfully
The number of manner
the
coma
in which he
cases
has led other
satisfactory. three injections at another
patient,
One
woman
recovered with
intervals of 15 minutes,,? who had been taken seventy
of the arm by an Esmarch bandage; to effectual local depletion; and to the employment of
strychnia.
These were all cases of tiger-snake bite. But Hunt of Queensland reported the case of a child, aged sixteen months, who had been bitten by a death adder. Three hours previous to the treatment, immediately after the bite, the finger of
the child was cut off and the stump sucked by its relatives, who also drenched it with ammonia and applied ligatures to the arm. The child when seen was almost comatose ; the pupils were dilated and insensible to light; the pulse feeble and irregular, and the face pinched and cyanotic. One thirtieth of a grain of strychnia was injected into the arm, the ligatures removed a
Faradic current
neck and after the
spine.
applied
A second
to the nape of the
dose,
15 minutes and then the child
injected, began to improve; slight twitches occurred, the child made a perfect recovery. first,
was
boy was a symptoms
little
drowsy,
but he had
spasm and vomited.
a steamer for medical aid, and was almost comatose, recovered with a single injection. In a third case reported by Dr. Stoker, recovery was attributed by him to effective ligaturing
and
marked
practi-
miles in
full doses of
constable. The snake was a cobra of dark grey colour, 3ft. 3ins. long. The lad was brought to the Fyzabad Sudder Dispensary at 7 A.M. On ad-
treated
employed strychnia the results
were
on
The father seized the snake and dashed it some distance away, where it was killed by a police
incised, washed with a strong solution of permanganate of potassium, and a bandage was applied tightly above the ankle. Five minims of the ordinary pharmacopceial solution of strychnia were injected every five minutes with the seventh injection the boy had a tetanic
tioners to adopt it, and McDonald reports a case of snake-bite followed by intestinal haemorrhage and death, which was treated in this way without effect; but states that in two other cases
A.M.
Surgeon-Captain
Hindoo lad who was the great toe by a cobra. a
of any kind. There was no on the great toe and the a mark of the tooth skin was ecchymosed and swollen. The wound
administration should
in this
bitten at 6-30
of
case
mission the
or
until it
patient's safety.
reported
a
if
be suspenThis ded, disappears. may be renewed if the symptoms come on again, when a repetition of the remedy is required to assure the the
and
Surgeon-Major Cadge Pratt
This dose should
collapse continues and if necessary it should be repeated until the twitching of the muscles show the physiological action of strychnia, when
383
but
was
on
at
once
about half
renewed 12
a.m.
at
the
an
hour
When
drowsiness
later the
injections
came were
and between 11 and succession of severe tetanic
longer intervals, boy
had
a
spasms, when the strychnia was discontinued. At 6-30 P.M. the ligature was removed and the
patient made a good recovery. We give in another column a summary of 11 cases which have been treated by hypodermic injection of strychnine. Two were ascertained to
be srenuine cases of cobra-bite, and both recovered; half an hour had elapsed between the time of the bite and the commencement of the treat-
ment; 65 minims in 13 doses
were given in the 4 in doses in the second. minims 60 and first case which recovered cases the kind of In two other
snake
was
Russell's
maining nosis
definitely ascertained,?one being
viper,
the other
a
krait.
In the
a
re-
five which ended in recovery the diaguncertain; while in regard to the two
was
which ended in death nothing was known as to the kind of snake which had inflicted the bite, and an interval of one and-a-half and three
hours,
respectively, elapsed before the commence-
ment of the treatment. The result is undoubtedly encouraging and justifies an extensive trial.
In the Therapeutic Gazette of August 1894) we notice a communication from Dr. Mueller in which he recommends in bad cases an injection of 16 minims of the liquor strych. to be repeated after 15 minutes if the does not
improve,
and
a
continuance
(B. P.), patient5 of injec-
tions of 8 minims about every 15 minutes until, all symptoms have disappeared or until the
.
INDIAN MEDICAL GAZETTE.
384
physiological effects of the strychnine begins develop. In the worst cases one-fifth to onethird of a grain has been necessary. Dr. Mueller believes that four things are proved: 1. That strychnine acts regularly and promptly. 2. Its to
action
poison
stops entirely after a time. like the poison of fungi,
mussels develops
regularly.
4. The
sometimes remains latent in the
considerable time,
so
parently conquered start
a new course
3. The snakeof fishes
and
snake-poison
system
for
a
that, when it has been apfor a time; it may suddenly
of
symptoms.
recommended that the
It is therefore of
strychnine injections employed until unmistakable symptoms of the snake-poison are perceptible, as the pioison may act so slowly that the patient succumbs to the strychnine before the state which requires and neutralises its action has developed; and secondly, it is recommended that the patient should be watched after the disshould not
be
appearance of the last symptoms for another 24 hours in order to be able to combat in time a sudden
relapse.
[Oct.
1894.
