July
1895.]
ELLIOTT ON THE DANGERS OF STRYCHNINE IN SNAKE-BITE.
THE DANGERS OF STRYCHNINE IN SNAKE-BITE. By Subgn.-Capt. It. H.
Elliott,
Professor of Biology, Madras Medical College. IT has been constantly urgeci Dy uie advocates of the strychnine treatment of snake-bite that their remedy is not only efficacious but also absolutely safe. With the inefficacy of strychnine in true cases of snake-bite, I have dealt fully elsewhere. At the same time I pointed out what a grave danger the abuse (I used the word where others would prefer to say use) of the alkaloid was to those who were not really snake-poisoned though they believed themselves so to be. Further, by induction from my experience with animals, I stated my belief that the reputed antidote would prove a source of danger to the truly .
snake-poisoned.
Indications of this danger were afforded by the recorded by Surgn.-Capt. H. Smith, Surgn. Capt. Drake-Brockman, Surgn. Lieut. Col.Waller Barrow, Surgn.-Capt. S. G. Prall, Brig.Surgn.-Lieut.-Col. J. Sargent and G. S. Krislinaswami Iyer, while Surgn.-Maj. Cadge and Surgn.-Capt. Pratt openly state that they nearly lost their patient by strychnisation. All the above cases have been noticed in my paper entitled "Is Stiychnine an Antidote to Cobra-poison ? which was reprinted in the columns of the Indian Medical Gazette. A still stronger argument is, however, afforded by the two cases which I now send you. They were communicated to the Surg.-General with the Government of Madras, and by his courtesy I am allowed to publish them, which I will do without further comment at present. cases
-
-
Snake-bite treated with Strychnine.? Treated by Civil Apoth. P. Muthuswamy, at L. F. Hospital, Tirunamamalai. Reported to Surgeon-General with Government of Madras, by Surgeon-Lieutenant.-Colonel H. Hyde, of Cuddfilore. Naramba Naiker?Bite inflicted at midnight on 13th August 1894 whilst patient was lying asleep in his house. Snake killed ; described as The patient a canaya viryan or deadly snake. was bled and dosed by native practitioners. Hospital Assistant saw patient first at 11-30 a.m. on 14th August 1894 about 12 hours after bite. 11-35 A.M.?Injection of liquor strychnine m. v (gr. TV) in left arm.
of patient.?On left ear two small half inch apart covered with blood. punctures General.?Drowsiness. Loss of power over extremities. Skin cold and clammy ; pulse feeble. slow and sobbing. Pupils slightly Condition
Respiration
dilated. Conjunctivse irritated tion of native remedies.
by local applica-
11-52 A.M.?No slower.
259
improvement; pulse feeble. Injection of liquor strychnine
Breathing m. v.
12-8 p.m.?Pulse feebler and irregular Breathing stertorous; 11 respirations per minute, Injection of liquor strychnine m. viii. 12-24 p.m.
?
?
?
?
getting
m.
v.?Patient
worse.
12-30 P.M.?Patient died. These notes were carefully abstracted by me from the Hospital Assistant's statement of the case. As his description was not considered very satisfactory, the Hospital Assistant was asked to state (1) whether he considered that the symptoms noted were due to snake-poison or to native treatment; and (2) whether he was of opinion that the remedy (strychnine) which he used hastened death. He replied as follows:?I beg to report that from what I now remember about the case, the patient was drowsy, and there was slight salivation also. The symptoms noted by me at the spot were, I believe, due to the snake-poison. After the fourth injection of strychnine, twitches were observed, and I believe the death of the patient might have been hastened by the same. J
(Sd.) is
S.
MUTHUSWAMY, Civil
Apothecary.
in the
The next case given reporter's own words. Minutes of a snake-bite case treated with Dr. A. Mueller's antidote at the L. F. Dispensary of Tirupporur during the year 1894 :?
boy of ten years old named Sigaman, of Tirupporur, was brought early in the morning this day, the 2nd October 1894, at 5-50, the father of the boy who brought him on his back complaining that he was suffering from snake-bite. On enquiry, the lad's father stated that he (the A
up from his bed all in a sudden at about 4-30 A.M. asking for a drink of water, as he felt dry about the throat, and that he, after having the drink, said that he felt oppression at the chest, and, as if something had bitten him at the foot; no snake was detected in the house. On examination a scratch was found on the second toe of his right foot. He appeared drowsy, with eyelids closed. On making him stand, he When questioned loudly was found to totter. he, with difficulty, answered that there was giddiness and loss of vision. Pupils rather dilated. Pulse small and feeble; breathing slow, and extremities cold. Treatment.?As he was able to swallow, m. v of liquor strychnine in ? oz. of water was given at once by mouth. He was found during 10 minutes' time after this dose to be getting more drowsy, motionless, and not able to anSo m. v of liquor strychnine swer questions. in left deltoid was injected hypodermically region. No signs of improvement;
lad) got
boy utterly
INDIAN MEDICAL GAZETTE.
260
unconscious.
jection,
m.
Fifteen minutes after tlie first in-
vii
injected, and again m. vii after 15 No improvement; breathing became
minutes. very slow and shallow, convulsions set the boy died soon after.
(Sd.) In this
in,
and
ARMOOGA NAIDU, 2nd Class
Hosptl.
Asst.
the symptoms pointed strongly to snake-poison, but the convulsions that ushered in death were so unusual that the reporter was case
asked?
(1) Whether the convulsions were in his opinion due to strychnine, and (2) Why local treatment was neglected. His reply is clear, reliable, and very instructive.
I give it in his
own
words:?
YI. 424
E?S- No' 28^957 No. 35. L. F.
Dispensary, Tirupporur. February 1895. '
26th From
The Hospital Assistant, L. F. Dispensary, Tirupporur. To The District Medical
and
Chingleput District.
Sanitary Officer,
Sir,?"With reference to your No. 26 of 22nd February 1895 ?which is herewith returned with other papers, I beg to state that the convulsions noted in the case appeared to be due to strychnine. The convulsions were not feeble but rather tetanic, though they did not last
long
before death.
2. Local treatment was not adopted, as strychnine treatment was tried with confidence, and, moreover, the lad was brought to me not immediately after the bite but about 80 minutes after the appearance of symptoms of poison. 3. As characteristic symptoms of snake-poison were present in the case with the presence of a clear scratch in the foot, a diagnostic incision over the seat of scratch was not thought of. Besides, there was no swelling at the seat of bite to indicate at least the necessity of incision. I beg, &c.,
(Sd.)
C. ARUMUKHA
NAYAKAR,
2nd Class
No. 346, Asst.
Hosptl.
VII. 424 No.
28-2-95.
to the Secretary to Surgeon-General with the Government of Madras with reference to his No. 1345 dated 18th February 1895.
Forwarded
(Sd.)
Chingleput, ) %h\d March 1895. )
H. A. F. NAILER, Dist.
M.B., Surgeon-Major, Medl. & Santy. Officer.
These selves.
cases
[July appear to
me
to
speak
1895.
for them-
In the second at least there was good evidence of snake-poisoning. The point which I would draw attention is that whether the symptoms were due to snake-poison ol* not, strychnine seems to have hastened the deaths of both patients. It will be hard for the advocates of this alkaloid to tell us in future that it is at least a harmless remedy. Will other observers come forward in the candid way as these Hospital Assistants have done and place their failures 011 record? If they will do so, we shall soon have heard the ' other side of the so-called Australian Antidote.'
same
)
/
1895.]
ELLIOTT ON THE DANGERS OF STRYCHNINE IN SNAKE-BITE.
THE DANGERS OF STRYCHNINE IN SNAKE-BITE. By Subgn.-Capt. It. H.
Elliott,
Professor of Biology, Madras Medical College. IT has been constantly urgeci Dy uie advocates of the strychnine treatment of snake-bite that their remedy is not only efficacious but also absolutely safe. With the inefficacy of strychnine in true cases of snake-bite, I have dealt fully elsewhere. At the same time I pointed out what a grave danger the abuse (I used the word where others would prefer to say use) of the alkaloid was to those who were not really snake-poisoned though they believed themselves so to be. Further, by induction from my experience with animals, I stated my belief that the reputed antidote would prove a source of danger to the truly .
snake-poisoned.
Indications of this danger were afforded by the recorded by Surgn.-Capt. H. Smith, Surgn. Capt. Drake-Brockman, Surgn. Lieut. Col.Waller Barrow, Surgn.-Capt. S. G. Prall, Brig.Surgn.-Lieut.-Col. J. Sargent and G. S. Krislinaswami Iyer, while Surgn.-Maj. Cadge and Surgn.-Capt. Pratt openly state that they nearly lost their patient by strychnisation. All the above cases have been noticed in my paper entitled "Is Stiychnine an Antidote to Cobra-poison ? which was reprinted in the columns of the Indian Medical Gazette. A still stronger argument is, however, afforded by the two cases which I now send you. They were communicated to the Surg.-General with the Government of Madras, and by his courtesy I am allowed to publish them, which I will do without further comment at present. cases
-
-
Snake-bite treated with Strychnine.? Treated by Civil Apoth. P. Muthuswamy, at L. F. Hospital, Tirunamamalai. Reported to Surgeon-General with Government of Madras, by Surgeon-Lieutenant.-Colonel H. Hyde, of Cuddfilore. Naramba Naiker?Bite inflicted at midnight on 13th August 1894 whilst patient was lying asleep in his house. Snake killed ; described as The patient a canaya viryan or deadly snake. was bled and dosed by native practitioners. Hospital Assistant saw patient first at 11-30 a.m. on 14th August 1894 about 12 hours after bite. 11-35 A.M.?Injection of liquor strychnine m. v (gr. TV) in left arm.
of patient.?On left ear two small half inch apart covered with blood. punctures General.?Drowsiness. Loss of power over extremities. Skin cold and clammy ; pulse feeble. slow and sobbing. Pupils slightly Condition
Respiration
dilated. Conjunctivse irritated tion of native remedies.
by local applica-
11-52 A.M.?No slower.
259
improvement; pulse feeble. Injection of liquor strychnine
Breathing m. v.
12-8 p.m.?Pulse feebler and irregular Breathing stertorous; 11 respirations per minute, Injection of liquor strychnine m. viii. 12-24 p.m.
?
?
?
?
getting
m.
v.?Patient
worse.
12-30 P.M.?Patient died. These notes were carefully abstracted by me from the Hospital Assistant's statement of the case. As his description was not considered very satisfactory, the Hospital Assistant was asked to state (1) whether he considered that the symptoms noted were due to snake-poison or to native treatment; and (2) whether he was of opinion that the remedy (strychnine) which he used hastened death. He replied as follows:?I beg to report that from what I now remember about the case, the patient was drowsy, and there was slight salivation also. The symptoms noted by me at the spot were, I believe, due to the snake-poison. After the fourth injection of strychnine, twitches were observed, and I believe the death of the patient might have been hastened by the same. J
(Sd.) is
S.
MUTHUSWAMY, Civil
Apothecary.
in the
The next case given reporter's own words. Minutes of a snake-bite case treated with Dr. A. Mueller's antidote at the L. F. Dispensary of Tirupporur during the year 1894 :?
boy of ten years old named Sigaman, of Tirupporur, was brought early in the morning this day, the 2nd October 1894, at 5-50, the father of the boy who brought him on his back complaining that he was suffering from snake-bite. On enquiry, the lad's father stated that he (the A
up from his bed all in a sudden at about 4-30 A.M. asking for a drink of water, as he felt dry about the throat, and that he, after having the drink, said that he felt oppression at the chest, and, as if something had bitten him at the foot; no snake was detected in the house. On examination a scratch was found on the second toe of his right foot. He appeared drowsy, with eyelids closed. On making him stand, he When questioned loudly was found to totter. he, with difficulty, answered that there was giddiness and loss of vision. Pupils rather dilated. Pulse small and feeble; breathing slow, and extremities cold. Treatment.?As he was able to swallow, m. v of liquor strychnine in ? oz. of water was given at once by mouth. He was found during 10 minutes' time after this dose to be getting more drowsy, motionless, and not able to anSo m. v of liquor strychnine swer questions. in left deltoid was injected hypodermically region. No signs of improvement;
lad) got
boy utterly
INDIAN MEDICAL GAZETTE.
260
unconscious.
jection,
m.
Fifteen minutes after tlie first in-
vii
injected, and again m. vii after 15 No improvement; breathing became
minutes. very slow and shallow, convulsions set the boy died soon after.
(Sd.) In this
in,
and
ARMOOGA NAIDU, 2nd Class
Hosptl.
Asst.
the symptoms pointed strongly to snake-poison, but the convulsions that ushered in death were so unusual that the reporter was case
asked?
(1) Whether the convulsions were in his opinion due to strychnine, and (2) Why local treatment was neglected. His reply is clear, reliable, and very instructive.
I give it in his
own
words:?
YI. 424
E?S- No' 28^957 No. 35. L. F.
Dispensary, Tirupporur. February 1895. '
26th From
The Hospital Assistant, L. F. Dispensary, Tirupporur. To The District Medical
and
Chingleput District.
Sanitary Officer,
Sir,?"With reference to your No. 26 of 22nd February 1895 ?which is herewith returned with other papers, I beg to state that the convulsions noted in the case appeared to be due to strychnine. The convulsions were not feeble but rather tetanic, though they did not last
long
before death.
2. Local treatment was not adopted, as strychnine treatment was tried with confidence, and, moreover, the lad was brought to me not immediately after the bite but about 80 minutes after the appearance of symptoms of poison. 3. As characteristic symptoms of snake-poison were present in the case with the presence of a clear scratch in the foot, a diagnostic incision over the seat of scratch was not thought of. Besides, there was no swelling at the seat of bite to indicate at least the necessity of incision. I beg, &c.,
(Sd.)
C. ARUMUKHA
NAYAKAR,
2nd Class
No. 346, Asst.
Hosptl.
VII. 424 No.
28-2-95.
to the Secretary to Surgeon-General with the Government of Madras with reference to his No. 1345 dated 18th February 1895.
Forwarded
(Sd.)
Chingleput, ) %h\d March 1895. )
H. A. F. NAILER, Dist.
M.B., Surgeon-Major, Medl. & Santy. Officer.
These selves.
cases
[July appear to
me
to
speak
1895.
for them-
In the second at least there was good evidence of snake-poisoning. The point which I would draw attention is that whether the symptoms were due to snake-poison ol* not, strychnine seems to have hastened the deaths of both patients. It will be hard for the advocates of this alkaloid to tell us in future that it is at least a harmless remedy. Will other observers come forward in the candid way as these Hospital Assistants have done and place their failures 011 record? If they will do so, we shall soon have heard the ' other side of the so-called Australian Antidote.'
same
)
/
