SERPENT WOUNDS AND THEIR TREATMENT
Every summer outdoor America leaves the heat and dust and turmoil of
the city for the peace and quiet of the wild. Doubtless many persons
penetrate, in their outing, regions where venomous serpents abound.
These will carry as a part of their equipment remedies intended for the
relief of wounds inflicted by these. Many of these remedies will be
absolutely valueless for the purpose intended, and many more will fail
from lack of intelligent application. A brief discussion of serpents
and the approved methods of treating their wounds may prove of interest
at this time.
Permit me to state at the outset that such information as may be
contained in this chapter is not the result of conjecture and
guesswork, but is derived from over twenty-five years study of
reptilian zoölogy, many years investigation in the laboratory, during
which time an extended series of experiments were carried out, and
twelve years' actual practice, in which all of the methods that have
suggested from time to time have been thoroughly tested.
There are, roughly speaking, something like twenty-eight varieties
of venomous reptiles in the United States. These figures include the
one lizard that is known to be poisonous and the several scorpions.
Of this number the rattlesnakes comprise at least eighteen. In fact,
so important are they that all others may be included in a discussion
of the crotalidæ; more particularly so as all serpent venoms act
chemically in the same manner.
Man is unreasoningly afraid of snakes. It is rare, indeed, that a
person concerns himself with the classification of the serpent that
chances to cross his path. He immediately possesses himself of a stout
club and proceeds to maul the unoffending reptile into the earth
without troubling his mind to find out if the snake is harmless or
otherwise. This is wrong, for when one comes to know them serpents
are quite interesting. It is wrong, too, for with a little study the
ordinary man can familiarize himself with the characteristic markings
of the venomous serpents and differentiate them from those that are
non-venomous.
All the deadly snakes, with the exception of the little harlequin snake
of the extreme South, are similarly marked and all belong to the class
of "pit" vipers, characterized by a depression or "pit" back of the
nostril. The head is triangular, with massive muscular development of
the jaw; the neck slender in proportion to the size of the head and
body. The body itself is quite thick, the skin rough. The pupil of the
eye is elliptical instead of being round as in the non-venomous snakes.
The harmless varieties, on the other hand, are long and slender, the
skin smooth and shining, the head oval or round. If in doubt after the
above, the investigator can pin his subject to the ground with a forked
stick placed just back of the head and examine the teeth. If he finds,
hanging from the upper jaw, or inclined forward from it, two fangs,
long and sharp as needles, he can be pretty safe in assuming that his
subject is poisonous. The non-venomous snakes have a dentition very
much the same as some of the smaller rodents, the mice for instance.
The habitat frequently furnishes a key to the character of the snake.
The venomous varieties choose by preference the rocky uplands, either
open or sparsely wooded. The harmless snakes live almost exclusively
in low swampy lands or along water courses. Venomous snakes are purely
terrestrial. One was never known to ascend a tree. In fact it is
impossible for one to do so.
While rattlesnakes are dangerous, their bite is not nearly so fatal as
is popularly supposed. This fact has at least two important reasons,
viz., season and the habits of life of the snake. In the extreme South
and in midsummer the venom attains its highest state of virulence.
Then the person fairly struck by a large rattler is in extreme danger,
provided the second factor in the equation does not intrude, that is,
the habits of life.
All venomous snakes, and more especially rattlesnakes, are sluggish.
They do not move rapidly or over great distances. Their lethal power
is given them as a means of procuring food and when once the snake
strikes he expends practically all the ammunition in his arsenal. It
requires hours and perhaps days to renew the supply, during which time
the serpent is defenseless. Should the human victim happen along at
such time and be bitten it is quite probable that he would not receive
a fatal dose of the poison.
The manner in which the rattlesnake inflicts his wound is worthy of
some study. In the first place, it may be assumed as axiomatic that the
snake cannot strike farther than his own length and seldom even that.
Stories of rattlesnakes lifting themselves from the ground bodily and
hurling themselves through the air are purely imaginative. Nor can
the snake strike unless coiled. It does not follow that he must be
in complete coil, but he must have at least a few kinks in his spine
before he can deliver a blow; then he can only strike the length of the
kinks.
If permitted he will assume full coil before striking and when
undisturbed he lies in that position. The maneuver of assuming full
coil takes longer than is generally thought. Writers who assert that
the snake can throw himself into full coil instantly are far from the
truth. In fact it takes, on an average, something like five seconds
for him to get his length in position to deliver his most powerful
blow. My experiments have developed another interesting fact, that the
snake cannot strike an object held directly over his head. It must be
held at an angle.
How deep will the needle-sharp fangs penetrate. That depends, too, upon
conditions. A large snake, striking from full coil, will naturally
drive his fangs much deeper than another smaller, striking from a less
advantageous position. Upon the bare flesh the snake will sink his
fangs to their full extent. His blow, however, is often delivered with
a raking motion and the wound inflicted resembles the scratch of a
briar.
Certain articles of dress are less permeable than others. Rubber, even
thin rubber, is wellnigh impenetrable. Soft, closely woven cloth is
also resistent. In experiments I have placed blotting paper behind two
thicknesses of heavy flannel and only in rare instances have I found
the virus staining the paper. This fact will serve to inform the reader
that the ordinary protection of the lower limbs will be adequate to
shield the wearer in a rattlesnake country.
The chances of being bitten, even in a country abounding in snakes,
are really quite insignificant. The rattler is the most inoffensive
gentleman of my serpentine acquaintance. He is perfectly willing,
if you will permit him, to lie all day basking in the sun upon some
convenient rock and never molest the passer in the least. If he has
sufficient warning he will slip quietly out of your path and give you
the right of way. He only strikes when in his reptilian mind he deems
himself insulted or in danger.
An extended discussion of the chemistry of serpent venoms would be
manifestly out of place at this time. We owe practically all our
knowledge upon the subject to the painstaking efforts of two men, S.
Weir Mitchell and Prof. Reichert. These gentlemen gave to the world
almost simultaneously the result of their labors. The lethal principle
of all serpent venoms consists of two elements, a venom peptone and a
venom globulin.
These elements are albuminoid in character, and it is interesting
to note that they act no differently from the pure albuminoses of
digestion. One element has the power to destroy the fibrin ferment in
the blood, the other acts as a paralyzant upon motor and sensory nerve
trunks.
Time has no effect apparently upon the poisonous quality of these
venoms. After twenty years' preservation in glycerine Dr. Mitchell
found the virus as active as ever, and it is known that arrows steeped
in rattlesnake venom retain their power for many years. Heat in varying
degrees, or a sudden violent application of it, will destroy the
poisonous property, as will also absolute alcohol.
The action of the virus on the animal economy is interesting and
worthy of study. When taken into the circulation the symptoms are
quite characteristic and not easily mistaken, even by the man of no
scientific training. This is well, as the wound itself is insignificant
and might be overlooked. In fact, I have known many persons to be
bitten and not know it until the symptoms apprised them of the fact.
A stinging, burning pain radiates from the wound and the wound itself
becomes inflamed and angry. Swelling comes on, the heart action is
immediately accelerated, and the respiration hurried. In a short time,
as the virus penetrates deeper into the systemic circulation, the heat
and respiratory symptoms change, the heart slows down, the respiration
decreases, the face becomes dusky and anxious, covered with profuse
perspiration, and the mind grows dull. Blindness, due to the effect
upon the optic nerve, takes place.
The patient staggers as he walks, and soon, unless relief comes, he
will become totally paralyzed. Spots of blood appear just beneath
the skin and especially upon the limb bitten. If the amount of the
virus is sufficient to produce death, all the above symptoms are soon
followed by tetanic convulsions and lockjaw. If, however, the dose is
not sufficient to produce death, they gradually subside, leaving the
patient much debilitated and subject to poisoned blood states that
manifest themselves in the form of skin eruptions and ulcers.
The reader will appreciate that in the above has been pictured an
extreme case. Nothing like nearly all cases bitten present even half
the symptoms described. Statistics reveal that only something like 12
per cent. of all persons bitten by the New World venomous serpents die
from their wounds.
Before passing to a consideration of the means for combating a poison
let us pause for a time and glance at the probabilities of being struck
even in a country where venomous serpents abound. The "rim rock" of
the Columbia River in Washington and Oregon is an ideal place for
rattlesnakes and they abound there in profusion.
Children run barefoot all summer among the basaltic rocks, and but
few of them are bitten. Haymakers fork them up with the haycocks,
harvesters find them beneath the bundles of bound grain, still it is
rare to hear of an accident. Among the "brakes" of the Clearwater in
Idaho the great "timber" rattler dwells. The Indians never molest him,
yet during my nine years' sojourn among them only seven cases appeared,
and two of these were very young children.
Still, people are bitten, and the location of the wound has much to do
with the chances of recovery. About 60 per cent. of all persons wounded
are struck on the lower limbs, thirty-five on the hand or arm, and
five on the trunk and face. Of these, wounds on the lower limbs are
the least dangerous and those on the trunk or face, being near large
nerve and arterial vessels, most so. The more remote from the general
circulation, the less danger from the wound.
The treatment of a rattlesnake wound resolves itself into the
application of a few very simple rules. In the first place a person
wounded by a snake usually does the very thing he should not do—that
is, goes tearing off at top speed for the nearest human habitation,
thereby increasing the circulation and disseminating the virus through
the system more rapidly. The man should sit calmly down and bind his
handkerchief around the limb (if it is a limb), break off a stout twig
and insert beneath the handkerchief, producing a rude tourniquet, and
twist until the circulation is effectually shut off.
With a sharp knife make an X incision over the wound, taking care to
penetrate deeper than the fangs have done. If he has good teeth and no
canker in his mouth, he may now suck vigorously upon the wound. It does
no good to suck the original wound. It is quite difficult to get any
virus back through an opening not greater in caliber than a fine needle.
If all this is done without delay, the chances are that the patient
will suffer no great inconvenience from his experience. If he chances
to have handy a stick of silver nitrate he can cauterize the wound
thoroughly. Failing that, a brand from the fire will serve. After a
time he may release his tourniquet somewhat and permit a portion of
the retained blood to enter the circulation; the system is capable of
taking care of a great deal of poison if it is allowed to flow into the
blood gradually.
If, however, the virus has been permitted to enter the circulation at
once the case is one calling for radical measures. In this connection
it is well to state that alcoholics defeat the end required. The
time-honored belief in the efficacy of whiskey in the treatment of
rattlesnake bites is pernicious in the extreme. Alcohol, like serpent
venom, has two effects, the later or depressant effect being exactly
the same as the depressant effect of the venom itself. Therefore the
man who recovers from a rattlesnake wound after drinking a large
quantity of whiskey does so in spite of his remedy, not with its aid.
The one sovereign remedy in these cases is strychnia, and no man should
penetrate a snake country without having this valuable adjunct with
him. The administration of strychnia is not so difficult but that any
man of ordinary intelligence can inform himself about it in a short
time. It is a powerful alkaloid, of course, and must be applied with
intelligence to accomplish the end desired. How much to administer will
depend upon the person and the character of the wound.
It must be taken into consideration that the system already poisoned
by the venom will tolerate a larger quantity than one in a normal
condition. The average dose of strychnia hypodermically applied is 1/30
of a grain. This may be increased to say 1/15 grain without any serious
danger. A person suffering from rattlesnake venom will bear without
danger perhaps 1/2 grain or even more.
It will be understood that this amount is not to be thrown into the
blood all at one dose, but spread out over an interval of thirty
minutes. Strychnia has its most important field in the treatment of
these cases after the depressant effect of the venom has taken place.
The rule then should be to administer until the heart approximates
the normal. The patient can take too much, then again he can take too
little.
Chemical antidotes directed against the venom of serpents are
extremely problematical. It is questionable if there is at present
any chemical that will exert more than an antiseptic effect upon the
virus. Permanganate of potassium may possess the property of setting
up a chemical reaction, but if so it is so prone to deteriorate when
in solution and requires so much time to place in solution that it is
nearly valueless.
Ammonia applied to certain of the less dangerous venoms is efficacious.
Applied to crotalus poison it is of no use. In fact, when the matter
is reduced to its lowest terms, the whole process of combating the
effect of serpent venoms is comprised in what has been stated above.
Restrict the circulation, destroy the virus by heat either chemically
or by fire, and keep up the vital forces. Very few Indian tribes have
any suggestion of a remedy for rattlesnake poison. The Moquis probably
have, though if so no white man has ever been able to extract the
secret from them. It is known that during the Moqui Snake Dance many
Indians are bitten and none of them die. It might be inferred then that
they do possess an effective antidote.
In conclusion permit me to suggest an equipment for the treatment
of rattlesnake wounds and briefly outline its uses. Procure a
rubber ribbon about four feet long, technically known as an Esmarch
tourniquet—this ribbon can be rolled into a compact form and is very
elastic—; a sharp surgeon's knife known as a bistoury which should
be securely wrapped in absorbent cotton; a blue bottle, or one about
which several thicknesses of blue paper have been wrapped, containing a
stick of silver nitrate; another bottle containing one hundred tablets
of strychnia sulphate gr. 1/30; an all-metal hypodermic syringe for
administering the same.
All these should be placed in an oiled silk bag and kept in a
convenient pocket. The bag should be changed when the clothing is
changed just the same as the watch or compass.
Now for their use: Let us suppose that you have encountered a rattler
and are not too scared to know what you are doing. You quietly sit
down, expose the limb, locate the wound, get out your Esmarch and
beginning at one end wrap it securely about the limb _above_ the wound,
gradually increasing the tension until the rubber sinks into the skin.
This done, take your knife and make a deep X over the wound, using
the cotton in which the knife was wrapped to sponge away the blood.
Encourage free bleeding. If you are near a stream bathe the wound
freely, either squeezing or sucking it. You need not fear to swallow
the poison. It will do no harm in the stomach. After the wound has bled
freely, take the stick of silver nitrate and burn it out quite to the
bottom. All of this will hurt, of course, but it is necessary.
The administration of the strychnia will follow next in order only if
the depressant symptoms of the venom indicate its need. Should the
patient feel the approach of the dizziness that is the beginning of the
stage of paralysis, he should then think about his strychnia. Dissolve
one of the tablets in warm water and fill the barrel of the syringe;
screw on the needle, first removing the fine wire that runs through it.
Plunge the needle into the fleshy part of the arm at an angle of about
ten degrees from the horizontal and push home the plunger. Repeat this
every fifteen minutes until the heart Has returned to the normal.
These directions closely followed will save every case of rattlesnake
bite, and in many instances the patient will not require the strychnia
at all. The wound made by the knife will require the same general
treatment as any other simple wound.
THE CAMPER'S MEDICINE CHEST
THE CAMPER'S MEDICINE CHEST
_Surgical Supplies_
One instrument roll, 80 cents.
One paper medium size safety pins, 10 cents.
One paper medium size common pins, 5 cents.
One-half dozen assorted gauze bandage, size one-to three-inch; 10 cents
each.
Two yards sterilized plain gauze in carton, 20 cents yard.
Four ounces sterilized absorbent cotton in carton, 20 cents.
One roll three-inch adhesive plaster, $1.
One-fourth dozen silk ligature braided, in glass tube fitted with half
curved needles, 30 cents a tube.
One card braided silk ligature, assorted on one card (white), about 30
cents.
One-half dozen assorted egg-eyed surgeon's needles, half to full curve,
50 cents.
One ounce Squibb's surgical powder, 50 cents oz.; or a like amount of
camphophenique powder, $1.
One hundred Bernay's antiseptic tablets (blue), 25 cents.
Two five-inch hemostatic forceps (Kelly's), about $1 each.
One pair straight, sharp-pointed surgeon's shears, about $1.25.
One needle holder (Emmet's), $2.50.
One splinter forcep, may be used also for dressing forcep. This forcep
should neither have mouse tooth jaws nor serrated jaws, and should run
to a fine point; 50 cents.
One hypodermic syringe, all metal, in metal case, $1.50.
One one-minute clinical thermometer in metal case; will cost about
$1.25, according to reliability. The best registered instrument is
cheapest.
One number 9 soft rubber catheter, 25 cents.
One cake surgical soap, in metal box, 75 cents.
The above will comprise practically everything that may be found
absolutely necessary. With them the ingenious man can perform
practically every minor surgical operation that he would care to
undertake. If he cares for a more elaborate outfit he may add the
following:
One yard oiled silk, in tube, 75 cents.
One pure rubber fountain syringe, $1.75.
Four ounces creolin, in metal screw-cap bottle, 25 cents oz.
One or more first aid packages at 50 cents per package.
One emergency tourniquet, $1.25.
Eight ounces carron oil for burns, 25 cents oz.
The size of the surgical outfit will depend, of course, upon the size
of the party. The dressings and things that will be destroyed will
necessarily have to be increased in proportion to the number of the
party.
_Medical Stores_
The suggestions here will be based upon a party of four staying one
month.
In the case with the hypodermic place one tube strychnia sulphate, gr.
1/30, price 20 cents. Use as a powerful stimulant hypodermically one
tablet every four hours, if needed, watching the action of the heart
carefully. One tube cocaine muriate, gr. 1/4, price 50 cents. Use as a
local anesthetic as suggested in chapter on surgery and for toothache.
Can be used to control vomiting—one tablet followed by swallow of hot
water every four hours, if needed. Solution of one tablet in spoonful
of hot water dropped in eye to deaden so as to remove foreign bodies.
One tube morphine sulphate, gr. 1/4, and atropine sulphate, gr. 1/100,
combined, price 25 cents. Use as a sedative for pain, one tablet
hypodermically repeated every two hours to effect; digitalin, gr.
1/100, price 25 cents. Use as heart stimulant where action of heart is
deranged, one tablet not oftener than thrice daily. One tube apomorphia
hydrochlorate, gr. 1/10, price 50 cents. Use to induce vomiting in
cases of poisoning, one tablet hypodermically only. One tube glonoin,
gr. 1/100, price 15 cents. Use as heart stimulant in shock and great
depression due to cerebral anemia; not in loss of blood, however.
One sole leather medicine case with screw-cap glass bottles, numbers
etched on bottles, price from $1 to $3, according to style and finish.
Book to slip in pocket for keeping list of remedies and their
therapeutic application, cost 25 cents.
The bottles filled as follows: The numbering need not adhere strictly
to that here given:
No. 1. Aconitine gr. 1/134. 200 at 25 cents per C. Use in cases of high
fever where heart is full and bounding and there is great congestion
as shown by headache, backache, etc. Use in beginning of all colds.
Take in all cases one tablet every fifteen minutes for an hour then
one tablet every two hours, or better still take every half hour until
pulse becomes soft and surface of skin is moist.
No. 2. Dosimetric Trinity No. 1. 200 at 50 cents per C. One tablet
every half hour to effect. The effect will be to reduce all fevers
much the same as above except that it may be continued over a longer
time and becomes a routine treatment in typhoid, pneumonia, grippe,
bronchitis, rheumatic fever, and in all cases of fever where the heart
seems to need a slight stimulation.
No. 3. Intestinal antiseptic. 500 at 50 cents per C. One tablet
every three hours as routine treatment in typhoid, diarrhea, colic,
dysentery, and all disordered fermentative conditions of the intestinal
tract.
No. 4. Quinine sulphate, gr. 5, either in tablet or capsule form, cost
about 10 cents a dozen; take 100. Use in malaria, one tablet every
four hours during attack and not less than fifteen grains daily as a
preventative. In decidedly malarial countries this amount will have to
be taken daily, consequently the amount carried should be materially
increased. Is somewhat valuable in colds, bronchitis, etc.
No. 5. Sun Cholera. 100 at 50 cents per C. One tablet every four hours
in cases of watery diarrhea, after bowels have been cleaned out by
purgative. Of use also in colic, flatulence, intestinal pain.
No. 6. Chlorodyne. 100 at $1.00 per C. Take one tablet every two or
three hours in extreme pain, vomiting from fermentative processes,
summer diarrhea, etc.
No. 7. Calomel, gr. 1/4. 200 at 10 cents per C. Use one tablet every
thirty minutes or every hour for eight doses, in all cases where bowels
need thorough cleaning out. As beginning treatment in all cases of
fever, vomiting, diarrhea, in fact about everything that happens.
No. 8. Phenacetine, gr. 5. 100 at 50 cents per C. One tablet every
four hours to reduce fever as in colds, some forms of dysentery, and
in severe headache. To be discarded when case bids fair to become
prolonged.
No. 9. Elaterin, gr. 1/16. 25 at one cent each. Use one tablet only
where it is necessary to secure an immediate watery passage from the
bowels in order to sweep out offending masses.
No. 10. Dover's powder, gr. 5. 100 at 50 cents per C. Use one tablet
every four hours in sudden acute colds. Its most valuable field is
in the colds and bronchitis of children. Continue until perspiration
ensues.
In case the medicine case holds more than ten bottles the additional
bottles may be filled with brown mixture, 100 at 25 cents per C.
One tablet every four hours to one three times a day in cases of
indigestion, flatulence, "sour stomach," etc.
Headache tablet consisting of acetanilid, sodium salicylate, ammonium
bromide. A choice tablet to be given every four hours where persons are
subject to congestive headaches. The least objectionable of all the
"coal tar" tablets. These may be had at about 25 cents per dozen, and
the case should contain at least 100 of them.
Tonsilitis tablet consisting of menthol, thymol, phenol, potash,
chlorate, and sodium chloride. Take 200 at about 25 cents per 100.
Use as a gargle in tonsilitis, sore throat, and pharyngitis. Dissolve
tablet in half pint hot water and gargle several times a day.
It will be noted that in the above unnumbered list aconitine and
Dover's powder have been substituted for apomorphia hydrochlorate
and digitalin recommended in Chapter III. Either list is good, and
will be found comprehensive for all ordinary emergencies.
THE END
* * * * *
Transcriber's note:
Italics is represented with _underscores_ and small caps with ALL CAPS.
Ambiguous hyphens at the ends of lines were retained. The following
corrections have been made:
p. 15 it is unnecsary -> unnecsary changed to unnecessary
p. 46 cavity as it probably has) -> added opening bracket (as it
probably has)
p. 99 sodium salycilate -> salycilate changed to salicylate
Everything else (including inconsistent hyphenation and archaic
spelling) has been retained as printed.