_only two years old_, bitten by a death adder on fourth finger of
left hand, the snake found clinging to finger. Ligature applied
and finger chopped off, but condition of child very precarious
when admitted to Toowoomba Hospital, after a night's journey, at
daylight, in complete collapse. Pronounced out of danger by Dr.
Hunt, the house-surgeon, at 10.30 and taken home in the afternoon.
Notes not furnished.
CASE 14.--Reported by Dr. Pain, of Allora, Queensland. Symptoms
serious. Four injections of m. xv., x., viii. and vii.
CASE 15.--Reported by Dr. Garde, of Maryborough, Queensland, girl
of 13 years, bitten by brown snake, requiring only two injections
of m. xv. and x.
CASE 16.--Reported by Dr. St. George Queely, of Maytown,
Queensland, lad of 19 years, bitten by black snake, symptoms
serious. Four injections of m. xv., xv., xx., and xv., total 65
minims of liq. strych. P.B. injected within less than two hours,
muscular spasms appearing after last injection. Patient made rapid
recovery, riding home, a distance of 16 miles, within a few hours
after treatment.
CASE 17.--Reported by Dr. Ray, of Seymour, severe bite of a tiger
snake. Within six hours 4/5th of a grain administered
subcutaneously, besides a considerable quantity given by the
mouth. Patient made a good recovery. "Every injection after the
second one," Dr. Ray reports, "having a distinct effect within
three or four minutes, and lasting from one to one and a half
hours before tendency to coma returned."
CASE 18.--Very remarkable. Read by Dr. Forbes, medical officer of
hospital, Charters Towers, Queensland, before the North Queensland
Medical Society. Boy, 6 years old, was admitted to hospital at 9
p.m. on 27th October, 1890, bitten on foot by a death adder, which
was killed and identified. Dr. Forbes reports: When seen by me,
two hours after the accident, he was sitting on his mother's knee
with his head hanging on one side, but quite conscious, and
answering questions rationally, pupils widely dilated with almost
no reaction to light, pulse very fast and soft, &c. Thinking his
condition might be due to fear I hesitated to use strychnine. So,
ordering strong coffee, I hurried to attend an accident case just
admitted with severe haemorrhage, and left the boy in charge of a
nurse, with orders to call me at once if she saw any change. I had
scarcely been away 15 minutes when the father rushed in saying his
boy was dead, and indeed his statement seemed but too true. The
child was lying quite limp, face blue, eyes half shut, extremities
very cold, no pulse perceptible, no respiration visible. I at once
injected m. x. of liq. strychniae P.B. and made artificial
respiration. He soon began to improve, and in about 20 minutes was
able to speak. He was watched all night, but suffered no relapse,
and was discharged on the next day.
CASES 19 TO 21, reported by Dr. Weekes, of Lithgow, N.S.W. Dr.
Weekes writes:--"Within the last year I have had three cases under
my care, all bitten by black snakes, and all in about the same
place, on the outside of the calf of the leg. The patients were
all comatose, exhibiting all the usual symptoms of
snakebite-poisoning, and in one, my last case, _the patient had
convulsions_. In all of them I made hypodermic injections of m.
xv. liq. strych., and the effects were most marked, the patients
being completely roused and becoming quite sensible and rational
each time," &c.
CASE 22.--Mrs. Ryan, of Oberon, N.S.W., bitten on leg by tiger
snake, comatose and nearly pulseless after three hours, treated by
Dr. Kingsburry, amount of strychnine not stated.
CASE 23.--Benjamin Childs, bitten on finger by death adder,
treated by Dr. Campbell, of Grafton, N.S.W.
CASE 24.--Rather remarkable. Reported by Dr. Lloyd Parry, of
Emmaville, N.S.W., in _Gazette_ of March, 1891, and further
particulars in private correspondence with writer. A Chinese
miner, aged 30 years, was bitten on the back of the foot by a
death adder. His mates, deeming medical aid useless, did not send
for Dr. Parry until death was imminent, and then only with a view
of getting a certificate of death, and avoiding autopsy and
inquest. When seen, three hours after infliction of bite, the man
was deeply comatose and pulseless, skin icy cold, pupils dilated
and insensible to light, lower jaw hanging down and tongue
protruding, respiration scarcely perceptible. He was in fact so
near death that this event was expected to take place from minute
to minute. In order to task the antidote to the utmost, Dr. Parry
cut the tight ligature without excising the bitten skin and then
injected xv. of liq. st. P.B. To his surprise in a few minutes the
man began to groan and very soon afterwards became conscious. Dr.
Parry then watched him carefully and in about an hour found coma
returning, when another injection was made and roused him for
good. There was much swelling and effusion in the leg, but no ill
effects followed.
In this case, judging from the comparatively small quantity of the
antidote required, only a small amount of poison had been
imparted, the bite being on the back of the foot, where the fangs
cannot penetrate deeply. Still there can be no doubt that even
this small quantity of the justly dreaded death adder poison would
have proved fatal, if it had not been counteracted by the
antidote.
CASE 25, reported from Tasmania by Dr. Holmes, of Launceston,
presents different features, showing the very large quantity of
the antidote sometimes required. After describing the condition of
his patient, a Mrs. Frazer, of St. Leonards, Dr. Holmes
writes:--"From her desperate condition I thought it too late for
the ammonia treatment and decided on injecting liq. strychniae. At
12.30 p.m. injected m. xv, at 1.40, m. xv., at 2.10, m. xv., at
2.40, m. xv., and 3.10, m. xv., at 4 p.m., m. x., and at 5, m. x.
A few minutes after the last dose I noticed the physiological
action of the drug and desisted from injecting. At 8 p.m. she
seemed almost well, pupils normal in size and reacting well, was
not sleepy and could swallow easily. The patient made a good
recovery."
This is the largest quantity of strychnine that has been required
in Australia, namely, 126 minims of liq. strych., or 1-1/9th gr.
injected in less than five hours, with the most beneficial result.
Surely the most cynical scepticism must give in to such facts.
CASE 26.--Reported by Dr. MacDonald, of Murwillumbah, N.S.W. Mr.
S., bitten on leg by a black snake. Coma, complete paralysis,
chin hanging down to sternum, pupils dilated, &c. An injection of
m. xv. had no effect; one of m. xx. very little. After a third one
of m. x. patient suddenly became conscious, could walk without
assistance, and in half an hour was sent to bed perfectly
recovered.
CASE 27.--Reported by Dr. Yeatman, of Auburn, South Australia. Mr.
D., a farmer, aged 45 years, bitten on thumb; snake not named;
cured by three injections of only m. v. each. Convulsions lasting
for an hour came on three hours after treatment--a very rare
occurrence--by Dr. Yeatman erroneously ascribed to the strychnine,
which in so small a dose would not have produced them in the
absence of snake-poison.
CASE 28.--Reported by officer in charge of police at Grenfell. Boy
of 6 years, bitten by brown snake, and treated by Dr. Rygate.
CASE 29.--W. Toomer, aged 19, bitten by tiger snake on thumb and
index finger, and not treated until 9-1/2 hours after bite, having
a long distance to travel. Recovery very slow through timid use of
antidote, five injections of 1/30th grain having but little
effect, until one of 1/10th restored him. Treated by Dr. Stokes,
of Echuca.
CASE 30.--Reported by Dr. Bennett, surgeon, Gulgong Hospital,
N.S.W. Mrs. Mears admitted to hospital comatose and pulseless,
nothing having been done to check absorption. The intravenous
injection of ammonia failing to rouse her, m. xv. of liq. strych.
were injected, when pulse returned, but coma continued. After a
second injection of m. xv. she suddenly became quite conscious,
and in an hour was fully restored.
CASE 31.--Reported by Dr. Mead, of Quirindi, N.S.W. John Simson,
aged 15 years, bitten by a death adder on forefinger of right
hand. Dr. Mead living 50 miles away, and the lad collapsing, a
layman, Mr. Robert Simson, had to undertake treatment, and
injected during the night m. 150 of a one in 240 solution of
strychnine, equal to 5/8ths of a grain. Dr. Mead, finding the lad
conscious and only a little drowsy, did not inject any more
strychnine until 2 p.m., when a relapse took place. He then
injected m. viii. of liq. str. P. B., and in half an hour m. vii.
more. The last injection produced slight muscular twitchings, and
subdued the snake-poison effectually, the lad making a good
recovery. The total quantity used in 13 injections was over
three-quarters of a grain within 18 hours.
CASE 32.--This case is another instance of the successful use of
the antidote by a layman, and can be verified by the writer, who
saw the patient, a girl of 14 years, after her father had carried
out the treatment successfully. The girl had been bitten by a
large brown snake whilst walking through a paddock, and very soon
afterwards lost the use of her legs, and for a time also her
eyesight. The symptoms being so very alarming, and the girl at a
distance of 35 miles from the writer's residence, the father at
once injected 1/12th of a grain of strychnine, and in a very short
time another 1/12th. The child then rallied somewhat, and a start
was made to bring her in, the father taking the precaution of
bringing the antidote-case with him. This was fortunate, for the
child collapsed several times, and each time had to be roused by
an injection before reaching the writer. When finally she
presented herself, walking into the writer's surgery with a firm
step, not a trace could be discovered either of the strychnine, of
which nearly half a grain had been injected, nor of the
snake-poison, also imparted no doubt in a fatal dose. The two
punctures on her leg, testifying to the size of the snake that had
bitten her, were the only tokens of the ordeal she had gone
through; and the only task remaining for the writer was to
congratulate her father (Mr. James Trebilcock, a farmer, of
Tawanga), on the plucky manner in which he had carried out the
treatment, and see to the child being properly watched during the
night in case of a relapse taking place. None, however, occurred,
and she left next morning perfectly well. Cases of this kind, in
which no doctor is called in, are frequently reported to the
writer, who finds that laymen are even more successful because
less timid than many medical men.
CASE 33.--Joseph Cartledge, bitten on calf of leg by a black
snake, was treated by Dr. Browne, of Sale, five hours after
accident. Two injections of 1/8th grain each used.
CASE 34.--Miss Davie, teacher, at Nerung, Queensland, treated by
Dr. Hannah, of Southport. Particulars not given.
CASE 35.--Mrs. Rogers, of Bulu Bulu, Gippsland, bitten on finger
by tiger snake, and treated by Dr. Trampy, first with intravenous
injections of ammonia, which had no effect, and when sinking with
strychnine injections, which had almost immediate effect, and in a
few hours placed her out of danger.
CASE 36.--Son of Mr. J. Beveridge, squatter, of Glengower, treated
successfully by Dr. Andrew, of Clunes, with strychnine injections.
CASE 37.--Theresa Byrne, aged 14 years, bitten whilst bathing,
snake not seen. Treated by Dr. Cuppaidge, of Normanby, Queensland.
Only 18 minims of L. S. required.
CASE 38.--Mr. Bullock, of Tenterfield, N.S.W., bitten by black
snake and treated by Dr. Morice.
CASE 39.--A boy, J. Taylor, bitten at Mount Keat, agricultural
settlement, Queensland, by a black snake, and treated successfully
by a layman, Mr. James Daniels.
CASE 40.--George Neilson, a Danish miner, bitten by a tiger snake
whilst bathing. Case reported by Dr. Gamble, of Walhalla. Forty
minims of liq. strych. required; recovery complete next morning.
CASES 41 AND 42, reported by Dr. Helsham, of Richmond, N.S.W. In
one of these where, judging from the symptoms, a large dose of
snake-poison had been absorbed, but very small doses of strychnine
were injected, convulsions set in, _whilst coma was still
present_, and lasted for two hours. Though semi-tetanic in
appearance they were erroneously ascribed to m. xxvi. of liq.
strychniae, which at the time of their appearance had not removed
the symptoms of snake-poison. They were evidently produced by the
latter and quite on a par with those occasionally occurring in man
before the strychnine is administered, and almost invariably in
dogs. As long as coma is present with other symptoms denoting the
snake-poison to be in active operation, such convulsions rather
call for the antidote, than contra indicate its use, for the
strychnine never produces them until it has completely conquered
the snake-poison, and even then they are always preceded by local
spasms and never set in suddenly. Timid medical men, when
administering the antidote and anxiously watching for the dreaded
strychnine effects, are too apt to see them in the slightest
irregular muscular action.
CASE 43, reported by Dr. Johnson, of Avoca, patient bitten by a
tiger snake, was comatose, pulseless, with very shallow
respiration, &c., and restored by three injections of m. xvi., xv.
and x. within less than three hours.
CASE 44.--Reported in _Australian Journal of Pharmacy_, from
Tasmania, treated by Dr. Tofft, of Campbell Town. The report
concludes: We have had some fatal cases of snakebite already this
season, and the successful treatment in the above case has created
a strong feeling in favour of strychnine in such emergencies.
CASES 45 TO 49.--Reported by Dr. Alex. Barber to _A.M. Gazette_.
He writes: "During the last year I treated four cases of snakebite
successfully with strychnine. In one of these, a bite of a brown
snake, I injected three doses of m. xx. each of liq. strych. P.B.,
in all over half a grain, in one hour."
CASE 50.--Reported by Dr. Barrington, of Benalla (Vic.), bite of
tiger snake, symptoms moderate. Completely removed in three hours
by 57 minims of liq. strych. P.B.
_Notes of eight cases as reported to the "Australasian Medical
Gazette" for July and November, 1892, by R. P. Banerjee,
B.A., G.B.M.S.L., Medical Officer, Salt Mines, Pachhadra,
Rajputana, India_:--
CASE 1.--Bhagwan Singh, aged 30, Hindu male, Sepoy, E. T. Force,
was bitten by a viperine snake (_echis carinata_) at 4 p.m. 10th
June, 1892, in the dorsum of left foot. He was removed to the
hospital, tight ligature applied, and with the following
symptoms:--Heaviness of both legs, staggered if allowed to walk,
giddiness, sense of sinking at the pit of the stomach, bleeding
from mucous surfaces and old scars; soon fell swooning.
Treatment.--The punctures incised, and blood let out, one-twelfth
of a grain of strychniae; acetas hypodermically injected. Again,
the insensibility not gone after 30 minutes, another dose given,
and so repeated the third time. The _bleeding stopped_ and the man
recovered his senses, but could not raise himself to talk. Many
more doses were given under the skin, with hour intervals, and the
man recovered the next day; but he was much exhausted and treated
for weakness three days, and discharged to duty on the 14th.
Punctures were distinct, symptoms well developed. Took _one and a
half grains_ of strychnine to effect cure, leaving no after
effects of the drug or poison.
CASE 2.--Sadig Husain, a Mussulman boy, aged 12 years, bitten on
the right ankle, just below the inner malleolus, by _echis
carinata_ (Khapar) on the 5th August, 1891, brought in with usual
symptoms, as before.
Treatment as before. This case took only one-fourth grain of
strych. acet. The boy was weak and sickly. He was discharged cured
on the third day, _i.e._, 17th August, 1891.
CASE 3.--Nathey Khan, Mussulman, customs peon, aged 35 years,
robust and strong, bitten by _echis carinata_ (yellow variety).
Punctures were on the left ankle, over the outer malleolus.
Symptoms as before given.
Treatment as before stated. This case took as much as one and
three quarter grains of strych. acet. Was admitted on the 9th
August, 1891, and discharged on the 12th August, 1891, cured and
fit for duty.
CASE 4.--Musamat Jewai, Hindu female, a labourer, age 40, strong
built. Bitten by kerait (_Bungarus coeruleus_), about 2-1/2 feet
long, above the left knee joint; ligature below the hip was used,
but all the symptoms were present and the patient was insensible.
Cyanotic marks were seen on the arms, abdomen, back and neck. At
first all hopes of recovery were given up, but attempts were made
to see if anything could do good.
Treatment.--Punctures scarified and cupping applied. Repeated
doses of strychnine acetas hypodermically given, but in _quarter
grain_ doses. It seemed marvellous. The cyanotic patches in the
skin gradually faded away and the body became warmer. It was
wondered if the person had expired, but suddenly the woman called
for a drink of cold water to bathe her dry and parching mouth.
This was done and she recovered sense. She was admitted on the 3rd
September, 1891, and discharged on the 10th. Took _three grains_
of acetate of strychnine to effect a cure.
CASE 5.--Paroati Devi, Hindu female, aged 67 years, healthy
constitution. Bitten on big toe of left foot on 10th September,
1891, symptoms were as preceding. The wound was cauterised.
Treatment.--Strychnia was given very cautiously, as the patient
was over-aged, the degeneration of the heart kept in view--1/10
grain eventually showed the peculiar strychnine symptoms. The
patient was cured in two days and discharged cured on the third
day, 14th September, 1891. This patient took in all _one and a
half grains_ of acetate of strychnia.
CASE 6.--Maya Swuper, aged 38 years, bitten by echis carinata
(without dots) on the lower third of the left leg, on the outside
of it. Mucous membrane of the mouth, eyes, nostrils, ears, and
urinary passages all bled profusely. Urine had clots in it and
symptoms resembled those in the first case.
Treated with strychnine and recovered in four days. Was admitted
on the 14th September, 1891, and discharged to duty on the 18th
September, 1891. Took in all _three grains_ to effect cure.
CASE 7.--Avghunandan, customs semadar, aged 55 years, Hindu male.
Bitten at 8 a.m. on the 29th March, 1892, by echis carinata (brown
variety) on the right foot near the cuboid bone. The punctures
were distinct and the symptoms like those of case 1. Bleeding was
profuse in this case.
Treatment.--Strychnine acetas injected _in quarter grain_ doses
under the skin and repeated as often as desirable. Patient
recovered after the sixth day and took in _all four grains of
strych. acet._ in six days. Only the bitten leg had erysipelatous
inflammation, which had to be treated afterwards, but the man was
quite safe.
Remarks.--In connection with echis bites one peculiar symptom was
always noticed, namely, the free oozing of blood from mucous
surfaces and old scars of wounds. The power of co-ordination was
very much affected from the first setting in of other symptoms.
Usually after 24 hours symptoms showed a relapse. In the treatment
with strychnia neither the symptoms of the drug nor of the
snake-poison ever showed themselves afterwards. Both seemed to
neutralise each other. Bungarus coeruleus, or kerait-bite, had its
own peculiar symptoms of cyanotic patches and insensibility,
swooning and stertorous breathing. The true comatose state was not
present in any, but only a slight one noticed in cases 4 and 5.
The other cases were generally delirious in the beginning.
CASE 8.--Dr. Banerjee communicated this case to the _Australasian
Medical Gazette_ separately and quite recently, November, 1892. It
is, of all his cases, the most important one. He writes:--"The
following case increases my number to eight, and should clear away
prejudice and prepossessed ideas, as strychnine saved this case, a
bite of _Duboia Russellii_. This snake is admitted by all hands to
be virulently poisonous, and the poison is said to be even more
virulent than that of the dreaded cobra:"--
_Rahimudden_, aged 43, Mussulman, customs peon, admitted for
treatment of snakebite on the 13th September, 1892, at 10.45 p.m.,
to the North India Salt Revenue Hospital, Pachhadra, Rajputana,
India, and put under my treatment.
_History of the Case._--The man is of strong build and healthy
constitution. While on duty he went round the salt pit, near his
beat. Suddenly he felt a prick on his foot, and, suspecting
snakebite, struck out with a bamboo stick he carried in his hand,
and heard the snake make a loud noise. He at once tore a piece of
cloth from his turban, and tied it tightly above the right ankle
joint round the leg, then tried to kill the snake, but could not
do so with certainty, as it was dark. He reported the case to his
superiors, and was carried to the hospital. Bitten at 9.30 p.m.;
admitted at 10.45 p.m.
_Present Symptoms._--Patient was delirious, and could not
understand what was told him; body cold and covered with
perspiration; breathing hurried, with a low rattle at the end of
expiration; mouth, tongue, and palate all dry; tongue leather-like
and cracked, and felt cold; tickling of throat, not exciting
vomiting; pupils dilated; conjunctiva congested; pulse 95; patient
talked, or rather muttered, with difficulty; could not tolerate
strong light or loud noise; the mucous membrane of the mouth
showed irregular dark patches of ecchymosed blood.
The right foot was swollen, and in a line between ankle and
knuckle of big toe showed two punctures--one deep and bleeding,
and surrounded by ecchymosis; the other one below this, more
superficial, the blood oozing thin and not coagulating. Received,
at 10.45 p.m., 1/12th grain of strychnine in left arm. At 11 p.m.,
the same dose; breathing the same, but no rattle; stupor rather
deepening; incoherency increasing. At 11.15, the same dose;
breathing easier; stupor the same; pulse, 85; temp, 97.6;
delirious at times, and moaning with inarticulate cries; could not
hear when spoken to in loud voice. 11.30 p.m., the same dose; no
change in condition. 11.45 p.m., the same dose; stupor now fading
away; delirium present; intolerant to light and noise; peculiar
grin and cramp in face-muscles when attempting to talk; temp,
95.8; pulse very hard; intense thirst; less bleeding from
punctures and blood thicker. 12 p.m., the same dose; no stupor
now, but cramps in lower extremities; no incoherency; only
occasionally uneasy and senseless for a moment, and then rising
suddenly like one startled when sound asleep. 12.30 a.m., no
further symptoms; bleeding stopped; great thirst; eyes red and
glaring; saccharine drinks given; no injection. 3 a.m., no sleep,
but only slight slumber; no pain in foot; no bleeding;
temperature, 98.8; thirst unabated; only drinks given.
_Sept. 14th, 10 a.m._--Better, but talking slightly incoherent;
received another injection of 1/12th grain of strychnine. 6 p.m.,
better; had good appetite; given milk and sago.
_Sept. 15th, 6 a.m._--Better. 6 p.m.--Better; had three motions,
rice and milk diet given, slept soundly between 10 a.m. and 2
p.m., no redness in eyes, swelling of foot abated.
_Sept. 16th._--Better, only complaining of heaviness in head. At 9
p.m. had a fit of stupor all of a sudden, became insensible, and
commenced to bleed again from the mucous membrane of mouth and
nose. The patient became almost insensible, and could only be
roused with difficulty. Twenty minims of liq. strychnine, equal to
1/6th grain, were now injected into the right arm.
_At 9.20_ stupor had passed away and consciousness was fully
restored. From this time onward convalescence was uninterrupted,
and patient was discharged cured on the 20th Sept., 1892.