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Prof. R. Kobert

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Digitized by the Internet Archive

in 2010 with funding from

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http://www.archive.org/details/onsnakepoisonitsOOmuel

ON

ITS ACTION

.A-DSriD

ITS ANTIDOTE

A. MUELLER, M.L>.

Sydney :
L. BRUCK, MEDICAL PUBLISHER,

13 Castlereagh Street.

1893.

Sydnky :

Websdale, Shoosmith & Co., Printers,

117 Clarence Street.

1893.

^lW^

PREFACE.

Since the method of treating snakebite-poisoning
by hypodermic injections of strychnine, discovered by
the writer and pubKshed but a few years ago, has
already been adopted by the medical profession through-
out the Australian colonies, and practised even by
laymen in cases of urgency with much success, it has
been repeatedly suggested to him that the subject calls
for further elucidation at his hands ; that the mor-
bid processes engendered by the snake venom and the
modus operandi of the antidote should be explained by
him in a manner satisfying the demands of science,
and at the same time within the grasp of the intelli-
gent, moderately educated layman. When the latter,
in a case of pressing emergency and in the absence of
medical aid, is called upon to administer a potent drug
in heroic doses, the aggregate of which w.ould be
attended by serious consequences in the absence of the
deadly ophidiaii virus, an intelligent insight alone into
the process he is about to initiate will give him that
decision and promptitude of action, on the full exercise
of which on his part it may depend whether, within a
few hours, a valuable and to him probably dear life
wil] be saved or lost.

11. PREFACE.

The foregoing applies, not to Australia only, but
to all other countries infested by venomous snakes.
The introduction of the writer's method in every one
of these countries is merely a question of time, for
snake-poison acts everywhere according to one uniform
principle, however different the symptoms it produces
may appear to the superficial observer. The antidote,
therefore, that cures snakebite in Australia will as
surely cure it elsewhere if properly and efficiently
applied.

To his Australian confreres, more especially to
those who adopted his method but had to practise it
more or less empirically, the writer also owes a more
elaborate explanation of his theory of the action of
snake-poison in all its bearings on the various nerve
centres than is to be found in the scattered writings he
has from time to time published in our periodical
literature. His warmest thanks are due to them for
the records of cases they have furnished to the Austra-
lasian Medical Gazette, and to the Hon. J. M. Creed,
its able editor, for the ample space he has invariably
allotted to the subject, and the valuable support he
has given him throughout. By our united efforts w^e
have reared in a dark and hitherto barren field of
research a column of solid knowledge, and on this
column Australia now occupies the highest and will
ever occupy the most prominent place.

Not the least pleasing feature in the history of
this discovery is the fact that it lias been made with-
out an elaborate series of experiments on animals, that

PREFACE. 111.

it is a peaceful conquest not attained by means of
doubtful justification, and which have hitherto invari-
ably failed in their object. This object — the discovery
ot the coveted antidote — instead of being brought
nearer, was, in fact, further removed by every succeed-
ing series of experiments. However fruitful in results
this mode of research has been in other domains, in
this particular one it has not only been a failure but
an actual bar to progress. Nature invariably refused
to yield her secret when thus interrogated. The
tortured animals, like the victims of Torquemada,
either did not answer at all or they answered with a
lie, and the baffled experimenter abandoned his task in
despair.

Still, these negative results notwithstanding, the
writer is confronted by a certain class of would-be
rigorous scientists, who tell him that his theory of the
action of snake-poison, though it explains all the
phenomena, cannot be accepted as correct until it has
been proven so by strict test experiments on animals,
and that the successful administration of the antidote
is proof only of the fact of neither antidote nor snake-
poison having killed the patients, who, probably,
might have recovered if left to themselves. This
may be strict logic, but common sense replies to it
that if recoverytakes place after proper administra-
tion of the antidote in cases which, according to all
our previous experience, would have ended fatally, it
is not illogical to assume that antidote and recovery
stand in the relation of cause and effect. This sceptical

IV. PREFACE.

attitude of the scientific mind can justly be maintained
only with regard to cases limited in number and in
which the symptoms left room for doubt as to their
final result, but in view of the formidable and con-
stantly increasing records of cures from snakebite
during the last three years, it is, to say the least of
it, unreasonable.

The demand for experiments on animals, in proof
of the correctness of his theory, the writer does not
feel called upon to satisfy, for, apart from the theory
proving itself by explaining all the symptoms the
snake-poison produces, it has also stood the test of
practical application. It is proven to be correct by
the success of the antidote to which it led, and which
is the logical outcome of it. After finally attaining a
goal one has striven for, it is quite unnecessary to
retrace one's steps with a view of ascertaining whether
the road that has led up to it is the right and proper one.

By a fortuitous concurrence of circumstances,
however, even this demand for experiments shall be
satisfied in these pages. The writer published his
theory of the action of snake-poison in May, 1888,
after having practised the strychnine treatment for some
years and thoroughly satisfied himself of its efficacy.
In the latter part of 1888 accounts of Feoktistow's
researches reached this country. His final conclusions
to the effect that snake-poison is solely a nerve poison,
that it does not destroy protoplasm, and has no effect
whatever on the blood to which its destructive potency

PREFACE. V.

on animal life can be ascribed, were in complete har-
mony with the writer's views, in fact, a re-statement
of his theory. It was a strange coincidence, or what-
ever it may be called, that, independent ot each other,
at almost opposite parts of the globe, and by opposite
methods, we had arrived at almost identical con-
clusions. Those of Feoktistow were drawn from 400
elaborate experiments on animals, both vertebrates and
invertebrates, made in the laboratory of Professor
Kobert at the University of Dorpat and in that of
Professor Owsjannikow at the Imperial Academy of
Sciences of St Petersburg. The writer's conclusions,
on the other hand, resulted entirely from a careful and
happy analysis of the symptoms observed at the bed-
side of his patients suffering from snakebite. On one
point only, but the most important one, he diflfers
from Feoktistow. The latter shared the fate of all
previous experimenters on animals. Though his
experiments with snake-poison led him to the correct
theory of its action, and even to the correct antidote,
his experiments with strychnine and snake-poison were
a failure. The animals experimented on died, and,
falling into the error of his predecessors, mistaking
the functional analogy that exists between the nerve
centres of the lower animals and those of man for
absolute identity, which does not exist, especially not
when they are under the influence of the two poisons,
he concluded his researches with the confession that a
physiological antidote for snake-poison cannot even be
thought of at the present state of science. Although,

PREFACE.

VI.

therefore, Feoktistow's labors would have led to no
practical result, they are, nevertheless, a most valuable
contribution to science as being the first to demon-
strate the action ot snake-poison on a strictly scientific,
experimental basis. For this reason, and with so high
an authority as Professor Kobert vouching for the cor-
rectness of the experiments, tliey will be frequently
quoted hereafter.

HISTORICAL REVIEW.

Snakebite and its cure have always been the
despair of medical science. On no other subject has
our knowledge remained for centuries so unsatisfactory,
fragmentary and empirical. The history of the subject,
in fact, may be summed up briefly as a series of vain
and spasmodic attempts to solve the problem of snake-
bite-poisoning and wring from nature the coveted
antidote.

Various and contradictory theories of the action
of snake-poison have been propounded, some absolutely
erroneous, others containing a modicum of truth mixed
with a large proportion of error, but none but one ful-
filling the indispensable condition of accounting for all
the phenomena observable during the poisoning process
and of reducing the formidable array of conflicting
symptoms to order by finding the law that governs
them all. We have the advocates of the blood-poison
theory ascribing the palpable nerve-symptoms to imag-
inary blood changes produced by the subtle poison, and
alleged to have been discovered by the willing, but
frequently deceiving microscope. Even bacteriology
has been laid under service and innocent leucocytes have
been converted under the microscope into deadly germs,
introduced by the reptile, multiplying with marvellous
rapidity in the blood of its victims, appropriating to

2 HISTORICAL REVIEW.

themselves all the available oxygen and producing
carbonic acid, as the saccharomyces does in alcoholic
fermentation. Others again, and among them those
supposed to be the highest authorities on the subject
now living, divide the honors between nerve and blood.
Some snakes they allege are nerve-poisoners others as
surely poison the blood, but with one solitary exception
they assume the terminations of the motor-nerves and
not the centres to be affected.

Thus then with regard to theories we have hitherto
had " confusion worse confounded," and as with theories
so it has been with antidotes. They were proposed in
numbers, but only to be given up again, some intended
to decompose and destroy the subtle poison in the
system, others to counteract its action on the system
with that action unknown. It is scarcely too much to
assert that there are but few chemicals and drugs in
the materia medica that have not been tried as antidotes
in experiments on animals and dozens upon dozens
that have been tried in vain on man.

The reasons for this somewhat chaotic state of our
science on a subject of so much interest to mankind are
various. The countries of Europe, in which scientific
research is most keenly pursued, have but few indi-
genous, and these comparatively harmless shakes. The
best scientific talent has, therefore, only exceptionally
been brought to bear on the subject. In those coun-
tries on the other hand in which venomous snakes
abound and opportunities for observing the poison-

HlStORICAL REVIEW. 6

symptoms on man are more plentiful, the observing
element has been comparatively deficient.

A still more potent source of failure must be sought
in the faulty methods of research pursued by most
investigators. Experiments on animals were far too
much resorted to, and their frequently misleading
results accepted as final, whilst observations on man
did not receive the attention their importance
demanded.

In the investigation of this subject the first
desideratum was no doubt to find the correct theory of
the action of snake poison and to define the law
governing that action, assuming as a working hypothe-
sis that there is but one law for all snake-poison and
not several ones, just as there is one law for the struc-
ture of these reptiles, admitting of variations, but not
of absolute divergence from the general plan. The
shortest and surest way to find this law is close obser-
vation and careful analysis of the symptoms produced
by the poison on man, and as the opportunities for such
observation are not of frequent occurrence to the indi-
vidual, co-operation and careful comparison of notes on
the part of many observers.

This method of investigation, which, during the
last few years, has been pursued in Australia with
most satisfactory results, was never practised any-
where else, not even in America, but instead of it
each observer, with few exceptions, kept his own
notes to himself, and if there happened to be one here
and there hungry for more knowledge than his scanty

HISTORICAL REVIEW.

opportunities for observation on man would supply,
his resort was usually experiments on animals. A few
snakes were caught, a few luckless dogs or other
animals procured, and the slaughter of the innocents
began.

As test experiments to confirm observations on
man, or made with a view of finding a correct theory
of the action of snake-poison, these attempts were
unobjectionable, although, without an elaborate scien-
tific apparatus and in other than skilled hands, they were
not likely to produce results of any value. But most
of the experimenters w^ere not content .with purely
theoretical aims. They were seeking to find the anti-
dote by a purely empirical method, and had nothing to
guide them in the choice of drugs. A dose ot snake-
poison was administered to an animal, and then a dose
of some drug or chemica], chosen ad libitum, sent after
it. Next day another presumed antidote was tried,
another animal slaughtered, and so on ad nauseam,
until finally the baffled antidote-searcher, not one whit
the wiser for all his trouble and the useless tortures
inflicted, confessed himself beaten and joined in the
" non 2^ossumiis " of his predecessors.

One important point has been completely left out
of sight and ignored in all this experimenting on
animals. It is the fact that the action of snake-poison
on the human system and on that of animals, more
especially dogs, though very similar, is not absolutely
identical, and that for this reason alone results of
experiments on the latter cannot be indiscriminately

HISTOKICAL REVIEW. 0

applied to man. As pointed out before, analogy has
been confounded with identity. When a dog, for
instance, has been bitten by a snake he does not
usually collapse as quickly as a human being, but is
able to drag himself about much longer before his hind
legs refuse their service and he is unable to walk. This
longer duration of the first stage of the poisoning process
is no doubt owing to a higher organisation and greater
functional power of the motor nerve centres of dogs.
The amount of motor force at their disposal is greater,
and hence they offer greater resistance to the invader
seeking to turn off this force. When finally the latter
gains the ascendency, irregular discharges of motor
nerve force still take place and find their expression in
convulsions, which in man only exceptionally occur.
But the difference between man and dog becomes more
marked yet when strychnine is administered to a dog
suffering from snake-poison. It counteracts the latter
quite as effectually in a dog as in man, but has to be
injected with extreme caution, for whilst in man a
slight excess in the quantity required to subdue the
snake-virus is not only harmless, but actually neces-
sary, any excess of it in a dog will at once produce
violent tetanic convulsions and cause the animal to die
even quicker than the snake-poison would have killed
it, if allowed to run its course. In the face of these
facts the judiciousness of the proposal lately made both
here and in India to subject the strychnine treatment
of snakebite once more to a series of test experiments
on animals appears more than questionable.

6 HISTORICAL REVIEW.

Another cause that has largely contributed to
render experiments on animals so barren of results
must be sought in the injudicious selection of sub-
stances intended to serve as antidotes. It is simply
impossible to act on an organic compound like snake -
poison, coursing through a living system, by chemicals
that will either combine with it or decompose it in a
manner likely to deprive it of its deadly qualities and
render it innocuous. Yet what do we find? Acids
and alkalis, arsenic, bromides and iodides, chlorine,
mercurial preparations, &c., &c., have been poured
into the luckless animals as if they were so many test
tubes. A chemical antidote, a substance possessing
special affinity to snake-poison and by means of this
affinity combining with it in some mysterious and
incomprehensible manner, one can hardly imagine to
exist. Physiological antidotes, on the other hand,
substances acting on the system in a manner the
exact reverse of, and in direct antagonism to the
snake-poison^, though apparently the' only feasible ones,
have been strangely neglected and almost despised by
experimenters.

In the vast storehouse of Nature the department
most likely to furnish such antidotes is the vegetable
kingdom. The untutored human mind has for
centuries past intuitively clung to this idea, and sought
among plants for remedies against the deadly ophidian
poison. Hence the great number of vegetable anti-
dotes that have from time to time been recommended
and the efficacy of some of which at least has been

HISTORICAL REVIEW

confirmed by reliable observations. But, the hint thus
given to science was not taken. Instead of research
being pushed on diligently in the only direction that
promised any chance of success, it was cut short by
the baneful method of experimenting on animals.
When it had been demonstrated that a dog, a cat, or
other animal, after having been saturated with snake-
poison, did not recover after the administration of an
alleged antidote, the illogical conclusion was drawn at
once that it could not possibly be of any use to man,
whilst, in reality, the only proof rendered by the
experiment, if made properly, was that the respective
antidote could not be relied on in treating animals of
the class experimented on. That some of these des-
pised antidotes are worth a little further investio-ation
may, in the light of present experience as to the value
of strychnine in snakebite, be inferred • from the fact,
that among them is the wood of Strychnos Colubrina,
and also the well-known Huang Noo, a vegetable ex-
tract made from another variety of the Strychnos
family, and largely used by the Chinese, whilst, accord-
ing to a letter in the Australasian Medical Gazette,
July, 1892, the principal ingredient of a strange com-
pound used by the native snake doctors of Central
America with much success is Niix Vomica.

It is superfluous to enter into a criticism of the
treatment of snakebite until recently in vogue, for,
with the exception of the local one by ligature and
excision, it stands self -condemned by its complete
inefficiency. It may be summed up as a vain attempt

8 HISTORICAL REVIEW.

to stem the collapse invariably attending snakebite by
the administration of stimulants, such as alcohol, ether,
ammonia, &c. The attempt is vain, for a person in
collapse from snakebite cannot be stimulated by any
of these remedies, since neither the heart nor the nerve
centres respond to them in the slightest degree, as
they do in the absence of snake-poison, the only one
that has any effect at all in slight cases being ammonia.
But the attempt is not only in vain, it is highly in-
jurious, especially if made with the usual large doses
of alcohol, for, in addition to the latter not having the
slightest influence on the snake-poison and its baneful
effects, they act as an ansesthetic and thus add to the
existing depression, besides increasing the tendency to
internal haemorrhage.

It might, under these circumstances, have been
expected that any new method of treating snakebite,
based on scientific grounds and holding out a sure
prospect of success, would be hailed with pleasure, and
that conservatism, opposing the new simply on account
of its newness, would refrain from its usual tactics in a
case where there was really nothing to conserve. But
this was not to be, and strange, indeed, it would have
been if the writer had escaped the opposition which is
almost invariably offered to the discoverer. It appears
to be one of the laws of human evolution, wisely de-
signed to prevent precipitate advance, that every
new discovery must run the gauntlet of men
whose mission it is to act as brakes on the wheels of
progress. Of the opposition which has been offered

HISTORICAL REVIEW. V

to the strychnine treatment it would, therefore, be
folly to complain, but just cause of complaint is
furnished by the unscientific attitude which was
assumed from the very first and has been maintained
throughout by its opponents.

Not a single attempt has been made to disprove
the correctness of the theory on which it is founded,
yet to leave this theory unquestioned but object to the
conclusion to which it leads, must strike even the lay
mind as a most illogical proceeding. It is self-evident
that, when strychnine is administered as an antidote to
snake-poison, the quantity of it injected must be in
proportion to that of snake-venom present in the sys-
tem, and that the doses in which we dispense it in ordin-
ary practice must be entirely left out of sight. Still, in
the face of these obvious conclusions, we have had
veterans, grave and grey, arguing pompously that the
heroic doses advocated by the writer could not be
countenanced, and that even medical men could not be
entrusted with the serious task of administering them.
Even as late as the last medical congress at Sydney
this absurd objection to large doses of the antidote
was again brought forward. After quantities averag-
ing from half a grain to a grain have been injected
many times in Australia with continuous success,
alter Banerjee has even gone as high as three and
four grains in India without a single failure, and with-
out in one single instance serious strychnine symptoms
being evoked, the writer of the paper on " Snakebite
and its Cure" based his principal objection to the

10 HISTORICAL REVIEW.

treatment on the alleged ground of there not being
sufficient evidence before us to justify heroic doses and
show them, to be safe in practice. When people wil-
fully shut their eyes against the most conclusive evi-
dence, it is improbable that any amount of it would
satisfy them. Apart, however, from the fully proven
antagonism between the two poisons rendering the
large doses of the antidote, which in all serious cases
are indispensable, perfectly safe, the fear of strychnine
is, in itself, a very strange aberration of judgment on
the part of my opponents, considering how easy it is to
counteract any noteworthy excess in its action, if, per-
chance, it should occur through unnecessary overdosing,
by appropriate remedies.

All other objections to the treatment require but
to be glanced at to show their absurdity. Certain
crude experiments on dogs made many years ago in
India, and put forward as irrefutable at first, have been
abandoned of late, and my learned opponents have now
taken up a position in their stronghold of statistics,
supposed to be impregnable, but in reality only the
last refuge of the destitute, a position from which, by
dexterous handling of alleged facts, anything and
everything can be proven, in short, to use a strong
expression, not my own, a convenient and respectable
form of lying. By means of these statistics they try
to prove, in the first place, that Australian snake-
poison is not at all the insidious death-dealing agent it
is supposed to be, since, according to statistics, only
1 26 persons died from it in three colonies within the

HISTORICAL REVIEW. 11

last ten years. Further study of these statistics leads
them to the inference that a strong healthy adult will
recover from snakebite ivithout any treatment, and thus
they finally arrive at the conclusion aimed at, that
persons cured by strychnine injections would probably
have recovered without them. These are the infer-
ences drawn by men, who/ practising in towns, have
probably never seen a case of snakebite. How do
they tally with the facts of the case ? It is true that
the mortality among those bitten by snakes is small
here as compared with India, though the poison of our
snakes, quantity for quantity, has been proven to be
quite as deadly as that of the Indian ones. Our
greater immunity is due to our snakes giving off less
poison at a bite, and with their short and (excepting
those of the death adder) merely grooved poison fangs
injecting it very superficially, thus making the process
of elimination of the poison by ligature and incision
or excision of the punctures much more easy and
successful. It is to this treatment, which, as a rule,
is immediately adopted in the bush, that our small
mortality is due. Our children are taught it in school,
and the most illiterate bushman knows how to carry
it out. Where it is omitted by persons not knowing
that they are bitten until the poison has been absorbed
recovery is as rare as it is with the ox and the horse
left to themselves without any treatment. But it
requires a prodigious stretch of the logical faculty to
understand what our small mortality from snakebite
has to do with the intrinsic merits of the strychnine

12 HISTORICAL REVIEW.

treatment. Even if nobody died at all its effects in
doing away with the misery and suffering, which,
before its introduction, invariably followed snakebite,
and often was never got rid of completely, would still
be sufficiently beneficial to render the senseless opposi-
tion to it on the part of a small section of medical men
little short of criminal ; for these effects are a matter
of constant observation, and cannot, like the rescues
from death, be called into question.

The statistics brought forward to prove that the
treatment has not reduced the death-rate are also most
faulty. Until it is thoroughly understood and in every
instance properly applied it is manifestly foolish as
well as unfair to lay non-success and failures at its
door. When a medical man is called upon to treat a
serious case, and instead of boldly addressing himself
to the task of combating the symptoms by injecting
the antidote irrespective of the quantity he may require
until it has conquered the snake-poison, becomes
nervous and ceases to inject, when, after what in
ordinary practice would be a dangerous dose, he sees
but little effect, or if from the first he injects small
doses at long intervals, the cause of failure surely lies
with him and not with the antidote, which rarely fails
where it is properly applied. The duty of dissemin-
ating a sound knowledge of the principles of the
strychnine treatment unquestionably devolves on our
health authorities, who ought, by this time, to have
taken some notice of it. But officialdom remains
obtuse and issues circulars on the treatment of snake-

Historical review. 13

bite, recommending, inter alia, the free use of
alcohol.

The literature on the subject of snake-poison is
very voluminous, but those who seek for enlighten-
ment in it will be as disappointed as the writer was
after wading through it. The toilers in this barren
field of research were numerous, but with few excep-
tions, they toiled in vain. Fontana may be looked
upon as the founder of that hideous experimentalism
by which, in his hands alone, four thousand animals
were tortured to death without a single tangible result
except that in his great work, " Reserche Fisiche sopra
il Veneno della Vipera," wdiich he wrote at the con-
clusion of his cruel labours, he left us a grotesque
monument of patient, but ill-guided research. Other
Italians, follow^ing his method, Redi, Mangili, Metaxa,
&c., were equally unsuccessful in shedding one ray of
light on the vexed and obscure problem.

Among the Germans who contributed to the sub-
ject may be mentioned: —

Wagner. — "Erfahrungen liber den Biss der ge-
meinen Otter."

Prinz Maximilian von Wiedd. — " Beitrage zur
Geschichte Brasiliens."

Lenz. — " Schlangenkunde."

Heinzel. — " Ueber Pelias Berus und Vipera Am-
modytes."

Among the French : —

SouBEiRAN. — " Rapport sur les Viperes de
France."

14 HISTORICAL REVIEW.

Bullet. — " Etude sur la Mosure de Vipere."

British and American Workers are the most
numerous. Commencing with the century we have : —

Russell. — "An Account of Indian Serpents,
collected on the Coast of Coromandel." Later on,

S. Weir Mitchell. — " Researches upon the
Venom of the Rattlesnake,"

Halford — "On Australian Snakes, and the Intra-
venous Injection of Ammonia, in British Medical
Journal^ Medical Times, and Australian Medical
Journal^

Jones. — " On Trigonocephalus Contortrix."

Nicholson. — " On Indian Snakes."

Sir Joseph Fayrer. — " The Tanatophidia of
India." Also, " Researches in conjunction with
Richards, Brunton and Eward."

Wall — " On the Difference in the Physiological
Effects produced by the Poison of Indian Venomous
Snakes." Proc. Royal Soc, 1881, vol. xxxii,, p. 333.

Among those enumerated above Wall is the only
one who formulated a correct and thoroughly scientific
theory of the action of snake-poison, which has since
been confirmed by Australian research and by
Feoktistow's elaborate experiments. It is strange
that, after finding the theory that explained all the
phenomena, he did not follow it up by applying the
antidote to which his theory should have led him.

SNAKE-POISON AND ITS
ACTION.

The poison gland of snakes is the analogue of the
parotid gland of mammals, both in position and struc-
ture. Its acini or alveoli are lined with a layer of
secretory, columnar, finely granular cells and arranged
with great regularity along the excretory duct, which
is straight and cylindrical and opens with vipers into
the hollow poison fang, with our colubrines into the
groove on the anterior surface of it. Snake-poison,
as it leaves this gland, is a thin, albuminoid, yellow
liquid of neutral reaction. On exposure to the air it
becomes viscid and slightly acid. Of its chemical
composition we know as yet but little, and it is very
questionable whether the most perfect chemical analysis
of its constituents would ever have given us a clue to
its action or will enrich our present knowledge of it.
Like all albuminoid secreta it becomes putrid after
prolonged exposure and then, through ammonia pro-
duction, loses its acid, and assumes an alkaline re-
action, still, however, though in a modified degree,
retaining its toxic properties, which are completely
lost only after an exposure of many months. Feok-
tistow found that freezing at 1° R. caused the poison
to separate into a solid mass and a thin, very yellow

16 SNAKE-POISON AND ITS ACTION.

liquid, which, even at a temperature of 4° R., remained
Hquid, and the poisonous properties of which greatly
exceeded those of the solid mass. Boiling diminishes
and, continued for any length of time, completely des-
troys the potency of the poison .

The microscope has done good service in the
investigation of snake-poison. It has, in the first
place, informed us with absolute certainty that there
are no micro-organisms or germs of any kind in the
fresh poison immediately after it leaves the gland.
But a still more important revelation we owe to it is
the fact that these organisms, when we introduce them
into a 2 % solution of the poison, do not die, but live,
multiply, and enjoy their existence most lustily, as
they do in any other non-poisonous albuminoid liquid,
whilst animals of a higher type — say a snail or a frog
— soon perish in it. In watching the movements of
the latter we find that they get slower and slower,
and finally cease. We now follow up the interesting
research, and take two frogs. Under the skin of one
of them we inject a few drops of the poison solution,
the other one for comparison we leave intact, and place
both into a glass globe partly filled with water. In a
very short time we have no difficulty to identify the
poisoned frog. Its hind legs begin to drop and their
movements become sluggish. This difficulty increases
from minute to minute, until at last all motion ceases,
and the legs hang down completely paralysed. At
the same time we observe that the animal shows
increasing difficulty of breathing, that, even when taken

SNAKE-POISON AND ITS ACTION. l7

out of the water, and placed on the table before us it
gasps for breath and is unable to move. At last
respiration ceases altogether and the frog dies.

Two problems now present themselves for solu-
tion, In the first place we have to account for the
fact of the snake- poison leaving the lower forms of
animal life intact and being fatal to the higher ones..
The symptoms we have observed in the frog point
unmistakably to an affection of the nervous system as
their cause. Now we know that the lower forms
which the poison does not affect have no such system,
and we are justified to infer that to the absence of
this system they owe their immunity. This infer-
ence leads us on to a second one equally justifiable,
namely, that there is a certain unaccountable attrac-
tion between the delicate nerve tissue and the subtle
ophidian poison, which renders the latter a specific
nerve poison.

Our second problem is to ascertain the nature of
the change in the nerves, to find out, if possible,
whether it is merely functional or an actual interfer-
ence with the structure of either cells or fibres. With
this end in view we once more consult the microscope.
We make two preparations, one of nerve fibres and of
nerve cells of the poisoned frog, and, under the micro-
scope, compare them carefully with an analogous one
from the killed healthy frog. The result is purely
negative as regards structural change. Both present
identical and perfectly normal pictures of apparently

J, 8 SNAKE-POISON AND ITS ACTION.

healthy cells and fibres. There bemg no visible
structural change we are driven to the conclusion that
only a functional one has been effected by the poison,
and with the symptoms observed all pointing in that
direction, that it is of central origin.

The writer's theory as to the action of snake-
poison, formed, in the first instance from observations
made at the bedside of his patients only, is thus con-
firmed by experiments specially instituted by him for
that purpose. Further proof of its correctness we
have in the brilliant results of the strychnine treat-
ment of snakebite in Australia, which is the outcome
and practical application of this theory. In those
desperate cases more especially, reported from all parts
of the colonies, in which death was imminent, and
pulse at wrists as well as respiration had already
ceased, the strychnine injections could not possibly
have effected complete recovery within a few hours
if the structure of the nerve centres had been impaired
or blood changes brought about incomjJatible with
life.

Feoktistow's experiments, made with viper poison,
fully bear out the correctness of the writer's theory,
besides proving that there is no essential difference
between the action of the viperine and colubrine
poisons. He proved conclusively that snake-poison
does not destroy protoplasm or interfere with infusorial
life, that injected into the heart of a mollusc it causes
an almost immediate cessation of its action, that

SNAKE-POISON AND ITS ACTION. 19

hypodermic injections of it in fish produce contraction
of the pigment cells and bleaching of the integuments,
followed by asphyxial respiration, general paralysis
and death. Similar results were observed on frogs.
In mammals the symptoms were : dyspnoea, asphyxia,
paresis and paralysis of the lower extremities with
succeeding general paralysis, sometimes tonic and
clonic convulsions, haemorrhages from bowels, lungs,
nose and bladder, and finally complete paralysis of
respiration and of heart.

Action of Snake-Poison on Special
Nerve Centres.

It must be borne in mind that the symptoms as
about to be detailed are successive only to some extent
in the order presented. They commence generally at
the lower part of the spinal cord, but immediately
afterwards, if not simultaneously, are ushered in with
great rapidity from other centres, masking each other
and rendering it extremely difficult to observe and
analyse them separately. They are also very variable
through the poison concentrating its action on special
centres, leaving others comparatively intact, and this
not only when from different varieties of snakes, but
also from snakes of the same variety. Another element
increasing the difficulties of correct analysis are the
depressing effects of fear, inseparable in all but the
stronofest minds from the consciousness of havinof been

20 SNAKE -POISON AND ITS ACTION.

bitten, and so similar in appearance to those of snake-
poison, that sometimes it is by no means easy to
decide which of the two is in operation, and that only
those cases are of real value to the observer from
which this element of fear is completely excluded.

A.— Action on the Anterior Cornua of the
Spinal Cord.

The anterior cornua are almost invariably the first
of the motor-centres attacked by the snake-poison, the
affection (commencing with paiesis and in serious cases
generally culminating in paralysis) beginning in the
lumbar ganglia and taking an upward course. The
lower extremities feel unnaturally heavy and a paretic
condition of the muscles supervenes simultaneously on
both sides. The walk becomes unsteady and stagger-
ing, very similar to that of persons under the influence
of large doses of alcohol. By a powerful effort of the
will, however, persons in this condition are often able
to walk and even run for some distance, especially if
by prompt ligature the absorption of the poison has
been checked. As the affection proceeds, though still
able to move the legs in a sitting posture, they are
unable to rise again. Ere long even sitting up becomes
impossible and they collapse helplessly. At this
stage sensation is still intact, and reflex action, by
pricking the skin, &c., still takes place. The upper
extremities generally retain the power of voluntary

SNAKE-POISON AND ITS ACTION. 21

motion, even after the muscles of the neck have become
paretic and the head is held up with difficulty or sinks
to one side.

With birds, according to Feoktistow, the reverse
is the case. The wings are usually first attacked, or
paresis comes on in wings and legs at the same time.

B.— Action on the Medulla Oblongata.

a.— The Yaso-Motor Centre.

Whilst the voluntary muscles are thus brought
under the influence of the poison, symptoms denoting
the invasion of the oblongata are rapidly developing.
The first of these is the deadly pallor and ashy hue of
the cold skin, evidently due to the blood receding from
the surface, a condition not unlike that obtaining in
extreme anaemia. As persons in this state complain
of an agonising feeling about the heart and of deadly
faintness, a paretic condition of the heart suggests
itself as the most obvious cause, more especially when
taken in conjunction with the small, frequent, and
compressible pulse. But though the heart muscle is
no doubt participating in the general paresis, the
condition of the surface of the body is in reality one
of anaemia. The blood, even at this early stage, begins
to accumulate in the large veins of the abdomen, which
expand gradually in consequence of the diminishing

22 SNAKE-POISON AND ITS ACTION.

motor force supplied by the splanchnicus, keeping
them in the normal state of contraction when intact
and having its centre in the medulla oblongata. When
this large vaso-motor nerve is cut in animals anywhere
in its course, the veins of the abdomen become distended
enormously. The animal is, so to say, bled into its own
belly.

By a series of most interesting experiments
Feoktistow has shown conclusively that snake-poison
has the same effect on the abdominal circulation as
section ot the splanchnicus. Even slight intravenous
injections of the poison produced quickly a high degree
of paresis of the nerve and a corresponding engorgement
of the veins of the abdomen, whilst after lethal doses,
the paresis culminated in a few minutes in complete
paralysis, followed by rapid collapse, excessive weak-
ness of the bloodless heart, and death from paralysis
of the latter and anaemia of the nerve-centres. One
experiment deserves special record, as it also shows
the untenability of the blood-poison theory.

The whole vascular system of an animal poisoned
by intravenous injection was thoroughly washed out
with the warm defibrinised blood of four animals of
the same species, the blood being infused into an
external jugular vein and allowed to flow out of a
crural artery. Although blood exceeding its normal
quantity was left in the animal, when the vessels
named were closed, the nerve affection remained
unchanged. The blood pressure raised during the
infusion sank at once again to zero, when it ceased,

SNAKE-POISON AND ITS ACTION. 23

and the paralysed veins of the abdomen became
eno-orp-ed once more with the whole, or nearly the
whole, of the blood-mass, leaving the rest of the body
anaemic as before. This interesting experiment also
shows how strong a hold the snake-poison has on
the nerve-cells when they are thoroughly under its
influence, and how independent this paralysing action
is of the blood, persisting, as it was in this case, after
all the poison had been washed out of the animal.

The heart in vaso-motor paresis and paralysis is
weakened in the first instance by the direct action of
the poison on the medulla oblongata and the intra-
cardial ganglia. Its pulsations, at first retarded in
frequency, become accelerated soon after the intro-
duction of the poison, the pulse rate increasing rapidly
and the waves becoming smaller and more easil}^
compressible in proportion to the frequency of the
pulse, which generally counts from 100 to 120 and
more per minute at a comparatively early stage of the
poisoning process. But an equally potent cause of
heart failure is its depletion by the simultaneous
stagnation of the blood mass in the veins of the
abdomen. Finally, to complete the mischief, we have
not only anaemia of the serai-paralytic oblongata, but
the scanty blood supply this important centre receives
becomes also surcharged with carbonic acid. Oxyhse-
maglobin disappears almost entirely from the blood
under the circumstances detailed, as both pulmonary
and internal respiration are greatly interfered with,
the blood tending more and more towards that thin

24 SNAKE-POISON AND ITS ACTION.

dark condition which it presents after death, and
which has been taken as prima facie evidence of the
direct blood-poisoning action of snake virus by one and
all of previous investigators.

That under the powerful combination of causes,
each of which 'is in itself sufficient to endanger life,
and greatly intensified as paresis gradually deepens
into paralysis, the heart, even of large animals, suc-
cumbs in a comparatively short time, may be readily
understood.

The blood-pressure, under the circumstances just
detailed, must necessarily be nil. Observations by
means of the sphygmograph at the bedside of a person
suffering from snake-poison are scarcely feasible,
except, perhaps, in a hospital, and thus far are not on
record. We must, therefore, once more fall back on
Feoktistow's experiments, which show that even the
smallest doses (0"02 to 0*04 mllgr.) of the dried
poison per kilo injected into the vein of a cat caused a
fall in the blood-pressure almost immediately, without
influencing either pulse or respiration, but that two to
four mgr. were sufficient to reduce the blood-pressure
to zero and bring on collapse, infusions of blood only
raising it temporarily. Of drugs raising the blood-
pressure he found ammonia the most effective, but only
after slight doses of the poison ; after lethal ones it
had no effect whatever on the blood pressure but
greatly increased the hsemorrhagic process in all
internal organs. This important observation should

SNAKE-POISON AND ITS ACTION. 25

be kept in mind by those who inject ammonia in
serious snakebite cases, and it probably applies like-
wise to the excessive use of alcohol.

This leads the writer on to the discussion ot this
singular hsemorrhagic process principally characteristic
of viperine poisoning, and only very exceptionally
produced by the poison of colubrines. It is among
the symptoms of snakebite poisoning one of the most
interesting ones, but also one most difficult of explan-
ation. There can be no doubt that it is produced by
vaso-motor paresis and paral37"sis. We further know
that it is preceded by dilatation of the capillaries and
small veins, and that it is effected principally through
the process known as diapedesis, or the passage of
both red and white corpuscles with plasma through
the unruptured capillary membrane, and even the thin
one of small veins, which is nearly of the same struc-
ture, being composed of endothelial cells united by
cement. This membrane possesses a certain degree of
porosity, which is probably increased by dilatation. In
the absence of plain muscular fibres contraction and
dilatation of the capillaries can only be effected by a
corresponding contraction and expansion of the nuclei
of the endothelial cells. As fibrils derived from non-
medullated nerves terminate in small end-butts in
connection with the capillary membrane, we may
assume that the nuclei of the endothelial cells are
under the sway of vaso-motor nerve currents, that
weak ones will expand, strong ones contract them.
We may further assume that the red and white cor-

26 • SNAKE-POISON AND ITS ACTION.

puscles force their way out of the vessels through
pores in the cement substance, since a passage of cell
through cell is not thinkable. Thus far we see
our way fairly clear. But the question now arises :
what causes the solid constituents of the blood
to force their way through the capillary membranes all
over the mucous surfaces, even the conjunctiva, and not
these alone, but also through serous membranes such
as the pericardium, and strangest of all, through old
scars in the skin ? If the most modern ideas as to
the cause of diapedesis being blood pressure are
correct, it is quite incomprehensible how it can take
place in the absence of blood pressure, and take place
so extensively. The theory of blood pressure may
apply to diapedesis accompanying the inflammatory
process. In snakebite poisoning it is more likely to
be due to passive engorgement of the capillary system
and probably also to blockage of corpuscles in the finest
capillary tubes. In vaso-motor paresis, and still more
paralysis, the arterioles supplying the capillaries are
widely dilated, and at the lowest blood pressure pro-
bably send more blood into the latter than in the normal
state. This circumstance in itself is apt to cause
capillary engorgement. In the finest capillaries per-
mitting only a string of corpuscles, one behind the other
but none abreast, to pass through in the normal state,
dilatation may cause blockage by two or three becoming
wedged in abreast and closing the lumen of the vessel
by a sort of embolism. On the arterial side of this
obsti'uction the crowded corpuscles force their way

SNAKE-POISON AND ITS ACTION. 27

through the porous cement substance by what little
" vis a tergo " there may be left yet, whilst in the
venous side, in the small veins corresponding with the
closed capillaries, engorgement must necessarily take'
place through this '' vis a tergo " being entirely absent,
and diapedesis, which here also has been observed,
follow in due course The writer has always been in-
clined to take this view, the correctness of which
appears to be borne out by an experiment recorded by
Feoktistow. He found on sprinkling a two per cent,
solution of snake-poison over the mesentery of an
healthy animal, that wherever a drop of the solution
fell, almost immediately the capillaries and small veins
became dilated and small point-like effusions of blood
appeared, gradually enlarging and ultimately becoming
confluent with adjoining ones. Large hsemorrhagic
surfaces were thus formed in a comparatively short
time. Here paralysis of the nerve-cells interspersed
in the vaso-motor nerve-ends was evidently the first
effect, followed by dilatation of the capillaries and
immediately afterwards by effusion. Without some
obstruction within the capillaries, like that above
described, effusion in this purely local poisoning process
appears unexplainable.

The special preference wdiich the viper-poison has
for the vaso-motor sphere will hereafter be referred to.
Haemorrhages from Australian snake-poison are com-
paratively rare. Even at the bitten place there is as
a rule very little swelling and effusion and frequently
none at all. When it occurs it quickly disappears after

28 SNAKE-POISON AND ITS ACTION'.

strychnine injections. Only a few cases have been
reported as yet of blood- vomiting. In one of these the
haemorrhage took place soon after the bite and was so
considerable that it must have arisen from actual
rupture of vessels consequent on abdominal engorge-
ment and not from mere diapedesis It is very doubt-
ful whether the latter ever takes place here as it does
after viper-bite in India and elsewhere. Even the
death-adder, although half a viper, and producing more
swelling and effusion locally than any other one of our
snakes, is not known to have ever produced the exten-
sive effusions from mucous surfaces in pericardium,
lungs, &c., described above. More research however
is necessary, especially more carefully conducted
autojisies. Since Australia has taken the lead in this
hitherto so obscure department, every practitioner
should make it his object and special ambition to con-
tribute his quota towards the elucidation of the subject,
not only by reporting successful cases, but also the
post-mortem appearances in unsuccessful ones, wherever
it is practicable. It is not by experiments on animals
but by a hearty co-operation of Australian practitioners
that we can ever hope to supplement our knowledge on
this subject.

1).— The Respiratory Centre.

Paresis of this centre does not play as important
a part here as it does in India, more especially after
cobra-bite. The peculiar, and as yet unexplained,
tendency of snake-poison to act with special virulence

SNAKE-POISON AND ITS ACTION. 29

on some centres, passing others by comparatively little
disturbed, is markedly shown by the cobra poison of
India as compared with that of our Australian cobra
(hojylocephalus curtiis.) The unfortunate victims of
the former are tortured by an ever-increasing dyspnoea,
and finally die from asphyxia, under what are supposed
to be carbonic acid convulsions. They retain their
consciousness more or less unclouded to the last, the
poison spending all its force on the respiratory centre,
and leaving the brain intact. Here we hardly ever
see actual dyspnoea after the bite of hoplocephalus or
any other Australian snake. Respiration becomes
quicker at an early stage, and then, from hour to
hour, shallower ; but our patients soon pass from sleep
into coma, and suffer no respiratory distress even
when, in consequence of general paralysis, the respira-
tory muscles cease to act, which usually takes place a
few minutes before the heart stands still.

Feoktistow records the following observations on
cats with reference to the respiratory centre : — Small
intravenous injections of the fresh poison (0-07 0"13
mllgr.) produced a great increase in frequency of
respirations (280-360 per minute.) Section of both
vagi at once reduced this frequency, from which he
infers that small doses act as an irritant to the
respiratory centre. When small doses were repeated
several times, the respiratory movements were gradu-
ally retarded, and asphyxia set in through paralysis of
the centre. Large doses produced this effect at once,
without any previous acceleration. Very large ones

30 SNAKE-POISON AND ITS ACTION.

paralysed respiration, heart, and vaso-motors almost
simultaneously, and caused the blood pressure to fall
to 0. By the kymograph respirations were found to
become shallower in proportion to their frequency. As
the latter was reduced, they became at first deeper,
but ere long shallower again, and were occasionally
interrupted by spasmodic inspirations. Artificial
respiration prolonged life for a short time only.

C— Action on Centres of Cranial Nerves.

Among the symptoms denoting paresis of motor-
centres of cranial nerves, together with sympathetic
ganglia, the first and most noteworthy is the early
dilatation of the pupil. This truly pathognomic con-
dition is ne\^er absent, and becomes intense when
paresis becomes intensified into paralysis. The most
glaring light, in immediate proximity to the eyeball,
has then no effect whatever on the pupil. If it
remains dilated after strychnine injections have restored
consciousness and the power to walk, it is a sure sign
that the snake-poison is not completely counteracted,
and will in all probability re-assert itself, necessitating
another injection, whilst a pupil restored to its normal
condition justifies the conclusion that the patient is
safe.

Another symptom denoting paresis of the cranial
nerve-centres is a marked change in the expression of
the face. The features become relaxed, and lose their

SNAKE-POISON AND ITS ACTION. 31

mimetic play. The cornea is dull, and, together with
the anterior surface of the eyeball, becomes dry, as
the eyelids are moved imperfectly, if at all, and the
tears in consequence are not properly distributed over
the conjunctiva. The nostrils become more or less
immovable, and the naso-labial fold is obliterated,
whilst the lower lip hangs down. The lips are apart,
as the lower jaw is not held up by the muscles. When
paralysis supervenes it drops entirely, and the tongue
protrudes.

Deglutition, somewhat difficult in paresis, is com-
pletely suspended in the paralytic stage, through
paralysis of the soft palate, the pharynx, and oeso-
phagus. Liquids forced on the patient in this
extremity may partly flow down the oesophagus, but
will also enter the larynx, and their administration
should be carefully avoided.

D. Action on motor-centres of Cerebellum and
Basal Ganglia.

Of this action little if anything is patent to obser-
vation. A certain want of co-ordination in the move-
ments has been noticed in the early stage of paresis,
and the peculiar staggering walk of persons in this
stage is probably owing to an affection of the motor-
centres of the cerebellum. That they do not escape
the action of the subtle poison, when symptoms denot-
ing the invasion of all the other motor-centres through-

32 SNAKE-POISON AND ITS ACTION.

out the body are in evidence, we have every reason to
assume. The co-ordination and automatic regulation
of the lower motor-centres must necessarily escape
observation when the function of these centres is
partially suspended, and when, moreover, the powerful
currents of nerve force the cerebellum and basal
ganglia receive from the motor cortical centres of the
cerebrum are partially if not wholly withdrawn.

E. Action of the Motor Cortical Centres of the

Cerebrum.

In all but the very lightest cases of snakebite-
poisoning there are always symptoms manifested that
cannot be referred to any other cause than an invasion
of the centres now under consideration. , They range
from mere stupor, confusion of thought and delirium
to the deepest coma, with complete extinction of con-
sciousness and insensibility to all external impressions.
Coma is a frequent and in serious cases an almost in-
variable sj^mptom in Australia. After the bite of our
death adder only we find persons sometimes collapse
and expire suddenly, when still conscious and able to
answer questions rationally. Coma invariably develops
from sleep. It is, in fact, sleep intensified. An almost
irresistible desire to sleep is one of the first symptoms
to be observed. If the dose of poison imparted by the
snake has been small, the desire may pass off or the
sleep may not assume the form of coma, but in all

SNAKE-POISON AND ITS ACTION. 33

serious cases it quickly assumes that form. Vice versa
the deepest coma becomes sleep again, when the
suspended function of the cortical centres is roused by
strychnine injections The insensible and completely
paralysed patient usually announces the gradual return
of consciousness by a few groans and uneasy move-
ments and not unfrequently begins to snore, as in
ordinary sleep, when a smart shake at the shoulder
will rouse him into full consciousness. At other times
this transition from coma back to sleep does not take
place and consciousness returns quite suddenl}^ the
persons opening their eyes and looking around them,
dazed and bewildered, but perfectly conscious at once.
When coma is fully established and the largest and
most powerful motor-centres have succumbed to the
insidious poison, general paresis becomes general
paralysis and all the motor-centres of the body are in
a condition of more or less suspended functional
activity. This and this only is the condition of the
centres, the whole secret of snake-poison, that has
puzzled the human mind for ages and yet appears so
simple when discovered at last. It is beautifully and
strikingly illustrated in the phenomena before us. We
have coma and complete general paralysis, every
motor-nerve cell, from the highest psycho-motor one
downwards, is thrown into a state of torpor and has
ceased to discharge the life force that regulates every
process of life and the entire absence of which inevit-
ably must be death. Only weak, lingering currents
are sent forth yet and put off the inevitable finale for

34 SNAKE-POISON AND ITS ACTION.

a time. But the strychnine is injected and mark the
change. It courses quickly to every one of the
sleepers, for whom it also has an affinity, but the direct
opposite to that of the deadly venom that has over-
powered them. It touches them as if with the wand of a
magician and orders them to awake and do their work.
There is no disobeying the mandate, for it is founded
on one of nature's unchangeable laws. Almost immedi-
ately the cells begin their work again, the life streams
flow afresh, coma and paralysis vanish and within a
very short time the subject of this beautiful experiment
is snatched from the brink of the grave and restored
to life and health.

The phenomena of sleep and coma as the result of
a poison acting as a depressant of motor nerve force
afford food for some interesting speculations, which,
however, as more concerning the psychologist, the
writer can only glance at here. It is evident that in
the highest or psycho-motor centres, the organs of
thought and of consciousness, the paresis of the lower
centres assumes the form of sleep, and paralysis that
of coma. Sleep, as a partial, and coma, as a complete,
obliteration of thought and consciousness must, there-
fore, be intimately connected with motor nerve
function, sleep being a reduction, coma a suppression
of this function, or a suspension of thought. Ideation,
to use J. S. Mill's very appropriate term for the
thought process, appears to be effected by motor nerve
currents, or, at all events, to be accompanied by them
and suspended with their suspension. The thinking

SNAKE-POISON AND ITS ACTION. 35

principle, the nous within us, is no doubt more than
mere nerve action, but it can, apparently, not manifest
its presence without motor nerve cells in healthy
action. Every thought, though not synonymous, is
evidently synchronous with a current of motor nerve
force, and it is not improbable that, by means of these
currents, that silent transference of thought is effected
from brain to brain, which modern psychologj^ has
demonstrated to be not only possible but actual under
certain conditions. But further speculation on these
interesting mysteries it would be out of place here to
indulge in.

F. Action on Sensory Centres and the
Reflexes.

The sensory sphere remains comparatively un-
affected in mild cases, and in the early stages of more
serious ones, but when paresis has deepened into
paralysis, sensation becomes ever more blunted, and
with the advent of coma, of course, quite extinct. Re-
flexes, both superficial and deep ones, are also com-
pletely abolished at this period of the poisoning pro-
cess, and the nerves of special sense do not react
against any, even the strongest possible stimulation.
The eye stares vacantly into a glaring light held close
before it, and the widely dilated pupil shows no sign of
reaction. The ear also appears deaf to any noise, and
strong ammonia vapour is inhaled through the nose

36 SNAKE-POISON AND ITS ACTION.

like the purest air, whilst pricking, beating, and even
burning the skin elicit not a quiver of a muscle.

Feoktistow's experiments with regard to reflexes,
more especially their restoration by strychnine, difler
in their results entirely from Australian observations.
Whilst we have no difficulty in restoring them with
the drug on man as well as the domestic animals, his
experiments on frogs were a failure, and merely showed
a decided antagonism between the two poisons. He
did not succeed in restoring the reflexes, and, instead
of following up with experiments on the higher animals,
he trusted implicitly to his results on frogs, and thus
lost his opportunity.

G Irregularities in the Action of
Snake-poison.

There is in the whole range of toxicology not a
single condition known to us in which the S3anptonis,
both in chronological order and in their strength and
relation to each other, show as much variety as those
of snake-poison. Experienced observers will agree
with the writer that it is but rarely we find two cases
of snakebite exactly alike in the symptoms they pre-
sent. Some of these puzzling variations have already
been alluded to, but it is necessary to consider them a
little more in detail. Apart from quantitative differ-
ences in the poison imparted, they arise principally
from the strange capriciousness with which the poison

SNAKE-POISON AND ITS ACTION. 37

concentrates its action on special nerve centres and
leaves others comparatively intact.

The nearest approach to regularity and orderly
sequence of the symptoms, as described in the fore-
going pages, we find in Australia after the bite of the
tiger snake (Iloplocephaliis curtus) and the brown
snake [Diemenia superciliosa), more especially that of
Queensland. Here we can trace the action of the
poison distinctly from centre to centre, from the lowest
part of the anterior cornua up to the cortex cerebri,
and even throughout the sympathetic ganglia as far as
they are patent to observation. The poison of these
snakes is extremely diffusible and quickly absorbed.
It spreads with rapidity and nearly equal force over
all the motor centres, the symptoms following each
other so quickly as almost to appear simultaneous,
though, in reality, successive. But even the poison of
these snakes leaves the arms only slightly paretic, when
paralysis in all the other voluntary muscles is well
pronounced, and does not paralyse them until coma has
set in. It also touches the respiratory centre but
slightly. Sometimes coma is light and the patients
can be roused for a little while, at other times it is deep
and lasts till death. But even greater variations are
observed occasionally. In one very extraordinary case
of tiger snakebite, the patient, a child of 9 years,
remained conscious to the last, and after vomiting
blood freely died under symptoms of heart failure. In
rare cases the symptoms resemble those of cobra
poison.

38 SNAKE-POISON AND ITS ACTION.

If we turn from these to the black snake (Pseude-
chis 'porphyriacus) a different picture presents itself
Its poison does not produce so deep a coma and often
none at all. The patients generally feel drowsy and
fall asleep, but are easily roused and sometimes awake
spontaneously. There is also not the same amount of
muscular paralysis. They are frequently able to walk
a few steps with assistance and can move in bed, the
arms especially being almost free from paresis But
the insidious poison none the less does its work, though
its effects are less patent. It concentrates its action
on the vaso-motor centre. The victims from hour to
hour become more ansemic in appearance through
increasing engorgement of the abdominal veins.
Anaemia of the nerve-centres hastens the collapse, and
from the combined effects of this and heart failure
death takes place suddenly and quickly as if in a faint-
ing fit. Here then we have an approach to the effects
of viper poison which is also shown in the greater
amount of swelling and effusion around the bite and in
the bitten limb.

This approach is still closer in the poison of the
death adder (Acantophis antarctica). There is gener-
ally much extravasation of blood locally. Muscular
paralysis is also less pronounced, but sudden collapse
from vaso-motor paralysis not unfrequently takes place,
when the patients fully conscious are still able to sit
up. That leading feature of viper poison, diapedesis
with haemorrhage, does not occur with either.

SNAKE-POISON AND ITS ACTION. 39

If we turn from Australian to Indian snakes, the
peculiar tendency of the j^'^^ison to concentrate its
action on special nerve-centres becomes still more
marked. The predilection of the cobra poison for the
respiratory centre has already been dwelt on. More
remarkable and strangle is the action of the Indian
viper-poison on the minute ganglia in the vaso-motor
nerve ends, which control the capillary circulation, and
by their paralysis bring about extensive haemorrhage
through diapedesis.

It is quite impossible for us with our present
scanty knowledge to account for these peculiarities and
irregularities in the action of a poison, which we know
now to accomplish its destruction of animal life by one
uniform design and principle of action. That the
protean forms under which the poison-symptoms
present themselves are one and all the result of reduc-
tion and suspension of motor nerve currents may now
be accepted as a well proven and fully established
scientific fact. But why the effects of one and the
same cause are so varying in their appearance, why the
poison of different varieties of snakes, and even that of
the same variety under different circumstances, make
such a capricious selection among the various motor
nerve-centres we can not explain and probably never
will. Chemical analysis of the dead poison, no matter
how minutely and elaborately it may be effected, will
probably never throw much light on the " why " of
this strange puzzle, for the subtle phenomena of life
are apt to elude the grasp of the analyst. We have to

40

SilAKE-POISON AND ITS ACTION.

do with a poison transferred from one living organism
■into another one and modified in its action by the con-
dition of the giver and the constitution and peculi-
arities of the recipient quite as much probably as by
slight variations in its chemical composition. Accept-
ing the " why " of these phenomena like that ot many
other ones, simply as a fact not to be accounted for at
present, we must be content to know " how " they are
effected, and, what is of more immediate and paramount
importance to know, that we now have an antidote
that will deal successfully with them all, that the con-
vulsions and haemorrhages of the Indian viper-poison
and the asphyxia of that of the cobra will yield as
readily to strychnine, when properly and boldly applied,
as the coma and general paralysis following the bite of
the deadly tiger snake.

THE ANTIDOTE.

The theory of the action of snake-poison as that
of a specific nerve-poison, depressing and more or less
suspending the function of the motor nerve-centres
throughout the body, has in the foregoing pages
received a double proof of its correctness.

In the first place, all the symptoms the snake-
poison produces have been passed in review, and
shown to be fully explainable by this theory. On
this ground alone it may be claimed to have been fully
established ; for it is an axiom in science that a theory
on any subject must be accepted as correct, if it accounts
satisfactorily for all the phenomena observable in con-
nection w^ith that, subject by showing them to result
from the operation of one law. The second inductive
proof of the correctness of the writer's theory has been
rendered by the experiments of Feoktistow on animals.

Science, however, demands that a theory thus
established inductively must also stand the test of
practical application or deduction It says in the
present case: — " Granting your, theory to be correct, it
is but a theory, which, however valuable it may be as
a contribution to science, is of little value to mankind
if you cannot apply it practically. If snake-poison
merely acts as a depressant on motor nerve-cells with-

42 THE ANTIDOTE.

out interfering with their structure, you must be able
to counteract it by administering some drug or sub-
stance which acts as a powerful stimulant on these
cells, if such a substance can be found,"

It is another illustration of that wise adaptation
of means to ends which, throughout the domain of
nature, denotes the presence and rule of a Supreme
Intelligence, that this substance has been provided for
us by nature, though we have been long in finding it.
Its discovery in strychnine, and its successful applica-
tion as the long and vainly sought antidote to snake-
poison, are glorious triumphs of scientific deduction.

Strychnine is the exact antithesis to snake-poison
in its action. Under its influence every motor nerve-
cell throughout the system sends forth stronger currents
of nerve force than it does in its normal state. These
currents run alike from cell to cell, and from cell to
peripheral fibre, and act by means of the latter on all
contractile, and especially all muscular tissue, causing
contractions, which, after poisonous doses of the drug,
assume the form of tetanic convulsions, provoked by
the slightest touch or even noise in consequence of
highly intensified reflex action.

Whilst, then, snake-poison, as we have seen, turns
off the motor-batteries and reduces the volume and
force of motor-nerve currents, strychnine, when follow-
ing it as an antidote, turns them on again, acting with
the unerring certainty of a chemical test, if adminis-
tered in sufficient quantity. Purely physiological in
its action, it neutralises the effects of the snake-poison.

THE ANTIDOTE. 43

and announces, by unmistakable symptoms, when it
has accompUshed this task, and would, if continued,
become a poison itself. Previous to this announcement
its poisonous action is completely neutralised by the
snake-poison, and the latter would therefore be equally
as efficacious in strychnine-poisoning as strychnine is
in snake-poisoning. Strychnine, in short, is the anti-
dote par excellence of snake-poison, and cannot be
surpassed by any other substance known to us.

With the symptoms following the introduction of
the subtle ophidian virus into the human and animal
system so markedly pointing to strychnine as the
antidote, it appears a matter of surprise that it was not
used as such before and that it was left to the writer
to discover the antagonism between the two poisons.
Misleading experiments with the drug on animals
erroneously considered to be final in their results,
together with confused and contradictory notions about
the action of snake-poison, were the chief factors,
already pointed out, that caused research on this im-
portant subject to remain for centuries so barren of
results, and made even able investigators with more
correct views than the rest, postpone the discovery of
a physiological antidote to a more advanced state of
science, when all the time it was lying ready at their
hands.

It is self-evident from preceding statements, that
in the treatment of snakebite with strychnine the
ordinary doses must be greatly exceeded, and that its
administration must be continued, even if the total

44 THE ANTIDOTE.

quantity injected within an hour or two amounts to
what in the absence of snake-poison would be a
dangerous if not a fatal dose. Timidity in handling
the drug is fraught with far more danger than a bold
and fearless use of it. The few failures among its
numerous successes recorded during the last four years
in Australia were nearly all traceable to the antidote
not having been injected in sufficient quantity. Even
slight tetanic convulsions, which were noticed in a few
cases, invariably passed oft quickly. It should be
borne in mind that of the two poisons warring with
each other that of the snake is by far the most insidious
and dangerous one, more especially in its effects on the
vaso-motor centres. The latter are wrought very
insidiously, and where they predominate require the
most energetic use of the antidote, for whilst the timid
practitioner after injecting as much strychnine as he
deems safe stands idly by waiting for its effects, the
snake virus, not checked by a sufficient quantity of it,
continues its baneful work, drawing the blood mass
into the paral3^sed abdominal veins and finally by
arrested heart action bringing on sudden collapse. In
such cases even some tetanic convulsions are of little
danger and may actually be necessary to overcome the
paralysis of the splanchnicus and with it that of the
other vaso-motor centres.

Whilst then it must be laid down as a principle
that the antidote should be administered freely and
without regard to the quantity that may be required
to develop symptoms of its own physiological action,

The antidote. 45

the closes in which it is injected and the intervals
between them must be left to the practitioner's judg-
ment, as they depend in every case on the quantity of
snake-poison absorbed, the time elapsed since its in-
ception and the corresponding greater or lesser urgency
of the symptoms. If the latter denote a large dose to
have been imparted and it has been in the system for
hours, delay is dangerous and nothing less than 16
minims of liq. strychnise P.B., in very urgent cases
even 20 to 25 minims should be injected to any person
over 15 years of age. Even children may require these
large doses, as they are determined by the quantity of
the poison they have to counteract and are kept in
check by it. The action of the antidote is so prompt
and decisive that not more than 15 to 20 minutes need
to elapse, after the first injection, before further
measures can be decided on. If the poisoning symp-
toms show no abatement by that time, a second
injection of the same strength should be made
promptly, and unless after it a decided improvement
is perceptible, a third one after the same interval.
As the action of strychnine when applied as anti-
dote is not cumulative, no fear needs to be entertained
of violent effects suddenly breaking out after these
large doses repeated at short intervals. They
are, so to say, swallowed up by the snake-poison
and remain latent except in counteracting the latter.
This has now been proven abundantly by scores of
qualified observers in all parts of Australia, and still
more by Banerjee in India. No hesitation, therefore.

46 THE ANTIDOTE.

should be felt by medical men in other snake- infested
countries to adopt the Australian treatment. It is
seldom tha.t more than halt a grain of strychnine
administered in 16m. doses of liq. strychnise is required
here to effectually counteract the venom and place its
intended victim out of danger. Ligature and excision
of the bitten skin have usually been practised and
much of the poison eliminated before the antidote is
applied. Our snakes, however, as already pointed out,
with their shorter and merely grooved fangs, do not
perforate the cellular tissue to such depth nor instil as
large a quantity of poison as the cobras, kraits and
vipers of India or the rattlesnake of America, all
having perforated and much longer fangs and much
more productive poison glands. Even if after the
bite of a vigorous cobra, for instance, a ligature has
been applied and the bitten part deeply excised, a
comparatively large quantity of poison will probably be
absorbed requiring much larger quantities of the anti-
dote, perhaps grains of it, to effect a cure.

If under the influence of these large doses the
symptoms abate, or if the latter are comparatively
mild from the first, smaller doses of strychnine should
be injected, say from 1/1 5th to l/lOth of a grain, but
under all circumstances the rule that, distinct strych-
nia symptoms must be produced before the injections
are discontiimed, should never be departed from.
This rule is a perfectly safe one, for its observance
entails no danger, a few muscular spasms or even slight
tetanic convulsions being easily subdued and harmless

THE ANTIDOTE. 47"

as compared with that most insidious condition exem-
plified in case No. 1, cited below, the first one treated
with strychnine by the writer, who, having no experi-
ence in the treatment, did not administer quite enough
strychnine. The patient, after apparently recovering
from a moribund condition and being able to walk and
even to mount a horse, remained partly under the
influence of the poison and succumbed to it during
sleep, when, according to subsequent experience, one
more injection would have saved him.

The tendency to relapses is always great when
much snake-poison has been absorbed. Apparently
yielding to the antidote for a time, the insidious
venom, after a shorter or longer interval, during which
it appears to have been conquered, all at once reasserts
its presence, and has to be met by such fresh injec-
tions, regardless of the quantity of strychnine pre-
viously administered, but the amount required in
most relapses is not a large one. The writer formerly
inclined to the belief that the strain thus put on
the delicate nerve-cells would limit the usefulness
of the antidote to cases requiring not much above a
grain. Knowing "the Indian snakes to impart to their
victims such comparatively large quantities of venom,
he had strong misgivings as to his method standing
the severe test of Indian practice ; and it was most
fortunate for this method that its first practical
application in India was made by a gentleman who,
whilst thoroughly familiar with its principles and
convinced of their correctness, had the courage to

48 THE ANTIDOTE.

apply them fearlessly by injecting what to us Aus-
tralians appear enormous quantities, ranging as they
do up to three and four grains per patient. Dr.
Banerjee's eight cases, all successful, and of which
the ' most important one, relating to the much and
justly dreaded Duboia Russellii, was published in the
November number of the Australasian Medical Gazette,
settled the treatment of snakebite in India as well as
elsewhere. If the poison of Bungarus coeruleus, Echis
carinata, and Duboia Bussellii can be successfully
counteracted, and if for this purpose four grains of
strychnine can be injected with perfect impunity, it
may be inferred with certainty that the poison of the
cobra, fer-de-lance, and the rattlesnake — in fact, of
any snake known to us — will be found amenable to
the antidote, and that, if four grains can be injected
with safety, we may venture on six and eight grains, if
they are required. In those cases only where the long
fangs of these snakes perforate into a vein, and a large
quantity of the venom injected into the blood-stream
overpowers the nerve-centres so as to make death
imminent, if not almost instantaneous, the subcutaneous
injections may be found of little use. Here intravenous
injections of half a grain and even one grain doses
would appear to be indicated, and might yet fan the
flame of life afresh, even when respiration and pulse at
wrist have already ceased. We have seen both these
functions extinct in Australia and restored by com-
paratively small doses of the antidote, and can see no

THE ANTIDOTE. 49

reason why a more energetic use of* it should not
restore them in India,

Considering the terrible mortahty from snakebite
in India, Dr. Banerjee's merit in being the first to
introduce the strychnine treatment there is of a very
high order, and his grateful countrymen will ever
cherish his memory. When his Excellency the
Viceroy had been appealed to in vain by the writer,
and the adoption of his method in India urged
through two Austrahan Governors, a native of India
has stepped forward and taken the first step towards
alleviating an evil that has hurried over two millions
of his countrymen in every century to an untimely
grave.

The cases as reported by him to the Australasian
Medical Gazette are cited below.

CASES.

If the deductions and conclusions set forth in the
foregoing chapters are correct, it may be justly con-
tended that all cases of snakebite treated with
strychnine should invariably end in recovery if the
antidote is properly applied, according to the rules
above detailed. This contention the writer fully and
cordially endorses. Given the largest amount of poison
a snake can give off at one bite, strychnine injected in
time and sufficient quantity — either by the hypodermic,
or, if urgent, by the intravenous method — must rouse
the dormant nerve-cells into action, as long as the vital
functions are not completely extinct. Wherever it
fails, the fault lies with the operator not injecting it
in sufficient quantity — a fault committed by the writer
himself in his first case.

The following condensed accounts of fifty cases
treated in Australia, and eight in India, the writer has
taken mostly from the Australasian Medical Gazette.
Two of these only are from his own practice ; others
were kindly communicated to him by his colleagues.
It is not claimed that all these cases were rescues from
certain death. Some of them undoubtedly were, others
would have recovered under some other treatment or
no treatment at all ; but m none of them would

CASES. 51

recovery have been so rapid and complete. The two
poisons are thrown out together, and no ill-efFects of
either are experienced beyond a certain degree of
weakness, which passes off quickly. This is a boon to
be appreciated fully by those only who have gone
through the slow, lingering, and painful process of
convalescence from snakebite as formerly treated, with
its deadly languor and weariness, making life itself a
burden and all physical and mental exertion impossible.

Case 1. — A. H., 15 years old, a farm labourer, was bitten on
tlie right index finger whilst feeling for a rabbit in a burrow. Did
not see the snake nor suspect snakebite, but collapsed helplessly in
a few minutes after returning to his work. The writer saw him
three hours after the accident. He was then completely paralysed
and in deep coma ; pupils widely dilated and not reacting to light ;
sense of sight and hearing dead ; heart action extremely feeble ;
pulse small, thread-like, and scarcely countable ; respiration quick
and shallow ; skin blanched and very cold Seeing him dragged
along the road between two men, had him quickly carried to the
next house, and injected 20 minims of liq. strychnine. Ouly a groan
or two and a slight improvement in the pulse, indicating a change
in his condition, gave him a second injection about twenty minutes
after the first one. A change for the better then became rapidly con-
spicuous. The pulse gained in strength from minute to minute,
respiration became deeper, and the coma was visibly reduced to
mere sleep, from which there was no difficulty in rousing him to full
consciousness by a vigorous shake of the shoulders. This marvellous
change was brought about within forty minutes ; and this being the
first case to which the writer had applied his theory by injecting
strychnine, its unparalleled success exceeded his most sanguine
expectations, but unfortunately also lulled him into a false sense of
security, which proved disastrous to his patient. Not knowing then as
he does now that the snake-poison after having been subdued by the

52 CASES.

antidote is not thrown out of the system as quickly as the strychnine,
and is therefore apt to reassert itself, he allowed another urgent
engagement to take him away from the lad after watching him for
two hours and actually taking the evening tea with him. His
instructions to the mother not to let her son go to sleep and to watch
him carefully for the slightest sign of the return of symptoms, were
unfortunately disobeyed. Both mother and son went to sleep,
deeming all danger over. During this sleep the lad again relapsed
into coma and was found so at daylight. All attempts to rouse him
were fruitless, and he died before the messenger intended for me had
time to saddle a horse. The death of the unfortunate lad, however,
has saved some lives since. It taught the writer the lesson never to
trust to the apparent success of the antidote until it shows distinct
signs of its own physiological action, and even then to watch his
patients carefully for the first twenty-four hours, and let them sleep
for short periods only.

Case 2.— A.H., a vigorous girl of 20 years, bitten above the
left ankle by a snake in some long grass, and therefore not identified.
Had applied two tight ligatures above the bite, ran home and got
her mother to cut out the bitten skin, showing two distinct punctures.
Seen within an hour after the bite the girl presented distinct, but
moderate symptoms, deadly paleness, very cold skin, small frequent
pulse, and a peculiar feeling of agony about the heart, just able to
sit upright, but unable to walk. All symptoms increased rapidly
after writer cut ligatures. She reeled from side to side, and sud-
denly fell forward as if in a swoon. Injected g^th grain of strych.
nitr., and, as she did not lose consciousness, was able to watch the
interesting and rapid efiect of the antidote. It had not been
injected more than five minutes when slight colour returned to the
cheeks, naturally very red. Patient then stated that the distressing
feeling about the heart was getting less and also that of drowsiness.
From minute to minute her condition improved, and in about ten she
was able to rise and walk a few steps. Profiting, however, by the
lesson his first case had given him, the writer did not trust to her
apparent recovery, but seeing that much of the poison had been

CASES. 53

eliminated by the prompt measures taken before he saw her, he
injected only /2th of a grain, which produced slight muscular spasins.
Careful precautions were taken in this case against a relapse, but
none took place, and when visited next morning the girl declared
herself as well as ever she had been in her life.

The following notes of two cases of tiger snake bite ( Hoplo-
cephalus curtus), treated with strychnine, were read by Dr. Thwaites
before the Intercolonial Medical Congress of 1889. This gentle-
man, a young practitioner just entering practice, had the courage to
use the antidote according to the writer's directions in spite of the
hostile criticisms of his seniors in the profession and even his own
university teachers, and thereby not only saved two valuable lives,
but also set a praiseworthy example, which was soon followed by
others. The writer gives the notes abbreviated.

Cask 3. — J. B., a strong, robust labourer, bitten by a tiger
snake on the back of right hand. Killed the snake, which hung on
to the hand and was with some difficulty shaken off. Made slight
incision through the punctures and tied a rag round the wrist, but
too loosely to check circulation ; then started for the next neigh-
bour's house, distant a mile, which he reached with difficulty,
staggering like a drunken man when he arrived. The bitten skin
was here excised, whisky administered and patient sent on in a
buggy, but distance being 30 miles to Dr. Thwaites' residence, a
messenger on horseback galloped ahead to get Dr. Thwaites to meet
buggy on road. The latter writes : " I met buggy four miles from
my residence. Patient had to be held up on the seat of the vehicle
between two men. He had not spoken for some time, pulse very
weak, pupils greatly dilated, face very pale. I injected 10 minims
of iiq. strychnine P.B. at once, and in a few minutes noticed some
improvement. He now answered when spoken to, his pulse became
stronger, and he could walk a few steps. This was at 5.30 p.m.,
and he kept up fairly well till 8.15, when he collapsed completely,
I now injected 20 minims of Iiq. strychniae, which in a short time
brought him round • but at 9.15 another relapse took place, when a

54 CASES.

third injection of 15 m. was made. This was followed by slight
twitchings about the face and neck, after which improvement and
recovery were uninterrupted.

Dr. Thwaites' second case is even more remarkable and telling.
When the girl, after a journey of 30 miles, was carried into his
surgeiy, she appeared to be dead, and a second medical man, who
happened to be present, declared her to be so^ and all attempts to
revive her useless.

Case 4. — A. D., aged 15 years, a school girl, bitten by a vigorous
tiger-snake on the outside of left leg, the snake also holding on for
some time. She at once tightened her garter above the knee and
ran home, a distance of three-quarters of a mile. The bitten skin
was at once excised, another firm ligature applied, whisky adminis-
tered, and a hurried start made for Dr. Thwaites', distant 30 miles,
where she arrived five hours after accident. The latter writes : —
" She was then pulseless at wrists, cold as a stone, and with pupils
insensible to light. I could not perceive any respiration, but felt
the heart yet faintly fluttering. She was to all appearances just on
the point of death. I injected at once 17 minims of liq. strychnife.
In about two minutes she sighed, and then began to Dreathe in a
jerky manner. In about ten minutes, on my pulling her hair, she
opened her eyes and looked around, but could not recognise any
one. Pupils now acted to stimulus of light. In a short time she
could speak when spoken to, but not see at any distance. Her
sight gradually returned completely ; she kept on improving, and in
four to five hours after the one injection she seemed quite well, but
rather weak. I gave small doses of stimulants till morning,
and did not let her go to sleep till next evening. She suffered no
relap.se, and her recovery was complete."

Case 5. — This remarkable case was not published in the medical
press, but in many of the papers of Queensland, where it created
much sensation. The writer is indebted for an account of it to Dr.
Thwaites, who vouches for its correctness. It appears that this
gentleman acquainted the well-known explorer of Northern Queens-

CASES. 55

land, Mr. Johnstone, who is his uncle, and now police magistrate at
Maryborough, Queensland, with his success in treating snakebite
with strychnine. Mr. Johnstone, who during his explorations had
seen inuch of snakebite and many deaths from it, wrote rather
incredulously in reply, stating that our southern snakes were
innocuous in comparison with those of the north ; and that, having
seen twelve persons bitten and die by the deadly brown snake of
the north ( Diemenia super ciliosa), he must withhold his belief in
the new antidote until he had witnessed a case of brown snakebite
cured by it or reported on good authority. This desire he had
quickly gratified, and by a strange fatality in his own person.
Whilst taking his children for a walk in the bush a few weeks
afterwards he stepped aside the path to pluck a flower from a bush,
and in doing so was bitten on the leg by a vigorous brown snake.
He at once applied a ligature, and had the punctures sucked by an
aboriginal, but became comatose before he reached home. Three
medical men were summoned in haste, injected ammonia into
several veins, and finally had to resort to artificial respiration,
declaring the case a hopeless one. In this extremity Mi's Johnstone
rushed to a fourth one, who had seen Dr. Thwaites' letter, and dis-
cussed its contents with her husband in her presence. This gentleman
— Dr. Garde — laid up in bed, quickly furnished the lady with liq.
strychnine, accompanied by the request to his colleagues to inject it
freely. She came back to her husband's bedside, when artificial respira-
tion was about to be given up, but the very first injection rendered it
no longer necessary and two more restored Mr. Johnstone completely.
Saving the life of this highly respected and popular functionary, who
was the first in Queensland treated with the antidote, paved the
way for it in that colony, where it is most needed and is now highly
appreciated.

These five cases, thoroughly typical of the efifects of strychnine
in snakebite, are almost in themselves sufficient to bear out the
correctness of the writer's deductions, but for the benefit of a certain
class of rigorously incredulous scientists, who would not be satisfied
with five cases, the writer submits 45 more and in addition to these

56 CASES.

— last but not least — Dr. Bannerjee's eight Indian cases. They are
all well authenticated, being mostly taken from the Australasian
Medical Gazette or from private notes, but to avoid useless repetition
the greater part of them will be merely cited and only the more re-
markable ones be given in detail. Whether in the face of this
formidable array of evidence that blind incredulity and senseless
opposition, usually blocking the way of every new discovery, will at
last give way, remains to be seen. The writer has had his full share
of them, and but for the valuable aid he received from the Hon. Dr.
Creed, the able editor of the A. M. Gazette, would probably be
struggling yet for the introduction of his antidote. When it is con-
sidered that, in spite of such evidence as here produced, his discovery
has as yet received no official recognition from any of the Australian
medical authorities, and that even now there are medical men who
can write such effusions as that of Dr. T. L. Bancroft, of Brisbane,
beginning with the words : " It is deplorable to still see recorded
cases of snakebite treated with strychnine, &c.," (see Gazette for July,
1892) — the attitude assumed from the first by Dr. Creed and his un-
failing advocacy of the antidote can not be too highly appreciated
and lay both the writer and the public under a debt of deep gratitude
to him. Cut for his early recognition of the soundness of the writer's
theory and treatment of snakebite many valuable lives now saved
would have been lost. As early as June, 1889, Dr. Creed wrote in
an editorial : " We desire to call the special attention of the pro-
fession to Dr. Mueller's papers on the pathology and cure of snake-
bite, published in our issues for Nov., Dec, Feb , April and May
last, and to press upon them the justice and, we submit, the necessity
of extremely careful consideration of his theory and of the results
shown in the cases in which, acting on it, he has used hypodermic
injections of strychnine for the treatment of snakebite. We formerly
expressed our concurrence in the opinion of Sir Joseph Fayrer, who
wrote : ' I do not say that a physiological antidote is impossible, all
I assert is, that it is not yet found.' We are indeed pleased to state
that we believe such an antidote is now found and that Dr. Mueller
is the happy discoverer. We are of opinion that his theory as to

CASES. 57

the pathological changes set up in the human system by the injection
of snake-poison is a sound one and that the treatment he has
suggested and used is correct and proper, and the one likely to avert
death in cases of snakebite, which would otherwise in all probability
prove fatal. We therefore press the use of hypodermic injections
of strychnia in the manner described by him upon the attention of
practitioners who may have to treat cases in which the symptoms
present are the result of snake or dangerous insect poison, and
think that, should the patients die without its having been used, all
will not have been done to save life that might have been." With-
out such utterances repeated from time to time and without the
ample space always allowed in the Gazette to the subject, a record
like that now submitted would not have been possible.

Case 6. — P. Evans, a girl of 20 years, bitten on wrist by a
brown snake. Symptoms — Staggering gait, drowsiness, &c. Only
/gth grain in four injections Notes furnished by Drs. Mahoney and
Kennedy, of Albury.

Case 7. — W. Thiplin, a labourer, bitten on hand by brown snake.
Three injections. Notes by Dr. Baird of Healesville.

Case 8. — Luke Dewhurst, labourer, bitten on hand by tiger
snake. Cured by one injection of m. xv. liq. strychuiae after
ammonia had failed. Notes by Dr. Dutton, of Lillydale.

Case 9. — ^^P. Moroney, labourer, bitten on thigh at night, snake
not identified. Cured by three injections of 12th grain each. Notes
by Dr. Pardey, of Myrtleford.

Case 10. — Mrs. Skinner, bitten on thigh, at Carrum. Treated
by Dr. Verity.

Case 11 — Child of Mr. Weeks, aged three years. Treated by
Dr. Degner, of Myrtleford.

Case 12. — Annie Rankin, servant, at Corowa. Treated by
local chemist.

Case 1 3. — Child of Mr. F. Daniels, of Mount Kent, Queens-
land, only two years old, bitten by a death adder on fourth finger of
left hand, the snake found clinging to finger. Ligature applied and

58 CASES.

finger chopped off, but condition of child very precarious when
admitted to Toowoomba Hospital, after a night's journey, at day-
light, 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, Queens-
land, 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 May town,
Queensland, lad of 19 years, bitten by black snake, symptoms
serious. Four injections of m. xv., xv,, xx., and xv., total 6-5
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 jth of a grain administered sub-
cutaneously, 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 con-
scious, 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

CASES. 59

strychnine. So, ordering strong colfee, I hurried to attend an
accident case just admitted with severe hteraorrhage, 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, T at once injected m. x. of liq. strychnine 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, ray last case, the patient had convulsions. In all of them
I made hypodermic injections of m. xv. liq. strych., and the efifects
were most marked, the patients being completely roused and becom-
ing 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. Kiugsburry, 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

60 CASES.

jaw hanging down and tongue protruding, respiration scarcely per-
ceptible. 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 im-
parted, the bite being on the back of the foot, where the fangs can-
not 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 treat-
ment and decided on injecting liq. stryclmise. 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 IJth 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

CASES. 61

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 Aus-
tralia. 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| hours after bite, having a
long distance to travel. Recovery very slow through timid use of
antidote, five injections of g^^th grain having but little effect, until
one of loth 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 strych-
nine, equal to |^ths of a grain. Dr. Mead, finding the lad conscious
and only a little drowsy, did not inject any more strychnine until

62 CASES.

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 j^ath
of a grain of strychnine, and in a very short time another jUh. 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 con-
gratulate 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,

CASES. 63

Cash 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 ^th 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 intra-
venous 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 in-
jections.

Case 37. — Theresa Byrne, aged 14 years, bitten whilst bathing,
snake not seen. Treated by Dr. Cuppaidge, of Normanby, Queen-
sland. 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, agricul-
tural settlement, Queensland, by a black snake, and treated success-
fully 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

64 CASES.

snake-poison. They were evidently produced by the latter and quite
on a par with those occasionally occurring in man before the strych-
nine 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.

CASES. 65

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 symp-
toms : — 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 strychniaj acetas hypoderinically 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. Symp-
toms as before given.

66 CASES.

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|^ 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. Re-
peated 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 efiect 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 —
iJ 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 halj
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.

CASES. 67

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 riglit foot near the cuboid bone.
The punctures were distinct and the symptoms like those of case 1.
Bleeding was profuse in this case.

Treatment. — Strychnise acetas injected in quarter grain doses
under the skin and repeated as often as desirable. Patient recovered
after the sixth day and took in aWJour grains oj strycli. 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 treat-
ment 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, swoon-
ins 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 Austral-
asian Medical Gazette separately and quite recently, November,
1892. It is, of all his cases, the most important one. He writes:
— " The following case increases tny number to eight, and should
clear away prejudice and prepossessed ideas, as strychnine saved
this case, a bite of Duhoia 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 : "—

68 CASES.

Bahimudden, 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 snake-
bite, 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 under-
stand what was told him ; body cold and covered with perspiration j
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., 12th grain of strychnine in left arm. At 11 p.m., the
same dose ; breathing the same, but no rattle ; stupor rather deepen-
ing; 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

CASES. 69

present ; intolerant to light and noise ; peculiar grin and crarap 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. IJt-th, 10 a.m. — Better, but talking slightly incoherent ;
received another injection of jUh grain of strychnine. 6 p.m.,
better ; had good appetite ; given milk and sago.

Sept. loth, 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. strychnise, equal to
^th 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.

In his remarks on this case Dr. Banarjee, after reporting that
the snake with back broken in two places was brought to him on
the following day from the exact locality where Rahimudden had
been bitten, gives the following description of it : — Head, large and
triangular; nostrils, large and kidney-shaped ; scales, much imbri-
cate, ventral scales 169,' subcaudals 48; confluent, irregular ring-
like, dark brown spots along the back, and with lateral black

70 CASES.

patches or rings with white borders. Tlie head marking very
peculiar double V shaped mark, the angle directed between the
nostrils ; interstitial coloration, yellowish brown, belly white, and
with brown or amber spots ; eyes, large, pupils erect, irides yellow,;
body, stout and compressed laterally ; poison fangs, large and
recurved, size about half an inch. The length of snake was 3 feet
5 inches, and from these characters it was identified to be the chain
viper (Duhoia Bussellii, Gray), the most venomous of Indian vipers.

The total quantity of the antidote in this case administered
was only 110 minims of a one in 120 solution of strychnise acetas,
or {gths of a grain of that drug. Considering the extremely venom-
ous nature of the snake and the large quantities of strychnine
required in some of the previously reported cases of echis and
bungarus bites, the quantity used seems disproportional, but this
evidently is explained by the fact that only one of the fangs perforated
deeply, and at the back of the foot, probably struck the bone before
entering to its full length, the snake thus failing to impart the full
quantity of venom at its disposal.

The chief interest of Dr. Banerjee's cases centres in the fact that
they are mostly viper-bites. They prove conclusively, as do Feok-
tistow's experiments on the lower animals, that the theory of viper-
poison being a blood poison, as asserted in all works on the subject,
is not tenable and must be abandoned. If it effected changes in the
blood, incompatible with life, strychnine, acting solely on the nerve-
centres, could not possibly obliterate these changes within a few
hours or even days On the other hand the successful treatment of
bungarus bite with strychnine places it beyond doubt that cobra-
poison will also yield to it, if fearlessly and vigorously applied.

It is most gratifying to the writer to know from good authority
that Sir Joseph Fayrer,the President of the Medical Board at the India
office, has recommended to the English Government the adoption of
the strychnine treatment of snakebite in India, and that this adoption
will not be subject once more to the doubtful result of experiments on
the lower animals, which, according to newspaper reports, were con-

Cases. 71

templated at Calcutta as a test. It would have been deplorable to
see more precious time lost in these experiments, whilst the only
proper subjects for experiments, the unfortunate natives, are perishing
by thousands. The step taken by Sir Joseph Fayrer does honour
both to his head and his heart, and if his recommendation is accepted
and vigorously carried out it will still further increase the debt of
gratitude which India owes to British rule, and with regard to its
terrible snake plague, to the one Englishman who of all others has
distinguished himself by an almost life long study of the subject and
indefatigable labours for its alleviation.

Her Majesty the Queen has also been pleased
most graciously to interest herself in this subject.
MenioriaUsed by the writer before Sir J. Fayrer's
recommendation to the British Government, above
alluded to, was known to him, our gracious Sovereign,
ever intent on the welfare of her subjects, has resolved
on having the writer's method thoroughly tried in
India, and communicated this her intention to him in
a despatch from the Secretary of State for the Colonies
to His Excellency the Governor of Victoria, dated
nth Nov., 1892, inviting him, at the same time, to
forward any proposals he may have to make direct to
the Secretary to the Government of India in the
Home Department ; and thus adding one more to the
many noble deeds that mark her benevolent, long, and
glorious reign.

UNSUCCESSFUL CASES.

Considering the newness of the strychnine treat-
ment it would be folly to expect that the conditions
necessary to insure success should have been observed
in every case, and that every practitioner should at
once have made himself familiar with it and the theory
on which it is founded. Hence a few failures were un-
avoidable. Of these a record has been kept, but for
obvious reasons the writer withholds it here. To give
names and dates would be invidious, though the
opponents of the treatment have exultingly pointed to
the few deaths that have occurred as palpable proofs
of its uselessness, some of them even going so far as to
ascribe these deaths to the direct action of the antidote.
There is, however, not a single case on record, in
which death took place under strychnine-convulsions.
All the patients died under palpable symptoms of snake-
bite-poisoning. As these symptoms have now been
proven beyond all doubt to yield to strychnine, when
properly administered, the inference that it was not so
administered in the cases referred to becomes not only
j astifiable, but unavoidable. In one case only, that of
a child of tender years, blood was vomited so copiously
that death may be ascribed to that cause and the
snake-poison combined, but in all the other six fatal

UNSUCCESSFUL CASES. 73

ones, mostly of children, it was undoubtedly due to the
snake-poison not being properly checked by the anti-
dote. The gentlemen who officiated on these occasions
were evidently not Banerjees, but the very reverse of
their Indian confrere. They do not appear to have had
very clear ideas of the absolute antagonism existing
between the two poisons, and entirely disregarded the
most important point in the treatment, namely, the
necessity of administering the antidote until it has
completely subdued the snake poison, regardless of the
quantity that may be required for that purpose. In a
few instances the treatment was correct enough at first,
but when, as is often the case, a relapse took place
after the patient had apparently recovered, the large
quantity of the antidote already administered appears
to have given rise to the erroneous notion that it
would be useless to resort to it a second time, and thus,
through this error and the fear of strychnine-convul-
sions, the patients were allowed to die. In most of the
six fatal cases collected by the writer, however, the
doses and total quantities given were altogether inade-
quate to cope with the poison. They did probably
more harm than good, for the snake-poison when only
partially checked by strychnine seems to renew its
onslaught on the nerve-cells even more insidiously
than when not interfered with at all Convulsions
also, as shown in cases, are sometimes called forth by
this timid use of the antidote.

A few instances will show the correctness of these
observations. Thus an old woman sleeping in a shed

74 UNSUCCESSFUL CA.SES.

is awakened at daylight by a tiger snake having
fastened on to her wrist. She pulls off the snake,
alarms the neighbours, and a doctor, living only a mile
away from the place, is sent for. He appears on the
scene four hours afterwards, when complete coma and
collapse has set in, makes two injections of gr. i\ each,
which of course had no effect and the patient is allowed
to die without any further effort on the part of her
medical attendant. Case 2. — A boy of 10 years is
admitted to a N. S. Wales hospital in a state of com-
plete collapse, barely alive, having been bitten by a
brown snake 22 hours before admission. Instead of a
rousing injection of at least 15 minims and the same or
smaller ones repeated at short intervals, he receives
only 5 minims of liq. strychnise P.B. every twenty
minutes, when death was imminent, and dies 65
minutes after admission. Case 3 is also that of a boy
in an hospital. He is admitted fully conscious and
apparently but slightly under the influence of snake-
poison, for a five minims injection is reported to have
removed the symptoms. On the following day, how-
ever, he became comatose, and instead of having the
antidote freely administered, gets only one more injec-
tion of five minims and dies in coma. Case 4 is even
worse. A little girl of 3 years, bitten by a tiger snake,
receives three minim injections every half -hour, and
after three of them, whilst in a state of complete coma,
gets convulsions. These are attributed to the strych-
nine, which thereupon is withheld, the finale being
death in coma.

UNSITCCESSFUL CASES. 75

There can be lio doubt that in all these cases life
could have been preserved under a more energetic
treatment. Hereafter, when theory and treatment
are better understood, and when officialdom has seen
fit to issue instructions as to the proper treatment of
snakebite to medical practitioners, such cases as those
cited will be put down as malpractice and have to be
accounted for. Until then the guardians of the health
and the lives of her Majesty's subjects, and a certain
portion of the medical press of Australia, superciliously
and persistently ignoring the subject, are more respon-
sible for the lives lost than the busy country practi-
tioner, who may not have had time or opportunity to
inform himself thoroughly on a comparatively new
subject, more especially at a period when Banerjee
had not yet taught us that in administering strychnine
as antidote to snake -poison we can venture into grains
of it with impunity.

Since the above chapters were put in proof, the
writer has seen a fatal case of tiger snake bite, con-
veying two lessons of such interest and importance
that it must be placed on record here. It illustrates
in an extraordinary and forcible degree the erratic,
capricious, and insidious course the snake-poison takes
at times.

A handsome girl of 17 is bitten in a bathroom on
the back of the second right toe at dusk on a Sunday
evening by a half-grown tiger snake, subsequently
caught and killed in the room. She does not suspect

76 UNSUCCESSFUL CASES.

snakebite, and no ligature is applied until the poison
has been absorbed and overpowers her. Instead ot
sinking into coaia, she becomes unconscious for a short
time only. Her brain then clears itself, and all symp-
toms seem to disappear so completely that when a
medical man of undoubted ability and skill sees her a
few hours after the bite, she declares herself quite well
again, and does not appear to require any treatment,
least of all that by strychnine injections. She passes
a good night, but on Monday morning symptoms de-
noting paresis of the respiratory and glosso-pharyngeal
centres make their apj^earance, almost identical with
those described by Indian writers as following cobra-
bite. She has difficulty in breathing and swallowing,
but one injection of i^o^h of a grain removes it com-
pletely and speedily, and once more all danger is
thought to be past. On Monday evening, however,
dyspnoea and dysphagia appear again in an aggravated
form. The urine also becomes scanty and loaded with
albuminates Strychnine now is again resorted to, but
it fails to act as before, and from hour to hour the
young lady's condition becomes more critical. When
the writer reached her on Tuesday afternoon, 42 hours
after the bite, paralysis of the centres named was
imminent, and her case appeared a hopeless one, unless
a vigorous use of strychnine yet turned the scales in
her favour. One-tenth grain doses were therefore
injected every half-hour, and continued until the
physiological action of the drug showed itself. This
took place, but failed to have the least effect on the

UNSUCCESSFUL CASES. 77

affected centres, and complete paralysis ensued 45
hours after the infliction of the fatal bite.

The first lesson the Australian practitioner should
learn from this sad case is that of extreme care and
caution in dealing with any case of snakebite, no
matter how slight it may appear at first sight. It is
not for the first time we have been taught this lesson,
though it has rarely, if ever, been conveyed in so
singular a manner. Recent utterances about the
innocuousness of Australian snake-poison find a fitting
answer in this melancholy occurrence.

The second lesson it conveys is a new one, even
to the writer. From the fact of one strychnine injec-
tion removing all poison-symptoms early on Monday,
but the free use of the antidote failing entirely to have
this effect on Monday night and on Tuesday, we are
warranted to draw the conclusion that the antidote
can only be relied on within the first 24 hours after
the bite ; and that, after this period, the snake-poison
produces organic changes in the afiected nerve-cells,
preventing their depressed functional activity from
being restored by the antidote. Further observations,
of course, are required to confirm these conclusions.
Their correctness, however, appears to be borne out
by the fact observed by the writer, that the larger
domestic animals, who sometimes linger on for days
after being bitten by a snake, usually recover under
the strychnine treatment if it is applied immediately
or soon after a bite, but die when found and treated in
an advanced stage of the malady.

78

UNSUCCESSFUL CASES.

That the grave kidney complication, checking the
ehmination of the poison from the system, mihtated
against recovery in this case, and greatly influenced
the singular course of the poisoning process, cannot be
doubted.

CONCLUSION.

In the little work submitted herewith to the
medical profession and the general public, for both of
whom it is intended, the author may justly claim to
have solved the difficult and long-standing problem of
snake-poison. We have at last a correct theory of its
action, and, what is of more importance to the public,
we have an effective antidote. These facts, being as fully
established in these pages as any scientific facts can
be, the most exacting and even captious criticism
will not upset, nor can further research add anything
very material to the writer's deductions and their final
result.

In order to show how an obscure Australian
country practitioner succeeded in a discovery, for
which all his predecessors in this field of research had
laboured in vain, it will be necessary in conclusion to
give a short history of the discovery as by slow
degrees it has originated and matured in the writer's
mind, who during the last 35 years with respect to
this subject had followed the advice which Schiller
gives in his grand poem, " Die Glocke :" —

Wer etwas Treffliches leisten will,
Hatt' gem was Grossesgeboren,
Der sammle still und unerschlafft
Im kleinsten Punkte die gros^^te Kraf^,

80 CONCLUSION.

which, translated into Enghsh, means that whoever
aims at any great achievement must quietly, but
indefatigably, concentrate the highest force on the
smallest point. Now this smallest point has to the
writer been snake-poison from the very commencement
of his Australian career. When yet a new-chum, a
vigorous tiger snake gave him the first lesson on the
action of the insidious venom which nearly cost him
his life, but afforded some valuable glimpses into the
mystery of snakebite — in fact, gave him the key to
unlock that mystery. On analysing the horrid sensa-
tions he had experienced before he lost consciousness,
and even after regaining it, he saw " depressed nerve-
action, emanating from the central nervous system,"
written on the ffice of every one of them, so much so
that this became the foundation and corner stone of
his present structure, which, however, it took him a
quarter of a century to erect ; for the material he
required, namely, cases of snakebite observed from an
early stage, and from which all disturbing elements
were excluded, did not occur very frequently in his
practice. Though he lived all the time among moun-
tains, the beautiful Australian Alps, on the rivers and
creeks of which snakes are abundant, and though these
creatures and anything connected with them had an
almost fascinating interest for him, years sometimes
elapsed without adding one single good case to his
notes. Sometimes his patients were dead when he
reached them, and all his entreaties for an autopsy
were in vain with the relatives. More frequently he

CONCLUSION. 81

found that they were not bitten at all, and only Ksuffered
from the effects of fear or of enormous doses of alcohol.
On persons really bitten, but completely paralysed
and comatose, observations were also unsatisfactory, as
they had to be supplemented by second-hand evidence
obtained from those who had been with them before
they became unconscious. Thus within 25 years the
author did not see more than half-a-dozen really
instructive cases ; and frequently his desire for more
evidence overcame his reluctance to inflict on animals
the agony of snakebite he had himself endured, and
he made a few experiments, but soon gave them up
again as unsatisfactory. All the evidence, however,
he had thus far collected tended to confirm the correct-
ness of his ideas as to the action of snake-poison. At
last, some ten years ago, he obtained absolute certainty,
and this, strange to relate, by a case of spiderbite.

He was called early one morning to visit a little
boy, two years old, and on examination found that he
presented symptoms almost identical with those of
snakebite poisoning. Although there was no evidence
of the child having come in contact with a snake, the
writer naturally concluded that during the night a
snake had obtained access to the bedroom through the
open door or window, and after biting the child
sleeping in its low cot, had escaped again. He
therefore searched most carefully for the usual two
punctures, but they were not to be found. The child
evidently laboured under the effect of some poison,
and spiderbite suggested itself, but the symptoms

82 CONCLUSION.

were so much more aggravated than anything the
writer had frequently seen of spiderbite that he
hesitated to accept it as the cause, although it
appeared almost the only possible one. A careful
inquiry into the history of the case elicited from the
mother the important fact that on the previous after-
noon the little fellow, just able to toddle about, had
gradually lost the use of his legs, and also become
very peevish, and that suspecting nothing but a little
temporary indisposition, she had put him to bed, to
find him in the morning all but dead. He was
scarcely breathing when the writer saw him, and only
the stethoscope gave evidence of the heart still
beating feebly. His body was very cold, pupils
widely dilated, and the sight even apparently gone,
the eyes wide open, staring fixedly upwards and not
noticing a lighted match in closest proximity to them.
Consciousness also appeared extinct, as liquids intro-
duced into the mouth were not swallowed. Examining
once more for traces of spiderbite in the skin, the
writer noticed faint red stripes extending up the arm
from a little cut on the right index finger near the
nail, and on inquiry it was ascertained at last from an
elder brother that he had seen the child pick up a
little black spider with a red back, hold it for some
time between thumb and index finger, and then throw
it away. This was evidently the Katipo (Latrodcctus
icelio), the poison of which acts on the same principle as
snake-poison, but generally much milder. The greater
severity of its action in this case was accounted for by

CONCLUSION. 83

the mandibles having been inserted into the cut, and
the insect, being squeezed by the child, having
emptied the whole available contents of its poison
gland into the cellular tissue exposed in the cut,
whence it was quickly absorbed. This also accounted
for the absence of all irritation and of the neuralgic
pains usually accompanying spiderbite, when the
mandibles merely perforate the epidermis and the
poison is deposited in the upper cutis, where absorp-
tion is slow and local irritation consequently greater.

Minuteness of detail in relating this case must be
excused on account of the extreme interest and import-
ance attached to it. Being brought about under such
peculiar and almost unique circumstances it presented
the effects of spider-poison in a superlative degree and
showed them to be identical with those of snake-
poison. But whilst the latter ushers in the symptoms
with such rapidity that they cover each other and are
difficult of separate analysis, in this case the highly
significant paresis of the lower extremities, evidently
of central origin, remained separate for some time.
Taking this symptom for his guide and interpreting
the formidable array of the others, developed during
the night, on the same principle, the writer's diagnosis
of the case, as it presented itself to him, was paralysis
of the motor and vaso-motor nerve-centres. This, he
found, and this alone could explain all the symptoms,
and he therefore determined to put its correctness to a
practical test. There was but one remedy to make
this test with and this had to be applied without delay,

84 CONCLUSION.

for the child was rapidly sinking and had almost ceased
to breathe. One twelfth of a grain of strychnine was
therefore injected in the arm, a bold dose for so young
a child, but, as the result showed, exactly the one that
was required. The test was eminently successful.
Having to leave the child immediately after the injec-
tion, the writer on returning in half an hour found his
little patient sitting up in bed, perfectly restored, with
both poisons so completely neutralising each other,
that not a trace of either could be detected. Thus
the writer's structure was at last completed, and an
insignificant spider furnished the last material required
for an important discovery.

There are a few hypothetical points yet in the ex-
planation of some of the symptoms of snakebite-
poisoning by the writer's theory, but these imperfec-
tions are more those of science than of the theory.
The whole subject of vaso-motor paralysis for instarice,
and of the pathological changes that follow it, is more
or less a terra incognita. Diapedesis is now supposed
to be the result of blood pressure, but it occurs in
snakebite, when blood pressure is at zero. Feoktistow,
we have seen, produced it locally on the mesentery of
animals with normal blood pressure, whilst Banerjee
arrested by strychnine-injections profuse haemorrhages
from all the mucous surfaces, which were no doubt the
result of diapedesis. We know that neither snake-
poison nor strychnine affect the nerve ends but only
the nerve cells. There must therefore be nerve cells
at or near the terminations of the nerves regulating

CONCLUSION. 85

the capillary circulation in the mucous membranes, but
microscopical anatomy has yet to find them, for minute
gangha have only been discovered at present in sympa-
thetic nerve ends of the abdomen.

On other subjects also, besides that of vaso-motor
paralysis, the strychnine treatment of snakebite has
thrown an unexpected light. We did not know before it
was demonstrated by this treatment that sleep is merely
a reduced discharge of motor-nerve force, a partial
turning off of the motor-batteries, by which, through
rest, they are invigorated for fresh action during the
waking hours, and that the degrees of this reduction
range in their effects from sleep, more or less deep,
down to coma, and can be raised again from coma to
sleep, and from sleep to complete wakefulness. We
knew that every movement and action is brought
about by a discharge of this force, but we did not know
that even the silent thought must be carried on the
wings of it, and cannot take place without it, at least
not in our present state of existence. All these im-
portant revelations are now the property of science,
and it will be well for science to take note of them.

In conclusion, the writer may be permitted to
express his joy and thankfulness for having been made
the instrument, by Divine Providence, to confer a
boon on humanity that will prevent much suffering and
thousands of premature, untimely deaths.