On Snake-Poison: Its Action and Its Antidote

Chapter III: Part 3

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CASES 41 AND 42, reported by Dr. Helsham, of Richmond, N.S.W. In
one of these where, judging from the symptoms, a large dose of
snake-poison had been absorbed, but very small doses of strychnine
were injected, convulsions set in, _whilst coma was still
present_, and lasted for two hours. Though semi-tetanic in
appearance they were erroneously ascribed to m. xxvi. of liq.
strychniae, which at the time of their appearance had not removed
the symptoms of snake-poison. They were evidently produced by the
latter and quite on a par with those occasionally occurring in man
before the strychnine is administered, and almost invariably in
dogs. As long as coma is present with other symptoms denoting the
snake-poison to be in active operation, such convulsions rather
call for the antidote, than contra indicate its use, for the
strychnine never produces them until it has completely conquered
the snake-poison, and even then they are always preceded by local
spasms and never set in suddenly. Timid medical men, when
administering the antidote and anxiously watching for the dreaded
strychnine effects, are too apt to see them in the slightest
irregular muscular action.

CASE 43, reported by Dr. Johnson, of Avoca, patient bitten by a
tiger snake, was comatose, pulseless, with very shallow
respiration, &c., and restored by three injections of m. xvi., xv.
and x. within less than three hours.

CASE 44.--Reported in _Australian Journal of Pharmacy_, from
Tasmania, treated by Dr. Tofft, of Campbell Town. The report
concludes: We have had some fatal cases of snakebite already this
season, and the successful treatment in the above case has created
a strong feeling in favour of strychnine in such emergencies.

CASES 45 TO 49.--Reported by Dr. Alex. Barber to _A.M. Gazette_.
He writes: "During the last year I treated four cases of snakebite
successfully with strychnine. In one of these, a bite of a brown
snake, I injected three doses of m. xx. each of liq. strych. P.B.,
in all over half a grain, in one hour."

CASE 50.--Reported by Dr. Barrington, of Benalla (Vic.), bite of
tiger snake, symptoms moderate. Completely removed in three hours
by 57 minims of liq. strych. P.B.

_Notes of eight cases as reported to the "Australasian Medical
Gazette" for July and November, 1892, by R. P. Banerjee,
B.A., G.B.M.S.L., Medical Officer, Salt Mines, Pachhadra,
Rajputana, India_:--

CASE 1.--Bhagwan Singh, aged 30, Hindu male, Sepoy, E. T. Force,
was bitten by a viperine snake (_echis carinata_) at 4 p.m. 10th
June, 1892, in the dorsum of left foot. He was removed to the
hospital, tight ligature applied, and with the following
symptoms:--Heaviness of both legs, staggered if allowed to walk,
giddiness, sense of sinking at the pit of the stomach, bleeding
from mucous surfaces and old scars; soon fell swooning.

Treatment.--The punctures incised, and blood let out, one-twelfth
of a grain of strychniae; acetas hypodermically injected. Again,
the insensibility not gone after 30 minutes, another dose given,
and so repeated the third time. The _bleeding stopped_ and the man
recovered his senses, but could not raise himself to talk. Many
more doses were given under the skin, with hour intervals, and the
man recovered the next day; but he was much exhausted and treated
for weakness three days, and discharged to duty on the 14th.
Punctures were distinct, symptoms well developed. Took _one and a
half grains_ of strychnine to effect cure, leaving no after
effects of the drug or poison.

CASE 2.--Sadig Husain, a Mussulman boy, aged 12 years, bitten on
the right ankle, just below the inner malleolus, by _echis
carinata_ (Khapar) on the 5th August, 1891, brought in with usual
symptoms, as before.

Treatment as before. This case took only one-fourth grain of
strych. acet. The boy was weak and sickly. He was discharged cured
on the third day, _i.e._, 17th August, 1891.

CASE 3.--Nathey Khan, Mussulman, customs peon, aged 35 years,
robust and strong, bitten by _echis carinata_ (yellow variety).
Punctures were on the left ankle, over the outer malleolus.
Symptoms as before given.

Treatment as before stated. This case took as much as one and
three quarter grains of strych. acet. Was admitted on the 9th
August, 1891, and discharged on the 12th August, 1891, cured and
fit for duty.

CASE 4.--Musamat Jewai, Hindu female, a labourer, age 40, strong
built. Bitten by kerait (_Bungarus coeruleus_), about 2-1/2 feet
long, above the left knee joint; ligature below the hip was used,
but all the symptoms were present and the patient was insensible.
Cyanotic marks were seen on the arms, abdomen, back and neck. At
first all hopes of recovery were given up, but attempts were made
to see if anything could do good.

Treatment.--Punctures scarified and cupping applied. Repeated
doses of strychnine acetas hypodermically given, but in _quarter
grain_ doses. It seemed marvellous. The cyanotic patches in the
skin gradually faded away and the body became warmer. It was
wondered if the person had expired, but suddenly the woman called
for a drink of cold water to bathe her dry and parching mouth.
This was done and she recovered sense. She was admitted on the 3rd
September, 1891, and discharged on the 10th. Took _three grains_
of acetate of strychnine to effect a cure.

CASE 5.--Paroati Devi, Hindu female, aged 67 years, healthy
constitution. Bitten on big toe of left foot on 10th September,
1891, symptoms were as preceding. The wound was cauterised.

Treatment.--Strychnia was given very cautiously, as the patient
was over-aged, the degeneration of the heart kept in view--1/10
grain eventually showed the peculiar strychnine symptoms. The
patient was cured in two days and discharged cured on the third
day, 14th September, 1891. This patient took in all _one and a
half grains_ of acetate of strychnia.

CASE 6.--Maya Swuper, aged 38 years, bitten by echis carinata
(without dots) on the lower third of the left leg, on the outside
of it. Mucous membrane of the mouth, eyes, nostrils, ears, and
urinary passages all bled profusely. Urine had clots in it and
symptoms resembled those in the first case.

Treated with strychnine and recovered in four days. Was admitted
on the 14th September, 1891, and discharged to duty on the 18th
September, 1891. Took in all _three grains_ to effect cure.

CASE 7.--Avghunandan, customs semadar, aged 55 years, Hindu male.
Bitten at 8 a.m. on the 29th March, 1892, by echis carinata (brown
variety) on the right foot near the cuboid bone. The punctures
were distinct and the symptoms like those of case 1. Bleeding was
profuse in this case.

Treatment.--Strychnine acetas injected _in quarter grain_ doses
under the skin and repeated as often as desirable. Patient
recovered after the sixth day and took in _all four grains of
strych. acet._ in six days. Only the bitten leg had erysipelatous
inflammation, which had to be treated afterwards, but the man was
quite safe.

Remarks.--In connection with echis bites one peculiar symptom was
always noticed, namely, the free oozing of blood from mucous
surfaces and old scars of wounds. The power of co-ordination was
very much affected from the first setting in of other symptoms.
Usually after 24 hours symptoms showed a relapse. In the treatment
with strychnia neither the symptoms of the drug nor of the
snake-poison ever showed themselves afterwards. Both seemed to
neutralise each other. Bungarus coeruleus, or kerait-bite, had its
own peculiar symptoms of cyanotic patches and insensibility,
swooning and stertorous breathing. The true comatose state was not
present in any, but only a slight one noticed in cases 4 and 5.
The other cases were generally delirious in the beginning.

CASE 8.--Dr. Banerjee communicated this case to the _Australasian
Medical Gazette_ separately and quite recently, November, 1892. It
is, of all his cases, the most important one. He writes:--"The
following case increases my number to eight, and should clear away
prejudice and prepossessed ideas, as strychnine saved this case, a
bite of _Duboia Russellii_. This snake is admitted by all hands to
be virulently poisonous, and the poison is said to be even more
virulent than that of the dreaded cobra:"--

_Rahimudden_, aged 43, Mussulman, customs peon, admitted for
treatment of snakebite on the 13th September, 1892, at 10.45 p.m.,
to the North India Salt Revenue Hospital, Pachhadra, Rajputana,
India, and put under my treatment.

_History of the Case._--The man is of strong build and healthy
constitution. While on duty he went round the salt pit, near his
beat. Suddenly he felt a prick on his foot, and, suspecting
snakebite, struck out with a bamboo stick he carried in his hand,
and heard the snake make a loud noise. He at once tore a piece of
cloth from his turban, and tied it tightly above the right ankle
joint round the leg, then tried to kill the snake, but could not
do so with certainty, as it was dark. He reported the case to his
superiors, and was carried to the hospital. Bitten at 9.30 p.m.;
admitted at 10.45 p.m.

_Present Symptoms._--Patient was delirious, and could not
understand what was told him; body cold and covered with
perspiration; breathing hurried, with a low rattle at the end of
expiration; mouth, tongue, and palate all dry; tongue leather-like
and cracked, and felt cold; tickling of throat, not exciting
vomiting; pupils dilated; conjunctiva congested; pulse 95; patient
talked, or rather muttered, with difficulty; could not tolerate
strong light or loud noise; the mucous membrane of the mouth
showed irregular dark patches of ecchymosed blood.

The right foot was swollen, and in a line between ankle and
knuckle of big toe showed two punctures--one deep and bleeding,
and surrounded by ecchymosis; the other one below this, more
superficial, the blood oozing thin and not coagulating. Received,
at 10.45 p.m., 1/12th grain of strychnine in left arm. At 11 p.m.,
the same dose; breathing the same, but no rattle; stupor rather
deepening; incoherency increasing. At 11.15, the same dose;
breathing easier; stupor the same; pulse, 85; temp, 97.6;
delirious at times, and moaning with inarticulate cries; could not
hear when spoken to in loud voice. 11.30 p.m., the same dose; no
change in condition. 11.45 p.m., the same dose; stupor now fading
away; delirium present; intolerant to light and noise; peculiar
grin and cramp in face-muscles when attempting to talk; temp,
95.8; pulse very hard; intense thirst; less bleeding from
punctures and blood thicker. 12 p.m., the same dose; no stupor
now, but cramps in lower extremities; no incoherency; only
occasionally uneasy and senseless for a moment, and then rising
suddenly like one startled when sound asleep. 12.30 a.m., no
further symptoms; bleeding stopped; great thirst; eyes red and
glaring; saccharine drinks given; no injection. 3 a.m., no sleep,
but only slight slumber; no pain in foot; no bleeding;
temperature, 98.8; thirst unabated; only drinks given.

_Sept. 14th, 10 a.m._--Better, but talking slightly incoherent;
received another injection of 1/12th grain of strychnine. 6 p.m.,
better; had good appetite; given milk and sago.

_Sept. 15th, 6 a.m._--Better. 6 p.m.--Better; had three motions,
rice and milk diet given, slept soundly between 10 a.m. and 2
p.m., no redness in eyes, swelling of foot abated.

_Sept. 16th._--Better, only complaining of heaviness in head. At 9
p.m. had a fit of stupor all of a sudden, became insensible, and
commenced to bleed again from the mucous membrane of mouth and
nose. The patient became almost insensible, and could only be
roused with difficulty. Twenty minims of liq. strychnine, equal to
1/6th grain, were now injected into the right arm.

_At 9.20_ stupor had passed away and consciousness was fully
restored. From this time onward convalescence was uninterrupted,
and patient was discharged cured on the 20th Sept., 1892.

In his remarks on this case Dr. Banerjee, 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
imbricate, ventral scales 169, subcaudals 48; confluent, irregular
ring-like, dark brown spots along the back, and with lateral black
patches or rings with white borders. The 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 (_Duboia Russellii_, _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 strychniae acetas, or
11/12ths of a grain of that drug. Considering the extremely
venomous 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
Feoktistow'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 contemplated 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. Memorialised 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 11th 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 treatment 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 unavoidable. 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 snakebite-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 justifiable, 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 ones, mostly of children, it was undoubtedly due to the snake-poison not being properly checked by the antidote. 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-convulsions, 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 inadequate 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 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. 1/15 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 complete 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. strychniae 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, however, he became comatose, and instead of having the antidote freely administered, gets only one more injection 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 strychnine, which thereupon is withheld, the finale being death in coma.

There can be no 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 responsible for the lives lost than the busy country practitioner, 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, conveying 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 snakebite, and no ligature is applied until the poison has been absorbed and overpowers her. Instead of sinking into coma, she becomes unconscious for a short time only. Her brain then clears itself, and all symptoms 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 denoting paresis of the respiratory and glosso-pharyngeal centres make their appearance, almost identical with those described by Indian writers as following cobra-bite. She has difficulty in breathing and swallowing, but one injection of 1/10th of a grain removes it completely 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 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 injection 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 affected 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.

That the grave kidney complication, checking the elimination of the poison from the system, militated 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,
Haett' gern was Grossesgeboren,
Der sammle still und unerschlafft
Im kleinsten Punkte die groesste Kraft,

which, translated into English, 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 sensations 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 face 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 mountains, 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 found that they were not bitten at all, and only suffered 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 correctness 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 spider bite.

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 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 afternoon 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 introduced 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 (_Latrodectus 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 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 absorption is slow and local irritation consequently greater.

Minuteness of detail in relating this case must be excused on account of the extreme interest and importance 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, 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 injection, 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 explanation of some of the symptoms of snakebite-poisoning by the writer's theory, but these imperfections are more those of science than of the theory. The whole subject of vaso-motor paralysis for instance, 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, where 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 the capillary circulation in the mucous membranes, but microscopical anatomy has yet to find them, for minute ganglia have only been discovered at present in sympathetic 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 important 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.

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On Snake-Poison: Its Action and Its AntidoteChapter III: Part 3

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