On Snake-Poison: its Action and its Antidote Part 2

The sensory sphere remains comparatively unaffected 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. Reflexes, both superficial and deep ones, are also completely abolished at this period of the poisoning process, 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 like the purest air, whilst p.r.i.c.king, 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, differ 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 symptoms, 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 present. Some of these puzzling variations have already been alluded to, but it is necessary to consider them a little more in detail. Apart from quant.i.tative differences in the poison imparted, they arise princ.i.p.ally from the strange capriciousness with which the poison 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 foregoing pages, we find in Australia after the bite of the tiger snake (_Hoplocephalus 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 p.r.o.nounced, 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.

If we turn from these to the black snake (_Pseudechis 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 a.s.sistance 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 anaemic 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 fainting 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 generally much extravasation of blood locally. Muscular paralysis is also less p.r.o.nounced, 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.

If we turn from Australian to Indian snakes, the peculiar tendency of the poison 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 strange 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 reduction 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 circ.u.mstances, make such a capricious selection among the various motor nerve-centres we can not explain and probably never will. Chemical a.n.a.lysis 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 a.n.a.lyst. We have to do with a poison transferred from one living organism into another one and modified in its action by the condition of the giver and the const.i.tution and peculiarities of the recipient quite as much probably as by slight variations in its chemical composition. Accepting the "why" of these phenomena like that of 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 convulsions 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.

[Ill.u.s.tration]

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 pa.s.sed 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 connection with 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 without interfering with their structure, you must be able to counteract it by administering some drug or substance which acts as a powerful stimulant on these cells, if such a substance can be found."

It is another ill.u.s.tration 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 application as the long and vainly sought antidote to snake-poison, are glorious triumphs of scientific deduction.

Strychnine is the exact ant.i.thesis 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, a.s.sume 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 following it as an antidote, turns them on again, acting with the unerring certainty of a chemical test, _if administered in sufficient quant.i.ty_. Purely physiological in its action, it neutralises the effects of the snake-poison, and announces, by unmistakable symptoms, when it has accomplished 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 antidote _par excellence_ of snake-poison, and cannot be surpa.s.sed 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 important 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 quant.i.ty 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 quant.i.ty. Even slight tetanic convulsions, which were noticed in a few cases, invariably pa.s.sed off 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 pract.i.tioner after injecting as much strychnine as he deems safe stands idly by waiting for its effects, the snake virus, not checked by a sufficient quant.i.ty of it, continues its baneful work, drawing the blood ma.s.s into the paralysed 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 quant.i.ty that may be required to develop symptoms of its own physiological action, the doses in which it is injected and the intervals between them must be left to the pract.i.tioner's judgment, as they depend in every case on the quant.i.ty of snake-poison absorbed, the time elapsed since its inception 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. strychnine 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 quant.i.ty 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 symptoms 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 antidote is not c.u.mulative, 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, should be felt by medical men in other snake-infested countries to adopt the Australian treatment. It is seldom that more than half a grain of strychnine administered in 16m. doses of liq. strychniae 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 quant.i.ty 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 quant.i.ty of poison will probably be absorbed requiring much larger quant.i.ties of the antidote, 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 1/15th to 1/10th of a grain, but under all circ.u.mstances the rule that, distinct strychnia symptoms must be produced before the injections are discontinued, 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 as compared with that most insidious condition exemplified in case No. 1, cited below, the first one treated with strychnine by the writer, who, having no experience 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 succ.u.mbed 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 re-a.s.serts its presence, and has to be met by such fresh injections, regardless of the quant.i.ty of strychnine previously 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 quant.i.ties 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 apply them fearlessly by injecting what to us Australians appear enormous quant.i.ties, 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 Russellii 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 quant.i.ty 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 comparatively small doses of the antidote, and can see no reason why a more energetic use of it should not restore them in India.

Considering the terrible mortality 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 Australian 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.

[Ill.u.s.tration]

CASES.

If the deductions and conclusions set forth in the foregoing chapters are correct, it may be justly contended 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 quant.i.ty--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 quant.i.ty--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 in none of them would 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 pa.s.ses 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 the 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. Only 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 conspicuous. 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 antidote is not thrown out of the system as quickly as the strychnine, and is therefore apt to re-a.s.sert 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 gra.s.s, 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 suddenly fell forward as if in a swoon. Injected 1/6th grain of strychnine and, as she did not lose consciousness, was able to watch the interesting and rapid effect 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 eliminated by the prompt measures taken before he saw her, he injected only 1/12th of a grain, which produced slight muscular spasms. 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 (_Hoplocephalus curtus_), treated with strychnine, were read by Dr. Thwaites before the Intercolonial Medical Congress of 1889.

This gentleman, a young pract.i.tioner 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.

CASE 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 neighbour'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 liq. 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 liq. strychniae, which in a short time brought him round; but at 9.15 another relapse took place, when a third injection of 15 m. was made.

This was followed by slight twitching 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 surgery, 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 schoolgirl, 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 administered, 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. strychniae. In about two minutes she sighed, and then began to breathe 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 relapse, 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 Queensland, 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 much 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 superciliosa_), 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 Mrs Johnstone rushed to a fourth one, who had seen Dr. Thwaites'

letter, and discussed its contents with her husband in her presence. This gentleman--Dr. Garde--laid up in bed, quickly furnished the lady with liq. strychniae, accompanied by the request to his colleagues to inject it freely. She came back to her husband's bedside, when artificial respiration 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 effects 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 cla.s.s of rigorously incredulous scientists, who would not be satisfied with five cases, the writer submits 45 more and in addition to these--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 repet.i.tion the greater part of them will be merely cited and only the more remarkable 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 considered 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 att.i.tude a.s.sumed from the first by Dr. Creed and his unfailing advocacy of the antidote can not be too highly appreciated and lay both the writer and the public under a debt of deep grat.i.tude to him. But 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 profession to Dr.

Mueller's papers on the pathology and cure of snakebite, 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 a.s.sert 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 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 pract.i.tioners 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." Without such utterances repeated from time to time and without the ample s.p.a.ce 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 1/16th grain in four injections. Notes furnished by Drs. Mahoney and Kennedy, of Albury.