Part 5

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 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 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 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 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-assert 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 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 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.

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. strychniæ, 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. strychniæ. 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. strychniæ, 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 class 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 repetition 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 attitude assumed 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 gratitude 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 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 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." Without 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 1/16th 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. strychniæ 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 1/12th 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 13.--Child of Mr. F. Daniels, of Mount Kent, Queensland, only two years old, bitten by a death adder on fourth finger of left hand, the snake found clinging to finger. Ligature applied and finger chopped off, but condition of child very precarious when admitted to Toowoomba Hospital, after a night's journey, at daylight, in complete collapse. Pronounced out of danger by Dr. Hunt, the house-surgeon, at 10.30 and taken home in the afternoon. Notes not furnished.

CASE 14.--Reported by Dr. Pain, of Allora, Queensland. Symptoms serious. Four injections of m. xv., x., viii. and vii.

CASE 15.--Reported by Dr. Garde, of Maryborough, Queensland, girl of 13 years, bitten by brown snake, requiring only two injections of m. xv. and x.

CASE 16.--Reported by Dr. St. George Queely, of Maytown, Queensland, lad of 19 years, bitten by black snake, symptoms serious. Four injections of m. xv., xv., xx., and xv., total 65 minims of liq. strych. P.B. injected within less than two hours, muscular spasms appearing after last injection. Patient made rapid recovery, riding home, a distance of 16 miles, within a few hours after treatment.

CASE 17.--Reported by Dr. Ray, of Seymour, severe bite of a tiger snake. Within six hours 4/5th of a grain administered subcutaneously, besides a considerable quantity given by the mouth. Patient made a good recovery. "Every injection after the second one," Dr. Ray reports, "having a distinct effect within three or four minutes, and lasting from one to one and a half hours before tendency to coma returned."

CASE 18.--Very remarkable. Read by Dr. Forbes, medical officer of hospital, Charters Towers, Queensland, before the North Queensland Medical Society. Boy, 6 years old, was admitted to hospital at 9 p.m. on 27th October, 1890, bitten on foot by a death adder, which was killed and identified. Dr. Forbes reports: When seen by me, two hours after the accident, he was sitting on his mother's knee with his head hanging on one side, but quite conscious, and answering questions rationally, pupils widely dilated with almost no reaction to light, pulse very fast and soft, &c. Thinking his condition might be due to fear I hesitated to use strychnine. So, ordering strong coffee, I hurried to attend an accident case just admitted with severe hæmorrhage, and left the boy in charge of a nurse, with orders to call me at once if she saw any change. I had scarcely been away 15 minutes when the father rushed in saying his boy was dead, and indeed his statement seemed but too true. The child was lying quite limp, face blue, eyes half shut, extremities very cold, no pulse perceptible, no respiration visible. I at once injected m. x. of liq. strychniæ P.B. and made artificial respiration. He soon began to improve, and in about 20 minutes was able to speak. He was watched all night, but suffered no relapse, and was discharged on the next day.

CASES 19 TO 21, reported by Dr. Weekes, of Lithgow, N.S.W. Dr. Weekes writes:--"Within the last year I have had three cases under my care, all bitten by black snakes, and all in about the same place, on the outside of the calf of the leg. The patients were all comatose, exhibiting all the usual symptoms of snakebite-poisoning, and in one, my last case, the patient had convulsions. In all of them I made hypodermic injections of m. xv. liq. strych., and the effects were most marked, the patients being completely roused and becoming quite sensible and rational each time," &c.

CASE 22.--Mrs. Ryan, of Oberon, N.S.W., bitten on leg by tiger snake, comatose and nearly pulseless after three hours, treated by Dr. Kingsburry, amount of strychnine not stated.

CASE 23.--Benjamin Childs, bitten on finger by death adder, treated by Dr. Campbell, of Grafton, N.S.W.

CASE 24.--Rather remarkable. Reported by Dr. Lloyd Parry, of Emmaville, N.S.W., in Gazette of March, 1891, and further particulars in private correspondence with writer. A Chinese miner, aged 30 years, was bitten on the back of the foot by a death adder. His mates, deeming medical aid useless, did not send for Dr. Parry until death was imminent, and then only with a view of getting a certificate of death, and avoiding autopsy and inquest. When seen, three hours after infliction of bite, the man was deeply comatose and pulseless, skin icy cold, pupils dilated and insensible to light, lower jaw hanging down and tongue protruding, respiration scarcely perceptible. He was in fact so near death that this event was expected to take place from minute to minute. In order to task the antidote to the utmost, Dr. Parry cut the tight ligature without excising the bitten skin and then injected xv. of liq. st. P.B. To his surprise in a few minutes the man began to groan and very soon afterwards became conscious. Dr. Parry then watched him carefully and in about an hour found coma returning, when another injection was made and roused him for good. There was much swelling and effusion in the leg, but no ill effects followed.

In this case, judging from the comparatively small quantity of the antidote required, only a small amount of poison had been imparted, the bite being on the back of the foot, where the fangs cannot penetrate deeply. Still there can be no doubt that even this small quantity of the justly dreaded death adder poison would have proved fatal, if it had not been counteracted by the antidote.