Part 6

CASE 25, reported from Tasmania by Dr. Holmes, of Launceston, presents different features, showing the very large quantity of the antidote sometimes required. After describing the condition of his patient, a Mrs. Frazer, of St. Leonards, Dr. Holmes writes:--"From her desperate condition I thought it too late for the ammonia treatment and decided on injecting liq. strychniæ. At 12.30 p.m. injected m. xv, at 1.40, m. xv., at 2.10, m. xv., at 2.40, m. xv., and 3.10, m. xv., at 4 p.m., m. x., and at 5, m. x. A few minutes after the last dose I noticed the physiological action of the drug and desisted from injecting. At 8 p.m. she seemed almost well, pupils normal in size and reacting well, was not sleepy and could swallow easily. The patient made a good recovery."

This is the largest quantity of strychnine that has been required in Australia, namely, 126 minims of liq. strych., or 1-1/9th gr. injected in less than five hours, with the most beneficial result. Surely the most cynical scepticism must give in to such facts.

CASE 26.--Reported by Dr. MacDonald, of Murwillumbah, N.S.W. Mr. S., bitten on leg by a black snake. Coma, complete paralysis, chin hanging down to sternum, pupils dilated, &c. An injection of m. xv. had no effect; one of m. xx. very little. After a third one of m. x. patient suddenly became conscious, could walk without assistance, and in half an hour was sent to bed perfectly recovered.

CASE 27.--Reported by Dr. Yeatman, of Auburn, South Australia. Mr. D., a farmer, aged 45 years, bitten on thumb; snake not named; cured by three injections of only m. v. each. Convulsions lasting for an hour came on three hours after treatment--a very rare occurrence--by Dr. Yeatman erroneously ascribed to the strychnine, which in so small a dose would not have produced them in the absence of snake-poison.

CASE 28.--Reported by officer in charge of police at Grenfell. Boy of 6 years, bitten by brown snake, and treated by Dr. Rygate.

CASE 29.--W. Toomer, aged 19, bitten by tiger snake on thumb and index finger, and not treated until 9-1/2 hours after bite, having a long distance to travel. Recovery very slow through timid use of antidote, five injections of 1/30th grain having but little effect, until one of 1/10th restored him. Treated by Dr. Stokes, of Echuca.

CASE 30.--Reported by Dr. Bennett, surgeon, Gulgong Hospital, N.S.W. Mrs. Mears admitted to hospital comatose and pulseless, nothing having been done to check absorption. The intravenous injection of ammonia failing to rouse her, m. xv. of liq. strych. were injected, when pulse returned, but coma continued. After a second injection of m. xv. she suddenly became quite conscious, and in an hour was fully restored.

CASE 31.--Reported by Dr. Mead, of Quirindi, N.S.W. John Simson, aged 15 years, bitten by a death adder on forefinger of right hand. Dr. Mead living 50 miles away, and the lad collapsing, a layman, Mr. Robert Simson, had to undertake treatment, and injected during the night m. 150 of a one in 240 solution of strychnine, equal to 5/8ths of a grain. Dr. Mead, finding the lad conscious and only a little drowsy, did not inject any more strychnine until 2 p.m., when a relapse took place. He then injected m. viii. of liq. str. P. B., and in half an hour m. vii. more. The last injection produced slight muscular twitchings, and subdued the snake-poison effectually, the lad making a good recovery. The total quantity used in 13 injections was over three-quarters of a grain within 18 hours.

CASE 32.--This case is another instance of the successful use of the antidote by a layman, and can be verified by the writer, who saw the patient, a girl of 14 years, after her father had carried out the treatment successfully. The girl had been bitten by a large brown snake whilst walking through a paddock, and very soon afterwards lost the use of her legs, and for a time also her eyesight. The symptoms being so very alarming, and the girl at a distance of 35 miles from the writer's residence, the father at once injected 1/12th of a grain of strychnine, and in a very short time another 1/12th. The child then rallied somewhat, and a start was made to bring her in, the father taking the precaution of bringing the antidote-case with him. This was fortunate, for the child collapsed several times, and each time had to be roused by an injection before reaching the writer. When finally she presented herself, walking into the writer's surgery with a firm step, not a trace could be discovered either of the strychnine, of which nearly half a grain had been injected, nor of the snake-poison, also imparted no doubt in a fatal dose. The two punctures on her leg, testifying to the size of the snake that had bitten her, were the only tokens of the ordeal she had gone through; and the only task remaining for the writer was to congratulate her father (Mr. James Trebilcock, a farmer, of Tawanga), on the plucky manner in which he had carried out the treatment, and see to the child being properly watched during the night in case of a relapse taking place. None, however, occurred, and she left next morning perfectly well. Cases of this kind, in which no doctor is called in, are frequently reported to the writer, who finds that laymen are even more successful because less timid than many medical men.

CASE 33.--Joseph Cartledge, bitten on calf of leg by a black snake, was treated by Dr. Browne, of Sale, five hours after accident. Two injections of 1/8th grain each used.

CASE 34.--Miss Davie, teacher, at Nerung, Queensland, treated by Dr. Hannah, of Southport. Particulars not given.

CASE 35.--Mrs. Rogers, of Bulu Bulu, Gippsland, bitten on finger by tiger snake, and treated by Dr. Trampy, first with intravenous injections of ammonia, which had no effect, and when sinking with strychnine injections, which had almost immediate effect, and in a few hours placed her out of danger.

CASE 36.--Son of Mr. J. Beveridge, squatter, of Glengower, treated successfully by Dr. Andrew, of Clunes, with strychnine injections.

CASE 37.--Theresa Byrne, aged 14 years, bitten whilst bathing, snake not seen. Treated by Dr. Cuppaidge, of Normanby, Queensland. Only 18 minims of L. S. required.

CASE 38.--Mr. Bullock, of Tenterfield, N.S.W., bitten by black snake and treated by Dr. Morice.

CASE 39.--A boy, J. Taylor, bitten at Mount Keat, agricultural settlement, Queensland, by a black snake, and treated successfully by a layman, Mr. James Daniels.

CASE 40.--George Neilson, a Danish miner, bitten by a tiger snake whilst bathing. Case reported by Dr. Gamble, of Walhalla. Forty minims of liq. strych. required; recovery complete next morning.

CASES 41 AND 42, reported by Dr. Helsham, of Richmond, N.S.W. In one of these where, judging from the symptoms, a large dose of snake-poison had been absorbed, but very small doses of strychnine were injected, convulsions set in, whilst coma was still present, and lasted for two hours. Though semi-tetanic in appearance they were erroneously ascribed to m. xxvi. of liq. strychniæ, 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 strychniæ; 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.