Part 8

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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.

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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, Hätt' gern was Grossesgeboren, Der sammle still und unerschlafft Im kleinsten Punkte die grösste 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 hæmorrhages 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.

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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.

+-----------------------------------------------+ | Transcriber's Note: | | | | Inconsistent hyphenation and spelling in the | | original document have been preserved. | | | | Typographical errors corrected in the text: | | | | Page 23 intracardial changed to intracardiac | | Page 69 Banarjee changed to Banerjee | | Page 73 ease changed to case | +-----------------------------------------------+