“Public Notice.
“For the public good the Governor requests the population to capture poisonous snakes in all places where they are found; to take them alive if possible; and to bring them to the Hospital without removing their fangs.
“One rupee will immediately be paid for each snake brought in.
“Those who read this notice are requested to communicate it to their acquaintances.”
The Indian snake-charmers at once responded to this appeal, and the harvest of snakes was soon abundant. The first provision of 200 rupees, allotted to us by the Administration in June, 1901, had to be successively renewed in May and October, 1902. Since then, on the proposition of our successor, Dr. Camail, this sum of 200 rupees has been included in the local budget, thus definitively sanctioning the principle of the collection of venom in our Indian Settlements.
The venom forwarded by us to France has been exclusively derived from the cobra, or Naja tripudians. Other venomous serpents are found in the French Settlements in India, especially the species of Hydrophis, or sea-snakes; but the cobra is by far the commonest species, and our trading stations teem with it. Yanaon is infested by it at all seasons, but especially at the time when the Godavari is in flood; the reptiles then make their way towards spots spared by the inundation, and the natives frequently kill them in their houses. Thus M. Mariapregassam, the Sanitary Officer in charge of the the Medical Service of this dependency, was in a position to procure for us, at the very commencement of our operations, important doses of venom: it should be added that he acquitted himself of this task with a perseverance and devotion worthy of the fullest recognition. Of the 653 cobras captured between August 1, 1901, and February 23, 1903, 229, or more than one-third, were furnished by Yanaon. Moreover, the cost price of the cobra fell in proportion to its numbers, and Yanaon paid for its snakes on the average at the rate of 33 centimes apiece; while at Chandarnagar and Pondicherry the snake-charmers frequently received 1 rupee (1 franc 67 centimes) per reptile, though it is true that even this was an extremely poor remuneration, when we consider the risk of the calling.
Again, owing to the limited amount of our grants, we were obliged to restrict our expenditure, regulating the purchase-price of the snakes according to the quantity of venom collected. Thus at Pondicherry, having observed that each cobra yielded on an average twenty drops of venom, we fixed the value of two drops at one fanon (one-eighth of a rupee), never more. In this way it was decidedly to the snake-charmer’s interest to bring us fresh snakes, and not such as had been previously deprived of their venom.
In spite of this new regulation, snakes continued to pour into the hospital, and several were repeatedly brought to us at the same time; in October and November, 1902, the figure 9 appears three times in our statistics.
The combined results of the snake-harvest at our five settlements, from August 1, 1901, to February 23, 1903, are shown in the following table:—
| Number of cobras | Sum expended | Quantity of venom collected | Averagen weight of dry venom per cobra | Average price of the cobra | Average price of 1 gramme of venom |
|---|---|---|---|---|---|
| 653 | R. 446 | 242 | 0·37 | R. 0.68 | R. 1.84 |
| grammes | grammes | (1.13 fr.) | (3.07 fr.) |
On an average, therefore, nearly three cobras are necessary to furnish 1 gramme of dry venom, since freshly collected venom weighs more, owing to the proportion of water contained in it, which is greater than half the total weight. Thus the quantity of fresh venom extracted from an average cobra may be estimated at about 80 centigrammes. It may be added that the product of the glands differs considerably in appearance, according as it is derived from a dead or living snake. In the former case it takes the form of extremely small, glistening lamellæ, of a golden-yellow colour, similar in appearance, when in bulk, to iodoform. Venom extracted from the living snake, on the other hand, is of an amber-brown colour, and forms much larger lamellæ, which are translucent and slightly elongate, resembling particles of gum arabic. When the product is impure and mixed with a small quantity of blood, it has a dull appearance, and is of a dark, dirty brown, almost black colour.
At the Pondicherry Hospital venom is collected in the following manner;[168] The snake is brought by the snake-charmer in a chatty, a kind of earthern pot, covered with a rag, or half a calabash. Ensconced at the bottom of this receptacle, the reptile has a difficulty in making up its mind to emerge, which it does only after having been stirred up several times. Once it is outside the charmer forces the cobra to uncoil, and, while the animal is moving slowly along, fastens it to the ground by placing the end of a bamboo on its neck, quite close to the head. The Indian then cautiously seizes the head of the cobra with his forefinger and thumb, and, with a rapid movement, throws it into a jar prepared for the purpose, containing a few tampons of absorbent wool impregnated with chloroform. As soon as the snake is inside, an assistant quickly slips a metal plate over the opening of the jar and presses his hand firmly down upon it. In a few minutes the animal is dead; it is then taken out of the jar and its mouth is swabbed out; next, the fangs having been raised by means of a probe, a saucer is placed between the jaws, and, by pressure exerted upon the poison-glands laterally and from behind forwards, the venom is made to spurt out. The fresh product obtained in this way is of a very pale yellow colour, and viscid. It is protected from the air and light until completely desiccated; then, when it is in sufficient quantity and distributed in flakes round the sides of the saucer, like the colours on a palette, it is cautiously detached with a spatula, taking care to protect the eyes against risk from flying particles of venom. After being placed in well-corked bottles, the product is despatched to France.
In spite of the precautions observed in the course of these proceedings, and although the venom has not been extracted until after the death of the animal, some regrettable accidents have taken place, as we shall show further on.
Cases of bites from poisonous snakes appear but seldom in the statistics of our settlements in India, and, contrary to what is the case in the neighbouring English possessions, hardly any deaths are officially recognised in the annual returns as being due to this cause. It is true that the death statistics are very badly authenticated, and that the natives frequently conceal the real cause of death.
We have been informed by Dr. Cordier, Surgeon-Major of the Sepoy Corps, that, during a previous tour of duty in Bengal, he had successfully treated two cases of cobra-bite with Calmette’s serum.
At the end of 1901 the following note was forwarded to us by Dr. Paramananda Mariadassou, Physician to the Karikal Hospital:—
“Case I.—In the month of November, 1901, a woman of robust habit was brought about midnight to the Karikal Hospital, in a semi-comatose condition. Her husband stated that an hour before, while lying on a mat stretched on the ground, she felt herself bitten in the shoulder when in the act of placing her head on the pillow. With a start of surprise she half rose and then lay down again. It was only on being bitten for the third time that she made up her mind to seek for the cause; passing her hand beneath the pillow in the darkness she touched the body of a snake and cried out. Directly afterwards she pointed out to her husband, who had at once hastened to her, the snake coiled up against the wall; the man killed the reptile and burnt it on the spot. According to him the snake was about a metre in length, and as thick as all five fingers put together. The woman had barely time to tell her husband what had happened, for she speedily became unconscious, and was in this condition when brought to the hospital.
“On admission the following symptoms were observed: The patient did not reply to questions put to her, the eyelids remained closed, and the teeth clenched. On the right shoulder, a little on the inner side of the deltoid prominence, two or three punctures were distinguishable, marked by a small spot of coagulated blood. The respiration was normal, but the pulse was feeble and thready. When a pledget impregnated with ammonia was held under her nose the woman reacted, but immediately relapsed into the soporose condition.
“Two doses of antivenomous serum were at once injected, one in each flank: the patient seemed scarcely to feel the insertion of the needle. The wound on the shoulder was then washed with a fresh solution of hypochlorite of calcium, 1 in 60, and six injections, each of 1 gramme, of the same solution were given round the wound. The latter was covered with a pad of cotton-wool saturated with the solution, and two more doses of serum were injected into the flanks. As the result of this treatment, which altogether took nearly half an hour, the woman began to unclench her teeth, and to respond to her name. She was made to swallow a few mouthfuls of very hot black coffee. A little later she resisted when a fresh injection of serum was about to be given her. After having taken a second cup of coffee she sat up, opened her eyes, and recognised those about her. She immediately asked to go home, but was detained for some time longer. After being carried from the operating table to a bed, she was wrapped in a blanket; a few minutes later profuse perspiration set in, and the patient felt so well that she was allowed to go.
“On the following day the husband came to thank us, and stated that his wife had quite recovered, and that, while she had been unable to sleep for the remainder of the night, it was rather from fear caused by what had happened than in consequence of the pain.”
Case II.—We feel it our duty to relate in detail the following case, having regard to the peculiar circumstances under which it took place.
Coupin, the son of Ponnin, aged 25, living at Carouvadicoupom, near Pondicherry, is a snake-charmer, and one of those who regularly supply us with venom. In the course of July, 1902, this man pointed out to us a shrub[169] growing in one of the alleys of the hospital, to which he attributed so marvellous a power against the bites of poisonous snakes, that he offered to make a cobra bite him in our presence, little as we showed any desire to witness such an exhibition. We allowed him to talk, not wishing to encourage such an act of bravado.
However, on July 23 he returned to the charge, and, as we were leaving the hospital accompanied by our colleagues, he showed us a cobra which he had just caught, and declared himself ready to carry out the proposed experiment there and then. In the face of so much confidence and sang-froid, and, apart from this, being interested in learning the justification for the reputation for immunity possessed by Hindu snake-charmers, we thought we ought not to oppose this voluntary test.
Coupin then turned out from the chatty in which it was imprisoned a medium-sized cobra, and amused himself for a few moments by teasing it. Irritated by this sport, the snake reared itself up, hissed, and struck at its aggressor several times, as though it would bite him; but, at each dart, Coupin stopped it with his hand and gaze, and the snake remained fascinated, with open mouth, hesitating to drive home its fangs. At one moment the snake even crawled up to the native’s outstretched hand, and appeared to lick it: it was evident that the animal’s only intention was to defend itself, not to attack.
Coupin, however, was bent on getting bitten, and, by dint of exciting the snake, the latter became so exasperated that, with hood dilated, it struck at the snake-charmer’s right hand and drove in its fangs. The man quietly raised his arm, to allow it to be clearly seen that the cobra had a firm hold; then, forcing the animal to let go, he came to us to prove that he was really bitten. There were two bleeding spots, 6 millimetres apart, in the centre of the fourth intermetacarpal space of the right hand. The time was exactly 4.40 p.m.
The snake, which was immediately killed, was still able to yield twelve drops of venom, when lateral pressure was applied to its glands.
Coupin walked towards a shrub of the kind mentioned above, which he had planted that very morning in the courtyard of the hospital,[170] plucked some leaves from it and began to chew them, making rather a wry face, for he said that they were very bitter. He then seemed to meditate for a few moments before the shrub. We asked him whether he was afraid, but he stoutly denied it, declaring that this was not his first experience, and that indeed he had been bitten by cobras so often that he could not remember the first occasion. We endeavoured to discover whether he was not rendered immune, as Indian snake-charmers are reputed to be, by inoculating themselves subcutaneously with increasing doses of venom, according to a principle to a certain extent analagous to that on which the preparation of antivenomous serum is based. He, however, assured us that he knew nothing about such practices, and that the properties of the plant in question had always sufficed to cure him without other treatment. Such was his confidence in his specific that, before the cobra was killed, he suggested to our hospital-warder that he should allow himself to be bitten in his turn, in order to render the experiment still more conclusive, adding that his own assistant would be the subject at the next demonstration.
Nevertheless, a slight œdema began to appear round the bite. The injured man seemed to be suffering a little, but the pain did not extend above the wrist; a slight trembling appeared in the other arm. From time to time Coupin gently massaged the affected limb with his left hand from above downwards, in order, he said, to lessen the pain, and perhaps also with a view to checking the diffusion of the venom. A slight perspiration broke out over the body; the pulse was regular, 92, twenty minutes after the bite.
Towards 6.15, or about an hour and a half after the experiment, the man, refusing an injection of serum, prepared to go home, but we insisted that he should remain at the hospital for at least two hours longer, so as to enable us to watch his condition. He consented to this, and asked for something to eat. At this time the back of the hand was somewhat more swollen, but Coupin seemed to be little disturbed by it; he even declared that the swelling would increase still further on the following day, and that, in two or three days, he would make an incision in order to let out the impure blood collected at the spot; also that the trouble was now localised, and would not extend higher. He merely complained of acute thirst, and of a certain difficulty in swallowing, which was due, he declared, to the extreme bitterness of the leaves that he had just masticated. Temperature 36·8° C.; pulse 36. After the brief reaction at the outset, there was a certain amount of hypothermia, but the general condition seemed satisfactory, and the man remained perfectly calm. We therefore left him under the supervision of the resident student and the male attendants, giving orders that we should be sent for immediately in case of any serious symptoms arising.
At 7.15 we received a note from the student to the effect that Coupin had vomited, that his pulse was small, there was difficulty in breathing, and that he had just received an injection of antivenomous serum. We hastened to the hospital, where we were speedily joined by Drs. Cordier and Lhomme.
On our arrival we found Coupin in a rather prostrate condition. The pupils were fixed, he was foaming slightly at the mouth, respiration was regular, the pulse was strong and quite rhythmical at 96; the man was somewhat chilly. The patient was unable to speak, but had not lost consciousness, for, when we asked him how he was, he indicated by signs that he felt very ill. We subsequently learnt, from the student on duty, that towards 6.45 the condition of the patient became suddenly worse, after his companion had administered to him some medicine, the nature of which we have been unable to discover; on swallowing this drug Coupin was seized with vomiting, and became collapsed. We thought it more likely, however, that this was a mere coincidence, rather than the result of a poison adding its effects to those produced by the bite of the snake.
While waiting for our arrival a ligature had been applied to the injured arm, and near the bite there had been made two deep incisions, from which some dark blood escaped. At the same time the patient received hypodermically a first injection of 10 c.c. of Dr. Calmette’s antivenomous serum, and two injections of ether and caffeine. As the result of this treatment we found a marked increase in pulse-rate. After a subcutaneous injection of 500 grammes of artificial serum, there appeared to be a further distinct improvement until about 8.45 (four hours after the bite). From this moment, however, the patient gradually sank. A second dose of antivenomous serum was injected beneath the skin,[171] and, since the respiratory movements gradually became slower, artificial respiration by Sylvester’s method was resorted to, while the tongue was rhythmically drawn forward. From time to time these proceedings were interrupted for a few moments, in order to observe the condition of the respiration; at the base of the thorax and in the flanks abrupt, jerky, tetaniform undulations were observable, but there was no free respiratory movement. The abdominal aorta, the pulsations of which were visible behind the navel, raising the anterior wall of the abdomen, was somewhat misleading, simulating the rhythmical oscillations of the abdominal respiratory type. The heart, however, continued to beat regularly, without any appreciable weakness. The radial pulse persisted, although weak and slow: rate 48.
The patient was kept alive by repeated injections of ether and artificial serum (1¼ litres in three doses). About 8.30 there appeared to be a slight improvement; the patient was warmer, and showed some degree of sensation in the region of the bite. On pinching the vasculo-nervous bundle in the left axilla reflex movements were produced in the fingers, which closed convulsively. The pulse, which had momentarily disappeared in the radial artery, could again be felt, weak but regular. At the same time, when the epigastric region was examined, a few faint respiratory movements were just perceptible. A third injection of antivenomous serum was given and artificial respiration was continued.
This factitious amelioration, however, was not maintained, and after a few scarcely visible movements of the thorax the end soon came. The eyes were fixed and insensible, the pupils slightly dilated; no sweats, no urine passed. The body slowly grew cold; the pulse disappeared from the femoral and carotid arteries, and diminished in the aorta. The contractions of the heart were once or twice irregular, and its beats became weaker and gradually lower. The reflexes had disappeared. There were still a few slight muscular contractions near the base of the chest, and the patient quietly passed away at 11.5 p.m., as the result of the progressive arrest of the heart’s action, respiration itself having virtually disappeared two hours before the heart had ceased to beat.
Case III.—A week after this sad occurrence, another snake-charmer, Kingilien by name, aged 25, was bitten in the first phalanx of the right forefinger, when taking hold of a cobra in the courtyard of the Pondicherry Hospital. Refusing an injection of antivenomous serum, the man ran off as fast as he could go, after having a simple ligature applied to his wrist. Scarcely had he reached his dwelling, when he fell into a deep coma, in which condition he was carried to Cottacoupom, to the abode of one Souraire Kramani, a kind of sorcerer, who administered to him a certain medicament in a betel leaf. After having vomited a large quantity of bile he was taken home. At this time, according to the summary investigation that we caused to be made, the patient was unable to utter a single word; he could only open his mouth with difficulty, and his eyelids remained closed. Kingilien, who had partially regained consciousness, seemed to be suffering from continuous attacks of vertigo; his head, if pushed to one side, drooped, and the man was incapable of voluntary movement. Respiration was fairly easy, swallowing painful. The entire hand was greatly swollen; poultices of leaves were applied to it, after a few incisions had been made with a knife in the back of the hand, in order to reduce the congestion. The arm was rubbed from above downwards with the very bitter leaves of the Vëmbou, or mango-tree, and prayers were recited. This is all the information that I have been able to obtain with reference to this man, who, after a prolonged convalescence, is said to have recovered (?).
Case IV.—One Latchoumanin, aged 25, also a snake-charmer, of Caradicoupom, was bitten at the Hospital at 10 a.m., on August 2, while handling a cobra. The bite was situated in the second joint of the right thumb. After it had bitten the man, ten drops of venom were extracted from the reptile’s glands.
A ligature was immediately applied, and the wound was made to bleed by hard squeezing. Refusing all other treatment, especially injection of serum, although we repeatedly urged it, the man made off home with all speed, but on arrival failed to find the specific on which he was relying. All that was then done was to recite a few prayers over him, and a Brahmin priest was called to bless him. About 11.30, after acute suffering, Latchoumanin sank into a comatose condition. At 12.30 respiration became stertorous, and the patient succumbed at 2 p.m., four hours after being bitten. Just as the medical officer, deputed by us, reached the dying man, two chatties containing live snakes were deposited at his bedside, to ward off ill-luck!
On the whole, the evidence collected in the last two cases is as confused as it is incomplete, and we can scarcely say how much we regret the obstinacy of these unfortunate victims in refusing to submit to our treatment, for the serum would undoubtedly have produced its maximum effect in them, since it would have been possible to make use of it in good time. These disastrous occurrences, however, will not cure natives of their exclusive reliance upon empirical practices; and as regards the inhabitants of the Tamil country, that is to say, Southern India, it may be foreseen that for a long time to come they will continue to remain refractory to the serotherapic treatment, submission to which the English have had less difficulty in securing from the natives of Bengal, whose intellectual development undoubtedly stands on a higher plane.