SECT. II.—THE GENERAL TREATMENT OF ALL PERSONS BITTEN OR STUNG BY ANY VENOMOUS ANIMAL.
If a person happen to be bitten or stung by any venomous animal he ought immediately to get the part sucked. The person who sucks it should not be fasting, and he ought first to rinse his mouth with wine and retain oil in it; and then, if the part admits, it should be cupped with much heat, scarifying also the surrounding parts; for the poison is forced back out of the body along with the spirits and blood which are drawn out. The part in which the wound is situated ought also to be burnt and eschars formed on it, and amputation of the extremities may then be seasonably practised if the animal that inflicted the bite be of a deadly nature, such as the asp, the cerastes, the viper, and the like: as Galen relates that a certain vine-dresser being bitten by a viper, and knowing the animal, immediately cut off the finger that was bitten with his pruning hook, and was entirely freed from the danger. But if the poison be already distributed over the body, venesection ought to be had recourse to immediately, especially if the person bitten be plethoric; and pepper and garlic given to eat with the food, and strong wine to drink, whereby the system will be filled with fresh vapours and a suitable heat. Afterwards cataplasms are to be applied that can warm and stimulate the bite, such as a mixture of the ashes of cabbage or of fig with vinegar, or with the strained lye, or with the sauce of pickle. Likewise onions may be mixed with polenta or bread, and strong leeks with salts, or warm liquid pitch with salts, or cedar-rosin, or goat’s dung. It will also be proper to pour upon the parts hot vinegar in which calamint has been boiled, or with vinegar and sea water, or with brine. We are to apply to the part fowls, more especially hens, cut up and still warm, or other such animals, for they absorb the poison and soothe the pains. And we must have recourse to plasters, such as that formed from salts, that from rosemary and adarce, and on the whole such things as are of an acrid nature. And in general all persons bitten or stung by any venomous animal ought, unless the deep-seated parts are wholly unhurt, to take in the first place potions containing endive, heath, or astragalus with vinegar, or bitumen and Christ’s thorn in like manner, or a decoction of Christ’s thorn; or two drachms of dried weasel with wine, which is a cried-up remedy; or the blood of the sea-tortoise, or a drachm of castor with diluted wine, or a drachm of frankincense, or of Sicyonian root, or the juice of leeks, or ground pine, or alsander, or cinnamon, or birthwort, or the seed of the chaste tree, or cypress balls, or seseli, or pepper, or the seed of trefoil, or bay berries, or river crabs roasted or boiled. Use the following compound theriac.
A theriac for venomous animals, and deleterious substances, and for persons bitten by vipers and scorpions. Of bryony, of opoponax, of Illyrian iris, of the root of rosemary, of ginger, of each, dr. iv; of birthwort, dr. v; of frankincense, of wild rue, of each, dr. iij; of the flour of tares, dr. ij; form trochisks with wine, and give three oboli with wine. Purging will also be proper for them, with sudorifics, and taking the theriac of vipers.
Commentary. These general directions are mostly taken from Dioscorides, who is greatly indebted to Nicander. Neither of them, however, makes mention of venesection among his remedies.
The remedial means recommended by Dioscorides are scarification, cupping, sucking, excision; and in extreme cases, amputation; clysters, and acrid applications to the part in order to clear out the venom; pure wine, must, or acrid substances to extinguish it and counteract its effects; and finally as adjuvants of these means, purging of the bowels, sweating, and some other particular remedies as stated under their proper heads.
The general remedies mentioned by Nicander are, sucking the wound, applying cupping instruments to it, and afterwards strong stimulants, hot irons, and leeches. He directs that the person who sucks it should not be fasting; from which it may be inferred that he had a correct idea that the vessels absorb most readily when in an empty state. This physiological doctrine was lately announced as a new discovery; but frequent allusions to it are to be met with in the works of Galen, our author, Avicenna, Avenzoar, Averrhoes, and Haly Abbas. The dangers resulting from an empty state of the vessels, whether produced by fasting or venesection, is well expressed by Gorræus in his Preliminary Dissertation on the Alexipharmics of Nicander: “Nec vero id tantum incommodi habet fames, sed in multo majus periculum adducit hominem, quando et venæ plurimum exinanitæ et cibum vehementer appetentes, venenum avidius ad se pertrahunt et in intima viscera, cordisque arcem immittunt.” “Quod si quis etiam abundare videatur, et nihil eorum repugnet quæ sunt in venæsectione observanda, sanguinem audacter mittamus, non quidem per initia (sic enim in venas deleteria traherentur, a quibus omni studio atque industriâ excludi debent) sed post vomitus alvique dejectiones,” &c.
Serapion, contrary to most of the authorities, recommends that the person who sucks a poisoned wound, should be in a fasting state; but as he is a servile copyist from his predecessors, it might be suspected that the text is in fault, if the same directions were not given by Rabbi Moyses, with this explanation: that a fasting person will perform this office with more risk to himself, but with greater advantage to the patient, than one who had taken food immediately beforehand. (De Venenis, i, 1.) All this shows how well the ancient savans were acquainted with the physiological fact, that the absorbent powers of the vessels is in the inverse ratio of their state of repletion.
Celsus recommends nearly the same general remedies as Nicander. Thus he directs us in the first place to apply a ligature round the limb, but not too tightly, for fear of occasioning torpor; and then to extract the poison by sucking, or by a cupping instrument along with scarifications. His local applications are of a hot stimulant nature. As internal remedies he recommends emetics, which may be supposed to expel the poison from the system by the concussion which they produce, and various articles of a calefacient nature, such as wine and pepper; because, says he, “maxima pars venenorum frigore interimit.”
Isidorus states in still more general terms that the poisons act by oppressing the vital heat. He says, “Omne autem venenum frigidum est, et ideo anima quæ ignea est, fugit venenum frigidum.” He states, likewise, that poisons do not act upon the system unless mixed with the blood: “Venenum autem dictum eo quod per venas vadit. Infusa enim pestis ejus per venas vegetatione aucta discurrit et animam extinguit. Unde non potest venenum nocere nisi hominis tetigerit sanguinem.” Lucanus: “Noxia serpentum est admixto sanguine pestis.”
This, however, is an imperfect account of the action of poisons, whether such as act by being introduced into the stomach, or those that prove deleterious when applied to a wound. Perhaps the classification given by Avicenna may be mentioned as the most complete of any proposed by the ancient authorities. He states that poisons act either by some certain quality, or by their whole substance. Of the former class some are corrosive and putrefactive, like the lepus marinus; some inflammatory and calefacient, like euphorbium; some frigorific and stupefying, like opium; some prove obstruent of the respiratory passages, like litharge; some act with their whole substance, as the wolf’s bane, and these are the most deleterious of all. Of these some act upon one member in particular, as cantharides upon the bladder, or the lepus marinus upon the lungs, and some upon the whole body as opium. (iv, 6, 1.) Schulze, in his ‘Toxicologia Veterum,’ has stated the ancient arrangement somewhat differently, and we are at a loss to think what authors he has followed. He says, the ancients arranged poisons according to their properties into the frigorific (ψυκτικὰ), corrosive (διαβιβρώσκυντα), and septic (σηπεδονώδη). The frigorific, he properly remarks, are those substances now called narcotics; to which class, as Galen mentions, the conium, poppy, henbane, and mandrake belong. On the action of narcotics, see [section xliii]. Galen remarks that the human frame becomes habituated to bear the action of these medicines without injury. He mentions the case of an old Attic woman, who by little and little had accustomed herself to take hemlock in any quantity. (De Simpl. iii.)
Avicenna states that the great indications of cure in all cases of poisoning are to comfort and rouse the vital heat, and to resolve (neutralize?) or expel the poison. When the poison is distributed over the system, his remedies are venesection, purging, and the like. He states decidedly that the proper time for venesection is either when the poison is distributed over the body, more especially when it is in a plethoric state, or when the poison is a substance not likely to be absorbed. His other remedies are such as expel the poison from the body, namely, emetics and sudorifics, or such as prevent it from entering the system, namely, ligatures to the extremities, prohibiting sleep, applying cupping instruments, or leeches, sucking the wound, amputation of the limb, using actual and potential cauteries, and keeping the wound long open. Upon the whole the general remedies recommended by him and the other Arabians are little different from those of the Greeks, especially of Dioscorides, who is the great authority upon theriacs.
Haly Abbas allows bleeding when the poison is distributed over the body, and like the others also, makes mention of cupping with heat and of amputation. He also joins in the general praise of the theriac.
Alsaharavius recommends strong ligatures, cupping, and, in urgent cases, amputation. He also approves of applying the bodies of hens still warm. Serapion approves of bleeding under the same circumstances as the others, and of the same general treatment that they recommend. Rhases recommends sucking and cupping the wound, and the application of stimulant dressings, such as a plaster consisting of mustard, lime, and pitch. He, and most of the ancient authorities on toxicology, recommend salt as an application to the wound. Most of them also join Dioscorides in recommending the application of caustic leys. They also in general direct us to prevent sleep. The ligature to prevent absorption is recommended by Rhases, as it is in fact by most of the ancient authorities. As a matter of course all of them speak highly of the theriac, and acquiesce in Galen’s celebrated eulogy upon its virtues. (Ad Pison. ii, 457, ed. Basil.)
The Arabian authorities notice cursorily the treatment of poisoned weapons of war, more especially of the Armenian arrows. Galbanum and assafœtida administered internally, and applied to the wounds in various forms, are the two articles which are most generally approved of by them. They also recommend sucking the wound, as in other cases of poisoning by a wound. (See further, [B. vi, 88].)