No better results are obtained by injections of strychnine, as recommended by Dr. Mueller, in Australia. Moreover, the statistics published by Raston Huxtable[106] positively condemn this therapeutic method. They show that, in 426 cases of snake-bite, out of 113 treated by strychnine 15 proved fatal, the ratio of mortality being 13·2 per cent., while the 313 cases not treated by strychnine only resulted in 13 deaths, or a mortality of 4·1 per cent.
In the case of animals intoxicated by venom, injections of strychnine, morphia, nicotine, or curare in small doses always prove ineffective; they even considerably assist the progress of the intoxication and hasten death. The use of these drugs in the case of human beings should therefore be absolutely forbidden.
It appears, on the other hand, that alcohol and coffee, or tea, absorbed by ingestion, are very often beneficial. Indeed, it was long ago observed that the swallowing of alcohol until symptoms of drunkenness appear retards or diminishes the phenomena of torpor and paresis that precede the ultimate phase of the intoxication. Its use may therefore be recommended when it is impossible to have recourse to the only treatment really specific that modern science places in our hands—antivenomous serum-therapy. It is important, however, to state that, when serum is used, alcohol must be forbidden. The latter hinders the effects of the former.
In practice, the rational treatment of the bite of a venomous snake must be directed towards:—
(1) Preventing the absorption of the venom.
(2) Neutralising, by the injection of a sufficient quantity of antitoxic serum, the effects of the venom already absorbed.
In order to prevent the absorption of the venom introduced into the wound, the first precaution to be taken is to compress the bitten limb by means of a ligature of some kind, such as a handkerchief, as close as possible to the bite, and between it and the base of the limb. The ligature must be tightly twisted, and, by compressing the tissues around the bite, an attempt should be made to squeeze out the venom that may have been introduced into them. The expulsion of the poison should be hastened, either by making an incision 2 or 3 cm. in length and 1 cm. in depth in the direction taken by the fangs of the reptile and also parallel to the axis of the bitten member, or by sucking the wound hard.
The ligature on the limb should not be applied for more than half an hour; if it were kept on longer it would interfere with the circulation to a dangerous degree, and would certainly injure the vitality of the tissues. The period in question also usually affords sufficient time for taking the patient to a place where help can be obtained, and for the preparation of everything necessary for his subsequent treatment.
The wound should then be freely washed with a fresh 2 per cent. solution of hypochlorite of lime, or with a 1 in 1,000 solution of chloride of gold. In default of hypochlorite of lime or chloride of gold, either eau de Javel, diluted with tepid water to a strength of 1 in 10, or a 1 per cent. solution of permanganate of potash, may be employed. These reagents should be made to penetrate as deeply as possible into the tissues, and a few cubic centimetres of them should even be injected with a Pravaz syringe into the punctures caused by the bite and all round them.
The wound being then covered with a damp dressing by means of compresses saturated with hypochlorite of lime, or at least with pure alcohol, the next thing to be done is to prepare to apply the serum-therapic treatment in order to arrest the general intoxication, if this has already commenced to take effect, or to prevent it from setting in.