XIII.—Case reported by Dr. Deschamps, of Thiès (Senegal).
“In the month of October, 1898, I was called to a native, a local constable, who had just been bitten by a Naja. The Ouoloffs of Senegal are much afraid of the bites of this reptile, since they are generally fatal. In this case the man had been bitten in the forehead by a snake, which was coiled up in his bed, as he was placing his head on the pillow. Being in the dark, he got up greatly frightened, lit a candle, and saw the snake glide from his bed and escape through the half-open door. I arrived a few minutes after the accident; the constable already felt very weak, and complained of nausea and of pains in the head and back of the neck. In the middle region of the forehead I found two adjacent wounds, around which the tissues were œdematous. I washed the wounds with a solution of permanganate of potash, and had a telegram sent to St. Louis asking for antivenomous serum. Half an hour after the bite, the patient was seized with vomiting and cold sweats. At 6 a.m. on the following day there was considerable œdema of the face and dyspnœa, while the pulse was small and intermittent. The patient, who had not slept, was dull and depressed. He vomited a little milk which I tried to make him take. Forty hours after the bite the patient, who was already paralysed, became comatose; the face and neck were enormously swollen. The dyspnœa had increased; it was difficult to hear the respiratory murmur; the pulse was thready, slow, and intermittent; the skin was cold; the temperature, taken in the axilla, was 35·8° C. At this moment the serum asked for arrived from St. Louis. I injected into the buttock the only dose that I possessed, 10 c.c. The coma persisted throughout the evening and during part of the night; at 6 a.m. on the following day, fourteen hours after the injection, the patient awoke and said that he felt quite well. The œdema of the face and neck had diminished, that of the eyelids had disappeared. Three days later the constable returned to duty.”
XIV.—Case reported by Professors H. P. Keatenje and A. Ruffer (Cairo).
“A girl named Hamida, aged 13, while picking cotton on October 7, 1896, at Ghizeh, near Cairo, was bitten in the left forearm by a large Egyptian cobra, which measured 3 feet in length. She cried out, and her brother and others who were working with her ran up. She was brought to hospital by the police at 7 p.m. in a state of complete collapse. She was almost cold, with upturned eyeballs and imperceptible pulse. The forearm had been bandaged with a dirty cloth, and the entire arm was covered with a thick layer of Nile mud (a favourite remedy among the Fellahîn). Above the wrist two deep punctures were clearly visible, evidently corresponding to the fangs of the reptile. The patient, whose condition seemed absolutely desperate, had no longer any reflexes; she was completely insensible; the moderately dilated pupils scarcely reacted at all to luminous impressions. Dr. Ruffer injected, with the customary antiseptic precautions, 20 c.c. of Calmette’s antivenomous serum beneath the skin of the abdomen. The child gave a groan while this was being done; this was at 7.30 p.m. At 11 o’clock at night her condition improved; the pulse was 140, and bodily heat returned; the patient replied to questions that were put to her. A second injection of 10 c.c. of serum was given in the flank. She slept for the remainder of the night, and passed her water four times under her. At 8 a.m. on October 8 she appeared to be out of danger. She took food, and dozed throughout the day. On the 9th she was convalescent. There were no complications resulting from the injection, neither eruptions nor pains in the joints.”
XV.-Case reported by Dr. Maclaud, of Konakry (French Guinea).
“At 7.30 p.m., on June 22, 1896, there was brought to the Konakry Hospital a native soldier, named Demba, who had just been bitten by a snake. This man, who was employed in the bakery, was stacking firewood, when he felt an extremely acute pain in the left foot; simultaneously he saw a large snake making off; he succeeded in killing it, and found it to be a black Naja. After having applied a stout ligature to the limb, the injured man hastened to the hospital, where, immediately afterwards, he fell into a condition verging on coma. The body was bathed with cold sweat; the temperature was subnormal; the pulse, which was small and thready, was 140. There was difficulty in breathing, and severe vomiting. At intervals the patient was aroused by spasms, and excruciating pains in the injured limb, which exhibited considerable œdema above and below the ligature. Tendency to asphyxia. I washed the wounds with 1 per cent. solution of permanganate of potash, and injected a dose of antivenomous serum into the subcutaneous cellular tissue of the left flank. In view of the severity of the symptoms I gave two other injections of serum, an injection of 3 c.c., followed by one of 2 c.c. The patient dozed all night. Next day the general symptoms had entirely disappeared. Two days later Demba returned to duty.”
C.—Bungarus fasciatus.
XVI.—Case reported by Surgeon-Captain Jay Gould (Nowgong, Central India, British Medical Journal, October 10, 1896, p. 1025).
“On June 11, 1896, a punkah coolie was bitten on the dorsum of the left foot, between the second and third toes. He had only the distinct mark of an incisor, a very slight prick, with a stain of blood which marked the spot. Within ten minutes we had injected 20 c.c. of Calmette’s serum into the abdominal wall, after which we made a local injection of a 1 in 60 solution of hyperchlorite of calcium. Two hours after the injection the temperature was subnormal, the pulse full and slow. Twelve hours later the patient was perfectly well and walking about.
“The snake was a Bungarus, full grown, measuring 28 inches. Unfortunately the syces killed it; it died the very moment I arrived, so that I was unable to test its virulence.”