K.—Bitis arietans (Puff Adder).
XXXII.—Case reported by Dr. P. M. Travers, Chilubula Mission, North-eastern Rhodesia.
“On Thursday, September 6, 1906, information was brought to me that a child, aged 7 or 8, in inserting his hand into a mole’s hole had been bitten by a lifwafwa (’Death-Death,’ i.e., Puff Adder). I set off in all haste on my bicycle. An accident obliged me to leave the road when half-way, and, to complete the series of mishaps, I went to a village with a similar name, a good half-hour distant from that where the patient lived. The result was that by the time I arrived I should say that about two hours had elapsed since the child had been bitten. The snake had been killed, and was, indeed, a puff adder. It had bitten the child in the middle finger of the right hand, and half the arm was greatly swollen, and as hard as stone. As quickly as possible I gave an injection of 10 c.c. of antivenomous serum, and then vainly endeavoured to make the wound bleed. In a very short time the serum was absorbed. On the following morning the child was still ill, with wild eyes resembling those of an epileptic. He yawned continually, and did not seem altogether conscious; the inflammation, however, had greatly diminished. A few days later recovery was complete, but a large abscess formed on the forearm, and the hand became necrosed. I was obliged to amputate all the phalanges. The natives said the child was going to die during the night. In my opinion the serum saved the child’s life, and recovery would have been more rapid had I not been so late in arriving.”
L.—Lachesis ferox (known as the Grage, in French Guiana).
XXXIII.—Case reported by Dr. Lhomme.
“In May, 1898, A., aged 48, a European convict undergoing sentence, was admitted to the Penitentiary Infirmary, of Roches de Kouvous (French Guiana), suffering from a poisonous bite.
“The man had been bitten while engaged in felling timber, at the place called Passouva. The locality is one that is infested with snakes, especially at the end of the wet season. Two venomous species in particular are found there in considerable numbers, the rattle-snake and another called the Grage by the blacks, which appears to be a Lachesis.
“The patient arrived at the Infirmary in the evening, about twelve hours after the accident. We endeavoured to obtain precise details, but, owing to special circumstances, A., who was alone, had been unable to see what animal had bitten him. The clinical signs, however, pointed to a venomous snake; inflammatory phenomena and pain set in soon after the wound was inflicted, and in a very short time became acute.
“Clinical Signs.—On examining the patient we found that the whole of the right arm was swollen. The skin, which was of a dark red colour, was acutely inflamed. The slightest touch or the least movement caused the patient to cry out. The hand showed traces of the bite, in the shape of two small red marks, each surrounded by a bluish areola. The general condition was good. The thermometer, however, indicated a slight rise of temperature, and the pulse seemed a little soft. The urine on being examined on the day after the accident contained a small quantity of albumin. Organs normal. General health before the accident excellent. Nothing worth mentioning in the previous history.
“Progress.—The conditions that we have just described disappeared very quickly, once the treatment was applied. The pain soon ceased, the temperature fell, and the patient was able to get a few hours sleep. By the following day the inflammatory phenomena had noticeably diminished. The œdema of the forearm and hand, however, persisted for some time, though there was no formation of pus. On the third day after the accident the albumin had completely disappeared from the urine. Finally, after the lapse of a fortnight, the condition became normal, and the convict, who had recovered the entire use of his arm, was able to resume work.