Present Symptoms.—Patient was delirious, and could not understand what was told him; body cold and covered with perspiration; breathing hurried, with a low rattle at the end of expiration; mouth, tongue, and palate all dry; tongue leather-like and cracked, and felt cold; tickling of throat, not exciting vomiting; pupils dilated; conjunctiva congested; pulse 95; patient talked, or rather muttered, with difficulty; could not tolerate strong light or loud noise; the mucous membrane of the mouth showed irregular dark patches of ecchymosed blood.
The right foot was swollen, and in a line between ankle and knuckle of big toe showed two punctures—one deep and bleeding, and surrounded by ecchymosis; the other one below this, more superficial, the blood oozing thin and not coagulating. Received, at 10.45 p.m., 1/12th grain of strychnine in left arm. At 11 p.m., the same dose; breathing the same, but no rattle; stupor rather deepening; incoherency increasing. At 11.15, the same dose; breathing easier; stupor the same; pulse, 85; temp, 97.6; delirious at times, and moaning with inarticulate cries; could not hear when spoken to in loud voice. 11.30 p.m., the same dose; no change in condition. 11.45 p.m., the same dose; stupor now fading away; delirium present; intolerant to light and noise; peculiar grin and cramp in face-muscles when attempting to talk; temp, 95.8; pulse very hard; intense thirst; less bleeding from punctures and blood thicker. 12 p.m., the same dose; no stupor now, but cramps in lower extremities; no incoherency; only occasionally uneasy and senseless for a moment, and then rising suddenly like one startled when sound asleep. 12.30 a.m., no further symptoms; bleeding stopped; great thirst; eyes red and glaring; saccharine drinks given; no injection. 3 a.m., no sleep, but only slight slumber; no pain in foot; no bleeding; temperature, 98.8; thirst unabated; only drinks given.
Sept. 14th, 10 a.m.—Better, but talking slightly incoherent; received another injection of 1/12th grain of strychnine. 6 p.m., better; had good appetite; given milk and sago.
Sept. 15th, 6 a.m.—Better. 6 p.m.—Better; had three motions, rice and milk diet given, slept soundly between 10 a.m. and 2 p.m., no redness in eyes, swelling of foot abated.
Sept. 16th.—Better, only complaining of heaviness in head. At 9 p.m. had a fit of stupor all of a sudden, became insensible, and commenced to bleed again from the mucous membrane of mouth and nose. The patient became almost insensible, and could only be roused with difficulty. Twenty minims of liq. strychnine, equal to 1/6th grain, were now injected into the right arm.
At 9.20 stupor had passed away and consciousness was fully restored. From this time onward convalescence was uninterrupted, and patient was discharged cured on the 20th Sept., 1892.
In his remarks on this case Dr. Banerjee, after reporting that the snake with back broken in two places was brought to him on the following day from the exact locality where Rahimudden had been bitten, gives the following description of it:—Head, large and triangular; nostrils, large and kidney-shaped; scales, much imbricate, ventral scales 169, subcaudals 48; confluent, irregular ring-like, dark brown spots along the back, and with lateral black patches or rings with white borders. The head marking very peculiar double V shaped mark, the angle directed between the nostrils; interstitial coloration, yellowish brown, belly white, and with brown or amber spots; eyes, large, pupils erect, irides yellow; body, stout and compressed laterally; poison fangs, large and recurved, size about half an inch. The length of snake was 3 feet 5 inches, and from these characters it was identified to be the chain viper (Duboia Russellii, Gray), the most venomous of Indian vipers.
The total quantity of the antidote in this case administered was only 110 minims of a one in 120 solution of strychniæ acetas, or 11/12ths of a grain of that drug. Considering the extremely venomous nature of the snake and the large quantities of strychnine required in some of the previously reported cases of echis and bungarus bites, the quantity used seems disproportional, but this evidently is explained by the fact that only one of the fangs perforated deeply, and at the back of the foot, probably struck the bone before entering to its full length, the snake thus failing to impart the full quantity of venom at its disposal.
The chief interest of Dr. Banerjee's cases centres in the fact that they are mostly viper-bites. They prove conclusively, as do Feoktistow's experiments on the lower animals, that the theory of viper-poison being a blood poison, as asserted in all works on the subject, is not tenable and must be abandoned. If it effected changes in the blood, incompatible with life, strychnine, acting solely on the nerve-centres, could not possibly obliterate these changes within a few hours or even days. On the other hand the successful treatment of bungarus bite with strychnine places it beyond doubt that cobra-poison will also yield to it, if fearlessly and vigorously applied.
It is most gratifying to the writer to know from good authority that Sir Joseph Fayrer, the President of the Medical Board at the India office, has recommended to the English Government the adoption of the strychnine treatment of snakebite in India, and that this adoption will not be subject once more to the doubtful result of experiments on the lower animals, which, according to newspaper reports, were contemplated at Calcutta as a test. It would have been deplorable to see more precious time lost in these experiments, whilst the only proper subjects for experiments, the unfortunate natives, are perishing by thousands. The step taken by Sir Joseph Fayrer does honour both to his head and his heart, and if his recommendation is accepted and vigorously carried out it will still further increase the debt of gratitude which India owes to British rule, and with regard to its terrible snake plague, to the one Englishman who of all others has distinguished himself by an almost life long study of the subject and indefatigable labours for its alleviation.