On Snake-Poison: Its Action and Its Antidote

by A. Mueller

It is superfluous to enter into a criticism of the treatment of snakebite until recently in vogue, for, with the exception of the local one by ligature and excision, it stands self-condemned by its complete inefficiency. It may be summed up as a vain attempt to stem the collapse invariably attending snakebite by the administration of stimulants, such as alcohol, ether, ammonia, &c. The attempt is vain, for a person in collapse from snakebite cannot be stimulated by any of these remedies, since neither the heart nor the nerve centres respond to them in the slightest degree, as they do in the absence of snake-poison, the only one that has any effect at all in slight cases being ammonia. But the attempt is not only in vain, it is highly injurious, especially if made with the usual large doses of alcohol, for, in addition to the latter not having the slightest influence on the snake-poison and its baneful effects, they act as an anæsthetic and thus add to the existing depression, besides increasing the tendency to internal hæmorrhage.

It might, under these circumstances, have been expected that any new method of treating snakebite, based on scientific grounds and holding out a sure prospect of success, would be hailed with pleasure, and that conservatism, opposing the new simply on account of its newness, would refrain from its usual tactics in a case where there was really nothing to conserve. But this was not to be, and strange, indeed, it would have been if the writer had escaped the opposition which is almost invariably offered to the discoverer. It appears to be one of the laws of human evolution, wisely designed to prevent precipitate advance, that every new discovery must run the gauntlet of men whose mission it is to act as brakes on the wheels of progress. Of the opposition which has been offered to the strychnine treatment it would, therefore, be folly to complain, but just cause of complaint is furnished by the unscientific attitude which was assumed from the very first and has been maintained throughout by its opponents.

Not a single attempt has been made to disprove the correctness of the theory on which it is founded, yet to leave this theory unquestioned but object to the conclusion to which it leads, must strike even the lay mind as a most illogical proceeding. It is self-evident that, when strychnine is administered as an antidote to snake-poison, the quantity of it injected must be in proportion to that of snake-venom present in the system, and that the doses in which we dispense it in ordinary practice must be entirely left out of sight. Still, in the face of these obvious conclusions, we have had veterans, grave and grey, arguing pompously that the heroic doses advocated by the writer could not be countenanced, and that even medical men could not be entrusted with the serious task of administering them. Even as late as the last medical congress at Sydney this absurd objection to large doses of the antidote was again brought forward. After quantities averaging from half a grain to a grain have been injected many times in Australia with continuous success, after Banerjee has even gone as high as three and four grains in India without a single failure, and without in one single instance serious strychnine symptoms being evoked, the writer of the paper on "Snakebite and its Cure" based his principal objection to the treatment on the alleged ground of there not being sufficient evidence before us to justify heroic doses and show them to be safe in practice. When people wilfully shut their eyes against the most conclusive evidence, it is improbable that any amount of it would satisfy them. Apart, however, from the fully proven antagonism between the two poisons rendering the large doses of the antidote, which in all serious cases are indispensable, perfectly safe, the fear of strychnine is, in itself, a very strange aberration of judgment on the part of my opponents, considering how easy it is to counteract any noteworthy excess in its action, if, perchance, it should occur through unnecessary overdosing, by appropriate remedies.

All other objections to the treatment require but to be glanced at to show their absurdity. Certain crude experiments on dogs made many years ago in India, and put forward as irrefutable at first, have been abandoned of late, and my learned opponents have now taken up a position in their stronghold of statistics, supposed to be impregnable, but in reality only the last refuge of the destitute, a position from which, by dexterous handling of alleged facts, anything and everything can be proven, in short, to use a strong expression, not my own, a convenient and respectable form of lying. By means of these statistics they try to prove, in the first place, that Australian snake-poison is not at all the insidious death-dealing agent it is supposed to be, since, according to statistics, only 126 persons died from it in three colonies within the last ten years. Further study of these statistics leads them to the inference that a strong healthy adult will recover from snakebite without any treatment, and thus they finally arrive at the conclusion aimed at, that persons cured by strychnine injections would probably have recovered without them. These are the inferences drawn by men, who, practising in towns, have probably never seen a case of snakebite. How do they tally with the facts of the case? It is true that the mortality among those bitten by snakes is small here as compared with India, though the poison of our snakes, quantity for quantity, has been proven to be quite as deadly as that of the Indian ones. Our greater immunity is due to our snakes giving off less poison at a bite, and with their short and (excepting those of the death adder) merely grooved poison fangs injecting it very superficially, thus making the process of elimination of the poison by ligature and incision or excision of the punctures much more easy and successful. It is to this treatment, which, as a rule; is immediately adopted in the bush, that our small mortality is due. Our children are taught it in school, and the most illiterate bushman knows how to carry it out. Where it is omitted by persons not knowing that they are bitten until the poison has been absorbed recovery is as rare as it is with the ox and the horse left to themselves without any treatment. But it requires a prodigious stretch of the logical faculty to understand what our small mortality from snakebite has to do with the intrinsic merits of the strychnine treatment. Even if nobody died at all its effects in doing away with the misery and suffering, which, before its introduction, invariably followed snakebite, and often was never got rid of completely, would still be sufficiently beneficial to render the senseless opposition to it on the part of a small section of medical men little short of criminal; for these effects are a matter of constant observation, and cannot, like the rescues from death, be called into question.

The statistics brought forward to prove that the treatment has not reduced the death-rate are also most faulty. Until it is thoroughly understood and in every instance properly applied it is manifestly foolish as well as unfair to lay non-success and failures at its door. When a medical man is called upon to treat a serious case, and instead of boldly addressing himself to the task of combating the symptoms by injecting the antidote irrespective of the quantity he may require until it has conquered the snake-poison, becomes nervous and ceases to inject, when, after what in ordinary practice would be a dangerous dose, he sees but little effect, or if from the first he injects small doses at long intervals, the cause of failure surely lies with him and not with the antidote, which rarely fails where it is properly applied. The duty of disseminating a sound knowledge of the principles of the strychnine treatment unquestionably devolves on our health authorities, who ought, by this time, to have taken some notice of it. But officialdom remains obtuse and issues circulars on the treatment of snakebite, recommending, inter alia, the free use of alcohol.

The literature on the subject of snake-poison is very voluminous, but those who seek for enlightenment in it will be as disappointed as the writer was after wading through it. The toilers in this barren field of research were numerous, but with few exceptions, they toiled in vain. Fontana may be looked upon as the founder of that hideous experimentalism by which, in his hands alone, four thousand animals were tortured to death without a single tangible result except that in his great work, "Reserche Fisiche sopra il Veneno della Vipera," which he wrote at the conclusion of his cruel labours, he left us a grotesque monument of patient, but ill-guided research. Other Italians, following his method, Redi, Mangili, Metaxa, &c., were equally unsuccessful in shedding one ray of light on the vexed and obscure problem.

Among the Germans who contributed to the subject may be mentioned:—

Wagner.—"Erfahrungen über den Biss der gemeinen Otter."

Prinz Maximilian von Wiedd.—"Beiträge zur Geschichte Brasiliens."

Lenz.—"Schlangenkunde."