Symptoms.
—A snake bite is like a hypodermic injection of a deadly poison, and symptoms set in promptly. These are both local and general. There is more or less local pain, with swelling and discoloration, which are due to effusion of blood. They increase in intensity, and are followed by vesication and necrosis of tissues—that is, gangrene—if the patient survive for some time. Constitutional symptoms are not long delayed, and are characterized by severe prostration, including cold, clammy sweat; feeble and rapid pulse, irregular respiration, etc. When patients succumb they usually die in collapse. The pathological changes are not well-marked or characteristic.
Treatment.
—Treatment of snake bite must be prompt if it is to be successful. It should consist of incision and drainage of blood from the part, in order to prevent diffusion into the rest of the body by means of the returning blood and lymph. Bleeding should be facilitated by cups or by sucking the wound. An elastic tourniquet should be applied around the limb near the trunk, the site of the wound freely incised, and the blood worked both ways toward the wound by “stripping” the member. If there be any known antidote to snake poison it consists of potassium permanganate or calcium hypochlorite (chloride of lime), applied locally in solution, the former sufficiently strong to have a marked color and capable of producing local irritation (1 per cent.). With these local measures, constitutional stimulation should be indulged by means of volatile and other stimulants. There is a popular fallacy in favor of inducing alcoholic intoxication. To do this is a mistake. Nevertheless, alcohol may be given freely, dosage being limited not by amount but by effect. Strychnine, digitalis, atropine, etc., will often prove serviceable. The tourniquet should be gradually released after being in use for two or three hours, and an assistant ready to antidote the poison which may then enter the system with the necessary doses of stimulants above mentioned. One-half grain of strychnine may be administered in divided doses, it apparently being an antidote to the snake venom. There is much reason from recent experimentation to expect benefit from serum therapy—i. e., by injection of serum from immunized animals who have been fortified by increasing doses of the snake poison. Calmette advises the use of 20 Cc. of serum from a horse which has been immunized by cobra poison. He believes the active poison of all venomous serpents to be essentially identical. Good results have been reported even after an interval of an hour. In this country, however, such treatment will be called for so seldom that there is not the hopeful outlook for the serum therapy of snake bite that there is in India.
POISONING BY LIZARDS.
A large lizard found in the southwestern part of this country and in Northern Mexico, known as the Gila Monster (Heloderma suspectum), is credited with being a poisonous animal. The probability is that the bite is fatal to some of the lower animals and may produce more or less serious disturbances in man. Nevertheless there is little real evidence that this is to be considered in the same category with the venomous serpents above mentioned.
POISONING BY SPIDERS AND SCORPIONS.
Certain species of spiders are venomous, the tarantula being the best known. Certain scorpions also inflict poisonous stings, and centipedes and other animals occasion at least serious local disturbance by bites or stings. These insects and animals seldom attack unless irritated or disturbed. Tarantula bites are occasionally inflicted in the Northern States by spiders which have concealed themselves in shipments of fruit, bunches of bananas being especially likely to be their hiding places. The injuries inflicted by these animal organisms cause local pain, considerable swelling, with remote effects on the nervous system, prostration, restlessness, etc. They are seldom fatal, but may cause annoyance and serious disturbance. These cases are to be treated in the same way as bites of poisonous serpents, adapting the measures and the energy of the treatment to the severity of the symptoms.
POISONING BY WASPS, HORNETS, AND BEES.
Wasps, hornets, and bees are capable of inflicting severe stings; domestic insects, like mosquitoes, bed-bugs, etc., inflict minute wounds which sometimes occasion excessive annoyance. Their sting is followed by pain, burning sensation, sometimes intense itching, and more or less swelling. Enough poison is deposited to produce local vasomotor paralysis, as the result of which wheals resembling those of urticaria, or more extensive swellings, quickly result. If the sting of an insect has been broken off in the flesh it may remain and intensify the disturbance. Two or three injuries of this kind create local disturbance, but there are some instances on record where men and animals have been stung to death when attacked by swarms of these insects, death apparently being due to intensification of effect owing to increased dosage of poison. If a sting occur upon loose tissues, like the eyelid, or upon the tongue or lips, swelling and suffering may be extreme. If symptoms of depression present, they should be combated by stimulants, diffusible or other, and by hypodermic medication pro re nata. Local discomfort may be alleviated by ice, by menthol, by chloral camphor, etc.[5]