[APPENDIX.]
I. Bites of Venomous Reptiles.—The poisonous reptiles provided with fangs are the Ophidia, or Serpents.
Accidents from serpents’ bites rarely, of course, happen in this country, but are of frequent occurrence in India, Australia, and America.
On the morning of the 20th October, 1852, one of the keepers at the Zoological Gardens in the Regent’s Park, was wounded by a cobra, which he had removed from its cage and was playing with. For twenty minutes after the animal bit him at the root of the nose no peculiar symptoms were manifested, and the part was merely bathed with water. Forty minutes afterwards the man was admitted into University College Hospital, his face then being livid, respiration impeded, and the power of locomotion imperfect. He pointed to his throat as the seat of pain, but could not speak, and was unable to swallow. Artificial respiration was employed for fifty minutes, and subsequently galvanism; but stupor rapidly succeeded to faintness, and the patient died comatose fifty-five minutes after admission. The chief appearances found on dissection were an unnatural fluidity and blackness of the blood, with great congestion of the lungs and spleen.
The only poisonous reptile indigenous to this country is the common viper or adder. It is found on the heaths and in the dry woods of all parts of England, Scotland, and Wales, and is much feared on account of its venom. Very few cases are known in which the bite of this animal has proved fatal. In May, 1862, a little boy, at Burgess Hill, near Brighton, clambered up a bank, to examine a bird’s nest. Groping with his hand among the moss, he felt, as he thought, a sharp prick from a thorn. It turned out to be a bite from an adder. As the real cause of the wound was not suspected, the swelling of the hand and arm was not properly attended to until too late, and the poor child died on the second day.
The poison apparatus of the viper consists of a gland placed by the side of the head, a duct, and a fang or pointed curved tooth, moulded in the form of a tube on either side. On being bitten, the person has pain in the wounded part, which quickly becomes severe and extends up the adjoining tissues. The limb swells greatly, becomes red and livid; while faintness soon sets in, and the pulse gets rapid and small. Bilious vomitings, dyspnœa, profuse cold sweats, jaundice, delirium, and convulsions, have also been noticed. In a few days the symptoms usually amend; but in weak sickly individuals gangrene of the limb may follow, or death may occur in the course of two or three days.
The treatment of the bites of venomous reptiles must be local and constitutional. Immediately the wound is inflicted it should be sucked freely and perseveringly. If the patient is too faint to do this for himself, a bystander may fearlessly help him; for it is well known that these poisons may be smeared upon the lips and tongue, or even swallowed, with impunity. At the same time a ligature is to be placed around the limb, above the wound; or if this be impossible, from its situation, the textures around are to be compressed. Then, the bitten part may be excised; or it may be destroyed by the actual cautery, nitric acid, the strong liquor ammoniæ, or nitrate of silver.
Professor Halford, of the University of Melbourne, in a paper published at the commencement of 1869, recommended the injection of liquor ammoniæ into the veins for snake bite. Of twenty cases of snake bite since treated in this manner, by different practitioners, recovery occurred in seventeen. The snakes were all venomous, and included the tiger snake, the brown and black snake of Australia, &c. These, according to Professor Halford, are as deadly as the cobra and rattlesnakes of India. The plan of proceeding is to expose the vein, and then to pierce its coats with the sharp point of a hypodermic syringe containing the officinal liquor ammoniæ—sp. grav. 0·959. At least thirty minims are to be employed; the dose being repeated as the power of the preceding injection is expended. Professor Halford formerly thought that in consequence of the entrance of the snake poison into the blood a rapid growth of new cells occurred, which took up and exhausted the fibrin and oxygen of the blood, and rendered them incapable of ministering to the wants of the system. He now thinks that the new corpuscles are only the white corpuscles of the blood altered and enlarged, the change in them being caused by an alteration in the liquor sanguinis; this alteration being, in fact, a disappearance of the fibrin under the action of the poison. The ammonia is believed to counteract this power, and in favor of this view many Australian physicians have spoken strongly. Dr. Fayrer, however, has found the proceeding a failure in India. This gentleman is of opinion that the activity of the poison in some Indian snakes is so great that it is impossible to counteract it by any method.
The constitutional remedies are derived chiefly from the class of diffusible stimulants. No agent is more generally recommended than ammonia; and therefore the officinal compound tincture of ammonia (formerly known as eau de luce) should be given in half-drachm doses, well diluted; or the aromatic spirits of ammonia may be administered in the proportion of two drachms to an ounce and a half of water. Supposing that no ammonia is at hand, brandy will prove an excellent substitute. Transfusion of blood has been likewise recommended; but I do not know of any instance in which it has been resorted to.