The failure in myotic power of the heart and in the muscles of respiration through reflex influence of par vagum and great sympathetic nerves, whereby pulmonary circulation is impeded, are among the earliest of phenomena. Breathing becoming retarded and laborious, the necessary supply of oxygen is no longer received, and blood still venous, in that it is not relieved of its carbon, is returned through the arteries, whereby the capillaries of the brain are gorged with a doubly poisoned circulation, poisoned by both venom and carbon. In this we have ample cause for the attending train of symptoms that, beginning with drowsiness, rapidly passes into stupor followed by profound coma and ultimate dissolution—marked evidence of the fact that a chemical agent or poison may produce a mechanical disease; and autopsical research reveals absolutely nothing save the general disorganization of blood corpuscles, as already noted.
Taking circumstantial and pathological evidences into consideration, the hope of the person thus poisoned rests solely upon lack of vitality in the serpent and its venom, and in his personal idiosyncrasies, habits of life, condition of health, etc., and the varied chapters of accidents. To look for a specific, in any sense of the word, is the utmost folly! The action of the poison and its train of results follow inoculation in too swift succession to be overtaken and counteracted by any antidote, supposing such to be a possible product, even if administered hypodermically. We have evidence of this in iodic preparations, iodine being the nearest approach to a perfect antidote that can be secured by mortal skill, inasmuch, if quickly injected into the circulation, it retards and restrains the disorganizing process whereby the continuity of the blood corpuscles is lost; moreover, it is a marked antiseptic, favors the production of adhesive inflammation, whereby lymph is effused and coagulated about the bitten part, and absorption checked, and the poison rendered less diffusible. But when a remedy is demanded that shall restore the pristine form, functions, and energy of the disorganized globules, man arrogates to himself supernal attributes whereby it becomes possible not only to save and renew, but to create life; and we can scarce expect science or even accident (as some expect) to even rival Nature and set at defiance her most secret and subtle laws. Such, however, is the natural outcropping of an ignorant teaching and vulgar prejudice that feeds and clothes the charlatan and ascribes to savage and uncultured races an occult familiarity with pathological, physiological, and remedial effect unattainable by the most advanced sciences; and whereby the Negro, Malay, Hindoo, South Sea Islander, and red man are granted an innate knowledge of poisons and their antidotes more than miraculous. A reward of more than a quarter of a century's standing, and amounting to several thousand pounds, is offered by the East India Government for the discovery of a specific for the bite of the cobra, and for which no claims have ever been advanced; and the "snake charmers" or jugglers in whom this superior knowledge is supposed to center are so well aware of the futility of specifics, and the risk to which they are subjected, that few venture to ply their calling without a broad-bladed, keen-edged knife concealed about the person as a means of instant amputation in case of accident. Medical and scientific associations of various classes, in Europe, Australia, America, even Africa, and the East and West Indies, have repeatedly held out the most tempting lures, and indulged in exhaustive and costly experimentation in search of specifics for the wounds of vipers, cobras, rattlesnakes, and the general horde of venomous reptiles; and all in vain. Even the saliva of man, as well as certain other secretions, is at times so modified by anger as to rival the venom of the serpent in fatality, and it has no specific; and a careful analysis of the pathological relations of such poison proves that further experimentation and expectation is as irrational as the pursuit of the "philosopher's stone."
It is an indisputable fact, however, that there are individuals whose natural or acquired idiosyncrasies permit them to be inoculated by the most venomous of reptiles without deleterious or unpleasant results, and Colonel Matthews Taylor[7] knew several persons of this character in India, and who regarded the bite of the cobra or tic paloonga with nearly as much indifference as the sting of a gnat or mosquito. Again, in 1868, Mr. Drummond, a prominent magistrate of Melbourne, Australia,[8] met with untimely death under circumstances that attracted no little attention. An itinerant vender of nostrums had on exhibition a number of venomous reptiles, by which he caused himself to be successively bitten, professing to secure immunity by reason of a secret compound which he offered for sale at a round figure. Convinced that the fellow was an imposter, and his wares valuable only as a means of depleting the pockets of the credulous, Mr. Drummond loudly asserted the inefficacy of the nostrum, as well as the innocuousness of the reptiles, which he assumed to be either naturally harmless, or rendered so by being deprived of their fangs; and in proof thereof insisted upon being himself bitten. To this experiment the charlatan was extremely averse, offering strenuous objections, and finally conveyed a point blank refusal. But Mr. Drummond's demands becoming more imperative, and observing that his hesitancy impressed the audience as a tacit acknowledgment of the allegations, he finally consented, and placed in the hands of the magistrate a tiger snake, which he deemed least dangerous, and which instantly struck the gentleman in the wrist. The usual symptoms of serpent poisoning rapidly manifested themselves, followed by swelling and lividity of the part, obstructed circulation and respiration, and coma; and in spite of the use of the vaunted remedy and the attentions of physicians the result was most fatal. The vender subsequently conceded the worthless character of his nostrum, declaring that be enjoyed exemption from the effects of of serpent poison by virtue of recovery from a severe inoculation in early life; and he further added he knew "some people who were born so," who put him "up to this dodge" as a means of gaining a livelihood.
It is a general supposition that such immunity, when congenital, is acquired in utero by the inoculation of the parent, and Oliver Wendell Holmes' fascinating tale of "Elsie Venner" embodies many interesting features in this connection. Admitting such inoculation may secure immunity, recent experiments in the action of this as well as kindred poisons give no grounds for believing it at all universal or even common, but as depending upon occult physiological or accidental phenomena. For instance, the writer and his father are equally proof against the contagion and inoculation of vaccination and variola, in spite of repeated attempts to secure both, while their respective mothers suffered terribly with smallpox at periods subsequent to the birth of their children; and it is well understood that there are striking analogies between the poisons of certain contagious fevers and those of venomous serpents, inasmuch as one attack conveys exemption from future ones of like character. In other words, many animal poisons, as well as the pathological ones of smallpox, measles, scarlatina, whooping cough, etc., have the power of so modifying the animal economy, when it does not succumb to their primary influence, as to ever after render it all but proof against them. Witness, for instance, the ravages of the mosquito, that in certain districts punishes most terribly all new comers, and who after a brief residence suffer little, the bite no longer producing pain or swelling.
Regarding the supposed correlation of serpent poison and the septic ferments of certain tropical and infectious fevers, they are not necessarily always contagious. It may be interesting to note that one Doctor Humboldt in 1852,[9] in an essay read before the Royal Academy of Medical Sciences at Havana, assumed their proximate identity, and advocated the inoculation of the poison of one as a prophylactic of the other. He claimed to have personally inoculated numberless persons in New Orleans, Vera Cruz, and Cuba with exceedingly dilute venom, thereby securing them perfect immunity from yellow fever. Aside from the extraordinary nature of the statement, the fact that the doctor affirmed, he had never used the virus to an extent sufficient to produce any of its toxic symptoms, cast discredit over the whole, and proofs were demanded and promised. This was the last of the subject, however, which soon passed into oblivion, though whether from failure on the part of the medico to substantiate his assertions, or from the inanition of his colleagues, it is difficult to determine, though the presumption is largely in favor of the former. Nevertheless, it is worthy of consideration and exhaustive experimentation, since it is no less plausible than the theory which rendered the name of Jenner famous.
Outside of the transfusion of blood, for which there are strong reasons for believing would be attended with happy results, the sole remedies available in serpent poisoning are measures looking to the prompt cutting off of the circulation of the affected part, and the direct stimulation of the heart's action and the respiratory organs, until such a time as Nature shall have eliminated all toxical evidences; and these must necessarily be mechanical. Alcoholic stimulants are available only as they act mechanically in sustaining cardiac and pulmonary activity, and where their free use is prolonged efficacy is quickly exhausted, and they tend rather to hasten a fatal result. They are devoid of the slightest antidotal properties, and in no way modify the activity of the venom; and an intoxicated person, so far from enjoying the immunity with which he is popularly credited, is far more apt to succumb to the virus than him of unfuddled intellect. The reasons are obvious. Theoretically, for purely physiological and therapeutic reasons amyl nitrite should be of incalculable value, though I have no knowledge of its use in this connection, since its vapor when inhaled is a most powerful stimulator of cardiac action, and when administered by the mouth it is unapproached in its control of spasmodically contracted vessels and muscles. The relief its vapor affords in the collapse of chloroform anæsthesia, in which dissolution is imminent from paralyzed heart's action, is instantaneous, and its effect upon the spasmodic and suffocative sensations of hydrophobia are equally prompt. Moreover, without further discussing its physiological functions, it is the nearest approach to an antidote to certain zymotic poisons, and especially valuable in warding off and aborting the action of the ferment that gives rise to pertussis, or whooping cough. Iodide of ethyl is another therapeutical measure that is worthy of consideration; and iodoform in the treatment of the sequelæ incident to recovery.
The native population of India, in spite of the contrary accepted opinion, are remarkably free from resort to nostrums that lay claim to being antidotes. The person inoculated by the cobra is at once seized by his friends, and constant and violent exercise enforced, if necessary at the point of stick, and severe and cruel (but nevertheless truly merciful) beatings are often a result. In this we see a direct application, without in the least understanding them, of the rules laid down to secure certain physiological results, as for the relief of opium and morphia narcosis, which serpent poisoning almost exactly resembles. The late Doctor Spillsbury (Physician-General of Calcutta),[10] while stationed at Jubulpore, Central India, was informed late one evening that his favorite horse keeper had just been dangerously bitten by a cobra of unusual size, and therefore more than ordinarily venomous. He at once ordered his gig, and in spite of the wails and protestations of the sufferer and his friends, with whom a fatal result was already a foregone conclusion, the doctor caused his wrists to be bound firmly and inextricably to the back of the vehicle; then assuring the man if he did not keep up he would most certainly be dragged to death, he mounted to his seat and drove rapidly away. Three hours later, or a little more, he returned, having covered nearly thirty miles without cessation or once drawing rein. The horse keeper was found bathed in profuse perspiration, and almost powerless from excessive fatigue. Eau de luce, an aromatic preparation of ammonia, was now administered at frequent and regular intervals as a diffusible stimulant, and moderate though constant exercise enforced until near dawn, when the sufferer was found to be completely recovered.
The value of violent and profuse cutaneous transpiration, thereby securing a rapidly eliminating channel for discharging poison from the system, is well known; in no other way can action be had so thorough, speedy, and prompt. Captain Maxwell[11] tells us it was formerly the custom among the Irish peasantry of Connaught, when one manifested unmistakable evidences of hydrophobia, to procure the death of the unfortunate by smothering between two feather beds. In one instance, after undergoing this treatment, the supposed corpse was seen, to the horror and surprise of all who witnessed it, to crawl from between the bolsters, when he was found to be entirely free from his disorder; the beds, however, were saturated through and through with the perspiration that escaped the body in the intensity of his mortal agony. More recently a French physician,[12] recognizing the incubatory stage of rabies in his own person, resolved upon suicide rather than undergo its attendant horrors. The hot bath was selected for the purpose, with a view of gradually increasing its temperature until syncope should be induced, which he hoped would be succeeded by death. To his surprise, however, as the temperature of the water rose, his sensations of distress improved; and the very means chosen for terminating life became instead his salvation, restoring to perfect health. Again, Dr. Peter Hood[13] relates that a blacksmith residing in the neighborhood of his country house was in high repute for miles about by reason of his cures of rabies. His remedy consisted simply in forcing the person bitten to accompany him in a rapid walk or trot for twenty miles or more, after which he administered copious draughts of a hot decoction of broom tops, as much for its moral effect as for its value in sustaining and prolonging established diaphoresis.
Though the pathological conditions of hydrophobia and serpent poisoning are by no means parallel, the rationale of the methods employed in opening the emunctories of the skin are the same; and were it not for its powerful protracting effect and depressing action upon the heart, we might perhaps secure valuable aid from jaborandi (pilocarpus). since it stimulates profusely all the secretions; as it is, more is to be hoped for in the former disorder than in the latter. It would be desirable also to know what influence the Turkish bath might exert, and it would seem worthy at least of trial.