Part 5

CASE 5.--This remarkable case was not published in the medical press, but in many of the papers of Queensland, where it created much sensation. The writer is indebted for an account of it to Dr. Thwaites, who vouches for its correctness. It appears that this gentleman acquainted the well-known explorer of Northern Queensland, Mr. Johnstone, who is his uncle, and now police magistrate at Maryborough, Queensland, with his success in treating snakebite with strychnine. Mr. Johnstone, who during his explorations had seen much of snakebite and many deaths from it, wrote rather incredulously in reply, stating that our southern snakes were innocuous in comparison with those of the north; and that, having seen twelve persons bitten and die by the deadly brown snake of the north (_Diemenia superciliosa_), he must withhold his belief in the new antidote until he had witnessed a case of brown snakebite cured by it or reported on good authority. This desire he had quickly gratified, and by a strange fatality in his own person. Whilst taking his children for a walk in the bush a few weeks afterwards he stepped aside the path to pluck a flower from a bush, and in doing so was bitten on the leg by a vigorous brown snake. He at once applied a ligature, and had the punctures sucked by an aboriginal, but became comatose before he reached home. Three medical men were summoned in haste, injected ammonia into several veins, and finally had to resort to artificial respiration, declaring the case a hopeless one. In this extremity Mrs Johnstone rushed to a fourth one, who had seen Dr. Thwaites' letter, and discussed its contents with her husband in her presence. This gentleman--Dr. Garde--laid up in bed, quickly furnished the lady with liq. strychniæ, accompanied by the request to his colleagues to inject it freely. She came back to her husband's bedside, when artificial respiration was about to be given up, but the very first injection rendered it no longer necessary and two more restored Mr. Johnstone completely. Saving the life of this highly respected and popular functionary, who was the first in Queensland treated with the antidote, paved the way for it in that colony, where it is most needed and is now highly appreciated.

These five cases, thoroughly typical of the effects of strychnine in snakebite, are almost in themselves sufficient to bear out the correctness of the writer's deductions, but for the benefit of a certain class of rigorously incredulous scientists, who would not be satisfied with five cases, the writer submits 45 more and in addition to these--last but not least--Dr. Bannerjee's eight Indian cases. They are all well authenticated, being mostly taken from the _Australasian Medical Gazette_ or from private notes, but to avoid useless repetition the greater part of them will be merely cited and only the more remarkable ones be given in detail. Whether in the face of this formidable array of evidence that blind incredulity and senseless opposition, usually blocking the way of every new discovery, will at last give way, remains to be seen. The writer has had his full share of them, and but for the valuable aid he received from the Hon. Dr. Creed, the able editor of the _A. M. Gazette_, would probably be struggling yet for the introduction of his antidote. When it is considered that, in spite of such evidence as here produced, his discovery has as yet received no official recognition from any of the Australian medical authorities, and that even now there are medical men who can write such effusions as that of Dr. T. L. Bancroft, of Brisbane, beginning with the words: "It is deplorable to still see recorded cases of snakebite treated with strychnine, &c.," (see _Gazette_ for July, 1892)--the attitude assumed from the first by Dr. Creed and his unfailing advocacy of the antidote can not be too highly appreciated and lay both the writer and the public under a debt of deep gratitude to him. But for his early recognition of the soundness of the writer's theory and treatment of snakebite many valuable lives now saved would have been lost. As early as June, 1889, Dr. Creed wrote in an editorial: "We desire to call the special attention of the profession to Dr. Mueller's papers on the pathology and cure of snakebite, published in our issues for Nov., Dec., Feb, April and May last, and to press upon them the justice and, we submit, the necessity of extremely careful consideration of his theory and of the results shown in the cases in which, acting on it, he has used hypodermic injections of strychnine for the treatment of snakebite. We formerly expressed our concurrence in the opinion of Sir Joseph Fayrer, who wrote: 'I do not say that a physiological antidote is impossible, all I assert is, that it is not yet found.' We are indeed pleased to state that we believe such an antidote is now found and that Dr. Mueller is the happy discoverer. We are of opinion that his theory as to the pathological changes set up in the human system by the injection of snake-poison is a sound one and that the treatment he has suggested and used is correct and proper, and the one likely to avert death in cases of snakebite, which would otherwise in all probability prove fatal. We therefore press the use of hypodermic injections of strychnia in the manner described by him upon the attention of practitioners who may have to treat cases in which the symptoms present are the result of snake or dangerous insect poison, and think that, should the patients die without its having been used, all will not have been done to save life that might have been." Without such utterances repeated from time to time and without the ample space always allowed in the _Gazette_ to the subject, a record like that now submitted would not have been possible.

CASE 6.--P. Evans, a girl of 20 years, bitten on wrist by a brown snake. Symptoms--Staggering gait, drowsiness, &c. Only 1/16th grain in four injections. Notes furnished by Drs. Mahoney and Kennedy, of Albury.

CASE 7.--W. Thiplin, a labourer, bitten on hand by brown snake. Three injections. Notes by Dr. Baird of Healesville.

CASE 8.--Luke Dewhurst, labourer, bitten on hand by tiger snake. Cured by one injection of m. xv. liq. strychniæ after ammonia had failed. Notes by Dr. Dutton, of Lillydale.

CASE 9.--P. Moroney, labourer, bitten on thigh at night, snake not identified. Cured by three injections of 1/12th grain each. Notes by Dr. Pardey, of Myrtleford.

CASE 10.--Mrs. Skinner, bitten on thigh, at Carrum. Treated by Dr. Verity.

CASE 11.--Child of Mr. Weeks, aged three years. Treated by Dr. Degner, of Myrtleford.

CASE 12.--Annie Rankin, servant, at Corowa. Treated by local chemist.

CASE 13.--Child of Mr. F. Daniels, of Mount Kent, Queensland, _only two years old_, bitten by a death adder on fourth finger of left hand, the snake found clinging to finger. Ligature applied and finger chopped off, but condition of child very precarious when admitted to Toowoomba Hospital, after a night's journey, at daylight, in complete collapse. Pronounced out of danger by Dr. Hunt, the house-surgeon, at 10.30 and taken home in the afternoon. Notes not furnished.

CASE 14.--Reported by Dr. Pain, of Allora, Queensland. Symptoms serious. Four injections of m. xv., x., viii. and vii.

CASE 15.--Reported by Dr. Garde, of Maryborough, Queensland, girl of 13 years, bitten by brown snake, requiring only two injections of m. xv. and x.

CASE 16.--Reported by Dr. St. George Queely, of Maytown, Queensland, lad of 19 years, bitten by black snake, symptoms serious. Four injections of m. xv., xv., xx., and xv., total 65 minims of liq. strych. P.B. injected within less than two hours, muscular spasms appearing after last injection. Patient made rapid recovery, riding home, a distance of 16 miles, within a few hours after treatment.

CASE 17.--Reported by Dr. Ray, of Seymour, severe bite of a tiger snake. Within six hours 4/5th of a grain administered subcutaneously, besides a considerable quantity given by the mouth. Patient made a good recovery. "Every injection after the second one," Dr. Ray reports, "having a distinct effect within three or four minutes, and lasting from one to one and a half hours before tendency to coma returned."

CASE 18.--Very remarkable. Read by Dr. Forbes, medical officer of hospital, Charters Towers, Queensland, before the North Queensland Medical Society. Boy, 6 years old, was admitted to hospital at 9 p.m. on 27th October, 1890, bitten on foot by a death adder, which was killed and identified. Dr. Forbes reports: When seen by me, two hours after the accident, he was sitting on his mother's knee with his head hanging on one side, but quite conscious, and answering questions rationally, pupils widely dilated with almost no reaction to light, pulse very fast and soft, &c. Thinking his condition might be due to fear I hesitated to use strychnine. So, ordering strong coffee, I hurried to attend an accident case just admitted with severe hæmorrhage, and left the boy in charge of a nurse, with orders to call me at once if she saw any change. I had scarcely been away 15 minutes when the father rushed in saying his boy was dead, and indeed his statement seemed but too true. The child was lying quite limp, face blue, eyes half shut, extremities very cold, no pulse perceptible, no respiration visible. I at once injected m. x. of liq. strychniæ P.B. and made artificial respiration. He soon began to improve, and in about 20 minutes was able to speak. He was watched all night, but suffered no relapse, and was discharged on the next day.

CASES 19 TO 21, reported by Dr. Weekes, of Lithgow, N.S.W. Dr. Weekes writes:--"Within the last year I have had three cases under my care, all bitten by black snakes, and all in about the same place, on the outside of the calf of the leg. The patients were all comatose, exhibiting all the usual symptoms of snakebite-poisoning, and in one, my last case, _the patient had convulsions_. In all of them I made hypodermic injections of m. xv. liq. strych., and the effects were most marked, the patients being completely roused and becoming quite sensible and rational each time," &c.

CASE 22.--Mrs. Ryan, of Oberon, N.S.W., bitten on leg by tiger snake, comatose and nearly pulseless after three hours, treated by Dr. Kingsburry, amount of strychnine not stated.

CASE 23.--Benjamin Childs, bitten on finger by death adder, treated by Dr. Campbell, of Grafton, N.S.W.

CASE 24.--Rather remarkable. Reported by Dr. Lloyd Parry, of Emmaville, N.S.W., in _Gazette_ of March, 1891, and further particulars in private correspondence with writer. A Chinese miner, aged 30 years, was bitten on the back of the foot by a death adder. His mates, deeming medical aid useless, did not send for Dr. Parry until death was imminent, and then only with a view of getting a certificate of death, and avoiding autopsy and inquest. When seen, three hours after infliction of bite, the man was deeply comatose and pulseless, skin icy cold, pupils dilated and insensible to light, lower jaw hanging down and tongue protruding, respiration scarcely perceptible. He was in fact so near death that this event was expected to take place from minute to minute. In order to task the antidote to the utmost, Dr. Parry cut the tight ligature without excising the bitten skin and then injected xv. of liq. st. P.B. To his surprise in a few minutes the man began to groan and very soon afterwards became conscious. Dr. Parry then watched him carefully and in about an hour found coma returning, when another injection was made and roused him for good. There was much swelling and effusion in the leg, but no ill effects followed.

In this case, judging from the comparatively small quantity of the antidote required, only a small amount of poison had been imparted, the bite being on the back of the foot, where the fangs cannot penetrate deeply. Still there can be no doubt that even this small quantity of the justly dreaded death adder poison would have proved fatal, if it had not been counteracted by the antidote.

CASE 25, reported from Tasmania by Dr. Holmes, of Launceston, presents different features, showing the very large quantity of the antidote sometimes required. After describing the condition of his patient, a Mrs. Frazer, of St. Leonards, Dr. Holmes writes:--"From her desperate condition I thought it too late for the ammonia treatment and decided on injecting liq. strychniæ. At 12.30 p.m. injected m. xv, at 1.40, m. xv., at 2.10, m. xv., at 2.40, m. xv., and 3.10, m. xv., at 4 p.m., m. x., and at 5, m. x. A few minutes after the last dose I noticed the physiological action of the drug and desisted from injecting. At 8 p.m. she seemed almost well, pupils normal in size and reacting well, was not sleepy and could swallow easily. The patient made a good recovery."

This is the largest quantity of strychnine that has been required in Australia, namely, 126 minims of liq. strych., or 1-1/9th gr. injected in less than five hours, with the most beneficial result. Surely the most cynical scepticism must give in to such facts.

CASE 26.--Reported by Dr. MacDonald, of Murwillumbah, N.S.W. Mr. S., bitten on leg by a black snake. Coma, complete paralysis, chin hanging down to sternum, pupils dilated, &c. An injection of m. xv. had no effect; one of m. xx. very little. After a third one of m. x. patient suddenly became conscious, could walk without assistance, and in half an hour was sent to bed perfectly recovered.

CASE 27.--Reported by Dr. Yeatman, of Auburn, South Australia. Mr. D., a farmer, aged 45 years, bitten on thumb; snake not named; cured by three injections of only m. v. each. Convulsions lasting for an hour came on three hours after treatment--a very rare occurrence--by Dr. Yeatman erroneously ascribed to the strychnine, which in so small a dose would not have produced them in the absence of snake-poison.

CASE 28.--Reported by officer in charge of police at Grenfell. Boy of 6 years, bitten by brown snake, and treated by Dr. Rygate.

CASE 29.--W. Toomer, aged 19, bitten by tiger snake on thumb and index finger, and not treated until 9-1/2 hours after bite, having a long distance to travel. Recovery very slow through timid use of antidote, five injections of 1/30th grain having but little effect, until one of 1/10th restored him. Treated by Dr. Stokes, of Echuca.

CASE 30.--Reported by Dr. Bennett, surgeon, Gulgong Hospital, N.S.W. Mrs. Mears admitted to hospital comatose and pulseless, nothing having been done to check absorption. The intravenous injection of ammonia failing to rouse her, m. xv. of liq. strych. were injected, when pulse returned, but coma continued. After a second injection of m. xv. she suddenly became quite conscious, and in an hour was fully restored.

CASE 31.--Reported by Dr. Mead, of Quirindi, N.S.W. John Simson, aged 15 years, bitten by a death adder on forefinger of right hand. Dr. Mead living 50 miles away, and the lad collapsing, a layman, Mr. Robert Simson, had to undertake treatment, and injected during the night m. 150 of a one in 240 solution of strychnine, equal to 5/8ths of a grain. Dr. Mead, finding the lad conscious and only a little drowsy, did not inject any more strychnine until 2 p.m., when a relapse took place. He then injected m. viii. of liq. str. P. B., and in half an hour m. vii. more. The last injection produced slight muscular twitchings, and subdued the snake-poison effectually, the lad making a good recovery. The total quantity used in 13 injections was over three-quarters of a grain within 18 hours.

CASE 32.--This case is another instance of the successful use of the antidote by a layman, and can be verified by the writer, who saw the patient, a girl of 14 years, after her father had carried out the treatment successfully. The girl had been bitten by a large brown snake whilst walking through a paddock, and very soon afterwards lost the use of her legs, and for a time also her eyesight. The symptoms being so very alarming, and the girl at a distance of 35 miles from the writer's residence, the father at once injected 1/12th of a grain of strychnine, and in a very short time another 1/12th. The child then rallied somewhat, and a start was made to bring her in, the father taking the precaution of bringing the antidote-case with him. This was fortunate, for the child collapsed several times, and each time had to be roused by an injection before reaching the writer. When finally she presented herself, walking into the writer's surgery with a firm step, not a trace could be discovered either of the strychnine, of which nearly half a grain had been injected, nor of the snake-poison, also imparted no doubt in a fatal dose. The two punctures on her leg, testifying to the size of the snake that had bitten her, were the only tokens of the ordeal she had gone through; and the only task remaining for the writer was to congratulate her father (Mr. James Trebilcock, a farmer, of Tawanga), on the plucky manner in which he had carried out the treatment, and see to the child being properly watched during the night in case of a relapse taking place. None, however, occurred, and she left next morning perfectly well. Cases of this kind, in which no doctor is called in, are frequently reported to the writer, who finds that laymen are even more successful because less timid than many medical men.

CASE 33.--Joseph Cartledge, bitten on calf of leg by a black snake, was treated by Dr. Browne, of Sale, five hours after accident. Two injections of 1/8th grain each used.

CASE 34.--Miss Davie, teacher, at Nerung, Queensland, treated by Dr. Hannah, of Southport. Particulars not given.

CASE 35.--Mrs. Rogers, of Bulu Bulu, Gippsland, bitten on finger by tiger snake, and treated by Dr. Trampy, first with intravenous injections of ammonia, which had no effect, and when sinking with strychnine injections, which had almost immediate effect, and in a few hours placed her out of danger.

CASE 36.--Son of Mr. J. Beveridge, squatter, of Glengower, treated successfully by Dr. Andrew, of Clunes, with strychnine injections.

CASE 37.--Theresa Byrne, aged 14 years, bitten whilst bathing, snake not seen. Treated by Dr. Cuppaidge, of Normanby, Queensland. Only 18 minims of L. S. required.

CASE 38.--Mr. Bullock, of Tenterfield, N.S.W., bitten by black snake and treated by Dr. Morice.

CASE 39.--A boy, J. Taylor, bitten at Mount Keat, agricultural settlement, Queensland, by a black snake, and treated successfully by a layman, Mr. James Daniels.

CASE 40.--George Neilson, a Danish miner, bitten by a tiger snake whilst bathing. Case reported by Dr. Gamble, of Walhalla. Forty minims of liq. strych. required; recovery complete next morning.

CASES 41 AND 42, reported by Dr. Helsham, of Richmond, N.S.W. In one of these where, judging from the symptoms, a large dose of snake-poison had been absorbed, but very small doses of strychnine were injected, convulsions set in, _whilst coma was still present_, and lasted for two hours. Though semi-tetanic in appearance they were erroneously ascribed to m. xxvi. of liq. strychniæ, which at the time of their appearance had not removed the symptoms of snake-poison. They were evidently produced by the latter and quite on a par with those occasionally occurring in man before the strychnine is administered, and almost invariably in dogs. As long as coma is present with other symptoms denoting the snake-poison to be in active operation, such convulsions rather call for the antidote, than contra indicate its use, for the strychnine never produces them until it has completely conquered the snake-poison, and even then they are always preceded by local spasms and never set in suddenly. Timid medical men, when administering the antidote and anxiously watching for the dreaded strychnine effects, are too apt to see them in the slightest irregular muscular action.

CASE 43, reported by Dr. Johnson, of Avoca, patient bitten by a tiger snake, was comatose, pulseless, with very shallow respiration, &c., and restored by three injections of m. xvi., xv. and x. within less than three hours.

CASE 44.--Reported in _Australian Journal of Pharmacy_, from Tasmania, treated by Dr. Tofft, of Campbell Town. The report concludes: We have had some fatal cases of snakebite already this season, and the successful treatment in the above case has created a strong feeling in favour of strychnine in such emergencies.

CASES 45 TO 49.--Reported by Dr. Alex. Barber to _A.M. Gazette_. He writes: "During the last year I treated four cases of snakebite successfully with strychnine. In one of these, a bite of a brown snake, I injected three doses of m. xx. each of liq. strych. P.B., in all over half a grain, in one hour."

CASE 50.--Reported by Dr. Barrington, of Benalla (Vic.), bite of tiger snake, symptoms moderate. Completely removed in three hours by 57 minims of liq. strych. P.B.

_Notes of eight cases as reported to the "Australasian Medical Gazette" for July and November, 1892, by R. P. Banerjee, B.A., G.B.M.S.L., Medical Officer, Salt Mines, Pachhadra, Rajputana, India_:--

CASE 1.--Bhagwan Singh, aged 30, Hindu male, Sepoy, E. T. Force, was bitten by a viperine snake (_echis carinata_) at 4 p.m. 10th June, 1892, in the dorsum of left foot. He was removed to the hospital, tight ligature applied, and with the following symptoms:--Heaviness of both legs, staggered if allowed to walk, giddiness, sense of sinking at the pit of the stomach, bleeding from mucous surfaces and old scars; soon fell swooning.

Treatment.--The punctures incised, and blood let out, one-twelfth of a grain of strychniæ; acetas hypodermically injected. Again, the insensibility not gone after 30 minutes, another dose given, and so repeated the third time. The _bleeding stopped_ and the man recovered his senses, but could not raise himself to talk. Many more doses were given under the skin, with hour intervals, and the man recovered the next day; but he was much exhausted and treated for weakness three days, and discharged to duty on the 14th. Punctures were distinct, symptoms well developed. Took _one and a half grains_ of strychnine to effect cure, leaving no after effects of the drug or poison.

CASE 2.--Sadig Husain, a Mussulman boy, aged 12 years, bitten on the right ankle, just below the inner malleolus, by _echis carinata_ (Khapar) on the 5th August, 1891, brought in with usual symptoms, as before.

Treatment as before. This case took only one-fourth grain of strych. acet. The boy was weak and sickly. He was discharged cured on the third day, _i.e._, 17th August, 1891.