CASE OF DEATH
FROM SNAKE-BITE.
By Surgeon-Major A.
Long,
A. M.
?
D.,
Senior Medical Officer South Station Hospital, Secunderabad. No. 1174, Private G. A., set. 33, 2nd Battn. S. W. Brs., came to hospital at 9-15 A. M. on the 13th May, stating that he had been bitten three and a half hours before between the thumb and forefinger of the right hand by a small watersnake, which he knew to be almost harmless ; had sucked the place at once, expectorating freely ; had only experienced slight tingling up the arm which had almost entirely disappeared. He made light of the matter, and said he had only come to hospital in consequence of being urged to do so. The man was looked on in the regiment as quite an authority on snakes, being in the habit of catching them for the sake of their skins. The snake had been killed, but
he did not know what had become of it. Gave him Liquor ammonite at once. On examination with the naked eye of the part indicated, I found three small specks such as might be caused by punctures with the point of a needle, and with a lens a fourth ; they were a little distance apart forming a square ; there was no pain on pressure, swelling, redness nor discoloration of the hand or arm, or around the specks before mentioned, which were perfectly dried up. Pulse natural. 10 A. M.?Complained of violent pain in the epigastric region ; said he was subject to it ; the apothecary on duty gave him another dose of Liquor ammonise with Liquor potassse ; this pain soon passed off, when he said he felt perfectly well, he however took no dinner, and I afterwards ascertained very little breakfast. As the bowels had not been moved, had a turpentine and castor oil enema, which brought away some hardened fasces. 2-30 p. M.?I was sent for, as he complained of tightness of the chest; 1 found him to be suffering from slight congestion of the lungs with some difficulty in swallowing, with a tendency to spasms of the glottis. Pulse 96, of fair volume ; skin warm and dry ; throat congested ; pupils slightly dilated ; very restless ; had passed urine freely. Gave him a warm bath with the result of bringing on profuse perspiration. Hearing the snake was in possession of one of the men, I sent for it. I recognised it as a krait, (Bungarus Caerulius). measuring 20 inches. I was told that Pte. A. had the snake by the tail, and was playing with it when it turned and bit him. After the bath he was much easier and breathing better, but still a tendency to spasm of the glottis on attempting to swallow. Applied mustard plasters and poultices to the chest and throat, and attempted to steam the latter.
November 1, 1882.
A MIRROR OF HOSPITAL PRACTICE.
5 p. M.?Appeared to be doing well; had an enema of strong chicken broth with brandy ; retained. About 6 P. M. the spasm returned worse than before, coming on every ten or twelve seconds without any apparent cause ; shortly some swelling of the throat externally appeared ; being propped Pulse 98, skin up in bed and sucking ice gave him ease. moist; again improved ; but shortly after 7 o'clock took a turn for the worse. 7-30 p. M.?Frequent severe spasm of the glottis. Pulse 100, of fair volume. Skin soft; pupils dilated ; external swelling of throat less. I had thought of operative interference, but did not like the state of the lungs. 9-30 P. M.?Considerably better ; spasms slighter and at longer intervals. Pulse 96, fair ; pupils only slightly dilated ; skin cool ; breathing easier. Ordered another enema of chicken broth and brandy : retained. The spasms in a short time ceased entirely, he passed a fairly good night, sleeping from time to time, and took small quantities of chicken broth, brandy and water by the mouth without bringing on the spasms, and sucked ice. 19th, 5. A. M.?I was sent for as he was taken suddenly I found the heart's action and worse, becoming quite faint. pulse fluttering and irregular; after a little brandy and water by the mouth these improved ; could swallow much more easily ; no spasms ; external swelling very much less. Pupils not so dilated. Breathing easier. Lungs not so congested. Enema of chicken broth and brandy not retained. Temperature 102,6? F. 7 A. M.?Appeared much better but had a most extraordinary pulse, which appeared to flow under the finger and then come up with a sudden jerk. Heart's action peculiar and irregular. 9 A. M.?Improved in every respect. Temp. 100? F. 11 A. M.?Still improving ; will only take small quantities of nourishment by the mouth as he was afraid of bringing on the spasms of the throat: had another enema of chicken broth and brandy, all of which was retained for a considerable time, then a part came away. Continued in much the same state up to 2 P. M. when he expired quite suddenly, the cause of death being syncope. The patient never lost consciousness, although during the greater part of the time he did not speak for fear of bringing on the spasms, answering questions by nodding or shaking the head. Treatment.?Liqr. Ammonite, Spts, Ammon. Arom., Liqr. Potassse, coffee, chicken broth, brandy, &c., by the mouth. 01. Terebinth, 01. Kicini, Liqr. Potass?, chicken broth, brandy by enemata. Externally mustard plaisters, poultices, fomentations, warm bath, &c. I am of opinion that the poison was not absorbed frbm the place bitten, but from some sore or abrasion of the mouth, gums, or fauces, at the time he sucked the wounds. The above case presents several points of interest. 1 st. The time that intervened between the bite and the supervention of the symptoms (ten hours). I am of opinion the pain referred to the epigastrium may be excluded. 2nd. The strange intermittency of the symptoms. 3rd. The peculiarity of those symptoms. 4tlb. The marked improvement previous to the fatal issue. 5th. The rarity of death from snake-bite in soldiers, I myself not knowing of another authenticated case.
Post-mortem appearances 3? hours after death. General aspect of body.?Well nourished ; good muscular
development. Joints supple with the exception of jaw, which was firmly fixed. No swelling or discoloration of body or right upper extremity. Only two of the punctures between thumb and forefinger to be seen with the unaided eye,
but the others recognised with a lens. Brain and membranes.?Both congested ; vessels distended with dark fluid blood. Brain 50 oz. No fluid in ventricles. Thoracic cavity.?On removing the organs, the blood was found to be very fluid, and extremely dark colored. Lungs.?Right 23 oz., left 24 oz. Both highly congested. Heart 8 oz., contracted, contained a little dark fluid blood. Vessels contained blood of same description. Abdominal cavity.?Peritoneum natural. Liver 62 oz., highly congested. Gall bladder distended with bile. Spleen 8 oz,, highly congested.
Stomach,
a
patch
hand at cardiac end. a little fluid.
295
of congestion about the size of palm of Very corrugated internally ; contained
Duodenum, Ileum, Colon and Rectum healthy. Ileum contained a large Taenia solium, only one head could be discovered ; this parasite I think accounted for the pain in the epigastric region. Kidneys.?Right 7\ oz.,' left 8 oz., very congested, both specimens of lobulated kidney, more especially the right. Fauces and tongue swollen and congested. Lining membrane, larynx and trachea congested. No sore or abrasion could be discovered. Blood from the thorax had a slight acid reaction, whereas that from the base of the skull was slightly alkaline; neither appeared to clot firmly on exposure. Secunderabad, 11th September 1882.
FROM SNAKE-BITE.
By Surgeon-Major A.
Long,
A. M.
?
D.,
Senior Medical Officer South Station Hospital, Secunderabad. No. 1174, Private G. A., set. 33, 2nd Battn. S. W. Brs., came to hospital at 9-15 A. M. on the 13th May, stating that he had been bitten three and a half hours before between the thumb and forefinger of the right hand by a small watersnake, which he knew to be almost harmless ; had sucked the place at once, expectorating freely ; had only experienced slight tingling up the arm which had almost entirely disappeared. He made light of the matter, and said he had only come to hospital in consequence of being urged to do so. The man was looked on in the regiment as quite an authority on snakes, being in the habit of catching them for the sake of their skins. The snake had been killed, but
he did not know what had become of it. Gave him Liquor ammonite at once. On examination with the naked eye of the part indicated, I found three small specks such as might be caused by punctures with the point of a needle, and with a lens a fourth ; they were a little distance apart forming a square ; there was no pain on pressure, swelling, redness nor discoloration of the hand or arm, or around the specks before mentioned, which were perfectly dried up. Pulse natural. 10 A. M.?Complained of violent pain in the epigastric region ; said he was subject to it ; the apothecary on duty gave him another dose of Liquor ammonise with Liquor potassse ; this pain soon passed off, when he said he felt perfectly well, he however took no dinner, and I afterwards ascertained very little breakfast. As the bowels had not been moved, had a turpentine and castor oil enema, which brought away some hardened fasces. 2-30 p. M.?I was sent for, as he complained of tightness of the chest; 1 found him to be suffering from slight congestion of the lungs with some difficulty in swallowing, with a tendency to spasms of the glottis. Pulse 96, of fair volume ; skin warm and dry ; throat congested ; pupils slightly dilated ; very restless ; had passed urine freely. Gave him a warm bath with the result of bringing on profuse perspiration. Hearing the snake was in possession of one of the men, I sent for it. I recognised it as a krait, (Bungarus Caerulius). measuring 20 inches. I was told that Pte. A. had the snake by the tail, and was playing with it when it turned and bit him. After the bath he was much easier and breathing better, but still a tendency to spasm of the glottis on attempting to swallow. Applied mustard plasters and poultices to the chest and throat, and attempted to steam the latter.
November 1, 1882.
A MIRROR OF HOSPITAL PRACTICE.
5 p. M.?Appeared to be doing well; had an enema of strong chicken broth with brandy ; retained. About 6 P. M. the spasm returned worse than before, coming on every ten or twelve seconds without any apparent cause ; shortly some swelling of the throat externally appeared ; being propped Pulse 98, skin up in bed and sucking ice gave him ease. moist; again improved ; but shortly after 7 o'clock took a turn for the worse. 7-30 p. M.?Frequent severe spasm of the glottis. Pulse 100, of fair volume. Skin soft; pupils dilated ; external swelling of throat less. I had thought of operative interference, but did not like the state of the lungs. 9-30 P. M.?Considerably better ; spasms slighter and at longer intervals. Pulse 96, fair ; pupils only slightly dilated ; skin cool ; breathing easier. Ordered another enema of chicken broth and brandy : retained. The spasms in a short time ceased entirely, he passed a fairly good night, sleeping from time to time, and took small quantities of chicken broth, brandy and water by the mouth without bringing on the spasms, and sucked ice. 19th, 5. A. M.?I was sent for as he was taken suddenly I found the heart's action and worse, becoming quite faint. pulse fluttering and irregular; after a little brandy and water by the mouth these improved ; could swallow much more easily ; no spasms ; external swelling very much less. Pupils not so dilated. Breathing easier. Lungs not so congested. Enema of chicken broth and brandy not retained. Temperature 102,6? F. 7 A. M.?Appeared much better but had a most extraordinary pulse, which appeared to flow under the finger and then come up with a sudden jerk. Heart's action peculiar and irregular. 9 A. M.?Improved in every respect. Temp. 100? F. 11 A. M.?Still improving ; will only take small quantities of nourishment by the mouth as he was afraid of bringing on the spasms of the throat: had another enema of chicken broth and brandy, all of which was retained for a considerable time, then a part came away. Continued in much the same state up to 2 P. M. when he expired quite suddenly, the cause of death being syncope. The patient never lost consciousness, although during the greater part of the time he did not speak for fear of bringing on the spasms, answering questions by nodding or shaking the head. Treatment.?Liqr. Ammonite, Spts, Ammon. Arom., Liqr. Potassse, coffee, chicken broth, brandy, &c., by the mouth. 01. Terebinth, 01. Kicini, Liqr. Potass?, chicken broth, brandy by enemata. Externally mustard plaisters, poultices, fomentations, warm bath, &c. I am of opinion that the poison was not absorbed frbm the place bitten, but from some sore or abrasion of the mouth, gums, or fauces, at the time he sucked the wounds. The above case presents several points of interest. 1 st. The time that intervened between the bite and the supervention of the symptoms (ten hours). I am of opinion the pain referred to the epigastrium may be excluded. 2nd. The strange intermittency of the symptoms. 3rd. The peculiarity of those symptoms. 4tlb. The marked improvement previous to the fatal issue. 5th. The rarity of death from snake-bite in soldiers, I myself not knowing of another authenticated case.
Post-mortem appearances 3? hours after death. General aspect of body.?Well nourished ; good muscular
development. Joints supple with the exception of jaw, which was firmly fixed. No swelling or discoloration of body or right upper extremity. Only two of the punctures between thumb and forefinger to be seen with the unaided eye,
but the others recognised with a lens. Brain and membranes.?Both congested ; vessels distended with dark fluid blood. Brain 50 oz. No fluid in ventricles. Thoracic cavity.?On removing the organs, the blood was found to be very fluid, and extremely dark colored. Lungs.?Right 23 oz., left 24 oz. Both highly congested. Heart 8 oz., contracted, contained a little dark fluid blood. Vessels contained blood of same description. Abdominal cavity.?Peritoneum natural. Liver 62 oz., highly congested. Gall bladder distended with bile. Spleen 8 oz,, highly congested.
Stomach,
a
patch
hand at cardiac end. a little fluid.
295
of congestion about the size of palm of Very corrugated internally ; contained
Duodenum, Ileum, Colon and Rectum healthy. Ileum contained a large Taenia solium, only one head could be discovered ; this parasite I think accounted for the pain in the epigastric region. Kidneys.?Right 7\ oz.,' left 8 oz., very congested, both specimens of lobulated kidney, more especially the right. Fauces and tongue swollen and congested. Lining membrane, larynx and trachea congested. No sore or abrasion could be discovered. Blood from the thorax had a slight acid reaction, whereas that from the base of the skull was slightly alkaline; neither appeared to clot firmly on exposure. Secunderabad, 11th September 1882.
