A. Mueller

“ When a medical man is called upon to treat a serious case, and instead of boldly addressing himself to the task of combating the symptoms by injecting the antidote irrespective of the quantity he may require until it has conquered the snake-poison, becomes nervous and ceases to inject, when, after what in ordinary practice would be a dangerous dose, he sees but little effect, or if from the first he injects small doses at long intervals, the cause of failure surely lies with him and not with the antidote, which rarely fails where it is properly applied. ”

“ Misleading experiments with the drug on animals erroneously considered to be final in their results, together with confused and contradictory notions about the action of snake-poison, were the chief factors, already pointed out, that caused research on this important subject to remain for centuries so barren of results, and made even able investigators with more correct views than the rest, postpone the discovery of a physiological antidote to a more advanced state of science, when all the time it was lying ready at their hands. ”

“ Another cause that has largely contributed to render experiments on animals so barren of results must be sought in the injudicious selection of substances intended to serve as antidotes. It is simply impossible to act on an organic compound like snake-poison, coursing through a living system, by chemicals that will either combine with it or decompose it in a manner likely to deprive it of its deadly qualities and render it innocuous. ”

“ It is quite impossible for us with our present scanty knowledge to account for these peculiarities and irregularities in the action of a poison, which we know now to accomplish its destruction of animal life by one uniform design and principle of action. That the protean forms under which the poison-symptoms present themselves are one and all the result of reduction and suspension of motor nerve currents may now be accepted as a well proven and fully established scientific fact. ”

“ It is evident that in the highest of psycho-motor centres, the organs of thought and of consciousness, the paresis of the lower centres assumes the form of sleep, and paralysis that of coma. Sleep, as a partial, and coma, as a complete, obliteration of thought and consciousness must, therefore, be intimately connected with motor nerve function, sleep being a reduction, coma a suppression of the function, or a suspension of thought. ”

“ Not a single attempt has been made to disprove the correctness of the theory on which it is founded, yet to leave this theory unquestioned but object to the conclusion to which it leads, must strike even the lay mind as a most illogical proceeding. It is self-evident that, when strychnine is administered as an antidote to snake-poison, the quantity of it injected must be in proportion to that of snake-venom present in the system, and that the doses in which we dispense it in ordinary practice must be entirely left out of sight. ”

“ Coma is a frequent and in serious cases an almost invariable symptom in Australia. After the bite of our death adder only we find persons sometimes collapse and expire suddenly, when still conscious and able to answer questions rationally. Coma invariably develops from sleep. It is, in fact, sleep intensified. An almost irresistible desire to sleep is one of the first symptoms to be observed. If the dose of poison imparted by the snake has been small, the desire may pass off or the sleep may not assume the form of coma, but in all [Pg 33] serious cases it quickly assumes that form. ”

“ In the first place we have to account for the fact of the snake-poison leaving the lower forms of animal life intact and being fatal to the higher ones. The symptoms we have observed in the frog point unmistakably to an affection of the nervous system as their cause. Now we know that the lower forms which the poison does not affect have no such system, and we are justified to infer that to the absence of this system they owe their immunity. ”

“ When it had been demonstrated that a dog, a cat, or other animal, after having been saturated with snake-poison, did not recover after the administration of an alleged antidote, the illogical conclusion was drawn at once that it could not possibly be of any use to man, whilst, in reality, the only proof rendered by the experiment, if made properly, was that the respective antidote could not be relied on in treating animals of the class experimented on. ”

“ But though the heart muscle is no doubt participating in the general paresis, the condition of the surface of the body is in reality one of anæmia. The blood, even at this early stage, begins to accumulate in the large veins of the abdomen, which expand gradually in consequence of the diminishing [Pg 22] motor force supplied by the splanchnicus, keeping them in the normal state of contraction when intact and having its centre in the medulla oblongata. When this large vaso-motor nerve is cut in animals anywhere in its course, the veins of the abdomen become distended enormously. ”

“ When a dog, for instance, has been bitten by a snake he does not usually collapse as quickly as a human being, but is able to drag himself about much longer before his hind legs refuse their service and he is unable to walk. This longer duration of the first stage of the poisoning process is no doubt owing to a higher organisation and greater functional power of the motor nerve centres of dogs. The amount of motor force at their disposal is greater, and hence they offer greater resistance to the invader seeking to turn off this force. ”

“ When people wilfully shut their eyes against the most conclusive evidence, it is improbable that any amount of it would satisfy them. Apart, however, from the fully proven antagonism between the two poisons rendering the large doses of the antidote, which in all serious cases are indispensable, perfectly safe, the fear of strychnine is, in itself, a very strange aberration of judgment on the part of my opponents, considering how easy it is to counteract any noteworthy excess in its action, if, perchance, it should occur through unnecessary overdosing, by appropriate remedies. ”

“ They retain their consciousness more or less unclouded to the last, the poison spending all its force on the respiratory centre, and leaving the brain intact. Here we hardly ever see actual dyspnoca after the bite of hoplocephalus or any other Australian snake. Respiration becomes quicker at an early stage, and then, from hour to hour, shallower; but our patients soon pass from sleep into coma, and suffer no respiratory distress even when, in consequence of general paralysis, the respiratory muscles cease to act, which usually takes place a few minutes before the heart stands still. ”

“ At other times this transition from coma back to sleep does not take place and consciousness returns quite suddenly, the persons opening their eyes and looking around them, dazed and bewildered, but perfectly conscious at once. When coma is fully established and the largest and most powerful motor-centres have succumbed to the insidious poison, general paresis becomes general paralysis and all the motor-centres of the body are in a condition of more or less suspended functional activity. ”

“ Until then the guardians of the health and the lives of her Majesty's subjects, and a certain portion of the medical press of Australia, superciliously and persistently ignoring the subject, are more responsible for the lives lost than the busy country practitioner, who may not have had time or opportunity to inform himself thoroughly on a comparatively new subject, more especially at a period when Banerjee had not yet taught us that in administering strychnine as antidote to snake-poison we can venture into grains of it with impunity. ”

“ We knew that every movement and action is brought about by a discharge of this force, but we did not know that even the silent thought must be carried on the wings of it, and cannot take place without it, at least not in our present state of existence. ”

“ Strychnine is the exact antithesis to snake-poison in its action. Under its influence every motor nerve-cell throughout the system sends forth stronger currents of nerve force than it does in its normal state. These currents run alike from cell to cell, and from cell to peripheral fibre, and act by means of the latter on all contractile, and especially all muscular tissue, causing contractions, which, after poisonous doses of the drug, assume the form of tetanic convulsions, provoked by the slightest touch or even noise in consequence of highly intensified reflex action. ”

“ It is true that the mortality among those bitten by snakes is small here as compared with India, though the poison of our snakes, quantity for quantity, has been proven to be quite as deadly as that of the Indian ones. Our greater immunity is due to our snakes giving off less poison at a bite, and with their short and (excepting those of the death adder) merely grooved poison fangs injecting it very superficially, thus making the process of elimination of the poison by ligature and incision or excision of the punctures much more easy and successful. ”

“ The thinking [Pg 35] principle, the nous within us, is no doubt more than mere nerve action, but it can, apparently, not manifest its presence without motor nerve cells in healthy action. Every thought, though not synonymous, is evidently synchronous with a current of motor nerve force, and it is not improbable that, by means of these currents, that silent transference of thought is effected from brain to brain, which modern psychology has demonstrated to be not only possible but actual under certain conditions. ”

“ A chemical antidote, a substance possessing special affinity to snake-poison and by means of this affinity combining with it in some mysterious and incomprehensible manner, one can hardy imagine to exist. ”

“ It is scarcely too much to assert that there are but few chemicals and drugs in the materia medica that have not been tried as antidotes in experiments on animals and dozens upon dozens that have been tried in vain on man.
The reasons for this somewhat chaotic state of our science on a subject of so much interest to mankind are various. The countries of Europe, in which scientific research is most keenly pursued, have but few indigenous, and these comparatively harmless snakes. The best scientific talent has, therefore, only exceptionally been brought to bear on the subject. ”

“ The tendency to relapses is always great when much snake-poison has been absorbed. Apparently yielding to the antidote for a time, the insidious venom, after a shorter or longer interval, during which it appears to have been conquered, all at once re-asserts its presence, and has to be met by such fresh injections, regardless of the quantity of strychnine previously administered, but the amount required in most relapses is not a large one. ”

“ On no other subject has our knowledge remained for centuries so unsatisfactory, fragmentary and empirical. The history of the subject, in fact, may be summed up briefly as a series of vain and spasmodic attempts to solve the problem of snakebite-poisoning and wring from nature the coveted antidote. ”

“ The animals experimented on died, and, falling into the error of his predecessors, mistaking the functional analogy that exists between the nerve centres of the lower animals and those of man for absolute identity, which does not exist, especially not when they are under the influence of the two poisons, he concluded his researches with the confession that a physiological antidote for snake-poison cannot even be thought of at the present state of science. ”

“ Given the largest amount of poison a snake can give off at one bite, strychnine injected in time and sufficient quantity—either by the hypodermic, or, if urgent, by the intravenous method—must rouse the dormant nerve-cells into action, as long as the vital functions are not completely extinct. Wherever it fails, the fault lies with the operator not injecting it in sufficient quantity—a fault committed by the writer himself in his first case. ”

“ If we turn from Australian to Indian snakes, the peculiar tendency of the poison to concentrate its action on special nerve-centres becomes still more marked. The predilection of the cobra poison for the respiratory centre has already been dwelt on. More remarkable and strange is the action of the Indian viper-poison on the minute ganglia in the vaso-motor nerve ends, which control the capillary circulation, and by their paralysis bring about extensive hæmorrhage through diapedesis. ”

“ This is a boon to be appreciated fully by those only who have gone through the slow, lingering, and painful process of convalescence from snakebite as formerly treated, with its deadly languor and weariness, making life itself a burden and all physical and mental exertion impossible. ”

“ The theory of blood pressure may apply to diapedesis accompanying the inflammatory process. In snakebite poisoning it is more likely to be due to passive engorgement of the capillary system and probably also to blockage of corpuscles in the finest capillary tubes. In vaso-motor paresis, and still more paralysis, the arterioles supplying the capillaries are widely dilated, and at the lowest blood pressure probably send more blood into the latter than in the normal state. ”