Alfred John Wall

“ In cases of cobra-poisoning of longer duration, we have the disturbing influence of the local inflammation to consider, which would account for some variation in temperature.
In the special senses and their organs no marked change can be seen in cobra-poisoning: as long as consciousness is preserved the victim appears to see and hear perfectly. In regard to the eye there is very little to be noticed. The pupil can be said neither to be dilated nor contracted by the influence of the poison; at the moment of death it dilates widely, while up to that time it responds to light. ”

“ To sum up the different modes in which cobra-poison destroys the respiratory function : — First, almost instantaneous paralysis of the respiratory centre, a primary stimulation of a very violent but very transient character having occurred. This form of death must be exceedingly rare, if it ever occur, in the human subject, as the shortest period of fatal poisoning in man on record appears to have been a little under a quarter of an hour. ”

“ It is clear, therefore, that the poison exists in the blood. That it causes changes in it, there is also evidence. In a man poisoned by a cobra it is very generally, indeed, found that his blood has become incoagulable, though in dogs it is exceptional for this to be the case. Very occasionally, too, the mucous discharges from the body are stained with blood, as if the relation existing between the blood and the tissues had been in some way altered. ”

“ One of the most characteristic features of cobra-poisoning in the human subject, is paralysis of the legs. The patient is unable to walk or to stand, though his arms as yet have not experienced any loss of power. Now it would be difficult to suppose that this was due to the terminations of the motor nerves of the legs becoming paralysed, while those of the arms remained unaffected. It is much more probable that the spinal cord is becoming paralysed ”

“ It will have been observed that paralysis of the lips, tongue, larynx and pharynx, as evinced by inability to retain the saliva within the mouth, by incapacity to move the tongue, or to speak, or to swallow, are very prominent signs of cobra-poisoning both in men and animals. It is singular that the striking resemblance of these symptoms to the disease known as glosso-laryngeal paralysis has not been previously noticed. ”

“ On secretion cobra-poison appears to have considerable influence. It seems as if most secreting structures were stimulated by it. The lachrymal glands act freely during cobra-poisoning. Salivation is a most marked and constant symptom; it is very rarely, indeed, absent in dogs, and it appears to be equally common in man. In dogs, the saliva often runs from the mouth literally in streams; nor in man does it seem much less copious. Should only a small quantity of poison have entered the system, salivation may be the only symptom. ”

“ But in cobra-poisoning in dogs, paralysis of the hind-legs without the fore, is rarely seen. In the vast majority of cases, power is lost simultaneously in all four members. As a rule, in those cases in which it has been noticed that the hind-legs have suffered first, the animal has been bitten on the hind-leg, which would always cause a certain amount of lameaess, and difficulty difficulty of walking with the hind-quarters, due to the local effect of the poison. ”

“ If an incision be made through the skin and carried through the punctures made by the snake's fangs, very little difference will be found in the true skin. It may be a little more injected than normal, and the punctures will be found to be intensely so just at the edges, and a small quantity of blood may be effused there. But the areolar tissue lying beneath the true skin is the site of the chief change. It will generally be seen to be of a purple colour, and to be infiltrated with a large quantity of coagulable purple blood-like fluid. ”

“ From these various causes it often happens that a man is left without an attempt at treatment because the bite is not visible or does not look like that inflicted by a venomous snake, or because there are no symptoms. Now we know that symptoms may not occur till more than an hour has passed, when all chance of preventing the absorption of the poison has gone. ”

“ The special symptoms of cobra-poison now rapidly manifest themselves. It man it is very commonly observed that the patient cannot any longer keep his eyes open, and about this time it is found that he is losing power in his legs. When he walks he staggers, and, if left unsupported, falls. The arms seem to retain their strength much longer. In the case of dogs, the animal at this stage can scarcely stand without falling frequently, but there does not seem to be that difference between the anterior and posterior extremities that is observed in the legs and arms of a man. ”

“ From these considerations it appears evident that the local effect of cobra-poison is simply severe and acute inflammation, to which the pain attending cobra-bite is due, with a more than ordinary tendency to effusion from the blood-vessels. Corroborative testimony to what is here advanced must be present to the mind of everyone who has had much to do in the manipulation of cobra-poison. A very frequent, but involuntary, experiment is to get some of the poison into the eye. ”

“ Thus, when an animal has survived the nerve symptoms produced by cobra-poison, it at once passes into a state of complete health, and to suffer no further inconvenience from blood-poisoning or other causes, save the local inflammation produced by the bite. ”

“ In scurvy and allied diseases, and after injuries, we constantly see effusions of blood rapidly absorbed as recovery proceeds. Again, effusion of blood is seldom attended by pain. Moreover, by using solutions of cobra-poison of different strengths any degree of local mischief can be produced — from an engorgement and acute effusion that scarcely differs from blood, to a slight hyperæmia attended with a pale serous-like effusion. ”

“ In very rapid cases of poisoning, when a very large quantity of poison has entered the circulation at once, instead of the gradual extinction of function of the cerebro-spinal centres, the poison appears to act almost immediately by stopping the action of the respiratory centre. ”

“ Although the gravity of a case of snake-poisoning can hardly be over-estimated, yet it must be considered full of promise that recovery may follow even the severe hæmorrhages of viperine poisoning. No wound inflicted by a venomous snake can be despised, yet even when symptoms have developed no case should be considered necessarily fatal. ”

“ The heart is distended with blood, especially the right side. The liver bleeds freely on incision, and is quite dark from contained blood, but this is not universal. The kidneys vary from normal to excessive congestion, being seen in all stages. The stomach may, or may not, contain food — a proof that cobra-poisoning in the human subject does not always cause evacuation of the contents of the stomach. There is no regular change in the intestinal tract, which may be injected in places. The bladder is generally firmly contracted.
Local Effects of Cobra-poison. ”

“ They base their reasoning on the results produced by experiments in which the excitability of two nerves of the same animal is tested, one of which has been subjected to the action of the poison, and the other has been kept from contact with the poisoned blood by the limb to which it is distributed being ligatured, the nerve, however, being kept intact. ”

“ He appears to be conscious, but is unable to express himself, through the paralysis of his larynx and tongue ; but it is not unfrequently the case for the victim to become quite unconscious. The action of the heart is somewhat quickened, but the organ acts with fair strength. At length the breathing, too slow and too slight to support life, ceases, and with or without general convulsions the heart shortly after stops. ”

“ Cases of poisoning by snakes do not usually occur in crowded cities with hospitals always open, vyith every appliance to receive the sufferer, but in the fields where the peasant steps on the lurking reptile, or more frequently still in the remote village where the wife is bitten in a dark corner of her hut by the snake which superstition has compelled her household to protect. ”

“ I once noticed the pupil remain contracted after death from cobra-poisoning, in which long-continued artificial respiration had been resorted to. Whether cobrapoisoning affects accommodation cannot well be known, and what evidence there is appears to be against its being affected. The eye retains its sensitiveness, and the eye-lid the power of closing, for some time after Most other parts are paralysed. But in the human subject drooping of the upper eye-lid is often an early symptom of the action of the poison. ”

“ Moreover, it does not necessarily follow that because a nerve to which poison has had access conveys electrical stimuli in a very imperfect manner, or not at all, therefore that the effect of that poison has been to paralyse the nerve. It is unfortunate that the only test we have of the vitality of a nerve is its power of causing contraction in a muscle when irritated by electricity or mechanically. ”

“ It gives nearly the whole course of the respiratory movements of a fowl, from the moment of the injection of the poison till the occurrence of death, in a case in which a large amount of cobra-poison was given, causing death very rapidly. From it will be seen how very much more pronounced the acceleration is when a large quantity of poison is given, and that when the stage of acceleration is passed the excursus is lessened quite as rapidly as the frequency. ”

“ In all these experiments, as long as the cord possessed power at all, contraction could be excited in either leg provided the nerves had not been mechanically injured, which would rather indicate that the nerves retained their irritability, at the same time that the excitability of the cord was exceedingly quickly lost. ”

“ In spite, then, of occasional discharges of blood from mucous surfaces, and that the blood of man is generally found fluid after death, if we take into consideration the facts that death, except from nerve symptoms, is unrecorded ; that after the subject has recovered from the nerve effects, he at once regains his usual health, sequelae being unknown, at least if we trust the available evidence — always excepting the local results of cobra-bite which are most severe ”

“ In dogs, as might be expected, convulsions are much more common than in man, being very generally present; and while in man the extinction of the respiratory act is, as a rule, a very slow and gradual process, in dogs it is not unusual for respiration to stop quite suddenly, and almost immediately after for its place to be taken by violent convulsions. In birds the symptoms are usually very regular in their occurrence. ”

“ On the other hand severe measures have been resorted to, even ending fatally, when it has been proved afterwards that the subject had not been bitten by a poisonous snake at all. It is therefore of great importance to be enabled to say whether a man has really been poisoned as well as bitten by a snake. ”

“ III. is a series of tracings from a large pariah dog, the acceleration followed by retardation, and the accompanying diminution of excursus are well shown; but the nature of the convulsive movements at the end are of great interest. They begin by regular contractions of the respiratory muscles; in the period of their gseatest violence they lose all respiratory character, and then gradually fade away in gentler and gentler attempts at inspiration. The cat is an animal that shows a peculiar power of resisting cobra-poison, presenting a marked contrast to the dog. ”

“ In dogs it is not unusual for the salivation to be manifested before any other constitutional symptom, and in them a chewing movement of the jaw and lips is often seen immediately before the salivation. ”

“ Cobra-poison cannot be said to exercise a very great effect on the circulation. The heart can be kept acting, and the blood circulating, for very many hours after the rest of the functions of the body have been suspended, if only artificial respiration is continued. In ordinary cases of cobra-poisoning the heart can generally be felt acting for a short time after respiration haa stopped. Absorbed in the ordinary way, cobra-poison appears to slightly nccelerate the heart's action, and it also lessens the blood-pressure, at any rate for some time. ”

“ A poison that produces death by totally different means than paralysis, may yet cause in nerves a complete deadness to stimuli.
Experiment XI.
The right thigh of a frog (Rana tigrina) was tightly ligatured, so as to completely prevent circulation through the limb, the nerve being included. One cubic centimetre of a solution of strychnia, containing two centigrammes of strychnia, was injected into its dorsal sac. ”

“ The bird then generally seems drowsy, from its being unable to keep the eyes open, the head droops as if the neck were unable to support it, but the bird constantly recovers itself with a jerk. It at last sinks down to the ground, ultimately falling over on its side, unable to raise either its head or itself. ”

“ Although every effort has been made to test the various remedies that have been proposed for snakebite — and they have been very many — it has not been thought necessary to give the unsatisfactory results of the various trials. ”