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A case of snake-bite in Cyprus
.~15
TRANSACTIONSOF THE ROYALSOCIETYOF TROPICAL MEDICINE AND HYGIENE. Vol. X•III. No. 3. November, 1929.
A CASE OF S N A K E - B I T E IN CYPRUS. BY
LAURENCE FRASER, L.R.C.P. & S.E.
P.M.O., Famagusta, Cyprus.
On 20th June, 1929, a man was brought in to the Hospital at Famagusta, who had been bitten by a " Koufi " snake (Greek, K~o¢o~--deaf), the Viper lebetina of LINNAEUS. He is a shepherd, and, kneeling down to drink from a forest pool, he was struck on the scalp, a little to the left of the middle line at the junction of the frontal and left parietal bones. On admission, some eight hours after the accident, his face, scalp and neck were very cedematous, as also the upper part of both sides of the chest in the subclavicular region. He was semi-conscious and i'n great pain. Both eyes were closed by (edema, deglutition was difficult, and speech impossible. At midnight he became delirious, and be continued so until 6 a.m., when he regained consciousness. The temperature was 99 ° F., the heart's action weak, and the pulse quick and feeble ; there was no nausea or vomiting. On 21st July he hawked up much blood and mucus from the throat ; this ceased after eight hours. Next day there was marked ecchymosis of the eyelids, throat and right side of the abdomen, which was deep purple, and there was cedema of the penis and scrotum, the former being much discoloured. The patient could now speak and swallow without difficulty. When the eyes could be opened, sub-conjunctival hmmorrhages were present in both, but were much more marked in the right. The wounds inflicted by the snake and the surgeon healed slowly, but without suppuration. The patient was discharged on 31st July. The treatment was the usual crucial incision, with rubbing in of potassium permanganate crystals, with hypodermics of strychnine, adrenalin and oil of camphor, and normal saline by the rectum. The poison is evidently a powerful hmmolytic, but without, in this case at least, any action on the nervous system. The difficulty in speech and swallowing was due, apparently, to (edema of the fauces and soft-palate. The larynx and the re~t of the respiratory tract were not affected, and the tongue appeared normal. The snake is fairly common here, but accidents are rare. The villagers wear boots reaching to the top of the calf for protection. Animals sometimes suffer, and I have known a mule, struck on the fetlock, die in half an hour.
TRANSACTIONSOF THE ROYALSOCIETYOF TROPICAL MEDICINE AND HYGIENE. Vol. X•III. No. 3. November, 1929.
A CASE OF S N A K E - B I T E IN CYPRUS. BY
LAURENCE FRASER, L.R.C.P. & S.E.
P.M.O., Famagusta, Cyprus.
On 20th June, 1929, a man was brought in to the Hospital at Famagusta, who had been bitten by a " Koufi " snake (Greek, K~o¢o~--deaf), the Viper lebetina of LINNAEUS. He is a shepherd, and, kneeling down to drink from a forest pool, he was struck on the scalp, a little to the left of the middle line at the junction of the frontal and left parietal bones. On admission, some eight hours after the accident, his face, scalp and neck were very cedematous, as also the upper part of both sides of the chest in the subclavicular region. He was semi-conscious and i'n great pain. Both eyes were closed by (edema, deglutition was difficult, and speech impossible. At midnight he became delirious, and be continued so until 6 a.m., when he regained consciousness. The temperature was 99 ° F., the heart's action weak, and the pulse quick and feeble ; there was no nausea or vomiting. On 21st July he hawked up much blood and mucus from the throat ; this ceased after eight hours. Next day there was marked ecchymosis of the eyelids, throat and right side of the abdomen, which was deep purple, and there was cedema of the penis and scrotum, the former being much discoloured. The patient could now speak and swallow without difficulty. When the eyes could be opened, sub-conjunctival hmmorrhages were present in both, but were much more marked in the right. The wounds inflicted by the snake and the surgeon healed slowly, but without suppuration. The patient was discharged on 31st July. The treatment was the usual crucial incision, with rubbing in of potassium permanganate crystals, with hypodermics of strychnine, adrenalin and oil of camphor, and normal saline by the rectum. The poison is evidently a powerful hmmolytic, but without, in this case at least, any action on the nervous system. The difficulty in speech and swallowing was due, apparently, to (edema of the fauces and soft-palate. The larynx and the re~t of the respiratory tract were not affected, and the tongue appeared normal. The snake is fairly common here, but accidents are rare. The villagers wear boots reaching to the top of the calf for protection. Animals sometimes suffer, and I have known a mule, struck on the fetlock, die in half an hour.