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EXPERIMENTS WITH THE POISON OF THE COBRA DI CAPELLA.
615 A post-mortem, l William) Jenner.
and the expectoration became tinged with blood. Has taken the oil regularly. Physical signsFlattening and ob- I. scure breathing in left front; dry cavernous sounds above left scapula; loud tubular above right. May 16th, 1865. -Continued well and in business, with only occasional cough till lately, when only took oil once a day (instead of twice). Patient at present weak and exhausted, with irregular pulse. Ordered oil twice a day in tonic of hyperphosphite of iron and strychnia. Soon improved, and has lost
tion,
cough.
1867.-Has continued well, and at his business ever since. Physical signs : Dry tubular sounds at and above both scapulae. Thirteen years have elapsed since this patient’s first symp-
examination was made by Dr. (now Sir The abdominal walls were found to be covered with fat, an inch thick. The ileum, just above the caecum, was perforated by ulcers of a tuberculous character, of which there were several. Both lungs were strongly adherent at their apices, especially the left, and in both cretaceous matter was found-in the right varying in size from a pin’shead to a pea; but in the left lung there was a large mass of the same material, which quite filled the ancient cavity at the summit of the lung. This patient had been free from chest symptoms for eight years. This case is less remarkable for the duration of his life after recovery from the third stage of consumption than for the completeness of the cure of his chest-symptoms, and for the demonstration it afforded, after death from another cause, of the arrest of the tuberculous disease which had made rapid strides eight years before.
toms. CASE 11.-lVlr. -, aged thirty-two. Jan. 14th, 1852. Well till, two months ago, he caught cold, and since has had Has been severe cough, with copious greenish expectoration. (To be continued.) taking quinine in last three weeks, and cough worse, with much pain in chest, especially on the left side. Urine very thick. Physical signs : Dulness and tubular sounds above the right scapula; moist crepitus below. The same on left EXPERIMENTS WITH THE POISON OF THE side, but to less extent. Ordered cod oil in mixture of iodide COBRA DI CAPELLA. and carbonate of potass, hydrocyanic acid, and orange-peel; and liniment of acetum cantharidis. BY JOHN SHORTT, M.D., F.L.S., M.R.C.P.L., &c., Feb. llth.-Taken medicines well, and is very much better SUPERINTENDENT-GENERAL OF VACCINE, MADRAS PRESIDENCY. in all respects. Has been at Hastings. Crepitus gone. (Concluded from p. 557.) Breath-sound still weak in right chest. July l3th.-Lost cough since May, and is stronger and more active than ever. In May had discharge from right ear, which No. 16. is still deaf. Still tubular sounds above the right scapula. Breath pretty clear below. Dec. 21st, 1867, -An aged bay Arab horse, standing fourteen Dec. 6th, 1859.-Continued well and active till last June, hands two inches high, and in good working condition, was when, after much excitement and exertion at an agricultural placed at my disposal for experiment. He was bitten on the meeting, he had an attack of bronchitis, with much expectora- lip and nostril by a fresh, vigorous, and full-sized cobra at tion, sometimes fetid, and was much reduced. Has since improved, but still coughs. Lately very bilious, and taken no 2.28 P.M. The blood-points caused by the fangs of the snake 2.30 : oil. Dulness and tubular sounds in upper right. Small weredistinctly visible, and were two in number. To take Heart’s action 40. 2.33 : Heart’s action 40. 2.36: Heart’s cavernous voice and croak above the right scapula. oil in mixture of calumba and nitric acid; and use cantharides action 36; maxillary pulse 40. 2.38 : Heart’s action 36; liniment. maxillary pulse 40. 3.7: Heart’s action 36; maxillary pulse July 2nd, 1862.-Continued the remedies without difficulty, and regained flesh, strength, and activity. Gained six pounds, 32. 3.30: Heart’s action 48; maxillary pulse 36. Pupils and often walks twenty miles. Was out as usual last winter. contracted ; horse constantly looking at his flanks; lower lip 3.45: Pupils very much conHas still some cough and expectoration. Taken no oil for two drooping; twitches; dull. intermittent. 4.15 : 4.5: Defecated. 24, tracted ; Tubular sounds at above pulse and both left as years. scapulae, Muscular contractions of the neck; pupils dilated ; glairy much as right; but no crepitus or rhonchus. Feb. 21st, 1867. -In the last five years has taken little oil, saliva from mouth. 4.21: Urinated. 4.25: Pulse fluttering; as it made him bilious. Cough has increased; breath become restless; puffiness of abdomen. 4.55 : Pulse fluttering, inshorter; and now can walk only two miles. Nails convex. termittent, 28. 5.5 - Twitching of muscles of extremities; drooping. 5.20: Lay down; groaning. 5.30: Up on Dulness, collapse, and moist cavernous sounds below the right head clavicle. Breath much obstructed all down the right back. his legs again. 5.45: Restless; much swelling about the Tubular sounds above the left scapula. To resume oil in wound, and much thick saliva from the mouth. 6 P.M.: Lay mixture of nitric acid, strychnia, &c. Upwards of fifteen years down full length; violent convulsions of the limbs; mouth have elapsed since this patient’s first symptoms. His latter open; pupils dilated. 6.5: Dead; 3 h. and 37min. after being bitten. deterioration came on after long suspension of treatment. Unfortunately, I had not the necessary time to make a postCASE 12.-A brewer’s clerk, aged twenty-five, first consulted mortem examination. Dr. Williams on September 13th, 1847. A year and a half ago No. 17. he had syphilis, and was treated by mercury for three months. Dec. 23rd.-2.9 P.M.: Dog bitten. 2.55: Defecated; mic. Eight months ago an eruption appeared on the skin, followed turated. 2.58 : at but afterwards with Vomited ; lay down suddenly; convulsed ; by cough, slight first, becoming violent, purulent expectoration, and lately accompanied by sweats, and pupilsdilated. 4.45: Dead; death in 2 h. 36 min. loss of flesh, strength, and breath. Physical signs: Marked No. 18. dulness below left clavicle, extending to mammary region; Dec. 23rd.-2.26 P.M.: Dog bitten. 2.42: Passed blood gurgling sounds and crepitation around ; loud tubular sounds within and above right scapula. Ordered oil, and counter- (per anum). 3 P.M.: Lay down, moaning. 3.10 : Thick saliva from mouth; pupils dilated. 4 p.m.: Dead; death in irritation with iodine liniment. May 24th, 1848.—Has taken oil regularly all the winter, 1 h. 34 min. No. 19. and has quite recovered flesh and strength. Cough slight, with scanty, opaque morning expectoration ; still dulness in Dec. 23rd.-3.9P.M.: Dog bitten. 3.30: Sick. 3.45 ; upper left chest, with dry cavernous sounds above and belowrDead; death in 36 min. clavicle, but no crepitation ; vesicular sound fairly heard in No. 20. lower chest; less tubular sounds in right lung. A cobra was made to bite a Dec. P.M.: 1867.-1.10 26th, Sept. 1850.-Quite well, and taking active exercise ; dulness much diminished; some tubular sounds in upper left chest,’ sheep standing 25 inches high, and about a year old. 1.11 : Animal lame. 1.12 : Drooping in opposite hind quarter; front and back ; no cavernous sounds, but breathing harsh: Bee. 26th, 1856.-Heard from Dr. Carlill that the patientt wounded leg raised. 1.27: Suddenly dropped down; con. had just died suddenly of peritonitis from intestinal perfora- vulsed. 1.31: Pupils contracted. 1.35: Convulsed; pupils tion. Hehad been well and actively engaged in business till1 widely dilated; thick saliva from mouth. 1.45 : Dead; death in 35 min. ten days before his death, subject only to occasional attacks ofin . No. 21. headache and costiveness. After walking a mile, he wass seized with sudden and severe pain in the abdomen, with colDec. 26th.—1.17 P.M.: Dog bitten. 1.45 : Lay down; dull. lapse, and other symptoms of perforation, and died in two 2.5: Drowsy. 2.55: Comatose. 4.15: Dead; death in 2 h. 58 min. days. .
-
.
616 -Vo. 22. "’ 1.38: Drowsy; Dec. 30th.-1.30 P.M. : Dog bitten. death in 9 min. convulsed. 1.39 : Dead; ing ; *
quite pale again), and deposited a similarly coloured flaky scaly sediment, indicating a change and the formation of
comes
’
..,
or
stagger-
salt. 6. On the addition of liquor of ammonia to an aqueous solution of the poison, it remained unchanged. NO. 2 3. 7. On the application of nitric acid to an aqueous solution, 1.50 : La Dec. 30th.-1.36 P.M.: Dog bitten. 1.0 Lay down. down. it became tinged of a greenish colour, depositing a copious 2 r.M.: Dull. 2.46: Restless; eyes injected; pupils dilated; white, opaque, solid sediment,, indicating the presence of albuconvulsions. 3.30: Dead; death in2 h. 24 min. men. 8. On the addition of carbonate of potash to an aqueous No. 24 solution of the poison, a whitish, flaky, or scale-like sediment .... March llth, 1868. -An aged flea-bitten grey horse, Persian, was deposited, the supernatant fluid remaining clear. standing fourteen hands two inches high, in rather ill condiA series of experiments were now begun, by injecting the tion, with a large corroding scrotal ulcer, was injected, by sediments as well as the supernatant fluid from these several means of a hypodermic syringe, with forty minims of a solutubes with a hypodermic syringe under the skin of a number of tion of the cobra poison (composed of cobra poison, sun-dried, quails at the same time and place, and it was found that the half a grain ; distilled water, two drachms) into the right and quails all died in from five to fifteen minutes, excepting when left cheeks just above the nostrils, in succession, at 11.40 A.M. solution No. 5 was used, which contained the discoloured 4 P.M.: Drank water with some difficulty; defecated and potash solution. Neither the supernatant fluid nor the sedi6 P.M.:. Uneasy; restless; frequently looking ment urinated. produced any deleterious effects on the quails. The towards flanks ; tries to nibble at grass, but ineffectually ; was repeatedly performed by adding liquor potassm experiment endeavours to bite the ulcer on the scrotum. 9 P.M.: Very to fresh portions of the poison, and in every instance the solurestless ; has bitten his scrotum ; ate three parts of a measure tion became discoloured, brown, and the scaly sediment deof boiled horse-grain given him. 10 P.M.: Lay down full posited, thus proving clearly and satisfactorily that liquor length. the poison, forming some salt, and neupotassaé decomposes 12th.-4 A.M.: Is up and on his legs again ; head drooping ; tralising its deleterious properties. The internal administration inclined to stray about ; moves heavily and slowly ; much and external application of the liquor potass2e to the wound swelling of the face and lips ; breathing hurried ; lips parted, failed to effectacure and lower lip pendulous. 10 A.M. : Very uneasy; tongue proThe point next worthy of consideration is, how this fact truding; breathing hard. Noon: Fell down in a convulsive can be applied practically, and how this compound may be fit, and expired at 12.15 P.M., death taking place in 24h. 35m. speedily introduced into the circulation of an animal which has been bitten with the view of destroying the deadly influIf blood be drawn from the system, and a small quantity of ence of the poison. On the 18th inst. a solution of potash (liq. potassae, eight cobra venom be added, it becomes dark, remains fluid, and does not coagulate. On the 2nd of March, 1868, blood so ounces; aqua distillata, four ounces) was injected into the drawn was placed in two separate test-tubes. Into one of right jugular vein of a half-grown dog at 12.37 P.M. by means these two drops of the poison were let in, and the other left of "Richardson’s transfusion apparatus." The operation of alone. In five minutes the blood in the latter coagulated, and injecting lasted 13 minutes. The dog continued lame, but the usual separation of serum and crassamentum took place, was otherwise well up to 10 P.M., and died in the course of whilst the fluid in the other tube became dark-coloured, and the night. There were no symptoms of poisoning; and I am remained fluid for thirty hours after, when it was thrown away of opinion that the solution was faulty-perhaps too strong. owing to its proving offensive. The serum from the second Further experiments are necessary to test this remedy fairly. Five grains in weight of the fresh poison from the cobra, on tube was poured off, and a drop of cobra poison let in, when in a few seconds it became quite black. being carefully sun-dried (which was effected in a couple of The poison of the cobra is somewhat oily, limpid, and at hours) and weighed, yielded one grain of solid substance; thus times of a very pale, light straw colour. Specific gravity of indicating that the poison contains four parts fluid to one of fresh liquid poison is 1046 at 85° Fahr.; acrid to the taste ; solid, or one grain of solid in five of the fresh poison: the blistering, and causing numbness to the part of the tongue to solid concretes into small granular masses of various sizes and which it is applied. To test the force with which the poison shapes. One-fiftieth of a grain of the solid poison so obtained, is injected into the wound, capillary tubes, two inches long, which had been kept for eight days, killed a quail weighing and an eighth of an inch in diameter, were curved slightly at 1 3/4oz. in 10 minutes. one end, so as to fit easily into the fang; both the fangs being A solution was made of half a grain of the dried poison, thus armed, a small pad of cloth placed in the mouth be- which had been kept for a week, in two drachms of distilled tween the fangs induced the cobra to close its jaws, when the water; and forty minims of this were injected into a horse poison was seen to ooze over along the groove, and from the (vide Experiment No. 24), which it killed in 24 h. and 35 min. minute opening at the bottom of the fang into the tube. No A dog (full-grown bitch), weighing 18 lb., was killed by force was brought into play, but the poison simply flowed into twenty-five minims in 2 hours. A second bitch, weighing the tube. 151b., was killed in 1 h. and 27 minutes. A more convenient mode was adopted for collecting the One drop of the fresh poison placed on the tongue of a quail poison for examination. A piece of paper was stretched across kills it in 10 minutes; there is much choking apparently, as a silver spoon, and the cobra made to grasp it, when the the bird constantly opens its mouth, stretching out its neck fangs penetrating the paper over the hollow part of the spoon, and gaping. Half a drachm of the poison was given to a chicken weighing the poison was found deposited there on the snake relaxing its eight ounces three days running. The chicken looked seedy, grasp. 1. A piece of test-paper (litmus), moistened with distilled with ruffled feathers, for a time, on the first day; but on the water, gave decided acid reaction, the reddish colour remain- second and third days the bird seemed well after swallowing the poison. ing, even on exposure to the atmosphere. When the fresh poison is applied to the eyeball or its imme2. A few drops of the poison were dropped into a test-tube, and on the addition of a small quantity of distilled water, it diate coverings, it seems to cause much pain and swelling, with was readily dissolved, the solution being perfectly clear and profuse lachrymation, and some inflammation of the part. The translucent, indicating the absence of mucus. pain seems so great that the animal sickens. The general 3. On the addition of alcohol to the poison, it remained in- duration of the pain appears to be from 24 to 36 hours, without soluble ; the sides of the test-tube where the poison had producing any injurious effect either in the animal, the surtouched became instantaneously coated with an opaque whitish rounding textures, or the visual organ itself. The poison of the cobra, freshly extracted, is a gelatinous deposit on contact with the alcohol, and a similar sediment formed at the bottom of the tube, thus indicating the presence fluid, presenting very much the appearance of the albumen of of much albumen. egg. Like it, also, it consists of cells suspended in an albu4. On the addition of carbonate of soda to an aqueous solu- minous fluid ; and when dried in the sun separates in granules, tion of the poison, it readily dissolved, the solution remaining which is also the case with albumen of the egg. When these transparent. granules are wetted with water, and placed in the field of the .). On adding liquor potasse to an aqueous solution of the microscope, the cells become manifest, with particles of organic poison, a discoloration of the liquid occurred in a few minutes, matter (amorphous). The poisoned blood shows under the microscope a peculiar becoming gradually dark-brown (when retained in the testtube for a few days, it loses the dark-brown colour, and be- notched appearance, and apparently what appeared to be small
P.. : Do bitten.
.
some
617 It requires further research with a more powerful hand, having the thumb well down on to the perineum, with my right hand I took hold of the left ankle (using them as an microscope than I can at present command. From a review of all my experiments, the effects of the extending and counter-extending force); from the ankle I made cobra poison observed in mammals and birds are the follow- firm, but gentle extension in a direct line with the body. After ing :-The poison injected having found its way into the cir- continuing this for a short time, I pressed my left thumb culation, restlessness, dulness, drooping of the head, and jacti- against the head and upper part of the femur in a direction uptation follow successively. The restlessness and change of wards and outwards, at the same time bringing the leg with position of the animal are constant. The bowels are evacuated, my right hand towards the middle line, when we had the pleaand the urine is passed. The pupils act irregularly, dilating sure of hearing the head of the bone slip into the acetabulum or contracting. Respiration is slow and irregular, at times with a distinct snap. The untoward symptoms all disappeared, stertorous, with foam or frothy mucus issuing from the and the child now bore movement of the limb with apparently mouth, spasms, and muscular twitchings. Reflex action is very slight pain. The remaining treatment was merely to tie arrested, as the animal cannot be roused by pricking or pinch- the legs together with a handkerchief at the knee, enjoining ing the skin. Consciousness and ocular recognition continue the recumbent posture, and strict care in moving the child to the last in most instances; sensation is retained, though about. It is now doing well. The case is one not of common occurrence, and it impressed modified; whilst the paralysis is incomplete. The voluntary movements, sometimes after becoming more energetic, soon me at the time with thoughts of how careful we should be in our examination of cases, apparently thought of a slight nature cease altogether; and the animal may die without the slightest trace of convulsions or tetanic spasms. When the poison has by parents. Also the history of the injury, as a cause, tallies been rapidly absorbed, its effects become apparent more well, I think, with the result. The arm of the chair pressing quickly; and the venom is readily absorbed by any living against the trochanter major, or between it and the ilium, it
granules.
tissue. The post-mortem examination discovers the right side of the heart to contain some tarry-looking, black, soft clots of blood; and the left side empty. The entire venous system is engorged with the same kind of blood, more especially the large venous trunks. The liver is found hyperaemic, enlarged, and darkcoloured. The first effect of the poison in the system seems to me to damage the current of blood, by the cells of the poison perhaps deranging the vital affinities existing between the blood-corpuscles and the serum in which they float, and by that means the nervous centres are affected and nutrition arrested. On life becoming extinct, the pupils remain permanently dilated, and the blood found in the larger vessels, when removed from the body, coagulates within four or five minutes after death. Rigor mortis absent, the limbs remaining supple for hours after life becomes extinct, except only in a few instances, where it occurred in a couple of hours.
CASE OF
DISLOCATION OF THE HIP-JOINT CHILD SIX MONTHS OLD. BY JOHN
IN A
POWDRELL, ESQ., M.R.C.S.
ON the 23rd April last Mrs. C- brought her child to me little girl six months old,-having reason to think it had been injured by a fall. It was a well-nourished, average-sized child, and apparently very healthy. The history was, that about a week previous to the above date the child was placed in a small arm-chair, and secured there with a handkerchief tied from arm to arm. By accident, the chair and child were upset; and on the mother going to her assistance, she says she had some difficulty in extricating it, as it was doubled on its side over the left arm of the chair. The child cried a good deal on being loosed from its awkward position; still the mother did not then think it was seriously injured. After this fall the child appeared to give way on the left side, as if in pain somewhere; and (as the mother expressed herself) when she tried to make it feel its feet, it would resist putting its left foot down on to the floor. Placing the child on its back on the mother’s knee, and removing its clothes from the lower part of its body and extremities, the legs were seen to be drawn up and flexed on to the abdomen, with the knees inclining towards the middle line. On extending the legs the child screamed out, and more so when the legs were placed together. Now, on comparing the two sides, the nature of the injury was seen. The left leg was between an inch and an inch and a quarter longer than the right, the left toes were extended out, and the heel was drawn up; the left trochanter major was much less prominent than the right, and behind and above it there was a depression not discernible on the right side. From these symptoms I at once came to the conclusion that it was a case of dislocation of the head of the femur, downwards and forwards, on to the obturator externus. My partner, Mr. Luke, coming in at this time, came to the same diagnosis. Grasping, as it were, the left side of the pelvis with my left - -a
highly probable the inner side of the knee or leg was hit during the fall, and hence the head of the bone was forced out
is
of the acetabulum. Euston-road, May, 1868.
AN IMPROVED TROCAR AND CANULA FOR PUNCTURING THE BLADDER PER RECTUM. BY
JOHN
D. HILL, F.R.C.S.,
SURGEON TO THE ROYAL FREE HOSPITAL.
IN surgical practice cases of retention of urine are sometimes met with which require the operation of puncture of the bladder per rectum and the retention of the canula in the bladder until a catheter can be introduced through the urethra. Having had some experience in this form of treatment, I have directed my attention to a defect in the instrument now used, which in some cases is attended with a chance of local mischief, and in all cases with discomfort to the patient. This instrument is so constructed that the canula is beveled to a sharp edge on the point of the trocar, for the double purpose of allowing it to slide with the trocar through the coats of the bladder without obstruction, and at the same time to spring over the bulb of the trocar by means of a fissure inserted in one or two of its sides. Hence it will be seen that when the trocar is withdrawn, and the bladder emptied, its walls are in actual contact with the sharp edge of the canula. Further, both ends of the canula being always open, the urine trickles away, keeping the patient constantly wet and uncomfortable. To remedy this defect I have lately passed an elastic bougie through the canula, securing it to the outer lip by a piece of tape. Carrying out this principle, Messrs. Weiss and Son have, under my direction, constructed an inner canula, with one end shut and rounded, to project beyond the sharp edge of the outer canula, while the outer end is locked to the lip of the external canula, a small ring being fixed to it as a handle. Thus when the bladder has been relieved by puncture, and the canula secured with tapes, the internal canula is introduced and fixed. By this means the external canula can be retained with perfect safety and comparative comfort, the urine being drawn off as may be required. This instrument answers so well that I am induced to ask my professional brethren to give it a trial. Guildford-street, May, 1868.
ULSTER TYTEDICAL SOCIETY.-The annual
meeting
of
the Ulster Medical Society for receiving the report and for the election of office-bearers, was held on Friday week at the General Hospital. The following are the office-bearers elected for the present year :-President : Professor Cuming. VicePresidents (for town) : Dr. Henry Whitaker and Dr. John M’Cras; (for country) Dr. Archibald Dunlop, Holywood, and Dr. John Kelso, Lisburn. Treasurer : Dr. William MacCormac. Secretaries : Drs. John Moore and James Hill. Other members of Council: Drs. Robert Stewart, James Patterson, James Moore, Angus M. Porter, Hugh P. Rea, and John
Fagan.
and the expectoration became tinged with blood. Has taken the oil regularly. Physical signsFlattening and ob- I. scure breathing in left front; dry cavernous sounds above left scapula; loud tubular above right. May 16th, 1865. -Continued well and in business, with only occasional cough till lately, when only took oil once a day (instead of twice). Patient at present weak and exhausted, with irregular pulse. Ordered oil twice a day in tonic of hyperphosphite of iron and strychnia. Soon improved, and has lost
tion,
cough.
1867.-Has continued well, and at his business ever since. Physical signs : Dry tubular sounds at and above both scapulae. Thirteen years have elapsed since this patient’s first symp-
examination was made by Dr. (now Sir The abdominal walls were found to be covered with fat, an inch thick. The ileum, just above the caecum, was perforated by ulcers of a tuberculous character, of which there were several. Both lungs were strongly adherent at their apices, especially the left, and in both cretaceous matter was found-in the right varying in size from a pin’shead to a pea; but in the left lung there was a large mass of the same material, which quite filled the ancient cavity at the summit of the lung. This patient had been free from chest symptoms for eight years. This case is less remarkable for the duration of his life after recovery from the third stage of consumption than for the completeness of the cure of his chest-symptoms, and for the demonstration it afforded, after death from another cause, of the arrest of the tuberculous disease which had made rapid strides eight years before.
toms. CASE 11.-lVlr. -, aged thirty-two. Jan. 14th, 1852. Well till, two months ago, he caught cold, and since has had Has been severe cough, with copious greenish expectoration. (To be continued.) taking quinine in last three weeks, and cough worse, with much pain in chest, especially on the left side. Urine very thick. Physical signs : Dulness and tubular sounds above the right scapula; moist crepitus below. The same on left EXPERIMENTS WITH THE POISON OF THE side, but to less extent. Ordered cod oil in mixture of iodide COBRA DI CAPELLA. and carbonate of potass, hydrocyanic acid, and orange-peel; and liniment of acetum cantharidis. BY JOHN SHORTT, M.D., F.L.S., M.R.C.P.L., &c., Feb. llth.-Taken medicines well, and is very much better SUPERINTENDENT-GENERAL OF VACCINE, MADRAS PRESIDENCY. in all respects. Has been at Hastings. Crepitus gone. (Concluded from p. 557.) Breath-sound still weak in right chest. July l3th.-Lost cough since May, and is stronger and more active than ever. In May had discharge from right ear, which No. 16. is still deaf. Still tubular sounds above the right scapula. Breath pretty clear below. Dec. 21st, 1867, -An aged bay Arab horse, standing fourteen Dec. 6th, 1859.-Continued well and active till last June, hands two inches high, and in good working condition, was when, after much excitement and exertion at an agricultural placed at my disposal for experiment. He was bitten on the meeting, he had an attack of bronchitis, with much expectora- lip and nostril by a fresh, vigorous, and full-sized cobra at tion, sometimes fetid, and was much reduced. Has since improved, but still coughs. Lately very bilious, and taken no 2.28 P.M. The blood-points caused by the fangs of the snake 2.30 : oil. Dulness and tubular sounds in upper right. Small weredistinctly visible, and were two in number. To take Heart’s action 40. 2.33 : Heart’s action 40. 2.36: Heart’s cavernous voice and croak above the right scapula. oil in mixture of calumba and nitric acid; and use cantharides action 36; maxillary pulse 40. 2.38 : Heart’s action 36; liniment. maxillary pulse 40. 3.7: Heart’s action 36; maxillary pulse July 2nd, 1862.-Continued the remedies without difficulty, and regained flesh, strength, and activity. Gained six pounds, 32. 3.30: Heart’s action 48; maxillary pulse 36. Pupils and often walks twenty miles. Was out as usual last winter. contracted ; horse constantly looking at his flanks; lower lip 3.45: Pupils very much conHas still some cough and expectoration. Taken no oil for two drooping; twitches; dull. intermittent. 4.15 : 4.5: Defecated. 24, tracted ; Tubular sounds at above pulse and both left as years. scapulae, Muscular contractions of the neck; pupils dilated ; glairy much as right; but no crepitus or rhonchus. Feb. 21st, 1867. -In the last five years has taken little oil, saliva from mouth. 4.21: Urinated. 4.25: Pulse fluttering; as it made him bilious. Cough has increased; breath become restless; puffiness of abdomen. 4.55 : Pulse fluttering, inshorter; and now can walk only two miles. Nails convex. termittent, 28. 5.5 - Twitching of muscles of extremities; drooping. 5.20: Lay down; groaning. 5.30: Up on Dulness, collapse, and moist cavernous sounds below the right head clavicle. Breath much obstructed all down the right back. his legs again. 5.45: Restless; much swelling about the Tubular sounds above the left scapula. To resume oil in wound, and much thick saliva from the mouth. 6 P.M.: Lay mixture of nitric acid, strychnia, &c. Upwards of fifteen years down full length; violent convulsions of the limbs; mouth have elapsed since this patient’s first symptoms. His latter open; pupils dilated. 6.5: Dead; 3 h. and 37min. after being bitten. deterioration came on after long suspension of treatment. Unfortunately, I had not the necessary time to make a postCASE 12.-A brewer’s clerk, aged twenty-five, first consulted mortem examination. Dr. Williams on September 13th, 1847. A year and a half ago No. 17. he had syphilis, and was treated by mercury for three months. Dec. 23rd.-2.9 P.M.: Dog bitten. 2.55: Defecated; mic. Eight months ago an eruption appeared on the skin, followed turated. 2.58 : at but afterwards with Vomited ; lay down suddenly; convulsed ; by cough, slight first, becoming violent, purulent expectoration, and lately accompanied by sweats, and pupilsdilated. 4.45: Dead; death in 2 h. 36 min. loss of flesh, strength, and breath. Physical signs: Marked No. 18. dulness below left clavicle, extending to mammary region; Dec. 23rd.-2.26 P.M.: Dog bitten. 2.42: Passed blood gurgling sounds and crepitation around ; loud tubular sounds within and above right scapula. Ordered oil, and counter- (per anum). 3 P.M.: Lay down, moaning. 3.10 : Thick saliva from mouth; pupils dilated. 4 p.m.: Dead; death in irritation with iodine liniment. May 24th, 1848.—Has taken oil regularly all the winter, 1 h. 34 min. No. 19. and has quite recovered flesh and strength. Cough slight, with scanty, opaque morning expectoration ; still dulness in Dec. 23rd.-3.9P.M.: Dog bitten. 3.30: Sick. 3.45 ; upper left chest, with dry cavernous sounds above and belowrDead; death in 36 min. clavicle, but no crepitation ; vesicular sound fairly heard in No. 20. lower chest; less tubular sounds in right lung. A cobra was made to bite a Dec. P.M.: 1867.-1.10 26th, Sept. 1850.-Quite well, and taking active exercise ; dulness much diminished; some tubular sounds in upper left chest,’ sheep standing 25 inches high, and about a year old. 1.11 : Animal lame. 1.12 : Drooping in opposite hind quarter; front and back ; no cavernous sounds, but breathing harsh: Bee. 26th, 1856.-Heard from Dr. Carlill that the patientt wounded leg raised. 1.27: Suddenly dropped down; con. had just died suddenly of peritonitis from intestinal perfora- vulsed. 1.31: Pupils contracted. 1.35: Convulsed; pupils tion. Hehad been well and actively engaged in business till1 widely dilated; thick saliva from mouth. 1.45 : Dead; death in 35 min. ten days before his death, subject only to occasional attacks ofin . No. 21. headache and costiveness. After walking a mile, he wass seized with sudden and severe pain in the abdomen, with colDec. 26th.—1.17 P.M.: Dog bitten. 1.45 : Lay down; dull. lapse, and other symptoms of perforation, and died in two 2.5: Drowsy. 2.55: Comatose. 4.15: Dead; death in 2 h. 58 min. days. .
-
.
616 -Vo. 22. "’ 1.38: Drowsy; Dec. 30th.-1.30 P.M. : Dog bitten. death in 9 min. convulsed. 1.39 : Dead; ing ; *
quite pale again), and deposited a similarly coloured flaky scaly sediment, indicating a change and the formation of
comes
’
..,
or
stagger-
salt. 6. On the addition of liquor of ammonia to an aqueous solution of the poison, it remained unchanged. NO. 2 3. 7. On the application of nitric acid to an aqueous solution, 1.50 : La Dec. 30th.-1.36 P.M.: Dog bitten. 1.0 Lay down. down. it became tinged of a greenish colour, depositing a copious 2 r.M.: Dull. 2.46: Restless; eyes injected; pupils dilated; white, opaque, solid sediment,, indicating the presence of albuconvulsions. 3.30: Dead; death in2 h. 24 min. men. 8. On the addition of carbonate of potash to an aqueous No. 24 solution of the poison, a whitish, flaky, or scale-like sediment .... March llth, 1868. -An aged flea-bitten grey horse, Persian, was deposited, the supernatant fluid remaining clear. standing fourteen hands two inches high, in rather ill condiA series of experiments were now begun, by injecting the tion, with a large corroding scrotal ulcer, was injected, by sediments as well as the supernatant fluid from these several means of a hypodermic syringe, with forty minims of a solutubes with a hypodermic syringe under the skin of a number of tion of the cobra poison (composed of cobra poison, sun-dried, quails at the same time and place, and it was found that the half a grain ; distilled water, two drachms) into the right and quails all died in from five to fifteen minutes, excepting when left cheeks just above the nostrils, in succession, at 11.40 A.M. solution No. 5 was used, which contained the discoloured 4 P.M.: Drank water with some difficulty; defecated and potash solution. Neither the supernatant fluid nor the sedi6 P.M.:. Uneasy; restless; frequently looking ment urinated. produced any deleterious effects on the quails. The towards flanks ; tries to nibble at grass, but ineffectually ; was repeatedly performed by adding liquor potassm experiment endeavours to bite the ulcer on the scrotum. 9 P.M.: Very to fresh portions of the poison, and in every instance the solurestless ; has bitten his scrotum ; ate three parts of a measure tion became discoloured, brown, and the scaly sediment deof boiled horse-grain given him. 10 P.M.: Lay down full posited, thus proving clearly and satisfactorily that liquor length. the poison, forming some salt, and neupotassaé decomposes 12th.-4 A.M.: Is up and on his legs again ; head drooping ; tralising its deleterious properties. The internal administration inclined to stray about ; moves heavily and slowly ; much and external application of the liquor potass2e to the wound swelling of the face and lips ; breathing hurried ; lips parted, failed to effectacure and lower lip pendulous. 10 A.M. : Very uneasy; tongue proThe point next worthy of consideration is, how this fact truding; breathing hard. Noon: Fell down in a convulsive can be applied practically, and how this compound may be fit, and expired at 12.15 P.M., death taking place in 24h. 35m. speedily introduced into the circulation of an animal which has been bitten with the view of destroying the deadly influIf blood be drawn from the system, and a small quantity of ence of the poison. On the 18th inst. a solution of potash (liq. potassae, eight cobra venom be added, it becomes dark, remains fluid, and does not coagulate. On the 2nd of March, 1868, blood so ounces; aqua distillata, four ounces) was injected into the drawn was placed in two separate test-tubes. Into one of right jugular vein of a half-grown dog at 12.37 P.M. by means these two drops of the poison were let in, and the other left of "Richardson’s transfusion apparatus." The operation of alone. In five minutes the blood in the latter coagulated, and injecting lasted 13 minutes. The dog continued lame, but the usual separation of serum and crassamentum took place, was otherwise well up to 10 P.M., and died in the course of whilst the fluid in the other tube became dark-coloured, and the night. There were no symptoms of poisoning; and I am remained fluid for thirty hours after, when it was thrown away of opinion that the solution was faulty-perhaps too strong. owing to its proving offensive. The serum from the second Further experiments are necessary to test this remedy fairly. Five grains in weight of the fresh poison from the cobra, on tube was poured off, and a drop of cobra poison let in, when in a few seconds it became quite black. being carefully sun-dried (which was effected in a couple of The poison of the cobra is somewhat oily, limpid, and at hours) and weighed, yielded one grain of solid substance; thus times of a very pale, light straw colour. Specific gravity of indicating that the poison contains four parts fluid to one of fresh liquid poison is 1046 at 85° Fahr.; acrid to the taste ; solid, or one grain of solid in five of the fresh poison: the blistering, and causing numbness to the part of the tongue to solid concretes into small granular masses of various sizes and which it is applied. To test the force with which the poison shapes. One-fiftieth of a grain of the solid poison so obtained, is injected into the wound, capillary tubes, two inches long, which had been kept for eight days, killed a quail weighing and an eighth of an inch in diameter, were curved slightly at 1 3/4oz. in 10 minutes. one end, so as to fit easily into the fang; both the fangs being A solution was made of half a grain of the dried poison, thus armed, a small pad of cloth placed in the mouth be- which had been kept for a week, in two drachms of distilled tween the fangs induced the cobra to close its jaws, when the water; and forty minims of this were injected into a horse poison was seen to ooze over along the groove, and from the (vide Experiment No. 24), which it killed in 24 h. and 35 min. minute opening at the bottom of the fang into the tube. No A dog (full-grown bitch), weighing 18 lb., was killed by force was brought into play, but the poison simply flowed into twenty-five minims in 2 hours. A second bitch, weighing the tube. 151b., was killed in 1 h. and 27 minutes. A more convenient mode was adopted for collecting the One drop of the fresh poison placed on the tongue of a quail poison for examination. A piece of paper was stretched across kills it in 10 minutes; there is much choking apparently, as a silver spoon, and the cobra made to grasp it, when the the bird constantly opens its mouth, stretching out its neck fangs penetrating the paper over the hollow part of the spoon, and gaping. Half a drachm of the poison was given to a chicken weighing the poison was found deposited there on the snake relaxing its eight ounces three days running. The chicken looked seedy, grasp. 1. A piece of test-paper (litmus), moistened with distilled with ruffled feathers, for a time, on the first day; but on the water, gave decided acid reaction, the reddish colour remain- second and third days the bird seemed well after swallowing the poison. ing, even on exposure to the atmosphere. When the fresh poison is applied to the eyeball or its imme2. A few drops of the poison were dropped into a test-tube, and on the addition of a small quantity of distilled water, it diate coverings, it seems to cause much pain and swelling, with was readily dissolved, the solution being perfectly clear and profuse lachrymation, and some inflammation of the part. The translucent, indicating the absence of mucus. pain seems so great that the animal sickens. The general 3. On the addition of alcohol to the poison, it remained in- duration of the pain appears to be from 24 to 36 hours, without soluble ; the sides of the test-tube where the poison had producing any injurious effect either in the animal, the surtouched became instantaneously coated with an opaque whitish rounding textures, or the visual organ itself. The poison of the cobra, freshly extracted, is a gelatinous deposit on contact with the alcohol, and a similar sediment formed at the bottom of the tube, thus indicating the presence fluid, presenting very much the appearance of the albumen of of much albumen. egg. Like it, also, it consists of cells suspended in an albu4. On the addition of carbonate of soda to an aqueous solu- minous fluid ; and when dried in the sun separates in granules, tion of the poison, it readily dissolved, the solution remaining which is also the case with albumen of the egg. When these transparent. granules are wetted with water, and placed in the field of the .). On adding liquor potasse to an aqueous solution of the microscope, the cells become manifest, with particles of organic poison, a discoloration of the liquid occurred in a few minutes, matter (amorphous). The poisoned blood shows under the microscope a peculiar becoming gradually dark-brown (when retained in the testtube for a few days, it loses the dark-brown colour, and be- notched appearance, and apparently what appeared to be small
P.. : Do bitten.
.
some
617 It requires further research with a more powerful hand, having the thumb well down on to the perineum, with my right hand I took hold of the left ankle (using them as an microscope than I can at present command. From a review of all my experiments, the effects of the extending and counter-extending force); from the ankle I made cobra poison observed in mammals and birds are the follow- firm, but gentle extension in a direct line with the body. After ing :-The poison injected having found its way into the cir- continuing this for a short time, I pressed my left thumb culation, restlessness, dulness, drooping of the head, and jacti- against the head and upper part of the femur in a direction uptation follow successively. The restlessness and change of wards and outwards, at the same time bringing the leg with position of the animal are constant. The bowels are evacuated, my right hand towards the middle line, when we had the pleaand the urine is passed. The pupils act irregularly, dilating sure of hearing the head of the bone slip into the acetabulum or contracting. Respiration is slow and irregular, at times with a distinct snap. The untoward symptoms all disappeared, stertorous, with foam or frothy mucus issuing from the and the child now bore movement of the limb with apparently mouth, spasms, and muscular twitchings. Reflex action is very slight pain. The remaining treatment was merely to tie arrested, as the animal cannot be roused by pricking or pinch- the legs together with a handkerchief at the knee, enjoining ing the skin. Consciousness and ocular recognition continue the recumbent posture, and strict care in moving the child to the last in most instances; sensation is retained, though about. It is now doing well. The case is one not of common occurrence, and it impressed modified; whilst the paralysis is incomplete. The voluntary movements, sometimes after becoming more energetic, soon me at the time with thoughts of how careful we should be in our examination of cases, apparently thought of a slight nature cease altogether; and the animal may die without the slightest trace of convulsions or tetanic spasms. When the poison has by parents. Also the history of the injury, as a cause, tallies been rapidly absorbed, its effects become apparent more well, I think, with the result. The arm of the chair pressing quickly; and the venom is readily absorbed by any living against the trochanter major, or between it and the ilium, it
granules.
tissue. The post-mortem examination discovers the right side of the heart to contain some tarry-looking, black, soft clots of blood; and the left side empty. The entire venous system is engorged with the same kind of blood, more especially the large venous trunks. The liver is found hyperaemic, enlarged, and darkcoloured. The first effect of the poison in the system seems to me to damage the current of blood, by the cells of the poison perhaps deranging the vital affinities existing between the blood-corpuscles and the serum in which they float, and by that means the nervous centres are affected and nutrition arrested. On life becoming extinct, the pupils remain permanently dilated, and the blood found in the larger vessels, when removed from the body, coagulates within four or five minutes after death. Rigor mortis absent, the limbs remaining supple for hours after life becomes extinct, except only in a few instances, where it occurred in a couple of hours.
CASE OF
DISLOCATION OF THE HIP-JOINT CHILD SIX MONTHS OLD. BY JOHN
IN A
POWDRELL, ESQ., M.R.C.S.
ON the 23rd April last Mrs. C- brought her child to me little girl six months old,-having reason to think it had been injured by a fall. It was a well-nourished, average-sized child, and apparently very healthy. The history was, that about a week previous to the above date the child was placed in a small arm-chair, and secured there with a handkerchief tied from arm to arm. By accident, the chair and child were upset; and on the mother going to her assistance, she says she had some difficulty in extricating it, as it was doubled on its side over the left arm of the chair. The child cried a good deal on being loosed from its awkward position; still the mother did not then think it was seriously injured. After this fall the child appeared to give way on the left side, as if in pain somewhere; and (as the mother expressed herself) when she tried to make it feel its feet, it would resist putting its left foot down on to the floor. Placing the child on its back on the mother’s knee, and removing its clothes from the lower part of its body and extremities, the legs were seen to be drawn up and flexed on to the abdomen, with the knees inclining towards the middle line. On extending the legs the child screamed out, and more so when the legs were placed together. Now, on comparing the two sides, the nature of the injury was seen. The left leg was between an inch and an inch and a quarter longer than the right, the left toes were extended out, and the heel was drawn up; the left trochanter major was much less prominent than the right, and behind and above it there was a depression not discernible on the right side. From these symptoms I at once came to the conclusion that it was a case of dislocation of the head of the femur, downwards and forwards, on to the obturator externus. My partner, Mr. Luke, coming in at this time, came to the same diagnosis. Grasping, as it were, the left side of the pelvis with my left - -a
highly probable the inner side of the knee or leg was hit during the fall, and hence the head of the bone was forced out
is
of the acetabulum. Euston-road, May, 1868.
AN IMPROVED TROCAR AND CANULA FOR PUNCTURING THE BLADDER PER RECTUM. BY
JOHN
D. HILL, F.R.C.S.,
SURGEON TO THE ROYAL FREE HOSPITAL.
IN surgical practice cases of retention of urine are sometimes met with which require the operation of puncture of the bladder per rectum and the retention of the canula in the bladder until a catheter can be introduced through the urethra. Having had some experience in this form of treatment, I have directed my attention to a defect in the instrument now used, which in some cases is attended with a chance of local mischief, and in all cases with discomfort to the patient. This instrument is so constructed that the canula is beveled to a sharp edge on the point of the trocar, for the double purpose of allowing it to slide with the trocar through the coats of the bladder without obstruction, and at the same time to spring over the bulb of the trocar by means of a fissure inserted in one or two of its sides. Hence it will be seen that when the trocar is withdrawn, and the bladder emptied, its walls are in actual contact with the sharp edge of the canula. Further, both ends of the canula being always open, the urine trickles away, keeping the patient constantly wet and uncomfortable. To remedy this defect I have lately passed an elastic bougie through the canula, securing it to the outer lip by a piece of tape. Carrying out this principle, Messrs. Weiss and Son have, under my direction, constructed an inner canula, with one end shut and rounded, to project beyond the sharp edge of the outer canula, while the outer end is locked to the lip of the external canula, a small ring being fixed to it as a handle. Thus when the bladder has been relieved by puncture, and the canula secured with tapes, the internal canula is introduced and fixed. By this means the external canula can be retained with perfect safety and comparative comfort, the urine being drawn off as may be required. This instrument answers so well that I am induced to ask my professional brethren to give it a trial. Guildford-street, May, 1868.
ULSTER TYTEDICAL SOCIETY.-The annual
meeting
of
the Ulster Medical Society for receiving the report and for the election of office-bearers, was held on Friday week at the General Hospital. The following are the office-bearers elected for the present year :-President : Professor Cuming. VicePresidents (for town) : Dr. Henry Whitaker and Dr. John M’Cras; (for country) Dr. Archibald Dunlop, Holywood, and Dr. John Kelso, Lisburn. Treasurer : Dr. William MacCormac. Secretaries : Drs. John Moore and James Hill. Other members of Council: Drs. Robert Stewart, James Patterson, James Moore, Angus M. Porter, Hugh P. Rea, and John
Fagan.