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PERMANGANATE OF POTASH AND SNAKE-POISON.
761
fever produced
the two previous years, 1879-1880 (I have not the returns by me for a longer period), there were only 33 deaths from of all kinds. How many of these were typhoid it does not say, and only six deaths occurred from diphtheria. I am, Sir, your obedient servant, W. KEBBELL, M.D., Senior Physician to the Sussex County Hospital. Hove, May lst, 1882. Hospital.
PERMANGANATE OF POTASH AND SNAKEPOISON.
To the Editor of THE LANCET. with great interest the important article by read SIR,-I Dr. Vincent Richards, published in THE LANCET of the 7th of January, and I see that the results of his experiments agree entirely with those of my own in Brazil. I desire, however, in order to re-establish the truth, to present some facts in regard to a doubtful point in that important article. Dr. Vincent Richards supposes that my conclusions relative to the neutralising effects of permanganate of potash are based on experiments made with viper poison. I should say first of all that the viper is unknown in Brazil. My experiments were made with the venom of the following species: Surucucú (Lachesis rhombeata), a reptile that attains a large size (two metres and more), and whose bite is considered to be one of the most dangerous; jararaca
!
solution of 1 in 100 has no irritating effect, and that in the it has never numerous cases in which it has I propose to make a methodic collection of a scab. the clinical cases of Brazil, and at the proper time will give an account of them in your journal. Before closing I wish to make a remark on one topic of Dr. Vincent Richards’ article. He says that although from a scientific point of view the discovery may be valuable, he fears it will be of little practical utility in India, because there the victims of snake-bites cannot for the most part obtain the aid of competent persons. With reference to what has taken place in Brazil, I may state that the greater part of the applications have been made by persons completely foreign to the medical profession, according to the given in my circular. When once the practical method of application and the use of the syringe of Pravaz have been taught to countrymen of India, and the substance and necessary instruments are placed within their reach, all these difficulties will have disappeared. I am, Sir, your obedient servant, J. B. DE LACERDA. Rio de Janeiro, March 29th, 1882.
directions
OÖPHORECTOMY. To the Editor of THE LANCET. SiR, -I am sorry that I did not see your remarks upon one of the cases of removal of an ovary related by me at the Obstetrical Society in time to reply to it in last week’s LANCET. I consider your strictures unfair and incorrect; not intentionally so of course, but simply because the report upon which you founded them did not contain a sufficiently detailed account of the case. " This is the first time we have heard of dyspnoea depending on heart disease in a patient, pale and out of breath, being referred to an ovarian disorder, and we fail to discover in the report of the In answer to case the slightest evidence for such a view." this, I reply that the dyspnoea did not depend upon heart disease alone. It was to a great extent a reflex affection, and its source was a diseased ovary, as the result proved. The patient certainly had an old mitral disease, and during the attacks of dyspncea there was increased action of the heart; but the patient herself, in describing the feeling, always referred her distress to the abdominal region, and generally used the same words-" shortness of breath in my body." An attack could only be relieved by one of three very peculiar positions-1. By sitting on a stool and arching the body forwards until the forehead rested upon a stool. 2. By curling herself up on one side in bed. 3. By the knee-elbow position. The patient was never able to sleep upon her back, and had long been accustomed to sleep in the knee-elbow position, her forehead resting upon her hands, which were supported by pillows. After removal of i the prolapsed ovary, none of these positions were ever again necessary, and the patient could sleep in the dorsal position. I should take up too much of your valuable space were I to go further into the matter, but your analogy with the testicle is quite beside the mark. The ovary, on removal, was found to contain small cysts, and to be the seat of chronic inflammation, as proved by Dr. Galabin’s report of his micro. scopic examination of sections properly hardened and pre-
the most common of our venomous and whose dimensions seldom exceed one metre; jararacussú (Bothrops jararacussu), whose bite is as much feared as that of the surucucú, and which attains a larger size than the jararaca; and finally the urutu, a species not very well defined as yet zoologically, but which is similar to the bothrops, and is endowed with a very active poison. I have already collected about forty cases of bites in man, of individuals belonging to these different species, in which hypodermic injections of permanganate of potash have given the best results. Among these there are even two cases of bites by the rattlesnake (Crotalus horridus). I now see that the permanganate of potash is also efficacious against the poison of the cobra de capello. I cannot agree with Dr. Vincent Richards that the poisons exercise a different action according to the species. At least, for the species of Brazil, I can affirm, based on the results of more than 400 experiments, made under various conditions and with a minute physiological analysis, that the poisons of these species all act in the same way; that they particularly on the blood or on the nerve centres, but on all albuminoid matter. If differences have been at times observed in the manner in which the animal responds to the action of the poison, these differences depend on the individual and specific conditions of the animal, or on the manner by which the poison is introduced in the organism. If the poison be introduced in quantity in a vein, the animal succumbs rapidly, the mechanism of death being at times somewhat varied, but the perturbations of the nervous centres predominating. In these cases there is not sufficient time for the blood to become more fluid. In slower cases bleeding due to the decomposition of the blood may occur. It is possible that the poison of the cobra de capello forms an exception to this rule, but the above is perfectly exact, with regard to the Brazilian species. Dr. Vincent Richards establishes in his conclusion No. 6 a point of the greatest importance. I have already stated in my published works on the subject, as well as in a circular indicating the mode of application of the permanganate of potash, which the Brazilian Government distributed throughout the empire, that to be efficacious this substance should be put in immediate contact with the poison in the tissues. On this account I recommend that the injection should be made as quickly as possible in the orifice made by the fangs of the snake. When the application is delayed and the poison has had time to spread itself in the member, I iecommend that a number of injections should be made not only at the point of inoculation of the poison, but also in different parts of the member up to the limits of the sound portion. By following these instructions a number of individuals have been saved by injections made eight and ten hours after being bitten. The local effects of the poisoning were arrested, and in the course of two, three, or four days the wounded member had returned to its normal state. It should not be forgotten that permanganate of potash in a
(Bothrops jararaca),
species,
donot act
been applied
You say:
second
pared.
In the second case the ovary was not removed on account of hysteria, as you imply, but for pain more or less constant. This ovary was also found to be diseased. The general tone of the discussion which followed the reading of my paper was very favourable, with the exception of the remark of the President, with whom the ovary is a sacred organ, never The removal of a proon any account to be meddled with. ovary is a very trivial operation. I am, Sir, your obedient servant, JAMES BRAITHWAITE. Leeds, May 2nd, 1882.
lapsed
JAMES
HOSPITALS AND THE STATE. To the Editor of THE LANCET. read with very much pleasure the able review on SIR,-I Mr. Burdett’s paper, published in your issue of the 15th April, and I am quite certain that hospital managers generally will fully endorse the reviewer’s remarks. Mr. Burdett’s tables are good as far as they go, but they lack some of those vit al details which are absolutely necessary to
fever produced
the two previous years, 1879-1880 (I have not the returns by me for a longer period), there were only 33 deaths from of all kinds. How many of these were typhoid it does not say, and only six deaths occurred from diphtheria. I am, Sir, your obedient servant, W. KEBBELL, M.D., Senior Physician to the Sussex County Hospital. Hove, May lst, 1882. Hospital.
PERMANGANATE OF POTASH AND SNAKEPOISON.
To the Editor of THE LANCET. with great interest the important article by read SIR,-I Dr. Vincent Richards, published in THE LANCET of the 7th of January, and I see that the results of his experiments agree entirely with those of my own in Brazil. I desire, however, in order to re-establish the truth, to present some facts in regard to a doubtful point in that important article. Dr. Vincent Richards supposes that my conclusions relative to the neutralising effects of permanganate of potash are based on experiments made with viper poison. I should say first of all that the viper is unknown in Brazil. My experiments were made with the venom of the following species: Surucucú (Lachesis rhombeata), a reptile that attains a large size (two metres and more), and whose bite is considered to be one of the most dangerous; jararaca
!
solution of 1 in 100 has no irritating effect, and that in the it has never numerous cases in which it has I propose to make a methodic collection of a scab. the clinical cases of Brazil, and at the proper time will give an account of them in your journal. Before closing I wish to make a remark on one topic of Dr. Vincent Richards’ article. He says that although from a scientific point of view the discovery may be valuable, he fears it will be of little practical utility in India, because there the victims of snake-bites cannot for the most part obtain the aid of competent persons. With reference to what has taken place in Brazil, I may state that the greater part of the applications have been made by persons completely foreign to the medical profession, according to the given in my circular. When once the practical method of application and the use of the syringe of Pravaz have been taught to countrymen of India, and the substance and necessary instruments are placed within their reach, all these difficulties will have disappeared. I am, Sir, your obedient servant, J. B. DE LACERDA. Rio de Janeiro, March 29th, 1882.
directions
OÖPHORECTOMY. To the Editor of THE LANCET. SiR, -I am sorry that I did not see your remarks upon one of the cases of removal of an ovary related by me at the Obstetrical Society in time to reply to it in last week’s LANCET. I consider your strictures unfair and incorrect; not intentionally so of course, but simply because the report upon which you founded them did not contain a sufficiently detailed account of the case. " This is the first time we have heard of dyspnoea depending on heart disease in a patient, pale and out of breath, being referred to an ovarian disorder, and we fail to discover in the report of the In answer to case the slightest evidence for such a view." this, I reply that the dyspnoea did not depend upon heart disease alone. It was to a great extent a reflex affection, and its source was a diseased ovary, as the result proved. The patient certainly had an old mitral disease, and during the attacks of dyspncea there was increased action of the heart; but the patient herself, in describing the feeling, always referred her distress to the abdominal region, and generally used the same words-" shortness of breath in my body." An attack could only be relieved by one of three very peculiar positions-1. By sitting on a stool and arching the body forwards until the forehead rested upon a stool. 2. By curling herself up on one side in bed. 3. By the knee-elbow position. The patient was never able to sleep upon her back, and had long been accustomed to sleep in the knee-elbow position, her forehead resting upon her hands, which were supported by pillows. After removal of i the prolapsed ovary, none of these positions were ever again necessary, and the patient could sleep in the dorsal position. I should take up too much of your valuable space were I to go further into the matter, but your analogy with the testicle is quite beside the mark. The ovary, on removal, was found to contain small cysts, and to be the seat of chronic inflammation, as proved by Dr. Galabin’s report of his micro. scopic examination of sections properly hardened and pre-
the most common of our venomous and whose dimensions seldom exceed one metre; jararacussú (Bothrops jararacussu), whose bite is as much feared as that of the surucucú, and which attains a larger size than the jararaca; and finally the urutu, a species not very well defined as yet zoologically, but which is similar to the bothrops, and is endowed with a very active poison. I have already collected about forty cases of bites in man, of individuals belonging to these different species, in which hypodermic injections of permanganate of potash have given the best results. Among these there are even two cases of bites by the rattlesnake (Crotalus horridus). I now see that the permanganate of potash is also efficacious against the poison of the cobra de capello. I cannot agree with Dr. Vincent Richards that the poisons exercise a different action according to the species. At least, for the species of Brazil, I can affirm, based on the results of more than 400 experiments, made under various conditions and with a minute physiological analysis, that the poisons of these species all act in the same way; that they particularly on the blood or on the nerve centres, but on all albuminoid matter. If differences have been at times observed in the manner in which the animal responds to the action of the poison, these differences depend on the individual and specific conditions of the animal, or on the manner by which the poison is introduced in the organism. If the poison be introduced in quantity in a vein, the animal succumbs rapidly, the mechanism of death being at times somewhat varied, but the perturbations of the nervous centres predominating. In these cases there is not sufficient time for the blood to become more fluid. In slower cases bleeding due to the decomposition of the blood may occur. It is possible that the poison of the cobra de capello forms an exception to this rule, but the above is perfectly exact, with regard to the Brazilian species. Dr. Vincent Richards establishes in his conclusion No. 6 a point of the greatest importance. I have already stated in my published works on the subject, as well as in a circular indicating the mode of application of the permanganate of potash, which the Brazilian Government distributed throughout the empire, that to be efficacious this substance should be put in immediate contact with the poison in the tissues. On this account I recommend that the injection should be made as quickly as possible in the orifice made by the fangs of the snake. When the application is delayed and the poison has had time to spread itself in the member, I iecommend that a number of injections should be made not only at the point of inoculation of the poison, but also in different parts of the member up to the limits of the sound portion. By following these instructions a number of individuals have been saved by injections made eight and ten hours after being bitten. The local effects of the poisoning were arrested, and in the course of two, three, or four days the wounded member had returned to its normal state. It should not be forgotten that permanganate of potash in a
(Bothrops jararaca),
species,
donot act
been applied
You say:
second
pared.
In the second case the ovary was not removed on account of hysteria, as you imply, but for pain more or less constant. This ovary was also found to be diseased. The general tone of the discussion which followed the reading of my paper was very favourable, with the exception of the remark of the President, with whom the ovary is a sacred organ, never The removal of a proon any account to be meddled with. ovary is a very trivial operation. I am, Sir, your obedient servant, JAMES BRAITHWAITE. Leeds, May 2nd, 1882.
lapsed
JAMES
HOSPITALS AND THE STATE. To the Editor of THE LANCET. read with very much pleasure the able review on SIR,-I Mr. Burdett’s paper, published in your issue of the 15th April, and I am quite certain that hospital managers generally will fully endorse the reviewer’s remarks. Mr. Burdett’s tables are good as far as they go, but they lack some of those vit al details which are absolutely necessary to