REPORT OF A CASE OF SNAKE-BITE, AND RECOVERY.

288 to the knowledge of medicine are their nostrums, addressed to the too credulous, in the columns of newspapers, to the great danger and detriment of the public. The object desired, is to have the principle of treatment for this malady carefully laid down, leaving it to the judgment of the practitioner to select the medicament which will most surely accomplish the end in view. A great and useful object would be gained in setting at rest the public anxiety, by its being known that the principles of the treatment of the disease were thoroughly understood, and that the sole object of trying the various remedies proposed, is to arrive, in the readiest and most certain manner, at the accomplishment of those few principles. Thus the empirical system of giving, at random, so called specifics for the cure of the disease, would resolve itself into one of a treatment based upon its pathology. There is a little to say with respect to the history of cholera. It would appear that there is an idea very generally adopted, that the disease known as Asiatic cholera is of recent origin-in fact, that it was unknown in England, at least, before its last violent access in the year 1832. But why such an idea should have been entertained in the face of very precise and marked descriptions of the malady to the contrary, I cannot imagine. Let us see what was known on the subject in the year 1669. That "worthy and excellent practical physician, Dr. Thomas Sydenham," when speaking of the " epidemick constitution" of part of the year 1669, and three following, at London, says: " At the beginning of August, 1669, the cholera morbus, the gripes without stools, and the bloody flux, were very frequent; whereas for ten years before they seldom happened." Further on, he gives a description of the symptoms of cholera morbus; and in that distinctly points out, that the disease now consi’dered a stranger, and of modern Asiatic origin, was well known, and distinguished from the commoner malady of surfeit or diarrhoea, long before the time of hii then writing. He says: " That disease comes as certainly at the latter end of summer and at the approach of autumn as swallows at the beginning of spring, and as cuckoos at the heat of the following season. That disease, which is occasioned by a- surfeit, comes at any time; the symptoms are, indeed, alike, and the cure the same, yet ’tis of another kind. The disease is easily known; for there are violent vomitings, and an evacuation of ill humours, with great difficulty and trouble by stool; there is a violent pain and inflammation of the belly and guts; an heartburning thirst, a quick pulse, with heat and anxiety, and often a small and unequal pulse, with great nauseousness, and sometimes a colliquative sweat; contractions of the arms and legs, fainting, a coldness of the extreme parts, and such- ’, like symptoms, which frighten the bystanders, and kill the patient in twenty-four hours." In the method of treatment proposed by him, he considers it improper either to evacuate or astringe the bowels in too great a degree-choosing, as he says, a middle way. He proposes t.o clear out tlxe "sharp and acrimonious humours," by taking chicken broth to vomiting, and, at the same time, removing offending matter from the bowels by using broth for clysters. He then administers an anodyne-his own quaint formula being :-Take of cowslip water, one ounce ; of aqua mirabilis, two drachms ; of liquid laudanum, sixteen drops. Mix them. Though he adds, " any other narcotick of£ the shops may be used instead of it." And "if the vomiting and looseness have continued many hours, suppose ten or twelve, and the sick is worn out, so that the extreme parts wax cold, I say in this case, all other remedies being omitted, the must immediately fly to laudanum, the sacred anctor physician 2n this disease, which must not only be given when the symptoms are urgent, but also after the vomiting and looseness go off." The succeeding remarks are so pertinent to the entire question of cholera, the season of the year, and probable duration of the true disease, and express so shrewdly some of the speculations of the present day, that I feel called on to them also. The Doctor says :quote " Though this disease is epidemical, as was said before, yet it very seldom lasts longer than August, wherein it first began; upon which account I have been induced to consider the excellent contrivance of nature for the production of epidemick diseases ; for though the same causes wholly remain, so that many should be seized with this disease as well in September as August, by reason of eating too much fruit, yet we see the same effect does not follow ; and he that shall carefully observe the phenomena of a legitimate cholera, will confess that that disease which invades at any other time of the year, though coming upon the same occasion, and accompanied with some of the same symptoms; is altogether different from this

profession, pretenders putting forth

,

spoken of, as if there were some secret and peculiar thing in the air of this peculiar month that impresses on the blood or on the ferment of the stomach some such specifick alteration as is fit only for the disease." In the year 1676 the cholera again visited London, and apparently with as much, or even greater violence than before, and attended with more violent spasms. In this he recommended the same method of treatment, but with a larger dose of laudanum. In a case attended by him and Dr. Goodall, when called to a patient just dying, by reason of the violence of the convulsions, in a cold sweat, with his pulse scarcely to be felt, and with violent vomiting, twenty-five drops of liquid laudanum were given for a dose, in a spoonful of cinnamon water, and the dose repeated in half an hour, and as the symptoms were apt to recur on the least motion, smaller doses were repeated at intervals : the case terminated favourably. From all this it will be seen that the epidemic now raging is by no means new in the annals of medicine, nor does its treatment seem to have been in such uncertainty two hundred years ago as at the present time. I am not now entering into the relative merits of the leading methods of treating the malady, but I feel satisfied that the laudanum treatment which proved successful in the hands of so practical a physician should not carelessly be set at now

naught.

I am somewhat supported in this view, since nearly every mode of treatment proposed admits more or less the use of some preparation of opium, and though perhaps in the collapsed state its sedativeeffect is not the one to be desired, I consider that its stimulant qualities have a peculiar power in sustaining the vital energies until other remedies have suf8cient time to act. I do not quite agree with Dr. Sydenham in his idea that true cholera terminates in the month in which it has made its commencement, neither that it is confined to August, since I have often seen fatal cases at other seasons of the year. Nor am I satisfied that opium alone can be found sufficient for the treatment of the disease ; but in considering it, the sedative power is not to be regarded as the only one it possesses. Upper Charlotte-street, Fitzrop-square,-Sept. !84g, REPORT OF A

BY

CASE OF SNAKE-BITE, AND RECOVERY. FRED. J. BEARDMORE, EsQ., M.R.C.S.E., Sydney,

New South Wales. ON the’7th of Dec. 1848, a young woman, aged about twenty, was walking in a garden on Milsom’s Point, and suddenly felt as if stung with needles in the back and lower part of the calf; but not seeing a snake, she was uncertain what to do, until swelling of the- leg and uneasy feelings caused her to send for medical aid, which arrived about eleven o’clock A.M., nearly two hours after the accident. On examining the part, a blue mark, like an old bruise, three inches long, curved downwards, and shaped like the forefinger, appeared; at the upper part of this mark might be seen, with close inspection, four to six very minute red spots. These spots (through which, doubtless, the venom had been conveyed) were cut out, with the adjacent skin, according to Dr. Bland’s method-a ligature was applied directly above the part, and the foot was immersed in hot water. Very free bleeding ensued. As the patient was getting very drowsy, ammonia, camphor, brandy, and small-doses of laudanum, were administered; the patient was kept roused, and a breast-pump applied to the wound, and caustic. Drowsiness increasing, at the request of some persons present an ipecacuanha poultice was applied. On the patient getting worse, mustard poultices were applied- successively down the back, and seemed to have considerable effect in keeping the patient awake; but in spite of stimulants and constant arousing, the drowsiness and the intervals of unconsciousness increased. The appearance of the patient was at this time (four hours after the accident) deplorable: a constant winking of the eyes, insensibility for three minutes together, waking for a moment to ask " Shall I get over it ?" then sinking lack apparently insensible; yet, when again aroused for a moment, she related with accuracy every circumstance connected with the accident, and said that she felt no pain. Her Christian name, as is usual, was most successful in calling forth an answer. Towards two o’clock, Dr. O’Brien, of Castlercaghstreet, arrived from Sydney; the stimulants, counter-irritation, &c., were continued. About this time, a flush appearing to pass over the face, eight or ten leeches were applied to the temple. At this time I left, but understood that, not long afterwards, the drowsiness began to abate, and at six o’cloek

289 the patient was sitting on a chair in the yard, evidently free I have also given calomel in grain doses in three other from the poisonous effects of the venom; and on applying a cases of less severity, every fifteen minutes, with simple bottle of hartshorn to her nostrils, she was instantly over- effervescing draughts every hour, containing two minims of powered, although a few hours previously it had no effect on tincture of opium; and in each case the vomiting and purging her when applied continuously. For two days she suffered have been arrested, as if under the influence of a charm. from sickness and uneasiness in the bowels, which were re- Two out of the three cases were salivated, though in one case lieved by a few doses of calomel, and senna and salts; on the only twenty grains were taken; in the other, fifteen grains. third day the wound began to be painful; diet ordered to be Biackburn, Sept. 1849. generous; poultice to the wound; adjacent part to be rubbed with stimulating embrocation, and a bandage from the toes to the wound, to prevent the matter from descending under the ON SYPHILIS. -skin; the blue mark still visible. J. BY C. CHRISTOPHERS, EsQ., M.R.C.S. London, &c. Remarks: If the snake is not seen, as in this case, a person (Continued from p. 39, vol. i.) may be bitten, and yet scarcely be aware of it. The venom of this snake acted like that which caused the death of Cleopatra-no pain; and the patient might have departed this life IF, by settling the question of the non-identity of the poisons in a sound though delusive sleep. " Bite" of a snake conveys of syphilis and gonorrhcoa, a moiety of victims at least were idea in many cases; blood is frequently not drawn, as wrested from the dominion of mercury, a large addition has ainwrong this case. As a powerful stimulant and exciter of the great been made to the number subsequently, through the researches by inoculation. spinal system, mustard poultices down the back will be found of M. Ricord, aided be It ought not to too much to say, that what vaccination one of the most important means of stimulating the nervous system, and will rank with the ligature, excision, and suction, has done for variola, inoculation may be made to do for as a certain remedial agent in all cases of depressed vital syphilis, and though not itself (as in the former case) the propower from venomous bites ! On talking over the accident phylactic, it has been the means to indicate it. Variola,under afterwards, our attention was directed to the blue mark, the influence of vaccination, is now well-nigh extinct, and which extended downwards towards the heel, and not up- were inoculation practised in every case of genital sore, and wards to the knee, as the current of blood towards the heart every sore that inoculation proves to be syphilitic excised would have led us to suppose; of course presuming that this and cauterized before the fifth day of its existence, the same mark was caused by the poison extending under the skin. remark might nearly apply to syphilis. The only cases reor concealed chancres, Why did the track of the venom extend downwards ?2 The maining would -be those of urethral lady of the house queried, was it the ligature, which was and cases of direct absorption, of which (the last mentioned) I applied immediately, and before the arrival of medical aid; have not seen an instance. The power to convert the germ of a loathsome, disgraceful, doubtless it was, and thus the current of the blood was constitutional disease into a changed from its direction to the heart, and vital centre, and contagious, and contaminating caused to retrograde towards the foot; and this affords ocular simple, harmless, local ulcer, easy to cure, and of short duradue to proof of the value of the ligature, in altering, at least tempo- tion, is no slender privilege, and honour and credit are of the blood. It appears to me that the distinguished surgeon whose acute perception detected rarily, the currenthave the means to rid mortality and its- offspring of a most potent some powerful controlling action on ipecacuanha may the local effects of the bite or sting, particularly when the curse. The next step that tended to infringe on the ancient heroic bite is unconnected with dangerous constitutional symptoms; but the idea that, locally applied, it can have any saving mercurial mode of treating syphilis is due to the introduceffect on real constitutional symptoms, seems to me pre- tion of iodine and its compounds in the treatment of secondary and tertiary symptoms; formerly, when, under the influence posterous. of mercury, those cases appeared to retrograde, or failed to North Shore, Sydney, Feb. 1849. ,

SUCCESSFUL TREATMENT OF CHOLERA BY SMALL AND REPEATED DOSES OF CALOMEL. BY JOHN

PICKOP, ESQ., M.R.C.S. &c., Blackburn.

I BEG to forward you the subjoined case, as proving the power and efficacy of calomel in subduing cholera in its worst form, when administered as recommended by Dr. Ayre. My patient, a fine, athletic young man, aged twenty-five, after a diarrhoea, which continued three days, was seized on the lst of September with every symptom of Asiatic cholera. I visited him at half-past twelve P.M. I found him in bed, complaining of severe pain in the bowels and legs; haggard expression of countenance; voice almost inaudible; pulse very feeble; cold, livid condition of the skin; extreme thirst, with incessant vomiting and purging of the peculiar rice-water evacuations. Treatment.—A grain of calomel every five minutes; simple effervescing draughts, with two minims of tincture of opium every hour; toast and barley-water ad libitum. Visited him three times betwixt then and nine P.M., to ensure the steady exhibition of the calomel, but found little change until that *’ hour. He was then warmer; pulse very feeble, but improving ; purging less severe; vomiting still urgent; no urine passed; voice better. Ordered a grain of calomel every fifteen minutes; draughts as before.

Sept. 2nd.-Eight A.M.: Considerable improvement; pulse quick, but fuller; has dozed at intervals during the night; perfectly warm; restless and very sick. Ordered one grain of calomel every hour, and one minim and a half of prussic very

acid every hour with the draught, instead of the tincture of opium; cantharides blister to the epigastrium.-Nine P.M.: Progressing favourably; sickness not so urgent. Omit the calomel; a draught every third hour (unless asleep). 3rd.-Nine A.M.: Slept a great part of the night; has passed urine twice for the first time, and had two bilious evacuations. After this, his recovery was so rapid and easy, that on the 5th he was removed in a gig to his own home-a distance five miles. Calomel taken, 140 grains; no ptyalism.

progress, the necessity toincrease the mercurial dose was thought to be imperatively indicated, in order (as it was imagined) that the antidote, so called, might keep pace with, and eventually outstrip, the disease. The notion that it might aggravate, and even that it might produce the symptoms it was given to cure, was of course rarely, if ever, eptertained; that fatal fallacy, simple treatment, happily, has unma&ked and it is now very generally admitted, that some of the worst cases of secondary and tertiary symptoms, that mercury was most largely employed to remedy, owed their severity and duration to its misuse. Sir Astley Cooper, however, in his lectures, page 519, exhibits some misgiving of this kind, and though a strenuous advocate for its employment in syphilis generally, observes, that " Mercury itself unfortunately produces diseases very similar, both in appearance and in effect, to syphilis." He continues : "II recollect at the commencement of my studies at these hospitals, one day, on going round the wards with a surgeon, having been very much surprised to see mercury so indiscriminately employed, and at seeing every poor emaciated wretch continually rubbing-in. There was one individual, I remember, in a dreadful state, who had been using mercury for a great length of time, and under which treatment he continued to get rather worse than better. In this case I took the liberty of suggesting the propriety of discontinuing it, when, in a short time, the patient became completely cured. Mercury, in reality, when given injudiciously, or to excess, will sometimes produce ulcers, that a man of little experience would say were venereal." Mercury, at the present time, in the hands of its best advocates, is rarely persevered in long after the primary sore is healed-never after the induration around it disappears. Secondary symptoms supervening, the patient having gone through a mercurial course, it is not by any means universally employed; but recourse is had, for the most part, to iodine, or to some of its preparations. The general effect of iodine appears to be to increase the secretions, and the first and a constant evidence of its influence is the occurrence of coryza, and congestion of the mucous membrane of the nose, eyes, and fauces, somewhat like that produced by small and repeated doses of arsenic. If it be administered while the gums under the influence of mercury, it will maintain that

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