Mental Condition.-The fear of death and anxiety associated with snake bite may sometimes be purely psychological. It has been absent where the pain of the bite was believed to be due to the scratch of a cat, and has been present where the injury was believed to be a snake bite and was not. Sadness and dwelling on death (while awake) are induced. Inability to collect thoughts or pursue a train of thought; making mistakes in spelling (in a good speller), thinking of the proper letter or word and writing a wrong one; dull and stupid feeling and faulty “perception” (or judgment,) “in crossing a street would have been run over but for watchfulness of sister,” and loss of memory,”could not remember what she had gone into shop to buy.” These were experiences of healthy experimenters. They form valuable clinical guides in mild crotalus cases. Provers and patients develop a weepy mood-are easily moved to tears during conversations, &c.
In fevers the delirium is predominantly of a low type, mumbling, incoherent speech, going on to stupor; movements slow and hesitating.
Head.-The crotalus headaches vary a little. The head feels too large, feel full to bursting. Waves of pain come and on recur; they are liable to be brought on by moving, such as turning over or rising up in bed or any changing of position, or by a jar. A sudden disabling pain, as if struck on the back of the head with a hammer, is a well-known characteristic head pain of crotalus, valuable as a clinical indication. Rest relieves the headaches. The head feels so heavy that the muscles seem too weak to hold it up, and it requires the support of the hand. The headaches are usually worse in the morning, except pains centering in the orbits, which are usually worse in the evening. The morning headaches soon go off after moving about. A frontal headache is common, worse after each meal. Vertigo is a frequent occurrence: it comes in sudden attacks, on the slightest movement.
Eyes.-Crot. causes yellowness of the conjunctiva, and is used to clear up keratitis and iritis.
The face looks puffy, livid, bloated, stupid or mottled, after snake bites, and these features characterize many cases of low toxaemic disorders requiring crotalus; if the disease has come on suddenly, as in choleraic diarrhoea, a haggard expression, with the body bathed in cold perspiration, would be an item in favour of crotalus. Sneezing and nasal catarrh come on without any special characteristics. Epistaxis is common, especially in diphtheria and whooping cough.
The digestive symptoms may be merged in the toxic picture in febrile and septic cases. Burning thirst with inability to swallow what has been taken is an example of this.
In slighter cases, thirst, retching, a faint sinking or hungry feeling in the epigastrium, with trembling and weakness, may be present. The same intolerance of constriction and of clothing round the waist in common to crotalus and lachesis. Attempts at walking are liable to bring on the retching.
Swelling of the abdomen, with pain and tenderness on pressure, when combined with the toxic symptoms have led to its successful use in peritonitis.
If an icteric tinge is present this would confirm the selection of the drug. Lying on the right side in hepatic cases is liable to bring on vomiting of a bilious nature (“dark green vomiting”) or of “coffee-grounds” when crotalus is indicated.
Diarrhoea, of offensive, watery, dark stools may occur from some forms of poisoning, as from high game. If blood is passed as such it is dark and does not coagulate. In toxic cases the evacuations will frequently be involuntary. In catarrhal jaundice with toxic features the stools would be white.
A rather striking symptom, noticed first in a teetotaller and repeatedly verified, is intense craving for alcohol, especially for urine. In some cases of delirium tremens in broken-down subjects crotalus may be called for, and this feature would confirm its selection. Apart from delirium tremens, chronic alcoholism may require this remedy.
Circulatory and Respiratory Systems.-Aphonia and trembling where the patient has been weakened by illness, acute or chronic, ex. gr., diarrhoea, is found in the milder crotalus cases, with quickened compressible pulse. Palpitation, with a feeling as if the heart turned over, may accompany almost any stage of illness requiring this remedy. A spasmodic cough, with cardiac embarrassment, blue face, epistaxis and great weakness has led to the use of crotalus in whooping-cough. In toxic cases, bronchitis, pleurisy, and pneumonia, with puffed face, lividity, haemoptysis of dark thin blood or bloody mucus, form part of the crotalus complex. The chest pains are mostly left-sided, and if the right lung be affected there may be hepatic symptoms and some jaundice. The venom has caused and may be indicated in pericarditis with effusion.
Urinary System.-The urine, especially in fever, contains albumin and is smoky from transuded blood, or when the liver is attacked it may be green-yellow from the pressure of bile.
Sexual Sphere.-Crot. is not much used for disorders of the reproductive system unless associated with other symptoms also requiring its use. It would be indicated if there were excessive and premature menstruation, preceded by weight in the head and by pains before the flow, extending from the hypogastrium and back down the thighs. The flow is likely to be intermittent, and may be accompanied by pain in the region of the heart, palpitation and cold feet. In men there may be pain in the glans, diurnal sexual excitement but actual impotence.
The pains of crotalus remit and recur with great frequency; pain in one part may alternate rapidly with pain in another, or with other symptoms. Except as regards headache, the pains have a tendency to appear and disappear somewhat suddenly.
THERAPEUTIC SUMMARY.
Dr. J. W. Hayward, by whom crotalus was made prominent as a remedy in this country, summarizes its uses as follows: (1) In septic and zymotic diseases it plays a large and important part, ex. gr., in typhus, diphtheria, enteric, malignant smallpox and malignant scarlet fever. While he was himself experimenting with the drug he affected a dramatic cure in the last-named disease in a member of his own family. (2) In yellow fever, in South America and the southern U.S.A. States, it has been regarded as the prime remedy, especially where the haemorrhagic features are prominent. The diluted venom has been injected as a prophylactic.
Recalling the vomitings, purgings and cramps, with the cold surface and shrunken countenances, Dr. Hayward suggests its use in “malignant cholera.”
For acute tubular nephritis, the characteristic urinary conditions with general Oedema, somnolency and convulsions suggest the drug.
The symptoms of acute alcoholism and delirium tremens are sometimes fairly well reproduced in crotalus poisoning.
Tetanic features are also represented in the pathogenesis, and in the Medical Times and Gazette of 1874 it was recommended for hydrophobia (by “inoculation”).
Chorea, epilepsy convulsions (exanthematic and puerperal), haemorrhages, malignant jaundice, hysteria, neuralgia, “dropsy,” and other conditions are mentioned by Hayward as calling for the consideration of this remedy.
Altogether the viper poisons must rank among our most important polychrest remedies.
LEADING INDICATIONS.
(1) Consult those of lachesis.
(2) Note that its right-sided symptoms are more numerous than its left.
(3) Note that the “empty swallowing” difficulty (lach.) is replaced in crotalus by difficulty in swallowing solids.
(4) Intense flushings at the menopause with heavy perspiration.
(5) Skin cold and dry; boils, carbuncles, vesicles, pemphigus, with blue or mottled surrounds, peliosis rheumatica.
(6) Haemolytic and septic conditions, with dark, thin blood from many orifices and surfaces.
(7) Dissecting wounds, bites of insects, scorpions, &c.
(8) Cellulitis, sloughing, gangrene; anthrax; carbuncle.
AGGRAVATIONS:
Lying on right side (vomiting), cold air (throat and respiratory), morning and waking, constrictive clothing, right side (many symptoms), after a meal (frontal headache), touch and pressure.
AMELIORATION:
Rest (headache).
Edwin Awdas Neatby founded the Missionary School of Homeopathy and the London Homeopathic Hospital in 1903, and run by the British Homeopathic Association. He died in East Grinstead, Sussex, on the 1st December 1933. Edwin Awdas Neatby wrote The place of operation in the treatment of uterine fibroids, Modern developments in medicine, Pleural effusions in children, Manual of Homoeo Therapeutics,