Including the poisons of the Lachesis trigonocephalus and Crot. horridus (rattlesnake). Venom preserved dry or in glycerine; low dilutions in glycerine and high in alcohol.
INTRODUCTION
THE chief snake poisons used therapeutically are those of Lachesis trigonocephalus (one of the lance heads), Crot. horridus (one to the rattlesnakes), naja tripudians (one of the cobras), and Elaps corallinus (the coral snake). The first two are Viperines, and the last two Colubrines. The following account of the gross effects of snake bites is condensed from the works of Calmette, Manson-Bahr, and Byam and Archibald.
All the vipers are venomous; their poisons differ from those of the colubrines in that they produce much more marked local symptoms than do the colubrine poisons, owing to the strong direct haemolytic action. Severe pain comes on at the site of the bite, free bleeding and thrombosis, followed, if not at once fatal, by local inflammation and sloughing, and even gangrene. Death may follow the bite from the following causes: (a) If a vein has been pierced, quickly from thrombosis; (b) after some hours from heart failure, through paralysis of the vasomotor centres; (c) after a few days from secondary bleeding; (d) later from septic infection of the necrotic area around the bite.
The colubrine snakes (except those of Australia) secrete a preponderance of neurotoxins, and the effects of these poisons will be referred to later.
The viperine poisons produce symptoms both local (immediate) and remote, and have many features in common, though the different species differ in degree of virulence and in quality in some of the finer points.
The effects depend upon the species, the dose, the condition of the snake and the resisting power of the victim. The venom is transmitted down the grooved or channelled fangs to the base of the wound and cannot be wiped off by clothing, as in the case of the rabies virus. The bite of vipers is followed at once by severe pain and is quickly succeeded by oedema, bloody serous discharge and ecchymoses in the vicinity of the bite.
Nausea, vomiting, and feeble, rapid, irregular pulse soon set in, leading to loss of consciousness and collapse. A distinguishing feature of the viperine poisons is that the pupils are dilated and insensitive from a very early period and throughout. (From the colubrine bites the pupils are contracted until asphyxia is well advanced.) The loss of consciousness may be temporary only. If the general (central) effect passes off, the area of the wound becomes serious; inflammation, bleeding (“oozing”) sloughing, malignant oedema and gangrene may supervene. Haemorrhages in distant parts also occur, shown by haematuria, melaen, epistaxis, &c. Tetanus may set in.
The bite of a rattlesnake (Crot.) is followed by general local manifestations than some of the other vipers. Swelling and purple discoloration of the limb follow, and may extend even to the trunk. Fever, with delirium and blood poisoning, sets in, followed by suppuration, haemorrhage or gangrene.
Treatment has a better change in viperine poisoning; to be effect it must be immediate. A ligature sufficiently tight to arrest circulation must be followed at once by local measures to destroy the injected venom. Strong solutions of permanganate of potassium do this; they should be used to swab the wound, or be injected, or the crystals be rubbed in, or thorough cauterization be carried out. Amputation of small parts performed at once is most effective; sucking the wound is useless. If the appropriate antivenin is at hand, it should be injected intravenously at once. Warmth, small doses of strychnine, or adrenalin may be useful.
A single case of poisoning (bite of a “copperhead” snake, Ancistrodron contortrix) gives a few extra general symptoms, as reported by an American doctor, who saw the case during an endemic of yellow fever. He saw the patient, a heavily built man of sanguine-lymphatic temperament, seven hours after the bite. He was “trembling all over,” had “rigors and hurried, laboured breathing; flushed face, eyes, eyes bloodshot and suffused with tears, great anxiety, voice tremulous, and breath cold, pulse 110-115, small, jerky, wiry.” He complained of pain over his heart and said he knew he would die. The heart’s action was tumultuous; “slight nausea, tenderness over epigastric region, intense headache, photophobia, severe aching a back and limbs, and tongue flat, spongy and with red edges were present….”
“The tissues” round the bites “were of a greenish hue, shading off into yellow at the edges.” The hand and arm up to the shoulder were considerably swollen. After several doses of aconite 2x, with heat applied externally, free perspiration occurred, bringing relief. Next day there was general stiffness and soreness, the heart was still painful, and a marked yellow tinge of the entire surface of the body, of the eyes and the tongue was present. (C.D.P., vol.3)
The provings of the snake poisons are too lengthy and detailed to be referred to in extenso. The salient symptoms of the leading spheres alone can be brought forward. For the rest the provings themselves or the elaborate schemata must be consulted.
The mental state reflects the primary and secondary effects of the venoms-the former being stimulative and the latter depressant; a few symptoms, perhaps, occupy the neutral zone. First is noted rapid flow of ideas and great mental activity; even excitability with an apparently prophetic intuition. there is great loquacity, especially in the evening; and rapid changing from one subject to another-a thought or a word diverting the mind into a new channel, so that with the over-activity there is associated instability, which may verge on incoherence; mistakes may be made in speaking and writing, and as to time and the order of events. A certain emotionalism may be present-ready laughter, or weeping from soothing poetry-or impatience, anger, or even rage, aroused by trifles, may be present. With onset of the second or depressed phase there may be evidence of weakened memory, lessened mental power, and a degree of inability to grasp an abstract subject and to understand what is said. Indifference, sadness, and to understand what is said. Indifference, sadness, and anxiety on waking are further features of the depressed state, coupled with fears, as of being poisoned, &c., and delusions that the patient is dead and preparing his funeral.
Pride, jealousy, ridiculous ideas, and mocking satire are other states of mind induced by the drug or found in diseased conditions for which it it is indicated.
Head.-Giddiness is a feature of snake poisoning and developed by experiment with the diluted venom. It occurs chiefly in the morning on waking, on raising the head from the pillow (bryonia), and comes on in momentary attacks on closing the eyes.
The lachesis headaches are chiefly unilateral, and they are predominantly left-sided, though not exclusively so, a throbbing headache over the right eye occasionally occurring. They are mainly of a hyperaemic character, being described as heat in certain areas, as flushing or “rush of blood” to the head. In addition to the unilateral type (which is most characteristic) there are pains from the vertex, concentrating at the “root” of the nose, or in the forehead over the eyes, or in the occiput extending down the neck and shoulders (here resembling the pains of kalmia). The head is heavy and can scarcely be raised from the pillow. Other sites affected are the temples and vertex; pains may extend from the one site to the other, from the forehead to one or both eyes, from the zygoma to the ear. There is a sensitiveness of the scalp and side of the face (“as if sunburnt”), or numbness and a sensation of crawling on the lest side of the head; the hair falls out, especially during pregnancy. Direct sunlight aggravates the headache-this feature should be borne in mind and also the left-sidedness. Motion, stooping and lying all tend to aggravate the headache; also waking from sleep, so that the patient fears to go to sleep again.
Circulatory System.-Full doses of venom cause rapid, feeble heart’s action, soon followed by collapse. Pain in the cardiac region soon comes on an is very persistent; it may by aching, or crampy and constrictive (as if grasped), with anxiety and tumultuous palpitation and laboured breathing. No pressure can be borne over the cardiac area. Headache (see that section) may be intense. The patient may feel, faint, either from the cardiac pain or the feeble, depressed action of the heart, or as part of the nausea complex; a suffocative feeling with the crampy pain may prevent lying down. Pain under the sternum and beneath the heart may be present.
Respiratory System.-Hoarseness, with rawness and dryness in the larynx, are present, and cause hawking and frequent swallowing (empty). Cough is induced by pressure on the larynx or touching the throat, and is worse after sleep. General oppression of breathing and suffocative attacks, necessitating taking deep breaths, are present in greater or less degree, and are probably of central origin. Indeed, many of the so-called respiratory symptoms of the larynx are of nervous origin. Such are: a sensitiveness to touch, a sudden sensation running from the throat to the larynx, on awaking from sleep, and apparently due to spasm of the glottis; a sensation of constriction of the throat- tight clothing or any constriction round the neck is irksome; aphonia, more from nervousness than catarrh. The patient wants to be fanned all the time, slowly and at a distance- he cannot bear anything near his face which appears to interfere with the supply of air.
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,