116 PHYSIOLOGY AND TOXICOLOGY 



The last argument against stimulants used by Dr. Brainard, is tlio fact that 

 intoxicated persons Lave died from Crotalus bite. He states that he has authentic 

 infonnatiou as to four such cases. Now it is plain, as I have urged, that deep 

 drunkenness is not the condition which we desire, and it is most probable that a 

 person who was in this state would be overcome by the venom with more than 

 common facility, as indeed may be inferred from Dr. Brainard's statement. If, 

 however, the cases which he refers to were only somewhat intoxicated when bitten, 

 it would be very requisite to know whether or not any means were taken to sus- 

 tain the stimulation, without which the primai'y state of excitement would very 

 soon disappear before the terrible depression caused by the poison. 



The remaining instance of death from a bite given to an intoxicated man is the 

 case of Adam Lake, reported by Dr. Horner. The particulars are as follows: 

 The patient was in the habit of drinking daily from ha:lf a pint to one pint of 

 alcoholic liquors, and, as was seen at the autopsy, was constitutionally the worse 

 for this habit. When somewhat intoxicated, he was bitten at the bend of the arm, 

 both fangs entering. Some time, I presume at least two or three hours, passed by 

 before he sought aid, and during this period so little effect was produced that he paid 

 no attention to the wound until the itching annoyed him. From this time he was 

 under treatment, the arm rapidly swelling and becoming painful. Now, Crotalus 

 poison may produce but slight local effects, but when it is in such amount as finally 

 to kill, it does not long delay the exhibition of its influence on the system. Yet in 

 this person, who did afterwards die, some time evidently elapsed without any con- 

 stitutional expression of poisoning. Was this reprieve due to the partial intoxica- 

 tion of the sufferer? Whatever answer we may give, it is quite clear that this 

 was no case to quote against the use of stimulants, since, in addition to what I have 

 urged, we learn yet further that with the exception of a little ammonia and two 

 half-ounce doses of sp. vin. dilut., used late in the malady, he took no stimulants, 

 and that no regular effort was made to sustain or renew the primary stimulation, 

 which, at first, had so guarded his .system. 



It sometimes happens that the physician finds it impossible to produce stimula- 

 tion in the presence of so potent a sedative as the venom. When this is the case, 

 it is possible that absorption does not occur with sufficient rapidity, or at all events, 

 that cases may occur, where it is necessary to stimulate fully and suddenly. 



Under these circumstances I would recommend luliakdion of the fames of ivann 

 uJcu/tol, or even of ether if used witJt catUioii. 



While advocating the employment of stimuli as rational therapeutic means of 

 meeting a most obvious indication, it is proper to admit that cases have been and 

 will be encountered, in which the dose of venom has^een so great, that no remedy 

 is of any avail. Such, however, must be rare, and it is on the whole more than 

 probable that the danger from the bite of the Eattlesnake has been over-estimated, 

 and that in a large majority of cases the patient would recover, oven if unassisted 

 by any remedy. 



Where stimidants are of any use, the patient commonly recovers without further 

 diilicidty. In some cases, however, which attain to the stage of alteration in the 

 blood, we have to deal with conditions which are also present in other cases of 



