APPENDIX. 
173 
Severe pain in the bitten part ensued at once, and rapidly extended 
towards the trunk; a sense of intoxication followed by paralysis of 
the legs and of the muscles used in articulation, were the first 
constitutional symptoms, while the muscles of the arms and those 
concerned in moving the neck were scarcely, if at all, affected. 
The pupil retained the power of contracting after the legs were 
completely paralysed, and permanent dilatation only preceded death by 
a very short period. The poison exerted little or no depressing 
influence on the action of the heart. Viscid saliva flowed profusely 
from the mouth and almost choked the patients. The respirations, at 
first normal in character, became accelerated and then gradually 
slower and slower until complete asphyxia closed the scene. 
The condition of the internal organs after death also bore a strong 
resemblance to what is met with in the lower animals under similar 
circumstances, except that the blood did not coagulate on exposure to 
the air. 
The lungs and venous system generally were much congested, all 
the cavities of the heart were distended with blood, and if the two men 
had been deliberately strangled, the post-mortem appearances indicative 
of obstructed respiration could not have been more strikingly marked. 
(The heart has frequently been found more or less empty after 
death from Cobra bite, but this I believe to be due to post-mortem 
changes. In all such cases it will generally be found that the post¬ 
mortem examination was made a considerable time after death, or after 
the body had been carried some distance exposed to the heat of the 
sun.) 
With the exception of small quantities of brandy administered by 
the mouth, Professor Halford’s remedy—viz., the injection of liquor 
ammonite into the veins, was the only one resorted to, and it failed in 
both cases. The liquor ammonise was of the strength of the British 
Pharmacopoeia, and was procured from the Government Medical 
Depot at Allahabad. Before it was used about an inch and a half 
of the vein destined to receive it was laid bare, and I am quite 
certain that every drop in the syringe entered the circulation at each 
operation. 
In the case of the Punkah Cooly, it may be said that the remedy 
was used too late to be of any service, although resorted to within 
three-quarters of an hour after the infliction of the bite; but in the 
other case no such objection can be raised, for I had the advantage of 
being assisted by Dr. Ruttledge, and for a period of two hours before 
death had the instrument ready to administer the remedy in case 
of any failure in the circulation. As it was, fifty minims were injected 
into the basilic vein and twenty-five more into the heart itself, and 
I may here observe that the post-mortem examination showed that the 
point of the syringe had reached the cavity of the right ventricle. 
Why then, it may be asked, is Professor Halford’s remedy found to be 
efficacious in Australia and useless in India? 
Numerous instances have been recorded by our professional brethren 
in Australia where the application of the remedy was followed by 
almost instantaneous recovery, and it would be ungenerous to 
suppose that these gentlemen have attributed to it greater virtues than 
it actually possesses, or that they have misinterpreted the phenomena 
presented to them by the cases of snake-bite they have been called on 
to treat. 
The true explanation I conceive to lie in the fact, that the poison of 
the more common venomous snakes in Australia is essentially different 
in its nature and in the effects it produces on the system from that of 
the Cobra and Krait. 
In my letter to Government on this subject, dated 6th December, 
1871, and published in the supplement to the Gazette of India of the 
22nd February, 1873, I ventured to express an opinion, formed from 
experiments on the lower animals, that the Cobra caused death by 
apncea from paralysis of the muscles of respiration, and the two cases 
recorded above occurring in the human subject tend to confirm this 
view. How this result is produced has not yet been clearly demon¬ 
strated, but it is generally believed to be through the paralysing action 
of the poison on the medulla oblongata and spinal cord. From the 
former proceed the vagi nerves, which are known to play an important 
part in the process of respiration, while in the spinal cord originate 
the motor nerves which supply the diaphragm and the muscles of the 
chest. That the cerebrum is little affected is shown by the case of the 
grass-cutter, who remained perfectly conscious long after his legs were 
paralysed. Cobra poison indeed would seem to act in much the same 
way as conium, but with this difference ; that it does not appear to influ¬ 
ence the contractility of the voluntary muscles themselves. This I think 
may be inferred from the frequent spasmodic twitching that is noticed 
in the paralysed limbs after Cobra bite and from the complete rigor 
mortis. But however the obstruction of the respiration may be pro¬ 
duced, there can be little doubt, I think, that the venom of the Cobra 
is essentially a respiratory poison. On the other hand, its action on 
the heart is indirect and feeble. This organ in both the bitten men 
beat forcibly and without intermissions as long as the breathing re¬ 
mained unimpeded, after which its action became somewhat accelerated. 
But from beginning to end there was no sign of collapse, and the pul¬ 
sations of the heart both in man and the lower animals in such cases 
would seem always to continue for one or two minutes after respira¬ 
tion has ceased. If it be admitted then that the tendency to death 
! be by asphyxia, what good can possibly be effected by stimulating the 
! heart, which, Proiessor Halford says, is the first object to be obtained 
in the treatment of snake-bite ? 
With the Australian snakes the symptoms are very different. Here 
collapse is the most prominent feature, and paralysis of the voluntary 
muscles would seem never to be present except when accompanied with 
complete insensibility; from which it may be inferred that the cere¬ 
brum and sensory ganglia are chiefly influenced by the poison. 
Whether the insensibility is due to the action of the poison primarily 
on these ganglia, or to the failure of the circulation induced by the 
poison paralysing the muscular tissue of the heart either directly or 
through the sympathetic system of nerves, has not yet been proved, 
but from the almost miraculous manner in which patients recover after 
stimulation of the heart by Professor Halford’s method, it may be 
presumed that the latter is the correct view to take. 
But it is not the Australian snakes alone that kill in this way; the 
venom of the Rattlesnake ( Crotalus horridus) of America, like that of 
the Australian species, is also a cardiac poison, and if the reader should 
have any doubt on this point I would refer him to a recent number of the 
American Journal of Medical Science, vol. lxiii., where he will find a 
detailed account of two very interesting cases of bite by this reptile which 
occurred in the practice of Dr. E. A. Anderson of Wilmaughton, N.C. 
Allied to the Rattlesnake is the Indian genus Trimeresurus, the poison 
of which would also seem to act by depressing the action of the heart. 
While serving in Bhootan in 1865 a Sepoy of the 26th N.I., to which I 
| was then attached, was bitten by a small green grass snake (probably the 
Trimeresurus carinalus). At first merely local symptoms were observed, 
and it was. not till fully twenty minutes after the bite that the system got 
under the influence of the poison,which was indicated bycomplete collapse 
and partial insensibility, but there was no paralysis, no frothing at the 
mouth, no obstruction of the respiration, nor indeed any of the symptoms 
characteristic of the physiological action of Cobra poison. Nitric acid was 
applied freely to the bitten part, ammonia and brandy were adminis- 
teredbythe mouth,and thepatient recovered after being inrather a critical 
state for two or three hours. In this case it is probable that injection of 
| ammonia into the veins would have been attended with signal success, and 
would have produced speedier results than its administration by the 
mouth. 
It may be considered hasty to generalize upon somewhat insufficient 
data, yet it appears possible, even at this stage of our knowledge of the 
physiological action of snake-poison, to divide snakes into two distinct 
classes according to the manner in which the system is affected by 
their poison. 
The difference may be stated as follows :— 
First Class. 
Second Class. 
In which may be placed the Cobra, Krait, 
Daboia, and other Indian Snakes. 
Comprising the more common Australian 
poisonous snakes, the Battlesnakos and the 
Indian genus Trimeresurus. 
I. Paralysis of the lower extremities 
and of the muscles of articulation, a 
most prominent symptom. 
I. No paralysis, or occurring merely 
as an adventitious symptom. 
II. Heart’s action, regular or inter¬ 
mitting. Little diminution in the force 
of the pulsations. 
II. Failure of the heart’s action. 
III. Breathing obstructed by paralysis 
of the respiratory muscles. 
III. Respiration not impeded. 
IY. Consciousness retained for a long 
time after the development of the con¬ 
stitutional symptoms. 
IY. Consciousness more or less ob¬ 
literated from the first. 
Y. Sensory ganglia little affected. 
V. Function of the sensory ganglia 
perverted or obliterated. 
YI, Injection of ammonia into the 
veins, followed by no beneficial effect. 
VI. Patient recoverable by injection 
of ammonia into the veins, and adminis¬ 
tration of stimulants. 
Dr. Fayrer, recognising the tendency to death by asphyxia in cases 
of Cobra bite, has recently recommended artificial respiration, with a 
view to keep the patient alive until the poison can be eliminated from 
the system ; but although the interesting experiments of Mr. Richards 
tend to show that life may be prolonged for a few hours by this 
method of treatment, I fear it will never succeed when the quantity of 
poison that finds its way into the circulation is considerable. 
In all my experiments on the lower animals, artificial respiration 
carried on by alternately compressing and relaxing the chest, has 
been attended with no good result. In the case of the Punkah Cooly, 
who was effectively bitten by a large fresh snake, the patient was from 
the first hopelessly beyond the reach of any therapeutical agents with 
which we are at present acquainted, and I cannot but think that our 
best chance of discovering an antidote, lies in experimenting on tlie 
lower animals with those neurotic poisons which affect the nervous 
system differently from the venom of the Cobra. Possibly, wc may at 
least succeed in finding one directly antagonistic in its action. 
