III. The Case of a Man, who died in consequence of the Bite of a Rattle-snake; with an Account of the Effects produced by the Poison. By Everard Home, Esq. F.R.S.

Read December 21, 1809.

OPPORTUNITIES of tracing the symptoms produced by the bite of poisonous snakes, and ascertaining the local effects on the human body when the bite proves fatal, are of such rare occurrence, that no well described case of this kind, is to be met with in any of the records that I have examined. I am therefore induced to lay before this Society the following account, with the view of elucidating this subject, in which the interests of humanity are so deeply concerned.

THOMAS SOPER, 26 years of age, of a spare habit, on the 17th of October 1809, went into the room in which two healthy rattle snakes, brought from America in the preceding summer, were exhibited. He teized one of them with the end of a foot rule, but could not induce the snake to bite it, and on the rule dropping out of his hand, he opened the door of the cage to take it out; the snake immediately darted at the hand, and bit it twice in succession, making two wounds on the back part of the first phalanx of the thumb, and two on the side of the second joint of the fore finger. The snake is between 4 and 5 feet long, and when much irritated bites the object twice, which I believe snakes do not usually do.

The bite took place at half past two o'clock. He went

immediately to Mr. HANBURY, a chemist in the neighbourhood. There was at that time no swelling on the hand, and the man was so incoherent in his language and behaviour, that Mr. HANBURY Considered him to be in a state of intoxication, and gave him a dose of jalap to take off the effects of the liquor, and made some slight application to the bites. It appeared on enquiry, that the man had been drinking, but that before he was bitten, there was nothing unusual in his behaviour. After leaving Mr. HANBURY the hand began to swell, which alarmed him, and he went to St. George's hospital. He arrived there at three o'clock. The wristband of his shirt had been unloosed, and the swelling had extended half way up the forearm before his admission. The skin on the back of his hand was very tense, and the part very painful. At four o'clock the swelling extended to the elbow, and at half past four it had reached half way up the arm, and the pain had extended to the axilla. At this time Mr. BRODIE, who visited him in my absence, first saw him; he found the skin cold; the man's answers were incoherent: his pulse beat 100 strokes in a minute, and he complained of sickness. Forty drops of aqua ammoniæ puræ, and thirty drops of spiritus ætheris vitriolici in an ounce of mistura camphorata, were given to him, but did not remain on his stomach. The wounds were bathed with the aqua ammoniæ puræ, and the arm and forearm had compresses wetted with camphorated spirits applied to them. At five o'clock he took two drams of spiritus ammoniæ compositus, and go drops of æther, in an ounce and a half of mistura camphorata, which remained on his stomach. At six o'clock his pulse was stronger; at half past seven his pulse was very feeble, and go drops of æther, and the same

quantity of aqua ammoniæ puræ were given in water. At half past eight it was repeated. At nine o'clock he had the feeling of great depression, his skin was cold, his pulse weak, beating 80 strokes in a minute. The dose was increased to fifty drops of both medicines, and repeated. At a quarter past ten o'clock the pain had become very violent in the arm: his pulse was stronger, but fits of faintness attack him every fifteen minutes, in which the pulse was not perceptible, but in the interval his spirits were less depressed. In the course of the evening he had two stools. At half past eleven o'clock I first saw him. The hand, wrist, forearm, and arm were much swelled up to the top of the shoulder, and into the axilla. The arm was quite cold, and no pulse could be felt in any part, not even in the axilla, the swelling preventing me from feeling the axillary artery with any degree of accuracy. The wounds made on the thumb were just perceptible; those on the finger were very distinct. His skin generally was unusually cold. I took some pains to diminish his alarm of danger, and found his mind perfectly collected: he said he hoped he should recover. At one o'clock in the morning of the 18th, he talked indistinctly: his pulse beat 100 in a minute; the attacks of faintness came on occasionally. The medicine was repeated every hour.

At eight o'clock in the morning of the 18th, his pulse beat 132 strokes in a minute, and was very feeble. The swelling had not extended beyond the shoulder to the neck, but there was a fulness down the side, and blood was extravasated under the skin as low as the loins, giving the back on the right side a mottled appearance. The whole arm and hand was cold, but painful when pressed; the skin was very tense; on

the inside of the arm below the axilla, and near the elbow, vesications had formed; and under each of the vesications there was a red spot in the cutis, of the size of a crown piece. The skin generally over the body had become warm. He was low and depressed; there was a tremulous motion of his lips, and the faintings recurred at nearly the same intervals as in the preceding evening. The last dose of medicine was rejected by vomiting, but some warm wine remained on his stomach. The arm was fomented. At twelve o'clock, in addition to the above symptoms, there was a starting of his limbs. He had attempted to take some broth, but his stomach did not retain it. The skin of the whole arm had a livid appearance, similar to what is met with in a dead body, when putrefaction has begun to take place, unlike anything which I had ever seen in so large a portion of the living body. An obscure fluctuation was felt under the skin of the outside of the wrist and forearm, which induced me to make a puncture with a lancet, but only a small portion of a serous fluid was discharged. My colleague, Dr. NEVINSON, was present at this visit, and we agreed to continue the internal use of the volatile alkali, with the view of rousing the stomach to action, not considering it as having any specific power over the poison. At eleven o'clock in the evening, finding that his stomach did not always retain the medicines, nor even small quantities of brandy, which were given him, I directed the volatile alkali to be left off, and two grains of opium to be given, and repeated every four hours. At this time his pulse was scarcely perceptible at the wrist, the fainting fits were not less frequent. The vesications and red spots were increased in size.

October 19. At nine o'clock in the morning his pulse was