Oldalképek
PDF
ePub

IX.

III. The Case of a Man, who died in consequence of the Bite of a Rattlesnake; with an Account of the Effects produced by the Poison. By EVERARD HOME, Esq.

F. R. S.*

OPPORTUNITIES of tracing the symptoms produced Well described

bites of snakes

by the bite of poisonous snakes, and ascertaining the local cases of fatal effects on the human body when the bite proves fatal, are very rare. 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.

a rattlesnake.

Thomas Soper, 26 years of age, of a spare habit, on the Man bitten by 17th of October 1809, went into the room in which two healthy rattlesnakes, 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 The snake bit two wounds on the back part of the first phalanx of the twice. 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 suakes do not usually do.

The bite took place at half past two o'clock. He went Effects of the immediately to Mr. Hanbury, a chemist in the neighbour- bite. hood. 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 inquiry, that the man had been drinking; but that, before he was bitten, there was nothing Abridged from the Phil. Trans. for 1810, p. 75.

unusual

Fffects of the unusual in his behaviour. After leaving Mr. Hanbury the bite 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 fore-arm 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,

At 9 o'clock he had the feeling of great depression, his skin was cold, and his pulse weak, beating 60 strokes in a minute. At a quarter after 10 the pain had become very violent in the arm: his pulse was stranger, but fits of faintpess attacked him every fifteen minutes, in which the pulse was not perceptible; yet in the interval his spirits were less depressed. At half after 11 the hand and arm were much swelled, up to the top of the shoulder, and into the armpit. The arm was quite cold, and no pulse could be felt, even in the armpit, where the swelling was such as to prevent the artery from being accurately distinguished. The wounds made on the thumb were just perceptible; those on the finger were very distinct. His skin in general was unusually cold.

In the morning of the 18th his pulse beat 132 strokes ip a minute, and was very feeble. The swelling had not extended upward 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 of the arm and hand was cold, but painful when pressed; the skin was very tense; on the inside of the arm vesications had formed below the armpit and near the elbow, and under each of the blisters was a red spot of the size of a crown, The skin generally over the body had become warm. At noon the skin of the whole had a livid appearance, similar to what is met with in a dead body, when putrefaction has begun to take place,

arm

unlike any thing I had ever seen in so large a portion of the Effects of the living body. An obscure fluctuation was felt under the bite,

skin of the outside of the wrist and forearm, which induced me to make a puncture with a lancet, but only a small por tion of a serous fluid was discharged.

On the 19th his pulse was scarcely perceptible: his ext tremities were cold: the vesications were larger, the size of the arm was diminished, and he had sensation in it down to his fingers.

On the 21st the size of the arm was farther reduced, but the skin was extremely tender.

On the 22d the right side of the back, down to the loins, was inflamed and painful; and had a very mottled appears ance from the extravasated blood under the skin.

On the 23d the vesications had burst. On the 26th the arm was more swelled and inflamed. The inflammation increased; and on the 28th a slough had begun to separute from the inside of the arm below the armpit. On the 29th a large abscess had formed on the outside of the elbow, which was opened, and half a pint of reddish brown matter was discharged with sloughs of cellular membrane floating in it. The lower part of the arm became much smaller, but the upper part continued tense.

On the 30th the redness and swelling of the upper part of the arm had subsided. On the 31st the discharge from the abscess had diminished. On the 1st of November ulceration had taken place on the opening of the abscess, so that it was much increased in size. The next day this ulcera tion had spread to the extent of two or three inches; and mortification had come on in the skin nearer the armpit. On the 3d the mortification had spread considerably; and the fore finger, which had mortified, was removed at the second joint. And on the 4th of November he died at half after four o'clock in the afternoon.

on di section.

Sixteen hours after death, the body was examined by Appearance Mr. Brodie and myself, in the presence of Mr. Maynard, the house surgeon, and several of the pupils of the hospital.

With the exception of the right arm, which had been

bittens

Appearances bitten, the body had the natural appearance. The skin on dissection. was clear and white; and the muscles contracted.

The wounds made by the fangs at the base of the thumb were healed, but the puncture made by the lancet at the back of the wrist was still open. That part of the back of the hand, which immediately surrounded the wounds made by the fangs, for the extent of 1 inch in every direction, as also the whole of the palm, was in a natural state, except that there was a small quantity of extravasated blood in the cellular membrane. The orifice of the abscess was enlarged, so as to form a sore on the outside of the arm, elbow, and forearm, near six inches in length. Around this, the skin was in a state of mortification, more than half way up the outside of the arm, and as far downwards, on the outside of the forearm. The skin still adhered to the biceps flexor muscle in the arm, and flexor muscles in the forearm, by a dark coloured cellular membrane. Every where else in the arm and forearm, from the axilla downward, the skin was separated from the muscles, and between these parts there was a dark coloured fluid, with an offensive smell, and sloughs of cellular membrane resembling wet tow, floating in it. The muscles had their natural appearance every where, except on the surface, which was next the abscess. Beyond the limits of the abscess, blood was extravasated in the cellular membrane; and this appearance was observable on the right side of the back as far as the loins, and on the right side of the chest over the serratus major anticus muscle.

In the thorax the lungs had their natural appearance. The exterior part of the loose fold of the pericardium, where it is exposed on elevating the sternum, was dry, resembling a dried bladder. The cavity of the pericardium contained half an ounce of serous fluid, which had a frothy appearance, from an admixture of bubbles of air. On cutting into the aorta, a small quantity of blood escaped, which had a similar appearance. The cavities of the heart contained coagulated blood.

In the abdomen, the cardiac portion of the stomach was moderately distended with fluid: the pyloric portion was

much

on dissection.

much contracted; the internal membrane had its vessels Appearances very turgid with blood. The intestines and liver had a healthy appearance, The gall bladder was moderately full of healthy bile. The lacteals and the thoracic duct were empty; they had a natural appearance.

In the cranium the vessels of the pia mater and brain were turgid with blood; the ventricles contained rather more water than is usual, and water was effused into the cells, connecting the pia mater and tunica arachnoides. It is to be observed, that these appearances in the brain and its membranes are very frequently found in cases of acute diseases, which terminate fatally.

Mr. Home then adds two cases, that were sent from India to the late Dr. Patrick Russell, which correspond in many of the circumstances with the preceding; and an experiment he made formerly in the island of St. Lucia on the effects of the poison of a snake on two rats. The first case is that of a boy, who was bitten by a snake, called kamnlee by the natives, in the lower part of the arm, at 8 o'clock in the evening. The blood flowed very freely for some time. He died next day at noon in great pain.

The second is that of a sepoy, 60 years of age, bitten on the back part of the hand by a cobra di capello. He recovered, though slowly.

The paper concludes with the following observations.

It appears from the facts, which have been stated, that Effects of the the effects of the bite of a snake vary according to the inten- bites of snakes sity of the poison.

different.

active.

When the poison is very active, the local irritation is so When the sudden and so violent, and its effects on the general system poison is very are so great, that death soon takes place. When the body is afterward inspected, the only alteration of structure met with is in the parts close to the bite, where the cellular membrane is completely destroyed, and the neighbouring muscles very considerably inflamed.

When the poison is less intense, the shock to the general When less so. system does not prove fatal. It brings on a slight degree of delirium, and the pain in the part bitten is very severe: in about half an hour, swelling takes place from an effusion of serum in the cellular membrane, which continues to in

crease

« ElőzőTovább »