The poison gland of snakes is the analogue of the parotid gland of mammals, both in position and structure. Its acini or alveoli are lined with a layer of secretory, columnar, finely granular cells and arranged with great regularity along the excretory duct, which is straight and cylindrical and opens with vipers into the hollow poison fang, with our colubrines into the groove on the anterior surface of it. Snake-poison, as it leaves this gland, is a thin, albuminoid, yellow liquid of neutral reaction. On exposure to the air it becomes viscid and slightly acid. Of its chemical composition we know as yet but little, and it is very questionable whether the most perfect chemical analysis of its constituents would ever have given us a clue to its action or will enrich our present knowledge of it. Like all albuminoid secreta it becomes putrid after prolonged exposure and then, through ammonia production, loses its acid, and assumes an alkaline reaction, still, however, though in a modified degree, retaining its toxic properties, which are completely lost only after an exposure of many months. Feoktistow found that freezing at 1° R. caused the poison to separate into a solid mass and a thin, very yellow The microscope has done good service in the investigation of snake-poison. It has, in the first place, informed us with absolute certainty that there are no micro-organisms or germs of any kind in the fresh poison immediately after it leaves the gland. But a still more important revelation we owe to it is the fact that these organisms, when we introduce them into a 2% solution of the poison, do not die, but live, multiply, and enjoy their existence most lustily, as they do in any other non-poisonous albuminoid liquid, whilst animals of a higher type—say a snail or a frog—soon perish in it. In watching the movements of the latter we find that they get slower and slower, and finally cease. We now follow up the interesting research, and take two frogs. Under the skin of one of them we inject a few drops of the poison solution, the other one for comparison we leave intact, and place both into a glass globe partly filled with water. In a very short time we have no difficulty to identify the poisoned frog. Its hind legs begin to drop and their movements become sluggish. This difficulty increases from minute to minute, until at last all motion ceases, and the legs hang down completely paralysed. At the same time we observe that the animal shows increasing difficulty of breathing, that, even when taken Two problems now present themselves for solution. In the first place we have to account for the fact of the snake-poison leaving the lower forms of animal life intact and being fatal to the higher ones. The symptoms we have observed in the frog point unmistakably to an affection of the nervous system as their cause. Now we know that the lower forms which the poison does not affect have no such system, and we are justified to infer that to the absence of this system they owe their immunity. This inference leads us on to a second one equally justifiable, namely, that there is a certain unaccountable attraction between the delicate nerve tissue and the subtle ophidian poison, which renders the latter a specific nerve poison. Our second problem is to ascertain the nature of the change in the nerves, to find out, if possible, whether it is merely functional or an actual interference with the structure of either cells or fibres. With this end in view we once more consult the microscope. We make two preparations, one of nerve fibres and of nerve cells of the poisoned frog, and, under the microscope, compare them carefully with an analogous one from the killed healthy frog. The result is purely negative as regards structural change. Both present identical and perfectly normal pictures of apparently The writer's theory as to the action of snake-poison, formed, in the first instance from observations made at the bedside of his patients only, is thus confirmed by experiments specially instituted by him for that purpose. Further proof of its correctness we have in the brilliant results of the strychnine treatment of snakebite in Australia, which is the outcome and practical application of this theory. In those desperate cases more especially, reported from all parts of the colonies, in which death was imminent, and pulse at wrists as well as respiration had already ceased, the strychnine injections could not possibly have effected complete recovery within a few hours if the structure of the nerve centres had been impaired or blood changes brought about incompatible with life. Feoktistow's experiments, made with viper poison, fully bear out the correctness of the writer's theory, besides proving that there is no essential difference between the action of the viperine and colubrine poisons. He proved conclusively that snake-poison does not destroy protoplasm or interfere with infusorial life, that injected into the heart of a mollusc it causes an almost immediate cessation of its action, that Action of Snake-Poison on Special Nerve Centres.It must be borne in mind that the symptoms as about to be detailed are successive only to some extent in the order presented. They commence generally at the lower part of the spinal cord, but immediately afterwards, if not simultaneously, are ushered in with great rapidity from other centres, masking each other and rendering it extremely difficult to observe and analyse them separately. They are also very variable through the poison concentrating its action on special centres, leaving others comparatively intact, and this not only when from different varieties of snakes, but also from snakes of the same variety. Another element increasing the difficulties of correct analysis are the depressing effects of fear, inseparable in all but the strongest minds from the consciousness of having been A.—Action on the Anterior Cornua of the Spinal Cord.The anterior cornua are almost invariably the first of the motor-centres attacked by the snake-poison, the affection (commencing with paresis and in serious cases generally culminating in paralysis) beginning in the lumbar ganglia and taking an upward course. The lower extremities feel unnaturally heavy and a paretic condition of the muscles supervenes simultaneously on both sides. The walk becomes unsteady and staggering, very similar to that of persons under the influence of large doses of alcohol. By a powerful effort of the will, however, persons in this condition are often able to walk and even run for some distance, especially if by prompt ligature the absorption of the poison has been checked. As the affection proceeds, though still able to move the legs in a sitting posture, they are unable to rise again. Ere long even sitting up becomes impossible and they collapse helplessly. At this stage sensation is still intact, and reflex action, by pricking the skin, &c., still takes place. The upper extremities generally retain the power of voluntary With birds, according to Feoktistow, the reverse is the case. The wings are usually first attacked, or paresis comes on in wings and legs at the same time. B.—Action on the Medulla Oblongata.a.—The Vaso-Motor Centre.Whilst the voluntary muscles are thus brought under the influence of the poison, symptoms denoting the invasion of the oblongata are rapidly developing. The first of these is the deadly pallor and ashy hue of the cold skin, evidently due to the blood receding from the surface, a condition not unlike that obtaining in extreme anÆmia. As persons in this state complain of an agonising feeling about the heart and of deadly faintness, a paretic condition of the heart suggests itself as the most obvious cause, more especially when taken in conjunction with the small, frequent, and compressible pulse. But though the heart muscle is no doubt participating in the general paresis, the condition of the surface of the body is in reality one of anÆmia. The blood, even at this early stage, begins to accumulate in the large veins of the abdomen, which expand gradually in consequence of the diminishing By a series of most interesting experiments Feoktistow has shown conclusively that snake-poison has the same effect on the abdominal circulation as section of the splanchnicus. Even slight intravenous injections of the poison produced quickly a high degree of paresis of the nerve and a corresponding engorgement of the veins of the abdomen, whilst after lethal doses, the paresis culminated in a few minutes in complete paralysis, followed by rapid collapse, excessive weakness of the bloodless heart, and death from paralysis of the latter and anÆmia of the nerve-centres. One experiment deserves special record, as it also shows the untenability of the blood-poison theory. The whole vascular system of an animal poisoned by intravenous injection was thoroughly washed out with the warm defibrinised blood of four animals of the same species, the blood being infused into an external jugular vein and allowed to flow out of a crural artery. Although blood exceeding its normal quantity was left in the animal, when the vessels named were closed, the nerve affection remained unchanged. The blood pressure raised during the infusion sank at once again to zero, when it ceased, The heart in vaso-motor paresis and paralysis is weakened in the first instance by the direct action of the poison on the medulla oblongata and the intracardiac ganglia. Its pulsations, at first retarded in frequency, become accelerated soon after the introduction of the poison, the pulse rate increasing rapidly and the waves becoming smaller and more easily compressible in proportion to the frequency of the pulse, which generally counts from 100 to 120 and more per minute at a comparatively early stage of the poisoning process. But an equally potent cause of heart failure is its depletion by the simultaneous stagnation of the blood mass in the veins of the abdomen. Finally, to complete the mischief, we have not only anÆmia of the semi-paralytic oblongata, but the scanty blood supply this important centre receives becomes also surcharged with carbonic acid. OxyhÆmaglobin disappears almost entirely from the blood under the circumstances detailed, as both pulmonary and internal respiration are greatly interfered with, the blood tending more and more towards that thin That under the powerful combination of causes, each of which is in itself sufficient to endanger life, and greatly intensified as paresis gradually deepens into paralysis, the heart, even of large animals, succumbs in a comparatively short time, may be readily understood. The blood-pressure, under the circumstances just detailed, must necessarily be nil. Observations by means of the sphygmograph at the bedside of a person suffering from snake-poison are scarcely feasible, except, perhaps, in a hospital, and thus far are not on record. We must, therefore, once more fall back on Feoktistow's experiments, which show that even the smallest doses (0.02 to 0.04 mllgr.) of the dried poison per kilo injected into the vein of a cat caused a fall in the blood-pressure almost immediately, without influencing either pulse or respiration, but that two to four mgr. were sufficient to reduce the blood-pressure to zero and bring on collapse, infusions of blood only raising it temporarily. Of drugs raising the blood-pressure he found ammonia the most effective, but only after slight doses of the poison; after lethal ones it had no effect whatever on the blood pressure but greatly increased the hÆmorrhagic process in all internal organs. This important observation should This leads the writer on to the discussion of this singular hÆmorrhagic process principally characteristic of viperine poisoning, and only very exceptionally produced by the poison of colubrines. It is among the symptoms of snakebite poisoning one of the most interesting ones, but also one most difficult of explanation. There can be no doubt that it is produced by vaso-motor paresis and paralysis. We further know that it is preceded by dilatation of the capillaries and small veins, and that it is effected principally through the process known as diapedesis, or the passage of both red and white corpuscles with plasma through the unruptured capillary membrane, and even the thin one of small veins, which is nearly of the same structure, being composed of endothelial cells united by cement. This membrane possesses a certain degree of porosity, which is probably increased by dilatation. In the absence of plain muscular fibres contraction and dilatation of the capillaries can only be effected by a corresponding contraction and expansion of the nuclei of the endothelial cells. As fibrils derived from non-medullated nerves terminate in small end-butts in connection with the capillary membrane, we may assume that the nuclei of the endothelial cells are under the sway of vaso-motor nerve currents, that weak ones will expand, strong ones contract them. We may further assume that the red and white The special preference which the viper-poison has for the vaso-motor sphere will hereafter be referred to. HÆmorrhages from Australian snake-poison are comparatively rare. Even at the bitten place there is as a rule very little swelling and effusion and frequently none at all. When it occurs it quickly disappears after b.—The Respiratory Centre.Paresis of this centre does not play as important a part here as it does in India, more especially after cobra-bite. The peculiar, and as yet unexplained, tendency of snake-poison to act with special virulence Feoktistow records the following observations on cats with reference to the respiratory centre:—Small intravenous injections of the fresh poison (0.07-0.13 mllgr.) produced a great increase in frequency of respirations (280-360 per minute). Section of both vagi at once reduced this frequency, from which he infers that small doses act as an irritant to the respiratory centre. When small doses were repeated several times, the respiratory movements were gradually retarded, and asphyxia set in through paralysis of the centre. Large doses produced this effect at once, without any previous acceleration. Very large ones C.—Action on Centres of Cranial Nerves.Among the symptoms denoting paresis of motor-centres of cranial nerves, together with sympathetic ganglia, the first and most noteworthy is the early dilatation of the pupil. This truly pathognomic condition is never absent, and becomes intense when paresis becomes intensified into paralysis. The most glaring light, in immediate proximity to the eyeball, has then no effect whatever on the pupil. If it remains dilated after strychnine injections have restored consciousness and the power to walk, it is a sure sign that the snake-poison is not completely counteracted, and will in all probability re-assert itself, necessitating another injection, whilst a pupil restored to its normal condition justifies the conclusion that the patient is safe. Another symptom denoting paresis of the cranial nerve-centres is a marked change in the expression of the face. The features become relaxed, and lose their Deglutition, somewhat difficult in paresis, is completely suspended in the paralytic stage, through paralysis of the soft palate, the pharynx, and oesophagus. Liquids forced on the patient in this extremity may partly flow down the oesophagus, but will also enter the larynx, and their administration should be carefully avoided. D. Action on motor-centres of Cerebellum and Basal Ganglia.Of this action little if anything is patent to observation. A certain want of co-ordination in the movements has been noticed in the early stage of paresis, and the peculiar staggering walk of persons in this stage is probably owing to an affection of the motor-centres of the cerebellum. That they do not escape the action of the subtle poison, when symptoms denoting the invasion of all the other motor-centres E. Action of the Motor Cortical Centres of the Cerebrum.In all but the very lightest cases of snakebite-poisoning there are always symptoms manifested that cannot be referred to any other cause than an invasion of the centres now under consideration. They range from mere stupor, confusion of thought and delirium to the deepest coma, with complete extinction of consciousness and insensibility to all external impressions. Coma is a frequent and in serious cases an almost invariable symptom in Australia. After the bite of our death adder only we find persons sometimes collapse and expire suddenly, when still conscious and able to answer questions rationally. Coma invariably develops from sleep. It is, in fact, sleep intensified. An almost irresistible desire to sleep is one of the first symptoms to be observed. If the dose of poison imparted by the snake has been small, the desire may pass off or the sleep may not assume the form of coma, but in all The phenomena of sleep and coma as the result of a poison acting as a depressant of motor nerve force afford food for some interesting speculations, which, however, as more concerning the psychologist, the writer can only glance at here. It is evident that in the highest of psycho-motor centres, the organs of thought and of consciousness, the paresis of the lower centres assumes the form of sleep, and paralysis that of coma. Sleep, as a partial, and coma, as a complete, obliteration of thought and consciousness must, therefore, be intimately connected with motor nerve function, sleep being a reduction, coma a suppression of the function, or a suspension of thought. Ideation, to use J. S. Mill's very appropriate term for the thought process, appears to be effected by motor nerve currents or, at all events, to be accompanied by them and suspended with their suspension. The thinking F. Action on Sensory Centres and the Reflexes.The sensory sphere remains comparatively unaffected in mild cases, and in the early stages of more serious ones, but when paresis has deepened into paralysis, sensation becomes ever more blunted, and with the advent of coma, of course, quite extinct. Reflexes, both superficial and deep ones, are also completely abolished at this period of the poisoning process, and the nerves of special sense do not react against any, even the strongest possible stimulation. The eye stares vacantly into a glaring light held close before it, and the widely dilated pupil shows no sign of reaction. The ear also appears deaf to any noise, and strong ammonia vapour is inhaled through the nose Feoktistow's experiments with regard to reflexes, more especially their restoration by strychnine, differ in their results entirely from Australian observations. Whilst we have no difficulty in restoring them with the drug on man as well as the domestic animals, his experiments on frogs were a failure, and merely showed a decided antagonism between the two poisons. He did not succeed in restoring the reflexes, and, instead of following up with experiments on the higher animals, he trusted implicitly to his results on frogs, and thus lost his opportunity. G. Irregularities in the Action of Snake-poison.There is in the whole range of toxicology not a single condition known to us in which the symptoms, both in chronological order and in their strength and relation to each other, show as much variety as those of snake-poison. Experienced observers will agree with the writer that it is but rarely we find two cases of snakebite exactly alike in the symptoms they present. Some of these puzzling variations have already been alluded to, but it is necessary to consider them a little more in detail. Apart from quantitative differences in the poison imparted, they arise principally from the strange capriciousness with which the poison The nearest approach to regularity and orderly sequence of the symptoms, as described in the foregoing pages, we find in Australia after the bite of the tiger snake (Hoplocephalus curtus) and the brown snake (Diemenia superciliosa), more especially that of Queensland. Here we can trace the action of the poison distinctly from centre to centre, from the lowest part of the anterior cornua up to the cortex cerebri, and even throughout the sympathetic ganglia as far as they are patent to observation. The poison of these snakes is extremely diffusible and quickly absorbed. It spreads with rapidity and nearly equal force over all the motor centres, the symptoms following each other so quickly as almost to appear simultaneous, though, in reality, successive. But even the poison of these snakes leaves the arms only slightly paretic, when paralysis in all the other voluntary muscles is well pronounced, and does not paralyse them until coma has set in. It also touches the respiratory centre but slightly. Sometimes coma is light and the patients can be roused for a little while, at other times it is deep and lasts till death. But even greater variations are observed occasionally. In one very extraordinary case of tiger snakebite, the patient, a child of 9 years, remained conscious to the last, and after vomiting blood freely died under symptoms of heart failure. In rare cases the symptoms resemble those of cobra poison. This approach is still closer in the poison of the death adder (Acantophis antarctica). There is generally much extravasation of blood locally. Muscular paralysis is also less pronounced, but sudden collapse from vaso-motor paralysis not unfrequently takes place, when the patients fully conscious are still able to sit up. That leading feature of viper poison, diapedesis with hÆmorrhage, does not occur with either. It is quite impossible for us with our present scanty knowledge to account for these peculiarities and irregularities in the action of a poison, which we know now to accomplish its destruction of animal life by one uniform design and principle of action. That the protean forms under which the poison-symptoms present themselves are one and all the result of reduction and suspension of motor nerve currents may now be accepted as a well proven and fully established scientific fact. But why the effects of one and the same cause are so varying in their appearance, why the poison of different varieties of snakes, and even that of the same variety under different circumstances, make such a capricious selection among the various motor nerve-centres we can not explain and probably never will. Chemical analysis of the dead poison, no matter how minutely and elaborately it may be effected, will probably never throw much light on the "why" of this strange puzzle, for the subtle phenomena of life are apt to elude the grasp of the analyst. We have to |