Considering the newness of the strychnine treatment it would be folly to expect that the conditions necessary to insure success should have been observed in every case, and that every practitioner should at once have made himself familiar with it and the theory on which it is founded. Hence a few failures were unavoidable. Of these a record has been kept, but for obvious reasons the writer withholds it here. To give names and dates would be invidious, though the opponents of the treatment have exultingly pointed to the few deaths that have occurred as palpable proofs of its uselessness, some of them even going so far as to ascribe these deaths to the direct action of the antidote. There is, however, not a single case on record, in which death took place under strychnine-convulsions. All the patients died under palpable symptoms of snakebite-poisoning. As these symptoms have now been proven beyond all doubt to yield to strychnine, when properly administered, the inference that it was not so administered in the cases referred to becomes not only justifiable, but unavoidable. In one case only, that of a child of tender years, blood was vomited so copiously that death may be ascribed to that cause and the snake-poison combined, but in all the other six fatal ones, mostly of children, it was undoubtedly due to the snake-poison not being properly checked by the antidote. The gentlemen who officiated on these occasions were evidently not Banerjees, but the very reverse of their Indian confrÈre. They do not appear to have had very clear ideas of the absolute antagonism existing between the two poisons, and entirely disregarded the most important point in the treatment, namely, the necessity of administering the antidote until it has completely subdued the snake poison, regardless of the quantity that may be required for that purpose. In a few instances the treatment was correct enough at first, but when, as is often the case, a relapse took place after the patient had apparently recovered, the large quantity of the antidote already administered appears to have given rise to the erroneous notion that it would be useless to resort to it a second time, and thus, through this error and the fear of strychnine-convulsions, the patients were allowed to die. In most of the six fatal cases collected by the writer, however, the doses and total quantities given were altogether inadequate to cope with the poison. They did probably more harm than good, for the snake-poison when only partially checked by strychnine seems to renew its onslaught on the nerve-cells even more insidiously than when not interfered with at all. Convulsions also, as shown in cases, are sometimes called forth by this timid use of the antidote.

A few instances will show the correctness of these observations. Thus an old woman sleeping in a shed is awakened at daylight by a tiger snake having fastened on to her wrist. She pulls off the snake, alarms the neighbours, and a doctor, living only a mile away from the place, is sent for. He appears on the scene four hours afterwards, when complete coma and collapse has set in, makes two injections of gr. 1/15 each, which of course had no effect and the patient is allowed to die without any further effort on the part of her medical attendant. Case 2.—A boy of 10 years is admitted to a N. S. Wales hospital in a state of complete collapse, barely alive, having been bitten by a brown snake 22 hours before admission. Instead of a rousing injection of at least 15 minims and the same or smaller ones repeated at short intervals, he receives only 5 minims of liq. strychniÆ P.B. every twenty minutes, when death was imminent, and dies 65 minutes after admission. Case 3 is also that of a boy in an hospital. He is admitted fully conscious and apparently but slightly under the influence of snake-poison, for a five minims injection is reported to have removed the symptoms. On the following day, however, he became comatose, and instead of having the antidote freely administered, gets only one more injection of five minims and dies in coma. Case 4 is even worse. A little girl of 3 years, bitten by a tiger snake, receives three minim injections every half-hour, and after three of them, whilst in a state of complete coma, gets convulsions. These are attributed to the strychnine, which thereupon is withheld, the finale being death in coma.There can be no doubt that in all these cases life could have been preserved under a more energetic treatment. Hereafter, when theory and treatment are better understood, and when officialdom has seen fit to issue instructions as to the proper treatment of snakebite to medical practitioners, such cases as those cited will be put down as malpractice and have to be accounted for. Until then the guardians of the health and the lives of her Majesty's subjects, and a certain portion of the medical press of Australia, superciliously and persistently ignoring the subject, are more responsible for the lives lost than the busy country practitioner, who may not have had time or opportunity to inform himself thoroughly on a comparatively new subject, more especially at a period when Banerjee had not yet taught us that in administering strychnine as antidote to snake-poison we can venture into grains of it with impunity.

Since the above chapters were put in proof, the writer has seen a fatal case of tiger snake bite, conveying two lessons of such interest and importance that it must be placed on record here. It illustrates in an extraordinary and forcible degree the erratic, capricious, and insidious course the snake-poison takes at times.

A handsome girl of 17 is bitten in a bathroom on the back of the second right toe at dusk on a Sunday evening by a half-grown tiger snake, subsequently caught and killed in the room. She does not suspect snakebite, and no ligature is applied until the poison has been absorbed and overpowers her. Instead of sinking into coma, she becomes unconscious for a short time only. Her brain then clears itself, and all symptoms seem to disappear so completely that when a medical man of undoubted ability and skill sees her a few hours after the bite, she declares herself quite well again, and does not appear to require any treatment, least of all that by strychnine injections. She passes a good night, but on Monday morning symptoms denoting paresis of the respiratory and glosso-pharyngeal centres make their appearance, almost identical with those described by Indian writers as following cobra-bite. She has difficulty in breathing and swallowing, but one injection of 1/10th of a grain removes it completely and speedily, and once more all danger is thought to be past. On Monday evening, however, dyspnoea and dysphagia appear again in an aggravated form. The urine also becomes scanty and loaded with albuminates. Strychnine now is again resorted to, but it fails to act as before, and from hour to hour the young lady's condition becomes more critical. When the writer reached her on Tuesday afternoon, 42 hours after the bite, paralysis of the centres named was imminent, and her case appeared a hopeless one, unless a vigorous use of strychnine yet turned the scales in her favour. One-tenth grain doses were therefore injected every half-hour, and continued until the physiological action of the drug showed itself. This took place, but failed to have the least effect on the affected centres; and complete paralysis ensued 45 hours after the infliction of the fatal bite.

The first lesson the Australian practitioner should learn from this sad case is that of extreme care and caution in dealing with any case of snakebite, no matter how slight it may appear at first sight. It is not for the first time we have been taught this lesson, though it has rarely, if ever, been conveyed in so singular a manner. Recent utterances about the innocuousness of Australian snake-poison find a fitting answer in this melancholy occurrence.

The second lesson it conveys is a new one, even to the writer. From the fact of one strychnine injection removing all poison-symptoms early on Monday, but the free use of the antidote failing entirely to have this effect on Monday night and on Tuesday, we are warranted to draw the conclusion that the antidote can only be relied on within the first 24 hours after the bite; and that, after this period, the snake-poison produces organic changes in the affected nerve-cells, preventing their depressed functional activity from being restored by the antidote. Further observations, of course, are required to confirm these conclusions. Their correctness, however, appears to be borne out by the fact observed by the writer, that the larger domestic animals, who sometimes linger on for days after being bitten by a snake, usually recover under the strychnine treatment if it is applied immediately or soon after a bite, but die when found and treated in an advanced stage of the malady.That the grave kidney complication, checking the elimination of the poison from the system, militated against recovery in this case, and greatly influenced the singular course of the poisoning process, cannot be doubted.