Volume 1

A dictionary of practical surgery: exhibiting the present state of the principles and practice of surgery ... comprehending also an account of the instruments, remedies and applications employed in surgery, and the etymology and signification of the principal terms / [Samuel Cooper].

Samuel Cooper

Date:: 1822

Credit: A dictionary of practical surgery: exhibiting the present state of the principles and practice of surgery ... comprehending also an account of the instruments, remedies and applications employed in surgery, and the etymology and signification of the principal terms / [Samuel Cooper]. Source: Wellcome Collection.

1201/1246 (page 1189)

$Fontana believes, that much of the faintness, &c. which ensues upon the bite of a viper, are the mere effects of terror. ‘* Upon a person’s being bit (says he) the fear of its proving fatal terrifies himself and the whole family. From the per- suasion of the disease being mortal, and that not a moment is to be lost, they apply violent or hurtful remedies. The fear increases the com- plaint. T have known a person, that was imper- ceptibly bit in the hands or feet, and who, after seeing the blood, ‘and, observing a viper near him, suddenly fainted away ; one, in particular, continued in a swoon for upwards of an hour, until he was accidentally observed, and reco- vered out of it by being suddenly drenched in cold water. We know, that death itself may be brought on by very violent affections of the mind, without any internal disease. Why may not people, that are bit, die from a disease, pro- duced entirely from fear, and who would not other- wise have died from any complaint produced by the venom?” Although it must be owned, that Fontana bestowed a great deal of attention upon this subject, the above reasoning is hypothetical and inconclusive. If it were to be granted, that some very timid, delicate, or nervous people, die from fear alone, it could not be admitted, that the generality of people, bit by snakes, perish also from the violent effect of mental alarm, Whenever the patient dies, the catastrophe is always ascribable to the quantity of venom in- serted in the wound; the number of bites; their situation near important organs ; and the neglect of proper means of relief. In ordinary eases of a single bite upon the extremities, the patients would get well even without any assist- ance; but the symptoms would probably be more severe, and the cure slower. From some facts, recorded by Sir Everard Home, and observations made on the operation of the poisons of the black spotted snake of St. Lu- cia, the cobra di Capello, and the rattle snake, it appears, that “ the effects of the bite of a snake vary according to the intensity of the poison. When the poison is very active, the local irri- tation is so sudden, and so violent, and its effects on the general system are so great, that death soon takes place. When the body ts afterwards 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 in- flamed. When the poison is less intense, the shock to the general system does not prove fatal. It brings on @ slight degree of delirium, and the puin'in the part bitten is very severe: in about half an hour, swelling takes place from an effusion of serum im the cellular membrane, which continues to increase, with greater or less rapidity, for about twelve hours, extending, du- ring that period, into the neighbourhood of the bite.. The blood ceases to flow in tie small vessels of the swollen parts ; the skin over them becomes quite cold; the action of the heart is so weak, that the pulse is scarcely perceptidle, and the stomach is so irritable that nothing és retained by it. In about sixty hours, these sym- ptoms go off; inflammation and suppuration take place in the injured parts ; aud when the abscess formed is very great, it proves fatal. 1189 When the bite has been in the firger, that part has immediately mortified. When death has taken place, under such circumstances, tke ab- sorbent vessels, and their glands, have wnder- gone no change, similar to the effects of morbid poisons, nor has any part lost its natural appear- ance, except those immediately connected with the abscess. In those patients, who recover with difficulty from the bite, the symptoms, pro- duced by it, go off more readily, and more com- pletely, than those produced by a morbid poison, which has been received into the system.”’ (Sir E. Home, Case of a Man who died in Conse- quence of the Bite of a Rattle Snake, in Phil. Trans. 1810.) Numerous remedies for the bites of common vipers have obtained celebrity. According to certain writers, each of these remedies has effected wonderful cures; and yet, as Boyer well remarks, every one of them has been in its turn relinquished for another, the sole recom- mendation of which has frequently consisted in its novelty. Any of these boastei medicines, though of opposite qualities, cured, or at least seemed to cure, the patients, and the part'sans of each considered, that he had a right to extol his own remedy as a specific, when the patient, to whom he administered it, was seen to recover perfectly, after suffering a train of severe sym- ptoms. But the reason of this pretended efficacy becomes obvious, when one knows that the bite of a viper is of itself rarely mortal to the human subject, and that the severity of the symptoms materially depends upon the quantity of the venom in the wound. (Boyer, Traité des Maladies Chir. T..\, p. 426+) The treatment of the bite of a viper is divided into local and genera] means. The local treatment has for its principal object the destruction of the venom ; the prevention of its entrance into the vessels, or the removal of it from the wound. Of scarifying the wound, I shall only say, a view of letting such dressings be applied, as are extolled as specifics; for, we now know, that there is no local application, which is en- titled to this character. Fontana was an adyo- cate for applying a ligature ronnd the limb, in order to check the ingress of the venom into the circulation; and he thought, that he had seep much good result from this practice. Sir Everard Home is also of opinion, that * the only rational local treatment, to prevent the secondary mis- chief, is making ligatures above the tumefied part, to compress the’cellular membrane, and set bounds to the swelling, which only spreads in the loose parts under the skin ; and searifying freely the parts already swoln, that the eftused serum may escape, and the matter be discharged as soon asit is formed. Ligatures (he says) are employed in America, but with a different view, viz. to prevent the poison being absorbed into the system.” (Phil. Trans. for 18.0, p. 87.) At all events, if compression be em- ployed, it should be ‘so regulated as not to create any risk of gangrenous mischief, by its interruption of the circulation. Suction of the wound has been proposed, and seems founded on reason; but experienee, I be- lieve, has determined little in its favour. A$