The poison of Elaps corallinus, the Brazilian coral snake. N.O.Ophidia. Sub-order Colubridae. The fresh venom of the living snake is triturated with sugar of milk or diluted first with glycerine and later with alcohol.
PATHOGENESIS AND THERAPEUTICS.
THE conditions produced by the bite of this snake resemble in general terms those brought on by the bite of other colubrines. The bitten part and its vicinity become painful, swollen and discoloured. Bleeding takes place, not only at the site of the wound but from the various orifices of the body. Haemorrhages and discharges are characteristically very dark or even black. This colour and the bleeding from many mucous surface point to the extensive haemolysis which takes place. The article on lachesis should be read in conjunction with this one, as it is unnecessary to recapitulate the gross features of snake poisoning.
In contrast with lachesis, this venom seems to select the right side of the body for its chief attack, though the left side does not altogether escape. The following symptoms are right- sided: Buzzing and pain in ear; pain in the lungs, especially the right apex; swelling, redness and itching of right cheek, extending to the side of the nose; pains, felt most in right axilla; sensitiveness to touch of similar area; swelling and bluish colour of right leg and foot; hot red spots on right wrist; paralysed feeling of right hand; icy-cold feeling of right leg; red spots on right nostril.
The left side feels the influence of the poison in the left ear (loud noise, deafness and discharge); the eyelid (itching and styes); ulceration of left side of throat; rheumatic pains in left leg and foot. The lachesis symptom, pain on left side extending to the right, is repeated under elaps as regards the head.
The spasmodic or constrictive element is noticeable in some areas and functions as an elaps effects, but it is not so pronounced as in lachesis and naja. It is notice able in the throat, the abdomen (colic and twisting pain), the chest and the forearm; there are also anal spasm and strangury.
The elaps candidate is very sensitive to the cold and to wet weather, draughts and wind yet he cannot tolerate much covering.
Periodicity is to some extent present in these cases, shown by provers, and as an after-effect from bites. As regards febrile symptoms the chills tend to repeat themselves about mid-day and heat without sweat occurs in the afternoon and at night. Non-febrile flushes occur, especially in the head and chiefly in the evening “Hectic” fever results as a late symptoms from bites probably due to suppurative changes round the wound.
Mind.- The mind mental effect of elaps is to produce loss of memory and absent-mindedness. There is also as a further stage, apprehensiveness, the result of which is that the patient dreads to be alone lest some calamity may overtake him, although were it not for this fear he would prefer to be by himself and not to be spoken to.
Head.- Here the feeling of weight or pressure is frontal, but the sensation as if a heavy load or weight were pressing on a part is widespread. Pain in the occiput, especially right- sided, is present, and it is aggravated by stooping and by mental exertion; stooping causes giddiness.
Face.-The patient’s aspect is bloated and the eyes bleary; dark reddish areas and swelling are noticeable, especially on the right cheek. There is some photophobia and objects appear white even at night. Coryza is readily induced by draughts, and sudden epistaxis may come on while out walking. Digestive system.- Some digestive symptoms have already been mentioned; many of them are common to most cases of illness, but a few must be singles out as clinically (therapeutically) important. There is a cold feeling in the stomach and chest, fruit and cold drink feel icy cold. The pains and heaviness after food are relieved by walking about. The symptoms “fluids roll audibly into the stomach ” is recorded but its source is not stated. If genuine it should cause the remedy to be considered in cases of “leather-bottle stomach.”
Respiratory.- A few chest symptoms occur such as dry cough, with expectoration of dark blood-stained sputa; taste of blood before coughing; stitches in the chest, worse from breathing (like pleuritic pains).
A pain in the chest as if the lungs were being pulled apart is described in elaps cases. The various chest symptoms produced by the poison have led to its administration in the early stages of phthisis and much later when the case is complicated by infection with secondary organisms and mild septic symptoms or a hectic temperature.
Limbs.- Here coldness, cramps (calves), stiffness and paralysed feelings attract attention.
Skin.- Red pimples and itching with or without spots especially in the right axilla have been cured by elaps.
Sleep may be disturbed by headaches (shooting pains),and by dreams of the business of the day.
Fever of a low asthenic type (with passive haemorrhages, blackish discharges, as in some cases of typhus, enteric, phthisis, sepsis) calls for the consideration of elaps.
(1) Black colour of haemorrhages and discharges.
(2) Sensitiveness to cold, windy and wet weather.
(3) Food and drink feel icy cold in stomach.
(4) Food (especially fluid ) drops audibly into stomach.
(5) Noises in ears (right) as of thunder.
(6) Absence of mind followed by apprehensiveness and fear of being left alone in consequence.
(7) Different parts feel as if pressed upon by heavy weight on body.
(8) Periodicity of febrile and nerve phenomena.
(9) Useful for : Septic processes, lung affections, chronic post-nasal catarrh with ozaena, rash and itching of skin (axilla)
At night and early morning (some what similar to the lachesis indication worse after sleep) from the warmth of bed (skin); from wet and windy weather, from touch, going upstairs (dyspnoea), sitting still (stomach pain), swallowing, stooping and mental exertion.
From rest, walking (epistaxis and gastric pain), lying on the abdomen.