Including the poisons of the Lachesis trigonocephalus and Crot. horridus (rattlesnake). Venom preserved dry or in glycerine; low dilutions in glycerine and high in alcohol.
THE chief snake poisons used therapeutically are those of Lachesis trigonocephalus (one of the lance heads), Crot. horridus (one to the rattlesnakes), naja tripudians (one of the cobras), and Elaps corallinus (the coral snake). The first two are Viperines, and the last two Colubrines. The following account of the gross effects of snake bites is condensed from the works of Calmette, Manson-Bahr, and Byam and Archibald.
All the vipers are venomous; their poisons differ from those of the colubrines in that they produce much more marked local symptoms than do the colubrine poisons, owing to the strong direct haemolytic action. Severe pain comes on at the site of the bite, free bleeding and thrombosis, followed, if not at once fatal, by local inflammation and sloughing, and even gangrene. Death may follow the bite from the following causes: (a) If a vein has been pierced, quickly from thrombosis; (b) after some hours from heart failure, through paralysis of the vasomotor centres; (c) after a few days from secondary bleeding; (d) later from septic infection of the necrotic area around the bite.
The colubrine snakes (except those of Australia) secrete a preponderance of neurotoxins, and the effects of these poisons will be referred to later.
The viperine poisons produce symptoms both local (immediate) and remote, and have many features in common, though the different species differ in degree of virulence and in quality in some of the finer points.
The effects depend upon the species, the dose, the condition of the snake and the resisting power of the victim. The venom is transmitted down the grooved or channelled fangs to the base of the wound and cannot be wiped off by clothing, as in the case of the rabies virus. The bite of vipers is followed at once by severe pain and is quickly succeeded by oedema, bloody serous discharge and ecchymoses in the vicinity of the bite.
Nausea, vomiting, and feeble, rapid, irregular pulse soon set in, leading to loss of consciousness and collapse. A distinguishing feature of the viperine poisons is that the pupils are dilated and insensitive from a very early period and throughout. (From the colubrine bites the pupils are contracted until asphyxia is well advanced.) The loss of consciousness may be temporary only. If the general (central) effect passes off, the area of the wound becomes serious; inflammation, bleeding (“oozing”) sloughing, malignant oedema and gangrene may supervene. Haemorrhages in distant parts also occur, shown by haematuria, melaen, epistaxis, &c. Tetanus may set in.
The bite of a rattlesnake (Crot.) is followed by general local manifestations than some of the other vipers. Swelling and purple discoloration of the limb follow, and may extend even to the trunk. Fever, with delirium and blood poisoning, sets in, followed by suppuration, haemorrhage or gangrene.
Treatment has a better change in viperine poisoning; to be effect it must be immediate. A ligature sufficiently tight to arrest circulation must be followed at once by local measures to destroy the injected venom. Strong solutions of permanganate of potassium do this; they should be used to swab the wound, or be injected, or the crystals be rubbed in, or thorough cauterization be carried out. Amputation of small parts performed at once is most effective; sucking the wound is useless. If the appropriate antivenin is at hand, it should be injected intravenously at once. Warmth, small doses of strychnine, or adrenalin may be useful.
A single case of poisoning (bite of a “copperhead” snake, Ancistrodron contortrix) gives a few extra general symptoms, as reported by an American doctor, who saw the case during an endemic of yellow fever. He saw the patient, a heavily built man of sanguine-lymphatic temperament, seven hours after the bite. He was “trembling all over,” had “rigors and hurried, laboured breathing; flushed face, eyes, eyes bloodshot and suffused with tears, great anxiety, voice tremulous, and breath cold, pulse 110-115, small, jerky, wiry.” He complained of pain over his heart and said he knew he would die. The heart’s action was tumultuous; “slight nausea, tenderness over epigastric region, intense headache, photophobia, severe aching a back and limbs, and tongue flat, spongy and with red edges were present….”
“The tissues” round the bites “were of a greenish hue, shading off into yellow at the edges.” The hand and arm up to the shoulder were considerably swollen. After several doses of aconite 2x, with heat applied externally, free perspiration occurred, bringing relief. Next day there was general stiffness and soreness, the heart was still painful, and a marked yellow tinge of the entire surface of the body, of the eyes and the tongue was present. (C.D.P., vol.3)
The provings of the snake poisons are too lengthy and detailed to be referred to in extenso. The salient symptoms of the leading spheres alone can be brought forward. For the rest the provings themselves or the elaborate schemata must be consulted.
The mental state reflects the primary and secondary effects of the venoms-the former being stimulative and the latter depressant; a few symptoms, perhaps, occupy the neutral zone. First is noted rapid flow of ideas and great mental activity; even excitability with an apparently prophetic intuition. there is great loquacity, especially in the evening; and rapid changing from one subject to another-a thought or a word diverting the mind into a new channel, so that with the over-activity there is associated instability, which may verge on incoherence; mistakes may be made in speaking and writing, and as to time and the order of events. A certain emotionalism may be present-ready laughter, or weeping from soothing poetry-or impatience, anger, or even rage, aroused by trifles, may be present. With onset of the second or depressed phase there may be evidence of weakened memory, lessened mental power, and a degree of inability to grasp an abstract subject and to understand what is said. Indifference, sadness, and to understand what is said. Indifference, sadness, and anxiety on waking are further features of the depressed state, coupled with fears, as of being poisoned, &c., and delusions that the patient is dead and preparing his funeral.
Pride, jealousy, ridiculous ideas, and mocking satire are other states of mind induced by the drug or found in diseased conditions for which it it is indicated.
Head.-Giddiness is a feature of snake poisoning and developed by experiment with the diluted venom. It occurs chiefly in the morning on waking, on raising the head from the pillow (bryonia), and comes on in momentary attacks on closing the eyes.
The lachesis headaches are chiefly unilateral, and they are predominantly left-sided, though not exclusively so, a throbbing headache over the right eye occasionally occurring. They are mainly of a hyperaemic character, being described as heat in certain areas, as flushing or “rush of blood” to the head. In addition to the unilateral type (which is most characteristic) there are pains from the vertex, concentrating at the “root” of the nose, or in the forehead over the eyes, or in the occiput extending down the neck and shoulders (here resembling the pains of kalmia). The head is heavy and can scarcely be raised from the pillow. Other sites affected are the temples and vertex; pains may extend from the one site to the other, from the forehead to one or both eyes, from the zygoma to the ear. There is a sensitiveness of the scalp and side of the face (“as if sunburnt”), or numbness and a sensation of crawling on the lest side of the head; the hair falls out, especially during pregnancy. Direct sunlight aggravates the headache-this feature should be borne in mind and also the left-sidedness. Motion, stooping and lying all tend to aggravate the headache; also waking from sleep, so that the patient fears to go to sleep again.
Circulatory System.-Full doses of venom cause rapid, feeble heart’s action, soon followed by collapse. Pain in the cardiac region soon comes on an is very persistent; it may by aching, or crampy and constrictive (as if grasped), with anxiety and tumultuous palpitation and laboured breathing. No pressure can be borne over the cardiac area. Headache (see that section) may be intense. The patient may feel, faint, either from the cardiac pain or the feeble, depressed action of the heart, or as part of the nausea complex; a suffocative feeling with the crampy pain may prevent lying down. Pain under the sternum and beneath the heart may be present.
Respiratory System.-Hoarseness, with rawness and dryness in the larynx, are present, and cause hawking and frequent swallowing (empty). Cough is induced by pressure on the larynx or touching the throat, and is worse after sleep. General oppression of breathing and suffocative attacks, necessitating taking deep breaths, are present in greater or less degree, and are probably of central origin. Indeed, many of the so-called respiratory symptoms of the larynx are of nervous origin. Such are: a sensitiveness to touch, a sudden sensation running from the throat to the larynx, on awaking from sleep, and apparently due to spasm of the glottis; a sensation of constriction of the throat- tight clothing or any constriction round the neck is irksome; aphonia, more from nervousness than catarrh. The patient wants to be fanned all the time, slowly and at a distance- he cannot bear anything near his face which appears to interfere with the supply of air.
After the suffocative attacks quantities of ropy mucus may be brought up.
Generalities.-The intolerance of constriction, or pressure of clothing mentioned above, is found in other regions-round the waist, round the limbs, &c. It is in part a physical feeling, as in the neck, where it indicates respiratory embarrassment, and partly nervous, ex. gr. in limbs.
There is general weakness, physical and mental, felt most in the morning. Associated with weakness there may be trembling and jerking of the whole body; or alternatively, bodily restlessness and tossing about in acute cases; or in chronic cases this may be replaced by a busy, hurried feeling-the patient must do everything as quickly as possible and talks all the time.
A general desire for open air, as adding to the sense of well-being, or as an expression of air hunger in a mild degree, is found in lachesis cases. In the latter sense anything which may be supposed to interfere with free access of air is irksome- the proximity of objects or of people. This may be the interpretation of the symptom “wants to be fanned at a distance.”
Lachesis appears to affect predominantly the left side; ailments may be limited to the left, or begin on the left and pass across to the right.
Sensitiveness to extremes of cold and heat is a lachesis feature, with a preponderance in the direction of aversion and aggravation from heat, especially from exposure to the direct rays of the sun.
The lachesis patient is not a good sleeper; he is specially wide awake in the evening; sleep, when it comes, is apt to be restless and disturbed by dreams. They may be of an amorous nature or may be a repetition of any worries on the patient’s mind, which are accentuated during the dream and wake him in a fright. Most of the symptoms are aggravated on first waking. Instead of the patient being strengthened and refreshed by sleep, his maladies all seem worse. Patients wake confused and unable to recognize their surroundings, wonder where they are, &c.
Urinary System.-Frequent micturition is caused by lachesis, and the urine may have a strong odour; straining is sometimes induced. The haemolytic effect of snake poisons is shown in this region by the presence of dark or blackish urine, which froths when first passed; examination shows that it contains albumin and decomposing blood.
Generative System.-Similarly the menstrual blood is dark and unusually offensive, the flow is usually scanty, and is accompanied by labour-like (uterine intermittent) pain or by sharp, cutting pains in the abdomen, chiefly in the left ovarian region, passing over to the right side. The abdomen is sensitive nose. The fauces partake of the purplish colour noticed elsewhere, and the cervical glands swell. The neck and throat are sensitive to touch, to the pressure (or even the presence) of clothing.
So pressure, or to the weight of the bed-clothes. The onset of flow relieves these pains.
Skin.-The cutaneous lesions of lachesis appear to be due to or secondary to the haemic disorganization.
Petechiae, ecchymoses and their attendant discolorations, and erythema and oedema are fairly definite. During the septic stages, after a viper bite, old scars may break down. When recovery is taking place, in milder cases, a general icteric tint, apparently of haematic origin, is commonly present.
Digestive System.-Mouth.-Toothache and neuralgia, left-sided from jaw to ear are present, and the tongue is dry and black.
Throat.-The throat feels swollen inside; it is described as if a lump or a crumb were there, requiring to be swallowed; or as if two lumps were blocking up the fauces, but there is little real swelling. The discomfort or pain on deglutition is more on swallowing liquids than solids, and most on empty swallowing; fluids, especially if warm, are liable to cause choking, and to return through the nose. The fauces partake of the purplish colour noticed elsewhere, and the cervical glands swell. The neck and throat are sensitive to touch, to the pressure (or even the presence) of clothing.
Stomach.-The appetite may be increased, but not necessarily; thirst may be insatiable in febrile conditions, with dry tongue and skin. An ordinary meal may be followed by a sense of repletion, but when the stomach is becoming empty a gnawing sensation may come on, relieved by eating. A craving for oysters is said to accompany some Lachesis cases, and is not due to a liking for the acid dressings of these mollusks, for there is aversion from sour things. There may be abdominal distention and severe cutting pains on the right side. Symptoms indicative of peritonitis are found in some cases of poisoning- pain, sensitiveness to touch and all pressure, nausea, vomiting, distention amounting to tympanites, with attendant lessened abdominal respiratory movements.
The state of the bowels varies; there may be a watery offensive diarrhoea, containing altered blood and, in severe and septic cases, loss of control of sphincters; in less severe illnesses, offensive, soft, yellow stools occur. In chronic cases a form of constipation is likely to be present-loss of expulsive desire and power, and voluntary straining may be necessary. Throbbing in the anus and prolapsus rickety after stool occur; also pain from anal spasm grasping the prolapsed mucosa.
Limbs.-Weakness of limbs and pain in left arm and leg are occasionally felt.
The Face.-The complexion varies with the stage of the illness; it may be flushed, swollen and purplish or pale and grey during collapse.
The foregoing description of the powers of viperine poisons would suffice to indicate their usefulness in the treatment of a large number of diseased conditions. As remedies they are, however, so important that a review of their curative powers, though involving a certain amount of repetition, is worth while. This is especially the case because clinical experience has shown that they are very valuable therapeutic agents in certain conditions which are but dimly foreshadowed in the pathogenesis.
The great blood-disintegrating (haemolytic) powers of lachesis and crotalus are utilized in a number of febrile, septic, toxic and typhus-like conditions, present in many named diseases, and in some forms called “malignant” exanthems, where the body resistance has more or less completely broken down. When this point is attained the distinguishing or diagnostic features of the particular diseases have largely disappeared. As Professor Teale, in a lecture before the British Homoeopathic Society, explained: “Widely different bacteria may produce very similar clinical features… When profound poisoning occurs, instead of the poisoning becoming more it becomes less characteristic and clinically is seen to be in the typhoid state.”
T.F. Allen’s “Handbook of Materia Medica and Homoeopathic Therapeutics” gives under Crot. (p. 433) so good a general description of these conditions that it is worth quoting with one or two slight alternations. The description is clinical, and is dated 1889, and refers primarily to the U.S.A. “Crot. is, “he says, “extremely valuable in fevers of a malignant type, especially malignant scarlet fever, and in all fevers which, present a haemorrhagic or putrescent (septic) character.” There are present “great weakness, tremulousness, torpor, unconsciousness, efforts to vomit anything taken into the stomach; when vomiting, blood oozes from the gangrenous fauces; the respiration is sighing and intermittent; epistaxis and extreme prostration are present, and the tonsils and fauces are dark red and tumid.” Similarly it is valuable in measles, with a dark confluent eruption, oedema of face, stupor, &c. Malignant subtertian malaria cases, “bilious” remittent fevers and low types of fevers generally call for crotalus: “the tongue is dry, cracked, brown in the centre and deep red at the edges, the stools are pasty and black” (and offensive), ” the urine is dark and scanty,” drowsiness, lapsing into unconsciousness, prostration, yellow colour of face and skin, gnawing aching pain in liver and sometimes hepatization of base of right lung are present.
An American doctor called to a case of snake bite while attending yellow fever cases was struck by the clinical resemblance of those cases to that due to the bite of the viper (see page 578). Crot. is “the most homoeopathic remedy for yellow fever, with symptoms of blood-poisoning,” vertigo, “as if falling over a precipice”; pain all over the body and tenderness of the liver, or with swollen parotids, nose-bleed, dusky face, hands nearly black; yellow skin; dark, involuntary and bloody offensive stools; black, scanty or suppressed urine (haematuria) and haematemesis. (Modified quotation end here.)
The present writer, recently reading some cases of infectious jaundice (spirochaetosis ictero-haemorrhagica) in the British Medical Journal, was struck with their great resemblance to the provings of viper poisons. Crot. has indeed been recommended for that disease, and for the similar spirochaetal “seven-day fever”-with what results we cannot say. It is,however, known that crotalus and lachesis stand very high as therapeutic agents in the treatment of some of these fevers-notably yellow fever, plague, bad subtertian fevers, and black-water fever before anuria has set in. In many cases it is impossible for want of time, lack of apparatus or skill, to diagnose the parasitic cause, but where the clinical symptom-complex of drug and disease corresponds, the indication is clear and sure even without the microscope.
Stages of enteric and typhus also require lachesis or crotalus. Diphtheria, too, sometimes requires lachesis, especially when it begins on the left side, associated with the spasmodic (constructive) symptoms of faucial and laryngeal origin, with the sensitiveness of throat and larynx to touch or pressure of hand or clothing. Prostration and heavy bluish-red flush on face (indicating commencing carbon-dioxide poisoning, whether from respiratory on obstruction or destruction of red blood-cells), with aggravation during sleep and on waking, are essential indications. For post-diphtherial laryngeal paralysis, palatal paralysis, laryngitis, spasmodic cough, pertussis with toxic symptoms waking patient from sleep, some low forms bronchitis and pneumonia, and for cough of reflex origin (of pelvic or abdominal source), lachesis will require study, and if the lachesis diagnostic symptoms be present in the patient it will not cause disappointment unless his responsive reaction be already exhausted.
Mental States.-The mind symptoms of the drug are chiefly valuable in guiding to its selection in chronic and neurotic cases, but they may point to its used in a few cases of actual alienation where the symptoms are not part of a name disease. Delusions of being away from home, of robbers being in the house from which the patient feels he must escape: mental disturbance with great loquacity or muttering delirium during fevers, religions melancholy, and extreme unfounded jealousy, frequently point to lachesis. The religious aberration may take the form of self-accusation of misdeeds of which the sufferer is innocent; of a desire to confess imaginary crimes amounting to mental torture if the opportunity does not present itself; of the feeling of being unpardonably wicked, Suspicion of being poisoned or of plots to murder him or her may possess the mind. Delusions of being somebody else or of being under the control of superhuman powers may be present; these powers seem to be commanding the patient to kill or steal, Fears of insanity coming on, of natural or eternal death, that God’s promises do not apply to him or her, may add to the patient’s misery, and may result in feelings of revenge or acts cruelty.
Other indications are furnished in the section on pathogenesis.
Headaches.-The only symptoms connected with the site of pain in lachesis cases which are of much value in selecting the remedy are the unilateral left-sided situation, and the radiating pains mentioned on p. 578. For the rest, the sites are so many that they are of little help. Waves of pain, not synchronous with heart-beats somewhat resembling the waves of heat or flushes in the face and elsewhere, spread from the neck up over the head. They come on suddenly, possibly after some movement or exertion, and settle into a quiet ache or disappear gradually. The headaches may be associated with momentary confusion or vanishing of thought or consciousness, somewhat resembling petit mal.
The pains are various in character.-bursting and throbbing in head or all over simultaneously, and weight or pressure are common varieties.
Head and heart symptoms in lachesis cases often go together, weak, quick pulse, throbbings and palpitations. In neuroses (ex. gr. menopausic), flushes and perspiration and flushed face are added to the head pain. In cardiac cases the face may be purple or mottled, and the body and limbs cold. In antagonizes chloral in its action on the heart (Linn Boyd).
The scalp may be sensitive to a light touch, but hard pressure relieves. Noise, conversation, motion, vibration but firm pressure relieves.
Eyes.-Lachesis is not much used for external ocular troubles (conjunctivitis, &c). For dimness of sight from muscular fatigue, with black flickerings before the eyes, worse in the evenings; for aching in the eyes, relieved by open air; for blue or fiery rings round artificial lights, and photophobia especially in direct sunlight, lachesis may be required. It has also found a plus place in the treatment of optic neuritis and retinal haemorrhage, with or without albuminuria. The eyeball is painful and “feels as if squeezed”-possibly indicating increased intra-ocular tension. The possibility of glaucoma requiring surgical aid must not be overlooked. If that is unobtainable, or for any reason undesirable, lachesis should be thought of and its general indications studied in connection with the case. The ocular pains and dread of light are worse after sleep or from touch; touching the throat may cause pain in the eyes. The eyelids may be puffy.
Special Senses.-Sight, hearing and smell are painfully acute, and the external parts-globe, meatus auditorius, nose, all sensitive to touch. Eustachian catarrh and thickening come on, and nasal catarrh and headache may accompany other symptoms. The nasal orifices and bones are sore, and ozaena with foetor and discharge of thin, dark blood would suggest the use of lachesis in nasal syphilis or tuberculous conditions.
The facial aspect will vary with the nature of the case- bluish from venous stasis in cardiac conditions, jaundiced or sallow in liver cases, dusky and besotted in septic cases, mottled in the same and in alcoholic cases, pale and cold in collapse. Lachesis may correspond with any of these conditions.
Mouth.-As a part of a septic condition the mouth may be slimy, the gums bleeding easily, the breath foetid; or the tongue may he dry and dark or black, with red edges, hard and leather- like, or dry, red and shiny, as if varnished. Enunciation may be thick and indistinct from these states or from mental dulling; the patient may be unable to control the tongue-it trembles or jerks or catches against the teeth during efforts to put it out- which attempts are liable to be painful.
Thick, stringy saliva is excreted in excess, efforts to spit it out are ineffectual and it runs away.
Throat.-In diphtheria, lachesis has proved of great service, and there are experienced practitioners of homoeopathy who believe that with this drug and cyanide of mercury, a large proportion of diphtheria cases may be cured without antitoxin. It is probable that the drugs and the antitoxin are not incompatible. The drugs stimulate the formation of a natural antitoxin by the patient’s own tissues, and that is supplemented by mass introduction into the circulation of a similar antitoxin produced by the horse’s tissues.
Clinically, the site of the diphtheria-infected tissue is not of much value as an indication for lachesis; membrane may be visible or not; also any degree of severity may be present in a lachesis case. The indications are: a decided tendency to bleeding (noticed after a choking cough), the blood being dark; decided foetor; origin of the attack left-sided, warm drinks aggravate and tend to induce choking, cold drinks less so, solids are swallowed more easily than fluids, aggravation in a warm room (cough, choking), sensitiveness to touch, aversion from clothing round neck, clutching at throat due to a feeling of obstruction to breathing or constricted feeling, a bluish colour of the mucosa, especially around patches of membrane or ulceration.
Less often lachesis is useful in tonsillitis; such of the above symptoms and modalities as are relevant must be present to justify its use. For the follicular form, however (especially of the left side), when the orifices of the follicle are seen to be plugged with white mucus, which may be mistaken for membrane, and may lead to an erroneous diagnosis of diphtheria, lachesis has been found to be a useful and reliable remedy (merc, biniod.).
Female Sexual Organs.-Lachesis is one of the most used and most useful remedies for menopausic discomforts. Its routine use, regardless of its modalities, tends to bring it into disrepute. The general aggravation from heat, in the evening and after sleeping, should be among the patient’s symptoms. The waves of pain and of heat, i.e., “flushes,” are chiefly felt in the upper part of the body-neck and chest to head, sometimes with perspirations. Headaches, burning and weight on the vertex, and throbbing are frequent accompaniments, as also in nausea. Sometimes the daytime flushes are replaced at night by chills.
The menstrual pains are intermittent, they may extend from the pelvis up to the chest, or a definite sharp, the navel. If the pain is unilateral it is usually on the left side, and may pass over to the right. This would be an indication in ovaritis or ovarian pain. Pain just above the left groin attributed to subacute salpingitis has often yielded to lachesis. The flow is also liable to intermit, and if it stops, headache, &c., comes on, being relieved by the return of the flow. The patient feels better during menstruation than at other times. Suspension or delay of this or other discharge may mean distant symptoms, which disappear when the discharge is re-established. Diarrhoea before menstruation is another lachesis indication.