the australian medical joitioal

THE AUSTRALIAN

MEDICAL JOITIOAL. JULY, 1876.

MEDICAL SOCIETY OF VICTORIA.

" Kyne ton, June 24, 1876. " Dear Sir,—In reply to your inquiries, I find, on referring to my'

notes, that the boy Piggins was bitten twenty-seven hours before admission. Five minims of the Eq. ammon. fort. were injected on three occasions, with very little effect. (The boy was nine years old, so I suppose the dose was equal to ten or eleven minims for an adult.)

" I have no doubt that he was poisoned by a snake, and of the failure of the ammonia, but as to whether it would have been efficacious if administered earlier, I can offer no opinion.

" The woman Donovan was, I am certain, on the point of death When I injected, the heart's action had almost ceased, the pupils Were dilated. I had great difficulty in finding a vein.

"This took place at 1 a.m. It was about half-past 6 on the Previous evening that Dr. Rigby saw her. She was then undoubt-edly intoxicated, but not extremely so ; from first to last she had less than eight ounces of brandy. I did not think we should expect that quantity of brandy to induce fatal collapse, although it i8 possible that it may have added to the depressing effects of the

VOL. XXI. Q

ADJOURNED MEETING. WEDNESDAY, JUNE 28, 1876.

(117 Collins Street East.) Present: Dr. McMillan, Dr. Singleton, Dr. McCrea, Mr. Ruda11,

Dr. Barker, Mr. Girdlestone, Dr. Ryan, Dr. Martin, Dr. Molloy, Mr. A'Beckett, Mr. Cobb, Mr. Fitzgerald, Dr. Bowen, Dr. Jonasson, Dr. P. Smith, Dr. Rees, Dr. Bird, Mr. Ford, Professor Halford, Dr. Bleasdale, Mr. Wooldridge, Dr. Neild, Dr. Blair, Mr. W. Barker, Dr. Lawrence, Mr. Gray, Mr. James.

The Vice-president, Dr. McMillan, in the chair.

CORRESPONDENCE. The following letters were read :

214 Medical Society of Victoria. [July,

snake-poison. The inference I draw from this case and others that I have seen reported is, that the absorption of snake-poison is some-times followed by such failure of the heart's action, as to threaten immediate death, and that in such cases the injection of ammonia is effective as a stimulant.

" In its use we are only trying to resist the tendency to death, and do not claim for it that it is an antidote to snake-poison. We do not say that astringents or stimulants are antidotes to the poison of typhoid fever, yet we use them in certain phases of that disease.

No amount of failures in dogs who have received a full dose of snake-poison can prove that ammonia may not be effective in human beings who have received a very small or moderate dose. Since the case of the wowan Donovan, I have seen ten cases of alleged snake-bite, and from the circumstantial accounts given, I have no doubt the greater number were really such.

" In most of them the friends had intoxicated them before they came to me. In none of them did I find any very marked symptoms. No treatment was adopted by me except very moderate stimulation. The period for excision or ligature had always passed before I saw them. I allowed them to sleep, keeping them watched for any failure in the temperature, and examining the pulse myself from time to time. From this I infer that in many cases, perhaps most, very little of the poison reaches the circulation, being emitted while the fang is passing through the clothes, or perhaps not emitted at all, where the snake is startled, and not previously irritated.

" I remain, dear sir, yours faithfully, " To Professor Raiford." " W. LANGFORD.

" Learmonth, June 17th, 1876. " Sir,—As the subject of intra-venous injection of ammonia as a

remedy or antidote in cases of snake-bite is being fully discussed by members of our profession, I cannot let the opportunity pass without adding my experience as to its efficacy or otherwise.

" On Sunday, November 8th, 1874, a man of the name of Jenkins, living at Mount Bolton, brought his son, aged seven years to me, he having been bitten by a carpet snake. The boy, in getting over a log of wood, slipped and fell on the snake, which bit him in two places on his wrist. The boy ran home to his father and said he had been bitten by a snake, who immediately ligatured the wrist and sucked the wound ; he then hastened as fast as he could to me, when, on his arrival at my house, I noticed the following symptoms as showing themselves in the boy : they were—incessant vomiting, impaired vision, syncope, staggering walk, pupils fully dilated, sleepiness, feeble respiration, and intense coma. Without losing any time, I hypodermically injected fifteen minims of liquor ammoniac with the same quantity of water into the basilic vein of the arm affected. I had scarcely withdrawn the point of the syringe, when he, to my astonishment, opened his eyes, his lips became red (when he came they were livid), the vomiting ceased, and be

1876.] Correspondence. 215

appeared to be going on well ; in an hour after, he seemed as bad as ever. I gave him an injection a second time, and with the same beneficial result. He was doing very well for about two hours, When, finding that the symptoms were recurring in all their intensity,

for the third time injected again ; this was at 3 p.m., and from that time out to the time he left my house, he went on doing remarkably well, no symptom of poisoning lurking about, nor did any show themselves the day after.

" On the 8th November the punctures inflicted were plainly visible, and blood had flowed sparingly from each.

" Here then is a true case of genuine snake-bite successfully treated by your method. The injection into the vein was followed by instant relief. I could scarcely believe my eyes, to see the wonderful effect it had upon him. I look upon the injection of ammonia, intra-venously, more as an antidote than a remedy, as I believe the word antidote means a medicine given to expel the mischief or danger of another. My faith is so great in your antidote, that I consider a medical man would be morally guilty of the death of a patient from snake-bite, did he not use the injection of ammonia intra-venously in such cases. I regret not being able to join in the discussion of this important subject at your next meeting of the Medical Society, but you can make what use of this communication in whatever way you like, if you think fit to do so.

" I am, Sir, yours faithfully, "FRANCIS LEOPOLD HOOPER, M.R.C.S.E. & L.S.A.

" To G. B. Halford, Esq., M.D. &c., Melbourne." " Learmonth, June 26, 1876.

" In the case of the boy Jenkins, living three miles away from this place, I removed the ligature prior to injecting the ammonia intra-venously, a fact which speaks volumes a hundredfold in favour of your method, in the ammonia killing, so to speak, the venom of the snake. Before your remedy was known to me I had, some years ago, a case of snake-bite ; I treated it by cutting out the bitten part, removing the ligature, applied caustic to the wound, and giving large quantities of brandy, walking the patient about. I need scarcely say the patient died, and no wonder.

" I am, dear sir, yours faithfully, " Professor Halford." " FRANCIS LEOPOLD HOOPER.

The following letter was also read :- "Melbourne University, June 26, 1876.

" To the President and Members of the Medical Society. " Gentlemen,—Though at present only a proposed member of the

Society, I venture to address to you a few thoughts as to the physiological action of snake-poison and of ammonia on the human system.

" The direct action of snake-poison on the blood appears to me to be probably limited to diminution of the quantity of fibrin present,

Q2

1 1 ;

216

Medical Society of Victoria. [July,

with increase of the white corpuscles, the latter being perhaps produced, at least partly, from the former.

" The explanation of the action of the virus which seems to me to be most consistent with the results of experiment is, that the poison produces a profound impression on the sympathetic and vaso-motor centres, thus causing contraction of all the small arteries of the body, forcing all the blood into the veins, and causing general congestion and deficient textural nutrition.

" This contraction of the small arteries, and lessened circulation occurring in the lungs, will give rise to imperfect oxidation of the blood, just as in cholera; • and the circulation of unoxidised blood, charged with carbon, will induce imperfect nutrition and defective. action of all the organs of the body, especially when we remember that all these organs are in a state of high congestion with arterial spanmmia.

" Would not this explain the muscular weakness, the failing action of the heart, the dimness of sight, livid face, and final coma I Would not congestion of the stomach, with a watery state of the blood (from loss of fibrin), explain the vomiting and hzematemesis ? Would not congestion of the retina, with accompanying irritation of the sympathetic, explain the dilated fixed pupil 1

" Is it necessary to take for granted that the defective oxidation of the blood is consequent on the primary action of the poison on the blood corpuscles (as with sulphuretted hydrogen or carbonic oxide) I Is it not more probable, looking to the effects of treatment, that it is a secondary effect of contraction of the pulmonary vessels ?

" It seems to me that all the symptoms may be dependent on the action of the virus on the sympathetic and vaso-motor centres, the only changes in the blood being-1. A leucocytosis, due perhaps to irritation of the lymphatic and vascular gland systems ; and 2. A deficiency of fibrin, the result probably of diminished oxidation of the tissues generally, and therefore a secondary effect of the poison.

" Whether the virus has any specific action on the higher nervous centres, is I think very doubtful.

" If this be accepted as a possible theory of the action of snake-poison, we have in ammonia, according to the experiments of Professor Raiford and of Kiihne, a genuine antidote, which meets the virus in its own territory, by producing reflex dilatation of all the small arteries of the body ; but owing to the more transitory influence of ammonia, relapses are apt to occur, and necessitate further injections being made.

" As animation returns after the use of ammonia, there has frequently been noticed remarkable activity of the kidneys ; and here, I think, is the key to the rapid elimination of the poison from the body.

" Nourishment, formerly useless, from the general congestion, can now be administered, and must be given, for means must be supplied for the rapid production of force in the body, as ammonia, powerful stimulant though it is, can merely evoke the force existing poten-

1876. Report on Snake-Poisoning. 217

tially in the system, and further, like all powerful stimulants, must inevitably cause great depression after a certain period, unless there be an extraordinary source of energy supplied by concentrated food, &c., to meet the extraordinary call on the vital powers. And it is to the neglect of this precaution that it would seem the non-success of ammonia may in many cases be attributed.

" Apologising for the length of this letter, " I am, gentlemen, yours sincerely,

" HARRY B. ALLEN, KB., " Demonstrator of Anatomy."

RESUMED DISCUSSION UPON MR. WOOLDRIDGE'S MOTION. Dr. BIRD said a good deal of what he had intended saying had

been anticipated in the letter of Dr. Allen. He would, however, ask if a case of snake-bite were brought to anyone of those gentlemen who so vehemently opposed the intra-venous injection of ammonia, what they would do, supposing, as would very likely be the case, the ligature, excision, suction, stimulants, exercise, and all the usual routine treatment had been tried, and the patient nevertheless was still growing worse ? What remedy, he would ask, was there, under such circumstances, comparable to ammonia ? Whatever might be the explanation of the action of ammonia, there could be no question of its being a most powerful stimulant, which obviated the tendency to death ; and seeing that the power of absorption by the stomach was lost, what alternative was there, admitting the value of ammonia as a stimulant suitable under the circumstances, but intra-venous injection ?

Dr. MARTIN had been charged with importing personal matters into the discussion. He had not designedly offended, and if he had hurt anyone's feelings in what he had said, he begged to apologise for doing so. With regard to the motion under consideration, he found himself somewhat awkwardly situated, for while he differed altogether with Mr. Wooldridge and Dr. McCrea, he was yet not prepared to accept Mr. Wooldridge's proposition without qualifi-cation. He could not agree with Dr. McCrea that we should adhere to the conservatism, or rather, he might say, the retrogradism, of affirming in .that Society, that the ligature and excision should be the only reliable remedies in cases of snake-bite ; because the ligature was rarely applied properly by non-professional persons, and excision in the hands of non-professional persons was proverbially imperfect. It was evident, from the record of cases published by Professor Halford, that a medical man was scarcely ever on the scene until an hour after the snake-bite, and they knew by practical ex-perience that, in case of snake-bite, deadly as it was, the same thing occurred as in the hypodermical injection of other poisons, and in three minutes the poison was carried through the entire system, a few seconds sufficing in some poisons. Consequently, when a Medical man came in an hour afterwards, he found that notwith-standing excision, and ligature imperfectly applied, the constitution

218 Medical Society of Victoria.

was invaded, and the system was succumbing, and he had to deal with the poison in the constitution. The public, therefore, expected a remedy not merely to shut the door against the poison, but calcu-lated to deal with it when it had got in, and therefore it was that he thought Dr. McCrea took up an untenable position in advocating that the Society should give its dictum to relying only on excision and ligature. He also differed from Dr. McCrea entirely in the statement that whoever, in future, practised the intra-venous injection of ammonia for snake-bite, was trifling with human life. He thought it was very likely that Dr. McCrea, in the remarks he was about to make, would back out of that position, because it was also quite untenable. He (Dr. Martin) had not himself seen a case of snake-bite, but he had in ten instances injected ammonia, and he could say from practical experience that it was not trifling with human life, or that human life was prejudiced in the least. He was• also at issue with Mr. Girdlestone in his view of the matter. Mr. Girdlestone had dwelt especially on the point, that when the blood of the person bitten was charged with the fermenting effects of the venom (whatever they might be) it was useless to stimulate the heart—that ammonia could not rouse the circulation. Now, when they considered the facts detailed by trustworthy witnesses as regarded the alteration in the colour of the lips after the injection of ammonia, and when they reflected over the explanation given at the last meeting by Professor Halford of the mode of access by which ammonia not only stimulated the heart, but roused up the involuntary muscles, he did not think that Mr. Girdlestone could adhere to his opinion. He (Dr. Martin) found on looking through the list of cases recorded by Professor Halford, another objection to his agreeing with Mr. Girdlestone. Mr. Girdlestone laid great stress on the fact that out of the number of cases recorded, only a few could be considered as genuine cases, genuinely and properly reported. He made out that a number of respectable practitioners, reputable, skilful, and trustworthy, had entered into a conspiracy whereby each should detail the same kind of symptoms.

Mr. GIRDLESTONE denied that he had said so.

Dr. MARTIN was not quoting Mr. Girdlestone's words, but that was the inference to be drawn from his. remarks, that a conspiracy had been entered into all over the country by a number of prac-titioners who never saw each other, or had any communion at all, but argued entirely apart from each other, and yet who gave the same conditions and the same facts, and who recorded cases which were as similar as possible. They all recorded the facts—the important facts—that after the administration of ammonia in cases of snake-bite, there was always, with scarcely an exception, an arousing of the vital powers, and escape from almost immediate death, and that if the injections were kept up as the influence the ammonia exercised failed and faded away, they were records of bond-fide recoveries. He thought accumulations of evidence of this kind from all parts of the country, and the similarity of the

1876.]

Report on Snake-Poisoning. 219

symptoms, all pointed in the same direction to a remedy or means of treatment (that was the proper term) which met the poison in the system and dealt with it there, holding up the unfortunate patient and stimulating the excretory organs until they had got rid of the enemy. After stating all this, it might seem strange that he should say he could not go the length of Mr. Wooldridge's resolution, but mature thought and reflection had brought him to think that the Society occupied at present a very critical position. They were looked to by the public and expected to form a definite, or, at all events, a safe opinion. That was not an unimportant consideration ; but they were also looked upon by scientific societies and their medical brethern in all parts of the world—he thought he was not going too far in using the expression—for a deliberately fair and scientific and logical conclusion on the facts before them. They had, as he had already pointed out, a fair right to confide in ammonia, to trust to it, and to feel that they were wrong if they did not resort to it ; .

but yet, logically and scientifically, he thought they needed more proof before they bound the Society to asserting the strong opinion contained in Mr. Wooldridge's resolution. It seemed to him (Dr. Martin) that the series of conclusions drawn in the address presented to the Society by the late president (Dr. Bowen) crystal-lised, as it were, the expression of opinion which it would be safe and proper for that Society to give, viz :--" I. That the bites of Australian poisonous snakes are extremely deadly. 2. That the symptoms are the same in Australia as in India ; that they differ somewhat in animals and man ; that they are distinct in character from those of alcoholism. 3. That ammonia is the best form of stimulant to exhibit, and that the intra-venous injection is the best method for its administration." He was prepared to support that series of conclusions as an amendment on the original motion, and he would therefore move these three conclusions as an amendment.

Mr. FITZGERALD seconded the amendment. He said he had not heard any gentleman give the exact symptoms of snake-poisoning, and the difference between it and alcoholic poisoning ; but Mr. Girdlestone, in his remarks, had stated that many of the cases that were treated for snake-poisoning, were no more than alcoholic poisoning, and that the symptoms of snake-poisoning were not of that comatose character. He (Mr. Fitzgerald) had seen three cases of snake-poisoning many years ago. One occurred in Lonsdale-street, the person being bitten by a cobra-di-capello, one of two snakes he had brought from India. This was before Professor Halford had Introduced his method of treatment, and he applied the ordinary remedies, ligature, coffee, and stimulants, but not in excess. He also used artificial respiration. He did not give the patient any large quantities of stimulants, but the patient died completely Insensible and comatose. Two other cases occurred in his experience, in which the persons were bitten by Australian snakes, in which the symptoms were exactly the same, and he thought, therefore, it was scarcely fair to state that the cases which had been treated in the country were cases of alcoholic poisoning. He would also

220 Medical Society of Victoria. rJuly,

refer to another point. They had every, confidence in the gentlemen who had conducted these experiments, but had any of them practical experience of the result of the injection of ammonia on a biped, or was it all confined to mongrels ? because that was a most important point. He had injected ammonia, and saved life with it. He did not say it was good for snake-bite, as he had never had any experience as to its use in such a case, but he certainly thought it was unfair and unkind to knock on the head altogether, a method of treatment which had been obtained after many years' labour, until something better was got. In reference to a case related by Mr. R. Robertson at last meeting, in which he had administered the ammonia injection to a patient in a dying state from embolism, Mr. Fitzgerald stated that he was present at the case in consultation, and it was his opinion that another injection would have done the patient good.

Mr. WOOLDRIDGE said he would accept the amendment and withdraw his own motion.

DR. P. SMITH said, I am glad the motion has been withdrawn, as both its form and substance were objectionable. At this stage of the discussion, and especially now that the motion has been with-drawn, it may seem like captiousness to object to the form, but as a good deal of attention will have been given to this controversy, I think it only right to make it clear that we have been guided in our conduct through it with ordinary acumen and logical exactness. The form of Mr. Wooldridge's motion, then, seemed to me an example of irrelevant conclusion, the conclusion deriving no support from the premises. For a moment invert the proposition, and see if it was not absurd. This Society was asked to be of opinion that in cases of snake-bite in the human subject, the intra-venous injection of ammonia is the best remedy at present known, because there is a wide difference between (1) the symptoms produced by the virus of snake, and various other poisons, in man and dogs, and (2) between the effects of remedial agents, &c. I think I merely need to state it in this form to show what I have said. It were better far to give reasons less vague and more direct than these for our opinion, or to give no reasons at all. I hold there are better and more definite reasons than those given, as I hope presently to show ; and I trusted, if we were to express the opinion set forth in the motion, it would be for these, and not Mr. Wooldridge's reasons. But if I objected to the form of this motion, I objected far more to its substance. This motion, I take it, would have made us by implication affirm, that in regard to the effects of drugs (among which I include poison), it is not competent to reason from dogs to men. If we affirmed such a principle, we should take up a position antagonistic to that of the whole scientific world in times past as well as at this moment. It is a clear case of " I, Athanasius, against the world." We, the Medical Society of Victoria, against the world. We might be right, and all the world wrong, but our isolation of position should make us suspicious of its basis, to say the least. Have we in

18761


the course of our experiments made any new discovery that warrants our position ? The report reached us by last mail of a Royal Commission on Vivisection, comprising names of men foremost in original researches, in physiology, and therapeutics. I need only mention the names of Watson

' Burrows, Paget, Sharpey, Fergusson,

Simon, Burdon-Sanderson, Klein, Carpenter, McKindrick, and Ferrier. This commission recommends experiments on the lower animals to be continued, on account of the knowledge of the effects of poisons and medicines derivable therefrom. If this principle is exploded, as one speaker seemed to imply, then, indeed, we are in the van and they in the rear. They, it is evident, believe that it is competent to reason from dogs to men. How very much knowledge of the effects of therapeutic agents we now possess, from dog experiments chiefly, any materia medica will testify. It would be only wasting time to enter on this. If we affirmed the opposite Principle—that it is not competent to reason from dogs to men—then we might well exclaim-

" A marciful Providence fashioned us holler, A-purpose that we might our principles swollen"

" Treatment that will cure snake-poisoned dogs will cure snake-poisoned men," was the principal on which Professor Raiford started ; and we signified our approval—after the event.

When we, as a society, learned the results of the Indian Commission, did we accuse the members of being illogical in refusing to try the intra-venous injection on men, because it had failed in dogs ? Nay. We simply fell foul of their facts. Was it not in the full expectation of upsetting their facts that our special committee was set to work ? When it began to dawn on us that the intra-venous injection was a failure as regarded dogs, did we not look on the case as a bad one for men ?

But after all this we were called upon to make a new departure—to acknowledge that all the while our logic was at fault. Having erected a bridge, and induced a few gentlemen, headed by Dr. Dempster, to Walk over, we were to make it a draw-bridge, and from our standpoint call out, " We reached this point by reasoning from dogs to man ; the bridge carried us over, it served the purpose of establishing the value of intra-venous injection of ammonia in men, but let no man henceforward walk over such a bridge."

However, we were not to be slaves even to consistency, and the principle being a false one, we cast it away. I did not believe this Society would do otherwise.

But Mr. Wooldridge invited us to affirm that "there is a wide difference between the symptoms produced by the virus of snakes and various other poisons in man and dogs." At an early stage of the controversy, I threw it out as a subject for discussion, Whether, considering certain differences in symptoms, it was com-petent to reason from dogs to men : I did not give it as my opinion, though I was so reported. Now, while I still admit differences in •mptoms, I consider it more a difference in the order of symptoms

222


than of the symptoms themselves. There are as wide differences between the symptoms of a pneumonia and a pneumonia, a typhoid and a typhoid in man, as between the symptoms of snake-poisoning in man and dogs. I cannot agree with Mr. Wooldridge in saying that the difference in these symptoms is a wide one. I maintain they are altogether unimportant, and that the symptoms in man and dogs ,

are in all essentials the same. Mr. Girdlestone dealt so fully with symptoms that I do not take them up again. But were the symptoms ever so different, I hold that that would be no ground on' which to come to the conclusion to which this motion invite us to come.

It was a clear case of irrelevant conclusion, the grounds of the conclusion having no direct relation to it. How does this read, "The intra-venous injection of ammonia is the best known remedy, &c., &c., because there is a wide difference between the symptoms in. man and dogs." If we were to express the opinion that Mr. Wooldridge would have had us, let it for any sake be on some more definite ground than this.

The second reason which we were invited to give for our opinion, was " the wide difference between the effects of remedial agents in, man and dogs." If this were true, as I have already pointed out, it would be no reason at all for the opinion ; but, is it true If it were meant to be affirmed as a general principle, that there is a wide difference between the effects of remedial agents in man and dogs, I hold on the same grounds as already given against his first reason, that it is contrary to fact.

If, however, it was intended to restrict the term "remedial agents" to ammonia given by the intra-venous method, and if we were invited to say that there is a wide difference between its effects in snake-poisoned men and snake-poisoned dogs, we were at once face to face with the main issue between the advocates and opponents of the intra-venous injection.

What are the effects of the ammonia injection on snake-poisoned dogs ? Some would answer nil—the effects are negative or some-thing worse—it hastened death.

If our tables are examined, it will be seen that dogs bitten by snakes lived longer by some ten hours without treatment of any kind, than with ammonia injection ; while those poisoned by the hypodermic syringe lived longer by some eight hours with no treat-ment than save injection. It thus appears from our experiments, as well as the Indian, that the ammonia injection actually shortens the life of snake-poisokied dogs.

If it is competent to reason from dogs to men quoad ammonia injection, our own experiments and the Indian pronounce against it in the most unmistakable rnannner. Not on one single point do our and the Indian experiments countenance it.

But we have other facts from dog experiments besides our own and the Indian—the six of Professor Halford, and the two of Messrs. Ellery and Stoddart. Now, these are most troublesome facts. Without them it would have been possible to dogmatise with

1876.] Report on Snake-Poisoning. 223

regard to the utter worthlessness and even the injuriousness of

of ammonia injection. These cases cannot be denied the dignity and weight of facts.

As far as I can see, the dogs were poisoned undoubtedly, and reco-very took place. Were it not for these eight cases Mr. Wooldridge dare not make mention of dogs in his motion. Now, though the cases number only about eight, and the unfavourable over a hundred, mere numbers will not get rid of them. Professor Halford has accepted our facts as facts, can we do less than accept his ?

It is said in all these cases the dose of poison was very small, and that no true blood-poisoning had been effected. But more of this presently.

I grant the dose of poison was quite uncertain, but if I say it was small, I judge without reason. The smallest dose of poison given by us produced no such effects as coma, insensibility, collapse ; nor did our dogs recover by the ammonia injection like magic ; nor was there any similar case in the Indian experiments. This I cannot account for.

It may be that these dogs had only a small dose, and were restored. But would it not follow from that, that the injection could cope with a small dose, though not with a large one, and that it might after all be sufficient for the ordinary run of cases of

snake-bitel If we allow that the ammonia can cope with a small dose, how

shall we refuse to treat the first snake-bitten man that is brought to us since, for aught we know, his may have been a small dose ?

It would appear, therefore, that the effect of ammonia on dogs snake-bitten, is to restore some, and on some to have no beneficial effect.

What are the effects of the intra-venous injection of ammonia on snake-bitten men The sum and substance of all the recorded cases may be given in brief thus, —In some cases it has failed to do any good : its advocates allow this. On the other hand, in many cases it has succeeded in restoring in a wonderful manner.

Now, if this be so—and for the time I shall take it for granted that this is a true description of its effects—I hold that these are exactly its effects on dogs, and that therefore when Mr. Wooldridge would have had us say that there is a wide difference between the effects of the remedial agent in man and dogs, he asked us to affirm a

proposition which facts are clean against. Leaving for a time Mr. Wooldridge's motion, let me ask you to

consider briefly some of the a priori reasons for and against the intra-venous injection of ammonia.

The opponents of the treatment say, that the reputed cases of recovery in snake-bitten men, may indeed have been cases of genuine snake-bite, that the snake may even have been poisonous, but that so small a dose had been given as only to cause insensibility and collapse, and that recovery would have taken place without the injection at all.

Well, in all cases of bite, the dose is quite uncertain. The dose

"MI


may have been a small one, or it 'may have been large. But I ask, were collapse, insensibility, coma, any of the symptoms shown by the dogs with the smallest quantity of poison injected by us ? "In one-quarter grain doses," says the report of the Special Committee, " the dogs were sensible to the last."

I hold, therefore, that the small dose theory is a mere assumption, and cannot be proved. Even if true, it is a marked concession to the advocates of injection, to allow that it is able to cope with at least a small dose of poison. If this is the case, then I hold that a medical man having a case of snake-bite brought to him for treat-ment is bound to employ the intra-venous injection, since, for aught he knows to the contrary, the dose of poison may be a small one, and just such a one as could be effectively cured by the injection. That recovery would have taken place without it is as clearly an assumption as the other.

Another objection put forward by its opponents is, whatever the condition may have been from which the injection roused the so-called cases of recovery, it could not have been one involving the alterations in the blood which snake-poisoning involves : cases of snake-bites they may have been, but not of snake-poisoning. For both microscopic and post mortem examinations of the blood testify that the blood is greatly altered in true snake-poisoning ; unless therefore, the intra-venous injection is an antidote in the strict sense, or chemically alters the character of blood (which its advocates do not allege), it cannot do any good. Anything short of that, supposes recovery without elimination of the poison—an utter impossibility.

The mere stimulating effect on the heart, of the ammonia, is well answered by Mr. Girdlestone, who urges that the mere causing of the poisoned blood to circulate through organs already surcharged with it, could do no good.

Now, though ammonia may not do its work in a way that we do understand, it may do it in some other way not at present under-stood. No one can understand recovery without elimination of the poison. The thing is an utter impossibility, and the sudden reco-veries so termed are certainly a most formidable fact to deal with.

Professor Halford, however, shows how ammonia; via the nervous -system, does change the character of the blood, aiding oxidization and deoxidization, giving strength and regularity to the heart's action as well. I shall not here detail the explanation given last meeting. It may be a question with some whether, even granting the action on the heart and blood by ammonia, it is an adequate cause for the effects following—whether a series of injections even could be effectual in causing elimination of the poison. It seems to me that the whole question of the value of ammonia greatly depends on the answer to this question. No one can believe in cure without elimination. Is the process set up in the blood by ammonia injection an adequate cause for such effects ? Had Professor Halford not offered this explanation, I should have answered that it was not ; as it is I am inclined to accept it.

1876.]


The sudden recoveries may possibly be only recoveries to consciousness ; the process of elimination may be going on for days afterwards, and though the intellect may be clear, it by no means follows that the blood is quite healthy ; considering that in cases of recovery there is no evidence to show that the doses of poison Were small, and that an explanation of how ammonia may act in purifying the blood, I see no a priori reason to doubt its being Possible for it to effect cures.

Among the a priori arguments for the use of the injection, one or two demand notice. The advocates of injection say, that though it may as a general principle hold good that remedial agents have the same effects on men as on dogs, yet, that as belladonna as well as some others are universally allowed to form exceptions to that Principle, ammonia intra-venously given may also be an exception. This reasoning is no doubt correct. But if ammonia is to be classed in the list of exceptions, as clear a difference between its effects on Man and dogs ought to be made out, as has been for belladonna. This has not been done. The effects of ammonia intra-venously given, as already pointed out, are essentially the same in dogs and man ; therefore ammonia does not form an exception to the general rule.

With regard to all a priori arguments either for or against the expediency of the intra-venous injection of ammonia in man, Whether derived from experiments on dogs, or from well established Principles in therapeutics, advocates and opponents are agreed that such reasoning must give way to an appeal to facts. The advocate for injection may say, I cannot explain perhaps to your satisfaction how ammonia acts in curing ; it is enough for me to point to the fact that it does cure. I leave you to deal with the facts. On the other hand, whatever a priori arguments may be brought to show that injection ought to cure, yet if it does not cure, the a priori arguments fall to the ground.

If we reject all cases complicated with alcohol in large quantity, and all cases doubtful from supposed incompetency of observers, &c., there still will remain at least a residuum of cases in which recovery Must be set down to ammonia injection ; and if these cases do not amount to more than two, it would be sufficient. It is just possible that it may yet be shown that it is some idiosyncrasy in dog or man that confers the power to resist snake-poison, just as some idiosyncrasies resist other poisons, or recoveries may be shown to arise in some other way. I cannot ignore the repeated recoveries, and I confess that to my mind, until some further explanation of them be forthcoming, to set them down as due to the ammonia injection is the most natural and rational course. I hold we are Compelled to accept the ammonia injection as at least the best provisional theory.

The facts, both those derived from dog experiments and cases of snake-bitten men, it must be allowed, conflict. A large number of facts go to show that in dogs, snake-poisoned, the ammonia injection does no good, but positive harm. But, on the other hand, some


few experiments on dogs go to establish that it does great good—is magical in its effects.

In snake-bitten men a certain number of cases go to prove that the injection is most beneficial, others do the opposite.

Under these circumstances both the advocates and opponents, holding loosely to their theories, must stick to their facts. The ultimate appeal must be to facts. I hold this to be the only true position to take up. Let us criticise and scrutinise each other's facts most narrowly, since it is said there are more false facts than false theories. We need wider induction, no doubt, but it is to cases of snake-bite in men that we have to look for a reconciliation of seemingly antagonistic facts. I do not see what more light we are to get from experiments on dogs. The results in our own and the Indian experiments have been so uniform and so much alike, as almost to resemble experiments in physics and chemistry.

In the mean time what is to be our practice in cases of snake-bite ? Are we to discontinue the use of ammonia ? Only one thing would warrant such a proceeding, viz., proof or strong presumptive evidence that it was injurious. The facts in our possession will carry various convictions to various minds, but to me the record of cases of snake-bitten men afford no proof that in skilful hands the injection was attended with injurious results ; the presumption is in favour of beneficial results.

Whether Mr. Wooldridge's motion had been affirmed or rejected, I think we ought to have spoken out clearly as to the proper place of am-monia injection, as well as to the risks attending thereon. The proper place of ammonia injection the profession are all agreed upon, viz., that it should come as a sequel to other measures, such as ligature, excision, suction, &c. I fear, however, that among laymen a different opinion prevails. So much prominence has been given to ammonia injection and its magical effects by the press in this and other colonies—the very syringe (which to some is a token of a new triumph of science) so appeals to the love of the novel, and quasi-scientific, that it has come to be regarded by the bushman as the sole and only remedy, taking the place of the old-fashioned ligature, excision, suction, &c. A bushman with an apparatus in his pocket thinks himself, I fear, armed cap-a-pie for all snake emergencies. If any such idea prevails, the terms of the motion certainly countenanced it —" the best mode of treatment at present known." Now, all that Professor Raiford himself, claims for ammonia injection is, that it is not a treatment complete in itself, but it is a part of treatment ; thatit an adjunct and valuable auxiliary to other measures which should, if possible, precede it. I therefore object to the terms of the motion as favouring a belief that ammonia injection supersedes all other measures.

If the alternative were presented to any of us, that when snake -bitten we should be treated by ligature, excision, suction, &c., alone, or by ammonia injection alone, I feel sure some of us would make choice of the former instead of the latter. We would agree that the mere chance of preventing the poison entering the circula -


tion, was better than dealing with it at work there. The motion, in my opinion, ignore ligature and excision.

I should like to see added to the case now in popular use, a ligature, needles and knife, such as were once in use in these colonies. The present " directions " which accompany the case I should like to see supplemented by others setting forth the treatment from first to last, insisting not only on the proper time for the use of ammonia, but also on the use of the ligature, &c. This is a matter for the Central Board of Health or for the Humane Society. To set the proper place of ammonia injection before the public, some-thing of the kind ought to be done.

The risks attending the injection ought also to be clearly set forth. Mishaps have occurred with the syringe in the hands of medical men ; they are much more likely to occur in the hands of laymen. Do I say then that on account of the risks a layman is never to use the syringe ? Nay ; only that a layman should use it only when a medical man is not available.

If he must operate, let him clearly understand that if ammonia does not enter the vein, but the cellular tissue, where it not only creates a slough, but does no good whatever—if he misses the vein he misses fire altogether.

The chief ground on which it seems to me this conclusion can be arrived at is, the record of cases of snake-bitten men, and the motion takes no cognisance of such cases, but utterly ignores them. Even this record is not absolutely favourable to the conclusions, for the ammonia treatment failed in some cases of snake-bitten men. But the experiments on dogs, with the exception of eight cases already mentioned are all against the ammonia treatment, and that in a most unmistakable manner.

The conclusion itself I objected to, because it countenance an impression which I believe to be prevalent, viz., that ammonia injection is a complete treatment in itself whereas, it is only, at best, part of a treatment.

I objected, then, to the form of Mr.Wooldridge's motion, because it was a perfect example of irrelevant conclusion ; the conclusion might be right, but the premises did not bear it out ; because its adoption made us by implication repudiate the principle acted on by all experimentalists of our own and former times, viz., that with regard to poisons and remedial agents generally, the effects on dogs are essentially the same as in man. If this is so, all experiments on dogs are useless. The motion also would have had us affirm that there is a wide difference between the symptoms produced by snake-virus in man and dogs, as well as between the effects of remedial agents in man and dogs, both of which propositions I have tried to prove to be incorrect.

(A motion at this stage proposing that during the remainder of the debate the speeches should be limited to ten minutes was disapproved of.)

Dr. BLEASDALE desired to say a few words as an hon. member of


the Society, and a connecting link with the outside public. The general impression of the public was that in former times people died almost as a matter of course from snake-bite, but that since the introduction of the ammonia remedy a considerable number of lives had been saved. Whether it was the ammonia which caused the change or not, ammonia was to the people outside the outward and manifest agency which operated beneficially in such cases, and they therefore drew the inference that ammonia was at least useful.

Dr. MOLLOY said he had lived in the country for a number of years, but during that time he had seen only two cases of snake-bite, which showed how rarely they occurred. In one he had administered ammonia internally at different times, and the person recovered. This was in 1867, before the introduction of the injection. During the last fortnight he had attended a case of collapse from scarlatina, which resulted in death from blood-poison-ing Ammonia was injected in that case, and he believed it had been of decided benefit, as it prolonged the life of the patient six hours. He considered the practitioner who allowed a patient to die without an effort to cure him by the injection of ammonia, was liable to a charge of malpractice, and was also, to use the words of Dr. M'Crea, trifling with human life. He thought the objectors to this mode of treatment should suggest a better. He would support the resolution of Dr. Martin.

Dr. RYAN thought it remarkable that this subject had formed the occasion of discussion 100 years ago in Italy. Both in India and Australia he had observed, the tendency to death was by asphyxia, through poisoning of the cerebro-spinal nerves. The desirability of artificial respiration therefore seemed to be indicated. It had certainly been successful in poisoning by woorara, an anala-gous poison. Perhaps atropine, as the antidote of opium, might also be found of value.

Dr. REES said that one thing which struck him as remarkable was that those who opposed the ammonia-treatment had never tried it in the human subject except in one instance which had been related by Mr. R. Robertson, and Mr.Fitzgerald had put that case in a different light. He (Dr. Rees) had injected ammonia in four cases, and he had seen, as regarded the physiological effects, the livid lips become pink, as mentioned by Professor Halford, showing the restoration of circulation. He referred in detail to the cases. In any bad example of typhoid fever he would not have the least hesitation in injecting ammonia.

On the motion of Dr. Jonasson the discussion was adjourned for a week.

1876.] 229 New Members.

ORDINARY MONTHLY MEETING.

WEDNESDAY, JULY 5, 1876. (117 Collins Street East.)

Present : Dr. Singleton, Dr. P. Smith, Mr. Rudall, Mr. Ralph, Dr. Bird, Dr. Bowen, Dr. Ryan, Dr. Fulton, Dr. Molloy, Dr. Moloney, Professor Raiford, Mr. Gillbee, Mr. Girdlestone, Dr. Neild, Dr. McCrea, Mr. Wooldridge, Dr. Rowan, Dr. Healy, Mr. R. Robertson, Dr. Dempster, Mr. Cobb, Dr. Jonasson.

Dr. Martin in the chair.

CORRESPONDENCE. The following letter wAs read :

" Alexandra, July 4, 1876. " A few months ago a little girl about two years old was bitten

on the ankle by a tiger-snake, seven miles from Alexandra. The child was brought to Mr. Wheeler's chemist's shop about an hour after the infliction of the wound, a ligature having been applied above the part bitten.

" When I arrived, the child was in a state of great prostration—quite unconscious, pulse almost imperceptible, the eyes fixed, pupils very much dilated, the face deadly pale, and the lips blanched. The two punctures caused by the fangs of the snake were distinctly Visible. I removed the ligature, and injected half a hypodermic syringeful of ammonia into a neighbouring vein.

" The effect was marvellous and startling in the extreme. Hardly had the syringe been removed, when the child suddenly sat upright, looked round, and recognised her father, who stood near. The pulse became strong and natural ; the pallor of the face dis-appeared, and was replaced by a healthy flush of the cheeks ; and the eyes assumed their ordinary appearance, A little brandy and Water was administered, and within a quarter of an hour the child seemed to have fully recovered.

" About an hour and a half afterwards all the alarming symptoms above described set in afresh, and the child suddenly fell back in the father's arms in a state of almost pulseless coma. I immediately injected another quantity of ammonia into a vein in the arm. As in the former instance, the effects were instantaneous. The symptoms of poisoning again disappeared. The child became quite lively, talked freely with her father, and beyond a slight sickness and vomiting, experienced no further inconvenience.

" Hot wine and beef tea were given at intervals until she fell asleep. She slept well all night, and was taken home next morning, and is now alive and healthy.

" JAMES FERGUSSON, M.D."

NEW MEMBERS. The following gentlemen were elected members of the Society :

Dr. McInerney, Dr. R. D. Pinnock, Dr. W. A. Dobbyn, and Dr. H. B. Allen. One gentleman was proposed.

230 Medical Society of Victoria. [July.

RESUMPTION OF THE DISCUSSION ON Dr MARTIN'S MOTION. Dr. P. SMITH explained that he had not, as reported, used the

word " discreditable " in speaking of Mr. Wooldridge's motion. Dr. McCREA said he had waited purposely in order to hear

whether there were any new facts or arguments to be brought forward in favour of the injection of ammonia, but he had not heard either one or the other. He was quite as open to conviction at the present moment as he was before the experiments were made, and if really good reasons could be brought forward for the injection of ammonia, no one would more gladly welcome them than he. He was glad that the tone of the discussion on the last evening of meeting was different to what it was previously. Only one speaker departed from this rule, who first of all apologised for any person -ality, and immediately afterwards picked out Mr. Girdlestone and himself for attack, for a thing which had been frequently con-tradicted before. He was apparently conscious of this, for he begged the chairman to protect him from contradiction. There was one speaker (Dr. Smith) who certainly astonished him by the conclusions he arrived at. He said he was satisfied that the effects of the injection of ammonia and of snake-bite were precisely the same in dogs as in men, and yet he afterwards said he thought that the results of some of the experiments made with ammonia might be accepted as facts. If they were facts they were certainly contrary to the conclusions he arrived at. Another gentleman who spoke, alluded to the difference in the effects of some poisons in men and dogs, and instanced belladonna. It was pointed out to him (Dr. McCrea) at the time that this was a mistake, and he took down Pereira, and he had since examined other authorities, and found that the action of belladonna was precisely the same in men and dogs.

Dr. BIRD.—That is a matter of opinion. Two different observers, one against the other.

Professor HALFoRD.—Pereira died 20 years ago. Dr. ICCREA could show a later authority than Pareira. One thing

had struck him throughout the debate, which was that, first of all, Professor Halford's experiments on dogs were relied on by him and his friends to a very large extent ; in fact it was they who first induced other medical practitioners to inject human beings. Even

in that debate, Mr. Ellery had mentioned a case in which he concluded snake-bite in a dog had been cured by the injection of ammonia. He thought that any person who had listened to Mr. Ellery would conclude that there was no snake-bite at all on the dog in question. Mr. Ellery stated that the dog, after being treated , though previously apparently dead, got up with a shudder and recovered, and walked about immediately. Any person, however, who knew anything at all about snake-bite, would know that if a dog could get up immediately after treatment like that, there could have been no snake-bite in the case at all. He thought that any body who considered the case mentioned by Mr. Ellery, must conclude


that the dog had simply been in a fit. Dr. Stodart's dog had also been brought into the discussion, and so likewise had the dogs experimented on by the German investigator referred to, and it seemed that dogs were introduced into the discussion for the sake of convenience. Why were they brought forward in support of a proposition, and then, after the committee of the Society had proved that injections of ammonia were of no use to cure snake-bite in them, was it said the effects of ammonia injection were different on dogs and men ? As regarded the 42 cases reported in the Medical Journal, he considered some of them were open to objection. There Was one case—No. 8—reported among those 42 cases, by Mr. W. Rae, as having been successfully cured at Bacchus Marsh. He had written to Dr. Bone, of Castlemaine, who was cognisant of that case, and Dr. Bone gave a very different opinion of the case from what Mr. Rae did. Dr. Bone's reply was as follows :—" I have carefully watched the histories of cases of snake-bite, where the intra-venous injection has been used, but it has always appeared to me that there has been a perfect possibility of the so-called coma being merely the effects of alcoholism. In instance, let me recall the case which Occurred to Mr. W. Rae, of Bacchus Marsh. This was in the Middle of winter, and the accident (so called) took place at about 8 a.m., when there was a white hoar-frost on the ground and ice on the waterhole where the man (a new chum Irishman of 19) went to procure a drink. Up to this time he had never tasted spirits. Whilst leaning one hand on a stone, in order to break the ice and procure a drink of water, he felt something prick the outside of his hand, and immediately visions of death by snake-bite crossed his mind. He ran back to his fellow-workmen, without ever having seen any snake, and told them he had been bitten by a snake in the water. He was taken to Mr. Rae, who ridiculed the idea, and sent him back home. Fright, however, had laid hold of him, and his Companions dosed him with about half a pint of bush brandy. The patient very naturally became comatose, and about 3 p.m., was again taken to Mr. Rae, who then finding him comatose, proceeded to make an incision into his arm, and inject Eq. anamoni. The effect was magical ; the man sat up and was restored to consciousness immediately, and the intra-venous injection of ammonia in snake-bite was quoted throughout the length and breadth of the land as a specific, but I opined .that most drunken men when they get a hole made in them with a sharp knife (let alone the stimulant effect of the ammonia) would sit up and become conscious,' and many decidedly pugilistic. The idea of a snake being in Water covered with ice in the depth of winter is simply absurd. Mr. J. C. M'Causland, now of Sandhurst, then manager of the -.National Bank, Bacchus Marsh, can, and doubtless will, corroborate All these statements with regard to this particular case."

Professor HALFORD.—Read Mr. Rae's account in the Journal. Dr. M'CREA opined that he could read what he liked, and he

Would not be dictated to by any one. He had no objection to read Mr. Rae's account, but he did not like to be dictated to by any

R 2


person. [He then read Mr. Rae's account, in which the cause of cure was ascribed to the injection of twelve minims of liq. ammoniac.] '

The statement of Mr. Rae must be taken for what it was worth. The case occurred in the depth of winter, when snakes were hardly ever seen, when they seldom or never bit, and when, even if they did bite, the venom given would be so small that it would poison very few people. During the course of the debate he had sent the following letter to ninety-five medical practitioners of long standing in this colony :-

"Melbourne, June 22, 1876. " SIR,—I shall feel obliged if you, as a medical practitioner of

long standing, would reply to the enclosed queries as quickly as possible, not later than the 26th inst.

" Your obedient servant, " W. M'CREA, C.M.O.

" Queries : 1. How many cases of snake-bite have occurred in your practice 1 2. In how many of such cases respectively were the ligature, excision, scarification, or suction used ? 3. In how many cases was intra-venous injection of ammonia used 1 4. How many deaths followed in all, and how many after intra-venous injec -tion of ammonia ?"

He received 62 answers to those queries. He found from them that in 190 cases of snake-bite in which ammonia was not injected, there were 11 deaths reported. In most of those cases the remedies of scarifying, ligatures, or suction were employed, and the propor-tion of deaths was only 5.8 per cent. He also found from the replies that there were 63 cases in which injection of ammonia was resorted to, and in those 63 cases, 14 deaths were mentioned, or 21 .5 per cent. He submitted the following table, which gave the mode and kind of replies thus received :

ANSWERS TO QUERIES IN RE SNAKE-BITE.

How many cases of snake- NAMES OE bite have

PRACTITIONERS. occurred in your practice?

In how man of such cases

y

respectively were the liga-tare, excision, ' scarification, or suction used?

'• ce

.,9 ,th g A ..1,7 g L3 8 o ,g1

4 ° 1"' °

How many followed in

how many intra-venous injection ammonia?

deatbsd all, ao

after

of

Other A110°- Causes.

Mr. J. Johnston, Beaufort I One One Nil Nil Dr. Semple, Kilmore - About 6

doubtful cases Excision and r scarification

generallyused

Nil Nil

Mr. Talbot, Coburg - Nil Nil I Nil Nil Dr. Rohner, Chiltern - 4 Lig., excision

scarificat'n were used in all 4 cases

Once Nil

Mr. Davy, Malmsbury - 4 2 cases, 1 case applic'n.

nitric acid

One Nil

A

1876 .] Report on Snake-Poisoning. 233

[In how many p.,i6= ;', 'ci How mony deaths

. How many cases of snake-

of such cases respectively

,9 . '2 ''' 0 2 •P .

followed in all, and how many after

NAMES or bite have were the liga- e3 E intra-venous PRACTITIONERS. occurred in

your practice ? tnre, excision, scarification, or suction used ?

S ,73 o 4 'a 2 g ,« 4 o 1.- 0

j inection of

ammonia?

Other Ammo- Causes. ma.

• Pestell, Kyneton - 12 Scarification in most cases

2 1 death after 1 injection of ammonia

'• Tovell, Brighton - Nil Nil Nil Nil

'. Roche, Creswick - 6 ,6 Nil Nil

'. Pierce, Dunolly - 1 Lig. &c. with ester. applic. of ammonia

— Nil

'. Dunce, Ballarat - Nil Nil Nil Nil

• Crosland, Inglewood- Nil Nil Nil Nil

• Phillips, Dandenong- 1 Nil 1 1 1

• Sharp, Ararat - - 5 4 1 1 death, 1 ammonia treatment

• Hutchison, Castle- main

2 1 scarificat'n and brandy

1 Nil

'. Starke, Inglewood - About 6 cases

Brandy, cxci- sion, 87,e. in all

1 Nil

• Barnett, Stamen - 3 1 2 Nil

r• Reid, Geelong - - 2 or 3 In all Nil Nil

L.• Malcolm, Castlemaine 3 All Nil Nil

r. Whitcombe, Ballarat 3 3 Nil Nil

'• Boyd, Sandhurst - Nil Nil Nil Nil

r • Casey, Brighton - 4 4 Nil Nil

r• Shaw, Geelong - Nil Nil Nil Nil

• Bone, Castlemaine - 2 2 Nil Nil

c'• Mackin, Geelong - 1 1 Nil Nil

r. Williams, Queenscliff 1 1 Nil Nil

r• Gow, Campbell's Ck. 4 4 Nil Nil

r• Crosson, Echuca - 1 1 Nil Nil

1*• Hood, Ondit - - 2 1 1 Nil

•Atkinson, Sandhurst Nil Nil Nil Nil

• Austin, Camperdown 2 Brandy and amm. intern.

Nil Nil

l'• Woolhouse, Brighton 1 1 Nil Nil

l'• Scott, Geelong - - 6 6 Nil Nil

r. Elmes, Lilydale - 6 4 2 . Nil

r- Cheyne, Yea - - Nil Nil Nil Nil

X. Rae, Colac - - 6 4 2 2 2 deaths in all, none by injection of ammonia

,- Ronald, Plenty - .r. Bleeck, Heidelberg -

1 1

1 Brandy and ammonia

Nil Nil

Nil Nil

[• Meyler, Winchelsea - 2 1 1 1 Death,ligature, &c.

4'• Owen, Ballarat -

t. ,.

zugby, Kyneton -

5 doubtful cases.

20 to 30

4, no treatment

—

1

5

Nil

Death, injee. 1 of ammonia

ti•• Harrington, Warr- nambool

1 Brandy and ammonia

Nil Nil

Al

0-

■1111111

[July, 234 Medical Society of Victoria.

1

Nil Nil

'TONERS, occurred in tare, incision,

How many of such cases cases of snake- respectively OF ] bite have were the liga- your practice ? scarification, or

suction used ?

In how many

In h

ow m

any

case

s w

as i

ntr

a-

veno

us

inj e

ct'n

of

amm

. u

sed

?

H fol

Oi Cau [aryborough 2 doubtful 2 cases, Nil

cases scarification 1, Avoca - 10 Scarification, Nil

&c., used in all cases

ank, Sand- 1 Suction and Nil carb. of soda

lvoca - - 3 or 4 cases Ligature & Nil ammonia

,st Charlton 1 Excision & Nil ammonia

, St. Arnaud 1 Do. Nil on, Albury - 5 Lig., excision Nil

& ammonia , Mansfield - 3 Ligature & Nil

brandy yneton - 6 Ligature, &c. 3 1 I

in 4 cases (

ewstead - Nil Nil Nil Creswick - 5 Lig. & excis. 2 I

in 3 cases in

Stawell - 1 Suction, &c. Nil & ammonia

e, Qu'nscliff 1 Nil Nil I, Kangaroo 5 Ligature, Nil 2

&c., in all ile - - 6 Ligature, Nil

excision, &c. itzroy - 3 Ligature, &c. Nil 1 , Penshurst 3 Ligature, Nil

excision, &c. ortland - 3 Ligature, &c. Nil

& ammonia

n, Alexan- 6 5, ligature, 1 1

• &c., do. ick'nd'nd'h 1 Ligature do. 1 sham - 1 Ligature & 1

excision 5 18 or 20 Do. do Belfast do. } 1 2

ale - 16 Do. do. Nil k - g 2 Salivation Nil

- - 2 1 scarified 2 and sucked,

1 brandy Swan Hill 5 1 suction 5

nythesdale 2 2 2

I - - 226 38 11 3S of injec- ammonia 36

190

Nam

PRACTI

Mr. Dunn, 11

Dr. M'Maho

Dr. Cruiksh hurst

Mr. Morris,

Mr. Dean, E a

Mr. Brisbane Mr. Hutchin s

Dr. Reynolds

Mr. Geary, K

Mr. Smith, N Mr. Lindsay,

Mr. Bennett,

Mr. Macfarlan Mr. O'Donnel

Flat Mr. Forbes, S

Mr. Daniel, F Dr. Dickinson

Mr. Brewer, P

Dr. Fergusso dra

Dr. Mueller, Y Dr. Steel, Hor

Mr. Jermyn, Dr. Hedley, S Dr. Clutterbuc Mr. Langford

Mr. M'Intyre, Mr. Jordan, S

Cases in a l Deduct cas

tion wit

ow many deathsowed in all, and ow many after intra-venous injection of ammonia ?

her Ammo" ses.

Nil

eaths in all, 3 from injec.

If ammonia Nil

eaths in all• 2 both from jec. of amm.

Nil

Nil 2 Deaths

1 death Nil

Nil

Nil

Nil

Nil

Nil

Nil

Nil

Nil

1

1

Nil Nil


The gentlemen who took the opposite side of the argument had asked for facts against the injection of ammonia treatment, and he hoped the facts he had given them from the replies he had received to his queries would satisfy them. The small doses of ammonia which were said to have effected a rapid cure in some of the 42 cases reported in the Medical Journal for 1875, could not be accepted as correct authority, as it would be impossible for such small doses to have such rapid or curative effects. In 22 of the 42 cases recorded, there were not, he said,12 minims of liq. ammonim injected, and in some as little as 4 minims only. In the other 16 cases, above 12 minims were injected. They must remember that 12 minims were as to the blood in the human system, only one part •

in 18,000, and then they would see what little effect as a stimulant it could have on the heart, more especially when they bore in mind the rapidity with which the blood circulated. As to Nos. 10, 19, and 31 of the 42 reported cases, in which large repeated quantities of ammonia were injected, and the patients were a long time under treatment before they recovered, if those cases were considered, the conclusion must be arrived at that the other reported cases, in which small doses were administered, as was said, with rapidly magical curative effects, were cases in which no poison had been received into the system, or only so small a quantity that a very little stimulant would revive a patient from it. Ammonia was not claimed by those arguing in its favour as a curative, but only as a stimulant, and therefore, even on the argument of its supporters, it could be useful only in cases where but a small amount of poison had reached the system. With regard to ligatures, scarifyings, and suctions in cases of snake-poisoning, they removed the poison from the system if resorted to in time ; and even in lethal cases, the plan of ligatures, suction, and scarifying was better than the ammonia treatment. He read case 37, in which it was stated that Mrs. Finegan, of Belfast, was bitten by a snake, and that her daughter sucked the wound, and Mrs. Finegan recovered without the injection of ammonia, though brandy and ammonia were administered inwardly. The daughter of Mrs. Finegan, who sucked the wound, however, afterwards showed symptoms of poisoning, and was cured by a medical man by the injection of ammonia. He (Dr. McCrea) asked the members of the society to remark that there was no intra-venous exhibition of ammonia in the case of the mother, yet she got better, and that the quantity of poison which the child could have absorbed into the system, as she sucked the wound, and expectorated immediately what she sucked, must have been very small indeed. In 39 of the Journal cases, 22 were excised or scarified and seven sucked. If the same relative percentage held good in the cases that had come to him, in answer to his queries, he thought he was fairly entitled to say that the same percentage of recoveries would have taken place in these cases in which ammonia was first injected. With the last part of the motion, that ammonia was the best form of stimulant to exhibit in cases of snake-bite, he agreed. He thought, when administered in

"NC


proper ways and proper doses, it was the best stimulant ; but he entirely dissented from what followed, that the intra-venous injection was the best method for its administration, for he thought, when they considered the rapid recovery of those people whose bites had been either scarified, sucked, or ligatured, and that it had been shown both by the experiments in India and here, that the death of dogs proceeded more rapidly after the injection of ammonia than before, the Society would hardly come to the conclusion that the intra-venous injection of ammonia was the best mode of exhibiting it. One member last evening said he had a rod in pickle for him, and, quoting from The Argus without acknowledging it, said those who opposed the injection of ammonia failed to state what they would administer.

Dr. BIRD.—I never plagiarised from any one in my life that I know of.

Dr. MCCREA.—It was no part of their duty on this occasion to state what they would do.

Professor HALFORD.—For humanity's sake.

Dr. MCCREA would conclude by moving, as an amendment-" That the immediate application of the ligature, excision of the bitten part, and suction, followed by the judicious use of stimulants, either through the stomach or rectum, are the most reliable remedies for the treatment of snake-bite."

Dr. BOWEN asked whether Dr. McCrea considered that there was a single intelligent medical man in the colony, who did not consider that suction, ligature, and scarification should not precede all other treatment ?

Dr. MCCREA did not know what medical men would do, but neither in Mr. Wooldridge's motion nor Dr. Martin's amendment were these things mentioned.

Dr. BOWEN took it that this treatment was an understood thing. Dr. Martin's proposition was that the injection of ammonia was the best method for its administration, but he really meant, he thought, that to all intelligent minds it was the most powerful method for its administration in advanced cases.

Dr. MCCREA said the motion stated that the intra-venous injection was the best method. He denied that utterly. He would gladly believe all Professor Halford said, but the facts which had come to his notice were altogether against it.

Dr. BLAIR seconded the amendment. They knew that some of the best scientific minds in Europe were working in this groove, and why should they be in a hurry to come to a decision, when they night have to eat humble pie ? A great deal had been said about Fontana, but long before his time, in Sir Christopher Wren's day, all sorts of things were injected into the blood. Shortly after

1876.]


Harvey's discovery of the circulation, it was a sensation to be injected, and Wren and others submitted to it, but these things

" They have their day, and cease to be."

No doubt it would be a great thing for the Society to have the honour and glory of making this discovery, but they should be cautious in coming to a decision on so important a subject.

Dr. DEMPSTER said he was the first to attempt the experiment of injecting ammonia into the veins in a case of snake-bite, after reading an article in The Argus eight years ago, and the result to his mind was undoubtedly successful. He thought the practitioner would be very culpable who would allow a man to die without the injection of ammonia. They knew that ammonia was given by the stomach in India, but surely it was more scientific to inject it immediately into the blood than allow it to go through the chemical processes required by the stomach. (Hear, hear.) He did not consider ammonia injection an antidote positively, or that it was to dispense with cutting, cauterising, suction, or ligature. He did not understand the motion meant that at all.

The CHAIRMAN looked upon cutting, suction, and ligature as understood remedies which nobody needed to be told of.

Dr. DEMPSTER pointed out that Professor Halford's first instruc-tion was to cut out the bitten part, and after that to inject ammonia.

was present at some experiments on dogs at Beechworth some years ago, and he saw ammonia fail there. A deaf adder killed the first dog, but, beyond drawing blood, no symptoms occurred in the others which it bit. A brown snake, supposed to be very poisonous, bit a dog well twice, but to his astonishment, two hours elapsed without any effect being produced, and then the dog went into convulsions and died at once. He was satisfied, from what he had seen, that ammonia did not effect any cure in dogs whatever, but that it did in human beings. He did not think sufficient attention had been called to one particular fact with regard to the injection of ammonia. It was a very dangerous procedure for an unqualified person to undertake, and there were ten chances to one that the syringe would go through the vein and cause sloughing, and he would ask Mr. Robertson whether an epileptic fit did not follow in the case in which Mr. Fitzgerald in consultation with him injected ammonia.

Mr. ROBERTSON.-A violent epileptic fit.

Dr. DEMPSTER said no doubt in many of the cases reported, the persons had been bitten by non-venomous snakes, or were suffering from terror ; but, taking all the facts into consideration, he had Much pleasure in supporting the motion.

Mr. RALPH suggested that as a good deal of doubt had been thrown upon cases which had been reported by medical men as being cases of snake-poisoning, they should in future draw a small quantity of the blood and transmit it between two pieces of glass to Professor


Halford, and in that way he would be able to confirm them to a large extent; because in snake-poisoning there was a change in the blood.

Dr. MCCREA remarked that the same cells would be found in the blood in cases of prussic acid poisoning.

Mr. RALPH said the unusual amount of white corpuscles in snake-poisoning, and the action of the poison on the blood, would, he thought, sufficiently mark the case.

Dr. MOLONEY remarked that although it was incontrovertible that the bites of Australian snakes were deadly, we could not always be sure of the symptoms. A friend of his had remarked that the bulk of experiments in snake-poisoning had been carried on in winter, and so they were not reliable. Moreover, the Australian snakes in India might not be found to possess the same activity in India as on their native soil. Their blood might not be in a normal condi-tion. Any one, however, carefully noting the effect of poisons upon the lower animals, could not but say that we could not always reason from the lower animals to the higher. Thus, in fever, dogs gave statistics quite different from those furnished by man. In experi-ments upon the sugar-forming power of the liver, it was found that the saliva of the aog did not change starch into sugar. The analogy therefore claimed in these experiments did not obtain. Dr. Richard-son had said in his " Diseases of Modern Life," remarking on the behaviour of poisons with glycerine, that Dr. Fordyce had diluted vaccine with glycerine, and had found there was no effect. Dilution went on, and at a certain point the effect ceased. We might not find a specific for any disease, but the intra-venous injection method was a step in that direction. It was possible we might find an explanation of the difference of effect of ammonia in different cases, in the fact that the fibrin was dissolved in some instances and not in others. As to the distinction of snake-bite from alcoholism, the process was not so easy, for alcoholism covered almost every other condition. There was hardly any symptom which alcoholism could not simulate. Dr. Blair had mentioned Sir Christopher Wren's time as an instance of the comparative oldness of the method of intra-venous injection, but Ovid, a good many hundred years before, had spoken of the injection, by Medea, into }Eson's veins of the juice of certain herbs, in order to restore to him the lost vigour of his youth. But the revival of old methods was no new thing. Simpson thought acupressure was new, but it was not, and it was no disparage -ment of the value of the intra-venous injection of ammonia, to say that it was an old method. It was because we knew so little of the past that we sometimes thought present things novel. He had seen• an Egyptian prescription which might readily enough have been taken for a modern one. As to the blood, we were in a maze of uncer-tainty ; one experiment contradicted another. The merit of the intra-venous method was that it was the best method we had up to this point. The stomach would not absorb remedies in the collapse of snake-bite, and therefore we injected them directly into the

1876.] Report on Snake-Poisoning. 239'

blood. It had been found possible to cure typhoid fever by injecting carbolic acid into the blood. The objection taken, that so small a quantity of ammonia in so large a quantity of blood would be virtually inert, was of no value. He remembered dropping two minims of liquor ammoni2 upon a wound upon his hand. It produced a shock which went direct to the heart, and he argued from that, that a drop in a vein would have a like effect Ammonia was not, and never had been claimed to be a specific. Like Touchstone's Audrey it might be but " a poor thing," but it was our own ; it was, as he had said, the best method yet known, and it was both unscientific and illogical to denounce it because it was not infallible.

Dr. BOWEN asked if Dr. Martin would alter the words in his motion, " the best method for its administration," into " the most rapid and powerful method for its administration."

The CHAIRMAN said he would be glad to alter the motion as asked if Dr. McCrea would adopt it in that form. He believed the alteration would meet the argument of Dr. McCrea.

Dr. McCREA replied that he could not accept the injection of ammonia system as a cure for snake-bite at all.

Mr. REDALL desired to repeat what he had stated formerly, that it was very undesirable for the Society to pledge itself either one way or the other on the question of snake-bites.

Dr. NEILD wished, in justice to Dr. Day, their president, to read a letter which he had received from that gentleman. The letter was as follows :-

" Yarra-street, Geelong, July 3, 1876. " My Dear Dr. Neild,—If you will kindly cast your eye over the

Australian Medical Journal for November, 1871, you will find a copy of a letter containing my views regarding the physiological action of snake-poison, which you were kind enough to read for me before the Medical Society so long ago as April, 1869. Those views were, I believe, perfectly original, and met with approval from two or three good physiologists at home ; consequently I was rather proud of them. At the meeting of the Medical Society, held on June 28, you read a letter—and a very clever one, too—from Dr. Harry B. Allen, expressing precisely similar views, although more highly elaborated. Now, as president of the Society, I should feel that I was acting rather churlishly if I were to say anything which might appear like an attempt to be taking the wind out of the sails of a very promising young member. At the same time, when a man has thought out a theory, he naturally has a fondness for it, and does not wish to see it adopted by another. If, after comparing the two letters, you are satisfied that Dr. Allen's mode of accounting for the action of snake-poison is similar to my own, I should feel obliged by your making some little friendly allusion to the subject at the next meeting.

"JOHN DAY."' " I am, yours sincerely,

240


He (Dr. Neild) then said that, as the question had been so fully discussed, he did not wish to say more upon it than that it seemed to him that the two sides into which the Society was divided, though in a most friendly way, approached very nearly to each other. He thought that in cases of snake-bite, where the stomach would not retain anything, they were driven to the conclusion that the best way of administering a stimulant was to put it into the vein, so that after all there was very little difference in the opinions of either side.

Mr. WOOLDRIDGE, in reply to remarks which had been made, said that from the experience of ammonia which they had, it was far more safe to inject it as a cure for snake-bite than not. He expected that Dr. McCrea, when he said the injection of ammonia for snake-bite was trifling with human life, would have shown how it was trifling, but he had not given them a single case to support his remark. It appeared to him that it would be really trifling with human life not to inject ammonia in case of snake-bite, and there were numerous cases in which it had saved life when injected. Dr. McCrea had said that they had not brought forward any new argument. The reply to that was that their arguments were eight years old, and that new arguments were not really necessary, though they would of course be accepted if they were offered, and were valuable. Dr. McCrea had picked out some few cases which he had marked as doubtful himself, and he thought it a great pity if Dr. McCrea's case was a good one, that he'should take advantage of there being no allusion in the resolution, to the preliminary treat-ment to be adopted before the injection of ammonia. It was not necessary for him in his resolution to go into these particulars. It was sufficient for him to say that ammonia was the best remedy ;known. He was quite ready to adopt the amendment, but to show that he was in good company, he would quote Professor Holmes, of the Royal College of Surgeons, and of St. George's Hospital. He then read an extract in which Professor Holmes stated that the intra-venous injection in cases of snake-bite had acted beneficially, and so far as could be judged from public accounts had saved life, and therefore it was desirable that it should be fully tested in other countries ; also, that if the treatment was a delusion, no other was at present known. They had been constantly asked by the opponents of this treatment, what was the action of ammonia ? 'Those gentlemen knew that they could not answer them. They were in the habit of prescribing various drugs—colchicum, arsenic, opium, senna, quinine, and other remedies—could they tell how they acted ? They were in the habit of vaccinating children ; could they tell how that acted ? They were quite content with the results, to get the credit of their cures, but they knew nothing of the action of these medicines, and yet when they came to ammonia they demanded to know how it acted. But since Professor Halford explained the other night one portion of the action—the capillary action—which had been beautifully exemplified in cases that had been quoted, it had struck him that possibly the chemical cow-

1876.]

Ammonia in Snake-bite. 241

ponent parts of ammonia, as well as the stimulus it conveyed to the sensorium, might have something to do with the blood. He mentioned this matter with extreme diffidence, because he was neither a philosophical nor physiological chemist. They knew the blood owed its coagulation to a great extent to the presence of albumen, which existed in both the serum and the fibrin, and if these became disorganised, the question then presented itself, as they consisted of carbon, oxygen, hydrogen, and nitrogen, whether the nitrogen and hydrogen of the ammonia could unite with the blood, and thereby produce albumen. With respect to the matter altogether, he maintained that they were bound to vindicate the position they held as Victorian surgeons. When, on the one hand, they were referred to by the Indian Commission as being incapable of distinguishing genuine cases of snake-bite, and as upholding a system opposed to fact, and on the other they , had the testimony of Dr. Tyler Smith and ,ten other gentlemen of the successful injection of ammonia in cases of snake-bite, they were bound to vindicate themselves from the aspersions which had been cast upon them.

Mr. RUDALL then moved, and Dr. SINGLETON seconded, an amendment—" That it is undesirable for this Society to adopt a resolution advising any particular mode of treatment for snake-bite."

Several members objected to an amendment being proposed after the reply had been made. It was put to the meeting whether it should be received or not, and it was decided by 10 to 8 that it should be.

This amendment was then negatived by 7 to 6, Dr. McCrea's amendment was lost by 13 to 4, and the motion carried by 13 to 4.

Ait tratian Airbiral JULY 1876.

AMMONIA IN SNAKE-BITE. The long discussion which has taken place in the Medical

Society, on the report of the committee appointed to test the value of intra-venous injection of ammonia in snake- poisoning, is by this time a thing almost of the distant past. It will be remembered however, in the records of that body, as an example of the earnestness with which its members have endeavoured to work out an investigation, having issues important both of a scientific and hygienic character. The conclusion arrived at, will give satisfaction to the great majority of those who have thought upon the subject at all, and although this conclusion by no means shuts out the necessity for further inquiry, it at any rate affords a

242 Melbourne Hospital Chronicles. [July,

re-assurance to those who, without having considered the matter from a scientific point of view, have taken the remedy upon trust, encouraged by the long array of cases in which its value has been demonstrated.

No doubt these cases have been subjected to a most close scrutiny, and it is quite right they should have been, for it is upon them that Professor Halford and those who hold with him, have rested their belief in the soundness of the intra-venous treatment. Eliminating all those of a doubtful character, there still remained a sufficient number to establish the correctness of Dr. Martin's motion, and the utmost that the opponents of the method could do in contesting its claims to recognition, was to collate and to compare them with the experiments performed by the committee. The issue then was narrowed to the point whereon they declared that, as the alleged effects of ammonia upon man were different from those they had observed in dogs, therefore the accounts given of its value in snake-poisoning in man were unreliable. It was somewhat amusing however, to find how readily they shifted their ground from a denial that certain recorded phenomena had taken place, to a laboured argument to show that physiologically they could not and ought not. But if even the facts had not been against them, the scientific explanation furnished of how the ammonia really acts, should have been enough to •controvert them.

After all, however, it seems that upon one point both sides are agreed. They mutually admit that the remedy to be given is ammonia, only the opponents of the Halford method would put it into the rectum, where it would stay and do no good, while its advocates more rationally would inject it into the circulation, where it would reach the heart. In the next series of experiments let us hope the rectum plan will be tried. It only requires this further test of the ammonia treatment, to bring the opponents of Professor Raiford's. plan into complete accord with its most enthu-siastic supporters.

MELBOURNE HOSPITAL CHRONICLES. July 4.—Committee Meeting. Dr. Lewellin having completed

two years' service as Resident, was re-appointed with additional salary.

July 18.—Committee Meeting. Dr. Williams reported in reference to a complaint made respecting an alleged unnecessary post mortem examination upon a man named Kiely, that the autopsy had been made in accordance with the rules of the institution.

1876.] Local Topics. 243

The chairman (Mr. Bailliere) stated that he wished to call attention to the fact that two men had recently been admitted to the institution evidently suffering from some internal injuries. The cases had been placed in Mr. Beaney's ward, and he had called a consultation upon them, but they had not been attended by the other honorary surgeons. He had therefore allowed them to be treated by the resident medical officers, and both men had subse-quently died.

July 21.—Meeting of the Contributors at the AthenEeum for the purpose of confirming the by-laws. They were confirmed without discussion.

July 25.—Committee Meeting. The following motion was adopted : " That a sub-committee, consisting of Messrs. Moody, Bailliere, Knaggs, and Aarons, be appointed to inquire into the statements made by Mr. Gunsler, charging Mr. M`Guigan, a member of the ball sub-committee, with being beneficially interested in the contract for the ball refreshments."

LOCAL TOPICS.

The following gentlemen registered their qualifications at the meeting of the Medical Board on the 7th July : John Cornelius Fonsworth, Wagga Wagga (N. S.W .), M.R.C.S. Eng., L. S.A. Lond. 1865 ; Charles Henry Haines, Melbourne, M.D. et Ch. M.I. 1870 ; Francis Meagher, Harricks, Corowa (N.S.W.), L.R.C.S.I. 1870, L. et L.M.K.Q. C.P.I. 1871; Alexander Mackintosh, Melbourne, M.B. et Ch. M. Glas. 1874; Hugh Mackintosh, Melbourne, L.R.C.S.I. 1875 ; Henry Francis McGrath, Rokewood, M.R.C.S. Eng. 1857 ; William Ryan, Albury (N. S.W.), L.R.C. S.I. 1874, L. et L.M.K.Q.C.P.I. 1875 ; William Francis Sweetnam, Hamilton, M.D. et Ch. M.Q.U.I. 1869. The following

.additional qualification was registered : J. J. Wolfenden, Dunolly, L. et L.M.K.Q.C.P.I. 1875.

The following gentlemen have lately been appointed officers of health : Mr. James Morton, for Footscray ; Mr. John Tuck, for Graytown ; Mr. D. W. Eaton, for Portland ; Mr. Richard Bunce, for Sebastopol ; Dr. J. B. Elmes, for Lilydale.

The following vaccinators have lately been appointed : Mr. J. H. Wolfenden, for the district of Bealiba, vice Mr. Bridgman resigned ; Dr. W. L. Richardson, for the district of Chiltern, vice Dr. Rohner resigned ' • Mr. W. E. Crook, for the district of Ceres ; Mr. R. S. Stewart for the district of Carngham, vice Dr. Kieser resigned ; Mr. H. F. McGrath, for the district of Rokewood, vice Mr. A. B. Vanes resigned ; Mr. R. Bunce, for the district of Sebastopol and Cambrian Hill, vice Mr. H. Barnett, resigned ; Dr. C. Kieser, for the district of Macarthur, vice Dr. Wylie deceased.

On the 20th July, a presentation was made to the late resident medical officer of the Alfred Hospital, Mr. John Cooke, who, after three years' tenure of office, had severed his connection with the institution, in order to commence private practice in Prahran. It consisted of an illuminated address, and was signed by the officers, servants, and patients.

244 Notices to Correspondents. [July,

On Friday, June 30, Dr. Gibson, of Blackwood, committed suicide by taking hydrocyanic acid while in a condition of delirium tremens.

Dr. George Haley has been elected resident surgeon to the Wangaratta7District Hospital, vice Dr. Poulton resigned.

On June 30th, Mr. Sydney Gibbons delivered a lecture before the Australian Health Society, on " Kissing, and its Consequences," his object being to show that many forms of disease, especially those presumed to depend upon fungoid bodies for their reproduction, are communicated by this means.

As an instance of the folly and danger of trusting to non-medical publications for medical advice, the newspapers in an adjoining colony lately quoted from the Cincinnati Gazette the following, " Cure for Epilepsy." "Take of bromide of potassa two and one-half ounces, dissolved in one pint of rain water. Dose : a tablespoonful three times a day before eating. Should, your throat become sore, weaken it." Taking an imperial pint of water to be meant, the dose would be just a drachm !

At a meeting of the Central Board of Health on the 12th, it was resolved to call on the local boards of health to enforce the provisions of the Act for the Prevention of Adulteration of Articles of Food or Drink, in consequence of a recent analysis of the confectionery commonly sold in and about Melbourne, having shown that the colours in a good many samples were produced by means of poisonous materials, such as chromate of lead and arsenite of copper, and that the colouring matter is frequently used in such large proportions as to render the articles highly dangerous to health.

In the early part of this month (July), the news was received in this colony of the death on the 4th of Mr. F. T. Van Hemert, and of Mrs. Van Hemert in Dunedin. Mr. Van Hemert's former long residence in this colony at once prompted those who had known him, to commence a subscription for the relief of his family of nine children, who, it was said, were left unprovided for. About four hundred pounds were thus raised.

NOTICES TO CORRESPONDENTS.

Communications have been , received from Mr. Rudall, Dr. McCrea , Mr. T. R. Wilson.

The following publications have been received : The Lancet for May 6, 13, 20, 27 ; The British Medical Journal for May 6, 13, 20, 27; The Medical Press and Circular for May 3, 10, 17, 24 ; The London Medical Record for May ; The Students' Journal for May 6, 20 ; The New York Medical Record for May 20, 27, June 3, 10 ; The Pacific Medical and Surgical Journal for June ; The New York Medical Journal for June ; Specimen fasciculus of a catalogue of the (U.S.) National Medical Library ; Burgoyne Burbidge's and Co.'s Monthly Prioes Current for May 15 ; The Anglo-Indian Commercial Advertiser for April 30 ; Le Courier de l'Europe for April 29 ; Abstracts of Specifications of Patents, Metals part II., section 1 ; The. Histo-chemistry and Pathology of Tubercle, by William Thomson ; An essay on the Wines sent to the late Intercolonial Exhibition, by the Rev. J. J. Bleasdale, D.D.

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Australian Medical Journal 1876

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