THE DOCTOR'S BAG
the blog about 19th century Medicine and Surgery
Keith Souter aka Clay More
Rattlesnake (Crotalus horridus) bites are common in western novels and movies. The treatment of them always involved pulling out a knife, cutting a cross over the bite, then sucking out the poison and spitting it away. The knife blade would then be heated to red heat and used to cauterize the wound. The bitten person would then develop a fever and probably rave deliriously throughout the night beside a stoked up fire. By morning, he would probably be shown to have recovered.
It would not be so simple, but that is an abbreviated form of the treatment that was usually advocated in the Old West of yesteryear.
Most rattlesnake venom actually contains a hemotoxin. (especially the western and eastern diamondback rattlesnakes). This toxin causes blood cells to burst and it tends to cause blood clotting and it also causes (sometimes widespread) tissue damage. Shock can occur and bites can prove fatal to humans, although it is rare. Currently, about 7,000 to 8,000 people receive rattlesnake bits every year, but only about five prove fatal. How serious a bite will be depends on what part of the body is bitten, the amount of venom injected by the snake and the species involved. The fatality is more likely if the person is very young, very old or in impaired health.
Some species also have a neurotoxin. This can cause paralysis and is more dangerous. The Mohave rattlesnake, for example, has this toxin in its venom.
Sushruta, a surgical genius
The basic treatment outlined above has been used by people throughout the world for centuries. The Indian physician Sushruta, who practiced in the fifth century BC, described the treatment for a venomous snakebite. A tourniquet was to be applied to the limb bitten, to contain the venom. The wound should then be sliced open, between the fangs, to allow drainage of the venom. The venom should then be sucked out, or encouraged out by use of cupping. Basically, a glass cup would be prepared by burning a candle or burning ball and placing the cup over it, which would burn the oxygen away to create a vacuum. The cup was then rapidly put over the wound to draw the venom out by suction. Then cauterization would be used.
In the Old West branding irons, cigars or even gunpowder would be applied to the wound to cauterize it. Some doctors advised cutting the wound out entirely. This was because the hemotoxic can cause extensive necrosis or death of the local tissues.
Dr John Packard, surgeon to the Episcopal Hospital and St Joseph’s Hospital, Philadelphia, wrote about snakebite treatment in the International Encyclopedia of Surgery in 1882. He states that Bibron’s antidote was advocated by many doctors. It had been invented by Professor Gabriel Bibron (1806-1848), a French naturalist. It consisted of bromine, mercury bichloride and potassium iodide.
The following case in which it was used was reported by Dr Charles H Hughes, surgeon of the 1st Infantry Regiment, in the American Journal of the Medical Sciences, 1864.
“Private William Vinoss, Co. F. Ist Infantry Mo. Vol., Mil., a German,
aged 22, entered the regimental hospital July 13th, having been bitten a few
hours previously by a genuine specimen of the reptile known in the West-
ern States as the copperhead. The seat of the bite was the extremity of
the little finger of the left hand.
Immediately after the reception of the bite, the comrades of the bitten
man applied a tight ligature around the finger, a little anterior to the
metacarpo-phalangeal articulation, which effectually prevented the venom
from mingling with the general circulation, and dosed him with whiskey,
but not in sufficient quantities to produce intoxication. In this condition
he was brought to the hospital, and on the morning of the fourteenth,
the treatment to which we attributed his recovery was instituted.
Few other surgeons would have hazarded an attempt to save the finger,
but would have removed it at once, and been content with the salvation of
the patient's life, considering it cheaply purchased at the expense of simply
a finger; we began our treatment with the design, if possible, of not only
saving the whole, but of preserving the part also.
To fulfil the indications which presented as necessary for the salvation of
the finger, we loosened the ligature, incised the finger as for whitlow, and
immersed it in warm water for twenty-four hours. To this treatment we
added an emollient anodyne poultice on the third day, and continued it
through the fourth, when simple cerate dressings were daily applied until
July 30th, at which time he was returned to duty.
This constituted all the local treatment save the lancing of the sacs of
infiltrated blood and serum, and the application of anodyne and astringent
lotions to the hand and forearm.
In the part all the customary symptoms of venomous snakebite were
manifest. The black and deadened appearance around the bite, the sero-
sanguinolent exudation and the excruciating pain were all present in the
finger from the time the bite was received, and as soon as we loosened the
ligature, became apparent in the hand and forearm. Here the swelling
was great and the pain intense; the former extending to the elbow, and the
latter reaching to the axilla.
Constitutional symptoms were but slightly manifest. They consisted in
slight nausea, a little anxiety of countenance, faintness and rigors, all of
which very speedily disappeared as soon as the antidote had taken full
effect upon the system.
The constitutional treatment consisted exclusively of Bibron's antidote,
which was commenced ( a fluid drachm diluted with a tablespoonful of wine or brandy) soon after the ligature was removed and the dose
repeated, on the first day, every three or four hours, on the second three times a day,
and on the third day pro re nata (when needed). In all, about twelve doses were given.
No internal anodynes were exhibited, and no other internal remedies, ex-
cept a copious draught of whiskey at bedtime to procure sleep.”
The patient recovered and his finger was saved. It is unclear why this treatment would have worked, yet clearly it was considered efficacious for decades until it became obsolete by the end of the century.
Ammonia was another treatment that found usage throughout the century.
Tobacco juice and Snakeroot
Native Americans used to apply tobacco juice to snakebites and make a poultice from mashed leaves of tobacco.
Snakeroot, Aristolochia serpentaria, was also used. The root would be chewed and a poultice of the root applied to the wound. It is, however extremely nephrotoxic, meaning that it can damage the kidneys, so it should not be used today. In fiction, however, under the administration of a wise medicine man, it would be plausible.
What should you do today?
- The 'ligate, cut, suck and burn treatment’ advised in the past is no longer advocated. Instead, you should:
- aim to protect the person from getting bitten again
- identify the species of snake if possible
- keep the person calm, so be reassuring
- call for help, to get the person to medical care
- place the bitten limb, if it is a limb that was bitten, below the level of the heart, to minimize movement of the venom make the limb comfortable by removing rings, bracelets, etc
- don’t cut or suck the wound
- don’t give alcohol or other drugs
Some of Clay More's latest releases:
- a novelette- novella
Sam Gibson used to be a lawman, until the day he made a terrible mistake that could never be taken back. Since then, he has alternated between wishing there were a way he could redeem himself and believing he deserved punishment.
He’s about to get both…
And his collection of short stories, including Rattler's Nest, about Doc Marcus Quigley is published by High Noon Press
Available at Amazon.com:
And his latest western novel Dry Gulch Revenge was published by Hale on 29th August.
And the collection of these posts has just been published in book form by Sundown Press.