POISONOUS SERPENTS AND THEIR VENOM.

By Dr. G. ARCHIE STOCKWELL.

Chemistry has made astounding strides since the days of the sixteenth century, when Italian malice and intrigue swayed all Europe, and poisons and poisoners stalked forth unblushingly from cottage and palace; when crowned and mitered heads, prelates, noblemen, beneficed clergymen, courtiers, and burghers became Borgias and De Medicis in hideous infamy in their greed for power and affluence; and when the civilized world feared to retire to rest, partake of the daily repast, inhale the odors of flower or perfume, light a wax taper, or even approach the waters of the holy font. These horrors have been laid bare, their cause and effect explained, and tests discovered whereby they may be detected, providing the law with a shield that protects even the humblest individual. Great as the science is, however, it is yet far removed from perfection; and there are substances so mysterious, subtle, and dangerous as to set the most delicate tests and powerful lenses at naught, while carrying death most horrible in their train; and chief of these are the products of Nature's laboratory, that provides some sixty species of serpents with their deadly venom, enabling them in spite of sluggish forms and retiring habits to secure abundant prey and resent mischievous molestation. The hideous trigonocephalus has forced the introduction and acclimation of the mongoose to the cane fields of the Western tropics; the tiger snake (Heplocephalus curtus) is the terror of Australian plains; the fer de lance (Craspedocephalus lanceolatus) renders the paradise of Martinique almost uninhabitable; the tic paloonga (Daboii russelli) is the scourge of Cinghalese coffee estates; the giant ehlouhlo of Natal (unclassified) by its presence secures a forbidding waste for miles about; the far famed cobra de capello (Naja tripudians) ravages British India in a death ratio of one-seventh of one per cent. of the dense population, annually, and is the more dangerous in that an assumed sacred character secures it largely from molestation and retributive justice; and in Europe and America we have vipers, rattlesnakes, copperheads, and moccasins (viperinæ and crotalidæ), that if a less degree fatal, are still a source of dread and annoyance. All these forms exhibit in general like ways and like habits, and if the venom of all be not generically identical, the physiological and toxicological phenomena arising therefrom render them practically and specifically so. Indeed, their attributes appear to be mere modifications arising from difference in age, size, development, climate, latitude, seasons, and enforced habits, aided perhaps by idiosyncrasies and the incidents and accidents of life.

In delicacy of organism and perfection in mechanism and precision, the inoculatory apparatus of the venomous reptile excels the most exquisite appliances devised by the surgical implement maker's art, and it is doubtful whether it can ever be rivaled by the hand of man. The mouth of the serpent is an object for the closest study, presenting as it does a series of independent actions, whereby the bones composing the upper jaw and palate are loosely articulated, or rather attached, to one another by elastic and expansive ligaments, whereby the aperture is made conformatory, or enlarged at will—any one part being untrammeled and unimpeded in its action by its fellows. The recurved, hook-like teeth are thus isolated in application, and each venom fang independent of its rival when so desired, and it becomes possible to reach points and recesses seemingly inaccessible.

The fangs proper, those formidable weapons whose threatening presence quails the boldest opponent, inspires the fear of man, and puts to flight the entire animal kingdom—lions, tigers, and leopards, all but the restless and plucky mongoose—and whose slightest scratch is attended with such dire results, are two in number, one in each upper jaw, and placed anteriorly to all other teeth, which they exceed by five or six times in point of size. Situated just within the lips, recurved, slender, and exceeding in keenness even the finest of cambric needles, they are penetrated in their longitudinal diameter by a delicate, hair-like canal opening into a groove at the apex, terminating on the anterior surface in an elongated fissure. As the canal is straight, and the tooth falciform, a like groove or longitudinal fissure is formed at the base, where it is inclosed by the aperture of the duct that communicates with the poison apparatus.

At the base of each fang, and extending from a point just beneath the nostril, backward two-thirds the distance to the commissure of the mouth, is the poison gland, analogous to the salivary glands of man, that secretes a pure, mucous saliva, and also a pale straw-colored, half-oleaginous fluid, the venom proper. Within the gland, venom and saliva are mingled in varying proportions coincidently with circumstances; but the former slowly distills away and finds lodgment in the central portion of the excretory duct, that along its middle is dilated to form a bulb-like receptacle, and where only it may be obtained in perfect purity.

When the reptile is passive, the fangs are arranged to lie backward along the jaw, concealed by the membrane of the mouth, and thus offer no impediment to deglutition. Close inspection, however, at once reveals not only their presence, but also several rudimentary ones to supply their place in case of injury or accident. The bulb of the duct, too, is surrounded by a double aponeurotic capsule, of which the outermost and strongest layer is in connection with a muscle by whose action both duct and gland are compressed at will, conveying the secretion into the basal aperture of the fang, at the same time refilling the bulb.

When enraged and assuming the offensive and defensive, the reptile draws the posterior portion of its body into a coil or spiral, whereby the act of straightening, in which it hurls itself forward to nearly its full length, lends force to the blow, and at the same instant the fangs are erected, drawn forward in a reverse plane, permitting the points to look outward beyond the lips. The action of the compressor muscles is contemporaneous with the blow inflicted, the venom being injected with considerable violence through the apical outlets of the fangs, and into the bottom of the wound. If the object is not attained, the venom may be thrown to considerable distances, falling in drops; and Sir Arthur Cunynghame in a recent work on South Africa relates that he was cautioned not to approach a huge cobra of six feet or more in length in its death agony, lest it should hurl venom in his eyes and create blindness; he afterward found that an officer of Her Majesty's XV. Regiment had been thus injured at a distance of forty-five feet, and did not recover his eyesight for more than a week.¹

With the infliction of the stroke and expression of its venom, the creature usually attempts to reverse its fangs in the wound, thereby dragging through and lacerating the flesh; an ingenious bit of devilishness hardly to be expected from so low a form of organism; but its frequent neglect proves it by no means mechanical, and it frequently occurs that the animal bitten drags the reptile after it a short distance, or causes it to leave its fangs in the wound. Some serpents also, as the fer de lance, black mamba, and water moccasin, are apparently actuated by most vindictive motives, and coil themselves about the part bitten, clinging with leech-like tenacity and resisting all attempts at removal. Two gentlemen of San Antonio, Texas,² who were bitten by rattlesnakes, subsequently asserted that after having inflicted all possible injury, the reptiles scampered away with unmistakable manifestations of pleasure. "Snakes," remarked one of the victims, "usually glide smoothly away with the entire body prone to the ground; but the fellow I encountered traveled off with an up and down wave-like motion, as if thrilled with delight, and then, getting under a large rock where he was safe from pursuit, he turned, and raising his head aloft waved it to and fro, as if saying. 'Don't you feel good now?' It would require but a brief stretch of the imagination to constitute that serpent a veritable descendant of the old Devil himself."

As the first blow commonly exhausts the receptacle of the duct, a second (the venom being more or less mingled and diluted by the salivary secretion) is comparatively less fatal in results; and each successive repetition correspondingly inoffensive until finally nothing but pure mucus is ejected. Nevertheless, when thoroughly aroused, the reptile is enabled to constantly hurl a secretion, since both rage and hunger swell the glands to enormous size, and stimulate to extraordinary activity—a fortuitous circumstance to which many an unfortunate is doubtless indebted for his life. The removal of a fang, however, affects its gland to a degree that it becomes almost inoperative, until such a time as a new tooth is grown, and again calls it into action, which is commonly but a few weeks at most; and a person purchasing a poisonous serpent under the supposition that it has been rendered innocuous, will do well to keep watch of its mouth lest he be some time taken unaware. It may be rendered permanently harmless, however, by first removing the fang, and then cauterizing the duct by means of a needle or wire, heated to redness; when for experimental purposes the gland may be stimulated, and the virus drawn off by means of a fine-pointed syringe.

In what the venom consists more than has already been described, we are not permitted to know. It dries under exposure to air in small scales, is soluble in water but not in alcohol, slightly reddens litmus paper, and long retains its noxious properties. It has no acrid or burning taste, and but little if any odor; the tongue pronounces it inoffensive, and the mucous surface of the alimentary track is proof against it, and it has been swallowed in considerable quantities without deleterious result—all the poison that could be extracted from a half dozen of the largest and most virile reptiles was powerless in any way to affect an unfledged bird when poured into its open beak. Chemistry is not only powerless to solve the enigma of its action, and the microscope to detect its presence, but pathology is at fault to explain the reason of its deadly effect; and all that we know is that when introduced even in most minute quantities into an open wound, the blood is dissolved, so to speak, and the stream of life paralyzed with an almost incredible rapidity. Without test or antidote, terror has led to blind, fanatical empiricism, necessarily attended with no little injury in the search for specifics, and it may be reasonably asserted that no substance can be named so inert and worthless as not to have been recommended, or so disgusting as not to have been employed; nor is any practice too absurd to find favor and adherents even among the most enlightened of the medical profession, who have rung all the changes of the therapeutical gamut from serpentaria³ and boneset to guaco, cimicifugia, and Aristolochia India to curare, alum, chalk, and mercury to arsenic; and in the way of surgical dressings and appliances everything from poultices of human fæces,⁴ burying the part bitten in fresh earth,⁵ or thrusting the member or entire person into the entrails of living animals, to cupping, ligatures, escharotics, and the moxa.

Although the wounds of venomous serpents are frequently attended with fatal results, such are not necessarily invariable. There are times and seasons when all reptiles are sluggish and inactive, and when they inflict comparatively trifling injuries; and the poison is much less virulent at certain periods than others—during chilling weather for instance, or when exhausted by repeated bites in securing sustenance. Young and small serpents, too, are less virile than large and more aged specimens, and it has likewise been observed that death is more apt to follow when the poison is received at the beginning or during the continuance of the heated term.

The action of the venom is commonly so swift that its effects are manifested almost immediately after inoculation, being at once conveyed by the circulatory system to the great nervous centers of the body, resulting in rapid paralysis of such organs as are supplied with motive power from these sources; its physiological and toxicological realizations being more or less speedy accordingly as it is applied near or remote from these centers, or infused into the capillary or the venous circulation. Usually, too, an unfortunate experiences, perhaps instantaneously, an intense burning pain in the member lacerated, which is succeeded by vertigo, nausea, retching, fainting, coldness, and collapse; the part bitten swells, becomes discolored, or spotted over its surface with livid blotches, that may, ultimately, extend to the greater portion of the body, while the poison appears to effect a greater or less disorganization of the blood, not by coagulating its fibrine as Fontana surmised, but in dissolving, attenuating, and altering the form of its corpuscles, whose integrity is so essential to life, causing them to adhere to one another, and to the walls of the vessels by which they are conveyed; being no longer able to traverse the capillaries, œdema is produced, followed by the peculiar livid blush. Shakespeare would appear to have had intuitive perception of the nature of such subtle poison, when he caused the ghost to describe to Hamlet

"The leprous distillment whose effect Bears such an enmity to the blood of man That swift as quicksilver, it courses through The natural gates and alleys of the body And with sudden vigor it doth posset And curd like eager droppings into milk, The thin and wholesome blood: so did it mine And a most instant tetter marked about Most lazar like, with vile and loathsome crust All my smooth body."

It is not to be supposed, however, that all or even a major portion of the blood disks require to be changed or destroyed to produce a fatal result, since death may supervene long before such a consummation can be realized. It is the capillary circulation that suffers chiefly, since the very size and caliber of the heart cavities and trunk vessels afford them comparative immunity. But of the greatly dissolved and disorganized condition of the blood that may occur secondarily, we have evidences in the passive hæmorrhages that attack those that have recovered from the immediate effects of serpent poisoning, following or coincident with subsidence of swelling and induration; and, as with scurvy, bleeding may occur from the mouth, throat, lungs, nose, and bowels, or from ulcerated surfaces and superficial wounds, or all together, defying all styptics and hæmastatics. In a case occurring under the care of Dr. David Brainerd in the Illinois General Hospital,⁶ blood flowed from the gums in great profusion, and on examination was found destitute, even under the microscope, of the faintest indications of fibrine—the principle upon which coagulation depends. The breath, moreover, gave most sickening exhalations, indicative of decomposition, producing serious illness in those exposed for any length of time to its influence. We may add, among other sequelæ, aside from death produced through primary and secondary effects, paralysis, loss of nerve power, impotence, hæmorrhage, even mortification or gangrene.

The failure in myotic power of the heart and in the muscles of respiration through reflex influence of par vagum and great sympathetic nerves, whereby pulmonary circulation is impeded, are among the earliest of phenomena. Breathing becoming retarded and laborious, the necessary supply of oxygen is no longer received, and blood still venous, in that it is not relieved of its carbon, is returned through the arteries, whereby the capillaries of the brain are gorged with a doubly poisoned circulation, poisoned by both venom and carbon. In this we have ample cause for the attending train of symptoms that, beginning with drowsiness, rapidly passes into stupor followed by profound coma and ultimate dissolution—marked evidence of the fact that a chemical agent or poison may produce a mechanical disease; and autopsical research reveals absolutely nothing save the general disorganization of blood corpuscles, as already noted.

Taking circumstantial and pathological evidences into consideration, the hope of the person thus poisoned rests solely upon lack of vitality in the serpent and its venom, and in his personal idiosyncrasies, habits of life, condition of health, etc., and the varied chapters of accidents. To look for a specific, in any sense of the word, is the utmost folly! The action of the poison and its train of results follow inoculation in too swift succession to be overtaken and counteracted by any antidote, supposing such to be a possible product, even if administered hypodermically. We have evidence of this in iodic preparations, iodine being the nearest approach to a perfect antidote that can be secured by mortal skill, inasmuch, if quickly injected into the circulation, it retards and restrains the disorganizing process whereby the continuity of the blood corpuscles is lost; moreover, it is a marked antiseptic, favors the production of adhesive inflammation, whereby lymph is effused and coagulated about the bitten part, and absorption checked, and the poison rendered less diffusible. But when a remedy is demanded that shall restore the pristine form, functions, and energy of the disorganized globules, man arrogates to himself supernal attributes whereby it becomes possible not only to save and renew, but to create life; and we can scarce expect science or even accident (as some expect) to even rival Nature and set at defiance her most secret and subtle laws. Such, however, is the natural outcropping of an ignorant teaching and vulgar prejudice that feeds and clothes the charlatan and ascribes to savage and uncultured races an occult familiarity with pathological, physiological, and remedial effect unattainable by the most advanced sciences; and whereby the Negro, Malay, Hindoo, South Sea Islander, and red man are granted an innate knowledge of poisons and their antidotes more than miraculous. A reward of more than a quarter of a century's standing, and amounting to several thousand pounds, is offered by the East India Government for the discovery of a specific for the bite of the cobra, and for which no claims have ever been advanced; and the "snake charmers" or jugglers in whom this superior knowledge is supposed to center are so well aware of the futility of specifics, and the risk to which they are subjected, that few venture to ply their calling without a broad-bladed, keen-edged knife concealed about the person as a means of instant amputation in case of accident. Medical and scientific associations of various classes, in Europe, Australia, America, even Africa, and the East and West Indies, have repeatedly held out the most tempting lures, and indulged in exhaustive and costly experimentation in search of specifics for the wounds of vipers, cobras, rattlesnakes, and the general horde of venomous reptiles; and all in vain. Even the saliva of man, as well as certain other secretions, is at times so modified by anger as to rival the venom of the serpent in fatality, and it has no specific; and a careful analysis of the pathological relations of such poison proves that further experimentation and expectation is as irrational as the pursuit of the "philosopher's stone."

It is an indisputable fact, however, that there are individuals whose natural or acquired idiosyncrasies permit them to be inoculated by the most venomous of reptiles without deleterious or unpleasant results, and Colonel Matthews Taylor⁷ knew several persons of this character in India, and who regarded the bite of the cobra or tic paloonga with nearly as much indifference as the sting of a gnat or mosquito. Again, in 1868, Mr. Drummond, a prominent magistrate of Melbourne, Australia,⁸ met with untimely death under circumstances that attracted no little attention. An itinerant vender of nostrums had on exhibition a number of venomous reptiles, by which he caused himself to be successively bitten, professing to secure immunity by reason of a secret compound which he offered for sale at a round figure. Convinced that the fellow was an imposter, and his wares valuable only as a means of depleting the pockets of the credulous, Mr. Drummond loudly asserted the inefficacy of the nostrum, as well as the innocuousness of the reptiles, which he assumed to be either naturally harmless, or rendered so by being deprived of their fangs; and in proof thereof insisted upon being himself bitten. To this experiment the charlatan was extremely averse, offering strenuous objections, and finally conveyed a point blank refusal. But Mr. Drummond's demands becoming more imperative, and observing that his hesitancy impressed the audience as a tacit acknowledgment of the allegations, he finally consented, and placed in the hands of the magistrate a tiger snake, which he deemed least dangerous, and which instantly struck the gentleman in the wrist. The usual symptoms of serpent poisoning rapidly manifested themselves, followed by swelling and lividity of the part, obstructed circulation and respiration, and coma; and in spite of the use of the vaunted remedy and the attentions of physicians the result was most fatal. The vender subsequently conceded the worthless character of his nostrum, declaring that be enjoyed exemption from the effects of of serpent poison by virtue of recovery from a severe inoculation in early life; and he further added he knew "some people who were born so," who put him "up to this dodge" as a means of gaining a livelihood.

It is a general supposition that such immunity, when congenital, is acquired in utero by the inoculation of the parent, and Oliver Wendell Holmes' fascinating tale of "Elsie Venner" embodies many interesting features in this connection. Admitting such inoculation may secure immunity, recent experiments in the action of this as well as kindred poisons give no grounds for believing it at all universal or even common, but as depending upon occult physiological or accidental phenomena. For instance, the writer and his father are equally proof against the contagion and inoculation of vaccination and variola, in spite of repeated attempts to secure both, while their respective mothers suffered terribly with smallpox at periods subsequent to the birth of their children; and it is well understood that there are striking analogies between the poisons of certain contagious fevers and those of venomous serpents, inasmuch as one attack conveys exemption from future ones of like character. In other words, many animal poisons, as well as the pathological ones of smallpox, measles, scarlatina, whooping cough, etc., have the power of so modifying the animal economy, when it does not succumb to their primary influence, as to ever after render it all but proof against them. Witness, for instance, the ravages of the mosquito, that in certain districts punishes most terribly all new comers, and who after a brief residence suffer little, the bite no longer producing pain or swelling.

Regarding the supposed correlation of serpent poison and the septic ferments of certain tropical and infectious fevers, they are not necessarily always contagious. It may be interesting to note that one Doctor Humboldt in 1852,⁹ in an essay read before the Royal Academy of Medical Sciences at Havana, assumed their proximate identity, and advocated the inoculation of the poison of one as a prophylactic of the other. He claimed to have personally inoculated numberless persons in New Orleans, Vera Cruz, and Cuba with exceedingly dilute venom, thereby securing them perfect immunity from yellow fever. Aside from the extraordinary nature of the statement, the fact that the doctor affirmed, he had never used the virus to an extent sufficient to produce any of its toxic symptoms, cast discredit over the whole, and proofs were demanded and promised. This was the last of the subject, however, which soon passed into oblivion, though whether from failure on the part of the medico to substantiate his assertions, or from the inanition of his colleagues, it is difficult to determine, though the presumption is largely in favor of the former. Nevertheless, it is worthy of consideration and exhaustive experimentation, since it is no less plausible than the theory which rendered the name of Jenner famous.

Outside of the transfusion of blood, for which there are strong reasons for believing would be attended with happy results, the sole remedies available in serpent poisoning are measures looking to the prompt cutting off of the circulation of the affected part, and the direct stimulation of the heart's action and the respiratory organs, until such a time as Nature shall have eliminated all toxical evidences; and these must necessarily be mechanical. Alcoholic stimulants are available only as they act mechanically in sustaining cardiac and pulmonary activity, and where their free use is prolonged efficacy is quickly exhausted, and they tend rather to hasten a fatal result. They are devoid of the slightest antidotal properties, and in no way modify the activity of the venom; and an intoxicated person, so far from enjoying the immunity with which he is popularly credited, is far more apt to succumb to the virus than him of unfuddled intellect. The reasons are obvious. Theoretically, for purely physiological and therapeutic reasons amyl nitrite should be of incalculable value, though I have no knowledge of its use in this connection, since its vapor when inhaled is a most powerful stimulator of cardiac action, and when administered by the mouth it is unapproached in its control of spasmodically contracted vessels and muscles. The relief its vapor affords in the collapse of chloroform anæsthesia, in which dissolution is imminent from paralyzed heart's action, is instantaneous, and its effect upon the spasmodic and suffocative sensations of hydrophobia are equally prompt. Moreover, without further discussing its physiological functions, it is the nearest approach to an antidote to certain zymotic poisons, and especially valuable in warding off and aborting the action of the ferment that gives rise to pertussis, or whooping cough. Iodide of ethyl is another therapeutical measure that is worthy of consideration; and iodoform in the treatment of the sequelæ incident to recovery.

The native population of India, in spite of the contrary accepted opinion, are remarkably free from resort to nostrums that lay claim to being antidotes. The person inoculated by the cobra is at once seized by his friends, and constant and violent exercise enforced, if necessary at the point of stick, and severe and cruel (but nevertheless truly merciful) beatings are often a result. In this we see a direct application, without in the least understanding them, of the rules laid down to secure certain physiological results, as for the relief of opium and morphia narcosis, which serpent poisoning almost exactly resembles. The late Doctor Spillsbury (Physician-General of Calcutta),¹⁰ while stationed at Jubulpore, Central India, was informed late one evening that his favorite horse keeper had just been dangerously bitten by a cobra of unusual size, and therefore more than ordinarily venomous. He at once ordered his gig, and in spite of the wails and protestations of the sufferer and his friends, with whom a fatal result was already a foregone conclusion, the doctor caused his wrists to be bound firmly and inextricably to the back of the vehicle; then assuring the man if he did not keep up he would most certainly be dragged to death, he mounted to his seat and drove rapidly away. Three hours later, or a little more, he returned, having covered nearly thirty miles without cessation or once drawing rein. The horse keeper was found bathed in profuse perspiration, and almost powerless from excessive fatigue. Eau de luce, an aromatic preparation of ammonia, was now administered at frequent and regular intervals as a diffusible stimulant, and moderate though constant exercise enforced until near dawn, when the sufferer was found to be completely recovered.

The value of violent and profuse cutaneous transpiration, thereby securing a rapidly eliminating channel for discharging poison from the system, is well known; in no other way can action be had so thorough, speedy, and prompt. Captain Maxwell¹¹ tells us it was formerly the custom among the Irish peasantry of Connaught, when one manifested unmistakable evidences of hydrophobia, to procure the death of the unfortunate by smothering between two feather beds. In one instance, after undergoing this treatment, the supposed corpse was seen, to the horror and surprise of all who witnessed it, to crawl from between the bolsters, when he was found to be entirely free from his disorder; the beds, however, were saturated through and through with the perspiration that escaped the body in the intensity of his mortal agony. More recently a French physician,¹² recognizing the incubatory stage of rabies in his own person, resolved upon suicide rather than undergo its attendant horrors. The hot bath was selected for the purpose, with a view of gradually increasing its temperature until syncope should be induced, which he hoped would be succeeded by death. To his surprise, however, as the temperature of the water rose, his sensations of distress improved; and the very means chosen for terminating life became instead his salvation, restoring to perfect health. Again, Dr. Peter Hood¹³ relates that a blacksmith residing in the neighborhood of his country house was in high repute for miles about by reason of his cures of rabies. His remedy consisted simply in forcing the person bitten to accompany him in a rapid walk or trot for twenty miles or more, after which he administered copious draughts of a hot decoction of broom tops, as much for its moral effect as for its value in sustaining and prolonging established diaphoresis.

Though the pathological conditions of hydrophobia and serpent poisoning are by no means parallel, the rationale of the methods employed in opening the emunctories of the skin are the same; and were it not for its powerful protracting effect and depressing action upon the heart, we might perhaps secure valuable aid from jaborandi (pilocarpus). since it stimulates profusely all the secretions; as it is, more is to be hoped for in the former disorder than in the latter. It would be desirable also to know what influence the Turkish bath might exert, and it would seem worthy at least of trial.

[1]

Presumably the Natal ombozi, or spitting cobra, Naja hæmachites, who is fully equal to the feat described.

[2]

On the authority of N.A. Taylor and H.F. McDaniels.

[3]

Serpentaria derives its name from its supposed antidotal properties, and guaco and Aristolochia India enjoyed widely heralded but rapidly fleeting popularity in the two Indias for a season. Tanjore pill (black pepper and arsenic) is still extensively lauded in districts whose serpents possess little vitality, but is every way inferior to iodine.

[4]

A Chinese remedy—as might be imagined.

[5]

Still extensively practiced, the first in Michigan, the latter in Missouri and Arkansas, and inasmuch as one is cooling and soothing, and the other slightly provocative of perspiration in the part, are not altogether devoid of plausibility.

[6]

Medical Independent, 1855.

[7]

Vide report to Prof. J. Henry Bennett.

[8]

London Times.

[9]

London Lancet.

[10]

London Lancet.

[11]

Wild Sports or the West.

[12]

L'Union Medicale—name withheld by request of the gentleman.

[13]

London Lancet.