DANGER IN THE SUBCUTANEOUS INJECTION OF SOLUTIONS OF CROTALIN
Journal of the American Medical Association
In a preliminary report in 1910, Dr. Ralph H. Spangler1 reported the results of the treatment of eleven eases of epilepsy by injections with a solution of the venom of the rattlesnake (Crotalus horridus). In a second paper2 he reported on fifty-one additional cases treated with rattlesnake venom. Since then there have appeared reports from others on the use of solutions of crotalin for the treatment not only of epilepsy, but also of certain other conditions, including tuberculosis, all based on
... losis, all based on purely empiric grounds. I shall not discuss at this time whether or not rattlesnake venom is a cure for epilepsy, nor shall I enter into an analysis of the reported effect on the course of the disease of the venom treatment; but I think it proper to state that it hardly seems permissible to conclude from the published reports that the treatment was of any very great permanent benefit. In the second paper Spangler gives certain information on the method of preparation of the venom solu¬ tion, dosage, local reaction, and other matters connected with the treatment. The points which, at this time, mostly concern us are in regard to the solution and the local reaction. It is stated in the paper that the solution used should be "as near a standard and as uniform as possible," and that it consists of the "dried, crystal-like scales, from the venom of Crotalus horridus, dissolved in sterile water, to which has been added a few drops of trikresol for its preservative and antiseptic effect." "This sterile, antiseptic solution" is dispensed in sterile ampules con¬ taining one dose each. In view of what is said later it will be apparent to every one that a sterile solution is not always dispensed : on the contrary, solutions prepared, as suggested, have been found to contain dangerous bacteria, and death has resulted from the use of such a solution. If by a "standard, uniform solution" is meant a solution of uniform toxicity for equal weights of dried venom, it is difficult to understand how such a standard solution can always be obtained, especially since Noguchi states that different observers estimate that the loss in weight by drying of the fresh venom is from 25.15 to 50 per cent. swelling, erythema and cellulitis produced by the injec¬ tion of rattlesnake venom, and that even in the same person great variation is noted in the local reaction. He says that at times 1/100 grain will cause a more severe local reaction than will 1/50 grain at another time. This to my mind is more probably an indication of the lack of uniformity in the strength of the venom solution than of variation in susceptibility of the individual. He emphasizes the statement that a good local reaction is necessary to produce a systemic effect, and that the "value of the treatment bears a direct relation to the presence of a satisfactory local reaction." There can hardly be any doubt that a severe local reaction is likely to make a more profound psychic impression, but there also can be little doubt that a severe local reaction is more likely to invite secondary infection, and especially to favor the growth in the tissues of certain anaerobic bacteria such as were found in the tissues of the fatal case referred to in this paper. This brings up another very important point in regard to the dangers of the use on almost empiric grounds of rattlesnake venom for the treatment of certain diseases. Weir Mitchell many years ago pointed out the great possibility of a secondary infection in a subject which survives the acute action of rattlesnake poison, and also called attention to the rapid decomposition following death from snake venom. Welch and Ewing in 1893 showed that rattlesnake venom has the property of almost completely destroying the bactericidal power of the blood.