Junk, I y 10.J DANGER OF INTRAVENOUS INJECTION OF PERMANGANATE. .201

riginal ^I'trcles.

THE TREATMENT OF SNAKE-BITE CASES

WITH POTASSIUM PERMANGANATE.

By VV. B. BANNEKMAN, m.d., d.sc.,

LT.-COL.,

Director, Bombay Bacteriological Laboratory.

At the Bombay Medical Congress last year several papers were read on snake-bite and the

treatment of snake-poisoning. In one of these

papers printed at pages 250-251 of the Trans-

actions recently published, we find discussed

the advisability of using potassium permanga- nate as an antidote. After stating the well-

known fact tliat this chemical will neutralise

snake venom if mixed with it, and calling attention to the difficulty that Fay re r had

found in bringing the two substances into close - ? 1 *

contact in the tissues^of the victim ; the article

proceeds as follows :? "Now it appears to me

there is no difficulty in bringing the two substances into intimate

relationship in the system if the permanganate is injected into the blood stream instead of

into the tissues. As far as I am aware this has

never been done, and I think that exhaustive

experiments should he made on the lower

animals with a view to determining the efficacy of this agent, administered in this fashion, and

fixing a dose." Later in the same paper the

author recommends " the intravenous injection

of 350 c.c. of a 5 per cent, solution of permanga- nate of potash

" in cases of snake-poisoning in

human beings. It is against this procedure that I wish to

warn the medical profession, and the urgency of

the matter must be the excuse for the publica- tion of uncompleted experiments.

In the course of carrying out certain experi- ments ordered by the Government of India, to

test the value or otherwise of potassium permanganate as an antidote for snake venom, it was necessary to use the intravenous method of administration. As a preliminary a few

control experiments were curried out to see if

this salt was harmless when injected into the

blood stream. As 350 c.c. of a 5 per cent, solu-

tion was recommended for ^he treatment of a

human case, it was thought that about 50 c.c. of a similar solution might safely be injected in the case of a dog of about twenty pounds weight. Accordingly a warmed solution of this strength was slowly injected into h

vein of the hind leg of a dog weighing lbs. 15. When ten c.c. had been

introduced, however, the dog was gasping for breath and was dead in 75 seconds. Post-

mortem examination revealed the cause of death to be intravascular clotting. Further experi- ments confirmed this trial ; 5 c.c. being suffi-

cient to cause death in 63 seconds.

Experiments with a solution of potassium permanganate of a strength

of 0'5 per cent, only Sid not cause sucli suddeii death, but the result

was just as certain. For instance, a dog of

fifteen pounds weight, received 40 c.c. of a 0*5

per cent solution of potassium permanganate Intravenously in the course of 4 minutes.

Next day the leg was swollen and cedematoii?, but gradually became normal

in size. The dog died however, seven days after injection in a

very' wasted condition. The -post-mortem examination revealed intense yellow discoloura-

tion of the whole of the tissues. II,e liver

was lemon-yellow coloured and very friable, null reminded one of the appearances seen in

acute phosphorus poisoning The right lung was highly congested and hepatised- coking, though portions floated

m water. Both kidneys highly congested. , . .

Another do" to which oO c.c. were adminis-

tered intravenously was in 15 minutes attacked

b? Violent colic, passing blood-stained mucus.

The urine passed next day was dark brown and

contained traces of manganese. 11,e leg was

very much swollen. J he dog died on the

^Tlie post-mortem examination showed con-

crested lungs. Heart contained clots Liver pale and mottled like a fatty

liver and bile-s ained.

Kidneys enlarged and purple coloured and

much congested. The spleen was crepitant like a lun? and several bubbles

of air were noticed

under" the capsule. On section, air was easily n fl.

' the cut surface. As the car-

expiess fectiy fresh, this could not have

beenTe8 to decomposition but was probably

?1 hy t?s.- potassium p '

() pained several inky-black collnpse ant

a pin_head to that of a

maSlTSnea The vein of the injected leg was small Pea- . tire length, and about an

inc7,mof?cTot projected up into the vena cava. After the above experiences lie would be a

. TV ..iim (lied such methods on man

even in'the attempt to save him from death from

8nTheebtreeatment "f snake-bite by the local . . e s. r>pi* cent, solution or potassium iniection ot a o pei .

r . .

~rman?anate is likewise not a very promising

method?at least so far as our experiments have n produces local gangrene and

yet gone, foit 10 oc P b J

extensive sloughing01 f j

under the skin of a do0