Chapter V - The medical treatment of snake bites

Now we shall discourse on the Chapter which deals with the medical treatment of snake-bites (Sarpa- dashta Kalpa-Chikitsita).

General treatment of Snake-bites:—

In all cases of snake bites ligatures of cloth, skin, soft fibre or any other soft article (consecrated with the proper Mantras), should first of all be bound four fingers apart above the seat of the bite in the event of its occurring in the extremities, inasmuch as such a proceeding would arrest the further (upward) course of the poison in the body. As an alternative, the seat of the bite should be incisioned, bled and cauterized where such a ligature would be found to be impossible. Incision, cauterization, and sucking (of the poisoned blood from the seat of the bite) should be highly recommended in all cases of snake-bites. The cavity of the mouth should be filled with a linen^[1] before sucking (the blood from the wound). It would do the man bitten by a snake an immense good if he could bite the serpent that had bitten him or failing that, bite a clod of earth without any loss of time. 2-3.

The seat of the bite by a Mandali snake should not, however, be cauterized inasmuch as the preponderant Pittaja character of the poison, aggravated by the application of the heat, might lead to its speedy expansion or coursing in the system. 4.

Mantras:—

A physician well-versed in the Mantras of anti-venomous potency should bind a ligature of cord consecrated with appropriate Mantras which would arrest a further spread of the poison. The Mantras full of occult energy of perfect truth and divine communion, disclosed by the Devarshis and Brahmarshis of yore, never fail to eliminate the poison from the system, and hold their own even in cases of deadliest poisons. Elimination of the poison with the help of Mantras, full of the energy of Brahma, of truth and austerities, is more rapid than under the effects of drugs. 5–A.

A man, while learning the Mantras, should forego sexual intercourse, animal diet, wine, honey, etc., should be self-controlled and clean in body and spirit and (before learning the Mantras) shall lie on a mattress of Kusha-grass. For the successful application of his newly acquired knowledge (Mantras), he shall devotedly worship the gods with offerings of perfumes, garlands of flowers, edibles, (animal) oblations, etc., and with the appropriate Mantras sacred to them as well as with burnt offerings, since a Mantra chanted by a man in an unclean spirit or body, or accented or uttered incorrectly will not take effect. The medicinal compounds of anti-venomous drugs should also be employed in such cases. 5.

Blood-letting in Snake-bite:—

A skillful physician should open the veins round the seat of the bite and bleed the affected part. The veins of the fore-head and the extremities should be opened in the case where the poison would be found to have spread through the whole organism. The poison will be found to have been fully eliminated with the passage of the blood (from the incisioned wound). Hence bleeding should be resorted to as it is the best remedy in a case of snake-bite. 6–A.

Plasters of anti-poisonous drugs (Agada) should be applied all round the seat of the bite after scarifying it, which should be sprikled with water mixed with (red) Sandal wood and Ushira or with their decoction. The appropriate Agada compounds (according to the nature of the bite) should be administered through the medium of milk, honey and clarified butter, etc. In the absence of these, the patient should be made to take (a solution of) the black earth of an ant-hill (dissolved in water). As an alternative, (a paste of) Kovidara, Shirisha, Arka and Katabhi should be prescribed for him. The patient should not be allowed to take oil, the soup of Kulattha- pulse, wine and Sauviraka. The patient should be made to vomit with the help of any other suitable liquid available, since vomiting in most cases leads to the elimination of the poison from the system. 6.

Specific treatment of the bite by a hooded (Darvi-kara) Snake:—

In the case of a bite by a hooded (Darvi-kara) snake, bleeding by opening the veins should be resorted to in the first stage of poisoning. In the second stage, the patient should be made to drink an Agada compound with honey and clarified butter. In the third stage, anti-poisonous snuffs (Nasya) and collyrium (Anjana) should be employed. In the fourth stage, the patient should be made to vomit, and medicated Yavagu (gruel) mentioned before (in connection with vegetable poison—see Chapter II, para. 26, Kalpasthana) should then be given him for drink. In the fifth and the sixth stages, after the administration of cooling measures, strong purgatives and emetics should be administered and the foregoing medicated Yavagu (gruel) should be administered to the patient. In the seventh stage, strong medicated Avapida-snuffs and strong collyrium of anti-venomous efficacy should be employed for the purification (purging) of the head. Superficial incisions like the marks of crow’s feet should be made on the scalp and the affected flesh and blood should be removed. 7.

Specific treatment of bites by a Mandali Snake:—

In the first stage of a case of poisoning by the bite of a Mandali snake, the treatment is the same as in the corresponding stage of a Darvi-kara (cobra) bite. In the second stage, an Agada compound should be given with honey and clarified butter and after making the patient vomit the preceding medicated Yavagu (gruel) should be administered to him. In the third stage, after the exhibition of drastic purgatives and brisk emetics, a proper and suitable medicated gruel should be administered. In the fourth and the fifth stages, the treatment would be the same as in the corresponding stages of a Darvi-kara (cobra) bite. In the sixth stage, the drugs of the Madhura (Kakolyadi) Gana taken with milk prove efficacious. In the seventh stage, anti-venomous Agada compound in the shape of Avapida (snuff) would neutralise the effects of poison. 8.

Specific treatment of Rajiman- bites:—

In the first stage of a case of Rajiman -bite, bleeding should be resorted to and an Agada should be administered with milk and honey. In the second stage, emetics and an anti-venomous Agada should be given to the patient. In the third, fourth and fifth stages, the treatment should be the same as in the corresponding stages of a case of Darvi-kara-bite. In the sixth stage, the use of the strongest (anti-venomous) collyrium and in the seventh stage, that of an Avapida (snuff) of similar virtue should be prescribed. 9.

Contra-indication to blood-letting in cases of Snake-bites:—

In the case of an infant, an old man, or an enciente woman having been bitten by a snake, all the foregoing remedies in milder doses with the exception of blood-letting should be employed according to the requirements of the case. 10.

Dosage of Collyrium, etc., to be resorted to incases of different beasts and birds:—

The quantity of medicated collyrium (Anjana) to be used and blood to be let out in the case of a goat or a sheep bitten by a snake should be equal to those laid down in connection with a similar human patient, while the quantity should be doubled in the case of a cow or a horse. In the case of a camel or a buffalo it should be trebled, while in the case of an elephant, it should be quadrupled Birds of what soever species in a similar predicament should, however, be treated only with sprays of cold water and cooling medicated plasters. 11.

General dosage of medicines in cases of Snake-bites:—

In cases of snake bites, collyrium to the weight of one Mashaka (Masha) should be used at a time. The dosage of medicated snuff (Nasya), potions and emetics being respectively double, quadruple and eight times thereof. But a wise physician should treat a case of snake-bite with a full regard to the nature of the country, season, temperament, as well as to the intensity and the particular stage of poisoning the case has reached. 12–13.

We have described the anti-venomous measures and remedies applicable to the different stages of poisoning (by a snake-bite). We shall now deal with the specific treatment of poisoning of either kind according to the physical symptoms developed in the patient. Blood-letting should be speedily resorted to in the case where the poisoned limb had become discoloured, rigid, swollen and painful. Curd, Takra, honey, clarified butter and meat-soups should then be given to the patient affected with a poison marked by a preponderance of the aggravated Vayu and by a craving for food. A person affected with a poison marked by a predominance of the aggravated Pitta would have thirst, epileptic fits, perspiration and a burning sensation in the body and should be treated with shampooing with cold hands and with cold baths, and cooling medicinal plasters. A person affected with a poison marked by a predominance of the aggravated Kapha and bitten in the winter would have cold salivation, epileptic fits and intoxication and should be treated with strong emetics. 14.

Specific treatment of the different Supervening Symptoms:—

Purgatives should be exhibited in the event of the patient being oppressed with such symptoms as pain and burning sensation in the abdomen, Adhmana (tympanites), retention of urine, stool and flatus, painful urination and other troubles of the deranged Pitta. Collyrium should be applied (along the eyelids) in the case of a swelling of the eyeballs, somnolence, discolouring of the eye, cloudiness of vision and discoloured appearance of all objects. The head of the patient should be cleansed (purged) with medicinal errhines (Nasya) in the case of pain and a heaviness of the head, lassitude, lock-jaw, constriction of the throat (Gala-graha) and violent wryneck (Manya-stambha). Powders of such drugs of the Shiro-virecana group as are of strong potency, in the shape of Pradhamana Nasya should be blown into the nostrils of the patient suffering from the effects of poisoning in the case wheresuch symptoms as loss of consciousness, upturned eyes and drooping of the neck would set in. The veins of his forehead and of the extremities should be instantly opened. When such opening of the veins would not be attended with (the desired) bleeding superficial incisions in the shape of cow’s feet (Kaka- pada) should be made by an experienced surgeon on the scalp of the patient. These failing, the incisioned bits of flesh mixed with blood should be removed and the decoction or powders of a Carma-vriksha (Bhurja patra) should be applied to the incisions. Dundubhis (small drums) smeared with anti-venomous plasters should be sounded around the patient. The patient thus restored to consciousness should be treated with both purgatives and emetics. A complete elimination of the poison from the system is a very difficult task but it is indespensably necessary, since the least remnant of the poison may again be aggravated in course of time and cause lassitude, discolouring of the complexion, fever, cough, headache, swelling, emaciation (Shosha), cataract, blindness, catarrh (Pratishyaya), aversion to food and nasal catarrh (Pinasa). These diseases and any other supervening symptoms of poisoning should be treated according to the injunctions laid down under their specific heads with a careful consideration of the Dosha or Doshas involved in each case. 15.

The ligature should then be removed, the seat of the bite incisioned and an Agada plaster should be applied there, so inasmuch as the poison is found to be lodged in a condensed form (in the puncture of the fangs) and is likely to be afterwards aggravated (if not fully eliminated). 16.

Remedy for aggravated Doshas due to poison:—

If the Vayu of the body be found to be in an aggravated condition, even after a careful elimination of the poison from the system with the help of suitable Mantras, measures and medicinal remedies, it should be pacified and restored to its normal conditon with any Vayu-pacifying Sneha, etc., other than oil. The use of fish, Kulattha -soup and acid articles (fermented rice-gruel, etc.) is forbidden. The aggravated Pitta in such a case should be remedied with the application of a Sneha-Vasti and with the decoction of drugs prescribed in cases of Pittaja-fever, while the deranged Kapha should be corrected with Kapha -subduing remedies or with (the decoction of) the drugs of the aragvadhddi Gana mixed with honey, or with a diet consisting of bitter and parching (Ruksha) articles of food. 17.

A person found to be unconscious from the effects of a fall from an uneven ground or from the top of a tree or precipice as well as a drowned man rescued unconscious, or one in a state of suspended animation owing to strangulation should be treated according to the injunctions and with remedies laid down in connection with the treatment of persons who have become unconscious from the effects of poisoning (mentioned in the present chapter). 18.

If a deep seated incision (Praccita) in, or an extremely tight fastening (Arishta) around the seat of the bite, or an application of extremely irritant plasters or any such other application thereon gives rise to a local swelling which emits a bad smell and slimy matter it should be inferred from these that the inherent poison in such a case has putrefied the flesh of the affected part which can be made amenable to medicine only with the greatest difficulty. 19–A.

Sypmtoms of wounds from poisoned darts, etc:—

The poisonous character of a dart or of an arrow with which a person has been pierced (Digdha-viddha) should be inferred from the following symptoms, viz., flow of black-coloured blood from an immediately inflicted wound, suppuration, a constant burning sensation (in the incidental ulcer) and sloughing of black coloured, putrefied and morbid flesh mixed with a mucopurulent discharge from the wound, and thirst, vertigo, epileptic fits, a burning sensation in the body and fever. 19.

Treatment of a poisoned wound:—

In a case where all the above symptoms of poisoning are present whether in a case of snake-bite or of a bite by a spider (Luta). or in a case of being pierced with a venomed arrow, or in a case of poisoning of any kind, where putrefaction has set in, the putrid flesh of the incidental ulcer should be judiciously removed and the vitiated blood of the locality should be speedily extracted by applying leeches thereto. The system of the patient should then be cleansed with purgatives and emetics and the affected part of his body should be profusely sprayed or washed with the decoction (of the bark) of a Kshiri-Vriksha A poultice prepared with the anti venomous drugs of cool potency mixed with clarified butter (washed a hundred times and) placed inside the folds of linen should also be applied. In the event of its being caused by the insertion or introduction of a bone^[2] of any animal, the bone of which is poisonous in itself, the measures and remedies laid down above as well as those prescribed under the treatment of the “Pitta-poisoning” should be adopted and used. 20.

Recipe of different Agadas Maha-gada:—

The powders of Trivrit, Vishalya, Yashtimadhu, the two kinds of Haridra, Rakta (Manjishtha), Narendra (Aragvadha), the five kinds of officinal salt and Tri-katu, pasted with honey, should be placed inside a horn. This Agada or anti-poisonous compound used as snuff (Nasya), collyrium and anointment acts as a good neutraliser of poison. It is irresistible in its potency and is of mighty efficacy. It is called the Mahagada. 21.

Ajitagada:—

A compound made of powdered Vidanga, Patha, Tri-phala, Ajamoda, Hingu, Chakra (Tagara), Tri-katu, the five kinds of officinal salt and Citraka, pasted with honey, should be kept for a fortnight inside a cow’s horn covered with a lid of the same material. This anti-venomous compound (Agada) is known as the Ajitagada and is efficacious in cases of both vegetable and animal poisoning. 22.

Tarkshyagada:—

A compound made of the fine powders of Prapaundarika, Deva-daru, Musta, Kala- nusarya, Katu-rohini, Sthauneyaka, Dhyamaka, Padmaka, Punnaga, Talisha, Suvarchika, Kutannata, Ela, white Sindhu-vara, Shaileya, Kushtha, Tagara, Priyangu, Lodhra, Jala (Balaka), Svarna-Gairika, Magadha, (red) Chandana and Saindhava salt, taken in equal parts and pasted with honey, should be kept inside a horn. This Agada is called the Tarkshyagada and is capable of neutralising the effects even of the poison of a Takshaka. 23.

Rishabhagada:—

A compound made of the powders of Mansi, Tri-phala, Murangi, Manjishtha, Yashti-madhu, Padmaka, Vidanga, Talisha, Sugandhika, Ela, Tvak, Kushtha, Teja-patra, Chandana, Bhargi, Patola, Kinihi (Apamarga), Patha, Mrigadani, Karkatika, Pura (Guggulu), Palindi, Ashoka, Kramuka and flowers of Surasi and of Bhallataka, well pasted with honey and with the bile of a boar (Varaha), Godha, Peacock, Shallaka, cat, Prishata (deer) and of mungoose, should be preserved inside a horn. This anti-venomous medicine is called the Rishabhagada. Snakes never visit the house of the fortunate and mighty one wherein this well prepared remedy is preserved. Venomous insects dare not come within the precincts of such a mansion and even their poison loses its quickness and fatal character. The sound of trumpets and drums, smeared with this compound and blown upon and beaten, tend immediately to destroy the effects of poison. If a poisoned patient would only look at the banner plastered with this Agada the poison from his system would be thereby eliminated. 24

Sanjivana Agada:—

A compound made of the powders of Laksha, Harenu, Nalada, Priyangu, the two kinds of Shigru, Yashti-madhu, Prithvika (Ela) and Haridra, pasted with honey and clarified butter, should be preserved inside a cow’s horn and covered in the above manner. This anti venomous medicine is called the Sanjivana Agada and should be used as snuff, collyrium and drink. It is capable of restoring even a man apparently dead (by poisoning) to life. 25.

Darvi-kara-Rajila-Vishahara-Aga da:—

An Agada consisting of the powders of Shleshma- taka, Katphala, Matulunga, Shveta, Girihva, Kinihi, sugar and Tanduliya should be regarded as the best remedy in cases of poisoning by Darvi kara or Rajila-bites. 26.

Mandali-Vishahara Agada:—

One part each of Draksha, Sugandha, Naga-vrittika^[3] and Samanga (Varaha kranta), two parts each of the following drugs, viz.,—leaves of Surasa, Vilva, Kapittha, and of Dadima, and half a part each of the following, viz.: (leaves of) black Sindhuvara, Amkotha and Gairika, should be powdered together and mixed with honey. This anti- venomous medicine (Agada) is highly efficacious especially in the case of poisoning by a Mandali-bite. 27.

Vamsha-tvagadi Agada:—

An Agada should be prepared with the scrapings of green bamboo (Vamsha-tvak), amalaka, Kapittha, Tri-katu, Haimavati, Kushtha, Karanja- seeds, Tagara and Shirisha flowers, pasted with cow’s bile. Used as a plaster, snufìf or collyrium, it destroys the poison of a spider, mouse, serpent or any other (poisonous) insect. Used as a collyrium (over the eye-lids), as a plaster over the umbilical region, or as a Varti (plug), it removes the obstruction of stool, urine and Vayu (flatus, etc.), or of a fetus in the womb. Used as a snuff or a collyrium, its curative potency is manifest even in such dangerous eye-diseases as Kacha, Arman, Kotha, Patala and Pushpa. 28.

Panca-Shirisha Agada:—

A potion consisting of a decoction of the roots, flowers, bark, seeds and sprouts of a Shirisha tree, taken with honey, the five officinal kinds of salt and a profuse quantity of powdered Tri-kutu, proves speedily efficacious in a case of poisoning by an insect-bite. 29.

Sarva-Kamika Agada:—

An Agada prepared with Kushtha, Tri-katu, Darvi, Madhuka (flower), the two kinds of salt (Saindhava and Sauvarchala), Malati (flower), Naga-pushpa and all the drugs of the Madhura (Kakolyadi) group and pasted with the juice of Kapittha and mixed with honey and sugar destroys all sorts of poison specially that of a mouse (Mushika). 30.

Ekasara Agada:—

The following drugs viz., Somaraji seeds and Somaraji flowers,^[4] Katabhi, Sindhu- vara, Choraka, Varuna, Kushtha, Sarpa-gandha, Saptala, Punarnava, flowers of Shirisha, Aragvada and of Arka, Shyama, Ambashtha, Vidanga, Amra, Ashmantaka, black earth and Kuravaka comprise the Ekasara Agada. These should be applied singly^[5] or in combination of two or three to destroy the effects of poison. 31.

 

Thus ends the fifth Chapter of the Kalpa-Sathana in the Sushruta Samhita which deals with the medical treatment of snake-bites.

Footnotes and references:

[1]:

Dallana recommends burnt earth or the earth of an ant-hill or ash for the purpose of filling up the mouth before sucking the poisoned blood.

[2]:

Dallana holds that by the word “bone” in the text should be understood all the different sources of poison, viz., fæces, urine, nail, tooth, bristle, etc., of an animal.

[3]:

Dallana says that in place of “Sugandhā Naga-vrittikā” some read “Sugandhā Naga-mrittikā” which means “the sweet-scented earth of the mountain” known to be possessed of anti-poisonous virtues.

[4]:

Some explain “somarājiphalaṃ puṣpaṃ” to mean ‘Somaráji, Phala (Madana) and Pushpa (Nága-keśara).’

[5]:

Some explain “ekaśo histriśo vāpi” to mean that the Agada should be used “once, twice or thrice” according to the requirements in each case.