LACHESIS MUTUS [Lach]:

– Pierce W.I.

Introduction
The venom of the various poisonous snakes is obtained by pressing on the poison glands, the snake being pinioned or under chloroform at the time, and as the venom drops from the fangs, it is received on pulverized sugar of milk, with which it is triturated up to the 3d in the proportion of one to ninety-nine. Above this trituration it can be converted into a liquid potency by the customary method, as alcohol seems to have no bad effect on the venom above the 3d. The bite of a venomous snake, where the fangs do not first meet with an obstacle, legging, clothing, etc., usually means death; and we use the snake poisons as medicines in many cases that except for their intervention, would result in death. Of the many antidotes that have been recommended for the bite, I know of none that are reliable; and of the many tried, alcohol is the best known and the oftenest used. While it frequently fails, it will be well to remember if we are even called upon to use it, that the supply must be large and the amount administered unlimited, for, to effect a cure, the patient must be gotten thoroughly under the influence of it, “dead drunk,” in technical terms, and it takes a much larger quantity of alcohol to produce its physiological effects in a person who has been bitten by a poisonous snake than it would if he was in his normal condition. Hughes considers the various phenomena of snake-bites according to their severity, and says that they “fall into three groups corresponding to three leading forms of disease.” It will well repay you to read the article in full as found in Hughes Pharmacodynamics, as we can simply give his summing up here. “1. In the first group the symptoms are those of direct poisoning of the nerve centres, without local inflammation or blood changes. The great shock of the poison is first felt in the centres of the cord, gradually involving those of the medulla oblongata, and lastly implicating the functional integrity of the brain; the sympathetic system (at any rate in its cardiac portion) being the last to suffer. The main effects are seen in the parts supplied from the nerves arising at the base of the brain, especially the pneumogastric. “2. The second form of serpent poisoning which seems to obtain is the purpuric or haemorrhagic,” which we will see exemplified many times as we study the symptoms of the various snake poisons. “3. In the third place, we have those symptoms which result from the local affection induced by the bite,” often as a malignant character, and, as Allen says, “the action of all the serpent-venoms is directly on the blood, destroying its vitality and inducing a great variety of diseases characterized by disintegration of tissue.” Lachesis is the best known and has been more carefully proved than any of the other serpent-venoms. Hering collected the virus in Brazil, in 1828. The first records of cases in which the remedy was tried were published in 1835 and in 1837 it was introduced into our Materia Medica.
Symptoms
Lachesis is especially suitable for people of dark complexion (88) and bilious temperament, to ailments associated with the menopause and, as Hering says, it is “better adapted to thin and emaciated than to fat persons.” It is a left-sided remedy (125), or the troubles calling for it start on the left-side, especially in the upper portion of the body. There are two other prominent symptoms to keep in mind; one, the extreme sensitiveness of the affected parts to touch (166), especially to light pressure, which sensitiveness is out of proportion to the severity of the disease; the other, the almost universal distress which comes during sleep and wakens the patient in agony and fright. We must remember that this latter condition is not the simple waking in fright (81) from dreams, or with a start, for it differs from this inasmuch as whatever pain or trouble the patient has it increases during sleep and they wake, or rather the aggravation wakens, the, with their troubles increased. So pronounced is this condition, that the patient may tell you that she is afraid to go to sleep, as she wakens feeling so much worse. “They sleep into an aggravation” (Farrington). While the symptom often reads, worse on waking, it means under Lachesis, “trouble that is brought on by going to sleep at any time, day or night” (H. N. Guernsey). There is in Lachesis extreme prostration (155) and tendency to disorganization of the blood, the blood being dark-colored and does not coagulate. It is especially suitable for persons of a phlegmatic temperament, with a disposition of melancholia and indolence, and is useful in melancholia and religious melancholia (131), particularly in women at the climacteric, with attacks of sadness and anxiety on waking. In the delirium from alcohol (54), and there is great aggravation in Lachesis from alcoholic drinks (5), and in the delirium during or following fevers, loquacity is usually a prominent feature (55). This loquacity differs from that of some other remedies, inasmuch as they do not confine themselves to one thought, as they do in Stramonium, for instance, but with the increased mental activity, there is a lack of mental continuity as they constantly change from one subject to another, without waiting or caring for your answer. Again, with the prostration of the remedy we may have a muttering delirium (55). In the delirium we may have fear that they are in a strange place, with attempts to get of bed (53) so as to go home, or fear that there are robbers in the house, with desire to escape from them. Talcott tells us (neither symptom is in the Hand-book) that the Lachesis patient may “think himself under superhuman control (54),or he thinks that he is dead and that preparations are being made for a gaudy funeral.” A symptoms spoken of by Guernsey in reference to a prominent aggravation under Lachesis, is concerning convulsions, where the “patient has none while awake, but as soon as he is asleep they appear (36).” Amongst other things, Lachesis is a drunkard’s remedy. In addition to delirium tremens, of which we have already spoken, it is useful in sunstroke (98) and threatening apoplexy (18) in those who are in the habit of using alcoholic stimulants, when we find dark red face and cold extremities. Lachesis is useful in meningitis (133) and in neuralgic headaches, the pain starting in the vertex and spreading over the head. The headaches are usually neuralgic, are worse in the morning on waking (95) and are accompanied by extreme sensitiveness of the affected part to touch. The pains are severe, usually worse on the left side and better from warm applications (92). We may have neuralgic headaches where the pains seem to concentrate at the root of the nose (104), or the pain extends to the eyes and face, or even to the shoulders. A frequent form of neuralgic headache is where the pain is located in the occiput (100) and due to cold, or draft of air blowing on the back of the head. The pain is worse, or at least is first noticed, on waking in the morning, with soreness of the occiput to touch; even the pressure of the pillow is distressing. The pain is less, or wears away during the forenoon, only to return on succeeding mornings if you do not give Lachesis. In the eye we have dimness of vision, with black specks flickering before the eyes (77) and it is a remedy useful in muscular asthenopia (72) after diphtheria. Whenever there is photophobia, it is worse in the morning after sleeping (76). It is a remedy to be thought of in neuralgia of the orbit, worse left, and the eye feels as if it had been squeezed. It is rarely useful in external inflammatory diseases of the eye, but it is very valuable for haemorrhages of the optic nerve and retina (77); this apoplexy may occur in persons who have no albuminuria. It not only “absorbs the haemorrhage” but “control inflammatory symptoms and diminishes tendency to retinal extravasation” (Hering). In the ear, Lachesis is one of several remedies where the pain goes from the throat to the ear on swallowing (191). It also has deafness and dry, hard wax in the ear (65), with sensitiveness to sounds; usually these ear symptoms are associated with diseases of the throat or other parts of the body, thus making the choice of the remedy easier and more positive. In the nose we have epistaxis of dark blood (142), ” mostly in the morning” (Hering) (142) and Lachesis is useful in typhoid and in amenorrhoea (138) with this symptom. In diphtheria and in ozaena (148) we have obstruction of the posterior nares, discharge of bloody matter and often soreness of the nostrils and lips. The gums are blue, swollen and bleeding (84) and with this condition we often have a toothache which is periodic, coming on in the morning on waking and worse from eating (187) and from warm (187) or cold drinks (187). The tongue under Lachesis is red, dry and tremulous (192). We have a red tip or a red stripe running through the center (192). It is to be thought of in paralysis of the tongue (192) when it cannot be protruded, but catches in the teeth. It is useful in ulceration (192) and for canker sores (140) on the tongue, with great sensitiveness to touch, and in aphthae (140) and gangrene of the mouth (141), with dark purple color and offensive odor. In and around the throat we find many conditions of interest. Outside and inside there is great sensitiveness. They cannot bear to have anything touch the neck (166) and are constantly pulling at the collar to loosen it, no matter how much room there may be. Dr. Hering, “who could never tolerate tight clothing about his neck, noticed during the proving of Lachesis that this symptom annoyed him more than usual and he made a note of it, although he did not place much value on it. Since then the symptom has been confirmed many times in practice, and has been found true, not only as a local symptom of the neck, but as a symptom of the body generally” (Farrington), for the whole surface is sensitive and they cannot bear anything, not even the clothing, to touch them. In the throat we have elongation of the uvula, a sensation as if a crumb stuck in the throat, with hawking (44) and constant efforts to get rid of the irritation. We often have a feeling of a lump in the throat, which will waken one out of a sleep, This sensation of a lump, or as if they throat were swollen and he would suffocate, is noticed on empty swallowing or when swallowing liquids, more than when swallowing food (183). In certain conditions when the attempt is made to swallow liquids they regurgitate through the nose (183), but in all diseases of the throat there is extreme sensitiveness to external touch or pressure, which causes a feeling of suffocation. The disease starts on, or is confined to the left side, the throat is swollen and of dark red or purple color (191); there is soreness or sharp pains that extend from the throat to the ear on swallowing (191) and the odor from the throat to the ear on swallowing (191) and the odor from the throat is very offensive (62). With those symptoms Lachesis is indicated in all forms of throat troubles, from follicular tonsillitis and pharyngitis to ulceration (including syphilitic), gangrene and the severest forms of diphtheria (62). With the throat lesions the submaxillary and salivary glands are apt to be swollen. In the stomach Lachesis is valuable for the gastritis of drunkards (176) and for weakened digestion after mercury (139). It may be needed in the vomiting of pregnancy (153) and it must not be forgotten in yellow fever in the stage of black vomit (209), but the important thing to remember in all stomach and abdominal conditions is the soreness and sensitiveness to touch and the intolerance of the pressure of the clothes (12). A couple of pathogenetic symptoms, of different degrees of severity, read : “Obliged to wear the clothes very loose, especially about the stomach; even in bed is obliged to loosen and raise the night dress, in order to avoid pressure; she dares not even lay the arm across the abdomen on account of the pressure” (Allen’s Encyclop.). We can make a note here that, as Allen points out, “the right side of the abdomen presents numerous symptoms of Lach., while in the throat most of the symptoms are on the left side.” It is a remedy that has been found useful in appendicitis and in a late stage of peritonitis, and in a great variety of debilitating diseases of the abdominal and pelvic viscera, always with the aggravation from sleep, as well as the intolerance of clothing over the affected part. It has been used in gall-stone colic (82), with jaundice (82), the liver swollen and very painful,and in inflammation of the liver, with threatening abscess (127). It is to be thought of in ascites (11) of drunkards and for “threatened gangrene in strangulated hernia” (Hering). Lach, is useful in haemorrhoids (86), especially when strangulated, with great constriction of the anus (158) and a feeling of a plug there (160), with stitches running upward and severe throbbing. It is of value in fissures of the anus (159), with throbbing and beating as of many little hammers. The stools of Lachesis are very offensive and putrid (59). “Of the odor of putrefying snakes”, as one symptom reads; but as few of us have had the opportunity of verifying the odor, the words putrid or cadaverous-smelling must satisfy our demands for exactness. The stools are sometimes involuntary, especially in low types of disease. In low types of disease we have haemorrhages from the bowels of black decomposed blood, with as several authors, other than in the Handbook, say, “black particles of blood on the bottom of the vessel looking like charred straw.” It is useful in diarrhoea worse in warm weather (57), for the diarrhoea of women at the climacteric, and for that of drunkards. The urine under Lachesis is scanty and offensive, dark or blackish (193), with a sediment of decomposed blood (94) looking like coffee-grounds. It is to be thought of in general dropsy (63) after diphtheria and scarlet fever, with this black, albuminous urine of decomposed blood, and dark purple or bluish skin. It is useful for chancroidal ulcers and buboes, with a general bluish look (26) and with a tendency to become gangrenous. In reference to the female sexual organs, Allen says, “the most frequent indications for Lach. in all diseases of the uterus and ovaries are the intolerance of the weight of the clothing, the tendency to the disease to extend from left to right” and the aggravation during sleep; with these symptoms “it has cured almost every pathological condition to the female organs, tumors, inflammations, displacements, indurations, neuralgic, etc.” In addition Lachesis is useful in “menstrual colic beginning in the left ovary” (Hering), in dysmenorrhoea and in membranous dysmenorrhoea (138), worse alcoholic stimulants (5), with pain in left ovary (147) darting upward. It is valuable for inflammation of the ovaries, worse left (148), especially if the menses are offensive (137), with general relief on the free appearance of the flow (134); also of value in puerperal metritis, with offensive lochia (153), and in phlebitis following pregnancy. Lachesis is very valuable for many troubles occurring during the climacteric, some of which we have already spoken of. One of the most important uses for the remedy at this time is for the flushes of heat to the head and face, the “hot flushes” that are so annoying (32). With this we have as prominent symptoms, the desire to loosen the clothes about the waist and especially around the neck, for they feel as if they would suffocate if the collar touched them. It is valuable for metrorrhagia at the climacteric (136), with hot flushes, fainting turns, pain in the ovary and aggravation from sleep. Hering gives as an additional indication for the remedy, “women who have not recovered from change of life, `have never felt well since that time.” On the respiratory organs under Lachesis we find the same prominent symptoms that we have now given so often that you begin to look bored at the mere mention of them; but for all that, I am going to repeat them and venture to predict that in spite of your familiarity with them at the present moment, there will come a time when they are presented to you in practice that you will overlook them, and instead of giving Lachesis at once, you will hunt all around for the remedy to fit the case, very like the woman who always looks under the bed for the man instead of between the sheets, where she might expect to find him. There is the sensitiveness of the larynx to external touch or pressure (191), the feeling of suffocation and the cough from external pressure (44). It is to be thought of in nervous cough (46) at the climacteric (42), or cough of reflex origin (42), without symptoms of local inflammation. We have asthmatic attacks (19) coming on during sleep and making the patient afraid to go sleep for fear she will die, so difficult is it to get her breath when she wakens. It is useful in emphysema (66), with the dyspnoea so great that the patient cannot lie down on account of the suffocative fulness of the chest, and with necessity to have the clothes around the neck and chest very loose. It is useful in cough and whooping cough, the attacks waking one out of sleep, and in both false and true croup, “the child may be fairly well while awake but as soon as it gets to sleep the croup symptoms appear in great violence, the child almost suffocates, and the mother or nurse in consequence fear to let the child go to sleep” (Guernsey). In diphtheria and croup there is great fetor (62) under this remedy, with blue face and extreme prostration. Hering says in reference to diphtheria, “constitutional symptoms out of all proportion to local manifestations, prostration considerable even before any local evidences of disease could be detected.” We can think of Lachesis in mastitis (22), with suppuration, bluish appearance of the breast and extreme sensitiveness of the nipple. In the heart Lachesis is indicated in all inflammatory diseases, with palpitation (111), suffocation, intolerance of pressure about the heart (107) and pain going down the left arm (110). It is extremely useful in atheromatous arteries, in chronic aortitis, in angina pectoris (107) and hypertrophy of the heart (110) with the terrible dyspnoea. It is also of value in nervous affections of the heart, with palpitation (111) and feeling as if the heart were growing up (113) and would suffocate him, or with the violent beating there is a sensation as if the heart turned over (114). It is a valuable palliative in congenital cyanosis (207) and “blue baby.” Remember Lachesis in neuralgia and inflammation of the spine (171) and spinal nerves, myelitis, in neuritis and in neuralgia of the coccyx (34). The skin under Lachesis is bluish or purple (207). In erysipelas (68) we would think of it in severe cases starting on the left side, and accompanied by great swelling and bluish look. In purpura haemorrhagica (158) the whole body is swollen, extremely sore and intolerant of the pressure of the clothing. There is tendency to ecchymoses, with purple or black spots (65), and to bed-sores and intolerant of the pressure of the clothing. There is tendency to ecchymoses, with purple or black spots (65), and to bed-sores (21), with black edges. It is useful in indolent, varicose (205) and venereal ulcers, with sensitiveness, bluish-purple color, and general tendency of the sore to become gangrenous (82), as well as in carbuncle, suppurating wounds and ulcers which threaten to become gangrenous. It is of value in pustular eruptions, which suppurate and become bluish-black, and has proved curative in the Bubonic plague. In intermittent fever, Lachesis would be indicated in chronic cases, with tendency to recur in the spring, or recurring in the spring or summer “after suppression in previous fall by quinine” (Hering) and this latter symptom is called “guiding” by H. C. Allen. The chill begins in the small of the back (121) and is “better in warm room or from external heat” (Hering) (121). During the fever we would have livid complexion, loquacity and the desire to loosen the clothes about the neck, as if they hindered the circulation and caused suffocation. The sweat is profuse and strong smelling, especially sweat in the axilla smelling like garlic. Lachesis is useful in all typhoid types of disease, and in typhoid fever we would have in addition to the extreme prostration of the remedy,loquacity, dry, red tongue, offensive discharges and exhalations and the tendency to haemorrhages (193) of dark blood. Lycopodium follows Lachesis well and Am. carb., Dulc., Nit. ac., Psor., and “Acet. ac.” (Hering) are injurious or incompatible.