THE GARDEN OF SERPENTS, BUTANTAN, BRAZIL.'

By Prof. S. Pozzi,

Member of the Academy of Medicine, Paris, in charge of scientific expedition to Brazil and the Argentine Republic.

I passed but 12 days in Brazil on my way back from Buenos Aires to Europe. There is much to be said about the medical institutions of the two large cities where I stopped, Rio de Janeiro and St. Paul. I wish that I could express all the admiration I have for my colleagues, the physicians and surgeons of Brazil, and tell of all I saw and appreciated; but I can cite only a few names: At Rio de Janeiro, Prof. Feijo, jr., head of the faculty; Dr. Aug. Brandao, professor of gynecology; Dr. Daniel d'Almeida, Dr. Magalhaes, Dr. H. de Toledo-Dodsworth, Dr. Antonio Rodriguez Lima, the Drs. Hilario and Nabuco de Govea, Dr. Olympio da Fonseca; the general secretary of the Academy of Medicine, Dr. Aloysio de Castro, and others. At St. Paul, I would mention especially the Drs. Alves de Lima; my excellent pupil, Dr. Arnado Carvalho; Dr. Synesio Rangel Pestana, and Dr. Oliveira Botelho, formerly minister of agriculture and a distinguished gynecologist. Toward all I have a deep feeling of gratitude for my pleasant reception.

But I must limit myself. So I will choose from among my experiences my visit to the antivenom therapeutic institution at Butantan near St. Paul.

This institution has at its disposal incomparable means for this study and work because of its situation in a region where snakes abound. Our eminent compatriot, Prof. Calmette, of Lille, one of the pioneers in the scientific vaccination against snake bites, has been too often impeded and limited in his laboratory work because of the difficulty in procuring the exotic snakes whose venom was necessary for his researches. At Butantan, the country people from all sides bring in their captured snakes, in exchange for which they receive tubes of the beneficial serum.

1 Abstract of a lecture given by Prof. S. Pozzi, at the Henri de Rothschild Polyclinic, Mar. 29, 1911. Translated by permission from Revue Scientifique, Paris, Apr. 22, 1911. The illustrations in the origi nal paper here omitted.

Brazil may be considered as one of the countries most infested by venomous serpents. Though they have completely disappeared from the most frequented places, they are still extremely numerous in the surrounding country, and their bites are a fearful source of danger to the workmen of the coffee or sugar plantations who go with naked feet.

Two great genera of serpents live in Brazil, the Crotalus and the Bothrops. They are found in the forests, the thickets, and the damp places. Naturally rather timid, they flee as soon as disturbed by a noise, but if by chance one of them is touched it turns upon and angrily bites whoever molests it. So that if a passerby inadvertently puts his foot on one he is at once bitten. This happens very frequently to beasts or horses when they disturb the peace of a snake. Hunters dread them for their dogs when the latter search in the brushwood.

According to statistics, up to 1906 there died annually in the State of St. Paul alone more than 240 persons from the bites of snakes of the Crotalus and Bothrops genera. Since the distribution of serum from the serotherapeutic institution of Butantan, the number of fatal cases has diminished at a rapid rate.

This serotherapeutic institution consists of a large number of buildings separated by courts. They include the laboratory, the cells for the snakes, the stables for the inoculated horses, the storehouses for the manipulation of the serum, and the dwellings of the staff. Everything is perfectly organized.

Many obscure points relative to the physiology of serpents still require study. In order to better know the habits and all the details of the lives of serpents, Dr. Vital Brazil, the eminent director of this institution, conceived a surely novel idea. He has made an inclosure with thick walls, not so high but that one can easily look over them. Within there is a large space, a kind of rustic inclosure, covered in places with luxuriant vegetation, traversed by wide paths, with glades here and there. A large interior ditch, close to the wall and filled with water, forms a second barrier and prevents the escape of the dangerous guests that people these thickets. The most venomous serpents are to be placed here where they are to live at liberty. When I was at Butantan last year the construction of this place was almost complete. At the present time, without doubt, Dr. Vital Brazil and his fellow workers have already made many curious observations while walking to and fro in this frightful paradise, in this garden of snakes.

Before proceeding it will be well to state some theoretical conceptions which will help to explain the importance of the work accomplished by this institution.

The pathological physiology of venom poisoning has become very well known through the researches of Calmette and V. Brazil. The poisoning resulting from the bite of a Bothrops is hemorrhagic in nature. After a bite there occurs a decomposition of the blood which escapes from the capillaries, causing profuse hemorrhage in the subcutaneous and submucous tissues, accompanied by acute congestion of the liver, kidneys, and brain. It is a sort of acute purpura. The Crotalus venom, on the contrary, is a paralyzing poison. It produces bulbar paralysis with disturbances of the respiration, the vision, and the circulation. Local reaction at the seat of the wound is absent or extremely slight. Death of the victim, if a man, results after a variable time, generally about 24 hours.

Vital Brazil has made elaborate studies of the effects of venoms upon animals. The poison of the Crotalus terrificus kills a pigeon when one one-thousandth of a milligram is injected into its veins. The fatal doses for other venoms vary slightly.

I will now describe in a few words the preparation of the antivenom serum at Butantan.

The serum prepared at Lille by Dr. Calmette has little efficacy in Brazil. Indeed, he himself says in his remarkable book, Upon Venoms, "For each venom there is a corresponding serum." Since the serum of the institution at Lille is almost wholly prepared with the venom of Asiatic snakes, although excellent for counteracting the bites of European vipers, it is useless against the bites of the Brazilian Bothrops or Crotalus. Accordingly Dr. Vital Brazil has prepared two specific serums, one anticrotalic, the other antibothropic, each having, in small doses, a particular efficacy against the bites of the corresponding snakes. But as it is rare that the kind of snake producing a bite is known, it was important to have also a polyvalent serum, that is one equally active against all venoms. Such a serum Dr. Brazil has made.

The animal used to furnish the antitoxic serum is the horse. A young and healthy animal is taken, free from any disease, and particularly from glanders. Horses are very sensitive to the venom from snakes. At first a minimum does is injected, five one-hundreths of a milligram; then the does is increased. The injections are repeated every five or six days; as soon as the animal seems to suffer or to lose weight the injections are stopped. It is a curious fact that as soon as the immunization is complete the animal seems to thrive from the absorption of the poison; it grows fat, its weight increases. And yet further, a horse in the process of immunization, if the injections are stopped, pines away somewhat as does a morphiomaniac when the latter is deprived of his habitual poison. The horse has become, in fact, a seromaniac.

The immunization lasts about a year, and toward the end enormous doses are given reaching 1 gram. The horse is then ready and the serum from its blood is antitoxic for the venom with which it has been inoculated,

In such manner is prepared at Butantan the anticrotalic, the antibothropic and the polyvalent serums. The last is obtained by alternating the injections, using the venom first from one kind, then from the other kind of snake, and, as its name indicates, it is valuable as a remedy for the bites of all Brazilian snakes. It is therefore of exceptional practical value.

An immunized horse will furnish serum for a very long time, provided that from time to time new injections of the venom are administered. After each bleeding necessary for a supply of serum, the antitoxic power of the horse diminishes rapidly but recovers several days afterwards.

In the case of man, the injection of the serum under the skin should be made during the 12 hours following a bite. If the kind of snake producing the bite is known, the serum specific to that kind is the more efficient toxin to employ in doses of from 10 to 20 c. c., for it works more quickly and with special efficacy. If the kind of snake is not known, as is usually the case, then the polyvalent serum must be injected in doses up to 60 c. c. in serious cases.

The serum is furnished to the public in sealed tubes packed in little wooden boxes. A minimum price is charged. Further, the institute at Butantan distributes the serum free to hospitals, to cities, and to the very poor, together with injection syringes and the necessary directions for its use. The only remuneration asked by Dr. Brazil, at times, in exchange for the serum, is the snakes which are essential to him; and so by bringing a cascavel or a jararaca, the Brazilian countryman receives a tube of the liquid serum.

I was very curious to visit the institution at Butantan during the few days I stopped at St. Paul near the outskirts of which it is situated. My distinguished colleague and friend, Dr. Alves de Lima, whom I can not thank too much for his generous hospitality, kindly offered to accompany me there. I copy the following account from the note book of my travels:

A powerful 40-horsepower automobile carried us, raising clouds of dust, along the route which traversed a smiling country dotted with trees and exotic shrubs. After a ride of about half an hour we stopped at the gate of a kind of large chalet which belonged to a group of new buildings, the serotherapeutic institution of Butantan. A man of about 40 years of age, tall, energetic, sun burned, wearing a black mustache, with remarkably deep, black eyes, a reserved and deliberate manner in marked contrast with his southern appearance, received us on the threshold. He wore a long white coat, such as surgeons and physiologists wear. Such was Dr. Vital Brazil, director of the institution and a great philanthropist. To him Brazil, and indeed all the other countries of South America, owe the systematic production of the serum

which cures the bites of the numerous snakes of those tropical regions, deadly bites which but lately killed more than 1,000 persons a year.

He commenced his study by himself; he is indeed a "self-made" man; later he continued his studies at Paris with Roux, at Lille with Calmette, and at Berlin with Koch. He speaks French very purely although not very fluently. Indeed he talks very little. It was always necessary to ask for explanations from this modest and somewhat taciturn man.

We at once entered the laboratory, a great hall with rows of jars containing snakes in alcohol. There were snakes of all sizes, of all colors, of all forms, whole and dissected to show their various organs and with some of them (who would have believed it?) full of parasites peculiar to the snakes. In other jars there were horrible, venomous insects, enormous scorpions, and great spider crabs. We had but little time to devote to this visit, we were therefore in a hurry and Dr. Vital Brazil realized it. He knew of a special attraction for us, a snake eater of snakes, the good snake, so to speak, which, inoffensive himself, destroys his venomous confreres whose bites are harmless to him. I asked Dr. Brazil to show us this curiosity. He was prepared for my request and very courteously acquiesced. Only the good serpent had already eaten some eight days ago, and for a snake digestion is very slow and the appetite long in returning; nevertheless he let us see.

And here we saw the good serpent: It was taken from a box by means of a long crooked stick, with a handle, which seized the snake by the middle, like a common sausage, and deposited it on the ground near us. It was a kind of great adder, about a meter long, of a blue color having the sheen of steel, so shiny that it seemed wet. It crawled slowly, erecting its flat head, darting out its tongue, and seemed formidable despite its good reputation. In order to reassure us, Dr. Brazil took it in his hands and twined it about his arms; he told us at the same time the snake's scientific name, Rachidelus brasili, locally known as the "Mussurana." The natives and especially the hunters have known it for a long time, but until very recently were ignorant of its habits and its so useful tastes.

With the same crooked stick he took from a box another serpent, this time an exceedingly venomous one, the terrible Lachesis lanceolatus, the "Jararaca" of the Indians. Its bite in a few minutes kills man or animal. We recoiled instinctively. He placed it close to the good Mussurana, and, at a respectful distance, we formed a ring about them. I confess I looked back of me to see whether an open door was at hand. The two snakes lay there almost motionless, side by side, and apparently seemed to take no notice of each other. Dr. Brazil thought surely that the Mussurana, having just eaten his fill, would not "make a march," if I may so express myself. Suddenly it made a movement and drew nearer to its formidable victim. The latter, as well as we, had seen the undulation of his adversary; it also stirred. Did it wish to escape or did it rely upon its irresistible fangs? With incredible quickness which told plainly that its apparent torpor was only tactical, the good serpent darted its open mouth upon the neck of its prey, evidently aiming to get hold of the nape of its neck in order to render its opponent helpless. The latter, upon its guard, quickly turned and darted its fangs into the body of the other. The good serpent is, however, immune to the poison by nature. And see, in an instant the Lachesis is enlaced, twisted about in the muscular spiral formed by the body of its adversary; they roll convulsively, one about the other, one within the folds of the other, and I wondered for a minute whether the Mussurana was not trying to choke the Jararaca. Very soon I discovered the purpose of this maneuver; it had seized the enemy lower than it had wished at the first grasp, and little by little was advancing its hold gradually until it had its mouth up close to that of the Jararaca. Now it had a firm grip close to the lower jaw; it had the jaw as in a vice with its little flat head, which looked like an instrument of a surgeon or of a torturer, closed nippers of steel. The venomous head, lamentably open and as if disjointed in the constant effort to escape, extended several centimeters