Report by Dr. A. Herbert Hallen on envenomation by Conus geographus , forwarded to the Australian Museum, Sydney, by Dr. B.G. Corney, from Fiji, 10th September 1901.

"I had under observation the case of an European lady here who was the subject of a severe form of poisoning by a shell-fish, of the species of which a shell is now sent for identification.

The lady was fishing not far from the shore in the evening, with her family and native servant in the boat. The shell-fish having been obtained, the boy cracked it to extract the meat, which was large in quantity for the size of the shell, and having cracked the shell, handed it to his mistress with the meat hanging from its internal attachment. To free the flesh she inserted her little finger towards the upper end, and she declares, felt the animal shoot out a sharp-pointed thing which penetrated her finger and caused such a peculiar sensation that she at once called out that she was bitten and poisoned.

The poisonous matter is said to be the yellow pulpy matter at the thicker end of the shell; it might of course be merely reproductive or digestive tissue, or again there might well be a modification of some secretory gland to form a protective poison gland, and in the latter case, nature would surely provide along with the poison, some mechanical means to promote injection into the enemy.

The point of puncture in this case was minute and only to be seen with great care; indeed, that it was a puncture was much less readily seen than the local effect of the poison which caused a bluish discolouration of the surrounding tissues. It was situated at the point of the patient's little finger near the side of the nail. Through so small a puncture, and in so short a time as was allowed to its insertion (she did not unfortunately suck the wound), but a most minute quantity of the poison could have entered the circulation, yet the effects were most grave. Locally a numbness was first experienced. This extended rapidly up the arm, which became paralysed and the paralysis spread thence rapidly throughout the body.

It was peculiar that not only was general muscular control abolished, even so far that the head had to be supported over the trunk in order that unimpeded breathing might be allowed to continue: but there was a loss also to a lesser degree (as I think) of sensation, with numbness and "pins and needles" beginning in the arm and becoming generalised though the body, and to more marked degree there was a disappearance of muscular sensation and a complete absence of knee jerks. The patient constantly asked where her limbs were. Utterance was thick and indistinct. The respiratory and cardiac muscular apparatus did not at any time participate to a dangerous degree in the paralysis. The stomach, however, may have been affected (or was it the recti abdominis and other abdominal muscles) for I could not induce vomiting.

When at its worst some 3 or 4 hours after the poisoning began, the condition distinctly affected the throat, and a good deal of distress was caused by the difficulty in removing accumulated fluid. The poison seemed to me to clearly belong to the class of which curare is the type.

Of this I felt assured as soon as I had examined the patient and observed the freedom of the respiratory and circulatory centres from its actions compared with the absolute abrogation of voluntary muscular paralysis so that, the patient weighing 16 odd stone, I felt a good deal of anxiety as to whether the arms would not dislocate at the shoulder when the body was lifted in the chair by the hands under the armpits; indeed it was exceedingly difficult to move the patient, all the parts being so abnormally yielding. The treatment I adopted was merely directed to sustaining of life till the poison should have been destroyed. the heart and lungs were quite equal to their work if other circumstances could be kept favourable. This was done by placing the patient in a semi-recumbent position in a canvas chair, and by keeping the head in such a position that breathing and swallowing were facilitated. I should have liked to relieve the circulation by inducing vomiting, but failed to do so.

Had I had strychnine with me I should have injected it hypodermically, but I did not feel justified in leaving the patient to get it. Urination was involuntary. The worst was past in about 6 hours. The wound was made about 9.30 p.m. Paralysis lasted on with steadily diminishing intensity till late next day, but the numbness lasted considerably longer in the injured finger, and for a month after the patient experienced a shock in the little finger on hard impaction - as in playing the piano.

This was the last symptom to clear up unless the sore eyes which began and lasted later are to be attributed to this poison as their cause. though natives declare that recovery from fish poisoning is often complicated by sore eyes, yet I am not aware that the tradition would apply to this kind. I have heard since of other cases of this kind of fish poisoning, and among others of a kadava woman who died before she could be got from the shore".

So take care when next you are visiting the Great Barrier Reef and other tropical reefs. Don't pick up cone shaped shells with your bare hands no matter how pretty they appear.

Beware the killer snails - and take care out there !

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BGL January 96

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