TBEATMENT OF SNAKE POISONING. 3 



third a few inches above the ankle. In bites higher up the extremities, 

 the ligatures should be employed, at suitable distances from each other, 

 with the utmost promptitude. Sir Joseph Fayrer recommends the 

 insertion of a piece of stick or other lever between the cord and the 

 limb or member, with a view to twist the ligature to the utmost. 



3. Carefully identify the punctures made by the fangs of the snake. 

 Excise the part with a sharp penknife to the extent of a finger-nail, if 

 the bite is on a finger or toe, if possible, round each puncture, and deeply, 

 almost down to the bone, or in depth from a quarter to half an inch. 

 Scarify freely the circumference of the wound, and encourage bleeding. 

 Wash and squeeze it effectively to expel poison. Then apply to the 

 bottom of the wound a red-hot iron so as to cauterise and kill the adja- 

 cent soft tissues so that they may be incapable of absorbing any poison 

 that may not have been removed by the excision or destroyed by the cautery. 



4. As the soft parts at the ends of the fingers and toes are comparatively 

 dense, and the diffusion of the poison consequently limited, the extent of 

 the excisions should be proportionately restricted. But if the fangs have 

 penetrated the skin of any part of the extremities above, such as the leg, 

 thigh, forearm, or upper arm, the extent of the diffusion of the poison 

 is much greater, owing to the looser texture of the areolar tissue in 

 these regions. The excision of the poisoned tissues must therefore be 

 considerably extended and deeper. The scarification of the margins at 

 the bottom of the wound and the cauterisation, either with a red-hot 

 iron or live coal, must also be applied with more freedom. If the bite 

 has been inflicted by the daboia, it may be needful even to excise mus- 

 cular tissue, as well as skin and areolar tissue ; because the fangs of this 

 viper are much longer and penetrate deeper than those of the cobra. 



5. It will often happen that absorption of poison to a greater or less 

 extent may have occurred before the ligatures have been applied. In 

 such cases they must not be relaxed ; because their relaxation will 

 admit the ingress of more poison into the blood. By keeping them 

 firmly adjusted, we may hope, if they have been applied early enough, 

 that such a limitation of the absorption of the poison may have been 

 effected as to conduce materially to the preservation of life ; whilst by 

 their premature removal, the renewal of the absorption may, even in cases 

 where only a small quantity of the virus has been thus introduced, turn 

 the balance irretrievably against the patient and cause a rapidly fatal issue. 



