TREATMENT OF SNAKE POISONING. 5 



8. B. By the Surgeon. — In many cases the surgeon, on arrival, often 

 finds himself placed under circumstances of the greatest responsibility 

 and difficulty. Presuming that the foregoing measures have been adopted 

 with efficiency and promptitude after the bite, and that symptoms of 

 poisoning are consequently in abeyance, he should carefully examine the 

 ligatures and see that they are tightened sufficiently to prevent absorp- 

 tion, and also the wound made by the excision, in order to ascertain 

 whether it is wide and deep enough to facilitate the extraction of the 

 whole of the poison or the total destruction of the remainder by the live 

 coal or the actual cautery. In a case of this kind he will have time to 

 find out whether the snake which inflicted the injury was, in all human 

 probability, a poisonous one or not. If he be satisfied that the bite was 

 inflicted by a poisonous reptile — especially by a cobra or daboia — and 

 that it was an effective one, he is called upon, in a preponderating 

 majority of instances, without the chance of a consultation with another 

 surgeon, to decide on the spur of the moment as to the course to be 

 pursued. He may reason somewhat in this way : "If the ligatures be 

 removed, absorption will set in ; the blood will be charged with a fatal 

 quantity of the poison ; the functions of the great nerve-centres will be 

 destroyed; the respiration will cease, and soon after the circulation also, 

 cotemporaneously with actual death. It is true that mortification will 

 be prevented, but then this comparatively insignificant gain at the best 

 will only be temporary, and attained at the sacrifice of the life of the 

 patient. On the other hand, it is quite clear that little or no poison 

 has as yet gained access to the blood and the great nerve-centres, and 

 that, to maintain this desirable condition, one of two things must be 

 done ; either the ligatures must be kept on until all chance of absorption 

 be removed by gangrene, and the patient thus exposed to other risks of 

 blood-poisoning, such as pyaemia, and a protracted convalescence ending 

 sooner or later in amputation ; or the poisoned member must be removed 

 two or three inches or more above the site of the bite." In the case of 

 fingers and toes, where the bite has been proved to be effective either 

 by the existence of the fang-marks or unimpeachable testimony, there 

 ought to be no hesitation as to the procedure to be adopted — viz., 

 immediate amputation. These minor amputations are generally un- 

 attended with much danger to life ; whilst, if an attempt be made to 

 save the member, life is almost certain to be lost. By amputation 



