TREATMENT OF SNAKE POISONING. 7 



Bat the man was faint, depressed, nauseated, and prostrated. After 

 seeing that the ligatures were tightened as firmly as possible, I asked 

 the Brahmin native doctor to prevail upon the patient to let me take 

 off his thumb, and so save his life. The thumb was first chopped 

 off to economise time through the first phalanx, and subsequently ampu- 

 tated in the usual way at the metacarpo-phalangeal joint. He passed 

 through a stage of severe nervous prostration, with intense nausea, 

 vomiting and diarrhoea with bloody evacuations ; but eventually rallied, 

 and made a good recovery. 



10. When the bite has been made on the forearm or leg, the upper 

 arm or thigh, the ligatures, excision and the cautery may be practised 

 more frequently, without having recourse to amputation. Because, in 

 most cases, unless indeed the poison, as occasionally happens, is poured 

 directly and en masse into a vein or artery, a sufficient quantity of the 

 soft parts can easily be removed, so as to include the whole area of the 

 poisoned district. The extent of the excised area must depend upon 

 the depth of the skin and subcutaneous areolar tissue, the density of 

 the infected areolar tissue, and the length of the penetrating fangs 

 of the snake. Over the shin the depth of skin and areolar tissue is 

 small ; over the thigh the depth is greater, the cellular tissue is loose, 

 and more easily penetrated by fluid, such as snake poison. Thus, in 

 the former situation, both the area and depth of the excised part would 

 be less than in the latter regions, because the area of its diffusion would 

 be less. Over the shin, the depth of the excision should be down to 

 the periosteum, and to the muscles on either side, and it should 

 embrace an area of a square inch or more. In the thigh, the excision 

 should be down at least to the fascia covering the muscles, and ought 

 to be even more extensive, including an area of a couple of square 

 inches or so. There is reason to believe that one reason why 

 excision has not been attended with the expected success, has arisen 

 from the fact that all the infected tissue has not been removed. 

 It is manifest that, if any be left behind, the remaining poison may be 

 insidiously absorbed, and eventually destroy life. Then again, if the 

 bite has been inflicted by the daboia, on a thin and spare individual, the 

 muscles of the calf or thigh may be penetrated. And, in such a 

 case, muscle, in addition to skin and areolar tissue, may have to be 

 excised. 



