8 TKEATMENT OF SNAKE POISONING. 



11. Amputation here is in itself a grave proceeding, and it is for- 

 tunate that it is not primarily involved in the consideration of the case. 

 Provided the ligatures have been tightened to the utmost, time will be 

 allowed in which to make the excision so extensive and deep as to em- 

 brace the whole of the infected area ; to resemble, in truth, in principle 

 at least, and in completeness, the small and comparatively unimportant 

 amputation of the fingers or toes. But it will often happen that 

 gangrene will have resulted from the ligature, and, as a secondary 

 measure, amputation will become needful. A case of this kind occurred 

 to me at the Calcutta General Hospital The patient, a Mohammedan, 

 had been bitten in the forearm by a daboia. Ligatures and the cautery 

 were applied. Gangrene supervened. He was admitted under my care. 

 The soft parts, up to within half an inch of the axilla, were destroyed 

 by sloughing and gangrene. Enough skin over the deltoid remained 

 for a flap. The arm was taken off at the shoulder-joint, and the patient 

 made an excellent recovery. 



12. When an effective bite has been inflicted on any part of the 

 trunk, the ligature cannot be employed. But excision and the cautery, 

 if done at once, may be the means of saving life. In these cases suffi- 

 cient time usually elapses to permit the absorption of a fatal quantity of 

 poison before the arrival of the surgeon. It may sometimes happen, 

 where only a limited quantity of poison has been injected, that, even 

 after the signs of snake poisoning have been fairly developed, the com- 

 plete extirpation of the infected parts may succeed in saving life, which 

 would otherwise be sacrificed. 



13. It is much to be regretted that the intravenous injection of 

 ammonia first introduced by Fontana and the Italians, and energetically 

 revived by Professor Halford, of Melbourne, has not been found (by the 

 Calcutta Snake Poison Commission) to be of any practical use in dogs 

 poisoned by Indian or Australian snakes. Nor does the liquor potassse 

 recommended to be injected into the blood by Dr. Short, of Madras, 

 apparently do much good. It might do more if injected freely into the 

 poisoned part. 



Sir Joseph Fayrer recommends that liquor ammonise, nitric acid, 

 carbolic acid, strong whipcord, and a small sharp knife be kept at all 

 police stations for immediate use in cases of snake poisoning. 



