222 Trans. Acad. Sci. of St. Louis. 



has been localized by ligatures and minimized by incision 

 of the wound, sucking, or, better, cupping of the blood, 

 the treatment next to be applied depends upon whether 

 the offending snake is a Pit Viper or a Coral Snake, for 

 if it was a rattlesnake, a copperhead or a water moccasin, 

 attention should at once be directed to the local lesion, 

 unless the state of the patient imperatively demands an 

 immediate stimulant, in which case small doses of alcohol 

 may be useful. Apparently the best treatment of the local 

 lesion is a 1 to 100 solution of chromic acid injected into 

 the incised wound, the punctures of the fangs, and into the 

 surrounding swelling, as quickly as circumstances will 

 allow, since the success of this treatment depends upon 

 the chemical reaching and destroying the venom before 

 it is absorbed into the circulation. Kneading of the tis- 

 sues surrounding the wound in order to bring the venom 

 and chemical in close contact may be useful. If chromio 

 acid is not at hand, chloride of gold, permanganate of 

 potassium, etc., may be substituted. 



''There does not seem to be any necessity for amputa- 

 tion in a case where hypodermic injection of any of these 

 chemicals can be applied. It can only be recommended 

 in such extreme cases in which these remedies are not to 

 be had, and the danger is great. But even in this case 

 the amputation must follow quickly or not at all. 



"The local lesion having been attended to, the general 

 systematic treatment may commence, as by this time the 

 venom has probably already entered the circulation, it 

 being necessary occasionally to loosen the ligatures for a 

 moment to prevent mortification. Alcohol in small doses 

 and washing out of the stomach may now be in order, as 

 well as the administration of suborific and diuretic reme- 

 dies, preferably extract of jaborandi. Hypodermic in- 

 jections of 15 to 20 minims of liqu. strychinae repeated 

 every twenty minutes until slight tetanic spasms appear, 

 seem to be warranted. Constant watching for relapses, 

 :and attention to the local lesion will do the rest. 



