476 REPORT OF NATIONAL MUSEUM, 1893. 



A similar treatmeut also seems advisable iu such cases of slow poison- 

 ing* in wliicli the patient lias already reached a stage of collapse, or 

 coma, before assistance can bo rendered, provided not more than 

 twenty fonr hours have elapsed since the bite was ioflicted, in which 

 case injections of strychnine seem inapplicable. 



If iu case of slow poisoning help can be administered very soon after 

 the infliction of the wouud and the venom has been localized by liga- 

 tures and uiininiized by incision of the wound, sucking, or, better, cup- 

 piug of the blood, the treatment next to be applied depends upon 

 whether the ottendiug snake is a Pit Viper (Crotalid)or an Ulaps, for if 

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

 should at once be directed to the local lesion, unless the state of the 

 patient imperatively demands an immediate stimulant, in which case 

 smaU doses of alcohol may be useful. Apparently the best treatment 

 of the local lesion is an 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 the 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 

 tissues surrounding the wound in order to bring the venom and chemi- 

 cal in close contact may be useful. If chromic acid is not at hand, 

 chloride of gold, permanganate of potassa, etc., may be substituted. 



There does not seem to be any necessity for amputation in a case 

 where hj^podermic 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 great. But even in this 

 case the amputation must follow quickly or not at all. 



The local lesion having been attended to, the general systemic treat- 

 ment 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 ijrevent mortification. Alcohol in small 

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

 the administration of sudorific and diuretic remedies, preferably 

 extract of jaUorandi. Hypodermic injections of 15 to 20 minims of 

 liqu. strychni;e 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. 



The acti(m of the venom of the elapid snakes being so much more 

 rapid and the local changes so insignificant as not to cause any great 

 alarm, the chances are that when the i^atient asks for help and treat- 

 ment the venom has already entered the circulation, and that attempt 

 to destroy any appreciable quantity of the poison in the wound would 

 be futile. However, whenever possible this should not be neglected. 

 The usual first treatment would nevertheless be general, viz, the 

 administration of stimulants, sudorifics and duiretics as instanced 

 above, since the danger from a quick paralysis of the nerve centers is 

 so much greater in these cases. 



I 



