OF THE VENOM OF THE RATTLESNAKE. 109 



mere sudorifics, or entirely inert, the local therapeutics of Crotalus bite have been 

 always of the most decisive and potent character. Without entering into the his- 

 tory of these means, I desire to assign to them their proper place in the treatment, 

 and also to define the real limits of their utility. We shall, therefore, discuss them 

 in turn, and for this purpose shall divide them into, Ist, Those which remove the 

 poison and the poisoned part, as excision, amputation. 



2d. Those which partially remove the venom, and more or less detain it in the 

 wounded part. In this class, we have a variety of agents acting in ways as va- 

 rious, as 



Scarifications. Suctions. 



Ligature. Caustics. 



3d. Those agents which, being injected into the wound, or wounded part, are 

 supposed to destroy the venom, or to render it innocuous, as injections of iodine. 



4th. Local applications of various substances, as alcohol, ammonia, indigo, olive 

 oil, etc. 



Class 1st. Excision, the only local means which proposes to remove at once and 

 entirely the poison and the poisoned part has been occasionally resorted to. Dr. 

 Harlan, Case 14 of the Table, used it freely. In another instance, in France, 

 even amputation of a finger was promptly and successfully resorted to in a case of 

 Crotalus bite. 



Excision and amputation are more or less usefully available, as the resort to them 

 is more or less early, and their utility is also increased when a ligature has been so 

 applied as to arrest the local circulation, immediately after the bite. In the French 

 case, the instant ablation of the part was perfectly successful; in Dr. Harlan's case 

 the malady was extremely grave after the operation, and we have, indeed, no 

 means of saying whether or not it proved useful. It seems likely that in so severe 

 a case, the removal by excision of any part of the poison might favorably determine 

 the issue of the almost balanced chances. Necessarily, excision would be unavail- 

 able where the ftmg had buried itself deeply in a part like the neck. 



Where the snake has been long confined without using its venom,' so that the 

 amount injected has probably been great, and where the part bitten is a small 

 extremity, excision, or, rather, amputation, would be justifiable. Where, on ac- 

 count of the serpent being at large, we cannot judge as to the quantity of poison 

 stored up in its ducts, and where excision would affect important parts, it is cer- 

 tainly better to accept for the patient the ordinaiy prognostic chances of the poi- 

 soning, under a less heroic local treatment. Above all, is it to be i-emembered 

 that, while it may be good practice to amputate a finger within a few moments 

 of the bite, the value of the operation lessens as we recede from this period, because 

 the poison exerts its power so rapidly, that its effects soon pass beyond the reach of 

 any justifiable operation, and excision then could do only what other and safer 

 means might effect. 



' It is curious that the fatal cases found in tl\c journals were nearly all occasioned liy the bite of snakes 

 which, during long imprisonment, had accumnlated a large amount of venom. 



