110 PnySIOLOGY AND TOXICOLOGY 



Class 2d of local means acts in ways so various as to make it necessary to con- 

 sider these separately. 



Scarifications. — It is not easy to see how mere incisions could be of much value, 

 unless made expressly so as to cut oif the wound from the system, by destroying 

 for a time its vascular connection with the centres. Where ablation or excision is 

 no longer justified, incisions may be made into the part, and so directed as to tra- 

 verse the line of the fang wounds. 



Suction. Cups. — Suction by the mouth is an ancient practice, and one which is 

 supposed to be effectual. It is not probable that the narrow fang-track would allow 

 of the return of the poison under any suctorial power of which the lips are capa- 

 ble, unless the wound were unusually large. Where a previous incision has been 

 carried deeply through the bitten part, it is possible that suction may remove some 

 of the venom, but as Dr. Pennock has shown, it is more likely that the cups and 

 suction merely delay the constitutional poisoning, by retarding the local circulation 

 and the subsequent distribution of the venom. Either may be thus of value, as 

 Barry proved in regard to cups, but neither can do more than afford time for the 

 administration of general and more permanent local means. Cups are available 

 only in certain localities ; suction by the lips may be used on the small extremities, 

 in advance of all other means. 



Ligatures. — The first resource in serpent bite has been to tie a ligature around the 

 limb. Of course, there are localities in which this cannot be done, and where only 

 cups can be used. The value of the ligature has been repeatedly tested, not only 

 in this, but in other modes of poisoning, and it is perfectly clear that a ligature 

 tightly applied above the wound will, for a time, secure the system from the con- 

 sequences of the venom inoculation. But this is all which it can do. Time is 

 obtained for the use of other means, both local and general, and then a period 

 arrives when the swelling and interrupted circulation threaten the bitten member 

 with gangrene, and at last the physician reluctantly loosens the band which qua- 

 rantined the deadly material, and the system passes rapidly under its influence. 

 Allowing the ligature — as we must do — to be of the utmost value for a time, can 

 we not derive from its use yet further advantages, without subjecting our patients 

 to the sudden influx of the poison when the guarding band is loosened ? Two pre- 

 cautions will probably insure the requisite end. Let the cord be loosened for a 

 few minutes at a time, and at intervals, with a constant eye to the constitutional 

 symptoms, and let the delay secured by the ligature be used not only to apply local 

 means, but to administer general remedies. This method, which I shall term the 

 intermittent ligature, seems to have been first emploj^ed by the well known natu- 

 ralist. Prof. Holbrook, of Charleston, South Carolina, in conjunction with Dr. Ogier. 

 Their experiments, which were numerous and satisfactory, have never been pub- 

 lished. 



The precautions in the use of the ligature which I have just recommended have 

 been advocated singly, or together, by several more recent authors, and especially 

 by Drs. Alexander and Jeter. 



Several writers have recognized the danger of suddenly removing the ligature, 

 and it would be easy to criticize some of the reports of treatment in which the 



