TREATMENT OF SNAKE BITE 295 
For these obvious reasons I earnestly caution practitioners not to view the 
future of the antivenin therapy of snake bite in a gloomy light. All thera- 
peutic experiments on animals point to the high curative property of anti- 
venins, and this is especially marked in the cases of crotalus antivenin and 
ancistrodon antivenin. 
Enough has been said to uphold the practical value of antivenins, and it 
now remains to give the rules for administering these specific antidotes: 
(1) The injection should be made as soon after the bite as possible. 
(2) The injections should be made both intravenously and locally. In the 
latter the intramuscular as well as subcutaneous injections should be made 
somewhat distant from the incised wounds of the fang punctures. Here 
1 per cent solution of potassium permanganate should be injected at and 
around the point of the bite, and the antivenin introduced somewhat remote 
from the chemical. 
(3) With the present preparations of antivenins a quantity, at least, of 
100 c.c. should be injected into the vein and also as much into the bitten limb 
or parts of the body as will be absorbed by the tissues. ‘The injections there 
may be made not at one spot, but at several places surrounding the entire 
circumference, for example, of the limb involved. 
Where specific antivenins are employed general medicamentation becomes 
entirely superfluous and any excessive use of alcohol is decidedly objectionable. 
A decidedly favorable report has recently been made by Kitashima on the 
antivenin treatment of Habu poisoning in man. Antihabu serum has been 
tried upon a number of cases in Anami, Oshima, and Riu kiu since 1905. In 
most cases the serum has been gratuitously distributed among the practitioners 
of the islands. The neutralizing power of the antivenin was such as Io C.C. 
of it will render 0.1 gram! (dry weight) of the habu venom completely inactive 
when mixed in vitro and allowed to act during 30 minutes at 37°C. At 
present 40 c.c. of this antivenin are put in a bottle as a curative dose for 
one case. In achronic case, twice or more is used. The injection is made 
near the bite, which is incised slightly, washed and dressed in the usual 
manner. 115 cases were treated with the antivenin, of whom 5 died, making 
a death rate of 4.2 per cent. One patient was brought in 3 hours after the 
bite and died in a few minutes after receiving the antivenin. Kitashima 
states that if the antivenin is given immediately after the bite, swelling only 
makes its appearance, with only the slightest phenomena of toxication. In 
ordinary cases general symptoms, such as vomiting, colic, and pain soon 
disappear. Pain at the site of the bite also decreases in 2 to 3 hours and 
the swelling subsides after serum treatment. 
In the future when r c.c. of antivenin may become so active as to neutralize, 
for example, 0.or gm. of venom or even more, the incision or dissection may 
be abandoned and the non-specific venom-destroyers, such as permanganate 
of potash and certain chlorides, may also become superfluous. 
Aces en UNE RNS Bee seeen mals Nope ude eer ee 
1 A habu‘discharges, under natural circumstances, 0.3 to 0.5 C.c. of venom, equaling about 0.1 gram 
of the dried venom. 
