TREATMENT OF SNAKE POISONING. 7 
But the man was faint, depressed, nauseated, and prostrated. After 
seeing that the ligatures were tightened as firmly as possible, I asked 
the Brahmin native doctor to prevail upon the patient to let me take 
off his thumb, and so save his life. The thumb was first chopped 
off to economise time through the first phalanx, and subsequently ampu- 
tated in the usual way at the metacarpo-phalangeal jomt. He passed 
through a stage of severe nervous prostration, with intense nausea, 
vomiting and diarrhoea with bloody evacuations ; but eventually rallied, 
and made a good recovery. 
10. When the bite has been made on the forearm or leg, the upper 
arm or thigh, the ligatures, excision and the cautery may be practised 
more frequently, without having recourse to amputation. Because, in 
most cases, unless indeed the poison, as occasionally happens, is poured 
directly and en masse into a vein or artery, a sufficient quantity of the 
soft parts can easily be removed, so as to include the whole area of the 
poisoned district. The extent of the excised area must depend upon 
the depth of the skin and subcutaneous areolar tissue, the density of 
the infected areolar tissue, and the length of the penetrating fangs 
of the snake. Over the shin the depth of skin and areolar tissue is 
small; over the thigh the depth is greater, the cellular tissue is loose, 
and more easily penetrated by fluid, such as snake poison. Thus, in 
the former situation, both the area and depth of the excised part would 
be less than in the latter regions, because the area of its diffusion would 
be less. Over the shin, the depth of the excision should be down to 
the periosteum, and to the muscles on either side, and it should 
embrace an area of a square inch or more. In the thigh, the excision 
should be down at least to the fascia covering the muscles, and ought 
to be even more extensive, including an area of a couple of square 
inches or so. There is reason to believe that one reason why 
excision has not been attended with the expected success, has arisen 
from the fact that all the infected tissue has not been removed. 
It is manifest that, if any be left behind, the remaining poison may be 
insidiously absorbed, and eventually destroy life. Then again, if the 
bite has been inflicted by the daboia, on a thin and spare individual, the 
muscles of the calf or thigh may be penetrated. And, in such a 
case, muscle, in addition to skin and areolar tissue, may have to be 
excised, 
