6 TREATMENT OF SNAKE POISONING. 
before the symptoms of poisoning have become developed, owing to the 
prevention of absorption by the successful application of the ligatures, life 
may often be saved. And I am persuaded it will be usually so saved if 
the ligatures, excisions, and cautery have all been employed immediately 
after the poisoning has taken place, and also in many cases where only 
a very small quantity of poison has been poured into the soft parts or 
into the blood. 
9. In poisoning of fingers and toes, where, either from delay in 
the application of the ligatures, &c., or from their not having been 
used at all, the symptoms of snake poisoning have become unmistak- 
ably pronounced, when the surgeon arrives upon the scene, the question 
whether amputation is justifiable naturally arises, not because there is 
much risk attending the procedure itself, but because, as may be argued, 
all operative measures may be regarded as utterly hopeless. Under such 
circumstances the surgeon is again placed in a situation where self- 
reliance and prompt decision are all-important. In cases of this kind 
there has probably been too much delay and hesitation already, caused 
by ignorance as to the measures to be adopted, or dismay at the injury 
which has been inflicted. Neither the one nor the other can be per- 
mitted to influence the surgeon. He may, however, reason in this way : 
“Life is in imminent danger, and death will probably follow, do what 
he may. Perhaps sufficient poison has been introduced into the cir- 
culation to produce all the signs of snake poisoning, but not enough to 
prove fatal, provided the ingress of fresh supplies be promptly pro- 
hibited. Thus, although a successful result is problematical, amputation 
is clearly the only hopeful proceeding.” The part bitten should be at 
once isolated by the ligature if this has not been done already, and the 
member removed, in order to cut off all fresh supplies of the poison. 
When I was serving with the Meywar Bheel Corps, at Kherwarrah, near 
Oodeypore, a Hindoo was brought to me, having been bitten on the end 
of the thumb by a full-grown cobra. After getting up in the morning, he 
had put his hand into a gurrah, or earthen vessel, to remove something 
it contained. A cobra, which was secreted in the vessel, seized him by the 
thumb. The snake was secured and brought with the patient. He was 
presented to me half an hour after the accident. The marks of the fangs 
were identified. The native doctor had seen him a few minutes after 
the bite, and had applied a stout cord round the thumb at two places. 
