TREATMENT OF SNAKE POISONING. 5 
8. B. By the Surgeon.—In many cases the surgeon, on arrival, often 
finds himself placed under circumstances of the greatest responsibility 
and difficulty. Presuming that the foregoing measures have been adopted 
with efficiency and promptitude after the bite, and that symptoms of 
poisoning are consequently in abeyance, he should carefully examine the 
ligatures and see that they are tightened sufficiently to prevent absorp- 
tion, and also the wound made by the excision, in order to ascertain 
whether it is wide and deep enough to facilitate the extraction of the 
whole of the poison or the total destruction of the remainder by the live 
coal or the actual cautery. In a case of this kind he will have time to 
find out whether the snake which inflicted the injury was, in all human 
probability, a poisonous one or not. If he be satisfied that the bite was 
inflicted by a poisonous reptile—especially by a cobra or daboia—and 
that it was an effective one, he is called upon, in a preponderating 
majority of instances, without the chance of a consultation with another 
surgeon, to decide on the spur of the moment as to the course to be 
pursued. He may reason somewhat in this way: “If the ligatures be 
removed, absorption will set in; the blood will be charged with a fatal 
quantity of the poison ; the functions of the great nerve-centres will be 
destroyed; the respiration will cease, and soon after the circulation also, 
cotemporaneously with actual death. It is true that mortification will 
be prevented, but then this comparatively insignificant gain at the best 
will only be temporary, and attained at the sacrifice of the life of the 
patient. On the other hand, it is quite clear that little or no poison 
has as yet gained access to the blood and the great nerve-centres, and 
that, to maintain this desirable condition, one of two things must be 
done ; either the ligatures must be kept on until all chance of absorption 
be removed by gangrene, and the patient thus exposed to other risks of 
blood-poisoning, such as pyzemia, and a protracted convalescence ending 
sooner or later in amputation ; or the poisoned member must be removed 
two or three inches or more above the site of the bite.” In the case of 
fingers and toes, where the bite has been proved to be effective either 
by the existence of the fang-marks or unimpeachable testimony, there 
ought to be no hesitation as to the procedure to be adopted—viz., 
immediate amputation. These minor amputations are generally un- 
attended with much danger to life; whilst, if an attempt be made to 
gave the member, life is almost certain to be lost. By amputation 
