THE TREATMENT OP SNAKE BTTE 443 



In iMan.— LocLil pain, swelling, lividity. Rapid swelling and 

 spreading decoloration, excitement, thready pulse, hurried respirations, 

 and later, stertorous breathing. Cold universal sweat, the swelling 

 reaches the trunk, convulsions, and dealli from failure of the circulation 

 ensue. 



P.M. — Meninges and lungs congested. 



The Bitis arietans or puff adder is the same in kind but less severe. 



The Echis is very poisonous; its effects are much as the Colubrine. 



Crotaline Venom, e.g., Crotalus horridus. 



Local oedema, swelling, infiltration of incoagulable blood, necrosis, 

 suppuration, sloughing. Fall in B.P. accompanied by vaso-dilatation 

 of the portal svstem, respiration gradually ceases due to the failure of 

 the circulation. The phrenics are not paralysed, and the respiratory 

 centre is not primarily affected. There are hcCMiiorrhages into the peri- 

 and endo-cardium, peritoneum, and pleurc'c but not into the nervous 

 system. There is no primary stimulation. 



Few persons die of snake bite compared with the number alleged to 

 have been bitten by venomous reptiles. 30 per cent, has been 

 suggested. 



THE TREATMENT OF SNAKE BITE. 



The indications are : — 



(i) To prevent the absorption of venom. 



(2) To neutralize the venom absorbed. 



(3) To aid the excretion of the venom. 



(4) To maintain the strength of the patient. 



(5) To treat the symptoms as they arise. 



(6) To prevent as far as possible secondary infection. 



(1) To Prevent the Absorption of Venom. 



Stop the flow of blood and lymph from the bitten area by ligature. 

 This must be slackened for two seconds at intervals and must be 

 applied for half to one hour. This allows time : — 



For the dilution of the venom absorbed already. 

 For the neutralizing process to commence. 



And permits of a gradual absorption only from the affected area. 



Open the poisoned area freely for the application of antidotes and 



the local excretion of venom; this to be along the vessels in particular. 



The bite of the Echis, however, usually bleeds so freely that the 



difficulty is in controlling it. 



Pour into the wound a strong solution of potassium permanganate 

 and wash it well into the wound, attempting thus to neutralize some of 

 the venom locally. Use crystals if there is no water available. Some 

 find I per cent, chromic acid or hypochlorite of lime useful. 



