446 DISEASES DUE TO VENOUS AND POISONS 



Simple amputation of the digit immediate!}' when the toe or 

 finger only is bitten. 



Local injections of lo c.c. of 5 per cent, solutions of potassium, 

 zinc or calcium permanganate are good. Or of iodine tri- 

 chloride or of gold chloride, which is the best of all. 

 Local injections must be given at once and after ligature, to be 

 of any use. They do not afifect that poison already absorbed. 

 Incision and excision of the wound, electrolysis, irradiation^ 

 cauterization, bleeding, perfusion, &c., are all ineffective. 

 Intravenous injections of potassium permanganate are useless 

 and dangerous. 

 The neurotoxin of cobra venom is absorbed quickly but fixed 

 slowly and not firmly. 



The venom of Russell's viper is absorbed slowly and fixed firmly, 

 Hence delay in giving antivenene is more dangerous in viper than 

 cobra bite. 1 



The union of venom and antivenene in vitro is instantaneous^ 

 hence in cobra bite half-hour doses are almost as good as one whole 

 dose at once, but for viper bite give the whole dose at once in one 

 dose, 50-100 c.c. intravenously or 100-200 c.c. intraperitoneally. 

 Acton and Knowles conclude : — 



(i) Apply a firm ligature immediately. 



(2) Impregnate the whole area of the bite with a hypodermic 

 injection of a strong solution of gold chloride. 



(3) Inject from 100 to 200 c.c. of antivenene intravenously, if 

 the biting snake is suspected to be a cobra or Russell's 

 viper. 



If symptoms of venom intoxication come on, further and 

 even larger doses of antivenene should be given intra- 

 venously. 



With sera concentrated ten times, a dose of 20 to 60 c.c. 

 should save every case of cobra bite. 

 Prophylactic Measures. 



When crossing jungle or grassy districts wear strong boots and 

 puttees or leggings. 



Carry a stick when travelling; it is often useful in striking down 

 snakes. 



When doubtful look upon all snakes as dangerous. 



Carry a lantern when walking after dark. 



Always carry a little permanganate in case of need. 



Never sleep upon the ground. 



Cover drain pipes with gratings. 



Keep the gardens free from long grass. 



