TREATMENT 247 



it has a retarding effect, and also some limited neutralizing 

 power upon the neurotoxins of other Indian Colubrines 

 as well as of certain sea-snakes. All competent observers 

 agree, however, that Calmette's antivenom is of no avail 

 at all against the venom of the Viper idee. 



(2) Practical Treatment of Snake-bite. Whether a re- 

 liable antivenom synthetic or specific is available or 

 not, energetic local treatment is always obligatory, the 

 indications being to prevent or delay absorption of 

 venom, to attempt to destroy the venom locally, and to 

 assist its elimination. 



To prevent or delay absorption, a ligature should be 

 applied as soon as possible, or two ligatures, one a good 

 deal higher than the other. The ligature must be twisted, 

 in the words of Sir Joseph Fayrer, "without mercy," 

 but it must not be kept on longer than is necessary to 

 accomplish thoroughly the next steps in the treatment. 



The knife must now be freely used. It must be 

 remembered that the fangs may have been driven in 

 deep, that the venom is injected with force, and that 

 the fine interstices of the areolar tissue exercise capillary 

 attraction, so that the venom may have travelled far from 

 the points of puncture. For these reasons it is a vital 

 matter to make long and deep cuts, to lay the wounds 

 well open, and to let the blood flow and perhaps carry 

 away some of the venom that has lodged. 



With the object of destroying the venom the wounds 

 should be thoroughly well washed out with some of the 

 reagents that are known to render venoms inert in vitro. 

 Calmette recommends a 2 per cent, solution of hypo- 

 chlorite of lime, or a T T Q per cent, solution of gold 

 chloride ; but the best for many reasons is the strong 

 solution of permanganate of potash advocated by the 

 British school. 



If suitable antivenom is at hand it should be used as 

 soon as possible to neutralize the venom that has been 

 absorbed. Martin and Lamb insist that, of antivenoms 

 at present obtainable, at least 100 c.c. should be injected, 



