TREATMENT OF SNAKE BITE 295 



For these obvious reasons I earnestly caution practitioners not to view the 

 future of the antivenin therapy of snake bite in a gloomy light. All thera- 

 peutic experiments on animals point to the high curative property of anti- 

 venins, and this is especially marked in the cases of crotalus antivenin and 

 ancistrodon antivenin. 



Enough has been said to uphold the practical value of antivenins, and it 

 now remains to give the rules for administering these specific antidotes : 



(1) The injection should be made as soon after the bite as possible. 



(2) The injections should be made both intravenously and locally. In the 

 latter the intramuscular as well as subcutaneous injections should be made 

 somewhat distant from the incised wounds of the fang punctures. Here 

 i per cent solution of potassium permanganate should be injected at and 

 around the point of the bite, and the antivenin introduced somewhat remote 

 from the chemical. 



(3) With the present preparations of antivenins a quantity, at least, of 

 100 c.c. should be injected into the vein and also as much into the bitten limb 

 or parts of the body as will be absorbed by the tissues. The injections there 

 may be made not at one spot, but at several places surrounding the entire 

 circumference, for example, of the limb involved. 



Where specific antivenins are employed general medicamentation becomes 

 entirely superfluous and any excessive use of alcohol is decidedly objectionable. 



A decidedly favorable report has recently been made by Kitashima on the 

 antivenin treatment of Habu poisoning in man. Antihabu serum has been 

 tried upon a number of cases in Anami, Oshima, and Riu kiu since 1905. In 

 most cases the serum has been gratuitously distributed among the practitioners 

 of the islands. The neutralizing power of the antivenin was such as 10 c.c. 

 of it will render o.i gram 1 (dry weight) of the habu venom completely inactive 

 when mixed in vitro and allowed to act during 30 minutes at 37 C. At 

 present 40 c.c. of this antivenin are put in a bottle as a curative dose for 

 one case. In a chronic case, twice or more is used. The injection is made 

 near the bite, which is incised slightly, washed and dressed in the usual 

 manner. 115 cases were treated with the antivenin, of whom 5 died, making 

 a death rate of 4.2 per cent. One patient was brought in 3 hours after the 

 bite and died in a few minutes after receiving the antivenin. Kitashima 

 states that if the antivenin is given immediately after the bite, swelling only 

 makes its appearance, with only the slightest phenomena of toxication. In 

 ordinary cases general symptoms, such as vomiting, colic, and pain soon 

 disappear. Pain at the site of the bite also decreases in 2 to 3 hours and 

 the swelling subsides after serum treatment. 



In the future when i c.c. of antivenin may become so active as to neutralize, 

 for example, o.oi gm. of venom or even more, the incision or dissection may 

 be abandoned and the non-specific venom-destroyers, such as permanganate 

 of potash and certain chlorides, may also become superfluous. 



1 A habu;discharges, under natural circumstances, 0.3 to 0.5 c.c. of venom, equaling about o.i gram 

 of the dried venom. 



