6 TKEATMENT OF SNAKE POISONING. 



before the symptoms of poisoning have become developed, owing to the 

 prevention of absorption by the successfiil application of the hgatures, life 

 may often be saved. And I am persuaded it wiU be usually so saved if 

 the ligatures, excisions, and cautery have aU been employed immediately 

 afber the poisoning has taken place, and also in many cases where only 

 a very small quantity of poison has been poured into the soft parts or 

 into the blood. 



9. In poisoning of fingers and toes, where, either from delay in 

 the apphcation of the ligatures, &c., or from their not having been 

 used at aU, the symptoms of snake poisoning have become unmistak- 

 ably pronounced, when the surgeon arrives upon the scene, the question 

 whether amputation is justifiable naturally arises, not because there is 

 much risk attending the procedure itself, but because, as may be argued, 

 aU operative measures may be regarded as utterly hopeless. Under such 

 circumstances the surgeon is again placed in a situation where self- 

 reliance and prompt decision are all-important. In cases of this kind 

 there has probably been too much delay and hesitation already, caused 

 by ignorance as to the measures to be adopted, or dismay at the injury 

 which has been inflicted. Neither the one nor the other can be per- 

 mitted to influence the surgeon. He may, however, reason in this way : 

 " Life is in imminent danger, and death will probably follow, do what 

 he may. Perhaps sufficient poison has been introduced into the cir- 

 culation to produce all the signs of snake poisoning, but not enough to 

 prove fatal, provided the ingress of fresh supplies be promptly pro- 

 hibited. Thus, although a successfiil result is problematical, amputation 

 is clearly the only hopeful proceeding." The part bitten should be at 

 once isolated by the ligature if this has not been done already, and the 

 member removed, in order to cut off all fresh supplies of the poison,. 

 When I was serving with the Meywar Bheel Corps, at Kherwarrah, near 

 Oodeypore, a Hindoo was brought to me, having been bitten on the end 

 of the thumb by a full-grown cobra. After getting up in the morning, he 

 had put his hand into a gurrah, or earthen vessel, to remove something 

 it contained. A cobra, which was secreted in the vessel, seized him by the 

 thumb. The snake was secured and brought with the patient. He was 

 presented to me half an hour after the accident. The marks of the fangs 

 were identified. The native doctor had seen him "a few minutes after 

 the bite, and had applied a stout cord round the thumb at two places. 



