104 THE POISONOUS SNAKES OF INDIA. 



In a case recorded by Lamb and Hanna this continued for 24 

 hours. If lacerations or punctures are seen sealed up with blood 

 within a few minutes of the casualty, as in the case of ordinary 

 wounds, there is very strong justification for believing that no 

 poison has been injected. 



(4) Tissue changes. — Should the presence of any of the above 

 local conditions call for local operative measures, the condition of 

 the tissues as revealed by incision will furnish confirmatory testi- 

 mony of the entrance of snake poison which, in the opinion of my 

 namesake A. J. Wall, is absolutely characteristic. He says the 

 areolar tissue becomes purple in colour and infiltrated with 

 coagulated purple blood-like fluid. This fades gradually to a 

 pinkish colour, and this again to normal conditions as the site of 

 the poisoned wounds are receded from. These changes are 

 extremely rapidly produced having been seen by this authority 

 within 30 seconds of the entrance of the poison. 



To the surgeon this sign is invaluable. Its presence proclaims 

 the envenomed nature of the wound, and dictates a course of 

 action completely different from that necessary in its absence. 



(5) Discolouration. — A greenish or bluish tinge is frequently 

 observed in the skin in the immediate neighbourhood of the 

 punctures within a few minutes of the bite when venom has been 

 introduced. Sometimes, indeed, the skin is purplish from severe 

 subcutaneous bleeding. 



(6) Slouching. — The tissue cells in the vicinity of the wounds 

 frequently die as a result of the powerful action of the poison. 

 The result is the formation of a slough varying in extent to the 

 dose of the poison injected. This dead matter under normal con- 

 stitutional conditions ofiers an ideal pabulum for putrefactive 

 gerins to flourish. But in snake poisoning among other things 

 it has been shown by Ewing, that the natural germicidal proper- 

 ties of blood are rendered inert, so that with the entry of germs 

 there is a grave danger of another form of blood poisoning to be 

 set up, and death may be the result of an intoxication from such 

 germs. When the slough separates a deep ulcer is left which 

 takes some time to heal. 



