TREATMENT OF POISONOUS SNAKE-BITES 263 



vitality of the tissues. The period in question also usually affords 

 sufficient time for taking the patient to a place where help can be 

 obtained, and for the preparation of everything necessary for his 

 subsequent treatment. 



The wound should then be freely washed with a fresh 2 per cent. 

 solution of hypochlorite of lime, or with a 1 in 1,000 solution of 

 chloride of gold. In default of hypochlorite of lime or chloride of 

 gold, either eau de Javel, diluted with tepid water to a strength 

 of 1 in 10, or a 1 per cent, solution of permanganate of potash, may 

 be employed. These reagents should be made to penetrate as 

 deeply as possible into the tissues, and a few cubic centimetres of 

 them should even be injected with a Pravaz syringe into the 

 punctures caused by the bite and all round them. 



The wound being then covered with a damp dressing by means 

 of compresses saturated with hypochlorite of lime, or at least with 

 pure alcohol, the next thing to be done is to prepare to apply the 

 serum- therapic treatment in order to arrest the general intoxication, 

 if this' has already commenced to take effect, or to prevent it from 

 setting in. 



For the employment of serum it is necessary to be in possession 

 of a sterilisable syringe of the capacity of 10 c.c, similar to those 

 used in the treatment of diphtheria. 



If the life of the patient be not immediately in danger, care 

 should first be taken to have the syringe boiled, or at least to rinse 

 it out with boiling water, making sure that the piston fits tightly, 

 and that the syringe itself is in good working order. 



Should a syringe of 10 c.c. not be available, any kind of Pravaz 

 syringe, previously washed out with boiling water, may be em- 

 ployed, but in this case the use of so small an instrument renders 

 it necessary to give several painful injections. 



The entire contents of a bottle of serum (10 c.c. of liquid serum, 

 or 1 gramme of dry serum dissolved in 10 c.c. of boiled water) 

 should be injected into the subcutaneous areolar tissue of the 

 abdomen, on the iright or left side. There is no advantage in 



