CHAPTER XXX. 

 THE TREATMENT OF SNAKE BITE. 



NOW-SPECIFIC TREATMENT — IMMEDIATE LIGATURE AND DISSECTION. 



In order to prevent the absorption of the venom a ligature should imme- 

 diately be placed on the limb above the point bitten. It must be applied 

 where there is only one bone and not on the forearm or lower leg, and must 

 be tight. A stout India-rubber band is very suitable for this purpose, but in 

 ordinary circumstances only part of the clothing would be available and 

 answer quite well, a stick being passed under the ligature and twisted. 



The value of the ligature differs according to the nature of the venom. 

 Should the venom contain fibrin ferment, as in Daboia, Echis carinata, Not- 

 echis scutatus, and Pseudechis porphyriacus, the benefit of the ligature is very 

 great. In these cases the ligature prevents the absorption of the venom and 

 brings about intravascular thrombosis throughout the peripheral vessels 

 into which the venom enters. There is then no further absorption of venom 

 into the circulation, and upon the removal of the ligature no general venom- 

 toxication follows. Martin established this interesting and important fact 

 upon animals. 



On the other hand, the ligature has no more advantage in most colubrine 

 venom-poisoning than to prevent the absorption of the venom mechanically. 

 As soon as the ligature is removed the usual venom poisoning sets in, and 

 the ligature can never be left for longer than 30 minutes without danger, 

 lest the entire limb undergo gangrenous mortification. In that case, the 

 destruction of the venom deposited locally must promptly be commenced by 

 means of certain chemical agents, such as potassium permanganate, chlorides 

 of gold and calcium, and others. 



There is another way of preventing the absorption of the venom, that is, 

 dissection of the bitten locality. Wall recommends careful and deep dissec- 

 tion with the knife of all parts likely to contain the poison. The dissection 

 must be free in all directions, especially so in the direction of the lymphatics 

 and venous return. In the case of the fingers, hand, and such parts it should 

 be carried clear down to the bone. After this free and careful dissection 

 the wound should be freely washed out with a strong solution of potash 

 permanganate. 



Martin and Lamb call attention to the danger which would arise from the 

 injection of chloride of gold or chloride calcium, as these solutions are liable 

 to attack the least resistant tissues instead of following the venom, and would 

 produce a nasty slough. These authors believe that the washing of the 

 punctures with any reagent is futile and that the application of any destruc- 

 tive agent to an incision through wounds is almost useless, because the exact 

 site of the venom deposited is extremely difficult to strike in this way. 



To suck the wounds is absolutely useless. 



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