288 VENOMOUS SNAKES AND THE PHENOMENA OF THEIK VENOMS 



LOCAL TREATMENT. 



Local treatment of the place of the snake bite is of great importance and 

 should never be neglected, no matter whether the therapeutic agent be a non- 

 specific or a specific. The retardation of the venom by means of a timely 

 ligature above the point of the wound is first to be resorted to, and imme- 

 diately afterwards the fang punctures must be freely and widely incised in 

 order to facilitate the closer contact of a chosen reagent with the venom in 

 situ. Meanwhile, the solution of the antidotal reagent is to be injected intra- 

 muscularly in such manner that the solution will besiege the venom in the 

 spot, and any attempt of the latter to escape and be absorbed into the system 

 will necessarily meet with the destructive reagent. Of course certain re- 

 agents — non-specific as they are — are much more promptly diffusible 

 than the venom and have a better chance to reach the venom even when the 

 former are injected somewhat distantly from the wound. Notwithstanding 

 numerous experiments, we are to-day in a position to choose for the local 

 treatment only certain reagents which are comparatively less destructive to 

 the tissues than others. In the following I describe some whose usefulness 

 has been fairly established. The chemicals which destroy venom are numer- 

 ous, but most of them can not be used for local treatment on account of their 

 injurious action on the tissues themselves. 



As to the local treatment with specific agents, namely, the specific antivenins, 

 it must be remembered that certain snake venoms, such as the viperine and 

 crotaline, are enormously destructive to the local tissues, and it is but rational 

 to inject the antivenin at and around the point of the wound. This does not 

 mean that the intravenous injection of the antivenin can be neglected; on the 

 contrary, the injections should be made both intravenously as well as locally. 

 Even in the case of colubrine poisoning local treatment with the antivenin 

 must be resorted to, especially when the case comes under treatment soon 

 after the incident. Naturally here the intravenous injection deserves the 

 primary attention. 



It would be of great value to use non-specific and specific agents in com- 

 bination, should the patient come early under observation. In such case the 

 non-specific chemicals must be applied closer to the bitten place and the 

 antivenin should be applied somewhat distantly from the point of the injec- 

 tion of the solution of the non-specifics, in order to avoid the destructive 

 action of the chemical upon the antivenin. Here it is understood that the 

 antivenin is also to be given intravenously. 



POTASSIUM PERMANGANATE. 



Early in i860 S. Weir Mitchell made thorough studies on the effect of 

 various chemicals upon the toxic properties of rattlesnake venom and found 

 numerous agents capable of depriving the venom of its fatal activity. The 

 first experiments on the use of permanganate of potash as an antidote were, 

 however, made by Fayrer 1 in 1869, both by local application and by intra- 

 venous injections, but without satisfactory results. 



1 Fayrer. The Thanatophidia of India, 1872, p. 95. London. 



