TREATMENT 



275 



The advantages of the ligature or tourniquet have been known 

 since ancient times, but C. J. Martin has shown that its principal 

 action with colubrine poison is not merely to delay the absorption 

 of the poison, but also to give time for any already absorbed to be 

 excreted. In the viperine poisons, which coagulate the blood by 

 fibrin ferment, it is most beneficial; for the blood, in coagulating 

 locally, retains the poison, which therefore but slowly passes into 

 the general circulation, and may, as Martin and Lamb suggest, 

 unite with the cells near the bite. 



There is therefore no doubt that the correct immediate treatment 

 in a bite due to any kind of poisonous snake on a limb is the applica- 

 tion of a proximal tourniquet. 



(2) Free Opening into the Poisoned Area.— it will be obvious that 

 the two minute punctures caused by the fangs are not sufficiently 

 large openings into the area of the bite for the application of anti- 

 dotes. 



Therefore the next step is to cut, not merely round the apertures 

 of the fangs, but also to extend the incision along the course of the 

 veins and lymphatics, and in some cases to remove the piece 

 of skin marked out. In this way the area of inoculation is 

 freely opened. 



(3) Neutralization of the Poison Locally. — ^The next indication is 

 to diminish the toxicity of the poison as much as possible, and to 

 do this the best remedy we at present possess is permanganate of 

 potash, though recent laboratory experiments have thrown some 

 doubt upon its efficacy. 



This should be used in strong solution, and not as a solid, as the 

 liquid penetrates better into the interstices of the wound, which 

 should be well washed with it. For carrying out this treatment a 

 most useful little case has been devised containing a little lancet for 

 "making the wound, and permanganate crystals for making a solu- 

 tion. This little case only costs a few pence, and can be carried 

 without any inconvenience in the waistcoat pocket, and therefore 

 should be carried by everyone in countries where poisonous snakes 

 abound, especially when on business or pleasure in jungles or grassy 

 places. Should there be no water available to make a solution, 

 then the crystals can be rubbed into the wound. 



If the bite is on the head or trunk, the incision should be made 

 as above, and the resulting wound thoroughly soaked with per- 

 manganate of potash solution (3 per cent.). The subcutaneous 

 tissue must be freely opened, otherwise the permanganate may be 

 prevented from doing its work properly. 



The after-treatment should be boric fomentations, frequently 

 repeated at first; but if there is no marked swelling of the part, 

 these may be gradually, not quickly, diminished in number, and 

 finally a mild antiseptic dressing should be applied until the wound 

 heals. 



2. Neutralization of the Poison in the System. — We have already 

 endeavoured to impress on the reader the following facts : — ' 



