SNAKE BITES.
A ligature or tourniquet should instantly be applied to the limb on the proximal side of the wound, and very firm pressure applied by inserting a small stick under the cord, which, on rotation, powerfully compresses the vessels and retards absorption of the venom, whilst the tissues around the bite are freely excised and bleeding encouraged. By the application of a rubber bandage close to the trunk and extending down to the spot where the temporary ligature is to he applied the efficacy of the latter is greatly augmented.
There is little danger in immediately sucking the wound whilst the ligature is being rapidly adjusted if the patient or assistant washes the mouth promptly with strong alcohol. The prompt injection of Adrenalin solution would probably delay absorption.
After excision of the site of the bite, Permanganate of Potassium in crystals or powder should be freely rubbed in. Solution of Chlorinated Soda or Calcium, Carbolic Acid, Chloride of Gold, Chromic Acid or Peroxide of Hydrogen may be employed to irrigate the wound in the absence of the permanganate, but there is little use in recommending injecting these agents into the surrounding tissues unless excision is first performed. The ligature should not he removed for at least half an hour. Any hope of success depends upon the rapidity with which these measures can be carried out, owing to the swiftness of the action of the venom of the most poisonous serpents. In the case of the cobra and the highly poisonous serpents these measures nearly always fail, so terribly active is the venom and so rapid is its absorption. The writer was informed by a friend long resident in the East that he could obtain no evidence of recovery from cobra bite (outside the circle of snake-charmers) save in one solitary instance, and this was in the case of a man who, whilst chopping wood, was struck in the finger by the snake. Recognising his danger, he
amputated the finger by instantly bringing down his uplifted axe.
In rattlesnake bites the prospects are brighter, as the action of the venom is not so terribly rapid as that of the cobra.
Constitutional measures for combating the depressing action of the poison on the heart and nerve centres should be promptly employed. These consist in the intravenous injection of Ammonia and Strychnine or Digitalis, and Alcohol should be liberally administered to combat severe collapse.
Fraser and Calmette have demonstrated the efficacy of Serum Therapy in the case of cobra wounds. The serum is prepared by immunising the horse with gradually increasing doses of the venom obtained from living cobras, till the animal is able to withstand a single dose corresponding to the amount of poison extracted from a score of these serpents. The serum is prepared and standardised after the manner of the antidiph theritic sera. It is only specific for the venom of all snakes of the same genus, but the dose originally proposed has been found useless, and 30o c.c. should be injected at the earliest possible moment into the veins, a much larger amount being necessary if the hypodermic route is selected. The use of the serum should be preceded by ligaturing the limb and excision of the bite in all cases.