Bites of re1101110113 Snakes.—These are frequently fatal in tropical climates. The only snake that is to be feared in Great Britain is the viper. Its bite, however, is seldom fatal except where some peculiar state of the constitution is favourable. Immediately on the receipt of the bite a pain and a burning sensation are felt in the part, which are followed by rapid swelling and a livid discoloration of the part. The constitution becomes atlected also rapidly, and there is giddiness, extreme prostration of strength, depression of spirits, faintness, syncope, a small quick irregular pulse, difficulty of respiration, profuse cold clammy sweats, confusion of vision, headache, vomiting of bilious matter, a general yellow tinge of the skin, and a great pain about the navel. These symptoms are observed iu greater or less degree to follow the bites of most venomous snakes. The bite of some of the snakes of Africa and America is certainly fatal, and persons dio in a few hours after receiving the wound.
In the treatment of cases of bites from snakes, the first object should be to endeavour to prevent the passage of the poison into the system. Various modes are adopted for fulfilling this intention. The most effective is the immediate excision of the part. This will hardly be required after the bite of the British viper, as it seldom proves fatal ; but it is frequently the only remedy with regard to tropical snakes. The application of the tourniquet or a ligature above the wounded part has been recommended; also the application of cupping-glasses. These remedies, however, do not extract the poison, and only arrest its effect. The application of caustic may in some instances have the effect of destroying the poison. Various local applications have had a great reputation for their prevention of the effects of the poison of snakes, but none of them seem entitled to any consideration. The treatment of the constitutional symptoms consists in the administration of stimu lants : of these, ammonia is preferred. It is the basis of the Eau de lace, a remedy once very popular for the bite of snakes. Mr. Ireland, whilst in the West Indies as a surgeon to a regiment, employed arsenic in doses of one grain as a remedy against the effects of the bite of the Wilber carinatus. In South America, the plant they call Guaco is said to have a very beneficial effect. I'oeppig, in his Heise,' has collected all the evidence which he could procure of the value of Guaco in these cases, but this is far from being satisfactory as to the value of this remedy. Cases from the bites of rattlesnakes and other poisonous serpents have occurred in this country, as these reptiles are often brought over here for the purposes of exhibition. A man died a few years since from this cause in St. Georges Hospital.
Wounds of Particular Parts of the Bucly.—When any of the viscera of the body are wounded, questions frequently arise as to the treat ment, which can hardly be answered by general principles : hence the wounds of particular parte of the body require consideration. Wounds
of the head are frequently accompanied with concussion and compres sion requiring a modification of the treatment. Wounds of the scalp are also frequently attended with severe inflammatory symptoms, and no injuries of the body require more attention and close watching than these. Of all wounds which the surgeon is called on to treat, those of the throat are perhaps the most common, and require the most prompt attention. These wounds are generally the result of attempted suicide, and vary in extent according to the greater or less determination of the individual, as well as the edge of the instrument used for effecting the wound. The first thing to be attended to in these eases is to arrest the haemorrhage, which must be done by placing ligatures on the wounded arteries.
When the trachea is opened, the entrance of blood into the lungs should be avoided as much as possible, as its existence there as a foreign body may bring on inflammation of the lungs. Illen a wound occurs in the larynx above the rime, glottidis, every attention should be paid to removing anything that may irritate the glottis or prevent the free passage of air to the lunge. When the cesophagus is wounded, all the food of the patient should be administered by means of a tube passed through the mouth, nostrils, or the wound. It is sometimes the case that a surgeon sent for to a cut throat will attempt imme diately to bring the edges of the wound together by sutures. If this be done the chances are that the patient will die of suffocation as soon as this ie effected. When the bleeding has ceased, an attempt should be made gradually to bring together again the disunited parts. This is frequently done with the most perfect success, and sometimes the very worst cases of cut throat will recover. It will, however, generally require great skill and ettention on the pert of the surgeon to meet all the difficulties that will arise in the treatment of cases where so many important organs are involved.
Wounds of the chest become dangerous when they involve the viscera of the thorax, end several important questions nrise out of the nature and extent of these wounds. The must important compli cations of these are-1, the entrance of foreign bodies into the cavity of the thorax ; 2, the injury of one ur more of the intercostal arteries; 3, the protrusion of a portion of lung from the wound ; 4, the occur settee of emphysema from the wouudiug the lungs; and r), extravasation of blood iu the cavity of the thorax. Wounds of the abdomen, when superficial, require the same treatment as wounds generally. lu pene trating wounds of the abdomen there is always groat danger of the occurrence of peritonitis, which requires watching oil the part of the surgeon. lu cases where there is protrusion, the same general treat ment will be required as for hernia. [Ileneta.1 (Cooper's Dictionary of Surgery ; Cooper's First Lines of Surgery; Cooper's, Sir Astley, Lectures on Surgery; Liston's Elements of Surgery.)