TREATMENT OF SNAKE POISONING. 3
third a few inches above the ankle. In bites higher up the extremities, the ligatures should be employed, at suitable distances from each other, with the utmost promptitude. Sir Joseph Fayrer recommends the insertion of a piece of stick or other lever between the cord and the limb or member, with a view to twist the ligature to the utmost.
3. Carefully identify the punctures made by the fangs of the snake. Excise the part with a sharp penknife to the extent of a finger-nail, if the bite is on a ſinger or toe, if possible, round each puncture, and deeply, almost down to the bone, or in depth from a quarter to half an inch. Scarify freely the circumference of the wound, and encourage bleeding. Wash and squeeze it effectively to expel poison. Then apply to tho bottom of the wound a red-hot iron so as to cauterise and kill the adjacent soft tissues so that they may be incapable of absorbing any poison that maynot have been removed by the excision or destroyed by the cautery.
4. As the soft parts at the ends of the fingers and toes are comparatively dense, and the diffusion of the poison consequently limited, the extent of the excisions should be proportionately restricted. But if the fangs have penetrated the skin of any part of the extremities above, such as the leg, thigh, forearm, or upper arm, the extent of the diffusion of the poison is much greater, owing to the looser texture of the areolar tissue in these regions. The excision of the poisoned tissues must therefore be considerably extended and deeper. The scarification of the margins at the bottom of the wound and the cauterisation, either with a red-hot iron or live coal, must also be applied with more freedom. If the bite has been inflicted by the daboia, it may be needful even to excise muscular tissue, as well as skin and arcolar tissue ; because the fangs of this viper are much longer and penetrate deeper than those of the cobra.
5. It will often happen that absorption of poison to a greater or less extent may have occurred before the ligatures have been applied. In such cases they must not be relaxed; because their relaxation will admit the ingress of more poison into the blood. By kceping them firmly adjusted, we may hope, if they have been applied early enough, that such a limitation of the absorption of the poison may have been effected as to conduce materially to the preservation of life; whilst by their premature reinoval, the renewal of the absorption may, even in cases where only a small quantity of the virus has been thus introduced, turn the balance irretrievably against the patient and cause a rapidly fatal issue.
