TREATMENT OF SNAKE POISONING. 5
8. B. By the Surgeon.—In many cases the surgeon, on arrival, often finds himself placed under circumstances of the greatest responsibility and difficulty. Presuming that the foregoing measures have been adopted with efficiency and promptitude after the bite, and that symptoms of poisoning are consequently in abeyance, he should carefully examine the ligatures and see that they are tightened sufficiently to prevent absorption, and also the wound made by the excision, in order to ascertain whether it is wide and deep enough to facilitate the extraction of the whole of the poison or the total destruction of the remainder by the live coal or the actual cautory. In a case of this kind he will have time to find out whether the snake which inflicted the injury was, in all human probability, a poisonous one or not. If he be satisfied that tho bite was inflicted by a poisonous reptile-especially by a cobra or daboia—and that it was an effective onc, he is called upon, in a preponderating majority of instances, without the chance of a consultation with another surgeon, to decide on tho spur of the moment as to the course to be pursued. He may reason somewhat in this way: "If the ligatures be removed, absorption will set in; the blood will be charged with a fatal quantity of the poison; the functions of the great nerve-centres will be destroyed; the respiration will cease, and soon after the circulation also, cotemporaneously with actual death. It is true that mortification will be prevented, but then this comparatively insignificant gain at the best will only be temporary, and attained at the sacrifice of the life of the patient. On the other hand, it is quite clear that little or 110 poison has as yet gained access to the blood and the great nerve-centres, and that, to maintain this desirable condition, one of two things must be done; either the ligatures must be kept on until all chance of absorption be removed by gangrene, and the patient thus exposed to other risks of blood-poisoning, such as pyæmia, and a protracted convalescence ending sooner or later in amputation; or the poisoned member must be removed two or three inches or inore above the site of the bite." In the case of fingers and toos, where the bite has been proved to be effective either by the existence of the fang-ruarks or unimpeachable testimony, there ought to be no hesitation as to the procedure to be adopted-viz., immediate amputation. These minor amputations are generally un-attended with much danger to life; whilst, if an attempt be made to save the menuber, life is almost certain to be lost. By amputation
