6 TREATMENT OF SNAKE POISONING.
before the symptoms of poisoning have become developed, owing to the prevention of absorption by the successful application of the ligatures, life may often be saved. And I am persuaded it will be usually so saved if the ligatures, excisions, and cautery have all been employed immediately after the poisoning has taken place, and also in many cases where only a very small quantity of poison has been poured into the soft parts or into the blood.
9. In poisoning of fingers and toes, where, either from delay in the application of the ligatures, &c., or from their not having been used at all, the symptoms of snake poisoning have become unmistakably pronounced, when the surgeon arrives upon the scene, the question whether amputation is justifiable naturally arises, not because there is much risk attending the procedure itself, but because, as may be argued, all operative measures may be regarded as utterly hopeless. Under such circumstances the surgeon is again placed in a situation where self-reliance and prompt decision are all-important. In cases of this kind there has probably been too much delay and hesitation already, caused by ignorance as to the measures to be adopted, or dismay at the injury which has been inflicted. Neither the one nor the other can be permitted to influence the surgeon. He may, however, reason in this way: "Life is in imminent danger, and death will probably follow, do what he may. Perhaps sufficient poison has been introduced into the circulation to produce all the signs of snake poisoning, but not enough to prove fatal, provided the ingress of fresh supplies be promptly prohibited. Thus, although a successful result is problematical, amputation is clearly the only hopeful proceeding." The part bitten should be at once isolated by the ligature if this has not been done already, and the nieiber removed, in order to cut off all fresh supplies of the poison. When I was serving with the Meywar Bheel Corps, at Kherwarrah, near Oodeypore, a Hindoo was brought to me, having been bitten on the end of the thunb by a full-grown cobra. After getting up in the morning, he had put his hand into a gurrah, or earthen vessel, to remove something it contained. A cobra, which was secreted in the vessel, seized him by the thunb. The snake was secured and brought with the patient. He was presented to me half an hour after the accident. The marks of the fangs were identified. The native doctor had seen him a few minutes after the bite, and had applied a stout cord round the thumb at two places.
