8 TREATMENT OF SNAKE POISONING.
11. Amputation here is in itself a grave proceeding, and it is fortunate that it is not primarily involved in the consideration of the case. Provided the ligatures have been tightened to the utmost, time will be allowed in which to make the excision so extensive and deep as to embrace the whole of the infected area; to resemble, in trutlı, in principle at least, and in coinpleteness, the small and comparatively unimportant amputation of the fingers or toes. But it will often happen that gangrene will have resulted from the ligature, and, as a secondary measure, amputation will become needful. A case of this kind occurred to me at the Calcutta General Hospital. The patient, a Mohammedan, had been bitten in the forearm by a daboia. Ligatures and the cautery were applied. Gangrene supervened. He was admitted under my care. The soft parts, up to within half an inch of the axilla, were destroyed by sloughing and gangrene. Enough skin over the deltoid remained for a flap. The arm was taken off at the shoulder-joint, and the patient made an excellent recovery.
12. When an effective bite has been inflicted on any part of the trunk, the ligature cannot be employed. But excision and the cautery, if done at once, may be the means of saving life. In these cases suffi- cient time usually elapses to permit the absorption of a fatal quantity of poison before the arrival of the surgeon. It may sometimes happen, where only a limited quantity of poison has been injected, that, even after the signs of snake poisoning have been fairly developed, the complete extirpation of the infected parts may succeed in saving life, which would otherwise be sacrificed.
13. It is much to be regretted that the intravenous injection of ammonia first introduced by Fontana and the Italians, and energetically revived by Professor Halford, of Melbourne, has not been found (by the Calcutta Snake Poison Commission) to be of any practical use in dogs poisoned by Indian or Australian snakes. Nor does the liquor potassa recommended to be injected into the blood by Dr. Short, of Madras, apparently do inuch good. It might do more if injected freely into the poisoned part.
Sir Joseph Fayrer recommends that liquor aramoniæ, nitric acid, carbolic acid, strong whipcord, and a small sharp knife be kept at all police stations for immediate use in cases of snake poisoning.
