TREATMENT OF SNAKE POISONING. 7
But the man was faint, depressed, nauseated, and prostrated. After secing that the ligatures were tightened as firmly as possible, I asked the Brahmin native doctor to prevail upon the patient to let me take off his thumb, and so save his life. The thumb was first chopped off to economise time through the first phalanx, and subsequently ampu. tated in the usual way at the metacarpo-phalangcal joint. He passed through a stage of severe nervous prostration, with intense nausoa, vomiting and diarrhoea with bloody evacuations; but eventually rallied, and made a good recovery.
10. When the bite has been made on the forearm or leg, the upper arm or thigh, the ligatures, excision and the cautery may be practised more frequently, without having recourse to amputation. Because, in most cases, unless indeed the poison, as occasionally happens, is poured directly and en masse into a vein or artery, a sufficient quantity of the soft parts can casily be removed, so as to include the whole area of the poisoned district. The extent of the excised area must depend upon the depth of the skin and subcutaneous areolar tissue, the density of the infected areolar tissue, and the length of the penetrating fangs of the snake. Over the shin the depth of skin and areolar tissue is small; over the thigh the depth is greater, the cellular tissue is loose, and more easily penetrated by fluid, such as snake poison. Thus, in the former situation, both the area and depth of the excised part would be less than in the latter regions, because the area of its diffusion would be less. Over the shin, the depth of the excision should be down to the periosteum, and to the muscles on either side, and it should embrace an area of a square inch or more. In the thigh, the excision should be down at least to the fascia covering the muscles, and ought to be even more extensive, including an area of a couple of squaro inches or so. There is reason to believe that one reason why excision has not been attended with the expected success, has arisen from the fact that all the infected tissue has not been removed. It is manifest that, if any be left behind, the remaining poison may be insidiously absorbed, and eventually destroy life. Then again, if the bite has been inflicted by the daboia, on a thin and spare individual, the muscles of the calf or thigh may be penetrated. And, in such a case, muscle, in addition to skin and areolar tissue, may have to be excised.
