An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.
- William Williams Keen
- Date:
- 1899
Licence: Public Domain Mark
Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
![tion of the rod l)lood-coi'pu.scles niiiy likewise each be a sufficient cause of death. Symptoms.—Much siinihirity characterizes the effects wliicli follow bites of all Viirieties of ])()isonous serpents. The amount of the venom injected and the rapidity with which it enters the circulation govern the intensity and the rai)idity of the symptoms ])roduced. The local symptoms are pain—at first slight, but later becoming more severe—with rapid tumefaction and ecchymotic discoloration in the vicinity of the wound. Symptoms of cardiac and respira- tory depression soon manifest themselves by feeble and fluttering pulse, faint- ness, cold perspirations, mental distress, nausea and vomiting, and labored respiration. In the more intense cases of poisoning death may result in a short time by the paralyzing effect of the venom upon the heart, but more frequently the struggle extends over a number of hours. When life is pro- longed over forty-eight hours, the special symptoms of venom-poisoning give place to those which are due to the disintegrating effect of the venom upon the blood and the tissues; that is to say, a sapremia of intense form remains, which may prove fatal by exhaustion or may be slowly recovered from. When death takes place from the primary effects of the venom, it is ushered in by delirium and coma, with intensification of all the primary symptoms. The post-mortem appearances are those which would follow the blood-changes and the visceral disturbances that have been described. In the neighborhood of the bite the tissues are infiltrated with hemorrhages and with the results of rapidly-extending gangrene, the right heart is engorged, the general blood-mass is fluid, and all the internal organs, especially the brain, spinal cord, and kid- neys, are congested and present multiple ecchymoses. Treatment.—When a bite by a venomous serpent has been received, instantaneous and energetic efforts must be made to prevent the entrance of the venom into the general circulation. When the bite has been upon any portion of a limb, a ligature should at once be thrown around the limb above the wound, and by twisting be drawn so tightly as absolutely to check the circu- lation of blood in the part. This ligature should be a broad one, so as to diminish later pressure-effects; then free excision of the wounded part should be done. When the bite is upon a part of the body other than a limb, imme- diate excision should be practised, and, when this is impracticable, vigorous suction of the wound should be made, which can be done without fear if no cracks or abrasions of the lips or mouth are present, for the poison is harmless when taken into the mouth. Should a hot iron be accessible, its vigorous and free application within the wound might safely replace excision or suction. When none of these procedures are practicable or have been only imperfectly applied, there remains the device of permitting the poison to be admitted into the gene- ral circulation in instalments by slackening the ligature a little at intervals, and then tightening it again, while constitutional treatment is being resorted to for the purpose of antidoting the poison thus slowly admitted into the circulation. Permanganate of potassium, in 1 per cent, aqueous solution, freely injected by means of a hypodermatic syringe into a serpent's bite, or calcium hypochlorite, in an 8 per cent, solution, freshly prepared and diluted at time of use with nine volumes of water, injected into the tissues in the region of the bite, and also at intervals in other parts of the body, in doses of from 20 to 30 C.C., are reported to have acted as effectual antidotes to serpent- venom. The hypodermatic injection of an antitoxic serum, derived from an animal rendered immune to snake-poison by repeated injections of venom in doses of graduated strength, it has been asserted, will act as an antidote to the effects of a bite of a venomous snake, even if the injection is delayed as](https://iiif.wellcomecollection.org/image/b21217014_0163.jp2/full/800%2C/0/default.jpg)
