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606                                               MEDICAL JURISPRUDENCE

to stop the blood circulation in the part, but it should be slackened for a few
seconds at regular intervals of ten minutes and should not be kept for more
than half an hour.

2.    Make free and deep incisions into the punctures, taking care not
to cut any large blood vessel or injure any underlying bone.   Suck the
poison from the wound provided there are no sores about the mouth and
lips, or neutralize the poison by washing the wound with a weak aqueous
solution of potassium permanganate.   If possible, inject hypodermically JLEL
grains of gold chloride dissolved in a minimum quantity of water at the site
of the bite.   Ahuja and his co-workers suggest the administration of h^pariu
intravenously as well as by local infiltration around the site of the bite from
a daboia, as heparin can effectively counteract the effects of daboia venom.1 (>

3.    In the case of cobra or krait bite local infiltration with a five per
cent solution of carbolic soap round the site of the bite has been recom-
mended as a first-aid treatment, when antivenene is not at hand.

4.    Inject intravenously at least 20 ml. of the polyvalent anti-snake-
venom serum as soon after the bite as possible and repeat the dose two hours
later or earlier if the symptoms of collapse appear.   In severe cases repeat
the dose every six hours till the complete disappearance of the symptoms.
In the case of viper bite inject some serum round about the site of the bite
to prevent sloughing and gangrene.

Forty to sixty millilitres of the anti-snake-venom serum may be injected
subcutaneously or intramuscularly, if expert medical aid is not available.
It must, however, be remembered that subcutaneous or intramuscular injec-
tions of the serum are not as effective as intravenous injections.

This polyvalent anti-snake-venom serum is prepared in the Haffkine
Institute of Bombay, and neutralizes the venoms of cobra, common krait,
Russell's viper, and echis which are the common poisonous snakes of India*
The serum is lyophilised by drying it from the frozen state undor high
vacuum. The dried serum dissolves readily in water and retains its potency
for ten years when stored in a cool dark place.

If the anti-snake-venom serum is not available, inject hypodermically,
preferably intravenously, 40 cc. of antivenene as soon as possible and repeat
the same dose if the symptoms do not abate. Antivenene is prepared at
Kasauli from the combined venoms of the cobra and the Russell s viper and
is specific for the bite of either. Antivenene has also been found to neutra-
lize the hsernorrhagin but not the other fractions of the Echis venom,11

5.    Administer morphine, veronal or aspirin to relieve pain and nervous-
ness in cases of bites from Russell's viper and Phoorsa (Echis),   They should
be used with care in cobra and Krait bites.

6.    Inject hypodermically strychnine, pituitrin, or adrenaline chloride,
and intramuscularly 0.9 grain of calcium chloride in 20 minims of water,

7.    Avoid alcohol if antivenene has been used but give hot coffee or tea*

8.   Promote warmth of the body by hot water bottles, and by friction
with ginger or mustard.

9.    Administer intravenously normal saline or transfuse Hood or plasma.

10.    Start artificial respiration, when necessary.

Post-mortem Appearances.—Lesions resulting from snake-bite are, as a
rule, two lacerated punctures about & inch deep in the case of colubrines and
about 1 inch deep in the case of vipers. They may be so minute that they

10.   Ind. Jour. Med. Res., Vol. XXXIV, No. 2, Oct. 1946 p  317

11.   Taylor and Mallick, Ind. Jour. Med. Res., XXIII, I, July 1935, p, 141,