Nearly all, if not all, of the cases treated by stimulation alone have, according to my experience, perished if they have received a full dose of virus from a vigorous snake.  One of these cases lived for upward of a month.  He then perished of what might be considered a chronic pyaemia, the symptoms being those of blood poisoning, accompanied by multiple abscesses.  Another case, not occurring in my own practice, died at the end of four days apparently of cardiac failure.  Active delirium persisted all through this case.  Two other cases treated by stimulants also died with symptoms of more or less acute blood poisoning.

The feeling is almost universal among the people of Wyoming that a fair strike from a rattlesnake is certain death, and that the free use of stimulants simply postpones the end.  I do not for a moment deny that a strong, lusty man may be struck fairly by a rattlesnake and if the wound is at once opened and cauterized, and the heart judiciously supported, he may yet recover; still the fact remains that the great majority of these cases perish at a longer or shorter interval following the infliction of the wound.  Hence any treatment that will save even the majority of such cases is a distinct gain, and one which has saved every one of nine cases to which it has been applied needs no further commendation.

The first case of rattlesnake wound to which I was called occurred in 1885.  A cow boy was bitten on the foot, the fang penetrating through the boot.  He was brought forty miles to Fort Fetterman, where I was then stationed.  I saw him about twenty-four hours after he was struck.  There was an enormous swelling, extending up to the knee.  The whole limb was bronzed in appearance.  There was no special discoloration about the wound; in fact, the swelling disguised this to such an extent that it was impossible to determine exactly where the fangs had entered.  The pulse was scarcely perceptible at the wrist; the heart was beating with excessive rapidity.  The patient was suffering great pain.  His mind was clear, but he was oppressed with a dreadful anxiety.  Up to the time I saw him he had received absolutely no treatment, excepting the application of a cactus poultice to the leg, since there was no whisky at the ranch where he was wounded.  I at once made free incisions, five or six in number, from one to two inches in depth, and about three inches in length.  These cuts gave him very little pain, nor was there much bleeding, though there was an enormous amount of serous oozing.  Into these wounds was poured a fifteen per cent. solution of permanganate of potassium, and fully half an hour was devoted to kneading this drug into the tissues.  In addition I made many hypodermic injections into all portions of the swollen tissue, but particularly about the wound.  Since there was no very distinct line of demarkation between the swollen and healthy tissue, I did not, as in other cases, endeavor to prevent the extension of the cellular involvement by a complete circle of hypodermic injections.  I employed, in all, about forty grains of the permanganate.  In addition to the local treatment I pushed stimulation, employing carbonate of ammonium and whisky.  By means of diuretics and laxatives the kidneys and bowels were encouraged to eliminate as much of the poison as possible.