The patient went on to uninterrupted recovery.  The wound healed with very little sloughing.  The patient returned to his work in about a month.  The cure of this case was regarded by the cow boys as most exceptional, since, in their experience, similar cases, even though very freely stimulated, had not recovered.

Some time later I was called to see a girl, aged 14, who was struck by a rattlesnake, fifty-six miles from Fort Fetterman.  There was some trouble about procuring relays, and I was compelled to ride the same horse all the way out.  This took a little short of five hours.  This, together with the time consumed in sending me word, caused an interval of about twenty hours between the infliction of the injury and the time I saw the patient.  I found the fangs had entered on either side of the distal joint of the middle metacarpal bone.  The arm was enormously swollen, almost to the axilla, and exhibited a bronzed discoloration; this was especially marked about the wound and along the course of the lymphatics.  The swollen area was boggy to the touch, and exhibited a distinct line of demarkation between the healthy and diseased tissues, excepting along the course of the brachial vessels, where the indurated discolored area extended as a broad band into the axilliary lymphatics, which were distinctly swollen.  The patient was delirious, was harrassed by terror, complained bitterly of pain, and had an exceedingly feeble, rapid heart action.  There was marked dyspnoea, and all the signs of impending dissolution.  I at once made free multiple incisions into all parts of the inflamed tissue, carrying two of my cuts through the wounds made by the fangs of the snake.  In the arm these incisions were several inches long and from one to two inches deep.  As in the former case, the bleeding was slight, but there was a free exudation of serum.  Into these wounds a fifteen per cent. permanganate of potassium solution was poured, and as much as possible was kneaded into the tissues.  In addition multiple hypodermic injections were made, these being carried particularly into the bitten region, and circularly around the arm just at the border of the line of demarkation, thus endeavoring to limit by a complete circle of the antiseptic solution the further extension of the inflammatory process.  In the region of the brachial vessels I hesitated to make my injections as thoroughly as in the rest of the circumference of the arm, fearing lest the permanganate of potassium might injure important vessels or nerves.

This treatment caused very little pain, but immediately after the constitutional symptoms became distinctly aggravated.  I stimulated freely, and at once made preparations to take the patient to the Fort Fetterman hospital.  She was transported over the fifty-six miles, I riding the same horse back again, and arriving at Fort Fetterman the same evening.

The after treatment of this case was comparatively simple.  She was stimulated freely as long as cardiac weakness was manifested.  As in the former case, diuretics and laxatives were employed.  The arm was wrapped in cloth soaked in a weak permanganate solution, was placed in a splint, and was loosely bandaged.  There was some sloughing, but this was treated on general surgical principles.  The patient recovered the entire use of her arm, and was turned out cured in about six weeks.