The third case I saw about fourteen hours after he was struck.  The patient was a healthy blacksmith, about 30 years of age.  The wound was at about the middle of the forearm, the fangs entering toward the ulnar side.  When I saw the patient he exhibited comparatively trifling symptoms.  His heart action was rapid, and he was suffering from the typical despondency and terror, but I could not note the profound systemic depression characteristic of the great majority of cases.  Surrounding the wound and extending up the forearm for several inches there was a boggy swelling, exhibiting a sharp line of demarkation.  It was bronzed in color, and was apparently spreading.  I at once applied the intermittent ligature just above the elbow, and injected the permanganate of potassium solution freely all through the involved tissues, particularly in the region of the bite and about the periphery of the swelling, surrounding the latter by a complete ring of injections.

The general treatment of this patient was continued on the same general line as described in the former cases, stimulants being employed moderately.  He recovered without any bad symptoms.  There was no sloughing; the swelling disappeared without any necrosis of tissue.  He is still pursuing his trade in Cheyenne, and suffers from absolutely no disability.

I saw but one case shortly after the wound was inflicted.  This patient was a healthy young man, who was struck about the middle of the dorsal surface of the hand, the fangs entering on each side of a metacarpal bone, and the poison lodging apparently in the palm of the hand.  The patient, when seen, exhibited the characteristic terror and depression, weak, rapid heart action, and agonizing local pain.  I made two small incisions in the region of the wound upon the dorsum of the hand, and injected permanganate of potassium freely.  This patient ultimately recovered, but only after sloughing and prolonged suppuration.  I believe that had I incised freely and at once from the palmar surface, I would have been spared this unpleasant complication.

I have had in all nine cases, and without a single death.  The others are in their general features and in the treatment employed quite similar to those given.

The symptoms resulting from snake bite poison are strikingly like those dependent upon the violent septic poison seen in pre-antiseptic times.  There is often the same prodromal chill, the high elevation of temperature, the profound effect on the circulation, and the rapid cellular involvement.  The tissue disturbance following snake poisoning differs from ordinary cellulitis, however, in the following particulars:  The color is bronze, not red; the involved area is boggy, not brawny; and the extension of the process is exceedingly rapid.