ither 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