Potassium Permanganate Crystals in Snake-Bite

To the Editor, The Indian Medical Gazette. Sir,?In the issue of the Gazette for April 1926, on p, 178, is reported a case of recovery from cobra poisoning in which potassium permanganate crystals were used locally in the incisions made at the bitten parts with resultant sloughing, and it is in this connection that I write to enquire whether the rubbing in of these crystals is of any real value or benefit in the treatment of snake-bite. Potassium permanganate is a caustic, three grains producing one grain of caustic potash, and its vigorous application is bound to result in severe inflammation of the tissues encountered; even a one per cent, solution injected subcutaneously stings severely, and it might therefore be asked whether the crystals would achieve any more than the washing freely of the wounds inflicted with a solution of the permanganate. _ Another point in this connection is the depth of incision to be made. I have seen free multiple incisions down to bone and even distant from the actual punctures made on the leg and foot of a patient bitten by a snake which was not identified. Now, since the depth of fang penetration is not more than half an inch, it is quite unnecessary to make incisions except over the punctures only, not exceeding two-thirds of an inch in depth, and since the venom is diffused in the tissues, it would be useful to massage the parts, with a view to pressing the venom on to the surface of the wound, which should be freely irrigated with a solution of potassium permanganate; say a grain to an ounce. This will be sufficient to render inert any of the venom it comes into contact with, at the same time .not damaging the tissues and not producing sloughing, with later deformity of the parts. Since only two foreign substances have been in contact with the tissues?the venom injected and permanganate crystals?and since venom does not produce sloughing, it is only logical to conclude that it is the caustic employed that is responsible for the injury done to the patient in one's efforts at saving life. I am not touching on the use of antivenene and the application of the tourniquet, both are indispensable; the latter should not be kept on too long, but gradually released, watching symptoms and injecting anti-serum,