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To the Editor.—
The communication by Dr Glass ("Early Debridement in Pit Viper Bites") contains a number of statements to which I take vigorous exception, his vast surgical experience notwithstanding.First of all he states that, on envenomation, ischemia develops; he then goes on to recommend not only proximal but distal tourniquets, despite apparently believing that there is little lymphatic absorption of venin. I have always felt that tourniquets were placed solely to retard lymphatic spread of venin, especially its lysolecithin fraction, which is extremely destructive of tissue and is also a potent kinin releaser. If, as he states, he believes venin is not significantly transported by lymphatics then he is apparently recommending tourniquets to obstruct venous absorption of venins: this would require a very tight tourniquet in an admittedly ischemic extremity and would therefore substantially increase the chance of ischemic tissue loss.He then goes on, without saying why,
Ward AN. Treatment of Snakebite. JAMA. 1976;236(16):1843. doi:10.1001/jama.1976.03270170009003