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October 18, 1976

Treatment of Snakebite

Author Affiliations

Smithfield Medical Center Smithfield, Pa

JAMA. 1976;236(16):1843. doi:10.1001/jama.1976.03270170009003

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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,