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To the Editor:—
I was perturbed by the sweeping conclusions of J. Fred Mullins and Don Naylor in their article on "Successful Management of Cobra Bite with Cryotherapy" in The Journal, Nov. 26, 1960. There is a vast difference between snake bite and snake envenomization. About 20% of bites result in no envenomization. The percentage of envenomous bites is considerably lower for cobras. Any treatment will result in a high percentage of success if no envenomization occurs. No such bites should be reported without some system of gradation for the Elapidae similar to that of Wood et al. (Virginia Med Monthly82:103-135 [March] 1955) for envenomization of the North American Crotalidae.The authors mentioned the use of a tight tourniquet and ice water, always a potentially dangerous combination. This resulted in subsequent gangrenous slough in the finger, a finding not associated with cobra envenomization. Swelling during and after use
Shannon FA. Successful Management of Cobra Bite. JAMA. 1961;176(4):387–388. doi:10.1001/jama.1961.03040170133024
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