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To the Editor:—
Some of the points in Dr. Shannon's letter are well taken and deserve comment. We agree that the local necrotizing properties of Naja venom are not as marked as those of the Crotalidae. Naja venom contains several digestive enzymes. The intense localization of this venom by immediate ligature and cryotherapy accounted for the local tissue loss in our case. The local damage with snake bite has long been a neglected subject due to its secondary importance to saving the victim's life. With wider use of antivenin more attention can now be directed toward this local morbidity.The ligature in this case remained in place 25 minutes. All of the patient's fingers were immersed in the ice water an equal time, yet only the envenomized finger suffered a necrotic slough.The question of envenomization versus simple bite is a difficult problem. The severe pain at the bite site
Mullins JF, Naylor D. Successful Management of Cobra Bite-Reply. JAMA. 1961;176(4):388. doi:10.1001/jama.1961.03040170133025
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