To the Editor.—
The SPECIAL COMMUNICATION by Thomas G. Glass, Jr, MD, mentioned the use of cortisone, tourniquets, and ice bags. I think the following points are worth bringing out.
Cortisone has never been demonstrated to have any effect whatsoever on any snake venom known.
Cortisone has never been shown to have any effect on the tissue product breakdown of the actions of snake venom.
Cortisone has never been demonstrated to be of any benefit in the systemic manifestations of pit viper envenomation. The fact that Dr Glass uses it and his patients survive can not be used as proof of efficacy.
The hyperdynamic shock state so characteristic of Gram-negative shock has never been demonstrated in pit viper bites.
The use of tourniquets will decrease perfusion. This combined with cryotherapy will enhance tissue loss. This fact is well known to both physicians and lawyers, and