To the Editor.—
The physician's dilemma was precisely stated by Robert K. Myles, MD (1981;245:1579). Recent literature1 (1976;235:2513, 1978; 240:654) on snakebite management is controversial and contradictory. Each school of thought reports its results in an inadequate, almost anecdotal fashion, ignoring both the work of others and its own shortcomings.Administration of antivenin is not innocuous; the incidence of serum sickness approaches 100%, regardless of the volume used. Early debridement, fasciotomy, and bite excision may produce large wounds, delayed healing, and increased morbidity. Is there nothing in between?Our experience in treating 42 cases of Crotalidae envenomation has indicated that the treatment of snakebite, like that of other diseases, must be individualized. No single method is adequate; often a combination of techniques must be used.