DOCUMENTS 369 



antivenomous serum was injected beneath the skin/ and, since the 

 respiratory movements gradually became slower, artificial respiration 

 by Sylvester's method was resorted to, while the tongue was 

 rhythmically drawn forward. From time to time these proceedings 

 were interrupted for a few moments, in order to observe the con- 

 dition of the respiration ; at the base of the thorax and in the flanks 

 abrupt, jerky, tetaniform undulations were observable, but there 

 was no free respiratory movement. The abdominal aorta, the 

 pulsations of which were visible behind the navel, raising the 

 anterior wall of the abdomen, was somewhat misleading, simulating 

 the rhythmical oscillations of the abdominal respiratory type. The 

 heart, however, continued to beat regularly, without any appreciable 

 w^eakness. The radial pulse persisted, although weak and slow : 

 rate 48. 



The patient was kept alive by repeated injections of ether and 

 artificial serum (1;^ litres in three doses). About 8.30 there appeared 

 to be a slight improvement ; the patient was warmer, and showed 

 some degree of sensation in the region of the bite. On pinching 

 the vasculo-nervous bundle in the left axilla reflex movements were 

 produced in the fingers, which closed convulsively. The pulse, 

 which had momentarily disappeared in the radial artery, could again 

 be felt, weak but regular. At the same time, when the epigastric 

 region was examined, a few faint respiratory movements were just 

 perceptible. A third injection of antivenomous serum was given 

 and artificial respiration was continued. 



This factitious amelioration, however, was not maintained, and 

 after a few scarcely visible movements of the thorax the end soon 

 came. The eyes were fixed and insensible, the pupils slightly 

 dilated ; no sweats, no urine passed. The body slowly grew cold ; 

 the pulse disappeared from the femoral and carotid arteries, and 

 diminished in the aorta. The contractions of the heart were once 

 or twice irregular, and its beats became weaker and gradually 



• The thick and cloudy appearance of the contents of the bottles made us 

 hesitate to have recourse to intravenous injection. 



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