326 The Bite of Russell' s Viper [Dec. 



the inner side of the right heel, about an inch above the sole. There 

 was then no bleeding, and very slight pain. The surrounding tis- 

 sues had a faint bluish tint, and the limb was swollen from the 

 knee downwards. The Hgatures, I found, were not too tightly 

 appHed. The patient complained of great weakness, and there was 

 much restlessness, violent retching, and inabihty to sleep. 



I incised the wound freely, injected into it a saturated Solution 

 of permanganate of potash, and also made a series of punctures 

 all round it. The same Solution was injected hypodermically into 

 the tissues. Powdered crystals were then rubbed in, and the wound 

 packed with the same. The limb was postured, and compresses 

 of the Solution also applied and frequently renewed. 



Four fluid ounces of whisky and half an ounce of sal volatile 

 were administered internally at once, and a füll dose of strychnine 

 and ether injected hypodermically into the arms an hour later. The 

 subsequent treatment consisted of a mixture of carbonate of ammo- 

 nium, citrate of caffeine, strychnine, and digitalis, and hypodermic 

 injections of adrenalin and strychnine. The treatment adopted was 

 that described by Dr. J. W. Watson Stephens, and in his hands 

 proved very successful in Siam. The vomiting ceased after the 

 first dose of whisky had been administered. I was not certain as 

 to whether the vomiting and cold sweats were due to the snake 

 poison or to the emetic administered by the constable, but it was 

 evident later that these were effects of the former. The poison, 

 there fore, had undoubtedly entered the general circulation before I 

 first saw the patient. At dawn the patient was not so restless, but 

 complained of great thirst and hunger. The bowels had acted once 

 and were relaxed, the skin was warm, the tongue dry, the expres- 

 sion anxious, and the eyelids had now a very heavy appearance, 

 the patient being unable to open them wide. The elevators of the 

 lids exhibited paretic Symptoms. The pupils were contracted, fixed, 

 and equal. Pulse was quick, 115 per minute, and moderately füll. 



Finding that the Hgatures were rather lax, I proceeded to remove 

 them, following the procedure recommended by Prentiss Willson 

 in the Archives of Internal Medicine, June, 1908, by intermittingly 

 relaxing the ligature nearest to the heart, letting it become looser 



