191 1] A. E. Spaar 327 



and looser until it was entirely removed. The other ligatures were 

 removed in the same manner, the effect on the patient being noted 

 at the same time. At midday vomiting commenced again, but was 

 not persistent. The tissues all about the wound were slightly 

 tumefied and inflamed. Bleeding took place every now and again, 

 especially if the patient exerted himself. A noteworthy feature 

 of the blood was that it was thick, dark in color, and did not coag- 

 ulate. Restlessness was more marked. Weakness, depression, and 

 exhaustion and pains in the small of the back were complained of, 

 but there were no cramps, no paralysis of the limbs, and no con- 

 vulsions. The skin again began to break out in cold, clammy sweat. 

 The abdomen was distended and tympanitic, the Upper part exhib- 

 iting a board-like hardness. Eructations were f requent, but did not 

 appear to relieve the patient. He complained of suffocating pains, 

 as if both sides of his ehest were being compressed. There was 

 great oppression. Respiration was hurried and labored, and the 

 pulse was becoming weak and more rapid — 125 per minute. Sight 

 was rather dimmed, but recognition of objects and persons was 

 possible. Sinapisms were applied to the feet and over the prse- 

 cordial region. Saline infusions were injected per rectum. The 

 patient seemed to- rally somewhat, the pulse falling to 118 per 

 minute. At this stage, however, his case was taken over by a 

 native " snake physician of known repute," and English treatment 

 given up, but the case was watched by me with interest to the end. 



Drops were instilled into the eyes by the " vedarala," and this 

 appeared rather to aggravate the dimness of sight. Internal 

 remedies were also administered, but with the withdrawal of stimu- 

 lants there was a steady rise in the pulse, tili at 5 p.m. it registered 

 132 beats per minute, and was soft and feeble. Respiration also 

 became more hurried and difficult. 



At 10 P.M. the pulse rose to 142 per minute, and slight signs of 

 lividity were noticed about the face. The native physicians were 

 now making preparations against the twenty-fourth hour, which is 

 stated to be a critical time with cases of snake bite. At about 

 II P.M. dried bile from chickens was insufflated into the nostrils, 

 which made the patient feel very short of breath. Within a couple 



