368 VENOMS 
tory, and the man remained perfectly calm. We therefore left 
him under the supervision of the resident student and the male 
attendants, giving orders that we should be sent for immediately 
in case of any serious symptoms arising. 
At 7.15 we received a note from the student to the effect that 
Coupin had vomited, that his pulse was small, there was difficulty 
in breathing, and that he had just received an injection of anti- 
venomous serum. We hastened to the hospital, where we were 
speedily joined by Drs. Cordier and Lhomme. 
On our arrival we found Coupin in a rather prostrate con- 
dition. The pupils were fixed, he was foaming slightly at the 
mouth, respiration was regular, the pulse was strong and quite 
rhythmical at 96; the man was somewhat chilly. The patient 
was unable to speak, but had not lost consciousness, for, when 
we asked him how he was, he indicated by signs that he felt very 
ill. We subsequently learnt, from the student on duty, that 
towards 6.45 the condition of the patient became suddenly worse. 
after his companion had administered to him some medicine, the 
nature of which we have been unable to discover; on swallowing 
this drug Coupin was seized with vomiting, and became collapsed. 
We thought it more likely, however, that this was a mere co- 
incidence, rather than the result of a poison adding its effects 
to those produced by the bite of the snake. 
While waiting for our arrival a ligature had been applied to the 
injured arm, and near the bite there had been made two deep 
incisions, from which some dark blood escaped. At the same time 
the patient received hypodermically a first injection of 10 c.c. of 
Dr. Calmette’s antivenomous serum, and two injections of ether 
and caffeine. As the result of this treatment we found a marked 
increase in pulse-rate. After a subcutaneous injection of 500 
grammes of artificial serum, there appeared to be a further distinct 
improvement until about 8.45 (four hours after the bite). From 
this moment, however, the patient gradually sank. A second dose of 
