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 
weakness. 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. 
24 
