SPECIFICITY AND THERAPEUTIC VALUES OF ANTIVENINS 245 
Notwithstanding the pessimistic calculations of Martin and Lamb, Cal- 
mette still adheres to his well-known optimistic views. He recommends the 
injection of 10 c.c. of his antivenin when the symptoms are not yet manifest, 
but 30 c.c. must be injected subcutaneously if the patient should come under 
treatment after some delay or the snake should prove to be a cobra or a bun- 
garus. Where symptoms of toxication are already present 10 to 20 c.c. of 
the antivenin must be given intravenously. 
The third factor, which equally lessens the possibilities of the practical 
application of antivenin treatment of snake poisoning, lies in the difficulty 
of obtaining sufficient venom for immunizing large animals. In order to 
promote the degree of immunity to a much higher standard than hitherto 
accomplished, enormous quantities of venom would be required. To obtain 
ro grams of dried cobra or daboia venom is by no means easy, but to accumu- 
late many kilograms of such material appears to be impracticable. In fact 
Lamb, who had every encouragement and support from the British govern- 
ment and no doubt was best situated to undertake such work, confesses his 
discouragement about the future of serum therapy for bites of Indian snakes. 
Again, in every case of snake bite we have to inject the specific antivenin 
only, and no other. It is rather difficult to identify the nature of the snake 
from the description of the victim. Even when the snake is identified, it may 
happen that it is too small, though deadly, to furnish enough venom for pre- 
paring its specific antivenin, and in such an instance there will be no available 
antivenin. 
Although the future of antivenin therapy may appear hopelessly gloomy, 
yet the problem of antivenins has its bright side. The circumstances which 
control the amount of the venom injected by a snake are extremely variable. 
Not every snake bite ends disastrously. Only those which occur under cir- 
cumstances very favorable to the snake prove fatal. Under some conditions 
only superficial scratches of the fangs may be inflicted. Between these two 
extremes there must be a series of variations in which the excessive amounts 
(beyond the dose which a man can bear) vary from a mere fraction of 0.001 gm. 
up to those doses which would require 50 or 100 c.c. of the present antivenins 
to neutralize and to prevent death. I conceive, therefore, that injections of 
specific antivenins are of a great benefit in cases of snake-poisoning. It 
would be necessary to employ the maximum practicable dose of antivenin in 
every instance, no matter what quantity of the venom might have been injec- 
ted by the snake. 
In America the future of antivenin therapy of snake bites is of a more 
optimistic nature. The average fatality from the bite of the more common 
American venomous snakes is extremely low and the occurrence of the accident 
is comparatively rare. The collection of venoms is not as difficult as in India, 
for Crotalus and Ancistrodon yield rather large amounts of venom. At the 
Rockefeller Institute stronger antivenins for crotalus and moccasin venoms 
are now being prepared. 
