904 16. CROTALIDM 



however, from time to time, be loosened for a few seconds. 

 The length of time that the bandage should remain loose, 

 and the intervals between these periods, must be regulated 

 by the symptoms which follow. Loosen for two or three 

 seconds and tighten again. If no effects are apparent in 10 

 minutes loosen again, increasing the period to five seconds. 

 Repeat this procedure every 10 or 15 minutes, adding two 

 seconds each time. If shortness of breath, rapid or irregular 

 breathing, and depression or faintness, or any other serious 

 symptom, appear, lengthen the interval and shorten the 

 period of bandage release. 



If, in spite of all these measures, the patient develops 

 alarming symptoms, the treatment should be similar to that 

 for anaphylactic or surgical shock. The respiration, the cir- 

 culation and the temperature must be supported and con- 

 served. Blankets and hot water bottles should be used to 

 keep the patient warm. Suitable stimulants may be given. 

 A few teaspoonful doses of whiskey or brandy at intervals 

 of one-half or one hour may not be harmful, but large doses 

 certainly are. Strychnine and caffeine probably are the best 

 stimulants. One-thirtieth of a grain of Strychnine sulphate 

 or nitrate dissolved in a little boiled water may be injected 

 under the skin with the hypodermic syringe. If time will 

 permit the syringe should, of course, be boiled for a few 

 (three to five) minutes before it is used, to prevent infection. 

 This injection should not be near the part of the body bitten 

 by the snake. This dose of strychnine may be repeated once 

 or twice at intervals of one half hour if the symptoms seem 

 to demand it and if there are no muscular spasms. Caffeine 

 citrate in one grain doses may be used in the same manner, 

 or strong black coffee may be given by mouth or rectum. 

 Adrenalin seems sometimes to be of use as an aid in restor- 

 ing vascular tone. In desperate cases the subcutaneous or 

 intravenous administration of large quantities of physiologic 



