248 TROPICAL MEDICINE AND HYGIENE 



with due precautions, into a vein. Calmette prefers 

 injection under the skin of the flank, and considers that 

 a dose of 10 c.c., followed, if necessary, by a second, is 

 enough. After the injection the patient must be kept 

 warm and at rest. According to Calmette, strong stimu- 

 lants are not only useless but actually interfere with the 

 action of the antivenom. 



If no suitable antivenom is at hand, then, after local 

 measures have been carried out efficiently, the case can 

 only be treated on general principles. The patient must 

 be kept at rest and kept warm, and, when possible, warm 

 drinks should be given to excite perspiration. Alcohol 

 in small doses, and ammonia, may be given as stimulants ; 

 but enormous doses of alcohol are likely to be hurtful, 

 as they tend to paralyse the vaso-motor control. 

 Strychnine is always useful, both as a respiratory stimu- 

 lant and to raise fallen blood-pressure. Sir Lauder 

 Brunton has suggested nicotine, and Leonard Rogers 

 adrenalin, to raise the blood-pressure. In cases of 

 Colubrine poisoning artificial respiration should be 

 resorted to if necessary ; and for the haemorrhage of 

 the latter stages of Viperine poisoning several officers 

 of the Indian Medical Service have lately used adrenalin 

 with success. In cases of viperine poisoning, that have 

 not been immediately fatal, precautionary measures 

 should be taken against septicaemia, from the rapid and 

 extensive sloughing that is very likely to occur. Several 

 observers, it may be mentioned, consider that this slough- 

 ing is due to the destruction by the venom of the normal 

 germicidal power of the blood. 



4. GENERA AND SPECIES OF VENOMOUS SNAKES AND 

 THEIR GEOGRAPHICAL DISTRIBUTION. 



We have to consider (i) the Proteroglyphe Colubridce 

 with two sub-families, Hydrophince and Elapincv ; and (2) 

 the Viperida, also with two sub-families, Viperincv and 

 Crotalince. The characters that differentiate Colubridce 



