294 VENOMOUS SNAKES AND THE PHENOMENA OF THEIR VENOMS 



SPECIFIC TREATMENT. 



The most rational treatment of snake poisoning is by specific anti- 

 venins. That the action of antivenin is highly specific has been related 

 under the chapters concerning antivenin. The therapeutic value of anti- 

 venin is also discussed at length, and we may duly hope that in the near future 

 specific antivenins of higher potency for the most deadly venoms will be 

 produced and placed in the hands of practitioners in the countries where 

 accidents and death from venomous serpents are frequent. 



Up to the present time a polyvalent antivenin is not sufficiently strong 

 to be of much practical use, and it would be necessary to employ various 

 monovalent specific antivenins for the cases indicated. There are, at the 

 least, several available antivenins for practical purposes, as follows: Cobra 

 antivenin, Daboia antivenin (issued from the Pasteur Institute, India), No- 

 techis antivenin (Tidswell, Australia), Lachesis antivenin (Brazil,) Crotalus 

 antivenin and Moccasin antivenin (Rockefeller Institute, New York). A 

 seventh is another Lachesis antivenin (Trimeresurus antivenin) and may be 

 gotten from the Institute for Infectious Diseases, Tokio. 



Besides these monovalent antivenins there is a polyvalent antivenin pre- 

 pared by Calmette at the Pasteur Institute, Lille, although its action is more 

 pronounced against cobra venom than the other venoms. 



As Martin and Lamb rightly pointed out, the antitoxic powers of all these 

 antivenins are still feeble and are far from being satisfactory for practical 

 purposes. But, as I have stated elsewhere, the amounts of venom introduced 

 into the body by the bite are extremely variable, and death may occur in 

 certain instances as the result of a small excess over the quantity which by 

 itself is insufficient to be fatal. Here antivenins are of immense service in 

 averting death by neutralizing that excess. The excess may again be very 

 variable, but there must be a range of doses by which the antivenins, however 

 feeble they may be, can prevent the venom from reaching the vital organs of 

 the organism. Remembering that the antivenins are the only agents that 

 can neutralize the venom after the absorption of the latter into the general 

 system, we are amply justified in injecting as large a dose of antivenin as 

 practicable in every case of snake bite and, indeed, no practitioner would be 

 justified in hesitating to use this specific agent freely simply because of the 

 comparatively low antitoxic value which our present preparations of anti- 

 venins possess. 



To my mind there can be no room for the slightest doubt as to the great 

 service that antivenin has rendered towards saving the unfortunate victims 

 of snake poisoning from certain death. In many instances the cases of 

 recovery might have been due to the shortage of amount of venom introduced, 

 but equally as many cases must have been due to the removal of the excess 

 of the venom by the use of antivenin. The cases of death in spite of the 

 injection of antivenin are the instances where the excess of the venom has 

 been more than the employed dose of antivenin could neutralize. 



