234 JOURNAL, BOMB A Y NA TUBAL HISTORY SOCIETY, Vol. XIY. 



kill a man. It is also apparent that we must, however, always 

 calculate on the assumptions that the snake has been a full- 

 sized one and that it has injected the maximum quantity which 

 can be squeezed out from the gland, and, further, that man 

 is as susceptible, weight for weight, as the most susceptible animal 

 with which we are experimentally acquainted. Granted these as- 

 sumptions, there is no doubt that from 30 to 40 cubic centimetres 

 would be necessary in some cases of snake-bite in order even to save 

 the life of the patient. It is, of course, evident that in many cases, 

 such as, when the snake has been a small one, when it has already 

 exhausted its poison, when it has not got properly home with its bite, 

 &o., a much smaller quantity would suffice. I should, however, recom- 

 mend you to inject right off in all cases of Cobra bite three bottles of 

 serum and to watch the result. If no symptoms appear, nothing further 

 need be done. Should symptoms come on after this injection, another 

 injection of the same amount should be given. 



The above doses apply only in those cases in which marked 

 nervous symptoms have not developed before the patient comes 

 under treatment. Should paralysis have begun, then intravenous 

 injection should be made of at least 30 cubic centimetres and, if neces- 

 sai'y, repeated. The symptoms show us that the venom has already 

 joined on to the nerve centres, and to affect it now, " mass " action 

 must be resorted to. The poison must be separated from its connection 

 with the nerve centres by means of an overwhelming amount of 

 antitoxin. 



If the antidote is used in this way and in these quantities, I am 

 convinced that, if a patient is not absolutely moribund when he 

 comes under treatment, every case of Cobra bite should be saved. 



Now a word, in conclusion, as regards the local treatment of these 

 cases. Nothing should be done, with the exception, perhaps, of ap- 

 plying a tight ligature above the bite. This delays the absorption 

 of the poison and gives the serum time to be absorbed into the 

 blood and to neutralise the poison circulating there. Cutting open 

 the wound, sucking, cauterising with the actual cautery or with 

 strong acids and such like heroic measures are of little avail. They 

 may destrf)y a small quantity of the poison with which they come 

 in contact, but in animal experiments it has been definitely shown 

 that they do not or only slightly delay the march of the symptoms. 



