ZOOLOGICAL SOCIETY BULLETIN 



1361 



in swallowing through loosely connected bone 

 mechanism, is capable of much lateral and ver- 

 tical distortion in biting. 



Within two minutes after receiving the in- 

 jury, Keeper Toomey's arm had been ligatured 

 above the elbow, and a minute or so after an- 

 other ligature was applied at the wrist. A cab- 

 inet in the Reptile House, always ready for ac- 

 cidents, supplied the surgical rubber ligature 

 that was applied over the lower portion of the 

 biceps muscle. The lower ligature was of thick 

 and soft cord applied in torniquet fashion. Im- 

 mediately after application of the ligatures. 

 Senior Keeper Snyder sucked the wounds in an 

 endeavor to draw away some of the poison. 



After these immediate, first-aid measures, in 

 which Toomey's fellow-workers expeditiously 

 took matters in hand. Dr. W. Reid Blair, offi- 

 cial Veterinarian of the Park, was summoned 

 from his office across the road from the Reptile 

 House. Dr. Blair decided that lancing the fang 

 punctures, as usually is followed in cases of 

 snake-bite, was not advisable, owing to the pos- 

 sibility of great tissue destruction. His con- 

 tention was further strengthened by doubt as to 

 which of the several wounds were fang punc- 

 tures, and the disjDosition of all wounds to freely 

 bleed. He prepared a solution of permanga- 

 nate of potassium with which all the wounds 

 were repeatedly bathed. In the meantime Dr. 

 Gilbert Van der Smissen, official physician of 

 the Park, had been summoned, and twenty min- 

 utes after the accident he arrived with a com- 

 plete set of instruments for treatment, and a 

 sterilizing tank. He also decided against scari- 

 fication of the wounds. 



The injury occurred at 9:30 a. m. on Janu- 

 ary 27, 1916, and Dr. Van der Smissen assumed 

 charge of the case at 9:50. The patient at this 

 time appeared normal beyond complaining of 

 intense pain caused by the ligatures. He ex- 

 plained that the bite caused a severe burning 

 sensation in his hand. The physician at once 

 started to fluidify a tube of Calmette's anti- 

 venomous serum, prepared at the Pasteur Lab- 

 oratories at Lille, France. For sixteen years 

 we have kept this serum on hand for emergency, 

 renewing it at regular intervals. It is prepared 

 chiefly for immunization against cobra venom. 

 The serum is in dessicated form, of rather hard, 

 yellowish granules. Reduced to this form the 

 product is placed in cylindrical glass tubes 

 sealed with a flame. 



As this was the first time we have had occa- 

 sion to use the Calmette serum, we were not 

 prepared for the disappointment experienced 

 with its slow solubilitv. The argument for 



dried, dessicated serum is that it is preserved 

 much longer in warm climates ; but from our 

 experience the writer would urge the use of 

 fluid serum, even though it must be renewed at 

 more frequent intervals. 



About forty-five minutes of very precious 

 time were consumed in dissolving the serum 

 granules in sterilized water. During this time 

 the patient suJffered great pain from the liga- 

 tures. It was slightly over an hour after the 

 injury that the patient was given the first hy- 

 podermic injection of one tube of dissolved ser- 

 um. The injection was made under the skin 

 of the abdomen. The ligatures were removed 

 ten minutes later. Meanwhile, washing the 

 wounds with permanganate of potassium had 

 been continued. 



Within half an hour after the removal of the 

 ligature the usual symptoms of poisoning from 

 snake-bite developed in the form of profuse 

 perspiration, shivering and vomiting. Moderate 

 doses of brandy were administered at regular 

 intervals, and between them the patient was 

 given liberal drinks of milk, as the stomach ap- 

 peared to collect and eject a certain proportion 

 of the poison. 



At 1 p. m. Keeper Toomey's hand and arm, 

 particularly the former, showed pronounced 

 swelling. He complained of little pain except 

 a burning sensation in the hand, which was not 

 severe. At this time a second injection of Cal- 

 mette's serum was made. 



At 3 :30 p. m. the patient was removed by 

 private ambulance to the German Hospital. 

 Between 1 1 a. m. and 3 :30 o'clock there had 

 been administered about a pint of brandy. Vom- 

 iting had become very frequent. A pronounced 

 weakness had set in at the time of transferrence 

 to the ambulance. Severe chills continued. At 

 the time of leaving the Reptile House, however, 

 the patient was quite conscious, and directed 

 the disposition of his clothing, and it is to be 

 recorded that he exhibited no nervousness 

 whatever. 



Arriving at the hospital, more alarming 

 symptoms developed. Dr. George Semken, of 

 the hospital staff, now became associated with 

 Dr. Van der Smissen in the treatment of the 

 case. A condition of coma developed and was 

 met by hypodermic injections of strychnine. 

 The arm increased to enormous size, with at- 

 tendant enlargement of the axillary glands. 

 The swelling quickly extended over half the 

 breast and downward toward the abdomen. 

 Marked discoloration of the swollen area soon 

 followed. 



