522 SNAKES OF CEYLON. 



the body was brought to me. The Russell's viper is well known 

 locally, and both men knew quite well what it was. The 

 victim himself tied a ligature of cord round his leg, below the 

 knee, and walked to his house. He was then brought to 

 hospital, in a bullock-cart, by an old missionary lady of 80, 

 who sat up with him all night, and mounted guard subsequently 

 to ensure rejection of the innumerable offers of remedies and 

 charms brought by his visitors. It was, therefore, at least two 

 hours after the bite that I saw him. 



He was in very great pain, and the leg was much swollen 

 up to the level of the cord. There was a small (2-anna bit 

 size) area of discolouration around the puncture, but apart 

 from a congested appearence, probably due to the ligature, 

 no discolouration of the leg. He was sweating, but his skin and 

 extremities were cold ; respiration shallow, 26-30 ; pulse 120, 

 feeble. It was noticeable that in spite of the general condition 

 and feeble pulse the superficial veins of the limbs were full. 

 Pupils normal, and no sign of any paralysis. 



I immediately injected 20 cc. Kasauli antivenene intra- 

 venously and 20 cc, subcutaneously under the skin of the 

 abdomen. I then made a crucial incision over the puncture 

 and applied permanganate crystals. I did not consider this 

 procedure likely to be of benefit, and it certainly increased 

 the pain, but it was obviously expected of me. The incisions 

 were superficial and the tissues, except for the dark area 

 mentioned, appeared to be merely cedematous. One cc. 

 pituitrin was also given. Vomiting occurred twice shortly 

 after admission, the vomit consisting of blood and mucus 

 only, about 4-6 oz. of blood on each occasion. It had also 

 occurred several times before admission. The ligature below 

 the knee was then removed and a tourniquet applied above 

 the knee, a brief interval being allowed without appreciable 

 effect. Half an hour later, although the pain was just as 

 severe, the general condition was improved and the pulse 

 considerably stronger. At 10 p.m. the condition was distinctly 

 good, and no further vomiting had occurred. The tourniquet 

 was now relaxed, and relaxation having no effect it was 

 removed altogether. At 11 p.m. although no new symptoms 



