SNAKES OF CEYLON. 523 



had appeared, I considered his condition distinctly worse than 

 it had been an hour previously, and I therefore injected 

 subcutaneously the remaining 20 cc. antivenene. Within 

 half an hour his condition had again improved very consider- 

 ably, and about midnight I left feeling satisfied that there 

 was no immediate danger. Adrenalin was held in reserve for 

 any further hsemorrhagic symptoms, and calcium lactate, 30 

 grains, given by mouth and continued, t.d.s., to a total of 180 

 grains. 



May 30, 1919. — Morning, 14 hours after bite : Temperature 

 99 '4°, pulse 120, general condition good, but pain still severe 

 and patient had had no sleep. Local condition considerable 

 oozing from incisions, soaking through a thick dressing. 

 Foot somewhat discoloured, swelling extends above the knee, 

 and is obviously increasing. 



Evening, 24 hours after bite : Temperature 99 '6°, pulse 

 120, general condition .good, still in great pain and restless, 

 but no sign of onset of delirium or convulsions. Paraldehyde, 

 one drachm, given. 



May, 31, 1919. — Morning, 36 hours after bite : General 

 condition good and pain diminished, had a fair night. The 

 leg and thigh are now enormous, and patches of subcutaneous 

 haemorrhage are seen, especially where ligature and tourniquet 

 were applied. On the tense swollen leg the patches of 

 discolouration resemble post mortem staining. 



The patient's condition subsequently gave rise to no anxiety, 

 but the oedema extended over the lower part of the back and 

 abdomen and discolouration appeared on the hip and gluteal 

 regions. 



He was discharged on the 13th day, his leg being still much 

 swollen. 



One other point of interest was noted by Mr. P. A. K. Chari, 

 S.A.S. On the second day the patient begged for and was 

 granted a cigarette, one inhalation from which was immedi- 

 ately followed by definite faintness. The patient, however, 

 was not convinced as to the cause, and later in the day repeated 

 the experiment, under close observation and with the same 

 result. 



72 6(6)20 



