524 SNAKES OF CEYLON. 



Comments. 



The antivenene was supplied to me twelve months before 

 use, with a note to the effect that it was then one year old, 

 but had been kept in cold storage. Personally, I am convinced 

 that the antivenene saved the patient's life. It may, ol course, 

 be argued that he did not receive a lethal dose, and perhaps 

 the fact that only a single puncture was found favours this 

 view. On the other hand, it cannot be denied that a Russell's 

 viper of over 36 inches can, and usually does, inject a fatal 

 dose. Moreover, the improvement which followed the 

 injection of antivenene on each occasion was very marked and 

 cannot be attributed to any other cause. 



Comments by Author. 



The report on this case is exceptionally valuable as the 

 snake that inflicted the injury was killed and brought in. It 

 was identified as a Russell's viper by my old friend Colonel 

 G. H. Evans, so there can be no doubt on this score. 



The fact that so severe a degree of syncope was observed 

 within two hours of the bite, coupled with the recurrent haema- 

 temeses which occurred even earlier, proves that a considerable 

 dose of venom must have been discharged into the tissues. 



I believe it is very unusual for haemorrhages to appear so 

 rapidly. I know of no case that proves the value of antivenene 

 more conclusively. 



It is dubious if calcium had any action in this case, or if 

 the cessation of haemorrhages was entirely due to the anti- 

 venene. It seems to me unlikely, however, that antivenene 

 can restore to the blood its lost clotting power or repair damage 

 to the intima. This is a matter that could be demonstrated 

 in the laboratory. It is an important point to clear up in the 

 treatment of these cases. It is conceivable that leakage from 

 vessels might continue after antivenene has neutralized the 

 venom in circulation, and a case might still be lost unless 

 agents like calcium and adrenalin are made use of (F.W.). 



