SNAKES OF CEYLON. 525 



(m) Interval before Death: This, of course, depends upon 

 the dose injected. There are records of death following the 

 bite in from 15 minutes to 14 days or more. Mr. Vernede 

 told me of a cooly woman who was bitten by a large Russell's 

 viper, judged to be 5 feet long, on his estate in the Nilgiris in 

 1917. In ten minutes from the casualty she was brought in 

 a comatose state for treatment, and within fifteen minutes 

 of the accident was dead. It is difficult to say positively if 

 this was to be attributed to the toxaemia, or to fright acting 

 upon the heart. However, Acton and Knowles* say, though 

 exceedingly rare in the human subject, cases of pulmonary 

 embolism do occur, and it is possible this fatality may have 

 been due to this cause. Usually death from the acute form 

 of poisoning, due to syncope or exhaustion from haemorrhages 

 occurs in from a few hours to a few days. The chronic form, 

 leading to septicaemia, may cause death as late as two or 

 three weeks after the casualty. 



(n) Treatment recommended : The one certain remedy is 

 antivenene, and 40 cc. of this serum should be run into the 

 veins as early as possible, and repeated if the symptoms do 

 not abate within half an hour, or in extreme cases even less 

 than that time. 



As syncope due to emotional causes is to be expected in all 

 cases of ophitoxaemia, this should be treated on the lines 

 suggested under the treatment of cobra poisoning. It is to be 

 noted that antivenene may successfully neutralize the poison 

 in circulation and the case still be lost, if syncope due to 

 emotional causes as well as to the toxaemia is not vigorously 

 treated. Bayliss' fluid is specially to be advocated intra- 

 venously until normal blood pressure is re-established. It 

 consists of gum arabic 7 parts, sodium chloride * 9 parts, and 

 water 92 ■ 10 parts, and it must, of course, be sterilized. Again 

 it is to be noted that haemorrhages must be controlled, and 

 suitable remedies employed with this object. Antivenene may 

 successfully achieve its purpose, and a case still be lost from 

 haemorrhages. 



* Ind. Journal of Medical Research, 1914, Vol. 2, No. 1, p. 95. 



