SNAKES OF CEYLON. 541 



about indirectly by the cardiac weakness supplying insufficient 

 blood to the respiratory centre, and not by any direct influence 

 of the poison on the respiratory centre in the brain, or on the 

 terminations of the phrenic nerves. 



(m) Illustrative Case : Bite from Echis, 12 inches long. 

 Death in 27 hours. Autopsy. Reported by Captain C. H. 

 Reinhold, I.M.S. (Indian Medical Gazette, November, 1910). 



At Hangu, on July 13, at 7 a.m., dhooly bearer R., age about 

 40, while removing a dhooly from a tent, was bitten by a snake 

 on the outer side of the forearm, 3 inches above the wrist. 



He at once went to the hospital assistant, and told him what 

 had happened. The hospital assistant, with commendable 

 promptitude, applied a ligature immediately above the site 

 of the tooth mark, from which oozed two minute drops of 

 blood, he then incised across the tooth marks, and removed 

 semi-circular flaps of skin to the size of an 8-anna piece, 

 induced free bleeding, and rubbed in cryetals of permanganate 

 of potash. 



By this time the snake had been killed by some sepoys, and 

 the hospital assistant went to see it ; recognizing it as a 

 poisonous one, he applied a further ligature round the fleshy 

 part of the forearm of the man. 



Since the hospital at Hangu is only a camp one, the patient 

 was removed in a cart to the civil dispensary, and here, at 

 9 a.m., rubber ligatures, above and below the elbow, were 

 substituted for the cloth bandages, and potassium perman- 

 ganate re-applied. 



No antivenene being available, it was not used. 



The wound in the arm continued to ooze all day, but the 

 patient complained of severe pain in the arm, which was 

 attributed to the ligature, however, he managed to get some 

 sleep. 



At 5 p.m., there was considerable swelling of the arm, and 

 severe pain complained of : as the general condition of the 

 man remained satisfactory, it was decided to remove the 

 ligatures. 



