140 THE POISONOUS SNAKES OP INDIA. 



acts like adrenalin by constricting the blood vessels, but is much 

 more powerful, and its effects longer sustained. It has a similar but 

 more forcible action on the heart, and is an ideal stimulant in 

 snake poisoning and its accompanying hsemoj-rhages. I am not 

 aware of its trial in practice, but it seems to me to offer gi'eat 

 possibilities, especial!}- in conjunction with calcium chloride. 



In being confronted with a reputed case of snake-bite, even if a 

 poisonous snake is produced one's first duty is to ascertain ^\-hether 

 the case is one of snake-bite, or snake poisoning. One's decision 

 should, I think, be based primarilj^ upon the local signs as alreadj'' 

 discussed in Pai-t, II. p. 103. 



I have now seen twelve cases of reputed snake-bite in this 

 country, one of which was without doubt snake poisoning, the viper 

 being produced. I have alwaj-s been guided by external signs, 

 have in consequence never administered antivenene, and only once 

 permanganate of potash, and every case recovered. Had I been 

 an enthusiast foi' the ammonia, permanganate, or any other form of 

 treatment, a series of cases such as these would have appeared very 

 convincing tfstiniony of the efficacy of such to many people. 



(4) LOCAL TREATMENT. 



A ^^'idp excision of the bitten part is pei-haps the best practice 

 and the application of permanganate of potasli crystals. One must 

 do something in cases where life is seriously jeopardised, and dis- 

 appointing as these measures have proved by experiment, there is 

 alwa3-s the possibilit)- of reducing a supralethal dose to a sublethal 

 one. All wounds require special attention to render them aseptic as 

 aJreadj^ shown under Daboia (page 143). 



(5) SPECIAL TREATMENT IN THE CASES OF THE 

 COMMONER SNAKEvS. 



Treatment of Cobra PoisoNiNti. 



The intravenous injection of 1 00 c. c. of antivenene as speedily as 

 possible after paralytic symptoms have become manifest is imper- 

 ative. If the symptoms after fifteen minutes exhibit a "crescendo" 

 I'athei- than a " diminuendo " tendencj^ this should be repeated, and, 

 if necessary, a third or fourth injection given. 



