368 VENOMS 



tory, and the man remained perfectly calm. We therefore left 

 him under the supervision of the resident student and the male 

 attendants, giving orders that we should be sent for immediately 

 in case of any serious symptoms arising. 



At 7.15 we received a note from the student to the effect that 

 Coupin had vomited, that his pulse was small, there was difficulty 

 in breathing, and that he had just received an injection of anti- 

 venomous serum. "We hastened to the hospital, where we were 

 speedily joined by Drs. Cordier and Lhomme. 



On our arrival we found Coupin in a rather prostrate con- 

 dition. The pupils were fixed, he was foaming slightly at the 

 mouth, respiration was regular, the pulse was strong and quite 

 rhythmical at 96 ; the man was somewhat chilly. The patient 

 was unable to speak, but had not lost consciousness, for, when 

 we asked him how he was, he indicated by signs that he felt very 

 ill. We subsequently learnt, from the student on duty, that 

 towards 6.45 the condition of the patient became suddenly worse, 

 after his companion had administered to him some medicine, the 

 nature of which we have been unable to discover ; on swallowing 

 this drug Coupin was seized with vomiting, and became collapsed. 

 We thought it more likely, however, that this was a mere co- 

 incidence, rather than the result of a poison adding its effects 

 to those produced by the bite of the snake. 



While waiting for our arrival a ligature had' been applied to the 

 injured arm, and near the bite there had been made two deep 

 incisions, from which some dark blood escaped. At the same time 

 the patient received hypodermically a first injection of 10 c.c. of 

 Dr. Calmette's antivenomous serum, and two injections of ether 

 and caffeine. As the result of this treatment we found a marked 

 increase in pulse-rate. After a subcutaneous injection of 600 

 grammes of artificial serum, there appeared to be a further distinct 

 improvement until about 8.45 (four hours after the bite). From 

 this moment, however, the patient gradually sank. A second dose of 



