double the amcont rather than be content, with the minim"um. 



It is most highly advised to keep the bowels of the patient open and 

 free, using an irrigation of salt and soda solution if necessary. 



S pecial Directions for the Physician 



If the victim has not received an injection of antivenin, it is' 

 important to inject the contents of one syringe as soon as possible. At 

 the sariie time, release the tourniquet, if one has been applied. 



Repeat the injections everj/' one or two hours unless and until 

 symptoms are markedly diminished. To ha.stenthe absorption of the serum, 

 intramuscular injections are advised, and, in severe cases and those seen - 

 late, intravenous injection is recommended. In small children, when intra- 

 venous injection is difficult, the antivenin may be given intraperitoneally* 

 In shocked cases, physiological salt solution injected intravenously and, 

 blood transfusion are supplementary measures of life-saving value. For 

 weak pulse and threatened heart failure, give caffeine or strychnine. 



If incisions have been made at the site of the bite, the wounds 

 should be irrigated with a 1 or 2 percent salt solution (not normal saline). 

 The application ox strong suction m.ay be continued over these incisions, 

 if the symptoms and condition of the patient indicate the necessity of 

 pushing the treatment. Otherwise, apply a hot application of a l:lG^-000 

 part solution of .mercury bichloride or a strong magnesium sulphate solution. 



Extra Precaations 



It sometimes happens that after the first shock and reaction have 

 passed, the patient will show marked improvement. Some fatalities from 

 snake bite are pla.inly caused by an undue sense of security following the 

 observation that most patients do well for the first 15 hours. Even though 

 the general symptoms m.ay be mild, it is important to keep the patient under 

 close observation for at least 24 hours, ajid active treatment should be 

 continued as long a.s the swelling is progressing, Heper^t the injections 

 of antivenin every 1 or 2 hours if the swelling is increasing. The danger 

 is alv/ays in iuider-trea.tment rather than in over-treatmen t. 



In treatment of snake-bite in children it is im.portant to double 

 the initial adult dosage. The reason for this is that a mathemuatical rela- 

 tion exists between the weight of the body ond the amount of venom that it 

 can normally neutralize ajid dispose of without serious injury, although 

 the air.ount injected by the snake is approximmtely the s.-m.e. The smaller 

 and lighter the body of the victim, the less venom it can withstand, and 

 the greater the excess of venom over the normual body resistance. Therefore, 

 if the victim is a young child, there is much m.ore venom, requiring 

 neutralization by the serum. 



MTTLES 



According to popular superstition a rattlesnake acquires a new ring 

 on the rattle each year, and hence the number of rings composing the rattle 



- 13 - 



