NOTES. 
189 
Four fluid ounces of whisky and half an ounce of sal volatile were 
administered internally at once, and a full dose of strychnine and 
ether injected hypodermically into the arms an hour later. The 
subsequent treatment consisted of a mixture of carbonate of 
ammonium, citrate of caffeine, strychnine, and digitalis, and 
hypodermic injections of adrenalin and strychnine. The treatment 
adopted was that described by Dr. J. W. Watson Stephens, and in 
his hands proved very successful in Siam. The vomiting ceased 
after the first dose of whisky had been administered. I was not 
certain as to whether the vomiting and cold sweats were due to the 
snake poison or to the emetic administered by the constable, but 
it was evident later that these were effects of the former. The 
poison, therefore, had undoubtedly entered the general circulation 
before I first saw the patient. At dawn the patient was not so 
restless, but complained of great thirst and hunger. The bowels 
had acted once and were relaxed, the skin was warm, the tongue 
dry, the expression anxious, and the eyelids had now a very heavy 
appearance, and he was unable to open them wide. The elevators 
of the lids exhibited paretic symptoms. The pupils were contracted, 
fixed, and equal. Pulse was quick, 115 per minute, and moderately 
full. Finding that the ligatures were rather lax, I proceeded to 
remove them, following the procedure recommended by Prentiss 
Willson in the “ Arch, of Internal Medicine,” June, 1.908, by inter- 
mittingly relaxing the ligature nearest to the heart, letting it become 
looser and looser until it was entirely removed, and the other 
ligatures removed in the same manner, at the same time watching 
the effect on the patient. At midday vomiting commenced again, 
but was not persistent. The tissues all round the wound were 
slightly tumefied and inflamed. Bleeding took place every now 
and again, especially if the patient exerted himself. A noteworthy 
feature of the blood was that it was thick, dark in colour, and did not 
coagulate. Restlessness was more marked. Weakness, depression, 
and exhaustion and pains in the small of the back were complained 
of, but there were no cramps, no paralysis of the limbs, and no 
convulsions. The skin again began to break out in cold, clammy 
sweat. The abdomen was distended and-tympanitic, the upper 
part exhibiting a board-like hardness. Eructations were frequent, 
but did not appear to relieve the patient. He complained of 
suffocating pains, as if both sides of his chest were being compressed. 
There was great oppression. Respiration was hurried and laboured, 
and the pulse was becoming weak and more rapid—125 per minute. 
Sight was rather dimmed, but recognition of objects and persons was 
possible. Sinapisms were applied to the feet and over the prae- 
cordial region, and saline infusions injected per rectum, and the 
patient seemed to rally somewhat, the pulse falling to 118 per 
minute. At this stage, however, his case was taken over by a 
native u snake physician of known repute,” and English treatment 
