S. Faust concludes from his physiological investigations that

salamandrine takes effect upon the central nervous system, especially

upon the respiratory centres. It is a convulsion-producing poison,

comparable to picrotoxin, but its effects differ from those of the

latter substance in that the convulsions are accompanied by tetanic

spasms.

The venom of the Japanese Salamander (_Cryptobranchus japonicus_) has

formed the subject of studies by Phisalix.[153] This investigator

has shown that this venom, which is highly soluble in water and in

glycerine, is very unstable; alcohol and heating for twenty minutes

at 60° C. are sufficient to destroy it. When inoculated into frogs

it produces œdema and hæmorrhage; if injected into warm-blooded

animals it causes necrosis. In sufficiently strong doses it kills by

arresting respiration. Its effects strongly resemble those produced by

VIPERINE venoms. This venom, if attenuated by being heated

at 50° C. and injected into mammals, vaccinates them and leads to the

formation in their blood of antitoxic substances, which are capable of

preventing intoxication by salamander-venom, and, curiously enough,

also confer immunity against viper-venom and the serum of the common

snake.

_Toads_ are easy to distinguish from frogs owing to their squat and

clumsy shape, and to the mass of glands with which each side of the

neck and a more or less extensive portion of the body is furnished

in these animals. According to G. A. Boulenger, the number of known

species amounts to seventy-six, which are found in the Old and New

Worlds, but have no representatives in Australia. The species that are

the most common, and most interesting from the point of view of their

venoms, are:--

The Common Toad (_Bufo vulgaris_), in which the skin, which is very

thick and rugose, is covered on the back with large rounded tubercles

with reddish summits. This species is a great destroyer of insects,

and, as such, is very useful to agriculturists.

The Natter-Jack (_Bufo calamita_), in which the digits are palmate at

the base. When irritated it contracts its skin and covers itself with a

white frothy exudation, which gives off an odour of burnt powder.

The Green Toad (_Bufo viridis_), which is especially abundant in

Southern Europe, the Levant, and North Africa.

The Musical Toad (_Bufo musicus_), a species distributed throughout

North America as far south as Mexico, and in which the back is covered

with pointed conical tubercles resembling spines.

The Brown Pelobates (_Pelobates fuscus_), common in the neighbourhood

of Paris, the skin of which is almost entirely smooth. Although it

appears to be nearly destitute of glands, this animal secretes a very

active venom, which has a penetrating odour and kills mice in a few

minutes, producing vomiting, convulsions, and tetanic spasms of the

muscles.

The toxicity of the venom of toads was long ago demonstrated by the

experiments of Gratiolet and Cloëz.[154] It is manifest only in the

case of small animals, and in man merely produces slight inflammation

of the mucous membranes, especially of the conjunctiva.

That this venom preserves its toxic properties for more than a year in

the dry state was shown by Vulpian, and satisfactory studies of its

composition and physiological action have been made by Fornara,[155] G.

Calmels,[156] Phisalix and Bertrand,[157] Schultz,[158] Pröscher,[159]

and S. Faust.[160]

Toad-venom was prepared by Phisalix and Bertrand in the following

manner: Holding the head of one of these batrachians under water, they

expressed the contents of the parotid glands with the fingers or with

a pair of forceps. They repeated the same operation with a second, and

then with a third toad, until they had sufficiently impregnated the

water, which serves to dissolve the venom. In this way they obtained an

opalescent, acid liquid, which they filtered with a Chamberland candle

under a pressure of from four to five atmospheres. There remained on

the filter a yellowish substance, with a highly acid reaction and

partly soluble in ether and chloroform, while there passed through

the pores a clear, reddish, and slightly acid liquid, which on being

evaporated left behind a greyish-white precipitate. This precipitate

was separated by filtration, washed in water, and redissolved in

absolute alcohol or chloroform. The albuminoid matters were thus

separated, and the liquid, after being rendered limpid by filtration,

was evaporated away. The substance obtained in this way represents one

of the two active principles of the venom. It acts on the heart of

the frog, and arrests it in systole. It assumes the appearance of a

transparent resin, the composition of which roughly corresponds to the

formula C^{119}H^{117}O^{25}. It is the _bufotalin_ of Phisalix and

Bertrand, and is probably identical with that obtained by S. Faust,

the formula of which, according to the latter author, is said to be

C^{11}H^{23}O^{5}.

Bufotalin is readily soluble in alcohol, chloroform, acetone, acetate

of ethyl, and acetic acid. When water is added to a solution of it in

alcohol it is precipitated, giving a white emulsion, which has a very

bitter taste.

From the aqueous extract whence the bufotalin has been separated, it

is possible to separate a second poison, which acts on the nervous

system and causes paralysis. In order to obtain it in a pure state,

the extract is treated with alcohol at 96° C., filtered and distilled;

the residue dissolved in water is defæcated with subacetate of lead

and sulphuretted hydrogen. The solution thus obtained is successively

exhausted with chloroform to extract the cardiac poison, and with

ether, which removes almost the whole of the acetic acid. The second

neurotoxic principle, called _bufotenin_, remains in the residue of the

solution after being evaporated _in vacuo_.

Toad-venom, therefore, contains two principal toxic substances:

_bufotalin_, which is of a resinoid nature, soluble in alcohol,

but scarcely soluble in water, and is the _cardiac poison_; and

_bufotenin_, which is readily soluble in those two solvents, and is the

_neurotoxic poison_.[161]

Pröscher, on the other hand, has extracted from the skins of toads a

hæmolytic substance, termed by him _phrynolysin_, which possesses all

the properties of a true toxin and is not dialysable. It is obtained by

pounding the skins with glass powder in physiological serum.

Phrynolysin dissolves the red corpuscles of the sheep very rapidly, and

(in order of sensitiveness) those of the goat, rabbit, dog, ox, fowl,

and guinea-pig. The red corpuscles of the pigeon, frog, and toad are

scarcely affected. When heated at 56° C. it loses its properties. By

the ordinary methods of immunisation it is possible to obtain a very

active antilysin.

There is, therefore, a very close analogy between the venoms of _toads_

and _salamanders_. These highly complex substances are composed of

mixtures of poisons, some of which are in all respects analogous to the

vegetable alkaloids, while others are closely related to the microbic

toxins and snake-venoms.

In the spawning season the cutaneous glands of the male toad are gorged

with venom, while those of the female are empty. Phisalix[162] has

shown that at this period the venom of the female is accumulated in the

eggs, which, if extracted from the abdomen at the moment of oviposition

and dried _in vacuo_, give off in chloroform a product that has all the

toxic properties of cutaneous venom (bufotalin and bufotenin). No trace

of this poison is to be found in the tadpoles.

B.--Lizards.

The Order LACERTILIA includes only a single venomous

species, which belongs to the family _Lacertidæ_, and is known as the

_Heloderm_ (_Heloderma horridum_, fig. 124). It is a kind of large

lizard, with the head and body covered with small yellow tubercles on

a chestnut-brown ground. It sometimes exceeds a metre in length, and

its habitat is confined to the warm belt extending from the western

slope of the Cordilleras of the Andes to the Pacific. It is met with

especially in the vicinity of Tehuantepec, where it inspires the

natives with very great dread. It is a slow-moving animal, and lives in

dry places on the edges of woods. Its body exhales a strong, nauseous

odour; when it is irritated, there escapes from its jaws a whitish,

sticky slime, secreted by its highly developed salivary glands. Its

food consists of small animals. Its bite is popularly supposed to be

extremely noxious, but, as a rule, the wound, though painful at first,

heals rapidly. Sumichrast caused a fowl to be bitten in the wing by a

young individual, which had not taken any food for a long time. After a

few minutes the parts adjacent to the wound assumed a violet hue; the

bird’s feathers were ruffled; a convulsive trembling seized its entire

body, and it soon sank to the ground. At the end of about half an hour

it lay stretched out as though dead, and from its half-open beak there

flowed a sanguinolent saliva. There was no movement to give any sign

of life, except that from time to time a slight shiver passed through

the hinder part of its body. After two hours, life seemed gradually

to return, and the bird picked itself up and crouched on the ground,

without, however, standing upright, and still keeping its eyes closed.

It remained thus for nearly twelve hours, at the end of which time it

once more collapsed, and expired.

[Illustration: FIG. 124.--_Heloderma horridum._]

A large cat which Sumichrast caused to be bitten in the hind leg

did not die, but immediately after being bitten the leg swelled

considerably, and for several hours the cat continued to mew in a way

that showed that it was suffering acute pain. It was unable to stand,

and remained stretched out on the same spot for a whole day, unable to

get up, and completely stupefied.

Interesting observations on the _Heloderm_ have been made by J.

Van Denburgh and O. B. Wight. The saliva of this lizard was found

to be highly toxic at certain times, and harmless at others. When

injected subcutaneously it produces various effects, such as miction,

defæcation, and abundant salivation, with accelerated respiration

followed by vomiting. The animal drinks with avidity, and remains

lying down, in a very depressed condition. Death finally supervenes,

from arrest of respiration and also of the heart’s action. The poison

likewise acts upon the arterial tension, which falls very rapidly and

very markedly. The sensory nerves are also attacked; irritability is

at first increased, then diminished, and at last entirely lost. These

changes take place from behind forwards, and from the periphery to

the centre. The coagulability of the blood is at first intensified

and then lessened, as when acted upon by VIPERINE venom (H.

Coupin).[163]

C.--Mammals.

The only mammal that can be considered to be provided with a

poison-apparatus belongs to the Order _Monotremata_, and is known as

the Duck-billed Platypus (_Ornithorhynchus paradoxus_ or _O. anatinus_,

fig. 125). The head of this animal is furnished with a kind of flat

duck’s bill, armed with two horny teeth in the upper jaw, while the

body, which is covered with dense fur, resembles that of a beaver. The

tail is broad and flat; the legs are short, and the feet are provided

with five toes, armed with strong claws and webbed.

This singular animal is found only in Australia and Tasmania. It lives

in burrows near watercourses, entered by holes which it digs in the

bank, one above the other on the water-level. It spends much of its

time in the water, and feeds upon worms and small fishes.

In the males the hind feet are armed with a spur, having an orifice at

the extremity. At the will of the animal, there is discharged from this

spur a venomous liquid secreted by a gland, which lies along the thigh,

and is in communication with the spur by means of a wide subcutaneous

duct (Patrick Hill).[164]

It has often been proved in Australia that this liquid, when inoculated

by the puncture of the spur, may give rise to œdema and more or less

intense general malaise. Interesting details with reference to the

effects produced by this secretion have been published by C. J. Martin,

in collaboration with Frank Tidswell.[165]

[Illustration: FIG. 125.--_Ornithorhynchus paradoxus._ (After

Claus.)]

When a dose greater than 2 centigrammes of dry extract of the venom

of _Ornithorhynchus_ is injected intravenously into the rabbit, it

produces phenomena of intoxication analogous to those observed after

inoculation with VIPERINE venoms.[166] Death supervenes in

from twenty-five to thirty minutes, and at the autopsy hæmorrhagic

patches are found beneath the endocardium of the left ventricle.

This venom has been studied afresh in my laboratory by Noc, thanks

to the acquisition of a small supply kindly forwarded to me by C. J.

Martin. Noc proved that it possesses _in vitro_ certain properties of

snake-venoms; like the venom of _Lachesis lanceolatus_, it induces

coagulation in citrate-, oxalate-, chloridate-, and fluorate-plasmas.

Heating at 80° C. destroys this coagulant power.

Contrary, however, to what is found in the case of the venoms of

_Vipera_ and _Lachesis_, the secretion of _Ornithorhynchus_ is devoid

of hæmolytic and proteolytic properties.

Lastly, its toxicity is very slight, at least five thousand times

less than that of the venoms of Australian snakes. A mouse is not

even killed by 5 centigrammes of dry extract, and in the case of the

guinea-pig 10 centigrammes only produce a slight painful œdema.

It has been remarked that the volume and structure of the poison-gland

exhibit variations according to the season of the year at which it is

observed. It is therefore possible that these variations also affect

the toxicity of the secretion (Spicer).[167]

By certain authors the poison of _Ornithorhynchus_ is considered to be

a defensive secretion of the males, which becomes especially active in

the breeding season, and this hypothesis is plausible. In any case it

would seem that as a venom the secretion is but very slightly nocuous.

It will have been seen from the papers quoted above that the chemical

nature and physiology of the various venoms, other than those of

snakes, are as yet little understood and need further investigation.

The main outlines of this vast subject have scarcely been traced,

and the study offers a field of interesting investigations, in which

the workers of the future will be able to reap an ample harvest of

discoveries, pregnant with results for biological science.

PART V.

DOCUMENTS.

I.--A FEW NOTES AND OBSERVATIONS RELATING TO BITES

OF POISONOUS SNAKES TREATED BY ANTIVENOMOUS SERUM

THERAPEUTICS.

A.--Naja tripudians (India and Indo-China).

I.--Case published by A. Beveridge, M.B., C.M., Surgeon S. Coorg

Medical Fund (_British Medical Journal_, December 23, 1899, p. 1732).

“A strong coolie, aged 26, was bitten by a cobra on the right ankle,

just above the internal malleolus. He was brought to the surgery about

one hour after being bitten, in a state of comatose collapse. The pulse

was rapid, and the surface of the body cold. He was given an injection

of 10 c.c. of Calmette’s antivenene deeply into the right flank. He was

kept under observation: the paresis and insensibility were very marked.

On visiting him some hours afterwards I found he could walk without

assistance, but staggered, and complained of weakness and pains in both

legs. Next morning he was much improved, the paresis gradually wore

off, and the pulse steadily gained strength. The patient returned to

work four days later, quite recovered.

“A few days previously a coolie had died after being bitten by a snake

under the same conditions, but without having been treated. Occurrences

like these point to the necessity that every Government or private

dispensary should be supplied with antivenene, which is certainly the

best remedy for snake-bite available.”

II.--Case reported by Robert J. Ashton, M.B., Kaschwa Medical Mission,

Mirzapur (N.W.P.).

“A coolie, aged 27, was bitten in the right foot by a cobra at 5.30

a.m., on September 16, 1900. Half an hour later 10 c.c. of antivenomous

serum were injected subcutaneously into the left forearm. The patient

experienced great pain in the foot, torpor, and great weakness.

Recovery, without complications.”

III.--Case reported by Dr. Simond (Saigon).

“Nguyen-Van-Tranc, an Annamese, aged 25, employed in the Botanical

Gardens at Saigon, was bitten at 10.30 a.m., on March 11, 1899, by a

cobra which had escaped from its cage. The bite was inflicted on the

palmar surface of the index finger of the right hand, and the fangs had

penetrated deeply.

“This native, to whom a sensible comrade had applied a ligature round

the wrist, was brought to the Pasteur Institute three hours later. He

was drowsy, with drooping eyelids; his speech was difficult and almost

unintelligible. Deglutition was impossible, and ingurgitated liquids

caused vomiting. The hand was greatly swollen at the seat of the bite,

and the œdema extended to the forearm. There was partial anæsthesia of

the skin. As soon as the patient arrived, I gave a single injection,

beneath the skin of the flank, of three doses of serum, that is, 30

c.c. In the evening I again injected 10 c.c. of serum. At 10 p.m. the

general condition of the patient seemed to be improving. Next morning

he was less depressed, spoke more easily, and was able to swallow.

Convalescence began from this moment; the œdema and numbness of the

hand and arm, however, persisted for several days.

“Recovery was complete on March 20. I have no doubt that in this very

serious case the antivenomous serum preserved the life of the patient,

since his condition was desperate when I saw him.

“This is the second instance within four months of the successful

treatment of snake-bites at Saigon by Calmette’s serum. In the former

case two natives were bitten by the same animal. One of them, who

permitted the injection of serum, which was performed by Dr. Sartre,

recovered; the other, who refused it, died within twenty-four hours.”

IV.--Case reported by the Fathers of the Khurda-Mariapur Mission

(India).

“At 1 p.m., on October 31, 1905, a woman, aged 35, who had been

bitten by a cobra, was brought to us from Khurda. After being at our

dispensary for about an hour she became drowsy; she paid no attention

to anything that was said to her, and merely replied that she felt

sick. We thereupon injected 10 c.c. of serum. The woman did not even

appear to feel the prick when the needle was driven into her calf.

Immediately after this was done she dozed and went to sleep. The pulse

was feeble, and the entire body cold. We were disposed to give a second

injection, but, since we had only two bottles left, we hesitated to

sacrifice one of them. At last, after sleeping for about half an hour,

the woman awoke of her own accord, sat up, and began to recover her

senses. Bodily heat returned almost immediately, and a few moments

later the patient asked to be allowed to go home; she was, however,

kept at the dispensary. In the evening she continued to complain of

headache, but on the following day she was able to walk, and was quite

well.”

V.--Case reported by Dr. Brau (Saigon).

"Nhuong, an Annamese agriculturist, on passing through a piece of waste

ground beside the barracks, at about 5.30 a.m. on Sunday, September 11,

felt himself suddenly bitten behind the right knee. He caught a glimpse

of a large blackish snake, with all the characteristics of a cobra,

including the raised head and dilated hood, gliding hurriedly away, but

was unable to overtake it.

"The seat of the bite merely showed two small blackish punctures. The

part soon became painfully swollen, and the patient began to feel

giddy. Other natives came to his help; he was lifted into a Malabar

cart and brought to the Military Hospital, whence he was sent to my

house, where he arrived about a quarter past six.

"I entered the vehicle, and immediately drove with the patient to

the Pasteur Institute. The only treatment that he had received was

a ligature round the middle of the right thigh. The lower leg was

enormously swollen, and the swelling was not stopped by the slight

barrier formed by the ligature, but had already extended to the base of

the limb.

"The patient lay stretched out between the two seats of the vehicle,

with head thrown back and eye-balls turned up and ghastly. His skin and

extremities were cold, and his pulse was scarcely perceptible. In order

not to lose time, he was not even taken up to the first floor of the

Institute, but was carried to an inoculating table. He was then made to

swallow black coffee and rum, and was given an injection of as much as

six doses of antivenomous serum, which had just been received from the

Pasteur Institute at Lille.

"Under the stimulus of this injection, somewhat drastic I admit, an

absolute resurrection took place in the sick man. The pulse became

strong and bounding, bodily heat returned, and, although the swelling

did not at once diminish, its progressive extension seemed to be

sharply arrested, while the pain was also greatly lessened. The patient

was able to sit up without assistance, and relate the incidents of his

misadventure.

"In a few minutes time I thought it possible to have him taken to

the Choquan Hospital, the Director of which Institution, First-class

Surgeon-Major Angier, has been good enough to furnish me with a note of

the subsequent history of this case.

“’The Annamese Nhuong, who entered the Choquan Hospital on September

11, suffering from snake-bite, was discharged on September 20.

“’On admission, heat and puffiness were observed in the calf and

thigh. Slight dyspnœa, severe fever, tendency to coma. September 12,

temperature 38°, 39·2° C. September 13, temperature 37·3°, 37·6° C.

September 17, temperature 36·8°, 37° C.

“’On discharge, slight œdema and puffiness in the region of the bite.

General condition good.’”

VI.--Case recorded by Dr. Robert Miller, Bengal-Nagpur Railway Company

(_Advocate of India_, Bombay, January 15, 1902).

“On the evening of October 23 I was called to a coolie woman, who

had been bitten by a large cobra about 7 o’clock; some two hours

had already elapsed since the accident. The woman was, so to speak,

moribund, unconscious, and suffering from paralysis of the throat,

after having exhibited all the characteristic symptoms of poisoning

by cobra-venom. I immediately injected 10 c.c. of Calmette’s serum,

without any hope of a successful result, however, so desperate did

the condition of the patient appear. The effect of the serum was

marvellous; fifteen minutes later she regained consciousness. I gave a

fresh injection of 10 c.c., and three hours after the first the patient

was out of danger. Dr. Sen, my assistant-surgeon, was present. I have

forwarded a note of this case to Dr. L. Rogers, Professor of Pathology

at the Calcutta Medical College.”

VII.--Case recorded by Captain H. A. L. Howell, R.A.M.C. (_British

Medical Journal_, January 25, 1902).

"Shortly before 4 p.m. on November 17, 1901, Lance-Corporal G., Royal

Scots, was bitten on the right forefinger by a snake. On being brought

to hospital, Assistant-Surgeon Raymond tied a tight ligature round the

finger, scarified the wound, and applied a strong solution of calcium

chloride. On my arrival I found the patient apparently quite well, and

not at all alarmed. As I could get no information as to the nature of

the snake, I injected into the patient’s flank at 4.30 p.m. 3 c.c. of

Calmette’s serum, and sent for the snake, which was the property of one

of the men in barracks. The snake was brought to me just before 6 p.m.,

and I found it to be a cobra about 3½ feet long, of the pale-coloured

variety that natives call Brahmini cobra. I at once injected 7 c.c. of

Calmette’s serum into the other flank. The patient thus received one

full dose of serum. The ligature was removed from the finger, which was

swollen and very painful.

"Up to half an hour after the bite the patient, a healthy and powerful

man, presented no abnormal symptoms: pulse, respiration, pupils,

temperature, and general appearance, all were normal. His pulse and

respiration began to increase in frequency, and the pulse became very

compressible, but quite regular. After the first injection of serum

his temperature was 98° F., pulse full, high tension, regular, 88, and

respirations greatly increased in frequency. He now became very drowsy,

and had to be roused when the second injection of serum was given.

Soon after this the patient’s general condition and pulse improved....

He had complete loss of sensation in the bitten finger, in the part

terminal to the site of the puncture, for some days.... The injection

of Calmette’s serum gave rise to no local reaction, and caused no pain.

It did not affect the temperature, but was followed in half an hour by

perspiration, which was very profuse four hours after the injection....

The patient made a complete recovery.... The serum used in this case

was fresh, having been prepared at Lille in July, 1901.”

VIII.--Note of case treated by Major Rennie, R.A.M.C., transmitted by

M. Klobukowski, French Consul-General at Calcutta, September 5, 1899:--

“A remarkable cure effected by Major Rennie, by means of Calmette’s

method, has just taken place at Meerut. Since the introduction of this

remedy three years ago, its efficacy has been abundantly proved, but

the present case is especially interesting, since it seems to show

that the serum can be successfully employed even in cases apparently

desperate. The well-known symptoms of poisoning by cobra-venom were

already so advanced that the patient, who was insensible, was kept

alive by artificial respiration in order to give time for the serum to

be absorbed and to take effect.

“The truth of the above statements is attested by six doctors, and is

also vouched for by the Commissioner and Magistrate of the military

cantonment, who, although not medical men, have, nevertheless, had long

experience of Indian matters.”

IX.--Case recorded by Binode Bihari Ghosal, Assistant-Surgeon, Jangipur

(“A Case of Snake-bite [Cobra?].--Recovery,” _Indian Medical Gazette_,

January, 1905, p. 18).

“While fastening her door about 10 o’clock one night a Hindu woman

was bitten by a cobra in the left foot, about 1 inch above the

metatarso-phalangeal joints of the second and third toes. About ten

minutes after the bite natives applied three strong ligatures, one

above the ankle, one below, and one above the knee-joint. Four hours

later ‘Fowl’ treatment was applied, which it appears gives marvellous

results. The author arrived about nine hours after the accident,

during the ‘Fowl’ treatment, for which nineteen chickens had already

been sacrificed. In spite of this the patient was pulseless (no radial

pulse--the brachial pulse was thready and flickering); respiration

about six per minute. An injection of strychnine improved her condition

for a few minutes. When the incision, which had been made over the

bite, was crucially enlarged, large quantities of dark blood were

withdrawn by cupping. In spite of this the patient’s condition grew

worse, and her respiration fell to three a minute; she then received

an injection of 10 c.c. of Calmette’s serum in the left buttock. The

pulse immediately became stronger, and respiration increased to ten

per minute. About half an hour after the first, a fresh injection of

10 c.c. of serum was given in the same place. Within five minutes the

appearance of the patient, who had seemed to be dying, became normal.

The pulse grew stronger, and respiration was about fifteen per minute.

One hour after the injections the patient was practically cured.

“The ‘Fowl’ treatment consists in applying directly to the wound, after

the latter has been slightly enlarged by means of an incision, the anal

apertures of living fowls, from which the surrounding feathers have

been removed. The fowl immediately becomes drowsy, its eyes blink, and

its head falls on its breast with the beak open, after which the bird

rapidly succumbs. Twenty fowls had been employed in the present case,

but in vain.” (The author does not appear to have troubled himself to

ascertain whether the fowls were really dead, or had merely fallen into

a hypnotic condition.)

X.--Case reported by Major G. Lamb, I.M.S., Plague Research Laboratory,

Parel, Bombay, October 18, 1900.

“Ten days ago I was bitten by a large cobra, from which I was

collecting venom. I had only some very old serum in the laboratory, but

I immediately gave myself an injection of 18 c.c. Three hours after

being bitten I felt faint, my legs became paralysed, and I was seized

with vomiting. In the meantime, fresh serum had been obtained at a

chemist’s, and I received an injection of 10 c.c. The symptoms improved

very rapidly, and an hour later I felt perfectly well. I applied no

local treatment, relying altogether upon the serum.”

XI.--Case reported by Dr. Angier, of Pnom-Penh (Cambodia).

“At 11.30 one night in April, 1901, His Majesty, the second King

of Cambodia brought to me in a carriage one of his wives who, when

crossing the courtyard of the palace at about 8 o’clock, was bitten by

a snake, which she said was a cobra (in Cambodian _Povek_).

“The bite was situated in the lower third of the leg, in front of

the internal malleolus. The patient complained continually; she was

suffering greatly from the leg, which was swollen as high as the knee.

Great lassitude. An injection of 10 c.c. of antivenomous serum was

given, half in the leg and half in the flank. The wound was washed,

squeezed and dressed. Twenty minutes later the pain had ceased, and the

patient went away, feeling nothing more than a slight dulness in the

injured limb.”

B.--Naja haje (Tropical Africa).

XII.--Cases reported by Dr. P. Lamy, of the Houdaille Expedition.

“Lamina, a Senegalese, bitten on the outside of the left thigh, on

February 18, 1898. Treated with serum. Recovery.

“Momo Bolabine, bitten in the heel on April 20, 1898. Ten c.c. of

serum. Recovery.”

XIII.--Case reported by Dr. Deschamps, of Thiès (Senegal).

“In the month of October, 1898, I was called to a native, a local

constable, who had just been bitten by a Naja. The Ouoloffs of Senegal

are much afraid of the bites of this reptile, since they are generally

fatal. In this case the man had been bitten in the forehead by a snake,

which was coiled up in his bed, as he was placing his head on the

pillow. Being in the dark, he got up greatly frightened, lit a candle,

and saw the snake glide from his bed and escape through the half-open

door. I arrived a few minutes after the accident; the constable already

felt very weak, and complained of nausea and of pains in the head and

back of the neck. In the middle region of the forehead I found two

adjacent wounds, around which the tissues were œdematous. I washed the

wounds with a solution of permanganate of potash, and had a telegram

sent to St. Louis asking for antivenomous serum. Half an hour after

the bite, the patient was seized with vomiting and cold sweats. At 6

a.m. on the following day there was considerable œdema of the face and

dyspnœa, while the pulse was small and intermittent. The patient, who

had not slept, was dull and depressed. He vomited a little milk which I

tried to make him take. Forty hours after the bite the patient, who was

already paralysed, became comatose; the face and neck were enormously

swollen. The dyspnœa had increased; it was difficult to hear the

respiratory murmur; the pulse was thready, slow, and intermittent; the

skin was cold; the temperature, taken in the axilla, was 35·8° C. At

this moment the serum asked for arrived from St. Louis. I injected into

the buttock the only dose that I possessed, 10 c.c. The coma persisted

throughout the evening and during part of the night; at 6 a.m. on the

following day, fourteen hours after the injection, the patient awoke

and said that he felt quite well. The œdema of the face and neck had

diminished, that of the eyelids had disappeared. Three days later the

constable returned to duty.”

XIV.--Case reported by Professors H. P. Keatenje and A. Ruffer (Cairo).

“A girl named Hamida, aged 13, while picking cotton on October 7,

1896, at Ghizeh, near Cairo, was bitten in the left forearm by a large

Egyptian cobra, which measured 3 feet in length. She cried out, and her

brother and others who were working with her ran up. She was brought

to hospital by the police at 7 p.m. in a state of complete collapse.

She was almost cold, with upturned eyeballs and imperceptible pulse.

The forearm had been bandaged with a dirty cloth, and the entire arm

was covered with a thick layer of Nile mud (a favourite remedy among

the Fellahîn). Above the wrist two deep punctures were clearly visible,

evidently corresponding to the fangs of the reptile. The patient, whose

condition seemed absolutely desperate, had no longer any reflexes;

she was completely insensible; the moderately dilated pupils scarcely

reacted at all to luminous impressions. Dr. Ruffer injected, with the

customary antiseptic precautions, 20 c.c. of Calmette’s antivenomous

serum beneath the skin of the abdomen. The child gave a groan while

this was being done; this was at 7.30 p.m. At 11 o’clock at night her

condition improved; the pulse was 140, and bodily heat returned; the

patient replied to questions that were put to her. A second injection

of 10 c.c. of serum was given in the flank. She slept for the remainder

of the night, and passed her water four times under her. At 8 a.m. on

October 8 she appeared to be out of danger. She took food, and dozed

throughout the day. On the 9th she was convalescent. There were no

complications resulting from the injection, neither eruptions nor pains

in the joints.”

XV.-Case reported by Dr. Maclaud, of Konakry (French Guinea).

“At 7.30 p.m., on June 22, 1896, there was brought to the Konakry

Hospital a native soldier, named Demba, who had just been bitten by a

snake. This man, who was employed in the bakery, was stacking firewood,

when he felt an extremely acute pain in the left foot; simultaneously

he saw a large snake making off; he succeeded in killing it, and found

it to be a black Naja. After having applied a stout ligature to the

limb, the injured man hastened to the hospital, where, immediately

afterwards, he fell into a condition verging on coma. The body was

bathed with cold sweat; the temperature was subnormal; the pulse, which

was small and thready, was 140. There was difficulty in breathing, and

severe vomiting. At intervals the patient was aroused by spasms, and

excruciating pains in the injured limb, which exhibited considerable

œdema above and below the ligature. Tendency to asphyxia. I washed

the wounds with 1 per cent. solution of permanganate of potash, and

injected a dose of antivenomous serum into the subcutaneous cellular

tissue of the left flank. In view of the severity of the symptoms I

gave two other injections of serum, an injection of 3 c.c., followed

by one of 2 c.c. The patient dozed all night. Next day the general

symptoms had entirely disappeared. Two days later Demba returned to

duty.”

C.--Bungarus fasciatus.

XVI.--Case reported by Surgeon-Captain Jay Gould (Nowgong, Central

India, _British Medical Journal_, October 10, 1896, p. 1025).

“On June 11, 1896, a punkah coolie was bitten on the dorsum of the left

foot, between the second and third toes. He had only the distinct mark

of an incisor, a very slight prick, with a stain of blood which marked

the spot. Within ten minutes we had injected 20 c.c. of Calmette’s

serum into the abdominal wall, after which we made a local injection

of a 1 in 60 solution of hyperchlorite of calcium. Two hours after

the injection the temperature was subnormal, the pulse full and slow.

Twelve hours later the patient was perfectly well and walking about.

“The snake was a Bungarus, full grown, measuring 28 inches.

Unfortunately the syces killed it; it died the very moment I arrived,

so that I was unable to test its virulence.”

D.--Bungarus cæruleus.

XVII.--Case reported by Major S. J. Rennie, R.A.M.C., Meerut, N.W.P.,

India.

“A twelve-year old Hindu boy, named Moraddy, was brought to me at

6 p.m., on July 10, in a semi-comatose condition, with commencing

paralysis of the respiratory muscles. I was told that the child was

sleeping on the ground, when he was bitten in the left hand. He

immediately felt very great pain and giddiness, and his arm began to

swell. Two small wounds were clearly visible, corresponding to the

marks of the fangs of a krait, or _Bungarus cæruleus_.

“The child had salivation, and ptosis of both eyelids. Respiration was

difficult, and deglutition impossible; the pulse was 110 and dicrotic.

The patient’s breathing was of an abdominal character; the surface of

the body was covered with cold sweat. The child soon became lethargic

and collapsed; his condition appeared absolutely desperate. I gave a

subcutaneous injection of 12 c.c. of antivenomous serum, and commenced

artificial respiration, which I continued for half an hour in order to

give the serum time to take effect. In forty-eight hours the symptoms

gradually disappeared, and the child became quite well. Diplopia of the

left eye persisted for a few days, but this also entirely passed away.

“This case shows that, in Calmette’s antivenomous serum, we have a

very powerful remedy against snake-bites, which may take effect even

in desperate cases. It further proves that the serum will keep for a

very long time, even when exposed to all the vicissitudes of the Indian

climate, for the serum employed by me had been in my possession for

nearly four years.”

E.--Sepedon hæmachates (Berg-Adder).

XVIII.--Case reported by Mr. W. A. G. Fox, Table Mountain, Cape of Good

Hope.

“On February 9, 1898, I was summoned to the Town Council’s Camp to

treat a native who had been bitten by a berg-adder in the left leg,

just below the knee. I immediately injected a dose of Calmette’s

antivenomous serum in the left flank, and the wounds were washed. The

injection was given two and a quarter hours after the accident. The

patient was already very ill when I saw him, and I have no doubt that,

without the antivenomous serum, he would have died.

“On the following day he had recovered, and I saw him again three

months later; since then he has not experienced any functional trouble.”

F.--Hydrophiidæ (Sea-Snakes).

XIX.--Case recorded by Mr. H. W. Peal, Indian Museum, Calcutta (_Indian

Medical Gazette_, July, 1903, p. 276).

“On April 1, 1903, at 7.30 p.m., a man was bitten at Dhamra, in

Orissa, by a sea-snake which had been caught in a fishing net. He was

not brought to me until 2.30 the next day, when he was in a state of

collapse, semi-unconscious, and unable to speak, with eyes dull and

almost closed. The bite was on the third finger of the left hand, just

above the first joint. The finger was swollen, tense, and stiff. I gave

the man an injection of 5 c.c. of antivenene ten minutes after he was

brought to me. Three or four minutes after the injection the man with

some assistance was able to sit up, and said he felt much better. He

complained of great pain at the back of the neck and also in the lumbar

region. He was able to speak fairly coherently after a little time. His

eyes were brighter and he seemed to be aroused from his lethargy.

“I had about one hundred living sea-snakes with me, belonging to the

three genera _Enhydrina_, _Hydrus_, and _Distira_. He identified

_Enhydrina valakadien_ as being the snake which bit him; so did the men

who were with him. The snake was said to be about 3½ to 4 feet long.

“The antivenene did the man so much good, that he himself asked me to

give him a second injection. This I gave him at 2.25 p.m. (5 c.c.).

“Date on bottle used, May 8, 1900.

“The pains in the joints had disappeared on the second injection

(which was given in opposite flank). At 5 o’clock the man walked away

with assistance. He was quite well a couple of hours after the second

injection, and when I saw him again on May 8 he was in perfect health.”

G.--European Vipers (_Pelias berus_ and _Vipera aspis_).

XX.--Case published by Dr. Marchand, of des Montils, Loir-et-Cher

(_Anjou médical_, August, 1897).

“About 11 a.m., on Friday, July 23, Jules Bellier, aged 26, was mowing

in a damp spot, when he was bitten in the heel by a large viper

(_Vipera berus_). The bite, which was deep, was situated on the outside

of the foot, 1 cm. behind the malleolus and 3 cm. above the plantar

margin; at this point there were two punctures in the skin, 1 cm.

apart. Directly after the accident the patient left his work, tied his

hankerchief tightly round the lower third of his leg, made the wound

bleed, and came to me with all speed, hopping on one foot for about a

kilometre. When I saw him scarcely twenty minutes had elapsed since

the accident; his general appearance was altered, and his pulse rapid.

The patient had vomited twice; he complained of pains in the head, and

of general weakness, and ’was afraid,’ he said, ‘of fainting.’ The

foot and leg were painful under pressure; a slight tumefaction was

visible in the peri-malleolar region, around the bites, which bled a

little. Forthwith, after washing the wound freely with a solution of

permanganate of potash, I injected 10 c.c. of Calmette’s serum into

the antero-external region of the middle part of the thigh; then I

enveloped the leg in a damp antiseptic dressing as high as the knee.

The patient breathed more freely and plucked up his spirits. After

lying down for quarter of an hour he went home on foot (he lives a

hundred yards from my house).

“In the evening I saw my patient again. He was in bed, with a

temperature of 37·2° C.; pulse 60; no malaise, no headache, no further

vomiting; he had taken a little soup, and a small quantity of alcoholic

infusion of lime-tree flowers. He complained of his leg, which was

swollen as high as the knee; the pain was greater in the calf than at

the malleolus. I applied a damp bandage. The patient had a good night,

and slept for several hours, but still had pain in the leg. On the

following morning, July 24, I found him cheerful, with no fever, and

hungry. Around the bite the œdema had become considerable, and had

extended to an equal degree as high as the instep; the calf and thigh

were swollen, but to a much less extent. I gave a second injection of

10 c.c. of antivenomous serum in the cellular tissue of the abdominal

wall. The day was good; indeed, the patient had no fever at any time;

the spots at which the injections were made were but very slightly

sensitive on pressure. In the evening the general condition of the

patient was satisfactory; he complained most of his calf. Thinking that

a contraction was possible, due to his having hopped along quickly on

one leg after the accident, I ordered him a bath.

“On July 25, the second day after he was bitten, the only symptom still

exhibited by the patient was a somewhat considerable amount of œdema in

the peri-malleolar region and lower third of the leg. This œdema was

slowly and gradually absorbed on the following days.

“_Remarks._--(1) At this season of the year viper-bites are both

frequent and dangerous in this district of the Loir-et-Cher. A year

never passes without several cases occurring, and it has very often

happened that deaths have had to be recorded in spite of the most

careful treatment.

“(2) The therapeutic effect of Calmette’s serum was rapid and

efficacious; the injections did not cause any pain or febrile reaction.

“(3) The œdema resulting from the bite was a long time in being

absorbed; this, indeed, was the only remarkable symptom after the

injection of the serum.”

XXI.--Case recorded by Dr. D. Paterne, of Blois (Anjou médical,

September, 1897).

“My _confrère_ and friend Dr. Marchand (des Montils) published in last

month’s _Anjou médical_ an interesting case of viper-bite, cured by

Calmette’s serum. May I send you particulars of another case, which can

only increase the interest of the one that you have already published?

The facts are as follows:--

“Léon Bertre, aged 55, living at 17, Rue du Puits-Châtel, Blois,

professes to be a snake-charmer, and really catches and destroys large

numbers of dangerous reptiles in the vicinity of Blois.

“On Sunday, the 30th of last May, he went among the rocks of the

Chaussée Saint-Victor on his favourite quest, and soon returned with

ten large female vipers, and amused himself by exhibiting them to a

group of interested spectators in an inn. A dog came up and began

to bark. Bertre, whose attention was momentarily distracted, ceased

to fix his gaze on the vipers, one of which, being no longer under

the influence of its fascination, bit him on the back of the right

hand, between the metacarpals of the thumb and index-finger. (I here

reproduce the account of the occurrence as I received it from the

snake-charmer’s own lips.) Bertre immediately felt an acute pain; his

hand swelled up _almost suddenly_, and, since he was perfectly aware

of the seriousness of what had happened, he ran with all speed in the

direction of my consulting-room. The unfortunate man, however, had

hardly gone 200 metres, when he fell insensible on the highway. He

was brought to me, and Dr. Moreau, of Paris, _locum tenens_ for Dr.

Ferrand, of Blois, who was away, rendered first aid. He washed the

wound, dressed it with perchloride of mercury, and injected 10 c.c. of

Calmette’s serum into the right flank. The accident took place a little

before 5 p.m., and the injection was given about 6 o’clock.

“Dr. Moreau, who was interested in the case, asked me to take charge of

it, which I gladly consented to do. The patient’s general condition was

very grave, since he remained two days and two nights without regaining

consciousness.

“On Tuesday, June 1, about 11 o’clock, Dr. Moreau gave a second

injection of 20 c.c. Considering the condition of the patient, we

hardly hoped for a successful result. To our great surprise, however,

the patient regained consciousness about 3 p.m., and the improvement

progressed rapidly.”

XXII.--Case recorded by Dr. Thuau, of Baugé (_Anjou médical_,

September, 1897).

“X., a young man of Volandry, a parish 10 kilometres from Baugé,

was bitten in the heel at 10 a.m. on the 6th of last August, by an

aspic, about 50 cm. in length, while engaged in harvesting. He at once

had himself taken to Baugé, knowing that there was an antivenomous

serum dispensary there, and about noon he arrived at the house of my

_confrère_ and friend Dr. Boell. The latter, in view of the grave

symptoms exhibited by the patient (nausea, vertigo almost amounting to

syncope, pain in the chest, profuse sweating, &c.), gave him, with all

the customary precautions, a first injection of 10 c.c. of Calmette’s

serum in the flank. After about half an hour, since the alarming

symptoms did not appear to diminish, he did not hesitate to give a

second injection of 10 c.c., and then had him sent to the Baugé Civil

Hospital, where he came under my care about 3 p.m. I then found that

this young man had been bitten in the left foot, a little below the

external malleolus, midway between the latter and the plantar margin.

The snake’s fangs had penetrated rather deeply; the two little wounds

were about a centimetre apart. About this time the patient experienced

great relief, and his general condition continued rapidly to improve.

The axillary temperature was 37·8° C.

“Locally the patient complained of somewhat acute pain in the entire

foot; the latter was purple and greatly swollen, and the swelling had

affected the whole of the lower leg and extended to a little above

the knee. I made a slight incision in the region of the two wounds

caused by the bite, made the place bleed a little, and washed it with a

solution of permanganate of potash, advising that the dressing should

be changed several times a day. In the evening the temperature was 37°

C., and never varied again from the normal until recovery was complete

on August 25.

“The two injections of antivenomous serum did not produce any painful

or inflammatory reaction.”

XXIII.--Case reported by Dr. Clamouse, of Saint-Epain, Indre-et-Loire.

“Léonie C., a servant at a farm, aged 19, bitten on June 1, 1900,

by a red viper on the dorsal face of the left ring-finger. Somewhat

serious symptoms of intoxication. In default of serum, injection of

Labarraque’s fluid, 1 in 12. Serum obtained from Tours was injected at

11 p.m. on June 2, thirty-eight hours after the accident.

“On the morning of June 3, very marked improvement. On June 7, general

condition excellent. Recovery.”

XXIV.--Case reported by Dr. G. Moreau, of Neung-sur-Beuvron,

Loir-et-Cher.

“A. B., aged 12, living at Villeny, in the canton of Neung-sur-Beuvron

(Loir-et-Cher), was bitten on June 23, 1900, on the left external

malleolus. The parents contented themselves with applying a ligature

above the wound, and did not bring the child to me until 12.15 p.m.

“Tumefaction of the entire foot. Ecchymosis of the skin extending

half-way up the leg. General condition excellent. I gave antiseptically

an injection of 10 c.c. of antivenomous serum in the right flank,

followed by a draught of acetate of ammonia and syrup of ether. Damp

bandage applied to wound and swollen part.

“I saw the child again on the following day. Generalised œdema and

tumefaction of the bitten limb. Heart excellent; no vomiting, no

fever. I again gave an injection of 20 c.c. of serum, and ordered a

continuance of damp phenic dressings to be applied to the entire limb.

Condition very good.

“On June 25, no fever at the time of my visit. Pulse irregular. Ordered

treatment to be continued.

“I did not see the patient for four days, when I was summoned by

telegram. I found that the child had fever, 39° C. Complete tumefaction

of the left leg, abdomen, and trunk, with ecchymosed patches.

Prescribed quinine. Arhythmia of pulse and heart. Prescribed digitalis

and Jaccoud’s tonic. The febrile condition was due to congestion of the

base of the right lung. I ordered cupping and sinapisms alternately.

“I saw the child again two days later. The congestion still continued.

Temperature 39° C., but the general tumefaction showed a tendency to

diminish.

“On July 4 I again saw the child. Now only slight œdema. General

condition very satisfactory. Temperature normal. The child was making

rapid strides towards recovery. The leg was doing well, and the wound

was almost healed.

“Summary: A very serious bite and, above all, great delay in injecting

serum (injection not given until four hours after the accident);

unforeseen complications in the lung, by which recovery was delayed.”

XXV.--Case reported by Mons. H. Moindrot, Assistant to Dr. Martel, of

Saint-Étienne (Loire).

“Claude L., aged 8, living at Ricamarie, was brought, on May 26, 1904,

to the Bellevue Hospital. The parents stated that about 10 o’clock the

same morning, while playing near a stack of faggots, the child was

bitten by a snake in the third finger of the right hand. Since the

wound caused by the bite seemed to them of little importance, they

contented themselves with squeezing the injured finger in order to make

it bleed a little. A few moments later, however, the child began to

complain of a feeling of distension in the region of the bite, caused

by œdema, which soon increased to an alarming extent. A doctor, who was

called in, carefully washed the wound, applied an aseptic dressing, and

at once sent the little sufferer to the Hospital.

“_On admission_, enormous œdema, including fingers, hand, entire right

arm, cervical region on the same side, and the anterior face of the

thorax, nearly as far as the inner margin of the false ribs. This œdema

was not very painful, though fairly tense, yielding but slightly to

pressure. In the affected region the skin was cold, of a dull livid

colour, with a few ecchymosed patches. In the bitten finger, a small

wound with no special characteristics.

“General condition bad; the child was unable to stand. He was

indifferent to what was passing around him, merely groaning a little

when examined. The pulse was feeble, thin, and easily compressible;

it was also very irregular. The extremities were cold. Lungs: nothing

abnormal on auscultation, rapidly performed, it is true. Respiration,

however, was distinctly accelerated, 30 per minute. Temperature not

taken on admission. No urine passed since the accident.

“The patient’s condition being so alarming, not to say desperate, we

thought it almost useless to have recourse to Calmette’s method, more

especially since at least seven hours had already elapsed since the

child was bitten. Nevertheless we gave a hypodermic injection of 20

c.c. of Calmette’s serum. At the same time the wound was crucially

incised, and bathed with a 1 in 1,000 solution of permanganate of

potash, after which a damp dressing was applied to the whole of the

swollen limb. The patient was put to bed, and kept warm. He was given

an injection of 50 centigrammes of caffeine, and 300 grammes of

artificial serum. In the evening the temperature was 36·8° C.

“May 27.--General condition more satisfactory; pulse still weak, but

less irregular. Persistence of dyspnœa, explained by a series of small

râles at the bases of both lungs. This morning the little patient

passed his urine, about 200 grammes. He is more lively, and replies

better to any questions addressed to him.

“May 28.--The improvement continues; the dyspnœa has almost entirely

disappeared; only a few râles are still heard at the extreme base. The

pulse is stronger and remains regular. The secretion of urine gradually

reappears. The temperature of the extremities has become normal.

“On May 29 and following days the œdema continued to diminish, and had

totally disappeared eight or ten days later.

“Recovery was complete by about June 15. The child was discharged on

June 23, 1904.

“It seemed to us worth while to report this case, in order to emphasise

the conclusion that forces itself upon us, namely that in all cases of

bites from poisonous snakes an injection of Calmette’s serum should be

given, without considering the efficacy of this therapeutic agent as

being rendered doubtful by the length of time that may have elapsed

since the bite was inflicted.

“In the present case, as we have seen, there was extensive

intoxication, which had seriously affected the functions of the various

organs, since we found cardiac arhythmia and pulmonary œdema, and that

the patient was threatened with collapse, algidity, hypothermia, and

anuria. Impregnation by the virus having continued for seven hours,

we might have felt ourselves justified, on the one hand in merely

employing the proper means for the relief of the general condition, on

the other hand in treating the local condition, without having recourse

to the serotherapeutic method, that seems to us in this case, in so

far as it is permissible to make such a statement, to have been the

determining factor in the recovery.”

XXVI.--Case recorded by Dr. Lapeyre, of Fontainebleau (from _L’Abeille

de Fontainebleau_ of June 27, 1902).

“M. X., who arrived at Fontainebleau on Sunday morning with a friend,

keeps grass snakes at home, in Paris; he finds his hobby as good a

means as any other to remind him of the forest and its charms. Human

nature includes all kinds of tastes, so that this particular one need

not be further discussed.

“The journey, therefore, had a twofold object: firstly to spend a whole

day in sunshine and in the open air, and secondly to catch grass snakes

to add to the collection.

“On leaving the train, our Parisian walked up the Amélie Road, and saw

a snake under a rock. Never doubting that it was one of the kind that

he knew so well, to kneel down, pass his left arm into the hole, and

seize the snake, was the work of a moment; he quickly succeeded, even

better than he intended, for instead of his seizing a grass snake, the

viper bit him so hard in the left forefinger, that he could only make

it let go by pulling it off with his other hand. Well knowing that he

had been dangerously bitten, he went down to the Station Road to get

the wound dressed, after which, thinking that all necessary precautions

had been taken he returned to the forest, but soon felt uncomfortable.

His arm and then his body swelled up, and he was seized with vomiting.

It was time to go to Fontainebleau to seek medical assistance, for he

had acute pain in the abdomen and stomach, his tongue was swollen, and

his body was turning black.

“Accompanied by his friend he reached the town. His condition becoming

more serious every moment; the injured man was carried into a hotel,

where Dr. Lapeyre administered injections of antivenomous serum. After

three hours--the same period as had elapsed between the accident and

the first treatment--the general condition of the patient, which had

never ceased to be alarming, showed marked improvement. By the end of

the day he appeared to be out of danger, and left for Paris on Tuesday

evening, delighted at having got off so cheaply.”

H.--Echis carinata.

XXVII.--Case recorded by Lieutenant C. C. Murison, I.M.S. (_Indian

Medical Gazette_, May, 1902, p. 171).

“G. W. R., a Mahomedan, aged about 12, was admitted into hospital on

March 10, 1902, at 9.30 p.m., having been bitten by a snake on the

dorsum of the right foot an hour and a half previously. The snake was

killed by his sister, and was subsequently identified at the Research

Laboratory, Bombay, as an _Echis carinata_ (Phoorsa).

“I saw the patient at about 9.45. The dorsum of the foot was swollen,

and the swelling extended above the ankle-joint. The knee reflexes

were very exaggerated, and the boy was somewhat drowsy. Since he was

gradually getting worse, I decided to inject 5 c.c. of Calmette’s

antivenene. I got the hospital assistant under my supervision to inject

it into the right calf, to cauterise the bite with silver nitrate, and

to apply a 1 in 40 carbolic poultice. Very soon (fifteen minutes) after

this the pain in the thigh, which had reached to the right groin, began

to disappear. During the night the patient was very sleepy, and the

attendants had great difficulty in keeping him awake.

“March 12.--This morning the patient is much better; there is still

considerable swelling of the foot, but the pain is much less. All other

symptoms are gone.”

XXVIII.--Case reported by Surgeon-Captain Sutherland I.M.S., Saugor,

C.P., India.

Case of a woman bitten on the finger on July 22, 1898, by an _Echis

carinata_. Treated six hours later with 10 c.c. of serum. Recovery.

I.--Cerastes.

XXIX.--Case reported by Dr. Moudon, of Konakry, French Guinea.

“On December 9, 1898, a Foulah woman, eight months pregnant, was

collecting wood when she was bitten in the heel, behind the internal

malleolus of the right foot, by a snake which, from the description

given, must have been a Horned Viper. When I saw her, four hours after

the accident, the whole of the lower leg was swollen and painful.

The swelling extended to the groin, and the patient complained of

vertigo and nausea. I immediately gave her an injection of 10 c.c. of

antivenomous serum in the right flank, followed by a second injection

at 10 p.m. Ten days later, with the Commandant of the _Fulton_, I

saw her again at her village; she had no symptom of malaise, and the

pregnancy was taking its normal course.”

XXX.--Case of a bite from a Horned Viper reported by Dr. Mons, in

charge of the Military Hospital of Laghouat, Algeria.

“Mohamed ben Naouri, a day labourer, aged 26, during the summer catches

Horned Vipers, which he stuffs and sells.

“On August 3 a _Cerastes_, which he was holding down on the sand with a

forked stick, disengaged itself and fastened on his hand. The snake was

a large one, about 50 cm. in length.

“The accident happened at 6.30 a.m., 6 kilometres from Laghouat, and

the man was bitten on the joint between the second and third phalanges

of the third finger of the right hand. He applied a ligature to his

wrist, and started to run as fast as he could towards the Military

Hospital, where he arrived an hour later.

“He was immediately given an injection of antivenomous serum, in

accordance with the instructions, and, around the bite, five or

six injections of permanganate of potash, 1 in 20. On the next and

following days, tense œdema of the arm and left side of the chest.

Extensive purplish ecchymosis of the inner face of the arm; no fever.

The phenomena gradually diminished, and, on August 17, there was merely

a trifling wound where the bite had been inflicted. The patient was

discharged at his own request.

“Like Dr. Marchand (des Montils), we can certify that the action of

Calmette’s serum was rapid and efficacious. The injection did not cause

any pain or febrile reaction.”

XXXI.--Case reported by Dr. Blin, of Dahomey.

“On March 5, 1906, native hospital attendant C., while gathering

vegetables in the hospital garden, was bitten in the right hand by a

_Cerastes_. The bite was inflicted in the tip of the index finger.

Ten minutes later a ligature was applied to the base of the finger

and another to the upper arm, and as soon as we saw the man, which

was after the lapse of about an hour, he was given an injection of 10

c.c. of antivenomous serum. The patient complained of feeling cold and

vomited. The axillary temperature was 36·1° C.; the pulse was weak,

irregular, and rapid. The finger and hand were swollen. A few minutes

later we gave a second injection of serum. Until evening (the accident

took place at 11 a.m.) the patient suffered from nausea, but sweating

set in, and at 7 o’clock the temperature had risen to 36·7° C. The

feeling of depression was much less. On the following day the symptoms

had disappeared, and forty-eight hours afterwards the patient returned

to duty.”

K.--Bitis arietans (Puff Adder).

XXXII.--Case reported by Dr. P. M. Travers, Chilubula Mission,

North-eastern Rhodesia.

“On Thursday, September 6, 1906, information was brought to me that a

child, aged 7 or 8, in inserting his hand into a mole’s hole had been

bitten by a _lifwafwa_ (’Death-Death,’ _i.e._, Puff Adder). I set off

in all haste on my bicycle. An accident obliged me to leave the road

when half-way, and, to complete the series of mishaps, I went to a

village with a similar name, a good half-hour distant from that where

the patient lived. The result was that by the time I arrived I should

say that about two hours had elapsed since the child had been bitten.

The snake had been killed, and was, indeed, a puff adder. It had bitten

the child in the middle finger of the right hand, and half the arm

was greatly swollen, and as hard as stone. As quickly as possible I

gave an injection of 10 c.c. of antivenomous serum, and then vainly

endeavoured to make the wound bleed. In a very short time the serum was

absorbed. On the following morning the child was still ill, with wild

eyes resembling those of an epileptic. He yawned continually, and did

not seem altogether conscious; the inflammation, however, had greatly

diminished. A few days later recovery was complete, but a large abscess

formed on the forearm, and the hand became necrosed. I was obliged to

amputate all the phalanges. The natives said the child was going to

die during the night. In my opinion the serum saved the child’s life,

and recovery would have been more rapid had I not been so late in

arriving.”

L.--Lachesis ferox (known as the _Grage_, in French Guiana).

XXXIII.--Case reported by Dr. Lhomme.

“In May, 1898, A., aged 48, a European convict undergoing sentence, was

admitted to the Penitentiary Infirmary, of Roches de Kouvous (French

Guiana), suffering from a poisonous bite.

“The man had been bitten while engaged in felling timber, at the place

called Passouva. The locality is one that is infested with snakes,

especially at the end of the wet season. Two venomous species in

particular are found there in considerable numbers, the rattle-snake

and another called the _Grage_ by the blacks, which appears to be a

_Lachesis_.

“The patient arrived at the Infirmary in the evening, about twelve

hours after the accident. We endeavoured to obtain precise details,

but, owing to special circumstances, A., who was alone, had been unable

to see what animal had bitten him. The clinical signs, however, pointed

to a venomous snake; inflammatory phenomena and pain set in soon after

the wound was inflicted, and in a very short time became acute.

“_Clinical Signs._--On examining the patient we found that the whole of

the right arm was swollen. The skin, which was of a dark red colour,

was acutely inflamed. The slightest touch or the least movement caused

the patient to cry out. The hand showed traces of the bite, in the

shape of two small red marks, each surrounded by a bluish areola. The

general condition was good. The thermometer, however, indicated a

slight rise of temperature, and the pulse seemed a little soft. The

urine on being examined on the day after the accident contained a small

quantity of albumin. Organs normal. General health before the accident

excellent. Nothing worth mentioning in the previous history.

“_Progress._--The conditions that we have just described disappeared

very quickly, once the treatment was applied. The pain soon ceased,

the temperature fell, and the patient was able to get a few hours

sleep. By the following day the inflammatory phenomena had noticeably

diminished. The œdema of the forearm and hand, however, persisted for

some time, though there was no formation of pus. On the third day after

the accident the albumin had completely disappeared from the urine.

Finally, after the lapse of a fortnight, the condition became normal,

and the convict, who had recovered the entire use of his arm, was able

to resume work.

“_Treatment._--On admission to the Infirmary, A. received a hypodermic

injection in the thorax of the contents of a bottle of antivenomous

serum. At the same time he was given tonics (alcoholised coffee). The

injured limb was placed in a hot phenic arm-bath. These baths were

continued on the following days, alternately with damp dressings. Milk

diet, and daily aperients.

“We saw the patient again more than a year after the accident; his

recovery had been complete; there was no loss of power in the arm

whatsoever, and he had never suffered from the nervous troubles

mentioned by some authors as a complication ensuing after a long

interval, and attributed by them to the antitoxic serum.”

XXXIV.--Case reported by M. Jean, Veterinary Surgeon of Artillery in

Martinique.

“C., a negro, aged 26, employed in the artillery quarters at the

Rivière d’Or, was bitten in the right leg by a snake measuring about 1

metre in length, which he declared was a _Trigonocephalus_. The patient

came to me twenty minutes after the accident. The marks of the bite

were clearly visible a hand’s breadth above the external malleolus.

The wounds were inflamed, and appeared as two small red spots 1·5 cm.

apart, from which a few drops of serum were exuding. I did not notice

any congestion. The patient, however, complained of a feeling of weight

in the leg, and supported himself upon the sound one. After making the

man lie down upon a bed, I applied a tight ligature above the bitten

part, and, with a penknife passed through a flame, I endeavoured to

incise the wounds. The instrument, however, was blunt and I obtained

but little blood.

“The treatment prescribed in Dr. Calmette’s directions was then

strictly followed. With the usual antiseptic precautions, I made

several hypodermic injections of the solution of hypochlorite of

calcium round the bite, and injected the dose of serum indicated in two

places in the abdominal wall. The patient was then vigorously rubbed

and covered with woollen blankets. He was made to take two cups of a

strong infusion of black coffee. Since he could not be induced to go

to hospital, he was carried half an hour later to his home, where he

placed himself in the hands of a ‘dresser.’

“According to information furnished by Captain Martin, who lived on

the spot and was able to follow the course of the case, the patient

remained throughout the day in a state of profound prostration, and had

several attacks of syncope. The injured limb was greatly swollen, and

the swelling, which extended to above the knee, produced a mechanical

difficulty in using the joint, leading to a belief that paralysis was

setting in. During the first five days the condition of the patient was

so alarming as to cause a fatal issue to be apprehended. By degrees

these symptoms diminished, until they disappeared about the fifth day.

“On the twentieth day, C. returned to his work. I saw him again a

month later, when he was in perfect health; his leg had returned to

its normal size, and all that remained were two small fibrous nodules

showing where the bite had been inflicted.”

XXXV.--Case reported by Dr. Gries, Fort-de-France, Martinique.

“On June 21, 1896, a young black, who had just been bitten in the

foot by a _Bothrops_ of large size, was brought to the Fort-de-France

Hospital. The entire limb was swollen and benumbed.

“Two hours after the accident I gave an injection of 10 c.c. of serum

in the abdomen, and the patient was taken back to his family. I saw

him again ten days later, and found that he was quite cured. His

friends stated that recovery had taken place much more quickly than

could have been hoped after so serious a bite, and without the usual

complications.”

XXXVI.--Case reported by Dr. Gries, Fort-de-France, Martinique.

“About 7 a.m., on November 25, 1896, G., aged 23, a fusilier belonging

to the disciplinary battalion, was bitten by a _Bothrops_ at Fort

Desaix under the following circumstances. One of his comrades had just

caught the snake, and was holding its head down on the ground by means

of a forked stick applied to the neck. G. passed a running noose round

the reptile’s neck, but, his comrade having withdrawn the fork too

soon, the snake had time to dart at him and bite him in left thumb. At

the moment when he was bitten the man was squatting, but he quickly

stood up, carrying with him the snake, which remained for a few seconds

suspended from the thumb by its fangs, and did not let go until its

victim had struck it on the head with his fist. G. immediately ran

to one of his officers, who applied a tight ligature to the base of

his thumb, and sent him off to the hospital, where he arrived on foot

and quite out of breath, ten or twelve minutes after the accident. He

was at once given a hypodermic injection of 10 c.c. of antivenomous

serum in the left flank; the thumb was washed with a 1 in 60 solution

of hypochlorite of calcium, after which the ligature was removed. A

few moments later, thinking the case a serious one, I caused a second

injection of 10 c.c. of serum to be given in the right flank.

“Immediately after being bitten the patient experienced complete loss

of sensation in the limb, as far as the middle of the arm. About 9 a.m.

he complained of acute shooting pains in the hand. At 11 o’clock the

limb was still benumbed, but by degrees sensation returned. Profuse

sweating.

“On November 26 sensation was restored in the whole limb; no

inflammatory phenomena. The patient was perfectly well.

“The _Bothrops_ on being brought to the hospital measured 1 metre 47

cm. in length.”

XXXVII.--Case reported by Dr. Lavigne, Colonial-Surgeon at

Fort-de-France.

“At 7 a.m. on January 19, 1897, G., aged 22, was going along a footpath

near Trouvaillant, when he was bitten in the left external malleolus by

a _Trigonocephalus_ which was rutting (a circumstance which, according

to the natives, aggravates the character of the bite).

“After killing one of the reptiles (the other having escaped), the

young man made his way to the detachment of gendarmery stationed close

by. The officer in command applied a ligature to the upper part of

the leg, cupped the man a few times, and sent information to us at

the Military Hospital. On reaching the spot at 9.15 we found, on the

postero-inferior surface of the left external malleolus, two small

wounds resembling those caused by the bite of a snake. The leg was

swollen and painful, and the patient could hardly put his foot to the

ground.

“At 9.30, after taking the usual antiseptic precautions, we gave

an injection of Calmette’s antivenomous serum, from a bottle dated

December 26, 1896. Not having any hypochlorite of calcium at our

disposal, we washed the wound with a 1 in 60 solution of hyposulphite

of soda, and applied a dressing of carbolic gauze. An hour later the

patient was taken to Saint Pierre in a carriage. Temperature 37·2° C.

No vomiting, or tetanic phenomena. In the afternoon the pain was less

acute, and the œdema seemed to have diminished a little. Mercurial

ointment rubbed in.

“Four days later the patient, being cured without having had the least

rise of temperature, proceeded to the country.

“This case is interesting, since a single dose of antivenomous serum

(20 grammes), injected two hours and a half after the accident,

sufficed to cure a young man bitten by a _Trigonocephalus_ measuring 1

metre 20 cm. in length.”

M.--Crotalus horridus.

XXXVIII.--Case recorded by Dr. P. Renaux, of Piriapolis, Uruguay (_La

Tribuna popular_, Piriapolis, December 14, 1898).

Silverita, aged 20, bitten in the ankle by a _Crotalus_, on December

7, 1898. Symptoms of serious intoxication. Treated with a dose of

antivenomous serum, injected half in the right flank, half in the left.

Recovery.

II.--A FEW NOTES AND OBSERVATIONS RELATING TO DOMESTIC ANIMALS

BITTEN BY POISONOUS SNAKES AND TREATED WITH SERUM.

A.--Naja haje.

XXXIX.--Case reported by Dr. Maclaud, of Konakry, French Guinea.

“A hound belonging to the Governor of Konakry was bitten in the ear

by a black _Naja_. A similar accident happened last year, and the

animal died on the fifth day. In the present case, serious phenomena

had already manifested themselves: depression, convulsions, and great

swelling of the entire head and anterior portion of the trunk. A dose

of 10 c.c. was injected at three different points: in the flank,

neck, and cellular tissue of the injured ear. Improvement was almost

immediate. On the following day the animal recovered its appetite, and

two days later was completely cured.”

XL.--Case reported by Dr. Marotte, of Konakry.

“At 10 a.m. on November 1, 1898, a large dog (a German brach), weighing

33 kilogrammes, was running about in some tall grass. It returned

to its master, looking unhappy, with its eyelids swollen. Thinking

that his dog had been bitten by a _Naja_, a snake which swarms round

Konakry, he took it to the hospital. The animal was unable to cover

the distance, which was only 300 metres; it was dragged along, but

collapsed, and had to be carried. Its head was swollen, it panted, and

its breathing was rapid and irregular; there was profuse salivation.

On the inner face of the right ear the marks of the two fangs of the

reptile were distinctly visible. A hypodermic injection of 10 c.c.

of antivenomous serum was immediately given in the right flank: this

was at 10.10 a.m. At 11 o’clock the symptoms appeared to become less

acute; the animal was easier, and its breathing became less rapid and

more regular. At 1 o’clock the animal succeeded in getting on to its

feet; the œdema had somewhat diminished, and it was able to half open

its eyes. At 6 o’clock the dog was taken back to its master’s house; it

seemed just as lively as though nothing had happened.

“On the following morning there was still a small amount of œdema in

the eyelids, but the appearance of the head had become normal.”

B.--Pelias berus (Common Viper).

XLI.--Case reported by M. de Maupas, of Challay, by Trôô.

“About 1 p.m., on July 30, 1898, a fairly large pointer was brought

to me, bitten in the right paw. On shaving off the hair the marks of

the two fangs of the snake were clearly visible. The wound had bled

a little, and the injured limb was painful and swollen. I ligatured

the paw above the joint, and injected a bottle of antivenomous serum,

which had been in my possession since September 6, 1897. The effect

was very rapid; after a quarter of an hour the dog reopened its eyes,

which until then had been half closed. Towards 5 o’clock I removed the

ligature. On the next day but one the swelling had almost disappeared,

and the dog took its food of its own accord; it ran about and seemed

lively.”

XLII.--Case reported by M. de Villiers, Mayor of Villiers-le-Duc,

Côte-d’Or.

“About 2 p.m., on May 23, 1898, the widow Veillard, of Villiers-le-Duc,

while driving her herd of cows to pasture among the brushwood, saw a

viper which she killed, and then, a few moments later, three others

in succession, which she likewise killed. Madame Veillard thought of

leaving this place, which seemed to her to be too much infested, when

one of her cows, which was quietly feeding, swerved violently and

dashed off through the scrub. With the help of her dog she succeeded in

recovering the cow, which appeared uneasy, ceased to feed, and had a

swollen muzzle. Madame Veillard then decided to return to the village.

“Towards 6 p.m., that is to say about three hours after the accident,

I was sent for. The head and tongue of the cow were swollen, there

was foam on the mouth, and the animal had difficulty in breathing. I

injected a dose of antivenomous serum, from our first-aid station,

beneath the skin of the shoulder, and gave a second injection a few

moments later. The cow was then led back to her shed.

“At 9 p.m. she was quiet. The swelling did not increase, and the cow,

which had previously refused all food, ate a handful of hay.

“On the following morning there was nothing to be seen beyond a little

swelling in the neck. The animal fed as usual, and gave her normal

quantity of milk.”

XLIII.--Case reported by M. P. Rat, engineer, of

Saint-Rambert-en-Bugey, Ain.

“About 2 p.m. on Sunday, September 7, 1902, while I was out shooting,

my bitch was bitten in the lower lip by a very large viper. Since I was

a long way from home, I was unable to give the injections until 6 p.m.,

by which time the poor beast was in a pitiable condition. Her head was

as large as a saucepan; she had no strength left, trembled, and was

unable to stand. I injected 15 c.c. of serum in the left flank. This

was all that I did.

“At 7 o’clock on the Monday morning the bitch ate and drank a little.

She began to walk about, and by the evening had completely recovered.

There was nothing but a very little swelling left.”

C.--Cerastes.

XLIV.--Case reported by Dr. Boyé, of Kissidougou, French Soudan.

“At Kan-Kau, on December 19, 1896, a cow belonging to the post, which

had been bitten by a snake at 8 a.m., seemed about to die. The snake,

which was killed by the herdsman, was a _Cerastes_ (Horned Viper).

“On going to the cattle-shed I found the animal on her side and

panting, with the limbs completely relaxed. A thick foam was dropping

from the half-open mouth, and asphyxia seemed imminent. The cow had

been bitten in the teats, which were enormously swollen; the œdema

extended over the whole of the belly and inner face of the thighs. Two

doses of serum were injected, one at the base of the teats, the other

in the subcutaneous tissue of the flank.

“On the following morning the œdema had diminished, and the breathing

was much easier; the animal seemed to be conscious of what was passing

around it.

“Forty-eight hours later the cow was able to walk and went out to

graze, having apparently entirely recovered from the accident.”

III.--NOTE ON THE COLLECTION OF VENOM AND THE TREATMENT OF BITES

FROM POISONOUS SNAKES IN THE FRENCH SETTLEMENTS IN INDIA.

By Dr. PAUL GOUZIEN.

Principal Medical Officer of Colonial Troops.

From the time of our arrival in India, in February, 1901, we turned our

attention to ensuring the regular collection of snake-venoms, with a

view to satisfying the desire for them that had been expressed by our

friend Professor Calmette, Director of the Pasteur Institute at Lille.

To gain this end, the moral and financial support of the Administration

was indispensable, and this did not fail us. Acting on our suggestion,

as formulated by letter on May 25, 1901, Governor Rodier, on June 11,

issued an order by the terms of which a sum of 200 rupees was placed

at the disposal of the Chief of the Sanitary Service, “with a view

to encourage the catching of poisonous snakes, and to assist the

collection of snake-venom by the granting of bounties to natives.”

On the issue of this order, we drew up instructions for the collection

of venom, which we caused to be distributed to all posts in the Colony.

At the same time an appeal in the vernacular was posted up in each of

our sanitary institutions, inviting the Hindus to commence the campaign

forthwith. The notice placarded on the door of the Pondicherry Hospital

ran as follows:--

“Public Notice.

“For the public good the Governor requests the population to capture

poisonous snakes in all places where they are found; to take them alive

if possible; and to bring them to the Hospital without removing their

fangs.

“One rupee will immediately be paid for each snake brought in.

“Those who read this notice are requested to communicate it to their

acquaintances.”

* * * * *

The Indian snake-charmers at once responded to this appeal, and the

harvest of snakes was soon abundant. The first provision of 200

rupees, allotted to us by the Administration in June, 1901, had to

be successively renewed in May and October, 1902. Since then, on the

proposition of our successor, Dr. Camail, this sum of 200 rupees has

been included in the local budget, thus definitively sanctioning the

principle of the collection of venom in our Indian Settlements.

The venom forwarded by us to France has been exclusively derived

from the cobra, or _Naja tripudians_. Other venomous serpents are

found in the French Settlements in India, especially the species of

_Hydrophis_, or sea-snakes; but the cobra is by far the commonest

species, and our trading stations teem with it. Yanaon is infested by

it at all seasons, but especially at the time when the Godavari is

in flood; the reptiles then make their way towards spots spared by

the inundation, and the natives frequently kill them in their houses.

Thus M. Mariapregassam, the Sanitary Officer in charge of the the

Medical Service of this dependency, was in a position to procure for

us, at the very commencement of our operations, important doses of

venom: it should be added that he acquitted himself of this task with

a perseverance and devotion worthy of the fullest recognition. Of the

653 cobras captured between August 1, 1901, and February 23, 1903, 229,

or more than one-third, were furnished by Yanaon. Moreover, the cost

price of the cobra fell in proportion to its numbers, and Yanaon paid

for its snakes on the average at the rate of 33 centimes apiece; while

at Chandarnagar and Pondicherry the snake-charmers frequently received

1 rupee (1 franc 67 centimes) per reptile, though it is true that even

this was an extremely poor remuneration, when we consider the risk of

the calling.

Again, owing to the limited amount of our grants, we were obliged to

restrict our expenditure, regulating the purchase-price of the snakes

according to the quantity of venom collected. Thus at Pondicherry,

having observed that each cobra yielded on an average twenty drops of

venom, we fixed the value of two drops at one _fanon_ (one-eighth of a

rupee), never more. In this way it was decidedly to the snake-charmer’s

interest to bring us fresh snakes, and not such as had been previously

deprived of their venom.

In spite of this new regulation, snakes continued to pour into the

hospital, and several were repeatedly brought to us at the same time;

in October and November, 1902, the figure 9 appears three times in our

statistics.

The combined results of the snake-harvest at our five settlements,

from August 1, 1901, to February 23, 1903, are shown in the following

table:--

Average

weight Average Average

Quantity of dry price price

Number Sum of venom venom of the of 1 gramme

of cobras expended collected per cobra cobra of venom

653 R. 446 242 0·37 R. 0.68 R. 1.84

grammes gramme (1.13 fr.) (3.07 fr.)

On an average, therefore, nearly three cobras are necessary to furnish

1 gramme of dry venom, since freshly collected venom weighs more,

owing to the proportion of water contained in it, which is greater

than half the total weight. Thus the quantity of fresh venom extracted

from an average cobra may be estimated at about 80 centigrammes. It

may be added that the product of the glands differs considerably in

appearance, according as it is derived from a dead or living snake.

In the former case it takes the form of extremely small, glistening

lamellæ, of a golden-yellow colour, similar in appearance, when in

bulk, to iodoform. Venom extracted from the living snake, on the other

hand, is of an amber-brown colour, and forms much larger lamellæ, which

are translucent and slightly elongate, resembling particles of gum

arabic. When the product is impure and mixed with a small quantity of

blood, it has a dull appearance, and is of a dark, dirty brown, almost

black colour.

At the Pondicherry Hospital venom is collected in the following

manner;[168] The snake is brought by the snake-charmer in a _chatty_, a

kind of earthern pot, covered with a rag, or half a calabash. Ensconced

at the bottom of this receptacle, the reptile has a difficulty in

making up its mind to emerge, which it does only after having been

stirred up several times. Once it is outside the charmer forces the

cobra to uncoil, and, while the animal is moving slowly along, fastens

it to the ground by placing the end of a bamboo on its neck, quite

close to the head. The Indian then cautiously seizes the head of the

cobra with his forefinger and thumb, and, with a rapid movement, throws

it into a jar prepared for the purpose, containing a few tampons of

absorbent wool impregnated with chloroform. As soon as the snake is

inside, an assistant quickly slips a metal plate over the opening of

the jar and presses his hand firmly down upon it. In a few minutes

the animal is dead; it is then taken out of the jar and its mouth is

swabbed out; next, the fangs having been raised by means of a probe, a

saucer is placed between the jaws, and, by pressure exerted upon the

poison-glands laterally and from behind forwards, the venom is made to

spurt out. The fresh product obtained in this way is of a very pale

yellow colour, and viscid. It is protected from the air and light until

completely desiccated; then, when it is in sufficient quantity and

distributed in flakes round the sides of the saucer, like the colours

on a palette, it is cautiously detached with a spatula, taking care to

protect the eyes against risk from flying particles of venom. After

being placed in well-corked bottles, the product is despatched to

France.

In spite of the precautions observed in the course of these

proceedings, and although the venom has not been extracted until after

the death of the animal, some regrettable accidents have taken place,

as we shall show further on.

Cases of bites from poisonous snakes appear but seldom in the

statistics of our settlements in India, and, contrary to what is

the case in the neighbouring English possessions, hardly any deaths

are _officially_ recognised in the annual returns as being due to

this cause. It is true that the death statistics are very badly

authenticated, and that the natives frequently conceal the real cause

of death.

We have been informed by Dr. Cordier, Surgeon-Major of the Sepoy Corps,

that, during a previous tour of duty in Bengal, he had successfully

treated two cases of cobra-bite with Calmette’s serum.

At the end of 1901 the following note was forwarded to us by Dr.

Paramananda Mariadassou, Physician to the Karikal Hospital:--

“Case I.--In the month of November, 1901, a woman of robust habit was

brought about midnight to the Karikal Hospital, in a semi-comatose

condition. Her husband stated that an hour before, while lying on a

mat stretched on the ground, she felt herself bitten in the shoulder

when in the act of placing her head on the pillow. With a start of

surprise she half rose and then lay down again. It was only on being

bitten for the third time that she made up her mind to seek for the

cause; passing her hand beneath the pillow in the darkness she touched

the body of a snake and cried out. Directly afterwards she pointed out

to her husband, who had at once hastened to her, the snake coiled up

against the wall; the man killed the reptile and burnt it on the spot.

According to him the snake was about a metre in length, and as thick as

all five fingers put together. The woman had barely time to tell her

husband what had happened, for she speedily became unconscious, and was

in this condition when brought to the hospital.

“On admission the following symptoms were observed: The patient did not

reply to questions put to her, the eyelids remained closed, and the

teeth clenched. On the right shoulder, a little on the inner side of

the deltoid prominence, two or three punctures were distinguishable,

marked by a small spot of coagulated blood. The respiration was normal,

but the pulse was feeble and thready. When a pledget impregnated with

ammonia was held under her nose the woman reacted, but immediately

relapsed into the soporose condition.

“Two doses of antivenomous serum were at once injected, one in each

flank: the patient seemed scarcely to feel the insertion of the needle.

The wound on the shoulder was then washed with a fresh solution of

hypochlorite of calcium, 1 in 60, and six injections, each of 1 gramme,

of the same solution were given round the wound. The latter was covered

with a pad of cotton-wool saturated with the solution, and two more

doses of serum were injected into the flanks. As the result of this

treatment, which altogether took nearly half an hour, the woman began

to unclench her teeth, and to respond to her name. She was made to

swallow a few mouthfuls of very hot black coffee. A little later she

resisted when a fresh injection of serum was about to be given her.

After having taken a second cup of coffee she sat up, opened her eyes,

and recognised those about her. She immediately asked to go home,

but was detained for some time longer. After being carried from the

operating table to a bed, she was wrapped in a blanket; a few minutes

later profuse perspiration set in, and the patient felt so well that

she was allowed to go.

“On the following day the husband came to thank us, and stated that his

wife had quite recovered, and that, while she had been unable to sleep

for the remainder of the night, it was rather from fear caused by what

had happened than in consequence of the pain.”

Case II.--We feel it our duty to relate in detail the following case,

having regard to the peculiar circumstances under which it took place.

Coupin, the son of Ponnin, aged 25, living at Carouvadicoupom, near

Pondicherry, is a snake-charmer, and one of those who regularly supply

us with venom. In the course of July, 1902, this man pointed out to us

a shrub[169] growing in one of the alleys of the hospital, to which he

attributed so marvellous a power against the bites of poisonous snakes,

that he offered to make a cobra bite him in our presence, little as

we showed any desire to witness such an exhibition. We allowed him to

talk, not wishing to encourage such an act of bravado.

However, on July 23 he returned to the charge, and, as we were leaving

the hospital accompanied by our colleagues, he showed us a cobra

which he had just caught, and declared himself ready to carry out the

proposed experiment there and then. In the face of so much confidence

and _sang-froid_, and, apart from this, being interested in learning

the justification for the reputation for immunity possessed by Hindu

snake-charmers, we thought we ought not to oppose this voluntary test.

Coupin then turned out from the chatty in which it was imprisoned a

medium-sized cobra, and amused himself for a few moments by teasing

it. Irritated by this sport, the snake reared itself up, hissed, and

struck at its aggressor several times, as though it would bite him;

but, at each dart, Coupin stopped it with his hand and gaze, and the

snake remained fascinated, with open mouth, hesitating to drive home

its fangs. At one moment the snake even crawled up to the native’s

outstretched hand, and appeared to lick it: it was evident that the

animal’s only intention was to defend itself, not to attack.

Coupin, however, was bent on getting bitten, and, by dint of exciting

the snake, the latter became so exasperated that, with hood dilated, it

struck at the snake-charmer’s right hand and drove in its fangs. The

man quietly raised his arm, to allow it to be clearly seen that the

cobra had a firm hold; then, forcing the animal to let go, he came to

us to prove that he was really bitten. There were two bleeding spots, 6

millimetres apart, in the centre of the fourth intermetacarpal space of

the right hand. The time was exactly 4.40 p.m.

The snake, which was immediately killed, was still able to yield twelve

drops of venom, when lateral pressure was applied to its glands.

Coupin walked towards a shrub of the kind mentioned above, which he

had planted that very morning in the courtyard of the hospital,[170]

plucked some leaves from it and began to chew them, making rather a

wry face, for he said that they were very bitter. He then seemed to

meditate for a few moments before the shrub. We asked him whether he

was afraid, but he stoutly denied it, declaring that this was not his

first experience, and that indeed he had been bitten by cobras so

often that he could not remember the first occasion. We endeavoured to

discover whether he was not rendered immune, as Indian snake-charmers

are reputed to be, by inoculating themselves subcutaneously with

increasing doses of venom, according to a principle to a certain extent

analagous to that on which the preparation of antivenomous serum

is based. He, however, assured us that he knew nothing about such

practices, and that the properties of the plant in question had always

sufficed to cure him without other treatment. Such was his confidence

in his specific that, before the cobra was killed, he suggested to our

hospital-warder that he should allow himself to be bitten in his turn,

in order to render the experiment still more conclusive, adding that

his own assistant would be the subject at the next demonstration.

Nevertheless, a slight œdema began to appear round the bite. The

injured man seemed to be suffering a little, but the pain did not

extend above the wrist; a slight trembling appeared in the other arm.

From time to time Coupin gently massaged the affected limb with his

left hand from above downwards, in order, he said, to lessen the pain,

and perhaps also with a view to checking the diffusion of the venom. A

slight perspiration broke out over the body; the pulse was regular, 92,

twenty minutes after the bite.

Towards 6.15, or about an hour and a half after the experiment, the

man, refusing an injection of serum, prepared to go home, but we

insisted that he should remain at the hospital for at least two hours

longer, so as to enable us to watch his condition. He consented to

this, and asked for something to eat. At this time the back of the hand

was somewhat more swollen, but Coupin seemed to be little disturbed by

it; he even declared that the swelling would increase still further on

the following day, and that, in two or three days, he would make an

incision in order to let out the impure blood collected at the spot;

also that the trouble was now localised, and would not extend higher.

He merely complained of acute thirst, and of a certain difficulty in

swallowing, which was due, he declared, to the extreme bitterness of

the leaves that he had just masticated. Temperature 36·8° C.; pulse

36. After the brief reaction at the outset, there was a certain amount

of hypothermia, but the general condition seemed satisfactory, 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 antivenomous

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 condition. 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 coincidence, 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 500 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 antivenomous serum was injected

beneath the skin,[171] and, since the respiratory movements gradually

became slower, artificial respiration by Sylvester’s method was

resorted to, while the tongue was rhythmically drawn forward. From

time to time these proceedings were interrupted for a few moments, in

order to observe the condition of the respiration; at the base of the

thorax and in the flanks abrupt, jerky, tetaniform undulations were

observable, but there was no free respiratory movement. The abdominal

aorta, the pulsations of which were visible behind the navel, raising

the anterior wall of the abdomen, was somewhat misleading, simulating

the rhythmical oscillations of the abdominal respiratory type. The

heart, however, continued to beat regularly, without any appreciable

weakness. The radial pulse persisted, although weak and slow: rate 48.

The patient was kept alive by repeated injections of ether and

artificial serum (1¼ litres in three doses). About 8.30 there appeared

to be a slight improvement; the patient was warmer, and showed some

degree of sensation in the region of the bite. On pinching the

vasculo-nervous bundle in the left axilla reflex movements were

produced in the fingers, which closed convulsively. The pulse, which

had momentarily disappeared in the radial artery, could again be felt,

weak but regular. At the same time, when the epigastric region was

examined, a few faint respiratory movements were just perceptible.

A third injection of antivenomous serum was given and artificial

respiration was continued.

This factitious amelioration, however, was not maintained, and after

a few scarcely visible movements of the thorax the end soon came. The

eyes were fixed and insensible, the pupils slightly dilated; no sweats,

no urine passed. The body slowly grew cold; the pulse disappeared from

the femoral and carotid arteries, and diminished in the aorta. The

contractions of the heart were once or twice irregular, and its beats

became weaker and gradually The reflexes had disappeared. There were

still a few slight muscular contractions near the base of the chest,

and the patient quietly passed away at 11.5 p.m., as the result of the

progressive arrest of the heart’s action, respiration itself having

virtually disappeared two hours before the heart had ceased to beat.

Case III.--A week after this sad occurrence, another snake-charmer,

Kingilien by name, aged 25, was bitten in the first phalanx of the

right forefinger, when taking hold of a cobra in the courtyard of

the Pondicherry Hospital. Refusing an injection of antivenomous

serum, the man ran off as fast as he could go, after having a simple

ligature applied to his wrist. Scarcely had he reached his dwelling,

when he fell into a deep coma, in which condition he was carried to

Cottacoupom, to the abode of one Souraire Kramani, a kind of sorcerer,

who administered to him a certain medicament in a betel leaf. After

having vomited a large quantity of bile he was taken home. At this

time, according to the summary investigation that we caused to be made,

the patient was unable to utter a single word; he could only open his

mouth with difficulty, and his eyelids remained closed. Kingilien,

who had partially regained consciousness, seemed to be suffering

from continuous attacks of vertigo; his head, if pushed to one side,

drooped, and the man was incapable of voluntary movement. Respiration

was fairly easy, swallowing painful. The entire hand was greatly

swollen; poultices of leaves were applied to it, after a few incisions

had been made with a knife in the back of the hand, in order to reduce

the congestion. The arm was rubbed from above downwards with the very

bitter leaves of the _Vëmbou_, or mango-tree, and prayers were recited.

This is all the information that I have been able to obtain with

reference to this man, who, after a prolonged convalescence, is said to

have recovered (?).

Case IV.--One Latchoumanin, aged 25, also a snake-charmer, of

Caradicoupom, was bitten at the Hospital at 10 a.m., on August 2,

while handling a cobra. The bite was situated in the second joint of

the right thumb. After it had bitten the man, ten drops of venom were

extracted from the reptile’s glands.

A ligature was immediately applied, and the wound was made to bleed

by hard squeezing. Refusing all other treatment, especially injection

of serum, although we repeatedly urged it, the man made off home with

all speed, but on arrival failed to find the specific on which he

was relying. All that was then done was to recite a few prayers over

him, and a Brahmin priest was called to bless him. About 11.30, after

acute suffering, Latchoumanin sank into a comatose condition. At 12.30

respiration became stertorous, and the patient succumbed at 2 p.m.,

four hours after being bitten. Just as the medical officer, deputed by

us, reached the dying man, two chatties containing live snakes were

deposited at his bedside, to ward off ill-luck!

* * * * *

On the whole, the evidence collected in the last two cases is as

confused as it is incomplete, and we can scarcely say how much we

regret the obstinacy of these unfortunate victims in refusing to submit

to our treatment, for the serum would undoubtedly have produced its

maximum effect in them, since it would have been possible to make use

of it in good time. These disastrous occurrences, however, will not

cure natives of their exclusive reliance upon empirical practices;

and as regards the inhabitants of the Tamil country, that is to say,

Southern India, it may be foreseen that for a long time to come they

will continue to remain refractory to the serotherapic treatment,

submission to which the English have had less difficulty in securing

from the natives of Bengal, whose intellectual development undoubtedly

stands on a higher plane.

INDEX.

d’Abbadie, M., on inoculation, 238.

_Acalyptophis_, 133.

_Acanthophis_, 96.

“ _antarcticus_ (death adder), 96.

“ “ “ “ bite dangerous, 100.

_Acanthopterygii_, 290, 301, 304.

_Acanthurus_, 301.

“ _luridus_, 301.

Adder, 25, 26. _See also Vipera berus._

Africa, poisonous snakes in, 57-81.

“ “ “ geographical distribution of genera (tables), 143, 144.

“ (Central), witch doctors of, snake-bite remedies, 237.

“ (East), Vatuas’ method of inoculation, 239.

Agglutinins of venoms, 202.

_Aipysurus_, 140.

“ _annulatus_, 140.

“ _australis_, 140.

“ _lævis_, 140.

“ _eydouxii_, 140.

Albuminoid of snake-venom produces hæmorrhages, 162.

Albumins of venom devoid of toxic power, 164.

Albumose of snake-venom attacks nerve-cell of respiratory centres,

162.

Albumoses of venoms of _Colubridæ_, 162.

“ “ “ method of separation, 162.

“ _See also_ Proto-albumoses, Hetero-albumoses.

Alcatifa, extraction of venom from, for inoculation, 239.

Alcock, researches of, on glands of snakes, 147.

Alexins, 198, 209.

“ characteristics of, 207.

“ fixation of, 210, 211.

“ of normal serum, fixation by cobra-venom, 211.

“ neutralisation of, 212.

Alkaloids in venom, 160.

Alps, and mountains of Central Europe, _Salamandra atra_ found in,

313.

Amboceptors, 198, 210.

“ fixation of, 208, 220.

America, snakes in, geographical distribution of genera of (table),

146.

“ venomous snakes in, 100-131.

America, (Central), _Batrachus tau_ found on shores of, 302.

“ (North), musical toad found in, 318.

“ (South), witch doctors of, snake-bite remedies, 237.

“ (Tropical and Sub-tropical), _Latrodectus mactans_ found in, 275.

Ammonia, injection of, only temporary antidote against snake-venom,

261.

_Ancistrodon_, 49, 109, 110.

“ venom of, precipitation of anticoagulant substance in, 195.

“ _acutus_, 49.

“ _bilineatus_, 111.

“ _blomhoffii_, 50.

“ _contortrix_, 111.

“ _himalayanus_, 50.

“ _hypnale_, 51.

“ _intermedius_, 50.

“ _piscivorus_, 110.

“ _rhodostoma_, 51.

Anderson, relation of escape from _Naja haje_, 60.

_Anemone scultata_, 269.

Aniline colours, action of, diminishes toxicity of venoms, 167.

Animals, venomous, definition of, 1.

Arachnolysin, poison from _Latrodectus_ prepared by, 276.

_Araneida_ (spiders), 274.

Armstrong, H., chemical analysis of cobra-venom, 159.

Arrows, poisoned by Hottentots with venom of _Bitis arietans_, 72.

Arthropods, poisonous species of, 274.

Asia, poisonous snakes inhabiting, 30, 57.

“ “ “ “ geographical distribution of genera (tables), 142, 143.

Asp, 27, 28. _See also Vipera aspis_.

_Aspidelaps_, 64.

“ _lubricus_, 64.

“ _scutatus_, 64.

_Atheris_, 78.

“ _ceratophorus_, 78.

“ _chlorechis_, 78.

“ _squamiger_, 78.

Atlantic (Tropical), _Acanthurus_ found in, 301.

“ “ _Muræna moringa_ found in, 309.

_Atractaspis_, 78.

“ _aterrima_, 80.

“ _bibronii_, 80.

“ _congica_, 79.

“ _corpulenta_, 80.

“ _dahomeyensis_, 80.

“ _hildebrandtii_, 79.

“ _irregularis_, 79.

“ _leucomelas_, 81.

“ _microlepidota_, 81.

“ _micropholis_, 81.

“ _rostrata_, 80.

Australia, health authorities’ notices against venomous reptiles, 100.

“ mortality from snake-bite in, 100, 261.

“ poisonous snakes of, 81-100.

“ snakes of, almost all confined to sub-family _Elapinæ_, 5.

Bacteriolytic action of venoms, 206.

“ “ “ how differing from that of rat-serum, 208.

Bailey, action of venom on brain, 185.

Batrachians, 312.

_Batrachiidæ_, 302.

_Batrachus grunniens_, 302.

“ _tau_, 302.

Bavay on the spitting snake, 63.

Bee-sting, remedies for, 286.

Bees, venom of, 282.

Bertrand, researches of, 147.

Bertrand and Phisalix, experiments on immunity of hedgehog to venom,

226.

“ “ preparation of toad-venom, 319.

Bettencourt, R., venom antitoxin treatment of yellow fever, 184.

Bibron and Duméril on coloration of snakes, 16.

“ “ _Naja_ worship in Egypt, 61.

Bile, destructive effect on cobra-venom, 215.

Birds, symptoms after inoculation with lethal doses of venom, 172.

_Bitis_, 69.

“ _arietans_ (puff adder), 69.

“ “ “ “ bite from, 350.

“ “ “ “ venom used for poisoning arrows by Hottentots, 72.

“ _atropos_, 72.

“ _caudalis_, 73.

“ _cornuta_, 73.

“ _gabonica_, 73.

“ “ does not attack man, 74.

“ _inornata_, 72.

“ _peringueyi_, 72.

Black snake, 88. _See also Pseudechis porphyriacus._

Blin, bite from _Cerastes_, 349.

Blindness following bite of viper, 178.

Blood, anticoagulant action of venom on, mechanism of, 195.

“ coagulability, action of venom of _Lachesis lanceolatus_ on, 191.

“ “ destroyed by venoms of _Colubridæ_, 179, 188, 189, 191, 192, 193.

“ “ “ “ certain species of _Crotalinæ_, 191, 192, 193.

“ “ uncertain action of venom of Vipera berus on, in certain animals,

189, 190.

“ coagulation of, connected with action of venoms of _Viperidæ_ on

nervous system, 185, 186.

“ “ produced by venoms of _Viperidæ_, 179, 188, 189.

“ not coagulated after death caused by venoms of _Colubridæ_, 171,

188, 189.

“ of hedgehog toxic before heating, antitoxic afterwards, 226.

“ of scorpion antitoxic, 279.

Blood, toxicity of, in reptiles, 217.

“ “ “ confers partial immunity to venom, 218, 219.

“ “ “ destroyed by heating, 218.

“ “ in venomous snakes, 217.

Blood-corpuscles, red, agglutination by venoms, 202.

“ “ dissolution only effected by combination of venom with

blood-serum or lecithin, 197.

“ “ dissolved by snake-serums, 219, 220.

“ “ effects of venom upon, 196.

“ “ resistance to large doses of venom, 199, 200, 201.

“ “ “ “ “ “ explanation, 200, 201.

“ “ washing of, important before presentation to action of venom,

196, 197.

“ unaltered under action of simultaneous doses of venom and serum,

220.

“ white, effects of venom on, 203.

Bombay, laboratory for production of antivenomous serum at, 248, 252.

Bonaparte, Lucien, chemistry of venom of vipers, 160.

_Bothrops_, bites from, 353, 354.

Bottard on venomous fishes, 288.

_Boulengerina_, 58.

“ _stormsi_, 58.

_Brachyaspis_, 95.

“ _curta_, 95.

Brain, comparative action of venoms of _Colubridæ_ and _Viperidæ_ on,

185, 186.

“ substance of, fixation of venom on, 186.

Brazil, _Thalassophryne maculosa_ found on shores of, 303.

Brehm, on _Crotalus confluentus_, 125.

“ the daboia (_Vipera russellii_), 46.

“ _Echis carinatus_ (efa, viper of the pyramids), 76, 77.

“ reverence paid by Hindus to _Naja_, 38.

Broad-headed snake, 94. _See also Hoplocephalus variegatus._

Briot, A., experiments with weever-venom, 298, 299.

“ poison of _Scolopendra_ prepared by, 280.

Bromized water, saturated, modifies or destroys venoms, 164.

Brown snake, 87. _See also Diemenia textilis._

Brunton, Sir Lauder, on harmless ingestion of venom exceeding lethal

dose, 214.

_Bufo calamita_ (natter-jack), 318.

“ _musicus_ (musical toad), 318.

“ _viridis_ (green toad), 318.

“ _vulgaris_ (common toad), 318.

Bufotalin, 319, 320.

“ first active principle of toad-venom, and cardiac poison, 319, 320.

Bufotenin, 320.

“ second active principle of toad-venom, and neurotoxic poison, 320.

_Bungarus_, 30.

“ venom of, active hæmolysing power possessed by, 199.

“ _cæruleus_ (common krait), bite, cure of, 337.

“ “ “ “ venom of, dose lethal for different animals, 174.

“ _candidus_, 32.

_Bungarus candidus_, resemblance to _Lycodon aulicus_, 33.

“ _fasciatus_, 31, 32.

_Buprestidæ_, food for larvæ of _Cerceris bupresticida_, 285.

Bushmaster, or surucucu, 112. _See also Lachesis mutus._

_Calamaridæ_, species of _Callophis_ feed only upon, 42.

_Callionymus_, 301.

“ _belennus_, 301.

“ _lacertus_, 301.

“ _lyra_, 300-301.

“ _vulsus_, 301.

_Callophis_, 40.

“ feeds only on snakes belonging to _Calamaridæ_, 42.

“ _bibronii_, 41.

“ _gracilis_, 41.

“ _maclellandi_, 41.

“ _maculiceps_, 41.

“ _trimaculatus_, 41.

Calmette’s serum, cobra-bites treated with, 363-5. _See also_ Serum,

antivenomous.

Calvados, _Callionymus lyra_ common on coast of, 301.

_Cantharis_ (blister-beetles), 281.

Cantor, on venom of _Naja bungarus_, 39.

“ vindictiveness of _Naja bungarus_, 39.

Captivity, poisonous snakes kept in, 61, 62, 125, 156, 223.

Carawalla. _See Ancistrodon hypnale._

Cardiac poison of toad-venom (bufotalin), 319, 320.

Caribbean Sea, _Scorpæna grandicornis_ found in, 293.

Carpi and Morgenroth, lecithide of bee-venom prepared by, 285.

Carrière, experiments on ingestion of venom, 214.

Cascavella (_Crotalus terrificus_), 124.

Cato, army of, patronage of snake-charmers by, 228.

_Causus_, 67.

“ _defilipii_, 67.

“ _lichtensteinii_, 68.

“ _resimus_, 67.

“ _rhombeatus_, 67.

Cells, dissolution of. _See_ Cytolytic action.

_Cerastes_, 47, 75.

“ bites from, 348-350.

“ “ cured, 358.

“ secretion of, 150.

“ venom of, fatal to barefooted pedestrians, 76.

“ _cornutus_, 47, 75.

“ _vipera_, 75.

_Cerceris bupresticida_, 285.

Ceylon, snake-charmers of, 229.

Chameleons succumb rapidly to snake-poisoning, 172.

Chelicera (fang of spider), 274.

Chemical reactions exhibited by venoms, 162.

Chemical substances modifying or destroying venoms, 164.

Chemistry of snake-venoms, 159.

Cherry and Martin on antagonism between toxins and antitoxins, 253.

_Chilomycterus_, 307.

“ _orbicularis_, 307.

“ _tigrinus_, 307.

China and Japan, _Lophius setigerus_ found in seas of, 304.

Chloride of gold, antidote to venom before absorption, 261, 263.

“ “ solution, modifies or destroys venom, 164.

“ lime solution, modifies or destroys venom, 164.

Cholesterin, antidote to lecithin, 198.

Chromic acid, antidote to venom before absorption, 260.

“ “ solution, modifies or destroys venoms, 164.

Clamouse, on bites from European vipers, 343.

Clot Bey on Egyptian snake-charmers, 228-229.

Clothing protective against dangerous effects of snake-bite, 170.

Cobra, bite of, clinical symptoms, 169.

“ “ “ “ exhibit rapid general intoxication, 169.

“ “ treated with Calmette’s serum, 363.

“ extraction of venom from, method, 153.

“ Egyptian (_Naja haje_ or _haie_), 59.

“ method of carrying after capture, 21.

“ snake-charmers’ skill with, 229.

“ venom of, 149.

“ “ alkaloids in, 160.

“ “ chemical analysis, 159.

“ “ comparison of toxicity by means of intra-cerebral injections, 186.

“ “ destructive action of bile on, 215.

“ “ dissolution of trypanosomes by, 207.

“ “ dose lethal for different animals in twenty-four hours, 174.

“ “ fixation on nervous elements, 186.

“ “ local effects on serous membranes slight, 179.

“ “ potency of antineurotoxic antivenomous serum against, 250, 251,

252.

“ “ vaccination against, 242, 244, 245.

Cobra-di-Capello, 33. _See also Naja tripudians._

“ “ spectacled, used by Hindu snake-charmer, 229.

_Cœlenterates_, poisonous species of, 269.

_Cœlopeltis_, 22.

“ _moilensis_, 23.

“ _monspessulana_, 23.

Cold, intense, toxicity of venom not diminished by, 166.

Colombia, herons of, probably immune to snake-venom, 227.

“ “ hunt young snakes for food, 226.

Coloration of snakes, 15, 16.

“ “ subject to biological laws of mimicry, 15, 16.

_Colubridæ_, 3, 30, 57, 82, 100, 101-109. _See also Acanthophis_,

_Aspidelaps_, _Boulengerina_, _Brachyaspis_, _Dendraspis_,

_Denisonia_, _Diemenia_, _Elapechis_, _Elapognathus_, _Furina_,

_Glyphodon_, _Homorelaps_, _Hoplocephalus_, _Micropechis_,

_Notechis_, _Ogmodon_, _Opisthoglypha_, _Proteroglypha_,

_Pseudechis_, _Pseudelaps_, _Rhinhoplocephalus_, _Rhynchelaps_,

_Sepedon_, _Tropidechis_, _Walterinnesia_.

_Colubridæ_ (sub-family _Elapinæ_). _See also Bungarus_, _Naja_,

_Hemibungarus_, _Callophis_, _Doliophis_.

“ resemblance to harmless snakes, 3.

“ species of, bite rapidly produces general intoxication, 168.

“ venoms of, absorption by digestive tract often without ill-effect,

180, 181.

“ “ “ “ “ “ “ cause, 181.

“ “ action on nervous centres profound, 185.

“ “ affinity of scorpion poison to, 278.

“ “ albumoses of, 162.

“ “ destroy coagulability of blood, 179, 188, 189.

“ “ dialyse slowly, 161.

“ “ lethal effects on mammals, 170.

“ “ minimum doses lethal for guinea-pig in twenty-four hours, 173.

“ “ precipitation of anticoagulant substance in, 195.

“ “ recovery rapid after non-lethal doses, 177.

“ “ resistant to heat, 161.

“ “ richness in neurotoxin, 249.

Common rattle-snake, 125. _See also Crotalus durissus._

Congestin, poison from _Anemone scultata_, 271.

Conjunctivitis caused by discharge into eyes of venom of spitting

snake, 63, 64.

Copperhead, 90. _See also Denisonia superba._

Coral-snake, 104.

“ immunity from bite of, 238.

“ venomous nature of, 108.

“ _See also Elaps corallinus._

Coral or harlequin snake, 106. _See Elaps fulvius._

Cordier, D., cobra-bites treated with Calmette’s serum, 363.

Cotes, E. C., on extraction of venom by charmers, 234.

_Cottus_, 289, 290, 292.

“ poison-apparatus of, 293.

_Crabronidæ_, 285.

“ stings of females of, toxic to other insects, nearly harmless to

man, 285.

_Crotalinæ_ (_Viperidæ_), 101, 109.

“ characteristics of, 6.

“ venoms of certain species of, non-coagulant, 191, 192, 193.

“ _See Ancistrodon_; _Lachesis_.

_Crotalus_ (rattle-snake), 110, 122.

“ comparative toxicity of organs, 220.

“ eggs of, rich in poison, 220.

“ poison glands of, 148.

“ venom of, alkaloids in, 160.

“ “ comparison of toxicity by means of intra-cerebral injections, 186.

“ “ ingestion causing death, 180.

“ “ weak hæmolysing power possessed by, 199.

“ _adamanteus_, venom of, dose lethal for rabbit, 175.

“ _cerastes_ (horned rattle-snake), 129.

“ _confluentus_ (Pacific or mottled rattle-snake), 124.

“ “ “ “ “ habits, 125.

“ “ devoured by pigs, 125.

_Crotalus confluentus_, secretion of, 150.

“ _durissus_ (common rattle-snake), 125.

“ _horridus_, 127.

“ “ bites from, 355.

“ _lepidus_, 129.

“ _mitchelli_, 127.

“ _polystictus_, 129.

“ _scutulatus_ (Texas rattle-snake), 124.

“ _terrificus_ (dog-faced rattle-snake or cascavella), 124.

“ _tigris_, 127.

“ _triseriatus_, 129.

_Cryptobranchus japonicus_ (great Japanese salamander), 313-315, 317.

“ “ venom of, 317.

“ “ “ action similar to that of viperine venoms, 317.

_Curados de Culebras_, immunity produced by inoculation by, 235-237.

Cytolytic action of venoms, 206.

Daboia. _See Vipera russellii._

Deafness following bite of viper, 178.

Death adder, 96. _See also Acanthophis antarcticus._

Delezenne, establishment of existence of kinase in venoms, 204.

“ on the kinasic properties of venoms, 204, 213.

_Dendraspis_, 65.

“ _angusticeps_, 66.

“ _antinorii_, 66.

“ _jamesonii_, 66.

“ _viridis_, 66.

_Denisonia_, 88.

“ _carpentariæ_, 92.

“ _coronata_, 89.

“ _coronoides_, 89.

“ _dæmelii_, 90.

“ _flagellum_, 91.

“ _frenata_, 90.

“ _frontalis_, 91.

“ _gouldii_, 91.

“ _maculata_, 91.

“ _melanura_, 92.

“ _muelleri_, 90.

“ _nigrescens_, 92.

“ _nigrostriata_, 92.

“ _pallidiceps_, 92.

“ _par_, 92.

“ _punctata_, 91.

“ _ramsayi_, 90.

“ _signata_, 90.

“ _superba_ (the copperhead), 89.

“ _suta_, 90.

“ _woodfordii_, 93.

Dialysis, results of, in experiments with venoms of _Colubridæ_ and

_Viperidæ_, 161.

Diastases, action upon venoms, 214.