Loss of sight following snake bite.

Notes of Original Lesion.t-A European male, aged 51, was admitted to hospital at 7 p.m. on February 11, 1952, within half an hour of being bitten by a viperine snake on the dorsum of the left foot (specimen identified as Echis carinatus). He was treated immediately by tourniquet and incisions of the bitten area under pentothal; 10 ml. antivenine were injected locally and 10 ml. intramuscularly. February 12, his general condition was good, but the incisions started oozing blood and continued to do so, despite styptics and pressure dressings. February 13, the systolic blood pressure fell to 85 mm. Hg, and the erythrocytes to 2.5 million, necessitating immediate blood transfusion (450 ml.) with marked benefit. February 14 and 15, slight oozing only of wounds and mucous membranes of mouth, but extensive extravasation of blood into muscles of thigh and buttocks at sites of penicillin injections and application of tourniquet. The oozing from the incisions was well controlled and there were no local or general signs of sepsis and no leucocytosis. On these two days the haemoglobin figures were 60 per cent. and 65 per cent. February 17, general condition very poor with the blood pressure 85 systolic. For the first time he complained of lower field blindness of the right eye. A second blood transfusion (500 ml.) started at 12 noon raised the systolic blood pressure to 120, and his general condition improved. February 18, no change occurred in the vision of the right eye. February 19, In the morning he complained of " blind spots " in the temporal field of the left eye. February 20, both pupils reacted to light but the left pupil was a little larger than the right. No perception of light was present in the lower right visual field; there were no obvious changes in the disks. The haemoglobin was 65 per cent. and a further blood transfusion of 500 ml. was given. February 21, the left eye was worse subjectively and the pupil a little larger than before but still reacting to light though dilating almost at once. February 22, there was no perception of light in the left eye and the pupil response was negligible. February 23, haemoglobin 75-80 per cent. and the blood pressure 120 systolic; the patient's general condition was excellent.