4. Antivenin. Polyvalent or specific antivenins prepared from venoms of snakes in the same geographic area should be administered in therapeutic quantity as recommended by the manufacturer only with full realization that the hazard of immediate allergic reaction or delayed serum sickness are factors to be evaluated in the decision to carry out this type of treatment. During hospitalization, antivenin should be given intravenously, provided that sensitivity tests indicate that the patient is not allergic to the antiserum to be used. Desensitization, if necessary, should precede the administration of antivenin by any route. The use of antivenin in such cases should be carefully evaluated. Injection in normal muscles in other extremities would be the second choice, since local injections into the deposit site do not diffuse efficiently into the entire damaged area and would increase the hazard of pressure ischemia leading to increased tissue necrosis. Epinephrine should be available for immediate use when foreign protein is being administered. 5. Corticosteroids. The use of corticosteroids should be restricted to the prevention or treatment of late manifestations of allergy following administration of antivenins. 6. Antibiotics. A broad-spectrum antibiotic should be administered promptly in appropriate dosage if the reaction to envenomation is severe. Since the nature of the injury markedly predisposes to infection, and pathogenic bacteria are found in the wound, this use of antibiotics seems justified. Laboratory sensitivity tests, if available, should control the continuing choice of antibiotics to be used. A massive wound infection with severe systemic reaction could be mistaken for severe envenomation. Repeated blood and wound cultures would be of help in making the distinction. 7. Tetanus Prophylaxis. Tetanus toxoid should be administered upon admission if it has not been given as a first aid measure. 8. Respiratory Paralysis. If respiratory paralysis develops following envenomation by one of the _Elapidae_ (this family includes the coral snake), the use of tracheostomy and intermittent positive pressure artificial respiration is indicated. 9. Renal Shutdown has been an occasional occurrence following massive envenomation. An awareness of this possible complication can do much toward the prevention and treatment of secondary effects arising after its occurrence. Routine daily tests such as B.U.N., CO₂ combining power, and serum potassium levels are indicated in severe cases. B. Local Measures During Hospitalization