VIPERA.
GENERALITIES.
►
Persons become prematurely old; the development of children is arrested,
[54]. ►
Modification of the functions of the blood becomes apparent, the fibrin
is altered, the globules are less able to perform their proper
functions, with tendency to hæmoptysis, especially epistaxis; the blood
coagulates imperfectly, [54]. ► Symptoms of chronic cachexia after the
bite, [54]. ►
Every year subsequent to the bite, at the first hot weather, he was
seized with a painful œdema of the limb, colic and efforts to vomit;
digestion became disturbed; he was tormented with somnolence, the gums
became fungoid, and his skin had an icteric tint; he was chilly, with
great physical and intellectual weariness, [54]. ► The
symptoms subsequent to bite have a periodic character, with tendency of
the cachectic symptoms to return. In a large number of cases there is
for many years a return of the troubles on a certain day every year, the
swelling, pain in the bitten limb, prostration, loss of appetite,
nausea, and jaundiced hue of the skin. One girl in Nantes had for years
at the period of the bite an eruption of livid spots on the bitten limb.
A Young man had for years, at the anniversary of the bite, general
malaise, swelling of the limb, and development of spots, [54]. ► In
many cases, after about eighteen months to two years, there is a marked
tendency to apoplexy; the death is due to cerebral congestion or hæmorrhage,
[54]. ►
Each subsequent year, at the anniversary of the bite, he suffered from
troubles of digestion and debility, and after four years died of
apoplexy, [42]. [This person had
always enjoyed excellent health, and had never shown any tendency to
cerebral troubles.] [420.] ► The chronic local effects consist of
permanent alteration of the tissues; in some cases the œdema persists
for a very long time; in others there is tendency to ulcers or blisters,
[54]. ►
Ecchymoses appeared in the endocardium and pericardium; the lungs were
hyperæmic, the mucous membrane covered with ecchymoses, the tissue
œdematous; the mucous membrane of the intestines was ecchymosed; the
blood did not coagulate, [38]. ► General chilliness; nausea; vomiting;
somnolence; great dyspnœa; black spots on the limb and even over the
abdomen; temperature depressed, as in cholera, [54]. ►
Falling to the ground in a faint, vomiting several times, lying as if
completely paralyzed and unconscious, with involuntary stools and urine,
followed by death after half an hour, without swelling or spasms, [39]. ►
Intoxication, with sleep, exhaustion, loss of vision, with difficulty of
breathing, retching and vomiting, spasms, violent pain in the umbilical
region, tension of the abdomen, pulse small and rapid, voice almost
lost, wanted to be allowed to sleep, even were it death to him, [40]. ►
Violent headache, with inclination to sigh, which the pain prevented;
restlessness even to despair; eyes glistening; face slightly yellow,
cheeks red; violent thirst, with moist tongue, which is white in the
middle, red on the edges; pulse weak and small; constantly inclined to
faint; pains in the loins; warm dry skin; constipation; copious
discharge of clear urine (from Orfila), [40].
► After ten minutes he became thirsty
and very much exhausted, which symptoms continued to increase, so that
it was with difficulty that he could reach the house. After half an hour
violent vomiting and diarrhœa set in, at first consisting of bilious
and sour liquid, afterwards only of substances smelling like broth, with
most unquenchable thirst. The pulse was scarcely perceptible, the skin
pale and covered with clammy sweat; the lips, tongue, and the affected
arm œdematous, as far as the elbow, the latter colorless and
insensible. In the evening the pulse became stronger, the sweat less.
Delirium at times. The swelling of the lip and tongue diminished, but
that of the arm extended to the shoulder. On the next day the vomiting
and diarrhœa had ceased, the delirium was better, pulse full and strong
not rapid, skin hot and dry; lips and tongue normal; glands of the
axilla swollen and sensitive; the swelling had extended up the arm and
along the spine as far as the right hip. On the third day the delirium
had ceased entirely, though the fever was still violent, the swelling
continued, and in the lower portion was of a bluish-red color. On the
fourth day the redness had extended up the back of the arm, along the
back, and on the hip, places upon which he lay in bed were bluish black,
though severe pressure caused no pain, indeed the skin over the whole
surface of the swollen parts was insensible. The fever and swelling
gradually diminished, sensitiveness returned, and on the thirteenth day
the patient was able to be about, with only the hand somewhat swollen,
and only the index finger insensible, [30].
► Violent pain immediately after the
bite, sinking down in a faint, loss of all power; at the same time
sensation of heat and shivering shooting like lightning through the body
for half an hour, when he was first able to call for help. This was
followed by vomiting of bile several times, afterwards with great
relief. Thirst, cold clammy sweats, features drawn, eyes protruding,
look staring, color dark yellow; pulse very slow, hard and full. Jaws
spasmodically closed; talking and swallowing very difficult. Swelling at
first of the bitten foot. After emetics vomiting of bile followed by
relief, and diarrhœa, warm perspiration and sleep instead of cold
perspiration; recovery after fifteen days, [40]. ► After
a bite on the tongue, the face speedily becomes red, the eyes look like
one raving, after three minutes reeling and falling forward; face as
usual; speaks of going home, stumbles against an object, so rising and
falling, or standing still, reeling and falling again; but then also
speaking distinctly; after a quarter of an hour he remained lying down,
face red, eyes dim, complaining of heaviness of the head; jerking of the
tongue, which protruded between the teeth, and which was pale and not
swollen, began to have a rattling, and died in fifty minutes after the
bite (from Dr. Lenz), [39]. ► After a bite on the right ring finger
sudden violent, pain, some blood flowed from the finger, which began to
swell, then she became quite sick, had cold shivering with violent
thirst, and frequent vomiting and several evacuations of the bowels, at
the same time she was more cold than warm to touch. After nine hours and
a half the limb was swollen to the middle of the upper arm, the whole
limb painful to touch, pale, very œdematous, only slightly pitting on
pressure; associated with paleness of the face and shivering; pulse very
slow and weak, with general exhaustion, [39].
[430.] ►
Inflammation and enlargement of the lymphatics extending from the bite, [54]. ►
Black blood flows from a wound near the bite; the cellular tissue is
green and blue, [40]. ► Swelling and induration about the wound
persisted for a long time, [8]. ► Swelling began on the next morning,
extending from the toe to the neck, involving the whole right side of
the body, not in the least the lest side, [39].
► General swelling, with cold sweat
and twitchings, followed by death, [39],
[40]. ►
The hand, arm, and even the whole right side of the trunk, began to
swell under the violent pain, so that the patient repeatedly fainted
away, [6]. ►
The swelling frequently involves the lymphatics and extends to the body,
[38]. ►
Swelling and inflammation of the margins of the bite and neighboring
parts, [39], [40]. ►
Swelling of the bloodvessels, with general weakness, [39], [40].
► General œdema, [54]. [440.] ► Enormous œdema, nausea, vomiting,
syncope, and death, from a bite in the foot, [54]. ►
General œdema, with profound coma, followed by death, [54]. ►
Painful tumefaction, followed by vomiting, [48]. ► Great
tumefaction of the bitten parts, [54].
► General œdema over the whole body
(second day); even to the eyelids (third day), [43]. ►
General œdema, followed by profound coma and death, [44]. ► The
whole extremity became tumefied and covered with livid spots; this
tumefaction extended to the thorax, and was followed by nausea,
vomiting, somnolence, difficult respiration, and death, [45]. ►
Tumefaction of the part bitten is a constant symptom, accompanied by
œdema, redness, and heat; the parts become hard, tender, and swollen to
twice or three times their normal size; the tumefaction lasts from four
to eight days, sometimes persists a long time; the pain accompanying the
inflammation consists of tension, which is rarely acute, [54]. ►
Swelling of the extremity, with livid spots in the skin, followed by
general chilliness, dyspnœa, nausea, and vomiting, and death on the
seventh day, [47]. ► Swelling of the arm and hand began after
half an hour, was followed by nausea and vomiting; after an hour and a
half the swelling had extended to the shoulder, the arm was hot; the
swelling gradually extended to the body over the chest; the upper
extremity was of a livid color, covered with black and dark-red spots of
ecchymoses; the arm was of enormous size, about that of the thigh, the
skin tense, but not painful to pressure, the livid red color
disappearing on pressure, but the color the spots of ecchymoses was not
affected thereby, the lymphatic glands of the axilla not much swollen;
at the point of the bite blisters of a large phlyctenular form with
reddish serum; several of these phlyctænulæ developed on the back of
the hand. The patient complained of cephalalgia, great vertigo, had a
rapid pulse, and pale tongue. After this the hand began to diminish in
size, but the shoulder continued very large, covered with black mottled
spots; the whole scapular region of the left side and part of the right
of a livid red color, with several spots of ecchymoses; this red color
and these spots extended over the anterior portion of the thorax; the
right breast became œdematous and hard, and presented a spot of
ecchymoses that extended into the corresponding axilla; apparently this
trouble in the right breast, where it was isolated from the rest of the
trouble, was caused by a blow; afterwards these ecchymosed spots spread
over the lumbar region. On the ninth day the sclerotic was somewhat
yellowish. On the tenth there seemed to be an aggravation, the back
became more œdematous, and the ecchymoses and infiltration spread over
the nates. On the twelfth the ecchymoses had greatly diminished, but the
œdema of the upper extremity and shoulder still continued; the hardness
was remarkable. On the fourteenth the sclerotic again became yellow; the
urine was perfectly clear and transparent. On the fifteenth the œdema
of the upper extremity still persisted, with a yellowish tint. On the
seventeenth days there was still hardness of a portion of the arm and
back, but all the ecchymoses had disappeared, though the skin over the
arm and back was still yellow; the urine was perfectly clear and
transparent; the sclerotic still somewhat yellow, [33]. [450.] ► The bitter part becomes black, hard,
swollen, and covered with spots, [39].
► After a quarter of an hour the arm
began to swell, it became tense and bluish red; together with nausea,
violent vomiting, great prostration, and at times inclination to
fainting. The bite was found to look like the scratch of a pin, and to
extend scarcely through the epidermis, nevertheless the whole hand and
arm as far as the elbow was swollen, so that a rather large shirt had to
be cut away; there was no pain, either in the wind or in the room, but
an unpleasant tense sensation; the skin dark bluish red, with black and
yellow spots, and stripes following the course of the cutaneous veins of
the arm. The usual fresh and ruddy color of the face had rapidly changed
to a very yellow and earthy color, the mood was anxious and irritable;
pulse weak, slow; there was also a constant sensation of faintness. The
yellow color of the face continued five days, and of the arm ten days, [7]. ►
Finger became swollen and painful; and sense of numbness and rigidity
gradually extended up the hand and arm (in five minutes); towards
evening the hand and arm became painfully inflamed and swollen to three
or four times their natural size. Spots of purpura hæmorrhagica
appeared the next day in various parts of the body and limbs. The
inflammation, which was of an erysipelatous character, gradually spread
from the arm to the shoulder, integuments of the neck, chest, abdomen,
and back, on the right side, as low down as the hip. The bright-red hue
of the skin began to fade on the fourth day, leaving it of a mottled
livid color, with patches of ecchymoses. The œdema of the legs was
considerably relieved by finely puncturing with a lancet. At the end of
a week I was able to leave my bed, but the hand and arm were quite
useless, and did not recover their former powers until six or eight
weeks after the accident; the right leg also remained weak for some
time, causing me to drag it in walking. After a fortnight, collections
of matter formed successively in the finger, hand, forearm, and axilla,
requiring evacuation by the lancet, [34].
► After a bite on the foot, swelling
and pain suddenly extended to the abdomen; for many years afterwards the
leg was always diseased, presented at times yellow, at other times blue
spots, and was painful. After various remedies these suddenly
disappeared and attacked the eyes; after suffering for a long time she
became completely blind for two years. Then the eyes improved, but it
extended through the whole body, and grave rise to pains internally, in
various parts of the abdomen and limbs. At last she became almost numb, [39]. ►
The bitten extremity was covered with leaves, the tumefaction
disappeared on the fourth day, and the patient seemed convalescent, but
on the seventh day he was seized with extreme suffocation, followed by
death, [48]. ►
The pain was at first exceedingly acute; the wound became livid, and the
arm was much enlarged, towards evening; the next morning the swelling
encompassed her whole breast, and even extended to the bottom of the
true ribs; the third day the swelling extended over the lower part of
the abdomen, and her body was considerably increased beyond its natural
size, [18]. ►
After being bitten in the finger and sucking it, there was swelling of
the finger and also of the mouth, he was obliged to sit down, it was
impossible to do forward; he felt as if he would die, became helpless
and weak, leaned against a tree, the hands became black and cold, the
mouth and abdomen swollen, constantly said that he should die, followed
by bloody vomiting, diarrhœa, and death, in an hour and a half, [39]. ►
The foot becomes as blue as if washed with indigo, without swelling,
after the vomiting and great weakness; the next night he had violent
fever with much delirium, and in the morning decided swelling from the
bite as far as the neck, the whole right side of the back was bluish,
greenish, and yellowish; there was no swelling at all on the left side.
Therewith the urine was dark yellow, as in jaundice. So weak that every
time he rose he fainted, [39]. ► Subsequently a gangrenous slough formed
at the place of the bite, involving the soft tissues, including the
tendons of the muscles, which after several weeks sloughed off, [55]. ►
Gangrenous spots on the foot. After the bite on the foot some drops of
blood flowed from the wound which he sucked into his mouth. This was
immediately followed by vomiting. The foot swelled and became
insensible. The vomiting was incessant, with bleeding from the nose,
oppression of the chest, and indescribable anxiety, sunken eyes;
distorted face. The foot was greatly swollen as far as the abdomen,
grayish yellow, covered with large blisters. After fourteen years the
knee still remained stiff and the leg drawn backward, [39]. [460.] ► Whole body pale, and from time agitated
by fits of shivering (after one hour and a half), [5]. ►
Paralysis yearly with pain and insensibility, [39]. ► Stiff,
rigid, cannot make the slightest movement, [39]. ►
Epilepsy one, two, and five years after the bite, [39]. ►
Violent spasms, [39]. ► General spasms, with raging pain in the
abdomen and head, [39]. ► Restlessness, [54]. ► Easy
fatigue, [54]. ► Weakness, [38],
[40]. ►
Weakness, so that he was unable to stand upon his feet, [8]. [470.] ► Weakness, so that he was no longer able
to move, [39]. ► Great weakness and sleepiness, [40]. ►
Extreme weakness, unable to move a limb, having barely strength to
speak, [24]. ►
So weak that he fainted every time he raised the head, [39]. ►
Falling down when standing, [39]. ► Extreme debility, [5], [6]. ► Great prostration, [32], [34],
[35]. ►
Prostration followed by death (fourth day), [49]. ►
General prostration of the vital forces, [54].
► General torpor (third day), [43]. [480.]
► Faintness, [3], [5], [8], etc. ►
Immovable, [39]. ► Sinking down with faintness, immediately,
[39]. ►
Sinking down with violent pains, after the bite, [39]. ►
Faintness with a feeling of warmth in the head, [39]. ►
Faintness, with loss of sight and hearing, almost imperceptible pulse, [40]. ►
Fell into a faint with alternate vomiting and diarrhœa, [39]. ►
Attacks of faintness in rapid succession, [32].
► Felt so faint that he was obliged
to lie down, [6]. ► He fainted after walking a few steps,
immediately after the bite, [15]. [490.] ►
Fainting alternately with great anxiety and restlessness, [13]. ► After
half an hour the patient could scarcely stand erect and was faint, [10]. ►
Fell to the ground in a faint and remained so for an hour, until he was
awakened by cold water, [40]. ► Collapse, followed by death, [38]. ►
Loss of acuteness of the special senses, [54].
► Sensitive to every change of
weather, [39]. ► After six years he asserted he still
experienced attacks of rather severe pain in the arm bitten, with
sensations of lassitude and malaise; these symptoms recurring every year
in the month of April, and lasting a month, [36]. ►
Violent pain in the part bitten, [21].
► Violent shooting pains through the
whole body, spreading from the point of the bite, [10]. ►
Violent pain began at the wound and extended through the whole limb, [10]. [500.]
► Violent pains after the bite, [39]. ►
The pain caused by the bite is not severe, but is followed by a burning
sensation, which spreads over the whole limb, [54]. ► The
bite was immediately followed by acute pain and by a burning sensation
of heat and tumefaction, [31]. ► Violent burning pain in the wound,
immediately, [8]. ► Pains like the sting of a bee in the
bite; after a time the wound became leaden gray, and swollen; the
swelling began to diminish after two or three days, [38]. ► The
bite was felt through the whole body like a streak of lightning, she
sank to the ground, [39]. ► The swelling was insensible, [39]. ►
When bitten he felt a stitch through the whole body, [39].
SKIN.
►
The skin of the hand is dead and comes off like a glove detached in
large plates, the subjacent tissues livid (third day), [55]. ► The
skin is of a yellowish color, [18],
[54]. [510.]
► The face and trunk had a jaundiced
hue, and the extremities exhibited diffused patches of redness (second
day), [12]. ►
The skin of the affected limb was of a yellowish livid hue, mottled, [43]. ►
Livid color of the skin, [54]. ► Livid spots on the skin, [54]. ► The
bitten limb became covered with livid violet spots like ecchymoses, [54]. ►
Livid spots appear later than the swelling, are very characteristic,
red, bluish, or blackish, varying in tint and intensity, in different
individuals an in different limbs; they usually begin within six to
twelve hours after the bite, and on disappearing leave a greenish or
yellowish spot, which persists of several days; they consist of true
ecchymoses of blood, sometimes followed by gangrenous sloughs, [54]. ►
Black petechial spots, extending over the whole body, which was cold to
touch, [32]. ►
Ecchymosed spots in the skin, which, after death, were also found in the
membrane of the brain, (Infusion of a bloody serum was found in the
ventricles of the brain.), [38]. ► Ecchymosed spots in various parts of the
body, just before death, [10]. ► Swelling covered with black and yellow
spots, [11]. [520.] ►
Very bright blue or almost black spots about the wound, [38]. ►
Reddish black spots all over, as large as peas, over the whole abdomen,
and even on the face, [40]. ► The parts about the wound became very
much swollen and very red, an blackish-blue spots appeared on both sides
of the thigh and leg, which after twenty-four hours turned yellow, and
disappeared after a few days, [8].
► The skin of the arm was of a
deep-red color (after ten hours), [1].
► Hands violet-colored, covered with
phlyctenules (second day), [55]. ► A disagreeable herpetic eruption, with
extremely distressing itching about the wound, persisted for a long
time, [8]. ►
Roseola-like eruption on the inner side of the arm and drown the side of
the body, [39]. ► About the bite, bluish-black spots
developed and discharged disorganized blood, [15]. ► Large
blisters developed about the bite, which, after an hour, burst an left
an ulceration; on the sixth day there was such great destruction of
flesh that the muscles were laid bare; the wound was a line and a half
in depth, an apparently was not inflamed; the muscles had a dark-red
color, were quite dry, and looked like smoked meat, insensible to touch;
the sore was offensive, [20]. ► Collections of pus sometimes but rarely
appear at the point of the bite, [54].
[530.] ►
Immediately afterwards the arm became swollen, red, livid, almost
purple; and with these local symptoms were extreme anxiety, headache,
vomiting, and shiverings. In the course of a few hours a large bulla,
with a dull red base, had developed itself over the wound. Afterwards,
bullæ of the same description made their appearance all over the body,
even on the face, the intermediate space being red and swollen. When
ruptured, a very large quantity of turbid serum escaped. This eruption
continued from 28th May, 1824, to November, 1825. On the 28th May, 1826,
the same phenomena reappeared; the eruption beginning at the seat of the
bite, and continuing until November of the same year. And every year,
from 1826 to 1863, the history of the patient has been the same, the
symptoms beginning in the month of may, with lassitude, anxiety, nausea,
headache, etc.; then, after six or eight days of these introductory
troubles, the cicatrix becoming, red and painful; then tingling and
swelling of the arm; then the development of the bullæ exactly as in
1824; the only difference being that the eruption disappears in five or
six weeks instead of continuing for five or six months as at first. In
the interval the patient is apparently quite swell, and a white faint
cicatrix is the only visible remains of her troubles, [37]. ► Skin
generally dry, [1]. ► Skin dry and burning, [19].
SLEEP.
►
Disposed to yawn, [11]. ► Heavy and drowsy, [24]. ►
Drowsiness, [55]. ► Sleepy without being able to sleep, [40]. ►
Great inclination to sleep, but the patient was unable to sleep, and was
constantly obliged to change the position, [19]. ►
Tendency to somnolence, [54]. ► Slept for several hours after the
vomiting, felt well on waking, [40].
[540.] ►
Sleep prevented by pains, [40]. ► Very restless during the night (first
night), [18]. ► Sleeplessness for three or four nights, [34]. ►
No inclination to sleep till noon of the second day, [39]. ► Loss
of sleep, [40].
FEVER.
►
Chilliness. ► Chilliness, [52]. ►
Great chilliness, [54]. ► Constant chilliness, with cold sweat, [43]. ►
Chilliness, with pale face and thirst, [39].
► Chilliness, with pain in the chest,
[39]. [550.]
► Chilliness, followed by fever
(second day), [8]. ► Shivering (after two hours), [3]. ►
Shivering, with flushes of heat, [40].
► Cold shivering, with nausea,
vomiting, and great thirst, [39]. ► Shivering, with febrile symptoms; small,
rapid, contracted, at times irregular, intermittent pulse, [39], [40].
► Coldness of the body, [27], [40],
[55]. ►
Surface cold and clammy (in two hours), [31].
► Coldness and rigidity, with clammy
sweat, [40]. ►
Temperature diminished; resists cold badly, [54]. ►
Diminished warmth of the body, immediately, [40]. [560.] ► Rather cold than warm to touch, with
desire for stool, [39]. ► Head and upper extremities ice cold, [2]. ►
Finger cold (after ten hours), [1].
► Heat. ►
Violent fever, [10]; towards
evening (first day), [15]. ► Violent fever, with delirium (second
night), [39]. ► The fever persisted for several days,
with an irregular type, and necessitated the employment of
antiperiodics, [43]. ► The reactionary fever after the poisoning
assumed the type of an intermittent, [52].
► Heat of the whole body, [8], [53].
► Violent heat, followed by
shivering, [40]. ► Burning heat rising from the heel to the
tongue, [40]. [570.] ►
Sensation of burning heat through the whole body, with swelling of the
hand that was not bitten, so that he could not close it, [40]. ►
Burning heat running up the arm, [40].
► Heat, thirst, and restlessness, on
the next morning with moderate pains, [39].
► Skin warm and dry, with brain
symptoms, [40]. ► Heat rises from the bitten foot into the
tongue, [40]. ► Burning heat, extending from the bitten
spot on the arm up to the chest, [40].
► When bitten, heat shoots through
the whole body like lightning, [40].
► For some minutes after a bite in
the heel, a kind of numbness in the foot, followed by a sensation of
heat, extending from the point on the foot up through the leg to the
abdomen, chest, and at last to the throat and tongue; this violent heat
affected him severely, and caused burning thirst; soon followed by
restlessness, febrile shivering, trembling of the whole body, and
complete loss of strength, [40]. ► Skin hot (second day), [55]. ► Sweat.
► Profuse perspiration, [40], [43].
[580.] ►
Perspiration after vomiting, [40].
► After chamomile tea copious
perspiration, except over the bitten limb from the abdomen to the toes, [39]. ►
Sweat with the coldness, [40]. ► Profuse cold perspiration with difficult
respiration, [40]. ► Cold sweat, with the most violent
attacks, [39], [40]. ► Cold
perspiration, with sticking at the heart, and faintness, [40]. ► Cold
sweat, [8], [10]. ► Whole
body covered with clammy sweat, [13],
[40], [50]. ►
Profuse cold clammy perspiration, [34].
► Body bedewed with a cold clammy
sweat (second day), [12]. [590.] ►
Perspiration relieves, [39], [40]. ►
No perspiration with the febrile warmth, [40].
CONDITIONS.
►
Aggravation. ► (Change of weather), Tearing and sticking pain
in bite; tearing and sticking pain in leg; the symptoms. ► (Pressure),
Pain at umbilicus. ► (Touch), Pain in extremity.
SUPPLEMENT: VIPERA.
Authorities.
56,
Mr. Tipple, Lancet, vol. xi, 1827, p. 732, a boy was bitten on the
tongue; 57, G. W. Jones, ibid.,
1828-9 (2), p. 78, a man was bitten on the leg; 58,
ibid., p. 507, C. S., æt. twenty-six years, was bitten in the right
hand; 59, G. W. James, ibid., 1831-2
(1), p. 294, P. B., æt. thirty years, was bitten on the right
index-finger; 60, Mr. Canton, ibid.,
1857 (2), p. 138, G. S., æt. sixteen years, was bitten on the right
thumb; 61, G. R. Halford, M.D.,
ibid., p. 181, a young man was bitten on the right index-finger; 62, Kadierske, All. Med. Cent. Zeit., 1860,
p. 90, a man was bitten on the foot; 63,
W. H. Wirt, M.D., Med. and Surg. Rep., vol. xxv, 1871, p. 112, W. A.,
æt. thirteen years, was bitten on the foot beneath the external
malleolus.►
Head hanging down, tongue protruding
from mouth; face and eyelids much swollen; there was general œdema of
the submucous tissue of the mouth and pharynx, with ptyalism, vomiting,
and pain at the pit of the stomach; no pain nor swelling of the right
hand or arm, but great pain in the right axilla. Within a few hours the
arm and forearm became enormously swollen, and the axillary glands
inflamed and painful. By the next morning the back and inner part of the
arm, and the corresponding side of the chest were much ecchymosed, as
though they had been beaten with a stick. The finger was the last to
become painful and swell, the symptoms travelling downward, [61]. ►
The tongue instantly began to swell, and in twenty minutes was greatly
swollen, and the vessels on the under surface were gorged with blood;
his countenance was pallid, and forehead bedewed with cold perspiration;
pulse quick and irregular; a copious discharge of saliva from the mouth,
tinged with blood; tongue felt benumbed; in two hours and a half the
swelling of the tongue had increased so much that it measured an inch
and a half in thickness, and was altered in shape, so as to appear
almost square; the under surface was nearly black; he was unable to
articulate, and had great difficulty in swallowing, the parts beneath
the jaw, and the throat on the right side were much swollen; one hour
later the swelling extended to the right side of the chest, as low as
the nipple, and it had a crackling or emphysematous feel, as if air were
extravasated in the cellular membrane, [56].
► In two hours the arm was
considerably swollen, and although so short a time had elapsed, his
tongue was very much furred; pulse 140, and irregular; he felt much
oppression at the præcordia, accompanied with hurried respiration, and
great depression of nervous energy. The tumefaction was of an œdematous
character; red lines extended in the lines of the absorbent glands,
which were tender and slightly enlarged, [59].
► The part immediately put on the
appearance of a nettle-sting, and was followed by a sensation of
creeping up the arm, and at the same time the veins became much
distended, feeling as if they were about to burst; this was attended
with severe pain and, subsequently, swelling of the whole extremity,
which rapidly increased. About five minutes after the infliction of the
wound, he felt a rumbling of the bowels, succeeded by extreme pain and
excessive vomiting, which was almost incessant. He became exceedingly
weak and faint, and his pulse is said to have sunk so low as 38, and was
scarcely perceptible; but from this partial state of asphyxia he soon
recovered, [58]. ► The thumb immediately began to swell, as
did also his hand and arm, and it gradually increased in size,
accompanied with great pain. This was shortly followed by sickness and
depression. In three hours his thumb, hand, and arm, as far as the
elbow, were found considerably swollen. This swelling was of rather a
peculiar character, being shiny, tense, and elastic, not pitting on
pressure. There was no wound observable on the thumb, but a peculiar
redness of the arm, which was very diffused; the deep red line of the
absorbents, however, could be distinctly traced through the whole length
of the arm to the axilla, and from thence separated in three distinct
lines, which were spread over the anterior surface of the thorax; from
the elbow to the axilla they appeared inflamed, in patches. The fingers
were very much swollen, and unable to be moved. He complained of a full,
or bursting sensation in his hand and arm, also of great smarting in his
axilla, and on pressure being applied to the glands in that region, and
along the line of the absorbents, he experienced considerable pain. The
pulse was rather weak and sluggish, but all the other constitutional
symptoms had subsided, [60]. ► On the next day the foot, leg, and thigh
were swollen, the skin red, the veins and superficial lymphatics
swollen, bluish-red above the popliteal space; the rest of the body was
also œdematous, especially the upper lids and tongue, which the patient
could scarcely move. Pulse small and rapid; respiration difficult; the
patient complained of great prostration, anxiety, pressure in the præcordial
region, and inclination to vomit. The wound had assumed an intensely
bluish-red color, and there was excessive anxiety about the præcordial
region. The patient had begun to be comatose. An infusion of Arnica was
applied to the limb. The patient was given Arnica, Camphor, and Sweet
spirits of nitre internally. After three days, the symptoms having
generally disappeared, the patient still complained of pain on the tip
and under surface of the tongue, and as though burnt, and as if there
were blisters on it. In fact, the epithelium was denuded, especially on
the tip of the tongue, and blisters had begun to form. For several days
the lymphatic vessels and glands, especially in the popliteal region,
were hard and painful on moving the limb, for which Iodine was given
internally, [62]. ► In two hours the swelling began to extend
rapidly upwards to some distance above the knee-joint, the patient
suffering great pain in the limb, accompanied by nausea, vomiting,
headache, and giddiness. [57]. ► The foot and entire limb enormously
swollen; pulse small, frequent, and irregular; occasional vomitings and
faintings; cold sweats; wild and woe-begone expression on his
countenance, [63].® 2000
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