Crotalus Horridus

C. horridus, Linn. Order, Crotalidse of the Ophidian family of serpents. Common names, Rattlesnake, Boiquira.

Preparation, Trituration of the virus with sugar of milk.

Authorities. 1, effects of bite, taken from Hering, Wirkungen des Schlangengiftes, 1837 ; 2, C. Hering, effects of 1st and 2d triturations from ibid. ; 3, Summer, from ibid. ; 4, Linen, ibid. ; 5, Schiller, ibid • 6, Wallace, ibid. ; 7, Gross, ibid. ; 8, Dr. Wilson, Am. Horn. Obs' 1872 p. 73, effects of bite ; 9, Dr. Horner, Am. J. of Med. Sci., 8, p. 397' effects of bite; 10, Dr. Philip, Am. J. M. S, vol. 8, effects of bite; 11, Chicago Med. J., 1866 (N. Y. Med. J.), effects of bite ; 12, Dr. Stokes, proving on an unmarried lady aged thirty-five, with the 3d dil., three doses first &day repeated on the third day, also a dose of the 4th on the tenth dav ■ 13 Dr. Rivers, Southern Med. Record (from Lond. Med. Rec Dec 1874)' effects of bite; 14, Dr. Pittard, N. Y. Med. Rec, Jan. 1875, chronic, re-

o e l then ? * u * mt° pins' " bass> venom> and al l" and sal-

lower them, sometimes at the rate of four a day.

reSnZlZ0^*1?1' Excessive excitability; for example, while

SSgj£ tst le<^ to naturalists in Berlin he was

Sars f eC8ta8y' •-Del»ri«m,1 ".-^DdHum at rc^.-Delirium

Delirium ^.t""f (seventeenth day), also the whole night,'.-

^SiS^S^0^FOT,,^ da-ys' a certain dread of select-

Dfnre io ' ^SP""7 18 au agreeable occupation^-Depression,1.-

thr n r^lTnH-i? ldlfffrenCf to everything,'.-[10.] Melancholy; milan-

exce? i vo 1 1ent\W,th SUdden ™*™»> headache, heartache, and

Tnrl ft dmrrhc^' — Anxiety, with restless heat/.-Apprehensiveness,1. A^^i^mdA7 weakness--Most heavenly sensation ; melanfere ce • JZ 7 1 HF* 1?°*° anticipate^^ ,-f-Remarkable indifthe S 1 , last?ff, f0Urteen *vears (chronic result of the bite), .—Intellectual. Remarkable heaviness and dulness, the first day, on account of which he is unable to express himself properly, and hence is unable to make a note of several symptoms,5.— Makes mistakes in writing cannot spell correctly,*.— Confused speech,1.— His answers are disconnected, with cold skin,\-[20.] Disconnected answers, with coldness Ben * 1 mp Pulse> -— -Remarkable weakness of mem ory*.— Loss of i H«ad'—C°nfuswn and Vertigo. Dull confusion of the whole head, —\ vertigo,".— Vertigo, with nausea,3.— Vertigo, with sopor,1.— Vertigo; headache in the forehead above the eves, in the temples, worse in the right ; with nausea, vomiting of bile ; is obliged to lie down ; together with constipation; better from walking in the open air,2.— Dizziness before the eyes even to falling down, with dilated pupils, earthy paleness of the face and blue rings around the eyes (first day),5.— General Head. Rush ot blood to the head, with convulsions, followed by death,1.— [30.] Feelinoof lightness in the head, with pressure in the temples, especially in the Jeff which makes him bite the teeth together,5.— Dull sensation in the head,5.— Pains through the whole head (immediately),1.— Headache, gradually increasing and decreasing,5.— Headache, extending into the eyes,*.— Headache, extending into the left teeth,5.— Headache, shortly before going to sleep; especially very severe on undressing, but disappearing in the morning after a good night's sleep,5.— Headache, with melancholy,1.— Forehead, Pains in the forehead,2.— Pains in the whole forehead, which became steadily worse, and at last intolerable; afterwards they were somewhat relieved, although they continued till towards evening (after half an hour),5. [40.] Tension in the muscles of the forehead and nape of the neck,5.— Pressive frontal headache, followed by sensation of nausea (after three hours),3. — Temples. Muscular twitches in the temples,4. — Pains in the temples,'2. Several times, a drawing-pinching pain in the right temple,5. — Pressure in the temples, especially in the left, which makes him bite his teeth together, with a feeling of lightness of the head,5. — Stitches in the left temple and whole left side of the head, lasting five minutes (after three-quarters of an hour),3. — Momentary stitches and pains in the left temple,5. — Dull stitches in both temples,5. — Severe painless pulsation in the temples/. — Vertex. [50.] Headache in the vertex; pressive, comes on in the afternoon and lasts till night, for three days (after eighteenth day). On the fourth day it changed to forenoon, with heat and flushing of the face,1'2. — Shies, Aching difficult to describe in the right side of the head, as though he would be seized with a violent headache, without its amounting thereto (after two hours),5. — Shaking and wavering in the left upper part of the head, especially on ascending steps or walking rapidly,5. — Alternations of various kinds of pains in the left side of the head, as for example, drawings, pressure, pinching, tension, and bruised pain, which extends into the teeth and orbits,5. — Occiput. Dull headache in the occiput/. — Pain as from a blow in the occiput, especially occurring on lying down again after rising, which he had experienced several years previously, now reappears,7. — External Mead. Violent itching of the scalp*. — Violent itching of the scalp, with a large quantity of dandruff,4.

Eyes p. 590

Objective. Eyes muddy and heavy, next morning

Red watery eyes (after one hour)

* Yellow color of the eyes ; frequently of the whole body

Blue rings about the eyes, with paleface

Blood exudes from the eye

Blood flows from the eyes, ears, and nose, at times

Dryness of the eye

The eyes feel dry

Sudden violent drawing pain from the vertex into the right eye, in the evening

Eroiv and Ovbit. Pains above the eyes

* Pressure and oppression above the eyes?.

Pressure above the right eye, nausea and vertigo, repeated for several days, at different times

Pressure above the left eye, with vertigo and sensation of nausea on moving ; the pain is especially felt over the eyes, particularly the right, not continuous, paroxysmal, jerklike

Pressure deep in the orbits, behind the ears, and in the nasal bones, so that, as with the pressure in the temples, he is obliged to bite the teeth together

Fine prickling and stinging above the left eye, as with fine needles

Lids. Dark redness of the left upper lid, with dryness and burning within the eyes and redness of the canthi

Eyes almost closed (after twenty-six hours)

Itching in the canthi

Lachrymal Apparatus. Frequent lachrymation and momentary disappearance of vision, especially in damp weather

Ball. Pain in the eyeball on moving the eye, like a pressure, and as if the eye were too dry internally

Vision. Dimness of vision

Momentary disappearance of vision, with profuse lachrymation, especially in damp weather

Vanishing of vision, while reading

Ears p. 590

Objective. Bleeding from the ears

External. Bruised feeling m the lobules of the ear3,5.

Internal. Heat in the ears

Heat in the right ear, with bruised sensation in the lobules of the ears,5. Stopped sensation in the right ear, and drawing within both ears, painful in the right, with heat and sensation as though earwax would run down into the mouth

Drawing in both ears, with stoppage of them

Drawing- in the right ear, with painfulness of the whole left side of the head and paralyzed feeling of the left jaw

Painful drawing in the right 'ear with sensation of heat in it

Hot, tickling sensation, as though earwax were in both ears

Nose p. 590

Violent sneezing, once at a time; with a stitch in the right side of the chest, near the shoulder-joint, followed by pains in the bones of the chest

* Bleeding from the nose and all the orifices of the body,. J J

Face p. 590

Objective. Paleness of the face, as in fain ness/.

Discolored face

Earthy face, with vertigo

* Yellow color of the face 1

Sickly yellow color of the face (chronic result)

Face leaden-colored immedl cdehj

Leaden color of the face, lasting during life

Swelling of the tare, of the whole head, and body

Face somewhat bloated, next morning

Subjective. Pressive-drawing pains in the bones of the lace nest in the right maxilla and zygoma, then in the left; then in both at the same time

Lips. Trembling lips, with weakness and faintness

-Lips and throat dry, without thirst

Jaw. Cramp in the jaws

Spasmodic contraction of the jaws, with swelling of the hand and arm, and other dangerous symptoms

Bruised pain in the whole right lower jaw and in the teeth

Mouth p. 591

Teeth. The teeth are loose in their sockets

Inclination to press the tongue against the lower incisors, with crumbling of them on the inside

Pain in the teeth, coming from the larynx

Sudden, very transient pain shooting into the right lower back teeth ; it shoots up and down in them several times, and then disappears (first day)

Violent shooting downward, almost like a blow, in an upper back tooth ; immediately disappearing (second day)

Teeth and jaws seem bruised

Gums, (rum white (fourth aud subsequent days)

* Bleeding of the gums

Tongue, Tongue red and sore (fourth and subsequent days)',12.

Brown tongue

Tongue brown and swollen, so that it closes the throat

* S welling of the tongue

* Swelling of the tongue till there is no more room in the mouth, with inflammation of it

* Tongue swollen to nearly twice the normal size

* Tongue tumid (after twenty-six hours)

General Mouth. Tickling of the palate and fauces

Saliva. Accumulation of saliva, obliging him to swallow

Taste. Sourish taste in the mouth, after the usual breakfast

Speech. Articulation indistinct (after twenty-six hours)

Loss of speech and of the senses

Speechless, without moving, trembling pulse

Unable to speak ; it seems as though the tongue and whole throat were tightly constricted

Throat p. 591

Dryness of the throat, with great thirst (after one hour)

* Throat dry, with thirst (fourth and subsequent days)

Sensation in the throat as though earwax were running down, with heat in the ear

Sudden attack of sore throat, and bronchial catarrh, in the evening, which went away the next morning, and returned at night

Painful rawness in the throat

Tickling in the pit of the throat, as if in the trachea, provoking cough without expectoration; after some days simple tickling without cough/.

Pharunx. Tickling in the pharynx

Swallowing. Frequent swallowing of saliva, with sensation as though the neck were compressed, without dyspnoea

Deglutition impeded to some extent (after twenty-six hours)

External Throat. Larynx is painful to touch (second day)

Stomach p. 591

Appetite. Appetite bad (first and second days)

Thirst. Thirst during the fever

Great thirst was an attendant symptom from the first, so much so that previous to my arrival she had allayed it with an immoderate quantity of water

* Unquenchable burning thirst

lira eta tiou. Eructations tasting of the food

Eructations of a sour, acrid fluid, after eating white bread (fourth day)

Rancid eructations the whole afternoon (fourth day)

Scraping rancid sensation, extending down the oesophagus to the stomach, with pressure in the pit of the stomach

Heartburn. Heartburn alter the usual light supper

Heartburn at 4 p.m., lasting the whole evening

Heartburn the whole clay, especially in the afternoon, with a feeling as if the whole oesophagus up to the mouth were full of rancid food, with eructations tasting of the food

Nausea and Vomiting, Nausea

Nausea, relieved by vomiting

Nausea, soon after taking it, coming on by paroxysms, lasting till noon, especially while walking or standing, relieved by sitting

Nausea and vertigo with the headache

Nausea with headache

Nausea, with sensation as though he must vomit, which, however, he is unable to do in spite of efforts (first day,)5.

Nausea amounting to vomiting (immediately after a bite)

Nausea and vomiting

Nausea and vomiting very decided, and always coming on very soon after the bite

Nausea, with a sensation as though something rancid rose in the oesophagus, and remained in the upper part of the chest

Nausea with coldness of the body

Nausea with cold skin

Extreme nausea and vomiting on the least exertion (after twenty-six hours)

Vomiting preceded the faintness

Vomiting follows violent pains in the forehead

Vomiting with vertigo

Vomiting with headache

Vomiting, with thirst

Sudden vomiting

Constant vomiting

Vomiting severely

Vomiting of food

* Violent vomiting of food for several days after a meal

* Green vomiting

Vomiting of a green fluid, with great pain in the chest

Vomiting of very bitter bile

Vomiting of blood

Stomach could retain only jellies, brandy, and coffee (fifth day)

* Stomach so irritable that it is unable to retain anything

Stomach Intolerance of the clothing about the epigastric region and beneath the hypochondria, not noticed previously or subsequently with the same clothing

- * Painfulness in the pit of the stomach

Pains in the stomach

Pains in the stomach after breakfast and dinner (fifteenth day)

Burning pain in the epigastrium for half an hour, when if ceased after a stool (tenth day)

Fulness and pressure in the stomach were relieved by the medicine (first day)

Pressure in the stomach, with discomfort in the epigastric and precordial regions, as though he had eaten too much, similar to the sensation experienced before fainting (after a few minutes)

Weight on stomach and chest (third and subsequent days)

Breakfast lies heavy all day (third day)

Sticking in the pit of the stomach

Stomach sore and tender on rising in the morning (fourth and subsequent days) ; worse after food (eleventh day)

Soreness returned in the epigastrium, extending upwards under the sternum (fifteenth day)

Throbbing at the pit of the stomach, with rancid sensation in the stomach

Abdomen p. 592

Hypochondria. Pain in the left side of the abdomen, like cuttings through the spleen after violent running, aggravated by deep inspiration (first day) ; the same pain remains on the second day after a larger dose, but is not so severe

Umbilical. Pains internally in the umbilical region, like a violent burning (first day)

Pressive achin«- in the middle of the abdomen, beneath the umbilicus, as though it were&too full

General Abdomen. Swelling of the whole abdomen

- Inflammation of the viscera of the abdomen

Flatulency and eructations (third and subsequent days)

Violent pain in the course of the colon at 112 a.m.; (next day)

Burning pains in the abdomen, lasting several days, with great sensitiveness, especially to touch

Violent burning pain in the abdomen

Tension in the abdomen, painful to touch, with burning pain

Hypogastrium and Iliac Rey ion . In the 'night she was awakened by violent burning pain in the hypogaster, going through to the sacrum (tenth day)

The inguinal glands on that side were much enlarged (after twenty-six hours)

Rectum and Anus p. 592

Bleeding from the anus and other openings of the body,1. J

Stool p. 592

DiarrJiwa. Diarrhoea, with nausea, anxiety, and thirst,1. Attack of diarrhoea ; after which the bowels were costive and the evacuations hard during a week

Frequent diarrhoea-like stool with colic, extending downward from the umbilicus

Diarrhoea-like evacuation in the afternoon

Involuntary evacuation of the bowels, of a dark bilious color, next morning

Pasty stool

* Has had several bloody papa^ed m 6oM,e&

Constipation. Bowels were rather const-

Urinary Organs p. 593

Urethra Hemorrhage from the urethra

JltctuntiO)t. Urine somewhat increased in quantity, and very lightcolored reddish-yellow (second to fifth day)

Urine scanty and red (eleventh day)

Urine Urine looks like that in jaundice

No blood m the urine; (blood in the urine is common in these cases)

Sexual Organs p. 593

Male. Sharp cuttings in the glans penis twice (without any other symptoms in this part)/.

Unusual sexual excitement during the day, with complete relaxation of the genitals; apparent impotence

Female. Catamenia a week too soon (twenty-five days after last dose) ; free, preceded by weight in the head and ears, accompanied by pains in the abdomen and back and cold feet. The period lasts some hours longer than is usual, and goes off after two clays with intense frontal headache, which lasts from 10 to 1 oclock in the night

Respiratory Organs p. 593

Larynx. Bruised pain, extending from the larynx to chin, and at times into the lower teeth ; it appears by paroxysms ; its seat is in the larynx, where it originates every time, and is sharper than in the chin, up to which it shoots (second day)

Voice. Hoarseness, with weak, rough voice

Cough and Expectoration. Cough ; a stitch in the left side, with bloody expectoration from the lungs

* Moderate cough, with expectoration of bloody mucus

* Spitting of blood

Respiration. Respiration 14; labored

Difficult respiration

Dyspnoea, with symptoms of inflammation of the lungs and intestines

Dyspnoea, with anxiety, thirst, nausea, diarrhoea

Chest p. 593

Inflammation of the lungs

Severe pains in the chest, with vomiting of a green fluid

The lungs seem passive ; respiration in the evening in bed is difficult ; the chest feels tight

Oppression of the chest while sitting, almost amounting to faintness (second day)

During several days there was some soreness in the chest and cough in the morning

A severe sore pain and a sticking, as if in the bones of the chest, in the middle of the chest, somewhat to the right side; worse on touch, but not on deep inspiration (first day)

Flout. Constant dull stitch in the forepart of the chest, extending into the bones of the left shoulder (after a quarter of an hour), returning next day

Sides. Pain in the right side below the arm ; afterwards also in the left

Pain beneath the left arm, extending into the left side of the chest, with very great pain on deep inspiration

Pressure in the right side of the chest; on the previous day pain in the left side

Stitches in the right side of the chest, quite near the sternum

Stitches in the right side of the chest, on sneezing

Mann<v. The milk of the mother became deadly poison to her five months child

Sudden pain above the left nipple, as from a blow, lasting two minutes, repeated after a few minutes (first day),3-

Heart and Pulse p. 593

Precordium. Pain in the heart

Heart's Action. Palpitation during the fever

Heart-beat feeble (55 per minute)

Pulse. Pulse rapid and full, at first

Pulse at first full, hard, and rapid

Pulse weak, rapid, with fever and exhaustion

Pulse at first hard, rapid, then weak and slow

Pulse 100, with

Neck and Back p. 593

38 cold skin

Pulse weak, rapid, 102, 80, intermitting

Pulse small, 130, in the evening

Pulse low, and about 60 strokes in a minute (after twentysix hours)

Pulse strong and full, after the formation of an abscess

Pulse at first hard, afterwards weak

Pulse tremulous

Pulse scarcely noticed, with loss of motion and speech

His pulse was almost imperceptible and threadlike, the next morning

Pulse scarcely perceptible, with faintness

Pulse not perceptible at the wrist

Pulse imperceptible

Neck and Back p. 594

Neck. Tensive pains, extending from the shoulder to the neck, worse on moving the arm

Drawing-tensive pain, extending from the right shoulder up along the neck, as if some one were pulling on a tendon extending from the shoulder to the neck, and drawn tense under the skin; moving the arm, especially bending it backward, and also pressure upon the affected part aggravated the pain

Drawing on the left side of the neck, posteriorly, extending to the shoulders

Back. Extravasation of blood in the loins

Visible twitching of the muscles of the lumbar region

Extremities in General p. 594

Objective. Whole extremity swollen to nearly double its size, and very painful

Convulsive movements of the limbs

Subjective. Heaviness of the arms and legs, as if the bones were made of heavy wood

Painful paralytic sensation in the bones of the fingers, arms, and legs, in the evening while sitting

A numb pain, as after a cramp, frequently in the toes and anterior portion of the fingers (second day)

Tearing in the limbs; yearly, or at times

Superior Extremities p. 594

Objective. The affected arm became inflamed, swollen, and gangrenous; diarrhoea, with delirium, and death on the eighteenth day

Next morning, the arm, from the shoulder and front of the thorax to the fingers, was swollen to twice its size

Swelling and heaviness of the arm that was bitten

The arm became again swollen and inflamed on the tenth day ; on the eleventh he was unable to rise, on account of heaviness of the arms and pains ; on the twelfth, it was worse ; on the thirteenth, diarrhoea, chills, with the formation of a large abscess on the outer side of the elbow, from which was discharged a reddish-brown matter, with membranous portions of the cellular tissue ; on the fourteenth, less redness and swelling ; on the fifteenth, less suppuration, diarrhoea ; on the night of the sixteenth, chill, followed by rapid extension of the ulceration ; on the seventeenth, the skin near the shoulder became gangrenous; on the nineteenth, death

Subjective. The arms feel numb in the morning

The arm was very painful when moved the next morning

Drawing in the bones of the right arm, extending into the thumb and little finger, together with pain in the left foot

Shoulder. In the forepart of the shoulder-joint above the axilla, several small soft lumps under the skin, with many persistent stitches, as from sharp needles thrust into the flesh ; worse on bending the arm backward (second day)

Glands in left axilla swollen and tender

Bruised pain in the bones of the shoulder, extending backward, especially on bending the arm backward, by paroxysms (second day)

Arm. Violent pain in the right upper arm just above the elbow

Bruised pain in both upper arms, a cramplike sensation 5. Elbow. Pain in the right elbow, together with a throbbing bruised pain in the ribs beneath the right arm ; worse when touched, and on moving the arm up and down

Forearm. Swelling of left forearm, extending up the arm, of right arm only to the elbow ; severe pain in left, moderate in right

The bite was followed by severe pain, and great swelling of the forearm and arm nearly to the shoulder, accompanied by discoloration of the integument

Sand. Both hands and forearms swollen, and very pain-

' 1 4* ? J , old swelling of the hand and arm, with painfulness to pres- SS ■~lrembhn9 oj the hands, during rest

Marked contraction of some of the flexors of the hand

Paralytic weakness in the hands and fingers

Violent pain in the palm of the left hand, as after the sting of a bee

but more spasmodic ; much worse on moving the middle finger, in the last joint of which the pain is first felt

Fingers. Oozing of blood from under the nails

Pam from the bite pierces to the extreme tips of the fingers

Pain in the last joint of the middle finger, on moving it

Violent pain in the last phalanges of the right little finger and of the left middle finger, as when in winter one suddenly brings a very cold hand very near the fire ; frequently the same pain attacks the left ring finger

At times, paralytic pain in the bones of the fingers, chiefly in the right index finger/.

Violent dull drawing pains in the bones of the left thumb

Bruised pain through the first (metacarpal) joints of the fingers of the right hand

Bruised pain in the two last phalanges of the left little finger, with pulsating in the tip of the finger

A pain shooting into the left ring finger six times, with rapid pulsation, lasting only a few seconds each time (fourth day)

Inferior Extremities p. 595

Objective. The bitten leg became of the color of the snake ; the flesh decayed, and fell off in pieces

Gait tottering

Subjective. Feeling as though the whole right leg were only half alive; on taking hold of the muscles, which he is involuntarily inclined to do, shivering through the upper part of the body, with shaking of the head, and tension of the forehead and muscles of the neck

Constant dull, aching weariness in the legs

Burning pains, with swelling of the leg that was bitten, very violent, with heat like fire

Tensive-drawing bone-pain from the left hip to the foot, with a bubbling sensation in the calf

Hip. A sharp stitch across the right hip-bone, extending backward, worse on motion

Thigh, A very weary and cramplike pain in the thighs, extending up to the abdomen and backward, as after excessive exertion in skating ; it seems as though the flesh would be drawn up, which makes the pain worse

Sudden attack of pain and throbbing in the head of the femur; the throbbing is perceptible to the hand; the pain suddenly disappears after five minutes (first day)

Bruised pain in both thighs, as if he had skated too much the previous day, worse while walking, or when touched (second day), continuing the fifth day

Knee. Some sudden pains in the right knee, like gout, while walking, which returned, and were continuous on sitting still (second day)

Outline drawings through the right knee, and down the lower leg, aggravated by standing on the right foot (after one hour)

Some dull, drawing pains, like gout, in the patella and right tibia, on walking, so that he could scarcely continue walking for a few moments (after four hours), followed by violent pain in the hand and jaw

Rheumatic drawing in the hollow of the right knee, between the tendons

Leg, Lower portion of the leg and foot so much swollen as to rupture the skin, from the toe to the ankle, and quite black in color

The legs go to sleep, and tingle when sitting

The legs fall asleep easily, after riding one over the other, for a short time

Pain in the right tibia

Disposition to cramp in the legs, next morning

Cramp in the calf of one leg

Drawing in the left leg, extending from the hip to the foot, once suddenly while walking in the evening

Feeling in the right leg, during and after walking in the street, asaf a tendon were drawn from the sole of the foot through the bone of the leg, and the foot was thereby pulled up

Dull drawing pain, as if through the marrow of the bone, extending from the left knee to the sole of the foot

A sore pain in the left calf, worse when touched (first day)

Bubbling in the calves, with pains in the bones

Alllde. Bruised pain in both malleoli, very painful, when walking

Bruised pain in the tendon behind the left malleolus, aggravated by moving the foot, and on touch (first day)

Foot. Swelling of the feet (chronic effect of the bite)

Swelling of the feet every evening, lasting the whole year

After the bite, the foot remained swollen, with ugly ulcers, for fourteen years ; yellow, sickly color of the face; remarkable indifference to everything; he seems only half alive

Heat and intolerable gnawing pain in the whole of the left anterior foot, together with drawing in the bones of the right arm, extending into the thumb and little finger (after one hour and a half)

Burning and dull sticking in the sole of the right foot, with a sensation as if the foot were as heavy as lead

Pain in the sole of the foot, in front of the heel, as from stepping on something sharp with the bare foot (fourth day)

Sore pain in the sole of the foot

Cramplike drawing pain in both heels, extending to the malleoli, chiefly felt within the bones

Toes. In a short time the bitten toe was much swollen and very painful,8.- T340.] The toes of both feet feel wearied, as if by a long walk

Cramplike sensation beneath the left little toe, feeling as if some one turned it around (first day)

Generalities p. 596

Objective. *Swelling of the whole body

Swelling, especially in the face

Swelling and maculae recurred yearly

The child became swollen, and died on the next year, when the spots returned

Swelling, with angry ulcers; lasting fourteen years

* Her body was considerably swollen (after twenty-six hours)

(Edematous swelling of the whole body, especially the head, after being bitten in the foot

General dropsy,1 'If

* Hemorrhage from all the orifices of the body, eyes, ears, nose, mouth, and urethra,,1.

* At times blood flows suddenly from the eyes, ears, nose, gums, and beneath the nails

Convulsions from time to time, with trembling of the limbs

General spasm, without foaming at the mouth, next morning, lasting a few minutes

Irregular spasmodic action of the muscles

Relaxation

Depression of the vital powers,13 -*Is easily tired by slight exertion -.-Standing up fatigues her much (third and subsequent days)

* General loss of power ; the muscles refuse their service, . Great loss of power, so that he is unable to make the slightest exertion

Weakness and delirium, with inflammations

General sudden weakness

* Tremulous weakness, all over as if some evil were apprehended : (third day),12.- Very great debility, next morning

Paralysis of one side, lasting during life

Faintness

Attacks of faintness, with paleness of the face/.-Frequent attacks of faintness, ™ ^Perceptible pulse, and inclination to vomit

Death by syncope 13

I urns about very much in bed

Subjective. Weariness ™d rapid loss of strength, with fever/.-The bitten part pains her severely (after twenty-six hours),- -Intense burning in the wound, extending over the body even to the top of the head,13.-Bruised sensation in the morning after waking; is scarcely able to rise,5.-Bruised pain in all the bones in the morning, on waking, disappearing after rising,5.-All the pains alternate rapidly with each other, and frequently recur,5.-All the pains, except the headache, appeared and disappeared suddenly, lasting from half an hour to three hours (first day)

Improvement "after Ammonia, Camphor, Opium, coffee, and brandy,1. 'Skin

Objective. *Yellow color of the whole body

lhe body is covered with yellow spots

Yellow spots break out at times

Yellow spot at the place of the bite, with swelling and pains from time to time (chronic result)

Blue and yellow spots with fever occurred yearly

Blue and yellow spots became again visible the next year after the bite, with swelling and death

Old scars break out again

Oozing of blood in the form of sweat in large quantities

Her left leg, as high as the hip, was enormously distended, and threatened mortification, the skin having a shining appearance, with discoloration, being black on the outside and mottled on the inside with black and yellow spots, so that one might have fancied it resembled the skin of the snake (after twenty-six hours)

EiuptioiiS, Dry. Eruption of numerous isolated red pimples, very small, with a few large ones upon and between the scapulae

The skin became constantly affected with pimples, and an ulcer formed on the right thigh, after a few doses

Era ]*ti oils. Moist. Blisters and livid spots on the body, with frequent attacks of faintness, and imperceptible pulse

Blisters on the swollen arm

Blisters surrounded by red areola?, as large as a six-franc piece, on the inner side of the arm, beneath the shoulder, and near the elbow (second day) ; these increased in circumference on the third day ; they healed on the seventh day,1-

Blisters formed about the wound, passing into ulcers

About the wound were several large vesicles filled with very dark bloody serum

Three months later there appeared upon the integument covering the metacarpal bone of the right thumb, an eruption of three or four small vesicles, accompanied by a "beating pain at the site of the eruption, together with contraction of the flexors and inability to extend the hand. In the course of a few days the vesicles dried up and the other symptoms disappeared. Since that time and up to the date of my visit she has had a return of the eruption, with contraction of some of the flexors, every three months,u.

Erupt ions, Pustular. A large pustule near the left wing of the nose, with tensive pains extending into the cheek, followed by long-continued redness aud hardness in this place

Ulcers. Formation of obstinate ulcers about an old bite

Gangrene of the bitten portion, extending over the body

Subjective. Itching on the middle joints of all the fingers of both hands

Some itching about the bend of the arm

Sticking itching alternately in all parts of the body, but worst on the scapula?.

Sleep and Dreams p. 597

Sleepiness. Yawning

Great sleepiness early in the evening

Uncommon sleepiness at bright midday (first day) ; almost irresistible at noon (second day)

Sleepy, at 11.30 a.m. (next day)

Sleep, with cold skin

Drowsy and heavy in the evening

Nearly comatose

Coma

Dreams. Anxious dreams

Many dreams at night of strife and anger; he dreamed that he had fallen out with his father, who would no more recognize him as his son because he had embraced homoeopathy

Fever p. 597

Chilliness. Surface cold,11 ; (after twenty-six hours)

Coldness of the skin, with inclination to vomit

Skin cold, with hot swelling of the arm

Coldness of the body, pulse 100, nausea

Shivering and diarrhoea

Extremities cold next morning

Cold hands aud feet

Hands cold

Cold feet (eighteenth day)

Shivering in

Head p. 598

Shiverings creep over the scalp, so that the hair stands up

Sent. Heat, with burning pain and swelling

The skin becomes hot.

swollen, very tense, and painful, the whole arm and hand cold; on the second day it is still cold, the skin tense, painful to pressure; on the fifth

day the swelling has greatly diminished, but the skin is still very tense ; on the tenth it becomes more swollen and inflamed, and on the thirteenth the abscess forms, which on the seventeenth becomes gangrenous, followed by death

Fever, with thirst, hiccough, vomiting of bile, with palpitation, anxiety, weak rapid pulse, exhaustion and rapid loss of strength

Dry exhausting fever, with dry tongue and thirst, lasting till death

Heat in the feet

Siveat. No sweat with the febrile heat

Conditions p. 598

Aggravation.

(Morning), Soreness in chest, etc.; arms feel numb ; after waking, bruised sensation ; on waking, pain in all bones.

(Forenoon), At 11.30 oclock, pain in course of colon.

(Afternoon), Headache in vertex; rancid eructations; heartburn.

(Evening), Drawing from vertex into eye; heartburn; pulse small, etc.; while sitting, sensation in bones of fingers, etc.

(Night), Delirium; pain in hypogaster.

(Ascending steps), Shaking, etc., in upper head.

(After breakfast and dinner), Pai ns in stomach.

(Damp weather), Lachrymation, etc. ; disappearance of vision.

(After food), Stomach sore, etc.

(Deep inspiration), Pain in left abdomen.

(Lying down again after rising), Pain in occiput.

(After a meal), Vomiting of food.

(Motion), Stitch across hip-bone

(Pressure), Pain from shoulder to neck.

( While reading), Vanishing of sight.

(During rest), Trembling of the hands.

( While sitting), Oppression of chest.

(Standing), ~Nnmea.

(Standing on foot), Drawing through knee, etc

( Walking), Nausea ; pain in malleoli.

( Walking rapidly), Shaking, etc., in upper part of head.

Amelioration p. 598

(Morning), After good night's sleep, headache; after rising, pain in bones.

( Walking in open air), Vertigo, etc.

(Sitting), nausea.

Appendix p. 598

Med. Repository, N. Y., vol. 2, 1799, p. 253, from Charleston, S. C. City Gazette, J. Miller. A man was bitten on the side of the foot about the middle of the hollow.

He struck me as the most frightful object I had ever beheld.— His head and face were prodigiously swollen, the latter black.— His tongue was prodigiously enlarged, and out of his mouth.— His eyes looked as if shooting from their sockets.— His senses gone.— Every appearance of suffocation • cured by olive oil.

Buffalo Med. Journ., vol. 9, 1853-4, p. 464, Dr. E. Stanley. Patrick Hume was bitten by a rattlesnake upon the index finger of the left hand near the second joint. ' '

Partial delirium (after ten hours).-Pulse very much excited, ranging from 115 to 130 (after ten hours).— Difficult and hurried respiration (after ten hours) — Skin hot and dry (after ten hours).— Eves red and fiery (after ten hours).— Hand, arm, and shoulder swollen to a great degree (after ten hours).— Pain in the limb almost insupportable (after ten hours) —Cupping, poultices, Amm. and Ether internally fatter ten hours) —Slight nausea (second day). — Arm, shoulder, and upper portion of the left side thickly covered with small blisters filled with a fluid of a yellow color (second day).

Buffalo 'Med. Journ., vol. 4, 1848, p. 203, Dr. Josiah Trowbridge. A boy of 12 was bitten on the side of one foot, near the small toe.

Limb badly swollen to the body (after two or three hours). — Skin discolored and mottled and, if I recollect aright, of a green and yellow color (after two or three hours). — Pain severe (after two or three hours).— Pulse accelerated (after two or three hours).

Same, a man of 50, somewhat intoxicated, was bitten between the thumb and forefinger.

Hand and arm badly swollen to the elbow, and paining severely (after one hour and a half or two hours).

Buffalo Med. Journ., vol. 4, 1848, p. 115. (From the Annalist.) Dr. Wain wright, A man of 40 was bitten in the last phalanx of the middle finger of the left hand, near its articulation with the metacarpal bone; an attempt was made to excise it, a ligature about the wrist, 10 grains of Carb. amm. and H grain Sulph. morph., given.

The wound was followed by a jet of blood. — Hand much swollen; swelling extending up the arm ; after the ligature was removed, extended half way between the elbow and shoulder-joint ; it was very considerable, hard, and terminated abruptly; the finger when passed along the arm dropping suddenly from the swollen part to that in its natural condition (after three hours); extending to the pectoral muscles (after five hours and a half). — The hand was of a greenish color ; the lower part of the arm was mottled blue, and greenish-yellow (after three hours) ; the discoloration did not extend as far as the swelling, and seemed to follow the swelling at about half an hour's interval. — Discoloration reached the axilla (after five hours and a half). — Face flushed (after three hours). — Manner excited (after three hours). — Pulse 80, of medium fulness and strength (after three hours) ; began to flag, becoming less full and forcible, but increasing in frequency to 100 (after three hours and a half); it afterwards reached 120; this was the maximum in frequency, becoming constantly more and more feeble ; extinct at the wrist, but could be felt at the groin (after four hours and a half). — He became stupid, taking no notice of what was passing around him (after three hours and a half or four hours) ; this lapsed into coma, and he died (after five hours and a half).

Boston Med. Intel., vol. 1, 1823, p. 62, James Teacher, M.D. A rattlesnake stuck its fangs into a man's hand.

A swelling commenced in a few minutes, with severe pain ; in half an hour his whole arm to his shoulder was swollen to twice its natural size. — The skin of his whole arm became of a deep-orange color, in half an hour. His body, on one side, soon became affected in a similar manner. — Nausea.

Buffalo Med. and Surg. Journ., vol. 1, Ang., 1861, p. 82, L. S. Ham. Mr. Lobel received a full blow on the right hand, in that triangular fleshy part which lies between the thumb and index finger. By drawing a line from the second joint of the thumb, and the third joint of the index finger, and a quarter of an inch above or back of that line, will give the exact locality of the wound. Both fangs entered full length and the snake had to be shaken off.

Hand much swollen, the swelling extending nearly to the elbow (alter three hours and a half).— Hand and lower part of the forearm dark and mottled (after three hours and a half); extending very rapidly, nearly to the shoulder (after five hours), although remedies were applied. — Very warm, after walking five miles (after three hours and a half). — Pulse 116 (after three hours and a half). — Vomited several times (after three hours and a half). — Indistinctness of vision (after three hours and a half).

Buffalo Med. Journ., vol. 8, 1852-53, p. 72, Dr. S. W. Woodhouse. Rattlesnake buried his fangs in the side of the index finger of my left hand, about the middle of the first phalanx.

The pain was noticed to momentarily produce, as it were, a severe shock, and accompanied by nausea. — Applied Amm. and drank whisky. — Glands of the axilla sore and painful. — Took a quart of fourth proof brandy and half a pint of whisky (enough to have killed a man under ordinary circumstances) to produce intoxication, which lasted only four hours. — During intoxication vomiting freely.— (Took Amnion, and Mass Hydrarg. and Colocynth. comp. ; pulver. Doveri grs x ; during night at least 4 grs. Pulv. Opium.) — Restless night, without sleep, although during the night took at least Pulv. Opium gr. 4. — Pain in the finger intense (second morning). — Several times to-day tried to walk across the room, but at times would be seized with nausea and commence vomiting (second day), continuing (fourth day). — Swelling down the left side as far as the hip (fourth day). — A wellmarked line of demarcation extended along the arm to the axilla (second morning). — The broad red line following the course of the lymphatic is now filled with a yellow serum (fourth day). — Nail became loose (fourth day); removed the nail (eighth day). — The point where the fang entered, for threeeighths of an inch in diameter, is of a dark-brown color (fourth day). — Hand much swollen and filled with serum (fifth day). — The first and second joints of the finger do not present a healthy appearance, the palmar surface having the appearance of gangrene; the discharge is thin and watery, without smell. The granulations do not present a healthy appearance ; they are rough, and many of them look as if they were sprinkled with yellow ochre (after seven days).— -Large slough, which gradually came away and left the last phalanx exposed in two places. A sinus remained open in the end of the finger ; upon introducing a probe into the latter, the bone could be felt quite rough. A discharge was kept up in this for nearly five months, when I removed the exfoliation of the end of the phalanx, showing evidently that the fang had entered the periosteum. Soon after this the sinus closed, leaving the finger in a deformed state, anchylosis having taken place in the first joint. — Circulation is very imperfect, one of the arteries' being destroyed, which renders the finger very susceptible to cold.

Footnotes p. 589

† Followed by S. 349.

† Authority 15, preceded by S. 14.