Vipera

Authorities. 56, Mr. Tip])le, 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., tet. twenty-six years, was bitten in the right hand; 59, G. W. James, ibid., 1831-2 (1), p. 294, P. B., set. thirty years, was bitten on the right index-finger; 60, Mr. Canton, ibid., 1857 (2), p. 138, G. S., set. sixteen years, was bitten on the right thumb; 61, G. K. Afford, 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., set. 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 oedema 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,®*.—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,®®.—In two hours the arm was considerably swollen, and although so short a time had elapsed, his tongue was very much furred; pulse 140, aud irregular; he felt much oppression at the prtecordia, accompanied with hurried respiration, and great depression of nervous energy. The tumefaction was of an cedematous character; red lines extended iu the lines of the absorbent glands, which were tender and slightly enlarged,®®.—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,—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,™.— 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 cedematous, 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 precordial region, and inclination to vomit. The wound had assumed an intensely bluish-red color, and there was excessive anxiety about the praecordial 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 ve.-sels and glands, especially in the popliteal region, were hard and painful on moving the limb, for which Iodine was given internally,™.—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,—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,™.