Vipera berus

 Including the following species and varieties: Vipera вerus. Daudin (Pelias вerrus, Merrem; V. trilamina, Millet; сoluber вerus, Linn.); including three varieties, сinerea, tartarea, rubiginosa. сommon names: Petite vipere or vipere peliade; the common viper of the North or Germany; the adder of England. Vipera Aspis. Merrem (including the quondam species V. сhersea, Delalande; V. вlaniensis, Leray; V. Redii; V. Delalande; V.
 Praester and V. ocellata). This is the Vipera вerus of Delalande non aliorum; V. communis, Millet. сommon names: Vipere commune, or Aspic; the common viper of the South, or Italy etc.

 W. A., age 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. вy 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 downwards. 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, and irregular; he felt much oppression at the precordia, accompanied with hurried respiration, and great depression of nervous energy. The tumefaction was of an edematous character; red lines extended in 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 infection 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 finger 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 edematous, 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 precordial region. The patient had began to be comatose. An infusion of Arnica was applied to the limb. The patient was given Arnica, сamphor, 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 began 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. 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 faintness; cold sweats; wild and woe-begone expression on his countenance.
 Generalities.
 Persons become prematurely old; the development of children is arrested. 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 hemoptysis, especially epistaxis; the blood coagulates imperfectly. Symptoms of chronic cachexia after the bite. Every year subsequent to the bite, at the first hot weather, he was seized with a painful oedema 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 the 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. 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 hemorrhage. Each subsequent year, at the anniversary of the bite, he suffered from troubles of digestion and debility, and after four years died of apoplexy. The chronic local effects consist of permanent alteration of the tissues; in some cases the oedema persists for a very long time; in others there is tendency to ulcers, or blisters. Ecchymoses appeared in the endocardium and pericardium; the lungs were hyperemic, the mucous membrane covered with ecchymoses, the tissue edematous; the mucous membrane of the intestines was ecchymosed; the blood did not coagulate. The person had always enjoyed excellent health, and had never shown any tendency to cerebral troubles. General chilliness; nausea; vomiting; somnolence; great dyspnoea; black spots on the limb and even over temperature depressed, as in cholera. 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. 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. 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). 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 diarrhoea 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 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 diarrhoea 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 thirtieth day the patient was able to be about, with only the hand somewhat swollen, and only the index finger insensible. Violent pain immediately after the bite, sinking down in a faint, loss of all power; at the same 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 amitoses vomiting of bile followed by relief, and diarrhoea, warm perspiration and sleep instead of cold perspiration; recovery after fifteen days. 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 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 Doctor Lenz). After a bite on the right ring finger sudden violent pain, some blood flowed from the finger, which began to swell, then she became quick 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 edematous, only slightly pitting on pressure; associated with paleness of the face and shivering; pulse very slow and weak, with general exhaustion. Inflammation and enlargement of the lymphatics extending from the bite. вlack blood flows from a wound near the bite; the cellular tissue is green and blue. Swelling and induration about the wound persisted for a long time. 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 left side. General swelling, with cold sweat and twitchings, followed by death. 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. The swelling frequently involves the lymphatics and extends to the body. Swelling and inflammation of the margins of the bite and neighboring parts. Swelling of the blood vessels, with general weakness. General oedema. Enormous oedema, nausea, vomiting, syncope, and death, from a bite in the foot. General oedema, with profound coma, followed by death. Painful tumefaction, followed by vomiting. Great tumefaction of the bitten parts. General oedema over the whole body (second day); even to the eyelids (third day).
 General oedema, followed by profound coma and death. 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. Tumefaction of the part bitten is a constant symptoms, accompanied by oedema, 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. Swelling of the extremity, with livid spots in the skin, followed by general chilliness, dyspnoea, nausea, and vomiting, and death on the seventh day. 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 of 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 large phlyctenular form with reddish serum; several of these phlyctaenulae 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 interior portion of the thorax; the right breast became edematous 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 ecchymoses 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 edematous, and the ecchymoses and infiltration spread over the nates. On the twelfth the ecchymoses had greatly diminished, but the oedema 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 oedema of the upper extremity still persisted, with a yellowish tint. On the seventeenth day 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. The bitter part became black, hard, swollen, and covered with spots. 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 time 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 followed 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. 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 hemorrhagica 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 oedema 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. 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. The eyes improved, but it extended through the whole body, and gave rise to pains internally, in various parts of the abdomen and limbs. At last she became almost numb. 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. 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. 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 go 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, diarrhoea, and death, in an hour and a half. 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 beck 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. 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. Gangrenous spots on the foot. After the bite on the foot some drops of blood flowed 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. Whole body pale, and from time to time agitated by fits of shivering (after one hour and a half). Paralysis yearly with pain and insensibility. Stiff, rigid, cannot make the slightest movement. Epilepsy one, two, and five years after the bite. Violent spasms. General spasms, with raging pain in the abdomen and head. Restlessness. Easy fatigue. Weakness. Weakness, so that he was unable to stand upon his feet. Weakness, so that he was no longer able to move. Great weakness and sleepiness. Extreme weakness, unable to move a limb, having barely strength to speak. So weak that he fainted every time he raised the head. Falling down when standing. Extreme debility. Great prostration. Prostration followed by death (fourth day). General prostration of the vital forces. General torpor (third day). Faintness. Immovable. Sinking down with faintness, immediately. Sinking down with violent pains, after the bite. Faintness, with feeling of warmth in the head. Faintness, with loss of sight and hearing, almost imperceptible pulse. Fell into a faint with alternate vomiting and diarrhoea. Attacks of faintness in rapid succession. Felt so faint that he was obliged to lie down. He fainted after walking a few steps, immediately after the bite. Fainting alternately with great anxiety and restlessness. After half an hour the patient could scarcely stand erect and was faint. Fell to the ground in a faint and remained so for an hour, until he was awakened by cold water. сollapse, followed by death. Loss of acuteness of the special senses. Sensitive to every change of weather. 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. Violent pain in the part bitten. Violent shooting pains through the whole body, spreading from the point of the bite. Violent pain began at the wound and extended through the whole limb. Violent pains after the bite. The pain caused by the bite is not severe, but is followed by a burning sensation, which spreads over the whole limb. The bite was immediately followed by acute pain and by a burning sensation of heat and tumefaction. Violent burning pain in the wound, immediately. 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. The bite was felt through the whole body like a streak of lightning, she sank to the ground. The swelling was insensible. When bitten he felt a stitch through the whole body.

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