Including the following species and varieties: Vipera Berus , Daudin (Pelias Berrus, Merrem; V. trilamina, Millet; Coluber Berus, Linn.); including three varieties, Cinerea, tartarea, rubiginosa.

Common names , Petite vipère or vipère peliade; the common viper of the North, or Germany; the adder of England.

Vipera Aspis , Merrem (including the quondam species V. Chersea, Delalande; V. Blaniensis, Leray; V. Redii; V. Delalandei; V. Praester and V. ocellata). This is the Vipera Berus of Delalande non aliorum ; V. communis, Millet.

Common names , Vipère commune, or Aspic; the common viper of the South, or Italy, etc.

Authorities.

1 , Dr. Merschner, Lond. Med. and Phys. Journ., 1826, p. 198, a boy æt. thirteen years, was bitten on third right finger; 2 , Revue Med., Oct., 1826 (Lancet, vol. xi, p. 284), a gardener was bitten on the hand; 3 , M. Piorry, Lancet, 1826, p. 560, a man æt. forty-six years, was bitten on the hand; 4 , Arch. Gen., from Rust's Mag. (Bost. Med. Intell., vol. v, 1827, p. 262), a shepherd was bitten on the tongue; 5 , Dr. Marianini, Repert. di Med. Torino, 1828 (Lancet, 1828-9 (1), p. 580), a woman, æt. twenty years, was bitten on the right ankle; 6 , M. Beaumont, Compte des Travaux Méd. du Dép. de la Moselle (Lancet, 1830-1 (1), p. 384), a boy was bitten on the finger; 7 , Dr. Kaiser, Heidelberg Clin. Annals, 1832 (Frank's Mag. 3, 145), a boy was bitten; 8 , Heyfelder, Sanitäts, Ueber das Furst. Hohenzollern, 1833 (S. J. 8, 123), a man was bitten on the leg; 9 , Dr. Franchi, Antologia Med., Agosto, 1834 (S. J. 9, 57), a boy was bitten on the foot; 10 , Dr. Paulet, Bull. de Thérap., 1835 (S. J. 9), a woman was bitten on the toe, during hot weather; 11 , Dr. Chas. P., Bibliothèque Hom. de Geneva, vol. v, 1835, a boy was bitten; 12 , Dr. Butazzi, Feliatre di Napoli (Med.-Chir. Rev., vol. xxvi, 1836, p. 509), a man æt. forty-four years, was bitten between the forefinger and thumb of right hand; 13 , Geis, Med. Zeit. Preuss., 1836 (S. J. 15), a girl was bitten; 14 , Schumaker, ibid.; 15 , Dr. Koch. ibid., effects of bite on the little toe; 16 , Dr. Lebrun, Zeit. für Geburstande, 1837 (A. H. Z. 15, 110), effects of the bite; , Casper's Woch. and Arch. de Med., Dec. 1839 (Lancet, 1839-40 (2), p. 111), a man was bitten on the tongue; , John Moodie, M.D., Med. Phys. Journ., vol. xi, p. 481, Catharine Bishop, æt. seventy years, was bitten twice on the back of the hand; , Gluckselig, Œst. Med. Jahrbuch, vol. xxiii (A. H. Z. 19, 335); , same, another case; , Bull. de Thérap., vol. vii (A. H. Z. 7, 259), a man was bitten; , Harvey K. Owen, Lond. Med. Gaz., vol. xxvi, 1840, p. 337, John Burr, æt. twenty years, was bitten on the hand; , Francis Adams, Lond. and Edinb. Month, Jour., vol. i, 1841, p. 796, a woman, æt. thirty-five years, was bitten by an adder on her leg; , Herbert Mayo, Magendie's Journ. of Exper. Phys. (Lond. Med. Gaz., vol, xxix, 1841-2 (1), 487), a man, æt. twenty-six years, was bitten on his inner ankle; , same, a robust woman, laboring under ague, was bitten on the ankle; , Wm. Stockbridge, Bost. Med. and Surg. Journ., vol. xxix, 1843, p. 42, a lady æt. twenty-two years, was bitten by an adder; , Pemberton, Lancet, 1849 (2), p. 638, a man, æt. fifty-one years, was bitten on the thumb by an adder; , Dr. Weger, S. J. 23, 218, a man was bitten on the tongue; , George Lambert, Lancet, 1851 (2), p. 437, a man, æt. twenty-three years, was bitten on the right ring finger by an adder; , Dr. Nick, Würt. Corr. Blat., 1851 (S. J. 71, 307), a pharmaceutist was bitten on the right index finger; , Pemberton, Lancet, 1851 (2), p. 157, a man, æt. thirty-one years, was bitten on the cheek by an adder; , Ipawitz, Œst. Med. Jahrbuch, 1857 (S. J. 17, 29), a woman was bitten on the foot; , Dr. Jarjavay, Gaz. des Höp. (Journ. de Chim. Méd., 1857, p. 604), a person was bitten on the hand by a V. aspis; , Philip Weston, Lancet, 1859 (1), p. 522, the author was bitten on the right forefinger by a viper; , Hussa, Allg. Wien. Med. Zeit., 1861 (A. H. Z., M. B., 4, 50), a person, æt. fifty-two years, was bitten on the foot; , M. Soubeiran, Sydenham Yearbook, 1863, p. 437, a gentleman was bitten; , M. Demeuret, Gaz. Hebd. de Méd. et Chir., Nov. 6, 1863 (Ranking's Abstract, vol. xxxviii, 1863, p. 195), a woman was bitten on the forearm, May 25, 1824; , Dr. Heinzel, Wien. Med. Woch., 1866 (S. J. 133, 192), symptoms from bite on himself, and from other observations; , Hering's Monograph "Schlangengift", 1837, Vipera torva; , same, Vipera redi ( to , Vipera aspis, from Dr. Viaud Grand-marais, Gaz. des Hôp., 1868, No. 62, and 1869, and Études méd. sur les serpents de la Vendée et de la Loire-inférieure, first and second edition); , Thomas of Nantes, a man was bitten in the left foot; , Merel, Boussay; , Dr. Bourdin, a woman, æt. sixty-one years, was bitten in the foot; , same, case of a child; , Drs. Clochard and Guitter, a child, æt. six years, was bitten on the right hand; , Dr. Duchaine, a child, æt. six years, was bitten on the foot; , Drouet, a man, æt. sixty years, was bitten on the left hand; , Dr. Clochard, a man, æt. nineteen years, was bitten on the left leg; , M. Pestre, a woman, æt. fifty-four years, was bitten on the right hand; , Riviere, case of a woman; , Lihorean, a woman was bitten on the hand; , Viaud Grand-marais, a boy was bitten on the hand; , same, another case; , same, general remarks; , Dr. J. B. Feuvrier, Deux Cas de Morsure de Serpent Venimeux, Paris, 1874, a child, æt. ten years, was bitten on the hand.

MIND

Delirium and raving, 54.
Delirium with vomiting, 40.
Somewhat delirious in the interval of fifty minutes between the bite and death, 39.
Appeared wandering, as if drunk, and answered questions in a mumbling incoherent manner (in two hours), 31.
During the night sick with delirium and vomiting, followed by profuse perspiration, 40.
Extremely melancholy, delirium alternating with sopor (after two hours), 9.
Irrational talking, with sleeplessness and pains, 40.
Screaming, followed by convulsions, 39.
Great agitation and anxiety, 54. [10.]
Great depression, 27.
Very great uneasiness of mind, 11.
Premonition of death, 39.
Anguish, 50.
Anxiety and vomiting, 39.
Great anxiety, 43.
Indescribable anxiety preceding death, 39.
Intellect confused (after two hours), 10.
State of great intellectual torpor, 54. [20.]
Loss of mental functions, with drawn features, 40.
Stupor, 55.
Stupefaction, with cutting pain in the abdomen, 39.
Loss of consciousness and a paralytic condition, 39.
Loss of consciousness with swelling, 39.
Loss of consciousness and sinking down, 39.

HEAD

Confusion in the head, 34.
Vertigo, 6, 38.
Frequent vertigo, 40.
Vertigo, headache with nausea, 40. [30.]
Vertigo, headache and vomiting, 40.
Vertigo frequently recurring, with nausea and vomiting, so that he fell into a faint, 40.
Staggering with vertigo and falling forward, 39.
Giddiness increased to loss of vision, 34.
Stupefaction of the head (after half an hour), 39.
Dulness of the head, 21.
Head felt heavy (after ten hours), 1.
Violent headache, 35.
Persistent headache for several days, 54.
Raging pains in the head, jaws, and abdomen, with general spasms, 49. [40.]
Tearing and sticking pain in the head on every change in the weather, chronic effect of the bite, 39.

EYE

Eyes glistening with the headache, 40.
Eyes pressed out, with swelling of the face, 39.
In a short time the eyes became red, inflamed, and very watery, 39.
Eyes sunken, 39.
The eyes immediately became dark yellow, 40.
Lids.
Paralysis of the lids (second day), 55.
Lids dropped over the eyes, 55.
Ball.
Eyeballs immovable, 55.
Pupil.
Pupils dilated (after two hours), 9, 12, 55. [50.]
Right pupil contracted, the left dilated (second day), 55.
Vision.
Vision became indistinct (after two hours), 10, 55.
Vision of the right eye lost, of the left dim (second day), 55.
Obscuration of vision, though he hears everything distinctly, 40.
Loss of vision, 34.
Loss of vision for several minutes during the excessive violence of the attack, though voices were still recognized, 39.

NOSE

Blood from the nose with vertigo, with anxiety, 39.

FACE

Staring look, 39 . Face expressed terror, 43.
Great anxiety expressed in countenance (after six hours), 29. [60.]
Countenance, naturally pale, has now an appearance of anxiety about it, 27.
Countenance, pallid, extremely anxious, covered with drops of perspiration (after half an hour), 22.
Face pale, 39.
Pale face with chilliness, 39.
Extreme paleness of the face, 55.
Face pale and hippocratic, with cold sweat on the forehead (after two hours), 9.
Face pale yellow, 13.
The face soon became yellowish, and assumed an expression of anxiety, 11.
Face livid, with an subicteric color, 54.
Excessive swelling of the face, 40. [70.]
Swelling, especially of the lips and eyelids, 40.
Face swollen and anxious, 17.
Enormous tumefaction of the face (after two hours), 3.
Face swollen, and nearly double its usual size; the neck also participated in the swelling, 2.
Excessive swelling of the face in a few minutes, so that he could not open his eyes, neither like erysipelas nor œdematous, not very painful, but very tense and blackish, with closure of the throat for eight days, 39.
After ten years there was still œdematous puffiness of the face at the place of the bite, 39.
Entire face presented a swollen appearance, and the parts immediately adjacent to the bite were discolored, of a livid hue (after two hours); diffuse cellular inflammation extended from the wound to the neck and sternum, and to the opposite side of the face (second day), 31.
Features considerably altered; the cheeks puffed; the lips and tongue enormously swollen, but not painful, covered with saliva, and very pale (after one hour and a half). The swelling of the tongue rapidly increased, so that is at last almost filled the cavity of the mouth, and caused great difficulty of breathing, 5.
Face convulsed (second day), 12.
Lips blue, 39. [80.]
Lips and tongue livid, swollen and protruding, .

MOUTH

Gums.
The gums often have the scorbutic line, 54.
Tongue.
Tongue dry, swollen, 13.
Tongue swollen, brownish black, protruding from the mouth, 40.
Tongue swollen, can be protruded but slowly, and in a small degree, and is evidently directed to the side affected; voice hesitating and thick, and somewhat resembling a man suffering from intoxication (after half an hour), 22.
His tongue began to swell, so that he could not articulate, 6.
The tongue immediately swelled so much that when he reached the nearest village he was unable to speak; the swelling increased rapidly so that his tongue hung partly out of his mouth, and two hours afterwards he died, 4. [90.]
A few minutes after the bite the tongue began to swell, and on the next morning he was found sitting up in bed, anxious, gasping for air, face pale, with an expression of the greatest anxiety, terrible swelling of the submaxillary and parotid glands, the tongue was immovable, blue, enormously swollen, protruding from the teeth, filling the whole cavity of the mouth, constant dribbling of saliva, 28.
The tongue at once became enormously swollen, and during the night the man could hardly breathe. The next day the tongue was scarified, but the swelling soon returned again, and he fell to the gound in a state of asphyxia. The respiration and pulse were now completely suspended; the face became purple, and the neck swelled to such a degree, that its circumference exceeded that of the head, 17.
Enormous swelling of the tongue (though bitten in the foot), 54.
In fatal cases the tongue became fuliginous, and the breath fetid, 54.
Protrusion of the tongue, paleness, 39.
Tongue black, dry, 21.
Black tongue, 48.
Tongue white in the middle, moist on the edges, with thirst, 40.
Tongue coated with a white fur (second day), 31.
Tongue generally, white, slightly tremulous, 27. [100.]
Tongue yellow, tip red, 19.
Thickly-coated tongue, with headache and bad appetite, 40.
Tongue discolored, .

THROAT

Closure of the throat, so that for eight days she could only swallow water and milk; afterwards biting in the fauces, the swelling of which became blackish, 39.
Pain in throat, with some difficulty in deglutition, and on examination a copious secretion of viscid mucus was seen to be adherent to the pharynx (after two hours), 31.
Violent pain in throat, 6.
Deglutition was greatly impeded. 18.
Great difficulty in attempting deglutition, 22.
Salivary glands tumified, 17.
Swelling like a goitre on the throat, remaining a chronic result, 39.

STOMACH

Appetite and Thirst. [120.]
Complains of hunger and thirst just before death, 39.
Complete loss of appetite, 19.
Thirst, 34.
Great thirst (after ten hours), 1, 13 , etc.
Troublesome thirst and craving for cold drinks (after half an hour), 22.
Thirst with the heat, 39, 40.
Thirst, with moist tongue, 40.
Febrile thirst, with shivering, 39.
Desire of water during the coma, 40.
Heartburn.
Cardialgia, 52.
Nausea and Vomiting. [130.]
Nausea, 3, 8 , etc.
Sickness at stomach and vomiting (within less than half an hour), 18.
Nausea and slight attempt to vomit, which appear to aggravate the suffering (after half an hour), 22.
Nausea is caused by sucking the yellow poison from the wound, which had a flat taste, 40.
Nausea with shuddering, 39.
Violent nausea, with oppressed respiration, 39.
Nausea, spasmodic vomiting (after two hours), 10.
Violent nausea, with vomiting, 39.
Nausea and vomiting, 11, 49.
Nausea and bilious vomiting, 43. [140.]
Immediately inclined to vomit, with attacks of faintness, 39.
Violent retching, 34.
Frequent efforts of vomiting (second day), 12.
Spasmodic retching and bilious vomiting affording transient relief, 8.
Vomiting, 3, 5 , etc.
Frequent vomiting, 15, 16 , etc.
Immediate vomiting, .

ABDOMEN

Hypochondria very tense, 19.
Extreme soreness of hypochondria, 24.
Intense pain about umbilicus, greatly augmented by pressure (in two hours), 31.
Swelling of the abdomen, raging pains and spasms, even to faintness; after drinking milk vomiting of a large mass of round worms; since that time the patient has been completely free from the worm troubles which he had before, 39.
Sudden flatulent distension of the abdomen, with colic, violent pain in the back and vomiting, 40.
Abdomen tense, pressure causes distension of the facial muscles, 39.
Rumbling in the bowels, 21. [190.]
Pains in the abdomen and back, 39.
Pain in the abdomen alternating with pain in the limbs, after the bite, 39.
Pain in the abdomen, with violent thirst and vomiting, 39.
Colic, 25, 51.
Colic, with profuse diarrhœa (third day), 39.
Colic, with headache instantly, which completely stupefies; with vomiting and violent swelling and blueness of the foot, 39.
Violent griping in the abdomen, 54.
Cutting colic, 39.
Violent pain in belly, 24.
Violent pains in the abdomen, immediately, 39. [200.]
Violent pains in the intestines and in the shoulders, 39.
Raging pain in the abdomen, afterwards also in the jaws and head, exceedingly like destruction, 39.

RECTUM AND ANUS

Pain and tenesmus in the rectum, 39.
Urging to pass stool and urine, 40.

STOOL

Diarrhœa, 21.
Much purged (after twenty minutes), 29.
Diarrhœa and vomiting, 39.
Diarrhœa with colic, 39.
Diarrhœa; bowels have acted five times since last night, 9 A.M. (second day), 27.
Bilious purging, 24, 25, 34. [210.]
Bowels acted frequently and involuntarily, and both blood and mucus were mingled with the motions (after two hours), 31.
Involuntary stools, 3, 39.
Copious stools (after two hours), 10.
Numerous stools, with urging shivering, and thirst, 39.
Evacuation of the bowels soon after the bite, 39.
Evacuation of the bowels very offensive, black (after two hours), 9.
Bloody stools, 39.
Discharge of much blood from the bowels, just before death, 10.
Discharge from the bowels of black coagulated blood, 32.
Stool on the second day consisting of masses of dark, horribly offensive blood, apparently from the scarification of the tongue, 28. [220.]
Stools very fetid, 2.

URINARY ORGANS

Sticking pains in the kidneys, 39.
Desire to micturate, but could not (after twenty minutes), 29.
Involuntary micturition, 39.
Increased secretion of urine, 40.
Frequent emission of watery urine, 19.
Copious secretion of clear urine, with constipation and headache, 40.
Profuse emission of urine, with pains in the back and abdomen, vomiting and purging, 40.
Incontinence of urine and fæces at times, 38.
The urine is usually completely suppressed, 54. [230.]
Strangury, 38.

RESPIRATORY ORGANS

Anxious respiration, as in croup, with threatening asphyxia, 54.
Respiration very anxious, 13.
Anxious, oppressed respiration (after two hours), 9.
Respiration was short and oppressed (after ten hours), 1, 18.
Difficult respiration, 10, 12 , etc.
Difficult breathing, with sticking pains in the heart, 40.
Great difficulty of respiration, 18, 43.
Dyspnœa, 22.
Suffocative sensation, with retching, 40. [240.]
Suffocation, 50.
He tore his shirt because suffocation threatened, preceded by vomiting, 40.
After being carried to the hospital the patient suddenly ceased to breathe, the heart stopped, the face became livid, etc., whereupon tracheotomy was immediately performed; blood drawn from the arm flowed scantily, was dark mixed with bright streaks, 28.

CHEST

Swelling of the chest, with difficulty of breathing, 39.
Soon after the bite on the face the chest became excessively swollen, without difficulty of breathing, and the abdomen swollen as far down as the navel, 39.
The veins in the chest and abdomen became thick and hard like quills, 39.
Œdema of the lungs precedes death, 38.
Double pneumonia, 54.
Oppression of the chest, with anxiety, 40.
Oppression of the chest, with great præcordial anxiety, 19. [250.]
Oppression of the chest, with violent efforts to breathe and to swallow, 40.
Violent pains in the chest, 39.
The patient complained of flying pains in the chest (after ten hours), 1.
Burning on the chest and abdomen, and longing for cold applications, though the skin was very cold to touch, 35.
Pressure over the four or five ribs of the right side causes pain (after half an hour), 22.
Violent pain in the thorax and left side (third day), 43.

HEART AND PULSE

Præcordium.
Præcordial anxiety, 38.
Great præcordial anxiety, 54.
Indescribable sensation of anxiety in the præcordial region, 21.
Dragging pain in the heart, so that he tears all his clothes, becomes faint and sinks down with weakness, with violent distress in the abdomen, violent vomiting ten times, deathly paleness, icy coldness of the body, blueness and blackness of the bitten finger, 39. [260.]
Great anxiety of the heart, with soreness of the foot that had been bitten, and paralysis of the right arm, at the same time, for four years, 39.
Pain at the heart and faintness, 40.
Short sticking in the heart, 40.
Sticking in the heart, 40.
Sticking pains at the heart, with great weakness, difficulty of breathing, and cold sweat, 40.
Heart's Action.
Pulsation of heart feeble; no pulsation was felt in the radial or carotid arteries, whilst that in the crural was very strong, 2.
Action of heart feeble (after two hours), 3.
Heart's impulse remarkably feeble, 27.
Want of pulsation in the radial and carotid arteries (after two hours), 3.
Beat of the heart slow, 40.
Pulse.
Rapid pulse, with unquenchable thirst, 39, 40. [270.]
Pulse rapid and feverish, 39.
Pulse small and rapid, 43, 55.
Pulse small and rapid, after the coma, 40.
Pulse small, rapid, with chilliness and cold sweat, 40.
Pulse thready, rapid (after two hours), 9.
Pulse small, rapid, scarcely perceptible, 13.
Pulse rapid, small, and hard; heart's action tremulous, with oppression of the præcordium, 19.
Pulse low, quick, and interrupted (second day), 18.
Pulse in the healthy arm was quick, strong, and full; on the contrary, that of the wounded arm was small and low (after ten fours), .

BACK

Pains in the back and abdomen, 39, 40.
Pains in the loins, 40.

EXTREMITIES

Limbs swollen, painful, 55.
Swelling of the whole limb, 16.
Swelling of the whole extremity, which was covered with bluish-red spots, 15.
The whole extremity was very much swollen and hard, with inflammation of the superficial veins; the boy complained of total loss of sensation in the extremity, 15.
The limb became swollen, like a phlegmonous erysipelas, with an ecchymosis around the bite, 25.
Pain, with œdema of the limb, the volume of which had become double it natural size (after two hours), 3. [310.]
Limb swollen, red, covered with yellow spots, 40.
The limb becomes swollen, blue and black, 39.
Dark-red swelling of the bitten limb, 39.
On the third day the whole extremity was swollen as far as the abdomen, with feverish coldness of the limb, 39.
The whole limb speedily became enlarged, blue and black, even the abdomen was distended, 39.
Erysipelatous inflammation of the whole limb, 54.
Swelling of the limb, with black spots; the swelling extended to the abdomen, was followed by syncope and death, 46.
Great œdema of the extremity, 50.
Dark color and great swelling of the affected limb, 39.
The limb became excessively tumefied, covered with livid spots, 52. [320.]
The extremity became excessively swollen and ecchymosed; at the bite there were several ulcers, which exuded a sanious liquid, 41.
The extremity became enormous in size, and covered with phlyctænules (second day), 43.
Excessive swelling of the limb; the swelling became doughy, the temperature elevated, the cutaneous veins looked like red stripes; every attempt to move the limb caused violent pains, 19.
Gangrenous spots on the limbs, 54.
The bitten limb had a yellowish-green color, with livid spots, 54.
Paralysis of the bitten limb for several years, even involving half of the body, 39.
Different limbs and even the whole half of the body paralyzed for the remainder of life, 40.

SUPERIOR EXTREMITIES

Paralysis of the upper limbs after a bite on the foot, 39.
Paralysis of the right arm, recurring for years after a bite on the foot, 39. [340.]
Œdema extending to the shoulder, 49.
The arm shoulder, chest, and back of the side bitten becomes greatly swollen and inflamed, 39.
Arm swollen, reddish blue, 11.
The whole extent of the right arm was enormously swollen, and its surface was of a livid red color (second day), 12.
On the third day the arm was slightly swollen, red, covered with spots, soft, and without pain, 39, 40.
The arm was greatly swollen and discolored; it retained for many years a sickly color, until death, which took place suddenly in the night (in an old woman), 39.
The bitten finger became bluish black, the wound was surrounded by enormous blisters, the hand and arm were greatly swollen, of a grayish-yellow color; scarification over the wound caused oozing of very black blood, 13.
The bitten part soon became hot, swelled, and the finger contracted; the contraction and swelling soon affected the arm, the latter extending above the elbow; the whole of the right arm was much swelled, especially about the joints (after ten hours), 1.
On the second day the arm was swollen and puffy, as in he had dropsy, 39.
Finger white, but little swollen; the back of the hand very much swollen; red lines reaching of the elbow; forearm not much swollen or discolored, but rather tender (after six hours); arm much swollen and ecchymosed, the discoloration extending to the axilla; the glands in that region also much swollen and inflamed, morning (second day); inflammation subsiding; ecchymosis extending down the side to the crest of the ilium, evening (second day); ecchymosis deepening in color (third day); color decreasing and becoming browner (eighth day); forearm and elbow very hard, and the patient complained of stiffness and pain in attempting to bend the elbow (tenth day), 39.
Part swollen, with tingling pain and sense of coolness (after one hour and a half); in a short time afterward the swelling increased enormously. It seemed to be of the nature of œdema, and its appearance indicated that gangrene would speedily supervene. The temperature of the part was lower than it usually is all over the arm, up to the axilla, to which part, in fact, the swelling had extended, 2. [350.]
Immediately felt a sensation of burning and smarting, and soon after the thumb became deadly white, and the lividity of the forearm came and went; during the evening the stiffness, which had been present slightly, began to increase; the arm became swollen, and lividity became permanent. These conditions became aggravated during the night, and in the morning presented the following appearance: the part looks sloughy and inflamed, and swelling extends from this point throughout the entire limb, terminating at the shoulder. Lividity commences on the posterior aspect of the thumb, prevails on the inner side of the dorsum of the hand, where it becomes a bluish tint, and gradually assumes the appearance of ecchymosis as it approaches the forearm. Here, and upon the upper arm, the ecchymosis is general, of a bright-red color in places, in others blue and everywhere tinctured with livid spots. The discoloration upon the posterior aspect of the forearm and arm is gradually shaded of a less intense hue. The discoloration and tumefaction terminate at the axilla. Pain on pressing the thumb. A general feeling of soreness extends over the extremity, not aggravated, however, by pressure, .

INFERIOR EXTREMITIES

Convulsive movement of the lower extremities, 54.
Shuffling gait caused by paralysis, chronic result, 39.
Paralysis of the leg and a feeling as if dead, 39.
Weakness of the lower extremities, 39.
Severe cramps in lower extremities, 34. [380.]
Great swelling of the leg, as far as the abdomen, which was bluish brown with blackish spots about the bite, 14.
The whole leg becomes enormously swollen as far as the abdomen, and of a quite black color, 39.
The bitten limb became excessively swollen as far as the abdomen, blue and yellow, 39.
Pain in the bitten leg like the sting of a wasp, or as after a drop of Sulphuric acid on a sore spot, 40.
Immediately he felt as if something moved upwards along his thigh, 24.
Knee.
Knees stiff for a year after, 39.
The knee remained stiff for a long time, flexion was difficult and painful, when walking, 8.
The boy complained of tension about the knee and ankle-joints (after one week). 15.
On very change in the weather, sticking and tearing in the knee and head, after fifty years, 39.
Leg.
Moderate degree of tumefaction in the leg, from the toes to near the knee, but without pain or discoloration, except a small circles of redness around the wound. The wound was filled with a drop of lymph, which was no sooner wiped off than it was succeeded by another (after four hours), 28. [390.]
The limb swelled rapidly up to the knee, and soon to the abdomen, became double its normal size, the swelling was pale green, red and yellow, 39.
The bitten spot became dark blue, the limb swollen as far as the knee, immovable, insensible to hard pressure or cutting, 39.
The bitten leg swollen and yellow, 39.
Leg swollen, as cold as ice, and as insensible as a piece of wood, 39.
Leg swollen, as if puffed up by air, with great pain, 39.
After two or three hours, pain in the wound, and towards morning the foot was inflamed and swollen as far as the knee; there was some swelling even after three months, followed for several years by paralysis of the foot, so that he was unable to ride horseback, .

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, .

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, .

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.

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, .

VIPERA.