C. Horridus, Linn.

Order , Crotalidæ 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 , Kummer, from ibid.; 4 , Lingen, ibid.; 5 , Schmoler, ibid.; 6 , Wallace, ibid.; 7 , Gross, ibid.; 8 , Dr. Wilson, Am. Hom. Obs., 1872, p. 73, effects of bite; 9 , Dr. Horner, Am. J. of Med. Sci., 8, p. 397, effects of bite; 10 , Dr. Phillips, 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 day; 13 , Dr. Rivers, Southern Med. Record (from Lond. Med. Rec., Dec., 1874), effects of bite; 14 , Dr. Piffard, N. Y. Med. Rec., Jan. 1875, chronic, recurrent effects of bite; 15 , Sir G. Lefevre, "On the Nerves," p. 329 (Month. Hom. Rev., 14, 194), Mr. Wallace, of Va., took all the poison from both fangs of a rattlesnake, made it into pills, "bags, venom, and all," and swallowed them, sometimes at the rate of four a day.

MIND

Emotional.
Excessive excitability; for example, while reading Humboldt's lecture to naturalists in Berlin, he was moved to tears, 4.
Sublime ecstasy, 6.
Delirium, 1, 13.
Delirium at night, 1.*
Delirium at night, from time to time (seventeenth day), also the whole night, 1.
Delirium, with convulsions, 1.
For several days, a certain dread of selecting remedies, which usually is an agreeable occupation, 5.
Depression, 1.
Depression and indifference to everything, 1. [10.]
Melancholy; misanthropic and indifferent, with sudden weakness, headache, heartache, and excessive diarrhœa, 1.
Anxiety, with restless heat, 1.
Apprehensiveness, 1.
Indifference, with sudden weakness, 1.
Most heavenly sensation; melancholy was quickly changed into gay anticipations, 15 . [Followed by S. 349.]
Remarkable indifference, seems only half alive; lasting fourteen years (chronic result of the bite), 1.
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, 4.
Confused speech, 1.
His answers are disconnected, with cold skin, 1. [20.]
Disconnected answers, with coldness of the skin and rapid pulse, 1.
Remarkable weakness of memory, 4.
Loss of senses, 1.

HEAD

Confusion and Vertigo.
Dull confusion of the whole head, 4.
Vertigo, 13.
Vertigo, with nausea, 3.
Vertigo, with sopor, 1.
Vertigo; headache in the forehead above the eyes, 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 of blood to the head, with convulsions, followed by death, 1. [30.]
Feeling of lightness in the head, with pressure in the temples, especially in the left 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, 5.
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, .

EYE

Objective.
Eyes muddy and heavy, next morning, 9.
Red watery eyes (after one hour), 1. [60.]
*Yellow color of the eyes; frequently of the whole body, 1.
Blue rings about the eyes, with pale face, 5.
Blood exudes from the eye, 1.
Blood flows from the eyes, ears, and nose, at times, 1.
Dryness of the eye, 5.
The eyes feel dry, 5.
Sudden violent drawing pain from the vertex into the right eye, in the evening, 1.
Brow and Orbit.
Pains above the eyes, 2.
Pressure and oppression above the eyes, 5.*
Pressure above the right eye, nausea and vertigo, repeated for several days, at different times, 3. [70.]
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, 3.
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, 5.
Fine prickling and stinging above the left eye, as with fine needles, 5.
Lids.
Dark redness of the left upper lid, with dryness and burning within the eyes and redness of the canthi, 5.
Eyes almost closed (after twenty-six hours), 10.
Itching in the canthi, 4.
Lachrymal Apparatus.
Frequent lachrymation and momentary disappearance of vision, especially in damp weather, 7.
Ball.
Pain in the eyeball on moving the eye, like a pressure, and as if the eye were too dry internally, 5.

EAR

Objective.
Bleeding from the ears, 1.
External.
Bruised feeling in the lobules of the ears, 5.
Internal.
Heat in the ears, 5.
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, 5.
Drawing in both ears, with stoppage of them, 5.
Drawing in the right ear, with painfulness of the whole left side of the head, and paralyzed feeling of the left jaw, 5.
Painful drawing in the right ear, with sensation of heat in it, 5.
Hot, tickling sensation, as though earwax were in both ears, 5.

NOSE. [90.]

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, 5.
Bleeding from the nose and all the orifices of the body, 1.*

FACE

Objective.
Paleness of the face, as in faintness, 4.
Discolored face, 1.
Earthy face, with vertigo, 5.
Yellow color of the face, 1.*
Sickly yellow color of the face (chronic result), 1.
Face leaden-colored, immediately, 1.
Leaden color of the face, lasting during life, 1.
Swelling of the face, of the whole head, and body, 1. [100.]
Face somewhat bloated, next morning, 9.
Subjective.
Pressive-drawing pains in the bones of the face, first in the right maxilla and zygoma, then in the left; then in both at the same time, 5.
Lips.
Trembling lips, with weakness and faintness, 1.
Lips and throat dry, without thirst, 12.
Jaws.
Cramp in the jaws, 1.
Spasmodic contraction of the jaws, with swelling of the hand and arm, and other dangerous symptoms, 1.
Bruised pain in the whole right lower jaw and in the teeth, 5.

MOUTH

Teeth.
The teeth are loose in their sockets, 1.
Inclination to press the tongue against the lower incisors, with crumbling of them on the inside, 4.
Pain in the teeth, coming from the larynx, 5. [110.]
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), 5.
Violent shooting downward, almost like a blow, in an upper back tooth; immediately disappearing (second day), 5.
Teeth and jaws seem bruised, 5.
Gums.
Gums white (fourth and subsequent days), 12.
Bleeding of the gums, 1.*
Tongue.
Tongue red and sore (fourth and subsequent days), 12.
Brown tongue, 1.
Tongue brown and swollen, so that it closes the throat, 1.
*Swelling of the tongue, 1.
Swelling of the tongue till there is no more room in the mouth, with inflammation of it, 1.* [120.]
*Tongue swollen to nearly twice the normal size, 11.
*Tongue tumid (after twenty-six hours), 10.
General Mouth.
Tickling of the palate and fauces, 4.
Saliva.
Accumulation of saliva, obliging him to swallow, 5.
Taste.
Sourish taste in the mouth, after the usual breakfast, 5.
Speech.
Articulation indistinct (after twenty-six hours), 10.
Loss of speech and of the senses, 1.
Speechless, without moving, trembling pulse, .

THROAT

Dryness of the throat, with great thirst (after one hour), 1. [130.]
Throat dry, with thirst (fourth and subsequent days), 12.*
Sensation in the throat as though earwax were running down, with heat in the ear, 5.
Sudden attack of sore throat, and bronchial catarrh, in the evening, which went away the next morning, and returned at night, 12.
Painful rawness in the throat, 5.
Tickling in the pit of the throat, as if in the trachea, provoking cough without expectoration; after some days simple tickling without cough, 4.
Pharynx.
Tickling in the pharynx, 4.
Swallowing.
Frequent swallowing of saliva, with sensation as though the neck were compressed, without dyspnœa, 5.
Deglutition impeded to some extent (after twenty-six hours), 10.
External Throat.
Larynx is painful to touch (second day), 5.

STOMACH

Appetite.
Appetite bad (first and second days), 12.
Thirst. [140.]
Thirst during the fever, 1.
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, 10.
Unquenchable burning thirst, 1.*
Eructation.
Eructations tasting of the food, 5.
Eructations of a sour, acrid fluid, after eating white bread (fourth day), 5.
Rancid eructations the whole afternoon (fourth day), 5.
Scraping rancid sensation, extending down the œsophagus to the stomach, with pressure in the pit of the stomach, 5.
Heartburn.
Heartburn after the usual light supper, 5.
Heartburn at 4 P.M., lasting the whole evening, 5.
Heartburn the whole day, especially in the afternoon, with a feeling as if the whole œsophagus up to the mouth were full of rancid food, with eructations tasting of the food, 5.
Nausea and Vomiting. [150.]
Nausea, 14.
Nausea, relieved by vomiting, 1.
Nausea, soon after taking it, coming on by paroxysms, lasting till noon, especially while walking or standing, relieved by sitting, 3.
Nausea and vertigo with the headache, 3.
Nausea with headache, 2.
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), 1.
Nausea and vomiting, 13.
Nausea and vomiting very decided, and always coming on very soon after the bite, 1.
Nausea, with a sensation as though something rancid rose in the œsophagus, and remained in the upper part of the chest, . [160.]

ABDOMEN

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, 5.
Umbilical.
Pains internally in the umbilical region, like a violent burning (first day), 5.
Pressive aching in the middle of the abdomen, beneath the umbilicus, as though it were too full, 5.
General Abdomen.
Swelling of the whole abdomen, 1.
Inflammation of the viscera of the abdomen, 1.
Flatulency and eructations (third and subsequent days), 12.
Violent pain in the course of the colon at 11 1/2 A.M.; (next day), 9.
Burning pains in the abdomen, lasting several days, with great sensitiveness especially to touch, 1. [200.]
Violent burning pain in the abdomen, 1.
Tension in the abdomen, painful to touch, with burning pain, 1.
Hypogastrium and Iliac Regions.
In the night she was awakened by violent burning pain in the hypogaster, going through to the sacrum (tenth day), 12.
The inguinal glands on that side were much enlarged (after twenty-six hours), 10.

RECTUM AND ANUS

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

STOOL

Diarrhœa.
Diarrhœa, with nausea, anxiety, and thirst, 1.
Attack of diarrhœa; after which the bowels were costive and the evacuations hard during a week, 12.
Frequent diarrhœa-like stool with colic, extending downward from the umbilicus, 5.
Diarrhœa-like evacuation in the afternoon, 3.
Involuntary evacuation of the bowels, of a dark bilious color, next morning, 9. [210.]
Pasty stool, 4.
Has had several bloody passages from the bowels, 11.*
Constipation.
Bowels were rather constipated, 10.

URINARY ORGANS

Urethra.
Hemorrhage from the urethra, 1.*
Micturition.
Urine somewhat increased in quantity, and very high-colored, reddish-yellow (second to fifth day), 5.
Urine scanty and red (eleventh day), 12.
Urine.
Urine looks like that in jaundice, 1.*
No blood in the urine; (blood in the urine is common in these cases), 11.

SEXUAL ORGANS

Male.
Sharp cuttings in the glans penis twice (without any other symptoms in this part), 4.
Unusual sexual excitement during the day, with complete relaxation of the genitals; apparent impotence, 4.
Female. [220.]
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 days with intense frontal headache, which lasts from 10 to 1 o'clock in the night, 12.

RESPIRATORY APPARATUS

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), 5.
Voice.
Hoarseness, with weak, rough voice, 5.
Cough and Expectoration.
Cough; a stitch in the left side, with bloody expectoration from the lungs, 1.
Moderate cough, with expectoration of bloody mucus, 11.*
Spitting of blood, 1.*
Respiration.
Respiration 14; labored, 11.
Difficult respiration, 1.
Dyspnœa, with symptoms of inflammation of the lungs and intestines, 1.
Dyspnœa, with anxiety, thirst, nausea, diarrhœa, 1.

CHEST. [230.]

Inflammation of the lungs, 1.
Severe pains in the chest, with vomiting of a green fluid, 1.
The lungs seem passive; respiration in the evening in bed is difficult; the chest feels tight, 7.
Oppression of the chest while sitting, almost amounting to faintness (second day), 5.
During several days there was some soreness in the chest and cough in the morning, 12.
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), 5.
Front.
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, 5.
Sides.
Pain in the right side below the arm; afterwards also in the left, 5.
Pain beneath the left arm, extending into the left side of the chest, with very great pain on deep inspiration, 5.
Pressure in the right side of the chest; on the previous day pain in the left side, 3. [240.]
Stitches in the right side of the chest, quite near the sternum, 5.
Stitches in the right side of the chest, on sneezing, 5.
Mammæ.
The milk of the mother became deadly poison to her five months' child, 1.
Sudden pain above the left nipple, as from a blow, lasting two minutes, repeated after a few minutes (first day), 5.

HEART AND PULSE

Præcordium.
Pain in the heart, 1.
Heart's Action.
Palpitation during the fever, 1.
Heart-beat feeble (55 per minute), 11.
Pulse.
Pulse rapid and full, at first, 1.
Pulse at first full, hard and rapid, 1.
Pulse weak, rapid, with fever and exhaustion, 1. [250.]
Pulse at first hard, rapid, then weak and slow, 1.
Pulse 100, with cold skin, 1.
Pulse weak, rapid, 102, 80, intermitting, 1.
Pulse small, 130, in the evening, 1.
Pulse low, and about 60 strokes in a minute (after twenty-six hours), 10.
Pulse strong and full, after the formation of an abscess, 1.
Pulse at first hard, afterwards weak, 1.
Pulse tremulous, 1.
Pulse scarcely noticed, with loss of motion and speech, 1.
His pulse was almost imperceptible and threadlike, the next morning, 9. [260.]
Pulse scarcely perceptible, with faintness, 1.
Pulse not perceptible at the wrist, 11.
Pulse imperceptible, 1.

NECK AND BACK

Neck.
Tensive pains, extending from the shoulder to the neck, worse on moving the arm, 5.
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, 5.
Drawing on the left side of the neck, posteriorly, extending to the shoulders, 5.
Back.
Extravasation of blood in the loins, 1.
Visible twitching of the muscles of the lumbar region, 4.

EXTREMITIES IN GENERAL

Objective.
Whole extremity swollen to nearly double its size, and very painful, 9.
Convulsive movements of the limbs, 1.
Subjective. [270.]
Heaviness of the arms and legs, as if the bones were made of heavy wood, 5.
Painful paralytic sensation in the bones of the fingers, arms, and legs, in the evening while sitting, 5.
A numb pain, as after a cramp, frequently in the toes and anterior portion of the fingers (second day), 5.
Tearing in the limbs; yearly, or at times, 1.

SUPERIOR EXTREMITIES

Objective.
The affected arm became inflamed, swollen, and gangrenous; diarrhœa, with delirium, and death on the eighteenth day, 1.
Next morning, the arm, from the shoulder and front of the thorax to the fingers, was swollen to twice its size, 9.
Swelling and heaviness of the arm that was bitten, 1.
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, diarrhœa 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, diarrhœa; 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, 1.
Subjective.
The arms feel numb in the morning, 12.
The arm was very painful when moved the next morning, 9. [280.]
Drawing in the bones of the right arm, extending into the thumb and little finger, together with pain in the left foot, 5.
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), 5.
Glands in the left axilla swollen and tender, 11.
Bruised pain in the bones of the shoulder, extending backward, especially on bending the arm backward, by paroxysms (second day), 5.
Arm.
Violent pain in the right upper arm just above the elbow, 5.
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, 5.
Forearm.
Swelling of left forearm, extending up the arm, of right arm only to the elbow; severe pain in left moderate in right, .

INFERIOR EXTREMITIES

Objective.
The bitten leg became of the color of the snake; the flesh decayed, and fell off in pieces, 1.
Gait tottering, 1.
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, 5.
Constant dull, aching weariness in the legs, 5.
Burning pains, with swelling of the leg that was bitten, very violent, with heat like fire, 1.
Tensive-drawing bone-pain from the left hip to the foot, with a bubbling sensation in the calf, 5.
Hip. [310.]
A sharp stitch across the right hip-bone, extending backward, worse on motion, 5.
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, 5.
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), 5.
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, 5.
Knee.
Some sudden pains in the right knee, like gout, while walking, which returned, and were continuous on sitting still (second day), 5.
Goutlike drawings through the right knee, and down the lower leg, aggravated by standing on the right foot (after one hour), 5.
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, 5.
Rheumatic drawing in the hollow of the right knee, between the tendons, 4.
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, .

GENERAL SYMPTOMS

Objective.
*Swelling of the whole body, 1.
Swelling, especially in the face, 1.
Swelling and maculæ recurred yearly, 1.
The child became swollen, and died on the next year, when the spots returned, 1.
Swelling, with angry ulcers; lasting fourteen years, 1.
*Her body was considerably swollen (after twenty-six hours), 10.
Œdematous swelling of the whole body, especially the head, after being bitten in the foot, 1.
General dropsy, 1, 15. [350.]
Hæmorrhage 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, 1.*
Convulsions from time to time, with trembling of the limbs, 1.
General spasm, without foaming at the mouth, next morning, lasting a few minutes, 9.
Irregular spasmodic action of the muscles, 13.
Relaxation, 13.
Depression of the vital powers, 13.
*Is easily tired by slight exertion, 12.
Standing up fatigues her much (third and subsequent days), 12.
General loss of power; the muscles refuse their service, 1.* [360.]
Great loss of power, so that he is unable to make the slightest exertion, 1.
Weakness and delirium, with inflammation, 1.
General sudden weakness, 1.
Tremulous weakness, all over, as if some evil were apprehended (third day), 12.*
Very great debility, next morning, 9.
Paralysis of one side, lasting during life, 1.
Faintness, 1.
Attacks of faintness, with paleness of the face, .

SKIN

Objective.
*Yellow color of the whole body, 1. [380.]
The body is covered with yellow spots, 1.
Yellow spots break out at times, 1.
Yellow spot at the place of the bite, with swelling and pains from time to time (chronic result), 1.
Blue and yellow spots with fever occurred yearly, 1.
Blue and yellow spots became again visible the next year after the bite, with swelling and death, 1.
Old scars break out again, 1.
Oozing of blood in the form of sweat in large quantities, 1.
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), 10.
Eruptions, Dry.
Eruption of numerous isolated red pimples, very small, with a few large ones upon and between the scapulæ, 4.
The skin became constantly affected with pimples, and an ulcer formed on the right thigh, after a few doses, 7.
Eruptions, Moist. [390.]
Blisters and livid spots on the body, with frequent attacks of faintness, and imperceptible pulse, 1.
Blisters on the swollen arm, 1.
Blisters surrounded by red areolæ, 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, 1.
About the wound were several large vesicles filled with very dark bloody serum, 11.
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, , .

SLEEP AND DREAMS

Sleepiness.
Yawning, 5.
Great sleepiness early in the evening, 4, 5.
Uncommon sleepiness at bright midday (first day); almost irresistible at noon (second day), 5.
Sleepy, at 11.30 A.M. (next day), 9.
Sleep, with cold skin, 1.
Drowsy and heavy in the evening, 12.
Nearly comatose, 11.
Coma, 1.
Dreams. [410.]
Anxious dreams, 12.
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 homœopathy, 4.

FEVER

Chilliness.
Surface cold, 11 ; (after twenty-six hours), 10.
Coldness of the skin, with inclination to vomit, 1.
Skin cold, with hot swelling of the arm, 1.
Coldness of the body, pulse 100, nausea, 1.
Shivering and diarrhœa, 1.
Extremities cold next morning, 9.
Cold hands and feet, 1.
Hands cold, 1. [420.]
Cold feet (eighteenth day), 12.
Shivering in the head, 5.
Shiverings creep over the scalp, so that the hair stands up, 5.
Heat.
Heat, with burning pain and swelling, 1.
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, 1.
Fever, with thirst, hiccough, vomiting of bile, with palpitation, anxiety, weak rapid pulse, exhaustion and rapid loss of strength, 1.
Dry exhausting fever, with dry tongue and thirst, lasting till death, 1.
Heat in the feet, 5.
Sweat.
No sweat with the febrile heat, 1.

CONDITIONS

Aggravation.
( Morning ), Soreness in chest, etc.; arms feel numb; after waking, bruised sensation; on waking, pain in all bones.
( Forenoon ), At 11.30 o'clock, 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 finger, etc.
( Night ), Delirium ; Pain in hypogaster.
( Ascending steps ), Shaking, etc., in upper head.
( After breakfast and dinner ), Pain 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 ), Nausea.
( Standing on foot ), Drawing through knee, etc.
( Walking ), Nausea; pain in malleoli.
( Walking rapidly ), Shaking, etc., in upper part of head.
Amelioration.
( Morning ), After good night's sleep, headache; after rising, pain in bones.
( Walking in open air ), Vertigo, etc.

APPENDIX TO CROTALUS. ADDITIONAL CASES, RECEIVED TOO LATE FOR ARRANGEMENT

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 burne 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).
Eyes 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 (after ten hours). Slight nausea (second day).
Arm, shoulder, and upper portion of the left side tickly covered with small blisters filled with a fluid of a yellow color (second day).

Buffalo Med. Journ., vol. 4, 1848, p. 203, Dr. Josiah Trow bridge. 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. Wainwright. 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 1 1/2 grain Sulph. morph., given.

The wound was followed by a jet of blood.
Hand much swollen; swelling extending 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 hands 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 Thacher, 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, Aug., 1861, p. 82, L. S. Ham. Mr. Lobdell 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 (after 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 Ammon. 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 well-marked line of demarcation extended along the arm to the axilla (second morning).
The broad red fine 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 three-eighths 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 hand 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.

SUPPLEMENT: CROTALUS HORRIDUS. Authorities.

16 , Dr. Renzger, Lancet, 1829-30 (2), p. 90, a child, æt. two years, was bitten on the left cheek, and died in a few minutes; 17 , Dr. Pihorel, Lond. Med. Gaz., vol. xxix, 1841-42 (1), p. 487, Mr. Drake was bitten, and died in nine hours; 18 , Bost. Med. and Surg. Journ., vol. xxxi, 1844, p. 208, Dr. Stadia was bitten on the right hand; 19 , T. A. Atchison, South. Journ. of Med. and Phys. Sci. (Bost. Med. and Surg. Journ., vol. xlviii, p. 200), Miss R., æt. seventeen years, was bitten on the left instep; 20 , J. C. Blackburn, Nelson's Amer. Lancet (ibid., p. 488), a negress was bitten on the ankle; 21 , L. E. Whiting, Bost. Med. and Surg. Journ., vol. l, 1854, p. 258, Mr. B. was bitten on the little finger; 22 , John T. Jones, M.D., South. Med. and Phys. Journ., vol. vi, 1858, p. 376, a girl, æt. eighteen years, was bitten just above the right ankle and on the anterior portion of the leg; 23 , Geo. T. Jenkins, M.D., Med. and Surg. Reporter, vol. xxii, 1870, p. 458, Chas. S. was bitten on the right forefinger; 24 , J. F. Richardson, M.D., Philada. Med. Times, 1879 (1), p. 306, Mr. R. was bitten on the left ringfinger.

Countenance of a deadly paleness; eyes half open and staring; mouth covered with foam; extremities cold and insensible; pulsation of heart irregular, trembling, and scarcely perceptible; respiration slow and laborious; body perfectly motionless, and covered with cold viscous sweat; eyes and ears appeared to be inaccessible to any impressions (in ten minutes); face slightly convulsed (after fifteen minutes), 16. [430.]
Almost as quick as thought the hand commenced swelling, and before the preventive could be applied the place of the bite had swollen to the size of a butternut, and so closed the wound that the medicine, if there was any virtue in it, could not take effect. Within one hour after he was bitten he was so overcome by its effects that he could not sit up; went to his bed; was bled as often as once an hour during the succeeding night; lingered through the next day until about 7 o'clock in the evening, 18.
Paleness; breathing stertorous; involuntary passage of urine and fæces; pupils contracted; complained of cold and vomited; the vomiting repeated every half hour; the matter thrown up of a yellowish-green color and fetid; difficult swallowing; anxiety; pulse scarcely perceptible, 17.
Almost moribund, pulse wavy and scarcely perceptible at the wrist, surface cold and bathed in perspiration, face swollen, with a besotted expression, mind wandering, pupils dilated, could not see, declaring it was very dark although candles were burning in the room, asked frequently if it was not raining hard, although the night was calm and clear, 19.
Deathly sick; cold rigors running over her; pulse 120, small, quick, and threadlike; the entire leg was swollen to twice its normal size, 20.
In about forty minutes the finger was enormously swollen, and the hand also, for about half way to the wrist, 21.
Foot and leg much swollen; extreme nausea and frequent puking; covered with cold perspiration, and shivering like one in the cold stage of an intermittent; anxious countenance; hurried breathing; pulse frequent and feeble; involuntary evacuations of urine every few minutes (after three hours), 22.
Suffering the most intense pain in the entire arm, which was swollen to more than twice its natural size, and of a livid, spotted color; respiration quick and laborious; pulse weak, and 115 per minute; surface covered with cold sweat; terrible state of nervous agitation (after four hours), 23.
On the second day the hand arm was greatly swollen to the shoulder; otherwise the case appeared to be doing well. Thus passed four days, he suffering some cerebral pain and malaise. On the fifth day he spoke of a feeling of soreness in the flesh of the right hip, and on examination a jet-black spot some two inches in diameter was discovered, with evaluation or thickening of the skin to the extent of about one line, edges well defined. During the next four days this discoloration extended up to a level with the umbilicus, completely around the body, and down the lower extremities, disappearing at the toes last, when convalescence was established, .

CROTALUS HORRIDUS.