SYMPTOMS OF VENOM POISONING IN MAN 107 
tissue can not be clearly estimated, as in all cases ligatures, cautery, excision 
and incision, alone or combined, were freely practised and the resulting 
damage is not to be ascribed to the effect of the venom alone. 
The constitutional symptoms: Crotalus poisoning is followed almost imme- 
diately by the general symptoms. It is probable that an interval of several 
minutes elapses, or the faintness of terror and pain has been mistaken for the 
constitutional effects of the venom. ‘There are, however, some exceptions in 
which general manifestations occurred after 20 or 30 minutes. The prin- 
cipal constitutional effect of the venom is a general prostration of the most 
appalling character. Sometimes within a few minutes, sometimes within 
one or two hours, this condition of sedation attains its height. The snake 
strikes and the faintness comes on while the person injured is trying to kill 
the snake. Or, as in another instance, he walks for some time and suddenly 
finds his limbs giving way beneath him. The condition of prostration is 
accompanied by a variety of phenomena. The patient staggers or falls, 
cold sweats bathe the surface, nausea, vomiting ensues, the pulse becomes 
quick, rapid, and feeble, the expression anxious, and, in a few cases, the mind 
slightly affected. But such acute and primary poisoning is not so frequently 
met with in the case of man, the nearest to this being death in 5.5 hours. 
If death does not intervene, the local symptoms soon begin to play a more 
important rédle, and the swelling and discoloration extend up the limb, and 
pass on to the trunk, so that when the arm has been wounded, half of the 
chest and back are seen to be discolored. 
Meanwhile, the signs of general poisoning develop, and within a few hours, 
or a day, the face and other parts become swollen and puffy. At the same 
time, the general weakness remains well marked, as shown by repeated 
syncope, the heart quick, feeble, and fluttering, and the respiration labored. 
In the majority of cases, the slight mental disturbance now passes away and 
the mind remains clear to the close, whatever the event may be. In other 
instances, delirium, restlessness, and insomnia are present, but in general 
the nervous symptoms are confined to slight incoherence and to rare sensory 
delusions. 
No statement is recorded as to the urine. Vomiting was one of the most 
frequent phenomena. In some cases diarrhoea was observed, once with the 
stool of a dark bilious character. 
Mitchell collected 16 cases, of which 4 were fatal. The earliest death was 
in 5.5 hours, then g and 18 hours. One case ended after 17 days, but 
death was not the direct result of poisoning. 
The coagulability of the blood was not lost in the case where the victim 
died in 9 hours, but was completely lost where death occurred in 18 hours. 
In cases of recovery the time required was from 1 hour(!) to many months, 
being usually several days. The depression disappeared in two days in one 
case. Post-mortem autopsies of these fatal cases revealed in some cases 
congestion of the pia with fluid blood, foamy mucous secretion with bloody 
tint in trachea and lungs. In some cases bloody serum was found in the 
