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 r61e, 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 diarrhrea 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 9 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 i 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 



