THE ADDER. 129 
Only when absolutely cornered does the adder turn 
to attack—for example, when in a box or something 
of that sort. The part most likely to be the seat 
of the bite is therefore the hand or the foot: especi- 
ally does the adder appear to aim just above the 
ankle, if nearly trodden upon. On examination the 
skin shows the two points of puncture made by the 
two fangs, looking like two severe pin-pricks. In 
doubtful cases the presence or absence of these marks 
must decide the diagnosis. The symptoms, which 
come on very rapidly, are, pain at the seat of the 
wound, sickness, and a feeling of extreme prostration, 
terminating in actual fainting and loss of conscious- 
ness. In fatal cases death occurs soon from heart 
failure. If, however, the dose injected was not so 
large, or the venom of the particular adder less potent, 
the patient recovers consciousness (or may not actu- 
ally faint), and a set of secondary symptoms set in. 
The day after the bite the vessels of the arm or leg, 
as the case may be, become painful, and the lym- 
phaties stand out as dark lines. The limb becomes 
swollen, and the swelling may extend to the body. 
The patient, in fact, exhibits all the signs of severe 
local blood-poisoning, in addition to great weakuess 
of the heart. In some cases the limb shows consider- 
able discoloration, more or less of a green colour. 
The symptoms then gradually subside, but the patient 
is some weeks before feeling quite the same as before 
the accident. 
