anomalies and curiosities of medicine-第182部分

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　minute　is　it。　There　is　swelling　due　to　effusion　of　blood；　active　inflammation；　and　increasing　pain。　If　the　poison　has　gained　full　entrance　into　the　system；　in　a　short　time　the　swelling　extends；　vesicles　soon　form；　and　the　disorganization　of　the　tissues　is　so　rapid　that　gangrene　is　liable　to　intervene　before　the　fatal　issue。　The　patient　becomes　prostrated　immediately　after　the　infliction　of　the　wound；　and　his　condition　strongly　indicates　the　use　of　stimulants；　even　if　the　medical　attendant　were　unfamiliar　with　the　history　of　the　snake…bite。　There　may　be　a　slight　delirium；　the　expression　becomes　anxious；　the　pulse　rapid　and　feeble；　the　respiration　labored；　and　the　patient　complains　of　a　sense　of　suffocation。　Coma　follows；　and　the　respirations　become　slower　and　slower　until　death　results。　If　the　patient　lives　long　enough；　the　discoloration　of　the　extremity　and　the　swelling　may　spread　to　the　neck；　chest　and　back。　Loss　of　speech　after　snake…bite　is　discussed　in　Chapter　XVII；　under　the　head　of　Aphasia。

A　peculiar　complication　is　a　distressing　inflammation　of　the　mouth　of　individuals　that　have　sucked　the　wounds　containing　venom。　This　custom　is　still　quite　common；　and　is　preferred　by　the　laity　to　the　surer　and　much　wiser　method　of　immediate　cauterization　by　fire。　There　is　a　curious　case　reported　of　a　young　man　who　was　bitten　on　the　ankle　by　a　viper；　he　had　not　sucked　the　wound；　but　he　presented　such　an　enormous　swelling　of　the　tongue　as　to　be　almost　provocative　of　a　fatal　issue。　In　this　case　the　lingual　swelling　was　a　local　effect　of　the　general　constitutional　disturbance。

Cases　of　Snake…bite。The　following　case　illustrative　of　the　tenacity　of　virulence　of　snake…venom　was　reported　by　Mr。　Temple；　Chief　Justice　of　Honduras；　and　quoted　by　a　London　authority。　While　working　at　some　wood…cutting　a　man　was　struck　on　a　heavy　boot　by　a　snake；　which　he　killed　with　an　axe。　He　imagined　that　he　had　been　efficiently　protected　by　the　boot；　and　he　thought　little　of　the　incident。　Shortly　afterward　he　began　to　feel　ill；　sank　into　a　stupor；　and　succumbed。　His　boots　were　sold　after　his　death；　as　they　were　quite　well　made　and　a　luxury　in　that　country。　In　a　few　hours　the　purchaser　of　the　boots　was　a　corpse；　and　every　one　attributed　his　death　to　apoplexy　or　some　similar　cause。　The　boots　were　again　sold；　and　the　next　unfortunate　owner　died　in　an　equally　short　time。　It　was　then　thought　wise　to　examine　the　boots；　and　in　one　of　them　was　found；　firmly　embedded；　the　fang　of　the　serpent。　It　was　supposed　that　in　pulling　on　the　boots　each　of　the　subsequent　owners　had　scratched　himself　and　became　fatally　inoculated　with　the　venom；　which　was　unsuspected　and　not　combated。　The　case　is　so　strange　as　to　appear　hypothetic；　but　the　authority　seems　reliable。

The　following　are　three　cases　of　snake…bite　reported　by　surgeons　of　the　United　States　Army；　two　followed　by　recovery；　and　the　other　by　death：　Middleton　mentions　a　private　in　the　Fourth　Cavalry；　aged　twenty…nine；　who　was　bitten　by　a　rattlesnake　at　Fort　Concho；　Texas；　June　27；　1866。　The　bite　opened　the　phalangeal　joint　of　the　left　thumb；　causing　violent　inflammation；　and　resulted　in　the　destruction　of　the　joint。　Three　years　afterward　the　joint　swelled　and　became　extremely　painful；　and　it　was　necessary　to　amputate　the　thumb。　Campbell　reports　the　case　of　a　private　of　the　Thirteenth　Infantry　who　was　bitten　in　the　throat　by　a　large　rattlesnake。　The　wound　was　immediately　sucked　by　a　comrade；　and　the　man　reported　at　the　Post　Hospital；　at　Camp　Cooke；　Montana；　three　hours　after　the　accident。　The　only　noticeable　appearance　was　a　slightly　wild　look　about　the　eyes；　although　the　man　did　not　seem　to　be　the　least　alarmed。　The　region　of　the　wound　was　hard　and　somewhat　painful；　probably　from　having　been　bruised　by　the　teeth　of　the　man　who　sucked　the　wound；　it　remained　so　for　about　three　hours。　The　throat　was　bound　up　in　rancid　olive　oil　（the　only　kind　at　hand）　and　no　internal　remedy　was　administered。　There　were　no　other　bad　consequences；　and　the　patient　soon　returned　to　duty。

Le　Carpentier　sends　the　report　of　a　fatal　case　of　rattlesnake…bite：　A　private；　aged　thirty…seven；　remarkable　for　the　singularity　of　his　conduct；　was　known　in　his　Company　as　a　snake…charmer；　as　he　had　many　times；　without　injury；　handled　poisonous　snakes。　On　the　morning　of　July　13；　1869；　he　was　detailed　as　guard　with　the　herd　at　Fort　Cummings；　New　Mexico；　when；　in　the　presence　of　the　herders；　he　succeeded　in　catching　a　rattlesnake　and　proving　his　power　as　a　sorcerer。　The　performance　being　over　and　the　snake　killed；　he　caught　sight　of　another　of　the　same　class；　and　tried　to　duplicate　his　previous　feat；　but　his　dexterity　failed；　and　he　was　bitten　in　the　middle　finger　of　the　right　hand。　He　was　immediately　admitted　to　the　Post　Hospital；　complaining　only　of　a　little　pain；　such　as　might　follow　the　sting　of　a　bee　or　wasp。　A　ligature　was　applied　above　the　wound；　the　two　injuries　made　by　the　fangs　were　enlarged　by　a　bistoury；　ammonia　and　the　actual　cautery　were　applied；　large　doses　of　whiskey　were　repeated　frequently；　the　constitution　of　the　patient　being　broken　and　poor。　Vomiting　soon　came　on　but　was　stopped　without　trouble；　and　there　were　doubts　from　the　beginning　as　to　his　recovery。　The　swelling　of　the　hand　and　arm　gradually　increased；　showing　the　particular　livid　and　yellowish　tint　following　the　bites　of　poisonous　snakes。　A　blister　was　applied　to　the　bitten　finger；　tincture　of　iodin　used；　and　two　ounces　of　whiskey　given　every　two　hours　until　inebriety　was　induced。　The　pulse；　which　was　very　much　reduced　at　first；　gained　gradually　under　the　influence　of　stimulants；　two　grains　of　opium　were　given　at　night；　the　patient　slept　well；　and　on　the　next　day　complained　only　of　numbness　in　the　arm。　The　swelling　had　extended　as　far　as　the　shoulder…joint；　and　the　blood；　which　was　very　fluid；　was　incessantly　running　from　the　wound。　Carbolic　acid　and　cerate　were　applied　to　the　arm；　with　stimulants　internally。　On　the　15th　his　condition　was　good；　the　swelling　had　somewhat　augmented；　there　was　not　so　much　lividity；　but　the　yellowish　hue　had　increased。　On　the　16th　the　man　complained　of　pain　in　the　neck；　on　the　side　of　the　affected　limb；　but　his　general　condition　was　good。　Examining　his　genitals；　an　iron　ring　3/4　inch　in　diameter　was　discovered；　imbedded　in　the　soft　tissues　of　the　penis；　constricting　it　to　such　a　degree　as　to　have　produced　enormous　enlargement　of　the　parts。　Upon　inquiry　it　seemed　that　the　ring　had　been　kept　on　the　parts　very　long；　as　a　means　of　preservation　of　chastity；　but　under　the　influence　of　the　snake's　venom　the　swelling　had　increased；　and　the　patient　having　much　trouble　in　passing　water　was　obliged　to　complain。　The　ring　was　filed　off　with　some　difficulty。　Gangrene　destroyed　the　extremity　of　the　bitten　finger。　From　this　date　until　the　30th　the　man's　condition　improved　somewhat。　The　progress　of　the　gangrene　was　stopped；　and　the　injured　finger　was　disarticulated　at　the　metacarpal　articulation。　Anesthesia　was　readily　obtained；　but　the　appearance　of　the　second　stage　was　hardly　perceptible。　Le　Carpentier　was　called　early　on　the　next　morning；　the　patient　having　been　observed　to　be　sinking；　there　was　stertorous　respiration；　the　pulse　was　weak　and　slow。　and　the　man　was　only　partly　conscious。　Electricity　was　applied　to　the　spine；　and　brandy　and　potassium　bromid　were　given；　but　death　occurred　about　noon。　A　necropsy　was　made　one　hour　after　death。　There　was　general　softening　of　the　tissues；　particularly　on　the　affected　side。　The　blood　was　black　and　very　fluid；not　coagulable。　The　ventricles　of　the　brain　were　filled　with　a　large　amount　of　serum；　the　brain　was　somewhat　congested。　The　lungs　were　healthy；　with　the　exception　of　a　few　crude　tubercles　of　recent　formation　on　the　left　side。　The　right　ventricle　of　the　heart　was　empty；　and　the　left　filled　with　dark　blood；　which　had　coagulated。　The　liver　and　kidneys　were　healthy；　and　the　gall…bladder　very　much　distended　with　bile。　The　intestines　presented　a　few　livid　patches　on　the　outside。

Hydrophobia。The　bite　of　an　enraged　animal　is　always　of　great　danger　to　man；　and　death　has　followed　a　wound　inflicted　by　domestic　animals　or　even　fowls；　a　human　bite　has　also　caused　a　fatal　issue。　Rabies　is　frequently　observed　in　herbivorous　animals；　such　as　the　ox；　cow；　or　sheep；　but　is　most　commonly　found　in　the　carnivore；　such　as　the　dog；　wolf；　fox；　jackal；　hyena；　and　cat　and　other　members　of　the　feline　tribe。　Fox　reports　several　cases　of　death　from　symptoms　resembling　those　of　hydrophobia　in　persons　who　were　bitten　by　skunks。　Swine；　birds；　and　even　domestic　poultry　have　caused　hydrophobia　by　their　bites。　Le　Cat　speaks　of　the　bite　of　an　enraged　duck　causing　death；　and　Thiermeyer　mentions　death　shortly　following　the　bite　of　a　goose；　as　well　as　death　in　three　days　from　a　chicken…bite。　Camerarius　describes　a　case　of　epilepsy　which　he　attributed　to　a　horse…bite。　Among　the　older　writers　speaking　of　death　following　the　bite　of　an　enraged　man；　are　van　Meek'ren；　Wolff；　Zacutus　Lusitanus；　and　Glandorp。　The　Ephemerides　contains　an　account　of　hydrophobia　caused　by　a　human　bite。　Jones　reports　a　case　of　syphilitic　inoculation　from　a　human　bite　on　the　hand。

Hydrophobia　may　not　necessarily　be　from　a　bite；　a　previously…existing　wound　may　be　inoculated　by　the　saliva　alone；　conveyed　by　licking。　Pliny；　and　some　subsequent　writers；　attributed　rabies　to　a　worm　under　the　animal's　tongue　which　they　called　〃lytta。〃　There　is　said　to　be　a　superstition　in　India　that；　shortly　after　being　bitten　by　a　mad　dog；　the　victim　conceives　pups　in　his　belly；　at　about　three　months　these　move　rapidly　up　and　down　the　patient's　intestines；　and　being　mad　like　their　progenitor；　they　bite　and　bark　incessantly；　until　they　finally　kill　the　unfortunate　victim。　The　natives　of　Nepaul　firmly　believe　this　theory。　All　sorts　of　curious　remedies　have　been　suggested　for　the　cure　of　hydrophobia。　Crabs…claws；　Spanish　fly；　and　dragon　roots；　given　three　mornings　before　the　new　or　full　moon；　was　suggested　as　a　specific　by　Sir　Robert　Gordon。　Theodore　De　Vaux　remarks　that　the　person　bitten　should　immediately　pluck　the　feathers　from　the　breech　of　an　old　cock　and　apply　them　bare　to　the　bites。　If　the　dog　was　mad　the　cock　was　supposed　to　swell　and　die。　If　the　dog　was　not　mad　the　cock　would　not　swell；　in　either　case　the　pers