“I saw the child again on the following day. Generalised œdema and tumefaction of the bitten limb. Heart excellent; no vomiting, no fever. I again gave an injection of 20 c.c. of serum, and ordered a continuance of damp phenic dressings to be applied to the entire limb. Condition very good.
“On June 25, no fever at the time of my visit. Pulse irregular. Ordered treatment to be continued.
“I did not see the patient for four days, when I was summoned by telegram. I found that the child had fever, 39° C. Complete tumefaction of the left leg, abdomen, and trunk, with ecchymosed patches. Prescribed quinine. Arhythmia of pulse and heart. Prescribed digitalis and Jaccoud’s tonic. The febrile condition was due to congestion of the base of the right lung. I ordered cupping and sinapisms alternately.
“I saw the child again two days later. The congestion still continued. Temperature 39° C., but the general tumefaction showed a tendency to diminish.
“On July 4 I again saw the child. Now only slight œdema. General condition very satisfactory. Temperature normal. The child was making rapid strides towards recovery. The leg was doing well, and the wound was almost healed.
“Summary: A very serious bite and, above all, great delay in injecting serum (injection not given until four hours after the accident); unforeseen complications in the lung, by which recovery was delayed.”
XXV.—Case reported by Mons. H. Moindrot, Assistant to Dr. Martel, of Saint-Étienne (Loire).
“Claude L., aged 8, living at Ricamarie, was brought, on May 26, 1904, to the Bellevue Hospital. The parents stated that about 10 o’clock the same morning, while playing near a stack of faggots, the child was bitten by a snake in the third finger of the right hand. Since the wound caused by the bite seemed to them of little importance, they contented themselves with squeezing the injured finger in order to make it bleed a little. A few moments later, however, the child began to complain of a feeling of distension in the region of the bite, caused by œdema, which soon increased to an alarming extent. A doctor, who was called in, carefully washed the wound, applied an aseptic dressing, and at once sent the little sufferer to the Hospital.
“On admission, enormous œdema, including fingers, hand, entire right arm, cervical region on the same side, and the anterior face of the thorax, nearly as far as the inner margin of the false ribs. This œdema was not very painful, though fairly tense, yielding but slightly to pressure. In the affected region the skin was cold, of a dull livid colour, with a few ecchymosed patches. In the bitten finger, a small wound with no special characteristics.
“General condition bad; the child was unable to stand. He was indifferent to what was passing around him, merely groaning a little when examined. The pulse was feeble, thin, and easily compressible; it was also very irregular. The extremities were cold. Lungs: nothing abnormal on auscultation, rapidly performed, it is true. Respiration, however, was distinctly accelerated, 30 per minute. Temperature not taken on admission. No urine passed since the accident.