[J] _Virginia Medical Monthly_, Vol. II., No. 9, pp. 633-38,
1875. "He was commissioned surgeon in the Confederate army,
July 1, 1861; served until August 1st in the field on the
peninsula; then placed in charge of hospital in Williamsburg;
afterwards ordered to Richmond and placed in charge of an
hospital, and remained until close of war." Failing to find
any further trace of him I am led to believe that he has been
mustered out of service by the Grand Commander.
"Spider bites are of rare occurrence in this vicinity, but are generally
productive of grave symptoms. [Isn't it bad taste for doctors to use the
words grave symptoms?] I will report all that have occurred to me in a
practice of forty years:
"CASE I. September 4, 1853. I was called to see Mr. D., at Old Point,
who had been bitten by a small, black spider on the prepuce, whilst on
the privy seat, at 12:30 o'clock. The bite at first caused only itching
of the prepuce, with a little redness of the part, but in less than half
an hour _nausea_, followed by _severe abdominal pains_, ensued. A
messenger was dispatched in haste for me to Hampton, three miles off.
Before I reached the patient, at 2:30 o'clock, _violent praecordial pains
extending to the axilla, and down the_ [left] _arm and forearm to the
fingers_, with _numbness of the extremity_, had succeeded, attended by
_apnaea_.
"In consequence of the violence of the symptoms, Dr. Stineca, surgeon of
the post, had been sent for, who had given two doses of _Laudanum_ of
[Latin: ezh]j each, and two of rectified whiskey of [Latin: ezh]ij each,
and, being in ill health and unable to remain, had ordered his steward
to apply four dry cups over the praecordia. This had just been done when
I arrived. I saw the _blood, thin and florid_, fill the cups like water
oozing through the muslin. When the cups were removed, the _blood_,
emptied into a basin, _did not coagulate_; and blood continued to ooze
slightly from the surfaces to which the cups had been applied until the
next morning, though a solution of _Tannin_ was applied.
"I found the patient _suffering extremely from the most violent
praecordial pains and from apnaea_, and also _violent pain in the left_
arm, which was almost _paralyzed_. His _pulse_ was 130 _and very
feeble_, his _skin cold_ as marble, and his _countenance expressive of
the deep anxiety_ he felt and expressed in words. The laudanum and
whiskey seemed to have produced no effect--the nausea and abdominal
pains having subsided before they were administered. There was no pain,
inflammation, or swelling where the bite was received. Even the itching
of the part had subsided. I gave the patient every half hour for several
hours [Latin: ezh]j of aromatic spirits of ammonia, and as much whiskey
and water as he could be induced to take, and afterwards gave them every
hour; also pediluvia of hot mustard and water, frequently repeated,
until the next night.
"September 5th, 8 A.M.--The symptoms continued unabated; indeed, the
patient grew worse until 2:30 o'clock, twenty-six hours after he was
bitten, for his _pulse_ had then become _so frequent that it could not
be counted, and so feeble that it could scarcely be felt_. He then
_vomited black vomit_ copiously--a quart or more. Soon afterwards
reaction set in, his pulse gradually gained force, and became less
frequent, the pain subsided and the respiration improved. At 8 P.M., the
pulse had gained considerable force, and the patient slept until some
minutes after 12; his pulse was pretty full at 1:10; his surface warm
and perspirable, and he felt almost free of pain. After a short interval
he again fell asleep, and slept quietly until morning, when he
awoke--his respiration healthy, pulse 80, regular and with sufficient
force, and entirely relieved of pain. He soon afterwards had _two pretty
copious evacuations from the bowels_, similar to the black vomit he had
vomited. After this he said he felt quite well, and took a light
breakfast and dinner, and returned that evening to his residence in
Portsmouth, and in a few days went to work at his trade.
"In thirty-six hours from the time he was bitten, he took three and a
half quart bottles of the best rectified whiskey--about three quarts
without showing the least symptom of intoxication."
I have cited this case at full length in order to present the _evolution
of the symptoms_, on which alone depends the resemblance of the action
of the poison to the chief symptoms of an attack of angina pectoris--a
closer resemblance than half a lifetime of somewhat wide reading has
enabled me to find in the effect of any other noxious agent. In fact,
after much searching, I find this case to be unique. In other cases of
spider bite I can find evidence that assures me of its genuineness, but,
to my knowledge, its _order of symptom evolution_ is as solitary as it
is singular and significant. This feature of _uniqueness_ will cause
many to regard it with suspicion. I think they will do wrong; for some
experience in proving work has taught me that one positive result from a
drug out-weighs any number of negative.
In the case of _Latrodectus mactans_ we shall find, from other
poisonings, that, as a rule, it displays an affinity for the praecordial
region as the _locus_ of its chief attack; and having assurance of that
fact, we shall not find it difficult to accept a clue from even a
solitary instance.
Of the remaining cases in Dr. Semple's paper I shall cite only the
symptoms, and be it observed that in all the cases as here given the
italics are my own.
CASE 2. A man "was bitten in the groin, and complained of only a slight
prickling and itching at the spot where he was bitten, but was
complaining [when Dr. S. saw him] of _severe abdominal pain_, with
_nausea_, and a _sinking sensation at the epigastrium_; and his _pulse_,
in a few minutes after the bite, had already become _quick and thready_;
and the _skin very cold_." The man soon recovered under ammonia and
whiskey--two quarts of the latter produced no symptoms of intoxication.
CASE III. A lad of eighteen years of age. "There was no pain, but only
itching and redness at the part bitten at first; but _violent pain soon
commenced there_ [on the back of the left hand] _and extended in a short
time up the forearm and arm to the shoulder and thence to the praecordial
region_."
CASE IV. "A tawny woman [daughter of a quadroon mulatto woman] about
twenty-two years old, the mother of two children." "Found her
_apparently moribund_; her _skin_ as _cold_ as marble; _violent pain
extending from the bite on the right wrist up the forearm and arm to the
shoulder, and thence up the neck to the back of the head on the right
side_; more _violent pain in the praecordia_, _extending thence to the
shoulder and axilla on the left, and down the arm and forearm to the
ends of the fingers_, and _this extremity partially paralysed_; added to
this, _apnaea was extreme; the respiration only occasional--gasping_; the
_pulse could not be felt in the left radial_, and I was not sure that I
felt it in the right."
In about fifteen minutes after the intra-venous injection of 13 minims
of undiluted _Aqua Ammoniae_, the doctor "was astonished at the calm and
painless expression of her _countenance_, so lately _expressive of
anxiety and pain_."
CASE V. A healthy young girl of 13. She felt a stinging sensation on the
[right] wrist, accompanied by itching and redness at the spot [bitten].
For several minutes there was but little pain, but in half an hour a
_painful sensation_ began to be felt at the spot, which quickly
_extended up the arm to the shoulder_, and, in the course of an hour,
_along the neck to the back of the head_. * * * _Pain in the praecordial
region, with apnaea_ coming on, I was sent for. When I arrived she was
screaming fearfully with _pain_, and frequently exclaiming she would
_lose her breath and die_. The _pulse_ had become _thready_ and the
_surface cold_.
From these _data_ the poison of _Latrodectus mactans_ is suggested for
trial in _angina pectoris_, in that its physiological action presents
the closest _similimum_ yet found.