Cases of Spider Bite.
BY G. WILLIAM SEMPLE, M. D., HAMPTON, VA.[J]
"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 præcordial pains extending to the axilla, and down the [left] arm and forearm to the fingers, with numbness of the extremity, had succeeded, attended by apnæa.
"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 ʒj each, and two of rectified whiskey of ǯij each, and, being in ill health and unable to remain, had ordered his steward to apply four dry cups over the præcordia. 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 præcordial pains and from apnæa, 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 ʒj 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 præcordial 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 præcordial 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 præcordia, 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, apnæa 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 Ammoniæ, 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 præcordial region, with apnæa 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.