"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.