FOOTNOTES:
[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.
II.
It may be well to offer a critical examination of the foregoing cases. If they are genuine effects of the poison of Latrodectus mactans, they must afford a recurrence of corresponding symptoms. They may differ in degree, because the quality of the venom may vary; first, from the season in which the bite occurred (and judging from cases I, IV and V, the poison of Latrodectus mactans is most virulent in the month of September), and, secondly, from the more thorough elaboration of the venom. It is known that the poison of Crotalus horridus differs in intensity according to the frequency with which the snake has bitten in a given period of time; of four successive "strikes" in four different organisms, and at brief intervals, the intensity of the action will vary, so that while the first wound is lethal the last is not—on which fact depends the vaunted reputation of many an antidote to the bite of the rattlesnake. That this may be also true of the spider poison is the only explanation I can offer for the fact that many naturalists have allowed themselves to be bitten by spiders of reputed poisonous species, and with impunity.
Recurrence of Corresponding Symptoms.
(Arabic numerals refer to the Cases.)
| I. | Nausea | 1 | 2 | |||
| II. | Abdominal pain | 1 | 2 | |||
| III. | Countenance anxious | 1 | 4 | |||
| IV. | Pain up arm to shoulder, | |||||
| thence to back of neck | 4 | 5 | ||||
| V. | Præcordial pain extending to | |||||
| left axilla, and down arm to | ||||||
| finger ends | 1 | 4 | ||||
| VI. | Left arm almost paralyzed | 1 | 4 | |||
| VII. | Pain up arm to shoulder, | |||||
| thence to præcordia | 3 | 4 | 5 | |||
| VIII. | Apnæa | 1 | 4 | 5 | ||
| IX. | Præcordial pain | 1 | 3 | 4 | 5 | |
| X. | Pulse feeble, thready | 1 | 2 | 4 | 5 | |
| XI. | Skin cold | 1 | 2 | 4 | 5 | |
| XII. | Sense of impending dissolution | 1 | 4 | 5 |
While Dr. Semple's reports do not precisely state it, I think we may safely infer a sense of impending dissolution in cases I, IV and V. The girl exclaimed she "would lose her breath and die;" the man in case I "expressed in words" "the deep anxiety he felt;" the woman in case IV was found "apparently moribund" with "gasping respiration," and therefore incapable of speech, but who can doubt that she had a sense of impending dissolution?
Isolated Symptoms.
- Numbness of the arm, 1.
- Black vomit, 1.
- Alvine evacuations similar to the black vomit, 1.
- Sinking sensation at epigastrium, 2.
- Respiration only occasional—gasping, 4.