Part 47

One case in particular which I recall was a young lady, about twenty years of age, a natural blonde, skin fair, bluish white, showing prominent veins, who had a glandular enlargement in the right supra-clavicular region, nearly the size of a goose egg, and one somewhat smaller a little farther back in the interval between the sterno-cleido mastoid and trapezius muscles. These had a certain amount of hardness, but they were movable. Others of the cervical chain were also enlarged, the right side being the only one affected. As the young lady was engaged to be married, these unsightly lumps were very distressing. Lapis albus 6, a powder four times a day, in a week caused a marked diminution of the size of the glands, and in three weeks they were not noticeable, and eventually entirely disappeared. This patient also had a ravenous appetite while taking the remedy, an unusual thing for her. Her anaemic color and complexion were also greatly improved.

The most remarkable effect of the use of the remedy I have had was in the case of goitre in a lady of about thirty-five, blonde, who had for over a year noticed a gradual increase in the size of the thyroid gland, until it was as large as a good-sized fist, when she came to me. Both halves of the gland seemed to be equally involved. It did not appear to be of the encapsulated variety. This patient had received previous homoeopathic treatment, having had Spongia, Iodine, Thuja, as well as some other remedies. Lapis albus 6 was prescribed, a dose every three hours. The swelling began to disappear at once, and continued to diminish in size until it completely disappeared, and at the present time over five years have passed with no return of the trouble.

LATRODECTUS MACTANS.

PREPARATION.--The spiders are triturated in the usual way.

(The following paper by Dr. Samuel A. Jones appeared in the Homoeopathic Recorder, July, 1889, under the title, "Latrodectus Mactans: a Suggested Remedy in Angina Pectoris"):

"The great result of the grim doctor's labor, so far as known to the public, was a certain preparation or extract of cobwebs, which, out of a great abundance of material, he was able to produce in any desirable quantity, and by the administration of which he professed to cure diseases of the inflammatory class, and to work very wonderful effects upon the human system."--Dr. Grimshawe's Secret.

I do not know that the doctor who is the direct occasion of this paper was grim, nor do I imagine he ever dreamed of such an application of his paper as I purpose to make. I never met him; though he wore the gray and I the blue during a struggle wherein fate might easily have thrown us together. It was not until the autumn of '76 that I became aware of his existence, and then by a contribution of his to a medical magazine--the special copy of which was found amongst the multifarious waifs of a bookstall. I could not "decline the article," although I was then entering upon a field of labor that would leave little time for such quiet research as the old doctor's paper so powerfully suggested, so I bought the odd number, and fourteen years later I am making such use of it as my sense of its significance enforces.

It is due Mr. A. J. Tafel to state that but for his most efficient services this paper of mine would never have been written. To his endeavors, stretching through some years, I owe the identification of the remedy, without which I should not have put pen to paper; and having secured this, from unimpeachable authority, too, he never rested from his labors until he had put in my possession dilutions of the poison itself. If, then, this magis venenum shall prove itself magis remedium, most assuredly the pars magna of its introduction is his.

From the days of Dioscorides and Pliny to the present a venomous quality has been ascribed to "the fluid emitted from the orifice in the fangs of the arancidae." That this quality was even lethal has been both believed and questioned. Insect Life, Vol. I., No. 7, pp. 204-211, Washington, 1889, contains "A Contribution to the Literature of Fatal Spider Bites," in which the credulity of mere medical observers and the emphatic incredulity of professed "entomologists and arachnologists" are dwelt upon, and concerning which its author cautiously concludes as follows:

"It will possibly appear to the reader that after collecting this testimony we are as far from the solution of the question--'Do spider bites ever produce fatal results?'--as we were before; but it seems to us, after analyzing the evidence, that it must at least be admitted that certain spiders of the genus Latrodectus have the power to inflict poisonous bites which may (probably exceptionally and depending upon exceptional conditions) bring about the death of a human being. Admitting in its fullest force the argument that in reported cases the spider has seldom if ever been seen by a reliable observer to inflict the wound, we consider that the fact that species of the Latrodectus, occurring in such widely distant localities as South Europe, the Southern United States, and New Zealand, are uniformly set aside by the natives as poisonous species, when there is nothing especially dangerous in their appearance, is the strongest argument for believing that these statements have some verification in fact. It is no wonder that a popular fear should follow the ferocious-looking spiders of the family Theraphosoidae; but considering the comparatively small size and modest coloring of the species of Latrodectus so wide-spread a prejudice, occurring in so many distinct localities, must be well founded." P. 211.

Is it indeed an argument that "in reported cases the spider has seldom if ever been seen by a reliable observer to inflict the wound?" How an Orfila, a Christison, and a Caspar would smile when asked if the evidence of a poisonous quality depended upon the administration of the poison being "seen by a reliable observer." Toxicology detects a poison by the physiological test as well as the chemical. Strychnia in quantity too small for the coarse chemical test is revealed by the tetanized muscles of a frog whether that "arch martyr to science" be in "South Europe, the Southern United States, or New Zealand," and that infinitesimal fractions of Strychnia will display its characteristics whether or not its administration is "seen" by a Christison, or a college janitor. Of course, a Christison would recognize Strychnia from and in the phenomena, while a college janitor (and here and there an over-scientific entomologist) might not.

It is neither the aim nor the purpose of this paper to establish the lethal property of spider poison; though I must acknowledge that, until I read the paper in Insect Life, I had no thought that its possession of such a property would be called in question. I shall content myself with calling attention to the pathogenetic quality of the poison of Latrodectus mactans, leaving my reader to discern the resemblance of its tout ensemble to an attack of angina pectoris, and therefore to infer its homoeopathic applicability in that dread disorder. I shall not enter upon the pathology--various and much confused--of that cardiac seizure, because, as I get older, I find the "like" more and more of a "pillar of cloud by day and pillar of fire by night," whilst in my short life I have found "pathology" as changeable as a dying dolphin--and every one knows that a dead fish "stinks and shines, and shines and stinks."

CASES OF SPIDER BITE.

BY G. WILLIAM SEMPLE, M. D., HAMPTON, VA.

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 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."