Part 15

CASE I.--Bruce McG., æt. 15, dark hair, gray eyes, spare habit, rigid fibre, nervous, quick, active, called at my office in the evening complaining of sore throat, worse on right side, and on swallowing. Headache dull and heavy, slight fever. Inspection revealed tonsils and fauces congested and angry looking. On right tonsil a patch of membrane the size of a split pea was seen.

_Lycopodium_ 30x was given. The next morning the entire trouble seemed to have gone to the left side; with it had come, also, stiff neck and tongue; profuse flow of saliva; temperature 101 F. Membrane somewhat larger. _Mercurius ruber_ 30x was given. In the evening the trouble was worse again on right side, the membrane now entirely covering both tonsils, temperature 102 F. Limbs ached, back ached, and patient was restless. Remembering the symptom, "membrane alternates between right and left sides," and this having been so characteristic, I gave _Lac caninum_ in the 30th potency. Improvement began immediately and at the end of the third day the membrane was entirely gone and case discharged as far as medicine was concerned.

CASE II.--Louisa McG., æt. 13, in temperament exactly like her brother, the preceding case. Was irritable and listless for two days, but owing to the fact that the fair began in a few days, to which she was determined to go, she did not complain. The third day, however, her mother noticed that she was truly sick and, there being a number of cases of diphtheria in town, looked into her throat. She found both tonsils covered with a membrane. I was called and as no other symptoms could be elicited I gave _Sulphur_ 30x and told them I would call again in the evening, which I did and found symptoms rapidly developing. Aching in all the limbs; headache; pain in the throat on swallowing; worse on the right side; neck and tongue stiff; membrane just the same. Temperature 101.5; same remedy continued.

Next morning the membrane was the same, pain now in left side, throat internally and externally oedematous, fauces and uvula glossy or varnished in appearance. Temperature 102, urine scanty, no thirst. _Apis_ 30x was now given. In the evening pain back in right side again. Temperature 102.5. Membrane spreading; stiffness of neck and tongue more marked and saliva profuse. Not having seen the case till the membrane had quite generally formed, but the patient being in temperament like her brother and the pain shifting from side to side, as in his case, I decided to give her _Lac caninum_. Improvement began immediately and at the end of four days the membrane was entirely gone.

CASE III.--The servant girl in the family where cases one and two had been, Anna B., æt. 17. In temperament the very opposite to the other cases, being fat, fair and flabby. Complained of pain in right side of throat on swallowing, neck stiff, tonsil slightly congested. Felt as if she had a bad cold. Advised her to come to the office and get some medicine. She had, however, some "dope" on hand and said she guessed she would take that first. Next evening I was called and found her with throat much worse. Membrane covering left tonsil entirely, also a narrow strip of membrane on posterior wall of pharynx, pain in left tonsil on swallowing, neck and tongue stiff, saliva quite profuse. Temperature only slightly above normal. _Lac caninum_ 30x was given. Patient never went to bed and at the end of the second day no trace of membrane could be seen.

Now, the symptoms common to all three cases and the only ones characteristic in each case were, first, both pain and membrane shifting from side to side; second, stiffness of neck and tongue; third, profuse saliva; fourth, aching in limbs marked; fifth, entire absence of prostration; sixth, character of pain was "as if throat was burned raw." Now, the question will arise in the bacteria man's mind, was this real diphtheria; were the German's bacteria present? I will answer candidly, I don't know; I never looked for them.

LAPIS ALBUS.

SYNONYM. Silico-Fluoride of Calcium.

PREPARATION.--The residue obtained by evaporation, from the waters of the mineral springs of Gastein, Germany, is triturated in the usual way.

(It was Von Grauvogl who first called attention to this drug, the product of certain mineral springs in Germany, that have reputation for curing ulcers, cancers, tumors, etc. In the Transactions of the American Institute of Homoeopathy, 1896, will be found the following by Dr. W. A. Dewey):

My experience with this remedy, and I have been somewhat interested in it, dates from about 1876. At that time a member of my own family had an enlargement of one of the cervical glands. It was nearly as large as a hen's egg, and had a soft, doughy feel. Under _Lapis albus_ 6, prescribed, I believe, by Dr. G. E. E. Sparhawk, now of Burlington, Vt., the swelling speedily and completely disappeared. A peculiar and unusual symptom noticed by this patient while taking the medicine was a marked increase in the appetite; it became ravenous.

Since that time I have used the remedy in many cases of scrofulous enlargement of the cervical glands, and find that it is almost specific where the glands have a certain amount of elasticity and pliability about them, rather than a stony hardness, such as might call for _Calcarea fluorica_, _Cistus_ or _Carbo animalis_.

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 anæmic 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 arancidæ." 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 Theraphosoidæ; 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.[J]

[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 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 [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 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 [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 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.

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 | +-----------------------------------------+---------+----------+