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 a.s.sures 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 a.s.surance 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 p.r.i.c.kling 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_."
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 praecordial region, with apnaea_ 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 12II. Abdominal pain 12III. Countenance anxious 14IV. Pain up arm to shoulder,thence to back of neck4 5V. Praecordial pain extending toleft axilla, and down arm tofinger ends 14VI. Left arm almost paralyzed 14VII. Pain up arm to shoulder,thence to praecordia34 5VIII. Apnaea 14 5IX. Praecordial pain 134 5X. Pulse feeble, thready 124 5XI. Skin cold 124 5XII. Sense of impending dissolution 14 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._
It must be admitted that many of our accepted provings cannot as well bear a similar test.
III.
There is another feature that the believer in the law of similars should find no insuperable difficulty in accepting as a criterion of the validity of a proving, namely: _the similarity of the drug symptoms to certain disease symptoms_. I am not ready to believe that drug symptoms are only the result of a "fortuitous concourse of atoms," nor can I for one moment imagine that they are the product of blind and aimless chance. I plainly discern in them the result of law, and I am wholly unable to conceive of existing law without the absolutely necessary _pre_-existing law maker. The consequent must have its antecedent.
Therefore, in a drug symptom I see a purpose, and by the light of the law of similars I find the purpose of a drug symptom in an a.n.a.logous disease symptom--they answer to each other as face unto face in the refiner"s silver--and behind and beyond them both is another purpose, of wisdom inscrutable, of love unfathomable. In a word, my reader, the problem of the visible universe forces upon me the alternative that weighed upon Marcus Aurelius--"either G.o.ds, or atoms." With atoms only I cannot account for law; with G.o.d and in G.o.d both atoms and law find a meaning and a purpose.
If I were submitting these convictions, or, if you will, this "working hypothesis," to a Sir Thomas Browne, or a William Harvey, or a Thomas Sydenham I should feel no momentary hesitation; as it is, I can only hope that the spirit that filled these worthies is not extinct in days when the "spiritual colic" that disordered an imaginary _Robert Elsmere_ is thought to disturb the eternal Verities. I much doubt if they who mistake an eclipse for an annihilation will get any good from this poor pen of mine.
The resemblance between the symptoms of angina pectoris and the effects of the poison of _Latrodectus mactans_ are so striking as to justify the presentation of a comparison; and it is hoped that physicians of wide reading will pardon what may seem to them a piece of supererogation for the sake of many a humbler pract.i.tioner whose opportunities have not been so happy. At the same time, the widest reader must admit that he has not found any one authority who has given a complete picture of angina pectoris. Nor is it essential that such an all-including "composite" shall now be presented; on the contrary, we shall offer only salient points substantiated by observers of the highest order.
It will be well to start from an authority whose scholarship has never been excelled--_Copland_. Of all our medical writers he may be called the _Great Definer_--his readers will know what that means.
"_Acute constricting pain at the lower part of the sternum, inclining to the left side, and extending to the arm, accompanied with great anxiety, difficulty of breathing, tendency to syncope, and feeling of approaching dissolution._"
Copland presents a group of constants, and, for a terse definition, has well covered the princ.i.p.al phenomena. As variants he has omitted the pulse and the surface temperature. He errs on the side of dogmatism in defining the character of the pain as "constricting;" "aching, burning, or indescribable," and "generally attended with a sense of constriction" is more in accordance with the actual condition. Of Copland"s seven constants, Case 4 presents an a.n.a.logue for each in symptoms IX., V., III., VIII., XII., and the "tendency to syncope,"
which is not included in our table because Dr. Semple did not put the fact in express words. If to this group we add the _thready pulse_ and _cold skin_, we shall have "covered" nine of the most prominent symptoms of angina pectoris; a pathological "composite" with a most striking pathogenetic _similimum_.
But all the elements of Copland"s group are not of equal importance; two of them, at least, are pathognomonic. "The two const.i.tuent elements of the paroxysm," says Latham, are "the sense of dissolution and the pain."
"Pain with one awful accompaniment may be everything." "This mixture of the sharpest pain with a feeling of instant death." According to Fothergill "the two prominent subjective phenomena are pain in the chest and a sense of impending death." Eulenburg and Guttmann include another element: "We regard the substernal pain, the feeling of anxiety, and the disturbance of the heart"s action, as the essential symptoms of angina pectoris." Romberg notes the companionship of these two elements: "The patient attacked with angina pectoris is suddenly seized with a pain under the sternum in the neighborhood of the heart, accompanied by a sense of anxiety so intense as to induce a belief in the approach of death."
We have laid the emphasis of these various citations on the "essential symptoms" in order to a.s.sert, with equal emphasis, that their a.n.a.logues occur in not only one case of _Latrodectus mactans_ poisoning. The praecordial pain is noted in Cases 1, 3, 4 and 5, and the sense of impending dissolution in Cases 1, 4 and 5. And that disturbance of the heart"s action which Eulenburg and Guttmann consider an essential element is found in Cases 1, 2, 4 and 5; so that the _tout ensemble_ presented by Case 4 is corroborated.
Another important element, though it is one subject to variations, is the direction of the extension of the pain. It most generally extends to the left axilla, and down the arm to the fingers; as variations it sometimes affects the right axilla and the back of the head. In Cases 1 and 4 the spider poison followed the direction of the disease, and in Cases 4 and 5 it also affected the back of the head. In Case 1 it produced the numbness of the arm and hand that is sometimes observed in the diseases.
Copland includes "difficulty of breathing" amongst the elements of angina pectoris. Trousseau does not regard this difficulty as real.
"Although patients think they are going to be suffocated during a paroxysm, the chest is normally resonant on percussion, and if it be auscultated as they draw in breath again vesicular breathing is heard everywhere." Watson says, "the patient is not necessarily out of breath.
It is not dyspnoea that oppresses him; for he can, and generally does, breathe freely and easily." Stokes is decided: "Respiration is _secondarily_ affected; there may be slight dyspnoea or orthopnoea, with lividity of the face, yet by an effort of the will (if the patient dares to encounter the pang this commonly produces) the chest may be pretty freely expanded, and the breathing relieved for a brief s.p.a.ce; dyspnoea is not a primary symptom of angina." Eulenburg and Guttmann say, "Our own experience leads us to adopt Parry"s conclusion, that the changes in the respiration are princ.i.p.ally, perhaps even solely, due to the pain." Bristowe speaks of the sufferer as "fearing to breathe." We can readily see that the "apnaea" observed by Dr. Semple in Cases 1 and 5 had physical origin, but in Case 4 he says "apnaea was extreme; the respiration only occasional--gasping." This shows to what an extreme extent the action of the spider poison had gone--even to implicating the diaphragm; and it is noteworthy that Anstie records a case of angina pectoris (_Neuralgia and its Counterfeits_, p. 67, London, 1871), in which "there was so marked a catching of the breath as to make it almost certain that there was a diaphragmatic spasm."
Of the changes in respiration accompanying angina pectoris we have, then, both the general, and the rarest, form, produced pathogenetically by the poison of _Latrodectus mactans_.
IV.
In its physiological action the poison of _Latrodectus mactans_ resembles angina pectoris vasomotoria--a purely functional derangement.
The similitude of the physiological action to pure angina pectoris corroborates the accepted pathology of the latter condition, because the phenomena of _Latrodectus_ poisoning were educed from previously healthy organisms, and in pure angina pectoris there is no pre-existent organic change occasioning the attack. According to the accepted pathology, we have in angina pectoris vasomotoria, sudden spasms of the arterioles; from this an increase of the arterial tension; to overcome this is more forcible and rapid action of the heart; as the arteriole spasm persists and doubtless deepens in intensity, distension of the left ventricle follows, and from overdistension the agonizing breast-pang, and even death from stoppage of the heart"s diastole. But we must include another element--spasm of the coronary vessels. "When there is a sudden rise in the blood-pressure in the arteries, due to vasomotor spasm of the peripheral systemic arterioles, and the heart-walls are strong and well nourished, palpitation is evoked; when the coronary branches are involved in the vasomotor spasm then angina is produced, and the heart-walls, acutely distended with blood, can scarcely contract in the face of the opposition presented to their contraction by the high arterial tension. When this sudden systemic arteriole spasm extends to the coronary vessels in a heart whose walls are diseased, a fatal attack of angina with the heart full of blood may be induced. The danger increases with the extent of the structural degeneration of the heart-walls. Sudden rises of blood-pressure in the arteries will tax hearts in their textural integrity, and lead to painful distension; such sudden demands on decayed hearts lead to agonizing angina pectoris, and the sense of impending dissolution is frequently followed by sudden death."
Spasm of the arterioles and coronary vessels, rise of blood-pressure in the arteries, embarra.s.sed action of the heart, and painful distension are just so many consecutive links in the phenomena produced by the poison of _Latrodectus mactans_, as Cases I and IV amply testify.
The spider poisons are akin to the serpent poisons in their property of producing a disorganization of the blood. In Case I, thin and florid non-coagulable blood continued to ooze from the cut surface despite the application of tannin. It may be a question whether this condition of the blood is directly toxicological, or a pathological result of stasis in the peripheral vessels. I incline to regard it as due to the latter condition, and I believe this explanation also holds good in the case of serpent poisoning.
The haemorrhage recorded in Case I was of gastric origin; splenic congestion existed, and the vasa brevia--branches of the splenic artery--gave way under the pressure. I once met a similar haemorrhage in a case of intermittent fever in a child, and I recorded the fact as a possible hint for the applicability of _Latrodectus mactans_ in a similar condition.
In all the year that the stray copy of the old magazine was in my possession I felt it a duty to write up this remedy. I have done it lamely, but as well as I was able. Reader, where my duty ends yours begins. May you discharge it more worthily than I.
(There have been a number of cases reported in which _Latrodectus mac._ acted as Dr. Jones predicted; from them we select the following by Dr. E. H. Linnell, _North American Journal of h.o.m.oeopathy_, December, 1890):
S. L. G., a man fifty years old, of bilious temperament, a dentist by profession, had slight attacks of angina after severe exposure and overexertion during "the blizzard" in March, 1888. He did not consider them of sufficient importance to consult a physician about them, but some months later he had a suppurative prostat.i.tis, which was followed by considerable prostration, and the attacks of angina became very severe. I never could get a satisfactory description of the character of the pain, and I never saw him during a paroxysm. The pain was brought on by exertion of any kind, and was especially frequent soon after dinner.
The pain was sometimes felt in the left arm, but was usually confined to the cardiac region. I once or twice detected a slight aortic obstruction sound, but aside from this failed to find any evidence of organic disease. The usual remedies gave no relief, but _Latrodectus_ [Latin: ezh]c was of great benefit. Under its use the attacks gradually became less frequent and less severe. He has taken no medicine now for at least six months, and he tells me that although he occasionally has a little reminder of his former trouble, the attacks are so slight that he pays no attention to them. I have given the remedy in another similar case, with even more gratifying success. The attacks were very promptly arrested and have not returned, although nearly a year has elapsed. I think we have in this remedy, to which Dr. S. A. Jones directed attention in one of the issues of the _h.o.m.oeopathic Recorder_, a very valuable remedy in this painful affection. It is probably, as Dr. Jones suggests, in angina pectoris vasomotoria that it will be found especially serviceable.
LEMNA MINOR.
NAT. ORD., Lemnaccae.
COMMON NAME, Duckweed.
PREPARATION. The fresh plant is pounded to a pulp and macerated in two parts by weight of alcohol.
(The following is by Dr. Robert C. Cooper, of London, and appeared in the _Hahnemannian Monthly_, 1894):
"The lowest form of phoenogamous vegetation. It consists," says Lindley, "of lenticular floating fronds, composed of stem and leaf together and bearing the flowers in slits in the edge." It forms the green sc.u.m found on stagnant ponds and d.y.k.es. It is found in two varieties, the _Lemna minor_ and the _Lemna gibba_.
Before going any further I may as well at once make a bald as well as a bold statement, and say that the special province of _Lemna minor_ is to pitch with vigor upon the nostrils; from the very moment I began prescribing it this was beyond question evident. I can think of no possible source of error except that this beneficial action may be due to the germs adhering to the fronds of the _Lemna_ rather than to the pure plant-force.