Vespa crab, Hornet; Guepe-frelon. Vespa vulgaris, Wasp. Order, Hymenoptera. Sub-order, Vespidae. Preparation: Tincture.
Next day, about 4 A.M., I was suddenly awoke by a sudden burning and stinging sensation in my cheek, and a great soreness and smarting along the course of the lymphatics down into my neck. I found my cheek much swollen and red, and there was a patch of redness about the size of a florin that felt as though it were being pierced with red-hot needles. The temporomaxillary joint was stiff and painful, and a feeling of soreness ran along the gums to the tonsil on that side of my face. After bathing for awhile the affected parts, I got into bed again, feeling somewhat relieved, and fell asleep; but about two hours afterwards, I was again suddenly roused, this time by a sense of suffocation and difficulty of swallowing, and a renewal of the former distress, with intensified severity. Feeling alarmed, I obtained some hot water, to which I added a few drops of tincture of Ledum, and fomented the whole of the affected region until the severity of the symptoms abated. During the remainder of that day, and for four days, afterwards, the attacks continued to return in paroxysms of more or less severity. The submaxillary and cervical glands on that side of my face became increasingly swollen and tender till the fourth day, when these conditions began gradually to abate; but in the immediate locality of the wound the pains assumed a more constant character, throbbing, smarting, and burning; still there was a marked periodically about the stinging and lancinating pains experienced for more than a month afterwards, although the wound suppurated and discharged freely. The general and constitutional disturbances were marked by slight rigors and febrile conditions, felt mostly in the evening, but I was not able to give much attention to them. Found her in a state of terrible anxiety, with eyes and face edematous, and quite unable to articulate or to protrude her tongue, but she could open her mouth a little, and I could see the sting imbedded in the middle of the middle third of the tongue; I at once extracted it. Tongue itself, with its root, and the whole floor of the mouth so swelled that the cavity of the mouth was entirely filled therewith, and then nothing else could be seen. She could not articulate a single word. She suffered great pain in the tongue, which she subsequently described as burning, throbbing, and aching. Her great anxiety was probably not due to the sting, but from fear arising from the evil repute of wasp-stings in general. To me the point of interest lies in the similarity of the appearance of the patient’s face, mouth, and throat to a severe synanche. There was great dysphagia, so that she could not swallow the teaspoonful of medicine, but was obliged to swallow it in halves, and that with extreme difficulty. The surface of the tongue and the lining of the cavity of the mouth did not seen specially red, the entire swelling being diffuse and deep seated. Was stung all over by wasps four or five years ago, this was followed by abscesses all over the body that caused great emaciation; every now and then gets seizures of prostration, with enuresis somni; heat especially overpowers him. Purulent catarrh of the middle ear of both sides.
Alopecia (after five years). Slight oedema pedum (After five years. Quaked and trembled, and may teeth chattered as if I had a paroxysm of ague. In less than an hour his hand became greatly swollen and painful, which followed immediately by swelling and puffiness of the lower lids and scrotum, together with integuments of the penis; the parts were swollen more than twice their usual size; almost immediately the skin on the abdomen arms, legs, neck, and nearly all the back turned purple (almost black), which was followed by an eruption of Urticaria which completely covered the body; two or three hours after the sting, his eyes nearly closed, and this dark color and urticaria were fully developed; they all continued about twenty-four hours, when they gradually disappeared in the order in which they came on, 12. Within ten minutes his thumb became considerably swollen, and the whole of his face, especially the eyelids, became swollen and puffy; very shortly the face, and more particularly the ears became very red, as if covered with a scarlet rash; the child was very restless during the night; he complained much of a sensation of heat, and much irritation; wherever he scratched himself there arose little spots, like the blain of nettle rash. There was some swelling and redness of the left hand and arm; but the most marked symptom was the swelling and redness of the face, which reminded him of erysipelas. After forty hours there was considerable oedema of the eye-lids especially of the lower, and the face was pallid and puffy. Swelling of the mouth and throat, with violent burning pains, nausea, and vertigo, so that the patient was obliged to go to bed. After two hours she was found in a violent fever, unconscious and delirious, the face, neck, and arms swollen and shining red. Respiration very much impeded, and swallowing very difficult. Pulse 126; heart’s action irregular and tumultuous. Cured by Camphor. It seemed as though a cutting instrument were piercing all the joints; he liked the sensation to electric shocks; the arm, face, and head became swollen; the eyes became red and twisted; red lines extended along the absorbents; itching over the whole body; complete insensibility, after ten minutes; vomiting,; pulse slow; heart’s action scarcely perceptible, 2. A violent heat that came over me, and I felt sick; then I turned giddy and spun round and round like a top, till I fell headlong into a currant bush; however, I managed to get up and staggered like a drunken man to the house, and got into chair, but in a moment fell out of it on my knees, all but fainting; they dashed water in my face, and at length I was able to lie down on my bed, 15. Body and extremities presented very nearly the same appearance as the face, though less bloating was present, 17. Marked nervi- muscular excitement. Feeble (second day). I felt once or twice as if I were actually dying (first night). General languor (after five years). Great prostration for several days. Faint feeling and trembling all day, with nausea (second, third and fourth days). Faintness. Great faintness at the time was succeeded later by marked and increasing languor. Universal distress.
Low-spirited (first and second days). Insensibility Soon loss of consciousness, with inability to move.
In the evening complained of itching of the right eyelid, and there was slight tumefaction (second day); eyelids more swollen and somewhat painful (third day); swelling increased, and there was considerable pain in the eyeball (fourth day); pain in the lids and through the eyeball very several all night (fourth night); lids greatly tumefied, with what seemed to be erysipelatous inflammation; the whole side of the face painful and swollen; upon opening the eyelid discovered almost complete chemosis of the conjunctiva, it being raised up on the sclerotic membrane, more than half over the eye to the border of the cornea, as if a fatty matter were underneath it, caused by the effusion, of lymph (fifth day); as abscess opened upon the inside of the upper eyelid about its center (sixth day); swelling began to abate, and the chemosis to flatten down, assuming instead of a semi transparent, a reddish hue, as in common ophthalmia; discharge from the abscess profuse (seventh day) in fourteen days chemosis entirely disappeared.9 Itching of the eyelids, which were adherent in the morning (after five years). 24. Injection of conjunctiva of right eye.
Subdued stitch like pain deep in right ear for a few seconds (after two hours and a half).
Anxious countenance (in two hours). Countenance livid. Face mouth, dark red, and bloated. Occasional facial neuralgia (after five years).
Inflammation and swelling of the mouth, so preventing respiration that he died. The tongue was very red, greatly swollen, and rounded in form. She could not move it about or protrude it. It appeared to entirely fill the mouth. She could not speak, only mumbled, and the act of swallowing was painful and difficult (after twenty minutes. Swelling of the tongue; in three hours it was very much swollen and quite tense; there was considerable swelling immediately below the chin, between that and the hyoid bone; pain referred to a point in the middle line of the tongue, about three-quarters of an inch from the apex; the patient could protrude his tongue, and answered questions quite distinctly; the pharynx was apparently not obstructed by the swelling, 19. The pain was burning and stinging, extremely violent; after a quarter of an hour the tongue became swollen, so that I could scarcely speak, relieved by Apis.11 The pain for a minute or two was intense, immediately followed by a peculiar taste, which can only be described by saying that it was a singular combination of palatal and nasal sensation, such as is noticed when a nest of these wasps is disturbed, and they dart about through the air; for a week it was constant and very annoying; it then became intermittent, but very pungent whenever I was heated by exercise or approached a hot fire, 18.
Throat greatly swelled.7 Sore throat. Her throat always troubled her the tonsils repeatedly becoming inflamed. Sensation of heat in the throat, soon. She had an attack which her doctor called “congestion of the lining membrane in the throat and chest” (after several months). Hypertrophied tonsils, which secreted a cheesy matter (after five years). Pharyngeal varicosis (after five years ).
Eructations (after one hour). Nausea. Nausea, with faint feeling and trembling (second, third and fourth days). Vomited freely. Vomiting, which brought some temporary relief. Feeling as if he had had nothing to eat. This is not unusual, as he seldom cared about his super (after six hours and a half). Indigestion, with flushing after food (after five years). Heat in the stomach (after one hour). Directly had cold feeling in stomach, which lasted all day (coldness, second day). In evening, after coming indoors, weight in stomach, with nausea (first day). A little gastro-enteric irritation for a few days before death, combined with an extremely irritable and rapid action of the heart.
Marked tenderness on deep pressure on both renal regions (after five years). A painful spot near the gall-bladder (after five years). Flatulence discharged both upward and downwards (after five years). 24. Uneasiness in bowels. The irritation was especially painful in the inguinal regions.
The urethra was cauterized with stick nitrate of silver this set up an acute cystitis, utterly uncontrollable by remedies (after six years). Incessant Enuresis (after six years). Remittent dysuria, with backache, formed prominent features in the history of the case. Urine sometimes thick and hot, always too frequent (after five years). 24. The microscope revealed copious blood-discs in the urine, but nothing further; repeated examinations of the urine, obtained under very varying conditions, always disclosed the presence of haematuria, but no casts of any kind were ever detected (after five years), 24.
“Congestion at the apex of the right lung” (after four years). The apices of the lungs were doubtfully, but not decidedly dull (after five years).
Back and neck
The part (right side of neck) began to swell that night, and was red and burning; the swelling gradually increased to the size of an egg, and lasted three weeks. Aching of the part (right side of neck) all day; next burning, last all night; cold water relieved the burning for a time, but it afterwards returned worse than before.20. Woke last night with pain in left neck, preventing her from turning it to left side; felt least when lying on back, best on right side; lasted one hour and a half (fourth day). Backache, with the remittent dysuria; she was in the habit of deadening the backache by immersion in ice-cold water.
Pain in shoulder in the region of the wasp stings; glands in right axilla, swollen (fifth day). During the whole progress of the case was much pain and soreness on the shoulder blade where the stings were received, and it subsided only with the other symptoms. Pain in left shoulder-joint on moving it, as if sprained; worse on lifting the whole arm and on twisting it (after two hours and a half). Aching of hand and arm up to shoulder, lasting all day. Burning of the part (right thumb), the swelling, red, with burning pain.
Rheumatic pain in left instep, lasting a week.
No sleep all night. Disturbed sleep (after five years). Very restless at night.
Feet cold, except in summer, when they burn uncomfortably (after five years).
The skin surrounding the sting immediately began to swell, erythema (alternating with large weals) spread over the whole surface of the body, into the mouth and down through the gullet to the stomach, causing vomiting which brought some temporary relief;the irritation was especially painful in the inguinal regions, thence it passed to the pudendum, giving rise to ulceration, 24. Erythematous blush on left half of body from head downward, lasted eight to ten days and desquamated; then rheumatic pain in left instep, lasting a week. The sting was followed by a burning sensation, as if something were sticking and drawing out; the part stung was bright red, elevated, with a hard swelling, the redness surrounded by a circle of cold chilly sensation, soon changing to a general chill, repeated at short intervals that seemed to extend in waves all over the whole body, 3. Hands, feet, and chest becoming as red as if I had scarlet fever. The cheek was also much swollen, and the skin soon became of a bright red tint. The redness spread rapidly in all directions over the head and down the neck, shoulders, back, and front of chest; wherever it travelled it was accompanied with pain and tenderness (after twenty minutes). Subsequent of the whole abdomen. Prurigo-like, pinkish, lentil-shaped spots upon hand and forearm, on neck and all over the down to the feet. An ulcer, lasting three months after the sting. Itched all over to a dreadful degree. Intense itching of the part (right side of neck), every day about 3 or 4 A.M., lasting about half an hour, slightly relieved by vinegar applications (after third day); immediately after the itching, there was burning for half an hour (from scratching the part); this continued for three weeks; towards the end of that time would intermit for a day or two, 20. Intense itching of the part (right thumb); it came on about 3 or 4 P.M. about 8 or 9 A.M., and again about 3 P.M.; it lasted half an hour each time, and was immediately followed by burning for half an hour; the itching was relieved by applications of salt and vinegar; this lasted four days; for the next three days the itching only came on between 8 and 9 A.M., and was less severe and shorter.
Heart and Pulse
Palpitation (after five years). Beating of carotid arteries was violent; pulse 160 per minute. With the gastro-enteric irritation, an extremely irritable and rapid action of the heart. Pulse 64 (after three hours). Pulse small and quick (fourth day). Feeble, quick pulse (in two hours).
The irritation passed to the pudendum, giving rise to ulceration. An irritable ulcer surrounded the os tincae (after five years). Pain in the left region (after five years). Catamenia preceded by mental depression, pain, pressure and constipation; the flow is sometimes brown (after five years). Catamenia intermittent, average is amount; always accompanied by pain and flatulence. Respiratory organs. Voice hoarse. Hoarseness, entire loss of voice. Huskiness (after four years). “Hacking cough on lying down” (after two years). Hurried respiration. Respiration 34, but not particularly labored, and not strikingly laryngeal in character (after three hour). Respiration and deglutition much impeded. About half a minute after an application of diluted liquor ammonia to the tongue, he was seized with a spasm of the glottis, his face became pale, with drops of perspiration on the forehead, and his arms were thrown to grasp for air (really to assist respiration by means of the pectoral muscles); he said, “I shall choke,” and got out of the stood upright, but with no improvement, for he sank back on the bed again, his face became livid, he ceased to breathe and the pulse stopped. He breathed about four times after tracheotomy was performed, and died in about three hours and a half after the bite. Dyspnoea (in two hours).