Latrodectus mactans

The venomous North American widow spider of the family Theridiidæ; the female’s bite produces a dramatic toxæmia (“latrodectism”) marked by violent thoraco-abdominal muscular spasm, agonising precordial pains with radiation to left arm and back, dyspnœa, anxiety, cold sweat, syncope-tendency, and autonomic storm (pupil and pulse lability) [Clarke], [Hughes]. Homœopathic use derives from toxicology and clinical confirmations in cardiac neuralgia/angina facsimile, pleurodynia and intercostal neuralgia, with modalities exactly mirroring the bite picture (collapse, cold sweat, fear of death, least motion aggravates) [Allen], [Hering], [Boericke]. The tincture is prepared from the live spider expressed or from venom; triturations and potencies reproduce the violent precordial constriction with left arm numbness and the small, weak, rapid pulse with impending syncope [Clarke], [Boger], [Farrington].

No formal Hahnemannian proving; the pathogenesis rests on detailed [Toxicology] of bites and [Clinical] confirmations in anginal states and neuritic thoracic pains compiled by Allen, Hering and Clarke. Constant features: intense precordial pain radiating to left arm and scapula, numbness/tingling of left arm and hand, sense of constriction about heart, icy sweat, small, quick, thready pulse, irregular heart-action, fear of death, worse least motion or speaking, worse lying on left side, better absolute quiet—repeatedly verified in cardiac cases [Allen], [Hering], [Clarke], [Boericke], [Boger], [Farrington]. [Toxicology] [Clinical]

The Latrodectus essence is crisis-angina with collapse: a crushing grip at the heart, darting to left shoulder and arm—the arm turning cold, numb and useless—with air-hunger, icy sweat and terror so intense that the patient dares not move or speak. The polarity is vivid: the anguish drives him to restlessness, but any movement, even a word or the physician’s question, exacerbates the pain; he therefore sits rigidly propped, pressing the sternum, begging for fresh air to the face while welcoming warmth over the chest. This double need—cool face, warm chest—belongs to the widow. The pulse is small, rapid, unsteady; the skin is pale to bluish; the bed must not be jarred; the left side is unendurable. In this the remedy stands between Aconite’s hot panic and Cactus’s chronic band: it is the acute neuralgic storm with vascular failure, a picture borne out by the spider’s toxic action on neuromuscular and autonomic systems [Clarke], [Hughes], [Farrington].

The kingdom signature (Arachnida) brings suddenness, hyper-reactivity, and radiating neuralgia; the miasmatic tint is acute-syphilitic—violent, potentially destructive if unrelieved, with cyanotic hue. The pace is nocturnal and paroxysmal; the locale is heart–chest–left arm–scapula. Selection rests on three pillars: (1) Constriction with crushing pain, (2) left arm numbness/tingling and coldness, and (3) collapse features—cold sweat, small thready pulse, fear of death—worse least motion or speech, worse lying left, better absolute quiet, pressure, sitting propped, fresh air. Micro-comparisons refine choice: Spigelia pierces but does not so collapse; Arsenicum burns and fidgets and seeks heat and company; Tabacum nauseates to deathliness but lacks the classic left-arm sign; Carbo-veg. wants fanning, yet heart pain is not the ruler; Bryonia demands stillness but lacks the icy sweat and death-terror. In intercostal neuralgia the same modalities persist, enabling Lat-m. to cure pleurodynias with cardiac facies. The clinical arc begins with a motion-provoked unbearable spasm; the physician reduces stimulus—hushed room, minimal questioning, fresh air, warm chest, firm pressure—and administers Lat-m.; as similitude engages, the left arm regains warmth and feeling, the pulse fills, the sweat dries, and the patient dares a deeper breath. When the anginal storm has abated, Spigelia or Ranunculus may gather the remaining stitches, and regimen forbids over-exertion, tight chestwear, and nocturnal excitement. Thus, Latrodectus is a small but sovereign remedy in death-terror angina facsimiles with the left-arm signature, where silence, pressure and likeness save motion and speech from killing.

• Heart and coronaries — neuralgic angina: constriction “as if grasped”; violent præcordial pain radiating to left arm, shoulder, and back; cold sweat, collapse, weak irregular pulse (see Heart/Chest/Generalities) [Clarke], [Boericke], [Boger].

• Great vessels and autonomic plexus — vasomotor storm; pallor progressing to cyanosis; syncope tendency with fear of death; slightest movement or speech aggravates (see Fever/Generalities) [Allen], [Hering].

• Intercostal nerves and pleura — pleurodynia, intercostal neuralgia, stitching pains running to scapulæ; breathing shallow from pain (see Chest/Respiration) [Farrington], [Clarke].

• Left upper limb — numbness, tingling, weakness of left arm/hand during cardiac pains; cannot move the limb without renewal of pain (see Extremities/Heart) [Clarke], [Allen].

• Dorsal spine and scapular region — pains shooting between scapulæ, especially left; sensation of a bar across the upper back (see Back) [Boger], [Clarke].

• Diaphragm and abdominal wall — crampy, board-like tenseness with thoracic crisis; vomiting with anguish (see Abdomen/Stomach) [Allen], [Hering].

• Larynx and respiratory centre — dyspnoea, air-hunger, must sit up; suffocation on lying left (see Respiration/Sleep) [Clarke], [Boericke].

• Mind — panic-terror with certainty of death; despair; cannot bear to be spoken to (see Mind) [Hering], [Boericke].

• Male sexual sphere — testicular pulling, pelvic neuralgia in toxic cases; occasionally priapic pains with cardiac crisis (see Male) [Clarke], [Allen].

The emotional picture is stormy and characteristic: extreme anxiety with absolute certainty of death, beseeching for help yet unable to tolerate speech or handling; this tallies with the modality (worse from speaking, worse from least motion) already noted [Hering], [Clarke]. The patient is restless from anguish, yet motion at once intensifies the precordial pain, producing a tormented stillness—an Arachnid polarity (Mind ↔ Heart). Timid, shrinking from examination, watching the pulse, counting the seconds; the sight of a door opening or a question renews the pain. Fear of lying down, fear the heart will stop if he relaxes (Mind ↔ Sleep/Heart). In intervals, despondency and dread of another attack; irritability to noise and light. When relief begins, the patient becomes grateful and quiet; a little air to the face and firm pressure over the sternum soothes, confirming the better-for fresh air and pressure.

Cannot lie down; fear of suffocation and heart-stoppage; sits propped, dozing between spasms (Sleep ↔ Heart/Respiration) [Clarke], [Boericke]. When sleep comes near morning it is short and unrefreshing. Starting from sleep renews the spasm; dreams of death and of pressure on chest.

Of impending death; of being bound about the chest; of drowning or being smothered; wake with a cry and hand at the sternum (Dreams ↔ Chest/Heart) [Clarke].

Latrodectus mactans is a heart–nerve crisis remedy: crushing præcordial pain, radiation to left arm and scapula, numb, cold left hand, small thready pulse, air-hunger, cold sweat, and terror of death—worse least motion, speaking, touch, lying left, at night; better absolute rest, sitting propped, fresh air to face, firm pressure, warmth over chest [Clarke], [Boericke], [Boger], [Farrington]. The picture sits between Aconite (panic with heat and bounding pulse) and Cactus (iron band constriction); Lat-m. adds collapse, icy sweat, and the left arm numbness as a keynote [Farrington], [Kent]. Spigelia shares sharp heart stitches but lacks the profound sweat-collapse complex; Arsenicum shares restlessness and fear of death but desires heat and company and has burning pains. In intercostal neuralgia/pleurodynia the same modality set holds: worse least motion or speech, better pressure and warmth. Direction of cure is from night to morning, from motion-provoked spasm to quiescent chest, from cyanosis to pallor to warmth, the left arm recovering power last.

Chill with cold sweat; face pale or livid; little true heat; anxious fever with small, quick pulse; temperature may be subnormal in collapse [Allen], [Clarke].

Chilliness predominates; sweat cold, clammy, accompanies pain; heat not sustained; alternations with tremors and sighing [Boericke], [Allen]. Sweating often ushers the decline of a paroxysm (modal echo).

Face pallid or bluish; cold sweat on forehead with every paroxysm; temples throb with a small, quick pulse (Head ↔ Heart/Fever) [Clarke], [Allen]. A band-like constriction across brow accompanies the sternal grip. Vertigo on attempting to rise or when an attack begins; cloud before eyes. Neuralgic shooting to left occiput during chest spasm; scalp sensitive to draughts. Headache is not primary; it reflects the vascular storm and improves as the heart quiets.

Stare of terror; pupils variable; dim vision with black specks during throes [Allen], [Clarke]. On relieving pressure, eyes brighten; any attempt to look about or speak renews pain (Eyes ↔ Mind/Heart). Lachrymation not marked; photophobia slight from nervousness.

Ringing and rushing sounds synchronous with the small, quick pulse; hearing acute to slightest noise which restarts the spasm (Ears ↔ Mind). No otitis.

Cold tip, pale alæ; breath drawn shallow through parted lips; air-hunger is nasal as well as laryngeal. Epistaxis is unusual.

Face pale, drawn, sometimes cyanotic; lips bluish in severe crises; lower jaw trembles on speaking [Clarke], [Allen]. Expression of mortal anguish; beads of sweat gather on upper lip. Touch of face is borne, but not of chest.

Dry mouth with thirst for small warm sips; tongue trembles; breath cold in collapse [Allen]. Teeth clenched during pangs; least attempt to answer questions sends a dart to heart (Mouth ↔ Mind/Heart).

No constant dental pathology; grinding or clenching may occur during paroxysms from pain tension.

Sense of throat constriction up to jaw angles during precordial agony; swallowing aggravates transiently [Clarke]. The tight collar is intolerable (modal echo).

The axis: agonising præcordial pain, constrictive, crushing, “as if the heart were gripped”—shooting to left shoulder/arm and often to scapulae, neck or jaw; the sufferer clutches the chest, sits propped forward, begs for air, and sweats cold [Clarke], [Boericke], [Boger]. Least motion or speech renews and intensifies the pains; jarring the bed is intolerable (chest-wall hyperalgesia). Intercostal spaces rigid; pleurodynia on left; superficial tenderness over sternum. The contrast with Cactus (iron band) is the extreme neuralgic radiations and the left arm numbness in Lat-m.; with Spigelia the focal stitch is sharper but less collapse and sweat [Farrington], [Kent].

Small, quick, weak, sometimes irregular pulse; præcordial constriction; threatening syncope; the patient is convinced of impending death [Clarke], [Allen], [Boericke]. Palpitation may be felt but the ruling sensation is pain with collapse; action irregular on slightest movement. Left arm becomes numb, tingling, powerless; hand cold; cannot lift it without stabbing return of pain (Heart ↔ Extremities) [Clarke]. Tight garments are intolerable; belt loosened. After the storm, pulse steadies, skin warms, and a grateful calm ensues.

Air-hunger with shallow rapid breaths; cannot lie; must sit up; worse on left side [Clarke], [Boericke]. A deep inspiration stabs the precordium; sighing attempts end in fear. Voice low; speaking aggravates dyspnœa and pain. Fresh air to face relieves the panic though the body loves warmth, a characteristic polarity (Respiration ↔ Modalities).

Nausea with faintness at height of attack; retching from diaphragmatic spasm; epigastrium tense and painful to slightest motion [Allen], [Hering]. Food aversion during crisis; afterwards craving for warm drinks.

Board-like abdominal wall spasm with thoracic pains; gripping in umbilical region shooting to back; cannot straighten without tearing sensation (Abdomen ↔ Chest) [Allen]. Gas accumulates from shallow breathing; stool suppressed till attack passes.

No characteristic tenesmus; rectum inert during crisis; stool later soft with great prostration.

Scanty urine during paroxysm; later increased, pale as anguish lifts [Clarke]. No burning; bladder spasm rare.

Desire for warm drinks in sips during crisis; stimulants aggravate palpitation and unrest; smoking ill-borne [Clarke]. Appetite absent; nausea with anguish.

Testicular drawing or pelvic dragging pains may accompany the thoraco-abdominal spasm (toxic analogue); sexual excitement or coitus has precipitated attacks in some reports [Clarke], [Allen]. After crisis, profound prostration with dread of renewal.

Cardiac neuralgia-like attacks around menses in sensitive women; thoracic constriction with left arm numbness; uterine cramps may alternate with chest pangs (arachnid polarity) [Clarke], [Farrington]. Fearful, cannot bear to be questioned; better warmth and rest.

Pain shoots to between the scapulæ, especially left; a bar-like sensation across upper dorsal spine; moving shoulders renews pangs (Back ↔ Chest) [Clarke], [Boger]. Lumbar region tight from guarding; cannot turn in bed without instant recurrence.

Left upper limb: numbness, tingling, weakness, hand cold and useless during attack; moving the arm aggravates præcordial pain [Clarke], [Allen]. Fingers sometimes flex to the palm; nails bluish. Lower limbs: cold, tremulous, ached with crampy restlessness; standing triggers faintness. After crisis, exhaustion in calves with residual tingling.

Clammy cold sweat, especially forehead, chest and hands; pallor passing to cyanosis in severe seizures [Allen], [Clarke]. Goose-flesh with chill; skin hypersensitive over sternum and left thorax.

Aetiology / Crisis Profile

• Aconitum — violent fear of death at onset with heat, red face, full bounding pulse; Lat-m. has cold sweat, small pulse, neuralgic radiation, worse from speech or motion [Kent], [Clarke].

• Arsenicum — anguish, restlessness, prostration, burning pains; desires heat and company; Lat-m. pains crush and radiate with left arm numbness; better from pressure, fresh air to face [Farrington], [Clarke].

• Digitalis — slow, weak pulse; fear to move lest heart stop; less violent neuralgia, more failure than pain; Lat-m. has sharp radiations with sweats [Clarke].

Keynotes — Constriction and Left-Arm Phenomena

• Cactus — “iron band” constriction, oedema, less left-arm numbness, more venous stasis; Lat-m. has collapse with neuralgic radiation [Farrington], [Kent].

• Spigelia — stabbing stitches, worse from motion, lying on left; left arm used cautiously but not typically numb; Lat-m. has conspicuous numb/tingly left hand [Clarke], [Farrington].

• Naja — cardiac pains with moral depression, throat complaints; collapse less violent; Lat-m. more acute, panic-sweat picture [Clarke].

Organ Affinity — Intercostal Neuralgia / Pleurodynia

• Ranunculus-b. — stitching intercostals, worse motion, weather changes, touch; less cardiac panic; Lat-m. shows heart-signs and left-arm numbness [Farrington], [Boger].

• Bryonia — chest pains worse least motion, wants absolute quiet, dry serous states; no death-terror or left-arm signs; Lat-m. adds cold sweats [Clarke].

Modalities — Worse Night, Motion, Lying Left

• Lachesis — worse after sleep, cannot bear pressure about neck, strongly left-sided, rapid talkative mind; Lat-m. silent, cannot bear speaking, seeks pressure on chest [Kent], [Clarke].

• Tabacum — deathly nausea, icy cold sweat, collapse; heart pain less radiating; Lat-m. has præcordial neuralgia radiating to left arm [Clarke], [Boger].

Collapse / Cyanosis

• Carbo-veg. — collapse, icy, gasping, wants to be fanned; less darting heart pain; Lat-m. combines collapse with anginal radiation [Clarke], [Farrington].

• Camphora — icy coldness, shock, prostration; no characteristic left-arm phenomena; Lat-m. has intense præcordial pain [Allen].

• Complementary: Cactus — both remedies have constriction; Cactus for venous stasis and “iron band” sensation; Lat-m. when left-arm numbness, radiations, and cold sweat dominate [Farrington], [Kent].

• Complementary: Spigelia — follows Lat-m. in residual stitchy neuralgia after the collapse stage has passed [Farrington].

• Complementary: Ranunculus-b. — for intercostal sequelae after cardiac panic is quelled [Boger].

• Follows well: Aconite — after the first panic-fever stage, when cold sweat, small pulse, and neuralgic radiations set in [Clarke].

• Follows well: Arsenicum — if burning anxiety subsides into crushing neuralgia with left-arm numbness [Clarke].

• Precedes well: Digitalis — when failure signs persist without acute pain, pulse slow and weak [Clarke].

• Related (compare): Naja, Lachesis, Tabacum, Carbo-veg., Camph., Bryonia — see differentials.

• Antidotes (states): Warmth, quiet, fresh air to the face; medicinally, Camph. for sudden chill-collapse; Acon. in the early panic stage, according to totality [Allen], [Clarke].

• Inimicals: None fixed in the classics; avoid alternation without new indications [Kent], [Boger].

• Angina facsimile / cardiac neuralgia — crushing præcordial pain with left-arm numbness, cold sweat, small thready pulse; worse from the least motion or speaking, worse lying on the left side. Lat-m. 6C–30C at short intervals during crisis; lengthen interval as pains remit [Clarke], [Boericke], [Farrington].

• Pleurodynia / intercostal neuralgia (especially left) — worse from motion, speech, or jarring; better from pressure and warmth. Consider Lat-m. before Ranunculus-b. if heart-signs are present [Farrington], [Boger].

• Post-fright cardiac panic — where Acon. fails due to collapse and cold sweat, Lat-m. often turns the corner; maintain quiet surroundings and wrap the chest warmly [Clarke], [Allen].

• Sequencing — in repeated nocturnal angina-like attacks, alternate regimen (avoid tight chestwear, no stimulants at night, early bed, fresh air) with Lat-m.; consider Cactus for persistent constrictive band, Digitalis if failure predominates [Farrington], [Clarke].

Mind

• Fear of death — absolute conviction he will die; cardinal in crises; prescribe when joined to left-arm signs [Hering], [Clarke].

• Anxiety — intolerant of being spoken to; conversation aggravates pains [Hering], [Clarke].

• Restlessness with enforced stillness — moves from anguish, yet motion worsens pain [Clarke], [Boericke].

• Despair — beseeches help, counts pulse; slightest attention renews spasm [Allen], [Clarke].

• Aversion to visitors, noise, light — excitement excites [Hering].

• Better — silence, dark room, fresh air to face [Clarke].

Head / Face

• Face — pale, bluish, covered with cold sweat during anginal storm [Allen], [Clarke].

• Forehead — sweat beads with each pang; brows knit [Clarke].

• Head — band-like pressure accompanying præcordial constriction [Clarke].

• Vertigo — on rising, with faintness [Allen].

• Lips — blue, trembling in crisis [Clarke].

• Touch — face tolerated, chest not [Allen].

Chest / Heart

• Angina pectoris — crushing pain radiating to left arm, shoulder, scapula; cold sweat; small, quick pulse; signature rubric [Clarke], [Farrington], [Boericke].

• Constriction — as if heart grasped; cannot bear tight clothing [Clarke], [Boger].

• Modalities (worse) — least motion, speaking, jarring, lying on left side [Clarke], [Boericke].

• Modalities (better) — pressure, sitting propped, fresh air to face, warm applications [Clarke], [Farrington].

• Palpitation — with collapse and impending syncope [Allen], [Clarke].

• Pains — shoot to between scapulæ [Clarke], [Boger].

Respiration

• Dyspnoea / air-hunger — must sit up; cannot lie on left side [Clarke], [Boericke].

• Deep inspiration — aggravates præcordial pain [Clarke].

• Voice low — speaking aggravates breath and pain [Hering].

• Better — fresh, cool air to face, though body craves warmth [Clarke].

• Sighing, shallow breathing — during collapse [Allen].

• Suffocative dread — on closing eyes to sleep [Clarke].

Back / Extremities

• Pain between scapulæ — left-sided predominance; cardiac radiation [Clarke].

• Left arm — numbness, tingling, coldness with heart pain [Clarke], [Allen].

• Motion of left arm — aggravates præcordial pain [Clarke].

• Hand — cannot use during attack; fingers flexed; nails bluish [Allen].

• Jarring of bed — explodes pain; must keep still [Clarke].

• Lower limbs — cold, weak, trembling in crisis [Allen].

Generalities / Modalities

• Worse — night (after midnight); least motion; speaking; lying on left; jarring; cold damp [Clarke], [Boger].

• Better — absolute rest; pressure on chest; sitting propped; fresh air; warm applications [Clarke], [Farrington].

• Cold clammy sweat — with pain and faintness [Allen], [Clarke].

• Pulse — small, quick, weak, irregular [Boericke].

• Cannot bear tight clothing — over chest [Boericke].

• Startled easily — start renews pain [Hering].

Allen, T. F. — Encyclopædia of Pure Materia Medica (1874–1879): toxicology/clinical data—anginal pains, cold sweat, small thready pulse, modalities.
Hering, C. — The Guiding Symptoms of Our Materia Medica (1879–1891): clinical confirmations—precordial constriction, left-arm numbness, worse motion/speaking.
Clarke, J. H. — A Dictionary of Practical Materia Medica (1900): remedy portrait—latrodectism, heart and intercostal neuralgia, fresh-air/pressure ameliorations.
Boericke, W. — Pocket Manual of Homœopathic Materia Medica (1901): keynotes—angina facsimile, collapse, modalities; relationships.
Boger, C. M. — Synoptic Key of the Materia Medica (1915): radiations to scapulæ; modalities (night, motion, jarring, pressure).
Farrington, E. A. — Clinical Materia Medica (1890): heart-remedy comparisons—Cactus, Spigelia, Naja; local applications and regimen.
Hughes, R. — A Manual of Pharmacodynamics (late 19th c.): toxicology of Latrodectus venom; autonomic/circulatory notes informing remedy essence.
Kent, J. T. — Lectures on Homœopathic Materia Medica (1905): comparisons in angina—Acon., Cactus, Spigelia; fear states vs. collapse.
Nash, E. B. — Leaders in Homœopathic Therapeutics (1899): practical hints in cardiac emergencies; remedy sequencing.
Dewey, W. A. — Practical Homœopathic Therapeutics (early 20th c.): angina and pleurodynia management; pressure/quiet regimen.
Lippe, A. von — Keynotes and Characteristics with Comparisons (late 19th c.): modal selectives—worse least motion, better pressure, left-side aggravation.
Dunham, C. — Homœopathy, the Science of Therapeutics (1877): philosophical indications in acute neuralgia/collapse pictures.