The Spider Research Project

White-tailed Spider

[Lindley Hall] Indiana University
Bloomington Campus

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Prologue

In the summer of 1993, Dale Clark experienced a bite from a Brown Recluse spider. Due to his network connection, he kept a constant diary of the condition of the bite in email and newsgroup entries. When it was over, he assembled the entire story and posted it to the newsgroup sci.med on June 28th.

This and some of the original posts have been collected here. I have exercised very little editorial control, except to collect, markup, and reduce overlap between Dale's summary and some of his original posts. When there was overlap, the summary was given precedence.

I am making this available as a public service, as I think we all should do our part, but this material was written by Dale Clark, and should he object to it being available here, I shall remove it. If anyone can contact him to get his approval or disapproval, I would appreciate it.

BROWN RECLUSE - THE ENTIRE STORY

[Memorial Day Weekend] Friday, May 28th, 1993.

An amusing side to this story is the fact that the reason I ever went into the basement closet was to find a book to use as reference material for an article I was going to post to another group on this network! Well, anyway, I knew it had to be in a box in a closet under the stairs we use for storage. There are also a bunch of old coats and clothes hanging on a rack. The boxes I was going through were underneath this rack of clothes and I moved them with my body as I bent over to look for this book. I can't remember, but I either had no shirt on at all, or a short sleaved shirt. It was warm here in Utah that weekend. We live in Bountiful, Utah, approximately 15 miles north of Salt Lake City, along the mountainside called the 'east bench.' Prior to this time, I had never heard of the brown recluse in my life. Growing up, we were only told of the black widow. You see them around once in a while, but generally they just stay in a corner by themself and you only rarely hear of someone getting bit. Anyway, I had got in the closet about 8-9PM.

Saturday, May 29th, 1993, 11:32 AM (Sounds like Dragnet don't it?)

I had finished mowing the lawn and came in and took my shirt off to cool down. I was sitting in front of the TV and I was just rubbing my hands along my arms when I felt puffy skin on my right arm, near the shoulder. I looked and saw an area about the size of a quarter that appeared as though it was burned! It shocked me because I couldn't figure out what could have happened. My immediate thought was that I did it just minutes before while I was outside, but I couldn't possibly see how. The skin was wrinkled and thin. It appeared to have 'pus' under it so I grabbed a kleenex and just hardly touched it. The skin came away easily and a yellowish-brown fluid discharged. I'd never seen anything like this. At this point it looked harmless, like a blister or floor-burn. The area left after the skin came off was just light red or pink and seemed as though it would heal-up and be gone in a day or so. I didn't put anything on it or even give it much thought the rest of the day. By 8PM the area had increased to about the size of a half-dollar and looked bad. I had taken a shower and was getting ready to go out when I looked at it. It was weaping clear, light-yellow fluid and the skin had strange spots and was appearing to turn to a dark red color. I showed it to my Dad and he thought 'it looks like impetigo.' My mother didn't think so, she said then that 'it looks like you've been bit by something.' I decided to put 'Gentian Violet' on it.

(Now, this was a mistake in the fact that the dark violet color hinders diagnosis because color is an important part of identifying problems on the skin. Doing this did cause a slight delay in diagnosis. However, of all the things I tried, viz., Hydrogen Peroxide, Burn Cream, Hydrocortisone, and Neomycin, it was the Gentian Violet that seemed to work the best. If I were bitten again, and knew I was bitten, I would use Gentian Violet for at least the first 6-7 days. Anyway, back to the story...)

Sunday, May 30th, 1993, 7:45 AM.

Get out of bed and --- YEECH! What have I got on my arm? It was weaping something fearce and there were 3 spots on the sheets where it had weaped yellow fluid but they were also stained blue from the damn Gentian Violet which drained out along with the fluid. Now, I had a thin piece of gauze taped over the wound, but it had drained to the point that it had become saturated and oozed through to the sheets. That's how much it was leaking. Gross. I shower and before I had put more stuff on it that day I noticed that our neighbor, a Pediatrician, was walking by the house. As I picked-up the morning paper I asked him to take a quick look at the ulcer on my arm to see if he had any idea what it was. (I'm sure doctor's are constantly asked about things by neighbors, but no more so I guess than I'm asked about computers). He looked at it and said, "You need to have this looked at, today if you can." Today? It's Sunday on Memorial Day Weekend - What's the sense of urgency? "That might be a brown recluse bite and I would really have it seen today." he said, and added, "Don't put any more of that violet crap on it." It kind of shook me up that he had a sense of 'do it now' to his voice. At 11 AM I went to the Bountiful "Instacare" (An 'always open' chain of medical clinics in the Salt Lake City area). The doctor said she was sending me to Salt Lake City LDS Hospital Emergency room right away. That she felt it was indeed a spider bite, but needed it confirmed and the clinic couldn't handle 'surgery' there if it was required. This really scared me to death. Especially when she told me about some people needing 'amputation' in extreme cases, etc. Went to ER and the doc there wasn't sure because of the 'violet shit' I put on it. (Those are the words he used). So, I got a painful shot of antibiotics in the rear. (Don't know what or how much unfortunately. I usually ask about everything I'm getting but in this one case I forgot). I was started on Prednisone (20mg - 4/day for 4 days, 3/day for 4 days, 2/day for 4 days, then 1/day for 4 days), and basically told to see my personal physician on Tuesday. Topically, I was to put bacitracin on twice daily when I changed the 2 x 2 guaze.

Monday, May 31st

Pain begins. I have diarrhea, stomach cramps, hot/cold flashes but didn't even once consider it was in any way related to my possible spider bite. I went to the store and bought several cans of Ortho Indoor Insecticide, making sure that the brown recluse was listed on the back of the can. Apparently, lindane is a necessary ingredient to kill them. I went to the basement and sprayed like crazy. We have no children nor pets so I really went wild. No one sleeps down there either. I had been asked the previous day by the doctors if I had been in any attics or dark closets,etc. At first I had said no. It didn't even hit me until sometime later when I remembered going into the closet for that book. That was the only 'dark unfrequented' room I had been in in the last several days. I gave the closet under the stairs a double-dose. Then I closed the doors to all of the basement rooms and made sure the windows were shut. I left it that way for hours, then went it and sprayed again. I wasn't messing around.

Tuesday, Jun 1st

I see my doctor in the morning. I was lucky to get in - there had just been a cancelation and apparently he was booked solid from the long weekend. By now, most of the violet stain had disappeared. It was the size of a dollar and looked terrible. I hurt terribly and didn't feel well. He didn't know what it was but wanted me to see a dermatologist in the same building. He set up the appointment himself as he didn't want me waiting more than a day at most to get in to someone. The appt. was for Wednesday. He told me to stop putting ANYTHING on it. Just leave it completely alone except for the guaze to soak up the drainage. He wanted the dermatologist to be able to see it without it having been affected by anything. At this point, the pain wasn't bad enough that I needed anything and I didn't even ask. When I got home that night, my Dad and I carefully removed everything from the closet under the stairs. We found 2 dead spiders. One was a small common black house spider, the other was strange. We had never quite seen a spider like this in Utah. It's legs were smooth and light brown. It's body was definitely brown and the fangs on its head were huge. On the cephalothorax was a little brown 'line' that on inspection with a magnifying glass looked like a small upsidedown violin. Bingo. The violin spider. It was so damn tiny! "Oh, come on.", my Dad said, "How could this little thing do that to your arm?" I doubted that it did also. My Dad thought about it, then said, "Hmmmm. It's so small it makes me wonder if there isn't others around here. Maybe this is just a baby one." The entire breadth of it was no more than the size of a nickel.

Wednesday, June 2nd

The dermatologist just happened to be from North Carolina and had treated 2 bites in the past. As soon as she removed the gauze she said, "Yup. Brown recluse." The wound was disgusting. It was huge and had a light brown/clear center with a dark/purpleish-red ring around it, then another thin ring of red skin. She called it a 'bulls-eye' and it did in fact resemble the eye of a bull. Pain was getting bad. I didn't like to do anything that put any torsion on the skin of my right arm at all. Even having a shirt on which rubbed the gauze hurt. When you put your hand lightly over the gauze you could feel 'warmth' from the wound - it was hot. Well, she wanted me to change the bandage twice daily and apply bacitracin again. Whenever I applied it, the wound would 'bubble' up with little pustules and drain crud out of it. This was not a fun wound. I showed the doctor the spider in the bottle and she said, "Well, I'm almost 100% sure that's was bit you. From your description of what happened, the fact you found a brown recluse, and the bull's eye wound, I just feel sure about it." She recommended a professional spraying and agreed that the fact that it was small may indicate there may be more. We called Orkin that day. I went back to my personal internal medicine physician and got a prescription for Mepergan Fortis (Demerol for pain, Phenegran ingredient for the frustrating itching).

I saw the dermatologist and my regular physician each Wednesday for the next 3 weeks. I watched with dismay as the wound increased in size and swelling began in my right arm. After about 2 weeks, it began to 'separate' into 2 circles. At first they were hooked together like a figure eight (8), but gradually they separated into 2 distinct circles (OO) about the size of a half-dollar each. Pain would wax and wain. The wound looked awful, after 2 1/2 weeks it turned a honey-brown color and looked disgusting. The purple part came off and I had 2 nice 'holes' in my arm, the pieces that came off were almost 'corroded' looking, not like a scab or skin or anything else, but like tissue that was destroyed. It was kind of scary. Each day you think, "This has got to be as bad as it's going to get, I'll be improving soon." But it goes on and on. And you can't hardly believe that it's expanding. I took good care of the wound and changed the bandages and took my medication religiously. Finally, the color of it concerned the dematologist. The honey/color suggested to her that staph might be in it. On Tuesday, June 22nd, she had me go in for a biopsy and possible surgery. Here's the posting I made to the news when I returned to work 2 days later:

Thursday, June 24th, 1993

GAK! I'm back!

Well, for those interested, here's what happened...

Biopsy confirmed presence of staph infection and deep areas of necrosis so they laid-on surgery for 11:30 AM.

Went in and stripped. Was given Valsed (not sure how much) and 150 mg Demerol. 20 minutes later I felt wonderful and scared to death. They put iodine on the arm (felt cold), then told me the numbing injection would be painful. Boy they weren't kidding. One nurse actually held me down on the table with both hands on my chest. Apparently it is an involuntary reaction to 'jump' and I did. The doc said, "OK you're going to feel the needle." And I certainly did, but it didn't hurt anything like the Xylocaine (or was it Marcaine?) going in. Good Grief that hurt like nobody's business.

Well after just a few seconds the pain went away. They used a 'burning needle' to cut away and I remember seeing smoke drift up towards the ceiling. I was starting to enter la-la land and my memory gets foggy here. I do remember a LOT of honey-colored crap being taken out. I felt them 'tugging' and heard 'noises' but felt nothing. Anyway, the doc told my Dad that he was 'suprised' at how much tissue was involved and just 'mascerated.' Dad said I had a 'hole' in my arm that was pretty deep. Approximately 6-inches long roughly the shape of a banana or diamond. It was sewn up and it . I don't even use my arm to try to open a door as it invokes pain. I drive with my left hand. To sit here and use the computer - I push the keyboard to the back of the desk and rest my arms on the desk so that no muscles are needed to support my arm.

The docs say, "Now, if we were to remove tissue from your left arm it would heal nicely. But this area here in your right arm is *not normal tissue* and it also has staph in it. Therefore, I'm on Cephalexin (250mg 4/day), Prednisone again (same dosage regimen as before), Dapsone (which required blood tests and crap), and my old friend that has helped me combat the pain: Mepergan Fortis.

Ladies and Gentlemen, if you have these things in your area I implore you to call Orkin. We spent $125 for inside and outside spraying by them and they found 2 more down behind a deep freezer we have in a darkened room not frequented. I don't know how much all of this is going to cost me but I'm sure it won't be cheap. The surgery I had will probably reach $2000.00.

Monday, June 28, 1993

Well, it has been 32 days since I was bitten and 6 days after surgery. Finally, finally on Sunday I could tell I was not only feeling better, but my arm is getting better. I can see absolute signs of healing going on. I'm sure now, that this thing will be healed up soon. I'll have a scar, but it will be a long thin one, instead of 2 huge round ones. The skin is red around the scar and there is a kind of scab there but I'm not worried about it anymore. I'm getting good use now out of my arm (it doesn't hurt nearly as bad - I can even open a door now) and I'm well on my way to recovery. I've only taken 1 pain pill all day and I wonder if I'll need one tonight. Thanks for all of your concern and thoughtful letters. If anything else happens - except for normal healing - I'll let you know!

Dale W. Clark

Selected Posts to sci.med during the same time

Unknown Date

Newsgroups: sci.med.telemedicine

I've been confirmed to have been bitten by Loxosceles reclusa (the brown recluse or violin spider), on the upper right arm near the shoulder. It's extremely painful, ecchymotic and erythematous. Blanching, blistering, and ulceration is evident. It began as a dime-size bleb and now looks about the size of two half-dollar pieces hooked together.

The spider was located in a dark closet I was digging in for a book, after I had fumigated the basement.

I started Prednisone (20mg p.o. 3/day for 4 days, then 2/day for 4 days, then 1/day for 4 days). This has slowed the necrotization, however, it continues to slowly expand. I don't know if excision of the area would be useful or not.

Some systemic symptoms included nausea, vomiting, malaise, and general weakness and lethargy. But these have pretty much abated. I apply a polymyxin-bacitracin ointment before I go to bed.

The pain is rather severe and I'm wondering if I should obtain a mild narcotic for a while.

Anyway, I was wondering if someone else could tell me what to expect. Should I consider excision of the area? If so, how long should I wait? Any suggestions/comments would be appreciated.

Dale

Unknown Date

Newsgroups: sci.med.telemedicine

*** UPDATE ***

I really appreciate all of the kind and informative remarks that so many of you have sent to me. I have 2 doctors monitoring it and I see them again on June 9th. My arm has acted very strange this weekend. While the bite area no longer appears to be expanding, the pain level has increased, almost doubled I would say. I can't even stand to have a thin bed sheet touching it at night would evoking pain.

Part of it is turning a bluish-black! Yech! It seems like it wants to scab-over, but something stops it. I also have edema in my right hand, and my nodes under my right arm are inflamed.

This has been positively ghastly. Thanks for all your data and encouragement. Your suggestions and comments have helped me keep on top of this thing, and have assisted me in knowing what to expect and what my options may be.

Thanks again.

Dale W. Clark

Wednesday, June 16, 1993

From: dale@unislc.slc.unisys.com 
(Dale Clark)

Subject: Re: Brown Recluse: UPDATE.

I just came back from the doctors' and here is what they said:

Dermatologist: She was very impressed with the ulceration on my arm. She felt it is doing fine, and the fact it itches is a good sign. She feels that I have been a typical case, except that the amount of tissue damage was not near as bad as the previous 2 cases she treated. She said that the same nerves that transmit itching can be affected by cold, so if I apply ice or a cold pack to it it wont itch as bad. It will itch when I remove the cold pack, but not while it is present.
Surgeon: Feels the area of necrosis should not be removed. A skin graft is likely because of the depth of tissue damage. Wants to see me again after it appears to have resolved.
Personal Internal MD: Says I feel so "gunky" because the steroids I was taking were holding the symptoms at bay. Now that I have finished taking them, the swelling and other symptoms of the bite appear. Also, after a course of them there is sometimes a "withdrawal" syndrome. He said I should feel better in a day or so.

Dale

Unknown Date (approximately June 20th)

Newsgroups: sci.med.telemedicine

Hi again.

Just thought I'd update you as several kind people have sent messages wondering how I was getting along. When this is all over, I'll publish a document of what I went through.

Anyway, I'm about at day 23 since I was bitten. Believe it or not, on day 20 the pain increased several-fold. My entire right-arm is swollen (not REAL bad, but it's bigger than my left arm), and my hand is swollen on top. I've finished taking the Prednisone and right now I only take Mepergan Fortis when I need it for pain. This pain killer works very well, the Demerol combats the pain, and the Phengran ingredient helps the horrible itching. It itches so bad I'd love to take a coat hanger to it!

Anyway, some systemic symptoms have appeared, although I don't know if they are related to this or not. I feel tired all the time, weak in my legs, as if by standing-up I feel at any moment I'm going to lose balance and strength and fall down. I feel "shakey" like my muscles are weak. My mental faculties seem 'cloudy', and this isn't when I take a pain pill, I feel this way all the time. I find I'm easily 'startled' by sudden sounds. This is really crazy and I'm quite concerned about what's going on. Anyway, I have an appointment tomorrow, (Wednesday) with the docs again and I'll carefully tell them what's happened in the last week.

Oh! And most importantly, the wound is no longer spreading out. It still weaps and the bull's-eye has sloughed off. In general, you can now tell the little bugger obviously bit me twice, as the wound appears as a large figure '8' made up about the size of 2 dollar pieces hooked together. It weaps a green/yellow junk and the wound color is now light red, white dots, yellow gunk, and some blue markings.

I'll keep in touch!

Dale

Tuesday, June 22, 1993

Article: 68848 of sci.med

From: dale@unislc.slc.unisys.com 
(Dale Clark)

Subject: Brown Recluse: Surgery Required DAMN!

Damn (please excuse me). They are going to 'cut' me today. The area of necrosis is large compared to the surface area. It's just the "tip of the ice-berg" I'm apparently seeing on top. Marvelous. I'm just hoping that I don't lose a lot of muscle with it. The bite (which I thought was 2 bites, but turns out that I have 1 circle for each fang) is located approximately where you get a small-pox shot.

Ah, yuk! I was hoping I could get away with no surgery, or at least just a skin graft. Now it looks like surgery AND a graft. Well, folks. I'll be gone for a bit. I'll write up a draft of this whole rotton experience and post it when I return.

Why don't the papers in Utah and the western states publish an article about these little buggers? I've never heard of them until I was bit! People need to be warned.

Cheers people. Thanks for all the support.

Dale "under the knife" Clark

Posts to sci.med made after the story's timeframe

Wednesday, June 30, 1993

From: dale@unislc.slc.unisys.com (Dale Clark)

Subject: One last question re: Brown Recluse

If you've followed my plight you know the story.

Anyway, I went to the doctor today for the last time. It was a good feeling to know I won't be seeing them again for a while. The dermatologist said something that just blew me away. She was happy with the scar and the results and stuff, and I noticed that I have a red mark, under the scan, all around the area where the surgery was performed. She said, she wouldn't expect the area to resolve and 'tan' until Christmas.

I'm not too suprised by the time element involved, but she said something else I've never heard. She said, it's because you are young and have a good immune system. The younger you are the more 'upset' your immune system will become to an insult to it. She removes skin cancers all the time, and said if I was 80, it would be resolved by August! She said surgeons love to operate on older people because they wounds resolve faster.

I'd never heard this and was suprised. You would think that it would be just the opposite. Well, that's the end of the story, I'm doing well and I can 'feel' that it is going away.

Monday, July 12, 1993

From: dale@unislc.slc.unisys.com (Dale Clark)

Subject: Dirty Little Buggers (Brown Recluse)

Well, here I am again. No - don't worry I didn't get bitten again. >yet<. We paid $125 for Orkin to come in and spray inside and out and I guess that spiders are hard to kill. Last night I'm sitting on the floor watching TV when I feel something CrAwLiNg up my arm. -YECH!- It was a brown spider of some kind. Oh my Gosh! It scared the hell out of me! I slapped it and hopefully killed it (couldn't find it afterwards which is even more scary).

I've checked myself all over and fortunately there are no little "bite" areas that I kind find.

Eeech. I hate spiders.

Wednesday, July 21, 1993

From: dale@unislc.slc.unisys.com (Dale Clark)

Subject: Brown Recluse Update - Ouch ouch ouch!

Hi. I thought this whole thing had ended, but I went into the doc's today to have a mole taken off. She decided to 'look' at the surgery area just to see how it was coming along. Something's wrong with it. The whole area around the wound is red and looks and feels 'funny' She biopsied the area and sent a little 'apple core' to the lab. She's not sure what is 'in the area' but I should know on Monday. I'll let ya know!

Thursday, July 22, 1993

From: dale@unislc.slc.unisys.com (Dale Clark)

Subject: Re: Brown Recluse Update - Ouch ouch ouch!

This is a fast followup. I've been layed-off and today is my last day (Don't bother to email me I'm out the door right now). SO, I'm afraid I won't be able to tell you what, if anything, was wrong with my arm again when the results of the test come back on Monday. Anyway, it's been real. Thanks to so many of you for your kind suggestions and remarks. I hope to get a job somewhere that plugs into the net.

Take care everyone!

Dale W. Clark

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