61. Russell, F. E., et al. Bites of spiders and other arthropods, Section 16, pp. 865-867. _In_ H.F. Conn (ed.). Current therapy. Philadelphia: W.B. Saunders, 1974. 62. Taylor, E.H., and W.F. Denney. Hemolysis, renal failure and sudden death, presumed secondary to bite of brown recluse spider. South Med J 59:1209-1211 (1966). 63. The brown recluse. Public Health Service Publ No. 2062, 1970. Urticating Caterpillars 64. Daly, J.A., and B.L. Derrick. Puss caterpillar sting in Arkansas. South Med J 68:893-894 (1975). 65. Kendall, R.O. San Antonio, Tex. Personal communication, 1975. 66. McGovern, J.P., et al. _Megalopyge opercularis_: Observations of its life history, natural history of its sting in man, and report of an epidemic. JAMA 175: 121-124 (1961). 67. Micks, D.S. Clinical effects of the sting of the “puss caterpillar” (_Megalopyge opercularis_ S. & A.) on man. Tex Rep Biol Med 10:399-405 (1952). 68. Mitchell, R.T., and H.S. Zim. Butterflies and moths. New York: Golden Press, 1964. APPENDIX: ARTHROPOD ENVENOMIZATION REACTIONS AND TREATMENT The material presented in this appendix was prepared by Lt Col John C. Moseley, USAF, MC, Dermatologist, Wilford Hall USAF Medical Center, Lackland AFB, Texas. BLACK WIDOW SPIDER REACTIONS _IMMEDIATE:_ Pinprick sensation from the bite _LOCAL:_ Dull numbing pain; two red puncture marks at bite site. Pain peaks at 1-3 hours and persists 12-48 hours _REGIONAL:_ 1. Severe muscular pain and spasm 2. Rigid boardlike abdomen 3. Tightness in chest and pain on inspiration _GENERAL:_ 1. Rigidity and spasm of all large muscle groups; excruciating abdominal pain 2. Convulsions, paralysis 3. Shock _DEATHS:_ 4-5% of untreated cases due to neurotoxic effect of the venom TREATMENT _LOCAL FIRST AID:_ Ineffective and unnecessary _SYSTEMIC:_ 1. Antivenin—1 vial IM (carefully follow package insert instructions) after testing for horse-serum sensitivity 2. Calcium gluconate—10 ml of 10% solution given IV immediately and prn to control muscle pain 3. Muscle relaxants—Give continuously over 8-16-hr period to relieve intensity of muscle spasm and pain 4. Treat for shock as necessary (Chart 2) BROWN RECLUSE SPIDER REACTIONS _IMMEDIATE:_ Very little pain, if any _LOCAL:_ 1. 2-8 Hours—Mild to severe pain with redness and vesiculation at bite site, followed by ischemia 2. 3-4 Days—Star-shaped firm area of deep-purple color with necrosis 3. 7-14 Days—Central area of depression and ulceration 4. 21 Days—Healing and scar formation. May not heal sufficiently and may require skin grafting _SYSTEMIC:_