ENVENOMATIONS - Medicine for Mountaineering and Other Wilderness Activities - page 505

Treatment consists of efforts to relieve the painful muscle spasms and antivenom for
small children. No treatment at all should be directed to the site of the bite, with the pos-
sible exception of applying an ice cube to relieve pain. Incision and suction are damaging
and useless and should not be performed.
Essentiallynothingcanbedoneoutsideofahospital,andsmallchildrenalwaysmustbe
hospitalized. Antivenom is produced by Merck. Antivenom is usually not administered to
healthy adults between the ages of sixteen and sixty, and only to individuals of small body
sizewithseveresymptoms whoaretwelve tofifteen yearsold.Instructions withthevialof
antivenom should be followed.
Periodic injections of calcium gluconate solution or methocarbamol to reduce muscle
spasms have been recommended in the past but have been shown to be no better than
placebo. A tranquilizer such as diazepam (Valium®) may help relieve less severe muscle
spasms.Hotbathsareoccasionallyhelpful.Stronganalgesicsarehelpfulbutrarelyprovide
complete pain relief.
Brown Recluse Spider Bites
The brown recluse or violin spider ( Loxosceles reclusa ) has received widespread atten-
tionasthecauseofnecroticarachnidism.However,thethreatbythisspiderisgreatlyover-
blown. Its distribution extends from the New Mexico-Texas border east to Alabama and
northern Georgia and north to western Kentucky, southern Indiana, Illinois, and Iowa and
the eastern portion of Kansas. Reports of bites outside this area are numerous, but most
are considered erroneous by arachnoidologists. Occasional bites by spiders transported by
travelers probably occur, but such bites should not be accepted as brown recluse bites un-
less the spider has been captured and identified by an arachnoidologist. Other Loxosceles
species are found along the southern borders of New Mexico, Arizona, and California.
In the area of their distribution the spiders are numerous and once established within a
house are quite difficult to eliminate. However, bites by the brown recluse are distinctly
uncommon.Mostindividualslivinginhouseswithhundredsofthesespidersneverreporta
bite.Bitesusuallyoccurwhenthespideristightlypressedagainsthumanskin,eitherwhile
puttingonclothesthathavebeenscatteredontheflooratnightorbyrollingoverthespider
while asleep.
Furthermore, 90 percent of the bites are innocuous and produce only a small red spot or
no mark at all. (Red skin lesions with a central pustule or necrotic center are almost never
spider bites, although some individuals claim they are. They are typical of methicillin-res-
istant Staphylococcus aureus [MRSA] infections.) The other 10 percent of the bites, which
are the ones that have earned this spider notoriety, produce a blister surrounded by an area
of intense inflammation about one-half inch (1.25 cm) in diameter. Pain is mild at first but
may become quite severe within about eight hours. Over the next ten to fourteen days the