Volume IV — Main text

TABACUM. Nkotiana Tahaeum, L. Tobacco. Nat. Ord., Solanaceie.

Provings, — I. Lembke from Feb. 4th to 28th took repeated doses of tinct. of from 5 to 20 dr. The only effect noticed was smarting and scraping feeling in tongue and fauces soon after each dose, lasting for nearly I h. Also soon after taking each dose he4t of head and face, burning of cheeks. Occasional feeling of sickness. During the whole proving had occasionally, not often, pains in several joints and long bones at various times of d. and n., and he had one or two (once three) soft stools, sometimes even diarrhccic, every d. He also tested the aq. nicotiana (Radcmach.), but though he took as much as 270 dr. in i d. he observed no effect. (N. "L.f, h. KL^ xii, 97.)
S — , medical student, aet. 24, was not a user of tobacco or coffee. In 10 d. took 3j tinct. and in 8 d. ^ij tinct. He had heat m lauces, constrictive pain in larynx, increased appetite ; nausea rising up from precordial region, borborygmus in transverse colon, increased flowf of urine of reddish colour and ammoniacal and foetid odour \ hoarsene:sa^| discrete papulous eruption on face, itching on thighs, pulse slower and^ full, pressive pain from occiput to temporal bones, tendency to vertigo, occasional feeling of heat throughout whole body, great lassitude an^^ prostration of body, somnolence, sleep disturbed by frequent waking ^^| morose and disinclined for work. (Riemschnbioir, Dt Htrba Nicotiana., 25.)
S— , medical student, set. 23, did not use coffee or tobacco. In 8 d. took 3>j tinct. He had burning pain in fauces, increased appetite, eructations, urine more copious and frequent (passed once at n. involun-

aS3

ilyl, nocturnal emissions, slight irritation in upper part of trachea with tickling sensation, followed each time the medicine is taken by bMrking; pressive pain in forehead, slight lassitude and uneasy dreams. lUil, 26.)

K — , medical student^ set. 25, abstains from tobacco. Took in 10 d. ^ tinct. He observed scraping and burning feeling in fauces, Mods mure frequent and loose, urine more copious, full ; pulse quick, full, large ; head confused more or less for 3 d,, restless sleep, wild dreanw, followed by great lassitude, moroseness, and disinclination for torif. (3iJ.)
K — , medical student, xt. 24, addicted to smoking and drinking beer and cofFec. In 8 d, took 3'v tinct. He had sensation of scraping and pressing in pharynx and larynx, oppression in epigastrium, feeling of heat in stomach, nausea, retching, more frequent stools, which are of » pasiy consistence (usually had a stool every other day) with itching «ai)U5, urine not increased in quantity but passed more frequently, and once dribbled away involuntarily, with slight itching in urethra, preslive and formicating sensation in Schneiderian membrane j oppression of chest with anxiety (such as used to precede attacks of fainting which he hid when a child), slight horripilation, general lassitude and laziness, which went off on the occurrence of copious sweat all over body, accompanied by slight tremor of limbs, drawing pains throughout the body, pulse small, hard, quick ; dull pressive pain deep in frontal region, pressure on eyes, moroseness and disinclination for work. All the 'ymptoms went off in i h. except the confusion of head and pressure un eyes and stomach. [Ibid.)

b. S — , medical student, aet. 22, accustomed to smoke and drink

coffee. In 8 d, took l^ij tinct. Symptoms; scraping, burning and heat

^ in pharynx, oesophagus and stomach, slight oppression in epigastrium,

B which symptoms soon went off, nausea, retching, stools softer but not

■note frequent, urine pale, increased, had to pass it several times at n.,

almost amounting to incontinence of urine ; pustular eruption on neck

»nd upper extremities ; pulse small, quick, irregular; feeling as if the

^ Wierior lobes of the brain were equally compressed from frontal region

B l*clcwards, moroseness and indisposition for work. {Ibid., 27.)

H 7- G — , surgeon, set. 28, accustomed to snuff and to drink coffee.

B ^1 10 d. took 3ij tinct. Symptoms: heat in fauces, appetite increased

II to Voracity, with great thirst ; slight catarrhal affection of tonsils ;

'Mj increased and pappy or sometimes slimy, preceded by flatus ;

urine much increased, once at n. burning and tickling pain in urethra,

^ "octurnal emission, respiration freer and lighter, increased cutaneous

B 'Urgor with violent itching, slight general perspiration, papulous eruption,

" Wounds and scratches on skin burn, inflame, and are long of healing ;

pulse normal, head very confused, pupils greatly contracted, feeling of

oialaise, great lassitude of body, restless sleep disturbed by anxious

I dreams, great moroseness and disinclination for work. [Ibid,, 28.)

H^ 8. E — , medical student, aet. 26. In 14 d. took in increasing doses

^Rv tinct. Symptoms : — roughness and scraping in fauces, flow of

^bliva, increased appetite, followed by nausea, retching, borborygmus,

^colic, increased and more liquid stools, increased urine, the discharge

of urine often preceded by pressive pain in renal region and itching in urethra, cutaneous turgor increased with itching and slight sweat, pulse slow, small, great confusion of head, pressive pain in forehead as though the brain was pressed against the skull there, pain increased by leaning the head to that side, pupils contracted, constant feeling of malaise* great lassitude and relaxation of whole body, sleep disturbed by dil? gusting dreams, moroseness and great disinclination for work, (UU.) 9. Seidel took tinct. in various doses.

a. 10 dr. Some stitches in 1. ear after a few m. When swallowing food pressive pain in lower part of oesophagus after 3 h. Burning in throat and mouth immediately, inclination to vomit and eructatioOa soon. The stool, which usually occurred m., not till e. and hirde than usual. Dull pain in middle of spine with bruised feeling of body especially upper extremities. Fain in loins and sacrum, espediily when sitting. Throbbing pain in sacral region, ist d., e., general reLuu-' tion of whole body with sore feeling and warm palms, soon. Feeling of increase of strength in muscles without the slightest wish to nnovc-, soon. Pulse quickened.

b. 20 dr. Dazedness and bruised feeling of body, soon. Boring in eyes on reading, e. Drawing in ears, increased by loud noise and by going into open air, lasting several d. Roaring in ears, especially m.-, tor several d. Ears feel as if stopped up, especially r. 3rd and 4th d., pressure and flow of saliva, soon. Spasmodic pressure in mouth ind stomach, soon. Pressure when eating in mouth of stomach after l h. Cramp in single fingers;after 2 h, and when washing, 2nd, 3rd, and 41)1 d. Increased heat, especially on palms, after a few m.

f. 30 dr. Very hypochondriacal humour 1st d. After dinner dull headache, especially in forehead, increased by movement. Wcalc, trembling movement of hand when reading after ^ h. Twitching in I. upper eyelid alter i h. Pressure in eyeballs after 2 h. Repeated eructation after i h. Slight pressure in scrob. cordis during and after dreams. PuUe 10 beats quicker and fuller, soon. Stool after 30 h. harder and darker than usual. Urine clear, lemon coloured and more copious. Throbbing pains above and in 1. gluteus, 1st d. Increased heat externally and disinclination to the slightest occupation, soon.

«/, 40 lir. Vertigo and no steadfastness in body. Confusion of head and dull pressure out towards root of nose, and feeling as if ears were stopped up. Violent pains in head, especially drawing in I. half of forehead and through 1. eye. A transient feeling through middle ol face as if the parts were dead, after 8 h. Tensive pain in submaxillary glands with feeling as if they were swollen and the lower jaw deprived^ of its motility, soon. Pricking in tongue, soon. Flat taste, ^M Eructation. Repeated twitching movement in scrob. cordis with inclination to vomit, lachrymation, and flow of saliva for i h. Rumbling in colon and desire for stool. During dinner some stitches under r. short ribs with tightness of chest. Pain and pressure on r. gluteus, 2nd d. Pain and tension in nates and muscles of thigh as after a long walk, 3rd d. Keeling as if the blood circulated quicker stronger in body, soon.

t. 60 dr. Violent digging drawing pains in eyeballs and tem{

regions, increased by movement, with distended blood-vessels and throbbing in them. Burning in throat and mouth, immediately. After several ineffectual efforts to stool a hard evacuation several h. after usual time. Intolerable sacral pains felt both in sitting and lying. Violent rigor with inclination to stretch body, ist d., e. Before midnight profuse sweat, as if soaked with water, with odour of tobacco, {/t. h. Z. xii, 150.)

A girl took 5 dr. tinct. Immediately violent toothache with beat of face and giddiness. Slight burning in gastric region and repeated eructation. Frequent urging to urinate. {Ibid.)
A young married woman took 2 dr. Violent, persistent throb-

bi.ng pain in several hollow teeth. Periodical sensation of a plug in

(esophagus with persistent dull pressure there. Nausea and eructation,

*<^lmich causes relief to oppression in scrob. cordis. No stool for 2 d.,

«»**aUy every d. {Ibid.)

I*. ScHRETBR proved tobacco of Havana cigars f doses and number of provers

"«*«; stated.

. a. After z m. shooting in 1. temple. After 3 m. severe pressive pain in crown.

"^*^r 4 m. urging to stool with fi-equent tenesmus in rectum. Rigor with yawning

^^^ stretching arms. After 5 m. giddy and staggering. Pressive pain over eyes.

T-^at of eyeballs. After 7 m. contraction of eyelids with smarting pain in eyeballs.

^^^^r 10 m. shooting and tearing in r. hand. After ^ h. venigo ; the room seems to

^**^ round in a circle, and he dared not rise from his seat, fearing to stagger. Pres.

^^^« contraction in temples. Burning in stomach. Shivering all over body. After

^ h. severe vertigo. Pressive pain over eyes, with flickering before eyes, worse when

^sUking. After i h. pressive pain over eyes, with heat of head. After i^ h. pain

^^ both sides of head as if broken on wheel. Drowsiness, After 1 h. great nausea,

almost to fainting, which goes off in open air. After 3 h. cold sweat of hands.

b. First d. After inclination to vomit, great apprehensiveness with oppression of chest and very sad humour, as if she anticipated some misfortune, relieved by weeping. Very morose, cross, and laconic. She is very cheerful and gay, dances about on one leg, and laughs without cause almost all d. Vertigo as from intoxication. Heaviness in head, can hardly hold it up. Great heaviness and pain in nape, so that be must take off his necktie. Pain in r. parietal bone when pressed upon. Pressure on crown as if a band were pressed on it. Immediately after eating severe internal pressure in crown. In temples alternately pressure and shooting. Shooting above r. eye over outer border of eyebrow to inner and into orbit. Shooting in 1. temple. Drawing shooting pain from 1. temple over forehead to crown. On walking quickly shooting pain from 1. parietal bone to occiput. Heat of head. Much congestion of blood and flying heat of head. Contraction in parietal muscles. The eyes smart as after long weeping. Stiff tension and drawing from 1. eye down upper jaw. A kind of burning, at same time cold feeling in 1. eye. Orbits heated, contraction of eyelids and lachrymation. Dimness of vision as from mucus. Flickering before eyes. More black spots seen than usual. Prickings in upper part of orbit. Shooting in ears. The can are burning hot and red. Flushing of heat in face. R. cheek not, 1; pale. Heat and tednesi of 1. cheek, e. When reading cannot emphasize ; he reads in a drawling way unlike his usual. Dry throat. Hawks up mucus. More appetite than usual, very little thirst. Frequent empty eructation. Frequent eructation with taste of food. Frequent eructations, nausea, and inclination to vomit. Hiccup. Nausea and pinching in belly. Sick, vrith pressure in stomach. Easy vomiting of sour liquid. Feehng as if stomach would turn over. Qualmishness in stomach. Frequent stitches in hepatic region below last ribs, e. Pricking as with a needle in liver, increased by breathing. Pressure in hypochondria. Pinching in bowelf. Rumbling and pinching in belly, as though diarrhoea would come on. Bowels not opened. Stool at unusual time and thinner than usual Erections towards m. Fluent coiyza lasting 4 d. ; shooting under siemuip with inability to breathe deeply. On breathing stitches in side and chest, and at same time weakness of

cod as if drunk, and flickering before eyes so that he cannot recognise p(opl< )' ^ distance. On breathing deeply, as if the intercostal muscles were cut from iHlott '" back, worse when touched ; tears flowed from eyes with the pain. Pulsation under r. shoulder. Pain in arm on raising it. Tension in I. arm, especially in elbo«. Ob turning forearm drawing pain in elbow-joint. Weakness in hands, On ^ -" i'-" knee shooting; when at rest, prcs-sure. Knees crack when walking. I'

feeling in r, foot. Cramp from toes to knee. Great weariness and tren.l .,

hand^ and feet. Great weariness as though the feel were paralysed, can hardly go upstairs, worse a.m. than p.m. Towards e. weakness, and when he moves a j>m immediately rigor and coldness, between shoulders, at same time giddiness anJ shooting in temples, forehead, and crown. Dislike to all work. Trembling of liinih. On both cheeks under eyes small elevations only perceptible to touch. Much yiwoing after dinner. Drowsy a.m., fell asleep for a short time. Yawning and slec)iincss after dinner. Wakes up repeatedly at n. Starts up out of slumber. Drcami that she wants to talk but cannot, on account of tongue being too big, which hug! out of mouth and reaches to nose, she wanted to cry out but cannot, weeps about tij and is quite inconsolable until she wakes up in great anxiety (a kind of nightirnR). Anxious dreams of fire. Cold feet. Chilliness and shivering in open air. Guokskin all d. Immediately after eating shivering that lasted almost all p.m., and often alternated with heat without thirst ; during the chill always perspired under irnu. Shivering all over botly with transient heat. While the body is hot the legs «tt cold. Heat and dry feeling increasing ever)' minute. Night sweat.

c. Second d. Disinclined for work. Cheerful and gay. Great vertigo. Vertigo ss from intoxication. All p.m. pressive headache, especially over r. eye. Stildrts from forehead to occiput, went off when in open air, but if she stood siill it came (in again, went off on lying down. Some stitches in temples, severe headache when moving, something seemed to shake in head, better when at rest m. Hear of head. Formication over 1. temple. Pains in eyes and flashing before them on looking tt an object. Cornea red, some photophobia, when she looks at the light must ciote the eyes. Eyes water when looking closely at an object. Objects seen less, distinctly than usual. Shooting in ears, especially in open air. As if something lay btlwre ears. Very powerful keen smell, m. Bad insipid taste, as when stomach is ditordered, m. Pressure in throat as if something were sticking in there. Scraping in throat all p.m. Dry thro.it. Throat so dry and scrapy she can hardly swallow, Hawks up grey mucus, m. Very little thirst. Loathes water. Hiccup. Nausei on rising, m. Nausea with shouting in 1. temple. Inclination to vomit. Spasm iu stomach. Relaxed feeling in "tomach with some nausea. Violent stitches abo»e scrob, cordis, better when at rest. Frequent purging. Erections without voluptuoas sensation. Discharge of some drops of a fluid like scrum from vagina i^d. ahrt menses. Irritation to cough and scraping in throat. Dry cough. On breathing deeply chest feels too narrow. Pressure and stitches in chest. Burning and tension in skin of side of neck. Burning under scapula. Shooting and drawing io L shoulder. On account of shooting pain in elbow could not extend r. arm quickly. Burning on side of sole as from red-hot iron, worst e. Constant inclination to stntch arms. Frequent itching like fleas on face. Corners of mouth sore. Murt yawning for several d. Drowsines in room, going oflT in open air. Hard to wakt m m. Slept proloundly n. Cold feet. Complained of coldness and shivering '" open air, m. Coldness with flushes of heat. All d, shivering and shaking, towsrd* e, cold sweat in palms,

d. Third d. Anxiety with dismal melancholy thoughts when walking. Cheerfol and gay. Compressive pain in whole head, especially occiput. Some deep stitcho 'S head towards crown. Shooting in I. temple. Towards c. she became nearly bltod for a few m,, it was as if there was a veil before eyes, worse after rubbing trO' Shooting in ears. Tickling in ears. Humming in I. ear. Very much impaired power of smell. Drawing pain in both angles of lower jaw. On laughing a shoo< in maxillary joint. Drawing pain in upper teeth, which goes off on pressings" cheek. When she bites on a hollow tooth there is a shootmg pain in it. Insip><l slimy taste, m. Sour taste, everything tastes sour, water tastes as if mixed wi'l* iron. Very loud eructation all d,, especially after eating. Sour, hot eructation, ni. Vomiting of sour fluid and mucus, followed by great relief. Some stitches under I. short ribs. Great urging to stool with forcing as if the farces were held back, atw'

TabacUm.

et the stool is soft. Freqoenr purging. Stopped nose. Dry cough. Chcsf oppt»«d, tight, oinnot breathe deeply, with apptehi-nsiun and anxiety, she cannot et rid of ihc idea that i miti'ortune is about to befall her, Preb>.ure on sternum as '1' lay there. Sort shcKiting in r. side oi chest, woi>t when at rcil. Great I. of heart. L. arm powerless and paintul. K, aim feels vprained, espeijji III ribow-joint in which he feels painful stitches on every exertion. Cramp ■ formication in j first fingers of 1. hand. Shooting in r. hip, e. Tension from r to foot when walking. Formication in I. leg from knee to toes. Weary in »j£h» and feet. Itching a^ from flea>bites on arms and neck. Itching here and there I b«xly, provoking scratching and then going off Many papules on forehead, with itciuiig rclicired lor a short time by nibbing. Itching papules on chest. Very kkcpjr, e. Could not sleep at n., nor wake ra. Legs from knees to toes icy cold, at lame rime burning of thighs and great heat. All d. rigor and pressivc pain between •Ikoultirrs.

/. 4ih li. She is as if stupid, cannot collect her thoughts properly. Great vertigo. Wakes with headache and a pressure in crown and temples almost all d. Pressure in toBptci for 10 d, Pressure in occiput. Repeated shooting in crown for 10 d. Shooting in ears. Very weak sense of smell ; only wine is smelt trora a great distance, 9o that she is almost intoxicated by a glass from which wine had been drunk that is »taBding ill the room. Formication in nostrils. Drawing in gums. Dry throat. ! --'hrs water. Great thirst, e. Heartburn from stomach up to throat. Shooting lob. cordis. Shooting utidcr r. short ribs, in hepatic region. Pinching in ^ followed by scrapy pain in stomach. Pinching and rumbling in belly for i z d. ; 1.0I fur I d. alter this. Immediately alter dinner purging and discharge of : _:_i. Purging with pain in belly. Purged 3 times with sore pain at anus. During ttool, tenesmus and great pain in sacrum, though (he stool was soft. Repeated wceztag, after which her head became much freer. Fluent coryza with acute smell. Dry eougb, e. On breathing deeply shooting under sternum. Shooting in r, side ot cheo, when tpeaking. Shooting in chest on breathing deeply. Great palpitation of heart. Shooting in r. scapula. Contractive sacral pain, especially after stool, Dnvring pain on a spot the size of halt a crown on I. arm, as though an ulcer would cgin« there. Shooting in houghs. Twitchings in whole body with pulsation in bead aOd paipitation ot heait. Immediately attcr dinner she became sleepy and slept I b.,C(Kil<i not waken up thoroughly till she got severe palpitation of heart. Cold. iteit and shivering, c. Internal coldness with hot face, hands sometimes cold, some. tifset warm, sometimes sweaty, no thirst.

j'. 5th d. Vertigo with sinking in stomach. Pressure in occiput. Stitches io 1,

udc of head. Much hair comes out on combing head. Heat ot eyes with lachry-

BaHoB. Shooting in ears from music. Dry throat. Bellyache, m. Cutting around

m«ri. Pressure under sternum. Drawing, lame, spasmodic pain in r. hand up lu

ciHow. In r. iliac region feeling of power. essness. Lame feeling under knee, as if

^■'-c asleep. Red itching eruption all over back. Small itching vesicles, with red

r and secreting a yellow fluid, which are sore to touch. Chattering of teeth

. n!dne>s. Body hot, bands icy c.tld.— 6th d. On waking, m., pressive pain in

ricit, going off on rising. Much hair comes out on combing head. On

.xtemal car pains internally. Shooting in cats; shooting behind I. ear,

.. fiirJ red swelling there. R- check glowing hot, 1. pale. Sour taste. Spasm

snach. In toe-balls of I. fool acute pain >o that he cannot tread properly. —

ifi .t. Headache as if both temples were compressed, e. Shooting in scrob. cordis

krough to back. Shooting in hypochondrium. Dry cough. Rigor almost all d.

■ Sih d. Burning in head, followed by formication there, anorexia, violent

in ear, la»tly coldness and rigor. Pressure in r. eye extending to occiput,

bed painful lips, Violmt drawing tearing pain in upper teeth going into fore-

Swollen gland under tongue, pamtul when touched. On hawking up mucus,

m-, »ickn(s» with flat taste. Sour and slimy vomiting with considerable straining,

m. Contractive pain in stomach after eating. Violent scraping in stomach after

ling. Pain in belly as it about to be purged, e. Teaiing in belly, n. Frequent

{irg to Mool, m. After urinating, burning itching pain in urethra. Orifice of

^hra somewhat inflamed and stuck together. Emis>ion without waking, n. Dis.

«karve of prostatic fluid. Stuffed uose. Shooting in chest on breathine deeply. i^floeck 10 thiit head loiild not be turned to r. side. Hands as if paralysed and

VOL. IV. '7

, thai kKaiag m tkoi widi wrndSmm of iagaJafu and dificalty of moring« af nar dae cnUBOB ibA ckSncs of bo^. SoootMi^ ia L tbigh, be - '^ " rtj tmA vmia mamam. Oampakaec. — yik d. Sfcaniiiig in earv M ikdHaac !)!■■■■,]■ llitt,fci Kwtitit dcqi» u^ wkk coMnets aiiw ........^ — ^-u

i: iKfc i. Kmli iifi ni aad iBziecj, » tboBgb a visfonunc were impcmliai, UK. nnrfw^ M if botk topics «rac coatptc^xd, c. Burning below nuK «i taw (evcir avjsa. Uppet ]sp ma^ and diy with tmnting feeling. Bitter out. SpisHB of dc^^lstidaa. Naaaca. Fira beUyitche dkoi violent spasm in ttofuciii peat namea a*d io« «f taEra. Pais on pteiHue ia hepatic region, iprcadiaf duongfc tft MTob. cocCk. Whea wm&iag tmowi in Urer extending to scroti, conlii. Shoanag ia Wpaiiic fcgiaa relieved by ooopi^b caanot straighten himMlf ob ■fBOOB of it. Stmwriag ia bjpockaadtiaaL AUp-a. wKilc walking severe ud ■oesnat bofbotygaHK ia bcBy. Coagh aad kiccin to^iier, as though ibc •boald becbolEed, tior i hi Great coaMiictiaac of d»e»t. Gets thin, espccialiy in back. , iKt cheeks abo aiv tkiaaer. Red fpob oa r. siiouUer which bum when touched.

L iithd. Staggering oa rising au During stool tenesmus and violent bumii>£^ IB aaus. Horriblcbaniiag in kaec, aad oa Umchiag it feeling as if it weft full \ din. Itckiag papoks oa tacnaa, baick,aBd fingeta. Chilliness ami rigor. — i ?'^ She aag »U J. Indistiact visoa for tome m. Adypiia, cannot get water NnoKa. Sboodng in aoob. eoids». All m. dtj cough vrith shooting in -^ con£«w Wbcaat ml pain as if excoriated iachcft. Wben she lay on I. side in palpitadoa of heart, — gniag off oa lyia^ on r. side. Serere sore pain in r. mam wilB feetii^ as though its nipple fnre bnten off. R. arm as if paralysed, with era ^^ in it. She becanc cmaaattd, all her drc»c» are too wide. L. hand cold, r. hoc '- , I jth d. Dry cough.— 14th d. Feeling to r. eye a> if a hair were in it, e. — «6tl» ,' Constant hunger, if she does not cat she gets sick, for 3 d. Finger* swollen foe b _^ j. (No time stated.) Apprehension and anxiety for scver^ afternoons, reltrreu ^ weeping. Apprehension for several e. Apprehension, anxiety and ineUuchtily» though she anticipated a death, at 4. p jd. for a succesMrc d. After dinner, bearin^^' of head. Pre^ite pain 00 crown, sometimes with shooting. Rumbling in belVT' On breathing deeply borborygmus in abdomen, for 8 d. Some formication in gUJ" penis. He ran breathe better when he leans over to I. side and against a supports The 1. side supers more than the r. Dreams that a tooth had fallen out. Every '■ rigor of whole body. Transient heat after vomiting. (Hartl&ub and TrixkI, R. J. M. L., iii, too.)

I J. a. Nensisc* — Soon- Sudden transient heat ri«c^ to bead. Rough and scrapy in throat. After 5 m. painful gnawing in r. ear. Burning •hooting externally in 1. hypocbondrium. Pain in stemam as if a knife were sticking there. Alter J h. heaviness of head on stooping. Violent itching in r. inner cantbus, after rubbing it bums. Shooting tearing in r. lower teeth. Suddenly a number of prickings in whole abdomen. Tickling in throat provoking frequent cough. Acute ^hooting in r. side of chest, near axilla relieved by inspiration. — i»t d. Great gaiety and loquacity a-s if intoxicated. Great heaviness of head, it tends to sink forward*. Painful tearing in r. ear. Sudden burning in I, nostril. Wakes after midnight with tenderness in abdomen, so that she can hardly bear it to be touched, without internal pain ; this was followed by soft stool, with cessation of the pain ; the same happened at 4 a.DL. The menses, which were 1 d. later, are more profuse than usual. Burning stitch under 1. breast. Tearing down 1. calf. Jerking tearing in dorsum of I. foot. Trembling of head and hands, with high spirits like intoxication, after a meal. Trembling or rather shaking of feet for a long time. Yawning and sleepy after dinner. Wakes before midnight but soon falls asleep again. Icy coldness of feet, could not get them warm in bed all n. From 5 to ? p.m. chilliness, at 6 p.m. thirst. — ind d. Jerking tearing in and outside r. ear. Painful drawing in r. Mde of lower jaw. Tearing in front of and behind r. ear. Inclination to vomit. Acute shooting in r. flank. In a h. % small soft stools, followed by internal sensitiveness o( abdomen. Two small soft Wools with straining for long afterwards, e. Two soft stools, n. Frequent urging to stool, and each time very Tittle was passed, with tome pain in belly before aadaftei.

• Ng.'s provingt, doubtlesi of the asuaj character, were made with the broad* leaved Hungary-grown tobacco. — Eds.

4S^

rnrm^ m undons of J. forearm toward* hand, and then in elbow, Often painful

lamij in little finger. — 5tb J. Violent tearing in facial bones and teeth, e. Bitter-

Sn*ol mouth, on waking, m. — 7th d. 5 diarrhceic stools at n. with burning and

' mnniut in anus. Frequent rumbling of flatulence, with pain in belly, then

[^iuri)(M with tenesmus, e.

i. (No time stated.) Apprehension, unhappy and pusiitanimous, with nausea ; ctiiiiiks she muit die; this goes off after vomiting (after dinner). Low spirited, Biloi disposition. She could not retain an idea, others always came into her mind, Fchuing out the first, with heaviness and oppression of head i thi» all goes off after oojltng ;ifter dinner). On coming into room after walking in open air, vertigo lith oaufra and eructation, the nausea increased in warm room so that she must I g» into open air, when she vomited her dinner. Vertigo round in a circle "«Tth prctsive pain in forehead and temple*. After dinner heaviness of head. Htadiche with vertigo. Dull pressive pain in forehead and root of nose. During dnncr pressure in r. side of head. Headache with feeling of slight throbbing in both trnplet. Headaches relieved in open air. Pressive feeling in eyes, especially ring them. Sight is lost when looking at a white object. Pressive feeling I orbit* with weakness of eyes and vertigo. Tearing and pricking in r. ear [Deathly paleness during nausea. Dryness of whole mouth with great thirst, i of tongue and lips. Mouth full of white viscid mucus, which must often be ut Bad taste as after burnt milk. Sore feeling in r. side of throat. Formicanog In throat which is painful on swallowing. Tickling and rough feeling in throat, fVitcid mucus in throat which cannot be got up. No appetite, loathes dinner. ,.App(tii< returns immediately after vomiting. Increased thirst. When sitting «jui«ly pretty well, but the slightest movement causes horrible nausea. Vomiting of •»I« only, during which it was green and yellow before eyes. As long as he sits ••ill he fin keep off vomiting, hut when he moves vomiting comes on. Pressive , tKling in uomacb. After vomiting weakness of stomach for a long time. Cold fictjiigg in ftomach and aJong spine. Pressive sensation under r. short ribs as if a r round body lay there ; the part is nainfiil to touch. Pains in abdomen, which dcd. Prrsiivc pain in umbilical region, with cramp.like retraction of navel, pre«<ive pain w hypogastrium with nausea and inclination to vomit, and [diillincv of whole body, relieved bv discharge of flatus. A painful pressive pain in •nal legion. Cmmpy pains in umbilical region. Digging and pressive feeling in lankilical region. Painful retraction of navel, especially when stooping. Rumbling ill Kt.K , «lih cold feeling all over body. A very quickly coming, almost irrcpress- . greenish -yellow stool followed by tenesmus. Greenish slimy diarrhceic rrnesmus, Liquid very fetid stools, foliovved by tenesmus. After stool ■ pain in anus. Increased discharge of yellowish-rcd urine. Dryness of nose, of chest relieved by deep breathing. Fine stitches in middle of chest into »>niium, Many transient stitches from before backsvards, increased by deep breathtng Quivering in a finger. Obtuse pressive pain in hip. and knee-joints. On riaog from seat and commencing to walk pressive pain in lumbar region which went oiron continuing to walk. Tearing externally in 1, tibia. Pre«sive pain on 1. ankle- Violent pressive pains with restlessness of whole body and sweat of anxiei}. tter in open air. Weariness and weakness of limbs. Trembling of whole body ing nausea. Itching in r. hypochondrium. Great drowsiness. (IhU.)

Dr. Hammond was not in the habit of using tobacco in any rm. He made two series of experiments, one when a sufficiency of was taken to keep up the weight and vigour of the body j the ber when the aliment was insufficient. a. Having first ascertained his normal averages for 5 d., for another 5 d. be smoked 150 gr, of T. (nearly two cigars) after each meal. As result, his weight increased an average of 07 lb., carbonic acid of ith 8804 &'■> ^^^^ ^^^^ °^ urine, 493 gr., uric acid 5.88 gr., phos> boric acid 28-83 gr., and sulphuric acid 441 gr. On the other hand, |ueoU9 vapour decreased by 29946 gr., fasces 0I oz., urine X'87 oz., 4'37 &'•■> ^^^ chlorine 23*04 gr. " The general cfFccts upon my

26o

system," he writes, " were exceedingly well marked. There *» great nervous excitement accompanied by irregular action of muscb, more particularly of eyelids, mouth, and lower extremities, which l4St«i for about 2 h. on each occasion of using the substance. The miiii^ however, was clear, and there was no headache. These seiisitiotis were succeeded by a pleasant feeling of ease and contentment, whicK also lasted about 2 h. During the first part of the n- there was wAc fulness, but this was always followed by a sound sleep, which continued till the h. for rising. The pulse was increased (from 85)- to an averJ of qa per m. The appetite was as good as usual. The perspirjtii was apparently diminished.''

i. After allowing 5 d. to elapse, H — cut down his bread from 18 12 02. daily, and his meat from 16 to 10 oz., in other respects conditions being same. After another 5 d. of observation without tobacc(^ fur same period he smoked as before. The loss of weight induced b^ the insufficient supply of food was lessened from the first and entirely overcome by the 4.th d. Excretion of carbonic acid from lungs wa.2 not perceptibly aifected. Amount of aqueous vapour was reduce*: '5994 S"""' faeces I'gi oz., urine i'5i oz., urea 62-54.gr., chlorine 1 5 gr. Free acid of urine was increased 3*03 gr., uric acid 4.'52 gt-^ phosphoric acid 30-23 gr., sulphuric acid 8"35. The general effects ora the system were almost identical with those previously observel. (Amer. Journ, of Mtd. cSf., N. S., xxxii, 316.)

II. Poisonings. — I. A woman of 40, and 3 girls set. 18, 18, and U rcspectivelyj* drank coffee the beans of which had lain among frjgmants of tobacco leaves, exposed for some d. in warm rainy weather Hardly had the cott'ee been drunk, when b suddenly complained of vertigo, fell unconscious from her chair, and was convulsed. M the same moment c was attacked with vertigo, nausea, trembling of limbs, and inability to hold herself erect, but did not altogether lose consciousness ; and d felt giddy, and vomited contents of stomach, after which she continued to feel languid and prostrate, with pale yellc»wish-grej complexion. The woman herself was but little aft'ected, though she had drunk the largest quantity. />, whose health had generally been

good, and who was of small stature and sanguine temp., was now lying on floor with flushed but cool cheeks, violently throbbing| carotids, distended jugulars, eyes staring and drawn upwards, pupils dilated and fixed, injected conjunctiva, head bent backwards as if by tetanic spasm, slow breathing, slow, hard and full pulse (60), cold feet and (inger-tips ; she was generally quiet save that extremities were occasionally moved by clonic spasms, head remaining tctanically drawn. She was quite unconscious. Pressure on abdomen with flat hand seemed to excite the spasms, r, a stolid phlegmatic girl, sat on a chair supported ; arms were hanging down relaxed, head inclining backwards ; face had a dingy yellow colour ; eyes were closed but could be easily opened ., every now and then she trembled all over, half moaning, half groaning; pulse 100, of unequal strength, apparently full but really Suit and large; carotids throbbed violently; resp. was hurried and anxious. She could just answer questions ; and it was thus ascertained • Thi-st will l)c dosciibcd as a, l>, c,J resptccively.

tht she felt violent palpitation with synchronous throbbing in head, kzmg in cars, dryness and scraping in throat, but no nausea or pain in rtomach or bowels. lAW made a good recovery. {Frank's Mag.^ i, 107.)

fl. An insane man, «t. 26, swallowed over '^ss of dry T. He

'•SJ insensible and motionless, in complete resolution ; resp. was feeble ;

rpuljc SareJy perceptible; pupils closely contracted. He was placed in

la Hrarm bath. After A h. he had violent tetanic convulsiuns, and

bundant alvine evacuations containing the debris of tobacco-leaves.

5totnach-pump was used, without more than the slightest effect on

ihc symptoms ; but the pupils became dilated. The convulsive

Itiacks were renewed, accompanied by vomitings and by mucous and

Woody stools. Tetanic stiffness with trismus became more and more

P'otiounccd ; pulse was always frequent, filiform, nearly imperceptible;

heart-beats irregular. Pupils had again contracted and gave no response

l« light. These symptoms continued for about 7 h., and patient died

I Jrncope.

i. /*.w., 40 h. after death. Cadaveric rigidity very pronounced.

iWrdulla oblongata and encephalic mass much congested, as were also

livtr and kidneys. Gastric mucous membrane showed on all its surtace

a number of ecchymotic spots ; intestines were contracted, and their

mucous lining vividly injected at places. Bladder was contracted and

empty. Blood everywhere black and semi-fluid. {%kj.e, Ed. Med.and

%'7«ni., 1855-6, p. 643.)

A girl of 18, for constipation, took an enema of about ^iij of common shag T. boiled in Oss of water. After \ h. she was seized »«h faintings and sickness, and fell into profound c<illapse. The face *i-s pale, the skin covered with cold sweat. She vomited several [Omcs, had slight convulsions, and died i^ h. after the injection. The lleart was found fljccid and empty. No redness in stomach or intcsne». (Eade, Lancet^ 1849, ii, 480.)
A woman of 23, affected with itch, prepared a decoction of 3 oz. T. leaves with which she soaked compresses and wrapped them round

arms and legs on going to bed. After 3 h. she felt a shudder throughit body, vwhich was followed by nausea and violent vomiting, with «pasm$ in extremities and even in muscles of back. These symptoms continued from I to 4 a.m., when a physician arrived. Pulse was lall and very frequent, fzce deathly pale ; patient vomited pure blood doctor's presence, and had vomited a large quantity of it before. 'here was no blood in faeces. The compresses were at once removed, and she was bled. After vomiting (of mucus only) 3 times she was soon restored; but had a weak stomach ami no appetite for a fortnight longer. {Frank's Mag.y i, 784.)

A man and his wife applied largely, for itch, a decoction of 60 gnu. of T. to 3 litres of water. This was at 8.30 p.m. They then

tnt to bed, — the woman having experienced during the application

hcaJachc and vertigo. In \ h. symptoms of poisoning shewed

slves, and Dr. Bianchard was called. He found the husband in

Ibis face pale, covered with viscid sweat ; he was in a stupor from

it was difficult to rouse him ; he complained of violent pain at

stomach, of excessive cold, and of frequent desire to micturate Surface was of ochre colour ; limbs trembled ; he had cramps in variou parts, making him cry out, and spoke deliriously. There was consta* retching, vomiting, and dejections recalling by their aspect tha of cholera. Pulse was small, slow, miserable. The woman was abl to assist in attending on her husband. She said that she had begun I feeling oppressed, stupid, benumbed, and then had been seized wil vomiting and purging. Her husband, thinking her worse than hia self, endeavoured to get up ; but fell like a drunken man, sayii that all went round with him. He managed, however, to call h neighbours to their help.

By means of coffee and other stimulants, and washing the skii the husband was revived ; but a measle-like eruption occurred in bot (Blanchard, Bu/i. gen. de The'r.^ Ixxvi, 525.)

Mr. HowisoN embarked on board of a sloop in one of the pot of Cuba. He went to sleep in the cabin, which was full of lar| packages j but was harassed by wild and frightful dreams, and sudden awaked about midnight, bathed in a cold dew, and totally unable speak or move. He knew perfectly where he was, and recollece everything that had occurred the previous d. ; but could not make a( bodily effort whatever, and tried in vain to get up or change his poi lion, " Four b*ils " was struck on deck, and he heard the soon (though rather, as it seemed, through their vibrating in his body thi by the ears) ; and he was conscious of other things that occurred,—! that he was not dreaming. At length he became totally insensibj and continued so till an increase of wind made the sea a little roug and the ship began to roll : this roused him, and he contrived tog upon deck. His memory was totally lost for about ^ h, ; he kn< that he was in a ship, but nothing more. While in this state he cl served a man drawing water from the sea in buckets, and requesti him to pour one on his head. On the seaman's doing so, ail li faculties were immediately restored ; and he acquired a most vivid r collection of a vast variety of ideas and events which appeared to h»l passed through his mind, and to have occupied him during the ttmei his supposed insensibility.

All this singular constitutional derangement had arisen from inhali lion of the fumes of T. : the packages in the cabin were full of thi narcotic ^ the sloop was laden with it. {Foreign Scenes^ Edinb., 1825

During the burning of a tobacco manufactory at Toulouse number of persons employed were overpowered by the smoke.

a, E. C — , soldier, aet. 23, was brought into hospital in a conditio of complete intoxication, face dark red, sparkling eyes, strong puis laboured breathing, relaxed limbs, cold extremities. He recovered col sciousness during the transport to the hospital, when he was bled ' ■^vj. He was then instantly seized with horrible convulsions, stiffiM of limbs, violent contraction of abdominal muscles, head drawn bac wards, dyspnoea, distended blood-vessels in head. He recovered afl 5 or 6 h.

h. A — , soldier, set. 30, became insensible and motionless, respii tion apparently gone, pulse smalJ and slow, face reddish-brown, gn

contraction of jaws, yellow mucus in mouth, flaccid limbs^ complete loss of animal heat, cold and blue extremities. After camphor frictions and other means, his breathing returned and became regular ; he passed from stupor into the merriest intoxication. He talked all sorts of funny nonsense, accompanied by convulsive movements and spasms of face. The eyes became small and like to close. He then fell asleep and awoke next m. quite well.

c, W. C — , soldier, aet. 27, had been working all d. in unpacking the tobacco. Complete insensibility, loss of voluntary motion and respiration, pulse very slow and weak, contracted jaws, froth in mouth, face brownish red, imperfect tetanus, cold and blue limbs. He threw up a little whitish mucus, fell into a profound sleep, and awoke well nextm.

d. Julia B — , aet. 30, had been exposed from 8 a.m. till 2 p.m. to the fumes from the half burnt wet tobacco. At first felt unwell ; headache, constant cough with feeling of burning in larynx, great flow of watery mucus from nose, pain in stomach. Soon afterwards vertigo and cold sweat all over body. She tried to get away but fell down insensible and was brought to the hospital in this state: Loss of respiration, pulse hardly perceptible, cessation of brain functions, violet-coloured face, stiffness and coldness of limbs. On recovering her senses under treatment she complained of her stomach and made efforts to vomit — got tart. em. — >Bd vomited slimy matter. The pain in stomach increased, frequent eructation, general convulsions with bending forwards of body and stretching of limbs, cried out with pain in stomach. Soon recover<id "•"Jer dry frictions. (Cany, Rec. de Mhn. dt Mid. ii, 379 j in Frani's ■«%• iii, 856.)

8- An infant of 7 d. old was given at 8 p.m. two tablespoonfuls of ""ter impregnated with tobacco-smoke, which was strong enough to "•"C tongue of mother ** smart dreadfully " when tasted. At 9 it was found with entire system flaccid, pallid, eyes closed, comatose j pulse imperceptible and heart's action almost so ; resp. spasmodic, deep, 6 per ^' i deglutition almost impossible ; temp. high. From this time till 4 >>ni. stimulants were used externally and internally, with artificial f^iration for 5 h. of the time ; at end of which, patient having ™c>thed spontaneously for 30 m., suddenly expired. P.M.^ 28 h. ^^^. — An unusual redness over entire surface. Ecchymoses about P|^'pital and part of temporal regions. Lungs gorged with venous ^^- L. auricle and ventricle filled with fluid blood ; r. side empty. Membranes of brain highly injected with blood. (WeAks, Bat. Med. "^ *«»y. Journ.^ xl vii, 461 .)

9- The symptoms of mild poisoning by tobacco-smoking are — ■jicreased flow of secretion from eyes, nose, and mouth, with feeling of ^tness in head as though a band were stretched round it, disturbance '^vision, with tinnitus and vertigo. Palpitation and praecordial distress WIow, and notably aching and feebleness of the arms. Then come Uusea, eructation, vomiting, clammy sweats, voidance of contents of owels, in fact, a state of general collapse. (Woakes, Deafness^ iffc.,

879* p. 59-) 10. A man, set. 42, laid a wager that he would smoke during one

afiernoon 25 pipes in succession, though he was not accustomeo more than 3 — 4 per diem. He gained his bet, but after somch.he| was seized with numbness followed bv loss of consciousness, which did not return till after very violent and repeated vomiting. This w»s in its turn allayed by buttermilk ; but for eighteen months after he had pains in head and vertigo which at times assailed him with great violence, and he took such a distaste to tobacco that the very sight of it made his head ache, {jouru, de Mrd.^ ^7S7t P- ^^■)

May 24th, 1815, Mr. J. H — , aet. ig, unaccustomed till a d. 1 two before to the use of T., smoked one and part of a second pipe without spitting, — partaking at same time of a little porter. Hij became aftected by violent syncope, retching, and vomiting. He turned home, complained of pain in head, undressed, and went to be^J Soon after he was taken with stupor and laborious breathing. He was found in this state by the medical attendant. The countenance wai suffused with a deep livid colour; eyes had lost their brilliancy ; conjunctivae were injected ; r. pupil was exceedingly contracted ; I. was much larger than usual, and had lost its circular form : both were insensible to light. Hands were joined and rigidly contracted, as was whole body ; arms were bound over chest. Breathing very stertorous, pulse 80 to 82, otherwise natural. There was no paralysis. He was bled from temporal artery with some relief, and an ipecacuanha emetic administered. Dozed during n. On m. of 25th patient was affected with syncope during efforts he made to get up and go to stool. At visit he complained much of pain in head and eves ; eyes and lids were red and suffused. Pulse 80, natural ; tongue loaded and brownish ; feet cold. Continued to doze. Bleeding repeated, this time from arm. On 3rd d. he still dozed, complained of pain in head, nausea, and tendency to faint. Face more natural ; pupils normal, contractins bjr light. A loose stool passed insensibly in bed. In c. he again became affected with a degree of stupor, spasms of hands, and stcrtorouj bteathing. Countenance was not livid. Treatment as at first. On m. of ayth patient was as on that of 26th, with dry and parched tongue ; still dozing. Thenceforward to 31st he gradually recovered.^ (Marshall Hall, Edinh. Med. and Surg, youm., xii, 11.) ■
a. The case of the human organism against tobacco is ma^e out by Dr. Richardson and others to be something as follows : — In smoking tobacco we take in carbonic acid and carbonic oxide, several ammonias, and an oily substance, which is crude nicotine. In this crude nicotine are nicotine proper, a volatile empyreumatic substance, and a bitter extract. The ammonias and the nicotine especially an the substances which so sadly poison the system, and thcv act H numerous directions: i. The ammonias, entering the blood, make it

• " It is difficult to account for the syni|itoms observed in this case nitho supposing that lho*ie which occurred after the patient reached his bed attributable to an attack of congestion ot the brain accidentally developed by sickness which the tobacco originated. Yet there is anothcc case on record wh presented symptoms closely resembling these; and if is the more remarkable becxa the same poisonous cause acted at the same time and equally upon two pcrv>ns, 1 whom one was affected after the us^ial manner, but the other presented the followil symptoms." (He then quotes II, 1.) (ST»l.t£.)

too alkaline and fluid, thus interfering with its proper nutritive activity. 2. The stomach is debilitated and dyspepsia induced by the general influence of the drug. - 3. The throat is made dry and red, the tonsils enlarged, and the morbid condition known as "smoker's sore throat" results. 4. The innervation of the heart is disturbed, its action being weak, irregular, and intermittent; palpitation, prsecordial pains, faintness and vertigo are the consequence, forming the well-recognised symptoms of the " tobacco heart." 5. The laryngeal and bronchial mucous membranes, if already irritable, are made more so. 6. Owing chiefly to the disturbance in the blood and heart, the processes of nutrition are slowed, and in the young may be seriously afl^ected — tissue is degraded (Acton). 7. The sexual organs are at first stimulated, especially by cigarette-smoking, but are eventually weakened in power ; "excessive smokers, if very young, never acquire, and if older, rapidly lose their virile powers" (Acton). 8. Vision is impaired, especially if alcohol is used in conjunction with the tobacco, '* tobacco amblyopia " being produced. 9. Muscular co-ordination is impaired, especially in the young ; drawing- masters find that young smokers cannot draw a "clean straight line." 10. The antidotal effect of alcohol to tobacco leads to forming the habit of drinking. 11. The power of concentrating the mind, and perhaps of intellectual activity in general, is lessened. The Minister of Public Instruction of France, finding that smokers, as a rule, stood lower in their classes than nonsmokers, has forbidden the use of tobacco in the public schools. " Alcohol oppresses the well-nourished brain, though it soothes the exhausted one " (Richardson) ; in general, a person can do more intellectual work without tobacco than with it. All smokers can do more work if they smoke moderately than if they smoke excessively.

b. The above includes about all that can be said against tobacco, and it is an indictment that is heavy enough. Indeed, we cannot but feel a little of the conscious guilt that comes when ruthlessly proclaiming the frailties of a friend. It is in the cause both of justice and scientific truth, therefore, that we hasten to state some modifications of the very damaging charges given. Tobacco is essentially a functional rather than an organic poison. It modifies the special energies and not the structure. It does not, like alcohol, leave a knobby liver behind to proclaim past indiscretions at the autopsy. This is the strongest point to those who argue for its use. It is an evasive poison. Then again, it is a drug that works its bad effects on a minority of those that use it } and these bad effects disappear very rapidly when the habit is given up. Tobacco is eliminated chiefly by the kidneys, and it leaves the system very rapidly ; both acute and chronic symptoms of tobaccopoisoning are, as a rule, in adults quite transient. The effect of tobacco upon the throat is not very often injurious ; Dr. Richardson's idea that it has a tendency to produce dyspepsia is opposed by the experience of many. Tobacco amblyopia is not at all common.

c. All this, and still other things, can be said in favour of the drug, but it is to be remembered that they apply almost entirely to tobacco as used by adults. The evils of tobacco are intensified a hundredfold upon the young. Here it is unqualifiedly and uniformly injurious j it

stunts the growth, poisons the heart, weakens the sexual organs, impairs the mental powers, and cripples the individual in everv way. Not that It does all this to every youth, but it may be safely asserted that no boy of twelve or fourteen can begin the practice of smoking without becoming physically or mentally injured by the time he is twenty-one. We refer to this with especial emphasis, because the practice among boys of smoking, and especially of smoking cigarettes, IS now very prevalent. The most prominent cause of rejection of candidates for apprenticeship in the navy, says Dr. Magruder, is irritable heart— caused, in most cases, primarily by tobacco. Ten out of eventhousand applicants, in the year 1879, were rejected for "tobacco heart." It is the duty of our public-school instructors to make the facts in regard to tobacco known and impressively felt by their scholars, and we hope that this field of sanitary mission work will be actively occupied. Sewer-gas is bad enough, but a boy had better learn his Latin over a man-trap than get the habit of smoking cigarettes. For we may lay it down as certain that tobacco is a bane to youth, though it may be the proper indulgence of manhood, and a solace to old aee. (N. r. Mtii. Record, 1881, p. 349.)

A young Catholic priest complained of incessant ebullitions of blood, extraordinary heat, vertigo, stupefaction, headache, sleeplessness, humming and roaring in ears, anorexia, constipation, burning in urethra during micturition, feeling of great debility, great dryness of mouth, violent thirst and pains in all timbs, pulse 120, face hot and bright red. The patient was in the habit of smoking ^ lb. of tobacco daily. He was persuaded to lessen this consumption of tobacco by i pipe a d., and at length he had reduced the quantity to 5 pipes. Seen 5 weeks later all the above symptoms had disappeared. (S9HMIDTMANN, Hufeland's Journal, xci, pt. 6, p. 112; in Frank'i Mag.^\, 813.)
M. Ic Comte de — , set. 42, had ever since he was 20 smoked 7 — 8 cigars daily, without having ever — as he asserts — exp'^rienced the least inconvenience. In 1853 1 frequently met him, and he seemed to be enjoying perfect health. It was quite otherwise when, at the commencement of 1856, he came to consult me. He then had considerable emaciation, especially noticeable in lower extremities ; sense of general weakness ; chilliness ; pulse rather weak, but regular, 70 — 72 \ temp, equable and mild, notwithstanding serious apprehensions about his health ; sleep not good, frequently disturbed, sometimes without apparent cause, but also often by cough and colic ; sinking at stomach if his meals were at all delayed beyond usual time ; attacks of ravenous hunger ; immediately after eating pricking in stomach, soon followed by a diarrhceic stool, of which he usually has 3 or 4 daily j frequent irritation of throat and larynx, causing hts of dry cough, especiaJty at n. ; dull pains in loins, which seem to alternate with the sore-throat j stools usually soft and often diarrhceic ; lastly, occasional violent diarrhoea with severe griping, sometimes lasting several d., and followed by constipation. ( Treatment of all kinds had been tried, but in vain, nor did T — 's prescriptions benefit save that veratr. alb. 3 arrested thediarrhcca and griping when it occurred. He was then ordered the water-

"^6,

cure, which, after several weeks, produced considerable amelioration j but the abdomen was still tender, and every meal was immediately followed by an acrid-smelling stool, pale and not formed. At last T — became convinced that the tobacco he smoked was the cause of his sufferings.) He adopted my advice, and was soon obliged to yield to the force of evidence. The less he smoked, the better he became — the stools formed, the pains diminished, &c. At last he gave up smoking altogether, and almost immediately the digestive functions were restored to their normal state. A week later he made the experiment of smoking for i d. only, the effect of which sufficed to convince him for ever. Two months later M, de — had regained his stoutness, and the rosy colour he had when 1 knew him in 1853. (Tzsn^ yaurn, de la Soc.'CUlk., 1858.)

a. Captam C — is aff^ected with an obscure disease, but which IS generally agreed to be serious. He is 43, and originally of good constitution, He first consulted me Oct, 5th, 1856. The following description of him is taken from the notes I made at the time : — Pale, or rather yellowish complexion, reminding mc at first sight of one affected by cancer; expression severe, melancholy, stamped with that indifference to everything going on which proceeds from excessive discouragement J eyes are dull, lustreless, sunk in the orbits ; lips arc colourless ; mouth dry ; tongue yellowish, not furred ; no thirst, no alteration in breath or taste. He has appetite, but dare not eat > every meal, even of the lightest sort, is followed in 2 or 3 h. by the most horrible sufferings m the stomach, soon succeeded by vomiting. VValking, driving in a carriage, and especially the motion of a train, cause same symptoms ; he then feels exactly as if sea-sick, has the same nausea and giddiness, coming on by fits, during which skin is covered with cold perspiration. Generally the vomiting affords relief; it sometimes occurs in m., fasting ; the matter vomited is a watery fluid, sometimes tasteless, sometimes acid ; on two or three occasions he has vomited blood in considerable quantities. He has habitual constipation, all the more obstinate the worse he is in himself; never diarrhoea. The whole abdomen, but especially epigastric and hepatic regions, is so sensitive that the pressure of his uniform coat is intolerable. Great heat or cold, and above all stormy weather, aggravate the symptoms, which on the other hand sometimes get belter of themselves for a longer or shorter period, under the influence of atmospheric conditions which the patient cannot precisely indicate. These days of respite are becoming rarer, but while they last abdominal pain becomes more tolerable, and he can eat without vomiting. Pulse was normal.

b. Cancer of pylorus or duodenum having been diagnosed^ T — carefully examined abdomen, but could find no tumour. Staphisagria 12 was prescribed, and at first with striking benefit ; but on his return from Paris to Cherbourg, the old symptoms recurred in force, and other medicines failed to touch them. At last treatment was given up, and T — saw no more of the patient till Jan., 1858, when he met him looking the picture of health ; his face fat, jovial, rosy; his eye sparkling ; a frank smile on his lips ; his step elastic. He seemed ten years younger. On inquiring who had cured him, he replied " Myself ;

dav I

y I gave up

I used to smoke, which you did not know. One fine smoking, and from that day I date my cure." {Ihtd.)

1 6. a. It cannot be less than 23 or 24 years since I commenced to smoke. The discomfort it at first produced grew less and less, but I have never altogether ceased to feel some inconvenience. The immediate effects precisely rccmble the secondary action of coffee — dulness of cerebral functions, confusion of ideas and inability to find words for their expression ; squinting if I attempt to read ; noise in ears; slight tremor of head and hands ; dislike to movement and society ; depression of spirits and desire to lie down, though 1 would take care never to go to bed in that state, being certain that I should be unable to close an eye. Soon the reaction commences. It begins by a slight disagreeable feeling about the heart and strong pulsation of temporal arteries; then the brain gets excited and there comes an immense flow of ideas. These intellectual paroxysms (if I may be allowed the expression) often last all n., leaving mc quite exhausted and ill the next d.

b. In Dec, 1856, having for some time past smoked more than usual, 1 perceived a disagreeable taste in my mouth, which I could only compare to that of rancid oil. The digestive functions were otherwise normal. The taste continued; felt on waking, going off during meals, returning an h. after. After some weeks of it, a yellow spot — size of a threepenny piece — appeared on one side of my tongue, looking like a piece of lichen growing there. I thought 1 discerned, when 1 sucked at the spot, that the bad taste proceeded from it. It grew a little, but slowly, and soon afterwards a similar spot appeared on the pillars of the fauces. I then became troubled with a dry cough, which in a short time became very violent j it was precisely like whooping-cough, and lasted day and night save when I was eating -y along with it there was dyspnoea and almost constant sibilant rales, which gave me a great deal of annoyance. The stethoscope found nothing but a good deal of bronchial congestion, Spongia and other medicines gave only temporary relief ; I then left off smoking, and in less than a week cough, dyspnoea, bad taste, spots — everything, in fact, had disappeared.

c, I made several attempts subsequently at moderate smoking, but found that if I persevered after the rancid taste had once set in, the cough and other symptoms would follow. At this time (Feb., 1858) I had to take a nine hours' railway journey, and was tempted to smoke all the way. The taste of rancid oil towards the end was so intense as almost to make me sick. On coming near home, moreover, I experienced some slight shootings in the hypochondria. My abdomen was fuller than usual ; and, while the seat of a dull pain, little increased bv pressure, was itself insensible to contact. I also had some difficulty in speaking, through a benumbed sensation not only of the tongue but of the buccal and maxillary muscles, which when I attempted to speak were affected with a sort of nervous trembling. On reaching home about 8 p.m. I sat down to dinner with great appetite, but had no sooner swallowed a few spoonfuls of soup when a sudden, sharp, indescribable pain, so severe as to make me cry out, c<iused the spoon to drop from my hand, and I fell back on my chair, pale as death, panting, and apparently at the last gasp. I could not utter a word^ and only my

hands clasped over my stomach revealed the seat of my sufferings. They got me to bed and applied hot fomentations, which gave much relief, and the pain went rapidly oft". Still feeling hungry, 1 ate a few mouthfuls of chicken, whereupon the pain returned, and I had a horrible n. It came every 20 or 30 m. at first, lasting l — 3 m., and ending iti copious perspiration. There were no other symptoms during the attack, and as soon as it was over I felt perfectly well. I had three more next d., but on the 3rd d., thanks to keeping my bed and eating nothing (though very hungry), they kept off. On the 4th d., after a good n., I swallowed a few spoonfuls of chocol.ite and went ouc in my Carriage. Scarcely had 10 m, elapsed when an attack came on, and I returned home in despair. The 5th and bth d. 1 spent in bed, taknig no food, and had no pain. On the 7th d. I took some chicken broth, and sat up a little. There was some slight pain in the sides, but no attack. Three d. later I resumed my usual diet and habits. Tongue, at first loaded, was still a little yellow at root. After having been ^^quitc well for 5 d. I tried to smoke a cigar ; but after 3 or 4 whirts there ^Bpccurred the acute characteristic pain in epigastrium, the rancid taste, ^■and sweat on the forehead. I should certainly have had an attack had r I persisted. [Ibid.)

M. Beau believes that tobacco is a frequent cause of angina pectoris. The following are the facts on which he grounds his j opmion :

a. A gentleman, aft. about 60, in the habit of smoking to excess, for a month suffered frequently at n. from palpitation, oppression, and pain \n shoulders. He discontinued smoking, and the attacks entirely ceased, the digestive functions becoming at the same time more regular. After 3 mo. he resumed his old habits, and again experienced the same symptoms. At length he completely eschewed tobacco, and has had no further return of the attacks.

b. A physician, xt. 50, troubled with dyspepsia and debility, indulged in cigarettes whenever opportunity offered. For some time he complained of palpitations, accompanied by oppression and sense of tightness about chest, recurring in paroxysms at various hours of d. or n. He gave up smoking, and the attacks ceased. One d. he was in the same room with several smokers, and though he did not imitate them, on the following n. the former symptoms returned.

c. A physician, act. 35, incessantly smoked cigarettes in the tnterals of his professional visits. For a long time his appetite had delined, and he consequently took very little food. One m., fasting,

hiie smoking on his way to a patient, he was suddenly seized with rzcordial anxiety and tightness across upper chest. He was unable to speak or walk ; his pulse became imperceptible, and his hands cold, hese symptoms lasted 4 h. He consulted M. Beau, and by his vice relinquished the habit ol smoking, promising to report if any •imilar paroxysm recurred. M. Beau had not heard of him since.

d. A Spaniard, aft. 30, in the constant habit of smoking cigarettes, ff'cred much from dyspe(>sia. One e., while indulging as usual, he

suddenly experienced violent constriction of chest, and for 10 m. his ulse was imperceptible. Alarmed at this occurrence, he greatly

diminished his daily consumption of tobacco, and the symptoms of angina have nut since returned.

t. A physician, who had been compelled to discontinue the pr<(Cticc of smoking on account of disturbance of the gastric functions, also experienced, while he was using tobacco, nocturnal attacks of tightness of throat, with palpitation and neuralgic pains in neck. He now enjoys perfect freedom from these symptoms.

f. A merchant, who for 15 — 20 years has suffered from dyspepsia consequent on immoderate smoking of cigarettes, suffers, chiefly at n,, from paroxysms of pra:cordial oppression, with palpitation and pain between shoulders. The features are drawn, and the puluc small and irregular. This gentleman now smokes more than ever.

g. A healthy and vigorous old man, <ct. 75, sought consolation in smoking from mental distress. One d. an attack of angina occurred, of i h. duration \ a second fie recurred next d,, and he was found dead in his bed the following m.

/;, A foreign diplomatic agent, an inveterate smoker, was seiicd one e. with angina pectoris, characterised by dyspnoea, smallness of pulse, coldness of extremities, and lividity of surface. He went to sleep at it, awoke next m. at his customary hour, and transacted business as usual. At 5 p.m., while smoking a cigar in his arm-chair, he suddenly expired. A fatty condition of heart was the only alteration detected at the post-mortem examination. (7. dt Med. et dd Chir. prat., July, 1862.)

Mr. L — , xt, 35, complained Dec. 12th, 1861, of sore throat, with partial aniesthesia of fingers, toes, and end of tongue. Fauces were red, and tonsils slightly enlarged. He was rather thin, and had a somewhat anxmic and cachectic look. On Jan. 1st he was losing flesh and strength y numbness was increasing, as also a tendency to constipation ; while appetite was inordinate. Urine was founed normal. By 1 2th he was confined to house ; numbness was now pretty general, Hnd eyesight somewhat affected. Heart beat a little irregularly, with a fiiight anarmic murmur. Tongue slightly coated. He had no erections or sexual desires. On calling on rsth. Dr. Farnsworth found patient in bed, and smoking. He then ascertained that he had been for several years in the habit of smoking the coarsest kind of tobacco in the foulest of pipes during all his waking hours. Anaesthesia was now general ; and motion, though itself unimpaired, was only possible by aid of sight. The smoking was stopped at once. Three d. later urine was heavily charged with urea, urates, and triple phosphates, with a distinct odour of nicotine ; he complained also of a fcetid sweat. By 22nd he was improving , perspiration still copious, smelling of nicotine. Sensibility did not return as fast as strength ; cold was hardly felt, and he had but little taste. Numbness now gradually went off up to March, passing downwards to extremities. He could then walk five miles to see the doctor as at first, and normal hue of face had returned. At this time, for experiment's sake, he tried a cigar. It produced nausea and all the feelings of a novice, together with a return of the numbness of the fingers, and a smarting of the fauces. {^Amer. Med. limtSy v, 189.)

%7t

The anaphrodisiac properties of T. have been long known j it

sed on this account in many monasteries in Italy. Demonstration

by recorded observations, however, is not abundant ; and 1 am glad to be

I a.l>le to cite the following cases furnished me by M. Martin-Damourcttc.

! a. A young man who spent part of his time in society, where he

j smoked more than 20 cigars daily, from a certain time felt his digestive

functions becoming impaired, his strength failing, his memory growing

vireak; and he became absolutely impotent. Wishing to marry, he

consulted a physician. By his advice he broke with his associates and

renounced his tobacco. His health returned, arvd with it his virile

capacities.

b. M. Martin-Damourette was consulted by a young physician the subject of complete sexual frigidity, for which he had taken, without effect of any kind, doses of strychnine increasing at length to 36 ccntigr. daily. No cause for the impotence appearing, he was questioned about smoking, and confessed to having a cigarette in his mouth the greater part of the day. His muscular energy and resistance were lensibiy diminished. The abandonment of tobacco completely cured the impotence, — no other therapeutic measures being needed.

(. A robust young man became inspector of the tobacco manu-

<^ures. After some time, he experienced a great enfeeblement of

genital power, and at last became impotent. After a fruitless trial

of ionic and stimulant measures, he decided on leaving his employment ;

»«^«d his sexual power was not slow in returning. (Foussard, £tu(ie

Rt^ U Tabac, Paris.) 20. a. The symptoms of central toxic amblyopia, which is a J^t her common affection, are : gradual failure of sight to much the same t>ctent in both eyes ; absence of any restriction of the field of vision, or indeed of any interference with the functions of the peripheral portions S^^ the retina ; and the existence of an oval scotoma, most marked for olours, extending from the point of fixation, which it involves, to the '•udspot. Most of such cases are met with in men after age of 40. ccisionally younger men are affected ; the youngest undoubted case Hive seen was 20. This form of amblyopia is very rare in women, though not quite so rare as was at one time supposed. Those who *ufFcr from it are almost invariably smokers ; and generally they have fJioked for many years before becoming affected. It is very doubtful " alcohol has anything to do with it, though this is maintained by ^^^nic. Certainly one not infrequently finds that those affected not ""'y smoke, but also drink to excess; yet the same symptoms are ^'^vcr observed to follow the excessive use of alcohol alone, though *^y are very frequently met with in smokers who abstain from 'cohol in any form. As a rule, when the affection begins, no change " been recently made in the amount smoked, and this circumstance *ccount8 for its being comparatively rare to find the patients suspect ^"C Cause of their amblyopia. Indeed, they not infrequently begin to ^inoke more after their sight has begun to fail, on account of the VfOrry that this causes. Very often smoking is indulged in on an «t»pty stomach, the first thing in the m. or very late at n., or, in the <a»eof bad sleeper8> during the n. It is owing to this circumstance.

probably more than to the difference in the kind of tobacco smoltcd* that tooacco umblyopia is mure common in the woricing than in the educated classes. Many men have to rise early and work several h. before partaking of a substantial meal, but ncvcnhctcss smoke during this time .... As a general rule not less than 3 — 4 02. of strong tobacco arc smoked in the week, often much more, — in exceptional cases less. In women a smaller quantity seems to suffice to bring on the symptoms. The same symptoms are produced by chewing tobacco.

L The defective area is oval in shape, with its long diameter horizontal, and stretches from the outer side of the blind spot to very slightly to the inner side of the point of fixation. It corresponds to the external projection of that portion of the retina which lies between the optic nerve and the outer margin of the macula, a portion which recent investigation has shown to be supplied by a special bundle of optic nerve-fibres — the so-called papillo-macular bundle. The fonn sense as well as the colour sense is defective over this area. . . -i

the defect is most marked for red and green As it is

only over a particular area that the colour sense is defective, the patients are often not aware of the colour-blindness they have acquired ; a large surface of red or green appears to them quite ^

distinct as formerly Individuals with tobacco amblyop'*

often complain of seeing worse in a strong light The

lesion which produces this peculiar form of amblyopia is not known. 1 he regularity in the shape of the scotoma, as well as the complete recovery which so often takes place, renders it extremely unlikely that, as has been maintained by some lately, it is a form of retrobulbar

neuritis It is much more probable that the poisonous

effect is exerted on some part of the brain which includes the central terminations of the papillo-macular fibres.

c. A large proportion of cases completely regain vision if the tobacco be stopped. Improvement, though less rapid, generally takes place when the amount consumed is reduced, or when the quality of the tobacco used is milder, (Berry, Dheases of the Eye^ 1889,)

I wish to make some remarks on a form of bad vision caused by the use of tobacco, and will call special attention to seven cases occurrine in women which I have observed at the Manchester Royal Eye Hospital. All complained of a rather rapid deterioration of vision, and the fundi were either quite normal or only showed very insignificant chango. How then was the diagnosis made certain in these, as it is in all case* of tobacco amblyopia, by the presence of a central colour scotoma? This test is easily applied by causing the patient to cover one eye, while with the other he or she gazes steadily at the eye of the exs" miner, who then brings a small piece of red or green paper, fixed on the end of a pen, into the centre of the patient's field, and notes the presence or absence of the patient's perception for colour in that part of his field. This test, so easily applied, is, I believe, an infallible test of bad sight produced by tobacco j and, further, I have never met with a central colour scotoma in a person who did not use tobacco, though

II ought here to say that some such cases have been recorded. In my experience, then, a case of central colour scotoma is synonymous with

tobacco amblyopia. I cannot too strongly insist upon the necessity of applying this test in all recent cases of failure of sight, whether in men or women, where the ophthalmoscope reveals a normal, or nearly normal, state of the fundi, and you will be astonished how large a proportion of such cases will fall under the head of tobacco amblyopia. Hardly a day passes at the Royal Eye Hospital without a case turning up. We must not be thrown oft" our guard by any slight changes we may find in the fundi, and at once conclude that they are the cause of the defective sight, for they may be only accidental changes in a case of tobacco amblyopia, and have little or nothing to do with the bad sight. For example, in three cases I have seen a solitary retinal bzmorrhage confined to one eye, the vision being equally diminished in both ; in several, fine vitreous opacities j in others high degrees of myopia with posterior staphyloma, and in one woman 1 at 6rst ima* gined the bad sight to be due to the presence of a few very minute l%hite ticks at the maculae, which were only made out with difficulty \hj the erect image. In this case I afterwards found a colour scotoma, and elicited the fact that the patient smoked. Again, I have seen two cases in patients with well-advanced locomotor ataxy, and have no facsiuiion in saying that it was tobacco, and tobacco alone, that was the cause of the bad sight. Professor Hirschbcrg, in a paper on Tobacco and Alcohol Amblyopia, in the second volume of this journal for 1879, says, " we never meet with the disease in women /' and the f^l^ cases I have seen recorded besides my own were published by Mr. G. A. Berry in the 'Ophthalmic Review,' April, 1884. I may further add that at the Royal Eye Hospital the first diagnosis of the affection in a woman was made rather less than twelve months ago. (GiiFFiTH, Brit. Med. Journ.., Dec. i8th, 1886.)

M. GuELLioT gives the following as the characters of tobacco unblyopia : It always commences in one eye (generally r.). At first jaiient sees through a mist, with central scotoma ; then from time to time he sees objects yellow. There is no confusion of colours. Sight i* worse in c. Pupils are contracted and immobile. (Alcoholic amaufO»u, on the other hand, commences in both eyes at once; there is confusion of colours, sometimes pain ; and patient sees better in e.) (li Progres Midical^ June 2, 1877.)
Dr. Chapman states that he was consulted by a member of CongrcM, in the meridian of life, and of a stout frame. "He told me thit from having been one of the most healthy and fearless of men, he had become 'sick all over, and as timid as a girl.' He could not even prntnt a petition to Congress, much less say a word concerning it, thuugh he had long been a practising lawyer and had served much on Icgiilative bodies. By any ordinary noise he was startled or thrown into tremor, and was afraid to be alone at n. His appetite and digestion were gone ; he had painful sensations at the pit of his stomach, and unrelenting constipated bowels. During the narrative of his ^uifcrings bis aspect approached the haggard wildncss of mental distemperjture. On inquiry, I found that his coijsumption of tobacco ''M almost incredible by chewing, snuffing, and smoking. Being o'ufied that all his misery arose from this pernicious weed, its use was

TOL. IV. 18

discontinued, and in a few weeks he entirely recovered." [Lontl. Gaz.f xxxvi^ (j^i.)

P. C — , aet. 30, on e. of Feb. i8th was suddenly seized while passing water with most violent pain in head, followed immediately bjf vomiting ; pain was so violent that he screamed for assistance. He was found pale ; skin cool, covered with clammy sweat ; pupils contracted, irresponsive to light ; pulse 48, small and feeble. He was perfectly conscious ; he complained bitterly of pain in head ; voice was feeble and low, and he was evidently in a state of great nervous prostration. He admits having been addicted to drinking ardent spirit* to excess, and to inordinate use of tobacco ; he was at same time exposed for several h. daily to fumes of tobacco while being " stoved." 19th, — Head easier, pulse 60, skin warm ; says that pain is now most intense when he makes water, coming on suddenly worse just as act begins. Urine high coloured, 1018, non-albuminous; pupils still contritteJ, but little responsive to light. During following days headache remawicJ much the same, always materially increased on micturition, but also on assuming erect posture. He never complained of uneasiness along urinary tract. By 22nd pupils were widely dilated and obedient to light. On 26th he was admitted to hospital, and found with pulse ' small and weak ; countenance anxious and distressed ; pupils dilated little sleep ; pain in head in paroxysms, and greatly increased at mictU' rition ; tongue moist, covered with white fur. He improved very slightly, if at all, till March 6th, when a strong smell of nicotine wa* observed all over his skin. He was now ordered a vapour bath every n., and left hospital on 12th much better, but was still suffering occasionally from pain in head up to April lith. (There was no syphilitic history.) (BABmcTON, Dublin ^ "Joum, of Med. Sc.., xlii, 545.)
A man, xt, 63, had smoked excessively since he was 14, and had nowsmoked Hungarian T. in a meerschaum several times daily lor 6 mo., besides several cigars each d. At last there came on almoft painful restlessness. " I was," he says, '' frequently obliged to change my position, and, when standing, to stand on one foot and fre<]uent]v change position of body, to lean or support body in some way ; while sitting was obliged to stretch out or bend up the feet and move them backwards and forwards ; while reading, the arm speedily became fatigued from holding the book, and sometimes there was stitching in the fingers and especially the thumbs; even in bed I was obliged frequently to change the position, and while asleep became very restless, so that my slumbers were frequently interrupted and I was often weary in m. Following this there was complete loss of co-ordination ofanugonistic muscles, so that while standing the knees gave way, or on sitting down I fell with my full weight on the chair. 1 became unable to draw on my clothes without supporting myself. At times the gait became slow and shuffling, the steps short, scarcely raising the feet from the ground, so that I frequently stumbled and became weary ; it was especially difficult to go upstairs, worse still if these were steep ; such ascent caused anxiety and dread of falling backwards, so that 1 went with the body bent forwards. This was associated with transient attacks of vertigo while walking in open air, especially on suddenly

kwlcing upward ; with great weakness and speedy fatigue, though there was no confusion of head or difficulty in performing mental labour j and with cpistaxis at times without cause." (Ritter, Med. Corr.-blatt^ lyurtentt.f xxxviii, 5.)

In a vast number of extreme cases of smoking, when those who hiirc indulged in such excess have had what has been called toothache, their sufferings have been great, yet in must instances I have observed that the crowns of the teeth seemed perfect, save that the enamel appeared to be altered in structure and colour. I therefore directed ipeciil attention to the state of the fangs, and found them, in all such cafes, denuded of their periosteum, being rough at the extremities, as if rasped ; while the fangs were of a darker hue than healthy dentine presents, and of a porous appearance. In consequence of the active absorption thus shown to be going on, the affected teeth act as foreign bodies and produce much local irritation. Hence I am led to the inference that T. affects the teeth themselves ; and that the affection rouJi not be confounded with their injury induced by the acidity often caused by stomach derangement resulting from an inveterate habit of smoking. The symptoms of the smoker's toothache are as follows : More or less uneasy sensations about the crowns of the teeth, which gr4duallv extend to the fangs; at this stage of the disorder, if the teeth are touched tenderness is experienced, and if birten on while in this condition a sudden and most painful sensation occurs. As the disease proceeds, the patient seems cognisant of its immediate seat, the agonising pain being confined to the bottom of the alveolar process of the affected tooth or teeth, which is attended with palpable throbbing, or, at an unscientific patient expressed it, "jumping pain." The most distressing symptoms are felt under vicissitudes of climate j, m great and sudden changes from heat to cold, and vice versa ; or after alcoholic stimulants : in fact the teeth, in this affection, suffer from anything that Kceicratcs the circulation. Among many of my most intelligent pilients, when there happened to be a space (from previous extraction)

{between the affected teeth, they have described their sensation as if a »triej of galvanic or electric shocks continually passed from tooth to tooth. (Levison, MeJ. Times, xxi, 27.)

Dr. G. Decaisnk has submitted to the Society of Public Medicine the results of some interesting observations on the effects due to the use of T. among boys. There were placed in his charge 38 rouths, *t. 9 — 15, who were in the habit of smoking to a greater or W8 degree. The effects of course varied. In 22 there was distinct ^listurbance of circulation, bruit in carotids, palpitation, deficient diges-

rtive power, sluggish intellect, and craving, more or less pronounced, for

alcoholic stimulants. In 3 there was intermittent pulse. Analysis of

Wood showed in 8 cases a notable falling-off in the number of red

urpuscles. 12 had frequent epistaxis, 10 complained of agitated

ep; 4. had ulcerated mouths, and i became the subject of pulmonary

bthisig. The younger the boy the more marked were the symptoms,

I the better fed suffered least,

Out of 1 1 who were induced to cease smoking, 6 were completely

ratored to health in less than 6 mos., while 3 others continued to suffer

slightly ; the other 2 were lost sight of. Treatment with iron ifl** quinine gave no satisfactory results, [Gaz. d. Hip., June 30th, 1868'}

Dr. Corson had been in the habit of chewing T. and swallotV' ing the juice. After 7 years of this he was suddenly seized with intcn*^ pain in chest, gasping for breath, with sensation as if a crowbar wcr^ pressed tightly from r. breast to 1., till it came and twisted in a kno tround heart, which now stopped deathly still for a m., and then Icapcc^ like a dozen frogs. After 2 h. of death-like suffering, the attack ceased ; but ever after the heart missed every fourth beat. For thenexi 27 years he continued to suffer milder attacks like the above, lasting from one to several m., as often as 2 or 3 times in d. or n. After discontinuance of T. attacks ceased. {Bost, Med. and Surg, Jtun,-^ xlix, 518.)
D. W — , a student of law, of nervo-sanguine temperament, hacd been a martyr to dyspepsia two or three years ; applied for treatment > i eyes, which were highly injected, cornea vascular and semi-opaque, anc3 lids granular. He had low spirits, want of resolution, and gcncnJ hypochondriasis. Had good relish for food, but a train of nervous symptoms came on directly after meals and lasted until stomach mts empty. Acidity, cardialgia, gastrodynia, palpitation of heart, vertigo, and fulness of head ; profound gloom, while keenly alive to every feeling i in constant fear of death, yet tempted to commit suicide. Had suffered thus for months, when a new symptom arose. Had had frightful dreams for more than a year; now, in first h. of sleep, was suddenly awoke by shock in epigastrium, causing great alarm. This recurred several times in n., as often as he fell asleep. The shocks were first confined to epigastrium, but after a few weeks they were transmitted to head, and were even more unendurable. They were followed in head by sensation of rush of blood, and a firm conviction he should die of apoplexy. Symptoms were palliated by morphine and carbonate of ammonia, but only temporary benefit was obtained. He used tobacco freely, by smoking, chewing, and snuffing. Abandoned the two latter, and his health improved, particularly the shocks and epigastric sinking. He then renounced smoking entirely, and the whole train of nervous symptoms vanished as if by magic. The gloom and despondency cleared away, and the inflammation of the eyes yielded readily to treatment. (ShipmaN, Bost. Med. and Surg. Journ.^ xxxi, 354.)
Sister of foregoing, act. 39 ; married, two children, youngest JO ; nervo-sanguine temperament. Dyspeptic for 10 years. Suffered since last confinement from leucorrhoea, partial prolapsus uteri, and hypochondriasis. Has smoked and snuffed tobacco fifteen years. Eight years ago began to have shocks at epigastrium, with sinking, cardialgia, acid eructations, sense of rushing of blood to head, palpitations, sleeplessness, and startings when first going to sleep. These symptoms kept increasing, and there came on tenderness all along spine, especially in cervical and lumbar regions, rigidity of limbs, costiveness, derangement of catamenia, &c. Snuffed and smoked more to soothe her feelings, with temporary relief; but on abandoning these habits the dyspeptic and nervous symptoms soon got well, the spine recovering under cupping, counter-irritation, anodynes, and tonics. Frequently

afterwards, venturing on moderate use of tobacco, the same symptoms invariably returned in slighter degree. (Ibid.)

II. S. E — , It. 4.0, in good health until 1838, when he began to emaciate and grow pallid ; his food did not digest well ; he had acidity, heartburn, gastralgia, palpitation, sinking at pit of stomach, and a host of nervous symptoms j gloom, hypochondria, and apprehensions of sudden death. Shocks in epigastrium when just falling to sleep followed, and his sleep became a succession of starts. After 2 h. these shocb came upon him during the d. Quite unfit for business, was weak, irresolute, and desponding. Was a heavy smoker, and on abandoning the habit rapidly recovered, the shocks in epigastrium leaving him after the first 3 d. of abstinence. [Ihid.)

C. P — , act. 43, farmer, temperate, nervo-bilious temperament ; haj been a tobacco smoker twenty years. Complained of similar symptoms to S. E- — , which rapidly subsided on leaving off use of T. Wis healthy until resuming it again after 18 mos. In 2 mos. shocks catncon with great severity. They were now felt in chest and cardiac Kgion, at first always in n., but after a while in daytime, with rushing

lof blood to head which would momentarily deprive him of conscious- I'lieji. The shocks also now took place in head. On abandoning T. i^in the shocks left him, sleep became quiet, dyspepsia disappeared, mind became calm, spirits elastic, and he was able to work. {Ibid.)

S. J — , act. 54, nervous temperament, farmer, has used T. 10 yari. It has frequently salivated him. Is emaciated, nervous, and hypochondriacal. Shocks commenced 2 years ago in bowels, first on

SI yjing asleep, afterwards in daytime, with epigastric sinking, ^cwtiyencss, and general dyspepsia. Gradually improved on leaving off

T. Similar symptoms to the foregoing, though to a much less extent, LWere observed in A. C — , act. 27, farmer, who had used T. to excess

'or 4 years ; and in Rev. Mr. H — , act. 30, who had used it 1 5 years.

Thfv both quickly recovered without medicine on abandoning the T.

,\f^'i)

Bridget V — , wife of a miller, set. 46, with regular catamenia, extremely emaciated, seen Feb. 7th, 1864. Had been much tried by ooiestic and other sorrows. Four years ago lost a daughter by typhoid ever. Since then had been so wretched that she resorted to all sorts

means to stupefy herself, drank much alcohol and ate all sorts of

E>bjcco, the kinds used for smoking, chewing, and snuffing. She ate

out two francs' worth every week. When seen was aphonic; she

could hardly utter some inarticulate sounds in a hoarse voice. Breathing

difficult, sighing ; pulse weak, slow. The heart scarcely beat. Pupils

ilated, insensible to light, her haggard eyes could hardly direct her hand

D any object offered to her ; almost total blindness. Hearing extremely

will. Face pale, emaciated, stupid looking ; tongue trembling, red,

y, pointed. Painful dysphagia in consequence of spasms of the throat.

Abdomen retracted. Stools like sheep^s dung, had long been only

p^Vcd by means of enemata or purgatives \ at first, on the contrary,

be had copious evacuations and vomiting. Soon, however, she lost her

ppciite, her gastro-iniestinal walls seemed to be affected with the

*upor the rest of her body showed, and she became prostrated.

Involuntary emission of urine, feebleness, cold sweats, sleeplessness When seen 2 d, later the voice was completely extinct, like that ofon^ suffering from cholera ; swallowing was impossible, her thorax scarcely moved, respiratory sounds and movements of heart scarcely pcrccptiblc- All the organs seemed to be, as it were, sent to sleep by the influence of the drug. Death ensued a few h. later. (Le Briert, Gaz.de Hif.y July list, 1864.)

In l8+q, the Academy of Medicine, at the request of the Minister of the Interior, appointed a commission to inquire into the sanitary state of the workpeople employed in the manufacture of tobacco. The report of the commission was drawn up by Dr. Melier. He writes : — " The first impression on the new workpeople is al*»ys more or less disagreeable ; all, or nearly all, find a certain difficulty in accustoming themselves to the work ; many cannot succeed, and art obliged to leave the manufactory. We ascertained that of 5 who entered at the period of our visit, t only had been able to remain. If they persist, their employment produces in course of time a peculiar alteration of complexion. This is not a simple loss of colour, an ordinary pallor ; it is a grey hue, somewhat dull, a mixed shade between chlorosis and some cachexia. The physiognomy assumes a peculiar character, by which the experienced eye can to a certain degree discern those who have long been employed in a tobacco manufactory; for this kind of countenance is never seen except among the old hands. The preparations of iron cure this state, and restore their original complexion to the workers. . . M. Hurteaux (the medical attendant of the manufactory at Gros-Caillon) has remarked that when the workpeople are bled, it is rare to observe a bufFy coat on the blood, or if there be one it is very slight ; and the coagulum is very soft. Thus the blood becomes modified to such a degree that a portion of its fibrin has disappeared. . . The men grow thin, and alter rapidly. We saw one who, when he first came into the manufactory, was fresh and stout ; now he is thin, and his complexion is assuming the dull colour above alluded to ; he is also much weaker than he was. Another informed me that he lost 10 lb. in a very short time." Finally, the reporter says that though he cannot positively prove from statistical tables that the mean duration of life is shorter among the tobacco manufacturers than among other classes of men, still there is much reason for believing that it is so. " All that we know/' he says, " is, that if among the workpeople there are some old men, there are very few or none in a flourishing state of health, most of the old hands being asthmatic or at least subject to dyspnoea."* (Teste, Uc. clt.)

III. Expetiments on animals. — i. Schubarth, in a series of 22 experiments {Horn's ylrchivy 1824), upon horses chiefly, found the action of T. on these animals most strikingly indicated by infrequcncy of puUe, which fell from 37 to 26 after administration of about 4 oz., and remained depressed for 24 h. Brodie {Phil. Trans., ci) found a strong infusion produce death in dogs by arresting action of heart ; while the empy-

It is fair to state that most enquirers into the subject take a more favou view than did the French Commission of the influence of'^tobacco-working on (See Still^, mb twrr)— Eds.

iinatic oil killed the animals without such cardiac effects. There retching, vomiting, faintness, tremor, and when the oil was employed spasms and convulsions also, before death. Wright found |that from 2 to 5 gr. of the essential oil, given to dogs 2 or 3 times a ,, induced gradual and complete marasmus; a peculiar dragging action of the hind legs ; loss of venereal power, and softening and |»shrivelling of the testicles; shedding of hair; and, before death, ' sloughing of eyelids and blindness. After death the blood was invariably found fluid, deficient in fibrin, and particularly so in red globules; the heart was pale, soft^ and smaller than natural ; the body never stiffened, and decomposed very rapidly. The gums began to swell and bleed early in the experiments, and the teeth became loose and sometim« dropped out. The mucous membrane of mouth, nose, and trachea was softer, more tumid, and more vascular than usual. (Slttti, ep. cit.)

Volume IV — Appendix

(See Tol. iv, p. *5a.)

II. 36. Herman B., aged 38, by occupation a bar-tender. Never bad any trouble with his eyes until about six months before he came CO me ; then for the first time noticed that his sight began to be a little dim, as if a light shade was before him. He could not see at a distance as well as formerly. The eyes were a little sensitive to light, especially gas-light. Did not sleep quite well — was rather nervous. Smoked ten or twelve cigars each day ; drank a little also, but not very much. Examination showed that his vision was |^, which was not improved by any glass. The ophthalmoscope showed the optic disc a yellowish, dirty pink, with blurred outlines. Retinal veins full, arteries diminished in size, with a dark red fundus. The case was diaenosed tobacco amaurosis. The use of tobacco in any form was forbidden, and nux v., 3rd trit., was given 3 times daily. He made rapid progress for the better; and when last examined, after about six weeks, was ^t approaching to a normal condition. (J. A. Campbell, Md. Call, Ju\y^ 1881.)

Jno. S., xt. 42, cigar maker. Eyes began to Ail him a few months before I saw him ; dimness before sight, not much — if any — pain. Felt that vision was gradually growing worse. Had used tobacco for many years, ^ smoked a great deal." Examination showed vision ^, not benefited by any glass. The ophthalmoscope revealed changes in the fundus similar to those described in 36, but the discs were not so discoloured, and the eye of a deeper red colour. Tobacco was prohibited, and nux v., 3rd trit., given as before. The result was a steady improvement for the better, until in about two months the vision was again normal. Now comes the confirmatory part of it. The patient had always expressed himself against the theory that tobacco was the cause of his trouble, because he had used it all his life, with no previous bad effects. Having full faith in his own views, strengthened probably by his own desires, he again commenced the use of tobacco, but found that after about six weeks his sight again began to be affected. Convinced at last, he applied for treatment a second time, and this was followed by the same success that attended the first.
Jan. aoth, 1878, J. W., act. 18, was sent to me by Dr. L. L. Danforth, on account of loss of vision in left eye. He is in college, and gives the following history : Three d. ago, on reading Greek in m. noticed a blur before vision, and on closing r. eye, found he could not see with 1. Next m. the sight was again lost, but improvement p.m. was not as marked. Since then, it has remained '' in statu quo." He is of a nervous temperament, and has been smoking to excess for a long time, from early in m. till late at n. ; does not use alcoholic stimulants. Status prasens : Rv. 20-20 difficulty } Lv. fingers at six feet } no improvement with glasses ; ophthalmoscope shows refractive media dear, and no changes in fundus j the eye, however, seems quite sensifive to reflected light, which causes a stinging pain in ball j there is

no headache, or subjective symptoms of any kind, with the exception of loss of vision. Considering the tobacco to be the cause of the trouble { stopped its use entirely and gave nux vom.™. 22nd.—Rv. 20-20 difficulty ; Ly, fingers at one and one-half feet ; ophthalmoscopic examination reveals no change, though the eye is not as sensitive to light ; the field of vision is very much contracted ; the patient has not used any tobacco ; he is restless at n., particularly the latter part, and is very thirsty ; always feels worse in m. Nux vom. 24th.—Rv. 20-20 ; Lv, fingers at six feet ; sleep better, and is less thirsty. Repeat. 26th.—Lv. fingers at fifteen feet (dark day). Continue. 2gth.—Lv. 15-200, Arsen.®, Feb. 1st—Ly, 15-200, Nux vom. Lv. 20-70. Continue medicine. 7th.—Ly. 20-40. Same. Ly. 20-30. Same. rgth.—Ly. 20-20. Same. For a week or two after last date there were slight asthenopic symptoms on using eyes, which gradually passed away, so that he was able to return to his studies in about three weeks, His vision has remained good up to this time, though I cannot say whether he has abstained entirely from the use Of tobacco or not. (Geo. S. Norton, ‘Trans. of Amer. Hom,

Ophth, and Otel, Soc., 1883.)

In the last annual report of the Michigan State Board of Health, Dr. Scott points outa hitherto unsuspected tobacco disease as follows :— “There has come under my notice for several years, but more particularly during the last two years, a kind of rheumatic condition of the walls of the chest. The patient complains of a dull heavy pain there,—in the majority of cases in the |. side, The pain is circumscribed, and limited to a space of not more than 2 in, in diameter, just below and a little tol.of nipple. At times itis very severe, and always constant, d, and n., when patient is awake. I find it to be most common among tobacco-users, especially those who indulge to excess, Patients suffering from this complaint invariably come to their physician with the belief that they have heart trouble. I have not found signs of organic lesion in any of the cases that I have examined, but there does exist in some of them what may be called ‘irritable heart.” If the patient abstains from his tobacco, the pain ceases and his condition improves. In one case, where the patient had abstained for 13 mos., pain had entirely ceased ; but then he recommenced its use, and after three weeks pain returned with all its severity.” (N. Engl. Med, Gaz., i, 383.)
Mr. T—, when smoking T.. in a pipe, after about three whiffs of it has feeling as if fingers were longer. If he continues smoking, he feels as if he had lost use of legs from knees downwards. Can smoke a cigar in open air ; but if he smokes halfof one indoors, his calves feel as if they did not belong to him, and as if they were dropping away, and he has a general feeling as if he were losing strength all over his body ; also his upper lip feels elongated and tongue swollen, so that in speaking his words run into each other. (BERRIDGE, 4m. ‘Fourn. of Ham, Mat. Med., ix, 244.)

To II, 19, add—* See also case by BRocHARD in Gazette Obstétricale, 1878"

A woman of 28 acted as saleswoman in a cigar shop. By and

bye she lost her appetite ; constipation set in, alternating from time to time with severe colic, tenesmus, and diarrhoea; constant pain in gastric region, and during the m. hours frontal headache. After a while she had from time to time spasms, with nausea, vertigo, disgust, obstinate vomiting, hebetude, anguish, palpitation, syncope, hiccup, and constriction in throat, so that she had, off and on, to keep her bed for several d. As intervals between such paroxysms lessened, she grew constantly weaker and more emaciated, her features turning to a pale yellow } menstruation, formerly regular, became irregular, the menstrual blood pale } and there was perfect disgust at all sexual connexion. Still keeping on in her business, dulness of head, giddiness, frontal headache and nausea became permanent. Nicotine was found in saliva and urine discharged dnring a paroxysm, whereas none could be found in that discharged during the free intervals. As the patient would not listen to the advice of her physician, her state became still more aggravated ; vision became dim ; there was general irritability and hypersesthesia of skin of back ; inappetence, cardialgia, nausea, disgust^ vertigo and dulness of head became constant, with addition of cough, sense of exhaustion, and night-sweats. {Amer, Oh.y Jan. 1880.)

a. A young man of 20, not being an habitual user of the weed, one Saturday smoked 1 2 cigars, and on the Sunday 3 or 4 more. That afternoon he began to act strangely. I was called at 9 p.m., and found him with all the appearances of delirium tremens (I was assured, however, that he had not been drinking). He was very wild, tossing about on the bed with hallucinations, seeing snakes, lions, bears &c. ; thought he saw his father's head cut ofF and the blood running from the body. During these wild paroxysms he would try to get out of bed, requiring several men to hold him } he would loll his tongue, and snap his teeth like a dog, so that some of his relatives thought he had hydrophobia. There was no spasm, however, when water was brought to him, and he drank it eagerly. Then he saw a beautiful lake, and wished to drown himself in it, trying to rise from bed for (he purpose ; and, being prevented, tried to choke himself, and actually became black in the face before his hands could be loosened from his throat ; then begged some one to take him out of doors and shoot him.

i. After 3 — 4. doses of belladonna 3X he quieted down, and from midnight till daybreak on Monday seemed to sleep. He was really, however, in a state of catalepsy } limbs could be placed in any position, and would remain there however uncomfortable it might be until they were moved. £yes were fixed and staring, and balls could be touched without making him wink. During the Monday the visions, &c., recurred whenever the influence of the medicine passed off, but he quieted down as soon as it was resumed, at last — 8 p.m. — falling really asleep, and not waking till Tuesday m., when he was a little flighty, but knew every one, which he had not done since Sunday at 5 p.m. He had no recollection, indeed, of anything he had done on the Sunday itself, though he had seemed quite rational up to 4 p.m.

c. He passed no urine up to 4 p.m. on Monday, when I drew off a. quart, high-coloured and of strong odour. On Tue&^v) ax tvooaVA

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