Opium

Volume III — Main text

OPIUM.

Inspissated juice of Papaver somniferum, L., white poppy. Nat. Ord., Papaveracea.

1. Provings. — I. Hahnemann, il/^/. J/<f</. /'t/ra, vol. i of original, vol. ii of translation. Contains 144 symptoms from self and 4 fellowprovers, and 518 from authors.

2. a. Bard counted his pulse every h. for a d., and found tt kept to 70 — 73, rising to 79 — 84 after meals. Next m. at 7, finding it 71, he took 1^ gr, of O. 8, B — now began to feel distinct effect of O., neither disagreeably nor pleasantly, in head and stomach ; had a sense of lassitude, difficult to describe, and occupation began to be irksome and even impracticable ; pulse was 69. During next J h. pulse fell to 64, and he had strong desire to sleep; there was dizziness in head but no pain, and sense of fulness in face without obvious turgor of vessels. 9, pulse 64 still, fuller than usual. 9.30, pulse 66 ; took a light breakfast, not without some repugnance. 10, pulse 65 ; he was thirsty, and his mouth was filled with an unpleasant tasce. At 10.30 pulse was 61, at iz, 60, at 11.30, 50. At 12 it was 57, and he could hardly keep awake any longer. Up to this time he had (as on previous d.) abstained from any exertion, but at 1, having walked two or three times about his room, pulse rose to 65. On sitting down again, by 1.30 it was 6^ ; at 2, 61 J at 2.30, 58 i at 3, 60. After dinner it now rose to 70, and thence after a walk to 75 \ nor did it fall again below 69. ^y 6 p.m. he felt no effects of O. save a slight pain in head. Next m. he woke with a most unpleasant taste in mouth, saliva thicker than usual, and yellowish, and tongue much coated. B — repeated this experiment on himself 4 times, and always with same results. When he took 2^ gr. he had nausea and vomiting for 2 — 3 h., and with this pulse was quickened.

b. On another occasion B — took same dose in 6 portions. Pulse,

which on previous d. was found as before, was 70 at 7.30 a.m., whez he began to take the 6 doses at half-hourly intervals. It was unchanget till after breakfast, when it rose to 76. By i x it had fallen to 66 slight vertigo had followed 5th dose at 10, and now desire for sleep canu on. Pulse continued to fall slightly, till at 2 it was 62. After dinnei it rose to 71, and remained thereabouts for rest of d.

c. On d. following all his experiments, respiration (undisturbe( during action of drug) was anxious and oppressed, with frequent sigh ings and mucous expectoration, and this lasting some 3 d. [Tent* J* Vir. Opii^ Edinb., 1765.)

1. a. One whom I well knew took before bedtime l gr. of crude O He slept at first as if anxious, and plagued with many, mostly sad< dreams, so that he seemed to be in a somnolent state, a prey to constani delirium. At this time the breathing was hurried, tight, and anxious. with quicker and feebler pulse than in the normal state. Later he slepi more soundly. After about 8 h. he perspired all over the body, and was next d. quite well save for a slight diarrhoea, very foetid ; a puffy face, especially in lower eyelids, with bluish and earthy-pale complexion, a white tongue, and weakness and torpor of the legs.

b. On another occasion he took, about 3 p.m., 3 gr. In the ist h. he noticed only sadness and mental weakness. Towards 5 p.m., feeling faint, he went to bed. He lay there moderately warm, tortured with precordial anxiety, constantly inclined to sleep, which yet he could not do ; his pulse was slower. There then arose gradually in both hypochondria, but especially the r., a pain which seemed to seize the region of the colon. As it grew more violent, it produced such tension in the abdominal integuments that a finger could not be introduced under the margin of the &Ise ribs towards the diaphragm. At last, between 7 and 8, it increased to an incredible degree of severity, and the rhythm of the respiration was at the same time so completely disturbed that he dreaded suffocation, and hastily got out of bed in the greatest anxiety. In utmost distress, and gasping with open mouth, he wandered with trembling limbs several times across the room. He felt ravenously hungry, and yet shuddered at food \ he passed much lemonyellow urine with copious sediment. Retaining his sound senses, he noticed that his pulse was slower and weaker. His pale skin, papillated with cold, secreted abundant perspiration. At 9 he took a lemon and drank some cups of tea. Now the cramp in muscles of chest and abdomen began to abate, and so did the pains ; his cold hands became a little warm, and some eructation followed. (With the dyspnoea there had been hoarseness, the glottis seeming to be tightly contracted and the gullet dried, while only a little phlegm could be detached by hawking.) Most of the torments were now ovier. The bitter taste of the mouth was succeeded by nausea, and this again by vomiting of the tea and lemon, and of gastric mucus. To slake his thirst he took several more cups of tea by sips, and lay down again in bed ; within 2 h. his feet got warm, and between 1 1 and 1 2 he began to sleep, at first anxiously and as overwhelmed by dreams, afterwards softly and quietly. At 5 a.m. slight general perspiration. Upon this he left his bed, little refreshed by sleep. He directed the business of the following d. with all his powers save

those of his intelligence. Before midday there occurred an evacuation of frothy fluid mucous fasces, with itching, burning, and extreme straining, which last continued many h., and caused much discomfort. Then everything returned to the healthy state, except that during this d. the tongue was dry and white, and the whole body pale and livid, (Grimm, Nov. Jet. Nat. Cur.^ iii.)

1. a. Having breakfasted lightly at 9 a.m., I took at 12 I gr. of O. diffused in a teaspoonfui of warm water. Pulse was ya — its natural standard. After 5 m. it was 74, after 10 m. 76, at 15 m. the same, at 20, 25, and 30 m. 74, at 35 and 40 m. 72, and thenceforward 70 again. I could scarcely perceive any variation in its strength or fulness, nor was the dose succeeded by drowsiness or any similar affection.

A. At I p.m. I gave to a robust, healthy young man, whose pulse beat but 44 in a m., i gr. as above. His pulse, remaining stationary for 20 m., at the 25th had reached 50, at the 30th 52, at the 35th 54. It then fell gradually till at the 90th m. it had gone down to 42, and at the iioth to 40. It was not till the ijSth that it had attained its normal rate again. Coincidently, after 25 m. there was manifest increase in strength and fulness also j which in an h. began to diminish, and continued to do so till near the end of the experiment. A slight heaviness, which came on at 55 m., was the only other effect experienced from it.

£■. At 12.45 pni., my pulse beating 70 as usual, I took 2i gr. in 3j of water. Already in 5 m. pulse had risen to 74, and by 30 m. it had reached 80. During the next 15 m. it fell to 64, and after another \ h. had returned to its normal rate. In 20 m. I perceived a slight warmth, and soon after a degree of moisture on my skin, fulness of pulse increasing as well as frequency. In J h. I found myself, or at least imagined myself, more alert and sprightly than before. In 40 m. I perceived a pleasing kind of languor, gradually increasing ; in 90 m. a dull headache, which in 2 h. time was much increased, and attended with drowsiness and nausea. In 2i h. every disagreeable symptom was increased. I took a spoonful of vinegar, which somewhat relieved the nausea. In 2| h. all symptoms still increasing, with slight vertigo and tremors in hands. In 3^ h. nausea increased to vomiting, and 1 threw up contents of stomach. The headache and vertigo were soon after relieved ; but I continued in a stupid state for rest of d. (Crumpe, Nature and Properties of Opium ^ '793')

1. a. GuNTz took 4 dr. of a tincture prepared by dissolving one part of purified O. in three of rectified spirit and three of distilled water ; within a few m. noticed slight pain over whole head, bordering on congested feeling, lasting only to m. ; at same time face and hairy scalp became warm. Six dr. of same tincture taken in \ oz. water caused some headache after 5 m., and lasting several h. Later, a diarrhoeic stool was passed. After 9 dr. same headache came on, but no other symptoms. Repeated experiments, beginning with i dr. After a few m. noticed slight pressing pain in region of glabella, lasting a few m. Two dr. produced same effect. After 3 dr. felt slight nausea, and for 5 m. increased secretion of saliva, followed immediately by pressing pain in frontal region, spreading after 5 m. towards root and later tip of nose, when it changed into colic, lasting only 15m.)

head was quite clear in ^ h. from taking dose. F^ces somewhat softer than usual. Four dr. produced same erfect. Afterbdr. neithernausea nor salivation occurred, and in place of headache confusion of forehead came on, lasting 1 h. During succeeding n, dreamt unusually vividly, but only awoke once, soon after midnight. Next m. at 6.30 had some cutting pain in abdomen, soon followed by loose evacuation. On August 4th, at 8.30 a.m., took 8 dr. in r oz. water ; same na.usea and flow of saliva followed. After 10 m. oppression of forehead came on, accompanied by heat and sweating of face ; after 20 m. this moderated, leaving only emptiness of head, lasting 3 h. Did not enjoy midday meal j dunng afternoon had cutting pain in umbilical region and at

7 p.m. loose stool. Next d. took 12 dr. ; after 5 m. oppression of forehead came on, interrupted at times by stabbing pains over eyebrows, which spread i h. later over whole head. This morbid condition of head improved towards midday, 50 that throughout p.m. only emptiness and dulness of head remained behind, although stabbing pains were still felt at times. Transient heat occurred at times in face, and kept whole body in a continual state of perspiration til! towards e. At 3 p.m. had feeling of constriction of chest, with dyspnoea, lasting J h. At 8 p.m. passed loose stool, preceded by few cutting pains in abdomen. On 6th, at 8 a.m., took 18 dr. After 10 m. head became so heavy and stupid that he was obliged to support it, and could almost feel rush of blood towards head. At xo a.m. was so sleepy that it needed all his efforts to keep awake, and he could hardly speak collectedly ; coupled with this there was heat of face and perspiration. The stupor, which passed off towards midday, was interrupted at times by feeling as of tight band round neck, with occasional fleeting stitches, apparently from within to without. During p.m. head remained dull, sleepy, and empty, and intellect clouded. Cutting pains and loose stool followed as before. During n. sleep was restless, and at midnight he was awoke with feelings of constriction of chest, which came on suddenly every 3 m., and after i m. vanished. Wild dreams disturbed his sleep during remainder of n. Next m. at 6 a.m. loose stool and cutting as before. Towards 8 a.m. head, which was clear on awaking, became as dull as during previous afternoon, but this soon passed ofF. Next d. bowels remained constipated.

t. Same took J gr. purified (solid) O., which he swallowed with ^ oz. water. After 10 m. confusion of head and pressing in eyes came on^ latter feeling as if upper lids were being pressed downwards towards lower. Both symptoms had vanished within 4 h. Next took i gr. at

8 a.m. After 10 m. felt confusion of head, increasing every m., face meanwhile glowing and head sweating. Globes of both eyes felt pushed from within outwards ; stabbing frontal headache alternated with drawing pains in internal ear. Head finally became so heavy that

.he was obliged to lie down at times or he would have fallen. Pulsebeat somewhat fuller than usual. These symptoms lasted till about 1 1 a.m., leaving behind great lassitude and somnolence ; some dulness of head and incapacity for mental exertion were noticeable until 5 p.m. Whole body perspired during p.m. Next d., except for slight lassitude, felt quite well. (JoRG, Materiai'iin,) b

1. Heisterbergic took i gr. rubbed up with 3 gr. magnesia and 4 oz. water. After i h. cutting pains in abdomen set in, and lasted 10 m. First evacuation took place next m., faces being copious and hard. Same effects followed ij gr. After i\ gr. pains were quite colicky, and lasted 10 to 12 m.^ returning less violently at 2 and 4. p.m. Bowels were constipated as before. After each dose felt disinclined for serious occupation. {Ibid.)

2. a. Kneschke took J gr. Slight confusion of whole head and pressing frontal headache followed after \ h., lasting fully I h. Same effects followed after \ gr. accompanied by slight giddiness. From 2 till 5 p.m. felt some lassitude, with inability to concentrate thoughts ; well-known things appeared less familiar, and his speech less voluble. Slept well, but arose unrefreshed next m., and bowels did not act until C.J after which they did not act again for 36 h. Effects of drug were noticeable until c. of 3rd d., especially in shape of indiff^erence to everything, even to favourite occupations. After j gr. same effects followed, coupled after 2 h. with slight cutting in small intestines, lasting a h. Pulse during d. was somewhat slower than normal. Bowels did not act for 60 h, after dose, fsces being hard, followed next m. by two liquid evacuations, and acting naturally on m. of 5th d. After i gr. same symptoms followed, only that pains in bowels were more colicky and lasted 4 h. Pulse was somewhat slower than normal during p.m. Towards c. frequent and troublesome vawning came on, and he wa^ obliged to go early to bed i slept well, but arose unrefreshed. Felt lassitude all next d. and bowels remained constipated. Next m. bowels acted slowly. All effects had passed off^ by m. of 4th d.

b. After doses of 6, 7, 8, and 9 dr. of tinct., noticed only slight confusion of head, lasting but a few m. ; felt also less lively p.m. Bowels regular, but fxces somewhat hard. {Ibid.)

1. a, LrppERT took, Jan. 30th, J- gr. of O. After few m. felt dull gentle frontal headache, lasting all forenoon, and slight aching in bowels. bame eff^ects but more pronounced followed dose of ) gr. On Feb. 3rd took I gr. Subsequent headache was more acute, spread over whole head, and was combined with heaviness, confusion, and buzzing in same. Colicky pains were more acute, and recurred for few m. every \ h. until noon, whilst head symptoms lasted until well on into c. Bowels acted rather oftener than usual. Next d. took 2 gr. After \ h. head became confused and giddy, so that he could hardly stand ; lassitude and weariness spread over whole body \ felt at first cheerful and good-tempered, but as other symptoms increased became quiet and serious. Pulse meanwhile was large, full, and quicker than usual. Colicky pains came on after 1 h., increased very much, and manifested themselves as tearing or cutting pains, but at longer intervals, and lasting till afternoon. Experimenter became gradually more weary and tired and very sleepy, so that he could not stand without danger of falling. Heat of skin was increased, but without sweating. These collective effects of drug increased gradually until noon, and decreased during p.m., so that by e. there was considerable abatement. After 3 gr. same effects followed, accompanied by unusual feeling of dryness m mouthj although neither mouth nor tongue were really dry, and.

further^ feeling as if he would be sick, although he felt no nausea ^ and lastly constipation until next m.

k After successive doses o( from I to 9 dr, of tinct^ he noticed only that evacuations were more difficult and scanty. After 12 dr. confusion of head, which also occurred after 14 dr., accompanied by quick, full, and hard pulse. Same symptoms occurred \ h, after 16 dr., accompanied by giddiness so that he could scarcely stand, and head Mt heavy even while sitting. The symptoms lasted nearly all d. Similar results followed t8 dr. After 24 dr., besides confusion of head felt dull pressing in same, passing on gradually to giddiness, so that thinking was rendered very difficult. Circulation was affected as before. (UU,)

1. rt. Otto look 2 dr. mixed in J oz.of water. Only noticed unusual weariness and lassitude of body, indifference to everything, aversion to usual occupation, much inclination to sleep and peculiar indolence, lasting together the whole d. Slept well, but arose next m. unrcfreshed. After 3 dr., besides lassitude noticed slight pressing headache, which ceased towards e. On August 6th, at 8 a.m., took 4 dr. ; towards 9 became giddy, his thoughts went astray, and occipital headache came on ; these head symptoms lasted 10 m. Towards noon weariness again appeared. At 4 p.m. this increased so much that he could not keep on his feet ; intense giddiness was also present, face became red and head hot ; sweat broke out all over body, darkness came before his eyes, and he lost consciousness, l^his condition, which lasted about 4 h., was ushered in by nausea, eructations, and inclination to vomit. Such weakness spread over whole body that it was with utmost difficulty that he could move his limbs, and yet an inw.ird unrest constantly urged him to sit or lie elsewhere; decided lassitude oppressed him until c, i bowels were not open during d. Appetite and sleep unaffected. Awoke next d. with slight headache, which he soon lost. Soft, pappy faeces passing during p.m. Urine since taking O. was browner, and covered with an iridescent pellicle. On repeating same dose on m. of next d. but one soon felt giddiness and confusion of head, lasting 15 m., then for ^ h. cutting pains in abdomen with urging to stool, followed by evacuation of soft scanty motion and transient weariness. At 4 p.m. pressing pain over whole head came on, and lasted till bedtime, accompanied by great distaste for work and indiffcr. ence to everything. Next day awoke with same headache, which became worse after getting up, but gradually passed off during forenoon in open air. During p.m. passed pappy stool.

A. O — now took J gr. of O. After 8 h. felt slight congestion of chest and head, lasting 15 m., but leaving behind slight confusion of head ceasing suddenly after 2 h. on going mto open air. On July 27th at 8 a.m., took i gr. After i h. felt lassitude and weariness of whole body, increasing gradually until he was obliged to sit ; he then passed into a reeling condition as if tipsy, everything in room appearing to him to turn round j felt at same time constriction of head as if brain were being compressed by scalp j slight pains coming and going inside head, and irritation of globe of eye, followed by diminished power of vision ; next came sleepiness, manifested by frequent dec yawning and general lassitude. Pulse-beat large, full, and sir

After this group of symptoms had lasted fully i h., they gradually passed offj leaving the headache and a feeling of general listlessness behind, lasting until e. Bowels did not act all d. nor till noon of next d., but f£ces were soft. On repeating same dose, experienced same effects, and in addition fixed tender pain in region of 1. mastoid process, which troubled him several hours during p.m. Bowels were affected as before. Next took ^ gr. j very soon felt slight giddiness, accompanied with belching up of flatus, and changing to oppression of head which here and there almost amounted to pain. Pain was also felt in abdomen, first in stomach then lower down in small intestines, changing later into general cutting, followed by copious natural action of bowels. During p.m. was troubled with lassitude and sleepiness. Slept well during n., but arose not thoroughly refreshed. Same abdominal symptoms followed j gr., but this time stool was pappy. After 15 m. from time of dose, slight giddiness came on, lasting only 15 m. and leaving no pain behind. Lassitude and weariness, especially of lower extremities, troubled him much, with sleepiness and indifference to everything, even his most important afEiirs. Sleep during n. was sound but unrefreshing J felt same weariness next d. [ibid,)

1. fl. riENrra, on February 4th, at 9 a.m., took \ gr. At 10 felt head confused, heavy and oppressed, pulse small and frequent, skin warmer than usual, whole body weary and unstrung, and spirits depressed; before 12 all had passed off. On 7th, took i gr. at 9 a.m. No symptoms occurred until 8 p.m., when there was dryness of mouth, constriction of larynx, pressing in and over both eyes reaching to vertex, increased superficial heat of whole body, and general lassitude j all passing off before 10 p.m. Next d. bowels did not act until after dinner. Next took \ gr. After i h. felt lassitude and weariness of whole body, followed immediately by oppression of head, and feeling as if he had been drinking spirituous liquors, trembling and weakness!^ in extremities, moist cold skin, dryness of mouth, thirst, and great inclination to sleep, all lasting i h. ; pulse meanwhile being weak and quickened. For next 3 h. suffered with nausea, want of appetite, belching of flatus and distension of abdomen, and general weakness. Pulse during this time had become fuller and quieter. Eyes became cloudy and dark. Next d. bowels acted only p.m., action being accompanied with slight colic in region of stomach. On repeating same dose, after J h. feeling of indifference came on, with tipsy feeling noticed above, confusion of head, and sensation of tension over surface of head. Later there were added, want of appetite, heaviness and rumbling in abdomen, and distension of intestinal canal, all disappearing after about 2 h. Bowels were affected as before.

b. P — also took 3 dr. of tinct. in \ oz. water. After i h. lassitude and inclination to sleep came on, accompanied by quicker and weaker pulse; both symptoms disappearing within i h. Had little appetite for midday meal. On repeating same dose lassitude and weariness lasted 2 h. On taking 6 dr., besides lassitude and somnolence, felt heaviness of whole head, pressure in forehead, and smaller pulse, lasting 2 h. (Ibid.)

1. Si£B£NHAAR, t h. after 5 dr., felt same heaviness in head, with

^

feeling asif head had been hanging down for a long time, lasting barely I h. Then took 6 dr. After i n. was surprised by feeling of pressure in region of stomach, followed shortly by heaviness and confusion of head lasting 15 m. Pulse meanwhile was quicker and smaller than usual. After 7 dr. same symptoms occurred, but lasted nearly 2 h. Appetite for dinner diminished. After eating this and going into street, was seized with such severe nausea that he with difficulty refrained from vomitings this nausea continued for 10 m. and then gradually disappeared, and was accompanied by an extraordinary feeling of lassitude and weariness, lasting whole d. and associated with inclination to sleep. During following n. was very restless; at 2 a.m., on getting out of bed, was seized suddenly with giddiness and nausea, so that he had to lie down again. This condition lasted 15 m., after which he fell asleep again. Felt some headache on awaking next m. Next d. took 8 dr. i after i h. felt troublesome pressing and cutting pain in region of stomach and deeper in abdomen, lasting about j h. ; with this there was confusion of head, especially in frontal and parietal regions, changing to actual pain, which lasted several h. Pulse meanwhile was slower and weaker than usual. During latter part of d. there was uninterrupted lassitude, weariness, and distaste for mental or bodily exertion. Next m. felt unrefrcshcd. Similar effects followed dose of 9 dr. except that he felt sleepy, and weariness and lassitude lasted all d. Pulse was unaffected.

b. February 4thj at 9 a.m., took \ gr. of Op. At 10 a.m. an attack of giddiness and confusion of head, changing at times to lassitude and indifference to everything around ; pulse meanwhile was several beats quicker but weaker than usual. These symptoms lasted about I h. Similar symptoms followed dose of { gr. with addition of constipation. On 9th, at 9 a.m., took i gr. ; towards 1 1 felt pain in abdomen more pressing than cutting in character, especially in umbilical region, spreading thence over whole abdomen, which appeared somewhat distended, increasing in intensity till noon, and disappearing at 1 p.m. During afternoon and e. felt more tired and weary than usual. Faeces next m. were hard. Similar effects followed dose of 1 J gr.,with headache during e. in addition. Next took 2 gr. ; after i h. abdominal pain came on, and lasted 5 h., leaving feeling of weariness, lassitude, and indifference behind. Zest for fuod was all day less than usual. Bowels only acted on m. of third dav, fsces being hard. (/t/V.)

1. JoRCj on August 15th, at 8 a.m., took ^ gr. j at 9 a.m. slight confusion spread over head almost imperceptibly, increasing about lO to feeling of complete intoxication, and accompanied with giddiness, vanishing a^ain about 11. From this time till e. felt frequent pressing in eyes, with diminished secretion of mucus, and mistiness of sight ; constant feeling of dust in one or other eye, with itching and burning in same ; at times felt as if accumulated mucus obstructed sight, eyelids were, however, rather dry. This condition of eyes passed oft* at dusk, but recurred during next 3 d. if exposed to bright light. On intestinal canal, drug produced following effects : — At 9.30 a.m. cutting in abdomen came on, and soon after great urging to stool, which he could not resist ; small hard motion was passed, but without relief, fur cutting

pain lasted till i p.m., nausea being present between 11 and 12, After 3 p.m. was troubled with pressing pain, sometimes in vertex, at others in occiput, spreading later towards nape of neck, and becoming at times boring in character, lasting till bedtime and only disappearing during n. after several h. of very disturbed sleep. Similar effects upon brain and intestinal canal followed dose of ^ gr. In addition to this, after i h. pulse beat 8 to 10 times in m. quicker than normal, was contracted and hard ; after 4 h. it became full, and towards e. gradually returned to its normal condition. From 2 C04 h, after dose felt pressing and stabbing in thorax, especially towards posterior wall, and at times as if to spinal muscles. Occasionally slight cough was present. Skin became generally warmer, — face being hot, and sweating considerably from 9.30 till noon ; complexion during this time changed several times from dark red to pale red, former being most prominent, especially on cheeks. During afternoon and e. bowels were constipated, and abdomen distended ; during n. sleep was much disturbed; awoke next m. tired and unrefreshed,and suffered from characteristic headache from 9 a.m. till noon, with some cutting pain in abdomen.

h. Took I dr. of tinct. After i h. felt pressure in forehead and over eyes, but not painful ; coupled with this was a tremulous drawing in scalp covering forehead and parietal region, lasting \ h. ; gradually pressure in forehead and over eyes changed to heaviness and inclination to sleep; felt all d. as if he had not slept enough. On Aug. /ch, at 8 a.m., took 2 dr. After 25 m. was attacked by pressing pain in both frontal eminences, descending to nose, and apparently affecting especially (both) nasal bones ; I h. later this pain passed on, but left behind pressure in forehead, especially over eyes, and general heaviness of head. With first appearance of pain increased heat suddenly spread over whole body, soon succeeded by outbreak of general perspiration and feeling of increased vascular action. Pulse-beat 10 above normal, large and hard ; fulness and hardness ceased at 10.30, and acceleration between 3 and 4 p.m.; perspiration ceased between 11 and ]2 a.m. Besides these effects of drug, at 9.30 felt pressing pain between tip of r. shoulder-blade and posterior wall of thorax ; pressing pain kept meanwhile coming and going in 1. frontal eminence. At same time eyes became dry and weak with feeling of dust in them, lasting till bedtime. From 5 till 10 p.m. slight pressing headache, especially in 1. half of vertex and forehead, alternated with pains in spinal muscles, at times extending into thorax. Bowels were sluggish. On 9th, at S a.m., took 3 dr. After 15 m. felt general oppression of head, passing on 15 m. later to confusion, almost amounting to giddiness, rendering thinking and speaking difHculi. At same time there came sudden heat over whole body, especially about head, where abundant sweat broke out. Pulse was contracted and rather hard, beating 10 above normal. At II a.m. the contraction passed off, and during p.m. circulation became normal. Confusion of head became less after 9 a.m., then came somewhat sensitive cutting in region of navel, soon accompanied with urging to stool. Cutting pain lasted i h., and was accompanied by recurring pressing in thorax., causing and relieved by slight cough. Almost at same time for 15 m. there was feeling of thrusting from

thorax and spine towards nape of neck, and as if muscles and vessels there were being squeezed together. Upon this followed at times recurrent stabbing, apparently spreading from within the thorax outwards, and especially to region of r. shoulder-blade. From lo, mouth and gullet became somewhat dry. During p.m. slight confusion of head continued, combined with two slight attacks of pressing pain on r. side of vertex and forehead, lasting each time about 20 m. From noon till e. abdomen was distended ; neither flatus nor fzces passed until 10 p.m., when after great straining a small stool, not hard, was passed. From noon till 6 p.m. felt heaviness, lassitude, and distaste for work 1 after 6 these symptoms changed to somnolence. N. was restless i sweated much and passed much foul-smelling flatus. Next d. felt " out of sorts," and for 3 d. was troubled with same pressing headache as after 2 drops. This pain in head and nose appeared as if fixed in periosteum. [Ibid,)

1. a. Edward Jorg took 1 dr. on Aug. loth at 8 a.m. After a few m. felt buzzing in head soon followed by confusion, and cutting pains in abdomen lasting till 9. 30, recurring at 10.30 and tasting A h. After y.30 confusion changed into true pressing headache, attacking forehead more especially, and descending towards eyes and nose, ending between ii and 12^ and leaving behind general weariness and lassitude. Next d, at same hour took 2 dr. After few m. smart cutting in region of stomach and umbilicus came on, and after 15 m. pressing and confusion spreading over whole head, but especially towards vertex. Ail these symptoms vanished about 10 a.m, j then eyes began to burn and feel as if there were sand or dust in them. At same time considerable heat of whole body came on, but more especially of head ; skin generally quickly began to sweat, and congestion of head showed itself; then head became really painful, especially in frontal region. Pulsebeat was 10 above normal, full and hard. Eyes were better towards noon, but other symptoms lasted until well on in afternoon, also accompanied with lassitude and general weariness. During p.m. and evening headache became at times very troublesome, spreading from vertex towards right orbit, and apparently pressing from within outwards. At 10 p.m., on going to bed, heat and headache prevented his sleeping i later on slept quietly ; next m. head confused and dull and abdomen heavy, but these symptoms gradually passed off during forenoon. Morning stool was abundant.

b. E. J — took ^ gr. of Op. Immediately after felt numbness of head, accompanied after i h. by increased heat over whole body, and 2 h. later by urging to stool. Numbness lasted 10 m., changing to confusion of head, and towards noon to pressing headache, which recurred from time to time during p.m. Increased heat lasted till 5 p.m. ; sleep was disturbed during early part of n. After -^ gr. noticed slight confusion of head, and, later, weariness, somnolence, increased heat of body, and quickened pulse, Next m. felt some headache, especially from vertex towards 1. eye, lasting with more or less intensity the whole d. (Ibid,)

1. a. Frau Ch — , on Aug. 14th, at 8 a.m., took ^ gr. After \ h. was seized with confusion and severe pain in head, especially in r. half

of forehead, becoming towards noon so acute that she could not collect her thoughts. Pulse meanwhile was quicker, larger, and fuller than usual» and skin was warmer than normal. During p.m. frontal headache was less troublesome, but she suffered from general pressing pain over whole head, and from rheumatic pains in 1. hand and arm. Eyes became hot, misty, and dry. During n. slept well, but next d. felt same pressing headache, weariness and lassitude of whole body, and considerable depression of spirits. Bowels were somewhat constipated both days, although she felt movements in stomach and small intestines as if from a dose of aperient medicine. On i6th, at 8 a.m., took -jlj. gr. Similar effects followed, but in addition there was increased heat of whole body, especially in face, and palpitation, pulse being 12 beats above normal, large and full. Palpitation lasted till 4 p.m., but increased heat, headache, and somnolence till bed-time j did not sleep till midnight, and during whole n. sleep was very disturbed \ bowels acted at 10 p.m., faeces being hard. Next m. felt very tired and weary, and suffered between 8 a.m. and noon from severe stabbing headache, especially over r. eyebrow, changing during p.m. to more moderate general pressing ache, which diminished gradually towards e. During a.m. felt also constriction of chest. From 2 to 3 p.m. distressing dreams during siesta, and, later, lowness of spirits. During following n. still felt constriction of chest, which disturbed her sleep. Next d. felt still some headache in r. frontal region, lasting from 9 till 1 1 a.m., and same, though in lesser degree, on following d. Bowels during all this time were constipated.

h. Same took \ dr. of tinct. After 15 m. felt slight confusion in head, and 10 m. later uneasy movements in stomach, lasting ^ h. After 1 h. confusion of head gradually disappeared. Next d. took

1 dr. After j m. felt above symptoms, pains in stomach approaching nearer to actual cutting, After these pains had disappeared for i h., felt sinking feeling as from prolonged fast, not relieved by eating. Enjoyed dinner, but immediately afterwards oppression of head, which had never ceased, changed to stabbing headache spreading from forehead to occiput, especially on r. side, accompanied by longing for sleep ; on sleeping for i h. had uneasy dreams and awoke unrefreshed. Headache

'lasted till 5 p.m., and was accompanied at 4 by giddiness. Bowels only opened in e. after several ineffectual attempts at stool. After

2 dr. same symptoms followed, uneasy feeling spreading to small intestines, and accompanied after 2 h. by sinking, nausea, and general lassitude. After 3 h. there was general warmth ; after 4 h. considerable heat and redness of cheeks, pulse being large, full, and hard, and 10

ibeats above normal. At noon had i h. of restless sleep j between 2 and 3 heat vanished, but headache became worse, especially in r. half of forehead. Bowels constipated all d., acting at lo p.m., fxces hard. During n. slept more quietly than at noon, but all next d. suffered with general lassitude, weariness, and, except at rare intervals, with headache. (/W.)

15, Th. J org, on August loth, at 8 a.m., took i dr.; almost instantly felt confusion and pressing pain in head and transient pressing in stomach ; after 15 m. momentary stabbing in 1. corner of 1. eye j

soon afterwards weariness, especially in knees, and frequent stretching and yawning. Head-symptoms and weariness became worse towards 10 a.m., and he was also troubled with rheumatic pains in joints and painful sensations in region of spleen and bacic ; by li a.m. confusion and weariness alone remained, and by noon these had disappeared. Pulse all a.m. was quickened and excited. Next d. took 2 dr, ; confusion of head with pressing in forehead followed after 15 m. and lasted till 10 p.m., though moderating towards e., and accompanied from 9 a.m. till noon by cutting pains in abdomen, changing during p.m. to distension of intestinal canal. During p.m. and e. nose was very dry, and watered several times. Pulse from 9 a.m till 2 p.m. was quicker than usual. During afternoon much troubled 'with sleepiness and distaste for work. [Ibid.)

1. a, WiBMER took, July a6th, n.45 a.m., ^ gr. Op. After J h. on rising up felt heaviness and slight stiffness in limbs, which went off after 20 m. In afternoon was very active, not the least desire for sleep. No stool all d., very unusual.

h, July 28th. — After a stool, took, at 7.30 a.m., the pulse being 70, 1 gr. Op. The bitter taste lasted some time. After 20 m. head felt heavy, heat of face, pulse increased by 3 or 4 beats. 7.45 a.m^ heaviness of head nearly gone, as also the heat of face, but arms and legs felt as heavy as lead, making all movements difficult ; at same time slight sickness and inclination to vomit, followed by eructation ; pupils somewhat dilated. 8.15 a.m., well, except some heaviness of head and weariness.

c. July 31st, 7 a.m., after stool, pulse being 72, took 2 gr. Op, After 20 m. head heavy, face hot, thinking and writing difficult, pulse 5 beats quicker, pupils not dilated. Ten m. later the limbs, especially thighs, could only be raised with difficulty. 7.45 a.m., heaviness of head and limbs and heat diminished, but he was unable to work, a kind of giddiness prevented him thinking. 8 a.m., sleepy, slept some m. After 8 a.m. head heavier than ever, trembling, sight dim, could neither think nor write. Nausea, eructation, retching and ineffectual efforts to vomit, after which he became easier. In open air, head remained heavy, giddiness and nausea. 12, noon, slept a little and ate his dinner, after which all the symptoms disappeared. (Op, dt,y iv, 72.)

1. Oppenheim took 7 gr. at once. He had congestion in head, pulse quickened, vertigo, headache, flickering before eyes, dyspnoea, increased heat, restless sleep. After 4 h. woke exhausted, stupefied, pulse quick. Felt unwell and excited for 24 h. (/A/V,, 73.)

2. PuRKiNjE took 5 gr. After i h. nausea in stomach, which gradually affected all motor nervous system, especially branches of sciatic, with feeling of great weakness and faintness, so that he could with difficulty walk J h. ; at same time great depression of spirits, always occupied with thoughts of death. All this went off after a glass of wine. (/^/V., 71.)

3. J. Hhukenbeck, let, 47, Feb. 8th, 7 and 1 1.30 a.m., 0*030 grm. 9.30 a.m., restlessness, a kind of anxiety, oppression of chest, trembling, chiefly of lower extremities and about lumbar vertebrae, frequent cructa-

47«

tion,dryness of tongue and palate, then painful pricking in jaws, especially about condyles, confused head. After 2nd dose nausea and inclination to vomit ; thereafter a slight contractive feeling in stomach, rumbling^ and pinching in bowels, in I. leg a feeling of movement as if a fluid moved to and fro in it. Afterwards had, however, extreme faintness^ drowsiness and uneasy sleep for 1 1^ h. After waking staggers as if intoxicated. P.m., alter supper all the symptoms went off, except the trembling; soon there came on nausea, eructation, lame feeling in knee-joints with an obtuse pain there, occasional painful twitchings in muscles, especially of limbs, dryness of whole buccal cavity and tongue, bitter rather burning taste, sometimes obtuse headache and staggering gait ; slight persistent pain in bowels. All symptoms went off by 8 p.m. No stool this day. — loth, 8.15 a.m. and 4.30 p.m., 0040 grm. 9.30 a.m., repealed eructations. After \ h. pinching in stomach, rumbling in bowels, slight bellyache, soon followed by dryness of tongue. ioa.m.,pain in bowels increased, dryness in fauces, 10.45, vertigo. 11.15 a.m., dull headache, staggering gait as if intoxicated, inclination to vomit and dizziness. 1 1 .45 a.m., sad humour, same feeling in knee-joints. 12 noon, creeping feeling in both legs. Slept from I till 2 p.m. On waking some headache and dryness of mouth all gone by 3 p.m. 5 p.m., eructation. 6 p.m., dryness in mouth, pinching in bowels. 6.30 p.m., trembling of thighs. 8 p.m., pain in stomach removed by movement, g p.m., quite well. One stool, hard and grey. — lOth, 8 a.m. and 3 p.m., 0'040 grm. 9 p.m., 0050 grm. Op. 10 a.m., some retching which ended with eructation. 1 1.15 a.m., slight lame feeling in knee-joints and transient pain in houghs. 11.30 a.m., vertigo. 1 1 .45 a.m., pinching in belly. 1 1 .58 p.m., all symptoms gone. Slept uneasily from 3.30 till 4 p.m., dimness and dryness of eyes, which felt stiff j sometimes they were very watery. From 6 till 7 p.m., vertigo. From 7 till 8 p.m., pressure in abdomen and oppression of chest, dry mouth. One stool, hard and yellow. Woke up at Z.30 a.m. with great itching of anus and hiccup. — nth, 8 and 11.30 a.m, and 8.30 p.m., 0050 grm. 9 a.m., a transient stitch in cardiac region. 9.30 a.m., alternate watering and dimness of eyes. 10 a.m., much hiccup till 1 1 a.m., then dryness of mouth. About noon, vertigo with continued dry mouth, and return of hiccup. After dinner slept 1 I h. From i till near 4, pains in head, after that very cross and angry without reason, with occasional intervals of cheerfulness, confusion of head and vertigo, bitter taste, dryness of mouth, pretty intense thirst. 7 p.m., pain in supra-orbital region. 7.30 p.m., hiccup. 9 p.m., a hard stool. 10 p.m., great headache, vertigo, staggering gait. Loss of appetite. Slept well. — 12th, 8.15 a.m. and 2.15 p.m., 0050 grm., and 9 p.m., 0060 grm. 929 a.m., violent pains in abdomen of short duration. 10 a.m., eructation. 10.30, slight dimness and moisture of eyes. 1 1. 15, formication in I. leg. 11*30 a.ui., pain in gullet on swallowmg, 12 noon, dry mouth, vertigo, trembling of whole body; transient stitch in 1. hypochondrium. After dinner slept till 1.30 p.m. ; quite well on waking. 3.46 p.m., violent pains in abdomen, watering of eyes ; abdomen tympanitically distended, slight pressure caused pain in umbilical region. 6 p.m., oppression of chest and choking in throat.

weariness of knee-joints, dry mouth, eructation. 7.30 p.m.^ rumbling in belly, coldness in stomach, trembling, depression of spirits, vertigo, headache and sleepiness. 8.30, quite well. No stool, slept wdJ. — 14th, 8.30 a.m., 2.30 and 9 p.m., 0050 grm. 1 1 a.m., dulJ prcssivc paJn in abdomen. 11.43 a.m., trembling of upper and lower extremities. 12 noon, vertigo, stupefaction and a kind of intoxication, not lively, dryness of mouth and sleepiness, little appetite for food which, however, tasted well, slight perspiration when eating, especially in upper part of body. After dinner slept till 2.15 p.m. ; quite well on waking. »oai 4 till 4.44 p.m., slight pain in abdomen. 5.30 p.m., vertigo, drowsy, great noise in ears, 6.16 p.m., very violent pain in chest lasting till e, and causing dyspnoea. Eyes watered in open air. Could read ind write by candle-light without spectacles, which he could not do before. 10 p.m., pulse 70, strong, slept well. During d. frequent dryness of mouth, no stool. — 15th, pulse 65, strong. 8.30 a.m., 3.30 p.m., o-o$0 grm. i 9 p.m., o'o6o grm. Good appetite on rising. 7 a.m., not quite wide awake, lazy, obtuse headache. 7.30 a.m., quite wide awake. 9.30 a.m., rumbling in abdomen and stomach. 11 a.m., vertigo and dull pressive pain in umbilical region. 11.30 a.m., perspired when walking. 5 p.m., vertigo with intoxication till 5.32 pm. Went to bed at 10 p.m., woke up at 3 a.m. with violent pain in stomach, oppression of chest, choking in throat, dry mouth ; then slept tilt 7 a.m. and wokequiie well. Pulse at 10 p.m. 68, no stool. — i6th, m., pulse 66. 8.30 a.m., noon, 4 p.m., O'o6o grm. Appetite good, but soon satisfied. During d. much flatus. The lirst 2 h. after each dose spasmodic contraction of anus ; one hard stool, 7 a.m., on rising pretty well. 1 1 a.m., vertigo, oppression of chest, lazy and sleepy. Noon, immediately after taking dose stiffness and weariness of knee-joints, vertigo. After dinner till i felt nothing, slept till 3.30 p.m. ; on waking felt as if he had been intoxicated. 6. p.m., vertigo, weariness of lower extremities, especially knee-joints. 6.30 p.m., sleepiness and laziness, 7.30 p.m., dull headache. On going to bed at 10 p.m., vertigo, formication in legs ; quiet sleep till 6.45 a.m. ; on waking, cheerful and brisk. — 17th, 10 a.m., pulse 66, not so strong as usual. 8.30 a.m., 3.0 and 9 p.m., 0'o8o grm. Appetite bad for dinner at noon, rest of d. good. Quite well on rising. 10 a.m., sleepy. 11.30 a.m., vertigo, confusion of head, intoxication, weariness in knees. Noon, dull headache, trembling of lower limbs, dry mouth. 12.30 p.m., after eating without appetite, symptoms gone, soon afterwards pressure in stomach. 12.45 P*""., cheerful and brisk. Slept till 2.45 p.m., woke thirsty. From 3 till 7 p.m., quite well and cheerful. 7.15 p.m., pinching pam in stomach. 7.30 p.m., violent pinching in abdomen. A hard and lumpy stool. Woke several times at n. with pains in abdomen till 5 a.m. During the abdominal pains, spasmodic closing of anus and difficult flatus. At n. slight sweat, and at 3 a.m. urging to urinate with difficulty of passing urine. — 18th, 8.30 a.m., 3 and 6 p.m., O'OBo grm., and 9 p.m. 0*090 grm. P.m. and c., bad appetite, no stool. On rising 7 a.m., well. 10 a.m., choking for a short time. 10.15 a.m., stiffness of eyes, sleepiness. 10.30 a.m., vertigo. 11 a.m., trembling of lower extremities. 11.30, well. From 1 p.m., restless, dreamful

sleep. 3.30 p.m., intoxication. 4 p.m., vertigo, great gaiety, and dysuria as if the urethra were closed ; this went of at 5.30 p.m. 6.45, nausea and vomiting, afterwards bitter taste, trembling of whole body, cold feet, pressive pain in stomach, eructation, vertigo, headache. 7.15 p.m., nausea, numbness and coldness of r. hand. 7.30 p.m., pain in abdomen, staggering gait and drowsiness. 8 p.m., vertigo. On going to bed at 9.45 p.m., intoxication and vertigo. Slept till 5 a.m. On waking difficulty of passing urine, violent pain in chest, dry mouth. -^iQth, 90 grm. blood abstracted, it a.m., 0060 grm. On rising

7 a.m., violent pain in chest, dry mouth, trembling of body till 9 a.m. 10 a.m., vertigo. 1 1. 30 a.m., sleepy. 12.15 P-m., trembling and lame feeling of knees. 2 p.m., well. 2.30 p.m., great vertigo till 3,30 p.m., then dull headache, sleepiness, bitter taste and trembling of whole body. 4 p.m., no symptoms. 5 p.m., vertigo, transient oppression of chest.

8 p.m., painful formication in 1. leg, pressive pain in abdomen, vertigo. All d. bad appetite and frequent urging to urinate, with scanty but ea.sy discharge of flatus j one stool, hard and lumpy. During all the proving no inclination for, or power of, coitus. — 20th, 2 stools, the first hard and very painful on account of the spasmodic closure of anus, the second easier. On rising at 7 a.m. brisk and cheerful. 8.30 a.m., vertigo. 1 1 a.m., sleepy for J h. The same vertigo and sleepiness at 3 p.m. 6 p.m., sleepy and not brisk, gnawing pains in belly till 9 p.m., then trembling of arms. — 21st, on waking m. trembling of whole body. A certain amount of laziness and exhaustion lasted for several d. The stools became gradually softer, were frequent (2 in d.) and painless. The hearing has not been so good since taking the Op. In 14 d. he was quite in his usual state. — During this proving the blood and urine were carefully examined, It was found, ist, that the weight of the body remained unaffected j 2nd, that the quantity of food consumed was lessened; 3rd, that the quantity of the urine was increased, to the amount of about 150 grms., but that the quantity of solid matter in it was diminished ; 4th, that the amount of the faeces, perspiration and semen was diminished. (Bocker, Zeiisch,/, Erfahrungiheiik., iv, pt. I, pp. I— 80; in Franks Mag.^ iv.)

1. a, Franz Alb — first proved several dilutions of opium, but they produced no effect except a bitter astringent taste and a feeling of scraping and constriction in the fauces for 2 or 3 m. On August 15th, at 9.30 p.m., he took 5 dr. tinct. The bitter astringent taste and scraping and constriction of fauces lasted 6 m. ; drinking water relieved it. Woke up at 3 a.m. with tickling in larynx, and violent, dry, fatiguing cough, lasting lo m., relieved by drinking cold water^ but it returned after 15 m. with such severity that the eyes overflowed with tears, again relieved by drinking cold water; fell asleep at 3.15 a.m., but awoke again at 6 a.m. with a fit of coughing with some mucous expectoration. 9.45 a.m., pressive tensive pain in occiput at insertion of m. cucullaris, that spread all over nape and inner border of scapula to their apices. The pain was most intense at the 4th cervical vertebra, whence it extended to last dorsal vertebra, aggravated by motion, relieved by rest ; on waking from midday siesta it was gone. At 10.30 a.m. tensive pain in flexor muscles of both thighs tu hough,

lasting 12 m. Heaviness and weariness in legs, his gait became slow, and on returning home at 12. 30 p.m. felt as tired as if he had taken a fatiguing walk. On sitting down became so drowsy that he could not help yielding to it, and lay down and fell asleep at once. At 3.15 p.m. was awakened by same dry cough with flow of tears, lasting 6 m^ relieved by drinking water. About 6 p.m. sudden drawing tearing pau'a in 2nd joint of r. ring finger, increased by movement, relieved by rest, lasting 10 m., then gradually diminishing, and spreading over wnsc to head of radius, lasting till 8 p.m. In 1. tittle and ring fingers numbneai from 2nd joint to tip, lasting 4 m., removed by rubbing fingers. Urine passed at 6.30 p.m. of normal colour and strong smell. T*he stool, which usually occurred in the m., was delayed till 6 p.m. and (hen passed with effort; it was viscid, dark brown, of fetid^ mouldy smell.— 16th. Was long in falling asleep on account of a very painful boil on L buttock. Dreamt of small humming-birds. At 2 a.m. ticklingin larynx and dry cough for 5 m. — 17th. At 11.15 ^•'^' heavy feeling in both legs till 5 p.m. Stool at 8 p.m. same as yesterday. — i8th. Urine passed at 5 a.m. in ^ h. turbid, with same peculiar smell. On coming home from a meeting at midnight had rumbling and griping in transverse colon, hurried call to stool, which was watery, copious, with much flatus passed with rapidity and noise, and followed by tearing in rectum for some m. Woke at 3 a.m. with the dry cough with tickling and scraping in larynx, lasting 5 m. — 19th. At 8 a.m. stool of viscid consistence, yellow-brown colour, and mouldy smell. 3.30 p.m., a second stool of same kind, preceded by griping about navel. Frequent discharge of flatus till 5 p.m. Tension and full feeling in whole abdomen, especially its upper part.

b. Sept 2nd, 5.30 a.m., 25 dr. 8.5 a.m., sight dim as if through a vcilj lasting 10 m. Dulness of hearing in 1. ear for 4 m. Tension in abdomen. 11 a.m., numbness from 1. shoulder-joint to tips of fingers, worst in volar aspect of hand, thumb, and little finger, lasting 6 m., recurring after 20 m. and lasting 4 m. Soon afterwards empty feeling in stomach, with feeling of hunger. Though he ate at dinner (i p.m.) much more than usual, the empty feeling lasted till 3 p.m. ; during this time eructation of air, 2 p.m., recurrence of the same dimness of vision. 3.45 p.m., copious discharge of urine. 5 p.m., slight drawing tearing pain on a small spot about the small fontanelle, gradually increasing, lasting 8 m., and then suddenly ceasing. It recurred after 20 m., thence spreading all over spinal column, and lasting 6 m. 6.30 p.m., horripilation from anterior aspect of r. thigh to knee for a few seconds, after J h. the same symptom occurred in nape, spreading over back to sacrum for a few seconds. Urine passed at 7.50 and 10 p.m. copious, of normal odour, and pale coloured. No stool. — 3rd. The dry cough came on later in m., with tickling and scraping in larynx and dry tongue. Soon afterwards urging to urinate, passed a large quantity of urine of yellow colour. On waking at 6 a.m. again copious urine. No stool. 7 a.m., after breakfast cramp and heavy feeling in legs on rising from seat, lasted till 6 p.m. 9.30 a.m.^sudden lightning-like tearing on outer side of r. knee-joint, going down outer ~ I stomach an

was not satiated by eating a good deal. At noon ate a large dinner, which did not remove the empty feeling in stomach. — 4th, 6 a.m., copious urine, stool. Noon, passed much urine, out of all proportion to fluid consumed ; also tension and fulness as though cloches were too tight. This continued till 38th. {Zeitsch. d, Vtr^ d, horn, Aerxt, Ofsterr.y i, 3, 28.)

1. Bresslauer, act, 43, proved 30th and 12th dil., but got few and unimportant symptoms except great urinary tenesmus, contraction in urethra and bladder, relieved by passing urine, and on one occasion haematuria for 4 d. {Ibid,^ 36.)

2. DuDiTsCH, medical student, proved the 30th and 12th dilutions, and carefully observed his pulse and respiration, both of which seemed to be slightly increased in rapidity. He also felt pressive stupefying headache in r. side of forehead, eructation of bitter fluid, shooting in 1. side of forehead, numb and priclcling sensation in 1. lower extremity and weakness of I. knee. {Ibid.y 40.)

3. a. Dr. EiDHERRj xt. 30, June 4th, 7 a.m., took 4 dr. ist dil. After 4 h., heat alternating with coldness along spine. Later, warmth proceeding from stomach over whole body with moist skin ; frequent yawning ; heaviness of head, especially of sinciput, and dazed feeling there ; inability to follow out train of thought. After 2 h. felt as if anus was spasmodically contracted ; when touched externally, burning pain there for xo m., when it gradually subsided, but could be renewed by touching the part. — 5th. 6 dr. after breakfast. After ij h. increased warmth throughout body and yawning; persistent tickling at anus, ending in itching there. — 6th. 8 dr. 10 m. after brcaklast. After J h. feeling of anxiety, restlessness, heaviness of limbs, general exhaustion and dazed head ; sensation of warmth proceeding from stomach and spreading all over body. Feeling of hunger, which on taking food changed into a feeling of emptiness and pressure in stomach ; rapid trembling of lower jaw for 5 m. Sensation of stupefaction, lasting I h. Profuse perspiration, unsteady gait, and soon tired. At 10.30 a.m. a cigar, which he was accustomed to smoke, caused vertigo, great nausea, inclination to vomit, cold sweat all over, trembling of limbs. All this was immediately relieved by a glass of cold water. The crampy feeling in anus lasted till 3 p.m. That same e. before going to bed took 10 dr. The n, was very restless, with much tossing about. Sleep very light, heard every noise in the street ; the striking of the clocks in the house painfully affected him. Had dreams of various sorts all n. — 7th. Did not rise so early as usual, and then felt more exhausted than when he went to bed. Head heavy and dazed. Took no med. — 8th. 20 dr. after breakfast. After i h. felt more exhausted, head confused, frequent yawning. — 9th. 24 dr. 2 h. before midday meal. After 20 m, same symptoms as on 6th, and besides, vertigo, pressive feeling in head, vision as through a veil, profuse sweat and sleep. Coflee relieved the symptoms. — 24th. Began with 4 dr., and increased the dose daily by i dr. until he came to take 10 dr. Similar symptoms were observed. Stool retarded all through this proving.

i. August 8th. 5 dr. of tinct. After 25 m. confusion of head with slight vertigo on looking to either side. Cheerful humour and

increased acuteness of hearing. After l^ h. out-pressing headache ia temples and forehead. Vertigo with buzzing noise as of a be«, wnh stopped-up feeling of both ears and diminished acuteness of heanng. Weariness of whole body, diminished mental power. When sitting writing became so sleepy he had to lie down, and slept for 20 m^then awoke auite well. Pulse increased from 60 in 40 m. to 68, in 1 h. to 72. — yth. 10 dr. Same symptoms, — loth. la dr. Same symptorm bat still greater drowsiness. — i ith, 9 p.m., 20 dr. After 15 m. head felt relieved, cheerful spirits. After 20 m. so sleepy he could not keep eyes open. All movements are performed lazily, and he hardly knew what he was doing. Woke after 2 h. by a noise in street and could not get to sleep again. Memory dull, could not think connectedly. Headache in temples as if compressed. Feeling of emptiness in stomach, relieved by breakfast for 20 m., when it again recurred and continued with slight intermissions all d., though he ate frequently. Great prostration and despondency all d. Next d. felt better, but the pressing pains in temples lasted all d. No stool on loth, ijth, and 12th, stool witb great forcing on 13th. Urine increased In n. of 1 ith. — 15th. 20 dr^ caused similar symptoms. (Ihid.^ 43.)

1. Dr. Freud, act. 25,May28th»6a.m,, 6dr. tinct. 10 p.m., same dose. — 29th, 6 a.m., 6 dr. No symptoms these 2 d, except constipis* tion. — 30th, 6 a.m., 6 dr. Sudden call to stool, which was soft. — 31st, No mcd. M., a pappy, soft, copious stool. In c. a violent pressive headache till bedtime. — June ist, 8 a.m., 6 dr. Very little appetite for dinner. In e. when sitting playing had a sudden faintness, so that he could scarcely sit on his chair. Lay down on so^ and the face was sprinkled with cold water, which soon revived him. — 2nd. Only slight exhaustion remained, and he had a coryza with cough that lasted 4 d. (Ibid.y 50.)

2. a. Surgeon Jenitschek, June 3rd, i^ h. before breakfast, 3 dr. istdil. Soon fulness and tension in abdomen. — 4th, m., 5 dr. No stool (was used to have 2 stools, one before and the other after breakfast). 8 a.m., uncommonly sleepy, great forgetfulness, fearfulness, with giddiness and excited condition, so that he was several times in danger of being run over. As the day advanced became cheerful. At 7 p.m. a copious firm stool. — 5th, Took 5 dr. No symptoms except irritability. — yth,

h. pain in forehead, forehead felt warm.

10 dr., no symptoms. — 9th. 10 dr., no

th. Frontal pain in afternoon \ it was in-

was a boring pain, intermittent, and spread

Tongue furred, sticky pasty taste ; but

6 a.m,

10 dr. After Peevish humour. — 8th. symptoms.— loth and 1 tolerable on the i ith, it from forehead to crown.

the stool was regular on the days when no medicine was taken, — 13th, afternoon, 15 dr. At 6 p.m. fulness in head, vertigo on stooping, tinnitus aurium and distinctly-felt pulsation of cerebral vessels, increased saliva, furred tongue, complete constipation ; urine turbid, dark red, saturated, frothy, with reddish-yellow greasy sediment. — 14th. 15 dr., DO symptoms except scanty, costive stool. — 15th, One h. before dinner, 15 dr. After dinner, when lying on sofa a painful beating and visible rising and falling of the full stomach synchronous with pulse, so that he co^ld not bear to lie on his back, but must get

»

up and walk about ; this gradually went ofF in i h.— i6th, m., 15 dr. No symptoms. — 19th. 20 dr., no symptoms. — 20th. 30 dr., and same dose on 21st. No symptoms.

h. June 24.th, 4 p.m., 3 dr. tinct. No effect. Continued taking ever-increasing doses up to 15 dr. till July 6th without effect, — yth, 4 p.m., 30 dr. 6 p.m., feeling of anxiety, weight in chest, must often breathe deeply, occasional gasping for breath, clothes (e]z too tight, heart's beats not felt j skin hot and its blood-vessels full. Later in e. nipping and pinching in belly, and all through n. noisy emission of a large quantity of inodorous flatus and occasional eructation of air, which continued during next d. — Sth. Early in m. a liquid, frothy, copious stool with great relief. Forehead confused, thickly furred tongue, pasty taste, redness of conjunctiva and increased secretion of tears ; felt very exhausted, prostrated, and cross ; felt as if he had passed a sleepless n. after a debauch. — 9th, afternoon, 30 dr. Recurrence of the pinching in belly, emission of flatus, distension of abdomen ; in c. a liquid stool. — loth, m., 3 liquid stools with tenesmus and burning in rectum and anus ; urine increased, at flrst dark coloured, afterwards less so. From nose and mouth there came a yellow, viscid, mouldysmelling mucus. As he felt great loathing at the medicine he took no more. (/AxW., 51.)

1. a. W. Jemtschek, zt. 9^, June 4th, 3 dr. ist dil. Soon, prcssive headache in forehead, pressive pain in 1. hypochondrium, nausea^ increased saliva for 2 h, — 5th, m., 5 dr. After i h. complained of frontal headache, forehead felt warm for ij h. Afternoon, kept eyes open by effort, they felt dry and as if dust were in them, had to rest them frequently ; increased redness of palpebral and ocular conjunctivrc. Constipation j skin dry, hot, and turgcsccnt.— 6th. 5 dr., frontal headache, constipation, and increased turgor vitalis. — 7th, No med. Stool normal. — 8th. S dr., frontal pain and eye symptoms as before, but the eyes were full of tears. Rumbling and pinching in bowels^ sweet taste, constipation.^-9th. 8 dr., frontal pain and increased temperature, constipation. Urine in forenoon turbid and dark. — loth, 4 p.m., 8 dr. 6 p.m., tongue thickly furred, pricking in belly, constipation.— 14th, afternoon, iO dr. t,, headache, transient shoots in head, noise in ears, furred tongue, scanty stool, hot skin. — I5ih. 10 dr., some confusion of head. — 16th. At bed-time 10 dr. No symptoms, — 20th and 21st. 15 dr., no effect. — 22nd and 23rd. 20 dr., no effect.

h. 24th and 25th, 2 dr. tinct. No effect. — 27th. 5 dr., some pricking frontal pain and increased warmth of forehead. — 28th. 5 dr., besides yesterday's symptoms constipation. — 29th. 5 dr., same symptoms.— 30th. 5 dr., shooting, throbbing, frontal pain, heaviness of head, feeling of a heavy body in it, swaying to and fro, increased heat of body. Burning shooting pain in r. wrist, and on back and palm of hand some pimples the size of peas which rose in blisters. E., 2 similar but smaller pimples on r. cheek, painful when pressed ^ constriction of stomach, constipation and lachrymose disposition. — From July 1st to 4th, 5 dr. Frontal pain, vertigo with swaying of body, objects seemed smaller. The blisters of yesterday gone, but others rose on the side of the neck ; they were not red but tender. — 4th to 7th. No mcd. No

symptoms, the pimples gone. — 7th, 4 p.m., 10 dr. Hard stool. — 8ih. 10 dr., hard stool, — nth and 12th. 15 dr., no effect. — 13th, 10 a.m^

20 dr., 4. diarrhoeicscoo

I J a.ca,

20 dr. In afternoon a liquid stool. — 14th.

{ibid., 56.)

1. Surgeon A. Schauer, st, 27, June 8th, 20 dr. tinct slight discomfort, confusion of head especially in forehead, lachrymation and burning in eyes, weariness of lower extremities. 2 p.m., these symptoms increased, and in addition a tiresome pain betwixt shooting and boring in coronal and sagittal sutures. Slight redness of conjunctiva of ball and lids, slight swelling of caruncula lacrymalis. Tongue furred more than usual. Little appetite for dinner, after which irresistible drowsiness ; an empty almost pressive feeling in stomach. Weariness of limbs, spasmodic twitching in muscles of calf; stool delayed for some hours ; emission of very fetid flatus. Sadness^ loss of power of thinking, incapacity for mental work ; then general prostration. From 5 to 7.30 p.m. pretty free from these symptoms ; then the confusion of forehead returned, with general weak feeling lasting till 9 p.m. Nex d. same symptoms but slighter. {Ibid.^ 60.)

2. Dr. Stern, xt. 36, accustomed to have 2 stools daily, oneearly,^ the second after a meal. The dilutions from 30th to 1st caused no symptoms. — May 25th. 5 dr. tinct., no stool. — 27th, 7 a.m., 8 dr. No stool. — 29th, 7 a.m., 10 dr. No stool. Confusion of head. Breathing laboured as if thoracic muscles were relaxed. After breakfast a second stool, and 1 h. later a third liquid stool. — 31st, 7 a.m., 15 dr. After j h. vision veiled, head confused as after drinking alcohol. Constipation, emission of flatus. Frcm 5 to 7 p.m. dull pain in occiput, tearing and drawing in forearms. — June ist, 7 a.m., 15 dr. Depressed spirits, dislike to work, constipation. — 3rd, 7 a.m., 20 dr. 9 a.m., vision dim. 1 1 a.m., feeling of discomfort, emptiness and sinking in stomach, accumulation of water in mouth, frequent spitting, inclination to vomit, exhaustion, trembling of hands and feet, transient jerkings in hands, cold sweat on forehead, confusion of head, heaviness in eyes. This lasted till noon. Cold air revives momentarily. Complete anorexia, loathes food. After a cup of coffee these symptoms went off. (Ibid.t 63.)

3. a. Dr. A. v. Szontagh, set, 27. Dilutions from 30 to 5 caused no symptoms. — July 6th, noon, 5 dr. tinct. No effect. — 8th, noon, 8 dr. In afternoon and next m. pressive pains in rectum like hasmorrhoida! congestion, increased by touch, — nth. 10 dr., no effect.— 13th. 15 dr., immediately pulse rose J4 beats higher, slight burning in ears, weakness of knees and prostration of whole body, nausea relieved by eructation. All this lasted i^ h., but on eating there was a kind of spasm of cesophagus which made even water difficult to swallow. — 16th, 15 dr., next m. at the normal time a stool, at iirst hard and difficult, at the end diarrhceic. — uth. Was wakened at 5 a.m. by call to stool *, he had a copious, pappy, dark-coloured stool. Pulse 90, roaring in cars for 8 m. Soon diarrhceic stool. E., on extensor side of I. thigh

size of peas, which went off after some d. — 19th, noon, 20 dr. Soon eructation, weakness in arms and legs, sleepiness > when eating, every

%

»i^

almost inodorous afterwards a second 2 itching wheals the

time he swallowed, spasm in oesophagus, after meal discharge of much flatus. A kind of urinary tenesmus ; at the commencmenc of micturition had always to wait some time on account of spasm of the sphincter vesica, but when the urine came it was in full uninterrupted stream. This occurred every time he urinated. Frequent erections at n. in sleep. — 2isr, noon, 25 dr. After eating, much flatus. E., roaring in ears for some m. Next d. pulse quickened by 10 beats, roaring in cars, heat and sweat for 10 m. After falling asleep n., a sudden jerk through whole body that woke him up. — 23rd, noon, 30 dr. Soon great weariness in legs, increased secretion of urine. After I i h, hurry in doing things, thinking, too, was rapidly performed, but its quality was unaltered. — 25th. While sitting roaring in ears for 20 m. — 28th, 35 dr., and 30th, 40 dr. Besides prostration and emission of flatus, no symptoms.

^. Aug. II, noon, 5 gr. 2nd trit. No effect. — 14th, noon, 5 gr. 1st trit. At midnight, after sleeping 1 h., profuse perspiration. — i6th, noon, 10 gr. Sweat at midnight. — 19th, 1.30 p.m., 15 gr. Soon weariness in knees, elbows, and masseter muscles. Difficulty of swallowing food or drink on account of spasm of oesophagus. — 2ist, 1.30 and 2 p.m., 10 gr. Weariness in legs and forearms. Pressure against external meatus auditorius ; spasm of cesophagus during and after swallowing. After 1 h, indistinctness of seeing and hearing as if slightly intoxicated ; this went off after 2 h. Increased secretion of urine ; with a full bladder difficulty of urinating on account of spasm of sphincter vcsicx ; the full stream is sometimes interrupted all d. — 24th. At same times I2 gr. Slight intoxication, which, however, did not interfere with his thinking or work, for which he had greater inclination and capacity than usual. Redness and heat of cheeks and feeling of burning in them j increased discharge of urine. All right in 2 h. Sleep at first restless, afterwards sound, refreshing. Stool next m. at usual time, but passed with greater effort. — 31st, i, i.30, and 2 p.m., 10 gr. (= 3 gr. pure opium). Pressure in maxillary joint and malar bones with heat and burning there, also in lobes of ears, slight noise in ears, pulse large and quick, disagreeable buzzing in ears when talking or whistling ; heaviness of upper eyelids as if they were swollen j increase of urine ; frequent interruption of the stream of urine, which only came after long delay on account of twitching in sphincter vesics ; drowsiness when reading. Next d, there appeared on wrist and flexor aspect of both forearms thickly set itching wheals, the size of hempseeds, which went off during n. (Ibid.^ 65.)

1. a. Dr. L. Tedesco, set. 42, March i6th, 6 a.m., 5 dr. 30th diJ. j 20th, 12 dil. ; 24th, 6th dil. No effect. — From 28th to 31st, S dr. 6th dil. 3 times a d. On 29th pressure in stomach for several h. On 30th a liquid stool. — April 28th, m., 5 dr. istdil. 2 p.m., pressive frontal pain till 10 p.m., after a refreshing sleep he woke quite well. — May 2nd, 7 a.m., 5 dr. In afternoon scraping, rough feeling in fauces. — 6th, m., 10 dr. After dinner pressive pain in forehead and occiput, confusion of head, giddiness, altered taste, dislike to tobacco, increased saliva, slight nausea, feeling of water-brash, lasting all afternoon, gradually going off in e. — I ich, m., 15 dr. Afternoon, pressive headache as

4^0

before ; at midnight a liquid stool. — i2th. 20 dr. Afternoon, frontal headache, liquid stool. — 13th to 17th, every d. 25 dr. Every d. frontal headache in afternoon till late in e. Also each d. 1,2, and liquid stools of whitish colour.

h. May 29th to June ist, every d. 5 dr. tinct. No eft'ect. — zn 10 dr. Some h. after dinner, dazcdnesss and confusion of head, passing into pressive pain over eyes to nape. Dislike to tobacco and unusual taste in mouth. 3rd, m., 15 dr. Same symptoms in afternoon. — 4th to 9th. 15 dr., no noteworthy symptoms. — 16th, 20 dr. ; 1 25 dr.; i8th, 19th, and 20th, 30 dr. No effect except more or 1 pressive frontal pain. — July 13th. 10 dr., only constipation. — 17 10 dr., no stool. — i8th. 10 dr., no stool, sight dim, — 19th. 10 d sight still dim. — 20th. 10 dr., in afternoon pressive, sometimes throb bing headache from back to front along median line. Sight 50 b chat when writing the letters ran together. Stool insufficient and bar — 2ist. 15 dr., eye symptoms as before, no stool. — 22nd. 15 dr., eye symptoms continued. 9 p.m., a normal stool. — 23rd, 15 dr., eye symptoms less.— 27th. 20 dr., dim vision, constipation. — 28th, 29111, and 30th, 25 dr. Same symptoms. A hard stool on 30th. — 31st, and Aug. 1st and 2nd, no mcd. On 2nd d. 2 fluid stools at 9 and (2 p.m., with slight griping.— 3rd, 4th, and 6th, 30 dr. Only the abovementioned symptoms in moderate degree. As the smell of the medicine^i caused loathing, stopped the proving. {Ibtd.^ 69.) ^H

1. 1 have tried many experiments with doses from gtt. -r^ to gtt. 1^^ of tinct., and in every instance the pulse has been quickened, and sometimes rendered sensibly fuller, in 2 or 3 m., e.g, from 66 to 68 and from 70 to 76. After a longer or shorter interval, e, g. in from 5 m. to an h., determined by the dose, the beats return to what they were at the beginning, and sometimes afterwards descend a little below this. (Sharp, Essays on Medicine (1874), p. 724.)

2. a. Nov. 2nd, 1 876, at 12 m., pulse being 64, 1 took 1 dr. of tinct in a little water. At 12.3 pulse had risen to 70, at 12.10 and 12.30 it was 68, and continued thus for a considerable time. On the 4th, at 7.25 a.m., pulse 68, 5 dr. were taken. In 15 m. pulse was 70, in 35 m. 74, in 60 m. 76, at which point it remained for an h., after which it fell gradually to 68, remaining thus for some h. At 25 m. there was flatulence, and after dinner at 1.30 considerable indigestion.

b. In Nov., 1876, Mr. S — , while continuing his usual habits and his active occupations, took (ar ray request and without knowing what it was) I dr. of ist dil. n. and m. for 10 d. The only cflect which he noticed was a considerable increase of appetite. At another time he took 5 dr. of the same dil. n. and m. for 10 d., under similar circumstances. The result was the same — a decided increase of appetite, 50 that he thought I had been giving him a tonic.

f. Mr. S — , at 6 p.m., having just finished tea, pulse 72, took 10 dr. of tinct. and sat down to read. P next 2 h., so that at i.io m. it was recover, and at 9.15 (after supper) it

n

fallen to 62, it is noted observed was drowsiness.

as

ulsc fell, somewhat irregularly, during

as low as 53 ; it then began to

was 64. At 70 m., when it had

very weak." The only other eftect

48»

d. On another occasion Mr. S — took 6 dr. at 12.30 p.m., pulse being 54. In 25 m. it had risen to 58, after which it fell to 52 (40 — 45 m.). When dinner had been taken it rose to 64. (Ibid., The Actiom of One Dost, p. 13.)

1. I frequently tested the pulse of a pupil, <ct. 16, in health, and always found it 90 — loB, when not quickened by exercise. I now rubbed into his leg a mixture of 5ij of laudanum with '^tij of olive oil till the whole was absorbed. In 10 m., when nearly half was rubbed in, pulse was 88, soft. In 20 m. it was 84 j he was drowsy, and complained of being cold ; eyes look heavy. In 50 m. pulse was 72, feeble, and small ; countenance pale j coldness continues, and is accompanied with disagreeable sensations. In 60 m. pulse 76, weak, and not quite regular ; complains of great weakness. Pulse rose through following 60 m. to 108, and grew regular and stronger. Disagreeable sensations did not go off till after supper, which he ate heartily. Experiment was repeated 2 d. later, ^iij of laudanum being used. Pulse, 95 before applying the O., fell in 30 m. to 83, and became soft and weak J he complained much of being cold, and felt so j looked sickly and dull \ felt depressed and drowsy. He ate breakfast greedily, and was soon relieved of disagreeable sensations. He said the word " horror ** well described the extremely unpleasant coldness he had experienced. (Ward, Mtd. and Phys, ^ourn.y vii, 136.)

2. Mrs. G. W — , set. 34, well save for paraplegia, had tn.vj of tinct. injected hypodermically. After i h. pulse accelerated 10 beats \ no somnolency \ had felt uncomfortable, and was now faint, and gave way to hysterical crying and sobbing. After 2 h., pulse weak, acceleraccd 16 beats \ had vomited twice, and now retched violently, and threw up mucus mixed with bile ; face pale and anxious. After 5 h., pulse small, feeble, and intermitting, accelerated 20 beats ; had vomited bilious matter twice, and experienced constant nausea, with considerable drowsiness, but was restless, distressed, and unable to sleep on account of illusory objects which continued to pass before the vision as soon as she closed the eyes ; surface cold. Nausea, repeated action of bowels, somnolence, giddiness and faintness continued up to the iith h., when she went to sleep for the first time, and slept throughout n. with much dreaming and wandering. Pupils and tongue remained unchanged throughout. (Harley, Old Vtg. Niurotics^ p. 130,)

3. Opium taken in the dose of i gr, always causes in me after 13 h. a diarrhoea that lasts at least 24 h. The evacuations are nut frequent, from 4 to 5 times in the 24 h., have a whitish colour, arc pappy, and cause burning in anus that lasts for \ h. (Strecker, A.h. Z., xii, 133.)

4. At first I took \ gr. O, for dose, always after a meal, but experienced no cfiect, whereupon I took i gr., and this did not act, But if I look it shortly before bedtime, my sleep at n. was often broken by waking up, and it was long before I could get to sleep again, 50 that once I got up at 3 a.m. When I took 2 gr. in the form of pills, they

^caused headache, sleepiness, red congested face, quickened pulse, and profuse sweat. The largest dose 1 took at once was 4 gr. in pills. One h. after swallowing it 1 had violent headache, my face became

VOL. III. 31

5 drowsi-1

redder, pulse accelerated, profuse sweat broke out ; there was siness, but I could not sleep quietly, and 5 h. after the dose I vomited 8 times without much straining, a thing I am not used to, and it caused great exhaustion. (Waltl, A. h. Z,, xxii, 160.)

II. Poisonings. — I. a, Mrs. T — , Et. 30, of slender form, hypochondriacal, and very irritable, was in the habit of frequently taking 30 dr. of laudanum for the purpose of relieving certain distressing sensations. On Feb. 27th, in a moment of passion, she swallowed 6 dessertspoonfuls, having previously taken four glasses of port wine and some spirits in her tea. After 3 h. she was found in her bed, and perfectly insensible. She was then deadly pale and cold, her limbs were relaxed, and felt H^bby when handled. She breathed slowly, and apparently with great difficulty. There was a loud mucous rattle in the trachea, with great frothing at the mouth, which was wide open, the under-jaw having fallen towards the sternum. The eyelids were closed, and when raised by the finger exhibited a distorted, fixed, suffused eyeball, with extremely contracted pupil ; pulse lOO, and exceedingly feeble, free from intermission, although the motions of the heart were tumultuous. The temperature of the body generally was very low, but it was high at the prscordium. There was paralysis of the muscles of deglutition, with intense coma. Fourteen h. were fruitlessly employed in the administration of emetics, stimulating enemata with sulphate of zinc, and frictions. Towards m. she could swallow small quantities of tea, coffee, broth, bread, and ammonia at intervals, and complained only of great distress in breathing. Soon afterwards she recognised her medical attendants, and knew all her domestics. She detailed all the proceedings of the preceding n., regretted what she had done, and expressed much anxiety as to the result. The limbs were still powerless ; the eyelids were raised, but only by a great effort, and they quickly resumed a half-open position, exposing suffused balls, a persisting contraction of the pupil, and a frightful strabismus. For a moment she appeared able to direct eyes to an object ; they then rolled as if free from control, and settled into quiescence, the cornea being turned upwards and wholly concealed. On a few occasions she vomited a small quantity of fluid darker than coffee, and without any odour of O. She partook of strong chicken broth, and was soon capable of conversing with a minister, from whose hands she received the Sacrament. This excitement being over, being about 18 h. afcer taking the dose, the difficulty of breathing became an agony. She referred all her sufferings to her lungs,* asked for a blister to her back, and announced that she was surely dying. The wrist was now pulseless, the extremities cold, the limbs relaxed, and in 5 h. more she was dead, retaining her consciousness until a few moments before she expired.

b. The body was inspected ig h. after death ; it was then warm and very rigid. The limbs were strongly extended, the hands clenched. The whole front was pale, while the underlying parts were deeply 1 ecchymosed. The lungs filled the chest, and scarcely retired on expo- ■

• Dr. Wright conMcters the dy»pnata of O. poisoning due to ilrynr^sof the mpiratory paitsagc^, and finds it greatly relieved by tnc inhalation of Mcam {Amrr. J of Med. Sc„ 1S51, p. 540).— Eds.

t

sure i they crepitated when handled^ and yet they felt firm and fleshy, and resisted the scalpel i their anterior surface presented an anaemic appearance, studded with small black spots of a circular form i internally they were gorged with livid blood. The large pulmonary vessels were nearly empty, as was the heart, the blood which they contained being fluid. The liquor pericardii amounted to ^ oz. The stomach was distended by a brownish, inodorous fluid ; the internal tunic exhibited purple marks, attributable more to vascular turgescence than to extravasation. The intestines were pale throughout, except near the gallbladder, where they were extensively and deeply tinged with bile ; and they were undistcnded by flatus. The voluntary muscles were particularly florid. Examination of the head was not permitted. (Kirby, Du6i, Med. Press, ili45j p. 406.)

1. An infant was killed in the course of a n. by a decoction of poppy-heads. There was a great deal of livor over the whole back part of the body, AH the sinuses and vessels of the brain were gorged with fluid blood, and a good deal of serosity was found in the ventricles and base of the skull.'*' The lungs were distended, and so gorged with fluid blood that it ran out in a stream when they were cut. The cavities of the heart contained the same fluid blood. Although the body had been kept only 2 d. in the month of February, the belly emitted a putrid odour when it was laid open.f (Christison, op, cit.)

2. A. S — , an unmarried woman, xt. 28, swallowed 3j (>f^ laudanum with suicidal intent. I saw her at 5 p.m., within an h. of its ingestion. VVhen I entered she was sitting supported in bed, her eyes were wild and staring, face flushed, skin hot, pulse (when it could be reckoned) 126, and voluntary muscles strongly convulsed. The violent action of the muscles occasionally relaxed, and was replaced by slight subsultus. Vomiting could not be induced till 5ij of sulphate of zmc in sol. were given. Her mind all this time was in a state of great confusion ; at one moment she was sensible of her crime and called for assistance, at another she resisted the means used to save her. Pain being complained of in abdomen, emollient clysters were given; at first It was difficult to introduce them from the contraction of the sphincter, afterwards to get them retained, owing to its relaxation. At 8 the increased action of the system abated, and the delirium was followed by languor and indiH^ercnce. The thirst was intense, but the stomach was so irritable that it rejected whatever was given. At 11 lethargy had increased so much that it required the utmost exertions to

• Turgc»ccncc of the vessels in the bniin, and watery effusion into (he venriicles and on the surface of the brain, arc generally tnet with. Or, Bright mcnttonn an instance where unusual turgescence was found, and on tlie surface of (he brain a spot of flight ecchyinosis as big as a crown piece. I have teen turgeM:cnce uf vessels and serous effusion in one instance to a considerable extent} each ventricle contained 5iij of fluid, the arachnoid on the surface of (he brain wa-s much infiltmted, and the vctiseU both in the substa.nce and on the surface of the brain wtre a good deal gorged.

f It appear% that the body is often apt to pass rapidly into putreHiction. In one of the cases I examined, although the body had been kept only 30 b. in a cool pbcci in the month of December, the cuticle wa& easily peeled oft', the joints were flaccid, and an acid smell was exhaled. — [C. mentions two other in&tancei, yet more pro* nounced.^£o5.]

keep her awalce ; pulse was 55> breathing laborious, countenance dark and often ghastly, eyes sunk and often shut, muscles flaccid, extremities coldish. 'Though thirst was still excessive, and she always called for drink when aroused, the stupor was so great that she sometimes fell asleep with the basin at her lips. Next m. pulse was 70, soft a.nd full ; tongue clean j thirst great ; no appetite j skin hot and dry; bowels natural. In the e, she was in a profuse perspiration, but gradually recovered, save that her mind continued to be in a state of imbecility till she had left town for a time. (McKechnie, Ed. Mtd. ami Surg, Journ.y vii, 305.)

1. A soldier took, to kill himself, ^\s% of laudanum and 5] of cxtr. of O. at 6 p.m. An h. later he was brought to hospital with colic, stiffness of whole body, and extreme tendency to sleep. Ten gr. of tart, emetic caused free vomiting, and this was followed up by draughts of diluted vinegar. Next d. he had violent spasmodic movements, with plaintive cries \ sharp pain in stomach and whole abdomen \ tongue was black ; pulse quick and full ; face animated \ there was considerable heat ; he complained of intense headache and prostration of strength. The heat was followed by profuse sweats. 3rd d. — Some abatement of symptoms, but I. arm was paralysed. 4th d. — Tongue not black now, but yellowish ; stools also, which were black at first, returning to their colour: urine lemon-yellow. By 6th d. paralysis of arm had disappeared, but on Hth headache, which had much lessened, regained its intensity. At 7 a.m. patient felt sharp pains momcnianly in lower jaw, and spasmodic contractions in muscles of face, lasting 2 m. and not recurring. On loth d. pain was lighter, and from this date he convalesced, always complaining, however, of drawing in abdomen, want cf appetite, and painful digestion ; of embarrassment of breathing at intervals ; and of a malaise he could hardly describe. He was subject also to numbness and weakness, now in one limb, now in another. {Jcurn.de Med.^ xvi, 21. 1808.)

2. A young man swallowed ^j of laudanum with intent to destroy himself. When seen he was lying in an armchair totally insensible ; a death-like paleness had come on, and his features were distorted, particularly angles of mouth ; lower jaw was fixed; respiration performed at long intervals, and laboriously ; pupils insensible to light \ skin cold \ hands clenched ; pulse rapid, small, and intermittent. Sulphate of zinc, &c., induced free vomiting, and he was walked up and down the room. He was now able to move one leg before another, perspiration broke out upon his forehead, and he groaned aloud. He became aifected with spasms, particularly of muscles of back, neck, and extremities. These continued some time, until consciousness returned. Next m. his face was flushed and hot, lips dry, tongue lined with brown fur, throat and stomach sore, pain in head with weight in eyes \ he was very drowsy ; pulse quick, but not hard or full. In a few d. he entirely recovered. (Yeatman, AUd.and Phys, Journ,^\xx,^b^,)

3. a. "In about 4 — 5 h. after taking a dose of O. I become suddenly almost deprived of sense and hearing, and then am seized with shivering. These symptoms go off as soon as I get warm in bed, and a rash then makes its appearance on my face, arms, hands, neck, and

48s

lower extremities, causing a burning, pricking sensation. The cfFect is the same on my skin when O. is applied externally. On one occasion 2 dr. of laudanum produced a slight attack of the kind.**

h. This was patient's statement. Reporter witnessed an attack of the kind, brought on by 2 small doses of paregoric. Vomiting was troublesome for a few h. Desquamation of cuticle began, as in scarlet fever, about end uf 5th d. ; and during convalescence she was at one time threatened with anasarca. (It was for a teasing cough, remaining after bronchitis, that she took the paregoric.) (Dubi Med. /*rwj, xlix, 319. 1863. A similar case, in an old lady, is reported at p. 489 of same volume.)

1. a. The first effect of O. on the Chinese smokers of the drug* is to render them more loquacious and animated. Gradually the conversation drops, laughter is occasionally produced by the most trifling causes, and to these effects succeed vacancy of countenance, pallor, shrinking of the features, so that the smokers resemble people convalescing from fever, followed by deep sleep for \ h, — 3 or 4 h. An inordinate quantity causes headache, vertigo, and nausea. The Malays are rendered outrageous and quarrelsome by the O. pipe.

A. The continuance of this destructive practice deteriorates the physical constitution and moral character of the individual, especially among the lower classes. Its powerful effects on the system are manifested by stupor, forgetfulness, impairment of the mental faculties, emaciation, debility, sallow complexion, lividity of lips and eyelids, languor and lack-lustre of the eye, appetite either destroyed or depraved, — sweetmeats or sugar-cane being the articles that are most relished. " In the m. these creatures have a most wretched appearance, evincing no symptoms of being refreshed or invigorated by sleep, however profound. There is a remarkable dryness or burning in the throat, which urges them to repeat the O. smoking. If the dose be not taken at the usual time there is great prostration, vertigo, torpor, lachrymation, and in some an involuntary discharge of semen even when wideawake. If the privation be complete a still more formidable train of phenomena appears. Coldness is felt over the whole body, with aching pains in all parts. Diarrhoea occurs; the most horrid feelings of wretchedness come on, and, if the poison be withheld, death terminates the victim's existence.*' The offspring of O. smokers arc weak, stunted, and decrepit, (Smith, of Penang, Lancet^ Feb, 19th, 1842.)

1. Hill witnessed O. smoking in the person of a Chinese soldier, set. 24. He took 8 whiff^s before going to sleep. After the 2nd, the eyes became full and sparkling, the face began to flush, and the pulse to increase in quickness and fulness ; the breathing likewise became more frequent, and the whole system seemed considerably excited. These symptoms continued to increase until the 7th application to the pot of O. (i h.), at which time the pulse was 120, full and bounding. After the next two applications (5 m. more) he appeared quite stupefied by the drug, and lying down on the couch instantly fell asleep. He was allowed to wake of his own accord, which he did in about 3 h.

• Only one full whifF is taken at a time, but it is repeated until the effects of the drug arc felt.

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Considerable depression now seemed to have followed the previous excitement, the eyes, though still full and projecting, being dull and heavy, and the whole countenance having a languid and stupid expression. The breathing was likewise heavy and oppressed, and the pulse considerably below the natural standard, scarcely 60. [Lancet, 1840-2,

i, 820.)

1. The effects of the O. fumes when inhaled are far more exhilarating and immediate, as well as more transient, than when the drug is taken into the stomach. The pulse vibrates, it becomes fuller and firmer i the face glows, the eyes sparkle, the temperature of the skin is elevated, and it becomes suffused with a blush ; the organs of sense are exquisitely sensitive ; perspiration flows profusely ; respiration becomes quicker ; the action of the heart is increased ; the nervous energy is exalted^ and a glow of warmth, and sensations similar to those which often attend highly pleasurable and agreeable feelings, overspread the body. The mind shares in the general exhilaration, and is filled with those delicious and brilliant ideas which follow the other modes of employing O. j but if the smoking is too long protracted, these pleasing feelings vanish. All control of the will, the functions of sensation and volition, as well as reason, are suspended ; vertigo, coma, irregular muscular contractions, and sometimes temporary insanity, supervene. (McPherson, Two Years in China, quoted by Stille.)

2. a. Mr. Little describes the mode, &c., of smoking at Singapore in terms nearly the same as those we have quoted from Dr. Mcpherson, adding that, after the effect of the stimulant has passed off, a state of languor, listlessness, and incapability of exertion succeeds, together with loathing of food, nervousness, aching of the limbs, gloom, and indefinable wretchedness, a state from which the smoker has no relief until the period comes round for renewed indulgence in the gratification which led to it, and which again infallibly induces it.

h. He also draws a frightful picture of the derangement of the nervous system and of the digestion, the oppressed breathing, and hazy, bleared eyes of the devotees of this vice. The sexual organs lose their power, and are affected with a gleety discharge j the flesh withers, and the bones are racked with pains. The stooping figure, shuffling gait, drooping eyebrows, and dull eyes surrounded by a livid circle, give an appearance of premature decrepitude. In both sexes the procreative power is lessened, and in females the secretion of milk is defective. Ultimately, the stomach is the seat of an incessant gnawing pain, the food is vomited, diarrhoea comes on, the urine is turbid, and Bright*s disease is not uncommon. (Ihid.)

1. Dr. LiBERMANN, who was a medical officer at the capture of Pekin by the English and French, has furnished a picture of the effects of this vice, which corresponds exactly to what has now been presented ; but he adds some touches which were wanting to complete it, by describing the state of chronic delirium into which the O. smoker ultimately falls. The wretched man is assailed by the most various hallucinations, but all very unlike the voluptuous visions which he enjoyed on his first dalliance with the poison. The muse disgusting

objects and the most horrible scenes are perpetually before him, but most of all at night, when he in vain seeks refuge from his misery in sleep. He is haunted by spectral toads and all manner of obscene animals, or a fiery dragon swoops around and drags him into a flaming pit. Sometimes he endures all the tortures of the Buddhist hell ; or, fancying himself one moment in voluptuous embraces, the next he finds within his arms the mangled limbs of a hideous monster. These images, which, we are assured, are literal copies of the O. eater's phantasms, present a vivid resemblance to the more familiar spectral illusions of delirium tremens. (Jhid.)

1. A young man who has a mind to accustom himself to the immoderate use of opium is initiated in the following way : — His master first gives him some grains of this juice in wine or brandy, and then a quantity of the latter to drink after it, till a heavy fit of drunkenness deprives him of all sensibility and throws him into a deep sleep. After 7 or 8 h. he is roused by shaking, however much the overpowering effect of the sleep fetters him, and has to drink a great deal of cold water. But each cup he throws up with vomiting, nausea, and retching, and with eyes full of tears stares at the bystanders with, out recognising them, or knowing what passes before htm. At last they give him warm wine with nutmeg. Now he no longer vomits, bur, sleepy and unconscious, yawns often, and by this time sleep threatens to overpower him again, when they give him a second but deuhltd do%Q of O. Laughing, crying out, dancing, noisy music keeps our scholar of some hours in a state of utter unconsciousness. He wants to talk, but the organs of speech remain immovable, though his mouth is open. He goes through a number of silly actions, which excite the laughter of the bystanders, e. g, he stretches out his arm to reach the guitar, and at the same instant forgets to take hold of it or to draw his arm back, and the like, until at last he falls to sleep smiling. After 4 h, rest, the sleeper is again awakened and doused with cold water, his eyes washed with vinegar, and every possible art employed to drive away sleep. They drag him out of bed, force him to walk, but hardly will his stumbling feet obey, until they are at last with some trouble put in some sort of motion. The scholar stammers out some half-intelligible words, and complains that he is cold ; they give him warm wine, he finds himself better, and longs to eat, but hardly has he swallowed a few morsels, after tedious chewing, when hunger and appetite flee away. He wishes to sleep, to which, however, he is not left till within a few hours before the expiration of the period, which is reckoned from the last dose of opium. Scarcely has he rested these few hours when he is awakened forcibly and obliged to take again the same quantity of opium, whereupon he is again treated as before. Thus the system is day by day accustomed to this medicine, and already between the 8th and nth d. the scholar feels the desired effect of the previous treatment \ he goes about, it is true, with a swollen face and bloodshot eyes, but his very peculiar significant look testifies to an inward happy feeling of a quiet state. But this joy is not lasting ; when the effect of the opium fails again, which with beginners is usually the case in 24. h., he feels great anxiety, restlessness, frightful

images all around, shivering, and nausea, which do not pass off till he has taken another dose of opium. Then these sufferings cease, and a quiet, agreeable intoxication sets in for lo or 12 m., and ends with the liveliest imagination of the very ideas which the opium-eater wished to experience. If, for instance, he sets his heart upon anger, he becomes passionate even to fury, and is capable of no other idea than this. He sees not the danger into which he blindly rushes at all risks, and even the person whom he attacks in his terrinc rage. On the other hand, if he wishes to give himself up to amiable, gentle feelings, he stays quiet, smiles with internal contentment, seeks to testify of his happiness in perfect silence to those around ; until after the intoxication has evaporated he leaves off' dreaming, returns to humanity, and goes about his business in tranquillity. Still he feels a certain timidity, becomes forgetful, incapable of any of the finer feelings, and for ever indifferent to pain and pleasure. The opiophagus requires continually larger quantities, and at shorter intervals. Afterwards i oz. is hardly enough for the d., and now he becomes dull, and in this state of apathy in every sense extremely miserable, sleep flies from him, no dream in the slightest degree recalls the memory of former enjoyment i the opium itself becomes disgusting to him, and yet a state which is otherwise intolerable and dangerous compels him to the frequent use of it, and he never dares, for fear of his life, leave off while he lives. His figure becomes quite deformed, his face swollen, with its muscles immovable and hanging quite flaccid, his eyes bleared, his whole body feeble and collapsed, as his bones refuse their sufficient support. He is always chilly, rolls himself into all warm places, baths, and hearths ; being incapable of rational ideas he forgets decency, and becomes an abhorrence to all men, until at last dropsy puts an end to his misery. (Reivecgs, Blumenbach's Med. BiH,, ii. 1785.)

1. De <2uin'CEY took O. occasionally for ten yeais, experiencing only its exaltation. A gastralgia which then supervened led him to take it daily, gradually increasing the dose till it reached to some 8000 dr. of laudanum. After describing the intellectual torpor and profound melancholy thus caused, he writes :

a, " I now pass to what is the main subject of these latter confessions, to the history and journal of what took place in my dreams, for these were the immediate and proximate cause of my acutest suffenng. The first notice I had of any important change going on in this part of my physical economy was from the reawakening of a state of eye generally incident to childhood, or exalted states of irritability. I know not whether my reader is aware that many children, perhaps most, have a powerof painting, as it were, upon the darkness all sorts of phantoms j in some that power is merely a mechanic affection of the eye, others have a voluntary or semi-voluntary power to dismiss ur summon them, or^ as a child once said to me, when I questioned him on the matter, ' I can tell them to go, and they go, but sometimes they come when I don't tell them to come.' Whereupon 1 told him that he had almost as unlimited a command over apparitions as a Roman centurion over his soldiers. In the middle of 1817, I think it was that this faculty became positively distressing to me ^ at nighty when 1 lay awake in

bed, vast processions passed along in mournful pomp j friezes of neverending stories., that to my feelings were as sad and solemn as if they were stories drawn from times before CEdipus or Priam, before Tyre, before Memphis. And at the same time a corresponding change took place in my dreams ; a theatre seemed suddenly opened and lighted up within my brain, which presented, nightly, spectacles of more than earthly splendour. And the four following facts may be mentioned as noticeable at this time : i. That, as the creative state of the eye increased, a sympathy seemed to arise between the waking and the dreaming states of the brain in one point, — that whatsoever 1 happened to call up and to trace by a voluntary act upon the darkness was very apt to transfer itself to my dreams, so that 1 feared to exercise this faculty j for, as Midas turned all things to gold, that yet baffled his hopes and defrauded his human desires, so whatsoever things capable of being visually represented I did but think of in the darkness immediately shaped themselves into phantoms of the eye, and, by a process apparently no less incvitable,when thus once traced in faint and visionary colours, like writings in sympathetic ink, they were drawn out, by the great chemistry of my dreams, into insufferable splendour that fretted my heart. 2. For this, and all other changes in my dreams, were accompanied by deep-seated anxiety and gloomy melancholy, such as are wholly incommunicable by words, I seemed every night to descend — not metaphorically, but literally to descend — into chasms and sunless abysses, depths below depths, from which it seemed hopeless that I should ever rcasccnd. Nor did I, by waking, feel that 1 had reascended. This I do not dwell upon, because the state of gloom which attended these gorgeous spectacles, amounting at least to utter darkness, as of some suicidal despondency, cannot be approached by words, 3. The sense of space, and in the end the sense of time, were both powerfully affected, ^Buildings, landscapes, &c., were exhibited in proportions so vast as the bodily eye is not gifted to receive. Space swelled, and was amplified to an extent of unutterable infinity. This, however, did not disturb me so much as the vast expansion of time. I sometimes seemed to have lived for seventy or 100 years in one night, nay, sometimes had feelings representative of a millennium, passed in that time, or, however, of a duration far beyond the limits of any human experience. 4, The minutest incidents of childhood, or forgotten scenes of later years, were often revived. I could not be said to recollect them, for if I had been told of them when waking I should not have been able to acknowledge them as parts of my past experience. But placed as they were before me, in dreams like intuitions, and clothed in all their evanescent circumstances and accompanying feelings, I recognised them instantaneously. I was once told by a near relative of mine, that having in her childhood fallen into a river, and being on the very verge of death but for the critical assistance which reached her, she saw in a moment her whole life, in its minutest incidents, arranged before her simultaneously as in a mirror, and she had a faculty developed as suddenly for comprehending the whole and every part. This, from some opium experiences of mine, I can believe ; I have, indeed, seen the same thing asserted twice in modern books, and accompanied by a remark

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which 1 am convinced is true, namely, that the dread book of accouDt which the Scriptures spcalc of is, in fact, the mind itself of each individuai. Of this, at least, I feel assured, that there is no such thing is forgttt'ing possible to the mind \ a thousand accidents may and wt]] interpose a veil between our present consciousness and the secret inscriptions on the mind. Accidents of the same sort will also rend away the veil ; but alike, whether veiled or unveiled, the inscription remains for ever; Just as the stars seem to withdraw before the common light of day, whereas, in fact, we all know that it is the light which is drawn over them as a veil, and that they are waiting to be revealed when the obscuring daylight shall have withdrawn.*'

b, "In the early stage of my malady the splendour of my dreams was chiefly architectural, and I beheld such pomp of cities and palaces as was never yet beheld by the waking eye, unless in the clouds.

. . . To my architecture succeeded dreams of lakes, and silvery expanses of water. . - . The waters now changed their character, — from translucent lakes, shining like mirrors, they became seas and oceans. And now came a tremendous change, which, unfolding itself slowly like a scroll, through many months, promised an abiding torment, and, in fact, it never left me until the winding up of my case. Hitherto the human face had often mixed in my dreams, but not despotically, nor with any special power of tormenting. But now that which 1 have called the tyranny of the human face began to unfold itself. Now it was that upon the rocking waters of the ocean the human face began to appear ; the sea appeared paved with innumerable faces, upturned to the heavens ; faces, imploring, wrathful, despairing, surged upwards by thousands, by mvriads, by generations, by centuries j my agitation was infinite; my mind tossed and swayed with the ocean. '

c, "One memorial of my former condition still remains" {Lt. after he had reduced his dosage to a minimum) ; "my dreams are not yet perfectly calm j the dread swell and agitation of the storm have not wholly subsided ; the legions that encamped in them are drawing off, but not all departed ; my sleep is tumultuous, and, like the gates of Paradise to our first parents, when looking back from afar, it is still (in the tremendous line of Milton) ' with dreadful faces thronged and fiery arms/"

d, *'Thc symptoms which attended my case for the first six weeks of the experiment" — of leaving the drug almost entirely off — " were these : enormous irritability and excitement of the whole system, the stomach in particular" (in which he had become " aware of an increasing callousness or defect of sensibility ") " restored to a full feeling of vitality and sensibility, but often in great pain ; unceasing restlessness night and day; sleep — 1 scarcely knew what it was — 3 hours out of the 24 was the utmost I had, and that so agitated and shallow that I heard every sound that was near me j lower jaw constantly swelling ; mouth ulcerated i and many other distressing symptoms that would be tedious to repeat, amongst v^hich, however, 1 must mention one, because it had never failed to accompany any attempt to renounce O,,— namely, violent sternutation. This now became exceedingly troublesome, somc-

times lasting for 2 h. at once, and recurring at least twice or three times a day." He speaks also of *' the excessive perspiration, which even at Christmas attends any great reduction in the daily quantum of O., and which in July was so violent as to oblige me to use a bath 5 or 6 times a day." [Confessions of an Opium Eater.)

1. In 1841 an opium eater, zt. 26, was admitted into the London Hospital. He was accustomed to take 3!] — 5iiss of solid O. daily. He originally began its use to relieve the attacks of angina pectoris. He was now most anxious to leave off this habit, though the difficulty of doing so was extreme. It did not diminish, but, according to his assertion, augmented his appetite ; for after each dose he ate voraciously. At first when he commenced its use it caused dryness of mouth and throat, and constipation ; but latterly his bowels have been as regular as usual. His pulse ranged from 88 to 96. His urine was somewhat less than natural. The condition of his skin varied ; in general it was dry, but occasionally was covered with profuse perspiration. He described the etfcccs of the O. on his mental faculties as those of calmness, comfort, and serenity. Under its use he was able to support great mental and bodily fatigue. He never experienced the exhilarating and pleasurable sensations described by De Quincey, His feelings, when not under the influence of O., were most distressing. At this time his eyes were hollow, dark, and sunken i features haggard ; hands trembling; voice and manner anxious; mouth parched ; appetite wanting; sleeplessness. Unable to sleep for want of his accustomed dose, he used to pace the ward of the hospital at n. almost frantic, though quite sensible of his miserable condition, and anxious to abandon the practice, (Pereira, ep, i/>., sub voce,)

2. a. E. M— , xt, 35, was admitted May 2bth, 1835. About 17 years before she began to suffer from a pain in the r. iliac region, for which a medical man ordered her to take 10 dr. of laudanum n. and m. I'his was gradually increased, the pain continuing, until at last she took 3 teaspoonfuls every 4 h, n. and d. At ftrst the xo dr. relieved the pain, but it was found necessary to increase the dose to produce the same effect, so that the 3 teaspoonfuls at last did not produce so much relief as did the 10 dr. at fir^t. As the dose was increased, she found it produce a very comfortable condition of the mind. She felt lively and cheerful, and capable of doing any amount of work ; it also produced a sense of warmth over the whole body. She had severe family afflictions^ but was not at all distressed by them while under the influence of O., though she felt them severely at other times- If she passed over the usual time for taking a dose, she felt the most distressing sensations about the joints^ not of pain, but such as she was unable to describe. She suffered from involuntary motions of the arms, fingers, and toes ; numbness in the limbs and body generally ; profuse perspiration ; nausea, vomiting, and loss of appetite ; saline taste of the saliva and bad taste in mouth ; tremor in limbs ; great sense of debility and lassitude. Memory and mental powers generally became greatly impaired, attended by a miserable depression of spirits. These symptoms were all relieved by a repetition of the dose. The O. also produced constipation, — not more than one motion occurring in a

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week, and she does not recollect whether even this was produced by medicine or not. If the dose was deferred, she always suffered from severe headache ; her sense of smell was so much impaired that she could perceive no pungency in snufFj her taste ^vas so much lost that she could not distinguish pepper or mustard ; and her hearing had become so defective that she could hardly detect the voice of anyone who spoke, yet her own voice sounded most disagreeably loud to her; her touch was so much affected that she could not execute any needlework. The acutcness of all her senses was restored by the usual dose, the want of which was attended by flushing and heat of the face. During the period of taking the O. she had very little sleep, and in the intervals she could not attempt to sleep for want of the desire, so that she generally worked all n. What sleep she had was generally in the daytime, and that little was much confused, and easily ended.

b. About 5 or 6 years ago, her resources being exhausted, she obtained admission into the hospital. Her laudanum ^vas here left ofF for the first 3 d., and all the above symptoms continued ; she now, for the first time, began to see frightful animals and other objects in the ward. The symptoms were again relieved by her usual doses. The laudanum was decreased during the whole time, and when she left the hospital she took only a teaspoonful in the course of the d. On returning home, and being dependent on her friends, she was obliged to discontinue the laudanum and wine, and was even unable to get beer. She was now more miserable than before, all the symptoms returning with increased severity, and for the first 6 mos. she was almost entirely helpless. She was then first affected with pain in her chest and a cough, which has continued ever since. She was 12 mos. at home before the above distressing symptoms disappeared. The only consequences of her opium eating at present are a much impaired taste, numbness of the limbs, coldness of the feet, inability to wallc far without aching pains in the limbs, and a general sense of lassitude. (Taylor, op. at., p. 589.)

1. The habitual opium eater (in Turkey) is readily recognised by his appearance. A total attenuation of body, a withered yellow countenance, a lame gait, a bending of the spine, frequently to such a degree as to cause the body to assume a circular form, and glassy deep-sunken eyes, betray him at the first glance. The digestive organs are in the highest degree disturbed; the sufferer eats scarcely anything, and has hardly one evacuation in a week ; his mental and bodily po^vers are destroyed. As the habit becomes more confirmed, his strength continues decreasing ; the craving for the stimulus becomes greater, and, in order to produce the desired effect, the dose must be constantly augmented. After long indulgence, the opium-eater becomes subject to neuralgic pains, to which O. itself brings no relief. These persons seldom attain the age of 40 if they have begun to use O. early. (Oppenheim, quoted in IhU.)

ly, A gentleman of a very haggard, sallow, gloomy appearance, and trembling all over, entered a druggist's shop and asked for an ounce of laudanum, which was properly refused without medical sanction. He then asked to be shown how much an ounce was j and when it stood

before him, measured in a graduated glass, he seized it from the counter, and eagerly swallowed it. The druggist was struck powerless. The gentleman, seeing his great alarm, assured him it was needless, as he had been a long time an opium-eater, and took twice daily as much as he had now drunk. He remained for ^ h. in conversation with the druggist, who was surprised to observe the wonderful change which so short a period had made in his visitor^ whose manner became animated, at the same time that his face became plump and suffused with a pleasing blush. (ICirby, quoted in Ih'td.)

i8. Madden, having witnessed O. eating in Turkey (which he describes as do others), tried it himself, taking 4 gr. in divided doses, and thus relates his sensations: — ^^ My faculties appeared enlarged^ everything I looked at seemed increased in volume. I had no longer the same pleasure when I closed my eyes which I had when they were open ; it appeared to me as if it was only external objects which were acted on by the imagination, and magnified into images of pleasure \ in short, it was 'the faint exquisite music of a dream' in a waking moment. I made my way home as fast as possible, dreading at every step lest 1 should commit some extravagance. In walking, I was hardly sensible of my feet touching the ground ; it seemed as if I slid along the street, impelled by some invisible agent, and that my blood was composed of some ethereal fluid, which rendered my body lighter than air. I got to bed the moment I reached home. The most extraordinary visions of delight filled my brain all n. h\ the m. I rose, pale and dispirited ; my head ached ; my body was so debilitated that 1 was obliged to remain on the sofa all d., dearly paying for my Arse essay at O. eating/* [Travels in Turkey^ &c., Lond., 1829.)

ig. a* There not unfrequently occurs in some persons, even after doses of gr. J to =f , a feeling of excessive fulness of head, dizziness, and headache, lasting several h., or even a number of d., seated sometimes in frontal, sometimes in occipital region. After larger doses, but still less than the maximum, there have been noticed buzzing and ringing in cars, confusion of ideas, dimness of vision, disturbances of hearing, and partial or complete unconsciousness. The motor sphere may also be affected, there occurring in some cases, as Albers stated, spasm of tendons, particularly of extensor muscles i tremor of the hands ; jerking, weakness, and even temporary paralysis of the legs.

b. The changes which sometimes occur in the skin after the use of O. are especially worthy of study. Aside from the sometimes very profuse sweating which takes place, the face is congested and intensely reddened, and the rest of the skin feels hot to the touch. Annoying itching, without eruption, may also be present. This " pruritus opii " was mentioned by Dioscorides and raulus ^gineta, and also by authors of the last century, and described as a tormenting and intolerable affection. In rare cases an eruption, with or without pruritus, is noticed after the use of O. The first recorded observation on this subject emanated from Tralles, who believed that the eruption bore a certain relation to the sweating which appeared simultaneously with it. The presence of the latter symptom is, however, not essential to the production of the exanthema. Ouclos lays special stress on the fact

that this may occur without augmentation of the secretion of the skin, It consists usually uf small red isolated spots, resembling in form those of measles. According to an observation of Rieken, these spots may spread diffusely over the whole body, and thus present the appearance of scarlatina. Even the mucous membrane of the mouth and throat, this writer states, may be attacked by this "erythematous inflammation." He witnessed the occurrence of such an eruption on a man every time he took O. internally, and even after the employment of ointments and collyria containing it. According to Bcrenguicr, the erythematous spots show themselves shortly after taking the drug, on face, neck> arms, and breast, and disappear without leaving traces of their presence behind. Hehrend has also recently studied an O. eruption. It appeared after taking a few \ gr. doses, accompanied with violent itching, on the chest from clavicles to lower end of sternum, on inner surfaces of both upper arms, flexor surfaces of forearms, and over wristjoints, spreading down legs and terminating at ankles in a stripe of livid colour about three Angers in width. It appeared as a pale scarlatinalike redness^ which, on closer examination, was seen to be composed of papules of pin-head size lying close together. Several d. after the eruption had passed away there occurred a fine branny desquamation of the epidermis. Brand also observed an eruption which spread over the trunk and flexor surfaces of the body, was attended with intense itching and high fever, and presented the appearance of a diffuse redness made up of innumerable small points. In this and a similar case there appeared after 8 d, a desquamation in the form of flakes of various sizeS) which lasted nearly lO d. (Lewin, op. cit.)

1. a. Dryness of mouth and fauces, huskiness of voice, and diminution in the sense of taste, occur in a short time, after administration of the drug in small medicinal doses, and continue during the whole period of its influence. To the dryness succeeds a viscid secretion, which contains excrementitious matter having a foul odour. When O, does not produce nausea^ the appetite may not be impaired, may be even increased \ but the rule is that the desire for food is lessened. The secretion of mucus, and of the special glandular apparatus of the gastrointestinal mucous membrane, is lessened by O., and hence the digestion and the peristaltic movements are less active. The excretions being thus locked up, dulncss and hebetude arc experienced, the skin looks muddy, the tongue is coated and the breath oft^ensivc. When the influence of the O. ceases, it not unfrequently happens that the constipation is succeeded by relaxation of the bowels ; and rather profuse and foetid evacuations, and increased urinary discharges, take place. The action of the heart becomes stronger, and the arterial tension rises. The face flushes a little, the pupil contracts slightly, the conjunctivae may be somemhatinjectcd, and the expression of the eyes more brilliant. At this st^e the ideas flow more rapidly, but arc less sustained and orderly. The appreciation of time, the sequence of events, and the sense of moral fitness, are diminished. The cerebral excitement is, after a period which varies in different individuals, succeeded by calm and drowsiness \ sleep when it occurs is usually disturbed by visions and dreams, often of a frightful character. In most subjects, when the

I I

stupor has passed oft, headache, vertigo, confusion o( mind, nausea, constipation and muscular hebetude are experienced.

b. When full medicinal doses are administered the symptoms above described occur in a more intense degree. The stage of cardiac stimulation and of cerebral excitement* is of much shorter duration, and the stage of intoxication and sopor not only comes on morequiclcl)r, but is much more pronounced. At first the pulse is increased in frequency, and the respiratory movements are more rapid, but the cardiac pulsations soon diminish in number and force, and the respirations become sighing in character and more shallow. There is also present decided dryness of mouth, fauces, and larynx, and swallowing becomes somewhat more difficult, and the voice grows husky. Nausea and vomiting, or at least weight and oppression of the epigastrium, ensue. Confusion of ideas, vertigo, somnolence, are succeeded by deep sleep, contracted pupils, slow and relaxed pulse, slow and snoring respiration, a perspiring skin, and in many persons a general pruritus, which, however, is more harassing at the nasal orifices. Persons not habituated to the use of O. usually experience, after a full dose has expended its force, very distressing sequelae, referable to the cerebro-spinal system. The most important of these after-effects arc headache, confusion of mind, vertigo — which is especially severe on assuming the erect posture, nausea, retching and vomiting,t complete anorexia, and constipation, A mild but defined hepatogenic jaundice not unfrequently occurs, and the urine is tinged with the colouring matter of the bile.( (Bartholow, op. at.)

1. a. Where the quantity of O. is large, and the form such as to permit rapid absorption of the whole, the course of symptoms is as follows : — The patient, if an adult, quickly becomes conscious of a sense of fulness in the head, which seems to commence in the nape of the neck, and to spread therefrom j and in the course of a few m. feels great and increasing drowsiness, and a sensation of general heat, which increases to an almost intolerable degree, and is then accompanied by sweating. This sweating, which generally bathes the body in moisture, tends to suspend all its other secretions.

h. If the dose given has been very large, it reduces the sur^ce to a clammy coldness. The drowsiness passes into semi-coma; the patient, unless aroused, lies unconscious, and is heedless of everything around him, but if roughly spoken to and shaken can still be induced — though the speech is thick and hesitating — to answer questions, and even to

• " It its commonly asserted that there is a stage in the action of 0. in which the aciivity of the mental faculties is exalted. This may be so in some persons, and especially in iho^c who have accustomed themselves tu the use of the drug as a stimulant; but my experience is that in those who do not habitually lake O. true mental power is, in all stages of the action of the drug, diminished rather than increaicd " (H.C. Wood).

t " Very frequently vomiting does not occur so long as absolute rest in the horizontal position is maintained j indeed, an almost diagnostic sign of this affection may be found in the fict that the stomach is quiet io long as the patient keeps the head upon the pillow, but the distress occurs at once upon rising up " (iBiD.).

X " Some persons can never take even a small dose of laudanum or morphia without producing for a day or two clay-coloured motions and high-coloured urine " (Ringer, ff/.W/.}.

get up and walk about ; on leaving him, however, he immediately subsides into his former stupor. The pupils are generally contracted to the size of a pin's point, and become insensible to light ; and there is buzzing in the ears. 7''he pulse, which in the first or hot stage was rapid and somewhat full, becomes feeble or irregular, and falls to the normal rate, or even below it ; simultaneously with this alteration the features become pinched and ghastly, and flushing gives place to livid pallor, while the muscles of the limbs are affected with spasmodic jerkings. The mouth and fauces arc dry, and there is commonly nausea, and often vomiting. The general depression of the system is marked. The respiration becomes more and more embarrassed; in the later stages the presence of a quantity of mucous secretion in the tubes makes itself known by the rattling sound of the breathing. The respiration comes to a standstill usually some m. before the entire cessation of the heart's action. Death, that is to say, takes place by apnoea.

c. The course of events differs considerably in young children, especially in infants. Here there is a more rapid passage into profound stupor, but what is specially characteristic is the much greater frequency with which convulsions occur. The convulsive movements vary from mere twitchings of the facial muscles to rhythmical startings uf the limbs ; to severe clonic convulsions, which may be hemiplegic^ or may affect both sides of the body alike ; and even to tetanic spasms. I have seen three adults thrown into a state of apparently complete tetanic rigidity of the whole body, the mouth open and squared, all the facial muscles highly tetanised, the spine strongly curved, resembling the shape of a well-drawn bow ; and this state of opisthotonos continue in each case without abatement 12 — 48 h., and then only become relaxed to grow rigid again for a longer or shorter time, according as the effect of the O. was kept up. One of the patients remained more or less in this state for 4 or 5 weeks, O. having been given in the first instance to relieve toothache, and continued for the convulsive spasms which followed. As soon as the O. was discontinued the patient recovered, but some months afterwards, having accidentally taken it again, the same results quickly reappeared. (Phillips, op, cit.)

III. Experiments on animals. — I. j. O. acts on all invertebrate animals by diminishing the contractility in the tissues which have this property, and consequently weakening all their movements. These animals always die in a completely powerless state, in a variable time, and without having shown any signs of excitement.

1. In vertebrate animals, O. exerts the same action on contractility ; it also depresses the nerves^ further weakening movements, and blunting the impressibility of the surface. It causes at the same time convulsive movements, tetanic contractions recurring paroxysmally, and the other signs of a violent over-excitement of the ccrebro-spinal axis.

c. In fishes, amphibia, and reptiles the convulsions are not strong enough to cause death, and they die powerless tike the invertebrata. Mammalia and birds often perish during the tetanic paroxysms,

d. The highest mammalia, besides the two previous classes of

♦97

effects, may present the phenomena of cerebral congestion, as in man ; but this is not strong enough to cause death.

These propositions are the rc<iult of numerous experiments. (Charvet, U Action dt POpium^ Paris, 1826.)

1. ScHROFF, who performed numerous experiments with O. and its constituents, remarks that although 2 and even 3 gr. certainly contain less than a gr. of morphia, yet their action is strikingly mure intense, occasioning rapidly a degree of narcotism bordering on coma, but soon subsiding without leaving decided secondary effects behind ; while morphia does not readily produce narcotism, but its after-effects are of longer duration. O., he further remarks, increases the temperature of the body and also the sense of heat, but morphia lowers the temperature even when the sense of warmth is increased. O. primarily augments the frequency of the pulse, and afterwards diminishes it as narcotism comes on \ but morphia primarily renders the pulse less frequent, O. is less prone than morphia to disturb the stomach and excite vomiting, or it does so« if at all, for a shorter time ; and it is also much less apt to produce vesical irritation and retention of urine. (Stillk, op. dt.)

2. a, I injected n^xx of tinct. beneath skin of a bitch, pulse being 120, pupils contracting to \ in, in the light and dilating to ^. Between 5th and 15th m. she was very qualmish, and at last vomited a heap of food. The diaphragm acted spasmodically for 3 m. more. She then lay down with head on the ground. After 7 m., bowels acted, clear mucus ran from mouth, and pulse was 1 12. In J- h. after injection, pulse was 78 and irregular ; respiration irregular and sighing ; glairy alkaline mucus continued to drop from mouth ^ pupils were broadly dilated in moderate light. Slight somnolency was now manifested for the first time, with a little twitching of the hind legs. As the somnolency did not increase, I injected at the end of the hour v\xx mure. In ^ h., pulse was 72, and very regular in rclat'on to the breathing — 1. f. the expiratory rate was 40, and the inspiratory about 120. Resp, 16, and regular. She continued in the same position, and there was no further contraction of the pupils. Every now and then she raised her head and looked about her, and then slowly laid it down again upon the carpet and closed the eyes. In 15 m. more she became decidedly drowsy, and the pupils, from being broadly dilated, contracted to I, The drowsiness continued for an h., but did not amount to sound and continuous sleep at any time ; and at the end of this period, upon being a little disturbed, she got up and walked away, and began to retch. From this time the drowsiness began to pass off*, and she continued to walk about, listen to footsteps on the other side of the door, and pry about. Pulse was now 78, and less irregular ; resp. 18.

If. Injected ii\xl by two punctures, one on either side of body. From 7th to loih m. vomiting, until stomach was emptied. At 15th m. lay down and remained quiet, with eyes open ; pulse 130, regular ; respiration shallow, irregular. During next | h., respiration was much disturbed, and occasionally suspended for 15 seconds; after a longdrawn inspiration, it gradually became slower, and ultimately sank to 15 i the pulse meanwhile was depressed to 72, and influenced by the

rOL. Ill,

breathings. Gtairy mucus continued to trickle from the mouth. U(> to end of 3rd h. she did not have any sound or continuous sleeps she remained dull and quiet, and when called, or disturbed by the approach of anyone, would get up and walk slowly into the next room, \Vhen left undisturbed she fell off into a nap, from which a slight noise awolce her. After 3I h. the somnolency had almost entirely passed off, and she was walking about most of the time. She could run, and jumped well off a chair. Pulse 80, respiratory. Resp. 15, irregular. Pupils contracted to ^ at diffuse daylight, and dilated widely towards dusky side of room. (Harley, op. cit.^ p. 1 09.)

Volume IV — Appendix

OPIUM.

(See vol. iri, p, 459.)

■

I. 36. A lady informed me that whenever she took laudaiium <* caused dull aching in nape and occiput, feeling of a band round neck, with sensation as if throat would burst, and as if blood were rushiKIT into head. There was also sickness, constant retching, food vomit«' at once; she was light-headed and sleepless. Nextd. perfect prostra* tion. (Morphia had same effect upon her, only with more sicicncH and prostration.) (Berridge, The Organon^ iii, 284.)

II. 22. A man had taken by mistake a preparation of O. intended for external use. After 5 h. he was found lying on his back, face pak and slightly livid, features drawn, eyelids closed; no expression of suffering } complete relaxation, limbs remaining wherever placed 1 somnolence, from which he was with difficulty drawn. Sensibility was much blunted ; pupils very contracted, punctiform j puUc about 100, small and compressible; beats of heart distinct but enfeebled; temp. 38° ; no nausea or spontaneous vomiting. The most remarkable phenomena were those of the respiration, which was reduced to 5 or even 4 in m. ; then, after a long pause of absolute apnoea, one heard a rattling or stertorous sound accompanied by a slight elevation of the chest and a semi-inspi ration, which was followed, without interval, bv

^

ep and fiill, but single one. The slower the breathing the more ked the fnllor and lividity of the face. Electricity (induced ent) through phrenic restored and maintained the respiration, and :2 h. patient had completely recovered. (Arnould, Bull. Med. du ^ 1879, p. SI.)