Oxalicum acidum

Volume I — Main text

ACIDUM OXALICUM.

Oxalic acid, HjC^O^. Acid principle of sorrel and other plants: prepared on large scale by action of caustic alkalies on sawdust.

I. Provings. — I. Reil, mt, 29, in good health and of simple habits. Made concentrated solution of acid in distilled water at 60*^, it rontained gr, 50 to 5vriJ, From this made dilutions with distilled water in proportion of r co 8.

a. Sept. 28th, 1 849, took at 730 a, tti., fasting, 20 drops of and diK, and repeated dose in e. Next d. took 30 drops in m. and e None but slight effects resulted, 30th. ^ m, and e.^ 40 drops. Oct. 1st, m. and e,, 50 drops ; 2nd, m., noon, and e., 60 drops ; 3rd, m,, noon, and c., 80 drops ; 4th, tn., noon, and e., 100 drops. On 30th had pressive frontal headache, eyes and forehead smarting as if coryza would set in (which it did not). This lessened on ist and disappeared on 2nd, leaving only aversion to mental exertion. After doses from 40 — 60 drops much rumbling in belly and increased discharge of flatus. Stools absent or difficult throughout,

b. Took 1st dil. from 5th to 9th inclusive, 20, 40, 60, 80, and 1 00 drops on successive days, three times a day. On 5th, pain in sacrum all day, relieved after difficult evacuation. Distension of abdomen this d. and next. No stool on 6th j on 7th abundant soft motion covered with mucus, preceded for some h. by frontal headache. Stool the same next d. J on 9th, after previous rumbling in abdomen, copious pappy evacuation with cutting pains. On 8th, empty feeling in stomach ; pain across kidneys j at n. unpleasant pinching around umbilicus repeatedly waking him up. On gth, feeling of lassitude all day.

c. From 1 0th to 13th inclusive took repeated doses of concentrated solution, from 10 drops to 50, without effect save flatulence and loose stools, with painful griping and twisting in stomach. Oct. 14th* — Took six doses of 100 drops each every 2 h. ; appetite good in spite of increasing pains in stomach. At 7.30 p.m., on going out, very severe bellyache, as if diarrhcea would set in ; no stool ; great lassitude. The urine passed in m. of 13th after standing 36 h, in a warm room was still strongly acid, and a mass of crystals had deposited in it, which under microscope and by the murexide test were recognised as uric

acid. Traces of oxalate of lime were seen as a milk-white precipitate, 15th. — A tab)csp<>onful every 2 h. ; soon after the ftr»t dose a papp^N evacuation ; all other symptoms as yesterday, Pafns in stomacl increase a while after eatings whilst formerly chey vanished after eatmj 3 p»m«, an uncomfortable diarrhccic evacuation, likewise at 7 p.m* though in smaller quantity. At 5, soon after food, pains in stomach were more troublesome than ever, and at same time nausea with inclination to vomit before food was present. i6th. — A tablespoonfut every 2 h. (= about 3 gr) ; on awaking early difficulty of swallowing with scraping sensation i tonsils and velum paUti slightly reddenei^ and covered with adherent mucus, which can only be detached by vioileni effort. During previous n frequent awaking from stomachache anf urging to pass water. After each meal more acute stomachache zni stronger inclination to vomit. Appetite previously gd, today absent, although gnawing sensation in stomach often simulates hunger ; at midday could, however, hardly swallow a few bites. Warm soup afforded relief, but after swallowing a few spoonfuls great urging to stool set in, which was thin, yellowish, slimy, and serous, and accompanied with tenesmus. The difficulty in swallowing increased after each meal. At 3.30 pm. occurred second evacuation of same consistency, without blood but with much tenesmus. Towards e pain in stomach and bowels became more acute, and obliged me to sit doubled up. As I had already noticed on taking my sweetened morning and afternoon coffee, the sugar in my tea seemed to increase the pains in the stomach* The tongue, in spite of the great loss of appetite, remained clean, moist, and uncoated. Throat still more reddened than in m. The morning's urine was strongly acid, deposited uric acid spontaneously, and contained oxalate of lime. lyih^ — ^Nothing taken. Throughout n. was disturbed by pains in stomach and abdomen, and burning in rectum ; before midnight and at 730 a.m. two serous stools with a few Streaks of blood and much tenesmus. Great prostration with feeling as if spine were too weak to carry body, l^he symptoms of angina, subjective and objective, were the same as yesterday. Cafe au lait with sugar increased the persistent stomachache. 11.30 a.m. another serous evacuation, mixed with some blood ; tenesmus. At midday little appetite J I took only some gruel, which relieved the painful sensations. In afternoon repeated but fruitless attempts to empty the bowels. Te nesmus during whole time. Climbing the stairs was especially troublesome. Head clear as heretofore. Character of urine same as yesterday, 1 8th. — Nothing taken. Sleep last night frequently disturbed by pains in anus; angina better; appetite also better, although food taken caused pains round and below navel, after a lapse of 2 h., that is, during its passage through the jejunum and ileum. Towards midday an evacuation, not so serous but still tinged with bloody slime ; tenesmus ; lassitude ; urine as yesterday, although the oxalate of lime is less. 19th. — Nothing taken. Sleep good ; still some burning in anus. Angina slight* Appetite good ; no pain after food or sugar. Urging to stool, but no evacuation. Lassitude improved. Urine still acid. Oxalate of lime can still be perceived. 20th.— Nothing taken. Condition nearly normal, only some lassitude still i appetite and digestio

good ; no stool. On following m., however, it occurred in normal mass and quantity, although still with some pain in anus. On the following days this symptom also vanished.

Roughly speaking I had during the last six d, taken roj ounces of the concentrated solution of oxalic acid, containing 65 grains of pure oxalic acid. Altogether, including the ist and 2iid dilutions, I must have taken about 70 grains. The largest dose was 3 grains, or 18 grains per diem. {Horn. Fitrieljahrsch^y ii, 340.)

1. A young physician to whom I gave some oxalic acid to prove, without his knowing what it was, experienced the following symptoms, which I give in his own words : — **• The 2nd dilution taken every 2 h, caused no noticeable change, except that after a 50- drop dose I had a somewhat sluggish motion and passed water somewhat oftener but perhaps in smaller quantity. With doses of from 80 — lOO drops, however, this symptom vanished.

'0f the concentrated solution I took doses three times a d. only^ and rose from 7 to 50 drops without detecting any change In my condition. Then the stools became more pappy and viscid, and called for longer and harder straining than usual. I remarked a weakness in the legs and increased transpiration all over the body, especially in the axilla. These symptoms remained the same up to doses of 80 drops, when there was a slight degree of qualmishness without inclination to vomit and a feeling of emptiness in the stomach. The latter was deceptively like hunger and often led me to eat^ without being in the least changed by it. Beyond this the weakness, which I had previously remarked only in the legs, spread over the whole body, so that work usually light to me exhausted me very much and left behind no slight degree of muscular fatigue. With 90-drop doses the nausea and feelmg of emptiness \n the stomach increased, accompanied by an uneasiness of the whole body, so that 1 did not dare to increase the dose.^ [Ibid.)

1. Dr, Hering took, May md, 1844, at 11 p.m., gr, ^ of Ix trit. In J b, pain pressing inwardly between vertex and occiput, on spot not targer than dollar on middle line. Sensation of slight numbness in 1. arm* A very violent contracting pain in outer tendon of 1. knee. Long and sound sleep at n. ^rd d, — In m. very bruised and stiff, cajinot leave hin bed till late. Had dreamt much which he could not remember. Bruised and stilF feeling in back on rising; but a chronic sore-throat and hxmorrhoidal uneasines*{ better than usual. Sour ta^te on rinsing mouth. Bleeding of ^ms to unusual decree while brushing teeth. At 9.30 a»m, internal sensation of neat^ especially in face; pulse 108 ; urinates lei(s than usuaL At it hiccup continuing for some time, though he had eaten nothing substantial ; and recurring for some h* whenever he thought of it. Face redder than usual. After walking out pain in testicles and spermatic cord, more in latter and worse t, side. While writing in forenoon violent jerking pain in ulnar side of r. arm near metacarpus. During speaking, much mucus in larynx, with hoarseness; he has to expectorate more tnan usual. Sensation of fulness in face and excitement, with di^tnclinntion to conversation^ 1245* Pulse 88. During hiccup stitching pressure over r. hip. In anus pain, like a dull slow stitch, often returning. Painful but dight pressure: in r. temple, and soon after in hollow of r. knee ; pain is somevvhat fcrTtlng. Great appetite for food at 1 p.m. ; 30 m. after pulse 96. A quick jerk in metacarpal joint of left index finger, soon also on ulnar side of hand, then on r. side ot head. After rising from recumbent posture, pain in r, lumbar region between last rib and hip, Greater love of his children, in one in whom this fueling always predominatei \ a decidedly expressed and clearly di^tinguii^hed symptom, it being

not traceable to any other cause. In afternoon violent starting at slamming of doors, excitement seeming physical rather than mental. Occasionally a pain in depth of ear, as in Eustachian tuhe, near thruat ; worst on r. side. In c, while sitting down after walking, violent itching nn small spot of neck, r. side of hairy scalp, 1. side of trunk, &c. Unwonted hunger at 1 1 p.m. 4th.— Again profound and long sleep ; on rising quite stupid, lay down again and slept another h. Usual pain in sacrum is absent : instead thereof bruised sensation in back from loins to shoulders. Thought is etfccted slowly and with difficulty : is hardly able to answei questions proposed to him. Scanty urination. Indolence : he can scarcely sit up, but wishes to lie down ; yet is not sleepy. Pulse quicker than usual. Some heat, at first in face, later in 1. leg, as from external warmth. In lying a movement in the upper l>ody, especially the head, like a fine rippling as of a stream. It seems to observe a rhythm, but not that of the pulse, than which it is three times faster. It is as if the blood was streaming through the smallest vessels, from below upwards and from within outwards. This feeling becomes plainer the more the thoughts are directed to it. On lying down also vertigo, like a swimming in the head towards 1. After a nap numbness in occiput and erectitms. He had dreamt of rapid sliding walking, and of water being poured over him. Some urging to urine and stOM while lying : on rising violent tenesmus in upper rectum, not as in diarrhoea but painful, almost like knife-stabs. On sitting down to stool pressing cutting pain from r. upper rectum to anus. Stocd pappy, light brown, clay-like. Scanty dear urine. After stool unde6nable sensation in anus for 4 h. Some jerking in writing as on 3rd. While yawning a pressive stitch in r. hip, taking away his breath. Pain in nose. Yesterdav and to-day peculiar tightness, a sort of weakness. During forenoon nap a decided sour ta^ite m mouth. Then, moreover, and also while walking later, pain in heart, from behind and below forwards. At i sensation in fauces as if there were acidity in stomach. Pain in heart is very violent, as of electric flashes coming from within. In afternoon again passage from bowels, pappy, thick and short, with sub«equent sensation in anus as yesterday. During passage violent stitches in ball of 1. thumb, like knife-stabs. The anal pains have to-day same character, but are much worse. After stool a heavy rumbling in r. side of abdomen (czcum) and noise from flatulency. A stitching pain between r. scapula and spine. On two following days same symptoms as on 4th, hut less pronounced. On 6th had red points on glans penis, without itching or other sensation. For 2 or 3 d. on rising from sitting posture a sort of dizziness, as if senses would leave him, but without whirling round.

All the pains from ox. acid seem to occupy only a small spot, } in. to i in. in length. They recur especially when thinking of them.

b, Jan. 5, 1845, <ook a small quantity of an aaueous solution. After tome h., while walking in open air, a very violent pain in 1. eye, as it were on small short spaces. Towards e. violent pressive pain within middle of upper arm, as if in bone (just at insertion of deltoid), increased by movement or use of arm : it lasted all the e., and slightly next m. All afternoon and e. excessive fretfulness. Woke next m. with pam in 1. kidney ; and that day and next at each micturition pain in front of glans penis, 6 or 7 jerks, not violent, but very disagreeable. In afternoon of 3rd d. very bad temper. {Amer. Arzneipr^ungem.)

1. Dr. Neidhard took Ix trit. before going to bed. Some m. after pain in upper head. Thereupon contractive feeling, difficult breathings at larynx a tightening with whistling breathing ; then pressure on whole chest, especially r. side ; then again the narrowing in the trachea with oppression of lungs. With these sense of emptiness in head and faintness ; it seemed as if all the blood had left the head, and caused anxiety. Being awaked by a noise could not sleep again for 2 h. In m., while in open air, tickling in throat causing frequent cough; larynx feels swollen; unwillingness to speak. At 11 a.m. pressure over eyes while walking; pulse quicker, fuller^ and harder than ordinary. Drawing pain with feeling of stiffness in angle of lower jaw, lasting some time during rest. Stitches in 1, chest, more when

walking; slight perspiration. At n. distinct dreams of daggers : numbness of head and tickling with soreness in trachea.

During and after the and trit. tickling cough with thick yellowish expectoration, {Ihid,)^

1. a. Dr. Koch, On ist d,, 3 rn. after taking a dose (quantity unknown) pulse fell from 70 to 65, and after 30 m. was 60 and irregular, thereafter more frequent and fuller. In \ h. warmth in stomach j in 45 m, burning on 1. haJf of tongue, as from pepper ; in 90 m, some tightness, with inclination to breathe deeply ; in 2 — 3 h. power of apprehension failed when reading, and there was throbbing pain in forehead^ and dull pain in middleof chest extending to scapula ; in 5 — 6 h. (e.) vertigo on looking out of window, as ( he should fall through, fine stitches in 1. ear, slight shooting pains in umbilicus, cough and tickling in throat, and sore feeling at pr^cordia, with heaviness of chest as in asthma or hydrothorax ; in 8 h. griping in bowels. On 2nd d., at 7 a.m., great quantity of clayey faeces, preceded by fine thin violent cutting in bowels ; then general malaise, urging to stool, and again a loose motion \ in afternoon diarrhoea and constant desire for stool, with evacuations of undigested food taken at dinner, followed by chilliness ; at n. aching in chest as if ulcerated ; in e. felt quite ill, and drank glass of wine, after which head was painfully confused ; after supper severe cutting colicky pains, lasting all c., with constant urging to stool ; there was also burning pain deep behind scapula. During day pulse was 60, skin always dry, disposition irresolute with indisposition to work, the eyes weak, fine stitches in cardiac region. In c, slight burning pain through urethra to its orifice, as if a drop of acrid urine wanted to come out. On 3rd d., immediately on rising, violent colicky pains so that he must cry out loud, followed by very copious diarrhoea ; this recurred at 9 a.m., with great weakness and prostration, then nausea, and cramp in calf ^ in afternoon again diarrhoea. Eyes were I sunken, with blue rings, pulse 60, gullet dry, breathing tightened. At 2 p.m. pain in chest, like sore shooting, extending backwards to between scapuljc ; after dinner immediately rumbling in belly \ in e, taste in mouth like sorrel, feet cold. During day constant dry cough on active exertion, with {in c,) anxiety and tightness, and in r, middle finger a penetrating, burning shooting pain, deep inside, most in last phalanx, like gout ; at n. undisturbed long sleep, quite unusual, with profuse night sweat ; the wet nightshirt on waking feels disagreeably cold to him. On 4th day, after coffee for breakfast rumbling in belly, especially 1. side, then diarrhcea, and later nausea \ at n. much discharge of flatus and rumbling. On 5th d. nothing noted. On 6th firm stool with much mucus and some blood 9 at lu violent burning when urinating, urine passing by drops. On 7th d. after exerting head severe pain there, especially in forehead, with confusion ; at n. cutting pains in hollow molars* On 8th d,, e., severe pains in teeth> and gums are

• The above is described as " out of Ncidhards day-book," This physician! tymptoms, however, as derailed in his schema in the Materia Medica qf Amerusm ^rtfo^iA^^, are more numerous than those here given, and only in tht tickling cough do tlicy coincide with them. Wc have, therefore, reported the others in their own place.

so

painful on various spoU, as If vesicles were there j from qA to Ijtii buming in gum of K lower incisor with pustules, surrounded by bright red areola aiid swelling.

k. On another occasion, took gr. 4* In 4 h. general maLatse, feeling as if hands and feet trembled. Next day, I h* after coffee at breakfast, quite sour eructation, and violent dry cough from tickling in throat, with severe pains in chest, lasting some time; nausea after eating during day, and no action of bowels. On 3rd d« thin cljijc]r| stool in m., and cutting in abdomen later*

r» Another time took repeated doses of a solution. Stool was pappy and tenacious, requiring longer and stronger straining than usual s absent next day ^ and for 3 — ^4 weeks bowels continued irregular^ seldom acting ofiencr than every 3rd d.

d. On another occasion ^ in m* on rising a vesicle in r, nostril^ shooting and burning when touched ; alae nasi swollen, now r., now U most so. This recurred every 2nd or 3rd d. for 2 weeks. On ittti d. nose was very painful, shooting and burning, swollen and shiny red. No stool on 12th and 13th d. [Ibid.)

1. A man proved acid in doses of gr, | — 5 under Dr* Koch's superintendence. No symptoms till 3rd J,, when he had vertigo in oi., with lassitude and thirst ; after rising, toes of r* foot spasmodically drawn downwards, without pain ; this repeated at noon, after sitting for some time ; in e., empty deglutition painful i before going to sleep^ rough voice* On 4th d., heat in face and hands i pale ^e, with sunken eyes ; nausea and want of appetite \ three watery stools | muscles of upper arm pain as if beaten \ in e., pain tn swallowing food. On 5th d.^ complexion yellowish pale, eyes sunken ; inflametl buccal cavity; pulse 105, hard and quick, at noon; all day chilliness, with heat on slight exertion ; in forenoon, after breakfast, three thin clayey diarrhocic stools in \ h. ; three more at noon ; at 8 p,m» another^ firmer, with some pressure towards anus ; in c,, after some wine> violent pulsating headache. Next d. from rising till noon three stools, but firmer, and 'without urging; violent pain on swallowing in m.^ better at noon* On 7th and 8th d. some scraping in throat ; on former pulse 78 and small. [Ibid,)

2. Another man took unknown quantities. On 3rd d, pressure in forehead on rising ; during dinner, nausea, thought he must vomit, but did not ; in e,, pain in hollow tooth. At other times, mucus in mouth and spitting, with clean tongue ; violent shooting in whole abdomen, extending to region of spleen, then impelled to deep breathing, after which it went off; pulse somewhat frequent, m. On 4th d,, heaviness in 1, hand, fingers obey will only heavily and slowly, and draw inwards. On 4th and 5th d. on rising, rough, scrapy throat, can only speak with effort ; in e., sour taste in whole mouth as if drug were still there. {Ib'ul)

3. A woman ; as last. On 3rd d., severe lateral headache, a cutting from r. side of forehead to mastoid process ; anxiety and dread, with vertigo ; trembling of whole body, with exhaustion. Same symptoms next d., so bad that she could scarcely walk ; headache causes closure of eyes ; at 5 a,m. was waked bv cutting in abdomen, which

SI

i recurs periodically all day, with alternate chill and heat ; pulse rather small ; thirst, with nausea, tastelessness of food, and white-coated tongue ; in e., constant yawning, with flow of water into mouth and flat taste there, followed by violent rigor with small contracted pulse, red face, feeling of heat in head without actual warmth there, and icycold hands as if dead. Next m*,8ame cutting in abdomen, with nausea, {Ibid).

1. Dr. S, R* Dubs, aet. 33, sanguine temperament ; disposed to stomach and bowel disorder, took February 16th, 1845, 3 gr. Ix trit. at 10 p.m. At II sharp shooting pain in r. shouJder-joint, coming on suddenly, and lasting about 15 m. Slept very little through n., and when he did had constant dreams with starting, and then waking up with , fright. The dreams w^rt of an unpleasant character. Sharp pains m forehead and vertex, with feeling of lightness. Pain was more acute over 1. eye and in 1. temple. Several times raised himself up in bed m alarm, and looked around room; but on recollecting where he was, lay down again, to repeat same action in an h. or so after, 17th, 7 a.m., dull pain and muddled feeling in forehead. Hawking up of thick, yellowish-white phlegm with a black lump in the centre the size of a pea, 830 a.m. Took same dose. Dull pain, with occasional sharp pains in forehead. Great increase of animation through the day with playfulness and mirth fulness, which had not of late years been natural to him Soreness of fauces on swallowing for about 2 h. this morning, after which it gradually passed off. Dull aching pains of molar teeth of r. and 1. upper jaw j worse in r. Lasted nearly all day, but passed away towards e* Bowels opened at 9 a.m. and again at 4 p.m. Slight colic pain in and around the umbilicus, just before afternoon evacuation. Natural in every other respect. Tongue dry, sore, and excoriated, worse towards tip ; continued so all d. and e. No thirst and rather a repugnance to water. 1 8th, 8 a.m., took same dose. Observed no particular symptoms in course of m. 4.30 p.m. Took 5 gr. Ix trit. In 15 m, felt dull pain in first molar tooth off, upper jaw, which is very distressing. Had now flushes of heat and perspiration all over the body, which he also had in m. and yesterday, but omitted to note it down. 5 p.m. Pain like a cramp, a little to 1. of umbilicus, and several m. after colic-like pain in the r, iliac region. Belching up of tasteless wind several times. Great disposition for play and mischief. Increase of pain in the r. molar tooth. 5 to 9 p.m. Disposition to pass water every two hours and in large quantities. Uneasiness in limbs and feet, which he can keep quiet for only a few m, at a time* 9 p.m. Distressed feeling around navel and through whole abdomen, with feeling of great debility therein. 10 pm. Dnll aching pains in abdomen, worse around umbilicus , occasionally aching pains in whole abdomen like colic, 11.30 Sharp and constant pain in 1. iliac region. Great increase of sexual desire thiough n. and In m., with voluptuous dreams. This has been the effect the past three nights and mornings, the 16th, 17th, and 1 8th February. 19th, 8 a.m., took 5 gr. Had flushes of heat and perspirations through the morning, with sharp pains iji forehead and vertex, which annoyed him very little as his spirits were so much elated. 4 p,m. Took 5 gr, more. 10. Distressed feeling and

great weakness in whole abdomen with flatulent colic. Aching pain in r. ankle-joint, with feeling of swcHii^ of this part and of whcue r. foot. Sexual excitement still. 20th. — Great flatulency the whole day with expulsion downwards of much wind. Swelling of abdomen, with dull colic-like pains occasionally in and around umbilicus, though worse in r. iliac region. Itching at anus with crawling sensation as if from worms, which was relieved by rubbing parts for several m. It, however, returned several times through n. 9 p.m. Sharp, shooting pain in 1. lung and heart, extending down to epigastrium, lasting for some seconds. Sharp, shooting pain, like neuralgia, on instep of r. foot, lasting for A h. at intervals. Inclination to pass water every h., and in large quantities each time. Slight burning in passing the urine. It is clear and of a straw colour. 21st, afternoon, stitches several times in I. lung. Eructation of wind (tasteless) after each meal. 8 p.m. Sharp pain in r. instep lasting 5 m. Profuse flow of lightcoloured urine frequently through e. Pain, colic-like, around umbilicus and in r. iliac region. It came and went oflF frequently. Weakness in loins and hips extending down to lower extremities. Continual dull pain in forehead and vertex. At n. and in m. excessive sexual desire, more so than he had experienced for some months previously. 22nd. — No symptoms sufficiently characteristic to note, 23rd. — Belching up of tasteless wind after each meal. Colic-like pains in and around the navel. E., belching up of wind tasting of food eaten. Sharp pain in r. ankle-joint. Sharp, lancinating pain in 1. lung coming on so suddenly that it took his breath for several seconds, and then gradually subsided. 24th, 5.30 a.m., felt perfectly well as he lay awake m bed. At 6 was suddenly seized with distressing feeling in whole abdomen, followed in several m. by twisting (tormina) in and around the umbilicus. After this had continued a few m., was compelled to resort to the close stool. The faeces were hard, of a dark brown colour, and small in quantity. Again retired to bed ; but at 6.15 pain and bearing down came on so violently that it caused him to use the chamber. The evacuation now was loose, though consistent, and of a muddy brown colour, accompanied by colic pains in navel and below this part, bearing-down and griping pains in anus. The latter were so severe as to produce severe nervous pains through whole head with heat in this organ. Retired to bed ; but in about 5 m. was compelled to get up again. Severe colic pains in navel preceded. When on the chamber, bearing down towards anus, with tormina and severe griping pains. Now copious evacuation of consistent, dark muddy-brown fieces. Went again to bed ; but so soon as he had resumed the horizontal posture peculiar pain in navel again came on. Had some tormina nearly all day. Much better whilst up, and still better when moving about in the open air. The inclination to go to stool would invariably come on whilst sitting or reclining for a few m. Two doses of mere, solub. 2 were taken in course of day ; otherwise he would have been unable to attend to his daily professional duties. In e. he was perfectly well. {Materia Medico of American Provings.)*

• We are indebted to Dr, Neidbard for the original of this proving.— Eds.

S3

10, Dr. Floto took one dose of Ix, ant! experienced rollowiog ^mipiomn t — Soon after taking it pain on vertex; emptiness in head, sensation ot taintnt*ss, as if all blood bad left bratn, with anxiety. On walking in open air, had watery mnning from nose, with sneezing; tickling in larynx, with scn&ation of sticking, several coughs are induced, larynx feels swelled ; stitches in L breast $ difficult breaching, with constrictive pain in larynx and wheezing, opprewion of chest towards r. side. Had also drawing pain with rigidity near angle of lower jaw, first in 1. then in r. >iide, l^ut longer in 1, Being awakened by noi&e In n., could not go to sleep again for i h. (Bid)

11, Dr, Kitchen took one dose each of Ix and ix, Nervous and vascular excitement, as from alcohol, constituting a feeling of hilarity ; pulse one third more frequent than usual, and tenne. After lying down in bed twitchings in L deltoid miisclC| and in a few in. one in r. Tensive pain in fleshy part of L thumbs with numbness and sensation of swelling, lasting about J h. (jo m.). A feeling as after a debauch the previous night ; dull headache, with a gnawing, tensive pain, and soreness in eyes and superciliary regions^ lassitude, disinclination to occupation, readings &Cv^ and inclination to stretch, with occasional yawning. Relief by walking in the cool open air (i d, atter ix). {Ihid,}

1. Dr« Neidhard took Ix and ix trits. Seems in its prlinary action to diminish the power of concentrating his ideas and afterwards to increase it. Greater presence of mind i the relations ot the world seem to be clearer to him, He feels more composed than usual, and very much exhilarated. Great cheerfulne^s of mind, quicker in thought and action. Whole forenoon unusual vivacity and power of concentration, which is still more decided in afternoon. Giddiness the whole d. Fulness in forehead above eyes. Pain in 1. temple^ extending as tar as Lower jaw (li h,). Jerking in I, temple. Augments in ist h, secretion of mucus from throat. Shght sickness of stomach. Qualmii»hiicss ot stomachy with sickness (6 h,), with sensation of grasping in stomachy very transient (in a few seconds). Slight gnawing burning in stomach, and eructations (ij b*). Pressure in stomach (in a few minute?). Wakes up at night with most violent pressive pain, like a heavy weight in pit of stomach ; it comes and goes at intervals of 15 m.» but diminishes in force at cacn renewal. It lasts altogether about z b. Discharge of flatulency relieves pain (from 5 drops of oxalic ether taken in m.). In c. after tea pyrosis, with much emission of flatulency and pressing downwards. Every e. pyrosis. Loss of appetite. Unu-iual thirst at 3 a.m. (a d.). Dull aching pain in r. side of abdomen, whole afternoon, on a small spot. Pain round navel like colic, repeatedly, but always alter symptoms in head. Sensation of soreness in abdomen. For \ h. after retiring continued pain in L hypochondrium. Pain between hypochondrium and navel, on I. side, like a development of flatulency (i h.). On sitting do%vn after a walk> violent effort to discharge tl at ulenc)' (as from small spot on 1. iliac region), with sensation as if part would burst. Pain in region of navel, with painful pressing down towards anus, and flatulency. Pain in region of navel, with emission of flatulency in n. Whole e. rumbling in bowels with pressing downwards. Twice passage of

^ bowels during day. In e. slight pain in region of^. kidney. Urging to pass water, (rith copious discharge j water is of a lighter colour than usual. Excitement ot

^sexual function, repeatedly. Sensation of contusion in both testicles. During walking in e. pretty severe pain and heaviness in both testicles, shooting along spermatic cords J worse on r. side. Jerking in testicles and spermatic cord. Slight cough, from tickling in larynx and trachea; also sensation of soreness in larynx. Immediately after lymg down in bed at n,, palpitation of heart for J h. 3 n. consecutively. Sensation of numbness in sacrum. Slight lameness and stiffness in lower

Pcxtremities. Itching on neck. On a spot on r. index finger, where a cut from a penknife had healed 4 d. ago, a very painful pustule appears (2nd). Continual and vivid dreams, always of a frightful nature; wakes up often and dreams constantly. Sleep very restless, but without dreams {^nd d.). After dinner, sleepiness, and profound sleep while in the sitting position. He is more inclined to sleep at n. than usual. Creeping of cold, particularly from lower parr of spine upwards. In e.^ after tea, sneezing, with chilliness. General sensation of heat. Pulse increased in frequency, 100 to 108. General excitement in e. Symptoms seem to be excited and aggravated by movement, as pains in bowels, testicles, kidney, back, SiC, Oxalic acid has a decided action on joints: ankle, knees, hip, wrist, shoulders*

5*

Evtrcmff Isnieude of bod^. 8| uiptamii of tnoMt aciil oee^demRf hi&mk Bir t

h. or 31 d.i aoil then irtum in a dtrntnished degree. Sotne, who irc genenlty micli affected by rold vvcather, appear hertrr able to bear it. (/^i^)

t^ Mr. E. Smith tr>nk one doK ot la. Dull headache on tMtex, Briifigw i m forehead and vertex (in m. after taking acid in e.>, Erurtaticms and praage o^ J flatulency da^rnwardi. Flatulent colic, like i% if He had eaten iini <M1

waking up at o„ below navel, which h increased by movement aitci j^ |

|)ain mnrtini^he^ during reit and return* periodically (n, after taking it^. ^ in iii«, after breakfktff on walking abittii^ Hime pain returns y get& better about f, ami di*« appcan entirely :tt is. Scnuition of M>fcnei» on touching, alt fr^und oaveL {JktJ.)

1. Dr WiLUAUsOtt took latiif in e. Unii<^ual power of coocyiHflttOP of mind. Hilarity and chcerfulne**. Pain along have ot occipit^ bon«. rcttifnifig wveral timc% during firt a d. Pain in both orbit, but wor^c in L A itickl&g pain m I, bypochondriuin (j HX Pain in dcMTiiding colon, foUowed by ffee rvarntion of tnuthy %tool in e. (1 h.). Similar pain returned the tecond e* discharge of urine at 5 a.m* after taking it. Sticking pain tii f. hip.joict* i »orenest around neck| u if chafed by coUar* {itfid*)

2. a. Dr Sharp* at 75 pm., pubc 72, took gr» -,V» in 10 ni of water At 7.10 pulse was 76 soon fell to 70. Soon after 8, giddiness and a little nausea ^ a loose motion » with a litde griping. At J 0.30 pulse w^$ 60.

h. At 11.50 a.m*, pulse 82* took gr* -^ in too ni of water* Pulse in 5 m. rose to 86, then fell to 80* After going to bed that n. heart made its beatings sensible in an unusual manner, and attracted attention* Next d. btiwels moved 3 times^ relaxed^ which is also unusual.

f . Took two doses of gr* j^^^. After first pulse fell from 72 to 68 § but second reduced it no farther, (Essays on Mediciniy p, 787*)

II, Poisonings, — I. J. Phillips, act. 57^ muscular and robust, at 8 a.m. swallowed by mistake ."^ss of acid in teacupful of water. Vomited after drinking warm water, but not subsequently, in spite of emetica, &c. When seen at 9 complained of excruciating agony in lower part of back, extending down thighs j body extremely cold and clammy with sweat ; skin of arms, chest, and face mottled i pulse very feeble and contracted ^ no pain in throat or abdomen, even when latter (which was distended) was pressed upon ; muscular prostration very great i complained of weight and powerlessness of limbs ; restlessness extreme^ requiring frequent change of posture ; respirations natural ; perfect consciousness and unaltered expression. During forenoon, constant involuntary discharge of fluid matter from intestines. At 3 p.m., patti in back and thighs continuing unabated, he had also some little pain m abdomen, slightly increased on pressure ; had recently vomited a pint of thick black fluid i pulse still more feeble. At 7 p,m,, pain in abdomen increased to utmost ; could not bear slightest pressure ; had had several copious alvine evacuations, consisting of a thick black offensive fluid, in which were seen a number of bloody shreds i pulse imperceptible ; respiration oppressed ; countenance exhibited great anxiety ; was sensible, and complained of having lost his sight: in this state he continued till 9 pm,, when he died. RAl, 10 h. after death Upper part of body much discoloured ; abdomen tumid. On opening

Jeritoneum, great distension and discoloration of small intestine^ lucous membrane of pharynx and oesophagus as if scalded ; villous coat of stomach pulpy, in some places of black colour, in others highly

S$

injected* Mucous lining and peritoneal coat of small intestines much

inflamed. Pelves of kidneys considerably more vascular than ordinarily^ and this extended a little way through ureter. Mucous membrane of larynx and trachea, and lungs themselves^ intensely inflamed* [Hebb, L/>nd. Med, Ripository, N,S., ii, 475.)

1. Dr. Arrowsmith, of Coventry, observed a case which lived 13 h. after an unknown quantity of the acid. He complained more of pain shooting down from loins to limbs than of pain in belly ; and had an eruption of mottled appearance on the skin in circular patches of a deep tint of redness. (Christison, op, at*)

2. Feb* ist^ 1825, at 7 p.m., Charlotte Walker, T2, drank a wineglassful of a solution of oxalic acid (strength gj to 3j water = 5ij of oxalic acid). Immediately acrid burning in mouth, gullet, and stomach. Complained when seen (very soon) of pain in stomach and belly ; appeared greatly alarmed j pulse quick, not strong. Got ipecacuanha wine and tartar emetic, without result. Irritation of fauces with finger caused vomiting. This relieved the pain. She got carbonate of lime as an antidote. Put to bed she fell asleep for z h. On awaking complained of lassitude and feebleness, particularly of lower extremities. Next morning, numbness and weakness of back and lower extremities, making it difficult to go upstairs. This gradually went off and she quite recovered, (Scott, Edin. Med, and Surg^ Journ.y xxiv, 67.)

3. A man swallowed at 7.50 a,m. 3ss of ox. ac. in solution by mistake for Cheltenham salts. Great irritation of fauces and stomach succeeded. Drinking water, and taking 4 gr, of tartar emetic, caused vomiting, but no alleviation ; diluted ammonia aggravated, but magnesia greatly relieved, burning distress. Pain, spasms, and vomitings (with blood), occurred from time to time; respiration was impeded; general numbness complained ofj clammy moisture bedewed whole frame ; pulse scarcely perceptible i extremities cold, nails livid ; general agitation and loss of strength. By noon, reaction had taken place, and became pyrexial j pulse 96 and firm. Diaphoresis followed, with pulse at 120 and small ; in e. 100. Tingling felt at tips of fingers. Early in m. retching, spasms and hiccup set in, — last continuing several d., also numbness in 1. arm. On 3rd d. face swollen, voice hoarse, general anxiety. Till 7th d* seemed improving much i hiccup then increased and emaciation set in j tongue patchy ; complained of acidity ; inclined to doze, and occasionally had hallucinations. C>n nth d. an eruption, papular and itchy, appeared all over body, which it reddened. Debility and emaciation increased i nothing but the blandest articles could be taken i and he died on 13th d. P.M. — Found complete destruction of villous coat of stomach, (Fraser, Ih'td.^ xiv, 606.}

4. A midd]e*aged shoemaker, a hard drinker, took J oz. of acid in crystals. Prepared chalk was given freely. Symptoms were : severe burning sensation in mouth and throat with great thirst and difficulty of swallowing; excruciating pain in epigastrium and cold, clammy perspiration ; numbness and tingling in extremities, legs drawn up towards abdomen ; pulse but just perceptible ; breathing slightly spasmodic ^ catures anxious and pallid. 8 p.m. (9 h, after first visit). Hot feeling

in throat and tingling of extremities continued. A new tymptom presented itself, viz. alteration of voice. The man, previous to taking the poison, possessed a remarkably deep bass voice ; it was now reduced to a very low key, giving one the idea of a person talking in an undertone. This symptom remained for more than a month without any amelioration, during the greater part of which period his legs used for several hours a day ^^ to go to sleep," as he termed it. Nine weeks from time of taking acid his voice, though stronger, was still '^a complete old man's voice."* (Bradley, Med. Times^ xxii, 293.)

1. A woman took 3iij in about ^iij of water ; the greater part was evacuated within 15 m. by means of stomach-pump. Subsequently there were convulsions, spastic contractions of muscles of jaws and extremities, forcible closure of mouth and drawing down of its angles; dilated alfff nasi, corrugated eyebrows, twitching of facial muscles and insensibility. Great cerebral excitement afterwards occurred, accompanied bv dry coldness of surface and imperceptible pulse ; symptoms less marked during intermission of tetanic spasms ; spasmodic symptoms declined in 3 h. from taking poison. (Bourne, Lancet, 1851, i, 320.)

2. A man took 477 grains dissolved in 5 oz. oi water. Besides usual symptoms, face was tumid and ot livid complexion, urine su|h pressed entirely, no stool (even after enema). Vomits grass-green fluid. 4th d. — Pulse 132, full and hard ; tongue has thin brown coat and red dry tip ; very thirsty ; no pain, but still distressed and anxious s vomiting diminished. 5th d. — Pulse 122, full, hard, and intermittent ; tongue covered with brown coat, red at tip and dry ; is very thirsty; passed urine twice in night. 6th d. — Pulse lOO, full, not hard ; vomits less ; is delirious at times ; tongue covered with bright yellow coat ; passes urine ; skin of face, head, chest and nates covered with red spots or petechia?, appearing as if bespattered with blood. 7th d. — Pulse 104, hard; tongue covered with brown coat, tip red and dry; no pain, but still distressed; vomits less frequently; feels sinking sensation at stomach. loth d. — Evidently smking ; race hip* pocratic ; pulse almost insensible to touch, very weak ; delirium and stupor ; bladder distended with urine, but cannot pass it ; does not vomit, although he has a desire to do so ; petechise still visible. Died quietly at 9 p.m. (Jackson, Boston Med. and Surg. Joum.^ xxx, 17.)

3. A robust man^ set. 40, took a quarter of a teaspoonful of ^salts of lemon " (binoxalate of potash). Two h. afterwards was attacked by vomiting, and about the same time by severe pain in loins and feeling of great weakness in lower extremities. Six d. afterwards, when first seen by the writer, complained of lumbar pain, swimming in the head, sensation of coldness succeeded by burning heat in chest and stomach, and great muscular weakness. Micturition was accompanied by sensation of scalding. Tongue abnormally red and irritable looking. Three days later says he has suffered from spasmodic contraction of hands, cramps in legs, and heaviness and pain in head. Tongue and

• " In a case related by Mr. Edwards to the Westminster Med. Society, the patient, a female, lost her voice for eight days; but whether this depended oq the action ot the oxalic acid she had taken^ or not, it is difficult to say.** (TAYLOa, Poisons y p. 149.)

fauces still red and irritated, (Webb, Med^ Times and Gaz^^ ^859, ii,

379-)

III, Experiments on animals, — i, a. When injected m a state of concentration into the stomach of a dog or a cat, ox. a. causes exquisite pain, expressed in cries and struggh^ngs. In a few m. this is succeeded by violent efForts to vomits then by sudden dulness, languor, and great debility, and death soon takes place without a struggle, After death stomach is found to contain black, extravasated blood, exactly like blood acted on by the acid out of the body ; inner coat of stomach is of a cherry-red colour, with streaks of black, granular, warty extravasation, and in some places surface of colt is very brittle and subjacent stratum gelatinized, evidently by chemical action of poison. If stomach IS examined immediately after death little corrosion will be found com pared with what is seen If inspection be delayed a day or two.

k When considerably diluted phenomena are totally difFerent. When dissolved in 20 parts of water, ox, acid, like the mineral acids in the same circumstances, ceases to corrode, nay it hardly even irritates ; but, unlike them, it continues a deadly poison, for it causes death by acting on the brain, spine, and heart. The symptoms then induced vary with the dose. When the quantity is large the most prominent symptoms are those of palsy of the heart, and immediately after death that organ is found to have lost its contractility, and to contain arterial blood in its 1. cavities. When dose is less animal perishes after several fits of violent tetanus^ which aftects respiratory muscles of chest in parti* cular, causing spasmodic fixing of muscles of chest and consequent suffocation. When dose is still less spasms are slight or altogether wanting^ and death occurs under symptoms 01 pure narcotism like those caused by opium : animal appears to sleep away. (Christison, op, cIl)

1. The first unequivocal sign of its action is generally a slight permanent stiffness of the hind legs, and increased frequency of the pulse ; about the same time there appears a slightly sudden check in inspiration from the respiratory muscles contracting before the chest is fully expanded. Gradually several of them come together, so as to constitute paroxysms of short hurried breathing with intervals of ease. Meanwhile the stiffness of the hind legs increases , they become likewise insensible, and often spasm gives place to paralysis ; the animal jerks the head occasionally backwards, walks with a peculiar stiff gait, and assumes very odd postures from inability to regulate the motions of the limbs. As the poisoning advances, the motions of the chest, during the paroxysms, become more and more confined by spasms of the muscles, and at last there is a period towards the close of each paroxysm when the spasm is so great as completely to suspend the respiration. This is commonly accompanied with more or less extension of the head, tail, and extremities, sometimes amounting to violent opisthotonos. The insensibility, hitherto limited to the hind legs, now extends to the trunk and fore legs, and lastly to the head. As the insensibility increases the breathing diminishes in frequency, the spasmodic paroxysms become more obscure and then cease altogether* For some time, however, they may be slightly renewed by striking the back and limbs , but at last the animal falls into a state of deep, pure

coma, with complete relaxation of the whole body. The heart can now be scarcely felt ; the breathing is low, regular, and short, and becomes gradually more obscure till, finally, life is extinguished widiotit a struggle. If the dose be larger fits of spasm come on early and with great violence, the intervals are marked by remissions onlv, and the animal expires in a paroxysm before the stage of insensibility begins. Death may be produced in this manner in 3, 5, or 10 m. If, on the other hand, the dose be much diminished, there may be stiffnesi ot the hind legs, much dulness, drooping of the whole body, and a sort or somnolency without insensibility, or even without spasmodic paroxysms, and then the animal will cwnmonly recover. (Christison and CoiNDET, Edin. Med, and Surg. Journ,^ xix, 182.)

1. According to the experiments of Cyon, in which ox. acid and the oxalate of sodium were injected subcutaneously or into the cavity of the abdomen, ox. acid and its salts are cardiac poisons. Soon aftei the injection the pulse becomes very weak and frequent, then follow quickly dyspnoea, convulsions, death ; the heart, at once laid bare, is stopped and full of blood. (Burnett, Brit. Journ. of Hom,^ xxxv,

3H.)

1. When an animal is examined immediately after death no appearance of note is found in the brain, peritoneal sac, or intestines. Unless death has been very rapid, the lungs are almost alwajrs studded on their surface with bright scarlet spots, and sometimes we have seen even the whole parenchyma of a uniform and beautiful scarlet colour. At the same time there never was any effusion either into the air-ceJb or their cellular tissue. In cases of poisoning that prove fatal before the stage of insensibility comes on, the heart, 2 or 3 m. after death, is found neither contracting nor contractile ; its pulmonary cavities are distended, and the blood is dark in those cavities and florid in the aortal. This fact is conformable with what we have observed in the same animals just at the time of death, viz. the contractions of the heart are almost imperceptible even before the breathing ceases, and never continue after it. In the slowest cases, in which coma prevails for some time before death, the heart, though very feeble in its contractions towards the close, beats a little after the breathing has ceased, and then the blood is found equally dark in both vascular systems. There is likewise an intermediate variety of poisoning, wherein the stage of insensibility is short, and the heart scarcely survives the stoppage of respiration ; and in such cases the blood in the aortal cavities is darker than natural, but still considerably more florid than that of the veins and pulmonary cavities. (Christison and Coindet, p. 184.)

Volume IV — Appendix

:^ ACIDUM OXALICUM.

-^ (See vol. i, p. 45.)

^'' 11. 9. B. K., aet. 19, took sixpenny-worth of oxalic acid

^ - •000 after a lundi of br«u], cheese, beer and coffee. In 5 m.

^r '*Ccbing and copious vomiting, burning pains in throat and abdo-

i?t ^^\ The stomach was washed out several times ; the vomit and

^\ ^^ '^S' were bloody. Half an h. later, grave collapse ; pulse 48,

jcP ^'^ irregular ; respiration 10—12, superficial ; skin covered with cold,

^~ rr^*»»y sweat j face livid and features sunken ; pupils dilated. Patient

^- ^^^ ^'^ ^^ when loudly spoken to and then falls back into his

■^ ftftK ^^ ***** ' *^"'' desire to vomit, but brings up mucus only—

■. a jL ^**>'* Hypodermics of camphor, hot coffi:e, brandy. At 8 p.m.,

'. ^^' ■'■SBfc.ter, complains of great thirst, burning and stitching in abdomen,

**■. '^lien collapse returned in a most threatening manner, with cya-

rr|" J» dyspnoea ; livid fingers and toes, and sensation altered in toes

r^V ''^X'* of fingers. Stimulants relieved again, and pulse regained some

l^"**^^ ; great restlessness with tonic and clonic spasms in upper and

i^^i^ extremities. Patellar reflexes increased on both sides, a slight

j^ causing long-continued crampy motions. Achilles tendon reflex

***** F^^riosteal reflex increased j when merely touching the 1. external

'"^J^'^^lus, tendon of 1. tibialis anticus becomes prominent. Triceps

' **"^^*^ reflex and periosteal reflex of epiphyses of humerus also increased

" .y^^th sides. Sensorium dull ; patient reacts only on loud calls ;

P**P"^ still dilated. At 9 p.m. spasms diminish in strength and fre-

L quen^^ . jgngorium more clear, realises that he is in the hospital ;

^ severe^ pains in throat when talking or swallowing ; pulse better j

I pa&ie«^f sleeps naturally, only interrupted by weak clonic spasms in

« Vpp6%- and lower extremities. 10 p.m., abdomen soft ; desires to urinate,

'l^ ^* Raises only 100 c.cm. of yellow, somewhat murky acid urine.

5 ^•**'^>rium clear and replies freely, though with a hoarse voice and

^ CiOO^ exertion. 11.30, examination shows complete anaesthesia of tips

s^ o( uOgers and toes, of palmar surface of hands and plantar surface of

^fep fieet> Incomplete sensibility of leg. Sensation in thighs and other

k fttta of body normal, pulse 80 ; temp. 38*2° C. Pains in 1. lumbar

« fCf^on and both legs : feet and hands feel as if asleep ; great thirst,

^ VutQing in mouth; sleeps but little during night. 2nd d. — Passes

: % ((ODtaneously 150 ccm. of acid urine, slightly bloody, leaving a thick

sediment; sp. gr. 1016; rich in albumen; epithelia and epithe| cylinders ; red and white blood corpuscles ; colouring matter of bio no sugar ; small quantities of oxalic acid crystals, amorphous, ofenV lope and so-called dumb-bell form. After standing 36 h., roicroico shows copious, whitish, shining crystals of oxalic acid and of oxalate ( lime in many forms — insoluble in acetic, soluble in sulphuric acid. Ii] e. pains in renal and vesical region, a crawlmg sensation over wholel body, especially in both lower extremities. Several times during d.' painful spasms in muscles of 1. calf; no appetite ; tendency to vomit-,] profuse perspiration on hands and feet ; discharges 300 ccm. ofdaili, jumentous urine ; tongue heavily coated ; pulse S4, temp. 38.6' C 3rd. d. — Urine 400 ccm., much albumen, many cylinders ; sensory disturbances continue ; no spasms; dulness in head, patient feels as if he had been drunk. Urine 600 ccm., no crystals ; temp, normal ; fret and hands dry. 4th d. — Urine 900 ccm. ; less albumen and fewer cylinders ; general improvement ; sensory and reflex phenomena disappear ; flight gastric disturbances still, but well enough to be discharged. (The lunch taken before the suicidal attempt andthe prompt washing out of stomach probably saved the patient's life.) (KoHler, transl. in Ham, Phjt., Sept., 1889.)