Phosphorus

Volume III — Main text

PHOSPHORUS.

Comtnon trarupsrcnc phosphorus,

1. Proving!, — I, Hahnemann, Chronic Diseases^ part v of original, vol. of translation. Contains 1915 symptoms, 1169 from 5clf, 662 from 9 fellow-observers, and 84 from authors.

2. Alphonse Le Roi took from 2 to 3 gr. Ph. in treacle. Was tormented by very disagreeable afTcctions for some h., felt heat and gnawing pains in stomach, which seemed to him to be distended with air, and he had frequent ineffectual efforts to vomit. Relieved by sipping cold water. Urine deep red colour. Next d. had great increase of sexual power and scarcely resistible desire for coitus, [Mem. dt la Soc. med, d'cmulation de Parts^ '797» ^' '» P- '7^-)

3. C. E. Weigel took I gr. of Ph. dissolved in oil. After ^ h. pulse increased in rapidity by 12 beats, on repeating the dose by 20 beats per minute. Increased heat of whole body with feeling of internal itching and great congestion of blood to head. {Diss, inaug^^ '797* P-

H-)

1. Franz Bouttatz dissolved 4 gr. Ph. in 3iv naphtha vitrioli, and

took of this 20 dr. every 2 h. The ist dose caused slight nausea, relieved by drinking water. The 2nd dose caused ravenous appetite, pulse became more lively, heat of whole body increased, felt a peculiar comfort and lightness of whole body. After i^ h. ate with the greatest appetite \ 2 h. after eating continued the med. ; he took in all 5 doses. Nothing disagreeable ensued, he felt extremely well towards c. Passed much Hatus, felt increased muscular power and unusual excitement of the genital parts. The quantity of urine passed was increased. (Quoted by Sorge, Der Phosphor^ 1 15,)

1. SuNDELiN took, 2 h. after break^st, i gr. Ph. in oil. Soon great heat in stomach, and later in whole abdomen. After i h. painful vomiting and diarrhoea with febrile symptoms. For several d. stomach remained very tender, could only bear light food. (Bibra and v. Geist, Krank. d. Arb. in d, Phosphor. Ziindh.^ 225.)

2. Dr. A, L — , apt. 40, phlegmatic temperament, well, with the exception of a slight catarrh, took, October lOth, 7 a.m., 4 dr. of 3rd dil. After ^ h., when washing, heaviness of r. arm, it cannot be easily raised, as if stiff" in shoulder-joint, lasting ^ h. Frequent rumbling in bowels. — r2th, 8.30 a.m., 6 dr. After J h., when washing, slight pressive pain in muscles of ulnar side of r. forearm, followed by heaviness of whole arm, more persistent than yesterday. Stiffness of shoulder located in deltoid muscle. Drawing in r. hand. In e. burning pricking in Hnger-tips of r. hand, several times repeated. At n. unusual and vivid dreams. — 13th, 7.45 a.m., 8 dr. Recurrence of stiffness in r. shoulder, a kind of tension extending up to occiput. — 15th, 6.45 a.m., 10 dr. After 5 m. a shoot upwards in r. half of brain towards r. parietal protuberance followed by pressure and heaviness of r. arm.— 1 8th, 6,45 a.m., 10 dr. While washing, a slight burning pressive sensation in r. shoulder-joint when raising arm. In deltoid muscle, as also in upper dorsal muscles, up to nape, a tensive-pressive sensation.

Heaviness of r. arm, sensation when it hangs down as if it were drawn downwards. During a somewhat unsatisfactory thin stool burning in anus i after 2 h. flat taste and frequent eructation with taste of food. — 19th and 20th,nomed. On two successive n. emission with confused dreams. — 2ist. 12 dr. ; when washing, and for some time afterwards, the same sensation in shoulder and nape and heaviness of arm. In occiput heaviness and pressive pain. Frequent eructation, taste of food even some h. after eating. Next n. uncommonly vivid and persistent dreams. — 22nd, no med. Tension in all dorsal muscles. 6 p.m., after discharge of fetid flatus, cutting in abdomen and a thin brownish stool. Frequent eructation with taste of food during d. — 24th, 7 a.m., 10 dr. After 10 m. in 2nd phalanx of r. middle finger a slight burning going to and fro in bone. A pressive sensation along extensor digiti medii up to middle of forearm. Later the same in and and 4th Angers. During and after washing, the usual heaviness in r. arm, tension and pressure in shoulder and nape muscles of r. side. Noon, recurrence of slight gnawing pain in 2nd phalanx of r, middle finger. — 25th, no med. Soon after rising in m. usual heaviness in r. arm felt when writing. P.m., spirits depressed, disinclination for work. In e. suddenly violent sneezing with heaviness of limbs and confusion of head, — 30th, 7 a.m., 10 dr. Soon pressure in stomach and rumbling in bowels. When brushing teeth, the tensive stiffness and heaviness of r. shoulder so »evere he had to Jet the arm fall several times. — 3151,6.30 a.m., 10 dr. No symptoms. — Nov. 1st, no med. Catarrhal symptoms without having had a chill. — 2nd, no med. Last n., as generally during the proving, uncommonly vivid dreams, remembered in m., which was unusual. When washing the stiffness and pressure in shoulder and heaviness of arm, also felt when writing. P.m., occasionally transient pressive pain in side of occiput as if in bone. — 3rd, no med. Same sensation in I. side of occiput, frequently recurring. 9 a.m., on outer side of r. leg, about the middle of m. tibialis amicus, in crossing legs four stabs as with a Icnife. The same pains repeatedly during d. at varying intervals, but more of the character of burning shooting. They were chiefly felt when sitting and when crossing legs, and when standing, not when moving. In addition, transient, sometimes shooting, sometimes pressive sensation in various joints and other parts of body. — ^^.th, 7 a.m., 4 dr. After i h. painful stiffness in hands, particularly r. middle finger. When brushing teeth and combing hair or raising arm, the sensation in shoulder, the stiffness, tension and pressure were worse than ever^ so that he must let his arm fall several times ; these feelings lasted all the m. Transient pressive and boring pains as if in bone in 1. thigh and leg. When sitting unusual numb feeling in feet, especially when covering them. — 5th, no med. When washing, brushing teeth and combing hair the usual heaviness of r. arm, stiffness and pressure in r. shoulder were much felt. The burning shooting pain in r. m. tib. ant. recurs frequently in course of a.m. No more med. taken. — 6th. The above-described pain in m. ant. tib, several times, which once extended to m. cxt. comm. The sensation in r. shoulder, back and forearm was very marked on 7th and lasted to some extent for four weeks. The consequence of the proving was a diminution of che

sexual desire and too speedy ejaculation during coitus. This lasted at least four months. (Sorge, c^. riV., 123.)

1. a. Dr. B — , act. 54, began from Jan. r6th to 25th with the 2Sth dil., which he took for 5 d. without much effect. He onlv felt slight urging in isthmus or neck of bladder, which was relieved by passing urine. A similar symptom occurred when taking the 12th dil. On Jan. 22nd to 29th he took every morning at 5 a.m. 5 dr. 2nd dil, without any effect, — Feb. 7th, 5 a.m., 6 dr. During d. had several times sudden urging to pass urine. Some prostatic fluid and urethral mucus came away. — 8th. 9 dr., several times urging to pass urine, which smells of violets. — Till 14th every day a dose, rising to 15 dr. No symptoms referable to the med. — 21st to 23rd, recommenced taking the Ph. — a4th. Pulsation in 1, hollow upper canine tooth when the cold air comes to it, frequently repeated (he has never had toothache). After continuing to take the same dil. up to 15 dr. the only noteworthy symptom he experienced was on March a4th, — the last r. upper molar somewhat loose, sensitive, and sunk down.

b, April 7th, began to take 12th dil,, which he continued with interruptions till May 24th. The only noteworthy symptom occurred repeatedly soon after ingestion ; it was burning in tongue, which on the 24th May lasted all d., and in e. spread all over palate.

c, May 27th, 5 a.m. 3 dr. of " alcohol phosphoratus.*' Soon burning in palate, Jess on tongue, in forenoon. — 28th and 29th. 4 and 6 dr., slight burning. — From 29th to June 5th took daily from 3 to 10 dr., which only caused slight burning on tongue and palate.

d, Oct. 9th, 5 dr. loih, 6th dr, nth, 7 dr. 3rd dil. On last d. p.m. occasional dull stitches in I. side of chest, relieved by deep inspiration.— 12th. 8 dr., soon transient burning on tip of tongue, later vertigo on quickly turning and raising head. — 13th. 3 dr., slight burning in tongue. On going upstairs bruised feeling in legs. — iBth, 3 dr., no effect. — 29th. 6 dr., burning in throat.

e, Nov. 3rd, m., 3 dr. ale. pt. Transient burning in tongue. — 4th,

5 a.m., 6 dr. Burning in tongue all a.m. In p.m. this extended to larynx, causing repeated cough ; it extended upwards to choana, causing there ^Ise smell, urine of violet odour. £,, 3 dr., and also 5th, m. ; slight burning. — 5th, 9.30 p.m., burning in tongue till 11 p.m., and burning smarting sensation in palate, with dryness of throat j urine of violet odour, — 6th. 4 dr., burning in tongue and in .throat, great relaxation of genitals, weak erections, transient oppression of chest, and dull pain in 1. thorax like rheumatism. — lOth, 5 a.m., some dr. Burning in tongue extending to palate. P.m., dry feeling on tongue and thirst ; increased urging to urinate, shooting drawing in middle of urethra. — nth. 3 dr., after coffee p.m. great thirst and frequent micturition; feeling in urethra as if prostatic fluid came to orifice, for i h., wetting him while walking. At n. dry feeling in mouth and burning on tongue. — 12th, 4 a.m.. 3 dr., after which he fell asleep. At

6 a.m. nightmare, so that he cried out, as he dreamt he was in danger. P.m., much thirst, dry feeling in mouth, frequent urging to urinate, urine of violet odour, acid. Towards e. for a short time glassy mucu& in orifice of urethra. Restless sleep at n., disturbed toww^a vcv.V^ -

drawing pressivc pain involving 1. $ide of thorax and abdomen, relieved by rubbing and removed by eructation of air and discharge of flatus. Tongue all d. as if burnt. P.m., drjness of mouth with thirst, tongue swollen, especially on I. side ; it is red and the papillx swollen into vesicles. — 14th, Tip of tongue still as if burnt, and 1. border of tongue swollen. P.m., wet feeling at orifice of urethra, dryness of mouth and thirst. Increased urging to urinate.— 15th. Tongue sensitive, its L border still swollen, yellow moisture at orifice of urethra. Dryness on tongue. E,, pruritus in glans penis, early drowsiness, sleep restless. At midnight emission without dream, after that slept better. — l6th, p.m., after coiFce frequent urging to urinate, thirst and dryness of mouth moderate. After the proving he had insufficient erections during coitus. {Ibid,^ 126.)

1. Otto B — , aft. 15, took, Nov. 5th, 6th, and 8ih, every e. 3 dr. 1st dil. Transient burning on tongue. Pain in r. side of head and pressure in r. temple came on on waking, m., worse on moving, especially stooping, only in room, went off in open air, — nth, e., 3 dr. undiluted ale, pt. Soon burning on tip of tongue. — 12th, m., on rising hoarseness, crawling in throat that became scraping when speaking. P.m., scraping in throat causes frequent coughing till c. — 13th, m., occasional short cough. A.m., repeated sneezing. P.m., thirst. E., repeated sneezing. — 14th. Voice rather affected. A.m., frequent sneezing, nose stopped up in r. and I. nostrils alternately. In room, c., nose more stopped up and sneezing. — 15th, 8 a.m., dry heat of face, head, and feet, fluent coryza and frequent sneezing all a.m., better in open air. P.m., in room sneezing and increased coryza. — 1 6th. Coryza very slight, [IbU.^ 130.)

2. Otto R — , :ct. 174, Oct. ist, 1 dr. ist dil. — 2nd, 3 dr. — 3rd. m., 5 dr. 10.30 a.m., heaviness of head with vertigo and indifference, and heaviness of feet ; standing was tiresome, and he had to sit down, better in open air. \ h. after dinner he was better, and quite well in another \ h, — 4th, 5 dr. g a.m., same state as yesterday, only worse, At same time felt in both renal regions pressure, and sometimes deep shooting pains. Strong pressure there was painful. 11 a.m., could not rest in house. Open air relieved head, but not kidneys, which got rather worse. Soon after dinner he felt quite well. — 5tn. 5 dr., same symptoms as yesterday, well after dinner. — 6th, 4 dr., relaxation of body and vertigo, lascivious thoughts and dreams with strong erections.— 27th. 2 dr. and dii., slight feeling of weight in feet, which went off at noon. — 28ih. 4 dr., languor of body and heaviness of feet from 9 a.m., becoming gradually so severe that walking was disagreeable. A.m., pain in head and vertigo. At 11 a.m. sensation as if a fluid went from trunk into limbs, especially knees, elbows, and wrists. All went off after dinner. — 29th, 4 dr. — 30th. 5 dr., noctu seoiinis ejaculatio cum somnio sordido conjuncta. — Nov. 1st, 7 dr.; 2nd, 8 dr. PoUutiosine somnio. — 3rd, 10 dr. — 4th. No med. Transient pain while urinating. — 5th. No med. Persistent shooting pain in whole penis, especially urethra. At n. pollutiosine somnio. — 6ch. No med. Same as on 4th, writes, " Non possum quin credam cogitationes libidinosas, quibus vcxor, a Ph. oriri.' — 27th. 5 dr. 1st dil., rheu

matic feeling in sacrum and knees. The most externa) part of urethra and penis itself painful, the pain was worst during micturition^ with also occasional dull headache and feeling as if he had not slept enough. — 28th. After midnight^ pollutio. At dawn took more than 5 dr. Great weakness of whole body, anorexia, dull frontal headache, better in the cold. Pain in urethra and glans penis. Towards e. nausea as if stomach was deranged. A glass of beer removed all these symptoms. About a fortnight after the last dose, after dinner a very disagreeable sensation of flatulent distension of stomach, as if it were full of air and dilated, with feeling of hunger but little appetite ; this was repeated for 5 successive d. — Dec. 26th. Still feit drawing and sometimes burning in penis and urethra during micturition and at other times. No emissions or lascivious dreams in Dec. — Jan. 4th. 3 dr. 2nd dil., weight in feet. During micturition several times violent burning but transient pain in fore part of urethra, frequent erections, lascivious dreams, and emissions. — 5th. 5 dr., sometimes when not urinating severe burning pain in urethra from scrotum forwards, lasting several m. Frequent erections, lascivious dreams, 2 emissions. — 6th. No med. In m. for i b. feeling as if someone pressed strongly on head ; weakness and weight in feet. Frequent erections. Poliutio in somnio se cum puella coire, which had never happened before. — 7th. Exhaustion. 10 p.m., feeling as if stomach was strongly pressed, aggravated by actual pressure. Frequent erections. — 8lh, 5 dr. ; 9th, 5 dr. Emissions without dreams. — loth. No med. A.m., itlight pain in apice glandis for i h. £., slight pain in scrotum ■ occasionally. — nth and 12th. 5 dr., frequent pain in orifice of urethra lasting long, sometimes also in upper part of scrotum. Since commencing the proving eats less than formerly; has blue rings round eyes. — From 22nd to 28th, daily, 5 dr. On last d. great formication on 2nd knuckle of 3rd 1. finger. — 29th. 5 dr., pollutio. — 30th. 5 dr., pollutio.— 3ibt, 5 dr. — From Feb. 1st to loih, 5 dr. Weakness and exhaustion of whole body, heaviness of feet, so that walking is repugnant. In head heat, and m. dull headache, disinclination for thinking and mental work. Better in cold and open air than in room. P.m., well. In bed m. and e, cogitationes et phantasmata libidinosa. — 2nd. P.m., weakness in whole body, especially feet. Scalp of vertex painful as though he had got a blow there, worse when ►pressed, and lasting the next 2 d. If, when sitting, he keeps his feet still for some time, one thigh gets numb and insensible ; this goes oft on walking. In e. a feeling in pubes as if one testicle was drawn up, — 3rd, m., weakness, — 4th, Heaviness of feet. — 5th. Great itching in anus while walking, going off in room. — 6th. Violent headache from m. till noon. When walking, itching in anus. On coming into room the whole upper part of body, especially chest, nape, and occiput, felt as if beetles were scratching with their feet ; this soon ceased. All d. stomach felt deranged, in e. as if it were compressed, worse on pressure. No inclination to work all d. — 7ih. All d. dull headache. The same on 8th. — 9th, m., knees felt trembling. — loth. Took last dose. — nth. All d. very languid and prostrated, withovix. !c«. least desire to do anything. — 13th, c., as if oive xe^uc\t nvtzl^ ^x-a.'««'cv

had often to loosen his

!ast lumbar vertebrae and

Phantasmata libidinosa

hue d. 29th, non habuit

up and pressed ; sanne on 15th. — 16th. From m. occasional spasmt pain in urethra and upper part of scrotum. The urine during proving was sometimes dark, sometimes clear, often turbid, frequently with slimy sediment which disappeared when heated, sometimes acid, sometimes neutral. — 24th, 2 p.m., pressure in stomach as if he had got a blow there. — 25th, p.m., as yesterday. After g p.m. violent pressure in stomach, which was distended as if he would vomit, retching and eructation of air till midnight. — 26th, p.m., as yesterday. 5 p.m., pressure with retching and eructation. After supper food rose several times. Urine very acid, sediment of reddish flakes, whitish slime on sides of vessel, urine turbid and dark yellow. — 27th. Same state a.m., not p.m. At beginning of March reported that he sometimes felt as if he had eaten something rancid, so that his throat felt rough. In the first days of March often sour eructations, especially a.m. After the last dose he had often, especially in e., a feeling of tightness of chest with slight pain, sometimes a stitch in 1. side above heart. These sensations occurred after sitting for some time, and lasted till e. From March i6th took daily, m., 10 dr. tst dil. On the days he took the Ph. he fell nothing, but after leaving it ofF, from 24th, he had after dinner, and sometimes a.m., a pressure in stomach with feeling of fulness and nausea, relieved by eructation i clothes. — 26th and 27th. Prcssive pain in on the r. side when sitting and standing. et erectioncs penis per longum tempus, ad neque pollutiones. — 28th and 29th. P.m. and sometimes a.m., in r. arm from elbow to wrist slight drawing pain ; p.m., nausea with voracious hunger. — 30th to April 3rd. P.m., voracious hunger, relieved by eructation. Urine often very dark, with bright red sediment. — 2nd, e., r. thigh quite numb as if gone to sleep, for more than i h. ; the following d. same in 1. thigh. — From 3rd the hunger became gradually less, but nausea continued. Sometimes transient shooting pain in r. side of chest. The pains in urethra, which had long ceased, returned in beginning of April. They were shooting and burning, lasting I m., always causing urging to pass urine. At end of April had a slight attack of colitis, with slight fever, and stools consisting of pus and bloody mucus with cutting and pressing. The sigmoid flexure was painful to deep pressure, and felt swollen. — From 27th to May ist he had often, especially in e,, pains in abdomen, chiefly in stomach, with distension of belly. A pain in renal region at this period seemed to be located in muscles. [Uid.y 131.)

1. G, MuLLER, a;t. 50, Sept. 15th, 7 a.m. took 2 dr. ist dil. No effect. — i7rh, 7 a.m., 3 dr. After breakfast pinching pain round navel for J h., then nausea, followed by rumbling in belly and urging to stool without result. Very weak in all limbs, cross without cause. 5 p.m., after eating a pear nausea with empty eructation. — 18th, 7 a.m., 4 dr. Soon languid and prostmted in whole body, morose and cross. 10.30a.m., dull pain in whole head, pressure in eyes and drowsiness, feeling of distension of belly, and loss of appetite, ate little for dinner with relief to headache. 3 p.m., cutting in abdomen with urging to stool, which was not loose. — 20th. ^ h. before bedtime look about 4 dr. of ale. pt.

mis only caused eructation* — 22rid. 5 dr., no effect. — 23rd. 7 dr., soon transient slight nausea with frequent empty eructation lasting Bcvenil h. After coffee discharge of inodorous ftatus with urging to scool, which was normal. {Ibid.^ 137-)

1. Th. de le R — , theological student, act. 20. In Sept. he took every m. from 5 to 10 dr. of ist dil. till the 2ist. After pausing a few d. he began on 27th to talce 5 dr. of 2nd dil. till Oct. 1st. Since the 17th Sept. he was often sick, acid water sometimes flowed into mouth, and appetite diminished till 2nd Oct. From 24th Sept. he had for several d. coryza with frequent sneezing and pressive pain on both sides of head. — 2gth. Frequent eructation like rotten eggs, and a feeling in bowels as if diarrhoea were coming on. — 30Ch. Diarrhific stool with discharge of flatus, some cutting in abdomen and eructation like rotten eggs. When urinating slight pain in prepuce that lasted till Oct, 2nd. — Oct. 1st. Pressive pain in r. middle finger and elbow. E., gone-to-slcep feeling of r. arm and on 2nd formication in r. fingers. After this he had nausea till) the 8th, and a drawing pain in bones of I. arm and in lower jaw like rheumatism. Exhaustion and prostration of whole body till 8th, A sensation of trembling in lower part of spine, in jaws and fingers, which plagued him on the 3rd and 4th, changed on the 5th to great nervous sensitiveness combined with a peculiar weak sensation, worst in lowest lumbar vertebrae and sacrum. Every little exertion fatigued him ; carrying a small basket gave him pain in back. This lasted till 7th, and he then had pressive pain in occiput and feeling of shaking of brain when stooping and rising up again. During and after the proving he had every week on 2 or 3 successive n. emissions, which were previously much rarer. — I9ih, 8 a.m., 2 dr. of pure ale. pt. During d. drawing pains in the tendons of semi-membranosus and semi-tendinosus muscles of both thighs. — From Nov. 14th to Dec. 12th took daily 5 dr. of 2nd dil. From middle of Nov. appetite bad and frequent eructation of sourish bitter water. Heaviness in houghs till end of Dec. Formication in limbs frequent, and for a day or two weakness in lower part of back. h\ Nov. and Dec. more given to start than formerly. {Uid.y 139.)

2. C. Shenk, coachman, a?t. 27. — Sept. i6th, 3 dr. ale. pt. After i h. frequent empty eructation, twice of tasteless water. From 9 a.m., nausea, slight persistent pain in cardiac region. While driving complained of chilliness over whole body as though he was in cold water; the pressure in cardiac region continued till supper, after which it ceased. — 22nd. 3 dr., no effect. — 23rd, 5 dr. ist dil. Till 10 a.m. frequent eructation, after that pinching, contraction, persistent pain in stomach, which was sensitive to pressure. The pain was worst from II to 12 a.m., so that he had often to bend forwards, and then came on pressive pain in forehead. The pains were relieved by eating. In e. nausea with empty eructation making his chest painful. — Oct. 1st. After breakfast 7 dr. Till 3 p.m. empty eructation ; after eating two plums, nausea, water came into mouthy and he must spit frequently. For 1 h. moderate contractive pain in abdomen with some chilliness, till late in e., when he had inclination to swallow frequently^ — 2nd, This last symptom continued, tongue yellow futtt^. '^ V-'^-i

, which caused air he felt wcJl.

constant slight pinching in abdomen for 2\ h, ^vith pressure under 1. thon ribs and water in mouth. Felt prostrated and phlegmatic. AMcr supper was quite well.— 3rd. No med. 1 1 a.m., cutting in abdomen incrcuing, twice with drawing in stomach, lasting till late p.m. After x very moderate dinner feeling as if belly were too full, and loud rumbling m it. Tongue furred, and fetid smell from mouth which he had never before observed. By 3 p.m. all these symptoms went off". — 24th. 3 dr. 3rd dil., no symptoms. — 26th, m., 6 dr. From 9.30 a.ni-, pressure in pit of throat with nausea and frequent flow of saliva which he must spit outj till 11 a.m. After a few spoonfuls of food inclination to vomit. P.m., flow of water into mouth, heaviness of head and whole upper part of body with feeling of tightness of chest till c. — 27th, 8 dr. From 10.30 a.m., heaviness and heat of head and dull pain in forehead down to root of nose and on upper eyelids, with vertigo, which was aggravated by turning and quickly moving head, so as to make him falL Face and forehead red, watering of mouth. From 2 p.m. head lighter. From 3 p.m. stoppage of nose, making him blow it often pain to middle of forehead. 4.30 p.m., when in fresh — 29th. 8 dr., slight pain in forehead, watering of mouth and frequent eructation, which sometimes brought up white, tasteless thin mucus. — 30th. In bed, e., cutting in abdomen for I h. relieved by bending double and lying on r. side. — Nov. ist. 3 dr. 2nd dil., empty, sometimes baulked eructations with nausea. A.m., severe drawing pain in bone of 1. side of forehead, which felt warm to the hand, till p.m, — and, 5 dr. — 3rd, i dr. 1st dil. No effect. — 5th. 2^ dr., some erucution. — 6th. No med. PVom 11 a.m., contraction and cutting drawingin pain round navel with inclination to vomit and flow of water into mouth. Stomach sensitive to pressure, — 7th. No med. g a.m., dull pain in whole head and giddiness so that he cannot hold his head up, and cannot see well, worse on turning head, when the pain extended to the face, relieved by laying the head face downwards, with watering of mouth and prostration of whole body, which showed itself in his weary look. From 9 to 11 a.m. this state increased ; was alleviated by a little sleep, and went off p.m. There then appeared in the middle of the forehead an irregular circle the size of a crown formed by a band ^ an inch wide, of bright red, in some places papular, elevated turgescence of the skin of forehead, which was warmer than the surrounding skin ; the redness disappeared under the pressure of the finger, but soon reappeared (eczema erythematosum). In the middle of the circle there was an irregular round patch of normal skin ; washing with cold water or cold air blowing on it caused smarting. — 8th. The eruption was not so well marked, hut the smarting from cold water and cold air remained. — 9th. Smarting gone, but ihe glabella felt warm and showed some red places. — 10th. Weight and slight pain in cardiac region when coughing for about 2 h. In other respects well. From middle of Alarch he observed that the gum of the upper and lower incisors was loose and bled easily and there was a feeling of fulness in it. On rising in m. he always observed that the anterior surface of all the incisors was covered with mucus and blood. The 17th April the gum of the upper and lower incisors and canines, which

■

was firm and sound, was swollen and redder than the rest of the gum and covered with a greyish-yellow, apparently purulent border. Blood easily came on pressing the gum, its posterior surface was all right. He thought his breath smelt ill, but others did not remark it. His ceeth have always been quite sound. (Jhid,^ 14^-)

1. Rosalie B — , housemaid, act. 17J, took from lOth to 19th March every m. 5 dr. 3rd dil. — loth and nth. No symptoms. — 1 2th. Since rising in m., has had severe pains in belly, with diarrhoea and heaviness and tired feeling in all limbs, could not do her work. — Z3th. Looked ill with blue rings round eyes, pains gone, menses came on. The weariness lasted till 16th. — From 14th to 17th. Pains in abdomen and diarrhoea every a.m., menses normal. — From i8th to April 9th was quite well. On the last d. menses came on and she took 4 dr. 2nd dil., m. From loth to 14th took no med. Menses normal. — 15th. [Apparently resumed the med. every m., though not stated.] Good appetite, cheerful. — 20th. Slight cutting in abdomen, and rush of blood to head. Same on list. — 22nd. Tearing in r. arm. — 23rd. Violent tearing pain in vertex and upper part of r. forearm as if it had been beaten, the pain felt in the flesh \ grasping it hurt her, at same time tearing in leg and weariness in whole body. — 24th. Same symptoms. — 28th. Slept restlessly at n. on account of severe p^iin on commencement of menses. The pains in abdomen increased from noon and were accompanied by pain on sacrum and drawing in lower extremities, which she had never had before, and all her limbs felt bruised, so that she was quite depressed in spirits and had no desire to eat or work. P.m., gradually became better, the menstrual flux normal and lasting till May 3rd. — May 1st. Slight cutting in abdomen. —2nd. Blue rings round dull eyes. — 4th. Occasional tearing pains for a short time in feet, and for i h. in face. — 13th to 20th. Every m. 4 dr. 2nd dil. — 21st. Menses came 2 or 3 days too late, very profusely and for 6 d., quite unusual. — 27th. Quite well. — From Aug, l6th to 31st took daily 5 dr. 2nd dil. During all this time felt quite well except that on 23rd she felt fatigued in all limbs. The menses expected on 24th did not come on till 31st, and then with cutting pain in abdomen and sacral pains, they were scanty, and lasted only 4 d. She took no more Ph., and next menses came on at right time and were quite normal. {IhiJ,^ '45*)

2. Miss A, T — , XI. 32, April 26th took 2 dr. 2nd dil. Great confusion of head, worst at noon, relieved by washing face in cold water, weakness in whole body. — 27th. 2 dr., great weariness of whole body, and a tensive spasmodic feeling in houghs till e. Appearance of menses 5 d. too early. — 28th. Quite well. — 29th. Menses stopped m., but returned slightly p.m. Hardly any on 30th. — May 1st, Menses gone. The scantiness and short duration of menses was quite unusual. Great weariness and spasmodic drawing in houghs till 2nd. — 3rd. Recommenced talcing 2 dr. After some h. great confusion of head and some feeling of catarrh, relieved by cold washing, open air and exercise, worse when sitting and when stooping. P.m., fulness of head. Cannot sleep at n. on account of excited imagination. For several n. has passed the n. half asleep with wild phantasies. — 4th. 2 dr.

3^

56i

A.m., confusion of head, chiefly in region of frontal sinus. After dinner was for some h. as if stupefied with vertigo, had to lie down ; this was attended with great languor of whole body, and the spasmodic sensation in houghs. At n. slept soundly and as if stupefied, was not inclined to get up in m.— sth. No med. Dull pressure on eyelids with compression of head, chiefly posteriorly. Since commencement of menses strong urging to urinate and cutting and burning when urine passed. — i2th. Well.— I4ih. 2 dr. ofadil. between ist and 2nd.— * 15th. 2 dr. of same dil. Rheumatic pain in 1. Icnee lasting some d., hindering her in bending it, e.g, when going upstairs. When she bent it quickly felt tightness of ligaments, and the inner condyle of femur tender on pressure.— 16th and 17th. 2 dr. — 18th. No med. — igih. 3 dr. Each d. confusion of head. — l6th. Repeated tinnitus aurium, difficulty of getting to sleep at n., uneasy tossing about. — 17th. Immediately after going to bed, tinnitus aurium for 2 h,, accompanied by palpitation of heart and fcelingasif blood were too restless, manydisagrccable phantasies until she fell asleep. — From l6th to i8th slight cutting in abdomen with frequent but ineffectual call to stool. Great longing for acid and piquant things. — 19th. Soon after dose, sensation as if blood were in mouth and loud rumbling in abdomen. Immediately after rising for about I h. small dark spots, changing their position, before eyes. Toothache, to which she was subject, much oftener and much worse than before. All through proving out of spirits and sad, very much affected by the crying of a child, which had never occurred before. Took no more after igih. — 25th. Great confusion of head and pains in sacrum. — 26th. Confusion of head and toothache in m. —27th. Toothache with headache and excitement of circulation. — 28th. Sacral pains. — 29ih. Toothache. — 30th. Confusion of head and toothache. — 31st. Disagreeable relaxation and heaviness of limbs. Severe toothache when heated. — June 4th. Nausea, great weariness and relaxation of arms and hands, disinclination for all occupation. — ^5th. Nausea, anorexia, heaviness in limbs. — 6th. Same st;ite.— 7lh. Menses 14 d. too late. (Ibid.^ '47*)

1. Mrs. H. L — , set. 32, took, Oct. 24th, 7 a.m., 3 dr. 2nd dil. Some time afterwards continued formication and gonc-to-sleep feeling in r. arm. After 4 h. single stitches in occiput, sometimes on one side, sometimes on the other. — 25th, 7.30 a.m., 6 dr. From 11 a.m. till 4 p.m. remarkable numb feeling in 1. leg from knee to toes^ sometimes sensation as if hot blood flowed into it. — 26th. No med. Transient numb feeling in both feet. — 27th. In course of d. here and there, transient drawing and numb pains. P.m., without cause much excited. — 28th, 7 a.m., 8 dr. Drawing forcing towards pelvis and rectum as if menses were coming on, some ineHcccual urging to stool. Urine when passed quite clear, on standing quite cloudy and turbid. — 30th, 7 a.m., 10 dr. From 2 p.m. on posterior aspect of thighs from lumbar region to knees a dull pain, such as is felt after lifting a great weight, worst when aC rest, and increasing so much in e. that she had to leave a party and go home, relieved by movement, only going ofF when got to bed. Legs go to sleep on ctossing them. Transient feeling of catarrh consisting of sneezing and stuffed nose. Since yesterday p.m., hurried call to

urinate with some forcing. — 31st, 7.30 a.m., 8 dr. At n. alternate I

going to sleep of arms and legs, waking her. — Nov. 1st, 7.30 a.m., lo I

dr. After i h. violent shootings in I. ankJc-joint, going off in i h. — I

2nd, No med. No symptoms. — 3rd, 7.30 a.m , 9 dr. At n. going to I

sleep of arms, drawing and forcing in hypogastrium at if menses were I

coming on. Transient shooting and pressive sensation in various joints. I

Arms and legs easily go Co sleep. — 4th, 7.'jO a.m., 8 dr. Almost all I

m. drawing and forcing down in hypogastrium as if menses were I

coming on, 8 d. before expected time. Drawing pressive pains in I

various joints of various degrees of intensit)', always recurring, worst I

when at rest, relieved by movement. — 5th. No med. No symptoms.— j

6th, Soon after rising drawing pains in joints. Very frequent going I

to sleep of limbs and numbness in arms when working ; transient pains I

in joints. — 7th. 10 dr. All d. violent drawing pitins in various joints, I

relieved by movement. In r. Hnger-ioints frequent stif^' and swollen I

feeling, so that she must cease needlework. Soon after taking dose I

feeling as if catarrh were coming on, going off after sneezing. P.m., I

for some h. roughness in throat and stuffed nose till e. No more I

med. taken \ after this slight pains in joints occasionally. On I ith, her I

usual I V regular menses came on 2 d. too soon and scanty. In Oct. I

and Nov. of next year took, every time 8 d. before expected menses, I

every m, 4 dr. ist dil. She felt all d. before they appeared drawing I

and forcing in iliac region as if menses were coming on. The first J

lime the menses came on 3 d. too soon and were more scanty. The I

second time the blood was darker than usual. During the days of the I

proving in the latter months she had frequent and persistent vertigo, so 1

that she was for hours as if intoxicated, or there was heaviness and j confusion of head with feeling as if she would have an attack of

apoplexy. During the proving she was very irritable and excited, so J

that the merest trifle would irritate her very much. In the last proving J she had pains in joints, especially shooting in ankles, often lasting for^H hours at a time, relieved by movement. She had frequently going tosleep^H

of lower and upper extremities. Also frequent transient feeling of 1

catarrh. (/iiV., 1 51.) I

1. MissN. S — , art. 23, took each time, about 8 d. before expected I

menses until they appeared, every d. from 3 to 7 dr. ist dil. From I

Sept. 19th she took daily for 8 d. 3 dr. without experiencing any effect. I

For 4 d., until menses came, daily 5 dr. On all 4 d. about 2 h. after I

the dose, chilliness all over body, lasting } h., with such a staggering I

gait that she thought she muiit fall. At i p.m. dull pain and heaviness I

of head and perspiration fur more than I h. The menses were less I

painful and more scanty than usual. In Nov. she took the first 3 d. I

5 dr. without effect, then for S d. 7 dr. On each of these latter d., I

a.m., for i h. chilliness and uncertainty of gair, and, p.m., heaviness ot' 1

head and perspiration. These symptoms came on daily i h. later, in I

the intervals she felt quite well. On 9ih d. of the proving the menses I

appeared, much scantier and without pain, but with sleeplessness^ |

loathing at butcher's meat, and bad appetite. They UsVtA «v-»j t, ^. j

Jn Dec. she took for 8 d. 7 dr., m. From \lV\ i. ^V\t Va^ ^tN«\s\v I symptoms both a.m. and p.m., coming on eac\ d. \ V.X^^.e-'c iCsV wft-!

menses appeared. They were painless, very scanty, and lasted onlv i d. She took no more med. after this. — Jan. 29th. Menses returned, quite painless and very scanty, lasting only 2 d. In the beginning of Dec. she was affected as never previously. At 10 p.m. anxiety about heart, accompanied by nausea, and peculiar feeling of hunger, removed by eating, but sometimes tormenting her for hours in bed. In Nov. she had another never before experienced ailment. A shooting began from sternum, and went through chest to below 1. scapula, was aggravated by working, slighter by d., worst in e. when spinning. In the c. this shooting is generally ushered in by slight chilliness, soon followed by slight perspiration. If she did not keep quiet during ihis state she was seized with anxiety and palpitation of heart. Pressure on the part of head afl^ccted was very painful. She had frequent tinnitus aurium, sometimes changing into beautiful tunes. She had often palpitation of the heart, during which she was much inclined to weep, and felt very unhappy without cause. All the other symptoms went away by the middle of February, but in July, when seen, she had distinct sufferings in the canal of the spinal cord, which she had ^It since the previous Nov. The spinal processes of the dorsal vertebric betwixt the scapular were very sensitive to pressure, or else the muscles betwixt the dorsal spine and the 1. scapula, less so on the r. side. Shooting pains commencing from the spot near the 1. scapula went through the centre of the chest to the front or vice versa^ and sometimes extended to upper arm. By leaning firmly on the back, by rest and warmth, the pains were relieved, but they were distinctly aggravated by lifting, working, during menses, and especially by disagreeable mental emotions. notably anger. These symptoms were not quite gone in the autumn, though they were milder. {Jbid.^ >53-)

1. Dr. SoRGE, set. 34, subject to hemorrhoids and congestion of choroid, took, Sept. 15th, 7 a.m., 2 dr. ist dil. After % m. feeling in fundus of stomach as if something was going on there, with slight rumbling in abdomen. After 5 m. feeling of tightness over heart to thyroid gland, as if of incarcerated flatulence, frequent need to take a deep breath, and slight nausea. After 10 m., the tightness having diminished, there ensued a warming sensation above r. side of heart and below 1. clavicle. This heat spread to apex of 1. scapula and to acromion, when it left the heart. Then, those symptoms having ceased, there was, till 8 a.m., empty, tasteless eructation, with continual nausea, aggravated by drinking cold water. After coffee and roll repeated eructation, as if something liquid rose up from stomach, with sour taste. From 9 a.m. disposition to emit flatus, with continued eructation. I h. after dinner had no relish for tobacco-smoking. When returning home from a drive at 7, felt chilly in spite of a cloak, with cold hands, pale face, nausea, with frequent empty eructation and transient pressive pain deep in r. side of forehead and parietal bone, with peevish humour. — i6th. Quite well ; took, 7 a.m., 3 dr. After a few m. slight pinching in epigastrium to transverse colon, as if flatulence were incarcerated there, which gradually spread equally on both sides of abdomen, with slight warmth. All a.m. empty eructation, only once with feeling of nausea $ sometimes rumbling in belly, with

discharge of flatus. Soon after coflfcc and roll chilliness in back and arms, followed by confusion of head, feeling of heaviness of head that extended to eyeballs, as though the head were drawn forwards by a weight ; at same time feeling of fulness in head and f«:cc, as if too much blood were in them, as he is accustomed to when he studies too hard. Whilst the weight was worst, drawing in 1. side of occiput. Head transiently relieved by smelling at spirit, and by shaking head, increased by work, ir p.m., still some tension in forehead and ^ce. All a.m, very irritable and cross. — 17th. No mcd. No noteworthy symptoms. — iSth, 7 a.m., 4 dr. Till 8 a.m., only flow of water into mouth. After usual breakfast, prcssivc headache, chiefly on r. side, as if head were heavy, with confusion and slight tension in both cheeks, as if too full of blood. Sneezed once, and water ran from nose. Headache went off during mental work. Feeling of exhaustion and prostration, almost amounting to trembling, twice slight formication in J. thumb. Better after dinner, in c. all right. — 19th. Frequent eructation of sour fluid, and general! prostration as if very ill. Loss of appetite for dinner and tobacco, which was recovered at supper-time. — 22nd, 6.30 a.m., 5 dr. After 10 m. empty eructation, repeated later. After j h. pressive sensation under r. short ribs. 8 a.m., when eating, scrapy feeling in palate and fauces, feeling as if heartburn would come on. After 9.15 a.m. feeling of distension of abdomen, oppressing respiration. After this heat of checks for J h., with prostration and weariness, most felt in forearms. Then slight dull headache as after prolonged study, with some giddiness. Numbness in tips of r. index and thumb. At 10 p.m., along with these symptoms, a dull pain betwixt shoulders. After dinner pressive heaviness in head, spine, and all limbs in jerks, with ill-humour, till e. — 24th, m., 6 dr. Some throbbing in 1 r. upper molars, and some empty eructation. — 25th, m., 8 dr. Empty eructation, and after 2 h. throbbing aching in 2nd upper r. molar for a short time. 10 a.m., urging to stool, with soft pappy evacuation. P.m., sour eructation, scraping in throat like heartburn, rumbling in belly. 7 p.m., another pappy stool. — 26th. From a.m. weight in occiput and nape, down whole spine a dull feeling, as if overfilled with blood, and in os sacrum a peculiar paralytic feeling like what one feels in limbs when exposed to some unavoidable danger. Along with this heaviness of feet, which were not placed on ground with usual energy. He walked less strongly and often stumbled on smooth road, so that his staggering gait was observable in e. Diminished sexual appetite, and feeling as if the penis could not become stiff when excitement was present. Indifference of mind, which was quite unusual. This, together with some tightness of chest, lasted all the 27th, till n., when the sensation in the 05 sacrum was especially tiresome. The symptoms are better during scientific conversation, but worse from drinking beer, which caused more severe and continued heartburn than he had ever experienced. In the n. of 27th was much troubled by a scraping feeling in throat. — Oct. 3rd. Feeling quite well, took, m., 10 dr. ist dil. Soon, slight heat of stomach. During a.m. irritability of temper and slight paralytic sensation, with trembling feeling in whole body, heaviness of head and upper part of back, and

towards lo a.m. paralytic feeling in upper part of os sacrum, and last lumbar vertebrsc. Numb feeling in r, side of upper lip and tip of tongue, formication in r. 4th and 5th fingers. In r. lower jaw, from foramen mentale backwards, tearing for 5 m. Feic well and cheerful after dinner. 3 p.m., when driving in close carriage, felt for 5 m. a sharp shooting pain in bone of ball of r, little finger, repeated after 3 h. Frequent tearing in bones of r. forearm and r. metacarpus on its dor&il aspect, and extending to humerus. In e., almost all m., r. hand on its dorsal aspect was numb for a short while. The above symptoms came, not all together, but one after the other. 7 p.m., no appetite, nausea, with scrapy feeling in palate and flow of saliva into mouth. From being irritable became indifferent, with faint feeling and weight of head ; m., 2 thin pappy stools ; p.m., frequent empty eructation and discharge of inodorous flatus. — 19th. Feeling quite well, took, m., 2 dr. 3rd dil. Soon, some oppression in scrob. cordis. All a.m. numb furmication in last phalanx o( r. little finger and thumb. 4 p.m., when driving in a close carriage and warmly clothed, felt chilly ; relaxed In limbs till 8, little appetite for supper. During this time slight drawing pain on r. side of head, deep in malar, frontal, temporal, and parietal bones. Nvery restless. The sexual desire, which had been strong during the previous 10 d., became suddenly weak on 19th. — 20th. Rose quite refreshed, and passed water with the greatest case. 7.30 a.m., felt gnawing and smarting from orifice to an inch back in urethra. Nothing abnormal in m.m. of urethra, but on r. side of apex glandis, beginning from upper surface and extending down to the urethral orifice, a pale red, soft swelling, about A'" above level of surrounding parts. This went oH* about 1 1 a.m., but after micturition drawing for } m. from external orifice to membranous part of urethra. — 23rd, m., 5 dr. 3rd dil. Soon a tightness in scrob. cordis, and all d. numb formication m all r. finger-tips, in 1. thumb and r. tittle toe, not all together, but successively.— 24th, 7 a.m., 6 dr. Soon, empty eructation and rumbling in abdomen, accompanied by a feeling of emptiness and weakness in scrob. cordis. 7.30 a.m., the formication in all r. fingers, in 1. thumb and index, in r. outer toes, in middle of vermilion of upper lip, in r. thumb, combined with warm feeling, returned m succession, lasting, with occasional pauses, till e., whilst there was pressive pain in r. metacarpal bones, and a dull drawing in r metatarsal bones for a short time. From 8 to 10 a.m. felt very cross and had a very striking sensation in muscles of r. upper arm to elbow, as if blown upon by a cold blast of air near a half-open window, or as if a strong wind blew upon a pari that had been wetted. In the elbow this feeling became a numbness, which extended slightly to the fingers. This cold drawing was felt even to the 25ih, on which d. he took 6 dr. — 26th, 2 dr. 2nd dil., no effect. — 27th. 6 dr., soon rumbling and workijig in abdomen till e., occasional formication, — 29th. 2 dr. ist dil., soon, tightness in scrob. cordis, with slight pain in stomach, and after ^ h. with rumbling and transient cutting in abdomen, and occasionally with empty eructation. The rumbling and discharge of flatus worst before and after supper. Pruritus in ano occurred always on the d. when the mcd. was taken, this d. also accompanied by slight pressure in r. lobe of liver.

There was weariness and bruised feeling in all limbs, accompanied by some tightness in scrob. cordis and on chest, until n. Indifference changed, p.m., without cause, to irritability. — 31st. 3 dr. 1st dil., all a.m., heaviness in back and sacrum, and p.m., greatly excited phantasy from reading a silly little story, so that he must make a great effort to go on with his worlc. In a.m., great sexual desire, and at n. restless, dreamful sleep, with much turning about. — Nov. ist. 4 dr. 4th dil., after i h. pain in sacrum and in its connection with last lumbar vertebra, as after lifting too heavy a weight, only felt when standing, walking, coughing, and particularly when standing on one foot and holding the other turned inwards and forwards, or when stretching the back and then moving sideways. When the 2 last lumbar vertebrse were pressed, numbness and stiffness were caused in both feet. This sensation increased till noon, and then declined till e. In the forenoon there was transient numbness on the volar side of r. hand. P.m., frequent rumbling in abdomen, and discharge of inodorous flatus. £., great irritation, followed by severe urticaria and many large wheals. — 2nd, m., urticaria and sacral pain gone, but both returned slightly in e., with much rumbling and discharge of flatus. — 4th, m.,

5 dr. 1st dil. After 4 h. pressive pain under middle and r. side of sternum, with some tightness of chest, relieved by eructation, lasting only 4 b. Frequent empty eructation, with heaviness and fulness in whole body. — 7th. 5 dr., pressing pain in a 1. upper molar, lasting J m. This symptom frequently occurred after taking ist dil. — 8th.

6 dr. A.m., dull tearing in bones of r. forearm and hand. For several months noticed a diminution of sexual function and frequent formication and weakness in limbs, which was quite unusual with him.

(/*«., 155.)

1. Of a sol. of I gr. of Ph. to 3J of alcohol. Dr. Holcombe took 20 dr. at 4 and at 9 p.m. of Feb. loth, 1858. Glowing sensation in stomach; slight fugitive pains during n., with many (intellectual) dreams. Had to pass a very large quantity of urine before daybreak. Jith, 9 a.m., same dose. After soft easy stool considerable discharge of blood, without pain. (Had been subject to bleeding piles, but had had no symptom of them for several months.) Sensation of heat in lungs; disposition to deep inspiration, with discomfort in it ; shooting pains in r. chest; occasional sneezing, which aggravates feeling in chest ; slight dizziness, with sensation as if muscles in walking would lose their equilibrium; frequent eructations ; some twitches in decayed teeth; stitches in lumbar region. 4 p.m., same dose. Fugitive pains in both thorax and abdomen ; very unusual and violent pain in teeth, immediately after eating some candy ; some hacking, tickling cough ; very tired feeling, without having taken even the usual exercise ; involuntary starting on someone's opening door ; noise very disagreeable. 10, repeated dose. Micturition more frequent than commonly ; colicky flatulence in r. side ; pains darting from small of back towards splenic region ; sleepless, inclined to study much later than usual j violent starting of whole body when falling asleep ; many dreams, character unremembcred. lath. — Woke with some hacking cough ; took 20 dr. more at 9 a.m. First part of stool natural ; last pait sok, vi'v.\v mMc:\

florid blood. An h. later, severe griping in bowels, with tcncsmic inclination for stool. Headache with dizziness all d. ; decided malaise, with feeling of exhaustion ; Bushes of pain in upper part of o/bits ; considerable tremulousness, especially of hands, while writing ; severe pain at back of I. lung, sometimes aggravated on inspiration, sometimes not. Could cat no dinner. Deep-seated and very severe pains in bones of 1, hand and fingers; deep-seated pain in eyes; mental irritability, uncommon vehemence in argument. lOp.m., 40 dr. Glowing sensation throughout epigastrium and chest ; very sharp stitches in sacroiliac region posteriorly ; sleepless, with prolonged disposition to study ; restless n., waiting frequently; erotic dreams. 13th. — 9 a.m., 20 dr. Veryconsider.ible mucous accumulation intrachea,with some hoarseness; sharp stitches in lumbar and splenic regions; urgent stool, followed by about ^ij of florid blood (a less quantity than before) ; pain in epigastrium for about an h. after dose, with much eructation ; frequent stitches through lungs, especially on deep breathing; tenacious mucus hawked up ; great sense of fatigue, with mental depression, and a mo&C uncommon tearfulness or timidity. During d. 3 or 4 attacks of violent cramp-like pain in breast, high up under sternum, lasting 15 — 30 seconds, and disappearing with flatulent eructations. At n, fearful dreams uf being bitten by a ferocious horse, so vivid as to make a very painful impression on the mind, 14th. — Woke with considerable mucous accumulation in throat, expectorated with difficulty; stool p;irtly bloody, as yesterday ; violent headache on riding ; pains going off. Took 30 dr. at 10 a.m., but no new symptoms occurred, nor were any of the old ones increased. On ifth there were only a few dr. of blood after stool, and on i6th this was perfectly normal. (No blood had recurred 3 mo. afterwards.) (N, A, J. rf ti.^ 1st S., vii, 144.)

1. a. Having just prepared some tinct. of Ph. [strength not stated], I took 5 dr. about 5 p.m. Thinking no more about it, I retired about 10, but was unable to sleep ; desire for it was very great, but I could not find a comfortable position. My mind was greatly oppressed with melancholy ; tears would start without cause ; a feeling of dread, as if awaiting something terrible while unable to resist or move, overcame me. Sometimes it seemed as if I was beginning to bloat, and then I could hear a multitude of voices saying, in high glee, " Fill him up a little more and he will burst," followed by demoniacal laughter, which made cold chills run over me. Darting, cutting pains gave me much distress, starting from separate points and flashing over whole abdomen ; I imagined myself an aurora borealis, and seemed to hear distinctly voices shouting, ^' Beautiful, oh ! was not that splendid V as the pains became more severe and bsting. Soon, however, the agony became so great that it threw off in a measure the stupor that clouded my senses. Springing from bed, I hastily dressed and sat down to collect my scattered thoughts. My fingers were all thumbs ; I felt a numbness of the whole body accompanied by sensation as if encompassed by innumerable needles that just touched, and on slightest motion entered, my body. Throat felt dry and parched ; a flame seemed passing through me. When I attempted to walk my legs seemed glued to the floor; the slightest motion caused great pain.

I I

With great exertion I reached the vessel. The moment the bowels began to move the pains assumed the form of cramps. The passages were like the scrapings of intestines and were almost constant, attended with tenesmus for upwards of 2 h., ac end of which Hay down on bed weak, sore, and almost helpless.

b. Abdomen was now sore but not tender to touch. Thirst intolerable ; drink did not quench ic, but caused drops of cold clammy sweat to exude from pores of skin the moment water entered stomach. Lun^s felt cloi;ged up; troublesome dyspnoea; pleuritic pains through thorax extending into throat and down r. arm j vertigo; headache; involuntary passages on least motion ; constant desire to urinate, but nothing passed. I lay in this condition for 8 h., when passages changed to mucus mixed with blood, still involuntary ; muscles became flabby, skin dry and wrinkled ; tongue was coated with a thick fur, dark centre and red edges ; sordcs on teeth ; breath oifensive, even to myself*, at no time was I free from pain ; could not extend my limbs, but lay with them drawn up ; least exertion produced great prostration.

e. At end of 12 h., passages began to come periodically, at first every \ h., then every h., still involuntary, with tenesmus for half the interval. Rectum lose its sensibility, sphincter became paralysed, and there was slight prolapsus ani atcer each stool. About 6 p.m. passage of urine became frequent, — copious, scalding, high coloured^ with strong ammoniacal odour; there was dull heavy pain in region of kidneys. After this symptoms began to abate. Appetite was ravenous ; but smallest quantity of food the moment it entered stomach produced vomiting and action of both bowels and bladder. My mind now became very clear ; memory of past was extraordinarily vivid. As darkness came on, I was disturbed by the most frightful visions and thoughts, constant fear of death, with almost uncontrollable desire to commit suicide. Pulse was thready, intermittent, and extremely variable in rapidity. During n. stooJs came every 2 h., still involuntary unless 1 anticipated them. Next m. 1 dressed with difficulty and went to office, feeling weak as from a long illness. Stools continued every 3 h. for 1 d., — always (as before) inodorous, save for a slight mouldy smell. After 3d. pains seemed to leave bowels and settle in joints, producing a crackling noise on movement. Every time 1 went from a warm room into open air my bowels would move. Could cat but little food, as a few mouthfuls satisfied my ravenous appetite. For some time i was not able to assume an upright posture while walking, or endure much fatigue. I did not regain my strength till 2 mo. were over, and during this time could cat nothing but the must digestible food, — spiced food and pastry invariably producing looseness of bowels. (Dr. E. R. Heath, Amer, Horn. Rru,, v, 115.)

1. Mr. H. RoBJNSON took 50 dr. of " tinct. " (probably 3X dil.) at bedtime in a wineglassful of water, and had 2 emissions during following n. On another occasion, from 20 dr. taken in same manner, had peculiar kind of painful stiffness in nape of neck, (Brit, Journ. 0,

peculi

Horn,

XXV,

ZV^)

pai

'f

1. Same gave to a young woman gtt. J of i^ dil. 4 times a d.

57«

After 7 or 8 d. enlarged tonsils, with much dysphagia, and small ecchymosed spots on chest and ("ace. In another, to whom he gave 2 dr. of 3x dil. 3 times a d., there was noticed, after several d.^ profuse lachrymation ; nose feeling stuffed up ; soreness of throat ; tightness of upper chest. (Ih'tH,)

1. Dr. Sharp touk at 8 p.m., pulse 74, I dr. of tsc dil. (probably prepared from the 3X as ^). Pulse rose to 76 during isc and and m., gradually dropped to 70 during 5 — 6 m., was 72 at loth, and 7X again at 20th, where it remained. At 8.30 took another dr. Pulse (cll at once to 72, and by 4th m. to 70, rising again to 72 from 8th — loch m., but at 20th found to be 70, and so continued. (Essays on Mtdidntf p. 720.)

2. After taking, in ethereal tinct., gr. ^ each m. for 10 d., and then gr. yj^ for nearly 4 wccks^ 1 experienced increased thirst and dryness of mouth with coated tongue, flatulent distension and eructation, and uneasy feeh'ng in region of gall-bladJer, without nausea or vomiting ; motions were dark but healthy, urine natural. There was slight headache and sense of fulness along vertex and over I. temple, with increased restlessness and sleeplessness. On discontinuing the medicine, these symptoms disappeared in about 3 d., and on resuming it at the end of a month I felt them return in about 10 d. time. (Phillips, op. cit.)

3. With special reference to the action of Ph. on the sexual organs, I have carefully experimented on 20 healthy men. Ten of them took -^ gr. daily for a fortnight^ 5 took - gr. for a similar period, and 5 toikk i &*"• every 3rd d. five times. Toxic symptoms occurred in some of the subjects, but, except possibly in one of the last set, no sign or feeling of increased sexual excitement was observed. 1 have, however, seen men at 40 — 60, apparently in good health, but suffering from complete loss of generative power (in consequence either of previous sexual abuse, or of overtaxed brain and nervous system), in whom very small doses — ^-^ gr. thrice daily — caused weak erections and involuntary emissions, but mental depression was developed to such an extent as to compel suspension of the drug. [Ihid,)

4. a. In a dose of ^ to -jJ^ gr., a little nausea may be observed soon after its ingestion. I'his symptom is not constant. At some time about the 2nd h., sensations of exhilaration begin to make themselves felt. The capacity for exertion, both mental and physical, is increased, and that condition which the French describe as one of h'un^etrt ii experienced. If the subject have taken the dose while in a state of fatigue, then he feels his strength renewed ; if while in a state of despondcxicy, he takes a more chcerlul view of things. The pulse becomes firmer and a little more frequent. These etVects pass odF gradually in the course of a few h., the period probably differing in different individuals. A state of depression does not ensue. My own experience, clinical and personal, agrees with the above description.

b. If the dose be repeated at regular intervals, so thjt from \ to I gr. is taken during the 24 h.^ some other symptoms may be observed '\n addition. Pulse and temperature rise, the former becoming fuller hut not firmer ; there arc signs of peripheral capillary expansion ; and subsequently to the first few d. the temp, is reduced by 3 or 4 decrees (Gubler) . 1 have noticed symptoois of ioioxication in my own persoo.

4 4

after solid phosphorus only. They came on about 45 m. after taking gr. -j^, and were shown by giddiness, and a tendency to roll in walking ; they lasted about 4 b., and were not accompanied by any confusion of intellect. The skin may become the seat of great irritation and itching (Lobel) ; it becomes moist, or perspires freely ; and the urine is secreted in larger quantity than usual, and is reddish and loaded. The sensations of increased muscular power, intellectual activity, and lightness of heart, before mentioned, appear and are sustained. At the same time tactile sensibility becomes more acute. . . . The gums have been known to suffer ; they may become inflamed and retracted from the teeth, especially from the incisors (A. Voisin). 1 have seen looseness of teeth in one patient, tenderness of gums and teeth in another. (J. Ashburton Thompson, Free Phosphorus in Medicine^

1874.)

1. During the following experiments the medicine was prepared fresh every m. as follows: xo drops of the 3X dil. were thoroughly mixed with 2 oz. of water, and put into the inhaler for use during thed.

a, Mrs. P — , act. 22, began inhalation Dec. 5th. No symptoms until m. of 8th, when i^ h. after inhaling for 15 m. she had a dreamy and indistinct sensation, as if objects were passing before the eyes; increased heat of head ; moisture all over body, especially palms of hands and chest ; feet very warm (usually very cold) ; a pricking sensation in the r. large toe, worse when walking ; acute pain in joint of I. great toe; acute pain in 1. side when taking a breath, worse on deep inspiration ; soreness of scalp on crown of head, worse by pressure ; raw feeling in lungs, especially r. At 5 p.m. a 2nd inhalation of 20 m. \ no symptoms until 11, then flashes of heat and cold across shoulders ; oppressive feeling at throat-pit ; severe pain at base of spine \ bearing-down and painful feeling of uterus and bladder, with smarting feeling on walking. 9th, m., another inhalation of 20 m. ; felt exceedingly petulant all d., nothing went right, dissatisfied with self as with others, it seemed as if everybody did or said something to provoke her. 3.30 same d., inhaled 15 m. ; about 3 h. after was seized, after eating, with severe vomiting and vertigo ; about 20 h. after, increased pain with swelling and appearance of inflammation all round joint of I. great toe ; slight cough immediately after rising, with large quantity of greyish phlegm as if mixed with dust ; eyes gummy on awaking in m. loth. — At I p.m. inhaled 20 m. ; i h. later violent pain in region of r. hip 'y pains in lower abdomen } severe pain in uterus and vagina \ about 3 o'clock was taken with severe chill, followed by fever and Hushed cheeks (especially 1.) ; very thirsty ; increased swelling of feet, with severe pain in bones of same, but they continue warm as at first ; pricking in r. toe has entirely disappeared ; head still sore on top ; about 8 p.m. pains in back and uterus have increased greatly, and resemble real labour pains, particularly in lower part of abdomen ; soreness of lungs much worse, very difficult to uke a full breath. In afternoon CiQtH\ pimples all o\zt body, bright red, with intolerable ucVv\tv^, %ci^xOkvw% relieved for a time only j feet very sore and ^\ntu. wvVv. — ^^T^'L with headache^ no cbiU^ indoJent adl d. laih. — ^Ftct uoi w>^»^-fc *^^

pain in joints ; diarrhcea (very unusual). 13th. — Bowels still quite loose, feet sore, headache. 14th. — Whitish discharge from vagina, with considerable fever in c. ; feet still sore. Tjth. — Headache with fever p.m. ; feet same. i6th, m., diarrhcra greatly increased with sharp cutting in abdomen before stool. 17th. — Diarrhcea and pain in abdomen less severe. All the symptoms of diarrhoea did not disappear for 2 weeks. The puffiness of toes and feet and the gouty pain in great toes also continued several weeks, making it difficult and painful to stand or walk.

b^ Another prover, after 2 inhalations, became covered with an itching eruption of a troublesome character, severe pain in chest and head, great difficulty of breathing,

c. Another had pain in chest, cough with difficult expectoration, and pains in limbs. (Marcy, A'. Am. J. of Horn. ^ Aug., 1885, p. 9+.)

1. Prtn/ings *with amorphous Ph. — (These were matic on the healthy subject, and with the first three dec. rnts. ; but no further infbmution is voudtoafcd, and ibc resiult^ are given in »-hema farm only.)

Dr. GuMPCRT. — Diiiinclination to Ktudyj anxiety and oppre«!>ton, as if he hwl beard bad newh ; dull, oppressed, ili-hurnoured j \ertigo, with slight headache ; bluody mucus from nojic \ dryness in throat and mouth, Litter tender also ; stomach tccU empty, without appetite ; nothing tastes right ; con&tipation, dry and »luggi%h ttool ; awoke at 4. a.m. with pain in iKiwels and diarrhora, and had 4, watery mooU between this and 6 ; pain in r. s'vde^ with occa^vianal stitches ; frequent and paintut crrctioni, awaking htm several times } flight burning in urethra whUc urinating \ some dtumit : tightnc!>& ahoDt cheat as it air was forcibly kept out \ cannot 611 hing^ as tull ^s u^ual (wortc on I. side) ^ feeling of fulncs:^ about chest j i^light pain, like rheumatism, tn both knees in m., by \ p. m. this was gone, but he had same feeling in ). arm shore elbow; painful feeling in I. intttep ; tioublewme itching q( both Ieg% ; re&tlr» a,, a long while getting to sleep, though very drowsy when retiring,— woke at 7 ■.ra. unrelreshed ^ stitches in dtH'erent parts, passing off soon. (H. N. Maktin» Hakm, Afonthi'jf, xit, is%)

1. Dr. Hand. (Took drug for a month.) — Frightened feeling, as rhough be were going to be run over; nervous feeling, ^ if he wcie going to die ; inabiiiiy to think ; neuralgic pain from I. temporal to occipital region ^ pain in back of head and its I. side, lasting 3 — 6 p.m. j ringing in cars, roaring in r. ear; diniDcss of vision j nausea from 1 p.m. till retiring at 11 p.m.; belching of large quanlttic» of wind tasting like rotten eggs; appetite impaired and irregular; loose and frequent stools, with much offensive flatus; sexual desire increased; urine turbid and high.coluiiml j pain from I. to r. nipple, thence to r. shoulder, thence ihooting down to r. Utilr finger} pain | In. below nipple, shooting like electricity, lasting ) h. ^ hideous dreams; sleepy and stupid, hard to keep awake ; chills at 1 p.m., lasting till ;, with ringing in ears, especially r. (3 d. in succession) ; nau-^a i — 5 p-ttu, then dull pain in occiput, tollowed by fever, flushed face, and thirst, till 9 p.m., also passing oJ great quantities of Irtud wind from bowcN, (JbtJ.)

2. Dr. J. W. K.IRK. (Proved, apparently, from May to Dec.). Could not itudy, which cauMrd hi-ailachc, or keep his mind on any particular subject long at a time J could nut keep still ; disinclined to converse, yet did not like to be alone. Heat in head, with dulness, better by moving about ; frontal headache with beat on wakening, with disinclination to rise or move about j stupid feeling In head ; headache on r. side from mental application ; vcr)- heavy dull feeling in head after eating j dizziness, with feeling of lightness in head following it, incrcaseil p.m. Pain in r. throat at breakfast, relieved after swallowing a few times, but i.ort there till 1 1 a.m. ; continual hawking and clearing throat, worse from singing, when also voice brrakt on »p|»er notes. Thirst fur large quantities of »vafer at rather long inttrvaU ; no appetite for meals ; belching of large quantities of wind ; sensation as if little Iuinp% rolled up (X!%ophagus to thruat, rtrlieved by swallowing, then returning again with slight nausea. Loose discharges from bowels, dark and offensive, accompanied witti

<

pain brfore and after^and between.whiln,also wirh urging and vfryMck feel!ng{ then for t or 3 week^ alrernately consripated and loo^e, — costive «tooU difficult to cxpel^ as horn inactivity of rectum ; pain in hypogastric region ; rumbling in abdomen ; soreness on pressure on borh &iues under short ribs, — when riding on horseback, stitching at r. side. Seminal emissions every other n., with dreams and dribbling t'rom urethra at slighest provocation, — also strong desire for collion, but feeble erections. Pain in lower chest on drawing deep breath j slight oppreMron of chc>t ; sense of constriction in chest, with painful, tlifTicult breathing, m. (all chest wmptoms worse on I. side) ; breathing rather hurried j towards 6 p.m. very weak feeling in chest, slight pains in different parts of chest, and disagreeable cough, lasting till retiring j cough of various kinds, with dragging feeling in lower chest, and sensation as if something was tearing loose in chest, worse from movement and from warmth. Soreness in nape, felt most on turning head to I. side. One glandular iiwelling in r. and 3 in I. axilla, two of which suppurated ; from I. axilla small lumps si^e of pea, at irregular intervals, ran down inner arm to wiist, tender on pres&ure ; vesicles on hands; itching eruption on anterior surface of arms (forming crusts, under which Hurface was raw and bleeding, scratching caused smarting, burning, sore feeling), and skin was chapped, rough, and scaly on borders of axillary spaces. L^gs heavy and weary ; eruption on thighs and legs; numbness of I. leg while lying on that side. Drowsine^s in ra. and e. Pulse shoit and quick; whole surface very hoi at n., alternating with chdly sensations, then profuse perspiration during sleep. (/W.)

1. Poisonings. — I. a. E. P — , a;t. 24, took on April 27th, 1 824, 3 centgr. of Ph. in some hot water. Experiencing no effect, he took, 3 d. later, 8 or 10 centigr. He breakfasted immediately afterwards, and felt no bad effects ; but towards 5 p.tn., bein^r at tabic, was taken with violent pain in abdomen, and had painful and continued vomiting and abundant alvine dejections. He continued to attend to his business till May 4th, when at 7 a.m. Dr. Worbc saw him (no account of his condition during this time is given). Abdomen was very tense; epigastrium exceedingly painful ; no priapism, Patient in state of extreme debility ; could only lie on his back ; speech slow and difficult j features had a sort of fixity, giving to his physiognomy a singular air of sadness, languor, and wandering of mind. Tongue and buccal membrane natural j lips and face of livid shade ; conjunctiva deeply tinged with yellow. Kycs dull, opened with difficulty, could not bear h'ght long ; pupil normal, iris little sensitive to light. Pulse a little hard. Urine normal ; but he had had no stool since the initial diarrhoea ceased. At 10 p.m. he recognised no one, was convulsively agitated, and tore off with violence everything placed on his abdomen. He carried his hands automatically to the epigastric region. Abdomen was contracted, and pressure elicited plaintive cries and disordered movements. Mouth was tightly closed -, eyelids opened with difficulty ; and at intervals he made deep subbing inspirations. On 5ch, m., stomach had become meteorised ; patient grew worse every h. ; there was involuntary dribbling of urine, and abundant alvine discharges, followed by extreme f^accidity of abdominal walls. Resp. became slow and easy ; strokes of heart regular and full. At 10 p.m., no radial pulse ; whole body intensely yellow and covered with cold sweat. He died next m. at 3.

b. P.M. — Skin yellow. Subcutaneous veins of abdomen and upper thighs large and arborescent ; scrotum bluish. In thorax much coloured serosity. Lungs gorged ; heart soft, collapsed, empty. Mucous membrane of stomach was the only inflamed part. About cardiac and

pyloric orifices much dark ecchymosis. Intestines full of gas. Had not opened. (Worbe, in Orfila, ffp, at.)

1. A lady, net. 30 odd, strong and healthy, swallowed at n., on going to bed, scrapings of lucifer matches containing about 3 gr. Ph. For 8 h. she concealed her sufferings. Her violent and noisy vomitings revealed her state to those in the house, and the doctor was summoned. The patient lay prostrated, cold^ and pallid, as if moribund^ and unconscious. Skin covered with cold clammy sweat, here and there of a waxy yellow colour^ complexion leaden-grey. 7he eves surrounded with dark blue rings, mouth closed, lips pate, respirations retarded, short, laboured ; heart's impulse weak, hesitating, intermittent ; radial pulse small, hard, slow, unrhythmic, now and then intermitting. Abdomen distended, all over very sensitive, the slightest touch caused violent pains, she could not bear the weight of her night dress, and her hand constantly moved as if to raise it. She had vomited some 12 times with great effort and noise, at first watery slimy fluid, mixed with epithelium and shreds of m.m., later some clotted blood and blood-corpuscles embedded in mucus. Along with this there were diarrhoeic stools of the same character. No urine was passed, nor did bladder seem to contain much. The utero-vcsical region was very sensitive to touch. There was complete collapse, the limbs hanging down in a relaxed state, and were as flexible as wax. Senses and mind were in unconscious apathy, she could only be roused by calling loudly into her ear. After Aeon, 1 every 10 m. she slowly revived. Afternoon, skin moderately warm, pulse freer, fuller, quicker, consciousness only disturbed for a few seconds at a time, otherwise quite clear. She complained of very violent burning pain in chest at its lower part (orsophagus ?), in the stomach and whole abdomen ; every touch and change of posture increased the pain. Vomiting and diarrhcra had ceased, but she had still retching and ineffectual straining at stool, when she felt burning like fire in large intestine smd anus. She passed with difficulty small quantities of dark yellow urine smelling strongly of garlic, after micturition very severe burning. Abdomen very much distended in every direction, and very sensitive to touch. In e. there came on a violent exacerbation, accompanied by frequent and persistent delirium, generally bearing on anticipations and apprehensions of death. Sometimes there were convulsions with loud crieg of anxiety. She tried to lean over the bed, but always fell back fainting. This was frequently repeated during n. Consciousness wa? completely gone. She now got Bell, i, 4 dr. in 3' v water, a teaspoonful every h., alternated with Aeon. After some h. improvement set in. She had longer intervals of quiet, the convulsive movements were seldomer and slighter. No more cries, and she slept quietly for hours. Consciousness returned. The heart's beats became rhythmical and strong, the body became warm, and covered all over with gentle perspiration, the pain in abdomen was much lessened, and she could bear it to be touched. She gradually improved. The abdominal and other symptoms declined, but on the loth d.she complained of drawing pains in r. upper part of chest which affected the breathing. After a short while this changed into deep persistent burning over spot sizcof a child's

hand in the region of the sixth and seventh ribs, which sometimes made it impossible to draw a deep breath. There was constant tendency to short cough, which she tried to suppress on account of the pain it gave. She now got Bryon. 3, and by the I2th d. all these symptoms were gone. From the 15th fur 2 weeks she was tortured with boring burning pains in the bones which deprived her of most of her sleep at n. I hese pains were particularly severe in the skull, the palatal and nasal bones, both jaws, and the teeth. The bornig burning toothache w<is aggravated by taking cold or warm things into mouth, or by chewing^ so that she could only take tepid liquid nutriment. Sometimes the pain in teeth became of a numb character j the teeth then felt loose as though they would fall out. There was a similar burning sore pain in the soft parts of mouth and throat, affecting also the orifice of the Eustachian tube ; the parts were bright red and slightly swollen, and she felt as if they were raw and covered with ulcers. 1 here was a similar pain in internal ear, a buzzing noise affecting the hearing humming and ringing occasionally. Swelling of concha and slight swelling of r. temporal and superior maxillary bones. Soreness of Schneiderian membrane; the opening to nostrils was covered with bloody scabs. SHcJlint; oi nasal bones and unusual blowing from nose of blood and mucus. The stools, which were passed with burning in anus and frequent tenesmus, contained bloody mucus, and small (faecal masses covered with blood. There was almost always an urging to stool. The urine was passed in drops which burned like fire, and there was pain in kidneys and bladder. Sometimes the scanty urine was mixed with blood. These symptoms improved under Merc. I and Mcz. 6. In the 8th week, when the patient was beginning to go about, she felt a peculiar sensation of general loss of muscular power. She could not walk upstairs. This condition increased until every movement was disagreeable and fatiguing. She took to bed and became quite apathetic, alternating with angry words and actions. During this time she was often very drowsy by d. No sooner did she fall asleep than she began to speak nonsense or she went into an erotic ecstasy, talked in a libidinous way, and touched herself so as to satisfy her sexual desires. I'he menses, which occurred twice during this illness, came regular as to time, but were very scanty and attended by spasmodic pains in uterus and renal region, which was quite unusual with her. After the menses she had burning Icucorrhcra that made the parts sore. The urine was clear and in good quantity. Simultaneously with these nervous symptoms there came on what the patient called '* gouty pains" in knees and ankles, which made walking very difficult. She had to take great care to avoid falling, and she said she felt a (gelatinous substance between the parts of the joints that were in contact, which offered great resistance to her movements. The soft parts of the joints were indeed somewhat swollen, but not red or painful to touch. There was considerable rigidity of the joints. 7'he skin, which had been pale and loose, now took on a yellow tint, there appeared bloated swellings in some places on the eyelids and face, which left a depression when pressed on with the finger. On the nape, back, and other parts the

skin could be raised up wich the Bngcrs in large folds, which slowly smoothed down ap;ain. Finally, a peculiar exanchem appeared, which affected the skin about the joints and was not of very great extent ; it resembled ordinary eczema, it consisted of small vesicles closely collected in groups, which rapidly turned into scabs> and frequently recurred. Sulph. was given, and the patient gradually recovered. (J. O. MuLLER, J. A. 2., 1. 163.)

1. A youth, xt. 1 7, on Jan. 6th swallowed the Ph. from a boxful of phosphorus matches without feeling any bad effects. — 7th, 10 a.m., he scraped the Ph. from i^ boxfuls into a cup of milk and drank the mixture. Soon he had fetid eructations and weakness. At noon he drank 3 glasses of beer. P.m., had a normal stool. 9 p.m., great sadness and nausea. Midnight vomiting of a sour brown fluid. After x restless n. he felt next m., 8th, very uncomfortable. ChiJlmess, shivering in the warm room. Dazedness, pressure and dizziness in head at times. Total loss of appetite, sour taste, tongue slightly furred, dryness of throat, constant thirst, rather increased than allayed by drinkmg water. He vomited twice, at same time rumbling and discomfort in belly, great exhaustion. After a doscof Nux v. 4 the symptoms ceased for 3 h., then they returned as before. Next n. restless, woke ofteOi frequent desire to change his position in bed. In the m. felt very exhausted and must yawn frequently, tiausea still present, taste sour; milk tasted burnt ; every smell, as of tobacco, wine or beer, incre^ised the nausea. Tongue clean. Urine dark coloured. Next n., 9th, resembled the last. During d. of lorh vomited once. Next n. very restless.— nth. Exhaustion increased; he felt so weak, kept his bed most of the d., still some dazedness of head. The stomach pains were pressive from the beginning, rumbling in abdomen. Noon, a formed but not hard stool, same m e. Jne. sour, sometimes fetid eructations 5 vertigoand stomach pain better. N. between 1 ith and iith quieter, headache and eructations gone. Noon, took some milk, but soon threw it up. P.m.^rumblmgin belly and slight pressure in stomach. Great languor, constant yawning. N. between 12th and 13th restless, woke at 4 a.m. and could not get to sleep again. Head confused. No nausea, but eructations tasting of food. Slight pressure in stomach. Rolling and rumbling in belly. Urine dark, tongue clean, not so languid as yesterday. Bad appetite; distaste fur meat and fat food. Still some thirst. Took another dose of Nux V. Betterine. N. between 13th and 14th better. Slept soundly till 4 a.m., fell asleep again but soon woke. — 14th, 8 a.m, got up and felt stronger. Head free, taste and tongue normal. Appetite not so good as usual. Some discomfort and fulness in abdomen just above navel. Noon, normal stool. P.m., rumbling in abdomen and pressure in stomach. Greater languor, desire to lie down. Bitter taste, especially after eating bread. N. good, — 15th. Slight pressure in stomach and rumbling in bowels. Languor. Skin of forehead and eyes slightly yellow. Urine dark. Says he has felt weak since 8th, cannot stand long, hands tremble so that he could not write. — l6th. Felt well, but skin yellower, rumbling in belly and pressure in stomach. Dark sediment in urine, fxces greenish rrd Next n. slept well. — 1 7th. Urine clearer. Skin not so yellow. StooJ

4 4

4 I

greyish red. — i8th. Still languid, fxces normal. — 19th. Complexion normal. (Elwert, A. h. Z, liii, 171.)

1. Laura M — , set. 21, July 13th, poisoned herself with phosphorus matches. From 13th to 15th vomited everything. Went to bed on 15th. Seen on i6th, when she complained of taste of Ph. in throat, colic, vertigo, and headache ; chilliness when she got up, thirst, and great weariness. The doctor, not knowing what she had done, gave puls, and visited her on the 17th. Lay in bed, uncomplaining. Pulse not very quick, but soft, skin moderately dry and warm, tongue dry, red in middle and shining, frequent drinking of small quantities of water, abdomen only slightly tender, gastric region very tender to deep pressure, complexion yellowish, on rising up complained of vertigo and trembled. — 18th and 19th. Got up, did light work, ate several times, and complained of nothing. — 19th. One white fetid stool ; vomited blood several times in e., and then lay down quietly in bed. — 20th. M., her mother found her lying on the floor, half unconscious, screaming horribly and tossing about. 5 p.m., cool skin ; chest, belly, face, and especially conjunctivae very yellow. Pupils sluggish. Lay constantly on r. side, writhed about much with upper part of body and head, screamed frightfully, bit into pillow and tore it with her teeth, bit her own fingers, also the spoon with which she was helped to milk, and spat out all fluids given her, frequently mixed with blood. Lips quite dry and bloody, eyes expressionless. Had passed neither urine nor feces. She gradually grew colder, and died between 10 and 11 p.m. — P.M.^Zist. Body already smelt badly, and was covered with many cadaveric suggillations. Much dark blood had flowed from mouth, the linen was fouled with grey faeces. Abdomen distended, its veins full of black blood. Nothing abnormal in brain or its membranes. Lungs bluish black. Heart collapsed, contained a little black blood ; duodenum reddened. A small quantity of bloody water in abdominal cavity, but no abnormal congestion. Stomach and intestines much distended, looked blue or bluish grey. The beginning of the duodenum and some spots in middle of small intestines showed dark red through their peritoneal covering. Liver felt soft and withered, when cut into appeared of an intense yellow colour ; gall-bladder empty. Kidneys contracted, bladder empty. Uterus empty, the m.m. of its fundus bright red. M.m. of stomach was thickened, bluish red, and gelatinous, and the fundus where the spleen touches it blackish grey. Its contents were bloody fluid mixed with a number of little black pieces. Intestines firm, pylorus of intense bluish red colour ; the very much swollen m.m. nearly filled the tube } at the top of small intestine there were blackish masses, m.m. congested but less swollen. In the large intestine the swollen m.m. completely filled the bowel. Whitish-grey, unctuous masses of faeces without mucus in the colon smelt of Ph, (Sorge, op. «/., 98.)

2. Mrs. K — took a quantity of the heads of phosphorus matches in order to poison herself. She had repeated retching and vomiting. When seen 2 d. afterwards she was lying in an apathetic state, with intermittent pulse ; after 3 to 6 regular but weak beats there was a pause. The tongue showed two slimy stripes ; no appetite, could hardly be induced to take any food. The 3rd n., like the previous ones, was

VOL. lU, "Vl

restless. Next d. pulse still intermittent about every 25th beat, and very small and weak. Repeated diarrhoea. Tongue without the stripes but dry. She resembled a j^rson affected with typhoid fever. — 6th d. Constipation. Patient groans and sighs j very depressed in spirits. Pulse no longer intermits ; r. conjunctiva very yellow, I. less so. Tongue moist and of a slate colour. — 7th d. Both conjunctiva: very yellow i great sensitiveness of lower border of liver, when touched she screams with pain. Great tearing pain deep in chest. She feels the whole skin burning like fire. The burning pain seems to be in the oesophagus. Burning and tearing in r. ear. — 9th d. Complains of stupid feeling in head ; she says her head feels dead, but the intellect is clear. Great anxiety, which makes her wish to get out of bed, though she is unable to rise. Cold sweat of anxiety ; rapid breathing without acceleration of pulse. Painful pressure in scrob. cordis. Wakes her husband at n. as she wants something to eat, must have some food every 10 m., though always something different. (Goullon, Int, Horn. Pressey x, 496.)

1. A woman on March 21st ate an unknown quantity of Ph. ratpoison in food. After i h. felt very ill. She complained of great distension of abdomen, increased anxiety, later of burning and cutting in abdomen and violent thirst, with inclination to vomit, and soon afterwards diarrhoea, which lasted all n. and next d. — 21st. ii a.m., she had a wretched fallen-in face, could hardly keep on her legs, and began to talk nonsense in an unconnected manner. Soon afterwards became delirious, and died on the n. of the 2ist. — P.M. Suffering expression on face, eyes sunken, surrounded by broad blue rings. The veins shone blue through the wax-coloured skin. The whole front of the surface of the body, especially the shoulders, chest, and abdomen, was studded with petechias of the size of a hemp seed, somewhat raised and of a bright red colour. When cut into they were found to be deposits of thin bright red blood betwixt epidermis and cutis. The finger-nails of a bluish-black colour. Peritoneum and omentum red and inflamed. Mesenteric veins distended with dark blood. Stomach externally dirty grey and reddish. Duodenum, jejunum, and ileum of reddish-brown colour, dotted here and there with verdigris-coloured spots; colon of a reddish tinge. Stomach contained 2 oz. of a greenish-grey viscid fluid. On posterior surface of stomach near pylorus two sloughing ulcers with elevated blackish-grey borders. A third ulcer, the size of a sixpence, on the carcum had penetrated all the walls of the bowel and peritoneum. The m.m. from cardia to fundus ash grey or dark red, in some parts swollen and softened. The veins of stomach resembled thick cords. The m.m. of intestines had a dark inflammatory redness, that of the colon was not inflamed. The 1. lobeof liver showed several bright red inflamed spots, l^he upper and under surface of diaphragm on the r. side of the foramen oesophageum was inflamed and red to the extent of I inch. The upper lobes of lungs were slate grey and marbled ; they crepitated. 7'he lower lobes were full of venous blood, felt solid, and crepitated little. The r. side of heart was distended by dark thin liquid blood. The oesophagus had a dark red ramified colour, its m.m. inflamed and corrugated ; at the entrance to stomach it was dark grey,

blackish, and could be easily removed in shreds. The blood-vessels of the pia mater congested with blood ; between it and arachnoid a collection of yellow opalescent lymphous exudation as thick as pasteboard, welding together the two cerebral membranes in several places. (Grobenschutz, jW^^. Zeit, V. Ver.f, Heilk.in Pnusseriy xii, '843, No. 31, p. 137, in Frank's Mag.y i, 125.)

1. Elise Stark, milliner, jet. 23, took, June iSth, m., the scrapedoiF heads of 1000 phosphorus matches [= 10 gr. Ph.]. She felt nothing till the n. of the i6th, when she had frequent vomiting, continuing on 17th and x8th, after which the pains in stomach, which had been severe, became less. On 18th pains in sacrum. She was brought to the hospital on the 19th. Her skin and conjunctiva were strongly icteric. Mucous membranes and cheeks very red. Countenance and demeanour indicated the greatest exhaustion. Pulse 92, hard and bounding. Tongue dry in the centre, and with a grey coating. Disgusting taste, anorexia. Abdomen distended, especially about epigastrium. Pain in splenic and iliac regions, and liver, which projects I to i^ inches in 1. lobe. Spleen enlarged. Stool retarded for some d. Urine brown, containing bile-colouring matter and some albumen. Six leeches were applied to epigastrium, and she got a mixture of decoct, althzx with aq. amygd. amar. Some vomiting, p.m. Temp. 38 'i° C, pulse 108. Next m. pulse still 108, temp. 377°. Pains in stomach less ; yellow firm stool. Though so weak, the pulse was full and strong. P.m., collapse, soon followed by death. — P.M,^ 30 h. after death. The icteric colour of skin and conjunctiva well marked. In all the serous cavities small quantities of bloody fluid. Mesentery, especially the appendices epiploics of sigmoid flexure, much congested, and the surrounding parts red. The endocardium, especially on the valves, shows bloody imbibition. Muscular substance of heart on both sides pale grey, on the 1. side of a greenish hue. The blood in heart fluid. M.m. of pharynx, larynx, and trachea partly dirty red, partly greenish. Dark red suffusion on both sides of entrance to larynx. Both lungs in posterior parts airless and very hyperaemic. The greyish-yellow m.m. of stomach, when its blackish-brown contents were removed, showed shallow depressions the size of peas on fundus and both curvatures. Similar matter appeared in duodenum, and a thick pappy matter in jejunum. In the ileum the contents were of a pale yellow colour, further down the yellow colour was deeper. The faeces in rectum were dirty green. Some patches of red in intestines. Small prominent pimples on jejunum, which when scraped off* left small pits. Gall-bladder empty. Thin dark brown bile in ductus choledochusjitsm.m.at its entrance through the intestinal parietes corrugated and red. Liver large and heavy, under its peritoneal covering large emphysematous bulla.. Surface and interior of liver greyish green, the central part of the large acini green. Spleen enlarged, nrm and chocolate coloured. Follicles hardly visible, trabecules numerous. The bladder, relaxed and empty, has ecchymosed spots in its fundus. Kidneys large, their glomeruli very red and the canaliculi very opaque. A red secretion can be pressed out of the papillae. The cellular substance of the pelvis of the kidneys is deeply imbibed with blood. The

liver cells under the microscope were partly filled with fat molecules, partly destroyed and changed into drops of fat. Uterus enlarged ; the blackish m.m. of the cervical canal shows a blackish slimy secretion. M.m. of uterus is blackish red with shreds of membrane attached to it. (Dr. E. Mannkopff, Spita/'s Xeitung^ 1^63, 26, in j1, A. Z. MnU B/att, viii, 16.)

1. ScHLAWio, a servant-girl, aet. 27, scraped off the heads of 3000 lucifer matches (= 30 gr. Ph.) into a pint of water and drank the whole, April 2nd, 10 p.m. Next m. no symptoms. In forenoon fainted twice, felt sick, and after noon vomited continually blackish-green matter, at first slimy, and afterwards watery. Entered the hospital e. She got milk, magnesia usta, and mucilage, and on account of violent pains in head cold compresses to it. After cutting pains in abdomen vomited thrice. No sleep. — 4th. M., skin slightly yellow and covered with profuse sweat. Conjunctivae of a deeper yellow than skin. Cheeks very red, expression dull and aching. Heart's action and respiration accelerated. Tongue red, clean. Arch of palate and posterior pharyngeal wall slightly reddened. Abdomen distended. Burning pain in pit of stomach, increased by deep pressure; r. hypochondrium very tender. The vomited matter contains only bile, no blood. Liver enlarged, its lower border on the median line lies 4 inches below base of ensiform cartilage. Urine scanty, clear. Yesterday there were pains in renal region, to-day pain is only felt there on pressure. Cataplasm to stomach and decoct, althaese and aq. amyd. amar. The patient after this vomited thin bilious fluid. On the 3rd and 4th d. there were several thin liquid stools, and no more till 7th d., when an enema brought away a pappy, bright brown stool. Temp, rose gradually to 39*6° C, and the pulse became quick in proportion. Perspiration ensued, and the skin became more active. At the same time the liver increased in size. The spleen, too, increased in size. Pressure on the liver caused great pain. The urine during the last 2 d. became more copious, sp. gr. 1020 — 26, acid, at first copious triple phosphates, latterly much uric acid. The colour was dark, and contained a quantity of colouring matter of bile. From the 4th d. it contained albumen and hyaline casts and some fat corpuscles. The headaches increased, and there were often attacks of faintness. The limbs were at first as heavy as lead, feeling as if paralysed, with pains in the muscles. The countenance expressed great exhaustion j consciousness was perfect. On April 9th the symptoms, suddenly increased in intensity, the pupils dilated and scarcely reacted, the extremities became cold, pulse intermittent and scarcely perceptible. At 8 o'clock she died. P.M., 3 d. after death. — Skin very yellow, with numerous suggillations. The fat brownish. Some reddish fluid in plcune. Bronchial tubes contain dark red mucus, and the m.m. red. Heart very lax, contains little blood. Endocardium, especially about valves, very red. Muscular substance of heart reddish grey, opaque, shows signs of fatty degeneration. Blood dark red, loosely coagulated. Peritoneal sac contained i pint of dark red bloody liquid, m.m. of pharynx and larynx of dirty grey colour. The distended stomach contained I J pints of greyish-red thin liquid. The m.m. on fundus red, at

The m.m. of small intestine is only red rest of it is grey. The follicles arc

pylorus and large curvature grey. Near an old cicatrix are two spots the size of peas, black in their periphery, not discoloured in the centres, lying under the m.m. In duodenum and throughout intestines grey masses, fluid in small intestine, of more consistence in colon. Gallbladder relaxed and empty, on the top of its folds, the

enlarged. The m.m. of uterus much swollen and reddened, covered with reddish secretion. The glomeruli of kidney much injected, the cubuli contorti tilled with a granular mass consisting of fat. Spleen enlarged, firm, and full of blood i reaches to 1. lobe of liver. The liver on the r. side extends 3 fingers' breadth below border of ribs. Its surface is smooth, some large red parts arc sunken in ; the remainder of it, especially the anterior border, is of an intense yellow colour. On cutting into it the yellow and red parts were abruptly delimited. The hepatic cells in the yellow part were larger and more rounded than normal, they seemed to be filled with firm fat corpuscles. In the red part there was free fat, chiefly in large drops. The yellow parts seemed saturated with yellow bile-pigment, but contained very little brown granular pigment. The red part was quite devoid of these pigments, but its acini were very large. {^Ibid.)

9, A workwoman, at. 26, Nov. 23rd, 4 p.m., swallowed the heads of 1000 phosphorus matches in a cup of cofFcc. After 8 h. anorexia, increased thirst, vomiting of phosphorescent masses, pains in epigastrium, which increased and extended to both hypochondria, and on the 24th, e., involved the lumbar region ; urine scanty. The vomiting was promoted by an emetic, and magnesia usta caused profuse diarrhoea. — 25th, c., patient brought to the hospital. Her expression and posture in bed show great exhaustion j skin dry ; frequent dry cough j pulse quick, small, and soft \ tongue thickly furred, no appetite, thirst great J pain in pharynx on drinking anything warm; abdomen much distended but soft, persistent pains, especially in epigastrium, both hypochondria and lumbar region, aggravated by pressure ; spleen enlarged ; liver shows as a firm tumour 2 inches below the ribs. It extends 5 J inches below the base of the ensiform cartilage. The urine drawn off by catheter contains bile-pigment and a little albumen. Cataplasm to abdomen and a mixture of decoction of bark, red wine, aromatic tincture, and syrup. Next m. she had an icteric colour of skin and conjunctiva, which increased next d. The frequent consistent stools were tinged with bile. Urine scanty, contained a little albumen and some bladder epithelium j its sp. gr. had sunk from 1024 to I0J2. The liver J inch lower. Respiration 76, pulse 136. Temperature in axilla rose from 382° C. to 398^ C. She complained of chilliness. Abdominal pains less. Vertigo and exhaustion increased. Headache, anxiety, and restlessness, no sleep for the last nights. The last d. her intellect was clouded. — 29lh, p.m. After extreme anxiety she suddenly became quiet, and after ^ h. she died, 6 d. after the poisoning. — i*.^.,4 h. after death. Brain and its membranes normal. Both pleurae and pericardium studded with ecchymoses. In cellular tissue of mediastinum considerable suffusion, which extended along the greatly injected bronchial tubes into lungs, which showed some hypos-

tasis but no titrations. Nothing abnormal in stomach except an old cicatrix, nor in intestines. The contents of the bowels had a slight yellow tinge. Spleen 4} inches long, af broad, I inch thick. Liver gi inches broad, the r. lobe SJ inches high, 1. 54 inches, r. 34 inches thick, 1. if inches, of doughy consistence; there were seme reddish places on its lower border. Acini ill defined. Gall-bladder contained a little brown bile. Kidneys soft, when cut into they showed congestion of the vessels ; the red glomeruli contrasted with the icteric coloured, very opaque urinary canals. M.m. of uterus, after the bloody mucus was washed off, appeared bright red. Blood very dark. Cardiac muscles doughy, of yellowish-red colour. The epithelia of kidneys were changed into firmly granulated detritus, no epithelial nuclei to be seen. The interstitial tissue appeared loose, and contained some drops of fat. The liver lobules large, no cells could be seen when cut into thin layers ; they were all, from vena portae to liver-vein zone, fatty-degenerated. Betwixt the acini were broad bands of cellular tissue, and betwixt its fibres a great number of star-shaped structures^ where lay a large number of fat-drops. {Ibtd.j 28.}

1. P. J — , aet. 25, came May 2nd into the hospital. The previous day at 6 p.m., after drinking a quantity of spirits, he scraped ofF the heads of 3 packets of phosphorus matches, put them into a glass of beer, and drank the mixture. He continued drinking wine and beer till [o p.m. At midnight he vomited a quantity of blackish-brown, metallic tasting fluid, and vomited 10 or 12 times before m. He came to the hospital at 7 a.m. He complained of headache, dryness and metallic taste in palate, slight burning sensation down oesophagus to stomach, anorexia, thirst. Tongue dry, brownish black, fauces red. Pulse full, regular, 72. Ltver normal as to size, spleen somewhat enlarged. Stomach towards pylorus tender to pressure, an uncomfortable feeling in it, but no pain. Magnesia hydnca was administered, and he got milk to drink at his own request. When seen, e., he had had 3 stools, and had vomited once. — 3rd. M., the pains in stomach increased, nausea repeatedly during d. Pulse quiet, 72 — 76. The skin, especially on chest, yellow ; urine dark-coloured, contained a quantity of bile-pigment, no albumen. He got ice pills, mistura oleosa, and cold compresses to ^stric region. — 4th. N., copious vomiting and i purulent stool. Complained of increased headache, pulse 88. Skin jaundiced, covered with perspiration, albuginea of both eyes yellow, urine dark brown. Stool black, owing to decomposed blood. Liver increased in size, very tender. — 5th, No change. — 6th, The same. Urine brown, sp. gr. 1021, acid, great sediment, urophaein diminished, uroxanthin increased, urea diminished, uric acid increased, no chlorides, earthy and alkaline phosphates increased, sulphates increased, much albumen and urates, much bilophsein and urocrythrin. Sediment, urates and earthy phosphates. — 7th. In the n. vomited 5 times, one stool, icterus increased. £., when lying asleep on 1. side, his whole body shook violently synchronously with each heart's beat, a loud blowing sound could be heard in the aorta at each systole. — 8th. After a sleepless n, he fell into a somnolent state, answered questions slowly and with difficulty, and his speech was dis-

connected. Colourofslcin intensely yellow j temperature high. Tongue very dry, with thirst, blackish-brown fur. Liver projected below ribs, and the tenderness of it increased. Pulse 108. At thee, visit the somnolence bad increased, pulse softer and slower, sound in aorta as yesterday. Liver decreased in size. — 9th. All n. cried out, made constant attempts to get out of bed, had to be tied into the bed. At 2.30 a.m. he fell asleep, and slept till m. Countenance fallen in,d'jll look ; lips, nose, forehead, and extremities had a livid hue, temperature of extremities low. Respirations slower and accompanied by loud rales. Size of the liver much diminished ; pulse very small, soft, 132 ; blowing sound in aorta very distinct. Since m. frequent convulsive movements of lower extremities ; when this happened the feet were drawn into the appearance of clubfeet. During a.m. convulsions of upper extremities also occurred ; trismus came on, so that it was impossible to get liquids into mouth : there was loud rattling both in inspiration and expiration. A quantity of dark frothy blood was discharged from the nose and mouth during expiration, which, as well as the body, had a cadaverous odour ; extremities cold, radial pulse could not be felt, and at 4 p.m., after a rapid succession of convulsions, he died. — P.Af, Dura mater pale, icteric tinge, vessels moderately distended, brain soft, in its cavities some drops, in base of brain i drachm, of pale yellow serum. The intermuscular cellular tissue of neck and mediastinum, as well as the sub-pleural cellular tissue of the thoracic walls, studded with numerous patches of extravasated blood. Back of tongue and m.m. of fauces covered with a blackish-brown slimy substance. R. lung adherent at the back j both lungs inflated, mostly bright red, containing fluid blood, in parts ccdcmatous ; the lower lobes interiorly somewhat swollen, dark red. In pericardium I oz. reddish-yellow serum ; heart collapsed, at its base ecchymosed ; the endocardium, especially of r. side, yellow tinged ; cardiac muscular substance fawn-coloured, in heart's cavities fluid blood. Liver small,contracted, wrinkled, tough, bloodless; when cut into, fatty, yellow and red — that is to say, on a red basis of interlobular tissue the acini appeared as icteric-yellow granules the size of millet seeds. The acini under the microscope were seen to consist of large and small fat-drups with a few hepatic cells among them, whilst in the interlobular tissue no cells were visible. Gall-bladder contained slimy blackish-green bile. Spleen very long-shaped, reddish brown, some of the splenic elements changed into aggregations of fat-globules. Stomach, duodenum, and upper part of jejunum HUcd with blackish-red and black tar-like fluid. M.m, of stomach pale, numerous harmorrhagic erosions on the pyloric end. In the rest of the small intestine yellow bilio-mucous matter, in the large intestine grey pappy matter. Kidneys large, their cortical substance swollen, yellowish red, fawn-coloured, the pyramids dark coloured. Under the microscope the urinary canaliculi of the cortical substance appeared dilated, filled with fat-globules, epithelium gone. In bladder ^ pound of orange-yellow urine. The urine taken from the body of a reddish colour, acid, with sediment of urates. The chlorides were in diminished quantity. A small amount of albumen and a large amount of bile-pigment. (Karajan, lyochinbl, d, Zeilschr. d. k. k. Get, d. ditxu in iVien^ 1863, 20 \ in A. h. Z, Mnt. 5A, viii, 29.)

1. a. On 5th June, at 8 p.m., 6 h. after eating, Maria L — swallowed the combustible matter of a box of matches suspended in a cup of coffee. In about % h. she felt severe pain in throat, sense of swelling in tongue and of pricking in epigastrium. Pain was paroxysmal, at intervals of about 5 m. The woman experienced great sense of fatigue, and there was a peculiar insensibility in the skin of the extremities. 6th. — Frequent and considerable nausea, without vomiting. The feebleness experienced did not prevent her from walking about all d. in the rain. Numbness of extremities with formication ; sensibility of fingers so much diminished that she could not pick up a pin. Pain along pharynx and oesophagus. Towards e. an incomplete attack of syncope \ was then brought to hospital. She was pale ; features slightly changed \ had lively thirst ; epigastric pains more marked ; skin dry ; pulse normal. An emetic was administered, which occasioned a little vomiting. 7th. — Diminution of epigastric and pharyngeal pains ; frequent painful regurgitations, with expulsion of gas having an alliaceous odour J commencing jaundice; chills. Very weak; intelligence intact ; calls for food. 8th. — The pains are dull ; bad taste in mouth, nausea, without vomiting ; somnolence. The jaundice is very decided ; the liver is sensitive to pressure, projects a very little beyond the false ribs \ more chills. (A purgative was given.) At 4 p.m., chills more intense; febrile condition. 9th. — Same symptoms; pulse 50 — 60; no appetite. loth. — Same. Upon arms some red spots, which disappear on pressure. Pain in hepatic region. (Leeches to anus, on nth calomel and jalap.) 12th. — Pain in liver easier after leeches, and now better still. 13th. — Augmentation of hepatic pain; liver very tender on pressure, extends two fingers* breadth beyond edge of false ribs; formication in fingers. (Blister on r. hypochondrium.) In n. delirium suddenly supervened, followed by a comatose state, interrupted by occasional screams. 14th. — Delirium, coma, dyspncea, yawning, difficult articulation. 15th. — Still coma; cries; trismus; death.

h. P.M.y 24 h. after death. Very slight vascularity of cerebral pulp. Bloody serum in cavity of pleurae and pericardium ; ecchymoses on costal pleura; pulmonary engorgement; heart small, collapsed, empty. Ecchymoses under peritoneum, and bloody serum in its cavity ; stomach and upper half of small intestines full of bloody mucus; in all this extent mucous m. tinged uniformly of a wine colour from imbibition of the contained liquid ; no softening or ulceration of the sur&ce. Liver larger than natural, of deep brown colour and softened ; spleen also enlarged and softened, with ecchymosis under its serous coat. Bladder contained a very large quantity of bloody urine and many ecchymoses under its mucous membrane ; kidneys healthy. Subperitoneal ecchymoses on uterus and its appendages, and also between laminae of mesentery. (Leudet, Arch, Gen, de Med.^ Mars^ 1857.)

1. a, A soldier, aet. 2i, swallowed ends of 6 packets of matches. In 3 h. he was seized with vomiting, which recurred frequently and expelled much of what he had taken ; pulse was frequent, tongue loaded, head hot ; he complained chiefly of headache. (Emetic^ cold to head, demulcents.) Next d. headache less severe ; pulse 92 ; stomach but slightly sensitive to pressure, but there were pains in each

hypochondrium. P.m., turgescence of face had increased, also hypochondriac pains, but headache was gone ; there was burning thirst, with dryness of mouth ; urine was high-coloured and frothy, its sp. gr. was increased, and it was found to contain albumen and exudation cells ; the colouring matter was augmented, as were also the sulphates and phosphates, while the chlorides were diminished. This state of urine continued throughout. Three d. after Ph. had been taken, thirst and dryness of mouth, with hypochondriac pains, had increased, and there were darting pains in chest ; epigastric sensibility was increased, and tympanitic percussion-sound over stomach more extensive. Tinge of face was brightened. (Leeches and ice to epigastrium ; ice and magnesia internally.) The above symptoms persisted, and face assumed a remarkable bluish-red colour, except a colourless band of about 1 in. in breadth, extending from highest point of forehead down median line to chin, sharply defined, and giving face a most peculiar appearance. An enema produced a yellowish evacuation. On 4th d. hypochondriac pains had somewhat diminished, but those of chest had become intolerable, without physical signs of mischief there. The bluish-red colour of face had changed into a perfectly cyanotic hue, median line continuing colourless. Epigastric pain had ceased. Patient sweated profusely, and exhalations from body gave out an intensely phosphoric odour (which breath and stool did not). Patient^ who retained perfect consciousness, stated that in the horizontal posture he could perceive a feeble ray of lights but that when he sat up he could not see at all ; pupils were so dilated that only a narrow ring of iris was visible, and they were uninfluenced by light ; he complained of darting pains in eyeballs. Pulse was lOO, moderately full and strong ; p.m., 140, small and weak. At this time hearing was lost, sweat profuse, extremities cool, and second sound of heart inaudible ; he complained still of severe pains in chest. Soon after, he died quite tranquilly.

b, P,M, — Brain was pale, bloodless, and softer than natural ; ventricles contained a minimum quantity of serum \ sinuses distended with dark fluid blood. Lungs dark red \ in r. many patches of extravasation ; sub-pleural and mediastinal cellular tissue presented same appearances ; much bloody serum in pleura, and some in pericardium ; heart soft, 1. ventricle empty, r. and large veins full of blood, fluid or loosely coagulated. Liver enlarged, fatty, and perfectly bloodless, as also was spleen. In stomach much thick mucus adhering to lining membrane, but no inflammation here or in other parts of alimentary tract. Some sub-peritoneal ecchymosis on intestines. Cortical substance of kidneys was granular \ Malpighian corpuscles showed as red points; on microscopic examination rete mirabile was found injected^ and uriniferous tubules blocked up with exudation matter. Mucous membrane of pelvis of kidneys showed some ecchymosis. Bladder contained a little cloudy urine. (Nitsche, Amer, Journ. of Med, Scy Jan., 1858.)

1. a. Marie S^, set. 31, servant, muscular and robust, entered hospital Jan. 2ist, 1859. On previous d. she steeped two boxes of matches in hot water for an h., and drank the liquid at 6 p.m. after stirring it. In | h. acute pain behind sternum and in epigastrium.

Towards 8, several vomitings of food, phosphorescent. By t i pai had spread all over abdomen. Towards m., vomiting containinn blood. She was given magnesia in water. At 9 a.m. her state was as follows : — Breath alliaceous ; no buccal lesions; pain behind sternum; acute pain — both spontaneous and on pressure — in whole abdomen (which was distended), but especially at umbilical region ; frequent desire to micturate, and pain in act ; pulse 72^ feeble. Face is little altered ; patient only seems fatigued, Some tepid water with white of egg caused several vomitings containing a little blood. 22nd. — Odour gone from breath, dysuria and vomiting ceased, several stools (she had had a purgative enema). 24th. — A vomiting without blood-tinge, a semi-liquid black stool, rectal tenesmus ; constant abdominal pains. (Cupping and poultices.) 25th. — No vomiting; otherwise same. 26th. — Constant rectal tenesmus ; liquid bloody stools ; vomiting of nearly pure blood, of dark colour. Liver is felt slightly beyond false ribs, tender on pressure ; heart-sounds distant and dull, its beat feeble^ but not abnormal ; brain quite clear, but patient feels very weak. (Stimulants and astringents.) On the following days patient's condition seemed to improve ; abdomen remained large, but less tense ; no more vomiting ; rectal tenesmus less ; abdominal pains had much diminished, save for an occasional colic preceding a stool containing a little blood. She had grown thin, and was weak, but not prostrate. She now stated that she was pregnant, and had seen nothing since November. Cervix uteri was accordingly found soft aiid closed. There had been no blood from the vagina ; nothing, therefore, to make one dread a miscarriage. Feb. 9th. — l^cappearance of blood in stools. I ith. — Vomiting, or rather regurgitation without effort of nearly pure blood J very abundant epistaxis, and haemorrhage from both ears — blood from all being very fluid and coagulating with difficulty. On the following days patient still threw on a little blood by the mouth, and there was always some in the stools. 14th. — Urine now tinged with blood. (Ice and cold affusions.) With return of hemorrhages nervous phenomena appeared — at Rrst, pain and numbness in I. arm, then in other limbs, cardiac pains, constriction of throat, and stiHed feeling. 16th. — Vesical tenesmus ; pains in kidneys and hypogastrium ; always blood in stools, and sometimes nothing else {very fluid) ; still blood in urine, and occasionally in sputa. 17th. — To-day a slight yellowness appeared on face and limbs (not in sclerotics), and on the following days became more pronounced j urine was not icteric, and hemorrhages nearly disappeared. On 27th, however, they returned — with stool and urine, and from nose. By March 1st patient was much weakened, lay supine, voice nearly extinct, eyes half closed, lips white ; pulse 70, very feeble, extremities cold. Hemorrhages now diminished again to complete cessation on 6th, but returned on loth through all channels. From I2th to 15th they subsided anew; and patient, less weakened this time, desired to leave hospital.

b. While away her health was fairly good, save that she was weak and easily fatigued, and had neuralgic pains in her limbs. The vesica] tenesmus had departed, but left in its place some incontinence of urine, especially while walking. On JOth blood reappeared in urine rather

freely, and on April ist she returned to hospital. On that d. there was copious vomiting of blood ; but it did not recur, and no fresh loss occurred save (up to 8th) a slight one by the kidneys. On 28th she left again in a fairly satisfactory state, save for some ansemia ; incontinence and neuralgic pains had disappeared. She subsequently had copious uterine h:rmorrhage early in July, but went on to full term, and was delivered without accident. She had scarcely recovered, however, when she was seized with diarrhcea — not sanguineous, which nothing would arrest, and she died in September. At the autopsy nothing was found amiss but a slate-coloured appearance of the intestinal mucous membrane. (Tardieu, op. cit.)

1. Both the symptomatology and also the processes of the deleterious action of Ph. have been dcHncd through the great activity of a large number of meritorious investigators, who have proved that by it sooner or later a fatty degeneration of the liver, kidneys, stomach, and heart, of the voluntary somatic muscles, of the non-striated fibres of the muscular tissue of the intestines, and even of the parenchyma of the lungs, is brought about, and that numerous sanguineous extravasations arc found throughout the body. I have examined a considerable number of cases of acute poisoning with Ph., and should like to give a prominent place to the fact that it is not only the central organ of the circulatory apparatus that is involved in the fatty degeneration, but also the peripheral parts of the arterial system, even as far as the minute microscopic vessels. This can be observed in all the organs, but most easily in the brain, in cartilage, in the marrow of the bones, and in the liver. The principal symptoms of it are the sanguineous extravasations. "When in a woman the poisoning occurs just before the menstrual periods, the physiological hypcraemia of the sexual organs strains the parietes of the vessels, which are lowered in their power of resistance by the fatty metamorphosis, and the haemorrhages become more severe, often so severe that general anzmia is a consequence. The blood from the uterine walls escaping, we find at the autopsy only a more positively hremorrhagic condition of the lining mucous membrane. It is, however, different in the ovaries. Here real bloodtumours are formed, and as probably the haemorrhage does not occur all at once, but gradually, these at first remain within the ovary, gradually enlarging its circumference j not until later are they voided, either into the peritoneal cavity or — when adhesions have been formed — into the rectum. The process attains its maximum when highly vascularised connective tissue has been formed about the uterus in consequence of a pre-existing perimetritis ; then the haemorrhage is not only into the ovary, but also from the numerous thin-walled and now fattily degenerated vessels of the new tissue. In 1870 1 had an opportunity of bringing before the Berlin Obstetrical Society 4 cases of poisoning by Ph., and of exhibiting preparations showing hematoceles of sizes varying from that of a cherry to that of a man's fist. In two of these cases they lay within the ovaries; in one there was a breaking up towards the pelvic cavity ; and in the fourth perforation into the rectum had followed. (Wegner, Firchow^s /ffchiv^ Bd. Iv.)

i^. a, Marie M — , art. 34, married, was confined May 25th, 1864.

5-

All went well till June i6th, when on account of some domestic troubles she determined to poison herself. She macerated in water for 24. h. the heads of a box-full of matches, and took the solution at 4 p.m., in her haste swallowing also some of the match-heads. There followed immediately acute pain along alimentary tract, but no vomiting or stool. At 8 a medical man who was summoned ordered an emetic, which acted freely upwards and downwards ; and this went on during n., with some relief to the gastru-intcstinal pains. On 17th, m., she had profuse cpistaxis. She was taken to hospital, where M. Vernay saw her at 4 p.m. General condition seemed to have been good, and mind was unimpaired. Bad taste (as of Ph.) in mouth ; sen&c of burning along throat and gullet; acute pains in abdomen, but especially at epigastrium ; belly lax, not distended with gas, but least pressure aggravated pain ; no nausea or vomiting since n., one stool in m. Acute frontal headache; she is drowsy, but cannot sleep; general bruised feeling; weakness; very distressing sensation of lassitude in arms and legs ; neither anaesthesia nor hyperesthesia. Slight cough, causing a little pain at base of sternum ; but no physical signs in chest (or heart). Face pale, anxious ; skin moist ; pulse soft, compressible, regular, 72. (To drink egg water, and to have a purgative enema.) i8th. — Sleepless but quiet n. To other symptoms is added very sharp pain in renal region. No stool. (Castor oil and enemata.) 19th, — A stool on previous e. had calmed somewhat the gastric pains. Headache constant ; insomnia ; pains in legs ; no fever. (Same, and milk with magnesia.) 20th. — Sleep restless ; colicky pains, and those in renal region very acute ; headache, nausea, very painful sense of lassitude. 2ist. — Last n. free evacuations upwards and downwards, which have much diminished the colic ; but headache persists, and she had during n. two very painful and long-lasting cramps in calves. (Stop magnesia.) 22nd. — A little better ; complains only of headache and some renal and epigastric pains ; limbs, especially legs, feel bruised. (Rice soup.) 23rd. — Pains worse ; nausea ; nervous twinges, which she attributes to emptiness. (Chicken.) 24th. — Had yesterday a slight hxroatemesis, which has relieved her ; prostration more marked ; sharp pains in epigastrium and kidneys j headache ; more pain in limbs. (Pcrchlorideof iron.) 23rd. — Catamenia appeared slightlv yesterday ; blood pale. Colic sharper, nausea, diarrhtra with blood. For first time liver tender on pressure ; does not seem enlarged. Urine scanty and albuminous. Headache less, but pains in limbs — especially legs — worse; patient feels as if something were gnawing the bones. Sensibility intact; no fever. 26th. — Vomited this m. lOO grms, of pure blood, was relieved but weakened thereby ; legs more painful, she can scarcely stand upright ; stools always copious and bloody. (Continue iron.) 27th. — A fresh harmatemesis this m., like that of yesterday j sharp colic, numerous bloody stools with tenesmus ; pain in liver and kidneys (especially r.) more acute; no jaundice ; increased prostration. 28th. — Blood from stomach and bowels, and with urine ; greater hepatic and renal pains. 29th. — Enterorrhagia with very painful tenesmus ; weakness more marked. 30th. — Same j more hicmaturia ; slight pain in eyes, feeling as of sand below upper lids, vision somewhat troubled.

conjunctivae of a dead white, pupils normal. July ist — 3rd. — Same; ansemia very pronounced ; pulse sphygmographically normal. 4th. — Yesterday e. somewhat copious h;ematemesis ; in n. 3 very painful cramps in legs ; headache ; sleeplessness ; great weakness ; blood with stools and urine ; a slight icteric tint over surface. 5th. — Same state ; sight much affected, with dazzlings, cannot see to thread a needle, iith. — Sanguineous diarrhcea has ceased, and is replaced by constipation, but colic persists, as also hepatic and renal pain ; copious haematuria ; pains in legs; icteric tint more pronounced. lyth. — Some improvement; appetite and strength better; otherwise as on nth. 2 1 St. — Urine always very scanty and bloody, and its emission accompanied with acute pains in kidneys ; till this m. she had passed no urine for 2 d. 25th. — General condition, including sight, now very fair, but urinary symptoms continue; liver is tender to pressure, and skin is decidedly icteric.

h. She now left hospital. Hsematuria gradually diminished, and ceased early in September. Hsmatemesis recurred only on Sept. 28th, after emotional disturbance. Jaundice and hepatic tenderness persisted longer, but at last disappeared. Since her confinement catamenia have occurred regularly, but are very scanty. (Tardieu, op. cit.)

1. M. J — , sempstress, set. 29, affected with syphilis, resolved to poison herself on the n. of 27th March. She soaked a number of heads of Ph. matches in water, and drank the mixture. During n. and following m. vomited copiously. Seen 30 h. afterwards. — Temperature and Circulation. The first 5 d. her temp, rose slightly in e. and in m. was normal. Pulse ranged from 104 to 120. On 6th d. she got remittent febrile symptoms, which reached their acme on the 8th d., e. Then the temp, rose to 406° C. Pulse 136, very small and weak. Thereafter the temp, declined, 9th d., m., 38-6°; e., 387°; 12th d., e., 392°. Pulse, 9th, e., 96; 12th, e., 112. With the 12th d. the fever became more intermittent, rigor with increased temp., which gradually fell. — 13th d. after poisoning. 1st rigor came on 8.15 a.m., lasted 20 m. Max. temp. 418°, pulse 144. Temp, fell with advent of profuse sweat to 40'i°, rose in e. to 41°. — 14th d. 2nd rigor, m. Max. temp. 406°, pulse 112 ; temp, fell in profuse sweat, e., to 379°; pulse 96. — 17th d. 3rd rigor came on e., lasted 25 m. ; temp, not observed. — x8th d. 4th rigor, m., lasted 30 m. ; temp. 41°, pulse 140. Temp, fell, e,, to 388°; next m. to 382°, with pulse 84. There was then a cessation of fever till 32nd d. 5th rigor, m., slighter, and duration less than formerly. Max. temp. 389°. With sweat, temp, fell, e., to 378°. — 36th d. 6th rigor, m. ; max. temp. 383° ; fell, till next m., to 37°. After this the temp, was very low for a considerable time, 364° to 36-1° m., 368° to 369° e. Then 4 weeks elapsed without any fever. — 63rd d. 7th rigor, lasted 20 m. Temp. 37'4°. — 65th d. 8th rigor. Max. temp. 383°, fell during sweat to 374°. — 71st d. 9th rigor. Max. temp. 384°, fell, p.m., during sweat, to 364°. — 79th d. loth and 12th rigors, ist, 8 a.m. ; 2nd, 10 a.m. Max, temp, 38-1°, fell, p,m., to 367°; next m. to 362°. — 89th d. 1 2th rigor. Max. temp. 384°, fell during sweat to 370°. Then came 3 paroxysms in which the temp, never exceeded 38°. — 129th d.

1 6th rigor. Max. temp. 38-8°, fell, p.m., to 36-4^. — 130th d. 17th rigor. Max. temp. 38*, fell 10 37*^. — 143rd d. i8th rigor. Max. temp. 378°. — 144th d. igth rigor. Max. temp. 378°. — 146th and 149th d. 20th and 21st rigors. No particular rise of temp. For the next 3 weeks during which the patient was in hospital no more paroxysms occurred. — Icteric symptoms, 3 d. after poisoning skin quite dry, 4th d, it had an icteric lint, the conjunctivae more yellow. — lOth d. The skin began to perspire. The icterus increased until 17th d., then gradually subsided till it disappeared on the 48th d. The urine on the 4th d. was slightly coloured with bile, and showed a little albumen ; its quantity decreased and sp. gr. increased. The bilious discoloration continued Co increase, but albumen could not always be detected. On i8th d, the urine became more copious, was of a brownish-green colour, sp. gr. 1009, albumen present. With the 20th d. the urine became clearer, the biliary colouring matter less apparent. After 30th d. only some albumen and biliary colouring matter appeared in small quantity. Between 35th and 38th d. there w.is strangury with urgent call to urinate, which the patient could not satisfy. As soon as the urine is passed the urging recommences. The urine is clear and very acid. — Sensorium. On 5th d., when the icteric symptoms were getting worse, there was great delirium, which lasted till the 7th d. She forgets to pass urine, respiration very laboured, very small pulse, dry skin, and brown furred tongue ; says she is quite well. The nights were mostly sleepless. From lOih d. the sleep improves, and her mental state also. On the 15th d. there is still a dazed feeling in head, with great exhaustion, and on 18th a manifest improvement sets in, with the decline of the icteric symptoms and the diuresis. This improvement continues till the 38tn, when the patient wishes to get up. — Peculiar symptoms. Copious epistaxis occurred on the 7th, iiih, 14th, 20th, 22nd, and 33rd d., and latterly was always attended with profuse sweat. A pustular eruption appeared on forehead on 20th d., which on the 22nd extended over face; the pustules were the size of a hemp seed and surrounded by a broad red areola ^ their centre was a hair follicle Ailed with pus. Ecthymatous pustules appeared on the nates and about anus, and some d. later on the I. natis a boil the size of a hazel nut, which discharged brownish bloody pus. This was all perfectly healed by the 32nd d. — On the 58th d. the menses, which had been absent 9 weeks, came on, the next time 27 d. afterwards, and the third time 21 d. after that. On the 105th d. after the poisoning there came on a gumboil in the 3rd r. carious upper molar, which caused the cheek to swell. — Stomach and bowels. Immediately after the poisoning there was copious vomiting, afterwards nausea, great tenderness of epigastrium, dry tongue with brownish-yellow coat distension of abdomen, firm and lumpy stools of a clay colour. Purgatives caused copious stools of the same colour. On the 3rd d. there were 3 stools, 4th d. 8, sth d. 6, 6th d. 3, 7th d. 3, some liquid, but most firm. After leaving off the purgatives the bowels became very sluggish, and could only be moved by enemata, which brought away copious evacuations, very loose, consisting partly of white, partly of yellow farces. About the loih d. the tenderness of epigastrium ceased, the

tongue became clear and moist. During the 1st and 2nd ague fits the epigastric tenderness increased^ and there was on both occasions great vomiting of greyish-yellow half-digested food, and this was generally observed during subsequent rigors. From the i6th d. the stools became coloured with bile, and occurred without enemata about once a d. On the 23rd d. the tenderness of epigastrium gone; on the 25th d. the appetite returned. A few d. later there was constipation, which was overcome by castor oil and enemata. There were symptoms of accumulation of faeces in colon descendens, tenderness to pressure above 1. lig. Poupartii, and abnormal resistance in 1. iliac region. The oil brought away hard balls of fseces well coloured with bile. On the 40th d. there occurred quite watery stools mixed with purulent and cheesy masses, occasional vomiting, tenesmus ; the stools are always more or less coloured with bile. These symptoms lasted till the 60th d., and then constipation again set in, which was removed by purgatives. The bowels only became regular after the xi2th d. — Liver. Within the first 4 d. there was painfulness on pressure in the hepatic region. On the 5th d. the dull percussion sound became more extensive. On the 6th d., e., the lower border of liver can be felt just above the navel. On the 7th d. the extreme boundary of the 1. lobe is 3" from the median line, the dull hepatic percussion sound is heard behind 5th rib, in mammillar line. The liver after this never grew larger, the painfulness on pressure declined, it only increased during the rigor. On the 17th d. the percussion sound of the liver became less intense, its upper boundary is still at the upper border of the 6th rib. A marked decrease in the size of the liver was observable from the 23rd d. ; the lower border is perceptibly higher up, and cannot be felt so easily. On the 36th d. the size of the liver is nearly normal, the upper boundary is at the lower border of the 5th rib, its lower border reaches 2 inches below the ribs on the r. sternal line, i^ in. in parasternal, i inch in mammillar line. On the 79th d. percussion showed the liver to be abnormally small. The lower border does not project below ribs. On the 98th d. the spleen shows an increase in size. — Respiratory apparatus. In the early days very decided increase of frequency of respiration, apparently owing to the tenderness in the abdomen \ auscultation showed only rare catarrhal rales posteriorly and in r. side anteriorly. Soon a frequent dry cough came on, with scanty expectoration branched like the bronchial tubes. (nach den Bronchien verzweigten Auswurf) , and the catarrhal sounds in posterior lungs, especially the r., increased. On 13th d. (ist rigor) percussion shows slight dulness posteriorly in lower part of r. lung, with masked respiratory murmur and fine rales. Change of posture alters the line of the dulness ; diminished fremitus under line of dulness on r. side posteriorly, from 9th dorsal vertebrae downwards. 14th d. (2nd rigor), the dulness i^ inch higher, bronchial respiration in the dull part. 17th d., the height of dulness somewhat lower, and the expansion of the lower border of the r. lung posteriorly is obvious, on deep breathing. The rales diminished, but the cough continues unabated ; it comes on in paroxysms, brings up a viscid muco-purulent expectoration, branched like the bronchial tubes ; after every rigor the

paroxysms of cough increase. 50th d. Nothing abnormal in physical sounds of respiration, but there is still great irritation to cough, which only goes off at a later date. Heart showed no important physical abnormality. The second (arterial) sounds were at first very weak ; in the Hrst weeks a very rough first sound was heard over the pulmonary artery. (Knoevenagel, BerL klin, IVochensch.^ April 19, 1869.)

1. Louisa K — , aet. 19, came into hospital July 4th, 1863 ; confessed on nth that on the 20th June had taken a quantity of tops of Ph. matches, dissolved in hot milk, which she drank when cooled in e., making two draughts of it. Soon she vomited for \ h. Slept well at n. Next m. appetite gone, frequent eructations, sense of fulness and pressure in gastric region. After 2 d. these symptoms declined, and the stools were retarded. After 3 d. skin coloured yellow and this gradually increased. Appetite returned to normal state, and she could do her work. For the constipation she took pills. — ^July 2nd. Observed slight swelling of joints, and the next d. the swelling had spread up legs to abdomen. The 1. labium majus was much swollen when she came to the hospital. — 5th. Skin and conjunctiva deeply jaundiced. Upper extremities and 1. labium majus cedematous. Pulse m. 88, e. 96 ; temp. m. 377° C, e. 382°. Abdomen much distended, tympanitic all over, also in r. lumbar region, dull sound in I. lumbar region. On account of this distension the size of liver could not be determined. Spleen enlarged. Tongue clean, appetite so ravenous it cannot be satisfied. Stools clay coloured, partly soft, partly lumpy. Urine deep yellow, sp. gr. 1007, little albumen, much bilious colouring matter. Breasts and uterus show she is pregnant. — 6th. M. temp^ 36-9°, pulse 96 ; e. temp. 379°, pulse 100. Abdomen more distended, fluid can be detected. Patient slept well. One pultaceous clay-coloured stool. Urine not so deep coloured, — 7th. M. temp. 37'7°> pulse 100 ; e. temp. 39'7°, pulse 120. Patient tossed about at n., and called for food to satisfy her hunger. Icteric hue remains. Lies all d. with closed eyes and sleeps much. Complains of headache, answers questions hesitatingly. Pain on percussion in middle of abdomen, where, as also in 1. lumbar region, the percussion sound is duller than yesterday. A distinct clearing of the dull sound on percussion. Absolute dulness in r. side, not complete in 1. side. The only tympanitic sound in abdomen is in its upper part to the 1. of the navel. In chest posteriorly slight dulness of both lungs where the respiratory murmur is diminished. — 8th. M. temp. 375°, pulse 100 ; e. temp. 378°, pulse 104. Last n. very talkative and restless, rather delirious the first part of n., became quieter afterwards. This m. she is quite sensible and seems well. Abdomen still rather tympanitic ; 2 stools whitish in colour and of pappy consistence.— 9th. M. temp. 373^5 pulse 112 j e. temp. 40°, pulse 132. Last n. raved much and made a great noise. This m. she looks stupid, answers irrationally. Some effusion in peritoneum is perceptible. One stool. The cedemaof labia majora, especially the l.,is increased ; latter has become gangrenous. At noon she had a rigor, followed by great heat ; in e. is delirious. Tenderness of hepatic region on percussion. Liquid stool of a yellow colour. — loth. M. temp. 389°, pulse 130; e. temp. 38*1°, pulse 116. Raved much deliriously in the n. This m. quieter

but sings in a low voice. Abdomen continues the same. Yesterday she had a large pultaceous stool, of yellowish colour, bilious. During n. and this m. has passed several similar stools. After puncturing the labia they collapsed ; aromatic infusion was applied to the gangrenous part. P.m. 2 stools, partly dull yellow, partly bright yellow. — nth. M. temp. 369°, pulse 100, e. temp. 394°, pulse 120. Was quiet last n., and slept the greater part of it after an opiate. About 3 a.m. had a violent rigor, which lasted 25 m. and was followed by heat. Is quite sensible, appetite not disturbed, tongue not furred, no increase of thirst. Abdomen still tympanitic. Liver not painful on strong pressure. A yellow stool in the n. — 12th. M. temp. 37'8°, pulse X16 i e. temp. 396% pulse 120. She had i gr. opium and slept well, no delirium. This m. still rational. Complains of nothing, appetite holds good ; 2 stools yesterday and i in m., of a greyish colour and moderately consistent. Urine of reddish colour, contains biliary colour, ing matter and a larger quantity of albumen than before. The gangrenous sloughs are beginning to separate. This caused p.m. a considerable haemorrhage from the labium majus, which was arrested by chloride of iron. — 13th. M. temp. 367°, pulse 112; e. temp. 396°, pulse 140. After i^ gr. opium she slept soundly and was not delirious. This m. rational. Yesterday many pultaceous and yellowish stools. 8.30 a.m., a rigor. In r. side of thorax, posteriorly and inferiorly, there is some dulness with slight bronchial respiration, and consonant rales. At the base of the heart a blowing systolic sound is heard. Ecchymosis in abdomen, on the thighs two pustules with bright red areolae and dusky centre. The liver does not project beyond the border of ribs. In the afternoon labour pains came on suddenly, and a foetus of about 6 months wasquickly expelled. — 14th. M. temp. 39'5°,pulse 124; e. temp. 39*8°, pulse 136. Last n., after \ gr. opium, she slept quietly, but before dawn she had a rigor. She is quite sensible, and complains of pains in chest and r. side of abdomen. Percussion on the lower half of the r. side of chest posteriorly gives a kind of dull tympanitic sound ; bronchial respiration cannot be distinctly perceived ; many medium and small rales, rather dry, distinctly consonant i in the lower half of the 1. side of the chest, the respiratory sounds are sharply vesicular, with some medium-sized moist rales. No expectoration. The systolic murmur in the heart is less than yesterday, not audible at all in apex. Abdomen very much distended. Percussion in hepatic region as before ; signs of increased effusion into peritoneum. Some foetor from vaginal discharge. There have been two or three stools of a grey colour. Pulse of medium tension. All p.m. she spoke and sang in a quivering voice, and showed much restlessness. Complains of abdominal pains; the whole belly is painful when pressed. In spite of fomentations the pains increased. Next n. she was very delirious ; towards m. she became quiet, and died about 6 a.m. — P.M. on the i8th. Endocardium stained with blood. Heart's valves act normally. A large quantity of ascitic fluid of an icteric colour. In the fundus of the stomach beneath the m.n>. there are depressed spots of the size of a pin's head, and of a dusky blackish colour. Liver very lax ; gall-bladder collapsed, contains only some bile-tinged mucus.. The length of the liver is 11", r.

VOL. Ill, 38

lobe 6", 1. 5" ; its greatest depth in the r. is 6i", in the I. 5i" ; thickness, r. 1 1", I. J". The colour of the r. lobe is reddish, of the 1. blackish yellow. In the yeliow parts there appear some haemorrhagic points, as also upon the yellow parts of the peritoneal covering. In the yellow parts the hepatic tissue is extinct, whilst in the red parts the hepatic lobules are still visible. Their periphery is grey, and between this and the yellow cortex a reddish zone is perceptible. Spleen much enlarged, length 9", breadth 4^", thickness i|" ; its substance is of a bluish-red colour, its connections soft. R. kidney enlarged, length 54", breadth 2J" ; when cut through it has an icteric appearance. Its pyramids are a little more congested than the cortical part ; they are rather opaque, and show a twigged form (delincationem virgatam). In the straight canaliculi many air-bubbles can be seen. L. kidney, length 4^", breadth 7!* ; same appearances when cut into. The capsule.s of both are easily detached. The uterus of large size, containing bloody mucus. Some ecchymoses in peritoneum. The intestinal m.m. is normal \ it contains a greyish fluid. The muscular substance of heart has a greyish-red colour. (F. A. Weihe, De Intoxicat Phosphor. Acut,^ Diss, inaug., Berolini, 1867.)

1. X — , a woman £t. 45, swallowed the Ph. from 120 matches in water. Half an h. later she was seized with violent vomiting, brought up almost all the poison, and, not wishing to betray herself, said nothing about it. After 3^ d. Dr. Ozanam was called to her. He found the following condition : — The general aspect was that of a typhoid febrile state, with profound prostration. Patient can with difficulty raise herself, and complains of vertigo. The tongue is red, dry and coated ; much thirst. Stomach sensitive ; patient had vomited several times each d., but had not taken much notice of it, as she often vomits when in her ordinary health. Pulse 90, skin cold j respiration painful, though no rales were found j there was a wellmarked bruit with first sound of heart \ urine red and scantv. Neither urine nor breath smelt of Ph. Next m. patient was less restless, pulse 90, slight general yellowness commencing to appear in eyes, chest and limbs; had vomited twice freely. The vomited matter was black like soot. It was chiefly fatty matter and blood-cells^ mostly altered or even changed to shapeless molecules ; it was acid. No other haemorrhage found, or brown patches of skin, as is sometimes the case j patient complained of frequent palpitation. She did not appear to suffer much, and only asked to drink, calmly remarking that the poison had done its work, and that it was too late for remedies. She died on the 7th d. {UArt Med., xix, 146.)

2. A man, set. 58, had been employed for 3 years in making Ph. matches. Though his working- room was also his living-room, he never felt any bad effects until one d. a quantity of Ph. took fire, and in his efforts to extinguish it he inhaled so much of the vapour that he felt suffocated and fainted. Soon after this he felt extremely weak in back, as though he should fall in a heap; thereafter weakness of limbs^ so that he tumbled when he walked or attempted to grasp anything ; later, sensation as if something twitched under skin or was creeping betwixt

skin and flesh. The genitals were more excited than usual at first, but after a few months he was unable to have erections. Functions in other respects normal. On coming into hospital his state was : — On standing his limbs trembled and knuckled under him, he could only walk a few steps, staggering and uncertain j his arms trembled when he grasped anything or held them extended. When he lay quite still the muscles of all the body, especially those of the extremities, appear to twitch up and down under the skin ; but the whole muscle does not twitch, only single bundles of fibres at different times, like playing on a piano. If they are quiet for an instant the slightest touch suffices to set them going again. It is these movements that cause the feeling of something creeping under the skin. The weakness of the back is such that he cannot sit upright. The tongue when speaking often refuses to move, so that he stammers. Pulse I12. Sulphur vapours and alcoholic baths, strychnine, &c., did no good. [Huss, Schwedische Hygea, 1884 ; A. h. Z., xxxiii, 58.)

1. A tradesman was engaged in unpacking large quantities of Ph. matches. He became suddenly so ill that he had to abandon his work. He had much nausea and vertigo. He had to lie in bed for several d, j whenever he attempted to rise, the vertigo made him fall back in bed. Thereafter he became emaciated, and his skin became yellow. Even after he recovered his skin retained a yellowish hue. For a long time he had anorexia and sleeplessness. (Goullon, /num. horn. Preae^ x, 496.)

2. Philip S — , xt, 2^, was suddenly attacked by weakness and exhaustion, complained of violent pains in stomachic region, slept restlessly, lost appetite, had occasional vomiting, perspired profusely, and grew perceptibly thinner. These symptoms had lasted 1 1 d. It was found that the child had been in the habit of playing with Ph. matches, which he sucked. The patient's skin was very pale, as also the mucous membranes ; he was very weak and faint, but he could sit up and sometimes walk about. Tongue white, furred ; he had frequent retching without vomiting, complained of pains in umbilical region ; he was constipated. Slight catarrh of chest. Very emaciated, perspired also by day, chiefly on head and chest. These symptoms increased day by day, especially the pain, sleeplessness, and weakness. On the 8th d. of treatment the gums appeared swollen and had a dirty brown coating 9 they bled readily when touched, and also spontaneously ^ the teeth had become grey, the m.m. of cheek showed several hicmorrhagic erosions, the breath was very foetid. It was now discovered that all this time he occasionally sucked the matches. On keeping the matches from the child and giving appropriate treatment he gradually recovered. (Kraus, AUg, IViener med. Ztg.^ '857, 5 ; in Sorgc.)

3. A girl, xt. 34, ate some Ph. paste. At first slight sickness, little or no pain, no fever, but constant thirst, apathy, then convulsions and coma, jaundice with white stools, dribbling of coffee-grounds-like fluid from mouth, death on 5th d. — P,AI. Liver much enlarged, and in a state of acute fatty degeneration. Heart and kidneys felt greasy on section. On 31'd d. no albumen, but some sugar was found in urine. (GroSE, Lancet, Nov. 2nd, 1889, p. 302.)

4. CoNCATo relates a case of poisoning with Ph. matches which terminated fatally on the nth d. Soon after taking the poison there was pain in throat and oesophagus. Stomach symptoms came on much later, there was never any increase of temperature or of the velocity of the pulse till shortly before death, when it ran up to 146 ; peculiar odour of breath, urine and sweat, constant green colour of stools, though there was great icterus, P,M, showed destruction of m.m. of oesophagus, of anterior wall of pharynx, and of epiglottis ; m.m. of stomach and duodenum intact, gall-bladder and gall-passages empty, increased size of the Brunner's and mesenteric glands, atrophy of liver, increase uf white blood-corpuscles, and diminished size and change of shape in red corpuscles hsematoidin crystals in liver, fat cells and margarin crystals in softened spleen. The urine contained biliary acids. {Virchovj and Nirsch's J ahresbericht^ 1868, i, 311.)

5. A child of between 2 and 3 had been caught in the act of sucking and swallowing the heads of lucifer matches. 2 d. afterwards she appeared unwell -, there was some feverish excitement, but no active symptoms — no pain, vomiting, or diarrhoea. 5 h. after she was first seen she became violently convulsed, and died 3 h. later. On inspection a quantity of mucus mixed with blood, of a coffee-ground colour, was found in the stomach. The mucous membrane of the organ was very vascular throughout, and for the space of 2 in. it had a florid red colour, and was covered with mucus. There were no less than 10

nvaginations in the small intestine, many of which included 2 — 3 in. of intestine, which was inflamed at the invaginated parts. There was no appearance of strangulation, and the bowels were empty. (Shephard, Lancet^ Dec, 1843.)

1. ViRCHow says that he does not agree with those who deny gastritis as an ordinary effect of Ph. poisoning. Sometimes it is unaccompanied by redness or hyperemia, or extravasation, and there is complete paleness of the parts after death. The m.m. is moderately thickened and of a peculiar muddy appearance, opaque whitish, or greyish or yellowish white. This swelling has its seat in the mucous glands, which are enlarged ; their epithelium fills the gland-ducts almost completely, and each single cell is larger, duller, filled with a fine granular mass, which by refracted light appears yellowish grey, by reflected light whitish. Later fat globules appeared, the cells became soft, broken down, and only granular detritus remained. There is here serious disease of the stomach glands, a gastritis glandulosa, or gastradenitis. {Firchow^s Archiv^ xxxi, 400. 1864.)

2. A scrofulous girl of 7 used to play a great deal with lucifer matches, lighting them, &c. Gradually a red swelling appeared upon under part of chin ; at first size of a fourpenny piece, it quickly enlarged till it extended over face as far as eyes, becoming pale and doughy, however, as it left the chin. Upon original spot a groupof pustules formed, from which — on their breaking — resulted an ulcer, size of a sixpence. At same time parts beneath became disorganized into a thin, slightly discoloured, ofl'ensive, purulent mass. A disagreeable smell emanated from mouth. Teeth, especially front ones of both jaws, became loose, and salivation set in. The child from the commencement complained

much of toothache and headache. Within 8 d. ulcer had destroyed soft parts, even to the bone. After removal of cause and suitable applications, in 1 0 d. 3 thin pieces of bone, size of a bean, came away, and on following days other small, very thin fragments of bone were observed upon the dressing. Upon this sanious discharge ceased, and ulcer in 3 weeks had cicatrised. (Pluskal, Oest. med. fp^ochemchr,^ July, 1846.)

1. Since the establishment of the phosphorus-match manu^ctories, workpeople have occasionally been received in the hospital (de la Pitie) from them. All these patients agree in saying that since they went into the manufactory they have been affected with cough ; they only seek admission when the cough has become habitual, grows worse, and is complicated with all the symptoms of acute bronchitis. In its nature this bronchitis does not differ from the ordinary kind ; but the array of symptoms with which it is conjoined is different, inasmuch as functional derangements of other organs are present at the same time. Even those patients who are affected in a slighter degree are in a state of excessive weakness ; they complain of want of appetite which they allege occurs to them at the very commencement of their work, and at the same time as the cough. Others suffer at the same time from diarrhoea ; the greater number from fever, even though there is no inflammatory chest affection present. Those who have been often affected with inflammatory pulmonary catarrh (and these constitute the majority) are strikingly emaciated, and sometimes suffer from palpitation of the heart, although neither heart nor large vessels are diseased. Their recovery from the attacks is very slow, and emphy. sema of the lungs often remains behind. (Gendrin, in v. Bibra und Geist, Krankh, d, Arb, in den Phosphorzund- Holxfahr'tken, 1847.)

2. J. Z — , aet. 52, tall, thin, but well made, with broad chest and robust constitution, had been engaged for 9 mo. in a match manufactory. At the commencement of his occupation he was affected with dry cough, which however went off when he put on warmer clothing and took some diaphoretic drinks. After 6 mo. he fell ill with the same symptoms, which were this time more severe, and at length compelled him to abandon his occupation. On examination, his face appeared congested ; forehead covered with perspiration ; tongue furred \ taste slimy ; frequent excitement to cough, with flying shootings under sternum and towards r. side of chest ; copious muco-purulent expectoration, with constant tickling and scratching sensation at bifurcation of trachea; anxious, short, and hurried breathing, with elevation of whole thorax, and especially of 1. side. Percussion gave a clear tone in middle of r. side \ auscultation revealed diffused mucous riles with pectoriloquy. Pulse was rapid, full, and hardish ; skin dry and hot \ thirst increased. Besides these, great depression and debility. No gastric symptoms. After antiphlogistic treatment and expectorants, he slowly improved, and sputa became mucous only; but great debility and depression, with anorexia, still remained, and required a lengthened course of quinine to remove them. (Geist, in ibid.)

3. a. The mo«t notable effect of the action of the Ph. fumes on the workpeople is the development of a peculiar disease of the jaw-

SqB

bones. The first symptom is toothache. This begins after having been in the factory from 6 mo. to 12 years (one case, however, occurred after only 5 weeks) ; it attacks one or several teeth, or in some cases spreads over one side of the jaw like rheumatic faccachc. Only in the rarest and most severe cases it attacks both sides. It is characterized by gnawing, throbbing pain, alternating with violent shooting, sometimes intermittent and sometimes continued. In some cases it comes on as soon as the occupation is commenced, lasts a few weeks, then leaves the worker for months or years, but afterwards recurs several times, until at length the more deeply-seated affection breaks out. With the exception of but few cases, in which the patients had not directed attention to the subject, or the teeth were extracted before coming under observation (as not unfrcqucntly happens), it was ascertained that it is decayed teeth in which the pain commences, and whence it seems to extend. With the toothache, according to Neumann's observations, in some cases itching of the gums occurs. After this toothache has lasted for weeks or months, it spreads over whole side of jaw in which the carious tooth is situated, and in more severe cases over face and neck of same side. In some cases the cervical glands swell and become painful -, the gum surrounding the diseased tooth reddens and swells, as also the cheek, and sometimes the soft palate. In other cases there is formed, amid drawing throbbing pains, a circumscribed phlegmon of the gum beside the diseased tooth -, an abscess is produced, which discharges at first laudable but afterwards grey foetid pus, and changes into an ulcer, which grows always larger by gradual recession of its border. In either case the gums recede, and the teeth, whether carious or healthy, become loose and fall out (according to the extent of the diseased bone). The abscesses now multiply, discharging foetid pus j gums are livid, and undermined with fistulous sinuses^ through which probe detects carious bone ; at last they altogether disappear, and the denuded alveolar processes are seen projecting into the buccal cavity. The cheek, the throat and the parotid may become sympathetically affected.

h. At the commencement of the disease the patients are affected with slight febrile action, lose their appetite, suffer from increased thirst and irregularity of the bowels, constipation being the most frequent complaint. Gastric symptoms are not unfrequently present — furred tongue, slimy bitter taste, pressure in epigastrium with frontal headache. The febrile action may continue throughout the whole course of the disease; or it may go off completely; or, if there are tubercles in the lungs, it may cause them to soften, and turn into hectic.

f. The form of the disease differs according to whether the upper or lower jaw is attacked. In the former it pursues generally a chronic and mild course, ending in exfoliation, cicatrisation, and cure. In the latter the necrosis may be either acute or chronic, but is always severe, and the patients usually die of '"" consumptive fever.'* Of 30 cases, the termination of which was known to the authors, 15 died, [Ibid,) 30. A countrywoman, who had always enjoyed good health, came to work in a lucifcr-match manufactory, After 14. d., during which

she had been employed in dipping the wood spills in the Ph., she

became affected with intolerable dry cough and later with violent bronchial catarrh. She now spent her time between the works and the hospital. On the 5th occasion of her coming into the hospital she suffered from frequent tiresome cough with muco-purulent expectoration^ quick respiration, great oppression so that she had to sit up to cough, at same time severe pain under sternum and feeling of constriction i remarkable resonance in upper third of r. side of chest, with moist sibilant rales ; ribs almost immoveable, thorax distinctly arched. Besides, — complete anorexia, furred tongue, several loose stools perdiem; earthy complexion, emaciation, fever. In others the same work caused cough, difficulty of breathing gradually amounting to violent bronchitis, at first without fever, very wealc pulse, great debility, emaciation, {j^nn. de Therap.y Fevr,, 1846, from jf. h. Z., xxxiii, 58,)

1. J. D — , aet. 21, had been engaged 4 years in preparation o lucifer matches. For 2^ years, further than the laryngeal irritation produced by the acrid fumes he suffered but little. At end of this time, however, he began to cough very much, and to expectorate a thick white mucus. He then suffered much from toothache, which he describes as having become violent, and which was accompanied with considerable swelling on r. side of face. A double tooth was extracted, but without relief; one tooth after another dropped out ; he became so weak that he was unable to walk ; a swelling the size of an egg formed below r. orbit, and in a fortnight burst, discharging a large quantity of white pus. He continued to get worse ; all teeth fell out^ and gums of lower jaw were retracted. On admission to dispensary, May 4th, 1846, r. cheek was considerably swollen. At r. angle of lower jaw is an opening discharging laudable pus, and through which probe can be passed 2 in. along bare bone ; and 2 in. anterior to this another aperture leads to same. On opening mouth whole lower jaw, as far as ascending rami and down to reflection of mucous membrane on cheeks, is denuded and of leaden greyish colour. On upper jaw, r. side, probe can be passed over a portion of bare bone. (Walker, Brit, "Journ. of Horn. ^ iv, 287.)

2. LoRiNSER thinks that in Ph. workers the poison acts on the

i'aws through the blood, and states that individuals under its influence lave a peculiar sallow bloated complexion, combined with a dull expression of the eye and gastric derangement. I have myself observed this remarkable appearance of the countenance in the dipper of a congreve match manufactory, whose jaws, however, were quite sound. (Pereira, op, cit,)

1. Anstie prescribed for a neuralgic patient gr. -^ in pill 3 times a d. He took pills regularly for a week, but during last 2 a, suffered from constant and increasing burning sensation at epigastrium ; urine was dark coloured, and on examination proved to be albuminous and bloody, but without casts. After omitting drug for 2 d. renal symptoms had almost disappeared, and stomach was much easier, though patient still felt a rather burning pain between scapulae. {Practitionery xi, 105.)

in. Experinunts on animals, — i. Bibra experimented on rabbits in three ways, — ist by Ph. introduced into the stomach; 2nd,

by exposure to its fumes so as to induce either rapid or slow poisoning (according to concentration of vapour). The first series merely show the violent irritant action of the poison on the parts with which it came into immediate contact. Of the second the following are specimens :

a. Rapid poisoning, — On October 1 0th an old rabbit was put into the box employed for the purpose. It seemed to be pretty well, ate its food, and showed no signs of uneasiness. On the 20th, however, it was found dead. Dissection showed venous system enormously distended with blood ; r. auricle and ventricle quite filled with a black coagulum, 1. ventricle empty ; lungs much reddened, in some places bluish ; liver congested, but blood very fluid (under microscope normal) ; gall-bladder contained a little cloudy bright green fluid ; intestines strongly injected. Other organs normal. A young rabbit was put into box Oct. 27th ; it died Nov. 4th. Dissection showed circulatory system as before, but lungs almost completely hepatized, very little or their normal parenchyma to be seen, and on cutting into them some portions were found beset with tubercles ; muscular parts much injected ; Stomach and intestines congested only ; liver exhibited some pale spots on surface and throughout substance ; gall-bladder very full, as also urinary bladder. Some of the rabbits that resisted the poisonous effects of the fumes longer exhibited an eruption, chiefly on abdomen, axillae and genitals ; hair fell off, and skin became covered with a scabby humid exanthem. In these rabbits the lungs were always healthy, whereas in the others there was often hepatization and tuberculous formation, and always congestion.

b. Slow poisoning. — On Oct. 8th an old rabbit was put into the box. After 3 weeks it began to emaciate, but did not lose its appetite j suppurating ulcers appeared on tongue and eyelids ; the creature grew dejected and apathetic. It was found dead December 4th. Dissec* tion showed tongue almost entirely covered with ulcerations, and the blepharophthalmia had so much increased that the eyes could scarcely be opened \ there was, however, no sclerotitis. Venous system was considerably engorged ; lungs very much reddened, on some parts black ; gall and urinary bladder both very full ; all else normal. Another rabbit was put in on Oct. loth ; on Dec. 28th it was found dead. After being 3 weeks in box suppuration of r. eye had begun, and increased to such a degree that soon it could not be opened. Dissection showed eye to be sunk, lids adherent, cornea thickened and opaque, pupil filled with pus, but lens and vitreous normal. Veins were full of black fluid blood ; muscular parts injected; lungs in some parts showed venous engorgement only, but were mostly hepatized, and here and there tubercles were observable ; liver rather congested, and gall-bladder greatly distended with reddish-brown bile,

c. In order to ascertain if he could produce in rabbits the disease of jaws met with in the human subject, v. Bibra exposed to the fumes some whose jaws he had previously broken. On their death, after about 8 weeks, a large spongy callus was found around the seat of fracture, presenting exactly the characters of the disease in man. The periosteum also was found much separated from the bone, and the

60 1

whole bathed in unhealthy-looking pus. (v. Bibra und Geist, op. at.)

2, The anatomically demonstrable action of Ph. when given in relatively small doses, incapable of killing either sooner or later, extend principally to two major systems of the body — the digestive apparatus, especially stomach and liver, and the osseous system.''^

a. Let rabbits, cats, or dogs be brought under the influence of Ph. in minimum doses, either by exposure to its fumes or by its introduction in pill form pfr a?tophagum, and the dose be gradually increased (but always short of any obvious toxical effect) ; and very remarkable changes take place. The gastric mucous membrane becomes hyperaemic; it swells j haemorrhages occur here and there, and later on real haemorrhagic infarctions are seen, especially on the summits of the natural folds, where flat pit-like ulcers are found, whose dirty-brown margin and floor show their origin. After the irritation has been going on for months the mucous membrane becomes two or three times thicker than it normally was ; it becomes indurated, and of a difl^use smoke-grey or brown colour that is most evident at the fundus. (Here the microscope shows whole masses of pigment in the form of black-brown granules imbedded in the tissue; the glands prolonged ; and the interstitial connective tissue, which in the healthy condition is scarcely demonstrable, becomes developed into thick broad threads.)

b. Alterations in the structure of the liver go hand in hand with the above. The whole organ is swelled and feels harder, and within it and in the connective tissue around the portal vessels there is an intense cellular hyperplasia and tough fibrous connective tissue is developed from the young cells, constituting a more or less broad stratum at the periphery of the acini. The peripheral zone of the hepatic cells undergoes fatty degeneration, and in the greater part of the acini the cells have an icteric colour, evidently in consequence of the pressure exerted by the new prolifically-developed tissue on the afferent ducts which course with the portal ramifications. In fact, we have interstitial hepatitis in opUma fQrma, the result of which is atrophy of a three-fold kind, — either a smooth induration of the liver ; or (as sometimes seen in syphilitic human subjects) a " hepar lobatum '* with numerous strips of cicatricial tissue dipping deep into the organ and deforming it j or, finally, the typical granular atrophy, the classical cirrhosis. \vi all these forms icterus is present, and in the last we regularly find those secondary disturbances so well known in human pathology — venous hyperjemia of the mucous membrane of stomach and intestines, indurative hyperplasia of the spleen, and finally death from ascites and hydrothorax, (Wegner, Vhchow^i Archiv^ Bd. Iv.)

1. a. Let rabbits be confined for weeks or months in an atmosphere pervaded with the fumes of Ph., and we shall see that, after the primary bronchial irritation has subsided, they get accustomed to it. In the cranial bones we see nothing abnormal except minute and hardly visible osteophytic sub-periosteal deposits on the bones forming

• Wegner did not find pneumonia in anirauls trxposed to the fumes any oftencr than under ordinary circumstances j and tuberculosis ne never obbenred.

the boundaries of the nasal cavities. But in an insignificant minority of them there arises, generally without any evident external cause, a tumefaction on the upper and lower jaws ; the bone pushes out processes, the soft parts often swell monstrously from extensive caseous infiltration, respiration becomes difficult, and mastication is interfered with. The thickening of the bone advances continually, the soft parts have become hard as a board, until, finally, movement of the jaws becomes impossible, and the animal succumbs from inanition. After the extremely firmly-adhering, caseously-infiltrated soft parts are stripped off (or, better, rolled off), we sec extensive and often enormously thick osseous deposits of very dense structure on the superficies of the jaw, generally starting from the alveolar margin. There are in the old bone, and often enough in the new, infundibuliform ulcerations filled with caseous exudations, and having crateriform everted edges, — in a word, partial necrosis. The process is essentially the maxillarr periostitis with masses of osteophytic new growth and necrosis, so well known from observations on the human subject. [Dr. Wegner now discusses the question why a few only among animals and workpeople are thus affected, and concludes that as carious teeth are generally the starting-point in the latter, some corresponding lesion must exist in the former, the process starting thus from a local irritation produced by the fumes. He admits, however, that there are exceptions to the rule of carious teeth being present in the workpeople, and that in one only of the animals affected could he discover any such ; so that, he says, " we must fall back upon the hypothesis of an opportune wounding of the periosteum." If this is induced artificially, animals hitherto untouched become the subjects of the Ph. bone disease.]

b. If we give to a rabbit, dog, cat, or fowl — while yet immature — minute doses of Ph. in pill, so insignificant that they produce no changes in stomach or liver ; or if we cause them to inhale air moderately charged with its fumes; and subsequently^ atter a relatively short time (lod. in those that are quickly growing, 3 weeks in others), carefully examine their bones, we shall find changes of a more or less different kind, and which evidence their presence in different ways, according to the stage of growth of the animals. In all those places where, physiologically, there is developed from cartilage spongy osseous substance, having wide meshes and much red medullary tissue, there is formed under the influence of Ph. a tissue that, seen with the naked eye, appears perfectly homogeneous, solid, and compact, just like the cortex of the long bones. That part of the spongy tissue which was developed before the feeding began remains perfectly unchanged. The substance of the Ph. stratum shows itself under the microscope to be real wellformed bone,

€, If the feeding with Ph. be continued, dense osseous substance is always added to the cylindrical bone from the intermediary cartilage,* while the spongy substance formed before the feeding obeys the physiological law by being disintegrated and absorbed to form the medullary canal. Thus one sees, after a certain period, according to the rate of

• Intermediary, that is, between the shaft and its epiphyses and apophyses. — Eds.

growth, the entire normal cancellous structure at the extremities of the diaphyses replaced by a compact solid bony mass. If we continue the feeding still longer, we And that the abnormally formed bone-substance likewise follows the physiological law for the formation of the medullary canal, — the oldest layers, which are pushed nearest to the centre, again become rarefied, and at last melt down into red medullary tissue. (If the feeding with Ph. be arranged with intervals of .abstinence, we find developed from the intermediary cartilage strata of dense compact substance alternating with others of ordinary spongy structure.)

d. If Ph. be given in small doses to animals after their bones have ceased to grow, the spongy tissue in the epiphyses, vertebrae, &c., gets a little thicker ; the osseous spicule and lamellx are a little broader and thicker, without, however, any approach to a sclerosis of the spongy part as we have seen it in the newly-deposited layers of growing animals. The compact substance, also, of the cylindrical and of the flat bones becomes more dense from the narrowing of the vascular canals. Just as the medullary tissue, in the meshes of the cancellous substance and around the circumference of the vessels in the Haversian canals, in part becomes changed into bone, so also, in consequence of continued feeding with Ph,, does a part of the medullary substance which fills the large medullary canal undergo an ossificatory process \ and it is the peripheral layers that ossify, so that while the circumference of the bones remains constant the medullary canal becomes contracted, and the compact crust grows thicker by the deposit of new layers within. In fowls we can at last succeed, by feeding several months with Ph., in obtaining a complete occlusion of the medullary canal with real osseous substance, — in this sequence : first the bones of the tarsus, then the tibia, the bones of the forearm, the femur, and lastly the humerus.

/. Analysis shows that the composition of the bones of the animals fed with Ph. does not differ materially from that of normal bones.* {Ibid,)

1. A young brown dog, after being kept for some d. without food, got from May loth to 16th several doses of alcoh. phosphorat., on 16th about 5ij. From i6th to 23rd no med., and as he seemed quite lively and ate with appetite, he got on 23rd ^ij ol. phos. Soon, restlessness. After I h. slimy saliva in clear viscid drops came from mouth and fauces. 10 a.m.^ froth came out of mouth, and he vomited with much retching a little yellow slime like poppy-seed oil. — 24th. Seemed pretty well. He then got at 7 a.m. another dose of ol. ph. Soon clear saliva dropped from fauces and viscid slimy froth hung about his mouth. 8 a.m., frequent ineffectual retching and then a thin, pappy, bright yellow slimy stool ; 10 m. thereafter vomited twice much white mucus with pieces of bread, this was very acid, and fumed and smelt of Ph. His belly contracted regularly and rapidly, with occasional pressing on the rectum. Pressure on belly caused him to moan a little. He ran about, fell, had short convulsions, got up again and

• I have been in a potitioD to prove the perfect analogy with the above of the proccssn in the human subject, though only in their earlier stages, in a child that had been treatnl during 1^ mo. with small do!;es of Ph. for bad devcloptnent of the O^ttous ^y&tem, and of whose body T performed an autopsy.

again fell down, and after a few convulsions with dilated pupils he died. — P.i/., 5 h. after death. No cadaveric rigidity. The salivary glands of one side showed strongly injected blood-vessels, as also the anterior surface of epiglottis. The brain and upper part of spinal cord showed distended blood-vessels. Trachea and bronchial tubes filled with froth, no reddening of m.m. Lungs had brownish-red and bright red spots, and dilated air-cells protruding on lower lobes ; when cut into frothy fluid exuded. R. side of heart and large veins filled with dark coagulated blood. Liver large, reddish-brown. Spleen of consistence and colour of leather. Kidneys, especially 1., showed under their peritoneal covering a number of white, millet-seed sized granules, looking under microscope like fat on the red brown cortical substance, which was traversed by visible vessels. The 2 lower thirds of m.m. of oesophagus were bright red. The m.m. of fundus of stomach was gathered into many folds and bright red, not so the cardiac and pyloric parts. The stomach contained white viscid mucus. The m.m. of intestines, as far as caecum, slightly red in parts. From there to anus m.m. throughout injected bright red. (Sorge, op^ cit,^ 44.)

1. Similar experiments were performed on several other dogs, which gave similar results. In some there appeared to be a kind of paresis of the hind legs. In one the rectum appeared to be distinctly inflamed. Exhaustion appeared in some, not to be wondered at as they could not eat. In some the liver had a gamboge yellow colour ; the duodenum had pushed itself into the pylorus to the extent of half an inch. The convulsions that attacked a good many in one case assumed the character of opisthotonos. The urine in a few contained albumen. In one the small intestine was much congested^ arborescent bloodvessels showing in the m.m., which was partly covered with bloody mucus \ on washing off this there appeared a whitish or greyish-yellow layer, which could be scraped off with the finger and displayed the congested blood-vessels. In several many of the blood-corpuscles were irregularly shaped. (Ibid.)

2. A number of experiments on rabbits showed much the same phenomena. In one the largest part of the r. middle and 1. upper lung was brown and hyperxmic, but not airless^ as it swam in water. In this case the liver was nutmeg-coloured, the 1. kidney blackish-blue, but yet showed no hyperemia under the microscope. In one the con* vulsions were so strong as to jerk the body, as it lay on its back, a few inches from the ground. In this case the pupils were contracted. In most of the other animals they were dilated. In this one the spinal cord was softer than normal, and about the level of the middle dorsal vertebra there was a dark blood-stain of about i in. on the anterior wall of the spinal canal under the dura mater. In another case both brain and spinal cord seemed softer than normal. In this case there were hepatized spots in the lungs, which felt and cut like flesh and sank in water. Yet another case showed softening of the spinal cord. One rabbit showed on surface of brain and cerebellum many bright bloodspots the size of a pin's head, and at the posterior border of the r. lobe of cerebrum a large black firm blood-clot the size of half a bean. T^his rabbit also had hepatized spots in lungs, and both kidneys were

dark blackish brown and hcpatized. The urine showed, besides bladder and kidney epithelium, a good many dark fibrinous cylinders, which were granular on their surface. (/^/V.)

1. a, LiEDBECK applied to a wound in a dog's neck ^ss of granulated Ph. The animal showed great distress and exhaustion, had dilated pupils, refused food, and died on 8th d. Animals poisoned in this manner are stated to have the blood darker and more fluid than natural, the liver studded with minute specks of a lighter colour than the rest of the organ, and the kidneys firmer and yellower than usual. Ramier placed fragments of Ph. beneath the skin of frogs, rabbits, and guineapigs. No local inflammation was excited, but in the case of the frogs at least, which did not die for 2 — 3 weeks, liver and kidneys were found to have undergone fatty degeneration.'**'

h^ Pelletier and Godman have seen unmistakable evidence 01 the aphrodisiac power of Ph., — a drake, a bitch, and a boar being the subjects of experiment. t (Stille, op, cit.)

1. Fatty degeneration was found by Munk and Leyden in the tissues of frogs and rabbits within 2 or 3 d. after giving Ph. In Tamassia's experiments it was still more rapidly induced. He injected 3 — (5 gr. into the rectum of 4 animals (dogs or rabbits) ; toxic symptoms occurred in about 5 m., death in 8 h. — the temp, falling 8° F. In all 4. the kidneys, and in 2 of them the liver also, were in a state of fatty degeneration. (Phillips, op, cit.)

2. In the livers of young rabbits the glycogen disappears in i^ d. after the giving of 0'02 — 0*03 grm. of Ph. (Nothnagel und Rossbach, op. cit.)

Volume IV — Appendix

PHOSPHORUS.

(See vol. iii, p. 551.)

l. 34. a. While taking the out-patient department of

^*»firmary for Mr. Rhys Griffiths on Sept. 14th, 1889, H.D — ,a|

^*id, aged 15, came as a patient. She complained of pains

. ^'■, great headache, vomiting of blood twice, faintness andi

**^guor, unquenchable thirst, and inability to take any food.

P^'^vjously she had been in perfect health. The illness bep

"pt. 7th with headache and faintness. Pains in the back hi

• ^omc the most intense symptom. On the 13th she had von

f**«it of blood, ''dark thick stuff." The next day she had|

. '-^Tilted one or two ounces of blood. On the 13th she notic

f-^^ become yellow. Her boweis throughout had been very

. 1 examination I found that the patient showed extreme prostr,

• ^^'' cheeks were brightly flushed, the tongue dry and black, afl

S

HU

-o

*"^^th extremely offensive. The pulse was 120, weak 'cr^k, and very compressible- Thinking the case was one ol *^c specific fever probably, I took the temperature and was si d it 985'^. The girl was plump and well nourished ; the( marked jaundice of face and body. The heart and lun ^^ «Tial. The whole of the abdomen was very tender to ^» ^^ liver dulncss was diminished, and the liver area very tender. ^ '^ above symptoms, and especially from the history of sudden ^^^ the normal temperature, I came to the conclusion that

^^ one of acute yellow atrophy, or phosphorus poisoning. On!

—^^tnination she could recall having taken nothing injurious or poll

any kind ; and after beating about with non-leading questic

x^»»i, I asked her whether she had had any rat poison in her p

r^fore her illness. She at once answered, as if it were quite

^^^ to her as connected with her illness, that she had had some,]

b72

her mistress had given her to spread for rats. She stated most pontively she had taken none, and had not touched it except with a knife, with which she spread it on bread. However, the admission of possession seemed sufficient, and 1 admitted her on the phosphoruspoisoning diagnosis. She passed into a condition of coma the samec, and after renewed haematemesis died at 7 a.m. next m. Her urine was secured previously, and found to be very highly coloured, with » deposit of epithelial cells like bladder-cells ; free from albumen ; kpyc most brilliantly the crimson reaction with mercurous nitrate typical 01 tyrosin, and on evaporation showed numberless sheaths of fine tyrosin needles and transparent glassy plates of leucin. Besides these, ther« were numerous hedgehog balls of coloured acicular crystals lookin like uric acid.

b. The necropsy was made by Mr, Thomas, house surgeon, 30 h, after death. The weather was warm. The rigidity was marked. Th« body was plump and well formed, but generally jaundiced. There wen no petechias. A liquid like cofFee-ground stuff streamed from the nose On opening the abdomen the liver was found to be shrunk outof s.igh beneath the ribs. The bowels were distended and darkly stained. Th< pericardium contained two ounces of straw-coloured fluid. The I. ii«J< of the heart was contracted, and the r. flaccid ; there were no clots. Tl* tissue was friable and stained yellow. The lungs were slightij" con gestcd. The stomach contained about two ounces of " coffec-grour»' stuff." The mucous membrane was stained black on the top of tN rugae, and was very thick, soft and friable all over. The intestine were full of "cofFee-ground stuff" in the ileum and jejunum. Tl»< mucous membrane was in the same condition as that of the stomacfc The large intestine was full of black-stained soft f«ces. The Iiv« was small in size and solid in consistence ; it weighed 45 ^ oz. Tb< capsule was adherent and thickened. The gall-bladder was empty. In the middle of the under surface of the r. lobe was a natural fiuuX half dividing it into two lobes, The surface was of a uniform, bright chrome-yellow colour. On section it was found to be soft, intewdj^ yellow, friable, greasy to the touch, and showing the lobules clearljl marked out with fatty and congested areas. The liver resembledi when broken, yellow fasces more nearly than anything else. The cortex of the kidneys was very pale, soft, and friable ; pyramids coo* gestcd ; capsule normal. The spleen was of normal size, pale mi difHuent. On opening the skull Mr. Thomas detected a distinct $ of phosphorus, and on making sections into the brain this was to all in the room. The brain was otherwise normal. No 1.. could be obtained from the organs.

In the inquest held on the case the most interesting fact obtained that the girl had been giving a "dark nlnnce" to other girl and had rubbed the paste into her hands and face to produce bl flame, just before the onset of illness. She denied to me most tively having taken any by the mouth ; and though she told me nothing: of the Seance she had said that she felt bad first after spreading the for rats. Probably she was ashamed of the seance^ and had rca" bad after anointing herself for this. The question therefore

whether death could occur from inunction of rat paste, which seems |>robable here. There is no case on record, I believe, of such a death.

uld she have rubbed the paste on her teeth and tongue, to emit blue

*4anie possibly ? From the severity of symptoms it looks as if much

poison had been absorbed. There was no cause for suspecting suicide j

the hymen was intact, and the uterus appeared to be just menstruating,

a Graafian follicle having just ruptured in the left ovary, and her whole

bearing was utterly unlike a suicide. Another point of interest in the

se is the fact that the poison could be diagnosed from the symptoms alone. Had I been a believer in acute yellow atrophy as a disease apart from phosphorus poisoning, I should probably have put down the case to that ; but believing the two to be one and the same thing, I was sufficiently pertinacious in my cross-examination to hit on the right track, and to prove the necessary possession of phosphorus. The patient died in the usual time, on the 8th day after initial symptoms. (Hill, Lancet, 1890, i, 398.)

1. a. W. S — , aet. 32, ship's steward, 5 feet ro in. in height, was admitted on June I2ih, \ h. after swallowing the greater part of half an ounce of phosphorus paste (Roth and Ringeisen's), The stomach was at once washed out with five or six basinfuls of warm water } 3 gr. of sulphate of copper were mixed in a pint of warm water, and given to him to drink. It was immediately vomited. The fluid with which the stomach had been washed out had a strong smell of phosphorus, and was luminous in the dark. In the subsequent course of the case the most prominent symptoms were vomiting and depression, with for a short time a very slow pulse, 46. Jaundice was first noticed on i6th, in conjunctiva, and the urine was of a dark red-brown colour, due to bile-pigment. It was acid, of specific gravity 1020, and contained no albumen. On the following day the jaundice was more marked, especially on the face and chest ; the tongue was furred ; there was some tenderness over the liver, but the area of dulness was not diminished. The vomiting continued ; he passed 40 ounces of urine, of a brownish-black hue, in the 24 h., and the motion passed on June 1 8th was very foul, and like chalk-and-water. The motions retained this character ; the intensity of the jaundice increased, and there was tenderness over the liver. Nocturnal delirium subsequently became marked. On 22nd, the respirations had the so-called Cheyne-Stokes character, and were only 8 per m. The pulse was 50. A roundworm (ascaris lumbricoides), six inches long, was found in the vomited matter. On 24th, the temperature rose to ioo'6'^; the pulse was 120, and the respirations had risen to 26. On 25th, temp, was I022' ; pulse 124, full, bounding; and resp. 28 per m., stertorous. The stupor in which the patient had previously remained was passing into coma. The motions and urine were passed involuntarily, and the perspiration was profuse. At noon, temp, was 102°; at 3 p.m., I02'4°i at 8, I02'6° ; at 11, I03'8° Pulse was then 162, and resp. 44, stertorous. He was in a state of profound coma. At 1.30 a.m. on 26th, temp, was 105°, pulse was 150, and resp. 54. At 2 a.m., temp, was 105'2°, and pulse could not be counted. The coma continued until death. Temperature at 3 a.m. was 106°; at 3.30, 106*4° >

vol. IV. 43

at 4, lof i at 4.30, 107-4°; at S, lo; after death, io8-6°. ,

b. The necropsy was performed deeply jaundiced, was of a brownish* section had a black tarry appearanc< frothy blood, mixed with minute oil-j weighed 13^ ounces, and was very sc had a pale reddish-yellow appearan< inner coats of the large arteries wei staining being noticed here and there, in size, weighing only 42f ounces, of soft and flabby, with thin edges, so tb it was greasy-looking. On section il brownish- yellow colour, bloodless, wi^ The gall-bladder contained a little thi (weight — r., 8 ounces ; 1., 7 j ounces) loosely attached, so that they were eal organs had a pale and oily appearance, its substance was soft, and of a tarry The stomach contained some fluid 1 its coats had the general yellowish all or congestion could be observed. Th microscopical examination, the organ gone fatty degeneration. This was n; had disappeared more or less completi globules of oil were seen to be studdo of the heart had lost the stri<ited appi minute molecules of oil. Extensive granular epithelium of the kidneys scope showed the deep brownish-yell Med. yourn.y Nov. 20th, 1886.)

1. A married woman, set. 20, t II d. later. Had nausea and vomil depression. Towards end, insensibili rhagia. — P.M., skin and conjunctivi tained | of a pint of dark claret-col blood from capillary hjemorrhage froi irritation. Its whole surface had a y of some Tugx which were bright pi Upper part of small intestine afrected contained a quantity of almost col weight 26 oz., both its outer and inter atrophy, except that there were g haemorrhage in patches. Lobules of nisable,, in others stood out in bold patches, in strong contrast to deep dark vasation. Gall-bladder contained yj of bile. Urinary bladder empty, ki bile-stained, of greater depth and

67s

Capillary hzmorrhage into r. lung and pleura, pericardium and itomach. {Lancet, July 14, 1888.)

1. Dr. Nathanson, in a Berlin graduation thesis, discusses the effect of phosphorus poisoning on the liver. He follows Virchow in drawing a sharp distinction between the infiltration of the liver-cells by fiit-globules and their metamorphosis into fat. He treated hardened Jtctions with ether, and found that when these were from a healthy subject no change was produced thereby. When they were from a liver affected with fatty infiltration, the fat-globules were dissolved, the remaining cell-structure continuing pretty much as it had been before. When, however, the sections were taken from bodies which had died of phosphorus poisoning, the structure was entirely obliterated by the ether, and the same occurred in the case of sections of the kidneys from the same subjects. The inference is that poisoning by phosphorus produces a true fatty metamorphosis of the tissues of the liver and kidney, (Lancet, June 28, 1890.)

2. An aged woman, after an attack of asthma, was much weakened, and had a dry spasmodic cough, which brought back the dyspnoea. I gave her Phosph. 3 every 2 h. " Immediately," she said, '* on taking the first spoonful, there came on, between the nose and fyc,oa the 1. side, a peculiar sensation, like a strong pressure, or a i^in proceeding from a nerve. At the same time it seemed as if the globe of the eye was swollen and pushed out of the orbit. The eye is painful during the cough, but especially the middle and side of the nose. On the forehead there was a drawing headache, describing as it Wrere a semicircle," These symptoms troubled the patient so much that she determined not to repeat the medicine. She attempted this fiext d., however, but with recurrence of precisely the same results. {.Ji-ame Hem. Btlge^ Avril, 1875.)

tfa,

Volume IV — Supplement

PHOSPHORUS,

Il. 39. a. A. D—, a widow, zt. 36, a fair-haired, well-nourished ‘woman, was admitted into the female ward of the North-West London Hospital on May roth last, under the care of Dr. Donald Hood. ‘The patient was brought to the hospital about midnight, with a history of having accidently taken a mixture of phosphorus paste in beer which had been prepared for the purpose of killing beetles, A small bottle holding about an ounce was shown, about one-third full of the paste, the remainder having been swallowed. When first seen the patient was retching violently, but after the administration of sulphate of zinc she vomited a small quantity of bilious fluid, smelling strongly

gy O81 i hina reminibence (very fine one) ofthe case recorded a8 3? Eos.

of the pouon. Previouslv to this she had taken hot mustard and

water, which had producea a copious etnesis. After the direct effects

of the emetic had passed ofF, the patient stated that she felt quite

recovered, and wished to go home } but in view of complications, both

medical and legal, arising, she was persuaded to stay in hospital. She

remained perfectly free from symptoms, both subjective and objective,

for four days after admission. The urine examined did not reveal

anything abnormal. The further course of the case was as follows : —

i. On May 15th, about 9 a.m,, she suddenly complained of

cramping pains in arms and legs, and commenced to spit a small

quantity of bright blood. On examination gums were found in a

'P^^gy condition, and oozing profusely. Tongue clean } temperature

Msloir the average ; pulse 80, somewhat compressible. There was

come cedema of hands and feet, especially over dorsal surfaces.

Extensor surfiices of both upper anns were marked with a deep bluish

iiottling, with considerable surrounding ervthema, somewhat raised,

^'^d very tender. There was also a similar eruption on anterior

^■'^es of both legs, and on outer and upper segment of r. breast.

powels open three times ; clay -coloured stools. Urine : Sp. gr. 1024 }

'^ Contained one-fourth albumen, bile, and a trace of blood} micro-

"^^pically a few blood-cells could be seen, also bladder and vaginal

Pthchum, with a considerable quantity of mucus. No tenderness

^ll^r hepatic region. Liver edge not felt. Vomiting after taking milk,

v**^ Vomit being intermixed with dark blood. 16th. — Slept badly j

^''■ng n. had an attack of hxmatemesis, bringing up about half a pmt

? bljurk, grumous fluid. Tenderness over whole of abdomen. Liver

*'^iess increased to two fingers' breadth below costal margin ; edge

. **' felt. Muscular pains persist ; slight icteric tinge about con-

4Jf**ctivaB J genera] dusky appearance; almost pulseless at wrists.

.^^'^ctiform eruption remains unaltered. Urine contains bile and one

^*H albumen } the blood test does not react. Bowels open twice ;

^^"^cter of stools unaltered. Is passing a small quantity of blood per

• ^nam resembling the normal menstrual flux. Urea, as estimated

j^ **^titatively, gives a per centage of i'8. Urine also examined for

P^^^ia and tyrosin, with negative result. The patient continued

'^^psed, and died at 6.30 p.m., retaining consciousness to the last. (1^ ^. Post-morttm. — Mucous membrane of oesophagus normal, as also ,^^^ of trachea. Heart: Endocardium and valves normal; muscular ,^^** of a pale yellow tinge, very friable ; weight 18 ounces ; numerous j^^ ^^orrhages into both layers of pericardium. Hemorrhages into ij^W parietal and visceral pleurae, a very large one extending over i^^^^aat the whole of the layer investing the diaphragm. Peritoneum ^_^^red with numerous petechiae. Stomach apparently normal as to ^j ^nucous lining, but very thin and readily torn. Liver somewhat (^^^^vged, of a uniform yellow colour, firm, floating readily in water, ;^^^ '^ on setting light to a portion, burning like the wick of a candle. ^^^^e small hemorrhages on its surface. Gall-bladder : Catarrhal ijj^^ition of its walls and duct, containing a small quantity of bile. .^^en slightly engorged. Kidneys palish-yellow in colour, enlarged, ^' congested. Uterus enlarged and congested, as also its adnexa.

weighing three ounces; 1. ovary, occupied by a large recent corpus luteum, measuring 1 in. by } in, Cavity of body of uterus contained alittle ‘blood-stained mucoid tissue ; no ovuline structure, Bladder normal. Microscopic sections showed complete fatty degeneration of liver cells, with numerous infiltrated fat globules ; well-marked fatty degeneration of the epithelial lining of the tubules and glomeruli of the Kidneys 5 and general itty degeneration, with some infltration, of the muscular wall of the heart. (Lancet, Oct. 17th, 1891.)