Kali Cyanatum
By Timothy F. Allen — The Encyclopedia of Pure Materia Medica
Potassium cyanide, KCy.
Preparation , Triturations.
Authorities.
1 , Lembke, provings with 1st and 2d trits. (1 to 50), doses of 2d trit., 1 to 8 grains, of 1st trit., 3 to 35 grains, afterwards with a solution of 1 grain crude in a drachm of water, doses increased to 20 drops each, A. H. Z., 49, 179; 2 , Mr. ---, took 3d trit., night and morning to third morning, Pub. Mass. Hom. Med. Soc., II, p. 18; 3 , same, took 1st trit., night and morning, for four days; 4 , another man took 1st trit. (first, second, and eighth days), from same; 5 , Weidner, effects of about 12 grains in solution, Casp. Woch., 1845 (Frank's Mag., 1, 163); 6 , a physician took about same dose, from same; 7 , Wagner, a man took a large quantity of a strong solution, Archiv f. Phys., 1859 (S. J., 105, 176); 8 , Blondlott, effects of a solution (?), J. de Chim. Méd., 1856 (S. J., 90, 169); 9 , Gunther, effects of a solution (?), Archiv f. Hom., 12, 1, 142; 10 , Orfila, fatal tox. by an injection of 200 grains; 11 , Ware, a woman took about 7 grains in a solution, Bost. Med. and Surg. J., 1856, p. 387; 12 , Perry, a child with slight cough took about 4 grains in solution, N. Am. J. of Hom., 1852, p. 475; 13 , Krause, a man took about 1 drachm, Am. J. of Med. Sc., N. S., 58, p. 422; 14 , Dr. O. R. King, a girl of six years, tasted of a solution containing 20 grains to an ounce Am. Hom. Rev., 1, 563; 15 , Schauenstein, three cases of poisoning, Am. J. Med. Sc., 1860, p. 279; 16 , Ebersberger, a girl aged three, took about 6 grains, Syd. Yr. Book, 1860, p. 460; 17 , Damme, effects of removing silver stains with KCy and vinegar, Br. and For. Med.-Chir. Rev., 1863, p. 535; 18 , Carriere, effects of injection of a solution, Bull. Gén. de Thér., 77, 458; 19 , Scholz, a man swallowed a piece the size of a pea, Monats. Bl., A. H. Z., 15, p. 7; 20 , Stearns, effects in a healthy man, Am. J. Med. Sc., 1869, p. 408; 21 , Frank, effects of a solution, Vjs. f. Ger. Med., 1868; 22 , Taylor, effects of 3 grains in solution (followed immediately by sulphate of iron and mustard and water, till vomiting was induced); 23 , Arnold, effects of about 1 grain on self, Am. J. Med. Sc., 1869, p. 103.
MIND
- Emotional.
- Disposition gentle (sixth day), 4.
- Good disposition of mind, with light-heartedness, jocularity, and brightness of feelings, all day (fifth day), 4.
- Had occasion to get angry, but could not; felt more like laughing instead (second day), 4.
- For two days, desire to find fault; crossness almost uncontrollable on entering the room; while the cold open air produces good spirits (third day), 2.
- At 7 P.M., while walking out of doors, feeling of crossness; carries on a kind of conversation within himself, as if quarrelling with some one with whom he had previously disagreed; thinks what he will reply in case certain things are said to him (this state of mind is really painful; there are occasional remissions of it, and there is really no cause for it), (fifth day), 3.
- As a general thing, for the past few days, easily provoked, and impatient at trifles (fifth day), 3.
- Intellectual.
- Perfectly bright and well on waking and rising (seventh day), 3.
- Sometimes cannot think clearly and to the point, in the forenoon (fifth day), 4.
- Memory seems weak (fourth day), 4. [10.]
- She remembered nothing from the time she tasted the solution till consciousness was restored (two hours and a half), 14.
- Perfectly lucid, but had no recollection of anything which occurred after she took the injection (second day), 18.
- Talked all the evening, but could not find words easily (ninth day), 4.
- Inability to recollect certain words (aphasia), for several days, 19.
- Seemed to lose all thought for a moment only; the same sensation again half an hour afterwards (fifth day), 4.
- Stupefaction, 1.
- Lying on the floor in a deep stupor, 23.
- Loss of consciousness, 5 ; (after a few minutes), 11.
- Almost complete loss of consciousness, 6.
HEAD
- Confusion and Vertigo.
- Head confused and heavy (after one hour), 6. [20.]
- Vertigo, even to losing his balance, 6.
- Intense vertigo so that all objects seemed to be moving around him (after a few minutes), 17.
- Violent vertigo, accompanied with a sort of swooning, then she fell and lost her consciousness (immediately), 18.
- Slight giddiness in the head (immediately), 23.
- General Head.
- Head drawn backwards (soon), 18.
- Head seems light, and also the tongue, with pleasure and power to talk, in the morning; had a headache on the day before commencing the proving, leaving head dull, which was replaced by lightness of the head and tongue (second and third day), 4.
- Started up suddenly complaining of pain in the head and pit of stomach (after two hours and a half), 14.
- Head began too feel full, and had dry feeling, with tension across nose and inner corners of the eyes; also around the mouth, at 7.30 A.M. (ninth day), 4.
- Headache (after two hours, second day), 18.
- He was unable to tolerate any covering on the head, whatever in the cold or warmth, because it caused the frightful headache, for months after the attack, 9.
- Forehead. [30.]
- Pressure in the forehead, 6.
- Headache in the forehead, dull, pressing, but confined to a small space over the frontal bone, while walking briskly in the open air, at 4 P.M. (third day), 3.
- Slight shooting pains in the forehead, over the eyes, particularly the left; pains shooting from below upwards, while riding in the open air, in the forenoon (third day), 3.
- Vertex.
- Oppressive headache on top of head, the pain moving about, sharp and tearing, for five minutes; then head feels dull, which passed away unaware, at 11 A.M. (third day), 4.
- Slight oppressive headache on the top of the head, in the forenoon (tenth day), 4.
- Occiput.
- Slight dull pain in back of head, aching about twenty minutes, just before going to sleep (first night), .
EYE
- Objective.
- Eyes fixed, 10.
- Eyes fixed and staring (after ten to fifteen minutes), 14.
- Eyes fixed and turned upwards (soon), 18.
- Subjective.
- Prickly feeling in the eyes, worse in the inner corners (ninth day), 4.
- Lids. [40.]
- Eyes were closed, almost immediately, 16.
- The eyelids began to open and shut alternately, the eyeballs stared in different directions (after a few seconds), 21.
- Ball.
- Eyes closed, but on raising the lids the balls were seen to be in uninterrupted convulsive motion, 19.
- (Chorea of the ball), 19.
- Motion of the eyeball slow, not co-ordinated after the attacks, 19.
- Pupil.
- Dilated pupils, 10, 12 ; (after ten and fifteen minutes), 14.
- Pupils moderately dilated, the cornea insensible to touch, 19.
- Pupils largely dilated, and insensible to light, 20.
- Vision.
- Obscuration of vision, so that it was with difficulty that he distinguished the features of those near him, 6.
- Loss of sight; as sight returned there was double vision, 17. [50.]
- Double vision after the return of consciousness, 19.
EAR
- Rushing in the ears, 6.
NOSE
- Objective.
- Phlegm from nose bloody, in stripes of clear blood, at 10 A.M. (third and ninth day), 4.
- Blew pure blood from nose about 10 A.M.; inside of nose feeling parched, hot, and dry; blood drying in the nose very quickly (ninth day), 4.
- Subjective.
- Feeling in the nares, like that before sneezing, with a drawing pain in the cheek-bone (first day), 2.
- Tension across nose and inner corners of the eyes, with fulness of the head, at 7.30 A.M. (ninth day), 4.
FACE
- Objective.
- Pallor of the face, 17 ; (soon), 18.
- Looked pale and exhausted, in the afternoon, 14.
- Face livid and bloated, 23.
- Turned blue in the face, 23. [60.]
- Flushed face, on waking in the morning (fifth day), 4.
- Face covered with red spots, with at times transient diffused intense redness if he made passive motions with the upper extremities, and also in the long pauses between the respirations, 19.
- Immediately the face became puffy and cyanotic, 19.
- Twitching of the face (after a few minutes), 21.
- Cheeks.
- Cheeks deadly pale, almost immediately, 16.
- Lips.
- Lips white, almost immediately, 16.
- Commissure of the lips covered with a light, white foam (soon), 18.
- A reddish froth covered the mouth and nose, 23.
- There was noticed slight twitching of the mouth when the patient was spoken to in a loud tone of voice, as though the sense of hearing were awakened, though the stupor still continued (third day), 19.
- Tension around the mouth, with fulness of the head, at 7.30 A.M. (ninth day), 4.
- Chin. [70.]
- Some difficulty in using my lower jaw in the act of speaking, 23.
- Jaws firmly closed, 20.
- Teeth closed so firmly and continuously, that only once or twice could anything be poured into the mouth, 12.
- Jaws tightly closed, the region of the masseter muscles very prominent and as hard as cartilage, 19.
- The patient lay in a frightful tetanic cramp, jaws so tightly closed that it was impossible to open them; the eyes were drawn completely back into their orbits, face distorted, nose pointed, mouth drawn outward, pulse imperceptible, and hands frequently attacked with muscular twitches, 9.
- Jaws violently closed (soon); the trismus was so violent that it was impossible to separate the jaws for the purpose of introducing a liquid into the mouth; a strong iron spoon introduced between the teeth, and used as a lever, effected a slight opening, .
MOUTH
- Lips and mucous membrane of the mouth pale, 19.
- Slight frothing at the mouth (after ten or fifteen minutes), 14.
- A peculiar astringent taste in the mouth, something like that of a saturated solution of alum or green vitriol (immediately), 6.
- Power of speech lost, but intelligence preserved, 17.
THROAT
- Astringent sensation in the throat and nausea, lasting till after midnight, 6.
- Feeling of constriction about the fauces, with muscular tremors about the throat; for one or two days afterwards he complained of a great degree of stiffness about the throat, 22.
- Immediately after meals, especially dinner, quite a painful feeling of fulness in region of œsophagus; also feeling of much accumulation of wind in the stomach, with desire to raise it; tried to but could not; this became particularly noticeable in the forenoon of the third day, and continued all through it; the above symptom became still worse after dinner than ever before, with painful soreness about œsophagus; feelings in the stomach are very troublesome, with a pressure upwards (third day); had these symptoms slightly and occasionally a few days before taking the medicine, 4. [90.]
- The patient was able to swallow as soon as a large amount of fluid filled the pharynx; after every swallow the whole body was seized with convulsive tremors and flushes of redness overspreading the face, 19.
- Had no sensation of the act of swallowing, 23.
STOMACH
- Appetite.
- Appetite good, but no hunger before eating (third day), 4.
- Less appetite for meals, though food relishes, but ate less than usual (fifth day), 3.
- Eructation.
- The trouble in stomach passed off with eructation of much wind, coming up easily and involuntarily, leaving only slight soreness about the œsophagus, at 4 P.M. (third day), 4.
- Vomiting.
- Inclination to vomit (immediately), 5.
- Great inclination to vomit, 6.
- Vomiting immediately, 15.
- Copious vomiting (after five hours); followed by return of consciousness, 23.
- Retching with copious vomiting, immediately after the difficult swallowing of a cup of milk; the vomiting was followed by relief, 6. [100.]
- Vomited twice at an interval of half an hour, a small quantity of yellow water having a peculiar smell (soon after two hours and a half), and from that time improved rapidly, 14.
- The color of matter first vomited was light-blue or greenish, 22.
- Stomach.
- The epigastrium prominent, almost immediately, 16.
- Pain in the pit of the stomach (after two hours and a half), 14.
- Severe burning in the stomach (immediately), 11.
- Great sensitiveness of the epigastric region (fourth day), 19.
ABDOMEN
- A feeling as if the bowels were about to act, 11.
- Pains in the abdomen, 7.
- Very severe, dull tearing pain in the bowels, beginning in the region of the bladder, and running quickly over whole abdomen towards outer surface; but also in the bowels, tearing, rolling, and cutting, which extended as far as the stomach; it lasted about five seconds, then it ceased slightly for a moment, and then again increased; and lastly passed away quickly, leaving no sensation, at 10 A.M. (ninth day), 4.
- Iliac Region.
- Pain in the groins, in the afternoon (tenth day), 4. [110.]
- Pain in right groin, at 9 A.M., passing into loins, and passing off towards 12 o'clock; pain in right groin made leg feel stiff, at 1.15 P.M. (ninth day), 4.
- Up to this time and previous to taking the medicine, had a dull, painful feeling in back after nocturnal pollution, with dread of head work or any exertion, which was replaced by pain in left groin (second day), 4.
- Pain in the left groin and hip-bone, in the night (ninth night), 4.
- Pain in left groin while standing, at 4 P.M. (ninth day), 4.
- Slight dull pain in right groin, which disappeared after a few seconds, and then reappears in back of head, aching about twenty minutes, just before going to sleep (after fifteen or twenty minutes, first night), 4.
- Slight dull pain in left groin, near top of hip-bone, which passed, at intervals of one or two seconds, to both thighs, chest, and top of head, at 10 A.M. (second day), 4.
STOOL
- Fæces came away involuntarily, 23.
URINARY ORGANS
- Bladder distended by a large amount of urine, which had to be evacuated with a catheter, 19.
- Urine came away involuntarily, 23.
- Examination of the urine showed a sp. gr. of 1.014, slightly acid, odorless, of a wine-yellow color, without sediment, the chlorides and urophæin normal, the uroxanthin increased, sulphates, alkaline phosphates, earthy phosphates, urea, and uric acid diminished (second day), 19.
SEXUAL ORGANS. [120.]
- Awoke at 4 A.M., after unconsciously having had a seminal emission; then fell asleep, with an indistinct dream and horizontal erection; strong sexual desire, producing a tendency to seminal emission (sixth morning), 4.
RESPIRATORY ORGANS
- Voice hoarse after the attack, 19.
- Loud mucous rattle, 13.
- Respiration superficial, 1.
- Slow and difficult breathing, 10.
- Respiration slow, regular, 19.
- Breathed slowly and heavily, 23.
- Breathing slow and noisy, inspiration quick, expiration very slow and prolonged, with a loud groaning noise (after ten or fifteen minutes), 14.
- Breathing not oftener than four or five times a minute, and stertorous, 20.
- Respiration slow, with extremely long intervals, 9. [130.]
- Respiration became very slow, only 7 to the minute; the expiratory act was prolonged; the intervals between the respirations were remarkably long (second day), 19.
- Respiration heavy and labored, producing the blowing of bubbles at the mouth, 23.
- Diminished frequency of respiration (12 to 16 per minute), 12.
- Respiration nearly suspended, but the thorax was convulsively raised, at irregular intervals, far enough a part (soon), 15.
- Struggled desperately for breath, and the horrible conviction of impending suffocation, though ignorant of its cause, did not leave me for a moment; this stage lasted hardly, thirty minutes; the violence of the asthmatic symptoms prevented my speaking, 23.
- Dyspnœa, 13.
- Inclination to yawn, to sigh, and to heave, immediately, 23.
- Respiration as if the chest were constricted, 21.
- Inability to take a deep breath without pain, 6.
CHEST
HEART AND PULSE
- Præcordium.
- Stitches in the heart and lungs, 1.
- Jerking stitches in the heart on respiration, 1.
- Heart's Action.
- Palpitation of the heart, 10.
- Pulse.
- Pulse 70, large, soft, and compressible, 19.
- Pulse small, but distinct, 60 per minute, 12.
- Pulse fell to 60, became small and soft (second day), 19.
- Pulse at times 15 beats slower than usual, 1.
- Pulse scarcely perceptible, slow and irregular (soon), 18.
- Pulse hardly perceptible, 23. [150.]
- Pulse at the wrist not perceptible, 20.
- The pulse insensible, the heartbeat scarcely perceptible (almost immediately), 16.
- No pulse (after ten to fifteen minutes), 14.
NECK AND BACK
- Vague pain in the nucha (second day), 18.
- Feel painfully weak in back and loins, during morning and forenoon (sixth day), 4.
- Very marked weakness in the lumbar regions, with dull pain and weakness of right and left iliac region, while walking and during the afternoon (third and fourth days), 3.
EXTREMITIES IN GENERAL
- Limbs rigid and convulsed (soon), 18.
- Spasms of the extremities, 13.
- Tetanic spasms of the muscles of the arms and legs, 21.
- Extremities relaxed, and when raised fell down as heavy as lead, 19. [160.]
- Limbs flaccid, with occasional slight general convulsions more like a shuddering than anything else (after ten or fifteen minutes), 14.
- The arms sank down, the cloth fell from the right hand, he leaned back upon the chair with the legs stretched stiffly forward, the head turned backward (after a few seconds), 21.
SUPERIOR EXTREMITIES
- Sharp stitch in right shoulder, in the morning, just after rising (third day); it occurred several mornings in succession, and was also felt at various other times during the day, though not so well marked, 2.
- Hands clenched (after ten or fifteen minutes), 14.
- The fingers were stretched out and spasmodically contracted (after a few seconds), 21.
INFERIOR EXTREMITIES
- Gait seemed to me to be unsteady, 23.
- Legs feel heavy, but with a disposition to walk, in the latter part of the afternoon (fourth and fifth days), 4.
- Pain in legs in different places, with weakness below the knees (fourth day), 4.
- Felt stiffness and pain in legs, as if from below on the thighs, while walking at 2 P.M., lasting all the afternoon (ninth day), 4.
- Severe rheumatic twinges on the inner side of right knee, lasting only a second, at 11 P.M.; they continue and assume the character of continued pain over the whole right knee; while the twinges continue at intervals of a few minutes for an hour after going to bed (fourth day), and are felt again next morning after rising (fifth day), 3. [170.]
- Became weak in the lower part of legs, below the knees, extending to a part of each foot; sometimes felt in the knees, but not in the ankles; felt at the same time a desire to walk, but could not walk with ease and pleasure; the legs feel heavy, at 4 P.M.; weakness of legs passed off at 6.30 P.M. (third day).
- Weakness in lower part of legs, extending to part of feet and ankles, but without pain, in the afternoon (fifth day).
- Slight weakness in lower part of legs, below the knees, passing away soon; after 5 P.M. (ninth day), 4.
GENERAL SYMPTOMS
- Objective.
- Moved with quickness and precision on rising, in the morning (fifth day), 4.
- Circulation languid, 12.
- Convulsions immediately, 12.
- Convulsions followed by death, 7.
- General convulsions, 10.
- Sudden convulsive action of the whole body, about ten minutes after the heart ceased to beat, 11.
- The muscles were in a condition of hyperæsthesia; if one pressed on the thigh, calves, upper arm or over the region of the stomach the whole body was seized with trembling startings like convulsions; these tremors gradually passed into short attacks of general tetanus if violent pressure was made upon the muscles or the epigastric region, or when introducing the catheter; after every such tetanic spasm mobility of the extremities was presented for a long time on account of muscular rigidity, and complete relaxation of the limbs came on gradually, and only after half an hour; these attacks of tetanic spasms were accompanied by moaning; at last three was observed for a minute or so a spasmodic trembling of the hands and feet; the diaphragm seemed to be affected by violently convulsive contractions, 19.
- The sphincters rigidly contracted, 16.
- Strong tetanic spasms, directly, and death in less than an hour (in a young girl), 15. [180.]
- Most frightful epilepsy repeated several times, the day after an attack, 9.
- Motionless (soon), 18.
- Sphincters paralyzed, 12.
- Lazy and sleepy, and disinclined to work, in the morning (tenth day), 4.
- General weakness, 1.
- Physical exhaustion (second day), 6.
- Great exhaustion, 17.
- His senses almost entirely disappeared, as in faintness, 6.
- Insensibility, 12.
- Became insensible and fell down, 20. [190.]
- Fell insensible, 16.
- Fell insensible on the floor, immediately, 14.
- The poison had hardly penetrated the intestine when she fell senseless, without a single complaint, 18.
- Fell off my chair before I had finished drinking the emetic, turned blue in the face, and breathed slowly and heavily; it was six hours before I gave signs of returning consciousness, .
SLEEP AND DREAMS
- Sleepiness.
- Sleepiness during day (ninth day), 4.
- Became very sleepy at 2 P.M. (fifth day), 4.
- Felt very sleepy at 8 P.M.; could not keep awake; became wakeful again at 9 P.M. (third day); slept soundly all night (third night), 4.
- After being quite awake and bright all day, became sleepy early in the evening, and wakeful again at 9 P.M. (second day), 4.
- Slept well all night (eighth night), waking with clear head, at 6 A.M. (ninth day), 4. [210.]
- Slept soundly all night (fourth night), 4.
- Slept soundly until 2 o'clock A.M. (second night), 4.
- Sleeplessness.
- The sleep at night had been restless; confused dreams, which he cannot remember after waking, for two nights (third night), 2.
- Restless, dreamful sleep all night; could not lie on one side for any length of time (third night), 3.
- Dreams.
- Dreams very lively, especially towards morning (third night), 4.
- Dreams clear, very lively, and practical, with very satisfactory feeling after waking and in regard to dreams (fourth night), 4.
- Lively dreams, but awoke only once during the night, and then continuing the dream had before waking, very lively, quick, and rushing (first night), 4.
- Rushing dreams, very clear and distinct, from 2 o'clock until morning (second night), 4.
- During the whole night, dreams horrid and exciting; then waking up partially, and feeling tired of lying on that side, as after great fatigue; turning on the other side, another dream, waking, and turning again, and so on till morning (fifth night), 3.
FEVER
- Chilliness.
- Surface of the whole body cold and moist (after ten to fifteen minutes), 14. [220.]
- Shiverings, 17.
- Coldness of the extremities, 10, 17.
- Coldness of extremities, which were pendulous and without muscular power, 12.
- Hands cold (soon), 18.
- Extremities icy cold, almost immediately, 16.
- Heat.
- Awoke about 6 A.M., with heat and disagreeable feverish perspiration over whole body, excepting legs below the knees, with flushed face (fifth day).
- Awoke about 6 A.M., with dry heat and perspiration (sixth day), 4 . [As in original text.]
- Heat in the head, 1.
- Sweat.
- Hands and face covered with and perspiration, 20.
CONDITIONS
- Aggravation.
- ( Morning ), All symptoms, 4 ; at 7.30 o'clock, fulness of head, etc.; after rising, stitch in shoulder.
- ( Afternoon ), Weakness in lumbar regions, etc.; weakness in lower legs.
- ( Evening ), All symptoms, 4.
- ( After meals ), Immediately, especially after dinner, fulness in region of œsophagus, etc.
- ( In room ), Crossness, etc.
- Amelioration.
- ( Motion in open air ), The symptoms, 1.
SUPPLEMENT: KALI CYANATUM. Authorities.
24 , E. Sandwell, Lancet, 1864 (2), p. 648, a child swallowed a drachm, dissolved in water, after a full meal; 25 , Wm. Gillibrand, Lancet, 1876 (2), p. 223, a man, æt. thirty-five years, took between 50 and 60 grains; 26 , A. H. Newth, M.D., Med. Times and Gaz., 1877 (1), p. 335, poisoning of a man; 27 , Geo. F. Sonwers, M.D., Phil. Med. Times, vol. viii, 1877-8, p. 345, a photographer worked some days with it, both in substance and solution.
MIND
- Some muttering delirium (which afterwards became more active, the patient evincing a desire to walk around), 27.
HEAD. [230.]
- Heaviness of head, 27.
- Gnawing pain across temples, 25.
- Soreness of the scalp over both parietal regions, 27.
EYE
EAR
- Ringing in the ears, 27.
FACE
- Face dull, slightly flushed, and expressionless, the tendency being to close the eyes, 27.
MOUTH
- Teeth, gums, and lips covered with sordes, 27.
- Tongue has a peculiar darkish background, seen through the heavy white coating, 27.
- Breath extremely fetid, 27.
STOMACH. [240.]
- Loss of appetite, 27.
- Some nausea, 27.
- Pain at the epigastrium of a griping intermitting character, 25.
STOOL
- Bowels obstinately constipated, 27.
RESPIRATORY ORGANS
- Breathing very slow and spasmodic, white froth issuing from the mouth, and the jaw fixed, 25.
BACK
- Pain in lumbar region, 27.
EXTREMITIES
- Extremities relaxed and limbs flaccid, 25.
GENERALITIES
- Immediately seized with convulsions, and soon became collapsed and rigid, the pulse at the wrist being imperceptible, though a slight action of the heart could be felt, 24.
- Found the man lying full length in bed on his back; the arms, which were straight down by his side, twitching convulsively; hands partially clenched, thumbs flexed across palm; body bathed in a clammy sweat; face pallid, expressionless; eyes fixed, partially closed, pupils widely dilated, tears in the corners of the eyelids; breathing stertorous, loud mucous rattle, foam around mouth; pulse imperceptible, and heart's action indistinct, 26.
SLEEP
- Sleeplessness, 27.