Piper methysticum, Forst.

Natural order , Piperaceæ.

Common names (Tahitian), Ava, Kava-kava.

Preparation , Tincture of the root.

Authorities.

1 , T. R. N. Morson, Pharm. Journ., 1844, p. 478, effects of a strong infusion; 2 and 3 , Cuzent, Pharm. Journ., 1861, from Journ. de Pharm., effects of a drink, prepared by chewing the fresh roots and mixing the result with water; 4 , same, effects in old drinkers; 5 , Dr. C. F. Nichols, New Eng. Med. Gaz., 8, 101, copied from Brigham's translation of Remy, effects of the drink, as in Nos.

2 and 3; 6 , W. N. Griswold, M.D., Hahn. Month., 1877, p. 547, proving with increasing doses (10 to 20 drops) of 3d dil.; 6 a , same, 2d dil., 10 drops, first day, to two teaspoonfuls eighth day (took a dose of Puls. 2d on ninth, and Nux vom. on eleventh night); 7 , F. Hiller, Jr., M.D., repeated doses of watery solution, first day, afterward of tincture, 25 to 30-drop doses, second, third, sixth, and seventh days, Hahn. Month., 1877, p. 617; 8 , M. A. A. Wolff, M.D., Cal. Med. Times, 1, p. 43, took tincture, three times a day, for about a month, doses 6 drops to three and four teaspoonfuls; 8 a , same, in let. to Editor, Feb. 1878, four weeks after last dose took two doses of 5 drops of strong tincture; on the day after the last dose a series of symptoms appeared.

MIND

When concentrated, drunkenness is almost instantaneous; with the ordinary dose, it occurs about twenty minutes after ingestion. In a small dose, kava is a tonic stimulating beverage, producing an agreeable excitement, and affording support against great fatigue. In increased doses, this root determines an intoxication of a sorrowful, silent, and sleepy character, completely different from that produced by alcoholic drinks. The habitual drinkers of kava take it six or eight times a day, but then a nervous trembling seizes them, and they can scarcely raise the cup to their lips, 2.
The intoxication does not last longer than two hours, but if a person only takes it occasionally, the effects may continue twelve; when taken at intervals of some days, the intoxication continues for six hours. When made from the root grown in damp soils, the drinker remains plunged in a deep torpor, and becomes irritated by the least noise, 3.
Often, when the dose is too great or too small, instead of the sleep an intoxication, accompanied by fantastic ideas and a strong desire to skip about, although one cannot for a moment hold himself on his legs. I felt these symptoms for sixty hours the first time I tasted this Polynesian liquor, 5.
(During this week my system was gradually "toned up," so that I was able to do a (for me) large amount of miscellaneous reading after business hours, without more than usual fatigue and with a relish. This was extraordinary, because for years (since December, 1867) I have not indulged in light reading , it having fatigued and brain-fogged me equally with professional reading, and my strength, perforce, has been reserved for necessary scientific and professional reading), 6.
(Have, for a long time, not gone through my daily work with such a cheerfulness and ease as to-day), (third day), 8.
Felt all day unusual life, vigor, and exhilaration (eighth day), 6a.
At 11 P.M. have felt satisfied and hilarious, since 10 A.M. (thirty-third day), 8.
Soon after 10 P.M. felt lively and wakeful (second day), 7.
Felt bright and lively after emission (third day), 7. [10.]
I feel more lively than usual; in better spirits; inclined to work (sixth day); feel lively; can dance with more ease than usual (seventh day), 7.
Want of vigor, timid, apprehensive, during day (second day), 6a.
Feelings varying and generally depressed (ninth day), 6a.
(Capable of doing more work, without fatigue or brain-fog), (third day), .

HEAD

Dizziness and frontal pressure, even when lying in bed, in the morning (seventh day), 6a.
From 5 to 9 P.M. unusually dizzy; assisting at obstetrical case, came near falling several times; swimming sensation and faintness, partly produced by going past evening meal without eating, but not all; never had such a dizziness and swimming sensation on going without food, usually a faint feeling near umbilicus or in epigastrium (seventh day), 6a.
Pains (especially of the head)

relieved temporarily by turning the mind to another topic, 6a.

Soon felt uneasiness in the head, 8.
Slight heaviness in the head (fourth day), 7.
Slight sensation of fulness, sometimes in one part of brain and sometimes in another, mainly in frontal region (first, second, or third day), 6a. [20.]
To-night brain feels tired ; a little rest relieves the tired feeling (seventh day), 6a.
Awoke with very worn feeling of the brain, decided brain-fog; getting on foot felt better (eighth morning), 6a.
Brain-fog is spoken of during the primary or active part of the proving; it was then caused by an excessive use of the brain in miscellaneous reading; in the latter part it was secondary or reactive effects of the drug, for I read as much as I could stand during the first period, and abstained from all reading as far as possible during latter part of proving, 6a.
Headache and sleepiness so great that I could hardly attend to a patient (after eight hours and a half), 8.
Dulness, fulness, and pressure in forehead, and vertigo on elevating or moving the head to either side; after the noon meal the pressure shifted to both lateral and the occipital regions, and on lying down increased to a considerable degree, not enough, however, to constitute real pain; pressure in head increased by remaining in one position, decreased by moving; impelled by something to move cautiously, as if there was some condition which would not admit of rapid movement; apprehensive of pain by rapid movement, but the move being mode, temporary relief, as by slower movement (third day), 6a.
Head ached all night, with fulness of frontal region (ninth night); aching continues; feeling as if frontal part of brain was solid with pain ; this ache, during the day, gradually moved backward to base of brain and along the medulla oblongata; relieved by slight motion, increased by large, continued, and more active motion (opposite of Rhus); slight mental effort, passing from topic to topic , for an instant relieves; sustained effort increases the aching pain; lay down this P.M. 71i

to rest the brain; frontal pain decreased, occipital increased; gravity seems to have overcome the force of the circulation in the vessels of the brain; vessels of neck and base of brain full, as if circulation had been cut off by a cord; whole back of head, neck, and cerebellum felt congested to the brain and ; sore inside and tender to outside pressure; all those parts of the nervous system (head, neck, etc.) felt as if double or treble their ordinary size; I lowered my head and straightened my neck, called for a soft pillow, caused mesmeric passes to be made downward by sides of the head, and with frequent slight changes of position; in about one hour relief began to come; action of the cerebrum weak, but clear; during the whole evening these conditions continued, gradually decreasing (tenth day), 6a.

After business anxieties, in the evening, pain commenced along the middle of the forehead, proceeded outward to each side of head, and after retiring at night, it followed around both sides of the head and attacked the posterior part of the brain, medulla, etc.; the sensation was not extremely painful, but almost indescribable; all the cerebellum, medulla, etc., were as if compressed by an even pressure from every direction, especially from front to back ; nervous system was forced to its highest tension; could not sleep first part of night, and later part only at intervals; could lie still but a few moments at a time; seemed as if head and neck would be compressed to death if I remained quiet long; changed from side to side, from back to face, and vice versâ ; hands sought cool places, otherwise no perceptible increase of heat; no thirst; constriction extended to chest and stomach as well as brain, though in less degree; the drug seemed to have affected, secondarily, the sources of animal life in cerebellum and medulla, partially and temporarily exciting , and then, to an extent, paralyzing, those functions; called up at 1 o'clock; while moving, much relieved (twelfth day). Nervous system still strung up (or on tension); considerable compressive pain about back of head and cervical part of spinal cord, gradually diminishing during the day (thirteenth day). The symptoms of twelfth night repeated (twentieth and twenty-ninth days). For the last month or more I have spent Tuesday or Wednesday night of each week with distress of head and sleeplessness, as above recorded, though the symptoms each week have gradually decreased in intensity (sixty-first day), 6a.
Great frontal headache all day; at 8 P.M. the ache especially over the eyes and deepseated (second day), 8.
Pain in frontal part of head (immediately after first dose, eighth day), 8.
Frontal headache and pressing pain, especially on left side, and deep in the upper part of the orbits; moving the eyes hurts (eighth day), 8. [30.]
Frontal headache, just above the eyes, at 5 P.M. (tenth day), 8.
Pressure in the head, back of the eyes (fifteenth day), 8.
Frontal pain, left side, 7.30 P.M. (eighteenth day), 8.
Frontal headache, at 7 P.M. (nineteenth day), 8.
Frontal headache, at 9 A.M., worse at 3 P.M.; slept from 5 to 6 P.M., hoping to sleep the headache away, but the pain was so distressing as to compel me to take, 6.30 P.M., a dose of

Nux vom .; pain being worse, took Bell . 3x; great headache at 12 P.M. (twentieth day); had disappeared when I was called at 2 A.M., then reappeared (twenty-first day); gone on waking at 5 A.M. (twenty-second day), 8.

Pain over the eyes, radiating from right frontal side, just above the eye, at 10 A.M. (twenty-fourth day), 8.
Headache, with pressure in upper part of the orbits of the eye (immediately after a dose, twenty-fifth day), 8.
Dull aching at intervals in the right frontal eminence (tenth day), 7.
Dull frontal headache during the whole afternoon and evening, with drowsy and stupid feeling (seventh day), 7.
Dull heaviness across the forehead (soon, first day), 7. [40.]
Heaviness in forehead (seventh day), 7.
Heavy pressure on the whole frontal part of head (seventh day), 6a.
Heavy dull headache in temporal and frontal regions, increased by thinking and reading (ninth day), 6a.
Head aching at right temporal region, across the eye and bridge of the nose, with feeling of pressure along the sides of the nose, half way to tip; right temporal pain not uncommon with me when fatigued (seventh day), 6a.
Sharp shooting pains in left temple (after first dose, second day), 7.
Uneasy sensation on each side of the head over each ear, as of pressure and weight (third day), 6a.
Stitches running through left side of the brain front to back, after 3 P.M. (second day), 7.
The severe pains and soreness in the back of the head and base of brain have gradually disappeared , leaving brain (cerebellum) only sensitive ; the feeling of continues, changing back and forth from frontal and occipital regions, being sometimes most prominent on sides of head, over ears, etc., in the temporal regions (eleventh day), 6a.
Eye and Ear.
A pain along the line of the optic nerve of the right eye, when reading, after 3 P.M. (second day), 7.
Pain in the left supraorbital nerve (first day), 7. [50.]
At 5.30 P.M., in the street, pain deep in left eye, as if the eyeball would be pressed out; at 6 P.M., in the house, this pain had ceased (second day), 8a.

FACE

A curious sensation of fulness in face, as of pressure from inside out, at 7 P.M. (nineteenth day), 8.

MOUTH

Teeth of a deep-yellow color, 4.
For the last six or eight days teeth have been very sensitive to cold water, cold air, tooth brush, washing, etc. (tenth day); sensitiveness of left upper first molar, predisposed by former disease, to the gums , did not cease for three or four months; last symptom to disappear, 6a. [60.]
Sensation as if the tongue was covered with fur or velvet (second night), 8.
Sensation of burning on the tongue (after a few seconds), 3.
Awoke from afternoon nap with great dryness in the mouth and heavy perspiration (it is a very hot day), (third day), 8.
Abundant salivation, 3.
Chewed in the freshly-gathered state, it tastes first sweet or aromatic, then bitter and pungent, 3.
The taste is first sweet, it then becomes piquant and sharp, 2.
The taste is very nauseous, 5.
Pappy taste in mouth, soon passing away (fifth day), 6a.
At every meal everything tasteless; fruit, tea, butter, meats, cake, etc., taste all the same (third day), 6a.

STOMACH

During some of the proving, noticeably a day or two previous and succeeding to the ninth day, took in food with a sort of ravenous haste ; no taste of food, but a nervous ravenousness would have impelled me to swallow anything with an abnormal avidity, 6a. [70.]
At noon meal, appetite unusually good, but food had not the usual relish or taste (third day), 6a.
Very hungry, but not able to eat much, at 12 M.; for supper, was able to eat but little (second day), 8.
Formidable appetite, at 8 P.M. (eighth day), 8.
Appetite slight (ninth day), 6a.
Sour eructations, especially before meals an hour , at times rolling up and rumbling all the way from stomach and mouth, but for the most part breaking at throat-pit with frequent succession. At throat-pit, some feeling as of something which ought to be swallowed; sensation relieved by eructation temporarily; returns soon; at night, eructations, and sensation at throat-pit and root of tongue so disagreeable, took Puls. 2

to relieve, with some effect (ninth day), 6a.

Stomach bloated, 11 P.M. (nineteenth day), 8.
Warmth in stomach succeeded swallowing the drug, 6a.
Warmth of stomach soon passing away (fifth day), 6a.
Crampy pain in stomach, lasting half an hour; relieved by pressing stomach against the edge of a table (tenth day), 7.
Feeling as if mucous membrane of the stomach, mouth, tongue, etc., was covered or furred over, and their sensitive power was lost; tongue not coated (third day), 6a.

ABDOMEN

Slight pain in the abdomen, above the umbilicus, soon passing away (fifth day), 6a. [80.]
After the first stool, in the forenoon, frequent colicky pains, and distressing sensation of fulness in the bowels (twenty-ninth day), 8.
Colic, about 9 A.M., every morning, 7.
Colic, relieved by motion (tenth day), 7.
Pain in right groin, when walking (after first dose, second day), 7.

RECTUM AND ANUS

Burning sensation in rectum has returned (thirty-ninth day), 8.
The only symptom that has troubled me for some days past is the sensation of going to have a stool every evening (fiftieth day), 8.
Sensation of desiring a stool all day (fourth day), 8.
Continual desire for stool (seventh day), 8.
All day have felt desire for stool (eighteenth day), 8.

STOOL

Bowels a little loose, in the morning, more difficult in the evening (second day); soft stool passes with more difficulty than usual (seventh day), 7. [90.]
About 10 A.M.

unusually (very) large stool, the latter part of which was quite soft, preceded by slight pain in the abdomen (sixth day), 6a.

Bowels, which have been regular, constipated (eighth to twelfth day), 6a.
At 9 A.M. had one passage; at 5 P.M., a second, natural, except in quantity , which was enormous (second day), 8a.
Small movement of the bowels, about 10 A.M. (thirteenth day), 6a.
An unusually large and very hard stool (fifth and sixth days); very small and very hard stool (seventh day), 8.
Very hard stool, at 10 A.M.; small stool, at 2.45 P.M. (tenth day); stool twice as large as usual, natural (eleventh day); none (twelfth day); very hard, at 2 P.M.; feel as if about to have another, at 2.45 P.M. (thirteenth day); during the forenoon, stool with less straining (fourteenth day); large stool, at 8.30 A.M.; another large soft one, at 8.45 A.M. (sixteenth day); all day desire for stool (eighteenth day); distressing desire for stool, at 10 A.M.; about 1 P.M., forced a stool, light-colored, hard, small, oblong (twice the size of a large peanut), fæces; another, a little darker and larger, at 7 P.M.; continuous desire for stool, at 11 P.M. (nineteenth day); forced a hard stool, which caused a prolapsus ani (twentieth day); small stool, less straining, at 5 A.M.; urging to stool, at 10 A.M.; softer stool, at 12 M. (twenty-second day); good stool, at 11 P.M. (twenty-third day), 8.
Good stool (twenty-third and twenty-fourth days); natural and large stool (twenty-fifth day), 8.
Two very large stools; another soft and large stool (twenty-ninth day); soft stool, at 9.30 A.M. (thirtieth day); large soft stool (thirty-second day), 8.
8 P.M., diarrhœa threatening (thirty-fourth day); at 1 P.M. (thirty-fifth day), 8.
Double-sized light colored stool, at 10 A.M. (thirty-fourth day); light colored, easy stool (thirty-fifth day), 8. [100.]
Stool, with straining, at 4 P.M.; during the evening, continued desire for stool (thirty-sixth day); treble the usual sized light-colored stool; towards evening, sensation of urging to stool returned (thirty-seventh day); sensation of urging to stool (thirty-eighth day); large stool (thirty-ninth day); good stool (fortieth day); large stool, at 7 A.M.; another stool, at 9 A.M. (forty-first day), 8.

URINARY ORGANS

Burning in the urethra, in passing water (fourth day), 8.
Seeing a great change in the urine, kept a clinical record in this respect (fifth day), 8.
Got up to pass water, at 4.45 A.M. (twentieth day); passed a small quantity, in the morning (twenty-sixth day), 8.
Urine increasing in quantity, normal in color and odor (seventh day), 7.
Urine, this A.M., when first passed, was hot, burned the urethra; at 10 A.M., urine nearly neutral; acidity hardly perceptible (eighth day); at night, hot and decidedly over-acid (ninth day); acid (eleventh day), 6a.

SEXUAL ORGANS

An erection, lasting about a quarter of an hour, in the afternoon (first day); after an emission, lasting one hour, about 4 A.M. (third day), 7.
Erections, but no emissions (fourteenth night), 8.
Shooting pain in penis (third day), 7.
Pains in right testicle (third day), 7. [110.]
More amorousness during the primary part of the proving than for years, 6a.
Emission, about 4 A.M., followed by wakefulness (third day); large emission early this morning; the emissions come on without dreams; am awakened by a large quantity of semen running over me (fourth day); emission during forepart of night (tenth night); during night (eleventh night), 7.

CHEST

Heaviness in upper part of chest, behind the sternum, as if filled with wind which cannot be eructated (fourth day), 8.

BACK

Pain in back, felt only on pressure, at 11.45 P.M. (tenth day), 8.
Soreness in the back, about second dorsal vertebra, at 5 P.M. (tenth day), 8.

EXTREMITIES

The most excruciating pains in the right arm, as if the marrow would be affected ; the location of the pain changes in the whole length of the arm , from the shoulder down to the finger-ends ; the hands , several times (paroxysmal), feel almost paralyzed ; I am then hardly able to keep hold of a pen; at the same time pain was felt in the big toe of right foot ; intermissions only after Bry. and Calc.; took medicine only when the pain became so distressing as to make me almost frantic . At 6 P.M., the pain in big toe, right foot , is severe, and another, less severe, is felt in and around right fibula; at 9 P.M., pain in toe disappeared, but appeared in right hand , especially in metacarpal part , next to the little finger (second day). At 1 A.M., in bed, pain in lower part of right arm unbearable; the hand feels so weak that I can hardly use it to grasp anything; 1 drop Bry.; fell asleep about 2.30; at 4 A.M., woke with exactly the same symptoms; another drop Bry.; fell asleep until 6 A.M.; got out of bed; the pain reappeared in its full strength; took 1 drop Rhus 3 x, 8 P.M.; since about an hour after taking Rhus, this morning, all pain in arm and hand has left; only the pain in right big toe has been somewhat distressing, but as it is wearing off I intend to leave it to itself (fifth day), 8a.

SUPERIOR EXTREMITIES

In the street, an aching pain in the whole left arm, and flushing heat in left hand, which, in time, changed to aching pains in the middle and third fingers (after one hour and a half); pain in second joint of left thumb (after four hours), 8.
A disagreeable dragging pain in the whole length of the left arm, at 8 P.M.; better at 10 P.M. (nineteenth day), 8.
The whole right arm aches and feels heavy, with slight pains running in all directions through it; the arm feels sore and tired (fourth day), 7.
Dull aching pain in left shoulder (soon after first dose, second day), 7. [120.]
About the middle of the day, a severe pain above the elbow at or near the insertion of the triceps (sixth day), 7.
A tingling in left arm and hand, running from elbow to hand, including all the fingers; the sensation was as if a mild current of electricity was running through the arm, hand, and fingers. The sensation was pleasant and lasted about fifteen minutes (seventh day), 7.
Numbness in right elbow (after first dose, second day), 7.
Severe pain, with slight stiffness, in right elbow and left knee (fourth day), 7.
Aching pain in right wrist, worse when writing (eighth day); severe pain in right wrist, lasting all day and evening (ninth day); a dull aching pain in the right wrist commenced at 10.30 A.M., with a slight prickling pain running up the arm to the elbow, also a sore pain in wrist (tenth day); soreness in right wrist (twelfth day), 7.
Sensation of weakness in left hand (eighth day), 8.
Pain in the joint of thumb of left hand, aggravated by pressure (seventh day); continues, with intermissions, for several hours (eighth day), 8.

INFERIOR EXTREMITIES

Weariness of the lower extremities all day (eighth and fifteenth days), 8.
Very weak in lower extremities, in the afternoon (thirtieth day); increased weakness (thirty-first day); weakness in limbs (thirty-third day), 8.
Weakness or weariness in lower extremities (thirty-fourth day), 8. [130.]
Feel weary and completely broken down in lower extremities (forty-first day), 8.
Fatigue in femoral part of both legs, as if unable to stand on them (after five hours), 8.
Pain in left knee, which made me limp when walking (soon after dose, seventh day), 7.
Stitching pain in left knee, when walking, at 4 P.M. (third day), 7.
Sharp pain under the right patella, causing me to limp when walking; it comes and goes; is much worse immediately after taking medicine (third day), 7.
Arthritic pain in left knee, when walking (fourth day), 8.
Pain, for a few moments, in left knee (tenth day), 8.
Weariness in legs (ninth day), 8.
Soreness in right leg moved down to tendo Achillis, at 8 A.M.; pain in leg removed to sole of left foot, at 4 P.M.; the pain hardly felt, at 7 P.M. (twenty-sixth day), 8.
Pain in the calf of right leg (fifteenth day), 8. [140.]
Keen pain in right calf (sixteenth day), 8.
Pain in both calves, after bathing (twenty-fifth day), 8.
Great pain in lower part of right calf, in the morning, (twenty-sixth day), 8.
Legs feel heavy, from knees down, when walking (seventh day), 7.
Aching pain and tingling in right instep, worse when sitting, and better on motion (after first dose, second day), 7.
Pain in left foot, at the outer and under border; the foot itself felt cold, with pain in the big toe of right foot (fourth day), 8.
Pain in left foot and toe (sixth day), 8.
Pain in right foot, sole (ninth day), 8.
Pain in right foot (ninth day), 8.
Pain and heat in whole right foot and back side of left hand, at 11.30 P.M. (fourteenth day), . [150.]

GENERALITIES

Complete emaciation and decrepitude, 4. [160.]
The body becomes emaciated (in habitual drinkers), 5.
Stimulating and sedative effects, lasting for twenty-four hours, and leaving the patient in profuse perspiration, 1.
After taking, a feeling followed as if the drug had descended and impressed the lower part of the system, producing trembling sensation of bowels and lower extremities, and bloodvessels connected therewith. On going downstairs, the drug seemed to come through the circulation upwardly, reaching the brain, and producing exhilarating dizziness and a disposition to swing and stagger, as if one were under the influence of alcoholic liquor; for half an hour or more, felt talkative and happy; dizziness soon disappeared and left a generally "toned up" condition of brain and nervous system; on commencing to move dizziness returned (eighth day), 6a.
(System generally feels stronger), (third day), 6a.
The effects are particularly pleasant, 5.
Feel lazy and drowsy (tenth day), 7.
Feel worn out, at 8.30 P.M. (tenth day), 8.
Worn tired feeling, before and on rising (seventh day), 6a.
Felt tired and "mean;" did not want to get up; when I got up and moved around, felt better (thirteenth morning), 6a.
An agreeable languor alternates with a pleasant, youthful freshness and vigor of body and mind; feeling of general tonicity comes on, as during the primary or actionary stage of the proving; voluntary muscular action, as then , so easy as to be almost involuntary; muscular action increased, but power of involuntary unconscious co-ordination of muscular action impaired; find myself walking fast before I am conscious of it; legs and feet seem to be running away with or from me; my will is called consciously into action to regulate my movements; feel otherwise unusually well and active, all day and evening (eleventh day); some business anxieties broke the general tonicity of the system (twelfth day), 6a. [170.]
Many uneasy sensations, during the day (twenty-fifth day), 8.
Feel myself the last week, for the most part, relieved from the effects of the Ava (eighty-second day), 6a.

SKIN

The skin is covered as in leprosy, with large scales, which fall off and leave lasting white spots which often become ulcers, 5.
A peculiar kind of skin disease, called at Tahiti, Arevareva, results from the daily use, 3.
Skin dry, scaly, cracked and ulcerated, especially where it is thick, as on the hands and feet, 4.
A painful lump, threatening to become an abscess, has appeared on right forehead, above minor canthus of right eye, just above the brow (eighth day); the swelling yet there, but redness disappeared and pain ceased (ninth day); lump on forehead swollen, painful to touch; swelling continues, with diminished pain (tenth day); size of lumps on forehead and back decreased (eleventh day); the threatening boils on forehead and back have disappeared (thirteenth day), 8.
A small painful swelling in lower corner of left ear (twenty-sixth day); lump in lower left ear less painful (twenty-seventh day); harder (twenty-eighth day), 8.

SLEEP

Feel somewhat drowsy and stupid, with a dull frontal headache during the whole afternoon and evening (seventh day), 7. [180.]
An irresistible sleep seizes you, and lasts twelve, twenty-four hours, or even longer, according to the temperament of the individual; often, when the dose is too great or too small, sleep does not follow, but in its place an intoxication, 5.
10 P.M., feel unusually sleepy (second day), 7.
Slept soundly, during the afternoon, which is unusual for me (tenth day), 7.
Lay down to sleep (soon); (in the afternoon), was awakened unusually lazy; lay down again; awakened again at 4 P.M., extremely indisposed to mental effort; to arouse myself, went out to walk; great drowsiness, at 6.30; in an interesting meeting felt languid and sleepy, hardly able to keep the eyes open, at 8.30; sleepiness and headache, so great that I could hardly attend to a patient, at 11 P.M.; slept excellently at night (first day); when awakened, at 3.30 A.M., had to exert myself unusually to keep awake during a serious case of obstetrics (second day). Sleep, during first hour, interrupted, then slept till morning (second night). Slept from 1.30 to 2.30 P.M.; fell asleep on the lounge (third day). During the day, wakefulness between 1 and 2 P.M., when usually sleepy (fourth day). Fragmentary sleep, from 12.30 to 4.20 A.M., with varied and exciting dreams; great sleeplessness, so much so that I had to get up, at 4.30 A.M.; did excitedly all kinds of unusual office work; slept soundly from about 1.30 to 2.45 P.M. (fifth day). Unusual drowsiness, at 3 P.M.; have slept very much, and very hard, several times during the day (eighth day). Returned home from patient, at 1 A.M.; fell asleep, only after great exertion, at 2.45 A.M.; slept well to 3 A.M.; feel completely worn out; took a dose Cinchona; slept light till 5 A.M. (ninth night). Sleep from 12.15 to 5 A.M.; twice interrupted by desire to urinate (fourteenth night). Have had a heavy sleep, with dreams, at 2 P.M.; feel very sleepy (fifteenth day); slept a great deal during the day (seventeenth day); slept soundly from 12.30 to 5 A.M., in spite of the much day sleep yesterday (eighteenth day). A restless night; to bed a 12 P.M.; after a good while, succeeded in falling asleep, but awoke at 1.30; sleepless; took an extra dose, one teaspoonful; fell asleep but awoke at 3 A.M. (twenty-fourth night); tried to sleep, but could not, at 9 A.M. (twenty-fifth day). To bed at 12.45 A.M.; no sleep; took a dose; soon fell asleep, but awoke after one hour; fell asleep again; slept to 4.45 A.M. (twenty-sixth day). Awoke twice during the night (thirty-first night). Very sleepy and drowsy (thirty-first day); drowsy, at 9 A.M. (thirty-second day); great and continued drowsiness (thirty-third day). Sleepless from 12 to 2.30 A.M. (thirty-third night); disturbed sleep (thirty-fifth night). Have no felt the want of afternoon sleep, at 11 P.M.; no desire to sleep these thirteen hours (thirty-third day); no inclination for afternoon sleep (thirty-fourth day), .

FEVER

8 P.M., for last few hours feel chilly (thirty-fourth day), 8.
Flush of heat all over the body (soon, first day), 7.
Feverish heat, at 9 A.M. (twenty-fifth day), 8.
This evening, feel a warm glow over all the upper part of the body, as of slight fever, but no marked increase of heart action (third day), 6a.
Feverish feeling in face and hands, especially left hand (tenth day), 8.
A flush of heat in both cheeks (after first dose, second day), 7.
Feverish heat in left ear flap and left hand (second day); flushing heat of left hand and ear less strong than yesterday (third day). Flush in left hand and ear (fourth day). Heat of left ear and hand continues (seventh, eighth, eleventh and twelfth days).
Heat in left hand, fingers, and ear, at 10 A.M. (twenty-second day), 8.
Heavy perspiration, with the great dryness of mouth, on waking from afternoon nap (third day), 8.

CONDITIONS

Aggravation.
( Morning ), Worn feeling in the brain; 9 A.M., colic; pain in lower part of right calf; worn and tired feeling; 9 A.M., heat.
( Afternoon ), Frontal headache; soreness in back; on waking from nap, perspiration and dryness of mouth.
( Evening ), Frontal headache; 7 P.M., fulness in face; sensation of going to have a stool; 8 P.M., chilliness.
( After bathing ), Pain in calves.
( Before meals ), Sour eructations.
( Moving head ), Vertigo.
( Moving ), Pain in great toe.
( Pressure ), Pain in back; pain in joint of thumb.
( Reading ), Frontal headache; pain along line of optic nerve.
( Remaining in one position ), Pain in head.
( When sitting ), Pain in right instep.
( Thinking ), Frontal headache.
( While urinating ), Burning in urethra.
( When walking ), Pain in right groin; pain in knee.
( When writing ), Pain in wrist.
Amelioration.
( Open air ), The symptoms.
( Closing eyes ), Dizziness.
( Eructations ), Feeling at throat pit.
( Mental effort ), Headache.
( Motion ), Pain in head; colic; pain in right instep; the symptoms.
( Pressing stomach against edge of table ), Crampy pain.
( Rest ), Tired feeling.
( Turning mind from one subject ), Pain in head.

Piper Methysticum