Plumbum metallicum, aceticum, carbonicum.

Preparation , Triturations.

Authorities. (Nos.

1 to 63 , from Hartlaub and Trinks, Mat. Med., 1, p. 8).

1 , Bethmann; 2 , Hartlaub; 3 , Hering; 4 , Nenning; 5 , Trinks; 6 , Act. Nat. Cur. Ann. III, Obs. XXX, effects in a worker in pewter; 7 , omitted; 8 , G. Baecker, Trans. of Coll. of Physicians, in London, and from Percival, effects of applying lead to a troublesome itching; 9 , Bernt, Rettungsmittel; 10 , Boerhaave, Elem. Chem., 2, 454; 11 , J. Alex. v. Brambilla, in Schmidt's Antigoulard, in part, effects of cosmetics in a girl; 12 , De Hæn, Ration. Medendi Contin., iii, 1, p. 403; 13 , Dioscorides, Mat. Med., lib. VI, c. 27; 14 , Ettmüller, Coll. Cons. Cas., 26; 15 , Fothergill, in Abhandl. f. Pract. Ærzte, 3, 519; 16 , Gabreely, in den Abhandl. d. K. Jos. Med.-Chir., Acad., 1, 189, in a woman working in paints; 17 , Gardane, sur l'Électricité Méd. avec des Rech. sur la Colique Métallique, Paris, 1778; 18 , Habenes, in Schmidt's Antigoulard, p. 145; 19 , Hahnemann, in Henke's Zeit. f. die Staats., 7, 1, 151; 20 , Haase; 21 , Hecker, Arzneim; 22 , Hirn, in Schmidt's Antigoulard, p. 94; 23 , J. Fr. Henckel, Ueber die Bergsucht und Hüttenkatze, Freiberg, 1728; 24 , Hermbstædt, from Orfila; 25 , Fr. Hoffmann, in der Aum. zu Lotier Opper. Med. ac Chem., Franckfort, 1698; 26 , Hohnbaum; 27 , Huberthy, in Fischer's Antigoulard, p. 87; 28 , Jahn, Mat. Med., 2, 312; 29 , Laurent, in Fischer's Antigoulard, from external application of lead water to a raw surface; 30 , Lindestolpe, de Venenis, effects of sugar of lead, drank in wine; 31 , Med. Ephem., Chemnitz, 1793; 32 , Mœgling hei Zeller, Docimasia Signa Causæ et Noxæ Vini Lythargyro Mang., Tubniger, p. 24; 33 , Jo. Nardius, Noct. Genial., Ann. 1, Bonon., 1656, 4, No. IV, from internal use of white lead; 34 , Nicander, in Alexi. Pharm.; 35 , Orfila, Toxicologie; 36 , Plenk, Toxicologie, p. 253; 37 , Plinius, Hist. Nat. Lig., 33; 38 , Poterius, Cent. II; 39 , Ramazzini, Diatribe de Artificium Morbis, Batav., 1713, ix, p. 54; 40 , Reinhartz, in Schmidt's Antigoulard, p. 228; 41 , Rhodius, Cent. III, Obs. 10, internal use of sugar of lead; 42 , Richter, Therapie; 43 , Schmidt, Antigoulard, Wien, 1785, p. 231, mostly from the internal use of white lead, in oil and brandy, for gonorrhœa, in a healthy man; 44 , Sennert, in Fischer's Antigoulard, p. 61; 45 , Stockhausen, Libell. de Lytharg. Fumo Noxio Morbifico, etc., Goslar, 1556, 16, p. 10; 46 , Stoll, Ratio Medendi, Th. VII, p. 309; 47 , Streitt, in Schmidt's Antigoulard, p. 186; 48 , Fernelius, de Lue Venereæ, 7; 49 , Thunberg, in den Schwed. Abhandl., 1773; 50 , Tissot, Epist. Med. Pract., p. 222; 51 , Tralles; 52 , Tronchin, Ueber die Kolik von Poitou in Kühn's Samml., Leipzig, 1784, effects in a woman, of sugar of lead, in hæmoptysis; 53 , Wall, in Percival on the poison of lead; 54 , Waderoliet, in den Samml. fur pr. Ærzte, VIII, p. 634; 55 , Vering, in Fischer's Antigoulard, p. 108; 56 , Volpi, in Fischer's Antigoulard, p. 77; 57 , Galen, de Med. Sec. Loc. Lib., 7, effects of drinking water from leaden vessels; 58 , Faber, Lanchymag., Lib. IV, p. 7, c. 32; 59 , Vekos-krift for Lækare, T. VI; 60 , Borelli, Obs. Cent., IV, Obs. 32; 61 , Quesnoy, Traité de la Suppuration, Paris, 1779, effects of the external application of sugar of lead; 62 , W. Cullen, Lectures on Mat. Med., p. 192, effects of applying ext. Saturni in erysipelas; 63 , Redlich, Diss. de Colic Saturn., Lipsiæ, 1800, 4; 64 , Duncan, Med. and Philos. Comment., 1784, p. 202, effects in a man, from frequent bathing a scalded leg with Goulard's lead water; 65 , same, p. 314, effects in several, from drinking water from a leaden cistern; 66 , Bartlett, Med. and Phys. Journ., 1804, p. 403, effects in a typesetter; 67 , Horn., Horn's Archiv., 1807 (Frank's Mag., 2, 210), poisoning of a worker; 68 , Meade, N. E. Med. Journ., 1813, p. 258, poisoning of a family of eight persons, by eating stewed apples that had stood for some time in an eathen, crock, the glazing of which was broken; 69 , Kerkhoffs, Journal Univers., 1820 (Frank's Mag., 4, 677), poisoning by extract of lead, taken for gonorrhœa; 70 , Long, N. E. Med. Journ., 1823, p. 455, poisoning of a family of four, by eating sugar that contained white lead (it was used for five weeks); 71 , same, special symptoms, in Mrs. L.; 72 , Baumer, Rust's Mag., 1824 (A. H. Z., 9, 79); 73 , Archives Gen., 1825 (Lancet, 1825), effects in a worker in carbonate of lead; 74 , same, in a brazier; 75 , Pierson, N. E. Med. Journ., 1825, p. 27, effects in a painter; 76 , Boston Med. Intell., 1827, Oct. 16, case of a painter; 77 , same; 78 , same, in a plumber; 79 , Jackson, Am. J. of Med. Sc., 1827, p. 300, case of worker in white lead; 80 , Hohnbaum, Henke's Zeit. f. Staats, etc., 1827, poisoning of a family by food cooked in an imperfectly glazed vessel; 81 , Roots, Lancet, 1828-9, p. 636, case of worker in white lead; 82 , Milroy, Lancet 1828-9, p. 234, a woman aged forty, swallowed three teaspoonfuls of sugar of lead (was suffering from urinary and menstrual disorders); 83 , Helbig, Heraclides, 1, 51, effects of bathing the hands, forehead, and cheeks with Goulard's water; 84 , same, proving with 1/10000th grain of Acetate of lead; 85 , Lancette Française, 1828, case of worker in lead; 86 , Hamilton, Lancet, 1829-30, p. 356, case of worker in lead; 87 , same, second case; 88 , Bright, Lancet, 1829-30, p. 356, case of painter; 89 , Pittschaft, in Hufeland's Journ., 1830 (Heraclides, 1, 51); 90 , All. Med. Cent. Zeit., 62, 1830, effects of a solution of 1 ounce of sugar of lead; 91 , Barkhausen, Frank's Mag., 3, 613, effects of working in lead; 92 , same, second case; 93 , Chancerel, Journ. de Méd., 1831, a woman, aged seventy, took some oil containing 3 ounces of extract of lead; 94, 95, 96 , Duplay, Archiv. Gén. de Méd., 1834 (Frank's Mag., 3, 304), cases of workers in lead; 97 , Latham, Lancet, 1834, 2, 687, worker in lead; 98 , Lancet, 1834, 2, 795, painter; 99 , Zeppenfeld, Caspar's Woch., 1835 (Frank's Mag., 1, 276), poisoning of a man by 2 ounces of the Acetate; 100 , Thompson, Lancet, 1835, 1, 92, a man took about 1 ounce of the Acetate; 101 , Mansa, Hygea, 3, 43, a woman, took 2 ounces of white lead; 102 , Caspar's Woch., 1835 (Frank's Mag., 1, 278), a pregnant woman took 3 ounces of white lead; 103 , Elliotson, Lancet, 1836, 1, 653, painter; 104 , Sander, Caspar's Woch. 1836 (A. H. Z., 9, 12), general effects in a large number of cases; 105, 106 , Dugas, Bost. Med. and Surg. Journ., 1837, p. 41 (Southern Med. Journ.), effects in printers; 107 , Cross, Lancet, 1837, 1, 849, a woman, aged thirty-three, took 6 to 8 drachms of Carbonate of lead; 108 , Bost. M. and S. Journ., 1837, p. 239, a man, poisoned by peas, that had stood in an earthen jar with imperfect glazing; 109 , Brockmann, Hanover Annals, 1837 (Frank's Mag., 1, 268), diseases of workers in lead; 110 , Bressler, Casp. Woch., 1837 (Frank's Mag., 1, 277), poisoning of a girl, by lead ointment applied to burns; 111 , Annali Univers. (Lond. Med. Gaz., 1837, 1, 948), effects of swallowing about 6 ounces of short on two successive days; 112 , Hornung, Frank's Mag., 1, 800 (Aust. J., 1837), effects of 4 ounces of the acetate; 113 , Seymour, Lancet, 1838-9, 30, effects in a painter; 114 , Montault, Journ. de Méd. et Chir., 1838, working in an atmosphere of lead; 115 , Tauflieb, Gaz. Méd. de Paris, 1838, application of lead plaster to an ulcer on the leg; 116 , Bayrenson, Journ. de Chim. Méd., 1839, effects of a solution of the acetate ( 117 to 226 , from Tanquerel des Planches, des Mal. de Plomb., Paris, 1839); 117 , "primary effects of various preparations;" 118 , a workman drank wine containing litharge; 119 to 124 , workers in lead; 125 , effects of daily doses of the Acetate, 3 to 24 grains, for two weeks, for cardiac hypertrophy; 125 a , same, repeated; 126, 127 , workers in lead; 128 , effects of injecting into the vagina Goulard's solution for uterine hæmorrhage at the menopause; 129 , effects of taking the acetate for several days, in a man; 130 to 171 , effects of working in lead; 172 , effects of eating bread baked in an oven heated by wood covered with white lead, Tanquerel, l. c. 2, 267; 173 to 201 , effects on workers in lead; 202 , effects in a young man, from taking the Acetate for seminal emissions; 203 to 226 , effects on workers in lead; 227 , Alderson, Med.-Chir. Rev., 1840, 32, p. 11, a woman, aged twenty-five, worker in a lead factory; 228 , same, in a man, from drinking water from a leaden cistern; 229 , Villeneuve, Journ. des Conn. Méd., 1841, a girl took 1 ounce of the Acetate in solution; 230 , Budd, Lond. Med. Gaz., 1841, 1, 411, a painter; 231 , omitted; 232 , Williams, Lond. Med. Gaz., 1841, 1, 478, in a painter; 233 , Schilbach, Fror. Notizen (Lond. and Ed. Med. J., 1841, 1, 220), poisoning of six persons by eating flour that contained lead; 234 , same, one individual; 235 , Buchner, Œst. Med. Woch., 1841 (Hygea, 15, 430), worker in lead; [The autopsy showed that the kidneys were less than half their natural size, granulated, dirty white, with numerous blackish-blue pigment-like deposits, and with cysts containing brownish serum.]; 236 , Johnson, Prov. Med. and Surg. Journ., 1841, effects in a plumber; 237 , Beer, Œst. Woch., 1841 (Frank's Mag., 1, 779), working in lead; 238 , Wilson, Med.-Chir. Rev., 1842, p. 40, worker in lead; 239 , Ann. d'Hyg. Publique, 1842, six persons poisoned by cider, that had stood in a leaden vessel; 240 , Bryce, Lancet, 1842, 1, 498, a man swallowed 3 ounces of shot, in three days, for a boil; 241 and 242 , Shipman, Am. J. Med. Sc., 1843, p. 89, several persons were poisoned by cider from a tub newly painted; 243 , Otto, Zeit. f. die Ges. Med., 1843, poisoned by snuff containing red lead; 244 , same, in a young physician; 245 , Knapp, Rust's Mag., 1843, lead poisoning; 246 , Snow, Lancet, 1844, 2, 144, a child ate white lead, a piece as large as a marble, death on fourth day; 247 , Schrœder, Med. Zeit. f. Preuss., 1844, in a painter; 248 , Schubert, Casp. Woch., 1844, a man poisoned by 5 or 6 drachms of lead; 249 , Otto, Frank's Mag., 3, 887, a girl took 3 drachms of the Acetate ( 250 to 259 , from Morea, l'Empoisonnement aigu par le Plomb. et ses Composés, Paris, 1875); 250 , Reynaud and Porral, poisoning by the Acetate; 251 and 252 , workers in lead; 253 , poisoning by the Extractum Saturni, from Rabateau, Toxicologie; 254 , Boudant, poisoning by 1 ounce of the Acetate; 255 , Pearle, Lond. Med. Gaz., 1845, effects on a man and children of drinking water through leaden pipes; 256 , Journ. de Pharm., 1845, effects of 300 grains of Carbonate of lead, in a man, suffering from heartburn; 257 , Melion, Prag. Vjs., 1845 (Frank's Mag., 3, 612), a girl took 1 ounce of the Acetate; 258 , Rumpelt, Diss., Dresden, 1845 (Œst. Zeit. f. Hom., 3, 205), general effects; 259 , Evans, Lon. Med. Gaz., 1846, 1, p. 997, worker in lead; 260 , Gœringe, Prov. Med. and Sur. Journ., 1846, 1 ounce of the Acetate, in a girl; 261 , same, in another girl, same quantity; 262 , Chowne, Lancet, 1847, 1, p. 173, from sleeping in a newly-painted room; 263 , Schonemann, Journ. de Kinderkrankheiten, 1849, poisoning of children by water containing lead; 264 , same; 265 , same; 266 , De Mussey, Dublin Med. Journ., 1849, p. 405, effects of water from leaden pipes, in thirteen persons; 267 , Banks, Lancet, 1849, 1, 478, poisoning of about five hundred persons by thirty pounds of lead mixed with eighty sacks of flour; 268 , Leboucher, poisoning of a girl by the Acetate, Journ. d. l. s. Gal., 2, 597; 269 , Curie, Clin. Lectures, N. W. J. of Hom., 1850, p. 23, worker in lead; 270 , Pluskal, same, poisoning by lead from a charge of shot in the leg (no local trouble); 271 , Murphy, Br. and F. Med.-Chir. Rev., 1852, 2, 258, effects of chewing lead; 272 , Orfila, Toxicologie, working in lead; 273 , same; 274 , Thouvenet, from Orfila, effects of about 1/2 ounce of the acetate, in a woman; 275 , Robertson, Lancet, 1851, 1, 202, about twenty girls poisoned by water from a leaden cistern; 276 and 277 , same, individual cases; 278 , Capello, Bull. Gén. de Thérap., 1851, a man was accustomed to chew leadfoil; 279 , Challiss, Trans. Am. Med. Ass., 1852, p. 197, effects of water from leaden pipes; 280 , same; 281 , Garrison, same reference, effects of water through leaden pipes; 282 , same, on himself; 283 , Adams, ibid., same cause; 284 , Howe, ibid., same cause; 285 to 289 , same; 290 , Crosby, ibid., same cause; 291 to 295 , same; 296 , Birdwell, ibid., same cause; 297 and 298 , same; 299 , Dalton, same; 300 and 301 , same; 302 , Stimson, same; 303 and 304 , same; 305 , Dr. Francis Black, general effects, Appendix to Br. J. of Hom., 1; 306 to 314 , various authorities cided by Black, l. c., lead poisoning; 315 , Anderson, Am. J. Med. Sc., 1853, worker in lead; 316 , same; 317 , same, effects of water drawn through leaden pipes; 318 , same; 319 , Eichmann, Gaz. des Hôp., 1854, poisoning of two children by sucking enamelled cards; 320 , Spengler, Med. Cent. Zeit., 1854, effects of a solution of 1/2 ounce of the Acetate, in a man; 321 , Addison, Med. Times and Gaz., 1856, p. 643, worker in lead; 322 , Cabot, Bost. M. and S. J., 1856, p. 21, vol. liv, effects of water from lead-lined tanks; 323 , Buck, Bost. M. and S. J., 55, 428, effects of water from leaden pipes; 324 , Hyde Salter, Lancet, 1857, 1, 649, effects in a compositor; 325 , Boufils, L'Union Méd., Feb., 1857, a boy poisoned by cider containing lead; 326 , Muller, Zeit. f. V. Oest., 1857, 1, 49, thirteen persons poisoned by water from lead pipes; 327 , Sieveking, Med. Times and Gaz., 1857, 1, 163, effects in a plumber; 328 , Jachimowiez, Zeit. f. V. Oest., 1857, 2, 418, woman, worker in lead; 329 , Leudet, ibid., workers in lead; 330 , Leared, Med. Times and Gaz., 1858, 1, 295, effects of 1 ounce of the Acetate; 331 , Kingsbury, N. Y. J. of Med., 1859, water from leaden pipes; 332 , O'Connor, Dubl. Med. J., 1859, case of a plumber; 333 , same; 334 , Mattei, Gaz. des Hôp., 1860, No. 62, poisoning of a married woman; 335 , Addis, Lancet, 1860, 1, 33, 3/4 pint of Goulard's Ext., in a girl, aged twenty-one; 336 , Chambers, ibid., worker in lead; 337 , Rees, ibid., from water containing lead; 338 , Johnson, ibid., effects of scouring pewter pots; 339 , Schotter, Virchow's Archiv., 1859, effects of frequent application of a leaden plate to the hair (covering the head with a sheet of lead at night, so that only a small portion of the face was uncovered); 340 , Moore, Br. and F. Med.-Chir., Rev., 1861, 2, 382, painter; 341 , Falconer, Br. Med. J., 1861, 464, plumber; 342 , Fouquet, Wien. Med. Woch., No. 11, 1861, 1 ounce of Acetate, in a man for spasmodic dysuria; 343 , Boreland, Bost. M. and S. J., 1862, 66, 453, by water from a leaden tank; 344 to 348 , Ollivier, Archiv. Gén. de Méd., 1863, workers in lead; 349 , Reynolds, Lancet, 1863, 2, 507, a man, with phthisis, took 4 grains of Acetate daily for twenty-seven days; 350 , Gonzales, El Criterio Med., Jan. 1864 (Am. Hom. Rev., 4, 551), from pickles kept in a glazed jar; 351 , Ward-cousins, Med. Times and Gaz., 1864, 2, 279, from use of lead cosmetics; 352 , ibid., p. 569, worker in lead; 353 , Wilkshire, Lancet, 1864, 2, 67, painter; 354 , Memorabilien, 1864, p. 245, worker; 355 , ibid., from holding type in his mouth; 356 , Fleming, Br. Med. J., 1865, painter; 357 to 361 , workers in lead, ibid.; 362 , Garrod, Lancet, 1866, 1, 345, plumber; 363 , Marmisse, Gaz. des Hôp., 1866, No. 25, exposed to fumes of lead; 364 , same, poisoning; 365 , Bowditch, Bost. M. and S. J., 1867, 76, 37, a boy aged eight, effects of drinking water through leaden pipes; 366 , Wilks, Lancet, 1867, 1, 9, from water through leaden pipes; 367 , Clapton, Med. Times and Gaz., 1868, 2, 611, worker in lead; 368 , same; 369 , same; 370 , effects of inhaling steam from leaden pipes; 371 , worker; 372 , painter; 373 , same; 374 , Murchison, Lancet, 1868, 2, 215, painter; 375 , same; 376 , same, cleaning pewter vessels; 377 , same, painter; 378 to 383 , Hitzig, Studien ueber Blei-vergift, Berlin, 1868, effects in workers in lead; 384 , Gubler, Med. Times and Gaz., 1869, 2, 7, in a plumber; 385 , same, in a painter; 386 , Woodman, Med. Times and Gaz., 1869, 1, 222, in a worker; 387 , same; 388 , same, in a painter; 389 , same; 390 , same, from cider containing lead; 391 to 401 , Lafont, sur le Tremblement Saturn., Paris, 1869, effects on workers in lead; 402 , Delaine, l'Hahnemannisme, 1869, poisoning, in a girl; 403 , same, worker in lead; 404 , Dalton, Bost. M. and S. J., 44, 356, in a child, from water drawn through leaden pipes; 405 , Duroziez, Gaz. des Hôp., 1869, No. 143, painter; 406 to 417 , same, workers in lead; 418 , Garrod, Lancet, 1870, 2, 781, worker in lead; 419 , Johnson, Br. Med. J., 1870, 2, 325, worker (glazed cloth); 420 and 421 , Bial, Die Chron. Blei-vergiftung Diss., Berlin, 1870, workers in lead; 422 , Taylor, Lancet, 1870, 1, 428, several cases of poisoning by beer containing red lead; 423 , Baker, Trans. Obstet. Soc. of London (Br. J. of Hom., 29, 709), a woman, in the habit of washing the clothes of her husband who worked in lead; 424 , same, painter's wife; 425 , Paul, Archives Gén. de Méd. (B. J. of Hom., 1871, 707), a woman worked cleaning type; 426 , same, histories of eighty-one cases; 427 , Hoyne, U. S. Med. and Surg. J., 1871, p. 171, lead poisoning; 428 , same; 429 , Lancereaux, Gaz. de Paris, 1871 (S. J., 154, 146), general effects; 430 , Nankivell, Hom. World, 6, 80, from bathing a wound with Goulard's lotion for several days; 431 , Schneller, S. J., 153, 318; 432 and 433 , Kersch, Memorabilien, 1872, p. 289, two children, poisoned by holding pieces of lead in the mouth; 434 , Riemer, Corr. Bl. f. Schw., 1872, p. 17, chronic poisoning; 435 , Hollis, Br. Med. J., 1872, 1, 154, worker in lead; 436 , same; 437 , Townsend, Phil. Med. and Surg. Rep., 1873, p. 33, worker; 438 , Lewis, Med. Times and Gaz., 1873, 1, 84, workers; 439 , Leidersdorf, All. Wien. Med. Zeit., 1873, painter; 440 , same; 441 and 442 , Wurt. Corr. Bl., 1873, workers in lead; 443 , Smith, N. Y. Med. J., 1873, from water drawn through leaden pipes; 444 , Bottentint, l'Union, 1873, worker; 445 , Browne, Lancet, 1873, 2, 146, painter; 446 , same; 447 , Samuelsohn, Monatsbl. f. Augenheilk., 1873, worker in lead; 448 , Brown, Hahn. Month., 9, 88, from cosmetics containing lead; 449 to 451 , Gaffky, Ueber d. ursachlichen zusamunhang zwischen chron. Blei-intox. und Nieren-affect. Diss., Berlin, 1873, workers in lead; 452 , Roque, in Mouvement Med. (M. H. Rev., 17, 119), observations on a series of selected cases; 453 to 455 , Elgnowski, zur casuistik d. Blei-lähmungen Diss., Berlin, 1873, workers in lead; 456 , Bouchardt, M. Hom. Rev., 17, 504, observations; 457 to 463 , von Tunzelmann, Br. J. of Hom., 32, 17, cases of poisoning by well water containing lead; 464 , Malassez, Gaz. Méd. de Paris, 1874, observations in a large number of cases; 465 to 489 , Manouvriez, Recherches clin. sur l'intox. Sat., Paris, 1874, effects in workers in lead; 490 , Earle, Am. J. Med. Sc., 1874, p. 279, a family poisoned by water containing lead; 491 , Shearmann, Practitioner, 1874, from drinking rain water from a leaden roof and leaden cistern; 492 , same; 493 , Danjoy, N. Y. J. of Hom. (from the French), 2, 210, workers in lead; 494 , Lancereaux, ibid., workers; 495 , Ollivier, ibid.; 496 to 498 , De Cours, De l'Hemi-anestésie Saturnine, Thèse, Paris, 1875, workers in lead; 499 , Waldo, Am. J. Hom. Mat. Med., 9, 48, in a painter; 500 , Halma Grand, Thèse, Paris, 1875, workers; 501 to 505 , Renant, De l'intox. Saturnine, Paris, 1875, in workers; 506 , same, in mothers; 507 , same, in fathers; 508 to 530 , same in workers in lead; 531 , Bucquoy, Gaz. des Hôp., 1875, No. 90, worker; 532 , Johnson, Med. Times and Gaz., 1875, 2, 233, cosmetic containing lead; 533 , Moreau, Empoisson. aigu par le Plomb, 1875, Paris, suicide of a woman by the Extract. Saturni; 534 , Dowse, Lancet, 1875, 1, 545, painter; 535 , Norris, Lond. Med. Rec., 1875, p. 277, from using a cosmetic containing lead; 536 , same; 537 , Popp, Bay. intell. Bl. (Am. Hom. Obs., 12, 47), in a worker; 538 , Berridge, Med. Invest., N. S., 1, 101, in a painter; 539 , same, a child swallowed some white lead; 540 to 543 , Remak, zur Pathogenese der Blei-lähmungen Diss., Berlin, 1875, workers in lead; 544 , same, in a girl from use of cosmetics for five months; 545 , same, another case; 546 , Knott, Lancet, 1876, 2, 531, from beer that had remained over night in a leaden pipe, taken every morning for three years; 547 , Pepper, Phila. Med. Times, 1877, 148, a packer of litharge; 548 , Franziska Tèburtius, Inaug Diss., Zurich, 1876, a painter; 549 , Turnbull, Edin. Med. J., April, 1877, a boy swallowed a bullet; 550 , Hardenhewer, Berlin Klin. Woch., 1877, lead poisoning treated by Jaborandi; 551 , Frank, Deutsch Archiv. f. Kl. Med., 16, 3; 552 to 555 , Da Costa, Med. and S. Rep., 1867, in workers; 556 , Milner, N. O. Med. and S. J., 1873, effects of water from leaden pipes; 557 , Tompkins, Virginia Med. Rec., 1874, p. 14, a girl, aged twenty-five, took 1 drachm of Acetate of lead three times first day, and once second day recovery; 558 , Corson, Canada Lancet, 1874, p. 141, effects of water from leaden pipes; 559 , Williams, ibid., p. 69, in a painter; 560 and 561 , Fearnside, Liverpool Med.-Chir. J., 1848, effects of drinking water from a leaden cistern; 562 , Orr, Ranking's Abstract, 32, 195, a worker in lead; 563 , Jones, Lancet, 1867, 1, 4 painter; 564 , Gubler, Med. Times and Gaz., 1869, 1, 531, general effects; 565 , Neftel, Centralbl. f. Med. Wiss., 1868, effects in three women; 566 , Maschka, Wien. Med. Woch., 1871, poisoned by the Acetate; 567 , Ramskill, Br. Med. J., 1875, 1, 559, twenty-five, workers in lead; 568 , Johnson, Med. Times and Gaz., 1875, 2, 233, from cosmetics, in a woman; 569 to 571 , Dowse, Med. Times and Gaz., 1876, 1, 357, three female workers in lead; 572 to 574 , Pauvert, De la Colique de Plomb., Thèse, Paris, 1877, workers in lead; 575 , Reich, S. J., 176, 11, poisoning of a child by leather containing lead; 576 , Ledetsch, Wien. Med. Presse, 1877, from preserves kept in a badly-glazed jar; 577 , Raymond, Gaz. de Paris, 1876; 578 and 579 , Brochin, Gaz. des Hôp., 1875; 580 , Lepine, Gaz. de Paris, 1875, worker; 581 , Boucheret, Hurbain and Leger, Archiv. de Phys., 1877, p. 424, worker in lead; 582 and 583 , Johnson, Chicago Med. J. and Exam., 1877, two girls used a cosmetic which contained lead; 584 and 585 , Richardson, Boston Med. and Surg. J., 1877, p. 379, workers in lead.

MIND

Delirium, 39, 53, 85 , etc.
Most violent delirium, with screaming and running about the room, succeeded the epileptiform spasm, 94.
Delirium, resembling the most frightful kind of madness, and impelling them to tear themselves and bite their own fingers, 171.
Furious delirium, resembling delirium tremens, 476.
Raging, alternating with quiet, delirium; the former came in paroxysms; no fever, 170.
Delirium, with violent raging, so that he had to be put into a strait-jacket, with hallucinations of vision, 444.
Raging delirium, 46.
Furious delirium, 305.
Violent delirium, at night, 35. [10.]
Violent delirium set in and continued for some days. As the delirium declined, the mind did not recover its clearness and integrity, on the contrary, his sensations and perceptions were vitiated and erroneous. Various morbid ideas took possession of him, and some of them remained, and continued to manifest themselves for many months after his apparent restoration to health, 561.
The delirium tranquil during the day, furious at night, 305.
Complete rage, 28.
Delirium, with bewildered expression, 35.
Delirium, with very violent convulsions, 96.
During the third day of delirium, he was awake, sometimes quiet, sometimes violent, but almost totally irrational. Pulse, 80; skin rather hot, 191.
Delirium, for three days (in a previous attack), 222.
Delirium, with trembling of the tongue and hands, 578.
At times delirious, 276.
Nightly delirium, alternating with sopor, 235. [20.]
He was at times delirious, very restless, and manifested great concern for his affairs, 279.
Delirium, alternating with sopor, 237.
Tranquil delirium, 305.
Appeared to be rapidly recovering, when he was suddenly seized, about 11 A.M., with furious delirium, attended at intervals, by general spasms. It was astonishing to see him, who, three hours before, could only pronounce with difficulty a limited number of words, whose voice was weak, and whose utterance was faint and drawling, now talking incessantly, and pouring forth shouts, screams, and abuse against all who approached him. His voice was loud and clear. His delirium turned chiefly upon the idea that his life was in danger from assassination or poisoning, and that every one about him was a murderer . His muscular strength was increased to such a degree, that, with one hand, he could lift all his mattresses at once with the greatest ease. He left his bed, and walked about briskly, knocking against every obstacle at random. His face was flushed; his eyes sparkling and fierce. At last a strait-waistcoat was put on him, which heightened his fury. Pulse, 65; heat of body rather increased. The delirium lasted about half an hour, when it was succeeded by coma, during which he lay stretched out and motionless, with closed eyes and somewhat pale face. Strong stimulation could only draw forth a few unmeaning grunts. An hour later, the delirium suddenly returned, to be followed again by coma, and thus, all that day and night, the opposing conditions alternated, 190.
Sudden attack of delirium, in the evening, accompanied by extreme restlessness; he railed, threatened, and then fell into a deep sleep. This alternation of delirium and somnolency continued until morning; next day, face flushed and covered with sweat. Eyes fixed and expressionless; bloodshot; lids swollen; pupils, especially the right one, extremely dilated, but moderately sensitive to light. Expression of face decidedly dull. Frequent movements, more or less forcible, of the head, limbs, and whole body; so that he had to be put into a strait-waistcoat, 190.
Did not close his eyes for a minute all night; sometimes was silent and quiet, sometimes hurried out of bed, wanted to dress himself, and went about looking for his clothes; talked incoherently; abused the nurses and patients. In the morning, to prevent him from disturbing the ward, he was put into a strait-waistcoat. He resisted violently; struggled, called for help, screamed, bawled, and even bit an assistant who had hold of him. After this, he became quiet and silent, and his limbs ceased trembling. When I entered the room, he called to me, and begged to be released. He had an astonished look; something unusual seemed to have altered his expression of face, 173.
During the paroxysms of colic, he tosses and rolls about in bed, weeps and laments; his pinched-up face denotes the sharpest pain; he is so distracted by the agony he endures, that he can pay no attention to what passes around him, nor when asked a question, 137.
During the paroxysms, the face expresses acute pain; he is restless, rolling about in bed, screams out, etc., 162.
During the paroxysms, he lay flat on his belly, dug his fingers into his navel, tied himself tightly in his cravat, uttered dismal screams, declared that he had to go to stool; sometimes got up and walked the room hurriedly, his hands pressed to his abdomen; we have seen the poor fellow leaning on his belly against the iron railing of his bed, 219.
During the paroxysms, a condition approaching to frenzy; constant restlessness; lying on abdomen; he knelt down and crouched together in his bed, etc., 211. [30.]
During the paroxysms, which occurred almost every ten minutes, the patient, suffering the greatest anxiety, his face all distorted, rolled about in bed uttering dismal groans; he laid his pillow over his abdomen and begged the bystanders to press upon it with all their force; this afforded temporary relief. He bits the sheets, his limbs writhed; at times he might have been taken for a furious madman, 209.
During the paroxysms, screaming, tossing about, and assuming the strangest attitudes, 122.
During the paroxysms, the face is contracted; he screams aloud, sticks his legs suddenly out of bed, etc., 131.
Between the paroxysms, mind often much affected. Would leave home without knowing where he was going; became enraged with persons he met; and generally remembered nothing of what had occurred. When brought home, he would shut himself up until he got right again. One day, he left home to enter the Hospital Beaujon; got lost, and was quite surprised to find himself at La Pitié, 521.
Although naturally patient of suffering, he was importunate, nay clamorous for relief, expressing himself in terms of agony, far stronger than his general appearance and symptoms seemed to warrant, 284.
When admitted he refused to go to bed, tore his shirt off, and spoke disconnectedly, 439.
With loud cries, he insists upon going to stool, 122.
Bites his garments and bedclothes, 208.
Begged and prayed to be released from the strait-waistcoat, "for," he said, "I am not mad; but the idea of being forcibly restrained is enough to drive me crazy," 172.
At times, the pains became so violent that he weeps and laments; and his whole frame is agitated, 132. [40.]
Difficulty in putting him to bed; he tore off the clothes, and spoke incoherently, 440.
Started out of bed as if beside himself, compressing his abdomen with his hands, 120.
Hung on to the bedpost, and kept swaying himself with a convulsive movement, 120.
He keeps thrusting his limbs out of bed, and then covering them up again, 136.
Frightful screams, with general convulsions, 56.
Screaming out, at intervals, 203.
Uttered piercing cries, 120.
Screaming, 215.
Screaming incessantly, 223.
Utters doleful groans, and screams loudly for relief, 208. [50.]
During the aggravations, he screams, draws himself together under the bedclothes, suddenly gets out of bed, then gets in again, and doubles himself up, etc., 209.
During the intervals of quietude, which were very brief, he kept up a sort of continual grumbling, closed his eyes, and shrunk down under the bedclothes, 212.
In the night, began to talk to himself quite incoherently, about all sorts of things; then left his bed, and wanted to lie down in another bed in the room. The nurse easily got him back to his own quarters; his gait was firm, and he had no tremor; his eyes were wide open, somewhat projecting and fixed. His face had an expression of astonishment. During the rest of the night, he talked much to himself; his delirium was mild and quiet. Next day, his expression was natural, and he had the use of all his faculties, but he seemed to take little interest in conversation, and his manner was remarkably listless. About 5 P.M., he began fairly to rave; would keep chattering for several minutes, and then be silent for awhile. His face had a wild expression, which struck the house surgeon on duty. Pulse, 85; no fever. Worse at night; took part in all the conversation he heard, or fancied he heard, 185.
On the fifth day of the delirium, in the afternoon, he had a sudden attack of epilepsy, characterized by violent convulsive movements of the whole body, bloody froth at the mouth, biting the tongue, interrupted breathing, etc. After an attack, which lasts about half an hour, he becomes slightly comatose, but soon rouses, and enters again into delirium. On the sixth day of the delirium, the general aspect of the countenance was more unnatural than before. There was less of that harmony of expression which is indicative of a well-balanced mind. Sometimes the eyes were fixed and the features concentrated; sometimes the former seemed to roll about, under the influence of serious thought, and the whole face to partake of this meditative look. He would still sometimes burst into laughter at the most unexpected moments. The limbs trembled, or rather, were shaken by slight spasms, which also ran over the face in different directions, coming and going at irregular intervals. The tongue was considerably swollen, from having been bitten during the epileptic seizures of the preceding day; utterance also was impeded, being stammering, hurried, and abrupt; an effect to which the slight spasms above spoken of also contributed. He was sometimes conscious of his condition, and said that he was insane. His talk became irrational more frequently, and continued so longer than on the day before. Yet even now, his intellectual aberration could only be discovered by very attentive observation. On the seventh day of the delirium, he talked much to himself, and tried to get into the neighboring beds; he wandered more in his speech; wanted to strike the nurse, without provocation; when threatened with the strait-waistcoat, he quieted down somewhat. He often talked to himself at night; what he said was incongruous, disconnected, and about all sorts of things. He got up three or four times, and tried to fold his bedstead together, under the impression that he was working some sort of machine; then he laid down again. Twice he rose from bed, walked about with bare feet, and urinated in the middle of the floor; next minute, he fancied one of the patients called to him, ran headlong to help him, and got into another bed at the opposite side of the room. His sight was unimpaired, his gait firm and confident. At times, he was silent and quiet, although he never closed his eyes. On the eighth day of delirium, he was quiet, but, in conversation, more decidedly irrational than on the day before. He spoke to others with a smiling face; he was silent and looked very thoughtful. Now and then, he perceived that he had used a wrong word, as was shown, by his impatient gestures, and he tried to recall the proper one; he talked to himself about all sorts of things. If he was spoken to so as to attract his attention strongly, and the questions were simple, and easily answered, his replies were rational. He talked no more sensibly about one thing than another. Even to-day, although not so apparent as yesterday, there was always, amid his delirious ravings, a certain semblance of good sense. The utterance is, as it were, spasmodic; more abrupt and jerky than on the day before; words are pronounced rapidly and incompletely, 196.
Out of his head, at times; at night, quite delirious, talked almost constantly; got out of bed; looked for his clothes, in order to dress himself; ran all about the room, trying to get into the other patients' beds; at last, after he had gone on in this way a good while, it was found necessary to put him in a strait-waistcoat, to which he submitted quietly. Next day, his eyes were wide open; his expression was rather wild. When alone, he talked much to himself, sometimes calmly, sometimes violently; generally about wine, which he would not take part in smuggling into the hospital. Sometimes he fancied himself at his foundry, at home, or in the street, etc. His conversation was a mixture of sense and extravagance. When his attention was strongly attracted to anything, what he said was at first rational, then he would suddenly drop the subject, and begin to talk about something quite different, mixing together in this way a great many ideas and incoherent words. But, on peremptorily recalling his thoughts to the topic gambolled from, he would again answer pertinently and sensibly for awhile, 184.
After trying in vain to find his clothes, he got up and walked the room, but with hesitating step, and feeling about with his hands, like one groping in the dark; runs against the stove, the beds, etc.; sometimes uttered incoherent words, or called for his wife, or his friends; wanted to talk about his business; often said "My wife! my wife!" more frequently was silent. At last he became quiet, soon got into bed again, and seemed to fall into a deep sleep. After awhile, would rouse up and begin to act in the same way again. Once he was about to urinate upon the stand which held the patient's diet-drink. Sometimes he spoke rationally, but generally poured forth unintelligible words in a trembling and hurried voice. He talked to those about him, and made the most incongruous demands upon them. He was not violent, and threatened nobody. Now and then he put his hands to his forehead or abdomen, his face contracted, he groaned and exclaimed "My God! my God!" then began to cry like a child. Sometimes he was observed to lie down on his abdomen. Constant sleeplessness. Delirium and restlessness, worse at night. Recognized those about him, and maintained a long conversation tolerably well; but, when a drunken patient happened to say to him, in an offensive tone, "They will put you in a strait-waistcoat, you old lunatic!" he became furious, stamped his feet, shook his fists, wept, etc.; poured forth a multitude of words. In a quarter of an hour, he became quiet again, and soon after slept a little. Being visited by his wife, he at first received her roughly, and loaded her with abuse; then suddenly began to caress her, and seemed greatly pleased with the visit, 186.
His facial expression does not at all times correspond with the character of the conversation he is engaged in, nor with the other external influences which surround him. Thus, he will sometimes burst out laughing, while speaking of some very ordinary matter, or look serious and thoughful while answering the most simple question. Yet quite often his face wears its natural expression. At first he would not be taken for a victim of cerebral disease; he is very quiet, and seems quite rational. But gradually as the conversation proceeds, he loses the thread of his ideas, and talks mere nonsense, or keeps contradicting himself most shockingly. When alone, he does not talk to himself. He eats, drinks, urinates, and goes to stool, as properly as anybody; sometimes he gets up to visit other patients in the next ward; the latter do not at first perceive that his intellect is at all affected, but when the hint is given them by the physicians, they soon declare that he talks wildly, 196.
Rose from bed in the night, and tied to get into his neighbor's bed; took a cravat from me; a pair of trousers from another; walked as if groping in the dark, and bruised himself against the stove, washstand, etc.; talked to himself; at last the warden managed to get him into bed again. Quiet during the rest of the night; but every now and then wanted his neighbors to give him " his drop ." Next day, face wild; eyes wide open; by turns fixed and wandering. Abdomen nowhere painful on pressure. Kept trying to get up in order to take his " drop ," and called to the other patients, "

Make haste and get up ." His limbs were tremulous. His constant efforts to get out of bed made it necessary to put him in a strait-waistcoat; he struggled hard against it, screamed, howled, uttered threats; became red with passion, and tried in every way to break loose; called out to the passers by and begged them to set him free. During the day, he was sometimes quiet and silent; sometimes furious at the thought of being tied. He was never sleepy. Fancied, at times, that he heard delightful music, which soothed his sorrows, 187.

His utterance is drawling, difficult and frequently broken; so that he talks like a child who has not learned to speak plainly; instead of " oui ," for example, he says " ui ." Sometimes he cannot get hold of the right word; then he frets and worries himself, and now and then becomes quite desperate. This difficulty seems to be met with chiefly in the case of substantives ; with adjectives, the intellect and organs of speech deal more easily, 195.
His colic was almost cured, when the nurses and his fellow-patients observed that his intellect was affected, and that he wandered in his speech, but to so slight an extent, that the aberration escaped the notice of the medical attendants. He lay quiet, with closed eyes, as if in a peaceful sleep; when pinched as hard as possible he showed no sign of sensibility. When the fingers, hands, forearms, or arms were placed in any position, and left unsupported, they remained there for a few seconds, then oscillated a little, and fell back on the bed. This experiment was repeated several times, with the same result. The body was rigid, so that he could not be made to sit upright, and his attention could not be aroused for a moment. Suddenly he began to make a great variety of the most expressive gestures, at first with one arm only, but soon the other arm, the legs, trunk, head and face, all took part in these movements, which were performed in co-ordination, and seemed to express the same idea. Every moment he appeared to be possessed by the most dissimilar and grotesque conceptions, which he embodied in this way. At the same time he cried out, and tried to speak, but was prevented by the liquid in his mouth. If, at this time, he was gently pinched, he showed by an abrupt movement, that he felt acutely. The upper limbs no longer remained fixed in any position they were placed in; they were too stiff to be moved at all. After the movements had lasted some minutes, they were succeeded by a state of absolute quietude, and he lay just as he done before they commenced; then they began again, to be again followed by a period of repose, and so on, in alternation. Now, he indicated, by a significant gesture, that he desired to eat and drink; now he suddenly spouted the ptisan, which he had been holding in his mouth, all over the surgeon in attendance. Then came an interval of quiet and unconsciousness, during which his limbs remained in any position they were made to assume. Next was witnessed a series of the most expressive gestures, although he kept his eyes shut, and uttered not a single word. Their significance is constantly varying; sometimes they seem to indicate rage, sometimes despair, sometimes entreaty, sometimes the most profound meditation. At last he suddenly opened his eyes, called for drink; then seemed to fall asleep again while swallowing his ptisan, but is easily aroused by being spoken to; then he opened his eyes fully, began to talk about his mother, and while rambling volubly from one incoherent idea to another, still answered questions rationally. Left to himself, he talked incessantly, followed up an idea for a minute or two, and then left it for another. At one time he became much agitated, tried to get up, addressed the doctors, abused them, tried to strike and bite the nurses when restrained; and at last, shouting and struggling, was put into a strait-waistcoat. On the second day of the delirium, he was lying quiet, with eyes half open. Soon he aroused completely, began to talk very fast, and at first answered questions rationally. But after conversing a few minutes, his thoughts became confused, and he began to ramble and talk to himself. By attracting his attention again, he could be brought back to the original topic, then got off the track again, and so forth; so that his talk was a mixture of sense and nonsense. He was frequently influenced by the most grotesque delusions; he fancied that a cavalry regiment was about to fall upon him; or that he was in the presence of his employer, who was finding fault with him. His face looked rather wild; at times he bursts out laughing. His head was full of notions. He recollected very well what happened a month or more ago; but could not call to mind things that occurred only a few days before his delirium set in, 199.
He seems to recognize familiar acquaintances; sometimes he talks unintelligibly to himself; more frequently is silent. When his attention is strongly attracted, he at first answers rationally; then suddenly utters some words without meaning or connection; afterwards takes up again the thread of logical thought. He usually waits some time before answering a question; it seems as if it required great mental exertion for him to understand what is said, 195. [60.]
During the evening of the seventh day, suddenly great restlessness; he hears everywhere threatening voices, officers come to arrest him, to seize his furniture, and to expel him from his lodgings; the voices come from the pillow, the mattress; they enter by the window, where he sees people, and they consult about him with closed doors; he gets up, looks for his clothing, wants to run away, to his lodge, etc. The next morning he sits at the edge of his bed, the eyes fixed steadily to the window, or looking about in a restless manner; he recognizes all persons around him, replies correctly to all questions, but cannot recollect what he ate yesterday, whether his bowels moved or not, and looks to his wife in an interrogating manner; insists, though as if afraid to acknowledge it, on the reality of his hallucinations, 537.
He had, some time back, illusions of vision; saw castles, palaces, but these have ceased since he entered the hospital, 509.
Has a cachectic look; cheeks hollow and pale; yellow complexion; no signs of lead poisoning, aside from the cerebral symptoms. Yet this case is not one of encephalopathy in any form. It is a chronic affection of the mind, which we must try to describe in order to characterize it. He is absorbed in himself; pays no attention to what goes on about him. He does not converse with his neighbors; when questioned he answers rationally, indeed, but briefly. When his wife and children come to see him, he pays no attention to them, and goes on with what he is about, as if they were not present; yet he says he is fond of them, and seems to think a good deal of their visits. He has never shown any irritability. When in bed he keeps moving his hands; folds and unfolds the coverings. Sometimes he gets up and wanders about the room, now singing, now gradually quickening his steps, as if impelled by an irresistible force, now stopping and turning about abruptly; his gait is uncertain. His behavior is nearly the same day and night, 509.
The patient imagined that he was constantly followed, and that he heard voices coming from the chimney (temperature 36.5°, pulse 64, regular and small, good appetite, clean tongue, very slight colic, no paralysis, with a blue line on the gum, with constipation); this man after a few days wished to leave the hospital and go home, because he was convinced that there were fiends in the building that pursued him and sought his life, 441.
The cerebral functions were strangely disturbed. Various hallucinations showed themselves. Erroneous ideas were formed as to the identity of herself and those around her, and the situation in which she was placed. A mild, but easily controlled form of delirium arose. For some days this alternated with a different state; if she attempted to speak to those around her, she seemed to have difficulty in finding language, and before she could succeed in conveying her meaning, the idea fled, and a jumble of unconnected words was all that escaped her. And now the condition of the nervous system became one of apathy. Impressions were made upon the senses with difficulty, and speedily vanished; her attention was no sooner gained than it was lost, and she remained for hours at once in a state of semi-consciousness. At this stage, phenomena were occasionally present approximating to those described as characteristic of catalepsy and ecstasy. On placing the arms, for example, extended in any particular position, they remained fixed in it for some minutes, and then slowly relaxed and sunk down; at other times she would remain for a considerable period unconscious of anything around her, but with her eyes fixed and gazing intently before her. On one occasion, after the action of a purgative, she was for about twelve hours quite insensible. She lived for five weeks after the appearance of the cerebral symptoms, and for four months from the time when her health began to break down. Before her death she was seized with convulsions of an epileptiform character, which continued with short intervals for forty-eight hours, and upon the cessation of which she passed into a state of complete coma and died, 56.
Often getting out of bed and wishing to go home; sometimes not recognizing his family; thought they were conspiring to kill him, 290.
Hallucinations of mind, she seemed to see her dead husband and child in a tree out of the window, 449.
He saw many colored figures in constant motion, as soon as he closed his eyes, 537.
Delusions at night, 387.
On first recovering consciousness the people in the ward seemed to him as small as dolls, and the opposite of the room seemed to be sunk forty feet below his own level. These erroneous impressions he was conscious of at the time, and they disappeared in four days, 327. [70.]
Random talking at night, 191.
The colic was not severe, and was getting better under treatment by Croton tig., when the face was observed to have a singular expression. There was an astonished look, as if something extraordinary had happened; and he had a thoughtful appearance, which was not borne out by his answers to our questions. In the evening delirium set in, and lasted all night. Next day he talked incessantly about everything. At 9 A.M. he had an attack of epilepsy, followed by deep coma, which lasted almost all day, and during which he only uttered a few cries, 191.
Talked rather wildly; got out of bed; ran about the room; called to his companions; wanted to go to work, etc.; yet complained that he could not see his way, and knocked against the beds, stoves, etc., 187.
He could keep up a long conversation quite well, but would wander in his speech every now and then. Generally, when he was talking, no one would imagine his brain was affected, if they did not see his strait-waistcoat. When he began to rave, the facial muscles were seen to twitch and contract spasmodically, giving his face a hideous appearance, 172.
Talks to himself a good deal, mostly about his business, his associates, or his relatives. When his attention is forcibly attracted, and he is asked where he feels pain, he places one hand on the middle of his forehead, and the other on his stomach, and utters a few words which indicate unmistakably the seat of suffering; but if he is not talked with, so as to keep his thoughts fixed, his mind begins to wander, or he falls asleep, 190.
Got up to go to stool, but, instead of returning to bed, began walking the room with bare feet, and talking incoherently on all sorts of subjects; imagined he was going to be poisoned; that his bed was full of ants, etc., 173.
Talked at random all night; rose and tried to get into the neighbor's beds; at times screamed out; abused the nurse furiously, 177.
Talked all night, mostly about how he should destroy his fastenings, 184.
Talked all day long; made attempts to get out of his strait-waistcoat, 184.
At night, does nothing but babble; now and then jumps out of bed, swears, blusters, so that he has to be put into a strait-waistcoat, 200. [80.]
In conversation he sometimes talks sense and sometimes rambles, 197.
Does nothing but babble all night; wants to get out of bed every now and then, 198.
Language extravagant, 186.
Searching about on the floor, 440.
The patients were in a state of nervous irritability, difficult to describe. In their beds they were restless and unable to find an easy position, and after many useless efforts they fell back exhausted and worn out, with pain; the respiration became hurried; the heart's action was painful and violent; groans and sighs were uttered with vehemence, whilst abundant tears ran from their cheeks; symptoms greatly resembling those of hysteria. These tears, sighs, and groans were not occasioned by the violence of the pains, and often coincided with the abatement of the suffering, 266.
Very nervous, unwilling to be touched or have anything done for her, 303.
Hasty temper, 269.
Manner frightened and nervous, 386.
Mind obviously much impaired, 360.
Mind very much affected, so that he scarcely knew his old acquaintances, 498. [90.]
When alone he sometimes talks to himself, but is generally silent and quiet, though he never closes his eyes, and thus he remains all day long, 198.
Between the paroxysms she is silent, and generally calm and quiet, sometimes rather restless, 128.
Is generally silent; when he speaks his words are disconnected, but his articulation is good, although the voice is somewhat broken. When he becomes interested in anything talked about, he sometimes answers rationally, sometimes sits facing his questioner in silence, without looking at him. At times he answers a simple question quite wide of the mark, 201.
He was quiet and silent when left to himself, 72.
Rather quieter in the evening than in the morning, but seems melancholy, owing to a terrified feeling, which he cannot shake off, 198.
Lies quiet in bed; when spoken to sometimes makes no answer; sometimes begins a sentence slowly, and hurries over the rest of it, showing signs of bad temper, 200.
He lies quiet in bed, seldom moving; groaning now and then. When asked a question, he answers in monosyllables, generally to the point, but sometimes at random. When alone he seldom talks to himself, and then only utters a few incoherent and trivial words, 161.
Patient lay perfectly quiet in bed, and constantly murmured unintelligible words, 444.
When spoken to, he looks everywhere but at his questioner, 188.
Lively, good-humored (after two hours), 4. [100.]
Good humored, lively, that soon disappeared, in the afternoon, 4.
Loss of the natural vivacity, 30.
Silent, melancholy, 187.
Repeated attacks of melancholy, of a religious character, 92.
Profound melancholy, 39.
He fell into a state of melancholy, with stupefaction, great dulness of the senses, coma, 42.
Melancholy and dejections; great anguish and depression of spirits, 305.
Mind greatly depressed (second day), 82.
Seemed rather melancholy, 173.
Would shed tears from slight causes, 228. [110.]
Sad, despairing mood, 145.
Sadness, 483.
He is very sad, has no desire to live, and has threatened to destroy himself, and is very fault-finding with his friends, 499.
That vivacity which was a marked feature of his character was gone, and sadness and silence sat enthroned, 280.
His mental condition was sad enough; given over to thoughts of life-long pain, he imagined his disease incurable, and gave way to the gloomy thoughts which the fear of death excited, and to repinings caused by the dread of his journey to Valencia, 350.
There was great mental prostration, approaching hypochondriasis, 271.
Great despondency, 317.
Great mental and physical depression, 446.
Much depressed, fearing to die if left alone, 440.
Despondency, 21, 332, 578. [120.]
Much depressed in spirits and unwilling to see any one, 303.
Great gloom and dejection of mind, 315.
Gloom of mind, 316.
His spirits greatly depressed; if a neighbor called to see him, he would burst into tears and be unable to speak for some time, 304.
Deep-settled gloominess of mind, 317.
Spirits depressed, 276, 292.
Exceedingly depressed, 297.
Longing for a distant friend, in the evening, before falling asleep, 3.
Avoids society, 153.
Naturally cheerful, his spirits became depressed, and he became very nervous, 299. [130.]
Extreme apprehension, 43.
Anxiety, with difficult respiration, so that the patient seemed almost suffocated from fright; he could get his breath only while sitting, 235.
Anxiety, 9, 233, 266, 350.
Anxiety and sighing, 5.
Extreme anxiety, 11, 50, 305.
Frightful anxiety, 26.
Great anxiety, during which she could not take a sufficiently deep breath, with increased palpitation (after three-quarters of an hour), 84.
Discouragement, 28.
Distrust, 114.
Fear; easily frightened, 114. [140.]
Uneasiness, 56.
Extreme restlessness, 51.
Discontented with his circumstances in the morning, on waking, 3.
Ennui; was out of sorts with everything (after six hours), 4.
Ennui, quiet reserve, in the afternoon, 4.
Hypochondriacal and peevish, 331.
Very much out of humor and weary of life, 3.
Out of humor, all work frets her, in the afternoon, 4.
Irritable, 271.
Great irritability, 145. [150.]
The child was sensitive and fretful, whenever any one approached; it cried and whined a great deal and would not play, 575.
Morose mood, disinclination to talk to any one, and frequent attempts to escape; this morose mood at times alternated with the most lively mood, during which he laughed immoderately, without reason, accompanied by hallucinations of mind, 442.
Complete indifference, with sopor, alternating with extreme difficulty of breathing and headache, 235.
Intellectual.
Extremely active, absorbed in work, thoughtful, in the afternoon, 5.
Mental indolence, 483.
Less inclination to work, 519.
Very indolent, disinclined to work, 4.
The desire and ability for work were very much diminished (third day), 5.
Indolent, weary (after three-quarters of an hour), 4.
Disinclined to talk, after dinner, 4. [160.]
No disposition to work, 259.
Indisposition to labor and conversation, 305.
The intelligence and power of utterance vary curiously at different times, 195.
The intellect more or less disturbed, 305.
Thought and speech difficult, 339.
Cannot fix his thoughts upon anything, 174.
Reading is very tiresome to him; he mistakes one word for another, and skips the lines, 188.
*Slow of perception, 356.
His answers are slow and short, 153.
Intellect seemed affected; answers not so rational, 188. [170.]
Answers slowly, and in a weak voice, 519.
Answers at random, 174.
Answers questions vaguely; and admits that his memory is much impaired, 517.
He answers well enough, but his evening made a mistake in giving his age, 521.
Sometimes utters a few broken, disconnected words, 174.
Memory much impaired; sometimes does not know his own bed, 509.
*Loss of memory, so that while talking, he was often unable to find the proper word, 339.
Loss of memory, 114, 444, 483, 487, 518.*
Memory difficult, 429.*
Remarkable weakness of memory, 92. [180.]
Loss of mind, 25.
Intellect clear, but memory seems much impaired, 170.
Weakness of memory (fourth day), 4, 7, 80.
Has been much troubled for twenty years by a singular cerebral affection, returning at intervals, and characterized by restlessness, constant inclination to move about, loss of memory, and indecision. This mental condition has several times obliged him to enter a hospital. He does not recollect either the dates of the duration of these seizures, nor anything respecting their treatment, 50b.
Loss of understanding, 186.
Memory is much impaired, 356.
Slightly lethargic, 353.
Apathetic condition, 520.*
Gradually increasing apathy, 519.
Her mind at first was stupid, 343. [190.]
Tendency to stupor, 106.
Mental torpidity; answers slow and stammering, 578.
Intellect obscure, 534.
Takes no notice of anything about him, unless aroused by pain or an attendant, 290.
While hard at work, and apparently in the best of health, he suddenly fell back unconscious; no spasms, foaming at the mouth, etc., 178.
She fell down unconscious while attempting to walk, soon, 274.
Loss of all senses, with constantly recurring, most violent general convulsions, 11.
For the most part unconscious, but at intervals he answered promptly the questions that were put to him, 439.
For the most part unconscious, but occasionally had lucid intervals, 440.
Scarcely recognizes his nurse, 174. [200.]
Loss of consciousness, 483, 511.
Loss of consciousness, occasionally returning, followed by epileptiform spasms, with bloody froth from the mouth; succeeding these attacks there was left-sided paralysis of motion and sensation, 577 . [Microscopical examination of the brain showed granular fatty degeneration of the walls of the vessels and deposition of large quantities of amyloid corpuscles.]
Lies motionless and crouched together; eyes shut or half shut. Often snores as if in the deepest sleep. Now and then he utters some dull grunts; makes some automatic movements; half opens his eyes and shuts them directly. Cannot be roused by the sharpest questioning; has to be pinched hard; then he opens his eyes, at first partially, then widely; and finally, without answering, falls back into lethargy. Sometimes, when annoyed by these experiments, he turns in bed, and makes a dull grunting, indicative of his displeasure, 187.
After working hard all day, feeling quite well, he took supper as usual, but on rising from table suddenly fell back unconscious, without spasms, foaming at the mouth, or paralysis. Was taken to bed, and in about three-quarters of an hour recovered consciousness, but was somewhat delirious. Next day this wild delirium continued, but nevertheless he walked to the hospital with some companions, 196.
Suddenly fell back unconscious, without convulsions or foam at the mouth. Two minutes after he raised himself up and said, "It is nothing." Next moment he was trying to reach the bed of one of his fellow-patients, when, for the second time he suddenly fell unconscious, without the slightest spasm, either then or afterwards; he was carried to bed in this condition, and remained in a state of profound coma, from which he could not be roused for two or three hours. At the end of this time he opened his eyes, now and then, and talked about all sorts of things, imagined he was spoken to, answered his neighbors, and then relapsed into somnolency. This alternation of coma and loquacity lasted a great part of the night. Next morning he was found apparently fast asleep; at the end of an hour he appeared to rouse up suddenly, half opened his eyes, uttered a great many disconnected words, tossed about in bed, rose and urinated on his pillows, put his head down and lifted his buttocks in the air, then relapsed into coma. If he was pinched or very sharply spoken to, during his lethargy, he at first would open his eyes and then shut them directly; at last, by continuing the use of stimulants, he was made to open his eyes completely; they were fixed and wild-looking. If now he was questioned earnestly, he would look hard at the questioner, without being able to utter a single word, or else he would stammer out some disconnected words, and then fall back into coma, 176.
Lies on his back, crouched together, quiet and sleepy, eyes shut or half shut. At times snores as if sound asleep. Rouses from this state of sopor only to utter a few inarticulate words in a weak voice, half open his eyes and immediately close them again. When stimulated, as by pinching, he at first gives evidence of no sensation whatever, but if the stimulation is kept up for some time, he slowly draws away the part operated on, and then opens his eyes, which look quite wild; rolls them about stupidly, and returns no answer when questioned; falling back finally into lethargy. His features are motionless and inexpressive; at times, some automatic movements of the head and arms take place, 177.
Intellectual torpor, 533.
Stupefaction and deep coma, 11.
He fell down stupefied, 24.
Complete stupefaction and insensibility, from which, however, he could be roused by loud cries, but gradually sank back into his former condition, murmuring unintelligible words, 339. [210.]
Seems to be always asleep; it is hard to rouse him from this state of coma, and he only wakes enough to half open his eyes, and answer everything with yes or no, indistinctly uttered in a loud voice, then turns over in bed and falls asleep again. If, after being well shaken, he is asked where he feels pain, he points slowly towards the umbilicus; he says and does everything very slowly, 189.
Alternate coma and delirium, 480.
Coma, lasting three weeks, 483.
Coma, 39, 385, 440.
Coma succeeded, at 4 P.M., by another epileptic fit, soon after which he begins to talk at random, 200.
About midnight, after a violent epileptic fit, he fell into a profoundly comatose state, from which he could not be aroused. Lay doubled up in bed, with eyes closed and pupils widely dilated, 201.
Coma, with at times automatic movements of hands to the occiput, 339.
The nurse said that the coma supervened upon a violent epileptic fit, which seized the patient about midnight, 189.
Comatose state, from which he arouses when spoken to, 520.

HEAD

Vertigo.
Vertigo, 20, 21, 47, 56 , etc. [220.]
Vertigo, almost immediately; everything seemed to tremble and whirl before her, 268.
Vertigo, immediately, 274.
Frequent vertigo, 28.
Vertigo, and intoxication in the head, 46.
Vertigo, on stooping or on looking up (eighth day), 5.
Vertigo and convulsions, 326.
An attack of vertigo, of short duration, 384.
One patient had vertigo and convulsions several times, 266.
Often suddenly seized with slight attacks of vertigo, 492.
Frequent dizziness (second day), 268. [230.]
A dizzy feeling, vanishing in the open air (after two hours and three-quarters), 4.
Attacks of giddiness, 566, 567.
Giddiness frequently, when stooping, 269.
General Head.
Trembling of the head, 92.
Head turned to the right, its rotation to the left being prevented by paralysis of the sterno-cleido-mastoid muscle of that side, 114.
Heaviness of the head, 429, 449, 479, 483, 485, 486.
Heaviness of the whole head, especially in the occiput, with slight stitches in the sinciput (after two hours), 2.
Heaviness of the head; it falls forward (after two hours and a half), 4.
Heaviness in the whole head, except in the occiput, with slow stitches in the sinciput, 2.
Heaviness of the head; it falls forward (after two hours and a half), 4.
Heaviness in the whole head, except in the occiput, with slow stitches in the sinciput, 2.
Head heavy, without real pain, 533. [240.]
Weight in the head (second day), 100.
Excessive heaviness of the head, 466.
Dulness of the head, 46.
Head dull, dizzy, soon, 112.
Head dull and confused, 339.
Head dull and heavy, while standing (after half an hour), gradually disappearing, 4.
Great dulness of the head, a kind of mixture of dulness and dimness of mind, so that he frequently rubbed the forehead with the hand (first hours), 2.
Headache, 9, 49, 93, 154.
Violent headache, 7, 111, 364, 496, 505, 511.
Excruciating headache, 537. [250.]
Violent headache, with vomiting, 237.
Violent headaches, with vomiting, frequently repeated, sometimes every two or three days, 235.
Terrible cephalalgia; it seemed to the patient that if it continued he would lose his reason, 573.
Severe headache, with vertigo, and sensation of intoxication, 402.
After this he has a very severe and long-lasting headache; for fifteen days it has been almost constant, 530.
Severe and persistent headache, all over the head, so bad as to prevent sleep, 508.
Rather severe headache, 396.
The patient was attacked with violent headache, confusion of mind, during which he answered slowly, and seemed to have lost his memory; fell asleep in the evening; soon woke dizzy and with mental dulness, that gradually developed into a comatose condition, and was followed by death, 581 . [The heart was fatty, the walls thicker and paler than normal. The capsule of the kidney was found adherent to its substance; the kidney showed interstitial inflammation, with fatty degeneration. The brain was softened.]
Habitual headache, 513.
Frequent headache, especially on waking, in the morning, 514. [260.]
Frequent headache, 483, 527.
Headache, for two months, 535.
Frequent attacks of cephalalgia and vertigo, 373.
Severe cephalalgia, 279.
Headache, with obscuration of vision and tendency to sleepiness, 429.
Headache, with anxiety, extending to the forehead, with dim vision, contracted pupils, 237.
Violent shooting headache, 274.
Slight headache anteriorly in the left parietal bone (after one hour), 4.
Headache and inappetency, 385.
Violent pressive headache, so that the patient could not hold the head up, 354. [270.]
Pressure beneath the skull, as from rush of blood to the head, 5.
Dull headache, 555.
Violent pain and heaviness of the head, with confusion of mind, 95.
Very severe pains in the head, 171, 259, 450.
Contractive pain in the head and cheek (from local application), 83.
Severe pain in the head, especially in the occipital region, 560.
Laceration pain in the upper part of the head, recurring at intervals, like those of the face, worse by paroxysms, and somewhat ameliorated by pressure, 134.
Pains in the cranial bones and in other flat bones, 383.
Rather severe left-sided hemicrania, extending to the same side of the face, with aggravation at night, 528.
Stitches here and there in the head, especially in the right ear, very violent in the afternoon and evening, 4. [280.]
Head symptoms relieved by hot-air baths, 492.
Forehead.
Sensation of heaviness in the forehead, soon vanishing, after the morning soup, 4.
Frontal headache, 140, 330, 466, 479, 481, 518.
A very severe headache, especially in the frontal and parietal regions, comes on immediately after each attack of colic, 127.
Much frontal headache, 153.
Frontal headache, worse by paroxysms, with feeling of dislocation, 168.
Frontal headache, with heaviness of the head, 489.
Headache in the forehead and temples, especially on the left side, 472.
Headache in forehead and temples, 471.
Dull headache in the forehead, with tearing in the nape of the neck, 4. [290.]
Violent pains in the forehead (first day), 274.
When asked where he feels pain, he says it is in the head, especially the forehead, 201.
Shooting pains across the forehead, with pressing pain, 269.
Tearing back and forth in the forehead (after two hours and a quarter), 4.
Headache; tearing in the forehead, with heat in the head and redness, without external heat, lasting a few minutes; in the afternoon, 4.
Sensation of tearing and contraction in the forehead (after six hours), 4.
Tearing in the middle of the forehead, slowly increasing, frequently intermitting (after two hours), 4.
Pressure in the forehead, rather externally (second evening), 4.
Sticking in the brain, in the forehead (after six hours), 4.
A small fine stitch in the left frontal eminence (after two hours), 4. [300.]
Frequent stitches in the right frontal eminence (after two hours and a half), 4.
Slight heavy pain in the forepart of the head, 126.
Temples.
Hard throbbing of the temporal arteries, 126.
Temples throbbing, 276.
Temples felt compressed, as if in a vice, and she experienced cruel lancinating pains there, 268.
Constant constriction and twitchings in the temples (second day), 268.
Sensation of "clucking" in the left temporal region, extending to the ear, 451.
Tearing in the right temporal region (after two hours), 4.
Tearing sticking in the left temple (after two hours), 4.
Tearing in the right temple, then in the right ear (after one hour), 2. [310.]
Dull sticking pain in the right temporal region, that was also sore externally (first day), 3.
Twitching in the right temple (after one hour and a half), 4.
Parietals.
Very violent pain in the left side of the head, 95.
Violent pains in left side of head, 133.
Violent sticking and beating in the right side of the head, while walking and standing, in the forenoon, 4.
Sticking inward in the upper part of the right parietal bone, 4.
Sticking and tearing in the upper part of the right parietal bone (after five hours and a half), 4.
Occiput.
Sensation of heaviness in the occiput, as if its weight were increased, 5.
Violent headache in the occiput, extending to the ears and temples, dull, pressive, commencing while asleep, so that the patient frequently rose from bed, walked about the room, holding his head with both hands, and as soon as the pain was somewhat relieved, lay down again to catch a short nap, 339.
Headache partly in the occiput, at times extending as far forward as the forehead, 235. [320.]
Dull pains in the back of the head, extending from the spine upwards, 285.
Pressure in the occiput forward towards the forehead, with a feeling as if the eyes would close with heaviness, disappearing on standing up (after one hour), 4.
Violent stitches in the sinciput, lasting a long time, at 9 P.M., 4.
External Head.
(The hair becomes remarkably fatty; formerly it has always been very dry), (curative action), (first day), 2.

EYE

Objective.
Eyes swollen, painful, 35.
Eyes wide open, fixed, and hard, 173.
Eyes wide open and fixed, 181, 186.
Sometimes the eyes are half open, sometimes kept wide open, but generally they are closed; when opened, they are wild-looking or fixed, looking nowhere in particular, 201.
Generally a fixed look, 153, 566.
Eyes fixed, and at times wild-looking, 195. [330.]
Eyes staring, 360.
Eyes wild and rolling, 315.
Eyes wild, 186.
Eyes rather wild, 188.
Eyes at times wild and shiny, 499.
Eyes glistening and protruding, 248.
Eyes brilliant, and projecting from their orbits (after one hour), 256.
Left eye quite transparent; iris slightly contracted by artificial light, 168.
Eyes unnaturally prominent, 562.
Protruding eyes, 235, 253. [340.]
Eyes hollow, and surrounded by blue rings, 122.
Eyes hollow and quite dim, 120.
Eyes sunken, 240, 278, 432.
Eyes hollow, and surrounded by blue rings, 176.
Blue color around eyes, the rest of the face having a decided dingy-yellow color, 222.
Blue rings around the eyes, which are somewhat sunken, 519.
Hypopium, 43.*
Convulsive twitching of the muscles of the eyes and in the hands, 575.
Frightful distortion of the eyes, 56.
Twitching of both eyes (after two hours and three-quarters), 4. [350.]
Squinting, 168, 432.
Strabismus; one eye turned in toward the nose, and he could not roll it out; the external muscle of the eye was paralyzed; he could see distinctly as ever with either eye separately, but when he looked with both the object appeared double, 304.
Eyes dull, 534.
Eyes large and red, 133.
Inflammation of the eyes (fourth day), 49.
Rush of blood into the eye (sixth day), 5.
Livid color of the eyes, especially of the inner canthi, 11.
Fundus oculi black, 168, 169, 178, 189, 201.
Sclerotica yellow, 519.*
Yellow color of the eyes, 326. [360.]
White of his eyes quite yellow, 282.
Eyes slightly jaundiced, 316.
Sclera dirty-bluish gray, 575.
Yellow tinge of sclerotica, 512.
Sclerotica somewhat jaundiced, 508.
Slight icteric color of the sclerotic, 541.
Eyes constantly shut; although the lids were kept somewhat apart by a stiffness of the muscles, they were not in the least paralyzed, 189.
Neuritis optici; papilla swollen (examination after death showed interstitial hyperplasia of connective tissue; the sheaths of the optic nerves were distended by fluid; the cerebro-spinal fluid was greatly increased; the brain-substance anæmic, and the gray portion yellowish), 536.
"Cirsophthalmia;" a varicose enlargement of the bloodvessels of the cornea, extending like a thick network to the centre, and causing complete obscuration of it, 43 . [From four months external use of Extractum saturni, in three ounces of rosewater, for taraxis.]
Ophthalmoscopic examination between the paroxysms showed that the disk was prominent, its outline hazy, its color an opaque bluish-white , the sclerotic ring not visible, and the vessels diminished in calibre. Beyond anæmia of the brain-substance, and a marked increase of cerebro-spinal fluid, there were no marked eye changes found in the brain; the sheaths of the optic nerves were distended; microscopic examination showed numerous capillary vessels throughout the swollen disk, and a moderate development of the nuclei of the connective tissue; there were none of the spindle-shaped swellings of the nerve-fibres found in the former case, 535. [370.]
Neuritis op .; with normal field, diminished acuteness of vision, with a central scotoma and persistent flickering, 431.
Subjective.
Heaviness on moving the eyes and pain in the internal muscle, extending backward (first day), 3.
Sensation of pricking in the eyes, 484.
Eyes fatigued, 221.
Sticking pain in the left eye, 95.
Burning in the right eye, as though tobacco were in it (after two hours), 4.
Brow and Orbit.
Much hair falls from the eyebrows, 3.
Supraorbital headache (after one hour), 268.
Pressive pain above the eyes, on moving them, lasting several days, 3.
Feeling of fulness and weight, together with excruciating pain, in the orbits, 198. [380.]
Sense of fulness and heaviness, together with excruciating pain, in the orbits, 186.
Weight above the orbits, 474.
Supraorbital pain (second day), 268.
Lids.
Eyelids red (second day), 2.
The eyelids became excessively swollen and sensitive, 235.
Lids agglutinated by thick yellow mucus, 177.
Upper eyelid droops very much, 182.
Twitching of the right upper lid (after one hour), 4.
Violent closing of the lids, as if the eye were placed in a press, 11.
Complete paralysis and insensibility of the lids, 11. [390.]
Ciliary neuralgia of the right side, followed by dulness of vision, 447.
Heaviness of the lids, 221, 339.
Contraction in the eyes, especially in the lids, 11.
Sensation as if something were under the lids, and as if the eyeball were too large, an acute pressive sensation, 3.
Tearing in eyelids, with sleepiness, after soup, in the morning (after three-quarters of an hour), 4.
Itching of the canthus of the left eye, and pain, as from rubbing, 5.
Itching on the left upper lid provokes scratching, which relieves (after a quarter of an hour), 4.
Lachrymal Apparatus.
Profuse discharge of acrid corrosive tears, that contract the skin, 49.
Profuse acrid lachrymation, with diminished vision, 11.
Profuse lachrymation, without any other affection of the eye, 117. [400.]
Profuse white watery discharge from the eyes, without inflammation or any other complaint of the parts; this discharge shortly became thicker and agglutinated the lids, so that he had to moisten them in order to open his eyes; in the morning, 138.
Conjunctiva.
Conjunctiva suffused with blood, 237.
Effusion of apparently coagulated blood under the conjunctivæ (fourth day), 246.
The conjunctiva of the left eye became suffused with blood, 235.
Conjunctiva œdematous, 433.
Conjunctiva pale, 437.
The conjunctiva is bloodless, 356.
Conjunctiva sallow, 547.
Conjunctiva somewhat jaundiced, 167, 182, 399, 400, 401.
Slight jaundiced color of the conjunctiva and skin, 344. [410.]
Conjunctiva of a well-marked livid yellow color, observed nowhere else, 175.
Conjunctiva yellow, 119, 166, 183, 184, 451, 485, 566.
Slight yellowness of conjunctiva, 137, 160, 170, 450, 538.
Conjunctiva dingy yellow, 222.
Conjunctiva dingy yellow, with a shade of blue, 120.
Dingy yellow hue of the conjunctiva and of the skin of the face and entire body, 215.
Conjunctiva of a well-marked dingy yellow hue, 203.
The conjunctiva shows this dingy yellow color very decidedly, and here it is usually blended with a well-marked bluish tinge, 117.
Conjunctiva dry, 575.
Ball.
Pains shooting through the eyeballs on closing the lids firmly (second day), 100. [420.]
Jerking tearing in the left eyeball, in the forenoon, 4.
Muscular spasms of right eyeball, 486.
A violent stitch, with burning, beneath the left eyeball, at 2 P.M., 4.
Pupil.
Pupils strongly dilated, yet the iris contracts, and vision is unimpaired, 181.
Pupils strongly contracted; iris insensible to a bright light, 198.
Pupil widely dilated, and insensible to artificial light; fundus oculi black, 197.
Pupils strongly dilated; insensible to light, 261.
Both pupils excessively dilated, but in different degrees, and unequally throughout their respective circumferences, 178.
Pupils exceedingly dilated, 173, 290, 562, 581.
Pupils strongly dilated, but irregular in their entire circumference; they do not contract near a bright light, 177. [430.]
Pupils, especially the right pupil, so much dilated, that only a trace of the iris was visible. A lighted candle had no effect on them at a distance of four or five inches, but when brought to within half an inch, the iris was seen to contract slightly, especially the left iris, and the lids made some efforts to close, 189.
Left pupil more dilated than the right, 528.
Pupil of right eye considerably dilated; iris absolutely immovable, 168.
Left pupil dilated, till the iris is almost invisible; it does not contract under artificial light, 169.
Right pupil dilates and contracts somewhat under the influence of light, and there is some power of vision in the right eye, 169.
Pupils uneven, the left one rather more than the right, 509.
Pupils moderately dilated, 188, 227.
Dilated pupils, 234, 361, 439.
The pupils are dilated, sometimes closed, 305.
Dilatation of left pupil less in degree, and unequal all around, so that the pupil is no longer circular, 168. [440.]
The pupils seem at first spasmodically contracted, unnaturally small, afterwards they become much dilated, insensible, paralyzed, and are not at all contracted by the light, 20.
Pupils contracted, and only slow of reaction, 511.
Pupils quite contracted, but sensitive to light, 170.
Pupils contracted, 517.
Pupils insensible to light, 439.
Vision.
In the left eye acuteness of vision was normal; by the right fingers were counted at only 1 1/2 meter (instead of 70, normal); ophthalmoscopic examination showed very greatly dilated veins in the fundus of the left eye, no neuritis optici, visual acuteness of the right eye 5/20, perception of color very feeble; field of vision very greatly limited, 20 degrees from the point of fixation, 498.
Sight and hearing have always been better on the right side than on the left, 482.
Diplopia, 308, 577.
The shortsightedness increases, 3.
(Shortsightedness diminished, with general increased vigor, in the forenoon, when walking in the open air), 3. [450.]
Dimness of sight, 100, 473, 485 , etc.
Sometimes dimness before the eyes, without noise in the ears, 168.
Impaired vision of the right eye, 481, 487, 488.
Dimness of vision, especially of the right eye, 476.
Impaired sight, 483.
Dimness of vision almost immediately, and second day, 268.
Very dim vision; cannot recognize persons, even at a short distance (for a few days), 517.
Dimness of vision, coming on in the following manner: He feels a weakness in all the limbs; at the same time there is a roaring in the ears, and an appearance before the eyes like falling snow or showers of fire; he almost loses consciousness, and has to lean against something to prevent falling. This occurs from twice to six times daily (generally two or three times in twenty-four hours), 530.
Weakness of sight, 433, 521.
Sight weak; some diplopia of right eye, which is also affected by external strabismus, 529. [460.]
Diminished sight and hearing, followed by complete amaurosis, that however, gradually disappeared, 95.
Vision dim and confused, 188.
Vision indistinct, 170.
Can hardly distinguish light from darkness with the left eye, which looks quite sound, 169.
Sight became weak in one, 266.
Vision became imperfect, 271.
Vision dim and veiled, double, 339.
Complains of obscure vision and a strange uncomfortable feeling, 384.
Diminished vision; the ophthalmoscope showed venous congestion, with sinuosities of the bloodvessels, 498.
Vision became feeble, 498. [470.]
Could not see anything distinctly; objects appeared double, except when she was close to them, 457.
He does not see as well with the left eye as with the right; objects at a certain distance seem double or triple, 471.
Vision diminished to 1/8; the visual field was not diminished; optic papilla normal, though the veins were greatly dilated with blood, 447 . [This amblyopia recurred after about a year, and was cured by tartar emetic and leeches.]
Amaurotic weakness of vision, 326.
Complete and sudden loss of vision succeeded an attack of most violent headache and colic, 96.
Sudden loss of vision, with headache, with sensitive pupils; after a few minutes the patient was able to count the fingers; this was associated with wide open staring eyes; the upper lids seemed drawn far above the upper corneal margin; on attempting to use the ophthalmoscope the patient became very restless and anxious, rolled the eyeballs, spoke unintelligibly, and tried to get out of bed; this was followed by an epileptiform spasm, with complete unconsciousness, 420.
The patient suddenly lost the power of distinguishing objects about him, and for a short time could not see the light; this sudden loss of vision was followed by a sudden paralytic spasm, with loss of consciousness; on the next day the sight partly returned, so that the patient was able to see as through a fog, and for five days the sight gradually improved; on the sixth day there was again sudden loss of vision, this time without headache and without subsequent convulsions, 94.
Loss of vision, 56, 186, 227.
Sudden loss of vision during or succeeding the attacks of lead colic has been noticed by many observes (Plater, Smetius, Schrock, Nebillius, and others), 96.
Eclampsia, consequent upon uræmic poisoning, with albuminous urine, 434. [480.]
Amaurosis, 12, 21, 23, 42, 584.
Amaurosis and deafness were complications of motor paralysis in only six cases out of one hundred and two, 117.
Blindness, 20.
Blindness (effects of large doses), 28.
Transparency of the organ perfectly preserved; sight completely destroyed, 168.
Dazzling before the eyes, 472, 476, 522.
Cloudiness of vision, 483.
Vision as through a fog, with contracted pupils and leaden colored sclerotics, 235.
Was frequently obliged to wipe the eyes; it seems as though there were a dimness in them; for half an hour, 3.
Sensation as of a cloud before the eyes; objects seem indistinct (after one hour), 4. [490.]
A cloud before the left eye, with agglutination of both eyes, in the morning and evening (third day), 4.
When his arm was fixed he used to feel dull, and had a mist before his eyes, 563.
Constant cloud about the eyes (after two hours and three-quarters), 4.
Everything before the eyes seemed to tremble and to turn in a circle, immediately, 274.
He sees only half of the objects he regards (in a painter; disappeared along with the colic), 313.
Small yellow spots before the left eye, which cover what is looked at; he distinguishes near objects no better than distant ones, though at a certain distance things seem to jump, 168.
Everything seems yellow, 258.
It becomes black before the eyes, 20.

EAR

Tension in the region of the right ear and the corresponding cervical muscles (after two hours and a half), 4.
Right arm painful; sensitive to pressure; lancinations from the shoulder towards the bend of the elbow, 486. [500.]
Tearing in the region of the right ear, after dinner, 4.
A fine stitch extending into the lobule of the right ear (after one hour), 4.
Boring in the right ear, after dinner, 4.
Transient pains within the left ear and in the meatus auditorius, 3.
Tearing deep in the right ear (after half an hour), 4.
Tearing deep in the left ear (after two hours and a half), 4.
Sticking tearing within the right ear, whence it extends to the concha (after three-quarters of an hour), 4.
Sticking in the right ear, while standing, in the forenoon, 4.
Scratching in the right ear, as from a spear of grain (after a quarter of an hour), 4.
Hearing.
Great sensitiveness to slight noise, 96. [510.]
Hearing, which for some time has been entirely lost in the right ear, is to-day duller than usual, 476.
Difficult hearing and numbness, 20.
Dulness of hearing since exposure to cold, 269.
Very hard of hearing, especially on the right side, 527.
Frequent sudden, transient diminution of hearing, in the evening, 4.
Impaired hearing in right ear, 488.
Hearing much diminished on the left side, 528.
Weakness of hearing, 433, 483.
Difficulty of hearing, 429.
Hardness of hearing in right ear, 481. [520.]
Hard of hearing in the left side, 450.
Partial deafness, 134.
Deafness of right ear, 487.
Deafness, especially on the right ear, worse at times, 471.
Vanishing of hearing, 56.
Almost constant roaring in the meatus auditorius, 134.
Roaring in the left ear, 485, 528.
Roaring in right ear; seldom in the left, 486.
Roaring in the ears, returning every evening, and causing slight deafness, 474.
Roaring in the ears (second day), 274, 478, 483. [530.]
Whizzing and humming in the ears (second day), 288.
Ringing in the ears, 476.

NOSE

Objective.
Erysipelatous inflammation of the nose, 3.
Sneezing (after seven hours), 4.
Constant irritation and ineffectual sneezing (after three-quarters of an hour), 4.
Hæmorrhage from the nose during the convulsions, 429.
Habitual and profuse epistaxis, 511.
Nosebleed with the second attack of spitting blood, 463.
Frequent bleeding of the nose, 237. [540.]
Frequent copious epistaxis, 235.
Oozing of blood from the nostrils (fourth day), 246.
Fluent coryza, with watery mucus, soon disappearing (after three-quarters of an hour), 4.
Fluent coryza without sneezing (third and fourth days), 2.
Fluent coryza, in the afternoon, lasting an hour, 4.
Water runs from the nose, during dinner, 4.
Much tenacious mucus in the nose, that he, however, cannot blow out, is only able to draw it backward through the posterior nares, where most of it seems to be accumulated (second day), 2.
Mucous membrane of the nose dry, 575.
Subjective.
Stoppage of the nose, 5, 450.
Sensation of stoppage in the nose, she is unable to blow it (third day), 4. [550.]
Pain in the tip of the nose, 3.
Sharp drawing pain in the right ala of the nose, and in the upper lip, 305.
Painful tearing in the septum of the nose in the right side (after five hours), 4.
Itching of the left nostril, relieved by scratching, in the afternoon, 4.
Smell.
Very bad odor from the right nostril, much less from the left, 497.
Horrible smell, 28 . [Effect of large doses.]
Sense of smell almost lost in the right nostril; less diminished in the left, 523.
Loss of smell, 39.

FACE

Countenance wild looking, 197.
Frequent sardonic smiling, 190. [560.]
Look confused, 35.
During the colicky attacks, the face was expressive of the utmost anxiety, 213.
Most anxious countenance (after five hours), 107.
Face expressive of extreme anxiety and suffering, 209.*
Countenance anxious and sunken, frequently of a peculiar livid hue, 267.
Peculiar anxious and distressed countenance, 302.
Face haggard, skin yellow, sclerotic coat of a yellowish tinge, 583.
Anxious expression, 73, 113, 240 , etc.*
Melancholy expression; he seems aware of his situation, and to be silently imploring pity, 174.
Expression sad and melancholic, 340. [570.]
Languid look and woe-begone countenance, 318.
He has a heavy stupid aspect, 356.
The face has a very stupid expression, 182, 195.
Expression of the face quite peculiar, almost stupid, 153.
Astonished stupid look; patient appears as if ecstatic; risus sardonicus; the patient has a sad, melancholy look, and weeps. Patient gives no satisfactory answer as to the state of his expression, 305.
Face stupid, 509.
Expression rather dull, 170.
Aspect vacant and stupid, 360.
Expression of face and eyes decidedly dull, 200.
The expression was of dull, heavy, unremitting pain, 446. [580.]
Countenance expressive of pain, 98.
Countenance entirely changed, and expressive only of extreme pain, which even prevents him from answering when spoken to; the application to his abdomen of a vessel of hot water is scarcely felt, 214.
The whole expression of the child was that of one suffering from pressure upon the brain, 432.
Features almost immovable, except during the paroxysms of colic, when they express the most acute suffering, 182.
Features almost entirely immovable, 181.
Features perceptibly sunken, 174.
During the paroxysms the face is shrunken; he lies on his belly crying out sometimes, 225.
During the paroxysms the face is a little shrunken, and he is somewhat restless in bed, 221.
Countenance shrunken and distorted, 120.
Face sunken (after a few hours), 112, 220. [590.]
Countenance fallen, 70.
Expression of face extremely altered, 111.
Face pinched and distorted, during the paroxysm, 215.
Face wrinkled, 215.
His face horribly contracted, was expressive of extreme agony, 217.
Features somewhat contracted, 133.
Features strongly contracted, 122.
Contracted features (tenth day), 240.
The left side of the face is fixed and devoid of expression, 562. [600.]
Features drawn, 235.
Features fixed, 509.
Rather astonished expression of face, 188.
The features are sharp and pinched, 356.
Fatigued expression of countenance, 152.
Expression of suffering, idiotic, 433.
Long, shrivelled face, 466.
Pasty, lustreless look about the face, 445.
Countenance haggard, 315.
Peculiar and indescribable expression of countenance, 173.
Face red (after four hours), 274. [610.]
Face red, with a slight shade of yellow, 126.
Countenance florid, warm, and moist, 97.
Face somewhat flushed, 140.
Face slightly red, with a tinge of dingy yellow, 203.
Flushed dusky countenance (two very dark), 277.
Face, usually pale, is this evening rather flushed; she has some fever; skin hot; pulse 98, 519.
Face red and turgid, 248.
Face turgid, with violent pulsating in the carotids (apparently the results of violent efforts to vomit), (after a quarter of an hour), 257.
Face dusky, 276.
Livid complexion, 234, 240. [620.]
Dingy lead-colored skin of the face and body, 133.
Face meagre, livid, wrinkled; he looks prematurely old, 142.
Livid skin of the face, lips, gums, and even of the whole body, 92.
Slight, livid yellowness of face, 196.
Complexion sallow, 232, 255, 373, 460.
He was of a sallow unhealthy aspect, 439.
Sallow pale face, 556, 558.
Sallow haggard countenance, 428.
Sallow and cachectic looking, 351.
All have sallow complexions and discolored sclerotics, 584. [630.]
Face of a well-marked dirty yellow color, 174.
Face of a dirty gray color, 152.
Very decided livid yellowness of the face and conjunctiva, 173.
Very decided dirty-yellow complexion, 181, 209.
Face of a decided ashen-yellow color, 183, 194.
Marked dingy yellowness of the skin of the face, 208.
Skin of face and body of a decided dingy-yellow; face all wrinkled, 214.
Deep-yellow cachectic complexion, 523.
Face livid yellow, 193.
Face livid yellow, and somewhat emaciated, 145. [640.]
Face of a decided yellow hue, and expressive of pain and anxiety, especially shown by violent spasmodic contractions of the features, when the colic paroxysms are coming on, 125a.
Complexion decidedly grayish-yellow, 182.
Complexion yellow, 190, 201, 514.
Yellowness of face and eyes, 186.
Complexion like yellow wax, 170.
Yellowish, cachectic-looking complexion, 517.
Becomes yellow principally at night, 513.
Face spotted with yellow, 544.
Face yellowish gray, somewhat puffy, 420.
Face yellow, and somewhat contracted, 188. [650.]
Dingy yellow complexion, 161, 180, 185, 139.
Complexion a little tinged with dingy yellow, 130.
Dingy yellow hue of the face and body, 120, 150, 167, 198.
Slight dingy yellow color of the face and body, 121, 136.
Dirty gray yellow complexion, 184, 331.
Grayish-yellow complexion, 166.
Lemon colored complexion, 132.
Face rather yellowish, 189.
Complexion dull yellow, 515.
Face of a very light ashen-yellow hue, 137. [660.]
Face pale yellow, 218.
Complexion of little yellow, 125, 160.
Complexion somewhat tinged with dingy-yellow, as also the surface of the body, in a less degree, 119.
Complexion dull and yellowish, 243.
Cachectic complexion, 468, 469, 471, 483.
Face pale and eyes sunken, immediately, 116.
Most of the girls lost the color of health from their faces; they became pale, puffy, and dark under the eyes, 275.
Face pale, anæmic, 449.
Pale cachectic face, with dry lips with sordes, pale mucous membranes, 455.
Patient looks pale, emaciated, 393, 402. [670.]
Face pale, icteric, 578.
Face pale and cachectic looking, 305, 400.
The face is pale and sallow, 356.
Face pale, with an expression of great anxiety (first day), 328.
Pale dirty-white complexion, and the physiognomy peculiarly marked, 304.
Face very pale, 319.
Face of a decidedly pale color, 39.
Pale face, 28, 233, 357, 481.
Face pale and puffy, 52 . [In a woman, from using sugar of lead for hæmoptysis.]
Looks very pale (first days), 2. [680.]
Looks like a corpse, 43.
He looks pale and cachectic, 42.
His countenance was pale and sunken, his expression melancholic, 280.
Great pallor of the countenance, 332.
Unusual pallor, 361.
Countenance blanched but no sallow, 228.
Pale sallow, complexion, 266.
Pale, cachectic-looking, 527.
Face pale, livid, and sunken, 186.
Face pale and rather anxious, 259. [690.]
Face pale or yellowish, 9.
Face pale or somewhat yellow, 35.
Face pale and yellowish, 258, 324.
Face pale, somewhat yellowish, 273.
Face pale and slightly yellow, meagre, and livid, 138.
Face rather pale and yellow, 177.
Face yellowish white, 433.
Face pale, covered with sweat, 254.
His face, pale, and wan, was marked by the deepest despair, from extreme suffering, 271.
Face pale and distorted from the severity of the pain, 74. [700.]
Erysipelas appeared in a slight wound on the face received in falling in the epileptic fit, rapidly spread over the face and head, associated with nausea and vomiting, delirium, pulse only 52; tongue coated white; violent headache; violent stitches, 272.
Great swelling of the face, especially of the lids, 237.
The face became very much swollen, especially about the eyes and lids, 235.
Swelling of the right half of the face, with very violent pains in the ear, especially on swallowing saliva, 49.
Œdematous swelling of the face, 235.
Œdema of the face, 237.
Face swollen and purple (fourth day), 246.
Face swollen (after one day), 256.
Bloated though anæmic countenance, 271.
Face especially emaciated, and wrinkled to such a degree as to impart an appearance of premature old age, and in some cases, a melancholy expression, 117. [710.]
Her face was thrown into active convulsions, so that it took her some seconds to get control enough to articulate a monosyllable, 343.
Face frequently affected with choreic convulsions, 271.
Has had quivering of the right side of the face from the first; latterly the left side is becoming similarly affected. There seems to be no actual paralysis of the facial muscles, but the mouth is a little drawn to the right, 563.
Face much drawn to the left side, 520.
Paralysis of the right side of the face, 50.
Face contracted, 480.
Paresis of the facial nerve; when talking all the muscles of the face twitch, 455.
The pains in the face and head become so violent at times, as to extort loud screams, 134.
Sensibility of the face considerably diminished, especially in the right side, 497.
Considerable diminution of sensibility on the face and neck, so that it is hard to find out which side is most affected, 525. [720.]
The whole right side of the face is devoid of sensibility in quite a marked degree, as respects simple contact, changes of temperature, and especially pain, 527.
Slight degree of anæsthesia on the left side of the face, 528.
Slight hypalgesia of the right side of the face, 480.
Lancinations in both sides of the face, increased by movement, but not by pressure. The pain is worse in the cheeks than anywhere else; is not felt in the nostrils, eyes, tongue or teeth, but extends into the ear, 134.
Cheeks.
The cheeks are somewhat flushed and covered with sweat, 222.
Cheeks sunken, 519.
A stitch in the right malar bone (after six hours), 4.
Slight anæsthesia of the left cheek, 474.
Slight diminution of sensibility in right side of face, 480.
Two tearings in the right upper jaw (after three-quarters of an hour), 4.
Lips. [730.]
Frequently moves his lips, as if smoking a pipe, 178, 198.
The hair falls from the mustache, 3.
Lips cyanotic, 429.
Dry and fissured lips, 537.
Lips and tongue blanched (eighteenth day), 549.
Lips, teeth, and tongue covered with thick fissured scabs, 174.
Desquamation of the lips every day without pain, indeed with unusual dryness, 3.
Lips covered with thin, brown scabs, 177.
Sharp drawing in the flesh of the upper lip beneath the right wing of the nose (first day), 2.
Trismus, 69.
Chin. [740.]
Violent loud movement of the lower jaw, with frightful grating of the teeth, 56.
Boring in the left side of the lower jaw and in three corresponding teeth (after one hour and a half), 4.
Boring in the right angle of the lower jaw, lasting a long time (after one hour and a half), 4.
Frequent violent tearing in the lower jaw, near the chin, and in the corresponding tooth (after one hour and a quarter), 4.
Tearing in the right side of the lower jaw near the chin; after rubbing, it extends into the right lower ribs, where it disappears of itself; it then returns in the former place and in the corresponding teeth; afterwards deep breathing causes a sticking below the right scapula, and when this ceases, a stitch in the upper part of the right scapula (after two hours), 4.
Tearing in the left side of the lower jaw extending upwards towards the left ear (after a quarter of an hour), disappearing on rubbing; while rubbing feels a beating in the left side of the occiput, that lasts a long time, 4.
Tearing in the lower jaw and lower teeth, not relieved by rubbing, 4.
Sticking and tearing in the right side of the lower jaw (after one hour and a half), 4.
Contractions of the jaws (first day), 274.

MOUTH

Teeth.
Violent grating of the teeth at night, with frequent waking (first day), 2. [750.]
Grinding of the teeth, 339.
Hard chattering of the teeth, as in violent ague, 223.
Usually, in cases of saturnine discoloration of the gums, the teeth are dark brown at their bases or necks, while their edges are of a lighter brown, with a shade of yellow or green. This appearance should not be mistaken for the ordinary deposit of tartar. The incisors and canines are most liable to this discoloration, but it may occur on all the teeth, though they are seldom affected in an equal degree. When the process of gingival absorption has resulted in a loss of substance, the discoloration of the teeth becomes more decided. The teeth thus affected finally deteriorate; they become brittle, break off, decay, and fall out long before the usual time. The coloring matter adheres firmly to the osseous substance of the teeth, with which it appears to combine, so as to be detached with difficulty, as is the case also with that of the gums, 117.
In general, when the blueness of the gums is very decided, the discoloration of the teeth is also strongly marked, and vice versâ, 117.
The discoloration of the teeth and buccal mucous membrane, by contact with lead molecules, may take place in five or six days, or after months or even years of exposure, the time varying in different classes of workmen, 117.
Teeth in a very bad condition, all brown, and most of them broken, 219.
Characteristic saturnine discoloration of the teeth and gums, 195.
Teeth and gums discolored, 161.
Most of the teeth destroyed, blackish; deep, slate-colored border on the gums; oxygenated water caused a whitish track of sulphate of lead, 220.
Teeth and gums black, 90. [760.]
Teeth black with the lead line on the gums, 498.
Teeth black, 39, 121, 123 , etc.
Teeth black at their necks, 175.
All the teeth black, especially the incisors and canines, 208.
Teeth black; partly destroyed, 215.
Teeth black, and mostly destroyed, 225.
Teeth all black; gums blue next to the teeth, 222.
Black teeth; gums slate colored, 122.
Teeth of a strongly-marked yellowish black, 203.
Teeth brown, 119, 201, 214, 285, 542. [770.]
Teeth brown at the base, yellow at the tip, 273.
Teeth greenish-brown, especially on their necks, 120.
Teeth and gums bluish-gray, 190.
Teeth dark-brown, 209.
Teeth dirty gray, 235, 237.
Yellowish color of the teeth was quite apparent, 365.
The teeth become covered with yellowish mucus, 49.
Yellowish coating at root of teeth, and slate colored border round several, 325.
Teeth and gums covered with sulphate of lead, 221.
Teeth covered with sordes (eighteenth day), 549. [780.]
The teeth were covered with a dark incrustation, 340.
Large accumulation of tartar, 322.
Teeth partly laid bare; blackish and somewhat decayed (they were sound previous to exposure), 209.
Teeth laid bare, 472, 476.
Teeth mostly destroyed, 166.
Most of the teeth decayed or destroyed, blackish, 124.
The teeth partially destroyed are brown at their bases and yellow at their summits, 126.
Teeth decayed, 479.
Their teeth are usually carious in the extreme, 438.
Carious teeth; teeth break easily, 305. [790.]
Teeth much decayed and loose; the edges of his gums are red and raw and ragged, and frequently bleed, and there is a slight blue line, 499.
After working three weeks, obliged to quit on account of a curious affection of the mouth. His teeth became loose, and there were small abscesses on the right gums, 520.
The teeth become loose, 7.
The teeth fall out, 39.
A tooth becomes hollow, has an offensive odor, and breaks off; the side which was thickest had become very brittle, 3.
Toothache in the sound teeth, as after eating sour fruit, 314.
Tearing in two right lower back teeth (after two hours and a half), 4.
Jerking pain in the right lower back teeth, in the morning, aggravated by cold (third day), 4.
Gums.
The first and most frequent indication of the presence of lead in the system, is a peculiar discoloration of the gums and teeth. The gums bordering on the teeth, to the depth of one or two lines, are usually blue or slate colored, their remaining portion being of a very light bluish-red, passing gradually into the natural hue of the buccal mucous membrane. Sometimes the discoloration spreads all over the gums, or even over the entire buccal mucous membrane. In a good many cases only the gums immediately bordering on the teeth become slate-colored, in strong contrast with the natural appearances of their remaining portion. They at first assume a violet-red tinge, becoming decidedly slate-colored, sooner or later, 117.
The discolored portion of the gums quite often becomes considerably thinner, sometimes as thin as a sheet of note-paper; or else, as more frequently occurs, it dwindles in superficial extent. In the latter case the interdental partitions gradually disappear, and the concavity of the gums is increased, in consequence of molecular absorption, which takes place within the substance of their tissue, without visible solution of continuity. When this process of absorption is complete, the teeth are stripped of a portion of their gums, and are laid bare. The gums thus form, quite frequently, only a more or less projecting pad, sometimes marked by vertical incisions. This change in the nutrition of the gums always follows upon their discoloration. The latter, however, often disappears, in proportion to the shrinking of the gums from interstitial absorption, so that what is left of them is only slightly tinged with blue. Usually the discoloration and loss of substance do not take place in both alveolar borders to the same extent. The twofold change is generally most marked in their anterior portion. The lower gums are apt to show rather more of it than the upper; and it sometimes happens that the gums of only two or three teeth are thus affected, 117. [800.]
The above described discoloration of the gums and teeth we have never observed, except in those whose buccal mucous membrane has been brought in contact with lead particles. We have examined the mouths of seven hundred and eighty-five persons who had not worked in lead compounds, or ingested them in any way, and in not one of them could we discover the least trace of the specific discoloration produced by sulphate of lead, 117.
The peculiar blue line on the gums, the edge of the gum where it is attached to the neck of the teeth, was fringed with a very distinct blue line, about one-twentieth of an inch in width, so that three or four of the molar teeth on each side in upper jaw were thus half surrounded towards the roof of the mouth with a blue crescent, 236.
The fatal line was more of less present in the gums of all; in two cases a slate-colored line was well defined, and in one of these the mucous membrane of the mouth was strewed with spots of the same color, 266.
Gums blue, 119, 121, 136, 160 , etc.
Distinct blue line along the margins of the gums, 261, 282, 340, 353 , etc.
Dark-blue line on the gums, 233, 337, 369, 558.
The gums bordering on the teeth exhibit a narrow and a well-defined grayish-blue line, 126.
Distinct blue line along junction of the gums, and a blackish stain on the teeth, 230.
Blue line at the junction of the gums with the teeth, 547.
Distinct blue line along the lower border of the gums of the upper incisors, 436. [810.]
Gums, with the exception of a slight reddish blue discoloration beneath the left lower canine tooth, were natural; later the bluish line extended beneath all the lower incisors and canine teeth, 435.
A blue line on the margin of the gums was always present, which varied in depth, in some cases involving the gum to the extent of one-eighth of an inch, in others being a mere trace, most observable opposite the bicuspid teeth, 446.
Gums show a very remarkable blue line, with the inter-dental processes much shrunken, 585.
Blue line along the alveolar border, 458.
There was a distinct dark-blue line on the edges of the gums about the upper incisor teeth, none elsewhere, 404.
A distinct blue line along the margin of the lower gum, 374.
A very distinct blue line, especially on the upper teeth, which were greatly decayed, 268.
Dark blue line around the teeth and gums, both of the upper and lower jaws, 315.
Gums where they run up between the teeth, bluish, but no distinct line (after treatment), 287, 292. [820.]
Blue line around gums of upper and lower incisor teeth, 318.
The gums are blue over one-fourth of their surface, 208.
Blue blotches or lines on the surface of the buccal mucous membrane, 205.
Blue rings along the gums, with accumulation of tartar at the base of the teeth, 531.
Gums covered with a blue tinge, 223.
Ashy-gray margin of the gums, 354.
Gums bordered with slate colored rings; teeth laid bare, 466.
Slate-colored gums, and teeth laid bare, 469.
Gums slate-colored almost all over, and bleeding at the slightest contact, 124.
Gums slate-colored over the greater part of their surface, 219. [830.]
The portion of the gums bordering the teeth, to the depth of two or three lines, is of a beautiful slate color, 209.
Slate-colored line on the gum, and similar bluish spots in the mucous membrane of the mouth, 326.
Gum dirty brownish-gray, 575.
Gums slate colored, 143.
Gums bordering on teeth slate-colored, 120, 203, 224.
Lead line on the gums; teeth laid bare, 479, 481.
Lead line on the gums, they are bluish and flabby, 513.
Well marked lead line on the gums, which are bluish and bloodless, 512.
Not all who breathe or swallow lead particles, for a certain length of time, have their teeth and gums coated with sulphate of lead; but I have met with very few in whom it was not perceptible, 117.
The coloring matter of the gums and teeth consist of sulphide of lead, 117. [840.]
Gums and teeth covered with sulphate of lead, 180, 181, 192, 198.
The gum exhibited a bluish-gray color, 273.
Discolored gums, 537.
Gums generally pale and spongy, 277.
Gums tense and very white (fourth day), 246.
Gum pale, 4.
The buccal mucous membrane may present different degrees of discoloration in different cases, or may in the same case, be colored in various shades of blue, 117.
Upper gums rather discolored, 470.
Gums scarcely at all discolored, 225.
Gums softened, 485. [850.]
Gums spongy and tender, and between the teeth slight elevations of a leaden hue, 259.
The gums were very spongy, and edged with a deep blue line, 343.
Gums soft and swollen, with a dark-colored line on the edges in contact with the front teeth (tenth day), 240.
Gum loose, swollen, 237.
Swelling of the gum at the roots of the teeth, 49.
Gum loose, retracted, 235.
Gums discolored and shrunken, leaving the teeth bare to their necks, 471.
Gums retracted from the teeth, covered with tenacious mucus, 339.
Gums blue; those of the lower jaw have retreated from the teeth; the partitions between the teeth have partly disappeared, so that the gums form a mere projecting pad, they look as if cut vertically, but there is no ulceration, 223.
Gums tender, 79. [860.]
Inflammation of gums, 322, 502.
Occasional congestion of the gums; they bleed when touched, 305.
Congestion of the discolored gums; they bleed at the slightest touch, 206.
Ulceration of the superior alveolar border of the gums of both jaws, with discoloration of almost the entire buccal mucous membrane, 207.
Pimple on the gum, that was very painful and hard, 49.
Tongue.
Some sudden burning pimples on the tip of the tongue, that are especially painful on talking, from 6 to 10 P.M. (first day), 4.
Blisters on the frænum of the tongue, 114.
End of tongue covered with many small bluish-black spots like small ecchymoses; the upper surface of the tongue was covered with a number of large ulcers, somewhat like mercurial ulcers; associated with painfulness of the tongue and lips, and offensive salivation, 101.
Inflammation of the tongue, 44.
Tongue occasionally swollen, red, dry, and large, 312. [870.]
Tongue clean, red, and enlarged, 519.
Tongue flat and broad, 271.
Tongue clean, but expanded, 86.
Tongue large and rather yellow, 224.
The tongue trembles, without being paralyzed, 140.
Trembling of the tongue, 439, 444.
Trembling of the tongue when protruded, 541.
Tongue and lower lip tremulous, 190.
When he tries to articulate, the tongue is readily seen to move with difficulty, and to tremble, 174.
Tongue pale and tremulously protruded, with slight yellowish coating in the centre, 437. [880.]
Some trembling of the tongue when protruded, 451.
Slight tremor of the tongue, but articulation is perfect, 399.
Tongue drawn quite forcibly to the left side, and folded in the same direction, 527.
Cannot put out his tongue, 520.*
Tongue and other parts of the body became partially palsied, 71.
Tongue flabby, tremulous, edges red, indented, a brownish fur down the centre, speckled with enlarged red papillæ, 277.
Tongue flabby, 267.
Tongue large, soft, red, rather dry, 212.
Tongue clean, pointed, red on the border (after four hours), 268.
Tongue covered with frothy saliva (second day), 3. [890.]
Tongue covered with mucus, 572.
Tongue and gums thickly coated, 339.
Tongue thickly coated, 112, 566.
Tongue dry and coated, 353.
Tongue furred, 282, 377, 531, 549.
Tongue foul, 111, 527.
Tongue lightly coated, 292.
Tongue pale, 341.
Tongue slightly furred, 230.
Tongue coated white, 43, 113, 192, 201 , etc. [900.]
Tongue blanched, covered with a white coat, red at the margin and tip, slightly swollen, 533.
Whitish, thick tongue, 219.
Large white tongue, 215, 223.
Tongue white and red; rather enlarged, 194.
Tongue whitish, thick, and rather dry, 217.
Tongue clean and rather white, 195.
Tongue dry and covered with a dense white fur, 232.
Tongue dry and white, 427, 474, 476, 479.
White, clean tongue, 127.
Tongue moist, white, the margin rosy red, 273. [910.]
Whitish, very large, moist tongue, 220.
Whitish, moist tongue, 123, 166, 188, 236.
Moist tongue, white in the middle and red on the sides, 125, 125a.
Tongue large, thick, and covered with a thin white coating, 120.
Tongue furred and white, 79.
Tongue white and loaded, 81.
Tongue white in middle, and red on the sides, 190.
Tongue somewhat dry and whitish, 218, 225, 466.
Tongue moist and rather white, 137, 193.
Tongue slightly whitish, 186, 471. [920.]
Tongue moist, with white fur, 376.
A brownish white fur on tongue, 368.
A white furred tongue, 367.
Tongue yellowish white, but moist, 485.
The tongue, covered with a yellowish-white coat about the base, was otherwise clean, and partly paralyzed on the right side, impeding the promptness and clearness of his utterance, 350.
Tongue slightly coated white (after treatment), 287.
Red tongue, 150, 221.
Tongue clean and rather red (after one year), 261.
Tongue dry and red (second day), 248.
Tongue red at the edge, a brown fur down the centre, 276.* [930.]
Margin of the tongue red (after four hours), 274.*
Dry, red tongue, rather pale and moist at the edges, 537.
Tongue extremely red (after eleven hours), 93.
Tongue red, moist, 222.
Tongue red, and somewhat coated with white, 183.
Tongue red on the sides, and slightly whitish in the middle, 175.
Tongue moist, large, and red, with a whitish coat, 173.
Tongue red on the sides, white in the middle, 168.
Tongue large and red, 140.
Red pointed tongue (second day), 268. [940.]
Tongue red and moist, rather white in the middle, 122.
Tongue red, dry, and enlarged, but papillæ not prominent, 214.
Tongue red and rather white on the sides, 198.
Tongue red and moist, 203.
Tongue coated yellow or white, 499.
Tongue furred, the mucus on its posterior part very yellow, 458.
Tongue furred, dirty yellow, 446.
Tongue coated yellow, 3, 211.
Thick yellow coating on the tongue, 133.
Tongue covered with a thick, partly dry, yellowish-white saburral coating; its borders red and rough, with projecting papillæ, 126. [950.]
Tongue coated with a thick light-yellow crust, 103.
Tongue enlarged, and covered with a rather thick yellow coating, 209.
Tongue coated, dirty yellow, flabby, and indented, 445.
Tongue dry, and covered with yellow fur, 336.
Tongue coated greenish and yellow, 46.
Tongue moist, and slightly coated on its posterior part, with a yellowish fur, 259.
Nasty and thick coating of mucus on the tongue, 28 . [Effects of large doses.]
Large tongue, covered with a pretty thick saburral coating, 208.
Tongue large and red, with a slight saburral coating in the middle, 124.
Bluish line on the margin of the tongue, 344. [960.]
Tongue covered with a slight brown fur, 97.
Tongue coated in the centre with a brown fur, 338.
Tongue coated with a thin, moist, whitish-brown fur, clearing off towards tip and edges, 538.
Tongue coated with a thick brownish-yellow fur, 546.
Tongue quite brownish, 49.
Tongue covered with a black crust (second day), 82.
Tongue dry, brown, and cracked, 20.
Tongue dry, with a dark streak in the centre, 242.
Tongue clammy, 509.
Tongue and fauces dry (tenth day), 240. [970.]
Tongue clean, somewhat dry, 91.
Dryness of the tongue, 26, 80, 256, 492.
Heaviness of the tongue, 44.
Burning in the tip of the tongue, as though he had bitten it, transient, about 2 P.M., 4.
Loss of sensibility in the right side of the tongue, 498.
General Mouth.
Mouth drawn aside, 87.
Tetanic closure of the mouth, 22.
Ulcers in the mouth, especially on the sides, with an offensive odor; they afterwards became yellow, 49.
Cannot eat or drink anything on account of three ulcers in the mouth, two on the under side of the tongue, and one on the inside of the cheek; cold drinks almost set him crazy; he swallows hot drinks best; the ulcers were of a perforating character, and had eaten into the tongue to the depth of four or five lines; rapidly healed by direct application of Alum, 428.
Aphthæ in the mouth and throat, 42. [980.]
Occasional discharge of wind from the mouth, 125a.
Swelling of the glands in the mouth and beneath the chin, 49.
Redness, tenderness, and ultimately a deep soreness of nearly the whole mouth and fauces; almost every sort of food, except the mildest kind, such as rice, gave me pain, both by its presence in the mouth, and by heat and smarting it occasioned, 108.
The whole mucous membrane of mouth and tongue slate-colored, with a few scattered, scarcely visible red points, 204.
Where carious teeth existed the interior of the mouth and fauces blackened by the action of sulphate of lead, 267.
The mucous membrane of the lips and throat was pale, and the gums discolored, 439.
Mucous membrane of the mouth without color, 402.
Mucous membrane of the lips pale, 433.
Mucous membrane of the mouth pale, 497.
Mouth slimy, 35. [990.]
Mouth slimy in the morning, on waking (second day), 3.
Clammy mouth, 122, 218.
Breath at times very fetid, 499.
Strong fetor in breath, 82, 336, 538, 582.
Peculiar ( saturnine ) fetor of the breath, 125a.
Fetor of breath so great that a fellow-servant, who slept in the same room, could scarcely endure it, 458.
Breath fetid, 142, 146, 148 , etc.
Breath extremely offensive; he is himself aware of it, 214.
Offensive metallic odor of breath, 513.
Foul breath from the mouth, 343, 537. [1000.]
Peculiarly offensive and nauseating smell of the breath, 401a.
Offensive odor in the mouth, from the hollow teeth, while eating (second day), 3.
Breath had a peculiar smell so often noticed in patients suffering from malignant disease of the stomach (eighteenth day), 549.
The breath has usually a characteristic odor. Its offensiveness is indescribable; it can only be called a saturnine breath, 117.
My mouth was usually more dry in the morning than at evening, though the thirst was rather less, 108.
*The mouth and nostrils are dry, 356.
Dryness of the mouth, 3, 21, 28, 99, 208, 214, 235, 237, 575.*
Great dryness of the mouth, 20.*
There was for four or five days an almost constant feeling of constriction of the mouth, especially of the lips, which I was prompted frequently, and, as it were involuntarily, to extend, 108.
Burning pain in mouth, throat, and stomach (soon), 260. [1010.]
Heat and burning in the mouth and tongue (fourth morning), 4.
Mouth and lips are dry, 357.
Saliva.
Excessive salivation; the saliva dropping from the mouth, immediately relieved by Mercurius sol., 428.
Profuse secretion of mucus in the mouth, 364.
The saliva is not usually increased; as some subjects say that their mouths are dry, it would seem that in certain cases the amount of this secretion is abnormally diminished, 117.
Sometimes there was a temporary salivation and a slight (if I mistake not) metallic taste, 108.
Secretion of saliva diminished, 49.
Bluish, sweet saliva, 28 . [From large doses.]
Much sweetish, slimy tasting saliva collects in the forepart of the mouth, with dryness at the root of the palate posteriorly and in the fauces, disappearing on swallowing saliva (first day), 3.
Bloody sputa (third day), 320. [1020.]
Sputa lumpy, bloody (second day), 90.
Spitting of blood, 92.
Saliva alkaline, 209, 223.
Froth in the mouth, 44.
Taste.
Sense of taste very much diminished, 497.
Sense of taste much diminished, especially in the right half of the tongue, 525.
His sense of taste was perverted, so that he no longer recognized ordinary articles of food, 561.
Taste perverted, 512.
The workmen, whose gums and teeth show any considerable amount of the sulphate of lead deposit, often complain of a peculiar taste. This is described by most of them as saccharine, styptic, astringent, i. e. , exactly like that caused by holding a preparation of lead in the mouth. Others says that it is both offensive and styptic, 117.
Sweetish taste in the mouth, with dryness, 99. [1030.]
*Sweetish taste, 9, 11, 120 , etc.
Styptic taste (second day), 268.
Horrible taste in her mouth, 458.
Taste astringent (second day), 274.
Bad taste in the mouth, 429, 469, 474, 475, 567.
Bad taste in the mouth, a sort of bitterness, especially at night, 518.
Nauseous taste, 210.
Disagreeable taste in the mouth, 325, 351.
Sweetish, sour taste in the mouth, which is a constant annoyance, 555.
Metallic taste, 175, 350, 355, 445. [1040.]
Disagreeable metallic taste, 111.
Taste pasty, 339.
Coppery taste in the mouth, when she first awoke, in the morning, 568.
Dry and bitter mouth, 126.
Peculiar taste in mouth, 562.
Bitter taste, 46, 111, 220 , etc.
Bitter taste in the mouth, every morning, 269.
Decidedly bitter taste, 190, 219.
Constant bitter taste, 485.
Taste flat, 235. [1050.]
Acrid taste in mouth and throat, 127.
Speech.
The utterance was panting and puffing, as in diaphragmatic pleurisy, 213.
Speech is slow, 509.
Speech is dragging and slow, 499.
Speech hindered, 44.
Difficulty in speaking, 483.
Speech difficult (with albuminuria), 429.
Speech slow and difficult, 91.
Speech is hurried and abrupt, 190.
Speech hasty, can hardly be understood, 537. [1060.]
Articulation somewhat stammering, 146.
Stammering, broken, shaky articulation, 140.
Stammering, 444.
Speech faltering and hesitating, 271.
Articulation imperfect, often even incomplete; sometimes, on attempting to speak, he uttered only confused sounds, more or less intelligibly, 144.*
His speech is rather impaired; he cannot utter his words so freely as in health, 583.
Impeded utterance, 503.
Difficulty of speech, showing itself in articulation, but the tongue was not drawn to one side, 453.
Speech faltered, 87.
Words indistinctly pronounced, 527. [1070.]
Incoherent speech, 177.
Speech almost inarticulate, 174.
Tries to speak, but only mutters unintelligibly, 520.
Some want of power of speech, two or three times, after a night attack, 365.
Sudden loss of speech, with short, rapid respiration, 256.
Inability to talk, 26.

THROAT

Hawking of sourish mucus (after half an hour), 4.
Hawking up of a sourish sputa, 306.
Mucus is expectorated from the throat with easy hawking, it is frothy like saliva, transparent, lumpy, and in yellowish-green tenacious masses (first day), 3.
Very tenacious mucus, 49. [1080.]
Choking, when swallowing, 258.
Choking sensation in throat (after one year), 261.
Sensation of dryness in the throat, in the morning, 5.
Dryness of throat (after five hours), 107.
Roughness of the throat, with somewhat hoarse voice (fourth morning), 4.
Rawness of the throat (after six hours), 4.
Swollen sensation in the throat, that obliges frequent swallowing, and does not disappear (after two hours), 4.
Swollen sensation in the throat, on swallowing, with retching (fourth day), 4.
Constriction of the throat, 21 . [From large doses.]*
*Constriction of the throat, 3, 43 ; (fifth and sixth days), 47, 56. [1090.]
The patient continued to suffer from constriction of the throat for three months after the poisoning, rendering deglutition difficult, associated with general muscular feebleness, 253.
Spasmodic constriction of the throat, 93.
Sense of constriction about the throat and epigastrium, 267.
Violent constriction of the throat, 253.*
Sensation as though the foreign body in the throat slipped downwards, afterwards tearing in the right scapula (after two hours and a half), 4.
Sensation as of a foreign body in the right side of the throat, with a sulphurous odor; the sensation afterwards extended towards the ear and lasted a long time, 4.
Sensation as if something in the throat moved suddenly up to the base of the skull and thence to the left orbital region, where it became a sticking; while smoking (first day), 3.
Sensation of a foreign body in the throat that provokes sneezing, on swallowing it extends far down, but immediately returns, it often disappears for awhile of itself, lasting the whole forenoon; it is not painful, 4.
A small body frequently rose into the throat, which she thought she must swallow again, by paroxysms (after three-quarters of an hour), 4.
Rising of a ball into the throat (globus hystericus), 46. [1100.]
Pains in the throat, 67.
Retching in the throat (after two hours), 4.
Heat in throat, 335.
Offensive taste of lead in the throat (second day), 320.
Sulphurous and sour taste low down in the throat, 4.
Uvula and Tonsils.
Uvula inflamed, 93.
Tonsils inflamed and indurated, 21.*
Tonsils swollen, 93.*
Dryness of the fauces, 350.
Fauces and Pharynx.
Sense of heat and tickling in the fauces (second day), 82. [1110.]
Pharyngeal muscles almost paralyzed, 21.
Paralysis of the pharyngeal muscles, and inability to swallow food, 43 . [From the use of lead water, towards the close of angina pituitosa.]
Constriction and cutting in the pharynx, extending as far down as the stomach, before and after eating, 5.
Frequent contraction of the pharynx, 43.
Œsophagus and Swallowing.
Feels food descending into the œsophagus and reaching the stomach (tenth day), 268.
When the colic is coming on, drinking is difficult, owing to a sensation of constriction extending from the epigastrium all along the œsophagus to the pharynx, which prevents the barley-water from passing; if he goes on trying to swallow, it is rejected almost immediately, 214.
Drawing sensation in the œsophagus, while eating, as if the œsophagus would be torn off (sixth day), 5.
Sensation of crawling in the œsophagus, 46.
Heat along the whole œsophagus, 93.
Difficult swallowing, 21, 90, 320, 556, 562. [1120.]
Swallowing difficult, at times almost impossible, 91.
External Throat.
Throbbing in the carotids and also in the crural arteries, 405.
Left parotid gland swollen and painful; skin hot and red. Right parotid somewhat swollen, 522.
Submaxillary glands somewhat swollen and painful, 430.

STOMACH

Appetite.
Great appetite, in the evening (first day), 3.
Sensation of violent hunger in the throat, extending down to the stomach, returning after eating (third day), 5.
Excessive hunger, he eats an unusual amount (after five days), 5.
Great hunger; eating a biscuit considerably aggravated the pains, and caused vomiting, 224.
Great desire to eat bread and biscuits the whole time; occurring even an hour after a meal, also late in the evening and early in the morning, 3.
Sensation of hunger and nausea, in the evening before going to sleep (sixth day), 5. [1130.]
Appetite generally craving, 236.
Appetite indifferent, 341.
Appetite poor, 499, 522 ; (after one year), 561.
Appetite very poor, 303.
Diminished appetite (second day), 4, 133, 302, 331, 512.*
Appetite much diminished, 521.
Loss of appetite before the colic, 214, 222.
No appetite nor thirst, 194, 198.
Loss of appetite, for two months, 535.
Loss of appetite and sleep, 29. [1140.]
*Loss of appetite, 16, 18, 19, 21, 23, 27, 35, 46, 48 , etc.
Great loss of appetite, and even aversion to food, 468.
Complete loss of appetite, 446, 473, 474.
Almost complete anorexia; perhaps some malacia, 519.
Anorexia, 120, 123, 124 , etc.
Prolonged anorexia, 479.
Anorexia before the colic, 217.
Anorexia, with considerable sickness, 97.
Anorexia, without loathing, 120, 209.
Complete anorexia, 208, 519, 555. [1150.]
Great relish for tobacco (first day), 3.
Aversion to food, 9, 12, 21, 35, 47, 51, 126.
Thirst.
Thirst inextinguishable (after one day), 236.*
Distressing thirst and desire for cold water, 248.
Great thirst; but liquids are returning, with much straining, as soon as taken, 217.
Violent thirst, 90, 254, 320.
Very great thirst, 235, 258.
Great thirst, 26, 80, 97 , etc.
Considerable thirst preceded the soreness of mouth, especially in the evening, 108.
A little thirsty and feverish, 103. [1160.]
Moderate thirst, 124, 125a, 208 , etc.
Thirst, even in the morning (fourth day), 4.
Thirst, after dinner (very unusual), 4.
Great desire for cold drinks, 126.
Much thirst for cold water, 3.
Absence of thirst, 158, 166, 168 , etc.
Dread of all drinks, 114.
Eructations.
Eructations, 9, 120, 121, 122 , etc.
Frequent eructations, 93, 120, 123 , etc.
Frequent tiresome eructations, and violent hiccough, 24. [1170.]
Frequent eructations and borborygmi, 212.
Frequent eructations and vomiting, 315.
Frequent inodorous eructations, 126.
Extraordinarily frequent eructations, with a sensation in the mouth as after eating sugar, 35.
Eructations, nausea, and vomiting, especially at the end of the paroxysms of colic, 120.
Frequent eructations, affording momentary relief, and feeling like something sweet rising into the mouth, 208.
Frequent offensive eructations, sui generis, 211.
Frequent eructations tasting of the food (after half an hour), 4.
Eructations of an offensive odor (after two hours and a half), 4.*
Sweetish eructations, 43 ; (fourth day), 47. [1180.]
Uprisings of sweet water, with emptiness of the stomach, 4.
Sweetish uprisings into the throat (after half an hour), 4.
Sweetish eructations, as if about to vomit, over a hundred times in two hours, 43.
Uprisings of tasteless water (after a quarter of an hour), 3.
Sour uprisings (after two hours and a half), 4, 221.*
Distressing eructations, 16.
Eructations of a strange taste, 21, 28.
Eructations of gas after breakfast (after a quarter of an hour), 4.
The gas eructated of a bitter fetid smell and taste, 305.
Eructations of gas and nausea, in the evening before going to sleep (seventh day), 5. [1190.]
Ineffectual attempts to eructate, followed by yawning (after half an hour), 4.
Empty eructations, followed by burning in the stomach, soon disappearing (after a quarter of an hour), 4.
Empty risings, eructations, 305.
Hiccough.
Hiccough once (after five hours), 4.
Hiccough, 13, 20, 46, 114, 128.*
Paroxysmal hiccough, frequently repeated, 3.
Violent hiccough, occasionally, 209.
Frequent hiccough, 148.
Nausea and Vomiting.
*Nausea, 9, 11, 120, 121 , etc.
Frequent nausea, 211, 218, 284, 353. [1200.]
Nausea (with the colic), 516.
Almost constant nausea, 212.
Violent nausea and vomiting of a blackish-yellow substance, soon, 320.
Constant and very fatiguing nausea, 120.
Constant nausea, 64, 209.
Frequent nausea, without vomiting, 168.
Nausea, without vomiting, 208, 221, 225 , etc.
Distressing sickness and vomiting of a yellowish-green fluid, 86.
Nausea and anxiety (second day), 82.
After every meal, uneasiness and nausea, 88. [1210.]
*Occasional nausea, sometimes followed by vomiting of food, 527.
They complained also of feeling sick at the stomach, 241.
Slight nausea, which continued several days, with a load at the pit of the stomach, 242.
Much sickness, and frequent vomiting, 238.
Nausea, before the colic, 214, 217.
Nausea and qualmishness in the stomach, soon disappearing (after two hours), 4.
Qualmishness, 46.
Qualmishness and uprisings as far as the chest (after two hours and a quarter), 4.
Nausea and vomiting, for two months, 535.
*Nausea and vomiting, frequently present, the latter symptom being most distressing, the stomach in some cases rejecting almost everything, 446. [1220.]
Occasional nausea and vomiting, for a year past, 404.
Severe nausea and vomiting, 287.
Nausea, and vomiting of bilious matter, 66.
Frequent nausea and vomiting, 70.
Almost constant nausea, with vomiting of porraceous, æruginous matters, 215.
Nausea, with vomiting of a little green, thick substance, 217.
Nausea, with vomiting, at long intervals, of a few spoonfuls of greenish matter, 125.
Nausea and vomiting, immediately, 112.
Nausea and vomiting, 52, 126, 159 , etc.
Frequent inclination to vomit, and occasionally greenish matter was ejected from the stomach, 74. [1230.]
Incessant inclination to vomit, 305.
Anxious wish to vomit, 335.
Incessant inclination to vomit, 28 . [From very large doses.]
Frequent and painful efforts to vomit, which he often sought to reinforce by putting his fingers in his mouth, 212.
Frequent empty retching, with eructations of thin white mucus or greenish bitter fluid, 258.
Retching, 43, 376.
Frequent retching, 26.
Violent retching (after one week), 262.
Retching and vomiting, at times, 26.
Inclination to vomit, and aversion, 32 . [In a woman who had applied a preparation to freckles on the face.] [1240.]
Extreme efforts to vomit, that were almost convulsive, 43.
*Vomiting, 19, 21, 76, 111 , etc.
Frequent vomiting, 12, 28, 64, 68 , etc.
Frequent vomiting, in the morning, 575.
Frequent vomiting, though without pain at the epigastrium, 223.
Violent vomiting (after fifteen minutes), 100.
Excessive vomiting, 45.
Constant vomiting, 52, 107, 278 , etc.
Frequent vomiting of grass-green substances, 235.
Obstinate vomiting, 256, 345. [1250.]
Incessant vomiting until fecal matter is evacuated through the mouth, 20.*
Constant vomiting, with obstinate constipation, 51.
Vomiting that could not be quieted, 26.
Vomits several times during the day, producing for the time, hard lumps in the region of the stomach, which, however, disappear on friction being applied, 103.
Frequent and tormenting vomitings, 98.
Vomiting of everything taken into the stomach, 129.*
Difficult vomiting, 198.
Violent vomiting, which continued almost without intermission for nearly six hours (after five minutes); mixed with the contents of the stomach a little blood was occasionally rejected, 82.
Vomiting with the abdominal pain, for four days, 81.
Vomiting and frequent retching, 80. [1260.]
Nothing would remain on their stomachs, even for a moment, for nearly six weeks, 65.
Nothing would remain on his stomach but ice, and for a short time only he could retain small quantities of Brand's essence of chicken and turtle jelly, 549.
Vomiting that does not relieve the patient, 28 . [From large doses.]
Vomiting, especially with sticking pains, 9.
*Vomiting of food, 46.
Vomiting thirty or forty times a day), 49 . [Effects of eating pancakes made of equal parts of meal and white lead.]
Vomiting soon after eating (during the colicky paroxysms), 512.
Vomiting every day, preceded by nausea, and consisting only of a clear, rather acid, fluid, or else of bile, 519.
Ill for three weeks; she vomited constantly, not being able to retain any food; there was also constant nausea, and even when no food was taken, there was still frequent vomiting of a greenish watery fluid; she vomited very much in the night, especially the early morning, 458.
Constant vomiting, so that she could not take the least food, 402. [1270.]
Constant vomiting of all food, 354.*
Vomiting, accompanied by colic, 305.
Difficult vomiting, attended with great anxiety, 305.
Food produced great distress and frequently vomiting, so much so, that he often took no supper, 290.
Severe attacks of vomiting, 341.
About five weeks ago she began to vomit everything he took, whether liquid or solid, and the vomiting has continued ever since (in one case), (after eleven months), 260.
The stomach has not retained anything for a fortnight, 103.
Bilious vomiting; constant nausea, 420.
Frequent bilious vomiting, 319.
Vomiting of a bitter, bilious, slightly green matter, 350. [1280.]
Frequent but difficult vomiting of mucus and bile, 128.
Vomiting of bilious yellow substances like green vitriol, 46.
Frequent bilious vomiting, preceded by nausea, 125a.
Vomiting a brownish liquid streaked with blood (fourth day), 246.*
Vomiting of a greenish watery fluid, 271.
Difficult vomiting of a bitter green substance (with the colic), 516.
Frequent greenish vomiting, 137.
Greenish, very bitter, vomiting, 127.
Almost daily vomiting of a green, bilious fluid, 290.
Vomiting, only excited by the greatest efforts, of dark-green, very bitter matter, depositing a very copious, thick, slimy sediment, 120. [1290.]
Vomiting of green, thick, and very bitter substances, 218.
Frequent vomiting of a deep-green substance, leaving a very bitter taste in the mouth and œsophagus; two basinfuls were ejected during the day and night, only a little at a time, 209.
Frequent green, watery vomiting, followed by a little momentary relief, 211.
Greenish vomiting, 398.
Several times vomited yellow mucus and bilious matter, 499.
The substance vomited tasted like liquorice, 26.
Fecal vomiting , with violent colic and obstinate constipation, 49.*
Vomiting of a yellowish offensive substance, with the most violent colic, 35.
Constant vomiting of a substance like corroded copper (vomitus æruginosus), 43.
Vomiting of blackish-yellow substances, soon, 90. [1300.]
Constant vomiting of a blackish substance, 42.*
Sometimes vomiting of a little slimy matter, like white of egg, 222.
Vomiting of a stringy substance, 519.
Vomiting of matter containing small whitish lumps, probably consisting of white lead, 478.
Bloody vomiting, 49.
Vomited a considerable quantity of blood (eighteenth day), 549.
All food is immediately vomited, with traces of blood, 533.
Even gum-water is not retained more than five or six minutes, and aggravates the pains, 126.
Stomach rejected all kinds of food; frequently ejected a greenish fluid, 331.
Stomach.
Epigastrium tender, 276. [1310.]
Epigastrium tense and hard, 209.
Epigastric region very sensitive, 235.
Sensation of emptiness or fasting in the stomach, frequently (after a quarter of an hour), 4.
Discomfort in the stomach, without qualmishness (after a quarter of an hour), 4.
Indescribable sensation of depression and distress at the pit of the stomach (immediately), 82.
Epigastrium depressed, 194.
Constriction about the epigastric region, 266.
Sense of constriction about the epigastrium and throat, 267.
Contraction of the stomach, 11.
Contractive sensation in the stomach (after six hours), 4. [1320.]
Tightness of the epigastrium, 278.
Tightness in the pit of the stomach, 7.
Sensation of fulness in the stomach, 576.
After eating he felt swollen, 538.
Taking nourishment does not cause pain, but only a sensation of uneasiness and of weight; digestion takes place very slowly, 519.
Pressure has no effect on the epigastric pain, 209.
Pressure and tightness about the stomach (after three-quarters of an hour), 84.*
Violent pressure in the epigastric region, 99.
Pressure in the stomach, as if it were pressed by a hundredweight, 28 . [From large doses.]
Pressure in the stomach, as from much undigested food, with a feeling of heaviness in the occiput, aggravated by moving the head, after a very moderate dinner, lasting till very late in the evening, 5. [1330.]
Pressure in the stomach, 28.
Pressure in the stomach, after eating, 3.
Pressive pain in the stomach, 46.
Pressure in the pit of stomach; a dull anxious pain (first day), 3.
Pressure and fulness in the epigastrium, after eating, 269.
Epigastrium tender on pressure (after one year), 261.
Uncomfortable weight in stomach, accompanied by eructations, 111.
Weight at the epigastrium, 216.
Heaviness in the stomach, 47.
Indigestion, 255. [1340.]
Impaired digestion, 28, 269, 438, 560.
Difficulty of digestion, 269.
Digestion completely out of order, 127.
Dyspepsia, associated with loss of appetite, usually with a clean tongue, with a peculiar sweetish taste, frequent accumulation of saliva, frequent nausea; associated with pressure and heaviness in the pit of the stomach, sometimes with pain and confusion of the head, general malaise, and prostration, 109.
Painful dyspepsia, 294.
Dyspepsia, 301, 559.
Heat of stomach (after five hours), 107.
Great heat in the stomach, 250.
Heat in the epigastric region, with violent pain, that extended to the region of the heart, 254.
Cardialgia, 45, 46. [1350.]
Cardialgia with the colicky pains, 243.
Cardialgia, vomiting, and all the symptoms of inflammation of the stomach, 21 . [From large doses.]
Violent burning in the stomach, immediately, 257.
Sensation of burning in the stomach, with nausea and vomiting, 101.
Burning in the stomach, 45, 56.
Transient burning in the stomach (after a quarter of an hour), 4.
Sense of burning in the epigastric region, 256.
When a cold drink reached the stomach, it caused a sensation as of boiling water, and was immediately vomited; the vomiting was profuse, of the color and consistence of coffee, 250.
Violent burning pains in the epigastric region, which was very sensitive to pressure, 257.
Constrictive burning pains in the stomach, and afterwards in the umbilical region, occurring at longer or shorter intervals, 46. [1360.]
Violent burning pain, much more severe at the epigastrium than at the umbilicus or hypogastrium, worse by paroxysms, and diminished by gradual pressure, 150.
Slight burning pain in the stomach (first day); more pain (second day), 100.
Most violent burning pains in the epigastric region, with violent vomiting (after a few hours), 248.
Cutting and burning pain in the stomach, extending through the abdomen, 533.
Occasionally a dull pain at the cardiac extremity of the stomach, 88.
Sometimes severe pains in the stomach, 108.
Very sharp pain at the epigastrium, worse at intervals, when there is a feeling of violent laceration, 209.
Extremely acute pain, confined to a space three inches in extent between the epigastrium and hypogastrium. He complained also of a much less severe pain, extending around the hypogastrium, 214.
Severe pain at the epigastrium; rather less at the right hypochondrium and the umbilicus; constant, but worse by paroxysms; tearing at the hypochondrium; elsewhere, twisting, 211.
Pains very severe at the epigastrium; less so at the umbilicus and hypogastrium; none elsewhere; they where of a tearing nature; constant but much aggravated at times, when, with shrunken, wild-looking countenance, she would throw herself into the strangest attitudes, uttering sharp cries, and begging and praying those about her to press their hands upon her abdomen with all their strength; this would give some relief; she also tied her handkerchief tight around her, 218. [1370.]
Lancinating pain across the stomach and lower part of abdomen, 70.
Sharp lancinating pains in the region of the stomach, 79.
Most violent pain in the stomach, abdomen, and loins, with a distressing sensation of internal heat, 48.
Violent pains in the stomach and umbilical region (seventh day), 47.
Excessive pains in the stomach and abdomen, 48.
Violent gastric pains, for two months, 535.
Violent pain in the epigastrium, almost immediately, 265.
Pain in the epigastric region and above the umbilicus, 576.
Great pain in the stomach, 499.
Violent pain in epigastric region, 325. [1380.]
Violent pain in the epigastric and umbilical regions, which the patient frequently rubbed; the muscles of the belly were drawn inward, 335.
Most violent pains in the epigastrium, immediately, 274.
Severe pain in the stomach, radiating thence to both groins, striking down both limbs, particularly the left, 287.*
Violent pains in the epigastric and umbilical regions (second day), 24b.
Great pain, chiefly in epigastrium (fourth day), 246.
Pain in epigastrium, gradually extending over the entire abdomen, 557.
Pain in the stomach, spontaneous, and on pressure, 485.
Pain in stomach, for eight days, 478.
Irregular pains about the epigastrium, 321.
Pain in stomach, 50, 261, 319, 330, 486, 488, 582. [1390.]
Pain extending from the pit of the stomach to the middle of the chest (after two hours and a half), 4.
Pain in the stomach, whence it extends over the whole abdomen, frequently (after two hours), 4.
Pain in the stomach, as from fasting, in the morning in bed, disappearing after rising (second day), 4.
Pain in the pit of the stomach, 474.
The epigastric region is painful on even slight pressure. Sensation of a heavy weight in the epigastrium, together with a constant and uniform smarting pain, 126.
Colic pains at the epigastrium and umbilicus, twisting, constant, but worse by paroxysms, during which her face is distorted, she utters grievous cries, lies on the belly, doubles herself up, ties handkerchiefs tightly round her, gets up and walks the room, etc.; but no position entirely relieves, 128.
Pain like a boring, in the pit of the stomach, extending into the right side, intermitting, 4.
Dull, heavy, epigastric pain, giving the sensation of the bowels being drawn toward the spine, 446.
Boring pain, quite severe at the epigastrium, slight at the hypogastrium, scarcely felt at the umbilicus; acute in the right testicle; worse by paroxysms. Pressure gradually applied with the flat hand relieved it, but it was aggravated by suddenly and forcibly bearing down on the abdomen; and pressure did not good unless the limbs were previously flexed upon the pelvis. Pressure on the abdomen uniformly caused the pain to shift its place; when it was applied from the umbilicus to the hypogastrium, the pain went up to the epigastrium, 220.
Severe twisting pain in the epigastrium, coming on paroxysmally every five minutes, and diminished by pressure, 194. [1400.]
Twisting pain at the epigastrium and umbilicus, diminished by pressure, and becoming much worse by paroxysms; he lies flat on his belly; bends double, keeps changing his position, and his face is remarkably pinched, 192.
Moderate twisting pains at the epigastrium and umbilicus; worse by paroxysms, slightly diminished by pressure, 166.
Pressive, tensive constrictive pain in the epigastric region, 112.
Constant aching pain at the epigastrium, which was very much aggravated at intervals, 236.
Slight pain at the insertions of the diaphragm, during inspiration, 523.
Have not been free from pain at the epigastrium for a year, 260.
Pain much worse after eating, and she cannot retain anything on her stomach (after one year), 261.
Hot or cold drinks increase the pain; tepid drink agrees best (after one year), 261.
Complains sometimes of a feeling as if a ball ascended from the epigastrium along the thorax to the throat, where it causes a kind of suffocation; at such times he can neither speak nor swallow, and suffers the greatest anxiety, 215.*
Cramp in the stomach, 53 . [From the application of a solution of sugar of lead to a contused wound.] [1410.]
Cramps in the stomach, 334.
Severe gastric and abdominal cramps, 569.
A sensation of the stomach and bowels, being strongly drawn upwards and backwards, 70.
Excessive irritability of the stomach, 70.
After swallowing any liquid, a sensation as if the stomach was turned, not followed by vomiting, but aggravating the abdominal pains, 168.
Pricking sensation at the pit of the stomach, gradually amounting to pain, which would be more violent at intervals, drawing him double, 103.
Tearing sensation at the epigastrium and umbilicus, worse by paroxysms, during which he is rather restless, often turning in bed; lies flat on his belly; complains and screams somewhat. Abdomen sensibly depressed, hard and contracted, 121.
Colic, first at the pit of the stomach, and gradually extending all over the abdomen, 516.
Violent stomachache, becoming worse every day, until it changed into ileus, 129.
Fine griping in the pyloric region, 3. [1420.]
Frequent stitches, extending from the pit of the stomach to the back, 4.

ABDOMEN

Hypochondria.
Liver enlarged, 519.
Out of one hundred and eighty cases, four died of cirrhosis of the liver, 329.
Liver contracted, 574.
Spleen large, extending below the margin of the ribs, 437.
Diseased spleen, 39.
Morbid sensitiveness of the splenic region, 471.
Hepatic region sensitive to pressure, but the liver is not enlarged, 485.
Liver sensitive to pressure, and somewhat hypertrophied, 475.
Spleen and kidneys also painful on pressure, 485. [1430.]
Pain in the region of the spleen, 474.
Pain in the liver, 484, 488.
Dull pains in the liver, 3.
Constant pains in the hypochondria, aggravated by touch, 91.
Sensation of heat and burning in the liver and spine (after three-quarters of an hour), 84.
Tearing in the left hypochondrium posteriorly toward the back, where it became a sticking, in the afternoon, 4.
Sticking pressure in the hepatic region, 3.
Persistent sticking pain in the hepatic region, first anteriorly, then posteriorly, 3.
Slight pain in the region of the spleen (second day), 2.
Stitches in the right hypochondrium (after one hour and a half), 4. [1440.]
Stitches in the right hypogastrium, in the afternoon, 4.
Stitches extending inward in the left hypochondrium, somewhat relieved by rubbing, but returning worse than ever, at last disappearing of themselves, frequently during the day (after one hour), 4.
Stitches in the left hypochondrium, relieved by rubbing (after two hours), 4.
Stitches in the left hypochondrium, extending backward (after one hour and a half), 4.
Umbilicus and Sides.
Cuplike depression at the umbilicus, 208.
Prominent swellings could be seen and felt at the umbilicus and hypogastrium, evidently formed by an aggregation of the intestinal folds, and disappearing when the acute pain subsided, 213.
Cuplike depression of the umbilicus, 217.
Abdomen in the umbilical region retracted to spine, 315.*
Umbilicus retracted; very painful to pressure, 112.
Navel retracted, 43, 46. [1450.]
Retraction of the umbilical region; the walls of the abdomen were pressed against the spine, and were sensitive to pressure, 9.*
Abdomen hard, spasmodically contracted, so that the navel approximates the spine, 28.
The whole abdomen is somewhat tense, especially the umbilical region; the latter, when pressed by the hand, feels as hard as a stone, 208.
Slight moving back and forth below the navel, like a rough substance (after one hour), 4.
Movements about the navel (after a quarter of an hour), 3.
Bubbling about the navel, frequently intermitting, 4.
*Extremely violent pains in the umbilical region, that shoot to other portions of the abdomen, somewhat relieved by pressure; at times they became so violent that the patient was almost wild, tossed about the bed, pressed both fists into the abdomen, and declared that he must go to stool immediately ; the abdominal walls were greatly retracted, associated with vomiting of greenish bile, with offensive exhalations from the mouth, 273.
Violent pain in a space three inches square around the umbilicus, a most severe twisting sensation, during the aggravations, 208.
Violent pain about the umbilical region, extending across to the right hypogastric region, 66.
Violent periodical colic in the umbilical region, 67. [1460.]
Violent pains, especially in the umbilical region, 449.
Violent twisting pain at the umbilicus, hypogastrium, epigastrium, and renal region, constant, and with frequent excessive aggravations, during which there was extreme restlessness, 120.
Violent pain in umbilical region, occasionally so severe as to oblige him to draw up his legs, 232.
Violent pains in the umbilical region, on vomiting, 235.
Violent crampy pains round the umbilicus, 267.
Most violent pains in the umbilical region, and a little above, described by the patient as constrictive and boring, 12.
Violent pain starting from the umbilical region and extending to the lower portions of the abdomen, accompanied by nausea, vomiting, and strangury, 576.
Violent pains in the umbilical region, 44.
Violent pain in the abdomen, especially in the umbilical region, 34.
Violent pains extending from the pit of the stomach to the umbilicus, and raging with great violence for an hour at a time, 16. [1470.]
Violent abdominal pains, especially about the navel, with hardness and retraction of the abdomen, 35.
Rather violent pain, especially about the umbilicus, worse by paroxysms, diminished by pressure, 175.
Severe pain, constant, but worse by paroxysms, at the umbilicus, and felt in a circle all around the abdomen and corresponding portion of the trunk; ameliorated by hard pressure, but aggravated by gentle pressure. During the paroxysms he draws himself together, clings to the bed-rail, and keeps up a hard rocking movement; sometimes he digs his fists deep into the navel, doubles himself up, lies flat on his belly, etc., 123.
Extremely severe pains in the umbilical region, extending into bowels generally; relieved somewhat by slow and gradual pressure; they become at times so violent that he is almost crazy, and utters sharp cries, tosses about and rolls in his bed, squeezes his bowels with his fists, insists on going at once to stool, etc., 125a.
Colic, by paroxysms, in the whole abdomen, especially about the umbilicus, unaffected by pressure; during the paroxysms he tosses about in bed, and his face is expressive of considerable suffering, 125.
Very severe pains in the whole umbilical region, as if the bowels were twisted , especially immediately around the navel; the pain is less severe in the hypogastric region. These colic pains remit and return about every five minutes; their approach is shown by the agonized and anxious expression of the features; they are accompanied by restlessness, all sorts of attitudes being taken in order to obtain; relief; to this end, the hands are instinctively rubbed lightly on the abdomen, and at last he cries aloud for help, 126.
Severe pain at the umbilicus and hypogastrium, becoming excruciating by paroxysms, during which he utters dismal screams, lies on his abdomen, rolls himself up, etc. Face shrunken and expressive of great anguish; abdomen retracted and hard, especially about the umbilicus. The pain during the attacks is of a twisting nature; between them, it is a mere feeling of constriction. Colic pains somewhat aggravated by pressure. No nausea or vomiting, but frequent eructations, 138.
Excruciating pain near the umbilicus, 282.
Excruciating pains at the umbilicus, hypogastrium, epigastrium, and base of the chest. They consisted, during the paroxysms, of a twisting sensation, relieved by pressure, and between them of a feeling of simple constriction, which pressure aggravated. Pressing the hand upon the abdomen imparted a sense of extreme hardness, 213.
*Pains in all the bowels, but much worse at the navel; they consisted of an excruciating tearing . The paroxysms, which returned at intervals of less than six minutes, caused the greatest agitation; with flushed face and wild eyes he uttered cries of rage and despair, which disturbed the patients in the adjoining wards. One of his companions thrust his fists into his abdomen in order to relieve him; he himself pressed it with all his force against a chair; at times he leapt out of bed, holding up his belly with his hands, and begging to have its pains relieved, 222. [1480.]
Late in the afternoon of the third day he began to feel general uneasiness, and a dull pain in the umbilical region, which radiated over the whole abdomen, especially in the direction of the recti muscles; this pain gradually increased during the night, becoming lacerating in its character, and causing great restlessness and moaning; it was accompanied by attacks of vomiting of a bitter, bilious, slightly green matter, metallic taste, anorexia, lack of thirst, chilliness, cramps in the lower extremities, sleeplessness, and anxiety, 350.
Severe pain around the navel; not increased, but rather relieved, by pressure; five days later, same pains in umbilical region, 86.
Severe pain at the umbilicus, extending to the hypogastrium and testicles; worse by paroxysms; sensation as if the bowels were torn out. The attacks come on not oftener than every half hour, 122.
Severe remitting pain, especially towards the umbilicus, slightly diminished by pressure, 193.
Severe pain in region of navel, 323.
Frequent and severe paroxysms of pain in the umbilical region, 317.
Intolerable pains about the navel, followed by very obstinate constipation, 52 . [Effects of inhalation of the dust by a man while working in lead.]
Exceedingly acute twisting pain at the umbilicus and epigastrium, often much worse by paroxysms, and only slightly relieved by slow and gradual pressure. During the paroxysms the abdomen is depressed and very much contracted; there is nausea or vomiting, he screams out, rolls about in bed, keeps changing his position, tries to provoke vomiting with his fingers; when questioned he answers quite rationally, but does not want to be spoken to, 182.
Severe twisting pain at the umbilicus and hypogastrium, returning in paroxysms, alleviated by pressure, 124.
Twisting pain about the umbilicus, shooting through to the back and down the limbs, 285. [1490.]
Twisting pain, at times very severe, at the umbilicus and epigastrium, 198.
Very severe twisting pain at the umbilicus, not so bad at the epigastrium; increased by pressure and diminished by friction, 219.
Lacerating pains at the umbilicus and epigastrium ; rather worse by paroxysms; slightly ameliorated by pressure. During the attacks he tosses about in bed, his face is contracted, he utters complaints, 159.*
Sharp lancinating pains in the pubic and umbilical region, with a sensation of twisting about the navel, 79.
Pain in all the abdomen, especially in the umbilicus, accompanied by a burning sensation in the intestines during an attack of pain, which frequently changed to a species of insensibility of the abdominal walls, 350.
Seated pain in the umbilical region, 43.
Pains in the umbilical region, 43.
Pain in the umbilical region and back, 26.
Pain about the region of the navel, 68.
When he can be got to pay attention, and is asked where he feels pain, he points to the umbilical region, 195. [1500.]
Pain at the umbilicus, hypogastrium, and renal region, constant, but with aggravations; paroxysms of twisting colic every five minutes, very slightly relieved by pressure, 203.
The pain is worst at the umbilicus; next worst at the epigastrium; the hypogastrium and sides are least affected, 217.
Pains at the umbilicus and hypogastrium, constant but rather worse at intervals; he compared them to twitchings; neither increased nor diminished by pressure, which made them rise up to the breasts, 221.
The pain was chiefly felt at the umbilicus, scarcely at all at the hypogastrium; during the paroxysms it was a twisting sensation; between them, a feeling of compression. The abdomen was neither retracted nor swollen, but is displayed a marked degree of tension, 223.
Very slight pain at the umbilicus; worse at intervals; diminished by pressure, 184.
Very slight pain about the umbilicus, 173.
Umbilical region painful to pressure, 527.
Pressure on the umbilical region only slightly alleviates the pain, 208.
Tenderness on pressure about the umbilicus, 230.
Feels very sore in umbilical region, 538. [1510.]
Forcible pressure on the umbilical region is attended with marked relief; pressure also diminishes the hypogastric pain, 126.
If the umbilical region be gradually pressed during the colic the pain is relieved and the patient can, under certain circumstances, allow two or three people to lie upon the abdomen; at other times the pain is aggravated by the slightest touch, 9.
Burning internally about the navel, transient (after one hour and a half), 4.
Cutting about the navel, which is retracted, while pressing at stool, disappearing after the stool (after five hours), 4.
Griping about the navel, followed by ineffectual desire for stool, disappearing after the emission of flatus (first day), 4.
Griping about the navel relieved by the emission of flatus, in the afternoon, 4.
Griping internally about the navel, followed by transient burning in it (after six hours), 4.
Sticking, as with a needle, below the navel, deep internally (after two hours), 4.
Stitches round about the navel, extending to the right and left (after one hour), 4.
Feeling of something like a mouse creeping in the left side of the abdomen (after two hours and three-quarters), 4. [1520.]
Sensation as if something had fallen down in the left side of the abdomen, in the afternoon, 4.
Slight drawing in the side, towards the back, as from distension, 3.
Stitches in the left side of the abdomen (after two hours and three-quarters), 4.
The sides of the abdomen were a little painful, 120.
General Abdomen.
Dull sound of the anterior portion of the abdomen on percussion, 126.
Abdomen inflated and sensitive, 439.
Abdomen distended, 90.
Projecting abdomen, 153.
Flatulent distension of the abdomen, 44.
Abdomen distended, with spasmodic pain (second day), 320. [1530.]
Great flatulent distension coming on after food, accompanied by severe pain, 377.
Abdomen large, somewhat tympanitic, 533.
Pain in and distension of the abdomen, 546.
Inflated abdomen, 484.
Abdomen hard, and at times distended by flatulence, often spasmodically contracted, 28 . [Effects of large doses.]
Abdomen extremely tense, with deeply retracted navel, 47.
Tension of the abdomen, 56, 73.
The abdomen is very tense, 43.
Abdomen and loins somewhat swollen, and painful to touch, 35.
Abdomen swollen, and the seat of acute pain, which the slightest pressure augmented, but which firm pressure relieved (after one day), 256. [1540.]
Uneven tense swellings on various parts of the abdomen, especially during the height of the paroxysms, 217.
Abdomen tense, exceedingly sensitive to the slightest pressure; pains relieved by hard pressure, 248.
Abdomen feels tense and hard; there is much tenderness near the umbilicus, 232.
Much rigidity of the abdominal muscles, 267.
Abdomen remarkably hard and contracted; it seemed glued to the spine; the umbilicus excavated, 120.
The abdomen is hard, but neither retracted nor swollen, 123.
Abdomen hard and tense, 339.
Abdomen hard and tense, not painful on pressure, but relieved by it, 575.
Abdomen hard, but of natural shape, 159.
Abdomen hard and swollen, slightly sensitive to hard pressure on the umbilical region, 485. [1550.]
Abdomen very hard, 238.
Abdomen very hard and uneven, being much sunken in along the median line, while the sides are elevated, 214.
Abdomen of natural shape; it felt rather hard here and there; its usual flexibility was diminished, 221.
Abdomen lumpy, uneven, and rather hard, 225.
Hard lumps could be felt in the abdomen, 42.
Abdomen slightly hard, 471.
Abdomen hard and painful, 477.
Abdomen hard and flat, but not retracted, 466.
Abdomen hard, not painful to pressure, 537.
Abdomen very hard and depressed, 217. [1560.]
Abdomen tender on pressure in one paroxysm, 243.
Some had tumid abdomen, 275.
Abdomen doughy to feel, 562.
Abdomen evinces a great degree of tumidity, and is unable to sustain pressure; and unremitting pain is likewise complained of, with paroxysms of intense pain , recurring at intervals, 97.
Abdomen flexible, sensitive to pressure, especially at the stomach and right side; the pain is even quite severe at these points, and ascends the length of the œsophagus as far at the throat (after four hours), 268.
Abdomen retained its natural shape, but not its softness, 127.
Abdomen soft, but digestion is not as easily performed as in health, 133.
The anterior walls of the abdomen lay in the same plane with the ensiform cartilage and pubis, 126.
Abdomen quite soft, rather projecting than retracted, 193.
Tympanitic abdomen, 367. [1570.]
Abdomen retracted, 26, 145, 162, 169 , etc.
Abdomen flattened, and very painful on pressure, 74.
The abdomen is exceedingly retracted; it communicates to the hand, on palpation, a feeling as if its muscular tissue were affected, with cramps, 124.
Marked retraction of the abdomen, 135.
Intense retraction of the integuments of the abdomen towards the spine, and a hard knotty feeling of the muscles in various places over its surface, 282.*
Abdomen retracted, hard, 572.
Great retraction of the abdominal walls, with painfulness to pressure, especially about the navel, 273.
Abdominal walls drawn in and perfectly rigid, 284.
Abdomen flattened, 479.
Abdomen retracted, tense, not sensitive to pressure; on the contrary pressure on the abdomen or lying upon the side rather relieved the pains, 449. [1580.]
Abdomen tense, painfully retracted, 354.
Abdomen retracted, hard, painful; the pain commenced at the umbilicus, and radiated to the lumbar region and to the iliac fossæ ; became so violent that he rolled upon the ground, and pressed the abdomen with great violence, 574.*
Abdomen retracted and concave, 473.
Contraction of the abdominal walls, 319, 350.
The parietes of the abdomen seemed glued to the spine, with no elasticity; I could grasp the curvature of the spine in the hand, and take hold of the descending aorta with the thumb and finger, 290.
Abdomen painful, retracted, 355.
Shrunk state of the abdomen, 76.
Abdominal muscles strongly contracted, 81.
The abdomen is sensibly retracted, 125a, 217.
Abdomen sunken, 235. [1590.]
Abdomen retracted, and slightly painful on pressure, 527.
Abdominal muscles retracted and rigid, 242.
Retracted abdomen, with tense tympanitic muscles like hard boards, 265.
Retraction of the whole abdomen, especially of the navel, 12.
The abdomen is sunken at certain spots and distended at others; the abdominal muscles are distinctly seen through the skin, 35.
The abdominal muscles are forcibly drawn inward, so that the navel often presses against the spine, 20.*
The abdominal muscles with all the intestines, were drawn back toward the spine; the sphincter ani was violently constricted, with persistent vomiting of tenacious greenish substances, 16 . [In a painter.]
Hard contraction of the abdomen, that could endure no touch, 50.
Contraction transversely about the middle of the abdomen, while sitting bent over (after five hours), 4.
Abdomen much contracted and hard; when asked where he feels pain, he says sometimes that he has no pain, sometimes that his whole body is painful, sometimes that he has pain in his abdomen only; strong pressure on the abdomen causes pain, 181. [1600.]
Abdomen tense, contracted, and very much depressed, 137.
Abdomen contracted, especially during the paroxysms, 168.
The abdomen is contracted to that degree that it describes a curve with the concavity upwards; when pressed, it feels as hard as a stone, 222.
The abdomen preserved its natural shape, yet was hard and contracted, as was evident on compressing it. The pain was unaffected by pressure. Constipation; no stool since the pains set in; one copious evacuation the day previous, 212.
Abdomen retracted and hard (during the paroxysms); relaxed and little depressed (between the paroxysms). Swellings, as large as the fist, frequently appear in various parts of the abdomen; they are very movable; the appearance and disappearance are almost instantaneous; percussion, palpation, and the gurgling they cause, show them to result chiefly from gaseous accumulations in the intestines, 215.
Abdomen exceedingly depressed, as if glued to the spine; it seemed extremely hard when pressed upon during the paroxysms, less so between them, 219.
The muscles of the anterior wall of the abdomen are tense, and the abdomen is depressed, chiefly over the median line. The tension is not relaxed by flexing the lower limbs upon the pelvis and occupying the patient's attention, and, together with the retraction, becomes worse at every return of the colicky paroxysms, 203.
Abdomen flat and depressed, not very painful on pressure, 524.
Abdomen depressed, hard, and contracted, 158, 198.
Abdomen slightly depressed and markedly contracted, especially throughout the space occupied by the recti muscles; this muscular tension gave rise to a sort of canal from the ensiform cartilage to the pubis, 213. [1610.]
Abdomen little depressed, but much contracted, 122.
Abdominal walls somewhat depressed, 175.
Ulceration of the intestines, 64.
The abdomen seems eviscerated and hard on account of the great retraction of the abdominal muscles; the navel seems to adhere to the spine, and the pain also involves the pectoral region, 21.
Inflammation of the intestines, mesentery, and peritoneum, with ulceration, gangrene, and death, 23.
Inflammation of the abdominal viscera, and even of the mesentery, with debilitating fever, turbid, red, and thick urine, 43.
Inflammation of the bowels, with excessive painfulness of the abdomen, great anxiety, and burning in the intestines, with general twitching, followed by death, 42.
Flatulence, 9, 22.
Much flatulence, 2, 145, 148.
Frequent emission of flatus (first evening), 4. [1620.]
Very offensive flatus, after eating fish, 3.
Short, partly loud emission of flatus, of a penetrating odor (first day), 3.
Discharge of hot flatus, that burns like fire (second day), 4.
Discharge of flatus upward and downward, 46.
Flatulent troubles, 2.
Emission of flatus, preceded by slight cutting colic, in the morning (fifth day), 5.
Emission of offensive flatus (after three-quarters of an hour), 4.
Gas often moves about noisily in the bowels, and then the abdominal swellings disappear, 225.
Fermentation in the intestines, 2.
Movements of flatus in the abdomen (second day), 4. [1630.]
Everything that he takes seems to turn to wind, 48.
Borborygmi, 120, 121, 15, 15 , etc.
Borborygmi, especially in the right iliac fossa, 210.
Audible rumbling and gurgling in the whole abdomen, in the morning, after rising; a stool after a quarter of an hour, at first formed, followed by violent purging (second day), 4.
Rumbling and gurgling in the abdomen, 43.
Loud gurgling of liquid and gas in the bowels, especially from pressure on the abdomen, 265.
Gurgling in intestines, 307.
Movements in the abdomen, with rumbling, in the evening, 5.
Colic (fifteenth and twenty-first days), 42, 66, 37, 187 , etc.
Violent colic, 13, 90, 111, 113 , etc. [1640.]
Most violent colic the patient pressed upon the abdomen and tossed about, with cries; the pain involved the whole abdomen, and lasted more than two hours (after one hour), 274.
Most violent colic, 40 . [From the internal use of sugar of lead.]
Very violent colic, with nausea and vomiting; the patient tossed about the bed with most violent pain, abdomen retracted to the spine, not sensitive to pressure, with constipation, 115.
Violent periodical colic, 8 . [In a woman.]
Violent colic; she doubles up like a worm, 48.
Violent colic, most severe about the navel, 20.
Severe colic, attended with inflammatory symptoms, 25.
Severe colic, worse by paroxysms, especially at the umbilicus, forcing him to scream out, roll about in bed, bend double, etc., 186.
Very severe colic; during the paroxysms, which are frequent, great restlessness, 109.
(Very severe colic six years ago, with obstinate constipation; a few days ago very severe pain in abdomen; copious diarrhœa), 522. [1650.]
(Quitted work on account of a severe attack of dry colic, which lasted five weeks; when recovered he returned to his former trade, in which he had nothing to do with lead; but after four or five days he began to feel pains in the joints, bad enough to make him break off work), 530.
Colic very violent; pains begin around the umbilicus, and extend towards the hypogastrium, 508.
On a sudden the complaint left the extremities of the body, and seemed to concentrate itself upon the abdomen in the form of a violent attack of colic, 560.
During the course of this disease, which was marked by its usual features, very severe colic set in, evidently caused by lead, 510.
Severe colic; the sufferer pressed her belly and rolled on the ground, screaming; the pain occupied the whole abdomen (after one hour), 268.
Suffered from violent colic, with obstinate constipation, 433.
Violent colic, relieved by hard pressure upon the abdomen, 444.
Severe colic, relieved by pressure applied secundem artem ; he is in the habit of pressing his own hands hard on the abdomen during the paroxysms, 466.
Violent colic, with retraction of the abdomen, 334.
Very severe colic; screamed aloud, and assumed the strangest postures to obtain relief, 226. [1660.]
Frightful colic, with nausea, constant vomiting, and obstinate constipation, 114.
Intolerable colic, with frightful anxiety, constant retching, retracted testicles, 247.
Slight or most violent colic, at first transient, afterwards persistent, 9.
Violent colic and convulsions, recurring seven or eight times in one day, with closure of the jaws, convulsive movements of the eyes and of all the limbs, with great uneasiness and such violent movements that several men could scarcely hold him, with impeded micturition, 35.
Colic characterized by the fact that he lay flat upon the abdomen, in such a way as to strongly compress it, 572.
During the paroxysms all the bowels seem in commotion, agitated by abrupt, spasmodic, irregular contractions. This is especially the case when hiccoughing comes on; at such times he becomes quite desperate, complaining of a most severe tearing sensation throughout the bowels. He generally lies flat on his belly, finding most relief in this position; sometimes the body and limbs are jerked about, and there is an audible lively chattering of the teeth, 214.
The colic was worse in paroxysms, which were extremely frequent; there was then great restlessness, loud screaming; sometimes he lay flat on his belly, sometimes got out of bed to lie on the brick floor, or strongly pressed a chair against his abdomen; sometimes struck himself with his hands, or tied his cravat around him; in short, tried in all sorts of queer ways to relieve the terrible pains, but any ease thus obtained was of short duration, 212.
Although perfectly rational he was so overcome by pain that he threw open his window in order to jump out, and at another time furiously seized his razor to cut his throat, 217.
During the paroxysm the pain often ascends from the epigastrium into the chest, extending thence along the external surface of the upper extremities; it then occasions the utmost uneasiness and anxiety; he sits up in bed, laboring under violent palpitation, and a feeling of suffocation almost amounting to syncope. Respiration 35-40. As soon as the colicky attack subsides, all the symptoms of the chest and arms disappear; he is prostrated by fatigue; he expands his chest slowly to its full capacity, 124.
(Having had lead colic the year before, for the first time, with cerebral symptoms, he now felt pains in the abdomen, followed by constipation and other symptoms of colic), 176. [1670.]
The colic alternated with pains in the joints and violent headache, 433.
Attack of colic, which felt behind a trembling state of the limbs, 440.
Colic lasting sometimes a quarter of an hour; relieved by pressure, secundem artem , although between the paroxysms, the abdomen is exceedingly sensitive, 471.
His first attack of lead-poisoning occurred ten years since. A year ago he had a second one, and was sick for a month; very bad colic, epileptic seizures, with loss of consciousness and consecutive paralysis. No colic in the interval, 473.
Attacks of colic lasting from morning till towards evening, and still worse in the night, 35.
Attack of colic, followed by an alvine evacuation, with febrile movement, general debility, and drowsiness; afterwards successive attacks of colic, with persistent constipation, 474.
Colic, with paralysis, 511.
Repeated attacks of lead-colic pains in both arms, 288.
Colic, with hard, tense, retracted abdomen, very painful to pressure, 245.
Colic every hour, and lasting about twenty minutes, 375. [1680.]
Colic, with paralysis of the lower extremities, [In a child who had had sugar of lead rubbed into a sore spot.]
Colic, with jerking, 14 . [From the continued use of sugar of lead in intermittent fever.]
The colic is seldom accompanied by uncontrollable diarrhœa, 21.
Colic at first slight, soon ceasing, but afterwards returning, and finally becoming intolerable, 35.
Colic, that often intermits for two or three days, or even one or two months, 35.
Cutting colic, as from flatulence, in the morning, in bed, 5.
Colic, with diarrhœa, followed by constipation, 140.
Had colic six times; the last time it was accompanied by paralysis of the extensor communis digitorum of the right side, 196.
Sometimes presses his fingers deep into his navel, or ties his cravat tightly around him, etc., 208.
Colic, consisting of intermittent boring pains in the abdomen, usually commencing in the umbilical region, sometimes so violent that the patient became perfectly wild and knocked his head against the wall, or even stood upon his head, with most frightful cries; tried to press with all his force upon his abdomen; the pain often extended to other regions, to the chest, threatening suffocation, to the small of the back, kidney, bladder, lower extremities , always accompanied by obstinate constipation, and usually by retraction of the abdomen; abnormally slow pulse, 109. [1690.]
A fit of colic coming on during micturition, the flow of urine suddenly stops, and at the same time the penis, which is very painful, becomes retracted, much shrunken, and concealed under the scrotum. When the fit is over the urine flows quite freely again; during micturition, and for some time afterwards, a slight smarting is felt all along the urethra, 215.
(Three previous attacks of colic; the last of these was accompanied by severe headache, delirium, epileptic seizures, and temporary amaurosis), 480.
(One previous attack of colic, with epilepsy and delirium), 488.
(Five previous attacks of colic, the third one accompanied by loss of consciousness, the fourth by motor and sensory paralysis of the lower limbs), 486.
Has had two attacks of colic, the last one severe, with restlessness and delirium; paralysis of the entire upper limbs, 475.
Has bad two attacks of lead colic. For some time past has noticed that he manipulates the type with much less ease than formerly, sometimes even letting them fall out of his hands, 399.
Colic, aggravated by cold, 122.
Colic, which was aggravated regularly, morning and evening, 63.
Colic, aggravated by any food, 91.
The colic pains are aggravated by sudden and forcible pressure on the abdomen, but if even hard pressure is applied gradually they are relieved, 127. [1700.]
The colic almost always becomes worse by paroxysms; there is then the most painful twisting sensation, 215.
Colic, only relieved by lying on the abdomen, 472.
Colic, relieved by lying on abdomen; the pain extends to the testicles, 479.
She did not suffer from lead colic during pregnancy, 334.
Colic, allayed by pressure secundem artem , but increased by hard pressure, 485.
Pressure neither increases nor diminishes the colic, 122.
Colic, relieved by external pressure, so greatly relieved that the patient would often wish two or three people to lie across the abdomen; at other times the colic was aggravated by the slightest touch, 35.
Arthralgic colicky pains, 289, 573.
Colicky pains in the abdomen, soon becoming extremely severe; they were worse than labor pains, lancinating, extending into the back and loins, 519.
Violent colicky pains, which made him scream loudly, and throw himself from one side of the bed to the other, 243. [1710.]
Great pain (colic pain) and swelling of the abdomen, 262.
Colicky pains all over the bowels, especially the umbilical region, where they are of a twisting nature, 127.
Dull transient colicky pains in the abdomen, worse after eating, 216.
Wandering pains before the colic, 214.
He twisted his handkerchief into a rope, and tied it tightly round his abdomen, 127.
Attacks of violent abdominal pain, coming on sometimes two or three times daily, with dull pain in the intervals. There is a feeling as of a bar lying across under the navel, succeeded by a pain rising towards the stomach. The pain sometimes extends into the back and loins, somewhat relieved by pressure on the abdomen. There does not seem to be any connection between the stools and the colicky paroxysms; the latter are more frequent in the night; the stools occur at intervals of several days; there may be two or three in the same day. The paroxysms are generally accompanied by a yellow tinge of the sclerotica, 512.
Horrible pains (in the bowels); rolls about in bed, trying to get into a position where his abdomen will be compressed as much as possible. Pressure on the abdomen with the fingers is painful; pressure with the flat of the hand is also painful, although he prefers to lie on his abdomen, 513.
Very acute pains in the abdomen, followed by very profuse diarrhœa, 496.
Great pain in the abdomen, which is much relieved by pressure and warmth, 338.
Pains in the abdomen, gradually increasing to very great intensity, accompanied by extreme constipation, 572. [1720.]
Severe pains in the abdomen, with constipation, 419.
A good deal of abdominal pain, and sometimes very much tenesmus, with the diarrhœa, 461.
Severe pain, coming on in fits, over the abdomen, so as to bend him double, 238.
Most acute pains in the whole abdomen; much worse at the umbilicus, 212.
*Excessive pain in abdomen, radiating thence to all parts of the body, 271.
Pain in the bowels, which gradually increased in intensity until it became excruciating, lasting more than a week; writhing with agony; pain extended to the lower extremities, especially to the feet, 105.
Most violent pain in the abdomen, followed by bilious vomiting; abdomen very tense, 249.
Violent pain in bowels; more intense in the umbilical and iliac region than any other part of the abdomen, 259.
Violent pains and contractions in the abdomen, 51 . [In a woman who used sugar of lead for leucorrhœa.]
Pain in the abdomen; painful flatulent distension below the navel; disappearing after the emission of flatus (after three hours), 4. [1730.]
Violent pains in the abdomen, kidneys, and lower extremities, 35.*
Most violent pains in the whole abdomen, aggravated by touch, 11.
Pain in the abdomen, constantly becoming more distressing, 28.
The most violent pains rage in the abdomen, 29.
Most raging pains in the abdomen, 30.
Violent persistent pains in the abdomen, that becomes contracted like a board and retracted about the navel, 16.
Intolerable pains in the abdomen, that cause great uneasiness, and even confusion of mind and faintness, 43.
Most violent pains in the intestines, 7, 25, 26.
Pains in the abdomen, extending up and down, 32.
Intolerable pains in the intestines, 53. [1740.]
Bruised pain in the abdominal muscles, transversely across below the ribs and about the navel, noticed on pressure, coughing, and the like, and aggravated by rising from a recumbent posture, 3.
Pains in the abdomen, aggravated by touch, 48.
Violent abdominal pains, not augmented by pressure, of five days' standing, 76.
Pain, worse by paroxysms, in the whole abdomen, and especially at the umbilicus, sometimes so violent as to extort screams; he seeks relief by pressing on the abdomen, 190.
Very severe lancinating pains in the whole abdomen, especially at the epigastrium and umbilicus, slightly increased by pressure, 137.
Unremitting pain in abdomen, much aggravated at intervals, though mitigated by moderate pressure, 98.
Pain in the whole abdomen, most severe in the epigastrium, and consisting of burning and a feeling of distension, becoming worse by paroxysms, 225.
Terrible abdominal pains, which forced him to roll about in bed, press his hands on the part, scream, call for help, roll about on the floor, implore his wife to kneel upon his abdomen, whereby he gained some temporary relief, 217.
Spontaneous pain in the front wall of the abdomen, aggravated by light pressure, but diminished by strong pressure, 513.
Lancinating pain in bowels, 279. [1750.]
Rather violent remitting pain, increased by pressure, in the whole abdomen, and especially at the umbilicus, 188.
Paroxysms of abdominal pain (after four days), 549.
Pains in the region of the transverse colon, aggravated by pressure, 278.
Pain in the whole abdomen, more severe at the epigastrium than at the umbilicus or hypogastrium; twisting during the paroxysms and compressive between them. During the attacks he inflated or puffed out his abdomen, which gave some relief, as also did pressure; he kept changing his position, screamed out, rose from bed, struck his abdomen with his clenched fists, etc.; his face was much shrunken, his eyes hollow and dim. Between the paroxysms the abdomen sank down; it felt hard and contracted, 224.
When asked where he feels pain he points to his abdomen, and tries long and vainly to pronounce the word "ventre," 195.
Severe tormina and constipation, 369.
Complained of pain in the abdomen, acute and lacerating, not continuous, in the region of the umbilicus, and relieved only by pressure of the hand, 350.
Pains in the bowels, which took place several days subsequent to the affection of the feet and legs, 242.
Severe pain in bowels, with flatulence, 255.
Severe abdominal pain, but there was no tenderness, and the pain was rather relieved than otherwise by firm pressure; it was often paroxysmal, 558. [1760.]
Constant pains that were seated in the small intestines, sticking, gradually increasing, especially in the transverse colon, 9.
Pain in abdomen for three weeks, and the last few days so severe as to cause him to writhe in agony; pain relieved by pressure, 81.
Considerable pain and tenderness of the whole abdomen, but felt more especially at the scrobiculus cordis, not increased on pressure (second day), 82.
Pain in bowels, which first commenced in the lower abdomen, 552.
Dull fugitive pains in the abdomen, which increased slightly after eating, and were relieved by pressure; pains were paroxysmal, more severe at night, and seemed to radiate from the epigastrium to all parts of the abdomen; after continuing for two or three weeks they grew more persistent and severe. The pain at this time was wringing, griping, twisting, and radiating to various parts of the abdomen. Afterwards he complained of a feeling of weight in the bowels, tenesmus, and a throbbing in the epigastrium. At night it was impossible to sleep, except from the effects of an anodyne. He was constantly restless, every moment changing his position for the purpose of allaying the violence of the pain, and with the hope of finding some relief from a new position; sometimes he would lie crosswise the bed, rise up suddenly to walk, making firm pressure upon the bowels with his hands, but the violence of the pain would soon compel him to discontinue his walk; he would also resort to various means to make firm pressure upon the abdomen, which seemed to afford temporary relief; sometimes uttered rending cries, 331.
Twisting pains in the whole abdomen, especially at the umbilicus; worse by paroxysms; diminished by pressure, 185.
Sticking pains in the transverse colon, 35.
Wandering pains in the bowels before the colic, 217.
Contractive pain in the upper abdomen, relieved by eating, with increased appetite, 83.
Pain along the course of the colon, 88. [1770.]
Tension and pain in the abdomen, especially in the umbilical region, with hectic fever, 91.
After the convulsive attack twisting pains in the abdomen, at times so acute as to extort screams, 179.
Moderate pain in the whole abdomen; worse at the epigastrium; constant, but sharper at intervals, slightly increased by pressure. I consists of a feeling of twisting or compression, 168.
Attack of pain in the abdomen, which was relieved by evacuations; this was followed by an uneasiness, nearly constant, in the bowels, constipation, and by occasional attacks of pain, like that described, but less severe; this uneasy sensation led the patient constantly to hold on, or press his hands upon his bowels, 292.
Pain in the whole abdomen, but not in a uniform degree; it is most acute in the hypogastrium, then the umbilicus and the epigastrium, 215.
Sudden pressure on the abdomen causes pain; gradual and gentle pressure, on the other hand, affords relief, 195.
Between the paroxysms he converses readily, and a vessel of hot water placed on his abdomen is promptly pushed away. The pain is then only a feeling of compression, the abdomen is quiet and but slightly contracted, but there is distressing nausea and difficult vomiting. The ejecta are green as leeks, and they leave a very bitter taste in the mouth and throat. Drinking has no effect on the vomiting, 214.
Constant and severe griping pains in the abdomen, attended with but little tenderness and no fulness, 315.
Griping pains in the abdomen, corresponding to the transverse colon, 437.
Griping in the abdomen, in the evening, 4. [1780.]
Griping in the upper abdomen (after six hours), 4.
Griping in the forepart of the abdomen and rumbling after a stool; it rises paroxysmally towards the stomach, that is sore, like a faintness (second day), 4.
Griping in the abdomen, 27, 240, 389.
Griping pains of great severity, 555.
Some griping in the lower abdomen (after a quarter of an hour), 4.
Violent and obstinate griping in the abdomen, 8 . [Effects of the internal use of a preparation of lead for distressing itching.]
Pains and griping in the abdomen, 11 . [From the internal use of white lead.]
Strong convulsive spasms in the intestines, 68.
Sense of constricture, as if a cord were drawn permanently tight around his body, at the navel, 299.
Constrictive pain in the abdomen, 12. [1790.]
Most frightful cramps, lasting several hours, with retention of stool and urine, and retraction of the abdomen (after four days), 110.
Violent spasmodic contractions about the abdominal cavity; the pain which it gave rise to was so distressing that he cried out like a woman in labor, and the parts became so sensible to touch that he could not bear the slightest pressure, not even that of the bedclothes, 66.
Constriction of the intestines and other viscera, so that the navel approximated the spine and the anus was drawn towards the abdomen, 11.
Pressure and violent colic, with which the abdomen is spasmodically contracted, with obstinate constipation, 21.
Pressive pain in one spot in the abdomen, in a line from the tip of the ilium to the symphysis, though nearer the former, continuing the whole day, seeming to be rather in the muscles; the place was distended, 3.
Incessant pressure in the upper abdomen, 43.
Abdominal pain, aggravated by pressure, 519.
Abdomen painful on pressure, 432, 517.
Abdomen sensitive to pressure, but no constipation or colic, 475.
Pressure with the palm of the hand on the abdomen is not much felt; with two fingers it is painful, 512. [1800.]
Pressure with the fingers on the abdominal region is painful, especially below the ensiform cartilage, 514.
Surface of abdomen very sensitive to pressure, 353.
Pressure on the abdomen gave some relief, 223.
Typhus abdominalis with acute nephritis, with nosebleed, enlargement of the spleen and liver, but without any marked eruption, frequently with hypostatic pleuropneumonia, 421.
Enteritis, 20.
Soon afterwards he became affected with severe enteralgia, to which the patient has ever since been subject, and which has latterly been accompanied by an exhausting fever, 270.
Leucophlegmasia, 15.
Ileus, 20, 44.
Meteorismus (after three days), 93, 235, 237.
Symptoms of paralysis of the intestines and bladder, 533. [1810.]
Abdominal distress, 284.
Uneasiness in abdomen, 281.
Constant abdominal uneasiness, and at times feels as if the bowels were twisted, 347.
Violent cutting pains in the abdomen, 435.
The cutting in the abdomen is relieved for a short time after the stool, 4.
Cutting in the abdomen the whole second day, 4.
Heat and burning in the whole abdomen (after two hours and a quarter), 4.
Burning in the whole abdomen internally, and a sensation of twisting about the navel, with stitches in the back, and a sensation as if a substance were lying upon it, with pains in the pit of the stomach (after two hours), 4.
Heat in the abdomen, 93, 335.
Confused feeling in the abdomen (first day), 3. [1820.]
Sensation in the upper abdomen as if something were torn off and fell down, without pain, followed by movements in the abdomen (after six hours), 4.
Movement in the abdomen and desire for stool, but only flatus was passed, in the afternoon, 4.
Ineffectual efforts to pass flatus, that afterwards is accomplished only by pressure, in the afternoon, 4.
Fermentation in the abdomen, with griping in the intestines, 1.
Slight convulsive movement and transient pains in the abdomen, 11 . [From white lead.]
Sensation of heaviness and dragging in the colon, with ineffectual efforts to evacuate the bowels; the sphincter ani remained tightly closed, and would allow neither gas nor fæces to pass, and presented an unyielding resistance to the violent contractions of the abdominal muscles, 326.
Sensation as if the abdomen were full and stopped, in the afternoon, 4.
Several pinchings in the bowels (after half an hour), 280.
Stitches in the whole abdomen, in the evening, 4.
Violent lancinations, worse by paroxysms, in the abdominal walls; they are renewed by bending the head on the chest while lying stretched out in bed, 135. [1830.]
The patient felt as if the intestines were lacerated with arrows drawn in contrary directions, and piercing the hypochondriac and iliac regions, 298.
Whole abdomen very sensitive to touch, 258.
Painful sensibility of the abdomen, 111.
Abdomen very sensitive, 473.
Abdomen tender to touch; pain aggravated by food, 555.
Tenderness on pressure all over abdomen (third day), 109.
Abdominal pain, seldom either increased or diminished by firm pressure, 446.
The abdominal pains are considerably aggravated by cold, 233.
The bowels gradually lose the ability to expel their contents, 216.
Relief by compressing the abdomen, especially during the paroxysms, 120. [1840.]
His abdomen seemed to be the centre from which his pain radiated, 271.*
Hypogastrium and Iliac Regions.
Movements in the lower abdomen, with cutting pain (second forenoon), 4.
Some borgorygmi in the right iliac fossa, 214, 221.
The hypogastrium sounded well on percussion, but at every attempt to introduce a catheter into the bladder the pains were much aggravated, causing fearful screams; an entrance was effected with some difficulty during the period of remission, but only a few drops of red urine were drawn off, 219.
The walls of the hypogastrium are very depressed, as if excavated, and extremely hard; the rest of the abdomen is also retracted and tense, but to a less degree, 201.
Sensation as if flatus were incarcerated in the lower abdomen and could not be passed, in the afternoon, 4.
Acute pressing outward pain very low down in the abdomen and down to the rectum, a kind of painless desire to pass flatus, that amounts to nothing, 2.
Oppression over hypogastrium, 282.
Griping in the lower abdomen (fifth and sixth days), 47.
Griping pain in the lower part of abdomen, relieved by pressure, 596. [1850.]
Paroxysms of painful constriction in the lower abdominal region, with anxiety, nausea, and eructations and after some hours a sensation as if two arrows were drawn through the abdomen in opposite directions; during the paroxysms the pulse became small and rapid, and the skin cold, 258.
Twisting pain, at times excruciating, in the hypogastrium and testicles, 239.
Dull pains in the hypogastrium and renal region, 219.
Feeling of compression and coolness at the hypogastrium, slightly aggravated by pressure, and becoming more severe at intervals, 162.
After retching she sometimes felt slight pain in the lower part of the abdomen, evidently of a myalgic nature, from fatigue of the abdominal muscles, 428.
Very acute tearing sensation extending along the flanks down to the bladder, constant, but with regular exacerbations, 210.
Inguinal glands somewhat congested, 467.
Increased sensitiveness of the right iliac fossa to hard pressure, 467.
Right iliac region painful to pressure, 421 . [An attack of "ileo-typhus" has been reported during the progress of lead-poisoning, but this has not been included in the symptomatology. -T. F. A.]
A stitch in the left groin on stooping; on rising up, sticking in the umbilical region, that disappeared on stooping; after dinner (after two hours and a half), 4.

RECTUM AND ANUS. [1860.]

When a finger was introduced into the rectum during the paroxysms, the sphincter ani, and the bowel as far as it entered, closed forcibly upon it; during the intermission this was not the case, 220.
A finger passed into the rectum is forcibly compressed by the sphincter and bowel. Injections cannot be retained more than five minutes; they are rejected hurriedly, 237.
Weight in the rectum, 350.
Much pain on evacuating bowels, 79.
It seems as though he would evacuate a thin stool, but he does not, immediately, and also later (first day), 3.
Violent efforts to evacuate, producing hæmorrhoids, 309.
Frequent tenesmus, 120.
Tenesmus, 347.
Tenesmus of the rectum and bladder, 136.
Difficult defecation, 120. [1870.]
Frequent and urgent tenesmus, 262.
Itching in the hæmorrhoids; the anus is retracted, 3.
(All the hæmorrhoidal troubles disappear), 3.
Itching and burning pain in the perineum and neck of the bladder, 55.
Prolapsus of the anus, 44.
Constriction and drawing up of the anus (introtractio ani), 12.
The anus was violently constricted and drawn up, 11.
Difficulty in passing the finger into the anus; the sphincter contracting during the paroxysms, 128.
Some cutting colic and cutting in the anus, during a soft stool (sixth day), 5.
Crawling and fine sticking in the rectum (after two hours and a half), 4. [1880.]
Burning in the anus during stool, 4.
The anus is drawn inward, 20.
Tenesmus in the anus, 4.
Tenesmus of the anus, which seems shrunken in; contracted on itself, 217.
Pressing-boring pains and tenesmus in the anus, 253.
Formication in the anus, 183.
Desire for stool and a watery evacuation (second forenoon), 4.
Painful urging to stool, 573.
Violent dragging and urging to stool, that was scanty, though of a normal color and consistent, with pressure, in the afternoon, 4.
Sluggish desire for stool, at times; the stool itself is sluggish, and consists of tenacious fæces, 3. [1890.]
Ineffectual desire for stool, 3 ; in the afternoon, 4.
Occasional ineffectual urging to stool, 227.
Tenesmus and frequent ineffectual urging to stool, 229.
A frequent but ineffectual desire to evacuate the bowels, 70.

STOOL

Diarrhœa.
Troublesome and constant diarrhœa, at times accompanied with a good deal of abdominal pain, and sometimes with very much tenesmus; after various remedies, the bowels still acted three or four times a day, the stools being quite liquid; no blood was passed, but mucus sometimes, 461.
Dysentery, 33 . [From the internal use of white lead.]
Dysentery, 57 . [From drinking water that had stood in a leaden vessel.]
Violent bloody dysentery, fever, incessant cutting in the stomach and abdomen, violent eructations, so that everything seemed changed to gas, 43 . [After the excessive use of sugar of led in gout.]
Dysentery, 48.
Frequent purging of yellow fæces, with pain (third to sixth day), 4. [1900.]
Diarrhœa, 44, 185, 198, 529.
Uncontrollable diarrhœa, in rare cases, 28.
Diarrhœa, with rumbling in the abdomen, without pain, for two hours, 1.
Very profuse discharge from the bowels, 93.
More or less decided diarrhœa, in some cases, 35.
Diarrhœa, whenever he had lead-colic, and at no other time, 222.
Evacuates the bowels in bed, 200.
Diarrhœa, before the colic, 214, 222.
Frequent offensive diarrhœa, 29.
Purged once freely (after three-quarters of an hour), 330. [1910.]
Some occasional diarrhœa, 275.
Diarrhœa, with paroxysms of colic; the evacuations were watery, and contained much mucus, 342.
Involuntary evacuations just before death, 329.
Diarrhœa, succeeded by constipation, 476.
Three stools this morning, without his having taken medicine; the evacuations are mostly liquid, 222.
Two stools, since 5 A.M., 201.
Very copious stool, in the morning, 135.
Bloody stools, with tenesmus, 100.
Bloody evacuation from the bowels, 250.
Yellow diarrhœa, 496. [1920.]
Rather copious, yellowish diarrhœic stools, 527.
Continually, small, thin, black stools, 537.
Ascites, with at times, most violent diarrhœa, 92.
Soft stool preceded by movements and flatulence (after three hours), 4.
Stool at first thin, liquid, afterwards in small pieces, of a penetrating odor (first day), 3.
Stools yellow, consistent; passed unconsciously, 174.
Thick black stool every other day, 133.
Extremely fetid black stools, 90.
Stool dry, light-gray, tenacious, difficult, 575.
The stools are of a decided fawn color, 117. [1930.]
Fæces smooth and dark-colored, 275.
The excrements were rather darker than usual, showing a sufficiency of bile, 232.
Leaden-colored fæces evacuated by vomiting, 48.
Stool leaden-colored, 48.
Very offensive stools, with most violent colic, soon, 320.
Fæces pale, 277.
(Stool more easy, curative action, in one usually constipated), (first day), 2.
Action of bowels regular, but the excrements were varied in their character, sometimes thin, sometimes globular, sometimes triangular, but nearly always dark colored . Afterwards he was constipated. After 6 drops of Croton oil, 1 drop being taken every two hours, the excrements were of a triangular shape, covered with thin flakes of mucus, and accompanied by a slight hæmorrhage, 331.
Evacuations hard, white, like sheepdung, passed with some effort, 12.
Fæces in the form of balls; often hard, and of a black or green color, 216.* [1940.]
Fæces scybalous, 88.
Stool hard and difficult, 67.
Evacuations hard, ashy gray, like sheepdung, 28.
Evacuation hard and scanty, 5.*
Evacuations scanty, hard, like sheepdung, 9.*
Hard scratching stool (second forenoon), 4.
Stool somewhat harder and more difficult to pass than usual (first day), 2.
Evacuations at first hard, afterwards with increasing colic (curative action), 52.
Stool yellowish, rounded, and hard like sheepdung; as the disease progresses they become softer, and at last frequently watery, 35.
Evacuation hard, with pressure, with a sensation as if something were pressing that caused sticking, in the morning; in the afternoon, three soft stools (fourth day), 4. [1950.]
Stools indolent and constipated, 245.*
Difficult stools before the colic, 217.
Difficult stools, 210, 226.
Irregular stool, 28.
Stool every other day, 3.
Stool tough, indolent, at last streaked with blood, 3.
Evacuations indolent, difficult, 46.
In three days there were only two scanty evacuations of hard fæces, like sheepdung, 16.
Stool only every two or three days; blackish, 512.
Constipation.
*Constipation, 8, 22, 44, 64 , etc. [1960.]
Obstinate constipation, 11, 26, 35, 50 , etc.
Bowels obstinately constipated, except that a few time she has had slight diarrhœa, and once a mild attack of dysentery, 499.
Obstinate constipation, evacuation of neither flatus nor fæces, 45.
Such obstinate constipation, that he passed neither stool nor flatus for fourteen days, 202.
Obstinate constipation; he often went to stool and thought he had a passage, when there was only tenesmus, 210.
Excessive constipation, with paroxysmal colic, 263.
Most obstinate constipation, with violent pain in the epigastric region and back, 30.
Obstinate constipation, aggravated by purges, that caused the evacuation of small hard balls of fæces, with great effort, 28.
Constipation and tormina, 388.
Constipation, with violent colic, 52 . [Effects of large doses of sugar of lead, taken of gonorrhœa.] [1970.]
Constipation increased to such an extent, notwithstanding the medicine, and careful dietetic management, that fissure of the anus took place, although the bowels acted nearly every day, 462.
Constipation, at first conquered by injections, now became more obstinate. The injections formerly retained in the bowel only in part were now retained entirely; the gases and liquids accumulated in the intestines produced under the pressure of the hand, a loud gargouillement , which could be heard at some distance; a sensation of fulness, and a pressing desire of going to stool, induced efforts without result; the sphincter ani remained contracted, and gave exit to neither gases or liquids, thus offering an invincible resistance to the strong contraction of the abdominal muscles, 266.
Bowels usually constipated, though in more than usually protracted cases diarrhœa existed, 445.
Constipation, with severe pains in the abdomen, 419.
Could never relieve her bowels except by taking enormously strong medicine, 482.
Constipation, neither stool nor flatus is evacuated, 23.
Constipation, with nausea and vomiting, 273.
Constipation, attended with a disagreeable sense of heat in bowels, 299.
Constipation in some, and in others tenesmus and small bloody stools, 281.
Difficult stools, 126. [1980.]
Neither stool nor urine the whole first day, 4.
About two weeks ago bowels became sluggish, and now has but one discharge in two or three days, 555.
Has suffered constantly from constipation, for the last seven years, 357.
Constipation and lead colic, two or three times, 358.
Stool only once in eight or ten days, of scanty, blackish fæces, whose expulsion caused acute suffering, 350.

URINARY ORGANS

Kidneys and Bladder.
Three years previously, the patient had been in the hospital with albuminuria and casts in the urine, but when discharged these symptoms had disappeared; at that time he had no brain symptoms except headache; on this occasion, the urine, which was retained in the bladder and had to be drawn with a catheter, contained albumen and a large number of casts; two days subsequently there was anuria, trismus, opisthotonos, convulsions followed by loss of mind; during the attack the tongue was badly bitten, the pupils contracted and indolent; on the following days the amount of urine, in spite of treatment (an infusion of squills), 600 and 700 c.cm.; the urine for twenty-four hours contained 17 grams of urea; the patient did not have another spasm, though he suffered from most violent pains in the upper and lower extremities ; after this the amount of urine increased, the urea rose to 39 and 41 grams, the albumen diminished, the pus disappeared and the mind became free, but after about two weeks he was seized with erysipelas, from which he died, 548 . [The post-mortem showed a very easy separation of the suprarenal capsules, the upper surface of the kidney granular, the parenchyma very moist, the cortical gray, somewhat reduced in size, the malpighian corpuscles not distinct, the pyramids gray. Under the microscope the kidneys presented an exquisite picture of interstitial nephritis in a rather early stage; the cortical substances especially presented in both transverse and vertical sections, great cellular hyperplasia and increase of interstitial connective tissue , though the process was not equally diffused; while frequently the whole field was occupied by small cells of connective tissue with scarcely a trace of uriniferous tubes, other sections exhibited the tubercles of normal size and configuration, but separated by abnormally broad septa of connective tissue ; the glomeruli presented varying characters, some normal, others atrophied to fibrillar knots of connective tissue, and others in all possible stages of degeneration . The substance of the pyramids was less affected than the cortical; the growth of connective tissue was here much less pronounced, and in many places was not noticed at all; the tubes were for the most part denuded of epithelium. The small arteries of the kidney showed no remarkable change; in the transverse section was seen a very broad zone of connective tissue; hyperplasia thickening of the walls and contraction of the calibre of the vessels were not noticed. The intertubular capillaries in both the cortical and tubular portions of the kidney were excessively filled; in the latter there were numerous spots of hæmorrhages into the urinary canals, and here and there the cativies of the urinary canals were found stopped by old plugs, and by some calcareous concretions. The liver showed analogous changes of hyperplasia of connective tissue, in some places even tubercular nodes of connective tissue growth . The heart showed inflammatory connective tissue growth, with chronic myocarditis; in some places very broad septa of small-celled connective tissue was formed between single muscular fibrillæ. (Microscopic examination of other parts of the body cannot be detailed here. -T. F. A.]
Chronic nephritis is a frequent affection in cases of lead poisoning; its development never accompanied by acute symptoms, 329.
Acute nephritis, with fever, 541.
Lacerating pain in the renal region, aggravated at the same time with the abdominal sufferings, and, like them, diminished by friction and pressure, 128.
Severe pain in the vesical region, 182. [1990.]
Bladder distended, 439.
Paralysis of the sphincter of the bladder, which allowed the urine to pass guttatim, 290.
Tenesmus of the neck of the bladder, 46.
When the paroxysm of pain has subsided, the sound is easily introduced (into the bladder), and without pain; attempting to introduce the sound during the accession, causes great increase of the pain, 305.
Bladder inactive; difficult urination, 523.
In one of the cases, the sphincter vesicæ did not permit the urine to pass for more than thirty-six hours, so much so, that the bladder extended up to the umbilicus; in the same patient the whole of the genito-urinary apparatus was especially affected. At times the testes were retracted into the inguinal canal, occasioning most excruciating pains in the back, loins, scrotum, and perineum, 266.
The patient had not passed water for thirty-six hours, and the bladder felt bloated. I examined the region of the bladder externally, but on account of the excessive tenderness, could not positively ascertain whether it was full or not; on passing the catheter I found it entirely empty, with the exception of a few drops of bloody mucus; there was in this case complete suppression of urine, 427.
Painful sense of constriction towards the neck of the bladder, difficulty of introducing a sound into the bladder, 305.
Induration of the prostate, 55 . [From the injection of liquor Goulardi, for gonorrhœa.]
Urethra.
Retraction of the urethra, 46. [2000.]
Pain in the urethra where it leaves the bladder (fifth day), 3.
Great smarting along the urethra on commencing micturition, 213.
Burning, during, and still more after micturition (second day), 4.
Scalding on micturition, 336.
Micturition and Urine.
Very frequent urging to urinate, with burning along the urethra, but only a few drops are discharged at a time, 182.
Frequent ineffectual urging to urinate, 203.
Desire to urinate, fruitless efforts, or the urine passed drop by drop, 305.
Frequent desire to pass urine, which was painful; urine often high-colored, and depositing a lateritious sediment, 287.
Quite frequent vesical tenesmus; ineffectual urging to urinate; sometimes after much effort, which increases the pains, urine passes guttatim . He urinated twice in twenty-four hours, during remissions, to the amount altogether of about a glassful. Bladder not distended. Catheter passed with difficulty; the operation caused great uneasiness, and almost threw him into convulsions, 224.*
Sometimes urging to urinate, which either was ineffectual, or the discharge required great effort, and much increased the pains, 217. [2010.]
Frequent vesical tenesmus, with much ineffectual urging to urinate; only half a wineglassful was passed in two days, 201.
Desire to urinate, with inability to pass urine immediately; it was retained; in the forenoon, disappearing in the afternoon (second day), 4.
Pain and difficulty in passing urine (after one year), 261.
Frequent tenesmus, and ineffectual urging to urinate, 212.
Frequent desire to urinate; micturition always scanty, 420.
Micturition painful, 420.
Unconscious discharge of urine and fæces, 177, 178, 181.
Urine passed unconsciously, 174, 201.
The patient passed urine involuntarily during the epileptic spasms, 580.
Frequent micturition of the usual amount, in the afternoon (first day), 4. [2020.]
Copious secretion from the kidneys, 97.
Greatly increased discharge of urine, 12.
Awoke at 4 A.M. to urinate; more than usual was passed; followed by pain in the abdomen as after taking cold; it disappears after the emission of flatus, which is followed by sticking in the abdomen (second day), 4.
Frequent difficult micturition of scanty urine, 46.
Some difficulty and pain in urinating, so that he thought he had contracted gonorrhœa, 210.
Difficult and sometimes painful micturition, 158.
Micturition difficult, and only effected by a forcible contraction of the abdominal muscles, which aggravates the pains, 214.
Difficult, even somewhat painful, micturition, 212.
Difficult micturition, a little at a time, 126.*
Difficult urination, with much effort, 220. [2030.]
Difficult micturition, 25, 80, 120 , etc.
Great difficulty in urinating; there was great difficulty in passing the catheter, but the subsequent history showed no permanent stricture, 499.
Evacuation of urine difficult and hindered, also complete suppression, 23.
Great difficulty in urinating, 498.
The urine is passed only by drops and always with difficulty, 11.*
Urine voided seldom, and in small quantities, 232.
Micturition less frequent than usual by seven or eight times, 128.
Discharge of urine very much diminished, 50.
At times she could not pass urine, 26.
Urine could be passed only during the remission of the abdominal pains, 16. [2040.]
Paucity of secretion from the kidneys, and high-colored, 98.
For some time there has been incontinence of urine at intervals between the epileptic seizures, 521.
Incontinence of urine, 529.
Micturition infrequent, 575.
Retention of urine, 89.
Secretion of urine completely suppressed, 29 . [From large doses.]
Suppression of urine, 13, 34, 45, 258, 534.
Repeated attacks of strangury, 340.
Retention of urine, with great distension of the bladder, 533.
Retention of urine (in one case lasting thirty-six hours, so that the bladder rose as far up as the navel), 326. [2050.]
Retention of urine during the colic, 453.
Complete retention of urine; the catheter could not be introduced for three days, 310.
Dysuria, 288.
Violent Dysuria, 55.
Ischuria, 43.
Ischuria, with inflammatory fever, 55.
Strangury, 109 ; in five cases, 567.
Hæmaturia, 109.
A large quantity of urine, of sp. gr. 1008, half of which became solid on boiling and adding nitric acid; blood-discs were abundantly seen under the microscope, but no casts; when he began to recover the albumen gradually diminished in quantity (as I discovered less lead in the urine) , and at last totally disappeared, but has occasionally a little, perhaps one-fiftieth part, albumen; later, albumen rapidly increased, and there was not an atom of urea in it, its sp. gr. being 1002, 491.
Voided a large quantity of urine, which afforded a sensible quantity of lead, 229. [2060.]
Secretion of a large quantity of watery urine, on the surface of which a pellicle had been observed after standing (the same had been noticed about a year previous and occasionally since then); the pellicle was of pearly whiteness (it looked exactly like spermaceti), with a distinct metallic lustre ; it left a greasy mark on the paper in which it had been wrapped; i. e. , fatty matter mixed with lead in some form; the color was natural; reaction acid, but not strongly so; sp. gr. 1022; no albumen; on standing for an hour, deposits a light flaky sediment (one fourth), showing under the microscope only a few granules (mucous), and a solitary cell of renal epithelium, containing several fatty globules, 59.
Urine scanty, yellowish-brown, turbid, sp. gr. 1019, albuminous, sediment consisting of a large number of tubular crystals of uric acid, perfectly hyaline cylinders, to some of which adhered cells similar to white blood-corpuscles, to others fat-drops; this was associated with epileptiform spasms, with complete loss of consciousness, during which the temperature was 40°, pulse 140, 541 . [It was possible that the epileptic attacks were not dependent upon the disease of the kidneys, since the patient inherited epilepsy from father and mother, and had suffered from it for many years.]
In the first stage, when the poisoning is of recent date, and there are colics and vomiting, there is generally a very notable diminution of the urinary secretion; it falls sometimes to as little as 1/4 or 1/5 of the normal quantity; the density is augmented, but not proportionally to the diminution in quantity, as is the case in simple oliguria; there is, therefore, a diminution of the extractive matters contained in the urine; the urea is from six to seven times less in quantity; the phosphoric acid, uric acid, and chlorides are less, but the coloring matters are ten to twenty times more abundant than normal. In the second period, the vomiting and colic have disappeared, and the lead is introduced into the various organs, and acts upon their functions; the quantity of urine still remains a little below the normal point; the extractive matters are still less in quantity, the urea being only half the normal quantity; the same may be said of phosphoric and uric acids; the quantity of coloring matter is still very great. In the third stage there is anæmia, and the intoxication is confirmed; there is a permanent alteration of the urine, characterized by a less quantity and density, and notable diminution of the urea and phosphoric and uric acids; whether this diminution is dependent upon some disturbance of assimilation, or is connected with a certain degree of impermeability, is still a doubtful point; nevertheless, as we find double the quantity of normal excrementitious matter present in the blood, we may rather ascribe their diminution in the urine to impermeability. Lastly, to anæmia, is coupled albuminuria; the quantity of urine secreted is very variable, sometimes approaching the normal; but the density is very low; the extractive matters are considerably diminished; and whether albuminuria exists or not, we do not observe any increase of the quantity of uric acid in the blood; nor is uric acid found in the serum of a blister, 436.
Diminished urine, 210.
Urine scanty, and easily discharged, 175.
Urine very scanty, and passed only once during the last twenty-four hours (tenth day), 240.
Urine passed a little at a time; frequent ineffectual desire to urinate, 120.
Urine scanty, 188, 212, 291, 327.
Urine scanty, often retained for nineteen hours, 339.
Cerebral affections and amaurosis, with albuminuria; the amaurosis is supposed to depend upon the chronic nephritis, which is produced by lead; this view is supported by the circumstance, that in several cases, the amaurosis and the cerebral (usually epileptic)

symptoms appeared and ceased coincidentally with the appearance and cessation of the albuminuria, 493. [2070.]

Large quantity of albumen in her urine, the sp. gr. being only 1010; when she began to recover the albumen gradually diminished in quantity, as I discovered less lead in the urine , and at last totally disappeared, 492.
Albumen was present in the urine; the albuminuria was either merely temporary, ceasing by the tenth day, or it was continued up to and after the patient's dismissal from the hospital. Lead was discovered several times in the urine, 495.
Four cases in which albuminuria existed during life, and nephritis was found after death; three of them were chronic, one comparatively recent, 494.
Urine heavily albuminous, without any œdema (in several cases), 348 . [Autopsy showed the kidneys smaller, the surface granulated, the cortical substance dark-yellow, and atrophied.]
Urine very heavily loaded with albumen, containing epithelial casts (and traces of lead), 347.
Urine albuminous, containing numerous cells from the kidney, 344.
The urine contained a trace of albumen, 418, 569.
Urine very albuminous, 429, 504, 509, 523.*
Urine albuminous, sp. gr. 1024, scanty, dark brown, 420.*
The urine contained a large amount of albumen; 150, 000 grams of urine contained 12 grams of urea, 581. [2080.]
Urine very albuminous, diminished in quantity to 1/2 litre in twenty-four hours, sp. gr. fell to 1009, 429.
Urine yellowish-brown, acid, clear, sp. gr. 1030, albuminous, containing numerous granular cylinders; after treatment, principally with Croton oil, the albumen gradually disappeared from the urine, though the sp. gr. remained high (no sugar), 449.
Later, the excretion of albumen in her urine has been gradually increasing, the sp. gr. being always under 1010, and often as low as 1002, with a very minute quantity of urea, 492.
Urine albuminous, containing numerous isolated cells from the kidney, 345.
Urine albuminous; sp. gr. 1010, 429.
Urine albuminous, 346, 385, 484, 534, 535.
Urine slightly alkaline, containing traces of albumen (and of lead, 1.95 grams to the litre), 580.
Secretion of kidneys scanty, and of a deep-red color, 267.
Urine red, soon decomposing, and becoming thick with flaky clouds, 485.
Urine (drawn by catheter), red and acid, 120. [2090.]
Scanty red urine, easily discharged, 125a.
Urine red and acid, 224, 217.
Urine reddish, fiery, 49.
Urine looking like Malaga wine, and of neutral reaction; slight film of uric acid, 502.
Only one-third or one-quarter of the normal amount of urine passed, 203.
Scanty and high-colored urine, 82, 103, 125, 322.
Urine dark-colored, brownish-red, turbid, with flocculent sediment, sp. gr. 1017, acid, albuminous; sediment consisting of a number of red blood-corpuscles, and a large number of short, rather thick, turbid cylinders, beset with red blood-corpuscles; the patient presented all the symptoms of acute, diffuse nephritis, 450.
Urine "hémaphéique," mahogany-colored; yielding, by M. Gubler's process, a thin pellicle of uric acid, 501.
Urine high-colored, depositing much lithates on cooling, 445.
Urine very scanty, 4 to 6 ounces in a day, and high-colored, 290. [2100.]
Urine scanty, high-colored, and sometimes voided with difficulty, 331.
Urine usually of a deep yellow color, but clear. Now, not very turbid, but of a reddish-amber color, containing much albumen, and a large proportion of uric acid, 503.
Urine dark, brownish-red, 35d.
The urine was rather more colored than natural, but did not present that peculiar play of colors with nitric acid, said to be indicative of the presence of bile, 282.
Urine transparent, high-colored, not at all yellow, 183.
Urine brown-yellow, 184.
The urine becomes dull yellow, 117.
Urine orange-colored, 119, 160.
High-colored urine, 73.
Urine dark-colored, 126. [2110.]
*Urine dark-colored and scanty, evacuated by drops, 576.
Urine scanty and dark-colored, 273.
Urine dark-colored and turbid, 245.
Yellow, acid urine, 172.
Urine clear, of a pale lemon-color, and without sediment; alkaline, although heat and nitric acid showed no abdomen. It turned red litmus-paper blue at once, but had no effect on tournesol-paper, 203.
Urine "hémaphéique" in the first degree, i. e. , merely amber-colored; copious deposit of minium, 505.
Urine acid, 212.
Yellow, acid urine, 182.
Urine plentiful and limpid, 275, 276.
Urine pale, bright, specific gravity 1015, 341. [2120.]
Urine pale, 357.
Urine scanty and limpid, 190.
Urine alkaline but not albuminous, 439.
Urine plentiful, pale, 277.
Urine usually acid, contained much lithates during the first few days under observation; the specific gravity ranged from 1015 to 1025; no albumen was ever detected. In two cases the urine was alkaline, and contained phosphates in considerable quantity; becoming, however, faintly acid in a day or two, and remaining so throughout, 446.
Lead in the urine, 440, 448.
Urine alkaline, not albuminous, 440.
Urine contains a little sugar and mucus, no albumen, 488.
Urine free from albumen, sugar, or lead, and is generally natural, but occasionally loaded with a dark-brown sediment, 499.
Urine natural, but watery in color, 46.

SEXUAL ORGANS

Male. [2130.]
Peculiar weakness of the genitals. (H. and T.) [From Plumbum muriate.]
Slight jerking in the spermatic cord, in the morning; in the afternoon, stitches in the place where it leaves the abdomen (first day), 3.
The pains return by paroxysms, during which they are quite severe, extending all along the spermatic cord into the left testicle, which then appears retracted; between the paroxysms the colic is slight or, in general altogether absent, 127.
Frequent erections, with spasmodic retraction of the testicles, and even with emissions during the colic, 109.
Erections in the morning, 5.
Flaccidity of the penis, 30.
The penis is as painful as the abdomen, 215.
The patient experiences a sensation as if the penis were tied at its root or along its course with a cord, 305 . [Attributed by Stoll and Dance to sudden contraction of the urethra.]
Biting on the frænum preputii, and emission of semen. (H. and T.) [From Plumbum muriate.]
Violent inflammatory swelling of the scrotum and penis, with violent inflammatory Dysuria constipation, delirium, and on the ninth day, gangrene of all these parts, followed by death on the tenth day, 47 . [From the external use of aqua Goulardi for gonorrhœa and phimosis.] [2140.]
Constriction of the scrotum, so that at times the testicles were drawn up into the inguinal canal, with the most fearful pains in the small of the back, scrotum, and intestines, 326.
Constriction of the scrotum, 46.
Soreness of the skin of the scrotum and thigh wherever they touched, after the perspiration, 3.
Great swelling of the testicles, 25 . [From the external use for spermatorrhœa.]
Swelling of the testicles, 72.
Retraction of the testicles at times, 46.
During the paroxysms both testicles were forcibly retracted, 210.
During the paroxysms the right testicle only rose toward the inguinal ring, 220.
Constriction of the testicles, 35.
Tension in the testicles, 9. [2150.]
The pain in the testicles was somewhat relieved by suspending them with the hands, 220.
Great pain in the testicles and spermatic cord, and also painful drawing in these organs, and contraction of the scrotum, 499.
Pain in the testicles, relieved by compression, 365.
Shooting pains through testicles of such severity as almost to produce fainting, 271.
Retching pain in the left testicle, that at times seems to extend into the spermatic cord (fourth day), 2.
Pains in left testicle, 471.
Emission of semen during sleep, quite unconsciously, after drinking wine, and the next morning, violent erections on every slight provocation; several nights in succession, 3.
Emissions. (H. and T.) [From Plumbum muriate.]
Emissions, during the morning sleep, with voluptuous dreams (sixth day), 5.
Very scanty emission of semen during coition (fifth day), 2. [2160.]
Involuntary seminal emissions, three or four times a week, causing great debility, 167.
Great inclination to coition. (H. and T.) [From Plumbum muriate.]
Diminution of sexual desire, 529.
Diminished sexual desire, 37 . [From binding a leaden plate on the lumbar region.]
Loss of sexual desire, 58, 488, 486.*
Anaphrodisia, of the same duration as the lead line on the gums and the urinary symptoms, 485.
Seminal weakness, 559.
Impotency, 72.
Complete impotency (secondary action?). (H. and T.) [From Plumbum muriate.]
Sterility in a man, 93. [2170.]
From one hundred and forty-one pregnancies by fathers laboring under the effects of lead poisoning, there were eighty-two abortions, four premature births, and five still-born infants. Of the fifty children born alive, twenty died in a year and a half, fifteen in a year and three months, fourteen survived longer, but of these only one exceeded three years of age, a period of life when children may be regarded as having escaped this fatal influence, 517.
Among seven women who had nothing to do with lead whatever, but whose husbands were subjected to its influence, there were thirty-two pregnancies, resulting as follows: eleven abortions, one still-born child, eight full-term children, which died in their first year, four that died in their second year, five that died in their third year, and two only that are now alive, one of them being only twenty-one months old, 426.
Female.
Vaginismus, 448, 565.
Four women had fifteen pregnancies, distributed as follows, viz., ten abortions, occurring between third and sixth month; two premature births, the children dying soon after birth; one child still-born; one delivery occurring at the full period, but the child died the same day; out of these fifteen cases only one child was born alive that did not show any symptom of lead diathesis. Five women had given birth to nine children before they were subject to the influence of lead poisoning; the children were healthy and alive; neither did the mother suffer from any menstrual irregularity; but after going into the type-cleaning works, they had together thirty-six pregnancies, distributed as follows: twenty-six abortions, from the second to the sixth month of pregnancy; one premature birth, the child dying soon after; two children still-born; seven at full term, of whom four died in their first year, and one in his second, and only two still alive, one of whom is very delicate and anæmic. A woman after having five abortions, left the type-polishing works, and after recovering from the effects of lead poisoning, gave birth to a healthy child, still living. A woman left the works for a time and then went back; during the time she was under the influence of lead poisoning, she frequently aborted, but during the interval she was absent from the works she gave birth to a healthy child, 426.
Previous to her present employment, she had been delivered of three healthy children at full term, still alive; but since her employment as a type polisher, she had suffered much from ill-health, an attack of painter's colic three months after beginning this work, and again four years later; shortly after second attack she became pregnant, and was delivered of a dead child; three years elapsed and she had a miscarriage at the fifth month of her pregnancy; she had become pregnant eight other times, and each time after a short suppression of the menses, and the delay of two or three months, she miscarried, characterized by an abundant menorrhagia, and accompanied by colicky pains at the time, 425.
Miscarriage in the second month of pregnancy, and in the third month of the next pregnancy; in the following pregnancy she suffered from alternating constipation and diarrhœa, did not miscarry, but the child was emaciated, and was a pitiful object, and lived only one month; she passed through the next pregnancy, but the child was very slight, weighed only 2600 grams; at this delivery she suffered from inertia of the uterus and post-partum hæmorrhage, which was arrested by compression of the aorta, removal of the clots, and by ergot; having now left her occupation of painting (she had a bad habit of holding the brush between her lips), she passed through her subsequent pregnancy with a more robust child than before, weighing 3200 grams, without hæmorrhage; this infant lived, 334.
About the third week in October, began to experience a "tired," heavy feeling of pain in the lower limbs, particularly her knees; the same pain was soon felt about the navel and in the groin, giving the sensation of a cord pulling down, and extending to the very lower part of the bowels; soon a similar pain was felt in the shoulders, back, arm, hands, fingers, feet, and toes, particularly over the tops of the feet and hands. She suffered the characteristic nausea of pregnancy for the first two months, none afterwards, until December 31st, when she was seized with vomiting, with an increase of all the symptoms just named, until it closed with abortion, January 9th, 286.
From twenty-seven pregnancies, occurring in five women, there resulted twenty-two abortions, four still-born, and only one living child. From forty-three pregnancies occurring after lead poisoning, thirty-two miscarriages, three born dead, two living, but puny children. One woman who had had five miscarriages left the occupation, and gave birth to a fine baby. According as women left off or resumed the business, their children would be torn alive or dead, 506.
Miscarriage and death, 59.
Miscarried four times, 424. [2180.]
Miscarriage at seven months of a dead fœtus, followed by death, 102.
Frequent miscarriages in women, almost habitual, 104.
Miscarriage, 432.
Miscarriage in the third or fourth month of pregnancy, with persisted hæmorrhage for five weeks, 423.
Of twenty-nine pregnancies among women who gave but slight evidence of lead poisoning, there were eight abortions, one premature birth, twelve at full term, which died in the first year of their life, eight children still living, 426.
Premature delivery, 426.
Has had two children, of whom one survives, but is feeble. Within thirteen months has had a miscarriage, followed by peritonitis, 472.
Abortions occurring between the third and sixth months of pregnancy, 426.
The menses, which had ceased for two days, returned (after one hour), 268 ; (after four hours), 274.
Upon each occasion the normal menstrual flow has ceased, although when otherwise employed, it has came on regularly enough; has not menstruated for three months, 559. [2190.]
Before this time she menstruated quite regularly, but so long as she followed this occupation the menstrual flow ceased. Upon giving it up, which she was compelled to do on several occasions, it returned, 570.
Menses have been absent for four months, 582.
In a short time after this, although quite regular previously, she ceased to menstruate. During these four years she has been afflicted many times in a similar way, whenever she returned to the same employment, 571.
Catamenia absent for fourteen months, until a month ago, when they appeared scanty, 261.
Disturbance of the menses, 15.
Leucorrhœa. (H. and T.). [From Plumbum muriate.]
Menorrhagia, 435.
All the women suffered more or less from menorrhagia. Occurrences of severe hæmorrhage, which he considers as abortions in many cases, 426.

RESPIRATORY ORGANS

Spasm of the respiratory organs, 20.
Constriction of the larynx, 46. [2200.]
Dry mucus in the upper part of the trachea, that he could loosen only with difficulty, and not without some pain in the chest, with whistling in the upper part of the chest on inspiration (second day), 2.
Intense general bronchitis, 140.
Voice.
Rough voice, with hacking cough, 12.
Rough, hoarse voice, 12.
Voice hoarse, almost toneless, 451.
Voice hoarse, 258.
Voice nasal, 527.
Voice toneless, hollow, 545.
Voice loud, 190.
Voice a good deal altered, and the tones of the voice much impaired, 228. [2210.]
The voice has lost much of its resonance, and is weak, like a woman's; articulation is impeded and sometimes even incomplete, 142.
Voice panting, stifled; he can scarcely make himself heard, 219.
His voice is weaker than usual, 195.
Voice very weak, 174.
His voice (which had been a little weak for some days previously) began to fail him one evening while he was reading aloud, 401.
Voice weak and dull, 537.
The voice is weak and husky, 356.
Voice became very weak, talking very difficult, 273.
Voice very weak, with imperfect utterance (tenth day), 240.
The voice had partly lost its strength and resonance, 144. [2220.]
Voice feeble, 254, 278.
Voice weak, 146.
For three or four months she noticed that with each return of the catamenia her voice became noticeably weaker, until it became merely a faint whisper, in which state it remained a period of six years and a half. Even a short conversation caused great fatigue of the muscles of the chest. This was at once explained by the laryngoscopic examination, which showed that there was not the slightest approximation of the vocal cords on attempting to speak, and the glottis remaining widely open; a large volume of air was required to be forced through it in order to produce the faint whisper above mentioned. This demanded an effort of the expiratory muscles, which was very fatiguing, 443.
Voice almost extinct, 141, 546.
She lost her voice for about eight weeks, at the end of which time it returned, 366.
Violent cramp, at night, in the left leg; it ascended up the entire body, and affected the throat, so that for a moment he could not utter a word. The difficulty of speaking lasted fifteen days, but gradually diminished, until he could speak as well as before, 401.
Aphonia, 12, 43, 69, 511, 567.
Aphonia permanent, 305.
Cough and Expectoration.
Cough, 13, 14, 560.
Cough at first dry, afterwards moist, with expectoration of mucus, finally accompanied by fever, 258. [2230.]
Cough in two paroxysms (third day), 4.
Cough, with purulent expectoration, 92.*
Convulsive cough, 20.
Hacking cough, 18, 27.
Frequent cough, with bloody expectoration, 235.*
Dry cough, 7.
Dry cough, with frequent vomiting, 235.
Dry cough on deep inspiration, 235, 237.
Short, dry, nervous, fatiguing cough, 305.*
Coughed up blood for three days, having lost altogether about half a pint; afterwards an attack of spitting of blood, without cough, 463. [2240.]
Hæmoptysis with fatal suppuration of the lungs, 31 . [In a young man who had suppressed erysipelas with white lead.]
Cough, with bloody expectoration, 237.*
Slight cough, caused by dry mucus in the upper part of the chest, in the morning (first and second day), 2.
Respiration.
Some râles, on auscultation, at the apices of both lungs, perhaps merely from bronchitis. Says he has no habitual cough, does not sweat, and is not emaciated, 310.
During the paroxysms the inspiratory movements become hurried, incomplete, and noisy, as if held in check by the pain, 211.
Real asthma at times, 21.
Asthma, 28, 45.
Respiration easy and regular, 221.
Respiration in short, rapid jerks (first day), 328.
Rapid, painful respiration, 326. [2250.]
Respiration rapid and anxious, 235, 237.
The breathing was intermittent. The average time of the intermissions was about forty-five seconds. I never counted less than thirty seconds. Forty-five to fifty-five seconds were common, and in the latter part of his illness I often counted seventy seconds. To be perspicuous, there were two periods, one the respiratory, and the other the non-respiratory period. The number of respirations ranged from nine to sixteen, not per minute, but per respiratory period. The longest respiratory periods marked the shortest non-respiratory periods, and vice versâ . In his best condition the time consumed in the two periods was about one minute. Then he had a comparatively refreshing sleep, and his respirations resumed without so much panting, and he would not generally be awakened, 556.
Respiration very quick, especially during the paroxysms of colic or arthralgia, when it is 68, and accompanied by a sort of noise at the entrances of the nose and mouth, 182.
During the paroxysms respiration considerably accelerated, sometimes it was suddenly arrested by a violent attack of colic, when it would become interrupted and choking, 217.
Breathing short and rapid, 566.
Respiration, 120, 158.
Respiration extremely rapid, 55 per minute, 214.
Respiration during the paroxysms, 65 per minute; between them 35 per minute, 211.
Respiration 48; quite incomplete, short, suffocating; a kind of jactitation was also observed; during the intermissions, respiration was more regular and less frequent, but the utterance was always panting, 213.
Respiration 35; anxious, difficult, irregular, especially during the paroxysms of colic, 120. [2260.]
Respiration 30 to 40, 219.
Respiration 30; short and rather quick (during the paroxysms); 25 (between the paroxysms), 212.
Respiration 30 to 35, interrupted, panting, hurried, 128.
Respiration 30 (during the paroxysms); 24 (between the paroxysms), 224.
Respiration 30; irregular, 209.
Respiration 30, 222.
Respiration 28, 220.
Respiration 26, 194.
Respiration 25; quite regular, 198.
Respiration 25, 135. [2270.]
Respiration rapid, 22, 273.
Respiration 20, 136, 178, 208, 209.
The air of a room filled with people is extremely oppressive; he feels as though he would faint; followed by darkness before the eyes (first day), 3.
Impeded respiration, 35, 44.
Difficult respiration, that compelled him to jump out of bed at night, open the window, and gasp for fresh air, 14.
Respiration difficult, superficial, and accelerated, especially during the colicky paroxysms, 219.
Respiration embarrassed, accelerated, 230.
Difficult respiration (fourth day), 5, 516.
Difficult respiration, with anxiety, 5.
Such a distressing craving for air, especially at night, that during warm weather she was obliged to keep both the door and window of her bed-room open, becoming in consequence deaf from getting a cold in her ears, 459. [2280.]
Oppressed respiration, 9, 21, 28.
Her breath was arrested, with sticking in the sternum, when standing or sitting, or on moving the right arm toward the left side, in the afternoon, 4.
Respiration painful, 254.
Loud groaning and sighing, at times, with excessive weeping; the patient seemed affected by a violent hysterical attack, 326.
Respiration frequently interrupted by sighing, 235.
Frequent sighing, 237.
Anxious sighing respiration, 20.
Anxious respiration, 22.
Respiring heavily (after five hours), 107.
Respiration slow and indolent; expiration stertorous, on account of weakened power of the buccinators, 339. [2290.]
Easily gets out of breath, 524.
The respiration suddenly cut short, 305.
Great shortness of breath on walking, especially on ascending a height, with hoarseness and oppression in the region of the heart, aggravated by pressure with the hand, 258.
Shortness of breath, with somewhat dry cough (fourth day), 5.
Shortness of breath, 7, 258.
Sense of suffocation on drinking, 120.
Feeling of suffocative oppression during the colicky paroxysms, 220.
Suffocation, causing death, 44.
Very feeble respiration (30), 491.
Respiration slow and sighing, 276. [2300.]
Dyspnœa, attributed to convulsion of diaphragm, 311.
Dyspnœa, 28 . [From large doses.]
Dyspnœa, 33, 194, 209.

CHEST

Suppuration of the lungs, 42, 45.*
The lungs were well distended during the respiratory period; the thorax expanded, and all of the respiratory muscles seemed to be active. The violent ingress of the air, and the violent efforts to get it, muffled the vesicular murmur, which could only be heard at the close of the respiratory period, and was louder than normal, and accompanied with more or less of mucous râles. Percussion sounds were usually resonant, except in the region of the heart and liver. A few days previous to the death of the patient, the lungs were evidently greatly congested, and he finally died with a gush of blood from the mouth, containing large coagulated clots, 556.
On examining his chest I found evidence of consolidation in the left apex, and appearance of its commencing in the other; there was no râles, moist or dry, and very little cough; while the poisoned water was being used there was scarcely any rising of the upper left chest on inspiration (the respiration being very harsh, almost bronchial; soon after pure water was used, the chest began again to expand, and the respiration became puerile), 462.
The condition of the left side was involved in great obscurity. To the touch that part extending from the false ribs to the crista ilii, and from the dorsal vertebræ to the left rectus muscle, presented a hard and indurated feel. The hardened mass lay immediately beneath the skin, and could be traced only to the muscular system, 280.
At the apex of the lungs bronchial respiration was heard, 439.
Weak action of the lungs, especially the left; distinct shade of dulness in the right apex (the left being the first affected), 463.
Labored movement of chest and diaphragm, 385. [2310.]
Two out of one hundred and eighty-four died of gangrene of the lungs; two of tubercles of the lungs, 329.
At one time the friction of the muscles of the chest was so loud, that combined with other symptoms, I had great difficulty in satisfying myself that she had not pleurisy, 492.
Accumulation of phlegm on chest, 566.
Rush of blood to the chest, when walking rapidly (fifth day), 5.
Symptoms resembling angina pectoris, 306, 310.
Tightness of the chest (fifth and sixth days), 47.
Great oppression of the chest, and anxiety, 99.
Oppression of the chest, 11 . [From the internal use of led water.]
Sudden oppression of the chest, returning at intervals, and constantly increasing in violence, 46.
Some oppression of the chest, in the morning (second day), 2. [2320.]
Tightness of the chest, 43.
Sense of constriction in the chest; the pains prevent him from fully dilating it, 135.
Feeling of constriction at the base of, and all around the chest, 217.
Oppressive cramp in the lower portion of the chest, with unusual fatigue, after physical exertion, 3.
Anxiety about the chest, 52 . [In a healthy man, from being exposed to the dust of white lead.]
Constant pressure across the chest, especially behind the sternum, causing anxiety and making respiration difficult; movement or pressure of the hand upon the left side of the chest aggravated the anxiety, 258.
Pressure upon the chest (after half an hour), 4, 19, 235, 237.*
A pressure similar to a sticking in the right and left pectoralis major muscles, 5.
About three weeks ago, had cutting pains in chest and throat, "as if scraped by a shell;" has the scraping feeling in throat now, "as if a shell were scraping it;" the pain comes and goes, lasting only about a minute; it makes him feel quite exhausted, 538.
Dared not dilate his chest, lest he should increase the pains, 209. [2330.]
A young man complained of very great pain in the anterior parietes of the thorax, which was greatly increased by the slightest touch, and even by the respiratory motions. It was more severe above the costal cartilages, 266.
Dragging pain from the chest, as if a string were stretched from it to the groin, 287.
Pains in the chest, 67, 290 , etc.
Paroxysmal pricking pain in the external subclavicular region, near the brachial plexus, diminished by pressure, 194.
Great sensitiveness of the anterior wall of the chest and in the cartilages of the ribs, 326.
Stitches in various parts of the chest and shoulders, 305.
Stitches in the left upper pectoral region; on rubbing it extended into the mamma, then backward and upward along the shoulder, in the afternoon, 4.
Sticking in the right costal region after sitting down, disappearing on walking about, 4.
Front and Sides.
Pain behind the sternum (second and tenth days), 268.
Pressure externally on the lower portion of the sternum (after one hour), 4. [2340.]
Pressure upon the lower portion of the sternum (after two hours and three-quarters), 4.
Applied perpendicularly over the sternum, the instrument showed .75 mm., 477.
Lancinations becoming worse, at intervals, in the front and sides of the chest, 135.
Sticking in the upper part of the sternum during inspiration, in the afternoon, 4.
A stitch in the middle of the sternum (after six hours and a half), 4.
Violent dull pressure as from a block of wood pressing against the anterior and lower portion of the left side of the chest, superficial, as if in the surface of the lung, very much aggravated on inspiration, especially on deep inspiration and also on laughing; lasting from morning after rising until after dinner; while lying upon the sofa after dinner he could not endure the pain, and could find relief in no position; this was accompanied by drawing sticking in the left upper arm, and at times sticking between the scapulæ, that lasted a few minutes, and then suddenly disappeared, together with a pain in the chest (ninth day), 2.
Dull pressure upon the left chest, always quite independent of inspiration or expiration, 3.
A dull sensation and pressive pain within the left chest, anteriorly and posteriorly, intermitting and returning, 3.
Severe pain in the lower part of the left side of the chest, apparently seated in the intercostal muscles, 561.
Dull pressive stitches in the left side of the chest, not affected by respiration, intermittent, 3. [2350.]
Tearing beneath the right arm (second day), 4.
Fine sticking in the left side of the chest near the sternum, disappearing on rubbing (after three-quarters of an hour), 4.
Sticking beneath the right arm, that takes away her breath, while standing, 4.
Sticking, now in the right, now in the left side of the chest (second afternoon and evening), 4.
Sticking in the left side of the chest (second afternoon), 4.
Sticking in the left side of the chest, extending through the scapula, in the afternoon (second day), 4.
Stitches in the region of the right lower ribs on turning the body to the right, and still worse on turning it backward; relieved by rubbing, in the afternoon, 4.
Stitches in the right side of the chest, becoming a twinging (second day), 4.
Violent fine stitches in the left side of the chest (after a quarter of an hour), 4.
Stitches in the left side of the chest, aggravated by inspiration, followed by tearing; not relieved after rubbing (after two hours), 4. [2360.]
Transient stitches in the left side of the chest (after two hours and a half), 4.
Mammæ.
The milk was very scanty, 254.*
Sudden attack of severe pain in the left mammary region. It was constant, boring, and extended into the back. Pressure aggravated it to an intolerable degree. It was accompanied by fever and very severe dyspnœa, as if suffocation was imminent, obliging her to keep sitting up in bed.

The beats of the heart were tumultuous, rapid, and resonant, 519.

Itching and sticking pains in both breasts; the left breast suppurated about the nipple and discharged for six days a somewhat serous water, after which it remained well; in the right breast there developed an induration extraordinarily large, occupying the whole substance of the breast, firmly adherent towards the outer portion, of a livid color, extending upward and outward over the whole periphery of this swelling, with here and there red streaks, together with violent pains in the swelling, that extended to the arm and affected its use; after being opened it discharged a large quantity of thin and corrosive matter, and after several days the swelling entirely disappeared, 1 . [Immediately following the application of lead ointment to a tetter-like rash of both hands, in a girl twenty-one years old; the rash disappeared on the twelfth day.]
Sticking below the right breast (after five hours), 4.
Sticking in the left mamma on inspiration, in the afternoon, 4.
Sticking in the left mamma (second day), 4.
Sticking beneath the mammæ (after five hours), 4.
Sticking beneath the left mamma, near the sternum, in the afternoon, 4.
Two stitches in and beneath the mammæ, lasting an hour, in the morning in bed, disappearing after rising (third day), 4. [2370.]
Stitches deep in the right mamma, not disappearing after rubbing (second day), 4.
A fine stitch in the left mamma, afterwards in the right (after six hours), 4.
Somewhat violent stitches below the right breast, extending into the right scapula (after one hour and a half), 4.
Stitches deep in the female breast, 305.

HEART AND PULSE

Prominence of the præcordial region; it gives a dull sound on percussion, over the space of three inches square, 168.
The præcordial region is shaken by the hurried and irregular beats of the heart; they seem as if stifled, on auscultation, but there is no abnormal sound, 217.
Pressure in the præcordial region, 238.
Jerking in the præcordial region (after half an hour), 4.
A stitch in the præcordial region on inspiration, then anxiety, with mounting of heat and redness into the face, soon disappearing (after six hours), 4.
Heart measures 15 by 20 centimeters; the beats can be noticed over the whole surface of the heart and in the epigastric region; violent pulsation in the jugular veins, which are enormously distended, pulse very small and rapid, associated with oppression and œdema of the limbs; the heart-sounds are very difficult to distinguish, consisting of indefinite double friction-murmurs, 414 . [Autopsy showed the heart large, hypertrophied (not dilated), firm, and resistant; the right auricle large, the tricuspid valves present numerous thickenings, the orifice measures 15 centimeters; the left auricle presents an opaline surface, the mitral orifice measures 115 millimeters; the aorta enlarged, atheromatous.] [2380.]
Heart dilated 12 by 14 centimeters; four beats are heard instead of two; associated with a pulse of 84, vibrating as in insufficiency of the aorta; moderate beating in the carotids, 406.
The heart measures 10 centimeters in length, 15 in breadth; the heart-sounds noticed over a larger surface than normal; the valvular sounds are wanting; instead there is a double bruit , very rough, rasping, which is transmitted along the carotids, 405.
Heart very much enlarged, the apex in the sixth space; the murmur at the apex diminishing in intensity along the aorta, 417.
The heart measures 11 by 12 centimeters; chlorotic sounds very marked, pulse 80 and feeble, 411.
The heart measures 9 by 14 centimeters; the heart-sounds are redoubled; the second sound rude, changed in character; it resembled a pericardiac sound. The chlorotic murmurs are considerable, 413.
Heart measures 11 by 16 centimeters; the sounds are sonorous; at one point, however, there can be recognized a little murmur in the second sound of the heart, 412.
Heart measures 11 by 12 centimeters; there is double rough blowing sound, which is transmitted along the carotids, associated with swelling of the limbs and albuminuria, 415.
The heart measures 11 by 12 centimeters, the apex is in the fifth intercostal space; the sounds seem altered; the chlorotic murmur can be heard in the vessels of the neck, 410.
The heart was evidently enormously large. It was impossible to lay the patient on his left side on account of it, as any pressure on that side could not be borne for a moment. His greatest suffering was a sense of pressure upon the heart, feeling as it were imprisoned by the thoracic wall; but it maintained its rhythm through the whole period of respiratory intermission, becoming at the beginning of the period slower, and falling to 100 or 105 beats per minute, holding that for a time, and then rapidly increasing in number until he breathed, when every available muscle was brought into violent exercise to give him air, 556.
Heart enlarged, 561. [2390.]
Organic disease of the heart occurred in seventeen out of one hundred and eighty-four cases; two workers died of parenchymatous nephritis, 329.
Affection of the heart in chronic lead poisoning is often difficult to diagnosticate, because it is dependent upon change in the muscular structure of the heart without coincident disease of the valves, and with or without atheromatous degeneration of the vessels; usually there is hypertrophy and dilatation of the left ventricle; ten cases out of twenty-five were associated with parenchymatous nephritis in the stage of atrophy, 329.
Anxiety at the heart and cold sweat, 32.
Anxiety at the heart and anxious perspiration, 23.
Nausea, with anxiety at the heart (second day), 52.
Anxious, apprehensive about the heart (after half an hour), 4.
General oppression about the heart, 429.
He complained of sudden and unusual pain in the region of the heart, third day after his entrance, and expired in a few minutes, 76.
Violent palpitation, with pain in the heart, 104.
Very violent palpitation, 114. [2400.]
Frequent palpitation, with dyspnœa, at times so great that it threatened suffocation; he seemed to feel the heart beating along the neck and as far as the vertex, with full, hard, regular pulse; the beating of the heart was visible and perceptible in the præcordial region over a space of about two and three-quarter inches vertically, and about three inches transversely; the sounds of the heart were audile over nearly the whole anterior portion of the chest, but were normal (for this palpitation the patient received 3-grain pills of the Acetate of lead; this treatment relieved the palpitation and violent action of the heart, so that the pulse became weak and full, about 50; but the Sugar of lead brought on the most violent colic, with nausea and vomiting, with pains in the lower extremities, on which account the remedy was suspended), 273.
Rather strong palpitation of the heart, slight bruit de souffle at the apex, 523.
Palpitation increased during the violent attacks, 217.
Excessive palpitation, 429.
Palpitation of the heart; the first sound is short, defective; the second sound unusually distinct; the impulse received in two intercostal spaces is jerky, but not forcible; there is no murmur, 437.
Palpitation of the heart, with slight bruit de souffle at its base, 474.
Suffered a good deal from palpitation, 459.
Palpitation of the heart, worse on going upstairs, or running too long, 168.
He feels the pulsation in the head, hands, and feet more distinctly after dinner, 307.
Palpitation at times, 21. [2410.]
Palpitation; beats of the heart irregular, like those of the pulse, 224.
Palpitation, 11, 28 ; (after one hour), 268, 274, 321.*
The beats of the heart are very perceptible, 5.
He felt the beat of the arteries distinctly in the feet, hands, and head, after dinner, 5.
Heart's action feeble, 340.
Impulse of heart feeble, and second sound indistinct, 558.
Contractions of the heart feeble, beating only 44, 440.
Irregular action of the heart just before death, 339.
Beating of the heart strong and irregular, 254.
Bruit de souffle , humeral only; none at the carotid artery of heart, 471. [2420.]
Double murmur in the crural artery, 408.
Cardiac impulse very strong, 481.
Anæmic bruit de souffle at the base of the heart and along the large vessels, 497.
"Bruit de souffle" during the first action of the heart, more distinct at the apex than at the base, 168.
Bruit de souffle in the cervical vessels, 514, 516, 518, 519, 527.
"Humeral" bruit de souffle, 474.
Anæmic blowing-sounds in the vessels of the neck, 326.
Carotid "bruit de souffle" in both sides, 466, 474.
"Bruit de souffle," at the apex of the heart, 466, 524.
Cat's fremitus at the apex of the heart, 168. [2430.]
Tremor of the jugular veins, on auscultation, 466.
The first sound of the heart is remarkably ringing, the second sound dull; the impulse of the heart strong, whirring; associated with dull pain under the sternum, 420.
Chlorotic sound of the heart, 416.
Soft systolic souffle at the base of the heart, 384.
First sound of the heart at the apex sharp and metallic, 339.
The sounds of the heart are modified; a double souffle is heard in the subclavicular region, but there exists none in the crural artery, 409.
At the apex of the heart is heard a bruit, sonorous, transmitted along the carotids; the second beat of the heart is heard under the sternum, 407 . [This was not a case of chlorotic bruit, as in the preceding case.]
A double friction sound at the heart, without enlargement, 408.
Heart-sounds were accompanied by metallic tinkling, 439.
Pulse.
Pulse rhythmical, but the heart impulse violent, 556. [2440.]
Forcible and visible beating of the aorta, which shakes the whole abdomen, 209.
Rapid pulse, 277, 282, 353.
Pulse usually very quick and weak, 492.
Pulse frequent, hardly to be felt, 402.
A small quick pulse, 368.
Pulse very small and rapid, regular (after four hours), 274.
Pulse rapid and hard, 278.
Pulse small, rapid, 91.
Pulse rapid, weak, small, intermittent, 11.
Pulse very small, irregular and rapid, 35. [2450.]
Pulse quick, 113.
Pulse very small and rapid, 35.
Pulse hard, full, feverish, rapid, 36.
Pulse feverish, with most violent colic, 9.
Pulse full and rather turgid, 66.
Pulse rapid, small and weak, 257.
Pulse hard, small, and quick (after five hours), 107.
Pulse soft and quick, 236.
Pulse quick and somewhat tense, in one paroxysm, 243.
Pulse usually full and hard, 258. [2460.]
Pulse very small, a little frequent, regular (after four hours), 268.
Pulse weak and but little quickened, 284.
Pulse very feeble and more frequent than usual, 271.
Pulse 140, and hard (fourth day), 246.
Pulse 140, rather full, 404.
Pulse 130 to 140, 491.
Pulse 126 and small, 583.
Pulse 130, feeble, 276.
Pulse 120 (after one year), 261.
Pulse tense, 112, 449. [2470.]
Pulse 110, hard and full, 97.
Pulse full, tense, 110, with considerable fever, 245.
Pulse 100, 534.
Pulse 100, slightly intermittent and of great tension under the sphygmograph, 384.
Pulse 100; regular very weak, hardly perceptible, 219.
Pulse 95; strong and cordy, 126.
Pulse 88, soft, 287.
Pulse 85, frequent and strong, 190.
Pulse 84, attended with a jerk, 98. [2480.]
Pulse 84, radial artery rigid, 377.
Pulse 80; quite strong and regular, 177.
Pulse 80, full, but soft, 81.
Pulse 80, compressible, 222.
Pulse 76, small, 292.
Pulse 72, tense and hard, 137.
Pulse 65-70; soft, 170.
Pulse 65, soft and regular, 135.
Pulse 65, soft and regular, 161.
Pulse 65, rather hard, 185.
Pulse 65, vibrating, 194. [2490.]
Pulse 60 to 65, not remarkably hard, dicrotic (observed several times), not constantly, but after every five or six normal beats, 212.
Pulse 60, vibrating and regular, 175.
Pulse 60, developed and hard, 221.
Pulse 60 and small (second day), 100.
Pulse 55 to 60, regular and strong, 186.
Pulse 55-60, hard, 188.
Pulse 56, hard, regular, large, 215.
Pulse 55, rather hard, 225.
Pulse 55, rather hard, vibrating, 193.
Pulse 55, somewhat hard and tense, 218. [2500.]
Pulse 55, soft, 220.
Pulse 55, slow and strong, 190.
Pulse 55, regular, large, tense, 203.
Pulse 50-54, 195.
Pulse 50-60, slow and weak, 151.
Pulse from 50 to 60, 323.
Pulse 50-55, hard and slow, 182, 201.
Pulse 50 to 52, quite feeble, 125a.
Pulse 50, regular, but somewhat hard, 178.
Pulse 46, indistinct, of irregular strength and intermitting beat (tenth day), 240. [2510.]
Pulse 45 to 50, 290.
Pulse 45, hard vibrating, regular, 209.
Pulse 45, hard, 198.
Pulse 45, hard, vibrating, 192.
Pulse 45, slow and hard, 160.
Pulse 45, hard and regular, 119.
Pulse 45, hard, large, vibrating, regular, 120.
Pulse 40, hard, slow, regular, 209.
Pulse 35, hard, and vibrating, 121.
Pulse 35, hard, 122. [2520.]
Pulse 24, large and soft, 136.
Pulse full, but not frequent, 111.
Pulse very weak, slow and easily depressed, 145.
Pulse slow, weak, and soft, 155.
Pulse small, weak, and slow, 138.
Pulse slower than natural, 331.
A slow small pulse, 367.
Pulse feeble, slow, and irregular, 490.
Pulse slow, 291, 354.
Pulse slow and weak, 355. [2530.]
Pulse slow, hard, tense, 50 to 60, 339.
Pulse generally slow and feeble, 267.
Pulse decreased in frequency, and he fell into a comatose state, 243.
Pulse weak, slow, soft, and easily depressed, 146.
Pulse small and slow, 235.
Pulse 112, small and rather weak, 103.
Pulse 50, strong and slow, 127.
Pulse quite slow, and almost imperceptible, 144.
The pulse is weak, slow, rather irregular, 141.
Pulse weak and slow, 153. [2540.]
Pulse 45, slow, hard, vibrating, 214.
Pulse slow, contracted, 67.
The pulse became slow and very hard, 21.
Pulse small and weak, 43.
Pulse hard, slow, 28.
The first tracing shows the characteristic peculiarities of the pulse of lead colic. The second tracing thirteen minutes after the injection of pilocarpin shows a decided diminution of tension. The third tracing thirty-three minutes after the injection shows still greater diminution of tension. The fourth tracing in the evening, about nine hours after the injection, shows a return of the former condition as in the first figure. I noticed that simultaneous with the diminution of tension, and in exact proportion to it, was the diminution of pain, 550.
This author has shown the most remarkable effect of Pilocarpin, administered subcutaneously in lead colic; the effect of which on the pulse is shown by the tracing annexed; corresponding to the control of the pulse by the Pilocarpin, was the relief of pain; this relief lasted only as long as the action of the drug was exhibited by the change in the pulse, 550.
The pulse is very evidently dicrotic to a degree inadequately represented by tracing 7. This gives a very good idea of the alteration of pulse which is characteristic of incipient lead poisoning. Renaut, pages 30 and 31, 530.
A very gradual fall at the end of the pulsation; strongly marked elasticity elevation; relatively small recurrent elevation; in some cases a very remarkable bicuspid point at the apex of the first elevation, apparently caused by the increased vascular tone during the colic, 551. [2550.]
Stoll asserts that he noticed a tense, full, hard, and vibrating pulse in workers in lead, who were otherwise healthy. We have observed nothing of the sort. On the contrary, we have remarked in workmen obliged to inhale or swallow large amounts of lead, a small, slender, soft, and easily compressible pulse. In rare cases, along with these changes in the arterial circulation, a marked diminution of the pulse is observed; it goes down to 40, 45, 50 or 55, having been 60 or 70 previous to exposure. This slowness of pulse occurs, with equal frequency, after the internal use of lead preparations, 117.
Pulse moderate, soft, and feeble, 303.
Pulse weak, thready, immediately, 116.
Pulse small and frequent, 74, 266.
Pulse weak, soft, easily depressed, and very slow, 117.
Pulse extremely feeble, 335.
Pulse small, 74, 439, 356, 340.
Pulse weak, 341, 362, 366.
Pulse small and soft, 37.
Pulse intermits every third or fourth beat, 171. [2560.]
Pulse 110 (fifth day); 100 (sixth day); 120 (eighteenth day), 549.
Pulse tremulous, 488.
Pulse 70-80, so feeble, depressed, and irregular, that it can hardly be counted, 174.
Pulse 65-69, soft, quite compressible; irregular, sometimes quick, sometimes slow, 224.
Pulse 65, irregular, 223.
Pulse irregular, from 90 to 115, 432.
Pulse always without power, slow when recumbent, but easily quickened by trifling exertion, 445.
Pulse frequent, depressed and irregular, 158.
Pulse 70 to 85, very irregular; every ten beats or less, followed by equal intervals; soft enough, but very deep, and easily compressed, 124.
Pulse 65 to 70, soft, but irregular, 213. [2570.]
Pulse 96, slender and irregular, 123.
Pulse 65, very irregular in frequency, 128.
Pulse extremely weak, filiform, and sometimes imperceptible, 161.
Pulse 50, irregular as to force, sometimes weak, sometimes vibrating, 168.
Pulse quite soft, irregular, sometimes very slow, sometimes hurried; the irregularity is noticed five or six times per minute, 208.
Pulse 65, very irregular; in one minute, by turns, slow and hurried, large and small, 211.
Pulse soft, varying constantly in rapidity; it was 65-80 within half an hour, 198.
Pulse 65, pretty soft, very irregular, 222.
Pulse small, contracted, hardish, intermittent, indolent, 20.
Pulse 75 to 80, very irregular; one moment slow and quite large, the next, hurried and scarcely perceptible, 217. [2580.]
Pulse very irregular, varying every hour in force and frequency; it never exceeded 90, 198.
The pulse is hardly perceptible, owing to extreme debility, 142.

NECK AND BACK

Neck.
Paralysis of the cervical muscles, 104.
Tension in the nape of the neck, more on the right side, extending into the ear, on turning the head sideways (after four hours and a half), 4.
The neck is stiff; the head is kept almost motionless, 132.
In the neighborhood of the last cervical and first dorsal vertebræ pressure causes a rather severe pain (point of hyperæsthesia), 528.
The pains are also felt in the neck, walls of the chest, back and loins, 132.
Tearing in the nape of the neck, disappearing on standing and rubbing it, after which it appeared in the left shoulder, when it disappeared of itself (after five hours), 4.
Back.
Weakness of the back and lower extremities, 65.
Weary feeling in the back, hardly amounting to pain, 457. [2590.]
Back lame, weak, and painful, 297.
"Rheumatism" of the back, hips, and lower extremities, 283.
"Spinal irritation," 301.
Neuralgic pains in the back, 291.
Pains in the back, hips, and down the spine, extending occasionally up the neck to back part of head, 287.
Pains in the muscles of the back, 531.
Dorsal.
Dorsal region of spine tender on pressure (after one year), 261.
Pains between the shoulders (after three-quarters of an hour), 84.
Pain as if sprained in right scapula (after a quarter of an hour), 4.
Tearing in the lower portion of the right scapula (after two hours), 4. [2600.]
Tearing in the right scapula, with a feeling as of something living in it that rose up; afterwards burning in the abdomen, and then again sticking in the right scapula (after two hours and a half), 4.
Violent tearing in the right scapula (after two hours and a half), 4.
Burning in the tip of the left scapula (after one hour), 4.
Sticking and burning in the right scapula (after two hours and a half), 4.
Persistent sticking in the right scapula (after two hours and three quarters), 4.
Sticking in the left scapula three times in succession, afterwards once, and then frequently, 4.
Two coarse stitches in the middle of the spine (after two hours), 4.
A stitch between the scapulæ (after one hour and a half), 4.
A stitch in the middle of the back, while standing (second forenoon), 4.
Lumbar.
The lumbar muscles were not affected, the patient could double himself up, etc., without increasing the abdominal pains, 210. [2610.]
The lumbar region of the spine and the lumbar muscles are affected by lancinations, and by cramps, which are worse by paroxysms, and are ameliorated by pressure, but aggravated by movement. The pain prevents him from bending himself, doubling up, or walking, 136.
Dragging pain in the lumbar region (this was an invariable symptom), 267.
Dragging pains in the loins and epigastrium, 259.
Violent pains in the loins, 48.
Pains in the loins, 46, 479.
Painfulness of the loins, nates, posterior portion of the thigh, knee, sole of the foot, and toes. The pain, which is equally severe on both sides, is felt somewhat on the inner surface of the lower limb; it usually consists of prickings or lancinations, together with occasional attacks of cramp, 130.*
Violent pains in the lumbar region (after four hours), 274.
Great pain in the muscles of the back, 499.
Severe pain in the lumbar region (after four hours), 268.
Lumbar pains, 475, 483. [2620.]
Pains in the small of the back, 260, 545.
Considerable aching pain in the back (lumbar region), 439.
Violent drawing pains in the small of the back, 451.
Drawing pain from the pubic region to the middle of the spine (second day), 2.
Pain in lumbar region, which is most marked when stooping forward, 547.
Pains about loins and chest, 303.
Neuralgic pains, especially in the lumbar region, 368.
Warmth and pain in the small of the back (after three-quarters of an hour), 84.
Tearing in the left lumbar region, while standing, in the afternoon, 4.
Sticking in the small of the back, which is sensitive on leaning against the chair, disappearing on rubbing it, in the afternoon, 4. [2630.]
Sticking in the right lumbar region, disappearing on pressure, in the afternoon, 4.
Sticking in the left lumbar region and right hypochondrium, while bending toward the left side, disappearing on rising and sitting erect, in the afternoon, 4.
Stitches in the left lumbar region, while laughing, in the afternoon, 4.
Sacral.
Pressive pain in the sacroiliac synchondrosis, 3.
Violent itching on the coccyx, above the anus, relieved by scratching (first day), 2.

EXTREMITIES

(Dilated veins on both legs and on the feet; on the upper third of the outer surface of the right arm there is a large serpentine varicose vein, and on the patella a large patch of varicose veins), 377 . [The patient suffered from these veins for a long time, and bad worked thirty-seven years in the factory.]
Œdematous swelling of the extremities, 70.
Has suffered from gout in the hands and feet, 359.
The limbs lie slightly flexed, and are never contracted; when raised, they immediately fall back again, 178.
Lay always with the limbs drawn up, 265. [2640.]
Usually the legs are kept flexed upon the thighs, and the forearms upon the arms, while the body is doubled together. This seems to be the easiest position, 132.
Convulsions of the limbs, 46.
The upper and lower extremities trembled, and the extensors of the former were paralyzed, 439.
Tremor of the legs and hands, especially the right, 484.
The limbs tremble much less when they are resting against anything, 401a.
The whole arm trembled so much that he could not carry a glass to his mouth. The lower limbs became similarly affected, in the evening. The oscillations quick and uniform, 396.
Tightness and spasms in the extremities and hands, 250.
Spasmodic flexion of the arms and legs, so the dorsal surfaces of both hands rested upon the chest, lasting a quarter of an hour, and followed by gradual relaxation, until the arms hung by the side; after a few hours the spasm was renewed, 339.
Numbness of extremities increased day by day, and there was an incessant trembling, worse at times, especially the upper extremities, in which the paralysis of the extensor muscles was manifest, particularly in the right hand, which could not grasp or hold any object, 350.
Convulsive movements of the extremities, 235. [2650.]
Sudden attack of violent convulsions in the upper and lower limbs, 138.
Tremor, first in the left lower then in the left upper extremity, with pain and difficulty in moving, 154.
Constant trembling of all the limbs, 173.
Tremor and convulsions of the limbs, 171.
Slight trembling of the limbs and face, 183.
Trembling and weakness of the limbs, even to sinking down, recurring from time to time, 11.
Trembling of all the limbs, and of the whole body, 7.
Trembling of the limbs, but especially of the muscles of the face, 3 . [From white lead used as a cosmetic.]
Tremor in the arms and legs, while walking and when at rest, 521.
Trembling of the upper and lower extremities, during both motion and rest, 498. [2660.]
Trembling of the limbs, 39, 64, 92, 440, 444.
Jerkings of the limbs, 20.*
Violent spasms of the limbs, 53.
Paralysis of the limbs; it was singular that this affected both lower extremities and the right arm, while the left remained unaffected; it was discovered while the child was obliged to lie in bed that suddenly he took everything with his left hand, and could not move the right, 263.
Paralysis of hands and legs, 45, 50, 227.
The left limbs are almost as much paralyzed as the right, 146.
Paralysis of the upper and lower extremities, 91.
Paralyzed extensors, 440.
Paralysis of the limbs, 8, 11, 52.
Paralysis of the arms and feet, 17 . [Cured by the application of electricity.] [2670.]
Left-sided hemiplegia of the upper and lower extremities, 577.
Limbs completely paralyzed and extremely wasted, 42.
Complete and incomplete paralysis of the upper and lower extremities, 12.
In the left limb the power of movement is unimpaired, 149.
Sometimes both upper or both lower limbs are palsied in the same degree, or the same muscles are affected in both. In other cases the complaint attacks one limb only; or the corresponding extremities may be affected by different degrees of paralysis, and the loss of power fall upon different muscles, or varying numbers of muscles in the two limbs, 157.
Out of one hundred and two cases of lead palsy, the upper limbs generally were deprived of motor power in five cases, the lower limbs generally in one case. In the remaining cases the loss was partial, being confined to a group of muscles, to one muscle, or to a single muscular fasciculus. Excepting in cases of general paralysis, only the posterior muscles of the limb are deprived of contractility in paralysis of the upper extremities, while in paralysis of the lower extremities only the anterior muscles are affected, 157.
Paralysis of the upper extremities, and partial paralysis of the lower extremities. The hands, with the palms turned inwards, hung by his side, and rather forward, perfectly powerless, rather swollen, and of a livid hue. He had no power of moving the forearm, nor of rising from his chair without assistance. When he walked he required the assistance of a servant on each side of him, and then his knees bent under him, and his gait was tottering, 228.
Complete loss of power in the limbs, with numbness; he lay on his back unable to make the least movement; the limbs yielded readily to external force; their tactile sensibility was entirely abolished, 138.
Immobility and insensibility of the arms and feet, 26.
Sensation and motion entirely unimpaired in the left leg, and in both upper extremities, 160. [2680.]
Failing power in the limbs, 321.
Since in paralysis of the limbs only some of the muscles are affected, while their congeners and antagonists act naturally, it follows that the equilibrium between the two classes is destroyed so that their movements become irregular, and partially influenced as if by normal contraction, occasioning more or less of deformity; which is gradually increased as the muscles become habituated to their unnatural position, 157.
Weakness of the limbs and pain in same, 583.
Three months ago he first felt great weakness in the hands and forearms; this gradually increased, and about three weeks subsequently he was suddenly affected, whilst walking, with intense pain in the thighs. The use of both pectoral and pelvic extremities was lost. At present he has very little power from the shoulder to the wrist; he can hold any light body in the hand, but cannot clasp with firmness. The arms hang loosely by his side; he has a little motion with the forearm, but cannot raise the limb from the shoulder, 87.
Sudden attack of slight bruised pain in the lower extremities, together with pricking and formication on the soles of the feet; walking aggravated the latter sensation to such a degree that it was both difficult and painful. This heightening of sensibility was more troublesome at night; in the daytime it soon disappeared after he got heated at work. Next the superior extremities began to lose strength, the wrists and fingers became somewhat flexed, and could not be fully extended, and at last the upper limbs became totally immovable, and were affected by very severe pains. The arms hung straight down, and seemed as if fastened to the sides; when raised and let go, they fell like dead weights. After immense exertion he succeeded, through the action of the pectoral and large dorsal muscles, in turning his hands back to back, and carrying them behind him. No amount of effort produced the slightest movement in a single muscle of the shoulders, arms, forearms, or hands. The trapezius remained some lifting power at the shoulder; the latter seemed depressed; the elbow, wrist, and fingers were slightly flexed. The forearm and hand were held edgewise, i. e. , in a position half way between pronation and supination. The limbs were freely movable in any direction by external force. The parts deprived of locomotion were very painful, feeling as if bruised; this pain was worse on the slightest movement, constant, aggravated at night, and affected only the parts around the shoulder, the subclavicular space, the axilla, and the whole of the upper extremity. When the arm was squeezed, he cried out that the marrow of his bones was being bitten. No the slightest pain was felt in any part of the spine. The sense of touch was unimpaired, 142.
Joints painful, cracking on motion, 258.
Contractions of the extremities (first day), 274.
Stiffness of the fingers, toes, and insteps, 479.
Stiffness and painfulness of the limbs, 578.
Stiffness of the limbs, 67, 502. [2690.]
Paralytic rigidity of the limbs, 234.
Contraction of the limbs, 23, 45.
Rigidity of the limbs, 60.
Stiffness of the limbs and general cold sweat; the patient answered only by nodding the head; after a while respiration stopped entirely, and rigidity extended over the whole body, though the heart continued to beat, lasting nearly two hours, 258.
The right limbs appear to fall back more easily than the left, 520.
The limbs are emaciated, and very sensitive to cold, 139.
The palsied limbs lost flesh with astonishing rapidity, showing in strong contrast with the general plumpness. Within a few days the shoulders had wasted away, so that the projections of their joints could be easily discerned. The contour of the muscles vanished. The skin grew yellow, and seemed too loose a fit for the parts it covered. All the tissues of the limbs became soft and flabby, 144.
His extremities were dwindled away to the mere sheaths of them muscles, 271.
He presented a well-marked arcus senilis and wasting and loss of power of the fingers, thumb, forearms, arms, shoulders, and thighs. The affection of the left upper extremity was more severe than that of the right, 418.
The paralyzed limbs have wasted almost to skin and bone; their integuments are of a dingy yellow, flabby appearance, and as if fastened to the bones, 138. [2700.]
Weakness of the limbs, 7, 269.
Prostration of the limbs (fifth and sixth days), 47.
The limbs on both sides are equally affected, 138.
Considerable weakness of the arms and legs, which went off gradually, until at the end of two months their strength was completely restored, 401.
Weakness of the limbs, especially the right, 483.
General debility in all the limbs; he fell when going upstairs, but without losing consciousness, yet he was able, without help, though slowly and with difficulty, to get to his home about three-quarters of a mile off; he then perceived that his limbs trembled a good deal, 401a.
Her joints became weak, 352.
Weakness of wrists, ankle, and knee-joints, 317.
Great weakness of all the limbs, 449.
Weakness of the hands and lower extremities, on rising from bed, in the morning, so great that she could walk only with difficulty, and like a little child learning to walk, gradually disappearing (second day), 4. [2710.]
Sensibility when tickled, which is lost in the palm of the right hand and sole of the right foot; is unimpaired in the corresponding parts of the left limbs, 466.
Loss of sensation and impaired power of motion of the right hand and the right leg and foot, 294.
The sensibility of the paralyzed parts is unimpaired, 161.
Marked diminution of sensibility in the whole forearm and thigh, especially on their anterior surface, 154.
Insensibility of the limbs, 20.
Slight analgesia of the right limbs; more in the leg and foot than in the arm, 469.
Torpor and numbness of the limbs, at times, 471.
Numbness of the arms and legs, 95.*
Numbness of the extremities, sometimes extending through the whole system, 70.
Sudden attacks of numbness, heaviness, and pain in the arms and thighs, 141. [2720.]
Benumbing sensation of the limbs, that gradually becomes a paralysis, 46.
Occasional sense of numbness of arms and legs, increased after movement, 240.
Even in cases where normal sensibility was preserved, a sense of fatigue and weight was always experienced in the paralyzed parts, and especially in the joints lying in the track of the affected muscles; in every case there was a feeling as if a heavy weight was suspended to the joints, and as if the chief obstacle to moving the parts was the specific gravity of the limbs which had to be lifted, 117.
Feeling of lassitude in the calves and arms, especially in the biceps muscle, 483.
Feeling of weight in the joints of the paralyzed parts, 146.
Heaviness of all the limbs (eighth day), 3, 349.
Heaviness of the upper and lower extremities, 46.
Woke at 4 A.M.; the hands and feet were weary and weak, even while in bed, especially the calves, disappearing after rising and walking about (third day), 4.
Cramps, felt first in the left middle finger, and successively affecting the knees, the popliteal spaces, calves, soles of the feet, etc.; sometimes accompanied with very severe pains, 119.
Cramps and constant pain in all the limbs, and especially in the deltoid muscle, 523. [2730.]
Cramps of varying severity in the muscles of the extremities were common, 446.
Cramps and pains in the knees and arms, 472.
Cramps in the hands and right leg, especially on extending them, from lying in bed, 483.
After a year or two he commenced to have what he called rheumatism in his wrists and ankles; they were stiff and lame, and very weak and painful, particularly in the morning when he went to work, 499.
Frequent and violent attacks of cramp have been felt in various parts of the body, but more particularly in the hands and feet, when those parts were first put in motion after an interval of rest, 103.
Cramps of feet and hands, 118.
Cramps in the extremities, 126, 472.
Cramps in the limbs; at times almost convulsions, 93.
Cramp so violent that the limbs were paralyzed for a long time after the attack, and remained covered with many nodes (ganglia), 11 . [Effects of Sugar of lead, in a man.]
During the past eleven years he had suffered from repeated attacks of violent pains in the limbs, 540.* [2740.]
Violent pains in the extremities, beginning in the fingers, extending through the elbows and upper arms; then beginning in the feet, and finally affecting the whole body, 455.*
Violent pains, beginning in the joints and extending through the limbs, 578.
*Violent pains in the extremities, 235.
Very severe pains in the joints; worse in those of the lumbar vertebræ and of the shoulders, but all the other joints are affected, though in a less degree. The finger and toe-joints and the articulations of the jaws are almost entirely painless. The pains are not much felt when the joint is at rest. They are aggravated by the least movement; pressure on the parts about the joint is less painful than movement; on pressing the bones together which belong to a joint (as for example the humerus against the glenoid cavity, or the tibia against the condyles of the femur) the pains are still more severe than during movement. There are no severe spontaneous pains; if he keeps still he is comfortable. The muscles themselves are entirely painless, 530.
Severe pains in the inside of her upper and lower extremities, more particularly about the inner angle of the elbow, and knees, 303.
Pain in knees, ankles, arms, and in the tendon of the pectoralis muscle, 236.
Severe pain in his arms and legs. The muscles moving the arms upon the shoulders gradually failed, and eventually became almost powerless, 561.
Severe pains, principally of the hands, and feet, 233.
Much pain in the large joints, particularly the knee, 70.
Quite severe pains all through the paralyzed limbs, which are aggravated by pressure and movement, 154. [2750.]
Pains in the extremities, especially in the evening and night , so that he constantly rubbed one foot against the other, 380.*
Severe pain in the limbs and joints, 396.
Sudden attack of severe pain in the joints, without redness or swelling, 397.
Intense pain in the lower joints of the right limbs, 409.
Rather severe pains about the large joints, constant and aggravated by the heat of the bed, 308.
Pungent pains in the limbs, worse at intervals, and much more severe in the lower limbs, 175.*
Pain in the limbs, especially in the muscular part of the thighs.*

After the persistence of this state for some time, the muscles of the arm became painful, 560.

Rheumatic pains in the limbs and loins, that extend into the knees, 46.
He had been suffering for three weeks with great pains in all his limbs, especially in the legs and left arm. He still complained of pain and weakness in the left knee, and a week previously this joint had been swollen as well as painful, 377.
Pain in the joints, especially the knees, 473. [2760.]
Pain in the limbs during movement and pressure, 481.
In twenty, pain in limbs or joints, or "all over," 567.
Pains in the joints and muscles during movement, 470.
On gently moving the limbs, both upper and lower, I found it was the flexor muscles that caused the pain on motion, 303.
Pains in the limbs, as if broken, 278.
Pains in the hands and feet, and numbness of the same, 287.
Neuralgic pains in the limbs, 291.
Pains in limbs, shoulders neck, face, and head, 284.
The slightest pressure aggravated the pains in the extremities, 235.
Pain in limbs, attended by violent cramps, 230. [2770.]
No pain or weakness whatever in the right limbs, 153.
Pain across legs and arms, 228.
*The pains in the limbs are worse by paroxysms, which are so severe that he cries out; they are somewhat relieved by pressure, but movement increases them, 183.
*Pains in the extremities, 75, 350, 545.
Vague wandering pains in limbs, 558.*
Pain in the joints, 198.
Dull pain in the extremities, 73.
*The pains in the limbs were aggravated, at night, 46.
Pains in the limbs, that rage most violently, at night, 35.*
Pains and cramps, not merely in the joints, but also in their surrounding muscles, 466. [2780.]
Pains in limbs, with the attendant trembling, 239.
*Pains in the limbs, 9, 76, 242, 290 , etc.
Pains in the arms and legs, 451.
Some pain in the limbs and joints, 393.
Bruised pain in the limbs, 185.
Bruised pain in the limbs, especially the lower, 189.
Lancinating pains all along the inner surface of the upper and lower limbs; sometimes cramps; at times these neuralgic pains cause as great suffering as the colicky paroxysms, 156.*
Lancinations in the elbows and knees, 471.
Drawing pains in the extremities, 26, 80.
Drawing and pains that affect now the arms, now the feet, 11. [2790.]
Hæmorrhage ceased entirely, but tearing pains began in the extremities, especially the lower, 128.
Violent tearing pains, lasting day and night, 18.
Tearing in the limbs, 23.
Some tingling of the limbs remained (after four days), 268.
Pressive, tearing, drawing pains in the extremities, 258.
Constant sensation of tearing in the limbs, 481.
Very violent stinging in the arms, forearms, and lower extremities (after two hours), 274.

SUPERIOR EXTREMITIES

Both arms, but especially the right, began to feel numb and weak after his third attack of colic. The weakness gradually increased, and in about three weeks a trembling began, at first slightly, but which is now very great. The oscillations, especially of the arm, are uniform in extend, and rapidly performed. He says that the trembling diminishes and increases alternately. It is greatly aggravated after fatiguing work. The legs are not affected in any way. All the movements of the arm are performed naturally; the fingers and forearm can be extended with the greatest ease. Electro-muscular contractility is normal. The force of compression in the right hand, according to the dynamometer, equals 30 kilograms; in the left hand, 45 kilograms. The pulling strength is 70 kilograms. Muscular strength, in this case, is but slightly impaired, 392.
Trembling of the arms, 451.
Trembling of the hands, followed by weakness of the third and fourth fingers, so that they could not be fully extended; afterwards the second and fifth fingers became affected, afterwards the wrist, and finally even the shoulders; the arms hung down relaxed; the shoulders and arms were emaciated, especially the deltoid muscles; the balls of the thumbs emaciated; on passive motion of the hands and fingers there were trembling motions of the muscles, also at other times there was exquisite fibrillar twitching; if he attempted to raise the arm, the trapezius and sterno-cleido-mastoid muscles contracted and raised the shoulder as much as three inches, then the pectoral muscles contracted and drew the arm slightly forward; he was, however, able to flex and extend the elbow by means of the biceps and long supinators on the one hand, and the biceps on the other; contraction of all the muscles was very weak; pronation and supination of the hand was possible, with trembling, etc., 542 . [Here follows, in the original the detailed careful examination of the muscles and groups of muscles by means of faradic and galvanic currents, with tables of the exact irritability for each. -T. F. A.] [2800.]
The whole right arm trembles a good deal. The oscillations are rapid and uniform, with a regular to and fro motion. The tremor persists even after the patient has been told to fix his attention on it, in order to prevent it. There is no decided movement of the fingers per se; it is rather a movement of the whole arm. The left arm also trembles, but in a much less degree, 401a.
Incoordinate movements of the superior extremities, which consist in an indefinite and irregular series of contractions, and have their set alternately in the extensor and flexor muscles. These oscillations continue in spite of the patient's effort to the contrary. The power of extending the arms upon the posterior portion of the trunk is much lessened. There exists a slight analgesia of the affected members, but not the least paralysis of the extensor muscles of the fingers, 384.
Convulsive movements from time to time in the arms, 324.
Trembling of the arms, worse towards evening, principally in the hands and forearms, but extending to the upper arms when he is compelled to any strong exertion of the limbs, 383.
Trembling, especially of the upper extremities, 114.
Trembling in the upper extremities, 273, 319.
Quite severe tremor, confined to the upper limbs, 397.
Very perceptible tremor of the upper limbs, 466.
Decided tremor of both superior extremities; oscillations rapid and uniform, 394.
The tremor diminished after a few sulphur baths; a paralysis of the extensors of both arms then set in, 396. [2810.]
Tremor of the right arm, 496.
About three weeks ago his arms became affected. They are "shaky," he says; are agitated by clonic convulsions when he attempts to use them. He cannot write, and can with difficulty feet himself; at one time he was unable. His right arm at one time was fixed, by the contraction of its muscles, to his side up to 10 or 11 A.M. every day. After walking for some time, his arms get quite steady for three or four hours. His grasping power is lessened, 563.
The superior extremities are affected with a decided tremor, not very perceptible when they are at rest, but plainly visible on holding them out in front, 329.
Tremor of the arms, especially the right arm, during voluntary motion, 517.
Well-marked tremor of both arms, preceded by weakness and numbness, which are especially felt towards evening, 395.
Several attacks of colic. Three years ago, taken with weakness and numbness of the arms, worse towards evening, succeeded by a gradually increasing tremor confined to the arms; these were cured in six weeks, 395.
Paralysis of the upper extremities; the extensor muscles became completely paralyzed; both arms hung by the side, could not be raised; the patient could not use the hands in eating, drinking, or dressing himself; the flexor muscles were somewhat weakened, and use was associated with trembling; this was followed by atrophy of the muscles, 364.
Paralysis of the extensor muscles of the arm. When he pronates the hand, the wrist droops to a right angle with the forearm; he cannot straighten it; supination is performed naturally, 525.
General paralysis of the upper extremities, 545.
Flexor muscles slightly enfeebled, 508. [2820.]
Want of power of motory co-ordination quite marked in both upper limbs, the left especially; when his eyes are shut, he cannot touch any particular spot on his face without feeling for it; analgesia to pricking and pinching in both arms, especially the left, 528.
Paresis of the upper limbs, especially of the right hand and forearm, 481.
Complete paralysis of superior extremities, 385.
Paralysis of the extensors of the upper extremities, especially of the forearms; flexor muscles unaffected; the paralysis of the fingers became so great that the patient was unable to write, 363.
Paralysis of the upper extremities and atrophy, 347.
Almost complete paralysis of upper extremities, and gradually increasing emaciation, 361.
Paralysis in the extensor muscles of both upper extremities and one of the lower, 394.
Upper extremities paralyzed as to muscular power (after three weeks), 78.
Painful paralysis of the arms, 35.
Inability, by any effort of will, to raise his arms, which hang down by his sides, 141. [2830.]
A few months ago, his arms and hands began to feel "fagged and powerless," 558.
Incomplete paralysis of the upper extremities; the extensors of the fingers, the supinators, extensors, abductors, and adductors of the thumbs seem to suffer especially, with incomplete paralysis of the feet, especially of the extensors of the leg, also the sensation of warmth not entirely lost, 12.
Paralysis of the left arm. He was able to make flexion and extension but to a slight degree; but, what is singular, the grasp was as perfect and as strong as in health, 250.
Both arms hung so powerlessly by his side, that the hands could not be raised more than a few inches from the body, 390.
Diminished power of the extensor muscles, especially on the right side. This want of power does not seem to be confined as much as usual to the extensors, for the flexors of the arms and hands are also much enfeebled. It is evident that neither flexion nor extension can be fully accomplished, so that the angle included between the furthest limits to which these movements can be voluntarily carried is considerably lessened. The fingers can be extended farther by the application of outward force, 466.
Almost complete paralysis of the extensors of the arms, 396.
Loss of power in the right arm, 498.
Paresis of the extensor muscles, especially of the left arm, 480.
Paralysis of the arm began with loss of power in the extensor of the fourth finger, after which, trembling of the arm after exertion was frequently noticed, 540.
The whole of that arm which used to be thrust into the furnaces was paralyzed, and not, as in most cases, only the hand and forearm, 476. [2840.]
The extensor muscles do not contract on the application of electricity; the inter. man-s contract., causing flexion of the first phalanges and extension of the second, 516.
Paralysis of the extensors of both arms, especially the right. Both arms hang down, but there is no contraction of their flexor muscles, 396.
Inability to lift the right arm, which is applied to the chest; its other movements are performed naturally. Pains in right side of neck, right shoulder, inner portion of right arm, bend of right elbow, palmar surface of right forearm and wrist; increased by movement; unaffected by pressure; worse by paroxysms, during which they burn like fire, and between which they are contusive. Skin of these parts insensible, but their contractility unimpaired, 165.
Whatever efforts are made to move the whole upper extremity, contraction is only noticed in the fibres of the deltoid, 143.
The motor power of the right upper limb is diminished; the muscles of the posterior region of the forearm are also somewhat wasted, 527.
The flexors, as well as the extensors, are somewhat affected, since, when he clenches his hands, he exerts very much less strength with the right than with the left, 530.
Paralysis of the extensors of the forearms; pronation impossible; the lower portion of the forearm, especially of the right much emaciated; the hypothenar decidedly diminished in volume; the action of the long supinators preserved; muscles of the right upper arm atrophied, as also those of the left, but in a less degree; deltoids also atrophied; analgesia and anæsthesia of both arms, especially of the right; the same symptoms were noticed in the lower extremities, only the extensors of the feet very little paralyzed; there was no ataxia of motion, 497.
The first indication of paralysis of the arm was noticed after writing, and manifested itself by weariness and trembling of the hands, and inability to completely extend the fingers; weakness affected at first the third and fourth, then the fifth and second fingers, then the thumb, at last the extensor carpi ulnaris, associated with transient weakness of the extensor muscles, not at all of the supinators (the patient was left-handed, and the paralysis was worse on the left side), 541.
Raising the arm became difficult and almost impossible; after awhile the arm became entirely paralyzed, especially the deltoid muscle; the elbow, wrist, and finger-joints were somewhat flexed; the hand retained its position midway between pronation and supination; the paralysis that began in the extensors gradually extended to flexors, and the arm became completely paralyzed; tearing pains in the arm, aggravated by pressure, worse at night, at times so violent that the patient became wild with pain; the sensation of touch was absolutely unaffected; sensation of heaviness in the wrists and fingers; finally, a feeling of icy coldness in the extremities, 273.
Arms hang straight down, and seem as if fastened to the sides; when raised and let go, they fall like inert bodies, 144. [2850.]
The arm is semiflexed at the elbow; it cannot be completely straightened; when this is attempted to be done, the limb immediately returns to its former position, 139.
Both arms fixed in pronation; no approach to supination possible, 138.
The left arm is laid against the chest; it cannot be raised by the action of the deltoid; its other movements are performed naturally, 166.
Upper extremities emaciated; the extensor muscles completely atrophied; the space between the radius and ulna sunken; skin dry, gray, rough; both hands flexed at the wrists; both osseous spaces hollowed; the basal phalanges stand at right angles with the metacarpus; the middle and terminal phalanges flexed into the palm of the hand, so that the nail pressed into the skin, the terminal phalanx of the thumb stands at right angles with the basal phalanx; abduction and adduction almost entirely lost; separation of the fingers impossible; all extensor motion is impossible; pronation and supination almost entirely lost; scarcely any power to flex or extend the forearm at the elbow; motion at the shoulder in free, 434.
There was a marked loss of substance over the right shoulder, all the scapular muscles being atrophied and shrunken; the head of the humerus could be distinctly felt, and even the irregularities on the surface of the shaft. Lower down, all the muscles of the arm and forearm were much wasted. The fingers were flexed. At times a distinct muscular tremor was seen in the affected muscles, but this was just after attempting to use them. He had no power to raise the arms, which hung useless by his sides. He complained of a good deal of tenderness when his arms were moved about, 362.
The flexor muscles, although not paralyzed, are somewhat reduced in size, owing to the long continuance of the disease, 161.
Upper limbs emaciated, but not paralyzed; he only complains of general muscular weakness, 515.
Upper extremities exceedingly emaciated, 143.
Arms emaciated, especially their lower part, 526.
Entire upper extremity greatly emaciated, 517. [2860.]
Arms very much wasted, 585.
Very numerous dilatations of the cutaneous veins of the forearm and under surface of the lower third of the upper arm ; the dilatations much larger than peas; especially noticed at the point of union of veins, but also at other points, especially after muscular exertion and on compression of the venæ profundæ brachii; these dilatations had the appearance of strings of pearls, 382.
Very numerous moniliform dilatations of the veins on the forearm, upper arm, and back of the hand, chiefly corresponding to the points of union of veins , always much more prominent after muscular exertion; there were no varices in other parts of the body, except a few slightly dilated veins on the calves; this was associated, as in other cases, with colic, arthritic pains, paralysis of the extensors of the forearm; relieved by a galvanic current, 383.
The veins of the arms were only slightly filled, but on compressing the deep veins of the upper arm they became swollen, and exhibited numerous rather large olive-shaped dilatations, 378.
Weakness of the right arm and hand; the middle and ring fingers are the weakest, 470.
General feeling of weakness in the arms, 194.
Weakness of the extensor muscles of the right upper extremities, 472.
Has noticed, for some time back, a good deal of weakness in the upper limbs, especially in the evening, 402.
Paralytic weakness of the arms, 458.
Diminished tactile sensibility in the hands, forearms, and arms, especially the right, 477. [2870.]
Loss of tactile sensibility on the anterior surface of the left wrist, left forearm, and lower half of left upper arm (the lead bar, when going into the furnace, slid over these parts). Tactile sensibility only diminished in the remaining portions of the left upper limb and in the palm of the right hand by which the metal was taken up, 480.
Muscular strength considerably diminished in both arms; none in the left, 528.
Complete insensibility of either arm from the junction of its upper with its middle third down to the finger tips. Tactile sensibility of these parts entirely abolished; the hardest pinching, the deepest pricking with pins and needles, was unfelt; his hands being tied behind him, a glowing coal was placed in one of them without eliciting any sign of feeling. Tactile sensibility was unimpaired in the shoulders and upper arms, 144.
Some analgesia and slight anæsthesia in both arms, but chiefly in the right, 525.
The extensor muscles of the upper limbs could not be made to contract by inductive currents of electricity; a constant current excited some fibres in the left arm to contraction, 517.
Tickling and changes of temperature less felt in the left upper limb, 480.
Numbness, formication, and weakness in the upper limbs, followed by all the symptoms of motor and sensory paralysis of those parts, 479.
Sensibility to tickling lost in the whole right upper limb and in the left hand; is only diminished in the remainder of the left upper limb, 477.
Sensibility to temperature slightly diminished in the right upper limbs, 477.
Sensibility he holds his arms against the hottest parts of the stove, sometimes wants to have them sprinkled with cold water, 136. [2880.]
Insensibility to pricking of the whole right upper limb, also of the left hand, wrist, and forearm; diminished sensibility of the left arm, yet burning caused pain, 477.
Sensibility to contact and pain is diminished in the whole right upper limb; he has to be pinched very hard to feel it; his skin may be pricked through without causing pain, 530.
Diminution of regional sensibility and of the sense of muscular movement in the right upper limb, 487.
Sensation of weight and powerlessness at the posterior surface of the middle portions of the arm and forearm, 152.
All forced movements of the limb are painful, 139.
The right arm is affected like the left, but in a less degree, 139.
Cramps in the superior extremities only, 475.
Lacerating pain in the upper limbs, 179. [2890.]
Lacerating pains, with occasional cramps, of the entire upper limb from the shoulder to the wrist. These are neither increased nor diminished by pressure or movement; they are sharp one moment and dull the next. No redness or swelling. The pains seems deeply seated. Cutaneous sensibility is unimpaired. The affected limbs tremble slightly all the time, 152.
The pains in the upper limbs are more acute about the shoulders and at the bends of the elbows, 132. [2900.]
Neuralgic pains in the upper limbs, 356.
Pains in the muscles and joints of the superior extremities only, 475.
Pressure upon the joints of the upper extremities, especially on the elbows and fingers, sensitive, 455.
Pain and formication in right arm, 488.
Fine boring in the right arm, extending from the middle of the forearm to near the shoulder-joint, after breakfast (after three-quarters of an hour), 4.
Dull, boring pain, especially at the bend of the elbow, and extending up to the shoulder; the hand is kept flexed, and cannot be straightened or lifted; the arm cannot be raised; uses both hands in carrying a glass to his lips; on trying to straighten the bent arm, while the patient opposes the effort, the supinator longus is perceived to resist quite forcibly, 517.
Transient tearing in the right arm, 49.
Shoulder.
The shoulder is raised without difficulty, 140.
Cannot lift the right shoulder at all, 152, 163.
Cannot raise the left shoulder, 132. [2910.]
Apparent difficulty in moving the shoulder-joint, and especially in raising the arm; the muscles are not wasted, 524.
Both shoulders are depressed; the upper limbs hang straight down, and he cannot lift them, 143.
The shoulder seemed depressed, 144.
Sense of weight at the shoulder and finger tips, 166.
There was a sense of weight in the shoulder, which was felt more in the elbow, and most of all in the wrist. The pains increased by the slightest exposure of the parts to cold; and there was a cold feeling all through the limb, especially on the dorsum of the hand, which was perceptible externally, 142.
Feeling of weight in the shoulders, felt more in the elbows, and most of all in the hands, 144.
Movement of the right shoulder painful, 456.
Marked numbness in the shoulders, 143.
Violent pains in the region of the shoulders, 364.
Acute pain in the shoulders, especially in the left, and along the extensor surface of the forearm on moving the upper extremity; pressure on the deltoid muscle painful, especially in the left side; on stretching out the arm there was decided tremor, 451. [2920.]
The shoulders were affected with constant pain, especially the deltoid muscles, which also were slightly paralyzed, 271.
Pain in shoulders and arms; the latter were much wasted and useless, 341.
Pain in right shoulder and between the shoulders, 338.
Pains in both shoulder-joints and in the flexor muscles of the upper arm, so violent that he was unable to raise the arm, 540.
Aching pains in the shoulders, extending down to the elbows, and more especially felt over the deltoid muscles, 362.
Sticking in the shoulders, 273.
Sticking from without inward, in the right shoulder (after one hour and a half), 4.
Sticking beneath the right shoulder, that extends outward at the shoulder (after two hours and three-quarters), 4.
Some fine burning stitches on the right shoulder (first day), 2.
A stitch in the right shoulder, 4.
Arm. [2930.]
Both deltoids were remarkably small and atrophied, and the wasting of these muscles was so apparent as to be a disfigurement. The sharp, lean, bony shoulders, incongruously associated with the fine, full, muscular development of all other parts of the frame, 390.
He could not extended (laterally) or raise his upper arms, but the antero-posterior movement of both arms were comparatively unimpaired, 340.
Remarkable immobility of the muscular fibres of the deltoid, while the surrounding fleshy parts are moving in different directions. All other movements of upper extremities are slow, feeble, and difficult, but not impossible, 141.
Electrization of the anterior fasciculi of the deltoid muscle causes no marked contraction of its fibres, 516.
Severe myosalgic pains, which seem to be most intense about the point where the radical nerve leaves the spiral groove of the humerus, 384.
Muscular pains only once in a while in the right pectoralis, 537.
Bruised pain in the deltoid muscle, 3.
Dull very acute drawing in the bones of the upper arm, hand, and fingers (fourth day), 2.
Tearing in the middle of the right upper arm (after a quarter of an hour), 4.
Boring in the right upper arm, together with tearing in the right lower teeth, afterwards with sticking in the left scapula (after two hours and a half), 4. [2940.]
Tearing in the right upper arm beneath the shoulder (after two hours and three-quarters), 4.
Tearing on the inner surface of the left upper arm, in the forenoon (second day), 4.
Tearing in the lower portion of the left upper arm, in the morning (fourth day), 4.
Acute drawing in the right humerus (eighth day), 2.
Tearing on the posterior surface of the left upper arm, which, on rubbing it, went into the elbow, 4.
Unable to raise his elbow to the level of his head, or indeed, to that of his shoulder, 552.
Muscular twitches above the left elbow (after one hour and a quarter), 4.
Some diminution of sensibility on the right upper arm, 518.
Loss of sensibility in all the tissues on the external and anterior surface of the left deltoid region. Pricking with pins and needles, electro-puncture, friction in every direction, forced and violent contraction of the deltoid muscle, elicited no sign of sensation, 159.
Feeling of weight in the elbows, and still more in the wrists, 155. [2950.]
A very annoying sensation of weight in the elbows, wrists, and fingers, 139.
Joints of elbow, wrist, and fingers slightly flexed, 144.
Twisting pains in the bends of the elbows, and the palmar surfaces of the forearms, worse by paroxysms; ameliorated by pressure, 131.
Lancinating pains from the elbow to the finger-ends, without swelling, and without apparent paralysis of any muscle, 168.
Pains confined to right elbow and wrist-joints, and to muscles of right arm, 487.
Pains in the joints and muscles of the elbow, wrist, the fingers and their tendinous sheaths, knees, popliteal spaces, and insteps; spontaneous or excited by movement and pressure, 479.
Sense of weight in elbows and wrists, and especially in the fingers; it is felt more in the left limb, 151.
Forearm.
The forearms and hands, especially the left, tremble considerably, 151.
Extensors of the forearm completely paralyzed, 523.
Paralysis of the extensors of the forearm, 374, 429. [2960.]
Complete paralysis and atrophy of the extensors of the forearm, etc., 548.
On applying Gaiffe's electrical machine, the extensor muscles were found to contract with difficulty, as also the deltoid and pectoralis major; the flexors also contracted with difficulty, as also the outer layer of the muscles of the forearm, and the posterior rhomboid, trapezius, and longissimus dorsi, 524.
Complete debility of the forearm, affecting particularly the extensor muscles, 322.
On waking suddenly, at 3 A.M., he found he had lost the use of his right forearm and hand; the palsy was not restricted to the extensors of the forearm, but also affected the flexors to a considerable extent, 435.
Great loss of power over the extensors of both forearms, especially the right; the affected muscles were greatly withered; the paralysis gradually stealing upon him during attack of colic, 436.
Loss of power in the right forearm and wrist. The extensor muscles are especially enfeebled, and he has wrist-drop on the right side. The left arm and wrist are also paralyzed, but less so than on the right side, 336.
Dropping of supinators soon after his first lead colic, 556.
Left forearm semiflexed upon the arm; it can be almost completely flexed at will, but its extension is impossible, 163.
Pronation and supination of the forearm and hand are easily performed; in the latter position, the flexors of the wrist and fingers cease to act, so that the parts become extended by their own weight, 149.
The forearm is capable of supination and pronation, abduction and adduction of the wrist and fingers are only possible by flexing them, 150. [2970.]
The forearm is kept pronated; supination is impossible, 139.
When at rest, the forearm is strongly pronated, it cannot be supinated; it is semiflexed, and incapable of extension, 140.
The superior portion of the outside of the forearm (edge of the radius) is no longer on the same plane with the inferior portion, which is twisted inwardly, 140.
The arm and hand held edgewise, i. e. , in a position midway between pronation and supination, 144.
Both forearms fixed in pronation; with much effort they can be brought to a position half way between pronation and supination; the hand does not take part in this movement, 145.
Electro-muscular contractility of the forearms greatly diminished, 395.
Posterior surface of right forearm visibly atrophied; a bony projection is observed at the carpo-metacarpal region; the skin of these parts is dried up and flabby, 136.
Muscles of the forearms and the thumbs are much wasted, the wasting being greater in the right arm and hand than in the left, 532, 568.
The inferior portion of the forearm in emaciated; the hypothenar eminences especially are diminished in size; upon the whole, the right arm is more affected than the left. Muscles of the right arm wasted, also those of the left, but in a less degree; also both deltoid muscles, 525. [2980.]
The muscles of the forearms, especially the extensor, were flabby, weak, and tremulous, 419.
During the three years the muscles of the forearm became atrophied, 403.
The posterior surface of the forearm in strikingly emaciated and flabby, while the anterior surface is more nearly of its natural size, 145.
The forearms are extremely wasted; they retain their normal sensibility, but, at intervals, are affected by pretty strong cramps, 148.
The posterior surface of the left forearm is as much atrophied as that of the right; the left thenar region has also fallen away; its muscles have apparently vanished, 156.
The forearm, wrist, and hand on the right side were found to measure in every part of their circumference some four or five less than on the left, 155.
Numerous pearl-like dilatations at the points of union of the veins of the forearms and hands, especially on compressing the venous trunks, and after working, 380.
Veins of the upper arm very large and knotted, varicose at the points of union, but the veins on the extensor surface of the forearm were scarcely visible even after compressure of the venous trunk, 381.
Arteries of the forearms extremely rigid and tortuous, 381.
The cutaneous veins of both forearms could not be seen, though after long working, on compressing the venous trunks, the cephalic could be seen on the left side, and on the right side a few dilated spots at the points of union of veins, 379. [2990.]
During the worst paroxysms, the palmar surface of his forearm becomes hard and tense, and it is affected by cramps, which are renewed on movement, 136.
Sensation of exhaustion in the forearms (fifth day), 5.
Weakness of the forearm, 313.
Bluntness of sensibility in the extensor surface of the forearm and fingers; the patient, however, is able to localize sensation; sensation benumbed; the test of electro-muscular contractility with the induced current shows in both arms moderate reaction in the extensors of the thumb, scarcely noticed in the extensors of the fingers; there is, however, good reaction along the course of the median and ulnar nerves; there is no reaction in the extensors digitorum communes; it is noticeable, however, that while the patient is able to extend both hands, there is no trace of action in the extensors of the wrist, 453.
Some anæsthesia on the back of the forearm, 435.
Analgesia and anæsthesia, especially of the forearms, 444.
On the both forearms, 68 millimeters of separation between the points of the æsthesiometer, 474.
Hypalgesia of the upper two-thirds of the palmar surface of the lest forearm; not so well marked in the rest of the limb, 480.
Skin of the forearm partially insensible, 396.
Almost complete anæsthesia of both forearms, especially of the extensor surface, 354. [3000.]
No sensation when pricked burned in the hands or forearms; only a partial sensation in the lower half of the arms. Burning does not cause even a feeling of warmth, and no pain was experienced, even when the anterior surface of the forearm was burned so as to raise a blister; yet there are severe pains in this region. Neither tickling nor changes of temperature are felt in the hands or forearms, 479.
Slight anæsthesia of the forearms; less in the fingers; it is much more decided in the lower extremities, 474.
Boring pains all over the palmar surface of the forearm, in the bend of the elbow, and in the axilla; the upper arm is not painful; ameliorated by gentle pressure, but somewhat aggravated by firm pressure; constant, but returning in very hard paroxysms, during which he squeezed his forearms with his hands; entreats to be tied round with ropes, his handkerchief, etc., 136.
Excruciating pains in the forearms, with paralysis of the extensors, 402.
Pain, especially in the left forearm, elbow-joint, and arm, 480.
Seized suddenly, in the daytime, with pains in both forearms; these pains took a course which seems to have corresponded with that of the radial nerve. They were so severe as to prevent sleep. At the same time, she felt a great deal of pain when stretching out the hand, though able to perform the movement. Only the ring finger of the left, and the ring and little fingers of the right hand, could not be extended. In both elbow-joints there was a sort of uneasiness, like a feeling of fatigue. This was also felt in the leg behind the ankle-joint, 518.
Wrist.
The wrists and hands shake and tremble very easily under the influence of any emotion, 147.
A small bony elevation, formed by the projecting heads of the second and third metacarpal bones on the back of the wrist, 139.
Wrists much swollen, while extensors of hand are completely paralyzed; supinators intact, 385.
Wrists entirely dropped, from complete paralysis, being perfectly helpless and unable to straighten either hand, unless by the aid of the opposite arm, and requiring all the care of an infant, in being fed, washed, etc., yet a comparatively good grip with his hands, 271. [3010.]
Marked wrist-drop, with wasting of forearms and hands. Has no power of extension of wrist-joint, and scarcely any power of separating the fingers, 360.
Complete wrist-drop on the right side, incomplete on the left, 532.
Wrist-drop of both hands, but the right hand more powerless than the left, 230.
Wrist-drop, 316, 337, 370, 443, 553, 554 , etc.
Subsultus tendinum, 334.
Wrist permanently flexed at a right angle with the forearm; it could be further bent; its extension, abduction, and adduction were impossible; it is somewhat turned inwards, so that the lower extremity of the radius forms a marked projection on its outer side, 146.
Right wrist remained flexed upon the forearm, 155.
The right wrist is permanently flexed at an obtuse angle with the forearm. Instead of the hollow space which naturally exists at its ulnar border, there is a slight convexity; while conversely, the convexity at its radial border becomes a hollow space, so that the entire wrist and hand are twisted outwards, 155.
The wrist is quite forcibly flexed upon the forearm, and can be bent still further by an effort of the will, but cannot be extended; abduction and adduction are equally impossible, 143.
The left wrist is carried into abduction; its ulnar border has become convex. It can also be straightened into a line with the arm; in short, there is paralysis of the extensor carpi ulnaris, 161. [3020.]
The right wrist and fingers are semiflexed, and can be bent still farther; when flexed as much as possible, the finger-ends fall upon the middle portion of the thenar and hypothenar regions. The semiflexed parts cannot be extended. When he shuts his hand, and then tries to open it, he merely stops contracting the flexors; the extensors do not act at all, 149.
Wrists strongly flexed upon forearms; the left much more so than the right; extension, abduction and adduction are impossible. Fingers flexed and extended at will. All other movements of forearms and hands freely performed, 148.
Right wrist strongly flexed upon the forearm; its extension, abduction, and adduction are impossible, 147.
Right wrist twisted inwards; its radial border describes a bold curve; it is incapable of abduction, and can only be carried a little further into adduction than when at rest. It can be extended, but cannot be burned back upon the forearm; on attempting this movement, the whole hand is thrown into adduction, 161.
The wrist is considerably flexed; the fingers form almost a right angle with the metacarpal bones; when most flexed, their tips touch the thenar and hypothenar regions, 140.
On clenching the fist, the flexion of the wrist is increased in proportion to that of the fingers, 140.
Right wrist flexed at a right angle with the forearm, and can be further flexed at will, but incapable of the least extension. Pronation and supination of the forearm freely performed, 156.
Between the paroxysms, the right wrist and the semi-flexed fingers could neither be separated nor completely extended. When the hand was closed, the tips of the fingers reached only to the thenar and hypothenar regions. All other movements of the upper limb were easily performed. No paralysis on the left side. The paralyzed parts have retained their normal sensibility; no cramps or tremor. Sleep is good; the senses are perfect; digestion well performed; a stool every day, 180.
The left wrist cannot be extended, 156.
The wrist is quite forcibly flexed upon the forearm, and can be bent still further by an effort of the will; but it cannot be extended, 138. [3030.]
The wrist and fingers are almost semiflexed, and can only be slightly extended, 150.
Left wrist flexed at an obtuse angle with the forearm; it can be bent further at will; its extension, abduction, and adduction are impossible, or nearly so, 154.
The wrist is slightly flexed on the forearm; it cannot be extended unless the hand is placed edgeways; it is with difficulty abducted or adducted at the same time that it is extended or flexed, 139.
Complete paralysis of the right wrist; the right hand dropped powerless, and could only be raised by means of the left, and he could not grasp anything, 324.
Paralysis of the extensor muscles of the wrist and partially of the fingers, 137.
Palsy of wrist and fingers, with decided tremor on trying to move them, 167.
Paralysis of the extensors of the right wrist and hand, 331.
Extension of the left wrist and fingers is slowly and feebly performed, 135.
When the left hand is closed, the wrist is easily extended, abducted, or adducted, 166.
The right wrist is less easily extended than the left; the extensors of the right wrist are somewhat paralyzed, 327. [3040.]
The left wrist is flexed and extended with ease, when the hand is previously closed, 147.
The wrist can still be straightened out upon the forearm, but in making this movement, it is brought into abduction, never into adduction; during extension, the strong action of the radial muscles is plainly visible, while hardly the slightest motion can be detected in the extensor carpi ulnaris, 135.
Weakness of wrists and fingers (after the subsidence of the colic), 140.
Sensation of heaviness in the wrists and fingers, 150.
Sensation of weight in the extremities of the wrists and fingers, 161.
Feeling of weight in the right wrist and fingers, 147.
Frequent attacks of pains, extending from the wrists up the arms, 382.
Pains in the articulations of the arm and hand, with convulsive movements, 11.
Tearing on the lower surface of the right wrist, extending thence to the back of the hand and fingers, in the afternoon, 4.
A peculiar sensation of numbness in the left wrist, 453.
Hand. [3050.]
(The parts chiefly exposed to contact with the paint were the right hand, wrist, and forearm; and these were also the parts most affected by paralysis), 466.
In the upper limbs, the trembling is almost wholly confined to the hands, which move to and fro in almost uniform oscillations. Only when he is vexed or fatigued, does it spread all over the upper limbs. The tremor is always worse in evening than in the morning. He can still squeeze quite forcibly with either hand; but as he is very powerfully built, it is evident that the strength of his limbs is not in proportion to his general muscular vigor. Measured by Duchenne's dynamometer, the compressive force exerted by the right hand is equal to 12 kilog., that of the left hand to 10 kilog., the pulling force is 62 kilog., which is certainly below what his appearance would indicate. The sensibility is entirely unimpaired. The muscles of the forearm contract as normally as those of other parts under the action of electricity. Tremor worse when he is intoxicated, 400.
Trembling of the hands, 30, 52, 357, 472, 585.
Constant violent trembling in the right hand, almost disabling him from work; unaccompanied, for eight days, by weakness, distortion, or pain of the part, 155.
His hands tremble violently when he tries to take his shovel, 585.
Hand unsteady and trembling, 499.
Began to notice that his hands trembled a little when he was fatigued; though his general strength seemed entirely unimpaired, 401a.
Had lead colic forty-seven years ago (his only attack), two or three months afterwards his hands began to tremble, and they have been trembling ever since, with some periods of remission and aggravation. He has observed that when anything goes wrong with him, the trembling becomes sensibly worse, 400.
When the hands are stretched out, they are both seen to tremble, the right one rather more than the left. The right ring finger hangs down semiflexed, and cannot be completely extended. The paralysis of the extensors affects especially the last phalanx. On the left hand, only the ring finger is paralyzed. The grasp of the hands, especially of the right hand, is very weak. The lower limbs are somewhat weak, but do not tremble. Cramps in the last three fingers of the right hand, and in the calves, 486.
He began to feel first tremor and weakness in the hands; the tremulousness increased; it was confined to the hands and wrists; his hands grew gradually worse for about six weeks, and then he had the "drop-wrist;" the ligaments were very lax, 262. [3060.]
Tremor of the hands, 335.
Some lead tremor, especially in the right hand (with which she handled the type), 469.
Tremor of the hands, especially the left, 480.
Sudden tremor of the right hand, while at work; this slight agitation of the fingers was soon followed by paralysis (a week after being cured of colic). Four days later, tremor and paralysis of the left upper limb, 152.
Slight tremor of the right hand, 482.
Slight tremor of both hands, 487, 523.
Both hands drooped. Had the power of pronation but not of extension, 389.
The back of the hand is convex; it exhibits two prominent projections formed by the heads of the second and third metacarpal bones, 146.
The back of the hand is convex; on the right side of the wrist is a small elevation formed by the projection of the second and third metacarpal bones; on the left side a swelling, similarly formed, by the trapezium and trapezoid, 145.
The backs of the hands were blue, clammy, and slightly infiltrated, 144. [3070.]
The back of the hand is curiously deformed; the metacarpal bones form a concavity, being much enlarged where they articulate with the phalanges; there is a small elevation on the wrist, formed by the projection of the second and third metacarpal bones, 138.
It is impossible to close the hand entirely; in attempting to do so, the tips of the fingers fall upon the thenar and hypothenar regions; the last phalanges are very slightly flexed upon the second, 155.
Hands flexed upon the forearms; when he tries to lift them he observes that the right hand is bent inward, and can scarcely be raised above the horizontal plane; the left hand, on the contrary, makes almost a right angle with the forearm, and is not bent inwards, 526.
The palm of the hand does not lie on the bed, but looks the other way, 140.
Wasting of the muscles of the hand, accompanied with great contraction of the flexor tendons and rigidity of the joints of the fingers. The hand has been stiff and useless ever since stopping the Goulard lotion, 430.
Phlegmonous swelling of the back of the hand and forearm, followed by an abscess, after the opening of which the patient improved, 578.
Shortly after the occurrence of the paralysis, a circumscribed swelling of the extensor tendons was observed, extending from the wrist to the middle or two-thirds of the metacarpus. The swelling was hard and nodose, but was formed without pain, although this was produced in a slight degree by pressure. The sheath of the tendon participated in the tumefaction, and on the back of the hand a series of three or four rounded and cylindrical digitations were observable, which caused a projection of the skin to the extent of two or three millimeters. In one of the patients, as the paralysis of the muscles gradually disappeared in the course of two months, so did this deformity of the tendons, 564.
Paralysis of both hands; they hang from the forearms quite relaxed; they are dry and deathly pale, constantly cold; the backs of the hands are raised by scabs under which cavities are formed, 54.
Four days after the use of the water had been stopped, she was suddenly seized with loss of power in her hands, one morning (she had awoke in the night with a feeling of numbness in them), 460.
Incipient motor paralysis of the right hand; with special weakness of the index and middle fingers; their complete extension has been impossible for several years, 471. [3080.]
Paralysis of the extensor muscles of the hands, 326.
Paralysis of the extensors of the hands and wrists, 75.
Paralysis of hands and forearms, worse on the right side, 475.
Complete paralysis of the extensor muscles of the right hand, 385.
Lost the use of his hands three years ago, so that he could not grasp anything, nor button his clothing, 403.
The hands were paralyzed to about the same extent as the feet. They hung down at right angles from the forearms, and could not be raised at the will of the patient. The wrist-joints looked flaccid and powerless like the ankles. When the forearms were placed in the supine position, and then pronated, the hands dropped down into their hanging position, as if they had been attached to the forearms, by hinges. The flexors seemed to be somewhat paralyzed, but not nearly so much as the extensors. There was no well-marked emaciation, except of the bundle of muscles composing the ball of the thumb. These were wasted almost entirely away, so that the shape of the metacarpal bone of the thumb could be distinctly traced through the integument, 404.
Paralysis of the hands, especially of the right, 581.
Paralysis of both hands, 52.
Paralysis of the extensors of the right hand. He cannot stretch out the fingers horizontally; they are always semiflexed, 530.
Having soon satisfied myself that these fingers were completely insensible when pinched, I made him stretch out his right hand as far as possible, when, despite all his efforts, the little and ring fingers hung down semiflexed on the palm, while the other fingers were fully extended. He could bend the two paralyzed fingers somewhat further, but no completely. Impressed by this peculiar attitude of the hand, which at once brought to my mind that rare affection, local lead poisoning, I mentioned my suspicions to my colleagues and the students in attendance. I questioned the patient concerning his occupation. He said he was employed in the manufacturing of certain chemical compounds, where he rinsed bottles, etc., but distinctly denied that any preparation of lead was among the ingredients used, and insisted that the same was the case as to mercury. He had never had colic, and his gums showed not the slightest trace of a lead line; but this was not inconsistent with my view of the case, under the supposition that the paralysis was due to the local and direct action of the metal. I asked him if he was right-handed. He answered in the affirmative. I then asked him to compress my hand in his right hand. He tried to comply; but that hand had no grasping power, being especially weak at its inner border; a trial with his left hand, however, gave me severe pain. The right little and ring fingers, also the inner border of the right hand and the inner half of the palm and back of the same, were completely insensible to touch, pricking, pinching, cold, and tickling; the other fingers, and the rest of the right hand, retained their natural sensibility. In spite of the patient's denial that he had been in the habit of touching lead, or of using a leaden tool, I assured him that he had been poisoned by that metal, which he had frequently handled with the last two fingers of his right hand. In order to convince him, I told him to take a sulphur bath, which, if it should have the effect of blackening the paralyzed hand only, especially its affected parts, would show, beyond doubt, the presence of lead in his system, and the propriety of his following my advice. If otherwise, then I would confess myself mistaken. I prescribed for him 1 gram of Iod. Potass. daily; and Iodide ointment to be rubbed with the right hand. Just as he was leaving the dispensary, he turned around and remarked, that "perhaps it was capping the vials which had done the mischief." Now, if I had not stuck to my theory, this case would certainly have slipped through my fingers. Seizing the cue thus presented, we got him to explain to us the mode in which he fitted on the leaden capsules. He applied the sheet-lead smoothly over the neck of the vial, by clasping the latter between the inner half of the palm and the last two fingers of his right hand; after working in this way for awhile, these parts became covered with a grayish-black discoloration derived from contact with the metal. On re-examining the palm of the hand, we found two callosities on the inside of the knuckle-joints of the two paralyzed fingers, and none elsewhere. These sufficed to show that the patient told the truth, since these were the precise points most subject to friction during the process he had described to us, 489. [3090.]
Hand flexed on forearm and on the phalanges, 524.
Stiffness of the entire right hand; in the left hand, of the fingers only, 481.
Left hand much enfeebled, but the right hand still more paralyzed, being unable to grasp an object. Lower limbs still quite strong, 485.
Her hands and arms presented all the characteristic symptoms of lead palsy; the wrists were dropped, and the power of extending the fingers almost lost, while the muscles composing the thenal and hypothetical eminences were remarkably atrophied, 351.
Some inability to extend the hand, or open the fingers, from want of power or control over the muscles of the wrist, 315.
Weakness of the hands, 15.
Right hand weaker than the left, 482.
Weakness of the hands, especially the right, 488.
The right hand is too weak to grasp anything; the left, on the contrary, is as strong as ever, 476.
Great difficulty in closing the left hand entirely, 154. [3100.]
After his first attack of colic, he began to perceive a difficulty in extending his fingers and hand; drawings in the arms and legs, 524.
His right hand is weak; he can extend it, but not completely. When extended as far as possible, the ring and little fingers are less extended than the other fingers, and form a curve whose concavity is directed towards the palm, 530.
Loss of strength in the right hand; it is bent upon the forearm and cannot be straightened, 521.
Weakness and trembling of the hands, 453.
The hands, the left especially, have a weak grasp of anything, 480.
Muscular weakness and paresis of the extensor muscles of the hand, especially the right. The right hand does not grasp as strongly as the left, 475.
The extensor muscles of the right hand no longer contract under the influence of electricity; those of the left hand react readily, 508.
Grasp of right hand evidently weaker than that of the left, 478.
Either hand exerts a force of 18 by the dynamometer, 523.
The compressive force exerted by the right hand is not great; it is registered at 5 kilograms by Duchenne's dynamometer; the left hand is stronger, marking 5 1/2 kilograms. The right hand is used with much difficulty; he cannot button his clothes with it, but can still employ it in conveying food and drink to his mouth. Movements are performed quite easily with the left hand. There is not the least paralysis of the extensor muscles; their muscular contractility is practically unimpaired, 401a. [3110.]
Compressive force of the right hand, as estimated by the dynamometer, 11 kilograms; of the left hand, 9 1/2 kilograms; pulling strength, 50 kilograms, 394.
Entire loss of electro-contractility in the extensors of either hand, 523.
Evident muscular weakness of the parts; compressive force of the right hand equal to 10 kilograms; that of the left hand to 9 1/2 kilograms; pulling strength much reduced; only equal to 14 kilograms, 393.
The muscular sense of the right hand is weakened, 481.
Skin of left palm entirely insensible to pinching or any other stimulus; superficial pricking was unfelt; a pin caused pain only when thrust into the subcutaneous tissues. Strong pressure upon all this region; a forced extension of the fingers was painful. The backs of the hands and sides of the fingers retain their sensibility, 166.
Loss of sensitiveness to tickling in the right palm; less sensitiveness in the right sole than in the left, 469.
On applying to the skin the lighted end of a match, a certain space is found to be insensible to the heat. This space includes the right hand and wrist, extending as far as the lower half of the dorsal surface of the forearm, but only 3 or 4 centimeters above the wrist, on its palmar aspect, so that it is shaped like a wrist-bandage, which is cut away slopingly from its posterior or dorsal portion. The transition from the total insensibility of this space to the normal sensitiveness of surrounding parts is gradual, 466.
Right hand, especially the fingers, insensible to pricking and burning. The latter only causes a sensation of warmth, 471.
Anæsthesia of the hands, wrists, and forearms; only partial insensibility of the lower half of the arms, 479.
Diminished sensitiveness to tickling of the palm of the right hand, 472. [3120.]
Diminished sensibility to pain, tickling, and changes of temperature, in the right hand, 478.
Sensibility to tickling is somewhat increased in the right hand, 482.
Diminished sensibility to temperature of the right hand, 482, 488.
Diminished sensibility of the right hand, most marked on its dorsal surface, 486.
Diminished tactile sensibility of the right hand, 478, 481.
Sensibility to tickling lost in the right hand; diminished in the left hand, 488.
Diminished sensibility to tickling in the hands, especially the right hand, 487.
Diminished sensibility to tickling and temperature on the palm of the right hand, 486.
Diminution of sensibility and of sensitiveness, to pricking and burning, of the right hand, right wrist, and lower third of the back of the right forearm, 482.
The right hand is less sensible to changes of temperature than the left; this is still more the case, corresponding, by with the feet, 469. [3130.]
Slight diminution of tactile sensibility, and of sensibility to pain, in the right hand and lower part of the right forearm, 475.
Slight degree of anæsthesia in the right hand and forearm; rather diminished sensitiveness when burnt on the right limb, 468.
Slight anæsthesia, especially of the right hand; on applying the æsthesiometer to the middle part of the anterior surface of the forearms, a difference of 8 mm. was observed in the distance at which the separated points, could be felt, 471.
Of the right hand, only the palm is deprived sensibility, 166.
Numbness in hands and arms, 297, 298.
Cramps only of the right hand, 487.
Jerking in the back of the left hand (after two hours and a half), 4.
Pains in the left hand, with loss of power, on moving it, 49.
Sudden pain in hands and arms, followed by inability to use the hands, 582.
Fine sticking, extending inward, in the back of the right hand (after two hours and a half), 4. [3140.]
Tearing in the right hand at the point where the pulse is felt (after two hours), 4.
Fingers.
Spasmodic flexion of the last phalanx of the thumb and in the third finger, 382.
The finger-nails become bluish-gray, 375.
Slight spasms of the fingers; these attacks were frequently repeated in the course of the next three days; then paralysis set in, 180.
Paralysis and atrophy of the extensor digitorum communis indicator, extensores digiti quinti et pollicis extensores carpi (except the left extensor carpi ulnaris), abductor pollicis longus and brevis, interosseous muscle, deltoid muscles, biceps, brachiales interni, and the supinators, 543.
Atrophy of the balls of the thumbs, 545.
About three months ago, he lost the power of the middle and ring fingers of the right hand; and after the last attack the index and little fingers of the same hand became similarly affected, 113.
Paralysis of the flexors, and especially of the extensors of the fingers, chiefly on the right side; he cannot grasp anything. Weak contraction of these muscles under the stimulus of electricity, 479.
Shortly after the admittance of the painter, in case twenty-nine, we were consulted by a young man who stated that, a few days before, the last two fingers only of his right hand had become benumbed and paralyzed. What astonished him was, that his health otherwise was good, 489.
Paralysis of the extensor muscles of the right fingers. Hand semiflexed upon the forearm. Fingers bent into the hand, 508. [3150.]
Unable to extend the fingers of either hand, 532, 560.
If his fist is clenched and he wishes to unclench it, he has merely to stop trying to contract the flexor muscles, when the fingers at once return to their state of semiflexion, the extensors taking no part in the movement, 140.
The two left middle fingers are firmly flexed upon the metacarpus; the other fingers are similarly bent, but to a much less degree, and can be extended almost completely, which is not the case with the former. When the hand is shut, the two middle fingers reach only to the upper portion of the thenar and hypothenar regions; the other fingers touch the palm, but fall short of the lower metacarpus. The left middle fingers can only be separated when flexing them. The left thumb can be abducted, adducted, and brought into opposition. The left wrist, when at rest, is less bent than the right, and can be straightened out without previously shutting the hand, 153.
The right fingers are bent almost to a right angle with the metacarpus; when the hand is shut, their tips only reach the upper portion of the thenar and hypothenar regions. When the hand is opened, and the flexors cease their contraction, the fingers return to their semiflexed condition by a purely mechanical movement, in which the extensors take no part. The right fingers can only be separated partially, and when flexing them. The right thumb cannot be abducted or brought into opposition, but is still capable of adduction. The right wrist is kept somewhat flexed; it can be straightened out only when the hand has been previously shut; it is then capable of adduction and abduction, 153.
The left middle and ring fingers are bent at a right angle with the metacarpus, and cannot be in the least extended; the thumb, index, and little fingers can be extended pretty well, but not completely; the dorsal surfaces of the latter describe a slight curve, and the superior extremities of the index and little finger form a considerable angle with those of the middle and ring fingers. During extension of the wrist and fingers, and when the forearm is brought into supination, the forcible contractions of the supinator and radial muscles, and of the extensor carpi ulnaris are plainly visible; and between the two lumps which they form is seen a very small portion of muscle which remains without motion; this is the extensor communis; on the back of the wrist, the tendons of the extensores proprii digitorum are seen contracting with their wonted energy; abduction and adduction, impossible by the middle and ring fingers, can be performed by the index and little fingers, though in an obscure and uncertain manner; the thumb is freely abducted, adducted, and brought into opposition, which last movement is easily effected by the little finger also; the phalanges can be bent on one another, so that the tips of the ring and middle fingers shall fall between thenar and hypothenar regions, while the remaining fingers touch the palm. The fingers of the right hand are similarly affected, but to a much less degree, 151.
The fingers are bent upon the metacarpus, at an obtuse angle, which is almost a right angle; they can be extended and separated a very little; the last phalanges are but slightly flexed upon the second phalanges; the hand cannot be firmly closed, and when this is attempted, the finger-ends come in contact with the middle portion of the thenar and hypothenar regions; the thumb and little finger cannot be placed in opposition; all other movements of the upper limb are easily performed, but they are rather slow and feeble, 146.
The two middle fingers of the right hand are less flexed than those of the left, but their extension and separation are equally impossible. The index and ring fingers, on the contrary, are held above the middle fingers, and are capable of complete extension and separation, but cannot long maintain these positions, being drawn into slight flexion by the weight of the paralyzed fingers, and by the permanent contraction of the flexors communi digitorum. On trying to squeeze a small object, the two middle fingers grasp it less firmly than the index and ring fingers. The thumb is moved naturally in all directions, 166.
The thumb is firmly flexed and turned inwards; it can be further adducted, but cannot be abducted, extended, or brought into opposition. All other movements are easy, 161.
The fingers are firmly flexed upon the metacarpus; on shutting the hand, their tips come into contact with the lower portion of the thenar and hypothenar regions. The fingers can be but partially separated, and that only when flexing them; on ceasing to contract they are drawn closer together, and they are quite incapable of extension, 161.
On the right hand, the ring finger alone is flexed at an obtuse angle, and it cannot be in the least extended; yet it does not seem so much bent down as the left middle fingers, because the other fasciculi of the extensor communis digitorum kept it somewhat extended. When the fingers are closed, the ring finger does not get as far down as the others, neither can its abduction and adduction be fully effected, 152. [3160.]
The left fingers, excepting the thumb and index, are firmly flexed, almost at a right angle. Their complete extension is impossible. When the last phalanges are flexed as much as possible, the tip of the index finger falls upon the metacarpus, while the other fingers cannot be carried beyond the thenar and hypothenar regions. All the movements of the left thumb are performed naturally, 166.
Right fingers flexed at an obtuse angle with the forearm; can be extended 3/4, and separated to a like distance. On shutting the hand, the right finger-tips fall beneath the thenar and hypothenar regions. The right thumb can be adducted and placed in opposition; it is incapable of abduction or extension. Right little finger easily brought into opposition, 156.
The left thumb is crooked, flexed at a right angle; the second phalanx is less bent than the first. Its movements of extension, abduction, and opposition are abolished; adduction, however, can still be performed, 156.
Fingers of right hand considerably flexed upon the metacarpus; they are capable of very slight extension, especially the forefinger; on shutting the hand, the finger-ends fall somewhat below the thenar and hypothenar regions. They cannot be far separated, except in the line of flexion, 147.
The two left middle fingers are semiflexed upon the metacarpus and cannot be extended; on closing the hand, their tips fall on the middle portion of the thenar and hypothenar regions, 147.
The left index and ring fingers are bent back; slightly flexed; only partially extensible; held above the middle fingers, so that, when the hand is shut, their tips fall below the thenar and hypothenar regions, but do not reach to the lower extremity of the metacarpal region, 147.
Fingers of left hand kept flexed at an obtuse angle with the metacarpus; their phalanges being similarly bent upon one another, and their extension, abduction, and adduction very imperfectly performed, 154.
The fingers are flexed at almost a right angle with the metacarpus; the two middle fingers appear somewhat more bent than the others, and can scarcely be at all extended by any effort of the will; they can be very slightly separated, but only in the line of their flexion, 155.
The fingers and phalanges are more than half flexed; on attempting to close the hand, the finger-ends touch the thenar and hypothenar regions; the fingers can neither be separated nor approximated, except in the line of their flexion. The thumb and little finger cannot be brought into opposition, 138.
The fingers are semiflexed on the metacarpus; they are capable of partial extension, adduction, abduction, and opposition; the hand cannot be firmly closed, as the finger-ends can only be brought to touch the lower portion of the thenar and hypothenar regions, 139. [3170.]
The thumb is kept turned inwards; it cannot be opposed to the other fingers, or abducted, 140.
The fingers, when flexed, can only be slightly separated, 140.
Middle and ring fingers of right hand became flexed so gradually, that he was hardly aware of it. During treatment for the colic, which supervened, the thumb and remaining fingers became bent in like manner, 135.
The fingers, as well as the two phalanges, are more than semiflexed; when he tries to clench the fist, the finger-ends are brought down on the thenar and hypothenar regions, 145.
Fingers of one hand were curled up into the palm, 343.
Fingers, especially those of the right hand, semiflexed into the palms, 306.
Fingers flexed upon one another without muscular contraction, 524.
From the beginning, he has observed that any attempt to stretch out the fingers results as follows: the middle and ring fingers are flexed, the thumb and little finger are extended, 326.
Both middle fingers are firmly flexed at an obtuse angle; and are incapable of the least extension; they can only be a little separated when in the act of flexion, 153.
Fingers difficult to move, 30. [3180.]
No contraction could be obtained by magneto-electricity, nor by inductive currents of electricity, in the extensor comm. digit.; by the continuous current (forty or fifty elements), a few faint contractions were produced in these muscles, on closing the current. They were scarcely visible in the extensor of the left hand, and it is doubtful if they occurred at all in that of the right, 517.
Complete extension cannot be accomplished by the right fingers, nor by the left middle and ring fingers, 451.
The thumb and little finger cannot be placed in opposition, 145.
When the hand hangs down, the fingers can hardly be separated in the least, 145.
The thumb cannot be completely abducted; the abductor pollicis longus remains entirely motionless, 155.
Opposition or abduction of the thumb is almost wholly impossible, 150.
The fingers cannot be separated except by flexing them a little, 149.
When the thumb is fully adducted, it is incapable of opposition or abduction, 149.
When the hands are kept forcibly extended, the fingers being flexed, he is unable to extend the latter, with the exception of the left little finger, and in a slight degree the right index, 526.
When the hand is shut, the tips of the index and little fingers reach to the lower portion of the metacarpus, while those of the middle fingers do not fall beyond the thenar and hypothenar regions, 182. [3190.]
The left middle fingers are less easily separated and approximated than are the forefinger and little finger, 147.
The left thumb and little finger are easily brought into opposition; the left forefinger cannot be abducted, 147.
The thumb moves freely in every direction, as also do the wrist and forearm, 152.
The left index, middle, and ring fingers are easily and completely extended separated, and flexed; on shutting the hand, their tips touch the lower part of the metacarpal region. The left little finger, however, is firmly flexed on the metacarpus, and cannot be extended separated, adducted, or brought into opposition, 159.
Abduction of the right thumb is easy, adduction is impossible, 147.
The extensors of the fingers are very much enfeebled on both sides, but more on the right. The left hand grasps very well, but the right can scarcely keep hold of anything, 483.
The contracted fingers when forcibly extended, the extension causing pain up the whole arm to the shoulder, were almost immediately again completely flexed, 341.
The index and little fingers are capable of complete extension, but cannot maintain it for any length of time, being drawn into flexion by the weight of the middle fingers, which are held immovably beneath them, and by the action of the flexores communi digitorum. Their power of abduction and adduction is unimpaired, 152.
Sudden weakness of the fourth and fifth fingers of the right hand, 453.
The feeling of weight in the left fingers is less decided than in the right, 147. [3200.]
Sensation of weight in the finger-tips, 153.
Weakness of the right ring finger; the left hand being almost unaffected, 486.
Loss of muscular sense in the right fingers, 470.
Dorsal and palmar surfaces of little and ring fingers entirely insensible to all stimuli; the anæsthesia extends also from the fourth and fifth metacarpal bones to the styloid process of the ulna. The skin of the inner surface of the middle finger, and of the third metacarpal bone is equally insensible. Pain is felt on thrusting a pin deep into the affected portion of the metacarpal region; and also on wringing or jerking violently the fingers whose skin is insensible. The fingers move without difficulty, but less nimbly than usual, and as if benumbed; but not one of their muscles is paralyzed, 164.
Diminution of sense of contact. Cannot distinguish a fine fabric from a coarse one by the touch merely, 488.
The sense of touch, judging from the perception of polished surfaces, is somewhat enfeebled, 485.
Sense of touch is weaker in right fingers, 486.
Slight dextral analgesia, especially of the finger-tips, 470.
Formication and numbness in the right finger-tips, 470.
Peculiar sensation of numbness and fuzziness in the tip of the left fourth finger, 379. [3210.]
Numbness of fingers, 304.
Numbness of the fingers and the muscles of the back of the arm with wrist-drop. He could not pick up a pin, although sensation, which was tested by two points, but not by galvanism, was unaltered, 532.
Falling asleep of the right thumb (after seven hours), 4.
Sensation of tension in the left thumb, painless, for five minutes, 4.
The fingers feel as if much swollen, and heavy, 530.
Cramps in the fingers whenever he tries to grasp anything; but without pain, 398.
Occasional cramps in the fingers, 481.
Pain in the fingers, 468.
Tearing on the side of the left index finger, between the second and third joints, in the afternoon, 4.
Tearing in the left thumb (after two hours and a half), 4. [3220.]
Tearing in the right ring and middle fingers, towards the tips, disappearing after rubbing, but returning violently (after one hour), 4.
Transient jerking in the left thumb (after seven hours), 4.

INFERIOR EXTREMITIES

Œdema of the lower extremities, 467.
Complete paralysis of the lower extremities; they seem numb and dead, 40 . [From the internal use of the Acetate of lead.]
Complete paralysis of the right lower extremity, 278.
In the lower extremities paralysis of the peroneal muscles and extensors of the toes, 545 . [Completely simulating infantile spinal paralysis.]
Paralysis in the lower extremity of the peroneal muscles and in the extensors of the toes, 544.
The right leg is somewhat flexed upon the abdomen, 167.
The left lower extremity is paralyzed as the right, except that the foot is twisted inwards by the permanent contraction of its "adducteurs flèchisseurs" upon the leg; the latter muscles acting naturally, while their antagonists, the abductors, are paralyzed. Complete atrophy of the tibial region, 161.
Sudden difficulty in going upstairs; without previous pain, 160. [3230.]
Loss of power in the lower extremities, while walking (first day), 2.
At present there is no trembling of the inferior extremities, 400.
Standing, and much more walking, are impossible. When he tries to stand, the thigh is flexed upon the leg, and the leg upon the foot, so that he falls down; the sole of the foot forms a deep hollow, 141.
Gait unsteady, 92, 575, 585.
Gait is weak and tottering from laxity of the knee and ankle-joints, 315.
Gait became tottering and unsteady, 245.
One foot began to drag, and soon he could only creep about "on all fours." The hand of that side was also soon affected; he could not button his clothes or cut his food, and was carried up and down stairs. Soon he regained power of his limbs. Again the paralysis returned, and the necessity of creeping, but I think the hand this time was only slightly affected. A subsequent amelioration took place, 365.
The mother perceived that the gait of the youngest, was awkward, that he frequently tumbled down in crossing the floor, that he staggered and complained that it hurt him to walk, and that his feet pained him, especially the bottoms of them. Soon the other children complained in a similar manner, 241.
Lower extremities either cramped or partially paralyzed, 267.
The lower limbs are the seat of an intense reflex excitability, aroused by pressure on the painful parts; it is especially severe in the left, 528. [3240.]
During the paroxysms, which occur oftener than every five minutes, he tries to obtain relief by moving about in bed, also by extending his limbs, which is impossible, on account of the strong spasmodic contraction of their muscles. Soon, however, the period of relaxation arrives; quietude returns; and the cramps and acute pains cease. The paroxysms occur more frequently in the night than in daytime, 119.
The tremor of the lower limbs does not affect the gait, but when he is sitting or lying, or when he is required to lift his legs, they tremble very perceptibly; the right limb much more than the left. The power of resistance to forced flexion and extension, though lessened, is still considerable. Sensibility unimpaired in both upper and lower limbs, 401a.
He cannot walk without the aid of a cane, and drags the foot along as stiff as a poker, being unable to plant the entire sole upon the ground, 153.
Walking is difficult; he drags his right leg, 537.
Walks with difficulty; is not very steady on his legs, but feels the ground well, 517.
When he attempted to walk he faltered in both legs, which seemed to converge at the knees, 340.
I started to run a short distance, and fell forward flat; my legs seemed not to obey the will; two or three times, while standing or walking on the smooth floor, my knees suddenly bent, and I fell; I fell repeatedly while dressing, 293.
Movement of the right lower extremity became difficult, 278.
Long standing is impossible; walking is painful and staggering; he drags his feet so that they stumble over the slightest obstacle, and he can hardly go up or down stairs, 128.
Walking is difficult and staggering; he drags his feet along so that the least obstacle causes stumbling, 154. [3250.]
Very evident want of motory co-ordination in the movements of both legs. When he tries to move them, the muscular effort is not exactly adapted to the desired end; walking is very difficult; he strikes the ground with his heel, when he put his legs out; in walking with his eyes shut he staggers, and would fall if unsupported, 528.
The lower limbs oscillate, but not sufficiently to impede the gait, 401a.
Scarcely able to walk for twelve months, 492.
Walking was difficult, a few steps caused fatigue, 487.
Considerable muscular weakness of lower limbs; standing is difficult, and he cannot walk far, 515.
Long standing is impossible, 154.
Weakness of the lower extremities, increasing so that the patient was unable to walk or stand, 455.
Weakness of the lower limbs, 483.
Weakness and stiffness of lower extremities, 285.
Weakness of the lower extremities, in the afternoon, 4. [3260.]
So great weakness of the lower extremities that she could scarcely keep upright, 578.
Painful prostration of the lower extremities, 474.
Great weakness of the lower extremities, 235, 237.
The numbness, before spoken of, affected the right limb a day or two after, and soon extended over the whole of both limbs, from the buttocks to the toes; and, for a long time, I so lost the sense of feeling in them, that I had no consciousness of where the feet were, unless I saw them; for many weeks I did not know whether one foot touched the other in bed, 283.
Numbness and stiffness of the lower extremities, 300.
Numbness and stiffness of lower limbs, so that frequently he was not aware when they touched the ground, 288.
Anæsthesia of the whole right lower limb and corresponding arm, also of the whole right chest, right abdomen, right loins, and right back, as in hemiplegia; it is bounded exactly by the median line, before and behind, 527.
The sensibility of the lower extremities is unimpaired, 479.
Anæsthesia of the lower extremities, 496.
Both lower limbs equally sensible to touch, 487. [3270.]
The lower limbs, especially the calves, are affected with strong cramps, 148.
Cramp in the whole of the lower extremities, 115.
Cramps in the lower extremities, 350.
Frequent cramps in the lower extremities, 496.
Frequent short-lasting cramps in the lower limbs, 527.
Cannot bear his weight on the affected limb; can scarcely walk from one bed to another with the aid of a crutch or cane, 167.
Violent pains in the lower extremities, chiefly in the anterior portion of the thighs and in the calves , so that he could with difficulty rise up in bed, 540.*
Violent pains in the lower extremities , especially in the knees and thighs, with at times cramps in the calves, 273.*
Most violent pains, extending from the hips to the knees, as though pierced with needles, 544.*
From time to time very sharp neuralgic pains, always seated in the lower limbs, though not limited to the joints, nor to any particular spot, 293.* [3280.]
Great pain in the lower extremities, 253.
The pain in the lower extremities was also very severe, commencing in the soles of the feet, which were so sore that he dreaded to touch the floor with them, and shooting up the limbs to the lumbar region with dreadful suffering, 271.
Rather severe pain in the lower limbs, especially about the calves and soles of the feet, 195.
The pains are more acute in the lower limbs than in the upper, 131.
Contemporaneously with the loss of animal contractility in the upper limbs, the exaltation of sensibility in the abdomen began to involve the inferior extremities. Severe bruised pains were felt in the forepart of the thighs, in the knees, calves, and soles of the feet; pains were also experienced in the lumbar region. They all disappeared entirely along with the colic; the paralysis alone remained, 135.
*Extremely acute and paroxysmal pains, as well as cramps, in the lower limbs, 126.
The pains in the lower limbs are worse by paroxysms ; they are diminished by gentle pressure, but increased by movement, 192.*
The lower limbs only , and especially the knees and thighs, are affected by severe paroxysmal pains, 125a.*
Intermittent contusive pains, confined to the lower extremities, and especially felt on the soles of the feet, and around the knees, 125.
Remittent pains in the lower extremities, especially in the soles and about the knees, with cramps in the calves, 273. [3290.]
Lacerating pains, without redness or swelling, all over the lower limbs, but worse in the popliteal spaces, calves, and soles, than in the thighs or in the other portions of the legs and feet, 132.
Pains in lower extremities, especially the soles of the feet, 126.
Pains always confined exclusively to the lower extremities, consisting of rheumatic pains in the knees and feet, and in the muscular portions of the thighs and calves; these muscular pains were excited by any movement, and were accompanied by cramps, 531.
Pains, spontaneous and aggravated by movement and pressure, in the lower limbs, which are red and inflamed, 488.
Pain on pressure, in the lower extremities; apparently rheumatic, though there were no rheumatic antecedents, 467.
Pains in lower limbs, with a sense of weakness, stiffness, and numbness, 299.
Pains encircling the lower limbs, 212, 529.
Bruised pains, with at times, cramps, becoming worse by paroxysms, in the lower extremities, especially the knees and soles of the feet, 180.
Tearing pains in the lower extremities, 245.
Shooting pains, extending from the soles to the hips, when walking or standing, 258. [3300.]
*Lightning-like pains in the lower limbs, 529.
Sensation of paralysis in the lower extremities, 247.
Hip.
(After a period of general fatigue, he felt, eight days previous to entering the hospital, some pain in the hip-joints, aggravated by walking. This extended to the malleoli, and obliged him to stop work for half a day. In the course of the following three or four days, he had two attacks of dizziness. Finally, there was œdema, with pain on pressure and during movement, which subsequently were in great part transferred to the knees), 467.
Sticking in the region of the right hip, afterwards in the right hypochondrium, relieved by walking, in the afternoon, 4.
Sticking in the right hip, the whole afternoon, always on moving the right arm towards the left, 4.
Acute drawing in the right hip-joint, while lying (first day), 2.
Thigh.
Both thighs slightly flexed upon the pelvis, in consequence of the semiflexion of the leg upon the thigh, caused by paralysis of the triceps and anterior crural, and the resulting permanent, contraction of their antagonizing muscles, 141.
The anterior portion of the thigh is wasted away so as to form a striking contrast with the remainder of the limb, 146.
Glutei muscles and the large extensor on the front of the thigh were greatly wasted; while the biceps and flexors, from the trochanter of the ilium to the tibia, were unusually strong and active, indeed in a constant state of contraction, 293.
Spasmodic shaking in the right thigh above the knee (after six hours), 4. [3310.]
Feeling of weariness in the extensor and adductor muscles of the thigh, 471.
After an hour's drive in a gig, a cramped feeling in the thighs, so uncomfortable that I seldom drove in any vehicle in which I could not stretch the limbs straight, 263.
Numbness over left thigh and buttock, with a diminished sensibility, 209.
Bruised pain in the thighs, 301.
A paralytic pain or a painful paralytic sensation in the thigh, knee, and ankle-joints on ascending steps (first day), 2.
Spontaneous pains in the thighs, knees, and tips of the toes, 483.
Severe pain in the thighs and knees, 349.
Lancinating pains and very frequent cramps in the thighs, knees, calves, and soles of the feet, 145.
Lancinations in the posterior and inner portion of the thighs, 131.
Lacerating pain, without redness or swelling, in the forepart of the thighs and knees; becoming worse at intervals; decidedly increased by movement, and scarcely alleviated by pressure, 169.* [3320.]
Lacerating pains in the forepart of the thighs, and in the popliteal spaces, 183.
Pains in the thighs, 223.
Pain along the course of the right sciatic nerve, 278.
Pains in the adductors of both thighs and in the extensor muscles of the left thigh; these regions were painful to pressure, 451.
Pain in a small spot in the middle of the left thigh, a hand's breadth below the groin, as if a tendon would snap, always at the commencement of a step, while walking, 3.
Burning pain, usually in not large spots, mostly in one or the other thigh, or in both at the same time, 46.
Prickings in the anterior portion of the thigh, 192.
Pricking pains in the forepart of the thighs, in the popliteal spaces, and in the tibial and peroneal surfaces of the legs, increased by movement, and diminished by pressure; they alternate with occasional cramps in the thighs, 184.
Tearing in the middle of the inner surface of the left thigh (after three-quarters of an hour), 4.
Jerking sticking in the inner and upper portion of the left thigh, in the afternoon, 4. [3330.]
Jerking a few times in the left thigh, to relieved by rubbing (after three days), 4.
Stitches in the right thigh, then also in the left, when walking (third day), 2.
Knee.
Inability to extend the knee, 160.
Stiffness of the knees, 18, 49.
Knees and legs, at times, extremely feeble, 297.
Knees became weak and stiff, making locomotion painful, 285.
When fatigued, he feels particularly tired in the knees, 154.
When he is fatigued, there is an especial sense of weariness in the knees, 138.
Weariness of the knees, on ascending steps (first day), 3.
Feeling of weight in the knee, when walking, 160. [3340.]
Two painful zones in the left leg, viz., at the ankle and knee-joints; anæsthesia of both legs, especially the left, to touch, temperature, and pain, 528.
Peculiar "aching" in the bend of the knee, which was apparently seated in the bone, 322.
During the paroxysms, the popliteal spaces and calves, as also the backs and soles of the feet, are seized by very painful cramps, temporarily relieved by pressure and walking; the muscles of the affected parts are very hard; the legs and feet are flexed. When the cramps cease, they are succeeded by a sensation of tearing, 131.
Dull pain, deep internally, in the right knee, in the morning, on ascending steps, 3.
Bruised pain in knees and thighs, 186.
Bruised pain in the knees, popliteal spaces, and soles of the feet, 192.
Very acute pains, passing from the knees to the soles of the feet, where they are much more severe than anywhere else. The backs of the feet, the toes, calves, and popliteal spaces are painful in degrees varying according to the order in which the parts are named. The pain is tearing, worse by paroxysms, increased by walking and movement and diminished by rest, but never affected by pressure; it is accompanied by a feeling of burning heat, without redness or swelling, which keeps him trying to place the parts in contact with cooling things; the warmth of the bed increases the pain. Now and then the cramps are felt in the calves and in the soles of the feet, which parts are also sometimes troubled with pricking and formication. Sometimes jerks and shocks, as of electricity, pass all through the body, and especially affect the lower extremities. The arthralgia is worse at night. At last, he is completely prostrated by the violence and duration of the pains, 123.
Firmly seated pain in the knee, under the soles, and between the lower extremities, even in the feet, making walking difficult, lasting two days (twenty-first day), 49.
Lancinating pains in the knees, popliteal spaces, calves, soles of feet, bends of elbows, metacarpi, and temples; constant, but worse by paroxysms, diminished by pressure; unaffected by motion. The excessive sensibility, which is unaccompanied either by redness or swelling of the parts, is most acute in the popliteal spaces and calves, 119.
Lancinations, at intervals, in the knees, calves, and soles of the feet, ameliorated by the warmth of the bed and by pressure; between the paroxysms, there is merely a feeling of constriction, 134. [3350.]
Lancinating pains from the knee to the soles of the feet; in the latter parts there is felt, five or six times a day, a kind of heat, lasting ten minutes, and neither increased nor diminished by motion or pressure, 160.
Lacerating pains in the knees, calves, soles of the feet, and palmar surface of the forearms; increased by movement, diminished by pressure, worse by paroxysms, during which there are often cramps, 122.
Violent lacerating pains in the knees and soles of the feet, increased by movement and the warmth of the bed; ameliorated by light friction, but aggravated by firm pressure. The pains become more acute at intervals, and are then accompanied by cramps in the feet, 135.
Lacerating pains in the popliteal space, calf, and sole of the foot, worse by paroxysms, during which there are cramps; the pains are increased by motion, and diminished by pressure, 143.
Pain in the knees, 468.
Pains in the left knee, with a good deal of effusion, 323.
Pain in the right knee and left hip, 522.
Lame, weak, painful limbs, particularly in knees, 296.
Pains in the knees and ankles, 348.
Pains in the knees and feet, 345. [3360.]
Pains in the knees, especially in the inner portions, 273.
Violent tearing-jerking pains in the knees, so that walking became impossible, 430.
Tearing above the left knee, while standing, disappearing on rubbing; then a sticking in the right hypochondriac region, after sitting, in the afternoon, 4.
Violent sticking in the right knee, while standing, disappearing while moving it back and forth, in the evening, 4.
Sticking through and through the right knee (after two hours), 4.
Some fine burning stitches in the inner side of the left knee, while sitting (first day), 3.
Leg.
Shaking, like a trembling of the legs (after two hours and a half), 4.
Legs tremble, but he moves them in every direction; he walks with difficulty, 524.
Spasmodic contraction of the legs, 53.
The right leg was semiflexed upon the thigh when the patient stood up; he could flex it further, but not completely. Extension was impossible; the knee could not be straightened. The right thigh was somewhat flexed upon the abdomen. All the other movements of the limb were performed naturally. He could not stand on the affected limb alone. While walking, which was only possible for a few minutes, and with the help of a cane, he dragged the right foot along, on tiptoe, 160. [3370.]
The right leg, when left to itself, either in sitting or when standing up, is semiflexed upon the thigh, and can be flexed further, but not to the full extent; in lying down, it is extended, by a mere mechanical movement; it cannot be spontaneously extended in the least, 167.
Left leg almost semiflexed upon the thigh, and can only be very slightly extended; its complete flexion is rather difficult; all other movements of the lower limb are freely performed, 154.
Leg semiflexed upon the thigh; it can be flexed still further, but not completely; long standing is impossible; walking is painful and staggering; he drags his feet after him, so that he stumbles over every obstacle; he can hardly get downstairs, but goes upstairs more easily; when fatigued, his knees feel particularly tired; all other movements of the lower limbs are easy, 146.
Inability to stand upon the leg, extend it, or flex the thigh upon the abdomen, and the thigh was very much atrophied, being about one-half the size of the other. There was loss of motion in all the muscles supplied by the anterior crural nerve. In attempting to raise the leg, it turned outwards by the action of the biceps, and in crossing the leg over the other, the patient required to lift it with his hands, 350.
The leg is semiflexed upon the thigh; it can only be extended a little with great difficulty, 138.
Great difficulty in extending the leg upon the thigh; it cannot be fully done, 146.
It caused paralysis of right leg, and the right thigh always remained smaller than the other, 539.
The tibialis anticus and peronæus tertius are paralyzed, 141.
Occasionally, much pain in upper part of one leg, and on examination distinct varicosis was found (none existing about the ankles); this swelling of the principal cutaneous vein at the back of the right leg had existed only a short time (two or three weeks); Hamamelis 3d reduced it in about three weeks, 460.
Enlarged veins on the calves, with numerous varicose dilatations, 380. [3380.]
Legs swollen, especially about the ankles (for three or four days), 519.
Symptoms of the legs are similar to those of the arms, except that the extensors of the feet are very little paralyzed, 525.
Some weakness and flabbiness of the muscles of the legs, 552, 568.
The right leg is rather weaker than the left; it gets tired sooner, 530.
The weakness of the right leg and thigh becomes apparent, on making a comparative examination of the lower limbs, while the patient lies on his back, 527.
Her legs are weaker, 519.
Great weakness in the legs, particularly in the knee-joints, 316.
Legs weak; seldom affected by cramps, 480.
Insensibility of the posterior portion of the right leg, from two inches below the knee to the ankle. The sticking of pins and acupuncture needles into these parts was unfelt. Neither pinches, blows, pressure, forced movements of the limb, nor any other stimuli, elicited a sign of feeling. Above and below these limits, as also in the tibial and peroneal regions, the sensibility of the limb was unimpaired. A slight sensation of numbness in the insensible parts, 160.
Slight degree of hyperæsthesia in the muscles of the calf, 529. [3390.]
Cramps in calves, especially the right, 498.
Violent cramps in the calves, so that he cried aloud, 114.
At times, extremely painful cramps in the calves, which prevent extension of the leg upon the thigh; to get rid of them he jumps out of bed, and presses his feet hard on the floor. These pains are worse at night, 168.
Much cramp in legs, 98.
Cramps in the muscles of the calf and thigh, 517.
Cramp in the calves and toes, 484.
Cramps in the legs, at times intense, 350.
Cramps in the calves, 125, 163, 192, 201, 245, 477 , etc.
Cramps in right calf, 160.
Falling asleep of the left leg, from the knee to the foot (after a quarter of an hour), 4. [3400.]
Painful sprained sensation on the outer side of the right ankle, on stepping upon it, in the morning, after rising, and continuing through the morning (fifth day), 2.
Muscles of the calves painful, 451.
Bruised pain in the legs, after rising, in the morning, disappearing after walking about (after two days), 4.
Very severe pains in the lower parts of the legs, the calves, and popliteal spaces, 167.
Sharp pains in the calves, before the colic, 225.
Pain in leg; frequently woke in the night in most intense agony; a sudden jump, with hard rubbing, would very soon cause relief, 297.
Pains in the left leg, 472.
Pains in the legs, especially at night, 383.*
Pains in the right calf, 486.
Transient pain in the tibia, when walking (first day), 3. [3410.]
Intolerable lancinations in the legs, arms, and fingers, 519.
Tearing in the left leg, towards the instep; on rubbing, it extends into the hollow of the knee; afterwards, again sticking in the former place, that disappeared after rubbing, in the afternoon, 4.
Jerking in the right tibia (after two hours and three-quarters), 4.
Sticking in both calves, disappearing of itself (third evening), 4.
Violent throbbing, in a small spot, on the outer side of the right calf, while lying down (first day), 2.
Ankle.
Œdema about the ankles, 497, 581.
Her ankles were œdematous, and the legs covered, posteriorly, by many livid spots and superficial ulcerations, 351.
Swollen ankles; they had been in that state for three or four weeks; the anasarca extended about half way up the leg; quite reduced in two months by Arsenicum, 6, 460.
Bony projection on the ankle, 161.
Swelling and pain in the left ankle-joint, 323. [3420.]
Pains in the left ankle, extending up to the knee, 544.
Pain in malleoli, 468.
Foot.
Feet swollen, 28 . [From large doses.]
Feet and legs considerably swollen, 585.
Œdematous swelling of the feet, 235.
(Edema of the feet, 237.
Gout in left foot, 335.
A spasmodic working of the feet from side to side troubled me, and they would often draw back out of the shoes. I was unable to draw on a boot. While sitting still, the legs would insensibly draw back on the thighs, till the feet got entangled under the chair; this involuntary drawing back of the leg made it very difficult to go upstairs, a man held the foot on the first stair, while a person behind assisted me to rise so as to lace the other foot on the next stair; and then the man would hold that foot in place, or it would certainly have drawn back so as to have thrown me down. While going downstairs, I straightened the whole limb before planting the foot upon the next stair, and, with the help of a man and the banister, could get down safely, 293.
She passed most of her time sitting up in bed, and while in this position her feet dropped over, and inclined inward, so as nearly to rest on their inner border, apparently from paralysis of the extensors, which should have supported them in an upright position. The toes also remained mod safely flexed, and she could not extend them. There was much apparent laxity of the ankle-joint, and the patient was incapable of moving the feet, or supporting the weight of her body upon them. When she was lifted up in the arms of an assistant, she cried out, and drew her feet under her body, for fear she would be made to attempt standing on them. The feet also appeared to be tender, as she cried whenever they were freely handled, 404.
The right foot is firmly extended upon the leg; it cannot be flexed nor carried at the same time into abduction or adduction; the foot points downwards, while the heel is drawn high up, 137. [3430.]
The foot is kept extended and motionless; it cannot be flexed in the least, and its abduction and adduction are equally impossible, 141.
The foot is extended upon the leg, and cannot be flexed nor brought into adduction or abduction, at the same time that it is attempted to flex it; all other movements of the lower limbs are unrestricted, 146.
The right toes are strongly bent upon the metatarsus; they can be further extended, but cannot be flexed upon the foot or separated in this way. The right foot is strongly bent upon the leg; it is incapable of flexion; its abduction and adduction can only be effected by extending it, and causing the leg to move the whole foot at once, 161.
The left foot is pointed downwards; the toes are firmly flexed; the instep is on the stretch, so that the heel is lifted high up, 163.
The foot points downwards; its plantar surface is hollow, so that he can hardly stand, much less walk, 148.
The dorsum of the foot is arched, and the sole much hollowed, 161.
Shortening of the foot by several lines, with paralysis and atrophy, 11 . [From the weekly external use of aqua Goulardi, for a bruise on the trochanter major.]
General difficulty in putting the foot to the ground; the soles seem dead, as if made of wood, and when stepping it seems as though there were several round sausages under them, that prevented a free gait (fourth day), 11.
In walking, the feet are lifted like dead weights, and when extended strike hard upon the ground, by pressure against which their flexion is effected. He seems to move by skips and jumps, 161.
Lateral movements of the foot are impossible, 163. [3440.]
Weakness of the feet, 18.
Heaviness and weariness of the soles of the feet, especially noticed while sitting, 5.
Heaviness of the feet, especially of the knees, 5.
Diminished sensibility to painful impressions on the back of the right foot, 481.
Numbness of the feet, 483.
Feet constantly inclined to fall asleep, 5.
Sensation of softness in the sole of the foot when touching the ground, 466.
Cramplike contraction in the muscles of the sole of the left foot, during rest, relieved by raising the foot and by motion; lasting several days, 5.
Cramps in the feet, 85.
Cramps and lancinations in the soles of the feet, before the colic, 225. [3450.]
Cramps in the feet, at times, 404.
Soreness and tenderness of the soles of the feet, when first getting out of bed in the morning, so much so as to be unable to walk without first rubbing them. The soreness disappeared in the course of the day, after taking exercise and getting warm, 242.
Dull, aching, heavy pains in her feet, which gradually extended to her legs and bowels, 287.
Pains in feet, after a mustard footbath which removed the headache, 133.
Pains in the soles of the feet, 273.
Excruciating-tearing pain in the soles of the feet, 201.
Tearing, extending upward, in the right heel (after two hours and a half), 4.
Quite painful pricking and formication in the soles of the feet, 125a.
Very painful pricking in the sole of the foot, 163.
Toes.
The toes are very strongly flexed upon the sole of the foot; they can only be very slightly separated in the way of flexion; their extension is impossible, 167. [3460.]
The toes are excessively bent upon, the soles of the feet, and can neither be separated nor approximated, 148.
The right great toe is strongly flexed upon the sole of the foot; it is incapable of extension, or of being brought into a line with the other toes, 155.
Right great toe flexed upon the sole of the foot, 155.
The toes are strongly flexed on the sole of the foot, and cannot be extended; that is, their extensor muscles are paralyzed, and their flexors, therefore, permanently contracted. Abduction and adduction of the toes are prevented by want of power in the interosseous muscles. All other movements of the lower limbs are easily performed, 141.
Swelling, now of one, now of another toe joint, with the most violent pains and sleeplessness; these attacks were repeated and finally extended to the ankle-joints, heels, etc., and lasted for several months, 439.
In another patient, there arose, at the same time as the tendinous tumefaction, an articular swelling of the great toe, with redness, heat, and severe pain, giving it very much the appearance of an attack of gout, 364.
Both great toe-joints are enlarged by tophaceous deposits, 341.
Swelling of the great toe, with pain and redness, 509.
Has had four attacks of gout; the metatarso-phalangeal joint of the left great toe was first attacked; this attack lasted for three weeks or a month; subsequently, the corresponding joint of the right great toe was attacked; some months later the left knee, and then the right knee, were similarly affected, 341.
Cannot extend the toes, or flex the foot upon the legs, 163. [3470.]
Sensation of falling asleep, and crawling in the toes, of the left foot, extending into the instep (after two hours), 4.
Drawing in the left great toe, by the nail; on walking, the sensation extended into the ball of the foot, disappearing on continuing to walk, 4.
Painful drawing inward of the two larger toes of the right foot, followed by drawing in the hollow of the right knee, afterwards also in the hollow of the left knee, where there was a sticking, while standing and sitting; afterwards the toes seem numb; gradually disappearing while sitting, in the afternoon, 4.
Intense pain in great toe, at night, which nothing relieves, 583.
Tearing in the two first toes of the left foot, disappearing on moving about (after three-quarters of an hour), 4.
Crawling in the right great toe (after two hours and three-quarters), 4.

GENERALITIES

Complete emaciation, 21.
Much emaciated, and looked ten years older than he really was, 219.
The atrophy becomes general; the patient resembles a walking skeleton, 305.
Atrophy, 43. [3480.]
*Emaciation, 23, 166, 180, 287, 292 , etc.
She had been suffering for five or six years or more from various remarkable spasmodic attacks, and was reduced, by their constant recurrence, from a well-made handsome woman to a mere skeleton. Was frequently seized with violent tonic spasms in the arms, fingers, legs, abdomen, and chest, as if she had been taking strychnine, 492.
He was wonderfully emaciated. If placed in an erect position, he fell over in any direction if not supported, and he had not the slightest command over the flexors or extensors of upper or lower extremities, especially the upper, which seemed to have ceased to act at all. The deltoids seemed entirely gone; the head of the humerus could be traced in the glenoid cavity quite plainly; his ribs were covered only by skin; in fact, he looked more like a dried skeleton than a living person, 546.
Gradually increasing weakness in her extremities, which she first noticed, she thinks, in her hands and arms. She lost all power over her limbs. She lies on her back perfectly helpless, and presenting literally the appearance of a skeleton. Every muscle in the body is wasted to a very unusual and remarkable extent. Those of the back share in the general atrophy, which, however, is perhaps most of all marked in the muscles of the hands and arms. The fingers are flexed, giving the characteristic "griffin's-claw" appearance, the flexion being of the phalangeal and not the metacarpo-phalangeal joints. The interossei seem to have entirely disappeared, so that the finger and thumb of an observer can be made to meet between the metacarpal bones. The radius and ulna can be made out throughout their entire length as distinctly as though covered only by integument. The legs and feet are in a very similar condition. So wasted are the abdominal muscles that the spine can be distinctly felt throughout the lumbar region. At first there was great constipation of the bowels, sometimes no action taking place for a month. This was succeeded after some months by diarrhœa, and she often passed her motions involuntarily, 366.
Greatly emaciated and very weak, 341.
On stripping the patient the clavicular and scapular prominences were very remarkable, the deltoid muscles had wellnigh disappeared, whilst the supra- and infraspinati were atrophied to such a degree as to present cup-shaped depressions above and below the scapular ridges. The latissimus dorsi and pectoral muscles were soft and slightly atrophied. The biceps and triceps of both arms were wasted, those of the right arm more than those of the leg. The extensors and flexors of both forearms were soft and atonic from disuse, but as regards their muscular volume they seemed intact, as also were the muscles of the thumbs and hands generally. The spinal, lumbar, and muscles of the lower extremities were sensibly atrophied, the left extremity generally more than the right, more particularly the left gluteals. The sensibility of the two extremities least atrophied - viz., the right leg and left arm - was increased so that the patient was unable to bear the weakest current of electricity, whereas he could bear electricity strongly applied to the alternate leg and arm, 340.
All the paralyzed parts are wasted and insensible to all stimuli. Thus, blisters applied to the thighs and arms may be torn off violently without eliciting any sign of feeling, 174.
The general plumpness is in strong contrast with the wasted condition of the limbs, 161.
Marked emaciation of the limbs and body, 153.
The paralyzed parts are wasted; their shrivelled dingy-yellow skin seems loosened from the flabby muscles. The adipose tissue seems to have dissolved; the contour of the muscles has disappeared. The hands are blue and slightly infiltrated, 142.
Emaciation supervenes after fifteen days, a month, or whole years of exposure to the fumes, and only in cases where great quantities have been absorbed, 117. [3490.]
He lost strength and flesh, notwithstanding a good appetite, 271.
Emaciated and weak, 545.
The muscles lose their contour, 145.
General feebleness of the muscular system, the muscles throughout the body being soft and wasted, 360.
Pale and emaciated, 422.
The muscles throughout the body are soft and flabby, 356.
Muscles are soft and weak, 357.
Muscles rather firm, not soft and pliable, 303.
Flabbiness and paleness of the muscles, 28.
Flesh soft and wasted; his countenance was more emaciated than the rest of his body, and showed profound despondency, 350. [3500.]
Pale and rather emaciated, 463.
Appearance meagre, 529.
Anæmic and cachectic appearance, 340, 578.
She was anæmic, and in a condition analogous to that of a person suffering from paralysis agitans, 343.
Profound anæmia, 437, 521, 522, 547.
Anæmic and very thin, with a sallow aspect, 362.
The whole surface is pale, anæmic looking, and of a characteristic hue, 466.
Anæmia, 384, 444, 456, 468, 568, 582.
General cachectic condition and hectic fever, 42.
The patient presented a cachectic appearance, pale, anæmic, with a jaundiced tint, 351. [3510.]
Cachectic condition after second attack of colic, which kept him from working for six months, 302.
The patient looked like one suffering in a high degree from anæmia and atrophy, 433.
Ictero-plumbic appearance, 370.
Excessive anasarca, 574.
Swelling of the body, 13, 567.
Face, feet, and legs have become œdematous, 492.
Mucous membranes pale, 449, 545.
Mucous surfaces of a waxen hue, 519.
Mucous membranes lose their normal color, 326.
He was seized with symptoms of asphyxia and died suddenly (after three weeks and four days), 78. [3520.]
Six cases of gout were observed out of one hundred and eighty-four, 329.
Had had several attacks of gout, 418.
Gout is much more frequent in persons suffering from lead-poisoning than in others ; this arthralgia of lead-poisoning is distinguished by the absence of redness and tumefaction; a tumor that appears on the dorsal surface of the wrist, in some cases coincident with the paralysis of the extensors, extends along the tendons, is not changed in color, consistence, or mobility; it is caused by hypertrophy of the tendinous expansions, never commences in the articulations, 300.
Dropsies, 42.
Diminished secretions and nutrition, 21.
The secretions generally are torpid, 438.
Consumption, 10 . [From the internal use of Acetate saturni.]
Gangrene, 41.
Ganglion, 11.
Most pernicious gangrene, 62 . [From the external application of Extractum saturni to erysipelas.] [3530.]
General scorbutic symptoms, with ulcers in the lungs, 92.
Complete absence of œdema throughout the whole case, though the urine was highly albuminous, and the patient suffered from uræmic convulsions, 429.
The number of blood-corpuscles is very largely diminished , in some cases to the number of 2,200,000 in a cubic millimeter of the blood; but while the number is so much diminished, their size becomes greatly increased, being relatively to the size of healthy blood-corpuscles, as 9 to 7, true macrocythemia ; this increase in the size of the red corpuscles is found not only in cases of acute but also of chronic poisoning, 464.
Blood corpuscles diminished from 1,800,000 to 1,500,000, and afterwards to 1,300,000, 578.
The serum of the blood shows a slight yellow reflection, but with no shade of green, 117.
The blood, under the microscope, shows an abnormal number of white globules, 519.
Nervous prostration not infrequently destroying life, 42.
Death of children within the first three years of their lives, 426.
Great mortality among children, especially during the first weeks of life, 432.
Apoplexy, 21. [3540.]
He seems as if attacked by apoplexy, 60.
Death either by apoplexy or complete wasting with hectic fever, 28.
Death either by apoplexy or syncope, with complete immobility and insensibility, (From large doses), 26.
Since his sickness, complete suppression of normal perspiration; walking difficult, can only take a few steps, and soon gets tired; disposed to sadness; loss of memory; much emaciation, 525.
(In this case the symptoms of poisoning were confined entirely to the parts most frequently brought in contact with the lead cement), 468.
Nutrition and all the secretions fail, and the skin becomes dry and discolored, 28.
Electro-muscular contractility of the parts unimpaired, 294.
No paralysis, anæsthesia, or hyperæsthesia on the left side, 167.
No redness, swelling, or morbid heat of the affected parts, 134.
Neither palsy nor anæsthesia affect the right side, 163. [3550.]
No redness or swelling of the painful parts, 136.
During the colicky paroxysms he lies flat on his belly, rolls about, presses his fists into the umbilicus, screams, 198.
Lies upon his back, apparently much prostrated, 521.
Dorsal decubitus, 195.
Lies on the back, with limbs relaxed and powerless, 520.
At intervals of about five or six minutes there was a short resting spell, when he became quiet, only groaning a little now and then, 223.
Lies on his left side doubled up, 223.
Decubitus on right side; lower limbs strongly, flexed upon the abdomen, and the head sunk between the shoulders, so that he seems doubled up and huddled together, 189.
Lies in bed, sometimes one way, sometimes another, 201.
When quiet he would lie on either side, generally on his left, with his thighs pressing against the abdomen, 290. [3560.]
He lay upon a sofa, on his right side, having his legs flexed upon his thighs, and these, in a slight degree, upon his abdomen, 350.
One another characteristic spoken of by Tanquerel was well marked in this case. It was the approximation to recovery and diminution in force of the attacks, so as to excite strong hopes of a speedy and complete restoration, and then a return of all the symptoms in their severity, followed by another amendment, what I should call getting up three feet and falling back two, 365.
After a few days he was taken with the characteristic symptoms of lead-poisoning, the diagnostic blue line on the gums included; he continued to be affected with the disease, with remissions and relapses alternating, for a period of two months, after which the recovery was progressive, though slow, 296.
First taken with vomiting, colic, and all the symptoms of lead-poisoning; since then has never been quite well; has an aversion to food; occasional slight colic and constipation. About four months after resuming work had a bad relapse; besides colicky symptoms there was a general debility, tremor in the legs and arms, and some œdema about the ankles; in a few days the hands were paralyzed, 525.
(Colic in 1850; second attack 1869; 1871, third attack. Paralysis began; lead rheumatism set in at the same time with the debility. Since the latter period, sleep has been troubled with nightmare. Since 1871, seven other attacks of colic, each successive one more severe, and accompanied by pain along the limbs, severe headache, and arthralgia; no delirium; no paralysis. In November, 1874, he left off working in lead; nevertheless, January 6th, without apparent cause, he was attacked by very severe colic), 508.
For four or five days has had severe symptoms of lead-poisoning; pain in the hypogastrium for two days; headache, restlessness, and even fully developed epileptic attacks for two days, 473.
(First attacked when at Montevideo; very severe colic, lasting fifteen days, accompanied by violent cerebral symptoms, so that he lay as if dead for some hours. Two months later another attack of colic, lasting three or four days only, but which he had scarcely got over when gradual paralysis set in, which so disabled him that he had to be fed by hand. Two months later the symptoms returned, only there was less paralysis than the first time), 526.
(His health remained good eight years, when he had a violent attack of colic, lasting about three months. Eight years later, weakness of the lower limbs; walking difficult, especially in the dark; from time to time, lancinating pains through the lower limbs; these grew much worse, and he could not clearly see a light), 329.
(Has had eight attacks of colic. Present symptoms: Dull colic; paralysis of extensors, of long standing; face much altered; profound cachexia; skin deep yellow), 501.
All the symptoms were aggravated at night, and particularly by lying in bed ; they produced such a continual agitation and anxiety as to compel him frequently to rise and walk about the house; in this mode he passed the nights, until the light of a new day saw him lie down on his couch worn out by fatigue and exhausted by suffering; these nightly walks always needed the aid of another person, and he retained when walking the same bent position as in repose, 350. [3570.]
Had his first attack of lead colic (quite a violent one) about twenty-two years ago. Had no further trouble of the sort until his second seizure in 1865. For some time previous to the latter date there had been a weakness of his upper extremities, to which, at the time of the second attack, there was added a trembling in them, that became in a few days very great. In a month, however, he left the hospital completely cured. Since then the tremor returned at varying intervals of time, but not very severely. It was worse in the morning, and he informs us that if he drank two or three glasses of brandy it would cease during the rest of the day. The affection had never been much as to prevent him from working. He had other symptoms of alcoholism, such as raising of phlegm in the morning, illusions of sense, etc. In the course of the last two months he had to spend several day in sandpapering some old wainscots painted in white lead, the process raising a fine dust, which he inhaled largely. On July 25th he had another and very severe attack of colic, and the trembling returned at the same time with great violence. According to his custom he took some brandy to relieve this latter symptom, but did not succeed in removing it. Being now disabled from work, he entered "La Charité" August 3d. The tremor affects the whole body. The upper limbs are agitated by rapid and well-defined oscillations. He has some difficulty in grasping objects, but electro-muscular contractility appears to be almost unimpaired. The lower extremities are similarly affected when he is standing up. The gait is uncertain; he staggers in his walk. The head also trembles perceptibly, the tongue quivers, yet there is no hesitation of speech. The dynamometer indicates a marked diminution of strength; the compressive force of the right hand equals seven kilograms, that of the left four and a half kilograms, the pulling strength twenty-two kilograms, 391.
The first symptoms which I can recall (I now speak of my first attack) are a peculiar uneasiness or moderate pain in the bowels, with a sort of feeling that there was or would be required some action of them, but no effect of the kind ordinarily followed, or could be induced by natural effort. Yet there was at that time no excessive constipation. This uneasiness, or these sensations, were not constant, but grew in frequency, the pain gradually creeping round to the lumbar region, when it became fixed and constant; by degrees, however, diffusing itself over the system, particularly the lower limbs. I do not recollect any pains in my head. But by the middle or latter part of the summer of 1838 I became greatly debilitated, yet was without fever, the pulse not elevated. An uneasiness or pain in the lumbar region now caused me continual suffering. I had a feeling of great misery; could walk but a few steps without wanting to sit down; and if I did so it was a great effort to rise again. I had a sense of constant lassitude or weariness, and an indisposition to motion. I was perplexed by the symptoms. The least fatigue, and all motion fatigued me, aggravated the suffering. I have now a very vivid recollection of going with two or three friends to pass a day at Nantasket Beach. We went out in a boat, and I well remember my sufferings as I lay listless in one end of it, trying by various changes to put myself in a posture of some ease, which I could not succeed in doing. I remember distinctly the question asked me by one of my companions: "Are you in pain?" I was scarcely able to get home. We rode in a carryall, and I remember the difficulty I had in supporting myself, holding as I could by different parts of the carriage. The bowels had now become wholly inactive, and it was, I think, two days, at least, before they could be moved, and then very imperfectly. During this time I was in a most restless state, day and night. There was no sharp pain, but a constant dull, gnawing pain, more particularly in the lumbar region and bowels, and a tired feeling in all the limbs. I was every moment changing my position, seeking ease, but not for a moment finding it. I would get out of bed every little time and sit in a chair, or attempt to walk the room, but it was all the same. There was no relief to be had. After the bowels had been effectually stirred, I found myself in a degree relieved. I went through the next year very well, keeping up my system of outdoor exercise so far as my duties allowed. In the latter part of winter, or in early spring, I had an attack, mainly, in the left side, apparently in the intercostal muscles. From this I recovered in no long time, and went on till late in the spring of 1840. Then and in the early part of the summer I had a return of the old symptoms described as occurring in 1838; only with this difference, that the development of the disease was much more rapid. I went through the same process of active medicines, injections, etc., before the bowels could be stirred. I became more debilitated than before, the countenance assuming in a more marked degree the peculiar earthy yellow described by M. Tanquerel. Then came on the pure arthralgic pains. They seemed to be deep, as if in the very bone, and were seated more particularly in the flexor muscles, as the inside of the elbow-joints and the joints of the knees. Soon after, that is in July, there commenced a trembling of the fingers, which soon passed into decided paralysis, the paralysis increasing for about three weeks. This paralysis was in the extensor muscles of the fingers, wrist, forearm, and arm of both the upper limbs; the lower limbs, with a slight exception, not being affected. My arms when left to themselves hung loose and dangling at my sides, as if turning on a pivot. Using only one at a time, I could elevate them only in a slight degree. I could not get my hand to my chin or mouth. But what puzzled me at that time was that there were certain motions which I could perform, for example, placing the palm of one hand against the back of the other, I could get them to my face; the flexor muscles of the hand, which were not paralyzed, being thus brought into action. So, too, I could draw on my boots almost as well as now, the same muscles acting. If my arms were elevated to a right angle with the body, the palm of the hand being turned downward, the whole hand fell at the wrist, hanging loose as a piece of cloth, and the will had no more power over it. I could not, without help, raise the hand in the least, not so much as one of my fingers, in the slightest degree. When I took a tumbler to drink, I clasped it with both hands fully spread, and could so get it to my lips. When I ate I rested my right arm, below the elbow, on the edge of the table, and grasping the wrist with the left hand, and then bringing my mouth down to within three or four inches of the table, I could get the food to it. The backs of the hands became prominently arched; the fingers, when left to themselves, became bent and half shut, the natural consequence I suppose of loss of power in the extensor muscles. The rotary motion of the arms was entirely lost, a fact to which my attention was directed, when they attempted to assist me to put on my coat. I tried all I could to exercise the poor lame muscles, but all fatigue, that is all use of them, seemed to be attended with injury. They had totally lost their contractile power. The abdominal muscles were similarly affected, though not in the same degree. If I had any it was only a slight power over them, which gave me great trouble when an action of the bowels was needed, though they could at this time be readily moved by medicine. All the time there was more or less of arthralgic pain, more particularly at this period in the inside of the knee-joints. The pain seemed to have no connection with the paralysis, and was greater in the parts not paralyzed than in those which were. The intercostal muscles on the left side were now affected; for months I could not sneeze; the moment the process began it was arrested by these muscles. The sensation was a very unpleasant one. I had no constant thirst, though I felt thirst at times, especially in the afternoon, or when unusually fatigued. I had little or no fever, though at one time a highly nervous pulse. I have spoken of the loss of the power of motion in certain muscles, or their loss of contractility. The sensibility of the muscles or nerves, with a slight exception, was not impaired, but the reverse. There was a soreness or peculiar tenderness in all my flesh. Sitting in a common wooden chair and leaning back, the parts of the chair seemed to penetrate to the very bones. The exception referred to was a small muscle in the inner part of the left thigh. There was a spot there or four inches in length, and two or three in breadth, which had lost its sensibility. There was at times a sensation of a peculiar and unpleasant kind at the bottom of my feet, a sort of burning, which I used to relieve, when in bed, by drawing up the covering and pressing the soles of my feet firmly against the foot board, which produced a cool and agreeable sensation. I had also at times a violent pain in the back between the shoulders, rather nearer the right than the left shoulder, which I would relieve by getting on my bed and lying flat on my back, bringing as much pressure to bear on the part affected as I could. This method mitigated the pain before a long time In a multitude of ways I was a great sufferer; but the brain I did not think was affected, and I do not now think it was, 283.
Tremor, 304, 505 ; in seventeen cases, 567 , etc.
Slight muscular tremors, 386.
Considerable tremor suddenly came on (the colic having ceased under treatment), especially in the arms, which appeared to be almost equally affected. The trembling of the lower extremities was comparatively slight, 398.
Each successive attack of lead colic had been followed by a worse attack of tremor. During the intervals the tremor was not sufficient to impede movement, and was chiefly aggravated after great fatigue. It was also considerably increased by any mental excitement, whether pleasurable or otherwise, and in this case extended to the lower extremities, 394.
Limbs and body almost incessantly jerked about, 217.
Tremor and partial delirium during two days, 322.
The tremor is worse in the evening, when he is fatigued, 399.
Slight tremor, with weakness of the left hand, 133. [3580.]
Aggravation of the tremor by excessive drinking, 399.
Repeated jerkings, 29, 52.
Jerking movements of limbs and body, 223.
General twitching and convulsions, 20.
The muscles tremble, they are even affected by painful convulsions, or also become paralyzed, pale, and soft, 21.
Tremulousness, with commencing paralysis of the upper extremities, 348.
Constant jactitation, 335.
Extreme agitation, 315.
Attacks of muscular agitation, accompanying the talking spells, 190.
Violent involuntary movements of the muscles, becoming horrible convulsions, 56. [3590.]
Spasmodic movements, 53.
Apoplectic attack, with paralysis of the left arm, 115.
Attacks of apoplexy, 46.
Death by coma or apoplexy, 171.
On the 7th of January he was suddenly attacked with epileptic fits . He had a succession of fits, which lasted for thirty-six hours. He stated that he had no recollection of anything that had happened from the time of his admission into the hospital until the 12th of January; that he woke up with severe headache, occupying the entire head, with vertigo, and found that he had lost the power of moving the left leg and the right arm. There was a decided diminution of sensation in the affected limbs, and the right hand was in a permanent semiflexed condition, with very little power of opening or closing the fingers, 327.
A sudden violent shock in the extremities, so that he fell to the ground, with spasmodic flexion of the legs; so great he heels touched the nates; on attempting to extend the legs he suffered the most violent painful cramps in the thighs and calves, at the same time the abdomen was retracted and so sensitive that the touch of even his shirt caused the most violent pains, with obstinate constipation; this was followed after a week by a similar sudden shock in the arms, with spasmodic pain; the hands were violently flexed and the fingers spread apart; the pains lasted several weeks, and gradually disappeared; during this period he was able to sleep only while lying on the back, with the right arm clamped between the legs; after the spasm left the arm he noticed that he could not use the right arm as easily as before, and that the fingers hung down; the next year the left hand became affected in a similar manner; all these attacks had been attributed to colds; the skin of the arms became rough, dry, cracked, 378.
Attack of lead epilepsy , while in bed. One quick loud cry; tetanic rigidity of the neck and limbs; face pale; entire loss of consciousness; respiration ceases in a moment; face blue; congested spots on the forehead and face; spasms of the facial muscles; slight clonic convulsions (movements concentric); bloody whitish froth at the mouth; this condition lasted three minutes. Paralysis of the limbs; coma, with stertorous breathing, lasting a quarter of an hour; aroused to half consciousness, but continued drowsy. Two other fits in the course of the day; not so strong, 523.
His face turns deadly pale; and without a cry he is seized with an epileptic fit , which lasted four minutes. The clonic convulsions were of so violent a nature, existing in the diaphragm and muscles of the larynx as well, that for a moment death from asphyxia seemed inevitable, 384.
Very violent epileptic attack at about 10 A.M.; immediately became unconscious; convulsions of the limbs; tetanic stiffness of head and body; face livid and horribly distorted; stertor; foam at the mouth; spasm of the eyeballs; this attack was succeeded by deep coma, during which he lay motionless in bed, with half-closed eyes and open mouth. Sensibility and motor power are retained, though in a diminished degree; some dull grunts at long intervals, and occasional automatic movements of the limbs are the sole evidences of animation, 200.
A sudden violent epileptic attack , with total loss of consciousness, deathly paleness of the face, stertorous respiration, with prolonged inspiration, pulse 112; for two minutes the arms and hands were forcibly extended and pronated, and affected with convulsive spasms, 580. [3600.]
epileptiform spasm , with convulsive twitchings of the face; followed by a transient general epileptic attack, with stertor and complete loss of consciousness, 578.
Epileptic convulsion ; the muscular contraction began in the abdomen, and extended upwards to the throat; the jaws were so violently brought into contact that a tooth was dislodged; the eyes rolled upwards; and lastly, the muscles of the limbs were affected. For an hour after the convulsion the patient lay perfectly motionless, and then became very restless and talked incoherently. In about nine or ten hours he had a second convulsion, and after nearly an equal interval a third, and again a fourth. Each fit lasted for one minute; they were all preceded by vomiting a dark-colored matter, and followed by symptoms similar to those which succeeded the first fit, 362.
Frequently put the hands to the head, with convulsive movements of the eyes, hands, and feet, 575.
Attack of fully developed epilepsy with biting of the tongue; it lasted a quarter of an hour, and was immediately succeeded by coma, which continued twenty minutes. On regaining consciousness he wanted to get up and walk about, work, take a drink, etc., then relapsed into coma, and so on alternately; the delirium lasting three times longer than the coma; the delirium more generally occurs after than before the epileptic attack. Pupils so much dilated that the iris is hardly visible, 197.
He was hardly in bed at the hospital before he told us he was about to have an attack, by the sensations of formication and pricking, which extended from the index and thumb of the right hand to the shoulder; at the same time the fingers became flexed into the palms, the thumbs being covered by them. The forearm was strongly flexed upon the arm, and held in forced pronation; the wrist also was strongly flexed, and the whole limb agitated by clonic spasms. The right hand and forearm were red from stagnation of blood; with his left hand he supported his right forearm, which tended in its movements to approach the trunk. The head also shook, and was inclined to the left. There were slight spasms of the eyes. There was a slight circular movement of the lower jaw, but no frothing at the mouth, nor was the intellect in the slightest degree affected, although he was unable to utter a word; and he fully understood everything that was said within his hearing. The attack lasted about half a minute. After it was over he complained only of a little numbness of the right hand, 180.
Four fits; two at intervals of several days, and the other two on the same day, 290.
A week before his admission into the hospital he had eight epileptic attacks , one after the other. Three days after admission he was seized with epileptic fits, which continued to recur frequently for two days, until death, 439.
Eight epileptic seizures , one after the other, on the eighth day before his admission to the asylum; a few days after admission the fits returned very frequently, 440.
Peculiar paralytic sensation extending from the back towards the hands and down to the feet, especially involving the left side of the body, which felt asleep; she was unable to move a limb; this paralytic condition seemed to disappear with a shock, and was followed by a sudden spasmodic stretching of the left extremities, which seemed as if dead; wherewith the fingers of the left hand were spasmodically closed, with pronation of the wrist and gradual extension of the arm at the elbow, and extension of the left lower extremity from the knee to the ankle, lasting several minutes; this cramp returned at short intervals; the patient cried aloud from pain, and, although consciousness was partly lost, yet she was able to make short, indistinct answers; after about twelve hours these spasms affected other muscles; whenever a spasm occurred the head suddenly and with a jerk was drawn to the left side, and at the same time bent forward, so that the chin rested upon the left clavicle; during the next day the spasms occurred every quarter or half an hour, and the excessive paleness of the face of the first day changed to a bright redness; on the third day the spasms began to affect the right side in a similar manner, and were associated with opisthotonos, so that the body was balanced upon the neck and heels; at the close of the paroxysms, rattling in the trachea and oozing of tenacious, frothy mucus from the mouth; at this time there began to be noticed, during the intervals between the spasms, a jerking of the facial muscles; pupils contracted, the sclerotic dirty yellow, lips bluish, gums retracted from the teeth, exhibiting a lead line, middle of the tongue covered with a yellowish-white coating, 328.
Epileptiform convulsions in the third, of which she died, 535. [3610.]
Fit of epilepsy, 77 , at 5 A.M., of which he was unconscious, 188.
Epileptic attacks, 385.*
Several had fits, described as being hysterical, 277.
Epileptiform spasms ; the patient fell to the ground unconscious, lips rigid, with spasmodic contractions, frothing from the mouth, eyes turned upward, pupils insensible, somewhat dilated, 272.
Epileptiform paroxysms , with frothing from the mouth, convulsions of the arms, 114.
During the fourth day of delirium, twelve epileptic fits , followed sometimes by delirium, sometimes by coma, 191.
During the fifth day of delirium, movements of an epileptic character took the place of distinct fits of epilepsy, and in these convulsions he passed away, 191.
During her last few days epileptic fits supervened, which by their violence and frequency, soon rendered her apparently quite insensible to what was passing around her, 71.
Epileptiform twitchings , in all parts of the body, followed by paralysis, 42.
Epileptic attacks , in which the tongue becomes excessively swollen, protruded, and bitten, 46. [3620.]
Epilepsy, 28

[From large doses.], 32

[From the application of White led to an excoriated place behind the ears, in a healthy man.]

Has had two attacks of epilepsy, 373.
Suffering from epileptic fits , occurring about once in a fortnight, severe in character, and of three years' duration, 372.
Ten epileptic seizures in about two years; in which he fell down with a cry; became very pale; there was at first stiffness; then followed contractions. The attack lasted about an hour, and was followed by great prostration. It was accompanied by involuntary urination, 521.
The paroxysms occurred only every half hour, 220.
Small spasmodic shocks shoot like lightning over his face and limbs, 188.
Spasms, 233.
Violent spasms, 315.
Tetanic spasms (after two hours), 274.
Spasms of particular muscles, and in two cases, of the whole body, with delirium, 70. [3630.]
Epileptiform spasms, 44.
A series of spasms, and convulsions of various kinds, at first with free intervals, which, however, gradually became shorter and shorter, until the last twenty-four hours the spasms were almost uninterrupted; on the fifth day the patient became comatose, 328.
Seized three times with what seemed like a tetanic spasm; then came sharp prickings in the hands, the forearm, in the whole lower limb, and then the limbs were stiffened, the jaws were clenched convulsively, 268.
Clonic spasms of the muscles of the face and extremities, with loss of consciousness, frothing from the mouth, and puffiness of the face (with albuminuria), 429.
Violent clonic and tonic spasms , with both eyeballs rotated upward, repeated four or five times daily, 432.
Suddenly seized with convulsions ; the upper and lower extremities were violently thrown into alternate flexion and extension; the body is forcibly and involuntarily shaken; the head bends backward. All sensation is lost, but there is neither frothing at the mouth nor stertor; the face is injected. The convulsions lasted about five minutes. When they cease, he lies quiet and motionless in profound coma, and cannot be stimulated into attention. After this has continued for a quarter of an hour, convulsions again set in, but do not last as long as at first. Thirty-four convulsive seizures were counted within twenty-four hours; between them he was always comatose, 198.
Convulsions , preceding which the patient cried out, turned very pale, then became very much flushed, immediately following which the body was seized with violent clonic spasms, lasting an hour, and followed by great perspiration; the attack was associated with involuntary discharge of urine, 498.
The latter part of September his brother reported that at school he had fallen, and according to his description was convulsed . It subsequently appeared that some days previous he had a similar attack while amongst his playthings in an attic room, when his brother noticed him lying on the floor and acting strangely, and asked, "What he did so for?" he replied, "He did not know." The evening of the day of the attack at school, the nurse called his parents, after he had been asleep, saying that he was breathing strangely. Nothing abnormal appeared when we arrived, but in the course of an hour I heard the heavy and laborious breathing, and found him in a convulsion, which continued not over a minute. The eyeballs were distorted, and the body and arms flexed spasmodically. These attacks numbered seven or eight daily, and in the course of two or three days amounted to fifteen daily, which number daily continued until the middle or latter part of the following February, having, however, once numbered twenty-two to twenty-three in twenty-four hours; but this was when the attacks were not the most protracted nor the most brief. The duration of each attack varied at different periods, from (I should judge from memory, not by the watch) one-third of a minute to one and a quarter or one and a half minutes. They did not vary much in duration and severity usually during a period of twenty-four hours, but did in a period of weeks. The heavy, laborious, almost stertorous breathing was our first admonition during the early attacks (when he was asleep); soon this ceased, and during the last month or two this symptom occurred only at the close of the convulsion, and was our first notice of its subsidence. Indeed, I remember failing to discover any sign of respiration during the greater part of an attack in some of the later weeks. Some other symptoms varied in a like manner, as to order, during the whole period. A small quantity of saliva ejected from the mouth terminated many of the attacks, perhaps one-fourth of them. The turning in of the thumb upon the palm was sometimes noticed, but was not always or uniformly the case, while I think strong flexion of the fingers was a usual accompaniment. The strong contraction of the muscles of the back and neck, at the termination of the convulsions, was noticed during the severe attacks, but did not accompany the lighter attacks. The attacks in the daytime were without premonition; sometimes he thought he had a slight dizziness a moment before, but was unable to notify us. To us the attacks seemed instantaneous; as when as cheerful as usual (talking the moment before) he would fall to the floor from his seat; once, when standing by the dinner-table chatting with his brother, he fell backwards, turning one-quarter around, the arms and neck contracting, otherwise at full length, striking his head against a sheet-iron stove, 365.
Having never had nervous complaints of colic (except an attack of the so-called "Madrid colic"), was suddenly taken, while eating, with convulsions movements of the limbs , soon followed by a general stiffness. No frothing at the mouth or stertor. He fell to the ground, but without loss of consciousness; could not answer questions, but understood all that was said about him. This state lasted five minutes; after which he could talk as sensibly as usual; only complaining of great weakness. Next day another convulsive attack like the above, 179.
Suddenly his head inclines forcibly to the right, his limbs stretch out, become stiff, and are strongly convulsed , as also is his face, which turns blue; his eyes are wide open and rolled upwards; pupils exceedingly dilated; violent shocks pass over the whole body; bloody froth issues from the mouth; the beats of heart and pulse are tumultuous and quite strong. Then the spasms of body and limbs subside, the oppression increases considerably, and he is threatened with suffocation; inspirations are deep-drawn and difficult. The previously dark-red face becomes pale as a corpse; only the whites of the half-opened eyes are visible; the body becomes cold; the frothing at the mouth ceases; he remains motionless an sleeps a little while; pulse 140, and very small. He awakes in a few minutes, his eyes fixed and staring, and his whole countenance looking very dull; is ill-humored, and will hardly answer questions; finally, turns over to his left side and falls asleep, 188. [3640.]
After working seven weeks, an attack of colic; five days later saturnine encephalopathy set in; he fell down unconscious when in the act of washing his hands; then he had spasms ; this attack lasted two hours. Four or five hours after, another attack like the first; it only lasted an hour; until this time his lead symptoms were confined to these to attacks, and a certain degree of muscular weakness in the upper extremity only. A few days afterwards he found that he could hardly use his upper limbs in eating; when he tried to carry a glass, for instance, to his lips, his arm shook so much that he could not drink; the muscles were also very weak. Next day there was slight formication in the lower limbs; walking was still almost natural. At the end of four days he walked with difficulty, and was obliged to lean against something so as not to fall down; at the same time he had severe headache, with dimness of vision and hard hearing, especially on the left side. In proportion as the difficulty in walking increased, the involuntary movements of the upper limbs became less decided, 528.
When seized by a paroxysm, he lies down on the floor, rolls about in every direction, places himself in all sorts of attitudes, squeezes his feet, calves and knees with his hands; groans aloud, calls for help, while his distorted face expresses the keenest agony; entirely engrossed by his pain, he can scarcely answer when addressed. In from three to five minutes, he gets more quiet, but is so completely exhausted he can hardly stand on his feet, 133.
Frightful convulsions with cold clammy sweat, 69.
Most violent convulsions , with loss of all the senses, in recurring attacks, 11.
Frequent and frightful convulsions and colic, 35.
Convulsions , with frothing from the mouth, as in epilepsy, 24 . [Immediately recurring after swallowing an ounce of extract Saturni Goulardi.]
*Convulsions, 9, 45, 71, 85 , etc.
Convulsions of the whole body, 12.
Convulsions, lasting four hours, 43.
Convulsions, that constantly recur at shorter intervals (eighth, ninth, and tenth days), 47. [3650.]
Convulsions, returning from time to time, followed by deep sighing, and on waking, pains in the limbs and in the epigastric region, 35.
Hypochondrium seemed distended and tympanitic; on moderate pressure gurgling sounds in various parts of the abdomen; pressure in the umbilical region seemed to cause pain; retention of stool and suppression of urine; even on the next day the left side was more affected by paroxysms than the right; sometimes they assumed a tonic, at other times a clonic character; on the sixth day, the muscles of the left side of the face only were affected; there was not only opisthotonos, but also sometimes emprosthotonos and pleurothotonos; the tonic spasms always occurred suddenly, as with a shock, affected especially the muscles of the face, neck, trunk, and extremities at the same time; the head became drawn towards the left side and fixed as above described, the muscles of the shoulder and nape of the neck drew up the shoulder; the left arm and left foot were so violently stretched out that the joints creaked; the muscles of the left half of the face were drawn down so that the lips were closed, and the left corner of the mouth drawn downward, and the left cartilage of the nose drawn to the left side; the attack generally lasted about two minutes and suddenly ceased; the clonic spasms affected all the muscles of the face; they usually occurred after the close of the atonic spasms, sometimes, however, preceded it, were characterized by trembling and twitching affecting the orbicularis palpebrarum and corrugator superciliorum, and also the levator labii, and sup. alæ nasi, the depressor alæ nasi and levator of the upper lip, zygomata, and risorius muscles; trismus I did not observe; closure of the mouth was effected by the orbicularis oris; at times also twitching of platysma myoides, 328.
Four or five convulsive efforts daily, characterized by spasms, during which the patient lost consciousness for half an hour or an hour, without frothing from the mouth, 35.
Every day or two he has an attack of spasmodic contraction of the flexor and adductor muscles; his legs are forcibly flexed on the thighs, and the thighs on the abdomen, and sometimes one leg is drawn over the other; his arms are drawn so forcibly against his chest that it is impossible to raise them, and the forearms and wrists are forcibly flexed; the muscles of the neck, particularly the sterno-cleido-mastoid, draw the head clear down upon the thorax, and greatly to one side, and occasionally the head is jerked from side to side; during these attacks he is perfectly conscious, but if he attempts to talk, he stutters and makes peculiar indistinct sounds, but cannot articulate; he also makes a groaning sound, which he says is involuntary; during the attacks of spasm, he suffers intolerable pain, and is left completely prostrated when they are over; during his worst attacks, the pulse does not exceed 80 beats per minute, and generally it is about 65, full and steady. The rectus abdominis, upon each side, contracts so as to be prominent and hard almost as bone, and all the muscles attached to the ribs contract so forcibly as to draw them in, and produce such pressure upon them as to cause him to frequently cry out that they are breaking, 499.
Convulsive tremulous movements of the muscles, 28.
Frequent spasmodic flexion of the arm and right leg, with automatic movements of the left hand to the head, shortly before death, 339.
Convulsions, with loss of consciousness, 498.
Uræmic convulsions, with distortions of the eyes and opisthotonos and complete loss of consciousness, with a puffy face; the spasms were repeated with increasing frequency, followed by slow respiration, sinking of the pulse to 36, 429.
Suddenly, while at work, without precursory symptoms, he was seized by violent convulsions, followed by profound coma, 200.
One patient had convulsions and vertigo, several times, 266. [3660.]
Every now and then, there came on a genuine paroxysm, accompanied by violent cramps in the legs and retraction of the testes toward the inguinal ring, 252.
Drinking seemed to hasten the return of the paroxysms; hence, though very thirsty, he dared not drink often, 212.
Slight convulsive seizures every five minutes, while in a state of the most profound coma. At last he succumbed, after a violent attack, which continued almost fifteen minutes, 198.
Sometimes a tendency to universal convulsions, 65.
Convulsive seizures, with loss of consciousness, 521.
Fell without consciousness (after a quarter of an hour), 268.
May determine in children, convulsions, idiocy, imbecility, and epilepsy, 452.
The limbs became quite rigid; jaws spasmodically closed; during these attacks, which lasted about ten minutes, the patient was unable to stand; chilliness at the close of the attack, 274.
He fell to the ground unconscious, 90.
Opisthotonos, 63, 575. [3670.]
Rigidity and tetanus, 56.
Two or three crises during the day, with prickings in the skin, and contractions of the jaw and of the limbs; violent supraorbital pain, twitching and constriction in the temples (first day); the spasmodic cries more frequent, but less violent; tingling in the limbs (first night), 268.
All movement, also standing, was impossible for about six minutes while the crisis lasted, 268.
Between the attacks he lay quiet; his features much sunken and expressing great anxiety. The pain is dull and benumbing. The paroxysms returned at very irregular intervals, 219.
Between the paroxysms he usually lay on his belly, with his eyes closed, and avoided the slightest movement, 222.
Between the attacks, he lay with closed eyes, silent and motionless, for fear of renewing the pain, 209.
Between the paroxysms, still restless; the pain, though less acute, was still overpowering, 211.
During the intervals of quiet, which were of very irregular occurrence, she lay tired out and almost motionless, with closed eyes, and not daring to move or even answer questions, for fear of renewing the paroxysms, 218.
General paralysis, 38, 53, 60.
General paralysis and deficient nutrition, followed by death, 42. [3680.]
Complete paralysis of the muscles, 28.
Syncope, 55.
Paralysis, 9, 23, 39, 41, 52, 290.
As the paralysis appeared the spasmodic pain in the abdomen disappeared (in many cases), 12.
Paralysis, commencing in slight numbness of the parts, and trembling, terminating in loss of motion and atrophy, 305.
Motor and sensory paralysis affecting chiefly the whole right side of the body, 483.
The paralysis equal on both sides, 141.
Electro-muscular contractility much diminished on both sides, 396.
One-sided paralysis, 53 . [In a child who often walked over hot sheets of lead with bare feet.]
Paralysis of the whole left side of the body, 579. [3690.]
Some years later, he had a second attack of dextral hemiplegia, which especially affected the upper part of the body, 470.
Motor and sensory paralysis, chiefly on the right side of the body, 476.
The paralysis is much worse on the left side; the right wrist is hardly at all affected, 150.
Left-sided hemiplegia, with contraction of the left hand and distortion of the face, towards the right, 575.
The paralysis is rather worse on the right side than the left, 140.
Great difficulty in moving himself in bed; so that he remains lying on his back; all other movements of limbs and body are as easy as usual, 143.
Lies on his back, sometimes turned one way, sometimes another; motion is freely performed, only the right extensor comm. digit. being paralyzed, 196.
Muscular movements are difficult, 44.
Seriously ill for the last twelve months, and had never been well for more than five years. He was totally unable, from want of muscular power, either to walk, turn round in bed, dress, or feed himself; this had been his condition for several months; he persisted in the idea that he was laboring under suppressed gout, 491.
Locomotor ataxy, especially when his eyes are shut, yet his muscular strength is undiminished; his leg cannot be bent upon the thigh, 529. [3700.]
(Attacks of colic; then suddenly motor and sensory paralysis of the upper part of the right half of the body, upper limb, and face. Epileptic seizures. Another attack of paralysis, limited like the first to the right upper limb and right half of the face, including the tongue. Four epileptic attacks. Face œdematous), 487.
Paralysis; the tongue and muscles on the right side being partially involved, and the right arm and right leg; completely, 536.
Transient paralysis, with immobility of the arms and legs, inability to talk, and insensibility of the limbs, 80.
Transient paralytic attack, 26.
Paralysis, involving both sides; more the right than the left, and not entirely limited to the upper extremities, though chiefly there found, 534.
No local paralysis; sensibility unimpaired, 399.
Paralysis of the right side, with curvature of the spine, 38.
Very general paralysis; he could not move either arms or legs, so that he was wholly unable to get out of bed, 553.
The right side became more and more feeble; mobility of the upper extremities very much diminished, associated with some atrophy of the muscles of the posterior portion of the upper arm, with very limited extension of the hand; sensibility of the arm to touch and temperature also diminished; of the lower extremities the right limb was very feeble, so that walking was very difficult; the right lower extremity was affected with anæsthesia, like that of the right side of the trunk, right arm, and right side of the face, corresponding exactly to the median line of the body; there was diminished sensibility of the right side of the tongue; the reflex movements in the throat were almost entirely abolished; the voice was nasal and speech very indistinct, 496.
No amount of effort produced the slightest movement in the large dorsal or pectoral muscles, or in those of the shoulders, arms, forearms, and hands; although after great and long-continued exertion, he succeeded by the action of the trapezius in raising his shoulders a little, 144. [3710.]
Eventually all muscular power seemed to leave her, and she tumbled from the chair in which she was sitting to the floor. I noticed that there seemed to be not so much a loss of muscular power as proper co-ordination; and, although if shaken and spoken to loudly, she would answer questions intelligently, immediately afterwards she lapsed back into stupor, 357.
First attack of lead colic, six years ago, severe. Eight or ten days thereafter, paralysis of the hands; could not lift them. This had been preceded by slight cramps in the fingers, which came on before the colic and lasted about fifteen days. Wandering pain throughout the body generally, now here, now there. Second attack four years ago; suddenly taken with colic and cramps; paralysis of the extensors remained. Third attack three years ago; increased paralysis, which remained. Fourth attack, one year ago; paralysis unchanged. Fifth attack, fifteen days ago; very severe colic; increase of paralysis, 523.
A certain degree of hemiplegia on the left side, 385.
Painful stiffness on movement, 475.
The right side is weaker than the left, 525.
He began painting at the age of sixteen years, and left it off to enter the army at the age of twenty-one, without having felt the slightest symptom of lead-poisoning. While still in the latter service, at the age of twenty-three or twenty-four, he suddenly felt, during a violent fit of sneezing, a cracking in the right side of the head; and immediately after was taken with formication and numbness in the whole right side of the body, together with weakness of these parts. All these complaints gradually got better, and when his term of service was ended, they had entirely disappeared, 470.
Lead palsy begins with a simple numbness or slight tremor, and ends with a complete loss of the power of movement. The degree of this loss bears no proportion to the extent of the paralysis. Saturnine tremor is rather a slight agitation, than a visible contraction and expansion of the muscles. It is never accompanied by that perceptible and almost spasmodic action which characterizes mercurial tremor. This affection really constitutes the first stage of lead palsy; it is connected with a marked weakness of muscular contraction. When the parts affected by tremor are put in motion, their muscles seem to hesitate or oscillate in their contractions, which are short-lasting, and doubtfully performed. Moreover there is always complaint of weakness in the parts affected by tremor, even when there is no fully developed paralysis. Upon saturnine tremor, when it has lasted some time, there almost always supervenes a complete paralysis of one or more muscles of the affected-parts. The tremor is almost always restricted to a part or the whole of one limb, rarely affecting two at once; but it may involve both the upper and lower extremities, the lips, tongue, or vocal apparatus, 117.
The paralysis, though incomplete, is widespread, and the external muscles are wasted and very soft; those of the upper extremities are most affected, 562.
About a month before he was seized with colic, followed by palsy of the forearm extensors, and of the lower extremities, and when first seen he had the characters of general paralysis of the insane. He could not lift the feet from the ground. Then followed bilateral facial spasms, trismus, frequent spasmodic jerkings of the upper limbs, the flexors of which were firm and rigid, while the lower limbs were rigidly extended, 544.
A condition of increasing chloro-anæmia, with nervous erethism, 364. [3720.]
General debility, 171, 351, 370, 483, 562.*
Such debility that he could hardly stand up, 474.
Debility extraordinary, with constant fainting spells; she could not rise up without swooning, 402.
Debility almost immediately, 268.
General debility, preventing him from standing up, 484.
General debility, and painful lassitude, 477.
General debility, and special weakness of the lower limbs, 468.
Obliged to lie on the bed the greater part of the day on account of excessive debility, 458.
Great debility, 215, 485.*
Increasing debility and loss of flesh, 560. [3730.]
Increasing debility, 537.
The emaciation is accompanied by more or less debility, 117.
After any excess, the debility is increased, and the paralyzed limbs are even affected by a slight tremor, 139.
He feels that he is debilitated. Can hardly lift a chair with his right hand. The left hand is much less affected. Frequently a feeling in the fingers, especially those of the right hand, of numbness and formication, lasting a few moments, and followed by a rather painful pricking sensation, 530.
General feebleness, with trembling of the limbs, 497.
Very feeble, 373.
All bodily movements are slow, difficult, and somewhat painful, 195.
Moves only when necessary, and very slowly, 201.
Great prostration at twilight; he lies down, feels the beating of the pulse, becomes hot in the face, that burns in several spots, without sweat and thirst; with trembling of the hands and vertigo, as if the couch moved, renewed by thinking of it, with sensitiveness to noise; he at last falls asleep and wakes after three hours with a weary prostration, that disappears after moving about; there, however, remains dulness in the head and a bruised feeling in the small of the back, 3.
General prostration, with great weakness of the extremities, 69. [3740.]
Extreme exhaustion, 12, 18 . [From the internal use of sugar of lead.]
*General prostration, 334, 466, 476, 479, 481, 531.
Great prostration, 73, 235, 278, 354, 385, 369.*
In the more aggravated cases, great prostration and collapse, 267.
Appears prostrated, profoundly anæmic, 319.
Prostration; he lies down, feels a beating in the neck and abdomen, and can sleep but little (first day), 3.
On rising in the morning, often (not always) completely enervated, with neither energy, strength, nor courage, 297.
The prostration, weakness, sleepiness, pains that follow, in direct contrast to the general feeling of health noticed the first day, seem to be extraordinarily agreeable; during the primary action it was cold and wet, during the secondary action it was the finest spring weather, 3.
If he puts himself out in any way he shakes violently, "like a leaf on a tree," and his gait becomes unsteady and jerky, 563.
Collapse and syncope, almost immediately, 229. [3750.]
Weakness and trembling, 52.
Unusually weak and relaxed after motion, 3.
Easily became fatigued, on walking (fifth day), 3.
Weakness and loss of sensation after the convulsions, with weak and slow pulse, 47.
She could not sit up in bed or extend her arm fully, 343.
Sense of great weakness and depression, 445.
Continually complained of excessive weariness; all exercise was fatiguing, 331.
Gradual loss of strength, 519.
But little strength, and is barely able to sit in a chair or walk across the room, 499.
Weakness and loss of power with loss of sensation, 27. [3760.]
Feels very weary and indolent, 42, 239.
Considerable weakness (of the affected parts); according to Duchenne's dynamometer, the compressive force of the right hand is equal to 6 kilogr.; that of the left hand to 8 kilogr.; pulling force, 43 1/2 kilogr., 399.
Such weakness of the muscular system generally as almost precluded the patient from walking, or even standing for any length of time, 232.
Weakness, fatigue (second day), 268.
Slight diminution of compressive and pulling strength, as estimated by the dynamometer, 397.
All his movements are slow and feeble, 138.
Malaise, 312.
Languor, 371.
Languor so complete as to unfit them for any exertion, 446.
Great languor and lassitude, 316. [3770.]
General languor, 70.
Lassitude, 209, 457, 459, 383.
Painful lassitude, 478.
General painful lassitude, 479.
Faintness, 32, 28 . [Effects of large doses.]
Frequent faintings, 276.
Frequently seized with a sensation of faintness and præcordial uneasiness, as of impending dissolution, 558.
Faintness, 232, 429, 277, 567, 584.
Attacks of faintness, frequently lasting an hour, 109.
Occasional fits of restlessness, 562. [3780.]
Generally restless, 297.
Exceeding restlessness for the last two nights, 97.
Extreme restlessness, 85, 549.
Incessant tossing about the bed, without being able to find rest, 326.
Turns himself about in bed, 223.
Nervous restlessness, 287.
Uneasiness, 233.
Constantly tossing about, 120.
Although the pains are aggravated by motion, he is constantly seeking relief by changing his position, 132.
During the paroxysms, he is restless, bends double, lies upon his abdomen, screams, etc., 194. [3790.]
Extreme restlessness, 208.
Restless; rolling himself up in the bedclothes; lying on his belly, etc. (during the paroxysms). Pain a mere constriction, but increased by pressure (between the paroxysms), 203.
During the remissions, which occurred only at long intervals, he had very little repose, but was not so extravagant in his manifestations, 217.
Constant change of position; he doubles himself up, but avoids lying on the abdomen, and any pressure on the latter somewhat aggravates, 215.
Sometimes with his head almost on the floor, his feet tangled in the bedclothes, and his hands grasping the rails, he kept up a sort of rocking movement, 223.
During the paroxysms, he kept turning himself in bed, but with difficulty, on account of his great corpulence. He often tried lying on his belly, but could not remain long in that position, as it suffocated him; he threw his limbs about and cried out at times, 220.
The slightest touch of the skin over the umbilicus, and indeed over other parts of the body, produced such terrific pain as almost to throw him into convulsions, producing all the effects of an electric shock, 271.
Hyperæsthesia of the skin, 429, 573.
Excessive hyperæsthesia of the cutaneous nerves, at times so great that it was impossible to lightly touch the surface of the body without the most violent pain, accompanied by crying and weeping, but deep pressure relieved the pain; the sensitiveness was not constant nor general, but affected sometimes one part, sometimes another, and sometimes disappeared entirely and returned without apparent cause; it seemed especially violent over the bony processes, as for example, on the spinous processes of the dorsal vertebræ, 326.
The surface of the body was affected with an excessive hyperæsthesia, so much so that it was often impossible to touch even slightly the skin of the chest, abdomen, back, face, and superior or inferior extremities, without forcing tears or cries from the sufferers. This hyperæsthesia was only superficial, and was much more excited by a slight touch than by hard pressure; thus, if instead of touching the abdomen with the end of my little finger, I applied firmly my open hands, far from increasing the pain, it lessened it. This increased sensibility of the cutaneous system was neither constant nor general; it was excited sometimes in one part of the body, sometimes in another; at times it would become less, and now and then entirely disappeared, to reappear soon after without any ascertainable cause, 266. [3800.]
Paralyzed parts very sensitive to cold, 161.
He immediately feels the slightest prick anywhere on the left side, 466.
Entire loss of cutaneous sensibility in the hypogastrium and iliac regions; also in the penis, scrotum, and upper two-thirds of the thighs. Pressure on the hypogastric region causes pain, which is not the case with the other insensible parts. The skin of the affected parts is insensible to pricking pinching, etc., but pain is felt when a pin a thrust deeply in, or the muscles are pinched, 162.
Complete analgesia over the entire surface. Sensitiveness when tickled, which is normally very acute, is considerably diminished, but not abolished. It is diminished in the palms of the hands, especially of the left. In the soles of the feet he scarcely feels any amount of tickling; although, before working in white lead, he was so sensitive to it, that it would make him jump immediately, 474.
Complete anæsthesia of the right arm, for both contact and temperature; this anæsthesia extended over the right side of the face and right lower extremity, 498.
Diminished sensibility over the whole body, 570.
Anæsthesia, 562.
The entire surface of the body was deprived of sensibility, 465.
Loss of sensation and motion, 13.
Insensibility to burning of the whole right side. But a small blister, applied over the middle of the forepart of the insensible right thigh, gave rise to pain in that spot, 476. [3810.]
Out of one hundred and two cases of motor-paralysis, anæsthesia of the affected parts was observed in five cases, and arthralgia in eight. In three cases out of the five, the paralytic anæsthesia seemed to involve the deepest tissues of the limbs; the muscles, as well as the skin, appearing insensible to all stimuli. In the two remaining cases, the loss of sensibility was confined to the skin, the patients complaining of violent pain deep within the limbs. Thus, paralysis may be accompanied at the same time by both anæsthesia and hyperæsthesia. When only hyperæsthesia coexists with motor paralysis, the pain is referred to the skin, the muscles, or even the bones, 117.
Complete absence of pain when pricked, in the right side (right limbs, and right half of the face and trunk). Quite a deep prick with a pin causes only a feeling as of a heavy touch, 466.
Loss of sensibility to tickling in the whole right side of the body, 476.
The affected members are in an almost complete state of anæsthesia, 385.
Insensibility to pricking in the right hard, lower half of right forearm, and right cheek; diminished sensibility to pricking in all the rest of the right half of the body, and lower half of left forearm. Loss of sensibility to burning in the right hand only; burning is only felt as a warmth, 487.
Insensibility to pricking, of the right upper limb (excepting the shoulder), and of the right foot, right leg, and lower third of right thigh. Diminished sensibility to pricking, of the right side of the face, right shoulder, and upper two-thirds of the right thigh; also of the left upper limb. The transition from entire to partial insensibility takes place abruptly, and along the line of junction of the lower third with the upper two-thirds of the right thigh, corresponding exactly with the lower border of the patient's shirt, 476.
Sensibility to temperature notably diminished in the right side, especially in the right upper extremity, 476.
No perception of temperature anywhere on the right side; the right foot, when resting uncovered on the ground, does not feel cold, as the left foot does, under the same circumstances, 466.
Sensibility to temperature is less on the right forearm, and also on the left side of the face, which is the one most affected with anæsthesia, 471.
Diminished sensibility to temperature in the whole right side, 487. [3820.]
Little sensibility to temperature in the whole right side, face, forearm, and lower limb, 472.
Sensibility to pricking generally lessened, but nowhere completely abolished, 516.
Sensitiveness to pricking, pinching, and burning, on right hand and dorsal surface of right forearm, on the right cheek, back of left hand, and palmar surface of left fingers, 488.
Less sensitive to tickling on the right side, 471.
Diminished sensibility of the hands, especially their dorsal surfaces, and of the left hand. In the forearms, the insensibility is greater on the palmar surface, and especially in the left forearm. Above the elbow the tactile sensibility is much less affected. On the left fingers and forearm, the pressure of the upper point only of the æsthesiometer is perceived. Anterior surface of left arm, 100 mm. Tactile sensibility of lower limbs unimpaired. Insensibility to pricking of the right thumb, the palm or surface of the right fingers, and the right palm of the palmar surface of the left fingers, and of the palm and back of the left hand. Diminished sensitiveness to pricking on the dorsal surface of the fingers of both hands, especially the left, also on both forearms; from thence it gradually diminishes towards the shoulders. Slightly diminished sensitiveness to pricking over the rest of the body. Immediate analgesia (or an algesia, properly so called), when burned, together with consecutive analgesia, or anodynia of the hands. Burning is only felt as a warmth, and causes no pain afterwards, though it has raised a blister. Diminished sensitiveness to burning on the forearms. General absence of sensibility when tickled. The upper limbs are insensible to changes of temperature, 485.
Very considerable loss of sensibility in right hand and right forearm, as far as two fingers' breadth below the bend of the elbow (as far as he plunged his arm into the liquid white lead). Less want of sensibility in the remainder of the right upper arm and in the right half of the face. He did not feel both points of the æsthesiometer until they were applied to the upper arm. Not much loss of sensibility in the right upper arm; and it became less and less along the forearm towards the bend of the elbow, 487.
Diminished sensibility in the arms, shoulders, and lower limbs, so that they feel only one point of the æsthesiometer; less diminished in the rest of the body, but more in the right than left side, 488.
Notable diminution of the sensibility to temperature all over the body, 474.
Diminished sensibility to temperature on the whole right side, especially the back of the right hand and forearm, and on the right leg; also in the sternal region, 481.
Electric irritability of the right side very much diminished, 496. [3830.]
Sensibility to touch slightly diminished, 529.
Sensibility more impaired on the right side of the body, generally, than on the left, 525.
Diminished sensibility to pain in the shoulders and arms, but especially in the lower limbs and face, 488.
Tactile sensibility is diminished in the whole right side of the body, and especially in the upper limb, where, when two points are applied to the surface at some distance apart, he feels only one of them, 466.
Diminished sensibility to pricking and burning, amounting almost to analgesia, on the right hand and forearm; less on the palmar surface of the right wrist and forearm, and the right arm. Slightly diminished sensibility to the same, on the left hand, and dorsal surface of the left wrist and forearm. Diminished sensibility to painful impressions on the right side of the trunk and on the front of the chest, corresponding to the part of the shirt worn during work, 481.
Diminished tactile sensibility of the upper limbs, especially the right, of the right side of the face, and on the right lower limb. It is more marked on the dorsal than on the palmar surface of the forearms, 481.
Diminished sensibility on the whole right side of the body, 472, 470, 476.
Insensibility of several scattered portions of the body, 395.
Occasional impairment of the senses, 294.
Slight analgesia of the right half of the body, especially the forearm and hand. The right cornea can be touched without causing pain. The left cornea has very little sensibility, 472. [3840.]
Tickling also is much less felt on the right side, 470.
Perversion of sensibility; pricking imparts a sensation of rubbing; pinching, a sensation as if touched, 527.
Feeling of numbness in the insensible parts, 139.
Feeling of faintness, relieved by food; often felt very faint, in morning, 538.
Has been suffering from occasional sensations of faintness, on ascending stairs, or taking any undue exertion, 340.
Between the paroxysms, he had a feeling of burning and compression, 120.
Sensation as if she were seated in cold water as far as the abdomen, immediately followed by heat of the abdomen, frequently (after two hours and a half), 4.
Feeling as if liquid ice ran through his veins, 136.
Feeling as if his bones were being gnawed, 136.
Soreness of the muscles generally, 70. [3850.]
Walking, or even standing still, brings on the cramps, which are characterized by a forcible and permanent contraction of all the affected parts, perceptible to both sight and touch; these cramps are exceedingly painful; they are somewhat diminished by pressure, and increased by motion of the limb, which motion they restrict; so that when they come on he has to go to bed, or lean against something. When lying down, he can move his limbs freely, excepting when the cramp comes on. The lancinations and cramps are more acute behind the knee-joint than anywhere else. Cold water compresses afford temporary relief. Not a wink of sleep, either by day or night, 130.
Crampy paroxysms every quarter of an hour, with severe pain, and a feeling of icy coldness, which passes like lightning from the groin to the leg, without involving the posterior portion of the thigh. If, when these attacks come on, he is standing leaning on a cane, he falls to the ground. This pain, though so deeply seated that he thinks it is in the bones, seems to be diminished by strong pressure. Between the paroxysms, there is a feeling of constriction in the limb, 167.
In the more aggravated cases, universal cramps and numbness, 267.
Frequent painful cramps in the paralyzed muscles, 508.
The tingling, the cramps return still every few minutes, but at longer intervals, and they are, moreover, less severe (third day), 1.
Slight cramps at long intervals, 471.
After a time he became troubled, more and more, with neuralgic pains in all parts of the body, sometimes so severe as to be almost unendurable, 499.
The colic and neuralgic pains in the thighs, arms, and thorax, had become so severe that he was unable to sleep much at night, groaning and twisting himself continually, 280.
Arthralgic and neuralgic pains about the trunk and extremities, 302.
Arthralgia, 290, 396, 502, 503. [3860.]
Chronic myalgia, 503.
Severe paroxysms of pain, 316.
Pain comes in paroxysms, 305.
Intervals of comparative ease are followed by such intense paroxysms of pain that the patient loses all self-control; shrieks violently, and cries like a child, 315.
Crawling pains by paroxysms, internally, in the bones, recurring from time to time, very violent, especially in the left thigh, above the knee, and in the left forearm; in the left thumb, dull and frequent, 3.
The pains intermit for a longer or shorter time, and return in intermittent paroxysms, 28.
Subject to rheumatic pains (muscular) for some years, 459.
Almost constant, dull, bruised pains, or, at times, pricking and formication, followed by numbness, in the paralyzed parts; they are also very sensitive to cold, which aggravates the pain, 145.
Compared the pain to a feeling of boring, as with an anger, 217.
Bruising, and sometimes gnawing pains, in the affected parts, 138. [3870.]
Dull fugitive pains, 203.
Wandering pains, 258.*
Exceedingly acute lacerating pains all through the limbs, loins, back, and walls of the chest; they are worse at intervals, both during and between the paroxysms of colic, and give rise to extreme agitation; they are slightly diminished by pressure, and sensibly increased by movement, so that he tries to keep as quiet as possible; but during the paroxysms, not knowing what to do to ease himself, he assumes all sorts of positions. These pains, which are unaccompanied by swelling or redness, are worse in the lower limbs, and especially the knees, in the forepart of the thigh, and in the soles of the feet. They are felt all through the limbs. There are no cramps, and motion is unimpaired, 182.
The pain in the paralyzed parts is sometimes lancinating, sometimes contusive; it is increased by motion and pressure, 141.
Severe lancinating superficial pains in several parts of the body, such as in the scalp and the thoracic parietes, 266.
Violent pains, convulsions, delirium, and copious stool, at night, 35.
Violent pain, 85, 298, 490.
Great pain in lower part of body, 228.
Severe shooting pains through the body, 271.* [3880.]
From the balls of both thumbs, which were much atrophied, excruciating pains would arise, shooting with great severity up his arms and shoulders, to the back of his neck and head, 271.
The pain in the head, thorax, inside of the arms and thighs, was, at times, so intense as to produce furious delirium, 290.
Feels pain in the bones, 154.
Pains all over; sometimes they appeared in one place, and sometimes in another ; but when she moved, she complained of its hurting her everywhere, 303.*
*Pain in trunk and limbs, 322.
Pain presents very various characters in the same case, at various moments, rapidly changing, 305.
Pains throughout the body for the last seven years, 357.
Pains in the muscles and joints, especially of the right side, 476.
The power of movement is retained, but its free exercise is prevented by pain, which, during the paroxysms, is so great that, at times, he is unable to stand up, 133.
Pain in left side (after one year), 261. [3890.]
Pains over the body generally, 281.
Pains were not severe, but constant, and aggravated from time to time, so as to cause the patient to cry out (after three weeks), 78.
Pains not increased by pressure or motion, 236.
He tried every position in order to relieve the pains without obstructing respiration; sat up, left his bed, walked about, etc., 213.
The only time he is free from pain, is when he can be perfectly still in bed, 499.
Drinking aggravated her symptoms, 402.
Pains worst during the night, 310.
Pressure relieves the pain, and cold increases it, 103.
During the paroxysms, pressure gave some relief; between them, it rather aggravated the pain, 211.
The pain is constant; is aggravated by the least degree of coldness, by forced movements, and by pressure, 138. [3900.]
Friction and strong pressure give a little temporary relief, 128.
Some apparent relief by drinking, 208.
Pressure relieved somewhat, 217.
Drinking has no effect on the pains or vomiting, 223.
No pains at night, 4.
All symptoms disappear at night, 4.

SKIN

The skin of the face shines as if oily, and feels oily, 3.
Skin flabby, 215.
The skin of the face was changed in texture and appearance, 465.
Face and most of the body and limbs so thickly covered with white-lead deposit that the color of the skin could not be perceived, 212. [3910.]
Nearly the whole skin became infiltrated with serum, 235.
Serous infiltration of the whole skin, 237.
Skin feels dry, 287.
The skin is dry and sallow; it is traversed by larger veins, 562.
Skin dry, cool, 67, 356.
Dry skin, 237, 257, 258, 278, 491, 492.
The skin of natural temperature, a little dry, 404.
Secretion of skin in most cases checked, 267.
A peculiar discoloration of the solids and fluids of the body; lead jaundice, 117.
The whole surface of the body is discolored, 23. [3920.]
Bluish color of the body, 44.
The hue of his skin generally was of a dusky cerulean character, 340.
Bluish color of the limbs, 34.
Redness of the lower extremities, 467.
Frightful jaundice, and excessive induration of the intestines, 18 . [From the internal use of the Sugar of lead.]
Obstinate jaundice, 8.
Very decided general jaundice, 141.
Severe attack of icterus, of a week's duration, 369.
The body, the face, and especially the conjunctivæ, have a decidedly jaundiced tinge, 185.
Jaundice over the whole body, 48. [3930.]
Jaundice, 9, 42, 43, 48, 387, 502.
Skin all over the body of a peculiar dead waxy hue, known among workmen as lead skin, 585.
Whole surface of body had a considerable jaundice tint, 73.
Skin pale, with a somewhat jaundiced hue, 485.
Skin and adnata of the eyes tinged with bile, 70.
Yellowish color of the skin and of the white of the eye, 12.*
Yellow or leaden color of the body, 28 . [From large doses.]
Skin of a yellowish hue, not like jaundice, but like that which obtains among workers in red or white lead, 350.
Yellow skin, 70, 291.
Skin had a yellowish tint, 458. [3940.]
General surface rather yellow, 519.
Skin of a faint yellow hue, 569.
Skin sallow and clammy, 583.
Skin had a sallow dingy appearance, 284, 292.
Slight livid yellowness of the whole skin, especially of the face, 168.
The skin, when most affected, is of a dirty-yellow or earthy color; when less so, of a pale-yellow or light-ashen hue. The discoloration is most marked on the face, though it is spread uniformly, but less deeply, over the body and limbs, 117.
Dirty-yellow color of the skin, with yellow discoloration of the albuginea oculi, simulating jaundice, 271.
Dirty-yellowish color of skin and eye, 287.
Dirty earthy-yellow tint of the skin, at first of a pale-yellow hue (occurring in workmen exposed to the emanations of lead), 305.
Skin assumed a yellowish-dingy aspect, 299. [3950.]
Skin dingy yellow, flabby, with desquamation, 145.
Very distinct dingy-yellow color of the skin (there it is not hidden by a powdering deposit of white lead), 209.
Skin dingy yellow (lead jaundice), 146, 188, 219.
Skin pale yellow, cachectic, 431.
His whole color is that of marked cachexia or anæmia, 437.
The skin assumed a well-marked cachectic color, 266.
Skin pale gray, very dry, in folds, 375.
Leaden color of the body, 13.
General paleness of the whole body, even of the lips, 91.
Surface pale, anæmic looking, 480, 581. [3960.]
General surface pale, 392, 398, 399.
Surface pale, 394, 395, 396, 476.
Surface pale and discolored, 401a.
Eruptions.
Body spotted with petechiæ (fourth day), 246.
Dark-brown spots over the whole body, 42.
Swollen red spots, without special sensation, in the fingers, disappearing after a few days, 49.
Hard movable elevations, six or seven lines broad, on the middle of the metacarpus, at the point where the tendon of the external radial muscle attaches to the metacarpal bone, 12.
Numerous small reddish and bluish veins on the calves, 378.
Erythematous rash spread over the whole breast, and he died, 440.
Cutaneous eruptions, 242. [3970.]
Two itching pimples on the back of the index finger, and another on the outer portion of the condyle of the left wrist, containing clear water, with simple pain after scratching (second day), 4.
Small red pimples on the chest, that desquamate after twenty-four hours, 3.
Slowly progressive painless red pimples on the chest, 3.
The difficulty he experiences in moving obliges him to keep lying in the same position, which gives rise to bedsores on the sacrum and thighs, 195.
Disgusting eruption on the skin, 42.
Vesicles on the forehead and nose, 3.
Cutaneous eruptions made their appearance on the legs, arms, and face, of a vesicular character, 241.
Excessive inflammation, swelling; eruption of itching vesicles, that contain a yellow liquid; formation of scabs, beneath which an offensive ichor exudes, and gangrene, with delirium and constipation, 18 . [From the application of Aceticum lithargyri and Aqua vegeto-mineral Goulardi, to a burn on the arm.]
Suppuration comes to a stop and disappears, 29.
A small prick inflames rapidly, suppurates rapidly, and then heals rapidly, 3. [3980.]
Pustules with thick pus in the angles of the nose, that is red; pus exudes after slight pressure (first day), 3.
Thick ecthymatous pustules over the whole surface of the body, with yellow color of the skin, 273.
In one year had thirty or forty-sores, something like boils, on the back of thigh and above; "push boils" in the commencement, but they enlarged and discharged very much, 297.
Small boil on the outer side of the right thigh, 511.
Sensations.
Skin of the whole right lower extremity insensible; the strongest stimuli produce not the slightest impression. Pain is caused in the subcutaneous tissues by strong pressure, twitching the muscles, or electro-puncture, 167.
Sensitiveness of the skin to the air (first and second days), 3.
General sensitiveness of the skin, 114.
Every part of the skin, especially the arms and lids, became exceedingly sensitive to touch, 235.
Burning like fire in ulcers, 29.
Skin burning, 111. [3990.]
Formication, 475.
Formication on the extremities (first night), 274, 476.
Severe formication in the forearms and fingers, 399.
Formication on the soles of the feet and insteps, especially on the right side, when standing up, 476.
Sensation of formication in the soles of the feet; it seems to him as though he were walking on nutshells, 529.
Formication on the feet, 468.
Formication on the soles of the feet, 225, 474, 481.
Violent sticking itching between the left middle and ring fingers (first day), 2.
Sticking and painful formication in the soles of the feet, 273.
Sticking in the skin (first day), 274. [4000.]
Some pricking on the soles of the feet, 122.
Fine stitches here and there in the skin of the face (sixth and seventh days), 2.
Itching of the whole body, 28 . [From large doses.]
Itching in the evening, H. and T. [From Plumbum muriate.]
Itching of the tetter, that was usually without sensation, 5.
Itching of the skin, 305.
Intense itching of the skin, 383.
Frequent itching on the face (first day), 2.
Itching on the skin between the right thumb and index finger (after one day), 2.
Itching between the left thumb and index finger, not at all relieved by scratching (after five hours), 4. [4010.]
Itching with burning, especially after scratching, on a spot on the inner side of the right wrist; after scratching a long time a numb sensation, lasting several hours (first day), 3.
Itching, especially on the thigh, 511.
Itching of a dry tetter on the right tibia, that usually had no sensation, 5.

SLEEP

Sleepiness.
Constant short yawning (after one hour), 4.
Frequent yawning (after one hour), 4.
Yawning and stretching (after a quarter of an hour, and one hour and a quarter), 4.
Yawning, with sleepiness, an hour after dinner, 4.
Profound drowsiness, 111, 361.
At times he closes his eyes as if in sleep, but this drowsiness is only momentary, 174.
Drowsiness, 466, 476, 479, 534. [4020.]
Sleepiness, 474.
Frequent inclination to sleep, with dulness of the head, 339.
Sleepiness, with heat over the whole abdomen and redness of the face (after two hours and three-quarters), 4.
She could scarcely keep from sleeping, after an hour, disappearing in the open air, 4.
Sleepy early in the evening; very sound sleep, 4.
Easy falling asleep while talking and knitting (after two hours and three-quarters), 4.
Some sleep immediately after a paroxysm, but he is soon aroused by a return of the pain, 127.
Talking during sleep, without knowing anything of it in the morning (second day), 3.
Frightful starting up on falling asleep, 46.
Sleep is pretty good, but he sometimes wakes with a start; he is also awakened whenever he stirs by the acuteness of the pains; nightmare almost every night, 530. [4030.]
The patient frequently fell into a soporous condition, 235.
Sopor, 439.
Sleeplessness.
Sleeplessness, 119, 121, 123, 128 , etc.
Entire sleeplessness, 126, 133, 138, 144 , etc.
Sleepiness at times, 190.
Sleeplessness, lasting for twenty days, 305.
Sleeplessness, caused by the nightly aggravation of the spasmodic pains in the abdomen, 12.
Sleeplessness for eight days, 11 ; for seven nights, 50 ; for twenty days, 48.
Could not fall asleep for a long time, in the evening, 4.
Restless night, 537.* [4040.]
Restless and dreamy sleep at night; was frequently obliged to turn over (first day), 2.
But little sleep, and this never quiet; always disturbed, 290.
Was unable to sleep on account of violent pains, 42.
Sleeps but little at a time on account of the great pain he suffers, 499.
Little sleep, which is disturbed by nightmare, 467.
Slept but little at first, afterwards it was impossible to sleep except from the effects of an anodyne, 331.
Little sleep, interrupted by nightmare, which awakes her with a start, 519.
Unable to sleep for two nights on account of pain, 325.
Dreams.
Sleep disturbed by dreams, 46.
Dreams and subdelirium, 434. [4050.]
Sleep much disturbed by dreams, sometimes pleasant, sometimes anxious, 305.
Slumber often interrupted by dreams (first night), 268.
Frequent dreaming, with sound sleep (first night), 4.
Sleep frequently interrupted by dreams (first night), 274.
Dreams of stealing fruit in a garden (first night), 4.
Talks with some one in a dream, in the evening, 3.
Lovely dreams of a distant beloved person, after midnight (first and second days), 3.
Many pleasant dreams, at night, 3.
Voluptuous dreams, with erections, without emission (sixth and seventh afternoons), 2.
Troublesome dreams, almost nightly, 297. [4060.]
Confused anxious dreams (third day), 4.
Heavy frightful dreams of falling (first night), 4.
Distressing dreams, 476.

FEVER

Chilliness.
Chilliness, 350.
Frequent attacks of chilliness (first day), 274.
Cold chills, 287.
Chills several times during the day (first day), 268.
Chills and fever (with the colic), 516.
Chills, without heat or sweat before the colic, 217.
Chilliness, from morning till afternoon, 3. [4070.]
Chilliness, always worse towards evening, even by a warm stove; head dull, dizzy, with thirst, redness of the face, and soft rapid pulse, over 100; while in bed, external heat with internal chilliness; at last the heat increased, the skin became hot and dry, pulse frequent, without thirst; after midnight, the skin became gradually moist until sweat broke out on the chest, abdomen, and head; after 2 o'clock, sleep with confused dreams; on the next morning, tongue coated, head dull, face pale, and always on rising there is a stitch extending through the head from below upward; this attack was repeated after ten weeks, 3.
Chilliness, towards evening, even when close to the fire; the head is affected and giddy, thirst, redness of the face, and soft frequent pulse, above 100, 305.
Shivering, 36.
Shivering, coldness at the end of the crisis (after about three hours), 268.
Shivering in all the limbs, 208.
General coldness, with frequent shivering, which obliged him to be warmly clad and remain near a fire, 350.
Temperature of the body very low, the skin very cold, 433.
Sense of coldness of body (ninth day), 240.
Sensation of coldness, while walking in the house (after one hour), 4.
Surface of body cold, 113, 120, 266, 303. [4080.]
Skin cool and dry, 259.
Coldness immediately, in the open air (after two hours and three-quarters), 4.
General sensation of coldness, not followed by heat, 35.
In twelve cases, there was a constant and very strong sensation of icy coldness, both externally and internally, in the paralyzed parts, and especially in the extremities of the affected limbs; this was perceived by others. It was aggravated by the least draught of air which fell on the affected parts, especially in cold weather, 117.
Face and extremities cold, 448.
Temperature in the morning 39.4° C., in the evening 41° C., pulse 126, respiration 28; this condition was associated with paralysis of the elbow and shoulder-joints, 450.
Nose cold for several days, 3.
Coldness of the limbs, 20, 43.
The extremities were always cold, 378.
Extremities cold, 278, 331, 420, 546. [4090.]
Hands and feet very cold, but not anæsthetic, 585.
Coldness of the hands and feet, 240, 379.*
Repeated coldness of both arms, 363.
Frequent coldness of the hands and forearms, and a very disagreeable asleep sensation, 382.
Icy cold hands, 402.
Hands cool and cyanotic, 543.
Coldness of the fingers, 380.
Unnatural coldness of the lower limbs, uncomfortable to myself, and perceptible to the touch of others. I wore my warmest winter clothing all summer, and always had a blanket shawl over my lower extremities, even the hottest days, when taking my drive; in the house I used an India rubber water cushion to sit upon, and had it filled with arm water every day, 293.
Coldness of feet, 287.
Absence of febrile symptoms, 35.
Heat. [4100.]
Fever, 57, 478.
Fever. He had pleurisy. (Is there here a relation of cause and effect, or merely a coincidence?), 519.
Fever, at first slight, with copious sweat, 519.
Immoderate fever, 16 . [In a painter.]
Fever, with unquenchable thirst, 28 . [From large doses.]
Violent inflammatory fever, with jaundice (second day), 102.
Hectic fever, 23.
Exhausting fever accompanying the enteralgia, 270.
Fever of a typhoid type, with bilious vomiting; the patient was delirious and very restless; afterwards epileptiform convulsions, followed by coma and death, 252.
Taken down with severe fever; the day before had a severe chill towards evening, followed by fever, 537. [4110.]
A little feverish and thirsty, 103.
Occasional slight feverishness, 70, 560.
Sensation of violent heat, 48.
Heat and thirst, 23.
Heat, followed by perspiration on the knees (after three-quarter of an hour), 84.
Increased sensation of warmth over the whole body, towards evening and at night, as in inflammatory fever, without increased warmth of the body or feverish pulse, 46.
Burning, dry heat, 537.
Heat, with weakness of the upper part of the body lasting a few minutes, followed by weakness of the hands and feet, after breakfast (fourth day), 4.
Anxious flushes of heat, with sweat, in the afternoon, 4.
Flushes of heat, immediately, 274. [4120.]
Transient flushes of heat, with redness of the face, without anxiety, with sweat on the upper part of the body, frequently in the afternoon, 4.
Temperature 100° to 103°; 106° to 110° in the last twelve hours of life, 534.
Skin hot and dry, 126, 276, 277, 347.
Skin hot, 140, 246, 282, 353, 474.
Sudden heat and redness of the skin of the face and scalp, while the rest of the body remained cold and covered with cold sweat, shortly before death, 349.
Increased heat of skin, 138.
Increase of temperature, with moist skin, 305.
Temperature of the skin in general normal, rarely when uncomplicated with inflammation is the temperature raise, 305.
Skin sometimes rather warm, and covered with perspiration, but generally cool, as in health, 174.
Skin hot and moist, immediately, 116. [4130.]
Skin warm and moist, 336.
Skin rather warm, and slightly moist, 212.
Head hot, with the rest of the body cool, especially the hands, 432.
Flashes of heat and of perspiration mounted to her face, almost immediately, 268.
Heat mounts to the head, without increase of external warmth (after one hour), 4.
Heat mounts into the head, with redness of the face (after five hours), 4.
Frequently heat rising from the abdomen into the head (after three hours), 4.
Very great heat in the region of the kidneys; the diffused engorgement can be felt in the lumbar region of the left side; it is apparently a perinephritis from calculus with urinary fistula; but the urine was scanty and high-colored, with fever, 251 . [No post-mortem was made.]
Warmth over the whole abdomen (after two hours and three-quarters), 4.
Burning in the limbs, 34.
Sweat. [4140.]
Copious sweat, 140, 305, 546.
Profuse general perspiration, during the colicky paroxysm, 127.
Surface hot, the perspiratory transudation copious, 98.
Sweat over the whole body (second day), 90.
On first beginning to work in lead, he usually perspired easily on exertion, and even at night, but of late there has been complete absence of perspiration, 382.
Sticky perspiration or perfectly dry skin, 28 . [From large doses.]
Bathed in sweat, at 6 P.M., 184.
Skin covered with sweat (after two hours), 274.
Skin sweaty, 100.
Surface bathed in perspiration, 198. [4150.]
Skin covered with cold sweat, 112.
Cold sweat, 28 . [From large doses.]
Cold sweat, 107, 354.
The paralyzed parts are often covered in the morning with copious viscous perspiration, 305.
A little moisture in the skin, 172.
Cold sweat on the forehead, hands, and feet (first day), 328.
Cold sweat on the forehead and over the whole body, 43.
Sweat on the face, immediately, 274.
Face bathed in sweat, 473.
Offensive perspiration on the soles, 5. [4160.]
Sweat very scanty, 383.
I have exposed her to hot air baths every other day, during which I have collected from her perspiration enough urea to be enabled to detect its crystalline flakes under the microscope most distinctly, and also proved it to be urea by converting it into nitrate and oxalate of urea, 492.
For several years absolutely no perspiration except under the influence of powerful sudorifics, 379.
Absolute lack of perspiration, 380, 497.*

CONDITIONS

Aggravation.
( Morning ), On waking, discontented; bitter taste; dryness in throat; thirst; early, vomiting; after rumbling in abdomen; colic; cough; in bed, stitches in mammæ; wrists and ankles weak and painful; tearing in left upper arm; after rising, pain in legs; on rising, soreness and tenderness of soles of feet; faintness.
( Forenoon ), Sticking and beating in right side of head; jerking tearing in left eyeball; while standing, sticking in right ear; sensation of foreign body in throat; tearing in surface of left upper arm.
( Afternoon ), Good-humored; ennui; ill-humored; absorbed in work; stitches in head; headache in forehead; 2 P.M., stitch in left eyeball; coryza; 2 P.M., burning in tip of tongue; tearing in left hypochondrium; stitches in right hypochondrium; stopped sensation in abdomen; stitches in pectoral region; sticking in upper part of sternum; sticking in left mammæ; tearing in right wrist; weakness of lower extremities of lower extremities; jerking in left thigh; flushes of heat and sweat; toward evening, chilliness, warmth.
( Evening ), Stitches in head; 9 P.M., stitches in sinciput; roaring in the ears; appetite; eructations of gas; colic; griping in abdomen; pain in extremities; trembling of arms; weakness in upper limbs; tremor of upper limbs; itching.
( Night ), Furious delirium; random talking; colic; pain in extremities; pain in arms; pain in calves; the symptoms; warmth.
( Open air ), Coldness.
( Ascending stairs ), Palpitation of heart; pain in thighs; weariness of knees; weight in knees; pain in right knee; faintness.
( Bending toward left side ), Sticking in left lumbar region.
( After breakfast ), Eructations of gas.
( Cold ), Pain in lower back tooth; colic; pains.
( Before colic ), Anorexia; nausea.
( After colic ), Frontal headache.
( After dinner ), Disinclination to talk; tearing in right ear; boring in right ear; thirst; pulsation in hands and feet; yawning and sleepiness.
( Drinking ), Paroxysms; the symptoms.
( Excessive drinking ), Tremor.
( Hot or cold drinks ), Pains.
( While eating ), Drawing sensation in œsophagus.
( Eating a biscuit ), Pains; nausea.
( After eating ), Pressure in stomach; pain; colicky pains; fish; offensive flatus; soup, tearing in eyelids.
( After any excess ), Debility.
( Mental exertion ), Tremor.
( After fatigue ), Tremor of hands; tremor.
( Food ), Colic.
( Inspiration ), Stitches in left side of chest; pressure of left side of chest; sticking in left mamma.
( When intoxicated ), Tremor.
( Laughing ). Pressure on left side of chest; stitches in left lumbar region.
( Looking up ), Vertigo.
( While lying ), Drawing in hip-joint; throbbing in calves.
( During micturition ), Burning.
( Motion ), Lancinations in face; anxiety about chest; lancinations in lumbar region; pain in joints; pain through paralyzed limbs; cramps in forearm; pains in lower limbs; pain in forepart of thigh; pain in knees, calves, and soles of feet; pains.
( After motion ), Weakness.
(Moving eyes), Pressive pain above eyes.
( Moving head ), Pressure in occiput.
( Moving right arm toward left ), Sticking in right hip.
( Moving limbs ), Cramps.
( Pressure ), Pain in spleen and kidneys; oppression in region of heart; anxiety about chest; lancinations in lumbar region; pain in mammary region; pain through paralyzed parts; pain through extremities; pains in forearm, elbow, and axilla; pain in arms; pain in lower extremities; pain in knees and soles of feet.
( Pressure on hypogastrium ), Pain.
( Firm pressure on abdomen ), Pain at umbilicus.
( When pressing at stool ), Cutting about navel.
( Respiration ), Pain in wall of thorax.
( During rest ), Contraction of muscles of sole of left food.
( Rising from recumbent position ), Pain in abdominal muscles.
( Running ), Palpitation of heart.
( While sitting ), Stitches in inner side of left knee; heaviness and weariness of feet.
( After sitting down ), Sticking in right costal region.
( While smoking ), Sensation in throat.
( While standing ), Head dull and heavy; stitch in left groin; sticking beneath right arm; stitch in back; tearing in lumbar region; pains from soles to hips; tearing in left knee; sticking in right knee.
( During stool ), Burning in anus; cutting colic, and cutting in anus.
( Stooping ), Vertigo; giddiness; pain in lumbar region.
( Swallowing ), Swollen sensation in throat.
( After swallowing liquid ), Abdominal pains.
( Talking ), Pain in pimples on tongue.
( Touch ), Pain in hypochondria; pain in abdomen.
( Turning head sideways ), Tension in nape of neck.
( Turning body backwards ), Stitches in right side of body.
( At twilight ), Prostration.
( Vomiting ), Pain in umbilical region.
( When anything goes wrong ), Trembling.
( Walking ), Rapidly, rush of blood to chest; shortness of breath; loss of power in lower extremities; pains from soles to hip; pain in middle of left thigh; stitches in right thigh.
( Warmth of bed ), Pain in large joints; pain in leg; pain in knees and soles of feet.
Amelioration.
( Morning ), After eating soup, heaviness in forehead.
( Forenoon ), When walking in the open air, short-sightedness.
( Night ), All Symptoms.
( Open air ), Dizziness; sleepiness.
( Hot-air bath ), Head symptoms.
( Cold water ), Cramps.
( Eating ), Pain in upper abdomen.
( Emission of flatus ), Griping about navel; pain in abdomen.
( Food ), Faintness.
( Friction ), Pain in renal region; pain in knees and soles of feet.
( Lying on abdomen ), Colic.
( Motion ), Contraction in muscles of sole of left foot; tearing in two first toes of left foot.
( Moving knee back and forth ), Sticking.
( During pregnancy ), Colic.
( Hard pressure ), Pain in epigastrium; pain about umbilicus; pain in abdomen; colic.
( Gentle pressure ), Pain in forearms, elbows, wrists; pain in lower limbs.
( Pressure with flat of hand ), Pain in abdomen.
( Pressure ), Pain in head; griping pain in lower part of head; pain in renal region; sticking in lumbar region; pains in bends of elbows; pain in knees; pain.
( Raising foot ), Contraction in muscles of sole of left foot.
( Rising and sitting erect ), Sticking in left lumbar region.
( Rubbing ), Pain in stomach; stitches in left hypochondrium; sticking in left side of chest; stitches in right side; tearing in nape of neck; sticking in small of back; tearing in right ring and middle fingers; sticking in left leg.
( Scratching ), Itching on left upper lid; itching of left nostril; itching on coccyx.
( Standing ), Pressure in occiput.
( Swallowing saliva ), Dryness at root of palate.
( Warmth ), Pain in abdomen.
( Warmth of bed ), Lancinations on knees.
( Walking ), Sticking in right costal region; weariness in hands and feet; sticking in region of right hip; pain in legs.

SUPPLEMENT: PLUMBUM. Authorities.

586 , John F. Luck, M.D., Med. Record, vol. xiv, 1878, p. 158, J. F., æt. fifty-one years, after a protracted debauch, took 3 ounces Acetate in water; 587 , Dr. M. Bernhardt, Berlin, Klin. Woch., June, 1878 (Lond. Med. Rec., July, 1878, p. 281), a case of lead palsy (cause not given); 588 , same, ibid., J. W., æt. twenty-nine years, has been a painter sixteen years.

After sleeping three hours he awoke feeling tolerably well; was about the village during the day, and only suffered from slight colic. I was summoned twenty-four hours after he had taken the poison and found him pale, anxious; pulse 58, feeble; temperature 97° F.; abdomen tense and retracted. He had vomited three pints of fluid matter containing blood and shreds of mucus; ejection black from change of Acetate to lead sulphide; six hours after vomiting, persistent, copious, without straining; prostration extreme; hands and feet numb; calves of legs cramped; pulse 50; no dejection; no urine voided since taking the Lead: abdomen hard and nodulated; colic pains constant, particularly severe and burning at pit of stomach; general tremor of body; unable to stand on account of vertigo; urgent thirst; delirious. Four hours after (after Ol. ricini, Ol. tiglii, etc) bowels had moved freely, dejected matter similar to that vomited, plus small quantity of scybala. Four hours later had passed 4 ounces of Highly-colored urine; blue line distinct along edge of gums; greatly prostrated; vigilant; delirious (potomania?), 586.
A. T., æt. forty-nine years, is a ruddy, healthy looking woman, and, excepting the paralysis of her left arm, considers herself well. The smallness and flatness of the left shoulder as compared with the right are very striking; the acromion projects forwards, and between it and the head of the humerus there is a furrow in which the index finger can be laid; the entire left upper arm is thinner than the right, especially on the flexor aspect; the forearm is overextended on the humerus and cannot be flexed by any effort of the patient. If you tell her to bend her left arm, she swings the whole limb upwards over her shoulder, and then the forearm falls of its own weight on the humerus. The arm bent by this means can be actively extended. If we partially bend the forearm upon the upper arm, and then ask patient to continue the movement, by a great exertion she is able to do so, but this is effected by the flexor carpi ulnaris and flexor digitorum profundis, which can be seen and felt to contract. Supination of the left forearm is not possible; if the arm be passively supinated pronation is readily effected. The movements of the left hand and fingers are in every respect free; the hand is a little curved and the skin bluish red, but no œdema or eruption is present; there is no atrophy of the interosseous or thenar muscles; the arm can be raised from the shoulder in spite of the visible atrophy, and the clavicular fibres of the deltoid can be seen to contract; adduction, internal and external rotation, and drawing of the arm are all well performed, although the last is not quite so perfect as on the right side; the right arm is quite normal, except a distinct atrophy of the ulnar side of the extensor aspect of the forearm, which is associated with inability to completely extend the fingers, the basal phalanges of the thumb and index finger being alone perfectly extended, the remainder persisting in a state of half flexion in spite of the strongest voluntary efforts, the middle and ungual phalanges of the same fingers being, however, as perfectly flexed and extended as in health. She feels a certain subjective sense of weight in the left arm. Electrical examination gives the following: In the right arm the muscles all react well to direct and indirect stimulation, except the extensor communis digitorum, which does not extend the three fingers above mentioned; the extensor capri radialis reacts more feebly than normal, although its contour is prominent. In the left arm the deltoid reacts only near its origin from the clavicle; the biceps and both supinators are absolutely without reaction; it is questionable whether or not some intact fibres of the long supinator exist in the upper arm where it is covered with fat. All the muscles of the arm, forearm, and hand react to both direct and indirect stimulation. Placing the electrode at the point mentioned by Erb, as that from which it is possible to stimulate both the biceps and long supinator together (at the exit of the fifth and sixth cervical nerves between the scaleni), gives a marked reaction of the muscles in question on the right side, but remains without effect even, with much stronger currents on the left. With the anode of the constant current on the neck, and the cathode on the right deltoid, a feeble contraction occurs with twenty-two cells, while on the left side thirty cells produce only a quick twitching of the clavicular fibres, the bulk of the muscles remaining unexcited; with thirty-three cells the remainder of the left deltoid reacts. The left biceps does not contract, the right contracts with thirteen cells. By stimulating the right radical nerve with twenty cells, there is short quick movement in the index finger and thumb. The muscular fibres of the extensor communis, from the three outer fingers of the right hand, do not react to direct or indirect stimulation. All the muscles of the left arm, innervated by the radial nerve, contract with twenty cells, except the supinators. We have in the case before us paralysis and atrophy of the deltoid, the biceps, and brachialis anticus, as well as of both supinators on the left side, and a part of the fibres of the extensor communis digitorum of the right side, 587.
After several attacks of colic one night, without any affection of the sensorium, paralysis of both hands and fingers supervened; the shoulders and the upper arms remained freely movable ; extension of the forearm on both sides was free; equally flexion of the forearm on the upper arm; the first interosseous space was not only sunken, but there was decided atrophy of the ball of the thumb, and on both sides the interosseous spaces were sunken, and the interosseous muscles were atrophied and incapable of function, so that the lateral movements of the fingers and the extension of the middle and ungual phalanges were not possible; the hypothenar eminences were also diminished in both hands; there was also paralysis of the muscles supplied by the radial nerves on both sides, and of some of those supplied by the median and ulnar nerves. But these undoubtedly interesting phenomena pass into the background when we consider the result of electrical exploration. With the induced current of the muscles supplied by the radial nerve on the left (the less affected) side, only the extensor carpi ulnaris and supinator longus react, but very feebly; all the other muscles remain unaffected, and these by direct and indirect stimulation. On the other hand, the muscles supplied by the ulnar and median nerves on the left side contract very forcibly to both direct and indirect stimulation, but the adduction of the interosseous and thenar muscles was very feeble, or almost nil . The same, only more marked in failure of reaction to the induced current, is the case on the right side; even with the strongest currents the supinator longus, a muscle which usually remains intact in lead-poisoning, scarcely displays its contour, and in the feeblest outline the tendons of the extensor carpi radialis longus et brevis display themselves, but without producing any corresponding movements. It is remarkable that muscles which have their functions quite unimpaired, and are used at will by the patient, and of the action of which he has never complained, should react either not at all, or only in the smallest degree to the strongest induced currents . This is the case for both the deltoids (except the clavicular portion), for the biceps and brachialis internus. With the constant current the deltoid, biceps, supinator longus, and the extensors of the hands and fingers of both sides, with strong currents (thirty to forty elements), give only fibrillar twitchings; in fact we have in the paralyzed, as well as the unparalyzed muscles, the most marked degenerative reaction, 588.

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