Volume I — Main text

ANTIMONIUM. TARTARICUM.

PotattjoAjitimoniou* tartrate, aK(SbO)C4H^O^,H,0. Tartar cractic,

J* Fried. Haknemank. In h h* nausea^ followed by yawning, with great watering of bath eycSj then vomiting. Sensation at scrob, cordis hke cold water, at same time is faint, like to fall, then follows heat on head. Cold sweat, {/trchiv^ rii, 146. No information.)

2, Gross. After \ h, stupefaction of head, as if bound up, with drowsiness, and tensive feeling in 1. half of head. Soon, feeling as if cold ran through the veins. Chilly as if soused with cold water, with goose-skin on arms, and repeated yawning* On 1st n. dreams constantly about incendiary fires from which he often wishes to escape, the fire breaks out in all places where he goes to, and yet the house is not burnt down, and n., he preaches without notes and sticks fast ; this incident confuses and bothers him just like the former a great portion of the n.

The following symptoms are without note nf time:

Headache round about in sinciput and vertex with tension and pressure. On waking at n. always pain as if brain in K half of forehead were pressed into a lump. Constriction of head. Tensive in-pressing pain in 1. half of skull. Tension in temple as if pinched \i^ with stupefaction. As if head from both temples was pressed together with blunt instruments. Pressing in left temple. Long-continued, painful drawing pressure in r, temple. Painful drawing in r* temple going down to zygoma and upper jaw. Headache as if constricted, with drawing and digging, down to root of nose (afternoon). On r, frontal protuberance obtuse undulatory pressure. Obtuse boring as with a blunt instrument under r, frontal protuberance. In r. half of forehead alt e. an acute pain with sensation as it the brain there were pressed into a hard heavy lump. Above and across root of nose a stupefying tension as if constricted with a band. Obtuse pressure above nose and 1. eye. Obtuse pressure on 1. zygoma. Painful drawing and at length obtuse pressure on 1. zygoma. Eyes tired as if they would close. Inclination to shut the eyes tightly. Burning in eyes iji e. as if he had been studying long by candle-Tight. Drawing up along r, side of lower jaw from chin. Tobacco not relished. Extraordinary appetite for apples and thirst for cold water ; drowsy early in e., which is unusual, Eats dinner with appetite, but when nearly satisfied has occasionally a kind of loathing. Hiccuping eructation of air. First eructation, then several limes belching up of a fluid (as if from food) which he swallows, after which a sourish taste and ascrapy feeling in throat remain. Flow of water into mouth without nausea, but with qualmish nasty taste. Nausea with inclination to vomit rises suddenly from umbilical and gastric regions in repoated attacks. A kind of qualmishness rises from stomach. Cutting in abdomen and feeling as if a stone lay across hypogastrium, with great nausea ; after retching six times and feeling of diarrhoea without evacuation, vomiting (with great straining,

trembling in abdomen, and cowering together) first of food with sour taste, that remains for some time and is associated with a continued scrapy feeling in throat, then chilliness, then two diarrhoeic stools, the last of which is like water. After vomiting, great exhaustion, weariness, and drowsiness, loathing at all ordinary food, pale pinched features, swimming dull eyes, but with appetite for cooling things, eg, apple squash. In scrob. cordis a painful feeling as from incarcerated flatulence, late at n. flatus is discharged with relief. A stitch shoots downwards from stomach to 1. side of abdomen and up again, pain there on expiration, and when touched. Afterdinnerqualmish feeling in stomach for a considerable time. After the nausea feeling of emptiness in stomach. Cutting and pinching in abdomen as from flatulence. In abdomen repeated transient nausea like pinching, as if diarrhoea would come on. Violent cutting and twisting in abdomen and tearing downwards through the inguinal region and through the thighs into knees like labour-pains ; at same time fine but violent stitches at the navel with nausea and water brash -, immediately afterwards diarrhoea preceded by rumbling in abdomen. Must lie down and stretch himself on account of discomfort in epi- and hypo-gastrium, at last falls asleep (11 a.m.). Round about under short ribs acutely painful tension, so that he can hardly sit, but only lie, from incarcerated flatulence, which is discharged occasionally. Along with repeated nausea and pinching and cutting in abdomen, empty eructation and discharge of flatus with transient relief. A kind of strife in upper and lower abdomen between nausea and inclination to diarrhoea, in which first the one and then the other prevails, with occasionally empty eructation and inclination to a natural discharge of flatus- Pressure in hypogastrium and pain with cold horripilation, as if menses were coming on. Repeated urging to stool. After repeated urging, a stool, which when passing seems to him to be almost watery but is in reality only pappy. A second stool a few h. after the first. (Twice strong sneezing.) Anguish with tightness of chest, and warmth seems to come out of heart. Burning prickling in knees. Under 1. knee on the external side a slow, regular, painful jerking, when at rest and when moving. Suddenly a transient aching prickling pain as from a blow over 1. instep. E,, in bed, on r. side itching and gnawing, so that he must scratch. In I. big toe sudden, regularly intermitting pulsating pain. Weak, uncomfortable, and prostrate. Great heaviness in legs and arms, so that she must let them fall down. Drawing here and there. Feels as if cold runs through blood-vessels. Tired and sleepy. Overcome by great exhaustion, warm feeling at heart, the arms fall down. Frequent violent yawning. Yawning and stretching limbs. In e., contrary to custom, he becomes sleepy so early that he can hardly keep awake, and after J h. he gets wide awake and remains so till late at n. He looks pale and wretched, and is so chilly when he goes into the open air that he shivers. Great (general discomfort coming from abdomen ; he groans and moans involuntarily, and restlessness drives him from his seat and makes him walk about. Anxious and restless. Feeling of anxiety and heat at heart with stronger beats ; it seems as if he felt them in his head. [IhidJ) J. RucK^R-r, Immediately confusion of head like pressure in temples.

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{ ti. Great throbbing in region of stomach, i h. Vomiting with headache and trembling of hands, i h. Trembling and drowsy, with tension in forehead, especially over 1. eye. Belching up of milk and an acid fluid. Violent pressure in abdomen as from stones, as if full, worse when sitting, especially in a bent position, changing sometimes to pinching in umbilical region, 2 h. Eructation of a salt watery fluid. Nausea, vomiting, 3 fi. On stooping, feeling in occiput as if some* thing fell forwards. 4 h, Pressive pain downwards in sinciput to L eye, a shooting with an inclination to close eyes. Pressure in forehead, especially in m. Sudden^ violent, startling stich from abdomen through rectum, 9 h. Transient stitch in rectum, ist d. Food tastes well and has some appetite, but can only take food into stomach gradually, it makes him (cd better and relieves pressure in abdomen. In bed, e., shooting in knee and hip. About 6 p,m*, great febrile rigor, then after supper great heat with drawing in occiput, 2nd d. Slight shooting in forehead. Violent, pressive tension in abdomen, especially over bladder, much increased about 6 p,m., lasting 6 d. Enormous quantity of flatulence, with rumbling in belly and slight pinching ; its easy discharge relieves. Stitch -I ike pain in rectum. Greater urging to urinate, which causes burning in urethra* Wakes at n, with violent thirst and urging to urinate, when very little is passed. All forenoon continued shooting pain in posterior part of urethra. Towards e, feeling in chest, especially L side, almost like a sore, in jerks, at same time a hopeless^ desponding disposition. Slight twitching in 1. calf. At il a.m. great drowsiness ; when he sits still he falls asleep immediately, has immediately very vivid dreams, during which the train of thought he had been following goes on. About 12 midnight, wakes with great thirst and urging to urinate. Febrile rigor attended with heat until 8 p.m., wakes at n. with thirst and urging to urinate. From 2nd to 6th d. The urinary symptoms last uninterruptedly 4 d., increase at first, then gradually diminish in severity, 3rd d. Attacks of vertigo^ with flickering before eyes. Heat increased by movement. Shooting in temples. For several successive m., immediately after waking, pressive and tensive pains, especially in forehead, relieved by washing in cold water. In forehead, dull pain changing into shooting, going into temple, increased by coughing. After dinner violent pinching and aching in abdomen, not relieved by stool at 3 p.m,, lasting till 4 p.m. Tension in abdomen going towards bladder. A very acute shooting pain in lower part of bladder, he thinks the pain of vesical calculus must be like it. Increased burning in urethra after urinating. Fever, comes first at 8 p.m., chilliness with transient heats. A peculiar internal trembling. 4th d. Dull pain in forehead as from a blow on head. Burning in ears. Chapped lips on waking at n. Cutting in abdomen. 9 p.m. The urine, at first clear like water, makes a flour*like scdiment, which mixes easily on moving the glass, and gives the whole a milky appearance. The urging to urinate and burning in urethra increase, little urine is passed, the last drops are bloody and attended by severe pain in bladder. Uncommon tightness of chest. Some fingers get dark yellow spots of large size, which last 2 d. There occur on hands some small red spots like fleabites, without pain, and go off after

2 h. Very restless sleep all n., she often wakes after anxious dreams with dryness of mouth and chapped lips. Pulse beats quickly and almost audibly, a general pulsation, which she thinks those about her must hear. About 6 p.m. fever like yesterday, with anorexia, afterwards increased pain in abdomen. 5th d. The urine has an inflammatory red appearance, and red bloody fibres form in it on standing. Cramp in calves, afternoon, which goes ofF on walking about. Fever, as on previous d. 6th d. Fever as on previous d.

The following are without note of time : — Indescribable headache. Heaviness of head. Shooting-like electric shocks in both inner canthi and pressure in eyes. Flickering before eyes, especially on rising from seat, several times in an h., of short duration, she seems to see through a thick veil, with vertigo (several d.). Disagreeable sensation in palate all the time. Appetite generally good, sometimes bad. Empty eructations. Great nausea with dislike to the accustomed milk and pinch, ing in belly. Nausea, inclination to vomit after eating anything. When sitting fermentation in abdomen that changes to pinching and discharge of flatus (afternoon). The belly seems full of stones, though he has eaten nothing, and it does not feel hard to touch ; a sensation like what occurs after long-continued sedentary work. The pain in abdomen causes great restlessness of body, with inclination to move some limbs or to change the position. The pain in abdomen is not violent, yet so severe as to cause great restlessness of disposition and disinclination to all work. Frequently a feeling of pulsation in abdomen. Pinching in belly with production of flatus. Sometimes the pressure in the abdomen when rising up and walking about is relieved by discharge of flatus, also when standing, but returns immediately when sitting, especially in a bent-forward position. Hard stool, one d. no stool. A quick peculiar burning irritation, somewhat like tickling, but not of a voluptuous character, yet extremely troublesome, relieved by nothing, extends, commencing from the region of the rectum through the urethra, to the glans penis, where the tickling is greatest (lasts uninterruptedly six or seven days and is the most annoying symptom). Violent tension in perinaeum, especially when walking, with great urging to urinate (several d. uninterruptedly). The tips of fingers die away, feel dry and hard, several d. Feet go to sleep immediately after sitting down. The fever continues uninterruptedly in a dull way, but is much aggravated by quick and violent movement, especially on sitting down afterwards. Great laziness in limbs. Relaxation of whole body. Great prostration and laziness in body, he feels best when he sits still and does nothing. When sitting the symptoms are frequent, or they are caused by it. Constant stretching and yawning, forenoon. Restless sleep. Chilliness. Several forenoons severe chills. Afternoon, constant heat aggravated by slightest movement, it affects head chiefly (daily). Towards e. hopeless, desponding humour, with chilliness, pain in chest, and great drowsiness. All the time an uncommon, remarkable wild merriment, less noticed by herself than by others j towards e. this went off and was replaced by vexation, crossness, and anxious thoughts for the future ; she thinks she shall remain permanently in this state. {Ibid.)

Staff. In { h,, drowsiness, eyes closed involuntarily, he fell asleep with head erect (he was being carried), so hard to awake that he did not do so when his eyes were forced open, when the pupils were found to be contracted, at same time moderatelv warm hands and face and tranquil breathing ; occasionally retching woke him up for a few m. (in a child 2 years old). In 3 h., audible movement of flatulence in stomach.

Without note of time ; — ^Slight tearing, drawing pain in L half of head from behind forwards. Head heavy and requires support behind. Occiput heavy, with anxious oppressed feeling. Slight attacks of headache in forehead ♦ Pressive headache in middle of forehead above nose. Pressive headache on 1. side of forehead, with pressure in eyes. Great pallor of face for 1 h. Burning and smarting of inner can thus of r. eye and redness of conjunctiva. Pressure in both eyes. Sudden stretching pain oji upper part of r, eyeball. Tearing pain on 1. side ot root of tongue, observed when swallowing. Grey furred tongue. Salt taste in mouth. Empty eructation j it relieves pressure in stomach for a time, Great flow of water into mouth. He retches several times violently and profuse sweat comes on forehead, legs very tired, water flows out of mouth j afterwards weakness. Nausea causing a peculiarly disagreeable sensation in throat. Confusion of head with increasing nausea. Empty eructation relieves the nausea for a very short time. Excessive nausea with pressure in scrob. cordis. Nausea somewhat relieved by expulsion of flatus. As the nausea increases and slight retching comes on in throat, a spasmodic movement takes place in upper abdomen. Nausea with slight pressure in scrob. cordis, then frontal headache. The anxiety becomes greater as the nausea increases, at the same time there is a slight pressure and some heat in abdomen, ill which there is a rumbling of flatulence. After violent pressure in stomach, retching. On drawing in the belly shooting pain below scrub, cordis. Up from scrob. cordis occasionally cutting sensation. Slight burning in stomach. Slight shooting tearing pains on a small spot in 1, hypogastrium. The abdomen is distended and there is a gurgling in it, felt externally Transient tearing pain in 1. side of upper abdomen, often recurring. On drawing in abdomen a small spot in I, upper abdomen is painful. Rumbling in bowels soon after taking med. The pressure in abdomen sometimes becomes stronger and is directed towards rectum, and then there is quietly discharged boiling hot flatus, whereupon the pressure is relieved. Bright brownishyellow diarrhoea. Before diarrhoea rumbling about in abdomen^ which is not distended. The diarrhcea is very watery. Burning in anus after stool. Urine dark reddish brown, turbid and of fragrant odour. Urine turbid and dark at first, afterwards clearer. Slight tearing pain in anterior part of urethra* Violent tickling in middle of trachea causes short cough. Violent, rheumatic long-continued pain in whole 1, side, repeatedly. Short, shooting- tearing pain, especially at lower part of r. side ot back near r. hip. Rheumatic pains in and over 1. hip. Just below I. hip transient rheumatic pain. Slight rheumatic feeling in 1. pelvic b<)nes. Rheumatic drawing in upper part of r, thigh. Violent rheumatic pain between 1. calf and ankle, and at same lime

rheumatic pains in furthest back lower r. molars. Rheumatic pain on outside of 1. calf. Cold feet. On rising, and shortly before, rheumatic and bruised feeling in limbs. Weariness in legs. He rests his eyes with his hands like one quite overpowered by sleep, and wakes up in bad humour, e. g. when anyone looks at him he begins to howl. Absence of thirst. {Ibid.)

No more desire for tobacco. Frequent spasmodic yawning. Desire for juicy fruit. Violent sneezing five times j then pain deep in chest and oesophagus. Appetite for sour things. Stitches above pubes. Sensitiveness of the oesophagus so that unchewed morsels cause much pain. Stomach internally sensitive, he feels the morsel all through the oesophagus and even in the stomach. Sour eructation. On the back of 1. hand when touching the little hairs fine severe pricks. Weariness in the knees. (Hering, Archiv^ xiii, 2, 183. No information.)
a. Dr. Mayerhofer dissolved i gr. crystallised tart. em. in ICO drops distilled water and took for 5 successive d. i dr. daily iu a spoonful of water before going to bed without obtaining any symptoms. 6th d. Took I dr. 3 times a d. Sleep more dreamful than usual. Woke in m. with sinciput confused, relieved by rising. Taste dry and pasty, appetite good. 7th d. Took 3 dr. 3 times a d. Felt pressure in scrob. cordis and greater confusion of sinciput, taste pasty, appetite more than usual. N., sleep restless and dreamful. 8th d. Same dose as yesterday. M., head much confused, pressure in frontal region, heaviness and pressure in stomach with bitter eructation. Taste bitter, pasty, and appetite less. M. urine dark yellow, clear, no sediment ; a cloudy sediment of bladder mucus soon formed, and next d. a voluminous sediment of pale red colour, and containing some earthy, phosphates and free uric acid; acid reaction; sp. gr. 1018 ; got turbid by heat, but clear again on adding nitr. ac, and contained am. carb. The earthy phosphates were copious, as also phos. sod. and sulph. sod. ; sod. chl. rather lessened. Uric acid free, but not much increased ; urea increased. After eating bitter eructation and pressure in stomach, fulness and oppression of bronchial tubes, with hard anxious breathing. Pulse somewhat excited and lively. Chilly feeling with prostration in extremities. For last 3 d. constipation with distended abdomen. Sleep next n. very restless and dreamful. 9th d. Took 4 dr. 3 times a d. Very painful pressure in crown, and confused frontal region, at same time strong pulsation of frontal arteries, and increased heat of whole head as from congestion to head. Oppression and pressure in scrob. cordis with anxiety about heart ; heart's beats small and unequal. Tight feeling in thorax with hard full breathing, increased secretion of viscid mucus from bronchi and trachea with audible mucous rales. Towards e. sour eructation, pressure in stomach, oppression and nausea, with irritation to vomit. Increased secretion of saliva. Urine pretty copious, and also two pappy stools. Urine dark, dirty yellow, slightly turbid, no sediment, acid ; sp. gr. 1018. Grew turbid when heated, which was removed bv nitr. ac. ; contained carb. of amm. Earthy phosphates copious, sulphates increased ; sod. chl. diminished^ phos. sod. copious. Uric acid free, copious ; nitr. of urea increased.

Next n. slept restlessly and had many dreams^ confused head, tossed about much. Passed much urine. M.^ felt head very confused^ and accompanied by obtuse pressure In frontal region, loch d. Same dos^ as yesterday at three intervals. Symptoms of head, heart, and respiratory organs as yesterday. Appetite diminished, pressure in stomach and weight as if overloaded with food ; bitter eructation, and after dinner constant inclination to vomit, with frequent belching of bitter bile. Taste bitter and pasty, great flow of water and saliva into mouth, appetite diminished, thirst increased. Frequently during d, horripilation, with slight retching, eructation, and constriction of oesophagus. Sometimes a chilliness going from within outwards, starting from tbd porsal vertebrae, and spreading all over abdomen and upper extremities" oljght cutting pains in belly, two semifluid stools. Urine pretty copious, like that of yesterday. Following n, sleep restless, dreamful for long spells could not sleep, luh d. Same dose at same time. Sam^ symptoms as previous d., only head and stomach symptoms more severe; appetite diminished, thirst increased. After dinner violent pressure in stomach increasing to nausea, when much water and saliva ran into mouth, tasting very bitter. The mucous secretion from bronchi copious. Occasionally during d. recurred heat of all the body so that he broke out in profuse perspiration, which stood on chest in large drops. During d. two semifluid stools, stomach and liver painful to touch, abdomen rather distended. The stools contained much bilious matter. Urine in good quantity, like yesterday. Next n. was restless and dreamful, nth d., m., 6 dr. In i h. violent pressure and weight in scrob. cordis, heat and restlessness of whole body, confused head, and nausea. Violent retching, and with great effort vomited viscid and watery phlegm after great flow of saliva and water into mouth ; the vomited matter tasted bitter, and had a very acid reaction. Antimony was detected in the vomit. Taste pasty and bitter, appetite diminished, thirst increased. Urine copious, observedly little altered, sp. gr. 1016. During d. two semifluid stools of bright yellow colour and strong smell. Traces of ant. in stools. Omitted taking drug till 14th and 15th d., when he took each d. 16 dro^ in 4 doses. Sinciput very confused, tensive pressure and weight about frontal region. In scrob. cordis boring and pressure with full feeling in stomach, bitter eructation and pasty bitter taste, tongue dirty white and furred yellow, appetite diminished, thirst increased. Towards c. abdominal integuments somewhat tense and sensitive to touch, urging tenesmus to stool, but without result, urine very copious. Tearing drawing and weight in extremities with chilly feeling all over body from within outwards, no power to get warm, combined with great malaise. Breathing in e. fuller and harder with great precordial anxiety. Pulse quick and not uniform. When lying in bed was taken with a peculiar vertigo, was often sick, and had frequent eructation, loathing, and flow of water into mouth. Urine dark yellow, slightly turbid, no sediment, sour reaction, sp, gr. ioi8, otherwise much the same as before. Next n. sleep restless and dreamful, and by next m. there were catarrhal symptoms in throat, and increased secretion of saliva. Next d, two emifluid stools of strong character and dark yellow colour i trace

lal II

ant. in them. The e. urine was dark yellow, slightly turbid, no sediment, acid, sp. gr. 1021, no albumen ; much uric acid and urea.

b. Next d. dissolved i gr. ant. t. in 100 drops water, and took 6 drops three times a d. Very ill after second dose, sinciput confused, tension in crown, peculiar pressure on eyes as if eyeballs were quite heavy. Anxious pressive feeling in precordia, bitter eructation, pasty bitter taste and loathing were the precursors of violent nausea. With third dose had great flow of watery saliva into mouth, frequent hiccup and eructation, urging in throat and violent retching, always increasing until vomiting occurred with great effort ; phlegm and water were vomited. After a short time retching again came on and he vomited viscid phlegm and bile \ matter vomited acid, and smelt sour. The attendant symptoms were general sweat upon chest, secretion of much bright coloured urine, and later two liquid slimy bilious stools, with rumbling and urging in belly. Pulse small and contracted, respiration lively, and thirst great. At n. much tough phlegm secreted in throat causing cough, breathing oppressed, slight stitches in 1. thorax on inspiration. N. very restless, full of dreams. Woke in m. with dull heavy head and great discomfort. Yesterday's urine was of bright yellow colour, clear, without sediment, acid, sp. gr. 1018 ; contained earthy phosphates in considerable quantity, sulphates increased, chl. of sodium normal, phosphate of soda copious. It contained traces of sulph. of ant. The n. urine was dark red, clear, without sediment, acid, sp. gr. 1020, uric acid and urea pretty copious. No traces of ant. . Next m. urine dark yellow, rather turbid, acid, sp. gr. 1025 ; contained a very small quantity of albumen^ uric acid and urea diminished. The thin liquid slimy stools of yesterday contained much biliary colouring matter, but very slight traces of ant. The matter vomited consisted of water, stomach mucus, and biliary colouring matter, was acid^ and contained traces of sulph. of ant.

Felt for some d. a peculiar weakness of limbs, deranged digestion, and confused head, increased secretion of viscid mucous fluid from bronchi, and catarrhal symptoms. In abdomen slight cutting pains with semifluid, rather pappy stools. After some d. felt tiresome itching in various parts of skin, especially on inner surfaces of thighs, where small pimples appeared. Urine remained for some d. copious. It gradually returned to its normal condition. Only once could traces of albumen be discovered.

c. Several weeks after this he took i gr. of crystallised ant. tart, at once in i oz. distilled water. In 10 m. felt pressure and heaviness in scrob. cordis, anxious breathing, and nausea; in 15 m. confused sinciput with sudden congestion of head, flow of water and saliva into mouth, quickened fuller breathing with full quick pulse, anxiety, losn of hearing and sight, weakness and weariness of limbs ; aftrr \ h. violent sickness, cold coming over him, pale face, loathing, hrqiicnt retching, constriction of throat, and finally, after great straining of chest and abdomen with sweat of anxiety, vomitin^^ of watery viw id slime, then of pappv masses of food, and finally of a slimy biliouscoloured bitter fluid. The vomited matter smelt and reacted a< id. Then passed much pale urine. After some h. two M;mi.liquid itocdi.

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After this felt very weak and prostrated, fell asleep tired out and awoke

in profuse perspiration. The ejected matter contained ant. The urine passed after vomiting was of bright yellow colour and sp. gr. ioi6, but showed nothing abnormal. The urine passed next, m* was very dark yellow, sp. gr. 1020, and resembled inflammatory urine. (HelUrs yfrchiv. f^ phys, u, path, Chemie u, MikroscopU^ III Jahrgang, 1846, pp. Ill — 124.)

Dr. DE Moor took gr J, and experienced flow of tasteless, dear water into mouth, running out in great quantity, with retching and straining that brought up nothing beyond a little clear mucus ; eructations, sometimes tasteless, sometimes nauseous ; indescribable malaise in region of stomach and abdomen, on touching parts gently pain increases in stomach but in abdomen is relieved ; dull belly-ache, with slight horripilation and goose-skin ; easy expectoration of a good deal of sweetish, transparent mucus ; frequent yawning; slight chills, with drowsiness and weakness. (Allen's Encyclopedia^ vol, i, from Rev* de la Mai. Med, Spcc.^ v, 436.)

8, a, — Following the example of Dr. Mayerhofer, I began, Sept. 1st, 1866, with I milligramme at 8 a,m,, pulse being 73* No efl^ect. At 3.15, pulse 71, took 2 mlgrms. After about f h, felt rather uncom* fortable for 10 m.j pulse rose to 72 and 73, after subsiding of discomfort returning to 71. On 2nd, at 8 a.m. took 3 mlgrms. After 45 m. some discomfort, disappearing after 12 m. On 3rd, took at same h. 4 mfgrms. ; pulse 72. After 40 m, slight headache, nausea, and very acute sticking pain in epigastrium, disappearing in J h. Pulse 74 ; in i h. 70, in another J h. 68. Appetite at noon diminished. At 3 pjn., pulse 73, injected I cxm, of a strong solution (— J cgm.) into I. thigh, pulse 73* After 5 m. vivid redness and burning pain at point of injection, relieved by cold compresses ; pulse 75. 10 m. after violent heat, headache, nausea, weakness, gradually increasing, till after 10 m, more sweat broke out; pulse 79, Much exhausted ; felt great need of rest. Pulse after 15 m. 72, after another J h, 67, In e. took very little food^ and then felt constant burning in throat, swallowing also was difficult, anorexia, increased thirst, sleep broken. 4th. — On waking slight headache in vertex, and little appetite for breakfast. Took about 8 mlgrms. of ant. tart.; pulse 71. After 38 m. came first symptoms of discomfort,- soon disappearing, but lO m, later returning with increased violence. Very disagreeable pressure with anxiety in scrob. cordis, which was distended, and very sensitive to touch, which caused a shooting ; constant recurrence of yawnings, eructations, and rumbling in abdomen ; alternations of chill and heat ; feeling of coldness in bands and feet ; pulse 74. After 15 m. this condition entirely disappeared, aud gave plare to weakness, weariness, and prostration of limbs, so that he could hardly rise from his chair ; pulse 70. Nausea continued all d., with disagreeable taste in mouth and copious secretion of saliva. Ate scarcely anything all d. Persisting weakness sent hnii to bed earlier than usual, .^th.— Rose with confused head and weakness of limbs, otherwise well. At 8 took 1 centigramme of ant. t. ; pulse 70, After J h. nausea, yawning^ eructations, rumbling, pain and pressure fn epigastric region, accele-

rated respiration (20), headache, burning in throat, dysphagia, accumulation of saliva in mouth, chilliness, weakness, and retching ; pulse 75. These symptoms gradually diminished, and in ^ h. only dulncss of head and weakness remained ; pulse 69. There was great aversion to all kinds of food, and scarcely had some soup (swallowing of which was very painful) been taken at noon when most violent retching came on, but without vomiting. A disagreeable taste in mouth obliged him to drink much cold water all d., which afforded some relief to this and to dysphagia. Weariness caused early retirement, and sleep was good. Next d. not much appetite, epigastric region felt painful ; headache persisted, but only to slight degree. Dysphagia considerably relieved.

b. On 8th, feeling perfectly well, took i cgrm. at 8 a.m. ; pulse 74. After 30 m. felt first indications of nausea ; pulse 79. With increasing nausea pulse rose to 84 : there was violent retching, chilliness, perspiration, and vomiting of some of his breakfast ; pulse 88. With increasing weakness and diminution of nausea pulse fell to 71, and \ h. later to 67. At noon most intense aversion to food, sight of which causes qualmishness. During d. weakness, headache, and pain in abdomen, latter increased in severity by slightest movement. At n. slept little and very uneasily. 9th. — Woke with confused head and burning in oesophagus ; at breakfast little appetite ; pulse 69. Took 12 mlgrms. After 34 m. nausea, epigastric region swollen and very painful ; pulse 72. These symptoms disappeared, but returned in greater violence after 5 m., with metallic taste, salivation, burning in throat, coldness of extremities, retching, chilliness, sweat ; pulse 77. Drank cold water : pulse fell to 72, but soon rose to 79. Symptoms disappeared after i^ h. ; pulse 72 ; only weakness, confusion of head, and pain in cesophagus remained. After i^ h. counted 65 weak beats of heart. Through d. copious saliva and no appetite. On following days weak and prostrated ; eyes surrounded by blue rings, and sunken j headache absent only for short periods ; pulse 69 and 70.

c. Dec. 1 2th, injected i cgm. in solution into a superficial vein in 1. forearm. He had scarcely emptied syringe when he experienced raging headache, saw sparks of fire, had burning heat in face and considerable pressure in brain ; at same time violent precordial anxiety. Dyspnoea followed, all became black before eyes, he was so giddy that he was obliged to sit down ; vomited green masses with great effort. Very free haemorrhage from seat of injection, requiring persistent compression to stop it. Through d. felt weak, as from severe illness. 13th. — Headache and pain in stomach continued ; took 7 mlgrms., after which there was nausea but no vomiting. Pulse rose within 34 m. from 75 to 79, and i h. later fell to 70. Little appetite ; slight diarrhceic stools.

d. On 14th injected about i^ cgrms. into I. forearm; pulse 68. Immediately violent burning at point of injection, which Kxjked very red. Face became hot ; violent headache in vertex and pressure 'u\ brain, and very anxious sensation in pit of stomach, nausea, retching, chilliness, and after 25 m. vomiting of green masses, with outbreak of copious perspiration. Pulse 80, very small. The whole d. very weak and unfit for any effort. On two following d. headache continued,

with sensitiveness in epigastrium, complete loss of appetite, and diminished digestive power. 17th, — At 715 a.m. took ijcgrm,; pulse 72. In i h. symptoms previously observed returned ; pulse 83, Headache and weariness lasted through d Sleep at n. short, restless ; some diarrhcea.

e. In spite of unpleasant remembrance of former injection into vein, he repeated it on j8th, with | cgrm. Immediately frightful headache, heat of face, vision of sparks, very anxious sensation in stomach, — in short, same symptoms as after former injection. Retching without vomiting. Inflammation of the spot where injection was performed. '^ On this d. I examined my urine with nitric acid and microscopically. After the acid there was slight turbidity, and the microscope showed desquamated epithelium of the uriniferous tubes. This led me to discontinue further experiments on myself/* Turbidity of urine lasted 2 d.j painjn stomach and head, and dysphagia, disappeared after 3 d,, and appetite returned ; but even after 2 months there were frequently recurring digestive troubles* During proving N. lost 7 lb. \n weight. (A. Nobilikg, Xehschrift fur BiologU^ Munich, 1868, iv, 4.2—46.)

1. Being in good health, pulse 64, took at 8 a.m., fasting, 5 mlgrms. of tart, em* in water. Dose was repeated for 5 d, without perceptible effect. On 6th dj at 4 p,m,, respiration seemed a little less free ; but feeling no other effects, and appetite continuing good, took about 9 p.m. a dose of i cgrm The n. was restless, sleep interrupted by a fatiguing heat ; felt necessitated to drink several times ; respiration slightly impeded. On rising, general uneasiness ; weariness similar to what follows a febrile fit \ mouth clammy. At 8 a.m. i cgrm. No appetite for breakfast. All d. in same state : about 5 p.m. greater uneasiness, especially about epigastric region ; nausea ; desire to vomit but without result ; respiration more impeded ; short dry cough, pretty frequent ; great thirst : heat in head j white tongue ; drinks always appear too sweet ; clammy mouth J two loose evacuations during d, ; palpitation ; bruised feeling and general weariness, compelling retirement to rest at 8, Ear applied to chest gave evidence of nothing abnormal, save that respiration appeared much too rough. At 9 p.m. took 5 mlgrms. Agitated sleep, difficult respiration, feeling of pressure on chest dnring sleep. At 5 a.m. wakened by violent rigor, lasting 20 m,, and followed by heat ; pulse, which had hitherto been little affected, increased to 78, was full and strong ; skin hot ; face red ; thirst urgent ; heat in head i pretty strong palpitation ; slight burning at stomach, fulness, and inclination to vomit ; respiration very much impeded, with feeling of pressure and constriction of chest ^ cough frequent, and a little moister i on auscultation, respiration appeared rougher than on previous e., and deep inspiration was accompanied by slight pain under 1. nipple. N. very agitated ; disagreeable dreams, even nightmare. Took no more medicine. Continued much the same till e. of loth d., when pulse was 72 ; respiration somewhat less difficult i cough the same \ hardly any pain in side ; great thirst \ much uneasiness ; 11, rather less restless. On i ith d., a little less roughness in breathing (on

auscultation) ; cessation of pain ; skin still hot; thirst less ; uneasiness diminished ; appetite in part returned ; respiration still obstructed ; cough a little less ; n. more tranquil. The symptoms continued to diminish, so that by i8th d. there remained nothing but slight cough, which persisted some time longer.

b. Three months later, during 8 d. took each m. 5 mlgrms. without feeling anything. The 9th d., at 8 p.m., took i cgrm. The n. was somewhat disturbed, and the respiration rather less free. A little weariness on rising next m. ; took another cgrm. During d. some uneasiness ; mouth clammy \ little appetite ; breathing impeded. About 10 p.m. 5 mlgrms. ; sleep very disturbed^ and towards m. uneasiness, especially at epigastrium ; some nausea ; loss of appetite 'y respiration impeded ; a watery stool at n. ; great fatigue ; urgent thirst. From m. of 8th d. cough appeared, and went on increasing ; it is short, frequent, and painful; auscultation gave no results. At 9 a.m. I cgrm. In course of d. rigor, lasting J h., with burning in head and beating of heart ; thirst ; inclination to vomit ; pulse 80^ strong ; skin hot ; cough dry and painful ; considerable difficulty of respiration ; sensation of weight on chest ; auscultation finds rough respiratory sounds ; general bruised feeling. This state continued all d. and n., latter disturbed by strange and fatiguing dreams. Two watery stools in the 24 h. On following d. symptoms declined, but more slowly than first time, so that by 25th d. health was not entirely restored. (Molin, Des Specifiques en Midecine^ Paris, 1847.)

c. On July 5th, 1855, began to take 2 drops of 6th m. and e. During 10 d. felt nothing abnormal. From i6th onwards heat of stomach after dinner^ which in 5 d. more came to last all d. On 23rd increased dose to 4 drs. Now difficulty in getting to sleep, sleep disturbed ; mouth pasty and bitter ; lively thirst, but after drinking precordial uneasiness. After bad n., had on 24th no appetite for breakfast and malaise all d., with precordial uneasiness after ingestion of either solids or liquids. After dinner, some griping below navel, followed by loose and copious stool. Similar symptoms continued up to 26th, when there was added heat at anus after greenish stool ; headache ; heaviness over eyes ; nausea ; and ineffectual efforts to vomit. In e., weight on chest and dyspncea ; also bad humour, all noise about him seeming intolerable. Pulse 68. 27th. — Was awoke this m. at 2 by colic, followed by a liquid evacuation of greenish colour ; burning pain at anus during and after evacuation ; stomach distended and sensitive to touch. Intense thirst. Headache is more severe and head very confused. Eyes feel larger and swollen. Breathing short, anxious, and very difficult. Now and then a little dry cough. Pulse 72, and full. Rose at lo; had cramps in legs, and constant desire to stretch ; no appetite, but forced myself to eat. Scarcely was meal over but sickness began, increasing till I vomited. I became very pale and felt stifled ; I had also gastric pains, to which I am subject. Am obliged to stop taking medicine. Same state of suffering continued all d., and I only took broth and wine now and then. Restless at n., and sleep bad. 28th. — At 4 a.m. a motion, semi-liquid. I can take no breakfast on account of the sick-

2<fO

ness^ which still continues* I suffer much pain in legs, and my stomach is very painful, although these are chronic pains to which I am subject* My breathing is oppressed and my face pale, I ate a little at mid-day and also in the e,, but without relish. I have great thirst, with a desire for strong liquors and acids. Slept pretty well. 29th. — Awoke feeling sick ; head confused ] conjunctiva rather yellow ; complexion not so pale. After breakfast bowels were relaxed. After dinner another motion, of a greenish colour. I felt very tired, and a strong inclination to go to bed. At n. bad troublesome dreams and nightmare. 30th. ^ — Still feci very tired, with a great desire to stretch myself. Pulse 64. My face has resumed its natural colour. After breakfast had a semi-liquid motion. The

fastralgic symptoms continue. Head and chest become comfortable. dine with a good appetite; and I sleep well. 31st. — All symptoms are abating, and on Aug. 2nd I find myself in my usual state of health.

li, June 3rd. — In good health. I commence to take every d, a drop of the iSih dil. m, and e. 1 ith. — No symptoms having occurred I double the dose (2 drops). 15th. — Sleep was rather uneasy in the n. 1 6th. — In m., and at noon, the bowels were relaxed. 1 have general uneasiness. 21st. — Nothing. I take 4 drops m, and e. 22nd. — Uneasy night ; awoke frequently, I have not much appetite. Stomach feels uncomfortable, and 1 have some pain in bowels. For last 4 d., motions have been soft. Head a little confused. 26th. — I take 6 drops m. and e. 27th,— Did not sleep well ; had several emissions of urine. Thirsty ; stomach very uncomfortable ; no appetite. At 12 I took breakfast, which I enjoyed. After that had pains in bowels and a soft motion. Then felt easier, and was pretty well rest of d. Had strong palpitations in n. which awoke me. Head felt heavy. Was very hot ; a dry heat, so disagreeable that I got up. Extreme thirst. 28th. — Head stili heavy ; feel fatigued. After breakfast, slight pains in bowels ; head heavy ; sleepy. Fell asleep in my chair^ and awoke in 20 m. with palpitation. Dined without appetite and was afterwards seized with colic, followed by an abundant liquid motion, accompanied by pain in bowels and back. 29th. — Awoke at I am. with strong palpitations. Head uneasy, but not aching. Felt irritable and wished to rise. The uneasiness continued all n. In m. I greatly desired some cold drink. General lassitude ; pale face ; no appetite. At noon, breakfasted in pain. An hour after, I had colic and an action of the bowels. Feel fatigued ; have pain in back, and a wish to stand up ; also cramps in the legs. I have very great fatigue ; head is still heavy ; no appetite. At n. uneasy, but not so much so as on the preceding one ; palpitations are less violent. 30th. — After breakfast, an abundant liquid motion, but no colic. Breaching is oppressed ; it requires an effort to take an inspiration. Heart beats more quickly. Very little appetite for dinner ; feel sick ; have great thirst. Feel so uncomfortable that I am compelled to go to bed. At midnight, I awake with palpitation j pain at base of r. lung, increased by taking a long breath ; respiration difficult and incomplete. Dry cough. Much thirst. Pulse 85. About 4 a.m slept quietly and perspired profusely.

July 1st. — No appetite ; feel sick ; pain in side is less. After soup taken at mid-day another motion with colic. Head is hot ; skin dry. Pulse continues more frequent. I am ill-tempered. Could take no dinner. At 9 p.m. griping pains ; also felt a want of food. Took a little wine with sugar, and two biscuits. Then I went to bed quite exhausted. 2nd. — Sleep has been disturbed. At 2 a.m., awoke with the pain in my side, which was worse ; to lie on that side was so distressing that I had to change my position. The difficulty of breathing increases the pain, and respiration is imperfect. The lungs feel full (distended) ; dry and frequent cough. Clothes feel too tight j obliged to unbutton my shirt collar. Determination of blood to head ; palpitation on left side. Skin is dry and very hot. Face much altered. Great thirst ^ nausea. In bed I am very uncomfortable. I leave ofF the medicine, but symptoms continue. I have a bitter taste and headache. At noon I eat a little. Headache is diminishing ; skin not so dry. I lay down and slept 4 h. Headache then much less. For dinner, broth and meat. Afterwards, a copious stool. I am excessively fatigued, and have pain in the back. At n. I am very restless, and have much pain, but no palpitation ^ stomach more comfortable. 3rd. — I eat with a relish. Lungs are more free ; pain in the side is less ; headache is diminishing. No action of bowels to-day. A pretty good n. 4th. — When I awake I am almost free from pain j headache gone. Still some discomfort of stomach, but I eat with relish. Pain in side and breathing not yet quite right. No motion. Good n. 5th. — Stomach is all right ; slight uneasiness in side. Appetite good. Bowels all right. loth. — All the symptoms are gone ; I am in perfect health.

1 think I may reasonably conclude that infinitesimal doses, on both man and animals,"^ produce pathogenetic effects, and that these patho- IcN^ical changes may be compared to spontaneously developed diseases. {Compte rendu du Congris MJd. Horn, de Bruxelles^ 1856.)

TO. Dr. Jankovich, of Ofen, on 14th July, 1841, took a dose of the following mixture every hour : Tartarised antimony, 1 2 gr. dissolved in 3 drachms of distilled water, of mucilage and opiate syrup each i oz. Dr. J. took 8 gr. of A. t. in 5 doses, or i \ gr. per hour, commencing at 1 1 a.m. ohortly after the first dose he suffered from giddiness and a feeling of illness ; after the second a shivering all over, cold perspiration, nausea, and retching ; after the third, a painful feeling in pit of stomach, with vomiting of much mucus and bile j uneasiness in bowels, but without pain or purging \ excessive and constant perspiration ; increased flow of saliva, and thirst, which he was compelled to satisfy by taking small quantities of cold water. He was so depressed and weak that he could not rise from his seat. The fourth dose was followed by increased illness, vomiting, and purging. After the fifth such apathy and disgust that he felt quite ready to die. His repugnance to any more doses was such that he found it impossible to continue it. He took some broth, which, however, he speedily vomited \ this was followed by a further action on the bowels, nausea, perspiration, and great depression, lasting until n. He slept calmly,

• See III, 7.

|bid the symptoms had disappeared next d, {Med, Jahrb. des asierr. Staatis^ 1842, p* 49.)

ii» Dr. Wetzler, of Augsburg, dissolved 12 grains of A, t. \n 6 oz. of water, and took a tablcspoonful (i grain) every hour from 5 a.m. till 3 p,m. The pulse was slightly increased. In i^ h, there was nausea with vomiting of a mucous fluid, but this ceased and did not return; there was then abundant perspiration for 12 m. The tongue was dry and brownish yellow. In 5 h. there was intense thirst. In 7 h. complete loss of appetite, fulness of head, heat of forehead, great depression, and a feeling of general illness. At 3 p.m. could take no more antimonial mixture. In a few d. he recovered. A fortnight afterwards he repeated the experiment with like results, except that, from a feeling of the greatest loathing, he could only take the antimonial solution for 7 h. In 14 d. more, he repeated the experiment again, and the solution was for taken \o\ h. Violent vomiting followed, and on this occasion the illness was more severe. Dr. Wetzler felt he could not continue his experiments. {N. Jahrh. d. teutsch, M, u* CA., xii, 1.)

To a strong young man I gave tart, em. in i gr. doses every 10 m. for nearly 7 h., inducing great nausea and vomiting, with profuse perspiration ; but during the whole time his temperature remained remarkably constant, varying not more than 0*4^ Fahr. (Ringer, op, cit.)
Dr. Sharp took a drop of rst diUn 5J of water, pulse being 72, and resp. 18. During next h. pulse varied from 66 to 74; but breathing, rising at 4th m. to 20, fell through next 24 m. to 10, when it consisted of deep uncomfortable sighings. During 14 m. more it continued to fall until tt became only 6 in the m. : it then rose, and by end of h. was 18 as at first. {Essays on Medicine^ p. 726.)
AcKERMA^fN selected three healthy young men, aet, 21 — 23, and made 3 sets of experiments on each, with 6 d. intervening. On d. before each experiment, subject was kept on regulated diet 5 on d. itself nothing was taken save cup of coffee in m. Subject was weighed after bowels and bladder had been emptied, and then went to bed and remained tranquilly in it for 9 h. Every 5 m. pulse and resp. were counted, and temp, of mouth and hands determined. After remaining in bed i h., a certain quantity of tarr. em. was given, usually 4 cgrms. ; and this dose, doubled or halved according to its slight or severe effect, was repeated. In i h. after drug had been taken bladder was emptied, and from this time urine was considered to be under the medicinal influence. Fhe following were the results :

a. Pulse.— Fur a variable time, according to the individual or dose (length of time being inversely as the dose), no effect was produced. Then commenced acceleration of the pulse ; and at the same time, or a few m, after, nausea was perceived. These two symptoms increased together, the former reaching its maximum with vomiting, then declining slightly, then remaining stationary for a time, and afterwards undergoing changes. The quickening of the pulse could be taken as the measure of the nausea, varying in amount with it, before vomiting came on. Amount of nausea and rapidity of pulse rose as the dose of

^93

A. t. was increased. The mean maximum of the rise (in three men) was 42 per m. Never during the nausea did the pulse^ even after vomiting, sink to the normal standard. The pulse was weaker as well as quicker, that is, the wave of blood was smaller as felt by the finger, 1 A diminution in the strength and extent of the heart's impulse was felt at the same time* The frequency and strength of the pulse were therefore in an inverse ratio. When the nausea ceased the pulse fell somewhat, but still remained frequent for a time, then increased again, and then finally declined. The second was never equal to the primary rise, it was greater and earlier in proportion to the dose. The size of the pulse was greater than in the primary rise, and the heart's action was increased. A fall in the pulse ratio to below normal was never seen by Ackermann during first 8 h. after a small or medium dose ot A. t. The weakness of the pulse, i,e, diminution of lateral pressure, was proved by Lenz by ha?madynamometric researches. The frequency of the pulse was referred to a weakened or paralytic condition of the vagus.

h. Temperature, — From 5 to 30 m, after quickening of pulse and nausea the temperature of the hand diminished. It bore a relation to the rapidity of pulse and nausea, was in proportion to cyanosis of hands and face, and gave the patient a sensation of general coldness. It was in proportion to the dose of A. t. Cyanosis disappeared, and tern* perature of hand usually rose (even to above normal) after cessation of nausea and vomiting, and about the time of the secondary rising of the pulse, when impulse of heart and size of pulse were alike increased. The temperature of the mouth was not lowered ; it was either normal, or varied very slightly until the secondary rising of the pulse, when it increased about i*^ F. on an average.

f. Respirations, — The respirations at first were quickened, lessened after the nausea was over to normal, and rose somewhat with secondary rising of the pulse.

d. Excretions ^nd Secretions, — With the nausea there was increase in the saliva, which was greatest shortly before vomiting* It came mostly from the parotid, and caused frequent deglutition. Referred to irritation of glosso'pharyngeal nerve, the gustatory branches of the fifth or the vagus, or, probably, due to nervous and vascular paralysis. The total excretions of the body were augmented according to the dose. The *' insensible perspiration " (skin and lungs) was increased by one half] in some cases, in others doubled or more than doubled. These included clammy sweats on forehead during nausea, perspiration during vomiting, and increased pulmonary exhalation. The quantity of vomited matters depended on largeness of the dose. There was purging in some cases. The water of the urine was lessened, in proportion to the dose, and to the amount of the other excretions. The quantity or urea was increased on an average by |ch or even |th, almost constantly in proportion to the dose. The quantity of chloride of sodium was less, especially when diarrhoea occurred. Pigment and uric acid increased generally, and the amount of free acidity was variable. 1

#, Summing up of Ackermann's results : (i) Tartar emetic quickens the action of the heart, possibly by partially paralysing the vagus.

(2) It weakens at first the force of the heart from an uncertain cause ; subsequently, when its effects are passing off, the heart's action augments in force.

(3) Jf produces at first general capillary and venous hypera&mia, on account of the weakened heart, and afterwards general relaxation of the vessels^ when the effects are passing off, and when the heart's action increases.

(4) It causes increased action of the skin during the hyperaemia (cold and clammy sweats) and during the after period of increased action (warm sweating).

(5) It lowers during the first period the temperature of extreme parts, and subsequently causes a moderate rise of temperature over the normal amount.

(6) It increases the number of respirations, and probably augments the pulmonary exhalations.

(7) It augments the gastric and intestinal secretions, producing vomiting and sometimes purging.

(6) It augments the flow of parotid secretion, whether from irritation (direct or reflected) or paralysis of the nerves is uncertain.

(9) It lessens the urinary water and chloride of sodium, on account of the increased discharges from the stomach, intestines, skin, and lungs.

(10) It augments the urea and uric acid from heightened metamorphosis.

(11) On the whole, in spite of the lessening of the urinary water, it augments the total excretions, even when there is no vomiting or purging, and this is produced especially by its great action on the skin. {Brit, and For, Med,-Chir. RivUwy xxiii, 346.)

6th April, from 7.45 to 1 1, took 5 tablespoonfuls of a solution of ant. t, gram. 0*100 in 10 tablespoonfuls water; at 1 1 p.m, and 12.30 a.m., I tablcspoooful. After 3 tablespoonfuls slight nausea. After the 4th tablespoonful occasional eructation. After the Sth tablespoonful at I [ a.m. a normal stool, accompanied by horripilation through skin, pinching pain below navel, nausea which frequently recurred. During the pain felt exhausted and weak, when the pain was gone felt quite wet J, only must spit frequently. App. diminished. After eating, rumbling in bowels. At 2.20 and 3,10 p.m,, i tablespoonful ; at 3.30, rumbling in bowels. At 4 and 5 p.m., i tablespoonful ; at 10.30 p.m. a second stool. Took 2 more doses without any effect. — 7th. g, 10,

11 a.m., 3, 4, 4^35, 5 p.m., i tablespoonful oi a soK of 0150 gr, to 5 02. water ; 540, 6.30, 9.30, 1 1 p.m., 2 tablespoonfuls of a soK of o"200 gr. to 5 oz. water ; no stool, no other symptoms. — Sth. Ant. t. gram. 0*200. in 5 oz. water j 7.33^ 8.35, 9.35, 10.35, 11.30 a,m.,

12 noon, I tablespoonful. Ant. t. gram. 0*220. in 5 oz, water; 3.40, 4.45, 5.25, 6.5, 10.30, I tablespoonful. M., some tight feeling in chest with frequent cough, expectoration of some mucus. Discharge of foetid flatus. At 1-39 p.m,, aching and pinching pains in belly lasting a m. App. little. Tongue in ni. thickly furred. Afternoon, roughness and tightness in chest and exj>cctoration of mucus, frequent discharge of feet id flatus preceded by rumbling in bowels. Very tired m. and afternoon, as after great exertion. £., after suppei, aching pains in abdomen

lasting I h.) ameliorated by stretching upper body backwards, aggravated by bending body forwards. Rumbling in bowels, as if water were moving in them. 8 to 9 p.m., pains ceased after eructation and discharge of flatus. 1 1 p.m., a thin stool with relief. Sleep at n. very restless, expectorated mucus at n. — 9th. At 8, 9.30, 11 a.m., 12 noon, 2.30 p.m., I tablespoonful of last sol., 4.5,5.15, i tablespoonful ant. t. gram. 0300 in 5 oz. water. App. bad, loathing and disgust at food. M. and afternoon coughed and hawked up mucus. No stool. — loth, at 7 and 8 a.m., i tablespoonful. M., on rising, rather hoarse, expectorated some thick mucus. After 2nd dose, nausea. Drank without relish a cupful of warm milk, and ate a bit of bread. Immediately must hurry to stool, and had a normal stool with slight pain in belly. Some saliva ran into his mouth, must often spit, and threw up the milk and bread and some mucus — not sour. Trembled all over, was much affected, hardly himself. For | h. after the vomiting, the respiration was very deep. The vomiting had a favourable effect on him, he felt lighter, more lively, had better appetite, but could eat very little. Afternoon, coughed and hawked up mucus. The hoarseness increased in e. Was up till 3 with a confinement, hoarseness increased, got a short cough and pain in larynx. He left off taking the ant. t. and his hoarseness gradually went off, app. improved, tongue became clean, stools normal. — 14th. Ant. t. gram. 0'200 in 5 oz. water, at 1 1 a.m. a tablespoonful ; at 2.45,3.21,4.3,4.36,5.17,6.11 p.m., half a tablespoonful. After each dose nausea. After dinner a thin stool, rumbling and pains in belly. Afternoon, expectorated some thick mucus. Tongue furred.-^ 15th, at 7.10 a.m., a tablespoonful; at 8.30,9.35, 10.37, 11.15, 11. 51 a.m., 2.35, 3.20,4.10,5 p.m., half a tablespoonful, 11. 10 p.m., i tablespoonful. At 9 a.m., a stool softer than usual. Rumbling in belly followed by nausea, lasting till noon. Soon satiated and almost sick when eating ; on leaving ofFfor a little, appetite returned. After a walk, on coming into house, had when coughing a peculiar sensation of soreness on chest, and expectorated some mucus. At 11. 15 p.m., a normal stool. — i6th, at 7 a.m., a tablespoonful ; at 8.45, 9.45, 10.45 a.m., 3, 4.23, 5.15, 6, 6.37 p.m., half a tablespoonful ; 1 i.io p.m., i tablespoonful. M., pains and rumbling in belly, and nausea lastmg i h. Forenoon, constant nausea, especially when swallowing saliva. Slight nausea in afternoon. All d. some coughing and hawking of mucus. I'ongue furred thickly, yellow. From 7.30 a.m. till 7.13 p.m. no urine. At II. 15 p.m. a soft stool.— 17th, ant. t. gram. 0150 in 5 oz. water, at 10.36, 1 1.25 a.m., 12 noon, 2.20, 2.50, 3.50, 4.26, 5.15,6.5, i tablespoonful. M,, very little appetite, some slight pains in abdomen. Feeling of fulness in stomach. After 5 p.m., slight but increasing nausea, with rumbling in belly, lasting till late in e. Tongue thickly furred. Frequent coughing and hawking of mucus. Great loathing at the medicine. No stool. The next d., no medicine being taken, the symptoms all gradually subsided and went off. During the proving there was a slight diminution in the solid constituents, the urea and the volatile salts, of the urine. (Boecker, op. cit,^ ii, 324.)

The effect of tart. em. on the urine has been investigated also by Beigel. His experiments were made on 2 men, who took in each

24 h. 2 grs., during 4 d. Great nausea was caused, and probably loss of appetite, though nothing is said on this point. The urine was sometimes increased, sometimes lessened in quantity j the urea was invariably decreased (by about 5 grms. in each 24 h,). Bcigcl attributes this to the tart, em., and not to the want of food j but this opinion may be questioned, and, on the whole, Beigel*s experiment do not seem entitled to much weight, as the conditions are imperfectly given. {Parkes, Urim^ sub voce,)

17, a, Oct. i8th, 1785, at 10 p.m,, rubbed into palms, with assistance of a few drops of water, 5 gr. of tart, em. Rested well till 4 a.m., when he awolcc, contrary to his usual custom, and felt slight nausea, heat of skin, aiid tenesmus. In less than an h. began to perspire, and continued to do so increasingly till he rose soon after 7. There was no further effect save slight disinclination to breakfast.

h. Next n,, rubbed in about 9 gr, in solution on self and two others. Woke at 4 as before, hot and uneasy, pulse quickened as after wine. Felt some nausea and peristaltic movement. Perspiration followed as beforehand in forenoon there were two loose motions. For 2 or 3 d, afterwards tendency to looseness continual, also increased flow of urine. His coadjulors were sweated in the n, j one was sick in the forenoon, the other slightly so, but briskly purged.

€, A lady, who rubbed in 5 to 7 gr,, had — besides these symptoms — 2 or 3 d, later a rash, with considerable itching over whole skin, which did not subside for 2 d. longer, (Sherwkn, Alem, of Med ^ &h. of London^ ii, 386.)

18, Gaitskill {Ibid.ylv^ 79) repeated these experiments on himself and others, with negative results ; but Hutchinson confirmed them, observing also increased disposition to sleep, [Ibid,^ v, 81. In Aledical RepoutQfyy xvi, 457, a case is recorded where violent vomiting, syncope, and death occurred in a child of 3, after rubbing ung, antim, tart, along spine),

iq* a. Taken internally, in small doses, tartar emetic increases the secretion and exhalation of the gastro-intestinal membrane, and of the liver and pancreas. Subsequently, it acts powerfully on other emunctories ; thus it causes sweating, without any very marked vascular excitement ; it renders the mucous membranes (especially the aerian membrane) moister, and, when the skin is kept cool, promotes the secretion of urine.

b. In somewhat larger doses, it excites nausea, frequently with vomiting, disorders the digestive functions, gives rise to an uneasy sensation in the abdominal region, depresses the nervous functions, relaxes the tissues (especially the muscular fibres), and occasions a feeling of great feebleness and exhaustion. These symptoms are accompanied or followed by increased secretion and exhalation from all the different emunctories, but especially from the skin, as above mentioned. Of all emetic substances, this causes most nausea and depression. (Pereira, op, clt.)

After small medicinal doses the stomach experiences a slight sensation of soreness^ — a sensation easily mistaken for hunger, . . • As an emetic, the action is somewhat tardy, sometimes delayed for

20 m. or 4 h- > the vomiting is repeated, and accompanied by much straining. (Ringer, op, cit.)

When the dose is large enough to produce vomiting, various general symptoms precede, acco npany, and follow this act. Such are, — a copious secretion of mucus and saliva in the mouth -, eructation of a watery fluid with an acrid and saline taste ; watery stools, preceded by colic ; pain in moving tongue ; pallor and collapse of features \ often cold sweat, especially of forehead y dizziness, and not infrequently scintillation before eyes ; general exhaustion, debility, and inclination to repose and sleep ; a weak, small, and sometimes infrequent pulse j often palpitation of heart, and sometimes disposition to syncope. In some cases face is hot, while rest of body is chilly. The act of vomiting is often accompanied by laborious and incessant straining and retchings which sometimes continue long after the complete evacuation of the stomach, and produce extreme relaxation and exhaustion. The matters vomited consist mainly of mucus and bile, which are sometimes mixed with blood. After the vomiting is over, a disinclination for food and a strong craving for cool drinks remain. (Stille, op, cit,)

II. Poisonings. — I. a. I have myself witnessed two cases of poisoning by tart. em. One occurred in a woman to whom I was called in consultation by an experienced practitioner, under the impression that it was a case of cholera,* though no epidemic of that disease was then prevailing. There was vomiting and purging of a whitish liquid without a tinge of bile ; the pulse was extremely feeble, the features shrunk, and the skin cold and of a bluish hue, especially in the hands and feet, of which the fingers and toes were of a dark livid or purplish colour; the fingers were shrunken like those of a washerwoman ; there were cramps of the extremities ; and she complained of extreme pain in her stomach and bowels. Upon investigating into the cause of the symptoms, we learned that she had taken, I think on the previous day, ^^ a five-pennybit's worth of tart, emetic."

b. The other instance was in an infant child, about a year old. Tart. emet. had been prescribed by the attending physician for an attack of croup, which was relieved ; but directions were left with the mother to give small doses of antimonial wine at short intervals, without any warning as to the possible danger, or limitation as to the length of time. When I first saw the child some days had elapsed from the first administration of the medicine. It was in the last stage of exhaustion, pulseless, cold, pale, and purplish, and discharging whitish stools. Death quickly followed.

It will have been noticed that, in both these cases, the evacuations were whitish. They had the appearance of opaque rice-water ; but differed in this respect from the stools of cholera, that they did not on standing separate into a clear liquid above, and a white flocculent precipitate. (G. B. Wood, Therap, and Pharm,, ii, 64.)

Two children, a boy of 5 and a girl of 3, each swallowed a powder containing 10 gr. of tart. em. mixed with a little sugar. In 20 m. they were seized with violent vomiting and purging, and great pros-

Dr. B. W. Richardson states that he has seen a small dose cause symptoms <* strictly analogous to those of Asiatic cholera ** (^Lwicit, 1856, i, 401).

traeion of strength, followed by convulsions and tetanic spasms ; there was also great thirst. The boy died in 8, the girl in 12 — 13 h, P,M.^ 4 — 5 d. later. In body of boy there was effusion of serum into r. pleura ; lower lobe of r, lung posteriorly was redder than natural, and peritoneum was injected from recent inflammation. Mucous membrane of duodenum was inflamed and covered with whitish-yellow viscid secretion ; this was observed throughout the intestinal canal, though colour was of deeper yellow in colon and rectum i there wa$ no ulceration. Peritoneal coat of stomach was inflamed^ mucous membrane much so, especially about larger curvature and cardiac orifice ; no ulceration here also, but in one place a patch of lymph. Tongue was covered with white fur and seemed reddened. Dura very vascular ; longitudinal sinus contained a coagulum of lymph, but very little blood ; vessels of surface of brain very much injected with dark bloody whole surface having a deep purple appearance, and every portion of brain presented many bloody points on section. Cerebellum and medulla oblongata also extremely vascular ; no effusion into ventricles* In body of girl, morbid appearances were similar ; there were also patches resembling eruption of scarlatina on arms, legs, and neck* Arachnoid was more opaque than usual ; and on mucous membrane of stomach, where inflammation was greatest, were two or three white spots, each about size of split pea, which seemed commencement of ulceration. {Lancet^ 1846, i, 460*)

Mr. — , tet, 35, lymphatic temperament, black hair and eyes^ ruddy complexion and inclined to corpulency, addicted to high living and the excessive use of stimulants, had taken for 15 d. 4 gr., upon an average, of tart. emeL in whisky, administered to hrm secretly by his wife ' to wean him from the love of intoxicating drinks," for which, unfortunately, he had acquired an uncontrollable appetite. Notwithstanding the drug had promptly produced its characteristic effect upon the stomach, the poor man had continued to drink until forced to take to his bed by the exhaustion caused by constant vomiting and the consequent loss of nearly all the food taken, as well as by the peculiarly debilitating effect of the drug. I was then called to attend him. He was lying on his right side, and any departure from this position was sure to be followed by an attack of vomiting. He complained of great weakness and exhaustion, was very despondent and apprehensive that he should not recover* He dreaded above all things to be left alone, even for a few moments, lest ^ he should be dreadfully nervous and not know what to do with himself/' His countenance was unusually pale, and wore an expression of extreme anxiety ; his tongue was covered with a thick, white, pasty coating i he had some appetite for food which, however, was quickly rejected ; his thirst was constant and insatiable. From the constant and long-continued use of the drug, his stomach had become intolerant of both food and drink, and he had now a great disgust for whisky, which he believed to be

the cause of his duced intense nausea, to 6a, While taking ictoris, from which he

illness. He declared that the very tha His pulse had sunk from 78^ tart. ^e had 3n ^B

form<

-f k

the had

had an ' great s

pro- .1 rate,

had for the past 4 years believed himself cured of it. Aside from this attack, which may have been accidental, neither the throat nor the thoracic viscera were affected by the use of the drug. He complained of a feeling of numbness and coldness in both legs. The r. arm and hand and the great toes of both feet were cold to the touch. Cramps in the calves of the legs frequently awoke him from sleep. His breast, the anterior surface of the upper arms, the wrists, the hypogastrium, and the inner surfaces of the thighs were thickly covered with an eruption of bright red, small, conical, distinct, hard pimples, with an inflamed base, like lichen simplex. The itching from this was intolerable, irritating him at times almost to frenzy. This began to appear on the fifth d. of the use of the drug, and did not appreciably abate until three d. after its discontinuance. The most careful examination failed to discover any traces of pustular development. (Woodbury, iV. EngL Med. Gaz.^ iv, 238.)

A man took 20 — 25 gr. of tart. em. by mistake. In a few m. there was an insufferable feeling of heat in epigastrium, then violent pain in forehead like clavus and some giddiness ; in ^ h. moisture in forehead and nape, vomiting for 20 or 30 m. ; headache and dizziness increased^ with redness of face ; castor-oil caused a return of vomiting of bilious matters ; burning in stomach and small intestines increased to such a degree that he became very restless, pulse weak (80), tongue white, throat dry, taste unpleasant ; inclination to sleep, which relieved him. Next d. mouth was very sensitive, gums bled, with a slight spongy appearance like scurvy, lasting 2 d. (Duffin, Ed, Med, Jtmrn.^ xix, 354.)
A man, act. 40, enjoyed good health till April preceding death. Began then to complain of frequent vomiting and burning pain after taking food, and grew thinner. In time he became so ill as to be confined to bed, and died in 10 d., with sickness, and burning pain in stomach as if hundreds of pins were pricking him ; emaciation and extreme prostration ; thirst ; sallowness of skin, gradually increasing to well-marked jaundice ; difficulty of breathing, which was very hurried at last ; pain on pressure in epigastrium, but not over other parts of abdomen ; gradual sinking, and death. There was no diarrhoea during any part of the illness, but, on the contrary, rather a sluggish condition of the bowels. He had no cramps, and never complained of constriction of throat or of dysphagia. P.M. Whole alimentary canal, from throat to rectum, more or less inflamed \ liver, kidneys, and bladder congested, as well as lungs ; heart and brain healthy. Antimony was found abundantly in body, and evidence showed that man's wife had been detected in mixing tart. em. with his food and drink. (Nevins, Liverp, Med.-Chir, Journ.^

h 36-)

A lady suffered from extreme irritability of the stomach and sickness*; the vomited matter was intensely yellow from admixture with bile. There was slight, unconnected wandering, no sleep, paleness or flushing of the countenance, swelling of the face, injection of the eyes, an aphthous state of the tongue and mouth, soreness and constriction of the throat, with pain and a burning sensation in the

region of the stom^ich, and tenderness in the abdomen ; there was a sense of loss of power and coldness from the waist to the toes, and a

tingling sensation in the upper and lower limbs, with slight muscular spasms in the arms and hands, There was irritability and soreness of the rectum, and movement short of diarrhoea* There was some tlifiiculty and pain in passing urine* The pulse was generally feeble and from 1 20 to 132* The most prominent symptom was a cemtani feeling of such depression that death seemed to he close at h&nd. The treatment had little effect* A portion of urine on analysis was found to contain antimony^ and the cause of the symptoms was revealed. No antimonial medicine had been given^ and now the metal was actually in process of elimination, (Taylor, Guy^s Hosp, Rep^rts^ 3rd «cr., lii, 373.)

Summary of appearances after death from antimonial poisoning. — There may be congestion of membranes of brain with softening and congestion of its substance. An inflamed or aphthous state of whole of mouth, fauces, and gullet, or this may be confined to mucous membrane of fauces and cardiac end of the gullet. The mucous membrane of the stomach is more or less reddened in patches or spots, the result of inflammation, the membrane softened or corroded and easily removed by friction, sometimes covered by false membrane or aphthous crusts ; the surface darkened, inflamed or ulcerated ; small ulcers with pustular exudation occasionally found ; the contents of the stomach of a dark brown colour, consisting chiefly of mucous matters coloured either by blood, bile, or by a mixture of both. The peritoneal or external coat of the stomach has been found inflamed ; the intestines present similar appearances, the inflamed portions of mucous membrane being seen chiefly in the duodenum, carcum, and rectum ; the contents of the intestines bilious or bloody with much mucus ; aphthous ulcerations of the glands of the small intestines y the lungs showing more or less congestion in portions of the lobes ; the heart empty, or, if blood be contained in its cavities, this is dark coloured and liquid J the blood liquid throughout the body. In cases of chronic poisoning the liver is enlarged, softened, and its structure easily broken. The organs of the body have been found well preserved. When life is protracted there has been noticed gastro-enteritis in a severe form. {IhidJ}
A weakly man was attacked with bronchitis accompanied with much fever. After losing a sufficient quantity of blood he was ordered by his physician to take nitrate of potassa, but on the 3rd d* from his attack he took 10 gr, of tart. em. dissolved in 7 oz. of water in l d* By this his chest was considerably relieved, but a severe form of angina supervened. The whole mouth and lips were very much swollen and excoriated in many places, as though from a salivation of mercury. The tongue was deep red, and dry in the middle. The soft palate and throat were likewise of a deep red, and covered with small vesicles, many of which had burst ^ and these parts were so much swollen and covered with thick mucus that the poor fellow was quite unable to swallow even liquids, and his breathing was obstructed* On my arrival I ordered the mouth and throat to be well rinsed with a Iuke> warm decoction of groats, and 1 observed this serious affection, which

was attended with a considerable fever and nightly delirium, to give way in 3 d. (Troschel, Med. Zeit.^ Oct. 9th, 1840.)*

A man, act. 58, affected with pneumonia, was treated Dec. 24th — 27th with tart, em., gr. iij to ^xvj of water, 2 tablespoon fuls every 3 h. On n. of 27th, throat became so much affected that he could not sleep ; deglutition of even small portion of h'quid accomplished with utmost difficulty. At noon on 28th pulse was found 100, and tremulous ; soft palate and uvula, with neighbouring parts of pharynx and roof of mouth, were covered with an ash-white envelope, apparently of some thickness, very much resembling the appearances produced by a free application of nitrate of silver ; portions not so covered had palered unhealthy colour. Next d., much thick mucus from throat and mouth. On 30th, part of " slough " came away ; parts underneath red and ulcerated. Fauces, up to Jan. 7th, were still bright red, with some superficial ulcerations.

At height of trouble patient felt as if head and throat were separated from trunk. (Annan, Medical Tlmes^ xiii, 316.)

The operation of tart. em. upon the gastric mucous membrane may produce a croupous process ; it is, however, commonly limited to a WW streaks. (Rokitansky, Path, Anat,^ Syd. Soc, ii, 26. Dr. Imbcrt-Gourbeyre, G^z. Med, de Paris^ i860, cites 6 cases, besides those given here, in which pseudo-membranous inflammation of parts of the alimentary canal had occurred from the use of tart, em.)
In 26 out of 144 cases of pneumonia treated with large doses ot tart, em., Boudet observed its effects on mouth and throat. There was a burning sensation with constriction in pharynx and oesophagus^ with swelling, dryness, heat and redness of posterior fauces, difficult deglutition, and a disagreeable metallic taste ; later, upon the arches, the velum, the pharynx, the edges of the tongue, and the cheeks, ulcers made their appearance. They were generally i or 2 lines, but sometimes \ inch, in diameter, except upon the dorsum of the tongue, where they were generally linear, and covered with a deposit resembling false membrane. (Stille, op, cit,)
The false membranes produced by tart. em. in the cavity of the mouth, and principally upon the tongue, have the form of irregularly rounded patches, whitish or greyish in colour, somewhat thick, consistent, and firmly adherent. In the oesophagus they are small, delicate, pale, and easily detached from the subjacent tissue. Beneath the pseudo- membrane, the lingual mucous structure is excoriated, ecchymosed, wrinkled, and forms an elevated margin around the plastic deposit, which is red and somewhat extended. The oesophageal mucous membrane is ulcerated, the borders of this ulceration are not elevated, but enclosed by a grey circle, the base being softened and greyish, and, at some points, ecchymosed. (Laboulbene, Recherches sur les affections pseudo-membraneuseSj p. 132.)
As in the case of mercurial, plumbic, and cupreous impregnation of the system, there is likewise an antimonial sign, which is perfectly

• " After the use of tart, cm, for some days, patienfs sometimes complain of irri. tation in the mouth and throat, with a metallic taste'* (Pereira).

3631

pathognomonic. It is, as with all other substances, a phenomenon of the gums and teeth. In copper impregnation, it is not so much the free margin of the gum, as the parts of the teeth next the gum, which are coated with sordes; whilst in antimonial impregnation, it is not the teeth, but the whole surface of the gums, both within and without, which assumes the appearance of the brightest pink velvet, with aj raised pile, {Lanct*t^ quoted by Marcy and Peters,) j

Tartar emetic i^ a powerful local jrntant. Its irritant proper^ ties may be regarded as of a peculiar or specific kind ; at least if wc] are to judge from its well-known effects when applied to the epidermis, as in the form of solution or ointment, or sprinkled over a plaster. It causes an eruption of painful pustules, resembling those of variola or ecthyma. The smaller ones are semi -globular ; the larger ones, when at their height^ are flattened, are surrounded with an inflammatory border, contain a pseudo-membranous deposit and some purulent serum, and have a central dark point. When they have attained their greatest magnitude, the central brown spots become larger and darker, and, and in a few d., desiccation takes place, and the crusts are throwm off. They are usually very painful I am acquainted with no agent which produces an eruption precisely like that caused by emetic tartar^

( Per E IRA, op, cit.)

The clear Jymph of the pustules which arise from the external application of tartrate of ant, produces inoculation pustules, which are quite indistinguishable from those produced by vaccination, , • . I have made 31 vaccinations and revaccinations with lymph of tartar 1 emetic pustules, and I have found them in all their relations analogous with those from cow-pox lymph. (Lichtenstein, HufelartiTs youmaiy xcii, 76.}
A girl of 14 took in the course of a fortnight [malady not i mentioned] 3] of tart. em. internally. Some d, after leaving offi medicine, there appeared a varioloid eruption, which ran a course exactly like that produced by tart. era. ointment, (Crichtok, Ferm^ Abh. einer Gcstli, prakt, Aerzte zu Sl Peiersh.^ 1835*)

J 8* A man, act, 34, took for pneumonia to gr, of tart. em. m solution during 36 h. In 24 h. after last dose there appeared an eruption having the most perfect likeness to that caused by, tart, em, ointment. It consisted of small papulae or vesicles, which rapidly enlarged and became full of pus, surrounded by a red areola, so that they resembled true variolous pustules : they were besides extremely painful. After a few d. they dried up and formed crusts. Some ot the pustules were larger than others, like those of ecthyma. Eruption commenced on inner surface of forearm, then spread all over back, where pustules were partly solitary, partly grouped, or even confluent. Neither vomiting nor sweat attended formation of pustules, but they were preceded by some watery stools, (Boeckh, Med. Zeit. von dim Ver.f. Heilk, in Pri'usstfi, 1843.)

An Essex farmer, suffering from pneumonia, had been taking tart. em. in 4 gr. doses every 3 h. for 6 d. Dr. Richardson states that he witnessed here the peculiar eruption on the skin which sometimes appears. The body was so generally covered with pustules that the

friends of the patient mistook the eruption for smallpox — a natural error. [Lancet^ 1856, i, 509.)

In 2 or 3 cases in which tart. em. had been administered, Dr. Brinton has seen a peculiar eruption of the skin, like that produced by the external application of the drug. {Ibid.^ p. 590.)
I have used tart. em. in large doses in croup for the last 15 years, in children of all ages, . . . and have obtained a cure without any accident. I have indeed sometimes met with slight antimonial eruptions, not very numerous, on different parts of the body. (Con- STANTiN, Gaz. des Hop.^Mzr. 26th, 1859.)
I have in 3 cases seen a profuse pustular eruption on the cutaneous surface result from the internal administration of tart. em. ; in 2 of the cases the eruption supervened on that of rubeola, where the complication of pneumonia had caused the medicine to be resorted to in moderate doses. (Butler Lane, Lancet^ 1846, i, 361.)
Dr. Imbert-Gourbeyre, in a paper on " Antimonial Eruptions," shows by observations and citations that the local application of tart. em. is liable to produce pustules on other parts of the body, and especially at the ano-genital region ; and maintains that these are the dynamic result of absorption, and not the effects of mere mechanical transference, on the following grounds :

1st. Several patients subjected to antimonial friction asserted that they did not touch the parts of the body which were the seat of the secondary eruptions (6 cases).

2nd. The medical attendants themselves in certain cases took great precautions in order to prevent any transference of the ointment (4 cases).

3rd. These secondary eruptions have been observed on infants in swaddlingclothes, and on a patient whose limbs were paralysed.

4th. The antimonial eruptions on the place where the ointment has been rubbed in leave cicatrices ; the sympathetic eruptions do not.

5th. If the patient's fingers are the cause, how does it happen that the secondary eruptions do not occur more frequently ? and especially how is it they do not occur very often on the eyelids, nose, lips, cheeks, fiicc I They have never been seen in these situations ; and yet does not a person apply his fingers to his face far more frequently than to the ano-genital region ?

6th. What is to be thought of those cases where the pustules fail to make their appearance on the spot subjected to the frictions, but are developed elsewhere (3 cases) ? and where, the friction having been discontinued, pustules appear elsewhere 2 — 5 weeks later (2 cases) ?

7th. On the mechanical hypothesis, how is it that the ano-genital eruptions are not more frequent ? whereas they occur extremely rarely in proportion. {Gaz. Med, de Paris^ i860.)

The same author cites 5 cases in which pustulation of parts of the alimentary mucous membrane occurred after the free administration of tart, em., and 3 in which it was observed on the surface of the peritoneum after a large quantity of antimonial ointment had been rubbed upon the abdomen. {Loc. cit.)

III. Exptriments on animals. — i . a. V iborg found that when tart. em.

was injected into veins of horses, in doses of 12 — 30 gr,, it occasioned

frequent and small pulse, trembling and twitching of muscles of skin gaping, and a drooping look. On injection of 60 gr. the symptomf^ were very striking : pulse grew very frequent, and breathing spasmodic and noisy ; there were thin dejections, a copious secretion of sweat, tears, and saHva ^ automatic movement of lips and tongue, as in the act of licking, grinding movement of lower jaw, restlessness, stretching of limbs, scratching of flanks with hind feet, repeated movements of head towards same parts, and tremulousness with spasms of shoulders, neck, and hams. When quantity injected reached 1 20 gr., the symptoms were sudden and violent. They consisted of cramps, vertigo, paralysis, and death within 3 h»

h. According to Lappe and Hertwich, when substance w^s administered by stomach in doses of \J or 5ij every 3 or 4 h,, there occurred, sooner or later, diarrhoea, debility, increased secretion from mucous membranes, and, if medicine was continued, a sort of typhoid condition, with diminished plasticity of blood. A single dose of ^ss caused frequency of pulse, thirst, borborygmi, and muscular spasms j 3j caused death in about 8 h. i 5U* same result in 2^ h.

f , Pecholier, in his experiments upon animals, found rate of pulse to fall, on an average, 20 — 25 beats a m. under influence of doses of grs. I or 2 i rate of respiration and temperature declined in like proportion. The more minute experiments of Ackermann confirm this statement, showing that immediately after injection of a solution of tart. em. into veins pulse rises rapidly ii\ frequency, even by 50 in m., after which it sinks below original rate. After poisonous doses, acceleration is slight and transient, but decline in frequency rapid until a few m. before death. It also becomes irregular. Oniformly arterial pressure is diminished, while duration of pulse wave is lengthened* The venous system becomes everywhere engorged ; parts like the tongue and gums, which in health possess hue of arterial blood, become first pale and then dusky in colour. The temperature falls lower the longer such a condition lasts. (Stille, op, at.)

2, Dr, Nevjn's experimented on 16 rabbits, the doses varying from ^ to 2 gr, : it required from 12 to 73 gr. to cause death. For first few d. no striking symptoms were present ; then animals lost spirit in great degree, and gradually became emaciated, but continued to take food almost to h. of death. All who lived beyond toth d. had diarrhoea (rabbits are incapable of vomiting). Spasms were not present in a single instance ; but several died in violent convulsions. The mouth was very severely ulcerated in several. P.M. Emaciation often extreme^ so that not a trace of fat remained in body. Stomach fre* quently inflamed in patches but not throughout j sometimes, but rarely, ulcerated ; always more than half full of blood j pylorus frequently so much thickened and indurated as to resemble cartilage under knife. Small intestines frequently inflamed in patches, rarely ulcerated ; intestinal glands sometimes excessively enlarged. Liver generally congested in parts, occasionally inflamed, hard and brittle. Kidneys generally more or less congested, sometimes one only. Bladder geneily distended with urine and more vascular than usual Trachea

and lungs frequently congested, sometimes highly inflamed ; the two lungs seldom alike. In several cases extensive extravasation of blood upon surface of lungs, liver, and stomach, and below mucous coat of cacum. Heart generally fidl of black, uncoagulated blood, {Lcc, ri>.)

3, Dr. Campbell found 5 gr, applied to a wound, kill a cat in 3 fa. Inflammation was set up in the wound, and vivid redness within the stomach. (Christison, ^. ctL)

4.^ — a. Dr. B. W. Richardson introduced into cellular tissue of large dog 5] of tart, em. in ^ij of distilled water. After i h. shivering and vomiting, latter repeated, much flatus and once purging. In I h» body quite powerless, limbs and breath cold, pulse and respiration greatly reduced, comatose sinking, death in i h. 40 m. Respiration survived heart 3 m, P.M. General venous system greatly engorged, and on inner surface of stomachy along greater curvature, a patch of bright pink 2 in, by i^.

h, A dog made to inhale antimoniu retted hydrogen died in 3 h* 45 m. Same P.M. appearances ; also pleural cavity contained gvj of pinkish serum, which, on being poured into a hot tube, coagulated firmly into a jelly-like clot, whence clear scrum exuded*

c, A wound in a dog being dressed with tart- em. ointment for 7 d., animal lost appetite, became thin and exhausted, and died on 7th d« There was no vomiting or purging. Same P.M. appearances, {Lancet^ 1856, i, 508.) _ ^ \

If one injects into the veins of an adult dog, of medium size, 6 or 8 gr, of tartar emetic dissolved in 4 oz, of water, there are at first vomiting and dejections more or less repeated ; then it becomes n>anifcst that the animal has difficulty of breathing, its pulse becomes frequent, then slight tremors like those which accompany chills appear ; the breathing becomes more and more difficult, the pulse irregular and even intermittent ; the saliva becomes more copious j the animal becomes restless, and knows not what attitude to take or preserve j the symptoms become more intense, and death ensues about 2 or 3 h* after the injection. In opening the cadaver, one sees that the lungs are profoundly altered ; they have changed their natural hue for one of orange if the animal is young, of violet if it is older. The crepitation proper to the pulmonary tissues has almost completely disappeared ; on incision, the lung substance is found gorged with blood, and as if hepatised at some points, while at others it appears to have undergone splenisation. The mucous membrane of the alimentary canal is injected » (MaG£NDI£, De fenietique^ p. 36,)
— a. A strong and active rabbit, breathing normally 80 times a m., took each d. 3 doses of tart. em. of 25 centigrammes each, at 4 h. intervals. At the end of 3rd d. the appetite had markedly diminished ; the respirations had risen to 1 10. On the 5th d. 3 liquid stools, greenish brown. During the next 3 d. frequency of respiration fell ; on the 8th it was 60, noisy, and like that of an animal that had been running \ it seemed more difficult. The number of respirations continued to diminish : on the nth breathing was 42, as noisy, and more and more laboured ; the inspiration much prolonged. On the 15th d. the animal took only 2 doses. In e, I found tt lying on its side, breathing

very noisy, and 37 only ; some cx>nvulsive movements in head and limbs. It died same c.

h, PaM.— A little serosity in L pleura ; its colour dead white. The L lung is dark red, slate-coloured in its two lower thirds and in all its upper border ; it is especially on the convex surface that this tint is most decided, and it is sprinkled there with blackish points. On the concave and internal surfaces the same coloration exists, but it is more greyish ; two spots here are almost gangrenous in appcarajicc* The superior third is congested and has an emphysematous strip* The r. lung is red, and simply congested* Crepitation is absent in the two inferior thirds of the left lung, and its density is increased ; at apex, signs of emphysema only are present. The r. lung crepitates throughout, but perhaps less than normally. Section of base of 1* lung shows granitic appearance even more than on surface ; at certain points it has an ashy appearance ; on scraping there is removed a little sanious liquid, bloody and greyish ; a piece placed in water sinks to the bottom : the cohesion is much lessened, the finger penetrating easily, and reducing the tissue to putrilage. The trachea contains a thick liquid, tenacious and bloody ; it presents a decided red punctation throughout, and towards the lower part a large wine- red patch; the mucous membrane h thickened especially at this point, and is easily stripped off. The redness diminishes gradually along the r. bronchi, where the mucus is not very abundant ; in those on the 1. it is very intense and extends farther \ they contain, like the trachea, a good deal of sanious and sanguinolent mucus : towards the ramifications the tint is more grey. On section, one sees little bubbles of liquid forming at the cut ends. In the heart, no blood in 1. cavities i r, auricle showed fatty degeneration, and this with its ventricle contained clots. In the digestive tract there was only a little redness ; some slight serosity in

peritoneum ; liver brownish ; mesenteric vessels gorged with blood.

I Nine other experiments produced like results \ only the larger the dose and the earlier the death of the animal, the more simply congested were the lungs, (Molin, Des Specif, en Med.)

7, a, I took a rabbit, 6 months old, vigorous, having, in its normal state, 78 respirations per m. April ist. — 1 administered to it, in sugar of milk, 4 drops of the 6th dilution o( tartan sed antimony m, and e, I fed the animal with bread, bran, fresh leaves and vegetables. Its shed was so constructed that it could not suffer from cold or damp. Up to June 25th I did not observe any symptoms resulting from the administration of the medicine. I then increased the dose to 8 drops of the 6th dil., m. and e. Towards the loth of July the appetite of the animal diminished, and it cared to eat of fresh leaves only* Resp. was short, and had risen to 90 per m. The animal kept at the further part of its shed. July 14th, — There were two liquid evacuations to-day. Appetite has returned. Respiration 95, short and anxious. July a4th.^ — The liquid motiuns, which are of a brownish colour, have continued during the last to d, 7^hc animal has lain on its abdomen with its paws stretched out. The bowels are much inHated, and on percussion sound as if distended with gas. The eye is rather dull j the ears arc hot. It does not like to be touched. Respiration 105, hurried and

short. It eats less and less. 28th. — Since yesterday m. it has taken no food. The liquid evacuations are more frequent. It lies at the end of the shed ; the eys are very dim, and the ears rest on its neck; the fur has lost its brilliancy. Respiration 110, and very anxious. 31st. — The animal died today ; I mzde post -mortem 6 h. after death About the lips there is a frothy liquid ; the gums are of a brownish colour i the mucous membrane of the mouth and of the pharynx is of a deep red colour, upon which I also observe some small white spots. The stomach contains a small quantity of fluids which is stringy. The mucous membrane is swollen and has patches of a red colour here and there. In the duodenum also 1 observe the red patches. In the rest of the small intestines are also streaks of red and arborisations. The mucous membrane of the large intestines is of a dark red colour ; and there are some ulcerations in the ciccum. The traces of inflammation get fainter as we get towards the end of the intestine. The peritoneum shows some traces of the same red colour. The liver is increased in size and of a deep red. It is rather hard, and more perceptibly so when it is cut. The spleen is normaK The kidneys are red and congested. The bladder is distended and contains thick, straw-coloured urine, having a strong ammoniacal odour. The mucous membrane of the larynx and trachea is red, and presents arborisations of a deeper hue. In the pleurae there is abundant fluid of a whitish-yellow colour, in which float threads of albumen. The membrane is red. The lungs are inflated, and the parenchyma is of a deep red. Crepitation exists in the lower two thirds of the r. lung. In the remainder the density is increased. Upon section there oozes a little red fluid, and I find in the tissue of both lungs clots of coagulated blood ; particularly in the apex. The pericardium is red, but there is no fluid in the cavity. There is coagulated blood in the cavities of the heart. Brain is normal.

if, A rabbit, 5 months old, not very strong. Respiration 82. Oct. 20th. — ^I administer to it, m. and e., 4 drops of the 6th diL oftartarised antimony. Nov. 8th. — Observing no symptoms, I give it 8 drops m, and e. 13th. — Its motions are liquid and yellow. Eats nothing all d. 14th. — It begins to eat again a little. The liquid motions continue. 1 8th. — ^The evacuations have been completely suppressed since yesterday e. ; but he eats very little. 24th, — Resp, becomes quicker, 105 per m., and very loud. He now and then makes a noise which one might call a cough. He is very restless, cannot remain quiet. Ears seem as if broken ; are flabby and very hot, Eyes are dull, and thick mucus comes from the mouth. The fur has lost its brilliancy. The stomach is inflated; percussion tympanitic. The animal rolls about as if he had colic. He no longer eats. He remained in this state till the 26th, when respiration became embarrassed and he died. I made ^ost -mortem 4 h, after death. The fur is dull looking and is easily Retached, From the nasal fossae comes a thick, black mucus. The membrane is red ; also the membrane of frontal sinus. Nothing abnormal in the brain. The jaws are firmly closed and can only be opened forcibly. A foetid odour is then perceived. The gums are blackish ; the saliva is glutinous, thick, rather dark, and contains bubbles

3o8

of air. The tongue is hard and rather contracted. The mucous membrane of the mouth and throat is red. The stomach has collapsed to its natural size and looks like parchment. The pyloric orifice is red and swollen* In the intestines there is redness in patches, particularly in the large ; and, like the stomach, they have returned (collapsed) to their natural size. There is rather a large quantity of dung in the large intestine and it is very hard. In the rectum are several ulcerations ; and the mucous membrane around the anus is swollen. The peritoneum is inflamed, but contains no fluid. The liver is pale, h^d^ and shrunken ; when cut a serous fluid escapes. Spleen Is normal. Kidneys are congested. Bladder is distended with a thick, reddishyellow liquid of a disagreeable odour. The vesical mucous membrane is very red, particularly towards the neck and the canal of the urethra* The pleura is injected, but there is no fluid. The lungs are of a violet red, the tint becoming deeper in the inferior lobes, and there are large blackish patches like spotted marbles. The hepatisation of the lesser lobe and of the inferior part of the superior lobe is less noticeable. There is no crepitation. On section, we see a granite-like appearance with blackish-red points. Clots of blood are found in great number in both lungs i and in the apices are crude tubercles, more especially in the 1, On section, there escapes a little sanious fluid. The pulmonary tissue easily breaks down when taken in the fingers. It has a hard^ granite-like look, something resembling the liver. A small piece put in water goes to the bottom. The pericardium presents no redness, nor is there any effusion. The heart is congested. The aorta is distended near the arch, and there is a pouch containing black and clotted blood. The animal is extremely emaciated. The flesh is soft, flabby, and discoloured. (Ibid, Compte rendu^ iic.y p. 85. Five other experiments were made with same dilution, and with similar results to those reported above »)

8, — a. In the ^Journal fif Phymhgy for 1878 I have published in conjunction with Mr. Murrell some experiments showing that tart, cm, I is a protoplasmic poison which destroys the functions of all the organs f of the body in the order of their vital endowments. VVe have shown that the general paralysis which ensues in a frog on the hypodermic injection of the drug is due to its action on the spinal cord, thus confirming previous experimenters ; and that it is also a direct paralyzer of the motor nerves, and of the muscles, including that of the heart*

h. Tart. em. is a general as well as a cardiac depressant. The general depression is usually attributed to the action of the drug on the heart, but, as ant. is a poison to all nitrogenous tissues, I would suggest that its depressing action is due also to its effects on the central nervous system, the nerves, and the muscles.

c. We noticed a peculiar effect on the skin. In a few h. the

cuticle of a poisoned frog became softened and gelatinous^ too soft to

I be stripped off, though it could be easily scraped off every part of the

f body. Even small doses soon produce this remarkable effect, for in

one experiment the skin, after a small dose, came into this condition

whilst the animal could still crawl pretty well. Miss Nunn, Lecturer

on Biology in the Wellesly College, Boston, U.S.A., under the direction of Dr. Michael Foster, investigated microscopically the action of arsenious acid and of tart. em. on the skin. Miss Nunn shows that the peculiar effect of these substances is limited to the epidermis and leaves unaffected the corium, with the exception of increasing the quantity of blood it contains. (Ringer, op, cit.)

The structural changes in the epidermis brought about by ant. are essentially the same as those produced by arsenic. There is (i) the same marked degeneration and partial solution of the columnar layer of cells, which causes the epidermis to be held less firmly to the dermis ; though, previous to the hardening, the extreme softness of the cells prevents it from being stripped away as can be done in the case of arsenic. There is (2) the same degeneration and separation of all the cells of the Malpighian layer, and (3) the same desquamation of the corneous and intermediate layers. The principal difference is the greater softness, or more complete isolation of the cells, and the somewhat more marked change in the intermediate layer. The cells of this layer appear more thoroughly detached from one another, and hence cavities are more frequently found between them ; hut their protoplasm is never formed with threads and processes enclosing spaces, as in the columnar cells. It is this separation of the constituent cells of the intermediate and also of the Malpighian layers which is the chief determining cause of the pulpy or mucilaginous condition of skin in antim. poisoning mentioned by Ringer and Murrcll. Altogether, the action of antim. is more rapid than that of arsenic, and the changes produced by it bear evidence of more violence. . . . 'f'he skin, under the influence of either drug, presents a striking contrast to one which has been left to disintegrate in a natural manner after death. . . . Both drugs affect the cornea similarly to the skin, but in a less marked manner. (Nunn, Journ. of Phys,^ 1878.)
Magendie removed the stomach of a dog, and attached a pie's bladder filled with fluid to the oesophagus in its place. Me then injected tart. em. into the veins of the animal^ and found that voniitin;/ occurred in the same way as if the stomach had been in situ, [Mem, sur le vomissementj p. 19.) This experiment has iKrcn con(iririf:ri by Brinton {Cycl. of Anat, and Phys,^ Supplement, p. 31'yj, wJio \\x\\v.r proved that when tart. em. was injected into the vein*} of un animal it was very freely and rapidly eliminated by the stomach. Dr. Kichanl son [Lancety 1856, i) has corroborated this, and ha*; also found that a similar elimination follows the inhalation of antimoniuretted hydro|i;cn. (H. C. Wood, op, cit.)

II. M. Chauppe divided the two pncumogahtric*i in a do;/, which was then allowed to rest till the vomiting provoked by th^: operation had entirely ceased. He then made a sul)cutaneoun or intra- venoiii injection of an emetic dose of the substance who.e action he wiis desirous of investigating. With tart, em., vomitin;.^ m curred as r)iji( kly and as freely in all instances as when the utryu'^ wen: intact ; and more so than when the drug was introduced into the stomach, (d/ty.. Mt'd, de Paris, Aug. ist, 1874.)

Volume IV — Appendix

ANTIMONIUM TARTARICUM.

(See vol. i, p. 178.)

I. 7. (Revision from original.) I took, May 20th, 184.2, at 6.30 a.m., gr. \ triturated for an h. with 25 gr. of sacch. lact., dissolved in a spoonful of water. After \ h., frequent eructations of air, now insipid, now flat-tasting ; afflux of clear flat-tasting fluid into mouth, running out in great quantity, with retching and straining which brought up nothing but a little clear mucus. Easy expectoration of much transparent sweet-tasting mucus. Indescribable malaise in region of stomach and belly, increased in former but diminished in latter by gently laying hand on the parts. Tenderness of abdomen. Sense of weight in stomach, which invades whole abdomen and causes great malaise ; this state is relieved in the open air, but aggravated indoors it is also diminished by eructation. Dull belly-ache in mesogastrium with slight shuddering and goose-skin. For 10 m. slight coldn prostration, and desire to sleep. Frequent yawnings. After a glass of 1 warm milk at 9 a.m. all these discomforts went ofF. After dinner, head was painfully attacked, especially in forehead ; this lasted \ h., and there was occasional transient pressure from without inwards, as if towards one another, in temples. By e. all had gone off. (De MooK, Revue de la Med, sptcifique^ v, 436.)

a. I had prescribed for a little boy of 14 mos. a gr. of tart. eta. in 3vj water, to be taken in 3 doses. He had no vomiting or purging, but his belly became large and tense, and his face and hands swollen ' Enemata, 3 — 4 a day, gradually relaxed the belly ; the cedema did not disappear for 8 — 10 d.

b. Dissolving 4 gr. in about -jij of distilled water, I took this solution in the palm of one hand and rubbed it against that of the other till both were dry. Some m. after, I felt a slight flat taste in the mouth, which filled with a quantity of water, as when one is on the point of vomiting. I had, however, no actual nausea or sickness. Repeating experiment, and rubbing in only a few dr. at a time, I felt slight nausea during the process. When the sol. was rubbed into the inner aspect

• In presence of the doubt as to the part played by arsenic in fuchsin poisoning we have limited ourselves to the above summary; but the use made of it, not in the school of Hahnemann only (see Brit. Jaum, ef Horn., xl, 18a), to remore «». ditions of the kidney characterised by albuminuria, requires such a basis. For a ax illustrating it* power of causing Euch conditions, see the Cliwi^ue for Nov., tSSi.

the thighs, no effect resulted. (Savary, Journ. dt Mid. dt

visarty xxvi, 248, from Ibid.)

a. The effects of tart. em. in health vary according to the loses administered. From i centigr. slight general perspiration ordilarily results ; after 2 or 3 the sweating becomes copious, or alvine rvacuations arc produced. From 5—15 centigr. we sec nausea, ihuddering, pallor, giddiness, salivation, repeated and violent vomiting, with sweat on forehead, obscuration of vision, and involuntary trembling >f the lower jaw. When given in larger doses still, it rarely produces ^oaiiting.

b. Whatever be the channel through which tart. cm. enters the lystem, it always produces the same results, /'. e., perspiration if its tction be slight ; stools and vomiting if this is more considerable ; reneral prostration if its full power b exerted. (Giacomini, from kid.)

Volume IV — Supplement

ANTIMONIUM TARTARICUM.

(See vol. i, p. 378 ; vol. tv, p. 486.)

Ismail Siek, of Loshkurpur, Pabna, aet. 40^ a man of strong build and short size, and bald head. At 6 a.m., 12th July, 1890, he took about a gr. of tartar emetic with the purpose of purging, and passed one stod of ordinary character ; but the patient was not satisfied ^th such stool, and took another er. at 8 a.m., and within ^ h. passed one profuse colourless watery stool. Third stool was watery, but n(^

In a healthy man, primary action.

{Curative action. CuratiTe action f

much in quantity, and had a slight tinge of yellow colour. Fourth stool watery and mixed with green mucus. After this vomiting took place, and patient began to pass innumerable colourless watery stools mixed with fakes of mucus resembling Kunjee water or rice water. These stools were accompanied with profuse cold sweats gathered over the skin like distinct drops of water. There was pain in abdomen, also at assing of stools. Cramps in hands and legs ; frequent faintings. rofuse watery vomiting of bilious or bluish-coloured matter made the man helpless. Body cold, pulse imperceptible ; cramps also took place fingers of 1. hand, He became prostrated and laid up in bed. Cramps were taking place very frequently in extremities ; clenching the teeth oftentimes ; fear of death ; sweats broke out like streams of cold water (attendants busily engaged to wipe off the sweats without success). Much restlessness and tossing about, Breathing after long pases.” Breathing was also dificult, Passed soo in the bed." Hope~ lessness prevailed. Now and then turned insensible ; watery vomiting and retching became very troublesome, Burning sensation inside body. There were also pricking and stinging sensations. No thirst. No since first stool. Felt much heat and heaviness in head ; asked for application of cold water to head and constant fanning ; conjunctive not congested, Voice turned hoarse and husky 5 breathing low, nasal, and short ; speaking made his breath hurried. ‘Tip of fingers and palms of hands shrivelled up and turned reddish blue. Eyes sunken with blue margin ; restlessness ; nothing retained in stomach, not even drop of water. "No urine; headache; feverish, and hiccup. Tin, of blood in the bluish watery vomiting. In e, pulse slightly improved ; purging stopped; retching, vomiting, and hiccup still con tinued. Tongue coated with thick white fur.” 13th.—Complained of pains al over Body 5, voice improved a little. Aching pain in loins spine, neck, and. shoulders, relieved by pressure, Inside chest felt pricking pains as if beaten, with stings ; retching was very troublesome, Thirst was not much ; two or three spoonfuls of water were sufficient to check it. Appetite very dull. Much burning sensation was comflained ofall over body. No burning sensation in feet and palms. joth extremities felt as heavy as if they were paralysed. 14th,—Fever came on at 9 a.m., and lasted till 1 p.m. Urine passed after 48 h. in small quantity, red in colour. No stool any more. Hiccup now and then, but less in force griping pains in umbilical region. Cold water applied to head with a small bit of cloth caused heat in head, and patient asked to discontinue the application, He desired to take cold fruits, such as pomegranates, papayas, cocoanut water, sugar-cane, He became hopeless of his life, he said he would die, and requested his friends to keep him under a best physician, Complained of hazy sight and vertigo now and then, Eyes looked as if they became of smaller ize. Ears were sharper. 4 p.m. no stool ; better on passing urine rricking and cramp-like pain inside chest in region of heart. Desire to lie down in bed with eyes constantly closed. Does not like to be disturbed ; does not like to be called out ; now and then twitching of limbs and’body. Desire to lie down on floor of house. No appetite, no thirst ; does not like to take barley.water, 8c. 15th.—Fever

*giin to-day from 6 a.m. to 8 p.m.; commences with chilliness. Sleepiness almost all d. and n. ; cannot open his eyes freely though he attempts to do so on being called out and shaken. Pain in abdomen ^^^^ wntinucs. i6th. — 9 a.m., bad appetite; does not like to take any

^^^^ (M'ng. Says he has no hope to live in the world. Pain in region of ^^^^1 ^eart less. Pain in umbilicus transferred to region of spleen. Pain ^^^^H ,^om neck to head. Fever was very high last e. At commencement ^^^^F ft Mns accompanied by shivering and chilliness, and excessive twitch- ^^m /"S* of limbs and body. Extremities cold, specially lower limbs up to

^^B ^'^ees. Hands cold up to wrist. Sweat on forehead. Fever of last

^V "• still continued. Eyes looked slightly jaundiced. Tongue, which ^H '^^s covered with thick white fur, became here and there denuded by ^B '^^•-tches. The patches looked very red. This white thick fur or " •'"*■ '%icus of the tongue seem to be such as might be easily scraped offj ■-t on scraping, the whiteness did not disappear. In e, I saw him, "^ngue from middle to the tip red ; side and root thickly covered with Ticus. To-day tor the first time he could sit up in the bed by leang on a bulky pillow. Yellow chick mucus began to issue out from e. Liking for acid fruits, except lemon, which tasted to him bitter, e like to take preserves of mango, plum, &c. Passed clear urine, iccup much less to-day, fever much less. Eyes not much closed day. Head very heavy ; did not like to keep it on pillow. Pain body here and there. Heaviness of head was the greatest complaint, hirst was very slight in the fever time, and was satisfied with a all quantity of water. 17th. — Great burning sensation all over y which kept him more restless. Eyes sunken and could not be pened properly. Pain in region of heart and abdomen was much :ss. Tongue improved. To-day passed a stool like sheep-dung. 8th. — Pain in heart less. Pain in abdomen like colic. Last n. lassed urine about 30 times in profuse quantity; this m. passed pro^ f~use urine 3 times only. Never had such diuresis in his life before, ^ast n. slight thirst ; now and then a sort of suffocating sensation, ^gth. — Urine less in quantity. Patient much improved ; no fever; tongue natural ; appetite gooid. (C. S, Kali, Indian Horn, Review^ JVlay, 1 89 1.)

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