Argentum nitricum

Volume I — Main text

ARGENTUM NITRICUM,

Nitrate of silver^ Ag. NO^» Lunar caustic.

1. Provings, — r, Hahnemann, Mat, Med. Pura^ voL original, vol. i of translation. Contains a few symptoms only,

2, J — , student, aet. 22, blond, of phlegmatic temperament, vigorous ; liable to branny spots on neck. Took of i, trit, as much as would cover point of knife, in water, each e. before retiring. After 1st dose,^ — metallic styptic taste, like ink, immediately ; dizziness before falling asleep ; restless sleep, dreamful, with much tossing about and frequent dazed awaking; woke early in m, with flatulent rolling and rumbling in bowels, and sensation as if he must go to stooL Three diarrhoeic stools at short intervals, the first evacuation being papescent and copious, the other two scanty and of a watery mucus, dark and fetid. Does not relish the usual breakfast (coffee and milk). The whole forenoon his limbs feel very weary and debilitated as after a distant journey, accompanied with great feeling of illness, dread of labour, drowsiness, chilliness, does not look well. No appetite ; frequent rising of air. Feels chilly all over in e, (in the room). After 2nd dose diarrhoea in n ; six liquid brown fetid stools. Sweat with chilliness as soon as he got warm in bed. After waking painful confusion in forehead j this disappears after eating, Weary^ debilitated, 'no appetite. White slimy tongue ; the papillae are enlarged, smarting

• " In man, even after the administration of large doses of silver nitrate, none of the above-mentioned symptoms or organic changes have been met with '* (Noth- NAGEL and RosaBACH)*

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like a sore. Looks very ill. Frequent emission of pale strong-smelling urine. Urine continues to drop out after the micturition is accomplished, with sensation as if the urethra were swollen. After 3rd dose drowsiness and tossing about in n., but no sleep. Palpitation, Sweat towards m. Tremulous weakness in the daytime, accompanied with general prostration and apathy, No appetite ; food tastes like straw.

The prover could not be induced to continue the proving lest he should be too ilL On 6th d.j 3 d* after he had discontinued taking the drug, his health was fully restored except some weakness in lower extremities* (Dr. J, O. Muller's provings, Oester. Zeitschr,/. Hom,^ vot it.)

1. H — , man of 32, short and thin, of phthisical tendency, had syphilis and hydrargyrosis years ago, but now quite healthy. Proved drug like No. 2. After ist dose, — bitter, astringent, metallic taste, " as of verdigris," causing nausea and retching ; could not get to sleep for fancies and " images hovering before him ; " then dreamful halfslumber for first prt of n. j scarcely had he become quiet when he was obliged to go to stool, with slight colic ; he had sixteen greenish fetid mucous discharges during the night, which went off with a quantity of noisy flatulence. Great debility in daytime, even to exhaustion ; lumbar region felt as if beaten to pieces* Papillae about K margin of tongue became erect in the shape of reddish, painful pimples ; the tongue pained as if burnt ; fauces and oesophagus felt burning and parched. After 2nd dose sleeplessness and tossing about in bed, with nervous excitement ; in m. mouth and fauces were covered with mucus ; he had to hawk and spit constantly. During d, dry titillation in the larynx inducing cough ; several turns of dry and hacking cough ; indefinable pain in the hypochondria. Cutting in sacrum and abdomen (also when touched) ; cutting and stitching in liver j violent empty eructations. White tongue ; collection of a watery, tasteless saliva in the mouth. Trembling and beating in stomach* Copious diuresis. After 5th dose, the same nightly restlessness, with a good deal of urination ; terrible headache in m. when waking, obliging him to gnash his teeth ; shifting of flatulence in abdomen ; two diarrhocic stools in m. A good deal of urine is frequently passed through the d., sometimes with divided stream. Creeping and burning in anus. After 4th dose, paroxysms of dry cough at n,, sometimes so violent that it induces vomiting ; and starting of lower limbs, especially of knees, the concussion wakes him in aftright. Mucus drips out of the urethra. Colic around umbilicus in forenoon (10), recurring several d. in succession. Tension in axillary glands of r. side. The chest is filled with mucus; watery mucus in mouth and posterior nares d. and n. The outer chest is painful to the touch. Two diarrhoeic stools in c. After sth dose, cough and sweat at n. Three very profuse involuntary emissions. After 6th dose there was no peculiar reaction perceptible ; and the experiment was now concluded. The tension in the axillary glands, which was very troublesome to the prover, continued for several d. On 9th d. of proving chancre-like ulcers were discovered on the prepuce ; at first their tips were covered with pus,

after which they became spread out over a pretty spacious depression, exhibiting distinctly the greasy covering of a chancre. They began to liminish next d. after their appearance, and on 4th d. they had dried up, except a little remaining dampness, {/hid.)

4, P — , woman, ^t. 30, brunette, fleshy, choleric temperament,

^venous constitution ; regular and in good healthy save that for 6

'years she had had some mucous Icucorrhoea, Took same dose one m, at 10 ; but it affected her so much that she was unwilling to continue proving. On 1st d,, immediately aft:er taking drug bitter, astringent, biting, coppery taste in mouth, inducing nausea and retching ; bluish colour of lips and soft parts of mouth i during d< frequent uneasiness in abdomen ; at n, violent spasm of the stomach, waking her from sleep j a sort of twisting in the stomach, which extends down into the abdomen ; towards m. she had several bloody mucous stools, without any particular pain. 2nd d., soreness in abdomen, with great hunger, abating after a meal, but then succeeded by trembling. Restless n., full of dreams. 3rd d., after dinner a fainting sort of nausea with violent palpitation of heart y she had it three times this after* noon. Extremely painful drawing and heaviness in the os sacrum, down the pelvis, as if the menses would make their appearance. Panu lytic heaviness and debility in the lower limbs, so that she knew not where to place them. She feels so debilitated that she is scarcely able to walk across the room, complaining a good deal of rigidity in the calves. She is near falling asleep in e. while sitting in a chair. 4th d., repeated complaints about pain in sacrum and loins ; heaviness m sacrum preventing her from sitting still ; digging there which docs not

1 permit her to stoop ; the sacral pain is relieved by standing or walking ; the lassitude of yesterday continues to-day, although less, and seems to have become concentrated in sacrum. The catamenia appear a fortnight before the time, flowing only a few hours. 5th d., pricking in the breasts* Swelling and pain of tongue as from submucous ulceration i ulcerated patches on mucous membrane of mouth, especially on !• cheek. Pain in throat when swallowing, as if swollen, or as if a splinter was sticking in the throat. Slicking drawing pain in hip down to tarsal joint. Sticking in 1. side of chest. Sticking in the spleen, recurring for several e. in succession. Biting (itching?) in nose. Erection of papillae on h side of the tongue. No stool since diarrhoea had passed off (stool appeared on the d. following). The mucous leucorrhcea ceased (it reappeared in a few weeks, was quite bland, and much less copious).

1. Dr. Mdller, act* 36, tall, slender, arterial constitution^ melancholic temperament, liable to hemorrhoids.

a. Took same dose as No. 4 at same time. Soon after taking drug, styptic constriction of mouth, metallic ink-like taste i some h* later, slight attack of nausea in stomach, with chilliness and shuddering, and pecdiar feeling of stiiFness in lower limbs, also gurgling noise in abdomen. Giddiness as if intoxicated (very transient), most before eyes. Accumulation of much thick, tenacious mucus in the throat, obliging him to hawk, and producing slight hoarseness (all d.). Pain in 1. nasal bone as if bruised ; rigidity and squeezing in the nasal

cavities. After eating, paroxysmal stitches in liver. Heaviness and drawing in loins, with great prostration and weariness, accompanied with a tumult in the knees and a tremor of the lower limbs, as after a fatiguing walk. The calves feel especially debilitated. Extremely disagreeable drawing and heaviness down the whole 1, side of abdomen when standing. Fulness and oppression in the chest with desire to sigh. Accelerated and increased micturition, the urine being copious and pale yellow j passes the urine with a facility which he had never felt before, and which was almost pleasant ; the stream was apparently larger. (The facility was only perceived to-day and next d, ; afterwards urinadon became difficult and almost fatiguing, although the quantity was the same.) Woke at n. in consequence of an acute pain in wrist-joint, as if sprained, accompanied with heat in the whole hand and restlessness in it, obliging him to change its position continually. In the m» he found a pimple not far from the joint, with pus in the tip causing a stinging pain as if a sphnter were lodged in it. The tip with the pus was surrounded by a red, hard base of considerable extent, and d., violent pain while sitting in sacrum, as if sprained, obliging him to rise (going off after several h.). Violent tearing, digging, raging pain below patella, first I. then r. Peculiar fulness in liver, which was sensitive, with occasional drawing and sticking there, especially when walking, sometimes reaching up into chest. Drawing tearing from knees into legs. 3rd d., violent pain while sitting in sacrum (m.), as if sprained, scarcely permitting him to rise, and not permitting him to walk about except sttx>ping (recurring in the same manner the 4 following d.). 4th d., in m. on waking, tongue is dry as bark ; even when washing the mouth with water the dryness is diminished only partly and for a short while ; palate and fauces so dry that he found it difficult to articulate ; burning pain in velum pendulum, palate, and posterior nares as if sore or as if corroded with pepper. Ringing in ears and diminution of hearing. Fine stitches in spleen in paroxysms. 5th d., through n head feeling dull and stupid i in m,, after waking, forehead feels full, with stinging digging in that region ; these pains in the forehead increase after rising. Drawing sticking pain in K frontal eminence. Had no stool till this m> since beginning proving, though the bowels were generally loose, he having sometimes two evacuations a day ; the substances discharged were dry and firm. Clear ringing before the ears, passing into momentary hard hearing with dull buzzing. Itching vesicles on the back, the itching being especially violent in e. and obliging him to scratch; here and there eruptions of small itching vesicles resembling scabies, especially on the chest and back towards the shoulders ^ intolerable itching at n. in region of boundaries of the hairy scalp in nape. 6th d., restless during n,, owing to itching of various parts of body. Light sweat in m. On confines of hairy scalp and nape are seen irregular blotches, which itch violently and are sore when scratched ; these blotches become inflamed after scratching for a time and appear to emit a humour. Headache \i\ forehead (excited by drinking coffee), at first a dull drawing, afterwards a stitching pain. This d. the itch-like eruption becomes more intense and spreads more j it becomes especially marked on back. The pains

in throat and nose mentioned above reappear to-dajr^ and are generally found to be constant and obstinate symptoms. 7th d., the eruption dries up (and disappears entirely on the d. foUowing, the itching having disappeared this d,)» No more symptoms were now felt save some lassitude, pain in sacrum and throat, and the rigidity and squeezing in nose. On 9th d. he felt quite well.

t,^ Took 10 drops of 2x dil, in water before going to bed. Confusion of head (after J h.). Fancies and images crowding upon his mind in sleep. Dull headache whole n. not permitting sound sleep. Wakes in m. from a slumber full of dreams, with painful confusion of head. In m. the lower limbs feel weary. Took 3 drops on tongue without water. R. hemicrania, consisting of drawing with pressure and of heaviness ; better at rest j increased by the least motion. General confusion of head the whole d,^ worst in occiput, in 1. side of the head and on the forehead, pressure outwards ^ frequent and copious discharge of pale urine. Wakes with a sorethroat, as if an ulcer were in throat, on r. side, with drawing and tension upward and downward ; sensation as if a splinter were lodged in throat when swallowing, eructating, stretching and moving the throat ; between whiles unduJatory motions and pulsations therein ; dark redness of the uvula and fauces. Early in m., on waking, the eyes burn and feel dry ; he had great difficulty in opening them. During the d» the affection of the eyes assumed the following form : — Pressure in the eyes as if too full j heat and pain in the ball when moving or touching it > mucous flocks causing illusions of sight and obliging him to wipe the eyes ; in e. the scarlet redness, which had shown itself in the inner canthus of the r. eye already in the m,, extended as far as the cornea j the conjunctiva of the ball and the eyelids was congested ; pain in eye as if a grain of sand were lodged in it, sticking, itching ; grey dots and serpentshaped figures were seen in the axis of vision ; mist before the eyes ; the candle-light is not coloured, but rather enveloped in mist j winking ; the aperture between the lids is diminished; all these symptoms being accompanied with general debility and weariness, and increased tern ^perature of the skin. At noon, violent tickling in the throat obliging him to cough* Pimple on septum of nose which bleeds easily. Pustule on skin of upper lip arising from a painful red shining blotch. In the afternoon dulness of sense, inattentiveness, inability to think j cannot find words to express his thoughts in a suitable manner, hence want of ease in speech. At 10 p.m. recurrence of the above-mentioned affection of the throat, being this time accompanied with roughness and dryness. In n, cough from tickling in larynx. In various parts of the chest pressing tensive pain in spots the size of a dime (sixpence). Agglutination of r. eye during n. and d., m,, it was closed by crusts of dry mucus, causing the lids to adhere and requiring to be washed away before the eye could be opened ; when opened it was found to be redder than yesterday j the pressure and heat in eye were more painful j aperture between lids smaller i photo-

• A considerable space of time was allowed to elapse between the dilfercnt provings on one and the »amc individual.

phobia. He hawked up yellow-brown mucus tinged with blood , At noon^ suffocative cough (recurring several d. in succession). Fever after meal ; chilliness, desire to lie down, excessive feeling of illness and prostration ; confusion in head. The whole afternoon felt feverish and ill ; constant faintness and languor. The inflammation of the eye is better in the coo! and open air, but intolerable in the warm room. In e., headache on r, side, heaviness, fulness, and pressure (several c, in succession). On 3rd d,, headache on waking ; full, heavy, stupefied ; the pain becomes intolerable by the slightest movement (lasting almost the whole dj. Pain in 1, side of head and forehead, first sticking, then digging, extending as far as the malar bone. Digging pain in r. side of the head. Tearing and twingeing in r. ear. The eyes are filled with mucus ; the inflammation is decreasing, but reading continues to be painful. The ulcerative pain in throat is permanent. Cough from tickling in throat. The urethra feels as if closed from swelling, and an ulcerative pain is experienced in it. Burning after micturition. In €., before retiring (and in the early m.), he has a dry, fatiguing cough, produced by a violent itching, almost burning, titillation in the throat. 4th d., hoarseness and roughness in throat. Pain in r. axilla as if strained or torn. Upon raising shoulder, pain descended along arm as far as hand, where a prickling sensation was felt. Paralytic drawing pain in whole of the r. upper extremity. During micturition burning and feeling of contraction in forepart of urethra. Whilst ejaculating the last drops of urine, cutting in back part of urethra as far as anus. Sunken, pale, bluish countenance. Diminished appetite; speedy repletion. Stitches in chest. 5th d., restless night, sleep disturbed by frequent paroxysms of cough j from 4 to 6 a.m., sweat. Dryness of the tongue in the m. In forenoon, accumulation of mucus in posterior nares obliging him to hawk. In e., cough i he is unable to bear the usual smoke of tobacco ; dry tongue (e.). In m., during first micturition, he feels a heat in the urethra with itching and tickling. Inability to emit the urine with a free rushing stream. Stoppage of nose and a good deal of itching. A third dose was taken at 10 a.m. on 6th d. of proving. About noon, intense titillation of palate and fauces, causing Kcs to run and a fatiguing hacking cough. Scraping in throat. Then drinking cold water, and on empty swallowing^ a sore feeling deep in throat. Sensation as if dampness were running along the urethra from behind forward. Painful urging in the urethra. After micturition, which left urethra feeling painful as if ulcerated, he again had desire to micturate, but ineffectual. In afternoon, painful heaviness and coldness in the head, with difficulty in collecting his senses nd a glowing heat in the head and cheeks. Difficult and fatiguing

Apprehension, Debilitated and weary. So debilitated in the afternoon that he had to lie down, accompanied with increased warmth in whole iy and heat in palms of hands. Going upstairs is very troublesome, accompanied with severe drawing in calves. Rough tongue* Painful

'blotches in the 1. corner of the mouth. Restless, stupefied sleep with horrid dreams. The lips, tongue, mouth and fauces are parched. Kext d. tip of the tongue is red and painful ; papilla erect. The I. eye is now affected as the r. was ; canthus is red as blood j swelling of

caruncula lachrymalts^ it stands out from the canthus like a lump of flesh ; intensely red clusters of vessels extend from inner canthus to cornea ; relaxation and swelling of the conjunctiva ; the secretion of mucus and tears increases. After breakfast diarrhoeic stool^ during which, after micturating, a burning drop was still running along the urethra* The urine on micturating was a longer time than usual in making its appearance. Vanishing of sight i is constantly obliged to wipe ofFthe mucus which is in the axis of vision. Pain in the head as if it would burst (from mental labour). Does not pass a n. without headache. After a meal, a cough which hinders speech. Paralytic weakness of the lower limbs and emaciation of same. Red swelling of conjunctiva round cornea towards inner canthus ; the conjunctiva of eye and lids is blood -red. Looks old ; skin of face is tightly drawn over bones, and hence marked prominence of facial mucles. Burning during micturition and feeling of swelling in the urethra; the latter portion ot the urine is not ejected freely. Itching and smarting in the K eye. The headache is worse in the open air. Fulness and heaviness of the head. On 3rd d. tongue and mouth are parched and dry. In m. fcctor from mouth. Itching from nose. Dragging pains when urinating. Sore feeling in interior of urethra even after micturition. The urethra is hard, swollen, and knotty to touch. The r. testicle is hard and larger than usual. Tumour-like itching elevations in the hairy scalp and in nape of neck. Blear-eyedness. Pustule in the 1. corner of the mouth. Fixed ulcerative pains deep in throat, apparently in the posterior wall of the pharynx. When yawning and taking a deep breath the pain is changed to an aching. [The phenomena denoting an affection of the mucous membrane in the parts designated above — ocular and palpebral conjunctiva, nose, mouth, fauces, and urethra — were the most troublesome and permanent.]

f. M — took 10 drops of 6x djl. in 4 spoonful of distilled water at 10 a.m. Unusual appetite and great desire to eat. Intermittent dull pressure, as of a foreign body, in the obliqui muscles, near the crest of | the ilium. After dinner depression of spirits. The throat feels rough and scraping, as if raw and sore. The isthmus, posterior nares and velum pendulum palati are red. Soap-like, ball-shaped clots of mucus in the throat occasion slight turns of cough, by which the mucus is thrown off. Roughness in the throat excites hawking. The dose was repeated next d. at same h. Soon after taking drug meditative and brooding, with vacant stare. Tickling in the throat as if he had drawn in a little feather, obliging him to hawk. Drawing with pressure in the top of 1, shoulder, as if pressed with a load. Prickling itching of various parts of the body, especially marked around h nipple* Slight astringent sensation about lips, buccal cavity, and tongue. The lips are dry and glutinous without thirst. With constriction of the mouth, confluence of watery saliva. Aching drawing pain in whole abdomen as far as groin, with distension as in ascites. At lo a.m., and again in the afternoon, long and deep yawning. Yawning and chilliness. Ulcerative pain in small spot in the velum pendulum palati. Peculiar tin* easiness and emptiness in abdomen with nausea. Painful urging sensation in groin, more intense when part is touched. Pimples on chin and '

cheeks, rapidly filling with pus. Irresistible desire for sugar in e. i

after eating it he experiences, about midnight, a fermenting flatulent colic, waking him from sleep, and followed by small discharges of watery f^ces, accompanied with emission of a quantity of noisy flatulence, A good deal of urging with the diarrhoea. In the m. he has diarrhoea, as above, but papescent, preceded by colic* Flat taste in the mouth after rising, tongue being white at tip and yellow at root, with sticky, dry lips, without thirst. Nausea as from hunger. Drawing tearing in L side of patella. Paralytic painful drawing, as if bruised, in rectus cruris muscle, a hand's breadth above the 1. patella. Clawing sensation moving about in the pleura, costal and visceral, with slight oppression of the chest. Took lo drops without any water, 3rd d,, at noon. The existing nausea in the stomach is momentarily increased, then suddenly abating. Constant drawing and digging in 1. frontal eminence, afterwards accompanied with drawing tearing along whole arm. Undulating tearing in the whole forehead. Stinging ulcerative pain on K side near stomach, directly below short ribs, made more violent by deep inspiration and by contact. Coitus painful ; the urethra feels stretched ; want of pleasurable feeling. Ulcerative pain in urethra between acts of micturition, as if a splinter had been thrust into it. At 6 p.m. another scanty brown evacuation. Gnawing pain In 1, side near stomach. Disagreeable sensation in the body, moving about; at one time felt in hmbs (especially r. upper limb), at another time in head (especially in r. temple). Next d,, great debility and weariness of the calves in bed^ as after a distant journey on foot. After rising, great nervousness, feeling of weakness, tremulousness, irritated and at the same time fretful mood. In m. he had one evacuation at the usual time, but much less copious than usual. An h, after the lirst he had a second evacuation, loose and in pieces, very little of it. At 10 a.m. he took 10 drops on the tongue, without water. At 10,30 another paroxysm of yawning, same as yesterday. Not long after that he had a peculiar paroxysm of spasm of oesophagus, developing itself in the following manner : efforts to eructate, with distension of the stomach as if it would burst ; the oesophagus is spasmodically closed at its orifice, hence the eiForts to eructate are ineffectual, and are accompanied with excessive strangulation and urging pain in stomachy faintish nausea, confluence of water in the mouth, and inability to stir j all this paroxysm ended in frequent and violent eructations, the spasm lasting in all ^ h., occasionally increasing, and then again decreasing. Rheumatic tearing where thumb joins metacarpus. Clawing in r, anterior cervical muscles like cramp. Confusion of the head, especially after drinking coffee. Stitches and digging in 1, frontal eminence (this symptom is perceived several times a d., but more frequently in the afternoon, and is the most constant of all the head-symptoms). He wakes frequently at night, owing to tormenting dreams about putrid waters, fishes, serpents, filling him with horror. He dreams towards m, that an insect had inflicted a deep bite in his heel, burrowing in the wound, and making it necessary that the insect should be cut out. Next d,, early in m., on waking, he experiences a violent pressure between the shoulders, which is especially deep seated at angle of r.

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shoulder. After breakfast he feels extremely debilitated, nervous, tremulous ; he dares not undertake anything lest he should not succeed* His spirits feel more affected than yesterday. Paralytic drawing in bones of forearm. For some d. past great apprehensive caution has been alternating with light sense of indifference. Drawing in streaks or bands over the surface of the brain, apparently in membranes and sinuses. Drawing in a streak from occiput into middle of brain* Slight digging in parenchyma of the brain, drawing to and fro. Sudden stitches darting through the abdomen, like electric sparks, especially when suddenly passing from a state of rest into a state of motion (only on K side). Paralytic heaviness in h lumbar region, extending as far as hip-joint of the same side ; lumbar region feels rigid and tense* Stiffness, heaviness, and paralytic pains from the sacrum along the pelvis and hips. Heavy and paralytic feeling in the region of the sacrum, making it difficult to sit a long while, and obliging him to stretch the dorsal spine as much as possible while sitting. The sacral region feels so painful that blowing the nose and sneezing causes him to start. {Ihld,)

1. K. M — , boy of 7, pasty, stout, slightly scrofulous, otherwise healthy. Took in e. 3 dr. of ix dil. mixed with 10 dr* of water. Immediately emissions of flatulence j n, very restless, tossed about in bed and spoke out loud. Next d. a good deal of itching in scalp (after 3 d, small itching blotches were found there, disappearing again gradually). Red blotches, changing to yellow blisters upon a red base^ on dorsum of r, hand and index finger. Pricking in outer side of r, ankle. 3rd d*, violent itching in nose, causing him to rub it until it becomes sore. 4th d., itching in the nose continues, 5th d., a good deal of sneezing j when sneezing he discharges from nose purulent mucus with specks of blood. 6th d,, in the m., much sneezing- Pain and swelling of the r. wing of the nose. After 3 d., when all reaction had ceased, the boy took 5 dr. of same preparation at the same h. The following symptoms made their appearance : At n. colic (?). Pricking in the liver. Rises four times m the night to urinate. Next m* much sneezing. {Ibid,)

7, ScHACBERT took gr, | in 3ss of distilled water, in m, fasting, and only remarked a very disagreeable metallic taste, and slight burning in throat. He repeated the experiment several times, but without producing any other symptoms. After taking gr. J, the burning in the throat lasted a little longer. Then for 3 d. he took gr. ss dissolved in '^ss of water. The burning sensation in the throat became rather severe. The tongue showed in various places a dark bluish colour, and in the stomach there was a sensation of increased warmth and slight nausea. These symptoms disappeared after taking food. The stools and pulse were not affected. Some time after this S. increased the dose to a grain, which he took i^ h. after dinner. The burning in the throat was very severe. The tongue showed for several d. a dirty brown colour. The feeling of increased warmth in the stomach increased to nausea and retching, without actual vomiting, and finally gave place to a persistent, periodically aggravated sensation of compression in the stomach, lasting several h,, when, towards e., diarrhcpa

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$ct in and continued during the following d* With the onset of diarrhoea the pressure in the stomach ceased. The evacuations were thinner than usual, but not altered in colour. In addition to these symptoms there was a distressing dull headache, seated especially in the forehead, and associated with a certain prostration and restlessness. Changes in respiration, pulse, and secretion of urine were not with certainty made out. On the 3rd d, all the symptoms of the drug action had disappeared. Eight d, afterwards he toolc i J gr. in m, fasting. Nausea and inclination to vomit, which followed the dose, he at once suppressed by eating a very copious meal, but nevertheless he felt unwell the whole d*^ and suffered from a dull headache. {Diss, de usu Arg. nit, interm^ ^^J?*)

1. " When I began my experiment I was quite well and strong, but afterwards was not in the same high state of health as previously, and my stomach suffered for several d. after I had discontinued the use of the silver : I frequently had heartburn, from which I had never before suffered, though these symptoms gradually disappeared. On the other hand I there supervened an almost constant neuralgic pain in the K infra-orbital region, that indeed but extremely seldom, and then only for a moment or two at a time, became very violent, and on the whole did not put me out very much, but yet continued uninterruptedly the whole of the following winter* At the same time the action of the heart became somewhat irregular, and the beats at times intermitted, of which I had a distinct disagreeable sensation in the chest, I was in addition tormented with a constant sensation of fulness in the region of the heart. If I turned my attention to the heart's action I felt this irregularity more strongly, but if I moved briskly about, the sensation almost entirely disappeared. Upon my disposition these symptoms had no effect. There were no paroxysms of anxiety connected therewith. The movements of my body were not interfered with. Only sudden, violent, muscular action, as, for instance, the exertion in jumping, or going quickly upstairs without stopping, caused violent palpitation just like emotional excitement. The said disagreeable sensations were most perceptible in a horizontal position, hence in the e, in bed. My sleep was but extremely rarely interrupted by palpitation of the heart. Towards the end of the winter the symptoms diminished in intensity/' (Krahmer tells us he did nothing to stop the evolution of the proving.) ** Physical signs of anything abnormal about the heart were wanting, as I was assured by a medical friend. With the summer all morbid symptoms had entirely disappeared.

" That these changes in my condition were really the result of the silver I am by no means sure. But in regard to time they occurred after taking it, and I know no other cause for them. I make this communication in order to add the request that those of my colleagues who may have an opportunity of making similar observations may bring the same to my knowledge. Perhaps they might then be able to throw some new light on the subject of the mode of action of silver.

** In observing the action of silver I have endeavoured as far as possible to pay attention not only to all the subjective, but also to

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all the objective symptoms ; changes in the pulse^ temperature, and character of the urine have been especiaUy observed, I lacked the proper apparatus to ascertain the amount of carbonic acid eliminated by respiration. My average pulse in the m. after rising was 66 ^ at noon, soon after returning from my visits^ 72 ; and in the e., after several h. rest, it fell to 68. A strict milk diet^ and the taking of arg. n. for more than two weeks, had no effect upon the character of the pulse. My temperature is from a9'6° to 30^ R. I examined the urine^ keeping account of the total amount, specific gravity, amount of water, quantity of uric acid, urea, and salts of incineration. In order to have correct data I examined the urine from the 6th to the 19th of October. I rose at 6 a.m., breakfasted on two cups of coffee, engaged in reading or writing till 9, visited patients till I, then took dinner; worked till 5 in my room, made e, visits, took supper at 8, and went to bed about 11* Noon and e. usually drank a glass of beer or wine. From October 19th to November 6th I kept a very strict regular diet; took daily 22937 grammes of fresh milk and 4185 grammes of white bread. October 26th, I took O' ( gr. of crystallised arg. n, 4 times j 27th, same ; 28th, 02 gr. 4 times ; 29th, same ; 30th, O'j gr. 4 times ; 3ist, 04 gr. 4 times ; November ist,o'5 gr. 4 times ; and, o'6 gr. 4 times ; 3rd, 08 gr. 4 times ; 4th, i gr, 4 times ; 5th, i'2 gr. 4 times* A consequence of the strict diet was that the stools, which are usually regular, were affected, so that on Oct. 2ist one was evacuated only after violent and painful effort, and on the 23rd there was no voluntary stool. After several h. effort to evacuate hard faeces, I took one ounce of castor-oil. In the e. there was a hard painful stool, and the next m. a pasty stool. On the 25th 1 repeated the oil, and the n. of the 25th and z6th I took in addition an extra half ounce, which was followed next m, by one hard and one soft stool. On the 28th took 2 oz. oil followed by four loose stools i also on the 29th ; and from the 29th to the 2nd of November I took daily a tablespoonful of castor-oil, so that the stools continued without great difficulty. After November 3rd I did not require the oil, as the large amount of silver nitrate kept the faeces soft. November 2nd my stomach began to suffer. At noon, after taking milk and bread, I experienced a pressing sensation of fulness in the epigastric region. November 3rd, especially towards e., the whole abdomen was very tense, November 4th, there was violent headache and I could scarcely force myself to take the necessary amount of nourishment. The n, was restless; I could not remain in bed after 4 o'clock. On the 5 th I was still more averse to food, though the taste was natural and the tongue not coated. Through the d. I had violent headache. The following n. was very restless. I rose at 3 o'clock and took nothing but a glass of milk before noon. The headache was very violent. In the afternoon, after passing the last quantity of urine for examination, I took two cups of strong black coffee, after which I felt relieved. Supper was relished, but the next d. I could take but a small quantity of food on account of heartburn. The action of the silver seemed to cause a sense of satiety, and my stomach seemed to need less nourish* ment than in a state of health. In a subsequent trial I took in the m. i grain of crystallised arg, nit^ with white sugar dry on the tongue.

I immediately experienced a very bitter taste, followed by warmth on the tip of the tongue, then in the pharynx, after whicn these two symptoms seemed to alternate with each other. I drank a little ciistiiled water, which was followed by slight eructations and a sensation of catarrh in the fauces and larynx. Ac noon, before dinner, I swallowed the same dose in a drachm of distilled water. I experienced a sweetish taste and feeling of warmth in the mouth- Three h. after dinner took i grain in distilled water. The sensations were the same as before, but perhaps more severe. The scraping sensation in the pharynx provoked hawking and coughing. After i h, 1 had a sensa* tion of warmth between the scapuTse and sternum, which gradually changed to slight pressure in the epigastric region. This was attended by tasteless eructations. The next m. I took I grain in water, and had only a very bitter taste, and after 10 m. very transient nausea.

'* The relation of the urea to the solid constituents in my case is somewhat less than that of another observer mentioned by Simon in his Handbook . I had an average of 263 per cent, of urea, perhaps dependent upon the peculiarity of my diet, which is generally vegetable. Under the effects of the milk diet this percentage rose to 37'6, and the amount of uric acid became quite small, which during my ordinary diet was 06, but was now reduced to ^045. The amount of urea was perceptibly changed, the daily diminution being 15 gramme, and the uric acid entirely disappeared from the urine, under the influence of silver The amount of incinerated salts during the milk diet remained very constant. After several d, use of the silver it rose considerably. In the e. of November 6th there was found O'liy gramme of pure silicic acid ; so far as I know no analysis of urine has shown a like amount of silicic acid. No changes were noticed in the circulation or temperature. Silver was not found in the urine/* (Krahmer, Das Silhtr all Arzmimtttel betrachtety 1845,)

y. a, — The prover was a prescription-clerk in an old-school pharmacy, aged 21, intelligent, sceptical as to the action of infinitesimal doses, and quite ignorant of the pathogenetic properties of nitrate of silver. He was in good general health and free from constitutional dyscrasia;. He sought Dr. Brewer's advice for a catarrhal condition of the mucous membranes, for which the silver was recommended, (The malady and its changes are expunged from the proving.) In consideration for his vocation and prejudice a low trituration was ordered — i gr. of the nitrate of silver to be triturated with 4 drachms of sugar of milk \ of this trituration i gr. to be taken twice daily. Misapprehending the directions, he took i gr. of the nitrate twice a d, for 3 d. 2nd d,, felt tired on waking, and apathetic in mind and body, but believing he might have taken a slight cold he continued the nitrate as before. 3rd d., in m,, felt so ill that he again visited his doctor. The whole head was heavy and full, but frontal sinus the focus of greatest intensity. The operations of the mind were sluggish, so that continued thought required special effort i yet when the mind was so exerted the bad feelings in the head were in no respect enhanced. He stated that the compounding of a prescription was peculiarly irksome at the time, as

his mind would aimlessly wander from one subject to another unless he exercised constant effort. In the mouth was a disagreeable metallic taste» The tongue was red and clean, the throat congested^ especially at the posterior part, and felt hot and burning. Deglutition unait'ected. Tonsils of normal si^e and appearance. The abdomen below umbilicus felt distended, or as if there was a weight on it. This sensation temporarily abated when flatus was passed, the flatus being discharged without pain and without effort. The bowels, which for weeks had been moving regularly once a d., now moved more frequently, there being two stools on the 2nd d. and four on the jrd. The stools consisted of a greenish semi-solid mass, made up of lumps of undigested food and mucus, passed with some flatus* The provcr was quite sure that their odour was very peculiar, but he could not describe it. Defaecation was free from tenesmus, or burning, or any other abnormal sensation. On the anterior wall of the rectum, about an inch above the sphincter, was a hot burning spot (prostate gland ?), unaffected by stooL Dragging and weight in the hypogastrium^ which at times amounted to actual burning pain. Micturition tern* porarily palliated the distress, hence the prover urinated frequently, yci the urine could be easily retained without appreciably affecting the distress. The urethra from meatus to bladder felt hot and burning, but at the meatus and below the scrotum were foci of greatest imen* sity. The lower extremities^ especially the legs, were fatigued and seemed too weak to support the body* At times they felt as if they would suddenly fail him*

This ended the first proving. The medicine was stopped* Dn Brewer says he "considered it desirable that the prover should again take silver, but in the dose originally recommended, gr. j^y thrice daily." He does not mention any interval as taking place between the discontinuance of the larger dose and the commencement of this j but there probably was one.

b. Second proving. — Gr. y^^-thVith sugar of milk thrice daily. 5 d. later, on rising in m,, weary and oppressed in body and mind. His ambition seemed to have fled. Even trivial duties were burdensome. He only desired to sit and think. About noon small running chills developed along spine, and followed each other in rapid succession ; meantime the face and extremities became flushed and hot. Towards 6 the chills ceased and intense sleepiness set in. He felt that he could not keep awake ; notwithstanding, on retiring he remained awake thinking, the thinking when yielded to absorbed the desire to sleep. By ID he had become so engrossed in thought that restlessness and real wakefulness followed. This continued until about midnight, when he went to sleep. The sleep was disturbed by monstrous dreams. The condition of the mind in sleep seemed but an extension of its state in working hours, for the patient stated that all through d. he was disinclined to talk, but took a morbid delight in building air-castles. The head felt dull and full. No visceral tenets m us or burning. The bowels were unaffected, except that they felt oppressed along the lower half of the abdomen ; some flatus was passed. The prover, recognising the effects as similar to those of the previous attack, stopped the silver, and

reported the symptoms as recorded. The symptoms at once decreased in intensity, and in 2 d. had disappeared.

c. Third proving, — 4 or 5 d. later the dose was renewed. 3rd d., on waking in m., head felt full and confused ; it ached all over, but with increased force at 1. frontal eminence^ temple, and occiput. He described the pain as heavy aching. At indefinite periods the occipital pain would cease, and the pain in the temples increase. The pain in the 1. frontal eminence remained constant and unvarying. The head felt enlarged and weighty ; occasionally slight vertigo suddenly appeared and ceased. Some relief was afforded to the pain by tightly binding or pressing the head ; cold air also palliated. The eyes were sensitive to light, and smarted and burned after long use. The lachrymal secretion was somewhat increased. Face pale. Peculiar, foetid, metallic taste in the mouth. Tongue coated at base with yellow fur, and felt dry to the prover, though to touch and sight it was moist : tirooling during sleep. Slight thirst. Congestion of the throat, with a slight burning soreness on the right side. Dysphagia. Slight flatulent dis' tension of the lower half of the abdomen : it felt greatly distended and oppressed. Emissions of flatus temporarily relieved the heaviness. Stool normal. The urinary organs were markedly affected. In the urethra, during and after*micturition, there was an intense burning, at times amounting to a stabbing pain \ there was also a sore and swollen feeling. At irregular intervals the cremaster muscle would contract spasmodically and draw the testicle high up into the scrotum. With this spasm a drawing pain extended into the testes. Independent of the cremasteric spasm, although sometimes associated with it, was a pain in the testes and scrotum, as from pins and needles, worse in the right side. The lower extremities, and especially the legs, were weak and tired as after prolonged exercise, yet the amount of exercise taken had not been unusual. A short walk exhausted. He said he felt as though he had experienced a long illness. In the afternoon and e. the feet were cold. In the lower lumbar and sacral regions the same lassitude was felt as in the gastrocnemii. About noon small chills developed along the spine, and with them a sensation of heat and increased lethargy. The hands and feet were not cold but rather hot, as also was the head. The chills appeared in the upper part of the spine, close to the occiput, and extended downward to the extreme end of the coccyx, bnt did not radiate from the spine. Warmth dissipated them for a time. Neither motion nor open air aflFected them. About 5 o'clock the chills subsided ; no sweats followed, but profound sleepiness set in, a sleepiness so intense that the prover retired 3 h. earlier than was his custom. He did not fall asleep, however, but only lay enchanted by a vivid imagination. This elysian state lasted till nearly 10 o'clock, and then slowly faded away. Then the prover became restless — the bed felt burning hot, the legs and back ached, and the brain seemed too large for the skull. With these feelings he tossed about till near midnight before sleep came. Before falling asleep he noticed that the palms of the hands, the lower part of the abdomen, and the inner sides of the thighs were bathed with perspiration. 4th d., med. discontinued. All symptoms as yesterday. Sleep disturbed by bad

3^4

dreams, 5th d., a burning spot is noticed in fore part of rectum, about an inch above the sphincter, and is aggravated by urinating. Micturition is more frequent, and the hypogastric tenderness is increased. The headache has become intolerable. Administered 1 drop of the tincture of actaea r., and repeated it in 2 h* This removed the headache. Has lascivious dreams during sleep. 6th d.^ the headache is gone f the legs are less weary, but the lumbo^sacral lassitude persists. The chill appears regularly at I2 m,, and ends about 5 p.m., without sweating. Dreamed of snakes last n* The rectal burning is very annoying. 7th d., no change from yesterday's condition ; stoob normal. Abdomen still distended and oppressed. 8th d,, same as yesterday* Chill as usual. 9th d., the rectal burning became so distressing that I prescribed ac. nitric, i^, gtt, v every 4 h. loth d*, abdomen still oppressed. Chill as yesterday, l ith d., weakness in sacrum and legs much less ^ the chill did not appear. 14th d., ac. n. discontinued. Rectal burning nearly gone. 22nd d., burning spot in rectum occasionally felt, especially at n., but is not distressing. 25th d., the prover is well again. (Dr. E. P, Brewer, in Hahn, Mmtkiyy July, 1883,)

15, Dr. Lembke, 20th Feb., 9 a.m., took 20 drops of a solution of t gr. in an ounce of water, 21st, 8,30, 30 drops. Almost the whole d. pressure and heaviness in forehead, heaviness over eyes, which were not freely opened, aggravated by stooping. Towards e. this pain abated* About 10.30 p.m., whilst sitting, suddenly on r. parietal bone a violent drawing upwards ^ immediately after pressure in L side of forehead, then deep in the r, wrist, drawing in r. side of lower jaw and r. knee. Today (22nd) whilst walking, several times a sensation as if the heart beat once or twice stronger, without, however, any hindrance to the walking, or any oppression of the breathing, 1 1 p.m., drawing in r. toes, strong pressure at the top of 1. shoulder when the arm was at rest j drawing in the L toes, and flying about to the parts named, noticed first after 10 p.m., not during the d. Drawing in the middle of lower edge of r. orbit, then in lower jaw both r. and 1. side, in lower molars, then in the forehead. Urine dark yeUow, acid. Shooting pains round about r. olecranon, rather violent and lasting j neither movement of elbow nor pressure had any influence on the pain, but it was somewhat increased during rest of the joint, 23rd, 8 a.m., 30 drops. Tearing in 1, side of forehead, inside 1. knee, then in r. knee, 8.30 a.m.., sensation in upper part of 1. forehead like a moving about in the skin. 3 p.m., pressure in I. shoulder-joint. 4.30 p.m., the beating in the forehead as before, lasted i h. Drawing on under edge of r orbit at 5 p.m. and again at 9.30. Pressure in 1. wrist at 10.30 p.m. 24th, 6 a.m., pain in 1. side of forehead as above. Tearing in internal aspect of elbow. Pressure in r, temple. 8.45, 30 drops. Pressure in r, temple. 10,30, frequent micturition. 25th, 8 a.m., a teaspoonful of above-named solution. Pain in forehead as above. 9 a.m., drawing in 1. hand. About 4 p.m. another teaspoonful ; pressure in lower edge of 1. orbit, and, 5 p.m., several times in r, wrist. March 1st, a teaspoonful at 7a,ra» 8 a.m.,' pain in forehead, as before on 1, side. Weight and pressure in fore part of head, lasting whole d., apparently worse on going into open

air, leaving off towards e., not aggravated by eating. 9 p.m., violent shooting in inner canthus of r. eye ; during the forenoon it seemed to me that I passed urine more frequently and more copiously, which was darker yellow than usual, especially in proportion to the quantity of fluid drunk. In e., on the other hand, there was strikingly little urine, contrary to habit. On 2nd, at 4 a.m. and 6 a.m., urgency to urinate, with very little urine, which was dark yellow. 4th, 0 a.m., a teaspoonful. Drawing in skin of forehead in K side ; in skin of 1. cheek sensation as if a spider's web lay on it, which was repeated. Pressure on r. side of top of forehead, and in r. nipple from within outwards. 9 a.m., violent pain in 1. wrist. About 9 a.m. strong urgency to micturate ; urine copious, bright yellow ; weight and pressure in forehead lasting all d. 8th, 3 p.m. (3 h. after food), ^ a teaspoonful of 2 gr. in 5J of distilled water. About 6 p.m. drawing in skin of 1. cheek and in 1. side of the forehead. loth, 6.30 a.m., i teaspoonful. Drawing in skin of both cheeks. 7 a.m.^ tearing in r. tibia and, 8 a.m., behind r. ear. About 9 a.m. very tired and sleepy. Pressure in 1. eyebrow. nth, 7 a.m., a teaspoonful. Pressure in r. knee 8 a.m. Boring deep in r. orbit on lower edge ; pressing drawing through the whole r. arm 8.30 a.m., sometimes more violent on back of hand or in upper arm ; then prickling in sole of r. foot while sitting. Pressure in 1. side of frontal bone, especially on frontal eminence, sometimes stronger, then slighter ; this pain persisted, changing sometimes into sensation as if there was a band over forehead, aggravated by motion. Sticking in point of 1. little finger. 9 a.m., drawing in front of 1. lee. i p.m., pressing together in the whole 1. leg whilst walking.. Violent boring in 1. forehead whilst walking at 1.30, and directly after feeling of pressure on chest, without palpitation, causing him to take deep breaths, lasted i h., came and went whilst walking, returned an h. afterwards, also whilst walking, but only lasted a short time. During the whole d. has passed urine more frequently and more copiously. 9 p.m., sticking in kiiuckles of third right finger and on back of foot. Pressure in 1. side of the forehead, drawing in 1. cheek. In e. unusually great hunger which could not be appeased; also in m. of T2th. In n. of nth micturition three times, much urging thereto, but little urine about 5 p.m. 1 2th. — Violent pressure in r. knee, also whilst walking, lasted an h., then shooting pain deep in tongue, lasting about an h. 10 p.m.^ tearing and pressure in middle of lower edge of r. orbit in several attacks whilst sitting ; touching or pressure has no influence ; at same time much thin saliva in mouth, and again shooting deep in point of tongue with a bitterish taste or like soap and water. Thereafter pressure anteriorly in under part of r. leg, and then the same pain in the r. orbital edge, either at the same time or alternately with the shooting in the tongue. After this pressure in 1. ankle, then on back of r. foot, immediately after the former pain in orbital edge. 1 1 p.m., whilst sitting, these pains were repeated several times, then drawing in all teeth of under jaw, but pain always went by preference to, and was most frequent and most violent at, the lower edge of the r. orbit ; this last pain remained when I went to bed at 11.30. Suddenly, whilst lying quite quiet on the back, pressing in the throat and violent, short,

dry cough without tickling in the larynx ^ after this I soon went to sleep. Woke in n. through urging to urinate, felt the former pain at the orbital edge, but the cough did not recur at all. I3thj 7 a,m. Whilst sitting, drawing in L instep. 8 a»m., a teaspoonfuL Boring in L frontal eminence* 8.30 a»m., drawing across whole forehead, lasted to-day only a short time* Early urging to urinate»8,45. About 3 p.m.^ whilst walking, sensation of pressure in region of heart without palpitation or cough j it was not necessary to stop whilst walking, but only the need of breathing deeper occurred, and the same condition remained on one occasion after I was resting quietly in my room, 15th, 8.30 a.m., '2 teaspoonfuls. Pressure in r, knee whilst sitting and walking, and on back of L foot. Drawing in r. fingers. Pressure and drawing across forehead and beneath 1. eye* During whole d. pressure and weight in front of head, worse on stooping. Strong pressure anteriorly in r, leg, later in L knee, 6 p,m. At 9 p.m, drawing through lower incisor teeth, not made worse either by cold air or warm drink ; then drawing in upper part of chin, under the skin. i6th.— After rising, drawing internally in middle of r. upper arm, then in muscles of r. thigh, inferiorly and internally, 6,30 a.m., 2 teaspoonfuls. Boring in upper half of K eye at 9 a,m. and later. Drawing in 1. knee. To-day and on 17th, here and there as if a plucking, only always in little spots, of upper arm or thigh, behind ear, on 1. cheek, burning in tongue, on a little spot of back of one or other hand, on inner protuberance of knees, whilst sitting and walking equally frequent. For several d, I have been two or three times to stool daily j the stools were softer than usual, no difference having been made in the manner of living. 17th. — At I p.m., whilst sitting, violent shooting and tearing below L internal ankle, making me get up and walk about quickly, with which the shooting and drawing gradually passed off. At 5 p.m. same pain returned but less strongly. Later, drawing on back of 1. foot and in second joint of 1. forefinger. At 8.30 p.m., whilst walking, the drawing under the 1. inner ankle came again very painfully, also passing off during walking. In n., on waking, the same sticking in circumscribed spots of limbs. The same happened also on 18th on little isolated spots of head early in m., about 1 p.m. Strong boring, increasing by fits and starts, at the top of r. side of head whilst walking, also on one quite narrowly-bounded spot j the same in L temple at 10 p.m whilst sitting, and after i h. in r. temple. Somewhat later, the same pain more to the 1. in the forehead. 19th, 6.30 a.m., soon after rising the same pain above 1. ear. 8.30, strong pressure in pit of stomach for a few m. and immediately after pressure on back of r. foot. Drawing in L thumb and on back of r. hand. In course of d. same pains in head as yesterday but less strong, also the plucking in circumscribed spots in the limbs. On 20th, 21st, and 22nd, before 6 a.m., I awaked through sudden call to stool ; the evacuations were copious, bright yellow, half liquid, painless, without tenesmus i and soon after the same necessity occurred again, sometimes without result, besides two stools daily j no alteration being made in the diet ; the appetite might be called slight. The plucking in various circumscribed spots of the limbs and head occurred on these days also. 23rd, 9 a,m,, a bright

yellow, copious, semi-lfquid, peculiar evacuation. 27th, 8*45 a»m., 2

tablespoonfuls of a fresh solution of 2 grains to the ounce of distilled water. Between 11 and r, whilst walking, sensation of trembling at heart without obliging me to stand still, without shortness of breath, occurring several times. About 12, whilst walking, pressure on a little spot on back of 1. foot, which also passes off whilst walking, without being increased by any motion of the foot ; about 1.30 the same sensation whilst sitting. Repeated severe drawing in lower incisors whilst sitting, not aggravated by anything. In n, and on m. of 28th frequent need to pass water, which was darker than usual and only passed in small quantity. 28th, 8.30 a.m., 2 teaspoonfuls* At 9 a,m. pressure in L forehead and r. knee j boring in frontal bone. Shooting in point of tongue, repeated several times later, Frequent urging to urinate the whole day. Tearing on 1* side of skull at 5 p.m. and in r, instep. Frequent pinching in inner corner of both eyeballs. About 8 p.m. boring on lower edge of L orbit, then strong pressure on one small spot of r. shoulder. About g.30 p»m. boring at both sides of glabella, then drawing in 1. toes» 29th, 7 a.m., boring in L temple, I, side of forehead then r., recurring several times during d. 8 p.m., violent boring in 1. temple, 10 p.m. in 1. shoulder-joint, worse by moving it. 11 p.m., in bed, violent boring in 1. temple and L frontal prominence. 5.30 a.m,, the same in bed and after rising at 6 a.m. 30th, 7.30 a.m., 2 teaspoonfuls. Since yesterday I noticed in the 1. wrist, on bending it) leaning on it, &c., a tension and stiiFness with a deep-seated pain, disappearing towards e. 7.45 a.m., a slight stool, but much passage of mucus from the rectum. Dull pressure in r. ankle and upper half of r. patella. 8 a.m., whilst sitting, tearing in 1. frontal eminence, then on right cheek. Drawing through end of urethra, 8.30, creeping inskiaof 1. cheek. Drawing in 1, toes, on r. side of skull, in 1. shoulder, in 1. frontal eminence, which recurred several times during d. 7 p.m., whilst walking, violent pricking in small spot now over, now at side of r- knee, seemingly in the skin, 9 p.m., pains through joints of 1, forefinger, increased by bending finger, with which a difficulty in moving joints was experienced as from swelling, which also lasted till m. of 31st. 31st, 7 a.m., 2 teaspoonfuls. Frequent shooting in [r. eyeball, tearing on r. side of skull in various small circumscribed spots. 8 a»m. pressure in 1. knee and r, ankle whilst sitting, later in r. thigh. Boring in r. temple 9 a.m. All these pains recurred often during 2 p.m,, whilst sitting, the above described sensation in heart, 1st- 6 a.m., on

d. At April rising head heavy^ and tearing in it as yesterday, 8 a.m., tearing in 1. ankle. The urine passed at noon is slimy and turbid, and the vessel, as far as the urine reached, was coloured with a red coating ; the urine passed at 5 p.m. is clear and yellow. On all these d. stool twice daily, in other respects not unusual except that it was softer, 2nd, 7.30 a.m., drawing in 1, shoulder, 1. side of head, and forehead, 8 a.m., i tcaspoonful (completing the ounce). Drawing anteriorly and inferiorly in the r, leg whilst walking, tearing in r. frontal bone. As previously the pain was confined to one small spot. The aiFection of the L index finger noticed on March 30th lasted till to-day. Boring in r. temple; shooting in tip of tongue, 9 a.m.

a p.m., violent boring above L eyebrow. In L cheek a wandering pain nice a creeping. 5 p.m., wandering boring in upper half of forehead. Drawing through L lower 1 imb whilst sitting, and in L little finger, which is painful when moved. 1 1 p.m., violent boring in 1, temple^ then the same pain, but constant, two or three fingers' breadths above n ear. In e. pain in 1. forefinger had almost entirely ceased. 3rd, 7 a.m., small, hard stool, but much mucus from rectum. Drawing in 1. toes. Shooting in tip of tongue. Boring in temples and head as yesterday, and in e. violent drawing through whole r, lower limb whilst sitting ; whilst vt^lking, in 1. Cdli a peculiar sensation like shootings also like a hot fluid running over the skin. 6 p.m., drawing through lower incisor teeth with a sensation of their being raised. 4th, in nu on rising, tearing on top of head, and about 8 a.m. a stronger tearing across skull. Drawing in knees and r. thumb. Boring in frontal prominences, fore part of head heavy. Tearing here and there in forehead all d. If pain in head ceased for any time, drawing occurred in the finger-joints, or in one knee, or in a little spot of r. upper arm a plucking as before described, or a similar pain in one leg. On all these days frequent urging to urinate, l^owards 9 p.m. pains in forehead ceased, has remained here and there in limbs* 10 p.m., violent shooting in r. eyeball* In 1. arm much pain on bending it or leaning on it, as on a former occasion, recurred again on 5th. Violent shooting in r. eye on 5th. 6th, II p.m., I teaspoonful of a 3 grains to the ounce solution. No pains, jth.^ — On rising, heaviness and pressure in forehead, drawing on 1. cheek, boring in 1. frontal eminence, drawing in r. toes and r, forearm. 8.30 a.m., i teaspoonful. Anteriorly and inferiorly in r, leg, pressure on one circumscribed spot, several times; then in 1. inner ankle, and in 1. shoulder. Boring in 1. frontal eminence, in head two fingers* breadth above the r. ear, and in r. shoulder. 12 noon, much clear urine, frequent urination. Whilst walking a pressing pain came on in the soft parts below and in front of L trochanter, which when stepping caused the joint to bend under him, which did not recur at each step, or each movement, yet happened very frequently. Boring in r. upper orbital edge. 3 p*m., whilst walking, pain in 1. calf as in cramp» Shooting in 1. cheek several times, in point of tongue, and in 1. toes, 8th. — Before taking dose some pains in cheeks, ankles, and shoulders, 7.30 a.m., a teaspoonful. 9 a.m., shooting and drawing in 1, cheek. Drawing in outer edge of r. foot and 1. side of forehead. Pressing in I. wrist and r. knee, equally strong whilst walking or sitting, also frequently later in the d. Violent boring in 1. temple at noon. Frequent shooting deep in I. ear. Whilst walking, on outer side of 1, calf, in a small spot, violent pain compelling him to bend the leg j also, whilst standing, same pain ; it lasted a few m. and then went away entirely. Violent boring on r. side of back of head j 4 p.m., in r. shoulder. Drawing in r. fingers. 7 p.m,, urging to urinate, copious bright-yellow urine. Oppressive feeling at heart without dyspnoea i even quick walking is quite possible without causing aggravation^ 9 p.m., whilst sitting, same violent pain in outer side of 1. calf. Strong shooting deep in I. side of chin, then through the r, molar teeth, then in upper back teeth. 10 p.m., whilst sitting, strong pressure in soft

parts above r. knee-joint, in 1. Jittle finger and back of r. foot ; these were all repeated. 11,30 p.m., in bed, the pain over the knee-joint^ also the following m. on rising, and subsequently. 9th, 7 a.m., drawing, anteriorly and inferiorly, in I, leg, in under part of K forearm, in several finger-joints, in 1, side of forehead, and joint of 1, knee, equally strong whether sitting or walking; also frequently recurring later. Boring in upper and lower r, orbital edge, later over I. ear, and higher up. Here and there creeping drawing in skin of front and I. side of nose. Otherwise the same pains as yesterday* 10 pm,, burning in tip of tongue, and a peculiar bitter taste (but not that of arg. nit.) so long as the burning lasted. loth, 6 a.m., on rising, much shooting in I. eyeball, more especially in its under part. 8 a.m., boring on r. side of top of head. Drawing on r. cheek. Boring deep in both sides of chin. The heart affection was felt frequently to-day as yesterday. In general to-day weariness and heaviness of limbs. Much inclination to fall asleep whilst sitting,also yesterday. Two or three liquid stools daily^ much mucus. 1 1 th, 8 a.m., very violent and lasting pains, shooting and beating, in tip of 1. forefinger for 5 m. Boring in 1, frontal eminence. In e. some pains in limbs. 12th, 5.30 a.m., in bed, violent boring in 1. outer ankle, and in 1, shoulder, at 8 a.m. in r. side of head and 1. wrisL The heart pain as on former days. Violent shooting and drawing in r, toes Violent tearing on head, now on r. side, now on 1,, also at n p.m. on 1. frontal eminence. 10 p.m., indications of the pain so powerfully felt behind and below inner L ankle on March 17th. Drawing in back of foot and in toes of I. side, 11 p.m., strong boring in r. upper orbital edge« 13th.— Much weariness and inclination to sleep whilst sitting ; also former pains. The same on the 14th. 15th, 8.30 a.m., r teaspoonfuL Boring in r. elbow ; burning in tip of tongue ; pressure and drawing in I. frontal prominence, L ankle, in soft parts of one or other thigh, always in the small spot ; drawing in the I. toes, in one little spot of one or other calf, pressure in front of 1. knee, in various parts of dorsal muscles, and on top of shoulders. Also whilst walking pressure in knee came on, stronger whilst stepping ; the pains generally came on whilst sitting as during motion. Drawing on 1. cheek and top of I, side of the head. Several times shooting in I eyeball. Boring in r. upper orbital edge and on frontal bone. These pains were felt the whole d, with little intermission, always in the same circumscribed spot. In n. many dreams {which seldom happens with me) of places where I was once, of persons whom I likewise saw once ; everything relating to time and proportion was tangled and confused, i6th. — Before taking the dose some of the above-mentioned pains. 8,30, i teaspoonfuL 9 a.m., on I. side of the top of the head a drawing like a creeping prickling ; then same in front of and over the r. ear. Drawing and pressure in frontal bone, in several spots of one or other forearm, also in one leg, and in r. side of nape of neck below hair border. 3 p.m., persistent tickling in larynx ; inspiration did not increase it, but rather seemed to lessen it ; short dry barking cough, scarcely ever ensued whilst sitting ; I had not been speaking continuously or anything of the sort. Drawing on 1. side of top of skull, extending downwards to above and behind the 1* ear ; pressure did not aggravate it. 4 p.m..

■

shooting in knuckles of r, hand. 1 7th. — Several of the above symptoms. Burning shooting in 1. zygoma, then in r, at 5 p.m* on outer edge of I. orbit. Shooting in tip of tongue, also in c» 6 p.in., strong boring in r. temple. 9 pm., pricking deep in r, car. Strong tearing and boring in upper part of forehead on 1. side, and U zygoma. Pricking in 1. inner canthus. In first part of night restless dreams of long faintly illuminated walks, along virhich glided peculiarly clothed figures, which on my advancing to meet them receded, and on my retreating followed me at same distance. On waking, tearing on one side of head, i8th, 7 a,m., tearing on I side of head, on back of r. foot, and on lower and fore part of r. leg. Pressure on r. wrist. 8 a.m., i teaspoonful. Boring in temples and 1. frontal bone ; pressure in knees on sitting or walking. The former pains : pains in joints, soft parts of arms and legs, always iji single isolated spots. 19th, 6 a,m., in bed, tearing in head, in temples, and in first phalanx of L forefinger. Boring in back of r. foot, directed inwards whilst sitting. 8 a.m., 1 teaspoonful, which completes the ounce. Boring in temples and shoulders ; shooting in zygomas, drawing behind and below r. inner ankle. 9 a.m., the former pains are repeated, especially much drawing in fore part of head with pressure and heavi ness, lasted several h,, equally severe whether sitting or walking ; also at 1 1 p.m. some pains. Stool all these d. normal. General health undisturbed. 20th. — In m. languid, great inclination to rest. 8 a.m*, from r. nostril a few drops of blood came out without blowing, touching, or moving it, or anything of the kind. Pains in forehead, check, and limbs ; much yawning and sleepiness in forenoon ; frequent shooting in meatus of urethra ; also 11 p.m. in bed. Violent pressing in lower and anterior part of r, leg. 21st, 6 a.m., in bed, violent boring in r, frontal eminence to side of head ; shooting in tip of tongue several times. The former pains, but moderate. 22nd, 8 a.m., one teaspoonful of fresh solution of 3 grains to the ounce. Even before the dose, some pains in the toes and knees, shooting in tip of tongue ; violent shooting deep in r. car and around it at 10 a.m. Pressure in front of r. knee continued, appearing and vanishing whilst walking* 2 p.m., drawing pain in little spots in soft parts of thighs and calves, especially in upper part of 1. thigh j also on m, of 23rd. 23rd, 8.30 a.m., i teaspoonful. Boring on both sides of 1. tendo Achillis j frequent urging to urinate and shooting in tip of tongue ; drawing in r. upper teeth 5 p.m. several limes, also in lower right back teeth ; cold or heat had no effect. Towards 5 a.m. violent pricking in rectum, which recurred on 24th after rising. Boring in r. ankle, in 1. upper orbital edge, in front of the 1. ear and in several finger-joints. 25th. — The same. 26th, 8 a.m., a teaspoonful. The same pains on the frequently indicated spots. Stool since last mention always slimy. In e, and in m. of 27th, in bed, some pains in limbs and head. 27th, 8 a.m., I teaspoonful. Before dose boring and tearing in several spots of leg, fingers, forehead, and sides of head. Shooting in 1. eyeball. Remarkably violent pressing at same time in both elbows and into the forearms, 9 a.m. Boring in frontal eminences, zygomas, and knees, as before, behind and below J. inner ankle, whilst walking at noon, more violent than the last time. Violent lasting shooting in the last phalanges of

3r«

the I, forefinger ; later the same in the first r loe. Towards c. on two occasions palpitation by movement of the body, 28th, — The same pains^ only feebler, especially in the e. for several h. ; much shooting and burning in the r. eyelids. 29th, 845 a.m., 1 tcaspoonful. Just before talcing dose pains in the joints and face. Otherwise ihe same pains as on the 27th, 30th, 8.30 a.m., 2 teaspoonfuls, which completed the ounce. Boring in r. lower orbital edge and behind and below K inner ankle-bone whilst walking, 9 a.m*, with which the pain, so to say, was felt in the heart, and in the chest a kind of unrest arose which absolutely compelled me to walk about ; the same took place at the other times when this pain occurred. Palpitation and feeling of uneasiness in heart, as well when standing as in gentle motion, several times. Frequent urination. Shooting in r. eyeball, 4 p.m., afterwards! the other pains in limbs and tip of tongue. May ist. — Marked boring^ in circumscribed spots of single joints and soft parts of limbs, in forehead, and side of head* Strong scent seemed to increase considerably these head pains, and. — Same pains, especially boring in several parts of head, 3 p.m., tickling in larynx and spasmodic cough, 3rd. — Same pains ; also pressure in stomach in several attacks without any known dietetic cause. On all these d. frequent urging to urinate with copious urine, bright yellow and acid. The quantity is considerably increased compared with the fluid imbibed, 4th, — The same pains* May 5th, 8.30 a.m., 1 teaspoonful of a 4 grains to the ounce solution, The same pains. 6th, 3 p.m., a teaspoonful. Urine not increased, 7th, 3 p.m., i teaspoonful. After this marked frequency of urging to urinate ; urine copious, yellow j after urinating cutting at meatus of urethra. Frequent palpitation on slight agitation and also by more rapid movements. After this the former pains. 8th. — The same pains, also palpitation, as yesterday. 9th, 8.50 a.m., i teaspoonful. Shooting in r. toes ; pressure in both wrists. Boring in various places of head, in n cheek, r. knee. r. temple, on a little spot of outer side of , r* calf. All these pains were repeated. Several n. cramp in the calves. 4 p.m., I teaspoonful. Besides the other pains marked boring in frontal prominences, on upper orbital edge, especially L ; also again at 10 p.m. At 6 pm., whilst walking, violent pain in muscles on 1. side under arm, along under part of chest to lumbar muscles, increased by each breath, lasting S m., and being increased by walking. Boring in the lower inner 1. orbital edge, 11 p.m., repeated in the course of the d. loth, 8,30 a.m,, I teaspoonful, and 9 a.m., i teaspoonful, which completed the ounce. The same pains as yesterday, especially the boring in the lower inner orbital edge of both sides ; subsequently below and behind 1. inner ankie whilst walking, in various parts of the frontal bone, the pains equally frequent whether walking or sitting. A strong cold wind which lasted several d. brought on no increase of the pains. About 2 p.m. much tickling in the larynx without cough. In n. of 1 1 th many dreams. On the m. of i ith palpitation on slight movement, the former I pains being repeated, Pricking in rectum. 12th. — Same pains. Shooting several times in rectum and L eyeball. On following d, urine much more scanty and dark. There appeared, now and then, pains up till 27th in limbs and head, especially boring in the forehead and side of the head«

w ^

^

ARGENTUM NITRICUM.

There were taken altogether 15 gr, of argent, nit. The weather

caused no amelioration of the symptoms. Coffee seemed sometimes to aggravate -, but 1 am not quite sure of this — for I drank, since March 1st, in the m. and after midday a coffee made of cocoa-husks or barley. The I. side appeared to be more frequently and powerfully affected. The pains also came on in n., but more frequently during a. They were as frequent and strong during rest as during motion. The mucous membranes were not very much affected, only the increase in the quantity of the urine was conspicuous. The action was powerfully manifested in the nerves of the head, face, under-jaw, and upper and lower h'mbs. The back gave little sign of being affected ; on one occasion, however, it was the seat of very painful symptoms. The action on heart and larynx was decided* Shooting in the ears and eyeballs, no symptoms in the conjunctiva. The pains in the limbs were especially on little circumscribed spots, frequently changing their seat \ nevertheless, under the date 30th of March, we read of very long-lasting symptoms. The most violent pains were those of the upper and lower orbital edges, In the forehead, and below and behind the 1. ankle. {Nttu Zeitschr,/, Horn, Klin.^ xi, 130.)

1. Dr. Byres Moir took ist trit. for several d,, in doses of gr, iss to gr, iij, but the results were too meagre and dubious to be recorded. (Dr. Clarke's provings, communicdUdJ)

17, W. F. C — y i8j medium height, slight, fair hair, dark eyes, nervous-sanguine. Has had sorethroat lately, but has been well of it some weeks. Is subject to headaches. On Aug. 27th, commenced to prove 3rd dil., taking 10 drops in J oz. of distilled water at 1 1 p.m., before retiring. The dose was repeated on seven consecutive n. The symptoms continued for one or two weeks after the medicine was stopped, ist d,, clayey taste in mouth immediately after dose. The same taste was noted after the dose the following n. 2nd d,, dry sensation in the throat. Pharynx reddened. 3rd d., throat feels well, and is not so red. On each posterior pillar of the fauces is a long white patch, as if they had been touched with solid nitrate. Just after tea (5.30 p.m.) noticed his palate felt sore and swollen. On examination it was found quite white as if it had been cauterised, and somewhat swollen, ^h^ pharynx was at this time red, the white patches were gone from the fauces. In the m. I had touched the under surface of the tongue with the cork of the bottle containing the tincture being proved, moistened with the tincture undiluted. By the afternoon this spot was found to be becoming white. On the following d. (4th) the spot was still distinguishable by its whiteness from the surrounding mucous membrane. The whiteness of this spot was never so dense as that of the patches on the pillars of the fauces and palate. This experiment was made to try how far the phenomena of the fauces and palate might be due to the local action of the tincture in passing over the surfaces whilst being swalloweA The fine mucous membrane under the tongue would show, I thought, any local effects the tincture might be capable of producing. There was no immediate effect when I touched it with the undiluted tincture. Nothing was felt and nothing was seen; and I was not a little astonished in the e. to find a distinct though faint

white mark at the spot I had touched* It was not nearly so densely white as the patches in the pharynx and paJate. On the 5th d, pharynx very sore again in afternoon ; red ; and at root of left posterior pillar a milky patch. 6th d., throat feels sore, white patch all but gone. On going to bed last n, a stuffed sensation in the chest, as if in for a bad cold. Out of sorts all today» 7th d.^ much rumbling of flatus in the n. Eyes bloodshot in the m. The eyes became worse. On the 8th and 9th d. could not read at n., and on the 9th he had smarting ; on nth eyes almost clear, 10th d, teeth inclined to ache, 12th, the same on the r, side, 20th d., throat and oesophagus sore and burning. I now gave him Ars. 6, gtt. j t. d,, and in the e, the burning sensation was all gone. The pharynx remained congested and tender long after the proving. {Ibid,)

1. Dr, J. H. Clarke, 28, medium size, spare, sanguinenervou6, being in perfect health, except for slight afternoon flatulence, and an undefined feeling of oppression at the epigastrium, soon passing away, noticed each afternoon for some d previously, began to prove argent* nit,, Aug. 17th, 1881, The proving lasted 19 d,, the effects 31 d. The dilution taken was the 6th centesimal, and the dose 10 to 12 drops in an ounce of distilled water, between 11.30 p,m. and i a.m,, just before retiring, ist d., soon after the dose a sensation of warmth at the epigastrium. 14 h. after, a styptic sensation in throat. A metallic-astringent taste was noticed after the dose all through the proving, and at length became persistent. On the 1 0th d. it was noticed that warm tea seemed to develop it. On 9th and 13th d. a feeling as if cauterised noticed in uvula. On 16th, 17th, and iSth days the taste of silver was very strong, 8th d,, fine superficial sticking in eighth rib about centre, at times during d. 9th d,, pricking in the eyes, iith d,, sneezing and coryza. 14th d., eyes gummed, smarting on waking, better after getting up. Pricking in I, eye. Headache over coronal sutures, passing to eyes and root of nose. 4 p,m,, sore pain in upper and inner part of r. eye when reading, 15th d.j aching in r. eye and nose, with same kind of headache, 17 th d,, eyes smart on closing them, 1 8th and 19th d., very bloodshot, smart by gaslight, 20th d,, much better. 21st d,, gone on rising, 24th d., painful. loth d,, pricking itching in a minute spot at back of neck, among the hair near hair border. Tenderness of tendons at back of r. index finger. Slight aching in r, molar teeth, in good condition, nth d«, slight transient aching in K teeth. Tenderness of tendons at back of 1. middle and r. index fingers continues, with hvpera^sthesia of skin over them. The hypera?sthesia extends up in a line from the finger to the outer condyle. During the d. the hyperarsthesia spread all over dorsum of r. hand to ulnar side, all up back of forearm, outer side of upper arm, shoulder, and r, side of face. The finger-joints became tender and stiff; outer side of head of ulna and olecranon very tender to touch. Shooting pain through metacarpo-phalangeal joint of index finger, felt also at elbow. The skin-sensation was like that of erysipelas, increased sensitiveness with diminished power of distinguishing sensations — a hyperaesthetic-ansesthetic condition — without any objective symptoms* Immediately after e. dose metallic taste with oppression and pain as if

374-

indigestion, slight nausea, burning of forepart of tongue. Spread of hypenesthesia to r. side of body, dull pressive headache (r. side), scalp tender, 12th d,, hyperaesthetic sensation increased. Slight tic (shoot* ing pain) in face, not in head ; head tender to cold, SHght stiffness in finger-joints. R, arm tender, and slightly painful, especially at shoulder, to move, 7 p,m*, hyperaesthesia affects outer side of L hand, and skin over distal end of 1. ulna. Metacarpo-phalangeal joints of 3rd and 4th I. fingers tender. 10.30 p.m., under 1. eye an elevated spot, size of split pea, with red base, looking like a blister, but only semi-fluid. It was seen before felt. There was a little burning, (This was unlike any urticarious spot I have seen, and I never, to my knowledge, had anything of the kind before, though I have frequently since, and do now — 1883 — very rarely.) On the 13th d. this spot had nearly gone, and another appeared on margin of r. lower eyelid. On the 22nd day, on both lower eyelids, on tarsal edges below the lashes, a spot of the same kind. In e, throat felt dry. On examining it a small irregularly oval white patch is seen at the back of the pharynx looking exactly as if it had been touched with lunar caustic, 14th d,, pricking in the throat making the r. eye water. 13th d., all symptoms lessened : no dose taken the previous n. Sick feeling in m, and afternoon, coming between meals and not interfering with the appetite, which is as good as usual* Muscles of r. side of neck sore and stiff. Skin of r. shoulder tender, irritated by brace, though r. brace not tighter than L, aching pain on motion and tenderness of muscles at back of r. scapula. Tenderness gone from hand and ulna (r. i). Pain in middle of back. 14th d., irritable urticarious spot back of r. shoulder. Muscles of shoulder still sore. Itching in perinaeum, i6th d,, slight return of hypersesthesia in r. arm ; it had almost vanished, soreness of muscles gone. Burning in back of arms after dinner, 17th d., increase of hyperassthesia of r. arm, especially outer side of elbow. On 19th d. it was very marked in r, arm and felt slightly in face* On 23rd d. it returned again ; 24th d., it was gone except from a patch on back of r, arm. On the 27th d. it returned again with slight tenderness of small joints, and in e. was very bad. On the 30th d. it was all gone. Shoot in r. side of face over ramus of jaw, 15th d,, pains round the loins passing off into flatus. This recurred frequently afterwards. On the i6th d. pain was as of slight band across loins. There was an aching in centre of back ; and a dull pain in sacrum. On the 17th d, there was general weakness of lower limbs ^ ascending stairs was much more of a labour than usual. Dull pain in centre of back at r. of spinal column. On 19th d,,in afternoon on standing, pain In sacrum and down thigh, 21st d,, rather severe pain on rising in r. sacro-sciatic notch, where the nerve passes out* 22nd d., a good deal of back-ache, especially in r. sacro-sciatic notch. On 23rd d. the backache had gone, i6th d,, rumbling of flatus in body, slight pain in abdomen (this on retiring after midnight, shortly after the e. dose) ; after rising in m,, sick feeling, with some belching and pain in abdomen. 17th d., feeling of looseness in bowels, with slight pain in lower abdomen. 22nd d., pain at r. of epigastrium and great tenderness. Giddiness (after dose repeated at noon). 17th d,, slight giddiness on rising with slight headache. After the evening dose,

nausea and slight giddiness. 20th d., tenderness of under part of r. heel on treading. Shoots longitudinally in r. and 1, sides of chest at different times. Shoot in r. ear whilst walking almost making me stop*

1. MoLt took doses of crystals from gr. ss to gr. ij* They caused first disagreeable sensation of stoppage in gullet and stomach j then feeling of warmth in stomach, with rumbling in bowels and escape of flatus. In larger doses drug occasioned compression of stomach, weight at scrob, cordis with involuntary urging to sigh, palpitation, tremor of limbs, general prostration, giddiness and singing in ears. There was usually added to these remarkable dryness of tongue, intense thirst, annoying choking at gullet, and obstinate constipation. [Handbuch der Pharmacohgie, ii, 133.)

II, Poisonings, — I. E. H — , jet. 2i, was brought to the St. Louis Hospital in a seemingly moribund state, from having swallowed a solution of arg. nit. The patient presented the following symptoms : Complete loss of consciousness j insensibility of all parts of body j upper limbs and facial muscles agitated by convulsive movements i jaws firmly clenched, eyes turned up, pupils much dilated and insensible to light i pulse full^ natural, 70. There were stains of nitrate of silver on the fingers. A glass of a solution of salt [\ drachm to the ounce) was administered every J h. He had received much magnesia and inert matters before admission. Towards 3 a.m. an amelioration was manifest ; muscles of face no longer agitated, jaws relaxed, pupils less dilated, 6 a.m., continued insensibility of lower limbs, sensibility obtuse in upper \ face strongly injected ; patient experienced violent pains in epigastrium, 8 a.m., no change in appearance ; sensibility a little less obtuse. Asked about quantity of poison he had taken, he could not answer, buti indicated it by sign of figure ^ 8.'^ The administration of salt solution was kept up all this time, and now he was limited to emollient drinks. Noon, sensibility returned in all parts of body. Epigastric pains. The patient recovered speech. He said he had taken 8 drachms of fused silver suspended in cassia water, 3 p.m,, he fell into coma difficult to describe, lost intelligence and sensibility, pulse 95. This lasted 2 h. 7 p.m., sensibility and intelligence had reappeared, and the patient passed a fairly tranquil night. At 8.24 a.m., he fell again into his habitual coma, persistent loss of intelligence and obtuse sensibility. At noon he was found in a satisfactory state j he complained of epigastric pains, but the sensibility and intelligence had reappeared ; by e. he could raise himself up and drink without help. On the 25th, about 9 a.m., the patient experienced a new crisis, but much less strong than the preceding, and in the e. he was found playing | cards with his neighbours. The following days he steadily progressedj but felt violent epigastric pains up to his departure on the 29th (PoUMAREDE, youm, dt chifti. med.^ 1839, p. 434.)

1. — a. A medical pupil, while touching a small ulcer beneath the tongue of a child aged 15 months with a stick of nitrate of silver, I inch long, which he held in his fingers by one end wrapped \n paper, had the misfortune to let it slip down the child's throat. Almost immediately the child vomited some oily matter supposed to be cod-liver

oil and tnilk^ the oil having been taken shortly after breakfast. When the vomiting had ceased, and within a few m. of the caustic being swallowed, common salt was given in considerable quantities, after which the child was slightly convulsed. Again vomiting took place, and now the matter ejected had a white curdy appearance, and no doubt was principally chloride of silver* The administration of salt was repeated frequently. Vomiting and convulsions occurred at short intervals till 11.30. (The caustic had been swallowed at 9.30.} At that time there was a copious liquid stool containing a quantity of the white curdy substance. At 1 p.m. the child fell into a composed sleep which lasted for 4 h , after which convulsions returned with increased violence and continued until 3. The extremities then became cold, the face pinched, the skin clammy, and the pulse almost imperceptible j the child died in violent convulsions at 3*30 p.m., 6 h. after swallowing the poison.

b. Pcst^mortim exanu^ 25 h. after death. — Child was well nourished and appeared to have been in good health. Cadavenc rigidity well marked. Under the tongue a small hard swelling, ulcerated on the surface, corresponding to the orifice of Wharton's duct. No marks of nitrate of silver in the mouth, but in the oesophagus two or three small patches of corrosion. The stomach contained 2^ ot. of inodorous fluid ; mucous membrane pale except one point of ecchymosis, and a large patch of corrosion, interrupted transversely in several places, but extending from the cardiac opening along the greater curvature for 4 in. It was \ in. wide at the cardiac end, and i J in. at the end nearest the pylorus, and was of a brilliant white colour. In the duo* denum and the first 12 in. of the jejunum, the valvulae conniventes presented a similar corrosion over nearly their whole surface, but of a greyer colour. This was not washed off by a gentle stream of water, nor by rubbing with the finger, by which, however, loose white particles were removed. There were no morbid appearances in the other parts of the alimentary canal, m which about 3 oz. of fluid were contained. The other viscera were healthy. Heart empty and contracted. Mucous membrane of trachea normal. The contents of the stomach, ileum, and rectum, were separately analysed. In each there was a considerable quantity of chloride of sodium, most in the stomach, and least in the rectum ; and of course, therefore, in none of them was there any nitrate of silver. The white patches rubbed off the corroded spots in the stomach and off the valvulse conniventes proved to be chloride of silver. (Scattergood, Brit. Med, Journey 1871, p, 527.)

1. In large doses it sets up nausea, vomiting, diarrhoea, with colic ; mostly also symptoms of an intense disturbance of the nerve-life of the whole economy, great faintness and depression, often stupor, want of breath. Sometimes there are cramps, convulsive contractions of this or that set of muscles, even paralysis of the limbs* (Oesterlen, Handt* der Pharm.y 1 856, p. 128.)

2. Nitrate of silver gives rise to heat in the pharynx, and irritates the digestive organs by its immediate impression on the mucous surfaces. It frequently excites colic and alvine evacuations the first time that it is taken. It has been seen to produce vertigo and transient

blindness. It has caused an increased secretion of urine. (Barbier, Traitede Mat. Med.^ p. 588.)

1. A woman aged 58, widow, and mother of several children, feeble indeed, but otherwise enjoying continuous good health, noticed in the year 1857 ^^^^ ^^^ ^^r was growing grey, and endeavoured to hide this mark of commencing old age by the use of a pomade compounded with lunar caustic, which she applied every fortnight. In January, i860, the following operations of the cosmetic came out: dyspnoea and palpitation ; soon after, oedema of lower limbs and ascites : the forces failed, and the patient was compelled to keep her bed. After the lapse of a month, the oedema of the lower limbs was removed, but in place of it a slate- grey colouration of the skin appeared, which, like the ascites, remained permanent. On June ifth, i860, the patient was brought into the hospital, when the following symptoms presented themselves : The skin of the legs showed, besides the slate-grey colouration, a hardness and tension which made it impossible to raise up the skin in folds, so that it assumed the complete character of brown sclerema ; nevertheless the sensation, temperature, and transpiration of these parts were normal. The legs were bent up towards the upper part of the thigh through contraction of the muscles, and were in such an advanced state of emaciation that they looked like the legs of a mummy. On the upper part of the chest and on the hands appeared a faintly -marked brown colouration. Auscultation of the heart and arteries gave the signs of commencing anaE:mia. In other respects all the organic functions are performed regularly and satisfactorily ; there was only a slight degree of ascites ; and the urine, which was passed in normal quantity, and without inconvenience, was in no way abnormal in its constituents. At first sight it might be doubted what was the nature of the peculiar colouration of the skin, and especially it might be thought to be Addison's disease ; in the meantime the characteristic colour of the hair and scalp soon led to the right track, and in answer to inquiries the above-mentioned history was given. Here, through the use of a pomade of nitrate of silver the same effect was called forth as in other cases following the internal use of argent, nit. That a deposit of nitrate of silver under the skin really ensued, was also established by this means, that by repeated application of a solution of iodide of potash the skin -colouration was made decidedly clearer. The ascites was undoubtedly owing to the anaemic condition,t which, on its part, found its explanation in the injurious action of the nitrate of silver. The indication for cure was to change the silver into a colourless and insoluble compound, as, perhaps, the iodide of silver, and by this means favour its removal from the organism. The internal administration of iodide of sodium, and the use of warm baths, had, indeed, a surprising effect, and after about a month's use of these curative measures, the patient found herself in the following condition :

• Roget also relates a case in which an epileptic having taken arg. nit. longer and (he suspects) in larger quantity than he intencled, her health suffered materially in consequence ; she t^came emaciated, and was reduced to a state of alarming debility, from which she was several months in recovering. (Cooke, Nervous DiseaseSy li, a, 151.)

f Wedemeyer relates, in Rust and Caspar's Repirtonmn^ xix, 454, a case of argyria

The dark slate-colour of the lower extremities had become a h'ght (.brown ; the skin was white ^ the muscles had lost their contraction

[id permitted the extension of the legs. The light-brown colouration 'of the chest and hands was quite lost ; the ascites, indeed, still remained, but was essentially diminished ; the anaemic symptoms were very much lessened by proper substantial diet which the patient was ordered* The patient was so satisfied with her condition that she would not wait for further completion of her cure, but left the hospital. (Gam- SERINI, Med. Neurgkt. Zf^., 1861, p. 6. Dr. G, adds — "By the

recorded cases we can confirm the observation of Lelut that the abnormal colour has its site in the corium and that the epidermis is ree.* Herein the very fixed skin alteration differs from that produced by outward contact with lunar caustic, with which the epidermis is chiefly concerned.^')

1. Stephen Martin, 18, sensible and temperate, always had good health till attacked by fits at 15. He could assign no cause. Dr. Badeley thought they possibly originated in the stomachy where there was great acidity. The fits occurred at nncertain intervals after the first attack, generally about every 3 or 4 weeks. They left a violent pain in the head, and particularly in the eyes, continuing next d. Between the fits and sometimes on their approach, he felt a sensation like flashes, or quick passing vapours behind his eyes, followed by a bewildering feeling, with a violent pulsation in the head, and a temporary deprivation of sight, so that he could see only a small part of anything at a time. These sensations were removed with the fits by the use of argent nit, unassisted, after leeches, blisters, emetics, mercurials, bark, steel, zinc, valerian, and turpentine had failed. The turpentine he soon discontinued, from the violent irritation it excited in the bladder. The argent* n. was taken in doses of gr, iss three times a day, made into pills with bread-crumb, and continued a year and a half. The fits gradually lessened in frequency till they entirely left him. The pills had no purgative efl^cct. *Thc dark colour did not make its appearance till some months after the fits had left him. As there had been no return of his complaint,! had not seen him for a quarter of a year \ but upon calling as I passed through the village, his mother desired me to observe the alteration that had taken place in his complexion. Not having seen or read of a similar effect from that medicine, and having given it in such small doses^ I did not impute it to that cause. Indeedi the disease being cured, I paid little attention to his colour, till I read the cases published by Dr. Roget in your 7th vol. These induced me to take an early opportunity of calling again, when I found the colour of his skin greatly increased, although he had discontinued the nitrate of silver 6 months. It is now near two years, and his face still 'retains the leaden colour, his bosom rather darker with a purple hue, the roof of his mouth, induced in an epileptic in which the patient died of diseased liver and dropsy. — Eds,

• ** It (silver) is never found in combination with the cellular elements, or tm. bedded in the intercellular substance^ but is radier found deposited in the basement substance of the connective tissue, and in the homogeneous membranes allied to connective tissue." (Nothnagel and Rossbach, c^. rri.)

inside of his cheeks, and back of his tongue dark ; the tunica sclerotica much discoloured. As blisters on negroes rise white, I applied two to Martin and found they did the same, which, I think, proves the seat of the colour to be in the rete mucosum. He has been now perfectly free from any symptoms of epilepsy during two and a half years." (Badeley, Med,'Chir. Trans.^ ix, 235.)

1. Heller {Jrchivy i, 324) found no silver in blood or urine of patients taking it for a length of time, whereas faeces contained it largely. He also found gastric juice precipitate it as chloride, and concludes that this passes through the alimentary canal unchanged. But the discolouration of the skin fully proves that absorption does take place when the medicine is exhibited in small but long-continued doses. (Pereira, op. at.)

2. A patient was treated with arg. nit. for a hemiplegia for 2 months. On Feb. 19th she complained of her mouth, which presented signs of a stomatitis characterised by swelling of the gums, which were of a dark red^ with violet border near the teeth, and a very great sensitiveness of the mouth, especially to heat ; metallic (not foetid) odour of breath ; no salivation. In spite of suspension of drug this increased next d., but on the 21st, after chlorate of potash, it subsided, to return slightly on March fth. {Bull, de Therap.^ 1866, p. 86.)

3. A man, accustomed for 12 months to dye his hair and beard with a strong solution, suffered from general weakness, confusion of thought^ loss of memory, tinnitus aurium, and defective sight, which symptoms ceased soon after stopping the dye. (Quoted from Schmidt's Jahrb. for 1874^ by Dr. Phillips, who adds — ^^ Within my own experience I have known men suffering from the same cause, with giddiness, vertigo,"^ and marked nervous depression, amounting almost to melancholia, and recovering quickly after ceasing the application." — Mat. Mid.^ p. 391.)

Volume I — Appendix

Argentom nitricum.— I. 7, 1. i, for " Schacbcrt '* read " Schachert."

Volume IV — Appendix

ARGENTUM NITRICUM.

(See vol, i, p. 350.)

II. 10. On June 23rd a pharmacy boy was brought to the Hopital Louis at 1 a.m. in a state which seemed to indicate imminent death.

4$4

He was completely unconscious, without sensation in any part of hit body ; upper limbs and muscles of face were agitated by convulsive movements ; jaws were strongly clenched, eyes turned up, pupils very much dilated and insensible to light. Evidence showing that he \ai taken nitrate of silver, jss of sea-salt was given in 3J of water e\ery 15 m. After l^ h. there was sensible improvement; pupils were less dilated, convulsions and clenching of jaws had ceased. The saline solution was continued for 5 h, more. Sensibility was now less blunt, and patient had very severe epigastric pains. It was not till midday, II h. after admission, that general sensibility of surface returned and patient recovered his speech. At 3 p.m. he fell into profound coma, which state lasted 2 h. ; and similar seizures were repeated oo 24th and 25th. It was not till end of latter d. that his state became altogether reassuring. Nothing now interrupted his convalescence, and he left on 29th, having only slight epigastric pains. Patient stated that he had swallowed 3viij of the nitrate, suspended in black currant ratafia. {Bull, de Therap,^ xvii, 195.)

II. The following symptoms were observed by Dr. J. O. MCLLCR, probably oi patients.

a. After 10 dr. of 6th dil., nocturnal pressive stupefying pain round about tie head, especially severe in temples and forehead, with heaviness of whole body, troublesome dreams and nausea. (In a woman, xt. }o.)

b. Pressing, digging headache, with chilliness and great bruised feeling of UmbL (In a young, strong man.)

r. After great itching the previous evening, dryness and weakne» of eyes; Anu lopment of blood-vessels all around, red bundles of vessels distributed here uid (Imt, red blood.points, exudation of blood on conjunctiva bulbi. The fingers Aztn crooked in a spasmodic way, so that she could not open the hand, which wat closed t* a half-fist. (In a lady, tet. 60.)

(L Chorea-like spasmodic movements of upper and lower extremities; sp; contraction of adductors of fingers j she can hardly separate the fingers, whii pressed closely towards one another ; severe pain in sacrum. (In a girl, xt. %.

t. For four successive d., always at 6 p.m., attack of fever ; general chi followed at a short interval by general heat, the former of long duration, and i diately recurring if uncovered during the heat, (he latter accompanied by < pulsation of the I. temporal artery. Both stages without thirst. After the tereum' tion of the attack, which lasted 1 to j h., painful swelling of scrob. cordis, with grta anxiety. (In a sensitive girl of »o years.) {Ztit. 4tt Ver, d. Aem. Afrzt, OtOtn^