Coffea cruda

Volume II — Main text

COFFEA . Cóffea arabica, L. Mocha coffee. Nat. Ord., Rubiacea. I. Provings.- 1 . [For the following provings from the Beiträge the crude bean was employed ; but no information is given as to doses or subjects, save that the latter were healthy.] HAHNEMANN.Oppression in fore part ofhead, at times changing into stitching-drawing pains in r. temple, worse when walking in open air ; gloomy feeling in head (3 h.) ; hemicrania, as if nail had been driven into parietal bone, renewed and aggravated after a meal, disappearing in open air, returning after short time in room ; headache, as if brains were torn or dashed in pieces, coming on during walk in open air, and soon subsiding again in room ; headache (after some reading) as if brain at frontal eminence, then behind frontal bone, were bruised, torn, or smashed (2 h.) ; cracking in brain in region ofear synchronous with pulse ; weight in head and heat of face ; rush of blood to head, especially when talking ; headache on waking in m., like a general tension of brain; he dislikes opening eyes, when stooping he feels as if brain fell forward, so great is pressure on temples and forehead ; headache as if brain were too full and broken, especially in occiput, on

waking from siesta, unaffected by motion, mental exertion, or open air (4 h.) ; an almost burning sore pain in l. nostril ; sudden, copious, watery discharge from nose ; epistaxis ; on rising in m. and at 6 p.m. bleeding from nose with weight in head and morose laziness, recurring for some d. at same time ; toothache, in shooting spasms from above down into nerve of fang ; pain in a molar tooth, only when biting on it ; in border of velum a simple pain when not swallowing, increasing during acts of deglutition (4 h.) ; a kind of sore-throat, swelling of velum, which feels like an accumulation of tenacious mucus ; taste in mouth as of hazel-nuts ; bitterness in mouth all d., -food, however, had no bitter taste ; bitter things had unusually bitter taste ; food has good but too strong taste, so that he cannot eat much, so also with tobacco (3 h. ) ; diminished appetite (8 h.) ; very great and continued anorexia and aversion to food, drink, and tobacco, with nausea and disposition to vomit and salt taste in mouth, taste of food natural (2 h.) ; aversion to coffee ; eructations tasting of ingesta, from noon to e.; great hunger before a meal, greedy, hurried eating; constant inclination to vomit, having seat in upper part of throat ; about 5 p.m. nausea, he becomes faint, must sit down, then inclination to vomit ; after eating agreeable food felt qualmish and nauseated; stitches in pit of stomach with pressure, after a few h. painless distension of epigastrium ; in m. in bed continuous pinching pressure in both sides of abdomen, also towards inguinal rings as if hernia would protrude, without distension, only momentarily relieved by emission offlatulence ; after walking in open air, fulness in abdomen ; at different times of d. feeling of pressure at pit of stomach, her clothes felt too tight, and she had to loosen them ; some fermentation in belly and emission of much flatus, the whole d. (4 h. ) ; forcible emission of much but almost inodorous flatus ; after 12 or more h. difficult emission of flatus in small quantity, which is constantly seeking escape, with uneasiness in abdomen ; fermentation in abdomen and then vomiting, soon repeated, and on third occasion bringing up worms ; stitching from out of inguinal rings, as in hernia ; jerking stitches on side of abdomen, at every expiration ; colic, as if belly would burst ; desire for stool, but insufficient relief, though stool is soft ; burning tearing in fore part of urethra ; pressure on bladder, obliging him to micturate; increased secretion of urine (14 h.) ; emission of much urine at midnight (5 h.) ; primary excitement, secondary depression, of sexual desire. In m. on waking larynx is raw and hoarse ; constriction ofchest (immediately) ; fits ofshort cough in quick succession, with frequent abrupt scrapings (1 h. ); he must stop coughing, all became dim before his eyes, and he felt as ifreeling; violent irritative cough for an h. about midnight; sudden attacks ofdry hacking cough, as if from a spasmodic constriction of larynx, which seems lined with dry mucus ; when coughing it hurts side of chest, almost like a stitch ; pain in sacrum while walking ; lame pain in sacrum while sitting or standing ; great weakness in arms and lassitude in whole body ; tearing in l. arm, so that she could not move it freely ; flexor cramp in one or other finger ; painful drawing or tearing downwards in flesh of fingers (2 h. ); pain as if bruised in nates under hip-joints, from ischia to femora, while sitting and walking, making him limp ; least

rubbing with woollen makes inner thighs sore, or at least causes very painful sense of soreness there ; on 1. tibia a jerking, gnawing and smarting, both at rest and in motion, and a sensation as if marrow were bruised, with feeling of heat there ; tremulous feeling in knee when going downstairs ; crampy sensation in calf when flexing knees, and in soles when flexing ankles ; below inner r. malleolus ajerking stitching while extending foot, treading on heel, or touching spot ; bruised feeling in alljoints, especially of those that have been bent, in m. in bed, disappearing on rising ; shooting jerking through one or other limb ; after every walk her legs feel so painful that she must lie down ; great weakness on going upstairs, soon passing off; pain in whole body, so that she has little rest ; eruption and itching over whole body ; little sleep ; overwhelmed with sleep, he dreads apoplexy ; at n. in sleep he tosses about unconsciously, so that in m. he finds himself feet uppermost; sleeplessness from 2-7 a.m. , with colicky incarceration of flatulence under ribs, causing anxiety, and with feeling of (dry) heat over whole body, without thirst, and desire to uncover himself; very long vivid dreams at n.; slight dreaming ; aversion to open air, in which all symptoms increase ; constant weariness of feet, extending half way up thighs, after walk in open air; during walk in open air becomes sad, lachrymose and disinclined for business ; violent thirst without heat of body or dryness of tongue ; thirst at n., frequent waking to drink ; dryness in mouth in m., without thirst ; feeling of warmth with somewhat red face, but without thirst ; at 5 a.m. and 1 p.m. violent chill in bed, without thirst ; at 4 p.m., limbs feel relaxed, heavy, and strengthless, knees give way, with febrile heat and chilliness externally and internally ; at 4 p.m., cold feet, and immediately thereupon headache and congestion to head, going off on walking in open air (24 h.) ; cold hands, then cold feet (2-3 h.) ; internal shuddering, even in chest, chill and immediately afterwards heat in head and sweat on face,-all without thirst ; free transpiration towards m.; general feeling of heat in e. after lying down, he felt altogether oppressed, at n. general sweat, especially on back ; at 8 p.m., heat, perceptible externally, all over body, with sense of great dryness in mouth and at same time shuddering in back and down posterior aspect of body, then hands and feet became icy-cold, on which followed when in bed alternate heat and great coldness till after midnight, in m. bruised headache, which made every step he took hurt him ; some chilliness and therewith heat in both cheeks; from 8-9 p.m., nausea as in stomach, a sort of faintness and giddiness, he must sit and lie down, and all his limbs felt heavy, with some chilliness ; at 3 p.m., without preceding chill his face was hot and red, with much thirst, after this sweat all over, with thirst for first few h.; for two m. running she wakes at times, feels great dry heat all over, and must turn round, breath was hot, but no thirst or dryness of mouth ; heat and redness in one cheek, with almost constant shuddering ; feeling of heat in m. in bed, nevertheless dread of being uncovered ; a little out of humour ; indifferent to business, loses interest while engaged in it ; very cross ; crossness, he is inclined to throw everything out of his hands ; she has nothing but vexed, sad ideas, cries aloud, and can be

appeased by nothing, but the ill-humour abates in the open air ; great anguish, she knows not how to find ease, she trembles and cannot hold her pen ; calm, composed, unperturbed mood (secondary) . (STAPF'S Beiträge.) 2. FRANZ.- Meditation causes drawing pressive headache in upper forehead ; he sometimes feels and hears a cracking in vertex while sitting still ; in open air his sight is much more acute than before ; taste in mouth as after sweet almonds ; while yet eating some bread after a moderate meal, he felt an extremely painful pressure on 1. side of region of stomach, continuing after he had left off; painful soreness on scrotum at least rubbing of trousers ; obstructed nostrils, as in dry coryza ; when keeping arms bent, a cramp-like and contractive sensation in them, almost a jerking ; rheumatic bruised pains in 1. upper arm ; his hands tremble when he tries to hold anything ; feeling of numbness in fingers (4 h. ) ; a finger which had been slightly burnt before taking drug, and almost painless, now is in violent pain ; sleeps restlessly all n., and must turn from side to side ; frequent deep yawning; the air, to which he was accustomed, and which was agreeable to him, seemed quite cutting, water flowed from eyes, and he soon became tired (6th.) ; repeated chills and shuddering in back, body having natural warmth ; cold feeling over whole body, she has a chilly creeping on back as in a cold room, then sudden redness and heat in face, with cold hands, whose palms then become hot, dorsa remaining cold ; lively fancy, many plans for future ; contrary to habit he was in continual sentimental ecstasy about beautiful scenery, or which he was reading adescription (3 h.) ; dose taken in e. was followed by great excitement and quickness of motion, all movement being performed with uncommon ease (12 h.) ; the utmost relaxation of mind and body ; when reading he loses sight of his subject, and neither recollects nor follows, without, however, being conscious of other ideas ; when not reading, a thousand ideas come into his head, and he thinks ofthings long past ; want ofmemory and attention (48 h.). (Ibid.) 3. STAPF.- Pressive headache in temples, drawing towards occiput, while walking in cold air, decreasing while sitting in room, again violently renewed in open air, but finally disappearing there ( h. ) ; heat in face and redness of cheeks (th.) ; feeling of dryness and slight burning on tongue, without thirst (I h.) ; copious urination ; oppression of chest, she must take short breaths, breathing visibly heaves chest (after subsidence of heat in face) ; short, momentary, hacking cough, as trom tickling in throat, often recurring ( 1 h.) ; trembling of legs (1 h.) ; sleeplessness from excessive erethism of mind and body ; attacks of chilliness, increased by motion ; chilliness through whole body (with warm skin), stronger and more perceptible while moving body, when rising from chair a cold chill escapes over her, and face is pale, for 10 m. ( h.) ; after the chilliness slight heat in throat and thirst (1 h.) ; chilliness in back, mixed with feeling of heat, especially from middle of back over hypogastrium he experiences warmth as if sweat would break out. (Ibid.) . 4. THORER. Vertiginous oppression of head (4 h.) ; vertigo and blackness before eyes while stooping ( I d.) ; inability to think acutely

(6 h.) ; head is heavy and giddy, with general anxietas, she thinks she must fall (2 d.) ; contractive frontal headache (2nd e.) ; slight rheumatic drawing in l. occiput ; heat in face with red cheeks, after a meal (6 h.) ; momentary drawing in a hollow l. upper molar, as after a slight chill ; drawing in l. malar bone ( Ist d.) alternating with tearing in tooth ; in m. bitter taste in mouth (2nd d.) and bitter taste of drinking water during d. (Ibid.) . 5. The following are fragmentary* or anonymous :-She feels as if she momen. tarily lost thoughts (2nd d.) ; pressive pain on vertex ; rushings of blood towards head, anxious heat and redness in face ; itching of hairy scalp ; boring in r. eye, with diminished power of vision ; music sounds over-loud to him, so that he must touch his instrument lightly; painfulness of fore-teeth on touching and while chewing, as ifthey were loose; hiccup; nausea in m.; tension over stomach and hypochondria ; disagreeable sensation below stomach, with subsequent distension and dull pain; after supper fulness in abdomen, as from incarcerated flatus (Hsch.); passage of much flatus; on 1st d., unusually, two stools, first hard, second fluid (Br.); on 2nd d. three hard stools ; itching at fore part of penis and glans for some h. (47 h.); frequent desire to pass urine, which comes only guttatim ( h.); urine blood-red, but not turbid; itching on r. side of scrotum; strangulating cracking pain in one testicle for first 3 d. want of sexual excitability, physical and psychical; for several e. fluent coryza with sneezing; in e. in bed, and on going to sleep and waking, coughing ; pressive pain in sacrum; feelingoftightness in limbs; sweat of hands while writing; drawing pain under r. knee ; slight stitches in balls of great toes, 4 p.m.; much yawning and drowsiness, 1st d.; sweat of feet with sore feeling in toes; great mobility of muscles, every movement is performed with ease and rapidity, and with steady force (A.) ; lightness of head and in all bodily adjustments, a great and unwonted sense of well-being and liveliness (A.) ; great wakefulness in e.; desire to lie down and close eyes, but without either ability or willingness to sleep (Br.) ; wakeful at first, soon after sleepy (Hsch.); after 1 h. great drowsiness with weariness (A.) ; sound sleep; he slept till 3 a.m., after this he slumbered only in dim consciousness (Br.) ; waking, with starting; frequent waking towards m. in affright (Lgh.) ; during n. his fancies turn uninterruptedly upon one thought, of which he cannot free himself, andwhich robs him of all sound sleep; great sensitiveness to cold; tremulous movement in back and between shoulders, with warmth (Hsch.) ; dry heat in face (Hsch.) ; warmth in chest and abdomen (Hsch.) ; unusually warm feet (Hsch.) ; anxiety and instability ; very discontented, indisposed to speak, and answers curtly (immediately) (Br.) ; great cheerfulness, acuteness of thought, vividness of ideas (A.) ; vexed, anxious, lachrymose mood. (Ibid.) 6. a. Jan. 18th, infusion of I oz. coffee, p.m.-19th, a.m., same dose ; p.m., same quantity ; urine acid, a.m., less so, p.m.-20th, a.m., urine highly acid ; p.m., same quantity of coffee. Felt well but excited, appetite diminished.-Feb. 1st, a.m., infusion of oz . coffee ; p.m., same quantity ; appetite moderate, felt well.-2nd. Same quantity of coffee as on 19th ; felt wellbut excited.-10th, a.m., I oz. coffee ; p.m., same quantity. Felt pretty well, little appetite, none in e. Very excited, could not sleep till 4 a.m., then very restlessly. Got up next m. not feeling sleepy. Urinated frequently at n. b. Aug. 20th, 1.50 p.m., 3 cups of coffee made from oz. beans. Two stools, unsteadiness of hand.-21st, 7.30 a.m., 3 cups ; 10.15, feeling of emptiness of stomach without hunger, unsteadiness of head gone ; 2.25 p.m., 3 cups ; 8 p.m., 3 cups, 2 stools.-24th, 2.40 p.m., 3 cups.-25th, 2 to 3.45 p.m., 5 cups ; 3.30 p.m., great ebullition of blood, slight unsteadiness of hand.-27th, 10.25a.m., 3 cups ; 2.20 * No information given as to provers here designated. VOL . II . 20

p.m., 3 cups ; 4.45 p.m., 2 cups ; eructations tasting of coffee, rumbling in bowels, no appetite for supper.-28th, 7.45 a.m., 4 cups ; 10 a.m., I cup ; rumbling in bowels.-29th, 8.30 a.m., 3 cups ; 2 p.m., 3½ cups ; disagreeable ebullitions of blood, trembling of limbs and faint feeling, no appetite. c. BÖCKER found that taking coffee as above, while it increased the quantity of urine passed, diminished all the solid constituents of the urine to a remarkable degree. It diminishes the amount of fæces, and also the amount of carbonic acid exhaled from the lungs, and correspondingly makes the inspirations more superficial. This last property ofcoffee was well shown in an experiment. He drank a quantity of coffee made from 1 oz. of the beans and sat down to his desk to write. After h. he had a true fit of asthma, oppression of the chest, trembling of limbs, great ebullition of blood and vertigo. He went into the open air and walked quickly without much relief, his knees tottered, he became deadly pale, and felt quite faint. He was too weak to sit up and had to lie down. He felt very uncomfortable, the dyspnea increased and lasted some h., when he noticed that he had to breathe more deeply. He had no appetite for supper, could not sleep, and had no stool for 2 d. His conclusion is that coffee hinders the waste of the tissues. It increases the serum, albumen, and corpuscles of the blood. (BÖCKER, Beitr. z. Heilk., i, 188 , et seq.) 7. COLE gives the result of his observations on the immoderate use of tea and coffee, the effects of which he says are practically identical. There is first considerable excitement, the face becomes flushed, the eyes sparkle, the pulse is full, throbbing and quick. By-and-by the hands and feet become as cold as marble and covered with clammy sweat ; there is also coldness and numbness of back of head. To this is sometimes added formication of scalp, intense headache, dimness of sight, unsteadiness in walking, vertigo with feeble, fluttering pulse. After a few m. to 2 or 3 h. craving emptiness in stomach, not relieved by eating. Fluttering as of a bird in 1. side, fulness of chest about clavicle and root of neck, breathlessness and frequent deep sighing. Sometimes this goes on to threatening ofsuffocation, insensibility, and convulsions. The sufferings in stomach are often aggravated to violent spasm. Violent palpitation or enfeebled action of heart, bringing on syncope. Temper peevish and irritable. A man, æt. 40, had been in the habit of taking 2 or 3 cups of coffee in m. and again in afternoon. He was troubled with constant headache, aggravated noon and e. Numbness of back of head with aching and throbbing, unsteadiness of gait, sinking and emptiness of stomach, fluttering of heart, cold hands and feet. Got well in 10 d. after leaving off coffee. ( Lancet, 1832-3, ii, 274.) 8. In 1859 I proved on myself, while in full health, the action of coffee, taken cold, in bed, fasting. I did not push effects so far as Cole, but I went far enough to feel the præcordial symptoms, pale face, coldness of skin and extremities, weakening and gradual retardation of beats of heart. Before commencing experiments pulse was 69 ; after fifth cup it had fallen to 61. (LAMARE-PICQUOT, Etudes Expérimentales, Paris , 1864.)

COFFEA . 307

1. Dr. LINDSLEY took for a proving 3 cups of strong coffee 3 m. in succession. Dreamt throughout following nights vivid and brilliant visions of magnificence; on 3rd n. dreamt that dome of sky was spanned by rainbows from horizon to zenith. These delightful visions were followed by dreams of death of dear friends, which did not abate his cheerfulness and mental exhilaration, he looking on all with supernatural indifference. ( Allen's Encyclopædia, iii, 446. ) 10. Two men got every morning and afternoon a decoction of 1 oz. coffee beans (roasted), which was double the strength of their ordinary drink. The effect was, urea diminished, quantity of urine passed increased, increase of heart's action, quick pulse, excitement, perspirations , anxiety, vertigo, faintness, and sleep disturbed by disagreeable confused dreams. (Dr. J. LEHMANN in BRILL, Das Kaffein, 82. ) 11. It will perhaps be remembered that several years ago I published some accounts of a peculiar characteristic symptom of coffea which had not been recorded as pathogenetic, namely : " Terrible toothache, relieved only by cold water held in the mouth-aggravated by everything else." I have frequently verified this symptom in practice, and so have many of my colleagues . I now have the pleasure of recording a case of poisoning by coffee, where this symptom was the most severe and persistent of all its effects. Mr. W-, a young lawyer, wishing to perform an important mental labour in writing, drank I cup of intensely strong coffee without milk or sugar about 8 p.m. After writing several hours he was seized with such an intense pain in the teeth of the right lower jaw (not decayed) that it drove him nearly crazy. He came to my office after midnight to get some relief. He had already observed that no application relieved the pain but cold water. So soon as the water became warmed in the mouth the pain returned. Not knowing that he had taken a poisonous quantity of coffee I gave him coffea 3, but to my surprise he came back in the morning reporting no relief. I then gave coffea 200, but no relief came in six hours. Then he told me about his coffee poisoning. Electricity was tried, and gave relief for several hours after the first application, but subsequent applications were of no benefit. He then tried a variety of nostrums for several d., but none gave more than temporary alleviation. I gave him nux vom. and cham. to antidote the coffee, and pulsat. for " relieved by cold drinks " (see Hull's Jahr), but no benefit accrued. The odontalgia gradually wore away in a week, leaving him so nervous and shattered that he was fully convinced that coffee was really a potent poison. We have now the necessary evidence corroborative of the power of coffee to cause and cure this kind ofodontalgia. (E.M. HALE, Hahn. Monthly, ix, 465. ) coffee to excess each time produces more or less of 12. Drinking the following primary symptoms :-Great loquacity ; his brain feels clear and is active ; he feels strong enough to do anything ; feels impelled to push things ; wants to keep going ahead and doing something ; veneration for the Supreme Being and love for family ; desire to perform good deeds intensified (benevolence excited) ; stinging pain in locality of amativeness on left side; pulse full and frequent. Then the following secondary symptoms :-Sensation of heaviness in the

forehead over the eyes, and cold clammy perspirations all over the body, but chiefly in the palms of the hands ; feet and hands cold ; on account of easy perspiration chilliness and shivering from the least exposure to cold air ; chilliness, with general shaking and chattering of the teeth ; cannot get warm ; the chills ascend from the fingers and toes to the nape of the neck, and thence to the vertex ; when chilly, cayenne pepper taken internally produces general warmth and makes him feel fearless and courageous ; vertigo with whirling sensation in the head, occasioning a general faint feeling, with aggravation when thinking-has to banish reflection ; with vertigo burning in the stomach ; vertigo partially relieved by a change of position, and general amelioration of symptoms from moderate out-door exercise ; on going to sleep starts up suddenly in affright with groans and fear of falling, or of some impending danger ; great sleeplessness from mental and nervous excitability ; timidity and fear of sudden death, this fear sometimes occasions trembling from head to foot ; muscular jerking , jerking of limbs ; great lassitude and general debility ; pulse variable, often weak and almost imperceptible, sometimes intermitting ; sensation of heaviness in cardiac region; frequent micturition ; profuse and colourless urine ; at close of micturition a slight milky discharge (probably prostatic), attended with a smarting or burning sensation at orifice of urethra ; afterwards cutting pains below the bladder, in sphincter vesicæ or region ofprostate gland ; great fulness in epigastrium and partial loss of appetite; cold water and cold food aggravate the distress in the epigastrium and 1. chest ; 1. side generally affected; constipation only when drinking coffee. ( H. V. MILLER, N. A. J. of H., N. S. , iv, 87.) 13. When I drink 2 cups more than usual I feel weakened, ebullition in the hypochondria, trembling in limbs, vertigo, and a kind of intolerable fearfulness. (ZIMMERMANN, Von der Erfahrung, p. 577 , quoted by Wibmer.) 14. After drinking several cups of strong coffee in afternoon I had restlessness, heat, tendency to tremble, palpitation of heart and sleeplessness lasting till midnight. (HOFFMANN, Med. rat. sys., iv, pt. i, p. 209, quoted by Wibmer.) II. Poisonings.-1 . A man æt. 66, who never took wine but consumed coffee in large quantities, latterly to the extent of 30 cups per diem, had, after some gouty symptoms with great prostration and weakness, a fully-developed attack of delirium tremens, which was cured by laudanum 5 dr. every 2 h. (HÖRING, Med. Correspondenzbl. d. würtemb. ärztl. Ver. , i, 204, quoted in Frank's Mag., ii, 68.) 2. An unmarried woman, æt. 27, whose menses had not appeared for 2 months, boiled 1 oz. of green coffee beans in I pints of water for 3 h. This she drank on going to bed at n. She repeated this for 3 succesive n. After the 3rd dose she was forced to call in the doctor at midnight. He found the following state :-She has an expression of the greatest anxiety, walks up and down room without resting, though her arms and legs tremble and feel as though theywould break at every step ; still she walks easily though unsteadily. She has a waxy pale complexion. She sometimes feels flushes of heat, at others like a cool air blowing on back ; this is followed by hot rushes of blood to head,

though cheeks are not much reddened. She feels terribly tired and prostrated. She did not sleep on either of the 2 previous n. after taking the decoction, nor can she sleep to-day though feeling great need for sleep, on account ofall sorts of thoughts chasing one another through her brain. Bits of poetry and verses from the Prayer-book occur to her. In her head she feels as if its contents went slowly round, first in one direction and then in another, and along with this there is a continual ringing in ears. A lump of lead appears to her to be nailed on to the parietal bones. Every movement of the head aggravates its symptoms. There is a mistiness before the eyes. She cannot bear candle light, its flame seems surrounded by a broad dim halo, and it causes her a painful pressure between eyebrows. The conjunctiva palpebrarum is slightly reddened, especially at edges of lids, the conj . bulbi slightly injected in canthi and around cornea. Cornea dull, iris contracted but movable, blue rings round eyes. Ringing in ears. She is painfully affected by every step and every word spoken by others. She feels best when there is absolute quiet. The face is much swollen, of a waxy-yellowish hue, like that of a dropsical person. Lips and tongue pale as in anemia, at same time dry. Taste in mouth and throat like that ofsome soporific powder she once took (opium ?), disgusting, making her feel faint. Loathing of every sort of food ; the only thing she likes is water in small quantities. Nausea and inclination to vomit. Distension which compels her to open her dress. The gastric region is much distended and projecting, filled with flatulence, extremely tender to touch, less so to pressure. Painfulness of hypochondria, belly feels alternately warm and cold, rumbling that causes heat and compels her to bend forward and lay her hand on it. The abdomen is tympanitic, the hepatic region very tender. After the Ist dose she had a copious motion, nothing since then. Frequent urging to urinate with discharge of scanty pale urine, accompanied by disagreeable tickling. Spasmodic feeling deep in uterine region which she cannot further describe. She feels as if something would force its way outwards but cannot on account of its always causing spasm. Palpitation of heart, a trembling vibration is perceptible to others. Fresh air relieved her a little. The doctor treated her with cold water outside and inside, and gave her a gr. of opium in 6 doses, and she soon recovered. ( KAPPER, Zeitsch. f. hom. Kl., iv, 194.) 3. A female servant, æt. 27, drank on Sunday in 1 h. 32 cups of coffee made out of 4 oz. of coffee beans. When she had drunk the greater part she felt ill, went out, vomited a little with difficulty, then she swallowed a glass of brandy with carraway seeds, and then drank the remaining cups. She now felt intolerable heat, the blood rushed to her head, and she broke out in general perspiration. She threw off her upper garments and stood for some time in a draught ofair. She became very giddy and was put to bed. At 10 p.m. she had intense fever, great heat, violent headache, spasmodic contraction in throat, rattling respiration, and could not speak. She was somewhat relieved by a few spoonfuls of vinegar and cold water, but passed a restless and sleepless n. Next m. great vertigo, shooting pains in abdomen, great urging to urinate with inability to pass a drop. Blood-letting and calomel. The

headache and pain in belly lessened, the urinary difficulty remained the same, the hypogastrium was swollen, tense, and painful. On the 3rd d. she went to a midwife and had the urine drawn off. Seen by the doctor on the 5th d. Abdomen swollen and hard, especially in vesical region, where it was very sensitive. A pain, which was quite independent of external pressure, in the l. upper part of abdomen, close below the spleen ; no appetite, stomach painful to pressure, food caused nausea . She was weak and disinclined for work, but there was no fever. There was great ischuria, she could hardly pass any urine, only a few drops after repeated attempts, accompanied by burning and pressure in bladder, urethra, and genitals. Well in a week. (TROSCHEL, Med. Zeit. v. Verein f. Heilk. in Preussen, 1843, No. 21 , p. 92, from Frank's Mag., i, 41.) 4. A woman, æt. 27, whose catamenia, expected in the beginning of the month, had not appeared, imagined she must be pregnant, and with the view of producing miscarriage took on Aug. 10th at one draught a decoction of 250 grms. of fresh-burnt coffee in 500 grms. water, which had been boiled for about 10 m. As within a h. she got very ill the doctor was called in. He found her seated on the sofa, shewould not lie down ; face pale, with expression of extreme anxiety. She wept and moaned that she must die, all hope was gone, she could not breathe, her chest felt tightly constricted. She clutched hold of the furniture and the bystanders convulsively, changed her place constantly, tried to rise up, but fell back helplessly. A peculiar trembling in limbs, especially hands, that sometimes amounted to twitchings, as in chorea, so that she could not hold a spoon or a glass. She knew the doctor and also the cause of her sufferings, but was not quite right in her intellect. The following d. she had but an imperfect recollection of what happened the previous d. She could not give intelligent answers. Pupils moderatelydilated, sensible to light. Forehead felt cold. Respiration laboured, short and quick, 24 to 30 per m. Complained of violent palpitation of heart. The heart's impulse shook the thoracic wall over a large space, the sounds were loud and sharp ; pulse 112, hard, tense. After I h. violent diarrhoea set in, which lasted till n. Almost every h. there was a thin watery stool with extreme tenesmus. Frequent urging to urinate, about every h. Quantity of urine only slightly increased, sp. gr. 1014, colour bright yellow. Morphia was given, and late in e. she got some rest and a short sleep, but the rest of the n. she was very restless, generally awake, but she had short spells of half-sleep which were disturbed by vivid dreams or visions. Next d. she was very exhausted and unsteady on her limbs ; she had besides vertigo, frontal headache, and inclination to vomit. The diarrhea and urging to urinate were gone. The pulse had its usual character, only it intermitted every 6-10 beats. Next d. quite well. The menses came on without suffering only a few d. later than expected. 5. The (CURSCHMANN, Deutsche daily use of coffee Klinik, 1873, for breakfast 377.) within a few produced weeks in a man of forty-five, somewhat predisposed to piles and of late unused to coffee, a discharge of exceedingly bright blood every m., with the regular stool. It also increased very perceptibly his myopia, and

caused the same affection in his daughter of thirteen years. All symptoms disappeared in a few days, after leaving off this stimulant. (F. G. OEHME, N. A. J. of H., N.S. , iii , 418. ) 6. Dr. Wood states that he was for years troubled with frequently recurring nervous headache, which at times incapacitated him for the performance of any active duty. " Scarcely a day passed without some uneasiness or deranged sensations in the head, such as roaring, buzzing and singing in the ears, sounds as of pounding, or bell-ringing in the distance, swimming or vertiginous feeling, muscæ volitantes, &c.; and I never walked in the street without the fear of a sudden attack ot these symptoms, which, when they came, took away all mental energy. in the It occurred to me that a single cup of coffee which I took daily m., and to which I had reduced myself from the necessity of escaping dyspeptic sufferings, which a free use of it had occasioned, might be the cause of these distressing phenomena ; I abandoned the habitual use of it, substituting black tea for coffee ; and from two weeks after that time up to the present, a period of many years, I have been almost entirely free from the symptoms referred to." (Pharm.and Therap., sub voce.) 7. Dr. LEGRAND de Saulle, in a series of articles on " agoraphobia," assigns the immoderate use of coffee as one of the causes of this neuropathic condition. We have had to attend a literary man affected with the symptoms of this malady, as described by the abovenamed author ; the general health was otherwise perfect, and there was no other psychical disturbance. We attributed the trouble to excessive use of café noir, and also of venery, and a similar effect having been observed from too great devotion to tobacco-we prescribed tabacum 6, with complete success. (L'Hom. Milit., 1879, p. 34.) 8. a. When a person unaccustomed to the use of coffee drinks a moderate quantity, or one accustomed to its use an immoderate one, for the first hours the consciousness of existence becomes more lively. He gets a circumscribed redness of the cheeks ; the forehead and palms become warm and moist ; there is a general agreeable yet uneasy sense of warmth ; there occurs a kind of voluptuous palpitation, somewhat resembling that occurring from great joy; the veins of the hands swell. Externally also he is warmer to the feel than natural, but this warmth never comes to the length of heat, even after a large quantity (it sooner turns into general perspiration) ; none ever become burning hot. Presence of mind, attention, sympathy, become more active than in the healthy natural state. All external objects appear to excite a feeling of pleasure ; they take on, if I may be allowed the expression, a joyous varnish ; and if the quantity of coffee taken was very great, they assume an almost over-pleasing lustre. b. If the quantity taken be immoderately great, and the frame very excitable and quite unused to coffee, there occurs a semilateral headache, from the upper part of the parietal bone to the base of the brain. The cerebral membranes also of this side seem to be painfully sensitive. The hands and feet become cold ; on brow and palms cold sweat appears. The disposition becomes irritable and intolerant ; no one can do anything to please. The patient is anxious and trembling, restless, weeps almost without cause, or smiles almost involuntarily. After a

few h., sleep comes on, out of which he occasionally starts up in affright. I have seen this rare state two or three times. c. In an individual of very irritable temperament, or who has already been enervated by the copious use of coffee and a sedentary life, the effects I have mentioned appear in a still more prominent form. An excessive sensitiveness, or a gaiety greatly disproportioned to the object of it ; tenderness almost partaking of a convulsive character ; an inordinate sorrowfulness ; a wit that is not altogether under the restraints of reason ; an excessive distortion of the features approaching to caricature,-under circumstances where a mere smile, a little joke, a slight perplexity, a moderate expression of grief or sympathy, would have sufficed. Even the muscles of the rest of the body exhibit an unnatural excessive activity ; and the ideas and the pictures of the fancy flow in rapid succession and in a continuous stream before the seat of imagination and sensation in the brain-an artificially accelerated, artificially exalted life. d. When the first transient effect of coffee has after a few h. departed there follows gradually the opposite state-the secondary action. There gradually creeps on a yawning drowsiness and greater inactivity than in the ordinary state; the movements of the body become more difficult than formerly ; all the excessive gaiety of the previous hours changes into obtuseness of the senses. If, during the first hours after drinking the coffee, digestion and defæcation were hastened, now the flatus becomes painfully incarcerated in the intestines, and the expulsion of the fæces slower and more difficult than before. If in the first hours an agreeable warmth pervaded the frame, this factitious vital spark now gradually becomes extinguished, a shivering sensation is felt, the hands and feet become cold. All external agents appear less agreeable than before. More ill-humoured than ordinarily, they are more given to peevishness. The sexual passion, which was excited by the coffee in the first hours, becomes all the colder and more obtuse. A kind of speedily satiated bulimia takes the place of the healthy appetite, and yet eating and drinking oppress the stomach more than previously. They have greater difficulty in getting to sleep than formerly, the sleep is heavier than it used to be, and on awaking they are more sleepy, more discouraged, more melancholy than usual. All these evils are rapidly driven away by a renewed application to this hurtful palliative ; a new artificial life commences, only it has a somewhat shorter duration than the first time, and then the repetition of the beverage becomes ever the more frequently necessary, or it must always be made stronger in order to enable it again to excite life for a few hours. e. It would be no easy task for me to indicate all the maladies that under the names of debility, nervous affections, and chronic diseases prevail among coffee-drinkers, enervating humanity and causing degeneration of mind and body.* The palliative agreeable sensation which it diffuses for some hours through the finest fibres leaves behind it, as a secondary action, an extraordinary susceptibility to painful sensations, which always becomes greater and greater the longer, the oftener, the * We have not, save for what follows, cited those which Hahnemann does indicate, as the connexion between them and coffee-drinking is dubious.-EDs,

stronger, and the larger quantity in which the coffee is drunk. Very slight things (that would make scarcely any impression on a healthy person unaccustomed to the beverage) cause in the coffee-drinking lady megrim ; a frequent, often intolerable toothache, which comes on chiefly at n. with redness of face and at length swelling of the cheek ; also a painful drawing and tearing in different parts of the body, especially the limbs-not in the joints, but between them, and more in the flesh or cellular tissue than in the bones, unattended by swelling or other abnormal appearance, and with scarcely any tenderness to touch. Apprehensiveness and flying heat are her daily complaints, and nervous semilateral headache her property. This last occurs in the morning, immediately or soon after waking, and increases gradually. The pain is almost intolerable, often of a burning character ; the scalp is also intolerably sensitive, and painful on the least touch. Body and mind seem both to be insufferably sensitive. Apparently destitute of all strength, the sufferers seek a solitary and if possible dark spot, where, in order to avoid the daylight, they pass the time with closed eyes in a kind of waking slumber, usually on a couch raised at the back or in an armchair, quite motionless. Every movement, every noise, increases their pains. They avoid speaking themselves and listening to the conversation of others. Their body is colder than usual, though without rigor ; the hands and feet in particular are very cold. Everything is distasteful to them, but chiefly eating and drinking, for an incessant nausea hinders them from taking anything. In bad cases the nausea amounts to vomiting of mucus, but the headache is seldom alleviated thereby. The bowels are constipated. This headache almost never goes off until evening ; in very bad cases I have seen it last 36 h., so that it only disappeared the following evening. It recurs at undetermined times, every two, three, four weeks, &c. It comes on without any exciting cause, quite unexpectedly ; even the n. previous the patient seldom feels any premonitory signs of the headache that is to come on the next m. I have never met with it excepting among regular coffee-drinkers . (HAHNEMANN, Lesser Writings, p. 453, et seq.)

Volume IV — Appendix

COFFEA.

(See vol. ii, p. joi.)

Il.^-g. A strong and vigorous man, in the absence of his wife, prepared for himself some coffee. Ignorant of the quantity to use, he made the infusion very strong, using about 3''ss of the ground berries. After 2\ h. vertigo came on ; this was followed by severe headache and tremors, limited at first to the head, and then becoming generalised. To these symptoms was subsequently added flushing of face, great palpitation, nausea and vomiting. A doctor saw patient about 6 h, after ingestion, at which time the most prominent symptom was general and intense tremor, especially noticeable in hands and face, and rendering speech very difficult to comprehend. Face wm deeply flushed, and forehead bathed in perspiration. There was much precordial pain, but heart-sounds were normal. Pulse lOO, very full and bounding. Patient frequently micturated. After potass, brow, sleep was induced, and symptoms gradually declined, man being convalescent in 3 d. {Medical Presi and Circular^ June 1 2th, 1889.)