Physostigma venenosum

Volume III — Main text

PHYSOSTIGMA.

P/iysostigma 'venenosumi fialfour. Calabar bean. Nat. Ord., Legummosa.

I. Provings. — i. Dr. Christison ate J of a bean one afternoon. It produced only a slight pleasant feeling of numbness in limbs, like that which precedes the sleep of opium or morphia, and which he remarked when awake for a m. twice or thrice during n, " On getting up in m., I carefully chewed and swallowed twice as much, viz. ^ of a seed (which originally weighed 48 gr.). A slight giddiness, which occurred in 15 m., was ascribed to imagination, and I proceeded to take a warm shower-bath, — which process, with the subsequent scrubbing, might take up 5 or 6 m. more. The giddiness was then very decided, and was attended with the peculiar indescribable torpidity over the whole frame which attends the action of opium and Indian hemp in medicinal doses. Being now quite satisfied that I had got hold of a very energetic poison, I took immediate means of getting quit of it, by swallowing the shaving-water I had just been using, by which the stomach was effectually emptied. Nevertheless, I presently became so giddy, weak, and faint, that I was glad to lie down supine in bed. The faintness continuing great, but without any uneasy feeling, I sent for medical aid. Dr. Simpson reached me within 40 m. of my taking the doscj and found me very prostrate and pale, heart and pulse extremely feeble and tumultuously irregular, — my condition altogether very like that induced by profuse flooding after delivery : my mental faculties, however, were quite entire, and my only sensation one of extreme but not unpleasant faintness. Dr. Simpson went to fetch Dr. Maclagan, returning with him in a few m. During his absence, feeling sick, I tried to raise myself on my elbow to vomit, but ^iled. I made a second and more vigorous effort, but scarcely moved. At once it struck me, * This is not debility, but volition is inoperative.' In a third effort I was more nearly successful ; and in the fourth, by resolute

exercise of the will, I did succeed. But I could not vomit ; the abdominal muscles acted too feebly, nor were they much aided by voluntary effort to make them act. I then gave up the attempt ; and at the same time the sickness ceased, and it never returned. There were now slight twitches across the pectoral muscles ; and I also felt a sluggishness of articulation. Dr. Maclagan, on his arrival, thought my state very like the effects of an overdose of aconite ; pulse and heart's action very feeble, prostration great, but mental faculties unimpaired. I had then no uneasy feeling of any kind ; but presently my limbs became chill, with a vague feeling of discomfort. Warmth to the feet soon relieved this, and a sinapism over the whole abdomen was peculiarly grateful when it began to act. Soon afterwards pulse improved in volume, but not in regularity. 1 was now able to turn in bed, and happening to get upon the 1. side, my attention was, for the first time, directed to the extremely tumultuous action of the heart, which compelled me to turn again on the back to escape the strange sensation. Two h. after taking the drug I became drowsy, and slept for 2 h. more ; but the mind was so active all the while, that I was not conscious of having been asleep. On waking, the tumultuous action of the heart continued. In an h. more, however, I took a cup of strong coffee ; after which I speedily felt an undefinable change within me, and on examining the condition of the heart, I found it had become perfectly regular. For the rest of the forenoon I felt too weak to care to leave my bed ; and on getting up, after a tolerable dinner, I was so giddy as to be glad to betake myself to the sofa for the e. Next m., after a sound sleep, I was quite well," {Pharm. Journ.^ xiv, 474. 1855.)

1. a, I ate 6 gr. of finely powdered kernel 2 h. after taking food. Pulse during previous 15 m. was found to average 68. In 6 m. it rose to 74, but thence fell gradually, till in 60 m. it was 62 only, and rather feeble. At 19 m. there was peculiar feeling ia epigastrium, which recurred at 40 m. At 50 m. slight giddiness was felt^ and epigastric sensation was much increased : it now resembled the somewhat painful sensation which is produced when large pieces of food are suddenly swallowed \ it recurred at intervals, at nrst slightly indicated by sensation in thorax, near upper sternum, which extends downwards, becoming more and more intense till it reaches epigastrium, when it is almost painful ; then eructations of gas occur, and this is followed by a reversal of the direction of the pain till it ends above. 60 m., dimness of vision and giddiness, which at 65 m. had increased, with a little perspiration. 70 m,, pulse 60, very small and wiry, but regular ; nausea. 75 m., copious perspiration all over body ; unable to continue reading, especially because of dizziness ; slight difficulty in walking. 80 m., pulse 60, thready, and difficult to count. 90 m., pulse 58 \ slight dyspnoea. 95 m., pulse 59, very feeble, with occasional intermissions. 100 m., pulse 56 i eructations without the epigastric sensation, considerable nausea, and dizziness, no m., great difficulty in walking ; breathing requires an effort. Pulse continued same till 130 m., when it was 60 and rather fuller. At 140 m. felt sick and went to bed } was conscious of having remained awake for some time, in a

dreamy state. Next m., felt uncomfortable^ had bad appetite, and experienced some dizziness during d.

b. Took 8 gr. with similar results. At 20 m. a dumb-bell, previously used with ease, was found a great burden ; the arm was with difficulty extended with it, and a steady erect position retained. At 80 m. pulse was as low as 54.

f. Took. 10 gr. Epigastric sensation came on violently at 3 m., and muscular weakness was experienced at 10 m. There was no change in pulse till 20 m.,when it began to diminish in frequency and strength. General lassitude and dizziness, had to stop reading ; pulse soon afterwards could not be counted. In walking downstairs, great dizziness and dimness of vision ; progression and gait very unsteady; encountered wall and handrail more than once on the way out.

d. Pulse averaging 70, took 10 m. of tinct. in water. In 5 m. pulse 76, and epigastric sensation. In i h. pulse 63, thready and feeble J in i^h. 54. It continued 52 — 60 for i h. longer. (Fras£R, Edinb. Med. Journ.^ 1863.)

1. a. Dr. H. L. Chase, in good health, took, Jan. 5th, 1865, at II a.m., 1 gr. of ist trit. In 15 m. sensation of contraction of lids, with difficulty in opening them, and a gush of tears when they were opened wide. In \ h. dizziness and sense of wavering in brainj while walking. Dryness and smarting of tip of tongue and lips all d. 6th, — At 9 a.m. I gr. Tongue as yesterday. At 10 a.m. sense of contraction of whole 1. face, with slight numbness ; effort required to keep L eyelid open. This lasted till n., with occasional severe pain in r. upper jaw, like toothache, although all teeth on that side had been extracted.

b. Proving was suspended till June i2th, when, at 4 p.m., he took 3 gr. of same. Within 15 m., same numbness, tingling, and smarting of lips and tongue occurred, with constant desire to moisten them. Inhere was pain in side of jaw where there were teeth. Wavering in brain not so marked as before. 14th, ii a.m., 2 gr. Same symptoms of tongue; there was also sense of contraction in alse nasi and upper lip, with frequent desire to rub them, lasting about 20 m. Then came deep-seated pain in forehead, with desire to rub it ; dizziness in walking, effort of will being required to keep from staggering ; sharp darting pain in r. elbow, extending down outer arm to 2 middle fingers ; numb pain in knees and ankles while sitting, with desire to move frequently. 15th. — Took 3 gr. at 6 a.m. Tongue, after 20 m., as if scalded ; severe pressing pain in forehead, as though something hard was bound tightly on it, accompanied by dizziness while walking, — this lasted all forenoon, gradually subsiding ; occasionally severe sharp darting pain in r. malar bone and in ramus of r. jaw. Limbs felt weary, as after great fatigue, with constant desire to move ; difficulty in concentrating thought; itching of 1. palm. i6th. — No medicine, still some scalding sensation on 1. side of tongue; occasional sharp pains in various parts. 17th. — 3gr. Nothing save tongue symptoms. 18th. — 4 gr. at 10 a.m. and 3 p.m. At 4 severe cramp-like pain in 1, popliteal space, making walking very painful, lasting 2 h., then gradually passing off; during rest pain ceased, commenced again on motion,

by continued motion relieved. Scalding of tongue continued 2 d. longer, though surface looked well. Took several doses later, without additional symptoms. (Publ, of Mass* Horn. Med. Soc.j ii,

4570

1. Dr. CuLLis, June 29th, 1865, at 10 p.m., took 2 gr. of ist trit. In 5 m. felt as if he had drunk a glass of liquor ^ head was confused, there was vertigo, and legs lost their strength. He staggered like a drunken man, and went to bed with head swimming; fell asleep, but awoke repeatedly during n. with terrible thoughts j he feared he was becoming crazy, and that he might get up and do some mischief; dreamed he was a lion. At 4 he rose with soreness in I. abdomen, which was painful on pressure. At 8 head felt clear, but soreness in bowels continued, becoming pain on moving about, and aggravated by riding ; it covered a spot as large as the palm, and continued 5 d. A small boil then appeared inside r. nostril, very painful ; pain expending up to eye and r. side of head ; it broke on 4th d., with but little discharge. (/W.)

2. Same gave to a lady, set. 30, nervous temp., health good, r gr, of ist trie, at 10.20 a.m. In \ h. felt strange, indescribable sensation throughout system. After dinner there came on heavy pain in back under I. shoulder, which, after continuing severe for an h., slowly passed away. At n. strange dizziness, had to hold on to bedstead to keep from falling. Next d. whole frame seemed loosened and powerless ; thoughts wandered, and she had difficulty in fixing attention. The strange indescribable feeling continued several d. (Ibid.)

3. a. Dr. C. VVkssf.lhoeft, in good health, save for disposition to headache after irregularities in diet, &c., June gth, 1865, took I gr. of 3rd trit. at 8.30 a.m. 9, feeling of constriction around forehead and temples, changing into oppressive pain over 1. orbit, which extended to the other parts, very troublesome in reading. Sharp twinges in r. instep, and various twinging pains about body, for \ h. Slept well all n. Next d. an attack of usual headache, but accompanied with extreme desire to sleep, which was unprecedented. Repeated dose on iith at 7 a.m. Drowsiness all forenoon, even while driving, increased p.m., so that he slept soundly for 2 h., though in uncomfortable position. Sleepiness continued for \ h. after this, while walking, lO p.m., took another gr., and slept well all n. (ordinarily a short nap in afternoon will spoil night's rest). Woke at 6 a.m., and felt bright for 2 h., when he became sleepy again while driving, with dull pressure encircling head, and dull weight along vertex, mostly 1. After a tight dinner, drowsiness became irresistible, and he slept some time. 12th, 3 p.m., another gr. Went to bed eaHy and slept well ; drowsy all next d., until 2 h. work in garden had caused profuse perspiration ; this dispelled drowsiness in part, but he felt it slightly the d. after. 19th. — Took 1 gr, at 10 a.m. and 10 p.m., and same next m., with no perceptible effect.

h, 2Sth. — Took 1 gr. of ist trit. at 10 a.m., and repeated dose n. and m. till 28th, After taking first dose, feeling of constriction around entire top of head, as if a tight cap were being pressed down as far as temples ; at same time severe pressure along sagittal suture, as if froov

^^

6io

fulness in longitudinal sinus, and dull aching in each temple. Similar effects occurred each n. and m. about 15 m. after dose. For two mornings he was sleepy while riding ; did not feel usual flow of spirits, and conversed with effort. After dinner great drowsiness, which was very diflicult to shake off i desire for sleep was uncontrollable, and he fell off to sleep so quickly that he was surprised, on waking, to find he had slept. Hard exercise would remove this drowsiness. He slept as well at n. as if he had not done so in afternoon. After last dose he felt pressing from within outwards in vertex and temples, which lasted 5 h.

1. Same gave 6 similar doses to 3 ladies.

ff. Mrs. P — , »t. 49, calamcnia for 2 years irregular and profuse, reports: — "June 16th, 1865, took I gr. at bedtime. At 3 a,m. 10 — 12 sharp darts of pain through r, thumb, at root of nail, and several weaker ones through r. finger-joints. For rest of n. dragging pain on 1. hip towards back. I slept, but was conscious of pain ; in m. awoke free from it. Took the medicine at 11 a.m.; 2, dull, heavy pain over 1. hip, extending to back, which continued through afternoon and c., with bearing down, as if courses would set in. Took 3rd dose at bedtime, pain diminished gradually in n., and I slept soundly. After 5ih powder I felt irresistible drowsiness for a week, especially up to 2 p.m." Menses did not come on till 30th.

h. Miss H. C — , xt. 42, in good health, but had menses twice only last year, and is a very heavy sleeper. She reports : — " From ist powder I perceived nothing unusual, save slight momentary pains in various parts a few m, after. Later, a short attack of vomiting and diarrhoea. From and, nothing. From 3rd, slight twinging pains in lower limbs. From 4th same, especially sharp in ankle. A former pain in r. hypogastrium, which had now been absent for 1 years, returned more troublesome than it usually had been. No further symptoms."

f. Mrs. N — , xt. 40, health perfect. "Six h. after ist powder felt drawing rheumatic pains through I. shoulder. After 3rd, very unusual feeling, — drawing pain low in back and abdomen, with bearing down, as if menses were coming, though it was a week before time. After 4 h. all passed off, and menses came at right time.*' During whole time of proving felt heavy and dull in head. [Ibid.)

1. fl. Dr. H. B. Clarke, set. 38, health good, proved ist trit, June 20th, at 8.30 p.m., took i gr. ; next m. sense of distension of abdomen, with soreness. 21st. — At 7 a.m., fasting, 1 gr. After 15 m., feeling of weakness passed down from occiput through back to lower extremities; feeling in legs was like that known as being "asleep." During fore part of d. (which was sultry) he had at times a feeling of weakness, though there was uncommon mental activity. 22nd. — Took 3 gr. at 7.30 a.m. lx\ 15 m. feeling in legs like that of yesterday, but sensation was less perceptible in back. (In c. colicky pains with copious loose discharge from bowels. As this did not recur. Dr. C — is doubtful whether to ascribe it to drug).

b. Five gr. on July 3rd, and 10 gr. on nth, were without effect. On 13th took 3 gr. at 8 a.m., fasting (last 2 doses had been taken

6x1

later). Immediately, sensation as on June 2ist, and slight exertion caused lameness and weakness in small of back. (Ibid.)

1. Dr. William P. Wesselhoeft gave to a lady, set. 35, "of a very sensitive temperament," one dose of the 3rd trit. Symptoms came on immediately and continued for 17 d., when they seemed still in full force, though the narrative then stops abruptly. They are all subjective, and can best be presented in the prover's own résumé '.-^ " The chief action of this medicine seems to me to be on the nerves ; all the other symptoms have been entirely accessory and secondary. And it seems to me, so far as I can judge, to have a very curious double action on the nervous system. The nerves in front of the body it appears to excite to an involuntary motion, causing tremblings going up and down in wave-like motion. But the nerves at the back of the body it seems to paralyse and numb, and during this numbing process it causes a good deal of pain, very similar to the pain in a tooth when its nerve is dying or being killed." [Tram, of Amer. Inst, of Horn. ^ 1 87+.)

2. Dr. W. E. Payne, at. 58, health good, took, Feb. 12th, 1874, 10 gr. of 30th trit, at 7 a.m. 12, general sense of great fatigue, as from long-continued labour, with fulness in forehead and tendency to ache, especially on r. side ; face hot, flushed and suffused, with feeling as if change into a lower temperature would produce a chill j appetite not so good as usual, with occasional nausea. Above symptoms continued during afternoon. 8 p.m., shooting pains in I. iliac region ; a few thrusts with aching sensation down thigh of same side ; dull heavy ache still in forehead, more on r. 9, feeling as if undigested food were lying in stomach ; smarting and tingling in nose, as if cold were coming on, with several sneezings j aching in wrist- and hand-joints, also in Icnees. Had comfortable n. and felt well next m. 13th, 7.45 a.m., took 20 gr. of same, and breakfasted an h. later. 9, breathless sensation at pit of stomach, with hard feeling as of undigested food, disposition to make deep inspirations, coming and going momentarily ; deepseated pain in head all d., aggravated by making a heavy or missed step, as if the brain were bruised ; fierce pains in r. lower jaw. Good n, 14th. — Took 20 gr, at 8 a.m. An h. later breathless feeling returned, with same sensation at pit of stomach \ undefinable pain in r. head, continuing same throughout d. Above symptoms passed away, and no more medicine was taken till xyth, when at 7.30 a.m. he took 20 gr. more. 11-3O1 dull, heavy, bruise-like pain in whole brain, but rather more severe in 1. temple, with sensation of general fatigue, continuing throughout d. till e,, together with general sensitiveness to cold or change of temperature. 6 p.m., a constrictive pain suddenly seized 1. arm, extending around just above elbow. An h. later, similar pain round 1. leg just above ankle. Both were transient. 7.30, shooting pain under I. knee in or near popliteal space, returning again and again, as did pain above 1. ankle. On following d. symptoms had greatly abated, though still of same character. (Ihid,)

1 1 . Same gave to a married lady, a;t. 35, I o gr. of 30th trit. She had sharp pains, nrst in 1. head and upper extremity, then in r. Their

seventy frightened her, and she declined to continue the proving. On following d. she fe)t a hard pain in stomach. (Ibid,)

1. a. Gale Allen, medical student, in good health, took ao gr. of triturated bean, March I ith, 1876, at 7.30 a.m. 7.45, sensation as of rush of blood to frontal and temporal regions. 8.30, slight nausea; weight in stomach, as from undigested food ; giddiness ; sensation as if brain were loose and rolling about in skull. 9, pulse variable, full and strong; heavy pain in frontal region, worse from motion. 10.30, burning sensation in stomach, with hot eructations ; slight nausea continues. 11.30, darting pains in epigastric region. 12, griping pain in pit of stomach, i p.m., last-named and nausea still continue, with giddiness. 2, darting pains in head -y stomach still disturbed, and nausea. 3*30, griping in epigastrium continues, also darting pains in temples, worse from motion. 4.45, headache still ; giddiness ; nausea; cold feeling all the time. 6, still griping, with soreness to pressure \ dull pain and disagreeable confused feeling in head, worse from motion. I2ih. — Has felt epigastric pain all the time, except when asleep ; sore and stiff all over, as if he had taken a severe cold ; seemingly rheumatic pains in 1. neck and shoulder (which he took aconite to relieve). b. 19th. — Ten gr. of 3rd trit, at 6.30 a.m. 6.45, slight nausea; transient darting pains in frontal and temporal regions. 7, griping in r. hypochondrium ; fronto-temporal pain, worse from motion ; deep sighing. 7.30, head-pains still, with heavy feeling ; pulse variable \ giddiness *, nausea ; resp. still sighing. 9, griping pains in stomach, and great oppression; nausea and giddiness worse from motion, better in open air ; darting pains in r, hypochondrium ; constriction of head, as if a tight bandage were round it. 1 1, soreness and transient pains in epigastrium \ soreness and pains as from rheumatism in 1. side of neck; pulse variable ; giddiness ; stomach unsettled; sighing; feeling of soreness in lumbar region. 2 p.m., transient pains in stomach, with sense as of undigested food there ; acute pain in 1. elbow, and darts of pain from thence to 4th and 5th finger of same side (these pains seemed to begin in 1. neck and extend to 1. leg j they were constant for hours) ; epigastric region sore to pressure j giddijicss with constricted feeling of head. 3, still pains in head, stomach, and arm. 8, giddiness has been constant, g, some trouble in stomach continues j soreness in lumbar region, with dull, heavy pins; a kind of paralysed feeling in 1. side throughout. 20th. — Quiet n., but on waking 2 or 3 times felt darting pains in stomach and paralysed feeling in 1. side. Urine now pale and copious ; stool lumpy, mixed with watery discharge ; still soreness and pains in stomach. 10 p.m., during d. giddiness and nausea ; dull pain in head ; heavy pains and soreness in lumbar region ; urine as in m. {Ibid.)

2. Dr. R. C. Smedlev took 5 gr. of 30th irit. once on Oct. agih, J873, and 3 times on 31st. No symptoms on these d., but on Nov. 1st bowels» which had been somewhat costive, moved twice, and appetite was diminished. Took same dose at 6 and 10 a.m. and 4 p.m. In forenoon sense of fulness and dull pain in transverse and descending colon ; two soft stools after dinner, with same pain, and tenesmus, also again in e. 2nd.— Five gr. at 6 and 11.30 a.m. and 4.30 p.m.

I »

Tot much appetite ; two soft stools after breakfast, with same pain ; drowsy in forenoon^ head heavy and dull. Same evacuations and pains after dinner ; brain felt tired. Lay down and slept (which he is not wont to do) ; dreamt that head was full, brain revolving upwards from front to back, and that he was almost blind ; after waking, brain felt confused, numb or tired feeling in limbs, pulse accelerated. Same stool and pain, with tenesmus (extending to bladder, as it did on previous e.), and at 10 p.m. slight epistaxis. 3rd. — Headache in m., with epistaxis, and same kind of stool after breakfast, with tenesmus of rectum and bladder during and after it. At 6 a.m., 3 and 8 p.m., 10 gr, each time. No symptoms except epistaxis while at supper; looseness ceased. On 4th took two doses of 10 gr., and on 5th and 6th two of 20 gr. each, without effect. Same absence of result followed repeated doses of 10 gr. of 3rd from 8th to 15th, save that he was constipated during days on which he took none, and freely but not loosely moved when he recommenced it. [Ibid.)

1. Dr. Houghton took dose of 3rd trit. at 8 p.m. In i\ h. uncomfortable sensation in r. ear^ felt inclined to bore in with finger ; then eructation, twice, each time causing sudden pain running from throat along Eustachian tube to middle ear, leaving in latter a transient stabbing. The desire to bore occurred repeatedly on several successive evenings. Next d. felt pains in r, arm, as from hitting ihc ncrvcj tingling, extending from elbow down ulnar surface and into 3rd finger ; repeatedly for 3 d. {Ibid,)

2. Miss S — took same. Headache across top of forehead, increasing till she went to sleep at n. ; pain in r. wrist (deep '\i\ bone) as if squeezed and gradually let go, also deep under r. shoulder-blade, transient, while sitting, and in r. great toe. [Ibid.)

3. Dr. Hering gave a man, March 13th (1865), i gr. of 3rd trit. at 530 p.m. Nothing followmg, he took 2 gr. at 820; in 5 m. dull pain in 1. occiput, lasting 10 m. On 25th took several dr. of tinct. In \ h. heaviness in stomach ; later, a stimulus, as he called it, in neck and occiput, going through whole head till it reached eyes, lasting an afternoon and e. Next d., sleepy, headachy, acted foolishly and said he felt crazy, and also as if he had taken a cold.* Next d. sick at stomach \ prostrated } felt severely indisposed ; had to lie down, and wanted doors to be shut j pains in eyeballs. (Ibid,)

ly. Dr. Berridge induced a gentleman to prove Ph. He took 5 gr, of powdered bean on retiring ; slept well ; woke with considerable stiff pain in hepatic region posteriorly, tender on pressure and on first moving j it went off after moving about a little. Disinclined for breakfast, slight nausea ^ looked tired. 10*30 a.m., took 6 gr. Noon, great languor; very distinct nausea in throat, and feeling as if he would be sick. Tensive headache, brain and scalp felt tight -, mental work difficult ; hands feel tremulous, as if he must make an effort to keep them steady ; in walking, feeling of unsteadiness from knees down-

♦ There is also noted on ihU day—" His eyes were worn as usual, the Mght bad all the time. Rather dull ; clouds passing over the sun interrupt his walking/' It is not clear from this enigmatical statement whether the drug had anything to do with the phenomena in question. — Eos.

wards, so that he had to tread carefully, felt especially when eyes were shut, he must look to where he is going j can see farther than usual (he is naturally myopic), pupils contracted. On going out had to take i. stick tu steady himself, and had feeling of weakness in ankles. Determined exertion of will conquers the unsteadiness. In m. before 2nd dose, and lasting all d., noisy emission of Hatus. P.m., whilst walking, stiffness in both recti femoris. Enjoyed dinner at i, but could not eat much on account of the nausea; this was relieved by lying, and he could eat a little more; after again testing, all symptoms passed off. Next m., same pain in hepatic region, and also stupid feeling in head. {Ihid.)

if.* a. R. W. Stone began, at 3 p.m. of April 3rd, 1873, to cake I gr. of i^ trit. hourly. 4th. — 9 a.m., throat had become very sore, with feeling as of a fishbone lodged in it ; swallowing of saliva very painful. At 8.30 p.m.^ violent and very unusual hiccough for 45 m., with great distress for breath. It was relieved at once by sleep, but on waking at 2 a.m. it recurred for \ h.

b. On 6th, at 2 p.m., began to take 4 dr. of saturated solution every i h. 7, again painful constriction of throat, soreness felt all through back of pharynx, with painful swallowing of saliva; by 10 throat had become quite dry. 7th. — 11*30 a.m., benumbed sensation of hands, very much increased by feeling pulse, which on r. side was double the strength of that of 1. 4 p.m., pain and constriction of throat continued, and small ulcers with yellow centres were seen on r. side of pharynx behind tonsil ; posterior nares also were dark red. loth. — Throat very sore, very difficult to swallow, and examination shows pharynx studded with small ulcers, especially on r. side, where pain is greatest. Excessively nervous ; cannot endure the pain. X2th| ^Though medicine has been discontinued for 2 or 3 d., throat symptoms continue, but less violent ; examination shows uvula considerably elongated. Sharp headache on r. side, transient.

c. On 14th, at 8 a.m., began taking every i h. I gr. of 2x trit. 10 a.m., heavy, dull, and oppressive frontal headache, with peculiar inability to express thoughts clearly and intelligently. 17th, — 2 p.m., sudden and severe headache over r. eye, with pulsation felt in occiput. 3.45, severe muscular pains beneath clavicles, extending down inner sides of both arms. 1 8th. — At 2 p.m., took 5 gr,, followed in 5 m. by constriction of throat and dysphagia. During whole p.m. throat was very sore, examination showing enlarged tonsils and elongated uvula J swallowing or speaking was very painful, and posterior part of tongue was tender to touch.

d. 23rd. — No more medicine having been taken, this m. took 30 dr. of saturated solution, followed in 10 m. by severe pain in both mastoid processes. 24th. — At 8 a.m. repeated dose. 10 p.m., nausea on lying down, though none had been felt before ; throat constricted as previously, but higher up. 25th. — 7 a.m., throat very much constricted, and great difficulty in eating, passing away before breakfast

• The provings 18 — j8 were made by students, under the superintendence of, for 18— a8, Dr. T. F. Allen, forig—ja, Dr. Hoyne, for 33—36, Dr. C. Wcwclhoeft, and for 37—39 Dr. A. K. Hills.

^

^ I

was finished. Examination shows posterior superior portion of mouth much injected. At 8.30, took 30 dr. more, followed by an all-gone feeling along cesophagus, and headache, with, at 3 p.m., sense of great debility. (Ibid.)

1. G. W. Flagg took powder of 30th trit. one n., and next d. and the following had a sharp attack of colic and diarrhoea, which, however, he had had within a week previously, and which recurred more slightly, after 3 d, without symptoms, on 7th and 8th d. Nov, 22nd. — Feeling quite well, took a second powder in e. Rose on 23rd with heavy aching head j it was better after rising, but at i p.m. was heavy over 1. eye and extended to whole forehead ; by 6 it was somewhat better, but eyes were sore and pained on moving them from side to side. Had bad dreams and a restless n. On Dec. 5th, feeling well, took a dose at 1 1 a.m. Some headache in e., with which also he rose next m., and from noon till e. of 6ch had persistent dull aching pain, worse from motion or pressure, over 1, eye (pupils normal). No other symptoms save sense of looseness of bowels, (Ibid,)

2. a, Charles E. Rowell, May 6th, 1874, took at 5 p.m. a powder of ist trit. 7th. — Noise (a child crying) affects him, causing lateral headache ; mind wanders from study ; bowels constipated \ amount of urine increased all d. At 7 p.m. repeated dose. 8th.— Pupils contracted j no appetite ; no stool to-day j urine more frequent and copious, and contains mucus. Repeated dose at 7 p.m. At 9, lateral headache, which seems deep in brain. 9th. — Pupils contracted \ no stoo), but urging to it. In e. throat very sore ; tonsils and soft palate dark red, with stinging pain, 10th. — Pupils still contracted \ throat less inflamed j no appetite or thirst \ much urging and straining to stool, but ineft'ectual. 6.30 p.m., headache in both temples, relieved by supper, nth. — 7 a.m., large light yellow soft stool; repeated at

, In e. intense lateral headache, relieved by food. Urine scanty to-d.

.45, took large dose of 1st trit. 12th. — Repeated dose at 8.30 a.m. and at noon. Soon after hrst, smarting of I. tonsil, which looked slightly inflamed ; cough from tickling in throaty and twitching of upper eyelid. In c. pupils very much contracted. 13th. — Large light-yellow stool \ pupils same j copious urine with mucus \ twitching ot upper eyelid -, back part of throat very sore in e. Bowels were constipated next 2 d., and frequently moved on 2 d. following. On 15th mcreased flow of urine and lateral headache.

/>. Nov. 6th— 8th, took 4 powders of 30th, and, nth — 13th, same of 3rd trit. without effect. Same result followed 4 doses of 1st. On 15th began i^ trit., taking i powder in e. and 3 next d. Had 3 stools on i6ih, and great desire for cold water all e, 17th. — I'ook 3 doses. Two stools. 18th. — Three doses. As yesterday. 19th. — One dose at 6.30 a.m. Prover had been constipated for years, no operation without an enema j since proving began, desire for stool every n., and copious evacuation every m., sometimes oftener.

(. Feb. 7th, at 9.20 p.m., took one powder of i^. VVent to bed l) h. earlier than usual, being so sleepy that he could not keep eyes open. Slept an h. later than usual, and on rising passed unwonted quantity of water. At u a.m. very copious stool. Tongue slightly

coated, more heavily towards root. Three more stools came later in d. No desire for drinking, even at meals, to-day. Food lay heavy on stomach next d., and he continued for some time to have 2 or 3 yellowish evacuations daily. {Ibid,)

1. Same gave to a friend a very large dose of 1st trit. in e. Next m. he reported lateral headache, with fear of opening his eyes lest it should increase pain. Pupils were contracted, and there was slight increase in flow of urine. [Ibid,)

2. W. W. French took, e. of Nov. 6th, a powder of 30th trie On waking next m. nausea and taste in mouth as of creosote, perspiration over whole body, pain in umbilical region. Was relieved by going out, but all excitement during d. brought on perspiration. Repeated dose* on e. of 14th and m. of 15th, 7 a.m. of latter, nausea, bad taste in mouth, which is full of saliva; tongue feels rough to touch \ severe pain along transverse colon ; drawing pain in r. iliac region, relieved by lying on r. side, by pressure, by walking in open air, and by eating, worse by lying on back or 1. siae. IO.15, pain in head over r. eye, dull and weary; profuse sweat on least exertion j pulse slow, {ibid.)

3. G. S. Farmer took 30th trit. at 5 p.m. on Nov. 6th and 7th. No symptoms till 9 a.m. of &th, when burning ache in forehead set in, and continued till bedtime. 11, heaviness and weakness of limbs, and general weariness of whole body ; easily exhausted on going upstairs ; burning spot in centre of forehead, i p.m., symptoms more severe, with fulness in ears and stupid feeling in head, relieved by closing eyes and keeping quiet, aggravated by mental activity and exercise. ,f, after an h.'s tenesmus, soft thin stool, followed by great exhaustion. Violent hiccup, 5 to 8 p.m. Pupils dilated, and general weakness over body. On 9th still weak and easily exhausted, but other symptoms not so severe, and on loth and xith, save for weakness, was as well as ever. On I2th took another dose, m., on rising. Same headache, general weakness, and tenesmus with stool ; with these in e. hiccup for 2 h. 14th. — Great weakness and stupidity, feels as if he had been out carousing previous n. ; some headache, worse r. side ; eyes weak and sensitive \ ears feel stopped ; 3 light-coloured thin stools. Weakness continued, but getting less, till 17th, {Ibid.)

4. P. N. Crosby took dose of 30th trit., e. of Nov, 6th. Felt nothing till e. of ych, when he had dull pain in bowels with feeling of looseness, and painful pressure on tympanum of each ear. Repeated dose on 8th at 7.45 a.m. By 9 stupefying headache had come on, worst over 1. eye \ it continued till 6 p.m. ; no other symptoms. On loth took a third dose at 7.40 a.m., and feeling no effect, repeated it at 6.40 p.m. At n. very restless, not feeling satisfied in any position j rumbling in bowels, and at 5 a.m. had a yellow stool with pain just below navel, nth. — At 5 p.m. took another dose (or possibly of 3rd j see note to No. 22). 1 2th. — Pain in head, as before, commenced in m., and grew worse till 10 p.m., when it began to subside ; head was at same time bathed in warm perspiration. Restless n., but woke

• Or, according to another statement, took 3rd trit. on these occasions.— £ds.

quite well. 13th. — At 11.40 a.m. coolc a second powder. Dunng afternoon some headache, increasing towards e., but nearly gone by bedtime i head felt strange and confused. Woke with it once more about 3 a.m. [Ibid.)

1. J- P. W — , past middle age, took 3 doses of 30th at 24 h. intervals. Six h. after 3rd (usual m. stool having occurred} had quite a watery evacuation with pain in transverse colon extending through to back ; pain increased ac n. so as frequently to wake him, and he had constant desire to change from side to side j from 2 to 5 a.m. was wide awake. There are also mentioned, but without note of time, headache, neuralgic stitches in knees and arms, fulness of head, faint feeling at times, and raw feeling of tongue, very disagreeable on swallowing. On waking finally next m. very disagreeable feeling, as though he had slept too soundly, with pain in r. head and neck, as if latter was '' stiiF." In walking noticed 2 or 3 times, on raising foot, momentary feeling as though he was floating upwards, and on foot touching ground an unpleasant feeling, making a shuddering sensation pass over him. Mind was disturbed and unsettled ; he could not concentrate it on his studies. For 5 d. inclination to looseness of bowels and diminished appetite. (Ibid.)

2. Dr. Theodore Foote took dose of 30th, Nov. 6th, at 8.15 p.m. By 9.30 already felt great muscular prostration, as if he had taken a five-mile walk. 7th. — Awoke with severe headache in forehead, ThiSj with the prostration, continued all d. and for part of 8th, The pain (Dr. F — notes) was very severe, and never before experienced ; he could not put his mind on anything, or recollect anything j it was mental exhaustion, not confusion. (Ibid,)

3. J. M. Dart took powder of 30th, Nov» 6thy at 8.10 p.m. Before retiring had pricking and rumbling in transverse colon^ and next m. had a large diarrhueic stool (he is ordinarily constipated^ with burning at anus, followed by sharp pains in stomach and bowels, atone time also in 1. thigh and forefinger. 10.15, headache in I. frontal regiun, with sensation of heat in abdomen, and slight nausea. 4 p.m., headache has spread over whole head, with qualmishness and slight perspiration over body; very languid and dullj eyelids heavy. Headache and qualmishness continued till bedtime j also next d., with lame bruised feeling in region of kidneys. On 9th felt quite well, and on lOth, at 8 a.m., took another powder.* In e. rumbling and gurgling, with heat in abdomen and slight colic pains. On tith, after a restless n., headache set in as before, with dull languid feeling and pain in region of liver. It continued next d., and was very bad \ irritable mood with it, and he could not study for it. On walking he became excessively tired, and could hardly get along j vision also grew misty. D — notes chat the two provings were alike, and that he never experienced such symptoms before. (Ibid.)

4. L. L. Brainard took 4 doses of 30th without effect. Nov, iiih. — Took 3rd trit. at 5 p.m. 6, expansive sensation in top of head. 10, slight aching pain in 1, eye. 12th. — Awoke with aching pains in

• This may have been the 3rd,— Eos. j

whole brain, worst on 1. side ; same at back of orbit, extending into brain, worse on reading (so that he must stop), causing nausea j pulse 72, full ; chills in paroxysms. A further dose on 14th, and one of 1st trit. on 19th, produced no effect, ilbid,)

1. J. W. R — {a woman) took 3rd trit. at 3 p.m. N. restless; pain in r. deltoid, only relieved by violent motion. On 2nd d. similar pain in arm. N. again restless, and she woke with dull heavy headache over eyes, which passed ofFon rising. Third n. again restless, and on 4th d., e., felt soreness and pain at umbilicus, which on examina* tion was found much inHamed. It continued thus 4 — 5 d., growing less gradually. On June 15th took another dose. Felt nothing till 8 p.m., when there came on deep pain in muscles of r. forearm and wrist J also pain with sharp stitches in ball of r. eye and in frontal bone, with a distinct pain running obliquely into temporal bone. 1 6th. — Return, e., of pains in eye and arm i former relieved by motion in open air. (ibid.)

2. a. Dr. W. H. Titus took gr. 1} of 3rd trit., m. Felt nothing during d., but woke next m. with bad taste in mouth, teeth feeling rough. While at church in forenoon was taken with chilly sensation in back and soon began to yawn and feel bad \ joints felt bruised ; every movement and every draught of air made him shudder. Pulse was 93, temp. 100^. Throat now began to be sore on r. side at small spot i profuse salivation followed, and pain in top and forepart of head. This increased till he had to lie down. He could readily count his pulse by the carotids, and hear the two sounds of the heart as his head lay on the pillow. Soon began to have backache, which kept him restless all n. ; pain seemed in region of kidneys, and he passed large quantities of colourless urine. No position favoured pain in back, but head was relieved when he sat up in bed ; strong pressure also relieved, and walking, but this he had not strength to continue long. Next d. pain in bowels, which seemed distended with gas ; darting pains in joints, more in legs than arms, extending up into body ; tcit great anxiety about friends at home, could not get them out of his mind \ could sit up only a short time, when he would be compelled to \t down again, on account of pain in bowels ; pain in knees when he flexed them; throat still sore on r. side; urine profuse and very clear. On 4th d. noticed 1. eye red and swollen ; submaxillary gland was tender and tumefied. Pain and flushing of face on rising from sitting position ; strong-smelling sweat about genitals, prepuce tender and swollen, with a number of small vesicles on glans penis, causing burning-itching sensation (these disappeared in 48 h.). Petechial eruption on back and arm, size of fleabites \ darting pains about body ; tongue coated white, with oily itt\ and bad taste ; curious feeling in face, extending to neck, like cramp, — at time when this was worst I. hand became quite numb, and it bothered him to hold anything, By next d. all troublesome symptoms had passed oiF, and he began to have good appetite — this having quite failed during proving.

b. Took 3 more doses in Jan., and again in Feb,, with same symptoms, but less well-marked (there was no eruption). {Ibid.) A. P. McDonald,

6.30 p.m., severe pains in r. eyeball, darting from within outwards, relieved by pressure on eye, continuing at intervals till 10, when they seemed to shift to supra-orbital ridge, and continued so till about 12, 30th. — On rising same pains in both eyes ; they went off after breakfast, but returned in I. eye when he sat down to study in e. j relief from movement. 31st. — Frequent paroxysms of twitching in vastus externus (lower 3rd), coming on every time he sat down during d. On Jan. 16th took another dose without effect, {Ibid,)

1. W. H. WiLLJAM took 30th at 2 p.m. At noon of following d. chilliness in r. back \ vomiting of acrid Huid ; slow digestion ; continued yawning, with drowsy feeling all d. ; severe colicky pains in 1. abdomen \ neuralgic pain in r. face ; dull pain in both temples, with pressing outwards in frontal region. Next d. head felt as if falling forward ; vertigo ; he stumbles on going up or down stairs ; sharp pain in supra-orbital region, running off towards nose. Hack very weak, unable to stand erect \ dull pain in it, with almost constant desire to urinate, passing large quantities of reddish urine \ oppressed breathing. Back continued weak for another d. (IbidJ)

33.* Mrs. Nichols took i gr. of 30th at 3 p.m. one Monday. In 15 m. brassy taste and increased saliva, which continued rest of d. In e, cough from tickling in throat, Tuesday. — Had slept better than for 6 mo. before. Took i gr. felt quite exhilarated during m., very gloomy towards noon. At 1 took another gr, 3, felt as though stomach swelled, continuing rest of d. 4, hard sore pain in splenic descending to inguinal region and across hypogastrium, quite severe and increased by motion. In c. pain was so severe it caused her to extend legs. Took 2 gr. before retiring. Slept soundly. Wednesday. — 1 ook I gr. in m. Had bad taste all d. ; paroxysms of burning in palms t soreness in 1. side and hypogastric region, hurting her to stand. 4 p.m., took I gr. Tongue felt sore on tip and rough; throat full \ stomach pressed ; sore pain in spleen for 2 h. ; eyes smart, lids sore. In c., hammering in r. ear, while external ear felt as though hot air were blowing on it, Took another gr. before going to bed, and another on Thursday m. While writing, pain in r. ear \ tongue dry, rough, and sore. P.m., pain at 1. of sacrum. This last felt on Friday m., and headache Friday e. and Saturday m. No symptoms afterwards. {Ibid,)

1. C S. Collins took 1 gr. of 3rd trit. Monday c. After 3 h. dull pain in region of heart, lasting nearly i h. On Tuesday m. I gr. 10 a.m., pain iu back of neck reaching to lirst dorsal vertebra. 3 p.m., pressure on top of head ; hot cheeks ; eyes suffused with tears. 9, took I gr. On Wednesday repeated dose at 8 a.m. and 9 p.m. At 3 p.m. very sleepy, hardly able to keep awake, until relieved by sleep. On I'hursday m. awoke with scitches in 1. breast, and unable to draw long breath. This continued all d., and was so uncomfortable that no more medicine was taken. On Friday pain was gone. (Ibid.)

2. L. Kennedy. On 2nd d. after beginning 3rd trit, slight contraction in region of stomach. On 3rd d. this feeling was more plainly

• These provings ^33 — 36) represent the only results obtained from 14 students taking the 3rd trit and 6 taking tne sotb.

marked^ continuing 4 or 5 d., attended with dull pain in I. side and forepart of head, not reheved by food. Appetite as usual. Symptoms began to diminish on 6th d. and had disappeared by 8th. (Ibid.)

1. Mr. Dillingham took 3rd trit. for 4 d. (Jan, 8th — 12th), and notes following results : — Pain over r. eye all e. of 8th ; dull heavy headache in forehead before rising on 1 2th. Bright marks when looking at an object ; dark yellowish spots on book when reading, covering one or two of the letters. Singing in ears, like escaping steam,

Iftfter lying down at n. Nose stuffed and hot (8th}. Face flushed and red (9th). Smarting of end of tongue; it feels as if burnt by hot liquid. Hunger, but can find nothing to satisfy it (12th) ; food has a flat taste. Stool irregular and loose ; anus sore, disposed to protrude (as if from relaxed sphincter) ; return of piles, which have not troubled him for 3 years. Frequent desire to urinate, often ineflrectual. Cannot fill 1. lung, as inspiration causes dull pain in its apex, relieved by pressure; stitches under inferior angles of scapulx during expiration ; slight constant inclination to cough from filling lunes. Cramp-like stitches up and down spine ; stiffness of 1. neck. ^A'rists feel weak, dull aching pain in them j hands first cold, then hot and red. Numbness in I. foot. Unduly profound sleep, Perspires very easily. Pulse, normally 60 — 65, during proving was 74 — 83^ at fir^t full and strong, then weak. {Ibid.)

1. A woman took powder of 30th, Oct. 2Sth, at 1 1 p.m. Next m. in church had dull tcmporo-frontal aching in fiti, with tension of skin of nose and forehead. Felt little of it during d., but again at church in e. it came on, preceded by dizziness in passing people, and accompanied by nausea, heat in face and down back, with chilliness of legs, and lasted till bedtime. 27th. — While taking m, bath sudden stilfneck, r. side, which lasted badly all d., involving ear, shoulder, aiid even chest of same side. 28th. — Stifiiiess almost gone, but headache recurred from 1 to 6 p.m., with great sleepiness, and hung about her for 2 or 3 d. more. [Ibid.)

2. Miss Griffith took powder of 30th on Oct. 21st. Next d. increased secretion of urine, with bruised sore feeling in renal region j reluctance to take ordinary bath and discomfort after it. (Fresh sym* ptoms, at length of some severity, occurred from 24th to 26th ; but as on 27th " fever blisters '* on upper lip are noted, they were probably of idiopathic origin. — Eds.) (Ibid.)

3. H. A. W., woman, took same one n., and next m. woke with headache like that of No. ^7^ including skin tension, but with more fulness and arterial throbbing. P.m. there were attacks of sharp darting pain in r, parietal eminence, lasting i or 2 m., and leaving sore bruised feeling. Headache hung about her also for some time, relieved by mental appli* cation, worse when walking out of doors. On and d. gieat aversion to cold bath, and severe aching in r. glutei ; on 3rd d. same about r« scapula. (Ibid,)

4. Dr. Henry G. Todd took 25 dr. of tinct. every 15 — 20 m. till he had taken 200 dr. in %\ h. This produced a very marked sensation of languor and indisposition to move } but by an efFort of will his muscles were as fully under his coutrol as before. No contraciioo

6a I

of pupil was discernible, and pulse remained without change. {Phil Med, and Surg. Reporter^ Jan., 1873.)

1. When extract is apph'ed to eyeball, it immediately causes copious secretion of tears, and in about 5 m. distinct contraction of pupil, confined CO side of application. In about 30 m. pupil has become a mere speck, but still retains a certain decree of mobility. It continues in this state for 12 — 14 h., but in some degree for (it may be) 5 — 6 d. Slight headache and dimness of vision, with myopia, in affected side arc al most always produced, but these only continue for I — 2 h., at commencement of the action. When extract is applied to edges and outer surface of lids, partial immobility of these is induced. (Fraser, loc, cit.)

2. Dr. Argyll Robertson digested 30 gr. of bean in alcohol and evaporated, dissolving residue in 5J of water. One minim of this solu> tion (=gr. j of bean) was dropped into eye. In 10 m., objects distant more than one foot were dim and indistinct \ all objects seemed nearer and larger; pupil unchanged. In 20 m., pupil 1 line in diameter (normally 2 lines) -, objects distant more than 9 in. are dim j all objects seem one-half larger and nearer. In 30 m,, pupil | line (other pupil 24 lines) ; no distinct vision beyond 8 in. In 70 m., pupil j line. On reading, heaviness and fatigue of eye; using it otherwise caused dull aching and heaviness ; it felt strained. In a subsequent experiment, concave 8 enabled him to see at a distance, but not nearer than 5 in. {Ed. Mid. Journ.^ iii, 815.)

3. tf. I touched my 1. lower lid at 5.5 p.m. with a strong solution, (My eyes are alike in optical power, and in all respects normal. Pupils had a diameter of rather more than a line.) In 5 m. I experienced a decided tight feeling, referable pretty accurately to the ciliary region of that eye, as if something were creeping about in it. 5.15, this continued, with occasional rather sharp pains at same place. Attempt to read with both eyes instantly increased this pain, and type was confused. In 13 m. near point of 1, eye (Jaeger No. I J was at 6J in., that of r. eye being 15 in. Type looked rather smaller with r. eye than with 1. Far point seemed as before in either eye. In 20 m. I could sec Jaeger 17 at 15 feet, but with 1. eye with remarkable oscillation in distinctness, now clearly, now the reverse, which coincided with the sensations present, as if ciliary muscle was undergoing irregular contractions. L, pupil was now observed to have become rather suddenly contracted to size of a large pin's head. This contraction continued to the full amount for 18 h., then gradually relaxed during about 3 d., after which it was like its fellow. With the sudden contraction came also a sudden twilight gloom, as of an eclipse of the sun. This lessened after a while, as the retina became accustomed to its reduced quantity ©flight. In 25 m., pupil being extremely small, astigmatism was noted. The vertical bars of a window were seen clear and sharp at 6 — 10 feet, the horizontal bars within the same range having thin edges, slightly hazy, but rendered clear by a concave cylindrical glass of 14 in. focus suitatsly placed. Distant objects, seen by 1. eye through a concave spherical glass of 50 in. focus, were very decidedly diminished in size. In 30 m. near point by No. i of Jaeger was for I. eye at 64 in., for r. eye only at 104 in. (not nearer or further off), and even at this distance

indistinct ; whereas with 1. eye letters were crisp and clear. With 1. eye near point for vertical lines was at 8^ in., for horizontal lines ac 6j ; with r. it was at i ij and 7 J in. respectively.

b. Strained feeling of 1. eye was less after ^ h., but did not quite cease till next m. The attempt to read continued somewhat painful all e., and even next d. both eyes were somewhat uneasy in sustained vision of near objects, with both eyes or either of them. After 18 h. both eyes were alike as to accommodation, and in both near point for vertical and horizontal lines was 1 in. nearer than natural. At 24 feet each eye could read No. 18 of Jaeger, only the letters were more defined with the I., and looked rather smaller. (Bowman, J/ir^. 'limes and Gaz.y 1863.)

1. On carefully watching the progress of the myosis, the iris is seen to contract convulsively with little jerks or twitches, very small and rapid. While iris was under influence of drug it was at all stages sensitive to light, /. /. it would contract still more from sudden strong light, — which shows sensibility of retina to be unaffected. The myosis lasts 2 — 4 d., and after it has passed off there is usually slight mydriasis for several d., especially in m. ; this seems to depend on a kind of fatigue of the sphincter, which passes off during the d. under the reflex stimulus of light. The action on accommodation consists in the approximation of the far point and also of the near point. This, also, does not usually progress steadily, but by spasms or jerks, just as the pupil contracts. The far point is approximated sooner than the near point. If a very weak sol. is used, so that the accommodation is not markedly affected, we find that on attempting to use binocular vision, as in reading, there is pain, blurring, and straining, so that one eye must be closed (relieved by using a weak concave glass). It seems as though the ordinary will-impulse caused too great an action of the accommodation. The affection of accommodation lasts a much shorter time than does the myosis. The approximation of the near point lasts much longer than that of the far point. Visual acuteness often sinks to one-half the normal under its use; letters seem in constant motion, and can only be seen at a large visual angle. One observer could bring his vision to perfect clearness, but only with very great and painful exertion. The circulation in the fundus of the ball is not affected. Towards end of myotic action there is experienced a painful tension, partly in the equator of the ball, partly in the ciliary region ; sometimes, also, there are nervous achings in the whole ball, which extend along the supra-orbital nerves and over half the head. (v. Graefe, Arch.f, Ophth.^ ix, 3, 112. 1863,)

2. C. K — , a:t. 29, who 4 years previously had lost the whole of the r. iris by an accident, but whose accommodation was stilJ considerable, had strong extract of calabar instilled into eye at 2. 58 p.m. This caused slight smarting in conjunctival sac for i m. — 3 p.m. Myopia A^ near point 5J", A reduced to j^j. The myopia after this gradually mcreased, and the near point diminished slightly. 3.20 p.m., M increased to 1^, near point 5", A reduced to ^, The sharpness of vision diminished to |. 3.30 p.m., the myopia had reached its extreme degree, viz. |^, the near point 4}'^ accommodation -^y vision at dts-

■

6.3

I I

I I

tancc very

mvopia beains

indistinct. 3^2 p.m., accommodadoo remains the s^mc,

gins CO dimmish. 3.45 p.m.f M •^, A ^. 3. 50 p.m.,

more than i. x.12 D.m.« M Jr<. near point q". A

5\ A After

J^^ A more than i. 4,12 p.m., M ^, near point nearly ^. 4.50 p.m., M A* near point 5*, A nonnal, i./. fj. this the rcfraccioo dtsturbances declined, and were all gone in i h.

(/A/V.)

1. Dr. Sharp rubbed orer his eye and temple mixtures of 2 dr.

of tinct. to 8 of water, and 4 dr. of tinct. to 4 of water, without appreciable effect on pupil. When 5 dr. of tinct. to 5 of water were employed, a slight, and when a drop of pure tincture was rubbed in, a decided, dilatation was soon noticed. When 10 dr. of pure tinct. were used, after about an h. pupil became very much contracted. {Essays on MedUinty p. 771.)

II. Poisonings. — I. A woman chewed and swallowed a piece^ about the size of a green pea. A very few m. thereafter she felt sickish, and had the feeling as if a ball were coming up to the throat. She went out, and felt stupid and giddy as she walked along, with sensation of great feebleness over whole body, rendering progression a matter of difficulty. (Maclarev, from Frascr, he, cit.)

1. A young man ate a whole bean. In \ h. he complained of violent epigastric oppression, inclination to vomit, and attacks of faintness. After copious draughts of water and mechanical irritation, he produced vomiting, with great rctchingj followed by collapse, with cold sweat in drops over whole body, and complete muscular relaxation, with continued fibrillary twicchings of the muscles. Pulse was small and frequent ; pupils not contracted ; vision not affected ; consciousness perfect. (Lindev, Petersh. AUd. Zat.^ vi, 244. 1864.)

2. Two boys, set. 6 and 3 respectively, broke a bean (weighing 65 gr.) in pieces, and swallowed these between them. At 7 p.m. the parents saw them playing with the beans, At 7.45 they entered the house. The younger child's head drooped listlessly, his eyes looked " sleepy-like," his hands were powerless. He suggcred, and was scarcely able to walk. He complained of severe pain in epigastric region, and asked to be put to bed. His pupils were slightly contracted, his pulse feeble and slow, and he appeared thoroughly prostrate. A small dose of ipecacuanha wine was administered, and then some lukewarm water. He vomited freely, and four pieces of the nut were found in the vomited matter. Of the other boy, his father stated that ** his eyes were working,*' or, as his mother said, "as if the nerves were upon him." He complained of severe pain in umbilical region ; looked sleepy, listless, and depressed ; and wished to go to bed. In a few m. copious vomiting ensued. He was so feeble as to be unable completely to eject the vomited matter, and a neighbour, on putting his finger in his mouth, removed 4 or 5 pieces of the nut. He then requested to be taken to the closet, but could neither stand nor walk. He was freely purged. Face was pale, eyes heavy, pupils and pulse natural. On the d. following the children complained of sickness and declined their food. On the 3rd d. they were quite well. (Voi;ng, £d. Med, Journ.^ x, 1 92.)

3. A crowd of children ace of beans found among sweepings of a

ship from Africa. Forty-six of them were brought to Southern Hospital (Liverpool). Their most prominent symptom was loss of muscular power, and a state of prostration, characterised by feeble slow pulse, cold perspiring skin, and cold extremities. Vomiting was present in nearly all the cases, and diarrhoea in j^ of them. Pain like that of colic was said to have been felt at the commencement of the illness, but subsequently there was a remarkable freedom from suffering. In a proportion, not stated, the pupils were contracted ; in one case they were observed to be contracted during sleep, but dilated when patient was aroused. In no case was there any form of convulsion. Only one case proved fatal, and that was a boy of 7 already weakened by phthisis, and who was stated to have eaten 6 beans on an empty stomach. He staggered as he walked, and then fell, kicking and rolling as if in pain, but afterwards became quiet. He could not hold up his head, and complained of a heavy weight ac chest. His pupils were not contracted. He was much purged ', pulse barely perceptible ; respiration rattling; skin cold and face livid. He was quite conscious, and able to swallow water. Directly after drinking he died without a struggle, some froth at the time issuing from nose and mouth. On dis. section the body presented no peculiar appearances belonging to the poisoning, except a fluid condition of the blood, which also distended the heart, whose muscular substance was very flaccid. The mucous membrane of the stomach was of a pale pink colour. {Med, Times and Gaz.^ 1864, ii, 406.)

III. Experiments on animals. — i. a. After a small &fatal dose a slight tremor seizes the animal, beginning posteriorly and advancing forwards. The posterior limbs soon grow powerless, next the anterior extremities, and then the trunk, till muscular movement ceases, and the whole frame becomes Jimp and flaccid. The bowels and bladder are often evacuated, and the pupils generally contract. At this stage all reflex action of the cord is destroyed. Respiration grows stertorous in inspiration as well as expiration, and also slow and irregular. Consciousness is preserved as long as life lasts, and while paralysis remains incomplete signs of sensibility may be elicited. Immediately after death the pupils dilate. After death the muscles are found unaffected ^ they contract when cut, and respond to the irritation of their nerves. The heart continues to beat the usual time after death, its parts ceasing to contract in their regular order. The intestines exhibit their vermicular action. The large veins of the thorax are distended, as well as those upon the surface of the brain ; the lungs, liver, and kidneys are engorged j cord normal,

h. After a large fatal dose, death occurs sooner, and the symptoms follow each other in quicker succession, but they are substantially the same. After a very large dose, death may be almost instantaneous, and it appears to be due to syncope ; for when the body is opened, the heart is motionless, dilated, and flaccid, and contracts but languidly on stimulation. The vermicular movements of the intestines are also more sluggish. (Fraser, /oc. cit.»)

2, A great number of other experiments have been made upon the lower animals. Their results are on the whole so uniform that it

seems needless to present them separately ; and the following may be stated as the result : —

a. The normal poisonous action of the bean is to cause speedy general paralysis, and death from failure of respiration — consciousness being unaffected. The seat of the paralysis is the spinal cord itself, the vital properties of the nerve-trunks and muscles being found intact. Reflex action is abolished, and also sensibility so far as pain is concerned ; but tactile impressions are perceived, and the muscular sense seems perfect. The muscles themselves are the seat of tremors and fibrillary contractions of a very persistent character, which seem due to a direct action of the drug upon them. In those of the involuntary class this excitation goes on to active movements, so that stomach, bowels and bladder expel their contents with frequency, — the intestines being often twisted up in knots. All the secretions — sweat, tears, saliva, faeces, urine — are somewhat increased.

b. In moderate doses the bean simply retards the heart's action, not regularly, but by prolonging the diastole, in which — when fatal poisoning is induced — the organ stops. The retardation seems due to an exaltation of the inhibitory power of the terminal extremities (not of the central origin) of the vagi. It is accompanied by heightened arterial tension, and the power of the heart is not diminished. But a larger dose perceptibly weakens the cardiac impulse, and a very large one may paralyze the organ at once.