Plumbum

Lead; the Metal, the Acetate and Carbonate.

Introduced by Hartlaub.

Provings and toxicological reports are numerous. See Allen's Encyclopedia, vol. 8, p. 1.

Clinical, Axjthokities Mental disturbance, Chapman, B. J. H., vol. 3, p. 170 ;

Uypopion, Theuerkauf, Riick. Kl. Erf., vol. 5, p. 118 ; Affection of eye, Woodyatt, Organon, vol. 1, p. 483 ;

Erysipelatous inflammation of nose, Eosenberg, Riick. Kl. Erf., vol. 0, p. 173 ; Stricture of esophagus, Sommer, Eiick.

Kl. Erf., vol. 5, p. 249; Gastralgia, Bute, Eiick. Kl.

Erf., vol. 1, p. 657 ; Cardialgia, Kunkel, A. H. Z., vol. 106, p. 189 ;

Lilienthal, Horn. CI., vol. 3, p. 43 ; Affections of stomach, Gross, Eiick. KL Erf., vol. 1, p. 656 ;

Kunkel, A. H. Z., vol. 102, p. 172 ; Jaundice, Guernsey, Hah.

Mo., vol. 5, p. 238 ; Colic, Miiller, Lorenz, Eiick. Kl. Erf, vol. 5, p. 370 ;

Hesse, A. H. Z., vol. Ill, p. 43 ;

Holland, B. J. H., vol. 32, p. 79 ; Miserere, Lor- bacher, M.

A. J. H., vol. 4, p. 340; Enteralgia, Hughes, B.

J. H., vol. 22, p. 239; Intussusceptio, Lorbacher, Theuerkauf, Eiick. Kl.

Erf., vol. 5, pp. 375, 383; Tumor cceci, Marcy, N. A. J.

H., vol. 4, p. 343 ; Impaction of feces, Lorbacher, B. J. H., vol. 29, p. 611 ;

Hernia, Baumann, Eaue's Rec, 1873, p. 127, from A. H. Z., vol. 85, p. 11; Incarcerated Aenii'o, Baumann, B.

J. H., vol. 31, p. 24; Diarrhcea, Fanning, Horn. CI., vol. 2, p. 193 ;

Cholerct, Henke, Kurtz, Ruck. Kl. Erf., vol. 1, p. 95 ; Gerstl, Eiick.

Kl. Erf., vol. 5, p. 482; C'onstij)ation, Hartlaub, Eiick. Kl.

Erf, vol. 1, p. 818 ; Dixon, B. J. H., vol. 28, p. 390;

Dudgeon, B. J. H., vol. 29, p. 612 ; Dake, Organon, vol. 3, p. 355 ;

C. D. F., Organon, vol. 3, p. 363 ; Spasms of. rectum, Chapmann, B.

J. H., vol. 3, p. 173 ; Qirrhotic kidney, Gatchell, Times Eet., 1877, p. 38, from A. O., vol. 1, p. 235 ;

Jones, A. H. O., vol. 12, p. 561 ; Desquamative nephritis, Weil, A.

H. Z., vol. 103, p. 131 ; Strangury, Brener, A. H.

Z., vol. 107, p. 99; Ovarian dropsy, Young, Times Eet., 1875, p. 93; Metrorrhagia, Griessel, Eiick. Kl.

Erf., vol. 2, p. 322 ; Hcemoptysis, Hartmann, Eiick. Kl. Erf., vol. 3, p. 222;

Phthisis, Trinks, Eiick. Kl. Erf., vol. 3, p. 390; Schleicher, Eiick.

Kl. Erf., vol. 5, p. 843 ; Weakness and paralysis of extensor muscles of fingers, Chalmers, Horn. Eev., vol. 13, p. 145 ;

Nervous affection of leg, Eussell, B. J. H., vol. 14, p. 376 ; Sciatica, Garay, Eiick.

Kl. Erf., vol. 5, p, 902; Offensive foot-sweat, Lilienthal, N. A.

J. H., vol. 14, p. 137 ; Eiick. Kl.

Erf., vol. 3, p. 592; Chorea, Peters, N. A. J.

H., vol. 3, p. 144; Epilepsy, Tietzer, Eiick. Kl. Erf., vol. 4, p. 589 ;

Burnett, Hom. Eev., vol. 22, p. 20 ; Brown, Hom. Eev., vol. 22, p. 267 ;

Paralysis, Hahnemann, Munnecke, Eiick. Kl. Erf., vol. 4, p. 475; Kunkel, A.

H. Z., vol. 102, p. 173 ; Paraplegia, Martin, T. H.

M., S. Pa., 1885, p. 200 ; Chlorosis, Winter, Buck. Kl.

Erf, vol. 2, p. 275 ; Winter, B. J. PL, vol. 3, p. 218 ;

Lead poisoning, Griffin, Times Eet., 1875, p. 160.

' Mind. I Weakness or loss of memory ; unable to find the proper word. I Slow of perception; intellectual torpor; gradually in- creasing apathy.

PLUMBUM. 476

I Anxiety, with restlessness and yawning. I I Gloom alternates with excitement.

■ Much depression of spirits, especially with colic. I Quiet and melancholic mood.

Indifference and somnolence, with lamentations about dif- ficulty of breathing and headache.

■ Deep melanchol_y, with timidity and restlessness; anxiety

at heart, with sighing and trembling; dislikes to talk or work; maniacal rage, with cries and convulsions; absence of mind; stupidity; pale, miserable, cachectic appearance ; somnolency ; colic.

■ Wild delirium with distorted countenance.

■ Delirium, alternating with colic; bites and strikes at

those near him ; tremor of head and hands ; yellow mucus collects about mouth and teeth.

I I Delirium furious at night, milder by day, with halluci- nations and sleeplessness at night and sopor by day ; tremulousness mostly in head and hands ; face red or straw-colored, with mucus in mouth, black teeth, fetid odor; grinds teeth; eyes swollen, or look is suddenly changed, as if frightened; throws off bedclothes; loss of all senses; delirium increases as senses diminish; puffing of cheeks, especially if paralysis is a sequel or is caused b}^ suppressed colic, with bloated abdomen.

I I Sudden fainting on going from one room to another full of company, with screams, fright without cause, spasms in muscles of face, but mind remains sound. ' I 1 Thought his life was in danger from assassination or ■ poison and that every one about him was a murderer.

■ Insomnia, severe headache, occipital or frontal, with or

without vertigo ; noises in ears ; disordered vision ; di- plopia; amaurosis; contraction of pharynx, though liquids are swallowed in gulps and greedily ; mind weak, morose and sad ; preceded by albuminous urine. I 1 Great depression of spirits ; though habitually very temperate had recourse to various stimulants, at first in moderation and openly, but soon immoderately and by stealth ; sleeplessness ; gloom ; despair of her salva- tion ; moody taciturnity ; fixed idea that she could only obtain peace and safety through absolution from a priest of the Papal Church, although she had been a zealous Protestant ; face nearly of a leaden hue ; perpet- ual movement of lips, as of one smoking, accompanied by a slight sound; very silent, but when spoken to answered rationally ; severe pain, starting up from back into head, as if something were working at top of head, with a sense of screwing from behind forward; some flatulence; frequent drowsiness by day, sleeplessness

477 PLUMBUM.

by night ; profound melancholy and frequent sighs ; brooded over any forbidden thing; would steal from house in servant's cloak and bonnet to obtain stimu- lants, but from the moment their prohibition was with- drawn ceased to have any desire for them ; after being permitted to visit a priest and converse with him ceased to talk and think of the Church.

i I Mental disturbance of eight or ten years' duration in a man addicted to masturbation ; has several times at- tempted suicide ; has been in seclusion ; greatest dejec- tion and despair; fixed, moody look, with a constant scowl; believes himself lost; has -the sounds of hell constantly in his ears ; hears voices and sees shadows of demons ; great disposition to make away with himself, or do himself some bodily injury ; gloom and taciturnity alternate with frantic delirium; drowsy sometimes in day, sleepless at night; constant pain and weight in upper part of neck and back of head ; complexion dark ; vio- lent palpitation of heart, < after eating and lying on 1. side ; pulse weak ; bowels regular but evacuations very dark ; seminal emissions very frequent, often occurring during stool ; testes wasted ; spasmodic stricture ; goose- skin.

Affections more of the emotions than the intellect. ^ Sensorium. Sopor after spasms; coma; stertorous breath- ing, with jaws fixed ; motion with mouth as if smoking; puffing of cheeks.

■ Apoplexy; consciousness blunted; memory deficient; speech impeded, single syllables are omitted or cannot be combined into words; mimic spasms of face while speaking; trembling' of tongue when put out; semi- paralysis of buccinator muscles and of velum palatinum manifested by violent snoring ; sleeplessness ; fear of death ; organs of sense torpid and insensible ; eyes prin- cipally afi'ected ; eyelids droop as if paralyzed ; pupils constantly dilated; all objects seem smaller and farther removed from focus of vision, they may be seen as through a gauze; diplopia; pulse always slow, 50 to 60, sometimes hard and tense like wire ; all the muscles . may be paralyzed, especially of 1. side; paralysis aff'ects equally motor and sentient nerves, is often attended with violent pains in paralyzed parts and considerable contractions, especially of extensor muscles, which feel as hard as wood ; in other cases spasms are tonic, and if they reach their full development run into complete epileptic convulsions; muscles of affected parts become atrophied ; if paralysis is not complete gait is unsteady, with particular tendency to fall forward ; paralyzed

PLUMBUM. 478

respiratory muscles often occasion a high degree of dysp- noea; sphincters scarcely ever paralyzed.

■ Stupefaction of head; he falls down unconscious.

■ Stupefaction with somnolence.

Vertigo : on stooping ; when looking upward ; > in open air ; epileptic. ^ Inner Head. • Heaviness in head, especially in cerebellum.

■ Headache: violent; frontal; pulling andpressive, chronic

in forehead, < from mental labor and intolerable in large company; in temples, < in r. ; as if a ball were rising from throat into brain ; with vomiting and vio- lent pains in umbilical region. iSick-headache, with pain in occiput, umbilical colic and bilious vomiting ; yellow skin, especially of face.

■ Chronic dull headaches, with depressed spirits and con-

stipation.

■ Congestion of blood to head, wnth heat and beating in it.

■ Paralysis occurring early; cerebro-spinal meningitis.

■ Meningitis, chronic, when paralyzed parts soon fall

away in flesh ; limbs become painfully contracted ; fre- quent spells of colic with retraction of abdomen.

■ Cerebro-spinal meningitis, with early paralysis.

■ Chronic encephalitis and myelitis.

■ Sclerosis of brain, or progressive muscular atrophy,

alternating with colic and constipation.

* Outer Head. ■ Violent pains in integuments of skull, from

occiput to forehead.

■ Great dryness of hair, it falls off even in beard and eye-

brows.

* Sight and Eyes, i ' Diplopia.

■ Cloudiness before eyes, inducing one to rest them.

I I Dimness of vision, especially on r. side ; sudden loss of sight or transient amaurosis and deafness complicating motor palsy in some cases.

I I Neuritis optici ; papillee swollen (examination after death showed interstitial hyperplasia of connective tissue; sheaths of optic nerves were distended by fluid ; cerebro-spinal fluid was greatly increased ; brain sub- stance ansemic and the gray portion yellowish).

Ophthalmoscopic examination between the paroxysms showed that the disk was prominent, its outline hazy, its color an opaque bluish-white.

I I Left eye affected for two weeks, badly for five or six days ; drooping upper lid ; intense photophobia ; very profuse, hot lachrymation, pericorneal injection, deep bluish-red, marked at corneal margin and fading oflp towards reflexial fold of conjunctiva ; slight redness of conjunctiva of lid, cornea very delicately hazy through-

479 PLUMBUM.

out its entire extent, as if breathed upon so as to dim its lustre ; and at lower inner quadrant opacity was a little denser and seemed as if it might develop into an ulcer ; cornea not normally sensitive to touch; pupil con- tracted ; vision impaired ; tension of eyeball diminished ; neuralgic pains in and around eye, < at night ; atropine only partially dilated iris.

I I Pupils contracted or dilated.

iHypopion after iritis, extending up nearly to centre of cornea ; nightly tearing pains in eye and forehead ; could hardly distinguish day from night.

I Eyeball feels too large.

I Ophthalmia, lachrymation, photophobia, redness of whole ball.

I I Inflammation, varicose distension of vessels of cornea, obscuring light.

I I Passive congestion, with soft large granulations.

I Yellowness of whites of eyes.

I Lids spasmodically contracted.

■ Paralysis of upper lids.

^Hearing and Ears, i Hardness of hearing; often sudden deafness.

Buzzing in ears.

I I Hears music; with frightful delirium.

• Stitches and tearing in ears, ' Smell and Nose. Smell too sensitive or too feeble ; even total loss of smell.

I I Loss of smell with epilepsy.

I I Fetid odor before nose.

iMuch tough mucus in nose, which can only be dis- charged through posterior nares.

I Cold nose.

I I Puffiness of nose.

I I Erysipelatous inflammation of nose, mostly in alse nasi, with redness and vesicles discharging a thick pus when slightly pressed. ^ Upper Face. iFace expressive of extreme anxiety and suf- fering; pale, ash-colored ; yellow, corpse-like; bloated; cheeks sunken.

I Sallow complexion; discolored sclerotic.

■ Swelling of one side of face.

■ Skin of face greasy, shining. 1 I Vesicles on face and nose.

* Lower Face, ii Violent loud motion of lower jaw and frightful grinding of teeth.

■ Lockjaw.

I iTearing in jaws relieved by rubbing them. I I Lips peel ofl" without pain or dryness.

PLUMBUM. 480

I Swelling of submaxillary and sublingual glands. '" Teeth and Gums, i Grinding of teeth. I I Teeth become black. I 1 Yellow mucus on teeth.

I Teeth hollow, decayed, crumbling, smelling offensively.

I I Distinct blue line along margin of gums.

1 1 Gums: pale; swollen; show a lead-colored line; blue, purple, or brown ; painful, with hard tubercles. ^^ Taste and Tongue. ■ Taste: sw^eetish; metallic; bitter. I Cannot put out his tongue.

I Tongue: dry, brown, cracked ; coated yellow or green;

dry, red, glazed, in chronic gastritis; dry and white (colic) ; red at edge ; brown far down centre ; inflamed, swollen ; heavy, paralyzed ; hurts as if bitten. ^^ Inner Mouth. ' i Saturnine breath.

I I Breath fetid.

■ Dryness of mouth.

I Accumulation of sweetish saliva in mouth.

I 1 Froth in mouth.

A yellowish mucus in mouth and on teeth.

Saliva increased; of a bluish color.

Salivation, with painful tongue and lips ; fetid smell and

languor (after abuse of mercury), with yellow purple

ulcers on tip of tongue and mouth. Salivation (mercurial) so profuse in damp weather as to

saturate pillow.

■ Aphthae: dirty looking ulcers and purple blotches in

mouth and on tip of tongue. Ulcers in mouth, with fetid smell ; they turn yellow. ^^ Throat. ■ Constriction in throat when trying to swallow, with great urging to do so.

■ Sensation of a plug in throat; globus hystericus. I I Difficult swallowing.

■ Fluids can be swallowed, but solids come back into

mouth ; burning in oesophagus and stomach some hours after eating. ^Stricture from spasm.

■ Paralysis of throat with inability to swallow.

■ Tonsils: swollen; inflamed, covered with small, painful

abscesses. I I Tonsillitis : going from l.to r., with yellow granulous or follicular ulcers ; small and very painful, with burn- ing, stinging pains.

■ Tough mucus in fauces and posterior nares.

■ Angina granulosa, going from 1. to right.

■ Angina on 1. side, with copious flow of purplish saliva

and spasms.

■ Diphtheria, with tendency to sloughing and implication

of larynx (also Plumb, iod.).

481 PLUMBUM..

'* Appetite, Thirst. Desires, Aversions. Great hunger or complete loss of appetite. I Violent thirst, especially for cold water. Desire : for cakes ; rye bread ; tobacco. '' Hiccough, Belching, Nausea and Vomiting, a Eructa- tions: empty; sweetish; of offensive odor ; sour.

■ Gulping up of sweetish water.

iNausea: frequent; constant; occasional, sometimes fol- lowed by vomiting of food.

■ Vomiting: most distressing; stomach rejecting almost

everything; of food ; constant, of everything taken ; in the night, especially early morning ; spasmodic ; with violent cardialgia; violent of sweetish, sour, or bitter substance, like white of egg, in chronic gastritis ; of grass-green substance, afterwards changing to retching; of a brownish liquid, streaked with blood ; of food and of discolored substances, with violent colic ; of food,_in morning, with great weakness ; of greenish and blackish substances ; of a blackish substance ; stercoraceous. I Vomited matter has a fecal odor. '' Scrobiculum and Stomach. i Feeling as if a ball ascended from epigastrium along thorax to throat, where it causes a kind of suffocation ; at such times can neither speak nor swallow, and suffers the greatest anxiety.

■ Contraction in oesophagus and stomach ; fluids can be

swallowed, but solids return ; some hours after eating a burning m stomach and oesophagus ; constipation ; pros- tration ; emaciation.

■ Heaviness as from a' load in stomach, with heaviness

in occiput.

■ Pressure and tightness about stomach.

■ Severe pain in stomach, radiating to both groins, down

both legs, particularly left.

■A^iolent pressure in stomach and pain in back; at times > bending backward, at others bending forward; > from hard pressure.

I I Pressure in stomach, as from a heavy weight, increasing to a strangling sensation during the severe colicky par- oysms and followed by sour and bilious vomiting; loss of appetite ; excessive thirst ; pains in back > some- times bending forward, sometimes backward ; constipa- tion, hard, knobby stool once a week ;_ taste always sweetish; abdomen compressed hard, like a board; constriction of throat ; paralytic weakness in extremi- ties, especially on r. side ; hands and feet cold ; total and striking want of perspiration ; paroxysms increase

VOL. VIII. — 31.

PLUMBUM. 482

in severity and duration and she is already atrophied and anaemic. ^Cardialgia.

I I Constant pressure in epigastrium ; severe constricting pain alter eating heavy food ; rolls about the floor in extremity of pain ; attack lasts from ten to twelve hours, at times longer; slight relief when lying down; at times has terrible pains when rising in morning and when stomach is empty ; epigastrium hard and swollen during paroxysm ; < belching and at night ; feces scanty, knotty, hard as a stone, evacuated with difficulty; at times sweetish taste.

I I Periodical pressing, burning and sensation of heaviness in epigastrium, as if everything were weighted down, with general indisposition; whole abdomen felt tense and rough to touch ; stool hard, knotty ; frequent at- tacks of shortness of breath without cause ; offensive foot sweat since childhood ; debility ; emaciation ; pro- fuse night sweats.

1 I Sudden severe pains in epigastrium, compelling her to bend backward and press something hard against abdomen for relief; < from motion; > from belch- ing ; after every attack eyes are deeply jaundiced. ^'Gastralgia. '^ Hypochondria. Hepatic region sensitive to pressure.

Sensation of heat and burning in liver and spine.

Persistent sticking pain in hepatic region, first anteriorly, then posteriorly.

Continued darting pain in region of liver.

I I Weak and exhausted; skin and white of eyes yellow;

urine very yellow ; stools light in color ; much nausea, particularly in evening or at night, when she vomits her food; restless, sleep broken at night; not able to leave her bed. ^Plumbum.

II Icterus: skin and sclerotica yellow; yellow ulcers in mouth; sweetish risings; abdomen bloated; colic; stinging in region of liver, > from rubbing.

Cirrhosis of liver; first enlarged then contracted. • Spleen enlarged. ^^ Abdomen. A sensation in abdomen at night in bed, which causes her to stretch violently for hours together ; feels that she must stretch in every direction ; the will to do so alone cannot accomplish it; as if from paralysis; irritation of sentient nerves.

I iBorborygmi ; rumbling in abdomen.

■ Drawing pain from abdomen to back.

iSevere colic, contracted abdomen ; bends backward ; motor nerves most affected.

Abdomen retracted ; hard, painful ; pain commenced at

483 PLUMBUM.

umbilicus and radiated to lumbar region and to iliac

fossae; rolled upon ground and pressed abdomen with

violence. Navel seems to adhere to spine and the pain also involves

pectoral region. B Sensation as if abdominal walls were pulled inward; as

if abdomen and back were too close together. I I Severe pains in abdomen, especially around navel, as if

bowels were twisted. lExcruiating tearing pains in all the bowels, but < at

navel. I I Lacerating pains at umbilicus and epigastrium.

■ Intense retraction of the integuments of abdomen towards

spine, and a hard, knott}^ feeling of the muscles in various places over its surface.

■ Extremely violent pains in umbilical region, shooting

to other portions of abdomen, somewhat > by pressure; at times they became so violent that he was almost wild, tossed about, pressed fists into abdomen and declared he must go to stool immediately,

I I Pain often extended to other regions, to chest, threat- ening suffocation, to small of back, kidneys, bladder and lower extremities.

llExcessive pain in abdomen, radiating thence to all parts of body.

■ Violent colic; abdomen drawn in, as if by a string, to

spine ; cutting, contractive pains with restless tossing ; > from rubbing or hard pressure ; abdomen hard as a stone; knots in recti muscles; anxious, with cold sweat and deathly faintness.

■ Constriction of intestines; navel and anus violently

retracted.

I I Pain above umbilicus, coming on every forenoon, ac- companied by vomiting. ^Enteralgia.

I I Severe paroxysmal pains in r. side of abdomen, com- pelling him to bend double, > from pressure of hand, < at night, causing sleeplessness; abdomen slightly bloated ; whole r. side sensitive to pressure; stool every second or third day.

I I Extremely severe pains in abdomen, recurring periodi- cally, with spasmodic contraction of abdomen and ob- stinate constipation ; hard, knotty elevations here and there over abdomen ; intestines as if constricted; pains and cramping of limbs.

I I Colic, with hard abdomen, great sensitiveness, relief only obtained by bending body forward and drawing up knees; obstinate constipation; abdominal walls re- tracted.

PLUMBUM. 484

I I Abdomen hard as a stone ; not ver}^ tympanitic ; recti muscles drawn into knots nearly as large as a fist; no alvine evacuation for two days, and no urine for eighteen hours ; countenance eypressive of greatest anxiety ; face and forehead bedewed with cold, clammy perspiration; pulse feeble, not very quick; during spasms (every three minutes) vomiting of a blackish, grumous fluid; deathly faintness; body bending backward, so as to form a semicircle, and so sudden as to throw him from bed ; pressure from flat hand gave some relief.

■ Colicky pains proceeding from spinal cord, with sensa- tion as of drawing in of abdomen to back, with great depression of spirits.

I iSuflering expression of face; pulse small and frequent; forehead and limbs cold, covered with clammy sweat; constant belching of off'ensive odor and at times vomit- ing of fecal-like masses ; tearing, burning pains in abdo- men, which seem to concentrate around umbilicus; < from touch, motion, and particularly vomiting, which is caused by drinking slightest quantity of water; abdo- men bloated; intestines distended with gas, so that they could be traced by finger; extremely sensitive swelling as large as fist, on 1. side of umbilicus ; great thirst ; stool absent.

I I Colic, accompanied on third day by vomiting of asca- rides ; next day continuous hiccough and offensive belching, with retching, followed at once by vomiting on drinking water; tongue coated ; foul taste in mouth; dryness of mouth without thirst; anorexia; no fever; pressing, burning and tearing in abdomen, which was distended ; around umbilicus spot as large as fist, sensi- tive to pressure, from whence the pains, mostly period- ical, originated; intestines as if distended with wind, so that course of each could be felt; constant borbo- rygmus; constipation of four days' duration, with frequent ineffectual urging to stool ; two days later fecal vomiting; belching of wind of fecal odor. ^In- tussusception.

I I Distension and hardness of CEecum and ascending colon, whole region swollen, painful to touch, on mo- tion; tongue dry; brown in centre; skin hot and dry ; much thirst; nervousness; headache; general depres- sion ; expression anxious ; feeling of lameness in lower extremities; sour eructations; nausea; inclination to vomit ; umloilicus retracted. ^Tumor cseci. ■ Large, hard swelling in ileo-csecal region; painful to touch and motion. ^Typhlitis.

I I Sensation as if an abscess were forming near umbilicus;

485 PLUMBUM.

abdominal walls hard and contracted, knotted in certain points. ^Rheumatism of bowels.

I Excruciating colic from poisoning with carbonate of lead.

I Colic, with paralysis of lower extremities.

I I Inflammation, ulceration and gangrene of bowels.

■ Incarcerated hernia.

I Intussusception, with colic and fecal vomiting.

I I Strangulated femoral hernia, 1. side; severe pain ; con- tinual vomiting of feculent matter.

I 'Strangulated scrotal hernia, r. side. ^'' Stool and Rectum. I Diarrhoea: violent; painful; fetid; 3'ellow; bloody, watery, with vomiting and violent colic.

I I Dysentery : with violent colic ; in violent cases with bloody masses of exudation ; violent fever, cutting in stomach and bowels, burning in anus during discharge and long-lasting tenesmus ; spasm of sphincter ani as if drawn in; burning in rectum and perineum.

iCholera, severe cases, particularly with spasms of abdom- inal muscles.

iStools: dark, offensive, watery; yellow; mucous and bloody; bloody; profuse, watery; involuntary; fetid, yellow and fecal ; watery, with vomiting and violent colic ; bloody masses.

I I Stool only once in eight or ten days, of scanty, blackish feces; expulsion of which caused acute suffering.

llConstipated stools: hard, lumpy, like sheep's dung; with urging and terrible pain from constriction or spasm of anus ; knotty, feces in form of balls, often hard, black or green; nearly always of a dark color; ball-shaped, hard as a stone; small, hard balls covered with greasy pellicle ; large and hard and covered with glairy mucus; dark-colored.

Before stool: ineffectual urging w^ith or without tenesmus; complete atony of rectum ; severe coliclike pains with constriction or spasm of anus.

During stool : great effort ; violent colic pains.

After stool : colic and at times diarrhoeic discharges.

I I Attacks of constipation ; enemas of little or no service ; stool attended with terrible agony, as bad almost as labor ; stools were in hard balls ; during worst pain felt a drawing from navel backward to spine.

I I For last three weeks stools which were always rather costive became more scanty and difficult, injections and purges brought away small lumps of healthy-look- ing feces ; abdomen began to swell and increased daily in size until it was as large as that of a woman seven months pregnant ; swelling greater on 1. side, and com-

PLUMBUM. 486

pletel}'^ filled up space between spine and navel ; con- volutions of bowels filled with hard feces could be dis- tinctly seen and felt ; on r. side it felt as if a bag not quite filled with fluid lay there ; sw^elling not very ten- der to pressure, but prevented her lying upon side ; at times very violent, spasmodically contractive, cutting pains with great restlessness, anxiety and cold sweat, whereupon lumps size of fist appeared on 1. side; after eating, violent retching and vomiting sometimes of food sometimes of mucus ; loss of appetite ; tolerably clean tongue; great thirst; flow of urine slightly diminished ; skin somewhat shrivelled ; weak, pale, emaciated, hol- low-eyed.

I I Gradual loss of strength; constant sickness; acid eruc- tations; vomiting of every article of food taken; con- stant dull pain in hepatic region ; violent attacks of enteralgia ; constipation, bowels wall not act without a purgative, motions hard and dark; numbness of upper and lower extremities; a sort of semi-paralytic condi- tion of arms so that knife would frequently drop from hand ; expulsive power of bladder weakened, urine expelled with difficulty and in a dribbling manner; urine high-colored and fetid ; sexual functions much weakened ; pulse weak and quick; extremely weak and emaciated.

I I Constipation interrupted by an attack of diarrhoea every week or ten days ; latter always came on between midnight and morning with great urgency for stool and violent pains in abdomen, > by passage of copious liquid discharge ; several discharges would occur during morning, sometimes continuing through day, and then she would be costive again ; with diarrhoea, sensation as of something pulling at umbilicus with actual retrac- tion of navel.

■ Obstinate habitual constipation: when the stools are dry

and lumpy and the intestines half paralytic and half crampy; in pregnant women and in persons of a para- lytic diathesis, or when due to paralysis of intestines ; especially when there are present dryness of the excre- tions and a muscular atony ; often there is an absence of intestinal mucus and bile; when Platina fails.

■ Alternation of constipation and diarrhoea. I I Light-colored stools. ^Jaundice.

■ Impaction of feces.

I I Intolerable pain, from spasms of rectum, with everj' evacuation lasting an hour or two ; suffering described as that of horrible constriction and spasmodic contrac- tion, very much increased if feculent matter is solid ;

487 PLUMBUM.

for last ten years has taken aperients ; if evacuation were not liquid his torture was extreme ; if he passed a day without an evacuation the suffering lasted several days.

I Spasmodic condition of rectum and anus.

I I Anus violently constricted and drawn up ; contraction of sphincter.

■ Prolapsus ani with paralysis.

■ Fissures of anus.

^^ Urinary Organs. ' ' Must get up two or three times at night to urinate; urine profuse, acid, albuminous, containing fine granular and hyaline casts of small diameter and no renal epithelium; much oppression for breath, making locomotion ahiiost impossible ; when walking is seized with severe cramplike pain in region of um- bilicus, > standing still ; perspires all over as soon as he gets into bed, perspiration comes and goes all through night; cough on first waking, as he gets out of bed continues till after breakfast; is caused by a sensation as if a " wheat-hull" were in throat just be- hind manubrium sterni; lying on back or r. side brings on cough ; when lying on back feels as if fluid rolled from one side of chest to other (subjective) ; in morning mouth and lips dry and lips swollen; tongue dry ; lips crack open when coughing; drinks at night on account of dry mouth; marked weakness; pasty, yellow look; lungs are hepatized and heart diseased. ^Cirrhotic kidney.

I I General indisposition, loss of appetite, frontal headache, made < by mental application; difficulty of breathing at all times, but especially noticed when lying down at night, causing discomfort and loss of sleep; both ankles highly oedematous; skin dry, does not perspire, even when taking active exercise on a hot day; a slight, dark cloud in urine, settles on standing; urine acid, specific gravity 1016 ; albumen, -^y ; finely granular casts and some blood corpuscles.

I I Urine decreased in quantity, red, albuminous, contain- ing blood corpuscles and epithelial cells, crystals of oxalate of lime and hyaline casts ; headache in occiput extending to forehead ; heavy, oedematous eyelids ; sunken eyes, staring look ; pains in limbs; emaciation; small, slow pulse ; hoarse voice ; catarrh of air passages with discharge of tough mucus ; dry, short cough ; cough with expectoration of blood ; constriction and oppression of chest; coated tongue; complete loss of appetite; vomiting; nausea for food ; belching; vomit- ing of mucus; constipation ; retention of urine; cramps

PLUMBUM. 488

of bladder; painful urination; urine fiery-red, bloody, albuminous; restless sleep; obstinate sleeplessness; great despondency and indifference. ^Desquamative nephritis.

■ Granular degeneration or cirrhosis of kidneys; little

dropsy or albuminuria, but a marked tendency to ursemic convulsions.

■ Morbus Brightii: colicky pains; retracted abdomen;

cutaneous ansesthesia; albuminuria; rapid emaciation and excessive debility. 1 1 Morbus Brightii, contracted kidney.

■ Diabetes: lowness of spirits, anguish and melancholy;

diminution of sight; dryness of mouth; dry, cracked tongue; suppuration of lungs; hectic fever; impotence; dryness and brittleness of skin ; emaciation ; gangrene.

I I Urine dark-colored, brownish-red, turbid, with floccu- lent sediment, sp.gr. 1017, acid, albuminous; sediment consisting of a number of red blood corpuscles and a large number of short, rather thick turbid cylinders studded with red blood corpuscles.

I I Albumen gradually diminished in quantity as less lead was found in urine; later, albumen rapidly increased, and there was not an atom of urea in urine, sp. gr. being 1002.

I I Amaurosis and cerebral symptoms appeared and ceased' coincidently with the appearance and cessation of albuminuria.

■ Hsematuria.

I I Complete suppression of urine.

I I Frequent vesical tenesmus: ineffectual urging to uri- nate; sometimes after much effort, which increases the pains, urine passes in drops.

■ Urine-: scanty, high-colored ; passed in drops; strangury;

will not pass as from atony of bladder ; dribbles, is high- colored and fetid; albuminous. I I Complete paralysis of urinary organs from spinal de- generation.

■ Much trouble with urine in not being able to pass it, ap-

parently from want of sensation to do so ; the will to dp so cannot affect it, as if from paralysis.

■ Chronic paralysis of sphincter vesicae.

I I Necrotic inflammation of bladder, caused by a decom- position of urea and formation of carbonate of ammonia, brought on by catheterization and introduction of bac- teride germs.

I I Urging to urinate every ten minutes; urine discharged in drops, with extreme pain; burning during and after urination ; sensation of constriction behind glans penis

489 PLUMBUM.

after urination ; urine at times containing blood ; < from motion; > from absolute rest; uses salt to excess. ^Strangury. ^^ Male Sexual Organs, i Increased sexual desire and violent erections. . .

I Slight provocations produce erections and emissions. _

■ Loss of sexual desire; impotence; chronic degeneration

of cord. 1 I Emissions, with relaxed organs, after wme. I I Prolonged, painful, spasmodic stricture. iTesticles: drawn up; feel constricted ; swollen, inflamed

and painful. I I Genitals swollen and inflamed. I I Prostatorrhoea.

■ Chronic gonorrhoea.

2' Female Sexual Organs. 1 1 Nymphomania.

a Wants to stretch limbs during ovarian pains ; ovarian

dropsy. I I Cessation of menses on invasion of colic; may reappear

after paroxysm, or not again until next period. I I Spasmodic dysmenorrhoea.

■ Menorrhagia, with a sensation of a string pulling from

abdomen to back ; during climacteric period dark dots, alternating with fluid blood or bloody serum, with a sensation of fulness in pelvis and bearing-down pams in small of back ; skin dry, pale, yellowish ; " liver spots" here and there; short of breath on going up stairs; debility; depressed spirits.

■ Vaginismus.

I I Strangulation of prolapsed portion of vagina ; intense

pain. I I Leucorrhoea, with inclination to miscarriage.

I I Mucous discharge from vagina.

*' Pregnancy. Parturition. Lactation. Feeling as if there were not room enough in abdomen, at night m bed ; must stretch violently.

II Pain drawing from abdomen to backbone, as_ it abdomen were drawn upward by a string; depression of spirits; constipation. Abortion.

■ She feels alack of room for foetus in uterus; inability ol

uterus to expand; threatening abortion.

Abortion from lead poisoning ; or, if born, the child lives but a year or two.

1 I Can scarcely pass urine ; apparently from want ol sen- sation to do so; the will to do so cannot effect it, as if from paralysis.

I I Puerperal eclampsia, especially with history of epilepsy; albuminuria.

PLUMBUM. 490

I Milk scanty and watery, with great emaciation.

I I Pulling, tearing, contractive pains in mammse, uterus, and vagina, with or without colic; the breasts be- come momentarily harder, or with" the colic they seem smaller.

I 1 Induration and inflammation of mammae. ^^ Voice and Larynx. Trachea and Bronchia. ■ Aphonia from paralysis of vocal cords.

Voice diminished both in power and vibration ; during paroxysms rough and stuttering speech or voice entirel}^ gone ; pants in talking as if out of breath.

Spasmodic closure of rima glottidis ; mucus rattling in throat, with sudden difficulty of breathing and asphyxia.

Lar^aigismus stridulus.

Constriction of larjaix.

I Bronchitis, with copious muco-serous or purulent expec- toration ; periodical asthmatic paroxysms. ^^ Respiration. Respiration anxious and sighing with lamen- tations and moaning.

Want of breath ; oppression from motion ; short breath on going up stairs.

Heavy difficult breathing.

Spasmodic dyspnoea ; sudden paroxysms force him up at night to the open window, with paralytic symptoms of laryngeal muscles. ^" Cough. I Cough: short, dry, nervous, fatiguing; dry, spasmodic; < during inspiration; with purulent expec- toration ; frequent, with bloody expectoration ; after hemorrhage from lungs, < lying on back and after getting out of bed in morning; dry, hacking, with tu- berculous diathesis ; in chlorosis.

Expectoration: copious, muco-purulent or purulent; tasting sweetish ; bloody. ^^ Inner Chest and Lungs, i i Pressure upon chest, with diffi- culty in breathing and short, dry, nervous cough.

Stitches in chest and sides.

I I Great emaciation : fever with evening exacerbation ; night sweats ; diarrhoea ; good appetite ; hectic flush ; constant cough, da}' and night, with profuse greenish, purulent, lumpy, blood-streaked expectoration ; dul- ness on percussion in apex of right lung, with rales. ^Phthisis.

■ Haemoptysis: phthisical disposition, when bloody or

purulent sputa alternate. I Haemoptysis, with pus and blood and stitch pains in chest. iPhthisis; suppuration of lungs; large vomica in lungs;

chronic cough, with bloody expectoration ; palpitation.

■ Suppuration of lungs.

491 PLUMBUM.

I Circumscribed pulmonary mortification ; also cheesy pneumonia. • i .

''Heart, Pulse and Circulation, i Palpitation : violent; spasmodic, with anxiety about heart.

1 1 Beats of heart very tumultuous, rapid and resonant.

Stitch in region of heart during an inspiration, with anx- iety, heat and redness of face; rushing of blood in region of heart, during a rapid walk; anguish about heart, cold sweat; violent palpitation and a sort of

angina pectoris. Hypertrophy and dilatation of heart. _

Change in muscular structure of heart without coincident disease of valves and with or without atheromatous de- generation of vessels ; usually hypertrophy and dilata- tion of 1. ventricle; ten cases out of twenty-five were associated with parenchymatous nephritis in stage of

atrophy.

I I Bruit de souffle at base of heart ; cat's fremitus at apex.

Pulse: rapid; weak and slow, about 40; variable, gen- erally small and slow, contracted ; at times hard and slow; at others small and accelerated; dicrotic or undulating. '" Outer Chest. Chronic myalgia.

^' Neck and Back. Tension in neck extending to ears when moving head. -14.

Pains in back sometimes > by bending forward, at others when bending backward.

Stitches in back and small of back and between shoulder blades.

Pain in back, with sensitiveness of affected spot, by lean- ing on it ; in afternoon > after rubbing.

Chronic spinal meningitis, with sudden loss of flesh ; painful contraction of limbs; colic with retracted

^ j> * -^-u

; I Wasting palsy: local paralysis, chiefly of forearm, with

atrophy of muscles and absence of anaesthesia. Multiple sclerosis : tremor of r. arm during voluntary mo- tion ; arms are " shaky " when he attempts to use them ; tremor of arms preceded by weakness and numbness; tongue trembles when being protruded or when he tries to articulate; speech dragging and slow; diplopia; dim- ness of sight ; neuritis of optic nerve. _ Paralysis: aneesthesia and hyperansesthesia in spinal