Atropinum

An alkaloid, obtained from Atropa belladonna. Formula, CuH^jNOg. Preparation, Triturations. (Most of the poison-symptoms were obtained from the sulphate of Atropine.)

Authorities. 1, Either, A. H. Z., 60, 11 et seq. proved 3d and 4th trits.) ; 2, W. S. Moffatt, Hale's provings, Trans, of Ham. Med. Sac. of N. Y., 6, 83 (proved the 2d dec. trit.) ; 3, C. S. Fahnenstock, ibid. (1st dec. trit.); 4, C. H. Chamberlain, ibid. (1st dec. trit.); 5, J. M. Smith, ibid. (1st dec. trit.) ; 6, Shrofi", Lehr.d. Pharm. (took .005 gramme) ; 7, Kafka, A. H.Z., 52, 178 (took g\f grain) ; 8, Harley, Old Veg. Neurotics (effects from subcutaneous injection of jgg to j'g gr.); 9, Lusanna, A. H. Z., 55, 157 (general statement of effects); 10, Woman (took part of a solution 2 grs. to 1 oz.), (prepared for the eye), N. A. J. of Horn., 1, 115 (N. Y. J. of Med.); 11, Sharply, Mon. Horn. Rev., 18, 39, from Lancet (took a sol. of Atrop. by mistake) ; 12, Blacker, M. Ham. Rev., 17, 481 (Rose E. took a teaspoonful of a lotion, 2 grs. to 1 oz.); 13, Andrew, Ed. Med. J., 1852 (girl 21 years took I gr.) ; 14, Piffingskold, A. H. Z., 54, 180 (took 6 drops of a sol., 5 grs. to 1 oz.) ; 15, Holthouse, A. H. Z., M. Bl., 1, 38 (child took ^ gr.) ; 16, A. H. Z., M. BL, 11, 59 (child took a sol., A gr. to^l oz.) ; 17, Well, A. H. Z., 1873 (Effects of Atrop. on conjunctiva) ; 18, Virch. Arch., 49, 450 gr. in sol.) ; 19, Virch. Arch., 48 (Effects of instillation into ej^e) ; 20, Chittenden, Med. Invest., 11, 478 (Effects from applying a sol. of i gr. to ^ dr. of water to a hollow tooth); 21, Hughes, poisoning of a boy 3-^ years old, by a solution of i gr. of Atropia, B. J. of Horn., v. 20; 22, Grand, in Pereira, Experiments with Atropine, to 1 gr. (see Hughes's Monograph on Belladonna) ; 23, Leach, Med. Times, 1865 (from Hughes) ; 24, Am. Journ. Ham. Mat. Med., Nov., 1872, from Atropia, gr. bisquater die, in a case of ulcer of stomach in a man of 40 (from Hughes) ; 25, Rose, Brit. Journ. of Ham., 27, 225 (from Hughes) ; 26, Pereira, Elem. of Mat. Med., 4th ed., London, 1855 (from Hughes) ; 27, Trousseau and Pidoux (from Hughes) ; 28, Practitioner, 4, 872 (from Hughes) ; 29, Ringer, in Practitioner, vol. 9 (from Hughes).

Mind, Emotions: Frenzied with excitement,^". — A long chill, followed by delirium, which had some resemblance to the subdelirium of certain typhoid fevers,^*. — Immediately upon closing the eyes, after retiring, the mind would become filled with strange and fanciful ideas, rambling, incoherent speech, special illusions, with frequent fits of wild, uncontrollable laughter. The delirium and spectral illusions continued through the night, during T^'which time I fancied myself afflicted with epilepsy, and was constantly fearful lest others should discover my unfortunate condition ; was nearly oblivious to all that transpired during the latter part of the night, but know from the bruises received and the sensations of pain occasionally experienced upon coming in contact with a stove, chair, table or some solid body, that it was passed in the wildest delirium (first day),l — Busily influenced by pleasing illusions and delusions, meddling with everything in his way, picking at and handling imaginary objects in the air, and accompanying his acts by muttering and smiling, or with loud chattering, interrupted by subdued laughter,**. — Frightful phantasies,^^ — Spectral illusions (first night),*. — On lying in bed, began to pick at specks and at the air,*^ — Picking at the bedclothes as if searching for something lost, with confused mutterings (first night),*. — At times, while it seemed to him that he was fully conscious, saw persons at the bedside and slowly reached out to grasp them, but his hand would pass through the object and no sense of touch tell him that there was any material in the apparition ; saw books and newspapers and tried to grasp them, but they would either recede or the hand would come in contact with them and feel nothing,*. — [10.] Mind has been wandering considerable of the time through the afternoon ; often thinks he is spoken to and answers imaginary questions (after ten hours),l — The symptoms during this period, six to nine hours after, exactly resembled those of delirium tremens. There was incessant rambling, great restlessness, a grasping at imaginary objects, and occasional screaming from fright. The character of the delirium varied ; sometimes the child saw objects which frightened him, and the utmost terror was depicted on his countenance, and he clung to his nurse's neck, or threw himself violently in different directions as if to escape them. Later, the delusions were of a more pleasurable kind, imaginary playing with toys, drawing, eating, etc.,". — Frequently, through the forenoon, thought that persons in the room spoke to me, and would carry on conversation with these imaginary beings (second day),^ — Now and then, he seems to have almost a consciousness of what transpires about him, so that, at times, he returns an answer, when addressed, whose commencement shows that he understood, but which passes into irrelevant, senseless talk,'*.— As to ray sensations, they were not blunted, but I misinterpreted them. Tims, I felt a wet cloth on my head, but supposed I had been out in the rain without my hat; and a dose of bromide of potassium given to me I recognized as a saline solution, but imagined it was mineral water from the Ai^rthry Springs which I had tasted on the spot some ten days before,".— The patient is busied with subjects which at other times occupy his mind, politics and stro-oles consequent on his relations in life,'l— Very restless and delirious, talking constantly about his affairs apparently,'\— Meddlesome delirium, and he will require attention to prevent him from getting out of bed, . "When put to bed, he struggles to rise almost incessantly,".— [20. "| He jumped out of bed several times, and insisted on dressing himself,". — Keeps his eyes closed, but on being spoken to loudly looks at speaker ; caught perhaps one word or a part of a sentence, repeated it, and said, " Oh, I shall lose my train,"". — Expostulates with those who try to lead him to bed ; says he will lose the train, that all things are packed up, and that he must start immediately,". — Resists when being undressed, saying continually that he will lose the train. Tries to put on his trowsers and fasten his necktie,". — I imagined I had to go off by a railway train, which started at ten in the morning, and that the hour was approaching, whilst I had nothing ready for the journey ; and I believed that I ^^shed to dress and to pack my things, but was thwarted and prevented by the people about me. At length I was persuaded that it was too late to catch the train, and agreed to wait till evening,". — Insisted repeatedly that her blood did not circulate, and that her feet must be put into warm water or she should die,^°. — Talked confusedly and almost unintelligible nonsense, on waking in morning,^l — Agitation and delirium, worse night,". — Violent delirium and restlessness (after four and a half hours),*. — Delirious and a little drowsy,". — [30.] Delirium followed by stupor,^ — Loud cries without any pains,". — Sadness,"". — Mentally either very sad, depressed in constant anxiety and restlessness, fearful of misfortune, or angry and inclined to be alone, seldom lively ,\ — Apprehensiveness followed his internal restlessness, and soon amounted to great anxiety,\ — Not quarrelsome or ill-tempered, but attempts to i-reason,". — Very sensitive,^^ — Constantly fretful,*. — I then became sensible that I was lifted into bed, and ordered on no account to rise, which I thought a most unreasonable restraint ; especially as I was tormented with irritation in the bladder, and almost incessant desire to pass urine, which was in very small quantity,". — Was generally restless and unmanageable, refusing to answer, to swallow, or to be examined ; appeared profoundly intoxicated (after one hour),*. — [40.] Evidently unconscious and very irritable, striking his mother when she took him from the nurse (after one hour),^'. — Incoherent quarrelling (after eight hours),*. — Morose, quarrelsome the whole day, everything went wrong; trifles which usually passed unheeded irritated him to anger,\ — Desire to scold and quarrel,^— Intellect : Upon making vigorous efforts to arouse hiui, he also exhibited some signs of consciousness,*". — When he closes his eyes the mind becomes confused and he sees all sorts of spectres (after thirteen hours),^ — Mind confused ; would commence a sentence, and forget what she wished to say,™. — Feel as though awakened from a dream (second day),^ — Appears dull and stupid (after ten hours),^ — Has only vague ideas of anything she said, or of what transpired that evening,^". — When left to himself he did not appear to drop off into coma as do those who have taken opium, but would occasionally open his eyes with a vacant, amaurotic expression, and turn his head from side to side,*". — [50.] At first, a slowness of intelligence ; ideas and replies are imperfect and indifferent,^^ — Dull and stupid all the afternoon (after six hours),^ — Cannot be made to understand where he is, that he is ill, or that he must keep quiet,**. — First, indolence of mind, then vertigo, and a condition of commencing intoxication,*. — Feels dull and not inclined to move about or to converse (after one hour),^ — Indisposition for mental labor,*. — No desire for his ordinary mental labor,*, — Prover was dull and disinclined to study for several days,^ — For several days a difficulty of fixing the attention upon anything for more than a few minutes at a time,^ — [60.] The prover was absent-minded at intervals for several days, and found difficulty in fixing his mind upon any subject for more than a few minutes at a time,^ — Loss of memory (after eight hours),*. — His memory is wrong, inasmuch as he thinks that what really happened from the eleventh to the twelfth, took place in the night from the tenth to the eleventh (after sixth day),'\ — Am absent-minded and forgetful ; when conversing often partly finishing a sentence ; was often obliged to stop and inquire what I had been saying (second day),'\ — He recognizes, momentarily, members of the family ; apparently notices when the door opens or one is busy about him, but, when spoken to, often turns his head to the ivrong side,^^. — Unconscious,^" — Unconscious, with incoherent speaking at internals,". — Comatose,'".

Head p. 611

Confusion and Vertigo: Head feels dull and unpleasant (after eleven hours)

Dull sensation in the head, with feeling as if his hair had become matted into a thick felt (first day)

Head very much confused; could be held up with difficulty

Head confused, as after a disturbed night; relieved on going into the open air (morning, second day)

Dizzy confusion of the head, evenings, alternating with vivid phantasies; gi-eat fatigue of the whole body, and at times ringing in the ears

Some vertigo (after one hour)

Some vertigo (after three hours)

Considerable vertigo (after seven hours)

Vertigo, iu consequence of which I was obliged to lie down,l

Vertigo at intervals, lasting but a moment at a time (after one hour)

Vertigo caused by turning the head quickly (after one hour)

Considerable vertigo, particularly upon turning the head suddenly (after half an hour)

Vertigo and confusion of the head, on waking, which increased on rising; vertigo so that he came near falling

Vertigo on rising iu the morning, so that it became dark before his eyes

Has had slight vertigo at intervals during the forenoon (second day)

Slight vertigo and pressure iu the temples with little or no pain (after a quarter of an hour)

Awoke very dizzy ; cannot walk across the floor, but staggers towards objects for support (after three hours),l

Giddiness

Giddiness, heaviness, drowsiness, or actual sleep, with great tendency to dreamy delirium, and, in women, slight occasional startings (from grain)

Awoke still feeling quite dizzy (second day)

Continued giddy, but walked steadily, though slowly and cautiously

Dizziness upon moving the head suddenly (after eleven hours),l

Dizziness upon moving the head quickly (second day),l

Dizziness when attempting to walk (after two hours),l

Pains: Head hot (after four hours),'l

Head very hot

Head hot (after ten minutes)

Head feels hot (after one hour)

Head and face much flushed and hot ; pulse full, bounding, and irregular

Head subjectively warm, but not painful ; cold applications are grateful (second day)

Head feels full and uncomfortable (after two hours),l

Feeling as if the head was screwed up ; walking caused the most severe sticking pains; relieved toward 11 a.m., and disappeared by evening

Dull pain in the head continues, with dizziness upon moving suddenly (third diij)

* Sticking pains in the base of the skull, and especially over the eyes, on every motion, and especially on stepping

Sensation of fulness in the anterior part of the brain (after one hour),l

Slight pain in the entero-superior cerebral region, coming on shortly after taking the drug continuing through the night and next day

Headache commencing in the middle of the forehead (fifteen minutes)

Fulness in the forehead and head hot, but at no time any throbbing of the carotids or arteries of the head

Slight fulness in the front part of the head, and dilatation of the pupils

Dull pain in the forehead, with dizziness on moving suddenly

Pressive pain in forehead

* jFi?ie, drawing, very sensitive stitches across the forehead and temples; recurred every four to ten minutes, and lasted several seconds or a minute

[110.} Slight pain in the temples (after half an hour)/.

Very slight pain in the temples and eyes (after twelve hours)

Fulness of temples and also of forehead, with very slight pain ; can scarcely walk, am so dizzy

A feeling of fulness and pressure at the temples

Slight pressure in the temples (after one hour)

Feeling in the head as though the temples were being pressed from without ; pressure worse on the right side (after one hour)

* Dull pain in the temples, coming on at intervals of perhaps a quarter of an hour, and lasting a Jew minutes. This pain is not severe, but seems like a deep heavy pressure ; at other times it is a steady tension in the anterior cerebral region, as if the brain was being pressed outward in all directions (first day)

Has a dull bruised feeling in the temples (after nine hour-s)

* Venj sensitive sticking in the left temporal region on waking in the morning ; it extended to behind the ear, and scarcely permitted him to open his left eye ; disappeared after moving about in the open air

Throbbing in the temporal regions (after ten minutes)

Feeling of pressure-e under the parietal bones

Eyes p. 612

In general: Strange appearance of the eyes, as though projected from their sockets (after one and a half hours)

Eyes appear fixed and glassy (first day),l

Eyes look glassy and congested (after one hour)

Glittering, excited eyes

Eyes restless (after one hour),l

Eyes move restlessly hither and thither (ordinarily, his look is not steady)

Simple inflammatory swelling of the mucous membrane, with muco-purulent secretion, often accompanied by swelling of the lachrymal sac, occasionally with less swelling, but more marked hyperemia and flow of tears

Eyes considerably congested, but the pupils have scarcely commenced to dilate (after one hour)

Eyes feel wearied (second day),l

Considerable pain and lachrymation

Slight pain in the eyes continued for about two hours, accompanied part of the time by an unpleasant sensation of fulness and pressure in the anterior part of the head, making me restless and uneasy

Eyes feel swollen, and pain in the eyes and temples slightly increased with each pulsation of the heart (after twelve hours)

Dull pain in the eyes and head

Dull pain in the eyes, and slight pain in the temples (after one hour)

Deepseated dull pain in the back part of the eye (after ten minutes)

Eyes and lids feel sore to the touch (after nine hours)

Brow, Lids, etc.: * Sharp pain under the right eye, with slight pain in the temples (after four hours)

Neuralgic pains, commencing under the left orbit, and running bach to the ear, lasting perhaps ten minutes at a time, and then disappearing for fifteen or twenty ; these have been noticed for several hours (second day)

Redness and excoriation of the skin of the eyelids

Eyelids swollen (after one hour)

* Avoid 9 p.m. eyelids felt heavy and difficult to keep open; yet she had no inclination to sleep

Dull, heavy, aching pain in the eyelids, not severe (second day)

Eyelids feel sore, are red and congested (second day)

I have myself once or twice experienced slight congestion of the entire conjunctiva, with dryness of the membrane and dull aching pain in the eyeball, after the use of a very weak solution of Atropia. On one occasion this condition followed the instillation of 12 drops of a solution of 1 part of Sulphate of Atropia in 400,000 parts of water

Slight injection of the conjunctival membrane

Conjunctivae vividly injected (after one hour)

Acute erysipelatous inflammation and swelling of the conjunctiva and eyelids

Atropine conjunctivitis

Severe pain in the left eyeball (after nine hours)

Slight pain in the eyes continued ; it is as if the eyeballs were pressed from without in every direction (after twelve hours)

Pupils not unusually dilated, but perfectly immovable/

Pupils dilated/.

Pupils somewhat dilated/.

Pupils very much dilated ; spectral illusions continue (second day)/.

Both pupils dilated, but not ad maximum

Excessive dilatation of pupils (first day)

Complete mydriasis

Pupils are still dilated ; can see to read quite distinctly for a few minutes, after which the letters, words, and lines run together and become indistinct (second day)

Dilatation and immobility of the pupil

Pupils slightly dilated; conjunctiva not injected/

Pupils still dilated, with diplopia (second day )

Pupils considerably dilated ; vertigo increasing (alter one hour)

Vision: Dimness of sight (after a quarter of an hour)

Dimness of vision (after eleven hours)

Dimness of vision, and bright circles of a golden color dancing before the eyes,'l

His difficulty in seeing small objects which were near him (the pupils were still dilated) was now the most prominent feature remaining of his illness (after twentyfour hours)

Only a circular line of iris visible ; was nearly blind ; a thick cloud obstructed vision, and images were confused, with a reddish tinge (after one hour)

Can see but little ; pupils considerably dilated, but contract readily under the influence of light (after three hours),l

Objects appear at first enveloped in a white vapor; the contours are no longer distinct ; if the dose is increased, almost complete blindness may ensue, -'I

Disturbance of vision ; objects seem enveloped in a cloud (the obscuration increases with the dose) ; even complete blindness ensues, but disappears in a day or two after ceasing the medicine

Vision obscured ; pupils dilated ; eyeballs injected ; she seems to see nothing about her,'l

Could see nothing (first day)

After looking at objects a few minutes, they become indistinct and fade from view (after two hours),l

While reading a book, the letters gradually grew indistinct, and seemed wavering- before the eyes,l

Can see to read a little, but after a few words the letters grow indistinct, and am obliged to close the eyes to rest them (second day),l

While talking with persons, they suddenly vanish (second day)

Eyes intolerant to light (second day),l

The eye is sensitive to the light held in front of it, which, however, does not affect the dilatation of the pupil,^l

It is impossible to cause color-confusion by the use of Atropine, but partial color-blindness may be induced by either the internal or external use of it. The impressions made by color are altered by Atropine as regards strength exactly as they are by the different degrees of solar light on different days

On several occasions through the night she had vision of great numbers of white flies on the door, which was white, and requested that they be brushed off. They were not in motion, and were rather smaller than the common housefly. This perversion of sight continued until noon of the following day, on closing the eyes

The medicine produced temporary bright spots and stars before the eyes, and a brilliant glow around the letters, which frightened him greatly

Bright flashes before the eyes, immediately on closing them (first night)

On one occasion my patient was much annoyed by the appearance of a large black bug, with veritable legs, a few inches below a black doorknob

On the following morning, imagining she saw a worm a thousand-legged worm on her carpet, she sprang out of bed, and was found trying to find it • failing- in this, she would look in another place and see it agar. This illusion kept her busy some time, before fully satisfied of the fallacy. The color of the worm was brown, the predominating color of the carpet

Illusions of sight; during the increasing dimness of vision, manifold pictures of gigantic figures, whirls, double images ; enlarged appearance of all objects ; laughable or frightful appearances of all kind,s

Objects round or oval seem elongated; for example, the human figure was distorted so that the vertical diameter of the face seemed equal to the rest of the body; especially prominent were the nose and chin, which seemed of considerable length, and their margins enveloped in a mist ; these appearances lasted some hours, for as I woke at half-past three, these images still floated clearly before the eyes; the pupils (on the next day) were very large and sluggish

First noticed diplopia (after five hours)

The next day these appearances were verified, though in a less degree ; all objects seemed really elongated, especially the ears looked like Midas ears, and seemed to overtop the head ; a round rubber ball looked eggshaped ; the table looked oval rather than round (lasted till 10 A.M.)

Vision much impaired ; the figures on the carpet, which were large, appeared to be constantly and successively rising up to her face (perpendicular diplopia, the apparent object below the real one)/

As late as a week she still experienced a sense of giddiness,, and the figures on the carpet would at times appear to her double

Quick rotation and duplication of objects

During the evening the eyes of the lady attendant seemed to her very large, and she could not avoid looking at them

Upon looking at a newspaper the letters seem to expand and contract with each pulsation of the heart ; can read but little (second day)

In attempting to walk, would reel and stagger, catch at objects which appeared to me in close proximity, but which in reality were far from my i-each ; would often stumble over objects which to me seemed to be many feet away (first day)

Cannot estimate distances correctly ;, when asked to put his hand upon an object within his reach, he either reaches too far or not far enough (after seven hours)

Entire loss of power to compare objects with the eye and determine their respective distances (first day)

Ears p. 614

Throughout the succeeding night the hearing and sight were morbidly sensitive

At night, when the eyes were closed, though not sound asleep, he heard every noise and every voice in the room and yard

Exquisite sensibility of hearing, and frequent illusions of this sense also

His attention cannot be attracted without speaking loudly to him

Perceptions of noise, tinkling sounds as of bells, etc.

Some roaring in ears

Illusions of hearing, ringing, roaring, etc.

Nose p. 614

Mucous membrane of the nose dry (after one hour)

-Dryness of the mucous membrane of the nose and eye

The dryness (of the throat) very often extends to the mucous membrane of the lower passage of the nares

He sneezed and rubbed his nose frequently

Face p. 614

Expression of mania

Looks and acts as if he had been on a spree (after seven hours)

Pale, slightly sweating face

Flushing of the face

Face flushed (after one hour)

Flushed face; burning in the face (after a quarter of an hour)

Face slightly red.'l

* Face hot and very red

Face red, with white spots,'l

* Twitching of the facial muscles, especially around the mouth and lids

Only the reddened face is warmer than the rest of the body Parched state of the lips,l

Mucous membrane of the lips dry and parched ; water affords no relief (after two hours)

Mouth p. 614

Teeth and Tongue : Teeth and lips dry, and covered with sordes

Teeth feel on edge (first day)

Tongue slightly coated white (second day)

Tongue thickly coated with whitish mucus (after one hour),l

Tongue thickly loaded with a dirty gray fur (second '^'iy)

Tongue coated whitish on margins, and yellow in middle/

Tip and edges of the tongue light red ; tongue trembles when protruded from the mouth (after one hour)

Anterior part of the tongue or whole of the dorsum, excepting a wide margin, will be found dry, brown, and rough

The raucous layer of the tongue becomes completely dry, brown, and hard Ut) grain),l

Tongue trembles when protruded (after three hours)

When asked to protrude the tongue he does it with difficulty, and only after considerable effort; cannot move the tongue about in the mouth at will,l

The tongue (shown one when desired), was protruded with difficulty and incompletely

Tongue thick, cannot articulate distinctly (first night)

The tongue and other muscles assisting in speech were difficult to move,'l

Tongue seemed partially paralyzed

Tongue moist, coated whitish-yellow (second day)

Tongue dry

Tongue and mouth dry (after half an hour)

Tongue dry and furred (after forty-eight hours)

Dorsum of tongue dry and parched, and the entire Loof of the mouth and velum palate dry and glazed

Complete dryness of the tongue, roof of the mouth, and soft palate, extending more or less down the pharynx and larynx, rendering the voice husky, and often inducing dry cough and difficult deglutition

Dryness of tongue and fauces (immediately)

Mouth: The mouth opens but little; masticator muscles rigid

Thick, viscid, or slimy mucus in the mouth, I

Thin coating of viscid, slimy, white mucus over the entire buccal cavity (second day)

Mucous membrane of mouth dark-red (second day)

Loss of sensation in the buccal cavity, with complete loss of taste. When swallowing water from a tumbler, I could not be persuaded that I had drank any until convinced by looking into the glass (first day)

Can drink water without difficulty, but produces no sensation in the mouth or throat, except a slight feeling of coldness ; is scarcely aware when he swallowed it (second day)

The hard and soft palate perfectly dry and glazed

Buccal cavity feels hot (after one hour),l

Saliva, Taste, and Speech: Great dryness of the mouth

Mucous membranes of mouth dry

Dryness of the fauces, seems extending over the whole mouth, I

Dryness of the throat has extended over the entire buccal cavity (after two hours)

Mouth very dry, so dry that upon inserting the finger, it will not be moistened (after two hours)

Food will remain in the mouth for minutes without becoming moistened in the least

The hard palate and the anterior part of the tongue and the soft palate dry, but not parched or glazed

Dryness of the mouth continued through the night,l

Dryness of the mouth has increased and now extends to the lips, which feel dry and parched (after half an hour),l

Those parts of the mouth which are adjacent to the median plane are so completely parched that they fail to impart the least moisture to a bit of bibulous paper or sugar, kept in contact with them for several minutes. It is observable that this dryness is greatest along the median line and on either side of it, and that after moderate doses it extends only a short w^ay outwards. Dryness of the lips, the buccal mucous membrane, and the pillars of the fauces, only occurs after large doses ; but a very moderate dose is required to render the central part of the tongue dry and parched from back to front, and the hard and soft palates and back of the oesophagus as dry and glazed as a piece of paper

Mouth very dry; no thirst; cannot feel the passage of water through the mouth or throat when drinking (after ten minutes)

Mouth and tongue very dry, with great difficulty in swallowing (after one and a quarter houi's)

Dryness in the mouth, and especially in the throat, reached such a degree that ou attempting to eat a piece of bread and butter he could not swallow it, unless he took water (two to three hours)

Dry mouth and fauces

Dryness of the mouth and fauces increased, so that swallowing became almost impossible

Gradually increasing dryness in mouth and fauces (in two hours), which became so severe in one hour that he could not speak a word, and the tongue almost stuck to the roof of the mouth

Could swallow no breakfast on account of deficiency of buccal secretions to moisten the food (second day)

Had great difficulty in swallowing food, ou account of non-secretion of saliva ; food will remain in the mouth for minutes without becoming moistened in the least (after one hour)

While the mouth continues in the dry condition above described, the salivary glands appear quiescent, and the morbid state of the tongue and palate renders it difficult, if not impossible, to excite a flow of saliva by gustatory impressions ; but they readily pour out abundance of secretion when an appropriate stimulus reaches them. In a patient who was suffering from severe neuralgia of the face, associated with profuse salivation, the secretion was in no degree diminished when, as occasionally happens, a severe paroxysm of pain came on during the action of a full dose of Atropia

Stoppage of secretion of saliva; smoking does not bring any saliva into the mouth

After continuing about two hours, the dryness of the mouth is suddenly relieved by the appearance of a viscid acid secretion of an offensive odor, like the sweat of the feet. The mouth becomes foul and clammy, and a bitter coppery taste is complained of

Excessive secretion of saliva (second day)

Everything tastes salt (after one hour)

Same slimy taste in the mouth (after three hours)

Slight sweetish taste in the mouth

Food all tastes alike, like sawdust; tastes dry and cannot be swallowed except by washing it down with some liquid, owing to the deficiency of secretion of saliva (after two hours)

Food is tasteless (after half an hour)

Difficult speech

Speech thick, probably from dryness of the mouth and throat

After many days action of Atropia, there manifested itself a slowness and embarrassment of articulation of words,^l

Frequent stuttering, especially at words difficult to pronounce (never used to do so), (sixth day)

Articulation indistinct, rapid, and chattering

Throat p. 616

Slight throbbing or heaving sensation in the carotids

Mucous membrane of the throat slightly darker than in health, and presents a mottled appearance (second day)

Constant choking in the throat, which was soon followed by an almost complete inability to swallow, with a feeling as if seized by the throat

In a few minutes a feeling of dryness in the throat, causing constant inclination to cough

On the third day he complained of sore throat, and inability to pass his water

Intense feeling of dryness in the throat, which abated toward morning

Shortly after taking the drug, a sensation of dryness in the throat

Dryness of the throat and feeling of pressure in the anterior and superior cerebral regions

Great dryness of throat and mouth (twenty to forty minutes),l

Violent burning in throat

Burning in throat and stomach

Slight feeling of fulness in the throat (after half an hour)

Soreness of throat increasing till quite hoarse (after eleven hours)

Throat has been quite sore for the past six hours ; pain upon swallowing (second day)

Throat feels raw and irritated (second day)

Throat feels raw and sore (after seven hours)

Drops of white mucus sticking to the uvula (after ten minutes),l

Fauces and uvula red (after ten minutes)

Slight dryness of the fauces

Dryness of the fauces (in two hours)

Feeling of dryness in the throat, causing constant inclination to cough ; swallowing water affords relief

Swallowing difficult, but not impossible

Feeling in mouth and throat made her think she "could not swallow but when impressed with the necessity of so doing, she drank with avidity the warm water offered, though at first it seemed quite dmeuh

* - Swallowing appeared to give pam, manifested bij grimaces and increased spasms of the facial muscles

* There ivas great difficulty in getting the child to swallow, each attempt to do so producing paroxysms of suffocation, which appeared to threaten his existence

Difficult deglutition, every attempt to swallow caused suffocation

Dysphagia, parallel with the dryness of the fauces

Difficulty in swallowing on account of dryness of the throat

Stomach p. 617

With constant hunger, was soon satisfied, the food seemed tasteless

Increased desire for salt food (anchovies, herrings, smoked meats, etc.)

Ate a light supper, having to wash the food down with water (after seven hours)

Aversion to meat and beer ; beer increased the empty feeling in the stomach and caused a painful pressure; this aversion to beer and the unpleasant symptoms caused by it continued through the whole proving

Appetite wanting (second day),'l

Loss of appetite (becomes after the drug-influence violent hunger)

No thirst, in spite of the dryness of the throat

Thirst moderate (second day)

Frequently asks for water to drink

Thirst greatly increased, threefold

Frequent empty eructations without relief

He had eructations tasting like the yolk of eggs, at intervals through the day (after ten hours),l

Nausea (after quarter of an hour)

Slight nausea (after one hour),l

Slight nausea (after ten minutes),l

Slight nausea, lasting but a few minutes ; these coming on again after an interval of half an hour (first day), I

Nausea, and transient inclination to voaiit

Fruitless vomiting of colorless mucus, and afterward of green bitter fluid after the morning vertigo

Vomiting, readily induced by drinking warm fluids (after two and a half hours),l

Vomiting after drinking milk, 'I

Hurried from bed and vomited profusely; easy vomiting of a watery fluid, tasting bitter at first, nearly tasteless afterwards ; during the vomiting, very severe sticking pains in the umbilical region ; vomited about five minutes, and then staggered back to bed (after eleven hours)

Great distress in the epigastrium, which seemed indescribable

Uncomfortable sensation in stomach (in fifteen minutes)

Uneasy sensation in the stomach, accompanied by frequent empty eructations, affording no relief The uneasiness, which gradually became associated with nausea and retching, increased to a pressing, sticking, and contractive pain, accompanied with frequent empty eructations. This spasm of the stomach, which was attended with paleness of the face, slight perspiration, singing in the ears, and an aching pain in the forehead, lasted two hours

Beer caused a constrictive pain in the stomach like a stomach-cramp, which obliged him to sit down, was increased by Walking; with copious eructations of air; though this pain steadily increased it completely disappeared after three hours

Some sensitiveness to very strong pressure in gastric region (after fourteen hours)

Much relief after vomiting, produced by copious draughts of warm water

Abdomen p. 617

Abdomen a little tense (after fourteen hours)

Abdomen swollen and tense, but not tympanitic; upon pretty firm pressure upon it, patient gave signs of suffering

Stool and Anus p. 617

Paralysis of the sphincters of the rectum and bladder

Paralysis of sphincter ani with involuntary fecal discharges (in three patients, from I j grain and upwards)

Hurried from bed by urgent desire to stool, followed by very copious watery stool coming with a gush. This stool relieved the pain in the umbilical region (after thirteen hours)

Another copious stool (after fourteen hours)

Arose and immediately had another copious, watery stool (second day)

During stool, felt badly generally, weak and terribly nervous, with general perspiration

In the stool, thin fluid seemed to be mixed with urine (after three hours)

Stool, only two to four days (in health, daily)

No evacuation for five days, and then only induced artificially

JJlhui7'lf OvgdUS.

Tenesmus and frequent desire to pass urine (after four and a half hours)

Frequent desire to micturate, passing only a moderate quantity of urine

Constant and frequent desire to pass water, but inability to do so

Incontinence of urine, and involuntary fecal discharges

Urine profuse ; first at 6 p.m. (after twelve hours)

Has had profuse urination for the past twenty -four hours (second day)

Urine passed slowly and increased in quantity (after three hours)

Frequent micturition at night

On the night of the first day, between 10 and 1 oclock, was compelled to urinate as often as ten or fifteen minutes, without pain. The quantity voided was profuse and almost colorless

Urine and thirst increased

Urine not increased, notwithstanding the dryness of the skin

Passed very little urine

On the fourth day he passed his water in drops and with great difficulty

Catheterism was required during the next four days

Dysuria, or more or less complete retention of urine for two or three hours, or longer, invariably follows the action of a full medicinal dose of the drug

No urine for nine hours (first day)

No urine passed for thirteen hours

He had passed no water since the preceding evening ; bladder not distended

Urine clear and corresponded in amount to the water drank (increased)

Urine acid, dark, brownish, without sediment, and containing Atropine

Respiratory Organs p. 618

Drv tickling cough, periodic, with a sore feeling in the throat and pressure on the chest; excited by speaking or smoking

Has had several paroxysms of coughing, caused by the collection of mucus in the throat, occurring once in fifteen or thirty minutes, attended with the difficult expectoration of a thick, tough mucus; after coughing, burning in the throat (second day)

Small quantity of thick, frothy, white sputa is ejected at intervals (after ten minutes)

Huskiness of voice (twenty to forty minutes)

She tried to call out but her voice refused her

The voice is sometimes weakened, or there may be complete aphonia

Sensation of choking in an hour after the first application

Respiration 28

Chest p. 618

Feeling of warmth as of a glow through the thoracic region (after half an hour)

Heart and Pulse p. 618

Heart's action irregular and apparently obstructed

Weak doses accelerate the heart and increase blood pressure ; poisonous doses have the reverse effect

Distressing fluttering sensation in the cardiac region

Pulse of fair fulness and strength

Pulse very weak (after two hours)

After ten or fifteen minutes, an acceleration of the pulse from 20 to 70 beats; no apparent change in volume, but a decided increase in the force of the cardiac contractions and of the arterial tone

Pulse accelerated, increased in volume and power (after ten and twenty minutes) ; if previously slow and feeble or intermitting, the change will be very decided ; the acceleration amounts to 20 to 25 beats per minute; it will take place suddenly and attain its maximum within one or two minutes ; after being maintained for half an hour a gradual decline takes place, and the heart soon returns to its usual state, and continues to beat as quickly and powerfully as before; just as the pulse rises a slight giddiness is often perceptible

Pulse sank at first ten beats, but soon began to rise, and in an hour and a half had increased forty beats

As moisture returns to the mouth, the pulse is observed to fall, and it now rapidly resumes its ordinary rate and character

She was able to rise in the morning, when the pulse was frequent, small, and irregular, and she complained of lassitude

Pulse 150, small and weak (after one hour)

Pulse accelerated to 140, with increased tone, but diminished volume

Pulse 138 (after one hour)

Pulse 136 ; heart's action greatly increased (after one hour)

Pulse 132 (after one hour)

Pulse 130, but not so full (after ten minutes),l

Pulse 130, and small

Pulse 124,1

Pulse 116 (after half an hour)

Pulse 112 (after one hour)

Pulse 112 (after one and a quarter hours)

Pulse 112; is hot and feverish (after three hours)

Pulse 112, lying down. Pulse had been taken until now ■when the prover was standing (after two hours)

Pulse 110, irregular, generally full, but varying much at intervals

After twenty minutes, pulse 110, unchanged in volume and power

After one hour', pulse 108, unchanged

Pulse 108 (after forty-eight hours)

Pulse 106-110 ; regular', somewhat fuller ; pulsations more defined (after fourteen hours)

Pulse 104 (after one hour)

Pulse 104; regular, not full, easily compressed ; the single pulsations not sharply defined (after three and a half hours)

Pulse 96, full and soft ; has been full and soft for several hours (after seven hours)

Pulse 86, full and soft (second day)

Pulse 76 (after twelve hours)

Pulse, 72 ; full, distinct (after twenty-four hours)

Pulse 60 (after thirteen hours)

Neck and Back p. 619

Cold sensation along the spine

Extremities in General p. 619

Weakness of the limbs

Partial paralysis of the arms and legs (after eight hours)

In proportion as the doses of Atropia augment, the limbs, and especially the lower, though still under control of the will, become heavy and inactive

The feeling of numbness and heaviness in the limbs was so great that she feared the result of going to sleep lest she should never awaken

Extremities cold

Upper Extremities p. 619

Constant, restless throwing about of the arms, hands, and fingers of both sides, similar to the movements in typhus delirium

Continual opening and closing the hands, and grasping at imaginary objects in the air (first day),l

Hands feel smooth and glassy (after ten minutes)

Hands feel dry and glossy (after two hours),l

Slight numbness and prickling in the hands, extending to the tips of the fingers. The prickling soon ceased, but the numbness continued and increased, till in a short time there was complete loss of sensation (first day)

Hands cold (after two hours)

Numbness of fingers, with partial loss of sensation ; cannot tell when I am holding small objects in the hand (after two hours),l

Numbness and partial loss of sensation in the fingers ; feels as though he were holding a book in his hands, which he is afraid he will drop ; upon taking a small object, as a pin, into his hand, it appears to him as though there were five or six of them (after one hour),l

Lower Extremities p. 619

Dragged the legs when compelled to walk (after two hours)

Stiffness in left knee and lower leg and in right great toe, though no pain (second day)

Has had slight jactitation of muscles of leg (after thirteen hours),l

Has awakened several times in the nio-ht by spasmodic jerkings of the muscles of the legs (first night),l Frequently wakened from sleep by sudden kicking out of the feet

Her limbs felt like sticks ;" thought she could not use them to walk across the room to the sofa, but with aid did so with considerable difficulty/

Generalities p. 620

After moderate doses the whole circulation is increased in force and rapidity. The force of the larger arteries is good, and if the circulation was previously slow, we find that they are usually increased in volume as well as in tone

Different parts of the body were affected with spasms

In women slight occasional startings

Occasional jactitation

Convulsive trembling in one or another muscle but never cramp ; as consciousness disappeared these movements became automatic, as carphology, convulsions

For the past two hours has had occasional spasms of the voluntary muscles, particularly those of the extremities (after eight hours)

During the last half hour has had several slight spasms of the muscles of the limbs and one of the entire body (after four hours)

At times during the night when nearly lost in sleep, she Avould suddenly start as if frightened

Jerkings of muscles, particularly those of the legs, arms, and face. When attempting to drink from a glass, arm suddenly contracted and the water was spilled. While walking, the flexor muscles of one or both legs would suddenly contract, throwing me to the ground ; do not dare to walk across the room for fear of falling (second day),l

Clonic cramp in face and extremities (moves arms forward in front of chest)

Clonic spasms of the biceps flexor cubiti and of the muscles of the jaw

Spasms not diminished ; could not hold a vessel of fluid in his hands nor carry it to his mouth

The spasms of the muscles above spoken of were increased by disturbing the patient ; when left to himself, they come on at intervals of two or three minutes

Busy with his hands pulling the bedclothes about

Able to walk home, a distance of a mile ; but when he reached the house he could not put the key into the door because he felt so stupid and shaky in the hand and had to seek assistance

Displays considerable strength, but his movements are unsteady, as if he had lost some control over his limbs ; for, when he tried to wipe mucus from his lips he raised his right hand with apparent difficulty a short way from his mouth, and then, with an effort and rather unsteady movement, raised his left hand and touched his lips

It was impossible to keep him in bed, and very difficult to prevent his walking about (after two hours)

Restless, constantly tosses about in bed and moves the head to and fro

Restlessness, and frequently great nervous agitation of mind and body

Restless and slept none

Continued tossing about and changing position in bed ; did not sleep any till next morning

Restlessness, a desire and inclination to perform all movements hastily and rapidly, becoming at last a desire to fight, so that the two provers who at the same time and place had taken the same dose, actually began to scuffle and wrestle, which they never before did

Has been nervous, wakeful for the last three hours (after eleven hours)

Although I could move my body and limbs, it was only by a great effort, and when I raised my arms they fell as if made of lead. This I ascribed to partial paralysis of the raotoV nerves, and I watched with some interest the return of power as the night advanced

Gait unsteady

Gait weak, totter-ing, the person must at last lie down

Staggering, or complete inability to walk

Very weak and unsteady in his gait (sixth day)

Very weak in the open air

Great weakness of muscular action, some transient but general trembling of the limbs, so that the gait was tottering, like a drunken person

Morning, felt very weak, could not decide to rise; lay in a half dreamy sleep ; after he was dressed great desire to lie down again

Inability to rise, although he makes efforts to do so

Patient keeps the recumbent posture on his back, and only at times makes attempts (which are easily repressed) to rise up and get out of b8d

Lies on left side,^l

Sight and hearing morbidly sensitive (1 gr.)

Daring the succeeding night he was morbidly sensitive to sounds and objects, with symptoms akin to the early stage of meningitis. Pulse in the morning 108, furred tongue and hot, dry skin,^l

Felt faint, and greatly in need of fresh air

On asking loudly if he had any pain in the head, he replied No pains whatever

Torpor and paralytic trembling

Anaesthesia, absence of all pain, slight sensibility to painful pressure, only touch seems very little influenced

Thrusting pins into the skin causes no sensation of pain ; water, either warm or cold, glides over the surface of the body without moistening it or producing any appreciable sensation. This anaesthesia continued several hours (first day)

Lost the power to estimate distances, either by the eye or touch ; touching an object does not produce the slightest sensation. Upon attempting to place the hand upon a table, cannot tell when the hand touches it (first day),l

Was unable to feel the arms and legs, and being alarmed called for help (after one-quarter of an hour)

General discomfort

Skin p. 621

Redness of the skin (after thirty to sixty minutes)

Skin burning hot and dry, red ; child scratched it

Skin feels hot and dry ; lips covered with dry mucus

Skin very dry and hot with a general feeling of biting and tickling as from vermin (forty minutes)

Skin hot and pungent

Skin pungently hot and dry, and covered with a rash closely resembling that of scarlatina, which the child was frequently scratching

The skin of the whole body began to feel tinged (?) and swollen (after fifteen minutes). In about an hour and a half it was covered with a rash precisely similar to that of scarlatina

Sleep and Dreams p. 621

Gaped very often, and said he should soon be asleep if he were in bed,l

Tendency to sleep (after one hour)

Somnolency

Somnolency and perversion of ideas

Somnolency, with sometimes a little flushing of the face (from gr. g'g)

Feels drowsy and not inclined to speak or move about (second day)

Felt sleepy and a little giddy

Heaviness, drowsiness, or actual sleep, with a great tendency to dreamy delirium

Had slept, and continued very drowsy

Was restless and uneasy through the night, but slept considerable of the time (second day),l

Was very restless through the night; dreamed of running horses; of playing baseball; of amputating a man's leg; saw dim, shadowy forms sitting or standing by the bedside or moving in the air (first night)

Arose feeling uneasy and unrefreshed (second day),l

Arose, feeling weary and unrefreshed (second day),l

Insomnia

Insomnia (after eight hours)

Wakeful and delirious (after eight hours)

Sleeplessness till one at night and then frightful dreams

He will have little or no inclination to sleep, but instead of this a little moderate delirium (from gr. a'^)

Troubled by dreams, and at intervals disturbed by a start. A fancied noise is a common cause of awakening, and at these times the patient generally manifests a little delirium

Dreams pleasant, of flying in the air, etc., so that he woke in the morning happy and continued so the whole day

Frightful dreams; wake from sleep three times in the night

Dreams of being frightened, pursued, great exertion, etc., etc., all of which fatigued him, some of which made him powerless, and he rejoiced, when wakened by a loud cry, to be rid of his unnatural state. His wife said that he was restless and sighed during sleep/.

Fever p. 622

Skin rather cool than warm on forehead and head/

Chilli ness and cramp, and tingling of the extremities (after one hour)

Internal coldness with external burning heat of the whole body ; toward 6 P.M., it became so great that he was apprehensive, and so restless that he could not remain anywhere; he hurried home expecting misfortune; scarcely had he entered the house when he had to seek the open air, only to return again to the house ; at 7^ P.M., he lay down hoping that the restlessness would go away by sleep; could not sleep till toward eleven; he tossed about in bed, with audible and perceptible palpitation and anxiety as great as if he had committed a great crime

General diffusion of warmth

Skin hot (after forty-eight hours)

The skin is hot and pungent, face flushed, veins of forehead tinged, and head burning

Slight elevation of the temperature of the surface, rarely exceeding 1°, and a still slighter and less appreciable rise of the internal temperature of the body

Temperature 100° (after twenty-four hours)

Temperature 102° (after fourteen hours)

Temperature frequently varied, now glowing heat, now cold over the back (cold predominated)

Alternate heat and chill, a violent tension of the chest, with dyspnoea, and feebleness of the pulse (from tasting Atropia)

Atropia check? sweating, whether physiological or morbid

Conditions p. 622

Aggravation.

(Morning), Talked confusedly, etc. ; on rising, vertigo ; on waking, very dizzy ; on waking, sticking in left temporal region ; felt very weak.

(Night), Immediately upon closing eyes, after retiring, delirium ; agitation, etc. ; frequent micturition.

(Toward 6 p.m.). Internal coldness, etc., of the whole body.

(In open air), Very weak.

(Beer), Caused pain in stomach.

( Upon closing eyes), Mind becomes confused, etc.

(After coughing). Burning in throat.

(After drinking milk), Vomiting.

(Evei'y motion). Pains in base of skull, etc.

(Periodic), Dry cough, etc.

(Each pulsation of heart). Pain in eyes, etc.

(Rising), Vertigo, etc.

(Stepping), Pains in base of skull, etc.

(Turning head quick/c), Vertigo.

(During the vomiting). Pain in umbilical region.

(On waking), Vertigo, etc.

( Walking), Severe sticking pains ; pain in stomach.

(Drinking warm fluids), Vomiting.

Amelioration p. 622

(Evening), Pains in head disappear.

(Towards morning). Dryness in throat.

(Toward 11 a.m.), Pains in head.

(Going into open air). Confusion in head.

(After moving about in open caV),. Sticking in left temporal region.

(Sitting), Feels better.

(Standing), Feels better.