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This is ascertained by applying a cold spoon, which could not be done without pain before the injection or even for some time after the operation; now the patient bears cold as well on one cheek as on the other; pressure on the affected nerves causes little pain. We observe that the amelioration commenced yesterday, the patient suffers less; there is now no excessive secretion of tears and saliva. The mode of administering the medicine was now changed. The patient was directed to take half a milligramme of Nitrate of Aconitine every four hours; in the morning she got a hypodermic injection in the painful part, one granule about 2 p.m., a hypodermic injection about 6 p.m., and two granules at night. In this way the patient felt little of the excitant action of the medicine, but felt its ansesthetic effects for a long while.

23rd.—9 a.m., pulse 74, temp. 374°. Injection of half a milligramme of Nitr. of Aconitine. 10 a.m., pulse and temp, idem, some tingling in hands and lips. Cold not much felt on affected cheek. Its sensibility is rather blunted; this is ascertained by pressing slightly and slight pinchings, and pricks with a pin. The patient does not taste sugar, Bhe only perceives a sweet taste when she swallows sugar well dissolved in the saliva. Same prescription as yesterday. The pains have completely subsided to-day, the patient has slept well, opens her mouth better without feeling the acute Bufferings of the previous days when she moved her lips or tried to chew. On pressing at the seat of the supraorbital, infraorbital, and auriculo-temporal nerves, it is evident that the sensibility to pain is much blunted. As regards the dermalgia, formerly spread over the small branches of these nervous trunks, it has completely disappeared. The hypodermic injection could not be performed this evening, and the patient took a granule at 1 o'clock ; in consequence, the neuralgic pains recurred, though in a mitigated form, about 7 o'clock, proving that the ansesthetic action of the granule taken at 1 o'clock occurred. At 8 o'clock a granule containing half a milligramme. Some seconds afterwards slight tinglings on the lips, and diminution of the pain about 10 p.m. The patient fell asleep at 11, woke at 3 a.m., and took her last granule.

24th.—The patient has no more pain; at 9 a.m., pulse 70, temp. 37°. Injections and granules as on the other days.

27th.—No more pain and same prescriptions since the 24th. Patient sleeps well, opens her mouth easily, has no trouble in chewing, and asks to go out.

Obs. 5. Acute articular rheumatism.A girl, set. 20, robust, of lymphatico-sanguine temperament. Had an attack of acute articular rheumatism four years ago.

July 14th.—At present all the joints are swollen, red, hot, very painful; the least movement, the slightest pressure, causes her to scream. Sleep impossible. Strong fever, pulse 120, cardiac sounds dull, distant, slight souffle with first sound at apex. Sulp. of Quinine one gramme per diem; application of cold compresses on joints. About a month later, August 10th, the patient had no more pain and got up. But the amelioration did not last long. Relapse 17th of August. Nitr. of Aconitine prescribed.

On the 18th, 8 a.m.—Patient in bed, weeps and says she suffers most on the whole of the right side, chiefly the hip, knee, and ankle. No swelling to be seen, nor any redness of the affected parts; but the pain is acute, and the slightest touch causes her to scream. Not so much pain on applying pressure to wrist, elbow, and shoulder. Peels pretty strong, pulse 103, temp. 37-6°. 10.30 a.m., % a milligramme of Nitr. of Aconitine injected under the skin of the right hip. Injection attended by a burning feeling, Boon followed by heat and redness to a certain distance round the point of injection; then cool feeling in the mouth, or rather sensation like peppermint drops; slight tingling of lips which feel numb. 11 a.m., pulse 108, temp. 37-7°. Burning less severe, but there is a pretty large red patch at the seat of the injection. The whole thigh and leg are the seat of tinglings and numbness, especially the thigh. The rheumatic pain remains the same. The tongue and lips are more numb, there are also pricklings in the arms and hands. 11.20 a.m., pulse 108 to 110, small, irregular; temp. 38°. All the right lower extremity is very sensitive. There are little shocks. The sensitiveness to pain and to cold seems more pronounced than before the injection. The patient is more sensitive to the touch of a pin or a cold spoon than before. The body is warm and tingling all over. The acute rheumatic pains are confounded with the effects of the drug. Three granules of \ milligramme, to take one in the afternoon and the two others in the night at four hours' interval.

19th.—10 a.m., pulse 90, temp. 37-5°. The patient says that the rheumatic pains were much lessened at 7 p.m. The thigh Btill numb but easily moved. All the other joints nearly free from pain. She took a granule at 8 p.m., fell asleep about 9, though she felt slight tingling in the toDgue and lips, and did not awake till 3 a.m., when she took the third granule. A little tingling on the lips and arms half an hour afterwards, but she fell asleep and slept till 6 a.m. Injection of | milligramme of the drug. 10.40 a.m., pulse 90 to 92, irregular; temp. 37.7°. Taste of peppermint, prickling in lips, tingling in arms; redness and burning on thigh where the injection was made. 11.30 a.m., pulse and temp, the same. Burning somewhat diminished, redness paler, but extending further on the hip. Three granules to be taken as yesterday.

20th.—Pulse 72, temp. 37-4°. Night good, slept well, scarcely any suffering, nothing but tingling of lips and hands after each granule. 9.30 a.m., injection of £ milligramme of the drug under the skin of the right arm. The pain in shoulder more acute this morning. 9.45 a.m., pulse 86, temp. 37-7°. Sensitiveness to pain and cold greater on the side where the injection was made. Tinglings and numbness. 11 a.m., pulse 76, temp. 37-6°. Three granules of | milligramme to be taken as before.

21st.—No pain, no fever, pulse 72, temp. 38-4°. 9 a.m., injection of i milligramme.

From 22nd to 26th no more pain, no more fever, no more injections. Two granules of £ milligramme per diem was continued by way of precaution. The patient left the hospital.

Obs. 6.—Acute articular rheumatism.—A man, set. 28, lively and nervous, arthritic antecedents, had an attack of acute articular rheumatism at the age of 16.

Present state: 13th June.—Acute shooting pains in the ankle and knee-joints, swelling and heat, pain in loins; arms free from rheumatism. Bellows sound at apex of heart with first sound, rough, slightly scraping. Snip, of Quinine, one gramme per diem, cold compresses to joints. Three days after this the joints of the lower extremities were free from rheumatism, but those of the upper extremities were affected. Same treatment; the swelling yielded rapidly, but very severe pains continued. So on 3rd July, at 10 a.m., the pulse being 82 to 86, irregular, the patient got five granules of £ milligramme of Nitr. of Aconitine, to be taken in the twenty-four hours thus: one granule morning and evening, and three granules in the night from 8 p.m. till 5 a.m. During the day the patient only experienced a little coolness in the mouth and a taste of peppermint, and very slight tingling in the upper extremities. These sensations were experienced about half an hour after taking the granule and lasted nearly two hours. The rheumatic pains slightly diminished. In the night, after having taken the second granule at midnight, he had strong tingling all over the body; he had flushes of heat, a little dryness of the throat, some strong beatings of the heart, and a slight numbness and heaviness in the limbs; he was long of falling asleep. The weather was very hot. During this time he did not suffer so much from rheumatic pains, and at 5 a.m. he took the last granule.

July 4th.—Complains of not having slept. Says his pains are diminished, and that he has slight tingling in the hands and some weariness. Pulse 80. At 1 p.m. one granule of £ milligramme of Nitr. of Aconitine; at 3 p.m. a granule of \ milligramme. He feels tinglings all over. Sensation of pepper in the mouth, gradually a kind of numbness in the limbs, itchings over the body, some dryness in the throat. At 4 p.m. the limbs are heavy, the pain in the joints is not much excited by the touch; pulse 80, irregular, intermittent; prostration and drowsiness. At 4.30 he is comfortable, is able to move the limbs without much pain. At 4.45, pulse 92, injection of i milligramme of Nitr. of Aconitine under the skin of the right forearm near the affected wrist. Scarcely was the injection made when the patient complained of great burning in the arm, and as he is very nervous he turns about in bed, makes faces, and forgets that his joints are affected. In a short time he has disagreeable tinglings in tongue and lips, he imagines for a moment that his lips and nose are increased in size; itching all over and intolerable feeling of heat. Pulse small, irregular, 92 to 96. At 5 p.m., general malaise, some inclination to vomit, slight obscuration of vision, constriction in temples, numbness and some stiffness in the limbs. Suddenly jerks in the arms like clonic spasms, lasting two or three minutes; then calmness, a kind of prostration, some cold sweat on the forehead, paleness of face, inability to grasp anything with the hands. No pain to the touch in any of the joints. Pulse 74 to 80, small, intermittent. Gradually strength returns with the heat; thirst for cold water ; says he has no pain and feels nothing but prostration. At 5.15, vision perfect; respiration easy ; appetite ; pulse 80, full, regular. The nig^t was good, the patient slept well and had little pain.

5th.—Pulse 80; movements of joints freer and less painful; patient is hungry. To take four granules of | a milligramme in the twenty-four hours.

6th.—Sleep quiet, pains very slight, but the movements are not easy, especially those of the shoulder. Six granules, one to be taken every four hours.

7th.—No fever, slightly depressed ; slept well at night, though there were some tinglings after each granule and slight prostratration. No pain in joints. Patient walks about in the ward and garden, eats at every meal and has no pain.

8th, 9th, and 10th.—Four granules per diem, after this he had no pain except on violent exertion.

Manganese in Amenorrhea.—In 1849 Harmon showed that chlorosis was curable by Manganese even when Iron failed, and in 1850 Dr. Madden mentioned (British Journal of Homoeopathy, viii, 195) that he had seen good effects in three cases of anaemia from -y^th of a gr. of Mang. acet., three times a day. Ringer and Murrell {Lancet, Jan., 1883, p. 7) call attention to the value of Permanganate of Potash in certain forms of amenorrhoea. One grain three times a day is what they commence with. The most striking results were obtained in young women between eighteen and twenty-five, who from some accidental cause, such as taking cold or getting wet, had missed the period once or twice, though previously regular. In cases where the patient had only menstruated once or twice, and had then ceased for several months, it did admirably. It also cured leucorrhcea of long standing in such patients. In chlorosis it often brings on the menses without improving the anaemia. This observation does not agree with that of Dr. Madden, who found it useful in anaemia.

Arnmoniacal Sulphate of Copper in Facial Neuralgia.—Fereol (Jour, de Therap., Oct. 25th, 1882) found this drug efficacious in tic when other remedies had failed. In almost all it relieved the pain, sometimes instantaneously restored sleep to patients who had been deprived of it for weeks. The usual dose was from ten to fifteen centigr., sometimes increased to thirty or fifty. The larger dose often caused derangement of the digestive organs.

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