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an hour. I saw him in this state, convulsed, the mouth drawn to one side, moaning and insensible, pulse quick, but rapidly sinking. I was wholly at a loss to account for his death, and imagined fifty things; but a post-mortem examination was out of the question.
At this time anomalous local pains, some like tic douloureux, were becoming remarkably prevalent.
On the 23rd January, Mr. R., æt. 40, accountant to the mission, of gouty diathesis, who had been formerly subject to ague, and latterly every six or eight months to plethora, complained that he had suffered much from headache for some days, and that last night, on putting his feet into warm water, the left foot was seized with numbness, as if asleep. At present, however, the pulse is good and soft, and he has no particular symptoms : ordered 2 pills of calomel and colocynth at bedtime, and compound jalap powder in the morning.
23rd.—Last night, at midnight, was seized with excruciating headache, and spasms, and numbness of the left leg and arm; the pain continued severe till 8 a. m., when it gradually abated. The medicine operated only once. To repeat the dose at night, and take salts and senna in the morning.
24th.-Has had similar attacks of pain and numbness of the whole of the left side, last night exactly at 12, and at 10 in the morning. Although somewhat relieved since 8 o'clock, has still much headache and some numbness of the hands. The medicine has operated little. Pulse full and bounding,
v. s. ad 3xx. Five grs. of calomel immediately, and castor oil two hours afterwards. This produced two full evacuations.
25th.—The pain returned at midnight, but was less severe, though continuing more constant in the morning. The spasms and sleeping of the left side the same as in the preceding night. To take ext. colocynth comp. gr. v and ol. croton m 12, immediately and at noon ; after which, every two hours, to take a grain of quinine, and two at 11 p. m.
26th.-Nightly accession of headache much less, but the numbness of the leg and arm came on at the same hour. To take rhubarb and magnesia zj immediately; and from 2 in the afternoon, to take one grain of quinine every hour, and three at 11.
27th.-Has still headache, the pain shifting a little to the cheek; had no accession at midnight, but still has sleeping of the leg and arm at the same hour. He went to office for an hour or two, but felt giddy, and had several spasms in the hands.
At four and a half p. m. was suddenly seized with a fit like epilepsy ; convulsions ; face and breast became mottled purple ; pulse good, without much power; hands and feet cold. He recovered his consciousness in a few minutes, but above an hour elapsed before the memory was completely restored. The pulse getting low, he had some spir. ammoniæ aromat. in water, and hot fomentations to the stomach. The headache continues severe, but the senses perfectly restored.
10 p. m.-Suddenly attacked with a second fit; face drawn to the left side, right arm and side affected with spasms, left apparently paralytic, frothing at the mouth and stertor, insensible. This attack lasted about ten minutes, the pulse bounding with extraordinary excitement-consciousness had already returned before v. s. ad zxx was performed. Has had no motion since yesterday forenoon. Capiat statim ol. croton tiglii mj, ex olei ricini zss. This was vomited immediately. A dose of scammony and jalap was then given, which was retained an hour and then vomited. Expecting another attack at twelve, I took care to be present a few minutes before the time, when, exactly at the hour, he was again attacked, more severely than before. Powerful convulsions of one side ; for a short time, quite purple in the face and chest. Two or three severe opisthotonic spasms, and horrid grinding of the clenched teeth, as in tetanus. Total insensibility-pulse about 90, very powerfully excited, so much, that although convinced that this disease was purely nervous, and little likely to be benefited by bloodletting, and that when this violent excitement passed, it would be succeeded by a condition of proportionate feebleness and prostration, yet I found it absolutely necessary to bleed again, in order to protect the brain. This time sensibility returned more slowly, with expressions of intense suffering from pain in the forehead. To have an injection of magnesiæ sulph. 3j; ext. colocynth co; pulv. jalap. rad. āā aj ; in warm water, immediately.
2 a.m.-Has vomited three times frothy mucus. Injection retained-repetatur enema ; calomel gr. v. statim.
28th., 10 morning.–The second injection brought away little but the first one. Fætor of breath, either from the calomel or from the tongue having been severely lacerated in the last attack of convul. sions. Still much excitement of the pulse, although less in power and volume. Headache excruciating, till eight a. m.; when, as usual, it abated, though still severe. Some pain in the region of the heart, the excited action of which is singular. Bowels not free. Borax lotion for the mouth. Enema of jalap and colocynth, ää aj; and to take every two hours one of the following pills,- ferri carb. zss; assafoetidæ Əj; fiant pilulæ x. A blister to be applied to the region of the heart.
4 p.m.—The enema brought away a little dark fætid matter. There is much drowsiness and disinclination to move; but he is perfectly sensible headache gone, and no numbness, but weakness of the limbs; pulse gentle, soft, and weak—wholly free from excitement-some pain in epigastrium, slight hiccough, but no return of vomiting since commencing the pills. The enema to be repeated, and to take a glass of wine with arrowroot.
12 p.m.—The enema brought away some dark fluid, smelling of assafoetida: no attack to-nightomit medicines.
After this he took, for a couple of days, carb. ferri Əj, in syrup of ginger, twice a-day, which acted
gently on the bowels ;* and, except having for a few days a good deal of feebleness, he has since been perfectly well.
Baba Beg, æt. twenty-four, of florid complexion. On the night of January 27, on returning from Mr. R—'s, I found this man recovering his sensibility, after having had two successive fits, which he says were each time preceded by great palpitation and painful oppression of the heart; the pulse is now 85, excited and bounding, but without much power. He has been disturbed for some nights past about the same hour, by sleeping of the right arm; and two nights ago, had a slight fit. His fellowservants tell me, that during the fits his hands were convulsed and face distorted. Ordered compound jalap powder and calomel.
28th.-Purged five or six times; to take ten grains of carbonate of iron, and repeat it in the afternoon. After this he had no return of symptoms.
Rassool, æt. thirty, my head groom, a spare man, 24th of January, complained of much pain and tenderness of the ears and parotids. I had several patients at this time who complained of the same thing. Ordered Epsom salts zj immediately-five leeches behind each ear.
25th.—Medicine operated frequently ; he feels
* This is a curious fact, which I have observed throughout the whole of the diseases of this year—that while, as frequently happened, none of the usual purgatives produced their effect, a small dose combined with iron acted immediately, as scammony gr. v. ferri carb. gr. x., or ferri sulph. gr. j. aloes gr. ij.