Understanding Plumbum met.

Dr. Claudio C. Araujo M.D., F.F.Hom. (Lon.) et al.

We have important observations from the forefathers of Homeopathy:

Hering: Affections more of the emotions than the intellect.  

Allen: The intellect more or less disturbed, 

Kent: Changeable; continually changing from one thing to another, from one group of imaginations to another, from one group of emotions to another. The whole remedy is intensely emotional. While the intellect is slowed down, yet most of the symptoms are emotional.

In their observations, emotions in the Plumbum patient played a strong part in the sickening process, and we should start from that point on.

How the emotions in the Plumbum patient are affected?

Plumbum is quiet, speechless, and very sad. He is afraid to spend his life in pain. He is discouraged, despondent.

Plumbum has many of the current XIX century fears and notions - of sinned away his day of grace, of guilty and regret – but what is pointed here is that a “zealous protestant” is looking for help with a Priest from the catholic church. Almost as if he was betraying his beliefs and his own church.

Plumbum, in its continuous intoxication, bring madness to the affected person. There are many and many symptoms of many ways to get mad, to lose one’s mind from the poisoning with Plumbum. But we can point up some individual ways to get mad that are showing themselves in between the Plumbum symptoms.

He bites, destroys his clothes and must be kept in a straight-waistcoat. 

He shrinks, cries and spoke disconnectedly.

He will behave like a madman.

He does not converse with his neighbors; when questioned he answers rationally, indeed, but briefly. When his wife and children come to see him, he pays no attention to them, and goes on with what he is about, as if they were not present; yet he says he is fond of them and seems to think a good deal of their visits. He has never shown any irritability.

When in bed he keeps moving his hands; folds and unfolds the coverings. Sometimes he gets up and wanders about the room, now singing, now gradually quickening his steps, as if impelled by an irresistible force, now stopping, and turning about abruptly; his gait is uncertain. His behavior is nearly the same day and night,

Talks to himself a good deal, mostly about his business, his associates, or his relatives. When his attention is forcibly attracted, and he is asked where he feels pain, he places one hand on the middle of his forehead, and the other on his stomach, and utters a few words which indicate unmistakably the seat of suffering; but if he is not talked with, so as to keep his thoughts fixed, his mind begins to wander, or he falls asleep.. 

Kent says that the Plumbum patient is a "cheating" person, the doctor must be careful on taking her symptoms:

“Plumbum produces an inclination to deceive, to cheat. The Acetate of lead produced in a woman, who took a little of it for suicide, a confirmed hysterical state. She would be in a hysterical condition for hours when any one was looking at her. When she thought no one was near she would get up, walk about, look in the glass to see how handsome she was, but when she heard a foot on the steps she would be on the bed and appear to he unconscious.

She would bear much pricking and you could scarcely tell she was breathing. Plumbum establishes a hysterical state in the economy; an inclination to deceive, to feign sickness; to exaggerate one's ills; and it goes to the root of the evil providing the symptoms agree”.

Should we assume that the Plumbum patient does not know that she is cheating? In her mental disease, did she lose her abilities to perceive what is real and what is not? Is she only feigning to be sick or did she will lie as well in other situations? 

Or Plumbum is protecting herself from the others? Kent says that she is cheating but what can we conclude from the combination of symptoms? From someone surrounded by murderers, people coming to take away everything she got, it’s logical to admit that she is not “feigning sick” but she is hiding her mental state from the others. She is, in fact, protecting herself. But protect in the Plumbum way, pretending being asleep, in a pre-coma, insensible and away from her surroundings.

Plumbum is in a very strange world. He can’t find the right words to communicate with people and if he tries, he completely forgot what he was about to say.

the cerebral functions were strangely disturbed. Various hallucinations showed themselves. Erroneous ideas were formed as to the identity of herself and those around her, and the situation in which she was placed. (…)

(…)  If she attempted to speak to those around her, she seemed to have difficulty in finding language, and before she could succeed in conveying her meaning, the idea fled, and a jumble of unconnected words was all that escaped her. And now the condition of the nervous system became one of apathy. Impressions were made upon the senses with difficulty, and speedily vanished; her attention was no sooner gained than it was lost, and she remained for hours at once in a state of semi-consciousness. (…)

He misses his family and his friends from long ago.

Hallucinations of mind, she seemed to see her dead husband and child in a tree out of the window. 

Lovely dreams of a distant beloved person, after midnight (first and second days), [3]. 

Longing for a distant friend, in the evening, before falling asleep, [3]. 

Plumbum loses his former knowledge of the place he has been living. He doesn’t know the streets, and how to arrive at some given place. He doesn’t recognize his city or even imagines that he is in someplace else.

He had, some time back, illusions of vision; saw castles, palaces, but these have ceased since he entered the hospital,. 

Those two dreams may remind us about the Tale of Paradise. Is it that so?

Dreams of stealing fruit in a garden.. 

Heavy frightful dreams of falling. 

Many symptoms are showing that Plumbum will become out of his mind from pain. He doesn’t tolerate it and from suffering from pain he start his madness.

He is desperate, he knows that he can’t resist to pain, any single painful experience will drive him mad.

Is pain the beginning of all there is? Sensitivity to pain? Ailments from pain? 

Plumbum got convulsions and delirium from pain and is dement onwards. Can we consider the emotional, existential pains also part of his suffering, bringing him symptoms as physical pains do?

During the paroxysms, the face expresses acute pain; he is restless, rolling about in bed, screams out, etc.,

The patients were in a state of nervous irritability, difficult to describe. In their beds they were restless and unable to find an easy position, and after many useless efforts they fell back exhausted and worn out, with pain; the respiration became hurried; the heart's action was painful and violent; groans and sighs were uttered with vehemence, whilst abundant tears ran from their cheeks; symptoms greatly resembling those of hysteria. These tears, sighs, and groans were not occasioned by the violence of the pains, and often coincided with the abatement of the suffering,

During the paroxysms, which occurred almost every ten minutes, the patient, suffering the greatest anxiety, his face all distorted, rolled about in bed uttering dismal groans; he laid his pillow over his abdomen and begged the bystanders to press upon it with all their force; this afforded temporary relief. He bits the sheets, his limbs writhed; at times he might have been taken for a furious madman, . 

Much depression of spirits, especially with colic. 
His mental condition was sad enough; given over to thoughts of life-long pain, he imagined his disease incurable, and gave way to the gloomy thoughts which the fear of death excited, and to repining* caused by the dread of his journey to Valencia, . 

During the paroxysms, the face is contracted; he screams aloud, sticks his legs suddenly out of bed, etc.,. 

Uttered piercing cries. 

Utters doleful groans, and screams loudly for relief,.

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 salvation; 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*; perpetual 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 by night; profound melancholy and frequent sighs; brooded over any forbidden thing; would steal from house in servant's cloak and bonnet to obtain stimulants, but from the moment their prohibition was withdrawn 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.

Although naturally patient of suffering, he was importunate, nay* clamorous for relief, expressing himself in terms of agony, far stronger than his general appearance and symptoms seemed to warrant,. 

Plumbum’s first and immediate reaction to pain is anger. Being in a fret, irritable, aggressive, biting and destroying everything around him. That’s what had been noticed in the child treated with Plumbum. He observer noticed that the child was “sensitive and fretful” and we can keep in mind that idea as a very good example of our remedy. Very sensitive to everything that hurts, even a very slight one but, immediately after, immerse in a state of fret, anger and violence.

Due to pain, he get into convulsions and delirium, he loses his self-control and starts his mental process.     

The child was sensitive and fretful, whenever anyone approached; it cried and whined a great deal and would not play,. 

Delirium furious at night, milder by day, with hallucinations 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 by suppressed colic, with bloated abdomen. 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. 

During the paroxysms, the face expresses acute pain; he is restless, rolling about in bed, screams out, etc.,].

The mental derangements are all around a certain number of situations, being the first one an idea that he is about to be murdered, poisoned.

Appeared to be rapidly recovering, when he was suddenly seized, about 11 A.M., with furious delirium, attended at intervals, by general spasms. It was astonishing to see him, who, three hours before, could only pronounce with difficulty a limited number of words, whose voice was weak, and whose utterance was faint and drawling, now talking incessantly, and pouring forth shouts, screams, and abuse against all who approached him. His voice was loud and clear. His delirium turned chiefly upon the idea that his life was in danger from assassination or poisoning, and that every one about him was a murderer. His muscular strength was increased to such a degree, that, with one hand, he could lift all his mattresses at once with the greatest ease. He left his bed, and walked about briskly, knocking against every obstacle at random. His face was flushed; his eyes sparkling and fierce. At last a strait-waistcoat was put on him, which heightened his fury. Pulse, 65; heat of body rather increased. The delirium lasted about half an hour, when it was succeeded by coma, during which he lay stretched out and motionless, with closed eyes and somewhat pale face. Strong stimulation could only draw forth a few unmeaning grunts. An hour later, the delirium suddenly returned, to be followed again by coma, and thus, all that day and night, the opposing conditions alternated,.

Often getting out of bed and wishing to go home; sometimes not recognizing his family; thought they were conspiring to kill him, 

Got up to go to stool, but, instead of returning to bed, began walking the room with bare feet, and talking incoherently on all sorts of subjects; imagined he was going to be poisoned; that his bed was full of ants, etc.,. 

He can trust no one. People had become a threat to him. He had to protect himself from everyone.

Distrust,

Avoids society. 

The patient imagined that he was constantly followed, and that he heard voices coming from the chimney (temperature 36.5°, pulse 64, regular and small, good appetite, clean tongue, very slight colic, no paralysis, with a blue line on the gum, with constipation); this man after a few days wished to leave the hospital and go home, because he was convinced that there were fiends in the building that pursued him and sought his life, 

During the evening of the seventh day, suddenly great restlessness; he hears everywhere threatening voices, officers come to arrest him, to seize his furniture, and to expel him from his lodgings; the voices come from the pillow, the mattress; they enter by the window, where he sees people, and they consult about him with closed doors; he gets up, looks for his clothing, wants to run away, to his lodge, etc. The next morning he sits at the edge of his bed, the eyes fixed steadily to the window, or looking about in a restless manner; he recognizes all persons around him, replies correctly to all questions, but cannot recollect what he ate yesterday, whether his bowels moved or not, and looks to his wife in an interrogating manner; insists, though as if afraid to acknowledge it, on the reality of his hallucinations. 

In his mental confusion he doesn’t know where he is, he doesn’t recognize the streets of his city.

Between the paroxysms, mind often much affected. Would leave home without knowing where he was going; became enraged with persons he met; and generally remembered nothing of what had occurred. When brought home, he would shut himself up until he got right again. One day, he left home to enter the Hospital Beaujon; got lost, and was quite surprised to find himself at La Pitié,]. 

Talked rather wildly; got out of bed; ran about the room; called to his companions; wanted to go to work, etc.; yet complained that he could not see his way, and knocked against the beds, stoves, etc., 

To protect himself against the others, Plumbum will end not recognizing his relatives, his family and his children. He is becoming apart, distant of everyone else.

 Often getting out of bed and wishing to go home; sometimes not recognizing his family; thought they were conspiring to kill him, 

Has a cachectic look; cheeks hollow and pale; yellow complexion; no signs of lead poisoning, aside from the cerebral symptoms. Yet this case is not one of encephalopathy in any form. It is a chronic affection of the mind, which we must try to describe in order to characterize it. He is absorbed in himself; pays no attention to what goes on about him. He does not converse with his neighbors; when questioned he answers rationally, indeed, but briefly. When his wife and children come to see him, he pays no attention to them, and goes on with what he is about, as if they were not present; yet he says he is fond of them and seems to think a good deal of their visits. He has never shown any irritability. When in bed he keeps moving his hands; folds and unfolds the coverings. Sometimes he gets up and wanders about the room, now singing, now gradually quickening his steps, as if impelled by an irresistible force, now stopping and turning about abruptly; his gait is uncertain. His behavior is nearly the same day and night, 

There is a strong aversion of become pregnant with the Plumbum woman, present in the symptoms. There’s no room in Plumbum’s womb. To someone so sensitive and vulnerable to pain the single idea of giving birth is maddening. Nowadays, with anesthesy and surgery to extract the baby, Plumbum would accept pregnancy, as she is not subject to suffering and pain.

Long time ago she would expels the fetus out of herself. But in modern society, she will be on estrogens during the most part of her fertile life, then avoiding pregnancy. 

Feeling as if there were not room enough in abdomen, at night in bed; must stretch violently. 


She feels a lack of room for fetus in uterus; inability of uterus to expand; threatening abortion. 


There’s a strong possibility of Plumbum to be someone not fond of having a family, to be with his wife/husband and children. How could he/she support one’s family?

Dozens of symptoms tells us how sterile is Plumbum.

Four women had fifteen pregnancies, distributed as follows, viz., ten abortions, occurring between third and sixth month; two premature births, the children dying soon after birth; one child still-born; one delivery occurring at the full period, but the child died the same day; out of these fifteen cases only one child was born alive that did not show any symptom of lead diathesis. Five women had given birth to nine children before they were subject to the influence of lead poisoning; the children were healthy and alive; neither did the mother suffer from any menstrual irregularity; but after going into the type-cleaning works, they had together thirty-six pregnancies, distributed as follows: twenty-six abortions, from the second to the sixth month of pregnancy; one premature birth, the child dying soon after; two children still-born; seven at full term, of whom four died in their first year, and one in his second, and only two still alive, one of whom is very delicate and anæmic. A woman after having five abortions, left the type-polishing works, and after recovering from the effects of lead poisoning, gave birth to a healthy child, still living. A woman left the works for a time and then went back; during the time she was under the influence of lead poisoning, she frequently aborted, but during the interval she was absent from the works she gave birth to a healthy child,. 

Opposite to his sensitiveness to pain there’s a strong sexual desire. Nymphomania, from the female part altogether violent sexual desire and erections, from the male side, can be related to an opposite reaction. Pain hurts them so much and sexual pleasure is so much enjoying.

Increased sexual desire and violent erections. 

Great inclination to coition. (H. and T.) [From Plumbum muriate.] 

 Emission of semen during sleep, quite unconsciously, after drinking wine, and the next morning, violent erections on every slight provocation; several nights in succession,

Nymphomania.

But, as is the nature of the remedy, there is suffering even from coition.

Vaginismus.. 

Loss of sexual desire; impotence; chronic degeneration of cord. 

To protect himself from pain, Plumbum will start his dormant process. Step by step and year by year, he will hide his strong sensitivity to pain behind a curtain of sensorium indifference. 

In our hypothesis, the neurologic symptoms belonged to Plumbum are first a consequence of his sensitivity (delirium, convulsions, psychosis) followed by his desperate reaction of becoming “numb”, his last attempt to stop all the consequences brought to his life due to pain.

The first symptoms belonging to this neurologic disease are related to his utterance, his quality of being able to express himself to the others

Cuprum loses his ability to communicate with the others. 

Thought and speech difficult, 

Reading is very tiresome to him; he mistakes one word for another, and skips the lines,

Answers questions vaguely; and admits that his memory is much impaired, [517]. 

He answers well enough, but his evening made a mistake in giving his age, [521]. 

In the night, began to talk to himself quite incoherently, about all sorts of things; then left his bed, and wanted to lie down in another bed in the room. The nurse easily got him back to his own quarters; his gait was firm, and he had no tremor; his eyes were wide open, somewhat projecting and fixed. His face had an expression of astonishment. During the rest of the night, he talked much to himself; his delirium was mild and quiet. Next day, his expression was natural, and he had the use of all his faculties, but he seemed to take little interest in conversation, and his manner was remarkably listless. About 5 P.M., he began fairly to rave; would keep chattering for several minutes, and then be silent for awhile. His face had a wild expression, which struck the house surgeon on duty. Pulse, 85; no fever. Worse at night; took part in all the conversation he heard, or fancied he heard. 

Weakness or loss of memory; unable to find the proper word.

His utterance is drawling, difficult and frequently broken; so that he talks like a child who has not learned to speak plainly; instead of "oui," for example, he says "ui." Sometimes he cannot get hold of the right word; then he frets and worries himself, and now and then becomes quite desperate. This difficulty seems to be met with chiefly in the case of substantives; with adjectives, the intellect and organs of speech deal more easily, 

He seems to recognize familiar acquaintances; sometimes he talks unintelligibly to himself; more frequently is silent. When his attention is strongly attracted, he at first answers rationally; then suddenly utters some words without meaning or connection; afterwards takes up again the thread of logical thought. He usually waits some time before answering a question; it seems as if it required great mental exertion for him to understand what is said,.

The intelligence and power of utterance vary curiously at different times,. 

Sometimes utters a few broken, disconnected words,

Intellect seemed affected; answers not so rational,.

Answers questions vaguely; and admits that his memory is much impaired,. 

Together with his impossibility to communicate, there’s slowness of perception and weakness of memory.

Has been much troubled for twenty years by a singular cerebral affection, returning at intervals, and characterized by restlessness, constant inclination to move about, loss of memory, and indecision. This mental condition has several times obliged him to enter a hospital. He does not recollect either the dates of the duration of these seizures, nor anything respecting their treatment. 

Remarkable weakness of memory.

Intellect clear, but memory seems much impaired. 

Weakness of memory, 

The next step is a continuous deep involvement of his mental abilities:

Loss of understanding, 

Slow of perception,. 

Loss of mind,

Following that stage there is a strong delirium present in the Plumbum patient. We tried to select the most important symptoms. Plumbum delirium is like as if one is possessed. He becomes stronger than normal. His countenance has completely changed.

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. 

Delirium furious at night, milder by day, with hallucinations 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 by suppressed colic, with bloated abdomen. 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. 

Delirium, resembling the most frightful kind of madness, and impelling them to tear themselves and bite their own fingers, 

Complete rage,

We all know how the Plumbum patient ends: in that mental and neurologic state of dementia, loss of mental faculties, Alzheimer’s Disease and other diagnoses related to mental and cerebral degeneration.

The evolution of his individual disease brings less blood irrigation to his brain and affects his memory, his utterance and his reasoning.

Loss of consciousness, occasionally returning, followed by epileptiform spasms, with bloody froth from the mouth; succeeding these attacks there was left-sided paralysis of motion and sensation,. 

Microscopical examination of the brain showed granular fatty degeneration of the walls of the vessels and deposition of large quantities of amyloid corpuscles.] 

Apathetic condition,  

Gradually increasing apathy, . 

Tendency to stupor, . 

Mental torpidity; answers slow and stammering, 

Intellect obscure, . 

takes no notice of anything about him, unless aroused by pain or an attendant, 

Summary

 

Is it the end or the beginning?

Violent delirium set in and continued for some days. As the delirium declined, the mind did not recover its clearness and integrity, on the contrary, his sensations and perceptions were vitiated and erroneous. Various morbid ideas took possession of him, and some of them remained, and continued to manifest themselves for many months after his apparent restoration to health,. 

 

Groups em Plumbum met.

Hahnemann, Allen, Hering & Kent

Dr. Claudio C. Araujo M.D. F.F.Hom. (Lon.)

Humor

► Lively, good-humored (after two hours), [4].

► Good humored, lively, that soon disappeared, in the afternoon, [4]. 

Irritability, out of humor

► The patients were in a state of nervous irritability, difficult to describe. In their beds they were restless and unable to find an easy position, and after many useless efforts they fell back exhausted and worn out, with pain; the respiration became hurried; the heart's action was painful and violent; groans and sighs were uttered with vehemence, whilst abundant tears ran from their cheeks; symptoms greatly resembling those of hysteria. These tears, sighs, and groans were not occasioned by the violence of the pains, and often coincided with the abatement of the suffering, [266]. 

► Very much out of humor and weary of life, [3]. 

► Out of humor, all work frets her, in the afternoon, [4]. 

► Irritable, [271]. 

► Great irritability, [145].

► Morose mood, disinclination to talk to any one, and frequent attempts to escape; this morose mood at times alternated with the most lively mood, during which he laughed immoderately, without reason, accompanied by hallucinations of mind, [442]. 

Anxiety

Anxiety, with restlessness and yawning.

► During the paroxysms, which occurred almost every ten minutes, the patient, suffering the greatest anxiety, his face all distorted, rolled about in bed uttering dismal groans; he laid his pillow over his abdomen and begged the bystanders to press upon it with all their force; this afforded temporary relief. He bits the sheets, his limbs writhed; at times he might have been taken for a furious madman, [209]. 

► Anxiety, with difficult respiration, so that the patient seemed almost suffocated from fright; he could get his breath only while sitting, [235]. 

► Anxiety, [9], [233], [266], [350]. 

► Anxiety and sighing, [5]. 

► Extreme anxiety, [11], [50], [305]. 

► Frightful anxiety, [26].

► Great anxiety, during which she could not take a sufficiently deep breath, with increased palpitation (after three-quarters of an hour), [84]. 

Depression, melancholy and sadness

► Much depressed in spirits and unwilling to see any one, [303]. 

► Great gloom and dejection of mind, [315]. 

► Gloom of mind, [316].

► His spirits greatly depressed; if a neighbor called to see him, he would burst into tears and be unable to speak for some time, [304]. 

► Deep-settled gloominess of mind, [317]. 

► Spirits depressed, [276], [292]. 

► Exceedingly depressed, [297]. 

► Great mental and physical depression, [446]. 

► Much depressed, fearing to die if left alone, [440]. 

► Naturally cheerful, his spirits became depressed, and he became very nervous, [299].

Gloom alternates with excitement.


Much depression of spirits, especially with colic.

► Would shed tears from slight causes, [228].

► Sad, despairing mood, [145]. 

► Sadness, [483]. 

► He is very sad, has no desire to live, and has threatened to destroy himself, and is very fault-finding with his friends, [499]. 

► That vivacity which was a marked feature of his character was gone, and sadness and silence sat enthroned, [280]. 

► His mental condition was sad enough; given over to thoughts of life-long pain, he imagined his disease incurable, and gave way to the gloomy thoughts which the fear of death excited, and to repining* caused by the dread of his journey to Valencia, [350]. 

*lamentar, resmungar, discontent.

► Loss of the natural vivacity, [30]. 

Deep melancholy, 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. 


Insomnia, severe headache, occipital or frontal, with or without vertigo; noises in ears; disordered vision; diplopia; amaurosis; contraction of pharynx, though liquids are swallowed in gulps and greedily; mind weak, morose and sad; preceded by albuminous urine. 


► Silent, melancholy, [187].

► Repeated attacks of melancholy, of a religious character, [92]. 

► Profound melancholy, [39]. 

► He fell into a state of melancholy, with stupefaction, great dullness of the senses, coma, [42]. 

► Melancholy and dejections; great anguish and depression of spirits, [305]. 

► Mind greatly depressed (second day), [82]. 

► Seemed rather melancholy, [173]. 

Indifference and somnolence, with lamentations about difficulty of breathing and headache. 


Screaming

► During the paroxysms, the face is contracted; he screams aloud, sticks his legs suddenly out of bed, etc., [131]. 

► Frightful screams, with general convulsions, [56]. 

► Screaming out, at intervals, [203]. 

► Uttered piercing cries, [120]. 

► Screaming, [215]. 

► Screaming incessantly, [223]. 

► Utters doleful groans, and screams loudly for relief, [208].

► During the aggravations, he screams, draws himself together under the bedclothes, suddenly gets out of bed, then gets in again, and doubles himself up, etc., [209]. 

► During the intervals of quietude, which were very brief, he kept up a sort of continual grumbling, closed his eyes, and shrunk down under the bedclothes, [212]. 

► During the paroxysms, screaming, tossing about, and assuming the strangest attitudes, [122]. 

Silent and quiet

► When alone he sometimes talks to himself, but is generally silent and quiet, though he never closes his eyes, and thus he remains all day long, [198]. 

► Between the paroxysms she is silent, and generally calm and quiet, sometimes rather restless, [128].

► Is generally silent; when he speaks his words are disconnected, but his articulation is good, although the voice is somewhat broken. When he becomes interested in anything talked about, he sometimes answers rationally, sometimes sits facing his questioner in silence, without looking at him. At times he answers a simple question quite wide of the mark, [201]. 

► He was quiet and silent when left to himself, [72]. 

Quiet and melancholic mood. 


► Rather quieter in the evening than in the morning, but seems melancholy, owing to a terrified feeling, which he cannot shake off, [198]. 

► Lies quiet in bed; when spoken to sometimes makes no answer; sometimes begins a sentence slowly, and hurries over the rest of it, showing signs of bad temper, [200]. 

► He lies quiet in bed, seldom moving; groaning now and then. When asked a question, he answers in monosyllables, generally to the point, but sometimes at random. When alone he seldom talks to himself, and then only utters a few incoherent and trivial words, [161]. 

► Patient lay perfectly quiet in bed, and constantly murmured unintelligible words,

[444].

Despondency

► There was great mental prostration, approaching hypochondriasis, [271]. 

► Great despondency, [317].

► Despondency, [21], [332], [578].

► Discouragement, [28].

► Uneasiness, [56]. 

► Extreme restlessness, [51]. 

► Ennui; was out of sorts with everything (after six hours), [4]. 

► Ennui, quiet reserve, in the afternoon, [4]. 

► Hypochondriacal and peevish, [331]. 

With Oneself

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 salvation; 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*; perpetual 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 by night; profound melancholy and frequent sighs; brooded over any forbidden thing; would steal from house in servant's cloak and bonnet to obtain stimulants, but from the moment their prohibition was withdrawn 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.

Mental disturbance of eight or ten years' duration in a man addicted to masturbation; has several times attempted suicide; has been in seclusion; greatest dejection 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; violent palpitation of heart, < after eating and lying on left side; pulse weak; bowels regular but evacuations very dark; seminal emissions very frequent, often occurring during stool; testes wasted; spasmodic stricture; goose-skin. 


Kent: Aside from the slowness of the mind, which is a general, the remedy is full of melancholia, sadness, feeling as if something terrible would happen; that she has sinned away the day of grace; that she has committed the unpardonable sin. The body and mind are weak.

► Very nervous, unwilling to be touched or have anything done for her, [303]. 

► Manner frightened and nervous, [386]. 

► Fear; easily frightened, [114].

► Extreme apprehension, [43]. 

► Discontented with his circumstances in the morning, on waking, [3]. 

Madness

► Did not close his eyes for a minute all night; sometimes was silent and quiet, sometimes hurried out of bed, wanted to dress himself, and went about looking for his clothes; talked incoherently; abused the nurses and patients. In the morning, to prevent him from disturbing the ward, he was put into a strait-waistcoat. He resisted violently; struggled, called for help, screamed, bawled, and even bit an assistant who had hold of him. After this, he became quiet and silent, and his limbs ceased trembling. When I entered the room, he called to me, and begged to be released. He had an astonished look; something unusual seemed to have altered his expression of face, [173]. 

► Although naturally patient of suffering, he was importunate, nay* clamorous for relief, expressing himself in terms of agony, far stronger than his general appearance and symptoms seemed to warrant, [284]. 

*or rather

► When admitted he refused to go to bed, tore his shirt off, and spoke disconnectedly, [439].

► With loud cries, he insists upon going to stool, [122]. 

► Bites his garments and bedclothes, [208]. 

► Begged and prayed to be released from the strait-waistcoat, "for," he said, "I am not mad; but the idea of being forcibly restrained is enough to drive me crazy," [172]. 

► Started out of bed as if beside himself, compressing his abdomen with his hands, [120]. 

► Hung on to the bedpost, and kept swaying himself with a convulsive movement, [120]. 

► He keeps thrusting his limbs out of bed, and then covering them up again, [136]. 

► Has a cachectic look; cheeks hollow and pale; yellow complexion; no signs of lead poisoning, aside from the cerebral symptoms. Yet this case is not one of encephalopathy in any form. It is a chronic affection of the mind, which we must try to describe in order to characterize it. He is absorbed in himself; pays no attention to what goes on about him. He does not converse with his neighbors; when questioned he answers rationally, indeed, but briefly. When his wife and children come to see him, he pays no attention to them, and goes on with what he is about, as if they were not present; yet he says he is fond of them, and seems to think a good deal of their visits. He has never shown any irritability. When in bed he keeps moving his hands; folds and unfolds the coverings. Sometimes he gets up and wanders about the room, now singing, now gradually quickening his steps, as if impelled by an irresistible force, now stopping and turning about abruptly; his gait is uncertain. His behavior is nearly the same day and night, [509]. 

► Talks to himself a good deal, mostly about his business, his associates, or his relatives. When his attention is forcibly attracted, and he is asked where he feels pain, he places one hand on the middle of his forehead, and the other on his stomach, and utters a few words which indicate unmistakably the seat of suffering; but if he is not talked with, so as to keep his thoughts fixed, his mind begins to wander, or he falls asleep, [190]. 

With the others

► Appeared to be rapidly recovering, when he was suddenly seized, about 11 A.M., with furious delirium, attended at intervals, by general spasms. It was astonishing to see him, who, three hours before, could only pronounce with difficulty a limited number of words, whose voice was weak, and whose utterance was faint and drawling, now talking incessantly, and pouring forth shouts, screams, and abuse against all who approached him. His voice was loud and clear. His delirium turned chiefly upon the idea that his life was in danger from assassination or poisoning, and that every one about him was a murderer. His muscular strength was increased to such a degree, that, with one hand, he could lift all his mattresses at once with the greatest ease. He left his bed, and walked about briskly, knocking against every obstacle at random. His face was flushed; his eyes sparkling and fierce. At last a strait-waistcoat was put on him, which heightened his fury. Pulse, 65; heat of body rather increased. The delirium lasted about half an hour, when it was succeeded by coma, during which he lay stretched out and motionless, with closed eyes and somewhat pale face. Strong stimulation could only draw forth a few unmeaning grunts. An hour later, the delirium suddenly returned, to be followed again by coma, and thus, all that day and night, the opposing conditions alternated, [190]. 

► Often getting out of bed and wishing to go home; sometimes not recognizing his family; thought they were conspiring to kill him, [290]. 

► Got up to go to stool, but, instead of returning to bed, began walking the room with bare feet, and talking incoherently on all sorts of subjects; imagined he was going to be poisoned; that his bed was full of ants, etc., [173]. 

► During the evening of the seventh day, suddenly great restlessness; he hears everywhere threatening voices, officers come to arrest him, to seize his furniture, and to expel him from his lodgings; the voices come from the pillow, the mattress; they enter by the window, where he sees people, and they consult about him with closed doors; he gets up, looks for his clothing, wants to run away, to his lodge, etc. The next morning he sits at the edge of his bed, the eyes fixed steadily to the window, or looking about in a restless manner; he recognizes all persons around him, replies correctly to all questions, but cannot recollect what he ate yesterday, whether his bowels moved or not, and looks to his wife in an interrogating manner; insists, though as if afraid to acknowledge it, on the reality of his hallucinations, [537]. 

► The patient imagined that he was constantly followed, and that he heard voices coming from the chimney (temperature 36.5°, pulse 64, regular and small, good appetite, clean tongue, very slight colic, no paralysis, with a blue line on the gum, with constipation); this man after a few days wished to leave the hospital and go home, because he was convinced that there were fiends in the building that pursued him and sought his life, [441]. 

► Distrust, [114]. 

► Avoids society, [153].

► The cerebral functions were strangely disturbed. Various hallucinations showed themselves. Erroneous ideas were formed as to the identity of herself and those around her, and the situation in which she was placed. A mild, but easily controlled form of delirium arose. For some days this alternated with a different state; if she attempted to speak to those around her, she seemed to have difficulty in finding language, and before she could succeed in conveying her meaning, the idea fled, and a jumble of unconnected words was all that escaped her. And now the condition of the nervous system became one of apathy. Impressions were made upon the senses with difficulty, and speedily vanished; her attention was no sooner gained than it was lost, and she remained for hours at once in a state of semi-consciousness. At this stage, phenomena were occasionally present approximating to those described as characteristic of catalepsy and ecstasy. On placing the arms, for example, extended in any particular position, they remained fixed in it for some minutes, and then slowly relaxed and sunk down; at other times she would remain for a considerable period unconscious of anything around her, but with her eyes fixed and gazing intently before her. On one occasion, after the action of a purgative, she was for about twelve hours quite insensible. She lived for five weeks after the appearance of the cerebral symptoms, and for four months from the time when her health began to break down. Before her death she was seized with convulsions of an epileptiform character, which continued with short intervals for forty-eight hours, and upon the cessation of which she passed into a state of complete coma and died, [56]. 

► Hallucinations of mind, she seemed to see her dead husband and child in a tree out of the window, [449].

► Lovely dreams of a distant beloved person, after midnight (first and second days), [3]. 

► Longing for a distant friend, in the evening, before falling asleep, [3]. 

Kent: Plumbum produces an inclination to deceive, to cheat. The Acetate of lead produced in a woman, who took a little of it for suicide, a confirmed hysterical state. She would be in a hysterical condition for hours when any one was looking at her. When she thought no one was near she would get up, walk about, look in the glass to see how handsome she was, but when she heard a foot on the steps she would, he on the bed and appear to he unconscious.

She would bear much pricking and you could scarcely tell she was breathing. Plumbum establishes a hysterical state in the economy; an inclination to deceive, to feign sickness; to exaggerate one's ills; and it goes to the root of the evil providing the symptoms agree.

Changeable; continually changing from one thing to another, from one group of imaginations to another, from one group of emotions to another. The whole remedy is intensely emotional. While the intellect is slowed down, yet most of the symptoms are emotional.

With the Environment

► During the paroxysms of colic, he tosses and rolls about in bed, weeps and laments; his pinched-up face denotes the sharpest pain; he is so distracted by the agony he endures, that he can pay no attention to what passes around him, nor when asked a question, [137].

► Between the paroxysms, mind often much affected. Would leave home without knowing where he was going; became enraged with persons he met; and generally remembered nothing of what had occurred. When brought home, he would shut himself up until he got right again. One day, he left home to enter the Hospital Beaujon; got lost, and was quite surprised to find himself at La Pitié, [521]. 

► Talked rather wildly; got out of bed; ran about the room; called to his companions; wanted to go to work, etc.; yet complained that he could not see his way, and knocked against the beds, stoves, etc., [187]. 

► He had, some time back, illusions of vision; saw castles, palaces, but these have ceased since he entered the hospital, [509]. 

► He saw many colored figures in constant motion, as soon as he closed his eyes, [537]. 

► On first recovering consciousness the people in the ward seemed to him as small as dolls, and the opposite of the room seemed to be sunk forty feet below his own level. These erroneous impressions he was conscious of at the time, and they disappeared in four days, [327].

► Dreams of stealing fruit in a garden (first night), [4]. 

► Heavy frightful dreams of falling (first night), [4]. 

► Complete indifference, with sopor, alternating with extreme difficulty of breathing and headache, [235]. 

Childhood

► The child was sensitive and fretful, whenever any one approached; it cried and whined a great deal and would not play, [575]. 

Male Sexuality

Increased sexual desire and violent erections. 

Slight provocations produce erections and emissions. 

► Frequent erections, with spasmodic retraction of the testicles, and even with emissions during the colic, [109]. 

► Erections in the morning, [5]. 

► Great inclination to coition. (H. and T.) [From Plumbum muriate.] 

► Emission of semen during sleep, quite unconsciously, after drinking wine, and the next morning, violent erections on every slight provocation; several nights in succession, [3].

► Emissions. (H. and T.) [From Plumbum muriate.] 

► Emissions, during the morning sleep, with voluptuous dreams (sixth day), [5]. 

► Very scanty emission of semen during coition (fifth day), [2]. [2160.]

► Involuntary seminal emissions, three or four times a week, causing great debility, [167]. 

Emissions, with relaxed organs, after wine. 

► Flaccidity of the penis, [30]. 

► Diminution of sexual desire, [529]. 

► Diminished sexual desire, [37]. [From binding a leaden plate on the lumbar region.] 

► *Loss of sexual desire, [58], [488], [486]. 

► Anaphrodisia, of the same duration as the lead line on the gums and the urinary symptoms, [485]. 

► Seminal weakness, [559].

► Impotency, [72]. 

► Complete impotency (secondary action?). (H. and T.) [From Plumbum muriate.] 

Loss of sexual desire; impotence; chronic degeneration of cord. 

Lead poison and sterility

► Sterility in a man, [93].

► From one hundred and forty-one pregnancies by fathers laboring under the effects of lead poisoning, there were eighty-two abortions, four premature births, and five still-born infants. Of the fifty children born alive, twenty died in a year and a half, fifteen in a year and three months, fourteen survived longer, but of these only one exceeded three years of age, a period of life when children may be regarded as having escaped this fatal influence, [517]. 

► Among seven women who had nothing to do with lead whatever, but whose husbands were subjected to its influence, there were thirty-two pregnancies, resulting as follows: eleven abortions, one still-born child, eight full-term children, which died in their first year, four that died in their second year, five that died in their third year, and two only that are now alive, one of them being only twenty-one months old, [426]. 

Female Sexuality

Lead poison and pregnancy

► Four women had fifteen pregnancies, distributed as follows, viz., ten abortions, occurring between third and sixth month; two premature births, the children dying soon after birth; one child still-born; one delivery occurring at the full period, but the child died the same day; out of these fifteen cases only one child was born alive that did not show any symptom of lead diathesis. Five women had given birth to nine children before they were subject to the influence of lead poisoning; the children were healthy and alive; neither did the mother suffer from any menstrual irregularity; but after going into the type-cleaning works, they had together thirty-six pregnancies, distributed as follows: twenty-six abortions, from the second to the sixth month of pregnancy; one premature birth, the child dying soon after; two children still-born; seven at full term, of whom four died in their first year, and one in his second, and only two still alive, one of whom is very delicate and anæmic. A woman after having five abortions, left the type-polishing works, and after recovering from the effects of lead poisoning, gave birth to a healthy child, still living. A woman left the works for a time and then went back; during the time she was under the influence of lead poisoning, she frequently aborted, but during the interval she was absent from the works she gave birth to a healthy child, [426]. 

► Previous to her present employment, she had been delivered of three healthy children at full term, still alive; but since her employment as a type polisher, she had suffered much from ill-health, an attack of painter's colic three months after beginning this work, and again four years later; shortly after second attack she became pregnant, and was delivered of a dead child; three years elapsed and she had a miscarriage at the fifth month of her pregnancy; she had become pregnant eight other times, and each time after a short suppression of the menses, and the delay of two or three months, she miscarried, characterized by an abundant menorrhagia, and accompanied by colicky pains at the time, [425]. 

► Miscarriage in the second month of pregnancy, and in the third month of the next pregnancy; in the following pregnancy she suffered from alternating constipation and diarrhœa, did not miscarry, but the child was emaciated, and was a pitiful object, and lived only one month; she passed through the next pregnancy, but the child was very slight, weighed only 2600 grams; at this delivery she suffered from inertia of the uterus and post-partum hæmorrhage, which was arrested by compression of the aorta, removal of the clots, and by ergot; having now left her occupation of painting (she had a bad habit of holding the brush between her lips), she passed through her subsequent pregnancy with a more robust child than before, weighing 3200 grams, without hæmorrhage; this infant lived, [334]. 

► About the third week in October, began to experience a "tired," heavy feeling of pain in the lower limbs, particularly her knees; the same pain was soon felt about the navel and in the groin, giving the sensation of a cord pulling down, and extending to the very lower part of the bowels; soon a similar pain was felt in the shoulders, back, arm, hands, fingers, feet, and toes, particularly over the tops of the feet and hands. She suffered the characteristic nausea of pregnancy for the first two months, none afterwards, until December 31st, when she was seized with vomiting, with an increase of all the symptoms just named, until it closed with abortion, January 9th, [286]. 

► From twenty-seven pregnancies, occurring in five women, there resulted twenty-two abortions, four still-born, and only one living child. From forty-three pregnancies occurring after lead poisoning, thirty-two miscarriages, three born dead, two living, but puny children. One woman who had had five miscarriages left the occupation, and gave birth to a fine baby. According as women left off or resumed the business, their children would be torn alive or dead, [506].

► Miscarriage and death, [59]. 

► Miscarried four times, [424].

► Miscarriage at seven months of a dead fœtus, followed by death, [102]. 

► Frequent miscarriages in women, almost habitual, [104]. 

► Miscarriage, [432]. 

► Miscarriage in the third or fourth month of pregnancy, with persisted hæmorrhage for five weeks, [423]. 

► Of twenty-nine pregnancies among women who gave but slight evidence of lead poisoning, there were eight abortions, one premature birth, twelve at full term, which died in the first year of their life, eight children still living, [426]. 

► Premature delivery, [426].

► Has had two children, of whom one survives, but is feeble. Within thirteen months has had a miscarriage, followed by peritonitis, [472]. 

► Abortions occurring between the third and sixth months of pregnancy, [426]. 

absent for four months, [582].

Pain drawing from abdomen to backbone, as if abdomen were drawn upward by a string; depression of spirits; constipation. θ Abortion. 

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

Nymphomania.

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

►► Vaginismus, [448], [565]. 

Feeling as if there were not room enough in abdomen, at night in bed; must stretch violently. 

She feels a lack of room for fetus in uterus; inability of uterus to expand; threatening abortion.


Milk scanty and watery, with great emaciation.

Epileptic fits, at first seldom and irregular, but soon regularly and coincident with menses; attacks very severe, lasting for hours, followed by great drowsiness and lassitude, compelling her to pass following day in bed; menstruation exceedingly painful, so that its approach fills her with great fear; severe frontal cephalalgia; constant sleepiness; for several years severe colic and obstinate constipation; face dirty pale; very poor memory; low-spirited, frequently sits in abject despair; strabismus, jerking with head, dragging speech, with slight frothing at mouth while talking.

Work

► While hard at work, and apparently in the best of health, he suddenly fell back unconscious; no spasms, foaming at the mouth, etc., [178]. 

► Extremely active, absorbed in work, thoughtful, in the afternoon, [5]. 

► Mental indolence, [483].

► Less inclination to work, [519]. 

► Very indolent, disinclined to work, [4]. 

► The desire and ability for work were very much diminished (third day), [5]. 

► Indolent, weary (after three-quarters of an hour), [4]. 

► No disposition to work, [259]. 

► Indisposition to labor and conversation, [305]. 

Intellectual

Utterance*

Weakness or loss of memory; unable to find the proper word.

► His utterance is drawling, difficult and frequently broken; so that he talks like a child who has not learned to speak plainly; instead of "oui," for example, he says "ui." Sometimes he cannot get hold of the right word; then he frets and worries himself, and now and then becomes quite desperate. This difficulty seems to be met with chiefly in the case of substantives; with adjectives, the intellect and organs of speech deal more easily, [195]. 

► He seems to recognize familiar acquaintances; sometimes he talks unintelligibly to himself; more frequently is silent. When his attention is strongly attracted, he at first answers rationally; then suddenly utters some words without meaning or connection; afterwards takes up again the thread of logical thought. He usually waits some time before answering a question; it seems as if it required great mental exertion for him to understand what is said, [195].

► The intelligence and power of utterance vary curiously at different times, [195]. 

► Thought and speech difficult, [339]. 

► Sometimes utters a few broken, disconnected words, [174]. 

Slowness of perception

► The intellect more or less disturbed, [305]. 

► Cannot fix his thoughts upon anything, [174]. 

► Reading is very tiresome to him; he mistakes one word for another, and skips the lines, [188]. 

Slow of perception; intellectual torpor; gradually increasing apathy.

► Loss of understanding, [186]. 

►► *Slow of perception, [356]. 

► Loss of mind, [25]. 

Affections more of the emotions than the intellect. 

Answers

► Intellect seemed affected; answers not so rational, [188].

► Answers slowly, and in a weak voice, [519]. 

► His answers are slow and short, [153]. 

► Answers at random, [174].

► Answers questions vaguely; and admits that his memory is much impaired, [517]. 

► He answers well enough, but his evening made a mistake in giving his age, [521]. 

► Memory much impaired; sometimes does not know his own bed, [509]. 

►► *Loss of memory, so that while talking, he was often unable to find the proper word, [339]. 

► *Loss of memory, [114], [444], [483], [487], [518]. 

► *Memory difficult, [429]. 

► Remarkable weakness of memory, [92].

► Intellect clear, but memory seems much impaired, [170]. 

► Weakness of memory (fourth day), [4], [7], [80]. 

► Has been much troubled for twenty years by a singular cerebral affection, returning at intervals, and characterized by restlessness, constant inclination to move about, loss of memory, and indecision. This mental condition has several times obliged him to enter a hospital. He does not recollect either the dates of the duration of these seizures, nor anything respecting their treatment, [50b]. 

► Memory is much impaired, [356]. 

Neurological

Delirium

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. 

Delirium furious at night, milder by day, with hallucinations 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 by suppressed colic, with bloated abdomen. 
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. 

► Delirium, [39], [53], [85], etc. 

► Most violent delirium, with screaming and running about the room, succeeded the epileptiform spasm, [94].

► Delirium, resembling the most frightful kind of madness, and impelling them to tear themselves and bite their own fingers, [171]. 

► Furious delirium, resembling delirium tremens, [476]. 

► Raging, alternating with quiet, delirium; the former came in paroxysms; no fever, [170]. 

► Delirium, with violent raging, so that he had to be put into a strait-jacket, with hallucinations of vision, [444]. 

► Raging delirium, [46].

► Furious delirium, [305].

► Violent delirium, at night, [35].

► Violent delirium set in and continued for some days. As the delirium declined, the mind did not recover its clearness and integrity, on the contrary, his sensations and perceptions were vitiated and erroneous. Various morbid ideas took possession of him, and some of them remained, and continued to manifest themselves for many months after his apparent restoration to health, [561]. 

► The delirium tranquil during the day, furious at night, [305]. 

► Complete rage, [28].

► Delirium, with bewildered expression, [35]. 

► Delirium, with very violent convulsions, [96]. 

► During the third day of delirium, he was awake, sometimes quiet, sometimes violent, but almost totally irrational. Pulse, 80; skin rather hot, [191]. 

► Delirium, for three days (in a previous attack), [222]. 

► Delirium, with trembling of the tongue and hands, [578]. 

► At times delirious, [276].

► Nightly delirium, alternating with sopor, [235]. [20.]

► He was at times delirious, very restless, and manifested great concern for his affairs, [279].

 ► Delirium, alternating with sopor, [237]. 

► Tranquil delirium, [305].

► Sudden attack of delirium, in the evening, accompanied by extreme restlessness; he railed, threatened, and then fell into a deep sleep. This alternation of delirium and somnolency continued until morning; next day, face flushed and covered with sweat. Eyes fixed and expressionless; bloodshot; lids swollen; pupils, especially the right one, extremely dilated, but moderately sensitive to light. Expression of face decidedly dull. Frequent movements, more or less forcible, of the head, limbs, and whole body; so that he had to be put into a strait-waistcoat, [190].

► On the fifth day of the delirium, in the afternoon, he had a sudden attack of epilepsy, characterized by violent convulsive movements of the whole body, bloody froth at the mouth, biting the tongue, interrupted breathing, etc. After an attack, which lasts about half an hour, he becomes slightly comatose, but soon rouses, and enters again into delirium. On the sixth day of the delirium, the general aspect of the countenance was more unnatural than before. There was less of that harmony of expression which is indicative of a well-balanced mind. Sometimes the eyes were fixed and the features concentrated; sometimes the former seemed to roll about, under the influence of serious thought, and the whole face to partake of this meditative look. He would still sometimes burst into laughter at the most unexpected moments. The limbs trembled, or rather, were shaken by slight spasms, which also ran over the face in different directions, coming and going at irregular intervals. The tongue was considerably swollen, from having been bitten during the epileptic seizures of the preceding day; utterance also was impeded, being stammering, hurried, and abrupt; an effect to which the slight spasms above spoken of also contributed. He was sometimes conscious of his condition, and said that he was insane. His talk became irrational more frequently, and continued so longer than on the day before. Yet even now, his intellectual aberration could only be discovered by very attentive observation. On the seventh day of the delirium, he talked much to himself, and tried to get into the neighboring beds; he wandered more in his speech; wanted to strike the nurse, without provocation; when threatened with the strait-waistcoat, he quieted down somewhat. He often talked to himself at night; what he said was incongruous, disconnected, and about all sorts of things. He got up three or four times, and tried to fold his bedstead together, under the impression that he was working some sort of machine; then he laid down again. Twice he rose from bed, walked about with bare feet, and urinated in the middle of the floor; next minute, he fancied one of the patients called to him, ran headlong to help him, and got into another bed at the opposite side of the room. His sight was unimpaired, his gait firm and confident. At times, he was silent and quiet, although he never closed his eyes. On the eighth day of delirium, he was quiet, but, in conversation, more decidedly irrational than on the day before. He spoke to others with a smiling face; he was silent and looked very thoughtful. Now and then, he perceived that he had used a wrong word, as was shown, by his impatient gestures, and he tried to recall the proper one; he talked to himself about all sorts of things. If he was spoken to so as to attract his attention strongly, and the questions were simple, and easily answered, his replies were rational. He talked no more sensibly about one thing than another. Even to-day, although not so apparent as yesterday, there was always, amid his delirious ravings, a certain semblance of good sense. The utterance is, as it were, spasmodic; more abrupt and jerky than on the day before; words are pronounced rapidly and incompletely, [196]. 

► During the paroxysms, the face expresses acute pain; he is restless, rolling about in bed, screams out, etc., [162].

 ► During the paroxysms, he lay flat on his belly, dug his fingers into his navel, tied himself tightly in his cravat, uttered dismal screams, declared that he had to go to stool; sometimes got up and walked the room hurriedly, his hands pressed to his abdomen; we have seen the poor fellow leaning on his belly against the iron railing of his bed, [219]. 

► During the paroxysms, a condition approaching to frenzy; constant restlessness; lying on abdomen; he knelt down and crouched together in his bed, etc., [211].

► In the night, began to talk to himself quite incoherently, about all sorts of things; then left his bed, and wanted to lie down in another bed in the room. The nurse easily got him back to his own quarters; his gait was firm, and he had no tremor; his eyes were wide open, somewhat projecting and fixed. His face had an expression of astonishment. During the rest of the night, he talked much to himself; his delirium was mild and quiet. Next day, his expression was natural, and he had the use of all his faculties, but he seemed to take little interest in conversation, and his manner was remarkably listless. About 5 P.M., he began fairly to rave; would keep chattering for several minutes, and then be silent for awhile. His face had a wild expression, which struck the house surgeon on duty. Pulse, 85; no fever. Worse at night; took part in all the conversation he heard, or fancied he heard, [185]. 

► Out of his head, at times; at night, quite delirious, talked almost constantly; got out of bed; looked for his clothes, in order to dress himself; ran all about the room, trying to get into the other patients' beds; at last, after he had gone on in this way a good while, it was found necessary to put him in a strait-waistcoat, to which he submitted quietly. Next day, his eyes were wide open; his expression was rather wild. When alone, he talked much to himself, sometimes calmly, sometimes violently; generally about wine, which he would not take part in smuggling into the hospital. Sometimes he fancied himself at his foundry, at home, or in the street, etc. His conversation was a mixture of sense and extravagance. When his attention was strongly attracted to anything, what he said was at first rational, then he would suddenly drop the subject, and begin to talk about something quite different, mixing together in this way a great many ideas and incoherent words. But, on peremptorily recalling his thoughts to the topic gamboled* from, he would again answer pertinently and sensibly for awhile. [184]. 

► After trying in vain to find his clothes, he got up and walked the room, but with hesitating step, and feeling about with his hands, like one groping in the dark; runs against the stove, the beds, etc.; sometimes uttered incoherent words, or called for his wife, or his friends; wanted to talk about his business; often said "My wife! my wife!" more frequently was silent. At last he became quiet, soon got into bed again, and seemed to fall into a deep sleep. After awhile, would rouse up and begin to act in the same way again. Once he was about to urinate upon the stand which held the patient's diet-drink. Sometimes he spoke rationally, but generally poured forth unintelligible words in a trembling and hurried voice. He talked to those about him, and made the most incongruous demands upon them. He was not violent, and threatened nobody. Now and then he put his hands to his forehead or abdomen, his face contracted, he groaned and exclaimed "My God! my God!" then began to cry like a child. Sometimes he was observed to lie down on his abdomen. Constant sleeplessness. Delirium and restlessness, worse at night. Recognized those about him, and maintained a long conversation tolerably well; but, when a drunken patient happened to say to him, in an offensive tone, "They will put you in a strait-waistcoat, you old lunatic!" he became furious, stamped his feet, shook his fists, wept, etc.; poured forth a multitude of words. In a quarter of an hour, he became quiet again, and soon after slept a little. Being visited by his wife, he at first received her roughly, and loaded her with abuse; then suddenly began to caress her, and seemed greatly pleased with the visit, [186].

► His facial expression does not at all times correspond with the character of the conversation he is engaged in, nor with the other external influences which surround him. Thus, he will sometimes burst out laughing, while speaking of some very ordinary matter, or look serious and thoughtful while answering the most simple question. Yet quite often his face wears its natural expression. At first he would not be taken for a victim of cerebral disease; he is very quiet, and seems quite rational. But gradually as the conversation proceeds, he loses the thread of his ideas, and talks mere nonsense, or keeps contradicting himself most shockingly. When alone, he does not talk to himself. He eats, drinks, urinates, and goes to stool, as properly as anybody; sometimes he gets up to visit other patients in the next ward; the latter do not at first perceive that his intellect is at all affected, but when the hint is given them by the physicians, they soon declare that he talks wildly, [196]. 

► Rose from bed in the night, and tied to get into his neighbor's bed; took a cravat from me; a pair of trousers from another; walked as if groping in the dark, and bruised himself against the stove, washstand, etc.; talked to himself; at last the warden managed to get him into bed again. Quiet during the rest of the night; but every now and then wanted his neighbors to give him "his drop." Next day, face wild; eyes wide open; by turns fixed and wandering. Abdomen nowhere painful on pressure. Kept trying to get up in order to take his "drop," and called to the other patients, "Make haste and get up." His limbs were tremulous. His constant efforts to get out of bed made it necessary to put him in a strait-waistcoat; he struggled hard against it, screamed, howled, uttered threats; became red with passion, and tried in every way to break loose; called out to the passers by and begged them to set him free. During the day, he was sometimes quiet and silent; sometimes furious at the thought of being tied. He was never sleepy. Fancied, at times, that he heard delightful music, which soothed his sorrows, [187]. 

► His colic was almost cured, when the nurses and his fellow-patients observed that his intellect was affected, and that he wandered in his speech, but to so slight an extent, that the aberration escaped the notice of the medical attendants. He lay quiet, with closed eyes, as if in a peaceful sleep; when pinched as hard as possible he showed no sign of sensibility. When the fingers, hands, forearms, or arms were placed in any position, and left unsupported, they remained there for a few seconds, then oscillated a little, and fell back on the bed. This experiment was repeated several times, with the same result. The body was rigid, so that he could not be made to sit upright, and his attention could not be aroused for a moment. Suddenly he began to make a great variety of the most expressive gestures, at first with one arm only, but soon the other arm, the legs, trunk, head and face, all took part in these movements, which were performed in co-ordination, and seemed to express the same idea. Every moment he appeared to be possessed by the most dissimilar and grotesque conceptions, which he embodied in this way. At the same time he cried out, and tried to speak, but was prevented by the liquid in his mouth. If, at this time, he was gently pinched, he showed by an abrupt movement, that he felt acutely. The upper limbs no longer remained fixed in any position they were placed in; they were too stiff to be moved at all. After the movements had lasted some minutes, they were succeeded by a state of absolute quietude, and he lay just as he done before they commenced; then they began again, to be again followed by a period of repose, and so on, in alternation. Now, he indicated, by a significant gesture, that he desired to eat and drink; now he suddenly spouted the ptisan, which he had been holding in his mouth, all over the surgeon in attendance. Then came an interval of quiet and unconsciousness, during which his limbs remained in any position they were made to assume. Next was witnessed a series of the most expressive gestures, although he kept his eyes shut, and uttered not a single word. Their significance is constantly varying; sometimes they seem to indicate rage, sometimes despair, sometimes entreaty, sometimes the most profound meditation. At last he suddenly opened his eyes, called for drink; then seemed to fall asleep again while swallowing his ptisan*, but is easily aroused by being spoken to; then he opened his eyes fully, began to talk about his mother, and while rambling volubly from one incoherent idea to another, still answered questions rationally. Left to himself, he talked incessantly, followed up an idea for a minute or two, and then left it for another. At one time he became much agitated, tried to get up, addressed the doctors, abused them, tried to strike and bite the nurses when restrained; and at last, shouting and struggling, was put into a strait-waistcoat. On the second day of the delirium, he was lying quiet, with eyes half open. Soon he aroused completely, began to talk very fast, and at first answered questions rationally. But after conversing a few minutes, his thoughts became confused, and he began to ramble and talk to himself. By attracting his attention again, he could be brought back to the original topic, then got off the track again, and so forth; so that his talk was a mixture of sense and nonsense. He was frequently influenced by the most grotesque delusions; he fancied that a cavalry regiment was about to fall upon him; or that he was in the presence of his employer, who was finding fault with him. His face looked rather wild; at times he bursts out laughing. His head was full of notions. He recollected very well what happened a month or more ago; but could not call to mind things that occurred only a few days before his delirium set in, [199]. 

*a nourishing drink, especially barley water

► The colic was not severe and was getting better under treatment by Croton tig., when the face was observed to have a singular expression. There was an astonished look, as if something extraordinary had happened; and he had a thoughtful appearance, which was not borne out by his answers to our questions. In the evening delirium set in, and lasted all night. Next day he talked incessantly about everything. At 9 A.M. he had an attack of epilepsy, followed by deep coma, which lasted almost all day, and during which he only uttered a few cries, [191]. 

► He could keep up a long conversation quite well, but would wander in his speech every now and then. Generally, when he was talking, no one would imagine his brain was affected, if they did not see his strait-waistcoat. When he began to rave, the facial muscles were seen to twitch and contract spasmodically, giving his face a hideous appearance, [172]. 

► Talked at random all night; rose and tried to get into the neighbor's beds; at times screamed out; abused the nurse furiously, [177]. 

► Talked all night, mostly about how he should destroy his fastenings, [184]. 

► Talked all day long; made attempts to get out of his strait-waistcoat, [184]. 

► At night, does nothing but babble; now and then jumps out of bed, swears, blusters, so that he has to be put into a strait-waistcoat, [200]. [80.]

► In conversation he sometimes talks sense and sometimes rambles, [197]. 

► Does nothing but babble all night; wants to get out of bed every now and then, [198]. 

► Language extravagant, [186]. 

► Searching about on the floor, [440]. 

Alzeimer disease?

► Loss of consciousness, occasionally returning, followed by epileptiform spasms, with bloody froth from the mouth; succeeding these attacks there was left-sided paralysis of motion and sensation, [577]. [Microscopical examination of the brain showed granular fatty degeneration of the walls of the vessels and deposition of large quantities of amyloid corpuscles.] 

► Slightly lethargic, [353].

 ► *Apathetic condition, [520]. 

► Gradually increasing apathy, [519]. 

► Her mind at first was stupid, [343].

► Tendency to stupor, [106].

► Mental torpidity; answers slow and stammering, [578]. 

► Intellect obscure, [534].

► Takes no notice of anything about him, unless aroused by pain or an attendant, [290]. 

► While hard at work, and apparently in the best of health, he suddenly fell back unconscious; no spasms, foaming at the mouth, etc., [178]. 

► She fell down unconscious while attempting to walk, soon, [274]. 

► Loss of all senses, with constantly recurring, most violent general convulsions, [11]. 

► For the most part unconscious, but at intervals he answered promptly the questions that were put to him, [439]. 

► For the most part unconscious, but occasionally had lucid intervals, [440]. 

► Scarcely recognizes his nurse, [174].

► Loss of consciousness, [483], [511]. 

► Lies motionless and crouched together; eyes shut or half shut. Often snores as if in the deepest sleep. Now and then he utters some dull grunts; makes some automatic movements; half opens his eyes and shuts them directly. Cannot be roused by the sharpest questioning; has to be pinched hard; then he opens his eyes, at first partially, then widely; and finally, without answering, falls back into lethargy. Sometimes, when annoyed by these experiments, he turns in bed, and makes a dull grunting, indicative of his displeasure, [187]. 

► Lies on his back, crouched together, quiet and sleepy, eyes shut or half shut. At times snores as if sound asleep. Rouses from this state of sopor only to utter a few inarticulate words in a weak voice, half open his eyes and immediately close them again. When stimulated, as by pinching, he at first gives evidence of no sensation whatever, but if the stimulation is kept up for some time, he slowly draws away the part operated on, and then opens his eyes, which look quite wild; rolls them about stupidly, and returns no answer when questioned; falling back finally into lethargy. His features are motionless and inexpressive; at times, some automatic movements of the head and arms take place, [177]. 

► Intellectual torpor, [533]. 

Convulsions

► After working hard all day, feeling quite well, he took supper as usual, but on rising from table suddenly fell back unconscious, without spasms, foaming at the mouth, or paralysis. Was taken to bed, and in about three-quarters of an hour recovered consciousness, but was somewhat delirious. Next day this wild delirium continued, but nevertheless he walked to the hospital with some companions, [196]. 

► Suddenly fell back unconscious, without convulsions or foam at the mouth. Two minutes after he raised himself up and said, "It is nothing." Next moment he was trying to reach the bed of one of his fellow-patients, when, for the second time he suddenly fell unconscious, without the slightest spasm, either then or afterwards; he was carried to bed in this condition, and remained in a state of profound coma, from which he could not be roused for two or three hours. At the end of this time he opened his eyes, now and then, and talked about all sorts of things, imagined he was spoken to, answered his neighbors, and then relapsed into somnolence. This alternation of coma and loquacity lasted a great part of the night. Next morning he was found apparently fast asleep; at the end of an hour he appeared to rouse up suddenly, half opened his eyes, uttered a great many disconnected words, tossed about in bed, rose and urinated on his pillows, put his head down and lifted his buttocks in the air, then relapsed into coma. If he was pinched or very sharply spoken to, during his lethargy, he at first would open his eyes and then shut them directly; at last, by continuing the use of stimulants, he was made to open his eyes completely; they were fixed and wild-looking. If now he was questioned earnestly, he would look hard at the questioner, without being able to utter a single word, or else he would stammer out some disconnected words, and then fall back into coma, [176]. 

Coma

► Stupefaction and deep coma, [11]. 

► He fell down stupefied, [24]. 

► Complete stupefaction and insensibility, from which, however, he could be roused by loud cries, but gradually sank back into his former condition, murmuring unintelligible words, [339].

► Seems to be always asleep; it is hard to rouse him from this state of coma, and he only wakes enough to half open his eyes, and answer everything with yes or no, indistinctly uttered in a loud voice, then turns over in bed and falls asleep again. If, after being well shaken, he is asked where he feels pain, he points slowly towards the umbilicus; he says and does everything very slowly, [189]. 

► Alternate coma and delirium, [480]. 

► Coma, lasting three weeks, [483]. 

► Coma, [39], [385], [440]. 

► Coma succeeded, at 4 P.M., by another epileptic fit, soon after which he begins to talk at random, [200].

► About midnight, after a violent epileptic fit, he fell into a profoundly comatose state, from which he could not be aroused. Lay doubled up in bed, with eyes closed and pupils widely dilated, [201]. 

► Coma, with at times automatic movements of hands to the occiput, [339]. 

► The nurse said that the coma supervened upon a violent epileptic fit, which seized the patient about midnight, [189]. 

► Comatose state, from which he arouses when spoken to, [520].