Recovery has followed the ingestion of an ounce of officinal hydrochloric acid. Black mentions a man of thirty-nine who recovered after swallowing 1 1/2 ounces of commercial hydrochloric acid. Johnson reports a case of poisoning from a dram of hydrochloric acid. Tracheotomy was performed, but death resulted.

Burman mentions recovery after the ingestion of a dram of dilute hydrocyanic acid of Scheele's strength (2.4 am. of the acid). In this instance insensibility did not ensue until two minutes after taking the poison, the retarded digestion being the means of saving life.

Quoting Taafe, in 1862 Taylor speaks of the case of a man who swallowed the greater part of a solution containing an ounce of potassium cyanid. In a few minutes the man was found insensible in the street, breathing stertorously, and in ten minutes after the ingestion of the drug the stomach-pump was applied. In two hours vomiting began, and thereafter recovery was rapid.

Mitscherlich speaks of erosion of the gums and tongue with hemorrhage at the slightest provocation, following the long administration of dilute nitric acid. This was possibly due to the local action.

According to Taylor, the smallest quantity of oxalic acid causing death is one dram. Ellis describes a woman of fifty who swallowed an ounce of oxalic acid in beer. In thirty minutes she complained of a burning pain in the stomach and was rolling about in agony. Chalk and water was immediately given to her and she recovered. Woodman reports recovery after taking 1/2 ounce of oxalic acid.

Salicylic acid in medicinal doses frequently causes untoward symptoms, such as dizziness, transient delirium, diminution of vision, headache, and profuse perspiration; petechial eruptions and intense gastric symptoms have also been noticed.

Sulphuric acid causes death from its corrosive action, and when taken in excessive quantities it produces great gastric disturbance; however, there are persons addicted to taking oil of vitriol without any apparent untoward effect. There is mentioned a boot-maker who constantly took 1/2 ounce of the strong acid in a tumbler of water, saying that it relieved his dyspepsia and kept his bowels open.

Antimony.—It is recorded that 3/4 grain of tartar emetic has caused death in a child and two grains in an adult. Falot reports three cases in which after small doses of tartar emetic there occurred vomiting, delirium, spasms, and such depression of vitality that only the energetic use of stimulants saved life. Beau mentions death following the administration of two doses of 1 1/2 gr. of tartar emetic. Preparations of antimony in an ointment applied locally have caused necrosis, particularly of the cranium, and Hebra has long since denounced the use of tartar emetic ointment in affections of the scalp. Carpenter mentions recovery after ingestion of two drams of tartar emetic. Behrends describes a case of catalepsy with mania, in which a dose of 40 gr. of tartar emetic was tolerated, and Morgagni speaks of a man who swallowed two drams, immediately vomited, and recovered. Instances like the last, in which an excessive amount of a poison by its sudden emetic action induces vomiting before there is absorption of a sufficient quantity to cause death, are sometimes noticed. McCreery mentions a case of accidental poisoning with half an ounce of tartar emetic successfully treated with green tea and tannin. Mason reports recovery after taking 80 gr. of tartar emetic.

Arsenic.—The sources of arsenical poisoning are so curious as to deserve mention. Confectionery, wall-paper, dyes, and the like are examples. In other cases we note money-counting, the colored candles of a Christmas tree, paper collars, ball-wreaths of artificial flowers, ball-dresses made of green tarlatan, playing cards, hat-lining, and fly-papers.

Bazin has reported a case in which erythematous pustules appeared after the exhibition during fifteen days of the 5/6 gr. of arsenic. Macnal speaks of an eruption similar to that of measles in a patient to whom he had given but three drops of Fowler's solution for the short period of three days. Pareira says that in a gouty patient for whom he prescribed 1/6 gr. of potassium arseniate daily, on the third day there appeared a bright red eruption of the face, neck, upper part of the trunk and flexor surfaces of the joints, and an edematous condition of the eyelids. The symptoms were preceded by restlessness, headache, and heat of the skin, and subsided gradually after the second or third day, desquamation continuing for nearly two months. After they had subsided entirely, the exhibition of arsenic again aroused them, and this time they were accompanied by salivation. Charcot and other French authors have noticed the frequent occurrence of suspension of the sexual instinct during the administration of Fowler's solution. Jackson speaks of recovery after the ingestion of two ounces of arsenic by the early employment of an emetic. Walsh reports a case in which 600 gr. of arsenic were taken without injury. The remarkable tolerance of arsenic eaters is well known. Taylor asserts that the smallest lethal dose of arsenic has been two gr., but Tardieu mentions an instance in which ten cgm. (1 1/2 gr.) has caused death. Mackenzie speaks of a man who swallowed a large quantity of arsenic in lumps, and received no treatment for sixteen hours, but recovered. It is added that from two masses passed by the anus 105 gr. of arsenic were obtained.

In speaking of the tolerance of belladonna, in 1859 Fuller mentioned a child of fourteen who in eighteen days took 37 grains of atropin; a child of ten who took seven grains of extract of belladonna daily, or more than two ounces in twenty-six days; and a man who took 64 grains of the extract of belladonna daily, and from whose urine enough atropin was extracted to kill two white mice and to narcotize two others. Bader has observed grave symptoms following the employment of a vaginal suppository containing three grains of the extract of belladonna. The dermal manifestations, such as urticaria and eruptions resembling the exanthem of scarlatina, are too well known to need mention here. An enema containing 80 grains of belladonna root has been followed in five hours by death, and Taylor has mentioned recovery after the ingestion of three drams of belladonna. In 1864 Chambers reported to the Lancet the recovery of a child of four years who took a solution containing 1/2 grain of the alkaloid. In some cases the idiosyncrasy to belladonna is so marked that violent symptoms follow the application of the ordinary belladonna plaster. Maddox describes a ease of poisoning in a music teacher by the belladonna plaster of a reputable maker. She had obscure eye-symptoms, and her color-sensations were abnormal. Locomotor equilibration was also affected. Golden mentions two cases in which the application of belladonna ointment to the breasts caused suppression of the secretion of milk. Goodwin relates the history of a case in which an infant was poisoned by a belladonna plaster applied to its mother's breast and died within twenty-four hours after the first application of the plaster. In 1881 Betancourt spoke of an instance of inherited susceptibility to belladonna, in which the external application of the ointment produced all the symptoms of belladonna poisoning. Cooper mentions the symptoms of poisoning following the application of extract of belladonna to the scrotum. Davison reports poisoning by the application of belladonna liniment. Jenner and Lyman also record belladonna poisoning from external applications.

Rosenthal reports a rare case of poisoning in a child eighteen months old who had swallowed about a teaspoonful of benzin. Fifteen minutes later the child became unconscious. The stomach-contents, which were promptly removed, contained flakes of bloody mucus. At the end of an hour the radial pulse was scarcely perceptible, respiration was somewhat increased in frequency and accompanied with a rasping sound. The breath smelt of benzin. The child lay in quiet narcosis, occasionally throwing itself about as if in pain. The pulse gradually improved, profuse perspiration occurred, and normal sleep intervened. Six hours after the poisoning the child was still stupefied. The urine was free from albumin and sugar, and the next morning the little one had perfectly recovered.

There is an instance mentioned of a robust youth of twenty who by a mistake took a half ounce of cantharides. He was almost immediately seized with violent heat in the throat and stomach, pain in the head, and intense burning on urination. These symptoms progressively increased, were followed by intense sickness and almost continual vomiting. In the evening he passed great quantities of blood from the urethra with excessive pain in the urinary tract. On the third day all the symptoms were less violent and the vomiting had ceased. Recovery was complete on the fifteenth day.

Digitalis has been frequently observed to produce dizziness, fainting, disturbances of vision, vomiting, diarrhea, weakness of the pulse, and depression of temperature. These phenomena, however, are generally noticed after continued administration in repeated doses, the result being doubtless due to cumulative action caused by abnormally slow elimination by the kidneys. Traube observed the presence of skin-affection after the use of digitalis in a case of pericarditis. Tardieu has seen a fluid-dram of the tincture of digitalis cause alarming symptoms in a young woman who was pregnant. He also quotes cases of death on the tenth day from ingestion of 20 grains of the extract, and on the fifth day from 21 grams of the infusion. Kohuhorn mentions a death from what might be called chronic digitalis poisoning.

There is a deleterious practice of some of the Irish peasantry connected with their belief in fairies, which consists of giving a cachetic or rachitic child large doses of a preparation of fox-glove (Irish—luss-more, or great herb), to drive out or kill the fairy in the child. It was supposed to kill an unhallowed child and cure a hallowed one. In the Hebrides, likewise, there were many cases of similar poisoning.

Epidemics of ergotism have been recorded from time to time since the days of Galen, and were due to poverty, wretchedness, and famine, resulting in the feeding upon ergotized bread. According to Wood, gangrenous ergotism, or "Ignis Sacer" of the Middle Ages, killed 40,000 persons in Southwestern France in 922 A. D., and in 1128-29, in Paris alone, 14,000 persons perished from this malady. It is described as commencing with itchings and formications in the feet, severe pain in the back, contractions in the muscles, nausea, giddiness, apathy, with abortion in pregnant women, in suckling women drying of milk, and in maidens with amenorrhea. After some time, deep, heavy aching in the limbs, intense feeling of coldness, with real coldness of the surfaces, profound apathy, and a sense of utter weariness develop; then a dark spot appears on the nose or one of the extremities, all sensibility is lost in the affected part, the skin assumes a livid red hue, and adynamic symptoms in severe cases deepen as the gangrene spreads, until finally death ensues. Very generally the appetite and digestion are preserved to the last, and not rarely there is a most ferocious hunger. Wood also mentions a species of ergotism characterized by epileptic paroxysms, which he calls "spasmodic ergotism." Prentiss mentions a brunette of forty-two, under the influence of ergot, who exhibited a peculiar depression of spirits with hysteric phenomena, although deriving much benefit from the administration of the drug from the hemorrhage caused by uterine fibroids. After taking ergot for three days she felt like crying all the time, became irritable, and stayed in bed, being all day in tears. The natural disposition of the patient was entirely opposed to these manifestations, as she was even-tempered and exceptionally pleasant.

In addition to the instance of the fatal ingestion of a dose of Epsom salts already quoted, Lang mentions a woman of thirty-five who took four ounces of this purge. She experienced burning pain in the stomach and bowels, together with a sense of asphyxiation. There was no purging or vomiting, but she became paralyzed and entered a state of coma, dying fifteen minutes after ingestion.

Iodin Preparations.—The eruptions following the administration of small doses of potassium iodid are frequently noticed, and at the same time large quantities of albumin have been seen in the urine. Potassium iodid, although generally spoken of as a poisonous drug, by gradually increasing the dose can be given in such enormous quantities as to be almost beyond the bounds of credence, several drams being given at a dose. On the other hand, eight grains have produced alarming symptoms. In the extensive use of iodoform as a dressing instances of untoward effects, and even fatal ones, have been noticed, the majority of them being due to careless and injudicious application. In a French journal there is mentioned the history of a man of twenty-five, suspected of urethral ulceration, who submitted to the local application of one gram of iodoform. Deep narcosis and anesthesia were induced, and two hours after awakening his breath smelled strongly of iodoform. There are two similar instances recorded in England.

Pope mentions two fatal cases of lead-poisoning from diachylon plaster, self-administered for the purpose of producing abortion. Lead water-pipes, the use of cosmetics and hair-dyes, coloring matter in confectionery and in pastry, habitual biting of silk threads, imperfectly burnt pottery, and cooking bread with painted wood have been mentioned as causes of chronic lead-poisoning.

Mercury.—Armstrong mentions recovery after ingestion of 1 1/2 drams of corrosive sublimate, and Lodge speaks of recovery after a dose containing 100 grains of the salt. It is said that a man swallowed 80 grains of mercuric chlorid in whiskey and water, and vomited violently about ten minutes afterward. A mixture of albumin and milk was given to him, and in about twenty-five minutes a bolus of gold-leaf and reduced iron; in eight days he perfectly recovered. Severe and even fatal poisoning may result from the external application of mercury. Meeres mentions a case in which a solution (two grains to the fluid-ounce) applied to the head of a child of nine for the relief of tinea tonsurans caused diarrhea, profuse salivation, marked prostration, and finally death. Washing out the vagina with a solution of corrosive sublimate, 1:2000, has caused severe and even fatal poisoning. Bonet mentions death after the inunction of a mercurial ointment, and instances of distressing salivation from such medication are quite common. There are various dermal affections which sometimes follow the exhibition of mercury and assume an erythematous type. The susceptibility of some persons to calomel, the slightest dose causing profuse salivation and painful oral symptoms, is so common that few physicians administer mercury to their patients without some knowledge of their susceptibility to this drug. Blundel relates a curious case occurring in the times when mercury was given in great quantities, in which to relieve obstinate constipation a half ounce of crude mercury was administered and repeated in twelve hours. Scores of globules of mercury soon appeared over a vesicated surface, the result of a previous blister applied to the epigastric region. Blundel, not satisfied with the actuality of the phenomena, submitted his case to Dr. Lister, who, after careful examination, pronounced the globules metallic.

Oils.—Mauvezin tells of the ingestion of three drams of croton oil by a child of six, followed by vomiting and rapid recovery. There was no diarrhea in this case. Wood quotes Cowan in mentioning the case of a child of four, who in two days recovered from a teaspoonful of croton oil taken on a full stomach. Adams saw recovery in an adult after ingestion of the same amount. There is recorded an instance of a woman who took about an ounce, and, emesis being produced three-quarters of an hour afterward by mustard, she finally recovered. There is a record in which so small a dose as three minims is supposed to have killed a child of thirteen months. According to Wood, Giacomini mentions a case in which 24 grains of the drug proved fatal in as many hours.

Castor oil is usually considered a harmless drug, but the castor bean, from which it is derived, contains a poisonous acrid principle, three such beans having sufficed to produce death in a man. Doubtless some of the instances in which castor oil has produced symptoms similar to cholera are the results of the administration of contaminated oil.

The untoward effects of opium and its derivatives are quite numerous Gaubius treated an old woman in whom, after three days, a single grain of opium produced a general desquamation of the epidermis; this peculiarity was not accidental, as it was verified on several other occasions. Hargens speaks of a woman in whom the slightest bit of opium in any form produced considerable salivation. Gastric disturbances are quite common, severe vomiting being produced by minimum doses; not infrequently, intense mental confusion, vertigo, and headache, lasting hours and even days, sometimes referable to the frontal region and sometimes to the occipital, are seen in certain nervous individuals after a dose of from 1/4 to 5/6 gr. of opium. These symptoms were familiar to the ancient physicians, and, according to Lewin, Tralles reports an observation with reference to this in a man, and says regarding it in rather unclassical Latin: "... per multos dies ponderosissimum caput circumgestasse." Convulsions are said to be observed after medicinal doses of opium. Albers states that twitching in the tendons tremors of the hands, and even paralysis, have been noticed after the ingestion of opium in even ordinary doses. The "pruritus opii," so familiar to physicians, is spoken of in the older writings. Dioscorides, Paulus Aegineta, and nearly all the writers of the last century describe this symptom as an annoying and unbearable affection. In some instances the ingestion of opium provokes an eruption in the form of small, isolated red spots, which, in their general character, resemble roseola. Rieken remarks that when these spots spread over all the body they present a scarlatiniform appearance, and he adds that even the mucous membranes of the mouth and throat may be attacked with erethematous inflammation. Behrend observed an opium exanthem, which was attended by intolerable itching, after the exhibition of a quarter of a grain. It was seen on the chest, on the inner surfaces of the arms, on the flexor surfaces of the forearms and wrists, on the thighs, and posterior and inner surfaces of the legs, terminating at the ankles in a stripe-like discoloration about the breadth of three fingers. It consisted of closely disposed papules of the size of a pin-head, and several days after the disappearance of the eruption a fine, bran-like desquamation of the epidermis ensued. Brand has also seen an eruption on the trunk and flexor surfaces, accompanied with fever, from the ingestion of opium. Billroth mentions the case of a lady in whom appeared a feeling of anxiety, nausea, and vomiting after ingestion of a small fraction of a grain of opium; she would rather endure her intense pain than suffer the untoward action of the drug. According to Lewin, Brochin reported a case in which the idiosyncrasy to morphin was so great that 1/25 of a grain of the drug administered hypodermically caused irregularity of the respiration, suspension of the heart-beat, and profound narcosis. According to the same authority, Wernich has called attention to paresthesia of the sense of taste after the employment of morphin, which, according to his observation, is particularly prone to supervene in patients who are much reduced and in persons otherwise healthy who have suffered from prolonged inanition. These effects are probably due to a central excitation of a similar nature to that produced by santonin. Persons thus attacked complain, shortly after the injection, of an intensely sour or bitter taste, which for the most part ceases after elimination of the morphin. Von Graefe and Sommerfrodt speak of a spasm of accommodation occurring after ingestion of medicinal doses of morphin. There are several cases on record in which death has been produced in an adult by the use of 1/2 to 1/6 grain of morphin. According to Wood, the maximum doses from which recovery has occurred without emesis are 55 grains of solid opium, and six ounces of laudanum. According to the same authority, in 1854 there was a case in which a babe one day old was killed by one minim of laudanum, and in another case a few drops of paregoric proved fatal to a child of nine months. Doubtful instances of death from opium are given, one in an adult female after 30 grains of Dover's powder given in divided doses, and another after a dose of 1/4 grain of morphin. Yavorski cites a rather remarkable instance of morphin-poisoning with recovery: a female took 30 grains of acetate of morphin, and as it did not act quickly enough she took an additional dose of 1/2 ounce of laudanum. After this she slept a few hours, and awoke complaining of being ill. Yavorski saw her about an hour later, and by producing emesis, and giving coffee, atropin, and tincture of musk, he saved her life. Pyle describes a pugilist of twenty-two who, in a fit of despondency after a debauch (in which he had taken repeated doses of morphin sulphate), took with suicidal intent three teaspoonfuls of morphin; after rigorous treatment he revived and was discharged on the next day perfectly well. Potassium permanganate was used in this case. Chaffee speaks of recovery after the ingestion of 18 grains of morphin without vomiting.

In chronic opium eating the amount of this drug which can be ingested with safety assumes astounding proportions. In his "Confessions" De Quincey remarks: "Strange as it may sound, I had a little before this time descended suddenly and without considerable effort from 320 grains of opium (8000 drops of laudanum) per day to 40 grains, or 1/8 part. Instantaneously, and as if by magic, the cloud of profoundest melancholy which rested on my brain, like some black vapors that I have seen roll away from the summits of the mountains, drew off in one day,—passed off with its murky banners as simultaneously as a ship that has been stranded and is floated off by a spring-tide—

'That moveth altogether if it move at all.'

Now, then, I was again happy; I took only a thousand drops of Laudanum per day, and what was that? A latter spring had come to close up the season of youth; my brain performed its functions as healthily as ever before; I read Kant again, and again I understood him, or fancied that I did." There have been many authors who, in condemning De Quincey for unjustly throwing about the opium habit a halo of literary beauty which has tempted many to destruction, absolutely deny the truth of his statements. No one has any stable reason on which to found denial of De Quincey's statements as to the magnitude of the doses he was able to take; and his frankness and truthfulness is equal to that of any of his detractors. William Rosse Cobbe, in a volume entitled "Dr. Judas, or Portrayal of the Opium Habit," gives with great frankness of confession and considerable purity of diction a record of his own experiences with the drug. One entire chapter of Mr. Cobb's book and several portions of other chapters are devoted to showing that De Quincey was wrong in some of his statements, but notwithstanding his criticism of De Quincey, Mr. Cobbe seems to have experienced the same adventures in his dreams, showing, after all, that De Quincey knew the effects of opium even if he seemed to idealize it. According to Mr. Cobbe, there are in the United States upward of two millions of victims of enslaving drugs entirely exclusive of alcohol. Cobbe mentions several instances in which De Quincey's dose of 320 grains of opium daily has been surpassed. One man, a resident of Southern Illinois, consumed 1072 grains a day; another in the same State contented himself with 1685 grains daily; and still another is given whose daily consumption amounted to 2345 grains per day. In all cases of laudanum-takers it is probable that analysis of the commercial laudanum taken would show the amount of opium to be greatly below that of the official proportion, and little faith can be put in the records of large amounts of opium taken when the deduction has been made from the laudanum used. Dealers soon begin to know opium victims, and find them ready dupes for adulteration. According to Lewin, Samter mentions a case of morphin-habit which was continued for three years, during which, in a period of about three, hundred and twenty-three days, upward of 2 1/2 ounces of morphin was taken daily. According to the same authority, Eder reports still larger doses. In the case observed by him the patient took laudanum for six years in increasing doses up to one ounce per day; for eighteen months, pure opium, commencing with 15 grains and increasing to 2 1/4 drams daily; and for eighteen months morphin, in commencing quantities of six grains, which were later increased to 40 grains a day. When deprived of their accustomed dose of morphin the sufferings which these patients experience are terrific, and they pursue all sorts of deceptions to enable them to get their enslaving drug. Patients have been known to conceal tubes in their mouths, and even swallow them, and the authors know of a fatal instance in which a tube of hypodermic tablets of the drug was found concealed in the rectum.

The administration of such an inert substance as the infusion of orange-peel has been sufficient to invariably produce nervous excitement in a patient afflicted with carcinoma.

Sonnenschein refers to a case of an infant of five weeks who died from the effects of one phosphorous match head containing only 1/100 grain of phosphorus. There are certain people who by reason of a special susceptibility cannot tolerate phosphorus, and the exhibition of it causes in them nausea, oppression, and a feeling of pain in the epigastric region, tormina and tenesmus, accompanied with diarrhea, and in rare cases jaundice, sometimes lasting several months. In such persons 1/30 grain is capable of causing the foregoing symptoms. In 1882 a man was admitted to Guy's Hospital, London, after he had taken half of a sixpenny pot of phosphorous paste in whiskey, and was subsequently discharged completely recovered.

A peculiar feature of phosphorus-poisoning is necrosis of the jaw. This affection was first noticed in 1838, soon after the introduction of the manufacture of phosphorous matches. In late years, owing to the introduction of precautions in their manufacture, the disease has become much less common. The tipping of the match sticks is accomplished by dipping their ends in a warm solution of a composition of phosphorus, chlorate of potassium, with particles of ground flint to assist friction, some coloring agent, and Irish glue. From the contents of the dipping-pans fumes constantly arise into the faces of the workmen and dippers, and in cutting the sticks and packing the matches the hands are constantly in contact with phosphorus. The region chiefly affected in this poisoning is the jaw-bone, but the inflammation may spread to the adjoining bones and involve the vomer, the zygoma, the body of the spheroid bone, and the basilar process of the occipital bone. It is supposed that conditions in which the periosteum is exposed are favorable to the progress of the disease, and, according to Hirt, workmen with diseased teeth are affected three times as readily as those with healthy teeth, and are therefore carefully excluded from some of the factories in America.

Prentiss of Washington, D.C., in 1881 reported a remarkable case of pilocarpin idiosyncrasy in a blonde of twenty-five. He was consulted by the patient for constipation. Later on symptoms of cystitis developed, and an ultimate diagnosis of pyelitis of the right kidney was made. Uremic symptoms were avoided by the constant use of pilocarpin. Between December 16, 1880, and February 22, 1881, the patient had 22 sweats from pilocarpin. The action usually lasted from two to six hours, and quite a large dose was at length necessary. The idiosyncrasy noted was found in the hair, which at first was quite light, afterward chestnut-brown, and May 1, 1881, almost pure black. The growth of the hair became more vigorous and thicker than formerly, and as its color darkened it became coarser in proportion. In March, 1889, Prentiss saw his patient, and at that time her hair was dark brown, having returned to that color from black. Prentiss also reported the following case a as adding another to the evidence that jaborandi will produce the effect mentioned under favorable circumstances: Mrs. L., aged seventy-two years, was suffering from Bright's disease (contracted kidney). Her hair and eyebrows had been snow-white for twenty years. She suffered greatly from itching of the skin, due to the uremia of the kidney-disease; the skin was harsh and dry. For this symptom fluid extract of jaborandi was prescribed with the effect of relieving the itching. It was taken in doses of 20 or 30 drops several times a day, from October, 1886, to February, 1888. During the fall of 1887 it was noticed by the nurse that the eyebrows were growing darker, and that the hair of the head was darker in patches. These patches and the eyebrows continued to become darker, until at the time of her death they were quite black, the black tufts on the head presenting a very curious appearance among the silver-white hairs surrounding them.

Quinin being such a universally used drug, numerous instances of idiosyncrasy and intolerance have been recorded. Chevalier mentions that through contact of the drug workmen in the manufacture of quinin are liable to an affection of the skin which manifests itself in a vesicular, papular, or pustular eruption on different parts of the body. Vepan mentions a lady who took 1 1/2 grains and afterward 2 1/2 grains of quinin for neuralgia, and two days afterward her body was covered with purpuric spots, which disappeared in the course of nine days but reappeared after the administration of the drug was resumed. Lewin says that in this case the severity of the eruption was in accordance with the size of the dose, and during its existence there was bleeding at the gums; he adds that Gouchet also noticed an eruption of this kind in a lady who after taking quinin expectorated blood. The petechiae were profusely spread over the entire body, and they disappeared after the suspension of the drug. Dauboeuf, Garraway, Hemming, Skinner, and Cobner mention roseola and scarlatiniform erythema after minute doses of quinin. In nearly all these cases the accompanying symptoms were different. Heusinger speaks of a lady who, after taking 1/2 grain of quinin, experienced headache, nausea, intense burning, and edema, together with nodular erythema on the eyelids, cheeks, and portion of the forehead. At another time 1 1/2 grains of the drug gave rise to herpetic vesicles on the cheeks, followed by branny desquamation on elimination of the drug. In other patients intense itching is experienced after the ingestion of quinin. Peters cites an instance of a woman of sixty-five who, after taking one grain of quinin, invariably exhibited after an hour a temperature of from 104 degrees to 105 degrees F., accelerated pulse, rigors, slight delirium, thirst, and all the appearances of ill-defined fever, which would pass off in from twelve to twenty-four hours. Peters witnessed this idiosyncrasy several times and believed it to be permanent. The most unpleasant of the untoward symptoms of quinin exhibition are the disturbances of the organs of special sense. Photophobia, and even transient amblyopia, have been observed to follow small doses. In the examination of cases of the untoward effects of quinin upon the eye, Knapp of New York found the power of sight diminished in various degrees, and rarely amaurosis and immobility of the pupils. According to Lewin, the perceptions of color and light are always diminished, and although the disorder may last for some time the prognosis is favorable. The varieties of the disturbances of the functions of the ear range from tinnitus aurium to congestion causing complete deafness. The gastro-intestinal and genito-urinary tracts are especially disposed to untoward action by quinin. There is a case recorded in which, after the slightest dose of quinin, tingling and burning at the meatus urinarius were experienced. According to Lewin, there is mentioned in the case reported by Gauchet a symptom quite unique in the literature of quinin, viz., hemoptysis. Simon de Ronchard first noted the occurrence of several cases of hemoptysis following the administration of doses of eight grains daily. In the persons thus attacked the lungs and heart were healthy. Hemoptysis promptly ceased with the suspension of the drug. When it was renewed, blood again appeared in the sputa. Taussig mentions a curious mistake, in which an ounce of quinin sulphate was administered to a patient at one dose; the only symptoms noticed were a stuporous condition and complete deafness. No antidote was given, and the patient perfectly recovered in a week. In malarious countries, and particularly in the malarial fevers of the late war, enormous quantities of quinin were frequently given. In fact, at the present day in some parts of the South quinin is constantly kept on the table as a prophylactic constituent of the diet.

Skinner noticed the occurrence of a scarlatiniform eruption in a woman after the dose of 1/165 grain of strychnin, which, however, disappeared with the discontinuance of the drug. There was a man in London in 1865 who died in twenty minute's after the ingestion of 1/2 grain of strychnin. Wood speaks of a case in which the administration of 1/100 grain killed a child three and one-half months old. Gray speaks of a man who took 22 grains and was not seen for about an hour. He had vomited some of it immediately after taking the dose, and was successfully treated with chloral hydrate. A curious case is mentioned in which three mustard plasters, one on the throat, one on the back of the neck, and another on the left shoulder of a woman, produced symptoms similar to strychnin poisoning. They remained in position for about thirty minutes, and about thirty hours afterward a painful stinging sensation commenced in the back of the neck, followed by violent twitching of the muscles of the face, arms, and legs, which continued in regular succession through the whole of the night, but after twelve hours yielded to hot fomentations of poppy-heads applied to the back of the neck. It could not be ascertained whether any medicine containing strychnin had been taken, but surely, from the symptoms, such must have been the case.

Tobacco.—O'Neill a gives the history of a farmer's wife, aged forty, who wounded her leg against a sewing-machine, and by lay advice applied a handful of chopped wet tobacco to it, from which procedure, strange to say, serious nicotin-poisoning ensued. The pupils were dilated, there were dimness of vision, confusion of thought, and extreme prostration. The pulse was scarcely apparent, the skin was white and wet with clammy perspiration. Happily, strychnin was given in time to effect recovery, and without early medical assistance she would undoubtedly have succumbed. There are several similar cases on record.

Although not immediately related to the subject of idiosyncrasy, the following case may be mentioned here: Ramadge speaks of a young Frenchman, suffering from an obstinate case of gonorrhea, who was said to have been completely cured by living in a newly painted house in which he inhaled the odors or vapors of turpentine.

White speaks of a case of exanthematous eruption similar to that of ivy-poison in mother and child, which was apparently caused by playing with and burning the toy called "Pharaoh's serpent egg."

The idiosyncrasies noticed in some persons during coitus are quite interesting. The Ephemerides mentions a person in whom coitus habitually caused vomiting, and another in whom excessive sexual indulgence provoked singultus. Sometimes exaggerated tremors or convulsions, particularly at the moment of orgasm, are noticed. Females especially are subject to this phenomenon, and it is seen sometimes in birds.

Winn reports the case of a man who, when prompted to indulge in sexual intercourse, was immediately prior to the act seized with a fit of sneezing. Even the thought of sexual pleasure with a female was sufficient to provoke this peculiar idiosyncrasy.

Sullivan mentions a bride of four weeks, who called at the doctor's office, saying that in coitus her partner had no difficulty until the point of culmination or orgasm, when he was seized with complete numbness and lost all pleasurable sensation in the penis. The numbness was followed by a sensation of pain, which was intensified on the slightest motion, and which was at times so excruciating as to forbid separation for upward of an hour, or until the penis had become flaccid. The woman asked for advice for her unfortunate husband's relief, and the case was reported as a means of obtaining suggestions from the physicians over the country. In response, one theory was advanced that this man had been in the habit of masturbating and had a stricture of the membranous portion of the urethra, associated with an ulcer of the prostate involving the ejaculatory ducts, or an inflammatory condition of all the tissues compressed by the ejaculatory muscles.

Hendrichsen quotes a case in which a spasmodic contraction of the levator ani occurred during coitus, and the penis could not be withdrawn while this condition lasted; and in support of this circumstance Hendrichsen mentions that Marion Sims, Beigel, and Budin describe spasmodic contractions of the levator and, constricting the vagina; he also cites an instance under his personal observation in which this spasm was excited by both vaginal and rectal examination, although on the following day no such condition could be produced. In this connection, among the older writers, Borellus gives the history of a man who before coitus rubbed his virile member with musk, and, similar to the connection of a dog and bitch, was held fast in his wife's vagina; it was only after the injection of great quantities of water to soften the parts that separation was obtained. Diemerbroeck confirms this singular property of musk by an analogous observation, in which the ludicrous method of throwing cold water on the persons was practised. Schurig also relates the history of a similar instance.

Among the peculiar effects of coitus is its deteriorating effect on the healing process of wounds. Boerhaave, Pare, and Fabricius Hildanus all speak of this untoward effect of venery, and in modern times Poncet has made observations at a hospital in Lyons which prove that during the process of healing wounds are unduly and harmfully influenced by coitus, and cites confirmatory instances. Poncet also remarks that he found on nine occasions, by placing a thermometer in the rectum, that the temperature was about 1 degrees F. lower just before than after coitus, and that during the act the temperature gradually rose above normal.

There are many associate conditions which, under the exciting influence of coitus, provoke harmful effects and even a fatal issue. Deguise mentions a man who had coitus 18 times in ten hours with most disastrous effects. Cabrolius speaks of a man who took a potion of aphrodisiac properties, in which, among other things, he put an enormous dose of cantharides. The anticipation of the effect of his dose, that is, the mental influence, in addition to the actual therapeutic effect, greatly distressed and excited him. Almost beyond belief, it is said that he approached his wife eighty-seven times during the night, spilling much sperm on the sleeping-bed. Cabrolius was called to see this man in the morning, and found him in a most exhausted condition, but still having the supposed consecutive ejaculations. Exhaustion progressed rapidly, and death soon terminated this erotic crisis. Lawson is accredited with saying that among the Marquesan tribe he knew of a woman who during a single night had intercourse with 103 men.

Among the older writers there are instances reported in which erection and ejaculation took place without the slightest pleasurable sensation. Claudius exemplifies this fact in his report of a Venetian merchant who had vigorous erections and ejaculations of thick and abundant semen without either tingling or pleasure.

Attila, King of the Huns, and one of the most celebrated leaders of the German hosts which overran the Roman Empire in its decline, and whose enormous army and name inspired such terror that he was called the "Scourge of God," was supposed to have died in coitus. Apoplexy, organic heart disorders, aneurysms, and other like disorders are in such cases generally the direct cause of death, coitus causing the death indirectly by the excitement and exertion accompanying the act.

Bartholinus, Benedictus, Borellus, Pliny, Morgagni, Plater, a Castro, Forestus, Marcellus Donatus, Schurig, Sinibaldus, Schenck, the Ephemerides, and many others mention death during coitus; the older writers in some cases attributed the fatal issue to excessive sexual indulgence, not considering the possibility of the associate direct cause, which most likely would have been found in case of a necropsy.

Suspended Animation.—Various opinions have been expressed as to the length of time compatible with life during which a person can stay under water. Recoveries from drowning furnish interesting examples of the suspension of animation for a protracted period, but are hardly ever reliable, as the subject at short intervals almost invariably rises to the surface of the water, allowing occasional respiration. Taylor mentions a child of two who recovered after ten minutes' submersion; in another case a man recovered after fourteen minutes' submersion. There is a case reported in this country of a woman who was said to have been submerged twenty minutes. Guerard quotes a case happening in 1774, in which there was submersion for an hour with subsequent recovery; but there hardly seems sufficient evidence of this.

Green mentions submersion for fifteen minutes; Douglass, for fourteen minutes; Laub, for fifteen minutes; Povall gives a description of three persons who recovered after a submersion of twenty-five minutes. There is a case in French literature, apparently well authenticated, in which submersion for six minutes was followed by subsequent recovery.

There have been individuals who gave exhibitions of prolonged submersion in large glass aquariums, placed in full view of the audience. Taylor remarks that the person known some years ago in London as "Lurline" could stay under water for three minutes. There have been several exhibitionists of this sort. Some of the more enterprising seat themselves on an artificial coral, and surrounded by fishes of divers hues complacently eat a meal while thus submerged. It is said that quite recently in Detroit there was a performer who accomplished the feat of remaining under water four minutes and eight seconds in full view of the audience. Miss Lurline swam about in her aquarium, which was brilliantly illuminated, ate, reclined, and appeared to be taking a short nap during her short immersion. In Paris, some years since, there was exhibited a creature called "l'homme-poisson," who performed feats similar to Lurline, including the smoking of a cigarette held entirely in his mouth. In all these exhibitions all sorts of artificial means are used to make the submersion appear long. Great ceremony, music, and the counting of the seconds in a loud voice from the stage, all tend to make the time appear much longer than it really is. However, James Finney in London, April 7, 1886, stayed under water four minutes, twenty-nine and one-fourth seconds, and one of his feats was to pick up 70 or 80 gold-plated half-pennies with his mouth, his hands being securely tied behind his back, and never emerging from his tank until his feat was fully accomplished. In company with his sister he played a game of "nap" under water, using porcelain cards and turning them to the view of the audience. "Professor Enochs" recently stayed under water at Lowell, Mass., for four minutes, forty-six and one-fifth seconds. The best previous record was four minutes, thirty-five seconds, made by "Professor Beaumont" at Melbourne on December 16, 1893.

For the most satisfactory examples of prolonged submersion we must look to the divers, particularly the natives who trade in coral, and the pearl fishers. Diving is an ancient custom, and even legendary exploits of this nature are recorded. Homer compares the fall of Hector's chariot to the action of a diver; and specially trained men were employed at the Siege of Syracuse, their mission being to laboriously scuttle the enemy's vessels. Many of the old historians mention diving, and Herodotus speaks of a diver by the name of Scyllias who was engaged by Xerxes to recover some articles of value which had been sunk on some Persian vessels in a tempest. Egyptian divers are mentioned by Plutarch, who says that Anthony was deceived by Cleopatra in a fishing contest by securing expert divers to place the fish upon the hooks. There was a historical or rather legendary character by the name of Didion, who was noted for his exploits in the river Meuse. He had the ability to stay under water a considerable length of time, and even to catch fish while submerged.

There was a famous diver in Sicily at the end of the fifteenth century whose feats are recorded in the writings of Alexander ab Alexandro, Pontanus, and Father Kircher, the Jesuit savant. This man's name was Nicolas, born of poor parents at Catania. From his infancy he showed an extraordinary power of diving and swimming, and from his compatriots soon acquired various names indicative of his capacity. He became very well known throughout Sicily, and for his patron had Frederick, King of Naples. In the present day, the sponge-fishers and pearl-fishers in the West Indies, the Mediterranean, the Indian Seas, and the Gulf of Mexico invite the attention of those interested in the anomalies of suspended animation. There are many marvelous tales of their ability to remain under water for long periods. It is probable that none remain submerged over two minutes, but, what is more remarkable, they are supposed to dive to extraordinary depths, some as much as 150 to 200 feet. Ordinarily they remain under water from a minute to one and a half minutes. Remaining longer, the face becomes congested, the eyes injected; the sputum bloody, due to rupture of some of the minute vessels in the lung. It is said by those who have observed them carefully that few of these divers live to an advanced age. Many of them suffer apoplectic attacks, and some of them become blind from congestion of the ocular vessels. The Syrian divers are supposed to carry weights of considerable size in their hands in order to facilitate the depth and duration of submersion. It is also said that the divers of Oceanica use heavy stones. According to Guyot-Daubes, in the Philippine Isles the native pearl-fishers teach their children to dive to the depth of 25 meters. The Tahitians, who excited the admiration of Cook, are noted for their extraordinary diving. Speaking of the inhabitants of the island of Fakaraya, near Tahiti, de la Quesnerie says that the pearl-fishers do not hesitate to dive to the depth even of 100 feet after their coveted prizes. On the Ceylon coast the mother-of-pearl fishers are under the direction of the English Government, which limits the duration and the practice of this occupation. These divers are generally Cingalese, who practice the exercise from infancy. As many as 500 small boats can be seen about the field of operation, each equipped with divers. A single diver makes about ten voyages under the water, and then rests in the bottom of the boat, when his comrade takes his place. Among other native divers are the Arabs of Algeria and some of the inhabitants of the Mexican coast.

It might be well to mention here the divers who work by means of apparatus. The ancients had knowledge of contrivances whereby they could stay under water some time. Aristotle speaks of an instrument by which divers could rest under water in communication with the air, and compares it with the trunk of an elephant wading a stream deeper than his height. In the presence of Charles V diving bells were used by the Greeks in 1540. In 1660 some of the cannon of the sunken ships of the Spanish Armada were raised by divers in diving bells. Since then various improvements in submarine armor have been made, gradually evolving into the present perfected diving apparatus of to-day, by which men work in the holds of vessels sunk in from 120 to 200 feet of water. The enormous pressure of the water at these great depths makes it necessary to have suits strong enough to resist it. Lambert, a celebrated English diver, recovered L90,000 in specie from the steamer Alphonso XII, a Spanish mail boat belonging to the Lopez line, which sank off Point Gando, Grand Canary, in 26 1/2 fathoms of water. For nearly six months the salvage party, despatched by the underwriters in May, 1885, persevered in the operations; two divers lost their lives, the golden bait being in the treasure-room beneath the three decks, but Lambert finished the task successfully.

Deep-sea divers only acquire proficiency after long training. It is said that as a rule divers are indisposed to taking apprentices, as they are afraid of their vocation being crowded and their present ample remuneration diminished. At present there are several schools. At Chatham, England, there is a school of submarine mining, in which men are trained to lay torpedoes and complete harbor defense. Most of these divers can work six hours at a time in from 35 to 50 feet of water. Divers for the Royal Navy are trained at Sheerness. When sufficiently trained to work at the depth of 150 feet seamen-divers are fully qualified, and are drafted to the various ships. They are connected with an air-pump in charge of trustworthy men; they signal for their tools and material, as well as air, by means of a special line for this purpose. At some distance below the water the extraordinary weight of the suits cannot be felt, and the divers work as well in armor as in ordinary laboring clothes. One famous diver says that the only unpleasant experience he ever had in his career as a diver, not excepting the occasion of his first dive, was a drumming in the ears, as a consequence of which, after remaining under water at a certain work for nine hours, he completely lost the use of one ear for three months, during which time he suffered agony with the earache. These men exhibit absolute indifference to the dangers attached to their calling, and some have been known to sleep many fathoms beneath the surface. Both by means of their signal lines and by writing on a slate they keep their associates informed of the progress of their work.

Suspension of the Pulse.—In some cases the pulse is not apparent for many days before actual death, and there have been instances in which, although the pulse ceased for an extended period, the patient made an ultimate recovery. In reviewing the older literature we find that Ballonius mentions an instance in which the pulse was not apparent for fourteen days before complete asphyxia. Ramazzini describes a case of cessation of the pulse four days before death. Schenck details the history of a case in which the pulse ceased for three days and asphyxia was almost total, but the patient eventually recovered. There is a noteworthy observation, in which there was cessation of the pulse for nine days without a fatal issue.

Some persons seem to have a preternatural control over their circulatory system, apparently enabling them to produce suspension of cardiac movement at will. Cheyne speaks of a Colonel Townshend who appeared to possess the power of dying, as it were, at will,—that is, so suspending the heart's action that no pulsation could be detected. After lying in this state of lifelessness for a short period, life would become slowly established without any consciousness or volition on the man's part. The longest period in which he remained in this death-like condition was about thirty minutes. A postmortem examination of this person was awaited with great interest; but after his death nothing was found to explain the power he possessed over his heart.

Saint Augustin knew of a priest named Rutilut who had the power of voluntarily simulating death. Both the pulsation and respiration was apparently abolished when he was in his lifeless condition. Burning and pricking left visible effects on the skin after his recovery, but had no apparent effect on his lethargy. Chaille reports an instance of voluntary suspension of the pulse.

Relative to hibernation, it is well-known that mice, snakes, and some reptiles, as well as bees, sometimes seem to entirely suspend animation for an extended period, and especially in the cold weather. In Russia fish are transported frozen stiff, but return to life after being plunged into cold water. A curious tale is told by Harley, from Sir John Lubbock, of a snail brought from Egypt and thought to be dead. It was placed on a card and put in position on a shelf in the British Museum in March, 1845. In March, 1850 after having been gummed to a label for five years, it was noticed to have an apparent growth on its mouth and was taken out and placed in water, when it soon showed signs of life and ate cabbage leaves offered to it. It has been said, we think with credible evidence, that cereal seeds found in the tombs with mummies have grown when planted, and Harley quotes an instance of a gentleman who took some berries, possibly the remnants of Pharaoh's daughter's last meal, coming as they did from her mummified stomach after lying dormant in an Egyptian tomb many centuries, and planted them in his garden, where they soon grew, and he shortly had a bush as flourishing as any of those emanating from fresh seeds.

Human hibernation is an extremely rare anomaly. Only the fakirs of India seem to have developed this power, and even the gifted ones there are seldom seen. Many theories have been advanced to explain this ability of the fakirs, and many persons have discredited all the stories relative to their powers; on the other hand, all who have witnessed their exhibitions are convinced of their genuineness. Furthermore, these persons are extremely scarce and are indifferent to money; none has been enticed out of his own country to give exhibitions. When one dies in a community, his place is never filled—proving that he had no accomplices who knew any fraudulent secret practices, otherwise the accomplice would soon step out to take his place. These men have undoubtedly some extraordinary mode of sending themselves into a long trance, during which the functions of life are almost entirely suspended. We can readily believe in their ability to fast during their periods of burial, as we have already related authentic instances of fasting for a great length of time, during which the individual exercised his normal functions.

To the fakir, who neither visibly breathes nor shows circulatory movements, and who never moves from his place of confinement, fasting should be comparatively easy, when we consider the number of men whose minds were actively at work during their fasts, and who also exercised much physical power.

Harley says that the fakirs begin their performances by taking a large dose of the powerfully stupefying "bang," thus becoming narcotized. In this state they are lowered into a cool, quiet tomb, which still further favors the prolongation of the artificially induced vital lethargy; in this condition they rest for from six to eight weeks. When resurrected they are only by degrees restored to life, and present a wan, haggard, debilitated, and wasted appearance. Braid is credited, on the authority of Sir Claude Wade, with stating that a fakir was buried in an unconscious state at Lahore in 1837, and when dug up, six weeks later, he presented all the appearances of a dead person. The legs and arms were shrunken and stiff, and the head reclined on the shoulder in a manner frequently seen in a corpse. There was no pulsation of the heart or arteries of the arm or temple—in fact, no really visible signs of life. By degrees this person was restored to life. Every precaution had been taken in this case to prevent the possibility of fraud, and during the period of interment the grave was guarded night and day by soldiers of the regiment stationed at Lahore.

Honigberger, a German physician in the employ of Runjeet Singh, has an account of a fakir of Punjaub who allowed himself to be buried in a well-secured vault for such a long time that grain sown in the soil above the vault sprouted into leaf before he was exhumed. Honigberger affirms that the time of burial was over 40 days, and that on being submitted to certain processes the man recovered and lived many years after. Sir Henry Lawrence verified the foregoing statements. The chest in which the fakir was buried was sealed with the Runjeet stamp on it, and when the man was brought up he was cold and apparently lifeless. Honigberger also states that this man, whose name was Haridas, was four months in a grave in the mountains; to prove the absolute suspension of animation, the chin was shaved before burial, and at exhumation this part was as smooth as on the day of interment. This latter statement naturally calls forth comment when we consider the instances that are on record of the growth of beard and hair after death.

There is another account of a person of the same class who had the power of suspending animation, and who would not allow his coffin to touch the earth for fear of worms and insects, from which he is said to have suffered at a previous burial.

It has been stated that the fakirs are either eunuchs or hermaphrodites, social outcasts, having nothing in common with the women or men of their neighborhood; but Honigberger mentions one who disproved this ridiculous theory by eloping to the mountains with his neighbor's wife.

Instances of recovery after asphyxia from hanging are to be found, particularly among the older references of a time when hanging was more common than it is to-day. Bartholinus, Blegny, Camerarius, Morgagni, Pechlin, Schenck, Stoll, and Wepfer all mention recovery after hanging. Forestus describes a case in which a man was rescued by provoking vomiting with vinegar, pepper, and mustard seed. There is a case on record in which a person was saved after hanging nineteen minutes. There was a case of a man brought into the Hopital Saint-Louis asphyxiated by strangulation, having been hung for some time. His rectal temperature was only 93.3 degrees F., but six hours after it rose to 101.6 degrees F., and he subsequently recovered. Taylor cites the instance of a stout woman of forty-four who recovered from hanging. When the woman was found by her husband she was hanging from the top of a door, having been driven to suicide on account of his abuse and intemperance. When first seen by Taylor she was comatose, her mouth was surrounded by white froth, and the swollen tongue protruded from it. Her face was bloated, her lips of a darkened hue, and her neck of a brown parchment-color. About the level of the larynx, the epidermis was distinctly abraded, indicating where the rope had been. The conjunctiva was insensible and there was no contractile response of the pupil to the light of a candle. The reflexes of the soles of the feet were tested, but were quite in abeyance. There was no respiratory movement and only slight cardiac pulsation. After vigorous measures the woman ultimately recovered. Recovery is quite rare when the asphyxiation has gone so far, the patients generally succumbing shortly after being cut down or on the following day. Chevers mentions a most curious case, in which cerebral congestion from the asphyxiation of strangling was accidentally relieved by an additional cut across the throat. The patient was a man who was set upon by a band of Thugs in India, who, pursuant to their usual custom, strangled him and his fellow-traveler. Not being satisfied that he was quite dead, one of the band returned and made several gashes across his throat. This latter action effectually relieved the congestion caused by the strangulation and undoubtedly saved his life, while his unmutilated companion was found dead. After the wounds in his throat had healed this victim of the Thugs gave such a good description of the murderous band that their apprehension and execution soon followed.

Premature Burial.—In some instances simulation of death has been so exact that it has led to premature interment. There are many such cases on record, and it is a popular superstition of the laity that all the gruesome tales are true of persons buried alive and returning to life, only to find themselves hopelessly lost in a narrow coffin many feet below the surface of the earth. Among the lower classes the dread of being buried before life is extinct is quite generally felt, and for generations the medical profession have been denounced for their inability to discover an infallible sign of death. Most of the instances on record, and particularly those from lay journals, are vivid exaggerations, drawn from possibly such a trivial sign as a corpse found with the fist tightly clenched or the face distorted, which are the inspiration of the horrible details of the dying struggles of the person in the coffin. In the works of Fontenelle there are 46 cases recorded of the premature interment of the living, in which apparent has been mistaken for real death. None of these cases, however, are sufficiently authentic to be reliable. Moreover, in all modern methods of burial, even if life were not extinct, there could be no possibility of consciousness or of struggling. Absolute asphyxiation would soon follow the closing of the coffin lid.

We must admit, however, that the mistake has been made, particularly in instances of catalepsy or trance, and during epidemics of malignant fevers or plagues, in which there is an absolute necessity of hasty burial for the prevention of contagion. In a few instances on the battle-field sudden syncope, or apparent death, has possibly led to premature interment; but in the present day this is surely a very rare occurrence. There is also a danger of mistake from cases of asphyxiation, drowning, and similar sudden suspensions of the vital functions.

It is said that in the eighty-fourth Olympiad, Empedocles restored to life a woman who was about to be buried, and that this circumstance induced the Greeks, for the future protection of the supposed dead, to establish laws which enacted that no person should be interred until the sixth or seventh day. But even this extension of time did not give satisfaction, and we read that when Hephestion, at whose funeral obsequies Alexander the Great was present, was to be buried his funeral was delayed until the tenth day. There is also a legend that when Acilius Aviola fell a victim to disease he was burned alive, and although he cried out, it was too late to save him, as the fire had become so widespread before life returned.

While returning to his country house Asclepiades, a physician denominated the "God of Physic," and said to have been a descendant of aesculapius, saw during the time of Pompey the Great a crowd of mourners about to start a fire on a funeral pile. It is said that by his superior knowledge he perceived indications of life in the corpse and ordered the pile destroyed, subsequently restoring the supposed deceased to life. These examples and several others of a similar nature induced the Romans to delay their funeral rites, and laws were enacted to prevent haste in burning, as well as in interment. It was not until the eighth day that the final rites were performed, the days immediately subsequent to death having their own special ceremonies. The Turks were also fearful of premature interment and subjected the defunct to every test; among others, one was to examine the contractility of the sphincter and, which shows their keen observation of a well-known modern medical fact.

According to the Memoirs of Amelot de la Houssaye, Cardinal Espinola, Prime Minister to Philip II, put his hand to the embalmer's knife with which he was about to be opened; It is said that Vesalius, sometimes called the "Father of Anatomy," having been sent for to perform an autopsy on a woman subject to hysteric convulsions, and who was supposed to be dead, on making the first incision perceived by her motion and cries that she was still alive. This circumstance, becoming known, rendered him so odious that he had to leave the community in which he practiced, and it is believed that he never entirely recovered from the shock it gave him. The Abbe Prevost, so well known by his works and the singularities of his life, was seized by apoplexy in the Forest of Chantilly on October 23, 1763. His body was carried to the nearest village, and the officers of justice proceeded to open it, when a cry he sent forth frightened all the assistants and convinced the surgeon in charge that the Abbe was not dead; but it was too late to save him, as he had already received a mortal wound.

Massien speaks of a woman living in Cologne in 1571 who was interred living, but was not awakened from her lethargy until a grave-digger opened her grave to steal a valuable ring which she wore. This instance has been cited in nearly every language. There is another more recent instance, coming from Poitiers, of the wife of a goldsmith named Mernache who was buried with all her jewels. During the night a beggar attempted to steal her jewelry, and made such exertion in extracting one ring that the woman recovered and was saved. After this resurrection she is said to have had several children. This case is also often quoted. Zacchias mentions an instance which, from all appearances, is authentic. It was that of a young man, pest-stricken and thought to be dead, who was placed with the other dead for burial. He exhibited signs of life, and was taken back to the pest-hospital. Two days later he entered a lethargic condition simulating death, and was again on his way to the sepulcher, when he once more recovered.

It is said that when the body of William, Earl of Pembroke, who died April 10, 1630, was opened to be embalmed, the hand raised when the first incision was made. There is a story of an occurrence which happened on a return voyage from India. The wife of one of the passengers, an officer in the army, to all appearances died. They were about to resort to sea-burial, when, through the interposition of the husband, who was anxious to take her home, the ship-carpenters started to construct a coffin suitable for a long voyage, a process which took several days, during which time she lay in her berth, swathed in robes and ready for interment. When the coffin was at last ready the husband went to take his last farewell, and removed the wedding-ring, which was quite tightly on her finger. In the effort to do this she was aroused, recovered, and arrived in England perfectly well.

It is said that when a daughter of Henry Laurens, the first President of the American Congress, died of small-pox, she was laid out as dead, and the windows of the room were opened for ventilation. While left alone in this manner she recovered. This circumstance so impressed her illustrious father that he left explicit directions that in case of his death he should be burned. The same journal also contains the case of a maid-servant who recovered thrice on her way to the grave, and who, when really dead, was kept a preposterous length of time before burial.

The literature on this subject is very exhaustive, volumes having been written on the uncertainty of the signs of death, with hundreds of examples cited illustrative of the danger of premature interment. The foregoing instances have been given as indicative of the general style of narration; for further information the reader is referred to the plethora of material on this subject.

Postmortem Anomalies.—Among the older writers startling movements of a corpse have given rise to much discussion, and possibly often led to suspicion of premature burial. Bartholinus describes motion in a cadaver. Barlow says that movements were noticed after death in the victims of Asiatic cholera. The bodies were cold and expressions were death-like, but there were movements simulating natural life. The most common was flexion of the right leg, which would also be drawn up toward the body and resting on the left leg. In some cases the hand was moved, and in one or two instances a substance was grasped as if by reflex action. Some observers have stated that reflex movements of the face were quite noticeable. These movements continued sometimes for upward of an hour, occurring mostly in muscular subjects who died very suddenly, and in whom the muscular irritability or nervous stimulus or both had not become exhausted at the moment of dissolution. Richardson doubts the existence of postmortem movements of respiration.

Snow is accredited with having seen a girl in Soho who, dying of scarlet fever, turned dark at the moment of death, but in a few hours presented such a life-line appearance and color as to almost denote the return of life. The center of the cheeks became colored in a natural fashion, and the rest of the body resumed the natural flesh color. The parents refused to believe that death had ensued. Richardson remarks that he had seen two similar cases, and states that he believes the change is due to oxidation of the blood surcharged with carbon dioxid. The moist tissues suffuse carbonized blood, and there occurs an osmotic interchange between the carbon dioxid and the oxygen of the air resulting in an oxygenation of the blood, and modification of the color from dark venous to arterial red.

A peculiar postmortem anomaly is erection of the penis. The Ephemerides and Morgagni discuss postmortem erection, and Guyon mentions that on one occasion he saw 14 negroes hanged, and states that at the moment of suspension erection of the penis occurred in each; in nine of these blacks traces of this erectile state were perceived an hour after death.

Cadaveric perspiration has been observed and described by several authors, and Paullini has stated that he has seen tears flow from the eyes of a corpse.

The retardation of putrefaction of the body after death sometimes presents interesting changes. Petrifaction or mummification of the body are quite well known, and not being in the province of this work, will be referred to collateral books on this subject; but sometimes an unaccountable preservation takes place. In a tomb recently opened at Canterbury Cathedral, a for the purpose of discovering what Archbishop's body it contained, the corpse was of an extremely offensive and sickening odor, unmistakably that of putrefaction. The body was that of Hubert Walter, who died in 1204 A.D., and the decomposition had been retarded, and was actually still in progress, several hundred years after burial.

Retardation of the putrefactive process has been noticed in bodies some years under water. Konig of Hermannstadt mentions a man who, forty years previous to the time of report, had fallen under the waters of Echoschacht, and who was found in a complete state of preservation.

Postmortem Growth of Hair and Nails.—The hair and beard may grow after death, and even change color. Bartholinus recalls a case of a man who had short, black hair and beard at the time of interment, but who, some time after death, was found to possess long and yellowish hair. Aristotle discusses postmortem growth of the hair, and Garmanus cites an instance in which the beard and hair were cut several times from the cadaver. We occasionally see evidences of this in the dissecting-rooms. Caldwell mentions a body buried four years, the hair from which protruded at the points where the joints of the coffin had given away. The hair of the head measured 18 inches, that of the beard eight inches, and that on the breast from four to six inches. Rosse of Washington mentions an instance in which after burial the hair turned from dark brown to red, and also cites a case in a Washington cemetery of a girl, twelve or thirteen years old, who when exhumed was found to have a new growth of hair all over her body. The Ephemerides contains an account of hair suddenly turning gray after death.

Nails sometimes grow several inches after death, and there is on record the account of an idiot who had an idiosyncrasy for long nails, and after death the nails were found to have grown to such an extent that they curled up under the palms and soles.

The untoward effects of the emotions on the vital functions are quite well exemplified in medical literature. There is an abundance of cases reported in which joy, fear, pride, and grief have produced a fatal issue. In history we have the old story of the Lacedemonian woman who for some time had believed her son was dead, and who from the sudden joy occasioned by seeing him alive, herself fell lifeless. There is a similar instance in Roman history. Aristotle, Pliny, Livy, Cicero, and others cite instances of death from sudden or excessive joy. Fouquet died of excessive joy on being released from prison. A niece of the celebrated Leibnitz immediately fell dead on seeing a casket of gold left to her by her deceased uncle.

Galen mentions death from joy, and in comment upon it he says that the emotion of joy is much more dangerous than that of anger. In discussing this subject, Haller says that the blood is probably sent with such violence to the brain as to cause apoplexy. There is one case on record in which after a death from sudden joy the pericardium was found full of blood. The Ephemerides, Marcellus Donatus, Martini, and Struthius all mention death from joy.

Death from violent laughter has been recorded, but in this instance it is very probable that death was not due to the emotion itself, but to the extreme convulsion and exertion used in the laughter. The Ephemerides mentions a death from laughter, and also describes the death of a pregnant woman from violent mirth. Roy, Swinger, and Camerarius have recorded instances of death from laughter. Strange as it may seem, Saint-Foix says that the Moravian brothers, a sect of Anabaptists having great horror of bloodshed, executed their condemned brethren by tickling them to death.

Powerfully depressing emotions, which are called by Kant "asthenic," such as great and sudden sorrow, grief, or fright, have a pronounced effect on the vital functions, at times even causing death. Throughout literature and history we have examples of this anomaly. In Shakespeare's "Pericles," Thaisa, the daughter to Simonides and wife of Pericles, frightened when pregnant by a threatened shipwreck, dies in premature childbirth.

In Scott's "Guy Mannering," Mrs. Bertram, on suddenly learning of the death of her little boy, is thrown into premature labor, followed by death. Various theories are advanced in explanation of this anomaly. A very plausible one is, that the cardiac palsy is caused by energetic and persistent excitement of the inhibitory cardiac nerves. Strand is accredited with saying that agony of the mind produces rupture of the heart. It is quite common to hear the expression, "Died of a broken heart;" and, strange to say, in some cases postmortem examination has proved the actual truth of the saying. Bartholinus, Fabricius Hildanus, Pliny, Rhodius, Schenck, Marcellus Donatus, Riedlin, and Garengeot speak of death from fright and fear, and the Ephemerides describes a death the direct cause of which was intense shame. Deleau, a celebrated doctor of Paris, while embracing his favorite daughter, who was in the last throes of consumption, was so overcome by intense grief that he fell over her corpse and died, and both were buried together.

The fear of child-birth has been frequently cited as a cause of death McClintock quotes a case from Travers of a young lady, happily married; who entertained a fear of death in child-birth; although she had been safely delivered, she suddenly and without apparent cause died in six hours. Every region of the body was examined with minutest care by an eminent physician, but no signs indicative of the cause of death were found. Mordret cites a similar instance of death from fear of labor. Morgagni mentions a woman who died from the disappointment of bearing a girl baby when she was extremely desirous of a boy.

The following case, quoted from Lauder Brunton, shows the extent of shock which may be produced by fear: Many years ago a janitor of a college had rendered himself obnoxious to the students, and they determined to punish him. Accordingly they prepared a block and an axe, which they conveyed to a lonely place, and having appropriately dressed themselves, some of them prepared to act as judges, and sent others of their company to bring him before them. He first affected to treat the whole affair as a joke, but was solemnly assured by the students that they meant it in real earnest. He was told to prepare for immediate death. The trembling janitor looked all around in the vain hope of seeing some indication that nothing was really meant, but stern looks met him everywhere. He was blindfolded, and made to kneel before the block. The executioner's axe was raised, but, instead of the sharp edge, a wet towel was brought sharply down on the back of the neck. The bandage was now removed from the culprit's eyes, but to the horror and astonishment of the students they found that he was dead. Such a case may be due to heart-failure from fear or excitement.

It is not uncommon that death ensues from the shock alone following blows that cause no visible injury, but administered to vital parts. This is particularly true of blows about the external genital region, or epigastrium, where the solar plexus is an active factor in inhibition. Ivanhoff of Bulgaria in 1886 speaks of a man of forty-five who was dealt a blow on the testicle in a violent street fight, and staggering, he fell insensible. Despite vigorous medical efforts he never regained consciousness and died in forty-five minutes. Postmortem examination revealed everything normal, and death must have been caused by syncope following violent pain. Watkins cites an instance occurring in South Africa. A native shearing sheep for a farmer provoked his master's ire by calling him by some nickname. While the man was in a squatting posture the farmer struck him in the epigastrium. He followed this up by a kick in the side and a blow on the head, neither of which, however, was as severe as the first blow. The man fell unconscious and died. At the autopsy there were no signs indicative of death, which must have been due to the shock following the blow on the epigastrium.

As illustrative of the sensitiveness of the epigastric region, Vincent relates the following case: "A man received a blow by a stick upon the epigastrium. He had an anxious expression and suffered from oppression. Irregular heart-action and shivering were symptoms that gradually disappeared during the day. In the evening his appetite returned and he felt well; during the night he died without a struggle, and at the autopsy there was absolutely nothing abnormal to be found." Blows upon the neck often produce sudden collapse. Prize-fighters are well aware of the effects of a blow on the jugular vein. Maschka, quoted by Warren, reports the case of a boy of twelve, who was struck on the anterior portion of the larynx by a stone. He fell lifeless to the ground, and at autopsy no local lesion was found nor any lesion elsewhere. The sudden death may be attributed in this case partly to shock and partly to cerebral anemia.

Soldiers have been seen to drop lifeless on the battle-field without apparent injury or organic derangement; in the olden times this death was attributed to fear and fright, and later was supposed to be caused by what is called "the wind of a cannon-ball." Tolifree has written an article on this cause of sudden death and others have discussed it. By some it is maintained that the momentum acquired by a cannon-ball generates enough force in the neighboring air to prostrate a person in the immediate vicinity of its path of flight.



CHAPTER X.

SURGICAL ANOMALIES OF THE HEAD AND NECK.

Injuries of such a delicate organ as the eye, in which the slightest accident can produce such disastrous consequences, naturally elicit the interest of all. Examples of exophthalmos, or protrusion of the eye from the orbit from bizarre causes, are of particular interest. Among the older writers we find Ficker and the Ephemerides giving instances of exophthalmos from vomiting. Fabricius Hildanus mentions a similar instance. Salmuth, Verduc, and others mention extrusion of the eyeball from the socket, due to excessive coughing. Ab Heers and Sennert mention instances in which after replacement the sight was uninjured. Tyler relates the case of a man who, after arising in the morning, blew his nose violently, and to his horror his left eye extruded from the orbit. With the assistance of his wife it was immediately replaced and a bandage placed over it. When Tyler saw him the upper lid was slightly swollen and discolored, but there was no hemorrhage.

Hutchinson describes extrusion of the eyeball from the orbit caused by a thrust with a stick. There was paraphymotic strangulation of the globe, entirely preventing replacement and necessitating excision. Reyssie speaks of a patient who, during a fire, was struck in the right eye by a stream of water from a hose, violently thrusting the eye backward. Contracting under the double influence of shock and cold, the surrounding tissues forced the eyeball from the orbit, and an hour later Reyssie saw the patient with the eye hanging by the optic nerve and muscles. Its reduction was easy, and after some minor treatment vision was perfectly restored in the injured organ. Thirty months after the accident the patient had perfect vision, and the eye had never in the slightest way discommoded him.

Bodkin mentions the case of a woman of sixty who fell on the key in a door and completely avulsed her eye. In von Graefe's Archiv there is a record of a man of seventy-five who suffered complete avulsion of the eye by a cart-wheel passing over his head. Verhaeghe records complete avulsion of the eye caused by a man falling against the ring of a sharp-worn key. Hamill describes the case of a young girl whose conjunctiva was pierced by one of the rests of an ordinary gas-bracket. Being hooked at one of its extremities the iron became entangled in either the inferior oblique or external rectus muscles, and completely avulsed the eyeball upon the cheek. The real damage could not be estimated, as the patient never returned after the muscle was clipped off close to its conjunctival insertion. Calhoun mentions an instance of a little Esquimaux dog whose head was seized between the jaws of a large Newfoundland with such force as to press the left eyeball from the socket. The ball rested on the cheek, held by the taut optic nerve; the cornea was opaque. The ball was carefully and gently replaced, and sight soon returned to the eye.

In former days there was an old-fashioned manner of fighting called "gouging." In this brutal contest the combatant was successful who could, with his thumb, press his opponent's eyeball out. Strange to say, little serious or permanently bad results followed such inhuman treatment of the eye. Von Langenbeck of Berlin mentions an instance of fracture of the superior maxilla, in which the eyeball was so much displaced as to lodge in the antrum of Highmore. Von Becker of Heidelberg reports the history of a case in which a blow from the horn of a cow dislocated the eye so far back in the orbit as to present the appearance of enucleation. The conjunctiva hid the organ from view, but when it was pulled aside the eyeball was exposed, and in its remote position still possessed the power of vision. In some cases in which exophthalmos has been seemingly spontaneous, extreme laxity of the lids may serve as an explanation. There is an instance on record in which a Polish dew appeared in a Continental hospital, saying that while turning in bed, without any apparent cause, his eyeball was completely extruded. There have been people who prided themselves on their ability to produce partial exophthalmos.

Rupture of the Eyeball.—Jessop mentions the case of a child of eight who suffered a blow on the eye from a fall against a bedpost, followed by compound rupture of the organ. The wound in the sclerotic was three or four lines in length, and the rent in the conjunctiva was so large that it required three sutures. The chief interest in this case was the rapid and complete recovery of vision.

Adler reports a case of fracture of the superior maxillary in which the dislocated bone-fragment of the lower orbital border, through pressure on the inferior maxillary and counter pressure on the skull, caused rupture of the conjunctiva of the left eye.

Serious Sequelae of Orbital Injuries.—In some instances injuries primarily to the orbit either by extension or implication of the cerebral contents provoke the most serious issues. Pointed instruments thrust into the orbital cavity may by this route reach the brain. There is a record of death caused by a wound of a cavernous sinus through the orbit by the stem of a tobacco-pipe. Bower saw a woman at the Gloucester Infirmary who had been stabbed in the eye by the end of an umbrella. There was profuse hemorrhage from the nostrils and left eye, but no signs indicative of its origin. Death shortly ensued, and at the necropsy a fracture through the roof of the orbit was revealed, the umbrella point having completely severed the optic nerve and divided the ophthalmic artery. The internal carotid artery was wounded in one-half of its circumference at its bend, just before it passes up between the anterior clinoid process and the optic nerve. The cavernous sinus was also opened. In this rare injury, although there was a considerable quantity of clotted blood at the base of the brain, there was no wound to the eyeball nor to the brain itself.

Pepper records a case in which a knife was thrust through the spheroidal fissure, wounding a large meningeal vein, causing death from intracranial hemorrhage. Nelaton describes an instance in which the point of an umbrella wounded the cavernous sinus and internal carotid artery of the opposite side, causing the formation of an arteriovenous aneurysm which ultimately burst, and death ensued. Polaillon saw a boy of eighteen who was found in a state of coma. It was stated that an umbrella stick had been thrust up through the roof of the orbit and had been withdrawn with much difficulty. The anterior lobe of the brain was evidently much wounded; an incision was made in the forehead and a portion of the frontal bone chiseled away entrance being thus effected, the aura was incised, and some blood and cerebrospinal fluid escaped. Five splinters were removed and a portion of the damaged brain-substance, and a small artery was tied with catgut. The debris of the eyeball was enucleated and a drain was placed in the frontal wound, coming out through the orbit. The patient soon regained consciousness and experienced no bad symptoms afterward. The drains were gradually withdrawn, the process of healing advanced rapidly, and recovery soon ensued.

Annandale mentions an instance in which a knitting-needle penetrated the brain through the orbit. Hewett speaks of perforation of the roof of the orbit and injury to the brain by a lead-pencil.

Gunshot Injuries of the Orbit.—Barkan recites the case in which a leaden ball 32/100 inch in diameter was thrown from a sling into the left orbital cavity, penetrating between the eyeball and osseous wall of the orbit without rupturing the tunics of the eye or breaking the bony wall of the cavity. It remained lodged two weeks without causing any pain or symptoms, and subsequently worked itself forward, contained in a perfect conjunctival sac, in which it was freely movable.

Buchanan recites the case of a private in the army who was shot at a distance of three feet away, the ball entering the inner canthus of the right eye and lodging under the skin of the opposite side. The eye was not lost, and opacity of the lower part of the cornea alone resulted. Cold water and purging constituted the treatment.

It is said a that an old soldier of one of Napoleon's armies had a musket-ball removed from his left orbit after twenty-four years' lodgment. He was struck in the orbit by a musket-ball, but as at the same time a companion fell dead at his side he inferred that the bullet rebounded from his orbit and killed his comrade. For twenty-four years he had suffered from cephalalgia and pains and partial exophthalmos of the left eye. After removal of the ball the eye partially atrophied.

Warren reports a case of a man of thirty-five whose eyeball was destroyed by the explosion of a gun, the breech-pin flying off and penetrating the head. The orbit was crushed; fourteen months afterward the man complained of soreness on the hard palate, and the whole breech-pin, with screw attached, was extracted. The removal of the pin was followed by fissure of the hard palate, which, however, was relieved by operation. The following is an extract of a report by Wenyon of Fatshan, South China:—

"Tang Shan, Chinese farmer, thirty-one years of age, was injured in the face by the bursting of a shot-gun. After being for upward of two months under the treatment of native practitioners, he came to me on December 4, 1891. I observed a cicatrix on the right side of his nose, and above this a sinus, still unhealed, the orifice of which involved the inner canthus of the right eye, and extended downward and inward for about a centimeter. The sight of the right eye was entirely lost, and the anterior surface of the globe was so uniformly red that the cornea could hardly be distinguished from the surrounding conjunctiva. There was no perceptible enlargement or protrusion of the eyeball, and it did not appear to have sustained any mechanical injury or loss of tissue. The ophthalmia and keratitis were possibly caused by the irritating substances applied to the wound by the Chinese doctors. The sinus on the side of the nose gave exit to a continuous discharge of slightly putrid pus, and the patient complained of continuous headache and occasional dizziness, which interfered with his work. The pain was referred to the right frontal and temporal regions, and the skin on this part of the head had a slight blush, but there was no superficial tenderness. The patient had been told by his native doctors, and he believed it himself, that there was no foreign body in the wound; but on probing it I easily recognized the lower edge of a hard metallic substance at a depth of about one inch posteriorly from the orifice of the sinus. Being unable to obtain any reliable information as to the probable size or shape of the object, I cautiously made several attempts to remove it through a slightly enlarged opening, but without success. I therefore continued the incision along the side of the nose to the nostril, thus laying open the right nasal cavity; then, seizing the foreign body with a pair of strong forceps, I with difficulty removed the complete breech-pin of a Chinese gun. Its size and shape are accurately represented by the accompanying drawing. The breech-pin measures a little over three inches in length, and weighs 21 ounces, or 75.6 grams. It had evidently lain at the back of the orbit, inclined upward and slightly backward from its point of entrance, at an angle of about 45 degrees. On its removal the headache was at once relieved and did not return. In ten days the wound was perfectly healed and the patient went back to his work. A somewhat similar case, but which terminated fatally, is recorded in the American Journal of the Medical Sciences of July, 1882."

The extent of permanent injury done by foreign bodies in the orbit is variable. In some instances the most extensive wound is followed by the happiest result, while in others vision is entirely destroyed by a minor injury.