ARTICLE CXI.

Case of General Paresis. By T. C. Fanning, M. D., of Tarrytown.

J. A. Cleveland, aged 56 years; temperament nervo-sanguine; temperate; drawing master.

Dates his ill health from an attack of measles about sixteen years previous to his death, from which he only imperfectly recovered, with a more or less constant cough.

About ten years after the measles, in consequence of very great exposure to wet and cold, he suffered from a severe attack of pleurisy, affecting both sides, from which he barely escaped with his life, and continually thereafter suffered from chronic bronchitis, which never seemed to be affected in the slightest degree by medicine, at least after he came under my care, which was about three years later. The cough was extremely violent, rather paroxysmal, sometimes dry, sometimes with copious greenish yellow, rarely bloody, sputa. He began the year 1860, with a large carbuncle on the back of the neck, which prostrated him so that he was never after able fully to resume the instruction of his classes, which he had continued until that time. The winter of 1865-6, he spent in Cuba, returning in about the same condition as when he left home. The thorax was always very sensi tive to pressure, with frequently recurring attacks of acute pain in breathing and coughing, until about a year before his death, after that time the attacks of acute pain were perceptibly less frequent, the cause of which was evident from the post-mortem appearances.

The feebleness of gait, obliging him to use a cane, and the trembling of his hands, to which he often called my attention, were evident for more than two years before his death, and were attributed to the weakness caused by cough and expectoration. To the same cause were attributed the frequent nocturnal seminal emissions (during sleep), with little or no sexual excitement, of which he made frequent complaint, until about a year before death, when they became much less frequent.

In October, 1867, he fell backward from a wagon striking on his head and shoulders, but with the exception of a few scratches and a general bruised feeling, he did not seem to have suffered from the fall. During the first three weeks of November, he was troubled with a slight looseness of the bowels (one or two loose evacuations daily) which he feared was taking away the little strength he had; yet he continued his customary, short daily

walk and general interest in affairs until November 28th, when he was confined to his bed, complaining only of general prostration and excessive trembling of the hands. For about a week he lay with no appetite and paying but little attention to anything; his pulse (usually frequent and weak) not perceptibly different from the ordinary rates; tongue heavily coated, brownish and dry; eyes dull and the left lid drooping. Then he seemed to revive, his appetite soon became better than for many months, his eyes brightened but the droop of the lid continued, and a slight thickness became apparent in his speech. The cough was never afterward so violent as before. There was as yet no aberation of mind noticed, the only unusual manifestation being a disposition to make ludicrous wry faces. Thus he continued, unable to feed or help himself, until March 6th, 1868, when he received his usual breakfast in bed, then got up, washed himself and walked without assistance down two flights of stairs, ate another breakfast at the table, which he found standing, and would have left the house but for restraint. For a short time previous to this he had pulled off the bed, at night, everything but the mattress, which he could not get off. He was now evidently insane, recognizing readily anybody whom he knew, but talking disconnectedly and muttering a good deal. He was not disposed to be violent except when restrained from going out, or prevented from taking in pieces a watch which he had in a little case like a clock. The desire to gain possession of this watch continued until a few days before his death, and he would become very much exasperated when it was refused him.

March 10, 11, 12, his strength seemed to be failing him again, though he was still quite restless.

March 12.-At 9 P. M., his wife was wakened by hearing him snore, and going to him, found his attendant asleep, while he was lying motionless, excepting a rapid spasmodic winking. He did not seem to see or hear anything; his respiration was snoring, and soon became very irregular; pulse as usual, except a slight fluttering when there was an unusually long interval without breathing.

March 13.-1 A. M., the respiration began to be more regular with less snoring, and in the morning he was much as before, except weaker. For two or three days previous to this attack, his face and head were quite red, and he pulled in pieces the cloths which he had to receive the sputa. His appetite now failed him,

and he manifested the exalted ideas of his possessions peculiar to this disease, desiring his wife to procure expensive presents for various persons, and planning the gorgeous decoration of a house which he proposed to buy, though for some time he had been de. pendent on his son for the necessaries of life. Two attacks, similar in kind, but less severe in degree, at intervals of about two weeks, followed that of March 12, and the last few days in April he became very quiet, scarcely noticing anybody and eating almost nothing; still his pulse varied very little in strength and rate from the condition it had maintained for months previous. Feet swollen.

April 30.-Was moved about a quarter of a mile on a bed, without apparent discomfort or inconvenience.

May 3.-Had a natural evacuation of the bowels while held on a stool chair. Sarcely able to articulate. For a week or two he had complained very much of pain and tenderness to pressure at the extreme lower part of the spine.

May 4.-Corners of mouth drawn down. Groaned very loudly all day. Swallowed, with difficulty, a little wine and milk put in the back part of his mouth. Entirely unconscious and motionless. Hands swollen, but swelling gone from the feet.

May 5, 6, 7.-The same, excepting the groaning. Tongue very dry and stiff; pulse as usual; respiration regular; very slight rattling cough.

May 6, P. M., and subsequently, enurisis.

May 8, A. M., died without a groan or struggle.

There was at no time a deviation from the straight line perceptible in the protrusion of the tongue.

Post mortem forty hours after death. Extreme emaciation. No evident effusion in the cavity of the arachnoid or in the ventricles; considerable opacity of arachnoid; general softening of both cortical and medullary substance; spinal cord not examined. Thorax. Cavity of pleura completely obliterated, lungs small, crepitant throughout; no tuburcular appearance.

The examination, unfortunately, was obliged to be held in the evening, in some haste; consequently the appearances could not be observed as minutely as was desirable.

In connection with this case, Dr. Fanning called the attention of the Society to the paper by Dr. J. P. Gray, on General Paresis, published in the Transactions of the Allopathic State Medical Society for 1866.

ARTICLE CXII.

Observations upon Cocculus Indicus. By CARROLL DUNHAM, M. D., New York.

Synonym.-Menispermum cocculus, cocculus indicus, cocculus suberosus, anamirta cocculus; the seeds or berries are the part used in medicine.

This substance was employed by the ancients as a poison for fish, stupefying them and rendering it easy to catch them. It is stated that the half ripe, bruised berries, being formed into little pellets and thrown into the water, are eagerly devoured by the fish, which, thereupon, are soon seized with dizziness and, after whirling around, remain motionless and float on the surface of the water. It is also stated that if the fish have eaten any considerable quantity of the cocculus before succumbing to its influence, their flesh becomes poisonous.

The active poisonous principle of cocculus is stated to be picrotoxin. Recent toxicological experiments have been made with this substance. It is probable, however, that this does not comprise the entire active principle of the cocculus any more than strychnia does that of nux vomica, or quinia of cinchona.

In consequence of its use as a means of stupefying fish, and also as the basis of an infusion for the destruction of pediculi and other vermin, cases of poisoning with it have been recorded from time to time. It has been, and still is, extensively used in Great Britain for the purpose of adulterating malt liquors, it being supposed to greatly increase their intoxicating properties, and also to prevent the secondary fermentation.

Cocculus was first introduced into the materia medica and used as a remedy in the treatment of diseases by Hahnemann. He published, in 1805, in the "Fragmenta de viribus Medicamentorum positivis," the germ of the materia medica pura, 156 symptoms of cocculus, together with a few observations from other authors.

He had already, in an essay on a new principle for ascertaining the curative powers of drugs, published in "Hufeland's Journal of Practical Medicine," in 1796, stated, on the authority of Amatus Lusitanus, some symptoms produced by cocculus on the healthy subject, and had used this language: "Our successors will find in cocculus a very powerful medicine when the morbid phenomena it produces shall be more acurately known."

In Hufeland's Journal in 1798, Hahnemann published a case of poisoning occurring in a healthy man from a single grain of the

cocculus seed. To this we shall recur at a later period, stating here that Hahnemann relieved the man with camphor.

In volume I. of the "Materia Medica Pura," Hahnemann published a proving of cocculus in 1811. Some additional symptoms were contributed by Hartlaub and Trinks in their materia medica pura, and Hahnemann incorporated these, with three exceptions, into his own proving, in the second edition of volume I. of his "Materia Medica Pura," published in 1830. This last publication we shall make the basis of our study.

In the introduction Hahnemann says, that "cocculus will be found curative, where the symptoms correspond, in certain forms of sneaking, insidious, nervous fevers, in so called abdominal cramps, and so called spasmodic pains of other parts of the body, etc.; in not a few cases of paralysis of the extremities, and in mental affections." From the publication of this proving to the present day, the records of the Homœopathic Clinique have furnished, from time to time, cases in abundance, corroborating these statements; and yet, in 1848, Tschudi announces the discovery that "cocculus acts chiefly on those parts of the nervous system which control muscular action," and has the impudence to claim, as original, the suggestion to use picrotoxin in paralysis of the extremities and of the sphincters; and Reil, acting on this suggestion, employed a tincture of the seeds of cocculus with success, in chorea, in hemiplegia from cold, and in paralysis of the bladder from the same cause."+

Turning now to Hahnemann's proving of cocculus in volume I. of the second edition of the "Materia Medica Pura," we proceed to make, in conformity with a schema for the study of the materia medica, published in the "American Homœopathic Review," volume III., the following:

Special Analysis.

I. Head; a. Sensorium; 1. Vertigo. Cocculus produces a well marked vertigo, described as " like drunkenness." It occurs when sitting up in bed, is a whirling vertigo, is always accompanied by nausea, which, together with the vertigo, compels a resumption of the recumbent position; is accompanied by a peculiar dullness in the forehead as if there were a board in front of the head. In the condition of circumstance, this vertigo resembles that of

"Canstatt's Jahresbericht," page 138.

Materia Modica der reinen Pflanzenstoffe," page 220.