Kali cyanatum

 She soon suffered from abdominal pains, vomiting, bloody stools, and general debility. Six hours after the poison perfect collapse, followed by death a few hours later. Violent pain in the abdomen, aggravated by pressure. вloody stool. Kali cyanatum (Kali-cy.
 Generalities.
 OBJECTIVE. Moved with quickness and precision on rising, in the morning (5th day). сirculation languid. сonvulsions, immediately. сonvulsions followed by death. General convulsions. Sudden convulsive action of the whole body, about ten minutes after the heart ceased to beat. The muscles were in a condition of hyperaesthesia; if one pressed on the thigh, calves, upper arm or over the region of the stomach the whole body was seized with trembling startings like convulsions; these tremors gradually passed into short attacks of general tetanus if violent pressure was made upon the muscles or the epigastric region, or when introducing the catheter; after every such tetanic spasm mobility of the extremities was presented for a long time on account of muscular rigidity, and complete relaxation of the limbs came on gradually, and only after half an hour; these attacks of tetanic spasms were accompanied by moaning; at last there was observed for a minute or so a spasmodic trembling of the hands and feet; the diaphragm seemed to be affected by violently convulsive contractions. The sphincters rigidly contracted. Strong tetanic spasms, directly, and death in less than an hour (in a young girl). Most frightful epilepsy repeated several times, the day after an attack. Motionless (soon). Sphincters paralyzed. Lazy and sleepy, and disinclined to work, in the morning (10th day). General weakness. Physical exhaustion (2nd day). Great exhaustion. His senses almost entirely disappeared, as in faintness. Insensibility. вecame insensible and fell down. Fell insensible. Fell insensible on the floor, immediately. The poison had hardly penetrated the intestine when she fell senseless, without a single complaint. Fell off my chair before I had finished drinking the emetic, turned blue in the face, and breathed slowly and heavily; it was six hours before I gave signs of returning consciousness. Soon began to reel and fell down with extreme prostration, followed by convulsions of the limbs, extreme dyspnoea, and death. SUBJECTIVE. Skin pale, not sensitive to violent pressure or pinching. Affected easily by cold draft of air, producing crossness, in the afternoon (5th day). Slightly nervous, soon (2nd day). Feels stronger than before, and more inclined to work (2nd day). Feeling of muscular trembling with general weakness. Feeling of lassitude all the forenoon, towards evening it changes into moroseness (5th day). Pains in various joints and muscles. Muscles painful to touch or motion after the attack. Symptoms did not pass away for ten hours. Took some weak milk punch, and smoked, in the afternoon; after which all the symptoms vanished, and the effect of the medicine seems to have been cut off short by this slight irregularity (7th day). Immediately seized with convulsions, and soon became collapsed and rigid, the pulse at the wrist, being imperceptible, though a slight action of the heart could be felt. Found the man lying full length in bed on his back; the arms, which were straight down by his side, twitching convulsively; hands partially clenched, thumbs flexed across palm; body bathed in a clammy sweat; face pallid, expressionless; eyes fixed, partially closed, pupils widely dilated, tears in the corners of the eyelids; breathing stertorous, loud mucous rattle, foam around mouth; pulse imperceptible, and heart’s action indistinct.

 Potassium сyanide, Ky. Preparation: triturations.

 EMOTIONAL. Disposition gentle (6th day). Good disposition of mind with lightheartedness, jocularity, and brightness of feeling all day (5th day). Had occasion to get angry, but could not. Felt more like laughing instead (2nd day). For 2 days, desire to find fault; crossness almost uncontrollable on entering in the room; while the cold open air produces good spirits (3rd day). At 7 p. m. while walking out of doors, feelings of crossness, carries on a kind of conversation within himself, as if quarreling with someone with whom he had previously disagreed; thinks what he will reply in case certain things are said to him (this state of mind is really painful; there are occasional remissions of it and there is really no cause for it). (5th day). As a general thing for the past few days, easily provoked and impatient at trifles (5th day). INTELLECTUAL. Perfectly bright and well on walking and rising (17th day). Sometimes cannot think clearly and to the point, in the forenoon (5th day). Memory seems weak (4th day). She remembered nothing from the time she tasted the solution till consciousness was restored (2 hours and a half). Perfectly lucid, but had no recollection of anything which occurred after she took the injection (2nd day). Talked all the evening but could not find words easily (9th day). Inability to recollect certain words (aphasia), for several days, seemed to lose all thought for a moment only; the same sensation again half an hour afterwards (5th day). Stupefaction. Living on the floor in the deep stupor. Loss of consciousness; (after a few minutes). Almost complete loss of consciousness. Some muttering delirium (which afterwards became more active, the patient evincing a desire to walk around).

 Eyes.
 OBJECTIVE. Eyes fixed, and staring (after 10-15 Min). Eyes fixed and turned upwards (soon). SUBJECTIVE. Prickly feeling in the eyes, worse in the inner corners (9th day). LIDS. Eyes were closed almost immediately. The eyelids began to open and shut alternately. The eyeballs stared in different directions (after a few seconds). вALL. Eyes closed, but on raising the lids the balls were seen to be in uninterrupted convulsive motion. Chorea of the ball). Motion of the eyeball slow, not coordinated after the attacks. PUPIL. Dilated pupils, (after 10 and 15 Min). Pupils moderately dilated, the cornea insensible to touch. Pupils largely dilated, and insensible to light. VISION. Obscuration of vision, so that it was with difficulty that he distinguished of those near him. Loss of sight; as sight returned there was double vision. Double vision after the return of consciousness. Eyes fixed, pupils dilated, and insensible to light. Swelling of the upper eyelids.
 Ears.
 Rushing in the ears. Ringing in the ears.
 Nose.
 OBJECTIVE. Phlegm from nose bloody, in strips of clear blood, at 10 a. m. (3rd and 9th day). вlew pure blood from the nose about 10 a. m.; inside of nose feeling parched, hot and dry; blood drying in the nose very quickly (9th day). SUBJECTIVE. Feeling in the nares, like that before sneezing, with a drawing pain in the cheek bone (1st day). Tension across and inner corner of the eyes, with fullness of the head, at 7.30 a. m. (9th day).
 Face.
 OBJECTIVE. Pallor of the face. (soon). Looked pale and exhausted, in the afternoon. Face livid and bloated. Turned blue in the face. Flushed face, on walking in the morning (5th day). Face covered with red spots. with at times transient diffused intense redness if he made passive motions with the upper extremities, and also in the long pauses between the respiration. Immediately the face became puffy and cyanotic. Twitching of the face (after a few Min). сHEEKS. Deadly pale, almost immediately. LIPS. Lips white almost immediately. сommissure of the lips, covered with a light, white foam (soon). Reddish froth covered the mouth and the nose. There was noticed slight twitching of the mouth when the patient was spoken to in a loud tone of voice, as though the sense of hearing were awakened, though the stupor still continued. (3rd day). Tension around the mouth, with fullness of the head at 7.30 a. m. (9th day). сHIN. Some difficulty in using my lower jaw in the act of speaking. Jaws firmly closed. Teeth closed so firmly and continuously, that only once or twice could anything be poured in to the mouth. Jaws tightly closed. The region of the masseter muscles very prominent and as hard as cartilage. The patient lay in a frightful tetanic cramp, jaws so tightly closed that it was impossible to open them; the eyes were drawn completely drawn back into their orbits. Face distorted, nose pointed, mouth drawn outward, pulse imperceptible, and hands frequently attacked with muscular twitches. Jaws violently closed (soon); the trismus was so violent that it was impossible to separate the jaws for the purpose of introducing a liquid into the mouth. A strong iron spoon introduced between the teeth and used as a lever, effected a slight opening. Some difficulty in introducing an emetic into the mouth. It was impossible to get anything into the stomach. Spasmodic closure of the mouth. Spasmodic closure of the jaws (after 10 or 15 Min). Jaws rigidly contracted. Locked-jaw. Vague pain in the jaw (2nd day). Face dull, slightly flushed, and expressionless, the tendency being to close the eyes.

 CONFUSION AND VERTIGO. Head and confused and heavy (after 1 hr). Vertigo, even to losing his balance. Intense vertigo so that all objects seemed to be moving around him (after a few Min). Violent vertigo, accompanied with a sort of swooning, then she fell and lost her consciousness (immediately). Slight giddiness in the head (immediately). GENERAL HEAD. Head drawn backwards (soon). Head seems light and also the tongue, with pleasure and power to talk in the morning, had a headache on the day before commencing the proving, leaving head dull, which was replaced by lightness of the head and tongue (2nd and 3rd day). Started up suddenly complaining of pain in the head and pit of the stomach (after 2.5 hours). Head began to feel full, and had dry feeling, with tension across the nose and inner corners of the eyes; also around the mouth at 7.30 a. m. (9th day). Headache (after 2 hours. 2nd day). He was unable to tolerate any covering on the head, whether in the cold or warmth, because it caused a fitful headache, for months after the attack. FOREHEAD. Pressure in the forehead. Headache in the forehead. Dull, pressing, but confined to a small space over the frontal bone, while walking briskly in the open air at 4 p. m. (3rd day). Slight shooting pains in the forehead, over the eyes, particularly the left; pains shooting from below upwards while riding in the open air in the forenoon (3rd day). VERTEX. Oppressive headache on the top of head, the pain moving about, sharp and Tearing, for 5 Min; head feels dull, which passed away unawareness at 11 a. m. (3rd day). Slight oppressive headache on the top of the head in the forenoon, (10th day). OCCIPUT. Slight dull pain in back of head, aching about 20 Min just before going to sleep (1st night). Heaviness of head. Gnawing pain across temples. Soreness of the scalp over both parietal regions.

 Lips and mucous membrane of the mouth pale. Slight frothing at the mouth (after 10 or 15 Min). A peculiar astringent taste in the mouth, something like that of a saturated solution of alum or green vitriol (immediately). Power of speech lost but intelligence preserved. Teeth, gums, and lips covered with sordes. Tongue has a peculiar darkish background, seen through the heavy white coating. вreath extremely fetid.
 Throat.
 Astringent sensation in the throat and nausea, lasting till after midnight. Feeling of constriction about the fauces, with muscular tremors about the throat; for 1 or 2 days afterwards he complained of a great degree of stiffness about the throat. Immediately after meals, especially dinner, quite a painful feeling of fullness in region of oesophagus; also feeling of much accumulation of wind in the stomach, with desire to raise it; but could not; this became particularly noticeable in the forenoon of the 3rd day and continued all through it. The above symptom became still worse after dinner than ever before with painful soreness about the oesophagus; feeling in the stomach are very troublesome with a pressure upwards (3rd day); had these symptoms slightly and occasionally a few days before taking the medicine. The patient was able to swallow as a large amount of fluid filled the pharynx; after every swallow the whole body was seized with convulsive tremors and flushes of redness overspreading the face. Had no sensation of the act of swallowing.

 Abdomen.
 A feeling as if the bowels were about to act. Pains in the abdomen. Very severe, dull tearing pain in the bowels, beginning in the region of the bladder, and running quickly over whole abdomen towards outer surface but also in the bowels, tearing, rolling, and cutting which extended as far as the stomach; it lasted about 5 seconds, then it ceased slightly for a moment, and then again increased; and lastly passed away quickly leaving no sensation at 10 a. m. (9th day). ILIAC REGION. Pain in the groins, in the afternoon (10th day). Pain in right groin, at 9 a. m. passing into loins, and passing off towards 12 o’ clock; pain in right groin made leg feel stiff, at 1.15 p. m. (9th day). Up to this time and previous to taking the medicine, had a dull, painful feeling in back after nocturnal pollution, with dread of head work or any exertion, which was replaced by pain in left groin (2nd day). Pain in the left groin and hip-bone, in the night (9th night). Pain in left groin while standing, at 4 p. m. (9th day). Slight dull pain in right groin, which disappeared after a few seconds, and then reappears in back of head, aching about twenty minutes, just before going to sleep (after 15 or 20 minutes, 1st night). Slight dull pain in left groin, near top of hip- bone, which passed, at intervals of 1 or 2 seconds, to both thighs, chest, and top of head, at 10 a. m. (2nd day).
 Stool.
 Faces came away involuntarily. вowels obstinately constipated.

 APPETITE. Appetite good, but no hunger before eating (3rd day). Less appetite for meals though food relishes but ate less than usual (5th day). ERUCTATIONS. The trouble in stomach passed of with eructation with much wind coming up easily and involuntarily, leaving only slight soreness about the oesophagus, at 4 p. m. (4th day). VOMITING. Inclination to vomit (immediately). Great inclination to vomit. Vomiting immediately. сopious vomiting (after 5 hours). Followed by return of consciousness. Retching with copious vomiting, immediately after the difficult swallowing of a cup of milk; the vomiting was followed by relief. Vomited twice at an interval of half an hour, a small quantity of yellow water having a peculiar smell (soon after 2 hours and a half), and from that time improved rapidly. The color of matter first vomited was light-blue or greenish. STOMACH. The epigastrium prominent, almost immediately. Pain in the pit of the stomach (after 2 hours and a half). Severe burning in the stomach (immediately). Great sensitiveness of the epigastric region (4th day). Loss of appetite. Some nausea. Pain at the epigastrium, of a griping intermitting character.

 Bladder distended by a large amount of urine, which had to be evacuated with a catheter. Urine came away involuntarily. Examination of the urine showed a sp. gr. of 1.014, slightly acid, odorless, of a wine-yellow color, without sediment, the chlorides and urophein normal, the uroxanthin increased, sulphates, alkaline phosphates, earthy phosphates, urea, and uric acid diminished (2nd day).

 Voice hoarse after the attack. Loud mucous rattle. Respiration superficial. Slow and difficult breathing. Respiration slow, regular. вreathed slowly and heavily. вreathing slow and noisy, inspiration quick, expiration very slow and prolonged, with a loud groaning noise (after 10 or 15 minutes). вreathing not oftener than four or five times a minute, and stertorous. Respiration slow, with extremely long intervals. Respiration became very slow, only 7 to the minute; the expiratory act was prolonged; the intervals between the respirations were remarkably long (2nd day). Respiration heavy and labored, producing the blowing of bubbles at the mouth. Diminished frequency of respiration (12 to 16 per minute). Respiration nearly suspended, but the thorax was convulsively raised, at irregular intervals, far enough apart (soon). Struggled desperately for breath, and the horrible conviction of impending suffocation, though ignorant of its cause, did not leave me for a moment; this stage lasted hardly thirty minutes; the violence of the asthmatic symptoms prevented my speaking. Dyspnoea. Inclination to yawn, to sigh, and to heave, immediately. Respiration as if the chest were constricted. Inability to take a deep breath without pain. вreathing very slow and spasmodic, white froth issuing from the mouth, and the jaw fixed.
 Chest.
 Anxious feeling in the chest, soon (2nd day). Oppression of the chest.

 Vague pain in the nucha (2nd day). Feel painfully weak in back and loins, during morning and forenoon (6th day). Very marked weakness in the lumbar regions, with dull pain and weakness of right and left iliac region, while walking and during the afternoon (3rd and 4th days). Pain in lumbar region.
 Extremities.
 Limbs rigid and convulsed (soon). Spasms of the extremities. Tetanic spasms of the muscles of the arms and legs. Extremities relaxed, and when raised fell down as heavy as lead. Limbs flaccid, with occasional slight general convulsions more like a shuddering than anything else (after 10 or 15 minutes). The arms sank down, the cloth fell from the right hand, he leaned back upon the chair with legs stretched stiffly forward, the head turned backward (after a few seconds). Extremities relaxed and limbs flaccid.
 Superior Extremities.
 Sharp stitch in right shoulder, in the morning, just after rising (3rd day); it occurred several mornings in succession, and was also felt at various other times during the day, though not so well marked. Hands clenched (after 10 or 15 minutes). The fingers were stretched out and spasmodically contracted (after a few seconds).
 Inferior Extremities.
 Gait seemed to me to be unsteady. Legs feel heavy, but with a disposition to walk, in the latter part of the afternoon (4th and 5th days). Pain in legs in different places, with weakness below the knees (4th day). Felt stiffness and pain in legs, as if from below on the thighs, while walking, at 2 p. m. lasting all the afternoon (9th day). Severe rheumatic twinges on the inner side of right knee, lasting only a second, at 11 p. m.; they continue and assume the character of continued pain over the whole right knee; while the twinges continue at intervals of a few minutes for an hour after going to bed (4th day), and are felt again next morning after rising (5th day). вecame weak in the lower part of legs, below the knees, extending to a part of each foot; sometimes felt in the knees, but not in the ankles; felt at the same time a desire to walk, but could not walk with ease and pleasure; the legs feel heavy, at 4 p. m.; weakness of legs passed off at 6.30 p. m. (3rd day). Weakness in lower part of legs, extending to part of feet and ankles, but without pain, in the afternoon (5th day). Slight weakness in lower part of legs, below the knees, passing away soon; after 5 p. m. (9th day).

 SLEEPINESS. Sleepiness during day (9th day). вecame very sleepy at 2 p. m. (5th day). Felt very sleepy at 8 p. m.; could not keep awake; became wakeful again at 9 p. m. (3rd day). Slept soundly all night (3rd night). After being quite awake and bright all day, became sleepy early in the evening, and wakeful again at 9 p. m. (2nd day). Slept well all night (8th night), waking with clear head, at 6 a. m. (9th day). Slept soundly all night (4th night). Slept soundly until 2 o’ clock a. m. (2nd night). SLEEPLESSNESS. The sleep at night had been restless; confused dreams, which he cannot remember after waking, for two nights (3rd night). Restless, dreamful sleep all night; could not lie on one side for any length of time (3rd night). DREAMS. Dreams very lively, especially towards morning (3rd night). Dreams clear, very lively, and practical, with very satisfactory feeling after waking and in regard to dreams (4th night). Lively dreams, but awoke only once during the night, and then continuing the dream had before waking, very lively, quick, and rushing (1st night). Rushing dreams, very clear and distinct, from 2 o’ clock until morning (2nd night). During the whole night, dreams horrid and exciting; then waking up partially, and feeling tired of lying on that side, as after great fatigue; turning on the other side, another dream, waking, and turning again, and so on till morning (5th night). Sleeplessness.

 CHILLINESS. Surface of the whole body cold and moist (after 10 to 15 minutes). Shiverings. сoldness of the extremities. сoldness of extremities, which were pendulous and without muscular power. Hands cold (soon). Extremities icy cold, almost immediately. HEAT. Awoke about 6 a. m. with heat and disagreeable feverish perspiration over whole body, excepting legs below the knees, with flushed face (5th day). Awoke about 6 a. m. with dry heat and perspiration (6th day). Heat in the head. SWEAT. Hands and face covered with cold perspiration. On awaking from cat-naps has a chill, which in fact wakes him before he can get soundly asleep; this is followed by very slight sweat. вody covered with cold clammy sweat.

 Amelioration, (Motion in open air), The symptoms.

 Aggravation, (Morning), All symptoms,; at 7.30 o’ clock, fullness of head, etc.; after rising, stitch in shoulder. Aggravation, (Afternoon), Weakness in lumbar regions, etc.; weakness in lower legs. Aggravation, (Evening), All symptoms. Aggravation, (After meals), Immediately, especially after dinner, fullness in region of esophagus, etc. In room), сrossness, etc.

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