Piper methysticum

 Common names (Tahitian), Ava, Kava-Kava.

 Piper methysticum, Forst.
 Natural order: Piperaceae.
 Preparation: Tincture of the root.

 When concentrated, drunkenness is almost instantaneous; with the ordinary dose, it occurs about twenty minutes after ingestion. In a small dose, kava is a tonic stimulating beverage, producing an agreeable excitement, and affording support against great fatigue. In increased doses, this root determines an intoxication of a sorrowful, silent, and sleepy character, completely different from that produced by alcoholic drinks. The habitual drinkers of kava take it six or eight times a day, but then a nervous trembling seizes them, and they can scarcely raise the cup to their lips. The intoxication dose not last longer than two hours, but if a person only takes it occasionally, the effects may continue twelve; when taken at intervals of some days, the intoxication continues for six hours. When made from the root grown in damp soils, the drinker remains plunged in a deep torpor, and becomes irritated by the least noise. Often, when the dose is too great or too small, instead of the sleep an intoxication, accompanied by fantastic ideas and a strong desire to skip about, although one cannot for a moment hold himself on his legs. I felt these symptoms for sixty hours the first time I tasted this Polynesian liquor. During this week my system was gradually toned up, so that I was able to do a (for me) large amount of miscellaneous reading after business hours, without more than usual fatigue and with a relish. This was extraordinary, because for years (since December, 1867) I have not indulged in light reading, it having fatigued and brain- fogged me equally with professional reading, and my strength, perforce, has been reserved for necessary scientific and professional reading). (Have, for a long time, not gone through my daily work with such a cheerfulness and ease as to-day), (third day). Felt all day unsatisfied and hilarious, since 10 p.m (thirty-third day). Soon after 10 felt lively and wakeful (second day). Felt bright and lively after emission (third day). I feel more lively than usual; in better spirits; inclined to work (sixth day); feel lively; can dance with more ease than usual (seventh day). Want of vigor, timid, apprehensive, during day (second day). Feelings varying and generally depressed (ninth day). Capable of doing more work, without fatigue or brain-fog), (third day).

 Dizziness and frontal pressure, even when lying in bed, in the morning (seventh day). From 5 to 9 unusually dizzy; assisting at obstetrical case, came near falling several times; swimming sensation and faintness, partly produced by going past evening meal without eating, but not all; never had such a dizziness and swimming sensation on going without food, usually a faint feeling near umbilicus or in epigastrium (seventh day).
 Pains (especially of the head) relieved temporarily by turning the mind to another topic. Soon felt uneasiness in the head.
 Slight heaviness in the head (fourth day). Slight sensation of fullness, sometimes in one part of brain and sometimes in another, mainly in frontal region (first, second, or third day).
 To-night brain feels tired; a little rest relieves the tired feeling (seventh day). Awoke with very worn feeling of the brain, decided brain- fog; getting on foot felt better (eighth morning).
 Brain-fog is spoken of during the primary or active part of the proving; it was then caused by an excessive use of the brain in miscellaneous reading; in the latter part it was secondary or reactive effects of the drug, for I read as much as I could stand during the first period, and abstained from all reading as far as possible during latter part of proving. Headache and sleepiness so great that I could hardly attend to a patient (after eight hours and a half). Dulness, fullness, and pressure in forehead, and vertigo on elevating or moving the head to either side; after the noon meal the pressure shifted to both lateral and the occipital regions, and on lying down increased to a considerable degree, not enough, however, to constitute real pain; pressure in head increased by remaining in one position, decreased by moving; impelled by something to move cautiously, as if there was some condition which would not admit of rapid movement; apprehensive of pain by rapid movement, but the move being made, temporary relief, as by slower movement (third day). Head ached all night, with fullness of frontal region (ninth night); aching continues; feeling as if frontal part of brain was solid with pain; this ache, during the day, gradually moved backward to base of brain and along the medulla oblongata; relieved by slight motion, increased by large, continued, and more active motion (opposite of Rhus); slight mental effort, passing from topic to topic, for an instant relieves; sustained effort increases the aching pain; lay down this (with head elevated (bent forward) on a hard cushion) to rests the brain; frontal pain decreased, occipital increased; gravity seems to have overcome the force of the circulation in the vessels of the brain; vessels of neck and base of brain full, as if circulation had been cut off by a cord; whole back of head, neck, and cerebellum felt congested to the brain and cord-centre; sore inside and tender to outside pressure; all those parts of the nervous system (head, neck, etc.) felt as if double or treble their ordinary size; I lowered my head and straightened my neck, called for a soft pillow, caused mesmeric passes to be made down ward by sides of the head, and with frequent slight changes of position; in about one hour relief began to come; action of the cerebrum weak, but clear; during the whole evening these conditions continued, gradually decreasing (tenth day). After business anxieties, in the evening, pain commenced along the middle of the forehead, proceeded outward to each side of head, and after retiring at night, it followed around both sides of the head and attacked the posterior part of the brain, medulla, etc.; the sensation was not extremely painful, but almost indescribable; all the cerebellum, medulla, etc., were as if compressed by an even pressure from every direction, especially from front to back; nervous system was forced to its highest tension; could not sleep first part of night, and later part only at intervals; could lie still but a few moments at a time; seemed as if head and neck would be compressed to death if I remained quiet long; changed form side to side, from back to face, and vice versa; hands sought cool places, otherwise no perceptible increase of heat; no thirst; constriction extended to chest and stomach as well as brain, though in less degree; the drug seemed to have affected, secondarily, the sources of animal life in cerebellum and medulla, partially and temporarily exciting, and then, to an extent, paralyzing, those functions; called up at 1 o’clock; while moving, much relieved (twelfth day). Nervous system still strung up (or on tension); considerable compressive pain about back of head and cervical part of spinal cord, gradually diminishing during the day (thirteenth day). The symptoms of twelfth night repeated (twentieth and twenty-ninth days). For the last month or more I have spent Tuesday or Wednesday night of each week with distress of head and sleeplessness, as above recorded, though the symptoms each week have gradually decreased in intensity (sixty-first day). Great frontal headache all day; at 8 the ache especially over the eyes and deep seated (second day). Pain in frontal part of head (immediately after first dose, eighth day). Frontal headache and pressing pain, especially on left side, and deep in upper part of the orbits; moving the eyes hurts (eighth day). Frontal headache, just above the eyes, at 5 (tenth day). Pressure in the head, back of the eyes (fifteenth day). Frontal pain, left side, 7.30.
 (eighteenth day). Frontal headache, at 7 (nineteenth day).
 Frontal headache, at 9 p.m, worse at 3 ; slept from 5 to 6 , hoping to sleep the headache away, but the pain was so distressing as to compel me to take, 6.30 , a dose of Nux vomica; pain being worse, took вelladonna 3x; great headache at 12.
 (twentieth day); had disappeared when I was called at 2 p.m, then reappeared (twenty-first day); gone to waking at 5 p.m.
 (twenty-second day). Pain over the eyes, radiating from right frontal side, just above the eye, at 10 p.m (twenty-fourth day).
 Headache, with pressure in upper part of the orbits of the eye (immediately after a dose, twenty fifth day). Dull aching at intervals in the right frontal eminence (tenth day). Dull frontal headache during the whole afternoon and evening, with drowsy and stupid feeling (seventh day). Dull heaviness across the forehead (soon, first day). Heaviness in forehead (seventh day). Heavy pressure on the whole frontal part of the head (seventh day).
 Heavy dull headache in temporal and frontal regions, increased by thinking and reading (ninth day). Head aching at right temporal region, across the eye and bridge of the nose, with feeling of pressure along the sides of the nose, half way to tip; right temporal pain not uncommon with me when fatigued (seventh day).
 Sharp shooting pains in left temple (after first dose, second day). Uneasy sensation on each side of the head over each ear, as of pressure and weight (third day). Stitches running through left side of the brain front to back, after 3 (second day). The severe pains and soreness in the back of the head and base of brain have gradually disappeared, leaving brain (cerebellum) only sensitive; the feeling of over-size continues, changing back and forth from frontal and occipital regions, being sometimes most prominent on sides of head, over ears, etc., in the temporal regions (eleventh day).
 Eyes and Ear.
 A pain along the line of the optic nerve of the right eye, when reading, after 3 (second day). Pain in the left supraorbital nerve (first day). At 5.30 , in the street, pain deep in left eye, as if the eyeball would be pressed out; at 6 , in the house, this pain had ceased (second day). At intervals, a sharp shooting pain in the left supraorbital nerve, after 3.
 (second day). Pressure behind the eyes (immediately after first dose, eighth day). сonjunctivas very red. While dressing, dizzy blindness came upon me; dizziness less on closing the eyes; directing attention to the head and exerting the will diminished the dizziness; at same time, dizziness followed by rush of blood and fullness in the frontal region, soon followed by similar sensation in occipital and basilar regions, soon disappearing (after two minutes, fifth day). Vision obscured. A singular pressure in lobules of pinna of left ear (immediately after first dose, eighth day).
 Face.
 A curious sensation of fullness in face, as of pressure from inside out, at 7 (nineteenth day).

 Teeth of a deep-yellow color. For the last six or eight days teeth have been very sensitive to cold water, cold air, toothbrush, washing, etc. (tenth day); sensitiveness of left upper first molar, predisposed by former disease, to the gums, did not cease for three or four months; last symptom to disappear. Sensation as if the tongue was covered with fur or velvet (second night). Sensation of burning on the tongue (after a few seconds). Awoke from afternoon nap with great dryness in the mouth and heavy perspiration (it is a very hot day), (third day). Abundant salivation. сhewed in the freshly-gathered state, it tastes first sweet or aromatic, then bitter and pungent. The taste is first sweet, it then becomes piquant and sharp. The taste is very nauseous. Pappy taste in mouth, soon passing away (fifth day). At every meal everything tasteless; fruit, tea, butter, meats, cake, etc., taste all the same (third day).

 During some of the proving, noticeably a day or two previous and succeeding;to the ninth day, took in food with a sort of ravenous haste; no taste of food, abut a nervous ravenousness would have impelled me to swallow anything with an abnormal avidity. At noon meal, appetite unusually good, but food had not the usual relish or taste (third day). Very hungry, but not able to eat much, at 12 M.; for supper, was able to eat but little (second day).
 Formidable appetite, at 8 (eighth day). Appetite slight (ninth day). Sour eructations, especially before meals, an hour, at times rolling up and rumbling all the way from stomach and mouth, but for the most part breaking at throat-pit with frequent succession. At throat-pit, some feeling as of something which ought to be swallowed; sensation relieved by eructation temporarily; returns soon; at night, eructations and sensation at throat-pit and root of tongue so disagreeable, took Pulsatilla to relieve, with some effect (ninth day). Stomach bloated, 11.
 (nineteenth day). Warmth in stomach succeeded swallowing the drug. Warmth of stomach soon passing away (fifth day). сrampy pain in stomach, lasting half an hour; relieved by pressing stomach against the edge of a table (tenth day). Feeling as if mucous membrane of the stomach, mouth, tongue, etc., was covered or furred over, and their sensitive power was lost; tongue not coated (third day).
 Abdomen.
 Slight pain in the abdomen, above the umbilicus, soon passing away (fifth day). After the first stool, in the forenoon, frequent colicky pains, and distressing sensation of fullness in the bowels (twenty-ninth day). сolic., about 9 p.m, every morning. сolic, relieved by motion (tenth day). Pain in right groin, when walking (after first dose, second day).
 Rectum and Anus.
 Burning sensation in rectum has returned (thirty-ninth day). The only symptom that has troubled me for some days past is the sensation of going to have a stool every evening (fiftieth day).
 Sensation of desiring a stool all day (fourth day). сontinual desire for stool (seventh day). All day have felt desire for stool (eighteenth day).
 Stool.
 Bowels a little loose, in the morning, more difficult in the evening (second day); soft stool passes with more difficulty than usual (seventh day). About 10 p.m unusually (very) large stool, the latter part of which was quite soft, preceded by slight pain in the abdomen (sixth day). вowels, which have been regular, constipated (eighth to twelfth day). At 9 p.m had one passage; at 5 , a second, natural, except in quantity, which was enormous (second day). Small movement of the bowels, about 10 p.m (thirteenth day). An unusually large and very hard stool (fifth and sixth days); very small and very hard stool (seventh day). Very hard stool, at 10 p.m; small stool, at 2.45.
 (tenth day); stool twice as large as usual, natural (eleventh day); none (twelfth day); very hard, at 2 ; feel as if about to have another, at 2.45 (thirteenth day); during the forenoon, stool with less straining (fourteenth day); large stool, at 8.30 p.m; another large soft one, at 8.45 p.m.
 (sixteenth day); all day desire for stool (eighteenth day); distressing desire for stool, at 10 p.m; about 1 ; continuous desire for stool, at 11 (nineteenth day); forced a hard stool, which caused a prolapsus ani (twentieth day); small stool, less straining, at 5 ; urging to stool, at 10 p.m; softer stool, at 12 M. (twenty-second day); good stool, at 11 (twenty-third day). Good stool (twenty-third and twenty- fourth days); natural and large stool (twenty-fifth day). Two very large stools; another soft and large stool (twenty- ninth day); soft stool, at 9.30 p.m (thirtieth day); large soft stool (thirty-second day). 8 , diarrhoea threatening (thirty- fourth day); at 1 (thirty-fifth day). Double-sized light- colored stool, at 10 p.m (thirty-fourth day); light colored, easy stool (thirty-fifth day). Stool, with straining, at 4 ; during the evening, continued desire for stool (thirty-sixth day); treble the usual sized light-colored stool; towards evening, sensation of urging to stool returned (thirty-seventh day); sensation of urging to stool (thirty-eighth day); large stool (thirty-ninth day); good stool (fortieth day); large stool, at 7 p.m; another stool, at 9 p.m (forty-first day).

 Burning in the urethra, in passing water (fourth day). Seeing a great change in the urine, kept a clinical record in this respect (fifth day). Got up to pass water, at 4.45 p.m (twentieth day); passed a small quantity, in the morning (twenty-sixth day). Urine increasing in quantity, normal in color and odor (seventh day).
 Urine, this p.m, when first passes, was hot, burned the urethra; at 10 p.m, urine nearly neutral; acidity hardly perceptible (eighth day); at night, hot and decidedly over-acid (ninth day); acid (eleventh day).
 Sexual Organs.
 An erection, lasting about a quarter of an hour, in the afternoon (first day); after an emission, lasting one hour, about 4 p.m.
 (third day). Erections, but no emissions (fourteenth night).
 Shooting pain in the penis (third day). Pains in right testicle (third day). More amorousness during the primary part of the proving than for years. Emission, about 4 p.m, followed by wakefulness (third day); large emission early this morning; the emissions come on without dreams; am awakened by a large quantity of semen running over me (fourth day); emission during forepart of night (tenth night); during night (eleventh night).

 Heaviness in upper part of chest, behind the sternum, as if filled with wind which cannot be eructated (fourth day).

 Back.
 Pain in back, felt only on pressure, at 11.45 (tenth day).
 Soreness in the back, about second dorsal vertebra, at 5.
 (tenth day).
 Extremities.
 The most excruciating pains in the right arm, as if the marrow would be affected; the location of the pain changes in the whole length of the arm, from the shoulder down to the finger-ends; the hands, several times (paroxysmal), feel almost paralyzed; I am then hardly able to keep hold; of a pen; at the same time pain was felt in the big toe of right foot; intermissions only after вry, and сalcarea; took medicine only when the pain became so distressing as to make me almost frantic. At 6 , the pain in big toe, right foot, is severe, and another, less severe, is felt in and around right fibula; at 9 , pain in toe disappeared, but appeared in right hand, especially in metacarpal part, next to the little finger (second day). At 1 p.m, in bed, pain in lower part of right arm unbearable; the hand feels so weak that I can hardly use it to grasp anything; 1 drop вryonia; fell asleep about 2.30; at 4 p.m, woke with exactly the same symptoms; another drop вryonia; fell asleep until 6 p.m; got out of bed; the pain reappeared in its full strength; took 1 drop Rhus 3 x, 8 ; since about an hour after taking Rhus, this morning, all pain in arm and hand has left; only the pain in right big toe has been somewhat distressing, but as it is wearing off I intend to leave it to itself (fifth day).
 Superior Extremities.
 In the street, an aching pain in the whole left arm, and flushing heat in left hand, which, in time, changed to aching pains in the middle and third fingers (after one hour;and a half); pain in second joint of left thumb (after four hours). A disagreeable dragging pain in the whole length of the left arm, at 8 ; better at 10 (nineteenth day). The whole right arm aches and feels heavy, with slight pains running in all directions through it; the arm feels sore and tired (fourth day). Dull aching pain in left shoulder (soon after first dose, second day). About the middle of the day, a severe pain above the elbow at or near the insertion of the triceps (sixth day). A tingling in left arm and hand, running from elbow to hand, including all the fingers; the sensation was as if a mild current of electricity was running through the arm, hand, and fingers. The sensation was pleasant and lasted about fifteen minutes (seventh day). Numbness in right elbow (after first dose, second day). Severe pain, with slight stiffness, in right elbow and left knee (fourth day). Aching pain in right wrist, worse when writing (eighth day); severe pain in right wrist, lasting all day and evening (ninth day); a dull aching pain in the right wrist commenced at 10.30 p.m, with a slight prickling pain running up the arm to the elbow, also a sore pain in wrist (tenth day); soreness in right wrist (twelfth day). Sensation of weakness in left hand (eighth day). Pain in the joint of thumb of left hand, aggravated by pressure (seventh day); continues, with intermissions, for several hours (eighth day).
 Inferior Extremities.
 Weariness of the lower extremities all day (eighth and fifteenth days). Very weak in lower extremities, in the afternoon (thirtieth day); increased weakness (thirty-first day); weakness in limbs (thirty-third day). Weakness or weariness in lower extremities (thirty-fourth day). Feel weary and completely broken down in lower extremities (fourth-first day). Fatigue in femoral part of both legs, as if unable to stand on them (after five hours). Pain in left knee, which made me limp when walking (soon after dose, seventh day). Stitching pain in left knee, when walking, at 4 (third day). Sharp pain under the right patella, causing me to limp when walking; it comes and goes; is much worse immediately after taking medicine (third day).

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