Phosphorus - General symptoms - T.F. Allen

GENERAL

General

(Morning), Grief.

on waking, anxiety. on rising, unable to collect senses.

after rising, confused feeling in head.

vertigo. dizziness. heaviness of head.

heat of head, and dull headache.

while sitting still, dull pain in head.

on waking, pressive headache.

headache. on waking, stupefaction in head.

pulsation in head. headache in forehead.

weakness of eyes. on waking, dryness of eyes.

agglutination of eyes, etc.

in open air, sticking in inner canthus.

twilight, vision better.

on waking, trembling objects in front of vision.

re-echoing in ears. sneezing.

yellow mucus in nose. blood and yellow mucus from nose.

nostrils stooped. itching in left nostril.

upper lip swollen. toothache.

gnawing and boring in tooth.

on waking, feeling as if teeth were chattering, with general trembling.

drawing in lower back teeth.

sour taste. glutinous taste.

hawking of mucus. on waking, dryness of throat.

rawness in throat. pressure in throat.

after rising, thirst. 8 to 9, nausea.

qualmish nausea. after stool, sour vomiting.

distended pain in stomach.

pain in stomach. in bed, pressure in stomach.

colic. heat in abdomen and face.

4 A.M., woke with pain in bowels and diarrhoea.

pain in abdomen. on waking, pressure in lower abdomen.

in bed, spasm in rectum.

three semifluid stools.

desire to urinate. micturition.

erections. hoarseness.

after rising, cough. oppression of chest.

on waking, tightness of chest.

constriction in chest.

catarrhal coating of chest.

on waking, pulsation. in bed, stretching of limbs and chest.

paralysis of limbs. after rising, weakness in limbs.

before rising, heaviness in the extremities.

after rising, drawing pain in joints.

falling asleep of arms.

tearing in inner side of left forearm.

trembling of hands. falling asleep of hands.

weakness in lower extremities.

falling asleep of left lower extremity.

pain in lower extremity.

on waking, tearing in left tibia.

in bed, tension in heels.

tremulousness. on waking, weariness and exhaustion.

on rising, weakness. after urinating.

weakness. exhaustion of mind and body.

after rising, feeling of mental and physical paralysis.

after heated exercise at night, freckles on nose.

perspiration..

(Afternoon), Good-humored.

dizziness. headache. while sitting, tearing in head.

pain in forehead. 3 to 6 P.M., pain in back and left side of head.

while sitting, sticking and tearing in right eyeball.

heartburn. 1 to 11 P.M., nausea.

griping in abdomen. griping jerk in lower abdomen.

5 P.M., fulness about chest.

swelling in axilla. nervous symptoms.

pimples over body. 1 to 5 P.M., chills.

internal chilliness. coldness.

while sitting, rising of heat from back into head..

(Evening), Vivid fancies.

in twilight, sadness. in bed, anxiety and restlessness.

fear. while walking, vertigo.

after eating, vertigo.

in bed, dizziness. 10 P.M., woke with vertigo.

while reflecting, headache.

stitches in head. in bed, turning in head.

pressive headache in forehead.

pain in forehead. stitches in temples and pain in head.

drawing pain in right side of head.

while sitting, turning in right side of head.

throbbing in right parietal bone.

pulsating pain in brain.

sensitiveness of eyes to candlelight.

lachrymation, biting mucus in right eye.

green halo about candlelight.

sneezing. coryza. nosebleed.

in house, nose stopped.

pale, sickly expression.

while lying down, tearing in maxillary bones.

toothache. gnawing and boring in tooth.

tearing in roots of right upper teeth.

bitterness in mouth and throat.

sour eructations. in bed, nausea.

vomiting. distended pain in stomach.

after lying down, cramp in stomach.

9 P.M. till midnight, pressure in stomach.

10, stitches in pit of stomach.

before going to sleep, cutting colic.

griping and constriction below navel.

cutting in intestines.

after eating, pressure in lower abdomen.

sensation in rectum, cutting in rectum.

after walking, itching in anus.

on falling asleep, stitch from neck of bladder into penis.

burning in urethra. pruritus of glans penis.

on reading aloud. dry cough.

in bed, difficult respiration.

oppression of lower portion of chest.

anxiety in chest. cramp in chest.

sticking through chest.

10 P.M., anxiety about heart.

on lying down, pulsation.

pain in arm. swelling in axilla.

uneasiness in lower extremities.

pain in left hip. after lying down, tearing in thigh.

drawing from knee to foot.

in open air, tearing in knee.

swelling of feet. on motion, stitches in left great toe.

orgasm of blood. weakness.

nervous symptoms. after lying down, burning in wart.

in bed, itching in hands.

itching in soles and toes.

yawning, with chilliness.

sleepiness. flushes of heat.

glowing heat of cheeks..

(Night), After midnight, woke ill-humored.

toward morning, on waking from a dream, moody and melancholic.

on waking, stupid. headache.

pain in ear. stoppage of nose.

toothache. tongue burning, coated white.

dryness of mouth, with burning heat.

thirst. eructations, tasting like rotten eggs.

vomiting of mucus, tasting of olive oil.

feeling as of a disordered stomach.

griping and twisting in stomach.

distension of abdomen.

pressure in lower abdomen.

erections. emissions. after waking, constriction in larynx.

woke about midnight by tickling in trachea.

about midnight, paroxysms of cough.

2 A.M., cough and expectoration of mucus.

after walking in open air, oppression of chest.

cramp in chest. on motion, stitches in chest and back.

falling asleep of arms and feet.

drawing in arm and leg.

swelling in axilla. in bed, tearing in right shoulder.

tearing in hands. paralyzed sensation in right lower extremity.

bruised pain in lower extremity.

in bed, dull pain in hip-joints.

tearing in right knee.

stitches in knees. tearing in left malleolus.

beating pain in heels.

orgasm of blood. uneasiness.

5 to 6 P.M., till towards morning, pains.

intoxicated feeling. pain in bones.

itching of blisters on hands.

crawling in feet. itching over whole body.

restless. frequent waking.

historical dreams. before midnight, chill, preceded by perspiration.

in bed, coldness in knees.

sweats..

(After dinner), Confusion of head.

vertigo. headache. jerking in upper part of left temple.

pressure inward above margin of left eye.

sneezing. stitch in palate.

hiccough. pain in stomach.

tension and pressure about stomach.

griping in abdomen. sticking and clawing in left side of anus.

cough. oppression of chest, with anxiety.

burning in lower end of sternum.

tearing in shoulder. sleepiness..

(After eating), Vertigo.

head heavy, dull. candy, pain in teeth.

blisters on tongue. scraping in mouth and weariness.

saliva tastes of food.

bitter taste. thirst. hiccough.

eructations. sour eructations.

empty eructations. acidity.

qualmishness. pressure in stomach.

pulsation beneath pit of stomach.

pressure in abdomen, with distension.

at noon and evening, twisting colic, with rumbling in the abdomen.

urging to stool. pressure upon chest and short breathing.

rush of blood to heart, and palpitation.

weakness. anxiety and uneasiness in blood.

heat in face. sleepiness..

(While sitting), Dulness of head.

roaring in head. tearing in right side of head.

boring and throbbing in right side of scalp.

rush of blood to head.

tearing beneath right ear.

jerking stitch from left ear into lobule.

burning stitches in margin of upper lip.

burning-hot uprisings.

jerks from stomach to throat.

pressure in pit of stomach.

stitches in right side of abdomen, with tearing in head.

pain in haemorrhoids. urging to urinate.

dry cough. oppression of chest.

stitches and sticking in chest.

beating in right side of chest.

jerking pain in left scapula.

weakness in small of back.

a long time, pain in back.

pain in last lumbar vertebra.

bent, pain in small of back.

pain in upper arms. jerking in condyles of wrist.

gnawing pain in right elbow.

stitches in right leg.

on crossing feet, numbness.

tearing in soles. tearing in toes.

jerking in left great toe.

warmth of body..

(While walking), Griping and cutting in upper abdomen.

cutting in left side of lower a abdomen.

stitches in anus. itching in anus.

incontinence of urine.

cutting beneath short ribs.

tightness of tendons under knee.

drawing in knee. tension in right calf.

pain in ankle. swelling of feet.

pain in soles. stitches in corns.

burning in toes. pricking in right great toe.

weariness..

(Rubbing), Itching in left eye.

tearing beneath right ear.

twitching in left malar bone.

tearing from back teeth to zygoma.

tension in malar bone.

griping in right hypochondrium.

stitches and burning in right hypochondrium.

pain in left side of thorax and abdomen.

tearing in left scapula.

pain in small of back.

tearing along forearm.

stitches in left hip. tearing from knee to back of foot.

tearing from knee-joint to inner side of calf.

tearing in toes. itching..

Delirium (fourth day).

dozed off frequently, but only to lapse, into a semi-delirious state (sixth day).

a peculiar phase developed itself in his delirium.

wherever he turned his eyes he saw faces.

they swarmed by him in long panoramic succession.

they leered at him over the footboard of the bed.

they squinted at him through the windows, or came trooping in when the doors were left ajar.

he would watch these apparitions for hours, complaining that they would not let him sleep (eighth day).

the haunting faces of the previous hallucination had disappeared, and he fancied he was some one else, or that he was in several pieces and could not get the fragments properly adjusted (tenth and eleventh days),.

Patient lies apathetic, screams out now and then, so loud that it aroused all in the house.

at other times she is unconscious, gives no answer when called, though there are free intervals during which she recognizes those about her (ninth day).

on the next day consciousness fails entirely.

on the eleventh day she regains consciousness, which she does not again lose,.

My mind was greatly oppressed with melancholy.

tears would start without cause.

a feeling of dread, as if awaiting something terrible, yet unable to resist or move, overcame me.

sometimes it seemed as if I was beginning to bloat, and then I could hear a multitude of voices saying in high glee, "Fill him up a little more and he will burst," followed by demoniacal laughter, which made the cold chills run over me. I imagined myself an aurora borealis, and could distinctly hear voices shouting, "Beautiful! Oh, was not that splendid?" as the pains became more severe and lasting.

soon, however, the agony became so great that it threw off in a measure the stupor that clouded my senses (after five hours),.

She soon became unconscious, and so remained for over twenty-four hours.

during this condition she frequently changed her position, often drew her legs up against the abdomen.

there was a low temperature, 31.2° in the axilla, 31.8° in the anus. The patient was completely apathetic, pupils insensible to light, pulse small, thready, 80, respiration 30, inspiration short, expiration long and stertorous.

the heart gradually became weak, and the patient died,.

Vertigo, followed by nausea and pressing-downward pain in the middle of the brain, with stupefaction, and sensation as if he would tumble down, in the morning and after dinner.

then, in the afternoon, nausea, heartburn, red face, and sensation as if something were seated in the throat, with sadness and weeping without cause.

in the evening, mistiness before the eyes and itching of the eyelids,.

Dull pain in the whole head, with dizziness, so that he could not hold up the head well, and at times could not see well.

on turning the head the pain was aggravated, and extended down into the face, somewhat better on leaning it forward, without heat, with accumulation of water in the mouth and general prostration and sickly look.

these symptoms continued to increase for three or four days, only somewhat relieved by sleep, until there appeared, in the middle of the forehead, an irregular circle, about as large as a half dollar, with a border half an inch broad, consisting of turgid skin of the forehead, which was warmer than the surrounding part.

the redness disappeared on pressure, but immediately returned (eczema erythematosum).

in the middle of this circle there was an irregular round spot of normal skin.

the diseased part of the skin was painless, but cold water and cold air caused smarting,.

Headache, consisting of a sensation of heaviness, extending to the eyeballs, as if the head were drawn forward by a weight, with a feeling of fulness and heaviness in the face, as if too full of blood, like that after studying too intensely.

when the headache was the worst it was accompanied by drawing in the left side of the occiput.

the headache was only transiently relieved by smelling of spirits of wine, and by shaking the head, aggravated by mental work,.

Violent numb and dizzy sensation, with pressive pain in the head, disinclination and inability to work, especially to perform mental labor, and sleepiness.

almost entirely relieved after lying quietly and partly sleeping, returning only after rising and moving about, with a feeling as if there were no firmness in the head, and with sore pain in various places in the head when touched, for several days,.

In the morning the face was red, in the afternoon the turgescence had increased (second day).

turgor of the face heightened, and in the afternoon it had assumed a remarkable bluish-red color, from which, however, the middle of the face was perfectly free.

a colorless band of about an inch in breath, extended from the highest point of the forehead to the chin, and was sharply defined, giving the face a most peculiar appearance (third day).

the bluish-red color of the face had changed into a perfectly cyanotic hue, the median line remaining free from all color (fourth day),.

At the end of three years her face began to swell and she then left the business.

the swelling gradually increased, and she entered the hospital.

several teeth were extracted, with but little relief.

she appears to have repeatedly left and returned to the hospital, with the swelling continuing, until at last an abscess formed in the superior maxillary bone, which left it carious,.

Violent pain in right upper jaw, which was soon succeeded by swelling and abscess of the gums.

eight teeth in succession became rapidly carious and were removed.

this had some effect on the swelling, but it soon increased again, extending to the cheek and part of the neck.

according to the patient's account, the suppuration at the commencement had a strong odor of Phosphorus. Pregnancy appeared to have proved favorable to the disease, but on new examination, there was found to be a necrosis of the superior maxilla,.

Pain in the left upper jaw, with swelling of the upper lip.

the pain afterwards disappeared for awhile, but the lip remained swollen.

several abscesses formed in the mouth, discharged matter between the teeth, and the patient had some of the back teeth drawn and experienced relief from pain for a time, but afterwards it considerably increased and the gum became swollen, so that the mouth could scarcely be opened and the bone became denuded,.

Gradually a red swelling appeared on the under part of the chin.

at first it was the size of a four penny piece, and quickly enlarged until it extended over the face as far as the eyes.

except upon the chin, however, the swelling remained pale and doughy.

upon the original swelling of the chin there was found a group of pustules of the size of hempseed and larger, which, after discharging their thin turbid contents, formed an ulcer the size off a six pence.

at the same time the parts beneath became disorganized into a thin, slightly discolored offensive purulent mass. A disagreeable smell also emanated from the mouth.

the gums and teeth, particularly the front teeth of both jaws, became loose from salivation, which set in at the same time, and the child, from the commencement of the affection, complained much of toothache and headache. Within eight days the ulcer had destroyed the soft parts, even to the bone.

after the use of remedies for ten days, three thin pieces of bone, the size of a bean, detached themselves from the surface of the lower jaw at the chin, and on the following days other small very thin fragments of bone were observed upon the lint.

upon this the sanious discharge was arrested.

the surface of the ulcer became clearer and began to discharge a thin pus, and to form granulations.

three weeks after the exfoliation, the ulcer was cicatrized,.

Suffered much from violent toothache, accompanied with considerable swelling of the right side of the face.

he had a double tooth extracted, but without relief.

the affection progressed so quickly that in a short time he ceased to be able to follow his employment.

one tooth after another dropped out.

he became so weak that he was unable to work.

a swelling of the size of an egg formed below the right orbit, which in a fortnight burst, discharging a large quantity of white pus.

he continued to get worse, all the teeth having fallen out, the gums of the lower jaw retracted, and he now presents the following appearance. The right cheek is considerably swollen.

at the right angle of the lower jaw exists an opening, discharging laudable pus, through which the probe can be passed a couple of inches along bare bone, two inches anterior to this there is another aperture likewise leading to dead bone.

on opening the mouth, the whole of the lower jaw, as far as the ascending rami and down to the reflection of the mucous membrane on the cheek, is quite dead, denuded, and of a leaden-grayish color,.

Seized with toothache, and swelling on the right side of the lower jaw.

to relieve it the gums were lanced, and, finally, the tooth extracted.

after this the pain ceased, but the swelling gradually increased, until a spontaneous opening formed on the under side of the jaw, with a discharge of pus, which has continued since.

she remained in the factory until one week previous to her admission into the hospital. Upon examination after her admission, the inferior maxilla was found necrosed on the right side, and partially on the left.

the jaw was painful, and that side of the face swollen.

the discharge was at times profuse, and apart of it took place through the buccal cavity, rendering it very annoying.

her appetite was good, but mastication difficult and painful.

the necrosis gradually extended, but her general health continued good,.

Two years ago he began to be troubled with carious teeth the three molars on the left side of the lower jaw became so painful that he was obliged to masticate on the right side exclusively. Afterwards the teeth on the right side pained him, and he was forced to employ the left ones again. Two months ago he took cold, and after a few days, he found a swelling about the left side of the lower jaw, accompanied with pains in the bone, extending to different parts of the head and face. He had three teeth extracted, which were rotted away at their crowns, but their fangs were entire. At the time of his admission, the three remaining incisors were quite loose.

entire gum on left side swollen and spongy.

fetid pus escaping on the slightest pressure, from the previous site of the extracted teeth.

a probe passed into these openings strikes on bare bone.

over these parts there was considerable exterior swelling.

pulse quick and feeble.

general strength impaired.

face puffy and very pallid.

sleep disturbed by pain in the jaws and general articular pains. The pain and swelling increased on the right half of the face, speedily bringing it into the same condition as the half first affected. The ulceration of the gum over the diseased alveoli advanced.

and as the several openings became confluent, the alveolar margin of the bone became exposed. The soft parts rapidly retracted from the surface of the bone, and the denudation became every day more complete, and its exposure was attended with a copious and most fetid suppuration. From then until now the only difference that has occurred has consisted in the gradually advancing isolation of the bone,.

Began to suffer with toothache in the right side of lower jaw.

this lasted for some time, and was followed soon by a hard lump upon the outside of the jaw.

the pain continued to increase and the swelling to enlarge until an abscess formed in the submaxillary region, and burst, and discharged a large quantity of purulent matter. Upon introducing a probe into the discharging orifice, I found that it led directly to the jaw, which was deprived of its periosteum and in a necrosed condition.

there was, however, no indication that exfoliation had taken place from any part of the jaw, but, on the contrary, the whole bone was firm and solid. At this time the disease seemed to extended only from the right lower canine tooth to the angle of the same side of the jaw. Later he presented himself in a condition much worse than before, now from weakness and exhaustion he had been forced to give up his occupation. All the teeth upon the right side of the jaw have loosened and fallen out.

besides several openings upon the outside of the face, that were freely discharging pus, there were two or three inside of the mouth, from which there issued a large quantity also, and which led directly to the diseased bone. The disease now seemed to involve the whole of the right side of the lower jaw, without there being made the least attempt, seemingly, by the periosteum to replace the dead bone with a new casing of osseous deposit such as usually forms in ordinary cases of necrosis.

nor was there any disposition to exfoliate or to form a sequestrum, but on the contrary the whole jaw was as firm and solid as at the time when it was first examined. His constitution had now become seriously affected, as he was much emaciated and weakened by the great drain of pus that was constantly poured forth from the diseased parts. Later, in the mouth can be felt and easily seen the denuded jaw for an extent of two inches. His breath smells very offensively. The disease now extends from the right temporal-maxillary articulation to the left lower canine tooth. He cannot eat solid food, though his appetite is tolerably good,.

During the last half year she had occasionally suffered from toothache on the right side of the lower jaw. In a few months it became more severe and ceased to be limited to the carious teeth, and extended through the whole jaw, over the cheek, and even to the temporal region and the neck. At the same time considerable febrile disturbance, with occasional rigors, supervened, accompanied by swelling of gums and cheek with erysipelatous redness of the latter. On admittance, the examination showed the right cheek much swollen, and very tense towards the eye, the mouth, the chin, and neck.

the tenderness most considerable in the vicinity of the lower jaw. Pain deepseated, throbbing, piercing, concentrated at the angle of the jaw, and radiating thence over the adjacent soft parts. Extreme tenderness on pressure. The gums of the diseased side of the jaw much swollen, tense, darkened, and tender.

the mucous membrane of the cheek equally so.

between the angle of the jaw and first molar, fetid pus of a phlegmonous character oozed out on pressure. The first and fourth molars on the right side of the lower jaw were carious, the other molars deficient. The swelling of the gums increased, became more tense, extended to the soft palate.

dysphagia and salivation supervened, and the jaw became almost immovable. Suppuration increased, pus laudable, but fetid. During the second week, the four incisors and one molar became loosened, suppuration ichorous and rusty, gums softened and livid, formation of sinuses on the external and internal surface, through which the probe reached the bone, which appeared in part rough, in part smooth. In the progress of the disease, increased retraction of gums from the alveolar surface, fresh abscesses, increased discoloration, and burrowing sinuses, so that the entire jaw was exposed to the probe, both externally and internally. The bone appeared almost entirely detached from the soft parts, floating in an excessively sanious fluid,.

The disease appeared to commence by a swelling in that part of the jaw whence a tooth had been extracted two years before.

the swelling continued to extend until the entire bone became affected. He said that he had suffered great pain through the entire jaw, and that his nights had been sleepless. He looked very ill, was much emaciated, and he presented a curious appearance of the mouth, which was pursed up into a round aperture in consequence of the protrusion forward of the enlarged jaw. There were two fistulous openings, one on each side of the upper part of the neck.

and a probe introduced struck the angle of the jaw, which was quite dead. I examined the mouth and found the jaw quite dead. I could distinguish every part of the bone except the condyles, which were imbedded in soft tissue. There was a large quantity of fetid discharge around the bone, but the principal part came from the vicinity of the condyles. The outside of the cheeks about the masseteric regions was much thickened. The teeth were all gone, and the appearance of the jaw was that from an edentulated cranium,.

Toothache in the left lower jaw, formation of an ulcer on the side of the middle back tooth with violent pains.

as the ulcer opened a piece of bone was discharged.

at last the cheek became swollen and erysipelatous and abscesses formed, which discharged much matter.

the necrosis of the bone progressed until the whole half of the lower jaw had to be removed,.

A carious molar of the right side of the lower jaw was extracted.

from this time (seven months since) the peculiar Phosphorus necrosis may be said to have fairly begun, and it progressed rapidly, for the subject of it was compelled to give up the charge of his department about a fortnight after the tooth was drawn. The face was very much deformed by indurated swelling, which was particularly conspicuous on the right side and about the chin.

three fistulous openings, surrounded by flabby granulations, were upon the right side of the neck.

from these fetid pus exuded freely.

a horribly offensive odor came from the mouth, and saliva and pus were constantly dribbling out.

the gums were spongy on the margin, but partook of the general induration at the sides.

four sound but loose teeth occupied the right alveolar cavities.

the upper jaw seemed healthy.

the patient could not part the two jaws sufficiently to introduce a finger with facility.

a probe detected necrosed bone both on examination in the mouth and through the sinuses.

the examinations gave excessive pain.

a portion of the left lower jaw only seemed clear of the disease.

the symphysis was completely involved,.

The disease seems first to attack the gum of diseased teeth.

it usually makes its appearance in a year or a year and a half after beginning work in the factory.

it is still questionable whether the disease is due to Phosphorus, Acid Phos ^{Phosphoric acid}, or to the ozone generated by the Phosphorus, or even whether it may not be due to general chronic Phosphorus poisoning. The lower jaw was affected in nine cases out of ten, the upper jaw in one case.

the disease very seldom spread from the upper jaw to the bones of the face. The first symptom was tensive pain in the teeth, then looseness of the teeth and discharge of matter between the gum and teeth.

if now the teeth be drawn the swelling and pain increase and involve the whole half of the jaw.

usually the disease progresses slowly and irregularly, with transient periods of improvement.

the soft parts covering the jaws, cheeks, sides of the mouth, become swollen and intolerably painful.

one tooth after another becomes loose, and every pressure upon the gum causes discharge of pus.

the pus often is discharged through the cheek externally. The skin of the margin of the lower jaw becomes red, soft, loosens, and at last infiltrated.

from this infiltration there follows a discharge of matter that seems to come from the alveolar process.

wherever the opening is probed denuded bone is found.

at the same time it is found that the periosteum that has been loosened from the bone has a new deposit of bone on its inner surface, so that the sound passes between two surfaces of bone, one consisting of old bone, the other of new growth.

the denuded bone decays in various directions and is gradually discharged with the matter..

With this the patient suffers from fever, at times violent, considerable emaciation.

nutrition is very much disturbed on account of the difficulty of swallowing, and the digestion suffers on account of the mixture of offensive matter with the food.

sleep at night is possible only by means of increasing doses of Morphia, and the patient gradually sinks with hectic and exhaustion. During the prostration tuberculosis frequent develops.

at times also lobular pneumonia, terminating in gangrene of the lung and pyohaemia,.

The Phosphorus disease of the jaw consists in the first stage of an inflammatory swelling of the gum and soft parts of the mouth, extending over the face and neck, associated with the development of masses of osteophyte of varying extent and thickness about the jaw.

in the second stage the teeth become black, the gum recedes, the osteophytes suppurate, and the jaw becomes denuded, rough, and blackish or grayish-green, and the teeth fall out.

Necrosis of the jaw. the disease begins as toothache, involving one or more teeth in the upper or lower jaw.

the disease spreads to the jawbone, which increases in volume and becomes painful to pressure.

afterwards the soft parts become swollen, especially the gums and cheeks, in the latter erysipelatous inflammation develops, even extending over the whole side of the face and down on to the neck.

the patients have fever, yellow color of the skin, especially of the face, loss of appetite, thirst, irregular stools.

the pain at last extends to the ear and temple, with increased secretion of saliva. Various teeth become loose, and between them there is a discharge of offensive matter, that collects in various parts of the jaw under the gum or under the skin externally, and gradually makes its way into the mouth or through the skin, usually by a number of circuitous channels. The teeth fall out, the jaw becomes denuded, and the necrosis either becomes circumscribed or involves the whole jaw,.

the complaints only appeared after a sojourn in the factory for at least two years, and in individuals habitually exposed to the fumes.

all the workmen whom he had observed had decayed teeth before the disease commenced, not unfrequently before commencing the manufacture.

many other workmen with sound teeth have preserved them in the midst of phosphoric vapors, a fact which induces him to believe that carious teeth constitute a predisposing cause of the disease,.

The disorder at first resembled ordinary toothache, attended however, with swelling of the face.

as the severity of the symptoms increased she became a patient at the Royal Infirmary, but derived little benefit from the treatment.

six months later all the teeth on the right side of the lower jaw fell out, or were removed without difficulty, before the jaw was removed, and on the left side as far as the second bicuspid, all the teeth were sound. There is a great deal of new callus thrown out in the situation of the old bone, so much so that there will be scarcely any disfigurement from the loss of the jaw, a little from the loss of the teeth.

she can close her jaw and chew her meat and bread well.

the bone and teeth of the upper jaw are in a perfectly healthy state, and she now enjoys excellent health,.

Scrofulous subjects are most affected, and in them the disease is most fatal.

almost all the girls employed have the gums more or less affected, and at their junction with the teeth a red ulcerated line, like that produced by mercurial salivation, is apparent. When the individual is robust and the necrosis is confined to a small portion of the bone, exfoliation takes place and a gradual cure follows, but where there exists any tendency to scrofula, phthisis becomes developed, and the patient sinks under the combination,.

Looseness of the gums of the upper and lower incisors, that bled easily.

every morning, on rising the anterior surface of all the incisors was covered with mucus and blood.

the gums of these teeth and of the eyeteeth, all of which were sound and firm, were swollen above and below, very red, the margin became grayish-yellow, and looked as if suppurating.

it bled easily on pressure (the posterior surface of the gum was normal), with bad odor from the mouth,.

Pustular eruption on the forehead (twentieth day).

two days later it extended over the face, as large as a barleycorn, surrounded by a bright-red areola, in the centre of which was the opening of a hair-follicle.

at the same time ecthymatous pustules developed on the nates, about the anus, and a few days later a furuncle, as large as a hazelnut on the left natis, that discharged a greenish bloody matter.

these healed completely about the thirty-second day,.

Great oppression of the chest, so that the patient, during the attack of cough, and in order to expectorate, must sit up in bed, when she experiences great pain, with a constrictive sensation under the sternum.

mucous rattling. rhonchus sibilans in the two inferior thirds of the right lung, in the upper third of the right lung anteriorly, and in the lower half posteriorly.

uncommonly clear tone on percussion.

almost complete immobility of the ribs at these parts.

great arching of the pectoral walls,.

Sticking, commencing at the sternum and extending through the chest to the left scapula, aggravated by working, worse in the evening while spinning.

in the evening the sticking was usually accompanied by slight chilliness, lasting only a few minutes, followed by slight perspiration.

during this paroxysm she was obliged to keep very quiet, else she suffered from a feeling of apprehension, with palpitation.

the corresponding portion of the back was very sensitive to pressure,.

Pains in the upper portion of the right side of the chest, affecting respiration, afterwards changing to a deeply seated pain corresponding to the sixth and seventh ribs, so that deep respiration was at times impossible.

with this burning pain there was a constant desire to cough, which was with difficulty suppressed on account of the pain (tenth day),.

Pulse fell to 75 (after ten hours).

rose to 90, became feeble and irregular (after sixteen hours).

70, regular, in the morning.

60, strong and regular, in the afternoon (second day).

60, regular (third and fourth days).

72, feeble and irregular, in the morning.

90, feeble, at noon. 125, rapid and very feeble, in the afternoon.

130, very weak, in the evening (fifth day).

Dry, irritating cough (second day).

more troublesome, especially when the patient was lying upon the right side, or upon the back, and was attended with slight mucous expectoration (third day).

racking and deep (eighth day).

though severe, less racking (after eleven days).

there remained for two months a deep harassing but dry chest cough, the patient insisting that when the spells came on he could feel something loose and fluttering in the lungs, which occasioned persistent tickling sensations.

the cough was frequently accompanied by nausea and vomiting, especially soon after eating,.

Frequent dry cough, with scanty expectoration, with catarrhal symptoms in the posterior and lower portions of both lungs, especially of the right side.

on the thirteenth day (first chill), percussion showed slight dulness on the right lower portion posteriorly with diminished respiratory murmurs and fine vesicular râles.

change of posture caused a change in the area of dulness.

vocal fremitus diminished beneath the line of dulness on the right posterior portion of the ninth dorsal vertebra.

on the fourteenth day (second chill), the dulness extended upward half an inch, and bronchial breathing was distinct over the area of dulness.

on the seventeenth day the dulness had somewhat diminished, and the expansion of the lung on the posterior right side was more noticed on deep inspiration.

the râles had diminished, but not in the place of the cough.

the cough was now paroxysmal, accompanied by expectoration of tenacious purulent mucus.

the paroxysms of cough were always aggravated after a chill.

on the fiftieth day there were no physical signs of anything abnormal, though the cough was frequent and violent,.

Dry intolerable cough, with violent bronchial catarrh.

afterwards the cough was associated with a slimy, purulent expectoration, with rapid respiration, violent oppression of the chest.

so that when coughing was obliged to sit up, with violent pain beneath the stomach and sensation of constriction.

in the upper third of the right thorax there was remarkable sonority, in the lower portion moist sibilant râles.

ribs almost completely immovable.

thorax decidedly arched,.

The spinous processes of the dorsal vertebrae between the scapulae became exceedingly sensitive to pressure, also the muscles between the spinous processes and the left scapula were sensitive, much worse on the left side.

sticking pains were noticed, beginning at the bone near the left scapula, and extending forward through the chest, or in the reverse direction, from before backwards, at times also extending to the upper arm, relieved by firm pressure upon the back, by rest, and by warmth.

the pains were aggravated by lifting, by working.

worse during the menses, and especially aggravated by unpleasant emotional excitement and by vexation,.

A very decided and remarkable sensation as from a draft of cold air from being too near a half-opened window, in the muscles of the right scapula and along the posterior portion of the right upper arm to the elbow, or a sensation as if a raw wind were blowing upon a moist surface.

at the elbow this sensation changed into a numbness that extended to the fingers (second day),.

Pain in the sacrum at its union with the last dorsal vertebra, as if I had lifted too heavy a weight (after one hour).

not noticed while sitting, lying, stooping, or rising, but only while standing and walking.

aggravated by standing with the sacrum bent backward, coughing, and especially when standing on one foot with the other turned inward and forward, also by bending towards one side.

pressure upon the sacrum was not sensitive, but on the spinal processes of the two last lumbar vertebrae and the neighboring parts it caused a sensation of numbness and rigidity in both feet.

this symptom gradually disappeared in the afternoon,.

Appetite ravenous, but the smallest quantity of food, the moment it enters the stomach, produced vomiting and passages from both bowels and bladder (after twenty-three hours).

could eat but little food, as a few mouthfuls satisfied my ravenous appetite (third day).

could eat nothing but the most easily digestible food, spiced food and pastry invariably producing looseness of the bowels (after two months),.

Dulness over the liver increasing (fifth day).

the next evening the lower margin of the liver could be distinctly felt above the navel.

on the seventh day the margin of the left lobe of the liver could be felt three inches to the left of the median line, and dulness over the liver extended above the fifth rib.

the painfulness to pressure was always increased during and after the chills.

diminution in the volume of the liver took place the twenty-third day.

this corresponded to the diminished painfulness over this region.

on the seventy-ninth day dulness over the liver was found to be unnaturally small.

there was none to the left of the median line.

at this time, and afterwards there was decided enlargement of the spleen,.

Distension of the abdomen caused by moving flatus, with evacuation of a thin stool instead of flatus (first twelve hours).

on the second day, with the moving flatus in the abdomen, a bruised pain in the intestines.

on the third day, incarceration of flatus in the right side of the abdomen, with pressive pain.

on the fourth day, incarceration of flatus in the right side of the abdomen, with griping pain,.

Diarrhoea, which is something very unusual with me, as my bowels are generally constipated (third day).

bowels still quite loose (fourth day).

diarrhoea greatly increased, accompanied by a sharp cutting pain in the abdomen, before going to stool (seventh day).

continued but with much less pain, and less frequent discharges (eighth day). All the symptoms of diarrhoea did not disappear until the expiration of two weeks,.

The passages were like the scrapings of the intestines and almost constant, attended with tenesmus for upwards of two hours.

involuntary passages on the least motion.

eight hours later, the passages changed to mucus and mucus mixed with blood and slime, still involuntary. At the end of twelve hours, passages began to become periodical at every half hour, and then every hour, still involuntary, with tenesmus at least an hour after each passage, when they became as far apart as two hours. During the second night I was compelled to use the vessel a number of times, making my calculations to have a passage every two hours, as they were involuntary the moment anything entered the rectum.

this condition lasted for two days, obliging me to go to stool as often as every three hours. During the whole time the passages were odorless, except a slight mouldy smell. After three days, every time I went from a warm room into the open air my bowels would move. For more than two months spiced food and pastry invariably produced looseness of the bowels,.

Excessive constipation that could only be overcome by Castor Equi ^castor oil and injections, with symptoms of accumulation of faeces in the descending colon.

namely, sensitiveness to pressure about the left Poupart's ligament, abnormal hardness low down in the left iliac region.

these symptoms increased until about the fortieth day, then almost a dysentery of watery stools mixed with whitish-yellow and cheesy masses, and tenesmus, though not bloody stools.

this lasted until the sixtieth day,.

Biting and smarting in the meatus urinarius, extending backward for an inch, with pale red swelling on the right side of the apex of the glans penis, beginning at the upper surface and extending to within the orifice of the urethra.

after urinating a drawing extending from the meatus urinarius to the membranous portion of the urethra,.

Urine greatly increased in amount (after four days), and diminished in specific gravity, containing albumen from the fourth to the fourteenth day, containing bile pigment for two weeks.

on the fourth and fifth days it contained large amounts of casts of fat drops.

from the fifth to the tenth days a large amount of peptones.

after ten days a profuse sediment of urates,.

Urine copious, sp. gr. 1020 to 1026, at first slightly acid or neutral, afterwards quite acid.

the triple phosphates at first were very abundant, but disappeared and gave place to an abundant sediment of urates.

the urine was dark-colored and contained much bile-pigment.

after the fourth day of the poisoning the urine contained increasing quantities of albumen.

the microscope showed hyaline cylinders, with here and there some fat or fatty cells of kidney epithelium,.

Amount of urine 800 c.c., sp. gr. 1023 (seventh day).

steadily increasing to the twelfth day, when it was 3000 c.c., sp. gr. 1021.

afterwards it varied, and after three weeks was 3050 c.c., sp. gr. 1010.

afterwards varying, until after about five weeks it ranged from 1100 to 1600 c.c. daily, sp. gr. 1012 to 1016.

urea was always present in large amounts.

the ethereal extract of urine always contained more or less hippuric acid, portions insoluble in alcohol contain a large amount of urates.

urine increased on the ninth day, contained creating,.

The urine gave a reaction of bile-pigment, with some albumen.

sp. gr. 1026. the coloring-matters of the bile gradually increased, but the albumen was not constant.

there were at times copious dejections of water.

on the fourth day a copious secretion of urine commenced.

the urine was greenish-yellow, sp. gr. 1009, decided bile-pigment, decided albumen.

on the twentieth day the urine became clearer, with less bile.

there seemed to be no relation between the amount of bile in the urine and the paroxysms of fever,.

Two glandular swellings in left axilla rapidly increased in size for one week and then gradually disappeared.

very hard, red, and painful.

worse in the afternoon, evening, and forepart of the night.

slight pressure did not increase the pain, but hard pressure made them very painful.

from these, running down the inner surface of the left arm to the wrist, small lumps, about the size of a pea split in half, at irregular intervals, worse from pressure or rubbing quickly,.

Violent contraction of both hands.

the right hand was greatly pronated, the thumb adducted towards the middle finger, the index and middle finger extended, the fourth and fifth fingers partially flexed.

the left hand was in a similar condition, only the last three fingers were strongly flexed.

therewith the patient complained of drawing and pain in both hands and arms.

in the muscles of the thumb and little finger were noticed violent fibrillar twitchings (third day),.

The right hand became swollen as far as the wrist, soft and oedematous.

the base of the index finger and the whole finger thickened, became grayish-black, gangrenous.

sensitiveness to pressure almost completely disappeared.

there was no pain. the whole bone mummified, as in gangrenus senilis.

amputation of the first phalanx became necessary,.

On the upper third of the lower extremity (below the knee) are two moderately extensive wounds, not extending to the bone. After the necrotic parts had been thrown off and granulation was commencing, they were attacked by nosocomial gangrene.

after this had been subdued by strong Causticum ^caustic remedies, extensive gangrenous periostitis of the tibia, with severe febrile disturbance, supervened.

the periosteum peeled off from a large area upwards, as far as the knee-joint.

the bone was rough. It being impossible to expect this to heal, and as the enormous suppuration, the high fever, and the continual sleeplessness were threatening to completely exhaust the patient, amputation of the femur above the condyles was performed on the 4th of February. During the operation it was observed that the periosteum, although of normal thickness, and apparently of intact structure, adhered but very loosely to the bone, and could be turned back as far as the condyles with the greatest facility. We were obliged to take away the sutures a few days after the operation on account of the great pressure of the shaft of the bone against the soft parts.

Sensation as though a soft foreign substance were lying between the articular surfaces of the knees and ankles, so that walking was exceedingly difficult.

when walking she was obliged to be very careful to prevent falling, with some swelling of the soft parts about the joints, without redness or pain.

flexion gave rise to a sensation of great rigidity, but there was no crepitation or fluctuation,.

Stitches, as with a knife, on the outer side of the right leg, about the middle of the tibialis anticus muscle.

this pain was repeated during the day, at longer or shorter intervals, but especially as a burning sticking, at times acute.

they occurred only while sitting and on crossing the legs, and while standing, not on motion.

the points to which they constantly recurred were about the middle of the tibialis anticus, and at the origin of the extensor communis Digitalis Purpurea ^dig. ped. (twenty-fourth day),.

Increased swelling in the feet, with severe pain in the bones of the same, but continue warm as they did at first (after two hours).

feet very sore and painful, in the afternoon (first day).

feet not quite so bad, a dull pain in the joints (third day). The puffiness of the toes and feet, and the gouty pain in the great toes continued for several weeks, rendering it quite difficult and painful to walk or stand,.

During the first five days the patient had a moderate but regular elevation of temperature.

in the evening. in the morning it was nearly normal.

or even lower. with a relatively given frequency of the pulse (from 104 to 120). On the sixth day there was a constant fever of the remittent type.

continuing and reaching its highest point in the evening of the eighth day.

when the pulse was exceedingly small and soft. After the eighth day the temperature fell. On the thirteenth day there began a more regular intermittent form of fever.

with a decided shaking chill.

on the thirteenth day a shaking chill at 8.15 A.M.

lasting twenty minutes.

with a temperature of 41.8° C.

pulse 140. the temperature fell.

during the copious perspiration.

to 40.1°. in the evening rising to 41°. On the fourteenth day chill in the morning.

temperature 40.6°. temperature in the evening.

during the copious perspiration.

37.9°. On the seventeenth day a third chill.

in the evening. lasting twenty-five minutes. On the eighteenth day the fourth chill.

beginning in the morning.

lasting half an hour. temperature 41°.

falling in the evening to 38.8°. The next morning 38.2°.

after which there was almost a regular diminution of temperature.

without a regular type till the twenty-eighth day. There was.

on the average. the normal temperature until the thirty-second day.

when there was a fifth chill.

beginning in the morning.

with sweat in the evening.

also a chill on the thirty-sixth day.

in the morning. after which there followed a remarkably low temperature for a long time.

36.4°. and even 36.1°.

in the morning. and 36.8° to 36.9° in the evening.

then the patient had no chill nor fever for nearly for weeks. On the sixty-third day there was a seventh chill.

lasting twenty minutes.

temperature 37.4°. On the sixty-fifth day a chill.

temperature 38.3°. Seventy-first day a chill. Seventy-ninth day two chills.

the first at 8 A.M. the second about 10 A.M.

temperature fell in the afternoon to 36.7°.

next morning 36.2°. after this there were three additional chills.

during which the temperature did not rise above 38°. On the one hundred and twenty-ninth day the sixteenth chill.

temperature 38.8°. On the one hundred and thirtieth day the seventeenth chill. On the one hundred and forty-third.

one hundred and forty-fourth.

one hundred and forty-sixth.

and one hundred and forty-ninth days.

chills. after which there was no chill for more than three weeks,.

The affection of the bone is difficult to characterize.

it is not a simple caries, nor is it a simple necrosis.

the soft parts detach themselves from the bone to a large extent, and leave below a bony, gray, rough, but solid surface, and a gray fetid suppuration exhales.

after an uncertain period this separates, without any appearance of new bone being formed,.

Vomiting of nearly pure blood (fifth day). Vomiting, or rather regurgitation, without effort, of nearly pure blood, with very profuse epistaxis, oozing of blood from both ears.

the blood of these haemorrhages was very fluid and difficult to coagulate (twenty-first day). The next day the patient raised a little blood from the throat.

with these haemorrhages nervous symptoms returned, pain and numbness of the left arm, and afterwards of other extremities, pain in the region of the throat, stricture of the throat, and sensation of suffocation.

as the haemorrhages diminished, the skin became more deeply jaundiced. After more than a month the haemorrhage returned.

the stools contained a large quantity of pure blood.

there was epistaxis, regurgitations of blood in the throat, and haematuria, followed by great prostration, almost complete loss of voice, very feeble pulse, cold extremities, bruit de souffle with the first sound of the heart.

these haemorrhages gradually diminished, and ceased entirely after about a week. On the fiftieth day there were renewed haemorrhages from the throat, nose, anus, bladder, with pain in the right iliac fossa and in the thigh of the same side, with weakness of the limbs, so that the patient was unable to walk.

these renewed haemorrhages lasted several days, except a little blood with the urine, which continued for five days.

the patient was very much less prostrated by this haemorrhage than by the preceding. After seventy days blood reappeared in the urine.

the patient stated that she had lost as much as two glassfuls of nearly pure blood with the urine. On the next day there was profuse vomiting of blood.

the urine continued to be colored by blood for nine days. This patient, even after three months, suffered from weakness, the bruit de souffle in the praecordial region persisted, and though she was pregnant she did not miscarry.

the blood seemed to be completely restored, and her vital forces re-established.

she passed through her pregnancy, and was delivered without accident, but afterwards she was seized with inveterate diarrhoea, not bloody, which could not be stopped, and which terminated her life eight months after the poisoning,.

Feeling of weakness in the back, as if crushed, followed by weakness of the extremities and trembling after the least exertion. When admitted into the hospital, both the lower limbs were so feeble that the patient was only able to stagger for a moment or two with a trembling step.

when attempting to stand, his knees shook and gave way.

his hands and arms trembled when he attempted to use them.

so feeble that the patient was neither able to raise himself nor to remain in a sitting posture.

all efforts to help him were fruitless.

he continued to live three or four years longer, although the paralysis went on increasingly,.

Dressed myself with difficulty and went to my office.

I was as weak as one suffering from a long and severe fit of illness.

I then took eight pellets of Camphora ^Camphor, this being the first I had taken, the attack being so sudden and prostrating I was not able to help myself to medicine or call assistance (after thirty-five hours),.

Sour bilious vomiting, towards evening, preceded by violent vertigo, with nausea.

together with icy coldness and complete numbness of the hands, afterwards of the feet, with cold sweat on the forehead.

after repeated vomiting, two natural stools within two hours.

the nausea and cold sensation disappeared only after lying down (the twenty-sixth day),.

Violent gastro-enteritis.

the patient was lying cold and pale, like a dying person, unconscious, sunk down in bed, skin covered with cold clammy sweat, here and there a waxy-yellow color, the face almost leaden-gray, with dark rings around the eyes, mouth closed, lips blue, respiration retarded, short, difficult.

heart's impulse weak, intermittent, radial pulse small, slow, irregular, now and then intermittent.

epigastric region and abdomen distended, exceedingly sensitive to the slightest touch.

the patient could scarcely bear the weight of her nightdress, so that she made constant automatic efforts to free herself from all clothing,.

Sensitiveness of the epigastric region, aggravated by pressure.

at the same time the pulse became very rapid. 128, the temperature rose to 38.5°.

during the following night tormented by violent thirst, without sleep, small pulse, 96, temperature 38.8°, with headache.

the icterus of the body was very intense, even the face was slightly yellow.

tongue dry, yellowish.

fetid odor from the mouth.

epigastric region distended, very sensitive to pressure.

palpitation beneath the right ribs moderately painful.

Griping constrictive pain in the epigastric region, which was sensitive to pressure.

afterwards the pain increased and extended upward and downward, so that he was frequently obliged to bend forward, which, however, caused a pressive pain in the forehead, without vertigo or heat.

neither of these pains were affected by walking or by lying down, but were decidedly relieved by eating,.

The menses came on with less pain, were less profuse, and lasted only five days (the next period, previous to which she had taken no medicine, occurred sooner than expected, and was less painful than usual).

in a subsequent proving the menses came on almost entirely without pain, indeed almost unnoticed, but lasted only two days,.