for six days, with regularity. She was then deprived of the opportunity of obtaining a fresh supply of her medicine; but she informs me, now nearly three months after treatment, that although not cured, the attacks have been much less frequent, and that whereas they formerly utterly prostrated her, she now finds them so light as not to interfere with the performance of her ordinary duties.

Case 28. This patient had had cervico-occipital neuralgia of medium severity seven weeks. For four days she took five grains of sodium hypophosphite in water every three hours. She then thought herself a trifle better, and the dose was increased to ten grains. She continued this quantity for six days, and was then of opinion that she had derived no benefit from the treatment. She was therefore put upon F. No. 3, from which she soon received much relief. She was not a persevering patient, however, and could not be persuaded to continue to take medicine after the pain was in a measure removed.

The foregoing are the only three cases in this series not entirely successful, and each presents circumstances which, on the part of the remedy used, may be considered extenuating. I will now detail a few of the most noteworthy cases which were treated with phosphorus in other forms, first of all describing the other two cases which were in the first place submitted to the action of hypophosphite of soda.

Case 29 had suffered from severe right trigeminal neuralgia seven days, during which there had been "no" sleep. To take 7 grains of hypophosphite of soda every three hours. There was no improvement at all in three days, when the dose was increased to fifteen grains. As in five more days there was still no improvement, and the pain was of the severer class, the experiment was not pursued; F. No. 2 was substituted for the hypophosphite, and she recovered in four days from that time.

Case 30 had had left trigeminal neuralgia in the slighter degree five weeks; she had occasionally been deprived of sleep by it, but as a rule got worse towards and during the evening, recovered somewhat during the night, and woke with an accession of pain lasting until ten o'clock A.M. To take half a drachm of hypophosphite of soda every three hours. There was

no improvement in sixty hours; she was therefore directed to take F. No. 2, on which she speedily recovered.

Case 25.-An old gentleman aged sixty-nine. He had been suffering for six weeks from ague, chronic bronchitis, and oldstanding stricture. During three weeks he had had severe cranial neuralgia, which for five days had been excruciating, and had deprived him of sleep. In consequence he was now in a fair way to sink under his other disorders. He was put upon F. No. 3 (gr. 4 tis. h.) After the fourth dose he had five hours' sleep, and he was entirely recovered in five days. He is the father of Case 13.

Case 27 had suffered from general cranial neuralgia (medium) for nine days. She was cured in twelve hours with F. No. 3, the mixture having been made two months previously and being the remains of that given to Case 25. (See remarks above on the stability of this prescription.)

Case 31 was suffering from her third attack. On each of two previous occasions general cranial neuralgia had followed miscarriage, attended by flooding and great exhaustion. Both trigeminal and the cervico-occipital nerves were now affected either simultaneously or in turn (severe); the pain had been constant with slight diurnal alleviations, and had entirely prevented sleep during the last few nights. She was in a very debilitated condition, dyspeptic, and in the first stage of consumption, of which disease her mother and sister had died. She was directed to take F. No. 3, and in eighteen hours she was very much relieved. In four days she described herself as well, although she did not lose all symptoms of nerve disorder for four days more. Under other treatment she recovered strength to a great extent, and has had no return of neuralgia (ten weeks).

Case 33 and 34 was treated for an attack of neuralgia (medium) in April last, with F. No. 2, when he recovered in twenty hours. He returned in three months, and was put upon F. No. 3; he recovered in thirty hours. This patient had been liable for some years to such repeated attacks. He had not therefore gained any immunity from his disease by his treatment in April; on the other hand, the rapidity of cure on that occasion has not laid him open to a speedier return of it than was customary to him.

Case 40, a young lady, aged fifteen. Menstruation had commenced early, and she had been growing very rapidly during the past year. She had also shown during this period a want of control over the emotions, occasionally culminating in a hysteric paroxysm; and these attacks, which did not correspond with a menstrual period, were always preceded or followed by neuralgic headache and left trigeminal neuralgia (slight.) She presented the full drooping eyelid which accompanies such a condition of health, and was now suffering from all the above symptoms. She was quite cured of' her neuralgia in forty-eight hours, but continued to take F. No. 3 for a fortnight. At the end of this time she was much improved in general health, and her spirits were distinctly more equable and controllable.

Case 41. This patient has borne six children, and, as a rule, has suffered very severely during each pregnancy; but, in addition, the slightest provocation has been sufficient to excite an attack at any other time. She had now been ill more than three weeks, and at the commencement of treatment was suffering in the most severe manner. Notwithstanding the acuteness of the attack, and the frequency with which the disease has been in the habit of recurring, this patient was entirely cured in forty-eight hours, nor has she had (during one month) any return of it, except such occasional transient pains as she did not mention but on very strict inquiry.

GENERAL REMARKS.-In the number of this journal for August, Dr. Anstie records a case in which a few doses of onethirtieth of a grain of phosphorus appear to have been followed by symptoms of poisoning. On reference to works on poisons, cases may be found in which one-eighth of a grain, one grain taken in divided doses and spread over four days, one grain and a half, and larger quantities, have proved fatal. Usually some hours elapse before well-marked symptoms occur, and several days-from five to seventeen-before the fatal result. The general symptoms are those of irritation of the intestinal tract-vomiting, purging, burning pain, and great debility; but any or all of these, except the last, may be absent, or they may all intermit, to reappear after a few hours of relief. In case of recovery they are followed by long-continued de

bility. The special symptoms are the occurrence of collapse, or extreme weakness, without any other symptom; purpuric hæmorrhages (and from mucous membranes); jaundice; and muscular irritability or convulsions, terminating in death by coma. Or death may be quite sudden from syncope.

Post Mortem-there may, or may not, be found evidence of inflammation of the intestinal tract and perforations of the intestines: ecchymoses on the surface of various organs; softening of the muscular structures; fatty degenerations, and liquefaction of the red corpuscles of the blood.

The only cases in which symptoms approaching those of poisoning have come under my observation are Nos. 7, 35, and one other not neuralgic. In Case 7, six doses, each of onetwelfth of a grain of pure phosphorus dissolved in oil, and taken during twenty hours, were followed by violent vomiting and purging, alarming collapse, and long-continued debility. There was no hæmorrhage, however, nor any burning pain; while diarrhoea (which was present) seems to be one of the least constant symptoms of this form of poisoning.1 Case 35, after six doses of two-thirds of a grain each of zinc phosphide, vomited two or three times, but took other two doses, which continued the symptom. Here again cross-examination failed to elicit any direct evidence of poisoning-no pain, hæmorrhage, sudden weakness, or purging. Lastly, the third patient, not neuralgic, took two-thirds of a grain of zinc phosphide and vomited violently; but persevered with the remedy, and took other two doses. These seemed to continue but not to aggravate the effect of the first dose. She then intermitted one day, and recovered; but, on resuming the medicine, again became sick after one more dose of it. In this case too I could not discover any special symptom of poisoning.2

The occasional existence of such a remarkable susceptibility as Dr. Anstie's case shows to be possible, should guard our administration of this drug with a caution which I confess my experience would not have led me to think necessary. That many more than the forty-one cases here recorded (in not one of which was

1 For note of this case, vide Practitioner, July 1873, pp. 22, 23.

2 It should be observed, however, that the phosphide was given in both these cases in the form of pill.