92 THOMPSON YATES AND JOHNSTON LABORATORIES REPORT 
occasion eight times). There was no tenderness or pain, save headache, and no 
nausea or loathing of food. On the bad days an attempt at any exertion, even to 
read a letter, was certain to precipitate an attack of vomiting. About February 14 
there was vomiting, once or twice, on alternate days. Took Liquor Arsenicalis, two 
to six drops three times a day.' 
March 10. Stopped arsenic ; left her station for a change. 
March 16. Headache and vomiting. 
March 17. Severe vomiting, bile-stained vomitus. 
March 18-20. Well. 
March 22. Vomiting and headache, next day emesis more severe ; vomitus 
bile-stained. 
March 24. Fairly well. 
Match 25. Severe headache, vomiting, fever (maximum i04 - 4°F.) The fever 
gradually lessened during the two following days, and from March 29 to April 12 
patient was ' quite well.' 
Quinine was given during this fever, but was, probably, never retained, since 
the ingestion of anything, liquid or solid, provoked emesis. 
Physical examination. — April 15, 1904. General condition : Well-made woman ; 
height, 5 feet 6 inches ; weight, 126 lbs. ; rather anaemic appearance; complains 
only of shortness of breath and of becoming easily fatigued. 
Skin : No erythemata ; no distinct oedemas, although the skin of legs has a 
distinctly doughy feel ; on scratching skin capillaries contract. 
Lymphatic glands : Slightly enlarged, palpable in axillae and neck. 
Circulatory system : Slight venous pulsation in neck ; slight epigastric pulsation. 
Heart : Apex beat normal in position ; cardiac dulness normal ; no thrill over 
heart or in neck ; sounds, a slight blowing systolic murmur limited to apex area, the 
aortic and pulmonary second sounds are rather loud ; no venous hum in neck. 
Pulse : Frequent (96), tension medium, regular in time and force, artery 
normal. 
Respiratory system : Nothing abnormal subjectively or objectively. 
Digestive system : Appetite good ; bowels fairly regular, occasional slight consti- 
pation ; tongue clean. 
Liver : Dulness normal, no tenderness on pressure. 
Spleen : Not enlarged nor tender. 
Nervous system : No headache or pain ; sensation to pain acute ; sensation to 
touch, heat, cold, and distance between pin points perfect; there were distinct localized 
hyperaesthetic areas on different parts of the body, under right nipple, at apex of 
heart and on shins, slightest pressure causes acute pain. Superficial reflexes normal ; 
knee jerks just obtainable. Mental condition normal. 
Eyes : Pupils react to accommodation and light ; both discs definitely congested 
(left more than right). 
