374       DEATH  FROM  TWO-FIFTHS  GRAIN  OF  ELATERIUM. 
would  be  to  give  anodynes  to  relieve  her  of  pain,  and  prolong 
life  by  the  administration  of  diuretics,  hydragogue  cathartics, 
etc.  She  was  very  feeble — decubitus  on  left  side.  Her  skin 
was  cool  and  dry ;  pulse  100,  small,  quick,  and  feeble  ;  breath- 
ing slow  and  labored ;  tongue  rather  dry,  and  covered  with  a 
yellowish  coat ;  considerable  thirst ;  appetite  gone,  and  stomach 
so  irritable  that  almost  everything  she  swallowed  was  ejected ; 
bowels  not  moved  for  two  days,  and  then  with  castor  oil.  I  ad- 
ministered to  her  two-fifths  of  a  grain  of  elaterium,  and  took  my 
departure.  At  four  o'clock  in  the  afternoon  I  was  summoned 
to  her  bedside.  I  was  informed  that  a  few  minutes  after  she  had 
taken  the  medicine  she  commenced  purging,  and  had  had  a  dozen 
or  more  watery  stools  before  my  arrival.  She  was  greatly  pros- 
trated, could  only  speak  in  a  whisper,  and  as  I  approached  her 
she  took  me  by  the  hand  and  said,  "  Doctor,  I  fear  you  have 
killed  me."  Her. pulse  was  scarcely  perceptible.  I  commenced 
at  once  with  the  administration  of  stimulants,  and  small  doses 
of  opium,  combined  with  the  acetate  of  lead.  Her  bowels  were 
moved  every  five  or  ten  minutes — stools  watery.  The  purging 
was  not  fully  arrested  until  10  o'clock,  P.  M.  I  left  at  midnight. 
She  never  rallied.  Death  took  place  at  five  o'clock,  P.  M., 
March  25th. 
I  report  this  case  to  warn  the  practitioner  against  commencing 
with  the  dose  of  elaterium  recommended  in  the  U.  S.  Dispensa- 
tory, 12th  edition,  page  364 :  "  The  full  dose  of  commercial 
elaterium  is  often  from  one  to  two  grains ;  but,  as  in  this  quan- 
tity it  often  vomits  if  of  good  quality,  the  best  plan  is  to  give  it 
in  the  dose  of  a  quarter  or  half  of  a  grain,  repeated  every  hour 
until  it  operates."  I  learned,  on  my  second  visit  to  this  patient, 
that  a  tablespoonful  of  castor  oil  usually  operated  within  five 
minutes  after  administration,  and  that  the  sulphate  of  magnesia, 
in  an  ordinary  dose,  purged  her  almost  as  severely  as  the  elate- 
rium, and  produced  similar  dejections.  It  would  be  well  for  the 
practitioner  to  inquire  into  the  idiosyncrasies  of  his  patient  be- 
fore administering  remedies,  which  I  regret  I  neglected  to  do  in 
this  case. —  Western  Journal  of  Medicine,  May,  1868. 
