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Related post: Two weeks after the operation the patient left the hos-
pital, the spasm somewhat improved, but certainly not
cured. Dr. Mills had had a nutnber of these cases, Tritace 5mg and
some years ago wrote a paper on the subject. Two of the
•cases reported recovereid largely under the use of the
.actual cautery.
One of the questions which arise in a consideration of
these cases is whether some of them are cortical in origin,
•due to lesion of the centres for conjugate deviation of the
head. He believed that such a view could be entertained,
but probably not for such a case as he had referred to,
or for such as Dr. Dercum had reported. The persist-
ence of the spasm Tritace 10mg and its tonic character in most cases
.are against the supposition of cortical lesion.
Dr. Dercum said that the point is. How are we to
•differentiate between the spinal and cerebral cases ? If
conjugate deviation of the eyes occurred with the move-
ments, there would be reason for supposing that there
was a cortical lesion. It is, however, rare to have this
.association. It was not present in his case.
As an indication of the utter hopelessness of operations
on the muscles and nerves, it would be well to bear in mind
that the movement is one in which a large number of
muscles are involved. There are nine muscles, in addi-
tion to the sterno-mastoid and trapezius, which are called
into play in the act of turning the head and neck, besides
two others which act as rotators Buy Tritace at times.
Dr. J. H. Lloyd reported the following
■which presented such a characteristic cUnical picture of
a disease which is not common, that he was led to report
it in spite of the fact that the pathological study was
Margaret M., aged about thirty-five years, was admitted
into the nervous ward of the Philadelphia Hospital in
May, 1888. She had a family history of phthisis on the
father's side. The patient had never been very strong,
but had had no sickness Tritace Tablets except the ordinary diseases of
childhood. She was married at seventeen and had had
four children, the last labor occurring five years before
admission. She denied syphilis, and presented no le»ons
of it. She also denied excessive drinking, but an inquiry
of her fiiends revealed the habitual use of alcoholics,
sometimes in excess, from her childhood. Four weeks
before her admission she awoke one morning to find both
her feet paretic. For one week preceding this she had
had severe pains in both legs.
On examination the following £acts were noticed : The
patient was anaemic, very despondent in expression, and
rather emaciated. She presented double wrist-drop, more
marked on the left side, with wasting of the arm muscles,
also more marked on the left side. There was paralysis,
quite complete, of the anterior leg muscles on both sides,
with consequent foot-drop, and wasting. The extensor
muscles of the left forearm contracted sluggishly to the
faradic and galvanic currents, and showed the serial re-
actions of degeneration : A. C. C. > C. C. C. The ex-
tensors of the feet (muscles especially supplied by the
anterior tibial nerves) also reacted sluggishly and showed
reactions of degeneration to galvanism. The patellar
reflexes were abolished. There were small areas of
anaesthesia over the legs and feet. She would believe
that a pin was touching the foot when it was touching the
leg, and confused the legs. The sensory symptoms were
very significant. She suffered from severe burning ptain
on the soles of the feet, and later in the palms of the
hands, causing her to complain. The nerve trunks were
acutely sensitive. Pressure over the popliteal and pero-
neal nerves of the main trunks of the arm wa^ productive
of most severe pain. The peroneal nerves especially
were sore. The muscles of the leg were extremely sen-
sitive to touch, and those of the calves especially were
very tender.
The lungs were normal. The heart presented a &int
systolic murmur at the apex ; not always heard, and pos-
sibly anaemic (?). The pulse was small in volume, very
rapid, constantly ranging from 122 to 140, and easily
compressible. Her temperature was constantly afebrile,
except on two days, when it rose to ioiJ°. For more
than half of the time she was under observation (about
four weeks) the temperature was rather subnormal, fall-
ing as low once as 96!°. It was taken in the axilla.
The loss of appetite was complete, and the tongue was
furred. She slept poorly and her mind wandered. At
times she was in a well-marked delusional condition, and
was restless always and complaining.
The patient, as she layjn bed, with the wrist-drop and
foot-drop, bore a striking resemblance to the picture
which Cowers has, in his recent work, of a patient with
this disease.
The indications for treatment were especially to relieve
pain and sustain the power of a fuling heart. It was
soon evident that the patient would not respond to treat-
ment. The heart, in particular, never improved in its
action. Digitalis was given in the form of tincture, in-
fusion, powder, and poultices of the leaves, but the pulse
remained rapid and feeble. A full liquid diet was ad-
ministered in oft-repeated quantities, but alcohol was not
given until toward the last, and then in small doses. It
is not necessar)' to detail all the treatment. Partial re-
lief was obtained from the burning pains in the soles of
the feet by lotions of carbolized water ; and small can-
tharidal blisters were used with some benefit over some
Digitized by
November 17, 1888.]

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