Clinical Reports.

CASE REPORTS.

BY DR. HAZLE PADGETT, OF NASHVILLE, TENN.

CASE I. Syringomelia.-S. P., man, age 52. Strong, healthy, robust, and had no sickness during life prior to this time, when he noticed that objects did not feel natural and that he could not quite place his foot where he wanted to. At my examination I found a well nourished, healthy looking person with no disease of the cardio-circulatory apparatus. Gastro-intestinal and respiratory tracts normal, also kidneys and bladder. There was no change in optic nerve, retina, or blood vessels; acuity of vision and iris reflexes normal. There was a complete thermo-anesthesia with analgesia. Sticking of needles through the skin produced no sensation. Rubbing of the end of the finger over the ocular conjunctiva and cornea produced no sensation whatever. Inability to distinguish flavors; and chewing was simply mechanical, without knowing what was being masticated. The patellar reflex was increased with no spasticity. Ankle clonus present. Muscular atrophy was only very slight, and the anesthesia existed from the vertex to the soles. I saw the patient often, but he finally passed from my observation and died a few months afterward with pneumonia.

CASE II. Bradycardia.-A. M., male aet. 53, compositor on large city daily. Always thought himself perfectly healthy. One day while seated on high stool was seized with severe vertigo that caused him to slide off the chair to the floor. No nausea or vomiting. Applied for treatment and the physical examination revealed the following: A well nourished man with normal gastro-intestinal and respiratory tracts. Blood vessels, kidneys, and bladder normal. Optic nerve, retina, blood vessels, with iris reflexes normal. The neurologic examination was negative. Heart, pericardium, and all valves normal. The man had no discoverable habit of drug use. The pulse was so interesting

that once having felt it one could never forget giving the impression of some tidal wave power trying to burst through the bounds of some elastic confines, beating eighteen times to the minute. This was not one of an alternate pulse or skip, for the cardiac beat was the same. This condition was the only discoverable one found upon a most careful physical examination that revealed the absence of every disease. In the course of two weeks the rate gradually reached thirty-two, when the patient passed from under my observation feeling perfectly well.

CASE III. Thrombosis and Softening of Internal Capsule.In contrast to above I will relate the case of R. S., age 84, weight 220, and a giant in his makeup. No sickness prior to his complaining of a little gastric indigestion and constipation, with a feeling of numbness of the right side and a weakness of right hand. Urine normal, blood vessels soft. Respiratory tract normal. Optic nerve, retina, and blood vessels normal. Heart nor

mal; valves and pericardium normal with a pulse, when I first saw patient, of 42. The numbness and muscular weakness gradually increased till he had a profound hemiphlegic condition, with a pulse of 32, regular and very full. For some time mental condition clear, but gradually became duller and duller till profound unconsciousness, with a pulse still of 32. I made the diagnosis of thrombosis, with softening of internal capsule. Just a short time before death patient still had a pulse of 32. Post mortem confirmed my diagnosis.

Gastro

CASE IV. Perinephritic Abscess.- W. O., white, male, age 18, in perfect health, no sickness at any time in life, family history negative. He began to complain of a dull pain in left lumbar region. The pain was not reflected and no tenderness on pressure for several weeks. Spleen normal. Microscopical examination of urine normal. No tubercle bacilli or albumen. intestinal tract normal. At the end of two weeks he developed a little pain on pressure, but no enlargement of kidney. perature at this time was 100°. The pain and temperature gradually increased, and I made the diagnosis of a perinephritic abscess. At the time of the operation a quantity of pus was evacuated. Kidney normal and no change in urine at any time.

Tem

Pa

tient made a rapid recovery, and case interesting from the unknown cause of the inflammation.

CASE V. Athetosis from Local Traumatism.— B. L., male, age 49, perfect health, no constitutional taint, family history negative. Physical examination revealed no visceral disease. His neurologic functions are perfect with the exception of that I will relate. He received a very severe blow over the back of left hand, and in the language of the patient, "that put his entire hand dead asleep." This condition lasted for several days, when sensation began to return, and with the return of sensation developed a muscular disturbance that eventually resulted in a most typical athetosis just of the type seen in central lesions of the brain. The athetoid movements were so intense and painful that the patient seriously considered an amputation. There was nothing of this kind before the injury to the hand, and the relationship of the two are too significant to doubt, and yet it must be very rare for a peripheral injury to result in a typical local athetosis.

Selected Articles

OBSERVATIONS IN THE TREATMENT OF IRREGULAR MENSTRUATION.

BY A. W. SHIELDS, M. D., EATON, COLO.

IN prescribing a new and comparatively unknown remedy, the conscientious physician must work slowly and carefully along lines which are necessarily of a more or less experimental nature. In my own experience, I have always found it hard to desert an old, well-tried preparation and transfer my faith to one which, though highly recommended and endorsed by reputable physicians, is known to me only through such recommendations and endorsements. But in the case of Ergoapiol I feel differently; for, when I first encountered it, the mere name in some way ap

pealed to me as descriptive of a preparation or combination which I thought ought to prove efficient in the treatment of that class of cases for which it is recommended. I have in the latter part of my sixteen years' experience been a great believer in apiol as an emmenagogue, and especially in those painful cases which occur in young girls, who have just reached the menstrual period, and in whom functional inactivity is the chief cause which retards. the normal process of nature.

But, after many successes and a still larger number of failures, due, I believe, to the unreliability or instability of the drug, I resorted to viburnum and the various compounds containing it. My clinical experience with it was fairly satisfactory, but I was still on the lookout for "something better," when it was my good fortune to run across Ergoapiol (Smith). This was only about six months ago, when it was recommended to me, while in consultation with a physician in my locality, and the results were more than satisfactory.

Still, as often happens, through force of habit, I believe, I forgot it for the time being, and wandered back to my old routine, and it was not until my attention had once more been drawn to Ergoapiol by the receipt of a sample package that I once more prescribed it. I was just then wrestling with a case of obstinate amenorrhea, and it was on this case that I expended ten of the capsules, giving one every three or four hours. These proved sufficient to give relief at that particular time, though, of course, I have followed up the same line of treatment ever since with excellent results.

It was then that I began to consider the matter seriously, for I had tried every one of the so-called standard preparations without feeling any certainty as to results; but now, as the result of many trials, and but few failures, Ergoapiol is one of the trusted remedies in my armamentarium, and is likely to remain in that class as long as it is obtainable.

I have now had sufficient experience with it in the treatment of cases of uterine and menstrual disorders so common in the every-day practice of the general practitioner, that I have no hesitation in recommending its use.

In this introductory note, I can only say further that the cases quoted below, as having been successfully treated with this remedy, are only such as are met with in every-day practice, and as I regard this class of most practical importance to the general practitioner, I shall give but little attention to those that are only rarely encountered.

CASE I. Mrs. J. N. I first saw this case in April of this year, and on inquiry, discovered a history of two abortions, both in the third month of pregnancy. A slight leuchorrhea has resulted. from the first mishap, but after the second one, this became aggravated and was accompanied by severe pain in the region of the ovaries and an almost continuous backache, both of which were very markedly increased just previous to and during menstruation. Curettement had been performed twice, but without much improvement, and the menstrual periods began to be irregular, both as to time and quantity of flow.

At first I applied the usual forms of medication, internally and by douche, but while a slight improvement occurred, it was not until I put her on Ergoapiol (Smith) as her exclusive internal treatment that I obtained any marked results.

The May period was a week late and somewhat scanty, but those of June and July have come on time, and the amount of flow almost normal; the pain in back and sides is present in a slight degree, and then only during the first two days of menstruation. The color of the discharge is improved (due perhaps to the later addition of an iron tonic to the treatment), and in a general way, she is gaining rapidly. In this case I have never used more than four capsules daily, and that number only for a few days previous to the establishment of the flow and for two days thereafter.

CASE II.— Mrs. A. N. S., about 30 years of age, consulted me in regard to her condition about three months ago. She gave a history of a rather severe laceration of the cervix, the result of her first confinement, five years ago, but her previous record disclosed the fact also that her menstruation had always been difficult and very painful. After the laceration occurred, the periods. became irregular; the flow sometimes being profuse and some