peated a number of times that he would hereafter sleep throughout the night without any sleep-talking or screaming. Only this one treatment was given, but six weeks thereafter the father informed me that there had been no return of the disorder, and that the child slept quietly every night. Case V. SCIATIC NEURALGIA; NEURASTHENIA. A gentleman aged 46,of fine development and well-nourished but of neurasthenic diathesis, has been a sufferer at intervals during the past twenty-five years with a lameness and pain in his right leg, extending from the hip to the foot. The trouble originated from an injury caused by a heavy fall on a slippery stone pavement in the spring of 1873. The hip was badly bruised and for upwards of eight months the patient was unable to walk without the aid of crutches. Then followed a few months wherein his leg seemed to have perfectly recovered, but within fourteen months from the original injury another fall put him on crutches for two months longer. Then followed an interval of three years of seeming perfect restoration when the patient met with another accident, being thrown from a wagon, which kept him strictly confined to crutches for nine months. During these years of variable suffering the gentleman has been under skilled treatment and among other things, submitted to a thorough application of electricity, but which proved disastrous in its results. In August of the current year, the patient had the most severe and seemingly hopeless break-down that he had ever had. It was the result of a fivemile walk he had taken near The Hague in Holland. He broke down so completely that for about two weeks he was confined to his hotel chamber, and severe and protracted pain followed every attempt to walk, even three or four steps without crutches. About the first of October the patient was in my office, and was undergoing his usual experience of pain after having made some slight sallies afoot, unaided with crutches. I gave him his first treatment by suggestion, he having gone into a moderate degree of lethargy. When he awakened, the pain was absolutely gone. For one-half hour he tried various devices, such as walking and sitting in positions that had never failed to aggravate the pain, but he could not prevail upon it to return. That night he slept without pain, something he had not done since his last mishap. The following morning he walked about out-of-doors for nearly half an hour-the crutches having been relegated to the custody of a closet, at which time he thought that there were slight symptoms of returning pain. A second treatment followed immediately, with the entire removal of every trace of pain. During that day he walked, unaided, about half a mile, with a very slight premonition of pain at bed-time. A third treatment was then given with absolute relief. From that time on, the progress of the patient was phenomenal. The crutches were not again used, and from day to day he made rapid strides toward the perfect use of the limb. There would be occasional slight remissions of pain, but so slight as to in no way inhibit the constant increased use of the leg, and these gradually vanished. Within about a week after the third treatment, the patient was walking two miles a day in the woods, and by the third week he was walking six miles a day without undue weariness. A fourth and last treatment was then given. Especial interest centers in the case of this gentleman, in view of the long years of persistent suffering and limited usefulness of the limb. His is one of a class of cases which above all others are proving to be most particularly amenable to hypnotic suggestion. Case VI. HYSTERICAL CONTRACTURE. A married woman of thirty-five, suffering for twelve years with a contracture of the left wrist and an entire inability to flex the fingers of the hand. She has from time to time, suffered with hysterical paroxysms of a mild type. The hand was of very little use to the patient, owing to its sensitiveness and the inability to flex the fingers and grasp any object. She would try to do the family washing and in order to wring out the clothes would twist the garment with her right hand and her teeth. The idea of any farther possibility of use of this hand had long since been abandoned. The first treatment enabled her to incompletely flex the fingers, restored sensation to the numb finger, and removed the pain from the entire hand so that I could handle it freely. After the third treatment the fingers could be flexed sufficiently so that she could make a very passable fist, could grasp any object firmly, and began to lift flat-irons from the stove and alternate with the well hand at ironing. Treatment is being continued at the present writing as the wrist is still somewhat flexed, but in all other respects the patient has recovered the use of her hand, knits with it, and uses it in all her work. The cold and abnormal feeling of the hand has wholly disappeared. This woman has also benefited greatly, through suggestion, with respect to other disturbances from which she suffered, amongst which were fear of the dark, irritability of temper and transient aberration of mind. Case VII. CHRONIC ARTICULAR RHEUMATISM. This man had been ill for ten weeks, having begun with an attack of rheumatic fever which left him with a severely swollen and painful knee, ankle, and wrist. There was so much pain in the sacrum and lumbar vertebræ that he could only rise from his chair after a number of attempts and forward lunges and with the aid of his hands. He could not turn over in bed. After treatment the patient arose from the couch unaided, and easily walked across the room erect. That night he enjoyed the luxury of being able to turn over in bed at will. Twenty-four hours after the first treatment the circumference of the knee had diminished, by actual measurement, one inch, and this joint was freely movable and gave no pain whatever. The swelling in the the other joints also began to diminish, but less rapidly. But the pain element had practically vanished from the first and it was due to this fact, making the increased use of the limbs possible, that the increasing circulation rapidly removed the effusion about the limbs. After five treatments, the patient walked to my office, distant one-half mile from his house, with ease. The knee-joint was then normal and the swelling of the other two joints nearly so, and the patient felt practically as well as before the onset of his illness. The effects of suggestion as compared with those obtained from drugs, are of much greater permanency and seem to possess the quality of projecting themselves sometimes for years into the future. If they can be renewed from time to time, they go into effect much more easily, the way seemingly being left open. The explanation of this greater impressionability probably lies in the fact that the impression produced is a purely psychic one the very center itself that controls the function being reached, and a new shape given to the impulse it transmits-whilst the results produced by drugs may be said to be more peripheral in their effects, producing the resultant change in a round-about way. In view of the fearful preponderance of nervous diseases, the complexity of the relations between disorders of the body and coexisting mental states, developing the more as our civilization meets the results of present social conditions, none can deny the urgency of the needs that demand of the physician the bringing of every rational resource to his aid. May we not hopefully assume, in the light of our growing knowledge upon the subject, that in hypnotic suggestion there lie as yet unsounded depths and untouched heights of helpfulness? Senator Caffery, of Louisiana, on March 22 made an argument before the Senate for the national quarantine bill. In the course of his argument Mr. Caffery said that he wanted the whole quarantine power in the hands of the United States government, the only authority which could make a quarantine effective, and he added that he was as staunch a state's rights. advocate as any man. Said he: "We want uniformity of action in this matter of quarantine regulation, backed by such financial and legal power as will enable the authorities to cope with the dread diseases which are likely to ravage the country." If the state or municipal power were sufficient, he said, he would not insist that a national authority should be paramount, but it was evident that state and municipal authorities were unable properly to cope with epidemics. In conclusion, after speaking for nearly three hours, Mr. Caffery said that state quarantines were utterly inefficient, utterly powerless against an epidemic of yellow fever. Under this inefficient state quarantine system he had known the most brutal and savage acts to be performed. He had himself, he said, been accosted by petty quarantine officers with shotguns. For the exercise of that kind of state police power he had no use and no regard. Cleveland Journal of Medicine THE OFFICIAL JOURNAL OF THE CLEVELAND MEDICAL SOCIETY AND OF THE UNION MEDICAL ASSOCIATION OF NORTHEASTERN OHIO PUBLISHED THE TENTH OF EVERY MONTH AT 512-515 NEW ENGLAND BUILDING, 129-131 EUCLID AVENUE, CLEVELAND One Dollar a Year in Advance Single Copies Ten Cents EDITORIAL H DIET IN TYPHOID ARE, in an editorial in the Therapeutic Gazette for March, discusses the question of diet in typhoid, and points out the fact that the profession is not standing as hard and fast for a milk diet as formerly. He quotes Shattuck of Boston for figures from the Massachusetts General Hospital to the effect that 233 cases of typhoid. during seven years were treated on a strict milk diet, with a mortality of 10 percent, while in 147 cases treated during five years on a more liberal diet the mortality was 8.1 percent. He agrees with the same author that it is the patient we should treat and not the disease. Hare says well that soups, broths and beef-juices are not safe articles in this disease, because they furnish too good a culturemedium for bacteria. Eggs, however, can in most cases be used liberally and with hope of preventing some of the terrible tissue waste of this disease, with its consequent loss of strength and prolonged convalescence. The eggs may be administered raw, or, better, boiled just long enough to take away the raw taste, but not to coagulate the albumen. They can then be put in a cup and fed by spoon or by drinking, if the patient is able. Milk in all its preparations, the prepared foods, light crackers, barley-water, toastwater, and especially soft cup-custards, may be judiciously used. This certainly seems a very rational program, but must, of course, always be guided by the condition and type of the case. It would certainly seem, however, that such amount of light food as can be borne without detriment should be given to sustain tissue integrity and shorten the convalescence as well as maintain the strength for meeting serious phases of the disease. The number of competent men who are today with discretion giving their typhoid cases a more liberal diet with excellent results shows clearly that it can be safely done and the patient receive much benefit. PNEUMONIA W more or re HILE a large percentage of primary pneumonias presents a less classic symptomatology, it is well to member that cases are not infrequently observed in which the relative intensity of the symptoms is so disproportionate, especially as regards the nervous system, as to readily distract attention from the point of lesion. Such cases, according to Osler, (Maryland Medical Journal, March 12,) may be conveniently arranged under three headings—the "cerebral pneumonias of children," the acutely maniacal, and those with toxic features simulating uremia. Characteristic of the first are convulsions, high fever, headache, delirium, great irritability, muscular tremor and even retraction of the head and neck. Such cases are often diagnosed as meningitis, and the local affection entirely overlooked. When acute mania occurs as an initial symptom, a similar mistake is possible. An instance is cited of a young man who, while on a train, developed the delusion that he was being followed. His conduct was such that he was put off as a lunatic and taken by the police to a hospital, where he attempted suicide whilst delirious. He had no cough and but little fever, and it was only several days later that the pneumonia was recognized. In other instances the acute onset of violent delirium without obvious implication of the lung may readily prove deceptive. The importance of a careful examination of the chest in all such cases cannot be too strongly emphasized. In the last class the writer places those in which a profound toxemia tends to mask the true nature of the affection. Chill, pain and cough may be absent, the fever slight, and respiration but little affected. The patient rapidly grows dull and heavy and in a few days passes into a low, muttering delirium. "In many of these cases," concludes the writer, "the most characteristic symptoms of the disease may be absent, particularly the cough and rusty expectoration. In fact, certain of them offer a striking contrast to the cases I was lately speaking of, in which all the symptoms of the disease were present-the cough, rusty expectoration, leucocytosis, fever and shortness of breath-without physical signs; whereas, in the type of case under consideration, all the characteristic symptoms are lacking, but the physical signs, if you can get at them, are well marked." |