Page images
PDF
EPUB
[ocr errors]

such ways.

when the physician made bis reputation ing themselves with their profession yet, as both in attainments and in specious appear- a general rule, erery physician owes it to ances by his attention to private practice. himself and his patients to derive the benefits Escepting special lines of medical research, of the experience and study of others and, in notably, insanity,deaf-mutism, etc., and prob. turn, he owes to his profession the very mod. lems in which a rapid examination of a large est financial and the moral support of affili. number of cases is desired the greater intelli. ating with his fellows and imparting such gence, command of facilities and average original observations as he may make. longer period of observation of private pa- Under present conditions, he should at least tients render them superior material for med. join the formal, county or euqivalent componical study. Then, too, in an economic sense, ent of the state and national association, and including not only the narrow financial wel. should be guided by special interests, amount fare cf the profession, but that of the com- of leisure and other circumstances, as to munity at large, clinical study, has its greatest other membersbip. Regarding other societies, value as applied to a higher stratum of so. it is well tc choose according to personal ciety than usually seeks dispensaries and ability and tastes. There is a prevalent and hospital wards.

justifiable prejudice against active political A general principle that applies to didactic work by a phyiscian, certainly if undertaken and hospital and dispensary positions as well from interested motives. On the other band, as to nearly every other "side line" in med. there is every reason why a doctor should be icine, is that, unless they pay for the time known as a good citizeu. The writer's es. directly or in opportunities for genuine study, perience has been that the acquaintance made they are not worth while. Certainly, if ob. in various scientific, literary and social or. tained by political machinations or beld by ganizations, will at least pay the actual exmen who act the part of the dog in the ran. pense of membership. At the same time, ger or if their duties are not performed sin- one should avoid wasting too much time in cerely and in good faith, they do not pay,

The golden mean is to follow even in a commercial sense.

genuine inclinations, to join only such organNumerous minor problems will arise with izations as one can use to good advantage, regard to office cards, signs, prescription and in which he can be useful to others. blanks, conduct of the office, etc. In various ways, the young physician will be tempted to stretch a point in order to attract atten. tion to himself, for instance, by using a ACCIDENTS OF THE Foor. BALL SEASON. scholastic degree on bis card or sign, by The 1906 foot-ball season ended with the plastering his door and windows, or even ad- games of November 30th statistios have been joining lamp posts with signs, by printing his tabulated of accidents of the game up to and name in some fancy way, by distributing re- including November 24, which tell of 14 prints to the laity, and by various other deaths and more than a hundred players seri. dodgers which he intends to keep within the ously injure, a marked decrease from the reclimit of ethical regulations. When tempted ord of last year, when 18 players were killed in such ways, it should be remembered

be remembered and 159 seriously injured. In the record that it is risky to drive too near the edge of dead and injured in this year's games the of a precipice. The only safe rule is to most significant feature is the decrease in the follow local customs (if you please, eti. casualties among high school players. In quette), and to avoid anything which will the season of 1905 11 high school players advertise, not so much the doctor, as the fact were killed and 47 were injured. that he is trying to make bimself conspicu- seven received injuries which resulted in ous. For instance, it was unwise in a doc. death and 25 were badly hurt. All the college tor, known to his friends as “Phil.” to have and bigh school games this year were played bis sign read “Dr. P. Moore Wetmore," and under the new rules drawn up after the close in another to announce his specialty as “The of last season to satisfy the agitation for less Jack Asthmatic Institute." A national so. dangerous football aroused by the startling ciety dealing largely with ethical matters, record of casualities in the season of 1905. once rejected a candidate for office because In that year and the preceding years the his card was filled with notices of his numer- brunt of the casualities was borne by high ous life insurance and railroad appointments. school players. It was realized that football

The question of activity in medical, scien- as it was played was too dangerous a game tific, political and social organizations early for the average immature school player and and repeatedly comes before the physician. the new rules were designed to eliminate as Many physicians do fairly good work and far as possible the brutality and roughness achieve financial success without identify. under the old rules.

This year

The Medical Society of City Hospital Alumni

President, LOUIS H. BEHRENS, 374? Olive Street
Vice-Pres., WALTER C. G. KIRCHNER, City Hospital

Secretary, FRED. J. TAUSSIG, 2318 Lafayette Ave.
Treasurer, JULES M. BRADY, 1467 Union Avenue

CHAIRMEN OF STANDING COMMITTEES :

Scientific Communication, Wm. S. Deutsch, 3135 Washington Ave. Executive, A. Ravold, Century Building

Publication, W. E. Sauer, Humboldt Building Entertainment, Frank Hinchey, 4041 Delmar Ave.

Public Health, R. B. H. Gradwohl, 522 Washington Ave

[blocks in formation]

ST. LOUIS.

A CASE OF HYSTERIA IN THE MALE.

pale, slight tremor. Teeth, gums and pharynx in good condition.

Poor appetite, PETER J. WEBER, M. D., PH. G.

digestion impaired; complained of food lying in his stomaob for hours witb a great deal of

distress. Bowels always costive. Herpes surThe subject of this paper, a blackopith, round entire lips. Spleen enlarged and palTHE

. afflicted with tertian malaria and hysteria. pable. Abdomen soft and lax, sinking lower

Name, Wm. H. S.; age 31; color, white; margin of sternum. Xiphoid cartilage at sex, male; birth, October 3, 1875; nativity, edge very soft, movable and flexible. Trans

, 3 Kentucky; oocupation, blacksmith.

verse colon distended with fecal material, Habit.—Drinks beer and wbisky moderate- some tenderness over it and in the region of ly. Uses tobacco to excess in chewing and gall bladder.

. Liver dullness normal, smoking. No drugs. Sexual habits frugal. Respiratory Tract.-Well developed obest, Regular hours for eating, sleeping, etc. good equal expansion and excursions, normal

Family history good. No bistory of rheu. fremitus. Peroussion and auscultation negamatism, consumption, cancer or nervous dis- tive. Voice clear; no dyspnea, cough or exorders.

pectoration. Personal History.--Measles, mumps, chiok. Cironlatory Apparatus.-Apex beat noren-pox. Congenital double inguinal hernia. mal position, beart sounds good and clear. Malaria eight years ago.

Gonorrhea four Pulse good volume and tension, anteries soft years ago; good recovery. Sore on his penis and full. Skin and mucous membrane very sixteen years ago, pronounced leutic by bis anemic. father, a practitioner of medicine. Pain in Urinary Apparatus.—At times passed his bones, especially at night, otherwise no sec. urine once in twenty-four hours, sometimes ondary symptoms. Treatment for one week. once in two days large quantity. Difficulty In 1897 had an attack of acute articular rheu. in starting stream; number of times commatio fever; off and on attacks for several pelled to stand up in order to urinate. years. November 20, 1900, fell from tele. Urine analysis, negative. graph pole, thirty-five feet, fracturing right Nervous System.--Sensorium clear, papillankle; one year later joint resected. 1901, ary reflex good, slight Rombergian; knee double successful radical herniotomy per. jerk diminished. No ankle olonus Babinski formed. 1902, bemorrhoids removed surgi- on right foot. Cornea and solera anesthetic cally.

on both sides. Visual field narrowed. Anes. Present Trouble.- Last Tuesday afternoon thetic areas both forearms and chest. Com felt very hot, headache, sick at stomach, tired plains of shaking sensation in throat as a and depressed feeling; difficulty in breath. ball. Laryngoscopio examination revealed ing. Fever continued Wednesday, Thursday 'nothing. Complains of frequent pain in about 3 p.m. developed severe ohill followed region of occiput. Restless nervous individ. by higb fever and sweat. Friday high fever, ual. Dull facial expression. headache, anorexia malaise, nausea and con- Blood Examination. Tertian malarial stipation, then entered hospital.

plasmodium. Physical Examination.-Fairly well devel- Diagnosis.- Tertian malarial fever, hysoped, muscular and nourished wbite man. teria. Height 5 feet 10 inches; weight 160 pounds. Prognosis.-Good for malaria. Treatment. Dark sallow complexion. Right ankle stiff -Quinine, arsenio and valerian; dietetic and ankylosed. Projection right clavicle and eliminative. from former fracture. No glandular enlargement or skin eruption. Marked herpial

DISCUSSION. eruption about the mouth.

Dr. W. H. Luedde.-In regard to the narDigestive Tract.—Tongue moist, white coat, rowing of the visual field, we must look upon

this symptom in the same way as we consider A CASE OF FRIEDREICH'S ATAXIA. the anesthesias in other parts of the body. It is an anestbesia of the retina, as it were. An

PETER J. WEBER, M, D., PH. G. ingenious metbod to detect simulation or ex

ST. LOUIS. aggeration on the part of the patient is the so-called "Eck-Kampimeter." After the I wish to present a case of Friedreich's usual method of examining the visual field, ataxia without a family history, but simply the patient is placed at a certain distance a neurotio family taint. from and facing a corner. The two side walls Name G. C.; age 32; male; color white. are marked off in tangents of degrees. The Social condition single. Birth, 1874, Maroh patient is confused by his new position, and 31. Nativity Kentucky. Occupation farmer. thus any large errors in the field taken in the

Habits. --Worked as a farin hand until ordinary way can be shown up. Discussion twenty years old; past twelve years has

; will not explain the corneal anesthesia. It worked at odd jobs, occasionally begged. is as real as any of the symptoms of this dis- Uses whisky moderately, beer when he can ease, and certainly very marked in this case. get it. Temperate smoker of tobacco; chews

to excess. Dr. Hoge. These anesthesias are of course of a hysterical character and apparently de. veloped at the same time in consequence of the malarial attack, just as any existing influence might bring out the hysterical symptoms in a patient predisposed to them. This patient, it seems, has had such symptoms before.

Dr. Campbell. This is of course a case of bysteria. I would like to call attention to the definite value of a sign very frequently, but not invariably present in hysteria, which we find in this patient. I refer to anesthesia, not of the sclera, but cf the cornea. In test. ing your patient touob the cornea with a piece of paper or a olean tooth-pick held lightly in the band, so as to leave the epithelium un. injured. If the patient does not wink the eye one may exclude the idea of simulation on bis part.

The corneal reflex is never under the control of the will, and is never absent except in hysteria, or in certain affections of cranial nerves, which if present, make them. selves manifest by obvious signs and symptoms.

Dr. Weber, in closing.- What led me to suspect bysteria was that he complained one morning of a ball sensation in his throat and we could find nothing to account for it. Then we found the anesthesia of the eyeball and the anesthetio area on the arm and the other conditions brought to your attention. Whether malaria has any tendency to produce these conditions I am unable to say. Family History.-Father living in good

Dr. Campbell.— In a hysterical individual, bealth; mother died of cranial trouble at 47 anything that would put him below par would

years. Grandfather died of paralysis. One

brother and sister living in good health. be likely to produce the attack. Any other

Personal History - Measles, obicken-pox fever would be as apt to produce an attack.

and smallpox. Went to school for five years, can read and write. Says he was always

olumsy in walking and running, he would In seeking the source of an obscure sepsis, often fall and stumble. His mother thought do not overlook an examination of the ischio- it was due to his large boots. At 18 years rectal region.

of age, fell from a wagon injuring his left knee; one month later developed what bis Appetite and digestion good. Bowels regudoctor called white swelling; it was painful, lar. Abdomen sunken, soft and lax; spleen tender, red and swollen. Joint aspirated, not palpable. Liver dullness normal. poultice applied which removed a great deal Respiratory Tract.-Well developed unof pus. Then confined to bed for six months, symmetrical chest, considerable deformity. first three months remained unconscious; Musoles, shoulder girdle, hypertrophied, gradually regained bis senses, found himself while those lower down are atrophied, es. in a paralyzed condition, noticed curve in his pecially those of the back.

[graphic]

pecially those of the back. Vocal and tactile fremitus normal. Peroussion, normal pul. monary resonance. Auscultation, normal respiratory movement, abdominal breathing, good marginal expansion and excursion. No cough, dyspnea or expectoration.

Circulatory Apparatus.-Apex beat nor. mal position, cardiac area normal, heart sounds good and clear. Pulse 76, good volume and tension. Arteries and veins soft. Skin and mucous membrane slightly anemic.

Urinary Apparatus.—No symptoms, good control of bladder and rectum. Urine analy.

[graphic]
[graphic]

back, unable to move about. Patient unable to give clear history as to is temperature, eto. Denies all venereal diseases. Upon leaving bed be discovered he could not walk without aid of crutches; short period later could walk short distance without them. Then became more and more helpless, until finally crutches became useless, required invalid's obair.

Physical Examination.- Well nourished muscular wbite man; dark complexion, black hair, brown eyes, soleras clear. Facial expression dull. No skin eruption or gland- sis: Color amber; reaction acid, specific grav. ular enlargement. Left knee shows old ity 1025; transparency clear; no albumen; scars and striae former aspiration. Both feet no sugar; no casts. sbow condition talipes equinus valgus and Nervous System. - Sensorium apparently tendency for the great toe to turn upwards. clear, intelligence fair, speech slow and scanMarked curvature of spine (kyphosis) and ning. Pupils react to light and accommoscoliosis to the right in dorsal region.

dation. No nystagmus noticed when the Digestive Tract. — Tongue clean, moist, eyes look directly ahead, but when directed teeth, gums and pharynx in good condition. upwards and outwards lateral nystagmus appears. Vision good, normal color perception; emia apparently hastening the degenerative no facial paralysis. Tongue bas po tremor, process. But there is a congenital defect in projeots in the median line. No paraes- these cases to begin with. It is not limited Thesia, can recognize sharp from dull all over to the columns of Gall and Burdach, but ex. body and face. Hand grasp very strong on tends to the pyramidal tract and the anterior both sides. No intentional tremor, can raise horn cells. The prognosis is altogether un. cup full of fluid to his mouth without spill. favorable. That does not make it any the ing a drop. Handwriting free from tremors. less inoumbent upon the physician to make Marked ataxia of arms when eyes are closed, a correct diagnosis, because while your prog: unable to touch his nose with index finger. nosis can only be unfavorable, if you can tell Shoulder girdle muscles markedly hypertro- your patient what the trouble is you can pbied, witb bis arms he can raise himself save him expense in the way of further at. from bed into an invalid's chair, vice versa. tempts at treatment. Unable to support his trunk without artifi. cial support or his arms. Both knee jerks

Dr. F. B. Hall.-The very fact of the exlost. Ankle jerks lost. No ankle clonus. Ab.

tensive degeneration in the nervous system domidaland cremasterio reflexes present. Stat.

without hope of repair, would make it seem ic ataxia present, oscillating movement of head

useless to attempt any correction of deformi. and body. Voluntary actions are overdone,

ties. I am very much interested in the case, wben picking up things. Claw-like grasp in

not having had the opportunity of observing both hands. Big toe Alexed dorsally on first such a case so olosely before. phalanx. Choreiform movements present. Dr. Weber, in closing.-In such a case it Powerful extension of both legs while flexors

is not necessary to have the family bistory are very weak. In walking requires some one

as long as you have the neurotio history. to support him; throws his legs out as a

In multiple spinal sclerosis, for which this tabetic; strikes the floor with tips of toes

condition might be mistaken, you have an in. with great force, resulting in pain and in- fectious history. jury.

One point of importance Well behaved, good cheerful disposi. is the flexors are much weaker than the extion; makes no complaint, spends time read.

tensors. ing newspapers and magazines. Diagnosis.-Freidreich's ataxia.

Dr. Campbell.-Has any one related to Prognosis.-Unfavorable.

him had similar trouble ? Treatment. – Arsenio, dietetic, sympto

Dr. Weber.-His mother died of cranial matic. No improvement under inoreasing

trouble and his grandfather had some nervous doses of Fowler's solution up to ten mipims

trouble. three times daily for one month, then reduced to fire minims thrice daily.

Dr. Campbell.–Would not tenotomy en. I am indebted to my colleague, Dr. Neer, able him to get around better? for valuable belp in the preparation of this paper; Mr. Belton for photograbs with Dr.

Dr. Hall.-It would be a very simple proKirschner's kind permission.

cedure and would seem worthy a trial, as it

might add to the patient's comfort. DISCUSSION.

(In reply to Dr. Campbell's question in re

tenotomy.) Dr. Given Campbell.–We are all glad to see this case. It is quite typical of its kind. Of course those cases often run in

IDAHO WILL HAVE HEALTH Laws.families, but apparently his own is the only

Idaho is unique among the states in having case this patient knows of among bis relations. The visual and eye-muscle defect is

no laws against the spread of contagious disa little unusual. The nystagmus, of course,

eases, no quarantine regulations, no laws for

the registration of births and deaths. It is is what we would expect, but the atrophy is a little more than we usually see it.

said efforts to pass such laws have been re

peatedly defeated in the legislature by the Dr. M. W. Hoge.—The bistory is very full Mormons who have feared that thereby the and complete, the case has certainly been registration of births might become necessary, well examined. The diagnosis, of course, thus exposing their polygamous marriages. cannot be questioned. The history in this This year the political parties are pledged to case in one point corresponds with the his. the enactment of health and vital statistics tory brought out in numerous others; the de. laws in such a manner that it is believed the velopment of the condition occurring after Mormons will be unable to defeat them and an infectious disease. This patient bas bad the state will be relieved from its present measles, snjallpox and chicken-pox, the tos. anomalous condition in these respects.

« PreviousContinue »