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eyes; while undisturbed, however, there is muttering delirium. The patient sleeps most of the time, and when awakened is not refreshed. This lethargy varies from the mild type, in which a child may continue in school though dull and inattentive, or a patient may continue at work though stupid or apathetic.

In the more severe cases the stupor increases, and in a few days high temperature arises and the patient succumbs, or the lethargic stupor may continue for weeks. In a few cases there is no stupor and the patient suffers severely from insomnia.

Pathology: The pathological changes are engorgement and congestion of the pia mater and arachnoid membranes. There is no change in the dura mater. The brain itself always shows marked congestion and signs of edema. Minute hemorrhages have been noted in the brain substance and in the pia and arachnoid by some observers. The basilar portion of the brain was observed to be most affected, but very slight changes were noted in spinal cord.

Treatment: The treatment should be symptomatic, meeting the different conditions as they arise with indicated remedies. Belladonna will be most usually thought of at first. Later the anemia which sometimes develops may be met by some form of iron. Strychnia is thought to be of advantage in most all cases. It is possible that withdrawal of spinal fluid may be of advantage.

Report of a case: April 5, 1920, a man, forty-eight years of age, formerly a worker in tobacco, now working as a mechanic, was compelled to quit work, but was able to come to my office. His symptoms were headache, dizziness, double vision, muscular pain in back and limbs. Seemed to have slight fever, though the temperature was not taken. Two days later I was called to his home and found symptoms much aggravated. Drooping of eyelids and delirium marked, temperature 102 degrees, and general appearance that of a very sick man. These symptoms prevailed for several days, temperature coming down to about 100 to 101 and remaining so morning and evening. Patient slept most of the time, but when awake complained of most severe pain in right side of head, in the temple, right eye and cheek, also the entire right ear, the outer edge of the auricle being particularly painful. The symptoms gradually grew better, the delirium growing less, the ptosis improving and pain subsiding as the temperature went back to normal. The appetite was fair all the time, and when the patient was thoroughly aroused he talked rationally and was able to walk about the room, but when left alone soon sank into a lethargic condition.

The improvement has been slow, but now (May 10th) he is able to walk a few squares, but he feels weak and is easily exhausted. The eyesight is poor. Reflexes were about normal throughout the disease.

DISCUSSION.

DR. NELLANS: Have had experience with sleeping sickness-my sister, twenty-six years of age, by occupation a stenographer in a physician's office. Nothing in previous history of any value to help diagnose the case. The

patient seems to get up in the morning as tired as at night. The memory is poor; a veil in front of the eyes; people not natural around her; next thing à slurring of the speech; very difficult to give proper pronunciation; then for seventy-two hours a complete suppression of urine; a closing of eyes occurred; a sensation same as heavy rain on tin roof; could not smile; a complete paralysis. She would fall into a stupor; slap her or quarrel with her to arouse her. She did not complain of pain in the occipital region, but of an itching condition of the neck. She had a ravenous appetite. It was pronounced sleeping sickness because of the gradual conditions. We put her on belladonna. A specialist was called in consultation and he suggested gelsemium. We put her on Fowler's solution of arsenic. It has been four months and she is not well. She tires readily. She can smile, but not naturally.

DR. BECHTEL: Are there any pronounced indications for any of our specific drugs?

DR. SMITH: No, I do not think so. I gave gelsemium to benefit the neuralgic condition, while we think of belladonna for the sleepiness.

DR. WELLING: I have found this out-don't let the intake be greater than the waste of the body. Probably a great deal of their trouble comes from the great amount eaten So to re-establish health, do not feed him more than the waste of the body can take care of. Give him plenty of water and do not let him eat more than he in his weakened condition can take care of.

DR. SMITH:- I will simply add, do not think all these cases are so severe. There are mild cases. Watch this when "flu" is prevalent. I cannot find that it is necessary to have "flu” first, yet it seems to prevail during an epidemic of influenza.

PULSATILLA IN ITS RELATION TO OBSTETRICS
AND GYNECOLOGY.

R. R. BARRETT, M.D., MANSFIELD, O.

Pulsatilla exerts a special influence upon the reproductive organs of the female, and is a prominent remedy in the hands of gynecologist and obstetrician. It has much influence to restore normal menstrual function and to relieve some unpleasantness during gestation, and often ai and before menstruation. Cases of nervous headache are completely relieved and we find the menses are seemingly obstructed, patient is pale, chilly sensations in back, limbs cold and very nervous. Anemic subjects, tardy or scanty from taking cold or emotional causes. This remedy relieves the pain and promotes the discharge. For pregnant women with dysuria, accompanied with pain and tenesmus in the bladder, it also a good remedy.

In subacute inflammations of the mucous surfaces, with a mucopurulent discharge, use this remedy. For leucorrhea use it. Dr. Locke said use it both locally and internally; locally, s.m., one-half drachm to one pint of water; inject into vagina. Gonorrhea of the female may be relieved by it. In uterine colic it is often thought of. For dysmenorrhea give it between and during the menstrual periods.

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Ellingwood says that in amenorrhea with mental excitement and great apprehension of trouble, and in spermatorrhea with fear of dire results, it is found especially efficient. With many women we find great worry about the reproductive organs and their functions. Its influence is through the sympathetic nervous system influencing the reproductive organs. It increases tone and functional power and often overcomes irregularity in menstruation Some doctors use it in convulsive condi

tions due to uterine disorders.

In general nervousness due to chronic uterine disorders, with or without hysteria, there may be deficient, suppressed, irregular menstruation-in such cases this remedy is of rare value. It is thought of during pregnancy with general nervousness, with a general relaxed and atonic condition, and its efficiency is helped by the addition of another remedy-macrotys.

Sluggish, ineffective and weak labor pains, leucorrheal discharges attended with pain in the loins, weariness, depression of spuits, loss of appetite and general disauangement of the nervous system are often satisfactorily relieved by pulsatilla It is, I believe, one of the important remedies found in the viburnum com and other combinations for amenorrhea, dysmenorhea, menorihagia, ovarian neuralgia with tearing and tensive pain, and as a general uterine tonic. The pregnant uterus is sometimes attacked by rheumatism, with spasmodic action causing movement of fetus in utero, the mother worries much and has a sense of sickness and uneasiness. Pulsatilla should be thought of in these cases. It is a remedy with a big field, but more particularly with the following pictures: Gloomy mentality, state of nervous depression and unrest, a disposition to brood over real or imaginary things, tendency to look on dark side of life, sadness, mild restlessness, weeps easily, the pulse sometimes weak and soft, and often about the eyes we notice that sunken, dark color. There is a general picture of sadness, moroseness, despondency and lack of tone. The lines of nervous depression are well marked. This is your case for pulsatilla. We often look upon such a patient in our obstetric and genecological work.

DISCUSSION

DR. J. D. SMITH: I want to emphasize pulsatilla in nervous conditions of the heart-where there is a rapid heart or nervous or palpitating heart, all conditions of exhaustion. Sometimes it is irregular or you may be able to discern very little trouble, but the patient may complain of palpitation. It will act well with men as well as women.

DR. BOWLES: The last few years I have used pulsatilla with passiflora and gelsemium in extreme nervous conditions. I used to think gelsemium and pulsatilla were antagonistic with each other, but I find they work well together. Given in extremely nervous cases, it quiets them down. Just at present using it in a case of tachycardia. I have used it in a stroke of paralysis. Gelsemium 1 drop, pulsatilla 20 to 30 drops, passiflora as much as you think necessary. Try it some time.

DR. BARRETT: Pulsatilla is one of the first remedies I use in grippe.

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Eye, Ear, Nose and Throat

CONDUCTED BY R. C. HEFLEBOWER, M.D., CINCINNATI.

Professor of Ophthalmology and Otology, Eclectic Medical College.

Dislocation of the Crystalline Lens.

Charles F. Clark, in the Ohio State Medical Journal, says that luxation or subluxation of the crystalline lens, whether its causes be traced to direct traumatism, to disease of the eye, or to a congenital defect of the zonula, always presents to the ophthalmic surgeon a problem that is worthy of his most careful consideration. So-called spontaneous luxation is in its etiology so intimately associated with coloboma of the lens and coloboma raises so many questions requiring for their solution the consideration of the diseases and accidents of fetal life, that we are prone as practical clinicians to leave them to the embryologist, who in turn, owing to the relatively infrequent occurrence of such conditions. has little opportunity to study them. The study of congenital defects of the eye is of real importance, and if we are to do our bit in contributing to the advance of ophthalmology each of us should at least make a careful study of every case of this character passing through his hands and see to it that the facts are carefully placed on record for the use of those who are equipped to work out the problem involved

That these cases of congenital coloboma and so-called spontaneous luxation are rare is evinced by the fact that in our own office practice. extending over a period of more than thirty-five years and including carefully indexed records of about forty-eight thousand patients of all kinds, we find eleven cases of this class, four having subluxation and seven coloboma, only one positively exhibiting both coloboma and subluxation; but how rich a field of rare cases sometimes falls to one individual is indicated by the fact that of these eleven cases seven are the descendants in two generations of one man.

Groups of dislocations: I hope in a future contribution to put these cases of congenital defect on record, but in the present paper we are concerned only with the more practical clinical phases of dislocations of the lens, whatever may be its cause. For our purposes we may group dislocations as follows:

(a) Subluxation in which the walls of the lenticular fossa are not broken down and the lens is only slipped partially out of its proper position by the stretching or breaking of a portion of the suspensory liga

ment.

(b) More complete luxation in which the vitreous is partly broken down or liquified but the lens is still held up by a portion of the suspensory ligament and prevented from falling onto the floor of the vitreous chamber.

(c) Complete dislocation in which the fluid vitreous allows the lens

to drift about in the vitreous chamber or, under certain circumstances, to fall through the pupil into the anterior chamber.

While well marked disturbance of vision may result from any of these forms of luxation, it is only in the latter form (c) that disaster to the eye is imminent, for while an eye may remain quiet for a long time with a clear or even a cataractous lens on the floor of the vitreous chamber, sooner or later signs of irritation are apt to present themselves, and only too often we have cyclitis with danger of sympathetic ophthalmia or an equally disastrous glaucoma.

In such cases the lens should be extracted before these symptoms become pronounced, or it may later be necessary to remove the eye, and, while the extraction of such a lens may appear to the uninitiated as a simple affair and the operator sometimes is fortunate in obtaining a good result by the employment of the ordinary methods, every operator of large experience will agree that such cases sometimes tax all his resourcefulness to the limit, and a guarded prognosis should always be given.

Hysterical Blindness From Operation Compensable.

(Weber v. George Haas Mfg. Co et al. (N. Y.), 181 N. Y. Supp. 140)

The Supreme Court of New York, Appellate Division, Third Department, in affirming an award under the workmen's compensation law, says that the claimant sustained an injury to his right eye which made its removal by operation necessary. Simultaneously with the operation the sight of the left eye became affected, and was almost wholly lost. No injury appeared to have been done to the eyeball, the optic nerve or any physical thing constituting a part of the organ of sight. Yet distinguished physicians were agreed that the claimant was not simulating blindness, and in fact did not see. A neurologist said that the claimant could not see at all, and diagnosed the trouble as "traumatic neurosis" or "hysterical blindness," stating that "this psychic shock, the surgical operation which produced the shock, was the primary means of producing that hysterical blindness." It was not important that the claimant had an uninjured physical equipment with which he should, but could not, see. After all, a man sees with his brain, not with his eyeball or his optic nerve, and if an operation performed on an eye so affects the mind, the nerves or even the imagination that a man genuinely loses vision with his other eye, then the faculty of sight has been more directly attacked than when assailed through the mechanical contrivances by which it functions. The workmen's compensation law of New York provides that every employer shall pay or provide compensation for the disability or death of his employee resulting from an accidental personal injury. All the consequential results of an accidental injury are thus made compensable. The operation of this section is not in the least limited by the provision which merely makes certain that conditions

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