or

membranes be ruptured. The third would History of Present Illness.—About two show that plugging the vagina will sometimes three years ago she first noticed some numbstop the hæmorrhage and enable the pregnancy ness on the outer aspect of the right thigh. to go on to full term. The fourth, that ex- This was not preceded by any pain in the back tracting the placenta in cases of complete or down the thigh, and she made no complaint placenta prævia may sometimes be easier than of this to anyone; but about 12 months perforating it with the fingers, as advocated before I saw her she complained to her mother by Rigby.

of some pain and burning sensation down the (Read before the South Australian Branch of the thigh. The pain was so severe at that time British Medical Association.)

that she was unable to get about, and she was

considered to be suffering from hip disease. THREE CASES OF MERALGIA PARÆSTHETICA:

She was kept in bed for three weeks, and

during that time all the pain practically By George E. Rennie, M.D., M.R.C.P. (Lond.), disappeared, and she was able to get about

Tutor in Medicine, University of Sydney, and and to go to dances, etc., without any discomAssistant Physician Prince Alfred Hospital, fort, though she still had the numbness. She Sydney.

remained free from pain for 10 months, but In 1895 Bernhardt published a paper in the

the numbness persisted all the time. Recently

she has noticed the numbness and burning Neurologisches Centralblatt detailing reports of

sensation on the front of the left thigh. several cases which presented a curious group of nerve symptoms, viz., disturbance of sensa

On examination I found the patient to be a

She tion on the front and outer aspects of the

well-developed and well-nourished girl. thigh, unaccompanied by any other signs either

presented no appearance of suffering; she had of central or peripheral nerve lesion. This

gained in weight, and her temperature was

normal. condition was subsequently described by Roth, and named by him “Meralgia Paraesthetica." Nerrous System.—She had no headache, and Up to the present time not more than about there was no sign of any disease or defect in 100 cases of this disease have been recorded, any of the cranial nerves. Her intelligence and, so far as I have been able to ascer- was normal, and there were no signs at all tain, none of these have been reported by suggestive of hysteria. The muscular power British authors. The disease has been chiefly was good in ail the limbs at all the joints. studied by the American and Continental There was absolutely no pain or limitation of neurologists, and no case has, I believe, been movement about either hip joints. There was no previously recorded in Australia.

tenderness on percussion of the skull or spine. CASE I.—This case was referred to me by my

Sensation: The only objective disturbance of friend, Dr. Blackwood, of Summer Hill, Sydney.

sensation was on the right thigh; there was A girl, æt. 19, single, was first seen by me in

distinct tenderness on pressure along the line of June, 1900. She complained then of a burning ,

the external cutaneous nerve of the thigh. On sensation on the outer aspect of the right thigh,

the anterior and lateral aspects of the right with occasional slight swelling of the same leg.

thigh there was

of anæsthesia, She also complained of a burning sensation

analgesia, thermal anesthesia, and Faradie over a small area about the size of the palm of

anästhesia. This area corresponded genethe hand on the front of the lower third of the

rally with the cutaneous distribution of the left thigh.

posterior root of the third lumbar nerve.

| The transition from the area of sensation Family History.—Her father died of phthisis

to that of anæsthesia

sudden and 12 years ago; mother is healthy; one brother

well defined. There and one sister

Do anästhesia are healthy; her maternal

detected anywhere else. Over the area of the grandmother suffered from rheumatism, but no others in the family. There is no history of there was no objective disturbance of sensation

burning sensation on the front of the left thigh gout, paralysis, fits, or any other nerve disease in the family.

or anæsthesia detected. Personal History.—She was a healthy child

The knee jerks were active, but not exag. from birth up till the age of three years, when

gerated; no ankle clonus; the plantar reflexes she had an attack of chicken pox. She also were flexor in type on both sides. She had no had scarlet fever at the age of five years, and

sphincter trouble, and there were no signs of measles at six years. She has had no other

trophic disturbance. illness. There has been no venereal disease or The heart, lungs and abdominal viscera were alcoholic excess; and no history of any accident, normal; urine normal; menstruation quite injury or strain.

regular.

:

an

area

Was

was

On examining this patient a few months later gesia, and much delayed sensation of heat and her condition was much the same, except that

cold. Faradic stimulation was not recognised. the area of anæsthesia had extended a little In addition there was a burning sensation lower down the thigh, and the sensation of along the line of the nerves on both sides. burning on the left thigh had disappeared. There was no loss of muscular sense, and no CASE II.-A medical man, aged 50, consulted

Rombergism. The knee jerks were normal; me about twelve months

ago
in

no ankle clonus, and the plantar reflexes

of
consequence
showed the normal flexor response.

There a numb feeling in both thighs.

He was very nervous about himself, as he thought he was in

was no sphincter affection, and no trophic for locomotor ataxy.

disturbance or herpes. Family History.-Both parents died from

CASE 3.—The third case was that of a man cerebral apoplexy at the age of 90. There is

aged 48 years, an engine-fitter by trade, but no history of gout or rheumatism, and no who had been engaged in laundry work for nervous disease of any kind in the family.

the past four years.

He had extensive

tubercular disease of the larynx and lungs, Personal History.--He has had good health all his life. He had an attack of gonorrhæa 25

and was practically dying when I saw him. years ago, but no syphilis. He has been in

He complained of a feeling of numbness over

the anterior and outer surface of the upper active practice for several years and has taken no holiday. He suffered heavy financial loss

part of the right thigh. On examination I

found that there was complete anæsthesia and in 1893. Present Illness.--On January 1st, 1901, he

analgesia over the area corresponding to the

cutaneous distribution of the posterior root of was sitting for five hours continuously on a seat

the third lumbar nerve on the right side. In on one of the stands erected on the route of the

this region there was also a subjective sensaCommonwealth procession in Sydney, but he tion of formication, but no evidence of any says he felt no discomfort, and was not cramped tenderness of nerve trunks. This had been in in any way; but about a week afterwards he

existence for some months. He died shortly noticed a burning sensation down the left thigh,

afterwards, and I had no further opportunity and on placing his hand on the spot he found it

of examining him. was anæsthetic to touch. He also noticed that

Remarks.-Sir William Gowers, in his there was distinct tenderness along the line of "Manual of Diseases of the Nervous System,” the external cutaneous nerve on the left side.

says: Impairment of sensation in an area on About a month later he observed the same

the front of the lower half of the thigh is thing on the right side. Since then he has

occasionally met with as an isolated symptom, been much worried about himself, fearing the

usually in men in the second half of life. It onset of serious spinal cord disease.

comes on without pain, and may pass away On examination I found him to be a well

after months, or may persist for years. The loss nourished and well-developed man, and found

is greatest in the middle of this region, but the no evidence of disease in the lungs, heart or

transition to normal sensibility is well defined. abdomen; the urine was normal.

Its origin and nature are mysterious, except Nervous System.—There was no disease or that the subjects of it are usually gouty. It affection of any of the cranial nerves; seems to have little significance. Again, in affection of the cranium or spine; no loss of speaking of anterior crural neuritis, he says: muscular power in any of his limbs at any of "Such an affection of the fibrous tissue may be the joints.

On testing his sensation I found limited to that related to a single nerve, or no evidence of any disturbance in the head, some other branch of the sacral or lumbar

or trunk. But there was marked plexus may be the seat of a neuritis like that disturbance in the areas of distribution of the which underlies sciatica. The anterior crural external cutaneous nerves on both sides. On or a branch suffers most frequently, with the left side at the upper and outer side of the resulting symptoms on the front of the thigh upper half of the thigh tactile sensation was or on the outer part. These are chiefly sensory; not lost, but only impaired; at the lower third motor symptoms are seldom conspicuous in of the outer side of the thigh there was cases so limited in area. The outer part of the complete anesthesia, and painful sensation thigh in the upper two-thirds is a specially much impaired. Heat and cold were only frequent seat of pain, and occasionally diminished recognised as such after some delay. Faradic sensibility. Anesthesia in this region somesensation was not recognised as an electric times develops in a very chronic manner, without stimulation. On the right side, at the lower pain, as an isolated but curious and enduring part of the outer and anterior part of the thigh, symptom, usually stationary when discovered, there was complete anesthesia, partial anal- and apparently the result of a limited neuritis

no

a

of chronic form. It seems to have no sinister but which is, nevertheless, severe enough to significance, but has little tendency to yield to produce complete tactile anæsthesia. treatment.

The pathological evidence available to throw It is pretty evident that Sir William Gowers any light on the condition is very scanty. One is here describing cases similar to those I have case has come to autopsy. It was that of a recorded above, though he does not use the man, 80 years of age, who had been under the same name for them, and seems to incline to observation of Navratski. A spindle form the view that the symptoms are due to a neuritis swelling was found in each external cutaneous or gouty peri-neuritis of one of the branches of nerve at the place where it crosses over the the anterior crural nerve, or of the lumbar or crest of the ilium, and in the region of the sacral plexus. I would emphasise the fact that swelling there were the changes characteristic though it is not a condition of serious import, of neuritis and peri-neuritis, with secondary yet in my first case the symptoms were severe degeneration of nerve fibres. In other cases, enough to give rise to the supposition that the however, in which resection of the nerve has patient was the subject of hip disease, and she been performed as a therapeutic measure, was treated accordingly for a short time; and careful examination of the excised fragment of in my second case the diagnosis of locomotor nerve has failed to reveal any abnormality ataxy was suggested by the patient himself. whatsoever. Hence, I have thought it well to draw attention As regards treatment, it seems that absolute to this condition so that the error of mistaking rest is essential for the relief of the pain. In it for serious organic nerve disease may be cases where this is not possible resection of the avoided.

nerve may be performed with a reasonable In the cases hitherto recorded the etiological hope of cure. No drug treatment is of any factors assigned have been so various that it

material service, beyond improving the general seems doubtful if there be

any
real connection

state of nutrition of the system. between the supposed cause and the pathological

[Read before the New South Wales Branch British Medial condition present. Thus among the causes of

Association.] this disease are placed the following:-Typhoid fever, influenza, syphilis, pregnancy, alcoholism, gout, exposure to cold, cold douches, the striking

THERAPEUTICS OF THE RÖNTGEN RAYS. of the sword against the thigh in soldiers, etc. In many cases no cause can be assigned. In By L. HERSCHEL HARRIS, M.B., Ch.M., Hon. my first case no satisfactory cause could be Skiagrapher and Assistant Surgeon, Sydney elicited, but it is possible that as the girl was Hospital; Hon. Skiagrapher, Children's Hospital. much given to dancing, and the nerve appears from a study of the area of disturbed sensation to be somewhat abnormal in distribution, the

As we all know, the Röntgen Rays, as well as frequent irritation and compression of the nerve

having photographic properties, are possessed by the fascia of the thigh may have determined

of certain chemical properties also, and on this a chronic neuritis of the nerve. In the second

account experiments are being conducted in case the patient was in a low state of health,

different parts of the world to test their theraand it appears probable that the external

peutic value. After experimenting on a number cutaneous nerves of both thighs were compressed

of cases I have formed the following conby the fascia during the long occupancy of the

clusions : seat in what must have been a more or less Lupus Erythematosus.— The two most common cramped position, and so a condition of pressure forms in which this disease occurs are the eryneuritis was set up, just as we get a musculo- thematosus and sebaceous varieties. Of these spiral compression neuritis from long pressure the former is the inore difficult to deal with, and on the nerve during sleep. These suggestions, a long time is required for treatment. It is however, involve two assumptions. First, that questionable even then whether improvement the nerve can be compressed by the fascia of results. The sebaceous form rapidly responds to the thigh to such an extent as to cause either treatment. As a rule 20 to 30 sittings suffice. actual neuritis or some pathological change in Occasionally a reaction occurs producing inthe nerve sufficiently severe to impair its flammation of the part under treatment. If function. Second, that the dissociation of due care be not exercised this might even sensations and paræsthesia, which may persist produce alarming effects.

produce alarming effects. I do not consider for months or years, may be caused by a lesion it essential that any reaction should be proof the nerve trunks, which, however, is not duced to effect a cure, for of nine cases of lupus accompanied by any trophic change in the skin, which I have treated thus, five have not or the development of any herpetic eruption; suffered any reaction whatsoever.