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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.
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
no ankle clonus, and the plantar reflexes
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
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
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.
THE AUSTRALASIAN MEDICAL GAZETTE, September 20, 1902.
CASE OF RODENT ULCER OF NOSE. ILLUSTRATING DR. L. HERSCHEL HARRIS' PAPER ON THERAPEUTICS OF THE RÖNTGEN Rays. therapeutic properties of the Röntgen Rays will be much availed of in the treatment of many indolent forms of skin disease.
[Since I wrote this paper-nearly two months ago—I have had eight additional cases of rodent ulcer under treatment, each of which is rapidly responding to the radiations.]
TREATMENT OF CANCER BY RONTGEN RAYS.
By T. G. Beckett, L.R.C.P. & S., etc., Hon. Medical
Electrician Alfred Hospital, Melbourne.
The results have been very satisfactory, with the exception of the first case. Then I produced an excessive reaction, and as a consequence the patient did not report herself again for further treatment. One case of the erythematosus variety at present under my care is only progressing moderately.
Norman Walker, M.D., in his book, "An Introduction to Dermatology,” referring to this mode of treatment as applied to lupus erythematosus, says:
“It is certain that the X-rays should only be used with great caution, and only by those who have had considerable experience both with the rays and with the disease. Often a few minutes' exposure sets up a violent reaction, which if improperly treated may result in an extension of the disease. On the other hand this reaction is sometimes followed at an interval by great improvement, and in other cases improvement sets in without any marked evidence of irritation.”
Several of the cases mentioned were kindly transferred by Dr. McMurray from the skin department to the skiagraphic department of the Sydney Hospital, and the treatment was carried out under his supervision. I wish to thank Dr. Newmarch, of North Sydney, for
case in a man aged 74 of many years duration, which after treatment appeared to be perfectly cured.
Rodent Ulcer.-Unfortunately I have only had the opportunity of trying the effects of the rays in one case, kindly sent to me by Dr. R. Steer Bowker. This was in a man aged 6+, and, as seen by the illustration, involved the end of the nose.
It was of several years standing, and had been scraped once.
This case rapidly responded to treatment, and after 32 sittings appeared to be quite healed.
Hypertrichosis.--I have tried several cases. The hairs fell out after 15 to 30 sittings, but soon reappeared. In one case I continued treatment, on and off, for seven months, but eventually gave it up in despair, and removed
, the hairs effectively by electrolysis.
Keloid and Hypertrophied Scar Tissue.-In one case where hypertrophied scar tissue formed after an operation for tubercular glands of the neck I was successful in removing this after three months intermittent treatment with
The Medical Annual of this year refers to the case, which was published in the dustralasian Medical Gazette of April, 1901. Dr. W. H. Goode, who has since seen the case, expresses great satisfaction with the result.
Carcinoma.—I have several cases at present under treatment, and shall report on them on some future occasion.
This embraces my limited experience in the matter, but the results obtained are so gratifying that I feel confident in predicting that the
[Abstract.] The subject that I have the honour to address you on to-night is the treatment of cancer by Röntgen Rays, and before commencing I must ask for your kind indulgence towards me on account of two or three features in my lecture. In the first place, partly in order to make the most of the limited time at my disposal, I shall omit nearly all references to the published work of others, and confine myself almost entirely to my own personal experiences of this matter.
The second point I must apologise for is my presumption in giving this lecture at all, considering my limited experience in this work, and my only excuse is that this subject is so very new that I am not aware of anyone who can claim to have a very extensive experience of it yet. Owing to this fact it is quite possible that some of the opinions that I express to-night I may, after a more extended experience of a few years, be compelled to modify in the light of further evidence. The title of this lecture will naturally provoke the question : Can cancer be cured by X-rays? My answer is this, that by the aid of the X-rays, in easily accessible and superficial cases of malignant disease, we have an undoubted cure which has been proved by many successful cases and by many observers. In regard to more serious cases, where the disease has obtained a deeper hold, such promising results have been already obtained by some, that looking at the very early nature of our experience with this new line of treatment we have good grounds for hoping that, with improved methods and more extended experience, a wider range of possibilities is open to us. Even the present results are not to be despised, for how very many of what are serious and extensive cancers now were once only very small and superficial malignancies ; that is, they could have been cured with our present means had they been treated early enough.
There are probably very many who will for many years only regard thi new line of treatment as merely another cancer cure-another