ferentiated clearly from those due to nephritis, we have the objective symptoms of dimness of vision, flashes of light before the eye, floating specks, etc. Opthalmoscopic examination may show all grades of irritation from a simple hyperaemia of the retina to a choked disc. The more severe cases showing a neuroretinitis, outlines of the disc very lazy, arteries much contracted and the veins congested and tortuous. Lymph extravasations may be seen throughout the retina, but hemorrhages are usually absent.

Knapp reported some time ago a series of cases, all multiparae, of neutritic atrophy with no other charges in the fundus, and were not due to albuminaria, and he further states that he has often been impressed with the frequent appearance of pale optic nerves in women with normal vision, who have borne children, and raises the question if this is not an evidence of some toxic influence, occurring during previous pregnancies.

I would especially call your attention to complaints of transient loss of vision in your patients. These cases cannot be regarded as uraemic or hysterical amaurosis, because of its slow progression and long duration, but Groeno states that they are rather due to a transient neuritis, secondary to auto-intoxication, and are evidently warning signs of more serious optic or retrobullar neuritis, that the pregnancy is the reason is proven by its recurrence with each succeeding pregnancy.

Hurst also reports a case in the second month of pregnancy in which there was persistent nausea and vomiting, headache and dimness of vision. Ophthalmoscopic examination revealed a neuro-retinitis and lymph extravasations into the retina, with no improvement after a period of eliminative treatment. Labor was induced, when all symptoms were rapidly ameliorated. In this case, at no time was there any albumin in the urine, and the urea test varied so from day to day that it was of little value. He rereports another case of similar type, which in spite of the induction of labor, the condition progressed and the patient died.

I have had five cases of the eclamptic type in my own practice, two of which I feel of sufficient interest to report:

Case I. Mrs. primipara, age, 34; married three years. Patient had always been well and strong; early in the pregnancy there was persistent nausea and vomiting. In the seventh month there was transient periods of dimness of vision; these increased in frequency and headache was persistent. Early in the eighth month, vision was reduced so that it was hard to recognize friends in her home. Ophthalmoscopic examination revealed an intense neuro-retinitis, general retinal appearance was that of a choked disc.

The blood vessels were full and tortuous, and both retinae were dotted with retinal hemorrhages. In the macular area were the typical signs of albuminuric retinitis, yet no albumin had appeared in the urine until a week previous to my examination

of the fundus. Artificial labor was induced. Prognosis of the ocular condition was given as grave.

This case has been under my observation now a little over two years, vision has gradually cleared until it reached normal in each eye some seven months after labor. There are still to be seen evidences of a previous serious retinitis. The eyes are very sensitive to bright light and fatigue is manifest after continued close work. Her present condition is fairly good, yet her endurance is much below normal. Urinalysis during the first year showed varying amounts of albumin and occasional costs, but during the past year analysis have been negative. Case 2. Has an identical history with case 1.

Patient,

Mrs. primipara, age 38. Labor induced at the beginning of the ninth month because of severe neuro-retinitis, associated with a serious nephritis. This case I am reporting because six months after the induction of artificial labor, she became again pregnant. At this time the retinal symptoms of the previous pregnancy had not disappeared. On account of the recurrence of the ocular trouble, the termination of pregnancy was advised, but was refused.

Toward the end of the eighth month, the retinal lesions. were so extensive, that labor was induced with the delivery of a viable child which lived about six months. Following labor, the urine was loaded with albumin, the ocular symptoms remained stationary for about three weeks, when there began a steady but slow improvement. This case has been under my observation now three years; there is still a trace of albumin in the urine, but the retinal symptoms have sufficiently cleared so that she has vision of 7 in the right and .8 in the left eye. The eyes are extremely sensitive to light and become fatigued after a very moderate amount of close work.

NEW REMEDIES:

The following paragraph is taken from "PocketBook of Treatment" by Leftwich:

"The young practitioner purrs when he is told he is up to date. When he becomes more experienced he will have discovered that it is safer to be, say, six months behind the times. In fact, the up-to-date physician may be defined as a man who experiments on his patients. Leaving on one side remedies which are introduced to the profession for purely commercial reasons, a new remedy, or a new application of an old one, is to its discoverer what a new baby is to its mother-wonderful and unparalleled! In both cases, and without any dereliction from good faith, the judgment is biased. The remedy is introduced with a fanfare of trumpets loud in proportion to the status of the originator. Chemists (druggists) stock it, and other manufacturers not only imitate it, but puzzle their brains in coining fresh trade-marks which they hope will induce the public to think that theirs is the real original product, et puis bon soir! For, twelve months afterward, it is forgotten by all but the exasperated chemists (druggists) who have stocks of it left on hand. Sometimes, as in the case of a well-known preparation of arsenic, it is found to be downright dangerous."

Case V.

CLINICAL DEPARTMENT.

CONDUCTED BY A. H. RING, M.D.

Diagnosis: Pressure Neuritis.

This is not an uncommon type of neuritis to meet with in an outpatient clinic as a result of sleeping off the effects of an alcoholic debauch with the head resting upon the arm in such a manner as to press upon the musculo-spiral nerve. It is a splendid illustration of the physiological fact that the motor neurons are more susceptible to injury than are the sensory and lose the power of functioning earlier in slowly acting trauma or poisoning, as from pressure, lead, etc.

In this case the wrist drop was marked and the condition clear from the start, being directly due to the pressure of the tourniquet. The everted hand was due to the unequal tension of the tendons at the wrist.

The prognosis is generally good, but progress is slow; three to six months or more may elapse before nerve repair is complete and conduction re-established.

The active application of the static sparks and high frequency current applied in this case at the start was a mistake. Much rest is indicated and the daily use of the galvanic current up to the strength comfortably tolerated by the patient. The kathodal electrode placed over the part injured and the andal pole peripheral to it has given the best results. Case VI. for Diagnosis:

The case is that of a woman, 45 years old, of New England stock. Family history: The grandfather and his two brothers and one sister all died of apoplexy, one of the brothers at 31 years. The father, a stern, quiet man, who does things, is living at the age of 75 years. This side of the family was dogmatically religious.

The mother, a highly-strung, idealistic woman, given to emotionalism, is also living at the age of 72 years. There were eight children; two died in infancy. Of those remaining, all are well excepting two girls, one of whom is markedly hysterical, and the patient.

The patient was a healthy baby. One day, when a child, having been berrying in a very hot sun, she remembers being unable to speak and the mother crying about it. When ten she had a similar but more severe attack lasting a few hours, and a little later a spell when she could not walk home from school as her legs gave out. When thirteen, she had sonie chronic movements of the left face muscles. Menstruated at fifteen normally; was bright at school and became a teacher.

During the summer vacation of her twenty-second year, she had some emotional worry, slept poorly, and one morning at breakfast found suddenly that she could not feel things with her left hand and her speech got thick. She went out and walked up and down the street and found that left foot dragged and the houses looked different. Then she vomited and went to sleep. Next day she was all right, but a weak later the mouth became drawn to the left and she was unable to close the right eye, which condition lasted some weeks. At this time she would go to sleep easily and anywhere, and once did so when the children were filing out of school.

From this time there were moments when she could not move her left arm, or the left foot would stick to the floor. Also she had a gassy dyspepsia, which was a source of great discomfort.

She married at twenty-six, at which time she weighed ninety-nine pounds (usual weight 118 pounds). From this time on, life was easier and very happy and she improved and was relatively well, using both sides of the body equally. Eight years later she had a miscarriage and a year later a normal girl baby. Labor was difficult and she thinks that she was never completely recovered from it. Before it, she was very religious and a regular attendant at church, but afterwards, prayers and hymns lost their significance. She was then relatively well for ten years, excepting for occasional attacks of gassy dyspepsia. She has never evinced any emotionalism and has always kept an even, placid temperament, free from anything that might be styled hysterical.

Now followed two severe emotional shocks which greatly changed the current of her life. Then in January, 1910, she would at times feel as if her left foot dragged. In February she struck her head against a hot-air furnace pipe and immediately her left foot hung loose and useless, but after an hour was sufficiently better for her to take a train and go to the city. Next morning at breakfast she had a sudden feeling as if her head was being pushed through the ceiling and had to lie down, her left foot dragging. However, she took another trip on the cars and train. From this time on she has not been able to use the left foot properly and has never been able to flex the foot on the leg. She became an invalid with many neurasthenic symptoms, severe back-ache, unable to read or talk or be talked to, and noise was unbearable.

Next came an epileptiform seizure one morning in March, during which her mouth was drawn to the left, the eyes rolled up, speech got thick and she was unconscious. There have been several such occurrences since, with minor attacks in the left arm and neck, and sometimes in the left rectus abdominalis muscle. They always begin in the left hand. In May, 1910, pain in the abdomen led to an operation for appendicitis. She was then somewhat better, until in September, when she had another convulsion and again in December another, after each of which the neurasthenic symptoms re-occurred and her mind was much confused and clouded.

The patient is now dressed each day and able to hold connected conversation. She has told this story as recorded. She has black hair and a muddy complexion, and is rather emaciated. There is a large scar from a burn gotten from a hot water bag during a convulsion last September. The temperature, touch and pain sense all are intact except that it is a little difficult to tell the sharp from the dull point on the inner surface of both legs. Left knee-jerk is slightly spastic, and there is a marked clonus and upward planter reflex on left side. On right there is a slight pseudo-clonus, and knee-jerk is normal.

Small articles placed in her hands she can recognize by the feel. The pupils reach to light and distance and are equal. There is no nystagmus, but lateral movement of the eyeballs is limited to both right and left side, and in conversation the eyeballs occasionally assume an eccentric

position, probably from unequal tension of the muscles. The tongue protrudes slightly to the left of the median line.

Heart sounds are distinct but normal, and position is good. Blood pressure 100. Abdomen negative. Except that she is exacting of the nurses and seems to place an unreasonable importance upon drugs, etc., she could not be called emotional.

What is this probable diagnosis and from what would it have to be differentiated?

It has been necessary to postpone the papers on the mind until after the June medical meetings.

A case lately shown in Dr. Frederick B. Percy's clinical lecture and discussed by Dr. Fred T. Murphy, who operated upon the patient, is worthy of report.

It was that of a man forty-eight years old who was perfectly well up to the last of December. While attending to his duties in his office, his left hand suddenly felt numb and queer. He was conscious of feeling faint, and dropped to the floor unconscious and was convulsed. After twenty minutes he revived and was taken home in a carriage. In half an hour he had a similar attack and was taken to the Massachusetts General Hospital. There he remained for a few days. A positive diagnosis was not made, but he improved and went with his friends to a camp at the shore, where he remained about two weeks. The last day at the camp, while picking up to go home, he felt his left hand getting numb again and got to a sofa in time to save falling, when he was unconscious again for twenty minutes. He then came to Boston and was admitted to a private hospital, where he was seen by Drs. F. B. Percy, F. T. Murphy and E. W. Taylor.

Systematic examination revealed the fact that the patient had lost his ability to recognize objects held in his left hand (loss of stereognostic sense). It is known that the centers for this sense are in the upper posterior convolutions of the parietal lobes. This fact, together with the other, i. e., that the spells always began in the left hand, led to the theory of some cortical irritation in the right parietal region.

Dr. Murphy operated, making the usual horse-shoe flap, and came down upon an inflamed dura mater under which was found a rapid growing glioma. As much as possible of this was scraped away without entering the ventrical, and the patient made a good early recovery, appearing at the clinic four weeks after the operation in excellent condition. At this time the patient's mind was well collected and oriented. He could with a little hesitation name articles placed in his left hand.

Dr. Murphy described the case in detail, but said that such a glioma cannot be safely extirpated sufficiently to insure recovery and that the chances of relapse were great. This has proved true; the tumor has recurred.

The New England Society of Psychiatry held its semi-annual meeting with Dr. G. Alder Blumer at the Butler Hospital, Providence, R. I., on March 28. Dr. Henry R. Stedman of Brookline was elected president