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when the physician made his reputation both in attainments and in specious appearances by his attention to private practice. Excepting special lines of medical research, notably, insanity, deaf-mutism, etc., and problems in which a rapid examination of a large number of cases is desired the greater intelligence, command of facilities and average longer period of observation of private patients render them superior material for medical study. Then, too, in an economic sense, including not only the narrow financial welfare of the profession, but that of the community at large, clinical study, has its greatest value as applied to a higher stratum of society than usually seeks dispensaries and hospital wards.

A general principle that applies to didactic and hospital and dispensary positions as well as to nearly every other side line" in med. icine, is that, unless they pay for the time directly or in opportunities for genuine study, they are not worth while. Certainly, if obtained by political machinations or held by men who act the part of the dog in the manger or if their duties are not performed sincerely and in good faith, they do not pay, even in a commercial sense.

Numerous minor problems will arise with regard to office cards, signs, prescription blanks, conduct of the office, etc. In various ways, the young physician will be tempted to stretch a point in order to attract attention to himself, for instance, by using a scholastic degree on his card or sign, by plastering his door and windows, or even adjoining lamp posts with signs, by printing his name in some fancy way, by distributing reprints to the laity, and by various other dodgers which he intends to keep within the limit of ethical regulations. When tempted in such ways, it should be remembered that it is risky to drive too near the edge of a precipice. The only safe rule is to follow local customs (if you please, etiquette), and to avoid anything which will advertise, not so much the doctor, as the fact that he is trying to make himself conspicuous. For instance, it was unwise in a doctor, known to his friends as "Phil." to have his sign read "Dr. P. Moore Wetmore," and in another to announce his specialty as "The Jack Asthmatic Institute." A national society dealing largely with ethical matters, once rejected a candidate for office because his card was filled with notices of his numerous life insurance and railroad appointments. The question of activity in medical, scientific, political and social organizations early and repeatedly comes before the physician. Many physicians do fairly good work and achieve financial success without identify.

ing themselves with their profession yet, as a general rule, every physician owes it to himself and his patients to derive the benefits of the experience and study of others and, in turn, he owes to his profession the very modest financial and the moral support of affiliating with his fellows and imparting such original observations as he may make. Under present conditions, he should at least join the formal, county or euqivalent component of the state and national association, and should be guided by special interests, amount of leisure and other circumstances, as to other membership. Regarding other societies, it is well to choose according to personal ability and tastes. There is a prevalent and justifiable prejudice against active political work by a phyiscian, certainly if undertaken from interested motives. On the other hand, there is every reason why a doctor should be known as a good citizen. The writer's experience has been that the acquaintance made in various scientific, literary and social organizations, will at least pay the actual expense of membership. At the same time, one should avoid wasting too much time in such ways. The golden mean is to follow genuine inclinations, to join only such organizations as one can izations as one can use to good advantage, and in which he can be useful to others.

ACCIDENTS OF THE FOOT-BALL SEASON.The 1906 foot-ball season ended with the games of November 30th statistics have been tabulated of accidents of the game up to and including November 24, which tell of 14 deaths and more than a hundred players seriously injure, a marked decrease from the record of last year, when 18 players were killed and 159 seriously injured. In the record of dead and injured in this year's games the most significant feature is the decrease in the casualties among high school players. In the season of 1905 11 high school players were killed and 47 were injured. This year seven received injuries which resulted in death and 25 were badly hurt. All the college and high school games this year were played under the new rules drawn up after the close of last season to satisfy the agitation for less dangerous football aroused by the startling record of casualities in the season of 1905. In that year and the preceding years the brunt of the casualities was borne by high school players. school players. It was realized that football as it was played was too dangerous a game for the average immature school player and the new rules were designed to eliminate as far as possible the brutality and roughness under the old rules.

The Medical Society of City Hospital Alumni

President, LOUIS H. BEHRENS, 3742 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 Entertainment, Frank Hinchey, 4041 Delmar Ave.

OFFICIAL

Publication, W. E. Sauer, Humboldt Building
Public Health, R. B. H. Grad wohl, 522 Washington Ave

1 RANSACTIONS.

A CASE OF HYSTERIA IN THE MALE.

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

ST. LOUIS.

THE subject of this paper, a blacksmith, afflicted with tertian malaria and hysteria. Name, Wm. H. S.; age 31; color, white; sex, male; birth, October 3, 1875; nativity, Kentucky; occupation, blacksmith.

Habit. Drinks beer and whisky moderately. Uses tobacco to excess in chewing and smoking. No drugs. Sexual habits frugal. Regular hours for eating, sleeping, etc.

Family history good. No history of rheumatism, consumption, cancer or nervous disorders.

Personal History.-Measles, mumps, chicken-pox. Congenital double inguinal hernia. Malaria eight years ago. Gonorrhea four years ago; good recovery. Sore on his penis sixteen years ago, pronounced leutic by his father, a practitioner of medicine. Pain in bones, especially at night, otherwise no secondary symptoms. Treatment for one week. In 1897 had an attack of acute articular rheumatic fever; off and on attacks for several years. November 20, 1900, fell from telegraph pole, thirty-five feet, fracturing right ankle; one year later joint resected. 1901, double successful radical herniotomy performed. 1902, hemorrhoids removed surgically.

Present Trouble.-Last Tuesday afternoon felt very hot, headache, sick at stomach, tired and depressed feeling; difficulty in breathing. Fever continued Wednesday, Thursday about 3 p.m. developed severe chill followed by high fever and sweat. Friday high fever, headache, anorexia malaise, nausea and constipation, then entered hospital.

Physical Examination. -Fairly well developed, muscular and nourished white man. Height 5 feet 10 inches; weight 160 pounds. Dark sallow complexion. Right ankle stiff and ankylosed. Projection right clavicle from former fracture. No glandular enlargement or skin eruption. Marked herpial eruption about the mouth.

Digestive Tract.-Tongue moist, white coat,

pale, slight tremor. Teeth, gums and pharynx in good condition. Poor appetite, digestion impaired; complained of food lying in his stomach for hours with a great deal of distress. Bowels always costive. Herpes surround entire lips. Spleen enlarged and palpable. Abdomen soft and lax, sinking lower margin of sternum. Xiphoid cartilage at edge very soft, movable and flexible. Transverse colon distended with fecal material, some tenderness over it and in the region of gall bladder. Liver dullness normal.

Respiratory Tract.-Well developed chest, good equal expansion and excursions, normal fremitus. Percussion and auscultation negative. Voice clear; no dyspnea, cough or expectoration.

Circulatory Apparatus.-Apex beat normal position, heart sounds good and clear. Pulse good volume and tension, anteries soft and full. Skin and mucous membrane very

anemic.

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this symptom in the same way as we consider the anesthesias in other parts of the body. It is an anesthesia of the retina, as it were. An ingenious method to detect simulation or exaggeration on the part of the patient is the so-called "Eck-Kampimeter." After the usual method of examining the visual field, the patient is placed at a certain distance from and facing a corner. The two side walls are marked off in tangents of degrees. The patient is confused by his new position, and thus any large errors in the field taken in the ordinary way can be shown up. Discussion will not explain the corneal anesthesia. It is as real as any of the symptoms of this disease, and certainly very marked in this case.

Dr. Hoge. These anesthesias are of course of a hysterical character and apparently developed 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 hysteria. 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 testing your patient touch the cornea with a piece of paper or a clean tooth-pick held lightly in the hand, so as to leave the epithelium uninjured. If the patient does not wink the eye one may exclude the idea of simulation on his 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 themselves manifest by obvious signs and symptoms.

Dr. Weber, in closing.-What led me to suspect hysteria 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 anesthetic 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.

Dr. Campbell.-In a hysterical individual, anything that would put him below par would be likely to produce the attack. Any other fever would be as apt to produce an attack.

IN seeking the source of an obscure sepsis, do not overlook an examination of the ischiorectal region.

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knee; one month later developed what his doctor called white swelling; it was painful, tender, red and swollen. Joint aspirated, poultice applied which removed a great deal of pus. Then confined to bed for six months, first three months remained unconscious; gradually regained his senses, found himself in a paralyzed condition, noticed curve in his

Appetite and digestion good. Bowels regular. Abdomen sunken, soft and lax; spleen not palpable. Liver dullness normal.

Respiratory Tract.-Well developed unsymmetrical chest, considerable deformity. Muscles, shoulder girdle, Muscles, shoulder girdle, hypertrophied, while those lower down are atrophied, especially those of the back. Vocal and tactile fremitus normal. Percussion, normal pul. monary resonance. Auscultation, normal respiratory movement, abdominal breathing, good marginal expansion and excursion. No cough, dyspnea or expectoration.

Circulatory Apparatus.-Apex beat normal 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.

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back, unable to move about. Patient unable to give clear history as to is temperature, etc. Denies all venereal diseases. Upon leaving bed he 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 chair.

Physical Examination.- Well nourished muscular white man; dark complexion, black hair, brown eyes, soleras clear. Facial expression dull. No skin eruption or glandular enlargement. Left knee shows old scars and striae former aspiration. Both feet show condition talipes equinus valgus and tendency for the great toe to turn upwards. Marked curvature of spine (kyphosis) and scoliosis to the right in dorsal region.

Digestive Tract.- Tongue clean, moist, teeth, gums and pharynx in good condition.

sis: Color amber; reaction acid, specific gravity 1025; transparency clear; no albumen; no sugar; no casts.

Nervous System.- Sensorium apparently clear, intelligence fair, speech slow and scanning. Pupils react to light and accommodation. No nystagmus noticed when the eyes look directly ahead, but when directed upwards and outwards lateral nystagmus ap

pears. Vision good, normal color perception; no facial paralysis. Tongue has no tremor, projects in the median line. No paraesthesia, can recognize sharp from dull all over body and face. Hand grasp very strong on both sides. No intentional tremor, can raise cup full of fluid to his mouth without spilling a drop. Handwriting free from tremors. Marked ataxia of arms when eyes are closed, unable to touch his nose with index finger. Shoulder girdle muscles markedly hypertrophied, with his arms he can raise himself from bed into an invalid's chair, vice versa. Unable to support his trunk without artificial support or his arms. Both knee jerks lost. Ankle jerks lost. No ankle clonus. Abdominal and cremasteric reflexes present. Static ataxia present, oscillating movement of head and body. Voluntary actions are overdone, when picking up things. Claw-like grasp in both hands. Big toe flexed dorsally on first phalanx. Choreiform movements present. Powerful extension of both legs while flexors are very weak. In walking requires some one to support him; throws his legs out as a tabetic; strikes the floor with tips of toes with great force, resulting in pain and injury. Well behaved, good cheerful disposition; makes no complaint, spends time reading newspapers and magazines.

Diagnosis.-Freidreich's ataxia.

Prognosis. Unfavorable.

Treatment. Arsenic, dietetic, symptomatic. No improvement under increasing doses of Fowler's solution up to ten minims three times daily for one month, then reduced to five minims thrice daily.

I am indebted to my colleague, Dr. Neer, for valuable help in the preparation of this paper; Mr. Belton for photograhs with Dr. Kirschner's kind permission.

DISCUSSION.

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 families, but apparently his own is the only case this patient knows of among his relations. The visual and eye-muscle defect is a little unusual. The nystagmus, of course, is what we would expect, but the atrophy is a little more than we usually see it.

Dr. M. W. Hoge.-The history is very full and complete, the case has certainly been well examined. The diagnosis, of course, cannot be questioned. The history in this case in one point corresponds with the history brought out in numerous others; the development of the condition occurring after an infectious disease. This patient has had measles, smallpox and chicken-pox, the tox

emia apparently hastening the degenerative process. But there is a congenital defect in these cases to begin with. It is not limited to the columns of Gall and Burdach, but extends to the pyramidal tract and the anterior horn cells. The prognosis is altogether unfavorable. That does not make it any the less incumbent upon the physician to make a correct diagnosis, because while your prog. nosis can only be unfavorable, if you can tell your patient what the trouble is you can save him expense in the way of further at. tempts at treatment.

Dr. F. B. Hall.-The very fact of the extensive degeneration in the nervous system without hope of repair, would make it seem useless to attempt any correction of deformities. I am very much interested in the case, not having had the opportunity of observing such a case so closely before.

Dr. Weber, in closing.-In such a case it is not necessary to have the family history as long as you have the neurotic history. In multiple spinal sclerosis, for which this condition might be mistaken, you have an infectious history. One point of importance is the flexors are much weaker than the ex

tensors.

Dr. Campbell.-Has any one related to him had similar trouble?

Dr. Weber. His mother died of cranial trouble and his grandfather had some nervous trouble.

Dr. Campbell.-Would not tenotomy enable him to get around better?

Dr. Hall. It would be a very simple procedure and would seem worthy a trial, as it might add to the patient's comfort.

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

It is

IDAHO WILL HAVE HEALTH LAWS.Idaho is unique among the states in having no laws against the spread of contagious diseases, no quarantine regulations, no laws for the registration of births and deaths. said efforts to pass such laws have been repeatedly defeated in the legislature by the Mormons who have feared that thereby the registration of births might become necessary, thus exposing their polygamous marriages. This year the political parties are pledged to the enactment of health and vital statistics laws in such a manner that it is believed the Mormons will be unable to defeat them and the state will be relieved from its present anomalous condition in these respects.

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