MORTALITY REPÓRT OF THE CITY OF DETROIT FOR THE MONTH OF JANUARY. Prepared from Statement furnished by C. H. BORGMAN, Esq., City Clerk.

ТНЕ

PENINSULAR JOURNAL

OF MEDICINE.

MARCH, 1876.

Original Communications.

A CLINICAL LECTURE ON PARÉSIS, OR FAILURE OF MUSCULAR POWER. (Third lecture.) By A. B. PALMer, M. D., Prof. of Pathology and Practice of Medicine, in the Department of Medicine and Surgery of the University of Michigan.

GENTLEMEN. Since the last lecture on the subject of paresis, four additionalcases have presented themselves, where more or less loss of muscular power was a prominent symptom; and before proceeding in the promised remarks on the therapeutical principles concerned in these forms of disease, I will ask your attention to a review of the history of these additional cases.

The first of these, or the eighth of the series, was that of Mr. F. R., aged 27, farmer, married three months before, whose residence is in the western part of the State, and who was at the clinic on the 16th of February 1876.

He informed us that as boy and man he had been very vigorous and athletic, and accustomed to the most active labor and sports.

He had passed successfully through the usual diseases of childhood, though when a lad from a cut on his foot he had had "erysipelas" in it, which lasted for seven months, but he recovered from this, he thought, completely.

He informed us that he had indulged in occasional "sprees," but had never been a habitual drinker, and had used very little tobacco. Though he thought he had been what might be called "rather a fast boy," yet he thinks his health has never been injured by any form of excess.

Six years ago on a hunting excursion he accidentally got into the water, and soon after had "numbness" of his left foot and leg-could not "handle it right;" but this state disappeared after three or four weeks. In the summer of 1872, he was hard at work and much exposed in a malarious region, drank surface water, etc., when the "numbness" of the same leg came on again much as before, continuing four or five weeks and again disappeared. Not far from this time and after, he had several attacks of malarial fever, and at one time was for three months more or less under its influence and for three weeks was severely ill.

Last May he had "numbness" of the right hand, which after a while improved, but it is still "numb and weak." Two months before his visit to us he was obliged to quit work—had headache, sickness of the stomach, and general bad feelings. After taking some cathartics he improved in general condition, but soon his eyes "blurred" so that he was unable to read, though during the earlier part of his attack he had read much, and now the "numbness" returned, most in the left leg, but some in the right as well. He said there had been defective vision in his right eye for a long time, but now both eyes are so defective that though he can for a moment see the letters of ordinary print, they soon run together so he cannot read.

As you saw, his gait was unsteady, sometimes partly staggering, with dragging of the left foot quite marked. The special

defective co-ordination of movements was not more marked than the loss of power. There was deficient sensibility, particularly of the left foot-a feeling as if a "wad of cotton "" was under the foot, and he had difficulty of standing with his eyes shut, still he could maintain his balance and walk, but more awkwardly with the eyes closed.

You observed this gentleman was rather pale; and his skin, pulse, respiration, appetite, digestion, thirst and condition of bowels appeared in a fairly normal state-there was at least no marked improper condition apparent, though his tongue was slightly coated.

It was to be regretted that we failed to have a careful examination of the eyes with the Ophthalmoscope, but expect to have that done at his next visit.

The urine was carefully examined, as should always be done in cases of this kind, and the indications afforded by it were of much value. The quantity passed in twenty-four hours was not accurately ascertained in consequence of his short stay, but was judged to be not far from normal. Reaction was acid; specific gravity 1030. The microscope showed crystals of oxalate of lime in very great abundance. The chemical examination showed phosphates in great excess, and urea in excess; and mucus was mingled with the crystals of the oxalates.

I recall thus minutely the features of this case, as all these particulars are important in forming a diagnosis and the indications for treatment. In all cases, especially of obscurity, you cannot be too minute in ascertaining and recording the pheno

mena.

Although this was not a typical case, yet the apprehension was expressed that in time there might be found a more perfect development of that most obstinate form of want of co-ordinaation and failure of muscular power known as Locomotor Ataxia, or at least a progressive form of paralysis dependent upon organic changes of certain nerve matter. Still a hope was expresed

that the extreme oxalæmia as manifested by the oxalates in the urine, together with the effects of malarial poison may have induced these symptoms, and that by the removal of these conditions decided improvement might possibly occur. As the malnutrition resulting in oxalæmia seemed the most prominent remediable condition, it was selected as the point of attack, and the patient was directed to take Dilute Nitro-Hydrochloric Acid in doses of thirty drops, thrice a day largely diluted after meals, and to increase the dose if no irritation of the stomach was induced, up to fifty or sixty drops. He was also directed to take occasionally for a few times, a few grains of blue mass followed by a saline laxative, with the hope of modifying favorably thereby the action of the digestive organs.

Although a variety of quite severe nervous symptoms is often produced by oxalate of lime in the system, including motor as well as sensative, yet I have never seen so much disturbance of the motor functions as in this case from that cause, and I fear we shall be obliged to attribute the symptoms of other pathological states-to degenerative changes of vesicular nerve matter.

Case ninth, though seen by only a part of the class, yet having features resembling the last, and perhaps in the future history, if not so much in its past, being capable of throwing light upon this subject, I will refer to in some detail.

Mr. E. L. F., also from the western part of the State, age 48, married, farmer—a resident of Michigan for thirty years-presents the following medical history: No hereditary predisposition to disease, general health has usually been good. He served in the Middle Division of the Western Army for three years during the war of the rebellion-most of the time in Tennessee, was not seriously ill during the time, but has had attacks of malarial fever nearly every fall since. He had an injury when a boy by a cart-wheel running over his body diagonally, affecting most his shoulder and hip. He was about soon after