mass of the fluid is pus, I think admits of no doubt." (Italics my own.)

Dr. Hutchins writes: "The microscope showed me red and white blood-corpuscles and pus cells; a few epithelial cells, and micro-organisms usually seen in decomposing fluid, probably accidental. Not likely an aneurism."

The result of these tests was to place Dr. Smith and myself, as it were, "between two fires." On the one hand the clinical history and physical signs ("bruit" excepted) led us to pronounce the disease aneurism. On the other hand the previous statement of Dr. Elliott, who has seen many cases of aneurism, and the chemical and microscopical examination of the fluid, proved directly the opposite-not aneurism. For who had ever seen an aneurism whose contents were almost entirely composed of pus? No one could be found. So we consulted each other again, for the twentieth or thirtieth time, argued both sides of the question, and finally came to the conclusion we were wrong. We could not fight experience and judgment, armed with both chemistry and the microscope. We succumbed, and concluded that something must be done or we would soon lose the opportunity. Our patient was growing rapidly weaker; the tumor had assumed larger proportions, extending from one inch on left of edge of sternum 41⁄2 inches to the right, breadth 4 inches, with general bulging of chest walls on right side. There was not at this time, nor previously during progress of the case, any marked difficulty in either breathing or swallowing. We decided to aspirate the tumor and draw off all of its contents, although it was evident the termination of the case would soon be fatal. The fluid which first flowed through the instrument was almost pure pus, with only a trace of blood. The patient, seeing this, exclaimed, "Thank the Lord!" The poor fellow rejoiced in the hope then of a speedy recovery, but alas! the hope was short-lived. This flow of pus was in a moment followed by the | same fluid sent to Atlanta to be tested. After about one-half ounce of this was taken, pure blood began to flow. Becoming alarmed, we withdrew the needle, and closed the opening with adhesive plaster.

About the first of June, Dr. H. J. Williams

of Macon was sent for, who, after a long examination, heard the aneurismal murmur posteriorly near the inner edge of scapula between third and fourth ribs. Nowhere else could it be found. This was the first time it had been heard in that region, although many times hunted for. From this time it could always be heard, but only there. The sounds over tumor continued the same as at first, similar to the normal heart sounds but exaggerated in intensity. There was, of course, no more doubt of the character of tumor. Dr. Williams informed patient of the nature of his disease and its probable early ending. He bore the sad news with his usual Christian fortitude, and answered, "It is all right.”

I

On my visit the next morning, I saw that notwithstanding all the disappointments he had had during the tedious course of this most painful affection, hope had revived. could scarcely tell which to admire most, the fortitude, faith, and hopefulness of the man, or the self-control and cheerfulness of his faithful, loving wife, who never at any time during his illness gave away to her feelings. Tumor continued to grow, and patient clamored for another operation. Dr. Williams was called again on the 8th. consultation we concluded to attempt the introduction of silver wire into cavity of tumor, as it gave some slight hope of causing coagulation of blood in cavity. The family were informed of our decision, also of the severeness of the operation, and consented to give him the benefit of the chance, slight as it was. He, of course, was willing and ready to submit to anything that gave the least hope, and was much more collected than his sorrowing mother.

The operation was not a success, it being impossible for Dr. Williams to introduce the wire-owing to its extreme smallness, as he thought. From the time of the operation, patient grew steadily and rapidly worse, and on the 20th of June he died in great agony during one of his paroxysms.

Throughout his whole illness, protracted (lasting six months) and painful as it was to a most extreme degree, no one ever heard him groan or utter a complaint, except his devoted wife and medical attendant, and then only when suffering with the awful

paroxysms. At the time of death, tumor was 5 inches in length and 41⁄2 in breadth.

Post-mortem examination was refused by the family, although insisted on. This I This I very much regret, as it would undoubtedly have thrown much light on this very rare and interesting as well as instructive case.

This case has been reported because of the great difficulty in making a correct diagnosis, even after it had been under treatment for several months, although seen by some of the most skillful and experienced surgeons in the State; and because of the strange character the tumor presented: First, the complete absence of the "bruit" for months, and, when heard, found only posteriorly; second, the unusual character of its contents. I have seen no physician or surgeon who has ever seen or read of a case of aneurism containing pus in decided quantity; nor have I ever read of a case of that kind.

Hawkinsville, Ga.

"HYSTERICAL HEMIPLEGIA.”*

BY W. T. SARLES, M.D.

As a member of the Committee on Neurology, I feel it a duty to assist, but must frankly state my standing as distinctly amateur in this department. The two following cases of pronounced "hysterical hemiplegia," and some of the practical lessons connected therewith, which have recently come under my care, lead me to present the same to this Society for the little they may add to this subject:

Case 1.- Miss Ella B- —, aged 12 years, for the past six years an inmate of the State Public School for Dependent Children at Sparta, came under my professional care for the first time Feb. 27, 1893, on account of supposed "winter cholera." This case, with two others taken in like manner and time, and who the fourth day were discharged as convalescent, followed a similar attack the

week previous of six children in an adjoining cottage, who all made rapid and uninterrupted recoveries. Two days later, being March 4th, I was hastily summoned with the announcement that the patient was found by

*Read before the Wisconsin State Medical Society, May, 1893.

the side of her bed on the floor and could not use her right arm and leg. Found patient with complete right hemiplegia-no marked nervous symptoms. Patient inclined to sleep easily, and as she was quiet and cir culation good I left her in care of a nurse with little attention ordered until morning, when I had her removed to a single room in the hospital building on the grounds, where more quiet and better care could be furnished her.

At this date, March 5th, I made a test examination, assisted by my partner, Dr. D. C. Beebe; found electro-contractility of muscles of the affected side; tongue protruded at times to the affected side, at other times straight; facial muscles not affected, but at times appeared so to a degree; temperature 102.4; pulse 100; pupillary reaction normal; patellar tendon reflex of affected side subnormal; muscles of chest not affected; muscles of right arm and leg completely paralyzed as regards motion, but not seriously as regards sensation; marked venous congestion; sluggish capillary circulation and subnormal temperature of affected arm and leg; mind clear, but some hesitancy in speech; patient lay on her back, inclined to the affected side; bowels somewhat constipated at this time, following her diarrhoea and vomiting of a few days previous; functions

of bladder normal; has menstruated twicethe second time during this attack, but without pain or apparent abnormality either time.

"Doctor, what is your diagnosis and prognosis of this case?" I asked of my counsel; who answered that it was evidently organic in character, caused presumably by a lesion of the internal capsule of left side of brain, and that the patient would soon die. I had assumed the position that no organic lesion of the brain or cord existed, but that the case was one of pronounced "hysterical hemiplegia" and ought to recover; but as I had discharged her cured with others but two days previous, and now she was helplessly paralyzed, I was more ready to concur than to disagree with honorable and learned counsel. At this juncture my counsel tersely remarked he believed me half right, as the "hemiplegia" was evident to a blind man, but where was the history of any "hysteria?"

I give this bit of conversation to show how perplexing these recent cases are to two gen

eral practitioners who see the same case at the same time, but in directly different light as regards diagnosis and prognosis-two essentials in any given case.

March 6th I was again hastily summoned, with the statement that patient was having convulsions and was likely soon to die. I now felt the weight of my counsel's position in the case, and would easily have been made to concur without further argument, but, arriving at her bedside, found her first calm, then in a hysterical condition, laughing and crying almost simultaneously, with muscular twitchings of unaffected side. The nurse alleged that "patient straightened out stiff with well side, and that the affected side jerked violently during her convulsions," which had ceased before my arrival. I ordered the use of codeine and pot. bromide for producing quiet, and the use, three times daily, of grain of strychnine and 4 grain of aloin, and rubbing of the affected arm and leg❘ with alcohol twice a day. I now felt confident that the character of the hemiplegia was hysterical without doubt.

March 20th, the sixteenth day following her attack of hemiplegia, and during which time her right arm or leg had never moved a muscle voluntarily either awake or asleep, I commenced the daily use of electricity, using the faradic battery secondary current to arm

and leg.

March 24th, slight voluntary movement of muscles of arm began; and on March 25th the muscles of leg asserted themselves.

April 1st, the patient walked down-stairs to the dining-room below, unassisted; and at this date, April 4th-just one month from date of complete hemiplegia-patient has normal use of right arm and leg, and is up and about in her usual health.

Case 2 is a woman 34 years of age, married and the mother of two children. Nearly two years ago patient came to me with a lacerated cervix uteri and much alleged nervousness, the laceration being of some four years' standing. I repaired the cervix, which healed favorably; and, following this, patient had a "hysterical bladder." During my absence patient fell into the hands of a neighbor physician for treatment for this latter trouble, and, being treated, as for inflammation, on the plan of douchings, etc., of that organ, she

became rapidly worse. Withdrawing all direct treatment, and with no special treatment, she suddenly recovered from the bladder trouble. This was followed by "aphonia," which recovered largely after a short period of period of "placebo" treatment. Then followed hysterical cough. Finally, about nine months ago, patient developed right incomplete hemiplegia, manifestly hysterical in character, but which, though it defies all treatment at my command, I expect to see suddenly disappear some day as her other hysterical lesions have done.

Previous to my knowledge of this patient, her local physician, having exhausted his patience if not skill with the case, referred the matter to her husband, who took upon himself the duties of physician, and at times of her "hysterical spasms" would either throw her in a snow-bank or deluge her with water, and, as he alleges, with perfect results. However, I never have used such radical treatment, and am not a believer in many of the "cures" for "hysterics" and a "balky horse"-which in reality are quite alike-as advised by some pseudo-medical authorities.

The practical lessons to me in these two. cases are: First, that among a number of cases of apparently like character in the same ward or household, one of entirely different character might be classed with those in general, and a false and erroneous diagnosis and prognosis given, and the embarrassment of the physician be in degree according to the station and circumstances of the case. Second, that when you get a case of hemiplegia in a young or middle-aged patient, you cannot be warranted in giving too hasty a diagnosis and prognosis, for often the best directed skill and observation will be unable to immediately arrive at the proper solution of the case. In the two cases just cited, the one complete and apparently in the beginning organic in character recovers rapidly and permanently, while the incomplete case remains as such after months of reasonable care and treatment. The third and to me important lesson is, that when you find a nervous and hysterical woman suffering from lacerated cervix, which you believe to be the cause of her reflexes, and which, as Prof. Fred. Byron Robinson says, is troubling her "abdominal brain," you are

justified in repairing the same, but you must not tell her to expect a speedy recovery, nor need you tell her she will have "hemiplegia," but don't feel disappointed if she does, and don't make her feel disappointed if she is at least one-half as long recovering her nerve equilibrium after the operation as she has been in neglecting to have the same performed.

The literature upon this subject of "hysterical hemiplegia" is not very exhaustive. Authorities give the left side as the one chiefly affected, and state that paralysis of sensation rather than motion is present in greatest degree. In the two recent cases in my limited experience the right side has been the one affected, and motion has been greatly in excess of sensation in degree of paralysis.

Certainly the simple reporting of these cases met by the general practitioner, which do not seem to harmonize with existing statistics, will assist the specialist in giving to us a more reliable and accurate class of literature in the several departments of medicine and surgery, and in none more needful at present than that of neurology. Sparta, Wis.

THE DIAGNOSIS OF LOVE.

Dr. James Finlayson, in an historical review of Herophilus and Erasistratus (Glasgow Medical Journal, May, 1893), quotes a story from Plutarch concerning the latter. Antiochus, son of the king Seleucus, fell in love with his step-mother the young and beautiful Stratonice. His condition was extremely unhappy. He made the greatest efforts to conquer his passion, but they were of no avail. At last he resolved, in his despair, to rid himself of life, by neglecting all care of his person and abstaining from food; for this purpose he made sickness his pretense. Erasistratus easily discovered that his distemper was love; but it was difficult to conjecture who was the object. In order to find it out, he spent whole days in his chamber; and whenever any beautiful person of either sex entered it, he observed with great attention not only his looks, but every part and motion of the body which corresponds most with the passions of the soul. When others entered he was entirely unaffected, but when Stratonice came in, as she often did, either

alone or with Seleucus, he showed all the symptoms described by Sappho: the faltering voice, the burning blush, the tumultuous pulse, and at length, the passion overcoming his spirits, a deliquium and mortal paleness.

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Erasistratus concluded from these tokens that the prince was in love with Stratonice and perceived that he intended to carry the secret with him to the grave. He saw the difficulty of breaking the matter to Seleucus yet, depending upon the affection which the king had for his son, he ventured one day to tell him "that the young man's disorder was love, but love for which there was no remedy." The king, quite astonished, said "How ! love for which there is no remedy!" "It is certainly so," answered Erasistratus, "for he is in love with my wife." "What, Erasistratus!" said the king "would you, who are my friend, refuse to give up your wife to my son when you see us in danger of losing our only hope?" Nay, would you do such a thing," answered the physician, "though you are his father, i he was in love with Stratonice?" "O my friend," replied Seleucus, "how happy should I be if either God or man could remove his affections thither! I would give up my kingdom, so I could but keep Antiochus." He pronounced these words with so much emotion, and such a profusion of tears, that Erasistratus took him by the hand and said "Then there is no need of Erasistratus You, sir, who are a father, a husband, and a king, will be the best physician too for your family." Upon this Seleucus summoned the people to meet in full assembly, and told them it was his will and pleasure that Antio chus should intermarry with Stratonice, and that they should be declared King and Queen of the Upper Provinces.

For the cure of the young prince, Erasistratus is reported by Pliny to have received a fee of 100 talents, which is calculated as amounting to more than one hundred thousand dollars.

One peculiarity of the above case was that Sappho, a lady without professional claims. was the authority for the diagnosis, and Stratonice, a lady who had never expressed a desire to get a divorce, was prescribed without consultation to cure the case, while Erasistratus drew the fee.

Correspondence.

WHAT A HEALTH RESORT OF THE ITALIAN RIVIERA IS LIKE.

[Special Correspondence from a former resident.]

The present writer spent five months last year in the immediate vicinity of that secluded Arcadia of the Italian Riviera-Ospedaletti. Who has ever heard of the place? Few indeed! So let him tell you something you don't know, but ought to know.

The present account of the resort is treated solely from the medical man's view-point. It is not intended for the general reader, and its technics would be out of place in a general journal. Nor does he who pens these lines claim strict originality for the following. Credit to whom credit is due. Much of it is now translated for the first time from the recent interesting and skillful work of Dr. Ederling, of Ospedaletti. So faithfully has the translation been carried out that even some of the idiomatic peculiarities of expression of the original are retained.

Climatological and Medical Observations by

Mons. the Doctor Ederling.

Humidity of the Air.-The climate of the Riviera of the West passes in general for being dry, and this ought, after our observations, to apply in a special manner to Ospedaletti. The average of relative humidity is, in effect, during the months of winter, of about 62.5 per cent. The sea develops during the day an atmospheric humidity sufficient to supply a heavy dew for the succeeding evening. One must search for the cause of this relatively intense humidity of the air in the disposition of the places (sheltered country, planted lands, etc., etc.). This is, for the invalids, of capital importance. We will add that, precisely because of these favorable conditions, the air is much less charged here with dust than in all the other stations of the Riviera.

At Ospedaletti they do not know (it might be said) what clouds are: they keep themselves ordinarily at a great height above the level of the sea, or at least rest close to the slopes of Mount Nero. During our sojourn of three years, the snow has fallen only once

-March 2, 1890-and it did not rest a long time; on the following day it had completely disappeared. Even during the cold winter of 1890-91 there was no snow, while one had announcements from Italy, Spain, and Algeria of enormous falls of snow.

The Sun. The profoundly vivifying influence of the sun on the organism is a fact well known. The more the sun shines gaily and long, the better it accomplishes in us the phenomena of assimilation and of disassimilation. In general, and by way of consequence, our faculties, physical and intellectual, redouble their activity. This is why, in all the stations which are particularly favored with the sun, one ought to note with care how many hours of sun there are each day, and make an abstract of the clear days and of those which are more or less cloudy. One knows well enough that on these borders, clear and blue, of the Mediterranean, and particularly on the Riviera, the sun does not show itself niggardly of light and of heat; indeed, the sunshine of the Riviera has passed into a proverb.

But we have to note some interesting peculiarities. At the epoch when the days. are shortest, one sees the sun surge from the sea in the morning, and replunge therein in the evening. Thus, even during the solstice of winter, one can see the sun in the sky for about nine hours daily.

The rays of the Levant sun commence by adorning the eminences of Bordighera; Ospedaletti is still in the amber. But when the star has passed the crupper of Cape Nero, its light invades at a stroke the entire territory of Ospedaletti, and persons the most delicate can at once go out in the country. moment comes about, in winter, between eight and half-past in the morning, according to

the months when one is there.

This

The Winds.-The privileged situation of Ospedaletti, which we have just described, shelters it completely from the cold north winds.

It is, then, very exceptionally that this. which they call here the Tramontana (wind from the north) blows in the valleys from the heights of the Monte Nero and the Monte Caggio. It is the same with the wind from the northeast, of which the presence is not sensible to us except by the drift of the