NEW YORK MEDICAL ABSTRACT. CLITORIDIAN CRISES IN PROGRES- SIVE LOCOMOTOR ATAXIA. BY DR. A. BITRp:S. Translated for the Medical Abstract. and the waist, and shooting pains either in the superior or the inferior members. These symptoms taken together enable us to affirm that Francoise R. has progressive locomotor ataxia which is advanced to the paraplegic period. Let us see what information this very intelligent patient has to give of the first phases of her malady. During her youth she had very good health. There were no signs of syphilis and no great venereal excesses. She had two children at term ; there were no miscarriages or premature deliveries. In 1870 she entered an establish- ment where she was required to use a sewing machine. This work, not laborious of itself, soon became very disagreeable for Franqoise, for the movement of the thighs necessary to the working of the pedal, often provoked in her a series of voluptuous sensations, with erotic spasms which ended in ejaculation. In spite of the immediate pleasure caused by these excitements she controlled them as much as possible, for they were followed by extreme gastric weakness. In 1871 she left the estab- lishment, and until 1874 enjoyed pe rfect health. It appears, however, that during these three years, despite the fact that she no longer used the sewing machine,she experienced in periods, varying from eight to 15 days, violent sensa- tions of a voluptuous character which seized her without her being aware of any exciting cause. The excitation was likely to occur at any hour of the day, especially when she was inactive, and—let us fully understand—without any artificial provocation whatsoever, or any lustful thought \pensee lubrique] . The excite- ment commenced by a sort of vibratory titilla- tion in the vagina. The sensation reached the clitoris, which soon entered into a condition of erection, and there soon followed a veritable erotic spasm with ejaculation—absolutely as in regular coition. These spontaneous voluptu- ous crises were almost always repeated three or four times in the same day and, after pass- ing away, returned in periods of from one to two weeks. They were followed by painful debility of the stomach. Let us note that at this period Franjoise was living maritally with the father of her children, and that she used moderately, but in all liberty, the pleasures of conjugal life. Toward the close of 1874 she commenced to feel the constrictive pains and formications, and six months afterward she had for the first time the lancinating pains of tabes. The first crisis was extremely violent and lasted for 12 days. The pains were of a gnawing and tor- menting character; they were described as being acutely felt in the flesh and bones and, generally, in the deeper recesses of the system. The patient was seldom without the shooting Ataxic crises of the clitoris were first de- scribed by MM. Charcot and Bouchard in a communication to the Socidld de Biologie (Paris, 1866). In the case reported, the patient had crises of severe pain in the limbs, and “ volup- tuous sensations which occurred spontaneously and were similar to those experienced during coition.” The greater part of such writers who, since 1866, have occupied themselves with the symptomatology of tabes, describe the subjective and intermittent troubles re- ferred to in the communication under the generic name of “ tabetic crises.” But none of them has reported further and more fully detailed cases of this singular anomaly in the genital organs. Clitoridian crises are never- theless not rare either at the beginning or in the course of locomotor ataxia ; but for reasons readily understood physicians generally are unaware of their existence. The three cases which follow will give the characteristics of these crises, show their semiological value, and demonstrate the importance that a knowl- edge of them may have at the commencement of the evolution of tabes. Frangoise R., aet. 48, now in the hospital for incurables at Bordeaux, presents symptoms which leave no room for doubt as to the ex- actitude of the diagnosis of tabes. Inco-ordi- nation of the inferior members has arrived at such a point that the patient is incapable of rising, and even of remaining in a standing position ; yet the muscular force is so well preserved that it is impossible to bend her legs back upon her thighs when she is requested to keep the limbs extended. The muscular sense is so profoundly affected that she never knows exactly the position of her lower members unless she sees them. The rotulian reflexes are wholly wanting. The sensations derived from contact, pricking and heat are scarcely perceived. There are no trophic troubles. The superior members are the seat of a con- stant sensation of formication. ' These patients cannot execute the simplest movements without a certain degree of hesita- tion. When their eyes are closed the uncer- tainty of movement is very greatly augmented, and they are often observed to put their finger upon their forehead or chin when, perhaps, they have desired to touch their cheek or ear. In the present case no intellectual trouble has been observed. The bladder is inactive and micturition slow and difficult. There are gastric crises three or four times a year, fre- quent attacks of coughing occurring mostly at night, binding pains at the base of the thorax NEW YORK MEDICAL ABSTRACT. pains described. In 1878 the ambulatory troubles were fully established. In this year also the first gastric crises appeared. The cough was not observed until 1882. During the entire duration of this progressive phase of tabes (from 1874 to 1883) the erotic crises con- tinued in the same manner as at the beginning of the malady. They still occur from time to time with intervals of two or three months. But the patient dreads them now more than ever, because they almost always announce an approaching onset of the lancinating pains and the gastric troubles. Jeanne P., 48, a cigar-maker, has been in hospital for two years with progressive tabes and clitoridian crises. At 45 she was in per- fecthealth; no syphilis, no alcoholism. Married at 19, she had six children ; three of them are living and in good physical condition. She has always been of a very ardent disposition concerning sexual pleasures. Has been a widow since 1870 ; her malady commenced in 1880. Without known cause or anterior suf- fering she had in the morning upon rising, painful glairy vomitings. They were associated with violent efforts and sharp pains in the stomach. After they had ceased she felt no uneasiness of any kind. Her appetite and digestion were very good. At the same period (1880), the first clitoridian crisis appeared. About twice a month, without physical or psychical provocation, the patient felt a titilla- tion of the clitoris which persisted and augmented in intensity during 15 or 20 minutes and terminated by a complete erotic spasm with abundant vulvo-vaginal secretion. This symptom was manifested both at night and in the daytime, and was preceded by no prodroma. The clitoridian erection ceased very soon after ejaculation and the emission was followed by no notable sensation of fatigue. During an entire year the vomitings and clitoridian crises were the only morbid symptoms observed. In 1881 there appeared for the first time the shoot- ing pains common to these cases. They were not intense at first, but soon augmented in violence ; they appeared capriciously upon the trunk, the face, or the limbs. At nearly the same time the patient commenced to feel a persistent pain at the waist, and a subjective sensation of pain in the inferior members. At the end of 1881 perambulation became hesi- tating and, a short time afterward, impossible. The patient now remains constantly in bed, suffering terribly from the shooting pains and a girdle pain which, in its spasmodic action, tightly binds her abdomen. The patient’s condition in 1883 is: Con- firmed ataxia ; cannot stand unless well sup- ported ; efforts to walk followed by excessive pains in limbs ; muscular force well preserved; loss of sensation of position of inferior mem- bers ; rotulian reflexes wanting; no trophic troubles ; sensations caused by pricking and tickling perceived slowly and without preci- sion ; no motor inco-ordination of superior members ; patient can button her clothing; has felt within a few months formications in left hand; no trouble in organs of sense ; micturition slow and difficult; urine passed drop by drop except when great effort is made; shooting pains very frequent and seated in almost any part of body. At the level of in- ferior part of abdomen patient feels binding pains. The sensation of cold in the inferior members is partially avoided by thick layers of cotton. The clitoridian crises are less fre- quent than in 1881, but they rarely appear less often than once a month—a few days before the catamenia; they have the same character as formerly. The patient sometimes has uterine pains similar, she says, to those of child-bed. An examination of the genital organs reveals no grave affection. The uterine neck is volu- minous and a little humped, but there is no tumor. There is no leucorrhoea, and menstrua- tion is regular. There is nothing abnormal in the vulva. Honorine R., 44, entered hospital in 1883. Had typhoid fever at 13. Married at 17 she had five successive premature deliveries fol- lowed by a normal pregnancy which terminated in giving birth to a well-made child who is living and has always been in good health. Patient denies all venereal symptoms. Toward 36 years she became subject to sharp lan- cinating pains seated in the occiput and temples; her physician considered them neuralgic. At this time the first clitoridian crisis appeared. They were preceded by violent palpitations of the heart. In a few moments the genital organs became the seat of voluptuous sensa- tions precisely as in coition and terminated in an abundant vulvo-vaginal secretion. The erotic impression was so profound that the patient always rested in a condition of semi- prostration for several minutes. These volup- tuous crises were reproduced with the same characteristics for 4 or 5 times a month during about 10 years (1871-1881). They appeared during the night or in the daytime and were brought on by no erotic thought. They often surprised the patient while she was occupied with her household duties. Toward the end of 1880 the head pains disappeared, but six months afterward (1881), lancinating pains, sharp and short, began to appear in the inferior members. In 18S2 her walk became hesitating, the sufferings grew more severe, and a con- stricting pain appeared at the base of the thorax. The patient now presents the most characteristic signs of confirmed, progressive, NEW YORK MEDICAL ABSTRACT. locomotor ataxia. Her limbs in her attempts at walking are moved violently from side to side in any effort she may make to reach a desired point. The resistance offered by the floor she tries to walk on is not perceived ; the sensibility of the inferior members is obtuse, and prickings are recognised only after a delay of several seconds. The shooting pains are very sharp ; they are seated in the limbs and upon the trunk, and their appearance is ordi- narily preceded by local perspiration. The rotulian reflexes are wanting on both sides. Micturition is slow and there are no trophic or visual troubles. At present there are no clitoridian crises. They ceased in 18S1—at the time the shooting pains commenced. Trousseau formerly pointed out that in man also, these violent and prolonged erections, followed by rapid ejaculations, were to be found at the commencement of locomotor ataxia. There is, perhaps, reason for sus- pecting an intimate connection of these troubles of the male genital organs with those phe- nomena of clitoridian excitation which may show themselves in women under like condi- tions. That there are good reasons for this comparison must assuredly appear when we remember that MM. Charcot and Bouchard wrote : “ We call attention to the spontaneous voluptuous sensations which appear to us to have a certain analogy with genital excitation, and to the facility and rapidity of the seminal emission which is not rarely seen, in ataxic men, to precede the period of anaphrodisia.” An interesting particular to be derived from our cases is, that the clitoridian crises may appear at the very beginning of tabes—before inco-ordination, and even before the charac- teristic shooting pains. In our first patient the voluptuous crises were, for four years, the sole subjective symptoms of medullary affec- tion. In the second, well defined clitoridian and gastric crises preceded by one year the onset of the first characteristic pains in the limbs. In the third, the only symptoms recog- nized by the patient for six consecutive years were neuralgiform, cephalic pains—whose tabetic nature is very doubtful—and clitoridian crises. The facts lead us to attribute to these crises a semiological value equivalent at least to that of all other tabetic crises, and to formu- late concerning them the two following propo- sitions : 1. When we observe clitoridian crises we should suspect tabes, even in the absence of all other symptom of medullary affection. 2. When the clitoridian crises coexist with any one of the ordinary symptoms of ataxia, we should diagnosticate tabes even in the ab- sence of inco-ordination.—Le P) ogres Medical, Sept. 13, 1884. Dear Sir : We give in the following pages a few specimen illustrations which appeared in the Medical Abstract for 1883. The color-plates and lithographs (of which there were several) we cannot show here. In all there were over two hundred illustrations in 1882, over two hundred in 1883, and about three hundred for 1884. Specimen copy sent free. NEW YORK MEDICAL ABSTRACT, 93 Fulton St., N. Y. Volumes for 1882, 1883, or 1884: Unbound, $1.00 ; in cloth, $1.50 ; in half-morocco, $2.00. Our calls for Volume I, 1881, are very many, even at the present time ; we will exchange, copy for copy, with anyone who has numbers of 1881. A FEW OF THE ILLUSTRATIONS IN VOL. Ill, T883, OF THE MEDICAL ABSTRACT. Five Hundred Pages. Unbound, $r.oo. Bound in cloth, $1.50. Bound in half-morocco, $2.00. “HYSTERIA IN YOUNG BOYS;” “HYSTERICAL CONTRACTION OF TRAUMATIC ORIGIN;” “VARIETIES OF APHASIA;” Charcot, from the French ; 18 illustrations. SITUATION OF EGGS AND FETUSES IN TWIN PREGNANCY, Budin, from the French ; 8 illustrations. The best diagnostic article on the subject published. ILLUSTRATIONS IN NEW YORK MEDICAL ABSTRACT, 1883. CLINICAL LECTURES ON DISEASES OF THE LOWER BOWEL, Hamilton ; 7 cuts and 5 plates, 4 of which are printed in colors. BASILYSIS FOR DYSTOCIA FROM HYPERTROPHIC ELONGATION OF THE CERVIX UTERI, Simpson ; 3 illustrations. ILLUSTRATIONS IN NEW YORK MEDICAL ABSTRACT, 1883. SPONGE-GRAFTING, Franks ; a practical article, giving several ca.ses ILLUSTRATIONS IN NEW YORK MEDICAL ABSTRACT, 1883. EXPERIMENTAL RESEARCHES IN THE EMPLOYMENT OF THE MAGNET IN EPILEPSY, Bourneville and Bricon ; an interesting little article on the subject. RELATION OF MICRO-ORGANISMS TO TUBERCULOSIS, Cheyne. This is the Report to the Association for the Advancement of Medicine. Full details are given. Illustrated with 13 colored drawings. CAUSES, SYMPTOMS, AND TREATMENT OF PHIMOSIS AND PARAPHIMOSIS, Ormsby, 7 illustrations and much interesting information. ILLUSTRATIONS IN NEW YORK MEDICAL ABSTRACT, 1883. OPERATIVE TREATMENT OF HARE-LIP, Whitson; 14 illustra- tions—one color plate. OPERATIVE SURGERY OF THE JAWS, TONGUE, AND PALATE, Stokes. FOR CONSUMPTION AND WASTING DISEASES. HYDROLEINE Has been proved of the highest value in CONSUMPTION and all WASTING DISEASES, invariably producing IMMEDIATE INCREASE IN FLESH AND WEIGHT. FOnMULiV of IIYDnOLEINE. Each dose of two teaspoonfuls, equal to 120 drops, contains: Pure Cod Liver Oil 80 m. (drops.) Distilled Water 35 “ Soluble Pancreatin 5 grains. Soda 1-3 grains. Boric Acid 1-4 “ Hyocholic Acid 1-20 “ DOSE—Two teaspoonfuls alone, or mixed with twice the quantity of soft water, to be taken thrice daily with meals. The principles upon which this discovery is based have been described in a Treatise on “The Digestion and Assimilation of Fats in the Human Body,” by H. C. BARTLETT, Ph.D., F.C.S., and the experiments which were made, together with cases illustrating the effect of Hydrated Oil in practice, are concisely stated in a Treatise on “Consumption and Wasting Diseases,” by G. OVEREND DREWRY, M.D. In these Treatises the Chemistry and Physiology of the Digestion of the Fats and Oils is made clear, not only by the description of a large number of experiments scien- tifically conducted, but by cases in which the deductions are most fully borne out by the results. Copies of these Valuable Works will he sent free on application. HYDRATED OIL, WATER .A. IN'ID OIL. HYDROLEINE is readily tolerated by the most delicate stomachs, even when the pure Oil or the most carefully prepared Emulsions are rejected. The Oil is so treated with pancreatin, soda, boric and hyocholic acids, that the process of digestion is partially effected before the organs of the patient are called upon to act upon it. Consequently it is readily assimilated. It will nourish and produce increase in weight in those cases where oils or fats, not so treated, are difficult or impossible to digest. In Consumption and other Wasting Diseases, the most prominent symptom is emaciation, of which the first is the starvation of the fatty tissues of the body, including the brain and nerves. This tendency to emaciation and loss of weight is arrested by the regular use of HYDROLEINE, which may be discontinued when the usual average weight has been permanently regained. The permanence and perfection of the emulsion, and the extreme solubility of the HYDRATED OIL, solely prepared and sold by us underthename of HYDROLEINE, is shown by its retaining its cream-like condition as long as the purest Cod-Liver Oil will retain its sweetness. Unlike the preparations mentioned, or simple Cod-Liver Oil, it produces no unpleasant eructation or sense of nausea, and should be taken in such very much smaller doses, according to the directions, as will insure its complete assimi- lation ; this, at the same time, renders its use economical in the highest degree. To brain-workers of all classes, Hydrated Oil is invaluable, supplying, as it does, the true brain food. Economical in use—certain in result. Tonic—Digestive and Highly Nutritive. 1UT7W PRINCIPLE FOR THE 17 A T INilW ASSIMILATION. lAl. KIDDER & LAIRD, Agents tor the United States, Retail Price, 1.00 per Bottle. Depot, 83 John Street, New York. FOR PHYSICIAN’S USE ONLY. SVAPNIA OR PURIFIED OPIUM. 77^ NE AND soP0*'* ALKALOIDS #cl-ODSS 'S°*OUS & CoNV^uSNN| CODEIA, NARCEIA AND MORPHIA ALKALOIDS THEBAIN, NARCOTIN AND PAPAVERIN This article is not intended, for popular use, but only on prescrip- tion of the profession. It is to take the place of Opium in cases where that drug acts injuriously. dose, _a_s o^itxivc. Dr. John Harley, of London, in his “Old Vegetable Neurotics,” details a large number of experiments upon the human and animal system, with six of what he con- siders the narcotic alkaloids. He concludes that although all six possess both narcotic and hypnotic properties, yet these are so varied in degree and force, as to make their effects, when exhibited singly, very distinct from those following their exhibition in combination. Taking the experience of practical physicians with Dr. Harley’s results, as a basis, we would group them in the following order : First Group. \ Anodyne and Hypnotic Elements. | 1. Morphia. j 2. Narceia. ! 3. Codeia. Second Group. Narcotic and Convulsive Elements. i. Thebain. 2. Cryptopin. » 3. Papaverin. Now Svapnia is a distinctive name given to the first group, representing the anodyne and hypnotic elements; the second group, or the narcotic and convulsive elements of Opium being elitninated; and is not, therefore, a simple principle, or a single constituent of Opium. The relative values of each being known, we can select and utilize those that are valuable, and reject those known to be deleterious and inert. This is what we claim, and all we claim .for Svapnia. It can be relied upon and given in all cases where Opium or Morphia is indicated with,equally good effects; and in addition to this, there will be found in the practice of every physician, cases occurring almost every day, in which idiosyncrasy and peculiar states and diseases of the brain debar us from the use of Opium and Morphia, but where Svapnia can be exhibited with the happiest results. In Svapnia, there is retained all the Morphia and the greater part of the Codeia and Narceia, but combined with the native acids of Opium, meconic and thebolactic, in such a manner as to render those constituents soluble and active. Svapnia is uniform in its proportions, and is prepared to conform to a standard of Opium representing ten per cent, of Morphia. This is done by a simple proportion of the neutral excipient, after determining the actual amount of the alkaloids obtained from the Opium used. We may safely affirm that the danger of bad results is much diminished by a resort to that preparation of Opium, in which the poisonous elements are eliminated, and the anodyne elements in such a state of combination, as to reduce their toxic, and enhance their hygienic effects, such as has been proved to be the case with Svapnia. SOLE AGENTS: K.IDDBR. dt LAIRD, 83 John Street, Neiv York. Office New York Medical Abstract, 93 Fulton St., New York. 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