in some cases of hemiplegia the two varieties may be found coexisting, the affected limbs jerking more or less violently during excitement, at other times the hands only being the seat of the slow movements as he described them. The third variety is called hemi-paralysis agitans, and in it there is a limited movement of the fingers and thumb in frequent but rhythmical oscillations which persist during repose. The movements become larger during voluntary action, so that the whole limb may be put in motion, in the same way as in true paralysis agitans. In the fourth variety the movements are similar to those of the third except that the oscillations cease when the limb is at rest. This form is called hemi-sclerosis in patches. Finally, we have a variety characterized by incoördination during voluntary action, and termed hemiataxia. It may occur as a symptom without the existence of any involuntary movements, and is probably present to a greater or less extent in the four preceding varieties of movement whenever the cerebral lesion interferes with certain sensory nerve fibres. He summed up his subject by saying that lesions from any of the causes before mentioned, occurring in any part of the motor tract from the cortex above to the commencement of the spinal cord below, may be the cause of any of the varieties of symptomatic hemichorea. 112 Küssmaul112 reports the case of a girl 10 years old who had from her birth movements of athetosis involving both sides, hands, fingers, feet and toes. These were usually clonic, but occasionally became tonic. The feet often assumed, in consequence, the position of equino-varus. Other neurotic symptoms were absent. The contractures were not dependent on paralysis of antagonistic muscles, but were an expression of athetosis. Bilateral Athetosis.-Hughes,113 of St. Louis, has reported a unique case of bilateral athetosis. This boy had not complete voluntary control over the movements of his muscles; that is, he could not by direct effort of the will, along the regular channels of nerve conduction, restrain either the rhythmical movements or the spasmodic attitude assumed by the fingers; but he could, by strategy, modify both attitude and movement, by bringing one limb to bear upon another and assuming for the affected limbs flexed positions; but no matter how much he succeeded in managing these movements, grotesque attitudes would always be assumed by one or more of the fingers. His affliction unfitted him for any occupation requiring manual dexterity. He tried a number of things, but had to give them up because of physical incompetency. This young man had no history of epilepsy as it existed in most of Hammond's cases; never had convulsions nor chorea in infancy, nor is there any evidence or history of genuine hemiplegia. The case appears to be in every way a distinctive symptomatic one, even more fully sustaining Hammond's claim for this disease as a distinct pathological entity than this author's own recorded cases. The following is briefly the history of this case: George E. M., aged 20, American born, about nine years ago met with an accident on the railroad, causing injury by concus sion and direct violence. He was taken from the wreck in an unconscious state, but remained so for a few minutes only. He had two ribs broken, and was hurt in the lower dorsal region, but not seriously enough to affect the functions of bladder, kidneys, or bowels, or the power of moving the lower limbs. He was able to go out within six weeks after the accident, but had an incomplete brachial monoplegia. About one year after the accident contracture of the left forearm on the breast appeared, and embarrassed movement of the right arm set in, so that he could not throw a stone easily or project it far from him. He "threw like a woman," he says, and could not make a full rotary movement. About four years ago, long after he had fully recovered the general use of the upper extremities, irregular contractions first appeared in the fingers and flexors and extensors of the arms and forearms. About one year ago the left arm grew worse, and the right arm became useless for three months and had to be carried in a sling. SNAPPING FINGER (DOIGT À RESSORT). 114 Eulenburg reports two cases of this interesting affection. One of these was a man who was affected in the ring finger of both hands. The cause was supposed to be the pressure of his gun upon the tissues at the base of the finger. An induration was caused in the tendon, which being alternately held and suddenly released during flexion and extension caused a sudden jerking movement. The second case was a compositor, in whom both thumbs and both little fingers were affected. The phenomena. were similar to those in the first case. Eulenburg directs treatment to (1) reducing the induration, (2) to widening the sheath. The first indication is met by baths, poultices, iodine, compresses, massage and electricity; the second by fixing the fingers midway between flexion and extension, in order to widen the sheath by prolonged pressure of the indurated part. This treatment is painful. It may be combined with massage, local beating, and electricity. He does not recommend surgical interference. 115 Mesinger reports a case which he calls "snapping finger and describes as follows: The thumb of the left hand of a workingman was jerked or snapped, evidently in the inter-phalangeal joint in both flexing and extending. A little protuberance could Cough. PERIPHERAL NERVOUS DISEASES. 177 be felt on the tendon which was held by the narrow sheath, thus causing a snapping or jerking movement. The sheath was cut in the region of the swelling, which was pared down, and the wound sutured. After healing, the cure was complete. PARAMYOCLONUS MULTIPLEX. Kowalewski11 reports a case of this novel neurosis in a woman aged 34, after a nervous shock. The symptoms were symmetrical, tic-like, and even tetaniform convulsions of whole muscles in the extremities, back and neck. The facial muscles were not affected. The intensity and extension of the convulsive phenomena varied, so that there were good and bad days. They were weakened during voluntary power and ceased during sleep. Patient had also giddiness, anxiety and weakness of memory. The reflexes were increased. After three weeks' treatment by galvanism of the cord and sympathetic system, and cauterization along the column, with nourishing diet, a cure was accomplished. He regards grave psychical shock in the neuropathic constitution as the most important etiological factor in these cases. He also thinks that the disease is not so rare as it is sometimes considered, but that it may have been confounded with tic convulsion or chorea major. He regards the symmetry of the affected muscles and the exemption of the face-muscles as pathognostic. Starr118 described another case of this affection, with valuable comments. NERVOUS COUGH. Bresgen 120 makes the following observations: No local cause exists for these nervous coughs; no local treatment, however careful, has been able to cure them. The psychic treatment must be enforced. Rosenbach believes that the cough can always be traced back to a local cause, which disappearing leaves this cough. It is probable that these local causes, coexisting with a weakened state of the general health, are the real cause of the affection. Hence in treatment attention must be paid to the general health, especially to warmth, to bathing, etc. THE PATHOLOGY OF DISEASES OF THE NERVOUS SYSTEM Singer says that neuralgia, paralysis and aphasic affections (?) are the most common disorders due to this cause. The typical appearance, their disappearance with decrease of the fever, and the favorable influence of quinine prove their connection with malaria. Disorders of the central nervous system, as paraplegia, acute ataxia, or of the peripheral system, as neuritis or polyneuritis, are less noted after malaria. When they do appear, it is apt to be in the period of convalescence. He gives a case of acute polyneuritis following severe malarial infection in a man æt. 26. He contracted in Singapore what appears to have been a malarial remittent fever, not amenable to quinine, but which was cured by a resort to a high altitude. Returning to Singapore, he had paræsthesia in the toes, followed by complete paraplegia. At the same time sensory and motor disturbance appeared in the arms, followed by facial paralysis on both sides. There was no fever, no cerebral phenomena, and no affection of sight and hearing. Improvement took place under galvanism, sulphur baths, iodide of iron, and a journey through the Desert, until he had almost recovered when scen by Singer. WAKING NUMBNESS. Aulde22 reports four cases which had come under his own observation. A gentleman in the vigor of manhood, experienced when waking in the morning, or, in fact when waking out of sleep at any hour of the day, numbness and tingling which lasted for a minute or less, but after which everything seemed to adjust itself. In the second case the patient suffered from numbness and tingling in the fingers, so that she was unable to fasten her clothing in the morning, and it was afternoon before she was able to pick up a pin or a needle. The third case was a widow, aged 47, who believed she was threatened with paralysis, having suffered for some time with this peculiar sensation of dumbness and tingling. The fourth case was a married lady, aged 40, who after quinsy requested him to advise her concerning an unpleasant sensation which she had experienced for several years. A numbness, tingling and pricking sensation in the fingers of both hands, made its appearance at almost any time in the day, sometimes at night when she awoke, and occasionally in the morning. Dr. Aulde for his cases gave iodide of potassium and carbonate of ammonia in combination. Dr. Mitchell123 speaking of this class of cases, says that the disorder may be a mere tingling or actual loss, or lessening of tactile sensation; but in any case it |