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Related post: chronic and possibly subacute periods. When one February 15, 1913.] WILLIAMS: CRAMPS IN PSYCHASTHENIA. 333 preparation seems to have failed, the other should be tried, serum or bacterin, as the case may be. I have lately been using larger doses, especially of the bacterin, with apparently better results. If time bears out this observation, it will be analogous to that in the case of diphtheria, namely, that the larger doses of antitoxine succeed when the smaller ones fail. In Avalide 300 25 Mg this connection I recall the case of a man with double, chronic, relapsing seminal vesiculitis, so severe as almost to constitute an acute attack dur- ing each relapse. He preferred to postpone Fuller's operation of double seminal vesiculotomy. I there- fore began to give him gluteal, intramuscular injec- tions of autogenous bacterin, 400 million organ- isms at a time, at first every other day, then twice a week, and latterly once a week. Up to the pres- ent time the man has received about forty injec- tions. His prostate, vesicles and testicles have all returned virtually to normal and no relapse has been even suggested by symptoms. I purpose ex- ploring his deep urethra with the urethroscope very shortly. For this reason I can make no note of findings now. I have endeavored to touch upon the indications of acute urethritis in the matter of treatment from the standpoint of anatomical, physiological, patho- logical, and bacteriological data rather than from the data of mere lists of drugs or formulas avail- able. This seems to have been the best plan of approaching an old subject because, if one carries in mind clearly what is going on in a definite part of the urethra and its annexa during acute gono- coccal infection and its complications, the selection of the drugs or of the means of treatment is rela- tively easy. One rule, however, should be followed, that of observation, gentleness, and conservatism. "When in doubt do nothing," is a very safe axiom in gonococcal infection. 45 West Ninth Street. MULTIPLE PROFESSIONAL CRAMPS IN A PSYCHASTHENIC. Psychoanalysis and Treatment. By Tom A. Williams, M. B., A. M., Edin., Washington, D. C, Neurologist, Epiphany Dispensary; Corresponding Member, Paris Neurological Society, etc. The history which follows shows and explains the origin of writer's cramp, which, like that of all truly occupational dyscinesias, is psychological. Although, on account of marked scrupulosity and anxiety, the patient was regarded as a psychas- thenic and the cramps were interpreted as tics, yet she presented many symptoms distinctly hysterical in mechanism. The proneness to suggestions of Avalide Hct medical source on the part of so many individuals is seen, and the inconveniences of such suggestions are strikingly revealed. Their tenacity in this case should furnish a warning to medical men against the danger of giving to patients false notions regarding disease, their bodies, and minds. Finally, the relative unimportance of the sexual factor in the genesis and cure of her disabilities is maintained in the analysis and supported by the success of the precedures employed in treatment. The importance of an Buy Cheap Avalide understanding of psycho- pathology for the treatment of such patients (shown by the previous failures of skilful physical therapy in this case) is not diminished by the need also for careful management of the bodily functions, in or- der to give the highest efficiency to the instrument, the brain, which carries out the trying psychomotor discipline required for the reeducation of such per- sons. Case. F. S., single woman, aged twenty-nine years, was referred, April 10, 1910, by Dr. John Dunlop after the failure of orthopedics and massage to improve an inca- pacity Lo write, apparently due to a painful stiffness and cramp of the shoulder and wrist of two years' duration. Several months in the country had also failed to remedy the cramp, although she had gained ten pounds in weight and became much stronger. Physical examination revealed no organic disease. She was left handed, as was her brother's daughter of two years. The muscles were strong and respiratory capacity was ample; and in spite of hypotonia, there was no im- pairment of movement, either in extent or force. More- over, contractions could be maintained for thirty seconds without fatigue. But in the act of writing, the wrist stiffened, the fore- finger and thumb tightened up on the pen, the hand trem- bled, and she complained of severe pain in the wrist and between the first and second metacarpal bones. There was not the decided deformity of attitude so often seen in cases of professional cramp : indeed the hand was held in a fairly good writing position, except for a rather too great extension and radial adduction of the wrist. She declared that she was prevented from writing rather by the pain than by the tremor or stiffness. She did not have the great difficulty of voluntarily re- laxing the limbs which I have found in so many cases of professional cramp. It was only in the right shoulder and arm that there was some lack of perfect freedom when passive movements were imparted. There was, however, at first, some uncertainty in performing directed tensions and relaxations of the lower limbs. But I could not sat- isfy myself that this was not due to embarrassment and imperfect comprehension Avalide Cost of what was desired. The deep reflexes, especially in the lower limbs, were very active, and there was a false clonus. The muscular tonus, especially of the arms, was poor. She had cold and clammy extremities and there was a slight tremor. There was a dry eczema in the left axilla. Sensibility was normal. She had always been much constipated, with a capricious appetite, which had latterly been ravenous. Every few Related links: Bactroban Nasal Ointment For Mrsa, Sinemet Cost, Zyvox Cost, Cheap Amoxicillin, Rhinocort Coupons, Purchase Coversyl, Generic Glyburide, Where To Buy Minoxidil, Purchase Finax Online, Clotrimazole Buy
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