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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

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