479 — 
t 
the third day notwithstanding the fever had fallen and the he- 
morrhage ceased she miscarried. This was followed by hemipa- 
resis of the right side, accompanied by partial aphasia which was 
for the most part sensory. In about a month the patient recovered 
from this paralysis but there remained for a long tlme a State of 
psychical weakness with great excitability and a group of symp- 
toms recalling the phenomena of disseminated sclerosis. A com¬ 
plété cure was finally effected. 
1 hâve recently had the opportunity to observe a case. A brief 
history follows ; Mrs B..., female, aged 22, married, nullipara, a 
native of West Virginia, has been living on a shanty boat in 
Eastern Arkansas for three years. The cause of her father’s death 
is unknown ; her mother died of heart disease. The patient had 
typhoid fever complicated with pneumonia when a child and has 
had chronic otitis media on the left side since babyhood. For 
about five years she has had chills during both summer and 
winter at intervals not exceeding one month. During the summer 
of 1907 while she was having a sériés of chills purpuric spots ap- 
peared ail over the body and the sanie time hemorrhages began 
to occur from the mouth and nose. The bleeding from the mouth 
was abundant and during the night would saturate cloths placed 
under the head and soak through to the pillow. During the day 
she was constantly spitting blood. The épistaxis was not so pro¬ 
fuse. As the malarial paroxyms would abate the hémorrhagie 
symptoms would gradually disappear to return again with the 
onset of the chills. The menstruation has been very irregular 
for the past few years being sometimes scanty, at other times, 
especially when the purpuric symptoms were in evidence, exces¬ 
sive. When I first saw her on April ist. 1908, she had just reco¬ 
vered from the effects of a hemorrhage from the mouth and nose 
sufficiently to make the trip to the office. She was pale and the 
abdomen distended so that she appeared to be about six months 
prégnant. The entire body was covered with petechiæ and ecchv- 
moses, and petichiæ were to be seen upon the mucous membrane 
of the mouth ; the tongue looked pale and anæmic. The puise was 
110 and very soft and compressible; the température was 97°5. 
The first sound of the heart was scarcely audible. The spleen 
which was very hard, reached beyond the umbilicus and to the 
anterior superior spinous process. The patient was verv nervous 
34 
