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he says he saw a flash of light, and this was immediately followed by double vision and intense photophobia. At first glance, there is apparently a double ptosis, but the eyelids can be moved upward. Ordinarily they droop in an effort to protect the eyes. There is slight nystagmus and a decided paresis of the left rectus externus muscle. The pupils are irregular; they do not react to light, and but slightly to accommodation. The case had been re- ferred to him by Dr. Marple, who had found nothing, on ocular examination, to explain the photophobia. Further examination showed a very widespread and marked hemi-analgcsia, but no impairment of tactile sensibility. He had arrived at the conclusion that there is a large hysteric element in the case. The visual fields are nor- mal, the reflexes are normal, and there is no evidence of loss of power in the extremities. His diagnosis was hys- teric ophthalmoplegia. Dr. Fraenkel said that in a recent monograph hys- teric ophthalmoplegias of this character had been described. Aside from the clinical aspect of the case, its development after emotional disturbance is buy esidrix particularly significant. About six months ago a man, in very simi- lar condition, had applied for admission to the Montefiore Home. He presented ataxia, loss of knee-jerks, ptosis, and ophthalmoplegia. After admission, his ptosis and ophthalmoplegia disappeared, and the case clearly proved to be one of locomotor ataxia, the other symptoms having been hysteric, and added to the ataxic symptoms with a view to securing buy hydrochlorothiazide admission to the hospital. Dr. Leszynsky said it is important to distinguish be- tween ptosis and blepharospasm. In the case under dis- cussion there seems to be a certain amount of blepharo- spasm. With photophobia, tonic blepharospasm is much more likely to occur than ptosis. He had seen a number of such cases in hysteric individuals, and quite recently one in a young girl who responded promptly to hypnosis. Dr. Sachs then presented another case of ophthalmo- plegia, in a boy seventeen years old. In October, 1894, at 9 a.m., the patient had found himself unable to utter words. This had passed away, but had been repeated at noon and at 4 p. m. the same day. He then had a convulsion, lasting ten minutes, after which the left eye- lid had been hydrochlorothiazide tablets noticed to droop. There had been no con- vulsions since then. He had been perfectly well pre- viously. Examination showed complete ptosis of the left and slight ptosis of the right eye. The outward and inward movements were limited in single and conjugate action ; both pupils reacted well to light and accommodation ; the sensation of hydrochlorothiazide cost the face Was normal. There had been com- paratively little change in the past three years. There is now diplopia, chiefly when looking to the left. The diagnosis lay between thrombosis or embolism in the basilar artery. The heart action is irregular and rather rapid, but no murmur is audible. Dr. Sachs also presented a man, thirty-nine years of age, who had been admitted to the Montefiore Home some time ago. cheap hydrochlorothiazide There was no evidence of syphilis. At the age of twenty he was weak in the purchase hydrochlorothiazide online knees and frequently made missteps. In 1887 he had sought medical advice because of difficulty of locomotion, noticed especially in climbing stairs. When buy hydrochlorothiazide online examined in March, 189$, he complained chiefly of difficulty in walking, weakness in the extrem- ities, and slight difficulty in speech. At first, the case was supposed to be buy cheap hydrochlorothiazide one of locomotor ataxia. He now has an ataxic spastic gait, and also has static ataxia; the pupils react to light and for accommodation; the patellar reflexes are absent. There is no Argyll-Robert- son pupil. generic hydrochlorothiazide There is distinct ataxia of the right upper ex- tremity. He has a form of speech which is between a slow speech and a bulbar speech. The diagnosis lies between a bulbar form of multiple sclerosis and the pos- sibility order hydrochlorothiazide online of a Friedreich's ataxia instead of an ordinary tabes. The great point against the latter is its occur- rence rather late in life. There is no disturbance of sen- sation. The jaw-jerk is absent. Dr. Fraenkel said that although the lack of coordi- nation was first noticed when the patient was nineteen years of age, when his attention was naturally directed to it by entering the army, it was not improbable that it had been present long before. There was also slight atrophy of the optic nerves. The absence of sexual and sphincteric disturbance, and the peculiar thick and scan- ning speech seemed to point rather to the hydrochlorothiazide mg diagnosis of multiple sclerosis. Dr. Collins order hydrochlorothiazide hydrochlorothiazide price said that when he had first seen the Digitized by Google 542 REVIEWS. [Medical Newt man, three years ago, the intention-tremor and the optic atrophy had not been present, and it was then thought that the man had Friedreich's disease. In the last two years the speech had become very much more esidrix or zaroxolyn bulbar in quality. He was inclined to believe that there was a dif- fuse hydrochlorothiazide online insular sclerosis, bulbar and spinal. Dr. Hirsch said that even at the present time there is not a perfect purchase hydrochlorothiazide agreement as to what constitutes the pathologic basis of Friedreich's esidrix 25 mg disease. The case seemed to him like the spinal form of Friedreich's dis- ease. Dr. Sachs said that the term "Friedreich's disease" is at the present time usually applied to the ordinary

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