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to Dr. Hammond's description of Convulsive Tremor, and I soon became satisfied that my patient was suffering from that disease.
As regards what shall be called Convulsive Tremor; what are its causes, what its morbid anatomy, and what its pathology, I shall quote a few of the Considerations of Dr. Hammond; for so far he has hardly expressed positive opinions on the subject. His treatment is fully set forth in his work to which I have previously alluded. The treatment adopted in my own case will be presented presently.
Dr. Hammond says: "Under the designation of Convulsive Tremor, I propose to include all those cases of non-rhythmycal tremor or clonic convulsive movements which are unattended with loss of consciousness, but which, nevertheless, are paroxysmal in character," p. 696. Farther on, he concludes that "convulsive tremor is an affection characterised by clonic convulsions affecting the voluntary muscles and unattended by loss of consciousness or by mental aberration, though sometimes there is emotional disturbance." * *
The causes he believes to be obscure, as a rule, though in some of his cases alcoholic and sexual excesses were the apparent provocatives of the attacks.
The morbid anatomy and pathology of the disease he considers to be "an irritation of the nerve-centres in the cortical substance of the cerebrum, conjoined with an hyperæsthetic condition of the medulla oblongata and upper part of the spinal cord." p. 705. And again, he says: "The morbid anatomy of the affection under notice is entirely a matter of supposition, and indeed there are not many data for forming an opinion relative to the essential nature of the structural alteration. So far as we can judge from a consideration of the phenomena, the seat is in the cortical substance of the brain, and in the medulla oblongata and upper part of the spinal cord. The disturbances of the respiration and circulation point to these latter organs as a part of the anatomical substratum." p. 707.
The treatment in the case reported was, in the beginning,
tincture of Gelsemium, min. x, in a tablespoonful of water. This remedy was continued in five-minim doses every halfhour for four doses.
I continued the remedy for another twenty-four hours in minim-doses every two hours. The bowels were greatly constipated, and failing to relieve them by the common enema of water, brown soap and castor oil, the compound liquorice powder, zi, to which Merrill's leptandrin, gr. v, was added, was administered and acted well. After this the bowels were kept soluble most of the time by the enema just mentioned. The diet consisted principally of milk and broths. As the paroxysms recurred I resorted to the bromide of sodium in doses Ji to ij, until the attacks ceased to recur. On the 10th day of the sickness I prescribed as follows: R.-Ergotine (Squibbs), grs. xxx; Ext. Quassia, grs. xxxv; Bromide of Zinc, grs. xlv. M. Make pills No. xxx. One of the pills was taken at 7 A. M., I and 9 P. M. In the after attacks, during the paroxysms, the pills were discontinued and the bromide of sodium was administered as in the first attack, with Gelsemium in alternation in ten-minim doses until the physiological effect was produced on the eyelids if so much was needed. The permanent treatment was the bromide of zinc pill, and the cure apparently is complete.
BY V. A. BAKER, M. D., Adrian, Mich.
In the beginning of this discussion I cannot but remark that all diseases are self-limited. I suppose, however, that it is expected that this paper will define that class of maladies that have a stage of incipiency, of excitement and decline, leaving the patient, within a limited time, free from the influence of the same, circumstances being equal.
To this order belong the whole family of acute diseases that are governed by fixed laws, especially exanthemata; the
system receiving the germs contagiously or infectiously, being governed by almost exactness in passing the several stages to recovery or death.
Measles, for example, are uniformly ushered in from ten to fourteen days after exposure, a stage of excitement then coming on, fever, blotched skin, mottled look, weak eyes, cough and a uniform set of concomitant symptoms, lasting a uniform time-four to six days; then marked by a gradual decline of symptoms and recovery, in favorable cases. We might say as much of scarlet fever, small-pox, chicken-pox, etc., so far as uniformity in symptons are concerned. There seems to be and probably is, from the time of exposure ("period of incubation") to the time when the initial chill and following fever occurs, a condition that may be compared to leaven that, however little in the beginning, finally "leavens the whole lump" -a sort of ferment, that arriving at a certain pitch, so to speak, provokes the strainerage of the body to unusual activity, to expel the offending cause, the irritable quality of which produces the specific influence upon the skin, and also the irritable cough, congested eyelids, etc.
In scarlet fever the law varies quite noticeably, both as regards period of incubation, skin symptoms, absence of inflamed eyelids, etc. In scarlet fever usually the fourth day from exposure ushers in the symptoms, as sore throat, rigors, vomiting and often delirium.
Small-pox presents another class of symptoms; fever, back-ache, bones-ache, headache, vomiting, etc.; eruption occurring on third day of fever, differing from either scarlet fever or measles, being more prominently expressed papilla, more elevated, the body covered more or less with a crop of pustules very prominent, each malady being governed by a well-defined law, differing as to time of incipiency or incubation-time when fever appears, declines, etc.—showing that each affects the system differently from the other. According to modern conjectures in pathology, each disease must be caused by different spores from the great baccillus family, and without discussing this matter, or even assuming to know, I may, perhaps, not be considered far astray with my subject if
I merely express it as my opinion, founded on observation, investigation and thought, that the present craze in this direction is out of proportion to the modicum of base underlying the truth in the matter. At least I would much sooner accept the parasite as a sequel than a cause in considering all selflimited maladies where blood-poisoning symptoms occur.
Constitutional tendencies, or idiosyncrasies, must account for the difference in the severity of contagious and infectious diseases. As a rule, mild and severe cases contrasted, although circumstances may convert a mild case of exanthemata into a severe one, nevertheless, it cannot be denied and careful observers will confirm the statement, that there are persons so constituted that they may be compared to the torch applied to material moderately combustible or highly so. Poison ivy, poison sumac, etc., will in some instances produce symptoms akin to aggravated erysipelas in persons with the right tendencies; while others may handle it with impunity. I know of individual cases of this type-persons who contract the poison-ivy erysipelas-like condition several rods away from it, if the wind blows the pollen into contact with them; while others will only be endangered by actual contact, and still others are not susceptible to its influence in any manner.
There is, then, much to learn regarding the cause of many common forms of disease, and much that is not properly attributable to the new theory, that micrococci or micro-organisms are the cause of all our troubles, but more likely a result. Every decaying pile of offal, subject to certain fixed laws, i. e., warmth, moisture and light, will soon teem with numberless parasitic creation, all of which seems to be wisdom in Nature's order to change death into life again, and decay, that would be a stench to the nostrils and an evil against physical life, into animate life again; so the physical decay of life's molecules, invaded by some subtile, invisible something we call by this or that name, is thus wisely invaded in the order of things it may be, thus shortening the disease by using up its products-products once exhausted, the life that fed thereon ceases, and all is eliminated from the system by its well
known regulating forces. Either this must be true, or where and how does the multiplied billions of parasitic life end?
If, in self-limited diseases of the order under consideration, the sporule is animate, a cause rather than a sequela, it seems to me that untoward cachectic constitutions could never recover, as multiplied cause of disease would be constantly furnished as new products to hinder recovery. Indeed, without this proviso, it seems upon surface-reasoning, that the human organism would soon become a mass of corruption. Be this as it may, all practical tests prove that suitable bases soon teem with life, and we know that, microscopically, a drop of water is an ocean of life and animation.
I have met, not unfrequently, persons who present themselves for treatment, with the statement that since they had measles they have never been well. They suffer from cough, and if they are ill, they often have a mottled appearance of the skin, fever, weak eyes, etc. I have at this time a patient in charge, who some years ago contracted small-pox, having it in the usual way. He had never been vaccinated, was unusually sick, but finally recovered; at least so far as confinement to the house was concerned, but was left in poor health and impaired digestion. The skin performed its functions abnormally, ulcerations occurring at intervals here and there, and healing in time to make way for others. Usually every spring, and sometimes in fall, also, he would be seized with rigors, fever a few hours, followed by a rash lasting a day or two, gradually fading, when he got better and was about again. He has been under the treatment of eminent men but never received more than passing benefit. I saw him at intervals during three or four years, treating him at times with no better result than my neighbors. Finally I decided to vaccinate him, and did so, using the first remove from an infant five months old, whose arm had been under my supervision from time of vaccination to filling of lymph-product, which I secured in the usual way and used on the subject under consideration. No marked peculiarities were presented. The second day after vaccination a slight elevation over the puncture was noticeable, with redness of skin, which spread slight