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rapidity, so as to reach, in three or four days, to one centigramme, or one centigramme and a half in the child, and to two or three centigrammes in the adult. This rapid mode of administration is better than the long continuance of small doses, because the economy habituates itself to the latter, and the therapeutical effects may be lost; and this proceeding has the additional disadvantage of leading more easily to the saturation of the economy, and consequently to intolerance. If a cure does not take place in a short time, on the plan recommended by M. Aran, namely, by the rapid administration of increasing doses, or if there are not any favourable changes in the disease, then the arsenic does not agree with the patient, and it must be discontinued, and some totally different medicine substituted.
For the reasons already given, M. Aran does not approve the practice of continuing the use of arsenic for a long time in small doses. It may have been harmless in a certain number of cases, but this does not prove its utility. In conclusion, he observes that the arsenical treatment is undoubtedly efficacious in a certain number of cases of chorea; that it appears especially applicable to obstinate and anomalous cases of that disease; that nothing proves that it may not be employed with advantage in the treatment of simple and recent cases; that, employed prudently and cautiously, it does not produce any serious symptoms; and that the cure, when it takes place, is generally obtained in a very short time. Such," says M. Aran, "are the considerations which, as it appears to me, ought to recommend this treatment to the attention of the medical profession; I do not hope that the prejudices of physicians will completely disappear before so small a number of cases as I have just related; but let them try the remedy, and if they meet with results similar to those I have recorded, they will arrive, like myself, at the conclusion that this medicine is one of the most remarkable therapeutical weapons we possess against a very serious and obstinate disease."
XVII. On the Influence of Mercurial Preparations upon the Secretion of Bile. By Dr. GEORGE SCOTT. (Beale's Archives of Medicine, No. 3.)
Dr. Scott relates the details of some experiments made on dogs, with the view of ascertaining whether the preparations of mercury really increase the flow of bile, as has hitherto been generally believed. In these experiments the ductus communis choledochus was tied, so as to prevent any bile from reaching the intestine, and the gall-bladder was opened in order to allow all the bile secreted to escape externally. It was then collected in an apparatus constructed for the purpose, and calomel being given at different periods, the quantity of the bile secreted was carefully noticed. In the first place, however, Dr. Scott ascertained the normal amount of bile secreted by a dog's liver in the twenty-four hours. The quantity amounted on an average of three days to 2752-562 grains of fluid bile each day, the average weight of the dog being seventeen pounds, and the average amount of food being 7000 grains, and of drink nineteen ounces, or 8312·5 grains of milk.
In determining the effects of calomel on the secretion of bile, Dr. Scott calculated the average amount of bile secreted in twenty-four hours two days previously to the administration of the drug, and then the average amount secreted in twenty-four hours two days after the calomel was given. calomel was given each time after the morning's bile was collected, and therefore the effect of the medicine was upon the bile of the day following that on which it was given. The four experiments performed by Dr. Scott all gave the same rather paradoxical result-namely, that there was a diminution in the amount of fluid bile and bile-solids secreted after the administration of large doses of calomel.
Although Dr. Scott considers that it would be rash to venture any decided opinion from the results of four experiments, yet these all point so much to one conclusion, that if they should be confirmed by future and more varied trials, they will throw considerable doubt upon the generally-received opinion that calomel in large and purgative doses increases the flow of bile. It may be urged, he adds, that although calomel does not increase the secretion of bile in the dog, there is no reason why it may not do so in man, and that even if mercury does not excite the liver to increased secretion in a healthy state of the organ, it may yet do so in some of its diseased conditions. But if the first objection were true, the same could be urged against the results of experiments on the lower animals to ascertain the action of poisons or any articles of the materia medica. With regard to the second objection, nothing analogous occurs in the action of drugs upon other organs, and it seems difficult to suppose that anything which diminishes the flow of bile in a healthy condition of the liver, should increase it in a diseased state of that organ. Whether it be the mere purgative effect of calomel which causes the diminution in the secretion of bile, or some specific action, must be decided by further experiments. It is also a matter for further inquiry, whether small and frequent doses of calomel continued for a length of time, so as to produce the specific action of mercury upon the system, may not really augment the biliary secretion.
XVIII. On the Use of Raw Meat in the Colliquative Diarrhoea of Children at the Breast. By Dr. J. F. WEISSE, Director of the Children's Hospital at St. Petersburg. (L'Union Médicale, April 7th, 1859.)
Seventeen years have passed since Dr. Weisse drew the attention of the profession to the beneficial effects attending the use of raw meat in the treatment of the colliquative diarrhoea of children at the breast, and since that time numerous writers have confirmed the views originally advanced. Dr. Weisse now declares, after an experience of twenty years, that raw meat, reduced into a pulp by scraping, to the exclusion of all other treatment, is the true specific for this destructive form of diarrhoea. He cannot agree with the remarks of Mr. Charles Hogg, who recommends beef-tea in preference, for he finds in raw meat not only an aliment for the children, but also a remedy for the kind of diarrhoea in question; besides, he has never spoken of the juice of the meat, but has recommended the muscular substance itself, minced or scraped, so as to be swallowed and digested without difficulty. The object proposed is to introduce into the digestive tube the muscular substance of the meat, and the beef-tea has no controlling power over the diarrhoea, for by its mere fluidity it traverses too rapidly the intestinal canal. By giving the meat in a pulp, the solid parts remain longer in the intestine; they act by contact, and may, by exciting the intestinal mucous membrane, stimulate absorption; and it is probable also that this plan may contribute to neutralize the acidity of the gastric juice. The treatment of children's diarrhoea by raw meat has become general at St. Petersburg, and has been adopted rather by the establishment of the good effects which have resulted from it than by the publication of special memoirs. Dr. Weisse has employed the treatment in nearly 200 cases, and the result has been always satisfactory when the case has been taken in time. When the disease is too far advanced, and has assumed the character of gastromalacia, a cure is seldom obtained; but even in such circumstances it is possible to mitigate some of the symptoms felt by the patient, such as the inextinguishable thirst and the vomiting.
QUARTERLY REPORT ON PATHOLOGY AND MEDICINE.
By EDWARD H. SIEVEKING, M.D.
Fellow of the Royal College of Physicians, Physician to, and Lecturer on
I. On Cerebral Deficiency and Hydrocephalus. By Professor R. HESCHL, in Cracow. (Prager Vierteljahrsschrift, xvi. Jahrg. 1859, Erster Band, p. 69.)
PROFESSOR HESCHL has observed four cases of deficiency of the central gyri of the brain and of the adjoining parts. The first case occurred in an idiotic beggar, who died at the age of twenty-six, who had only had an imperfect power of executing the ordinary movements, and whose range of speech had been very limited. His left side was more powerless than the right. The right parietal bone bulged out, the most prominent parts being reduced to from one-half a line to one line in thickness, while the remainder of the cranial vault was from two to two and a half lines thick. The left cerebral hemisphere and its membranes were essentially normal, nor was any malformation perceptible in the cerebellum, medulla oblongata, and spinal cord. In the right cerebral hemisphere the whole middle portion of the centrum ovale, together with the convolutions appertaining thereto, both on the surface and at the Sylvian fissure, were absent, so that on removing the dura mater one at once looked into the patulous lateral ventricle. The space was occupied by a large bladder with very thin parietes, containing about a pint of clear serum. This bladder evidently consisted of the distended internal cerebral meninges of the defective portion; it was in close proximity externally with the dura mater, and was intimately united to the arachnoid and pia mater of the remainder of the hemisphere. The right corpus striatum and thalamus opticus was smaller than those of the left side; the septum was perforated at two points. The tissue of the brain was otherwise healthy, and nowhere showed any extravasation or traces of inflammation.
It is unnecessary to give the further details of this case, or to specify those of the remaining cases, which in their essentials are identical with the first. The author sums up the conclusions to which he is led by the analysis of these cases as follows:
1. Idiots affected with hemiplegia exhibit a congenital defect in the brain, which gives rise to a communication between the lateral ventricles and the sac of the arachnoid. He terms this defect porencephalia.
2. This porencephalia is always associated with other defects in the formation of the hemispheres.
3. Porencephalia is probably not an arrest of development, but a true disease occurring during the growth of the brain.
4. It is sometimes associated with hydrocephalus, but as little as other cerebral defects explicable as the effect of intra-uterine hydrocephalus.
5. Intra-uterine hydrocephalus is probably the consequence and not the cause of numerous malformations of the brain.
II. On Partial Hypertrophy of the Brain. By GIACOMO SANGALLI. (Gazz. Lomb. 30, 1858, Schmidt's Jahrb., Jahrg. 1859, No. 4.)
Some doubt existing as to the reality of partial hypertrophy of the brain, and such cases at all events being very rare, the following deserve attention. It is right to add that we have not seen Dr. Sangalli's own account nor his illustrations, we therefore give the cases without further comment :—
1. A youth, aged nineteen, well formed, with unimpaired mental powers, had been out of health for some months; this became worse, and after a fortnight's serious illness he died comatose and icteric. The autopsy revealed acute yellow atrophy of the liver. The dura mater was yellowish, the pia mater normal. Convolutions of usual size; no change in the vascularity, consistency, or colour of the brain. On exposing the centrum ovale, the surface of the corpus callosum was found abnormally curved, with its convexity upwards. In the lateral ventricles there was a drachm of clear serum, and the left thalamus opticus was manifestly much larger than the right one, which was of normal size. The left thalamus retained the usual form; its long diameter was 47 millimetres (1.83 inch), its transverse diameter at the thickest part was 27 millimetres (1.05 inch), while the corresponding dimensions of its fellow were 37 (144 inch), and 18 millimetres (0.70 inch). No material change was observed in the tissue of the part. The author is of opinion that the condition must have been congenital, or have been developed soon after birth, because there was another congenital defect-viz., material contraction of the entire aorta.
2. A peasant, aged twenty-seven, died of pleuro-pneumonia. On raising the anterior half of the brain a protuberance was discovered, connected with a convolution of the posterior part of the left middle lobe. It was of the size of a small hazel-nut, shaped like a wart, rather softer than the cerebral tissue, not covered by pia mater, which ceased abruptly at the commencement of the projection. The grey investment (of the protuberance) was 1 millimetre (0.039 inch) thick, and passed into the adjoining grey cortical substance; the subja cent medullary matter was normal. The microscopic examination showed few nerve fibres with double outline, many fine fibres of cortical tissue, and between them molecular granulations, nuclei with nucleoli, and some transparent nerve cells without remarkable prolongations. The other portions of the brain were perfectly normal, and neither the dura mater covering the protuberance, nor the bone above, were in the least altered. The man had never exhibited any cerebral disturbance.
3. A man, aged sixty, had died of severe diarrhoea, accompanied by severe abdominal pain, without manifesting marked cerebral disturbance. There was extensive suppurative enteritis, besides other abdominal lesions. In the brain was found an oval white-grey transparent body, of the size of a small bean, and with a smooth surface, situated on the middle of the right corpus striatum, external to the tænia semicircularis. Its longest diameter corresponded with that of the part from which it was developed. It was invested by a thin membrane traversed by delicate vessels. The tissue of which it was composed resembled the brain of a child; exhibited nothing to distinguish it materially from the remaining cerebral tissue, and like it, was traversed by capillaries. No other abnormity could be discovered in the brain, but the larger arteries exhibited a medium degree of fatty degeneration.
III. On the State of the Mental Powers in Chorea. By M. MARCÉ.
In a memoir, read before the Academy of Medicine, on the above subject, the author advances the following conclusions:
1. The moral and intellectual functions are very commonly affected in choreic patients, at least two-thirds show some affection of the kind; the immunity enjoyed by the remaining third cannot be explained either by the age or the sex of the subjects, by the acuteness or chronicity of the disorder, nor by the extent or intensity of the convulsions.
2. Four morbid elements, which are sometimes isolated, but most fre quently associated, should be studied together in the mental condition of chorea patients.
a. Derangements of the moral sensibility, consisting in a notable change of character, which becomes irritable and capricious, and may be unusually animated, but is more frequently depressed.
b. Derangements of intellect, characterized by a loss of memory, by too great a flow of ideas, and by the impossibility of fixing the attention."
c. Hallucinations which occur in the state intermediate between sleeping and waking, rarely in the morning and on waking; these hallucinations are commonly limited to the sense of sight, and rarely extend to hearing or general sensibility; they occur most frequently in hysterical subjects.
d. Chorea may from its commencement be complicated with maniacal delirium ; this frequently terminates in death, or, if recovery takes place, intellectual disturbance remains.
IV. Cases illustrating the Pathology of Mental Disease arising from Syphilitic Infection. By JOHN B. CHAPIN, M.D. (The American Journal of Insanity, Jan., 1859.)
The author argues that the defective nutrition of the brain resulting from the syphilitic diathesis perverts its healthy nutrition in such a way as to induce insanity. The perverted nutrition induced by the long-continued action of the morbific cause, the loss of sleep, the pain and other circumstances accompanying constitutional syphilis, cause, first, a change in the temper, affections, and morals of an individual, which gradually pass into the graver forms of mental disease. The mental disease may not alone arise from the effects upon the brain of this general cachexia, but from a direct syphilitic affection of some of the intra-cranial structures. "The fibrous structure of the dura mater, the fibro-serous tissue of the arachnoid; the periosteum and the cranial bones, are severally and collectively liable to syphilitic inflammation, presenting in itself no different characteristics from those observed when fibrous structures in other parts are affected. Yet, from their proximity and the relation they hold to the nervous mass, no serious lesion of either can occur without influencing the latter." The author dwells upon the effects of syphilitic inflammation upon the dura mater, as the part most frequently involved; he has no cadaveric evidence to offer, however. His views as to the pathology of some forms of mental disease are supported by a series of cases, partly culled from his own experience, partly from that of other writers, in which the subsidence of the mental alienation was coincident with the effect of the mercurial or other treatment directed towards combating the syphilitic symptoms which had manifested themselves.
V. On Ataxie Locomotrice Progressive. By Dr. DUCHENNE (de Boulogne). (Archives Générales de Méd., Jan., Feb., March, April, 1859.)
In our last number (p. 530) we gave a brief summary of Dr. Duchenne's first essay on the disease to which he has given the above name. He continues the subject in detail in the four first numbers of the Archives of the present year. Those who have read our short abstract may have felt that the disease described resembled in its symptoms what has been described as tabes dorsalis; Dr. Duchenne adverts to the circumstance, but observes that one cannot decide whether in tabes dorsalis the loss of balancing power depended upon a loss of sensibility or a lesion of the psychical faculty which controls movement; besides, muscular weakness has been demonstrated in these patients, a circumstance that does not accompany the ataxie locomotrice, in which the muscular power remains intact.
Dr. Duchenne reserves his remarks about treatment for a future time; but