ple puncture; and (6) section of the sciatic nerve. In guinea-pigs treated in any one of these various ways irritation of certain epileptogenic zones produces convulsions. Similar experiments were made by Westphal and Obersteiner, who were able to confirm Brown-Séquard's observations. The latter also maintained that the offspring of epileptic animals were epileptic and had certain defects of the toes corresponding to those produced in the parents by division of the sciatic nerve. Sommer 1 has repeated Brown-Séquard's experiments in 40 guinea-pigs, and found that epileptic convulsions occurred in all the animals; but he looks upon them, not as genuine epilepsy, but as reflex epilepsy, and does not believe that they can be compared with idiopathic epilepsy in man. These 40 animals gave birth to 23 young, in none of which epilepsy developed, nor were the defects of the toes of the parents produced by division of the sciatic nerve transmitted to the offspring. [Although the question of the hereditary transmission of acquired characters has been for years one of great interest, it still remains unsettled. Among pathologists, Ziegler is one of the strongest adherents of Weissmann's view that pathologic characters are not transmitted. The burden of proof rests upon those who claim that they are transmitted; the negative experiments of Sommer are of value, in that they disprove the validity of one of the famous objections to the Weissmann theory.] 1 Beiträge zur pathol. Anat. u. zur allg. Path., Bd. XXVII, Heft 2, 1900. NERVOUS AND MENTAL BY ARCHIBALD CHURCH, M.D., OF CHICAGO. SYMPTOMATOLOGY AND SYMPTOMATIC DISORDERS. Epidemic Intercostal Neuralgia.-T. F. Riley 1 reports an epidemic marked by a feeling of distention in the right loin, as if due to a swollen spleen, attended by fever, nausea, and intercostal pain, and frequently the development of zoster near the splenic region or at a distance, sometimes on the face. Although the pains and herpetic manifestations came on in some instances in paroxysms, neither the examination of the blood nor the use of quinin gave any weight to the idea of malaria. The author also calls attention to an article in the Medicinische Wochenschrift for September, 1899, in which Wille reports over 100 cases occurring in the limited area of a small German city. [The probability of grippe causing these epidemic manifestations is not considered by these authors, though grippe in recent years has been particularly marked by neuralgic symptoms.] Enuresis. Amat, limiting his consideration to what he calls the true neurotic type of enuresis, where there is no objective cause, such as phimosis, calculus, etc., considers that there are several varieties demanding distinct treatment. In his first variety the vesical muscular fibers are too sensitive to distention. During the day they are mastered by the will to some extent, but contract as the patient drops off to sleep. For this variety bromids, chloral, opium, and, better still, belladonna, atropin, and antipyrin, are indicated. In the second variety there is hyperesthesia of the vesical and urethral mucous membrane even when the bladder is flaccid. The condition is revealed by the catheter, and is met or cured by bromids, valerian, asafetida, and ammoniosulphate of copper. In the third variety the ease with which the catheter can be passed through the membranous part of the urethra shows that the vesical sphincter is not irritable, but weak. Here strychnin, rhus aromaticus, and, above all, electricity, are needed. Fourth, there seems to be a form of enuresis of a purely mental character, in which the child must be aroused and made to micturate 2 or 3 times a night. Physical exercise and general treatment here play the major part. The Sleeping Sickness.-F. W. Mott 3 makes an additional report upon the 2 cases of sleeping sickness mentioned in the YEAR1 Med. Rec., Nov. 5, 1899. 2 Bull. Gén. de Thérap., Nov. 8, 1899. Brit. Med. Jour., Dec. 16, 1899. BOOK for 1899. Both cases terminated fatally and the microscopic appearances were essentially similar. In both, leptomeningitis and encephalomyelitis were found. Throughout the whole central nervous. system, and especially in the medulla and at the base of the brain, the pia-arachnoid was infiltrated with mononuclear leukocytes, and the inflammation could be traced along the blood-vessels and septa into the nervous system. Both the clinical history and the morbid processes point to the chronic processes. It might, therefore, be attributed to a parasite, but to the author's mind, the evidence is insufficient, and there are some clinical features that resemble pellagra, so that the disease may be due to bad food, as is believed by some writers. Possibly it is due to an infectious organism for which a suitable stain has not yet been found. The author points out that the poison, whatever it may be, acts especially upon the lymphatic system, and particularly upon that of the central nervous system. The bacillus isolated by Gagigal and Lepierre was not found, although a careful search was made. The case reported by Stephen Mackenzie a few years ago and the microscopic sections derived from that case correspond entirely to the findings by the author. Cerebral Ataxia.-Sanger Brown 1 reports 3 cases of persistent ataxia associated with cerebral disease, and refers to a number of other instances in the literature. These cases he describes under the title of permanent nonprogressive ataxia," and in two instances they seemed secondary to some infectious process. [See also YEAR-BOOK for 1900, article "Cerebral Ataxia."] 66 Babinski's Sign.-F. W. Langdon 2 gives a very satisfactory outline of what is known of this sign, especially a report made upon it by Collier, whose conclusions were published in the YEAR-BOOK for 1900. He tabulates 110 cases in which the sign was present in conjunction with disturbance of the pyramidal tracts. G. L. Walton and W. E. Paul 3 contribute a very important study of this valuable sign. They found Babinski's reflex in 70% of hemiplegics and diplegics, and in the same percentage of other cases with disease involving the pyramidal tract in the spinal cord. They never found this sign in health, and they doubt its existence in either functional or organic nervous or other disease not implicating the pyramidal tract. They consider that this sign is one of the earliest to appear in disease of the pyramidal pathway; for instance, at the onset of a hemiplegic attack, before exaggeration of the knee-jerk and ankleclonus appear; and it may persist when other reflexes are absent, as, for example, when the knee-jerk and ankle-clonus are absent on account of ankylosis, contracture, and muscular wasting. This sign occasionally appears in meningitis, hydrocephalus, poisoning by alcohol or in uremia-those conditions, in other words, which furnish a disturbance of the cortex and of the upper end of the pyramidal path. Their conclusions, which are based upon the investigation of a very large 2 Cincin. Lancet-Clinic, Feb., 1900. 1 Am. Jour. Med. Sci., June, 1900. Jour. Nerv. and Ment. Dis., June, 1900. number of patients, seem to have been reached with the greatest care, and are substantiated by the results obtained by other observers. This sign is one of extreme importance and value in connection with injuries and disorders of the pyramidal tract. Kernig's Sign.-F. A. Packard 1 reports 3 cases of verified meningitis in infants, 2 being 16 months and 1 being 4 months old, in which Kernig's sign could not be elicited. He believes the sign to be of less value in the early years of life than later. Convulsions.-Muehlig 2 reports, in a in a man 23 years of age, typhoid marked by epileptiform convulsions. On the twentieth day of the convalescence clonic spasms began in the outer fingers of the left hand, passed on to the eyelid, and then became general, lasting half an hour. The pupils were dilated and stationary. Another similar attack occurred 3 hours later, lasting 20 minutes; and after 5 hours, one lasting 10 minutes; 6 hours later a final attack, with interruptions, of an hour's duration. Between the attacks the patient felt well, but subsequently complained for 10 days of numbness and formication in the two outer fingers of the left hand. The exact nature of the cortical disturbance is a matter of speculation. During the course of the typhoid the patient had been very somnolent, and at times delirious. [Typhoid is recognized as a cause of epilepsy by all competent writers, and Eberth's bacillus has been found in the meninges frequently enough to bring these two facts into probable relation of cause and effect.] Mirror-writing.-Arthur Sweeney 3 contributes a very interesting paper on this subject, with the details of a number of cases. He believes that mirror-writing is almost invariably due to visual defects, and quotes Hotz and others, who were able immediately to correct the mirror-writing by supplying the patient with proper glasses. [This does not account for the cases of mirror-writing following hemiplegia, in which it is probably due to the easier centrifugal movements, those of writing away from the body, although the author is not inclined to accept this explanation.] Nodding Spasm.-John Thompson 4 contributes a very interesting article on this neurotic manifestation of childhood, and in discussing its causation says that there is, first, a special age-4 to 12 months-during which the coordination and the movements of the eyes, with those of the head, are being provided. Second, there is the nervous element: the disorder occurs in nervous families, and during the weakness of convalescence from various diseases, and nearly always during the excitable period of teething. Third, the most probable explanation of the striking association of these cases with insufficient light is the eye-strain consequent thereto. He has noticed that almost invariably children so affected have been housed in dark rooms and under unfavorable conditions of illumination. Fourth, there is also at times a history of a blow 2 Münch. med. Woch., 1900. 1 Arch. Ped., April, 1900. 3 St. Paul Med. Jour., 1900. Festschrift in honor of Abram Jacobi, New York, 1900. on the head and of fright. Lastly, the presence of rickets is an important predisposing cause. Lumbar Puncture to Produce Anesthesia.-Severeanu 1 reported 70 cases to the Thirteenth International Congress at Paris, in which he had produced anesthesia for operative purposes in the lower extremities by injecting hydrochlorate of cocain into the spinal canal. In all these cases he observed a general weakness, lasting 2 days, and sometimes causing great anxiety. Frequently vomiting was severe, with headache. An inconvenience arising from the procedure is furnished by the patient watching the operation, thereby producing sometimes mental shock of serious degree. In the same discussion Tuffier said that he had performed 125 operations-of which 58 were laparotomies-under cocain anesthesia by Bier's method, 5 of which died. In 4 instances he did not hold the anesthesia responsible, and even in the fifth case postmortem showed heart lesions and pathologic complications of the lung. Racoviceanu-Pitesci, of Bucharest, had also operated on 125 patients under Bier's method of anesthesia, using doses of from 1 to 4 cg. of the hydrochlorate of cocain. In 3 patients symptoms resulted of such a character as to necessitate artificial respiration and subcutaneous injections of ether, and he claimed to know of 2 cases in which death had followed the method. [This method properly should be credited to Corning, of New York. It is attended by considerable danger, and the limitations of its usefulness are not clearly defined as yet.] Nervous Complications of Diabetes Mellitus.-Desbonnets 2 divides the nervous complications of diabetes into motor, trophic, sensory, and mental. Of the motor disorders, he enumerates muscular feebleness, often of sudden appearance in the midst of apparent health, and chiefly affecting the lower extremities. It tends to disappear with the reduction of sugar. Paralysis of various forms-namely, monoplegia, hemiplegia, and paraplegia-may occur. The cases of paraplegia being really due to peripheral neuritis with insidious onset, many of the symptoms grow worse at night. This form of motor disorder may also involve the upper extremities; it bears considerable resemblance to alcoholic peripheral paralysis, and sometimes is mistaken for tabes, owing to the diminished or abolished knee-jerk, especially as gastric crises, perforating ulcer, and anesthesia may be encountered. The sensory manifestations of diabetes consist in neuralgia, especially involving the sciatic, the trifacial, the intercostal, and the cervico-occipital nerves. These various regions may be coincidentally affected, or the condition may be bilateral, and such combinations give assistance to the diagnosis. Gastralgia, arthralgia, and angina pectoris are encountered, and the special senses may be affected. Taste and smell may be lost or perverted. Deafness is also encountered. Amblyopia and ocular paralysis also occur. Amblyopia may be temporary or permanent. Among the trophic lesions, perforating ulcer, muscular atrophy, loss of nails and hair, and involvement of the nail-matrix are enumerated. The mental symptoms vary from profound depression with delusions to simple dis1 Brit. Med. Jour., Aug. 25, 1900. 2 Thèse de Paris, 1900. |