Page images












[merged small][merged small][ocr errors][merged small][merged small]
[blocks in formation]






PAGE Cholectotomy............


Original Communications.
The Diagnosis of Pyosalpinx................

36 PAGE The Treating of Pneumonia by the Ice. New Therapeutic Agencies. By Prof.


37 Dujardin-Beaumetz......

The Physiological Action of the lodide Berlin Letter Two or Three Strong Practical Thera

of Potassium.......

Berlin Letter...

60 peutic Points of Every-Day Applica Cocaine in Diabetes...

London Letter ...........

62 tion, By Henry M. Field, M.D........ II The Physiological Action of Hydro Paris Letter.....

64 Historical, Critical, and Scientific As

cyanic Acid.............

42 Contagion of Scarlet Fever ........... 65 pects of Brown-Séquard's Discovery Glycosuria.....

42 Nitro-Glycerin as a Remedy for Shock.. 66 -The So-called " Elixir." By G. The Physiological Action of Thallin..... 45 The Dose of Gelsemium Sempervirens.. 66 Archie Stockwell, M.D., F.Z.S. (con The Comparative Value of Antipyrin, Sulphonal as a Hypnotic in Typhoid cluded)........... 14 Antifebrin, and Phenacetin as Anti


67 Arsenite of Copper in Bowel Complaints. pyretics.........

45 Remarkable Tolerance for Morphine..... 67 By L. Worsham, M.D..................... 19 The Treatment of Hepatic Jaundice by Report of Three Cases of Remarkably Hypodermic Injections of PilocarSlow Pulse. By D. W. Prentiss, M.D.

Notes and Queries. pine........... (concluded)...

Syzygium Jambolanum in Artificial Di. The New Hypnotics-Sulphonal, Amy.

46 lene Hydrate, Hydrobromide of Hy.
The Amount of Fat in Condensed Milk 47 oscine, Hypnone, Paraldehyde, and
Leading Articles.
The Therapeutic Value of Senna-Pods 48 Urethan

63 The Action of Sulphonal as a Hypnotic 31

The Treatment of Endometritis............ 48 The Treatment of Chronic Metritis by

The Elimination by the Stomach of Chloride of Zinc Pencils......... Lead-Poisoning..........

32 The Use of Bromide of Rubidium and

Morphine Injected Subcutaneously.... 49 A New Diagnostic Sign of Abscess of The Cure of Hemorrhoids by Excision

the Antrum..........

71 Ammonium in Epilepsy


and Closure with the Buried Animal Solanum Carolinense in Epilepsy.......... 71 Hypnotism........


49 A Method of Administering Chloral An Important Work........


The Treatment of Syphilis by Quinine Hydrate in Eclampsia..............
and Mercurial Injections...


The Non-Tubercular and Non-Cardiac Reports on Therapeutic Progress. Arsenical Paralysis.......

53 Hæmoptyses of Elderly Persons........ 72 Eucalyptus in Scarlet Fever.............


The Action of Salicylate of Sodium upon Treatment of Whooping-Cough by Eu The Therapeutic Properties of Infusion the Uterus.. calyptus.......... 30 of Yellow Raspberry.

54 Bromoform in Whooping-Cough.......... 72






Original Communications. odd symptoms, among which are to be noted :

a sense of general enfeeblement; coldness of

the extremities; a change of disposition reNEW THERAPEUTIC AGENCIES.*

sulting in hypochondriasis and gloom ; wakeLECTURE III.-ON GASTRIC NEURASTHENIA fulness, manifesting itself generally at the AND ITS TREATMENT.

same hour, about midnight; and a general

emaciation, the first cause of which has escaped BY PROFESSOR DUJARDIN-BEAUMETZ, Paris, FRANCE.

the knowledge of the physicians who have 'ENTLEMEN :-A female patient has already attended her.

just been to our clinic to obtain help for Notwithstanding the strangeness and mania nervous malady from which she is suffering. foldness of the nervous symptoms of which It is an affection characterized by a train of this patient complains, you will not find in

her the clear marks, the stigmata, of hyste* A second series of “ New Medications,” published ria. She has not the embonpoint nor the outin 1887.

ward appearance of this disease, --she is, on † From advance sheets, revised by the author (translated by E. P. Hurd, M.D.). Lectures delivered in

the contrary, thin and spare, without any Cochin Hospital, Paris, France.

hysterical crises properly so called ; there is


no hysterogenous zone, no anæsthesia of the Under the names of nervousness, neuropapharynx. There is nothing on the part of the thy, hystericism, neurasthenia, medical writers uterus to account for her sufferings, and at have endeavored to designate an aggregate of the same time she complains of great abdomi symptoms which seems to be differentiated nal discomfort, and for years she has received from both true hypochondriasis and from treatment from a specialist who has made re hysteria, and they have created a series of peated cauterizations of the os and cervix divisions in these neurasthenic states correwithout benefit.

sponding to the different forms which they But there exist evident disorders in the func had before them. Thus Beard, who invented tions of the digestive tube; digestion is habitu the word neurasthenia, described a neurasally long and laborious; the patient complains thenia by cerebral, spinal, sexual, and even of gases distending the stomach and stopping gastric exhaustion. digestion ; has alternately diarrhoea and consti | Writers have also tried to discover the first pation, but is oftener constipated. The fæces cause of these nervous perturbations, of this have an excessively fetid odor ; there is at exhaustion of the nervous system, and some times a mucous enteritis. The appetite is have placed this cause in fatigue of the cerecapricious, and the patient carefully avoids bral or spinal functions, in disorders of the many articles of diet which she has found to great sympathetic, in uterine troubles, in give her pain and discomfort. All these alterations of the blood; but one of the orsymptoms go back to a distant date; she gans often incriminated has been the stomach, has, in fact, long been a dyspeptic and a ner and to-day the labors of Bouchard and those vous invalid.

of the school of Lyons have given to this If now, after having ascertained these neurasthenia a form more precise and more data, you examine the abdomen more at: concrete, and have enabled us to constitute a tentively, you note both by percussion and pathological aggregate having for its basis by succussion and by the bruit de clapotement

dilatation of the stomach. (a peculiar swashing sound), which the latter The very intimate relations which exist be. determines, that the stomach is greatly dis tween the functions of the cord and brain tended; the greater curvature descends con have engaged the attention of physicians from siderably below the umbilicus; in certain remote antiquity, and we have evidence of cases, as you know, it even reaches the pubes, this in the name hypochondriasis, which, since so that the stomach seems to occupy the entire Galen's time, has been applied to a great abdominal cavity.

number of nervous disorders. It is certain If you make the patient take a long breath that, long after Galen, medical writers were while grasping in your hand the left flank just in the habit of classing under this name of below the border of the false ribs, you will hypochondriasis (i.e., a disease having its origin feel a hard, smooth organ between your fingers in the hypochondriac regions) almost all which can be easily seized ; this is the kidney. strange, morbid, nervous manifestations. Percussion of the liver enables you to perceive Coming down nearer to the present time, to some enlargement, and the attentive scrutiny Sydenham's epoch, we find this writer distinof the hands, which are cold and damp, will guishing hypochondriasis from another nerreveal an exaggerated prominence of certain vous state which he compares to a Proteus, articulations of the phalanges, and in particu- taking an infinite variety of forms; to a chalar of that of the medius.

melion, whose colors are so various; and this You will now be able to make your diagno. malady he called hysteria. Lastly, Whigtt sis, and affirm that this woman belongs to that described a third form of nervous functional class of patients who have dilated stomachs, disorder which was neither hypochondriasis a class which is very numerous at the present nor hysteria, and which had chiefly for its day, and comprises, in the expressive phrase- origin stomach troubles. ology of Trastour, the déséquilibrés du ventre To explain these disorders dependent on (those whose stomachs are not equilibrated); bad functionment of the nervous system they constitute the rank and file of the neuras three theories or hypotheses have been thenic.* It is to the treatment of this gastric broached,-a theory purely nervous, a meneurasthenia that I now desire to call your chanical theory, and a humoral theory. Let attention.

us examine rapidly these three theories.

The nervous theory is the oldest. It is * Trastour, “Les Déséquilibrés du Ventre,” etc.,

this which Beard has ably defended in Paris, 1889.

speaking of nervous exhaustion of dyspeptic

origin.* Leven has latterly taken up anew moreover, Cuilleret has published in the this theory, and has assigned to the modifi. Gazette des Hôpitaux a very interesting artications of the nerve-cells of the solar plexus cle on this affection. Lastly, since then, Glea preponderant rôle. He believes that irrita nard has communicated upon this subject a tions of these cells determine disorders in great number of observations which give supthe gastric mucosa and in the neighboring port to these views. organs.

The mobility of the kidneys, so frequent in I protest that this explanation explains these patients with dilated stomachs, is, acnothing. To say that irritation of the solar cording to this theory, but a mechanical conplexus entails disorders of the gastric mucous sequence of the prolapsus of the right flexure membrane, is to make a statement which would of the colon, and the nephroptosis thus results demand an anatomical demonstration more from the enteroptosis. To the purely mechaniprecise than that which has been furnished cal theory of Glenard, we may oppose the huby Leven. One might well ask, moreover, moral theory of Bouchard, contrasting, if we What is the cause of these irritations of the may so speak, Bouchard's disease with Gle. solar plexus ?

I pass now to the second nard's disease. theory, which is somewhat more plausible, and It was in 1884 that Bouchard made known which has been advanced by Glenard. I to the Medical Society of the Hospitals the

According to this writer, all sorts of func- important pathogenic rôle which may be astional nervous troubles, such as are included signed to dilatation of the stomach, and it under the head of neurasthenia, depend on a must be acknowledged that the discoveries of modification effected in the reciprocal rela Armand Gautier concerning the ptomaines tions of the different portions of the intes and leucomaines seem to confirm in great tine. These modifications or displacements, part the views of Bouchard.** In his able to which he gives the name of ptoses, may work on the auto-intoxications, Professor pertain to all the organs contained in the Bouchard takes up the subject of dilatation abdomen.

of the stomach, and considers it as a type But what dominates in this splanchnoptosis of chronic auto-intoxications of intestinal (to speak the language of the school of Ly- origin. ons) is the prolapsus of the right flexure of The functions of the stomach are arrested the colon and the first part of the transverse or hindered by the prolonged sojourn of alicolon. Here is the fundamental organic le ments in that cavity, and processes of fermension, the constant and irremediable lesion of tation take place which lead to the production enteroptosis, and it is this enteroptosis which of ptomaines. These ptomaïnes, carried along is the origin of all the phenomena observed the digestive tube, are taken up by the abin patients whose gastric functions are not sorbents, and their presence in the economy equilibrated.

gives rise to a series of symptoms of selfIt was in the year 1885 that Glenard began poisoning, the latter being the determining to make known this theory of enteroptosis, cause of the varied morbid phenomena preand we see it defended in Paris by Féréol, sented by the subjects of gastrectasis. at Nantes by Trastour, in Italy by Sanctis il In this pathogeny the role of the liver is

considerable. You know the important office * G. M. Beard, “A Treatise on Nervous Exhaus

assigned to the liver as a destroyer of alkation," etc. New York: Wm. Wood & Co., 1880.

loids. One of Bouchard's pupils, G. H. † Leven, “Estomac et Cerveau,” Paris, 1884, and “ La Névrose,” Paris, 1887.

Roger, repeating the experiments of Heger, Glenard, “ Application de la Méthode naturelle à of Schiff, and of Victor Jacques, has given us l'analyse de la Dyspepsie nerveuse;" “ Détermination a clear exposition of this protective rôle exerd'une Espèce”—“De l’Entéroptose” (Lyon Médical, cised by the liver. When the dilatation of the mars, 1885); “Entéroptose et Neurasthénie" (Société

stomach causes too great a production of Médicale des Hôpitaux de Paris, 15 mai, 1886, et Semaine Medicale, 19 mai, 1886); “ À propos d'un Cas

ptomaïnes, there results a secondary congesde Neurasthénie gastrique" (entéroptose traumatique);

tion of the liver, which augments in volume Diagnostic de l'Entéroptose,” “Conférence Clinique de and depresses the right kidney, and if these l'Hôtel-Dieu de Lyon" (Province Médicale, 7 avril, congestions repeat themselves often, it is 1887); " Exposé Sommaire du Traitement de l'Entérop easy to see that this transient depression tose” (Lyon Médical, juin et juillet, 1887).

Féréol, “ De l'Entéroptose” (Bulletin de la Société 1 Cuilleret, “A Clinical Study on Enteroptoses, or Medicale des Hôpitaux, 5 janvier, 1887).

Glenard’s Disease” (Gas. des Hộp., 1888, No. IO9). || De Sanctis, “ Sulla Malattia di Glenard,” etc., ** Bouchard, “ Lessons on the Auto-Intoxications in 1888.

Disease,” Paris, 1887.

[ocr errors]
« PreviousContinue »