On some rarer factors in Graves's disease.

  • Maude, Arthur.
Date:
[1893]
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Licence: Public Domain Mark

Credit: On some rarer factors in Graves's disease. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    peptic and organic substances and a glucoside which is the active prin- ciple of the extract. Five grammes (seventy-five grains) of the finely powdered root con- tain : water, 26 centigrammes; salts (the glucoside inclusive), 2 grms. 01 centigrammes; organic substances, 2 grms. 73 centigrammes. I have investigated the action of the extract of moyrapuama on dogs, rabbits and frogs; the most prominent change found in animals, which had died after tne administration of variable doses, consisted in pro- fuse haemorrhages especially into the alimentary canal. In frogs, the cardiac and respiratory movements persisted much longer than normal after death under the influence of this substance. The Advantages of the Yellow Oxide of Mercury over the Red Oxide in Medicinal Preparations. Dr. Patein.—The substitution of the yellow oxide of mercury for the red oxide of the same metal in medicinal preparations presents certain advantages. Both oxides possess identical properties but the yellow oxide is more easily obtained, besides being much more definite in its composition. Its molecular condition permits of its being easily reduced to powder. The red oxide, on the other hand, is obtained in a conglomerated state by heating and is less stable in its composition than the yellow salt. The red oxide of mercury frequently becomes black from the decomposition of a suboxide of mercury. Hence me- dicinal preparations of this substance are the more likely to be defec- tive the more carefully they are compounded. BRUSSELS. ACADEMY OF MEDICINE OF BELGIUM. Saturday, September jotb, i8g7. On Cholera. Prof. Crocq.—Prof. Koch maintains that among other pathological appearances signs of enteritis are constantly to be found after death from cholera. It was formerly denied by Broussais that inflammation of the intestines was a constant phenomenon of cholera and for my own part I consider that this lesion is absent in the majority of cases. In respect of the changes which take place in the other organs in the various stages of the disease, I invariably found that the heart stopped in diastole ; in a large proportion of cases the lungs were cede- matous with hypostatic congestion at the bases. Tubercles are rarely met with and the presence of granulations in the last case related by Prof. Rommelaere is to be accounted for by the fact that the patient was already suffering from phthisis when he was seized with cholera. This in itself is an exceptional occurrence, for cholera seldom attacks the subjects of tuberculosis. During the reaction stage pneumonia is not unfrequently present, large areas of lung substance being the seat of hypostatic congestion. The spleen usually presents one or more infarcts. Contrarily to the opinion of certain observers 1 believe that the leuco- cytes ultimately disappear from the mucous membrane leaving only some cellular debris behind, and that pus may be found in the intestine in cases of Asiatic cholera as in those of cholera nostras. The cerebral meninges are thickened, while the cortex of the brain is markedly cedematous. The ventricles and sulci also contain a large quantity of serous effusion. The heart is dilated and the blood has undergone certain changes in its composition, resulting in arrest of the heart’s action. Prof. Rommelaere has succeeded in detecting the presence of the cha- racteristic bacilli in the motions of a number of patients as late as forty days after recovery from an attack of cholera; these bacilli are also alleged to have been found in cases of simple intestinal catarrh a long time before the appearance of an epidemic and in one case of typhoid fever without choleriform symptoms. Several observations of a similar kind have been reported by Dr. P. Guttmann in Germany , and during the epidemic of 1892 a Hamburg phy- sician diagnosed a typical case of Asiatic cholera as one of cholera nostras because he was unable to discover any comma bacilli in the dejections. In view of such facts I maintain that it is impossible to admit that Koch’s comma bacillus is the only cause of cholera and I firmly believe that this organism is only one of the numerous microphytes which inhabit the intestine and that it does not possess any of the specific pa- thogenic properties which have been attributed to it. I consider that to diagnose a case as Asiatic cholera on the strength of the presence of comma bacilli in the dejections, and as cholera nos- tras because these bacilli are absent, is a fanciful and very unscientific practice. Dr. Gallez.—I have observed several interesting cases of cholera in which the disease could not be traced to any of tne ordinary sources of infection. For example, I have met with fatal cases of cholera among miners who were suddenly seized with the symptoms of the disease while at work in the mine and died within a few hours, though the locality was per- fectly free from cholera at the time. The' disease once suddenly appeared in a village of Hainaut where no other cause could be traced for the outbreak than a fall in the level of the water in a neighbouring marsh, as a result of mining operations. In another case under my observation the occupiers of a house situated far away in the country and without any communication with the external world, were all attacked with cholera. The comma bacillus was found after death in all these cases and it is difficult to understand how it originated under these circumstances, seeing that cholera was unknown in the district at the time, and the presence of the bacilli could not be accounted for by the insanitary condition or the topography of the locality, nor were they imported from without. practical 3DcMctttr* Injections of Grey Oil in Cerebral Syphilis. It is a recognised fact that intra-muscular (intra-gluteal) injections of grey oil according to the method of Prof. Lang (Vienna) possess a very rapid and powerful antisyphilitic action. If this method is not more frequently employed by specialists and general practitioners it is because it exposes the patient to the risk of acute mercurial intoxication and of pulmonary embolism, should the injection be made directly into a vein. These dangers can, however, be avoided, or at any rate reduced to a minimum, by means of certain precautions, so that Prof. Lang’s method may nevertheless be indicated as a last resource in certain very grave cases of cerebral syphilis which have resisted all other forms of treat- ment. It is precisely under such circumstances that this treatment was resorted to in three cases of cerebral syphilis reported by Dr. J. Sacaze, chef de clinique to Dr. Grasset, Professor of Clinical Medicine at the Me- dical Faculty of Montpellier, and Mr. E. Magnol, House-physician. These cases seem to us to merit a brief description because of the great practical interest which attaches thereto. In the first case the patient was a woman, aged 35 ; she had since the age of 15 suffered from epilepsy, and for the last five months she had complained of intolerable headache with nocturnal exacerbations. All the ordinary analgesic remedies had been tried without success. The presence of certain suspicious signs of recent syphilis (coppery-coloured eruption, symmetrically distributed on the inner surfaces of the knees, alopecia, enlargement of the inguinal glands), led to the headache being attributed to a specific cause. Accordingly mercurial frictions with thirty grains of iodide of potassium in the twenty-four hours were pres- cribed, but as no improvement took place in the patient’s condition, at the end of five days the frictions were abandoned and instead hypodermic —not intra-muscular—injections of grey oil were administered.' The oil was prepared according to the following formula : R. Metallic Mercury §ss. (by weight). Lanoline gr. 70. Liquid Vaseline ad siss. (by weight). Mix. Each drachm of this mixture contains thirty grains of mercury. A dose equal to two or three divisions of a hypodermic syringe, i.e., from 5/<> to 1 '/6 of a grain of mercury, was injected on each occasion. The headache subsided soon after tne first injection, and at the end ot five days it had entirely disappeared. The treatment was commenced on March 10th; the injection was repeated on March 24th and 31st, and on April 7th. The headache reappeared on April 27th; the patient received a fifth injection and on the following day she was perfectly free from pain. Since that time she has received several injections at irregular intervals and the headache has not returned. The second patient under Dr. Sacaze and Mr. Magnol’s observation was a robust young woman of 23, a domestic servant, who was suffer- ing from epileptiform attacks accompanied by grave mental disturbance (apathy, hebetude). Bromide and borate of sodium were administered without success, but the discovery of patches of alopecia and a cuta- neous eruption suggested the existence of syphilis, and an injection of grey oil was made although the patient denied having ever had the disease. On the evening of the same day a remarkable change was observed in the patient’s mental condition : the apathy and hebetude disappeared and she did some work. The improvement was maintained on the following days, while the epileptiform attacks ceased. The injections of grey oil were repeated at intervals of a fortnight and the patient left the hospital cured about two months and a half after the first injection. The third case was that, of a woman, aged 38, the subject of alcoho- lism, who for about a year had complained of mild epileptiform attacks associated with symptoms of dementia. Syphilis was suspected from the presence of alopecia although the patient presented no other specific manifestations. The epileptiform attacks ceased immediately after the . first injection, while the cerebral symptoms entirely disappeared after two other injections, repeated twenty-two and thirty-one days after the 1 first- „ „ In view of the results obtained in these three cases Dr. Sacaze and Mr. Magnol suggest that injections of grey oil may prove a valuable means of diagnosis in patients presenting grave manifestations such as epileptiform attacks, coma, etc., the cause of which is obscure. Treatment of Prurigo by Massage. It is generally recognised that the intolerable itching of prurigo is not usually amenable to any of the remedies at our disposal. As a result of a series of experiments recently performed by Dr. R. Hatschek in 11 cases of prurigo at the clinique of Dr. Kaposi, Professor Extraordinary of Dermatology at the Medical Faculty of Vienna, it would appear that massage is an excellent means of soothing the itching of prurigo, a fact to which attention was called for the first time in 1% by Dr. Mur- ray (Stockholm). .. ,. , In Dr. Hatschek’s cases the treatment consisted in the application of energetic friction in a centripetal direction. The treatment was limited to tlie extremities, commencing at the root of the limb and extending gradually to the fingers and toes. Each extremity was massaged every day for from ten to fifteen minutes at a time. The time was subsequently reduced to five and even three minutes, according to the degree of im- provement obtained. The parts may be rubbed with the dry hand or, preferably, with vaseline, which adds to the soothing effect of the treatment. In all the cases in which this treatment was tried, the itching sub- sided after the first sitting, while in some of them it completely disap-