PSEUDO-BULBAR PARALYSIS.
1
426 the classical symptoms of tumour and on account of the fact that the onset of symptoms had been acute, thought that the cause of the symptoms was encephalitis rather than tumour ; but as no improvement took place an operation was decided upon. The cortex of the central convolutions was healthy. The foot centre-there had been cramps starting in the right foot-was then determined electrically, and an incision made. A tumour was at once evident, and this was removed, together with some brain substance. In the evening and on the next day there was no increase in weakness or impairment of ordinary or of muscle sensibility. The patient unfortunately died from septic meningitis, and the necropsy showed that the rest of the brain was quite healthy. The interesting points in the case are that it was one of tumour without any of the usual symptoms and with quite a sudden onset. The condition after operation, in which presumably there had been removal of a certain part of the cortex, is also interesting because of the absence of any sensory disturbance as a result of this. TRIONAL. AN abstract of an important contribution on the action of trional by Dr. K. Rychlinski appears in a recent number of the Neurologisches Centralblatt. Fourteen cases of sleep- lessness due to various causes, chiefly psychical conditions, were treated with this drug, and at different times sulphonal, chloral hydrate, and daboisin were substituted, and their effect compared with that of trional. He found that in certain cases of long-continued insomnia trional in doses of from one-half to one gramme was efficacious without pro- ducing any headache ; whereas in the same cases ordinary doses of chloral hydrate or sulphonal were inefficacious and larger doses only procured a short sleep. In certain cases the dose was limited to one gramme, but in only two of the fourteen cases were large doses of four grammes necessary in order to procure unbroken sleep for eight or ten hours, and in those cases chloral hydrate and sulphonal were more efficacious in smaller doses of two or three grammes. Trional in hot milk or tea procured eight hours’ sleep usually within half an hour. Sometimes, however, its effect was not produced until two hours after administration. Several times dose took effect also on the second night, but only when a large dose was administered. In a case of mitral regurgita- tion there was no evidence of any bad effect produced on the heart, and this was confirmed by sphygmographic tracings. Although further experience of this drug is still requisite it cannot be denied that experiences such as those recorded in this paper suggest that in trional we may find a safe, efficient, and reliable hypnotic. - MEDICAL WITNESS AND JUDGE. ON Feb. 8th, at the Winchester Assize, before Mr. Justice Cave, a labourer named Cousins was indicted with having attempted to carnally know a girl aged ten years. The jury found the prisoner guilty, and he was sentenced to eighteen months’ hard labour. The case is of interest to the medical profession on account of the severe strictures passed on the medical testimony by the judge. Dr. L. Maybury and Mr. Colt gave it as their opinion that " there was no evidence that penetration had occurred," whereupon Mr. Justice Cave remarked that the witnesses were attempting to decide the case and so usurping the province of the jury. It seems to us that the conflict between the judge and the medical witnesses unfortunately arose through the latter-no doubt uninten- tionally-stating there was no evidence of penetration. What they intended to say was that the evidence as obtained from an examination of the prosecutrix was not conclusive, since the hymen was not ruptured and there was no laceration or bruising of the parts. At the same time there was pre- sumptive evidence of the act, for the vulva were inflamed and there was a purulent discharge, and on the shirt of the prisoner the microscope revealed semen, pus, and epithelial scales. We regret that the learned judge did not take a more generous view of the medical evidence, instead of practically ascribing an interested motive. Nevertheless, the incident should form a valuable object-lesson of the importance, especially in criminal cases, of using correct phrases and of drawing logical inferences. - PSEUDO-BULBAR PARALYSIS. DR. SACAZE of Montpellier records in the Revue de Médecine the case of a patient who in consequence of two separate attacks suffered from left hemiplegia, hemi-chorea, aphasia, and aphonia, with great difficulty in swallowing, and paresis of the tongue and of the soft palate. The necropsy revealed areas of softening in both hemispheres, the internal capsule, the lenticular nuclei, and the caudate nuclei being destroyed on both sides. The pons and medulla, apart from com- mencing secondary degeneration of the pyramids, were quite normal. This case illustrates the fact, which has now frequently been pointed out, especially by Dr. Barlow and Drs. Hughlings Jackson and James Taylor in this country, that a lesion on each side of the cerebrum gives rise to symptoms which so closely resemble those of bulbar paralysis as to be clinically almost indistinguishable from these. The reason of this seems to be that whereas a unilateral lesion in the brain gives rise to only transitory and slight affection of the bilaterally associated movements, the occurrence of a second lesion on the opposite side of the brain so weakens those movements as to cause very distinct impairment of the cesophageal, laryngeal, palatal, and tongue movements, thus giving rise to symptoms which closely simulate those of bulbar paralysis. THE DIFFUSION OF SMALL-POX. THE new cases of small-pox notified in London last week were 11 in number, and the admissions to institutions of the Metropolitan Asylums Board were 18, against 6, 8, and 21 in the preceding three weeks respectively. The disease continues to prevail in the parish of Marylebone, to which belonged the 3 deaths from small-pox registered in London during the week. On Saturday last there remained 56 cases of small-pox under treatment, an increase of 5 on the total on the preceding Saturday. Last week witnessed an increase of fresh cases in West Ham, where over 6 attacks were chronicled. One or two cases came to light in other suburban districts. A dozen attacks at Birmingham show that the disease is getting under control there ; and, moreover, no death was registered, Generally the midland districts were free, as compared with recent weeks. In Scotland small-pox continues to spread in Glasgow. A death occurred on Wednesday of last week in the person of a sailor from London, and 4 fresh cases came to light, followed by 2 more the next day; when also two persons were dismissed from the infirmary, having been admitted under a mistaken diagnosis. The total cases in the city were then 39 in number. In Edinburgh there were 25 patients known to be under treatment in the middle of last week, 7 cases having been notified since Jan. 27th. In Govan and Auchterarder stray cases have recently been dis- covered. In Dublin in the week ended the 2nd inst. 69 cases were admitted to hospital, 64 discharges took place, and 171 patients were left under treatment, 131 ad- ditional convalescent cases being under isolation at EI- mainham. Five deaths occurred, including 2 in vaccinated persons (aged nine and fifty years respectively) and 2 in un- vaccinated persons, both under ten years of age. A total of 106 deaths had been reached up to the date in question. Much good will, it is hoped, be effected by the very stringent order of Archbishop Walsh as to the disabilities of persons in the
Transcript of PSEUDO-BULBAR PARALYSIS.
426
the classical symptoms of tumour and on account of thefact that the onset of symptoms had been acute, thoughtthat the cause of the symptoms was encephalitis ratherthan tumour ; but as no improvement took place an
operation was decided upon. The cortex of the central
convolutions was healthy. The foot centre-there had been
cramps starting in the right foot-was then determinedelectrically, and an incision made. A tumour was at once
evident, and this was removed, together with some brainsubstance. In the evening and on the next day there wasno increase in weakness or impairment of ordinary or ofmuscle sensibility. The patient unfortunately died from septicmeningitis, and the necropsy showed that the rest of thebrain was quite healthy. The interesting points in the caseare that it was one of tumour without any of the usual
symptoms and with quite a sudden onset. The conditionafter operation, in which presumably there had been removalof a certain part of the cortex, is also interesting because ofthe absence of any sensory disturbance as a result of this.
TRIONAL.
AN abstract of an important contribution on the action oftrional by Dr. K. Rychlinski appears in a recent number ofthe Neurologisches Centralblatt. Fourteen cases of sleep-lessness due to various causes, chiefly psychical conditions,were treated with this drug, and at different times sulphonal,chloral hydrate, and daboisin were substituted, and theireffect compared with that of trional. He found that incertain cases of long-continued insomnia trional in doses offrom one-half to one gramme was efficacious without pro-ducing any headache ; whereas in the same cases ordinarydoses of chloral hydrate or sulphonal were inefficacious andlarger doses only procured a short sleep. In certain casesthe dose was limited to one gramme, but in only two of thefourteen cases were large doses of four grammes necessaryin order to procure unbroken sleep for eight or ten hours, andin those cases chloral hydrate and sulphonal were moreefficacious in smaller doses of two or three grammes. Trionalin hot milk or tea procured eight hours’ sleep usuallywithin half an hour. Sometimes, however, its effect was notproduced until two hours after administration. Several timesdose took effect also on the second night, but only when a
large dose was administered. In a case of mitral regurgita-tion there was no evidence of any bad effect produced on theheart, and this was confirmed by sphygmographic tracings.Although further experience of this drug is still requisite itcannot be denied that experiences such as those recorded inthis paper suggest that in trional we may find a safe, efficient,and reliable hypnotic. -
MEDICAL WITNESS AND JUDGE.
ON Feb. 8th, at the Winchester Assize, before Mr. JusticeCave, a labourer named Cousins was indicted with havingattempted to carnally know a girl aged ten years. The juryfound the prisoner guilty, and he was sentenced to eighteenmonths’ hard labour. The case is of interest to the medical
profession on account of the severe strictures passed on themedical testimony by the judge. Dr. L. Maybury and Mr.Colt gave it as their opinion that " there was no evidencethat penetration had occurred," whereupon Mr. Justice Caveremarked that the witnesses were attempting to decide thecase and so usurping the province of the jury. It seems to us
that the conflict between the judge and the medical witnessesunfortunately arose through the latter-no doubt uninten-tionally-stating there was no evidence of penetration.What they intended to say was that the evidence as obtainedfrom an examination of the prosecutrix was not conclusive,since the hymen was not ruptured and there was no lacerationor bruising of the parts. At the same time there was pre-sumptive evidence of the act, for the vulva were inflamed
and there was a purulent discharge, and on the shirt of theprisoner the microscope revealed semen, pus, and epithelialscales. We regret that the learned judge did not take a moregenerous view of the medical evidence, instead of practicallyascribing an interested motive. Nevertheless, the incidentshould form a valuable object-lesson of the importance,especially in criminal cases, of using correct phrases and ofdrawing logical inferences. -
PSEUDO-BULBAR PARALYSIS.
DR. SACAZE of Montpellier records in the Revue de Médecinethe case of a patient who in consequence of two separateattacks suffered from left hemiplegia, hemi-chorea, aphasia,and aphonia, with great difficulty in swallowing, and paresisof the tongue and of the soft palate. The necropsy revealedareas of softening in both hemispheres, the internal capsule,the lenticular nuclei, and the caudate nuclei being destroyedon both sides. The pons and medulla, apart from com-mencing secondary degeneration of the pyramids, were
quite normal. This case illustrates the fact, whichhas now frequently been pointed out, especially byDr. Barlow and Drs. Hughlings Jackson and James
Taylor in this country, that a lesion on each sideof the cerebrum gives rise to symptoms which so closelyresemble those of bulbar paralysis as to be clinically almostindistinguishable from these. The reason of this seems to bethat whereas a unilateral lesion in the brain gives rise to onlytransitory and slight affection of the bilaterally associatedmovements, the occurrence of a second lesion on the oppositeside of the brain so weakens those movements as to cause
very distinct impairment of the cesophageal, laryngeal,palatal, and tongue movements, thus giving rise to symptomswhich closely simulate those of bulbar paralysis.
THE DIFFUSION OF SMALL-POX.
THE new cases of small-pox notified in London last weekwere 11 in number, and the admissions to institutions of theMetropolitan Asylums Board were 18, against 6, 8, and 21 in thepreceding three weeks respectively. The disease continues toprevail in the parish of Marylebone, to which belonged the 3deaths from small-pox registered in London during the week.On Saturday last there remained 56 cases of small-pox undertreatment, an increase of 5 on the total on the precedingSaturday. Last week witnessed an increase of fresh casesin West Ham, where over 6 attacks were chronicled. One ortwo cases came to light in other suburban districts. A dozenattacks at Birmingham show that the disease is getting undercontrol there ; and, moreover, no death was registered,Generally the midland districts were free, as comparedwith recent weeks. In Scotland small-pox continues to
spread in Glasgow. A death occurred on Wednesday of lastweek in the person of a sailor from London, and 4 fresh casescame to light, followed by 2 more the next day; when alsotwo persons were dismissed from the infirmary, having beenadmitted under a mistaken diagnosis. The total cases in the
city were then 39 in number. In Edinburgh there were 25patients known to be under treatment in the middle of lastweek, 7 cases having been notified since Jan. 27th. In
Govan and Auchterarder stray cases have recently been dis-covered. In Dublin in the week ended the 2nd inst. 69cases were admitted to hospital, 64 discharges took place,and 171 patients were left under treatment, 131 ad-ditional convalescent cases being under isolation at EI-mainham. Five deaths occurred, including 2 in vaccinatedpersons (aged nine and fifty years respectively) and 2 in un-vaccinated persons, both under ten years of age. A total of106 deaths had been reached up to the date in question. Muchgood will, it is hoped, be effected by the very stringent orderof Archbishop Walsh as to the disabilities of persons in the
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