Aspiration in Abscess of the Liver in Hypochondriacal Melanciiolics
89 EPITOMISED TRANSLATIONS.
It is stated that Dr Hammond has communicated to the Neurological Society of America that in his private practice during- about a year, he has observed five cases of patients labouring under Hypochondriacal Melancholia, in which there was present abscess of the liver. In these five cases his suspicion was confirmed by a puncture of the skin, followed by Aspiration which withdrew a more or less quantity of pus. The results were that no physical disturbance or determent followed, and that there was considerable alleviation of the mental symptoms. He adds that in all cases of melancholia with hypochondriasis, the region of the liver ought to be carefully explored, and that the simple and perfectly safe operation of aspiration should be resorted to even when no trace of fluctuation indicating the presence of abscess can be detected. The recorders of this experience, Dr. Henocque, in the Gazette Ilebdomadaire and the editor of th? Anal. Med. Psy. concur with Dr Hammond only so far that attention and careful examination should be directed to the hepatic region in patients suffering from hypochondriacal melancholia, but that no operation should be ventured upon unless or until distinct evidence of the presence of an abscess can be obtained.
Exploration of Cerebral Temperature.
The first attempt to attain information as to the temperature of the brain, or rather of the head, was made by Albers, of Bonn, in 1861, and repeated some years afterwards by Dr. Costa Alverenga, but it was only in 1877 that the interest of scientific men was excited in the Thermic Examination of the Encephalon, when M. Broca made a communication on the subject at the session of the French Association for the Advancement of Science, which had met at Havre. Various works in the development of the inquiry have since appeared both in France and in other countries, and M. Voisin has likewise made contributions to our knowledge by the facts collected by him in connection with the General Paralysis of the insane. But the most important and comprehensive researches upon the subject are those of MM. les Drs. Maragliano and Seppillis.
In different works which have recently appeared there will be found detailed instructions and cautions as to the care to be taken by the experimenter in the selection of suitable thermometers and the other instruments employed, the region selected for examination, the due appreciation of the apartment, the season, the hour in which the experiment is made, and the physical and mental condition of the individual to be examined.
But even were all sources of uncertainty as to the mode and surrounding circumstances in the act of exploration removed, it becomes very questionable whether the differences indicated by the thermometer should be localised with the cerebral region under experiment, or should be interpreted as due to the subjacent tissues, the integuments and cranial walls. Moreover, such sources of fallacy, numerous as they may be when the subjects examined labour under cerebral lesions, become more numerous and complicated when the investigation is extended, as has been done by M. Amidon of New York, to healthy subjects, for the purpose of determining the precise site and influence of motor centres over the contraction of this or that muscle.
Restraint and Non-Restraint.
It would appear that an animated, almost a bellicose, discussion bas been and is going on in France, Germany, and England, as to the expediency or humanity of non-restraint in the management of the insane. A certain number of the most celebrated of the disputants contend that, in a small number of dangerous patients, the application of a properly constructed camisole is preferable to the strife and struggles which ensue when the manual and muscular forces of attendants are substi tuted, or to the employment of narcotics in excessive doses, or to their being consigned to seclusion and solitude in a cell, whether that be padded or not. At a meeting of the Medico Psychological Society of Paris in October last, at which almost every expert, distinguished or unknown, connected with the care and custody of the insane, were present, M. Christian read a paper on this much-controverted subject. His conclusions may be briefly stated as that the emancipation of the lunatic from bonds was introduced by Pinel and not by Conolly; that non-restraint is an error in practice, compromising the health, safety, and restoration of the insane, and that the camisole cannot and should not be disused. In these conclusions every individual present, with the exception of M. Magnan, emphatically, several enthusiastically, concurred. M. Christian affirmed that nonEPITOMISED TRANSLATIONS. 91 restraint was no longer practised in France, Germany, or Switzerland. In the United States, where a similar controversy has been waged during the past two years, but where the matter agitated is rather the use of the crib or conservative bed than the strait waistcoat, the contest became so violent as to attract the attention of the Government, and three commissioners, appointed for the purpose, are now engaged in taking evidence and in visiting different asylums, so that they may be enabled to report on the merits of the propositions and experience bearing upon the whole question at issue.
The bed, which forms the gravamen of this national dispute, was constructed not so much for the purposes of coercion as to economise the strength of the feeble and the aged, and to protect these and other classes of patients from accidents and the effects of self-inflicted bruises and wounds during excitement and restlessness. It consists of what was formerly-designated a box bed, the sides of which are lined with soft padding or mattresses of wool, the bottom being a network formed by girths, which bear the necessary complement of bedding and of air and water cushions, should such be required, while the lid is likewise formed of a network of girths, the interspaces being so small as to prevent the passage of the head &c., but so large as to admit an ample supply of air and light, so that the medical captive may read and suffer but little inconvenience in his novel position. The lid, or cover, is in urgent cases locked to either of the sides.
The invention is claimed by M. Aubanel, of Marseilles, where, however, it is now not regarded with favour. The arrangement was described some years ago by the late Dr W. Lauder Lindsay, of Murray’s Asylum, Perth, in the Edinburgh Medical and Surgical Journal, and is believed to be still in use in Scotland.
Hallucinations in Delirium of Persecution.
M. Falret has advanced the opinion, founded upon his experience, in describing the evolution of the Delirium of Persecution, that this neurosis is almost invariably accompanied by hallucinations of the sense of hearing, while M. Mabille holds that the affection may be complicated with hallucinations of sight. Professor Laseque, who confirms M. Falret’s opinion, has constructed a table illustrative of what he conceives to be the pure type of the disease. It is somewhat doubtful that such a type can be established, and we are inclined to believe that should the inquiry extend to chronic cases it might be possible to reconcile these conflicting views. Compulsory Alimentation.
M. De Regis, in reopening the discussion upon Compulsory Alimentation in patients affected with sitophobia, has discussed the three following practical propositions :? 1. That the washing out or ablution of the stomach by alkaline solutions, or, what is better, the waters of Vichy, may be indicated in such cases of abstinence as may be supposed to depend upon physical disease of the stomach. This expedient, introduced from Germany, has been resorted to in various of the Parisian hospitals.
2. He suggests that where artificial feeding is practised for a long time it would be prudent that the aliments thus conveyed should contain doses of pepsine, in order to secure the absorption of sufficient quantities of albumen. 3. That in the mechanical process of introducing food, the tube should be so constructed as to expand itself laterally, so as to occupy the whole of the passage into which it may have entered, and thus to announce that the passage entered is or is not the larynx.
The Chronicle commenced in the Annates Medico Psychologiques for January 1881, is to be continued for the purpose of epitomising and recording all facts relative to the clinical and theoretic study of mental maladies.
Albuminous Uiiine in Epileptics.
The first recherches on this subject seem to have been made by Drs. Sutherland and Rigby in Britain and Michea in France. The Physicians of St. Luke’s investigated the cases of 192 insane patients, and found albumen in the urine of seven. Michea, confining his inquiries to epileptics and hysterica, found neither sugar nor albumen in the urine of such cases.
M. Hubert, resting on the experience of English observers, affirms that the presence of albumen in the urine of epileptics has been demonstrated.
MM. Moreau de Tours, Sailly, Jaccoud, and Bourneville, pronounce emphatically against the presence of albumen, while Otto found it rarely in the urine of epileptics.
These contradictory conclusions were tested at Mareville by M. Christian, who examined the urine of 38 epileptics, before, during, and subsequent to a paroxysm, and notwithstanding all scientific care in the manipulation, albumen was detected in the urine of only one individual, who, it was found, clinically laboured under parenchymatous nephritis, albumen having been discovered not only before and after a paroxysm, but associated with granular fatty cylinders. The experiments of Claude Bernard, by puncturing the fourth ventricle, and the subsequent appearance of albuminuria, and the supposed connection of the surrounding cerebral region with epileptic disease, has not been borne out by the researches now under consideration. It is obvious that the obstacles presented to respiration during an epileptic fit, by the immobility of the muscles of respiration, and by the closure of the larynx, though grave, are not of sufficient duration to prevent the formation of albumen, and, consequently, according to M. Bourneville, no such substance was detected in a patient who died during the paroxysm. Besides, the visceral congestions present during an attack, rapidly disappear on its cessation.
Recent works contain the theory of M. Hamon that albuminuria is itself a nervous affection, dependent upon the central and ganglionic systems. It has been added that attention should be directed to the condition of the nerves whicli supply the kidneys, as in eclampsia; the presence of albumen must be regarded as a consequence and not as a cause of the disease. Lesions of the nerves, and even conditions of the encephalon may lead to interstitial nephritis, and consequent albuminuria. It should be added that in the examination of 14 persons who died in the Statu Epilepticus, and of various other diseases, with the exception of two instances of slight congestion, no perceptible structural change could be detected in the substance of the kidneys. M. Bourneville has recorded a similar experience in five cases.
It would appear from these observations that no connection lias been established between epileptic affections and the secretion of albumen by the kidneys. De Witt, an American, is reported to have found albumen in one-twentieth of the cases of epilepsy which have come under his treatment.
It would appear from the above observations, and from the experience of a large number of the most distinguished French experts, delivered upon the controverted points, that traces of albumen may be detected in the urine of epileptics, especially after repeated attacks of the malady; but that the occurrence is very rare, and, as none of the concomitant or collateral conditions or symptoms of the patients in whom the detection was made have been described, no reliable conclusion can be drawn as to the connection between albuminuria and this form of the neurosis ; indeed, it is probable that where this condition was observed, it depended upon renal, or even remote causes, and not upon epilepsy.
Annates Medico Psychologiques, Nov. 1880.
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