BMJ (Clinical Research Edition)
Professor Lindsay discussed tlle possibility of the case being one of acute ascendillgt mliyelitis, actlte poliomyclitis, or acu-to toxic polyneuLritis, but was of. opinion, that these coniditions could be excluded, and that the case was a genuine. cxamiiple of Laiidry's. syndrome. (2) MAyasthenia graxis. Tlhe patient was a man of good general plhvsique anii( of good lhealth hiistory, aaed 44. He had becn a famouts atlhlete, lad L)layedl for six or seven years in International football, anid
... l football, anid had beeni a noted swiimmer, cricketer, and hockey player. His fatlherlhad been alcolholic and hiad died inisanle after a detenition of tlhirty years in the B3elfast District Asyluim. The patient lhad suffered a great slhock by the death of his wife by accidenit two years before tlhe onset of hiis illness. Tllere was no alcoholic or venereal hiistory. TI ic early symptomns, wlicil showed tlhenmselves ii 1912, were ptosis in botlh eyes, witlh a feelinig of wveacLIEss anid " deadniess " in. the legs after brisk walking. Tle p)tosis d-isappeared in a few weelis. After a few monitlhs tlhe patienit's speech became affected. He lhad a lisi) anid a difficulty in pronounIcing som-ie words. Siniling alnd whistling became difflicult. Deglutition was inipeded, anid tlhe food tended to loclge betweLii the clheeks andi tllc teetlh. At a later stage trenmor and weakniess of thi liands set in, anid the patienit was obliged to relinquisi hlis work, wllichi was that of a cabinet milaker. Stiffness, veaklkess, and troemor of tile muscles of the neck were later developmiients. His walking powver becarne mucli reduticed. Palpitation became troublesomie, ancd lhe lost weighit decidledly. Th'ere, was no complaint of pain, btit the limbs felt cold andl " dead." There were no mlenital syi'lptomBs, anid intelligence was above the average. After a night's sleep the patient often felt quite well. He was admitted inito thle Royal Victoria Hlospital, Belfast, on November lOthi, 1914. I-is weight -was 9 st. 3 lb. 11 oz. The temperatuLre and urine were inorImlal. Tlih lheart was normal, but the piulse was rather frequent, snall, anid of loiv tension. Passive tremor ias present in tIme hands anid arms. Sensation was norm-lal. The reflexes were niormal whien first tested, btit spee(lilv became weak and disappeared, to retuirn after a shiort rest. 'li' sphlincters were lnot involved. The imyastlieniic reaction in thle miuscles was well marke(l. All thle symptoins tended to abate after rest. The patielit remiained ncarly fotur monthls in hospital, and hiis coniditionl, wvitli some temiporary flucttuations, remained substantially iuclialiaged. P'rofessor Lindsay discussed the points of dlistiniction between myasthienia gravis and cases of aggravated neurastlhenia, laying stress upoIn the predominance of miusele fatigue, the myasthienic reactioni, thle condition of time reflexes, thle absenlce of pain, thle absence of morbid inItrospectioln, aind the alternllating cllaracter of tlle sviymptoms as characteristic of the foriier disease. (3) Automatismn. The patient was a gentleman, aaed 60, of temperate liabits and good lhealth hiistory. Tllele was no hiistory of hereditary nervous disease, alcolholism. or syphiilis. His general lealtl was excellent, and llis weiglht was 14 st. 7 lb. Tlhere was no evidenc of organic disease in any of tIme viscera. His story was that on several occasioins lie had found Iiimiself at considerable distances frorin his office withiout any recollection of wlhat had lhappenied in tlhe inlterval. He lhad niever liad a convulsion, bad niever fallen or hiuirt himlself, and had never passed water duLriDg an attack. On recovering from a seizure lie felt perfectly well, and there were no after-phienomena. Phtysical exanilination was entirely negative. The patient was put ulpoIn a course of bromidle and belladonna, and in a shiort tinle the attacks ceasel. Wlen last seen he had been free from attaclks for a period of nearly five years. Remiarlks wero made by Dr. DRURY, Dr. PARSONs, Dr. IDAWSON, Dr. II. BEWLEY, anid Professor LINDSAY replie(d. TiE Royal Dental Hospital, Leicester Square, has received a doniation of £500 from the trustees of Smith's (Kensingtonl E.state) Charity. COLUMBIA UNIVERSITY, New York, is about to build olne of thje largest imiedical schools in the worl(l. The University and the Presbyteriani Hospital have joined forces for the p)urpose. The new ilmedical school will replace the present College of Plhysicians alnd Surgeons, anid the Presbyterian Hospital w\ill 1)0 removedl to a newv site. Columbia University has, we learnl fr'oni thle MUedical Rsecord, set five years as thle timue limit for thle raisinlg of a fundl of £1,500,000, wvhiclh will inclulde the cost of its shlare of the land, thle cost of buiklding a newv mnedlcal school, and an enldowNment funmdfor the nilainteanlec of' thle school. 3KtbebIuv. IIJUAM N PHYSIOLOGY. THlE thlird volumiie of Professor LuCIANI'S; Hainan P-hysio. loyl lhas beeln translated by M1iss WELBY, anid edited by Dr. GORDON HOLMES. Thle edition fronm wlhiclh the translationi was miiade was publislhed in 1913, when a comImiiemuorative muedal anid an albumn colntaininia the autograplhs of almost all the world's nmost eninent phlysiologists were presented to tlec autlhor. Tlhe volumie conitainis the gelneral plhysiology of mn-uscle, the miieclhanics of the locomiiotor apparatus, plhonation anid articulation, anid tlio physiology of tlle nervois, systemi. Miss Welby has done lher work very well, and we are grateful to lher for giving, uis this sch0olarly volumne in Enilishl. The great value of Luieiani lies in hiis adimiirable exposition of the hiistorical evolution of the science. For examiiple, in the disecLssioii oni the psyehical inmportance of the brain, we iead that "Rudinger (1882) notecl the imnportanit fact that the parietal conivolutionis are extraordinarily wecll developed in mnen of highl intelligence as compared witlh ordinary inidividLals and the lower huinmani races. He was able to obtain eiglteen brains of people wvitlh differenit claims to eminence, amiiong tlleml-D6illinger, Biscloff, Lasaulx, and Liebig. In examininig tlhese lie was specially struck by the ex:ceptional developmient of the colnvoltutionis anld fissuLre-s of tlle parietal lobe, which gives this region quite a differenit aspect frolml that of the brainis of uiicuiltured pesons. The study of the skulls of Kanit, Gauss, and Dirielhlet also slhowed iimarlked developmenit of the parietal regioni. In the skulls, of Bacl and of Beethoven, whiiclh have been studied by His anid by Fleclhsig, theere wvas a marlied developmenit of the posterior regiOnS of the braini, parieto-occipito-temporal, and the Rolanidic regioni, wlhile the pre-fPontal lobes were of onily comiiparatively inlsignificant dimiielnsions. Trhe brain of the astroniomiier Gyldeln, examinied by Retzius, slhowved considerable developmen l of the parietal lobe, especially of the, anlgutlar gymLis. In Helmhilioltz's braini, according to Mansenmalnn, thle precunetus and the parietal reoioni included between the angLular gymus and tlle upper temiiporal gyrms were remarliable in size. Raffaelle's craniumii, studied by Miliaazziii in an autlhenitic clallk drawillg at Urbinio, shows a strikinig contrast between tllc modest heihlit of tlle forehead and the great expansion of the occipital and parietal lobes. rThie skulls of Gauss and Richiard Wagner, according to His and Flechsig, on tlle colntrary, exhibit a striliing development not olnly of the posterior associatioln area, bn'u also of the anterior or prefrontal association area of Fleclisia." S. Sergi (1909) ' has also brouglht out the fact tllat the developmuent of the frontal lobe is niot in ratio witlh the degree of initellectual developmelnt, and that the hlighest races are characterized by predomi-inating developnient of the parietal alnd occipital lobes." We niote the inclusion of somle ilnterestinig ex.;,erimients by Kaliseher (1907). He educated dogs to swallow pieces of meat onily on hcariag a given sound, and not to toucll themii at souncds of a differenlt pitchl. These animals retained a capacity for recognizing the 'i dinlnier sound(l" eveni wlheni the cortex of botlh temporal lobes lhad been destroyed. He taught otlher dogs to touchl tlleir food only in brillianitly lighltedl surroundinigs, and niot to take it in a dim lialht. Th'is liabit was preserved after remioval of botlh occipital lobes. A "dinniier colour," on Tlie otlher hlanid, was lost. In the section dealina with tlec functions of the tlhalamus thjo interestina researches of Head and Goidon Holines require mention. Tlhe editcr lhas been too miiodest in not securing a referenlce to tl( se, at aiiy rate in the bibliograplhy, whichi is supposed to iinclude all imiiportant recent Englisli researches. Professor N ORL PATON la-s issued the fourth edition of hiis Essentials of Humanut Physiology.2 The recenit rapid growtlh of the scienice, the autlhor says, " hlas rendered it I Hum.17ant PhIyJsiolofly.