Sydney Ringer
1879 The Lancet  
290 the constant current had occasional exquisite pain at certain spots in his right thigh, at the time of his discharge it was felt less in the right than in the left limb. There was no longer any pain on percussion over the lower part of the spine, nor could any spots tender to pressure be discovered in the thigh. Here were two carpenters, then, who both, by a strange coincidence, suffered from extremely acute pain, loss of power, and wasting in the right lower extremity, following exposure
more » ... chill; who both, according to their own account, lost a couple of stones weight in their illness ; and who both got well under similar treatment. In spite, however, of this singular correspondence in fortune, I think we must feel that, although they both suffered from perineuritis, the I , cause of the inflammation was probably not alike in the two 1 men. I In the case of Hthere was a periosteal node. I do not mean to assert that a swelling of this kind could not possibly be occasioned by rheumatism, though I have no experience of such an occurrence. As a matter of common observation, however, there can be no doubt that if one meets with so well-marked a symptom as this in a case where there is a history of a former bubo, and the node rapidly disappears under iodide of potassium, it is not safe to doubt its syphilitic origin. In C-'s case, on the other hand, there was no existing sign or past history of syphilis. I should not take much account of this absence of evidence if there were other reasons for strongly suspecting syphilis, for we are continually meeting with cases in which the symptoms caused by lesion of some part of the nervous system constitute of themselves the only testimony to the specific nature of the disorder, and experience shows these to be quite as pathognomonic as affections of the skin. But in this case, the nature of the disorder pointing with at least as great probability to rheumatism as to syphilis for its basis, it becomes necessary to attach very considerable weight to the circumstance that there is an entire absence of all signs of the latter disease. Moreover, it must be noted that, notwithstanding the great improvement in the patient's condition, he is still suffering from more or less pain and weakness, and that, when he came to us last week, he complained of pain, evidently of rheumatic character, in the muscles of one arm. That iodide of potassium is often of great service in chronic rheumatism is a well-attested fact, which requires, however, to be remembered when we are inclined, as we sometimes are, to find too readily in the improvement alone produced by its use strong evidence of the syphilitic nature of the lesion for which it is employed. But it has often seemed to me that there is an exceptionally sharp and decided influence exerted by the drug in many syphilitic affections which is only mildly imitated, as a rule, by its effects in chronic rheumatism. In H—— this was well seen. In a very short time the whole mischief was swept clean away, and the man remained apparently as strong and well as ever. In C-, although the influence of the iodide was greater than is perhaps usually seen in rheumatic cases, yet the improvement of the first few days was by far the most important, and the cure, though certainly striking enough, cannot be said to be complete. Nor must it be forgotten, in reference to this point, that C-'s illness, when he came under treatment, had lasted only one-ninth part of the time during which Hhad been suffering. The pains in the case last related were referred to the regions innervated by the ilio-hypogastric, ilio-inguinal, genitocrural, external cutaneous, anterior crural, and obturator nerves of the right side. From the fact of the left limb being also, though very partially, involved, and from the intense pain in the lumbar portion of the spine when this was percussed, it seems likely that the actual seat of the lesion was in the nerves going to constitute the lumbar plexus, whilst they still occupied the cavity of the spinal canal. That the lesion did not (as in certain respects the symptoms appeared to suggest) consist of a tumour, pressing especially upon one-half of the cord, is shown, I think, by two circumstances-1st, there was no exaggeration of skin-reflex upon tickling the right sole ; 2nd, there was no marked cutaneous anaesthesia of the left lower extremity. VACCINATION GRANTS.-The following gentlemen have received the Government grant for successful vaccination in their districts :-Mr. J. THIS interesting drug is derived from Duboisia Hopwoodii, and belongs to the order Solanacese, but differs strangely from the other medicinal plants derived from this family. With Dr. Bancroft and Mr. Murrell, I have shown that, given to animals, it causes drowsiness, dilates thf pupil, produces general weakness, twitchings of the muscles hurried breathing, and antagonises the action of muscarin and pilocarpine on the heart, in these particulars correspond ing with atropia and duboisia; but pituria differs strikmgl from these drugs in producing copious salivation. Mr. Percy Gabb and I have recently made some add-tional observations regarding its action on man. M. Gerrard obtained the pituri with which our observation were" made from Mr. Macalister through Mr. E. A. Clat, of the Queensland section of the Paris Exhibition. It ws. grown in the botanic gardens at Brisbane by Mr. Hill, or whom it was exhibited. Mr. Gerrard extracted the alkaMB and prepared the nitrate. Our observations were made on four men, aged respctively seventeen, twenty, twenty-three, and forty-eigit. We found that one-eighth to one-tenth of a grain grem hypodermically produced in these cases well-marked synptoms, and in all the observations from which we now dnw our conclusions this dose was administered. We mdetwelve observations. We find that pituri produces fant. ness, pallor, giddiness, tremor, hurried and superfiial' breathing, increased frequency of pulse, and contraction of the pupils and perspiration. We shall now speak of ach symptom separately. Faintness and pallor were noted four times, and on me occasion the man became pale, but did not feel faint; jhe faintness was only slight, except once, when he said he lalt as if he " should faint away." Giddiness was several times very marked. It occurred six. times in our twelve observations. Tremor affected the whole body, and was rather rhythmic in character ; the head shook a little, and the hand and arm,. especially when the arm was raised. The muscles also. twitched a good deal, even the muscles of the face. This symptom occurred four times. Respiration.-Breathing was quickened in five cases, namely by 6, 6, 10, 10, 12, 15 respirations respectively per minute. Pulse.-The pulse was increased eight times by 6,6,12, 14, 24, 24, 24, and 44 beats per minute respectively, Pupils.-In every instance the pupils became slightly but decidedly contracted a very few minutes after the iD jection. Perspiration occurred ten times, in some cases standing n drops on the body. We are inclined to think that the pll"o spiration is especially abundant in the legs and feet, but tie : excess we there noted may be due to the greater accumua-, tion from the bedclothes hindering evaporation. In no instance did it appear to affect the mouth, produang . neither dryness nor salivation. The symptoms passed avay completely in twenty minutes to half an hour. . We made four observations respecting the innuen(3 of . the topical application to the eye on the pupil, and in Clery i instance the pupil became for a short time slightly con-I tracted, and then widely dilated. We used a one per ent. l solution, but this caused considerable smarting, which be<ame , less on the second application a few minutes after, and ceased . on the third application a few minutes later. The pupil be-; came widely dilated, but generally responded a little to light. r The dilatation began in about half an hour, and lasted only . for a short time, disappearing in one case in eight hours, in 1 another in less than twenty-four hours, and in a third the ; pupils became nearly equal in twenty-four hours. This solanaceous plant, pituri, we find, then, produces : faintness, pallor, giddiness, tremor, hurried and superficial breathing, increased frequency of pulse, perspiration. ; in larger doses, salivation, drowsiness, convulsive twitchings, -spasmodic rigidity of the extremities. In small doses, m-, temally administered, it contracts, in large it widely dilates the pupils ; locally applied, it contracts and then widely
doi:10.1016/s0140-6736(02)45997-1 fatcat:sypg67hjpve3fkivwx4sxf6wje