Reports of Societies

1887 Boston Medical and Surgical Journal  
Kast8 reports two cases of this affection with autopsies which were made at an earlier stage than any yet reported one of them being made only fourteen months after the onset of the symptoms. In both cases there was a wasting of the convolutions of the brain on the side opposite to the paralysis, aud the microscope revealed a degenerative process, a disappearance or diminution in the number of the ganglion cells, especially the small pyramidal cells in the second and third layers. There was
more » ... a olecided increase in the neuroglia, together with an accumulation of spider and granular cells, which extended down into the white substance. The hemisphere on the affected side showed a decided arrest of growth. The writer, on the strength of these autopsies, considers that Strütnpell's hypothesis of a polieucephalitis incomplete, as there is also a leuko-encephalitis. He also failed to finol the peri-vascular changes regarded by Jendrássik and Marie as the initial process, or any traces of the venous thrombosis, which Gowers has long considered to be the morbid change giving rise to these atrophie conditions of the brain. HYSTERICAL HEMIPLEGIA. Oserezkowski, in a recent thesis,9 has called attention to the following diagnostic points in the distinction between hysterical and organic hemiplegia : (1) Hysterical hemiplegia developes most frequently after some psychical irritation. (2) It often comes on as a monoplegia. and may be distinguished from the organic form by severe disturbances of sensibility, contractures, etc. (.J) In hysterical hemiplegia the peripheral parts are less paralyzed than the central parts, anol the small joints are less affected than the large. (4) Mobility returns soonest in the peripheral aud small joints. The opposite is the rule in organic hemiplegia. (5) The face aud tongue are rarely paralyzed. (Charcot says that facial paralysis may be simulated by spasm of the opposite side of the face, and Roth, in the discussion on Oserezkowski's paper, thinks there is a real hysterical facial paralysis.) (6) Anaesthesia is parallel with the paralysis. (7) The distribution of the anaesthesia is peculiar. In full hemiauaesthesia the hand and foot may be free. (8) Aphasia is rare, and is replaced by dumbness. (9) Heniianopsia is very rare. (10) The diagnosis of hysteria is based on anaesthesia of the fauces, polyopia, transfer phenomena, hysterogenous zones, etc. MUSCULAR ATROPHY IN HYSTERIA. Babiuski has recently reported 10 a series of cases which, in his opinion, seem to show that, contrary to the current belief, trophic troubles may be present in hysteria. The cases all had paralysis, anol hemiauaesthesia, most pronounced in the paralyzed limb. In most of the; cases there was also contracture, and in one there was loss of smell and taste on the affected side with peripheral limitation of the field of vision. In all the cases there was a simple muscular atrophy of the paralyzed limb, with a diminution of two or three centimetres in circumference. In one case a magnet « Archiv, f. Psychiatrie xviii, «7, 18s7. * Abstract iu Centralblatt f. Nervenheilknnde, Maroh IS, U8T. 10 Archivas d» Neurologie, July, September, 1886. produced transfer and return of sensibility. The atrophy diminished as the arm regained its power. From the anaesthesia, the variations in the amount of contracture, the transfer phenomena, and other manifestations of hysteria, the writer decides that the atrophy also was of hysterical origin, due to a functional neurosis, a purely dynamic alteration in the trophic centres. "DIFFUSION" ELECTRODE. Adamkiewicz has recently devised n a new form of electrode to be used in the treatment of neuralgias for the purpose of obtaining local anaesthesia. It was his object to aid the action of the constant current by adding some medicament whose absorption might be furthered by the kataphoric action of the current itself. For this purpose he trieol chloroform, but found that with the ordinary electrode be could not keep enough chloroform constantly applied to the skin to get any anaesthesia, owing to the rapid evaporation, lie, therefore, has contrived a hollow, metallic electrode, closed by a carbon plate. The hollow chamber is filled with chloroform, the electrode itself is covered with flannel as usual, and the covered carbon surface is applieol to the skin. This electrode is made the anode, and a mild current, gradually increased to 5-7 ma., is passed through the patient for five minutes. The local anaesthesia thus produced is wellmarked, and affords great relief, especially in trigeniinal neuralgia.-Paschkis and Wagner have criticised Adanikiewicz's work.12 They claim that chloroform is an absolute non-conductor, and that a similar anaesthesia can be produced by the application of chloroform alone to the skin, that electricity adds nothing, and causes no kataphoric action whatever. Adamkiewicz, however, by subsequent experiments, has proven ls that there is a much greater degree of anaesthesia produced by the combined application of chloroform and galvanism than by chloroform alone, while galvanism alone produces a slight increase of sensibility. There is, therefore, he claims, a true kataphoric action, aud the new instrument is of value as an agent in producing local anaesthesia in neuralgia.
doi:10.1056/nejm188709291171304 fatcat:7pl325dryjg6jjwe6xlroipmoy