Vol. 60, 1909 - University of North Carolina at Chapel Hill

XXXII THE CHARLOTTE MEDICAL JOURNAL
may be associated with other nervous trou- congenital or tertiary acquired syphilis, has
bles in cases that show evidences of syphilis, sometimes seemed of value Repealed lumor
they may occur suddenly in children bar puncture has been used with some,
that have given no evidences of syphilis, though probably only with temporary, bene-
They may be preceded by symptoms of ma- fit. Patients should be advised to eschew
laise or convulsions for a few days. Such alcohol, tea, coffee, and tobacco, to avoid
hemiplegias may disappear entirely under as far as possible mental excitement and
specific treatment in a few weeks or months, loud noises, and to keep the bowels acting
or there may be left a variable amount of well. During a severe attack the recumimpotence
and atrophy, corresponding to bent posture should be enjoined, with ice to
an area of brain softening due to obstruc- the side of the head. When all other meastion
of some one artery. These conditions ures fail, and when life is made practically
are entirely similar to the specific hemi- intolerable, the advisability of destroying
plegias of adults, which are often of a pass- the labyrinth—at any rate the static portion
ing nature, and are caused by cerebral of it—should be entertained,
arteritis with ischemia. Whenever we have
^^ Treatment ol Acute Rheumatism.
a sudden hemiplegia in a child we may look ,...,,„,
forsvphilis, even if there are no other signs —Plehn (Deutsche medicinische Wochenof
its presence.— Revue de Medecine. schrift) emphasizes the wrong principle
appears to be gaining ground, to
^ which
Aural Vertlgc-Simon, in The British ^^^^^^^ ^f their supposed toxic effects on
Medical Journal, says that as regards treat- ^j^^ kidneys. Leuthje was the first to detnment,
this naturally has reference to the Q^^rale the changes in the urine which are
underlying aural affection, and iii giving a
. ^, . . ^ , throw overboard the older salicylates, on
^^t .^jje,, salicylates are given even in
prognosis one has to take into consideration
^^^derate doses. Klemperer considered that *
the possibility of the amelioration of this -^ -^ „ecessarv to use the smallest doses poscond.tion,
and also the period of associa-
^^^^^ -^^ ^^^^^ ^,^^ ^^ ^^p^^^ ^^^ kidneys to I
'
tion of the deafness and vertigo In non-
^^^^ ^^^.^ influence. Hauffe, representing
suppurative affections of the middle ear in
^^^ Schweninger school, which refuses all ;
which the vertigo has shown itself much
^jgdicamental treatment, claims to have |
later than the deafness or timitus, it has
obtained excellent results without salicylic
seemed to the author that the treatment of
^^-^ 1
However, closer investigation has
the aural condition was more likely to lead
^^^^^^^ ^^^^ ^^^ ^^^^^ irritation of salicylic
to its improvement or disappearance In ^^.^ -^ ^^^^ imagined than real, and ! that
treating the symptom itself the drug of most
^^fgctly normal, healthy persons frequent- i
efficacy is quinine. Charcot instituted tins ,
^ jj^.,,^^^^ j^^^^^ of 'albumin, and even
treatment on the principle that It gradually '
^ vvithout taking any of this drug.
destroyed the hearing, when, as it has been
^j^^^^ ^_^^^^ ^f albuminuria not infrequen - :
seen the vertigo disappears. On the other
j^ ^^^^^ ^^j^il^ ^^^ ^^^-^^^^ -^ ^^^-^^^ g^,j. j
hand. Urban Pritchard reports a case of se- ^j^^^^
^^ considers that even if slight |
vere vertigo from a poisonous dose of qui-
:
i^.^-^^.^^^^^, ^f the renal apparatus were pronine.
It is, however, not necessary to give
^^^^^ ^^ ^^^-^ ^^^^^ ^-^^^^ -^ acts specifically ,
It m such large doses. Given a gram at a .^^ rheumatic fever, just as mercury acts in ,!
time. It seems to reduce the irritation of the
^jJHs and quinine in malaria, it would be i
vestibular nerve, probably by overcoming ^-^^ ^^ ^-^^ -^ f^^^^^ ^.j^^ ^^^i^^^ g^y^ ^^^^ j
congestive changes.
j^ -g „ecessary to give it in large quantities j
On the ground that vertigo is due to ane- j^ order to obtain the full specific effects,
mia of the labyrinth—which, however, is pjrst, however, it must be certain that the
probably not as a rule well founded— Ler- rheumatic affection is really acute. He
moyez suggested the use of amyl nitrite, prefers pure salicylic acid to the sodium or
We are all aware, of course, that in condi- other salts. Plehn g\ves it in doses of 1
tions of severe anemia vertigo is common, gramme (that is, about 16 grains) every
but whether this is an aural phenomenon hours, or 0.5 gramme every hour during
or not, even when associated, as it often is, the first day, but none during the first night,
with tinnitus, is a doubtful point. At the Qn the following days he gives 6 grains in
same time it is quite probable that the actual i.,. or 1-gramme doses. This is continued
cause of vertigo is not so much either con- until the temperature has been normal for
gestion or anemia as the alteration in the three days and all pains and complaints of
pressure of the endolymph which may be all sorts have disappeared. Then he gives
brought about by either of these states. The 4 grammes a day for a week, and after three
bromides and iodides are sometimes useful, further days, during which the patient reand
pilocarpine, especially in patients in mains in bed but receives no salicylic acid,
whom the aural condition is dependent on i^g allows him to get up, provided that no