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BY S. D. HOPKINS, M. D., DENVER, COLO., PROFESSOR OF NEUROLOGY IN GROSS
CAL COLLEGE AND NEUROLOGIST TO ARAPAHOE COUNTY
AND ST. ANTHONY'S HOSPITALS.
J. J., male, age 39; merchant; born in Ireland; in Colorado sixteen years.
Family History-Parents died of old age. One sister died during childbirth. No history of cancer, tuberculosis or nervous disease in the family.
Previous History-Had the usual diseases of childhood; also suffered from sick headaches, which would occur about once a week and be associated with vomiting. The pain was in the frontal region (bilateral), dull in character, with periods of exacerbations and continued from early childhood until he was nineteen years of age, when it ceased. After this he enjoyed good health until his present illness began. Denies syphilis and alcoholism.
Present Illness-Began about two years ago, when he noticed a cold sensation in the occipital region of the head, which has continued to present date. Three months later tinnitus developed in the right ear, and at the same time he was troubled with vertigo. The former is continuous, while
the latter is paroxysmal, occuring about once a week and lasting one or two hours. In the beginning of the attack he has a subjective sensation of turning which lasts but a short time, when the objective sensation of turning appears and is so severe that he has to sit or lie down until the attack ceases. In turning he usually turns to the right or towards the affected ear, and in the attack the tinnitus is increased. The patient states that during the attack he appears to others as one intoxicated. After the attack of vertigo he complains of a numb and tingling sensation on the right side of the head, extending from the mastoid process up to the parietal position of the cranium.
Examination-No ataxia in arms, legs, or trunk muscles; deep reflexes throughout the body normal. All sensory phenomena normal.
Special Senses-Smell, present and equal on both sides. Taste, right side lessened; left, normal. Hearing (watch). right ear, heard at 1:30, but is not
heard when placed in contact with mastoid cells or on closing the external meatus. Tuning fork is heard when held in front of right meatus, but placed on vertex or teeth is heard best in left ear even when right external meatus is closed.
Left ear, watch heard at 30/30. To the tuning fork, bone and aerial conduction normal. Eyes, remote vision, right 2020, left 2020; pupils equal and respond to light and accommodation. Fields, normal. Fundi, normal. All external ocular movements good. Has a slight degree of astigmatism. All visceral organs normal. Urine, Sp. Gr. 1020, acid. No albumen or sugar.
In arriving at a diagnosis, certain functional and organic diseases of the nervous system, along with other diseases which come in the domain of special and general medicine, have to be taken into consideration.
We can exclude organic diseases of the brain, such as tumors, by the absence of the typical symptoms of neoplasm, e. g., optic neuritis, vomiting, headache, or any localizing symptoms. Vertigo is a symptom frequently seen in vascular lesions of the brain, but they can be excluded by the mode of opset and the subsequent development of mono-or hemi-plegia. In neurasthenia actual giddiness is rare, although some patients complain of a sense of impending giddiness, whereas, in case reported, the objective vertigo was distinct and from a definite cause.
A certain percentage of cases of vertigo is due to disorders in digestion; the vertigo coming after some stomach disturbance, and only after every other cause of the vertigo bas been excluded are we justified in making this diagnosis. Gowers states: "I do not think it is quite certain that there is such a thing as definite vertigo of pure gastric origin. Thirty
years ago, 80 per cent. of cases of giddiness were supposed to be solely due to the stomach. But we know now that in 90 per cent. of the cases of definite giddiness a morbid state of the labyrinth is the real cause of the vertigo. Certainly vertigo of purely gastric origin does not constitute more than 5 per cent. of the cases in which definite giddiness is a prominent symptom.” Ocular vertigo can be passed by in this case, as there is no deficiency in any of the movements of the external ocular muscles, and after correcting his astigmatism the attacks of vertigo continued the same as before. Frequently in the minor, and in the aura of major attacks of epilepsy, vertigo is the first symptom to appear, but comes on without any apparent cause, followed by loss of consciousness, and in the latter with a distinct convulsion; while in the case under discussion we have a definite cause for the vertigo. No loss of consciousness or convulsion.
Lesions of the spinal cord may produce vertigo, but in this case we have none of the characteristic symptoms of cord disease, as paralysis of sensation motion, disturbances with bladder or rectum or impairment in tendon and superficial reflexes.
Alcoholic, nephritic, anemic and gouty vertigo can be excluded with ease in this case. The diagnosis of Meniere's disease was made on the following symptoms; Continuous tinnitus in the right ear, with greater intensity at time of attack, subjective and objective vertigo occurring about once a week; gradual deafness coming on in right ear, and by the various tests made for the deafness showing that it is of nerve origin. The prognosis is unfavorable unless complete deafness is produced when the vertigo will cease. The treatment consisted
in the administration of bromides, with only slight improvement. Dr. Chas. H. Burnett, of Fuadelphia, in a recent article advises the removal of the incus in Meniere's disease and mentions two cases of over a year's
duration where prompt and absolute relief from vertigo was secured by this surgical procedure. If the patient does not make any further progress under the use of bromides, surgical interference will be recommended.
THE AMERICAN CIGARET.
BY F. A. SEYMOUR, M. D., LOS ANGELES, CAL.
The analysis by British chemists of numerous samples of American cigarets, all of which should prove free from other toxicants than tobacco, would not exempt the product generically from the right to its bad name. Until a few years ago the writer had supposed the report of drug addition an emanation from alarmists. In conversation with an unfortunate habitue, he learned that some brands gave no satisfaction to the confirmed smoker, while others did. The satisfaction was evidently not dependent on the quality of the leaf, for the infurmant hac been a cigar-user, and was of this a competent judge.
Aside from any drug supplement, there are independent elements of especial danger in this reduced paperbound edition of the aboriginal folly. The toxines of tobacco, nicotin, nicotinin and the pyridins, developed by combustion, are carried in the resultant smoke. It has been asserted by those in position to know that no snall proportion of the material employed in the manufacture of cigarets is obtained from the stumps of cigars gathered in large cities by child scavengers from gutters and garbage cans. It is possible that some efficient cleansing process may be adopted by the factor before shaving, but it is not probable. Any heat of less degree than sufficient to volatilize the essential toxines would fail to destroy the incidentally attached micro organisms.
Observation warrants the conviction that cigarmakers are frequently submoral, many of them syphilitic. Their environment is often conausive to the development of pulmonary tuberculo sis, to which not a few of them fall victims. In finishing a cigar the wrapper is moistened by the maker's tongue. This is always so in the folding of improvised cigarets by the user. Whether it is the case in the factory the writer is not informed. Conceding, as affirmed by the Lancet commission, that the cigaret contains but i per cent. nicotin, no estimate is furnished of the percentage of the destructive nicotinin, and the
poisonous pyridins. These, combined with the micro organic infections contributed by the maker, the primary smoker, the cuspidore, the gutter and the garbage can, certainly constitute a sufficiently grave menace to the well-being of our youth, without any addition of opium, cocain, cannabis indica, or nasheesh. Further, the duration of a burning cigaret is brief. The smoker early acquires the habit of inhalation, that he may get the full benefit of ais shortlived pleasure. The nearness of the burning tip to the mouth, and the porosity of the loose little roll, make the combustion of new, or diluted tobacco of 1 per cent nicotin, more disastrous in its results than even 4 per cent second-hand syphilitic and tubercular stumps could possibly be, if smoked in a long stem pipe. But,
taken altogether, despite the attractive envelope and an occasional decent photograph, the American cigaret is too vile for any defense. Surely the American medical conscience should
peither condone the offensive greed of its producers, nor treat lightly the peril of its countless juvenile victims.
307 South Broadway.
TREATMENT OF ACUTE OPIUM POISONING.*
BY F. D. BULLARD, A. M., M. D., LOS ANGELES, CAL. As there is no direct chemical anti- of Ottawa, states; "The elimination of dote to opium that can be utilized in the poison will be assisted by spirit the human body with any considerable of nitrous ether and copious draughts effect, the treatment of acute poisoning oi water. Pilocarpine has been emis comprised under the head of elim- ployed for the same purpose.” Wittination of the drug and support of the haus also recommends jaborandi as patient. Emesis should be attempted, stimulating perspiration and thus fabut probably will be futile. There is, voring elimination. however, the stomach tube, which is Venesection in opium narcosis perof the greatest service in emptying forms a two-fold functon-it unburthe stomach of its contents. The tube dens a clogged heart, and directly disis useful, not only for the evacuation poses of a part of the poison. The of the stomach, but in lavage, which hypodermic injection of salt solution should be repeated as often as the seems to me to be rational, as it would symptoms demand. Kerr estimates that allow a much greater bleeding and conone-half the morphine administered sequent withdrawal of more poison; it hypodermically may be recovered from would act as a stimulant or the kidthe secretion of the stomach. It is neys, thus favoring elimination and best to wash out the stomach first also act as a preventive of and as a with plain water, then with a warm support in shock. acidulated one per cent. potassium For the support of the patient two permanganate solution, leaving the factors especially emphasizedstomach full of the solution after each oxygen and forced artificial respirala vage.
tion. It seems to me that forced respiThe hypodermic administration of ration of highly oxygenized air or even permanganate is contra indicated as pure oxygen would be of especial value being almost sure to produce bad ul- in poisoning by opium. Playfair, 10 ceration, and when absorbed, if ab- ihe London Lancet, reports a case sorbed into the alkaline blood, it does where thirty grains of morphine acenot have the same antidotal effect as tate had been taken, where oxygen when in an acid medium. The repeated was administered continually before washing out of the stomach is prob- hopeful signs were discovered, and yet ably the greatest gain in the treatment the patient made a complete recovery. of opium poisoning that the past de Doctor Fell of New York gave a recade has given us.
markable history where artificial resEmptying and washing of the blad- piration was successfully persisted in der and rectum are advocated by some for seventy-eight hours, the longest for the same reason. Beaumont Small, treatment on record. In connection
*Read before the Southern California Medical Society May 5, 1900.