Page images

cess, resembling a meningeal reaction, and sometimes going on to perforation and fatal meningitis.

The abscess in the spinal cavity presses on the dura mater, the medulla or cord and causes corresponding nervous syndrome. If no surgical treatment is used, it may be found at autopsy.

This form manifests a mimber of symptoms clinically, some leading to consideration of typhus, lung trouble, peritonitis, etc., some attracting attention to the vertebral column (pain in moving, rigidity of column, etc.\ There might be slight kyphosis from contracted muscles.

It is important to note that nervous phenomena appear as soon as the vertebral lesion is evident, varying according to amount of compression. In the inferior lumbar region there is compression of the cauda equina with paralysis, loss of reflex, retention of urine, disturbance of sensibilities. Death occurs unless the abscess is treated, then nervous phenomena disappear.^ Cure must be effected by surgery and the results are better the sooner the diagnosis. Sometimes superficial incision of the abscess is enough., In encapsulated abscesses of the space laminectomy is performed with care not to injure the dura mater. The lumbar puncture must be made with care, when there is any suspicion of pus in the space, in order not to infect the meninges.

In the author's case the patient became ill with furunculosis; microscopic examination of a pus culture showed infection by Staphylococcus aureus. While the place of suppuration was cured, the infection moved without any previous trauma, located in the bony tissue of the second and third lumbar vertebra?. Fever recurred. There were lumbar pain and rigidity of movement in the lumbar tract.

The spondylitic process appeared with pus in the spinal cavity, causing compression of the cauda equina and a relative nervous syndrome. Stapyhlococcus aureus was found in a pus culture. With lumbar puncture compression was removed and cure effected.

This case showed the medullary syndrome of myelitis coexistent to pyogenic infection giving an acute purulent spondylitis with medullary syndrome of compression. Cure was effected by examination of vertebral column and puncture leading to an accurate diagnosis in time for surgical intervention.

Day, G. H.: Further Observations on Syphilis of the Nervous System with Report of Cases. Kentucky Medical Journal, March, 1921, xix, No. 3, p. 95.

Salvarsan is in no wise a specific, and until its limitations are understood and treated accordingly, we will receive the maximum in return for a correct understanding of such an adjunct. The simplicity of preparation of neosalvarsan, the ease of administration, and quickly attained results in the clinical picture, give us a false security; cases later develop neurosyphilis because of undertreatment. Persistently negative blood does not always mean that the syphilitic is cured; no patient should ever be discharged without many negative bloods and a negative spinal fluid.

Corbus found on spinal puncture in so-called cured cases that 18.3 per cent had cerebrospinal manifestations, none having symptoms or lesions of any kind or description.

Results in syphilis depend upon, first, time of instituting treatment while disease is in the so-called primary stage, second, power of resistance of host and the type of infection, and third, method of treatment and the qualifications of the physician extending such treatment.

First.—With an initial lesion, a positive dark field before the blood is positive, offers the best chance of an early cure.

Second.,—The resistance of patients varies- both as to the infection and to the treatment, being unquestionably different strains of spirocha?ta, and many times patients have a lowered resistance, developing neurosyphilitic symptoms rapidly in spite of well-directed treatment. With an early diagnosis in acute syphilis, a series of six salvarsans, followed by fifteen intramuscular injections of mercury, will usually give us a negative Wassermann; negatives obtained by mercury in series properly managed, will give us a cure, provided the treatment is checked by frequent Wassermann, and in every instance, spinal puncture made before pronouncing the patient cured.

Third.—A standardized treatment should be adopted, which can be applied to the average case, until a negative blood, when further specific treatment may be given until cure is effected. Routine may be altered in exceptional cases, treating blood primarily, patient secondarily. It is the cerebrospinal type that holds our interest at this time. We must decide the questions in the light of the results obtained in our own experience, for it is only results that count.

Two methods of treatment are advocated in neurosyphilis: one, intravenous, the other, intraspinal.No hard and fast rule «an be set down for a routine. Advocates of intraspinal therapy never claimed for the method that should be used to the exclusion of the intravenous, nor have they claimed that the choroid plexus is impermeable in all cases and that remedies introduced intravenously «ould not reach the cerebral or spinal tissues.

Patients who fail to improve under the most intensive treatment, symptoms rapidly increasing on administration of intra-spinal treatment, return from invalidism to full health, a fluid cell count of 50j a positive globulin and Wassermann, changed to normal cells and negative globulin and Wassermann.

Bat.thazard: Etiology of Criminal Assaults. The Victim. Assaults Falsely Alleged (Etiologie des attentats de la pudeur. La victume. Attentats faussement . allegnes). Le Progres medical, April 9, 1921, xxxvi, 159.

Most criminal assaults are committed by persons between 20 and 60 years of age, but as these compose the majority of males living, the statistics do not prove anything. A sort of perversion of paternal love leads these individuals to assault their own daughters. Diminishing genital power, genital malformation as cryptorchidism and hypospadias, and venereal diseases play a large part in the pathogeny of criminal assaults. At first because blenorrhagia creates for a certain length of time a misogyny. In some, this misogyny persists and they turn to sexual perversions, pederasty, etc. These reasons explain a large number of criminal assaults. There are other processes of psychology which turn certain individuals to homosexuality. All these individuals are responsible, they have a diminition of sexual power, but they are lucid and conscious. They have no excuse for their acts, which spring from impulses which they cannot resist. In another group of individuals there is less responsibility because they are really ill. Without being really deranged, there are some who have alterations of the central nervous system, psychic or medullary, which excite them to criminal assaults. These may be classified. The spinal cases commit the act without cerebral participation—it is an act of automatic reflex. There are the spinal cases which are at the same time "posterior cerebrals". In these the act is always brutal and imperious. In man this perturbation causes satyriasis, in woman nymphomania. Finally there are the "imaginative", the "anterior cerebrals". In this list are placed fetichism, sadism. The pure "anterior cerebrals" are poets, imaginative people who are content with .platonic love, called erotomaniacs,, in love with a star, or a statue, as Pygmalion was. There are exhibitionists who perhaps belong to excellent families but are arrested for exposing the geiiital organs in church, or elsewhere. They have an impulse which they cannot resist. These must not be considered deranged as Blanche holds. However, their responsibility is doubtful. Prison is often an effective therapy. These individuals are declared irresponsible and freed, recommencing their practices. An asylum for the criminal insane, or semi-responsible has been considered. This would be the best solution of this problem.


Vol. Ill MARCH, 1922 No. 3



Editorial Abstract Board - - '- - - - 194

Section on General Medicine 195-232

Section on Laboratory and Research .... 233-254

Section on Pediatrics - - - - "- - - 255-264

Roentgenology and Electrotherapeutics - 265-276

Neurology and Psychiatry 277-288

Analytical Table of Contents - i-iii

Index of Authors - -- -- -- - iv-xi

Index of Subjects - -- -- -- - xi-xxiii



PublUhed Monthly $3.00 Annually
Copyright. 1922, by W. F. Prior Company Inc..

« PreviousContinue »