Tire Contents

Postgrad Med J: first published as 10.1136/pgmj.5.56.129 on 1 May 1930. Downloaded from 4I)STHTIRE GR~ADUATE NEDlUAL J Ou1?NAL VOL. V. MAY, 1930. No. 56. CONTENTS PAGE THE TREATMENT OF GENERAL PARALYSIS BY MALARIA 1.. .. ... ... 29 By THOMAS TENNENT, M. B.GIas. THE ROLE OF HYDROLOGY IN MEDICAL PRACIICF ... ... ... ... 137 By MATTHEW B. RAY, D.S.O., M.D.EDIN. POST-GRADUATE NEWS ... ... ... ... ... ... ... ... ... 142 N OTICE .... .... ... ... ...... ... 14 5 FELLOWSHIP OF MEDICINE AND POST-GRADUATFE MEDICAL ASSOCIATION.- copyright. SPPECIAL COURSES ... ... ... ... ... ... ... ... ... i; THE TREATMENT OF genieral paralysis was recorded in 1798 by Haslam, who was then Apothecary of GENERAL PARALYSIS BY Bethlem Hospital. It was not, however, uLntil 1I822 that the conldition was recognized, MALARIA. http://pmj.bmj.com/ by a Fi-ench psychiatrist named Bayle, as a By THOMAS TENNENT, disease entirely based upon a known patho- NI.B.GLAS. logy. His description of the pathological Assisttant Medicall Officer, Maudslky Hospital. changes and of the clinical symptoms holds good in its essentials to-day. ITr has long been regarded that the outlook From this time unitil the discovery of the in general paralysis is most unfavourable, true niature of general paralysis many factor-s on October 2, 2021 by guest. Protected and that it is one of the most fatal diseases were elaborated to account for its xtiology, affecting the human race. Until recently all anid equially nLumerous and varied were the efforts to treat this condition proved worth- remedies suggested. The latter included less, and a fatal terminationi within a few such diverse methods as venesection, cautery years was the inevitable outcome. Remis- to the head and spine, baths of varying sions throughout the course of the illness temperature, purgatives and electricity. were recognized, but aiy claim of recovery Iron, potassium bromide, quinine, silver aroused, in the minids of most, giave doubts nitrate and digitalis were the more prominent as to the diagnosis. Fortunately this state drugs advocated. of affairs has changed and remissionis inay These methods of treatment held promill- now be iniduced by prompt and appropriate ence at various stages and, until a better treatment. uniderstanding of the xtiology was obtained, The first cliical accounlt of a case of little lheadway from the therapeutic angle Postgrad Med J: first published as 10.1136/pgmj.5.56.129 on 1 May 1930. Downloaded from 130 THE TREATMENT OF GENERAL PARALYSIS BY MALARIA was made. In I857 the relationship between such as pneumonia had set in, and it sug- general paralysis and syphilis was stressed gested to him that treattnent might be by Esmarck and Jessen, who reported three more effective still if directly produced by cases of syphilis followed by general infectious disease. paralysis. Thereafter there developed a Other two observations were reported controversy as to the nature of the causa- meantime bearing on this point anid are tion which lasted over fifty years, and was worthy of note. only settled by the researches of Wassermann (i) Bercovitz pointed out that neuro- and Noguchi. syphilis was extremely rare in certain areas Meantime treatment had progressed of China, although syphilis was extremely chiefly along two channels, the specific and common ; malaria in these districts was non-specific forms of therapy. It is witlh endemic. the chief variety of the latter that I propose (2) In I9I3 Pilcz and Mattauscliek to deal to-day, namely, the treatment by the analysed the case histories of over four induction of malarial fever. thousand officers and men of the Austrian The beneficial effect of fever in the army who had become infected with syphilis. psychoses generally had been recognlized They pointed out that those who during their and observed since the days of Hippocrates first year after infection had developed an and Galen. Many centuries later Pinel acute febrile illness such as pneumonia or elaborated among the conditions tending er-ysipelas did not later develop neuro- to produce a "permanency of cure" a syphilis. On the other hand, practically quartan a little fever. Clouston, over forty without exception, those who developed copyright. years ago, wrote: " I believe some day we neuro-syphilis had not suffered from an acute shall hit on a mode of producing a local febrile illness during the first year after inflammation or manageable septic blood- infection by syphilis. Fortified by these poisoning by which we shall cuit short or observations von Jauregg, in I917, thirty cure attacks of acute mania." This observa- years after his original suggestions, inocu- tion then, that the onset of a febrile illness lated his first series of nine cases of general during a psychosis frequently resulted in an paralysis with malaria, from a soldier who http://pmj.bmj.com/ improvement in the mental state, suggested had not been treated with any quinine. to Wagner vo-n Jauregg, in i887, the possi- Since then several thousands have been so biliiy of imitating this experiment of nature treated. for the cure of the psychosis. At that time TECHNIQUE. he mentioned malaria as one of the diseases suitable for such experimentation. He did The patient may be inioculated by either- not, however, employ this method then, but of two methods, namely, by mosquito bite, on October 2, 2021 by guest. Protected began to induce fever by injections of Koch's or by blood inoculation. tuberculin. In many cases, however, sooner If the former mpethod is adopted, then or later the disease recurred, and re-inocula- female mosquitoes of the anopheles group tion then proved of little value. Conse- are employed and are allowed to feed on the quen-tly he endeavoured to find a means patients. Such mosquitoes are readily which would produce better and more lasting obtainiable through the Ministry of Health. results, and this led to the employment of They are taken to the bedside in a glass con- typhus and later typhoid vaccine. In the tainer, the top of which is covered with course of these experiments he noted that muslin. The glass vessel is inverted over the most complete and lasting remissions the area of skin selected and the mosquitoes were obtained in patients in whom, during allowed to bite. It may be, however, that the course of treatment, an infectious disease the mosquito does not choose to feed at THE TREATMENT OF GENERAL PARALYSIS BY MALARIA 131 Postgrad Med J: first published as 10.1136/pgmj.5.56.129 on 1 May 1930. Downloaded from this moment, and so further attempts may have a deterrent effect on the inoculation. be necessary. It is therefore advisable to sterilize instri- The other method, by blood inoculation, inents, &c., by boilinig, but such must be has generally proved to be more advani- cooled prior to use. The exposure of the tageous; 2 to 5 c.c. of blood are taken from parasites to the influence of heat is inadvis- a patient either immediately before or during able. Rudolf founid that they were killed a febrile attack. If the inoculation is done if exposed to a temperature of 1200 F. for a in hospital, or in such circumstances that period of three minutes. Another cause of the two patients may be brought together, failure is the delaying of the inoculation after then the blood may be transferred direct. the blood has been withdrawn. If -such a if, howvever, the blood has to be transported, delay is necessary the blood should be kept then clotting must be prevented. This may on ice. It should, of course, be remembered be accomplished by adding an equal quantity that a few people possess an immunity to of 5 per cent. sodium citrate. Successful malaria which may account for the failure, results are obtained if the blood is simply as also may any antimalarial drugs taken dehbrinated. The blood is transferred just before or at the time of the inoculation. immediately from the syrinige into a sterile The incubation period is a variable factor test tube, and stirred briskly with a sterile anid usually extends from four to twenty-five glass rod. It should be stirred continuously days. If the patient's condition otherwise for twelve minutes, at the end of which is good, there is no necessity to keep him in period the fibrin is usually found collected bed durinig the day while the fever is devel- along the rod. oping. The temperature during the first The actual inioculationi may be given seveni days should be recorded at least twice copyright. subcutaneously, intramuscularly or intr-a- daily, and thereafter every four hours, until veniously. The site usually selected for sub- the onset of the fever. This is usually cutaneous inoculation is that betweena the preceded by headache, malaise and the scapula, but it mnatters little where the blood complaint by the patient. of feelinig out of is injected. It is desirable to move the sorts. He then welcomes bed. During the under the skin prior to with- rigor the temperature should be taken every needle about http://pmj.bmj.com/ drawal, thereby injuring some of the super- thirty minutes, and it is not uniusual to ficial vessels. The intramuscular method r-ecord temperatures over I050 F. No drugs does not differ materially from the subcu- should be administered to control the taneous. Either are useful where it is pyrexia. Tepid sponging of the patient is desired to keep the strain of the par-asite advocated if the degree of fever exceeds alive for the maximum period. I05° F. The intravenious metlhod is usually adopted As to the nature of the fever, this depends on October 2, 2021 by guest. Protected where the saving of time is important.

Load more