An Epitome of Curent Medical Literature

Tu BHamu SEPT. 20, I913] I MZmcM JOUBINAB 3 AN EPITOME OF CURENT MEDICAL LITERATURE. ptom is never found in normal persons, and it is usually MEDICINE. associated with exaggerated tendon reflexes. Cases are recorded illustrating the occurrence of clonus in infectious 128. The Effect of Temporary Occlusion of Renal diseases-for exarnple, septicaemia, typhoid, and tuber- Circulation on Renal Function. culosis either unilaterally or bilaterally, and generally not FITZ AND ROWNTREE (Arch. of Intern. Med., July 15th, persisting for more than a few days or weeks. Ankle 1913) studied experimentally the effect of temporary clonus is not uncommon in uraemia, arising in chronic occlusion of renal circulation upon renal function, because cases several days before a seizure, thus furnishing a of the surgical importance attached to the question con- valuable prognostic indication, and during narcosis from cerning the length of time that the renal vessels can be ether and chloroform its presence has been frequently clamped without permanent injury to renal function or noted. Its occurrence in hysterical and neurasthenic renal tissue. The vessels in rabbits and dogs were patients should always arouse suspicion of organic nervous clamped for varying periods of time, the renal function disease, suspicion becoming a certaiilty if the Babinski being subsequently tested by the excretion of phenol- toe sign is also present. After the use of hyoscine in sulphonephthalein, lactose, potassium iodide, and salt medicinal doses ankle clonus was noted in from one and water. The presence or absence of albumin or casts quarter to one half the cases, while the Babinski toe sign was also observed, and the functional results were con- was present in the still greater proportion of 86 per cent., trolled by histological examination of the kidneys. Pre- indicating a curious selective action on the part of the vious observers had lnoted that such clamping for periods drug not found after any other drug, and forming an ex- up to an hour may produce temporary anuria, albumin- ception to the rule that a positive Babinslii sign in adults uria, and cylindruria, and that permanent inter- indicates organic nervous disease. Chronic arthritis often stitial tissue increase follows prolonged interference causes increased reflexes of the corresponding linmb, and, with the renal circulation, but beyond this no sys- if the ankle is involved, clonus is by no means uncommon temnatic study had been made. In the authors' ex- apart from any organic nervous disease. Since the periments etherized rabbits and dogs were employed, concdition may appear in many toxaemias quite apart from the abdomen being opened aseptically in the niedian any demonstrable lesion of the central nervous system its line, the left kidney exposed, and the vessels freed diagnostic importance is restricted, but in the absence of from the surrounding tissues and clamped with a small toxic states it is still of practical value in the diagnosis rubber-protected bulldog clamp. No attempt was niade of organic nervous disease. In infectious diseases its to prevent the capsular circulation, and after the left presence addls to the gravity of the prognosis, as it indi- vessels had been clamped the right renal vessels were cates a high degree of toxaemia, but it does not preclude ligated and the right kidney remove(d and weighed. In the possibility of recovery. a few animals, for control, the right kiidney was left untouched. With the .clamp in sitit the abdomen 130. Glycosuria and Syphilis. was closed and covered with a warm saline pad FOLLOWING the publication by Laurent of a case and towel, light anaestlhesia beina maintained, and, of syphilis associated with glycosuria, MALHERBE of the desired time having elapsed, the clamp was Nantes (Ann. de Dcrmi. et Syph., June, 1913) describes removed, and, after the macroscopic appearance of the the case of a man aged 50 who consulted him ten kidney had been noted, the peritoneum and abdomen were years ago for the symptoms of diabetes. His urine sewn up, the bladder emptied, and tlle animals placed in contained 5 grams of sugar per litre, which, in spite metabolism cages. Tlle clamp was applied in series of of a mlonth's strict regime, showed no diminution animi-als for ten, twenty, thirty, forty, and sixty minutes, at the endl of that time. A thorou'gl examination and repeated studies of renal function were made, the revealed the presence on his forehead of seven or eight animals being finally killed, and the kidneys examined ham-coloured papules and other suspicious macular histologically. The excretion of lactose was regarded as and papular lesions on the front of the arms along the the index of vascular functional capacity; that of phthalein veins. There was typical enlargement of the inguinal and as an index of total renal function (though predominantly retro-mastoid glands. The patient, after much pressing, tubular); and the excretion of salt and iodide as the index admitted having had a sore some months previously, and of tubular functional capacity. In the majority of cases the penile scar was still evident. It was thought at first clamping of the renal circulation up to forty minutes that the diabetes had existed before the syphilitic infec- produced a definite disturbance of renal function the tion and had only lately produced symptoms, but in view intensity of which bore no relation to the length of time of the multiplicity of the lesions and the general state of the vessels were clamped, nor was the vascular or tubular the patient, an eniergetic mercurial and iodide administra- function chiefly affected, as shown by the presence of tion was immediately instigated, with the result that three albumin and casts, diminished phthalein output, and weeks later the sugar had (lisappeared from the urine, and delayed lactose and iodide excretion. Salt was constantly after six weeks the eruption was no longer visible. well secreted, and after recovery nearly normial function vas regained within six days, showing that the disturbance was slight and temporary. One animal failed to return to normal phthalein output, and two died quickly SURGERY. with marked signs of renal insufficiency. In every instance with one kidney renmoved and the other clamped 131. Cerebellar Tumour after 8light Injury. for an hour death took place within eight days. The THEILAND-POULSEN (Ugeskrift J. Laeger, June 19th, 1913), important role in renal surgery of the unoperated kidney in support of hIis contention that apparently trivial was seen in the series with a normal kidney renlaining in injuries iliay cause fatal cerebellar tumours, records the which clamping for an hour produced but slight temporary case of a farmer, aged 30, Nvho was tripped over, and falling disturbance. Pathologically the gross changes were backwards inlto a shallow ditch, stiucli the soft grass- marked congestion with scattered minute liaemorrhages, covered border with the back of hiis neck. He felt violent and microscopically haeniorrhage, oedema, necrosis, and pain in the back of his head, but as there was no other cellular infiltration. There was no evidence of any pro- sign of an injury lie continued his work. From this date gressive lesion. Except in extreme cases, no definite he suffered from constant headache, which was most relation was demonstrable by functional tests between the severe in the back of the lneclk, although lie had been per- pathological and functional disturbances produced. fectly well before the accident. After about three months lie could not continlue his work on account of headache 129. Ankle Clonus. radiating from the back of the neck to the forehead, TILESTON (Amer. Journ. of Mled. Sci., July, 1913) discusses vonmiting, giddiness, and dimness of vision. His gait was the importance of ankle clonus in diagnosis and prognosis, unsteady, but there was no paralysis of the limbs nor pointing out those conditions in which its presence is tender areas over the brain. The sensory and motor unaccompanied by other evidence of disease of the nervous functions were normal, and Romberg's sign was not present. system. True ankle clonus only is considered-that is, The left patellar and cremasteric reflexes were absent. wlhen continuous upward pressure on the sole of the foot The pupils were equal and their reactions normal. The is followed by a series of rhythmical oscillations with a optic disc was infiltrated and blurred, and the congested frequency of from five to seven a second, and often con- veins in this area disappeared under greyish-white stripes tinuing as long as the pressure is maintained. The sym- and spots. Surrounding the optic disc were some small, 744 A 34 TxYc^ JOURm]U-,A. PITOME OF CURRENT MEDICAL LITERATURE. [$F,PT. Zo, 1913a-, scattered haemorrhages, which were most numereus below sent to an isolation hospital. The pharynix was rather the disc. Potassium iodide and mercury did not improve red, btut there-was no cervical rigidity, no enlargemffent of matters; the ocular symptoms progressed, and the head- the spleen, or a characteristic roseola. Ficlier's reaction aches necessitated the use of morphine. Lumbar puneture was positive in dilutions of 1 in 50 andl 1 in 100. The tli-- -was also fruitless, and retinal haemorrhages appeare(d in perature rose gradually with remissions in the morning, botlh eyes. About five months after the accident the right and was suggestive of typhoid fever. After a month the parietal bone was trephined, and the dcura mater was patient was about to get up when the temperature became found distended, but otherwise normal. The brain sub- subfebrile, and the left foot became painful. Ficker's and stanee protruded somewhat throuah an incision in the dura Widal's tests were made, with positive results for the para- mnater, but it showed no pulsation.

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