toptt Jfldicat 3itcratm[c. MEDICINE. Hysterical

Aphonia.?By W. Scheppe-

grell, A.M., M.D. ( The Medical Neivs, Sept. 16, 1893).?Apparent paralysis', ofj the adductor muscles of tlie larynx or rather an inaptitude for sufficient contraction a

by

no means

Dr.

to

produce phonation

is

manifestation in hysteria. reports three cases in which

rare

Scheppegrell laryngeal examination

shewed the insufficiency of the contraction of the vocal cords. The voice is lost, but, the patient is generally able to speak in a whisper; and during an examination it will be seen that the cords do not approximate sufficiently for vocalisation. There is no organic change, nor do any inflammatoryjprocesses occur. The author gives diagrams shewing the position of the vocal cords in two of the cases recorded. In addition to constitutional treatment and treatment directed towards the removal of menstrual or uterine troubles, he recommends the Faradic current applied externally to the neck. The electrodes are applied to either side of the neck and the current gradually increased in intensity. In chronic cases it may be necessary to use also the galvanic current when the muscles have beThe negative come weak from want of use. electrode should be applied within the larynx and the positive electrode over the larynx. Under this treatment recovery took place in the three cases reported.

Sur

la

Pathogenie

du

Rhumatisme

Articulaire Aigu Franc.?Par H. Barbier. (Gazette Hebdomadaire de Medicine et de Chirurgie, Oct. 21, 1893).?From bacteriological examinations made by various observers the writer concludes that acute rheumatism is not a diathetic condition but an infection; not a uniform infection but in consequence of the presence of various pyogenic microbes. The appearauees noted by us iu a case of acute rheumatism are

Feb.

MEDICINE?SURGICAL EXTRACTS.

1894.]

such as can be explained by It might be the presence of a microbic poison. objected that the cases in which staphylococci have been found were cases of septic arthritis and not cases of pure rheumatism. As little, however, is known of the etiology of acute rheumatism, M. Bar bier's suggestions are not without interest.

merely symptoms

Beri-Beri?" Peripheral Neuritis".?

By

Dr.

Shewen.

(The

Australasian Medical

Gazette, Sept. 15, 18b3).

[This

have

extract will be

those who in the Calcutta Medical

interesting

to

similar cases and at the Presidency General Hospital, Calcutta. In the latter institution the cases are regarded as Beri-Beri, and they tally generally with those described by Dr. Max Gloguer of Sainarung, Java?[see Indian Medical Gazette, seen

College

January 1894,

pp.

1-5.]

to the Chinamen here [Sydney], who so frequently come to hospital with a peripheral neuritis, complaining of feeling so tired and with tender call and thigh muscles. The question is often asked whether these men I are suffering from Beri-Beri in a mild form. "

First

of all

as

have for some time held the opinion that they But in order to arrive at such an opinion are. it is necessary to take into consideration the habits ol the Chinamen, together with the more severe forms of the same disease which is so frequently met with amongst their countrymen in China. It is a matter of history that Beri-Beri in its worst form has followed the wake of ill-fed armies in the East, and that as the food was imBeri-Beri deproved so Beri-Beri disappeared. was not confined t" the this in way veloped coloured races, as can be proved by reference to various army reports; and that it has totally disappeared under a proper diet is also a well-known Its cause and its prevention are very fact. similar to those of scurvy (sic). This disease, which is now much more commonly met with iu China than elsewhere, presents in that country exactly the same symptoms as that which used to be so ol the East, and is to prevalent in the armies is and the same, brought about by the my mind food. bad same viz., cause, Anyone who is aware of the inconceivably filthy food which the lower and poorer orders of Chinamen feed upon can hardly be surprised that they should suffer from a disease which, as 1 have said, commonly followed the ill-fed armies of the East. I have lately been told by a medical man who has been in hospital practice iu Hong-ICong for some years past that the milder or dry form of BeriBeri is less common there than the acute, but that both are characterised by cardiac debility, varying only in intensity. In the acute form the patient dies before the usual signs of peripheral neuritis can be observed. Our Chiuameu very rarely uie of the disease, and get well

67

without any medicine when properly fed, just as the Chinese do in their own country, provided tiiey do not die from effusion into the serous cavities. I think a general consideration of these facts must lead us to the conclusion that the disease here is Beri-Beri, and that it is caused by want of proper food or bad food, or perhaps both. Analogy would point to its being something poisonous in the food when we recollect how often we get peripheral ueuritis as a sequel to diphtheria, and to tippling habits iu the female." Surg.-Capt. J. H. Tull-Walsh.