anomalies and curiosities of medicine-第215部分

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Meniere's　disease　is　a　disease　probably　of　the　semicircular　canals；　characterized　by　nausea；　vomiting；　vertigo；　deafness；　tinnitus　aurium；　and　various　other　phenomena。　It　is　also　called　aural　or　auditory　vertigo。　The　salient　symptom　is　vertigo；　and　this　varies　somewhat　in　degree　according　to　the　portions　of　the　ear　affected。　If　the　disease　is　in　the　labyrinth；　the　patient　is　supposed　to　stagger　to　one　side；　and　the　vertigo　is　paroxysmal；　varying　to　such　a　degree　as　to　cause　simple　reeling；　or　falling　as　if　shot。　Gray　reports　the　history　of　a　patient　with　this　sensational　record：　He　had　been　a　peasant　in　Ireland；　and　one　day　crossing　one　of　the　wide　moors　in　a　dog…cart；　he　was　suddenly；　as　he　thought；　struck　a　violent　blow　from　behind；　so　that　he　believed　that　he　lost　consciousness　for　some　time。　At　all　events；　when　he　was　able　to　get　up　he　found　his　horse　and　cart　some　distance　off；　and；　of　course；　not　a　soul　in　sight。　Under　the　belief　that　he　had　been　struck　by　some　enemy　he　went　quietly　home　and　said　nothing　about　it。　Some　time　afterward；　however；　in　crossing　another　lonely　place　he　had　a　similar　experience；　and　as　he　came　to　the　conclusion　that　nobody　could　have　been　near　him；　he　made　up　his　mind　that　it　was　some　malevolent　stroke　of　the　devil　and　he　consulted　a　priest　who　agreed　with　him　in　his　belief；　and　gave　him　an　amulet　to　wear。　A　series　of　similar　attacks　occurred　and　puzzled　as　to　whether　there　was　some　diabolical　agency　at　work；　or　whether　he　was　the　victim　of　some

conspiracy；　he　emigrated　to　America；　for　several　months　he　had　no　attacks。　A　new　paroxysm　occurring　he　consulted　Gray；　who　found　indubitable　evidence　of　labyrinthine　disease。　The　paroxysms　of　this　disease　are　usually　accompanied　by　nausea　and　vomiting；　and　on　account　of　the　paleness　of　the　face；　and　the　cold；　clammy　perspiration；　attacks　have　frequently　been　mistaken　for　apoplexy。　In　disease　of　the　middle　ear　the　attacks　are　continuous　rather　than　paroxysmal。　If　the　disease　is　in　the　middle　or　internal　ears；　loud　noises　are　generally　heard；　but　if　the　disease　is　in　the　external　ear；　the　noises　are　generally　absent；　and　the　vertigo　of　less　degree　but　continuous。　The　prognosis　varies　with　the　location　of　the　disease；　but　is　always　serious。

Human　rumination　has　been　known　for　many　years。　Bartholinus；　Paullinus；　Blanchard；　Bonet；　the　Ephemerides；　Fabricius　Hildanus；　Horstius；　Morgagni；　Peyer；　Rhodius；　Vogel；　Salmuth；　Percy；　Laurent；　and　others　describe　it。　Fabricius　d'Aquapendente　personally　knew　a　victim　of　rumination；　or；　as　it　is　generally　called；　merycism。　The　dissection　by　Bartholinus　of　a　merycol　showed　nothing　extraordinary　in　the　cadaver。　Winthier　knew　a　Swede　of　thirty…five；　in　Germany；　apparently　healthy；　but　who　was　obliged　when　leaving　the　table　to　retire　to　some　remote　place　where　he　might　eject　his　food　into　his　mouth　again；　saying　that　it　gave　him　the　sensation　of　sweetest　honey。　The　patient　related　that　from　his　infancy　he　had　been　the　subject　of　acid　eructations；　and　at　the　age　of　thirty　he　commenced　rumination　as　a　means　of　relief。　To　those　who　are　interested　in　the　older　records　of　these　cases　Percy　and　Laurent　offer　the　descriptions　of　a　number　of　cases。

In　a　recent　discussion　before　the　American　Neurological　Association　Hammond　defined　merycism　as　the　functions　of　remastication　and　rumination　in　the　human　subject。　He　referred　to　several　cases；　among　them　that　of　the　distinguished　physiologist；　Brown…Sequard；　who　acquired　the　habit　as　a　result　of　experiments　performed　upon　himself。　Hammond　reported　a　case　of　a　young　man　who　was　the　subject　of　merycism；　and　whose　mental　condition　was　also　impaired。　No　special　treatment　was　undertaken；　but　the　patient　was　trephined；　with　the　purpose　of　improving　his　mental　condition。　There　were　no　unusual　features　connected　with　the　operation；　but　it　was　noticed　that　there　were　no　ruminations　with　the　meals　he　took　until　the　fifth　day；　when　a　slight　rumination　occurred。　Eight　days　later　a　similar　button　was　removed　from　the　corresponding　side　of　the　left　skull；　and　from　that　time　（about　six　months）　to　the　time　of　report；　there　had　been　no　regurgitation。　Whether　the　cure　of　the　merycism　in　this　case　was　directly　due　to　the　operations　on　the　cranium；　or　the　result　of　the　mental　improvement；　is　a　question　for　discussion。　Hammond　added　that；　when　acquired；　merycism　was　almost　invariably　the　result　of　over…eating　and　loading　the　esophagus；　or　the　result　of　fast　eating。

In　remarks　upon　Hammond's　paper　Knapp　said　that　two　cases　had　come　to　his　knowledge；　both　in　physicians；　but　one　of　them　he　knew　of　only　by　hearsay。　The　other　man；　now　over　thirty；　had　regurgitated　his　food　from　early　childhood；　and　he　did　not　know　that　he　had　anything　very　unusual　the　matter　with　him　until　he　began　some　investigations　upon　the　functions　and　diseases　of　the　stomach。　This　man　was　not　nervous；　and　was　certainly　not　an　idiot。　He　had　done　active　work　as　a　physician；　and　called　himself　in　perfect　health。　He　was　something　of　an　epicure；　and　never　suffered　from　indigestion。　After　a　hearty　meal　the　regurgitation　was　more　marked。　Food　had　been　regurgitated；　tasting　as　good　as　when　first　eaten；　several　hours　after　the　eating。　If　he　attempted　to　check　the　regurgitation　he　sometimes　had　a　slight　feeling　of　fulness　in　the　stomach。　Lloyd　said　that　these　cases　were　forms　of　neuroses；　and　were　types　of　hysteric　vomiting。　There　was　no　gustatory　satisfaction　connected　with　any　form　of　hysteric　vomiting　that　he　had　seen。　In　some　of　these　cases　of　hysteric　vomiting　the　food　does　not　appear　to　enter　the　stomach；　but　is　rejected　by　a　sort　of　spasm　of　the　esophagus。　This　has　been　called　〃esophagismus；〃　and　is　apparently　closely　allied　to　this　neurosis；　which　some　have　called　〃merycism。〃　The　President　of　the　Association　said　that　this　would　seem　to　be　an　affection　common　among　physicians。　A　student　friend　of　his　who　had　been　affected　in　this　way；　had　written　an　elaborate　monograph　on　the　subject。　He　was　disgusted　with　the　habit；　and　finally　overcame　it　by　the　exercise　of　his　will…power。

Runge　discusses　three　cases　of　hereditary　rumination。　These　patients　belonged　to　three　generations　in　the　male　line。　The　author　subjected　the　contents　of　the　stomach　of　one　patient　to　quite　an　extensive　analysis；　without　finding　any　abnormality　of　secretion。

Wakefulness。Generally　speaking；　the　length　of　time　a　person　can　go　without　sleep　is　the　same　as　that　during　which　he　can　survive　without　food。　Persons；　particularly　those　of　an　hysteric　nature；　are　prone　to　make　statements　that　they　have　not　slept　for　many　days；　or　that　they　never　sleep　at　all；　but　a　careful　examination　and　watch　during　the　night　over　these　patients　show　that　they　have　at　least　been　in　a　drowsy；　somnolent　condition；　which　is　in　a　measure　physiologically　equivalent　to　sleep。　Accounts　of　long　periods　of　wakefulness　arise　from　time　to　time；　but　a　careful　examination　would　doubtless　disprove　them。　As　typical　of　these　accounts；　we　quote　one　from　Anderson；　Indiana；　December　11；　1895：

〃David　Jones　of　this　city；　who　attracted　the　attention　of　the　entire　medical　profession　two　years　ago　by　a　sleepless　spell　of　ninety…three　days；　and　last　year　by　another　spell　which　extended　over　one　hundred　and　thirty…one　days；　is　beginning　on　another　which　he　fears　will　be　more　serious　than　the　preceding　ones。　He　was　put　on　the　circuit　jury　three　weeks　ago；　and　counting　to…day　has　not　slept　for　twenty　days　and　nights。　He　eats　and　talks　as　well　as　usual；　and　is　full　of　business　and　activity。　He　does　not　experience　any　bad　effects　whatever　from　the　spell；　nor　did　he　during　his　one　hundred　and　thirty…one　days。　During　that　spell　he　attended　to　all　of　his　farm　business。　He　says　now　that　he　feels　as　though　he　never　will　sleep　again。　He　does　not　seem　to　bother　himself　about　the　prospects　of　a　long　and　tedious　wake。　He　cannot　attribute　it　to　any　one　thing；　but　thinks　that　it　was　probably　superinduced　by　his　use　of　tobacco　while　young。〃

Somnambulism；　or；　as　it　has　been　called；　noctambulation；　is　a　curious　phase　of　nocturnal　cerebration　analogous　to　the　hypnotic　state；　or　double　consciousness　occasionally　observed　in　epileptics。　Both　Hippocrates　and　Aristotle　discuss　somnambulism；　and　it　is　said　that　the　physician　Galen　was　a　victim　of　this　habit。　Horstius；　ab　Heers；　and　many　others　of　the　older　writers　recorded　interesting　examples　of　this　phenomenon。　Schenck　remarks　on　the　particular　way　in　which　somnambulists　seem　to　escape　injury。　Haller；　Hoffmann；　Gassendi；　Caelius　Rhodiginus；　Pinel；　Hechler；　Bohn；　Richter；in　fact　nearly　all　the　ancient　physiologists　and　anatomists　have　written　on　this　subject。　The　marvelous　manifestations　of　somnambulism　are　still　among　the　more　surprising　phenomena　with　which　science　has　to　deal。　That　a　person　deeply　immersed　in　thought　should　walk　and　talk　while　apparently　unconscious；　excites　no　surprise；　but　that　anyone　should　when　fast　asleep　perform　a　series　of　complicated　actions　which　undoubtedly　demand　the　assistance　of　the　senses　is　marvelous　indeed。　Often　he　will　rise　in　the　night；　walk　from　room　to　room；　go　out　on　porticoes；　and　in　some　cases　on　steep　roofs；　where　he　would　not　dare　to　venture　while　awake。　Frequently　he　will　wander　for　hours　through　streets　and　fields；　returning　home　and　to　bed　without　knowledge　of　anything　having　transpired。

The　state　of　the　eyes　during　somnambulism　varies　considerably。　They　are　sometimes　closed；　sometimes　half…closed；　and　frequently　quite　open；　the　pupil　is　sometimes　widely　dilated；　sometimes　contracted；　sometimes　natural；　and　for　the　most　part　insensible　to　light。

Somnambulism　seems　to　be　hereditary。　Willis　cites　an　example　in　which　the　father　and　the　children　were　somnambulists；　and　in　other　cases　several　individuals　in　the　same　family　have　been　afflicted。　Horstius　gives　a　history　of　three　young　brothers　who　became　somnambulistic　at　the　same　epoch。　A　remarkable　instance　of　somnambulism　was　the　case　of　a　lad　of　sixteen　and　a　half　years　who；　in　an　attack　of　somnambulism；　went　to　the　stable；　saddled　his　horse；　asked　for　his　whip；　and　disputed　with　the　toll…keeper　about　his　fare；　and　when　he　awoke　had　no　recollection　whatever　of　his　acts；　having　been　altogether　an　hour　in　his　trance。

Marville　quotes　the　case　of　an　Italian　of　thirty；　melancholic；　and