anomalies and curiosities of medicine-第218部分

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produce　similar　states；　for　example；　the　magic　drum's　sound　among　the　Lapps；　or　among　other　races　the　monotony　of　rhythm　in　song；　etc。　Instead　of　these　continuous；　monotonous；　weak　stimulations　of　the　senses；　we　find　also　that　sudden　and　violent　ones　are　made　use　offor　example　in　the　Salpetriere；　the　field　of　Charcot's　work；　the　loud　noise　of　a　gong；　or　a　sudden　ray　of　light；　however；　it　is　more　than　doubtful　whether　these　sudden；　strong；　physical　stimuli；　without　any　mental　stimuli；　can　induce　hypnosis。　Perhaps　we　have　to　do　here　with　states　not　far　removed　from　paralysis　from　fright。　The　sense　of　touch　is　also　brought　into　play　in　hypnosis；　Richet　set　great　value　on　the　so…called　mesmeric　strokes　or　passes。　It　is　often　stated　that　touches　on　the　forehead　induce　a　sleepy　state　in　many　persons。　Hypnotism　is　practiced　by　stimulation　of　the　muscular　sense；　such　as　cradle…rocking；　used　to　send　little　children　to　sleep。　Similar　states　are　said　to　be　produced　among　uncivilized　people　by　violent　whirling　or　dancing　movements；　the　movements　are；　however；　accompanied　by　music　and　other　mental　excitations。

Hypnosis　is　spoken　of　by　Huc　and　Hellwald　of　the　Buddhist　convents　in　Thibet；　and　Sperling；　who　has　had　a　particularly　wide　experience　in　the　field　of　hypnotism；　and　whose　opinion　is　of　particular　value；　says　that　he　has　seen　dervishes　in　Constantinople　who；　from　the　expression　of　their　eyes　and　their　whole　appearance；　as　well　as　from　peculiar　postures　they　maintain　for　a　long　time；　impressed　him　as　being　in　a　hypnotic　state。　The　state　may　have　been　induced　by　singing　and　uniform　whirling　motions。　Hildebrandt；　Jacolliot；　Fischer；　Hellwald；　and　other　trustworthy　witnesses　and　authors　tell　us　strange　things　about　the　fakirs　of　India；　which　set　any　attempt　at　explanation　on　the　basis　of　our　present　scientific　knowledge　at　defiancethat　is；　if　we　decline　to　accept　them　as　mere　juggler's　tricks。　Hypnotism　seems　to　be　the　only　explanation。　It　is　a　well　known　fact　that　both　wild　and　domestic　beasts　can　be　hypnotized　and　the　success　of　some　of　the　animal…tamers　is　due　to　this　fact。　In　hypnotism　we　see　a　probable　explanation　for　the　faith…cures　which　have　extended　over　many　centuries；　and　have　their　analogy　in　the　supposed　therapeutic　powers　of　the　Saints。

The　medicolegal　aspect　of　hypnotism　may　be　called　in　to　answer　whether　crime　may　be　committed　at　suggestion。　Such　examples　have　already　been　before　the　public　in　the　recent　trial　of　the　Parisian　strangler；　Eyraud。　It　was　claimed　that　his　accomplice　in　the　crime；　Gabrielle　Bompard；　had　been　hypnotized。　Bernheim　narrates　a　case　of　outrage　effected　in　the　hypnotic　condition；　which　was　brought　to　light　by　a　trial　in　the　South　of　France。

As　to　the　therapeutic　value　of　hypnotism；　with　the　exception　of　some　minor　benefits　in　hysteric　cases　and　in　insomnia；　the　authors　must　confess　that　its　use　in　Medicine　seems　very　limited。

African　sleep…sickness　is　a　peculiar　disorder；　apparently　infectious　in　character；　which　occurs　among　the　negroes　of　the　western　coast　of　Africa。　It　has　been　transported　to　other　regions　but　is　endemic　in　Africa。　According　to　Dana　it　begins　gradually　with　malaise　and　headache。　Soon　there　is　drowsiness　after　meals　which　increases　until　the　patient　is　nearly　all　the　time　in　a　stupor。　When　awake　he　is　dull　and　apathetic。　There　is　no　fever；　the　temperature　may　be　subnormal。　The　pulse；　too；　is　not　rapid；　the　skin　is　dry；　the　tongue　moist　but　coated；　the　bowels　regular。　The　eyes　become　congested　and　prominent。　The　cervical　glands　enlarge。　The　disease　ends　in　coma　and　death。　Recovery　rarely　occurs。　Sometimes　the　disease　is　more　violent；　and　toward　the　end　there　are　epileptic　convulsions　and　muscular　tremors。　Autopsies　have　revealed　no　pathologic　changes。

Recently　Forbes　contributes　an　interesting　paper　on　the　sleeping　sickness　of　Africa。　The　disease　may　occur　in　either　sex　and　at　any　age；　though　it　is　most　frequent　from　the　twelfth　to　the　twentieth　years；　and　in　the　male　sex。　It　begins　with　enlargement　of　the　cervical　glands；　and　drowsiness　and　sleep　at　unusual　hours。　At　first　the　patient　may　be　aroused；　but　later　sinks　into　a　heavy　stupor　or　coma。　Death　occurs　in　from　three　to　twelve　months；　and　is　due　to　starvation。　Forbes　reports　11　fatal　cases；　and　two　that　passed　from　observation。　At　the　autopsy　are　found　hyperemia　of　the　arachnoid；　and　slight　chronic　leptomeningitis　and　pachymeningitis。　There　is　also　anemia　of　the　brain…substance。　In　one　of　his　cases　the　spleen　was　enlarged。　He　was　inclined　to　regard　the　disease　as　a　neurosis。

Aphasia　is　a　disease　of　the　faculty　of　language；　that　is；　a　disturbance　of　the　processes　by　which　we　see；　hear；　and　at　the　same　time　appreciate　the　meaning　of　symbols。　It　includes　also　the　faculty　of　expressing　our　ideas　to　others　by　means　of　the　voice；　gesture；　writing；　etc。　The　trouble　may　be　central　or　in　the　conducting　media。　The　varieties　of　aphasia　are：

（1）　Amnesia　of　speech。

（2）　Amnesia　of　speech　and　written　language。

（3）　Amnesia　of　speech；　written　language；　and　gesture。

In　most　cases　there　is　no　paralysis　of　the　tongue　or　speech…forming　organs。　As　a　rule　the　intellect　is　unaffected；　the　patient　has　the　ideas；　but　lacks　the　power　to　give　them　proper　expression　through　words；　written　language；　or　gesture。　If　the　patient　is　enable　to　write；　the　condition　is　known　as　agraphia。　Word…blindness；　word…deafness；　etc。；　are　terms　of　different　forms　of　aphasia。

What　was　probably　a　case　of　incomplete　aphasia　is　mentioned　by　Pliny；　that　of　Messala　Corvinus　who　was　unable　to　tell　his　own　name；　and　many　instances　of　persons　forgetting　their　names　are　really　nothing　but　cases　of　temporary　or　incomplete　aphasia。　In　some　cases　of　incomplete　and　in　nearly　all　cases　of　complete　aphasia；　involuntary　sentences　are　ejaculated。　According　to　Seguin　a　reverend　old　gentleman　affected　with　amnesia　of　words　was　forced　to　utter　after　the　sentence；　〃Our　Father　who　art　in　heaven；〃　the　words　〃let　Him　stay　there。〃　A　lady　seen　by　Trousseau　would　rise　on　the　coming　of　a　visitor　to　receive　him　with　a　pleased　and　amiable　expression　of　countenance；　and　show　him　to　a　chair；　at　the　same　time　addressing　to　him　the　words；　〃cochon；　animal；　fichue　bete；〃　French　words　hardly　allowable　in　drawing…room　usage。　She　was　totally　aphasic　but　not　paralyzed。　Women　often　use　semi…religious　expressions　like　〃Oh　dear；〃　or　〃Oh　Lord。〃　Men　of　the　lower　classes　retain　their　favorite　oaths　remarkably。　Sometimes　the　phrases　ejaculated　are　meaningless；　as　in　Broca's　celebrated　case。

Aphasia　may　he　the　result　of　sudden　strong　emotions；　in　such　cases　being　usually　temporary；　it　may　be　traumatic；　it　may　be　the　result　of　either　primary　or　secondary　malnutrition　or　degeneration。

There　are　some　cases　on　record　in　which　the　sudden　loss　and　the　sudden　return　of　the　voice　are　quite　marvelous。

Habershon　reports　the　case　of　a　woman　who　on　seeing　one　of　her　children　scalded　fell　unconscious　and　motionless；　and　remained　without　food　for　three　days。　It　was　then　found　that　she　suffered　from　complete　aphasia。　Five　weeks　after　the　incident　she　could　articulate　only　in　a　very　limited　vocabulary。

In　the　Philosophical　Transactions　Archdeacon　Squire　tells　of　the　case　of　Henry　Axford；　who　lost　the　power　of　articulation　for　four　years；　after　a　horrible　dream　following　a　debauch　he　immediately　regained　his　voice；　and　thereafter　he　was　able　to　articulate　without　difficulty。

Ball　records　a　curious　case　of　what　he　calls　hysteric　aphonia。　The　patient　was　a　young　lady　who　for　several　months　could　neither　sing　nor　speak；　but　on　hearing　her　sister　sing　a　favorite　song；　she　began　to　sing　herself；　but；　although　she　could　sing；　speech　did　not　return　for　several　weeks。　Ball　remarks　that　during　sleep　such　patients　may　cry　out　loudly　in　the　natural　voice。

Wadham　reports　the　case　of　a　boy　of　eighteen　who　was　admitted　to　his　ward　suffering　with　hemiplegia　of　the　left　side。　Aphasia　developed　several　days　after　admission　and　continued　complete　for　three　months。　The　boy　gradually　but　imperfectly　recovered　his　speech。　Over　six　months　after　the　original　admission　he　was　readmitted　with　necrosis　of　the　jaw；　for　which　he　underwent　operation；　and　was　discharged　a　month　later。　From　this　time　on　he　became　progressively　emaciated　until　his　death；　twelve　months　after　Wadham　first　saw　him。　A　postmortem　examination　showed　nearly　total　destruction　of　the　Island　of　Reil；　popularly　called　the　speech…center。　Jackson　mentions　a　hemiplegic　patient　with　aphasia　who　could　only　utter　the　words　〃come　on　to　me；〃　〃come　on；〃　and　〃yes〃　and　〃no。〃　Bristowe　cites　the　history　of　a　sailor　of　thirty…six；　a　patient　of　St。　Thomas　Hospital；　London；　who　suffered　from　aphasia　for　nine　months。　His　case　was　carefully　explained　to　him　and　he　nodded　assent　to　all　the　explanations　of　the　process　of　speech　as　though　he　understood　all　thoroughly。　He　was　gradually　educated　to　speak　again　by　practicing　the　various　sounds。　It　may　be　worth　while　to　state　that　after　restoration　of　speech　he　spoke　with　his　original　American　accent。

Ogle　quotes　six　cases　of　loss　of　speech　after　bites　of　venomous　snakes。　Two　of　the　patients　recovered。　According　to　Russ　this　strange　symptom　is　sometimes　instantaneous　and　in　other　instances　it　only　appears　after　an　interval　of　several　hours。　In　those　who　survive　the　effects　of　the　venom　it　lasts　for　an　indefinite　period。　One　man　seen　by　Russ　had　not　only　lost　his　speech　in　consequence　of　the　bite　of　a　fer…de…lance　snake；　but　had　become；　and　still　remained；　hemiplegic。　In　the　rest　of　Russ's　cases　speech　alone　was　abolished。　Russ　remarks　that　the　intelligence　was　altogether　intact；　and　sensibility　and　power　of　motion　were　unaffected。　One　woman　who　had　been　thus　condemned　to　silence；　suddenly　under　the　influence　of　a　strong　excitement　recovered　her　speech；　but　when　the　emotion　passed　away　speech　again　left　her。　Ogle　accounts　for　this　peculiar　manifestation　of　aphasia　by　supposing　that　the　poison　produces　spasm　of　the　middle　cerebral　arteries；　and　when　the　symptom　remains　a　permanent　defect　the　continuance　of　the　aphasia　is　probably　due　to　thrombosis　of　arteries　above　the　temporary　constriction。

Anosmia；　or　loss　of　smell；　is　the　most　common　disorder　of　olfaction；　it　may　be　caused　by　cortical　lesions；　olfactory　nerve…changes；　congenital