The changes in the central nervous system of two cases of negro lethargy : sequel to Dr. Manson's clinical report / by Frederick W. Mott.
- Mott, F. W. (Frederick Walker), 1853-1926.
- Date:
- 1899
Licence: Public Domain Mark
Credit: The changes in the central nervous system of two cases of negro lethargy : sequel to Dr. Manson's clinical report / by Frederick W. Mott. Source: Wellcome Collection.
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![pai 1899 M92c if we naff whiLt pharmaeopeqial drug; and hence it is of ex- 2e that a student should know why many sub¬ net used, or that are rarely used, should not n the list of articles contained in the Phar- nt’a point of view the list of omissions is the and most satisfactory feature in the new There is a long list containing, I think, i88 sort and another that were included in the E 1885, and are deleted from the Pharmacopoeia egard to this list of omissions a great deal of Jailed, and in some of the initial steps which itions X had a large share, I feel satisfied in e out, but X should have been better pleased ed down the Pharmacopoeia still further, and in looking over the list of omissions X do not for a moment regret the exclusion of any single drug or preparation. The following question presented an initial difficulty: u On what principle is it to be decided that a drug is of no further value, or that its inclusion in the Pharmacopoeia is no longer desirable ?n While the first principle of th« Pharmacopoeia is to indicate the standard of purity of the substances used in medicine, there is no justification for retaining any drug that is not used with reasonable frequency by the general practi¬ tioner, Now with regard to the inquiries which were made by the Pharmacopoeia Committee, much assistance was given by a large number of authorities, including the Royal College of Physicians of London, and the Society of Apothecaries of London, as recorded in the Preface. It was possible, how¬ ever, that the opinions expressed were mainly those of teachers and consultants, and that they might scarcely repre¬ sent the views of general practitioners. Information of great interest and of a more wide-spreading character resulted from private enterprise; X mean from such inquiries as were undertaken by Mr. Martindale, for instance, who Iiad investigations made in several large centres of the last 2,oqo copies of prescriptions of pharmacopceial substances. These indicated the number of times that a drug was used in these centres, and in that way a list was pre¬ pared which showed the degree of popularity attaching to each drug. This list is of value, but it fails just where the list of recommendations obtained from the different examining bodies had failed before; it does not indicate what the general practitioner uses. It is of very little use to consult the pre¬ scription books of chemists, which only show how often certain drugs are prescribed. We do not in that way find out the drugs used by the general practitioner ; this analysis cannot represent what the doctor uses who dispenses his own drugs. Now, to meet that objection yet another investigation was undertaken by the Therapeutic Committee of the British Medical Association, and some of you may remember that a mysterious letter was sent round in which you were asked to indicate the relative frequency of your employment of certain drugs. It consisted of a table that was drawn up into three columns, marked: Often. Barely. Never. Although' from the first it was obvious that these lists con¬ tained numerous errors and must be used with discretion, they were of much service as an indication of the extent to which certain drugs had dropped out of use, and could there¬ fore be omitted from the Pharmacopoeia. To this inquiry, however, I shall have to refer more fully in my next lecture. The French Medical School of Beyrout.—The Medical School of Beyrout, Asiatic Turkey, which is under the direc¬ tion of Jesuit - Fathers, has recently obtained a charter enabling it to giant licences to practise/ The number of students has been steadily increasing for some years, and is now about 150. An extensive piece of land has recently been acquired, and on this site a new school is to be erected at an estimated cost of two millions of francs (j£8o,ooo). The French Government has promised a substantial subvention, A inrtr nf PYPmiripra Tina renentlu hoon 9ppointed, with Pro¬ filer members being agregh of the Paris School of Constants f Beyrout. THE CHANGES I,M THE CENTRAL SYSTEM OF TWO CASES OF NEGfco™ LETHARGY.: SEQUEL TO DR, MANS ON’S clinical report. [With Special Plate.] 18^*9 By FREDERICK W, MOTT, M.D., F.RJS,, Physician it* Charge of Out-patients Charing Cross Hospital; pim** ^ the Pathological Laboratory of the London County Asyium*^T|L Two cases of Congo sickness, brought to England few *3 Grattan Guinness, were admitted into Dr, Abercro* bie’s wards at Charing Cross Hospital last year at for a short time were under my care; and a lecht with an account of these two eases was delivered by Manson, and reported in the British Medical Jbu&n-. These patients subsequently died, and the central nerwj systems were handed to me for investigation. Before rytM ceeding to describe the changes which were found, and whiJS are illustrated in the accompanying micro-photographs, || be well to remind my readers of the principal clinical nomena presented by the patients during their illnesses 1 am enabled to do this by making a summary from the book notes carefully abstracted by the house-physician M? Clogg, to whom I wish to express my obligations. . ^ Case i.—Eli Mboko, aged 20, was a Congolese school teachu of exceptional talent, speaking English perfectly, and having] translated a book from English into his native language. Hill illness commenced twelve months before admission to thi hospital on September 2*th, 1898, Previously cheerful, h t ©rested' in his avocation, he became vacant-minded an miserable, with little interest in his daily work, and as the disease progressed he would frequently fall asleep while at! his work. These symptoms becam« more pronounced as timer: went on, but during hi3 voyage to England he appears to have’ improved a little. Upon admission to the hospital, he found to be fairly well nourished. The skin had to some ex-1 tent lost its natural glossy condition, and fcii^re were a few papules over the abdomen. There was a general enlargmeni of the lymphatic glands, but they were discrete, and not any¬ where massed together. , f Nothing abnormal was found in the thorax or abdouaenN Parchment scars on the fronts of both legs were evident. Ex-1 animation of the eyes by Mr. Treacher Collins revealed nothing abnormal. Examination of the faeces showed presence of the ova of thel following parasites: Ankyiostoma duodenal©, trichocephalu dispar, asearis lumbricoides (these parasites were ts-eated sac eessfully by anthelmintics). Examination of the blood byH Dr. Manson on numerous occasions showed nothing markedly abnormal except the presence of tin3 embryo fiiaria Persians,, although there was some slight degree of anaemia. The striking features to be associated with the nervous! lesions, and which continued and progressed till the fatal tei mi nation, were: 1. Lethargy and a tendency to sleep the greater part of the day. From this drowsy condition the patient could always ’ aroused. 2. Slowness of speech without any tremor and without any noticeable change, except that there was an unwillingness to-J respond to questions owing to a sense of fatigue drowsiness. The reaction time, as denoted by the time taken to frame an answer in response to a question, was much prolonged. When the patient spoke he usually made a carious grimace—elevation of the upper lip and nostrils. < 3, Progressive motor enfeeblement, paresis like a man who-, had suffered a-long illness. His gait also was that of weak- hesa rather than paralysis or ataxy. He shuffled along., 1 hardly lifting his legs from the ground, and with a wide base. Occasionally he would reel; there was nothing noteworthy about the reflexes, but the muscles, as indeed the whole body, j were wasted, although the appetite was fairly good. ^ was no loss of sensation, and he complained of bo definite’ 1 pain except a pain in the back of the head, which he had Mm ^ early in the illness. He suffered for sum® weeks with gingivitis- 4. TXie temperature until just towards the end of life, when ^ hyperpyrexia occurred, was either normal* gabaorow °- 22200157118](https://iiif.wellcomecollection.org/image/b30476094_0001.jp2/full/800%2C/0/default.jpg)
