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HYPERSOMNIA.
1093 ventilation when, instead
of
being held in a lady’ 3 electric wire. On shore as well as at sea, an electric fan is sometimes place( l on the ceiling of a restailrant or of a railway dining car, and when it whirls round it produces a sensatiOI of coolness. But what has this to do with ventilation ’ From the bacteriological point of view such a mechanica toy does not improve the situation. On the contrary, by propelling the air violently on the surrounding furniture, floor, and people, it lifts up dust and causes us to breathes larger quantity of dirt and its accompanying microbes than we should have done if the air had been left still. Fresh Ventilation does not consist of churning up the air. air is not manufactured on the same principle as fresh butteI Nor does ventilation consist of making a draught. Draughts destroy ventilation, because those who suffer from draughts. and they are many, proceed to close the ventilator at the first opportunity. The ideal ventilation consists of the introduction into and extraction of air from an inhabited place, house, assembly hall, theatre, railway carriage, saloon or cabin of a ship, in such a manner as to be imperceptible to the persons breathing that air. The text-books state that for such air to be pure the supply must amount to one cubic foot per second per adult. On the other hand, so that this airsupply should not cause a nuisance, it must not travel through the place ventilated at a greater speed than three feet per second. That is the standard, and short of that standard it is a mere delusion to talk of "a complete system of ventilation." If these rules have been successfully applied on board any ship we hope the owners of that ship will allow us to visit her and to describe how this most difficult problem has been solved. hand, it is attached
to
an
,
.
HYPERSOMNIA.
especially those involving neighbourhood, give rise A similar exaggeration of
the
pituitary body
actual the function of to
an
or
its
hypersomnia. sleep
occurs
in mountain sickness, and so imperative may be the desire to sleep that the patients sleep against their will, even though they know that their sleep will predispose them to death. A similar exaggeration occurs in workers in compressed air, after insolation, and after epileptic seizures. In all these cases it is associated with cerebral congestion. Hypersomnia also occurs in connexion with certain diseases of the nose, especially with adenoid vegetations. This is explained by Dr. Salmon as being possibly due to over-activity of a gland in the posterior pharyngeal region having the anatomical characters of the pituitary body, which has been describe! by Civalleri. Its existence has been confirmed" by Kilian, Erdheim, and other observers. A similar condi-tion of hypersomnia is described in connexion with inflammation of the sphenoidal sinuses. In regard to the treatmentof hypersomnia Dr. Salmon advises opotherapy in cases dueto defects of the thyroid, pituitary, and other glands, attention to the diet in cases due to gastric, intestinal, hepatic,. or renal defects, and surgical treatment in those due to nasalaffections. Although some of his opinions are somewhatspeculative in character, his observations are of considerable interest and should serve to direct attention to the disturbances of sleep other than insomnia, which have hitherto, perhaps, received less attention than their importance warrants. ____
THE
LONDON
THE exhibits
presented
MEDICAL EXHIBITION. to view at the London Medical
Exhibition, which was held this week in the Horticultural Hall, Vincent-square, Westminster, were of distinct interest-
to medical men, and each year shows an advance on thein the Médecine Revue de IN an interesting paper published previous one in regard to the real medical character of theEven many of the "side-lines’’were of of Sept. 10th Dr. Albert Salmon of Florence discusses demonstration. certain abnormalities of the function of sleep. He differ- scientific interest, while the progress of pharmacology and entiates hypersomnia, which is an increase in normal sleep, therapeutics was abundantly illustrated at the various stallsfrom somnolence, apathy, and torpor, such as occur in of well-known distinguished firms and makers of finecerebral tumours, in cerebral oedema, and in grave intoxica- pharmacological and therapeutic products. It was evident tions, and from the drowsiness which occurs in old people. on all sides how earnestly the pharmacist is working forHe accepts in part the toxic theory of normal sleep-viz., not only the chemical but also for the physiological Vaccines and the prothat it results from the action of the products of metabolism standardisation of medicaments. produced during waking activity ;but he denies that this ducts of serum therapy were a feature, and there was toxic action is exerted upon the nerve cells and suggests that also an interesting display of special foods, lighting and heatthe toxic products are neutralised by certain glands with ing appliances, balneological appurtenances, and so forth internal secretions, which form also specific hormones exert- The exhibition has evidently become of genuine interest to" ing a reparative influence upon the nerve structures. He the members of the profession, and judging from the increas-believes that the pituitary body is specially closely related ing attendance of medical men and others connected with theto the function of sleep, since hypersomnia is one healing art, the annual event must now be counted of of the most marked characteristics of affections of that importance, while it serves very well to refresh the memory structure. Hypersomnia depends generally upon an with the rapid advances which pharmacy and pharmaexaggerated action of the same causes which induce cology are making. The visitor will find it hard to go away normal sleep, the chief being intoxications. Dr. Salmon without carrying off some information of value in his promaintains that mild intoxications lead to an increased fessional work. function of the pituitary body or other glands conFACTS AND PROBLEMS CONCERNING RABIES. cerned, while more profound degrees of intoxication may lead to actual poisoning of the nerve cells, and eventually A USEFUL monograph on the subject of rabies has just to insomnia. in of occurs mild inbeen written by Dr. A. M. Stimson.1 He points out that thereHypersomnia degrees sufficiency of the thyroid, and in association with defects in are many points about the pathology of rabies that require the functional activity of the genital glands. It also occurs elucidation. The Negri bodies appear to be specific for in the slow intoxications of gastric, hepatic, intestinal, and rabies, but the determination of their exact significance renal origin, and sometimes in association with obesity and their relations to somewhat similar bodies found in. and diabetes. Influenza is often accompanied by a con- other diseases is still a problem and a most important one. siderable increase of sleep, which gives place during con- Until these problems are settled our ideas concerning valescence to deficient sleep or to insomnia. It also occurs immunity must necessarily be vague. It is known, howin cerebral syphilis.. In cerebral tumours, as in all cerebral ever, that artificial immunity can be conferred during the lesions which lead to increased intracranial pressure, there usual incubation period, and this knowledge has been of is a condition of somnolence or torpor, but not a true 1 Bulletin No. 65, United States Public Health and Marine Hospital hypersomnia. Tumours of the base, on the other hand, Service, Washington, D.C. (1910), pp. 90.
of
being held in a lady’ 3 electric wire. On shore as well as at sea, an electric fan is sometimes place( l on the ceiling of a restailrant or of a railway dining car, and when it whirls round it produces a sensatiOI of coolness. But what has this to do with ventilation ’ From the bacteriological point of view such a mechanica toy does not improve the situation. On the contrary, by propelling the air violently on the surrounding furniture, floor, and people, it lifts up dust and causes us to breathes larger quantity of dirt and its accompanying microbes than we should have done if the air had been left still. Fresh Ventilation does not consist of churning up the air. air is not manufactured on the same principle as fresh butteI Nor does ventilation consist of making a draught. Draughts destroy ventilation, because those who suffer from draughts. and they are many, proceed to close the ventilator at the first opportunity. The ideal ventilation consists of the introduction into and extraction of air from an inhabited place, house, assembly hall, theatre, railway carriage, saloon or cabin of a ship, in such a manner as to be imperceptible to the persons breathing that air. The text-books state that for such air to be pure the supply must amount to one cubic foot per second per adult. On the other hand, so that this airsupply should not cause a nuisance, it must not travel through the place ventilated at a greater speed than three feet per second. That is the standard, and short of that standard it is a mere delusion to talk of "a complete system of ventilation." If these rules have been successfully applied on board any ship we hope the owners of that ship will allow us to visit her and to describe how this most difficult problem has been solved. hand, it is attached
to
an
,
.
HYPERSOMNIA.
especially those involving neighbourhood, give rise A similar exaggeration of
the
pituitary body
actual the function of to
an
or
its
hypersomnia. sleep
occurs
in mountain sickness, and so imperative may be the desire to sleep that the patients sleep against their will, even though they know that their sleep will predispose them to death. A similar exaggeration occurs in workers in compressed air, after insolation, and after epileptic seizures. In all these cases it is associated with cerebral congestion. Hypersomnia also occurs in connexion with certain diseases of the nose, especially with adenoid vegetations. This is explained by Dr. Salmon as being possibly due to over-activity of a gland in the posterior pharyngeal region having the anatomical characters of the pituitary body, which has been describe! by Civalleri. Its existence has been confirmed" by Kilian, Erdheim, and other observers. A similar condi-tion of hypersomnia is described in connexion with inflammation of the sphenoidal sinuses. In regard to the treatmentof hypersomnia Dr. Salmon advises opotherapy in cases dueto defects of the thyroid, pituitary, and other glands, attention to the diet in cases due to gastric, intestinal, hepatic,. or renal defects, and surgical treatment in those due to nasalaffections. Although some of his opinions are somewhatspeculative in character, his observations are of considerable interest and should serve to direct attention to the disturbances of sleep other than insomnia, which have hitherto, perhaps, received less attention than their importance warrants. ____
THE
LONDON
THE exhibits
presented
MEDICAL EXHIBITION. to view at the London Medical
Exhibition, which was held this week in the Horticultural Hall, Vincent-square, Westminster, were of distinct interest-
to medical men, and each year shows an advance on thein the Médecine Revue de IN an interesting paper published previous one in regard to the real medical character of theEven many of the "side-lines’’were of of Sept. 10th Dr. Albert Salmon of Florence discusses demonstration. certain abnormalities of the function of sleep. He differ- scientific interest, while the progress of pharmacology and entiates hypersomnia, which is an increase in normal sleep, therapeutics was abundantly illustrated at the various stallsfrom somnolence, apathy, and torpor, such as occur in of well-known distinguished firms and makers of finecerebral tumours, in cerebral oedema, and in grave intoxica- pharmacological and therapeutic products. It was evident tions, and from the drowsiness which occurs in old people. on all sides how earnestly the pharmacist is working forHe accepts in part the toxic theory of normal sleep-viz., not only the chemical but also for the physiological Vaccines and the prothat it results from the action of the products of metabolism standardisation of medicaments. produced during waking activity ;but he denies that this ducts of serum therapy were a feature, and there was toxic action is exerted upon the nerve cells and suggests that also an interesting display of special foods, lighting and heatthe toxic products are neutralised by certain glands with ing appliances, balneological appurtenances, and so forth internal secretions, which form also specific hormones exert- The exhibition has evidently become of genuine interest to" ing a reparative influence upon the nerve structures. He the members of the profession, and judging from the increas-believes that the pituitary body is specially closely related ing attendance of medical men and others connected with theto the function of sleep, since hypersomnia is one healing art, the annual event must now be counted of of the most marked characteristics of affections of that importance, while it serves very well to refresh the memory structure. Hypersomnia depends generally upon an with the rapid advances which pharmacy and pharmaexaggerated action of the same causes which induce cology are making. The visitor will find it hard to go away normal sleep, the chief being intoxications. Dr. Salmon without carrying off some information of value in his promaintains that mild intoxications lead to an increased fessional work. function of the pituitary body or other glands conFACTS AND PROBLEMS CONCERNING RABIES. cerned, while more profound degrees of intoxication may lead to actual poisoning of the nerve cells, and eventually A USEFUL monograph on the subject of rabies has just to insomnia. in of occurs mild inbeen written by Dr. A. M. Stimson.1 He points out that thereHypersomnia degrees sufficiency of the thyroid, and in association with defects in are many points about the pathology of rabies that require the functional activity of the genital glands. It also occurs elucidation. The Negri bodies appear to be specific for in the slow intoxications of gastric, hepatic, intestinal, and rabies, but the determination of their exact significance renal origin, and sometimes in association with obesity and their relations to somewhat similar bodies found in. and diabetes. Influenza is often accompanied by a con- other diseases is still a problem and a most important one. siderable increase of sleep, which gives place during con- Until these problems are settled our ideas concerning valescence to deficient sleep or to insomnia. It also occurs immunity must necessarily be vague. It is known, howin cerebral syphilis.. In cerebral tumours, as in all cerebral ever, that artificial immunity can be conferred during the lesions which lead to increased intracranial pressure, there usual incubation period, and this knowledge has been of is a condition of somnolence or torpor, but not a true 1 Bulletin No. 65, United States Public Health and Marine Hospital hypersomnia. Tumours of the base, on the other hand, Service, Washington, D.C. (1910), pp. 90.