- Email: [email protected]
JAMES MACKENZIE INSTITUTE FOR CLINICAL RESEARCH, ST. ANDREWS.
REVIEWS AND NOTICES OF BOOKS.
1232
JAMES MACKENZIE INSTITUTE FOR CLINICAL RESEARCH, ST. ANDREWS. AT
a
meeting of the Institute
on
Nov. 24th Dr. Ivy
MACKENZIE gave an address on Insulin in the Treatment of Toxic Delirium. He explained that by toxic delirium he meant the condition recognised in psychiatric practice as " exhaustion psychosis," and sometimes referred to as toxic confusional insanity or amentia. The condition itself might be readily recognised by those who had an opportunity of seeing a large number of mental or nervous cases. It supervened on the basis of chronic nervous disorders of a hysterical or neurasthenic character ; it sometimes occurred in the puerperium and also after the production of an artificial menopause. It began suddenly with excitement, sometimes of a violent character ; the excitement passed into delirium, and if this stage were survived it was followed by a period of confusion which tended to clear up after a time. This form of illness he had seen only in women, and during the last year there were 18 cases among the 350 women who had passed under his notice in the mental observation wards in the Eastern District Hospital, Glasgow. Hitherto he had treated such cases with chloral with some success. A year ago, following a discussion with Dr. J. H. Burn on the action of insulin and its relation to other internal secretions, he employed that drug in three cases. The beneficial effect was beyond doubt and compared favourably with its influence in diabetes mellitus. Treatment was begun with 5 units thrice daily, and this was gradually increased to 7, 10, 12, and sometimes to 15 units thrice daily. Chloral was employed, but mostly at night only. In some cases the patients appeared to be more susceptible to the poisoning action of chloral when insulin was given. One death occurred, and that in a woman who had also chronic renal disease and arterial degeneration ; 14 had been discharged recovered, although some of these exhibited signs of what was probably their " nervous state " prior to the acute illness ; three were convalescing ; no patient suffering from this condition had been certified for asylum care since the treatment was initiated. Referring further to the clinical aspects of the cases, it was pointed out that fever was sometimes present, and that a leucocytosis of 10,000 to 20,000 was present in all except two. The blood-sugar curve was abnormal at some time in every case. It was frequently of the diabetic type, but occasionally there was an abnormally low curve, as, for example, in one case where the estimation was 0-05 per cent. on the fasting stomach, 0-09 per cent. at the height of the curve after 50 g. of glucose, 0-075 per cent. after an hour, and 0-06 per cent. after two hours. Notwithstanding the low estimate insulin was given, and after a week, when the patient had made considerable progress toward recovery, the curve had risen and showed the diabetic features with 0-135 per cent. on the fasting stomach, rising to 0-21, 0-25, 0-18, and 0-165 at half-hourly intervals. A striking feature of the metabolic abnormality was the presence in some cases of a blood-sugar content of 0-3 per cent. with no sugar in the urine, and no evidence of renal disease. The participation of the endocrine system in the upset of metabolic equilibrium which characterised the illness was probable. Reference was made to the experimental and clinical evidence of the relation of the ductless glands in diabetes, and in the case of toxic delirium it was pointed out that the abnormality of the ovarian system in all likelihood played a part. It was likely that the therapeutic use of insulin would be extended beyond the limits of diabetes mellitus, and that it would afford a means of approaching a solution of the problems not only of the ductless glands, but of a whole series of syndromes in which disordered metabolism played a part.
Reviews and Notices of Books. MODERN MEDICINE, ITS THEORY AND PRACTICE. An original contribution by American and Foreign Authors. Edited by Sir WILLIAM OSLER, M.D., Third edition, thoroughly revised. ReF.R.S. edited by THOMAS MCCRAE, M.D., Professor of Medicine in the Jefferson Medical College, Philadelphia, assisted by ELMER H. FUNK, M.D., Assistant Professor of Medicine, Jefferson Medical College, Philadelphia. Vol. I. : Bacterial Diseases ; Non-bacterial Fungus Infections ; the Mycoses. 1925. London : Henry Kimpton. Pp. 815. 212 12s. per set of six volumes. IN his preface to the first volume of the new edition of this monumental system of medicine Dr. McCrae states that at about the time of the onset of Sir William Osler’s last illness (some six years ago) correspondence was taking place as to the possibility of a third edition. It was a gratification to him to feel that this was being called for. Dr. McCrae adds some interesting personal notes as to the origin of the work which was to bring such widespread fame to its editor. At the first consideration of the possibility of his bringing out a system of medicine, Sir William Osler felt apprehensive that it might be too great an additional burden in his busy life, but finally consented to undertake it. With the work once started he became much interested and the success of the first and second editions pleased him greatly. His conception of the right article for a system was a discussion of a subject at a length between the brevity in a text-book and the extensive consideration possible in a monograph, with the needs of the general practitioner kept well in mind. For the most part he was able to inspire his contributors with his own ideals, and the result was a well-balanced work which merited the popularity it received. In the 12 years that have elapsed since the first volume of the second edition appeared many changes have occurred in our knowledge of disease, and new diseases, such as botulism and epidemic encephalitis, have come into prominence. The discovery of the aetiological agent or further study as to the cause has altered many points in the control and treatment of some diseases, such as scarlet fever and bronchial A new therapeutic aid has come into asthma. prominence, altering the whole aspect of the treatment of diabetes mellitus. In the present edition the discussion of the pathology of tuberculosis by Dr. A. K. Krause is a departure from the traditional Dr. Du Bois gives a clear and compremethod. hensive concept of the modern problems in metabolism. As to the subject-matter of this first volume, it has been to some extent rearranged. With the exception of the short section on fungus infections, the whole book is devoted to bacterial diseases. Scarlet fever has been placed among these, but the other exanthemata and fevers of doubtful causation, including rheumatic fever, are no longer included. The articles on typhoid fever, lobar pneumonia, and tuberculosis occupy more than half of the volume ; the first two of these retain their old form, but have undergone revision and enlargement. As already stated, the section dealing with the pathology of tuberculosis has been rewritten, and a large amount of new material has been incorporated in the sections on other aspects of that disease. The shorter articles contained in the second half of the book have received numerous additions embodying the advances of the last 12 years. Dr. McCrae has rendered great service to the medical profession in keeping up to date so valuable a work and in perpetuating the memory of its first editor. The essay on the Evolution of Internal Medicine, written by Osler in 1907 as an introductory chapter to the first edition, and omitted from the second, has been restored, and may claim a high place as a classic in the literature of the history of medicine.
1232
JAMES MACKENZIE INSTITUTE FOR CLINICAL RESEARCH, ST. ANDREWS. AT
a
meeting of the Institute
on
Nov. 24th Dr. Ivy
MACKENZIE gave an address on Insulin in the Treatment of Toxic Delirium. He explained that by toxic delirium he meant the condition recognised in psychiatric practice as " exhaustion psychosis," and sometimes referred to as toxic confusional insanity or amentia. The condition itself might be readily recognised by those who had an opportunity of seeing a large number of mental or nervous cases. It supervened on the basis of chronic nervous disorders of a hysterical or neurasthenic character ; it sometimes occurred in the puerperium and also after the production of an artificial menopause. It began suddenly with excitement, sometimes of a violent character ; the excitement passed into delirium, and if this stage were survived it was followed by a period of confusion which tended to clear up after a time. This form of illness he had seen only in women, and during the last year there were 18 cases among the 350 women who had passed under his notice in the mental observation wards in the Eastern District Hospital, Glasgow. Hitherto he had treated such cases with chloral with some success. A year ago, following a discussion with Dr. J. H. Burn on the action of insulin and its relation to other internal secretions, he employed that drug in three cases. The beneficial effect was beyond doubt and compared favourably with its influence in diabetes mellitus. Treatment was begun with 5 units thrice daily, and this was gradually increased to 7, 10, 12, and sometimes to 15 units thrice daily. Chloral was employed, but mostly at night only. In some cases the patients appeared to be more susceptible to the poisoning action of chloral when insulin was given. One death occurred, and that in a woman who had also chronic renal disease and arterial degeneration ; 14 had been discharged recovered, although some of these exhibited signs of what was probably their " nervous state " prior to the acute illness ; three were convalescing ; no patient suffering from this condition had been certified for asylum care since the treatment was initiated. Referring further to the clinical aspects of the cases, it was pointed out that fever was sometimes present, and that a leucocytosis of 10,000 to 20,000 was present in all except two. The blood-sugar curve was abnormal at some time in every case. It was frequently of the diabetic type, but occasionally there was an abnormally low curve, as, for example, in one case where the estimation was 0-05 per cent. on the fasting stomach, 0-09 per cent. at the height of the curve after 50 g. of glucose, 0-075 per cent. after an hour, and 0-06 per cent. after two hours. Notwithstanding the low estimate insulin was given, and after a week, when the patient had made considerable progress toward recovery, the curve had risen and showed the diabetic features with 0-135 per cent. on the fasting stomach, rising to 0-21, 0-25, 0-18, and 0-165 at half-hourly intervals. A striking feature of the metabolic abnormality was the presence in some cases of a blood-sugar content of 0-3 per cent. with no sugar in the urine, and no evidence of renal disease. The participation of the endocrine system in the upset of metabolic equilibrium which characterised the illness was probable. Reference was made to the experimental and clinical evidence of the relation of the ductless glands in diabetes, and in the case of toxic delirium it was pointed out that the abnormality of the ovarian system in all likelihood played a part. It was likely that the therapeutic use of insulin would be extended beyond the limits of diabetes mellitus, and that it would afford a means of approaching a solution of the problems not only of the ductless glands, but of a whole series of syndromes in which disordered metabolism played a part.
Reviews and Notices of Books. MODERN MEDICINE, ITS THEORY AND PRACTICE. An original contribution by American and Foreign Authors. Edited by Sir WILLIAM OSLER, M.D., Third edition, thoroughly revised. ReF.R.S. edited by THOMAS MCCRAE, M.D., Professor of Medicine in the Jefferson Medical College, Philadelphia, assisted by ELMER H. FUNK, M.D., Assistant Professor of Medicine, Jefferson Medical College, Philadelphia. Vol. I. : Bacterial Diseases ; Non-bacterial Fungus Infections ; the Mycoses. 1925. London : Henry Kimpton. Pp. 815. 212 12s. per set of six volumes. IN his preface to the first volume of the new edition of this monumental system of medicine Dr. McCrae states that at about the time of the onset of Sir William Osler’s last illness (some six years ago) correspondence was taking place as to the possibility of a third edition. It was a gratification to him to feel that this was being called for. Dr. McCrae adds some interesting personal notes as to the origin of the work which was to bring such widespread fame to its editor. At the first consideration of the possibility of his bringing out a system of medicine, Sir William Osler felt apprehensive that it might be too great an additional burden in his busy life, but finally consented to undertake it. With the work once started he became much interested and the success of the first and second editions pleased him greatly. His conception of the right article for a system was a discussion of a subject at a length between the brevity in a text-book and the extensive consideration possible in a monograph, with the needs of the general practitioner kept well in mind. For the most part he was able to inspire his contributors with his own ideals, and the result was a well-balanced work which merited the popularity it received. In the 12 years that have elapsed since the first volume of the second edition appeared many changes have occurred in our knowledge of disease, and new diseases, such as botulism and epidemic encephalitis, have come into prominence. The discovery of the aetiological agent or further study as to the cause has altered many points in the control and treatment of some diseases, such as scarlet fever and bronchial A new therapeutic aid has come into asthma. prominence, altering the whole aspect of the treatment of diabetes mellitus. In the present edition the discussion of the pathology of tuberculosis by Dr. A. K. Krause is a departure from the traditional Dr. Du Bois gives a clear and compremethod. hensive concept of the modern problems in metabolism. As to the subject-matter of this first volume, it has been to some extent rearranged. With the exception of the short section on fungus infections, the whole book is devoted to bacterial diseases. Scarlet fever has been placed among these, but the other exanthemata and fevers of doubtful causation, including rheumatic fever, are no longer included. The articles on typhoid fever, lobar pneumonia, and tuberculosis occupy more than half of the volume ; the first two of these retain their old form, but have undergone revision and enlargement. As already stated, the section dealing with the pathology of tuberculosis has been rewritten, and a large amount of new material has been incorporated in the sections on other aspects of that disease. The shorter articles contained in the second half of the book have received numerous additions embodying the advances of the last 12 years. Dr. McCrae has rendered great service to the medical profession in keeping up to date so valuable a work and in perpetuating the memory of its first editor. The essay on the Evolution of Internal Medicine, written by Osler in 1907 as an introductory chapter to the first edition, and omitted from the second, has been restored, and may claim a high place as a classic in the literature of the history of medicine.