Fletcher McDowell

THE EFFECTS OF INDUCED HYPERTHERMIA ON PATIENTS WITH MULTIPLE SCLEROSIS

Several authors have reported that induced hyperthermia causes new neurological signs to develop in patients with multiple sclerosis. Collins (1938) observed that a patient with multiple sclerosis while receiving fever therapy developed a series of neurological signs that reversed when the fever therapy was terminated. Simons (1937) pointed out that 62% of patients with multiple sclerosis gave a history of becoming weak when exposed to heat. Guthrie (1951) found that neurological signs can develop in a patient with multiple sclerosis when only a leg or arm is immersed in hot water, and he pointed out the frequent diminution in visual acuity and the appearance of scotomata when patients are totally or partially immersed in hot water. In an earlier study (Nelson, Jeffreys, and McDowell, 1958), we investigated the effects of induced hyperthermia by hot baths not only on patients with multiple sclerosis but on patients with a variety of other diseases of the nervous system. It was found that each of the 12 patients with multiple sclerosis developed neurological changes and that these were usually multiple (an average of 2-8 per patient). It was also found, however, that 550% of patients with diseases other than multiple sclerosis developed neurological changes. These were usually single signs and tended to occur at higher elevations of body temperature than in patients with multiple sclerosis. Patients with multiple sclerosis frequently developed alterations in extraocular movements, including the appearance of nystagmus, signs of dysfunction of the medial longitudinal fasciculus, and paralysis of extraocular muscles. Visual acuity also frequently decreased. It was found that three patients with multiple sclerosis developed signs before any elevation of body temperature was recorded. Because of the possibility that this may

RECURRENT TETANUS: REPORT OF A CASE

Excerpt Recurrent tetanus has been described infrequently. In a review of the literature through 1940 Vener and Bower1were able to find only six cases, including the one reported by them at that ti...

Pharmacology in Medicine

The impressive list of contributors to this new volume on pharmacology gives good evidence of its quality. There are nineteen major divisions, with eighty-eight special subdivisions, each written by a specialist well qualified in the subject. It brings up to date the growing amount of information on drug therapy. Of special interest are the sections on drugs influencing behavior, water and salt balance, and chemotherapy. Drugs effective in the treatment of epilepsy are fully discussed, along with an excellent general statement concerning their clinical use. The section on cholinergic drugs presents as concise and recent a statement about these drugs and their use in neurological disorders, such as myasthenia gravis, as can be found anywhere. Each section is clearly written and presents data concerning mechanisms of drug action, toxicity, effects on various systems, and therapeutic usage. This book is a valuable reference and should serve as an outstanding text for

Pathogenesis and Surgical Therapy of Involuntary Movements (in Polish)

The author attempts to demonstrate that the involuntary movements which characterize the so-called extrapyramidal diseases are not necessarily caused by lesions of the basal ganglia. In a majority of cases the lesions are multiple, and it is not clear which one should be considered as responsible for a given symptom. He reports on a group of 12 patients with involuntary movements and brain tumors (one tumor in the occipital lobe and the others in the frontotemporoparietal region, none being in the basal ganglia). Movements ceased after resection of the brain tumor, thus supporting the idea of a functional, rather than an anatomical, cause of these movements. In each of 30 patients with a variety of involuntary movements, he sectioned the corticospinal tract or the motor cortex. In eight of these patients the movements ceased and the patients were able to return to their previous occupations. He concludes that to obtain

Clinical Examinations in Neurology

Sixteen members of the Mayo Clinic neurology staff have contributed to this volume covering the clinical examination of the nervous system, both generally and in detail. This volume follows the usual pattern of outlining techniques in the taking of a neurological history and the examination of various cranial nerve functions, reflexes, strength, coordination of movement, and sensory perception. Included also are sections covering mentation, language and aphasia, autonomic function, electroencephalography, electromylography, and cerebrospinal fluid examination. The descriptions of the various clinical testing procedures are covered in sufficient detail to be complete but not to the extent that they will overwhelm the medical student and house officer. Included with this book is a series of charts for recording the examination which are used at the Mayo Clinic. These charts offer good suggestions for collecting and outlining data and should be of help to the reader.