William G. Lennox

THE BLOOD FLOW IN THE BRAIN AND THE LEG OF MAN, AND THE CHANGES INDUCED BY ALTERATION OF BLOOD GASES

The solution of various neurological problems awaits an increase in our knowledge of the circulation of blood within the brain. Much has been gained by the demonstration of Forbes (1) and his co-workers that the pial vessels of the cat are under both vasomotor and chemical control. These experiments consisted of actual inspection and measurement of pial vessels viewed through a window screwed in the skull, the pressure of the cerebrospinal fluid and of the blood being measured simultaneously. In particular, Wolff and Lennox (2) showed that changes in the gaseous content of the blood had a prompt and clear cut effect on the diameter of pial vessels, an effect which was independent of the systemic blood pressure. These authors observed that an increase in the carbon dioxide content of the blood was attended by an extreme dilatation of pial vessels whereas a decrease was followed by a constriction. Variations in oxygen content resulted in relatively small changes. An increase in oxygen tension produced a slight constriction and a decrease in tension a slight dilatation of the observed vessels. There are two difficulties in the way of accepting these observations as significant of cerebral circulatory changes in man. First, experiments were conducted on cats under amytal anesthesia. Second, the vessels lying in the pial covering of the brain may act differently from vessels lying within the brain. Intracranial circulation is of such great importance to the organism and is so modified by the closed box arrangement of the skull that there is need for specific experimentation in man. Observations concerning blood ffow through the brain of unanesthetized persons seemed impossible until Myerson, Halloran and Hirsch (3) demonstrated the feasibility of obtaining blood from the internal jugular vein. By means of this procedure, we have repeated the experimental observations of Wolff and Lennox (2), using patients and judging

Influence of drugs on the human electroencephalogram

Abstract The interrelationships of pharmacology seizures and dysrhythmia are discussed. Correlations have been made between clinical and electroencephalographic improvement in 100 patients receiving drug therapy. The two follow a broadly parallel course, changes in seizures and tracings being grouped simply as normal, improved or inimproved. In 66 percent of 108 periods of treatment, there was complete correlation. In 30 percent clinical improvement, in four percent the reverse was true. Clinical improvement and also complete correlation between seizures and dysrhythmia was more evident in patients with petit mal (73 percent correlation) than in those with other types of seizures (57 percent correlation). Medication seems to influence seizures, or an “externalizing mechanism” before it influences the dyrhythmia of an interseizure recording. Broadly speaking, repeated electroencephalograms assist in judging the progress of treatment and the prognosis of epilepsy.

Epilepsy: a paroxysmal cerebral dysrhythmia

Diseases change their names with increase, not of age (like Chinese children), but with increase of medical knowledge. Most disorders begin life bearing the name of the man who first recognized them or else they are temporarily tagged with some purely descriptive term. When the aetiology or pathology is discovered, the nomenclature is changed. Thus, consumption has become tuberculosis; locomotor ataxia has become tabes dorsalis; and palpitation of the heart has been classified into various disorders of cardiac rhythm as paroxysmal tachycardia, auricular fibrillation, c it is a paroxysmal cerebral dysrhythmia. This discovery places the study and understanding of epilepsy on a different and deeper level and requires a reorientation of our thinking. We say ‘‘a dysrhythmia,’’ because epilepsy is only one of many. For example, periodic breathing called ‘‘Cheyne–Stokes’’ respiration, is but the muscular registration of a medullary rhythm which is alternately slow and fast. Heart, viscera, endocrine glands, all have rhythms normal and abnormal. We have presented elsewhere details of observations [1–4] and certain interpretations of results [5,6]. At this time we shall review in brief outline seven new facts about epilepsy which we have gained in the last two and a half years by means of electro-encephalography. In this period we have made records of about 400 epileptic patients, examining many of them repeatedly. Of these patients, 120 had from one to hundreds of seizures while connected with the apparatus. With the exception of the pioneer observations of Berger, who published records of abnormal rhythm which occurred during seizures (fact one of our list), we believe the observations which we have presented, or now present, are new.

The effect of trimethyloxazolidine dione (tridione) on the blood.

Summary The blood of 127 patients taking tridione was examined periodically. The only significant changes were a tendency to neutropenia or eosinophilia, and a slight increase of lymphocytes. Definite neutropenia was present in 6.3 per cent of patients and borderline values in 7 per cent. In the remaining 87 per cent of patients, the number of neutrophiles remained within normal limits. Repeated examinations indicate that the neutropenia is a gradual reaction. Monthly testing would seem sufficient to prevent the development of serious neutropenia. Presumably, as with many drugs in common use, precipitate allergic reactions may occur, but we have not observed evidence of this among the patients whom we have studied. Tridione is a potent therapeutic agent and possible effect on the blood or the bone marrow should not prevent its proper use. The following rules should be observed. 1. Tridione should be used only when specifically indicated, and under medical supervision. 2. It should not be prescribed for patients with a history of blood dyscrasia and only cautiously for those with a history of idiosyncrasy to drugs. 3. The blood should be examined monthly. 4. Patients with total neutrophile counts below 2,500, should be checked more frequently, and if the neutrophile count goes below 1,600, therapy should be withheld.

The centenary of bromides.

THIS occasion calls for exercise of imagination. Imagine that you are one of the nearly 700 fellows of the Royal Medical and Chirurgical Society of London and that you are attending the biweekly se...

Methsuximide in Psychomotor and Petit-Mal Seizures

METHSUXIMIDE (N-methyl-a,a-methylphenylsuccinimide, PM-396) has emerged from studies of many succinimide analogues as an effective antiseizure medication. Use of a related drug, methylphenylsuccini...

Study of Epilepsy in America in 1938.

During the Sear 1938, 63 articles which had to do with some phase of epilepsy appeared in American medical literature. These contributions deal with all phases of the subject. Of outstanding importance in the understanding of the mechanism of seizures have been the studies of the electrical pulsations of the brain. In the treatment of patients, the introduction of the drug, sodium diphenyl hydantoinate (in America dilantin sodinm, in Europe epanutin) has been revolutionary.

Who Cares for the Epileptic

EPILEPSY is a larger public-health problem than is generally realized, even by doctors. Its supposed infrequence is due to the practice of concealment and to the widespread popular belief that for ...

The Problem of Epilespy

Epilepsy has been a cause of puzzled wonder to physicians and the laity from earliest days. Hippocrates devotes three times as much space to it (relatively) as does Osler. I n the United States there are some 500,000 persons subject to epilepsy. This is approximately the same number as have diabetes or active tuberculosis. Of the more than 400,000 hospital beds devoted to nervous and mental diseases in the United States, epileptics occupy about 10 per cent.