$3 ‘THE INDIAN MEDICAL GAZETTE.
(Jan. 1904.
examined (thanks to the kindness of Dr. W, Dowson), with precisely similar general results to the others, the same vaso-motor paralysis being induced by a small single intravenous dose without any intravascular clotting, as in the case of the Rattlesnake, while, in larger doses, it kills with intravasoular clotting like the true vipers. It has much less effect in causing hsmorrhages than either the Rattlesnake or the puff adder, but less than the Daboia.
Thus we find from a comparison of the action of these four vipers that while in the case of the two pit vipers a primary circulatory failure, quite in- dependent of any intravascular clotting, can be readily induced by a single intravenous dose of the venoms, the same result can also be brought about in the case of the two true vipers by first producing the negative phase of reduced coagulability by pre- liminary small doses of the venoms. Further, there are cases on record of complete Joss of clotting power for several days in which ultimate recovery took place, while the hemolytic changes, which are produced by all these venoms, are not of lethal intensity. The failure of respiration is always se- condary to that of the circulation, while none of these venoms have any marked direct paralysing action on the heart which could account for the circulatory failure.
On the other hand, we find a complete paralysis of the vaso-motor centre in the medulla is common to all these venoms, and will fully account for the lethal effects found, although in some of them the hemorrhagic effects will greatly aid it. If my con- clusion is correct that the essential action of the viperine poisons as a class is a paralysia of the central vaso-motor centre, juat as the Colubrine class paralyse the respiratory centre, then it would appear to be possible to produce an antivenin against the former venom on the same lines as Calmette’s serum against the Colubrine class, a mixture of vipeérine poisons being used for injections. In the meantime such drugs as adrenalin extract and nicotine, together with cardiac tonica, may be of material value in doubtful borderland cases in keeping up sufficient blood-pressure to insure a sufficient supply of blood to the medulla to maintain the respiratory centre working.
Review.
Modern Methods in the Surgery of Paralyses.—By A. H. Turby, M.S. (LOND.), F.R.C.S,; and Robert Jones, F.R.C.S.S. Macminttan & Co., London, 1903. Pp. 311, 93 Illustrations. Price 10s.
CONGENITAL and acquired forms of paralysis have usually been left in the hands of the family physician, supplemented by occasional visits to the nerve specialist or the shop for orthopedic appliances; and the treatment has been on the routine lines of electricity in some form, wassage, hydrotherapeutics and nervine tonies. Hitherto the ordinary surgeon has shunned this class of case as much as the patient has avoided the surgeon. Of recent years, however, the confines of surgery have been extended in a variety of subjects, and this work by Mr. Tubby and Mr. Jones is an excellent example of what can be accomplished by muscle- grafting, tendon-transplantation and arthrodesis, both for the the paralysis and for the deformity resulting therefrom.
The first chapter contains a comprehensive review of Infantile Paralysis, The infective theory of its origin is favoured, also Goldschei- der’s view of the inflammatory lesion chiefly involving the area of distribution of the cen- tral branches of the anterior spinal artery : and certainly this best accounts: for the subsequent retrogression of the paralysis, The two types of infantile paralysis—spinal and cerebro- spinal,—are duly recognised.
The authors accept the suggestion of Gossage that there may be three or more diseases which are grouped together as anterior poliomyelitis, viz.—(1) The type with sudden onset of paralysis without any antecedent symptoms. (2) The type in which the onset of paralysis is preceded by fever, vomiting, pain in the back and other general symptoms. (3) The epidemic type, in which the brain and distal nerves may involved. (4) The adult type as distinguished from the infantile and puerile. They also believe that the rapid recovery of the majority of muscular groups that have been paralysed points to pressure upon the nerve elements and cells rather than to a destructive inflammation. Their observations incline them to believe that girl children are more often affected than boys, whereas in poliomyelitis after puberty the disease is much more frequent in males. The lower extremities are most frequently involved, and in them especially the peronei ; in the upper limbs the deltoid is most commonly attacked, The resulting deformities are due to trophic changes and to mechanical causes following paralysis, The rate of growth is not dependent upon the degree of paralysis, and in some cases lengthening may result instead of shortening ; but the arrest of growth is proportionate to the growth rate, i.e, the younger the child affected the greater the shortening. Most of the defor- mities, however, are due to mechanical causes following paralysis. The authors attach no importance to the theory of antagonistic muscles, they acknowledge unbalanced muscular action as an etiological factor, but they lay most stress on the effects of gravity and of body pressure, especially superincumbent weight in the case of the lower limbs.
In their opinion the prognosis of infantile paralysis as to complete recovery of every affected muscle is not good ; but there is no case which cannot be benefited by one or all of the surgical procedures available. The recovery under proper treatment exceeds all anticipation. Treatment should be commenced as soon as possible. For the first few days medical treat- ment should be directed to reducing the fever, and after that surgical means) must be adopted
