A system of medicine / by many writers.

Date:: 1911

Credit: A system of medicine / by many writers. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

88/944 page 64

$diagnosis, and necessitate patience and very careful examination before an accurate opinion can be formed. In some of these, only constant observation over a considerable period of time will determine the solution of the problem. The myopathic and the myasthenic facies may sometimes strongly reseml^le one another, but further investigation of other parts should easily put any doubts at rest as to the category to which it belongs. Treatment.—The general features of myasthenia gravis, and parti- cularly the absence of any gross structural changes, lead one to hope that it may eventually be classed among the curable ailments, but the a{){)ropriate remedial measures are still to be discovered. At the present time we are obliged to be content with securing for the patient those conditions which do not aggravate his symptoms, and with giving a trial to those forms of treatment which appear to have exerted some favour- able influence in isolated cases. Rest, warmth, good food, careful nurs- ing, gentle massage, galvanism, and attention to general health meet most of the indications, and the administration of certain glandular extracts is always justifiable, if rarely successful. Some benetit has been claimed from the use of the dried extracts of the thyroid, thymus, ovary, and pituitary body, but their multiplicity affords ample evidence of their inefficacy. To the same category belong suprarenal extract and adrenalin, ))oth of which have been tried in vain. Even the few records of successful treatment must be regarded with some scepticism in view of the remarkable remissions forming an integral part of the natural history of the disease. Certain symptoms have to l)e met by the best means we can employ for their alleviation. The danger of choking when deglutition is seriously embarrassed must be avoided by rectal feeding, the use of the stomach-tube ])eing contra-indicated on account of the emotional dis- turbance and exhaustion it is apt to produce. Concentrated food of high nutritious value should be given in the early part of the day, in small (piantities at a time, to those cases who are still able to swallow when at their best. The food should be semi-solid and finely minced in order to spare the muscles of mastication. Attacks of respiratory failure may sometimes be cut short by drawing the tongue forward, by perform- ing artificial respiration, and by the administration of oxygen, but their repeated occurrence must generally be regarded as evidence that a fatal termination is not far distant. Arsenic and strychnine are probably harmless, and may imi)rove the patient's general condition. E. Farquhar Buzzard. REFERENCES 1. Bazike. Case of Paralysis of the I)iap]iraf,mi, with Remarks, Brit. Med. Joiirn., 1867, i. 597.-2. Brissaud et Baueh. Maladie de Basedow avec paralysis bulbo-spinale astlu'iii<iue, ylrch. dc netirol., Paris, 1905, xix. 75.-3. BuuR. A Case of I^Iyastheiiia Gravis with Autopsy, Journ. Nerv. and Ment. Dis., N. Y., 1905, xxxii. 172.—4. Buzzard, Farquhar. The Clinical History and Post-Mortem Examination of five Cases of Myasthenia Gravis, Brain, London, 1905, xxviii. 438.$

A system of medicine / by many writers.

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