Vol XVII, No 4 (1910)

I had the opportunity to demonstrate in the Society of Neuropathologists and Psychiatrists at the Kazan University a patient with a state of possession, which, in its origin and course, is of interest and differs in some features from psychoneuroses of this kind already described in the literature. This case is the subject of the present description.

The remarkable fact that sometimes an acute infectious disease proceeding with symptoms of fever has a curative effect on the mental illness existing in the sick person has long been known in the specialized literature, but we still do not have a satisfactory explanation of such a curative effect. This state of the matter is easily understood if we imagine the difficulties of explaining the effect of fever: on the one hand, healings that occur as a result of an accidental illness with an acute infectious disease are still extremely rare, since we usually observe that such diseases occur without the slightest effect on the state of mind. patient, and on the other hand, infectious diseases, to which a beneficial effect on psychosis is attributed, by their very nature is very different, for example. typhoid-diphtheria-malaria, so that the curative effect obviously does not depend on the specific effect of this infectious disease.

To what extent the regeneration of peripheral nerves after injury is a question resolved in a positive sense, and there is only a dispute about the mechanism of this regeneration—the regeneration of the spinal cord and, in particular, the posterior roots, is still denied by the majority of those who have worked on this issue.

Studying the literature on the question that interests us, we see that the regeneration of the central nervous system in warm-blooded and cold-blooded animals is not the same. So Müller (1864) 102) after the removal of the entire tail in a newt and a lizard, saw a complete regeneration of the spinal cord and intervertebral nodes in the newly formed tail. Masius and Vanlair (according to Stroebe) (1869) saw in frogs the regeneration of fleshy and non-fleshy fibers and even ganglion cells after cutting a piece 2 mm long from the spinal cord. The possibility of regeneration of the spinal cord in reptiles and amphibians is also confirmed by Fraisse (1885) (according to Stroebe).

Mental activity has a strong influence on the vital activity of the skin in two opposite directions: in the sense of weakening and strengthening it. This phenomenon is quite understandable if we take into account that the skin is genetically related to the nervous system (the cuticle and the nervous system develop from the same germ layer - ectoderm) and is abundantly supplied with a network of nerve fibers and nerve endings. Therefore, any spiritual movement (shame, grief, joy, etc.) is expressed by a change in the skin and its appendages: redness, blanching of it, sweating, and hair loss, their graying, etc. Under the influence of spiritual unrest, the appearance of many skin diseases: nervous itching, eczema, erythema, urticaria, psoriasis, etc. Similar changes in the skin occur under the influence of suggestion and self-hypnosis. A striking example of the latter is the so-called. stigmatized faces in the Catholic Church. In the same way, many authors have been able to get positive results from suggestion. Hence, according to the author, there is already one step towards the introduction of hypnosis into dermatotherapy: initial experiments in this direction have already been made with positive results (Hebold, Paul. Farez, Agadzhanyants).

This work, carried out at the suggestion and under the guidance of Prof. I. P. Pavlov, according to the method of conditioned reflexes, is divided into two parts. The first part deals with the study of auditory relations in normal dogs. After a literary review of the doctrine of conditioned reflexes, the author describes the method he used to form conditioned reflexes in four dogs to various tones of the harmonium and to chords, and then to the noise of an electric bell, devoid of a bell, and to scratching the skin. Conditioned reflexes were formed by combining a tone (ringing or scratching of the skin) with meat powder or with hydrochloric acid (0.25% solution). The experiments were carried out in such a way that the dog was put on the machine, the paws were put into rubber rings.

The described case represents the peculiarity that plaques of sclerosis were scattered not only in the white matter of the hemispheres and spinal cord, but also captured the gray cortical substance. The strong development of periependymal neuroglia, which formed a compact clutch of sclerous tissue around the aqueductus Silvii and the posterior horn of the lateral ventricle, is also unusual.

Atrophy of the parenchymal elements of nerve cells and fibers, according to the authors, is a secondary phenomenon; They consider primary changes in neuroglia, which are inflammatory and degenerative in nature. Together with Pierre Marie, the authors classify sclérose en plaques as a disease of toxic-infectious origin; the pathogenic beginning circulates, apparently, in the blood, which is why the localization of plaques is in close connection with the distribution of blood vessels.

The author gives the case history of a boy who, from the age of 13½, began to have periodic paralytic attacks; the intervals between them ranged from a few days to several months. The intensity of paralytic phenomena was not the same; at times they were limited to paresis of the lower extremities, sometimes they intensified to complete paralysis of the arms and legs. The patient's mother notes that some of the attacks were apparently caused by overwork; so, on the eve of one of them the boy rode a bicycle, another time he went to bed too late; finally, some attacks were preceded by a cold or gastrointestinal disturbances.

Early recognition of this disease can serve as a sufficient guarantee of the success of its operative detection. Meanwhile, just as here there are no completely reliable signs indicating a tumor of the appendage, the most important sign is hemianopsia bitemporalis, loss of visual acuity, etc., but all these signs are inconsistent. Even more unstable are disorders from other cranial nerves and changes in the fundus. A very important recognition feature is the expansion of the Turkish saddle and the change in the shape of the parts of the base of the skull adjacent to it, which are established by x-rays.

The authors describe two cases of a tumor of the cerebral appendage, diagnosed by them mainly in this last way. Among other signs of this disease, they first noted the absence of reflexes from the Achilles tendons.

A description of the disease under the influence of inhalation of gases during a stay in the Chambot pit is given, with a predominance of phenomena from the neuropsychic sphere. After an unconscious state, the patient experienced extreme depression, with the impossibility of walking without outside help. The latter is probably the result of paralytic phenomena. In this case, the author explains the disease by poisoning with coal gas in connection with other gases (ammonia, etc.).

The epidemics of acute childhood poliomyelitis observed in recent years in the United States, in Austria and in Germany have made it possible for various investigators to carry out a number of experiments in inoculating this disease into animals. But most of the animals commonly used in such cases—guinea pigs, rabbits, mice, pigs, horses—proved to be immune, and only monkeys managed to achieve infection and get symptoms of acute poliomyelitis.

To transmit the disease to monkeys, most researchers used an emulsion from the spinal cord of patients who died from poliomyelitis acuta. Römer went even further in this direction; by inoculating a monkey and inducing poliomyelitis in it, he used the spinal cord of this monkey to transmit the disease to other monkeys. In order to induce disease in this way, an emulsion containing active principles was injected into the very substance of the brain of trepanned animals, but further experiments showed that infection could also be caused in a simpler way. So, Flexner and Lewis used both subcutaneous injections and injections into the veins and into the peritoneal cavity.

In the treatment of brain tumors, the correct establishment of differentials is especially important. and local tumor diagnosis. The author dwells in particular detail on the diagnostic signs of tumors in various parts of the brain. A local diagnosis can sometimes be made with absolute certainty, for example. with tumors in the central gyrus, in the middle and posterior cranial fossa and in the bridge, sometimes it is impossible, for example. with tumors in the right temporal region or frontal (right) lobe. In some cases, the diagnosis is clarified by a trial puncture according to Neisser-Pollak. It is important for the treatment to clarify the properties of the tumor, but unfortunately the clinical picture rarely provides a basis for this.

The use of various arsenic compounds in parasyphilitic diseases of the nervous system was accompanied by an improvement in the general condition of the patients, but the objective symptoms of the underlying disease remained unchanged. The same results were obtained by the author in a number of other organic diseases of the nervous system (polyneuritis, Friedreich's disease, etc.), and only in the treatment of sclerosis disseminata in most cases an undoubted improvement was obtained.

Willige applied arsenic therapy in 12 cases of this disease; in 3 of them, which are among the severe, far advanced, the condition of the patients remained without significant changes, in the rest, an undoubted improvement was achieved both in the subjective state and in objective phenomena.

An irresistible craving for alcohol, according to the author, is the result of mental anomalies: weak will, painful irritability and impressionability of mood swings, in the form of periods of mental depression, etc. Therefore, it is natural to expect that mental treatment will be no less appropriate here than when using mentally -sick. The best results in this regard are obtained by occasional drunkenness, based on the patient's weakness, in the absence of sharp alcoholic changes in the body and psyche, the worst results are typical binge drinking, which is essentially due to periodic psychosis. On the basis of 3500 cases, the author argues that only alcoholism on the basis of severe mental illness is not amenable to treatment by suggestion. An indispensable condition for the success of our treatment should be the sincere desire of the drinker himself to give up drunkenness and undergo treatment, subject to complete abstinence from all alcoholic beverages. Otherwise, the alcoholic needs bed rest and vigorous general treatment. As regards the method of producing suggestion, here the author does not adhere to the calculus. certain rules, advising the use of one or another type of suggestion (with deep hypnosis, its mild degree, suggestion in a waking state), depending on the individual characteristics of the patient. Their frequency: the first suggestion daily, or every other day, then two days later, then less and less. In the 2nd half of the year, in successful cases, 1 session per month is enough.

Presided over by prof. V. P. Osipov, with the secretary Dr. V. K. Voroshilov. Full members were present: prof. N. A. Mislavsky, Dr. V. P. Pervushin, I. A. Veselitsky, N. A. Donskov, M. A. Chalusov; guests of Dr. N. K. Goryaev, I. D. Baklushinsky, Belitsky and 3 senior medical students.

The visitor, Dr. I. D. Baklushinsky, made a report: "On the casuistry of the state of possession with the demonstration of the patient."

Prof. Mislavsky recalls a similar incident. Several times I have seen ordinary hypochondriacs who complained that a snake crawled into the mouth while sleeping with its mouth open in the hayfield. One of these cases is interesting in the sense of therapy: a very rich and hefty Kyrgyz came to my father with a request to cut his stomach. - "Why"? - "Firmly"! strikes at the same time on the stomach; I can't feel anything, I'm so tense. Nothing came out under chloroform. They tried to dissuade him, but it doesn't work, he insists on an operation. Tried induction current; the patient liked it very much; the next day is better; I left a week later relieved.