Abstract of Lectures on Certain Practical Points in Connection with the Surgery of Childhood
Abstract of Lectures on Certain Practical Points in Connection with the Surgery of Childhood
复制标题
儿童外科手术若干实用要点讲座摘要
DOI：
10.1136/bmj.1.1000.313
复制
发表时间：
1880
影响因子：
--
通讯作者：
E. Owen
中科院分区：
文献类型：
--
作者：
E. Owen
3月6日，x88 go]英国医疗？我们的357例是几例卡斯的明显病因。其中，慢性酒精中毒是相对较少的原因-只有13例。有些人第一次发作是在醉酒期间，还有一些人在每次过量饮酒后都会复发。6例为慢性铅中毒患者。其中2例患者还患有慢性肾病。在另一个人中，癫痫从婴儿期就存在，但在铅中毒发展时变得更加严重。在其余三例中，铅中毒是发作的明显原因，其特征和过程与原发性癫痫相似。众所周知，急性铅中毒可伴有抽搐，慢性铅中毒可伴有抽搐。癫痫也可能引起慢性惊厥，就像普通癫痫病一样，这一点已经有人指出，但我认为还没有得到普遍的了解。铅可能引起的神经紊乱有很多种，其中包括急性和慢性精神错乱、神经痛、臂痉挛、麻痹、肌肉萎缩和视神经炎。众所周知，人死后大脑中会发现大量的铅。我已经提到，在两个铅中毒的病例中，也有并发性肾病。在另外两个慢性肾脏疾病的病例中，惊厥发作，完全是原发性癫痫，使患者接受治疗。在一个案例中，死亡后证明大脑没有任何粗糙的变化。因此，看来这种惊厥发作可能发生并复发数月，而无其他尿毒症损害的迹象。我还注意到几个由布莱特氏病引起的慢性精神错乱的病例。我没有遇到过任何病例表明吸烟对癫痫的产生有任何影响;但在一个病例中，癫痫的发作显然是由于病人，一个小伙子，不久前在烟草厂工作，他的职业经常引起恶心。在一个案例中，第一次发作发生在使用氯仿之后;在一个案例中，发作已经停止了很多年，在吸入一氧化二氮之后复发。在性过程中，月经延迟或停经，在许多4 ~ 17岁的少女中，与初潮同时发生;但要确定这两种情况之间的确切因果关系，是很困难的。在这种情况下，癫痫一旦发作，随后月经规律的建立似乎对癫痫发作的影响很小。在患癫痫症的男孩中，手淫无疑是普遍的;但在这里，又很难断定手淫在多大程度上可以被看作是癫痫症的原因，而且只有在少数情况下，手淫才是明显的原因。第一次发作发生在怀孕期间，没有其他明显的原因，在五个案件的疾病开始后分娩。在我所注意到的事实中，没有任何事实表明后天梅毒是原发性癫痫的一个原因。还有两种情况需要考虑，它们偶尔与癫痫有关，在某些情况下是因果关系，在另一些情况下可能只是巧合，或作为一种共同原因的影响，这两种情况是心脏病和舞蹈病。在93例病例中观察到hcart的异常情况;但这并不代表存在异常的整体比例，因为在许多情况下没有注意到它的情况。然而，我很少不检查癫痫患者的心脏，我认为..
March6, x88go] THE BRITISH MEDICAL? OURNALr 357 ences were the apparent cause ofthe diseas in several cass. Of these, chronic alcoholism was the cause in a comparatively small number-13 cases only. In some, the first fit occurred during intoxication; and in a few the attacks recurred after each alcoholic excess. Six patients were the subjects of chronic lead-poisoning. In two of these there was also chronic renal disease. In one of the others, the epilepsy had existed from infancy, but became much more scvcrc when the plumbism was developed. In the remaining three, the lead-poisoning vas the apparent cause of the attacks, which resembled, in character and course, those of idiopathic epilepsy. It is well known that acute lead-poisoning may be accompanied by convulsions; that chronic poison. ing may cause chronic convulsions precisely like those of ordinary epi-lepsy, has been pointed out by others, but is not, I think, generally known. The list of nervous disturbances whichmay result from lead is a long one, and includes, as cases I have seen testify, acute and chronic mental derangement, neuralgia, brachial spasm, as well as palsy, and muscular wasting and optic neuritis. It is known that lead is to be found after death in the brain in considerable quantity. I have mentioned that in two of the cases of lead-poisoning there was also con-secutive renal disease. In two other cases of chronic renal discase, convulsive attacks, reseinbling perfectly idiopathic epilepsy, brought the patients under treatment. In one, the absence of any coarse changes in the brain was proved post mortemz. It appears, therefore, that such convulsive attacks may occur and recur for months without other sign of urxemic mischief. Several cases in which chronic mental derange-ment resulted from Bright's disease have also come under my notice. I have met with no case whichsuggests that tobacco-smoking exerts any influence in the production of epilepsy; but in one case the fits were apparently due to the patient, a lad, having shortly before com-menced working in a tobacco-factory, where his occupation caused frequent nausea. In one case, the first fit occurred after the administra-tion of chloroform; and, in one, attacks, which had ceased for many years, recurred after the inhalation of nitrous oxide. Of sexual processes, retarded or absent menstruation coincided with the first fits in a large number of the cases which commenced in girls between fourtccn and seventeen; but the difficulty in determining the exact causal relationship between the two conditionsis very great. Epi-lepsy once set up in such cases, the subsequent establishmentof regular menstruation appears to exercise very little influence upon the fits. In boys who are epileptic, masturbation is unquestionably common; but here again it is most difficult to dlecide to what degree it can be regarded as a cause of the disease, and it was distinctly the cause in only a small iumber ofcases. The first fit occurred in seven cases during pregnancy, without other obvious cause, and in five cases the disease commenced after parturition. No facts which hav-e come under my notice suggest that acquired syphilis is a cause of idiopathic epilepsy. Thereremain for consideration two conditions, occasionally associated with epilepsy, in some cases causally, in others probably only by coincidence, or as the effects of a commlon cause-these are heart-disease and chorea. An abnormal condition of the hcart was noted in 93 cases; but this does not represent the proportion of the whole in which abnormality existed, since in many its condition was not noted. I have, however, rarely failed to examine the heart in cpileptics, and I think that the …