ON THE DIFFERENTIAL DIAGNOSIS BETWEEN MENIERE'S DISEASE AND OTHER CASES EXHIBITING MENIERE'S COMPLEX OF SYMPTOMS: WITH REMARKS ON THE PRACTICAL VALUE OF THE SETON IN OBSTINATE CASES OF BOTH CONDITIONS, TOGETHER WITH CASE ILLUSTRATING THE EXCELLENT RESULTS OBTAINED BY SETON IN THE LATTER CONDITIO
Authors: T. W. Parry
Journal: BMJ (1907)

r rI 107 tendency to depress the'recuperative power of a disordered nervous system.Yet, especially in former days, bromides were extensively administered to cure the very conditions in which that recuperative power was lacking.An artificial circle may also arise through the in- judicious use of aperients In constipation.The constipa- tion may be temporarily relieved; but the remote effect is frequently more obstinate constipation, requiring stronger ap'rients.-Another injudicious mode of treatment is met with in some cases of spinal weakness, where a mechanical support is relied upon, instead of physital exercises 'cal- cululed to cure the muscular weakness.The support increases the spinal weakness, which in turn calls for more and more complete support.Applying the lesson to a much commoner article of attire than the spinal jacket, we may say that the corset creates the demand which it supplies.Group VIII.-LpuriousCircles.The term "vicious circle" has sometimes been applied to conditions where there is no reciprocal action between cause and effect.Such conditions, therefore, do not fall ulder the definition given' above, but may be alluded to he're for the sake of completeness.A'so-called "vicious circle" is occasionally met with after the operation of gastro-enterostomy, when the con- tents of the afferent end of the jejunum (that is, the seg- ment above the artificial opening), instead of passing into the efferent segment, return through the artificial opening into the stomach and set up regurgitant vomiting.Or the contents of the stomach may pass into the afferent loop and back into the stomach instead of escaping through the efferent' loop.A "short-circuiting," in fact, takes place, leading to grave difficulties for which a com- plementary entero-enterostomy may be required.Other illustrations occur with a patent foramen ovale or other malformations of the heart, which permit of the direct communication of the arterial and venous system, with varicose aneurysm and aneurysmal varix.The diagrams below may be of service, especially to teachers, in the analysis of a vicious circle into its com- ponent factors.The simplest circles have but two factors; in others four or five mway be concerned.Aortic regurgitation Constipation V : N( 01~~J z U. i~J o Diabetic Retroverted Polydip ila., 0 gravi uterus.0~~~~~~CONCLUSION.This is not the place to discuss the treatment of the vicious circles described above.But it may be pointed out that the watchful practitioner may sometimes prevent their development, if he is thoroughly acquainted with the course diseases tend to follow, and at the right moment gives such aid as will check the morbid processes at work.Whe,i once a circle has been 'formed, an exact' diagnosis of the interacting forees is of.primary importance.Such a trivial condition as a tender ovary or a movable kidney may constitute one of the links by which 'the' patient is enchained, and may, if overlooked, perpetuate the dis- order.At other times, as in the case of acute glaucoma, an erroneous diagnosis may lead to dire consequences.Generally speaking, vigorous measures will be required' in view of the increased gravity of disease which is compli- cated by a vicious circle.REFERENCES.