was a case of chorido-iritis, with effusion, destroying the integrity of the retina. I was not, however, able to make an ophthalmoscopic examination. 4. A female, aged nineteen, under the care of Dr. Banks in the Hardwicke Hospital. When admitted, a week after the attack of cerebro-spinal disease had commenced, the right eyelids were somewhat swollen and closed, and a muco-purulent discharge oozing from between them; a circular ulcer was situate at the centre of the cornea, and a good deal of zonular vascularity existed. This girl recovered completely, and has excellent vision. 5. A man, aged twenty-one, with cerebro-spinal meningitis and large dark-coloured petechiae, in the Hardwicke Hospital, under the care of Dr. Gordon, had intolerance of light from the commencement of the illness. On the fifth day the right cornea became hazy, and on the seventh day opaque, and commencing to ulcerate. The opacity appeared to be confined to the external epithelial layer of the inferior third of the cornea, and the adjacent conjunctiva was dry and hazy; the upper part of the cornea was quite transparent and free from all disease, and the internal structures of the globe were healthy. As the patient lay in bed, asleep or awake, he presented a remarkable appearance; for, while the left eyelids were naturally closed and the globe concealed, the eyelids on the right side remained open, exposing that portion of the cornea which was the seat of the opacity. The eye was sunken, and a deep sulcus existed between it and the orbital margin, into which the upper eyelid had fallen; there existed also some paralysis of the orbicularis muscle; and during the patient's convalescence slight facial paralysis was remarked; the man appeared unable to close the eyelids. On the fifteenth day effusion occurred into the knee joint. A thin light compress bandage was applied by Dr. Gordon over the right eye, and the cornea became transparent. I regard this case as identical with lagophthalmus cholericus. A remarkable feature in all these cases is that the right eye was the one affected. Amaurosis is not an uncommon sequence of cerebro-spinal meningitis, and is due to disturbances within the cranial cavity and pathological changes in the cerebral substance; it may be temporary or permanent. The disease most frequently met with, and most fatal to vision VOL. XLIII., NO. 86, n. s. X in this epidemic is, according to my observation, acute and rapid choroiditis, with effusion; and I am inclined to attribute that condition to metastasis, similar to what I have seen occur in puerperal fever and other pyemic affections, where not only the eye but the joints and other localities were the seat of infiltration. The only local remedy that is of service is the sulphate of atropia, which should be employed twice or three times a day. As far as the general treatment is concerned, it should be similar or subservient to that adopted for the original malady. Practitioners are, I believe, still at variance as to what that should consist in. I may remark, however, that opium has been found highly efficacious in some of the Continental epidemics, and I have seen it produce undoubtedly the most beneficial effects. ART. XVI.-On the Form of Depraved Appetite known by the Name of Pica. By ARTHUR WYNNE FOOT, M.D., T.C.D.; Fellow of the King and Queen's College of Physicians. Read before the Medical Association of the College of Physicians. HAVING lately had under my observation some instances, in children, of the diseased condition of appetite called pica, I was led to enquire into the causes of this strange propensity to swallow substances universally admitted to be of an innutritious character. Although the name of pica applied to this depraved form of appetite is an old one there is not much information on the subject in books; and, therefore, the remarks on this affection by Dr. F. Battersby," Sir D. Corrigan, and Dr. Wm. Moore are the more interesting and valuable. The term applied to this affection is borrowed from pica, the Latin name for a chattering, greedy bird, supposed to be either the jay or magpie. The bird is mentioned in the Aves of Aristophanes by its Greek name, zírra, which word also bears the abstract signification of the longing of pregnant women, a false appetite, a craving for strange food. The list of substances which have been eaten in pica is a very extensive and miscellaneous one: comprising clay, sand, cinders, lime in various forms, slate-pencil, coal, twine, brick, pottery, sponge, and many other things. This Dublin Quarterly Journal, Vol. vii., p. 316. form of depraved appetite is not confined to the period of childhood, it has also been observed in adult males, in pregnant women, and in females suffering from suppressed or deranged menstruation, particularly about the time when that function is first established.a Under the name of pica, Paulus Egineta, in his first book on hygiene, refers to the diseased appetite which may occur at certain periods of pregnancy, when, he says, women have a desire for complicated and improper articles, such as extinguished coals, cimolian earth, and many more such things; and adds, that the affection is so called either from the variety of colours which the bird, pica, possesses, or from its being subject to this complaint. Volpato, who has described the pica endemic in certain parts of Italy under the name of allotriophagia (λλórios, pays), shows that, in early life sex does not predispose to this disease, since, of 226 cases which he collected, 111 were males and 115 female. In this country the affection among adults is almost wholly confined to females, chlorotic and pregnant women being the usual examples. In twenty cases Volpato observed that the disease was hereditary, having been transmitted to their offspring from parents themselves subject to it. Pica is to be distinguished from another morbid condition of the appetite, bulimia, the subjects of which, under the influence of ravenous hunger, will devour, almost indiscriminately, whatever presents itself, provided it be in any degree of a nutritive character. Burserius, in his Instituta Medecina, draws attention to this distinction. In bulimia quantity is generally the desired object; in pica the quality of the food seems a point of selection with the appetite; hence, in the former organic matter in some shape or other is sought for; in pica it is usually mineral matter, often of a completely inert nature, such as silica, talc, aluminum, which is swallowed. Bulimia occurs in its most extreme degree after long involuntary fasting, when substances are willingly devoured which nothing but the love of life would otherwise induce people to eat; while pica has been observed in the well-fed as well as among the poor, and may even exist with anorexia and distaste for the usual food. The aberrations of appetite observed from time to time in the insane seem related to bulimia rather than to pica, since their desires are not confined to food of a mineral nature, but filth of every kind, the materials of their dress or bedding, or even • Montgomery-Signs and Spts. of Preg., p. 280. e Vol. viii., p. 23. p. 254. their excrement is occasionally eaten. The lower animals are subject to eccentricities of appetite, which, in Germany, have been described under the name of pica, and which almost always indicate disease. Sheep, under certain conditions, exhibit a tendency to eat the wool off themselves and each other; hair concretions form in their stomachs, in consequence, and they do not thrive; they have to be separated and the wool smeared with bitter and disagreeable subatances. Among the early symptoms of rabies in sheep and dogs a depraved appetite is conspicuous. Lambs, soon after they are weaned, are subject to a disease in which the blood becomes very watery, the red corpuscles often scarcely amounting to one-fifth of their normal quantity; and such lambs have been observed eating sand in large quantity; as much as three pounds of sand has been taken from the cecum and other intestines, the latter being nearly blocked up with it. Dr. Crisp, in reporting upon this "lamb disease," considers that the tendency to eat sand is similar to that observed in chlorosis; and that it is connected with a vitiated condition of the blood. Limiting, then, the term pica to those cases of depraved appetite in which the substances craved for are, for the most part, of an earthy or mineral nature, the next considerations are the effect which the practice of eating such substances has upon the body, how the habit is acquired, and how the tendency to it is to be obviated. The mass of evidence on the subject is wholly against the wholesomeness of the custom. The example of certain clayeating tribes is often quoted in support of the habit; but an investigation into the results of pica, in places where it is endemic, proves that it is most injurious. The period during which the Ottomacs eat their ferruginous loam is not long; and Humboldt states that other tribes in South America do not fail to become diseased from this habit. The emaciating effects of a clay-diet are well known to the Javanese, among whom leanness is considered fashionable; and to make themselves thin the men and womenespecially the pregnant women-are said to eat toasted cakes, made out of a reddish clay which contains iron. John Hunter, writing on some of the diseases of the negroes in Jamaica, where pica is endemic, alludes to their propensity to eat clay, and to its effects upon them. Dirt-eaters, as he calls them, can seldom or ever, he Ed. Vet. Rev., Vol. v., p. 128. • Burdach-Traite de Phys., Vol. ix., p. 260. says, be corrected of this unnatural practice; for their attachment to it is greater than even that of dram-drinkers to their pernicious liquor. They have a predilection for particular kinds of earth at first, but in the end will eat plaster from the walls, or dust collected from the floor when they can come at no other. They are fondest of a kind of white clay, like tobacco-pipe clay, with which they fill their mouths and allow it to dissolve gradually, and express as much satisfaction from it as the greatest lover of tobacco could do. This practice is common at all ages, even almost as soon as they leave the breast, the young learning it from the old. Whatever the motives may be that induce them to begin the practice, it soon proves fatal if carried to great excess. There are instances of their killing themselves in ten days; but this is uncommon; and they often drag on a miserable existence for several months, or even one or two years. On many estates half the number of deaths, on a moderate computation, are due to this cause. The negroes subject to pica almost always complain of incessant pain in the stomach. On examination of the body after death there are frequently found in the colon large concretions of the earthy matter which they have swallowed, lining the cavity of the bowel, and almost completely obstructing the passage. The stomach has not presented the appearances which might have been expected, its interior being, usually, merely covered with a whitish viscid matter.b The effects of pica upon children in this country, when the habit has been long continued, are emaciation, with impeded development, anemia, constipation, sometimes diarrhea, great dulness of spirits; the abdomen feels doughy and tumid, and is often the seat of colicky pains; hard substances which have been swallowed can occasionally be felt through its parietes, and have been brought away from the colon by enemata. The stomach and intestines become tolerant of the foreign bodies introduced into them in a wonderful degree, they are rarely rejected by vomiting, and perforation of the alimentary canal very seldom occurs, except in the case of chlorotic females, where there seems, as Dr. Crisp has pointed out, a very probable connexion between the frequency of perforating ulcer of the stomach and the eating of such things as mortar and cinders. In a case of pica which came under my notice, where the child had been for two months in the habit of eating pieces of brick с Hunter-Obs. on Dis. in Jamaica, p. 310. Mason on Mal de l'Estomac.-Ed. Med. Jour., Vol. xxxix., p. 293. • Med. Times and Gaz., March, 8, 1862, p. 253. |
