急性一酸化炭素中毒後遺症に関する一考察—特に記憶障害をめぐって

A CONSIDERATION ABOUT RESIDUAL STATES AFTER ACUTE CARBON MONOXIDE POISONING:PARTICULARLY AROUND MNESIC DISTURBANCES

　抄録　本論文では急性一酸化炭素中毒後の多彩な後遺症の中でも，明らかに病態特異的とみられる記銘力障害を取り上げ，その際著者による自験例をも呈示して，この障害について考察した。このMerkschwächeは1930年GrünthalとStörringによって純粋に独立して現われるめずらしい残遺症状として初めて詳細に記載され，器質因性のものと診断された（Sekunden-Gedächtnis）が，その後40年の長きに亘ってこの病態の特異性，独立性—純粋性，器質因性を信ずる者は誰れもなく，終始批判と攻撃の的であった。Grünthalらの症例を再診察あるいはその記載を再検討したべつの著者達はこぞってHysterieあるいはPseudodemenzと診断した。そして1971年になってこの特異な記憶障害を取り上げ，集中的に論じたPauleikhoffらによってGrünthalらとその患者は一応その存在権利と価値を認められたものの，その後に及んでも，CO—中毒に関する文献は多くまた十分な中毒症例もあったにもかかわらず，この特異なMerkschwächeが注目されることはほとんどなかったし，現在もそれを論じた文献は見当らない。急性CO—中毒後のMerkschwächeは他に身体的—神経学的，精神医学的に異常はないのに純粋に完全に独立した形で現われる。これはあくまで器質因性であり，数十年に亘って残存する。そしてこれはコルサコフ症候群から厳に区別されるべきである。

About the sequelae of acute CO-poisoning many questions are still open. In this paper, retention defects (disturbance of fixation, Merkschwäche) which can be regarded as state-specific of mani-fold residual states of acute CO-poisoning are discussed. This retention defect (Merkschwäche) had been 1930 for the first time described by Grünthal and Starring in detail. (Sekunden- Gedächtnis) They said that the symptom could occur as a residual state of acute CO-intoxication in pure isolated form. In spite of no other psychic and neurological abnormalities, because of doubt about the authenticity of that case other several psychiatrists and neurologists (Ewald, Lotmar, Scheller, Völkel and Stolze etc) had later on ex-plored and investigated the patient of Grünthal and Störring and its history again and again. At last they had in those days diagnosed the patient of Grunthal and Starring as hysteria or pseudo-dementia. Then, for over 40 years Grünthal and Starring continued to be a target of sharp criti-cisms. But, with Pauleikhoff et al, who 1971 proved the truth of statements of Grünthal and Störring with the presentation of 30 patients with mnesic disturbances after CO-intoxication, the authors (Grünthal and Störring) have fairly well seemed to regain the true honor again. Despite many references and sufficient cases re-ported of acute CO-poisoning, however, scarecely any one has afterwards since Pauleikhoff et al taken this retention defect (Merkschwache) into consideration. The retention defect (Merksch-wäche) owing to acute CO-poisoning can occur in perfectly isolated pure form without any physical, neurological and psychic abnormalities, and the patient has self-criticism without confabulation. This retention defect is at all events brain organic sign and makes it a rule to exist unchan-ged for several decades after the intoxication. One must also strictly distinguish this symptom from Korsakow syndrome, which is characterized by confabulation, suggestibility and non-selfin-sight.