Menièreの原著とその周辺―第四編 Menièreの症例報告（1）

Menière's original papers with some regards Fourth part. Menière's case report-one

第四編の概要

　Menièreは1961年9月21日に主論文が掲載され前に症例を追加して三編の症例報告を行っている。すなわち，2月9日，4月13日，ならびに6月15日と2か月間に一編の頻度の掲載である。これらに共通することは，Menière病の疾患としての確立の主張，脳発作，ことに脳充血と脳卒中との鑑別の強調である。なお，この間に半規管病変に対するBrown-Séquard（1月25日掲載）の反対論，同じくHillairetの反対論，Signol et Vulpian（9月2日掲載）の支持論が発表されており，これらの原著は読了したが紙面の都合でご紹介できず残念である。なおPolitzerが1961年にMenièreを訪れておりドイツにMenière病の概念を知らしめた。しかし，その後の半規管病変説は旗色が悪く，迷路出血説，中耳病変説および脳中枢説が多勢を占める結果になるのであった。これも機会を改めて紹介したい。本稿では当時の脳充血の概念を当時の資料で紹介する。

　Meniere had written three additional case reports before the official publication of his paper which was published on September 21, 1861, at Gaz. méd. série 3 16：597-601, The first case report was published on February 9, at Gaz. méd. série 3 16：88-89, 1861. Here he presented two case records which were claimed as typical cases and Menière's disease was established as a clinical entity. He was delighted with many suppoting informations from colleagues. He urged the practioners to observe with care the entire course of attacks supposed to be due to cerebral congestion, thereafter follow complete recoveris only to leave grave deafness of varying degrees among the patients. He alluded to two types of reactions seen by the afflicted patients. The first one are all aware what occurred to themselves without turmoils and are informed that their diseaeses are originated from the inner ear, and not from the brain. The second ones are always preoccupied with those dreadful consequences of various cerebral accidents and are in no ways to be calm enough to think about the possibilities of lesions of the inner ear. Even among th second types, when the phsician in charge check the ears with care, confirm the levels of hearingloss, the proper diagnoses will be obtained and the routime hazardous treatments for cerebral conjestion would be readily avoided.