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M.D., B.Sc., M.R.C.P.E.

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J. D. ROLLESTON

M.A., M.D.

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THE REVIEW OF NEUROLOGY AND PSYCHIATRY contains
original articles, as well as digests, abstracts, reviews and bibliography
of the most recent neurological and psychiatrical literature.

Each Contributor of original articles will receive fifty reprints of
his paper.

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CONTENTS.

•■I«INAL ARTICLES s— rioa

The Nuoleus Intercalate of Staderini. LEONARD J. KIDD, M.D. 1

ABSTRACTS l—

Aa atomy x—

(1) A Note on the Sulcus Poet-Centralis Superior.

GEOFFREY JEFFERSON 21

(2) On the Microscopic Structure of the Otic Ganglion.

CARLO RIQUIER 22

(3) Contribution to the Knowledge of the Membranous Labyrinth. On a

Fourth Crista Acustica. C. B. BENJAMINS 22

Ptyekalogy i—

(4) Experimental Production in Mammals of the Pineal Precocious Macro-

Genito-Somatic Syndrome. SARTESCHI, U. 23

(5) Studies on Pellagra—I. The Influence of the Milling of Maize on the

Chemical Composition and the Nutritive Value of Maize Meal.

CASIMIR FUNK 24

Pathology s—

(6) On the Structure of the Myelin Sheath and its Alteration in Secondary

Degeneration. FERUCCIO GUIDI 25

(7) Contribution to the Pathology of Paralysis Agitans.

HASKOVEC and BASTA 25

(8) A Peculiar Form of Nodular Hyperplasia of the Liver Associated with

Brain Changes.

YUGO YOKOYAMA and WALTHER FISCHER 26
(0) Histological Observations on the Nervous System of the Progeny of

Animals Subjected to Chronic Alooholic Poisoning. M. FERRARI 26

Clinical Neurology x—

(10) The Investigation of the Higher Nervous Functions. I. PAWLOW 27
(Kr)- A'Biogene.tic Principle. • E. LUGARO 28

(12> The IdiopcthicvVafteties of Myoclonus, MOUIZ 28

(13T Traumatic Intramuscular Ossification. JOHN MORLEY 29

.(14). Absence of the Oc»*lo-Cardiac Reflex in Tabes.

M. LOEPBR and A. MOUGEOT 29

(15) ' Oh-the Incomplete Formsof Recklinghausen’s Disease. P. BERTEIN 30

(16) The Meningeal Form of Poliomyelitis. ARNOLD NBTTER 30

(17) Meningeal Syndrome of the Poliomyelitis Type.

E. JOLTRAIN and P. ROUFFLAC 30

(18) Meningitis after Follicular Tonsillitis. E. SIEMKRLING 31

(19) Hypertrophic Cervical Meningitis.

BABIN SKI, JUMENTIE, and JARKOWSKI 31

(20) A Case of Meningitis Purulenta Aseptica after Intr&nasal Interference.

LEOPOLD REISCHIG 31

(21) A Meningo-Cerebellar Symptom-Complex in Febrile Diseases occurring

in Tuberculous Individuals. FOKRSTBR 32

(22) Typhoid Cerebro-Spinal Meningitis in an Infant. L. LAGANE 32

(23) On the Spinal Cord Phenomena of Typhoid Fever, and especially

Metatyphoid Myelitis. G. GAUTHIER 33

(24) On Post-Diphtheritic Abducens Paralysis. C. ROTHER 33

(25) A Further Contribution to the Subject of Traumatic Hasraatomyelia.

BERNHARDT 34

REVIEW OF

NEUROLOGY AND PSYCHIATRY

REVIEW

of *... • : - **.: •'

NECROLOGY and PSYCHIATRY

(Founded by the Late Dr ALEXANDER BRUCE)

Editor

A. N INI AN BRUCE

M.D., D.Sc., M.R.C.P.E., F.R.S.E.

Assistant Editors

CHAS. MACFIE CAMPBELL S. A. KINNIER WILSON

M.D., B.Sc., M.R.C.P E. M.D., B.Sc., F.R.C.P. (Lond.)

J. D. ROLLESTON

Supported

F. W. MOTT, London
RISIEN RUSSELL, London

Sir E. A. SCHAFER, Edinburgh
C. S. SHERRINGTON, Oxford

G. ELLIOT SMITH, Manchester
PURVES STEWART, London
ALDREN TURNER, London

W. B. WARRINGTON, Liverpool
R. T. WILLIAMSON, Manchester

VOLUME XII.

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PRINTED AT
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EDINBURGH

Contents

ORIGINAL ARTICLES

pa<;E

The Nucleus Intercalates of Staderini. Leonard J. Kidd,

M.D..1

The Arcuate Nucleus in Man, the Anthropoid Apes, and

the Microcephalic Idiot. A. Ninian Bruce, M.D. - 51

The Parietal Area. Geoffrey Jefferson, M.S. (Lond.), F.R.C.S. 04

Notes of a Case of Recurrent Paralysis of the Third
Cranial Nerve. Robert A. Fleming, M.D., F.R.C.P.

(Edin.) ------- 58

Labyrinth Suppuration. (A Review.) J. S. Fraser, M.B.,

F.R.C.S. (Edin.).87

Iscovesco’s Experimental Researches on Lipoids of Organs.

(A Review.) Leonard J. Kidd, M.D. - - 100

The Neural Atrophy of the Muscles of the Hand, with¬
out Sensory Disturbances. J. Ramsay Hunt, M.D. - 137

On the Technique of Nerve Palpation by Nerve “Fric¬
tion.” Edgar F. Cyriax, M.D. - - - - 148

On the Mechanism of some Cases of Manic-Depressive Ex¬
citement. C. Macfie Campbell, M.D., B.Sc., M.R.C.P.E. 175

The Nature and the Treatment of the So-called “ Genuine

Epilepsy.” G. C. Bolten (The Hague, Holland) - 231

Notes on a Case of Pellagra. D. Maxwell Ross - - 244

Babinski’s “ Second Sign ” of Organic Hemiplegia in Hemi-

CHOREA, AND ITS BEARING ON THE ORGANIC NATURE

- of Chorea. Arthur F. Hertz - 250

A Case of Amaurotic Family Idiocy. W. E. Hume (New-

castle-on-Tyne) - - - - - - 281

315603

vi CONTENTS

PAUE

The Action op Adrenalin and Epinixe on the Pupil in

Epilepsy. R. M. Stewart .... 287

Drop-Methods of Counting the Cells of the Cerebro¬
spinal Fluid—The Relation of the Cell-Count to
the W asserhann Rbaction. R. Donald, B.Sc. (N.Z.),

D.P.H. (Oxf.).333

The Alleged Sensory Cutaneous Zone of the Facial Nerve

of Man. Leonard J. Kidd, M.D. - 393

The Mechanism of Periodic Mental Depressions as shown
in Two Cases, and the Therapeutic Advantages of
such Studies. L. Pierce Clark, M.D. (New York City) 433

The Pyridine-Silver Method. With a Note on the Affer¬
ent Spinal Non-Mrdullated Nerve Fibres. S. Walter
Ranson, Ph.D., M.D. ..... 467

The Significance of the Unconscious in Psychopathology.

Ernest Jones, M.D., M.R.C.P. (Lond.) - - 474

Studies in Neurological Technique.— No. 2 : Indication and
Method for the Use of the Electrical Re-enforce¬
ment for the Elicitation of the Absent Reflexes.

Walter B. Smith, M.D. (Boston, Mass.) - - - 507

■Review

IReurolocjE ant> pe^cbiatrg

Original Hrticles

THE NUCLEUS INTERCALATUS OF STADERINI.

By LEONARD J. KIDD, M.D.

1. Introductory Historical Remarks.

2. Morphological and Experimental Evidence.

3. Summary and Conclusions.

4. References.

1. Introductory Historical Remarks.

In the year 1894 Rutilio Staderini 1 described for the first time a
nucleus of small cells in the medulla oblongata of the rabbit,
situated between the hypoglossal nucleus and the dorsal vagus
nucleus. In 1895 he found it in the dog, and in 1896 in man
and the monkey. Although to him unquestionably belongs the
great credit of having been the first writer to describe this nucleus,
it is held to be probable that Stilling actually saw it some seventy
years ago, but failed to identify it as a definite cell-group. It
was also pointed out by Van Gehuchten 2 in 1898 that the cell-
mass which Gierke 3 in 1873 took to be the dorsal vagus nucleus
was really the nucleus intercalate: a reference to one of Gierke’s
figures shows that Van Gehuchten interpreted this point correctly.
Many modern works on neurology and anatomy figure Staderini’s
nucleus intercalate, but there seem to be still very few careful,
detailed studies of it in existence. All writers are agreed that
its cells are small, and that in the lower half of the floor of the
fourth ventricle a transverse section shows it intercalated between

LEONARD J. KIDD

.2:'.;-.

the hypoglossal nucleus and the dorsal vagus nucleus. So far as
the upper half of the medulla oblongata is concerned, most authors
describe and figure the nucleus intercalatus as being anatomically
continuous with the cells of the dorsal triangular vestibular
nucleus without any break whatever. This description un¬
doubtedly applies to many human and some other mammalian
brains, but not to all, as I shall show presently. So much has this
anatomical continuation with the dorsal vestibular nucleus entered
into the minds of descriptive neurologists that there is a wide¬
spread but rather surprising belief that the nucleus intercalatus
of Staderini is connected with the eighth pair of nerves.

2. Morphological and Experimental Evidence.

One of the most illuminating papers dealing with the cell-
groups and surface markings of the floor of the fourth ventricle is
that by Streeter 4 (1903). I hope to show in this paper, more
fully than I attempted to show in 1910 in my paper on the dorsal
vagus nucleus, that Streeter arrived correctly at the true morpho¬
logical position of the nucleus intercalatus of Staderini. Streeter
made a careful study of the surface markings of the floor of the
fourth ventricle in many human and some other mammalian
brains. He showed that in the lower half of the floor of the
fourth ventricle in man the trigonum hypoglossi consists of (1)
a narrower median field which overlies the frontal end of the
hypoglossal nucleus, and (2) a lateral field, the area plumiformis
of Retzius, which overlies the nucleus intercalatus of Staderini.
It is vital to note that a definite sulcus separates these two fields.
Streeter’s text-figure 1 of a Weigert preparation, made by Weigert
himself, shows beautifully the neuroglial partitions which separate
the ventro-mesially situated hypoglossal nucleus from the ventro-
laterally situated nucleus intercalatus, and the latter nucleus from
the dorso-laterally placed dorsal vagus nucleus, and also the
latter from the dorsal median vestibular nucleus. The three sulci
which separate respectively each two of the adjoining nuclei of
this series of four nuclei are as follows:—(1) The sulcus lateralis,
i.e., the surviving embryonic sulcus limitans of His, which separates
the dorso-laterally situated dorsal vagus nucleus from the ventro-
laterally situated nucleus intercalatus of Staderini; (2) the sulcus
dorsalis, which separates the dorso-laterally situated dorsal vagus

THE NUCLEUS INTERCALATE OF STADERINI 3

nucleus from the dorsally situated dorsal median vestibular nucleus;
(3) the sulcus ventralis, which separates the ventro-laterally
situated nucleus intercalatus of Staderini from the ventro-mesially
situated hypoglossal nucleus. I think we cannot doubt that these
sulci are primitive and fundamental, and that they separate
morphologically and physiologically distinct cell-groups. Thus,
in the lower half of the floor of the fourth ventricle, the four
primitive, fundamental subdivisions of the brain are represented
as follows:—(1) The ventro-mesial cell-column, developed in the
ventral lamina of the neural tube, the hypoglossal nucleus, somatic
motor; (2) the ventro-lateral cell-column, developed probably in
the ventral part of the embryonic schalt-stiick of His (the pars
intercalaris of the neural tube), the nucleus intercalatus of Staderini,
visceral motor for unstriped muscle; (3) the dorso-lateral cell-
column, developed probably in the dorsal part of the schalt-stiick
of His, the dorsal vagus “ nucleus,” visceral afferent for unstriped
muscle [the visceral afferent endoneural vagus ganglion of Kidd 14
(1910)]; (4) the dorso-mesial cell-column, developed in the dorsal
lamina of the neural tube, the dorsal vestibular nucleus, an afferent
reception-nucleus, somatic afferent I have attempted to show
these points diagrammatically in Figs. 1 and 2.

In the upper half of the floor of the fourth ventricle, i.e., the
region of the striae acousticae, which is just above the upper limit
of the dorsal vagus nucleus, the somatic motor column of the
brain is not represented, the reason being, of course, that in exist¬
ing vertebrates there is no somatic motor nucleus between the
abducens and the hypoglossal nuclei. In this region we have
the following arrangements:—(1) Mesially situated the nucleus
funiculi teretis, which I have previously suggested (1910) is a
median central sympathetic nucleus of unknown connections:
this nucleus is sometimes, at any rate, separated by a neuroglial
partition from (2) the nucleus intercalatus of Staderini, as is well
seen in Streeter's Fig. 2; and the nucleus intercalatus is (3)
similarly separated from the dorsal vestibular nucleus by a
neuroglial partition. It will be remembered that Streeter sug¬
gested in 1903 that the nucleus intercalatus of Staderini may be a
central sympathetic nucleus, an opinion which I adopted in 1910
as almost certainly correct. I believe, therefore, that the cell-
groups of the upper half of the floor of the fourth ventricle at the
level of the striae acousticae are arranged morphologically as

LEONARD J. KIDD

follows:—(1) Somatic motor column not represented in existing
vertebrates. (2) Visceral motor column probably doubly repre-

Sulcus Dorsalis.

Sulcus Lateralis Limitans of His.

Sulcus Ventralis.

Firs. 1 .—Diagram of the Four Primitive, Fundamental, Morphological,
and Physiological Subdivisions of the Neural Tube.

1. Ventro-raesial cell-column, somatic motor. 2. Ventro-lateral cell-column,
visceral motor. 3. Dorso-lateral cell-column, visceral afferent. 4. Dorso-mesial
cell-column, somatic afferent. Of these cell-groups, 1 is developed in the ventral
lamina of the neural tube ; 4 in the dorsal lamina; and 2 and 3 probably in the
ventral and dorsal parts respectively of the schalt-stiick of His (the pars inter-
calaris). The depth of the three sulci is purposely exaggerated.

sented, viz., by (a) the nucleus funiculi teretis, (?) a median
sympathetic nucleus, and ( b ) the nucleus intercalate of Staderini,

Floor of Fourth Vkntbici.k.

1. Ventre-mesial hypoglossal nucleus, somatic motor. 2. Ventro-lateral
nucleus intercalatus of Staderini, visceral motor. 3. Dorso lateral dorsal vagus
“nucleus,” visceral afferent (Kidd, 1910). 4. Dorsal vestibular nucleus, somatic

afferent.

a lateral sympathetic nucleus. (3) Visceral afferent column not
represented (as the level of the section is above the upper limit

THE NUCLEUS INTERCALATE OF STADERINI 5

of the dorsal vagus “ nucleus (4) Somatic afferent column,
the dorsal vestibular nucleus. Fig. 3 illustrates these points
sufficiently clearly, I think.

Now it is quite true that these neuroglial septa, described
by Streeter, are not seen in all human brains, and they are also
absent in some specimens of some other brains. And it is also
true that there is often unbroken continuity between the cells of
the upper part of the nucleus intercalatus and those of the dorsal
vestibular nucleus; this was the condition found by Stokes* in
his recent study of the acoustic-complex in the opossum (Didelphys
virginiana). A very well-marked sulcus ventralis is sometimes
seen on the ventricular border of the lower half of the fourth
ventricle between the hypoglossal nucleus and the nucleus inter¬
calatus of Staderini: this is extremely well seen in one of Cajal’s

Dorsal Vestibular Nucleus.
Nucleus Intercalatus of Staderini.

I-— Nucleus Funiculi Teretis.

Fig. 3.—Diagram of Cell-Groups of Upper Half of Floor
of Fourth Ventricle, in Region of Strias Acoustic m.

Columns 1 and 3 are absent in this level. 2' is the nucleus funiculi teretis,
(?) a median sympathetic nucleus (Kidd). 2 is a lateral sympathetic nucleus.
4 is a somatic afferent reoeption-nucleus.

figures reproduced in Quain’s “ Anatomy,” 1908, vol. iii., Part I.,
p. 135: the sulcus here appears to be about one-seventh the
depth of the nucleus intercalatus itself. There appear to be but
few published studies of the exact extent of the nucleus inter¬
calatus, but Streeter found, after an examination of many human
brains, that its length is 11 ram. and its greatest width 22 mm.
It will be noticed that its extent is very nearly the same as that
of the dorsal vagus nucleus which Streeter found to be 135 mm.
in length and 2 mm. in average width. It seems to me possible
that the greater width of the nucleus intercalatus may just about
balance the slightly greater length of the dorsal vagus nucleus:
in any case there can hardly be very much difference between
them in absolute bulk. The former extends, of course, a little

# J. H. Stokes, Amer . Joum . of A not ., vol. xii., 1912, p. 434.

LEONARD J. KIDD

higher cephalad than the latter, but not quite so far caudad. In
their general structure the cells of the nucleus intercalatus
resemble closely those of the dorsal vagus nuoleus and those of
the intermedio-lateral cell-column of the thoracic spinal cord; so
far as I know, the nucleus intercalatus does not contain such a
large number of spindle-shaped cells as the dorsal vagus nucleus
does: but I make this statement with much reserve, for it seems
that we need a careful histological examination of its cells by the
best and newest methods. The small size of the cells of Staderini’s
nucleus suggests that they are connected with the innervation of
unstriped muscles: they certainly do not resemble either somatic
motor or somatic afferent nerve-eells.

In my opinion there are some very strong objections to the
view that the nucleus intercalatus is connected with the eighth
pair of nerves. Thus, no one has brought forward any experi¬
mental evidence in its favour, whereas there is plenty of evi¬
dence that the dorsal vestibular nucleus is one of the afferent
reception-nuclei of the vestibular nerve. But let us, for the sake
of argument, admit for a moment the identity of these two nuclei:
to what conclusion would such a hypothesis inevitably lead us ?
We should have to teach that the upper part of the nucleus
intercalatus, a somatic afferent reception-nucleus, becomes lower
down in the bulb a visceral motor nucleus! The only alternative
would be to say that the nucleus intercalatus is really a complex
of two morphologically and physiologically distinct nuclei, viz.,
an upper somatic afferent and a lower visceral motor nucleus
Now, who can point to any instance in any vertebrate of a somatic
afferent nucleus of reception being anatomically continuous with
a visceral motor nucleus? I believe that the mistake hitherto
made by writers, with the exception of Streeter, has been that
they have failed to see that there is evidence in some human and
other mammalian brains of the existence of a neuroglial septum—
one of Weigert’s “ Kielstreifen ” or tracks left by embryonic sulci
—separating off the nucleus intercalatus from the dorsal vesti¬
bular nucleus. We know that there are considerable variations
in the bulb of the degree of development of the three sulci which
separate the various cell-groups from one another. It may be
objected that in the primitive mammal, the opossum, Stokes failed
to find any trace of a septum separating the nucleus intercalatus
from the dorsal vestibular nucleus; but that would not of itBelf

THE NUCLEUS INTERCALATE OF STADKU1XI 7

prove its non-existence in even higher mammalian forms. We
know that even highly specialised groups of animals may show, in
certain respects, characters of greater antiquity than even other
groups which are in most respects much more primitive. Thus,
in teleosts, which are a highly specialised group of fishes, we see
in their ontogeny certain features of great antiquity which are
not present in the selachians, which are on the whole a much
more ancient group. I may point especially to the extensive
studies of Calderwood, who has shown that many of the deep-sea
teleosts off the Scottish coasts reveal features of great antiquity.
There is also Ross 6. Harrison’s embryological study on the salmon,
which shows that the exoneural dorsal root ganglia are developed
from migrated endoneural afferent neuroblasts, a feature of great
antiquity.

We may now ask the question: If the nucleus intercalatus of
Staderini be really a visceral motor, lateral sympathetic nucleus,
how do its axons pass out from the central nervous system, and
round the cells of what sympathetic ganglion or ganglia do they
end ? One thing seems clear, viz., that they do not pass either
up the brain-stem or down the spinal cord to enter any cranial
nerve from the glossopharyngeal forwards, or any spinal nerve
from the first cervical nerve backwards; my reason for saying
this is that experimental sections made either just above or just
below the level of the nucleus intercalatus have never given any
retrograde chromolysis of its cells. There remain, then, only two
other possibilities, viz., the axons of its cells might enter (1) the
hypoglossal nerve, or (2) the vagus nerve. In the year 1898
Ossipow 6 found changes in the cells of the nucleus intercalatus
and also in the dorsal part of the hypoglossal nucleus—as well as
in both dorsal vagus nuclei—in two rabbits which survived ninety
and ninety-one days respectively after unilateral vagotomy, and
also in one dog which survived six months and three weeks after
bilateral vagotomy. I am not certain as to the exact situation of
Ossipow’s section of the vagus nerve. His work is briefly summar¬
ised by both Van Gehuchten 2 and Molhant 7 ; and in the German
abstract of Ossipow’s Russian paper it is stated that he divided
the cervical part of the vagus, rather a vague statement, which
leaves one in doubt whether the section was made above the
ganglion nodosum or not; but that it probably was so I gather
from the further statement in the German abstract that Ossipow

LEONARD J. KIDD

connects the “ root-bundles ” of the vagus nerve with the nucleus
intercalatus of Staderini. Although Ossipow’s work was of
interest from the point of view of the connections and nature of
that nucleus, it obviously required repetition on more scientific
lines. This was supplied in 1903 by Tricomi-Allegra* who *
“performed unilateral avulsion of the vagus nerve above the
ganglion nodosum in the cat and rabbit: the method of Nissl
showed constant chromolysis in the cells of the dorsal vagus
nucleus and also in those of the ventral vagus nucleus (the nucleus
ambiguus). In addition, he observed chromolysis in the cells of
a very small grey column situated outside and behind the central
canal at the limit of the white and grey matter, and even in the
caudal part of the hypoglossal nucleus. By the Marchi method
he found evident signs of degeneration in the solitary bundle and
its nucleus, the dorsal vagus nucleus, the nucleus intercalatus of
Staderini, the hypoglossal nucleus, and the commissural ganglion
of CajaL” The changes which Tricomi-Allegra found in the
hypoglossal nucleus are attributed by Van Gehuchten, doubtless
correctly, to damage done at the operation to some of the fibres
of the hypoglossal nerve; for there is abundance of experimental
evidence by Van Gehuchten 2 and others which proves that all the
axons of the cells of the hypoglossal nucleus pass out by the
hypoglossal nerve. Tricomi-Allegra held that the nucleus inter¬
calatus of Staderini is connected with the vagus nerve. But
Molhant 7 states that in 1898 Van Gehuchten failed to obtain any
chromolysis of the cells of that nucleus after section of the vagus
nerve in the rabbit. [I am not quite certain, from Molhant’s
description, and from Van Gehuchten’s own description 2 in
another paper, whether the latter observer divided the vagus
above or below the ganglion nodosum.] We may, I think, take
it as definitely established by the experiments of Molhant, Van
Gehuchten, and at least twenty other experimentalists, that section
of the vagus nerve below the ganglion nodosum does not give
retrograde chromolysis of any of the cells of the nucleus inter¬
calatus of Staderini. Therefore if that nucleus be really the
visceral motor nucleus for the innervation of the unstriped muscle
supplied by branches of the vagus nerve—as I believe it to be—it
is clear that its pre-ganglionic axons do not end round the cells of

* My account of his work is taken from Van Gehuchten (1903). a It is also
mentioned by Molhant (1911). 7

THE NUCLEUS INTERCALATE OF STALER INI 9

any of the ganglia of the terminal plexuses in the organs of the
vagus nerve, such as the pulmonary, cardiac, and myenteric, but
must end round cells of either the ganglion nodosum or the
ganglion jugulare vagi.

But before I discuss the nature of the ganglion nodosum it is
essential, for a proper understanding of the nature of the nucleus
intercalate of Staderini, to attempt to show why the currently
accepted doctrine, that the dorsal vagus nucleus is visceral motor
for the unstriped muscle of the vagus nerve, is erroneous. Quite
twenty experimentalists, from the work of Dees 8 (1889) up to the
truly admirable exhaustive study of Molhant 7 (1911), have proved
that the dorsal vagus nucleus gives origin to centrifugal fibres;
and some of these twenty observers have further proved that it
gives origin to centrifugal fibres exclusively, so that we must now
reject the belief that it is in part an afferent reception-nucleus.
There are three definite periods in the history of the “ nucleus ” :
—(1) Until the time of Dees 8 (1889) all writers held that it was
an afferent reception-nucleus for one or more of the vagus group
of nerves; (2) the second period extends from 1889 to 1910: it
may be called the motor period; and (3) the third began and
ended in 1910 with my attempt 14 to prove that all the cells of
this “ nucleus ” are afferent, and that it is the endoneural afferent
ganglion of the vagus nerve; but after three years I am still in a
minority of one in holding this opinion. Now it is obvious that
all the twenty experimentalists from the time of Dees to Molhant,
and over thirty descriptive writers who have specially written on the
dorsal vagus nucleus, have taken it for granted that the ganglion
nodosum and jugulare vagi are exclusively afferent root-ganglia,
and also that the only sympathetic ganglia of the vagus nerve are
the terminal ganglia situated in its peripheral organs; and they
have also assumed that the peripheral processes of the cells of the
dorsal vagus “ nucleus ” are interrupted in those peripheral vagus
terminal ganglia. There is, however, not an atom of evidence in
favour of any of these assumptions on which alone they base their
opinion that the dorsal vagus nucleus is motor. It is obvious that
the requisite crucial experiment cannot be performed; for we
want to divide all the nerve-fibres on the peripheral side of these
peripheral terminal vagus plexuses, and that is impossible. But I
believe that, if we could do this, we should still get chromolysis in
the cells of the dorsal vagus nucleus, as its peripheral processes all

LEONARD J. KIDD

pass, I believe, uninterruptedly from the medulla oblongata into
the unstriped muscle (and glands and blood vessels also probably)
of all those vagus organs which contain unstriped muscle.
Molhant performed his various experiments on the vagus nerve
and its branches in the rabbit at the following levels: (1) for the
stomach he divided the gastric branches of the vagus close up to
the cardia; (2) for the trachea he divided the recurrent laryngeal
branch at a point peripheral of the point at which its laryngeal
branches are given off: he had previously proved histologically
that at the point of his section the recurrent laryngeal nerve con¬
tains exclusively small nerve-fibres which go to the trachea (and
in man to the oesophagus also, but not in the rabbit, whose
oesophagus contains no unstriped muscle); (3) for the other
organs he divided cardiac branches and the thoracic vagus, and
attempted extirpation of one lung. Thus, when he found chromo¬
lysis of the cells of the dorsal vagus nucleus after these operations
he concluded quite rightly that that nucleus innervates exclusively
those vagus organs which contain unstriped muscle: but he
assumed that it is motor, and that its pre-ganglionic axons end
round cells of peripheral terminal vagus ganglia. But he seems
to have forgotten that, so far as we know, there is no group of
sympathetic ganglion cells interposed between the trachea and the
point of his section of the peripheral part of the recurrent
laryngeal nerve. If there be really no such ganglion cells, then
we cannot escape the conclusion that those fibres which come
from the dorsal vagus nucleus to enter the tracheal unstriped
muscle must pass the whole way without interruption. Now it is
important to note that when Molhant concluded from his study
that the dorsal vagus nucleus is motor to unstriped muscle—
instead of contenting himself, as he should scientifically have done,
with saying that it gives origin exclusively to centrifugal fibres for
unstriped muscle—he was really sinning against the light; for, at
the outset of his historical summary, on p. 144, he writes these
words concerning the earlier view of the nature of the dorsal
vagus nucleus, held up to the year 1889, that it is an afferent
reception-nucleus:—“ Its situation dorsally of the sulcus limitans
of the ventricle all the more justified this opinion, the embryo-
logical researches of His having established in fact that this
sulcus separates the sensory grey masses from the motor grey
masses." So that Molhant, in concluding that the “ nucleus ” is

THE NUCLEUS INTERCALATE OF STADERINI 11

motor merely because it gives origin to centrifugal fibres, in effect
throws the established “fact” of Wilhelm His, sen., overboard,
and thus teaches, along with over thirty other writers, that a cell-
group, situated always entirely dorsally of the more or less persist¬
ing embryonic sulcus lateralis limitans of His, is motor. Clearly,
if the thirty be right, then His and I are wrong; but if His and I
be right, the thirty must cry “ peccavimus.” I must here add that
Molhant, in his beautifully planned and executed experimental
study of the nucleus ambiguus in the rabbit, has proved that it
innervates exclusively striped muscles. Therefore it cannot be
the motor nucleus for the unstriped muscle of the organs of the
vagus nerve. Now if the dorsal vagus nucleus be not the motor
nucleus for these unstriped muscles, there are only three alterna¬
tive bulbar cell-groups left to us; these are (1) the hypoglossal
nucleus, (2) the small-celled nucleus of Roller, and (3) the small-
celled nucleus intercalatus of Staderini. We exclude the hypo¬
glossal nucleus because all its axons enter the hypoglossal nerve;
and we exclude Roller’s nucleus because section of the vagus nerve
either below the ganglion nodosum, or above it or the ganglion
jugulare, does not give any chromolysis of its cells. There remain
only the nucleus intercalatus; it is the motor nucleus, and the
only one, for the unstriped muscles supplied by the vagus nerve.

I must now attempt to show that the ganglion nodosum, and
possibly also the jugulare, is a ganglionic-complex, partly visceral
afferent, and partly a sympathetic ganglion. It will be remembered
that in 1886 and in 1889 Gaskell 9 suggested that the ganglion
nodosum x., ganglion petrosum ix., and the ganglion geniculatum
viL, are sympathetic ganglia. In the year 1912 Mollgaard 10 stated
that in an earlier paper of his own—published in what I take to
be either the Danish or some Scandinavian language—he showed
that the broncho-motor innervation of the vagus nerve is in¬
terrupted in the ganglion nodosum. We know that the ganglion
nodosum, petrosum, and geniculatum are of epibranchial origin.
Now, Mollgaard has traced, in the selachian, Acanthias vulgaris,
nerve-fibres passing from the medulla oblongata and ending round
cells of the branchio-gastricus ganglion: he homologises this
ganglion with the ganglion nodosum of higher vertebrate forms.
In his 1912 paper 10 he gives a detailed account of an experiment
in which he destroyed the dorsal vagus nucleus of a cat by a
2 mm. deep incision in the bulb: he found later a few degenerated

LEONARD J. KIDD

nerve-fibres ending round cells of the ganglion nodoBum and none
peripheral of that ganglion. But unfortunately he overlooked the
fact that of necessity his incision severed some, at any rate, of the
axons of the nucleus intercalate of Staderini, bo that it was a
mere guess on his part that all the degenerated fibres came from
the damaged dorsal vagus nucleus. He concluded that that
nucleus is partly a motor nucleus whose axons end round cells of
the ganglion nodosum, and partly an afferent reception-nucleus.
But we must reject both conclusions. For we have the evidence
of some twenty experimentalists that all the “axons” of the
dorsal vagus “ nucleus ” pass through the ganglion nodosum with¬
out interruption. I need hardly say, however, that I regard
Mollgaard’s finding of prime importance, when taken in conjunction
with the findings of the twenty experimenters just mentioned, and
also with the findings of Tricomi-Allegra.® For it goes a long way
towards the proof of the accuracy of my opinion of the nature of
the nucleus intercalatus: thus, it tends to show that some, at any
rate, of its axons end round cells of the ganglion nodosum, and
that the latter gives origin to all the post-ganglionic motor fibres
for the innervation of the unstriped muscle of the organs of the
vagus nerve. Mollgaard also made the important histological
discovery that the ganglion nodosum contains a few multipolar
cells. It is interesting in this connection to note, on the other
hand, that in 1911 L. R. Muller 11 found a few multipolar cells in
the ganglion jugulare but none in the nodosum. I may add that
Mollgaard’s view that the dorsal vagus nucleus is partly visceral
motor and partly visceral afferent (reception) is not likely to gain
adherents; it seems to me a decidedly bizarre morphological
curiosity, and it would be difficult, I think, for anyone to point to
any known instance, in any vertebrate, of such a strange complex.
It is evident also that, as his incision in the medulla oblongata of
the cat divided only some of the axons of the cells of the nucleus
intercalatus, the latter nucleus must send many more axons to
end round cells of the ganglion nodosum than the number of
degenerated fibres found by him would indicate.

I believe that not only is the ganglion nodosum in part a true
motor sympathetic ganglion, but that it is not improbable that so
also is the ganglion jugulare. I have been led to this belief partly
by the histological evidence of Muller 11 that the ganglion jugulare
vagi contains some multipolar cells, but even more by the study

THE NUCLEUS INTERCALATE OF STADERINI 13

of the admirable comprehensive embryological researches of
Kuntz 18 on the development of the sympathetic nervous system of
vertebrates from fishes to mammals. Kuntz has shown that the
vago-sympathetic system is almost certainly the most ancient
part of the whole autonomic-sympathetic system; he has shown
that the embryonic sympathetic nervous system is composed of
two distinct sets of nerve-elements, viz., (1) cells which migrate
out from the cerebro-spinal ganglia and neural crest, and (2) cells
which wander out from the ventral part of the neural tube; both
sets of cells enter the anlagen of the sympathetic ganglia. In the
case of the vagus nerve, cells migrate from the two vagus ganglia,
and from the wall of the rhombencephalon: the earliest cells pass
peripherally to the peripheral organs and enter the anlagen of the
peripheral terminal vagus plexuses (the vago-sympathetic plexuses
of Kuntz), viz., the pulmonary, cardiac, and the myenteric and
submucous plexuses of the digestive tube. It is only at a later
date that these plexuses receive a fresh accession of cells from the
thoracic sympathetic system. In his valuable paper on the evolu¬
tion of the sympathetic system Kuntz discusses the question of
the existence of a sympathetic system in Petromyzonts, and con¬
cludes, almost certainly rightly, that the earliest sympathetic
system, the vago-sympathetic, in which is probably to be included
nerve-elements belonging to the facialis nerve, was primarily
concerned with the innervation of the blood vessels of the
branchial apparatus. Now it seems to me that it is highly
probable that some of the neuroblasts which migrated out from
the rhombencephalon were arrested in the two vagus ganglia, or
at any rate the nodosum, and thus formed ultimately the persisting
proximal motor sympathetic ganglia of the vagus nerve. But I
go further than this: I believe that all the neuroblasts which
originally wandered down the vagus nerve into its terminal
plexuses, and were of two kinds, afferent and motor, formed
ultimately the only part of the vagus-sympathetic system which
is truly autonomic or independent of all impulses passing down the
vagi nerves. I have for many years rejected unconditionally the
teaching of Langley that the autonomic-sympathetic system is
entirely or mainly motor; it is, I believe, exactly the other way
round, being probably quite 60 per cent, afferent and only 40 per
cent, motor. It is probable, I think, that the terminal vagus
plexuses (I exclude for the moment the fibres which reach them

LEONARD J. KIDD

from the thoracic sympathetic) consist of both afferent and motor
migrated cells and that they are interconnected by nerve-processes
to form a local, independent-, autonomic, reflex nervous mechanism.
I admit of course that some of these points are difficult to establish,
but the last-named probability is suggested by the recent histo¬
logical study by Kuntz 12 (1913) of the local innervation of the
digestive tube. The point that has always astonished me in the
adherents of the entirely or mainly motor character of the
sympathetic-autonomic system is the fact that these are the very
observers who for a long period of years have accepted unques-
tioningly the genesis of the sympathetic system entirely from the
neural crest. Now the neural crest gives origin—mainly, if not
entirely—to afferent nerve-elements. One would have supposed
that a sympathetic system derived from the neural crest alone
would have become exclusively afferent, or nearly so. But the
researches of Kuntz (1909,-10,-11) have shown the falsehood of
the exclusively neural crest theory of the origin of the sympathetic
system; at the same time a careful detailed study of all his nine
papers has convinced me that the majority of the nerve-elements
of the sympathetic system are afferent; the number of elements
which migrate from the ventral wall of the neural tube is in all
vertebrate classes smaller than the number of those which come
from the neural crest and the cerebro-spinal ganglionic anlagen.

3. Summary and Conclusions.

The main reasons why the nucleus intercalatus of Staderini has
been hitherto misunderstood by most writers appear to me to be
the following:—(1) Failure to study its morphological position;
(2) failure to remember that, if histological structure and the size
of the nerve-cells of a nucleus be any guide whatever in the
determination of its function and morphology, then the nucleus of
Staderini is a visceral nucleus; (3) failure to see the morphological
inadmissibility of the motor view of the dorsal vagus “ nucleus ”;
(4) failure to grasp the ganglionic-complex nature of the ganglion
nodosum vagi; (5) failure to study the bearing of embryological
researches on the nature of both the ganglion nodosum and the
peripheral terminal vagus ganglia and plexuses. In order to
attempt to run these questions to earth it has been necessary
for me to enter on a rather lengthy discussion. Let us now see

THE NUCLEUS INTERCALATE OF STADERINI 15

what we have learnt from it all. We have a well-defined, small-
celled nucleus situated in the floor of the fourth ventricle of
many mammals up to that of man ; its total bulk is, so far as we
can judge by Streeter’s careful measurements, very nearly the same
as that of the dorsal vagus nucleus; in the lower half of the
ventricular floor it is obviously always situated in the primitive
ventro-lateral cell-column of the brain; it is therefore visceral
motor for unstriped muscle. In the upper half of the floor of the
fourth ventricle it is also situated in the same ventro-lateral cell-
column, as I have attempted to show; it is evident that Streeter 4
grasped this truth also, for he suggested that it might be a
central sympathetic nucleus. And it is also apparently true to¬
day that he and I are the only two writers who have yet grasped
this truth. By a process of exclusion I have further shown that
the axons of the nucleus of Staderini do not pass either up the
brain-stem or down the spinal cord; they do not enter any
cranial nerve except the vagus; they do not end round cells of
any of the peripheral terminal vagus ganglia (pulmonary, cardiac,
Bubmucous, myenteric). Therefore, if, as other evidence proves to
be the case, the nucleus intercalate of Staderini be really the
visceral motor vagus nucleus for unstriped muscle, its axons must
end round cells of one or both of the vagus ganglia (nodosum
certainly, jugulare possibly). In favour of the correctness of the
view expressed by Gaskell, 9 so long ago as the year 1886, that the
ganglion nodosum is sympathetic in character, we have:—(1) The
fact that it contains some multipolar cells; (2) the morphological
studies of Mollgaard 10 in Acanthias vulgaris', (3) his further
finding that, after a section 2 mm. deep made in the medulla
oblongata of a cat in the region of the dorsal vagus nucleus and
nucleus intercalatus—which incision of necessity served some of
the axons of the latter nucleus—some degenerated nerve-fibres
could be traced downwards and be found to end round cells of the
ganglion nodosum, and to be in addition absent in the vagus nerve
below that ganglion. And to these points I may add my own
suggestions, based on a study of the splendid series of embryo-
logical and histological researches of Kuntz. 12 The careful
experimental work of Molhant 7 (1912) has shown that the
nucleus ambiguus of the rabbit innervates striped muscles
exclusively. Here again I have shown by a process of exclusion
that the motor nucleus for the unstriped muscles supplied by

LEONARD J. KIDD

branches of the vagus nerve is not the hypoglossal nucleus, not
Roller’s nucleus, and not the dorsal vagus V nucleus.” The only
possible remaining cell-group which could be the required motor
nucleus is Staderini’s nucleus; and the experimental evidence in
favour of this has also been given here. It would he difficult to
point to anything stranger in the history of neurology than the
truly surprising way in which writers, who up to the year 1889
accepted the afferent reception-nucleus nature of the dorsal vagus
“nucleus,” then suddenly veered round to the teaching that it
was motor, and all, forsooth, because it was then proved that it
gives origin to centrifugal fibres, and they could not grasp the
conception of a centrifugal fibre being afferent. And yet, had
they studied their comparative neurology, they would have recog¬
nised that evidence had been in existence since the year 1877
which proved the existence of what I called in 1910 the “endo¬
neural afferent ganglionic system.” Then again a few years ago
J. B. Johnston* showed that such a system exists in Amphioxus,
which is in some respects one of the most ancient of existing
vertebrates; and further he traced the dendrites of these endo¬
neural afferent ganglionic cells into the skin. And Ross G.
Harrison f showed that the peripheral afferent root ganglia of the
teleost Salmo mlar are developed from migrated endoneural
afferent neuroblasts. And from this we learn that in at least one
ancient vertebrate form the endoneural afferent ganglionic system
is more ancient than the exoneural ganglionic, and actually gives
origin to it.

On the question as to the constitution of the nerve-elements
of the peripheral terminal vagus ganglionic plexuses, we must
recognise definitely that they are formed of two genetically
distinct parts, viz., (A) a part derived from the vagus nerve, vago¬
sympathetic, and (B) an ontogenetically and phylogenetically
younger part derived from the sympathetic system. And each
part consists of two parts, an earlier and a later. Thus, I believe
the vago-sympathetic system to be composed of (1) the earliest
formed elements, derived from the earliest migrated neuroblasts
which passed down the vagi from the hind-brain and the vagus
ganglia; these neurones of the terminal peripheral vagus plexuses
are entirely independent of all nerve-influences passing down the

* Biological Bulletin, Vol. i. f 1905.

t Archiv. fur Mikroa. Anat., Vol. lvii., 1901.

THE NUCLEUS INTERCALATE OF STADERINI 17

vagi; they are composed of both afferent and motor nerve-cells,
and they thus form a local peripheral, independent, autonomic reflex
mechanism for the unstriped muscle of heart, bronchi, lungs, and
digestive tube. [An interesting piece of experimental work by
Cannon and Burket 13 tends, I think, to support my view. These
authors have studied the question of the endurance of anaemia by
the nerve-cells of the myenteric plexus; they produced complete
compression of parts of the alimentary canal of cats, and found
evidence of the continued existence, both physiologically and
histologically, of the nerve-cells of the myenteric plexus after
three hours of complete anaemia, i.e., two hours longer than happens
in the case of the sympathetic ganglia. They are thus “ the most
hardy nerve-cells thus far found in the body.”] But it is also true
that the peripheral terminal vagus ganglionic plexuses give passage,
without any cell-connection, to two sets of vagus fibres shown
diagrammatically in Fig. 4; (a) the post-ganglionic motor axons
rising in cells of the visceral motor part of the ganglion nodosum,

Fig. 4.—Diagram or Constitution or Vagus Supply to Unstriped
Musclb, including Cardiac.

N.LS., Nucleus Intercalatus of Staderini. D. V.N., Dorsal Vagus “ Nuoleus.”
The local peripheral reflex vago-sympathetic ganglionic plexus is figured: it
hows two afferent cells and two motor cells, also a post-ganglionic motor axon
and a dorsal vagus ganglionio dendrite passing through the plexus without cell-
oonnection. The sympathetic part of the plexuses is omitted. The arrows
indicate the direction of physiological impulses.

LEONARD J. KIDD

and ( b ) the peripheral processes (dendrites) coming from the cells
of the dorsal vagus “ nucleus,” i.c., endoneural afferent fibres.

B. The part of these terminal vagus plexuses, which is geneti¬
cally derived from the sympathetic system, likewise consists of (a)
an older, independent, truly autonomic part, and ( b ) a younger, which
depends functionally on motor and afferent impulses which re¬
spectively reach it from and pass from it to the sympathetic
system. There are thus at least four great groups of neurones in
these vago-sympathetic terminal plexuses. I am very much in¬
clined to believe that (1) all the afferent fibres of the vagus nerve
which go to organs containing unstriped muscle (and the heart)
are either processes of the independent, afferent nerve-cells of the
terminal plexuses or else come from the dorsal vagus “ nucleus ”;
and (2) that the afferent fibres of the vagus nerve which rise in
cells of the ganglion nodosum and jugulare pass wholly to skin
of ear, dura mater of posterior fossa, muscles of pharynx and
larynx, and mucous membrane of pharynx and larynx. But it is
a very difficult matter to prove or to disprove. For, if it be found
that section of a branch of the vagus nerve which is distributed to
an organ containing unstriped muscle is followed by chromolysis
of some of the cells of the ganglion nodosum or jugulare, this could
be interpreted in two separate ways. Thus those who deny that
the ganglion nodosum contains any visceral motor cells would
naturally conclude that the chromolysed cells are visceral afferent;
whereas those who hold to the partly sympathetic nature of the
ganglion nodosum (and possibly also jugulare) would say that these
affected cells could theoretically be afferent, or motor, or both
motor and afferent. And I don’t at present see how anyone is
going to solve this problem. In conclusion, we need a careful
renewed experimental inquiry in order to place the question of the
nature and connections of the nucleus intercalatus of Staderini on
a sound basis. The chief thing to be done is to perform experi¬
mental section of the vagus nerve between the ganglion nodosum
and the ganglion jugulare; the animals ought to be kept not
longer than from four to six days. If we find chromolysis of all
the cells of the nucleus intercalatus of Staderini, we should con¬
clude that all its axons end round cells of the ganglion nodosum,
and none round those of the jugulare. If, however, a few cells of
Staderini’s nucleus escape chromolysis, we should attempt to per¬
form vagotomy above the ganglion jugulare. [One writer confesses

THE NUCLEUS INTERCALATE OF STADERINI 19

that he failed to do this in the rabbit; so one would suggest some
other animal for this purpose.] If we found then a total chromo¬
lysis of Staderini’s nucleus we Bhould conclude that some of its
cells end round cells of the ganglion jugulare. If positive results
were obtained by one or other of these operative procedures, we
could resort in another series of animals to Van Gehuchten’s
indirect Wallerian method. The animals must be kept for from
thirty to fifty days, and it should then be possible to trace by
Marchi’s method degenerated fibres passing down from Staderini’s
nucleus to one or both vagus ganglia. One would greatly welcome
a histological study by the best modern methods of the cell-
characters of the nucleus intercalatus of Staderini; and to this
might well be added a careful study of the medulla oblongata of
sub-mammalian vertebrates; for Staderini’s nucleus, or some cell-
group corresponding to it in position and cell-characters, ought to
be found in some of them at any rate, i.e., if it be really, as I have
here claimed to show, the visceral motor nucleus for the innerva¬
tion of all the unstriped muscle of the vagus organs, with the
exception of that part of this musculature which is innervated by
the truly autonomic part of the peripheral terminal vagus ganglia.
The formal conclusions may be stated thus:—

1. The nucleus intercalatus of Staderini consists of small cells
of visceral type, is situated in the ventro-lateral primary cell-
column of the hind-brain, is a central lateral sympathetic nucleus,
is the motor nucleus for the unstriped muscles supplied by the
vagus nerve, and has no morphological nor physiological connec¬
tion with any part of the eighth cranial nerve. That nerve is
exclusively a somatic afferent nerve.

2. The axons of the cells of Staderini’s nucleus end round cells
of the ganglion nodosum, and possibly also the jugulare. The
ganglion nodosum certainly, and the jugulare possibly, are really
ganglionic complexes, i.e., some of their cells are visceral afferent,
some visceral motor.

3. The dorsal vagus “nucleus” is the “endoneural afferent
ganglion " (Kidd, 1910) for the unstriped muscle supplied by the
vagus nerve; all its cells are afferent; it is not, even in part, an
afferent reception-nucleus.

4. The peripheral terminal vagus plexuses consist of four
distinct sets of elements, two of vagus origin, and two of sym¬
pathetic origin, (a) The older part of the vago-sympathetic

LEONARD J. KIDD

system consists of independent, truly autonomic, afferent and
motor neurones which form a local independent reflex mechanism;
(&) the younger part consists of nerve-fibres which are dependent
on influences passing by them from and to the vagi nerves, viz.,
(1) the post-ganglionic motor fibres which rise in the motor part
of the ganglion nodosum, and (2) the endoneural afferent fibres
(dendrites) which pass down the vagus nerve from the dorsal
vagus “ nucleus ”; (3) the older part of the sympathetic portion
of the peripheral terminal vagus plexuses is independent, and
forms a local reflex mechanism; (4) the younger part depends on
motor and afferent impulses passing respectively from and to the
sympathetic system.

5. A renewed experimental and comparative histological study
of the nucleus intercalatus of Staderini is needed.

I am indebted to Dr A. Ninian Bruce for his kindness in re¬
drawing my diagrams to my design.

4. References.

1 Stadkrini, R—

1894. Monitort. Zod. Ilal., Anno ▼., No. 8.

1895. Arch. Hal. de Bid., Vol. 23, p. 41.

1895. Internal. MonaUchr. /. A not. u. Phytid., Vol. 12, p. 220.

1896. Ibid., Vol. 13, pp. 326, 337.

* VAN GSHtrCHTXN, A.—

1898. /own. de Neurd. , VoL 3.

1903. Lt Nivraxe, VoL 5, p. 296.

* Gram*—

1873. PJlilgtr’t Arehiv.f. Phytid., Vol. 7, p. 583.

4 Strut**, G. L.—

1903. Amer. Joum. qf Anal., Vol. 2, p. 299.

* Ossipow, W. P. —

1898. Nevrologitechesky Wjeetnik., Vol. 6 (Russian language).

(Abstract in Neurd. Centroid., VoL 17, 1898, p. 697.)

* Tricomi-Allxgra, G.—

1903. Rivista. di Paid. Nerv. e. Mentale.

7 Molhant, M.—

1911. Lt Nivraxe, Vol. 11, p. 131 (Dorsal vagus nucleus).

1912. Ibid., Vol. 12, p. 221 (Nucleus ambiguus).

* Dus, O.—

1889. Arch./. Peychiatr. it. Nerven-Krankh., Vol. 20, p. 89.

* Gaskkll, W. H.—

1886. Joum. of Phyeid., VoL 7, p. 71.

ABSTRACTS

19 Mollqaard, H.—

1912. Skandinav. Arch./. Physiol. , Vol. 26, p. 315.
u Muller, L. R.—

1911. Deutsch. Arch./. Klin. Med., Vol. 101, p. 421.

11 Kuntz, A.—

1909. Anal. Ameiger, Vol. 35, p. 381; Anal. Record , Vol. 3, p. 458.

1910. Joum. Comp. Neurol. , Vol. 20, p. 211 (Mammals); Vol. 20, p. 283

(Birds).

1911. Amor. Joum. o/ Anal., Vol. 11, p. 279 (Reptiles).

1911. Joum. Comp. Neurol. , Vol. 21, p. 177 (Fishes); p. 215 (Evolution of
the Sympathetic Nervous System); p. 397 (Amphibia).

1913. Ibid., Vol. 23, p. 173 (The innervation of the digestive tube).

11 Cannon, W. B., and Burket, I. R.~

1913. Amor. Joum. o/Physiol ., VoL 32, p. 347.

14 Kidd, L. J.—

1910. Rev. o/ Neurol, and Psychiatry, Vol. 8, p. 673 (The dorsal vago¬
glossopharyngeal nucleus).

[A full list of references to the literature of the dorsal vagus nucleus will be
found in the papers by Molhant 7 (1911) and by Kidd. 14 The only additional
reference known to the writer now is the paper by Niedzvietzky (Bull. Soc. Imp.
des Naturalistes de Moscov ., Ann6e 1896, No. 3, 1897, p. 515); he is one of about
twenty experimentalists who proved that the dorsal vagus nucleus gives origin
to oentxifugal fibres: his work was done on four rabbits.]

abstracts.

ANATOMY.

A NOTE ON THE SULCUS POST-CENTRALIS SUPERIOR.

(l) Geoffrey Jefferson, Anat. Anxeig., 1913, xliv., Juni 12, S. 91.

The sulcus “ interparietalis ” of animals lower than anthropoids is
identical with the sulcus post-centralis of man, and should be
called by that name. The so-called sulcus post-centralis superior
of pithecicUe lies within the sensory area, and cannot therefore
really be “ post-centralis ” in function. It should be called sulcus
prse-parietalis as a distinguishing mark. The sulcus post-centralis
superior of man is a composite sulcus, and consists of three separate
parts, not all of which can be identified in any given case. The
sulcus cinguli has an arcus cinguli (mihi) thrown round its outer
end. Every deep sulcus is thus bounded by an arcus (e.g., parieto-

ABSTRACTS

occipital, calcarine). The arcus cinguli is bounded by a sulcus, to
which I have given the name of sulcus paracinguli. This sulcus is
frequently continuous with the sulcus post-centralis superior. To
this fact is largely due the variety of form which the latter sulcus
displays. It is advisable to distinguish limiting sulci as being of
the first and second degree, according as they separate areas of
totally different function and structure, or merely specialised parts
of one great area from one another ( e.g ., the parietal area).

A. Ninlan Bruce.

ON THE MICROSCOPIC STRUCTURE OF THE OTIC GANGLION.
(2) (Sulla fine struttura del ganglio otiro.) Carlo Riqjjier, Riv. di
Patol. nerv. e ment., 1913, xviii., p. 609.

The otic ganglion has been studied in this paper in preparations
made from the ox and the human subject. The type of cell in
the otic ganglion in both cases was found to resemble the cells
occurring in ganglia of undoubted sympathetic nature. The
differences that may be observed between the otic and the sympa¬
thetic ganglia are mainly those of gross structural form, or of
distribution and size of the cellular elements. F. L. Golla.

CONTRIBUTION TO THE KNOWLEDGE OF THE MEMBRAN-
(3) OUS LABYRINTH. ON A FOURTH CRISTA AOUSTICA.
(Beitrag zur Kenntnis des L&utigen Labyrinthes. Uber dine
vierte Crista Acustica.) C. E. Benjamins, Zttckr. /. Ohrenheilk .,
1913, lxviii., May, S. 101.

The author first of all defines the difference between the crista
ampullaris and the macula acustica. The crista lies on a fold of
the membranous wall, has long hairs united to a cupula, and lacks
otoliths; the macula, on the contrary, lies spread out flat, has short
hairs, and is always covered by otolithic crystals. He now gives a
description of the crista quarta as occurring in fishes, reptiles, and
mammals. A detailed description is given in the case of the eel.
The crista quarta is found on the floor of the so-called sinus
posterior utriculi, which runs between the ampulla posterior and
utriculus. It consists of an epithelial hillock of slightly lower
height than that of the crista ampullarum, and of a characteristic
round shape. It sits on an elevation of the membranous wall.
A little bundle of long hairs stretches into the lumen of the sinus
and is connected with a cupula. Otoliths are absent. The nerve
supply comes as a twig from the branch of the eighth, which

ABSTRACTS

supplies the posterior ampulla. Eighteen varieties of fish were
examined; the crista was found in all except the flat fish and
syngnatlivs acus. In the frog a sensory epithelial hillock with long
hairs is found in a recess of the upper sacculus wall. The author
thinks this probably is the homologue of the crista quarta. In
the adder the crista is found in the lower part of the utriculus,
close to the entrance of the ampulla posterior. In the pigeon it
lies close to the crista ampullaris posterior. In birds a consider¬
able reduction in size of the crista quarta is noticeable. The
mole, hedgehog, rabbit, mouse, pig, cat dog, Tarsius spedruvi, and
man were examined. In all of these the crista quarta is found in
the sinus posterior utriculi, near the ampulla of the posterior canal.
In the rabbit it was not found, but is probably present. It varies
from 90 p to 120 /x broad, and from 40 /x to 60 /x high.

Retzius had noticed the structure in fishes, and named it the
macula acustica neglecta. This name should be changed to crista
quarta.

A chapter is devoted to embryology. In bony fishes the crista
quarta is developed from the epithelium of the macula sacculi. In
mammals and fishes it develops from a high round layer of
epithelium on the lateral wall of the utriculus, which becomes
smaller and confines itself to the sinus posterior utriculi, becoming
differentiated into a round structure at the entrance of the hori¬
zontal canal, and the crista quarta. Some suggestions are thrown
out as to physiological significance which must be small in animals.
The article is illustrated with very fine micro-photographs.

Raymond V£rel.

PSYCHOLOGY.

EXPERIMENTAL PRODUCTION IN MAMMALS OF THE PINEAL
(4) PRECOCIOUS MACRO GENITO-SOMATIC SYNDROME. (La
Sindrome epifisaria macrogenitosomia precoce ottenuta speri-
mentalmente nei Mammiferi) Sartkschi, U., Pathologica., 1913,
v., Dec. 1, p. 707.

Sarteschi has produced, by means of pineal extirpation, the same
bodily overgrowth, hypertrophy of the testes, and premature
sexual development in very young rabbits and puppies which
Foa did in cockerels (1912). Sarteschi attempted pinealectomy
also in very young kittens, but with constantly fatal results. He
used the operative method of Lomonaco, and by ligature of the
stalk obviated the risk of haemorrhage; a temporary ligature of
the carotid artery gives an anaemic field of operation. Out of

ABSTRACTS

23 rabbits operated on at the age of about 45 days, 3 survived;
a small remnant of the pineal body was found adherent on
autopsy, and the testes were greatly hypertrophied; the animals
had grown much more than the controls of the same age. One
doe gave birth to young, and one buck became a father. All the
organs and internal secretory glands were normal. Sarteschi
concludes that in rabbits pinealectomy, whether it be complete or
incomplete, determines a great bodily development, sexual
precocity, and notable enlargement of the testes. In puppies, the
operation is more difficult: out of 27, 5 survived: operation took
place at the age of 2 months. The same results were obtained as
in the rabbits: one male puppy copulated completely several
times at the age of 6 months, but without fertilisation until he
was nearly 7 months old. It was noted that after each sexual
act he lost flesh, but his general health and nutrition remained
good; his testes were of adult size before he was 5 months old;
on autopsy they were histologically normal. Another male puppy
showed at the age of 5 months great size and adiposity, with
enlarged testes; but his sexual functions were not tested.
Sarteschi “ accepts Pellizzi’s hypothesis that the pineal body
exercises a moderating action on genito-somatic development.”
Four figures illustrate the testicular hypertrophy and the large
size of the fat puppy here mentioned. Leonard J. Kidd.

STUDIES ON PELLAGRA—I. THE INFLUENCE OF THE MILLING
(ft) OF MAIZE ON THE CHEMICAL COMPOSITION AND THE
NUTRITIVE VALUE OF MAIZE-MEAL. Casimib Funk,
Joum. Physiol 1013, xlvii., p. 389.

The chemical investigation of the different fractions of the maize
grain obtained during the milling renders it extremely probable
that the localisation of vitamines is closely analogous to that of
rice. There are four distinct layers which give on analysis
different results, and it would seem probable that the vitamines
are distributed in the external layers of the grain. This explains
why, according to the mode of preparation of maize-meal in
different countries, the manifestations of pellagra vary from mild
to severe forms. We are not able to say at the present moment
which of the three external layers is more likely to contain the
bulk of the vitamines. Besides vitamines the grain is deprived
during the process of milling of a great quantity of salts, proteins,
fat, and lipoids. The result of this investigation is that for the
present moment it would be advisable to abandon the present
mode of milling, since only the whole grain, including the skin,
can be regarded as a complete food. A. N ini an Bruce.

ABSTRACTS

PATHOLOGY.

ON THE STRUCTURE OF THE MYELIN SHEATH AND ITS
(6) ALTERATION IN SECONDARY DEGENERATION. (Sulla
itruttura della guaina mielinica e eul suo comportamento nelli
degeneration! secondarie con nn nuovo metodo dlndagine.)
Fkbuccio Goidi, Riv. di Patol. nerv. e ment., 1913, zviii., p. 638.

Thr method used is that of Besta, which is thus summarised:—

1. Blocks of nervous tissue are fixed in a solution of 20 per
cent, formalin with 2 per cent, acetic aldehyde.

2. They are washed for twenty-four hours in frequently
changed water.

3. Removed to 4 to 5 per cent, ammonium molybdate for forty-
eight hours.

4. Celloidin blocks prepared (alcohol, alcohol ether, ether, soft
celloidin, hard celloidin), and sections cut.

5. Sections of 20 to 30 /t stained for some hours in Mallory’s
phosphotungstic hsematoxylin at 40° C„ washed for some minutes
in water, differentiated by the method of Pal, and mounted in balsam.

By this method a preparation is obtained showing a well-
marked reticular appearance in normal nerve fibres both in
longitudinal and cross section.

In cross section it is seen that the reticulation is confined to
the sheath, and the axis is uncoloured.

In the process of secondary degeneration the alveolar reticular
structure becomes irregular, and later, granular in appearance;
finally the sheath appears to be uniformly clear'and structureless.

The first signs of degeneration are met with twenty-four hours
after the initial lesion. F L. Golla.

CONTRIBUTION TO THE PATHOLOGY OF PARALYSIS AGITANB.

(7) Haskovxc and Basta, Nouv. Icon, de la SalpStriire, 1913, March-
April, p. 127.

In two advanced cases of paralysis agitans the authors have found
that along the axones of the white matter of the central nervous
system a neuroglial network is often to be seen, and similarly a
network inside the nerve sheaths of the peripheral nerves. They
also noted regressive pigmentary changes in the nerve cells, more
advanced, in their opinion, than can be accounted for by the age
of the patients. They think the changes in the peripheral nerves
may explain the tremor.

They also noted changes in the thyroid, and venture the
suggestion that these are primary to the alterations of the
neuroglia and of the medullary sheaths of the peripheral nerves.

ABSTRACTS

Without further descriptions of the condition of the central
nervous system (basal ganglia, regio subthalamica, &c.), any
attempt to explain the pathogeny of the disease in this indeter¬
minate fashion is unsatisfactory. S. A. K. Wilson.

A PECULIAR FORM OF NODULAR HYPERPLASIA OF THE

(8) LIVER ASSOCIATED WITH BRAIN CHANGES. (Uber eine
eigenartige Form knotiger Hyperplasie der Leber, kombiniert
mit GeMmverftnderungen.) Yuoo Yokoyama and Walthkr
Fischer, Virckouft Archiv ., 1913, cci., S., 305.

Authors describe a case of a woman, set. 24, who at the age of
19, without any obvious cause beyond a fright, liegan to develop
curious mental symptoms. She lost the power of speech, and
became incapable of work of any kind. The reflexes were normal
but the gait spastic. Eventually she became unconscious, and
developed gangrene of the lower extremities. Post mortem, the
main changes were found in the liver and in the brain. The liver
showed numerous knob-like projections on the surface. On
section, yellow areas of liver tissue were found with intervening
bands of fibrous tissue. The brain showed slight lepto-meningitis
to the naked eye. Microscopically the liver showed areas of focal
necrosis, also bands of fibrous tissue dividing the liver substance
into areas varying much in size. There was well-marked prolifera¬
tion of the small bile ducts.

In the brain a gliosis was found in the cortex of the frontal
lobes. The vessels were increased in number and their walls
thickened. In other parts of the cortex a similar increase of
neuroglia was found, but in a less marked degree. There was
degenerative changes in the basal ganglia, with similar overgrowth
of neuroglia.

The authors regard the condition as probably toxic in origin,
the poison producing changes in the liver similar to those found
in subacute yellow atrophy, and in the brain degeneration followed
by overgrowth of neuroglia. As to the nature of the toxin, they
do not consider that they can make a positive statement ( v . Revieio,
1913, xi., p. 167). James Miller.

HISTOLOGICAL OBSERVATIONS ON THE NERVOUS SYSTEM

(9) OF THE PROGENY OF ANIMALS SUBJECTED TO
CHRONIC ALCOHOLIC POISONING. (Riserche istologiche del
sistema nervoso centrole in discendenti di animali cronicamente
alcoolizzati.) M. Ferrari, Clinica Medica Italiana, 1911.

The lesions produced in the nervous system of guinea-pigs sub¬
jected to prolonged alcoholic poisoning can be transmitted to their

ABSTRACTS

offsprings. Lesions are found in the meninges, the vessels, and
the nerve cells. The cells are most frequently and severely
damaged in the spinal cord. In some cases epileptic convulsions
occurred both in mother and offspring. F. L. Golla.

CLINICAL NEUROLOGY.

THE INVESTIGATION OF THE HIGHER NERVOUS FUNCTIONS.

(10) I. PxWLOyr, Brit. Med. Jowrn ., 1913, Oct. 18, p. 973.

The outlines are here given of twelve years of work upon the
mechanism of the formation of new reflexes and the mechanism of
the analysers. These reflexes of recent formation are termed
“ conditional reflexes,” from their great dependence on a multitude
of conditions. Ordinary reflexes may be termed “ unconditional
reflexes.” To study conditional reflexes the salivary glands were
used. The fundamental condition for the formation of a con¬
ditional reflex is that whatever indifferent stimulus is chosen for
the purpose of the reflex which it is desired to build up, it is given
at the same time as the food or acid is introduced into the mouth.
After a few such sittings it will be found that this formerly in¬
different stimulus alone is now capable of calling forth a secretion
of saliva, e.g., the usual result of painful stimuli is that the animal
either defends itself against it or attacks it. If electrical stimula¬
tion of the skin be accompanied by feeding of the animal, after a
time even the strongest electrical stimuli applied to the skin gives
rise merely to the feeding reaction, i.e., to secretion of saliva and
to no symptoms of fright or pain. Even cutting or burning the
skin merely causes symptoms of the keenest appetite. The im¬
pulse, which formerly went to a particular region, is now directed
to a different one, and one of the most important functions of the
highest parts of the central nervous system is the dispersion of
such impulses. These reflexes are subject to inhibition, which
may be spontaneous, external, internal, or conditional. In an
animal from which the cerebral hemispheres have been completely
removed it is impossible to form any “conditional reflexes” at
all. It appears, therefore, that the cerebrum is the organ for the
analysis of sensations and for the construction of new reflexes and
new connections. It represents that part of the animal organism
which is specialised for the purpose of retaining the animal always
in a state of equilibrium with the outer world, i.e., it is the organ
which is above all others necessary for the unimpeded evolution of
the organism. It is perhaps not rash to think that some of the
newly-formed conditional reflexes can be transmitted hereditarily

ABSTRACTS

and become unconditional thereby. During all this work the
author has never been able to turn to psychological conceptions for
help, or to use explanations founded on these conceptions. Such
help as psychology gives are mere examples of undetermined
thought, e.g., the animal has remembered, or desired, or thought,
&c. A. Ninian Bruce.

A BIOOBNBTIO PRINCIPLE. (Un Prindpio Biogenetivo: la molti-
(11) plic&zione degli effetti utili indirettL) £. Luoaeo, Riv. dt
Patol. nerv. e ment., 1913, xviiL, p. 129.

The study of the “ thinking horses ” of Krall leads the author to
the conclusion that the structure of the central nervous system is
such as to render possible under appropriate stimuli association
complexes which would never be developed during normal life.

F. L. Golla.

THE IDIOPATHIC VARIETIES OF MYOCLONUS. (Myoclonies
(12) essentielles.) Mouiz, Nouv. Icon, de la SalpStriere , 1913, March-
April, p. 85.

This is an excellent paper on a vexed subject and repays perusal
Mouiz distinguishes symptomatic from idiopathic myoclonus.
In the former group his classification is:—

1. Infective myoclonus, in toxi-infective conditions. Included
in this section is Dubini’s disease.

2. The myoclonus of hemiplegia.

3. Syphilitic myoclonus.

4. Hysterical myoclonus.

5. The myoclonus of degenerates (including Brissaud’s “ vari¬
able chorea ”).

6. Epileptic myoclonus, subdivided into—

(a) Intermittent epileptic myoclonus.

(b) Familial epileptic myoclonus—Unverricht’s disease.

In the latter group are:—

1. Idiopathic fibrillary myoclonus, inclusive of the myokymia
of Kny and Schultze and the fibrillary chorea of Morvan.

2. Paramyoclonus multiplex of Friedreich, in which as a rule
the muscular contractions do not produce displacement of the
limbs; and

3. Myoclonus with big movements (“ & grand displacements ”).
The author’s paragraphs on diagnosis are very good, but he

ABSTRACTS

cannot enlighten our ignorance of the etiology and pathogenesis of
idiopathic myoclonus. There is a valuable bibliography.

S. A. K. Wilson.

TRAUMATIC INTRAMUSCULAR OSSIFICATION. John Mobley,

(13) Brit Med. Joum., 1913, Dec. 6, p. 1475.

"Traumatic intramuscular ossification (‘myositis ossificans’) is
due to migration of osteoblasts into adjacent contused muscle and
blood clot, after destruction of the periosteum and loss of its
function as limiting membrane to the growth of bone. It is
essentially the same process as callus formation. The condition
may be produced experimentally in animals by reproducing the
same mechanical conditions by an aseptic open operation. In a
case of difficulty in diagnosis from sarcoma, open exploration is
advisable. Simple excision is usually, but not invariably, followed
by recurrence. Conservative treatment condemns the patient to
a long period of disability, which may occasionally be permanent.
Excision, combined with grafting of deep fascia on to the denuded
surface of bone, gives the best prospect of rapid and complete
recovery, and is urged for all cases not complicated by ossifying
periarthritis. Osteoblasts and chondroblasts are the same cells
under different conditions of nutrition.” A. Ninian Bruce.

ABSENCE OF THE OCULO CARDIAC REFLEX IN TABES.

(14) (L’absence dn rdflexe oculo-cardiaque dans le tabes.) M. Loepee

and A Mougeot, Prog. M6L, 1913, Dec. 27, p. 675.

In normal persons compression of the eyeballs is followed, after an
interval of at most two or three seconds, by a slowing of the
cardiac rhythm by about eight pulsations per minute: on cessation
of the compression the pulse-frequency returns to its normal.
The afferent limb of the arc is in the trigeminus nerve, the motor
limb in the vagus. The writers have carefully examined for this
reflex in twenty-one tabetics, also the knee and ankle jerks,
corneal reflexes, Argyll Robertson pupil, the sensibility of the
eyeballs on deep pressure, and the presence or absence of aortic
lesions. A table gives particulars of all these points in all the
cases. The oculo-cardiac reflex was abolished on both sides in
nineteen out of the twenty-one cases. The authors believe that
abolition is the rule in tabes; abolition may also occur in some
cases of exophthalmic goitre, diabetes, and plumbism. All the
twenty-one cases showed the A. R. pupils. The authors regard the
loss of the oculo-cardiac reflex in tabes as due to a mesencephalic
lesion ; it is analogous to the A. R. pupil, and is a sign of upper
tabes. Leonard J. Kidd.

ABSTRACTS

ON THE INCOMPLETE FORMS OF RECKLINGHAUSEN’S
(15) DISEASE. (Contribution & l’dtude dea formes firnstes de la
mal&die de Recklinghausen.) P. Bebtbin, Gas. d. Hop., 1913,
lxxxvi., p. 2093.

A soldier, aged 22, was admitted to hospital with multiple skin
tumours and pigmentation. There were no tumours along the
nerves. The condition had been present since childhood; at the
age of 5 years a large tumour had developed on the shoulder,
shortly after it had been injured by a cart wheel. Examination
of the tumours removed showed an absence of nerve fibres, but
Bertein regards this absence as apparent rather than real, and
thinks that the fibromatosis was a true neuro-fibromatosis with
exclusive localisation in the terminal cutaneous nerves.

J. D. Rolleston.

THE MENINGEAL FORM OF POLIOMYELITIS. Arnold Netter,

(16) Brit. Joum. Child. Dit., 1913, x., p. 531.

Poliomyelitis with meningeal onset has recently been remarkably
frequent in France, not only in Paris and the suburbs, but also in
the provinces ( v. Review, 1910, viii., pp. 35, 537, and 1911, ix., pp.
75-6). In other countries the meningeal form of poliomyelitis has
been less frequent, though cases have been recorded in Norway,
Sweden, Austria, Germany, Holland, and England. The confusion
between poliomyelitis and epidemic cerebro-spinal meningitis used
frequently to be made, and was the more excusable as the two
diseases might appear in epidemic form at almost the same time
and in the same countries, but the progress of bacteriology and
experimental pathology now renders the error avoidable. In the
diagnosis of the condition Netter attaches great importance to the
examination of the knee jerks, which are lost at an early stage, and
to the presence of pains in the limbs, which is more marked than
in other forms of poliomyelitis. J. D. Rolleston.

MENINGEAL SYNDROME OF THE POLIOMYELITIS TYPE.

(17) (Syndrome mfoingl k type de poliomyllite.) E. Joltrain and
P. Rouffiac, Bull, et mim. Soc. mid. Hop. de Paris , 1913, xxxvl,
p. 473.

A youth, aged 18, was admitted to hospital with well-marked signs
of meningitis. Previous attacks of bronchitis and the insidious
onset of the disease suggested tuberculous meningitis. There
were marked weakness of the lower limbs and loss of knee and
ankle jerks. Lumbar puncture gave issue to a clear fluid under
marked hypertension, containing a large quantity of albumin and

ABSTRACTS

abundant lymphocytes, but no microbes. Wassermann negative.
Within a week the symptoms subsided, and the reflexes returned,
first the ankle jerks and then the knee jerks.

Convalescence was slow, but there was no definite paralysis.

J. D. Rolleston.

MENINGITIS AFTER FOLLICULAR TONSILLITIS. (Meningitis

(18) nach follilmlttrer Angina.) E. Siemerling, Deut. Med Wchnschr.,
1913, xxxix., p. 2287.

A case of serous meningitis in a boy aged 15 years successfully
treated by repeated lumbar puncture and unguentum cinereum.
An unusual feature was the abundance of cellular elements,
especially lymphocytes (300 in 2 c.c.). Wassermann negative.

J. D. Rolleston.

HYPERTROPHIC CERVICAL MENINGITIS. Babinski, JumentiS,

(19) and Jabkowski, Nouv. Icon, de la Salpetriere, 1913, Jan. -Feb., p. 10.

In this case the clinical symptoms were those of a slowly pro¬
gressive quadriplegia, with bilateral atrophy of the shoulder girdle
musculature, spasticity, paralysis and contracture of the legs, but
with remarkably little sensory disturbance. The pathological
condition was a markedly thickened arachnoid in the cervical
region of the cord, of syphilitic nature, compressing the cord.
There was, however, little or no evidence of degeneration in the
spinal paths below or above the lesion. Similarly, the anterior
and posterior roots were less destroyed than might have been
expected. S. A. K. Wilson.

A CASE OF MENINGITIS PURULENTA ASEPTIOA AFTER

( 20 ) INTRANASAL INTERFERENCE. (Bin Fall von Meningites
purulenta aseptica nach einem intranasalen Eingriff.) Leopold
Rsischig, Zttchr. /. Ohrenheilk , 1913, lxix., August, S. 78.

The patient, a boy aged 7, suffered from nasal discharge coming
from the left ethmoid and antrum. The left middle turbinal
was removed and the anterior ethmoidal cells opened; the
antrum was punctured and washed out. The nose was lightly
plugged with iodoform gauze. Next morning the temperature
was 38 9, and the plug was removed. Two days later typical
symptoms of meningitis were developed; vomiting; slow, irregular
pulse, 54-60; temperature, 37‘8 ; distinct stiffness of the neck, and
Kemig’8 sign. Patellar reflexes were not increased, and Babinski
negative. 30 c.c. cloudy flocculent fluid were removed by lumbar
puncture, which gave on standing for an hour a green-yellow

ABSTRACTS

deposit of pus. No bacteria were seen in fibres, and no growth
got on culture. After the lumbar puncture improvement set in,
and in ten days the patient was recovered. He received treatment
also by urotropin. The author, discussing the cause of infection,
thinks it probably spread by the lymph paths, accompanying a
bundle of the olfactory nerve, which, according to Bonninghaus,
extends on the lateral wall of the nose as far as the middle
• turbinal. Raymond V£rbl.

A MBNINGO CEREBELLAR SYMPTOM-COMPLEX IN FEBRILE

(21) DISEASES OCCURRING IN TUBERCULOUS INDIVIDUALS.
(Der meningo-zerebellare Symptomencomplex bei fieberhaften
Erkrankungen tuberkulSser Individuen.) Fokrsteb, Neurol.
Centralbl 1913, Nov. 16, p. 1414.

In tuberculous children suffering from such affections as broncho¬
pneumonia, pneumonia, bronchitis, pleurisy, &c., the author has
noted the frequent development of definite and unmistakable
meningeal and cerebellar symptoms, as a rule with the disappear¬
ance of the febrile condition. Sometimes the nervous symptoms
have continued for weeks or months, sometimes they have been
of brief duration. They, too, always clear up. He is unable to
say whether the febrile process lights up a latent meningeal
tuberculosis, or whether there is a simple toxic meningeal irrita¬
tion, with internal hydrocephalus, or whether there is possibly an
encephalitic process. S. A. K. Wilson.

TYPHOID CEREBRO SPINAL MENINGITIS IN AN INFANT.

(22) (Mdningite ctfrtfbro-spinale k bacilles d’Eberth chez un nourisson.)
L. Lagane, Le Novriston , 1913, L, p. 360.

A male infant, aged 23 months, was admitted to hospital for a
febrile state of six days’ duration. There were no typical symp¬
toms of typhoid fever, but an incomplete meningeal syndrome was
present, consisting of slight rigidity in the lower limbs and marked
vaso-motor troubles. Lumbar puncture gave issue to a turbid
greenish fluid under hypertension. Antimeningococcic serum was
at once injected, but no improvement resulted, and death took
place four days after admission. No necropsy. Examination of
the cerebro-spinal fluid during life showed numerous typhoid
bacilli and polymorphonuclears. A blood culture showed typhoid
bacilli, but cultures of the cerebro-spinal fluid remained sterile.
The agglutinating power of the cerebro-spinal fluid was intense,
even in dilution of 1 in 300, while that of the blood, though
definite, was less marked (c/. Review, 1913, xi., p. 632).

J. D. Rollkston.

ABSTRACTS

ON THE SPINAL COED PHENOMENA OF TYPHOID FEYEB AND
(83) ESPECIALLY METATYPHOID MYELITIS. (Contribution k
l’dtude des accidents mddullaires survenant an cours de la fibvre
typhoids et en particulier de la mydlite metatyphoidique.) Q.
Gauthier, Thitet de Parte, 1913-14, No. 42.

Gauthier's main conclusions are as follows:—

1. Paralysis in typhoid fever due to well-marked myelitis is
infinitely rarer than paralysis due to neuritis. But cases of
incomplete myelitis are relatively frequent. The severity of the
attack of typhoid fever and the age of the patient have no
influence on the appearance of the spinal cord symptoms. They
seem, however, to be more frequent in convalescence.

2. Autopsies in well-marked cases of myelitis show diffuse
lesions, which are parenchymatous, vascular, and interstitial, the
grey substance being more affected than the white. The
parenchymatous lesions appear predominant.

3. typhoid fever does not give a specific character to the
special phenomena occurring in the disease.

4. The prognosis is very grave in well-marked myelitis, and
less grave in the abortive forms, but it is possible that these acute
toxi-infections play a part in the production of various chronic
processes of spinal sclerosis.

5. Before making a diagnosis of myelitis a minute examination
of the vertebral column is necessary to exclude the possibility of
typhoid spine.

The thesis contains the histories of eighteen cases, one of
which is original (</. Eevievj, 1909, vii., pp. 660-61, and 1913,
xi., pp. 489 and 493). J. D. Rolleston.

ON POST-DIPHTHERITIC ABDTJOENS PARALYSIS. (Tiber post
(24) diphtherische Abduzensiahmung.) C. Rotheb, Inaugural-Disser¬
tation, Breslau, 1912.

The thesis is based on the study of thirty-four cases observed in
the Hamburg-Eppendorf Hospital. The writer’s conclusions are as
follows:—

1. Abducens paralysis is relatively uncommon in diphtheria.
It occurred in 1 per cent, of Rother’s cases.

2. The average date for its appearance was the thirty-fifth day.

3. Males were chiefly affected, especially boys from five to
fifteen, in whom the affection was twice as frequent as among
girls of the same age in whom diphtheria was almost as frequent.

4. Abducens paralysis was not isolated, but was always associ¬
ated with other palsies.

ABSTRACTS

5. The left abducena was affected three times more frequently
than the right. A bilateral affection was the least frequent
event.

6. No family disposition to abducena paralysis was observed.

7. The prognosis was good. Complete recovery occurred in all
cases but one, who still had slight weakness of the right abducens
nine months after discharge from hospital.

J. D. Rolleston.

A FURTHER CONTRIBUTION TO THE SUBJECT OF TRAUMATIC
(25) TT JBMATOMYELIA. Bernhardt, Neurol. Centralbl ., 1913, Feb.

1, p. 147.

The chief point of interest in this case of hsematomyelia, develop¬
ing after a fall of 27 feet, is that the phenomenon of myotonia
appeared in the muscles of the right lower extremity—the lesion
was in the lumbar cord mainly—and the myotonic electrical
reaction was readily obtained. Myotonia has already been noted
in syringomyelia (Handelsman and others). It is worth re¬
membering that in the cases originally described by Kny and
Schultze as myokymia or myoclonus fibrillaris multiplex, the myo¬
tonic electrical reaction was found. In the present case, in the
somewhat atrophic affected muscles of the right leg, more or less
constant fascicular or fibrillar muscle twitching was present.

S. A. K. Wilson.

REMOVAL OF INTRATHECAL TUMOUR FROMLUMBAR REGION
(26) OF SPINAL CORD. J. Michbll Clarke and C. A. Morton,
Brit. Med. Joum ., 1913, May 3, p. 932.

A woman, aged 52, with no suspicion of syphilis, began to suffer
from “ rheumatic pains ” in the right thigh in 1909. In 1912 they
became worse, sharp and shooting in character, and the right leg
became weak and later numb. A month later it became quite
paralysed. Loss of power then developed in the left leg, and in
July she was paraplegic, had a feeling of tightness around the
lower abdomen, and occasional incontinence. She was examined
with difficulty on account of the great pain when moved or
touched. The right leg could not be moved, the left could be
drawn up slightly and bent at the knee. The paralysis was of
the flaccid type. The muscles below both knees were markedly
wasted, and the reaction of regeneration present. Sensation was
affected below the knees, and there was an indefinite zone of
hyperesthesia on the left lower lumbar region. Knee-jerks and

ABSTRACTS

ankle-jerks were present, with marked ankle clonus on right side,
not on left. X-ray and cerebro-spinal fluid normal. The diag¬
nosis was an extramedullary tumour at the level of the fourth and
fifth lumbar and first sacral root, chiefly on the right side. At the
operation a small fibroma was found about an inch in length
opposite the body of the twelfth dorsal vertebra. There was no
shock, and a good and uneventful recovery resulted.

A. Ninian Bruce.

THE SURGICAL TREATMENT OF CORD TUMOURS. Rotstaot,
(27) Aouv. Icon, de la SalpStrUre, 1913, Jan.-Feb., p. 36.

Three cases are described in some detail One point of diagnostic
value is emphasised by the author: the association of a pleocytosis
in the cerebro-spinal fluid, with marked increase in the albumin
content of the same, is very suggestive, if not pathognomonic, of
compression by a tumour. Nonne also has observed this associa¬
tion in six cases of spinal cord tumour. S. A. K. Wilson.

CHANGES IN THE SPINAL CORD IN TUMOURS OF THE
(28) POSTERIOR CRANIAL FOSSA (Les modifications dans la
moelle dpini&re an cours des tumours silgeant dans la fosse
postdrienre dn crane.) Raimistb and Nkiding, Aouv. Icon, de la
Salpitriere, 1913, May-June, p. 246.

In three cases of posterior fossa tumonr (in none were the knee-
jerks lost) the authors found, mainly in the dorsal cord, swollen and
cedematous fibres in the intramedullary part of the anterior and
posterior roots, specially the former. This change was most
marked when the roots entered the pia mater. No cellular changes
were found, and no systemic degenerations in the cord. Further,
in their three cases the writers also noted vascular engorgement,
mainly in the cord but also in the meninges. There was also a
dilatation of the perivascular lymphatics, especially in the lumbar
region.

The explanation they offer is that increase of pressure in the
cerebro-spinal fluid impedes lymph circulation in the dorsal cord,
and that the fluid itself penetrates between the intramedullary
root fibres; hence lymph stasis and dilatation of lymphatics. At
the same time the increased pressure leads to venous stasis, and
these, combined, produced the structural modifications already
noted, which may go on to actual degeneration.

S. A. K. Wilson,

ABSTRACTS

CONGENITAL FACIAL PARALYSIS. (Angeborene F&zuOis
(29) lahmnng.) Aloysio de C astro, Neurol. Centra Ibl., 1913, Dec. 1,
p. 1474.

Apart from obstetrical causes, congenital facial palsy is a rarity;
when it occurs it is usually of the infantile Kemschvmnd type.
The case here reported, however, is one of the even rarer cases
due to congenital agenesis of the petrous portion of the temporal
bone. The patient, in addition to having a typical peripheral
facial paralysis, was completely deaf on the same side : the pinna
was awanting, and a small pin’s-head canal was present at its
site, ending blindly. S. A. K. Wilson.

REPORT OF TWO OASES EXHIBITING LESIONS OF SPECIAL
(30) INTEREST FOR THE LOCALISATION OF APHA8I0 DIS¬
ORDERS. La Salle Archambault, Albany Med. Annals, 1913,
xxxvi., March, p. 126.

Case I. A man, aged 70, right-handed, had suffered for ten years
from postero-lateral sclerosis, for which he was under observation.
Lobar pneumonia in February 1910 was followed by a right
hemiplegia of unevenly distributed intensity. He gradually
rallied, but died 2nd June 1910. He was submitted to all the
tests usually employed for the detection of aphasic disorders, but
no deficit could at any time be demonstrated. At the autopsy,
the posterior third of the ascending frontal convolution was
completely destroyed, with slight involvement of the inferior third
of the ascending frontal convolution.

Case II. A woman, aged 54, right-handed, was suddenly seized
one day with motor aphasia and agraphia. This was complete
for one week, and gradually passed off. From this time on, for
three years, severe convulsions, followed by motor aphasia of one
to three days’ duration, occurred, with almost the periodicity of
true epilepsy at intervals of about six weeks. Then a severe
attack of right hemiplegia and complete motor aphasia occurred.
The paralytic symptoms cleared up slowly. There was no
dysarthria nor sensory aphasia. Her vocabulary never became
large, and if she used a wrong word, she was aware of the fact.
Spontaneous speech was not much in evidence. She still continued
to have severe convulsions at fairly regular intervals, with motor
aphasia for one or two days. At the autopsy three cerebral lesions
were found. The largest was of three months’ standing, and
completely destroyed the posterior two-thirds of the outer segment
of the lenticular nucleus, and the corresponding part of the external
capsule, the claustrum and sub-cortex of the island of ReiL The
second was small, and lay in the middle segment of the superior

ABSTRACTS

frontal convolution. The inferior frontal convolution was intact.
The third lesion was in the angular gyrus, at its junction with the
base of the second temporal convolution. A. Ninian Bruce.

CONTRIBUTION TO THE STUDY OF THE LOCALISATIONS

(31) IN APHASIA. (Contribution & l’6tude des localisations do
l’aphasia.) La Salle Abchambatjlt, JVouv. Icon, dc la SalpStrtere,
1913, Jan.-Feb., p. 20.

In the case of an old man of 70, with slight right facial weakness,
and a monoplegia of the right arm, and with no aphasia, it was
discovered subsequently that the posterior end of the third left
frontal gyrus was destroyed by a softening which slightly invaded
the corresponding part of the precentral gyrus. The patient was
right-handed. Although the descriptions from both the clinical
and the pathological side are somewhat meagre, the author is
perhaps justified in claiming this as a case in support of Pierre
Marie’s contentions.

In a second case, in a woman of 54, a lesion was found in¬
volving the posterior two-thirds of the outer segment of the
lenticular nucleus, and the corresponding part of the external
capsule, claustrum, and the island of Reil. There were also
lesions in the first frontal convolution, and the angular gyrus
of the same (left) hemisphere. The author says, in his considera¬
tion of the case, that the main lesion was sufficient “ k elle seule k
determiner une aphasie motrice k la fois tr&s marquee et per-
manente.” It does not appear, however, in his description of the
clinical symptoms, that the patient’s “ motor aphasia ” was either
typical or severe. She was evidently able to say a good deal in
response to questions, and after the ictus she “ continua k enrichir
quelque peu son vocabulaire pendant environ huit semaines.” She
was able to repeat words which she could not say spontaneously.
The author “ is convinced that the projection fibres from the
inferior frontal gyrus were not caught in the lenticular lesion.”

In this paper Figs. 1 and 2 are presumably interchanged.

S. A. K. Wilson.

A LEFT PREFRONTAL GLIOMA WITH APHASIA (Glioma pre

(32) frontale sinistio con afasia.) G. Pellacani, Riv. dc Patol. nerv.
t merit., 1913, xviii., p. 512.

The patient died soon after admission to an asylum, to which he
had been sent on account of mental depression culminating in an
attempt at suicide. He was found to have paresis of the right
arm, but no aphasia. Two days after admission he had a right¬
sided fit, followed by aphasia, lasting for three hours. A right

ABSTRACTS

hemiplegia with motor aphasia developed in the coarse of the
next few days, and the patient rapidly sank into a semi-comatose
state, and died. A glioma was found extending from the foot of
the superior frontal convolution to the beginning of its upper
third, and involving a portion of the middle frontal Whilst
superficially the area of Broca appeared to be intact, microscopical
examination of Weigert Pal preparations revealed the presence
of marked degeneration. F. L. Golla.

HAEMORRHAGE INTO THE LEFT SUPRAMARGINAL AND

(33) ANGULAR GYRL (Enorragia nel giro sopramarginali e nel giro
angolare dis sinistra.) E. Ciabla, Riv. di Patol. nerv.« ment.,
1913, xviiL, p. 473.

The patient presented periods of lucidity, alternating with periods
of confusion, partial auditory aphasia associated with dysarthria.
There was slight left facial and brachial paresis. Clonic contrac¬
tions of the neck muscles and the limbs occurred, chiefly localised
to the left, but sometimes generalised. During a generalised
attack there was conjugate deviation of the head and eyes to the
right There were occasional tremors of the left quadriceps and
choreiform movements of both upper extremities. No disturbances
of objective sensation, and no apraxia. The cerebro-spinal fluid
was yellowish. The homolateral motor discharges could not be
explained by non-decussation of the pyramidal tracts, as these
were found to decussate normally. It was noted that softening
from the cortical lesion had extended inwards sufficiently to
involve some of the cortico-callosal fibres. To irritation of these
fibres causing discharges from the right cortex the author ascribes
the homolaterality of many of the fits. Another point insisted on
is the absence of apraxia, although the left supramarginal gyrus
was in great part destroyed. F. L. Golla.

CLINICAL OBSERVATIONS ON TUMOURS OF THE PIA MATER.

(34) (Osservazioni clinichs ed anatomo patolgiche sopra i tumori della
pia cerebrals.) Ciurrmi, Riv. di PatoL nerv. e ment., 1913, xviii.
p. 709.

The author adds a fifth case to the four previously described of
this rare condition.

The cerebro-spinal fluid contained large round cells with
granular protoplasm which allowed him to make the diagnosis
of a tumour affecting the meninges. Post mortem, an endothelioma
of the pia was found, which occupied the greater portion of the
cerebral convexity, and compressed, without infiltrating, the
subjacent cerebral cortex. F. L. Golla.

ABSTRACTS

A CASE OF “ IDIOPATHIC HYDROCEPHALUS" IN THE FORM

(35) OF WEBER’S SYNDROME: RAPID CURE BY LUMBAR
PUNCTURE. (Uber einem Fall von “Hydrocephalus idio-
pathicus” outer der Maske des Weber’schen Symptomen-
komplexes. Sofortige Heilung durch Lumbalpunktion.) Conto,
Neurol. Centralbl 1913, Jan. 1, p. 20.

The patient was a man of 24, who for a month had suffered from
headache, giddiness, vomiting, and in whom a left hemiplegia and
a right oculomotor palsy had gradually developed. (The condition
of the optic discs is unfortunately not specified.) Within twenty-
four hours of a lumbar puncture, in which no fewer than 35 c.c.
were withdrawn, the patient’s condition showed a phenomenal
change for the better. A second lumbar puncture was made, 20
c.c. being withdrawn, and in a short time the patient left hospital,
every symptom having disappeared.

Unilateral symptoms in serous meningitis are rare, nevertheless
they occur: they are still rarer in idiopathic hydrocephalus. The
author imagines in his case that hypersecretion of the right
choroid plexus produced pressure symptoms, the hydrocephalus
increasing the tension especially where the plexus surrounds the
cerebral peduncle. S. A. K. Wilson.

A CASE OF TUMOUR OF THE PITUITARY BODY. A. L. Taylor,

(36) Lancet, Nov. 22,1913.

The case was that of a married woman, aged 48, with a history of
five years’ illness. The outstanding symptoms were mental apathy
passing into profound dementia, amaurosis, epileptic fits, and
vomiting: there were no dystrophic symptoms.

Death took place from cerebral compression after a sequence
of fifteen fits. The autopsy showed a spindle-celled sarcoma,
4'5 cm. x 6 cm., occupying the middle third of the anterial cranial
fossa, and arising from the sella turcica. No actual invasion of the
adjacent parts was present, but a deep hollow between the frontal
lobes was the result of the growth. Attention is drawn to the
pressure on the frontal lobes producing dementia; two other
similar cases are mentioned. Author’s Abstract.

HYPOPHYSEAL INFANTILISM. Souqurs and Chauvet, Nouv.
(37) Icon, de la Salpetribre, 1913, March-April, p. 69.

When the patient, whose case is described at length, came under
observation, he was 27 years old. Since the age of 8 he had
entirely ceased to grow, and at that age he had begun to show the
early symptoms of intracranial tumour. From the age of 8 to 18

ABSTRACTS

he remained in a stationary condition. Then slight improvement
set in, of a temporary kind. When seen and examined by the
authors his whole appearance was typically infantile, without any
adiposity at all. His height was 1 m. 27, his weight was 29£
kg. His body was well proportioned, with no hair in axillae or on
the pubis; the external genitalia were infantile. His voice had not
“broken.” The pupils were inactive to light, there was double
optic atrophy, and vision was nil. The urine was normal; so was
the cerebro-spinal fluid. An X-ray showed considerable enlarge¬
ment of the sella turcica.

In an interesting discussion, with references to analogous cases
in the literature, the author leans to the opinion that the
symptoms are due in this case to a hypo-function of the anterior
lobe of the pituitary body. S. A. K. Wilson.

THREE CASES OF DYSPITUITARISM. A. W. Falconeb, Edin.
(38) Med. Joum., 1913, xi., Dec., p. 487

Case I. —Female, aged 16£, with dwarfism, sexual infantilism,
emaciation, marked diminution of carbohydrate tolerance,
abnormally small sella turcica, left homonymous hemianopia,
with double optic atrophy, and history of polyuria: subject of
congenital syphilis, and Wassermann reaction strongly positive.

Case II. —Male, aged 21, with definite acromegalic features,
sexual infantilism, and characteristic type of adiposity.

Case III. —Male, aged 18, with feminine type of adiposity,
maxillary prognathism, high carbohydrate tolerance, slightly
enlarged sella turcica, and fits of “ dreamy ” type (associated with
irritation of uncinate lobe). Fits disappeared on glandular
feeding. A. Ninian Brucb.

DOES ACHONDROPLASIA CORRESPOND TO A PARTIAL HYPO
(39) PITUITARISM? (L’achondroplasie rdpond-elle k one uuraflisance
hypophysaire partielle 7) Baumel and Mabgarot, Nouv. Icon, de
la SalpHriere, 1913, May-June, p. 202.

Apropos of a case of achondroplasia the authors suggest as syndromes
of pituitary insufficiency the following:—

1. Defect of anterior lobe :—

Total —ateleiosis (Hastings Gilford).

Partial —achondroplasia: periosteal dystrophy.

2. Defect of posterior lobe:—

Total— -dystrophia adiposo-genitalis (Frohlich).

Partial —adiposity without genital hypoplasia: genital
hypoplasia without adiposity.

ABSTRACTS

It may be remarked that it is very far indeed from demonstrated
that ateleiosis is due to defect of anterior lobe function, and the
association of partial anterior hypopituitarism with achondroplasia
is purely hypothetical. Nor is it certain that genital hypoplasia
without adiposity is linked to partial defect of posterior lobe
function. S. A. K. Wilson.

ACHONDROPLASIA AND CH0NDR0HYP0PLA8IA. Ravenna,
(40) Nouv. Icon, de la Salpitriere , 1913, May-June, p. 157.

The author is concerned with those by no means rare atypical
cases of achondroplasia, in which the condition is limited in its
somatic distribution. He refers, among others, to the cases of
humeral micromely of Regnault, and Stannus and Wilson. His
own two cases are interesting, inasmuch as they present only
slight signs of what is commonly called achondroplasia, and illus¬
trate the extreme difficulty of determining where that condition
begins and ends. S. A. K. Wilson.

A FRESH CONTRIBUTION TO THE STUDY OF ACHONDRO-
(41) PLASIA. Parhon and Schunda, Nouv. Icon, de la Salpctriere,
1913, May-June, p. 185.

Four cases are described, one of which came to autopsy. The
main findings were sclerosis of the thyroid and also of the
pituitary. The patient, however, was 57 years old.

S. A. K. Wilson.

THE NERVOUS VARIETIES OF A NEW FORM OF TRYPANO-
(42) S0MIA8IS—CHAGAS’ DISEASE. (Lee formes nerveuses d’une
nouvelle trypanosomiase—Maladie de Chagas.) Carlos Chagas,
Nouv. Icon, de la Salpctriere , 1913, Jan.-Feb., p. 1.

The author describes the symptoms of a new form of trypano¬
somiasis produced by the Trypanosoma Cruzi, which reaches the
human body through the bite of the intermediate host, Triatoma
magista, one of the hemiptera. The disease occurs with remark¬
able frequency in Brazil: more than 200 cases have come under
the author’s notice. From the neurological standpoint the clinical
picture of the acute cases is that of a rapidly fatal diffuse meningo¬
encephalitis ; the chronic cases are of the diplegic type, sometimes
with cerebellar symptoms. The trypanosome has been found in
all the regions of the brain, both in grey and in white matter,

ABSTRACTS

and the foci in which it occurs are found to bear no relation to
the vascular system. Not a few of the cases which survive, and
become chronic, show the symptoms of pseudobulbar palsy, and
often their mental condition becomes reduced to one of idiocy.

S. A. K. Wilson.

TWO FAMILIES WITH SEVERAL MEMBERS IN EACH 8UFFER-
(43) ING FROM OPTIC ATROPHY. Jambs Taylor and Gordon
M. Holmes, Trans. Oph. Soc. of the U.K. , Vol. xxxiii., 1913, p. 95.

The first family consisted originally of nine, six males and three
females. Three of four surviving males had optic atrophy; the two
surviving sisters had good vision. The visual condition was very
similar in all three; in two practically no other symptoms were
present; in the third, in which there was also a history of lues,
absent in the other two, definite symptoms of tabes were present.

In the second family of ten children the affection was similar
but more widespread. Of six males, three showed the condition
under discussion, and one had been operated on for cataract. The
four females are healthy, the eldest married and had seventeen
children, of whom six died, one of orbital tumour. The mother
had three sisters and two brothers, one of whom was nearly blind.
Of the sisters, one had healthy descendants, another had three male
children, all with bad vision, and four females.

In all the cases the same type of visual affection occurred,
namely, central scotoma with more or less peripheral restriction
of the field of vision, in this particular differing from Leber’s
atrophy, which it resembled in its mode of onset. The disease
was transmitted by the females, and appeared only in the males,
affecting the younger members of a family, in which there was
more than one case, at an earlier age than the elder.

The paper is illustrated by charts and a pedigree.

H. M. Traquair.

NERVOUS SYMPTOMS ASSOCIATED WITH OPTIC ATROPHY OF
(43) THE FAMILIAL TYPE Jambs Taylor and Gordon Holmes,
Trans. Oph. Soc. of the U.K., VoL xxxiii., 1913, p. 116.

Seven cases are described which presented visual conditions re¬
sembling those found in Leber’s disease in association with nervous
symptoms, the most common of which were absence or diminution
of the deep reflexes, especially the ankle and knee jerk. Numb¬
ness and tingling in the limbs, together with some anaesthesia and
analgesia, were also present.

ABSTRACTS

In regard to the relation of these cases to Leber’s disease, two
possibilities are considered. They may belong to Leber’s type,
differing only in the coexistence of some organic nervous trouble,
or they may represent another type of familial degeneration
only related to Leber’s atrophy by the similarity of the visual
affection. While inclining towards the first of these alternatives, the
authors point out that the question can only be decided by the
investigation of a large number of undoubted cases of familial
optic atrophy.

Charts and a pedigree illustrate the paper, and a bibliography
is appended. H. M. Traquaib,

VASCULAR AND OTHER RETINAL CHANGES ASSOCIATED

(45) WITH GENERAL DISEASE. Jamjes Taylob, Trans. Oph. Soc.
0 / the U.K., VoL xxxiil, 1913, p. 1.

This paper deals mainly with so-called embolism of the central
artery of the retina, and with those cases which are characterised
by thrombosis of the retinal veins with effusion and haemorrhages.
In regard to the first group the author points out that cardiac
changes are not always present, and that some of the cases are
undoubtedly due to thrombosis. In eight cases of the second
group, seven had either cardiac hypertrophy or albuminuria, one
had neither.

Thrombosis of the retinal veins, therefore, while not of such
serious import as albuminuric retinitis, nearly always indicates
grave visceral disease. H. M. Traquaib,

EFFECT OF THE ADMINISTRATION OF ALCOHOL ON WAS8ER-

(46) MANN’S REACTION. (Effetto della somministnudone di alcool
sulla reazione di Wassermann.) A. Rkzza, Eiv. ital. di Neuro-
patol., Psychiat. ed Elettroter., 1913, vi, p. 464.

As the result of his study of nine cases, Rezza concludes that
the administration of alcohol in doses, recommended by previous
observers as sufficient to modify Wassermann’s reaction, does not
in any way affect the reaction in syphilis whether complicated or
not by nervous symptoms. J. D. Rollsston.

SPASMOPHILIA AND EPILEPSY. Gbaztz, Neurol. Centralbl., 1913,

(47) Nov. 1, p. 1366.

The relations between epilepsy and infantile convulsions are not
clear; some authors deny, though the majority assert, a definite
association between the two: any differences are in degree, not

ABSTRACTS

in kind. Included in infantile convulsions are so-called eclampsia
infantum, tetany with convulsions, &c. Some light is thrown
on this important question by a consideration of the signs of
spasmophilia: it is a constitutional defect characterised by (1)
increased excitability to anodal stimulation ; (2) the occurrence of
Chvostek’s sign: (3) direct muscular irritability—with “ tumour
formation on percussion: (4) hypertonus of the arteries from
overaction of the vaso-constrictors: (5) alteration in the blood
state—presence of Pappenheim’s leucoblasts (nucleus tending to
polymorphism, with basophil cytoplasm), and increase in large
mononuclears.

The author has examined a series of cases of genuine idio¬
pathic epilepsy from these standpoints, and finds that almost all
show these definite signs of spasmophilia, although the clinical
symptoms were not present. It' is remarkable to note the in¬
creased electrical excitability in some of the author’s cases, AOC
being obtained with 2 ma. and KOC with 3 ma. It is worth
remembering, also, that in more than 80 per cent, of 138
epileptics examined by and Long, muscle tumour formation
was obtained by direct percussion. In some cases of tetany from
removal of the parathyroids with the thyroid, Esser found a blood
condition analogous to that mentioned above, which the author
also obtained in five out of seven cases of epilepsy.

S. A. K. Wilson.

THE BRADSHAW LECTURE ON HYSTERIA IN SOME OF ITS
(48) ASPECTS. T. R. Glynn, Brit. Med. Jowrn ., 1913, Nov. 8, p. 1193.

A general review of this condition, with an account of a large
number of interesting cases. A. Ninian Bruce.

A CASE OF HYSTERICAL MONOPLEGIA FOLLOWING ELECTRIC
(49) SHOCK. Puevxs Stewart, Brit. Med. Joum., 1913, Dec. 20,

p. 1680.

A case of typical hysterical paralysis in a tall muscular young
man, in which the exciting psychical trauma was an electric shock.
The left upper limb dangled helpless and flail-like by his side.
There was total cutaneous amesthesia and analgesia of the limb up
to the level of the shoulder-joint, bounded by a sharp “ amputation¬
line.” This anaesthesia was observed by the patient himself, and
was not suggested to him by any of the various physicians whom
he had consulted. There was no evidence of a sexual clement,
although psycho-analysis had not yet been tried. Suggestion, after
one month, had produced no result. A. Ninlan Bruce.

ABSTRACTS

ON A CASE OF POLYNEURITIS OF PREGNANCY WITH

(50) SYMPTOMS OF GRAVES’ DISEASE. (Sopra un caso di
polineurite gravidic* unit* a morbo di Plaiani-Basedow.)
Pebbebo v. Fenoglietto, Riv. di Patol. nerv. e meat ., 1913,
xviii., p. 649.

The history is that of a case of pregnancy in which symptoms of
exophthalmic goitre developed towards the beginning of the fourth
month, followed by severe pains in the limbs. A premature birth
in the eighth month of pregnancy was succeeded by an aggravation
of the thyroid symptoms, and when examined four months later
the patient was found to be suffering from multiple neuritis. For
three months there was some fever, and then the condition
slowly improved. The case is discussed at some length, and from
the fact that the patient improved during the administration of
Moebius’ serum, the author concludes that the whole syndrome is
referable to hyperthyroidism. F. L. Golla.

GRAVES’ DISEASE IN THE MALE SEX. (Die Basedowsche Krank

(51) belt beim Manns.) Mendel and Tobias, Neurol. Centralbl., 1913,
Dec. 1, p. 1477.

Ah interesting revue d'ensemble.

From a large number of cases in the literature the authors
obtained the following figures: 9 3 cases in women to 1 in man,
in proportion: the majority of male patients were between the
ages of 20 and 40. The symptomatology does not vary much
in the two sexes, except that as a rule the more purely nervous
symptoms are more marked in the male. The prognosis is worse,
as a rule, with men, according to the consensus of recorded
opinion, but the authors have not found it so in their own cases,
which number 282, observed during the last ten years.

S. A. K. Wilson.

GRAVES’ DISEASE AND SOLERODERMIA. Mabinesco and
(52) Goldstein, Nouv. Icon, de la Salpetriere, 1913, July-Aug., p. 272.

In this case the typical syndrome of Graves’ disease was accom¬
panied by the presence of some twelve or fourteen plaques of
sclerodermia, more or less symmetrically placed on the lower
extremities below the knee. The authors go fully into the question
of the association of sclerodermia with diseased conditions of the
ductless glands, and admit its most frequent occurrence where
the thyroid is involved. They do not believe, however, that this
association is found in every case, and incline to the view that the
essential lesion is to be found in the centres for the innervation of
the ductless glands in the sympathetic system. S. A. K. Wilson.

ABSTRACTS

A CASE OF SOLEBODERMIA AND ITS RELATIONS TO THE
(53) SYNDROME OF PROFIOHET. (Etude radiologique d'un cm
de Scllrodermie. Analogies de la Sclfoodermie avec le syndrome
de Proflchet.) Bjertolotti, Now. Icon, de la Salpttri&re, 1913,
July-August, p. 291.

This is an interesting paper, raising many questions of importance.
The patient was a woman of 36, presenting unmistakable signs
of hypothyroidism, with sclerodermia more or less generalised, but
reaching a maximum in the extremities: there were also acro¬
cyanosis and local asphyxia of the fingers, and localised muscular
atrophy. There were signs of muscular induration, with contrac¬
tures, from interstitial myositis, but the atrophied muscles of the
neck and shoulders were not hard, and resembled those of a
myopathy. Further, in the neighbourhood of the sclerodermatous
areas were small, hard, calcareous nodules (syndrome of Profichet:
“ pierree de la peau ”): there was also a generalised bronzing of
the skin.

The author discusses the various points of interest in the case:
he thinks the nodules are secondary to the sclerodermia, which
in its turn is associated with the thyroidal atrophy.

S. A K. Wilson.

A CASE OF GRAVES’ DISEASE SUCCESSFULLY TREATED WITH
(54) THE MILK OF A THYROIDECTOMISED WOMAN. (Ein
erfolgreich mit Milch einerthyroidektomierten Frau behandelten
Fall von Morbus Basedowii.) Pychlau, Deut. Med. WocK., 1913,
xxxix., p. 2299.

A woman, aged 37, who had been suffering from Graves’ disease
for some years and had been unsuccessfully treated with rodagen,
antithyroidin and other preparations, showed rapid improvement
after being given the milk of her sister who had been thyroidecto-
mised for Graves' disease two years previously. 200 c.c. of the
milk was given daily, and the treatment was continued for four
months. Within a month the thyroid became smaller, and within
two months the exophthalmus disappeared, there were further
diminution of the goitre and marked improvement of the cardiac
action. This treatment had to be discontinued, as the sister
became pregnant and the milk dried up. J. D. Rollkston.

THE RELATION OF THE THYROID TO ANTITOXIN. Rufkkt
(55) F arrant, Lancet, 1913, clxxxv., Dec. 27, p. 1820.

“ Certain diseases, and especially certain toxaemias, cause hyper¬
plasia of the thyroid gland in man and animals. Among these

ABSTRACTS

diphtheria toxin has been examined especially, and it is found
that a small dose is sufficient to elicit hyperplasia in a susceptible
animal, but that as immunity is acquired the thyroid no longer
undergoes hyperplasia under the toxin. The hyperplasia thus
decreases as the antitoxic value of the serum increases. The
thyroid gland, in other words, is protected from the action of the
toxin by the presence of antitoxin in the serum. There is no
reason to suppose that any special relation exists between antitoxin
formation and the thyroid gland—for example, the latter is not
antitoxic itself.

“ In some cases commercial antidiphtheritic serum fed to rabbits
caused death, with the same symptoms as thyroid feeding; this
may be due to the serum of partially immunised horses containing
an unusual amount of thyroid secretion from the hyperplasia.
But this could not be controlled, as the amount of iodine in pure
serum was too small for accurate estimation. The pure antitoxic
serum does not appear to contain any estimable increase of iodine/'

A. Ninian Bruce.

A CASE OF EPILEPSIA ALTEBNANS. Db Vries, Neurol. Centralbl.,
(56) 1913, March 16, p. 341.

A bot of 5 suddenly developed an encephalitis at the age of 2£,
and from that time onwards he suffered from slight hemiparesis
of the left face, arm, and leg, with horizontal mystagmus in the
right eye only, and from attacks of tonic contraction of the left
face, arm, and leg, with forced tonic conjugate deviation of the
head and eyes to the right. The attacks lasted about three
minutes, and recurred some twenty or thirty times in the
twenty-four hours. Consciousness was never lost in them, and
there was no clonic twitching anywhere, except slightly of the
left face. There was an extensor response on the left side, with
exaggerated tendon reflexes, and very slight ataxia of the left
arm.

The author expressly notes that during the attacks the patient
was perfectly able to innervate and move the tonically contracted
left limbs, though slowly. For this reason he concludes that the
lesion did not involve the pyramidal tracts. The tonic cramps
were not of pyramidal origin. From a consideration of a few rare
cases of similar sort recorded in the literature, the author places
the lesion in the upper part of the right side of the pons, above
the level of the fifth cranial nerve, so situated as to involve the
cortico-pontine path for deviation of the head and eyes after it
has crossed to the right. On transverse section, he places the
lesion in the tegmentum, i.e., posteriorly.

He discusses briefly the fact of the tonic nature of the con-

ABSTRACTS

vulsions, and holds that stimulation of “ subcortical centres ”
produces tonic contraction, while typical clonic contractions are
of cortical origin. S. A. K. Wilson.

PSYCHIATRY.

THE TREATMENT OF GENERAL PARALYSIS WITH SODIUM
(57) NUOLEINATE AND SALVAR8AN. (Uber Behandlungs-
▼ersnche mit Natrium mtclemicnm und Salvaraan bei progressiver
Paralyse, Ac.) Jolowioz, Neurol. Centralbl., 1913, Feb. 15, p. 210.

Twenty-five cases of general paralysis were treated with intra¬
muscular injections of sodium nucleinate, at intervals of from
eight to fourteen days, followed by intravenous administration of
salvarsan. In none of the cases was any definite or permanent
amelioration obtained. The cerebro-spinal fluid, examined in
sixteen cases, showed no special alterations after treatment.

S. A. K. Wilson.

THE ALTERATIONS OF THE CELLS OF THE BULB FOUND IN
(68) A CASE OF DEMENTIA PR-ffiCOX. (Alterazioni delle cellule
gangliari del bulbo in un caso di demenza precoce con morte im-
provista.) A. Rezza, Riv. de Patol. new. e ment., 1913, xviii.,
p. 426.

Portions of the bulb were examined in a case of dementia prsecox,
death having been due to accidental causes. The autopsy was
performed twelve hours after death. The author found constantly
in the cells examined extensive vacuolation which was not only
obvious in the cell body, but could be demonstrated in its proto¬
plasmic processes. . F. L. Golla.

THE PSYCHOSIS OCCURRING IN TYPHOID FEVER. (Delli

(69) psicose nel duoroo del tifo.) Moissey Kobyunsky Riv. di Patol.
new. e ment ., 1913, xviii., p. 633.

The writer distinguishes three types of psychosis occurring in
typhoid fever.

1. States of acute confusion (amentia and delirium) that
resemble acute mania, and are prefebrile.

2. States of hallucinatory confusion with prevalent occupation
delirium.

3. States of maniacal depressive insanity which often simulate
the commencement of a katatonic form of dementia prsecox.

F. L. Golla.

REVIEW

THE MEIOSTAGMINE REACTION IN SOME CASES OF MENTAL
(60) DISEASE (La re&zione meiostagminica sul Bangui di alcuni
malati di mente.) F. Benioni, Riv. di Patol. nerv. e merit., 1913,
xviil, p. 92.

The surface tension of the blood of a number of cases of goitre,
cretinism, and idiocy was observed when the serum was tested
with antigens derived from neoplasm and thyroid glands. The
results are inconclusive. F. L. Golla.

TREATMENT.

THE HIGH FREQUENCY CURRENT IN THE TREATMENT
(61) OF HIGH BLOOD PRESSURE. H. van Rensselaer, Albany
Med. Annals, 1913, xxxvi., Feb., p. 77.

The underlying causes of most cases of high blood pressure is
metabolic, from faulty digestion of food. The hypertension usually
precedes renal, cardiac, and arterio-sclerotic changes. By proper
treatment with high frequency currents the general condition,
and especially the metabolic processes, are improved. If the
hypertension be recognised early the initial stages may be cured.
The actual development of Bright’s disease may be prevented,
and if renal or cardiac lesions are already present, their rapid
advance may be checked, and life thus prolonged. At a later
stage the resistance to the enfeebled heart may be lessened, and
the risk of apoplexy diminished. A. Ninian Bruce.

■Review.

INDUSTRIES FOR THE FEEBLE-MINDED AND IMBECILE. A.

(62) Bickmork, pp. vi.+66. 1913. Adlard & Son, London. Price2s.net

Mr Bickmore, who, for the past ten years, has been Craftsmaster
and Clerk of the Works at Darenth Industrial Colony, an institution
for feeble-mined and imbecile patients of all ages, gives here a
brief but most practical account of some of the principal industries
which may be taught to the feeble-minded. He first gives a short
history of Darenth Industrial Colony, and then devotes a few pages
to each of the following trades:—Carpentering, book-binding, brush¬
making, basket-making, shoemaking, fibre mat-making, wool rug-

BOOKS AND PAMPHLETS RECEIVED

making, tinsmith, tailoring, upholstering, printing, needlework,
house-painting, building, and wood-chopping. There are numerous
illustrations. The book is one which cannot but prove of value to
all those interested in the important question of the training of
the feeble-minded. A. Nenlln Bruck.

BOOKS AND PAMPHLETS BBOBIVBD.

Bickmore, A “ Industries for the Feeble-minded and Imbecile.” Pp.
vi.+66, illustrated, 1913. Adlard & Son, London. Pr. 2s. net.

Clark, L. Pierce. “A Clinical Contribution to the Irregular and
Unusual Forms of Status Epilepticus” (Amer. Joum. Insanity, 1913, lxx.,
Oct, p. 336).

Clark, L. Pierce. “Newer Aspects of the Treatment of Epilepsy”
(Med. Record, 1913, Aug. 2).

Dana, Charles A. “Mental Tests” (Med. Record, 1913, Jan. 4).

Dana, Charles A, and Berkeley, Wm. N. " The Functions of the Pineal
Gland” (Med. Record, 1918, May 10).

Eulenburg, A “Kinder- und Jugendselbstmorde” ( Sammlung Hocke,
1914, x., H. 6. Pr. M. 1).

Liepmann, H. “ Die ‘ freie Selbstbestimmung ’ bei der Wahl des Aufent,
haltsortes nach dem Reichgesetz fiber den Unterstfitznngswohnsitz ”
(Sammlung Hocke, 1913, x., H. 5. Pr. M. 1.20).

Rybakow, Theodore. “ La cyclophrdnie,” Moscow, 1914.

Scholz, L. “Die Gesche Gottfried. Eine kriminalpaychologische
Studie.” S. Karger, Berlin.

“ The Psychoanalytic Review.” Vol. 1, No. 1, November 1913. Issued
quarterly. $6.00 per volume.

“ Internationale Zteckr. f. Antlicke Psychoanalyse .” 1913, I., H. 6,
Nov. Jahrlich 6 Hefte. M. 18, =K. 21.00.

“State Hospital Commission.” Twenty-fourth Annual Report Oct 1,
1911, to Sept 30,1912. State of New York.

“ The Training School.” 1913, x., December.

■Review

IReurolog^ anb lP>8pcblatn>

©rigtnal Hrticles

THE ARCUATE NUCLEUS IN MAN, THE
ANTHROPOID APES, AND THE MICRO-
CEPHALIC IDIOT.

By A. NINIAN BRUCE, M.D., Edinbubou.

(With Plates 1 and 2.)

The arcuate nucleus is a small flattened mass of grey matter
situated on the ventral surface of the medulla oblongata im¬
mediately above the decussation of the pyramids. In the higher
levels of the medulla oblongata, where the open part of the
medulla is reached, this grey mass shifts its position, and comes
to lie upon the mesial aspect of the pyramid, and thus constitutes
the immediate boundary of the antero-median fissure. At the
upper end of the medulla the arcuate nuclei usually increase in
size, fuse together across the middle line, and become continuous
with the grey matter of the ventral part of the pons. Large
numbers of the anterior superficial arcuate fibres sweep out from
the antero-median fissure, and end in this nucleus, whilst others
take origin within it. Many of the anterior arcuate fibres, how¬
ever, pass continuously over its surface, and bind it down to the
pyramid (Cunningham, “ Text-Book of Anatomy,” 1902, p. 460).

The exact position of the arcuate nuclei in man is well shown
in Fig. 1, which is taken from a section through the upper part
of the medulla oblongata of a human adult. Examination of
similar sections from other adult brains shows that the actual

A. NINIAN BRUCE

amount of grey matter which composes this nucleus is subject
to considerable variation. In some brains it forms a continuous
narrow strip extending along the surface of the medulla oblongata
from the lower level of the inferior olive, to fuse with the pontine
nuclei above. In other brains the greater mass of the grey
matter is found about the middle of the inferior olive, and rapidly
tapers off above and below. In other cases it is not continuous
with the pontine nuclei. It also shows considerable variation in
shape, in some cases being roughly triangular in outline, in others
spreading over the greater part of the ventral part of the corre¬
sponding pyramids. In many cases it is broken up into a number
of smaller, more or less isolated, patches scattered irregularly over
the ventral and ventro-lateral surface of the medulla oblongata.

The development of the arcuate nuclei has been recently
described by Essick (Amer. Joum. Anal., 1912, xii., p. 25). They
arise from the “ rhombic lip ” of His in common with the inferior
olivary and pontine nuclei—“ the nuclei pontis being formed by
a migration through a restricted pathway, the corpus ponto-
bulbare; the nuclei arcuati along with part of the olive by a
superficial migration over the ventral surface of the medulla”
( loc . cit., p. 54). In the human embryo, about the beginning of the
second month, an intramedullary migration of cells takes place
from the rhombic lip to make up the inferior olive. Towards
the end of the month this path of migration becomes more and
more superficial, until many of the cells cross the raphe before
passing into the medulla. In the lower mammals, where the
arcuate nuclei are absent, the comparatively simple olivary com¬
plex soon acquires its allotment of cells, and when production
of olivary neuroblasts ceases, those on the surface soon find their
way into the anterior. In man, however, beforo the olive has
received all of its cells, and while the migration from the rhombic
lip is still proceeding actively, neuroblasts which cannot be dis¬
tinguished from those destined for the inferior olive begin to
appear upon the surface. These elements stop on the ventral
surface near the raphe, and constitute the anlage of the arcuate
nucleus. At first the pyramidal tract is found to be covered
from the cervical flexure to the pontine nuclei by this super¬
ficial layer of cells, but this uninterrupted sheet of nuclear
matter becomes later broken up by the formation of the external
arcuate fibres, and the growth of the pyramidal tract. The crossing

Plate 1.

Fn;. 1.

Transverse .section of Medulla
Oblongata of Human Adult.
To show |K)sition of the arcu¬
ate nuclei.

Plate 2.

Fkl 4.

Transverse section of Medulla
Oblongata of Orang. To
show absence of l>oth arcuate
nuclei.

Fid. f>.

Transverse section of Medulla
Oblongata of (JhinifKiiizee. To
show absence of both arcuate
nuclei.

Fid. (i.

Transverse section of Medulla
Oblongata of Microeephalie
I<liot (Robert Lindsay). To
show absence of both areuate
nuclei.

THE ARCUATE NUCLEUS IN MAN, ETC.

of the arcuate axones in the raphe begins to push the main mass
of the nuclei to each side of the middle line, but the further
separation into two separate masses is brought about by the
constant interstitial addition of pyramidal axones. This results
in a further separation of the inferior olivary nuclei as well as of
the arcuate nuclei. The arcuate nuclei, being situated on the
surface, are drawn away from each other, often, however, leaving
a small amount of grey matter in the form of a connecting bridge.

The point to which I wish to draw attention in this paper is
that the arcuate nuclei are absent in the anthropoid apes. This
fact was well known to the late Professor Cunningham, who
always referred to it in his lectures upon the structure of the
nervous system. The sections from which the accompanying four
figures were taken are from the brains of the gorilla (Fig. 2), gibbon
(Fig. 3), orang (Fig. 4), and chimpanzee (Fig. 5). The original
sj>ecimens were made by the late Professor Cunningham, and
formed part of his collection in the Anatomical Department of
the University of Edinburgh. It will be easily seen from them
that the arcuate nuclei are absent. In the case of the chimpanzee,
the whole medulla oblongata had been cut serially; in the orang
the series was also very complete. In the gibbon and gorilla the
series was not so complete, but there were sufficient sections to
make quite certain that the arcuate nuclei were absent.

It is also interesting to note that the arcuate nucleus is also
absent in the true microcepbalic idiot (Fig. 6). The case from
which this section was taken was that of Robert Lindsay, and will
be described later in full. His was a very typical case of the
condition, and the whole of the central nervous system was
examined. The medulla oblongata was cut serially from end to
end, and a careful examination revealed a complete absence of both
arcuate nuclei.

I am indebted to the Trustees of the Carnegie Trust who
awarded a grant to provide the illustrations.

GEOFFREY JEFFERSON

THE PARIETAL AREA.

By GEOFFREY JEFFERSON, M.S. (Lond.), F.R.C.S.

In two recent papers, 1 - 2 the writer has advanced some new
views on the anatomy and development of the parietal and post-
central areas of man. These views are based on the modern
conception of the origin and cause of the cerebral sulci put forward
by Elliot Smith. A brief account of this work of the last named
will be found in the new Cunningham’s “ Text-Book of Anatomy,”
and especially in the paper by him referred to below.

Difference of structure of the various parts of the cortex is the
principal factor in the causation of sulci. And with this difference
of structure we may assume a difference of function. From this
we may argue that as we trace the mammalian scale upwards we
shall find that with evolution new sulci will appear to limit or
infold the cortical areas with which the newly acquired functions
are associated. There can be few functions, however, that are
totally unrepresented on even the lowest brains. So that what
probably happens in the anthropoids is this: the very high
development of those cortical areas which are represented but
Blightly in the lowest animals. In such cases some of the ap¬
parently new sulci of the former will be merely exaggerations of
slight puckerings on the cortex of the latter, whilst the remaining
sulci will be quite new, being due to a differentiation of which
there is no trace in lower brains.

Since the cerebral sulci are called into being by the specialisa¬
tion of the cortex into areas, it follows that the sulci will be
identical in different brains only if the structure of the brains is
identically the same. It is the slight difference of structure, with
the corresponding slight differences in the shape and disposition
of the sulci, that causes brains to be so different in appearance,
even though belonging to animals of the same species. The more
highly evolved any two brains are, the more dissimilar will they
be; for now cortical specialisation will be reaching its highest

1 ‘‘ The Morphology of the Sulcus Interparietalis, B.N.A.,” Journal of
Anatomy, July 1913.

3 “A Note on the Sulcus Poet-centralis Superior,” Anaiomiechtr Anzieger,
1913, xlir.

THE PARIETAL AREA

forms, and the newer the area the more liable it is to slight
variation. In the second paper, referred to above, the writer has
stated: “I am fully aware that the sulci cannot be taken as the
rigid boundaries of specialised areas, as was pointed out long ago
by Sherrington. But at the same time, I cannot conceive of sulci
being far removed from such boundaries, seeing that it was
specialisation of cortex which produced them.”

The more primitive a sulcus is, and the more primitive the
area which it limits, then the more constant in position and shape
does it appear to be, though it may often be modified or obscured
by the confluence of newer sulci produced by the more recently
specialised areas. On the most primitive brains the sulci which
either limit or are infolded in the areas differentiated for loco¬
motion and general and special sensation are the only outstanding
furrows. On the anthropoid brains these furrows are much less
salient; their outlines are obscured by the appearance of a vast
number of sulci which have arisen with the new areas which
are characteristic of the higher brains. To take an example:
Evidence is adduced in the papers above referred to, for believing
that the parietal association area with the characteristic furrows
crossing it appears for the first time in the anthropoids, and is not
present in animals lower than they. This area widely separates
the areas of vision and common sensation from one another, and
its most characteristic feature in man is the great development of
its lower part, i.e., the angular and supra-marginal gyri. The
rudiment of a parietal area is present in apes as low as pithecidae,
but it is not at all similar in structure to that of man. In the
latter it consists most characteristically of four structurally different
quadrants. These are separated from one another by the furrows
which their differentiation has produced. Thus, the separation of
the area into upper and lower portions of different structure gives
rise to the sulcus parietalis horizontalis (ramus horizontalis of the
intraparietal sulcus of Turner in the old terminology). Then the
differentiation of each upper and lower portion into anterior and
posterior structurally different areas, leads to the formation of the
superior and inferior parietal sulci, which are, of course, vertically
directed. It seems likely that the changes in the lower parietal
area occur later in evolution than those in the upper. For the
pithecidse have a parietal cortex, small though it is, which some¬
what resembles that of the superior parietal cortex of man. But

GEOFFREY JEFFERSON

they have nothing comparable with the structure of the angular
and supra-marginal gyri (lower parietal lobule).

It will be realised from the foregoing remarks that the typical
parietal furrows can only appear in animals whose cortical
structure resembles that of man. Thus, no sulcus parietalis
horizontalis can arise until the parietal field is differentiated into
upper and lower portions. So that homologues between the
parietal furrows of man and those say of cercopithecus whose
parietal cortex is of uniform structure cannot truly be found.
Yet the more horizontal part of the oblique furrow on the retro-
central cortex of the last named is commonly urged to be homo¬
logous with the sulcus parietalis horizontalis of man. Which is
absurd. For everything points to the sulcus parietalis horizontalis
being a new furrow in the anthropoids, in whom for the first time
there is a specialisation of the parietal area into upper and lower
fields.

The sulcus parietalis horizontalis is frequently superficially
confluent with the sulcus post-centralis inferior. Each of these
furrows has a separate cause and origin, but as cortical development
proceeds, the two tend to run into one another. This confluence
has led anatomists to regard these two really perfectly independent
sulci as parts of a system of furrows to which the name “ Intra-
parietal sulcus of Turner ” has been given. This system is com¬
pleted by the addition to it of Wilder’s sulcus paroccipitalis. The
whole thus well merits Eberstaller’s epithet of Furchen conglomerat.
Such a grouping together of furrows can only lead to confusion.
In the papers referred to, the individuality of each sulcus has been
insisted upon and the simple names already alluded to applied to
each—this in the hope of a speedier recognition of their nature
and origin.

There is one further point not referred to previously. There
are three arching gyri in this region commonly described in
anatomical text-books as belonging to the inferior parietal area.
These are the supra-marginal, angular, and post-parietal gyri, and
they are said to be wound around the upturned ends of the lateral
fissure (Sylvius), the superior temporal, and the middle temporal
sulcus respectively.

There is some excuse for retaining the terms supra-marginal
and angular gyri as they do actually correspond to definite areas, i.e.,
the anterior and posterior inferior parietal areas. Each gyrus is

THE PARIETAL AREA

of homogeneous structure throughout its extent. On the other
hand, it is quite uncommon to find a well-formed post-parietal
gyrus. Usually it is absent The sulcus that it is said to be
thrown around is not the end of the commonly much broken up
middle temporal sulcus, but the anterior occipital. This last is a
limiting sulcus with a cortex of different structure in front of and
behind it. It is obvious, therefore, that the post-parietal can
never be as constant as the other two arching gyri for the reason
that it could not be homogeneous in structure. The anterior
occipital sulcus is the boundary line between the parietal area and

Description op Figure.

Scheme showing how the sulci separate different areas. The s. post-
oentrales, sup. et inj ., separate the general sensory area from the parietal associa¬
tion area, whilst this last is divided into four quadrants by its own special sulci.
In the inferior parietal area it will be noted that there are two sulci. Of these,
one, the s. pariet. inf., is a limiting sulcus separating the anterior and posterior
parts of the inferior parietal area, whilst the other, the ramus ascendens of the
sup. temporal sulcus, is an axial furrow infolded in the area of black triangles.
The figures used to denote the different areas have no special significance (after
Brodmann).

ROBERT A. FLEMING

the peri-striate (Brodmann) 1 or the rather indefinite area parieto-
occipitalis (Elliot Smith). 2 What the true anatomical boundary, if
any, of the occipital lobe should be may well be open to argument.
But the whole area for vision maps out the arbitrary text-book
occipital lobe fairly accurately. At the worst the mapping out of
precise boundaries for the occipital lobe is an extremely un¬
important point, as it passes into the parietal and temporal lobes
without break of surface. If a boundary must be found for it, it
should be the limits of the peristriate area of Elliot Smith, visuo-
psychic of Bolton and others.

1 K. Brodmann, “ Lok&liaation der Groeahirnrinde,” Jotum. fur Ptychologie
und Neurologic, Leipzig, 1906-7.

* Elliot Smith, “New Topographical 8urvey of Cortex,” Jonm. of A not.,
July 1907.

NOTES OF A CASE OF RECURRENT PARALYSIS
OF THE THIRD CRANIAL NERVE.

By ROBERT A. FLEMING, M.D., F.R.C.P. Edin.

C. C., aet. 12, school girl, was admitted to my wards on the 4th
March 1913, complaining of double vision and consequent vertigo.

There is no family history of alcoholism, epilepsy, or any
nervous disease, and no family predisposition to migraine attacks.
Her father, a rubber worker, is alive and healthy, her mother has
been several times in the ward, suffering from chronic interstitial
nephritis. The patient has six brothers and five sisters, all alive
and healthy. Her home is fairly comfortable, and there is always
a sufficiency of good food.

The previous illnesses include measles, abscess of both ears,
whooping-cough, and chicken-pox. She has frequently complained
of pain over the left mastoid, but at present there is no discharge
from either ear.

Her first attack of recurrent paralysis of the third nerve dates
from winter, three years ago, and commenced, according to the
mother’s account, with twitching or shaking of her head. This
went on for some days, and was followed by a sudden pain in her
left eye. The pain was very severe, and lasted over a week,
greatly interfering with sleep. The shaking ceased when the pain
began, and about two days after the pain started the left eye

NOTES OF A CASE OF RECURRENT PARALYSIS 59

closed, and the patient could only lift the lid with her finger, and
when she did so found she had double vision, and complained of
giddiness. The paralysis, which presumably, from her description,
was the same as that seen on the present occasion, gradually
passed off.

After an interval of eight months the patient had a second
attack, commencing much in the same way, with head-shaking or
twitching, followed by severe headache and pain especially referred
to the left eye, and ending in paralysis of the third nerve on the
left side.

Each of these two attacks was completely recovered from, the
double vision and ptosis completely disappearing.

The present—and third —attack began three days before ad¬
mission, and was preceded by a certain amount of head-twitching
or shaking and severe headache, mostly confined to the region of
the left eye. When I saw the patient there was marked ptosis of
the left eye, and complete paralysis of all the muscles, internal and
external, supplied by the third nerve on the left side. The pupil
was dilated, and the patient was unable to accommodate with the
left eye.

On the day after admission the paralysis had already begun
to pass off, and disappeared completely within a week. All the
affected muscles appeared to regain perfect functionating power.

The sight of each eye is $.

There is nothing else worthy of note as regards the nervous
system, and excepting that the child’s chest development is
somewhat unsatisfactory for her height, there is no other ab¬
normality. After admission to the ward there was no evidence
of any twitching or shaking of the head, similar to what the
mother stated had always preceded each of the three attacks,

The mother considers that excessive mental overstrain at
school was the cause of each attack.

It should be pointed out that eight months elapsed between
the first and second attacks, and two years and four months
between the second and third attacks, and that there has been no
increase in the severity of the attacks, and certainly no tendency
to periodicity, which is believed to be so common in these cases.
There is no neuropathic family history. The girl’s description of
her headache resembled migraine, only it has never been associated
with vomiting.

ABSTRACTS

I again saw the patient in July of 1913, when she looked in
the best of health, and much better coloured than she was after
leaving the ward. There had been no recurrence of the paralysis.

In many cases of recurrent or periodic paralysis the lesion
is limited to one or other division of the third nerve, or even a
single muscle. There is often more definite migraine-headache
followed by vomiting, and there is a tendency for the attacks to
recur at ever shortening intervals of time, and with greater and
greater severity.

Whatever the explanation may be, it is impossible to suppose
that either a new growth, or a plastic exudate, or other gross
morbid process, could explain the paralysis in this case. Vascular
spasm, inhibiting the flow of blood, or paralysis of vasomotor
nerves might cause distension of vessels, and so compress the third
nerve in whole or in part. Strzeminski distinguishes a functional
and an organic type, and would, of course, consider the present
instance functional. Luzenberger thinks that the cavernous sinus
may periodically swell or distend, while Plavee believes that the
hypophysis is to blame. Knapp states that there is rarely
complete recovery between the attacks, and obviously this would
imply the presence of some gross organic lesion. Other cranial
nerves are also occasionally affected, such as the fourth and sixth
nerves supplying the other eye muscles, and the seventh nerve.

No treatment was adopted in my case, nor was any necessary,
so rapidly did the symptoms disappear.

Hbstracts.

PHYSIOLOGY.

EXPERIMENTAL RESEARCHES ON CEREBELLAR FUNCTION.

(63) Andr6 Thomas and Durupt, L'Encephale , July 10,1913, p. 21.

The authors made small unilateral cortical lesions in the cerebellum
of Macacus rhesus in two instances. The first lesion was in the
right quadrilateral lobe, involving slightly the semilunar; the
central grey nuclei and the vermis (subsequently examined) were
untouched. After the operation the animal showed typical
dysmetria of the right upper limb, and nothing else. After about
ten days this dysmetria disappeared. The second lesion destroyed

ABSTRACTS

a much larger part of the quadrilateral and semilunar lobes, and
impinged on the right side of the vermis: the subjacent white
matter was much involved. The posterior part of the right corpus
dentatum was destroyed. The right superior cerebellar peduncle
was subsequently found to be degenerated. The animal had
constant falls to the right, sometimes preceded by oscillations
of the head and trunk. These defects of equilibrium and the
shaking movements soon disappeared. Discontinuity of movement
and dysmetria were strongly marked in both upper and lower
limbs on the right side, and these symptoms persisted. The
defect of equilibrium in the second animal is to be associated with
the slight involvement of the vermis. The dysmetria, practically
identical in the two animals, was especially well seen in the
attitude of the hand and foot in the act of grasping. It may be
that the behaviour of the animal’s limbs immediately after the
lesion—apparent indifference to abnormal attitudes—is to be
linked to a transient defect of deep sensibility. Little that is
certain is known of the relation of the cerebellum to sensation.

The authors go fully into the question of whether the
distribution of the lesions in the two cases may not explain the
presence of dysmetria in the inferior extremity in the second ape
and its absence in the first. They discuss the question of localisa¬
tion in the cerebellar cortex and nuclei. Their results tend to
confirm Rothmdnn’s views, that in the quadrilateral lobe is a
centre for regulating the motility of the upper limb, in the
semilunar, of the lower limb. S. A. K. Wilson.

CONSIDERATIONS ON THE PHYSIOLOGICAL PATHOLOGY OF
(64) CONTRACTURE. (Considerazioni sulla flsiopatologia della
contrattura.) Augusto Ott, Riv. de Patol. new. e merit., 1913,
xviii., p. 429.

The author criticises severely the theory of contracture propounded
by Buscaino, who attributes this condition to the effect on the
muscle of the accumulation of katabolic products due to imperfect
circulation in the paralysed muscle substance. The objections
advanced by Ott are as follows: (1) There is not sufficient
evidence of circulatory disturbance in the paralysed muscles.
(2) Though ligature of veins and also arteries may produce an
augmentation of muscular tone, there is no parallelism between the
experimental condition and that produced by paralysis. (3) There
is no direct relation between paresis and muscular rigidity, move¬
ment often being only slightly impaired in cases exhibiting great
spasticity. (4) The explanation of Buscaino does not account for
the flexor type of contracture that predominates in the arm.

ABSTRACTS

According to the author, the position assumed in contracture is
in reality a reproduction of the conditions that prevail during
intrauterine life and in the new born. The return to this primitive
posture of the limbs occurs when cerebral influence is interfered
with. Hypertonus is sharply separated from the mechanism of
contracture and attributed to cerebellar influence.

F. L. Golla.

ON THE FUNCTIONAL RELATION BETWEEN THE CORTICAL
(65) AND SUBCORTICAL CENTRES OF TONUS. (Sui rapporti
funzion&li tra i centri corticali ed i sottocorticali tonici dell’uomo
in condizioni normal! e patologiche.) V. M. Buscaino, Riv. de
PatoL nerv. t merit., 1913, xviii., p. 441.

A reply to the criticisms of Ott on the author’s theory of con¬
tracture. It is pointed out that the foetal posture varies when
the position in the uterus is not a normal one, and hence is
determined by external conditions and not by a nervous mechanism,
absence of control over which is, according to Ott, the cause of the
assumption of the foetal flexion of the limbs in contracture. The
author maintains his theory of the toxic origin of contracture.

F. L. Golla.

THE EXPERIMENTAL PRODUCTION OF REFLEX IRIDOPLEOIA.
(66) (Uber experimentelle reflektorische Pupillenstarre.) Karplus
and Kbeidl, Neurol. Centralbl., 1913, Jan. 16, p. 82.

Experimenting on cats and apes, the authors have traced the
course of the fibres in the optic tract that are reflexly concerned
with the reaction of the pupils to light. They find that all along
the optic tract, except when it enters the external geniculate body,
electrical stimulation produces contraction of the pupils, and these
pupil-controlling fibres can be followed, millimetre by millimetre,
along the superior brachium and the anterolateral edge of the
superior corpus quadrigeminum almost to the middle line. Cutting
through these fibres anywhere on this route electrical stimulation
of the central end always produced contraction of the pupil.
After bilateral section of the superior brachium the reaction of the
pupils to light is absent, and the authors have, in an ape, pro¬
duced bilateral Argyll Robertson pupil in this fashion, which has
remained unchanged eight months after the operation. They do
not assert, however, that in the Argyll Robertson pupil in man the
lesion is necessarily at the same spot where they have been able
to produce it experimentally, but the data are of considerable

ABSTRACTS

importance. A fuller account of their experiments is recorded in
Pfinger's Archiv, vol. cxlix. S. A. K. Wilson.

THE LOCAL ACTION OF NICOTINE ON THE DOG’S BIGHT
(67) CARDIAC AURICLE. (Action locale de la nicotine sur
l’oreillette droite da cceur chez le chien.) L£on Fkedericq,
Arch. Intemat. de Physiol., 1914, xiv., Jan. 31, p. 195.

These experiments were performed on the surface of the living
dog’s heart: destruction of Flack’s sino-auricular node by cold
was effected by a metal bar frozen by immersion in liquid air
or oxygen. Conclusions :—“The eardio-inhibitory action of the
cervical vagi is not abolished by (1) mechanical or thermal (heat
or cold) destruction of Flack’s node; by (2) thermal destruction
of the superficial portion of the centre of Marchand and Meyer
(the accessible portion of the dorsal aspect of the right auricle);
by (3) thermal destruction of the whole extent of the surface of
the two auricles directly accessible to the action of the heated
glass rod. The abolition of the eardio-inhibitory action of the
vagi which follows the application of nicotine to the region of
Flack’s node, or to Marchand and Meyer’s centre, is due, in at
any rate some instances, to diffusion of the poison to other parts of
the heart. Some fibres of the right vagus penetrate the heart in the
right auricle and act on it. Likewise the left vagus contains some
fibres exclusively destined for the left heart. This experimental
fact is against the notion of a single intra-cardiac moderating
centre in which the total number of the inhibitory fibres of
the vagi terminate.” Leonard J. Kidd.

A DIRECTLY EXCITABLE REGION IN THE HUMAN ENDO-
(68) 0ARDIUM (Sur one region endoc&rdique directement excitable.)

R. Argaud, Compt. Pend. d. 1. Acad, des Sciences , 1913, clvi., p. 1787.

Argaud observed a spontaneous contraction of the exposed heart
of a man, aged 20, forty-five minutes after decapitation: from this
time the heart did not contract unless it were stimulated
mechanically: the stimulus was most effective over the right
auricle: these contractions were evoked mechanically about every
ten seconds up to the fifty-second minute: they then lessened and
became more and more capricious, being sometimes auricular,
sometimes ventricular, and often there was even a slight inco¬
ordinate fibrillation. At the sixty-second minute the heart was
not mechanically excitable, and electrical stimulation of its surface
gave neither contraction nor fibrillation. The heart was now
opened; electrical stimulation of the endocardium of the right

ABSTRACTS

ventricle and of the whole of the left heart failed to evoke con¬
traction; but stimulation of the right auricular endocardium
evoked contraction of the whole heart. From the seventy-second
to the seventy-fifth minute three induction shocks were needed
for this, and at the eighty-third minute after decapitation the
heart was inexcitable. The most excitable region of all corre¬
sponded with the taenia of His, the Keith-Flack node, and the
valve of Thebesius, i.e., the region most rich in nerve-ganglia.
Argaud has often found nerve-ganglia in the substance of the
Thebesian valve of man and other mammals. He suggests that
in cardiac massage, instead of the usual continuous ventricular
massage, we should apply light taps by the tips of the fingers to
the right auricle at intervals, and watch, as far as possible, for the
myocardial response. Leonard J. Kidd.

HTPOPHYSBCTOMY AND GENITAL ATROPHY : AN EXPERI-
(69) MENTAL CONTRIBUTION TO THE STUDY OF THE ADI
POSO-GENITAL SYNDROME. (Hypophysectomie et atrophie
glnitale: Contribution explrimentale k l’ltude du syndrome
adiposo genital.) J. Camus and G. Roussy, Soc. de Neurol, de
Paris, Dec. 4,1913. ( Revue Neurol ., 1913, Dec. 30, p. 770.)

The authors showed five dogs, young and old, on which they had
performed hypophysectomy, more or less complete, by the palatine
route: only two showed any trophic genital changes: in one of
these the cauterisation of the pituitary region by a red-hot needle
had caused neighbouring lesions, as was shown by the presence of
disturbances of co-ordination and equilibration: in the other dog
the authors purposely produced a basal cerebral lesion which was
rapidly followed by a large polyuria and testicular atrophy.
They conclude tentatively that it is the basal lesion, rather than
the pituitary lesion, which causes genital atrophy. Adiposity is
not indissolubly connected with the genital atrophy, for they may
be dissociated, as in the case of their second dog, which showed,
after a total or almost total hypophysectomy, an enormous adi¬
posity combined with perfect integrity of genital organs and
sexual functions. They suggest that the adiposo-genital syndrome
may be due to lesions of separate centres which, though often
affected simultaneously by the same processes, can be dissociated.
As to the exact sites of these centres, we must wait for a detailed
histological examination. (For a further account of the authors’
experiments on these dogs, and two other dogs on which a dummy
operation was done without any consecutive polyuria resulting,
see the Compt. Bend. Soc. de Biol., (a) Dec. 5, 1913, p. 483, and (b)
Dec. 26,1913, p. 628). Leonard J. Kidd.

ABSTRACTS

n. T HE PH Y8IOLOQIOAL ACTIVITY OF THE ADRENAL OF
(70) THYROIDE0T0MI8ED ANIMALS. (Valent physiologique de
la gl&nde ■nrr^nale dee anim&uz dthyroldfo.) E. Olby, Arch.
Internal, dc Physiol ., 1914, xiv., Jan. 31, p. 175 (18 figs.).

Conclusions :—(1) “ Adrenal extract of thyroidectomised dogs or
rabbits, dying two to thirty-five days after operation, is quite as
active, to judge by the cardio-vascular action of the adrenalin
it contains, as normal adrenal extract. (2) Adrenal extract of
rabbits rendered myxcedematous by thyro-parathyroidectomy is
either as active, or a little less active, than that of normal animals;
but in these cases the animals have been in a state of general
organic cachexia on account of their malady, and one has been
unable to see in it a specific effect due to loss of an influence
normally existing and continuously exercised by the thyroid on the
adrenals. (3) The adrenals of thyroidectomised rabbits, either
sacrificed during the course of the cachexia thyreopriva or dying
from it, are notably hypertrophied and loaded with fat: this
hypertrophy is by no means a sign of hyperfunction.”

Leonard J. Kidd.

CONTRIBUTION TO THE STUDY OF HUMORAL INTER-
(71) RELATIONS.—I. THE ACTION OF THYROID EXTRACT
AND OF ORGANIC EXTRACTS IN GENERAL ON ADRENAL
SECRETION. (Contribution A l’6tude des interrelations humorales.
Action de 1’extrait thyroldien et an gdndral des extraits d’organes
sur la sdcrdtion surrdnale.) K Glby and A. Quinquaud, Arch.
Intemat. dc Physiol ., 1914, xiv., Jan. 31, p. 152 (21 figs.).

These experiments were performed in each instance on two dogs:

(1) a rather large one which supplied the adrenal blood, and

(2) a smaller one into which the collected blood of the first was

injected. Conclusions :—(1) “Extracts of pancreas, liver, thyroid,
testes, kidneys, and probably of other organs also, can increase the
amount of adrenalin which flows in the blood of the adrenal vein.
(2) Thyroid extract is not more active than the others in this
respect; it is less active than hepatic extract. (3) These experi¬
ments testify directly against the hypothesis of reciprocal
functional relationships between the adrenals and the thyroid, or
—more exactly—against the hypothesis of the reciprocal action of
the secretory products of these glands.” The mechanism, by which
the organic extracts determine this augmentation of adrenalin, is
to be studied in new researches. Leonard J. Kidd.

ABSTRACTS

OBSERVATIONS AND EXPERIMENTS ON GOITRE (SO-CALLED
(72) THYROID CARCINOMA) IN BROOK TROUT (Salveltaus
fontlnalla). David Marine, Joum. Exp. Med., 1914, xix., Jan.,
p. 70.

Goitre in fish is a non-infectious, non-contagious, symptomatic
manifestation of a fault of nutrition, the exact biochemical nature
of which has not been determined. Feeding the highly artificial
and incomplete diet of liver is the major etiological factor in
bringing about this fault of nutrition, which is at once corrected
by feeding whole sea fish. Water plays no essential part in the
etiology, transmission, or distribution of the disease in the fish of
this hatchery. A. Ninian Bruce.

PSYCHOLOGY.

THE MENTAL MANIFESTATIONS OF EPILEPSY. N. S. Yawger,
(73) Joum. Abnorm. Psychol ., 1913, Feb.-March.

In this paper the author discusses in a lucid manner the various
mental states met with in epilepsy and expresses the opinion that
the development of the well-known epileptic character and tem¬
perament may be produced by mismanagement of these persons by
their families. H. de M. Alexander.

A PSYCHO-ANALYTIC STUDY OF A SEVERE CASE OF HYSTERIA

(74) L. E. Emerson, Joum. Abnorm. Psychol., 1913, Feb.-March, April-
May.

A detailed description of a protracted psycho-analysis in a case
of hysteria. H. de M. Alexander.

A CASE OF SYNESTHESIA Isador U. Coriat, Joum. Abnorm.
(76) Psychol., 1913, April-May.

In this subject the colour blue in its various shades was distinctly
suggested by sounds. Coloured thinking, and to a less extent taste
synesthesia, was also present. There was no familial tendency
and the synesthesia, though present in a psycho-neurotic subject,
antedated the psychoneurosis by a number of years.

H. de M. Alexander.

AN UNUSUAL TYPE OF SYNESTHESIA Isador H. Coriat,
(76) Joum. Abnorm. Psychol., 1913, Juue-July.

This occurred in an intelligent woman of 40 years in whom from
childhood pain had produced a sensation of colour, but only when

ABSTRACTS

the pain was severe and persistent. Each type of pain produced
its individual and invariable colour. The duration of the colour
and the pain synchronised; and the individual colours produced
emotional associations of a depressing or soothing nature. The
synesthesia could be produced artificially by peripheral stimuli.

H. de M. Alexander.

THE ANALYSIS AND I NTER PRETATION OF DREAMS BASED
(77) ON VARIOUS MOTIVES. Meyeb Solomon, Joum. Abnorm.

Psychol., 1913, June-July.

From an analysis of some dreams the author is of the opinion
that:—

1. The law of determinism applies as certainly to dream life
as it does to all other mental states.

2. The content of the dream may depend only or mainly on
our more recent experiences.

3. Dreams do not necessarily depend on our infantile or child¬
hood experiences.

4. Dreams are merely the continuation of our waking life,
but are not so logical or orderly on account of the lessened
activity of clear consciousness.

5. Symbolism does not necessarily play any rdle in the dream-
content—this is determined by our fears as well as our wishes.

6. The underlying motives of dreams vary considerably—any
of our instincts (fundamental or otherwise) alone or in combina¬
tion, may be the driving force of the dream.

H. de M. Alexander.

PATHOLOGY.

ANATOMICAL EXAMINATION OF A CASE OF MULTIPLE
(78) SCLEROSIS FROM DISSEMINATED SYPHILITIC MYELITIS.

B£rikl and Dklachanal, L’Enc4phale, April 10,1913, p. 301.

The patient was a man of 33, whose case clinically was diagnosed
as ascending syphilitic myelo-encephalitis: the Wassermann re¬
action was positive both in the blood and in the cerebro-spinal
fluid. Pathologically, two sorts of lesions were found: (1) diffuse
inflammation of roots, meninges, and cord, typically syphilitic;
and (2) inflammatory foci and plaques of sclerosis. There could
be no doubt as to the occurrence of every intermediate stage of
sclerosis-development: the evolution of the plaques was definitely
in association with different degrees of the fundamental patho¬
logical process.

ABSTRACTS

The case may be considered in three ways:—

1. The plaques are of syphilitic origin. The possibility of
syphilis producing ordinary disseminated sclerosis has been
accepted by a few observers.

2. Syphilis may produce a disease allied to disseminated
sclerosis, but distinct from it. This view has something in its
favour.

3. The association of plaques of sclerosis and disseminated
syphilitic lesions is accidental.

The authors are greatly inclined to favour the first hypothesis,
and express their surprise that hitherto it has not gained much
credence, for not a few cases are now on record which undoubtedly
support it. They lay stress, further, on other cases where dis¬
seminated sclerosis, so called, has been indistinguishable anatomic¬
ally from disseminated myelitis of known toxic or infective origin,
and therefore are disposed to deny any specificity to the lesions of
classic disseminated sclerosis. S. A. K. Wilson.

ON CHANGES IN THE HYPOPHYSIS IN EXPERIMENTAL
(79) DIPHTHERIA, (tfber die VerSndemngen der Hypophyse bei
der experimentellen Diphtherie.) S. Abramow, Virchovft Arckiv,
1913, ccxiii., p. 408.

From experiments on guinea-pigs Abramow had previously found
that in diphtheritic intoxication exhaustion of adrenalin secretion
occurs at a very early stage (first to second day). He now shows
that the absence of adrenalin is compensated for by an increased
secretion of the hypophysis, which occurs as soon as the suprarenal
medulla is exhausted. Exhaustion of the hypophysis occurs
considerably later than that of the suprarenals (fourth to fifth
day). Thus fifteen guinea-pigs in whom death due to acute
diphtheritic intoxication occurred within fifteen to twenty-seven
hours showed no changes in their hypophysis except a high degree
of hypersemia. On the other hand, twenty guinea-pigs in which
the intoxication was less acute, showed in addition to marked
hypersemia of the capillaries a large number of cells which had
been exhausted by a great increase in their secretory activity.

Abramow concludes that diphtheria toxin does not exercise
a direct influence upon the secretion of the hypophysis, but that
this increase of secretion is due to a correlation between the
functions of the hypophysis and those of the other glands of internal
secretion, especially the suprarenals. J. D. Rolleston.

ABSTRACTS

HISTOLOGICAL RESEARCHES OH THE H7P0PHTSIS OF P8YOHO-

(80) PATHS. Laigkel-Lavastink and Jonnesco, L'EndpkaU, Jan. 10,
1913, p. 26.

The authors have examined thirty-two cases of mental disease,
but come to no very definite conclusions as to the condition of the
pituitary. They distinguish, however, the “general paralytic”
hypophysis as characterised by vaso-dilatation, and the “senile
dement" hypophysis by perivascular sclerosis.

S. A. K. Wilson.

FATS, STEABINE8, AND LIPOIDS IN THE NORMAL AND

(81) PATHOLOGICAL CENTRAL NERVOUS SYSTEM. (Grass!,
sterine e lipoidi nil sistema nervoso central! in condition! nor¬
mal!, sperimentali e patologiche.) Buscaino, Riv. de Patol. nerv.
e ment., 1913, xviii., p. 673.

Three methods were used: Examination by polarised light, by
specific fat stains, and by fractional extraction of the fatty matter.

In the walls of the cerebral vessels of healthy subjects minute
globules of neutral fats and non-saturated phosphatids were found,
together with traces of other lipoids insoluble in acetone and
petroleum ether.

In one case of cerebral degeneration large masses of fatty
matter were found in the vicinity of the areas of softening, and in
this case cholesterin was also found. The other cases appeared to
have a normal distribution of ether-extractable matter. The
yellow pigment of the cells of the normal cerebral cortex was
found to consist essentially of saturated phosphatids and some
other acetone insoluble lipoids. F. L. Golla.

THE GALAGT08IDE8 OF THE BRAIN.— L Otto Rosenheim,

(82) Biochtm. Joum., 1913, vii., Dec., p. 604.

A new method for the preparation of galactosides from the brain
by means of pyridine is described. Evidence is brought forward
to show that the galactosides exist in the brain in the preformed
condition. A. Ninian Bruce.

CLINICAL NEUROLOGY.

PHYSIOLOGICAL MECHANISM OF THE KNOCK-OUT. (M<can-

(83) !sme physiologique du knock-oat) H. Somen, Paris mid., 1913-14,
iv., p. 54.

Somen gives the following explanation of the knock-out which has
met with Babinski’s approbation, as well as that of certain medical
boxers.

ABSTRACTS

The knock-out is essentially due to auricular irritation analogous
to M£ni&re’s vertigo. A blow on the chin is transmitted to the
glenoid cavity by the condyle of the inferior maxilla, the internal
ear and semicircular canals receive a violent shock, and there
results a bulbar cerebral and cerebellar reflex which produces all
the symptoms of the knock-out.

This theory also explains why a blow on the side of the chin
is more effective in producing a knock-out than a blow aimed at
the centre of the maxilla. A lateral blow produces a shock on
the glenoid cavity of the opposite side only, while a blow on the
centre of the chin is transmitted to both glenoid cavities at once,
and its effect is thus deadened. Further, the disturbance of
equilibration is more considerable when the irritation affects the
semicircular canals of one side only than when it is bilateral.

J. D. Rolleston.

METALLIC POISONS AND THE NERVOUS SYSTEM. Gxorgk A.
(84) Molekn, Arrur. Joum. Med. Set., 1913, cxlvi., No. 6, Dec.

Tuf.se cases are briefly presented showing the effects of lead
intoxication, one of arsenic, and one probably of mercury.

The arsenical case was unusual, owing to the fact that the
patient had an optic nerve atrophy attributable to the arsenic.

The author’s conclusions are as follows:—

1. A wide variation exists in individual susceptibility to all
metallic poisons.

2. In those susceptible, if the nervous system is attacked, the
peripheral nervous system is the most vulnerable, and more
especially the extensor supplies.

3. There is with lead poisoning, in all probability, an early
lymphocytosis of the cerebro-spinal fluid, and probably coincident
with or succeeding upon the basophilic granulation of the red
blood cells.

4. Non-inflam matory degenerations of any portion of the
peripheral system should suggest the metals as a possible cause.

5. In the absence of skin evidences of arsenic and the blue line
of lead, the urine, the blood, and finally artificial abscesses may be
induced and examined for the metals; this procedure should lend
itself as a diagnostic as well as a therapeutic aid.

6. A positive Wassermann reaction would not seem to exclude
especially lead in favour of syphilis in primary nerve or tract
degenerations.

7. The source of the poison may not be detectable until long
after the presence of the metal as a cause has been established.

D. K. Henderson.

ABSTRACTS

A CONTRIBUTION TO THE STUDY OF HEREDITARY DE
(85) GENERATION. Cabl D. Camp, Amer. Joum. Med. Set., 1913,
cxlvi., No. 6 , Nov.

A cask of pseudohypertrophic muscular dystrophy is reported in
a child of 3 years, one of whose parents and a grandparent had
the spinal type of progressive muscular atrophy. The author has
not been able to find a similar case of heredity in the literature.

Another case is reported in a boy of 10 years who showed a
combination of Friedrich’s ataxia with a pseudohypertrophic
muscular dystrophy.

A third case was that of a boy 8 years old who in combina¬
tion with a pseudohypertrophic muscular dystrophy had an optic
neuritis. D. K. Henderson.

THE THEORY OF MYOTONIA. Gregor and Schilder, Neurol.
(86) Centralbl., 1913, Jan. 16, p. 86.

In a brief preliminary communication the authors show, by
electrical methods and the string galvanometer, that in Thomsen’s
disease the essential lesion is not in the muscles.

S. A. K. Wilson.

THE NERVOUS SYMPTOMS OAUSED BY SUBCLAVIAN
(87) ANEURYSM. (Oontribnto alio studio delli sindromi nervosa
determinate dagli aneurismi dell’arteria succlavia.) Paolo
Magaudda, Riv. de Patol. nerv. e mmt., 1913, xviii., p. 83.

Trophic disturbances evidenced by muscular atrophy may be found
in muscles of the shoulder joint, arm, and hand, caused by lesions
involving one or all of the branches of the brachial plexus.

Paralytic disturbances, varying from a slight paresis to complete
paralysis with muscular atrophy may occur. The muscles
supplied by the ulnar nerve are most often affected.

Subjective and objective disturbances of sensation are frequent.
Clubbed fingers are occasionally observed in the hand of the
affected limb. F. L. Golla.

COMBINED COLUMN-DISEASES OF THE SPINAL CORD. (Zur
(88) Frage der kombinierten Strangerkrankungen des Riicken-
marks.) Rothmann, Neurol. Centralbl., 1913, Nov. 1, p. 1363.

Rothmann, in a short paper, explains the difference between
combined “ Systemerkrankungen ” and “ Strangerkrankungen,”
apropos of subacute combined degeneration of the cord. He holds

ABSTRACTS

that in the latter disease there is no systematised tract affection,
but a combined column affection. In his experimental work on
dogs he was able to produce, by continued injection of pyridin
over several months, a profound anaemia associated with degenera¬
tion in the anterior and lateral and posterior columns of the cord,
comparable to what is found in subacute combined degeneration.
In experimental anaemia of the cord produced by clamping the
abdominal aorta, the short tracts of endogenous fibres in the
antero-lateral ground-bundles were more affected than the rest of
the cord—the reverse of what obtains in subacute combined.

S. A. K. Wilson.

TWO OASES OF TABES COMPLICATED BY HEMIPLEGIA.

(89) Marinesco and Noica, L'EncJphale, May 10,1913, p. 413.

Thb authors draw an interesting comparison between two cases of
tabes with hemiplegia. In the case with advanced tabes a slight
pyramidal lesion was sufficient to produce severe muscular
atrophy, and to aggravate the hypotonia and ataxia: in the case of
mild tabes a much more severe pyramidal lesion failed to produce
so much impairment of function. Reference is made to experi¬
ments by Marinesco and Minea, and by Parhon and Goldstein, in
which previous section of the sciatic nerve rendered more intense
the alterations produced in the anterior horn cells of the cord by
experimental destruction of the Rolandic zone or pyramidal path
than those in control animals whose sciatic nerves were intact.

S. A. K. Wilson.

ON THE TREATMENT AND NATURE OF DIPHTHERITIC
(90) PARALYSIS. (Bsitr&ge zur Behandlung und sum Wesen der
Diphtherieiahmung.) Rosier und Viekeck, Cmtralbl . /. Bakt .,
1913, lvil, Ref. Beiheft, p. 104.

The following views are current as to the influence of antitoxin
on diphtheritic paralysis. 1. Antitoxin has not only no effect in
preventing paralysis, but it even favours its occurrence. 2. Whether
paralysis will occur or not in no way depends on the injection of
antitoxin. 3. Antitoxin has a prophylactic action on paralysis.
4. Antitoxin is effective even when paralysis has actually developed.

The writers, from experiments with diphtheria toxin on guinea-
pigs, give the following answers to the above views. As regards
(1) the favouring action of antitoxin is apparent rather than real.
Experiments showed that acute lethal intoxication could be con¬
verted into sublethal intoxication with subsequent paralysis. As
regards (2) and (3) antitoxin is by no means without influence on

ABSTRACTS

the subsequent occurrence of diphtheritic paralysis. If given at
the right time it renders mild what would otherwise have been
severe paralysis, and under suitable conditions prevents the occur¬
rence of any paralysis at all. As regards (4) when once paralysis
has occurred, antitoxin has no therapeutic influence whatever
{cf. Review, 1907, v., p. 862).

Investigation of various diphtheria toxins as regards their
content of paralysis-producing toxin gave the greatest differences.
All attempts to separate toxin from toxone failed, and the writers
regard a final decision as to the nature of the paralysis-producing
toxin as at present impossible. J. D. Rolleston.

THE NERVOUS COMPLICATIONS OF VARICELLA. R. Miller

(91) and J. A Davidson, Brit. Joum. Child. Die., 1913, xi., p. 16.

The writers record the following case of encephalitis complicating
varicella and review the other examples of nervous complications
in the literature.

A boy, aged 2£ years, on the fifth day of a mild attack of
varicella was found unable to stand or to speak distinctly, and to
show a tremor of the limbs, head, and tongue. The cranial nerves
and reflexes were normal. The tremor gradually diminished in a
few days, and in a month from the onset had entirely disappeared.
The character of the tremor and the general appearance of the
child were exactly similar to those seen in cases previously
described by Miller, under the title of "acute tremor” {Brain,
1909, xxxii., p. 54), in which the lesions were situated in the
cerebello-rubro-spinal system.

The other nervous complications reported after varicella in¬
clude examples of poliomyelitis and peripheral neuritis, convul¬
sions, intracranial complications of otitis media such as meningitis,
cerebral and cerebellar abscess and lateral sinus thrombosis,
optic neuritis, haemorrhagic internal pachymeningitis, disseminated
sclerosis, neuromyositis, chorea and tuberculous meningitis {cf.
Review, 1907, v., p. 564; 1908, vi., p. 618; and 1909, vii., p. 206).

In discussing the occasional association between varicella and
herpes zoster, the writers suggest that focal lesions similar to those
which apparently occur in the central nervouB system may
originate in the posterior root ganglia, thus producing a herpetic
eruption. J. D. Rolleston.

SYRINGOMYELIA: WITH AUTOPSY FINDINGS IN TWO CASES.

(92) Oskab Rlotz, Amer. Joum. Med. Sci., 1913, cxlvi., No. 6, Nov.

Two cases of syringomyelia are reported clinically and patho¬
logically owing to their indicating the mode of origin of their

ABSTRACTS

cavities, in the one case with and in the other without the
presence of a tumour.

The first case is that of a married woman, 38 years, who had a
complete paraplegia which came on suddenly and lasted for about
seven months. Anaesthesia was complete to all forms of sensation
over the surfaces below a transverse line 3 cm. above the
umbilicus. The reflexes were abolished below the waist-line,
there were marked trophic disturbances, and loss of control of
bladder and rectum.

The anatomical diagnosis was acute softening of the cord,
syringomyelia, chronic pachymeningitis. The cord destruction
gave no indication of a true myelitis, nor was there evidence of
new growth. Cavities containing a necrotic material and outlined
by irregular walls extended in both directions of the cord, and
there was no evidence that the spinal canal was in any way
involved or associated with the cavities. The cavity formation
involved mainly the white matter of the posterior columns.

The second case was that of a man, 25 years, who had a
complete motor and sensory paralysis below the level of a line
situated about midwav between the nipple and umbilicus. The
anaesthesia was complete to all forms of sensation. There was
loss of control of sphincters.

The autopsy showed that between the seventh and eighth
dorsal nerves there was an area of extensive softening which
extended in both an upward and downward direction. The
anatomical diagnosis was: glioma of the cord with softening,
syringomyelia.

Cavities developed in the new growth by a process of degenera¬
tion. Under the following conditions cavities may be present in
the spinal cord : (1) neuro-epithelioma glimatosis; (2) diverticula
of central canal; (3) anomalies of closure of the posterior sulcus;
(4) degeneration of gliomas; (5) primary syringomyelia.

D. K. Henderson.

ETIOLOGY OF HERPES IN CEREBRO SPINAL MENINGITIS.
(93) (Presence of the meningococcus in the vesicles.) [Etiologie de
iherpto dans la mdningite cdrdbro-spinale. (Presence du mlnin-
gocoque dans les vfaicules.)] P. Durand, Lyon mid.> 1913, cxxi.,
p. 920.

The patient was a woman, aged 34, who recovered after injection
of anti-meningococcic serum. An abundant eruption of facial
herpes appeared during the first few days of the disease. Cultures
of the vesicles showed meningococci associated with the Diplococcus
crassti#, a frequent saprophyte of the mouth and nose. Drigalski
is the only other observer who has succeeded in finding meningo-

ABSTRACTS

cocci in the vesicles of herpes in cerebro-spinal meningitis. Durand
is in favour of a haematogenous rather than of a nervous origin
for the herpes in cerebro-spinal meningitis, and refers to the cases
of meningococcal septieiemia reported by Bovaird (v. Review, 1909,
viii., p. 419), Monziols and Loiseleur (ibid., 1910, viii., p. 304),
Pissavy, Kichet fils, and Portret (ibid., p. 486), in which herpes
appeared without any nervous manifestation.

J. D. Rollestox.

TUBERCULOUS MENINGITIS WITH ASSOCIATION OF THE
(94) MENINGOCOCCUS. (Mfaingite tuberculeuse avec association
da mdniogocoqae.) L B£riel and P. Durand, Lyon mdd., 1913,
cm, p. 913.

This association is rare. After reference to the cases reported by
Combe (v. deview, 1910, viii., p. 432), Lutaud (ibid., p. 622), and
others, the writers record a case of a youth, aged 16, admitted
to hospital with meningitis. The cerebro-spinal fluid was turbid
and rich in albumin, polymorphs, and meningococci. Cerebro¬
spinal meningitis was therefore diagnosed. The necropsy, how¬
ever, showed general miliary tuberculosis, including involvement of
the basal meninges. A small tubercle was also present in the
cerebellum. Histological examination and injection of a guinea-
pig confirmed the diagnosis of tuberculosis, which was in this case
the primary infection. J. D. Rollestox.

PRIMARY PNEUMOCOCCAL CEREBRO SPINAL MENINGITIS.
95) (Des mdningitM cdrdbro-spinales primitives A pneumocoques.)

H. Guichot, Them de Lyon, 1912-13, No. 19.

Guichot’s main conclusions are as follows:—

1. Primary pneumococcal meningitis is fairly frequent both in
a sporadic and in an epidemic form.

2. Epidemics differ from those of meningococcal meningitis in
being less extensive and not appearing regularly in successive
years.

3. The course of pneumococcal meningitis is generally more
rapid than that of meningococcal meningitis.

4. The only certain mode of diagnosis is by lumbar puncture.
Fairly frequent (in nine out of twenty-seven cases), a paradoxical
formula is present, viz., absence of leucocytic reaction and
abundance of microbes.

5. The prognosis is graver than in meningococcal meningitis,

the mortality being 75 per cent. J. D. Rollestox.

ABSTRACTS

PAROTITIS COMPLICATED WITH MENINGITIS. Q. N. Acker,
(96) Amer. Joum. Dis. Child., 1913, vL, p. 399.

A record of two cases with a review of the literature.

Case I. —Boy, aged 11 years. The meningeal symptoms occurred
during the acute stages of mumps, and were accompanied by
orchitis. Lumbar puncture, which was not performed till more
than a month after the onset, showed a normal cerebro-spinal fluid.
Recovery took place.

Case II. —Boy, aged 3 years. Meningeal symptoms developed
five days after the onset of mumps. Convulsions were frequent
and lasted till death, which occurred ten days later. The cerebro¬
spinal fluid showed marked hypertension and lymphocytosis, but
no micro-organisms. Post mortem basilar meningitis was found.
There were no signs of tuberculosis. J. D. Rolleston.

ON MENINGO-TYPHOID. (Contribution & l’tftude do mdningo-
(97) typhus.) H. Pacaud, Thiset de Lyon, 1912-13, No. 48.

The term meningo-typhoid applies to cases of typhoid fever with
an acute onset, resembling cerebro-spinal meningitis, and in which
the intestinal symptoms appear later.

In comparison with the frequency of nervous and meningeal
symptoms in typhoid fever, meningo-typhoid is rare. Its
frequency in former times has been over-estimated, because several
of the cases so described were really examples of paratyphoid fever
in which a meningeal onset is not uncommon (v. Review , 1911, ix.,
pp. 326-7; Ibid., 1913, xi., p. 278).

Meningo-typhoid must be distinguished from meningitis occur¬
ring in the course of typhoid fever. Although typhoid meningitis
without intestinal lesions may be classified under the heading of
meningo-typhoid, it aborts without presenting the intestinal phase
of meningo-typhoid properly so called.

The clinical diagnosis of meningo-typhoid is often very difficult,
and will chiefly rest upon the sudden onset, discordance between
the pulse (100) and the temperature (104* F.), and the evolution
of the disease. The cerebro-spinal fluid varies ; it is usually clear
and genei'ally under hypertension. Cytological examination is
frequently negative, but sometimes shows a variable degree of
lymphocytosis or a mixed formula (polymorphs and lymphocytes).

In exceptional cases the fluid contains typhoid bacilli and
sometimes may give a positive Widal’s reaction.

The meningeal stage lasts only a few days and is then replaced
by the ordinary symptoms of typhoid fever.

The prognosis depends upon the condition of the meninges, the
state of the intestine, and the degree of septicaemia. Death may

ABSTRACTS

occur at the beginning of the second week or earlier. Meningo-
typhoidis more frequently accompanied by complications or followed
by nervous sequelae than the ordinary form of typhoid fever.
Previous causes of meningeal irritance, especially tuberculosis and
syphilis, are important factors in the etiology.

J. D. Rolleston.

RESPIRATORY FORM OF THE ENCEPH ALOMENINGEAL
(98) REACTIONS IN TYPHOID FEVER IN THE CHILD. (Forme
respiratoire des reactions enclphalo-mlniiigtos au cours de la
flfcvre typholde chez l’enfant.) Nob£oourt and F. Mebcier, Paris
mM., 1913-14, iv., p. 32.

A record of two cases published in exienso in Caux’s thesis in
girls aged 10 and 12 years respectively. In both during the
second week of an ordinary attack of typhoid fever the respiration
was unequal, sighing and occasionally Cheyne-Stokes in character.
In both the cerebro-spinal fluid showed hypertension; in one
there were no leucocytes, in the other a few lymphocytes. Both
recovered. J. D. Rolleston.

RESP IRATO RY DISORDERS OF NERVOUS ORIGIN IN TYPHOID
(99) FEVER. (Los troubles respiratoires d’origine nerveuae dans la
flbvre typholde.) P. Caux, Theses de Paris, 1913-14, No. 59.

Anomalies of respiratory rhythm without obvious pulmonary or
renal lesions, and sometimes accompanied by a very slight
meningeal reaction, may occur in the course or at the onset of
typhoid fever.

These phenomena are most frequently found in children, and
the existence of a neuropathic state predisposes thereto. The
following classification may be adopted:—

1. Accelerated respiration which is often superficial and some¬
times irregular. This form is constantly found in the toxic and
adynamic forms of typhoid.

2. Irregular, unequal, or sighing respiration.

3. Cheyne-Stokes respiration. This may occur at a late
stage of the disease, when it is usually associated with a severe
attack, and is accompanied by a semi-comatose condition. But it
is most likely to occur at the onset of typhoid, and then doeB not
affect the prognosis, though it is often associated with symptoms
of meningeal reaction, and may lead to the mistaken diagnosis of
tuberculous meningitis.

The cerebro-spinal fluid, as a rule, shows no leucocytosis, or only
a slight and transitory lymphocytosis.

ABSTRACTS

The respiratory anomalies of typhoid fever appear to be due
to functional disturbances of the bulbar centres or of the cortical
centres governing the bulbar functions by toxins, among which the
typhoid toxin plays the principal part (cf. Review, 1907, v., p. 860).

The thesis contains the histories of fourteen cases, two of
which are original Ten relate to children and four to adults.

J. D. Rollkston.

THROMBOSIS OF THE CEREBRAL SINUSES AFTER MEASLES.

(10 i) (Trombosi dei seni cerebral! dopo il morbillo). C. Pizzata, Gazz.
internal, di med , chir., dec., 1914, p. 34.

A male infant suffering from broncho-pneumonia following
measles presented signs of meningitis. Lumbar puncture gave
issue to a blood-stained fluid under hypertension. Cytological
examination was negative. Death took place in a convulsion. The
necropsy showed sub-arachnoid suppuration in the left temporo-
sphenoidal region and thrombosis of the straight sinus, torcular
Herophili, veine of Galen, and veins of the left temporo-sphenoidal
lobe.

The paper also contains brief histories of ten other cases of
nervous phenomena following measles in children, aged from 11
months to 6 years observed in Concetti’s clinique between 1895 and
1903. They include examples of spastic and flaccid hemiplegia,
palpebral tic, spinal paralysis, disseminated sclerosis, and facial
palsy. J. D. Rollkston.

SYNDROME H£MI BULBAIRE, Ac. Duhot, L’Encdphale, Aug. 10,

(101) 1913, p. 132.

This is an excellent clinical example of thrombosis of the right
posterior inferior cerebellar artery, but the author seems to be
unaware of much of the literature bearing on this definite and
well established syndrome. S. A K. Wilson.

CONCLUSIONS DERIVED FROM FARTHER EXPERIENCE IN

(102) THE SURGICAL TREATMENT OF BRACHIAL BIRTH
P AL SY (Erb’s Type). A. S. Taylor, Amer. Jou m. Med. Set., 1913,
cxlvi., No. 5, Dec.

In 1905 Clark, Taylor, and Prout published “ A Study on Brachial
Nerve Palsy.” The clinical portion of the study was based on
seven operative cases. Since that time thirty-six additional cases
have been operated upon, making forty-three altogether. These
have varied in ace from 4 weeks to 19 years.

It is probable that both extraspinal and intraspinal lesions

ABSTRACTS

occur in different roots of the same plexus. The damage nearly
always extends from above downwards in the order of the roots,
and involves from one to all the roots.

When the lesion is intraspinal, or when the cicatrix involves
the root well into the intervertebral canal, operation as at present
performed offers little prospect of improvement.

Following permanent interference with nerve function, certain
secondary pathologic changes develop which have a decided bearing
upon determining at what age surgical interference should be
insisted upon. The bones of the extremity do not develop
normally. The clavicle is small, the scapula is small, the coracoid
process is often drawn downward and forward, forming a beak
which interferes with free mobility of the joint, and the glenoid
process maintains its infantile form.

The upper end of the humerus remains infantile, and this,
together with a similar process in the glenoid cavity, renders easy
the posterior dislocation seen in a certain proportion of these caseb.

The great majority of the cases are of the “ upper arm type,”
in which the injury involves the fifth and sixth roots.

The usual picture in the new-born child is that of a complete
flaccid paralysis of the extremity, which lies close along the side
with the elbow and wrist straight and the fingers somewhat flexed.
There is marked inward rotation of the entire extremity with
pronation of the hand. Careful palpation of the region of the
fifth, sixth, and seventh transverse processes invariably makes out
a characteristic induration which is always sensitive to pressure.

Prognosis is exceedingly bad in brachial injuries; complete
spontaneous recovery is rare.

Operation should be performed at the earliest feasible moment
considering the general condition of the child and the local
resistance. Seldom will it need to be postponed beyond three
months.

After operation the head and shoulders must be held in
approximation for weeks by a steel brace fitted before operation.
One illustrative case is reported. D. K. Henderson.

TWO OASES OF POST OPERATIVE HEMIPLEGIA. A. Webb
(103) Jones, Lancet , 1914, Jan. 10, p. 103.

Hemiplegia as a post-operative complication is rare.

Case 1.—Egyptian woman, aged 40, was operated upon for a
large uterine fibroid complicated by a tubo-ovarian abscess. The
operation lasted two hours and was very difficult. Complete loss
of power and sensation in the right arm and leg developed next
morning. Recovery was slow.

ABSTRACTS

Case 2.—Old woman with ruptured ovarian cyst, evidently
malignant. Operation simple and cyst removed. Next day right
hemiplegia with aphasia developed, succeeded by coma and death.
Post mortem no sign of haemorrhage could be found: the entire
left cerebral hemisphere showed white softening.

A. Ninian Bruce.

CLINICAL AND METABOLIC STUDIES OF A CASE OF HYPO
(104) PITUITARISM DUE TO CYST OF THE HYPOPHYSIS, WITH
INFANTILISM OF THE LORAIN TYPE D* Witt Stkttbn and
J. Rosenbloom, Amer. Joum. Med. Set., 1913, cxlvi., No. 6, Nov.

The patient was a male, 22 years old, who was operated upon in
the hope of improving his eyesight and relieving his headaches.

The cyst was evacuated, the headache was relieved, but no
improvement has occurred in the eyesight; the right eye is blind,
while with the left eye the patient can see movements of the hand,
and the pupil reacts normally.

The patient was placed on Folin’s diet which approximately
contains 119 gm. protein, 148 gm. fat, 225 gm. carbohydrate,
yielding 2,787 calories.

Examination showed a marked perversion of some metabolic
process leading to high and abnormal percentages of the neutral
sulphur and undetermined nitrogen of the urine.

D. K. Henderson.

RETROGRESSIVE INFANTILISM. (Infantilisme rtgresaif) Skringes,

(105) Joum. de mAd. de Bordeaux , 1913, lxxxiv., p. 842.

The patient had been healthy up to the age of 25, when he had
his left testis tom off in a carriage accident. The wound healed
well, but his right testis rapidly diminished in size, his penis
atrophied, his hair fell out, sexual appetite disappeared, and
erections, hitherto normal, became incomplete and rarer, and were
never followed by ejaculation. J. D. Rolleston.

THE NOGUCHI LUETIN REACTION IN SYPHILIS. George B.

(106) Foster, Amer. Joum. Med. Set., 1913, cxlvi., No. 5, Nov.

The test was applied to seventy-five persons, seventy of whom
at the time were or had been infected with syphilis, while the
remaining five individuals were used as normal controls. The
technique recommended by Noguchi was carefully followed in
applying the tests. In forty-eight cases the reactions were noted
daily for a period of ten days, and subsequently at periods of two

ABSTRACTS

to four days. In the remaining cases the reactions were examined
three to five days. All cases were under observation for from
three to five weeks.

The percentage of positive reactions among the thirteen
treated cases of secondary lues was 77 per cent.; of five tertiary
cases 80 per cent, reacted positively; while among the fifty-two
cases in the latent stage 88 per cent, gave a positive reaction. Of
the five apparently normal individuals used as controls, one case
developed a typical papular reaction. It is supposed that this
positive reaction may be explained from the fact that the maternal
grandmother had been luetic. D. K. Henderson.

SYPHILITIC FACIAL PARALYSIS. (Paralysis facials gyphilitique.)

(107) P. A Prbl, Thises de Lyon, 1912-13, No. 20.

Prel’s conclusions are as follows: Syphilitic facial paralysis is
most likely to occur in the early stage of syphilis, especially in
the secondary period. It then yields very readily to treatment,
but cure is very difficult when the paralysis appears at a later
stage. Specific treatment is the most important element in the
diagnosis, and should be applied in every case of facial paralysis
of doubtful origin. Definite cicatricial lesions may occur in the
nerve, in which case mercury is almost useless, and after failure
of potassium iodide the treatment for ordinary facial paralysis
should be employed. The thesis contains the histories of fifteen
cases, one of which is original. J. D. Rolleston.

LOCAL TREATMENT OF VINCENT'S ANGINA WITH SAL-
flOS) VARS AN. J. D. Rolleston, Practitioner , 1913, xcl, p. 847.

A record of a case in a man, aged 20, in whom the local applica¬
tion of salvarsan to the ulcerated area, after failure of other
methods, produced a rapid cure. There was no history or evidence
of syphilis, and Wassermann’s reaction was negative. A review
of the literature is given, and reference is made to other conditions
in which local application of salvarsan has been successful.

Author’s Abstract.

CHRONIC TROPHCEDEMA AND THE END00RIN0-8YMPATHETI0
(109) SYSTEM. Ayala, L'Enctphale, April 10,1913, p. 319.

Apropos of a case of chronic trophcedema of the left leg, in a man
of 51, the author advances arguments to suggest that chronic
trophcedema is a dystrophy determined either by a congenital
defect of the endocrino-sympathetic system, or, in acquired cases,
by some lesion of that system. S. A. K. Wilson.

ABSTRACTS

THE UREA CONTENT OF THE SPINAL FLUID, WITH SPECIAL

(110) REFERENCE TO ITS DIAGNOSTIC AND PROGNOSTIC
SIGNIFICANCE: A SERIES OF NINETY-SEVEN CASES.

Willard B. Soper and Selma Qrand, Archive* Intern. Med.,
1914, xiii., Jan., p. 131.

A spinal fluid urea content higher than 0 2 per cent, indicates a
severe uraemia and a rapidly fatal termination. A content between
01 per cent, and 0'2 per cent, means a rapidly fatal termination in
the majority of cases of nephritis. A content between 0*05 per
cent, and 01 per cent, does not permit of any definite conclusions
either as regards diagnosis or prognosis. Such a content is, how¬
ever, suggestive of severe urea retention, and must be taken into
consideration in the diagnosis of the condition. The authors
believe that the determination of the presence or absence of urea
retention in the body fluids will go far to clear up certain difficult
problems where the question of uraemia enters into consideration.

A. Ninian Bruce.

A CASE OF APHASIA FROM A LESION IN THE LEFT HEMI-

(111) SPHERE IN A LEFT-HANDED INDIVIDUAL : CROSSED
APHASIA AND DISSOCIATED APHASIA. Long, L'Enct-
phale , June 10, 1913, p. 520.

Clinically: Right hemiplegia and aphasia in a woman of 55.
Disappearance of the hemiplegia after one month; complete
aphasia for one fortnight, passing into a typical sensory aphasia;
little modification during the three remaining years of life.

Pathologically: Embolic softening in the left hemisphere, in¬
volving the posterior end of the second frontal gyrus, the third
frontal, the lower end of the precentral, a great part of the island
of Reil, external capsule, claustrum, and part of the putamen, as
well as the uncinate, arcuate, and occipito-frontal association bundles.
There are three features of peculiar interest in this case.

(1) Absence of motor aphasia. The difficulty resolved itself
when the author found that the patient had been definitely left-
handed, although she wrote with the right hand.

(2) Absence of areas of softening posterior to the precentral gyrus,
although the patient had word-deafness, word-blindness, paraphasia,
alexia, and agraphia. It is known, however, that an Inselaphasie
of itself will produce somewhat analogous symptoms, while inter¬
ruption of the association paths between the angular gyrus and
temporal lobe and the frontal lobe will have the same effect.

(3) The localisation of the sensory part of the function of
speech in the left hemisphere in a left-handed individual. This is
an anomaly which is difficult to explain. “ Crossed aphasia ” may
occur in both right-handed and left-handed people. As a rule the

ABSTRACTS

whole function of speech is located in the hemisphere contralateral
to the predominant “ handedness ” of the individual.

In Long’s case, however (as in an almost identical one recently
reported by Leipmann, and in an earlier one of Byrom Bramwell’s),
there seems to have been an undeniable division of the function of
language between the two hemispheres. The explanation is
uncertain: the facts are extremely important. Probably similar
instances occur more frequently than is usually supposed. There
are evidently individual variations. For this physiological variant
Long proposes the name of “ dissociated aphasia.”

S. A. K. Wilson.

A CASE OF PROGRESSIVE LENTICULAR DISEASE. (Ein Fall
(112) von progressiver Linsenkeraerkr&nkung. ) Cassirer, Neurol.

CentralbL, 1913, Oct. 16, p. 1284.

The case described by Cassirer is that of a youth of 17, who since
boyhood had suffered from a certain awkwardness of movement of
the right hand, especially in writing. Very gradually the condition
progressed; speech became a little slovenly and indistinct. The
previous history revealed no outstanding features beyond this
progressive awkwardness of the limbs and dysarthria. When the
patient came under observation it was noted that the facies was
somewhat expressionless; the patient’s attitude as a whole was
stiff; facial movements were slow and somewhat impaired; fine
tongue movements were slow and performed with difficulty.
Speech was slow, scanning, with a slight nasal intonation. There
was also some difficulty in swallowing. Saliva escaped from the
mouth. All voluntary movements were accompanied by irregular
trembling of the limb involved : sometimes there were “attacks ”
of generalised tremor, lasting a few minutes, of a “ shivering ” or
“ shuddering ” type. The patient was quite unable to make move¬
ments quickly, and on passive movement it was easy to detect
resistance both in flexor and extensor groups. The legs were less
affected than the arms. There was some flexor contraction in the
legs. Occasionally associated movements were noted. Sensi¬
bility was normal The reflexes, deep and superficial, were
normal. There was no actual paralysis anywhere.

The author emphasises as the cardinal features of this case the
tremors, stiffness and slowness of voluntary movement, the
dysarthria, and the absence of all signs of pyramidal affection. He
points out that it presents the closest analogies to the disease
described by the reviewer as “ progressive lenticular degeneration,”
and an excellent analysis and comparison of the two are given.
Cassirer draws attention to the “pseudosclerosis” group, pointing out
certain differences (mental condition, epileptiform attacks) between

ABSTRACTS

it and his own case, which he includes in the Wilson’s type,
although he agrees it may not be an etiologically identical case.
In the reviewer’s opinion Cassirer’s case is more closely allied to
Wilson’s disease than to the type described by Vogt, in which
athetoid movements predominated. S. A K. Wilson.

PROGRESSIVE EPILEPTIC MYOCLONUS. (Type Unvenicht-Lund-

(113) borg.) Jacquin and Mabchand, L'Enctphale, March 10, 1913,
p. 205.

A girl of 19 suffered from infantile convulsions at the age of 3,
developed epilepsy at the age of 10, and myoclonus made its
appearance when she had reached the age of 15. The myoclonic
attacks were quick, sudden, painless, non-systematised: they were
localised chiefly in the arms, and disappeared during sleep. The
patient died, set. 20, from pulmonary tuberculosis. There were
general cortical sclerosis, reaching as deeply as the pyramidal
layer, atrophy of the pyramidal cells and degeneration of tan¬
gential fibres. The glial sclerosis was extremely dense and fine,
and astrocytes were not seen. S. A K. Wilson.

PERIPHERAL NEURITIS FROM ISCHEMIA Dtthot, Pikeeet,

(114) and Vzehaeghe, VEnctphalc, Feb. 10,1913, p. 137.

A revue d'ensemble in which the authors draw attention to
histological changes in the peripheral nerves, both parenchymatous
and interstitial, occurring in the course of ischaemia from disease
of the vasa nervorum, and in this way explain some of the
symptoms of Volkmann’s paralysis and of arteriosclerosis,
intermittent claudication, &c. S. A K. Wilson.

NEUROSES AND SEXUALITY. Ladame, L'EnctphaU , Jan. 10,1913,

(115) p. 51, and Feb. 10,1913, p. 157.

These articles may be strongly recommended to the attention of
all who have followed the Freudian movement in recent years.
It is impossible to abstract them satisfactorily. It may be said,
however, very briefly, that their critical and common-sense scrutiny
of some of the pretensions of the Freudian School is eminently
calculated to sober the enthusiasm of those Athenians of to-day
who run after every new thing. S. A. K. Wilson.

THE TEACHING OF FREUD AND HIS SCHOOL. Rtois and

(116) Hesnaed, VEnctphale, April, May, and June 1913, pp. 356, 446,
and 537.

This long critical review is deserving of the attention of the
neurologist and psychiatrist. Its viewpoint is scientific, not

ABSTRACTS

sentimental: it is a reasoned, unbiassed, sober, and by no means
unsympathetic discussion of Freud’s teaching. It does not lend
itself to summarising, but we may translate some of the closing
sentences.

“Freud’s teaching is attractive, but extremely hypothetical,
mainly because it is a medico-philosophical system, and because it
brings into association an enormous amount of data inadequately
or not at all controlled. It should not, however, be therefore
misunderstood or condemned. On the contrary, its study should
be continued, provided it is always regarded as a provisional
and partial theory. . . . Freud may be pardoned for basing his
system merely on daring hypotheses as long as it is considered
simply as an attempt at a pathogeny for the psychoneuroses.”

There is a very extensive bibliography attached.

S. A. K. Wilson.

PSYCHIATRY.

SUPBABENAL APOPLEXY IN GENERAL PABALY8I8. SUDDEN

(117) DEATH. (Apoplexie surrfaale chez une paralytique gfafrale.
Mort subite.) Di Tbtssibu, Gaz. hebd. des Set. mid. de Bordeaux,
1913, xxxiv., p. 586.

The patient was a woman, aged 48, in the early stage of general
paralysis. In addition to the characteristic findings in the brain,
the necropsy showed a considerable haemorrhage into the right
suprarenal. J. D. Rolleston.

ON THE EEFliEXBS IN DEMENTIA PBABOOX. (Contribution t

(118) l’Atude det reflexes dans la ddmence prdcoce.) A Borel, Thises
de Paris, 1913-14, No. 68.

From an examination of twenty-three cases Borel came to the
following conclusions:—

1. In two-thirds of the cases the tendon reflexes were
exaggerated, and the cutaneous reflexes diminished.

2. With the exception of Pilcz’s sign, which was present in
78 per cent., the oculo-pupillary reflexes were too inconstant to
be of any value.

3. In 82 per cent. Leri’s reflex was negative or asymmetrical.

4. Disturbances of the reflexes in dementia praecox do not
depend upon the clinical variety of the disease, but occur
indifferently in every form of it, and do not appear to be affected
by states of depression and of excitement.

5. Similar disturbances of the reflexes do not occur in mania
or melancholia.

6. Disturbances of the reflexes in dementia prsecox seem to

ABSTRACTS

haimonise with the probability of the lesions being situated in the
higher nerve centres, lesions which have been observed by
numerous authors.

7. The presence of Pilcz’s sign and the absence of Leri’s reflex
in association with the disturbances of the reflexes mentioned
(vide 1) may be of considerable value in the diagnosis of dementia
prjecox. J. D. Rolleston.

RESEARCHES ON THE GENITAL GLANDS IN DEMENTIA PR.®

(119) 00X. Obrbgia, Parhon, and Urechia, L'Enetphale, Feb. 10
1913, p. 109.

From a histological examination of the testes and ovaries in
several cases of dementia pnecox, the authors conclude that
the development of the disease cannot be attributed to a disturb¬
ance of the internal secretion of the sexual glands. They have
noted absence of spermatogenesis in some instances, and this, with
other facts, such as alteration in the blood, suggests that dementia
praecox is a generalised pathological condition, not limited to the
brain. S. A. K. Wilson.

ACHONDROPLASIA WITH MANIC-DEPRESSIVE PSYCHOSIS.

(120) (Una alienata acondroplasica.) G. C. Befani, Raxsegna di Studi
Psichiat., 1913, iii., Nov.-Dee., p. 468.

A case of achondroplasia in a woman, aged 21, in whom the
condition was very marked in the lower limbs. The mental
condition was one of manic-depressive psychosis. The author
thinks that the mental state of such cases is “ hypomanic,” and
that such patients have a peculiar psychical vulnerability. They
are not, however, more liable to mental disease than normal people,
and when these do occur they are not in any way distinctive. The
author is inclined to think that on account of this peculiar mental
vulnerability these patients have an exaggeration of their usual
psychical phenomena, which is in the direction of the manic-
depressive psychoses (v. Review, 1918, xi., p. 557).

A. Ninian Bruce.

BOOKS AND PAMPHLETS RECEIVED.

Braun, Alfred, and Friesner, Isidore. “ The Labyrinth : An Aid to the
Study of Inflammations of the Internal Ear,” pp. 250. Rebman Ltd.,
London, 1913. Pr. 17s. 6d. net.

Franz, S. Ivory. “ Psychological Factors in Medical Practice ” ( Inter¬
state Med. Joum., 1914, xxi.).

Turrb, JR. “Les Origines de la Connaissance.” Felix Alcan, Paris,
1913 . Pr. Fr. 5.

■ftevnew

IReurologp anb jp>s£cbtatti>

Original Hrticles

LABYRINTH SUPPURATION.

(.A Review.)

By J. 8. FRASER, M.B., F.R.C.8., Edinburgh.

Development and Anatomy of the Labyrinth.

The membranous labyrinth is developed from the otic vesicle—
a hollow ingrowth of epiblastic neuro-epithelium, which sinks into
the mesoblast. Later the otic vesicle becomes differentiated into

(1) the Pars Superior, or Static Labyrinth, consisting of the
saccule, utricle, and the three membranous semicircular canals:
to this part is attached the vestibular nerve and its ganglion.

(2) The Pars Inferior, or Membranous Cochlea, to which the
cochlear nerve and its spiral ganglion are attached. From the
point of view of comparative anatomy the static labyrinth is con¬
siderably older than the auditory labyrinth.

1. Pars Superior .—The three membranous canals communicate
with the utricle by five openings—the superior and posterior
vertical canals having a common opening (crus commune) at their
non-ampullated ends. The three canals lie in the three dimensions
of space: each canal is dilated at one end into an ampulla which
contains a small mound of neuro-Qpithelium called the crista.
This mound is capped by the cupola, and is supplied by a branch
from the vestibular nerve. The utricle itself shows a layer of
8

J. S. FRASER

epithelium on the inner side of its external wall; the neuro¬
epithelium of the saccule is placed on the antero-internal wall of
the cavity at right angles to the plane of the sensory epithelium
in the utricle. The utricle and saccule each give off fine ducts
which join to form the endolymphatic duct; this again ends in
the endolymphatic sac between the layers of the dura on the
posterior surface of the petrous pyramid. The utricle and saccule
are supplied by tbe vestibular nerve and its ganglion in the
internal auditory meatus.

2. The Pars Inferior, or Membranous Cochlea, is a blind tube
(somewhat triangular on section), coiled round a central stem or
modiolus. In the floor of this tube, which is wider at the apex
than at the base of the cochlea, lies Corti’s organ—a small mound
of neuro-epithelium supplied by the cochlear division of the
eighth nerve and its spiral ganglion, which is situated in the
modiolus. In the embryo, and probably also in the adult, the
narrowest part of the cochlea is connected to the saccule by means
of a fine duct (canalis reunions ).

The Bony Labyrinth .—In the early embryo the membranous
labyrinth is surrounded by a layer of meBoblast, which develops
into a hollow capsule of cartilage. This, later on, becomes con¬
verted into dense bone and embedded in the petrous temporal;
the cartilage bone capsule of the labyrinth can, however, always
be distinguished from the stirrounding lamellar bone, with its
marrow spaces. If this cartilage bone capsule be artificially cut
out by a skilled workman, it will be found to consist of (a) the
bony semicircular canals, which contain the membranous canals,
and open into ( h ) the bony vestibule, which contains the utricle
and saccule, and communicates in front with ( c ) the bony cochlea,
which encloses the membranous cochlea. On the outer wall of
the vestibule we have the oval window, which is closed in the
living by the footplate of the stapes and the annular ligament.
The bony cochlea resembles the shell of a snail, and lies with its
base towards the internal auditory meatus. From the central
stem or modiolus of the cochlea the bony spiral lamina projects
into each coil of the bony cochlea. To the edge of the bony
spiral lamina the membranous cochlea is attached. The outer
surface of the membranous cochlea is attached to the outer wall
of the bony cochlea. In this way each coil of the bony cochlea
is divided into three parts: (1) the scala vestibuli above, which

LABYRINTH SUPPURATION

communicates with the vestibule; (2) the scala tympani below,
which begins at the round window; and (3) the membranous
cochlea with its spiral lamina, which lie between (1) and (2).
At the apex of the cochlea the scala vestibuli and the scala
tympani become continuous with one another at the helicotrema.
The membranous labyrinth is filled with fluid (endolymph), and
is surrounded more or less by fluid (perilymph), which separates
it from the endosteal lining of the bony labyrinth.

The best way to understand the anatomy of the labyrinth is
to think of a tunnel driven through a small hilL If a section be
made through this hill, the cut end of the tunnel will be seen, and
round it the stonework forming the wall of the tunnel The hill
corresponds to the petrous bone; the stone walls of the tunnel to
the dense cartilage bone which forms the true capsule of the
labyrinth. The cavity of the tunnel corresponds to the hollow
space within the bony labyrinth. If we further suppose that
the tunnel contains a train, and that both tunnel and train are
flooded with water, we find that the water in the train corresponds
to the endolymph, the train itself to the membranous labyrinth,
and the fluid between the train and the walls of the tunnel to the
perilymph.

The outer wall of the bony labyrinth is a party wall, ie., it is
also the inner wall of the middle ear. For this reason the oval
and round windows, the external or horizontal canal, and the
promontory, which contains part of the cochlea, are exposed to
infection in cases of otitis media. The oval window communicates
with the perilymph space of the vestibule, while the round window,
which lies at the top of a deep niche, communicates with the
perilymph space of the cochlea. Vibrations of the perilymph,
set up by movement of the footplate of the stapes in the oval
window, pass up the scala vestibuli of the cochlea to the apex,
and then through the helicotrema down the scala tympani to the
round window. Occasionally the bony labyrinth is almost entirely
surrounded by air cells which communicate with the tympanic
cavity and mastoid antrum, and form part of the middle ear cleft.

On the inner wall of the mastoid antrum we find a series of
small veins—the remains of an important foetal vein—which pass
through the fossa subarcuata beneath the dome of the superior
canal, to reach the posterior surface of the petrous pyramid, and
there to open into the superior petrosal sinus. Infection may pass

J. S. FRASER

along this route and give rise to extradural abscess and meningitis.
This mode of infection has nothing to do with labyrinthitis.

The lymphatic system of the labyrinth is divided into two
parts—endolymph and perilymph. The endolymph system ends
in the saccus endolymphaticus already mentioned. The perilymph
communicates directly with the subarachnoid space of the posterior
cranial fossa by means of the cochlear aqueduct, which opens out of
the scala tympani of the cochlea in the region of the round window.

The membranous labyrinth and its capsule of cartilage bone
are supplied by the internal auditory artery—a branch of the
basilar—which enters at the internal auditory meatus. The
veins, on the other hand, leave the labyrinth along the aqueducts
of the vestibule and of the cochlea.

Physiology.

From the physiological point of view the internal ear is divided
into (1) the auditory labyrinth, and (2) the static labyrinth.

1. The blind tube of the membranous cochlea commences
within the vestibule, and coils round the central stem or modiolus
as described above. At its beginning within the vestibule the
cochlear duct is narrow, and at this part the highest tones are
appreciated. At the apex of the cochlea the duct is wider, and
here the lowest tones are heard. The range of hearing of the
human cochlea extends from sixteen double vibrations per second
up to about eighteen thousand—at least in young subjects. The
auditory apparatus is tested by means of the voice (spoken and
whispered), the watch, or akoumeter, a series of tuning forks
ranging from C. 16 up to C. 4,096 double vibrations per second.
Above this the upper tone limit is best tested by means of tbe
monochord—an instrument on the principle of the violin string,
which can be made to vibrate transversely (lower tones, 4,000-6,000
D.V.S.) or longitudinally for the higher tones, 7,000-18,000 D.V.S.
It is unnecessary to describe these tests further. In order to
establish the presence of complete unilateral deafness (as in cases
of labyrinth suppuration) B&rdny has invented the clockwork
noise apparatus: this instrument is inserted into the patient’s
good ear, and, when in action, fully occupies the attention of this
ear, so that any sounds which the patient hears must be appreci¬
ated by the diseased ear. Syringing the healthy ear or rubbing

LABYRINTH SUPPURATION

(he auricle with the hand serve the same purpose as the noise
apparatus.

2. The Static Labyrinth (BArAny).—Movements of the endolymph
in the membranous canals act on the cristse and cupulae, and the
stimuli so created pass by way of the vestibular nerve to the vesti¬
bular nuclei at the base of the brain: from these nuclei fibres
radiate (a) to the nuclei of the motor nerves of the eye muscles
(giving rise to nystagmus), (b) to the motor neurones of the spinal
cord (giving rise to the irregular gait characteristic of vestibular
lesions), and (c) to the cerebellum. Ewald showed, by experiments
on pigeons (application of pressure to an artificial fistula in the
horizontal canal), that movement of the endolymph in the right
horizontal canal, from the smooth end towards the ampulla, caused
horizontal nystagmus to the right, while movement in the opposite
direction produced a weaker horizontal nystagmus to the left. In
the external canal, movement of the endolymph from the smooth
end to the ampulla is therefore the more effective movement.
Vestibular nystagmus is of the following type: Horizontal
nystagmus to the right consists of a quick twitch of the eyes to
the right and a slower movement to the left—it is a rhythmic
associated movement. Vestibular nystagmus is always most
distinct when the patient is made to turn his eyes in the direc¬
tion of the rapid twitch; on the other hand, the nystagmus will
be lessened or abolished when the patient looks in the direction of
the slow component. It is important to remember that the slow
movement of the nystagmus is the real vestibular component;'
the quick twitch is voluntary, and is abolished when the patient
is under chloroform.

The functions of the utricle and saccule are not definitely
known. It is believed, however, that they enable us to appreciate
passive movement in a straight line when the eyes are closed or
when we are in the dark, just as the canals enable us to appreciate
passive rotation. It has also been suggested that the saccule may
enable us to hear noises as distinguished from musical tones.

Clinical Methods of Testing the Vestibulab
Apparatus (BArAny).

It is first necessary to test the patient for spontaneous
nystagmus, as some normal people have slight but equal nystagmus
on looking to the extreme right or left.

J. S. FRASER

Botation .—The patient is placed in a turning chair with his
head upright, and is rotated at the rate of ten complete revolutions
in twenty seconds. At the end of the tenth turn the rotation is
suddenly stopped, and the duration of the resulting nystagmus
is measured by a watch: if opaque spectacles are worn by the
patient the nystagmus is rendered more marked. When the head
is in the erect position the rotation affects only the two horizontal
canals, as they alone are in the plane of rotation. At the beginning
of rotation to the right the endolymph in the right canal, in virtue
of its fluid inertia, flows towards the ampulla, relatively speaking:
in the left canal the fluid flows away from the ampulla. As the
rotation is continued, the endolymph catches up with the movement
of the canal wall until it rotates at the same rate. If now the
rotation of the individual be abruptly stopped, the movement of
the endolymph will continue, but its flow relative to the ampulla
will be in the reverse direction to what it was at the beginning of
rotation. In order to understand the movements of the endolymph
and cristse, we have only to think of what oocurs in an Edinburgh
tram car—especially on a wet day. When the car starts suddenly,
all the passengers are violently jerked backwards, but, as the car
goes on, they again assume an upright position, and maintain it
until the car stops suddenly, when they are all jerked forwards.
The cristae of the membranous canals correspond to the passengers.

Nystagmus produced by suddenly stopping the rotation of a
patient is known as “ after-nystagmus.” The average duration of
the horizontal “ after-nystagmus ” in a normal individual, due to
rotation with the head erect, is from fifteen to thirty seconds. By
bending the head in various directions it is possible to investigate
the remaining canals; this, however, is of little practical im¬
portance. We must remember that the posterior canal on the
right side is on a plane parallel to that of the superior canal on
the left side; the same thing, of course, holds with regard to the
posterior canal on the left side and the superior canal on the
right side (Crum-Brown).

The laws of nystagmus are as follows: I. Each pair of canals
induces nystagmus in its own plane. II. Nystagmus, due to rota¬
tion, corresponds to the line of intersection of the horizontal
plane with the cornea.

Caloric Nystagmus .—If a patient with normal vestibular
apparatus has his right ear syringed with cold water when his

LABYRINTH SUPPURATION

head is erect, horizontal and rotatory nystagmus to the left is
produced. If warm water (116° F.) be used, the nystagmus is
rotary to the right (the reader must distinguish between rotary
nystagmus and nystagmus due to rotation). The explanation of
caloric nystagmus is as follows: When the head is upright, the
summit of the superior canal is the highest point in the labyrinth,
while its ampulla lies lower down, near the outer labyrinthine
wall. If one cools down the outer wall of the labyrinth by
syringing cold water against it, a downward current is set up
which acts on the crista of the superior and horizontal canals, and
gives rise to nystagmus. In the same way warm water causes an
ascending current: if the fluid used be at body temperature there
is, of course, no reaction. If the vestibular apparatus be destroyed,
or the vestibular nerve paralysed, nystagmus cannot be induced by
syringing that ear. The caloric method has this advantage over
rotation that we can, by syringing, test each ear separately.

When nystagmus to the left is produced in a normal person,
he tends to fall to the right if he stands with his feet together and
eyes shut, i.e., he falls in the direction of the slow component of
nystagmus. If his head be turned ninety degrees to the left he
falls forwards; if turned ninety degrees to the right he falls
backwards.

Galvanism may be used to test the vestibular apparatus.
When the cathode is applied to the right ear we get rotary
nystagmus to the right; when the anode is applied we get
nystagmus to the left. Galvanism, however, causes nystagmus even
if the labyrinth be destroyed, as it acts on the vestibular nerve.
For this reason it is not of great practical importance, except in
cases of cerebello-pontine angle tumour.

Fistula Symptom .—An olivary ear piece—attached by rubber
tubing to a Politzer bag—is fitted tightly into the external
auditory meatus. If the bag be now squeezed so as to raise the
air-pressure in the external meatus, nystagmus is produced to the
affected side (typical fistula symptom). Occasionally we get a
reversed fistula symptom, i.e., compression produces nystagmus to
the opposite side. The fistula symptom is only obtained in cases
in which a fistula exists in the bony wall between the middle and
inner ear, and in which the vestibular apparatus is more or less
intact.

Pointing Test .—The patient shuts his eyes, closes his hand

J. S. FRASER

(palm downwards), and extends his index iinger to meet the index
finger of the examiner. He is then told to slowly flex the hand at
the wrist joint, and then to raise it again to meet the examiner’s
finger. Any pointing error present is in the direction of the slow
component of the nystagmus. A spontaneous error in the pointing
test is usually due to a lesion in the posterior fossa, such as a
cerebellar or extradural abscess.

Pathology of Labyrinthitis (Braun and Friesuer: Ruttin).

Infection of the inner ear occurs once in every hundred cases
of purulent otitis media—usually as the result of an acute exacer¬
bation in a chronic case.

Labyrinthitis may be—(1) circumscribed , or (2) diffuse.

1. The circumscribed form may affect only the bony capsule
(para-labyrinthitis), or it may have invaded the perilymph space
(peri-labyrinthitis). These two forms may be combined.

Within the vestibule there is a fibrous septum (Alexander),
which divides the utricle and canals on the one hand, from the
saccule and cochlea on the other. In this way labyrinthitis
may remain for a period confined to one set of structures. The
perilymph spaces of the ampullae of the canals are almost com¬
pletely shut off from the vestibule by septa of connective tissue.
Peri-labyrinthitis may, in this way, be further limited.

In the cochlea labyrinthitis may be limited to the lower half
of the basal coil, whether the infection passes by way of the round
window or oval window. The lower half of the basal coil of the
cochlea remains the lowest portion of the cochlear cavity in every
position of the head (Ruttin).

2. Diffuse labyrinthitis occurs in two forms: (a) Empyema of
the labyrinth (combined inflammation of the peri- and endo¬
lymphatic spaces), and (b) pan-labyrinthitis, in which the bony
capsule is affected in addition.

Circumscribed and diffuse labyrinthitis may be acute, sub¬
acute, or chronic.

Labyrinthitis may also be classified according to the causal
disease or organism, e.g., scarlatinal, cholesteatomatous, tubercular,
pneumococcic, &c. Fracture of the base of the skull and injury
with a pointed instrument, such as a knitting needle, may give
rise to a traumatic form of labyrinthitis.

Lastly, labyrinthitis may be classified according to the route

LABYRINTH SUPPURATION

of infection: (1) Meningeal, as in cerebro-spinal meningitis: from
15 to 50 per cent, of cases of cerebro-spinal meningitis are followed
by deafness; (2) Tympanic, as in suppurative otitis media; and
(3) Metastatic, as in mumps.

1. Meningeal cases. —From the meninges the labyrinth may be
infected through (a) the aqueduct of the cochlea from the
subarachnoid space, (6) along the internal auditory meatus, (c) by
necrosis of the inner bony wall in cases of extradural abscess.

2. Tympanic. —From the middle ear the infection may pass to
the labyrinth by way of (a) the oval window; (6) the round
window; (c) fistula of the external canal; and ( d ) fistula through
the promontory. If, for example, we take a case in which the
prominence of the external canal is gradually absorbed by pressure
of a mass of cholesteatoma in a case of chronic middle ear
suppuration, we find that in time the bone is worn through so
that the cholesteatoma is now in direct contact with the endosteum
lining the canaL A little fibrinous exudation may occur in the
canal in the region of this fistula ( circumscribed labyrinthitis).
The condition present in such a case corresponds to that in
Ewald’s experiment on the pigeon. If the air pressure in the
external meatus and middle ear be now artificially raised, pressure
will be exerted through the fistula on the labyrinthine fluid, and
therefore on the crista of the external canal; giddiness and
nystagmus are thus produced (fistula symptom). The hearing
power is not affected, except by the otitis media already present.
If now an acute exacerbation of the otitis occur, the feeble barrier
remaining may be broken down so that the labyrinth becomes
generally infected. At first the inflammatory exudation is sero¬
fibrinous, with only a few round cells ( diffuse serous labyrinthitis),
and if the process stops at this stage the labyrinth may almost
entirely recover. Such a mild attack may occasionally follow the
radical mastoid operation. On the other hand, if the inflamma¬
tory process continues, the labyrinthine fluid becomes definitely
purulent {manifest diffuse purulent labyrinthitis): in this condition
the patient suffers severely from giddiness, vomiting, and loss of
balancing. He is absolutely deaf, but does not usually complain
much of tinnitus. Within a few days (three to fourteen) the mem¬
branous labyrinth is entirely destroyed, and the condition passes
into the stage of latent diffuse purulent labyrinthitis. This stage may
last for several months, while granulation tissue and new bone are

J. S. FRASER

formed in the labyrinth. Finally, the hollow spaces of the inner
ear become filled with connective tissue and new bone, and the
case passes into the stage of spontaneous cure of labyrinth suppura¬
tion with compensation.

The inflammatory process may extend from the labyrinth—

(1) By way of the aqueduct of the cochlea to the subarachnoid
space of the posterior fossa, and give rise to lepto-meningitis.

(2) The infection may spread to the internal auditory meatus
along the subarachnoid sheath of the cochlear nerve, or along the
nerve to the saccule or utricle, and give rise to lepto-meningitis.

(3) In rare cases pus accumulates in the endolymphatic sac
(empyema of the saccus). (4) The pus in the labyrinth may burst
inwards, usually through the posterior or superior canals, and give
rise to extradural abscess.

Folitzer has pointed out that an abscess may form in the
fundus of the internal meatus, and may destroy not only the
nerve fibres but also the labyrinthine artery: this results in
necrosis of the membranous labyrinth, and of a large part of its
cartilage bone capsule.

The endosteum which lines the bony labyrinth is the most
resistant of all the labyrinthine structures. In those cases of
labyrinthitis in which spontaneous cure occurs, the organisation
of the pus in the labyrinth proceeds from this membrane: osteo¬
blasts pass in to the granulation tissue which fills the labyrinth
and form new bone until, eventually, the hollow spaces of the
labyrinth are entirely obliterated.

It will be seen that labyrinthitis may end in (1) return to
normal, in cases of mild serous labyrinthitis; (2) spontaneous
cure with slight permanent changes; (3) spontaneous cure with
destruction of the labyrinthine function; (4) extension to the
intracranial structures. If labyrinthitis extends to the cranial
cavity it usually gives rise to lepto-meningitis; more rarely it
leads to extradural abscess, cerebellar abscess, or sinus thrombosis.
The most frequent path of infection, in cases of meningitis, is the
perilymphatic or cochlear aqueduct; if it were not that this canal
is very narrow, and that in some cases swelling of its lining
membrane completely shuts off the perilymph in the cochlea from
the subarachnoid space, otitic meningitis would be even more
frequent than it is.

LABYRINTH SUPPURATION

Thb Clinical Aspect and Treatment of Labyrinthitis

(Ruttin).

1. Circumscribed Labyrinthitis, and Labyrinth Fistula.

In this condition the patient complains of attacks of dizziness,
with occasional vomiting, especially on stooping or turning quickly.
Spontaneous nystagmus may or may not be present; if present,
it may be to the healthy side, to the diseased side, or even to
both. The caloric reaction is usually diminished. With the
noise apparatus in the healthy ear, the patient can, as a rule,
hear fairly well. The fistula symptom is present (normal or
reversed).

Treatment .—The radical operation should be performed, but
great care must be taken not to interfere with the fistula. If, as
sometimes happens, the attacks of dizziness, from which the
patient suffers, interfere with his work, the labyrinth operation
may be performed (see page 98).

2. Diffuse Serous Labyrinthitis.

This condition occupies an intermediate position between
circumscribed labyrinthitis and manifest diffuse purulent laby¬
rinthitis.

Symptom of Diffuse Serous Labyrinthitis .—The patient com¬
plains of deep-seated pain in the ear, tinnitus, and deafness. The
vestibular symptoms (dizziness, vomiting, and loss of balancing)
are more important. The patient lies on the sound side and looks
towards the diseased side as, in this position, the nystagmus and
giddiness are less. The patient complains that external objects
appear to move from the sound to the healthy side. The tem¬
perature is not raised. With the noise apparatus in the sound
ear the patient is not absolutely deaf. If the lesion be on the
left side, spontaneous nystagmus to the right is present; when
standing with eyes shut the patient tends to fall to the side of
the lesion, ie., in the direction of the vestibular component of the
nystagmus—in this case to the left. The vestibular reaction to
rotation and syringing are, as a rule, still present, though
diminished. The fistula symptom may be present, but is usually
absent.

Treatment .—If the patient can still hear with the affected ear,
the labyrinth operation should not be performed. If, on the other

J. S. FRASER

hand, the diseased ear be quite deaf and the vestibular reaction
absent, the labyrinth must be opened and drained at the time of
the radical mastoid operation; in other words, if we cannot
diagnose between diffuse serous and diffuse purulent labyrinthitis,
we must treat the case as one of the more dangerous variety.

3. Manifest Diffuse Purulent Labyrinthitis.

This condition lasts only from three to fourteen days. During
this period the patient suffers from intense giddiness, vomiting,
and loss of balancing. The vomiting is accompanied by nausea,
and is not of the effortless cerebral type. Complete deafness is
present when the noise apparatus is going in the sound ear.
Marked spontaneous nystagmus is present to the sound side, and
the caloric reaction is absent on the diseased side. Spontaneous
pointing and falling are to the affected side. The fistula symptom
is not present, because the membranous labyrinth is destroyed.
The patient is too ill for the rotation test.

Treatment .—If there are no urgent symptoms, such as severe
pain, fever, or signs of intracranial trouble, it is permissible to
wait in order that a barrier may form. If, on the other hand,
interference is called for, a free radical mastoid operation should
be at once performed, so as to expose the promontory and the
two windows. The dura of the posterior fossa over the sinus
should then be laid bare with a blunt gouge. The dura is then
separated from the bone of the posterior fossa in an inward
direction by means of a blunt dissector, and protected from injury
with a small flat spoon or Stacke’s protector. The petrous bone
is now removed with the gouge and hammer in an inward and
forward direction, until the posterior and external canals have
been freely opened up behind the facial nerve. The vestibule is
now opened from behind by tracing up the smooth end of the
external canal Finally, the vestibule should be opened in front
of the facial nerve by two or three blows with a fine gouge,
removing the outer wall of the promontory, and joining the
oval and round windows. At the present time the general
opinion is that the cochlea should not be further interfered with
unless meningitis be present. In the latter case the inner wall of
the vestibule should be opened up and the subarachnoid space of
the internal meatus drained (trans-labyrinthine drainage of West
and Scott).

LABYRINTH SUPPURATION

4. Latent Diffuse Purulent Labyrinthitis.

At the end of from three to fourteen days the manifest stage
passes into that of latent diffuse labyrinth suppuration. The
labyrinth is now entirely destroyed. In this latter stage the
patient will, if carefully questioned, give a history of recent
dimness, vomiting, and loss of balancing. These symptoms have,
however, now passed off.

Symptoms in the Latent Stage .—There is complete deafness in
the affected ear. Spontaneous nystagmus is usually absent, but
there may he a slight rotary twitch to both sides. The caloric
reaction is absent in the diseased ear. On rotation, there is a
marked difference in the duration of the “ after-nystagmus,”
depending on the direction of the rotation, e.g., if the patient have
a latent labyrinthitis on the right side, and if we rotate him to
the right (thus mainly testing the left or healthy labyrinth), he
will get horizontal nystagmus to the left of almost normal
duration—say twenty seconds. When, however, we rotate him
to the left (thus mainly testing the right or diseased labyrinth), we
only produce very slight nystagmus to the right of from four to
ten seconds duration.

Treatment .—If the radical operation is called for, the labyrinth
operation, described above, must also be performed. If this be
not done the patient runs a grave risk of getting meningitis as
the result of the mastoid operation alone.

5. Healed Labyrinthitis with Compensation.

This condition is probably present at a period of six months
and upwards after the attack of purulent labyrinthitis. The
patient is quite deaf in the affected ear, and the caloric reaction is
absent. Rotation, however, to the right and also to the left,
produces an equal duration of “ after-nystagmus,” because compen¬
sation has been established, and the external canal on the healthy
side reacts equally to both directions of rotation. In such a case,
even if the radical mastoid operation be called for, Alexander holds
that it is not necessary to do the labyrinth operation, as there is no
fear of infection spreading from the inner ear to the meninges.
Other otologists, however, consider that it is impossible to be
quite sure that the labyrinth is filled with new bone. They

100

LEONARD J. KIDD

believe that pus may still be present, and that, for this reason, it
is safer to do the labyrinth operation at the time when the
radical mastoid operation is performed.

References.

BArXny. —“ Physiologic and Pathologic des Bogeng&ng- Apparatus.’' Vienna,
1907.

Braun and Friksnrr.— “ The Labyrinth.” London, 1913.

Ruttin. —“ Klinih der Seroaen und Eitrigen Labyrinth Entzundungen.”
Vienna, 1912.

ISCOVESCO’S EXPERIMENTAL RESEARCHES
ON LIPOIDS OF ORGANS.

(A Review.)

By LEONARD J. KIDD, M.D.

Henri Iscovksco's researches on this subject have been pursued
for at least four or five years; but his most recent work, embodied
in the ten papers now under review, is of special interest in
several directions, and brings out some new facts that bear closely
on some of our present beliefs as to the functions of organs.
These papers are published in the Compt. Bendus Soc. de Biol.,
(a) lxxv., 1913-14, pp. 361, 393, 445, 450, 510, 548, 681; (b) lxxvi.,
1914, pp. 34, 74, 117. Iscovesco’s mode of extraction of the
lipoids, several varieties of which are contained in each organ, is
described; and to each lipoid specially tested he gives a number.
A uniform procedure has been adopted, the special lipoid having
been injected, usually in an oily solution, hypodermically into the
loose cellular tissue of the neck in rabbits every day or two for a
period of months; the animals, and also the controls of the same
age, are weighed at the beginning of the treatment: later on,
autopsy includes weighing of the body and all the important
viscera, and tables are given of the relative weights in the treated
and untreated animals. In many of these studies Iscovesco has
injected these lipoid solutions into man.

The thyroid lipoid (II. Ba), when injected daily in a dose of
1 to 2 eg. per kg. of the rabbit’s body-weight, causes at

RESEARCHES ON LIPOIDS OF OROAKS. : i<3t

the end of two months a hypertrophy of the thyroid and
heart, tachycardia, and a true exophthalmos: it stimulates (i.e.,
increases the weight of) the adrenals, ovaries, uterus, and testes;
the female heart more than the male, the spleen slightly, the
kidneys only in males, and the thyroid very markedly, but more in
females. This lipoid also regularises the increase of weight and
the bodily growth in young animals, but, on the contrary,
diminishes the body-weight of adults.

Out of the many lipoids of the ovary the most important is
the fifth (V. Dc): when injected regularly for three months it
leads to utero-ovarian hypertrophy: this lipoid is the same one
whether it comes from cow, mare, or sow. To obtain the results,
the animals and the controls must be virgin and aged about three
months. Injected every two days for three months, it acts almost
exclusively on the uterus, ovary, and thyroid, and either not at all
or to a trifling extent on the adrenals, heart, liver, spleen, and
kidneys. It regularises and accelerates bodily growth in young
animals.

The lipoid (II. Bb) extracted from the testes was injected
into adult rabbits aged 8 months, and into young ones aged 7
weeks, in an oily solution. In the adults 1 eg. per kg. of body-
weight injected every two days for three months led to great
hypertrophy of the testes; it increases the weight of the kidneys
slightly (unlike the ovarian lipoid), and the thyroid slightly, but
less than the ovarian lipoid does. The body-weight of these adults
was increased: the animals became very excited, and the phe¬
nomena of rut were greatly accentuated. Iscovesco thinks the
testicular hypertrophy is probably due to a selective action on
the genital spinal cord centres. In very large doses (5 eg. per
kg.) and also in very young subjects it leads to wasting; and
if it be pushed, paraplegia follows: this, however, disappears
on stoppage of the injections. In the young rabbits, aged 7
weeks, a daily injection of 1 eg. per kg., continued for sixty days,
gave a more regular and rapid bodily growth than in controls
(100 v. 57). Iscovesco says that a daily dose of 2 eg. in man
confirmed his results.

The lipoid (II. Bd) extracted from the anterior lobe of the
pituitary gives these results when injected daily in a £ eg.
dose per kg. of body-weight: (1) Agitation, continual restless¬
ness, and pugnacity: these changes occur usually after four to six

w;-'*:: : LEONARD J. KIDD

• < • • • • •

weeks of treatment; (2) increased renal secretion, with increase
of the urea, chlorides, and phosphorus of the urine; (3) increase
of appetite; (4) active increase of bodily growth in young but not
in adults; (5) increased weight of adrenals, heart, and kidneys,
but not of the genital organs in either sex. Hypodermic injection
into man of a daily dose of 2 to 5 eg. gives at the outset a
temporary acceleration of pulse, slight diuresis, increased appetite,
and—in asthenic patients—a manifestly increased power of work.
Finally, in myocarditis a rise of arterial pressure is seen after a
certain time, and the cardiac movements are regularised.

The lipoid (II. Bd) of the adrenal cortex gives these results
when injected every two days, for 130 days, into rabbits aged
135 days, in a £ eg. dose per kg. of body-weight: (1) Marked
hypertrophy of adrenals, almost entirely confined to their cortex;
(2) stimulation of kidneys slightly, but more in males; (3) also of
liver; (4) markedly also of cutaneous glands. This lipoid has
no action on heart (unlike the medullary adrenal lipoid); powerfully
stimulates the growth of the fur; has an insignificant action on
bodily growth and weight. Hypodermic injection of 2 to 5 eg.
into man gives early acceleration of pulse, with a fall of arterial
tension: after a few hours both phenomena return to normal.
Abundant sweating follows in 60 per cent, of cases, and lasts for
many hours, even up to twenty-four: it is chiefly nocturnal.
Iscovesco thinks this is parallel with the stimulation of the hair-
system in his rabbits, and he suggests that the night-sweats of
phthisis may be explained by cortical adrenal stimulation, for he
finds on autopsy in these cases, and also in other infectious, that
there is evidence of lesions, or signs of stimulation of the adrenal
cortex. Finally, he finds that a daily injection of even only 1
or 2 eg. of this lipoid solution into man is followed by an
increase of strength and a feeling of euphoria which may be turned
to good therapeutic account in cachectic states.

The lipoid (II. Bd) of the adrenal medulla seems to have been
injected exclusively into female rabbits: treatment was continued
for sixty days: six does, aged 14 months, received daily a dose of
J eg. per kg. of body-weight: all were in perfect health when
sacrificed on the sixtieth day. The treated animals had gained
2*5 per cent, of their initial body-weight, the controls only 1*4 per
cent. This lipoid stimulates the adrenals, but to a very much less
degree than does the cortical adrenal lipoid, and its effect is mainly

RESEARCHES ON LIPOIDS OF ORGANS

103

on the adrenal medulla: it stimulates the heart so much that
after sixty days’ treatment the heart weighs 3*80 g. per kg. of
body-weight, as against only 2*69 in controls. Its action on other
organs is mostly insignificant or nil ; yet there is an increase of
weight of the ovary (135 v. 90 of controls) which “is not
negligible ”; the uterus, however, weighs only 80 v. 128 of controls’
uterus; atheroma was absent, and the aorta was normal. Daily
injection, into many, of 2 or 3 eg. slows the pulse and increases
the arterial pressure and the power of work. Isoovesco thinks
that in Addison’s disease the asthenia and the cardio-vascular
disturbances are due to lesions of the medulla, but that the
pigmentation and cutaneous manifestations are always to be
connected with the primary or secondary irritation of the adrenal
cortex. (In the Reviewer’s opinion, this is a rather disappointing
paper. We need to know the effects of this lipoid on male rabbits,
and also whether, if a larger series of does were used, the uterus
would be found to be constantly smaller than in controls.
Curiously, Iscovesco does not say whether the six does were virgin
or not)

The lipoid (II. Bd) of the pancreas was injected into rabbits,
aged 135 days, every other day for 131 days, in a dose of 1 c.c.
of a 2 per cent oily solution. At the end of this period they
showed the very large increase of 51 per cent, of their initial
body-weight, as against only 32 per cent, in the controls: the
treated animals had the better appetite. Autopsy showed heavier
adrenals than those of controls, lighter thyroids, and only in¬
significant changes in other organs for the most part. But the
weight of the liver was greatly increased (47 v. 36 of controls):
it was not fatty. No other lipoid has given Iscovesco so great an
effect on the liver. The histological changes in liver and pancreas
are reserved for a future paper. Daily injection into man of
1 or 2 eg. for a certain time gives: (1) Slight increase of
arterial pressure, and (2) a constant increase of body-weight. In
one case of diabetes an increase of sugar of 30 to 60 g. daily
followed; but in another case the sugar diminished and dis¬
appeared very quickly. Iscovesco concludes that this special
pancreatic lipoid aggravates hyper-hepatic diabetes, but rapidly
benefits the hypo-hepatic variety.

The liver is very rich in lipoids, e.g., in the horse, 20 g. of
lipoids in 100 g. of dried liver; and in the ox, 16 per cent.

104

LEONARD J. KIDD

Iscovesco isolated a special lecithide from the ox liver, which,
when injected in oily solution into young rabbits every two days
for 132 days in doses of 1 eg. per kg. of body-weight, led to the great
increase of 62 per cent of body-weight over their initial body-
weight ; and yet this occurred in spite of the unfavourable season
(December to February). This increase was more than double that
of the controls (29 per cent.). Autopsy showed that this hepatic
lecithide has no action on adrenals, heart, genitals, or thyroid;
but it stimulates the liver and spleen slightly, and favours very
strongly the development of the lungs. It is the only pulmonary
stimulant substance yet discovered by Iscovesco, with the single
exception of a lecithide extracted by him from commercial cod-
liver oil: the latter lecithide has exactly the same pulmo-stimulant
action as the former. In the last paper of his series of ten, he
shows that a special lipoid (II. Bd) can be extracted from the liver
after the special hepatic lecithide has been eliminated from the
liver. When this lipoid is given to young rabbits aged about
4£ months, every two days for a period of 132 days in a
1 eg. dose hypodermically in oil, it gives no effect on body-growth
nor on lung development, thus differing from the special hepatic
lecithide. But it stimulates the heart (3*80 v. 2*68 of controls),
the liver (41’93 v. 41 - 60), and kidneys slightly but much less than
does the hepatic lecithide. Iscovesco has obtained encouraging
therapeutic results, especially in children, in chronic pulmonary
tuberculosis and tuberculous adenitis by hypodermic injections of
a 2 per cent, oily solution of the hepatic lecithide, or by rather
larger doses by mouth. In all these patients he observed increased
weight, increased urea excretion, and improvement of appetite.
His paper on the cod-liver oil lecithide (p. 34, 1914, lxxvl) is
well worth study. He experimented on groups of rabbits by means
of (1) commercial cod-liver oil alone; (2) by ditto after depriva¬
tion of its lecithide; (3) by olive oil; (4) by the special lecithide
solution extracted from cod-liver oil. Of these, Nos. 4 and 1 gave
the greatest effect on growth and the lungs; and Iscovesco found
that rabbits bear animal oil better than vegetable oil

Doubtless we shall in the near future learn about other organic
lipoids from Iscovesco; meanwhile it is helpful to summarise his
researches as follows: (1) Bodily growth in young animals is
increased and accelerated by special lipoids extracted from the
pancreas, thyroid, ovary, testis, anterior pituitary lobe, and cod-

RESEARCHES ON LIPOIDS OF ORGANS 105

liver oil, and in rabbits aged 14 months by the adrenal medullary
lipoid; (2) the thyroid is hypertrophied by the lipoids of the
thyroid and the ovary, and slightly by testis; (3) the heart by
the thyroid, anterior pituitary, medullary adrenal, and the II. Bd
hepatic lipoid; (4) the ovary by the ovarian, thyroidal, and
medullary adrenal; (5) the uterus is hypertrophied by the ovarian
and thyroidal, and was diminished in weight (in six rabbits) by
the medullary adrenal; (6) the kidneys are either hypertrophied
or show increased activity by the use of the thyroidal (males
only), testis slightly, anterior, pituitary, cortical adrenal (chiefly
in males), the hepatic lipoid (II. Bd) slightly, but by the hepatic
lecithide much more; (7) the liver by the pancreatic, anterior
pituitary, cortical adrenal, and special hepatic lipoid (II. Bd);
(8) the adrenals by the cortical adrenal (markedly), medullary
adrenal (slightly and mainly its medulla); (9) the skin, fur, and
cutaneous glands strikingly by the cortical adrenal (sweating also
in man); (10) the appetite is increased by the pancreatic, anterior
pituitary, and the special hepatic lecithide which is identical,
chemically, physiologically, and therapeutically, with the leci¬
thide extracted from commercial cod-liver oil; (11) the testes
are hypertrophied by the thyroidal lipoid and testis lipoid; (12)
the lungs by the pulmo-stimulant lecithides of (a) liver and (b)
cod-liver oiL Changes in other organs, such as the spleen or
rectum, &c., are either slight or nil, so far, at any rate, as their
post-mortem weights are concerned. There are certain outstand¬
ing features of extreme interest and importance in Iscovesco’s
careful studies: (1) The production in rabbits of a veritable
Graves-Basedow disease (not to be distinguished from the human
disease) by means of a thyroidal lipoid; (2) the absence of any
genital changes in either sex from the use of the anterior pituitary
lipoid. That the posterior pituitary lobe is not responsible
for the production of the testicular atrophy of the adiposo-genital
syndrome was proved by the striking case published by Maranon
(1911) of a haemorrhagic focus which microscopical examination
showed had destroyed the anterior pituitary lobe and had entirely
spared the posterior lobe. But the absence of genital changes in
either sex after prolonged use of Iscovesco’s anterior lobe lipoid in
rabbits is on all fours with the recent experiments of Camus and
Roussy on dogs (C. R. Soc. de Biol., lxxv., 1913, pp. 483, 628), and
undoubtedly helps us to accept the provisional conclusion of those

106

ABSTRACTS

two writers that the genital atrophy (and the polyuria) of the
adiposo-genital syndrome of man is probably not due at all to a
lesion of the pituitary, even when—as often happens—a pituitary
lesion is unquestionably present, but depends rather on neighbour¬
ing parapituitary basal lesions which injure centres or paths,
situated near the pituitary body, which are intimately connected,
physiologically, in a way at present unknown to us, with the
nutrition of the genital organs, and especially the testes and
ovaries. It might be objected to this that Iscovesco merely failed
to prove genital changes by the use of his II. Bd anterior lobe
lipoid, and that there may conceivably be others that may give
them; but we can hardly believe that after all these years of
careful chemical, physiological, and therapeutic investigations,
Iscovesco would have failed to isolate these genito-dystrophic or
hypertrophic pituitary lipoids if they really had any existence.
These inspiring and illuminating researches of his are full of
therapeutic hints, csj., the possible value of the cortical adrenal
lipoid in such conditions as myxoedema, dry skin, ichthyosis, &c.
&c. Such positive studies as those of Iscovesco are infinitely more
valuable and less misleading than many of the inexact methods
beloved by experimentalists, such as organ removals, &c.

abstracts.

ANATOMY.

ON THE BULBAR NUCLEI, WITH SPECIAL REFERENCE TO
(121) THE EXISTENCE OF A SALIVARY CENTRE IN MAN.

Anthony Feiling, Brain, 1913, xxrvi., p. 225.

A miner, who had injured his neck, suffered from paralysis of the
left side of the tongue and of the left sterno-mastoid and upper
part of left trapezius, together with loss of taste in the whole of
the back of the tongue, especially on the left side, paralysis of the
left side of the palate, although no anaesthesia could he detected,
aphonic speech, and loss of power of swallowing even for liquids.
He died seventy-one days later from broncho-pneumonia. At the
autopsy a fracture of the posterior fossa of the skull was found,
involving the jugular foramen with injury to the trunks of the
vagus, glosso-pharyngeal, spinal accessory, and hypoglossal nerves,
without any injury to the brain itself.

ABSTRACTS

107

Degeneration was found in the cells of origin of the spinal
accessory nerve in the cervical cord, and in the whole length
of the nucleus ambiguus, with partial degeneration in the dorsal
nucleus of the vagus and in the hypoglossal nucleus, and marked
fatty change in the solitary bundle. In addition, scattered de¬
generated cells were found in the grey matter just dorsal to the
inferior olive and slightly neutral to the facial nucleus. It is
suggested that these cells represent cells of origin for the secretory
fibres which pass out with the glosso pharyngeal nerve, and
which, by means of its tympanic branch, become distributed to
the parotid gland. No clinical evidence as to the presence of any
disturbance of salivary secretion was made.

A. Ninian Bruce.

THE VAGUS NERVE: ANATOMICAL AND EXPERIMENTAL
(122) STUDY. PART III.-THE PERIPHERAL VAGUS GANGLIA:
LOCALISATION OF THE SENSORY GANGLIA AND PERI¬
PHERAL DISTRIBUTION OF THEIR ISSUING FIBRES.
(Le nerf vague : 4tude anatomique et expdrimentale. Troisidme
partie. Les ganglions plriphlriques du vague: localisation des
noyaus de sensibility et distribution pbriphdrique des fibres qui
en dmanent.) M. Molhant, Le Ntvraxe , 1913, sir., xv., Dec. 30,
pp. 521-679 (54 figs.).

Chapter I .—Histological examination of the cells of the rabbit's
ganglion nodosum by Cajal’s reduced silver method shows that
unipolar cells, large, medium, and small, markedly preponderate.
Molhant failed to find any multipolar cells of the type described
by Cajal for the spinal ganglia of man and animals, but he found
round some of the large cells of the ganglion nodosum a perisomatic
plexus similar to that found by van Gehuchten and many other
authors round spinal ganglion cells. He concludes that the ganglion
nodosum is a cranial homologue of the spinal ganglia.

Chapter II.—Structure and distribution of the sensory fibres
of the vagus. —Molhant divided intracranially all the root fibres
of the 9th, 10th, and 11th nerves so as to eliminate all the
motor vagus fibres, of bulbar origin, contained in its trunk and
branches. By keeping his animals for seven months he succeeded
in doing this: all trace of active degeneration of vagus fibres had
then disappeared. Almost all the large fibres and a good number
of the small fibres had then disappeared, and only the medium¬
sized fibres were unchanged: these, then, are the sensory vagus
fibres. The large majority come from the jugulare and nodosum
ganglia, the minority from spinal ganglia via the anastomotic
filaments of the intervago-recurrential sympathetic plexus. The

108

ABSTRACTS

proper vagus sensory fibres are found in the pharyngeal branch of
the vagus and the middle laryngeal nerve (rabbit), the superior
laryngeal, the depressor nerve of Cyon, the nervus recurrens, and
the thoracic vagus.

Chapter III.—Ganglionic origin of the sensory fibres of the
various branches of the vagus .—Molhant used the chromolysis
method, keeping his animals for eight or ten days. His experi¬
mental sections were made at the following levels: (1) Below
ganglion nodosum, respecting the superior laryngeal and the nerve
of Cyon; (2) section of superior laryngeal; (3) of nerve of Cyon;
(4) vagotomy 2£ cm. below origin of nervus recurrens; (5) section
of nervus recurrens; (6) ablation of upper and middle lobes of
right lung; (7) section of superior cardiac filaments of vagus; (8)
violent avulsion of left vagus at level of gastric cardia; (9) section
of pharyngeal branch of vagus. Conclusions: (1) The ganglion
nodosum gives origin to almost all the sensory fibres of the cervical
vagus, the ganglion jugulare to very few; (2) large cells in the
upper pole of the nodosum give origin to the sensory fibres of the
superior laryngeal nerve; (3) small cells in the zone adjoining
the external border of the upper pole of the nodosum to those of
the nerve of Cyon; (4) the middle and lower part of nodosum to
those of the thoracic vagus; (5) the sensory cesophago-tracheal
fibres of the nervus recurrens rise in cells situated diffusely, without
clear limits, between the upper extremity of the nodosum and its
swollen middle part; the laryngeal fibres of the nervus recurrens
rise in cells of the ganglion jugulare: Molhant could not determine
their exact localisation: “ It is probable that the notable distance
between the ganglion and the site of nervus recurrens interruption
led to too feeble a cell-reaction ”; (6) the fibres of the right, upper,
and middle pulmonary lobes rise in cells situated diffusely in the
outer parts of the middle and lower segments of the nodosum: “ if
we admit that the sensory fibres of the pulmonary lower lobe rise
in the same zones of the ganglion, as is probably the case, we may
conclude that the pulmonary sensory ‘nucleus’ of the vagus is
situated in this segment ”; (7) the sensory fibres of the nerve of
Cyon and of the superior cardiac vagus filaments seem to rise in
the intermediary zone between the base of the upper tapering
part of the nodosum and its middle dilated portion; (8) the sensory
gastric vagus fibres rise in the swollen middle of the nodosum, and
also in the zone adjoining the convex border of its lower extremity;
(9) the sensory fibres of the pharyngeal branch of the vagus (and of
the rabbit’s middle laryngeal nerve which springs from it) rise in cells
of the ganglion jugulare, but this “ nucleus ’’ represents only a small
fraction of that ganglion’s cells. Molhant finds that the rabbit’s
ganglion jugulare is usually intimately fused with the ganglion

ABSTRACTS

109

jugulare ix. Unfortunately, he made no attempt to determine the
ganglionic origin of the nervus auricularis x, nor of the meningeal
branch of the vagus; and in his intracranial vagus root section he
did not apparently try to trace the normal undegenerated laryngeal
muscle afferenta from the ganglion jugulare into the four muscles
supplied by the laryngeal fibres of the nervus recurrens. He does
not even mention the possibility that the ganglion nodosum may
be, in part, a motor sympathetic ganglion for unstriped fibres of
the vagus. Leonard J. Kidd.

STRUCTURE OF THE ROOTS, TRUNK, AND BRANCHES OF
(123) THE VAGUS NERVE. M. R. Chase and S. W. Hanson,
Joum. CompU Neurol ., 1914, xxiv., Feb., p. 31 (20 figs.).

Tine chief study was on the dog’s vagus, but that of man, rabbit,
cat, and rat was included. “ Most of the material was cut into
serial sections. In this way all branches of the vagus and con¬
nections with the sympathetic could be followed accurately. This
is especially important in the study of vagus roots, and of the
relations of the vagus and sympathetic. Some material was fixed
in ammoniated alcohol, and stained by the pyridine-silver technique
of Ranson; some fixed in Miiller, and stained by Weigert method;
some fixed and stained in 1 per cent, osmic acid.” The new fact
is brought out that enormous numbers of non-medullated axons
are present in the vagus rootlets. “ Molhant saw them in the
vagus trunk, and Gaskell inferred their presence here, basing his
inference on the unstained areas in osmic acid preparations.
Their presence in the rootlets shows that those found in the trunk
are not sympathetic fibres as Molhant maintained. They belong
properly to the vagus.” In the dog the so-called internal branch
of the spinal accessory has no existence; this agrees with the
findings of Van Gehuchten and Molhant in man and rabbit.

Leonard J. Kidd.

A STUDY OF THE ANATOMY AND THE VASOMOTOR PHENO-
(124) MENA OF THE SYMPATHETIC NERVOUS SYSTEM IN THE
TURTLE. D. J. Edwards, Amer. Joum. Physiol., 1914, xxxiii.,
p. 229.

An examination of the arrangement of the second, third, and
fourth cervical ganglia in five different species of turtles confirms
the view that these ganglia generally exist separately. The
abdominal and the cervical sympathetic systems are connected
by a small trunk, which extends from the fourth ganglion across
the necks of the first and second ribs to the first abdominal

110

ABSTRACTS

ganglion. Sympathetic fibres pass from the main sympathetic
trunk to the viscera in two groups—a small anterior and a larger
posterior splanchnic group. A sympathetic nervous control over
the blood vessels in the viscera was shown by the injection
of adrenalin into the vessels supplying this area. A vaso¬
constriction may be produced by stimulation of the fibres of the
anterior splanchnic, or of the posterior splanchnic group. A
greater rise in blood pressure results from stimulation of the
latter group: the average rise in blood pressure thus produced was
between 5 and 6 mm. Hg. The right posterior splanchnic
possesses a greater vaso-constricting power than the left. The
more common rhythmic variations in blood pressure are in¬
dependent of the respiratory movements. A. Ninian Bruce.

PHYSIOLOGY.

THE ALL-OR-NONE PRINCIPLE IN NERVE. R D. Asian, Journ.

(125) PhytioL , 1914, xlvii., Feb. 27, p. 490.

When a nerve is narcotised and stimulated at a point central to
the narcotised area, the strength of stimulus necessary to affect
the muscle does not rise gradually, but remains approximately
constant until conduction fails. This indicates that the ability
of the propagated disturbance to pass a region of decrement does
not depend upon the strength of stimulus which sets it up. In
other words, in each nerve fibre there would seem to be an all-or-
none relation between the strength of the stimulus and the size of
the propagated disturbance which follows it. A. Ninian Bruce.

HYPOPHYSECTOMY AND EXPERIMENTAL GLYCOSURIA.

(126) (Hypophysectomie et glycosuria experimental*) J. Camus
and Q. Roussv, Compt. Rend. Soc. de Biol., 1914, lxxvi., Feb. 27,
p. 299.

Glycosuria was found in only six out of forty-five dogs in which
operations on the pituitary, or its neighbourhood, had been per¬
formed. When it exists it is seen during the first few hours after
operation, and is transient. Glycosuria and polyuria are not
neoessarily associated; the latter is much the commoner pheno¬
menon. The kind of food taken by dogs before operation does
not appear to influence the appearance of glycosuria; the same is
true of age, sex, and gestation. In cats glycosuria is commoner
than in dogs: it occurred four times out of nine partial operations
on the two pituitary lobes. Glycosuria in dogs is not related to
partial or total hypophysectomy. The authors attribute it to
damage done to basal nerve-centres situated near the pituitary;

ABSTRACTS

111

for, out of six of their cases in which a lesion or temporary
irritation of the base of the brain was present, glycosuria occurred
in four. They cannot say where these centres are situated, nor
whether it is their stimulation or inhibition that provokes
glycosuria. Leonard J. Kidd.

THE INFLUENCE OF THE ADRENALS ON GROWTH. (Sur l’in-

(127) fluence exerde par les capsules surrfinales sur la croissance.)
Ferreira dr Mira, .ArcA. Internal, de Physiol., 1914, xiv., Jan. 31,
p. 108 (6 figs.).

The preliminary paper on this subject was abstracted in the
Review (1912, x., p. 526); Figs. 2 and 3 of the present full paper
bring out well the differences between a dog, which had undergone
unilateral adrenalectomy, and a control animal.

Leonard J. Kidd.

STUDIES ON BERI-BERL VIII.—THE RELATIONSHIP OF BERI-

(128) BERI TO GLANDS OF INTERNAL SECRETION. Casdor
Funk and Mackenzie Douglas, Joum. Physiol., 1914, xlvii.,Feb. 27.

Eight beri-beri pigeons were examined, and notes of the
conditions found on examination of the thymus, pituitary, thyroid,
suprarenal, ovary, testis, liver, kidney, pancreas, and spleen. All
showed a great diminution in size in every case. Microscopically
there was a marked degenerative change of the cells with higher
functions. In most cases the marked atrophy was due to a
disappearance of the cells, the framework of the gland alone
remaining. The most marked change was in the disappearance
of the thymus. A. Ninian Bruce.

PSYCHOLOGY.

THE HORSES OF ELBERFELD ONCE MORE. Ed. Clapar£de,
(129) Archiv. de Ptyehol., 1913, Sept, p. 244

Professor Clapar&de here gives an account of a second visit paid
by him to the learned horses of Elberfeld. This time he limited
his investigation to the attempt to solve the simple question, Can
the horses read numbers of one and two digits ? His results were
negative; the horses gave few correct responses, and he was
unable to decide whether it was a case of could not or would not.

The psychology of the controversy, which has arisen regarding
the abilities of the horses, seems to interest M. Claparede as much
as the establishment of the actual facts, and the greater part of
his article is devoted to an account of the recent literature on the
subject.

112

ABSTRACTS

At the last international Congress of Zoology certain well-
known German scientists circulated a “protest” regarding the
calculating horses of Elberfeld. M. Clapar&de gives this protest
in full, and then proceeds to make what we cannot but feel is a
very just counter-protest against the document as an unsuitable
and irrational method of taking part in a scientific inquiry.

Margaret Drummond.

AN ARITHMETICAL PRODIGY. J. M. Lahy, Archiv. de Psychol,

(130) 1913, Sept, p. 209.

An experimental study of an exceptional figure memory. The
subject of this study is Uranie Diamandi, sister of the lightning
calculator, Pericles Diamandi. After a detailed investigation of
her heredity and mental powers, the writer comes to the conclusion
that her marvellous figure faculty does not arise from any innate
disposition, but is rather the result of a deliberate self-training.

Margaret Drummond.

PATHOLOGY.

VITAL STAINING OF NERVE CENTRES BY MALACHITE

(131) GREEN. (But la coloration vitale des centres nerveux.)

P. Salmon, Compt. Bend. Soc. de Biol., 1914, lxxvi., Feb. 20, p. 265.

Intravenous injection of malachite green into mice is rapidly
fatal: only the brain and testis are coloured green. In rabbits
1 eg. of this per 2 kilos, of body-weight gives the same elective
staining of brain: but, unlike methylene blue, it gives definite
symptoms, viz., a kind of cerebral cry, salivation, and characteristic
oculomotor signs—sometimes exophthalmos, more often closure
of eyelids and gradual narrowing of pupils to pin-points. Autopsy
shows that mainly the grey matter is stained, the white matter
and nerves at base of brain remaining unstained. These oculo¬
motor signs are temporary, and are reproduced on each re-injection.
According to Wendelstadt and Fellmer malachite green is active
against the trypanosomic infection of nagana. Salmon finds it
inactive in the sleeping sickness of mice (virus of Mesnil), and in
the spirillosis of recurrent fever. Leonard J. Kidd.

A CONTRIBUTION TO THE PATHOLOGY OF MYASTHENIA

(132) GRAVIS. Sydney Kuh and Morris Braude, Joum. Nerv. and
Ment. Dis., 1913, xl., Oct.

A case is reported in which it was noted that passive movements
as well as active ones would cause a sensation of fatigue in the
affected muscles.

ABSTRACTS

113

The authors conclude, from a very thorough anatomical ex¬
amination of the case, that:—

1. Myasthenia gravis is a disease probably of neurogenic rather
than myogenic origin.

2. Certain peculiar vascular changes in selected regions of the
central nervous system may account for the distribution of its
symptoms and the usual mode of death.

3. These vascular changes consisted in the presence of minute
polymorphonuclear thrombi, mostnumerous in the pons and medulla,
thus accounting for the preponderating bulbar symptoms of the
disease.

4. An aberrant bundle of fibres was found in the cervical

region of the cord. D. K. Henderson.

CLINICAL NEUROLOGY.

THE RELATION OF THE MYOPATHIES. William Q. Spiller,
(133) Brain, 1913, xxxvi., p. 75.

This paper consists of a critical review of this subject, together
with several new cases. The subject is discussed under the
heading of amyotonia congenita, its relation to the Werdnig-
Hoffmann type of atrophy, the distal type of myopathy, myotonia
atrophica, and hypertrophia musculorum vera, a somewhat
questionable type. A. Ninian Bruce.

A CASE OF MYATONIA CONGENITA (OPPENHEIM). J. W.

(134) Courtney and H. B. Eaton, Boston Med. and Burg. Joum ., 1914,
clxx., Jan. 22, p. 117.

The case is that of a boy of five and a half years of age. He was a
seventh month child, and it was noticed from the moment of birth
that the head tended to fall backward on the shoulders, and that
the muscles were “ like jelly.” A. Ninian Bruce.

HERPES ZOSTER OTIOUS. A CRITICAL REVIEW, WITH RE-
(136) PORT OF A CASH Virginius Dabney, N.Y. Med. Joum., 1914,
xcix., Feb. 7, p. 272.

The patient was a woman, aged 68, who complained of sudden
deafness and tinnitus in her left ear. Several days later pain
developed, but it was not until a month after this that vesicles
appeared and the diagnosis could be made. The post-herpetic
neuralgia was severe and persistent, lasting for over four months

114

ABSTRACTS

after the healing of the last vesicle, the pain of which was only
temporarily relieved by high frequency electricity. The vesicles
appeared mostly singly, and not in crops as is usual in other
cases. A. Nlnian Bruce.

CAN HERPES ZOSTER EVER OCCUR TRAUMATIC ALLY?

(136) H. G. Lanowill, Clinical Jovm ., 1913, xlii., p. 569.

Langwill records two cases of herpes zoster suggestive of a trau¬
matic origin.

1. A sailor, aged 46, violently twisted and wrenched his right
arm while clinging to a rope to save himself falling into the water.
He suffered severe pain below the armpit, and a few days after¬
wards was admitted to hospital with extensive zoster of the fourth,
fifth, and sixth dorsal segmental areas.

2. A man, aged 28, fell through a hole in the floor of a loft,

but was caught by his left axilla catching on the edge. A week
later burning pains came on in the left scapular region, and in four
days’ time herpes appeared in the fifth and sixth left spaces and
below the left axilla. J. D. Rolleston.

ACUTE GENERALISED INFECTIVE PARALYSIS IN ADULTS.

(137) W. B. Warrington, Liverpool Medico-Chir. Jovm., 1914, Jan

The author relates cases of acute toxic polyneuritis, acute
generalised poliomyelitis, Landry’s paralysis, and acute ascendiug
myelitis.

He gives a table of differential diagnosis. Both cases of
Landry’s paralysis recovered, and it was noteworthy that the
electrical reactions were normal throughout the illness. The
cause of ascending myelitis was in all probability a sequela of
mumps. Author’s Abstract.

INTRACRANIAL SEROUS EFFUSIONS OF INFLAMMATORY
(138) ORIGIN. MENINGITIS OR EPENDYMITIS SEROSA—
MENINGISM. WITH A NOTE ON “ PSEUDO-TUMOURS ”
OF THE BRAIN. W. B. Warrington, Quart. Joum. Med .,
1914, vii., Jan., No. 26.

The author considers the question, how far intracranial serous
effusions of inflammatory origin are the cause of grave cerebral
symptoms.

He considers that there is no essential difference between
meningism, serous meningitis (or ependymitis), and purulent

ABSTRACTS

115

meningitis (or ependymitis), that they are each the result of toxic
processes, but that the important point is the recognition of the
fact that the inflammation may become arrested in the serous
stage. When this is so, he believes that toxins, and not micro¬
organisms, unless of very low virulence, penetrate the barrier of the
dura mater, and excite an inflammatory reaction.

Under etiology, he considers sepsis, notably otitic sepsis, tuber¬
culosis, the specific fevers, injuries to the skull and inanition.
Clinically, he discusses, with examples, the acute cases resembling
more fulminating meningitis, and the chronic cases resembling
cerebral tumour.

He concludes by a brief reference to certain cases of “ pseudo¬
tumour,” in which symptoms of intracranial pressure of improved
pathology are present.

These he divides into—

1. Cases chiefly in children in which all symptoms of intra¬
cranial pressure disappear for an indefinite time, perhaps perma¬
nently, without any special treatment.

2. Cases in which recovery, partial or complete, rapidly follows
a decompression.

3. Cases in whioh death occurs, the naked eye appearances
are normal, but microscopical examination has revealed a lesion.

4. A few cases in which no lesion has been found, even with a
microscopic examination.

A considerable bibliography is given.

The general conclusions of the writer are:—

1. The effusion may be the important pathological fact, and
the prognosis and treatment depend upon a recognition of this.

2. The progress of an inflammatory effusion within the skull
may be arrested at the serous stage.

3. The primary cause is commonly a near or distant focus of
septic infection; the toxins formed by this, but not the micro¬
organisms, stimulate the vessels of the meninges, brain, or ependyma
and the choroid plexuses to the formation or excessive fluid.

4. The primary cause may also be toxins, generated by non-
pyogenic organisms, and in rarer cases the excessive fluid results
from causes other than toxins of microbic origin.

5. The symptoms in the acute or chronic condition respectively
may stimulate the gravest form of brain disease.

6. The diagnosis is suggested when there is reasonable evidence
that the symptoms are those of increased intracranial pressure, if
other well-known conditions can be excluded, and it is strengthened
by the recognition of the primary cause.

Author’s Abstract.

116

ABSTRACTS

ON THE OHBONIO POEM OF EPIDEMIC CEREBRO SPINAL

(139) MENINGITIS. (Contribution k l’&ude do In mlningite
cdrfebro-spinale Ipidlmique k forme chroniqne.) B. Despujolb,
Theses de Lyon, 1912-13, No. 28.

The chronic form always succeeds the acute. It is characterised
clinically by (1) a conglomeration of trophic, psychical, and sphincter
troubles; (2) superadded and variable disorders such as febrile
attacks, and sensory and motor phenomena; (3) involvement of
the special senses. Anatomically the lesions are constant and
consist in diffuse pachymeningitis most marked in the cranial
meninges, pus in the ventricles and hydrocephalus, and lesions in
the nerve centres, roots and peripheral nerves. The chronic form
is most frequently found in young persons, and in subjects with
tuberculous antecedents, especially if the anti-meningococcic serum
treatment has been inadequate or used late. Examination of the
cerebro-spinal fluid hardly ever throws light on the diagnosis.

The prognosis is very gloomy; in cases that recover there are
usually sequelae, especially involving the special senses.

Intraspinal injections are chiefly preventive, intraventricular
injections have proved curative. Surgical treatment, i.e., crani¬
ectomy, is required in cases in which cerebral hypertension is marked
and no improvement follows lumbar puncture or trephining.

The thesis contains the histories of twenty-one cases, one of
which is original. J. D. Kolleston.

DIPLOCOCCUS CRASSUS SEPTICAEMIA WITH GEREBRO SPINAL

(140) LOCALISATION. (Un cas de septicdmie k Diplococcus crassus
avec localisation cfr&ro-spinale.) Biscons, Paris mid., 1913-14,
iv., p. 211.

A soldier, aged 23, had a long febrile illness starting with articular
symptoms and an erythematous rash which were followed by
signs of meningeal involvement. Lumbar puncture gave issue to
a turbid fluid under hypertension showing abundant polymorphs,
but no micro-organisms. The Diplococcus crassus, a saprophyte of
the naso-pharynx, was isolated in pure culture almost from the
onset and persisted throughout the disease, its vitality diminishing
as the symptoms abated. Recovery took place, but convalescence
was slow. J. D. Rolleston.

ON THE DIFFERENTIAL DIAGNOSIS OF SYPHILITIC AND

(141) TUBERCULOUS MENINGITIS IN THE ADULT. (Mtaingite
syphilitique et m&iingite tuberculeuse chez l’adulte (essai de
diagnostic differential).) L. Petit, Theses de Paris, 1913-14, No. 30.

Although the classical form of tuberculous meningitis is
sufficiently characteristic to be readily diagnosed, numerous sources

ABSTRACTS

117

of error may arise from the various forms assumed both by
tuberculous and syphilitic meningitis. One of the most important
clinical signs of tuberculous meningitis is the dissociation between
the pulse and the temperature which rarely occurs in syphilitic
meningitis. Vaso-motor troubles, convulsions and contractures
are more in favour of tuberculous than of syphilitic meningitis,
without being absolutely pathognomonic. A similar importance
attaches to the headache of syphilitic meningitis which is
characterised by long duration, intensity and nocturnal exacerba¬
tions. Psychical disturbance, disorders of sensation and of the
special senses, and paralyses are found in both affections. The
Argyll Robertson pupil is characteristic of syphilis, but is often
absent in syphilitic meningitis.

The most valuable laboratory methods are the examination for
the tubercle bacilli in the cerebro-spinal fluid and Wassermann’s
reaction. The luetin reaction may be useful in latent syphilis,
but it must not be forgotten that tuberculous meningitis may occur
in a syphilitic individual, and that therefore this reaction is not
sufficient by itself for the diagnosis of syphilitic meningitis.

The thesis contains the histories of six cases, two of which are
original. J. D. Rolleston.

THE NERVOUS COMPLICATIONS OF MUMPS IN THE CHILD.
(142) (Contribution & l’ltude des oreillons chez l’enfimt, et de certaines
complications nerveuses qui penvent s’y observer.) E. Missimilly,
Theses de Montpellier, 1912-13, No. 71.

The thesis contains the histories of seven cases, the following three
of which are original:—

1. A boy, aged 5 years, a few days after mumps complicated by
orchitis, developed poliomyelitis, manifested by complete loss of
power in the lower limbs. In the course of the next few months
the paralysis entirely disappeared in the right lower limb, but per¬
sisted in the muscles of the left thigh, which became atrophied
and showed R.D.

2. A girl, aged 3 years, on the sixth day of mumps, developed
meningeal symptoms which lasted for four days and then rapidly
subsided under treatment by baths, ice, and purgatives.

3. A boy, aged 10 years, on the eighth day of his disease, de¬

veloped meningeal symptoms which Tasted for forty-eight hours
and then rapidly disappeared. In none of the cases was lumbar
puncture performed. J. D. Rolleston.

118

ABSTRACTS

ACUTE POLYARTICULAR RHEUMATISM LOCALISED TO A
(143) LIMB AFFECTED WITH RECENT PARALYSIS OF THE
BRACHIAL PLEXUS. (Rhum&tisme polyaxticulaire aigu
localise but on membre attaint d’une paralysis r&ente da plexus
brachiaL) Q. Gulllain and S. Dubois, Bull, et mtm. Soc. med.
H6p. de Paris, 1914, xxxvii., p. 90.

The patient was a man, aged 50, who had had a generalised
attack of acute articular rheumatism fifteen years previously. In
November 1913 he dislocated his right shoulder, causing paralysis
of the brachial plexus, and about ten days later developed acute
articular rheumatism in the fingers and elbow of the same side.
Recovery followed in ten days after treatment by aspirin.

J. D. Rollbston.

ON THE PATHOGENY AND SYMPTOMATOLOGY OF POST-
044 ) DIPHTHERITIC POLYNEURITIS. (Uber die Pathogenese and
Symptomatology der Polyneuritis postdiphtberica.) A. Niekans,
Inaugural-Dissertation, Kiel, 1912-13, No. 19.

The thesis contains a record of a case of generalised paralysis in
a youth aged 17, preceded by precocious paralysis of the palate
( v . Review, 1906, iv., p. 608). J. D. Rollbston.

TYPHOID SPINE. WITH REPORT OF A CASE COMPLICATED
(146) BY THROMBO PHLEBITIS OF THE LEFT FEMORAL VEIN.

C. B. Conklin, Med. Record ’, 1914, Ixxxv., p. 157.

A man, aged 25, in convalescence from a typical attack of typhoid
fever complicated by intestinal haemorrhage, but without nervous
symptoms, began to complain of pain and stiffness in the lumbar
region with painful twitchings of the thigh muscles. A month
later he had tenderness over the left inguinal region followed by
swelling of the thigh.

The pain was relieved by the thermo-cautery along the spinal
muscles, and immobilisation and support were afforded by adhesive
plaster strapping. After five months recovery took place.

J. D. Rollbston.

FEAR AND ATAXIA. W. J. M. Malonby, Joum. Nerv. and Ment.
(146) Dis., 1913, xl., Nov.

The author states that the effect of fear upon tabetic symptoms
cannot be overestimated. Several cases are reported in which a
slight injury was supposed to have been the cause of the onset of
the ataxia, but conclusive reasons are given by the author showing
that fear was really the predominant factor. D. K. Henderson.

ABSTRACTS

119

REPORT OF A CASE OF JUVENILE TABES. C. E. Riggs, Joum.

(147) Nerv. and Ment. Die., 19131, xl., Nov.

A boy, 7£ years old, who since the age of 10 months had been
subject to vomiting spells at short intervals; these attacks usually
lasted about three days. Later he showed difficulty in walking
and complained of pains in his legs. Athetoid movements were
seen in the right hand, and there was some intention tremor of
both hands. The knee and Achilles jerks were absent, there was
a marked ataxia of both legs, and a mild hypotonia in the muscles
of the lower extremities.

The pupils reacted to light and on accommodation, and the
eye-grounds were normal. The blood serum and spinal fluid both
gave a positive Wassermann reaction. D. K. Henderson.

THE RELATION TO THE BLOOD OF THE VIRUS OF EPIDEMIC

(148) POLIOMYELITIS. Paul F. Clark, Francis R. Fraser, and
Harold L. Amoss, Joum. Exp. Med., 1914, xix., March, p. 223.

Specimens of human blood taken during the paralytic stage of
poliomyelitis and post mortem have proved not to be capable of
infecting Macacus monkeys. Specimens of monkey blood taken at
various stages of experimental poliomyelitis have not proved
capable of infecting monkeys (except in one case). When
suspensions of the spinal cord from a paralysed monkey have been
injected into the brain, or simultaneously into the brain and spinal
canal, the blood removed from one to forty-eight hours later failed
to cause paralysis after intracerebral injection. When large
volumes of active filtrate are injected into the circulation the blood
remains infective for seventy-two hours at least, but may be no
longer infective after ten days, when the paralytic symptoms first
appear. When, however, the filtrate is injected in smaller amount,
or when a filtrate of a less active virus is employed in large
' quantity, the blood either fails to convey infection or conveys it
irregularly. It is only when overwhelming quantities of an active
virus are injected into the blood that paralysis results. The
injection of moderate doses is not followed by paralysis, although
the virus may still be detected in a blood sample twenty-four hours
after the injection. The existence of a mechanism capable of
excluding the virus within the blood from the central nervous
organs is therefore inferred. Infection is accomplished far less
readily through the circulation than by means of the more direct
lymphatic and nervous channels of communication with the central
nervous system.

Several series of feeding experiments conducted with the biting
stable fly (Stomoxys calcitram) resulted negatively.

A. Ninian Bruce.

120

ABSTRACTS

THE BdLE WHICH HEREDITY PLAYS IN INDUCING BPI-
(149) LEP8Y IN CHILDREN SUFFERING FROM INFANTILE
CEREBRAL PALSY. L. Pierce Clark and E. A. Sharp, Joum.
Nerv. and Ment. Dit ., 1913, xl., Oct.

In the so-called idiopathic type of genuine epilepsy heredity
plays a very important rdle in the causation; it is present
perhaps in 70 per cent, of cases. In this study a comparison
is made of the heredity history between infantile cerebral palsy
associated with epilepsy, and the so-called idiopathic cases.

The data consisted of 443 cases of palsy with epilepsy, and
443 suffering from the genuine disorder. In a little less than one-
third of the hemiplegia epileptics there was no record of hereditary
influences; in 70 per cent, a definite record of hereditary in¬
fluence was found. Epilepsy and convulsions occurred in 115
instances: alcoholism was mentioned 110 times; insanity 46 times;
idiocy and feeble-mindedness in 10 instances; fainting spells,
hysteria, and apoplexy were also mentioned.

In the epileptics without hemiplegia the heredity presented
an almost similar picture. D. K. Henderson.

CHANGES IN THE SPINAL CORD FOLLOWING PERIPHERAL
(150) OR CEREBRAL LESIONS, ISOLATED AND COMBINED.
(Modificazioni spinale consecutive a lesioni periferiche o cerebrale,
isolate e combinate.) G. d’Abundo, Riv. Ital. di Neuropatol.,
Psichiatr. ed Elettroter., 1913, vi., p. 481.

The author carried out the following three series of experiments
on new-born animals (dogs or cats within the first twenty-four
hours of life).

1. He disarticulated a limb and examined the nerve centres,
two, four, six, and seven months later.

2. He removed portions of the motor cortex on one side and
subsequently examined the grey substance of the spinal cord.

3. Besides disarticulating a hind limb, he removed the motor
cortex on the opposite side to the disarticulated limb.

The results of the first series of experiments were as follows:—

1. Disarticulation of a hind limb in new-born dogs and cats
causes a defective development of the corresponding half of the
spinal cord, most marked in the lumbar enlargement.

2. In the hemi-hypotrophic grey substance the anterior horn
shows an obvious diminution of nerve cells.

3. As one passes from the middle of the lumbar enlargement
to the dorsal region of the cord, the defective development becomes
less evident in the anterior horn, and more marked in the posterior
horn.

ABSTRACTS

121

4. While a deficiency of unilateral development is found
throughout the white substance of the spinal cord, it is in the
posterior column, corresponding to the disarticulated limb, that
the deficiency is most marked.

5. All the nerve cells representing the disarticulated limb do
not disappear, but some survive, being intimately connected with
the rest of the spinal cord by dynamic associations and functional
spinal automatism.

6. Regenerative activity of the nerve trunks cut in disarticula¬
tion of the limb is the patent demonstration of the survival of a
considerable number of motor cells for the muscles of the disarticu¬
lated limb.

7. Although a division of labour exists in the functions of the
spinal cord, there is a very marked collective synergic solidarity
in these functions, whereas in the cerebral cortex there is a
decorticalisation of function better suited for a division of labour.

The results of the second series of experiments were as follows :
Removal of parts of the motor cortex caused a rapid and marked
hypotrophy in the corresponding posterior horn of the spinal cord;
whereas hypotrophy was hardly manifested at all in the anterior
horn on the opposite side to the cortical lesion, at least during the
first thirty-six days of life.

The third series confirmed the results of the first two, but the
author found that the disappearance of the nerve cells of the
spinal grey substance corresponding to the disarticulated limb
was much more marked than in the first series. He adds, how¬
ever, that before drawing conclusions it is necessary to keep the
animals alive for at least six or seven months, as was done in the
first series of experiments. J. D. Rolleston.

GLIOMA OF THE CAUDA EQUINA. REPORT OF A CASE WITH
(151) SECONDARY GLIOSIS OF THE SPINAL CORD. William
M. Leszvnsky, N. Y. Med. Joum., 1914, xcix., Feb. 21, p. 360.

A woman, aged 49, twelve years ago slipped and fell, striking
herself violently on the buttocks, but was apparently uninjured.
She remained well for three years, and then developed pain in the
left lumbar region. Four years later the right side became
similarly affected. Then numbness of both feet and toes followed,
with atrophy of the muscles of both lower limbs, and she became
unable to walk or stand, and suffered from incontinence.

The twelfth dorsal, first and second lumbar spines and laminae
were removed, and the whole spinal canal was filled by a large
grey-brown tumour. This was left for extrusion. She died three
months later, and at the autopsy a tumour mass of a fibro-hyaline

122

ABSTRACTS

structure was found loosely adherent to the dura. In the centre
a longitudinal cavity was to be seen about one inch and a half long
lying in the anterior portions of the posterior columns. It proved
to be a glioma. A. Ninian Bruce.

A CASE OF CONGENITAL HEMIATROPHY. (Un c&a d*Mmi-

(152) atrophia congtaitale.) J. Lkvy-Valensi, Paris mid., 1913-14, iv.,
p. 215.

The patient was a woman, aged 54, in whom not only the face
but also the trunk and limbs on the left side were affected. The
condition is attributed to intrauterine encephalitis or to an arrest
of development of the right hemisphere. J. D. Rolleston.

SENSORY CHANGES IN FRIEDREICH’S DISEASE P. W. Saunders,
(163) Brain, 1913, xxxvi., p. 166.

Twenty typical cases of Friedreich’s disease were examined, and
it was found that the elements of sensibility which it is assumed
are conducted through the dorsal columns of the cord are more or
less constantly and characteristically affected. The loss, especially
in the early stages of the disease, falls most heavily on the lower
extremities, i.e., on the regions innervated by the spinal segments
that are earliest affected, and tends to spread higher and higher
over the body, and to become more profound as the disease
advances. The frequency with which these sensory changes occur
would seem to justify their inclusion in the clinical picture of the
disease as an integral, not as an exceptional, feature.

A. Ninian Bruce.

CEREBRAL PALSIES WITHOUT DEMONSTRABLE ANATOMI-

(154) CAL FINDINGS. J. H. W. Rhein, Journ. Nerv. and Ment. Dis.,
1913, xl., Oct

A review of the literature is given, and two cases are reported
in which no anatomical findings could be found to account for the
clinical picture.

The author feels that one must look for the explanation in
some quality of nerve cell or fibre which cannot by our present
methods be demonstrated. D. X. Henderson.

CEREBRAL HAEMORRHAGE IN CHRONIC MYELOID LEUCA2MIA.

(155) (Sur un cas d’hlmorrhagie ctolbr&le au cours d’une leuclmie
myelolde chronique.) C. Laubry, Arch, dct mol. du cceur, 1914,
vii., p. 25.

Contrary to what is stated in some text-books, cerebral haemor¬
rhage is a rare termination of chronic myeloid leucaemia. The

ABSTRACTS

123

present case is that of a man aged 32. The blood pressure
taken on several occasions was normal and some improvement
was taking place under X-ray treatment, when he developed left
hemiplegia and died in coma within twenty-four hours. There
was no necropsy, but lumbar puncture gave issue to a bloody fluid
whose clot gave a formula identical with that of the blood.

J. D. R0LLK8T0N.

CASE OF CEREBELLAR EMBOLISM. L. Casamajob, Med. Record,

(156) 1914, lxxxv., p. 38.

A woman who had aortic disease following acute endocarditis in
childhood, at the age of 29 suddenly began to suffer from dizziness
and instability of gait and station. The knee and ankle jerks were
absent, and there was horizontal and rotary nystagmus. Wasser-
mann’s reaction in the spinal fluid was negative.

J. D. Rolleston.

ENCEPHALIC PUNCTURE BY THE ORBITAL ROUTE. ITS

(157) CLINICAL AND THERAPEUTICAL INDICATIONS. (La
ponction encdphalique par la voie orbitaire. Ses applications
diniques et thdrapeutiques.) L. B£riel (de Lyon), Bull, et m/m.
Soc. med. H6p. de Paris, 1914, xxxiL, p. 157.

The method consists in penetrating into the cranial cavity by
the outer end of the sphenoidal fissure. It may be used for re¬
moval of cerebro-spinal fluid, cerebral biopsy, or introduction of
drugs, such as salvarsan in general paralysis or serum in cerebro¬
spinal meningitis or tetanus. An anaesthetic is not required, but
B6riel has only used this method with general paralytics or coma¬
tose subjects. The operation is as easy as lumbar puncture, the
only drawback being the subsequent ecchymosis, which causes a
“ black eye ” for a few days. J. D. Rolleston.

ADIPOSITY DUE TO A JUZTA PITUITARY SARCOMA (Obdsitd

(158) par sarcome juxta-hypophysaire.) Laignel-Lavastihe and L.
Boudon, Bull, et m/m. Soc. m/d. des H6p. de Paris , 1914, xxx., Feb.
19, p. 283.

A woman of 41 developed an enormous adiposity simultaneously
with intracranial hypertension and blindness, due to a sarcoma
of the base of the skull. The writers attribute the adiposity to
secondary pituitary disturbances caused by the compression of
the tumour. The adiposity was universal, but there was normal
growth of hair on head, axillae, and pubes; here, then, only the
adiposity of the adiposo-genital syndrome was present. The
anterior pituitary lobe, although atrophied, showed histological

124

ABSTRACTS

evidence of its functioning, while the posterior lobe appeared to
be more damaged. The writers raise the question “ whether the
various parts of the pituitary may not be united together physio¬
logically as well as anatomically; in this way one can conceive
that a lesion which involves one lobe may react upon another lobe
which is seemingly intact.” They draw attention to the fact that
the adiposo-genital syndrome is often dissociated. They attribute
the adiposity in their case to a “ secretory or excretory insufficiency
of the posterior pituitary lobe.” Leonard J. Kidd.

FAMILIAL ADIPOSITY WITH ENDOCRINAL DISTURBANCES.

(159) (Oblsitl famili&le avec perturbations endocrines.) Laignel-
Lavastine and Pitulbsco, Bull, et Mini. Soc. Mid. da H6p. dt
Parity 1914, xxx., Feb. 19, p. 290.

Two adult brothers and two adult sisters of a Jewish family
showed an adiposo-genital syndrome, with evidence of thyroid
involvement; the males showed small genitals, sexual feebleness,
and perversions, with infertility; the females delayed or absent
menses, and limited or no fertility. One sister showed an
adiposity like the diffuse form of Dercum’s disease (figured), with
psychical changes; the adiposity was less marked in the others.
There is only one descendant of these four patients ; he is fat and
tall. Ovarian, luteal, thyroidal, and pituitary opotherapy was
useless. All the patients were tall; their adiposity had no
relation to dietetic habits. The possibility of syphilis is admitted,
but the Wassermann reaction was not tested. Leonard J. Kidd.

A CASE OF PROGRESSIVE LENTICULAR DEGENERATION.

(160) James E. H. Sawyer, Brain, 1913, xxxv., p. 222.

The case is that of a man now aged 36. The first symptoms of
the disease appeared at the age of 19, and consisted of tremor
and jerky movements, which gradually became worse. The case
was examined by Dr S. A. Kinnier Wilson, who pointed out that
the combination of tremors, rigidity, and true hypertonicity,
dysarthria, contracture-attitudes, the absence of any sign of
pyramidal involvement, and the state of the reflexes, establish
the case as essentially one of extra-pyramidal motor disease,
and that the lesions must involve the corpus striatum and sub¬
thalamic region on both sides.

The case differs from those already described as progressive
lenticular degeneration (v. Review, 1913, xl, p. 167) in the age of
the patient, the long duration of the disease, the absence of
emaciation and of contracture, the fact that the tremor was not
constant, and that the dysarthria was a long drawn-out, almost
staccato, utterance. A. Ninian Bruce.

ABSTRACTS

125

SYPHILITIC BONE DISEASE OF THE SKULL. M. S. Gkegory
(161) and M. J. Karp as, Joum. Nerv. and Ment. Die., 1913, zl., Oct.

Tub case reported is of interest, not only because of the rarity of
syphilitic bone disease of the skull, but also because the clinical
picture simulated that of a cerebello-pontine tumour.

D. K. Henderson.

DEATH FOLLOWING TWO INJECTIONS OF NEOSALVAB8AN
(162) AT THE ONSET OF SYPHILIS. (Un cas de mort & la suite de
deux injections de ndo salvarsan au dlbut de la syphilis.) E.
Joltrain, Bull, et m<hn. Soc. med. U6p. de Paris, 1914, xxxvii.,
p. 120 ; Milian, ibid., p. 124 ; Sicard, ibid., p. 124.

The patient was a robust man, aged 20. About three weeks after
the appearance of the chancre, when Wassermann’s reaction was
definitely positive, he received three injections of cyanide of
mercury. Four days after the first injection he was given, at his
own request, 0'30 eg. of neosalvarsan, which was followed by
Herxheimer’s reaction on the third day. A week later 0 20 eg.
was given. He passed a restless night, but continued at work till
three days later, when he was seized with vomiting and diarrhoea,
rapidly followed by convulsions and coma. Lumbar puncture
gave issue to a clear fluid under hypertension, containing a large
quantity of albumin and lymphocytes. Death took place three
and a half days after the injection. No necropsy.

In the subsequent discussion Milian attributed the death to a
special intolerance for the drug, which could be combated by
prophylactic injections of 1 mg. of adrenalin.

Sicard drew attention to the fact that in all severe or fatal
cases following injections of salvarsan, Wassermann’s reaction
was positive, and suggested that the conflict between the spirochaetes
and the drug was the cause of the disastrous results.

J. D. Rolleston.

FEVER AS SOLITARY SYMPTOM OF LATENT SYPHILIS.
(163) (Fieber als einziges Symptom latonter Lues.) H. Kraus, Wien.
Klin. Wock., 1913, xxvi., p. 2030.

A record of four cases in adults, aged from 25 to 40, all character¬
ised by obstinate fever of different types persisting for months,
inefficacy of all antipyretic treatment, absence of typical symptoms
of syphilis, history of infection confirmed by Wassermann’s reaction,
exclusion of any other organic disease, and rapid disappearance of
fever after antisyphilitic treatment. J. D. Rolleston.

126

ABSTRACTS

HAVE THE EARLY CLAIMS OF 8ALVARS AN BEEN REALISED ?

(164) C. Morton Smith, Boston Med. and Surg. Joum., 1914, clxx., Feb.
19, p. 269.

The early hope of curing syphilis with a single massive injection
of salvarsan has not been realised. It is a potent remedy in heal¬
ing all manifestations on the skin or mucous membranes. It is
more efficacious than mercury in changing a positive to a negative
Wassermann reaction. Its prompt action on early moist lesions
has a decided effect in limiting the spread of contagion. The early
fears of damage to the cranial nerves appear to be groundless.
When given in proper amounts at proper intervals it is practically
devoid of danger. A Ninian Bkuce.

PARALYSIS OF THE NERVOUS SYSTEM. James MTntosh and
(166) Paul Fildes, Henry Head and E. G. Fearnsides, Brain, 1913,
zzxvi, p. 1.

Parasyphilis of the nervous system is a purely clinical conception.
It is a diseased state that may affect any part of the brain or
spinal cord; the manifestations of tabes dorsalis and dementia
paralytica can only be erected into two clinical divisions by an
arbitrary selection of signs and symptoms. Some forms of
progressive muscular atrophy, lateral and combined sclerosis,
primary optic atrophy, and periodic epileptiform attacks may be
equally definite manifestations of parasyphilis. Parasyphilis is
slightly, if at all, amenable to antisyphilitic treatment with
compounds of arsenic and mercury, probably because these bodies
do not enter the essential structures of the central nervous
system. Parasyphilitic states are peculiarly liable to arise after
mild syphilitic infection. 60 per cent, of cases of tabes have
suffered from at most a primary sore, and in many instances the
whole course of the initial infection was run under cover of a
gonorrhoea. In dementia paralytica and in active, untreated
cases of tabes dorsalis and tabo-paresie, the cerebro-spinal fluid
yields a positive Wassermann reaction, often of great strength.
With acute or chronic syphilis of the nervous system, other than
parasyphilis, the behaviour of the cerebro-spinal fluid depends upon
the extent to which the spinal cord and its membranes, including
those of the brain-stem, are affected. Thus most cases of
meningomyelitis show a strong positive reaction in the cerebro¬
spinal fluid, whilst cerebral lesions tend to give a weakly positive
or even a negative reaction. But in cases of parasyphilis no
obvious change occurs in consequence of such treatment within
any comparable period.

Parasyphilis of the nervous system depends on an atrophy of
the nerve fibres and cells, associated with a cellular infiltration

ABSTRACTS

127

of the meninges and adventitial sheaths of the vessels, and
proliferation of the neuroglia. All infections lead to a change in
the character of the reaction of the tissues to the poison—they
may respond less and less (hypoallergic) until they cease to respond
altogether (anergie), or they may respond quicker and more
violently (hyperallergie), finally culminating in anaphylactic
shock. This hypersensitiveness (hyperallergie) of the central
nervous system is produced by the passage of the spirochaetes or
their toxins up the lymphatics of the nerves from the skin and
mucous membrane during the secondary period, or from a slight
“ encephalitis ” during the stage of infection. In consequence of
this hyperallergie reaction in the tissues, a renewed activity of
the spirochsete rapidly causes death of any set of fibres or cells
attacked and proliferation of the neuroglia. The clinical
manifestations of “ parasyphilis ” are an expression of the reaction
and necrosis of hypersensitised areas of the nervous system evoked
by reappearance of the Spirochccta pallida, and this reaction is as
truly syphilitic as the production of gummata. The difference
merely lies in the nature of the tissues participating in the
reaction. In tertiary syphilis the connective tissue is capable
of repair, and the focus is readily reached by the remedial agents.
In “ parasyphilis ” reaction of the essential nerve elements leads
to their death, and antisyphilitic remedies cannot readily reach
the spirochaite. A. Ninian Bruce.

THE WASSEEMANN REACTION AND ITS APPLICATION TO
(166) NEUROLOGY. Paul Fildes and James McIntosh, Brain , 1913,
xxxvi., p. 193.

In this paper the present state of our knowledge of the Wasser-
mann reaction in all particulars which bear directly upon
neurology is renewed. This is discussed under the headings of (1)
the technique of the Wassermann reaction ; (2) the occurrence of
the Wassermann reaction; and (3) the effect of antisyphilitic
treatment upon the Wassermann reaction. Before estimating the
value of a report upon the Wassermann test, the physician should
be acquainted with the methods and general results of the
serologist who gives the report.

The following general conclusions may be drawn: (1) In
general diagnostic work, exclusive of nervous conditions, a positive
reaction is so constant in active syphilis that such a diagnosis is
doubtful if the reaction be negative. (2) A positive reaction in the
cerebro-spinal fluid indicates a syphilitic lesion of the central
nervous system. (3) In active untreated cases of dementia
paralytica, tabes dorsalis, and cerebro-spinal syphilis, the reaction
is positive both in the serum and cerebro-spinal fluid. In cerebral

128

ABSTRACTS

syphilis, without involvement of the spinal cord, the cerehro-spinal
fluid is usually negative. (4) The reaction is apt to be negative in
the serum or cerebro-spinal fluid in cases of hemiplegia, non¬
progressive tabes dorsalis, and old lesions of the nervous system,
especially in cases of stationary congenital syphilis. It is also
usually negative in the serum, particularly in very recent nerve
lesions of the late secondary period, and in the cerebro-spinal fluid,
particularly in treated cerebro-spinal cases. (5) The occurrence of
a positive reaction in one of the test fluids when the other is
negative is so common that a reaction found negative in one
fluid only is insufficient to exclude syphilis. (6) Pure “para-
syphilitic” lesions do not respond satisfactorily to treatment,
as shown by the slight effect upon the reaction in the
cerebro-spinal fluid. Cerebro-spinal lesions react very readily to
treatment. The celerity with which the reaction in the cerebro¬
spinal fluid responds to treatment is an index of the “para-
syphilitic” or “ syphilitic ” nature of the case. (7) The positive
reaction in the serum is rapidly made negative by treatment in
acute syphilis ; but in chronic syphilis this effect is produced very
slowly. In the cerebro-spinal fluid, on the other hand, the rate of
reduction of the reaction does not depend upon the duration of the
infection. Thus, in gummatous lesions of the central nervous
system, as also in acute secondary cerebro-spinal syphilis, the effect
of treatment upon the reaction in the cerebro-spinal fluid is rapid.
(8) The “provocative” injection of salvarsan for the purpose of
exciting an exacerbation of the reaction has some, but probably an
exaggerated, diagnostic value. A. Ninian Bruce.

METHODS OF INCREASING THE ACCURACY AND DELICACY
(167) OF THB WASSERMANN REACTION. Francis H. Thiele
and Dennis Embleton, Lancet , 1914, clxxxvi., Feb. 21, p. 626.

The method is : 1. To diminish the amount of complement used
to one and a half times only that which will cause complete
hieinolysis of the system adopted. 2. To use large amounts, half
a cubic centimetre or more, of inactivated syphilitic serum. 3. To
use 50 to 100 units of the antigen. By this method purely anti-
complementary phenomena do not play a part. Anti-complementary
effects being rendered obvious in the control, true complement
fixation, even when minimal, can be readily demonstrated. In
this way (1) cases which would otherwise give a slight reaction,
so slight as to be doubtful on the ordinary reaction, give a full
fixation; (2) cases which otherwise give a negative can be made
to give a full reaction, thus bringing in a large number of latent
cases: and (3) no fallacious results with other diseases have been
obtained. A. Ninian Bruce.

ABSTRACTS

129

THE CEREBROSPINAL FLUID AND A SPECIAL METHOD OF

(168) TREATMENT OF ESSENTIAL EPILEPSY. Alfred Gordon,
N.Y. Med. Joum ., 1914, xcix., Jan. 17, p. 110.

One drop of blood drawn from the finger of one patient with
epilepsy was dropped on the centre of the surface of fifteen drops
of cerebro-spinal fluid taken from another patient, and vice versa,
and complete haemolysis took place. A drop of blood from each
patient brought into contact with his own cerebro-spinal fluid,
remained coagulated for days in the tubes. Each patient thus
had in his blood poisonous substances which were antagonistic to
the other’s blood, but not to his own.

Four patients were accordingly treated on this principle,
namely, subcutaneous injections of cerebro-spinal fluid taken from
another epileptic, and it was found that striking improvement
occurred, not only in regard to the severity of the attacks, but also
in their frequency. A. Ninian Bruce.

THE BRAIN OF A MACROCEPHALIO EPILEPTIC. J. Wiolesworth

(169) and George A. Watson, Brain, 1913, xxxvi., p. 31.

The patient was a man, aged 37, a piano-tuner. There was no
history of insanity or epilepsy in the family. He was bright and
intelligent as a child, although of a nervous, excitable disposition,
and early showed signs of great musical ability. At the age of
9 he had an attack of petit mal, but the first fit did not occur until
he was 16, and from then onwards they occurred at variable
intervals. About 27, gradual mental deterioration set in, and he
had to be removed to an asylum a year later on account of
delusions. He became dull and weak-minded, the fits increased
in number, his memory and intelligence failed, and he died from
broncho-pneumonia.

The brain, unstripped of membranes, was found to weigh
2,130 grms. (average weight being about 1,400 grms.). The
cerebral hemispheres were of good general shape and appeared to
be normally constituted, their great size and weight not being
accounted for by the slight increase in neuroglia and thickening of
the vessels which was found. The convolutional pattern was
exceedingly complex, but showed little that could be regarded as
definite marks of inferiority. It is described at considerable
length. The microscopic changes found also do not at all
necessarily bear upon the question of cerebral hypertrophy, being
merely those usually present in the brains of chronic epileptics.
There were, however, in the cerebral hemisphere many signs,
apart from their large size, of a formative activity much greater
than that usually seen. But this increased developmental activity

130

ABSTRACTS

has proceeded on regular lines, and on the whole the departures
from the ordinary in the convolutional pattern are in the
direction of superiority. On the other hand, the tendency to
insulation of areas of cortex, and the marked spurring and forking
of certain sulci, such as is seen particularly in the left temporal
region, may probably be looked upon as indications of formative
activity on irregular or aberrant lines. With this greatly in¬
creased developmental activity, whether in the direction of
superiority or of aberrancy, it seems likely that there would be
a tendency to instability. This patient was neither idiotic nor
imbecile, but was originally of average general intelligence, and it
would appear that even when the minute structure of the brain
appears to be normally constituted, the usual size of the brain,
apart from its increased complexity of pattern, cannot be largely
exceeded without introducing a condition of instability, which
renders its possessor liable to suffer from some form of nervous
breakdown, and especially from epilepsy. A. Ninian Bruce.

ANTERIOR CRURAL NEURITIS. C. M. Byrnes, Joum. Nerv. and
(170) Ment. Dit., 1913, xl., Dec.

This is the first part of an article which will be concluded in the
next number.

The anatomy of the anterior crural nerve is briefly considered,
and the various etiological factors and the importance of correct
differentiations of the neuritic condition are emphasised.

All cases in which one or both nerves has been the seat of
an inflammatory state, consequent upon internal or medical
diseases, as well as those of a so-called idiopathic nature, are dis¬
cussed. Those forms dependent upon distinctly local or surgical
conditions have been excluded.

In this paper 136 cases are analysed, and are grouped accord¬
ing to their etiology in the following order:—

Metabolic diseases, infectious diseases, septic conditions and
intoxications, local conditions in which circulating toxins may
have been a factor, and primary idiopathic neuritis.

Under metabolic diseases, cases are described as occurring in
goutj, rheumatic, diabetic, and pentosuric conditions.

In regard to infectious diseases, cases have been reported as
occurring in typhoid fever, in tuberculosis, and in syphilis. Cases
in the other groups are ascribed as having been due to chronic
suppuration, alcohol, appendicitis, prolonged surgical anaesthesia,
obstetrical conditions, exposure, and occupation and over-exertion.

The author has collected the records of eight cases in which
the anterior crural nerve has been the seat of an idiopathic in¬
flammatory condition. D. K. Henderson.

ABSTRACTS

131

SUBACUTE TETANUS CUBED BT ANTITETANIO SEBUM.
(171) (Tltanos It Evolution snbaiguB gu6ri par le slrum antitBtanique.)
L. Jacqubt and Debat, Bull, et mim. Soc. mid H6p. de Paris, 1914,
xxxvii., p. 190.

The source of infection was not definitely ascertained, but the
patient, who was a farmer, had numerous cracks on his hands.
300 c.c. were given in thirteen injections of 30 c.c. each and four
injections of 10 c.c. There was no opisthotonos, the contractures
being confined to the limbs, jaws, and neck. Recovery took place,
but flaccid paralysis of the anterior muscles of the left leg ensued
with diminution of cutaneous sensibility. Paralysis is a rare
sequel of tetanus in man, but is not infrequent in the horse.

J. D. Rolleston.

NOTES ON SUNLIGHT AND FLASHLIGHT REACTIONS, AND
(172) ON CONSENSUAL AMTOSIS TO BLUE LIGHT. A. Mykbson
and E. E. Eversolk, Journ. New. and Ment. Dis., 1913, xl., Nov.

The authors have made a systematic comparison of the pupillary
reaction when stimulated by flashlight (pocket flashlight) and
daylight. They found no case where, with proper technique,
daylight did not bring a reaction where the flashlight did, but
they did find cases, especially in general paralysis, where, with no
reaction obtainable by the use of the flashlight, daylight brought
about a smaller pupil, although in some cases the movement itself
could not be observed.

The question arose whether there were specific colour qualities
in daylight which might be specific in their stimulating power.
A determination of the properties of three colours, red, green, and
blue, in bringing about reflex responses of the pupil was attempted.

The results are summarised as follows:—

The consensual pupil reacts in a selective manner to the
colours red, green, and blue, in the order mentioned. If there is
disease the blue disappears first, the green probably next.

D. K. Henderson.

PSYCHIATRY.

AN ANALYSIS OF THE EBBOBS IN DIAGNOSIS IN A SERIES
(173) OF SIXTY OASES OF PARESIS. S. T. Obton, Journ. New.
and Ment. Dis., 1913, xL, Dec.

In nine out of sixty cases the clinical diagnosis of general paralysis
could not be confirmed at autopsy. D. K. Henderson.

132

ABSTRACTS

TRANSVESTISM B. S. Talmey, N. Y. Med. Joum ,, 1914, xcix., Feb.

(174) 21, p. 362.

The author describes here four cases of “ transvestism ” or “ cross
dressing,” all being men who dressed as women.

A. Ninian Bruce.

THE CATATONIC SYNDROME AND ITS RELATION TO MANIG-

(175) DEPRESSIVE INSANITY. George H. Kirby, Joum. Nerv. and
Ment . Die., 1913, xl., Nov.

According to Kraepelin, all non-organic cases with catatonic
symptoms belonged to the dementia preecox group, and such
manifestations were looked upon as significant of a deterioration
process. Kraepelin, of course, admits that about 13 per cent, of
the catatonics appear to recover, but the permanency of these
recoveries he regards as unsettled, and inclines to the view that
they are probably only remissions. Wilmans later reviewed
Kraepelin’s own Heidelberg cases, and found that catatonic
symptoms, as evidence of a deterioration process, had been greatly
overrated.

The catatonic syndrome is not a clinical unit, and it is prob¬
able that deteriorating and non-deteriorating catatonic cases
represent fundamentally different reaction types. A review of a
large material has shown that in acutely developing catatonic
states, when not preceded by any ominous prodromal symptoms,
recovery, with few exceptions, takes place, and in some instances
after a duration of several years.

The possible relation of these acutely developing catatonic
states in relation to manic-depressive insanity is discussed, because
the subsequent history of such cases shows not infrequently manic
attacks. Four such cases are described. The most reliable prog¬
nostic data in all these cases is gained from a close study of the
personality, and the mode of development of the psychosis.

The author believes that Kraepelin overvalued catatonic
manifestations as evidence of a deteriorating psychosis, and that
many such cases have served to unduly swell the dementia praecox
group. D. K. Henderson.

TREATMENT.

NOTES ON THE TREATMENT OF SCIATICA. John J. Grace,
(176) Lancet , 1914, Jan. 10, p. 102.

The author records six cases which have greatly improved by the
use of the 500 candle-power lamp and static electricity, twenty
minutes being devoted to each application. A. Ninian Bruce,

REVIEWS

133

IRevievps.

THE HIST0B7 OF THE PRISON PSTCHOSES. By Dra Paul
(177) Nitsche, Dresden, and Karl Wilmanns, Heidelberg. Anthorised
Translation by Francis M. Barnes, Jun., M.D., and Bernard
Glueck, M.D., Government Hospital for the Insane, Washington,
D.C.; with an Introduction by William A. White, M.D. “ Nervous
and Mental Disease Monograph Series,” No. 13. New York: The
Journal of Nervous and Mental Disease Publishing Company, 1912.

This admirably translated monograph is a critical review of the
principal German literature from 1853 to the present day on the
subject of the psychoses occurring in prisoners. The authors’ object
is in the main to set forth the evidences as to the influence of
imprisonment, and particularly of solitary confinement, in producing
insanity, and to determine whether the forms of insanity met with
amongst the criminal classes have any distinguishing characteristics
as compared with the classical types which are recognised as
occurring in ordinary free life. The literature has been divided
into three periods. The first embraces the observations chiefly of
the early prison physicians. The second deals with the relation
of the prison psychoses to the work of Kraepelin, while the third
reviews the later literature written under the influence of the
Magnan-Mobius ideas on degeneracy. It may be said for the
workers in the first period, called by the authors the “ old school,”
that many of the conclusions are evidently based upon the most
accurate observations of competent and enlightened prison
physicians, whose ideas are none the less worthy of notice because
the authors were not obsessed by the multiplicity of psychological
terms which have led later observers to the difficult task of fitting
the mental abnormalities of prisoners into the prevailing classifica¬
tions. Indeed the groundwork of the whole subject is to be found
in the observations of the old school that certain forms of insanity
met with in prison are a later stage in processes that have arisen
before imprisonment, and that acute forms of insanity may develop
in prison as elsewhere, aided or not in their causation by the
particular circumstances of the environment. Much of the
diversity of opinion expressed in this period is not only a testimony
to the excellence of the observations, but, as the authors point out,
is due to the varied nature of the material studied according as the
prisoners were already undergoing long sentences, recently sentenced,
or awaiting trial. Much stress is laid throughout upon the effects
of solitary confinement in producing insanity, and attention is
drawn to the description, particularly by Kirn, of two varieties
of psychoses which are said to be characteristic of solitary confine¬
ments, viz : The acute hallucinatory melancholia and the acute

134

REVIEWS

hallucinatory paranoia. In comparing these observations with
the occurrence of similar conditions at a later date, it must be
remembered that the circumstances that were said to have pro¬
duced these conditions must have materially changed. Those acute
conditions are very frequently met with at the beginning of a term
of imprisonment where the solitary confinement has not been of
any duration, and some cases of mild melancholia based upon the
affective disturbances due to the prisoner’s outlook are, if they are not
associated with a too strong neurotic predisposition, often quickly
cured by the quietude (combined in these cases with observation
and treatment) that results from the modified form of seclusion
that is now applied to prisoners. There is probably, however, in a
great majority of cases a strong neurasthenic basis, and although
in many of these there is the hysterical element in any hallucina¬
tory symptoms to be taken into account, it is necessary, and that
at once, to substitute in such conditions hospital treatment for the
seclusion. In these cases the cure, although immediate, is rarely
permanent, in that if returned to prison conditions the symptoms
reappear. In regard to the contention that acute hallucinatory
melancholia is not a common disease of free life but characteristic
of the effects of solitary confinement, it may be noted that in
many prisoners, probably all neurotic, this condition develops
often a very considerable time after imprisonment as a late post¬
alcoholic state, which would certainly not have been allowed to
occur in free life, but is not therefore due to the seclusion.

The second period is very briefly discussed in the authors’
conclusions. Here it is noted that all psychoses occurring in
prison assume a characteristic type, and show a certain outward
resemblance because of the particular environment—the prison
complex. A study of insane prisoners associated together in a
curative establishment might lead an observer to say that this
prison complex is much more an outcome of the characteristic
criminal disposition, for penal systems and prison regulations vary
much more than does this too-little noted temperament. In this
period also it is noted that much is added to the knowledge of the
prison psychoses because of the wider recognition that much
criminality and mental disease appearing in prison are processes
in a slowly developing dementia praecox.

The third period deals with the light thrown upon the prison
psychoses by the theories of degeneracy. Thus it was established
that the majority of the prison psychoses are not of pure
endogenous origin, but rather reach their development from the
reciprocal effect of the physically diseased constitution, and the
“ manifold physical and psychical traumata of person.” Again, the
“physically diseased constitution” as the predisposing cause
obscures the question of a psychological basis—the criminal mind,

REVIEWS

135

as much an evidence of degeneration as the other. Here special
attention is directed to the work of Siefert, who specifically
’ classified the forms of insanity met with and differentiated between
the acute psychoses arising as in ordinary free life and those
which were produced by an unsuitable environment—the prison—
acting upon a predisposition—degeneracy.

The authors’ conclusions are rendered in a truly critical and
scientific spirit, and a wise eclecticism leads them to begin and
end with a plea for “ more light,” which, it is interesting to note,
ia specially levelled at prison physicians, the modern representatives
of the old school.

A diffuse but highly scientific monograph, it is supported by
a preface in a somewhat rhetorical vein. Few prison physicians
will probably wholly subscribe to the preface in its description of
the mental state of the prisoner convicted of a serious offence
against the person. J. P. S.

THE LABYRINTH: AN AID TO THE STUDY OF INFLAMMA-
(178) TION8 OF THE INTERNAL EAR. By Alfred Braun, M.D.,
and Isidore Fribsner, M.D. Pp. 250, illustrated. Rebman
Limited, London. Price 17s. 6d. net.

For some years a want has been felt by men interested in the
labyrinth, as up till the present there has been no book in
the English language which contains the more recent work on the
physiology and pathology of the labyrinth. It has been necessary
hitherto to consult isolated works by German writers to acquire the
desired knowledge. This want has been ably filled by the book here
reviewed. It commences with a description of the anatomy of the
labyrinth, in which the fullest details of both macroscopic and
microscopic structures are described. This is followed by a section
on the eighth nerve and its central connections. The physiology
and methods of examination of the cochlea and vestibular apparatus
are explained in such a way as to render the comprehension of the
various complex reaction movements comparatively easy. The
clinical tests for localising the seat of trouble are carefully described
and their relative advantages and fallacies fully discussed. The
paths of infection and pathological changes have a chapter to
themselves, with numerous illustrations. The last chapter in the
book is devoted to indications for treatment and operative methods.
Finally, several pages are devoted to the bibliography of the
subject. In conclusion, one may say that although the illustrations
in many respects are not all that might be desired, the book forms
an excellent risuwtf of all the recent work on the labyrinth, and
is indispensable to the otologist who wishes to keep up to date,
and is worthy of perusal by most neurologists.

J. K. Milne Dickie.

136

BOOKS AND PAMPHLETS RECEIVED

PATHOLOGICAL INEBRIETY: ITS CAUSATION AND TREAT
(179) MENT. J. W. Astley Cooper. With Introduction by Sir David
Ferries. Crown 8vo., pp. xvi and 151. Baillifcre, Tindall, <fe Cox,
London, 1913. Pr. 2a 6d. net.

This little book is to be regarded as an attempt to convey to the
rank and file of the medical profession, and to those of the general
public who are interested in temperance reform, some knowledge
of the causation and the scientific and rational treatment of
pathological, chronic, and periodic drunkenness, and to show how
mistaken has been the attempt to cure inebriety by penal methods,
and how essential to proper treatment is adequate legal control.

It begins with short chapters upon the nature, forms, and
causes of pathological inebriety. This is followed by a description
of the complications, preventive treatment, and treatment by the
combined method. A few pages are also devoted to inebriety and
temperance societies. The psychical treatment and methods used
to establish and develop the power of self-control are of special
interest.

BOOKS AND PAMPHLETS RECEIVED.

Amoss, Harold L. “A Note on the Etiology of Epidemic Poliomyelitis ”
( Joum. Exp. Med L, 1914, xix.).

Clark, Paul F., and Amoss, H. L. “ Intraspinous Infection in Experi¬
mental Poliomyelitis” (Joum. Exp. Med., 1914, xix.).

Clark, Paul F., Fraser, Francis R., and Amoss, H. L. “The Relation
to the Blood of the Virus of Epidemic Poliomyelitis” (Jou m. Exp. Med.,
1914, xix.).

Flexner, Simon, Clark, Paul F., and Amoss, H. L. “A Contribution to
the Pathology of Epidemic Poliomyelitis” (Joum. Exp. Med., 1914, xix.).

Flexner, Simon, Clark, Paul F.,and Amoss, H. L. “A Contribution to
the Epidemiology of Poliomyelitis” (Joum. Exp. Med., 1914, xix.).

Lamar, Richard V. “ Chemo-immunological Studies on Localised In¬
fections” (Joum. Exp. Med., 1914, xix.).

Rybakow, Th. “La Cyclophr4nie (la psychose circulaire)” (Travaux
de la clin. psyckiat. de VUniversity de Moscoii, 1914, No. 2).

IRevnew

fleurologs anb flte^cbiatrs

©rtginal Hrticles

THE NEURAL ATROPHY OF THE MUSCLES OF
THE HAND, WITHOUT SENSORY DISTURB
ANCES 1

A Further Study of Compression Neuritis of the Thenar
Branch of the Median Nerve and the Deep Palmar Branch
of the Ulnar Nerve.

By J. RAMSAY HUNT, M.D.,

Associate Professor of Nervous Diseases, Columbia University, New York.

(With Plates 3 and 4.)

Atrophic paralysis of the small muscles of the hand occupies &
position of peculiar importance in symptomatology, because of
the great variety of pathological conditions in which it may
occur as an important and often early symptom. It may follow
involvement of the spinal cord, the anterior roots, the brachial
plexus, and of the ulnar and median nerve. As a rule, the
associated sensory disturbances or the absence of sensory symptoms
play an important and often determining rdle in the topographical
localisation of the lesion, indicating its neural, plexus, radicular,
or medullary origin, as the case may be.

The types of neural atrophy of the hand to which I shall refer
have already been described in previous communications, 2 and are

1 Read at a meeting of the New York Neurologioal Society, Jan. 1914.

9 Ramsay Hunt, "Occupation Neuritis of the Deep Palmar Branch of the
Ulnar Nerve," Joum. of Nerv. and Ment. Die., 1909, and “ The Thenar and Hypo-
thenar Types of Neural Atrophy of the Hand," Am. Jour, of the Med. Sci.,
1911, Feb.

138

J. RAMSAY HUNT

characterised by a strictly neural distribution with complete
absence of those disturbances of sensibility which usually
accompany lesions of the median and ulnar nerves. For this
reason they may resemble more or less closely certain of the
myelopathies and myopathies beginning in the small muscles of
the thenar, hypothenar, or interosseous regions of the hand.

This peculiar form of neural atrophy results from a neuritis or
compression of purely motor branches of the ulnar and median
nerves, and may be divided into a thenar and hypothenar type.

In the thenar group the atrophy is limited to the muscles of
the thenar eminence supplied by the median nerve, and is the
result of compression of the thenar branch as it passes beneath
the anterior annular ligament of the wrist.

The hypothenar group is characterised by paralysis with atrophy
of all the small muscles of the hand supplied by the ulnar nerve,
and results from compression of the deep volar branch as it passes
between the tendons of origin of the short abductor and the short
flexor of the little finger.

Both of the compressed nerves are purely motor in character,
which explains the occurrence of neural atrophy without disturb¬
ances of sensibility in their respective distributions.

In my previous papers, the separation of these two types of
neural atrophy from the other forms of occupation palsy was
discussed in detail. In the present communication I wish to
emphasise more particularly the points of differentiation from
certain of the spinal atrophies of the Aran-Duchenne type.

Cask I.

A Typical Case of the Hypothenar Type of Neural Atrophy
without Sensory Disturbances.

Patient is a man, 32 years of age. His occupation consists of
“ cutting, pressing, and ironing clothes.” There is no history of
lues, and he is moderate in the use of alcohol.

He was referred to the Vanderbilt Clinic, Department of
Nervous Diseases, in November 1910, on account of weakness
and atrophy of the muscles of the right hand. The weakness
was first noticed about six months previously, and the atrophy
had gradually followed. He has had no pain and no parasthesise

Plate 3.

. 1, Cask I.—The Hypothenar Type of Neural Atrophy without
Sensory Disturlwinces. Posterior View, showing Atrophy of
Interossei and Inability to Extend the Fingers. Compression
Neuritis of the Deep Palmar Nerve.

2, Cask I.—Hypothenar Type. Palmar Aspect, showing Atrophy
of Hypothenar and Interossei. Note Prominence of the Thenar
and the Sharp Border formed by the External Head of Flexor
Brevis Pollicis. Compression Neuritis of Deep Palmar Branch.

NEURAL ATROPHY OF THE HAND

139

in the hand, and has continued his occupation, but not without
great difficulty and inconvenience.

Physical Examination, November 1913.—The right hand is
the seat of paralysis and atrophy, which is strictly limited to the
ulnar distribution of the small muscles of the hand, i.e., the
hypothenar interossei and the adductor pollicis. The general
appearance of the hand suggests the main en griffe, with extension
of the basal and flexion of the middle and distal flanges (Fig. 1).
There is distinct prominence of all the metacarpal bones, with
marked wasting on the palmar aspect of the hand and flattening
of the hypothenar, which is in marked contrast to the thenar
group, which stands out prominently and is well preserved (see
Fig. 2). There is complete paralysis of the abductor, opponens..
and flexor brevis minimi digiti, the interossei, and the adductor
pollicis. The functions of the flexor carpi ulnaris and of the
palmaris brevis are preserved. An effort to abduct the little finger
produces the typical contraction of the palmaris brevis (see Fig. 3);
pressure over the pisiform bone also produces the usual contrac¬
tion of this muscle. The movements of the thenar muscles and
those of the forearm and upper arm are normal. No fibrillary
twitchings were noted at any time.

The objective sensibility of the hand is normal to touch, pain,
and temperature. Digital pressure of the ulnar nerve in the
groove at the bend of the elbow produces the usual tingling
sensation, which is a little more active in the paralysed than in
the unaffected hand. There is no tenderness of the nerve trunks.

Electrical Reactions .—Faradic and galvanic stimulation of the
ulnar nerve at the elbow produces contractions in the flexor carpi
ulnaris and in the palmaris brevis, hut no response in the intrinsic
muscles of the hand supplied by the ulnar nerve. Direct faradic
stimulation of the hypothenar group, interossei, and adductor
pollicis produces no contractions; direct galvanic stimulation of
these muscles elicits a slow vermicular response with reversal of
the polar formula (complete reactions of degeneration). The
muscles of the thenar region supplied by the median nerve (abduc¬
tor, opponens, and flexor brevis pollicis) yield normal electrical
reactions.

The general physical examination is negative. The man shows
good muscular development without signs of atrophy or weakness.

Pupils are equal and react promptly to light and accommodation.

140

J. RAMSAY HUNT

There is no tremor of the hands. Both knee jerks and both
Achilles jerks are present and equaL The arm reflexes (biceps,
triceps, and supinators) are normal and of equal intensity on the
two sides. The plantar, abdominal, and cremaster reflexes are
normal.

There is no lead-line on the gums. The urine is free from
albumen and sugar. The Wassermann reaction of the blood is
negative. The X-ray for cervical rib is negative.

Diagnosis .—The hypothenar type of neural atrophy without dis¬
turbances of sensibility; compression neuritis of the deep volar
branch of the ulnar nerve.

Remarks on the Hypothenar Type.

Including those previously reported six cases of this type have
come under my personal observation, all of which were unilateral
and identical in symptomatology with the case just recorded. In
all there was a complete paralysis of the intrinsic muscles of the
hand supplied by the ulnar nerve, without sensory disturbances.
In two of the cases in which this symptom was investigated the
function of the palmaris brevis muscles was preserved. This
peculiarity is explained by the anatomical distribution; the filament
supplying this small subcutaneous muscle is given off from the
superficial palmar branch of the ulnar nerve, and so escapes injury
in the compression of the deep palmar branch.

Complete reactions of degeneration were observed in all of
the cases, strictly limited to the ulnar distribution in the hand.

The seat of the lesion in this hypothenar group may be localised
with practical certainty. As the functions of the flexor carpi
ulnaris, the palmaris brevis, and of the sensory branches are
preserved, the compression must take place at a lower level, viz.,
the deep palmar branch. And as all the muscles supplied by
this nerve are paralysed, the injury must occur before the nerve
is broken up into its various muscular branches. This short
section of the nerve trunk corresponds to its passage between the
tendons of origin of the abductor minimi digiti and the floor
brevis minimi digiti, sometimes piercing the latter structure.
Immediately after its passage between these two muscles it comes
in close relationship to the hook-like process of the unciform bone.

The degree of neural atrophy varies with the duration of the
paralysis. If the case is recent and is seen in the early stage t

Kics. 3, Cask I. Hypolhenar Type; showing Ulnar Fluxion of the Wrist and
Wrinkling of Skin over the lkise of Hypothenur due to Contraction of the
Puimari* BrtvU Muscle.

Fro. o, Cask II.—The Thenar Type. Lateral Aspect, showing Atrophy of
Thenar Eminence and Sharp Edge of the Metacarpal Hone.

NEURAL ATROPHY OF THE HAND

141

wasting of the muscles is but slightly marked, but gradually
atrophy supervenes, and at this period may simulate a progressive
tendency. It, however, does not progress beyond the limits of the
ulnar distribution. The thenar eminence of the median innerva¬
tion always stands out sharply defined in the otherwise atrophic
hand.

Case II.

The Thenar Type of Neural Atrophy without Disturbances of

Sensibility.

A man, aged 49, was admitted to the Neurological Division of
the Vanderbilt Clinic in March 1913, with weakness and atrophy
of the muscles of the ball of the left thumb.

He denies lues, and is moderate in the use of alcohol. His
occupation has been the same for some years, and consists in doing
the general cleaning work of a large store, which includes sweeping,
washing, and scrubbing floors, polishing brasses, and other work of
a similar rough character. On an average he works from ten to
twelve hours a day. There has been no exposure to lead intoxica¬
tion, and there is no evidence of the lead-line on the gums.

Six months previously he states that the right thumb was
injured by a blow from a heavy bar of iron, which caused some
pain and swelling of both joints. He continued his work, however,
but doing as much as possible with the left hand. Thus a great
deal of work which had previously been performed with the right
hand was done by the left hand.

The history of his malady is as follows:—

About five weeks before coming under observation, he noticed
while working that the movements of the left thumb were weak,
and that he was unable to use this member as effectually as before.
This localised weakness appeared to increase for the next two or
three days, since which time it has remained stationary. There
was at no time the slightest evidence of pain or panesthesia in
the affected hand. The disease was one purely of weakness, with
no other subjective symptoms in the left upper extremity.

Physical Examination, March 25th, 1913.—The left hand
shows beginning atrophy of the muscles of the thenar eminence
corresponding to the abductor pollicis and the opponens pollicis.
No fibrillary twitchings are observed. There is a total paralysis

142

J. HAMS AY" HUNT

r of these muscles, and a decided weakness in the movements of the
I flexor brevis pollicis. All the other intrinsic muscles of the left
hand are perfectly normal in volume and in function. There is
complete preservation of the function of the adductor pollicis.

Electrical Reactions. —Strong faradic and galvanic stimulation
of the median nerve fails to produce any contraction in the
paralysed movements of the thenar eminence.

Direct faradism of the left thenar region elicits no response in
the alxluctor or opponens pollicis. The inner portion of the flexor
brevis pollicis and of the adductor pollicis yields good contractions.

Direct galvanism produces a slow vermicular contraction of
the paralysed muscles (abductor and opponens pollicis and
external portion of the flexor brevis pollicis) with reversal of the
polar formula. Quick, normal contractions of the inner head of
the flexor brevis pollicis and adductor pollicis are elicitable. All
other intrinsic muscles of the left hand, the interossei, and those
of the hypothenar give normal electrical responses.

The objective sensibility of the left hand and fingers is normal
to touch, pain, and temperature. There is no tenderness along
the course of the median nerve or where it passes beneath the
annular ligament.

The Eight Hand. —The phalangeal joints of the right thumb are
still enlarged and swollen, the result of trauma some months
previously, but are free from pain and tenderness. All the
intrinsic muscles of the hand are normal in function.

General Examination. —A careful study of the general muscula¬
ture of the body was made for evidences of weakness, atrophy, or
fibrillary twitchiugs, with negative results. The muscles of the
forearm, upper arm, and shoulder girdle are well developed and
normal. The spinal column is normal in movements and contour.

The pupils are unequal, right is larger than the left. They do
not respond to light. Keaction to accommodation is absent on the
right, active on the left.

The tendon reflexes of both upper extremities ( supinator , biceps
and triceps jerks) are of normal intensity, and are equal on the two
sides.

The masseter reflex is present. Both knee jerks are present
and active, and equal on the two sides. The Achilles jerks are
present and equal. The plantar reflex shows a flexor response on
both sides. The abdominal and cremaster reflexes are normal.

NEURAL ATROPHY OF THE HAND

143

The general sensation of the body is normal except in the
mammary region, where spots of analgesia and hypalgesia are
present.

Heart is negative. Urine: no albumen; no sugar.

Note .—On inquiry, the patient states that at rare intervals he
has had occasional lancinating pains in the lower extremities.
These are infrequent and not at all severe.

There is no vesical trouble, no dysarthria, no crisis, and no
paresthesia.

Re-examination, 24 th November 1913.—

The thenar atrophy on the left side is more pronounced, so that
a distinct scooped-out appearance is produced, limited on the outer
side by the border of the first metacarpal bone, and on the inner
side by the internal head of the flexor brevis pollicis (Figs. 4 and 5).
The paralysis and atrophy as well as the reactions of degeneration
are strictly limited to the distribution of the thenar branch of the
median nerve. No fibrillations have been noted at any time. The
other muscles of the left hand are normal in function and in
electrical reactions. The musculature of the right hand and both
forearms and upper arms is normal in function and volume.

The objective sensibility of the left hand and fingers is normal.

The pupils are unequal, the right is greater than the
left. Both are rigid to light, and the left only responds to
accommodation.

The arm jerks are all present and equal. The knee jerks are
present and unequal, the right being a little less than the left.
The Achilles jerks are equal. On plantar stimulation there is a
flexor response on both sides.

Patient has occasional lancinating pains in legs, not severe or
frequent, but typical in character.

The sphincters are normal. The mammary zone shows areas
of analgesia and hypalgesia.

Examination, January 1914.—In spite of advice to the
contrary, the patient persists in his occupation, working about
twelve hours a day.

The atrophy of the left thenar is still present, and is limited
strictly to the thenar distribution of the median nerve.

Electrical reactions of degeneration are still present, and are
limited to the median distribution of the thenar eminence. The
function, appearance, and electrical responses of the other intrinsic

144

J. RAMSAY HUNT

muscles of the left hand are all normal, including the adductor
pollicis and the inner head of the flexor brevis pollicis. No fibrilla¬
tions. Sensibility in the median distribution remains normal.

Pupillary responses are as noted at previous examinations.

Responses of the upper extremities are present, and equal on
both sides. Knee jerks are present and unequal, the left is less
active than the right. The Achilles jerks are present and equal.
The plantar reflexes are normal. The abdominal and cremasteric
reflexes are normal Wassermann reaction is negative. Spinal
puncture not performed. X-ray examination for cervical rib is
negative.

Diagmsis. —Incipient tabes and the thenar type of neural
atrophy.

Remarks on the Thenar Type.

Including those previously described, four cases of this type
have come under my observation, in two of which the atrophy was
unilateral and in two it was bilateral. In all four cases, including
those in which the atrophy was bilateral, the clinical features were
identical, viz., paralysis with atrophy of the muscles of the thenar
eminence innervated by the median nerve, with reactions of
degeneration and complete preservation of sensibility in the dis¬
tribution of the median nerve. Fibrillary twitchings were absent,
and a central affection was excluded. One of these cases made a
complete recovery, one a considerable improvement, and in one the
atrophy has persisted and remained stationary over a period of
nineteen years, while one case has been under observation for a
year and has not progressed.

The symptoms in this group of cases are purely motor in
character and are strictly limited to the thenar distribution of the
median nerve, and can only be interpreted as resulting from a
lesion of the thenar branch of the median as it passes beneath the
anterior annular ligament of the wrist. This theory of compres¬
sion by the annular ligament, which I expressed some years ago, 1
would seem to have received confirmation from a recent patho¬
logical study by Marie and Foix, 2 in which compression neuritis

1 “Compression Neuritis of the Thenar Branch of the Median Nerve: A
well-defined Clinical Type of Atrophy of the Hand/’ 7'ransactions of the
American Neurological Association , 1909.

* 2 “Atrophie iaotee de l’eroinenoe thenar d’origine nevritique. Role du
ligament annulaire dans la pathogenie de la lesion,” Btime Neurologtque , 1913,
xxi., Nov. 30, p. 647.

NEURAL ATROPHY OF THE HAND

145

of the median nerve was found localised beneath the anterior
annular ligament of the wrist in a case of double thenar atrophy.

The neural atrophy in the thenar as in the hypothenar group
comes on gradually, following in the wake of the paralysis, and
in this way a certain progressive tendency may be manifested in
the earlier months, which may be very suggestive of a beginning
spinal atrophy of the Aran-Duchenne type. There are, however,
no fibrillary twitchings, and the atrophy and reactions of degenera¬
tion are strictly limited to the median distribution of the thenar
eminence. (Abductor, opponens, and the outer head of the flexor
brevis pollicis.)

Remarks on Diagnosis.

The differentiation of the thenar and hypothenar types of
neural atrophy of the hand from the other groups of compression
neuritis, professional palsies and occupation atrophies occurring
in the hand, have been discussed at length in my previous studies
of this subject. Briefly stated, the essential points of difference
are, the absence of sensory symptoms in the affected neural
distribution and the complete paralysis of all the intrinsic muscles
of the hand supplied by the thenar nerve (thenar type) and
the deep palmar nerve (hypothenar type).

A complete paralysis in an entire neural distribution with
degenerative reactions would rule out conclusively those forms
of occupation palsy which have been ascribed to degeneration of
the peripheral motor terminals by muscular compression (Gessler), 1
as well as those professional atrophies assumed to be of royositic
or myopathic origin.

Certain types of spinal atrophy beginning in the small muscles
of the hand may cause uncertainty in diagnosis in the earlier stage
when atrophy is just beginning. But the absence of a sharply
defined limitation to a neural distribution and the progressive
tendency, the presence of fibrillary twitchings and the later
involvement of the other muscles of the forearm, with alterations
of the tendon reflexes, serve very effectually to indicate its
medullary origin.

1 “Eine eigenartige form von Progressive Muskei Atrophie bei Gold-
PolirinneIl. ,, Med. Correspondent, Blatt. des Wurtemberg , Ant. Land., Vertin *,
Bd. lxvi., No. 36.

146

J. RAMSAY HUNT

In a recent study of this subject Marie and Foix 1 have
described a curious type of spinal atrophy affecting the intrinsic
muscles of the hand, which remains strictly limited to this region
and shows no tendency to progress to the other muscle groups of
the upper extremity. This affection is extremely slow in its
evolution, the atrophy gradually increasing over a period of years.
In the two recorded cases with autopsy, the atrophy of the small
muscles of the hand was diffuse, involving chiefly the thenar but
also the hypothenar and interosseous region of the hand. The
electrical reactions of degeneration were present in the atrophic
muscles. In both cases clinical and pathological evidences of
syphilis were present.

The pathological lesions underlying this curiously limited and
non-progressive atrophy of the hand were found in a corre¬
sponding focal atrophy of the anterior horn. The grey matter and
cellular structures of the anterior horn were found shrunken and
atrophic in a small area of the cord corresponding in level to the
8th cervical segment, and encroaching slightly upon the adjacent
7th cervical and 1st dorsal segments. The cause of this focal
wasting of the anterior horn or tephro-rnalacia-anterior, as it has
been termed by the authors, is an endo-periarteritis of the ante-
rioles nourishing the affected region, which diminishes the calibre
of the vessels, with a consequent gradual shrinking of the grey
matter. As the vessels were not thrombosed, the gradual and
insidious wasting of the hand muscles was caused by the slow
diminution of the blood supply in this restricted area.

Such a clinical picture may from its non-progressive course
resemble very closely the thenar and hypothenar types of neural
atrophy. In the neural atrophy, however, the paralysis is more
rapid in its development and from the first occupies the complete
neural distribution of the compressed nerves.

Complete reactions of degeneration are also present at an early
period, likewise including the entire distribution of the compressed
nerves.

As the paralysed muscles gradually undergo atrophy, the
limitation of the wasting to the distribution of the compressed
nerves is even more apparent. In the thenar type the atrophic

1 “ L’atrophie isolee non progressive des petits muscles de la main. Tephro-
malacia-anterior.” Marie efc Foix, Novv. 1 conograph it de la Salpttribre, 1912,
xxv., p. 353.

NEURAL ATROPHY OF THE HAND

147

area presents a punched-out appearance, due to the well-defined
border of the internal head of the JleoMr brevis pollids, while in
the hypothenar type a veritable main en griffe may develop, with
complete preservation of the rounded prominence of the thenar
eminence.

While admitting that focal medullary affection, such as the
tephro-malacia-anterior, may simulate rather closely such a neural
picture, the difficulty in diagnosis is more theoretical than real;
so that in the thenar case with incipient tabes, reported in this
paper, I would exclude the tephro-malacia-anterion', as well as the
more diffuse forms of spinal atrophy, even in the presence of
syphilis, for the reasons stated above.

The persistence of the thenar atrophy in these cases is not
without interest, and by no means excludes the neural origin. In
one of my cases it had lasted through a period of nineteen years.
An explanation of this is to be found in the slight degree of dis¬
ability produced by the thenar palsy, so that the occupation is
continued which had originally caused the compression. Under
those conditions, the causative factor not being removed, regenera¬
tion of the nerve does not take place.

The same may be true of the hypothenar type, but in my
experience the disability being greater in this group of cases, the
occupation is usually abandoned, thus relieving the nerves from
further compression, and permitting regeneration to take place.

As the prelude to treatment, therefore, the particular move¬
ments of the hand instrumental in the production of the com¬
pression should be interdicted.

It is possible that with advancing years the annular ligament
may become more rigid and less elastic, and thus render
compression of the thenar nerve more likely in the thenar cases.
Under these circumstances, surgical relief of pressure might be
given consideration.

Concluding Remarks.

Atrophic paralysis of the intrinsic muscles of the hand, without
disturbances of sensibility, may be of myopathic, myelopathic, or
neural origin.

Neural atrophy of the hand may occur as two well-defined
clinical groups, both due to a compression lesion of a motor branch
of the median and ulnar nerves respectively.

148

EDGAR F. CYR1AX

The hypothenar type : This term indicating the seat of the com¬
pression lesion at the base of the hypothenar eminence and its
relationship to the ulnar nerve (compression neuritis of the deep
palmar nerve).

The thenar type: This also indicating the seat of the com¬
pression at the base of the thenar eminence, and its relationship
to the median nerve (compression neuritis of the thenar nerve).

ON THE TECHNIQUE OF NERVE PALPATION BV
NERVE “FRICTION.”

By EDGAR F. CYRIAX, M.D., London.

When the method of ordinary palpation is employed in order to
determine the position, shape, and size of nerves, a great deal of
information can thus be obtained. But this method is neither
so reliable nor so perfect as that which has been designated nerve
“ friction,” a procedure which not only gives information on these
points with greater precision and accuracy, but can frequently
reveal them when ordinary palpation entirely fails to do so.
This method of nerve friction, which is really more a therapeutic
than a diagnostic agent, is an improvement on the old nerve
pressings or vibro-pressings of the Ling school of medical gym¬
nastics ; its existence in its present form we owe to H. Kellgren.
In order to understand the method it will be necessary minutely
to describe the technique.

The part of the body in which the nerve lies should be easy
of access, and the muscles, fasciae, &c., that lie superficial to the
nerve should be relaxed. It is, however, not essential, though in
most cases preferable, that the part be denuded of clothing. 1 The
position of the medical man and the patient is simply that which
allows the friction to be most perfectly carried out, and the
relative positions of his digits, hand and forearm to the patient
will vary accordingly. The exact site of the nerve sought is

1 Nebel (Schmidts Jahrb ., 1891, ccxxx., 195) and Reibmayr (Die Massage uud
ihre Venoerthung , 1893, 16) both stated that it was impossible to detect nerves
by the sense of touch through ordinary clothing. How these two authors
failed to feel, say, the cords of the brachial plexus through thin clothing is
difficult to understand.

TECHNIQUE OF NERVE PALPATION

149

located either through knowledge of topographical anatomy, or
by means of actually feeling it by palpation: the medical man
then places one or more digits on or near the nerve to be examined.
Either the nail itself, or the nail together with the soft part, or
the soft part without the nail, of the forefinger or second finger,
less commonly of the thumb, is the actual part employed. The
friction is then executed by drawing the tip of the digit, together
with the superficial structures, across the nerve at right angles
to its long axis, a certain amount of pressure being applied
meanwhile. The amount of pressure should be the lightest
compatible with the effect desired; for example, a friction applied
to the facial nerve as it winds round the ascending ramus of the
jaw with a pressure equivalent to about one ounce, is sufficient in
many cases to enable the operator clearly to define the position
and size of the nerve, and to produce, from the patient’s point of
view, a mild but distinctly stimulatory effect. As soon as the
nerve has been traversed, the pressure is relaxed. The digit may
then either execute a friction in the reverse direction or be
brought back to its original position, and execute another in the
same direction. A certain amount of speed is necessary; on the
average it may be said that a single friction occupies from one-
fifth to one-half a second.

Care should be taken to avoid:—

1. Applying the pressure too long before beginning the friction,
and not relaxing it immediately after completing it.

2. Applying too great a pressure.

3. Executing the friction too slowly.

Each of the three above faults results in a dull aching sensation,
quite unlike the stimulatory one that results if the friction is
correctly executed.

4. Not locating the nerve. The mere causing of pain is not
an indication that the main nerve has been reached.

5. Moving across the superficial structures, not together with
them across the nerve.

From the purely physical point of view, the following major
effects are induced by nerve frictions when correctly executed.
Changes arise in the length, thickness, shape, and anatomical
position of the nerve thus treated, followed by a rapid return to
the normal; this return may in some cases give rise to a sound

150

EDGAR F. CYRIAX

which can be heard both by patient and operator. (As an example
of the last mentioned may be cited the facial nerve.)

1 now pass on to a list of the more important nerves in the
human body, whose position, size, and shape can be detected by
nerve friction, mentioning in each case the spot at which these
frictions can most advantageously be applied, and the direction
in which this preferably should be done.

Name.

Site for Application of
the Friction.

Direction in which the
Friction is to be Applied.

Supraorbital nerve—

(a) Before the notch -

(b) In the forehead
Supratrochlear nerve
Nasal nerve -
Infratrochlear nerve

Cutaneous branches of
the lachrymal nerve

Infraorbital nerve -

Auriculo-temporal nerve

Mental nerve -

Orbital plate of the frontal
bone

Forehead -

Nasal process of the
superior maxilla

Lower border of the nasal
bone

Nasal process of the
superior maxilla below
the supratrochlear nerve

Anterior edge of the ex¬
ternal surface of the
malar bone

Across the infraorbital
foramen

Half an inch in front of
the tragus

Across the mental fora¬
men

Transversely in either
direction.

Above downwards.

Behind forwards.

Above downwards.

Above downwards or
laterally.

Behind forwards.

Transversely in either
direction.

Facial nerve—

| (a) Behind the lower jaw 1

(6) Over the zygoma 1 -

! Superior laryngeal nerve—
(a) Internal branch -

(b) External branch - |

Recurrent laryngeal nerve!

Cervical plexus -

Great occipital nerve—

(a) As it becomes cut¬
aneous

Posterior border of the
ascending ramus

Posterior half of the
zygoma

Interval between the hyoid
bone and the thyroid
cartilage

On the alae of the thyroid
cartilage

Side of the trachea low
down

Anterior edge of the tra¬
pezius

Below the superior curved
line one inch from the
middle line

Above downwards.
Behind forwards.

Behind forwards.

Behind forwards.
Behind forwards.
Before backwards.

Without inwards.

1 Photographs showing these frictions have been published in Intern . Clin» %
1912, xxii. S. f i. 41-57.

TECHNIQUE OF NERVE PALPATION

151

Name.

(6) In the scalp -
Cervical portion of the
brachial plexus
Pudic nerve -

Suprascapular nerve

Brachial plexus in the
axilla

Median nerve—

(а) In the axilla -

(б) In the upper arm *

Ulnar nerve—

(а) In the axilla -

(б) Upper part of the

upper arm

(d) At the internal con¬

dyle

Musculo-spiral nerve

Great sciatic nerve—

| (a) As it lies between j

1 the tuber ischii and [

the great trochanter |
(6) In the thigh - - |

Internal popliteal nerve - |

Posterior tibial nerve - |

Internal plantar nerve as
it lies between the first
and second metatarsals
External popliteal nerve

Site for A implication of
the Friction.

Direction in which the
Friction \» to be Applied.

Parietal bone -
Angle formed by the
clavicle and acromion
External to the spine of
the ischium

Either side of the supra¬
scapular fossa
To either side of the cords

As for the brachial plexus

Without inwards.

Before backwards.

Transversely in either
direction.

Behind forwards.

Behind inner border of the
biceps

Anticubital fossa - - j Within outwards.

As for the brachial plexus

As for the median nerve *

Inner surface of the trioeps

To either side of the groove
or just above or below it
To either side of the groove

To either side of the nerve

Either side of the nerve • I
Either side of the nerve - \
Either side of the nerve - j
Either side of the nerve - j

Anterior crural nerve

. i

Inner side of the biceps
tendon

Either side of the nerve,
just below Poupart’s liga¬
ment

Transversely in either
direction.

Behind forwards.

Transversely in either
direction.

Within outwards.

Before concluding, I should like to make the observation that
a considerable amount of practice is necessary before becoming an
adept with the above methods, and that failure at first attempts
aocurately to define the nerves given in the above list is merely
another proof of the rule that practice makes perfect

152

ABSTRACTS

Hbstracts.

ANATOMY.

ON THE COLLOIDAL STRUCTURE OF NERVE CELLS. (Snr la
(180) structure colloldale des cellules nerveuses et ses variations it
l’6tat normal et pathologique.) O. Marinrsco, Joum. dt Neurol .,
1913, ziii. and xiv., p. 242.

There can be no doubt that the ultra-microscope is modifying many
of the accepted views as to the structure of nerve cells. In the
above important paper, the author shows that Nisei's corpuscles
are never seen in fresh cells, but can be produced at will by
various reagents, including metallic salts, acids, and alcohol.
Fresh cells contain very fine granulations, which vary in colour
and luminosity according to the locality from which they are
obtained, and the age of the patient. The absence of Brownian
movements of these granulations, and the behaviour of the cells
when treated by solutions of different concentrations show that
the substance of the cell is of a colloidal nature. The author
leaves open the question whether the neuro-fibrillar network is
present before fixation of the cell, but thinks that it possibly may
be so present. W. D. Wilkins.

PHYSIOLOGY.

REGENERATION OF MEDULLATED NERVES IN THE ABSENCE
(181) OF EMBRYONIC NERVE FIBRES, FOLLOWING EXPERI¬
MENTAL NON-TRAUMATIO DEGENERATION. Elbkrd

Clark, Joum. Comp. Neurol., 1914, xxiv., Feb., p. 61.

Degeneration of medullated nerve fibres was produced in fowls by
prolonged feeding on polished rice, and regeneration by a return to
an adequate nutritive diet.

In such fowls all traumatic and inflammatory effects produced
by cutting the tissues or tying the nerve are obviated and the
possibility of an ingrowth of fibres from other nerves into the
regenerating nerve is eliminated. The process can also be stopped
at any stage or greatly prolonged, and several stages of degeneration
are seen in different fibres of the same nerve.

Ten to twenty per cent, of the medullated fibre of the nervus
ischiadicus showed a complete fatty change in their medullary
sheaths into globules of degenerated myelin and a segmentation or

ABSTRACTS

153

granulation of their axis cylinders. No multiplication of the nuclei
of the neurilemma sheath could be observed. The fibres merely
attained new axis cylinders and the medullary sheaths returned
to normal. By prolonging the degenerative process, proliferation
of the nuclei of the neurilemma sheath resulted. When this
occurred the degenerated myelin quickly disappeared from the
fibre and thus the author thinks the proliferation of the neurilemma
sheath aids the absorption of degenerated myelin. In regeneration
a new axis cylinder was attained by outgrowth and in the absence
of neurilemma proliferation, and grew dowp the old medullary
sheath which still contained large globules of degenerated myelin
and fragments of the old axis cylinder.

No indications of degeneration were observed in the fibres of
the spinal cord. A. Ninian Bruce.

PSYCHOLOGY.

80MB NOTES ON “ TRANSFERENCE.” Smith Ely Jelliffe, Joum.
(182) Abnorm. Psychol, 1913-1914, Dec., Jan.

In this paper some observations are made on the forms in which
transference was revealed to the author, what it taught him to do,
and what not to do, and how it may be utilised for the purposes of
furthering the treatment of the patient, or of recognising that for
this or that patient the situation is not propitious so far as the
immediate examiner is concerned. “ In this latter case one should
see one’s duty and retire before an injury is done to the patient's
belief in psychoanalysis.” The patient may then be able to
establish a rapport with someone else whose personality fits better
with his own. H. de M. Alexander.

THE CASE OF LOUIS BONAPARTE, KINO OF HOLLAND. Ernest
(183) Jones, Jowm. Abnorm. Psychol , 1913-1914, Dec., Jan.

The author reviews the life history of Louis Bonaparte, and is of
the opinion that Louis’ lack of co-operation with Napoleon over a
period of some seventeen years, extending from a short time
antecedent to Louis’ short Dutch reign until the end of the
Empire, as opposed to his enthusiastic support of Napoleon both
before these years and after them, can be explained on the thesis
that Louis, though he never became a true paranoiac, certainly
exhibited definite paranoid tendencies against which (as well as
the homosexuality from which they sprang) he struggled all his
life. H. de M. Alexander.

154

ABSTRACTS

CLINICAL NEUROLOGY.

BULLET WOUND OF THE SPINE. A Case of Medico-Legal
(184) Interest. W. H. Battle, Lancet, 1914, clxxxvi., Jan. 3, p. 20.

A man and woman were found shot in a London hotel in October
1913. The woman was not much hurt. The man showed a round
bullet wound on the left side just below the nipple, which had
penetrated the chest through the intercostal space. There was no
wound of exit. He had retention and complete anaesthesia below
the waist with loss of all reflexes. The X-rays showed a bullet at the
level of the body of the seventh dorsal vertebra. It was thought
to be lying in the spinal canal and laminectomy showed it to be
situated between the dura mater and the vertebra. It was not
fixed and easily removed. There was no sign of injury to the bone,
and as there was no autopsy (the patient dying from cystitis
after catheterism) it was not possible to say how it reached this
position. A. Ninian Bruce.

BILATERAL OCULOMOTOBIUS PALSY FROM SOFTENING IN
(186) EACH OCULOMOTORIUS NUCLEUS. William Q. Sfillsr,
La Nevraxe, 1913, xiv.-xv., Dec., p. 126.

The patient was an officer, aged 52, who developed bilateral oculo-
motorius palsy in an apoplectic attack. The origin was syphilitic,
and every muscle supplied by the oculomotorius in each eye was
implicated. The cause was bilateral softening of two separate
lesions confined to the nuclei of these nerves. None of the other
cranial nerves were affected, except the optic, and there were no
other symptoms except preceding mental disturbance, convulsions,
and some change in the patellar reflexes, and succeeding dorsal
extension of each big toe from plantar irritation.

A. Ninian Bruce.

TABES AGGRAVATED BY “606” (Tabes aggravd par le “606.")

(186) Ganeau and Giroux, Ann. da Mai. v4n6r., 1913, viii., p. 297.

A case of tabes incipiens in a woman aged 38, in whom intra¬
venous injections of salvarsan caused amblyopia, malaise and
transient exacerbations of the lightning pains.

J. D. Rolleston.

THE DIAGNOSIS OF TABES DORSALIS. Gordon Holmes, Brit.

(187) Med. Jovm.y 1914, March 14, p. 673.

The author discusses the symptoms and physical signs of tabes,
and concludes that the characteristic subjective and objectively

ABSTRACTS

155

demonstrable disturbances of sensation are usually the earliest, the
most important, and the most unequivocal clinical signs of tabes
dorsalis; that they are frequently associated with loss of certain
of the deep reflexes, especially of the ankle-jerks and knee-jerks,
and with pupillary, ocular, and other less frequent symptoms and
physical signs; and that modern serological, cytological, and
chemical methods can supplement and confirm the clinical
diagnosis based on these clinical signs, and make the positive or
negative diagnosis of tabes as certain as anything can be certain
in clinical medicine. A. N ini an Bruce.

TABES WITH UNUSUAL DISTRIBUTION OF DEEP-PAIN LOSS.

<188) Tom A. Williams, Practitioner , 1913, xci., Sept, p. 426.

Two cases are described in which the perception of deep pain was
intact in the tendo Achilles and leg, but greatly impaired in the
thigh, i.e., in the distribution of the upper lumbar roots.

A. Ninian Bruce.

THE FIRST OBSERVED CASES OF FRIEDREICH'S ATAXIA IN

(189) AMERICA. J. H. Kellogg, Med. Record, 1914, lxxxv., March 7,
p. 431.

Friedreich first described this peculiar affection in 1863, and
later in 1864, 1876, and 1878. He regarded it at first as a
hereditary form of locomotor ataxia. The author points out that
he published an account of this condition in two brothers in 1875.
Both died two or three years later. This appears to be the first
observations of the disease in America. A. Ninian Bruce.

TONGUE-CHEWING. Bernard Myebs, Brit. Journ. Child. Dis., 1914,

(190) xi., p. 111.

Myers records four cases of this hitherto undescribed neurosis,
and gives the following summary of his paper:—

“ Tongue-chewing is first noticed about the second year of life
and persists until middle age, or, perhaps, throughout life. It
tends to be less noticeable with advancing years. Either sex may
suffer from it. It occurs, apparently, in healthy families, in which
certain members suffer from habit-spasms. Several members of
one family may suffer from it. The habit is inherited, as far as
one can see, and not copied. The same side of the tongue is
always chewed in the same individual. The mental condition
is quite normal, and the general health is not interfered with in
any way. Bromides stop the tongue-chewing, but in time, after
leaving off the drug, the habit recommences.”

J. D. Rolleston.

156

ABSTRACTS

▲ NOTE ON THE ETIOLOGY OF EPIDEMIC POLIOMYELITIS-

(191) Harold L. Amoss, Joum. Exp. Med., 1914, xix., p. 212.

The globoid bodies, or minute micro-organisms, cultivated from
the central nervous organs of human beings and monkeys that
have succumbed to poliomyelitis, may be detected in the incubated
brain tissues of infected monkeys in forms indicating post-mortem
multiplication. Incubating the poliomyelitic tissues in kidney-
ascitic fluid culture medium, and then crushing them, is a more
certain method for obtaining cultures of the organism.

Identical bodies have been detected in blood films prepared on
the twelfth day of the acute attack from a paralysed poliomyelitic
monkey inoculated intraspinously. The same organism has been
cultivated from the blood of a monkey that had received intra¬
venously a large dose of a Berkefeld filtrate of poliomyelitic virus.

No other micro-organisms were detected either in the sections
of the brain or in film preparations of the blood. These observa¬
tions tend to confirm the etiological relationship between the
minute micro-organism and epidemic poliomyelitis suggested by
the successful cultivation and inoculation experiments reported
by Flexner and Noguchi (v. Review, 1913, xL, p. 596).

A. Ninian Bruce.

A CONTRIBUTION TO THE EPIDEMIOLOGY OF POLIOMYELITIS.

(192) Simon Flexner, Paul F. Clark, and Harold L. Amoss, Joum.
Exp. Med., 1914, xix., p. 195.

A strain of the poliomyelitic virus was propagated in monkeys
for four years, during which time it displayed three distinct
phases of virulence, 'file several phases covered different periods
of time. At the onset the virulence was low, but by animal
passages it quickly rose to a maximum; this maximum was
maintained for about three years, when without known changes in
the external conditions, a diminution set in and increased, until at
the expiration of a few months the degree of virulence about
equalled that present at the beginning of the passages in monkeys.
The cycle of changes in virulence is correlated with the wave-like
fluctuation in epidemics of the disease, which also consist of a rise,
temporary maximum, and fall in the number of cases prevailing.
And an explanation of epidemics of disease is inferred in variations
or mutations among the micro-organismal causes of disease affecting
chiefly the quality of their virulence. A. Ninian Bruce.

ABSTRACTS

157

▲ CONTRIBUTION TO THE PATHOLOGY OF EPIDEMIC POLIO

(193) MYELITIS. Simon Flexnrb, Paul F. Clark, and Harold L.

Amoss, Joum. Exp. Med.., 1914, xix., p. 206.

The virus of poliomyelitis is neurotropic, and localises, and prob¬
ably is capable of multiplying, in the extramedullary parenchy¬
matous nervous organs. It has been demonstrated by inoculation
tests in the intervertebral, Gasserian, and abdominal sympathetic
ganglia.

All the ganglia show histological lesions, more or less severe,
similar to those of the spinal cord and brain. The severest occur
in the intervertebral ganglia, those next in severity in the
Gasserian, while the mildest appear in the abdominal sympathetic
ganglia. The interstitial lesions predominate over the parenchy¬
matous, and in preparalytic stages the intervertebral ganglia show
interstitial lesions, especially pronounced at the pial covering.

Epidemic poliomyelitis is a general disease of the nervous
system, although the most prominent and important symptoms
are those following injury to the motor neurones of the spinal cord
and brain.

The virus of poliomyelitis is highly resistant to glycerin, in
which it survives for more than two years; to 05 per cent,
phenol, in which it survives for more than one year; while it
succumbs after having been kept frozen constantly for several
months. It is unsafe to employ phenol to modify the virus of
poliomyelitis for the purpose of active immunisation.

The cerebro-spinal fluid of convalescents tends to be devoid of
the neutralising immunity principles for the virus of poliomyelitis,
although they may exceptionally be present within this fluid.
Doubtless the immunity principles are not produced locally in
the nervous tissues, but elsewhere in the body, and are carried to
the nervous organs by the blood. A. Ninian Bruce.

INTRASPINOUS INFECTION IN EXPERIMENTAL POLIO-

(194) MYELITIS. Paul F. Clark and Harold L. Amoss, Joum. Exp.

Med., 1914, xix., p. 217.

By intraspinous injections of specimens of poliomyelitic virus of
suitable virulence, infection can be caused regularly in Macaco*
rhesus monkeys. The virus passes from the subarachnoid spaces
into the nervous tissues in which it multiplies, and into the blood.

The constant involvement of the pia-arachnoid membranes in
poliomyelitis, even when no paralysis occurs, and the fact that
infection can readily be produced by intraspinous inoculation,
suggests anew that in the pathogenesis of poliomyelitis the inter¬
stitial tissue changes within the meninges, blood vessels, and
ground substance play a determining part.

158

ABSTRACTS

While the virus injected into the subarachnoid spaces can be
demonstrated there by inoculation tests forty-eight hours after the
injection, it can no longer be detected on the fifth day, at a time
when the first symptoms of infection make their appearance. The
failure of the cerebro-spinal fluid from human and experimental
cases of poliomyelitis to produce the disease when inoculated into
monkeys is due to the fact that the virus is either fixed by the
nervous tissues or passes into the blood. A. N ini an Bruce.

UNUSUAL MANIFESTATIONS OF POLIOMYELITIS. F. E. Batten,

(195) Brit. Journ. Child. Dit 1914, xi., p. 97.

An illustrated record of seven cases:—1. Athetosis of left arm
and left side of face, flaccid paralysis of left leg and some flaccid
paralysis of right leg. 2. Poliomyelitis with rigid extension of
the legs at the hips. 3. Poliomyelitis with flaccid palsy of the
right arm and left leg with rigidity of the right leg in the
flexed position. 4. Poliomyelitis of right arm and left leg
occurring during intra-uterine life. 5. Poliomyelitis and ataxia
probably due to involvement of cerebellum. 6 and 7. Poliomyelitis
and toxic neuritis. J. D. Rolleston.

ENCEPHALITIS IN MUMPS. (Encephalitis bei Mumps.) O. Bien,

(196) Verhandl. d. Getelltch.f. KinderheHk 1914, xxx., p. 288.

A previously healthy girl, aged 8 years, had a mild attack of mumps
at the same time as her brother. Eight days later she suddenly
had a convulsive attack and lost consciousness. Death took place
in twenty-four hours. The necropsy revealed an acute lepto¬
meningitis and encephalitis. J. D. Rolleston.

A CASE OF OTITIC MENINGITIS AND CESEBELLAB AB80E8S,

(197) WITH RECOVERY. A. E. Barnes and W. S. Kerr, Brit. Med.
Joum., 1914, March 14, p. 587.

Recovery in otitic meningitis is not very common. The present
case is that of a girl, aged 17, who suffered from severe occipital
headache, together with an offensive discharge from the right ear.
This was followed by delirium, high fever, and head retraction.
Under anaesthesia a few drops of turbid cerebro-spinal fluid were
obtained with difficulty. A radical mastoid operation was per¬
formed, and a large extra-dural collection of pus was evacuated
from the posterior fossa. The next day the right external rectus
was seen to be paralysed, and she continued to improve until five
days later, when the headache returned and a fresh evacuation

ABSTRACTS

159

of pus was made. The vomiting continued until the drainage
tube was removed, but she left hospital cured about four months
after the operation, the paralysis of the external rectus having
passed off. The organisms found were staphylococci, streptococci,
Gram-positive diplococci, and a Gram-negative motile bacillus
resembling B. pyocyaneus. A. Ninian Bruce.

SYPHILITIC BASAL MENINGITIS FIVE MONTHS AFTER IN-
098) FBOTION. (Syfilitisk Basalmeningitis 5 Maaneden after
Infektionen.) C. Rasch, Hoepitalstidende , 1914, IviL, p. 127.

A man, aged 20, developed a urethral chancre in November, his first
and only coitus having taken place in September. He was treated
with mercurial inunctions, of which he had forty-three between
December and the beginning of February, an intravenous injection
of 50 cgm. salvarsan and an intramuscular injection of 50 cgm.
salvarsan. At the end of February he developed extreme giddiness
and facial paralysis. The cerebro-spinal fluid contained an excess of
albumen and a well-marked lymphocytosis. Wassermann negative
both in blood and in cerebro-spinal fluid. The diagnosis of basal
meningitis with neuritis of vii. and viii. was made. The symptoms
disappeared in a month’s time under treatment with mercurial
inunctions, sarsaparilla, and hectin. J. D. Rolleston.

B RAIN ABSCESS DUE TO THE BACILLUS COLI COMMUNIS.

(199) E. P. Bernstein, Med. Record , 1914, lxxxv., p. 249.

A case of abscess in the posterior part of the left temporo-
sphenoidal lobe in a woman, aged 24, secondary to purulent otitis
media. B. coli was found in the pus from the ear during life, and
in the abscess post mortem. The mode of transmission of the
germ must have been by the lymphatics, as no thrombosis of the
petrous sinus was found at the necropsy. J. D. Rolleston.

A CASE OF RECKLINGHAUSEN’S DISEASE. (Uncas de maladie de

(200) Recklinghausen.) J. Rebattu and J. Martin, Lyon mid., 1914 ,
cxxii., p. 19.

The patient was a man, aged 68, free from syphilis or tuberculosis
and with no family history. He presented at least 2,500 cutaneous
tumours and very numerous pigment patches which had first
appeared after the age of 30. There were no tumours on the
nerves and no nerve tissue was found in the tumours. The
mental faculties were much below normal, but it was difficult to
say if this deficit was recent or congenital. There were no skeletal
deformities nor signs of disturbance of the glands of internal
secretion. J. D. Rolleston.

160

ABSTRACTS

A 0A8B OF TYPHOID SPINE. (XJn cas de spondylite typhique.)

(201) Philibert, Rev. cCOrthop&lie, 1918, 3 a6r., v-, p. 409.

A boy, aged 14| years, had an attack of typhoid fever with a
severe relapse. Five days after the temperature had become
normal, he began to suffer from severe lumbar pain radiating into
the right buttock and great trochanter, and an angular cyphosis
appeared involving the second, third and fourth lumbar vertebrae.
The X-rays showed the changes described by Bonhoure (®. Review,
1913, xi., p. 281). The patient was immobilised in a plaster jacket,
and recovery took place in about two months.

J. D. Rolleston.

VENESECTION IN CEREBRAL HAEMORRHAGE, WITH REPORT

(202) OF OASES. A. Macfarlane, Med. Record, 1914, lxxxv., p. 112.

A record of four cases:—

1. Man, aged 44, excessive smoker and hearty eater. Gradual
onset of left hemiplegia. Blood pressure, 235 mm.; 12 oz. of blood
removed from right arm with marked improvement. The next
day 1| pints were drawn from a varicose vein in the leg, and on
the following day 10 more oz. The blood pressure dropped to
180 mm., ana gradually rose to 200 mm. In eight weeks he was
able to walk without assistance.

2. Woman, aged 54. Had had two seizures during the last
two years, one said to be uraemic, and the other slight cerebral
haemorrhage, from which she had recovered without paralysis.
Sudden onset of left hemiplegia rapidly followed by coma. 12 oz.
of blood were drawn from arm, and blood pressure sank from
260 mm. to 185 mm. within an hour, but without improvement in
the comatose condition. Death occurred in a few days.

3. Woman, aged 65. Cerebral congestion without vascular
rupture. Blood pressure, 260 mm.; fell to 175 mm. after vene¬
section, and recovery took place.

4. Man, aged 70. Weakness of one side, which quickly

developed into hemiplegia. Rapid improvement after removal of
3 pints of blood from median basilic. He lived several years after
this attack. J. D. Rolleston.

A FAMILY WITH CEREBELLAR ATAXIA. C. A. Sprawson,

(203) Brit Med. Jowm., 1914, Jan. 3, p. 23.

A Eurasian male, aged 35, complained of tremors on standing
and giddiness of about three and a half years’ duration. His
father was similarly affected, the symptoms developing about the
age of 50, and three brothers also suffered from the same condition,
although their children are apparently healthy, but are still all
below puberty. A genealogical table of the family is given.

A. Ninian Bruce.

ABSTRACTS

161

A GA8B OF HEREDITARY ATAXIA WITH PARAMYOCLONUS
(SOI) MULTIPLEX. (Ataxto h<r6ditaire avec paramyoclonus multi*
plex type Unverricht.) Gaktano Boschi, Joum. de Neurol., 1913,
viii, p. 142.

A full clinical account of a case that combined the symptoms of
hereditary ataxia with those of paramyoclonus multiplex, and had
also attacks of an epileptic character. The author accepts the
view that hereditary ataxia is a clinical entity, Friedreich’s ataxia
and the cerebellar heredo-ataxia of Marie being sub-varieties, often
merging one into the other. The case described emphasises this
point, as the patient differed from the Friedreich type in that his
knee-jerks were exaggerated, and he had no nystagmus and no
deformities. On the other hand, he did not present the ocular
symptoms characteristic of Marie’s type.

The patient also presented the symptoms of the second disease
associated with the name of Friedreich, viz.: Paramyoclonus
multiplex, but as the myoclonus was of a familial character and
was associated with epilepsy, the author considers that the case
falls under the category of the type described by Unverricht, and
characterised by this triad of symptoms. It is interesting to note
that a brother of the patient suffered from Friedreich’s type of
hereditary ataxia, and a second from Marie’s type, the patient
himself presenting symptoms from each type.

W. D. Wilkins.

FAMILIAL FORMS OF WILSON’S LENTICULAR DBGENERA-
(206) TION AND WESTPHAL-STRttMPELL’S PSEUDOSCLEROSIS.
(Zur Klinik famili&rer Formen der Wilsonschen Lenticularde-
generation und der Westphal-Striimpellschen Pseudosklerose.)

H. Higibb, Zttchr. f. d. get. Neurol, u. Psychiat ., 1914, xxiii (Orig.),
S. 290.

Thk author discusses these two diseases and considers that they
are closely allied to one another, both being familial, rarely
hereditary, and both being accompanied by liver changes. Both
may be present in the same family. A. Ninian Bruce.

FURTHER NOTE UPON A CASE OF HYSTERICAL MONOPLEGIA
<206) FOLLOWING ELECTRIC SHOCK. Pobvbs Stewabt, Brit. Med.
Joum., 1914, March 7, p. 626; Proe. Boy. Soc. Med., 1914, vii., Feb.
(Neurol. Sect.), p. 41.

This case has already been abstracted (t\ p. 44). The paralysed
left upper arm showed no improvement from suggestive treatment,
strong electrical stimulation, cutaneous irritants, or psycho-therapy.
He was then given ether and nitrous oxide with plenty of air so

ABSTRACTS

H)2

as to prolong the stage of excitement. The normal arm was
bound to the trunk by a bandage, and the paralysed left arm was
allowed to hang free. Within a few seconds, while the anaesthetic
was being administered, the patient began to make slight move¬
ments of the paralysed arm, amounting shortly to violent fighting
movements, in which he tried to snatch the mask out of the hands
of the amesthetist. The anaesthesia was stopped and he remained
in a hypnotic state, during which voluntary movements were
normally performed in response to verbal commands. He has
since remained well. A. Ninian Bruce.

A CASE OF PITUITARY TUMOUR AND SELLAR DECOM-
(207) PRESSION. Wilfred Harris and Cecil Qkaham, Lancet , 1913,
clxxxv., Nov. 1, p. 1251.

The symptoms produced by a tumour of the pituitary body may be
divided into three groups: (1) Those produced by pressure on
neighbouring structures, especially the optic chiasma and optic
nerves, causing gradual failure of vision due to optic atrophy,
central scotoma, bitemporal hemianopia, &c. (2) Those produced

by general rise of intracranial pressure, c.g., hemiplegia, slow pulse,
torpor, failing memory or optic neuritis. (3) Those due to inter¬
ference with the secretion of the gland itself, e.g., acromegaly,
gigantism, infantilism, &e.

The case here recorded is that of a woman, aged 38, who
suffered from persistent headache, sleepiness, apathy, and gradual
loss of vision. The right eye was found to be blind and the left
showed temporal hemianopia, the left plantar reflex was extensor.
Skiagram of the skull showed an enlarged and boat-shaped sella
turcica. As she became more and more torpid, decompression was
decided on through the base of the sphenoid into the sella turcica
by the intranasal route. The operation is described at length and
the different steps clearly indicated. It was successful, as the
patient recovered consciousness, rapidly improved and left the
hospital to stay with some friends in the country, apparently
relieved of all her symptoms. Ever since the operation, however,
she had suffered from great thirst and polyuria. Three weeks after
leaving the hospital the headache and drowsiness returned. A second
operation was performed, and a piece of growth of a papillomatous
nature removed, but she suddenly collapsed thirty hours later.

At the autopsy an encapsulated growth the size of a small golf
ball was found in the position of the infundibulum in the floor of
the third ventricle distorting the optic tracts and raising the basal
ganglia. The fossa contained a markedly compressed pituitary
gland, but no more growth was found in the fossa. Microscopically
it was diagnosed as a perithelioma. A. Ninian Bruce.

ABSTRACTS

163

A OASE OF DIABETES INSIPIDUS. W. P. Herring ham, Lancet ,

(208) 1914, clxxxvi., Jan. 3, p. 16.

A case in a boy, aged 20, is recorded. On an ordinary diet he
passed about 8 litres of urine, the specific gravity of which
was 1,002 or 1,003. Sugar and albumen were lioth absent. Re¬
moval of salt from the diet produced no diminution in this amount.
Restriction in the amount of fluid taken lessened the output of
urine, but produced also loss of weight, great thirst, and loss of
appetite, and had to be discontinued. Codeine resulted in a steady
diminution until only about 4 litres were passed daily

A. Ninian Bruce.

A OASE OF MOTOR IMBECILITY. (Un cas d’insufflsance motrice.)

(209) Decroly and E. Henrotin, Joum. de Neurol ., 1913, x. and xv.,

p. 181.

The child described in this paper was at first looked upon as an
imbecile of the usual type, but careful study showed that the
delayed mental growth was due almost entirely to an inco¬
ordination of the muscles, especially of the tongue, eyes and neck,
but also affecting the limbs, which resulted in an inability to make
use of the impressions received in childhood. The authors
contend that it is not uncommon for such cases to be passed over
as simple cases of imbecility or idiocy, whereas they should be
looked upon as a form of imbecility due to deprivation of the
motor functions, analogous to that due to deprivation of the special
senses. The inco-ordination was probably due to an infantile
pseudo-bulbar paralysis. W. D. Wilkins.

TERTIARY SYPHILITIC FEVER AND SYPHILITIC POTT’S

(210) DISEASE. (Febbre sifllitica terziaria e morbo di Pott sifllitico.)
G. Cappkllo, Gazz. d. osp ., 1914, xxxv., p. 201.

A record of two cases in women, one of whom showed syphilitic
spondylitis and periostitis of the tibia. The fever in both was of
an intermittent type, and rapidly subsided under anti-syphilitic
treatment. J. D. Rolleston.

THE TREATMENT OF SYPHILIS OF THE NERVOUS SYSTEM

(211) BY INTRATHECAL INJECTIONS. Harry Campbell, Brit.
Med. Joum., 1914, March 14, p. 577.

Ten cases are briefly described (five being tabes, two tabo-paresis,
one general paralysis, and two interstitial syphilis). They were
given 0*9 gram neosalvarsan intravenously. After a week this was
repeated, and two hours later 4 oz. of blood were drawn off from a
vein and placed in a jar containing 1 in 20 carbolic solution.

164

ABSTRACTS

After twelve hours sufficient serum had separated for injection.
It was then injected by lumbar puncture in the usual way. Im¬
provement resulted, in some of the cases being very marked.

A. Ninlan Bruce.

NEOSALVARSAN. LATE

(212) Hdmipldgie tardive. Mort)

p. 282.

PLEGIA. DEATH. (NSo-salvarsan.

Carle, Ann. de mal. vinir., 1913, viii.,

A man and his wife were injected intravenously the same day with
0*45 gr. neosalvarsan. The woman, who had been infected by her
husband, was of a nervous disposition, but not hysterical or
epileptic. She had had four years regular treatment with mercury
and potassium iodide, but had suffered frequently from intermittent
headache at night The man bore the injection well, but the
week following the injection the wife’s headache got worse, and
six weeks later she developed right hemiplegia. Rapid improve¬
ment followed injections of benzoate of mercury, but left hemi¬
plegia subsequently occurred, and death took place six months
after the injection of neosalvarsan. J. D. Rolleston.

INFLAMMATION OF THE LABYRINTH AFTER INJECTION OF

(213) NEOSALVARSAN. (Labyrinthite aprts injections de ndo-
salvarsan.) Meneau, Gaz. held. d. Set. mid. de Bordeaux , 1914,
xxxv., p. 79.

Meneau has collected three cases:—

(1) De Asna’s case. A man, aged 26, suffering from severe
syphilis and tuberculosis, suddenly developed bilateral deafness
on the day following the third injection of neosalvarsan. Im¬
provement occurred after the fourth, and still more so after the
fifth injection. The deafness was regarded as a manifestation of
nerve syphilis.

(2) Sommer Greco’s case. A man, aged 25, after the fourth
injection of neosalvarsan, had a rise of temperature and loss of
hearing in the right ear.

(3) Gray’s case (v. Review, 1913, xi., p. 339).

J. D. Rolleston. "

WAS8ERMANN POSITIVE AFTER FORTY-SIX YEARS OF

(214) SYPHILIS. SYPHILITIC VARICOSE ULCERS. (Wasser-
mann positif aprds quarante-six axis de syphilis. Ulc&res vari-
queux syphilitiques.) Meaux Saint-Marc, Ann. dee Mai. vinir.,
1913, viii., p. 289.

The patient was a man, aged 63, who had contracted syphilis at
17, for which he had undergone regular treatment.

J. D. Rolleston.

ABSTRACTS

165

THE TECHNIQUE OF THE WAB8ERMANN REACTION. With
(216) special reference to the use of antigens containing cholesterin.
Carl H. Browning, Lancet , 1914, cixxxvi, March 14, p. 740.

Accuracy and delicacy in performing the Wassermann reaction
may be attained by attention to the following points:—

1. The accurate measurement of the amount of complement
absorbed by the mixture of (heated) serum and of antigen,
estimated in haemolytic doses, and controlled by an estimation of
the amount of complement inhibited by each component separately.

2. Complement is not an invariable quantity. Not merely do
different guinea-pigs yield serum with varying haemolytic power
for sensitised blood corpuscles, but the deviability of two comple¬
ment-containing sera with the same haemolytic dose may show a
wide difference. To control these variations known negative and
positive sera, whose behaviour has been determined in previous
tests, should be included in every series. An average specimen
of complement can be obtained with some degree of certainty by
using the pooled serum of ten to twelve guinea-pigs.

3. The test corpuscles should be sensitised to the maximal
degree by the addition of at least five doses of specific immune
serum (from the rabbit).

4. The “ antigen ” should itself possess little haemolytic or anti¬

complement action. Antigens which are highly satisfactory in
these and in other respects can be obtained by employing alcoholic
mixtures of cholesterin with certain other tissue lipoids. Choles¬
terin possesses a remarkable specific action in the presence of
syphilitic sera together with certain tissue lipoids, and thus has
proved of great practical value in eliciting the Wassermann
reaction. A. Ninian Bruce.

VARIETIES OF FACIAL SPASM AND THEIR TREATMENT.

(216) E. Farquhar Buzzard, Practitioner, 1913, xci., Dec., p. 746.

From a pathological point of view, spasms of the face may be
divided into three main classes: (1) psychogenic, (2) cortical, and
(3) peripheral. These are briefly discussed, attention being
specially paid under the third heading to chronic facio-spasm
(which may be treated by alcohol injection into the facial nerve),
post-paralytic contracture and “ fibrillo-tonic facial spasm ” (a rare
manifestation of cerebro-spinal syphilis). A Ninian Bruce.

THE PATHOLOGY OF MIGRAINE J. R. Chablss, Practitioner, 1913,

(217) xci., Sept, p. 414.

The author considers that the clinical features of migraine may
be explained satisfactorily as due to periodical enlargement of the

166

ABSTRACTS

pituitary gland. He explains the headache, nausea, and vomiting
as the result of increased intracranial pressure, the disturbance of
vision (mainly hemianopia) from pressure, and the fortification
figures, &c., from irritation of the optic tracts, the vasomotor
phenomena from increased secretion from the posterior lobe, or
from pressure on sympathetic fibres, and the sensory and motor
symptoms from pressure on the crus. A. Ninian Bruce.

ST HILDEGABD. C. Singer, Proc. Roy. Soc. Med., 1913, viL (Section of

(218) Hist. of Med.), p. 1.

The medical interest of this twelfth-century nun lies in the fact
that much of the text of her book “ Scivias ” is presented in the form
of visions. The illustrations show that the physical basis of these
visions were migraine or scintillating scotoma, typical fortification
figures, stare and coloured spots being represented. In some
cases a shimmering concentric appearance occupies the whole field
of vision. There is also evidence from her writings that Hildegard,
who in spite of her active life had very poor health, suffered from
migraine. J. D. Rolleston.

MEASUREMENT OF THE BLOOD-PRESSURE IN ALCOHOLISM

(219) AND FUNCTIONAL NEUROSES EXCLUDING CIRCULATORY
DISTURBANCES. (Blutdruckmessungen bei Alkoholikem und
functionellen Neurosen mit Ausschluss von Kreislaufstdrungen.)
K. Raff, Deut. Arch.f. klin. Med., 1913, cxii., p. 209.

Alcoholism. —Forty-one cases of chronic alcoholism in which the
heart and kidneys were normal were examined with Reckling¬
hausen’s tonometer, with the following results:—

1. A considerable rise of the systolic blood-pressure in the first
few days of total abstinence in hospital.

2. An almost constant level of the diastolic blood-pressure
throughout the whole period of observation so that the increase
in pulse-pressure was obviously due to a rise of the systolic
pressure.

3. This feature of the blood-pressure is so constant that in
doubtful cases it is of diagnostic value.

Functional Neuroses .—Fifteen cases of hysteria and five of
neurasthenia were examined with the following results:—

1. In hysteria lability of the systolic and diastolic blood-
pressures predominates, and is the only constant change in the
blood-pressure in this disease.

2. In neurasthenia a tendency to hypertension of the systolic

pressure predominates, and the diastolic pressure shows only slight
variations. J. D. Rolleston.

ABSTRACTS

167

CA8E WITH COMMENTS. EFFECT ON THE MENTAL STATE OF

(220) MINOR AND MAJOR ATTACKS IN EPILEPTIC INSANITY.

S. J. A. H. Walshb, Practitioner , 1913, xci., Nov., p. 715.

The patient was a man, aged 25, who had suffered from epilepsy
since the age of 7. He never had an aura, but the attacks were
preceded by delusions. These delusions were of two kinds, slight
delusions which lasted for from one to four days, and culminated
in one or two attacks of petit mal ; and delusions which lasted a
fortnight or longer and terminated in an attack of grand mal, or if
the delusional state had been prolonged sufficiently a second
major attack was necessary. If a major attack were deferred a
maniacal outburst usually occurred. The epileptic seizures thus
seemed to act as a safety-valve to the mental state to which the
patient was at times subjected. A. Ninian Bruce.

ADDISON’S DISEASE IN A BOY, WITH CALCIFICATION OF THE

(221) ADRENALS, WITH REMARKS. H. D. Rolleston and £. J.
Boyd, Brit. Jowrn. Child. Die ., 1914, xi., p. 105.

A boy, aged 12f years, showed general bronzing of the skin,
especially round the nipple, umbilicus, and pudenda. There was
a pigmented scar in the right groin, but on the right side of the
abdomen and thorax there were pale scars exactly like those left
by herpes zoster. The systolic blood-pressure ranged between
64 and 84 mm. Hg, and the boy was listless, sleepy, and sunken¬
eyed. The X-rays showed very definite calcareous particles in the
region of the last rib and suprarenal on the right, and less definite
ones on the left side. There were discrete opacities at the hilum
of the lungs suggesting calcified nodules. Adrenalin chloride
solution by mouth, and later sandwiches containing raw adrenal
glands, were followed by an increase in the pigmentation.
Rolleston suggests that the absence of pigmentation in the
herpetic scare was due to impaired innervation, and regards this
as an argument in favour of the view that the bronzing of the
skin in Addison’s disease is due to nerve irritation.

J. D. Rolleston.

ETIOLOGY OF ENDEMIC CRETINISM, CONGENITAL GOITRE,

(222) AND CONGENITAL PARATHYROID DISEASE. Robert
M'Carrison, Lancet, 1914, clxxxvi., March 21, p. 817.

As the results of experiments upon rats, the author concludes:—
1. Of the offspring of goitrous parents a small percentage are
born cretins; approximately 63 per cent, are born with congenital
goitre, 32 per cent, with congenital parathyroid disease, and 33
per cent, are bom with normal thyroid and parathyroid glands.

168

ABSTRACTS

2. Cretinism and congenital goitre are due to the action of toxic
substances derived from the intestines of the goitrous mother on
the foetal thyro-parathyroid mechanism. Cretinism represents
the maximum, and comparatively rare, effect of these toxins,
congenital goitre their minimum, and comparatively common,
effect. 3. Congenital parathyroid disease is due to the action on
the foetal gland of the toxic products of organisms, present in the
intestine of the goitrous mother, which are capable of growth
under anaerobic conditions. A. Ninian Bruce.

THE PATHOLOGY OF PELLAGRA. S. A. Kinkier Wilson, Proc.

(223) Roy. Soc. Med., 1914, vil, Feb. (Neurol Sec.), p. 31.

This preliminary paper is based on thirteen cases of pellagra.
Abundant pathological evidence was found of a widespread
generalised toxaemia of the peripheral and central nervous system.
Pellagra is readily distinguishable from the trypanosome diseases.
The histological changes are not those of an infection of blood- or
lymph-stream. Special attention is drawn to the presence of the
ir granules of Reich in the peripheral nerves. These are collec¬
tions of minute granules or flakes, all small, which stain brilliant
violet-red with thionin blue. According to Reich, they consist of
protagon, and are special products of the metabolism of myelin.
They do not stain with osmic acid. It is difficult to say when a
toxaemia of the peripheral nerves becomes a true neuritis, but in
some cases at least parenchymatous and interstitial neuritis occurs,
but whether these changes precede or succeed the changes in the
cord is uncertain. Probably an ascending toxic lymph-stream
invades the cord via the lumbar and dorsal posterior roots, and that
the effects of the toxsemia appear either simultaneously in the
nerves and cord, or previously in the former. Possibly the toxin
is of alimentary origin, and there is no pathological evidence to
disprove this.

There is no single pathological feature of itself pathognomic of
pellagra, the pathological process being essentially diffuse and
unsystematised. A. Ninian Bruce.

ZEISM OR PELLAGRA? P. A. Nightingale, Brit. Med. Joum., 1914,

(224) Feb. 7, p. 300.

Beri-beri, scurvy, pellagra, and zeism form a group of diseases
almost by themselves. “ Zeism ” is a disease found in the Victoria
Gaol, Rhodesia, and the author has examined forty cases. It was
found that prisoners fed on mealie meal developed this disease,
while those fed on rapoko meal did not. The difference between
these two meals is that the rapoko is hand-milled and contains

ABSTRACTS

169

the whole husk, while the mealie meal is steam-milled to a fineness
which allows 75 per cent, to pass through a 30-inch mesh sieve,
and thus a large proportion of the husk must be discarded. This
discarded husk is of great nutritive value and is used for feeding
cows. Prisoners who had been fed on mealie meal and contracted
the disease invariably improve under rapoko meal. Zeism closely
resembles pellagra in its alimentary symptoms, but differs consider¬
ably from it in its cutaneous, and bears no relationship at all to
its nervous symptoms. The prognosis is good. The etiology
appears to be directly opposed to any insect-borne theory, and if
the view that pellagra is insect-borne be correct, zeism would not
appear to be the same disease. A. Ninian Brxjce.

THE ANALYSIS OF NYSTAGMUS. Adolphe Abrahams, Lancet ,
(225) 1913, May 31.

This paper, which is an abstract of the author’s thesis for the
degree of M.D. Cantab., deals firstly with the history of previous
work in nystagmography, and then with the special instruments
and methods employed by the author himself. A specially
designed cinematograph camera made by the Kinrora Company of
London was used.

Charts are given of the movements in cases of post-rotation
nystagmus and spontaneous nystagmus of non-vestibular origin.

Miners’ nystagmus proved impossible to analyse by this
method, as the movements are too small and too rapid for cinemato¬
graphy. The paper closes with a short note on the varieties of
nystagmus and extensive bibliography. H. M. Traquair.

PSYCHIATRY.

THE SEBUM AND GEBEBBO-SPINAL FLUID BEAOTIONS AND
(226) SIGNS OF GENEBAL PARALYSIS. George M. Robertson,
Joum. of Mental Sci., 1914, Jan., p. 1.

An eminently useful and practical statement of the present
position of the clinical methods now in use for the diagnosis of
general paralysis. The author describes in detail how the serum
and cerebro-spinal fluid may be obtained and examined, and dis¬
cusses the importance, both actual and relative, of each of the six
methods employed by him. His opinion is in agreement with
that of the majority of clinicians in that he ascribes paramount
importance to the presence of the Wassermann reaction in the
cerebro-spinal fluid, and uses the other tests for confirmatory
evidence.

These reactions are also present in cerebral syphilis, but this

170

ABSTRACTS

can be distinguished by the administration of salvarsan, which
rapidly renders the reactions negative, whereas it has little or no
effect on the reactions in cases of general paralysis.

W. D. Wilkins.

SUDDEN DEATH FROM BULBAE HAEMORRHAGE IN A CASE

(227) OF DEMENTIA PRJSCOX. (Morte improvisa per emorragie
bnlbari in on caso di demenza precoce.) Vincknzo Scarpxni,
Rattegna di Studi Ptichiat., 1914, iv., Marzo-Aprile, p. 307.

The author records the presence of a large number of haemorrhages
in the medulla oblongata below the floor of the fourth ventricle in
a case of dementia praecox, which died suddenly and unexpectedly.
These also involved the nucleus of the vagus. The author
emphasises their importance. A. N ini AN Bbuce.

THE TREATMENT OF SYPHILITIC PSYCHOSES. (Essai da traite-

(228) ment des psychoses d’origine syphilitiqne.) H. Damayb, Arch.
Intemat. dc Neurol., 1914, xxxvi., March, p. 142.

A detailed account is given of two cases treated with encouraging
results; in both there were cardiac and renal lesions present.
Damaye sums up his principles of treatment of syphilitic psychoses
thus: In the first stage improve the general state by raw meat,
taw eggs, iodised antiscorbutic syrup, guaiacolised cod-liver oil, and
arsenic by large doses of cacodylate of soda. This treatment
greatly improves the mental state. In the next stage, when the
physical condition has become satisfactory, continue raw meat and
eggs and super-alimentation, and begin antisyphilitic treatment, at
first injections of atoxyl or hectine, and then mercurials. The
previous stage of super-alimentation enables the patient to tolerate
mercurial treatment. One can alternate the periods of arseuical
and mercurial treatment ; at the same time some iodide of
potassium is given. When thus carried out, the treatment of
syphilitic psychoses, of whatever type they may be, gives always
good and sometimes excellent results. One can thus arrest the
evolution of the meningo-encephalitic or encephalitic lesions, and
obtain their recovery either entirely or as nearly so as is possible.

Leonard J. Kidd.

ON THE STRUCTURE OF THE BRAIN AND THE INTERPRE-

(229) TATION OF MENTAL PHENOMENA IN RELATION TO
THE LAW. M. Pazzi, Rattegna di Studi Ptichiat., 1913, iii,
Maggio-Guigno, p. 200.

The author deplores the fact that, under the present laws,
infanticide ranks at the same level as the common crimes.
Pregnancy produces psychical reactions which show a diminution
of the inhibitory influences of the cerebral cortex and a relative

ABSTRACTS

171

functional autonomy of the lower centres; infanticide is a result
of this paralysis of inhibition. When such an act has occurred,
it is for the physician to judge how far the mother is to be
regarded as accountable for the act. As the psychology of
pregnancy is only to be understood by woman, movement in this
direction must come from her. A. N ini an Bruce.

the albumen in the CEREBROSFINAL fluid IN CASES

(230) OF MENTAL DISEASE H. D. MacPhail, Joum. of Mental Set.,
1914, Jan., p. 73.

The quantity of albumen in the cerebro-spinal fluid was estimated
in cases of the principal mental diseases, including some arising
from gross brain lesions and plumbism. The author states that if
the amount of albumen is 1 per cent, or over the case is almost
certainly one of general paralysis, and that in other cases the
amount of albumen is a fair criterion of the amount of damage
done to the cerebral tissue. W. D. Wilkins.

THE CLINICAL VALUE AND SIGNIFICANCE OF LEUOOCYTOSIS

(231) IN MENTAL DISEASE D. J. Jackson, Joum. of Mental Sci.,
1914, Jan., p. 66.

The author has made daily leucocyte counts in cases of the chief
mental diseases, and has found remissions or recoveries to be
usually accompanied by a leucocytosis, especially of the polymorphs.
This is most typically found in the acute confusional states, but is
also well marked in manic-depressives. In general paralysis it
was found that whilst remissions were accompanied, as before, by
a polynucleocytosis, seizures were heralded by a lymphocytosis.
Epileptics showed an increase in the polymorphs just before a fit,
and a diminution between the fits.

The author considers that artificial leucocytosis produced by
the injection of terebene has had a favourable influence in several
cases, and that remissions in general paralysis may be prolonged
by the use of tuberculin.

It is remarkable that many of the convalescent cases retained
the abnormally high number of 27,000 leucocytes per c.mm. for
weeks before discharge, and apparently showed no signs of a return
to a more normal percentage. W. D. Wilkins.

VACCINE TREATMENT IN ASYLUMS. W. Ford Robertson, Joum.

(232) of Mental Sci., 1914, Jan., p. 17.

The author discusses the vaccine treatment of many of the common
ailments and diseases to which asylum patients are liable, and
contends that it might be much more extensively practised than
is at present the case. He gives full particulars of the prepara-

172

ABSTRACTS

tion and dosage of autogenous vaccines, and gives the indications
for their employment.

Stress is laid upon the secondary infections in general paralysis
and tabes, especially by bacilli of the diphtheroid type, and support
is given to the view that these infections may determine the onset
of general paralysis in a syphilitic subject. W. D. Wilkins.

THE VILLA OS COLONY SYSTEM FOB THE CABE AND TREAT

(233) MENT OF CASES OF MENTAL DISEASE T. E. Knowles
Stansfield, Joum. of Mental Set., 1914, Jan., p. 30.

A strong plea in favour of the villa type of asylum, as exem¬
plified by the author’s experience at Bexley Asylum, and by his
knowledge of German and American institutions. He states that
he is able at Bexley to have about 170 male patients on complete
parole of the asylum estate, and that the number of escapes is
negligible. He claims that the patients are happier, work better,
and are more contented, and that a greater variety of treatment
can be given, ranging from the close supervision of acute cases to
the almost complete parole for convalescent patients. He also
claims that the first cost is less, and the difficulties of administra¬
tion are no greater than with the barrack system.

W. D. Wilkins.

THE WEIGHT OF THE PANCREAS IN THE INSANE. (Recharches

(234) ponddrales but le pancreas chez les alidnds.) C. Parhon, di
Jassy, and G. Zuoravu, Arch. Intemat. de Neurol., 1914, xxxvi.,
March, p. 137.

The authors examined the weight of the pancreas in 240 adult
cases of insanity; it was found to be heavier in the male sex.
Testut gives the average as 70 gr. for man and 66 for women.
The average weights in the various psychoses were as follows:
in alcoholism 79*37, mental confusion 78*62, G.P.I. 78*34, pellagra
69*60, dementia prsecox 69, epilepsy 65, imbecility 65, mental
debility 61, and senile dementia 55*43 gr. The importance of
toxic and digestive disturbances in several of these groups is
insisted on. Thus, the pancreas is heaviest in those psychoses in
which gastro-intestinal intoxication plays an important part. It
is uncertain whether these toxic substances act primarily on the
pancreas or whether its hypertrophy is due to hepatic troubles (the
liver being regarded as antagonistic to the pancreas). The low
average weight in the senile dements is probably due partly to
atrophic changes and partly to the fact that most of these patients
were females. Out of the 240 cases the commonest weight was
70 gr. (41 cases), then come 28 cases of 60 gr., 24 of 50 gr., 22 of
80 gr., 19 of 100 gr., 18 of 90 gr., and 14 of 75 gr. The greatest

REVIEW

173

weight was 150 gr. in a male 6.P.I. (compare this paper with
the author's one on the adrenals, v. Review, 1913, xi., p. 619).

Leonard J. Kidd.

TREATMENT.

PINEAL GLAND IN TREATMENT OF CERTAIN GLASSES OF
(235) DEFECTIVE CHILDREN. W. N. Berkeley, Med. Record, 1914
March 21, p. 512.

Mainly a shortened account of Dana and Berkeley’s paper (v.
Review, 1913, xi., p. 274). Berkeley adds that in about a dozen cases
of premature mental failure in middle-aged or elderly persons,
showing no distinct organic lesion, a fair trial of bullocks’ pineals
in capsules has given good results; some of these patients show
cheerfulness and increased mental activity while taking pineal, so
that it seems as if it “ stimulates the ageing brain to the faster
chemistry of younger days.” Berkeley insists on the importance
of keeping up pineal medication regularly for at least four to six
months in the case of backward children or Mongols on whom it is
being tried. Leonard J. Kidd.

"Review.

THE INTERNAL SECRETORY ORGANS: THEIR PHYSIOLOGY
(236) AND PATHOLOGY. Prof. Artub Biedl. With an intro¬
ductory preface by Leonard Williams. Translated by Linda
Forster. Pp. 606. John Bale, Sons A Danielsson, Ltd., London,
1913. Pr. 21s. net

Every day fresh advances in our knowledge of the function
of the internal secreting glands is being made, especially in their
relation to disease, and it becomes very necessary from time to
time that the literature on the subject should be collected together
in a compact and concise form. How extensive this literature
actually has become may be gathered from the fact that in this
book 158 pages are devoted to the mere enumeration of the papers
which are arranged in alphabetical order under their authors.

The book is divided into two parts, a general and a special.
The former is very short, extending to only twenty-three pages;
the latter is the most important part of the book. The thyroid,
thymus, suprarenal (to which alone 178 pages are devoted),
pituitary, pineal, and generative glands are described in turn,
and short accounts are given of the internal secretion of the
pancreas, of the gastric and intestinal mucosa and of the kidney.

174

BOOKS AND PAMPHLETS RECEIVED

We can confidently recommend this volume to all those
interested in this increasingly important branch of medicine.
The amount of matter compressed within these pages is enormous,
and is easy of assimilation on account of the large number
of headings under which it is arranged. The translation has
been well done and is remarkably free from errors; the type is
large and easy to read.

BOOKS AND PAMPHLETS RECEIVED.

Abbot, E. Stanley. “Psychology and the Medical School” (Amer.
Joum. Insanity, 1913. lxx., Oct.).

Anton, Prof. Dr Q. “ Psychiatrische Vortrage fur Arzte, Erzieher und
Eltern ” (Dritte Serie). Berlin, 1914, S. Karger.

Buckley, A. C. “ The Relation of Hyperthyroidism to the Nervous
System ” (N. Y. Med. Joum., 1913, Dec. 6).

Flexner, Simon. “The local specific Therapy of Infections” (Joum.
Amer. Med. Assoc., 1913, lxi., pp. 447 and 1872).

Frugoni, Prof. Cesare. “Contributo alio studio delle ‘crisi emateme-
tiche essenziali’ e dell’ ‘ osteoartropatia vertebrale’ nelle tabe” (Riv. Crit.
di Clin. Med., 1914, xv., N. 1, 2. and 3).

Frugoni, Prof. Cesare. “ Espir&zione cardiosistolicamente intercisa e
polso toracico negativo” (Riv. Crit. di Clin. Med., 1914, xv.).

Goodall, E., and Scholberg, H. A. “ On Complement-fixation, and on
the Cell-and-Protein-Content of the Liquor Cerebro-spinalis; a second
Series of Observations” (XVIIth Intemat. Congress of Med,., London,
1913).

Heiman, H, Feldstein, S., and Koplik, H. “ Meningococcus Meningitis.”
J. B. Lippincott Co. Pr. 12a 8d. net.

Jnstscnenko, A. “ Das Wesen der Qeisteskrankheiten und deren biolo-
gisch-chemische Untersuchungen.” Theodor Steinkopff, Dresden, 1914.
Pr. M. 4, geb. M. 5.

Oppenheim. “ Zur Kenntnis der Schmerzen, besonders bei den
Neurosen” (Deut. Ztschr.f. Nervenheilk., 1913,1.).

Oppenheim, H.. and Borchardt, M. “ Erfahrungen bei Operationen von
Kleinbirngeschwulsten ” (fieri, klin. Wchnschr., 1913, Nr. 44).

Oppenheim, H., and Krause, F. “ Operative Erfolge bei Geschwiilsten
der Senhugel- und Vierhugelgegend ” (Berl. klin. Wchnschr., 1913, Nr. B0) %

Oppenheim, H. ; and Krause, F. “ Ueber erfolgreiche Operationen bei
Meningitis spinalis chronica serofibrosa circumscripta” (Mitteil. a. d.
Grtntgeb. d. Med. u. Chir ., 1914, xxviL).

Prince, Morton. “The Unconscious.” Macmillan Co., New York,
1914. Pr. 88. 6d. net

Rixen, Peter. “ Zur Frage der Anrechnung des Irrenanstaltsaufenthaltes
auf die Strafzeit” (Jurist, -psychiat. Gremgeb., 1914, ix.). Carl Marhold,
Halle a S. Pr. M. 2,20.

Scholz, Dr Ludwig. “Nervos.” S. Karger, Berlin, 1914. Pr. M. 4,
geb. M. 6.

“ Klinik fiir psychische und nervote Krankheiten," 1913, viii., H. 4.
Pr. M. 3.

“ The Training School Bulletin,” 1914, xL, March.

IRmew

fleurolog^ anO ps^cbiatt*^

©dgfnal Reticles

ON THE MECHANISM OF SOME CASES OF
MANIC-DEPRESSIVE EXCITEMENT . 1

By C. MACFIE CAMPBELL, B.Sc., M.R.C.P.E.,

Associate in Psychiatry, Johns Hopkins Hospital, Baltimore; formerly First
Assistant Physician, Bloomingdale Hospital, White Plains, N.Y.

Cases of mental disorder may lie studied from more than one
point of view, and in a previous communication 2 emphasis was
laid on the importance of studying the individual case not only
from the point of view of formal differentiation, but also witli
the aim of understanding the content of the disorder, the meaning
of the morbid utterances and actions, the fundamental significance
of the distorted adaptation of the patient. Such an analysis leads
down to factors of more than historical significance, dynamic
factors at the roots of the individual’s activity. While the
importance of this line of study is sufficiently demonstrated in the
psychoneuroses, and is gradually becoming recognised in relation
to dementia prsecox (schizophrenia, paraphrenia), the manic-
depressive group has been chiefly studied from the point of view
of formal characterisation.

In the communication above referred to, brief summaries were
given of cases in which “ the individual attack appeared to be the
reaction more or less intelligible to a definite set of circumstances,
and therefore was not adequately conceived when considered to 1 >e

1 Read before the New York Psychiatrical Society, 7th January 1914.
a “The Form and Content of the Psychosis: the Role of Psychoanalysis in
Psychiatry,” Beview of Nevr . and Psych ., Sept. 1911,

176

C. MACFIE CAMPBELL

a quite unexplained explosion of a somewhat unstable emotional
constitution.” The occurrence of a manic excitement as a reaction
to disturbing undercurrents or painful experiences was brought
into relation with the phenomena of everyday life; “ the tension
of painful feeling may lead to a paradoxical appearance of mirth,
and flippant talkativeness of a superficial order may conceal a
serious pain.”

The continued study of cases from this point of view has
thrown much light on the mechanism of the manic excitement,
and it seems worth while to publish briefly a few cases in which
the situation has been made clear.

The first case 1 is that of a young woman, who presented tjie
picture of a typical manic excitement when she came under
observation; at that time the psychosis was of less than one
month’s duration. The patient was overactive, talked continuously,
was easily distracted by casual sounds or objects, showed some
flight of ideas; the mood was one of elation with considerable
irritability. There was no evidence of hallucinations, nor of fixed
delusions, but the patient made a number of extravagant statements,
the meaning of which was difficult to interpret at the time they
were noted. Her orientation was not quite clear; her general
condition made an accurate examination of the memory and of
other intellectual functions impossible. The patient complained
of dizziness and of buzzing in the ears; she had a burning pain
in the back of the head, like an X-ray, “ as though someone were
staring.” The neurological status was otherwise negative; apart
from a valvular heart lesion there was nothing to note in her
physical status.

The patient was treated with wet packs and in the continuous
bath; the excitement soon subsided, and in less than two months
the patient had completely recovered.

Here then was a typical manic excitement, said to have been
brought on by overwork and sunstroke. The question was
whether one had to be content with the general description, and
had to regard the case as a well-known type of explosive reaction
in a person of a certain constitution, the reaction having been
precipitated by the banal etiological factors above mentioned. As

1 I wish to express my thanks to Dr William L. Russell, Med. Sup., Bloom -
ingdale Hospital, for permission to use the eases referred to in this communica¬
tion,

CASES OF MANIC-DEPRESSIVE EXCITEMENT 177

an alternative the attempt was made to understand the psychosis
as the resultant of the actual forces in the individual’s life. No
excuse waa necessary for making such an attempt; for on the
assumption that the disorder was an explosive reaction elicited by
somewhat banal causes, the patient on recovery would be hardly
better able to meet difficulties in the future than in the past.
If, on the other hand, the psychosis were the resultant of more
definite factors which could be traced, these might to a certain
extent be open to modification and be managed in a different way.

The reconstruction of the whole situation was begun by follow¬
ing certain clues given by the utterances of the patient during the
excitement In the psychosis she frequently referred to coloured
men, coloured disease, coloured blood; she also said that she was
“ a poor white coloured actress ”; she harped on being a spinster,
talked of her married name, her unmarried name ; she asked what
her name was. She talked of being “ an old tired cock,” said that
she could not crow any more; “ I know what it means when the
cock crows twice.” In close connection she referred frequently to
the “ Scarlet Pimpernel ”; she talked of dying like a scarlet cock;
“ I broke my word to Miss A. as a white woman. No one knows
it but the scarlet doctor whom I told here.”

She frequently opened her mouth widely, and talked of some¬
one spitting into the mouth; “ Let me spit in your mouth—I will
spit straight in your face.”

A few weeks after admission the trends, which were beneath
these utterances, were gone into in the course of an association
experiment.

The references to coloured blood were at once admitted to be
references to sexual passion; she said that she had taken a morbid
view of herself; she had not been white through and through.
She had referred to herself as “ a poor white coloured actress "; at
the very beginning of the disorder she felt that she had to give Up
her work, and take up acting or be a nun. These obviously
represented two ways of escaping from the real world. In her
associations to the word “ angel," the patient, a Presbyterian,
expressed strong leanings towards the Roman Catholic Church,
“ they look after their people ”; she laid weight on confession, on
having someone to talk over things with, “ this might have pre¬
vented some things.”

As to the reference to the “ tired cock ” crowing, she had

178

C. MACFIE CAMPBELL

frequently lied to conceal the fact of her illegitimate child, she
had lied to a woman (Miss A.) who had done much to protect her.
Some of the utterances during the psychosis may be here quoted:
“ When I lied, lied, lied—that’s the third time the cock crowed ”;
“ that’s the fourth time the cock will have to crow to a Scotchman
who is married ”; “ I shan’t apologise all my life, die like a scarlet
cock ”; “ I’m only a poor old tired cock ”; “ I know what it means
when the cock crows twice—can you tell me how a tired cock
crows—I can’t crow any more.”

Behind these utterances was more than a reference to Peter’s
denial; she gave the following associations to cock, “ bird—tired
cock, symbol of tiredness—a picture in Life of a cock with its
head hanging down and the legend, * What’s the use anyway; one
day a rooster, the next day a feather duster’; have seen it
frequently in book stores.” She first saw it during the strenuous
period when she was trying to reconstruct her life and struggling
to support her illegitimate child.

For her the “ tired cock ” symbolised the futility of the struggle
which she felt was too much for her. In the utterance “ a good
woman if I have to go through life apologising to married men—
then you don’t know how a tired cock crows,” “ I shan’t apologise
all my life, die like a scarlet cock,” the association l)ecomes clear in
view of the reference to the illustrated periodical Life.

The cock was therefore “over-determined,” and represented
the meeting-point of two very important associative constellations.
The word crow, too, was probably over-determined.

The following were the associations to crow, “crow—bird
(l sec.; unusually wide deviation of the galvanometer mirror),
black disagreeable bird, can’t bear them, make so much noise,
always go in groups, I always have to count them, one a wish, two a
kiss, three a disappointment, not that I want a disappointment.”
Beneath the cultured woman there was enough of the pagan to
compel her to read the signs of nature to see if, after all, there
were not to be granted to her some satisfaction of her deepest
cravings which refused to be eliminated, even after her mistake
had seemed to put such satisfaction out of reach.

The “ scarlet cock ” was intimately associated in her utterances
with the “ Scarlet Pimpernel.” Her association to scarlet was red
(time 1*6 sec.; unusually wide deviation of the galvanometer
mirror). After a few associations relating to an attack of scarlet

CASES OF MANIC-DEPRESSIVE EXCITEMENT 170

fever, she referred to the “ Scarlet Pimpernel.” “ I don’t know why
I associated it so much, I talked of it in my sickness, it was used
as a password, I felt I had a password with Miss A., it seemed
to me there was a password to be exchanged—I had to hang on
to some password to save my reason, just the same as I was
discussing whether I should give up teaching to be an actor or a
nun, yet I had to keep in touch with Miss A., save my work,
perhaps my reputation, what could I do ?—that was uppermost, I

had to save myself to work, save my mind to work for my child-

the hero in the ‘ Scarlet Pimpernel ’ has two characters; in Denver
(where she fell sick) I couldn’t sleep, I asked if they couldn’t put
adhesive over one eye, give it a rest, then over the other, the hero
could sleep with one eye open, in one character he was stupid, in
his own life among his own people he appeared stupid, but he had
a brilliant intellect-”; a password meant “ standing for some¬

thing else, perhaps I want to get away from myself, I have tried
to stop thinking of my life in Washington" (period of careless
living and seduction).

The "Scarlet Pimpernel” was no trivial utterance, but ex¬
pressed her longing to gain recognition and admiration for
brilliancy, to have her apparent stupidity recognised as a mere
cover, to live an efficient life, to save her reputation, to save her
personality and support her child. In that “password” was
focussed the whole conflict of her life, and in the psychosis the
consciousness of that conflict was not submerged.

A few further associations may be mentioned in this connection;
to wicked, stupid, she merely repeated the stimulus words after
a long reaction time (9 - 4 sec., 4 0 sec.). “ Stupid—stupid, just as I
did to wicked, I just seemed to see that, I suppose I was thinking
about myself, but if I have self-confidence, I don’t think I am so
stupid—I have always more or less depended on other people.”
“Pride— myself, 1 have a good deal of pride, I wouldn’t acknow¬
ledge it, pride about my work, my looks, I like commendation,
thrive under it-”

“Pity—(she had given poor in the association test)—I don’t
remember it at all, charity, I wonder whether I do pity myself
(smiles), I think I have (hesitates), not because I’ve had a child,
because I didn’t take advantage of my opportunities ”; but she
regretted the lack of intellectual accomplishments because they
would have been means to secure admiration and affection.

180

C. MACFIE CAMPBELL

In this connection there was an interesting pseudo-reminis¬
cence. After giving her associations to stupid, she said—" And it
was the same with awkward, I gave awkward, I’m not clumsy,
perhaps the same as stupid—(give an example of awkward!)—
such as not to know when asked a question.” As a matter of fact
awkward had not been given as a stimulus word.

The length of the association time was frequently acknowledged
to be the result of a deliberate suppression, c.g., “child—I gave
niece, I was going to say mine, I remembered the nurse was in the
room”; “to paint—pink—pink carnations,” but she admitted that
she had suppressed the personal association that she had rouged—
“ I wouldn’t have got through my teacher’s course without it, they
would have thought me sick, I did not want to be sick ” (danger
of examination and disclosure of her secret).

How closely the utteranoes in the psychosis were related to
the dominating trends in the patient’s life was also seen in the
frequent recurrence to the topic of spitting, of which several
examples have been given above. In the same context we may
also quote the following utterances: “Have you ever wiggled
from a snake, and died to haemorrhage like a perfect woman ? ”
“ I can wiggle my leg like a snake,” “ the only way I can get
well is to wiggle and make someone laugh”; “I have Mrs S.’s
disease.”

The patient had once temporarily cared for Mrs S., who was
delirious; Mrs S. spat a good deal, thought she was having a
baby, thought a restraining strap was a snake. The patient had
been much impressed with the possibility that if she herself
became delirious she might give up her secret, and in her manic
condition she felt that she was behaving like Mrs S. The utter¬
ances were probably further determined by the erotic content of
the utterances of Mrs S.

The result of the above analysis had been to show that
beneath the smooth conventional surface of the routine life was
the actual woman, striving rather wearily and with a feeling of
futility to reconstruct her life (“tired cock”), supporting her
illegitimate child by consistent work and the sacrifice of all the
usual pleasures, ashamed at having lied more than once (the cock
crowing) to an admired woman friend, regretting the want of an
opportunity to unburden herself (leaning towards the Roman
Catholic Church), but also longing for a more positive happiness,

GASES OF MANIC-DEPRESSIVE EXCITEMENT 181

eager for any omen to indicate the possibility of it (associations to
crow), sensitive about her lack of attractiveness, but consoling
herself by the feeling that beneath the self seen by the world was
the real self of brilliant capabilities (“Scarlet Pimpernel”); in
addition, giving way from time to time and with much conflict to
an old-standing habit of masturbation.

It is sufficiently plain that such a working adjustment involves
considerable strain, and an equilibrium of this nature is not of the
most stable. What explained the actual break in the adjustment,
the date of the onset of the disorder ? Was it that the limit of
resistance had been readied, or had certain internal factors
received an augmentation of strength, or had Destiny created a
situation beyond her power to cope with ? A careful review of
the actual situation preceding the attack made the problem more
clear. A very short time before the attack the patient and her
mistress were interested in a sensational newspaper paragraph.
This contained the statement of a girl, picked up on the streets of
Chicago, who said that she had taken a berth on a train three days
previously, but remembered nothing subsequently, as she had been
probably drugged and assaulted on the train; she had come to
herself two or three days later, and found a mark on her throat as
if received during an assault. The railway company maintained
that the bruise was self-inflicted, and the patient and her mistress
discussed the improbabilities of the case, and agreed that the girl’s
statement was a falsehood. Immediately before the onset of the
psychosis the patient had to take a long railway journey ; she was
in the position of the girl of the newspaper paragraph, whose story
came back to her mind. She felt afraid the first evening that she
might be drugged, she thought that someone might look through
the curtain of her berth, she was suspicious of the coloured porter,
she felt chilly and took a little whisky. The next day she was
menstruating; she felt better, but on arrival at her destination
her usual control was disappearing. She realised that she was
talking too much, in conversation with a young man, who happened
to be at the hotel, her usual reserve was gone, and in a few days
the full-fledged manic picture had developed. The exposure to
heat was subsequent to the first indication of loss of balance.

When the patient was asked why the newspaper story should
have so much importance for her, she did not see that it had any
special significance; she did not realise that it had an intense per-

182

C. MACFIE CAMPBELL

sonal significance until the physician had put the pointed question
whether it was not in its essence her own story. Only then did
it slowly dawn upon her; yet she had previously told the physician
of the circumstances of her seduction, how after a champagne
dinner she was unconscious, and must have been seduced, for her
menstruation ceased, and after the third month the diagnosis of
pregnancy was made. She herself denied any more precise
memory of the actual seduction. How far this amnesia was
complete, or how far it might have been possible to resuscitate
memories repressed on account of their painful nature, is a matter
of doubt. The question was not pushed. The precipitating factor
was now apparently demonstrated ; the conscious and subconscious
forces, reactivated by the newspaper paragraph and accentuated
by the actual situation of the journey, were powerful enough to
make the usual control no longer possible, and the patient at last
gave expression to the forces so long controlled with difficulty.

The case shows how a manic excitement may be the expression
of a rather intense conflict in the patient's inner life, certain factors
in which have happened to attain an intensity which breaks down
the existing equilibrium, so that the repressed factors assert
themselves in only slightly disguised form. The characteristic
feature is that this conflict is not carried on at the deep level
where the schizophrenic tragedy is acted, but takes place on the
very threshold of clear consciousness; the patient has a fair
inkling of the factors at work, may realise to a large extent the
meaning of the reaction, and to appear on the stage of conduct the
forces at work do not need to assume the subtle disguises which
make the schizophrenic drama so hard to follow. When the patient
in the midst of her excitement was asked about her child, and told
that her reaction was an evasion of her difficulties, she said, “ I am
not fooling with you, I’m hysterical—I don’t want to get well, and
you’ve been posted like everybody else, and I haven’t had a baby,
and I haven’t coloured blood.”

In this statement the patient gave notice of the cessation of
her struggle, and welcomed the relief, and the cheerful abandon of
the manic no doubt largely depends on the cessation of the
continual inhibition. The emphasis which the patient laid on her
desire for confession encourages one in such a case to penetrate
beneath the flippant surface of the psychosis, and to help the
patient to talk frankly over the really serious factors in life; in

CASES OF MANIC-DEPRESSIVE EXCITEMENT 183

some cases a serious interview exerts a demonstrable influence un
the clinical picture, at least temporarily. The onset of the
psychosis in this case at the time of menstruation is also a fact not
to be overlooked, for the break of adjustment was no doubt
favoured by the periodic variation in the crude instinctive factors.

It is not pretended that the above attempted reconstruction of
the mechanism of the disorder is a complete answer to the question
why this woman should have had a manic attack at the given
date. Why did she not have a reaction of another type ? As in
the psychoneuroses and in the schizophrenic group (dementia
prscox) we have been forced to go down to the roots of the
personality in order to understand the surface phenomena, so here
too the type of reaction would have to be understood in the light
of the forces that were at the bottom of the individual character.
We would have to explain how it was that the patient had early
drifted into a rather frothy social life, how she had been accustomed
to take alcohol rather freely, and how her sexual instinct had been
so poorlytaken up into her adult life that an illegitimate pregnancy
was the result—such familiar facts of the anamnesis are in reality
a series of further problems. In attempting to estimate the
factors which had hampered or favoured the development and
elaboration of her sexual life, one would be forced to take into
account its earlier stages. That this factor had from an early
age been a difficulty in the patient’s life was shown by the fact of
masturbation since the age of 5 or 6; the habit had been self-
taught, and involved much internal conflict. In the association
test frequent references to her father cropped up, and the role *
played by her affection for him had no doubt been an important
factor in her life. She had a great deal of pride in her father’s
unpretentious family; she had been much fonder of her hard-work¬
ing father than of her ambitious mother, whose chief pleasure was
in society. The full bearing of these facts was not gone into.

It is evident that the complete study of such a case is a task of
considerable magnitude.

The second case is that of a rather brilliant young woman who
came under observation a few weeks after the development of
mental symptoms. The patient presented a typical manic picture;
she was overactive, elated, talkative, played on words, was easily
distracted by casual stimuli; there was no evidence of hallucina¬
tions nor delusions; her flippant answers made it impossible to

184

C. MACFIE CAMPBELL

examine accurately her intellectual functions, but she was
apparently oriented and showed no defect in her memory. The
following samples were typical of her utterances: (Name of this
place ?) “ The House of Mirth, Marathon, marry you; ” “ I’m a
club-ioot sandwich , a southern negro, that knee won’t grow”
(tapping her knee). She was keenly observant, and made pertinent
remarks on the details of the environment. Her physical health
was excellent.

The patient had been working very hard in a new and
responsible position, and the psychosis was attributed to overwork.

The spontaneous utterances of the patient consisted largely
of flippant comments, rhymes, plays on words, but interspersed
through these were open references to certain tragic circumstances
in her life; she had married a man of perverted habits, whom she
left on her wedding night, and subsequent divorce proceedings
had subjected her to humiliation and yielded unsatisfactory results.

While the patient was still definitely manic, although less
active than on the first observation, an endeavour was made to re¬
construct the situation out of which the psychosis had developed;
it was considered possible that a serious review of the important
factors might tend to cut short this inferior type of adjustment.

During the interview the patient frequently smiled, drifted a
little along superficial lines of association in her talk, showed a
tendency to resume her previous antics. She listened, however,
seriously; and although her conversation was mixed up with
drifting allusions, at times she talked in a very direct and sober
way about her troubles.

She talked of having been “murdered spiritually” and of
having caused “murder”; she was not to blame for being so
attractive; all her women colleagues had had trouble similar to
hers; she was very sympathetic, but had been a source of danger
to others. She regretted that she had been a danger to one
woman, her ideal, on whose beauty she commented again and
again. She had found this friend tired, had massaged her; this
had aroused a dangerous attitude in the other, and she herself had
become quite passionate. She suspected that similar improper
proceedings were going on throughout the house (“ projection ”).
She then felt that she had to go crazy.

As to the fiasco of her marriage, this had made it impossible
for her to love any man; she had felt that she could only find an

CASES OF MANIC-DEPRESSIVE EXCITEMENT 185

outlet for her affections in work for her own sex, but there, too,
she had met difficulties; “ I had either to go crazy or to die—one
can’t always be struggling.”

In this connection reference may be made to other facts con¬
firming the importance of the homosexual trend in her nature.
Among her intimates she was nicknamed David, “ as she had a talent
for friendship ”; when asked about this during her convalescence
she was a trifle embarrassed, said that the similarity was not
meant to be an identity, referred to the main incidents in David’s
life but made no reference to his friendship for Jonathan. When
this was referred to, however, she went on to discuss such
relationships and the fundamental trends underlying them, and
referred to certain suspicions touching the friendship of two
clergymen. One morning the patient, while still hypomanic,
dressed herself up like a man, with pyjamas rolled up to the knee;
on another occasion she said, “ I was meant to be a man, my father
meant me to be a man, I had my father’s heart ” (many of her
references showed the important role in her emotional life played
by her affection for her father). At the very onset of the psychosis
the patient had shown an exaggerated solicitude for the health of
a woman friend, which led her into rather absurd extremes.

The analysis had thus revealed dangerous elements in the
patient’s equilibrium previous to the attack, and some factors
which had probably made these elements unusually prominent.
As the patient became better she made the situation still more
clear; she told how the man she had married had recently got into
trouble, and just before the onset of the psychosis she had been
appealed to in order to save him from the threatened consequences
of his own acts. She had thus been put in a position out of
which she saw no outlet: “ I had either to go crazy or to die.”

In this case, as in the previous one, the analysis did not go far
back into the development of the patient’s character and of her
mode of getting satisfaction out of life. The painful episode of
her marriage did much to explain her later difficulties, but on the
other hand itself required explanation. That her sexual instinct
had early been a source of difficulty was obvious from references
to experiences at an early age, while the later prominence of a
homosexual trend was further evidence of the fundamental
difficulties placed by this instinct in the way of a smooth adapta¬
tion to life.

186 C. MACFIE CAMPBELL

In this case, too, the important disturbing factors were to a
large extent within the realm of clear consciousness, and the
patient had remarkable insight into the nature of the mental
reaction as indicating an inability to continue the struggle with
her instincts: “I had either to go crazy or to die.’' Another
possible solution of the struggle had suggested itself strongly to
her, namely, that she should enter the Roman Catholic Church
(rf. the previous case: “ I had either to become an actor or a
nun”). During her menstrual period the patient became much
more excited and irritable; she talked of the physician as her
murderer (cf. her earlier statement that she had caused murder,
referring to her sexual experiences). When quieter, her attitude
to the physician was somewhat erotic, but she would apologise
and say that if any woman, man, or child likes their doctor, they
say “ any old thing ” without wanting to flirt.

The third case is that of a middle-aged woman, a respectable
dweller in the suburbs, the wife of a hard-working clerk, absorbed
in his business and his own precarious health, which had precluded
marital relations for a long time. The patient had had one previous
attack of excitement, from which she made a complete recovery.
The present attack came on immediately after nursing her boy
most devotedly during an acute illness. The clinical picture was
that of a typical manic excitement. She was overactive, talkative,
exhilarated, but occasionally tearful; her stream of talk was
directed by superficial associations. There was no evidence of
hallucinations nor of delusions; she was clearly oriented, had an
excellent memory, and some degree of insight into the nature of
her disorder. The patient had mitral incompetence well com¬
pensated; she was slightly deaf, otherwise her physical health
was good.

The attack was attributed to the protracted strain of nursing
her lx>y; but it was clear that the nursing had been itself a rather
feverish and exaggerated activity, and it was interesting to know
that previous to this devoted nursing she had been an intolerable
nagging mother for more than a year, while in the psychosis she
more than once stated that her children would never have been
born if she had known how to avoid conception.

During the prolonged manic attack it became i>ossible to form
an approximate idea of the actual structure of the patient’s life, of
the factors which had led to the former attack, and of those which

CASES OF MANIC-DEPRESSIVE EXCITEMENT 187

had precipitated the present attack. It is difficult to condense the
results and at the same time to give a correct impression of the
material from which these results were drawn; the material
consisted of observations during a period of many months of her
behaviour, her spoken utterances, her letters, her dreams. When
the excitement simmered down and the patient was able to co¬
operate in a more consecutive review of her life, she gave still
more definition to the interpretation which had been tentatively
arrived at.

At the first interview her drifting talk contained many references
to her husband (“he is a fool—physically weak on account of
masturbation ”), and she spoke of being divorced; she referred to
“ an anniversary coming round—a broken engagement," an engage¬
ment when young to a bad man. On the third night after marriage
she had unconsciously murmured “ forgive me,” as she thought she
saw the figure of her former sweetheart (Mr B.) at her bedside;
to her husband’s query she had answered that she wa3 repeating the
service. She talked of her own age, said that she would allow any
young man to do anything to her; on the other hand she empha¬
sised her correctness: “ I wouldn’t speak to a man unless I had to”
(here she took the hand of the examiner); “ I was a flirt, but now
I am an old hag.” Tire contrast between youth and age occupied
her much, and in another interview, on seeing the stethoscope, she
said, “ You’re young. I’m old—you old flirt—try my heart—I’m
too old." Again and again she referred to the fact that beneath
her conventional married life were persistent regrets with regard
to an old love affair; she apparently felt it necessary to balance all
her references to this past affair by emphasising her satisfaction
with her married life. “ I have a lovely li/e, interested in charity
and society in a small way. I got through with my life before I
was 25 ’’; in the second half of the statement the truth breaks
through the conventional crust of the first half. She referred to
“awful things before marriage”; her husband would not let her
talk to him about them: she still wanted to talk over these matters
with him. As to divorce she said, “ No one thinks of a divorce
unless they are ready to step into a second home” (vid . infra,
Dream).

At a later period of her attack the patient made her statements
much more definite, and referred to her personal difficulties and
the rdle they had played in her life. During interviews the

188 C. MACFIE CAMPBELL

patient would, as a rule, be cheerful and flippant, but would
occasionally break down and cry, only to resume her cheerfulness
and make light of her tears. She stated that when out automobile
riding she would scan every passing car to see if it were that of
Mr A., an old friend; she thought this attitude childish, probably
the result of her protracted mental attack. She denied any
affection for Mr A., “ I was fond of interchanging ideas.” She then
admitted that she had not realised her true feelings towards this
man until she heard of his marriage; it came as a shock to her.
She did not wish to give the date of this shock, evidently so that
it might not be brought into relation with her own mental
symptoms. “ I don’t want to tell you when I felt badly—but
that was over my son. I gave my thoughts to my family. I
never had any foolish thoughts when I was caring for my son—
(When did you get the shock ?) It was in January. That is as
near as I will tell you—don’t ask me any more. I worried about
my son in December ” (but the husband placed the onset of the
boy’s symptoms in January), “ I don’t like to tell you dates.” She
still wished to see the cause of her sickness in her care of the boy,
and hesitated to have her convenient dates corrected. The
sequence had been that she had learnt suddenly of the marriage
of Mr A., with whom she had “interchanged ideas” for many
years, and for whom she had evidently had a very deep affection;
to ward off the realisation of the aotual situation she had devoted
herself with unsparing assiduity to the nursing of her boy. Even
this method had not been quite successful, and the situation was
complicated further by certain resemblances between her boy and
Mr A. Her complex mental state was probably also influenced
by the fact that she had been for some time nagging the boy, that
she had a latent desire that he had never been born, that she felt
that her husband’s weakness was partly due to past masturbation,
and that her son’s mental breakdown had also to be attributed to
this fact. During the period of nursing, the patient’s resistance
had given way, the conventional adjustment was no longer
tenable.

In a later interview, which was at first characterised by the
usual mixture of flippancy and tearfulness, of admission and with¬
drawal, the patient became quite serious, and said that the trouble
was outside her home; she had a liking, not an affection, for
Mr A., she intended to get a divorce, and leave home. She said

CASES OF MANIC-DEPRESSIVE EXCITEMENT 189

that she would have no scruples in making plans that would
involve the other man’s home. But after this assertion of her
resolve to get satisfaction at whatever cost, she asked the physician
seriously if he could influence her to prevent her from wishing to
leave her home. The patient had evidently a remarkable insight
into the nature of her trouble. She later wrote: “ I don’t think
Mr A/s wife is half good enough, but if he is content that is all
there is to be said, but I wish I didn’t every morning at my
solitary breakfast think of those two together; I must be turning
into a semi-idiot.”

So much for the precipitating factors of the patient’s second
attack. A further review of the case threw light on the onset of
the first attack, which had occurred many years previously.

The patient had frequently referred to an intrigue with Mr B.
before marriage; after a time she became more explicit, and
admitted how laige a part this affair played in her whole life.
The intrigue had been carried on over a period of about one year;
she gave a definite date for her seduction. She broke off relations
with this man because he was dragging her down, and she could
not raise him up. After two abortive engagements with other
men she married her present husband. “It was a marriage
without a shred of affection, a marriage of respect.” She thought
it “more proper, more lasting.” Her old love had not died,
“ absence makes the heart grow fonder ”; she still had “ a lonely
feeling under the heart.” She admitted having fantasies about
going away, having a lovely time for a month or so, and then
paying up. She talked of “ the lovely life I expected in a sunny
land, with flowers all the time, and music and pleasure-loving
people in the land of the siesta ” (Mr B. was of Italian origin).

Married to an invalid of narrow interests, her sexual instinct
unsatisfied, she had just before her first attack visited the scene of
the old intrigue and gone over all the hallowed spots; it was the
anniversary of her seduction. She returned home with the desire
to confess all to her husband ; she already presented symptoms of
loss of balance, was exhilarated, talkative, referred to divorce,
accused her husband of infidelity; the clinical picture was that of
a manic excitement. This condition, after lasting for more than
one year, was followed by a phase of depression, after which the
patient regained her previous equilibrium, but the memory of the
old love affair was only dormant,

190

C. MACFIE CAMPBELL

BeneAth the surface the old longing persisted, and it manifested
itself very clearly in the second attack; it furnished the material
of her fantasies by day and of her dreams at night. The
following is a good example of her dreams, and was written only
after she had refused to communicate it orally.

“Dr Campbell, now I will write you my dream—I really
couldn’t tell it to you and look you in the eyes afterwards.—I will
tell it exactly as it was, except I will omit some of the affectionate
conversation, if you please. I seemed to be taking a long journey
by railroad and hunting for some place—I was not comfortably

dressed and had little money—at last the guard called out D-

and I got out. (I never heard of that place, did you ?) Well, the
road was rough, and I walked and walked and walked past many
gangs of foreign workmen. I was dreadfully tired and all alone, and
in fear for night was near. The street lights shone in the distance
and I seemed to be in an impassable swamp—I think I was fleeing
from my family and they were hostile to me (I am a little hazy
on that point). Well, I saw a bright light, and in great fear I half
awoke and the lantern was going by, then I dreamed on and this
is not so clear. I was sick and faint with fright and I went up a
path in the swamp and into a new house and up the stairs, and
my shoes were full of water. I was helped to undress and put
into l>ed, and then the door opened and in came my ghostly friend
whom I imagine by my side when I am sleepless, as I told you,
but whose name I am not willing to speak to you. He came in
and shut the door. His brown hair had turned grey [identification
with a rich man, who appears in another dream; Mr B. had
postponed marrying patient on the ground of poverty] and he had
on his mixed business suit. He is very quiet in his ways. He
sat close by the bed and said, ‘ Now Mrs S. I want you to rest, no
one shall harm you,’ and we talked for a long time and my clothes
lay wet on the floor. He held my hand and my head too, and the
talk was the affectionate part which I shall certainly omit, and
suddenly there was a bright light and I woke up. So dreams do
make a difference, for I am generally so unhappy when I wake
up.”

The dream is sufficiently clear to require no detailed explanation.

The patient said that in the daytime she continually felt that
she was accompanied by someone. She referred to him as “ my
ghost ”; she would go to sleep by imagining that he was beside

CASES OF MANIC-DEPRESSIVE EXCITEMENT 191

her, “ good-night now, it is time for me to think of my ghost ”;
she felt that she oould not eat her breakfast unless she imagined
that someone was in the room.

To make clear the level of consciousness at which the conflict
in the patient’s mind took place, to show how little the actual
difiiculties were submerged, how good was her own realisation of
the difficulties, a few of the patient’s own statements may be
quoted. They show that she herself considered her condition to
be a mental disorder, a reaction to a situation which she felt to be
too much for her, a situation in the face of which her usual
working compromise could not be maintained, and for which no
solution within the limits of health was available. In the midst
of her flippancy she said, “ I’m not so sensible as I make myself
out to be. I keep thinking of things I don’t want to think of.”
She used the following expression, which is somewhat pathetic
in its appeal, “ I am not begging to be happy, Fm trying to get rid
of being artificially happy." In a letter she writes: “ I know I

shall be punished for this (i.e., leaving her home) and I am afraid,
but I have made my choice, and I go over it over and over agaiu
and think why cannot I go on with my life always as it seems
marked out for me, but I cannot. I realise I cannot, I must let
myself go. I guess I lived in a fool’s paradise for a long time and

didn’t know it.-1 think I write rather more honestly than I

speak. When I talk to you I like to gloss things over, so they
sound at least half way respectable.” She said that her life was
over, “my instincts were crushed years ago, I don’t think I’ll

have strong health again, you need something to back that up-.”

As to her manic behaviour, “ I like to make a fuss all the time just
to forget , that’s why I made this awful fuss.”

In her attitude towards the physician the patient showed an
alternation and mixture of like and dislike. In her irritable and
impatient condition she would make accusations which relieved
her of any personal responsibility for distressing thoughts, and
into these accusations she carried an excess of feeling which was
only intelligible when traced to its source. This method of
relieving the personal tension by indignation and accusation
against others is an important factor in determining the attitude
of the manic patient to the environment. Thus, one day after
a pleasant greeting, she came back to the physician, spoke to him
white with rage, stamped her foot, called him a nasty liar and
16

192 C. MACFIE CAMPBELL

other opprobrious names, and asked him if he would have dared
to make the same remarks in the presence of her husband. An
explanation was not forthcoming. A few days later, when more
accessible, she said that the physician had suggested that she
leave her home; she then corrected this to the statement that he
had said she was not satisfied at home. After playing on this topic
for a little, she vigorously asserted that she would leave her home,
that she intended to get a divorce and live out her own life. The
furious reaction against the physician was therefore a reaction
towards her own strong desire, for the presence of which she
would have made the physician responsible. On another occasion
she said, “ I don’t get angry at you, I get angry at myself for not
being able to keep it all to myself.” She asked the physician
to “ swallow down your anger and disgust, which influence your
actions more than you are aware.”

The patient on several occasions reacted rather well to an
interview with a frank review of her actual difficulties, and fully
appreciated the bearing of the treatment. “You are right, my
treasured friend, I am growing a little better, and I do see things
I don’t like a little clearer, that is an awfully involved period; ”
“ the past is over. You may help me arrange my present way of
regarding things all you wish, and I will follow you to the best

of my ability. I am far from being flippant-1 honestly enjoy

talking with you, and I have slept so much better these last few
nights, but don’t ask me any unnecessary questions, please. Vital
matters I do not mind at all discussing, as you seem to think ”
(extracts from her letters to the physician).

In this case the nature of the conflict and the level in
consciousness at which that conflict is staged, correspond with
what has already been observed in the two previous cases. The
conflicts which proved disastrous in later life had their founda¬
tions laid in earlier life; an intrigue of one year, two abortive
engagements, and finally “ marriage without a shred of affection,”
indicated a manner of dealing with her sexual instinct which
could hardly pass with impunity. What earlier factors had
determined this faulty adaptation of the young woman to her
adult responsibilities was not investigated; a thorough review
of her childhood was not taken up. It was known that her
mother became insane during the patient’s girlhood, and the
patient had lieen devoted to her father.

CASES OF MANIC-DEPRESSIVE EXCITEMENT 193

The fourth case is that of a young woman who presented
the symptoms of a typical manic excitement She was overactive,
talkative, easily distracted by casual impressions; there were no
hallucinations nor delusions, her orientation and memory were
excellent; she had good insight into the nature of her condition.
Her general nutrition was good, there was no disorder of the
internal organs; she had difficulty in control of her sphincters,
and some anaesthesia in the distribution of the lower sacral roots,
owing to an old spinal trauma sustained during a previous attack.
After a period of several months, during which the excitement
varied in degree from time to time, the patient was able to
resume her usual social life.

The patient attributed her attack partly to the strain of some
routine nursing she had to do at home, but laid special emphasis
on the rdle played by the sexual instinct. She at once plunged
into this topic: “ First one (i.e., engagement) was broken off, then
one was hopeless, terrible sexual pains, no satisfaction for it, if I
only had some way of curing it, aren’t the baths good for it ? ”
She was affable, bright, and eager, but said that she was sad and
melancholy: “I broke off a first engagement without exactly
knowing why, now he has married another woman”; she again
spoke of “ terrible sexual pains with no satisfaction. It’s terrible
to see my two sisters married with such lovely babies.” Just
before her attack her sister with two babies had come to stay at
her home, and this had made somewhat more acute the tension
of the forces which she was already barely able to control. The
leading interest in the patient’s life was a rather hopeless
attachment for a distinguished professional man which she was
carefully nursing; the hope of marrying him, although to an
outsider extremely fragile, meant everything to her, and probably
did much to sustain her in the cheerful conduct of her life. The
patient had already had several attacks; between the attacks she
was described as "an exceedingly agreeable personality.” A
review of the earlier attacks elicited several facts of cardinal
importance.

The onset of menstruation had been a critical period in her
life, and during the second menstruation, which came on after a
horseback ride, the patient was said to have been hysterical.
At each succeeding period she was a little upset. At the age of
14, after a period of depression with ideas of unworthiness, she

194 C. MACFIE CAMPBELL

passed into a condition of overactivity, and did many curious
things; at one period of this attack she persistently soiled
herself. One of her favourite forms of activity during this period
was to go through various military manoeuvres. During her
college period she had an attack in which from a “ modest, sweet,
innocent girl,” she changed into a boisterous, careless, and quarrel¬
some one; this condition persisted for several months; the patient
was boastful, talked a great deal about religion, but after a period
of several months returned again to her previous condition. At
the age of 20 the patient had a prolonged period of excitement,
in the early stage of which she jumped from a window and sustained
a fracture-dislocation of the spine. Three years later she had an
excited attack of five months’ duration; during this attack she
was hostile to her family, thought her sister was dead, wrote to
her father that God had told her that her mother hated her, she
showed a strong religious trend; masturbation was noted during
this attack. One more attack of a mild character, in which her
religious trend again appeared, occurred four years later, and then
the attack which is at present under consideration. The account
of these attacks from the patient herself threw a great deal of
light on many of the incidents. The role which her childhood
affection had played in her life stood out in sharp relief. In an
early attack she had gone through military manoeuvres; her
father was a soldier; he, the patient, and her sister had visited
the scene of his old exploits, and on the journey her sister had
shared the father’s berth to the patient’s indignation. After one
day’s riding together, menstruation came on, and she had to rest
while her sister rode round with her father (in one attack her
sister is dead); the patient had then shown “ hysterical ”
symptoms, and these tended to reappear at each period. When
the patient was older she became engaged, but the engagement w'as
broken over some trifle, as she refused to accept some condition;
another match which was possible did not result in anything,
partly on financial grounds. The attack during the college period
had come on immediately after the rupture of the engage¬
ment.

Her account of the following attack, during which she jumped
from the window, was striking. She had gone to join her father
in a separate establishment of his own, as he was now estranged
from the family; she was menstruating. She was ruminating

CASES OF MANIC-DEPRESSIVE EXCITEMENT 195

over her broken engagement, was evidently rather excited, and
aroused the anxiety of her father; when he entered her room, she
felt that it was in order to assault her, and she was panic-stricken
and became wildly excited. When taken home she jumped from
the window.

In the next attack the hostility to the family, especially to the
sister and mother, with the letter written to the father, again
revealed the importance of the same component in her life. All
these facts stood out in still greater relief in view of the complete
estrangement of the psychopathic father from the rest of the
family.

On further examination of the situation out of which the
present attack had developed the patient referred to a quite
recent visit to her home of her father; he had come, had spent
a few days, and again gone, but the emotional value of his
visit to her would have to be estimated in the light of the facts
related above rather than judged by her own clear feelings.

In this case, as in the others, we find an intense conflict which,
to a large extent, is clearly conscious, but here, much more than
in the other cases, we receive an unmistakable indication that in
estimating the whole conflict of forces the influence of the
affective life in childhood must also be taken into consideration.
In the three previous cases, too, the father had dominated the
affective life of the child, and it is striking that in all cases the
instinctive life had been so inadequately handled. The conflict of
later years has been brought into relation with earlier mishaps in
the sexual life; but these mishaps are not to be taken as incidents
purely of accidental origin, into which the personality of the
individual did not enter at all. One must try and understand
these mishaps, just as we try to understand the psychosis; if the
psychosis is to be looked upon as an inferior type of adaptation
in face of a difficult test imposed by the circumstances of life, is
the earlier mishap not also to be considered as an inadequate
adjustment in face of the crucial test of the adequate external
application of the sexual instinct ? If, then, one cannot so easily
absolve the patients from their share of responsibility in these
earlier mishaps, the problem is to determine what factors stood in
the way of a more normal adjustment. We are thus carried back
to an analysis of those intimate factors which lie down at the
roots of the instinctive life of the adult, and which can only be

196

C. MACFIE CAMPBELL

adequately understood when we have traced the development of
the affective life from early childhood.

In the cases above reported autoeroticism, childhood fixation
of the affection on the father, and homosexuality were factors of
importance, but in none of the cases was the analysis carried
very far; that is a point yet to be done, and Abraham has
already emphasised this aspect of the problem. The point
of attack in the present investigation was somewhat different,
the aim was to try to understand the attack in relation to the
situation out of which it evolved; but while this examination
has yielded fruit, it has also shown that one cannot rest there;
the situation cannot be understood until the patient is completely
understood in the light of the individual development.

In discussing the different types of neurotic disorder Freud 1
has separated one group where the most striking factor is the
denial by the outer world of a suitable opportunity for satisfaction
of the libido, while in a second group greater importance is to
be laid on the internal difficulties which prevent the adjustment
of the individual to a situation which offers fair opportunities of
satisfaction. In the latter type the individual cannot adjust
himself because he is unable to exchange certain forms of
satisfaction for those other forms which would naturally supplant
the former in the course of development. Freud emphasises the
point of view gained from psychoanalytic treatment, that we must
give up a fruitless contrast of external and internal factors, of
fate and constitution, and try to find the cause of the disorder
in a definite psychic situation winch may be determined in
different ways. These remarks, deduced from the study of the
psychoneuroses, apply equally well to the formulation of the
etiology of such cases of manic-depressive excitement as have
been reported above.

The patient, whose manic excitement can be more or less
understood in the light of the above considerations, may at
another period present a typical depression. In my previous
communication I have referred to the case of a young woman of
25, who iu her adult life had twice reacted to a painful experience
(marriage of adored brother, marriage of a man she admired) with
an excitement, while in girlhood she had twice reacted to a painful

1 8. Freud : “ Cher neurotische Erkrankungaten,” Zentralbl.f. PsychoawUytt,
1912, p. 297.

CASES OF MANIC-DEPRESSIVE EXCITEMENT 197

experience (death of father, drowning of favourite brother) with
an attack of depression. The analysis of attacks of simple
depression made along the same lines yields results of no less
interest than those obtained from a study of the excitements. It
would go a little beyond the scope of the present communication
to furnish an example of such an analysis, and this is perhaps not
necessary in view of Abraham’s 1 recent paper.

Abraham has stated his views in the rather dogmatic and
involved terms of a certain libido theory. In this communication
I have endeavoured to keep as closely aB possible to a clinical
formulation of the problem in terms which involve as little theory
as possible, a formulation which is easily open to the control of
wider observations.

The question may arise as to how far the above cases are
typical of the manic excitement in general, and whether the
formulation of the mechanism in these cases may not be applicable
only to a comparatively small group of cases. One point which
determined the detailed study of the above cases was their very
typical clinical picture; it was felt that the principles which
would explain these cases would be applicable to a very
large proportion of cases. In many other cases it has been
possible to see the same mechanisms at work, although they have
not been traced out in the same detail. It is true that in many
cases a satisfactory analysis is not possible; during the attack the
symptoms may prevent an analysis, while on their return to their
normal equilibrium the patients may not be willing to co-operate
to the necessary extent. From the point of view of prophylaxis,
a thorough analysis of the case is very advisable.

The insight gained from these typical cases enables one to deal
much more satisfactorily with many cases of acute excitement,
where in a setting of overactivity, talkativeness, and exhilaration
there occur many peculiar reactions, and where there is a florid
development of peculiar ideas, which evidently represent the
distorted symbolic expression of repressed trends. Here there
are obviously conflicts in the patient’s life at different levels, and
instead of trying to make a formal differentiation between manic-
depressive insanity and dementia praecox, we are encouraged to

1 K. Abraham, “ Ansitze zur paychoanalytischen firforsohung und Behandlung
dea manuoh-depreaaiven Irreaeina und verwandter Zuatifcnde,” Zentralbl. /.
Psychoanalyst, 1912, p. 302,

198

ABSTRACTS

try and estimate at what level the most important conflict takes
place, and to formulate our diagnosis and our prognosis in dynamic
terms which take account of the individual psychology of
the patient.

Summary.

In many cases of manic-depressive excitement the onset of the
attack becomes intelligible in the light of a careful reconstruction
of the whole situation out of which the attack has developed.

The difficulty of adjustment which leads to the manic attack
in these cases is much less deeply seated than in dementia praecox
and allied conditions; the conflict is much more clearly realised
by the patient, the flight into the psychosis coincides with the
relaxation of efforts which are recognised as inadequate to deal
with the actual situation, the cessation of the struggle permits the
frank expression of repressed elements. The elated mood and
exuberant activity of the manic patient are thus partly explained.

It is important to study closely the content of the utterances
of the manic patient in order to understand the meaning of the
situation leading to the attack; this line of investigation includes
an accurate estimate of the equilibrium of forces which make up
the patient’s personality, and involves a thorough study of the
individual’s development.

A thorough review of the above factors may put the patient
in a better position with regard to the possibility of avoiding
further attacks. -

abstracts.

ANATOMY.

THE TRACT OF LI88AUER AND THE SUBSTANTIA OELATlNOSA
(237) ROLAND! S. Walter Ranson, Amer. Joum. Anat., 1914, xvi.
March, p. 97.

The tract of Lissauer is present in man and in the monkey, cat,
rabbit, squirrel, rat, and guinea-pig, and possesses the same
structure in alL It is composed of small, somewhat widely-
separated medullated fibres and great numbers of fine non-medul-
lated axons, and lies in the apex of the posterior horn between the

ABSTRACTS

199

substantia gelatinosa Rolandi and the periphery of the cord. The
number of medullated fibres entering the tract from the dorsal
root is not sufficient to account for all the vertical medullated
fibres found there, many of which are probably of endogenous
origin. The major part of the non-medullated fibres of the tract
can be traced in man from the dorsal roots. In all cases there is
a tendency for the tract to spread out into the lateral column of
the cord, and as no oblique fibres pass ventro-laterally from the
dorsal paid into this lateral expansion, it seems certain that this
lateral part of the tract is of endogenous origin. The tract of
Lissauer and the substantia gelatinosa Rolandi are intimately
related to each other, although in the rat and guinea-pig, where
the substantia gelatinosa is excessively developed, the tract of
Lissauer (exclusive of the lateral expansion) is least well developed.

Two layers can be distinguished in the substantia gelatinosa,
and a third at the border between it and the ventrally-lying grey
substance. The most superficial layer of the substantia gelatinosa
is the stratum zonale. It contains many non-medullated axons
and fewer medullated fibres. It is most abundant just beneath
the tract of Lissauer, and between the two there is a free inter¬
change of fibres. From these facts one may assume that this layer
serves as a means by which the fibres of Lissauer’s tract reach the
substantia gelatinosa. The second layer, the substantia gelatinosa
proper, contains a plexus somewhat less dense than that in the
preceding layer. The fibres are almost all non-medullated. The
intermediate layer at the boundary between the substantia
gelatinosa and the neutrally-lying grey matter is a dense plexus
of fibres, mostly non-medullated. A majority of these fibres have
a vertical course.

The tract of Lissauer, the intermediate layer of vertical fibres,
and the substantia gelatinosa Rolandi, are all intimately related
to each other, and, taken together, form a complex system, the
function of which is unknown. The author thinks it is an apparatus
for pain and temperature sensations. The non-medullated fibres
of the dorsal roots have been shown to arise from the small cells
of the spinal ganglion, which are typical unipolar cells, i.e., they
are afferent in function. They have nothing to do with afferent
impulses from muscles and joints which pass up the posterior
columns. The assumption that the tract of Lissauer and the
substantia gelatinosa form an apparatus for the reception and
conduction of pain and temperature sensations does not exclude
the possibility that we are also dealing with a centre for vasomotor
and pilomotor control. The apparatus may have a double function,
serving as a central autonomic apparatus and for the reception and
conduction of pain and temperature sensations.

A. Ninian Bruce.

200

ABSTRACTS

THE PHYLOGENETIC EVOLUTION OF THE CORPUS STRIATUM

(238) De Lange, Lt Ntvraxe, 1913, xiv., p. 105.

Among some of the author’s conclusions may be mentioned the
following:—The palaeostriatum (globus pallidus) with the basal
ganglion exists in fishes. Dorsal to it is formed, in the ganoids
and bony fishes, a sort of epistriatum, in which are found the
terminations of secondary olfactory neurones. (This nucleus
does not, however, correspond to the epistriatum of reptiles.)
The palaeostriatum can be traced through the whole vertebral
series.

The archistriatum (nucleus amygdalae, &c.) is most highly
developed in the reptilia, and gradually diminishes through the
mammalia.

The neostriatum (putamen, nucleus caudatus) is found for the
first time in the lower reptilia, increases in relative size in the
lizards and progressively through birds and mammals: as a result
the archistriatum forms in the higher mammals only a small pro¬
portion of the whole striatum. The earliest appearance of a
separation by corticospinal fibres of the putamen and the caudate is
in the higher reptilia (Ariens Kappers). S. A. K. Wilson.

AN ANALYSIS OF THE JUZTA NBURAL EPITHELIAL PORTION
(¥39) OF THE HYPOPHYSIS CEREBRI, WITH AN EMBRYO-
LOOICAL AND HISTOLOGICAL ACCOUNT OF A HITHERTO
UNDESORIBED PART OF THE ORGAN. F. Tilnky, Intemat.
Monatichr. f Anat. u. Physiol ., 1913, xxx., H. 7/9, pp. 258-293
(52 figs.).

An embryological study in cat and fowl, and histological study of
the adult hypophysis of fowl, cat, dog, sheep, rabbit, rat. An
analysis of all the elements which enter into the formation of the
hypophysis shows the following:—

I. Pars Neuralis:

1. Eminentia saccularis (of tuber cinereum).

2. Infundibulum.

3. Processus infundibuli.

II. Pars Buccalis:

1. Pars juxta-neuralis.

(a) Pars tuberalis (this is the previously undescribed

portion).

( b ) Pars infundibularis.

2. Pars dist&lis.

“ The pars tuberalis differs histologically from the pare infundi-
bularis. They are also morphologically distinct elements:—the
pars infundibularis appears almost immediately after the anlage

ABSTRACTS

201

of the buccal portion is formed; the pars tubcralis arises relatively
late, and is formed from two secondary diverticula from the body of
the pituitary sac, which later fuse together, displace the body of the
pituitary sac ventrad, and thus secondarily assume their juxta-
neural position: this latter portion is intimately connected with
the neural portion by nerve fibres, blood vessels, and connective
tissue processes, so that the attempted separation of these two
portions cannot fail to lacerate or destroy the neural elements.
Complete hypophysectomy is impossible without removal of the
infundibular process, infundibulum, and saccular eminence of the
tuber cinereum. In accounting for the syndrome which follows
complete hypophysectomy, critical analysis cannot be too carefully
made in differentiating between the symptoms due to removal of
the glandular tissue on the one hand and the neural elements on the
other. Such an analysis is obviously wanting in many of the
reported accounts of experimental complete hypophysectomy, and
the conclusions drawn are hence open to criticism.”

Leonakd J. Kidd.

THE TWBENBRAIN AND MIDBRAIN OF REPTILIA. (Das
240 Zwirschenhirn und das Mittelhim der Reptilian.) De Lange,
Folia Newro-biologica, 1913, vii., Nos. 1-2, p. 67.

This is a long and valuable contribution to the study of the com¬
parative anatomy of the nuclei and tracts of the diencephalon and
mesencephalon. The area covered extends from the optic thalamus
to the nucleus ruber, fasciculus longitudinalis dorsalis, and nucleus
oculomotorius. The article does not lend itself to the work of
abstracting, however; but the student of the subject will here find
adequate discussion on all the ganglia and paths of this important
section of the brain. S. A. K. Wilson.

THE NERVTJS TEBMINALIfl IN MAN AND MAMMALS. J. B.

(241) Johnston, Anat. Record , 1914, viii., April, p. 185 (9 figs.).

Thb telencephalic nervus terminalis, first described by Pinkus
(1894) for Protopterus annectem, has been found in other fishes,
amphibia, reptiles, and mammals up to Man. Johnston points
out that it is larger in man than in many fishes and amphibians.
Brookover suggested that it is vasomotor in function. Johnston
finds that its central relations are different from those of the
olfactory nerve. It is still uncertain whether all its fibres are
afferent or whether some or all rise in cells within the brain: in
the latter event they might be considered pre-ganglionic motor.
Johnston thinks that probably it contains both afferent and motor
components. He gives descriptions of it in pig, horse, sheep,
porpoise, monkey, and man (foetus at term, four months’ baby,

202

ABSTRACTS

and fourteen adult brains: it was present in all human adult brains
examined). It contains some medullated fibres in the case of the
sheep, horse, and monkey. Its independence of the olfactory
nerve is well shown by its presence and large size in the anosmatic
porpoise. Leonard J. Kidd.

THE NBRVU8 TERMINALIS IN ADULT MAN. C. Bbookoveb,

(242) Joum. Comp. Neurol., 1914, xxiv., April, p. 131.

This short paper may be compared with Johnston’s ( v. supra).
Most of the cells of the nerve are situated median to the olfactory
bulbs on the surface of the dura, or embedded within it as far
ventrally and peripherally as the cribriform plate. Its iutra-
cranial course, posterior to the olfactory bulbs, lies over the middle
of the gyrus rectus (figured). Leonard J. Kidd.

CORRELATED ANATOMICAL AND PHYSIOLOGICAL STUDIES

(243) OF THE NERVOUS SYSTEM OF AMPHIBIA (1. The
afferent system of the trunk of Amblystoma.) Q. E. Coon ill,
Joum. Comp. Neurol., 1914, xxiv., April, p. 161 (60 figs.).

The greater part of this paper deals with Coghill’s anatomical and
experimental studies of the dorsally situated, intraspinal ganglion
cells (the giant ganglion cells of Rohon and Beard) in early
embryos of Amblystoma before any perceptible dorsal roots from
spinal ganglionic anlagm can be seen. These giant cells and their
processes constitute the sensory column of the cord: their axons
pass cephalad, their dendrites peripherally to end in skin and the
myotomes. A single neurone of this system may innervate both
skin and muscle. Coghill shows that these cells and their processes
form an afferent conduction-path which, through the greater part
of its extent, if not through it all, is physiologically distinct from
the motor tract of the same side. It is an integral part of a reflex
mechanism which has the essential characteristic of the typical
reflex arc of higher vertebrates. He concludes that “the giant
ganglion cells are muscle sensory as well as skin sensory in
function.” Leonard J. Kidd.

A NOTE ON THE CIRCULATION OF THE CORNU AMMONIS.

(244) Samvel T. Obton, Anat. Record, 1914, viii., April, p. 199.

The author injected six brains to determine how great a factor
the blood from the carotid system of cerebral vessels plays in the
supply of the cornu ammonis and its associated structures. The
path of communication from the carotid system to the hippocampal
region is by a branch of the anterior choroid artery, which lias
been found to be of constant occurrence, though variable in size,

ABSTRACTS

203

and which reaches the uncus hippocampi, to which it gives
cortical branches, and then, as is apparent in the injected specimens,
deeply penetrates the white matter of the cornu for a variable
distance. Figures are given showing the distribution of an
unopposed injection of the anterior choroid artery in a brain
from a case of general paralysis, about three hours after death.

A. Ninian Bruce.

A COMMUNICATION AS TO THE CAUSATION OF LARGE
(24ft) VASCULAR GROOVES FOUND ON THE INNER ASPECT
OF THE OS PARIETALE. Bernard Coen, Joum. Anat. and
Physiol ., 1914, xlviii., April, p. 293.

Some of the large gutter-like grooves found in the inner aspect of
the skull are due to diploic venous tissue, which has come to the
surface by the erosion of the inner table of the skull. It is
possible that when there is only one large gutter-like groove
present the meningeal and diploic vessels may be contained in
the same groove.

The factors which produce these grooves are:—(1) large diploic
vessels to commence with; (2) some degree of venous engorge¬
ment ; and (3) an atrophying skull consequent on advancing age.

A. Ninian Bruce.

PHYSIOLOGY.

VITAL STAINING AND CHEMOTHERAPY. (Vitale F&rbung und
(246) Chemother&pie.) Professor Goldmann, Perl. Klin. Wchnsckr .,
1912, xlix., Sept 2, S. 1689.

Goldmann describes the result of some researches as a sequel to
his book on intra-vitam staining. Examining histologically the
animals that had been injected during life through the vena jug.,
he found the central nervous system quite free from stain except in
the plexus choreoideus of the lateral, the third, and fourth ventricles.
This discovery led him to think that perhaps the choroid plexus
plays an important part in the nutrition of the foetus. He finds
that glycogen is stored up in the choroid plexus, and from there
given out into the cerebro-spinal fluid from a very early period
of foetal life onwards.

With regard to the behaviour of the vital stains to the choroid
plexus, they were fouud here in the form of minute granules. The
cerebro-spinal fluid remains free except in the cases where toxic
doses have been injected, and Professor Goldmann thinks the stain
filters through in consequence of injury to the choroid epithelium.
This view is confirmed by the observations of Evans, who found

204

ABSTRACTS

the ganglion cells diffusely stained in a case of experimental
poliomyelitis in a vitally stained animal.

If the stain is injected directly into the cerebro-spinal fluid, it
has a toxic effect, and the animal has severe spasms, and rapidly
sinks into a comatose condition, and dies within three or four
hours. A histological examination shows diffuse staining of the
cord, and of the pedunculus cerebri The stain is found in the
nerve roots as also in the cerebral nerves. Throughout the whole
substance of the cord, including the ganglion cells of the anterior
and posterior cornua, the stain is found, and the nuclei as well as
the processes are affected. In Some parts the glia-cells are also
stained. These results show that the choroid plexus acts as a
protective membrane which prevents the entrance of substances
injurious to the nervous system, in the same way that the placenta
prevents the entrance of substances injurious to festal life.

Laura Forster.

THE CEREBRO SPINAL FLUID.-II. CEREBROSPINAL PRES-

(247) SURE. W. E. Dixon and W. D. Halliburton. Jovrn. Physiol.,
1914, xlviii., p. 128.

The authors here record a number of experiments in which the
torcula pressure, the arterial blood-pressure, and the cerebro¬
spinal pressure were recorded simultaneously, and the effect of
changes in one of these factors observed upon the others. They
show that the cranial contents can no longer be regarded as a
fixed quantity without the power of expanding or contracting in
volume. The cerebro-spinal pressure is influenced passively to a
small oxtent by changes in the arterial and venous pressures,
but such alterations are insignificant compared with the
independent changes in pressure which occur as the result of
secretory activity. Of all the conditions which influence the
cerebro-spinal secretion, the most important are deficiency of
oxygen and excess of carbon dioxide in the blood.

A. N ini an Bruce.

POLYURIA FROM EXPERIMENTAL LESION OF THE OPTO

(248) PEDUNCULAR REGION OF THE BASE OF THE BRAIN.
THE REGULATING MECHANISM OF THE WATER CON¬
TENT OF THE ORGANISM. (Polyurie par ltfsion de la rdgion
opto-pddonculaire de la base du cerveau. Mdcanisme rdgulateur
de la teneur an eau de l’organisxne.) J. Camus and O. Roussy,
Compt. Bend. >Soc. de Biol., 1914, lxxvi., May 15, p. 773.

From their further experiments on this subject in dogs the authors
give these conclusions: (1) In the opto-peduncular region of the
base of the brain, in the neighbourhood of the tuber cinereum,

ABSTRACTS

205

there is a nervous area, which remains to be accurately determined,
a lesion of which gives polyuria; (2) this area appears to be a part
of a mechanism which regulates the water-content of the organism.
Lesions of this region may give—possibly according to their extent
—either a polyuria with accompanying polydipsia, i.e., without
disturbance of this regulating mechanism, or without consecutive
polydipsia, it., with such disturbance; (3) in young animals this
regulating mechanism appears to functionate less perfectly than
in adults ; (4) of all the disturbances which we have attempted
to produce in the absorption and elimination of water, viz.,
injection of urea or glucose or sodium chloride or caffeine, water
diet, or puncture of the base of the brain, the last mentioned
procedure acts with the greatest intensity and the longest duration.

Leonard J. Kidd.

VASOMOTOR NERVES IN THE LUNGS. Enid M. Tribe, Journ.

(249) o/Phy$iol., 1914, xlviii., May 18, p. 154.

Mrs Tribe here continues her previous researches (v. Review ,
1913, xL, p. 28). Her experiments were performed, by a slightly
modified Brodie and Dixon’s method, mainly on cats, but also on
dogs, rabbits, rats, guinea-pigs, and a ferret. She concludes:
(1) All preparations of adrenalin, in amounts not less than
‘01 mgm., under normal conditions of pressure and temperature,
produce constriction of the pulmonary vessels. This constriction
iB followed by a dilatation, especially marked in cats; (2) the
minimum amount of adrenalin capable of producing constriction
is ‘01 mgm., but dilatation is obtained with only *00002 mgm.;

(3) the effects of adrenalin are due to action on the smaller
arteries and arterioles, not merely on the pulmonary artery itself;

(4) stimulation of the stellate ganglion produces slight vasomotor
effects; (5) after ergotoxin, the constrictor effect of adrenalin is
lost, only dilatation being produced; (6) the constriction is due
to vasoconstrictor nerves of sympathetic origin.

Leonard J. Kidd.

OBSERVATIONS UPON DECEREBRATE RIGIDITY. Lewis H.

(250) Weed, Journ. Phytiol., 1914, xlviii., p. 205.

A number of experiments on cats are recorded here which were
undertaken with the view that probably the cerebellum presents
an essential link in the reflex which occasions decerebrate rigidity.
Various portions of the cerebellum were removed after decerebrate
rigidity had set in, and the effects recorded. The effect of section
of the cerebellar peduncles and of different levels of the mid¬
brain were also examined.

The main reflex centre and, in that sense, the source of decere-

206

ABSTRACTS

brate rigidity, lies in the mid-brain, and is probably the nucleus
ruber. The cerebellum forms a very important, if not absolutely
essential, pathway for the afferent impulses from the limbs and
trunk, concerned in decerebrate rigidity. The cerebellum forms
an essential link in the inhibitory pathway from the cerebral
cortex. The localisations of the cerebellum, as far as can be
ascertained from study of the rigidities in the various extremities,
are not sharply circumscribed or very minutely differentiated.

A. Nin i an Bruce.

THE HYPOTENSIVE ACTION OF PITUITARY POSTERIOR LOBE

(251) EXTRACT ON THE PULMONARY CIRCULATION. (Sur
1'action hypotensive de l’extrait dn lobe postdrieur cThypophyse
sur la circulation pulmonaire.) L. Hallion, Com.pt. Rend. Soc. de
Biol., 1914, lxxvi., April 10, p. 581.

Hallion experimented on dogs, recording the carotid and jugular
pressure, and that of the pulmonary artery and veins. He con¬
firms the findings of Wiggers (1911) that pituitary extract acts
on the pulmonary circulation, and finds that intravenous injection
of posterior lobe extract produces constantly in dogs a fall of the
pulmonary arterial pressure. This fact, taken along with the
known blood-coagulating power of posterior lobe extract (Weil
and Boytf, 1909), justifies its therapeutic use in the haemoptysis of
pulmonary tuberculosis recently adopted by Rist and others.

Leonard J. Kidd.

ADRENAL DEFICIENCY AND THE SYMPATHETIC NERVOUS

(252) SYSTEM. R. O. Hoskins and Hombr Whselon, Amer. Joum.
Physiol., 1914, xxxiv., May 1, p. 172.

Authors’ conclusions: (1) Complete ligation of both adrenal
glands of dogs at a single operation causes, within four to six
hours, characteristic weakness of the skeletal muscles, including
those of respiration; (2) the weakness is shared to a marked degree
by the cardiac muscle; (3) at a time when cardiac weakness is
strongly in evidence, blood-pressure remains at or near its initial
height; (4) a compensatory activity of the vasomotor system
therefore occurs; (5) vasomotor responses to Faradic stimulation
of the crural nerve persist. The vasomotor reactions to adrenalin
also persist undiminished. The reactions to nicotine are often
somewhat exaggerated as compared with preliminary observations
under the same dosages; (6) the vasomotor system, therefore, as
well as the vascular musculature, are unimpaired at a time when
marked asthenia of skeletal and cardiac muscle has developed;
(7) this asthenia is sufficient alone to account for the final fatal
results of adrenal extirpation; (8) we find no evidence, therefore,

ABSTRACTS

207

that the sympathetic system suffers primarily in any degree from
adrenal extirpation. Leonard J. Kidd.

EFFECTS OF ADRENALECTOMY IN GUINEA PIGS. (Effets de la

(253) capeolectomie chez le cobay e.) A. Marie and V. Morax, Comj>t.
Rend. Soe. de Biol., 1914, lxxvi., May 8, p. 699.

Marie showed in the same journal (1912, lxxii., p. 804) that
adrenalin neutralises the toxines of tetanus and diphtheria in vitro.
The most important point in the present experiments is that after
complete bilateral adrenalectomy performed at two separate sittings
with an interval of eight days—a method which gives a prolonged
survival of guinea-pigs—inoculation with a dose of tetanus toxin,
which is inactive for the controls and for incompletely adrenal-
eetomised animals, provokes a perfectly definite local tetanus, a
fact which seems to confirm Marie’s results obtained in vitro.

Leonard J. Kidd.

FURTHER OBSERVATIONS ON THE CONSTRICTING ACTION

(254) OF ADRENALINE ON THE CEREBRAL VESSELS. Carl
J. Wiqokrs, Joum. Physiol., 1914, xlviii., p. 109.

Out of thirteen experiments upon the brain removed from the
skull, adrenalin constricted the cerebral vessels in eight cases.
In four no reaction occurred, and in one, which may have been
due to an accidental rupture of vessels, an increased flow per¬
manently followed. A. Ninian Bruce.

MECHANICAL STIMULATION OF THE COCCYGEAL GANGLION :
(255) A CONTRIBUTION TO THE PHYSIOLOGY OF THE SYMPA
THETIC NERVOUS SYSTEM. E. F. and R. V. Cyriax, Zeitschr.
f. allg. Physiologie, 1913, xiv., Hft., S. 14, p. 297.

The authors experimented on dogs, and exposed the coccygeal
ganglion lying on the first coccygeal vertebra. Stimulation of the
ganglion from the secondary of an induction coil produced con¬
traction of the circular fibres of the colon and rectum, the former
only at the lower part of the descending colon. If the sympathetic
nerves were cut immediately proximal to the ganglion, it was found
that stimulation of the latter was without effect on the gut.

The route by which the impulses reach the rectum from the
coccygeal ganglion does not seem clear. The authors believe that
in mechanical stimulation of the coccygeal ganglion in man they
have discovered a useful therapeutic measure in the treatment of
certain cases of chronic constipation. S. A. K. Wilson.

208

ABSTRACTS

18 POLISHED BIOS PLUS VITAMINS A COMPLETE FOOD?

(256) Casimib Funk, Jour *. Physiol 1914, zlviii, p. 228.

The result of experiments upon pigeons shows conclusively that
polished rice and vitamine constitute a complete food. There iB
no justification at present to accept the necessity of two different
vitamines, one for curing the nervous symptoms, and one for
maintenance of body weight. A. Ninian Bruce.

PSYCHOLOGY.

THE PROBLEM OF THE THINKING DOG OF MANNHEIM.

(257) William Mackenzie, Archiv. de Psychol., 1913, Dec., p. 312.

THE MANNHEIM DOG. J. Labguieb des Bancels and En. Clapar^de.
(268) Archiv. de Psychol., 1913, Dec., p. 377.

We have here a detailed account of a three days’ visit paid to
Rolf, the thinking dog of Mannheim, by W. Mackenzie. The dog
answers questions, by means of rapping out with his paw numbers
which stand for letters: he does simple sums, and he describes
pictures: he sometimes makes remarks spontaneously. The writer
was given ample opportunity to conduct experiments under condi¬
tions determined by himself, and he seems thoroughly satisfied
of the genuine nature of the dog’s performances. Rolf’s work is
distinctly more remarkable than that of the thinking horses
of Elberfeld: and, as Mr Mackenzie does not fail to point out, any¬
one can become possessed of a dog, so that it may reasonably be
hoped that the fame of Rolf’s achievements will lead to further
experimentation in the same direction.

MM. Larguier des Bancels and Clapar&de add a brief contribu¬
tion giving an account of their interview with the wonderful dog.
They agree with Mackenzie in regarding the good faith of his
mistress as beyond question; they unhesitatingly accept her state¬
ment that Rolf often gives facts in his answers of which she is
unaware, yet they suggest that his answers may be derived from
her in that he is the vehicle of her subconscious mind—that he is,
in a word, an animated planchette. This hypothesis they en¬
deavoured to test. Any evidence they give tends to discredit it,
but their investigations were stopped prematurely by the illness of
\be dog. Margaret Drummond.

ABSTRACTS

209

PATHOLOGY.

PARTIAL AGENESIS OF THE CORPUS CALLOSUM. (Un cm

(259) d’agta&ie paxtieUe da corps calleux.) Roubinovitch and Barb£,
Nouv. Icon, de la SalpStriire, 1913, Sept-Oct. p. 407.

A considerable number of cases of agenesis of the corpus
callosum have already been recorded. As a rule they have occurred
in association with idiocy. The authors describe the case of a boy,
aged 5, an idiot, who could neither speak nor walk. His
intelligence was nil, he was unable to feed himself, and took no
apparent interest in his surroundings. He died of broncho¬
pneumonia, and at the autopsy it was found that there was no
trace of a corpus callosum, properly speaking. Below the callosal
gyrus on each side was a deep depression. On making a horizontal
section of each hemisphere, however, immediately above the level
of the optic thalamus, the authors found a band of white matter
running along the mesial side of the lateral ventricles, and uniting
the frontal to the occipital lobes. Thus although no corpus
callosum was visible mesially, yet each hemisphere possessed a
callosal association system. The view is taken that the case
corroborates the opinion of Archambault, that in most cases of
so-called agenesis of the corpus callosum, the agenesis is really
partial, and concerns the actual commissure only.

S. A. K. Wilson.

IRON INFILTRATION IN THE FIXED AND WANDERING

(260) CELLS OF THE CENTRAL NERVOUS SYSTEM. D. J.

M'Oakthy, Amer. Joum. Med. Set., 1914, cxlvii., March.

A case of extensive haemorrhagic encephalitis in the cortex is
described. The iron reaction was not demonstrated in the cortical
ganglion cells, but was obtained in a striking way in the plasma¬
like cells of the pia arachnoid and in the elastic coats of the
smaller cortical arteries. D. K. Hrnderson.

CLINICAL NEUROLOGY.

THE SIGNIFICANCE FOR DIFFERENTIAL DIAGNOSIS OF
(261) BArANY’S POINTING-TEST. (Zur differential-diagnoatischen
Bedeutung des Bdrdny’schen Zeigeversuchs.) Rothmann, Neurol.
Centralbl., 1914, Jan. 2, p. 3.

It is now fairly well recognised that Bdrdny’s pointing-test,
utilised after rotation of the patient on a revolving chair or after
injection of water into the ear, is of very considerable value in

210

ABSTRACTS

revealing what otherwise may be practically a latent defect of
cerebellar function. It has been shown that the defect in pointing
to the examiner’s finger may affect a whole limb, or a segment of
the limb only, and that such local defects correspond strictly to
local disturbances in specified portions of the cerebellar cortex.
Bdr&ny has further stated that deviations in the pointing-test can
only be detected when voluntary innervation is possible, and also
that the cerebral cortex (and ? the rest of the cerebellar cortex)
can compensate for the failure of cerebellar innervation in a
particular direction: in such cases only the caloric test will bring
out the mispoiuting, and so indicate the cerebellar impairment:
there is no spontaneous mispointing. The question may therefore
be asked whether there may not be normally in the cerebral cortex
itself a mechanism for correct direction of limb movements, whose
impairment may lead to similar mistakes in pointing by the
B£r£ny tests. Rothmann describes the case of a patient of 28,
with a traumatic subpial hsematoma over the left supramarginal
gyrus, diagnosed and corroborated by operation. There was neither
motor nor sensory defect of the right arm, yet in pointing tests it
was found to be grossly defective. No cerebellar symptoms were
present except a slight subjective feeling of giddiness.

Rothmann discusses whether this impairment, confined to the
right arm, was due to involvement of the cerebellum or to
“ Fernwirkung ” on the opposite cerebellar hemisphere, or to the
lesion of the supramarginal gyrus alone. He inclines to the last
of these, and points out that it is the parietal region which is
concerned with the correlation of visual and ocular and spatial
sensations. He quotes a personal case in which, with a cerel>e!lar
tumour invading the cortex of the gyrus quadrangularis posterior
and semilunaris superior no pointing mistakes were discovered by
B&rdny’s tests, and attributes this absence to complete cerebral
compensation. S. A. K. Wilson.

NERVOUS DISEASES OF ELEMENTARY SCHOOL CHILDREN—
(262) BOVS AND GIRLS. J. Priestley, Brit. Joum. Child. Bis., 1914,
xi., p. 113.

In a table compiled from the records of 62,236 children aged from
5 to 14 years, who were medically examined during the period
1909-11, the writer shows that in functional disorders, boys and
girls are approximately equal, but in every other nerve complaint
including the more serious ones such as mental dulness and de¬
fect, stammering, paralysis, and epilepsy, there is a marked
preponderance among boys. J. I). Rolleston.

ABSTRACTS

211

HERPES AND ZOSTER OF DENTAL ORIGIN. (Herpes et son*

(263) d’origine denture.) L. Lempkrt, Theset de Parity 1913-14, No. 138.

Lempekt’s main conclusions are as follows:—

1. A violent but transitory alveolo-dental irritation such as
trauma or acute inflammation of the dental pulp may give rise
to herpes.

2. Prolonged irritation such as suppurative arthritis of the
jaw, alveolo-dental cyst, or cutting of a tooth in association with
other causes may give rise to zoster in a subject in a state of
unstable nervous equilibrium.

3. Zoster of this kind almost invariably occupies the domain of
the fifth nerve or cervical plexus. Exceptionally it is situated at
a distance. Ophthalmic zoster is due to lesions of the upper
canines and premolars. Cervical zoster is related to lesions in the
lower jaw.

4. Zoster of dental origin is preceded by a long neuralgic
phase which lasts for weeks or months. The eruption appears
on the side on which the irritation exists.

5. Zoster of dental origin belongs to the large class of non-
infective zosters in the production of which reflex mechanism plays
an important part (rf. Review, 1909, vii., p. 360; ibid., 1913,
xi., pp. 211 and 485).

The thesis contains the histories of twelve cases including an
original one of a woman who developed herpes of the left half of
the upper lip on the day following extraction of the second left
upper molar. J. D. Rolleston.

HERPES ZOSTER IN A PATIENT WITH SPINAL CORD SYPHILIS.

(264) H. E. Alderson, Joum. Cut. Dis., 1914, xxxii., p. 230.

In October 1912 a man who had contracted syphilis eight years
previously had paralysis of the right lower extremity with crossed
disturbance of sensibility. After treatment with salvarsan and
mercurial inunctions he was so far improved that in January 1913
he could walk without aid. In the following October he presented
typical herpes zoster in the area corresponding to the sensory
distribution of the right ninth and tenth dorsal roots.

J. D. Rolleston.

ON A CASE OF EARLY SPINAL SYPHILIS WITH BULBAR
(266) PHENOMENA. (A propos dun cas de syphilis mddollaire
prlcoce avec phfoomdnes bulbaires.) A. Legris and J. Benech,
Pari* mdd., 1913, iv., p. 315.

The writers describe a case somewhat similar to that reported by
one of them some years previously (v. Review, 1910, viii., p. 564).
A previously healthy man, aged 21, developed a chancre in

212

ABSTRACTS

January 1913, and at the end of February secondary ulceration
of the buccal and genital mucosae Three intravenous injections
of 0 - 30 gr. salvarsan were given, followed by grey oil, and the
symptoms disappeared. Towards the end of May he took to
motorcycling, and shortly afterwards began to suffer from pains
in the lumbar region and thighs. On admission to hospital a
month later the knee and ankle jerks were abolished, there were
definite ankle clonus, and constant jerkings of' the calf, thigh, and
recti abdominis muscles, and a few, days later of the muscles of
the upper limbs. Generalised secondo-tertiary skin lesions were
present. The cerebro-spinal fluid showed hypertension and very
marked lymphocytosis. On July 3 an intravenous injection of
0 30 gm. salvarsan was given. On the 8th he began to suffer from
dyspnoea without signs in the lungs, and on the 17th he developed
strabismus, diplopia, and slight nystagmus, followed by loss of
power in the upper limbs, difficulty of deglutition, and other signs
of labio-glosso-pharyngeal palsy, and loss of sphincter control. He
also had attacks of vomiting, and lastly delirium occurred. Larger
doses of neo-salvarsan were given intravenously, as well as
biniodide intramuscularly, and after the fifth dose of neo-salvarsan
and the seventeenth of biniodide, improvement began, and by the
middle of October the patient was able to carry out his military
service without ill effects.

The localisation of the infection in the spinal cord is attributed
to the use of the motor cycle. J. D. Rolleston.

BINASAL HEMIANOPSIA OCCURRING IN THE COURSE OF
(266) TABETIC OPTIC ATROPHY. Charles K. Heed and George
E. Price, Joum. Amer. Med. Astoc., 1914, Ixii., March 7, p. 771.

A man, aged 48, unmarried, complained of failing vision, slowly
progressing for the past three months, until now he cannot see to
do his work. There was no history of diplopia. The pupils were
unequal and did not react to light. Both optic papilla} presented
a decided atrophic pallor, and on examination with the perimeter
a clear-cut bi nasal defect was found.

The gait was normal, Romberg’s sign was present, but not
marked. No other cranial nerves were affected. The knee-jerks
were normal, but both Achilles jerks were lost. A lymphocytosis
was present in the cerebro-spinal fluid. The Wassermann reaction
was negative, possibly the result of treatment by mercury and
pot iod.

The authors believe the binasal defect in the visual fields to be
the result of a selective atrophy affecting the intracranial portion
of the optic nerves, and refer to the rarity of the condition.
Shoemaker collected 18 cases of binasal hemianopsia in 1905,

ABSTRACTS

213

and added his own. Since then only one more case has been
recorded, making, with this one, 21 in all. Of this series, in 3
neuroretinitis was present, in 2 traumatic optic atrophy, 2 were
optic neuritis from brain tumour, 2 were tabetic optic atrophy,
2 chronic interstitial optic neuritis, 2 secondary optic atrophy, 4
primary optic atrophy, and 1 traumatic optic neuritis.

A. Ninian Bruce.

A CLINICAL NOTE ON FIBROMA MOLLUSCUM GRAVIDARUM.

(267) R. L. Sotton, A trier. Joum. Med. Set., 1914, cxlvii., p. 419.

Sutton alludes to the recent papers by Hirst ( v . Review, 1911, ix.,
p. 570) and others, and records the following case of fibroma
molluscum gravidarum or Brinckner’s disease. The patient was a
woman, aged 38, above the average in intelligence, an unusual
occurrence in well-marked cases of fibroma molluscum. During
her first pregnancy about twenty pigmented pedunculated tumours
appeared on her neck and chest but shrivelled up shortly after
delivery, and three months later entirely disappeared. During her
second pregnancy a second crop appeared but many persisted.
Examination showed that the lesions were histologically identi ial
with those of fibroma molluscum (the neurofibroma of von
Recklinghausen). J. D. Rolleston

FIBROMA M0LLU80UM GRAVIDARUM. S. M. Bkincknbr, Amer.

(268) Joum. Derm., 1912, xvi., p. 240.

This condition which was first described by the writer in 1906 is a
lesion of the skin appearing in the latter half of pregnancy, bearing
the histological characters of fibroma molluscum, but differing from
it clinically in its almost total disappearance post partum. Its
distribution is limited to the neck, breasts, and submammary area.
The lesions are frequently but not always pigmented.

J. D. Rolleston.

ON PREROSEOLAR MENINGITIS. (Sur les mdningites prdroseoliques.)

(269) C. Audry and Lavau, Anti, de Derm, et de Syph., 1914, v., p. 29.

A man, aged 25, had noticed a chancre on the penis for about
a month, but showed no eruption. Wassermann’s reaction was
positive in the blood, but negative in the spinal fluid which was
clear, under hypertension, and showed a well-marked lympho¬
cytosis. 0*60 areenobenzol and 10 cgm. of mercury were injected.
The same evening he had headache and nuchal rigidity, and
the following morning vomiting and Kernig’s sign. Within a
fortnight the symptoms subsided. Two more injections of 606
were well borne. A second lumbar puncture, three weeks after the

214

ABSTRACTS

first, showed a clear fluid still under hypertension, and with
increased lymphocytosis. Wassermann’s reaction was negative.
No eruption had appeared. A similar case was recently reported
by Achard and Desbouis ( v . Review, 1913, xi., p. 38).

J. D. Rolleston.

ON ASEPTIC REACTIONS OF THE MENINGES AND THEIR
(270) DIAGNOSIS. (Sur les reactions aseptiques des mdninges et leur
diagnostic.) J. Eoziebe, Paris mid., 1913*14, iv., p. 89.

The symptoms may be very incomplete or indicate nervous dis¬
turbance without meningeal localisation. As a rule, however,
there are signs of meningeal involvement which suggest tuberculous
or cerebro-spinal meningitis. Acute symptoms are usually of short
duration, and subside soon after lumbar puncture or spontaneously.
Occasionally sequelm have been observed such as deafness, or more
or less extensive paralysis.

Lumbar puncture gives issue to a fluid which is sometimes clear,
but often turbid and very frequently has the appearance of pus,
from which it is distinguished by being aseptic, and by the absence
of degeneration in the polymorphonuclear cells. The cerebro-spinal
fluid shows no excess of albumin, but an increase of sugar.

The syndrome is caused by meningeal congestion usually due
to toxic irritation such as uraemia, alcoholism, the toxaemia of
pregnancy or an acute lesion in the neighbourhood of the meninges
such as otitis, cerebral haemorrhage, or abscess. Puriform cerebro¬
spinal fluid is also found in insolation, influenza, pneumonia, and
syphilis, and in chronic diseases of the nervous system such as
tabes and general paralysis. J. D. Rolleston.

MENINGITIS IN MUMPS. (Les m&xingites ourliennes.) G C. Roux,
(271) Gaz. des Hop., 1914, Ixxxvii., p. 549.

Meningeal symptoms are very frequent in mumps, but typical
meningitis is rare. Roux 6aw only three examples among 274
cases of mumps admitted to the Claude Bernard Hospital in 1912.
As a rule it occurs at the height of the disease, 3 to 8 days after
the onset, but it may occur earlier, and even precede the parotid
swelling. There is almost always intense spinal lymphocytosis.
The symptoms usually subside rapidly and do not last more than
5 to 6 days.

An attenuated meningeal syndrome is much more frequent
than typical meningitis. It may occur at the onset or precede
the parotid swelling. The symptoms arq severe headache, vomit¬
ing, slight nuchal rigidity and rise of temperature. As a rule
they do not last longer than from 24 to 48 hours. Sometimes

ABSTRACTS

215

they are merely represented by bradycardia and spinal lympho¬
cytosis. The frequency of lymphocytosis in mumps is shown by
Roux having found it in 31 out of 67 cases on whom he performed
lumbar puncture. As a rule it is discrete, but it may be
abundant, and vary from 50 to 300 lymphocytes in a field.

Two theories have been put forward to explain the existence
of meningitis in mumps. 1. Meningitis is a manifestation of
the septicemia of the disease like the other complications of
mumps, especially orchitis, with which it is frequently associated.
2. Meningitis is an extension of the local inflammatory process
which precedes the parotitis. Chautt'ard holds that there is a
direct propagation of the infection of mumps to the basilar region
of the pharynx and perivascular lymph sheaths.

J. D. Rolleston.

ON THE OEBBBRAL COMPLICATIONS OF WHOOPING COUGH.
(272) WITH SPECIAL REFERENCE TO " PACHYMENINGITIS
PRODUCTIVA INTERNA.’’ (Uber die Gehirnkomplikationen
des Keuchhustens mit besonderer Berttckaichtigung der “ Pachy¬
meningitis productiva interna.”) B. Hada, Virchows Archiv ,
1914, ccxiv., p. 216.

A MALE infant, aged 14 months, was taken ill with a cough and
a fortnight later had four typical attacks of whooping with a
severe convulsion and collapse on the same day. Four days later
left otitis media developed, but both it and the cerebral symptoms
soon subsided. On the 76th day left hemiplegia occurred, and on
the 158th day erysipelas which was followed in a few days by
signs of severe meningitis, and death took place on the 168th day.

The necropsy showed purulent leptomeningitis with marked
external hydrocephalus, old pachymeningitis productiva interna,
extensive softening of the cerebral cortex especially on the right
side, and right otitis media. No bacteria were found.

The clinical symptoms showed that the acute leptomeningitis
and associated encephalitis were in no way connected with whoop¬
ing cough, but were caused by intercurrent erysipelas or otitis
media.

On the other hand the pachymeningitis and pressure atrophy
of the cerebral cortex which had given rise to hemiplegia probably
dated from the convulsion observed on the 14th day.

A review of the literature is appended in which it is stated
that the only clear case of pachymeningitis productiva interna
following whooping cough has been reported by Reimer. ( Jnhrb .
/. Kinderhcilk., 1876, x.).

Hada regards toxic or bacterial causes as responsible for the
various cerebral complications of whooping cough, and as able to

216

ABSTRACTS

produce various inflammations such as encephalitis, meningo¬
encephalitis, lepto-meningitis, and pachymeningitis, which frequently
assume a haemorrhagic character. J. D. Rolleston.

BRAIN ABSCESS CAUSED BY FUSIFORM BACILLI. G. F. Dick

(273) and F. A. Emge, Joum . Amer. Med. Assoc ., 1914, hdi., p. 446.

The writers allude to a previous paper by one of them (t>. Review,
1913, xi., p. 626), and report a fatal case in a man, aged 40, with
an abscess occupying the left frontal, temporal, and parietal lobes.
A pure culture of fusiform bacilli was obtained, and injection of it
into the brain of a rabbit was followed by convulsions in twelve
hours, and in thirty-six hours by paralysis of all four extremities
and death. J. D. Rolleston.

A CASE OF BRAIN ABSCESS. Cecil E. Reynolds, Joum. Amer.

(274) Med. Assoc., 1914, Ixii., Feb. 7, p. 449.

A MAN was taken ill during the night with headache and nausea.
These passed off, but his speech became indistinct, and mental
excitement was noticed. Severe headache and sleeplessness
developed, with slight weakness of his right arm. Pulse dropped
to 50. Five days later the pain was localised to the left side of
the head, and commencing optic neuritis on the nasal side of each
disc was noticed. On trephining, the cortex was darker than
nonnal, and the vessels swollen. Exploration deep into the
lenticular nucleus disclosed a cavity the size of a walnut filled
with thick, ill-smelling pus. This was drained, and a tube left
in situ. He began to improve, but became later comatose, and
died thirteen days after the operation. There were found at the
autopsy two abscess cavities side by side in the white matter of
the angular and intraparietal lobes, each about the size of half
a walnut. No sign of ear or nose disease was present The
organisms were the bacillus of influenza and Staphylococcus
aureus (cf. Review , 1913). A. Ninian Bruce.

PNEUMONIC HEMIPLEGIAS. C. F. Withington, Amer. Joum.

(275) Med. Set., 1914, cxlvii., February.

Cerebral accidents in pneumonia may be divided into two
classes:—

1. Those caused by gross anatomical lesions, such as meningitis
of pneumococcus origin, thrombosis, embolism, abscess, &c.

2. Those occurring in young, rather vigorous people, and having
a better prognosis than those cases belonging to the first group.

Four principal explanations have been advanced for the hemi-

ABSTRACTS 217

plegias belonging to this second group: (a) encephalitis, (b)
hysteria, (c) circulating organisms, ( d ) circulating toxins.

Pneumonic hemiplegia occurring without gross lesion is not
common, but usually appears about the second or third day from
the onset of the pneumonia.

Four cases are reported. D. K. Henderson.

A DEFECT IN INNERVATION OF THE FACIAL NERVE FROM
(276) TUMOURS OF THE POSTERIOR FOSSA (Uber sine Sttfnmg
der Innervation das N. facialis bei OeschwUlsten der hinteren
SchEde lgm be.) Lasarew, Neurol. Cenlralbl., 1914, Jan. 2, p. 13.

The author describes four cases of cerebellar tumour in which a
dissociation of function in the homolateral facial nerve was
observed. There was paresis of the lower face both for voluntary
and involuntary movements, with overaction on voluntary innerva¬
tion of the upper face. By asking the patient to open his mouth
and simultaneously to look up, the author was able to demonstrate
readily this dissociation. He offers no definite explanation of the
mechanism of this disturbance of innervation, but discusses several
possibilities. S. A K. Wilson.

TUMOUR OF THE MIDDLE CRANIAL FOSSA, INVOLVING THE
(277) GASSERIAN GANGLION. W. A Plummer and O. B. New,
Joum. Anver. Med. Assoc., 1914, lxil, April 4, p. 1062.

The patient was a man, aged 21. No evidence of tubercle or
syphilis. Three enlarged upper cervical glands had been discovered
on the right side of the neck twenty-one months previous to
examination. Three months later pain developed anterior to the
right ear, and the glands were excised but not examined micro¬
scopically. The pain soon became constant, with intermittent
tic-like paroxysms over the entire distribution of the fifth nerve.
These paroxysms occurred once or twice a day, and lasted from a
few minutes to an hour. Momentary attacks of diplopia and
indefinite objective vertigo were complained of. Deep alcoholic
injection of the branches of the fifth nerve gave some relief for
a week. On careful examination no symptoms of general intra¬
cranial pressure such as headache, vomiting, choked disc, &c.,
could be found. He was somewhat dull and apathetic, and
answered questions slowly. There were, however, definitely
localising signs, viz., anaesthesia of the first and second divisions
of the right fifth nerve and hypesthesia of the third division.
The sense of taste was absent from the right anterior portion of
the tongue, there was partial paralysis of all the right extrinsic

218

ABSTRACTS

eye-muscles with a nearly complete ptosis, a large immobile right
pupil and pallor of the right optic nerve-head. Possibly the
alcohol injection was responsible for at least part of the anaesthesia.

An operation by the Hartley-Krause method exposed a hard
mass below the right temporal lobe. Its extent could not be
determined, and removal was impossible. It proved to be a small
round-cell sarcoma. The patient died a few months later.

A. Ninian Bruce.

ON THE COMBINATION OF CRANIAL HYPEROSTOSES AND
(278) CEREBRAL TUMOURS. (Ober die Kombination yon Sch&del-
hyperostosen und Hirngeschwtilsten.) Schlesinger and
Schuller, Neurol. Centralbl. , 1914, Jan. 16, p. 82.

The authors record a fresh case of the type where a bony cranial
tumour corresponds exactly to an underlying meningeal or cerebral
tumour. The patient presented the general symptoms of intra¬
cranial growth without a single localising sign. An X-ray
photograph showed an osteoma the size of a hazel nut in the
right frontal sinus. The patient died from an intercurrent
affection, and a glioma, the size of a small apple, was found in the
right frontal lobe, situated exactly opposite the frontal osteoma.
The meninges were normal: the osteoma did not bulge into the
general cranial cavity. S. A. K. Wilson.

DIABETES INSIPIDUS AND INFANTILISM. (Di&bdte insipid® et
(279) infantilism®: rfile probable de l’hypophyse.) Lereboullet,
Faure-Beaulieu, and Vaucher, Nouv. Icon, de la SalpStribe, 1913,
Sept-Oct., p. 410.

The patient was a young man of 24, who developed normally up
to the age of 14, when he sustained a shock from involuntary
immersion in water. Shortly after he began to pass 7 or 8 litres
of urine daily, and at the same time suffered from polydipsia.
Neither sugar nor albumin was present in the urine. At the age of
16 the patient’s teeth all dropped out in the course of a few months
as the result of painful ulceration of the gums. A year or two
later generalised eczema of severe type appeared and proved very
intractable. On examination the youth was found to present well-
marked signs of infantilism. There was no hair on face or pubes,
and only one or two sparse hairs in the axillae. His voice had not
“ broken.” There was atrophy of the testicles and penis. The
sella turcica appeared to be of normal size and appearance in a
radiogram. There were no visual or ocular symptoms. Under
observation the patient often passed as much as 10 litres of limpid
urine in the twenty-four hours. Hypophyseal, thyroid, testicular,

ABSTRACTS

219

and pancreatic extracts were all given a trial without much result.
For somewhat inadequate reasons the authors attribute the
symptoms to defect of function of the pars intermedia of the
hypophysis. S. A. K. Wilson.

OXYCEPHALY AND THE OXYCEPHALIC SYNDROME. Charon

( 280 ) and Courbon, Nouv. Icon, de la Salpetribre , 1913, Sept.-Oct, p. 422.

The authors describe the cases of two male idiots presenting the
characteristic cranial features of oxycephaly. One had also a
degree of exophthalmos, but no other ocular symptoms. Both had
suffered from rachitis, while neither showed any recognisable
defect of function of the endocrinous glands. The authors discuss
and dismiss as unsatisfactory both the rachitic and the glandular
theories of oxycephaly. The idiocy suggests an early meningitis.

S. A. K. Wilson.

A CASE OF PROGRESSIVE FACIAL HEMIATROPHY. Grabs,

(281) Neurol. Centralbl., 1914, Jan. 16, p. 85.

This was a typical and advanced case of this rare affection, in
a man of 32, who died from a pulmonary affection. A complete
pathological examination was made, including the superior cervical
sympathetic ganglion, the Gasserian ganglion, the branches of the
trigeminal, the pons and medulla from the nucleus of the third
to the nucleus of the twelfth. No difference between the two
sides was found. This is the third recorded case where a patho¬
logical investigation was made, and it shows apparently that
progressive facial hemiatrophy occurs without recognisable changes
in the central, peripheral, or sympathetic nervous system. Un¬
fortunately the facial muscles were not examined.

S. A. K. Wilson.

THE DIAGNOSIS OF CEREBRAL HAEMORRHAGE BY MEANS

( 282 ) OF LUMBAR PUNCTURE. Ouvrr ;P. Bigelow, Cleveland
Med. Jovm., 1913, xii., April, p. 265.

Cerebral haemorrhage can be detected by examination of the
spinal fluid in about 90 per cent, of cases if the examination be
made within three weeks after the “ stroke.” For the first four
days or so there is a cloudiness or bloodiness of the fluid of
varying degree, depending on the amount of blood which has
escaped. Then a colour, due to haemoglobin, varying from light
canary-yellow to reddish-brown, appears and persists in some
degree for about three weeks. After that time our only guide
in the spinal fluid is a probable persistence for some time of a
slightly elevated cell count and proteid content.

A. Niuian Bruce.

220

ABSTRACTS

ON A CASE OF MUSCULAR ATROPHY FROM LEAD POISON

(283) ING. (Su di un cmo di atrofla muscolare di intossicasione
Batamina.) A. Scudkbi, Riv. ital. di Neurop., Psychic tr. ed
Elettroter., 1913, vi., p. 560.

The ner\ r ous complications of plumkism are extremely rare in
Sicily, this being the first case that has occurred in Prof.
d’Abundo’s clinique at Catania since its opening in 1894. The
patient was a man, aged 54, employed in a colour factory where
much lead was used and predisposed to nervous disease by having
had an alcoholic father.

For ten years he had suffered from lead colic, and for some years
had had gradually increasing weakness in the hands.

On admission the lesions were those of chronic poliomyelitis,
the muscles of the scapula and pectoral regions, forearm, hands, and
antero-external aspects of the legs being atrophied. The disease
was arrested, and slight improvement occurred on the patient
giving up his work and submitting to iodide and electrical treatment.

J. D. Rolleston.

THE SUPPOSED RELATION BETWEEN PARALYSIS AGITANS

(284) AND INSUFFICIENCY OF THE PARATHYROID GLANDS.

1. Geeen wald, Arner. Joum. Med. Set., 1914, cxlvii., February.

In experiments with dogs the author has shown that after para¬
thyroidectomy there is a marked diminution in the excretion of
phosphorus. This persists until tetany appears, and even longer.
Analyses of the blood and serum of parathyroidectomised dogs show
a decided increase in the content of phosphorus above the normal.

It was argued that if parathyroid insufficiency is a factor in
the etiology of paralysis agitans, then a similar increase in the
amount of acid-soluble phosphorus would be found in the blood
serum of patients with paralysis agitans.

In comparing the blood serum of patients with paralysis
agitans with the blood serum of other individuals, results were,
however, obtained that do not support the view that parathyroid
insufficiency plays a rdle in the etiology of paralysis agitans.

D. K. Henderson.

NUCLEINOTHERAPY IN PARALYSIS AGITANS. (La nucleino

(285) thfeapie dans la maladie de Parkinson.) I. N. Buia, Compt. Rend.
Soc. de Biol., 1914, lxxvi., March 27, p. 607.

Hypodermic and intravenous injections of a freshly prepared solu¬
tion of nucleinate of soda were tried on five cases of paralysis
agitans. The former improved symptoms, but failed to raise the
temperature above 38° C. The latter gave much better results,
and raised temperature to 39 8°: its fibrile reaction lasted about

ABSTRACTS

221

four hours, and showed a short cold stage with violent shivering
and marked trembling, a longer hot stage with calmness and
lessened rigidity and tremor, and a stage of slight sweating. Two
patients, bedridden for two years, walked up and down stairs
after treatment. Intravenous injections give euphoria, greatly
improved sleep, psychical benefit lasting for days, lessening of
tremor, and increased power dynamometrically. Particulars of
dosage and frequency of injections are given.

Leonard J. Kidd.

TWO DEATHS DDE TO SUPRARENAL INSUFFICIENCY. (Zwei
(286) Todeadtlle infolge von Nebenniereninsufflciens.) J. Hobnowskj,
Virchows Archiv, 1914, ccxv., p. 270.

Case 1 . —Woman, aged 38. Sudden death during parturition.
Post mortem, all the organs were found to be normal except the
suprarenale. The cortex showed -no marked changes, but the
medulla was very thin, the blood vessels were dilated, and more or
less extensive haemorrhages were found. Death was attributed to
insufficiency of the chromaffin system.

Case 2.—Man, aged 52. Death twenty-four hours after an
operation under chloroform for removal of cancerous glands in the
groin. Both suprarenals consisted almost entirely of scar tissue
and showed endarteritis obliterans, probably the result of syphilis.
The thyroid presented marked increase of glandular epithelium
similar to that found in Graves’ disease. J. D. Rolleston.

THE SYNDROME OF XANTHOCHROMIA AND COAGULATION
(287) BN MASSE OF THE CEREBRO SPINAL FLUID. (Snr le
syndrome de la xanthochromie et de la coagulation massive du
liquids cdphalorachidien .) Mabinesco and Radovici, Nouv. Icon,
de la Salpetriere, 1913, Nov.-Dee., p. 484.

In an interesting paper the authors report four new cases of
disease of the spinal cord, in which the cerebro-spinal fluid was
characterised by xanthochromia and massive coagulation. Most
recorded cases have been cases of paraplegia, with a lesion towards
the lower part of the cord. Some cases have been spastic, others
flaccid: some acute, others chronic. Speaking generally, the
clinical types in which this syndrome may occur are meningo-
myelitis, compression of the cord, ascending paralysis, and a
generalised meningitis. The fluid has a yellow coloration, and
coagulates as a rule spontaneously, while its cytological content is
quite insignificant. It is highly albuminous: fibrinogen and fibrin-
ferment are present. The pathological anatomy of such cases is
a morbid process invading the subarachnoid spaces, and thus to

222

ABSTRACTS

some extent isolating a portion of the fluid. The xanthochromia
is the result of the penetration of blood pigment into the sub¬
arachnoid spaces, pigment derived from haemoglobin, and probably
of the nature of urobilin. In these cases Gmelin’s test is frequently
positive. The pathogenesis is perhaps a series of minute and
repeated meningeal haemorrhages. The derivation of the fibrinogen
and fibrin-ferment (normally absent from the cerebro-spinal fluid)
is from the blood, inflammation or other pathological process
having impaired the integrity of the subarachnoid endothelium.
It may Ire supposed that minute meningeal haemorrhages set free
fibrinogen, and that it is passed by diosmosis via the colloids of the
cellular membranes. In the case of tumours it has been supposed
that toxins irritate the vascular surfaces, and that fibrinous
exudation is favoured by the stasis of the fluid.

S. A. K. Wilson.

THE LUETIN CUTANEOUS REACTION FOR SYPHILIS. Alson
(288) R. Kilgore, Joum. Amer. Med. Asnoc., 1914, lxii., April 18, p. 1237.

Those who have reported results with the luetin reaction are
practically agreed it is valueless in primary and secondary un¬
treated syphilis, and is of value only in the later stages. When
positive it is highly specific for syphilis.

The author, using Noguchi’s luetin, performed 150 tests in 120
cases, of which 36 cases were syphilitic and 84 were controls. All
the control cases gave negative reactions except two cases of
tubercular joint disease, which left hospital before the result of a
therapeutic test for syphilis could be observed. Of the 36 syphilitic
cases, 22 were of the tertiary and latent type. Of these 14 were
positive to the luetin test, i.e., 64 per cent., and 18 positive to the
Wa88ermann reaction, i.e., 80 per cent.; 12 were cases of cerebro¬
spinal parasyphilis, and of these 5 were positive to the luetin test,
i.e., 42 per cent., and 9 to the Wassermann reaction, i.e., 75 per
cent. The remaining two were congenital syphilis, and neither
reacted to the luetin test, while one gave a positive Wassermann
reaction.

Of 13 control cases none reacted positively on second inocula¬
tion. Of 15 luetic cases giving negative reactions, 5 gave positive
reactions on second inoculation. In 2 cases the second injection
gave a doubtful reaction.

The Wassermann reaction is thus positive in a higher percentage
of cases of late syphilis than is the luetin. The value of the luetin
reaction appears in the small number of cases of syphilis in which
it is positive, while the Wassermann is negative (4 out of 36 cases)

A. Ninian Bruce

ABSTRACTS

223

THE WAS8BRMANN REACTION IN THE BLOOD IN OASES OF
(288) ALKAPTONURIA. Soderbergh, Neurol. Centralbl. , 1914,

Jan. 2, p. 24.

In a patient with ochronotic osteitis deformans the blood gave a
positive Wassermann reaction. After a month’s mercurial treatment
the reaction was negative. The author began to doubt the
specificity of the reaction in this particular case, because of the
alkaptonuria. Accordingly, as tyrosin is known to increase
the quantity of homogentisinic acid in the urine, the patient
received 5 gm. of tyrosin at intervals of two hours to a
total of 15 gm. In less than twenty-three hours his completely
negative Wassermann reaction had changed into a strongly
positive one. S. A. K. Wilson.

OBSERVATIONS ON A STRAIN OF SPIROCH/ETA PALLIDA

(290) ISOLATED FROM THE NERVOUS SYSTEM. Henry J.
Nichols, Joum. Exp. Med., 1914, xix., April, p. 363.

Our knowledge of Spirocluda pallida is now entering on the stage
of differentiation of strains, and the author records a strain which
he isolated from the nervous system of a patient with definite
primary and secondary symptoms. The nervous system was con¬
sidered to have been invaded during the early secondary period,
and the patient would probably have suffered from nerve syphilis
later. The strain was obtained from the spinal fluid and showed
the following constant characters: (1) Thick form, (2) the pro¬
duction of hard, well-demarcated lesions with necrotic centres,
(3) characteristic location of the lesion, (4) short incubation period,
and (5) a tendency to generalise with lesions of the skin and eye,
following local inoculation of the testicle and scrotum.

It is suggested that these characters constitute a definite strain
of highly invasive power, and that a classification of members of
the pallida group may be made in accordance with this power.

A. Ninian Bruce.

THE TECHNIC OF THE INTRADURAL INJECTIONS OF NEO-

(291) 8ALVAB8AN IN SYPHILIS OF THE NERVOUS SYSTEM.

Uno J. Wile, Joum. Amer. Med. Assoc., 1914, lxii., April 11, p. 1165.

Injections of cocain for spinal anaesthesia may be followed by
vomiting, fever, headache, neuralgia, and troubles of micturition.
This was at first attributed to the cocain itself, but it was later
found that this resulted from an aseptic, sterile meningitis. A
watery solution, which was not isotonic, could produce meningeal
irritation, and by substituting cocain in isotonic solution, no
18

224

ABSTRACTS

harmful results followed. Later it was found that hypertonic
concentrated solutions acted even better.

The author, accordingly, uses a 6 per cent, solution of neo-
salvarsan in freshly distilled water. This solution is hypertonic,
and each drop contains 3 mg. of neosalvarsan. The dose injected
is from 3 to 12 mg., i.e., from 1 to 4 drops of the solution. The
patient is placed in the Trendelenburg position for at least an
hour after the injection to allow diffusion to take place. By this
method vomiting is eliminated. A little headache and neuralgia
may result. A. Ninian Bruce.

THE TREATMENT OF SYPHILITIC DISEASES OF THE CENTRAL
(292) NERVOUS iSYSTEM RY INTRAVENOUS INJECTIONS OF

SALVARSAN. Lesley H. Spooner, Boston Med. and Surg.

Journ., 1914, clxx., March 26, p. 441.

The author records a number of cases of syphilis of the central
nervous system satisfactorily treated by intravenous salvarsan in
an ambulatory clinic. As the patients had to go home after
the injection it was thought wise to give only 0-3 gm. salvarsan.
With the exception of six cases subsequently placed on serum
treatment, symptomatic improvement resulted in many cases of
tabes, and in all cases of cerebro-spinal syphilis. No distinct
improvement took place in a few cases of general paralysis. The
most striking improvements followed the first or second injection.
Reactions were infrequent. The most pronounced successes are in
those who show evidence in blood or spinal fluid of intense
syphilitic infection. The failures occurred in those showing
feeble reactions. Phthisis seems worthy of consideration as a
contra-indication. A. Ninian Bruce.

SALVARSANIZED SERUM (“SWIFT-ELLI8 TREATMENT”) IN
(293) SYPHILITIC DISEASES OF THE CENTRAL NERVOUS
SYSTEM. James B. Ayer, Boston Med. and Surg. Joum., 1914,
clxx., March 26, p. 462.

The author records the results of this method of treatment in 18
cases. Eight were cases of tabes, 4 of which were active and of the
lower spinal cord type. One of these showed no change after five
injections, the other 3 improved, 2 of which had failed to respond
to any other method of treatment. Of 2 cases of tabes of some
twenty years’ duration, improvement was found in 1 case, and in
2 cases where optic atrophy was marked, 1 was unaffected and the
other seemed to become stationary.

Four cases of early general paralysis, in 2 of which the diagnosis

ABSTRACTS

225

was doubtful, showed little improvement. A fifth case, called
"latent nerve syphilis," showed some improvement after four
injections.

The remaining 5 cases were of active cerebro-spinal syphilis,
and all improved as regards symptoms, signs, and laboratory tests.

The author considers this treatment reacts best in cerebro¬
spinal syphilis, in which a cure may be looked for in some cases
with persistent treatment. The next best effect is found in tabes
in which the disease may be arrested, and is least effective in well-
developed general paralysis. The keynote to success is persistence
in using this method of treatment. A. Ninian Bruce.

THE INTBABPINAL INJECTION OF SALVARSANIZED SEBUM
(294) IN PARESIS. J. A. Cutting and C. W. Mack, Jonm Amer.

Med. Assoc., 1914, Ixii., March 21, p. 903.

Seven cases are here recorded with two controls. The earliest
case of the series was of five months’, and the most advanced of
three years’ duration. They were all in the second stage of the
disease, and none were paralytic. None had a remission before
treatment. The injections were given at intervals of two weeks
until each patient had received three injections. A cerebro-spinal
fluid examination was made, and Wassermann reactions determined
before the beginning of the treatment, and at the time of injection
blood and fluid were taken for subsequent examination. In all
cases salvarsan was taken in preference to neosalvarsan. Very
few severe reactions followed the administration of the salvarsan.
There was no reaction following the spinal injections.

The cases are described at length. The neurological findings
show no marked alteration following the treatment. The mental
symptoms did not improve much except in one case. The Wasser¬
mann reaction was altered in two cases. The Noguchi butyric
acid test remained positive. The most striking result was a
reduction in the cell-count, the original counts, which were all
very high, showing marked reduction following each injection of
salvarsanized serum. A. Ninian Bruce.

INTRASPINOU8 TREATMENT (SWIFT ELLIS) OF GENERAL
(290) PARALYSIS: a preliminary note on four cases treated by this
method. Edward MAPOTHERand Thomas Beaton, Lancet, 1914,
clxxxvi., April 18, p. 1103.

The technique used was briefly as follows: (1) The intravenous
injection of 300 c.c. normal saline containing 0 - 4 gm. salvarsan
neutralised with caustic soda. (2) One hour later 40 c.c. of blood

226

ABSTRACTS

were removed and centrifugaiised, and 12 c.c. of the serum obtained
was diluted with 18 c.c. of normal saline, the mixture being then
heated for half an hour at 56° C. (3) The intraspinous injection,
after removal of an equivalent quantity of cerebro-spinal fluid, of
the 30 c.c. of this diluted serum prepared as above. The whole
process was repeated four times at intervals of two weeks.

The reaction immediately following the treatment was slight
and diminished in severity with each repetition, the symptoms
noted being vomiting, dizziness, slight pain in the head, neck,
back, and legs. The occurrence of these, however, was not constant.

The changes in the mental state have not been strikingly
favourable. The changes iu the physical signs are not very
marked, and not different from such as commonly accompanies
states of remission in the ordinary course of the disease. The
quantitative estimation of the Wassermann reaction in both blood
and cerebro-spinal fluid showed no change whatever. The author
concludes that there is little ground for the generally hopeful
attitude adopted in regard to this treatment.

A. Ninian Bruce.

THE TREATMENT OF TABES DORSALIS AND GENERAL
(296) PARESIS WITH S ALVARS AN. Gordon Bates, George S.
Strathy, and C. S. M'Vioar, Canadian Med. Atsoc. Joum., 1914,
iv., March, p. 197.

Of six tabetics improvement took place in all. Two of the cases
are reported, and in each the lightning pains were markedly
increased after the injection, but, ultimately, they and other
symptoms largely disappeared. The results in four paretics were
encouraging. The best effects were obtained from intensive treat¬
ment, i.e., one or two full doses per week. A. Ninian Bruce.

PSYCHIATRY.

ON ATTEMPTS AT SPECIAL SEROTHERAPY IN GENERAL
(297) PARALYSIS. (8ui tentativi di speciali sierotherapie nella
par&lisi generals progressiva.) G. d’Abundo, Riv. ital. di Neuro¬
pat., Ptichiatr. ed Elettroter., 1914, vii., p. 1.

After alluding to a recent communication by Levaditi, Marie and
de Martel to the Society de Biologie on the treatment of general
paralysis by injections of salvarsanized serum beneath the cerebral
dura mater, d’Abundo refers to a paper read by him at the
Psychiatric Congress of Naples in 1899, in which he related how
the serum of general paralytics injected hypodermically into

ABSTRACTS 227

patients in a less advanced stage of the disease, exercised a
sedative effect.

The paper concludes with remarks on the prophylaxis of
syphilis, in which the writer recommends that male visitors to
houses of prostitution should be examined, and that only those
should he admitted who were free from syphilis and other venereal
diseases. J. D. Rolleston.

CIVIL CAPACITY IN REMISSIONS FROM GENERAL PAR

(298) ALYSIS. (La c&pacita civile nelle remissioni della paralisi
generate progressiva.) A. Cbistu.ni, Riv. ital. di tfeun>pat. f
Plichiatr. ed Elettroter., 1914, vii., p. 24

The patient was a man aged 42, the head of a rich industrial
concern, who had contracted syphilis at 21. General paralysis
took on a severe course, and after it had lasted three years, bed¬
sores developed, the temperature became raised, and the patient
appeared moribund. Improvement, however, took place, and
finally only trivial somatic and psychical residues were left. At
the time of writing, the remission had lasted 7 years, and the
patient had resumed his work for 4 years. Other cases are on
record in which the remissions have lasted 9, 12, 14, 19, 20, 21,
and 25 years. J. D. Rolleston.

CORRELATIONS OF CEREBRO SPINAL FLUID EXAMINATIONS

(299) WITH PSYCHIATRIC DIAGNOSES. (A Study of 140 Oases.)

Maby £. Mors*, Boston Med. and Surg. Jour w., 1914, clxx., March
12, p.373.

Systematic examination of the serum and cerebro-spinal fluid
leads to a reduction in the number of cases diagnosed as general
paralysis. Out of eighty cases in which the diagnosis had been
made definitely or was suspected, examination of the serum and
cerebro-spinal fluid only confirmed it in fifty-seven cases, i.e., 71
per cent. On the other hand, three cases of paresis were discovered
in patients diagnosed on admission as senile dementia, arterio¬
sclerotic depression, and alcoholic hallucinosis. The cases which
have been found most difficult to differentiate from paresis without
examination of the serum and cerebro-spinal fluid are cerebral
syphilis, arterio-sclerosis, and Korsakow’s psychosis, and even the
findings in the serum and cerebro-spinal fluid may leave one in
doubt in the first case.

It would appear that general paralysis is not actually so
frequent as it appears to be from purely clinical observation.

A. Ninian Bruce.

228

REVIEW

TREATMENT.

SOME OF THE BROADER ISSUES OF THE P8YCHO-ANALYTIC
(300) MOVEMENT. James J. Putnam, Amer. Joum. Med. Set., 1914,
cxlvii., March.

The psycho-analytic method of treatment is not simply one more
means of palliation. It is based on a recognition of the fact that
the patients are suffering from emotional conflicts, the nature of
which they cannot understand unaided, and is an attempt to make
it possible for them to extricate themselves through self-study and
self-education from the effects of these conflicts.

The constant aim should be to encourage the patient to assume
the responsibility for the success of the investigation, so that it
may result in a sense of complete independence on his part.

It is admitted that there are certain cases which do not react
to this form of treatment, but if adequate care is taken in the
choice of patients, if the physician is well trained, and the patient
is in earnest, some good is almost certain to result. The phobias
and anxiety neuroses are the most curable forms, while the
compulsion neuroses are less amenable, and the well-marked
hypochondriacal cases even less so.

The article is a most clear and interesting one, and should be
read in the original. D. K. Henderson.

■Review.

ARBEITEN AUS DEM PATHOLOGISGHBN INSTITUT DER UNI-
(301) VERSITAT HELSINGFORS (FINLAND). Herausgegeben von
Prof. Dr E. A. IIom(:n. Neue Folge, Erster Band: Erates und
Zweites Heft, Mit 13 Tafeln and 34 Abbildungen im Text, pp. 190.
Jena : Verlag von Qustav Fischer, 1913.

The first volume of a new series of studies from the Pathological
Institute of the University of Helsingfors, published under the
iegis of the director, Professor Hom6n, contains a number of
interesting communications dealing with neuropathology.

1. Professor Hom&i contributes a long article on the develop¬
ment of abscesses of the brain, with especial reference to the types
of cells found in connection therewith. It is excellently illus¬
trated. From experimental researches, Professor Hom^n con-

REVIEW

229

eludes that the first result of the local invasion of the brain by
bacteria and their toxic products is degeneration and necrosis of
the tissue elements in the immediate vicinity. Exudative, in¬
filtrative, and proliferative processes follow at once. These
depend on the degree of virulence, the type, the numbers of the
invading bacteria, the resistive power of the individual and so
on. The older the pathological process is the more extensive are
the proliferative and reparative processes. At the margins of the
lesion, in its early stages, the common cell-form is the polymor¬
phonuclear leucocyte: certain other cells occur in smaller quantity.
In the infiltration zone, away from the actual bacteria, there
are fewer leucocytes, but many small lymphocytes and plasma
cells, and sometimes large lymphocytes: also large numbers of
polyblast-like glial cells, as well as Gitterzellen and Komchen-
zellen. At the margin of the infiltration zone are found proliferat¬
ing connective tissue elements from the adventitia, fibroblasts,
proliferating glial fibres, &c. Various combinations of these
differing processes are met with.

2. Dr Axel Wallgren contributes an interesting study of the
finer histological changes in acute poliomyelitis. It also is
accompanied with excellent coloured plates. The writer enters
into the fullest details as to the nature and origin of lymphocytes,
lymphoid cells, plasma cells, polyblasts, transitional forms, Gitter-
and Kornchen-zellen, &c. From this point of view, the paper will
be found- of value in establishing clear distinctions between the
various cell-forms.

3. Dr Fabritius’ contribution is on the question of acute
myelitis and so-called spontaneous hsematomyelia. He describes
two cases of interest from both clinical and pathological stand¬
points, and inveighs once more against the terminology of the
condition. He prefers the term paraplegia myelitiea or apoplectics,
or preferably myeloplegia, as more non-committal.

4. The same writer publishes a case of sclerotic atrophy of the
cerebrum. The patient was a woman of 53 with a left infantile
cerebral hemiplegia dating from the age of 14 months. Many
epileptiform attacks had followed. The hemiplegia was charac¬
teristic, with contractures. It had become worse some ten years
before the patient came under observation. The mental condition
was poor. At the autopsy, it was found that the right hemisphere
was much smaller than the left, the gyri on both sides were of
normal configuration, but those on the right were smaller. The
right froutal lobe was grossly atrophic. The cerebellar hemispheres
were equal in size. Microscopically, the chief alteration in the
atrophic region was loss of nerve cells, especially of the superficial
cortical layers, with glia proliferation. There was no degeneration
of the pyramidal path, and very little difference in the size of the

230

BOOKS AND PAMPHLETS RECEIVED

two pyramids. The author goes fully and critically into the litera¬
ture of these difficult cases, and concludes that there is no mere
“arrest of development,” but a pathological process the exact
nature of which is not yet understood. The absence of pyramidal
degeneration is attributed by the author to the conservation of
the Betz cells of the motor cortex.

Other papers combine to make this volume interesting and
useful to the neurologist and neuropathologist.

S. A. K. Wilson.

BOOKS AND PAMPHLETS RECEIVED.

Cyriax, Edgar. “ The mechano-therapeutics of chronic infantile
paralysis (Poliomyelitis anterior acuta)” (Brit. Joum. Child. Du., 1914,
xi., pp. 167-107).

Freud, Sigm. “On Dreams.” Only authorised English translation by
M. D. Eder from the second German edition. 1914. William Heinemann,
Ltd., London. Pr. 3s. 6d. net.

Fuller, Solomon C. “ Amyloid degeneration of the brain in two cases
of general paralysis ” ( Atner . Juum. Insanity, 1914, lxx., p. 837).

Mott, F. W. “ Archives of Neurology and Psychiatry ” 1914, vi.

Salmon, Alberto. “ Le problfeme du sommeil ” (L’Enafphale, 1914).

Tanzi, E., and Lugaro E “ Malattie mentali.” Vol. i. Societa
Editrice Libraria, Milan, 1914.

Internationale Zeitschrift fiir Arztliche Psychoanalyse. 1914, Jahrgang
II., Heft 2, Marz.

Klinik fiir psychische und nervose Krankheiten. 1914, ix., H. 1. Carl
Marhold, Halle a. S.

Kent County Lunatic Asylum. Annual Report for 1913.

“ The Training School .” 1914, xi., April.

IReview

IReurologs anfc pspcbiatn?

Original articles

THE NATURE AND THE TREATMENT OF THE
SO-CALLED “GENUINE EPILEPSY."

By Dr G. C. BOLTEN (The Hague, Holland).

When we desire to arrive at a really efficient treatment for an
illness, it is necessary first of all to have as complete a knowledge
as possible of the causes, the kind, and the nature of the illness.
If, therefore, we will discard the “ bromide ” treatment for epilepsy,
and substitute for it a method which indeed takes into considera¬
tion the real causes of epilepsy, we have first of all to answer
the questions: How, where, and in what manner does epilepsy
arise ?

These questions, asked for many centuries, have been answered
times innumerable, but not one of the answers may be considered
as validly consistent. In olden times Greek (Hippocrates,
Herodotus, Aristotle, Avicennes) and Roman investigators (Plato,
Celsus, Aurelianus, Paracelsus) occupied themselves in many
researches of the “ falling sickness ”; most of them strongly be¬
lieved that the moon and the stars influenced the development of
epilepsy. We find this idea, however foolish it may seem, existing
even in recent years, but in a more modified form. Michalek
(1910) observed that his patients had many more fits on a new
moon than on a full moon; Halbey (1910) finds that the variations
of the quantities of the atmospheric electricity have an influence on
epilepsy, or at least on the appearance of fits. Lomer (1906) finds
a connection between the number of the fits and the height of the
barometer; Sokolow (1897), on the contrary, finds a certain relation-
19

232

G. C. BOLTEN

ship between the fits and the magnetism of the earth, while
Lomer, still unconverted, even in the last year (1913) holds the
same opinion about the constant relationship between the number
of fits and the height of the barometer.

Turner considers that epileptics have a distinct increased
coagulation rate of the blood, and that the cause of the illness is
situated there; Besta found quite the opposite, namely, a diminished
coagulation rate of the blood, and therefore he declares the theory
that epilepsy is a dyscrasy, characterised by the diminution of
the quantity of the calcium salts of the blood. Hallager and
Bussell ascribe the fits to brain-anaemia, caused by cessation of
the pulse during the onset of the fit. In this way they resort in
some manner to the already old opinion of Kussmaul and Tenner
(1857), that epilepsy is caused by contractions of the blood¬
vessel muscles of the small arteries, especially in the medulla
oblongata. But all these opinions have not a single reason for
existence, and now they have only some historical value.

As in almost every case of illness, in epilepsy also bacteria
have been looked for, and, as a matter of course, found. Bra
(1902 and 1905) found a “neurococcus”; Lion (1911) feels some¬
thing for a “ spirillosis.” It may be safely said of all those recent
ideas, that no one at present accepts them except their inventors,
so long as they are alive.

In the last half century again and again they have endeavoured
to declare all cases of epilepsy as an anatomic affection of certain
parts of the brain, and thereby, as Redlich observes wittily, the
localisation of epilepsy has gone a bul bo-cortical way: Kussmaul,
Schroeder van der Kolk, and Tenner sought the cause in the
medulla oblongata, Nothnagel in the pons Varoli, Ziehen, Fuchs,
and Bothmann in the subcortical centres, and after this many
other investigators considered the cortex cerebri as the seat of the
alterations which might be the cause of epilepsy. Indeed, follow¬
ing the example of Chaslin (1890), a great number of neurologists
have commenced to occupy themselves with the investigation of the
microscopic alterations which might appear in the cortex cerebri
of epileptics.

Principally Alzheimer and Bratz have made statements to
this effect, and many others have followed them (Marinesco,
Marchand, Weber, Pohlmann, Lubimow, Heboid, Hajos, Orloff,
Worcester, Clark, Prout, Jolly, and many others). They have

TREATMENT OF SO-CALLED "GENUINE EPILEPSY" 233

determined that one often finds in cases of epilepsy a diffuse pro¬
liferation (varying much in extensiveness) of the supporting
tissues of the brain (indicated by Alzheimer as “ randgliose ”), and
accompanied by a strong setting of the real cortex elements
(ganglion cells, projection and association fibres), sometimes with
forming of the so-called "corpora amylacea.” Besides these, we
often find chronic alterations in the region of the ammon-horns,
which are characterised by induration, and which are known as
sclerosis of the cornu ammonia It is a pity, however, that the
results of these investigations are not at all constant: in many
cases they are wanting entirely; in fresh cases of epilepsy they
never occur; on the contrary, they are only to be found in old
and ehronic cases, which have already resulted in a secondary
dementia (Binswanger, Bouchd, Marchand, Claude and Schmiergeld,
Moore, Alexander, and others). Bratz, who is with many others a
vigorous champion of the cerebral pathogenesis of epilepsy, could,
in spite of that, determine the diffuse glia proliferation only in
half of his cases. Indeed, it is certain that this proliferation of
the glia tissue, which occurs constantly in every possible form
of dementia (and also in some other chronic intoxications), is only
the anatomical substate of the dementia; therefore it is not the
cause of the illness, but the effect of the chronic epileptic
intoxication.

The sclerosis of the cornu ammonis is also very inconstant (we
find it in about 50 per cent, of all cases), and consequently cannot
be the cause of epilepsy.

Opposite the great number of pathological anatomists who depart
from the wrong point of view that one can determine on the section
table or under the microscope the causes of a malady, and who
assign genuine epilepsy to the pure primary-cerebral affections,
and adjudge it a place amongst the cerebral diplegia of chil¬
dren (Little’s disease) and porencephaly, there are also a great
number of other investigators who consider genuine epilepsy
(“epilepsie essentielle” of the French; primary or idiopatic
epilepsy) as a chronic auto-intoxication. Among the numerous
followers of this theory are: Krainsky, Donath, Hall, Guidi,
Marinesco, Collolian, Ballet, Hay, Voisin, Petit, Teeter, Jelgersma,
Bouchd, and many others.

Krainsky proposes the supposition that epilepsy might be an
intoxication by carbamatic salts, but these, unless they are con-

234

G. C. BOLTEN

ducted immediately in the blood-passages, are not poisonous,
because they are changed by the liver into perfectly harmless
urea; also Krainsky’s observations were not exact: he claimed
that he could always determine immediately before the fit a rising
of the quantity of the uric acid in the urine, but many other
investigators did not find this, and, moreover, the uric acid and
the carbamatic salts have not any relationship with each other,
because uric acid is formed from the purin bases and not from
the carbamatic salts.

Donath thought that choline might be the cause of this chronic
intoxication, but choline is far too non-poisonous, and also it
is very doubtful if Donath is right; then many others failed to
find an augmentation of choline in any part of the body of
epileptics (Handelsmann, Ziveri, and others).

There is also no question whatever about an intoxication by
carbonate of ammonia (Guidi), because this substance is changed,
like the carbamatic salts, into urea by the liver.

A great number of investigators (Collolian, Ardin-Delteil,
Mairet, Galdi, Tarughi, Albrecht, Meyer, and others) conducted
experiments with the bodily fluids of epileptics, namely perspira¬
tion, blood-serum, cerebro-spinal fluid, and urine; they injected
these liquids into different test-animals to show their eventual
toxicity. It must be said in general that it seems by their results
(although there are some exceptions) that the above-named liquids,
unless gathered immediately before, during, or immediately after
a fit, are very toxic and invariably excite convulsions in the test-
animals (usually guinea-pigs); most of them died in consequence of
the injections.

There have also been very many investigations on the sphere
of the metabolism, especially concerning phosphorus-, nitrogen-,
and salt-metabolism (Bomstein, Lowe, Stromann, Goudberg,
de Buck, Stadelmann, Frohner, and others). Principally the
excretion of the phosphates, of urea, and of uric acid has
been inquired into times innumerable in the case of epilepsy.
Nevertheless it is not possible to come to definite conclusions in
all those researches, however exact they may be, because the results
of the one are quite opposite to the results of the other: on this
moment we do not dispose of a single due settled fact on the
sphere of the pathology of metabolism in cases of epilepsy.

This ever-returning and inexplicable inconstancy of experiences

TREATMENT OF SO-CALLED “GENUINE EPILEPSY” 235

becomes clear to us when we understand that the experimenters
did not take into consideration, on one occasion, that the word
“ epilepsy ” conveys only a very indefinite idea, and that it contains
quite a large number of pathogenetically divergent maladies,
although these maladies are characterised by almost the same
symptoms, especially the epileptic fit.

Indeed, many influential neurologists (Pierre Marie, Oppenheim,
Redlich, Binswanger, Heilbronner, Freud) draw attention to this
fact that, as the technique of the microscopical anatomy of the brain
and the methods of inquiry and research in general improve and
increase, the sphere of the so-called genuine epilepsy diminishes,
and continually there come fresh cases which, from a clinical point
of view, give quite the impression of “genuine” epilepsy, and which
were proved, after minute pathological-anatomical inquiry, to
belong to the secondary epilepsies in consequence of primary organic
cerebral affections. This had the result that they, little by little,
have fallen into another extreme, and, following the example of
Unverricht, declared that all epilepsies are of cerebral origin, and
the more, while through the researches of Alzheimer, Bratz, and
others the secondary alterations in the cortex cerebri of epileptics
were better known. In 1897 Winkler drew attention that this
conception was far too partial, and that it was not correct to regard
the numerous forms and kinds of epilepsy in the same manner,
and to ascribe them all to a primary cerebral alteration. Very
divergent maladies thus show the same symptoms, and this,
naturally, has led to a hopeless confusion; many investigators only
speak of “epilepsy,” and so include all cerebral and genuine
epilepsies; others always speak about “ genuine ” epilepsy, but in
reality their cases seem to belong solely or in part to cerebral
forms, and the one as well as the other leads to inconstant and
completely useless results.

I would propose the following classification of the different
clinical forms of epilepsy:—

1. Cerebral {secondary or symptomatic) epilepsy as a consequence
of chronic meningitis or encephalitis (in most cases a combina¬
tion of the two, namely, meningo-encephalitis); traumatism of
the cranium, the meninges, or the brain (so-called traumatic
epilepsy); hydrocephalus internus; Alzheimer’s disease, sclerosis
tuberosa; tumours of the cranium, of the meninges or of the brain
(including acromegaly); cerebral abscess; lues cerebri (as wel

236

G. C. BOLTEN

congenital as acquired), dementia paralytica, blood-clotting under
the meninges, porencephaly, scars in the meninges, arterio-sclerotic
foci, distrophia adiposo-genitalis, solitary tubercle, &c.

When epilepsy is combined with cerebral diplegia of children,
the epilepsy must be considered to be of cerebral origin, because
the cerebral diplegia of children is nothing other than a more or
less circumscriptive form of encephalitis.

2. Epilepsy by endogenous intoxications, as diabetes, uHernia, and
in case of children also with acetonsemia; in very close relationship
to this group is also eclampsia.

3. Epilepsy by exogenous intoxications, as chronic poisoning by
alcohol, absinth, tobacco (Bychowski), camphora tribromidi, ergotine
(von Jaksch and others), lead, santonine (Jeliffe), &c.

To this group also belongs the intoxication we call pellagra,
and which also causes sometimes epileptic or epileptiform fits (von
Jaksch).

4. The so-called “ affect-epilepsy ” (Bratz) of neuropaths and
psychopaths.

5. Cardiogenic epilepsy (Stokes-Adams’ disease).

6. Epilepsia tarda (epilepsia senilis, “ Spatepilepsie ” of the
German).

7. Genuine epilepsy (“ dpilepsie essentielle” of the French,
idiopathic epilepsy).

To this group there also belong the rather peculiar cases of
surgical — or wound — epilepsy, appearing after thyroidectomy
when too great a part of the thyroid gland is removed. (All cases
of surgical epilepsy are collected by Redlich.)

We must observe, that the so-called epilepsia procursiva
(poriomania or compulsory mechanical walking) in some cases
has to be classified as genuine epilepsy, as I could prove ex¬
perimentally, while the same can be determined of the dipsomania.
In other cases, on the contrary, dipsomania as well as poriomania
are the effects of very divergent organic cerebral affections, or of
various hereditary or acquired degenerative states.

Thus we see, that the same illness (genuine epilepsy) can
present itself in many very various forms: sometimes exclusively
fits of " petit mal,” at other times only complete epileptic fits, in
other cases only the so-called psychic epilepsy (dream-states,
equivalents, &c.), or merely by symptoms of dipsomania or
of poriomania. And opposite this stands the fact, that the

TREATMENT OF SO-CALLED “GENUINE EPILEPSY” 237

epileptic fits with all their peculiarities may occur in the seven
above mentioned groups of maladies, which, however, are very
divergent concerning their pathogenesis.

Experimentally I have proved that epilepsia tarda has
certainly not the same origin as genuine epilepsy; probably this
affection is caused by chronic troubles of the circulation in the
cortex cerebri (arterio-Bclerosis, See).

Further, the epileptic form of paramyoclonus (Unverricht) and
the so-called epilepsia corticalis continua or polyclonia epileptoides
continua (Koschewnikow and Choroschko) have no reason to exist as
separate maladies: they belong undoubtedly to the very large group
of cerebral epilepsies, and depend on more or less circumscribed
organic alterations of the cortex cerebri. (Choroschko accepts a
subcortical localisation.)

The series of minor fits (“ gehaufte, kleine Anfalle," Friedmann
and Heilbronner) do not form pathogenetically a simple type of
malady; they occur sometimes in organic cortex affections, and
other times in genuine epilepsy, while in many cases the patho¬
genesis is still quite obscure and perhaps a great number of them
must be incorporated with hysteria (Heilbronner).

With my own investigations I always have tried as much as
possible to separate the different groups of epilepsy, a necessity
which is, in fact, quite neglected by the majority of workers:
the groups 2, 3, and 5 are always easy to determine, because the
primary affection (endogenous or exogenous intoxications, Stokes-
Adams’ disease) presents itself in these cases very clearly, but for
the moment we do not dispose of due differential diagnostic signs,
which enable us to distinguish the cerebral from the genuine
epilepsy or from the epilepsia tarda, apart from the comparatively
rarer cases in which there exist undeniable focal symptoms
or other signs of a primary cerebral affection, which cases then,
of course, belong to cerebral epilepsy. Neither the nature and
the great number of clinical peculiarities of the fit, nor the ulti¬
mate progress of the disease enable us to a right differential
diagnosis.

Perhaps Abderhalden’s dialysing method (the indication of the
so-called defensive ferments), or may be the determination of the
antitryptic force of the blood-serum, will give results which may
be used for the differential diagnosis. (In cases of extensive
organic cerebral alterations we find an augmentation of the anti-

238

G. C. BOLTEN

trypsines of the blood; in due course the results of the researches,
now begun by us in this subject, will be made known.)

In my experiments I have limited myself, as far as possible, to
the sufferers of genuine epilepsy and as this diagnosis until now is
only to be made “ per exclusionera ” (thus one must exclude as
well as possible the countless forms of cerebral epilepsy and also
epilepsia tarda; consequently one had to manage previously with
almost exclusive anamnestic information), it was not always
possible to elude errors in the diagnosis of our cases. These errors,
however, could always be experimentally proved, unless the
sufferer had patience enough for a very prolonged and multifarious
treatment.

With a great number of sufferers of genuine epilepsy, I tried
to discover if this disease might have originated by:—

(a) Purification in the intestines (abnormal fermentations in

the stomach or in the intestinal tract), intestinal
parasites, chronic enteritis, or other intestinal affec¬
tions, such as ohronic constipation, &c.

(b) Intoxication by decomposition products of albumin, first of

all the purin bases (which play such an important
part for many neurologists) or by the albumoses. Also
the possibility of common salt-retention, and secondary
salt-intoxication has been inquired into.

secretion (hypophysis, thyroid, parathyroids, thymus,
liver, pancreas, spleen, ovary, testicle and adrenals;
only the epiphysis could not be experimented with.

All these researches and experiments have taken nearly ten
years, and have always been conducted upon several patients at one
time, and nearly always on clinical sufferers, who thus were under
our continual observation.

The results of these experiments may be summarised as
follows:—

Purification in the intestines seems to occur in case of
epilepsy only as a great exception, and when this symptom exists,
there is then produced in the intestinal tract indol, phenol, and
skatol, which appear in the urine as indican. Therefore, when
there is purification in the intestinal canal one finds a heightened
standard of indican of the urine. With a great number of epileptics
the indican-standard was determined by us, but important increases

TREATMENT OF SO-CALLED “GENUINE EPILEPSY" 239

were never found; neither was acetone discovered in the urine
of epileptics.

For these reasons it must be an established fact that intestinal
purification does not play a part with genuine epilepsy. And also
one does not find chronic diarrhoea with epilepsy, unless due to
faulty dieting; intestinal parasites and other intestinal troubles,
as chronic constipation, have also no influence of any importance
upon epileptic disease.

Moreover, Moore Alexander controlled exactly the intestinal
flora of epileptics and compared it with that of normal persons,
without finding a difference of any importance. The great influence
which many investigators (Rodiet, de Fleury, MacCaskey, Spratling,
and others) ascribe to stomach and intestinal troubles does not
exist at alL And the atonic and dilated stomach (Mangelsdorff,
de Groot), whether accompanied or not by hyperchlorhydria, belongs
to the secondary alterations, as there are found a great many in
epileptics, and which, concerning the pathogenesis, do not count
at all.

The administration of an extraordinary easily digestible diet,
the regular use of intestinal disinfectants, the continual cleansing
of the intestinal canal, the careful prevention of chronic constipation,
all that, in short, has not any influence worth mentioning upon
the chronic intoxication which we call genuine epilepsy.

Much attention was paid by me to the part played by the
food-albumins and their decomposition products (purin bases,
albumoses), but the results also were purely negative.

It is really not quite clear why many workers have conceded
and adjudged such an important position to the so-called purin
bases, because all those substances (xanthine, paraxanthine, guanine,
karnine, hypoxanthine, adenine, &c.; caffeine and theobromine
also belong to them) are fairly harmless, and are changed by
oxidation into uric acid. If the purin bases should be
insufficiently oxidised and excreted, then there would be formed
by epileptics less exogenous uric acid than by normal persons,
who keep quite the same diet. Concerning this there was no
evidence; epileptics (cerebral as well as genuine epileptic) show,
as we could demonstrate by ample researches, quite the same
standard of uric acid of the urine as normal persons, who
have been kept to quite the same diet, and who live under
quite the same conditions. And, moreover, the purin bases

240

G. C. BOLTEN

are not, or but very little, poisonous; adenine is the most
poisonous, and yet one can give adenine to epileptics with safety:
they do not react to it in any way. The food, rich with purins,
does not bring any change in the symptoms of epileptics, and
even when one puts the patient for a considerable period on a quite
“ purin-free ” diet (which is very well possible, and can be con¬
tinued for a long time), one does not get an obvious amelioration.
Investigators, who meant to observe such an improvement, have
not continued their experiments long enough, or else they have
had experience with too few patients. Hoppe also did not observe
the slightest difference between the phenomena, when rich purin
or non-purin foods are distributed and carried as far as possible.

And when one retains all albumins, animal as well as vegetable
(as far as possible, which, however, cannot be carried through
perfectly), one also does not notice any amelioration. And so it
is impossible to ascribe any part to the albumoses, which are, as is
well known, very poisonous (and which are transformed syntheti¬
cally to plasma-albumin during the passage through the intestinal
wall); epilepsy thus is not an intoxication by albumoses, nor by
purin bases.

With the eventual common salt-retention and secondary
intoxication we find the same. When one removes as far as
possible all salt from the food (the salt-free diet) then this has
not the slightest influence on the fits or on the other phenomena,
unless one applies bromides at the same time, and by this, namely,
the application of bromide salt in the diet poor of salt, the favour¬
able results proceed which many researchers (Roux, Gordon, Baluit,
Lortat-Jacob, and others) obtained with the treatment of Tolouse
and Richet; the diet poor of salt, however, is, without simultaneous
bromide application, completely inactive, as Van der Kolk also found.
The treatment, according to Toulouse and Richet, simply relies upon
this, that by the abstinence of the common salt and the
simultaneous application of bromide the lather accumulates much
more rapidly in the organism than with a combination of usage
of common salt; thereby a much larger bromide accumulation
(“ bromide-depot ”) is formed (Hoppe, Laudenheimer), and the effect
of the bromide salts is then much more intensive, but that is all.

Also a pure milk diet, by which Bregmann should have
obtained good results, has no more obvious influence on the fits
and on the other epileptic phenomena.

TREATMENT OF SO-CALLED “GENUINE EPILEPSY” 241

In general one can declare, as seemed also by our experiments,
that, firstly, all kinds of intestinal troubles carry on an unfavourable
influence on the epileptic phenomena; and secondly, that in
general there does not exist a single diet, that in the long run
really carries on any noticeable influence on the kind, the intensity,
and the quantity of the epileptic “ discharge ” (the fit).

Very many and lasting experiments have been made by us in
our endeavour to determine if one or more of the glands with
internal secretion have any influence on the origin or on the
symptoms of the epileptic disease.

Moreover, there must, of course, be considered the possibility
of an intoxication by a hyperfunction of one of those organs, the
more so, because Volland, Ohlmacher, and others often found a
persistent thymus and other congenital alterations at their
pathological-anatomical researches. But neither by the applica¬
tion of extracts of fresh thymus, nor by that of fresh adrenals, may
any lessening of the symptoms be caused, not even when great
quantities were applied. (There must be observed that in these
experiments there was always used freshly pressed extracts of the
glands with internal secretion, and that these fluids were always
given by the rectal way, in order to prevent their eventual
destruction by the gastric juice. Dry organs, given in tablet form,
are quite useless, because they contain, as appears by their odour, de¬
composition products, and therefore they cannot in any way imitate
the physiological function of the organs; moreover, most of these
glands contain ferments which are destroyed by the drying process.)

Successive very durable experiments have been made with
the pressed extracts of nearly all glands with internal secretion
(hypophysis, thyroid, parathyroids, liver, pancreas, adrenals, ovary,
testicle, spleen, and thymus). Their results can be recapitulated
as follows:—Firstly, that by the application of no one of the pressed
extracts of these glands there might be caused a deterioration of
the epileptic symptoms, and that, consequently, genuine epilepsy
surely does not depend upon a hypersecretion of one of the above-
mentioned organs; and, secondly, that on the contrary we obtained
a slight amelioration on the sufferers of genuine epilepsy (the
diagnosis, for want of better, always taken “ per exclusionem ”) by
application of pressed extracts of the parathyroids, and a very
remarkable amelioration by the application of the combined pressed
extracts of the thyroid and parathyroid glands. Cerebral epileptic

242

G. C. BOLTEN

patients (diagnosis taken also chiefly from anamnestic information)
almost failed to react in any way upon this treatment.

It cannot be denied that the results were very positive; they
were too constant and too durable, as any doubt should be justified.
Amongst my patients there were two who formerly had numerous
fits, and who now have been already more than three years free from
all symptoms; ten already are quite free from symptoms for
8 to 12 months, and ten others have not exhibited the slightest
symptom during 3 to 4 months, although before this new treat¬
ment they had regularly four to ten fits per month.

With this treatment all application of bromides was excluded,
and so we can conclude from these experiments, with absolute
certainty, that genuine epilepsy is a chronic auto-intoxication
relying upon the hypofunction of the thyroid and parathyroid
glands.

In what manner must we consider now the pathogenesis of
genuine epilepsy ?

According to new researches of many physiologists (Biedl,
Eppinger, Falta, Magnus, Levy, and others) the thyroid has a very
divergent, complicated, and important function. Apart from the
predominating part which it plays (in association with the hypo¬
physis and the thymus) on the development of the organism, it
has an accelerating influence on metabolism in general; the salt
as well as the nitrogen and the phosphorus metabolism are greatly
under its influence, with the result that, when the thyroid’s
function fails, a strong diminution of the excretion of phosphorus,
calcium, and magnesium salts, as well in the urine as in the faeces,
appears, while the gas change in the lungs is also importantly
lessened.

Moreover, the action of the chromaffine system and of
adrenaline becomes less intensive by hypothyroidism ; the chromaf¬
fine system and the thyroid supply each other’s function, and
both have to support a tonus in the sympathetic system, in opposi¬
tion to the pancreas, which has a retarding influence on it (Caro,
Biedl). Thus the thyroid and the sympathetic nerve form more
or less a closed system; the thyroid is innerved by the ganglion
inferior of the sympathetic nerve (Steiner; according to Asher and
Flak it would also receive branches of the n. laryngeus sup. and
n. laryng. inf.), and reverse, the thyroid supports a tonus in the
sympathetic system; consequently after thyroidectomy a diminished

TREATMENT OF SO-CALLED “GENUINE EPILEPSY” 243

sympathetic function appears (retarding intestinal peristalsis,
lessenc i secretion of intestinal ferments, trophic and circulation
troubles of the skin, &c.).

Other investigators (Juschtschenko, Leopold Lfevi, Rothschild)
have accomplished these experiments, and determined that the
thyroid accelerates the formation of all kinds of ferments of the
intestinal tract and of the intermediary metabolism. In con¬
sequence of hypothyroidism a quantitative decrease of all these
ferments appears; Juschtschenko has determined this especially con¬
cerning nuclease, katalase, and phylokatalase. Further, according to
Fassies, the thyroid accelerates the formation of alexines in the
blood, and advances the antibactericidal action of the blood, whilst
Walter has determined that with thyroidectomised animals the
regeneration of injured nerves occurred much slower than with
normal animals. It is still not certain if the thyroid has a directly
depoisoning action on blood (Trendelenburg).

Concerning the physiological function of the parathyroids, we
know still less with sufficient certainty. Some workers believe
that, after parathyroidectomy, the quantity of ammonia in the
blood increases; however, the acidosis found by Morel, von Fiirth,
and others, is probably not a direct consequence of the hypo¬
parathyroidism, but of the numerous and violent convulsions,
symptoms of the parathyreoprivie tetany.

Further, to declare the symptoms of genuine epilepsy we
still need the important results of the researches of Guillain and
Laroche, who were able to determine, experimentally, that the
cerebral cortex has a great affinity to different poisons, as
diphtheria and the tetanus toxin, and many others, as alcohol,
ether, different alkaloids (morphine, cocaine, &c.), and other
poisons, as absinthe, &c.

In the case of genuine epilepsy there exists a hypofunction of
the thyroid and parathyroid glands; the metabolism is retarded
and less complete, because all kinds of ferments, indispensable for
the metabolism, are insufficiently created, and all kinds of toxic
products of our own metabolism, as well as decomposition products
of feeding materials, come into the circulation, and gradually ac¬
cumulate and become lodged in the cerebral cortex, which, when
this accumulation of toxins has reached its maximum, react upon
that with a so-called “ discharge,” the epileptic fit, as a temporary
remedy of the organism to deliver itself of the toxins for a short

244

D. MAXWELL ROSS

period; we must thus regard the fit as a defence reaction of the
organism.

Summa summarum the following little recapitulation:—

1. Of the numerous cases of epilepsy which make their
appearance quite as genuine epilepsy, an important part, de¬
pending upon collective, divergent, primary cerebral affections,
belongs to the cerebral (secondary, symptomatic) epilepsy, and but
the smaller part ( ± 25 per cent, concerning our cases) to the so-
called genuine (essential, idiopathic, or primary) epilepsy.

2. Even now it is quite impossible to distinguish, less on pure
clinical symptoms, most cases of cerebral from genuine epilepsy.

The differential diagnosis between these divergent affections
must move itself in the sphere of the pathology of metabolism.

3. Genuine epilepsy is a chronic auto-intoxication, caused by
a hypofermentation of the intestinal tract and of the intermediary
metabolism, as a consequence of a hypofunction of the thyroid and
parathyroid glands (or of troubles in their nervous elements, to
know the sympathetic nerve).

4. Genuine epilepsy is quite curable by the administration,
rectally, of fresh pressed extracts of the insufficient glands, or better,
it is possible, in this manner, to free the patient from all
symptoms, as I have proved in a great series of cases.

NOTES ON A CASE OF PELLAGRA.

By D. MAXWELL ROSS, M.B., Ch.B., Assistant Medical Officer,

Royal Edinburgh Mental Hospital.

Since Dr Dods Brown and Dr Cranston Low 1 drew attention to
this subject by reporting a case of pellagra discovered in this
institution a few years ago, so many undoubted cases of the
disease have been placed on record that it seems worth while
recording cases in which the diagnosis has not proved quite so
straightforward. For that reason the following case is reported.

L. D., a mill girl from Leith, said to be of a quiet, retiring dis¬
position and good habits, was first admitted to this hospital in
November 1909, suffering from delusions of persecution and
auditory and visual hallucinations. Her family history was good,

1 Dods Brown and Cranston Low, “Pellagra,” Edin. Mtd. Joum ., 1909, Sept.

NOTES ON A CASE OF PELLAGRA

245

with the exception of a sister who died in thus hospital from
insanity following organic brain disease.

On admission her mental state was one of slight depression,
with some confusion and slowing of all her facilities. Physically
she was in poor condition, her skin was dirty, and she had an acne
eruption on her face. She had fine tremors of the fingers, and her
tendon reflexes were exaggerated. The Wassermann reaction was
found to be negative in the blood serum. She made a gradual but
good recovery from this attack, and was discharged in the spring
of 1910.

She is said to have remained fairly well until the summer
of 1913, when she became so run down in health and melancholic
that she had to be readmitted in July. She was found to be
markedly depressed, slightly confused with somewhat ill-defined
delusions and hallucinations. She was described as a flushed,
excited little woman in poor physical condition. The acne
eruption was again noted on her face but no rash elsewhere. She
exhibited marked motor restlessness and her tendon reflexes were
all exaggerated. She was looked upon at this time as probably
a manic-depressive with toxic manifestations, the immediate
diagnosis being mild delirious insanity.

Within three weeks of her admission the delirious symptoms
had disappeared, leaving her in a depressed and markedly neuras¬
thenic state. In the beginning of September she had a severe
attack of diarrhoea, and it was then noticed that she had an eruption
on the dorsum of both hands. The skin was red and slightly
swollen, the epidermis dry and fissured, with large flakes separating
off. It was noticed in addition that the facial acne was decidedly
worse, there being a diffuse redness on the cheeks and forehead,
and considerable complaint of a feeling of heat and burning. It is
interesting to note that the condition was described by the charge
nurse as a " very bad sunburn," a description not infrequently given
of the milder skin manifestations of pellagra.

The persistence of the diarrhoea, along with the presence of
haemorrhoids from which she suffered severely, necessitated her
confinement to bed. Mentally she was at this time slightly
depressed and querulous, but gave no signs of either delusions or
hallucinations. In spite of treatment the diarrhoea persisted, and
she became extremely weak and emaciated. The stools were
always liquid, latterly of a bright yellow colour, extremely offen-

246

D. MAXWELL ROSS

8ive, and often streaked with blood, probably from the haemorrhoids.
Her tongue was small, red, and dry, but she did not have any
stomatitis. Her skin eruption gradually improved, and in
November had disappeared from the hands, leaving, however, a
slight hyperkeratosis over the knuckles, but no pigmentation. In
November her weakness and emaciation became extreme, and her
movements showed well-marked muscular inco-ordination. She
now gave evidence of both visual and auditory hallucinations, and
became somewhat confused and incoherent. A blood examination
made at this time showed a mild degree of anaemia, a leucocytosis
of 14,000, and a differential count of 70 per cent, polymorphs,
298 per cent, lymphocytes, and *2 per cent, mononuclears. On
24th November diffuse clonic muscular twitchings commenced,
affecting at first the facial muscles, and later those of the limbs
and trunk. She was unable to speak, and could only swallow with
difficulty, but till a few hours before her death, on 26th November,
she appeared to be conscious. The temperature shortly before
death rose to 101°, but this was the only occasion during the
illness on which it rose above 100''.

A few hours after death some cerebro-spinal fluid was
obtained. The Wassermann reaction in this fluid was negative, as
was also the Fontana test; both the Noguchi and the Nissl Nonne
tests were positive, and the cell count was 141 per c.mm.

A post mortem examination was made sixteen hours after
death with the following findings:—

The skin on the dorsum of the hands showed brownish patches
of rough, dry, and thickened epidermis, more especially over the
knuckles. There was a small patch on each knee of a similar
character, but elsewhere, except for the acne on the face, the skin
presented no peculiarity.

On removing the calvarium the meninges were found much
injected, and in several places on the cortex there were minute
pial htemorrhages. There was marked excess of cerebro-spinal
fluid. The brain was soft, and weighed only 43£ ounces. Subse¬
quent microscopic examination of tissue removed from the cortex
showed little pathological change. There were no definite degenera¬
tive changes, no arteritis, and no increase of neuroglia. Unfortu¬
nately, the cord was not removed.

The heart and lungs were of normal appearance, the only
change of note being a marked congestion at the pulmonary bases.

NOTES ON A CASE OF PELLAGRA 247

The large intestine was found distended with gas and markedly
injected, as were also the small intestines and the mesentery, in
which there were numerous enlarged glands. Twelve inches above
the ilio-caecal valve was a recent intussusception easily reduced,
and evidently of only a few hours’ duration. The intestinal
mucosa was markedly injected, but at no point was there any
ulceration.

The liver weighed 35£ ounces, and was of fatty appearance.

The kidneys and spleen appeared normal.

Cultures were taken from the spleen and the intestinal mucosa.
From the former a gram positive coccus was isolated, and from the
latter a mixed culture was obtained, which was found to consist of
a coccus similar to that obtained from the spleen, and a bacillus
giving the characteristic reactions of the pyocyaneous group.

The symptoms of pellagra have been divided into four groups,
the mental, the alimentary, the nervous, and the dermatological.
It will be seen that this patient presented fairly characteristic
symptoms in each of these groups. Mentally, she was at times
mildly delirious, and when not delirious was depressed and
neurasthenic. According to Wood, Tanzi, and other authorities,
the mental symptoms of pellagra may present a wide diversity
of type, but the most characteristic is a neurasthenic depression,
while symptoms of delirium are frequently present during the
course of the illness, and especially towards its termination.

In the alimentary group gastro-intestinal irritation, stomatitis,
indigestion, and diarrhoea with frequently proctitis and. haemor¬
rhoids are the outstanding symptoms. The patient in this case
suffered most markedly from diarrhoea with haemorrhoids, but
there was no stomatitis, nor were the gastric symptoms at all
prominent. In passing it is interesting to note that her stools
were of a peculiarly offensive character, and Box in his article
on pellagra in the Practitioner (June 1913), notes that the odour
of the stool is said to be peculiar and offensive, suggesting
putrefactive changes.

With regard to the nervous symptoms much seems to depend
on the duration of the disease. Changes in the nervous system
in the cases of shorter duration are indefinite, consisting princi¬
pally of degenerative changes in the cortical cells. The symptoms
referable to sclerotic changes in the cord are of insidious onset,
and were not noted in this case, where indeed the most prominent

248

I). MAXWELL ROSS

nervous system was the exaggeration of the reflexes, which is
said to be the commonest change in pellagra. Though I can find
no reference to a terminal attack of clonic convulsions exactly
similar to that in which this patient died, convulsions do occur,
and one of Wood’s cases died from epileptiform convulsions after
having had three yearly recurrences of the disease.

The dermatological symptoms were very slight and transient
in character, but were the first to attract attention. I was
fortunate, while working in an American hospital, in seeing
several cases of pellagra, and the site rather than the character
of the lesions on the hands associated with a condition of neuras¬
thenia and depression at once raised tho suspicion of pellagra. I
was very interested to find that my colleague, Dr Neill, who had
charge of the case during October, and until a few days before
her death in November, considered pellagra as a possible diagnosis,
although the skin lesions were then much less than in September.
The acne of the face made it difficult to draw any definite conclu¬
sion from the skin condition there, but there was undoubtedly an
erythema, and the feeling of burning she complained of is a
fairly constant symptom in pellagra, though usually referred to
some other locality. Miller 1 describes a case in which in October
the patient used to stand with bare feet in the sea to obtain relief
from the sensation of heat.

The blood in this patient presented nothing very characteristic,
and in pellagra the only blood change that appears constant is a
tendency to an increase in the lymphocytes. With regard to the
examination of the cerebro-spinal fluid as it was obtained after
death no great importance can be attached to the findings. An
increase in the cell content has been noted, but not to the marked
extent present here.

The presence of the Bacilli pyocyaneus in the intestine was of
interest, and it is unfortunate that no bacteriological examination
of the 8tools was made during life. Whether the organism had
any relation to the diarrhoea is difficult to say. Several cases of
septicaemia in children with marked gastro-intestinal symptoms
caused by Bacillus pyocyaneus have been recorded, and it is
possible that the severe persistent diarrhoea may have had a
definite cause in this organism.

The pathological findings are quite in accordance so far as they
1 Amtr . Journ. Insanity , 1913, Jan., p. 551.

NOTES ON A CASE OF PELLAGRA

249

go with those of pellagra, although degenerative changes might have
been expected in the cortical cells. The absence of perivascular
infiltration and endarteritis is exactly in accordance with Mott’s
findings as described in a fatal case of Box’s examined by him.

The chief interest of the case lies in the mildness of the skin
manifestations, and in the fact that it raises the question of the
relations of sunburn and pellagra.

Pellagra sine pellagra is not generally accepted as a definite
clinical entity, but it is admitted that the erythema may be so
slight that it is either mistaken for a sunburn, or escapes
altogether the notice of the patient or his friends. A further
difficulty in diagnosis lies in the fact that during the remission
of the skin lesions there may be very little local evidence of their
ever having been present. Tucker, in an article contributed to
this year’s Medical Annual, states that during the intervals
between the attacks the skin may look either normal or smooth
and glistening.

Now that pellagra is so much to the fore, every case of sunburn
is looked upon with a suspicious eye, and yet in every asylum
numerous cases of most severe sunburn are to be seen every year,
so that a real pellagrous erythema may be very readily overlooked,
or a severely sunburnt melancholic all too readily labelled a
pellagrin. The modem open-air treatment so much used in
asylums and other kindred institutions has many benefits, and it
is not impossible that to it may be due the doubtful advantage of
adding many to the number of pellagrins in this country. It is a
point that seems worth remarking that in asylums the patients,
especially the female patients, are far more exposed to sunlight
and fresh air than they are when leading their normal life, and
more especially does this apply to town dwellers; and further they
usually have a diet consisting much more of rice and other cereals
than the diet they are accustomed to at home. In view of the
older theories as to the etiology of pellagra, these points seem of
some interest.

I have to thank Dr G. M. Robertson, Medical Superintendent
of the Royal Edinburgh Mental Hospital, for his kind permission
and encouragement in recording the case.

To Dr W. Abel, Pathologist to the Hospital, I am indebted for
the reports on the bacteriological and microscopical examinations.

250

ARTHUR F. HERTZ

BABINSKI’S “SECOND SIGN” OF ORGANIC HEMI¬
PLEGIA IN HEMICHOREA, AND ITS BEARING
ON THE ORGANIC NATURE OF CHOREA.

By ARTHUR F. HERTZ, M.A., M.D., F.R.C.P.,

Assistant Physician and Physioian-in-Charge of the Neurological
Department at Guy’s Hospital.

Although it is universally agreed that chorea is an organic disease,
the recognition of this fact depends less upon the symptoms of
the disease itself than upon its association with rheumatic fever
and its obvious organic complications, such as endocarditis and
pericarditis. There is indeed no feature about the symptoms of
chorea, which by itself would indicate the presence of organic
changes in the brain or spinal cord, and the anatomical lesions
which have been discovered in fatal cases are slight and inconstant.
Thus the optic discs are never affected and the pupils are normal;
the cutaneous and deep reflexes are neither increased nor diminished;
and the plantar reflexes are always flexor.

I have elsewhere 1 drawn attention to the great diagnostic
value of the sign described by Babinski as “ combined movement
of the trunk and pelvis”; for convenience I have called it
Babinski’s second sign. When a normal individual, lying on his
back with his arms folded and his legs widely separated, attempts
to sit up, both legs rise equally into the air; on falling back to the
ground, the legs again rise. In these circumstances in organic
hemiplegia the affected leg always rises higher than the other,
whereas in hysterical hemiplegia the paralysed leg remains flat on
the ground, although several muscles are brought into powerful
action when this occurs. I have recorded several cases in which
this sign proved the organic nature of the hemiplegia, although
the plantar reflex was flexor; in other cases, in which the plantar
reflex was unobtainable, the presence of Babinski’s second sign
has been very helpful in diagnosis.

I have had the opportunity of testing Babinski’s second sign
in seven cases of hemichorea. Without a single exception the
leg on the affected side rose higher than the other, although the
plantar reflex was flexor and the cutaneous reflexes and tendon-
responses of the two sides were equal. As this sign has never been

1 A, F. Hertz, Guy's Hospital Reports, 1911, lxv., p. 54.

ABSTRACTS

251

observed in any case of hemiplegia which was not organic, its constant
presence in hemichorea points strongly to the conclusion that the
upper motor neurone is affected by some organic change in
hemichorea, even if it is of a kind which escapes recognition by
the ordinary methods of histological examination. There is at
present no anatomical evidence to show what special significance the
presence of Babinski’s second sign has when the plantar reflex is
flexor, but it is highly probable that the two signs depend upon
lesions to different parts of the upper motor tract. The two parts
are generally affected together, so that both signs are present, but
in rare instances of otherwise unremarkable hemiplegia, and in all
cases of chorea, the part associated with Babinski’s second sign is
affected when that associated with the extensor plantar reflex is
spared. In much rarer cases of hemiplegia, but never in hemi¬
chorea, the opposite is the case.

As Babinski’s second sign is constantly present in hemichorea,
it may reasonably be concluded that the lesion with which it is
associated is constantly present in ordinary cases of bilateral
chorea. As this sign is the only evidence of the existence of an
organic lesion in hemichorea, and as it depends on a comparison
between the two sides, direct evidence of the organic nature of the
nervous symptoms in ordinary chorea is still wanting.

abstracts.

ANATOMY.

THE NERVE ARBORISATIONS OF THE BLOOD-VESSEL WALLS.
(302) (tfrber die Nervenverzweigungen innerh&lb der GeiUsswand.)
Glaser, Deut. Zeitschr. f. Nervenheilk., 1914, 1., Hft 5-6, p. 305.

By special histological methods the author has determined that
nerve plexuses are found in the middle and outer coats of the
blood vessels. The capillaries are accompanied and surrounded
by nerve twigs. It is possible to demonstrate nerve-end organs in
the blood vessels: the very finest twigs reach the intima.
Ganglion cells are found only in the outer layers of the adventitia
of such vessels as the aorta, internal carotid, and renal arteries:
they are awanting in peripheral arteries.

S. A. K. Wilson.

252

ABSTRACTS

PHYSIOLOGY.

THE MECHANISM OF MUSCULAR TONUS, OF THE REFLEXES,

(303) AND OF CONTRACTURE. Crocq, L’Enctphale , 1914, ix.,
Feb., March, April, pp. 147,197, and 293.

The author’s main conclusions are somewhat as follows:—

In the frog, tonus is a purely spinal phenomenon, and is
dependent on the integrity of short reflex paths. In the dog,
there are three “ centres ” for tonus: the spinal, the basal, and
the cortical; of these, the basal appears to be the most important.
Tonus depends on the integrity of long reflex paths, but if these
are interrupted, it appears that short reflex paths may supplement
them. In the ape, short reflex paths play only a subsidiary role:
the tonus centres are basal and cortical; the latter is at least
as important as the former. In man, the paths concerned with
the maintenance of tonus in voluntary muscles are the long reflex
paths, and the tonus centre is cortical. Destructive lesions of
the cortico-spinal path diminish or abolish tone in man: “irri¬
tative ” lesions produce hypertonus. In the new-born child, tonus
is spinal, and not cortico-spinaL As far as the reflexes are con¬
cerned, in the frog they are spinal. In the dog, tendon reflexes
and reflexes of defence are spinal: cutaneous reflexes are effected
normally by long paths, with a basal centre, and they are only
secondarily spinal In the ape, defence reflexes are spinal, tendon
reflexes are basal, cutaneous reflexes are both basal and cortical.
In man, defence reflexes are spinal, tendon reflexes basal, and
cutaneous reflexes cortical.

According to Crocq, contracture is the same as, and results
from the same causes as produce, hypertonus. He believes the
condition is caused by pericellular or periaxonal irritation of the
cortico-spinal path. Crocq depends to some extent for his position
on the results of complete transverse section of the cord in man,
which he says corroborate his views, and apparent contradictory
cases have been those in which it has been impossible to
demonstrate that the cord has been completely severed.

S. A. K. Wilson.

PATHOLOGY.

FURTHER OBSERVATIONS ON THE INFLUENCE OF TOXINS
(304) ON THE CENTRAL NERVOUS SYSTEM. D. Orb and R. G.

Rows, Joum. of Ment. Sci. t 1914, April, p. 184.

The previous researches of these authors have shown the
possibility of conduction of bacterial toxins to the central nervous

ABSTRACTS

253

system along the sheaths of peripheral nerves. The present
experiments throw light upon the method by which the spinal cord
and brain are affected by toxins in the abdomen. Celloidin
capsules of staphylococci were placed in different parts of the
abdomen of rabbits, and the animals were killed after six weeks.
The chief changes found in the cord were hyaline degeneration of
the blood vessels of both the grey and white matter, with hyaline
thrombi occluding them in many cases, myelin degeneration of
the peripheral areas of the cord, especially of the upper part, and
glial proliferation around the affected vessels. The nerve cells
were but slightly affected. The sympathetic ganglia in the
abdomen were found to be inflamed in every case.

The authors think that the cord changes are due to disturbance
of the circulation in the vessels of the cord from infection and
inflammation of the sympathetic nervous system, although direct
action of the toxins upon the affected vessels may have had a
secondary effect. They think that analogous changes may be
responsible for the lesions of general paralysis.

W. D Wilkins.

CLINICAL NEUROLOGY.

THE CEPHALOGRAPH, A NEW INSTRUMENT FOR RECORD-

(305) INO AND CONTROLLING HEAD MOVEMENTS. A. Knaubr
and W. J. Maloney, Joum. Nerv. and Afent. Dig., 1914, xli., No. 2,
Feb.

A clinical instrument has been constructed to record graphically
oscillations about a vertical axis of the upright standing or sitting
body, oscillations which, when exaggerated, are known as Romberg’s
phenomenon.

The instrument devised records the movements of the head in
two dimensions, in the sagittal and in the frontal planes. The
exact description of the apparatus with drawings is given.

It is said that in organic disturbances of the nervous system,
such as locomotor ataxia, and in many of the psychoneuroses,
especially in all kinds of tics, the chart will soon be covered with
lines of characteristic shape and direction. In the treatment of
morbid conditions the patient is systematically exercised to control
the excursions of the recording pen. D. K. Henderson.

THE CENAjSTHOPATHIBS. (Lea Gdnesthopathies.) Adstbbgesilo

(306) and Esposkl, L’Enctphale , 1914, ix., May 10, p. 425.

By the term cenaesthopathy is meant an alteration of common
sensibility (cenaesthesia), i.e., of those sensations from the different

254

ABSTRACTS

parts and organs of the body which, normally, do not impress
themselves on consciousness by any peculiarity either of intensity
or of modality. The health of our organs is affirmed by their
negation, so to speak. Censesthopathy is the constant subjective
sensation^ of the body. Disturbances of censesthesia are very
common in the general neuroses and psychoses, but the term
censesthopathy should be restricted to those cases where the
psychoneurosis take almost entirely the form of a disturbance of
centesthesia. The syndrome may occur by itself, or it may occur
with other psychoneuroses and be incorporated with them.

One of the predominant features in centesthopathy is a strange,
painful sensation which is usually distinguished by the patient
from ordinary pain. The head and the abdomen are the most
constant seats of these unpleasant sensations, which the patients
often have difficulty in describing. The authors record excellent
clinical instances of the syndrome, and discuss its etiology and its
treatment. S. A K. Wilson.

THE OCULO CARDIAC REFLEX IN GRAVES’ DISEASE. (Le
(307) rdflexe oculo-cardiaque dans le syndrome de Basedow.) B.

Qcillaumont, Theses de Paris , 1913-14, No. 229.

The oculo-cardiac reflex was first described by Aschner in 1908
(Wien. klin. Woch., 1908, xxi., p. 1529). In three-fifths of all
persons examined a slowing of the radial pulse by 5 or 6 pulsations
normally occurs when the eyeballs are pressed back into the orbits
(positive reflex). In other cases tachycardia results (inverted
reflex), or there is no change in the cardiac rhythm (negative reflex).

The writer examined 33 cases of Graves’ disease and found the
reflex was positive in 22, absent in 8, and inverted in 3. When
improvement took place and tachycardia diminished, difference in
the pulse rate caused by ocular compression was also less marked.

The anatomical substratum is the fifth nerve, bulb and vagus
or sympathetic, according as the reflex is positive or inverted.

J. D. Rolleston.

THE OCULO CARDIAC REFLEX. (Le rdllexe oculo-cardiaque.)

(308) Gautbblet, Paris Mid., 1912-13, iii., p. 583.

Gautrelbt never found cardiac acceleration after ocular com¬
pression in Graves’ disease, tuberculosis, or pulmonary disease in
general rheumatism or alcoholism. In three cases of tabes he
found slight diminution in the number of radial beats, but in two
cases there was acceleration, and in five no change at all after
ocular compression. Slight slowing of the pulse was found in

ABSTRACTS

255

heart disease, sciatica, and facial neuralgia, and slight acceleration
in radiculitis, polyneuritis, and hysteria. No reaction was noted in
cases of hernia, haemorrhoids, ulcer of the leg, and fractures of the
thigh. J. D. Rollbston.

THE OCULO CARDIAC REFLEX IN NORMAL SUBJECTS WITH-

(309) OUT BRADYCARDIA. (Le rlflexe ocnlo-cardiaque chez les
sujeta nonnaux non bradycardiques.) Petzetakis, Bull, et mbn.
Soc. mid. Hip. de Parity 1914, xxxviL, p. 662.

The writer examined seventy-five persons whose pulses varied
between 70,80, and 85, in the dorsal decubitus and found that the
oculo-cardiac reflex was normally manifested by slowing of the
cardiac rhythm. The slowing varied on the average from 5 to 12
beats per minute. In only three cases, two of whom were females,
was acceleration of the pulse noted. After injection of atropine
the reflex was abolished. After injection of pilocarpine the reflex
persisted, and in some cases was exaggerated.

The greatest slowing was caused by compression of the right
eye, which shows that the right vagus is the most excitable, as
has already been observed by S. Arloing and Trippier in animals,
and is the rule in normal subjects. J. D. Rolleston.

CIRCULATORY AND RESPIRATORY PHENOMENA PRODUCED

(310) BY OCULAR COMPRESSION. (Phlnomdnes drculatoires et
respiratoires produites par la compression oculaire.) Pktzetakis,
Compt. rend. Soc. dc Bud., 1914, lxxvi., p. 366.

Slowing of the cardiac rhythm is not the only phenomenon pro¬
duced by ocular compression. In a few cases acceleration occurs,
while in others both phenomena take place, a period of slowing
being followed by a few hurried beats.

These facts show that both cardio-moderator and cardio-
accelerator elements are concerned in the reflex, and that the
anatomical paths are the pneumogastric and the sympathetic.

In most cases the blood pressure rises while the number of
cardiac pulsations is diminished. This rise of pressure is to be
attributed to stimulation of the vaso-motor centre.

Ocular compression causes slight diminution in the number of
respirations. The amplitude of the respiratory movements may
be increased, the respiration often becomes spasmodic at first, and
subsequently there are inspiratory pauses which are the most
constant respiratory phenomena during ocular compression. As
these symptoms persist after injection of atropine, the phrenic
appears to be responsible for their occurrence.

J. D. Rolleston.

256

ABSTRACTS

OCULO CARDIAC REFLEX PRODUCING STOPPAGE OF THE

(311) HEART. VENTRICULAR AUTOMATISM AND AURICULO-
VENTRICULAR DISSOCIATION. OVARIAN INSUFFIENCY
ASSOCIATED WITH THYROID OVERACTIVITY. EPI¬
LEPTIFORM ATTACKS. (Rdflexe oculo cardiaque provoqu&nt
l’arrfet du coeur, l’automatisme ventriculaire et la dissociation
auriculo - ventriculaire. Syndrome hypo-ovarien et hyper¬
thyroidism Crises dpileptiformes.) H. Dufoue and Legras,
Bull, et mim. Soe. mid. H6p. de Paris, 1914, xxxvii., p. 686.

A woman, aged 22, after a miscarriage, developed signs of ovarian
insufficiency, characterised by amenorrhoea, complete loss of pubic
and axillary hair, and partial loss of hair on the scalp. On the
other hand, thyroid overactivity was shown by a slight goitre,
tachycardia, exophthalmus, and renewed growth of the hair on
the pubis.

Cerebro-spinal hypertension was shown by epileptiform attacks.

According to the degree of compression exerted, the oculo¬
cardiac reflex produced the following results:—

1. Total stoppage of the heart. 2. Slowing of the heart.
3. Auriculo-ventricular dissociation. 4. Ventricular automatism.

J. D. Rolleston.

CONSTANT SUPPRESSION OF THE OCULO CARDIAC REFLEX

(312) BY ATROPINE. (Suppression constants par l’atropine dn
rdflexe oculo cardiaque.) A. Monoeot, CompL Betid. Soc. de Biol.,
1914, lxxvi., p. 162.

Mongeot found that subcutaneous injection of 1 mm. of atropine
sulphate attenuated the oculo-cardiac reflex, and that a dose of
1J mm. in women and 2 mm. in men completely abolished it,
whether it was normal, exaggerated, or inverted before injection.
This result occurred 25 to 45 minutes after injection, and was
obtained both in normal persons and in cases of tachycardia
without arrhythmia. J. D. Rolleston.

CHANGES IN THE REFLEXES PRODUCED BY OCULAR OOM-

(313) PRESSION IN EPILEPSY. (Considdrations but les modifications
des rdflexes produites par la compression oculaire chez certains
Fpileptiques.) C. Lesieur, M. Vbrnet, and Petzbtakis, Bull, et
mfan. Soc. mid. H6p. de Paris , 1914, xxxvii., p. 510.

The writers first investigated the condition of the reflexes in
epilepsy apart from ocular compression, with the following
results:—Except in fits, the tendon reflexes were normal in most
cases. There was no knee nor ankle clonus. The abdominal
reflex was almost invariably absent or diminished. As a rule

ABSTRACTS

257

the cremasteric reflex was present. The corneal reflex was variable.
After slight fits there was no change in the reflexes. If the fit
was severe, a very limited period in which the reflexes were
absent was followed by a period in which they were exaggerated.

In some cases ocular compression produced a very marked
exaggeration of both tendon and skin reflexes. Ankle clonus
might occur. The writers attribute this exaggeration to a
stimulation of the reflex centres in the bulbo-pontine region.
In normal subjects this phenomenon does not occur on ocular
compression, because their reflex centres are not so excitable
as those of the epileptic. J. D. Rolleston.

STOPPAGE OF THE HEART BY THE OCULO CARDIAC REFLEX

(314) IN AN EPILEPTIC. (Considerations physio-p&thologiques but
un cas d’arrSt du cceur par le rdflexe oculo-cardiaque chez un
dpileptique.) C. Lesieur, M. Vernet, and Pbtzetakis, Bull, et
mim. Soc. mid. HGp. de Paris, 1914, xxxvii., p. 394.

In a man, aged 31, the subject of Jacksonian epilepsy and right
hemianiesthesia, extremely moderate compression of the right
eye produced complete stoppage of the heart. After eight or nine
seconds’ compression syncope ensued and compression had to be
interrupted, but later complete stoppage of the heart for fourteen
seconds was obtained.

The patient then showed considerable hyper-excitability of the
vagus, as is the rule in most epileptics. Associated with the slow¬
ing and arrest of the heart were disturbances of respiration,
mastication, deglutition, and vaso-motor troubles which undoubtedly
corresponded to bulbar stimuli. After subcutaneous injection of
2 mgm. of atropine the oculo-cardiac reflex was abolished, but
the respiratory disturbance continued, being due to the persistence
of an oculo-phrenic reflex, and was accompanied by disturbances
of deglutition and mastication, ptosis, mydriasis, and vaso-motor
troubles. The vagus, therefore, was exclusively paralysed.

J. D. Rolleston.

EXAGGERATION OF THE OCULOCARDIAC REFLEX IN

(315) EPILEPSY. ITS VARIATIONS UNDER THE INFLUENCE
OF MEDICINAL AND TOXIC CAUSES. (Contribution &
l’dtude du rdflexe oculo-cardiaque: son exagdration dans
l'dpilepsie. Ses variations sous l’influence d’actions mddicament-
euses ou toxiques.) C. Lrsieor, M. Vernet, and M. Petzetakis,
Bull, et mem. Soc. mid. H6p. de Paris, 1914, xxxvii., p. 440.

The writers examined 33 cases of epilepsy, 23 of whom were men
and 10 women, with the following results:—

258

ABSTRACTS

1. The reflex was always considerably exaggerated: 9 showed
slowing of from 30 to 50 beats per minute, and 20 slowing of more
than 16 beats per minute; in the remainder the slowing was from
12 to 16. The reflex was more exaggerated in female than in
male epileptics. With two or three exceptions patients with
fewest fits were those in whom the reflex was least exaggerated,
and those with frequent fits were those in whom the reflex was
most exaggerated.

2. Action of Potassium Bromide. —Epileptics with few fits who
were taking bromide had a less exaggerated reflex than those in
whom the bromide had been stopped. Cessation of bromide was
always followed by exaggeration of the reflex. The stronger the
dose of bromide, the nearer did the reflex come to normal. The
state of the reflex was thus a guide to the suitable dose.

3. Effects of Tobacco on the Cardiac Nerves. —Two epileptics, who
were heavy smokers, with a moderately increased reflex, were
chosen, and prevented from smoking for three days. The reflex
was noted before and after the deprivation of tobacco, and after
their return to it. The most typical case showed a slowing of
12 beats before cessation, during cessation a diminution of 8
beats, and after resumption of tobacco a slowing of 28 beats.

4. The State of the Reflex Before and After Fit. —The fit seemed

to diminish the hyperexcitability of the vagus, as the diminution
in the number of the beats, which before the fit had been 24,
immediately after was only 8. J. D. Rolleston.

PERSISTENCE OF OCULO CARDIAC REFLEX IN GENERAL

(316) ANAESTHESIA. (Persistence du rdflexe oculo-cardiaque pendant
l’anesthdsie gdndrale.) Fabbe and Pbtzetakis, Compt. Rend. Soc.
de Biol., 1914, lxxvi., p. 343.

The writers found that the oculo-cardiac reflex persisted longer
than the corneal reflex under general anaesthesia. During ether
anaesthesia the reflex persisted the whole time, while in chloroform
anaesthesia it only disappeared in very deep anaesthesia.

J. D. Rolleston.

INHIBITORY ACTION OF OCULAR COMPRESSION ON THE

(317) ABNORMAL MOVEMENTS IN A CASE OF DOUBLE
ATHETOSIS. (Action inhibitrice de la compression oculaire
sur les mouvements anormaux das un cas d’athdtose double.)

G. Guillain, Bull, et mdm. Soc. mid. H6p. de Paris, 1914, xxxvii.,
p. 850.

A record of a case of a girl, aged 20, in whom choreo-athetotic
movements of the face and limbs were almost completely stopped

ABSTRACTS

259

by ocular compression. Exaggeration of the oculo-cardiac reflex
was shown by diminution in the pulse rate of twenty-nine beats
per minute. The compression had to be discontinued, as it caused
a tendency to syncope. J. D. Rolleston.

THE OCULO CARDIAC REFLEX IN PATIENTS SUFFERING

(318) FROM VARIOUS TREMORS. (Le rlflexe oculo-cardiaque chez
des sujets attaints de divers tremblements.) C. Lksieur,
M. Vernet, and Petzetakis, Bull, et mem. Soc. mid. Hop. de
Parity 1914, xxxviL, p. 593.

The writers found the reflex normal in alcoholic and senile tremor,
lost in paralysis agitans, sometimes exaggerated in general
paralysis, and variable in disseminated sclerosis.

J. D. Rolleston.

THE OCULO CARDIAC REFLEX AND PARALYSIS AGITANS.

(319) (Rdflexe oculo-cardiaque et maladie de Parkinson.) C. Lesieur,
M. Vernet, and Petzetakis, Bull, et mini. Soc. mid. Hop. de Paris,
1914, xxxvii., p. 599.

The writers found complete and constant absence of the oculo¬
cardiac reflex in fifteen out of sixteen cases of paralysis agitans.
Their conclusions are as follows:—

1. The loss of this reflex can only be explained by some change
in the reflex centre.

2. The constancy of this loss suggests the probability of a
corresponding lesion in this centre in paralysis agitans, and so of a
mesencephalic, or more precisely, a bulbo-ponto-cerebellar lesion.

3. Morbid anatomy shows that this region is most frequently
affected in paralysis agitans.

4. The clinical study of paralysis agitans shows symptoms of
disorder of equilibrium resembling an incomplete cerebellar
syndrome.

5. The intensity of the tremor appears proportioned to the

intensity of the corresponding lesion. A unilateral tremor corre¬
sponds to a unilateral lesion, and causes a unilateral change in the
oculo-cardiac reflex. J. D. Rolleston.

FREQUENT ABOLITION OF THE OCULO-CARDIAC REFLEX IN

(320) SYPHILIS. (Abolition frdquente du rdflexe oculo-cardiaque chez
les syphilitiques.) Loepbr, Mongeot, and Vahram, Bull, et mim.
Soc. mid. H6p. de Paris, 1914, xxxvii., p. 506, and Progres mid.,
1914, xli., p. 157.

The writers examined 40 patients in various stages of syphilis, and
found the reflex absent in 30. Its absence was more frequent in
secondary than in primary syphilis, especially when the lesions of

260

ABSTRACTS

the skin and muoosfe were well marked. It was invariably absent
in nervous syphilis, and almost always so in tertiary syphilis,
independently of any cutaneous osseous or arterial lesions. The
loss of the reflex may be due to neuritis of the fifth or of the
vagus, and perhaps to mediastinitis and periaortitis, but it is chiefly
caused by a bulbar lesion. The frequency of the loss of the oculo¬
cardiac reflex in syphilis contrasts with the rarity of its abolition
in other infectious diseases, such as tuberculosis, pneumonia,
typhoid fever, or malaria. J. D. Rolleston.

ON THE FREQUENT ABOLITION OF THE OCULOCARDIAC

(321) REFLEX IN TABES. (Note but l’abolition frdquente du rdflexe
oculo-cardiaque dans le tabes.) C. Lesieub, M. Vernet, and
Petzetakis, Bull, et mem. Soc. mid. H6p. de Paris, 1914, xxxvii.,
p. 446.

Like Loeper and Mongeot the writers found the oculo-cardiac
reflex almost always abolished in tabes. In 9 out of 13 cases the
abolition was complete, in 3 the reflex was almost imperceptible,
and in 1 it was nearly normal. They also found that this reflex
may be absent although there is no Argyll Robertson pupil. The
writers think that the loss of the reflex indicates the condition of
the bulbar or the bulbo-pontine sensory roots, and therefore the
degree of upward extension of tabes. J. D. Rolleston.

ABOLITION AND INVERSION OF THE OCULO-CABDIAC BEFLEX

(322) IN PSEUDO-BULBAB PARALYSIS. (Abolition et inversion
dn rdflexe oculo-cardiaque dans les paralysies pseudo-bulbaires.)
G. Guillain and J. Dubois, Bull, et mem. Soc. mid. U6p. de Paris,
1914, xxxvii., p. 584.

Of six cases of pseudo-bulbar palsy examined, four showed loss of
the reflex, and two inversion. J. D. Rolleston.

FAVOURABLE ACTION OF OCULAR COMPRESSION ON

(323) CERTAIN NERVOUS MANIFESTATIONS, ESPECIALLY
HICCOUGH. (Action favorable de la compression oculaire sur
certaines manifestations nerveuses et en particular sur le hoquet.)
Loeper and Weil, Bull, et mim. Soc. mid. U6p. de Paris, 1914,
xxxvii., p. 631.

The writers found that bilateral compression of the eyeballs had a
favourable effect on vertigo, tinnitus, pharyngeal and pharyngo-
cesophageal spasm, but the most striking results were obtained in
the treatment of yawning, sneezing, or obstinate hiccough. Most
of these morbid symptoms are due to irritation of some of the
bulbar centres, and ocular compression substitutes a new stimulus
which has a regulating effect. J. D. Rolleston.

ABSTRACTS

261

GLYCOSURIA, ALBUMINURIA, AND POLYURIA CAUSED BY

(324) OCULAR COMPRESSION. (Glycosurie, albuminuria at
polyuria provoqudes par la compression oculaire.) C. Lksikur,
M. Vebnet, and Petzetakis, Bull, et mem. Soc. mid. Hop. de Paris »
1914, xxxvii., p. 515.

Three male and three female epileptics were examined. All
showed marked polyuria after ocular compression. Three had
albuminuria and four glycosuria. In two there was neither
glycosuria nor albuminuria. The albuminuria appeared two hours
after compression, and lasted about one and a half hours; the
glycosuria appeared three hours after compression. Five hours
after compression none of the urines showed either albumin or
sugar. These results resemble those obtained by Claude Bernard
after puncture of the fourth ventricle, and show that the centripetal
path of the oculo-cardiac reflex may sometimes be the sympathetic.

J. D. Rolleston.

FIBROSARCOMA OF THE LEG IN A WOMAN SUFFERING

(325) FROM RECKLINGHAUSEN’S DISEASE. (Fibrosarcome de la
jambe chez une femme atteinte de la maladie de Recklinghausen.)
H. Morestin, Bull. Soc. AnaL de Paris, 1914, xvi., p. 79.

A woman, aged 30, had had a small swelling on her leg since
childhood, but within the last few months it had grown rapidly.
The typical phenomena of Recklinghausen’s disease were present.
The tumour was successfully removed, and was found to be a
spindle-celled sarcoma. J. D. Rolleston.

TRANSITORY BROWN-S^QUARD’S SYNDROME AT THE ONSET

(326) OF SPINAL SYPHILIS. (Syndrome de Brown-Sdquard au ddbut
d’une syphilis m6dullaire.) Duhot and Boez, L'Echo mid. du
Nord, 1914, xviii., p. 197.

A man, aged 31, developed weakness of both legs, followed three
days later by complete paralysis of the right leg and difficulty in
micturition. There were thermal and tactile hyperesthesia in the
right leg, and hypoesthesia in the left leg. Babinski's sign was
present on both sides, syphilis was denied, but the tongue was
fissured and showed patches of leucoplakia, and Wassermann’s
reaction, though negative in the spinal fluid, was positive in the
blood. There were cerebro-spinal hyperalbuminosis and moderate
lymphocytosis. On the day following lumbar puncture the
monoplegia diminished, and sensibility returned in the left leg.
The patient was then treated with neosalvarsan, and the sensory
troubles disappeared, and the gait improved.

The transitory duration of Brown-S^quard’s syndrome and its
spontaneous disappearance showed that it was due to ischaemia

262

ABSTRACTS

and not to sclero-gummatous meningitis, which is the usual cause
of the syndrome in syphilis. J. D. Rolleston.

THE SEROTHERAPY OF OEBEBRO-SPINAL MENINGITIS. (La

(327) slrothlrapie de la mlningite clrlbro-spinale.) A. Orticoni, Bull,
et mim. Soc. mid. Hip. de Paris, 1914, xxxvii., p. 006.

Thirty-eight cases of cerebro-spinal meningitis occurred in the
20th Army Corps at Nancy between November 1913 and March
1914. Of these 34 were due to the meningococcus, whereas in the
previous year only 7 were observed during the same period. On
subtracting 1 case in which the meningitis was due to an associa¬
tion of the pneumococcus with the meningococcus, and another
who was injected in extremis, the mortality was only 8*8 per cent.
—the lowest on record. This favourable result was due to the
early use of anti-meningococcic serum. Each patient was given
30 or 40 c.c. for three or four consecutive days according to the
gravity of the case. Convalescence was early and rapid, and no
sequelae occurred. J. D. Rolleston.

RECURRENT FEVER AND MENINGEAL SYNDROME (EPL

(328) DEMIC OF RECURRENT FEVER IN GREECE DURING AND
AFTER THE TWO WARS OF 1912-13). (Filvre recurrent® et
syndrome mining* (£pid6mie de filvre recurrent* en Grice
pendant et aprls les deux guerres de 1912-13).) G. S. Coskin as,
Bull, et mem. Soc. mid. Hip. de Paris , 1914, xxxvii., p. 772.

Of 43 cases of recurrent fever treated at the Clinique Mldicale of
Athens University from March 1913 to March 1914, 8 cases, or
17 per cent., of whom brief histories are given, showed a meningeal
syndrome consisting of Kernig’s sign, rigidity of the neck and
other muscles, hyperesthesia, and mental disturbance. ThiB
syndrome might occur at any stage of the disease, but was moBt
frequent and intense in the first attack. Jt was not accompanied
by any changes in the cerebro-spinal fluid except a very slight
increase in the amount of albumin, and its occurrence did not
aggravate the prognosis of recurrent fever. J. D. Rolleston.

CEREBRAL RHEUMATISM EXPLAINED BY HEMORRHAGIC
(329 MENINGITIS OCCURRING IN THE COURSE OF ACUTE
ARTICULAR RHEUMATISM (Rhumatisme clrlbral expliqul
par one mlningite hlmorragique survenant &u corns d’un
rhumatisme articulaire aigu.) A. Robin and L- Lyon-Cabn, Bull
et mim. Soc. mid. Hip. de Paris , 1914, xxxvii., p. 717.

An alcoholic man, aged 37, had two attacks of acute articular
rheumatism. The first was complicated by delirium and meningeal

ABSTRACTS

263

phenomena, and the second by meningeal phenomena without
delirium.

The term “ cerebral rheumatism ” was justified by the following
considerations:—(1) The appearance of violent delirium during
the acute stage of acute articular rheumatism. (2) The pain and
swelling in the joints disappeared when the delirium occurred, and
returned when the mental state became normal. (3) The form of
the delirium—mental confusion with hallucinations—was typical
of toxi-infective delirium.

Although many cases of so-called cerebral rheumatism are really
examples of alcoholic delirium, the psychosis in the present case
was differentiated by the absence of tremor and the intensity of
auditory hallucinations. Alcoholism was, however, probably a
predisposing cause of the cerebral phenomena. Salicylate delirium
could be excluded because it is more sudden in onset and is
accompanied by false bradycardia and extrasystoles. Uraemic
delirium could also be excluded because there was no myosis, and
only slight and transient albuminuria. Before attributing the
meningitis to rheumatism, meningococcal, gonococcal, and syphilitic
infection had also to be excluded by appropriate examination of
the cerebro-spinal fluid. Recovery took place.

J. D. Rolleston.

TWO OASES OF SUPPURATIVE OTOGENIC MENINGITIS WITH
(330) RECOVERY. (Deux cas de mtaingite otog&ne suppurde suivis
de garrison.) G. Coulet, Rev. de Laryngol ., 1914, i., p. 621.

These cases were reported to the Otological Section of the
Seventeenth International Medical Congress.

Case 1. A man, aged 20, who had suffered from left Suppurative
otitis media from childhood was admitted to hospital with well-
marked meningitis. Examination showed osteitis of the walls of
the antrum and tympanum, with erosion of the labyrinth and
infection of the perilymph. A radical mastoid operation was
performed, followed by lumbar puncture, which showed a turbid
fluid with abundant polymorphs, and a few cocci, isolated or in
pairs. After a second lumbar puncture, by which a similar fluid
was obtained, the temperature came down to normal, and the
patient was discharged after a fortnight’s stay in hospital. When
seen three months later he was in good health.

Case 2.—A man, aged 36, developed acute right otitis media
which was treated by irrigation, and soon subsided, but a fortnight
later symptoms of meningitis ensued. Twenty c.c. of turbid
cerebro-spinal fluid were removed under hypertension, and were
replaced by 5 c.c. of electrargol. Microscopical examination showed
abundant polymorphs but no meningococci. After a second

264

ABSTRACTS

puncture the symptoms subsided, and the temperature became
normal five days after admission to hospital. A month later there
was a return of the symptoms of meningitis. Fifteen c.c. of turbid
spinal fluid were removed, and replaced by 5 c.c. of electrargol.
The following day the temperature became normal, and the patient
was discharged in good health six days after admission.

J. D. Rolleston.

HEREDO SYPHILITIC SPASTIC PARAPLEGIA. (Paraplegic spas-

(331) modique h6r6do-syphilitique chez lea grands enfants.) A. B.
Mabfan, Arch, de mdd. da enf., 1913, xvi., p. 561.

In addition to the congenital variety of spastic paraplegia (Little’s
disease), and the two postnatal forms, viz., the spastic paraplegia
of Pott’s disease and Strumpell’s familial spastic paraplegia, there
is a form which was first described by Marfan in 1909 under the
title of heredo-syphilitic spastic paraplegia. It is characterised
by spastic rigidity of the lower limbs which interferes with
walking, but which almost disappears when at rest, and is accom¬
panied by only a slight diminution of muscular power. Sensory
disturbance, sphincter troubles, muscular atrophy, and other trophic
disturbances are completely absent. On the other hand, ocular
troubles are always present. Argyll Robertson pupil or complete
paralysis of the pupils, and disturbance of visual acuity are
constant. Often there is some pallor of the optic discs, and
interstitial keratitis is frequent. There may be some mental
backwardness. The disease is progressive and shows no evidence
to spontaneous recovery. Mercury and potassium iodide are
ineffectual, but some improvement has followed intravenous
injection of salvarsan. Marfan has seen six cases of the con¬
dition, but none has come to autopsy. J. D. Rolleston.

SYRINGOMYELIA FOLLOWING A PERIPHERAL INFECTION.

(332) (Syringomydlie consecutive k une infection pdriphdrique.) G.

Guillain and J. Dubois, Bull, ct mim. Soc. mid. H6p. de Parity
1914, xxxvii., p. 634.

A plumber, aged 50, got a poisoned wound of the right middle
finger necessitating amputation in 1893. In the following years
multiple whitlows developed on both hands, and were followed by
sensory disturbance. In 1898 his gait became affected, and in
1909 he had arthropathy of the left shoulder.

At the present time he presents trophic disturbances and
enlargement of both hands, spastic paraplegia, with Babinski’s sign
and ankle clonus, and the characteristic sensory changes of
syringomyelia.

ABSTRACTS

265

Lumbar puncture showed no excess of albumin nor cellular
reaction in the spinal fluid. The tuberculin intra-dermo-reaction
and luetin reactions are negative, and both the blood and the
spinal fluid gave a negative Wassermann’s reaction.

J. D. Rolleston.

TWO OASES OF REMOVAL OF EXTRA DURAL TUMOUR OF

(333) THE SPINAL CORD. Philip Coombs Knapp, Joum. Nerv. and
Ment. Dig., 1914, xli., No. 1 , Jan.

The report of two interesting cases in whom improvement took
place after operation. The author believes that, owing to the
hopeless outlook in most of these cases, operation is always justified,
even where the growth cannot be wholly removed.

D. K. Henderson.

TRAUMATIC HJEMATOMTELIA WITHOUT VERTEBRAL

(334) LESION. Claude and Loybz, L'Encephale, 1914, ix., May 10, p. 403.

The number of cases of this sort, examined anatomically, appears
to be but small. The patient, a young man of 26, fell some fifteen
feet, and was diagnosed in hospital as a case of fracture of the
spine about the level of the tenth dorsal segment. He presented
the characteristic symptoms of a transverse lesion of the cord.
Death supervened on the fifth day. No lesion whatever was
found in the vertebral column, or in the spinal canal: the dura
was intact and normal. Nevertheless a vast hsematomyelia was
found to have taken place, extending from the fourth dorsal to
the third lumbar segment. The authors lay importance on the
occurrence of paralytic vasodilation as an explanation of late
apoplexy: in their case something of this sort must have occurred.

S. A. K. Wilson.

A CASE OF LANDRY’S PARALYSIS. R. O. Douglas, Australian

(335) Med. Joum., 1914, iii., April 25, p. 1530.

A blacksmith, aged 30, complaining of headache and tendency to
vomiting, followed by weakness of both legs, was admitted to
hospital with a diagnosis of typhoid fever. The bladder was
distended and required catheterisation. No reflexes could be
obtained in either leg or foot. There were no movements of the
toes or ankle, although the thighs could be moved well. Sensation
was normal. An absolute flaccid paralysis of both legs developed,
followed by weakness of both arms, and sudden cessation of
diaphragmatic breathing. Artificial respiration was performed
until death. Later, speech became inaudible, and diplopia developed,
and death occurred from sudden heart failure.

A. Ninian Bruce.

266

ABSTRACTS

GLIOMA OF THE CORPUS CALLOSUM AND LEFT PARIETAL

(336) LOBE: BILATERAL APRAXIA. Laignkl - Lav astute and
L&vy-Valensi, L’Enctphale, 1914, ix., May 10, p. 411.

Clinically. —A mental condition analogous to the dementia of
dementia paralytica, without any of the somatic signs of that
disease: spasmodic paresis of the limbs, bilateral extensor re¬
sponse: mixed bilateral apraxia (motor and ideational): death
thirty-six hours after a lumbar puncture.

Pathologically. —Glioma of the posterior two-thirds of the
corpus callosum, invading the centrum ovale of the left parietal
lobe: multiple small haemorrhages in both hemispheres.

The significance of the case is fully discussed. The authors
incline to the view that the parietal lesion was responsible for
the bilateral apraxia, and that the involvement of the corpus
callosum was a complication of little importance from the point of
view of the determination of apraxia. They consider that where
left-sided apraxia is produced by a lesion of the corpus callosum,
it is always the anterior part of that commissure which is
involved. S. A. K. Wilson.

A CASE OF SUBCORTICAL OR PURE MOTOR APHASIA

(337) (DEJERINE) OR ANARTHRIA (MARIE). F. X. Dercum
Journ. Nerv. and Ment. Dis., 1914, xli., No. 3, March.

A young man, 32 years, one day previous to his admission to the
hospital, suddenly became unable to talk, and had a complete
right-sided hemiplegia. There was no sensory involvement. The
patient was unable to make the slightest articulate sound. He
could grunt and make various discordant noises, but could not
even say the words “ yes ” or “ no.”

The patient’s understanding of spoken speech and com¬
prehension of what was said to him was perfect; he could read
written or printed matter, and could carry out instructions
perfectly. There was no agraphia. He could write from dictation.
This condition persisted for three or four weeks, when he began
to utter his own name and occasionally other words. It was
thought that the patient had had a subcortical syphilitic lesion,
involving the knee of the internal capsule, and probably the
adjacent portion of the lenticular nucleus. D. K. Henderson.

HEMIPLEGIA AND PROSTATECTOMY. (HemipMgie et prosta

(338) tectomie.) Loumkau, Journ. de Mid. de Bordeaux, 1914, lxxxv.,
p. 252.

A record of a successful operation in a man, aged 77, to show that
hemiplegia, far from being a contra-indication to prostatectomy,
may be an urgent reason for its performance. J. D. Rolleston.

ABSTRACTS

267

DIABETIC FACIAL PARALYSES. (La paralysis facials diabdtique.)

(339) Sarah Gaitz, Theses de Paris, 1913-14, No. 153.

The thesis contains the histories of 28 cases, including the
following original ones:—

1. A woman, aged 62, diabetic for the last twenty years,
developed right facial paralysis. About twelve months previously
paralysis of the left upper limb had occurred. Under appropriate
treatment the facial paralysis almost entirely disappeared in six
weeks, but the neuritis of the upper limb persisted.

2. A woman, aged 32, diabetic for the last two years, developed
right facial paralysis. Recovery took place after three weeks’
treatment.

3. A man, aged 40, diabetic for ten years, developed right
facial paralysis which lasted for three years. After two months’
treatment recovery took place.

The writer’s conclusions are as follows :—

i. Diabetic facial paralysis is an undoubted form of peripheral
facial paralysis.

ii. Its onset is sudden.

iii. It is often the first sign of diabetes.

iv. An anti-diabetic regime and electrical treatment are
sufficient in almost every case to effect a cure.

J. D. Rolleston.

A CASE OF FACIAL HEMIATROPHY. M. Neustabdteb, Med.

(340) Record , 1914, lxxxv., p. 700.

A case of right facial hemiatrophy in a woman aged 41, in whom
the disease started at the age of 12 years after an injury to the
forehead with a poker. The atrophy progressed till she was 21,
when it became stationary. At 32 she was seized with epilepsy
of the grand mod type, and had suffered at irregular intervals
from it since. The atrophy involved the skin, muscles, and bone.
There were no sensory changes beyond pain on deep pressure
along the course of V 2 and V s . Wassermann negative.

J. D. Rolleston.

THE PROBLEM OF SLEEP. Salmon, L’Encephale, 1914, ix., Feb.,

(341) March, and April, pp. 168, 250, and 364.

This is a long contribution to the study of the physiology of sleep,
based on papers and other communications already made by the
author.

Briefly, his view is that sleep is neither toxic nor psychical
in origin, but that it is a function of secretion. It is intimately
related to the functional activity of certain special glands of

268

ABSTRACTS

internal secretion. The particular secretory function associated
with sleep has its seat in the nerve-cells of the cortex, and consists
in chromatogenesis, or the elaboration and accumulation of
chromatophil elements in the cytoplasm. The chromatic substance
accumulates in nerve-cells during repose, and disappears in activity,
in the same way as glycogen accumulates in muscle-cells. The
author believes that the nucleus of nerve-cells acts on the
chromatin substance, and that the latter may be regarded as the
actual product of the internal secretion of the cells. Can this
active process of internal secretion which goes on during sleep
explain the mechanism of sleep ? The author advances arguments
to suggest that the elaboration of the chromatic elements by a
synthetic process is accompanied by a process of dehydration of
the nerve-cells; with this dehydration the neurofibrils rapidly lose
their excitability and their conductivity. Similarly, with the
diminution of osmotic pressure, the metabolism of the cell is
reduced. The tigroid bodies, it is known, are really colloidal
granulations in the living cells, and the greater their molecular
concentration, the less capable are they of transmitting nerve
vibrations. The chromatogenic function of the cell ceases when
the latter can no longer absorb any more material for its nutrition
from the pericellular lymph. Then the dehydration comes to an
end, and the chromatophil granulations undergo a process of
fluidification. With that the excitability of the cell returns.
Spontaneous awakening depends on the exhaustion of the secretory
function presiding over sleep. We awake because we are tired of
sleeping, as we sleep because we are tired of being awake.

The author’s views are elaborated with skill and force; and
the papers are well worth reading in the original

S. A. K. Wilson.

RESTITUTION PHENOMENA IN CEREBRAL PALSIES IN
(342) RELATION TO PHYLOGENESIS AND THEIR THERA¬
PEUTIC INFLUENCE. (Die Restitutionsvorg&nge bei den
cerebralen L&hmungen in ihrer Beziehnng zur Phylogenese und
ihre therapentische Beeinflnssnng.) Rothmann, Deut. Zeitschr.
f. Nervenheilk ., 1914,1., Hft. 5-6, p. 406.

In man a flaccid palsy follows section of the path between the
senso-motorium and lower motor centres. This flaccid palsy does
not persist, and eventually a degree of return of power takes place
with the development of spastic contractures. The conditions are
very different in this connection between man and the lower
animals. It has been supposed that the return of movement, such
as it is, and the development of contracture, are associated with the
assumption of function on the part of “lower motor centres.”

ABSTRACTS

269

Phylogenetically old centres assume a compensatory function when
phylogenetically recent centres are thrown out of gear. The
question arises whether and to what extent the intact hemisphere
can function for the injured hemisphere. It is known that in apes
a paresis produced by removal of one cerebral hemisphere is less
than that produced in the opposite limbs when their cerebral
centres are subsequently removed. Rothmann has shown that the
removal of the centres on the same side does not prejudice the
paretic movements that remain when the corresponding ( i.e .,
contralateral) centres have previously been removed. It is
supposed that commissural connections between “ midbrain motor
centres,” which are normally very incomplete, after removal of
cortical motor centres on one side, and the gradual increase of
function of “subcortical motor centres” of the corresponding
hemisphere, enable stimuli from the unimpaired cortical motor
centres passing to the “midbrain centres” of the same side, to
reach also the corresponding centres of the opposite side. In this
way “secondary” movements may take place in the originally
injured extremities. As phylogenetically old “subcortical motor
centres” Rothmann specifies particularly the nucleus ruber and
the tractus rubrospinalis. The size and importance of these are
in inverse proportion to the development of the cortico spinal
path. Hence there is greater difficulty in their assuming their
old function the higher the animal is in the series. Rothmann
also mentions extra pyramidal paths in the anterior columns of
the cord as capable of assuming motor functions, without, however,
specifying what these paths are.

Rothmann, however, is careful to point out that it is insufficient
to argue from the (possible) condition in apes to that in man,
inasmuch as the assumption of the erect attitude in man has
changed the functions of the motor cortex and “ subcortical motor
centres.” Weeks or months may elapse, in the case of man, before
the excitability of the “ ganglion cells of the midbrain centres ” is
raised sufficiently to send impulses to the spinal cord centres
capable of raising muscle tone and effecting “voluntary” move¬
ments. In the leg the flexors are apt to be most seriously
affected after a pyramidal lesion, whereas in the arm it is the
flexors that first show return of movement. There is an extension-
contracture of the leg and a flexion-contracture of the arm. This
is explained, according to Rothmann, by the assumption of the
erect attitude. He declares, further, that the first returning motor
impulses in paralysed limbs, after a pyramidal lesion, are solely of
“ subcortical ” origin, and that these are of a certain type (“ phylo-
geneticaUy old movement forms”). Later, the influence of the
intact homolateral hemisphere comes into consideration.

It is not the reviewer's duty to criticise the paper he abstracts;

270

ABSTRACTS

nevertheless, attention may be drawn to the fact that the interesting
hypotheses of this paper are not supported by any definition of
the “subcortical motor centres” constantly assumed, with the
exception, already mentioned, of the red nucleus. Rothmann
may be referring to certain “ Haubenbahren,” to which a motor
function was assigued by Probsfc, whose name Rothmann does not
mention. But the function of some of these paths is known not
to be that here presumably assigned to them. S. A. K. Wilson.

A CONTRIBUTION TO THE STUDY OF SO CALLED PSEUDO-
(343) SCLEROSIS, WITH CHANGES IN THE CORNEA AND IN
THE LIVER. (Em Beitrag zur kenntnis der sog. Pseudosklerose
mit gleichzeitiger Ver&nderung der Hornhaut und der Leber.)
Stbumpbll and Handmann, Deut . Zeitschr . f . Nervenheilk ., 1914,
L, Hft. 6-6, p. 465.

The patient was a man of 37, who for about six years had suffered
from tremor of the head and arms and fingers, and became
incapable of work. The onset of the disease was gradual. With
active movements the tremors increased. There was a certain
stiffness in facial expression. There was no tremor of the tongue.
Articulation was slow and somewhat syllabic. The tremors of
the arms were rhythmical and quick, and quite symmetrical. The
tonus of the musculature was not obviously altered. Cutaneous
and deep reflexes were normal. On the outer section of the
cornea was a brown-grey pigmented ring, about 2-3 mm. broad.
On close examination it was found to consist of minute dark
pigment particles. The liver dulness was unusually small, while
the spleen seemed enlarged.

There were no obvious psychical symptoms, and no apoplecti¬
form attacks, both of which are supposed to be common signs in
so-called pseudosclerosis. In spite of their absence, the authors
conclude that there can be no doubt that their case is one of
pseudosclerosis.

The argument is (1) that the tremor disappears entirely with
complete resting of the muscles; (2) it is most marked in the
muscles which are most in active contraction; (3) there is an
expressionless facies; (4) the peculiar pigmented ring of the
cornea is found only in pseudosclerosis; (5) there is evidence of
disease of the liver. Only (4) and (5) are of diagnostic significance,
however. Perhaps (4) may prove to be a point of distinction
between pseudosclerosis and progressive lenticular degeneration.
It must be clearly understood that various cases of pseudosclerosis
have been recorded where no liver cirrhosis was noted. In the
group, however, are several recent valuable cases where liver
changes were present. To this sub-group the present case may
belong. S. A. K. Wilson.

ABSTRACTS

271

ASEPTIC LEUCOCYTOSIS OF THE CEBEBRO SPINAL FLUID

(344) WITH SUBACUTE MENINGEAL SYNDROME IN THE
COURSE OF CEREBRAL HAEMORRHAGE. XANTHO¬
CHROMIA AND POLYNUCLEOSIS. (Leucocytose aseptique
du liquide cdphalo-rachidien avec syndrome m4ning4 snbaign
an cours dea h&norragies c4r4brales. Xantocromie et poly-
nndeose.) J. Amandrut (de Laval) and A Gendron (de Nantes),
Bull, et mem. Soc. med. H6p. de Paris, 1914, xxxvii., p. 766.

A record of two cases of cerebral luemorrhage, accompanied from
the first with meningeal phenomena such as nuchal rigidity,
Kernig, and Brudzinski. In both cases lumbar puncture showed
an amber-coloured fluid, the coloration of which gradually
diminished until it completely disappeared, with considerable
leucocytic reaction.

In the first case, that of a man aged 38, 5 days after the
onset of cerebral luemorrhage, the spinal fluid showed 688
leucocytes in each cubic millimetre, 18 days later 108, and at the
end of 35 days 41. The leucocytic formula evolved as in ordinary
meningitis, there being exclusive polynucleosis at the onset, then
polynucleosis and lymphocytosis, and finally pure lymphocytosis.
Recovery took place.

In the second case, that of a man aged 30, examination of the
spinal fluid at a date nearer the onset of the hemorrhage showed
a pink fluid not coagulating spontaneously, and yielding a red
clot on centrifugalisation. Subsequently the fluid became amber-
coloured, and showed a less marked leucocytosis than in the first
case (fifty leucocytes in each cubic millimetre).

Post mortem an encysted hemorrhage was found which had
destroyed the internal capsule and part of the grey nuclei. There
was no blood on the convexity nor trace of meningitis.
Wassormann’s reaction in the blood and cerebro-spinal fluid was
negative. J. D. Rolleston.

THE PROGNOSTIC AND DIAGNOSTIC VALUE OF THE SIGN OF

(345) ISOLATED HYPERALBUMINOSIS IN THE CEREBRO¬
SPINAL FLUID. (De la valeur pronostique et diagnostique da
signe de lbyperalbuminose isolde du liquide cdph&lo-rachidien.)

A. Vernes, Compt. rend. Soc. de Biol., 1914, lxxvi., p. 280.

A RETROSPECTIVE SIGN OF SYPHILIS — PURE HYPERAL
(316) BUMINOSIS OF THE CEREBRO SPINAL FLUID WITHOUT
LEUCOCYTOSIS AND WITHOUT WASSERMANN. (Un signe
retrospectif de la syphilis; hyperalbuminose pure du liquide
cdphalo-rachidien, sans leucocytose et sans Wassermann.) M.
Bloch and A Vernes, ibid., p. 281 .

Vernes has found isolated hyperalbuminosis not only in patients
without any clinical sign of nervous syphilis, but also in former

272

ABSTRACTS

syphilitic patients who no longer showed any signs of visceral or
cutaneous disease, and in whom Wassermann’s reaction had been
negative for many months.

In forty cases of syphilis Bloch and Vemes found that the
amount of albumen in the cerebro-spinal fluid ranged from 0 30 g.
to more than 1 g. per 1,000, as compared with the normal 018 to
0*20 g. per 1,000, while the number of leucocytes in the fluid was
normal, and Wassermann’s reaction was negative. It is difficult
to say whether this sign indicates an extinct lesion of the
meninges, or if it is due to some other cause. It may be met
with from one to thirty-five years after the onset of syphilis.

J. D. Rolleston.

XANTHOCHROMIA OF THE CEREBRO SPINAL FLUID IN
(347) A8TST0LIC PATIENTS. (La xanthocromie du liquids cdphalo-
rachidien chez les asystoliques.) A. Babes, Compt. rend. Soc. de
Biol., 1914, lxxvi., p. 313.

In examining the cerebro-spinal fluid of patients with failure of
compensation, Babes was struck by its yellow colour. In eight
cases it was intense, corresponding to 5 c.c. of 1 in 100,000 solution
of bichromate of potash, and in two it was hardly perceptible.
None of the cases showed any icterus, and none of the fluids gave
the reaction for bile pigment. Babes attributes the xanthochromia
to a transudation of the pigment of the blood serum into the
cerebro-spinal fluid. J. D. Rolleston.

SOME OBSERVATIONS ON THE OCCURRENCE OF THE WA8SER-
(348) MANN REACTION IN THE SERUM OF THE CHILDREN
OF THE POORER CLASSES. W. M. Elliott, QIclbqow Med.
Joum., 1914, Ixxxi., May, p. 339.

The method of carrying out the test was that recommended by
Browning and Mackenzie, and it was found that about 8 per cent,
of all classes of children from the poorer classes of Glasgow give
a positive Wassermann reaction, and thus, if this reaction is to
be taken as pathognomonic of syphilis, a considerable portion of
the children of the poorer classes are infected with this disease.
Congenital syphilis may exist without any apparent effect on the
general health of the child. Poorly nourished children are not in
that condition to any extent because of syphilitic infection, and
treatment to improve their health need not run on these lines.

A. Ninian Bruce.

ABSTRACTS

273

BIOLOGICAL REACTIONS IN SYPHILITIC DISEASES OF THE
(349) CENTRAL NERVOUS SYSTEM. (Biologische Reaktionen bei
syphilogenen Erkrankungen des Zentralnervensystems.) Nkue,
Devi. Zeittchr.f. Nervenheilk ., 1914,1., Hft. 5-6, p. 311.

1. The author uses Hauptmann’s method for the Wassermann
reaction, and finds it gives positive results in 100 per cent, of cases
of general paralysis; in tabes and cerebro-spinal syphilis it gives
positive results in “ a preponderating number ” of cases.

2. In organic nervous diseases not of syphilitic origin the test
is negative for the cerebro-spinal fluid even in individuals who have
formerly had syphilis, and in whom a positive reaction may be
present in the blood.

3. Hauptmann’s method is of the greatest value in determining
the etiology of an organic nervous disease.

4. Only the finding in the cerebro-spinal fluid is of significance
when it is positive, and the serum Wassermann reaction negative.

5. The Weil-Kafka hfemolysin reaction of the cerebro-spinal
fluid was positive in 90 per cent. (32 cases total) of general
paralysis, in 22 per cent, of cerebral syphilis, and 20 per cent, of
tabes cases. It was positive in 8 per cent, of 25 non-syphilitic
nervous cases. In combination with the “ four reactions ” it may
help to diagnose between general paralysis and cerebral syphilis.

6. Abderhalden’s reaction is positive only with the cortex in
cerebral syphilis, as a rule, whereas it is positive with the albumin
of various other organs as well (notably the liver, kidneys, and
pancreas) in general paralysis.

7. The luetin cutaneous reaction is of value in distinguishing
between cerebral syphilis and general paralysis.

8. The goldsol reaction of Lange (colloidal gold chloride) in the

cerebro-spinal fluid is of value in distinguishing syphilitic from
non-syphilitic nervous diseases. S. A* K. Wilson.

LATE SYPHILITIC FACIAL PARALYSIS ASSOCIATED WITH
(350) CHRONIC PULMONARY SYPHILIS. (Paralisi sifllitica tardiva
del 7° paio associata a sifllide pulmon&re cronica.) E. Verde,
Giom. internal, di Sci. med., 1914, xxxvi., p. 199.

The patient was a man, aged 31, who had contracted syphilis
many years previously, and had since suffered from cough and
night sweats. A few days before being seen by Verde he suddenly
developed right facial paralysis. Signs of broncho-pneumonia
were found at the left apex. He was treated with daily injections
of biniodide of mercury, and after thirty-eight injections complete
recovery took place. J. D. Rolleston.

274

ABSTRACTS

PRESENT STATUS OF NEOSALVARSAN IN THE TREATMENT

(351) OF PARASYPHILIS OF THE NERVOUS SYSTEM E. D.

Fibber, Joum. Nrrv. and Ment . Dis., 1914, xli., No. 1, Jan.

A short general statement, without value either from the laboratory
or clinical point of view. D. K. Henderson.

ON REFLEX EPILEPSY OF THERAPEUTIC ORIGIN. (De ftpilepue

(352) rlflexe thtoapeutique.) H. Dufotjr, Pari » mid ., 1913-14, iv., p. 511.

Dufour records several cases of typical epileptic convulsions
occurring after various trivial operations, such as thoracentesis,
phlebotomy, vaccination, lumbar puncture, injection of 606, or
even rectal or vaginal examinations. A personal or family history
of epilepsy can often be obtained in such cases, but undue appre¬
hension on the part of the patient is an important factor.

J. D. Rolleston.

ALCOHOL AND DELIRIUM TREMENS. Dbmole, L'Encephale, 1914,

(353) ix., Jan. 10, p. 5.

The author has employed the qualitative method of Lieben and
the quantitative method of Nicloux for the determination of the
presence of alcohol in the cerebro-epinal fluid, urine, blood, saliva,
and respired air of twenty-three cases of alcoholism. His conclu¬
sions are that at the commencement of an attack of delirium tremens
alcohol is found in the above-mentioned places only if the patient
has taken alcohol during the preceding twenty-four hours. It is
eliminated in twenty-four hours as in a normal individual, so that
the attack continues though there is no alcohol in the system. In
many cases of delirium tremens no alcohol is discoverable in the
system. Treatment by alcoholic drinks in gradually diminishing
quantity is quite unjustifiable. S. A. K. Wilson.

EXPERIMENTAL STUDY OF INTRANEURAL INJECTIONS OF

(354) ALCOHOL. Alfred Gordon, Joum. Nerv. and Ment. Pi*., 1914,
xli. No. 2, Feb.

In this paper the histological and corresponding functional results
obtained from injections of alcohol into motor, sensory, and mixed
nerves has been studied experimentally.

The same strength of alcohol (80 per cent.) was used, the same
number of drops (five), the same degree of penetration of the
needle into the substance of the nerve, the same dissection and
exposure of the nerve trunks, the same after care of the wounds,
and finally the same species of animals, viz., dogs.

The experiments were divided into two series: one series of
three dogs were kept alive nine days, the other series of three

ABSTRACTS

275

dogs lived twenty-nine days. The facial, infra-orbital, and sciatic
nerves wore experimented upon. The first was traced in its intra¬
medullary course. The other two were removed with their re¬
spective ganglia (Gasserian and spinal).

In the first series the infra-orbital nerve showed peri- and
endoneuritis, with accumulation of small cells around and in the
vicinity of the smallest nerve bundles. The latter were intact,,
with the exception of an occasional nervus nervorum which was
degenerated. The Gasserian ganglion showed chromatolysis in
some of the cells; the majority of the cells were intact. The
facial nerve at the periphery and in the medulla was found
intact.

The sciati: nerve presented about the same changes as the
infra-orbital, viz., perineuritis, with occasional degeneration of a
nervus nervorum.

In the second series the infraorbital nerve presented peri¬
neuritis with a very marked proliferation of round cells around
each individual nerve bundle; they were also seen in the
adventitia of the arteries. The Gasserian ganglion presented
marked chromatolysis and proliferation of cells of the capsule.
The peripheral facial nerve presented slight neuritis and evidences
of regenerating connective tissue fibres. The course of the nerve
in the medulla appeared to be normal. The sciatic nerve showed
very marked perineuritis, with extensive degenerative changes in
the nerve bundles. From these findings it is evident that the
changes are almost identical in sensory and mixed nerves, and that
these changes are in striking contrast to those found in the motor
(facial) nerve.

In the therapeutic management of affections of nerves, the
above differences in the susceptibility of motor and sensory nerves
to the effect of alcohol must be borne in mind.

D. K. Henderson.

ANTERIOR CRURAL NEURITIS. C. M. Byrnes, Joum. Nero, and
(355) Ment. Die., 1914, xlL No. 1, Jan.

The first portion of this article has already been abstracted in this
Review, The author, from a review of the literature and from
personal observations, has collected 136 cases in which the femoral
nerve of one or both sides has been the seat of an inflammatory
process originating from some internal or medical disorder.

The disease is chiefly met with in middle-aged and elderly
people, but one case has been described in a child 7 years old.
The onset of the disease may be acute or subacute. By far the
commonest and earliest symptom is pain in the distribution of
the crural nerve, or one of its neighbouring branches. In sub¬
acute cases, in the course of a week or month, the pain becomes

276

ABSTRACTS

more persistent, of wider distribution, greater intensity, and of a
continuous paroxysmal nature, with nocturnal exacerbations.

In regard to locating the pain, the striking feature is the
rather indefinite and vague effort to outline the exact area.
Sensory changes of a destructive nature are rather uncommon,
and the author has found only one case in which there was
.definite loss of sensation.

Vasomotor and trophic changes occur, and except in the
mildest cases there is always some motor disturbance.

The knee jerks are nearly always altered; in the mild cases
there is merely a diminution of the tendon reflex upon the
affected side, but in severe cases the knee jerk is invariably lost.

One definite personal case of idiopathic femoral neuritis is
"reported. D. K. Henderson.

THE RELATIONS BETWEEN EXOPHTHALMIC GOITRE AND

(356) THE PUERPERAL STATE. (Contribution k l’6tude des rapports
rdciproques dn goitre exophtalmique et de l’dtat puerperal.)

L. Boisboux, Theses de Paris , 1913-14, No. 127.

Both experimental work and pathology prove that a close relation
exists between the thyroid and the genital organs. The influence
of pregnancy on exophthalmic goitre may be favourable or the
reverse. Thus a goitre may develop during pregnancy, or a simple
goitre may be converted into Graves’ disease, or pre-existing goitre
may get worse. On the other hand, Graves’ disease may improve
during pregnancy.

Exophthalmic goitre may act on pregnancy in one of two ways.
Sometimes it causes abortion, premature labour, or haemorrhage
during and after delivery. More frequently it has no influence
at all on pregnancy or the puerperium.

In old standing goitre the effect on the puerperium is uncertain.
In such cases marriage or fresh pregnancies should be forbidden.
When pregnancy is normal, the ordinary medical treatment for
goitre should be carried out. Surgical and obstetrical treatment
should be reserved for the worst cases. The thesis contains the
histories of twenty cases, including two original ones, in one of
which the symptoms of Graves’ disease improved, and in the other
became worse during pregnancy. J. D. Rolleston.

EXOPHTHALMIC GOITRE AND GLTCOSURIA. FAILURE OF

(357) PITUITARY OPOTHERAPY. (Goitre exophtalmique et
glycosurie. Essais nlgatifs d’opothdrapie hypophysaire.) Duhot
and Hallbz, Echo mid. du Nord , 1914, xviii., p. 128.

The patient was a man, aged 38, who had suffered from
exophthalmos for twelve years, and goitre for the last three

ABSTRACTS

277

months. The urine did not exceed a total of from 1,500 to
2,000 g. in the twenty-four hours, but showed a slight and inter¬
mittent glycosuria (5 to 38 g. per litre). Repeated subcutaneous
injections of 1 c.c. of the posterior lobe of the hypophysis
caused slight improvement of the subjective symptoms, but did
not influence the glycosuria. A subcutaneous injection of 1 c.c.
of adrenalin was followed by malaise, vertigo, arterial hypertension,
and palpitation. J. D. Rolleston.

DEFACED TYPE OF ADDISON’S DISEASE. A. O. Holmes, Joum.

(358) Amer. Med. Assoc., 1914, lxii., p. 532.

The patient was a man, aged 72. The diagnosis during life lay
between pernicious anaemia and cancer of the stomach. The blood
pressure was not remarkably low (110), probably because the other
chromaffin cells of the chromaffin system supplied part of the
necessary pressor substance. Post mortem the only tuberculous
lesions besides those found in the suprarenals were slight puckering
and calcareous infiltration of the left apex. J. D. Rolleston.

TETANY IN THE ADULT AND ITS PARATHYROID ORIGIN.

(359) (Contribution k l’ltude de la tdtanie chez l’adulte et de son origins
parathyroldienne.) Mile. R. Lifschitz, Theses de Paris , 1913-14,
No. 221.

Tetany in the adult may be due to a variety of causes which
include infections and intoxications, exogenous and endogenous,
such as the puerperium (v. Review , 1911, ix., p. 515), gastric dilata¬
tion, and uraemia; it may follow partial removal of the para¬
thyroids; or, finally, it may occur without any obvious cause
(essential tetany).

In every case it seems to depend upon a disturbance of function
in the parathyroids. This hypothesis is undoubtedly true in the
case of surgical tetany, and appears probable in essential tetany,
and in tetany due to toxic causes.

One of the most important functions of the parathyroids is
to regulate calcium metabolism. When there is a disturbance of
function in these organs there is an excessive elimination of
calcium, and the tissues are left in a state of hyperexcitability
manifested by tetany.

Parathyroid opotherapy is the best treatment for tetany.
Calcium salts and bleeding have given good results in experimental
cases.

The thesis contains the histories of two original cases in
patients aged 17 and 18, the first associated with late rickets
and epilepsy, and the second being an example of essential tetany.

J. D. Rolleston.

278

ABSTRACTS

PSYCHIATRY.

THE COMPLEMENT DEVIATION IN CASES OF MANIC-

(360) DEPRESSIVE INSANITY. Lewis C. Bruce, Joum. of Merit.
Sci., 1914, April, p. 178.

An account of some further researches by this author to demon¬
strate the existence of specific toxins in cases of manic-depressive
insanity. He employed the serum of one case as the complement
and urine of another case as the antigen, or vice versa, and found
that in both instances deviation of the complement was obtainable,
whereas serum or urine from sane healthy persons did not give
the reaction. The urine of depressed cases has much greater com¬
plement-deviating power than the urine of elevated cases, while,
on the other hand, the serum from depressed cases has very much
less power than that from elevated cases. This holds good also
for urine or serum obtained during the depressed and elevated
stages of the same case of manic-depressive insanity. The sug¬
gestion is made that the presence in sufficient quantity of immune
body in the serum neutralises the toxin, and that whenever the
amount of immune body falls, the toxins become able to affect the
nerve tissues and produce depression. W. D. Wilkins.

THE CLINICAL SIGNIFICANCE OF KATATONIC SYMPTOMS.

(361) Henry Devine, Joum. of Ment. Sci., 1914, April, p. 278.

Two cases are reported of young women who presented character¬
istic symptoms of dementia praecox, but who recovered and were
discharged. They both relapsed and have again recovered, one case
having had three attacks. Neither showed any evidence of
permanent dementia. The author maintains that such cases
should be separated from those that show steady deterioration,
and are not to be looked upon as recoverable cases of dementia
prsecox, but rather as cases of hysterical insanity or as manic-
depressives with symptoms coloured by the youth of the patients.
He gives as the essential difference between the two types the
presence of confusion in dementia prsecox and its absence in the
recoverable cases, and maintains that katatonic symptoms, without
confusion, may occur in a variety of mental disorders, especially
in youth. W. D. Wilkins.

THE PUPIL AND ITS REFLEXES IN INSANITY. A. H. Frith,

(362) Joum. of Ment. Sci., 1914, Jan., p. 82, and April, p. 224.

A very full and exhaustive account of the condition of the pupil
and its reflexes in the various forms of insanity. A large number
of cases were carefully examined and tabulated, and the results are
compared with those of previous observers. The author finds that

REVIEW

279

minor changes are commoner than is generally supposed,
especially in alcoholic and other toxic insanities, but that well-
marked defects are uncommon except in general paralysis and
syphilitic insanity.

The view that diminution and loss of the sensory and psychical
reflexes and of pupil unrest are of diagnostic importance in
dementia praecox is not confirmed by these researches, as these
symptoms were found to be not uncommon in other types of
insanity. W. D. Wilkins.

THE IMPORTANCE OF DISTURBANCES OF THE PERSONALITY
(363) IN MENTAL DISORDERS. R. G. Rows, Joum. of Ment. Sci.,
1914, April, p. 192.

A full analysis of two cases in which the basis of the disorder was
a change in the personality of the patients. They first noticed a
feeling of strangeness, a feeling that their thoughts were not their
own, or as one of the patients expressed it: “ It was like two
circles of thought in one person.” Engrafted upon this, and
arising from an involuntary wish for explanation of the disturbing
feelings,' came numerous delusions. The author fully discusses,
but rejects, the theory that the consciousness of personality is
formed by the sum of all the organ sensations, and that such
disturbances of personality as are here considered, are due to
disturbances of these organ sensations. He considers that the
essential change is a failure of apperception, the patients being
unable to obtain clear consciousness from an inability to comprehend
external and internal impressions. Such failure of apperception
has been found to follow disturbances of the feelings, and in the
present cases these were of a sexual character. The patients were
unmarried women of 33 and 36 respectively, and had both
obviously suffered from their enforced and unwilling celibacy.
However, the author thinks that such cases as these may be due in
part to alterations of the organ sensations arising from lesions of
the sympathetic system, the result of toxic infections in the
abdomen and elsewhere. W. D. Wilkins.

■Review.

MALADIES DES MENINGES. By Professor Hutinel and Drs
(364) Klippel, Claude, Voisin, and Levy-Valensi, M6decins des
hdpitaux de Paris. With 49 illustrations. Paris: J. B. Baillifere et
Fils, 1913. Pp. 383. Pr., paper, 8 fr.; bound, 9 fr. 60.

The subject of meningitis is one of those which is claimed by
experts in different branches of medicine, or rather, which appeals

280

BOOKS AND PAMPHLETS RECEIVED

to the exponents of several specialties. Epidemic cerebro-spinal
meningitis seems to belong to the fever physician more than to
the neurologist; syphilis in its meningeal manifestations is being
taken in charge by the bacteriologist; while the neurologist may
be left with various meningeal conditions, not a few of which he
must hand over to the surgeon sooner or later. In the study of
the diseases of the meninges, in short, there is common ground for
the meeting of surgeon, physician, neurologist, bacteriologist,
syphilologist, and others still, no doubt. In view of these facts,
the compilation of a text-book on the diseases of the meninges is
bound to be effected satisfactorily only by collaboration. We may
claim justly that it is the province of the neurologist first of all,
but he finds himself therefore in the position of having to widen
his marches if he is to remain master of his subject.

The volume under review deals with the varieties of acute
meningitis of the brain and cord in a very elaborate fashion, but
the chapters on the more chronic forms, if less full, are at the
same time sound and well written. Sections are devoted to the
anatomy and physiology of the spinal meninges, to the cerebro¬
spinal fluid, meningitis circumscripta serosa, so-called meningism,
haemorrhagic meningitis, and so on. One of the sections is
concerned with the varieties of meningitis from the etiological
standpoint, and it is excellently done. The sections on treatment
commend themselves to the reader’s consideration by the careful
and practical nature of the suggestions they contain.

We suspect that the apparent rarity of meningitis circumscripta
serosa in France—there are no references to French cases in the
volume—has perhaps somewhat handicapped the authors of the
chapter concerned: it is no rarity in this country, and is met with
in forms not apparently familiar to them. There is comparatively
little reference to syphilitic meningitis in the book, as it is
dealt with in another volume of the series. In view of the
importance of the subject, the description of the cerebro-spinal
fluid deserves rather more space than is devoted to it, especially
since there is so much allusion to its pathology.

The book contains a thoroughly up-to-date account of the
diseases of the meninges, and may be cordially recommended to the
attention of all interested in the subject. S. A. K. Wilson.

BOOKS AND PAMPHLETS RECEIVED.

Aronsohn, Oscar. “ Der psychologische Ursprung des Stotterns.”
Sammlung Bumke , 1914, xi., H. 1 . Pr. M.l.

DSjdrine, J. “ S4miologie des Affections du Systfeme Nerveux.” Avec
560 figures en noir et en couleurs et 3 planches hors- texte en couleurs).
1914, Masson et Cie. Paris.

“ The Training School .” 1914, xi., May.

■Review

IReuroloQp mb flb8£cbiatii>

Original Hrticles

A CASE OF AMAUROTIC FAMILY IDIOCY.

By W. E. HUME, Newcastle-on-Tyne.

(With Plates 5-8.)

Cases of amaurotic family idiocy, or Tay-Sachs disease, are by
no means frequent in any part of the country, and in the North of
England are exceptional. And the reason for this local infrequency
lies in the fact that the disease is confined to the Jewish race, and
the latter do not collect in such large numbers in the northern
cities as they do, for instance, in certain parts of London.

Since Warren Tay first described the disease in 1881 many
instances of this affection have been recorded, and the clinical
manifestations of the disease are very definite and unmistakable.
Permission for post-mortem examinations is not easy to obtain
from Jews, and therefore the material available for complete
investigation in this uncommon disease has not been abundant.
A few cases, however, have been subjected to pathological investiga¬
tion, and Mott, amongst others, has described the histological
changes in the nervous system in great detail.

The present case was kindly transferred to me by Mr Wardale,
Senior Ophthalmic Surgeon to the Royal Victoria Infirmary,
Newcastle-upon-Tyne.

Clinical History.

Cissie A., aged 12 months, was brought on 4th April 1910 to
Mr Wardale, as the mother thought that the child was blind, and
she was afraid that “Cissie was going like the other two.”

282

W. E. HUME

Attention will be drawn to the fact that it is probable that two
other children suffered from, and died of, this complaint.

The present patient, bom at full term, and breast fed, was the
youngest of five children, and the mother thought that she had
been blind since birth. The child had never tried to sit up nor
crawl about. During the last six months the mother stated that
there had been frequent fits.

On admission she was well covered with subcutaneous fat,
though pale and flabby, and gave no indication of taking notice of
anything around her. There was some retraction of the head, and
the child cried when attempts were made to flex the head on the
chest. There seemed to be some general hyperesthesia, as the child
usually cried when she was touched or moved. Food was abundantly
taken, and she slept well. There was no strabismus and the pupils
reacted slightly to light. On ophthalmoscopic examination, in the
region of the macula the characteristic appearances were well
marked. There was a large circular white patch with a bright red
spot in the centre. The disc itself was pale and atrophied. It
was evident that the child had some appreciation of light, as the
eyes occasionally followed a lighted match.

The arms and legs could be moved, though little voluntary
effort was made to move them. The legs were flabby, and no knee
jerks could be obtained. There was an extensor response of the
big toe when the sole of the foot was scratched. When she was
lifted out of bed the general atony of the musculature became
very obvious.

After being in the hospital for one month, the irritability
and fretfulness gave place to perpetual apathy, and the child was
content to lie in any position in which she was placed, and could
not easily be made to cry.

She was discharged in this condition on 21st May 1910, and
was brought by the mother as an out-patient from time to time.

In July 1910 the child was thinner than she was during her
stay in the hospital, and it seemed that she was weaker.

In October 1910 the flaccidity of the muscles had been replaced
by rigidity. The thumbs of both hands were flexed into the
palms, and were grasped by the closed fingers. The legs were
extended at the knee joints, and the foot was likewise extended
at the ankle. The knee jerks were very active. The mother
stated that the child did not seem to notice anything, and that

LATE

Flo. 1. — Tay-Sachs Disease.
Motor cortex, x TOO.

•$

• <% *

? &
; jU*f>

; %iJ r

Fr;. 2. — Tay-Sachs Disease
Phagocytic cells contain¬
ing fat droplets, perivas¬
cular lymphatics, x 800.

j|?

Fr*.

3. — Tay-Sachs Disease. Motor cells,
with numerous fat granules in proto¬
plasm. x S00.

A CASE OF AMAUROTIC FAMILY IDIOCY 283

at times she had difficulty in swallowing. The ophthalmoscopic
appearance of the eyes remained the same.

In January 1911 the mother was persuaded to le^ve the
child in hospital. From the time of readmission until the child
died on 3rd March 1911, she remained in a semi-conscious condi¬
tion. She was always able to swallow small quantities of liquid,
and nasal feeding was unnecessary to the end.

The wasting became very marked, and the rigidity of the
muscles increased, the hands assuming the main-en-grifft posture.

The child died on 3rd March 1911, at the age of 23 months.

Family Table.

Gt. -Gt. -Grandfather
(died of eancer)

Gt. -Grandfather
(died at 30 years)

Grand¬

father

Male

Father

Gt. -Grandmother
(living)

I Grandfather Grandmother

(died j

foung) (died young)

XU _

1 Grand- !

mother | |

Female Female

_iJ' Jv _\

Male Male Male

looiftie tuimij Itiviug;

(living and healthy)

Mother

Female Male Female Male Female

(died at 14 months (living and (died at 11 (living and (present ease died
10 days) healthy) months) healthy) at 23 months)

Family History.

The parents were Russian Jews, and had always enjoyed good
health. The patient was the youngest child of a family of five.
Of the other four children two had died, and from the accom¬
panying pedigree it will be seen that they were both females.
The eldest child died at the age of 14 months and 10 days, and the
third child of the family died at the age of 11 months. The
mother was quite positive that both of these children suffered
from the same complaint as the present case. They had both
been blind from their earliest days, and had become paralysed
and rigid before death. They never “ noticed things ” like other
children. During the lifetime of these two children the parents
were living in Leeds, and their medical attendant was communi¬
cated with, but he was unable to recall the cases. The remaining

284

W. E. HUME

children, both males, are strong and healthy. The father’s father
died at the age of 30; his son thought that he had brought about
his own early demise by taking vinegar and oil, so that he might
render himself unfit for military service. The father’s mother
is living and well. He has one sister and one brother, who are
both said to be strong and healthy. The father’s grandfather
died from cancer. The mother’s parents both died when they
weTe comparatively young, and when she herself was only a
small child. The cause of their death is unknown. She has had
two sisters and three brothers, four of whom are living and
well: one sister died after confinement. No history could be
obtained which gave rise to a suspicion of any other nervous
disease being present in the family.

Pathological Examination.

Considerable difficulty was experienced in obtaining the
necessary permission to make a post-mortem examination, but
after much persuasion the parents gave consent for a limited
examination. This was done on the day following death.

The physiognomy did not suggest the characteristics of an idiot
or an imbecile. The calvarium was thin. On exposing the brain
there was no flattening or shrinking of the convolutions; in fact,
the brain appeared to be particularly well formed, and the gyri
were large and prominent. The brain was heavier and tougher
than normal. There was no excess of fluid in the basal cisterns.
The brain, a portion of the cervical cord, and one eye were removed
and forwarded to Dr Mott, to whom I am indebted for the histo¬
logical preparations from which the following figures were made.

Dr Mott has shown that the morphological changes in the
brain are very characteristic in this disease. Briefly, it may be
stated that there is a progressive failure of Nissl substance which
commences in the peripheral part of the cell, and gradually extends
inwards towards the nucleus, the latter becoming eccentric. A
fatty substance, of the nature of a lipoid, accumulates in the cell.
This accumulation and a process of hydrolysis cause the swelling
of the cell. These characteristic changes are best seen in the
cells of the motor cortex, the Purkinje cells of the cerebellum, the
anterior cornual cells of the spinal cord, and the ganglionic layer
of the retina.

Microphotooraph II. (x300 diam.).

Stained by Cajal’s method. Tlie large cells are distended
pyramidal cells.

Plat*: «>

Mkrophotocraph I. ( x 300 diam.).

Section of Motor Cortex. In centre of field is a large Betz
cell surrounded by degenerated pyramidal cells.

A CASE OF AMAUROTIC FAMILY IDIOCY 285

The Cerebrum .—Microphotograph I. represents a section from
the top of the ascending frontal and parietal regions of the motor
cortex, stained with methylene blue. In the centre of the figure
is a large Betz cell which has undergone considerable degeneration.
The whole cell is swollen. In a large part of it the Nissl substance
has completely disappeared, and this part of the cell has a bladder¬
like appearance. The nucleus is displaced towards the base of
the apical dendron, and does not stain well. There is some
incrustation of the nodal points in the intracellular network
around the nucleus. Two other cells above and below the Betz
cell are in a more advanced stage of degeneration, and are mere
shadows. The small deeply stained cells scattered throughout
the section are probably neuroglial cells, wandering and phagocytic,
and named “ Kronchenzellen ” by Alzheimer.

This is a section (Microphotograph II.) of the cortex stained
by Cajal’s neurofibril method. Throughout the section there are
numerous pyramidal cells which have the appearance of bladders,
studded over with minute globules or particles. The cell substance
is finely granular, and the cell is bounded by darkly stained fibrils.
In some of the cells the basal neurofibril process is split.

Coloured Drawing 1 ( x 700 diam.).

Section stained by Cajal’s method.

Coloured drawing 1 is a higher power drawing of Micro¬
photograph II., and shows very clearly the swollen and degenerated
pyramidal cells. To the left of the figure are two darker stained
neuroglial cells, which in other places are found to be freely
proliferating. The pyramidal cells in the figure demonstrate
different stages of degeneration.

Coloured Drawing 2 ( x 800 diam.).

Section stained with Sharlach R. Pyramidal cells are distended
and full of fine droplets of fat.

Coloured - drawing 2 is a section of the motor cortex stained
with Sharlach R., to show that the small granules and droplets
in the degenerated pyramidal cells are of a fatty character. In
this figure there are four distorted pyramidal cells, in one of
which no nucleus is visible. The whole cytoplasm of the cells
is infiltrated with fine droplets of fat.

286

W. E. HUME

The Spinal Cord .—Microphotograph III. represents a section
of the anterior horn of the cervical cord. In it the anterior
cornual cells are swollen (hydrolysis) and shadowy. The cell
outline is indistinct, and the nucleus has taken up an eccentric
position. As in Microphotograph I., there is some incrustation of
the nodal points in the intracellular network around the nucleus.
One or two anterior cornual cells in this figure have almost
completely disappeared.

The Cerebellum .—When sections of the cerebellum are stained
by Ranke’s Victoria blue method (Microphotograph IV.), it is seen
that there is considerable thickening (felting) of the surface, and
that below this there is a large increase in number of Bergmann’s
neuroglial fibrils. In the deepest part of the section near the
middle line, a Purkinje cell can be seen which has undergone
exactly the same type of degeneration as has been described in
the pyramidal cells of the motor cortex, and the anterior cornual
cells of the spinal cord. The more deeply stained cells are
“ Kronchenzellen.”

The Retina .—In the lower part of Microphotograph V. is
the ganglionic layer of the retina. The ganglionic cells are
abnormal in shape, and their processes in places cannot be seen.
The nuclei are fairly well stained, but the cytoplasm is poorly
stained, and the cell has a swollen appearance. With a higher
power no Nissl substance can be seen. Nothing abnormal can be
detected in the other layers of the retina.

Coloured Drawing 3.

The Removal of Fat .—The appearances represented by coloured
drawing 3 (x800 diam.) can usually be made out in sections
of the cortex stained by Sharlach R. It represents a perivascular
lymphatic in which numerous phagocytic cells are bearing away
the fat of the degenerated cortical cells. The most obvious
pathological characteristic is the degeneration of the cytoplasm
of the essential cells of the central nervous system into some
fatty substance which stains readily with Sharlach R. In order
to account for this fatty degeneration, Mott has suggested that
the nucleus provides a ferment which breaks down the cell
protoplasm into some substance or substances which he regards
as the first half of a vital process. The second half, which

Plate 7

Microphotchiraph III. ( x 300 diam.).

Cervical cord. Anterior cornual cells are swollen
and shadowy.

MiCROPHOTooRAPH IV. ( x 3(H) diam.).

Cerebellum stained by Ranke’s Victoria Blue method. Felt¬
ing of surface, below which there is an increase of
neuroglial fibres. In the deepest parts of the section
Purkinje cells are seen to be swollen and shadowy.

ACTION OF ADRENALIN ON THE PUPIL 287

normally consists in the synthetic building up of tissue (Nisei
substance), does not occur in this disease, because the nucleus
activity fails. “There may be a chemical decomposition on the
way to a fatty acid, e.g., choline glycerophosphoric acid and
stearic acid, and no recomposition” (Mott). In this way he
would account for the inherent failure of normal development
in these cases, and the occurrence of a fatty substance in the
nerve cells.

Summary .—A case of Tay-Sachs disease is described which
bears all the characteristic clinical and pathological features
of this disease.

The microphotographs and the coloured drawings were made
by Mr Richard Muir.

Reference.

Mott and Carlyle.— Proc . Roy . Soc . Med. y 1911. Path., pp. 147-198.

THE ACTION OF ADRENALIN AND EPININE
ON THE PUPIL IN EPILEPSY.

By R. M. STEWART,

Pathologist and Assist. Med. Officer, County Asylum, Prestwich.

Although epilepsy is a disease which has been known and studied
since the time of Hippocrates, we are still without any exact
knowledge of its pathology. Indeed, in no other department of
medicine has knowledge been more slowly gained, for at the
present day, after years of arduous research, we are in possession
of little more than a mass of conflicting hypotheses, and in treat¬
ment are guided solely by empirical rules.

In epilepsy, we cannot even claim the guidance of pathological
anatomy and are compelled to seek a solution of its problems in
the objective study of clinical cases. Accordingly, the convulsive
seizure has been so minutely investigated by both neurologist and
chemist that one might imagine that every mode of approach had
been thoroughly explored. But the discovery of new clinical
tests, rendered possible by the recent advances on our knowledge

288

R. M. STEWART

of the internal secretions of ductless glands, has brought to light
many new facts in relation to the central nervous system of great
importance, and will probably be of value in the elucidation of
many obscure diseases.

One of the most interesting of these is the employment of
extracts from the suprarenal body for purposes of diagnosis, and
by its use in epilepsy the writer has been able to observe certain
interesting phenomena not hitherto described, which suggest the
possibility of disturbance of the sympathetic as a factor in the
production of epileptic fits.

The occurrence in epileptics of derangement of the sympathetic
nervous system, and more especially of that part concerned with
vasomotor control, is not disputed, but the question of the part it
plays as a causal agent in the genesis of fits has long been a
subject of debate.

Of the many theories which have been promulgated, that which
assumes a sudden failure of the cerebral circulation seems worthy
of consideration, and is supported by a certain amount of collateral
evidence. It is well known, for example, that amemia of the
brain may be associated with involuntary muscular spasms, and it
is obvious that such a condition may be determined in one of
several ways. Temporary cardiac arrest, such as occurs in heart
block, may give rise to typical epileptiform convulsions, and it
can easily be demonstrated with the sphygmograph that arrest of
the pulse precedes the epileptic attack.

A considerable amount of evidence is forthcoming to show that
in idiopathic epilepsy a sudden cardiac inhibition may occur.
The pulse may be observed to disappear during the onset of an
attack, and to remain in abeyance until the commencement of the
clonic stage. But such an event is by no means constant, or even
frequent, and too much importance, therefore, cannot be attached
to it.

A comparable failure of the cerebral circulation might be
explained on the assumption of an abnormal vasomotor activity,
acting in such a way as to produce sudden vasomotor spasm of
the cerebral vessels. Direct evidence of such an event is of course
lacking, but its possibility cannot be entirely disregarded, since it
is known that in other diseases allied to epilepsy, such as
Raynaud’s disease and migraine, vasomotor constriction or dilata¬
tion occurs, and is the most probable factor in the production of

ACTION OF ADRENALIN ON THE PUPIL 289

the characteristic clinical signs. Moreover, a condition of spasm
of the retinal arteries during epileptic fits was described by
Hughlings Jackson, and termed by him retinal epilepsy.

But while it has been established beyond contention that
nerve fibres are supplied to the cerebral vessels, the evidence of
vasomotor activity is less positive.

It has been shown also that the regulation of the amount of
arterial blood in the brain is probably effected in an indirect
manner, the condition of the cerebral circulation varying passively
according to that of the skin and splanchnic area.

When, for example, vaso-constriction occurs in the splanchnic
area, the result is a rise of pressure in the circle of Willis, which
then forces more blood through the brain. It therefore follows
that a sudden splanchno-paresis would, if sufficiently profound,
bring about a cerebral anaemia as complete as that produced by
cardiac inhibition or other morbid agencies.

It was a consideration of the above facts which led the writer
to search for some test whereby a disturbance of the sympathetic
nervous system might be demonstrated, and the very intimate
physiological and embryological relationship between the supra¬
renal glands and the sympathetic suggested that in adrenalin one
might find the agent required.

Some success has been attained in the study of nervous and
mental disorders by the employment of intravenous or sub¬
cutaneous injections of adrenalin, but there is a simpler and safer
ocular test which may be termed “ adrenalin mydriasis.”

Lewandowsky was the first to make the observation that, under
normal conditions in man and in mammals, mydriasis is not
produced by the instillation of suprarenal extract into the con¬
junctival sac. After excision of the superior cervical ganglion
adrenalin produces a considerable enlaigement of the pupil, and
this effect has been explained on the supposition that there are
inhibitory fibres supplying the dilator pupillse, taking origin from
the superior cervical ganglion, and which are therefore destroyed
after excision of the latter. But the existence of such inhibitory
fibres has not been satisfactorily proved.

We can, however, with some confidence assume that adrenalin
mydriasis may be an expression of derangement of the normal
sympathetic mechanism. O. Loewi goes further and assumes that
the occurrence or non-occurrence of mydriasis after adrenalin

290

R. M. STEWART

instillation is an indication of the functional activity of the
sympathetic inhibitory nerves.

He considers that the pancreas normally exercises an inhibitory
influence on certain organs innervated by the sympathetic, since
enlargement of the pupil could always be produced in dogs and
cats by removal of the pancreas.

In artificial pancreatic insufficiency, and in many cases of
diabetes, adrenalin mydriasis occurs, and by continuous feeding
with thyroid extract Eppinger and others succeeded in producing
mydriasis in dogs.

The employment of adrenalin in epileptics demonstrated that
mydriasis may frequently be produced after epileptic fits, and that
such a phenomenon is subject to wide variations, manifested not
only in different subjects, but after successive instillations in the
same epileptic.

These will now be considered in some detail.

Solutions Employed.

There are several synthetic products possessing chemical and
physiological properties similar to those of the natural suprarenal
active principle, adrenine; of these the following were em¬
ployed :—

1. Adrenalin (C 9 H 13 0 3 N).—This well-known synthetic product
of the suprarenal gland can be obtained in solutions of varying
concentration. The writer has employed the 1 in 1,000 solution
of adrenalin chloride. It contains chloretone as a preservative,
and remains stable unless unduly exposed to air or light

2. Epinine .—This preparation is closely allied to the active
principle, adrenine, in both its chemical composition and physiological
action. A solution of 1 in 100 produced effects similar to those of
a 1 in 1,000 solution of adrenalin. It was the agent chiefly
employed in the present investigation, in dilutions varying from
1 in 100 to 1 in 100,000, and apparently remained perfectly
stable. In a considerable number of cases it produced mydriasis
where other synthetic preparations failed to have any effect.

3. Suprarenal Extract .—A solution was prepared by scraping
out the medulla of fresh suprarenal glands into normal saline.
After filtration and precipitation of the albumens, a rough attempt
was made to estimate the dilution by comparing the coloration

ACTION OF ADRENALIN ON THE PUPIL 291

produced by adding a few drops of 1 in 1,000 sublimate with that
of a similarly treated solution of adrenalin 1 in 1,000.

This solution, when fresh, gave results apparently not inferior
to those obtained when synthetic preparations were employed, but
extracts made from glands taken from patients succumbing to
chronic diseases were not found satisfactory.

The Effect of Adrenalin on the Normal Pupil.

Although adrenalin produces no effect on the pupil when a
single application is made, a moderate degree of dilatation may be
brought about by repeated instillations.

In an epileptic subject to long periods of freedom from attacks,
one drop of 1 in 100 epinine was instilled into both conjunctival
sacs every half hour, and a moderate degree of dilatation ensued.
The time taken to produce this effect varied on different occasions,
the shortest period being one and a quarter hours, and the longest
seven hours.

It was noticed that the pupil of one eye dilated several hours
before the other, the mydriasis appearing very gradually, and
remaining several hours after the application of drops had
been discontinued. Similar results were obtained from two other
patients.

These observations the writer repeated on himself; a moderate
degree of dilatation was produced in six and a half hours; that
is to say after some 15 m. of epinine had been instilled in each eye.

This amount was evidently sufficient to influence the general
circulation as an intense frontal headache was experienced, with
accompanying acceleration of the pulse rate.

It is evident, therefore, that the continuous action of adrenalin
on the sympathetic nerve endings is capable of producing a
mydriatic effect, but this is never as pronounced as that which
obtains in abnormal states.

Before passing on to study the effects of adrenalin on the
pupil of epileptics, it will be useful to briefly refer to certaiu
phenomena which may be observed during the course of an
epileptic convulsion, and to the various motor and sensory sequela;.

The Pupil .—Rapid and wide dilatation of the pupil is an
almost constant accompaniment of the tonic stage, and is of some
value in differentiating epileptic fits from those of hysterical origin.

292

R. M. STEWART

That it cannot be entirely ascribed to the effects of asphyxia¬
tion is indicated by the fact that it occurs at the commencement
of the seizure, and is invariable in petit mal attacks where there
are no tonic spasms.

At the completion of the tonic stage or even before it the
mydriasis ceases, and the pupils become contracted, remaining so
until the stage of coma has passed off.

In exceptional cases, however, a curious irregular fluctuation of
the pupil may be observed during the third stage.

Instead of remaining persistently contracted, the pupils may
be seen to momentarily dilate, and to again slowly diminish in
size, to subsequently dilate and contract a few seconds later, and
so on, until eventually they come to rest in the normal state.

This pupillary unrest differs from liippus in that the con¬
tractions are arhythmic, slower and irregular in their range.

In one case this condition was observed in the interparoxysmal
period.

The cilio-spinal reflex is often abolished for, it may be, some
hours after the seizure.

Reflexes .—Temporary abolition of the knee jerks and abdominal
reflexes during the comatose stage may be frequently noted, and is
usually followed by exaggeration. Ankle clonus can often be
elicited.

The 'state of the plantar reflex varies considerably, and has
been the subject of investigation by various writers.

Immediately after the cessation of a fit it may be normal,
abnormal, or more commonly, absent.

Babinski was the first to call attention to the occurrence of an
extensor response, and Keniston in a series of 1,088 observations
noted that it occurs with greater frequency some little time after
the seizure. When unilateral, it is more common on the left side.
A crossed extensor reflex has been noted, and in one case in the
present series Gordon’s paradoxical flexor response was found.

Temperature .—A transient rise of temperature often follows
the epileptic seizure, and cannot be entirely the result of muscular
contractions, Bince it is equally common after petit mal seizures,
(Spratling).

Motor Paralysis .—A temporary loss of motor power, most
marked upon the side which has shown the severer muscular
contractions, is commonly observed, and in rare cases may be

ACTION OF ADRENALIN ON THE PUPIL 293

entirely unilateral, giving rise to a condition of post-paroxysmal
hemiplegia.

The state of the plantar reflex is an index of the degree of
exhaustion of the nervous system, a unilateral extensor response
indicating the side on which the tonic spasm was more pronounced.

The Effects of Adrenalin on the Epileptic Pupil.

Instillation of suprarenal extract into the eyes of an epileptic
immediately after the cessation of a fit, may give rise to:—

1. Dilatation of both pupils.

2. Dilatation of one pupil only.

3. No change.

4. Contraction of one or both pupils.

These conclusions were derived from the study of the pupillary
phenomenon in fifty insane epileptics subject to major epileptic
attacks, and some 500 observations were made. In none of the
cases was any effect produced by the instillation of adrenalin
during an interparoxysmal period.

In every instance the period taken to produce any effect was
carefully noted, and an attempt made to estimate the length of
time during which such a change remained manifest.

In addition the plantar reflex, and in some cases the body
temperature, were noted.

Many of these observations were made by nurses. The pro¬
cedure was carefully explained to them, and no test accepted
until it was evident that they were competent to observe and
record exactly what happened.

The interest they displayed and their proficiency are here
gratefully acknowledged.

In order to eliminate error as much as possible, the first
hundred results were discarded and controls established by the
use of distilled water.

The method of application was simple. The solution was
distributed in phials of 30 m. capacity, and immediately after
the cessation of a fit, one drop was conveyed to the conjunctival
sac by means of an ordinary eye dropper, the time at which the
instillation was made being carefully noted.

The method of procedure will readily be grasped by reference
to the following table.

294 R. M. STEWART

1 .

O 3
fc D

O a

Left.

: : :

... |

3 hours
65

3.5

Right.

: . 18

3 hours
66

V $

4 3

: : :

IS 1888

- G

Right.

1 is

£S 12

:8 ^888

V •-
£ a

Left.

'•

: : :

Wide

Right.

Wide

Left.

+ + +

+ + + f

+ + + + + +

Right.

+ + +

+ + + +

+ + + + + +

Left.

fc5z;<2

«•<««

Right.

<K<

«<!««

MMMfQMm

Solution

Employed.

Epinine,

1 in 100
Distilled water

♦t

Epinine,

1 in 100

»>

Epinine,

1 in 100.000
Adrenalin,

1 in 1,000

s . .*> - *

~ d.
o

Character
of Fit.

> «*■»* « * *; n * * j

Hour.

2.30 a.m.

e a.m.
2.16 A.M.
12.16 A.M.

a - si a

< * & oi
»o

~ <N ~ «

h^»n( 54
s-4 »-X

«<

* * * »

2 « 288 ^

»—4 CO 00 ^4 co ^

i |

CO co co
^

2 2 £2 2

^■4

4* W *

*-*

CO coVo co^i*

-4

c* iq ■-* oo x
<N

<M CO ^

|Q CO I>00

O C* CO ^ *Q

p-s r-s f-< i—<

Absent. N = Normal flexor response. B = Babinaki’s extensor type.

ACTION OF ADRENALIN ON THE PUPIL 295

Dilatation of Both Pupils .—In 400 observations dilatation of
both pupils was recorded 141 times. The degree of dilatation was
subject to considerable variation, and was recorded as “slight/'
“ moderate,” or “ wide.” Wide dilatation, that is to say, a my¬
driasis equal to that which could be produced by atropine, was
noted in 120 instances. The time taken to bring about mydriasis
varied within very considerable limits, the average being fifteen
minutes.

Each patient, as a rule, showed a fairly constant period before
any change could be noted, which may be regarded as the time
necessary for local absorption of the agent, as in several instances,
where adrenalin had been instilled before a fit, the initial dilata¬
tion (which occurs under ordinary conditions) continued after the
stage of coma had terminated.

Absorption can, however, be very rapid, as in a number of
cases wide dilatation occurred two minutes after the solution was
employed. On the other hand, an interval as long as sixty minutes
may elapse before mydriasis is produced.

As a rule both pupils showed an equal dilatation, but this was
not invariable; sometimes one pupil was more dilated than the
other, the larger pupil dilating more quickly than its fellow.

The duration of the mydriasis was also subject to a wide
variation. Frequently the pupil remained dilated for fifteen to
thirty minutes, and then gradually returned to normal, but in
some instances it remained dilated for some hours, and not in¬
frequently a patient would have another fit before the mydriasis
had passed off

Of some interest was the discovery that in a few cases a second
instillation of adrenalin when the pupil had returned to normal
again produced a mydriatic effect, and even on a pupil which had
previously failed to dilate.

The above results obtained in epileptics differ very markedly
from those which may be present in patients the subject of visceral
disease, such as cancer of the pancreas, in that they are much
more rapidly produced, and persist for a smaller length of time.
Another important point of difference is the readiness with which
dilatation may be produced when a very dilute solution is employed.

A dilution of 1 in 100,000 of epinine (equivalent to 1 in 10,000
adrenalin) produced pupillary dilatation thirty-nine times in a series
of seventy observations, and in twenty-eight of these the dilatation

296

R. M. STEWART

was wide. The time taken to effect it was no longer than that
recorded when the stronger solution was employed.

No Change .—In a series of 400 observations negative results
were recorded 173 times, giving a percentage of 43-25. The most
frequently employed agent was epinine 1 in 100, as is indicated in
the following table:—

Solution Employed.

No. of

Observations.

Negative

Results.

Percentage.

Epinine, 1 in 100 -

282

110

41-9

,, in 100,000

44-2

Adrenalin, 1 in 1,000

Sup. ext., human -

60-6

34-2

Failure of suprarenal extract to produce mydriasis of either
pupil is a not infrequent event, but a constant negative result is
rare. Three patients only showed a constant failure with
adrenalin. Their fits were of the severe nocturnal variety, and
there was nothing to suggest any variation from the ordinary type.
The constant absence of the plantar reflex was noted in one, and
in another, an old woman of 75, the number of observations was
not sufficient to allow of any conclusion being made.

It is equally noteworthy that in no case were positive results
constantly obtained. The number of failures varied greatly in
different patients, and bore no relation to the severity of the fit
(leaving out of account petit mal attacks). Nor was it possible to
correlate the state of the plantar reflexes with the pupil phenomenon.
In 134 negative observations where the state of the plantar reflex
was ascertained, an extensor response was present on thirty-four
occasions; in seventy-nine the reflex was absent, and in the remain¬
ing twenty-one instances it was either normal or an extensor
response was present on one side only.

It was also noted that where a patient had a serial attack the
later fits were as likely to give negative results as the initial one.
Further, there was no similarity whatever in the successive
pupillary changes in cases where fits occurred in groups. One
patient, for example, had her convulsions always in groups of five,
which were separated by a considerable period of freedom from
attacks.

A comparison of these series showed a complete lack of uni-

ACTION OF ADRENALIN ON THE PUPIL 297

formity in the behaviour of the pupils; on one occasion the first
fit would be accompanied by wide dilatation, and on a subsequent
one there would be no result, and so on.

Unilateral Dilatation .—The occurrence of unilateral mydriasis
was a striking event, and was capable of production with all four
solutions. In the series of 400 observations it was noted 37 times
in the right eye, and 30 times in the left In the majority of
instances the dilatation was “ wide,” and the time occupied in its
production very similar to that required to produce bilateral
dilatation.

The mode of production of this one-sided dilatation is a problem
of great difficulty, and can hardly be conjectured, unless one invoke
the aid of the sympathetic.

In the same way that localised Jacksonian convulsions are
succeeded by paralysis of movement, so also, in the epileptic, ex¬
haustion paralysis follows a seizure, and is more predominant on
one side—the side on which the tonic spasm was most intense.

This suggests a possible relationship between the motor
paralysis and the unilateral pupil dilatation. The existence, of
mydriasis might conceivably be found to occur on the side on
which this exhaustion paralysis was most marked, in harmony
with the unilateral extensor planter reflex, but careful inquiry
showed that such a relationship did not exist.

Attention has already been called to the fact that when the
normal integration of the sympathetic is disturbed by experimental
means, the phenomenon of adrenalin mydriasis is readily produced,
and in certain clinical cases to be presently described, where
evidence of sympathetic irritation or disturbance was forthcoming,
a similar dilatation of the pupil could be brought about.

From the above considerations we are therefore drawn to
conclude that unilateral mydriasis, following the instillation of
adrenalin after a fit, is an expression of some functional disorder
of the sympathetic, in which there is perhaps an exhaustion of the
inhibitory nervous function.

Contraction of the Pupil .—This paradoxical behaviour was noted
on seven occasions, twice in the same patient.

In the first case both pupils, which were moderately contracted
in the comatose stage, became “ pin point ” five minutes after a
solution of epinine 1 in 100,000 had been instilled, and remained
in this condition for fifteen minutes, when they became moderately

298

R M. STEWART

dilated. At a subsequent date the same patient had another fit,
and adrenalin 1 in 1,000 brought about wide dilatation, which
lasted ten minutes. A second instillation when the mydriasis
had passed off was again successful, and on its repetition both
pupils, instead of dilating, became extremely contracted in fifteen
minutes, and remained half an hour in that condition. A fourth
instillation was then made, and the pupils now dilated widely.

The patient was awake the whole time during which these
phenomena were observed, so that the possible production of this
myosiB by the sleep state did not require consideration.

In another case, after the instillation of epinine 1 in 100, both
pupils rapidly contracted, and in ten minutes were “pin point.”
After remaining in this state half an hour they returned to normal,
and the use of epinine a second time resulted in moderate
dilatation.

One patient exhibited contraction of the pupil in the left eye
only, the other remaining unaffected. This condition was observed
ten minutes after the instillation of epinine 1 in 100, and persisted
for twenty minutes. Unilateral myosis was observed in two
other instances.

Since adrenalin affects only those tissues which have an
innervation from the true (vertebral) sympathetic, the myosis
produced in certain instances cannot be attributed to an effect on
the sympathetic nerve endings in the sphincter pupillae.

If, however, we accept the supposition that the sympathetic
carries both motor and inhibitory fibres to the dilator pupillae,
then it is possible that under certain conditions a disturbance of
the normal antagonism between these two sets of fibres occurs, and
operates in such a manner as to allow adrenalin to exercise an
action on the inhibitory fibres only.

Moreover, it has been conclusively shown that adrenalin is able
to act on inhibitory fibres, producing vaso-dilator effects on vessels
(such as the coronary arteries) where constrictor fibres are
apparently absent, and some observers (Sollmann and Pari) have
recorded vaso-dilator effects in certain vessels (the renal arteries,
for example), where both constrictor and inhibitory fibres are
present. These facts lend some support to the above hypothesis.

ACTION OF ADRENALIN ON THE PUPIL 299

Mydriasis in other Convulsive States.

A number of observations were carried out with a view to
determining whether adrenalin mydriasis occurred solely in idio¬
pathic epilepsy or in various other convulsive states as well. The
following convulsive types were investigated:—

1. Jacksonian epilepsy.

2. Congestive attacks in G.P.I.

3. Organic hemiplegia.

1. Jacksonian Convulsions in an Adult Male. —This patient
developed typical Jacksonian fits which involved at first the
right side of the face, and later the whole of the right side of the
body. He had in all ninety-eight fits, and developed aphasia of a
mixed type. There was a history of syphilis, and the case was
regarded as one of gumma cerebri in the neighbourhood of the left
precentral gyrus. Under KI. and H.G. a complete recovery ensued.
A solution of epinine 1 in 100 was employed on a number of
occasions. Wide dilatation of the left pupil only, resulted in
fifteen minutes. The eye returned to normal after three-quarters
of an hour. Two trials with epinine after fits gave negative results.

Thus epinine provoked dilatation of the left pupil in a patient
whose fits were limited to the right side.

2. Cerebral Thrombosis in a Female, aged 67.—This patient had
two transient “seizures,” followed by a left-sided hemiplegia
which developed in the course of a few minutes. Consciousness
was retained, and after a few days partial recovery of power in
the leg took place. Paresis of the lower part of the face was
marked, but emotional movement was not lost. The behaviour of
the pupils with epinine varied.

During the first few days following the convulsive seizure
both pupils dilated after epinine, the left more readily than the
right. The latter never dilated as widely as the left, and a week
after the onset of the illness it failed altogether to respond.
There then ensued an interval of about a week, during which no
mydriasis could be produced. This in its turn gave place to a
period during which both pupils dilated, the right usually to a
greater degree than the left. On several occasions epinine pro¬
duced mydriasis when adrenalin was without any effect.

Congestive Attacks in General Paralytics. —The effect of adrenalin

300

R. M. STEWART

and epinine on the pupils of G.P.’s was studied both after con¬
gestive attacks and during the ordinary course of the disease.

In two patients wide dilatation of the pupil was produced
after a seizure by the instillation of epinine. In one patient, who
had a right-sided seizure with aphasia, mydriasis was provoked
on the left side only, and in another no result followed the
instillation of adrenalin.

These facts seem to justify the conclusion that adrenalin
mydriasis may occur in general paralytics, and is subject to a
puzzling variation similar to that which prevails in the epileptic.

The following additional cases may be referred to here:—

A Patient subject to Convulsive Seizures associated with Brady¬
cardia. —This patient suffered from attacks of the nature of petit
mal, associated with temporary slowing of the pulse. They were
followed by marked mental confusion and automatism.

In two observations epinine 1 in 100 produced dilatation of
the right pupil only.

A Case of Migraine. —This patient, a middle-aged woman, is
subject to recurrent attacks of hemicrania, usually, but not always,
right-sided. With the intense headache there are associated
vomiting and nausea. On one occasion, in which the headache
was limited to the right side, epinine 1 in 100 produced moderate
dilatation of the left pupil, the right eye remaining unchanged.

This result is of considerable interest in view of the supposed
dependence of the clinical phenomena on abnormal vaso-motor
activity of the cerebral vessels.

Investigations on some twenty patients, the subject of
pulmonary tuberculosis, showed no uniformity in results.

In a considerable number negative results were obtained up to
the fatal termination. In others bilateral mydriasis was pro¬
duced, but with no constancy.

It was found, however, in some instances, that the production
of unilateral mydriasis could be correlated with the morbid
changes in the lung.

Thus, in one subject, only the left pupil dilated, the right
remaining unchanged although epinine or adrenalin were instilled
into both conjunctival sacs on numerous occasions. At the autopsy
a tubercular broncho-pneumonia was found affecting practically
the whole left lung. The right lung was free from disease, with
the exception of a small area near the hilum.

ACTION OF ADRENALIN ON THE PUPIL 301

In another patient Buffering from phthisis, epinine produced
dilatation of the right eye only. P.M. advanced bilateral tuber¬
culosis was found, but microscopic examination of the cervical
sympathetic chain showed that that of the right side was ex¬
tensively implicated by the disease at the apex of the right lung.
These cases suggest that morbid changes in the sympathetic are
to be suspected when adrenalin brings about a unilateral mydriasis
in a patient the subject of pulmonary tuberculosis.

As already stated, pancreatic “ insufficiency ” is associated with
adrenalin mydriasis. The writer has had the opportunity of
observing four cases in which the normal functions of the pancreas
were presumably deranged. In all adrenalin produced mydriasis.
Two were cases of carcinoma of the stomach with secondary
deposits in the liver, and implication of the pancreas by the tumour.
The fourth was a case of suppurative cholecystitis, with inflam¬
matory changes in the body of the pancreas.

In contrast with the dilatation occurring in epileptics, the effect
in these cases invariably remained marked for some hours.

It would be easy to extend this list, but probably enough
examples have been given to show that adrenalin mydriasis may
occur in a large number of very dissimilar diseases.

Careful scrutiny brings out a point of some importance, namely,
that in all there is evidence either of sympathetic derangement or
abnormal function of the ductless glands.

With regard to epilepsy, we may shortly infer from the above
considerations that not infrequently a disturbance of the normal
sympathetic mechanism takes place, which may be readily shown
by the employment of suprarenal extract as a clinical test; that
further, this disturbance may be unilateral or bilateral, and is
subject to variations which cannot at present be explained.

Lastly, it is necessary to consider whether this sympathetic
derangement plays any part in the production of epileptic fits.

The inconstancy of adrenalin mydriasis in epileptics, the wide
variations to which it is subject, and its occurrence in other con¬
vulsive types, make it probable that the convulsive seizure and the
sympathetic disturbance are related, not as cause and effect, but as
concomitant effects of a single pathological process, which has yet
to be determined.

References.

1. Bikdis— “The Internal Secretory Organs,” 1913.

2 . Spratling— “Epilepsy,” 1904.

302

ABSTRACTS

Hbstracts.

ANATOMY.

A STUDY OF GANGLION CELLS IN THE SYMPATHETIC
(365) NERVOUS SYSTEM, WITH SPECIAL REFERENCE TO
INTRINSIC SENSORY NEURONES. F. W. Carpenter and
J. L. Con el, Joum. Comp. Neurol ., 1914, xxiv., June, p. 269.

Sympathetic ganglion cells of the cat prepared by the Cajal
method show both Dogiel’s “ motor type ” of cell with heavy
dendrites and his “ sensory type ” with slender dendrites. They
also show cells with intermediate structural characters connecting
the two “ types.” On the basis of external cell morphology we
cannot say, therefore, that two distinct kinds of elements exist in
the sympathetic ganglia. The “types” of Dogiel are, in the
authors’ opinion, to be regarded as extremes of the variation which
occurs among the multipolar sympathetic cells.

Sympathetic ganglion cells of the rabbit prepared by the Nissl
method present a quite constant picture of chromatophile bodies,
which tend to be arranged near the periphery of the cell-body.
The cells cannot be divided by this feature of their internal
morphology into two well-defined groups.

The authors could find no anatomical evidence that ganglion
cells of opposite function ( i.e ., motor and sensory) exist in the
sympathetic system. If their structural similarity is an indication
of similarity in function, then all must be motor, since it is the
presence of intrinsic sensory neurones only that is open to question.

In the rabbit binucleate cells were found in the vertebral and
prevertebral ganglia of the trunk system (sympathetic division
proper of the autonomic system). Such cells were not seen in the
cranial autonomic ganglia, nor in the plexuses of the intestinal
wall (peripheral ganglia). A. Ninian Bruce.

THE STRUCTURE OF THE VAGUS NERVE OF MAN AS DEMON-
(366) STRATED BY A DIFFERENTIAL AXON STAIN. S. Walter
R anson, Anal. Anzeig., 1914, xlvi., Juni 12, S. 522-525 (with
one fig.).

The author points out that while we possess a large number of
excellent differential stains for distinguishing between medullated
and non-medullated nerve fibres, it is only recently that we have
possessed a similar differential stain for axons.

ABSTRACTS

303

The method he describes is the “ pyridine-silver technique,” and
is a modification of the Cajal stain, which itself does not differ¬
entiate clearly non-medullated fibres from connective tissue and
neuroglia. The animal is exsanguinated, and the tissue placed at
once in absolute alcohol containing 1 per cent, of strong ammonia
for forty-eight hours, rinsed in distilled water, placed in pyridine
for twenty-four hours, washed in many changes of distilled water
for twenty-four hours, put into 2 per cent, silver nitrate at 35° C.
in the dark for three days, rinsed in water, and then placed for
one day in a 4 per cent, solution of pyrogallic acid in 5 per cent,
formalin. The sections are cut in paraffin. By this method the
medullated axons are stained yellow, and are surrounded by a
colourless ring of myelin. Non-medullated fibres are stained
black, and are sharply differentiated from the light yellow endo-
neurium.

Large numbers of non-medullated fibres were found by this
method in the roots, trunk, and branches of the vagus. Most of
the large medullated fibres leave the vagus through the pharyngeal,
sup. laryngeal, and recurrent nerves, while practically all the non-
medullated fibres are carried down into the thoracic vagus. Most
of the medullated fibres in tbe thoracic vagus leave it through the
bronchial and cesophageal branches, so that the vagus as it passes
through the diaphragm is practically a non-medullated nerve.

A. Ninian Bruce.

THE ANATOMY AND FUNCTION OF BECHTEBEW’S NUCLEUS.
(367) (Uber die Anatomic und Funktion des Nucleus Bechterew.)

R. Leidler, Afonatsschr. /. Ohrenheilk., 1914, xlviii., H. 3, 8. 321.

There has always been some confusion about the anatomy of
Bechterew’s nucleus. Various writers have described different
groups of cells as Bechterew’s nucleus, and Bechterew himself did
not exactly describe its position. Leidler found Marchi’s method of
great assistance in his investigations. After section of tbe eighth
nerve in a rabbit, the degenerated fibres were seen to go to the
nuclei of Deiters and Bechterew, to the nucleus triangularis, and
also to a much broader area, where the ganglion cells were
scattered into irregular groups.

The writer quotes freely from a paper by Kaplan, who includes
in the nucleus of Bechterew not only the small celled ventricle-
angle group, but also a sharply defined mass of cells, which is seen
well in frontal and sagittal sections. It is placed between the
brachium conjunctivum and the motor and sensory nuclei of the
trigeminal. The cells of Bechterew's nucleus are easily dis-

304

ABSTRACTS

tinguished by their size from the nuclei of the trigeminal and
Deiters. The cells of Bechterew are arranged in four groups—
(1) Dorsoangular, (2) dorsolateral, (3) central or ventromedial, (4)
ventrolateral.

At present very little is known of the function of the nucleus.
Leidler, working on rabbits, partially or completely destroyed the
nucleus by puncture.

In the first case, the puncture passed through the nucleus
triangularis and destroyed the ventral part of Bechterew’s nucleus.
This caused no reaction in the eyes nor head; no nystagmus nor
head deviation. In the second case, the vestibular nerve, the
whole of Bechterew’s nucleus, flosculus, corpus restiforme, and
part of the lateral nucleus of the cerebellum of the left side were
destroyed; Deiters’ nucleus escaped. This caused degeneration of
the vestibular root, and its ascending and descending branches;
the nucleo-cerebellar tracts caudalwards, the whole motor and
part of the sensory and cerebral parts of the trigeminal, with
their concomitant fibres. The posterior longitudinal bundle re¬
mained intact. On microscopic section, fine fibres were seen
running towards the middle line and bending forwards just
lateral to the posterior longitudinal bundle. They appeared to be
fibres from Bechterew’s nucleus to the ocular nuclei. Soon after
the operation, the rabbit showed deviation of the eyes to the
right and nystagmus to the left (side of lesion). Next day
deviation of eyes and head to the left and nystagmus to the right.
Rolling of animal to the left. Vestibular reactions still present.
A third case gave somewhat similar results.

In all the animals in which the nucleus of Bechterew was
destroyed, a small track of degeneration was found arching
medially and then forwards lateral to the posterior longitudinal
bundle. A few fibres enter it, but most of them remain lateral to
it. It is not possible to be certain that all these fibres come
from Bechterew’s nucleus, some of them may come from Deiters’
nucleus. The nucleus of Bechterew has very little, if any,
connection with the posterior longitudinal bundle. From other
evidence, also, Leidler concludes that the fibres from Bechterew’s
nucleus are all ascending. He also concludes that damage or
destruction of Bechterew has no influence on the excitability of
the vestibularis, and produces no vestibular nystagmus. He also
adds that Bechterew’s nucleus may perhaps produce some eye
movement, e.g., simple rolling of the eyes. The chief function of
Bechterew’s nucleus is not yet known, but is probably intimately
connected with the cerebellar nuclei.

J. K. Milne Dickie.

ABSTRACTS

305

PHYSIOLOGY.

THE ANATOMICAL LOCALISATION IN THE BASE OF THE

(368) BRAIN OF THE LESIONS WHICH PROVOKE POLYURIA
IN DOCKS. (Localisation anatomique a la base du cervean des
ldsions qoi provoquent la polynrie chez le chien.) J. Camus and
Q. Roussy, Compt. Bend. Soc. de Biol., 1914, Ixxvi., June &, p. 877.

Four groups of operations are summarised: (1) Total hypo¬
physectomy by buccal route; (2) hypophysectomy followed by a
subsequent experimental lesion of the base; (3) a deep basal lesion
by red-hot needle after perforation of sphenoid by gimlet; (4) deep
lesions purposely made (a) in front of, and (5) behind the pituitary
region. Conclusions: (1) The lesion which causes polyuria in no
way involves the pituitary: five times puncture failed to touch it,
yet intense polyuria followed: this polyuria is neither greater nor
less when the pituitary is involved; (2) total hypophysectomy
without lesion of the infundibulum does not give polyuria; (3) a
preliminary hypophysectomy does not prevent the production of
polyuria by means of a subsequent experimental opto-peduncular
lesion; (4) the depth of the puncture, or a lesion of thalamus or
peduncle, seems to have no influence on the production or intensity
of the polyuria; (5) the really important thing is the superficial
basal lesion often unintentionally produced in hypophysectomies
which are followed by polyuria; (6) in dogs the polyuria-producing
zone is limited to the opto-peduncular region: its seat is the grey
matter of the tuber cinereum in the neighbourhood of the infundi¬
bulum ; (7) a lesion made either in front of, or behind this zone
does not give polyuria. Leonard J. Kidd.

THE HYPOTENSIVE CCELIAO REFLEX. (Sur les modifications

(369) dn pools radial conadcutives aux excitations du Sympathique
abdominal (plexus solaire et ramifications terminates). Rdflexe
coeliaque hypotenseur.) Andb£-Thomas and J. C. Roux, Compt .
Rend. Soc. de Biol., 1914, Ixxvi., May 29, p. 867.

It is sometimes possible to produce in man by a moderate, even
painless, manual compression of the abdomen halfway between the
navel and xiphoid cartilage a very marked feebleness of the radial
pulse, occasionally even abolition. As a rule, the greater the pain
the greater is the degree of the phenomenon. It is specially
marked in anxious melancholic neuropaths, and is usually less
marked in organic abdominal affections, partly because firm
pressure cannot be always safely applied. The writers compare
this abdomino-cardiac phenomenon with the similar condition
obtained experimentally by Brown-Sdquard, Goltz, and Laignel-
Lavastine. Leonard J. Kidd.

30G

ABSTRACTS

▲ NEW VASO DILATOR REFLEX IN THE DOG’S HIND LIMB.
(370) (Sur un nouveau r<flexe vaso-dilateur du membra postdrieur
chez le chien.) H. Busquet, Reunion, Biol, de Nancy , 19 Mai,
1914 ; Com.pt. Rend. Soc. de Biol., 1914, lxxvi., June 5, p. 891.

Experimental summary and conclusions:—In chloralosed dogs
cutaneous stimulation by prick of the hind limb, especially the
pad, or succession (striking table with wrist or hammer) gives a
rise of the femoral venous pressure simultaneously with a fall of
the carotid or femoral arterial pressure. Appropriate experimenta¬
tion shows that the discordant manometric variations of the vein
and artery can be explained only by an expansion of the system
between them. This new rettex is differentiated from the other
known vascular ones by the nature of the stimuli which evoke it,
by the objective criteria which testify to its reality, and by its
purity, i.e., absence of all appreciable concomitant vaso-constriction.
The phenomenon is still obtained after atropinisation or curarisa-
tion, but is abolished by infra-bulbar section of the spinal cord; its
centre is therefore encephalic. (The technique is described.)

Leonard J. Kidd.

ADRENALIN AND THE PUPILS. Antoni, Neurol. Centralbl., 1914,
(371) June 1, p. 674.

Intravenous injection of adrenalin dilates the pupil, but its
instillation into the conjunctival sac does not produce the same
effect, in normal conditions. In certain pathological conditions,
however, it does so: (1) in lesions of the conjunctival epithelium;
(2) when the sympathetic system is hyperexcitable, e.t/., in cases
of exophthalmic goitre, dial>etes, after lesions of the peritoneum
(laparotomies, &c.). Compare transient glycosuria after lesions of
the peritoneum; (3) after lesions of the sympathetic path to the
pupil, anywhere on its course. The author has reinvestigated the
phenomenon in other conditions. In 20 cases of dementia paralytica,
9 gave dilatation of the pupil with conjunctival instillation: it
begins within half an hour, and may continue for hours. Whether
these cases belong to group (2) or (3), mentioned above, is not
clear. In a large number of control cases (healthy and diseased)
a few cases were found where the pupils dilated by this method,
but only after some three to five hours; it is supposed they are
cases of physiological sympatheticotonus. In certain cases of
tuberculous meningitis, encephalitis, diffuse cerebral sclerosis,
hydrocephalus, &c., where the reaction is positive, it is supposed
that the frontal sympathetic centre is affected.

S. A. K. Wilson.

ABSTRACTS

307

PARATHYROID DEFICIENCY AND SYMPATHETIC IRRITA
(372) BILITY. R. Q. Hoskins and Homer Wheelon, Amer. Joum.

Physiol., 1914, xxxiv., June 1 , p. 263.

Conclusions: —(1) Parathyroid destruction in dogs results in a
marked increase of vasomotor irritability as shown by the reactions
to nicotin, epinephrin, and pituitrin; (2) all components of the
vasomotor mechanism, sympathetic cells, myoneural junctions, and
musculature, seem to be affected. The effects are of varying
degree in different cases; (3) there was observed no strict parallel¬
ism l)etween the external symptoms of parathyroid deficiency and
the degree of vasomotor irritability; (4) inconclusive evidence
indicates that calcium injections in some measure restore vasomotor
irritability toward normal; (5) the sympathetic system offers no
exception to the general increase of irritability that results from
parathyroid extirpation. (The authors confirm Carlson’s observa¬
tion that salivation is a common result of parathyroid deficiency.)

Leonard J. Kidd.

PSYCHOLOGY.

PSYCHOLOGY OP RELIGION. Georges Berguer, Archiv. dt Psychol.,
(373) 1914, Feb., p. 1.

This paper is divided into three parts, of which the first deals
with the normal, the second with the abnormal, psychology of
religion, and the third with theories of the origin and nature of
religious phenomena. In the course of fifty pages the author
gives an excellent survey of the field thus marked out. The fact
that the article is followed by a bibliography of forty pages gives
some idea of the amount of work — most of it comparatively
recent—which has been done on this subject.

Margaret Drummond.

ARTICULATE LANGUAGE IN THE NORMAL MAN AND IN THE
(374) APHASIC. J. Fboment and O. Monod, Archiv. dt Psychol.,
1913, April, p. 1.

This is a study of the psychology of aphasia. The authors
maintain that in the psychology of language in general the
hypothesis of motor images, whether articulatory or graphic, is
entirely gratuitous and unsubstantiated. The only images which
are called into play in speech or writing are sensory, i.e., auditory
or visual. These, then, are the images which are affected in motor
aphasia and agraphia, if like every other aphasia these disturbances
are due to a veritable amnesia. Margaret Drummond.

308

ABSTRACTS

ABE DEFECTIVE CHILDREN LACKING IN MORAL QUALITIES?

(376) Alick Dbmxeudres, Archiv. de Psychol, 1913, April, p. 21.

The author of this paper is instructress of a special class in Geneva,
in which there are thirty backward and twenty defective children,
the distinction being determined by the use of Binet’s scale, and
in accordance with his use of the terms. She writes to oppose
the very common opinion that moral qualities are at a low ebb in
such children. She gives many illustrations to show that qualities
of the heart, such as kindness and affection, are well developed
among her pupils. Margaret Drummond.

DOES THE MOTOR VERBAL IMAGE EXIST? E. Clapar^dk,

(376) Archiv. de Psychol., 1913, April p. 93.

The author takes the opportunity afforded him by the paper
referred to above to distinguish the various questions which arise
in connection with the function of articulate speech. With
respect to the special question of motor images of words, he differs
from Froment and Monod, and maintains that these images not
only exist, at least in certain subjects, but play an important part
in the mental processes leading on to speech.

Margaret Drummond.

ANALYSIS OF 80 0ALLED NEURASTHENIC AND ALLIED

(377) STATES. Trigant Burrow, Jowm. Abnorm. Psychol., Oct. -Nov.
1913.

The author suggests that the aetiology of neurasthenia should be
more carefully studied from the standpoint of its psychological
mechanism, so that through the establishment of the psychogenic
factors involved in these conditions a more systematised knowledge
may at last be resolved out of the present chaos of inco-ordinated
anatomical assumptions. H. de M. Alexander.

THE PSYCHOPATHOLOGY OF A CASE OF PHOBIA-A CLINICAL

(378) STUDY. Morton Prince, Joum. Abnorm. Psychol., Oct.-Nov.
1913.

A clinical detailed analysis of a case of phobia towards church
steeples and towers of any kind. H. de M. Alexander.

THREE EXAMPLES OF NAME - FORGETTING. H. W. Frink,

(379) Jowm. Abnorm. Psychol., Feb. -March 1914.

The writer formulates the following rule to account for many cases
of difficulty in recalling familiar names (or phrases) : The name

ABSTRACTS

309

forgotten is connected (accidentally or otherwise) with a repressed
complex, and is prevented from coming into consciousness by the
protective resistance against the painful ideas contained in the
complex. H. de M. Alexander.

SLIPS OP THE TONGUE AND PEN. C. P. Obebndorf, Joum.

(380) Abnorm. Psychol., Feb.-March 1914.

The author gives examples of lapses of the tongue and pen which
have given expression to the suppressed tendencies and thoughts,
instead of the more circumspect or correct utterance which was
intended. H. de M. Alexander.

INVENTOBIAL RECORD POEMS OF USE IN THE ANALYSIS OF

(381) DREAMS. Lydiaed H. Horton, Joum. Abnorm. Psychol Feb.-
March 1914.

Illustrations are given of record forms for the purpose of
analysing dreams. H. de M. Alexander.

RECENT LITERATURE ON JUVENILE SUICIDES. Lewis M.

(382) Terman, Joum. Abnorm. Psychol., April-May 1914.

At present the children of France (16 years of age and under) are
committing suicide at the rate of about 150 per year, though the
numbei* is now slightly decreasing. In Germany the situation
is little better. In Russia it is very common. The problem
exists with but slight variations in every country of the civilised
world. A table of causes of juvenile suicide is given by the author
as analysed by Eulenberg, Proal, and Oholpine. In this table
“fear of punishment” easily heads the list. The causes which
relate to the school exceed one-third of the total. Contrary to
common opinion, love affairs and insanity account together for not
more than 2 per cent.

Suicides of children are characterised by less deliberation than
those of adults, and are more likely to result from a momentary
passion, such as rage or the shock of sudden humiliation; and
cases of juvenile suicide are much less common in the country
districts.

The school cannot absolve itself of all responsibility merely by
guarding against becoming the immediate occasion of the tragedy.
It needs to train children in habits of healthful activity instead of
cramming the mental storehouses with knowledge which does not
function. H. de M. Alexander.

310

ABSTRACTS

PATHOLOGY.

REMARKS ON THE HI8TOPATHOLOOIOAL CHANGES IN THE
(383) SPINAL CORD DUB TO IMPACT. AN EXPERIMENTAL
STUDY. A R. Allen, Joum. New. and Mmt. Du ., 1914,
zll, March.

The present report is a continuation of previous experimental
work. After laminectomy had been performed on the dog and
without opening the dura, there was determined the maximum
amount of impact in gram-centimetres to the spinal cord, delivered
by a special mechanism, from which the animal would recover
with normal motor function without further operative procedure.
Then the amount of impact from which the dog would not recover
without operative procedure was determined.

Any impact up to 340 gm.-cm. was found to be hypo-impact;
and anything above this was termed hyper-impact. When an
impact of 450 gm.-cm. was used, the animal would invariably die
unless a median longitudinal incision was made through the
injured area of the cord. The beneficial change resulting is
ascribed to drainage of blood and serum.

In this communication the following points are discussed:
(a) the histopathological changes in the spinal cord of the dog
from fifteen minutes to six hours after hyper-impact injury; ( b )
the effect on the histopathological picture of the median longi¬
tudinal incision performed two hours after impact, the dogs being
killed six hours after impact; (c) consideration of hemolytic
change in the extravasated blood, in the substance of the cord due
to the action of crushed myelin; (d) three cases of median
longitudinal incision after fracture dislocation of the spinal
column in the human subject. D. K. Henderson.

AN ADRENAL TUMOUR IN A OOW. (Tumeur del a surrfoale chez

(384) un bovidd) C. Farise, Rivnion , Biol, dt Nancy , 19 Mai 1914;
Compt. Rend. Soc. de Biol., 1914, lxxvi., June 5, p. 902.

An account of an adrenal tumour in a cow: it measured 15 cm.
in diameter, and weighed 2 kilos. 500. Farise gives a histological
description and discusses its nature. He says that these adrenal
tumours are in the Hcrbivom compatible with perfect health, and
that they show a greater tendency to necrosis and calcification
than to generalisation. Leonard J. Kidd.

ABSTRACTS

311

CLINICAL NEUROLOGY.

CONTRALATERAL OPPENHEIM AND GORDON REFLEXES.

(386) Alfred Gordon, Joum. Nerv. and Ment. Dig., 1914, xll, March.

A short note mentioning the various conditions in which the
sign occurs. D. K. Henderson.

CONTRALATERAL PERIOSTEAL REFLEXES OF THE ARM.

(386) A Myerson, Joum. Nerv. and Ment. Dig., 1914, xli., March.

With the patient lying flat on his back, and his arms at his sides
in an easy, relaxed attitude, usually with slight flexion at elbow
and moderate internal rotation, the examiner taps the middle of
the clavicle with a reflex hammer. When present, the response
elicited is a contraction of the biceps and pectoralis major of the
other arm. Usually there is also a homolateral response.

This reflex has been noted in general paralysis, hemiplegia,
multiple sclerosis, brain tumour, and meningitis. It is present
occasionally in dementia pnecox, manic depressive insanity, and
hysteria. Its presence, therefore, indicates an abnormal condition
not necessarily associated with organic disease.

D. K. Henderson.

THE OCULOCARDIAC REFLEX IN DIPHTHERITIC INTOXICA-
(387) TION. (Le rtfflexe oculo-cardiaque au cours de l’intoxication
diphttfrique.) E. C. Aviragnet, H. Dorlencourt, and H.
Bottttier, Compt Bend. Soc. de Biol., 1914, lxxvi., p. 771.

The writers examined the oculo-cardiac reflex in 26 children
suffering from diphtheria either by simple digital compression of
the radial or by the spliygmograph.

In 15 it was abolished and in 11 it was normal. In 3 of the
latter the clinical diagnosis of diphtheria was not confirmed
bacteriologically.

The later the case came under treatment the more frequently
was the reflex lost, and in cases that required larger or repeated
doses of serum the reflex was more frequently lost than in those
in whom a small or a single dose was sufficient.

These observations show the frequency of the affection of the
pneumogastric in diphtheria and the influence of early treatment
in the behaviour of the reflex. J. D. Rolleston.

312

ABSTRACTS

THE OCULO CARDIAC REFLEX IN HEMIPLEGIA AND OBRB-

(388) BRAL DIPLEGIA. (Le rdflexe oculo-cardiaque dans las hdmi-
pldgies et les dipldgies cdrdbrales.) J. Roubinovitch and
R£gnauld de la Soudiere, Bull, et mem. Soc. med. H6p. de Parity
1914, xxxvii., p. 909.

In 6 out of 7 cases of cerebral diplegia, the reflex was abolished.
In one it was exaggerated. In 24 hemiplegics ocular compression
was carried out first on the paralysed, and then on the sound side.
The reflex was completely lost in 13, and inverted in 3, both on
the right and the left side. In 2 it was normal. In only 6 cases
was there obvious dissociation of the reflex ; on the sound side it
was normal, while on the paralysed side in 3 it was inverted, in
2 abolished, and in 1 weak. J. D. Rolleston.

HERPETIC FACIAL PARALYSIS IN A PATIENT WITH 8YM

(389) METRICAL LIPOMATOSIS. (Paralysis facials zostdrienne
chez un malade attsint ds lipomatoss symdtrique.) Laignel-
Lavastine and Romm*, Bull, et mem. Soc. mid. H6p. de Paris ,
1914, xxxvii., p. 875.

An alcoholic cooper, aged 51, suffering from generalised sym¬
metrical lipomatosis developed right occipito-cervico-facial and
otic zoster. There was an intense meningeal reaction shown by
hypertension and excess of albumen and lymphocytes in the
cerebro-spinal fluid. Eighteen days after the appearance of the
eruption, right facial paralysis occurred, and was accompanied by
marked tactile, painful and thermal hyposesthesia.

The zoster affected the second, third, and possibly fourth spinal
ganglia, and also the geniculate ganglion. J. D. Rolleston.

ZOSTER WITH FACIAL PARALYSIS; TROPHIC AND SENSORY

(390) TROUBLES OF THE LINGUAL MUCOSA. (Zona avsc paralysis
faciale; troubles trophiques et sensitifs de la muqueuse linguale.)
F. Ramon D and H. Poirault, Bull, et tnim. Soc. mid H6p. de
Parity 1914, xxxvii., p. 847.

A boy, aged 15 years, developed left facial zoster which was strictly
limited to the region of V 3 . The buccal mucosa and tongue were
affected as well as the cheek. In addition to the neuralgia
characteristic of zoster there were contracture of the masticatory
muscles and paresis of the muscles innervated by the lower
division of VII. The skin of the face corresponding to the eruption
showed a marked syringomyelic dissociation of sensibility such as
the writer had previously noted in zoster ( v. Review, 1911, ix., p.

ABSTRACTS

313

127). This dissociation was also present, though in a less degree,
on the left buccal mucosa and left half of the tongue. The latter
had lost the sensation of taste in its anterior two-thirds. Smell
and hearing were normal.

Trophic disturbances were shown by the smooth and shiny
surface of the left side of the tongue, which offered a striking
contrast to the thickly coated right half of the organ. All the
symptoms—motor, sensory and trophic—disappeared within a
fortnight.

Ramond suggests that in addition to the otic ganglion the trunk
and nucleus of V s were affected. J. D. Rolleston.

ON A CASE OF FULMINATING PARAMENINGOCOCCUS
(391) CEBEBBO-SPINAL MENINGITIS. (A propos d’un cm de
mdningite cdrdbro-spinale suraigu k paramdningocoques.)

M. Riser, Bull, et mim. Soc. mid. Hop. de Paris , 1914, xxxvii.,
p. 941.

A record of a case in a female child of 11 months, which proved
fatal in three days. The symptoms were those of meningococcal
meningitis, but injections of antimeningococcal serum were useless,
and bacteriological examination of the purulent cerebro-spinal fluid
showed the true nature of the case. J. D. Rolleston.

THE MENINGEAL SYNDROME IN RECURRENT FEVER. (Le
(392) syndrome mdningd dans la fi&vre recurrent®.) Lafforoue, Bull,
et mim. Soc. mid. H6p. de Paris , 1914, xxxvii., p. 883.

Like Coskinas (v. Review, 1914, xii., p. 262), Lafforgue, during
two years’ stay in Tunis, frequently observed meningeal syndromes
in recurrent fever. There was never any cellular reaction in the
cerebro-spinal fluid. «T. D. Rolleston.

THE ORBITAL BRAIN -ABSCESS AND ITS OPERATION. (Die
(393) orbitogene Himabsxess nnd seine Operation.) Elschino, Klin.
Monatsbl.f. Angenheilk., 1914, Miirz-April, S. 359.

The author describes fully the cases of abscess of the frontal lobe
arising from orbital or nasal sinus infection, one of which re¬
covered. Such abscesses occur always in the frontal lobes and are
easily attacked through the orbit, falling thus into the realm of
the ophthalmic surgeon. H. M. Traquair.

2 5

314

ABSTRACTS

ON RECKLINGHAUSEN’S DISEASE. (Contribute*) para o estudo da
(394) doenga de Recklinghausen.) L. Viegas, Anais Scient. da Faeult.
de Med. do Porto , 1913, i., p. 76.

A gikl, aged 12 years, presented all the features of Reckling¬
hausen’s disease except tumours in the nerves. There was no
family history of a similar complaint, but her maternal grandfather
and maternal uncle suffered from epilepsy. The most striking
characteristic of her case was that the left side was the most
affected. Thus the left side of her scalp showed atrophic mevi and
pigmentation and pigmentary mevi were most marked on the left
side of the forehead. The left side of her lips and tongue showed
papillomatous growths; the left deltoid was atrophied; the left
thumb, index, and ring fingers were shorter than the right; the
left thigh showed larger molluscoid tumours than the right; the
left foot showed skeletal deformities; and the left ear was
misshapen and deaf.

The patient also had complete anosmia, and tachycardia, attacks
of suffocation, and enuresis. She was able to read and write and
to do manual work, but suffered much from forgetfulness.

J. D. Rolleston.

A CASE OF HEMIPLEGIA IN DIPHTHERIA. (Un cas d’MmipWgie
(395) dans la diphtdrie.) J. Hall£, M. Bloch, and Foix, Bull, et mbn.

Soc. mid. H6p. de Parts, 1914, xxxvii., p. 896.

A girl, aged 3| years, had a severe attack of diphtheria complicated
by early palatal paralysis and myocarditis. Right hemiplegia and
aphasia occurred on the thirteenth day. Slight improvement
took place, but the child died from late diphtheritic paralysis
li months after the onset of diphtheria. The necropsy showed an
area of softening, probably of embolic origin, in the posterior two-
fifths of the putamen. J. D. Rolleston.

A OASE OF DYSTONIA MUSCULORUM DEFORMANS. C. C.

(396) Beling, Journ. Nerv. and Ment. Dis., 1914, xli., March.

A Russian Hebrew girl, at the age of 7 years, developed a progressive
generalised muscular spasm of a tractile and torsion-like character.
The disease began in the right foot, and exhibited itself as a dis¬
turbance of gait in which hypertonia and spasmodic components
were evident. These spasms produced peculiar deformities in the
trunk and extremities. The movements were almost always slow,
rather stereotyped, and not so graceful and rhythmic as those of
bilateral athetosis. The muscular spasms were not under the

ABSTRACTS

315

influence of the will. Complicated motor acts, such as rising,
walking, eating, &c., have been profoundly affected. The move¬
ments cease during sleep. The intellect has been entirely un¬
affected ; the emotional state has been normal. There have been
no hysterical stigmata, and neither suggestion nor hypnosis has
had any influence.

The disease is very similar to double athetosis, chronic chorea,
and degenerative tic. D. K. Henderson.

THE INTRAMENINGEAL TREATMENT OF TABES AND

(397) GERBBRO-8PINAL SYPHILIS. Thomas R Boons and R R.
Snowden, Arch. Int. Med., 1914, xiii., June, p. 970.

Brief accounts are given here of the results of the treatment of
eight unselected cases by means of intraspinal injection of sal-
varsanised serum. The method used was that described by Ellis
and Swift, except that the serum was injected undiluted and in
large quantities (25-35 c.c.). They found that the patients were
uniformly relieved from pain, and, as far as locomotion was con¬
cerned, there was a slow but definite improvement. The psychic
effect was also marked, the patients being encouraged by the quick
relief of pain, and their nutrition improved rapidly. The effect on
the cerebro-spinal fluid was very striking, the cell count first
falling to normal and the Wassermann reaction becoming negative
some time after the cells were reduced. They think that the fact
that the serum was injected undiluted may have been the cause of
their results being so favourable, and they point out that although
the reactions were sometimes rather severe, they do not contra¬
indicate the larger doses. The reactions produced by the injection
of the salvarsanised serum from another patient were very severe,
and should not be attempted. A. Ninian Bruce.

A CASE OF PROGRESSIVE THROMBOPHLEBITIS OF THE

(398) BRAIN SINUSES FOLLOWING ACUTE OTITIS MEDIA.
(Ein Fall von progredienter Thrombophlebitis der Himsinus
nach Otit. med. acuta. Septische Verl&ufsform. Operation nach
Jansen. Tod nach 36 Tagen.) C. J. M. Schmidt, Monataackr. /.
Ohrenheilk ., 1914, xlviii., H. 2 , S. 270.

A peasant woman, aged 40, in the beginning of June 1912,
developed a right-sided acute otitis media. Great pain in ear
and neck. Pain continued after ear discharged. Temperature
39* C. One week from commencement of illness developed right
facial paralysis. Two rigors. Vomited several times. Had great
vertigo. Could not get out of bed. In August improved some-

316

ABSTRACTS

what and came to see the writer. At this time had still complete
facial paralysis. Swaying, on standing with eyes shut. Mucosa of
right tympanum swollen and with granulations. Pus scanty but
very foetid. Tuning fork on right mastoid heard only in left ear.
Normal caloric reaction.

Radical mastoid operation performed. Facial canal found
exposed. No. fistula seen. After operation temperature rose at
once to 38'5. Pain in neck.

On 5th day after operation temperature still raised. Rigor.
Vomited twice.

On 6th day another rigor. Temperature, 39*6.

On 9th day another rigor. Temperature, 39*8.

On 10th day.—Delirious. Great headache and pain in neck.

On 11th day.—Second operation. Sinus exposed as far as the
jugular bulb. Opened. Clot removed. Labyrinth also opened.
No pus. Seven days later suddenly became unconscious. Three
weeks after second operation temperature had been steadily rising
to 41° C. Delirium. Pyaemic abscesses. Sudden protrusion of
right eye and oedema of eyelid. Two days later same appearance
of left eye. Died a few days later. Post mortem showed
cavernous sinus, right lateral sinus, and petrosal sinuses thrombosed,
with here and there pus. Purulent meningitis of base of brain.

The writer Bays that it is not common to get progressive
involvement of the venous sinuses, and gives references of a few
that had been described. He also discusses the anatomy and
physiology of the venous sinuses. J. K. Milne Dickie.

TWO BABE COMPLICATIONS OF FOBEION BODIES IN THE
(399) (ESOPHAGUS. (Zwei seltene komplikationen von Fremdktirpern
im (Esophagus.) Mieczyslaw Qantz, Monatuchr. /. Ohrenheilk.,
1914, xlviii., H. 2, S. 183.

The writer reports two cases as examples of how cases of foreign
bodies in the oesophagus should not be treated.

The first case was a man, aged 35. Four weeks previously a
fish bone had stuck somewhere in his throat. He went to his
doctor about it, but the latter could not find it. Five or six
days later the pain had become much worse, and there was now
some fever. Another doctor was called in who diagnosed angina,
as the fever was now over 40° C. A few days later he was advised
to go to Berlin to see if the fishbone could be discovered. On the
way to Berlin the patient felt very ill, and suddenly felt as if
something had burst in his throat. He spat out some purulent
fluid and immediately felt some relief. In Berlin he saw a

ABSTRACTS

317

laryngologist, who examined him with an oesophagoscope, and told
him that he would soon be well. The patient returned home and
was quite well for two weeks, when he suddenly had a rigor, his
temperature rose to 40°, and he had severe pain in the left side
of his neck. Swallowing and speech were not interfered with.
He resolved to go at once to Berlin, but stopped for the night at
Warsaw. While there he consulted a doctor, who diagnosed a
retropharyngeal abscess, and advised him to see Gantz in the
morning. During the night the patient noticed that he could not
move his left leg, and had to move it with his hand. He was
fully conscious, and his speech was unaffected. On his way to
the klinik next day he became unconscious. When seen by
Gantz his breathing was stertorous, eyes shut, profuse perspiration.
Meningitis diagnosed. Lumbar puncture gave stinking pus.
Death in two hours. Probable cause of death, the bursting of a
retropharyngeal abscess through the intervertebral canals into the
spinal canal.

The second case was a woman, aged 40. She had swallowed
a little piece of bone which had stuck in the left side of the
throat. She tried to push it down with bread, but only increased
the pain. A doctor was called in who tried, unsuccessfully, to
push it down with a wire covered with wool. Four or five people
made attempts to dislodge the bone with various instruments, but
without success. That night the patient could not sleep on
account of the pain in her throat. She visited Gantz seventeen
hours after swallowing the bone. There was great hyperaemia of
pharynx and larynx. The piece of bone was seen in the left
piriform sinus, surrounded by an area of great swelling. With the
oesophagoscope the bone, measuring 2 cm. by £ cm., was removed.
In spite of antiseptic painting, ice compresses, &c., the temperature
rose in the evening, accompanied by great pain. Two days later
the right wall of the pharynx became swollen. Symptoms of
asphyxia. Neck incised on left side, and stinking pus welled out
from region of oesophagus. Later an oesophageal fistula developed
through the wound, but gradually closed up again. The patient
eventually recovered, and in four weeks was quite well.

The writer attributes the rapid onset of septic complications
in the second case to the repeated and misdirected efforts at
removal. He recommends that in all cases of suspected foreign
bodies examination with the oesophagoscope should be carried out.
He quotes numerous cases in which wounds of the oesophagus
were observed after blind passage of instruments.

He concludes that all blind methods of removal of foreign
bodies should be carefully avoided, and that removal through the
oesophagoscope under the guidance of the eye is the only allowable

318

ABSTRACTS

procedure. If this is unsuccessful, oesophagotomy should at once
be performed. J. K. Milne Dickie.

SUDDEN DEATH FOLLOWING LUMBAR PUNCTURE. (La mort
(400) subite suite de ponction lombaire.) J. Minet, Joum. de mM.
de Paris , 1914, zzziv., p. 312.

Minet and Lavoix in 1909 collected thirty-four cases ( v. Review,
1909, vii., p. 479). The pathogeny of sudden death following
lumbar puncture is probably multiple. Sometimes vaso-motor
phenomena occur which may end in haemorrhage. In other cases
the fall of the cerebellum on the bulb may be the cause of death.
As a rule there is probably a bulbar shock. J. D. Rolleston.

THE ALBUMEN CONTENT OF THE SPINAL FLUID IN ITS RBLA-
(401) TION TO DISEASE SYNDROMES. A. Myrkson, Joum. Nerv.
and Merit. Dis. y 1914, zli., March.

A clinically quantitative estimation of albumen has been made
as a part of the routine examination of the cerebro-spinal fluid.
Into a narrow test tube, one with a bore of about 6 mm., 2 c.c. of
spinal fluid is dropped. The fluid is heated short of the boiling
point, and then six drops of a 33 J per cent, aqueous solution of
trichloracetic acid is added. In the normal fluid there is at once
a diffuse but not marked cloudiness, which gradually settles in
thirty minutes into a flocculent precipitate just covering the
bottom of the tube. Where there is a distinct increase, there is a
dense cloud which almost immediately becomes flocculent and
settles to a height of perhaps 5 cm. from the bottom of the tube.
The following general conclusions are drawn:—

1. In general paralysis the relationship of albumen, globulin,
cells, and Wassermann reaction is quite constantly one of paral¬
lelism, but in the remissions the Wassermann reaction disappears
first, the cell count and globulin diminish next, and the albumen
most constantly remains at a high level of increase; in the pre¬
paretic stage, therefore, the albumen increase is probably the first
sign of disease.

(a) In Korsakoff’s disease, in certain cases of tumour and in
other organic diseases, there is a dissociation of albumen and
globulin in this sense, that there is either marked increase of
albumen without globulin, or that a marked increase of albumen,
say 3 + , is accompanied by a globulin increase of 1+.

(b) The increase of albumen is a primitive reaction of the

nervous system, and is the first as well as the most constant of
the present known chemical and biological changes to appear in
the spinal fluid. D. K. Henderson.

ABSTRACTS

319

THE COLLOIDAL GOLD REACTION IN THE CEREBRO SPINAL
(402) FLUID. Sydney R. Miller and Robert L. Levy, Bull. Johns
Hopkins Hospital, 1914, xxv., No. 279.

The paper deals with one of the newer tests applied to the cerebro¬
spinal fluid; one in which the colloidal chemistry of the fluid
seems to be the determining factor.

It was known to Lange, who first described the reaction in
1912, that colloidal solutions of gold are precipitated by electrolytes,
and that solutions of proteins protect colloidal solutions of gold
from precipitation; also that the quantity and nature of proteins
present in a solution could be determined with great accuracy by
estimating the amount of the solution necessary to protect a
constant amount of colloidal gold in the presence of a fluid of
constant electrolytic power.

In attempting to apply this knowledge to the study of the
proteins of the cerebro-spinal fluid, he discovered that in
conditions in which the spinal fluid contained an abnormal
amount of protein substances, notably in syphilitic diseases of
the nervous system, he was unable to secure protection, but that
more or less complete precipitation of the gold occurred within
certain dilution limits of the cerebro-spinal fluid.

The dilution limits seemed to be definite and specific, and
seemed to vary in different diseases, thus making their differentia¬
tion possible by this method. The exact nature of the reaction is
unknown.

Lange is inclined to interpret the reaction as an indication of
the occurrence of different qualitative mixtures of protein sub¬
stances, rather than a true quantitative increase in one or other of
the protein constituents; for the strength of the reaction ap¬
parently bears no relation to the amount of protein present as
revealed by ordinary tests. Several other explanations have been
given.

The technique of the test is as follows:—

Eleven test tubes are placed in a row.

1*8 c.c. of a 0 4 per cent, salt solution are pipetted into the
first tube, 1 c.c. into each of the remaining tubes.

0 2 c.c. of cerebro-spinal fluid are then added to the first
tube and mixed.

1 c.c. of this 1-10 dilution of spinal fluid is transferred to the
second tube, where the mixing process is repeated, a
120 dilution resulting.

In a similar manner, dilutions are made in the remaining eight
tubes, giving ten dilutions from 1 in 10 to 1 5120. The eleventh
tube serves as a control to which no spinal fluid js added.

320

ABSTRACTS

To each tube 5 c.c. of colloidal gold solution are added, and
the result may be read off in a few minutes.

The result is deduced from the change in colour of the red
gold solution through red-blue, lilac, violet, purple, and pale blue
to the colourless solution which results from complete precipitation
of the gold.

In a negative reaction no change takes place; in different
diseases the maximum precipitation takes place fairly constantly
at certain dilutions.

The authors examined 210 cerebro-spinal fluids from 171 cases,
and give detailed particulars of their results.

They conclude that normal fluids give negative reactions, and
that the reaction peculiar to general paralysis is sufficiently con¬
stant to warrant its use as an aid in the differentiation of this
condition from others with which it might be confused. But they
are unable to agree with earlier workers, that the reactions in
other diseases of the nervous system—syphilitic, and otherwise—are
characteristic; or that the reactions seen in secondary and tertiary
syphilis can be said with certainty to be the earliest sign of
involvement of the nervous system.

They consider, however, that the test may prove to be more
sensitive as an indicator of the results of specific therapy than are
those at present employed. The authors describe their technique
and the method of preparing the gold solution in detail. A full
bibliography is appended. W. J. Adie.

PINEAL TUMOURS. (Lea tumours do la glande pintale.) A S£zary,
(403) Gaz. des H6p., 1914, Ann. 87, June 20 and 27, pp. 1141, 1205.

A good systematic account of pineal tumours. The macro-
genitosomatic precocious syndrome is well described, also the
differential diagnosis between pineal tumours and those of the
pituitary and adrenals. As the palliative operation of choice
Sdzary suggests ventricular puncture: he thinks that possibly
trephining followed by ventricular drainage will give more
persistent effects. A useful bibliography is given.

Leonard J. Kidd.

RESEARCHES ON TETANY AND SENILE CATARACT. (Fischer
(404) Triebenstein und Untersuchungen fiber Tetanie und Alterstar.)

Klin. Monattbl. f. Augenheilk ., 1914, 1 , S. 441.

The authors investigated sixty-eight cataractous subjects of ages
varying from 50 to over 70 years and found signs of latent tetany
(Latenzzeichen der Tetanie) in the great majority. The cases,

ABSTRACTS

321

with the signs found, are tabulated, as well as twelve cases of
similar ages who had no cataract and no latent tetany. They
suggest that the two conditions are connected and that all cases
both of lamellar and other forms of cataract in early life and
senile cataract should be examined by a neurologist.

H. M. Traquair.

ADRENAL VIRILISM. (Le virilisme surrlnal.) Tuffier, Bull, de
(405) PAcacL de Med., 1914, lxxi., May 26, p. 726.

A woman of 62 came for metrorrhagia, which examination showed
was apparently due to a large fibroid. Owing to a considerable
glycosuria operation had to be postponed. She was high-coloured,
vigorous, had a thick black beard and moustache, red swollen face
of masculine type, slight exophthalmos, masculine voice, great
muscular development and strength; had become fond of hard
manual work, digging, &c., which did not tire her at all; some
almost confluent yellow spots on forearms and hands; clitoris
hypertrophied, 4 cm. long, covered by a very large preface.
(Tuffier does not state whether her pubic hair extended vertically or
not.) All these abnormalities came on after the menopause. No
organic signs outside abdomen. Glycosuria quickly lessened under
treatment. Operation revealed a greatly hypertrophied uterus,
which was removed: glycosuria soon disappeared During
laparotomy examination of adrenal region revealed a bilateral
mass, half the size of a kidney, over the kidneys, of fibrolipomatous
consistence. Left ovary atrophied: right showed a tumour the
size of a large nut. One of the two photographs of the patient
shows a bearded face that every one would take for a man’s
(v. Review, 1912, x, p. 345). Leonard J. Kidd.

EPILEPSY IN CHILDHOOD. James H. Lloyd, Archives of Pediatrics,
(406) June 1913.

The author begins by quoting Gowers’ and Spratling’s statistics
showing the frequency of the disease in childhood : he then draws
attention to the relationship of infantile convulsions to epilepsy.
In discussing the heredity of the disease he throws considerable
doubt on the value of any investigations along this line. He
characterises heredity as largely a “ Terra incognita.” The
possibility of abnormal internal secretions, syphilis, and otitis
media are mentioned as possible causative factors. He points out
the value of surgery in certain traumatic cases, but warns his
hearers against trephining in essential epilepsy which has a
focal character.

322

ABSTRACTS

The difficulty of diagnosing nocturnal epilepsy in relation to
nocturnal enuresis is considered. Treatment is dealt with briefly,
because, as the author points out, there is nothing new to add.
He reiterates the importance of a strict hygienic, mental and
moral regime. A. Fergus Hew at.

THE RECOGNITION AND TREATMENT OF TRUE IDIOPATHIC
(407) BPILEP8T IN CHILDREN. J. N. G. Nolan, Dublin Jour, of Med.

Science , Aug. 1913.

In this article a review is given of the treatment employed, at
Hellingly Mental Hospital, for children suffering from idiopathic
epilepsy. The author also deals briefly with cases which he terms
“ secondary epilepsy ” arising from some cerebral lesion or defect.
The causes operative in both types of case are detailed and the
writer urges the more frequent use of the Wasserinann reaction as
an aid to diagnosis, because such cases which give a positive
reaction may be vastly improved by an antisyphilitic treatment.

An outline of treatment for the cases of secondary epilepsy is
mentioned, but the prognosis is acknowledged to be gloomy. Iu
dealing with the treatment of the idiopathic type considerable
stress is laid on the value of recognising early symptoms of the
disease in neurotic children. General lines of treatment are briefly
discussed under the following headings:—

(1) Prophylaxis, (2) Medicinal, (3) Dietetic, (4) Surgical, and
(5) Educational.

No new doctrines are brought forward, but the author insists
that manual and industrial work should figure largely in the
curriculum. More detail about the educational treatment would
have added largely to the value of this interesting paper. In
spite of the fact that only the worst types of epileptics go to an
asylum the author states that “80 per cent, of our defective
epileptics are usefully employed in the various industrial shops;
and the younger children all benefit by their school training.”
Finally, the author urges the importance of a very careful regime,
which must be started early and carried out with the utmost care
and perseverance in idiopathic epilepsy. A. Fergus Hew at.

SCORBUTIC POLYNEURITIS. (Polynlvrites scorbutiques.) A.

(408) Austreoesilo, Rev. Neurol ., 1914, xxii., Janvier 30, p. 76.

Scurvy may be difficult to diagnose from beri-beri, the difficulty
being greatly increased if it be accompanied by polyneuritis. Two
forms of scorbutic polyneuritis may be distinguished: (1) acute,
subacute or dropsical, resembling beri-beri, but presenting the

ABSTRACTS

323

general characters of scurvy, and (2) a post-scorbutic form,
appearing during convalescence, atrophic, of a chronic type and
difficult to treat. A. Ninian Bruce.

ON NYSTAGMUS. J. Igeshkimkr, Klin. Monatsbl.f. Augenheilk ., 1914,

(409) li., S. 337 and 66R

The paper discusses nystagmus specially from the point of view
of the oculist. After a short r&um6 of the relations of nystagmus
to affections of the cerebrum and cerebellum and of the auditory
apparatus, the author discusses the possibility of a connection
between nystagmus and convergent strabismus and retinitis
pigmentosa on the basis of inner ear disease as a common factor in
such cases, and decides against such a suggestion.

As differentiating points the nystagmus at the extremes of
movement is mentioned as characteristic of multiple sclerosis, and
the jerky nature of otogenous nystagmus oscillating nystagmus is
never aural in origin. Excluding miners’ nystagmus the author
recognises two groups of cases, those in which some local ocular
condition appears to be the cause and those for which such an
explanation is unavailable.

In the first group is contained a large number of cases
commonly termed Nystagmus Amblyopicus and frequently found in
blind asylums. In albinos who have no macula lutea, nystagmus
is frequent.

In other cases the nystagmus is associated with partial or total
colour blindness. In this group, while various cerebral processes
may be assumed to be disordered it is the amblyopia which
produces the nystagmus. On the other hand it is not easy to
explain why some children who become amblyopic in early life fail
to develop nystagmus.

In another group there is no noteworthy amblyopia. Here the
author has found that hereditary syphilis is very frequently the
cause, a relationship for which increased pressure in the fourth
ventricle is suggested as an explanation.

The paper closes with short notes on hereditary and familial
nystagmus. H. M. Traquair.

BOMB OASES OF HYSTERICAL DEFECT OF THE FIELD OF

(410) VIBION. (Binige F&lle von Hysterischem Gesichtsfelddefek.)

Hbnning Rouwe, Klin. Monattbl. f. Augenheilk. ., Marz-April 1914,
8.372.

While, in general, hysterical fields belong to a characteristic type,
there are many exceptions, and the author has shown in this
paper that the field changes in hysteria may be very various.

324

ABSTRACTS

The cases described include one in which the field was smaller
for a large than for a small object, and cases of scotoma, really
only subjective, some of which simulated toxic amblyopia or re¬
trobulbar neuritis. Great care is necessary to control the observa¬
tions so as to make certain as to the nature of the condition, as
the observer is apt to obtain the kind of field he expects, and he
should always bear in mind the possibility of a purely functional
defect. H. M. Traquair.

UNUSUALLY EXTENSIVE MBDULLATED NERVE FIBRES IN

(411) HIGH MYOPIA WITH AMBLYOPIA. (Ungewohnlich
ausgedehnte markhaltige Nervenfasem bei hochgradiger
Myopie und Amblyopic.) Berg, Klin. Monattbl. /. Augenheilk.,
1914,1., S. 495.

The present case occurred in a boy of 8 years who had a practically
normal eye on the left side with full vision, while on the right
there was high myopia with astigmatism and very poor vision.
The fundus showed extensive opaque nerve fibres spreading out
from the disc and arching over towards the macula illustrating
the anatomical arrangement of the fibres in a very well marked
manner. The condition is shown in an excellent illustration.

A list, with short descriptions, of twenty-five somewhat similar
cases is given.

The author suggests that faulty development may explain both
the opaque nerve fibres and the myopia. H. M. Traquair.

CHRONIC PALSY OF LIMBS DUE TO PROLONGED USE OF

(412) COLCHICINE. (Paralysie durable des membrcs par ingestion
prolongs de colchicine.) A. Souques, Bull, de VAcad. de Med., 1914,
lxxi., June 2, p. 750.

A vigorous man of 50, subject to annual attacks of acute gout,
took on his own responsibility repeated small doses of a colchicine-
containing preparation for a period of three weeks, and per¬
sisted in this in spite of diarrhoea and abdominal pains: he did
this to ward off what he regarded as an impending attack. He
was then seized with paralysis of all four limbs and trunk;
anaesthesia of feet at onset with severe deep muscular pains;
muscle tenderness persisted; no psychical changes, no involvement
of head, heart, or sphincters; no albuminuria or fever. (At one
period, it is said that there was abolition of deep reflexes and
respiratory disturbances, but Souques cannot vouch for this, as he
did not see the case then.) Even now, six months after the onset,
the motor and sensory troubles are not entirely cured. Souques
shows that acute colchicine poisoning gives the same effects on the
nervous system as the repeated continued small doses taken by

ABSTRACTS

325

his patient. He insists on the importance of strict medical super¬
vision in colchicine therapy, and its suspension if diarrhoea occurs.

Leonard J. Kidd.

the medical aspects of the obbek anthology, j. d.

(413) Rollkston, Proc. Roy . Soc. Med,., 1914, vii., Section of History of
Med. , pp. 3-13 and 30-56; and Janus, 1914, xix., pp. 35-46 and
105-131.

In the first part of this paper the writer deals with the medical
men connected with the Anthology, either as contributors or as
the subjects of the poems, and in the second part discusses the
numerous other medical allusions to be found in the work. Among
these may be mentioned the epigrams illustrating the relation of
medicine and religion; the prevalence of alcoholism in antiquity,
and its association with prostitution, the absence of any reference
to syphilis or any venereal disease, the homosexual, or rather
bisexual, life of the ancients, as well as allusions to dwarfism,
gigantism, hysterical paraplegia, hemiplegia or hemiatrophy,
epilepsy, paracusia, and other disorders of special sense. In
conclusion, the writer states that the Greek Anthology merits
more attention than it has hitherto received from the medical
historian for the following reasons:—

1. It offers numerous illustrations of the relations between
Greek medicine and Greek religion, especially as regards Asklepius.

2. It contains definite references to certain diseases such as
gout, alcoholism, and malaria, as well as numerous allusions to
epidemic diseases, the nature of which cannot be determined.

3. It supplies valuable negative evidence of the existence of
syphilis in antiquity, in spite of the numerous facilities for the
spread of the disease.

4. It illustrates many subjects in the life of the ancients, more
or less closely concerned with medicine, such as baths, latrines,
cosmetics, prostitution, popular remedies, and superstitions.

5. As a source of medical satire and caricature, it deserves to
rank with the works of the Latin poets.

Author’s Abstract.

PSYCHIATRY.

ON A PEDIGREE SHOWING BOTH INSANITY AND OOMPLI
(414) GATED EYE DISEASE: ANTICIPATION OF THE MENTAL
DI8EASE IN SUCCESSIVE GENERATIONS. £. I. Lidbktter
and £. Nettleship, Brain, 1913, xxxv., p. 195.

In Part I. a pedigree is described which formed the basis of an
article by Mott, the data of which was supplied by the present

326

ABSTRACTS

authors, but which they have more fully investigated from both
the mental and ocular sides. The result shows an association
between mental deficiency and ocular defects; the latter are fully
gone into, and consist chiefly of detachment of the retina; disease
of the choroid, with iritis, and in some cases secondary cataract;
little is said about the forms of insanity, with the exception that a
few are classed as imbecile. It is found on taking the third,
fourth, and fifth generations, that out of sixty-five persons, forty
are defective either mentally or physically. In the successive
generations there does not appear to be any evidence of an earlier
incidence in the eye disease, but there is an anticipation of mental
disease.

In Part II. there is given an anticipation in diabetes showing
occurrence of the disease at age of 50, 37, and 22, in successive
generations, and in a further pedigree at 58, 35, and 6|.

Part III. consists of a series of cases showing extensive coarse
disorganisation of the choroid in infants frequently associated
with mental defect.

The conclusions formed are that: (1) There is an association
between mental deficiency and ocular defects which is partly
developmental, partly morbid. (2) That amongst the members
who have not shown any definite mental or ocular disease a large
proportion have not been endowed sufficiently to compete success¬
fully in life, and have been in receipt of poor law relief. (3)
Mental deficiency tends to appear at an earlier age in succeeding
generations, but there is no anticipation in ocular defects. (4)
Anticipation is well seen in the case of diabetes.

A. W. Nkill.

ARACHNOID INJECTION WITH THE SERUM OF SYPHILITICS
(416) IN TABES AND GENERAL PARALYSIS. (Ein serothera
peutischer Versuch bei Tabes und Paralysis progressiva: Arach-
noideale Injektion mit Serum von Syphilitikem.) B£rikl and
Duband, Neurol. Centralbl., 1914, May 16, p. 612.

A number of intravenous injections of salvarsan are given to a
syphilitic patient; not less than twenty-four hours after the last
of these, serum is withdrawn by venipuncture. This serum is
not a mere chemical solution of salvarsan, but contains syphilitic
antibodes. The serum, be it noted, is not that of the patient to
be treated, but is obtained from a syphilitic patient who shows
recent evidence of the disease. The serum is injected by the
lumbar route in cases of tabes, and by the cranial route in cases of
general paralysis: twenty-four hours elapse after its withdrawal
from the syphilitic patient before it is thus employed: it is also
heated to 56° C. for half an hour. Some 10 to 20 c.c. are injected.

ABSTRACTS

327

The authors have given four lumbar injections and seven cranial
injections by this method. They consider it free of all danger,
and the results are promising. S. A. K. Wilson.

TREATMENT OF GENERAL PARALYSIS. H. Damayk, Progret

(416) Midical, 1914, June 6, p. 270.

A report of three cases of G.P.I., treated beneficially by essentially
the same treatment as that used by the author in cases of
syphilitic psychoses (v. Review, 1914, xii., April, p. 170), viz., first,
over-alimentation and tonics, secondly, after establishment of an
improved physical state, the addition to over-alimentation of
antisyphilitic remedies. Leonard J. Kidd.

METABOLISM IN DEMENTIA PRiEOOX. Ellison L. Ross, Arch.

(417) Int. Med., 1914, xiii., June, p. 889.

Five cases of dementia praecox, three in a chronic and two in a
subsiding acute phase of the disease, were used in these metabolism
tests. The metabolism of nitrogen, phosphorus, calcium, and
magnesium was normal in both classes of patients. The metabolism
of sulphur, except in the excessive total sulphate output and
possibly the inorganic sulphate output, was normal for the
chronic cases; but in the acute cases the excretion of total sulphur
was maximum normal, the total sulphate and inorganic sulphate
output was abnormal, and the neutral sulphur was above normal.
The abnormalities in the sulphur metabolism of the acute forms
indicate a reduced power of metabolic oxidation, a fact which is
not surprising since seemingly every bodily activity is decreased
in acute dementia prtecox. The fewer and less pronounced
abnormalities of sulphur metabolism in the chronic group suggest
a similar, though less extensive, deficiency than in the acute
group. A. Ninian Bruce.

ALZHEIMER’S DISEASE AND ITS RELATION TO SENILE

(418) DEMENTIA. Simchowicz, L'Encephale, 1914, ix., March 10,

p. 218.

The clinical aspect of the case here recorded resembled that of
Alzheimer’s disease, whereas the pathological picture was that
of senile dementia: the pathological condition, however, was more
localised than in the latter disease. The author thinks that the
curious distribution of the lesions is the explanation of the
differentiation of the clinical symptoms in his case, focal symptoms
which are not found commonly in senile dementia. There were

328

ABSTRACTS

marked changes in the cells of the cornu ammoniB, including a
granulo-vacuolated degeneration of the pyramidal cells—changes
which are found both in senile dementia and in Alzheimer’s
disease.

The case is worked out carefully on both the clinical and the
pathological sides, and is well illustrated. S. A. K. Wilson.

CLINICAL EXAMINATION OF THE MENTAL STATE OF DE
(419) MENT8. (L’examen clinique du fond mental chez les dements.)

Ballet and Genil-Pkrbin, L’Encephale , 1914, ix., Feb. 10, p. 101

The authors have worked out a very practical scheme for the
examination of the mental state in cases of dementia. It is
essential for comparison of cases that some scheme should be
adopted and regularly utilised, and the scheme here elaborated in
detail appears very applicable to the task in hand. The authors
analyse five different mental functions in their patients, viz.,
affectivity, attention, memory, association of ideas, general activity.
Each of these is in turn subdivided, and suitable tests are
devised for the examination of each. The results are expressed
in figures, and thereby a graphic representation of the patient’s
mental condition at any given period is obtained. The reader
must consult the original for the details of this interesting
investigation. S. A. K. Wilson.

TREATMENT.

THE TREATMENT OF NEURITIS BT ELECTRICAL METHODS.

(420) W. F. Somerville, Brit. Med. Jovm., 1914, May 9, p. 1014.

Nine cases of neuritis affecting various nerves are here recorded,
all of which were either cured or greatly benefited by high-
frequency electricity or ionic medication.

For the relief of neuralgic pain, high-frequency currents of from
500 to 800 milliamperes should be passed through the patient as
he lies on the condenser couch, while the affected area may be
stroked gently by the hand of the operator as he holds one
electrode while the patient grasps the other.

The best results in ionic medication were obtained by using a
2 per cent, solution of quinine hydrochloride. The electrode
lying on the pad soaked in quinine hydrochloride is connected
with the positive pole, and bound in place by bandages. The
current is slowly turned on, and may be increased from 50 to 100
milliamperes, and applied for thirty minutes. It should be
repeated daily unless the skin is tender. A. Ninian Bruce.

ABSTRACTS

329

OXYGEN HYPODERMICALLY IN NERVOUS AND MENTAL
(421) DI8EASBS. M. Dardxl, Rev. Med. de la Suinu Romande , 1914,
March 20, p. 192.

Oxygen increases the differential pressure, diminishes the viscosity
of the blood, increases haemoglobinaemia, slows the pulse, increases
the amplitude of respiratory movements, and usually gives some
degree of euphoria. Toulouse used it hypodermically in mental
affections with encouraging results: four acute psychoses yielded
rapidly; it calmed agitation, promoted sleep, lessened frequency
of epileptiform attacks, and always did some good. Dardel records
twelve cases thus treated: he injected the gas from a Martinet’s
oxygenator, connected by a rubber tube to a Pravaz syringe, into
the outer side of the thigh (description of mode of charging, &c.,
given). He advises very slow injection, even up to ten or fifteen
minutes: the skin bulges and there is pricking, tenderness, or
even transient pain; at the end of a few hours the gas is absorbed,
but usually next day some subcutaneous crepitation can be felt:
the site of injection is changed daily, and recumbency for at least
half an hour after injection is desirable. No accident or bad
result was ever seen. The most constant favourable sequela was
improved sleep, both during treatment and subsequently: it is
natural, deep, and free from subsequent narcotic-like malaise;
euphoria also occurred. Even in chronic incurable organic
cerebral diseases, oxygen gave improved sleep and general quiet¬
ing. The difficulty of eliminating the possible influence of sug¬
gestion is admitted. The doses used were usually either 200 or
300 c.c., at first given daily or on alternate days, gradually increased
to 400 or 500 c.c. One patient, a pale, thin, badly developed,
delicate boy of 11, bore 300 to 400 c.c. every other day extremely
well: the rest were adults from 26 to 59 years of age. The
patients comprised cases of neurasthenia, epilepsy, constitutional
psychopathy with chronic depression, ideas of persecution with
violent attacks of anger, circular insanity, chronic gastritis with
obstinate insomnia, catatonic dementia with remissions, and a
catatonic young woman who showed difficulty in collecting her
thoughts, and in speaking, and in doing what she wanted to do.

Leonard J. Kidd.

330

REVIEWS

■Reviews.

MENTAL DEFICIENCY. (Amentia.) By A. F. Trkdgold, L.R.C.P.,
(422) M.R.C.S., Consulting Physician to the National Association for the
Feeble-minded, and to the Littleton Home for Defective Children,
«fec. Second edition, revised and enlarged. London: Bailli&re,
Tindall, A Cox, 1914. Pp. 492 ; 67 illustrations. Pr. 12s. 6d. net

The second edition of Dr Tredgold’s book on mental deficiency
has been thoroughly revised, and many chapters have been entirely
rewritten. A fresh chapter has been added dealing with the
important practical points of case taking, and of tests of mental
ability. There is also an addendum on the Mental Deficiency Bill,
and its bearings on the relationship of the medical profession
to mental defectives, considered from various viewpoints. Re¬
reading of the volume under review confirms the high opinion
we have formed of its theoretical and practical value. The
neuropathologist will find accurate descriptions of the pathology
of mongolianism, microcephaly, and amentia in general, with its
different varieties : the clinician will find excellent studies of the
symptomatology of these conditions: the teacher and instructor
will find numerous practical hints for the training and education
of these types of mental deficiency. The legal and sociological
bearings of the problem of mental defect are fully considered. No
one who is called on to deal with this class of case, in any capacity,
should fail to make himself acquainted with this volume of
Dr Tredgold’s, which is written from the point of view of the
scientific physician, and is brought completely up to date.

FREUD’S THEORIES OF THE NEUROSES. By Dr Eduard Hitsch-
(423) mahn, Vienna. Translated by Dr C. R. Payne, New York. New
York: The Journal of Nervous and Mental Disease Publishing
Company. 1913. Pp, 154. Pr. $2.00.

Dr Hitschmann’s purpose in writing this book is to furnish the
reader with a synthetic account of Freudian theories on the nature
and etiology of the various neuroses. It is intended to serve as an
introduction to the study of Professor Freud’s works, and as a
stimulus to the application of the methods of psychoanalysis to
the problems of psychiatry: as the writer says, “it aims at
separating from the ranks of the indifferent and antagonistic those
whose position is due to insufficient or erroneous information.”
The book provides a lucid and coifcise summary of the chief
principles enunciated by Professor Freud, illustrated by clinical

REVIEWS

331

examples and supported by evidence from the works of other
investigators. It is in the main expository, and for that reason
may be recommended to those who wish to possess a logical
working acquaintance with Freudian theory. The translation is
well done: footnotes and a good bibliography increase the value of
the book from the point of view of the English reader.

THE PSYCHOPATHOLOGY OF HYSTEBIA. Chablks D. Fox, M.D.
(424) Richard G. Badger, The Gorham Press, Boston.

In this book Dr Fox sets forth the modern psychological theory
of hysteria as developed by Janet, Sidis, Morton Prince, and
Freud. He is well acquainted with the literature of the subject,
and he gives numerous cases illustrating the phenomena of the
disease—some well known, others drawn from his own clinical
experience. He adopts the view that all the functional neuroses
are dependent upon disintegration of personality, that is, upon the
activity of dissociated complexes; the terms neurasthenia,
psychasthenia, hysteria, hypochondria, &c., indicate differences
of degree in the dissociation; they do not correspond to any
distinction of kind, but only to clinical syndromes, thus being
useful merely as indicating what symptoms the physician may
expect.

Among those who accept this theory in a general way there
are, it is well known, many minor differences of opinion. Freud’s
views, for example, are not received in their entirety by men like
Morton Prince. Dr Fox gives a brief but clear and accurate
outline of Freud’s main theory : he does not criticise, nor does he
go deeply into the most controverted doctrines, but it is probable
that he himself agrees more closely with Prince than with Freud.

With regard to treatment he says, “the most logical and
effective form of therapeusis includes the discovery, by means of
some psycho-analytic method, of the causal submerged complexes ;
synthesis of these with consciousness; and, through the agency of
psychic re-education, the removal of psychopathic tendencies.”

In opposition to Freud he recommends hypnotism as a method
of reaching the submerged complexes. He also gives brief
accounts of Freud’s method of psycho-analysis and Jung’s word
association method.

Dr Fox seems to view with favour the opinion held by some
modem authorities that hysteria is potential in all of us, though it
does not seem easy wholly to reconcile this with his view that the
disease is rarely cured. The manifestations, he says, “ can be
removed easily in most cases, and the morbid temperament of the
patient somewhat modified, but all the accidents continue to exist

332

BOOKS AND PAMPHLETS RECEIVED

as potentialities which may become actual at any time, providing
that sufficient provocation occurs.”

The author’s style leaves a good deal to be desired. Many of
his sentences are loosely constructed, and unattached participles
abound; while a few gross grammatical errors have escaped
correction. But, as a whole, the book may be cordially re¬
commended as giving a sane and well-balanced account of the
nature and symptoms of hysteria in the light of modern research,
together with indications of the best methods of treatment.

Margaret Drummond.

BOOKS AND PAMPHLETS RECEIVED.

Auer, John. “The Effects of Intraapinal Injections of Serums with
and without Preservatives” {Journ. Amer. Med. Assoc., 1914, Ixii., p. 1799).

Fearntudes, E. Q. “Acute Poliomyelitis” ( London Hosp. Gaz ., 1914,
xx., March).

Fearnsides, E. Q. “Diseases of the Pituitary Gland and their Effect
on the Shape of the Sella Turcica” ( Proc. Roy. Soc. Med., 1914, vii.,
Electro-therap. Sect., p. 46).

Gregor, Adalbert. “Lehrbuch der Psychiatrischen Diagnostik,” mit
7 Abbildungen. Berlin, 1914, S. Karger. Pr. M. 4.80; geb. M. 5.80.

Klemm, Paul. “Die akute und chrouische Infektiose Osteomyelitis
des Kindesalters.” Berlin, 1914, S. Karger. Pr. M. 9; geb. M. 10.20.

Klinke, Otto. “ Die Operativen Erfolge bei der Behandlung des Morbus
Basedowii.” Berlin, 1914, S. Karger. Pr. M. 4.

Oppenheim, H. “ Gibt es eine zystische Form der multiplen Skleroset”
{Neurol. Centralbl., 1914).

Oppenheim, H. “ Uber Vortauschung von Tabes und Paralyse durch
Hypophysistumor. (Pseudotabes pituitaria, &c ) ” ( Ztschr. f. d. get.
Neurol, u. Psychiat., 1914, xxv. (Orig.)).

Oppenheim, H. “ Zur Therapie der syphilitischen Nervenkrankheiten ”
{Berl. klin. Wchnschr., 1914).

Taylor, Alfred S. “Conclusions derived from further experience in the
surgical treatment of brachial birth palsy” {Amer. Joum. Med. Sci., 1913
cxlvi., p. 836).

“ The Training School Bulletin.” 1914, xi., June.

“Review

TReurologv ant> psvcbiatrv

©dginal Hrticles

DROP METHODS OF COUNTING THE CELLS OF
THE CEREBROSPINAL FLUID —THE RELA¬
TION OF THE CELL-COUNT TO THE WASSER
MANN REACTION.

By R. DONALD, B.Sc. (N.Z.), D.P.H. (Oxf.).

(Bacteriological Laboratory, London Hospital—Prof. W. Bulloch,

M.D., F.R.S.)

Plan of the Article.

PAQB

Introduction --------- 334

Outline of other cell-counting methods ----- 335

A drop-chamber method (suggested) ------ 336

The drop-film method -------- 337

Brief outline --------- 337

Precautions taken in the investigation ..... 338

Counting “kept” specimens is still useful ----- 338

Swollen (degenerated) cells ------- 338

Centrifuging to be avoided ------- 339

Red cells to be allowed for ------ 339

Technique of the drop-film method ------ 339

Measuring the fluid by drops ------- 340

Drying and fixing the drop-films, collodioning, staining, mounting - - 341

Examining --------- 342

A useful lamp device -------- 342

Results Obtained.

Clinical indications for the punctions ------ 343

Classification of the cases—“crucial” division by the W.R. in one
direction and by the cell-count in the otherdirection -

343

334

R. DONALD

Notes on the Tables.

PAGH

Group I.—Serum-W.R. negative, without pleocytosis . - 344

Group II.—Serum-W. R. negative, with pleocytosis - - - - 344

Group III.—Serum-W.R. positive, without pleocytosis - - - 344

Group IV.—Serum-W.R. .positive, with pleocytosis (only Group IV. has

the c.s.f.-W.R. positive) - 345

Sub-group IVa.—Untreated nervous syphilis .... 345

Sub-group IV b, —Nervous syphilis much improved under treatment - 345

Sub-group IVc.— Nervous syphilis less improved under treatment - - 345

Parallelisms and divergences of the W.R. “curve” and the cell-count

“curve ( 1 ) to (7) 346

The meiostagmin test and Phase I. test ..... 349

Notes on kinds of cells found 350

Abbreviations and notation in tables and in text .... 351

The Tables.

Group I. tables are omitted.

Group II. ...

Group III. ....

Group IV. .....

Group IVa. .....

Group IV6. .....

Group IVc. - - . . .

Summary -

Acknowledgments ....

353

354

355
355
359
363

367

369

In connection with the research on “ parasyphilis 99 now being
made by Drs M'Intosh, Fildes, Head, and Fearnsides 1 more than
260 cell-counts have been done by the writer, during the past year
or so, on the cerebro-spinal fluids submitted simultaneously with
the sera to the Wassermann test by Dr Fildes.

An interim 2 report on the first hundred cell-counts and
Wassermann findings was published in September last. A
considerable number of cell-counts have since then been similarly
done, some on patients that had been repeatedly so tested before
September. The results of the 260 cell-counts (collated, through
the courtesy of the authors named, 1 with their Wassermann
findings, &c.) are of sufficient interest to justify a further report.

1 M'Intosh, Fildes, Head, and Fearnsides, Preliminary Report, Proceedings
of the Neuropathologieal Section of the XVIIth International Congress of
Medicine, London, 1913. Extended Report, Brain, Vol. xxxvi., Part i., July
1913, and following numbers. ’ ’’

* Donald, Folia Htrmatoloyica, xvii. (1913), 139-166.

DKOP-METHODS OF COUNTING CELLS

335

The drop-film method of cell-counting, used throughout this
research, was worked out in counting the earlier specimens of
cerebro-8pinal fluids.

Other cell-counting methods may first be outlined. They are
practically of three types.

Methods of the first type, comprising the French method and
Alzheimer’s method, use centrifuging to collect the cells into a
thick deposit.

By the French method a small, rather uncertain, quantity of
the deposit is dried on a slide, stained, and examined.

By Alzheimer’s method the c.s.f. is dropped into alcohol
before centrifuging. The resulting small mass of coagulum
is then embedded in celloidin, and sections from this are stained.

These methods show the kinds of cells present in the centri¬
fuged deposit, and not the absolute cell-counts, but merely an
empirical indication of the relative cell-counts of such c.s.fs.
as have been examined by exactly the same technique. Even
as regards the kinds of cells present, some cells, as will be
shown below, 1 may be lost through centrifuging, which also
probably more or less upsets the uniform distribution of the cells.
Moreover in Alzheimer’s process the red cells will be destroyed by
the alcohol, whereas, whether due to the puncture or due to
previous haemorrhages, they ought to be estimated. Indeed most
workers supplement the French result or the Alzheimer result by
a chamber count.

Methods of the second type give by means of counting chambers
an estimate of the total cell-count of the c.s.f. The principal
difficulty lies in distinguishing with ewe and certainty the
various kinds of cells in the chamber.

For c.s.f. one or even two fills of the Fuchs-Bosenthal
counting chamber, the capacity of which is about 3 c.mm., is
none too great a quantity to count through. The heavy cover-
glass, 0*4 mm. thick, and the deep counting chamber, 0‘2 mm.,
necessitate a low power objective, while the thickness of the
counting chamber floor hinders critical illumination. Now if
the c.s.f. be examined unstained, as recommended by one
worker, 8 narrow angle illumination must be employed, so these
just mentioned three circumstances combine to call for such
special skill and such patient effort as few can command.

1 See p. 339. 8 Frenkel, Neurol. Centralbl., 1912, Nr. 31, 8. 1085.

336

fi. DONALD

If, however, the c.s.f. can be satisfactorily stained in
the counting apparatus, the process of observation will be
considerably facilitated. A process that while staining the
white cells destroys the red cells may at once be dismissed as
misleading, unless when used by an experienced worker. The
only staining process that promises facility in distinguishing
clearly among the various types of cells, white and red, in the
counting chamber is that recently described by Dunzelt. 1 This
process, however, is described as requiring some considerable
time for the staining of c.s.f. cells—indeed more than half an hour
for the staining of the red cells in ordinary diluted blood. So,
probably, several chambers would have to be provided if half a
dozen c.s.fs. had to be dealt with in a sitting.

Suggested Drop-Chamber Method. —For the simultaneous
mounting in chambers of any number of c.s.fs., to be examined
alternately or repeatedly, eg., for comparison of the cells, there
may here be suggested a simple and efficient device, suitable also
for dark-ground illumination.

For each chamber there is taken an ordinary clean slide of the
thickness suitable for the dark-ground condenser, and to its under
side is applied a drop of immersion oil. Then on the upper side
are placed a pair of slips of ordinary cover glass about three-
quarter inch apart. Midway between these slips is deposited one
Morse 80 drop 2 of c.s.f. Then without delay there is lowered on to
the drop a clean ordinary cover glass, say 1 by £ in., to rest on the
placed slips. Vaseline may be used to steady the parts of this
simple chamber, as also to prevent drying, especially if the drop
(deposited on a spot previously wetted with HgCl, and then dried)
is to be kept some little time. It is well that the two slips be not
grossly unequal in thickness or the liquid will be drawn into the
thinnest part of the chamber.

Of course, the thinner the equal supporting slips are chosen
(from cover glasses 0*10 to 0'20 mm. thick), the larger proportion¬
ately is the area of the spread-out drop. The volume of a Morse 80
drop of average c.s.f. is 7| c.mm. Accordingly, the area of the drop
with supporting slips 015 mm. thick is 7*5/0*15, i.e., 50 sq. mm.

Such a chamber is well adapted for dark-ground illumination, 2

1 Dunzelt, Miinchener med. Wochenschrift, 1913, 8. 2616. 9 See p. 340.

* Ruled counting chambers have too thick a floor for use with ordinary
dark-ground condensers.

DROP-METHODS OF COUNTING CELLS 337

and the whole area may easily be scanned with a medium-power
objective and a moderately high eyepiece. But the chamber is
easily within the working range of a 4 mm. objective, and
practically within the ordinary collar-correction range, if thin
cover glasses and thin supporting slips are used.

Of current methods of cell-counting, there remains to be
described a third type, represented by Geissler’s ruled slide method,
devised to^ive in a stained film both a numerical and a qualitative
count. On a space 20 by 20 mm. ruled with parallel lines on an
optically finished slide, 40 c.mm. of the cerebro-spinal fluid is
deposited by means of an accurately graduated capillary pipette.
After drying and heating in an incubator, the film is fixed by
alcohol-ether mixture (one to two minutes), and is stained with
Pappenheim-Unna stain or with Leishman stain, then soaked
carefully in water and gently “ blotted.” Various other workers
had estimated the cell-count, by counting through some subjectively
chosen fields in dried films from a known volume of c.s.f. But
Gewsler makes an “ objective" estimate by counting through the
whole 40 c.mm. film.

Unfortunately, this method demands very special skill.
Ordinary skill can hardly stain and wash such films without con¬
siderable loss of cells. Moreover, in examining, as recommended,
uncovered films with a dry lens, the details of the cells will be
imperfectly made out unless the lens is specially constructed.
Thirdly, the slide is expensive, and the preparation cannot be
kept for reference, but the slide has to be cleaned off, with
special care, till under the microscope it is Been to be quite free
from cells.

The drop-film method of cell-counting described in this article
avoids some of the disadvantages of the above-mentioned methods,
and combines most of their advantages in a simply-prepared
permanent preparation.

On each of any number of ordinary slides, a couple of separate
drops of the c.s.f. are easily and accurately deposited, and
then dried and fixed. Next the slides are Boaked for a few
seconds in dilute collodion, and dried. Thus are obtained drop-
films that are practically thin collodion sections at most only one
dried cell in thickness. These films can now at leisure be stained,
e.g. y Giemsa, or Leishman, and Pappenheim-Unna, washed, and
dried, without the loss of even a bacterium from the film, A

338

R. DONALD

cover glass attached with clear soft paraffin completes a permanent
preparation that gives easily an accurate cell-count, and at the
same time a good cell-picture. The variously stained preparations
are permanent for reference and for comparison. The method
uses no special apparatus and avoids centrifuging.

Some details of the drop-film method may now be given.
Other details are given in a preliminary article in Folia Hoemato-
logica. 1 ' «

First may be mentioned some precautions taken.

The c.8.fs. were counted as soon as possible after puncture.
But a good many were not available until a day or so old.
However, by counting early in the research a number of c.s.fs. of
various types when fresh, and then again when twenty-four hours
old, it was found that at ordinary laboratory temperatures the loss
of cells in the twenty-four hours was negligible, 2 if the cells now
swollen in degeneration were stained and counted in.

Even after being kept nearly a week at laboratory temperature,
averaging 15* C., aseptic specimens of c.s.f. were found to yield a
useful indication of pleocytosis, especially when the preparation
was stained strongly and clearly with Giemsa or with Leishman stain.
For instance, the c.s.f. of F. S., case 134, taken on the evening of
May 11,1914, showed next day thirty-one cells per c.mm. Another
tube of the same specimen, kept at laboratory temperature
averaging 15° C. till May 16, 1914, showed fourteen cells per
c.mm., 75 per cent, of these being, indeed, considerably swollen.
Similarly a c.s.f. left by mistake undelivered for fully six days at
about 15° C., was on April 15, 1914, found to have forty-two
cells per c.mm., about 50 per cent, of them being swollen. (J. W.,
case 80. The fresh c.s.f. had probably over a hundred cells.)

So the c.8.fs. not available for a day or so could thus be
reliably counted, especially as for most of the time they were kept
in an ice-safe.

These swollen cells were, by strong clear Giemsa or Leishman
staining, found to arise in large numbers in many c.s.fs. a day or
so old, from the degeneration of cells, mononuclear and polynuclear,
that were unswollen in the fresh fluid. Also similar swollen cells
were seen to occur in considerable numbers in some freshly drawn

1 Donald, Fol. Ham., xvii. (1913), 139-166.

9 Donald, Fol. Ham., xvii. (1913), 144. Contrast Bigelow, Amir. Joum. of
Inanity, lxvii. (1911), 746.

DROP-METHODS OF COUNTING CELLS 339

c-s-fs., 1 indicating the activity of cell passage into the c.s.f. The
swollen cells have, accordingly, in this research been included in
the total cell-count.

Centrifuging was avoided. It was found to be a disturbing
factor difficult to deal with. Various c.s.fs. 2 were counted just
before centrifuging, and again after centrifuging and agitating.
The loss of cells after this treatment proved in the seven experi¬
ments to vary from a negligible quantity to 50 per cent, of the total
count, the greatest loss being of the swollen degenerating cells.

Any red cells present were demonstrated, counted, and allowed
for 8 according to a leucocyte count done, by a drop-film, on the
patient’s blood.

If the ordinary Fuchs-Rosenthal counting method be used,
then, as Dreyfus recommends, 4 any considerable blood admixture
must be avoided in performing the punction, or else not much
reliance must be placed on the result. But an important c.s.f
may at two consecutive punctions 6 happen to be the only blood-
mixed specimen in half a dozen; and, if a suitable method is used,
then, in spite of the red cells—nay, by their assistance—a
practically reliable count is usually possible.

Clotted blood in the specimen, of course, prevents a count.

The technique of the drop-film method is as follows:—
The slides are polished with a tuft of long-fibre grease-free cotton
wool. Before receiving the drops of c.s.f. they are conveniently
marked with a quill pen and, e.g., a waterproof Iudian ink.
This writing, when later collodioned, stands either wetting or
reasonable rubbing, though hardly both at once.

The specimen was shaken thoroughly just before measuring.
Even fine gauzy blood-free clots could then be well distributed.
A small square of washed smooth sheet rubber and the thumb are
convenient for closing the tube in shaking.

1 These findings are in line with those of Rous, of Rubinato, and of others;
Rous, Amer. Joum. Med. Science, 1907, p. 667; Cornell, Amer. Joum. of
Insanity, 1907-8, Vol. 64, p. 73; Villaret et Texier, Joum. de Physiologie et de
Pathologie gintrale , 1905, VoL 7, p. 841 (quoted by Rous); Rubinato, Fol.
Hamatologica, 1905, Bd. ii., 8. 781; Turner, Joum. of Mental Science, July
1910, p. 485.

2 Donald, Fol. Ham., xvii. (1913), 146, 147.

* Rous, Amer. Joum. of Med. Science , 1907, April, 567 ; Bigelow, Amer.
Joum. of Insanity, lxvii. (1911), 745.

4 Dreyfus, Miinchener medizinische Wochenechryft, 1912, 2567.

• E.g., A. C., case 84; cf. A. P., case 97, pp. 359, 361.

340

R. DONALD

Measuring' the c.s.f. was carried out by the easily calibrated
dropping-pipettes, described in a recent brief communication 1 to
the Royal Society.

Pipettes, with body about 4 cm. long, are drawn from glass
tubing about 3 mm. external diameter heated in a large by-pass of
a Bunsen burner. They are then pushed gently down into the
suitable hole of a wire gauge until just arrested, and are cut off
close to the upper surface of the plate. A convenient size. No. 80
of the Morse drill and wire gauge, is 0‘34 mm. in diameter. A
clean pipette of this size will, when held vertical, yield, at a
drop-rate not faster than one per second, at ordinary laboratory
temperature, a drop of average c.s.f. 1/135 c.c. in volume. The
pipette-capillary must be quite clean, and must be carefully kept
from contact with any trace of greasy matter. A fresh pipette is
used for each specimen measured out

The required slow steady rate of dropping can be conveniently
attained by means of a small mercury-plunger tube. 8 In use, this
is held at such an angle that the drop-rate is not faster than
one per second. At all rates slower than one per second a
dropping-point as small as 0*3 mm. in external diameter yields, of
a given liquid at a given temperature, drops that are practically
constant in weight 3

To prevent settling down of the cells in the pipette, during
the depositing of a number of equal drops on slides, the pipette
may be furnished with a bulb blown just above the capillary part
before gauging. During the blowing, the pipette may be held at
visual distance in a short rubber tube attached to a glass blowpipe.
An almost closed U of clean copper wire dropped into the bulb
will serve as a shaker without any ball-valve action.

1 Donald, Proc. Royal Society, B., Ixxxvi. (1913), 199.

3 Made thus: A piece of clean dry tubing 12 to 13 mm. long and 1} or 2 mm.
bore, is opened out slightly funnel-shaped at each end, one end is tightly plugged
with grease-free cotton wool, the tube is filled two-thirds with clean meroury, the
other end is tightly plugged with cotton wool, and a short pieoe (about 3 cm.) of
rubber tubing is fitted for attachment to the small pipettes.—Donald, Lancet,
1913, i., 1447.

To secure elastic air-tight fitting, the rubber tubing may have an external
“ sphincter ” formed of several turns of a very small rubber ring. This
“ sphincter ” is rolled back, the small pipette is inserted, and the sphincter rolled
down over it.

* OUivier, Annales de chimie el de physique, S4r. 8, Tom. x. (1907), p. 229;
Donald, Proc. Royal Society, Series B, 1913, Vol. Ixxxvi., p. 198.

DROP-METHODS OF COUNTING CELLS

341

The drops are conveniently dried at a temperature of about
37° C. on, e.g., a copper fixing-plate covered with several folds of
blotting paper.

The drop-films must be fixed by a water-free process, for any
water treatment of such a crust (of much soluble salt with, often,
few cells and a mere trace of albuminous matter) is, even after
fixation, altogether too precarious.

Heat-fixation, if thorough, is simple and satisfactory.

Heat-fixation under observation served, in the case of one
c.s.f., to suggest by the smell of ammoniacal fumes the pres¬
ence of urea in the specimen. Further tests confirmed the
suggestion.

Fixation by alcohol may be used for Pappenheim stain, but
the alcohol must be absolute.

Next comes the collodioning of the drop-films. While they
are still warm and dry, the slides are stood upright back to back
for a few seconds in a jar of dilute collodion (1 part collodion B.P.
with 9 parts alcohol and ether mixture). Then they are kept
upright to drain and to dry, with the least possible injury to the
collodion coating. Finally they are heated gently on the fixing
plate to dispel the last trace of alcohol, and so to render the
delicate film unlikely to be detached even by staining for
tubercle bacilli

Staining may be done as required. 1. For showing up all the
cells, including the swollen cells, and the ordinary stainable micro¬
organisms, dilute Giemsa or Leishman stain may be left in a
plump pool on the surface of the drop-film for about twenty minutes.
A large pool of dilute, e.g., Leishman, stain rocked from time to
time will dissolve out the salts, and so prevent some of the stain
pattern otherwise left. The use of warm stain in the incubator
dissolves out the salts and stains the film in half the time. The
stain is washed off with distilled water, containing about one part
of acetic acid in 20,000. This is left on for two to five minutes,
to remove the excess of stain adsorbed by the alkaline salts, and
to bring up a distinct red in the erythrocytes. Then a rinse with
the same, and gentle drying with blotting paper, pressed down by
a soft pad of gauze and cotton wool. On the warm drop-film is
melted the minimum quantity of clear soft paraffin, and the
cover-glass is well pressed down. If the procurable soft clear
paraffin is not optically fairly free from crystallising-out scales of

342

R. DONALD

higher homologues, then the minimum quantity of thick paroline
may be used. Such preparations are apparently permanent.

If any paraffin gets on to the upper surface of the cover glass it
is not so easily cleaned off as cedar oil would be, to leave the
cover glass bright and clear. The simplest plan is to put on a
clean cover glass.

If the paraffin has for any reason to be washed off a Giemsa
drop-film or other Romanowsky preparation, ligroin or other
paraffin spirit of similar boiling point ought to be used, not an
aromatic hydrocarbon such aB xylol, which dissolves out some of
the stain.

2. For showing up the finer structure of the cells, a drop-film
similarly stained for about ten minutes may be mounted.

3. Any plasma cells present may be demonstrated by Unna-
Pappenheim stain (pyronin-methyl green). About ten minutes at
37° C. will suffice. The stain is rinsed off with tap water and
finished as described. This stain, of course, shows up in pyronin
red any yeast cells, which, occurring singly in a Giemsa preparation,
might by cursory low power observation be mistaken for
micro-lymphocytes.

If Unna-Pappenheim staining is at all prolonged at 37°, the
preparations ought to be kept under an air-tight Petri cover on
a glass plate with a piece of cotton wool wet with alcohol and
phenol to prevent loss of those substances.

4. To show up either gram-positive or tubercle bacilli the
corresponding stains are used in the ordinary way on the film.
After decolorising by 90 to 95 per cent, alcohol, the gram film is
gently blotted and then dried before the watery neutral-red
solution is used.

Before examination of the slide the collodion may be rubbed
off the under side with a damp duster.

Examination of the stained drop-film may be done by powers
of 120 diameters upwards. A good system of 240 diameters, if
skilfully used, is sufficient for most differential counts.

Illumination is, of course, of great importance for rapid certain
work. A good simple lamp device may be suggested. Vertical
and on a level with the microscope mirror a small square, say
6 by 6 cm., of light opal glass in a simple lantern is strongly
lighted by a 32 c.p. metal-filament lamp at the focus of a
hemispherical mirror. Not the reflected light from the mirror,

DROP-METHODS OF COUNTING CELLS

343

but only diffused light from the front of the opal glass is used; so
the mirror may be merely the silvered back-hemisphere of a
spherical lamp, or even the bright tinned hemispherical bowl from
a kitchen ladle cut to accommodate a pear-shaped lamp.

Veiy useful for counting a cell-rich film is a square eyepiece
diaphragm with cross-lines. If the professionally-made appliance
is not available, a substitute may be made of black paper with
three or four parallel lines of a fine black hair laced, across the
square opening, through needle holes, and fastened at its two ends
by a touch of sealing-wax soldered down with a hot wire. Ruled
glass eyepiece “ diaphragms ” do not improve definition.

But, at any rate for cell-poor films, the ordinary circular
eyepiece diaphragm can be made to suffice. And even a very rich
film may be reckoned up by measuring the number of times that
the diameter of the circular field is contained in the mean diameter
of the nearly circular drop-film, squaring this number, and then
multiplying by the average number of cells per field.

A mechanical stage is practically essential.

Results Obtained by the Method.

In the patients on whom the 250 cell-counts were done
lumbar punction was found advisable, either on account of
probable meningitis without syphilis, or on account of possible
meningitis with syphilis that was, in many cases, syphilis with
evident nervous disease.

By the courtesy of the above-named authors, hitherto un¬
published tables of Wassermann results have been lent as a setting
for the cell-counts.

As the most important conclusions drawn from the considera¬
tion of the cell-counts are connected with cases of pleocytosis in
syphilitic nervous disease, we classify our matter so as to dispose of
the other, less important, cases first.

Classification of the Cases.

The serum-WR and the cell-count may be used as “ crucial ”
dividing tests, marking off the cases into four groups, as follows:—

Group L—Serum-W.R negative, without pleocytosis.

„ II.—Serum-W.R negative, with pleocytosis.

„ III.—Serum-W.R. positive, without pleocytosis.

„ IV.—Serum-W.R. positive, with pleocytosis.

344

R. DONALD

The c.s.f.-W.R does not disturb the distribution that we have
just made. For it comes out positive practically only in cases
with both (1) positive serum-W.R, and (2) pleocytosis—that is,
only in the most important group, IV., which we shall consider
in detail after disposing of the other groups, I. to III.

As the tables of Group I. possess interest in general rather
than in detail, they are not printed in this article.

They concern the cases with the W.R. negative in serum
and in c.s.f. and without pleocytosis.

These cases number 62, and include:—

Peripheral neuritis 4

Subacute combined de¬
generation 2

Amyotrophic lateral sclerosis 1

Non - syphilitic progressive

muscular atrophy - 2

Poliomyelitis (old) - - 1

Spastic paraplegia - - 2

Cerebro spinal tract lesion - 1

Friedreich’s ataxy 1

Neoplasm of cord 1

Neoplasm of the vertebrte - 1

Hsematomyelia 1

Cerebral neoplasm - - 5

Non-syphilitic cerebral and

bulbar thrombosis - 2

Labyrinthine disease

(Meniere) - - - 2

Neoplasm of ilium • - 1

Gallstones 1

Gallstones c. congenitally
abnormal pupillary re¬
action- 1

Non-syphilitic myocardial
failure 1

Epileptiform seizures - - 1

Paranoia - - - 2

Simple amentia 1

In these 62 cases the cell-count rarely reached 4 per c.mm.
In one case of neoplasm of the left crus cerebri, the cerebro-spinal
fluid showed 10 cells in 7£ c.mm., while the ventricular fluid
taken at operation showed no cells in the same volume.

The cases in Group II. (serum-W.R. negative, and c.s.f.-W.R
negative, but with pleocytosis), number 14. Taken along with
the cases of syphilitic meningitis (of Group IV., to be dealt with
presently) they illustrate the recognised fact that the cell-count
indicates the activity of the meningeal reaction rather than the
nature of the infective virus. One non-fatal case of meningitis
showed 1500 cells (80 per cent, polymorphonuclear, and 1 per
cent, plasma cells, the rest being lymphocytes). Other cases of
non-syphilitic meningitis had cell-counts equalled by those of
syphilitic meningitis.

Group III., p. 354, consists of some thirty-five cases with
serum-W.R. positive, but, at the time of observation, c.s.f.-W.R
negative.

DROP-METHODS OF COUNTING CELLS

345

Some of these cases have become c.s.f.-W.R. negative through
treatment.

Others again, e.g., M. C., case 19; W. C., case 21; G. C.,
case 22; E. H., case 24; C. K., case 25, are of special interest, as
illustrating a fact pointed out by the authors 1 already mentioned,
namely, that in the cerebral type of cerebro-spinal syphilis,
the c.s.f.-W.R. either is only weakly positive or is negative.

Group IV. consists of all the cases with the serum-W.R.
positive and with pleocytosis. Practically speaking, all these
cases, and only these cases, have, or had, or would have had, the
c.s.f.-W.R. positive. If at first observation of these cases the
c.s.f.-W.R. is negative, it is so because treatment either has made
it negative or has prevented it from becoming positive.

By their relation to treatment the cases are divided into
three sub-groups:—

First, untreated cases forming sub-group IVa.

Second, cases much improved under treatment, sub-group IVi.

Third, cases less improved under treatment, sub-group IVc.

Sub-group IVa., p. 355, is made up of untreated cases, diagnosed
with certainty through the indisputable aid that recent laboratory
methods have brought to clinical observation. In many of the
patients at the time of first observation it is impossible to say
whether the condition is to be called “ cerebro-spinal syphilis,” and
a hopeful prognosis given, or whether it belongs, or may presently,
especially if no treatment now be applied, belong to the clinical
group “ parasyphilis," with its relatively hopeless prognosis.

But here come in alike the value of treatment and the value
of modern methods in controlling treatment. The tables, of
consecutive cases, merely re-grouped in this article, indicate, in
sub-group IV£>. and sub-group IVc., p. 359, just how much the
W.R. and the pleocytosis can be modified by intravenous injections
of neo-sal varsan. In subsequent articles the authors mentioned
will show that in the cases of sub-group IV6. (“ cerebro-spinal
syphilis ”), the fall in the W.R. and in the cell-count is followed
by actual improvement in function, which improvement in some
cases proceeds to the recovery of good bodily health with some
mental improvement, and in other cases amounts to practically
complete recovery, e.g., F. J., case 92.

Moreover, they will show that, even in the cases of sub-group

1 M'Intoeh, Fildes, Head, and Feanuides, Brain, xxxvi., July (1913), p. 17.

346

R DONALD

IVc. (“ parasyphilitic ” cases), considerable clinical improvement
takes place in some cases, corresponding, no doubt, to some arrest
of the inflammatory processes, though not to resolution of any
secondary degenerations.

Parallelisms and Divergences of the W.R. Curve
and the Cell-Count Curve.

Examination of the figures in Group IV. will show interesting
parallelisms and divergences of, as it were, the W.R. curve and the
cell-count curve.

1. The c.s.f.-W.R. and the cell-count may fall together, either
(a) under treatment, or ( b ) without treatment.

(a) In seven cases the fall in the c.s.f.-W.R. and in the cell-
count took place under treatment, and was followed by clinical
improvement:—A. A., case 81; probably C. B., case 82, and D. B.,
case 83, although the specimen for the high cell-count in these
two cases was not secured; J. G., case 89; F. J., case 92; E. W.,
case 105; W. Hr., case 122.

(b) In two other cases the fall occurred without treatment,
but the fall was slight, and merely no fresh manifestations of the
disease appeared:—W. H., case 120; D. S., case 130.

Similarly, a cell-count already near normal may, under treat¬
ment, fall still further along with some fall in the W.R.:—F. P.,
case 99. In this patient there has been continued fall in the
W.R for the nine months since the cell-count reached 1 per c.mm.

2. The c.s.f.-W.R. and the cell-count may rise together some
time after treatment, probably through a recrudescence of the
disease after insufficient injection of the drugs:—W. G., case
90; G. P., case 98; A. B., case 106; A. G., case 117; Wm. G.,
case 118.

These are our only instances of pleocytosis increasing after
treatment with neo-salvarsan had been applied. They are
probably all instances of relapse, and not of a pleocytotic rise
provoked by salvarsan.

In A. B., case 106, the c.s.f.-W.R. and the cell-count did
improve after treatment, and then relapsed. G. P., case 98, showed
recrudescence to W.R. 4444 2/44443 six months after treatment,
then, after further vigorous treatment, the W.R. fell to 0/42000.

3. In two classes of cases the very coincidence of negative

DROP-METHODS OF COUNTING CELLS 347

W.R. with negative cell-count is of interest, (a) cerebral syphilis
and gumma cerebri (Group III., p. 354), probably examples of
purely cerebral lesions, whether meningeal or not, “ when the
cerebro-spinal fluid usually yields a negative reaction,” 1 (6) E. I.,
case 124, a naturally arrested case of tabes dorsalis.

4. The cell-count may begin to fall sooner than the c.s.f.-
W.R.:—S. 0., case 62; C. C., case 112; V. W., case 138. The
cases mentioned in (6) are more advanced instances of this.

5. The cell-count may remain high after the W.R. has fallen
to 0:—F. R., ease 100; G. W., case 136. “ In both these patients
the strength of the W.R. at the time of first observation was small,
and the affection was in the region of the exit of the third cranial
nerve. In case 100, the lesion was apparently basal; in case 136
it was a thrombotic lesion giving rise to Weber’s syndrome.”

6. The c.s.f.-W.R. usually falls more slowly than the cell-count,
and may even for some time after the cell-count has reached
normal (A. C., case 84; R. G., case 91; F. P., case 99; M. S., case
102; F. G., case 119; T. M., case 127; F. S., case 134), still remain
of appreciable strength, indicating that, even so far as concerns the
c.s.f. and the tissues represented by the c.s.f., there is still an
indication of unresolved mischief. Moreover, the serum-W.R.
usually falls still more slowly, thus prolonging the warning:—
F. P., case 99; M. S., case 102; E. W., case 105, and e.g., the other
cases quoted under (1), p. 346.

We may here remind ourselves that the c.s.f., and the tissues
represented by it, constitute by no means the whole patient, and
that, valuable as are these three signs (serum-W.R., c.s.f.-W.R.,
and cell-count), they have their limitations.

But they have also their great significance, namely, that in the
case of disappearance of even only two of them, c.s.f.-W.R. and
pleocytosis, the neo-salvarsan injected into the blood-stream has
reached the diseased meninges, and has profoundly affected the
lesion to the patient’s benefit.

It might suggest itself that the W.R. and syphilitic pleocytosis
are caused by the presence of the same substance in the c.s.f.,
inasmuch as these two signs practically always occur together
in the c.s.f. in nervous syphilis—as was pointed out in the remark
on Group IV., p. 344. However, the tables of Group IV. indicate
pretty consistently that in nervous syphilis pleocytosis (1) often,

* Brain , xxxvi., July (1913), pp. 20, 28, note 5.

348

R. DONALD

or perhaps always, appears before the W.R. in the c.s.f., and (2)
often, or generally, disappears before the W.R. has disappeared.

Now the earlier appearance of pleocytosis might suggest that a
small amount of the just-appearing Wassermann substance suffices
to stimulate pleocytosis. But the disappearance of pleocytosis
while the W.R. is still strong indicates that the substance exciting
pleocytosis is distinct from the Wassermann substance.

The fact that these two tests are, as it were, independent
witnesses, renders their concurrent testimony of much greater
value.

7. Pleocytosis may appear and even rise high before the
W.R. appears in the c.s.f.:—A. M., case 59; W. G., case 90; E. W.,
case 104.

This very important sign is, especially in these days of neo-
salvarsan, at once acted on; and prompt treatment prevents the
appearance of the confirmatory W.R. in the c.s.f.

The following note on W. G., courteously supplied for this
article, will be read with interest.

“Clinically W. G. showed on his first admission to hospital
merely subjective manifestations—malaise and pains in various
regions—together with pyrexial attacks.”

The brisk mercurial treatment applied resulted in apparent
recovery, followed, however, two years afterwards by a recurrence
with more severe pyrexial attacks.

“ On his second admission, however, evidence of irritation of
certain spinal nerve roots was forthcoming. This irritation
disappeared within 36 hours after the first injection of neo-
salvarsan. The presence of the root irritation gave a reasonable
explanation for the cytological findings.”

Of further interest is the case of C. G., case 44. This patient,
with the secondary rash at its height, had W.R. 44444/44000 and
a pleocytosis so high, 153, as to suggest that it might have appeared
before the W.R. in the c.s.f. The methods of investigation used by
Dr Head and Dr Fearnsides demonstrated irritation of some spinal
nerve roots within four months of infection. J. W., case 80, is
also a case of nervous disease in secondary syphilis.

Instances (4), p. 347, and (7), p. 348, of divergences of the
cell-count “curve” from the W.R "curve,” show that, both in
the diagnosis of early cerebro-spinal meningitic disease, and in
indicating progress under treatment, the cell-count is, on the whole,

DROP-METHODS OF COUNTING CELLS

349

a more sensitive but not less reliable indicator than the W.R., and
is certainly a diagnostic means that ought not to be neglected,
especially when, in any case, the c.s.f. has been procured for the
Wassermann test. Indeed, the W.R. and the cell-count are, of
course, not rival diagnostic tests, but are mutually supplementing,
mutually correcting, mutually supporting—just as the combined
arguments of such laboratory findings, on the one hand, and the
combined arguments of clinical findings on the other hand, are not
rivals, but are co-operating combined arguments to show up clearly
the condition from time to time of the patient.

The Meiostagmin Test and Phase I. Test.

Some work was done on two other tests.

The meiostagmin test, performed by means of the author’s
constant-pressure dropping apparatus, 1 was tried on a number of
the earlier specimens after the Wassermann test. But the greatest
fall in surface tension took place by no means always in the
W.R.-positive c.s.fs.

Phase I. test was done on most of the specimens. Usually the
degree of opalescence, measured merely by the eye, was roughly
proportional to the number of cells present, or to the W.R.,
whether meningeal affection was aljsent or was caused by any
form of syphilis or by tubercle. But in other cases the opalescence
was far from proportional either to the W.R. or to the cell-count.
For instance, sometimes a case with W.R. negative in serum and
in c.s.f. and with one cell per c.mm., showed more of opalescence
than a case with W.R. positive in serum and in c.s.f. and with
thirty-five cells. These apparent anomalies indicate the need for
considerable experience in using this test and for considerable
judiciousness in interpreting its findings.

One source of possible error is serum globulin remaining in the
c.s.f. after the corresponding few red cells have broken up and
are represented by only a faint straw colour, easily missed by
artificial light.

In S. O., case 62, tabes dorsalis, the test gave a nearly opaque
white, although two years before, with a very similar Wassermann
result. Phase I. test had given “ only a slight opalescence.”

1 Donald, Proc . Royal Society , 1913, Vol. Ixxxvi., pp. 198-202.

350

R. DONALD

Notes on Kinds of Cells Found.

The cells of c.8.f. have been described by Cornell, 1 by Szecsi, 2 * * * *
by Plaut, Rehm, and Schottmiiller, 8 and by others.

Of the various cells demonstrated in this investigation, some
kinds call for special mention.

Plasma cells were found, forming 0 2 to 3 per cent, of the
cell-count in syphilis meningo-vascularis, syphilitic encephalitis,
tabes dorsalis, general paralysis, juvenile general paralysis, also
in the meningitis of secondary syphilis, and in the following
non-syphilitic conditions:—Disseminated sclerosis, hydrocephalus,
cerebral haemorrhage, and in two non-fatal cases of meningitis of
which the causative organism did not grow in culture.

In the case of juvenile general paralysis (A. B., case 106),
plasma cells were found in nearly the same percentage in the
three specimens taken during the nine months after injection of
1-8 g. of 914.

One case of the meningitis of secondary syphilis (C. G.,
case 44) had 3 per cent, plasma cells, with 75 per cent, of
polymorphonuclears in a total cell-count of 154.

Polymorphonuclear leucocytes were found in the meningitis
of secondary syphilis, as just mentioned, and in smaller proportions
in some other cases as shown in the tables.

Where not otherwise specified, the total cell-count or the
balance consisted of lymphocytes.

Swollen (degenerated) cells, whether present in the fluid when
drawn, or developed later from sound cells, were included in the
cell-counts as given.

The total cell-count is, as shown in the tables and in the notes
on them, of special value.

The fairly large number of cell-counts considered above shows
a remarkable concordance. For the periods, up to eighteen months,
the successive counts, as many as five, of each case, are consistent
with one another, and are, in nearly all the cases, roughly “ pro¬
portional” to the simultaneous Wassermann figures. The few

1 Cornell, Amtr. Journ. of Insanity , 1907-8, Vol. lxiv., p. 73.

2 Szecsi, Monatsechr. /. PsychicU. u. Neurol ., Bd. xxix., S. 76-82 ; Ztitschr .. /.

d. ges . Neurol, u. Psychiat. Or., 1911, Bd. vi., 8. 637; Fol. Homed., 1910-11,

Bd. x., Archiv ., 8. 534.

* Plaut, Rehm, und Schottmiiller, Leitfadm zur Untermchung dtr Zertbro-

spinalfliissigktit , Jena, 1913.

DROP-METHODS OF COUNTING CELLS 351

divergences of the cell-count from this rough “proportionality”
are highly significant, and are consistent with the patient’s clinical
condition.

Case 90, F. P.

44443/44443

44441/44400

44440/44200

4444-/44400

44440/30000

Case 98, 6. P. -

0/44100

44442/44443

44200/44400

0/42000

Case 124, E. I. -

20000/0

22000/0
about 1

20000/0

...

Case 107, A. B. -

44444/44420

2 per cent,
plasma cells
5 per cent,
polymorph.

44440/44000

1 per cent,
plasma oells
3 per cent,
polymorph.

44440/44440

1 per cent,
plasma cells
1 per cent,
polymorph.

Case 89, J. G. -

44444/44443

44443/44300

44100/0

0/0

...

Case 92, F. J. -

44430/44440

44444/44000

44440/0

...

Case 120, W. H.

43200/44300

43100/42000

...

Case 122, W. Hr.

44444/44400

44430/40000

...

Case 125, F. K. -

44442/44440

44444/44300

...

The many other cell-counts obtained in this research are all
similarly consistent with the just-quoted counts.

In face of this concordance in the cell-counts, we may assume
that in the subarachnoid space, or at any rate in the part of it
reached by lumbar punction, the cells are to a considerable extent
maintained in suspension—by alterations in body-posture and in
the amounts of blood within the bony spinal canal. 1

Explanation of Abbreviations and Notation.

The case numbers as assigned are merely for convenience in
referring to the cases in this paper.

1 0. Fischer found in P.M. subjects different cell-counts at different levels of
tapping (Monatsschrifl fur Psychiatric und Ntwrologity June, 1910). Summarised
in Folia Hcematologica.

352

R. DONALD

The few necessary abbreviations will be readily understood—
“606” for “salvarean,” “914” for “neosalvarsan,” “914-serum”
for "neo-salvarsanised serum,” “S.” for “syphilis,” “Sc.” for
“ syphilitic,” “ c.s.f.” for “ cerebro-spinal fluid.” 1

The notation of the W.R. results is explained in the words of
the authors above referred to. 2

“Throughout this investigation we record the results of the
W.R. in this form. The test is quantitative, and falling doses of
serum and cerebro-spinal fluid are used. Formerly we followed
the usual method of recording the reaction and represented
complete inhibition by + + + + and incomplete inhibition by
+ + +,++, or +. To economise space these would now be
written 4, 3, 2, or 1. The figures 4, 4, 4, 4, 4 imply that the
reaction was complete in each of the five dilutions, whilst
4, 4, 4, 0, 0 shows that the reaction was complete in the first three,
but negative in the last two dilutions. Such results as 2, 0,0, 0, 0
or 1, 0, 0, 0, 0 have no diagnostic value. The figures above the
line always refer to the serum, those below the line to the
cerebro-spinal fluid." 2

In this article, for further saving of space in the extensive
tables, the horizontal line is represented by an oblique stroke,
the figures to the left of the Btroke referring, of course, to the
serum. Similarly, the negative result of the tests—here always
quantitative—is represented by a single 0 instead of 00000.

1 Apology is hardly needed for printing “c.s.f.-W.R.” for M Wassermann
reaction in the oerebro-spinal fluid,” especially just before the terse notation
of the quantitative reaction. The German * 1 Cerebrospinalfliissigkeit ” and the
French expression are no shorter than the English name. Serious writers express
their intolerance of the long term by often printing “fluid” in English or
“ Liquor ” in German, and by probably never writing the long clear expression.

9 MTntosh, Fildes, Head, and Fearnsides, Brain , Part I., 1913, VoL xxxvi.,

DROP-METHODS OF COUNTING CELLS

353

Group II.

Serum- W.R. negative with pleocytosis ( c.sf.-W.R. negative).

Case

No.

Initials

Age.

Diagnosis.

Treatment

W.R.

Cells per c.mm.

W. B.

...

Tuberculous menin¬
gitis. (P.M.)

...

Dee. 13,1913.

84;

4 per cent,
polymorph.

I. c.

Basal tumour.

...

Mar. 25, 1914,
0/0.

I. Dp.

Hydrocephalus.

Dec. 3, 1913,
0/0.

200;

20 per cent,
polymorph.,
0*3 per cent,
plasma cells.
Many r.b.c.
allowed for.

L. E.

Disseminated

sclerosis.

Oct. 29, 1913,
0/0.

63;

1 per cent
plasma cells
(atypical), 2
per cent
polymorph.

Em. H.

...

Cerebral tumour.
(Proved by P.M.)

...

Deo. 20, 1913.

15.

J. H.

Tuberculous menin¬
gitis. (P.M.)

Apr. 9, 1913.

400;

2*2 per cent
polymorph.,
2*5 per cent
swollen.

D. J.

...

Cerebral tumour.

...

May 6, 1914,
0/0.

R. K.

Cerebral haemorrhage
and fits.

Nov. 12,1913,
0/0.

200;

1 per cent,
plasma cells,
0*3 per cent
mast oells,
but blood
present.

H. L.

Tuberculous menin¬
gitis. (P.M.)

May 22,1914.

100;

40 per cent
swollen, 0*1
per oent.
plasma oells
(one day old).

10.

N. L.

• • •

Acute anterior polio¬
myelitis.

...

Nov. 4, 1913.

52;

70 per cent
swollen.

11.

V. P.

Meningitis. Cause ?

Apr. 3, 1913,

280;

3 per oent
polymorph.,

4 per cent
swollen.

12.

"Y.R.”

...

Cerebral tumour.

...

May 20, 1914,
0/0.

18.

13.

“T V ”

...

Mngtic. symptoms.

...

Oct. 22, 1913.

14.

Wm.Y.

Acute mngtis., non-
fatal.

Organism failed
to grow in culture.

1500;

80 per cent,
polymorph.,

1 per oent
plasma cells.

354

R. DONALD

Group III.

Serum - W.R. positive without pleocytosis
(c.s.f.-W.R. negative).

Case

No.

Initials

Age.

Diagnosis.

Treatment.

W.R.

Cells per c. mm.

15.

C. B.

Depression in a

None.

Deo. 3, 1913,

syphilitic. S.I. at 23.

4-/-

Deo. 17,1913,

M. B.

44444/0.

16.

Nephritis in a

4 years’ Hg.

June 4,1913,

syphilitic.

Myasthenia grav. in

and Kl.

4- JO.

17.

E. B.

None.

April 23,1913,

18.

P. B.

a syphilitic.
Transverse myelitis

Has had much

44444/0.
May 14,1913,

(stationary).

Hg. and also
salvarsan.

0/0.

19.

M. C.

Cerebro spinal 8.

April 1,1914,

S. C.

(Cerebral type.)

44300/0.

20.

Jacksonian seizures

Bromides,

April 29,1914,

W. C.

in a syphilitic.
Gumma of post-
central region

(operation 1911).

Iodides and Hg.

3 years.

43000/0.

April 22,1914,

21.

Old cerebral S. heroi-

Inunctions of

plegia.

Hg. and much

44400/0.

KL in 1911.

22.

G. C.

...

Old cerebral

3 “ doses ” 606

Aug. 20,1913,

thrombosis.

in Canada.

44441/0.

Left hemiplegia.

Dec. 17,1913,

Jan. 1913.

44441/0.

23.

W. G.

Progressive muscu¬

Hg.

Jan. 29,1914,

...

lar atrophy in a
syphilitio.

4-/0.

Mar. 4, 1914,

E. H.

44444/0.

24.

Gumma cerebri.

June 28, 1913,

June25,1913,

Increased intra¬

0'6 (914).

41000/0

cranial pressure.

July 10, 1913,
0-9 (914).

July 25,1913,

Secondary optio

40000/—.

atrophy.

July 17, 1913,
0-9 (914).

Nov. 5, 1913,
42100/—.

Nov. 12,1913,

2/7.

30000/0.

25.

C. K.

Cerebral S.

Hg. and KL in

July 30,1913,

Aortic disease.

1911.

44444/10000.

26.

B. L.

Psychasthehia in a

Hg. 4 months.

Oct. 23, 1912,

syphilitic.

April 1913, 0-9

44444/0.

(914) 3 doses.

April 16,1913,
44444/0.
July 2, 1913,

44444/—.
April 1,1914,

2/7.

44440/0.

27.

A. M.

Cerebral S.

Hg. and Kl.

2 years.

Jan. 1, 1913,

44443/0.

DROP-METHODS OF COUNTING CELLS

355

Group III. ( continued ).

Case

No.

Initials

Age.

Diagnosis.

Treatment.

W.R.

Cells per c.mm.

28.

E. P.

Multiple gummata.
Congenital S.

None recently.

May 21, 1913,
44444/0.

29.

M. R.

Interstitial keratitis.
Congenital S.

TBs. hip.

None.

June 25, 1913,
0/0.

30.

A. S.

Epilepsy in a
syphilitic.

Bromides only.

Jan. 14, 1914,

4-/-.

Mar. 18, 1914,
44420/0.

2 -

31.

L. Sp.

Sc. thrombosis of
cord.

Kl.

Oct. 3, 1913,

0-9 (914).

Oct. 8, 1913,
44442/0.

2 -

32.

E. W.

Vestibular disease in
a syphilitic.
Epilepsy in a
syphilitic.

Injections of Hg.
and Kl.

Jan. 8, 1913,
42100/0.

33.

: j

F. W.

June 11, 1913,
44430/0.

Group IV.

W.R. pos. po8., with pleocytosis.

(Only Group IV. has W.R. positwe in c.s.f.)

Group IV. consists of:—

• Group IVa.—Untreated nervous syphilis.

„ IVA.—Nervous syphilis much improved under treatment.

„ IVc.—Nervous syphilis less improved under treatment.

Group IVa.—Untreated Nervous Syphilis.

Case

No.

Initials

Age.

Diagnosis.

Treatment.

W.R.

Cells per c.mm.

34.

J. A.

Tabes optica.
Primary optic
atrophy.

No other manifesta¬
tion. (P.M.)

...

May 7, 1913,
44300/44300.

33.

35.

F. B.

Probably spinal
thrombosis.

Jan. 21, 1914,
—/44400.

Feb. 4, 1914,

4-/-.

Feb. 11, 1914,
44430/—.

80;

41 per cent. \
polymorph.

36.

S. B.

Acute Sc. enceph.
P.M. verification.

May 27, 1913,
44444/44444.

35.

356

R. DONALD

Group I Vo. (continued).

Case

No.

Initials

Age.

Diagnosis.

Treatment.

W.R.

Cells per c.mm.

37.

C. B.

Tabes dorsalis.

June 10, 1914,

Cerebro- spi nal sy ph -

44310/44000.

40 per cent.

J. C.

ilis, root lesion,
primary atrophy,
A. R. pupils.

swollen (3
days old).

38.

Tabes dorsalis.

...

Mar. 29. 1912.
44430/31000.

36.

39.

A. C.

Tabes dorsalis with

Aug. 20, 1912,

...

some amyotrophy
of upper limb.

41000/44441.
Fob. 25,1914,

100;

40000/44440.

0*5 per cent,
plasma cells.

40.

R. C.

Amyotrophy with
cerebral affection

Dec. 4, 1912,
44442/44100.

39.

and spasticity of
lower limbs.

41.

VV. C.

Sc. mngtis, root

None recently.

Oct. 29,1913,

43.

lesions.

4-/-•

Dec. 3, 1913,
44440/44440.

30.

S. 0.

Cerebro-spi nal

. •,

Mar. 4, 1914,

35.

44.

C. G.

syphilis.

S. II. c., root

44410/44400.
June 10, 1914,

154;

lesions.

44444/44000.

75 per cent,
polymorph.,

3 per cent.

; 45 .

plasma cells.

! H. G.

Sc. spinal meningitis

i .,,

Feb. 11, 1914,

74;

with A. R. pupils.

44440/44000.

1 per cent.

plasma cells.
Red oells

46.

T. G.

Tabes dorsalis.

Dec. 4, 1912,

present.

50.

Perforating ulcer of

43200/44400.

foot.

Jan. 29, 1913.

...

44310/—.

! 47.

48.

W. H.

H. H.

Tabes dorsalis.

Tabes dorsalis, c.

Feb. 25, 1914,
44440/44400.

18.

Apr. 1, 1914,

10.

49.

gastric crises.

44440/44440.

A. H.

Cerebral S. Mani¬

Feb. 18,1914,

festations chiefly

2-/-.

mental.

Feb. 25,1914.

25.

50.

K. H.

| —/44000.

Acute meningo

iNov. 6, 1913.

426; |

myelitis.

5 per oent.
polymorph., 1
3 per cent. |

plasma oells;

3 per cent,
endothelial

oells.

DROP-METHODS OF COUNTING CELLS

357

Group IVa . ( continued ).

Case

No.

Initials

Age.

Diagnosis.

Treatment.

W.R.

Cells per c.mm.

51.

W. J.

Spastic paraplegia.

April 22,1914,

35;

’

444—/44200.

5 per cent,
plasma cells.

52.

G. J.

Sc. hemiplegia with
amyotrophy of
right upper limb.

Nov. 12, 1913,

4-/-.

Nov. 19, 1913,

1 .

53.

S. K.

S. roeningo vascu-

44441/44300.

Mar. 25,1914,

64;

laris, mental de-
terioration.

44430/41000.

1 per cent,
polymorph.,

I per cent,
plasma cells.

54.

H. K.

Gummatous mngtis.

Mar. 5,1913,

23;

So. lesions of nu-

44440/0.

(many red

cleus of 9th, 10th
and 11th cranial

cells present.
Blood leuoo-

nerves.

oyte count

S.I. 12 months ago.

not secured.)

55.

Dementia paralytica.

• • •

Feb. 3, 1914,

60;

Red cells
allowed for.

56.

R. M.

Sc. enceph.

Feb. 25,1914,
44444/44440.

65.

58.

E. M.

Cerebrospinal

•..

July 9, 1913,

meningitis.

444-/43000.

specimen

3 days old.

59.

A. M.

So. encephalitis with

Mar. 4,1914,

...

leukoplakia.

4-/-.

Mar. 11,1914,

250;

-10.

30 per cent,
polymorph.,

0‘3 per cent,
plasma.

Mar. 18,1914,

• • •

44442/—.

60.

J. M.

Tabes dorsalis.

Feb. 28,1912,

4-/-.

May 22,1912,

AAAAA IAAAAA

1 ■ XX f/ 1111 A*

61.

E. M.

47 |

Tabes dorsalis.

Mar. 25,1914,

12 .

—/44440.

April 1,1914,
44444/—.

...

62.

S. 0.

Tabes dorsalis.

...

May 15,1912,

10000 /—.
May 22,1912,

16;

10000/44441.

Phase I., slight

Apr. 1,1914,
20000/44444.

opalescence.

3 |

c. 8. f. markedly

alkaline.

Phase I., nearly
opaque white.

an 8

K. DONALD

Group IV«. (continual).

Case

No.

Initials

Age.

Diagnosis.

Treatment.

63.

H. O.

Cerebrospinal 8.

affection of many
cranial nerves and

spinal roots.

64.

A. O.

Cerebrospinal S.

affecting many

cranial nerves

and several spinal

nerve roots.

65.

C. P.

Sc. meningitis.

66.

(i. Pb.

Pseudo-tal>es

...

syphilitica.

67.

T. P.

Cerebro spinal S.
A.R. pupils, root
lesions, spastic

paraplegia.

Tabes dorsalis.

68.

G, R.

Primary optic

atrophy.

69.

T. S.

Talies dorsalis.

70.

E. S.

“ Gastric crises.”

71.

* t t $ )f

! Meningo-myelitis.

72.

F. S.,
of B.
1). T.

j Dementia paralytica.

73.

Spastic paraplegia,
j c. A.R. pupils.

74.

W. T.

Cerebro-spinal S.

(S. 20 years ago.)
Gumma of testicle.

75.

C. W.

Tabes dorsalis,
i Ophthalmoplegia

externa.

76.

s. w.

Basal mngtis. affect¬

ing many cranial

nerves.

77.

G.R.W.I

Sc. bulbar throm¬

...

bosis. (P. M.)

W. R. Cells per e.mm.

Feb. 18, 1914,,
44444/44440.

|june 19, 1914,
44440/0.
June 25, 1913,
44000/44400.

Dec. 17,1913,

0 / 0 .

Oct. 8, 1913,
44444/44310.
June 10, 1914,
4-/44000.

Nov. 19,1913,
44444/44000.

Apr. 17, 1913,
44440/44100.
Apr. 30, 1913,
0/44100.
Nov. 29, 1913,
0 / 0 .

July 16,1913,
4-/4-.

May 13,1914,
44444/44440.
Apr. 23, 1914,
44444/44431.
Dec. 15,1913,
44444/44444.

Apr. 23,1913,

Mar. 4, 19U,
44400/44440.

May 12, 1914,
44440/44400.

uMar. 18, 1914,

4-/-.

Mar. 25, 1914,
—/40000.
Apr. 1, 1914,
44444/—.

55;

0 3 per cent,
plasma.

90;

1 per cent,
mast cells,
0'5 per cent,
plasma cells.
15.

14.

53;

1 per cent,
polyniorpli-

6 .

36.

12 .

200 ;

nearly all

expanded.
Sample some
days old.

31.

12 .

36.

104;

02 per cent,
plasma cells.
40.

27.

DROP-METHODS OF COUNTING CELLS

359

Group IVa. ( continued ).

Case

No.

Initials

Age.

Diagnosis.

Treatment.

W.R.

Cells per c. mm.

78.

E. W.

Acute encephalitis
(mental manifesta¬
tions).

Hg. 4 years ago.

Feb. 11, 1914,

4-/-.

Feb. 18, 1914,
—/44444.

13.

79.

E. W.

Depression.

May 13, 1914,
44444/44444.

29;

1 per cent,
mast cells.

80.

J. W.

Acute 8. II.
c. affection of many
spinal and cranial
nerves.

Apr. 15, 1914,
4 /44400.

43;

8 days old.

Group IY6.

Nervous Syphilis Much Improved under Treatment.

Case

No.

Initials

Age.

Diagnosis.

Treatment.

W.R.

Cells per c.mm.

81.

A. A.

Basal mngtis. affee-

May 6, 1913,

April 30,1913,

33.

tion of many cranial

0-9 (914).

44444/44432.

nerves and several

May 9, 1913,

Oct. 29, 1913,

spinal nerve roots.

0-9 (914).
June 26, 1913,

44441/0.

0'9 (914).

82.

C. B.

Brown-S&juard

1911, Hg., 36

June 19, 1912,

...

paralysis.

inunctions.

44410/41000.

July 22, 1912,

July 2, 1913,

1 .

0-6 (606).

44410/0.

July 27, 1912,

Oct. 15, 1913,

...

0-9 (914).

44410/—.

June 28, 1913,

Deo. 2, 1913,

2 .

0'9 (914).

44000/0.

83.

D. B.

Sc. transv. myelitis

Aug. 1912,

Aug. 2, 1912,

...

(stationary).

0-9 (914).

44443/44432.

Aug. 1912,

April 30,1913,

...

0-9 (914).

44443/—.

May 1913,

May 21,1913,

0*9 (914).

44430/0.

May 1913,

Feb. 18,1914,

2 .

0-9 (914).

44440/0.

84.

A. C.

Gastric crises.

Aug. 1913,

0'9 (914).

Aug. 6, 1913,
444-/44440.

40;

23 per cent,
polymorph.

Aug. 1913,

Feb. 18,1914,
44440/44440.

0-9 (914).

red cells

Aug. 1913,

0-9 (914).

Feb. 1914,

allowed for.

0-9 (914).

300

R. DONALD

Group I Vi. ( continued ).

Case
j No.

1 -

Initial

J Age

! Diagnosis.

Treatment.

YV.R.

Cells per c. mm.

f*.

G. D.

Sc. hemiplegia in

Hg. 2 years.

Feb. 7, 1912,

1900.

Feb. 11, 1912,

32000/0.

0-6 (606).

Feb. 17, 1912,

June 15, 1912
21000 /—.

0-6 (606).

May 21,1913,

0 /-.

July 2, 1913,

(

o/-.

Nov. 12,1913,

1 .

0 /0.

May 27,1914,

1 .

87.

W. F.

Pseudo-tabes syphil¬

Iodides.

0 /0.

Mar. 5, 1913,

itica, with amyo¬

4-/-.

88 .

u. f.

trophy of legs.

Mar. 4, 1914,
44420/44000.

2 .

Sc. basal mngtis.

Hg.

July 9, 1913,

affection of several

July 5, 1913,

4-/-.

89.

J. G.

‘27

cranial nerves.

0-9 (914).

Mar. 4, 1914,
44444/44000.

1 .

Acute cerebro-spinal

Hg. 6 months.

Oct. 8, 1912,

syphilis.

Oct. 14, 1912,

44444/44443.

S.I. end of 1911.

0-9 (914).

Oct 13, 1912,

Oct. 21, 1912,

44444/44410.

0-9 (914).

Dec. 10,1912,

16.

Nov. 4, 1912,

44443/44300.

0-9 (914).

Mar. 5, 1913,

Dec. 11, 1912,

44100/0.

0-9 (914).

April 23,1913,

...

Mar. 6, 1913,

10000 /—.

0-9 (914).

Oct. 29,1913,

April 23, 1913,

20000 /—.

0-9 (914).

April 22,1914,

2 .

90.

W. G.

Sc. mngtis.

12 inunctions

0 /0.

April 3,1912,

112 .

Nerve root irritation.

Hg. 1908.

44444/0.

117;

Hg. and Kl. 6

Mar. 4, 1914,

weeks in 1911.

44444/0.

3 per cent !

Mar. 4, 1912,

polymorph., '

0-9 (914).

10 per cent, j

Mar. 7, 1912,

swollen.

0-9(914).

Mar. 10, 1912,

91.

R. O.

Diffuse gummatous

0-9 (914).

May 16, 1913,

May 21,1913,

23;

mngtis.

0-9 (914).

AAAAA IAAAAA

I 1 I 1 1/ M M. M. M

1 per cent

S. 10 years ago.

May 31, 1913,

microlympho¬

0-9 (914).

July 14, 1913,

July 23,1913,

cytes.

0-9 (914).

44442/—.

1 .

July 31, 1913,

Aug. 6, 1913,

0-9 (914).

—/44430.

DROP-METHODS OF COUNTING CELLS

361

Group IV6. (continued).

! Case
No.

Initials

Age.

Diagnosis.

Treatment.

W.R.

Cells per c.ram.

92.

F. J.

Sc. "peeudoparesia.”
B.I. at 29.

Iodides only,
1912.

Mar. 13,1913,
44330/44440.

63.

April 17, 1913,

April 16,1913,

19.

0-9 (914).

44444/44000.

April 22, 1913,

July 9, 1913,

0-9 (014).

4-/-.

April 26, 1913,

Nov. 5,1913,

2 .

0-9 (914).

44440/0.

D.G.K.

Sc. myelitis.

Local Sc. menin-

July 10, 1912,
0-6 (606).

July 10,1912,
44300/44410.

...

gitis, Th. Vffl.

July 17, 1912,
0-6 (006).

May 15,1913,
32100/0.

10 .

Jan. 1, 1913,

0*9 (914).

94.

A. K.

Diffuse meningitis

Oct. 21, 1912,

Oct. 16,1912,

and gumma of

0'9 (914).

0/4-.

scalp.

Oct. 31, 1912,

Oct. 30, 1912,

0*9 (914).

20000 /—.

Jan. 17, 1913,

Jan. 22,1913,

0-9 (914).

43200/0.

[

April 24, 1913,

April 23,1913,

I 95.

N. M.

0-9 (914).

Jan. 8, 1913,
0*9 (914).

40000/0.

Cerebro spinal S.

(Vigorous

Aug. 27, 1913,

S.I. 3 years ago.
Right hemiplegia,

inunctions.)

44200/0.

97.

, A. P.

2 years.

Sc. encephalitis,

July 3, 1912,

44 pseudo - paresis ”

0-6 (606).

42000/43200.

syphilitica, hyper -

March 7, 1913,

May 5, 1913,

0 ;

piesis.

0-9 (914).

0 /0.

the white cells

May 5, 1913,

June 25,1913,

are practically

0-9 (914).

o/-.

accounted for

Oct. 15,1913,

by the red

o /-.

cells.

April 29,1914,

0 /0.

confirming

count.

98.

G. P.

Sc. encephalitis.

He. 2 years.

April 3,1912,

...

Feb. 1912, 0 -6

4-/-.

(606).

Nov. 13, 1912,

...

Feb. 11, 1912,

40000/—.

0-6 (606).

Nov. 28,1912,

85.

Nov. 27, 1912,

0/44100.

0-6 (914).

June 4, 1913,

90.

June 6, 1913,

44442/44443.

0-6 (914).

July 31,1913,

...

July 12 to 26,

44430/—.

0*9 (914),
in 4 doses.

Aug. 13,1913,
44200/44400.

362

R. DONALD

CtKOUP IV/>. ( continued ).

Cast*
i No.

Initials

99. F. P.

100. 1 F. R.

101 .

E. R.

102. M. S.

103. I E. T.

Diagnosis.

Treatment.

W.R.

Cells per c.mm.

Jan. 26, 1914,
0*9(914).

■Sept. 24,1913,
44200/—.
Nov. 19,1913,
01—

Jan. 28, 1914,
0/42000.

Pseudo-tabes

Jan. 4, 1913,

Jan. 1, 1913,

5. |

syphilitica.

0-0 (914).

44443/44443.

Jan. 14, 1913,
0-9 (914),

Mar. 2, 1913,
44441/—.

3. '

Jan. 21, 1913,
0-9 (914).

Apr. 23, 1913,
44444/44400.

April 25, 1913,
0-1 (914).

May 21, 1913,
44442/—.

April 29, 1913,
01 (914).

June 4, 1913,
44441/—.

May 2, 1913,
01 (914).

June 16, 1913,
44441/—.

May 3 to 27,
2-3 (914),

July 16,1913,
44442/—.

in 7 doses.

Jan. 28, 1914,

Sept. 3, 1913,
44440/44200.

0-9 (914).
June 12, 1914,

Jan. 28, 1914,
4444-/44400.

1 .

0-9 (914).

June 10, 1914,
44440/30000.

1 .

Gummatous mngtis.

Feb. 25, 1913,

Mar. 5, 1913,

11.

around 3rd cranial

0-9 (914).

44444/41000.

! io.

nerve.

Mar. 8, 1913,
0-9 (914).

Apr. 23, 1913,
0-9 (914).

Apr. 23, 1913,
44444/0.

Old Sc. muscular
atrophy and lateral
sclerosis. S. 19 j
years ago.

May 19, 1911.
20000/0.

Feb. 26, 1913,
0/0.

Oct. 29, 1913,
0/0.

Sc. amyotrophy.

July 20, 1912,
0-9 (914).

Mar. 14, 1912,
44444/—.

• • •

Aug. 1, 1912,
0-9 (914).

Apr. 22, 1912,
44444/44442.

20.

Nov. 30, 1912,
0-9 (914).

Nov. 21, 1912,
—/41000.

Dec. 3, 1913,
0-9 (914).

Dec. 4, 1912,
—/44300.
July 9, 1913,
44410/—.
Dec. 3, 1913,
44410/40000.

• • •

1- 1

Gummatous mngtis.,

Hg. and “606 ”

Jan. 22, 1913,

7. :

affection of several

injected abroad

32000/0. !

cranial nerves.

18 months ago.

___—

DROP-METHODS OF COUNTING CELLS

363

Group IVi. (continued).

! Case
No.

Initials

Age.

Diagnosis.

Treatment.

W.R.

Cells per c.mm.

104.

E. W.

Syphilitic hemiplegia.

“ Salvarsan.”

Oct. 22,1913,

31.

Oct. 18, 1913,

44444/0.

0 6 (914).

Oct. 23, 1913,

Nov. 12, 1913,

20.

0*9 (914).

Oct. 30, 1913,

44444/0.

0*9 (914).

105.

E. W.!

Sc. hemiplegia.

Mar. 7, 1913,

Mar. 5, 1913,

19.

0-9 (914).

44444/44000.

Mar. 10, 1913,

July 2, 1913,

• ••

0*9 (914).

44442/—.

Mar. 17, 1913,

Dec. 3, 1913,

• • •

0*9 (914).

44440/0.

Group IVc.

Nervous Syphilis Less Improved under Treatment.

Case

No.

Initials

Age.

Diagnosis.

Treatment.

W.R.

Cells per c.mm.

106.

A. B.

J u venile dementia
paralytica.

July 19, 1913,
0-6 (914).

July 25, 1913,

0 6 (914).

July 30, 1913,

0 6 (914).

Oct. 29, 1913,

0 6 (914).

July 16,1913,
44444/44420.

Oct. 29, 1913,
44440/44000.

Apr. 27, 1914,
44440/44440.

46;

2 per cent,
plasma, 5 per
cent, poly¬
morph.

21;

3 per cent,
polymorph.,

1 per cent,
plasma cells.

38;

1 per cent,
plasma cells,

1 per cent,
polymorph.

107.

A. B.

Epilepsy in a
syphili tic (old
meningitis).

Apr. 5, 1913,

0 9 (914).

Apr. 12, 1913,
0-9 (914). |

Apr. 19, 1913,

0 9 (914).

July 9, 1913,
0-9 (914).

Apr. 2, 1913,
44440/0.
Oct. 15, 1913,
4444^/

Dec. 17, 1913,
44442/0.

108.

J. B.

Pseudo- paresis
syphilitica.

Hg. 4 months.
Sept. 24, 1912,
0-9 (914).

Sept. 28, 1912, |
0 9 (914).

Sept. 18, 1912,
43000/42000.

Juno 18, 1914,
30000/44200.

109.

H. B.

Taboparesis.

S. 1894. (P.M.)

Hg. 12 months.
Oct. 25, 1912,

0 9 (914).

Oct. 23, 1912,
44431/44441.

364

R. DONALD

Group IVr. (continued).

Case

No.

j Initials Age.

Diagnosis.

Treatment.

W.R.

'Cell* per c.mm.

Oct. 29, 1912,

Feb. 5, 1913,

... i

0-9 (914).

44410/—.

Feb. 1 , 1913,

Sept. 3. 1913,

, specimen 3

0-9 (914).

44432/44420.

days old.

110 .

I J. c.

Dementia paralytica

June 6 , 1912,

June 5, 19J2,

progressive.

0-6 (606).

44421/44432.

June 12, 1912,

Aug. 20,1913,

25;

0-6 (606).

44440/44420.

1 per cent,
plasma cells.

111 .

E. C.

Taboparesis.

. ..

Sept. 24,1913,

4 -/-.

Oct 2, 1913,

! 4 -/44444.

1 May 13,1914,
44441/44442.

24.

112 .

C. C'.

Tabes dorsalis.

Nov. 3, 1912,

i Oct. 8 , 1912,

Leukoplakia, epi-

0 9 (914).

44200/44310.

thelioma of tongue.

Nov. 8 , 1912,

Dec. 4, 1912,

Death from second-

0-9 (914).

43200/—.

ary carcinomatosis.
(NoP.M.)

May 4, 1913,

Mar. 19,1913,

... 1

0-9 (914).

44200/—.

May 7, 1913,
44420/44200.

30.

Sept. 10 , 1913,
44420/44200.

10 .

113.

S. I).

Taboparesis pro¬

June 1 , 1913,

22 . !

gressive.

0-9(914).

44443/44444.

1 :

Later 4 intrathecal

June 21, 1913,

Oct. 8 , 1913,

injections, each

0.9 (914). !

44444/—.

28; j

10 c.c. of “ 914-

June 27, 1913,

Jan. 14,1914,

serum.”

0-9 (914).

44444/44444.

30 per cent |

Sept. 29 to

polymorph. 1

Oct. 10, 1913.

4 times 0*3 (914)

July 8 , 1914,
44444/44444.

18; |
blood account¬

in 30 c.c.

Jan. 1914,

0-9 (914).

ed for 9 cells.

119. ^

F. G.

24 !

“Parasyphili tic”

June 6 , 1913,

June 4, 1913,

40.

epilepsy, congeni¬

0-9 (914).

44-/44440.

i 1

tal S.

June 15, 1913,

June 11, 1913,

...

1 1

0-9 (914).

44200/—.

i i

June 18, 1913,

Dec. 3, 1913,

Muscular atrophy.

0-9 (914).

44100/44000.

122 .

W.Hr.

April 5, 1913,
0-9 (914).

April 12 , 1913,

Feb. 26,1913,

4 -/-.

April 3,1913,
44444/44400.

44.

0-9 (914).

April 19, 1913,
0-9 (914).

Sept 24,1913,
44443/43000.

...

8 ept. 23, 1913,

May 13,1914,

3|.

8 c. hemiplegia.

0-9 (914).

44430/40000.

118.

W. G.

May 20 , 1913,

...

0-9 (914).

DROP-METHODS OF COUNTING CELLS

365

Group IVc. ( continued ).

Case

No.

Initials

Age.

Diagnosis.

Treatment.

W.R.

Cells per c.mm.

May 30, 1913,

Aug. 20,1913,

50.

0.9 (914).

AAAAA ! A A A A A

Tim/ XTTTTi

Sept. 14, 1913,

Nov. 5, 1913,

0 9 (914).

44441/—.

Jan. 14, 1914,

163.

F. G.

0*9 (914).

44440/44444.

119.

Parasyphilitio epi-

June 6, 1913,

June 4, 1913,
44—/44440.

40.

lepsy, congenital S.

0*9 (914).

June 13, 1913,

June 11,1913,

0-9 (914).

44200/—.

June 18, 1913,

Dec. 3. 1913,

0-9 (914).

44100/44000.

120 .

W. H.

Erb’s Sc. spinal

No treatment

Feb. 28, 1912,

12 .

paralysis (stationary).

in 1912.

43200/44300.
May 7, 1913,

43200/—.

May 21, 1913,
43100/43000.

121 .

0. H.

Dementia paralysis.

Just finished 20

Nov. 28,1912,

injections of Hg.

20000/40000.
April 9, 1913,

4- /-•

Dec. 17,1913,

1 .

122 .

W. Hr.

43100/30000.

Parasyphilitio muse.

April 5, 1913,

Feb. 26,1913,

atrophy.

0 9 (914).

4 - /-.

April 12, 1913,

April 2, 1913,

44.

0 9 (914).

44444/44400.

April 19, 1913,

Sept. 24,1913,

• • •

•

0*9 (914).

44443/43000.

Sept. 23, 1913,

May 13,1914,

Si-

P. H.

0-9 (914).

44430/40000.

123.

Gastric crises.

Sept.-Oct. 1913,

Sept. 17,1913,

A.R. pupils.

K. J. and A. J. good.

3 doses 0*9 (914).

44444/44400.
June 25, 1913,

13 ;

| 124.

E. I.

44443/44410.

1 per cent,
polymorph.

Tabes dorsalis, 23

April 10, 1913,

Mar. 5, 1913,

years.

0-9 (914).

0 /—

Charcot knee

April 9,1913,

(stationary).

20000 /0.
April 18,1913,
£2000/0.
April 22,1913,

0*3.

22000 /0.
April 29,1913,

125.

F. K.

Taboparesis (P.M.).

20000 /0.

May 17, 1913,

April 16,1913,

44;

0-9 (914).

May 20, 1913,

44442/44440.

1 per cent,
polymorph.

Oot. 8, 1913,
44444/44300.

6 .

0-9 (914).

May 26, 1913,

0-9 (914).

\l DONALD

;)6G

Group IVc. (I'oiiliniliif).

Case

No.

Initial!

Age.

Diagnosis.

H. Kn.

Sc. encephalitis
(treated).

Now in asylum.

127.

T. M.

Dementia paralytica.
Now in asylum.

1*28.

M. M.

Sc. hemiplegia, with
relapse and de¬
velopment of psy¬
chosis.

129.

W. M.

Secondary optic
atrophy.

Old Sc. meningitis.

' 130.

D. S.

Tabes dorsalis.

131.

A. S.

Tabes dorsalis and
optic atrophy.

S.I., 1905.

132.

A. Ss.

Cerebro-spinal S.
S.I., 1890.

134.

F. S.

S. meningo vascu¬
laris.

S.I., 14 years ago.

135.

W.G.T

Dementia paralytica.
Onset with manifesta¬
tions of basal menin¬
gitis (progressive).

Treatment.

W.K.

Cells per c.irnn.

Get. 7, 191-2,

Oct. 2, 1912,

0 0 (914).

44440/44100.

Nov. 5, 1913,

4- /O.

c. bacteria.

Oet. 16, 1913,

Oct. 15, 1913,

• • •

0 9 (914).

4 / •

Oct. 22, 1913,

Oct. 22, 1914,

80;

0 9 (914).

44444/44444.

4 per cent.

Nov. 1, 1913,

Feb. 18,1914,

polvmorph.

* 3.

09(914).

44444/44444.

Feb. 4, 1914,

May 18, 1914,

0 9 (914).

44420/44444.

Oet. 5, 1912,

Oct. 2, 1912,

,,,

0-9 (914).

443J0/42000.

Oct. 9, 1912,

Nov. 25, 1913,

67.

0 9 (914).

44410/44300.

1 per cent.

May 21, 1913,

polymorph.,

2 per cent,
mast cells.

4-/-.

June 18, 1913,

20. 1

44410/10000.

...

Hg.

Dec. 14, 1911,

21;

May 7, 1913,

44410/44400.

(heart antigen).

0-9 (914).

May 7, 1913,

Hg. 2 years.

44442/44100.
Nov. 20,1912,

Nov. 15, 1912,

44442/44300.

0-9 (914).

Nov. 17, 1912,

Oct. 15, 1913,

0-9 (914).

44444/44100.

Nov. 19, 1912,
0-9 (914).

Feb. 1914,

Nov. 5, 1913,

0 9 (914).

4-/-.

Mar. 1914,

Feb. 25, 1914,

0-9 (914).

44443/44444.

Mar. 1914,

May 15, 1914,

0-9 (914).

44440/44410.

Apr. 1914,

0-9 (914).

30.

Has had Hg.

Nov. 12,1913,

44444/44444.
Dec. 9, 1913,

Hg.

—/44444.
Jan. 22, 1913,

50.

Jan. 25, 1913,

44430/44441.

0-9 (914).

39;

Jan. 31, 1913,

Oct, 15, 1913,

0-9 (914).

44440/44444.

5 per cent.

swollen.

DROP-METHODS OF COUNTING CELLS

367

Group IVc. ( continued ).

1 Case
j No.

Initials

Age.

Diagnosis.

Treatment.

W.R.

Cells per c.mm.

Feb. 5, 1913,

June 10, 1914,

38;

0-9 (914).

—/44444.

7 per cent.

Oct. 13, 1913,

swollen.

0-9 (914).

Nov. 14, 1913,

0 9 (914).

Nov. 18, 1913,

0-9 (914).
June, 1914,

0'9 (914).

136.

0. W.

Paralysis of 3rd

Hg. and 914.

Mar. 18,1914,

30.

cranial nerve and
crossed hemiplegia
(Weber’s syn-

0/41000.
May 8, 1914,

o/-.

drome). Sc. rash,

May 13,1914,

13.

Mar. 1913.

0/0.

| 137.

F. W.

Post-syphilitic amy¬
otrophic lateral

2 doses “ 606,”

Jan. 1913,

1913.

4-/-.

solerosis.

Aug. 2, 1913,
0*9 (914).

Aug. 6, 1913,
44200/44000.

...

Dec. 3, 1913,

0'9 (914).

43000/44000.

Dec. 4, 1913,

Mar. 4, 1914,

...

0-9 (914).

44300/—.

Dec. 8, 1913,

May 6, 1914,

0-9 (914).

42000/42000.

Mar. 4, 1914,

0 9 (914).

May 5, 1914,

• • •

0-9 (914).

138.

V. W.

• • •

Pseudo-paresis

3 times 0*9 (914)

Nov. 26, 1913,

14; |

syphilitica, im¬

in Nov. 1913.

44444/44444.

3 per cent.

proved under

plasma cells.

treatment.

June 10, 1914,

44441/44443.

139.

J. Z.

Sc. disseminated

Much Hg. and KI.

Dec. 3, 1913,

sclerosis. Onset

Dec. 22, 1913,

0 /0.

1909.

0*45 (914).

Deo. 30,1913,

...

o/—

Summary.

The drop-film method of counting the cells of cerebro-spinal
fluid is described, and more than 260 cell-counts, from cases dealt
with by Dre MTntosh, Fildes, Head, and Fearnsides 1 are discussed
in connection with extensive tables lent by those authors to show
the quantitative Wassermann test, done two to five times on the

1 Brain, Vol. xxxvi.. Part i., July 1913, and following numbers.

368

R. DONALD

e.s.f. simultaneously with the cell-count, and oftcner on the serum,
in a munher of cases in various stages of treatment.

The method avoids centrifuging, which is found to cause loss of
some cells, especially of the swollen degenerated cells. (These
exist in some freshly drawn c.s.fs., and they develop from
unswollen cells in e.s.f. kept for a day or two.) Also it avoids
the addition of alcohol or of acetic acid, substances that destroy
the red cells. (Red cells, whether due to the puncture or due to
previous luemorrhage are, as Rous insisted, to he demonstrated
and allowed for.) No special apparatus is used. The preparations
are permanent, and may l>e easily multiple, r.//., for class purposes.

On each of any number of ordinary slides a couple of separate
small drops of the e.s.f. are deposited by the simple dropping
pipettes described 1 recently in a short communication to the
Royal Society. The slides arc then dried, heat-fixed, dipped in
dilute collodion, and dried again. Thus are obtained drop-films
that are practically collodion sections at most only one dried cell
in thickness. These films, stained, <y/., Gieinsa, or Leishman, and
Unna-Pappenheim, and mounted in clear soft paraffin, give, with
the aid of a mechanical stage, at once clear cell-pictures and
convenient accurate cell-counts, without the loss of a single
bacterium. Staining for Grain-positive bacteria or for tubercle
bacilli may be done.

At any stage after the drying of the drop the process may be
interrupted, at the worker’s convenience.

When filed (c.g., by a “slide-index” method, to be described
later), the permanent preparations give a valuable record of the
cytological course of the case.

The cases dealt with are marked off into four groups by the
serum-W.R. and the cell-count. The main interest centres in
group IV., with serum-W.R. positive and with pleocytosis. Only
this group has the e.s.f.-W.R. positive.

In many of the patients at the time of first observation it is
impossible to say whether the condition is to l>e called “cerebro¬
spinal syphilis,” and a hopeful prognosis given, or whether it
belongs, or may presently, especially if no treatment now be
applied, belong to the clinical group “ parasyphilis,” with its
relatively hopeless prognosis. Not by the presence or by the
degree of pleocytosis—any more than by the presence or by the
strength of the W.R. in c.s.f. or in serum—but only by their
1 Donald, Proc. Royal Society, B, 1913, Vol. lxxxvi., p. 198.

DROP-METHODS OF COUNTING CELLS

369

behaviour under treatment do these cases show up as belonging
to the one type or to the other. The potency, in many of the
cases, of treatment by intravenous injections of neosalvarsan is
indicated in the tables of successive cell-counts and Wassermann
tests.

In subsequent articles the authors mentioned will show that
in the cases of sub-group IV&. (“cerebro-spinal syphilis”) the
fall in the W.R. and in the cell-count is followed by actual
improvement in function, which improvement in some cases
proceeds to the recovery of good bodily health with some
mental improvement, and in other cases to practically complete
recovery. Moreover, they will show that, even in sub-group IVc.
(“ parasyphilitic ” group) considerable clinical improvement takes
place in some cases, corresponding, no doubt, to some arrest of the
inflammatory processes, though not to resolution of any secondary
degenerations.

As the published tables show, the cell-count is a test that, for
significance and reliability, is a worthy co-operator with the
W.R. Indeed it often gives earlier than the W.R. (1) warning
of meningeal affection, and (2) after treatment, indication of
improvement.

The pleocytosis-producing substance is shown to be distinct
from the Wassermann substance.

A description is given of a simple microscope lamp, which has
shown itself of value in rapid qualitative cell-counts, with
moderate powers.

Besides the mainly-used drop-film method, there is described
a simple drop-chamber method, using ordiuary slides and cover
glasses, and suitable for dark-ground examination of unstained cells.

Acknowledgments are gratefully tendered to Professor
Bulloch, F.R.S., for encouragement and facilities towards the
working out of the method; to Professor Leonard Hill, F.R.S.,
who early recognised some value in the drop-method and gave
very practical help; to Dr H. M. Turnbull, Director of the
Pathological Institute, for advice in cytology; also to Dr G.
Bartlett, Assistant Director; and especially to the authors of the
work to which this has the honour of being a tributary, namely,
to Dr Head and Dr Feamsides, for courteously supplying the
notes of diagnosis and of treatment; and to Dr Fildes and Dr
McIntosh for the Wassermann notes; finally to the London
Hospital Medical College Research Fund for a subsidy.

370

ABSTRACTS

abstracts.

ANATOMY.

THE P YE AMID TRACT IN THE RED SQUIRREL ( SCIURUS
(425) HUDSONIANUS, LOQUAX) AND CHIPMUNK (TAM!AS
STRIA TUS, LYSTERL) Sutherland Simpson, Joum. Comp .
Neurol., 1914, xxiv., April, p. 137.

The cortical motor areas in the left cerebral hemispheres were
extirpated in three red squirrels and three chipmunks, and the
resulting degeneration followed by the Marchi method.

The degenerated pyramidal fibres were found to occupy the
usual position in the crusta, pons, and medulla oblongata. At the
lower part of the bulb a complete decussation occurs, no fibres
remaining on the same side. The fibres cross the middle line
abruptly in bundles which interlace with those of the sound side,
and pass through the grey matter into the funiculus cuneatus,
where they turn caudalwards and pass down the apex of the
posterior column of the spinal cord as far as the lower sacral
segments. No fibres pass down the lateral column of the cord.

A. Ninian Bruce.

THE BRAIN OF A BLACK MONKEY ( MACACUS At A UR US) : THE
(426) RELATIVE PROMINENCE OF DIFFERENT OYRI. Harris

E. Santee, Anat. Record, 1914, viii., May, p. 267.

In this brain, those parts which are motor or sensory in function
were well developed, while those regions which are concerned with
psychic functions were poorly developed, e.g., the frontal lobe
anterior to the prsecentral sulcus, the posterior parietal, and the
inferior temporal regions. These areas which were deficient in
this brain correspond, therefore, with the association areas of
Flechsig. A. Ninian Bruce.

THE DISTRIBUTION OF NERVES TO THE ARTERIES OF THE
(427) ARM. J. G. Kramer. WITH A DISCUSSION OF THE
CLINICAL VALUE OF RESULTS. T. Wingate Todd, Anat.
Record, 1914, viii., May, p. 243.

The subclavian and axillary arteries differ from the other arteries
of the arm in receiving a nerve supply direct from the sympathetic
chain. All other arteries in the upper limb obtain their nerve

ABSTRACTS

371

supply from sympathetic filaments which have travelled along the
spinal nerves, and which are distributed to the various blood
vessels at irregular intervals. The distal and peripheral vessels,
more especially those of the hand, receive nerve filaments at more
frequent intervals than do the proximal channels. The distribu¬
tion of nerves to vessels corresponds roughly with the distribution
of nerves to muscles and skin.

The fact that the subclavian trunk derives its nerve supply
direct from the sympathetic chain accounts for its escape from
involvement in the lesion associated with cervical rib. The
process of blood-vessel affection in this condition appears to be
(a) stimulation of vaso-constrictor fibres; ( b) paralysis of vaso¬
constrictors (with undisturbed action of vaso-dilators ?); (c) patho¬
logical changes in the vessel wall consequent on the lesion of the
nerve. (Cf. Review, 1913, xi., p. 92.) A. Ninian Bruce.

PHYSIOLOGY.

CEREBRO SPINAL FLUID.—III. THE GENERAL EFFECTS OF
(428) INCREASING THE CEREBRO SPINAL PRESSURE. W. E.

Dixon and W. D. Halliburton, Joum. Physiol ., 1914, xlviii., July,
p. 317.

A relatively small increase of cerebro-spinal pressure, artificially
produced by a pump connected to the cranio-vertebral space by a
cannula inserted into the subccrebellar cisterna, causes stimula¬
tion of the respiratory, vaso-motor, and cardio-inhibitory centres.
This stimulating effect is least marked on the respiratory centre.
When the pressure is increased to a height (300-400 mm. Hg.)
considerably above the normal arterial pressure respiration ceases
in a few seconds, but the other two centres remain active, and
the arterial pressure rises enormously in spite of the slow beat;
a little later the cardio-inhibitory centre is paralysed, and the
continued activity of the vaso-motor centre still further raises
the arterial pressure. This is a protective mechanism which
continues to force the blood along the compressed blood vessels.
Ultimately, however, if the high c.s. pressure is kept up, paralysis
of the vaso-motor centre ensues, and the arterial blood pressure
falls. On removal of the compression, the centres recover in the
reverse order, the vaso-motor first and the respiratory centre last.
The spinal centres, as tested by the occurrence of convulsions
after an injection of strychnine, recover their activity later still.
{Cf Review, 1913, xi., p. 591; and 1914, xii., p. 204.)

A. Ninian Bruce.

372

ABSTRACTS

THE PINEAL GLAND IN RELATION TO SOMATIC, SEXUAL, AND
(429) MENTAL DEVELOPMENT. Carey Pratt M‘Cord, Joum.

Amer. Med. Assoc., 1914, lxiii., July 18, p. 232.

M'Corp’s experiments on 110 guinea-pigs, 16 chicks, 18 puppies,
and 14 dogs show that the precocious macro-genito-somatic
syndrome can be obtained by feeding young animals with small
amounts of calves’ pineal tissue. Pineal-fed guinea-pigs gave
birth to young—normal in size and all other respects—about
fourteen days earlier than controls of the same age (with two
exceptions). M'C’ord concludes that administration of minute
quantities of pineal tissue from young animals to young animals
stimulates rapid growth of the body, but not beyond normal adult
size; and that there are also less well established indications of
precocity of mental and sexual development. The large size of a
pineal-fed chick and guinea-pigs is figured. (There is no state¬
ment that hypertrophy of the testes was produced, nor that young
females showed the same overgrowth of body as the males; but
from M'Cord’s description it seems probable that they did.)

Leonard J. Kidd.

PATHOLOGY.

ON THE CHANGES IN THE CENTRAL NERVOUS STSTEM IN
(430) EXPERIMENTAL DIPHTHERITIC INTOXICATION AND
HUMAN DIPHTHERITIC INFECTION. (Sopra le altenurioni
del sistema nervoso centrale nella intossicazione difterica
sperimentale e nella infezione difterica umana.) U. Sartkschi,
Jtiv. ital. di Neuropat., Psichiatr. ed Elettroter., 1914, vii., p. 145.

The changes found by the writer after subcutaneous injection of
diphtheria toxin in the central nervous system of rabbits, guinea-
pigs, and dogs were as follows:—

1. Degenerative lesions of an acute type in the tigroid
substance of the nerve cells of the cortex, cerebellum, and spinal
cord.

2. Progressive changes in the neuroglia.

3. Absence of vascular infiltration.

4. Presence of substances due to basophilo-metachromatic
disintegration.

5. Slight increase (more marked in rabbits and guinea-pigs
than in dogs) of lipoid substances stained by the Daddi-
Herxheimer method: Marchi method negative.

Examination of the brains of five children, aged from 1 £ to
4 years, who had died of diphtheria showed the following:—

1. Severe lesions in the majority of the nerve cells of the

ABSTRACTS

373

cortex and cerebellum, and less severe lesions in the cells of the
cord.

2. Changes, chiefly of a progressive type, in the neuroglia.

3. Abundance of fatty substances round the blood vessels,
either in the form of masses of free fat or as an accumulation of
granulo-fatty cells: a scarcity and often complete absence of nerve
substances in the protoplasm of the nerve cells and neuroglia.

4. Complete absence of perivascular infiltration and paren¬
chymatous haemorrhages.

5. Presence of substances due to basophilo-metachromatic
changes.

The histopathology of the lesions of the nervous system
produced by diphtheritic intoxication in man was therefore sub¬
stantially the same as in experimental diphtheria.

J. D. Rolleston.

ON A COUNTERSTAIN FOR WEIGERT PAL PREPARATIONS.

(431) (Uber eine Nachf&rbung bei Weigert-Pal Pr&paraten.) Paul
Rothig, Neurol. Centralbl., 1914, xxxiii., Feb. 15, S. 219.

After staining according to the received Weigert-Pal methods the
author recommends putting the sections for twenty-four hours, at
room temperature in a saturated watery (distilled water) solution
of “ vital-scharlach viiL” (Griibler), of which solution 10-20 c.c.
are taken and added to 90 c.c. distilled water. Thereafter the
sections are placed in tap water for fifteen minutes, 70 per cent,
alcohol for one hour, and in fresh 70 per cent, alcohol for half an
hour; this will take the colour out of the celloidin of the sections.
Then they go into 96 per cent, alcohol, and so through carbol xylol.

The ganglion cells and their processes, and the axones, are
stained a beautiful red. The stain seems to be permanent.

S. A. K. Wilson.

PECULIAR ALTERATIONS OF THE MYELIN SHEATHS IN DE

(432) GENERATING NERVE FIBRES. (Eigenartige VerStaderungen
der Markscheide an degenerierenden Nervenfasem.) Matlau-
schek, Neurol. Centralbl ., 1914, xxxiii., April 1, p. 403.

The author describes what is really a fairly frequent change in
degenerating nerve fibres—a swollen honeycomb-like network in
the myelin sheath which nevertheless stains deeply with Weigert-
Pal. He has found it in the central nervous system as well as in
the peripheral nerves, and considers it is not a mere artefact from
such a hardening solution as formalin. Its exact significance is
still unknown. Inasmuch as the affected sheath stains well, there
can not be any gross change in its chemical constituents.

S. A. K. Wilson.

ABSTRACTS

•>*-
<> i

CLINICAL NEUROLOGY.

THE NATURE OF CUTANEOUS SENSATION, WITH AN

(433) INSTRUMENT FOB ITS MEASUREMENT. Walter Timme,
Journ. New. and Ment. Dis., 1914, xli., April, No. 4.

Ca.iai. has stated that the nervous end-organs in the skin are so
arranged that a nervous “discharge” is produced by excitation
due to mechanical irritation, and furthermore that each terminal
organ, after receiving a certain quantity of stimulation, becomes
fatigued and ceases to react.

The author believes that the al>ovc view is incorrect.

Details and diagrams are given of an instrument which the
author has devised for the measurement of sensation.

D. K. Henderson.

THE OCULO-CARDIAC REFLEX. (Le rdflexe oculo-cardiaque.) M.

(434) Vernet and Pktzetakis, Gaz. d. Hop., 1914, lxxxvii., p. 83.

THE OCULO-CARDIAC REFLEX. (Le rlflexe oculocardiaque) F.

(435) Sainton, Paris Med., 1913-14, iv., p. 12*2.

Both papers contain a full account of the reflex, illustrated by
tracings and with a summary of the literature.

J. D. Rolleston.

PAINLESS TUMOURS OF THE SPINAL OORD. Pearce Bailey,

(436) Journ. Amer. Med. Assoc., 1914, lxiii., July 4, p. 6.

Four cases are here recorded. The first was a schoolgirl, aged 14,
who suffered from paraplegia so profound that she was unable to
stand or walk. The condition had begun three years previously after
measles. The paraplegia improved greatly after an operation for
right otitis media. The absence of pain and presence of scoliosis
suggested tuberculosis or syringomyelia, but the symptoms got worse,
and operation showed a brownish-red encapsulated tumour which
was intramedullary, and had burst through the posterior surface
of the cord. It proved to be a sarcoma.

The second case occurred in a blacksmith, aged 47, and was of
eight years’ duration. The special feature of his case was that,
although there was pain, it was intermittent, varied in location,
and the intermissions were so long that the pain was not associated
with the spastic paraplegia from which he suffered, and in conse¬
quence he was shown to the clinique for three years as a case of
multiple sclerosis. The tumour was intramedullary, and found in
the cervical region.

The third case was that of a woman, aged 28, who was found

ABSTRACTS

375

to have an extramedullary psammosarcoma of the upper dorsal
cord of six years’ duration. It was successfully removed, but the
symptomatic improvement was slight. The pain in her case was
never more than a dull ache, and was treated as rheumatism.

The fourth case was a woman, aged 34, who had an intra¬
medullary perithelioma of the raiddorsal cord of nine months’
duration. The pain was referred to a floating kidney, which
undoubtedly existed.

Presence or absence of pain is no proof that the condition is
intramedullary or extramedullary. A. Ninian Bruce.

GIANT TUMOURS OF THE CONUS AND CAUDA EQUINA.

(437) Joseph Collins and Charles A. Elsbbro, Amer. Joum. Med. Set.,
1914, cxlvii., April, No. 4.

Three cases are reported. The important features of the clinical
examination were the following:—

1. Rigidity of the lumbar vertebral column.

2. Weakness and stiffness of the lower limbs.

3. Paralysis of the peroneal groups of muscles and sometimes
of the tibialis anticus group.

4. Absence of knee and ankle-jerks.

5. Tenderness of the lower lumbar spines.

6. Irregular and unsymmetrical sensory disturbances.

7. Lumbar puncture was negative.

At operation a large reddish-brown, not vascular, tumour
within the dura was found. The results of the operative inter¬
ference were not satisfactory, although there was considerable
improvement in two patients. It was impossible to remove the
growths entirely, although most of it could be removed if the
operation was divided into two stages. D. K. Henderson.

▲ EASE CASE OF SPINA BIFIDA, WITH SUBSEQUENT DE-

(438) VELOPMENT OF SYMPTOMS REFERABLE TO INVOLVE¬
MENT OF THE CAUDA EQUINA, CONUS MEDULLARIS,
AND EPICONUS. (Ein seltener Fall von Spina bifida mit
sp&terem Einsetzen der Symptoms seitens Canda equina, Conns
mednllaris, Epiconus, usw.) Tutyscbkin, Neurol. Centralbl.,
1914, Feb. 1, p. 153.

The patient was born with a spina bifida, which gave rise to no
neurological symptoms until he was 21 years of age. At that age
a gradual onset of weakness in the legs occurred, with subsequent
muscular atrophy and contractures, trophic changes in the joints,
enuresis, pigmentation of the skin, and sensory changes, extending
from the fourth lumbar to the fifth sacral segment.

S. A. K. Wilson.

ABSTRACTS

TRAUMATIC LESION OF THE DISTAL SEGMENTS OF THE
(439) SPINAL CORD FOLLOWED BT PROGRESSIVE SPINAL
AM7OTROPH7. (Sn di an caso di lesione traumatica dei segmenti
distali del midollo spinale seguita da amiotrofia spinale pro¬
gressiva. ) G. Biondi, Riv. ital. di Neuropat ., Psichiatr. ed
Elettroter ., 1914, vii., p. 49.

A previously healthy man, aged 34, without hereditary ante¬
cedents, foil off a tree six metres from the ground. After a brief
period of retention he had incontinence of urine and faeces,
absolute sexual impotence, and paralysis of the lower limbs.
There was no immediate loss of motor power in the upper limbs,
but the distal segments of lx>th upper and lower limits gradually
developed hypotrophy. On examination a year after the accident
the incontinence of urine and fteces and loss of erectile power
persisted. There were also “ riding-breeches ” anaesthesia, paralytic
gait, hypotrophy, and hypotonus of the muscles of the dorsum
pedis and leg on each side of the thenar and hypothenar emin¬
ences, and dorsal interossei of the hand. The movements of the
fingers and distal segments of the lower limbs were feeble and
limited.

The lesions were attributed to one or more haemorrhagic foci
in the lumbo-sacral cord, especially in the conus medullaris.

J. D. Rolleston.

FEMININE TABES. A COMPARATIVE STUD7 OF TABES AT
( 440 ) BIC&TRE AND THE SALPETRIErE. (Tabes ftminin. Etude
comparde du tabes k BicStre et & la Salpdtridre.) R. Peknet,
Theses des Paris , 1913-14, No. 313.

Peknet studied 40 cases of tabes in men at Bicetre and
43 in women at the Salpetriere, and found that most of the
symptoms in both sexes occurred with equal frequency and
severity. Thus the percentage of ocular palsy in men was 14 ')
and in women 16*2. Arthropathies occurred in 22 5 per cent, of
the men and in 25 per cent of the women.

Gastric crises were more frequent in women. The most
characteristic feature, however, of feminine tabes was its para¬
plegic tendency, shown by a disturbance of gait necessitating
confinement in bed, considerable loss of muscular power, especially
of the dorsal flexors of the foot, frequency of club foot(Joffroy), and
severe sphincter troubles.

The preponderance of paraplegia in the female patients is
attributed to the congenital weakness of the lower limbs in women
(Duprd). (Cf. Review, 1912, x., pp. 233 and 551.)

J. D. Rolleston.

ABSTRACTS

377

A CLINICAL AND PATHOLOGICAL CASE OF ISOLATED

(441) ARGYLL ROBERTSON PUPILS IN THE ABSENCE OF
GENERAL PARALYSIS, TABES, AND CEREBRO SPINAL
SYPHILIS. Nonne and Wohlwill, Neurol. Centralbl ., May 16,
1914, p. 611.

The patient was an alcoholic woman of 38, who had syphilis
thirteen years previously. The only clinical nervous symptom
was fixed pupils with slight myosis. The blood and cerebro-spinal
fluid were normal to the usual tests. After death (cause not
stated) the central nervous system was found to be normal: it is
noted, however, that the arachnoid was thickened and contained
more cells than usual: this the authors think is due to the
alcoholism.

Unfortunately there was no examination made of the veiy part
of the brain likely to have been affected, viz., the origin of the
third nerve nuclei. The authors nevertheless conclude that fixed
pupils may be the only residuum of previous syphilis, and that
they are not necessarily the expression of an already existing or
commencing tabes, or general paralysis, or cerebro-spinal syphilis.
They consider their case of “primary importance” for reasons
which are not convincing. S. A. K. Wilson.

ON RECKLINGHAUSEN’S NEUROFIBROMATOSIS. (Zum Stadium

(442) der Recklinghausen’schen Nenrofibromatose.) G. Hebxhbimer
and W. Roth, Beitr. z. path. Anat. u. z. allg. Path., 1914, lviii.,
pp. 319-389.

This article contains the record of the following four cases, and
an exhaustive discussion of every aspect of Recklinghausen’s
disease.

Case 1.—Man, aged 38. Multiple skin fibromata present since
birth, and multiple fibromata of the large peripheral nerves.
The father had also been similarly affected. A tumour in the
region of the thyroid rapidly increased in size and caused con¬
siderable dyspnoea, which necessitated tracheotomy. Death
occurred shortly afterwards. The necropsy showed sarcomatous
changes in the fibromata and metastases in the lungs.

Case 2.—Man, aged 55, with multiple skin fibromata for twenty
years. A few months before death severe pain in the right hip
occurred, and a rapidly growing tumour appeared on the right side
of the os sacrum. Lumbar puncture showed no lymphocytosis.
Wassermann’s reaction was positive. Death occurred from
cachexia. The necropsy showed isolated fibromata of the inter¬
costal and lumbar nerves, a small sarcoma of the left lumbar
plexus connected with a large tumour situated in the pelvis,
tumours of the sympathetic cord and the sympathetic lumbar

378

ABSTRACTS

intervertebral ganglia, a tumour in the medulla of the right
suprarenal, and multiple subserous nodules in the jejunum.

Com 3.—Man, aged 03. Multiple skin tumours of thirty
years’ duration without obvious nerve tumours. No pigmentation
nor blue spots.

Case 4. — Girl, aged 21, witli skin tumours and anomalies of
pigmentation. J. 1). Rolleston.

PNEUMOCOCCAL MYELITIS. (Lea myllites pneumococciques.)

(443) Mlle. N. Bachmachnicoff, Theses de Paris, 1913-14, No. 300.

Myelitis is a very rare complication of pneumonia. It usually
occurs after defervescence, and only exceptionally before the
temperature has become normal. It may run a mild course
manifested by incomplete paraplegia, with rapid recovery, or
assume the type of acute ascending paralysis with rapidly fatal
termination. The thesis contains the histories of eleven cases,
including the following original one:—

A woman, aged 24, two days after the temperature had
almost reached normal, suddenly developed incontinence of urine
and fteces, and complained of severe pain in the loins and lower
limbs. There was paresis of the lower limbs, especially of the
extensor muscles, and both knee and ankle jerks were abolished.
The cerebro-spinal fluid escaped under hypertension, but was
otherwise normal. Recovery took place in about a month.

J. D. Rolleston.

A CASE OF TUBERCULOUS DISEASE OF THE VERTEBRA,

(444) COMPLICATED BY AN EXTENSIVE ACUTE SUPPURATIVE
MENINGITIS. James Miller and A. Fergus Bewat, Lancet,
1914, July 25.

This case was seen after symptoms of acute meningitis had
developed. There was a previous history of tuberculous disease
of the spine. The pathological findings confirmed the presence
of tuberculous vertebra;, and the terminal infection was due to
the Streptococcus mucosas. The purulent exudate around the
spinal cord was very thick, and stretched from the foramen
magnum to the lowest part of the cord. Authors’ Abstract.

MENINGEAL SYNDROME IN NORTH AFRICAN RECURRENT

( 445 ) FEVER. (Syndrome mlningd dans la fidvre recurrent® nord-
afiricaine.) Abdin - Deltheil, M. Raynaud, Coudray, and
Derrien, Bull et Mem. Soc. me'd. Hop. de Paris, 1914, xxxvii.,

p. 1126.

Of 41 cases observed by the writers, 16, or 39 per cent., showed a
definite meningeal syndrome. With a single exception, in which it

ABSTRACTS

379

appeared first during the second attack, this syndrome occurred
constantly during the first attack. In most of the cases it
appeared in the subsequent attacks as well. In all the cases
the cerebro-spinal fluid was perfectly clear, and in most contained
an excess of albumin. Cerebro-spinal lymphocytosis was always
found. Bacteriological examination was invariably negative.
Soulie ( Compt. rend. Soc. de Biol., 1907, lxiii., p. 249) is the only
observer who has found spirilla in his cerebro-spinal fluid in
recurrent fever. In some patients a more or less intense icterus
occurred simultaneously with the meningeal syndrome.

J. D. Rolleston.

A CASE OF TYPHOID SPINE. (Tin cas de spondylite typhique.) E.

(446) Job, Bull, et Mem. Soc. mid. H6p. de Paris, 1914, xxxvii., p. 990.

A soldier, aged 22, contracted typhoid fever at the end of August
and became convalescent on October 21. On December 7 symptoms
of typhoid spine developed, and complete recovery did not take
place till March 6. The presence of meningeal reaction was
shown by cerebro-spinal hypertension, excess of albumin, and
lymphocytosis. J. D. Rolleston.

ORGANIC HEMIPLEGIA OF DIPHTHERITIC ORIGIN. (Les

(447) htfmiplegies organiques d’origine dipht&ique.) A. Mollet,
Theses des Paris, 1913-14, No. 264.

The thesis contains the histories of seventy-four cases, including
those recently reported by Leede (v. Rcvieio, 1913, xi., p. 436)
and the abstracter {ibid., p. 280), and four not hitherto published.

1. Hallo’s case ( v. Bemeto, 1914, xii., p. 314).

2. Girl, aged 11 years. Severe faucial diphtheria. Left hemi¬
plegia on twenty-first day. Some improvement.

3. Boy, aged 6 years. Severe faucial and laryngeal diphtheria.
Right hemiplegia and aphasia on fourteenth day. Improvement
of aphasia and persistence of flaccid hemiplegia.

4. Boy, aged 3£ years. Moderate faucial and laryngeal

diphtheria. Left hemiplegia on thirty-third day. Death from
nephritis and broncho-pneumonia on thirty-ninth day. Necropsy
record lost. J. D. Rolleston.

INTRAMUSCULAR INJECTIONS OF ANTITOXIN IN THE

(448) TREATMENT OF DIPHTHERIA J. D. Rolleston and C.
Macleod, Brit. Joum. Child. Bis., 1914, xi., p. 289.

The writers think that the more rapid absorption of antitoxin by
the intramuscular as compared with the subcutaneous route is
shown not by the effect on the faucial or laryngeal process, but

3S0

ABSTRACTS

By the lesser incidence of paralysis, especially of a severe
kind.

Of 201 cases of diphtheria treated by intramuscular injections,
33 eases, or 12 6 per cent., showed some form of paralysis, but only
2 of these were severe. Eighteen were examples of palatal palsy,
usually shown by a nasal voice only without regurgitation of fluids,
8 of ciliary palsy, 1 of squint only, 2 of palatal palsy and
squint, 2 of palatal and ciliary palsy, 1 of cardiac palsy, which died,
and 1 of palatal pharyngeal and diaphragmatic paralysis, which
recovered. Probably life would have l teen saved in the one case,
and the paralysis have been less extensive in the other, had Larger
doses of antitoxin been given during the acute stage. Though the
total number of cases is too small to be absolutely conclusive, the
comparatively low rate of paralysis, especially of a severe kind,
is noteworthy, and is in striking contrast to the higher incidence
noted by one of the writers (v. Jxcriar, 1913, xi., p. 398). Among
2,300 cases treated by subcutaneous injection, of whom 477 cases,
or 20 7 per cent., had some form of paralysis, 184 were severe and
85 fatal eases. Authors’ Abstract.

IS THERE A CYSTIC VARIETY OF DISSEMINATED SCLEROSIS?

(449) (Gibt os eine zystische Form der multiplen Sklerose ?) Oppen heim,
Neurol. Centralbl., 1914, Feb. 15, p. 211.

Optic neuritis occurs every now and then in disseminated sclerosis.
Its presence may be explained as resulting from an accompanying
internal hydrocephalus or meningitis serosa, if the sclerotic process
is localised in the immediate neighbourhood of the ependyma.
Or it may result from an encephalo-myelitis disseminata in
acute varieties of the disease. Or conceivably there may be a
generalised cerebral oedema in acute cases, leading to optic neuritis.
Oppenheim publishes two cases to show that another possibility is
the occurrence of a meningitis serosa cystica. In these two cases,
the patient was operated on for intracranial tumour: in each so-
called meningeal cysts were found: eventually, unmistakable
signs of disseminated sclerosis made their appearance. A few
similar cases have been recorded. S. A. K. Wilson.

HEREDITARY CEREBELLAR ATAXIA. S. A. Blauner, N.Y. Med.

(450) Joum., 1914, c., July 11, p. 83.

In this family three children were affected, each presenting
different symptoms. In the first child, the eldest, the disease
from the beginning until his death showed the cerebellar tendency,
and the diagnosis was simple. In the second child the diagnosis
was more difficult, and the condition resembled disseminated

ABSTRACTS

381

sclerosis at first, until the cerebellar gait and the peculiar carriage
characteristic of cerebellar ataxia began to manifest itself. In the
third child, the youngest, death intervened too soon for the
symptoms to become classical, but sufficient were present to justify
the assumption that with time typical symptoms would have
presented themselves. No autopsy. The father and mother were
English Jews. A. Ninian Bruce.

CLINICAL AND ANATOMO-PATHOLOGICAL NOTES ON A CASE

(451) OF BULBO-PONTINE GLIOMA (Note cliniche ed anatomo-
pathologiche su di un caso di glioma bulbo-protuberanziale.)
G. Bolzani, Riv. ital. di Neuropat ., Ptichiatr. ed Elettroter ., 1914,
vii., p. 205.

A girl, aged 7 years, developed left internal strabismus in
August, followed by slight left facial palsy in October. In
November and December she had attacks of giddiness. In
February weakness of the right upper and lower limb was noted,
and shortly afterwards deafness in the left ear. In April she
had frequent vomiting, the paresis of the limbs became more
marked, there was difficulty of deglutition, and the respiration
assumed the Cheyne-Stokes type. In June paresis of the right
sixth nerve and lower facial occurred. Subsequently the palate
and larynx became affected, and lastly the limbs on the right side.
Death took place in November. The necropsy showed a giiomatous
tumour embedded in the thickness of the pons.

The tumour originated in the middle third of the pons on its
dorsal surface, and first affected the nuclei of origin of VI., and
almost simultaneously of VII. and later of VIII. on the left side.
Gradually the tumour extended to the ventral surface of the pons
and involved the left pyramidal tract, and at the same time the
nuclei of origin of VI. and VII. and the pyramidal tract on the
right side. Lastly, its invasion of the bulb was shown by the
successive lesions of IX., X, and XII. J. D. Rolleston.

LEFT HEMIPLEGIA OF CENTRAL ORIGIN WITH PERIPHERAL

(452) HOMOLATERAL PARALYSIS OF THE TONGUE FROM A
CEREBRAL TUMOUR WITH DOUBLE LOCALISATION.
(Emiplegia sinistra di origine centrale con paralisi periferici
omolaterale della lingua a doplice localizzazione.) Bandettini
di Poooio Francesco, Riv. ital. di Neuropat., Ptichiatr. ed
Elettroter., 1914, vii., p. 97.

The patient was a man, aged 41, who had had syphilis at 17.
Wassermann’s reaction was slightly positive in the blood and
negative in the spinal fluid. The hemiplegia was gradual in its

3°

382

ABSTRACTS

onset, and only well marked during the last weeks of life. There
were no contractures, abnormal reflexes (Babinski and Oppenheim),
nor sensory disturbance. Death took place after three months’
illness. The necropsy showed a tumour which was histologically
a round-celled sarcoma in the right Rolandic area, and a metastatic
nodule adherent to the meninges near the left anterior condyloid
foramen. J. D. Rolleston.

ANOEIOMA IN CEREBELLAR PEDUNCLE: FATAL INTRA-

(453) CRANIAL HAEMORRHAGE. C. Wynn Wiboman, Lancet, 1914,
cIxxxtL, June 20, p. 1746.

A man, aged 19, who had suffered from “nagging pain” at the
back of the head from time to time, was suddenly found dead.
He had been quite cheerful half an hour previously. At the
autopsy a cavity measuring 4 by 2 cm. was found in the white
matter of the right cerebellar hemisphere. It contained a blood
clod. Anterior to this the section of the right cerebellar peduncle
was marked by an irregular grey patch, which microscopically
proved to be an angeioma. The vessel walls were mostly in a
condition of hyaline degeneration and calcified in places.

A. Ninlan Bruce.

TUMOUR OF FRONTAL REGION OF BRAIN. Theodore Diller and

(454) R. T. Miller, Jun., Amer. Joum. Med. Set., 1914, cxlvii., April, No. 4.

The report of a case in which the tumour was successfully
removed. D. K. Henderson.

OPERATIVE REMOVAL OF A PINEAL CYST. (Die operative

(455) Entfemung einer Zyste der Glandula pinealis.) Pussbp, Neurol.
Centralbl., May 1, 1914, p. 560.

The patient was a boy of 10, with symptoms referable to the region
of the corpora quadrigemina: a tumour either of that part, or of the
superjacent pineal gland, was diagnosed. The author operated by a
large bilateral occipital craniectomy, in two stages. By opening the
dura to one side of the middle line, dealing with the sinuses, and
splitting the tentorium right forward, he was able to reach a cystic
tumour of the pineal which was evacuated. The patient died on
the third day after operation. S. A. K. Wilson.

ANEURISMS OF THE VESSELS OF THE BRAIN. John H. W.

(456) Rhein, Joum. Nerv. and Ment. Die., 1914, xli., April, No. 4.

The case of a man, 57 years, is described, showing that paralyses,
which are met with in some cases, may be coincidental rather
than related directly to the aneurism itself.

D. K. Henderson.

ABSTRACTS

383

▲ CASE OF PEOGBESSIVE LENTICULAR DEGENERATION.

(457) E. M. Auer, Joum. Nerv. and Ment. Bit., 1914, xli, April, No. 4.

A CASE without autopsy in a woman, 62 years, showing continuous
tremor, constant rigidity, true contractures, dysphagia, dysarthria,
possible familial hepatic disturbance, and evidence of disease of
the liver. D. K. Henderson.

ON RIGHT-BRAINEDNESS IN BIGHT-HANDED INDIVIDUALS.

(458) (Uber Bechtahirnigkeit bei BechtshKndern.) Mendel, Neurol.
Centralbl., 1914, March 1, p. 291.

This case is extremely important and deserves careful
attention. The patient, a woman of 42, right-handed, with no
left-handedness in the family, developed a sudden left hemiplegia
with complete motor aphasia, which continued to her death many
months later. The lesion was an embolic (from heart disease)
softening in the distribution of the right sylvian artery, involving
and destroying the right inferior frontal gyrus, the insula and the
superior temporal gyrus. It was proved microscopically that the
left hemisphere was intact.

It is certain, therefore, that in this right-handed patient the
motor speech centres were in the right hemisphere. As there was
no trace of sensory aphasia, in spite of the situation of the lesion,
the author concludes that the sensory speech centres were in the
left hemisphere, and regards the case as one of dissociated or
crossed aphasia. S. A K. Wilson.

CLINICALLY NEGATIVE OASES OF APHASIA (Zur Casuistik

(459) der kliniscb negativen FElle von Aphasie.) Bickel, Neurol.
Centralbl., 1914, March 1, p. 287.

The patient was a right-handed man of 50, suffering from a cerebral
tumour found subsequently in the left island of Reil: both the
inferior frontal gyrus and the superior temporal gyrus were
compressed and flattened. The patient spoke slowly and in¬
distinctly, and had occasional difficulty in finding words. The
author calls this a negative case, and explains the absence of more
definite aphasia on the ground that with a slow growing tumour
the right hemisphere had time to function vicariously for the left.
He does not mention, apparently, the possibility of its being a case
of so-called crossed or dissociated aphasia. S. A. K. Wilson.

ON THE BELATION OF THE FUNCTION OF SPEECH TO INTONA-

(460) TION, TONE, AND BHYTHM. (Uber die Beziehung der Sprech-
funktion zur Intonation, zum Ton und Bhythmus.) Agad-
schanianz, Neurol. Centralbl., 1914, March 1, p. 274.

The first case was that of a patient of 62, who had a slight stroke
producing hemiparesis on the left side. He had formerly been a

ABSTRACTS

'584

good violin player. On examination lie was found to have vocal
and instrumental motor amusia, sensory and motor defect in
rhythm, and incomplete word deafness and melody deafness.

The second case was that of a doctor of medicine, aged 50, who
had been an expert pianist. He had a stroke on the right side,
which cleared up as far as the paralysis was concerned. It was
found, however, that while there was no instrumental amusia, the
patient could no longer sing, although he could speak. He under¬
stood spoken words imperfectly, but much better than familiar
melodies played in his presence. He repeated spoken words much
better than melodies played over for him; there was gross defect
in the appreciation and reproduction of rhythm.

S. A. K. Wilson.

A CASE OP AMYOTONIA CONGENITA. C. E. Belwg, Journ. Nerv.

(461) and Afent. Dis., 1914, xli., April, No. 4.

The main feature in the case was a loss of muscular tone, which
was thought to lie due to a defect in the sensory mechanisms in
the muscles.

Certain points in the case suggested the possibility of a
poliomyelitis. D. K. Henderson.

THE PATHOGENESIS OF MYASTHENIA. Stern, Neurol . Centralbl.,

(462) 1914, April 1, p. 409.

The author describes the case of a female patient of 31, who
suffered from exophthalmic goitre. The first sign of the myas¬
thenia that subsequently complicated the case, was an almost
complete ophthalmoplegia externa: a few months later, typical
defects in speaking and swallowing appeared, with myasthenic
fatigability and the myasthenic reaction. Later, Chvostek’s sign
was prominently present on both sides, and the skin became
bronzed in patches. In the case, therefore, clinical evidence was
forthcoming of alteration of function of the thyroid, parathyroids,
and suprarenals. A considerable number of other cases have now
been reported, when the evidence may be taken to suggest that
myasthenia is a disease of the ductless glands.

S. A. K. Wilson.

ON SUPRARENAL AND PITUITARY OPOTHERAPY IN MYAS*

( 463 ) THENIA GRAVIS. (De l’opothtoapie snrrdn&le et hypophysaire
dans certains c&s de myasthdnie gravis.) Mllk. S. Blumenfeld,
1'heses des Paris, 1913-14, No. 270.

In some cases of myasthenia gravis suprarenal opotherapy, either
alone or associated with pituitary extract, may produce definite

ABSTRACTS

385

results which can fairly be attributed to the treatment itself and
not to remissions of the disease. In some cases recovery seems
to have taken place, while in others there was considerable
improvement.

The thesis contains the histories of nine cases, including one
hitherto unpublished, in which the treatment was ineffective.

J. D. Rolleston.

CRITICAL EXAMINATION OF ONE HUNDRED PAINTERS FOR

(464) EVIDENCE OF LEAD POISONING. Emeby R. Hayhubst,
Amer. Joum. Med. Sci., 1914, cxlvii., June, No. 6.

Of one hundred painters examined under favourable conditions,
seventy showed evidence of chronic plumbism.

The factors most frequently of value in diagnosing chronic
plumbism are:—

(a) Significant past history of certain complaints, e.g., loss
of strength, nausea, foul taste, constipation, headache, insomnia,
arthritic pains, &c.

(b) Neuro-muscular abnormalities such as tremor, slight inco¬
ordination, abnormal reflexes, weakened hand-grip, and weakened
wrists.

(d) Conditions of the gums—pyorrhoea, rarely lead-line.

D. K. Henderson.

OBSERVATIONS ON 120 CASES OF LEAD ABSORPTION FROM

(465) DRINKING WATER. W. W. Stainthobpe, Lancet , 1914,
clxxxvii., July 25, p. 213.

The outbreak occurred in Guisborough and was due to the fact
that the water passed through lead service pipes. All stages
of the intoxication were seen from the commencing general languor
and debility, attended by anaemia, to the paralytic stage ending in
convulsions and death. Four cases ended fatally, and three infants
below 6 weeks, who had been nourished solely on the breast, were
affected. Lead was found in the mother’s milk in each instance.
Premonitory symptoms were present in every case, often very
vague. Abdominal symptoms occurred in 108, headache in 91,
anaemia in 96 (basophilia was not specially marked), nervous
and muscular disorders in 89, menstrual disorders in 55, constipa¬
tion in 40, albuminuria in 20, blue line on gums in 15, abortions in
5, and convulsions in 2. In all of the above cases the diagnosis was
based on the presence of lead in the urine, which, when evapor¬
ated to dryness and dissolved in HC1, became brown with H 2 S.

386

ABSTRACTS

The following test is also worthy of note: if the hand be painted
with ammonium sulphide the skin becomes black from the con¬
version of the lead excreted by the skin into lead sulphide, best
seen on the thenar eminence. A. Ninian Bruce.

SYPHILITIC TESTS IN LATENT AND TREATED SYPHILIS.

(466) E. P. Corson-White and S. D. Ludlum, Joum. Nerv. and Ment.
Di»., 1914, xli., April, No. 4.

The most marked reduction in the Wassermann reaction appears
in those cases treated with mercury and salvarsan or neosalvarsan,
and next in those with salvarsan or neosalvarsan alone. Salvarsan
apparently acts more rapidly than the neosalvarsan, although
apparently the neosalvarsan remains longer in the blood than
the salvarsan. Mercury gives a slow, steady diminution.

Negative reactions do not necessarily mean absence of
syphilitic infection or cure, even although the reaction has been
negative for a considerable time.

The luetin skin test, the specificity of which has up to date
never been disproved, is less easily influenced by treatment, and
is to-day the best criterion of genuine cure or absence of infection
in our hands. D. K. Henderson.

SYPHILIS AND THE ADRENALS. (Syphilis et glandes surrtnales.)

(467) A. Sf.zary, Gaz. des H6p., 1914, Ann. Ixxxvii., July 16, p. 1317.

Congenital syphilis, when mild or of recent date, provokes a
hyper-spongiocytosis of the adrenal cortex, but scarcely affects the
medullary cells; but, when virulent or of long duration, it leads
to cortical hypo-spongiocytosis and also medullary lesions: these
are permanent and are accompanied by sclerosis. If a congenital
syphilitic with adrenal sclerosis survives, he shows throughout
life a chronic latent hypoadrenalism or adrenal debility which
may become manifest under stress of any acute infection or
intoxication. Acquired syphilis is less harmful to the adrenals,
but it also can lead to sclerosis and adrenal debility. Sezary does
not believe that mercury is dangerous in syphilitic subjects whose
adrenals are affected; for he found that injection of even fatal
doses of corrosive sublimate into guinea-pigs gave no marked
adrenal lesions. He urges search for evidence of syphilis in cases
of adrenal insufficiency, and vice versa ; in positive cases one
should combine adrenal opotherapy with mercurial treatment:
iodide of potassium seems to be a useful adjuvant. He urges
great caution in the use of salvarsan or any arsenical treatment in
syphilitics who present any evidence of adrenal involvement.

Leonard J. Kidd.

ABSTRACTS

387

THE PRODUCTION AND HISTOPATHOLOGY OF EXPERIMENTAL

(468) SYPHILIS OF THE CENTRAL NERVOUS SYSTEM IN
RABBITS. (Zur Erzeugung and Histop&thologie der experi-
mentellen Syphilis des Zentralnervensystems beim Kaninchen.)

Stbinsb, Neurol. Centralbl ., 1914, May 1, p. 546.

Tub interested reader should consult the original. The author
has found that frequent intravenous injection of an emulsion of
syphilitic rabbits’ testicles into albino rabbits produces typical
central nervous system changes more rapidly and, probably, with
greater certainty than in dark-haired rabbits.

S. A. K. Wilson.

THE TREATMENT OF PARENCHYMATOUS SYPHILIS BY

(469) INTRACRANIAL MEDICATION. Habby Campbell, Lancet,
1914, May 30.

The experiments earned out by Golla have led Campbell to treat
cases of parenchymatous syphilis by injecting salvarsanised serum
into the subarachnoid space through the anterior horn of the lateral
ventricle. Golla found that, by introducing colloidal carbon into
the upper cranial subarachnoid space, it found its way to all parts
of the cerebro-spinal axis more or less evenly, whereas only a
small fraction reached the cerebral hemispheres when it was
injected into the spinal sac.

While spinal injections usually suffice for ordinary cases of
tabes, Campbell thinks that in the form in which optic atrophy
occurs intracranial injections should prove of decided advantage,
because by this means the optic nerves can readily be reached, as
has been proved by Golla’s experiments. R. Dods Brown.

SAL VARS AN IN OPHTHALMIC ZOSTER. (Salvarsan bei Herpes

(470) Zoster ophthalmicus.) H. Gebb, Med. Klinik, 1914, x., p. 1096.

A record of two non-syphilitic cases with negative Wassermann
reactions in which intravenous injections of salvarsan or neo-
salvarsau were followed by rapid healing of the lesions. Gebb
suggests that this result is due to the specific bactericidal or
trypanocidal action of salvarsan on herpes zoster, which is now
generally regarded as an infectious disease.

J. D. Rolleston.

A METHOD BY WHICH REMEDIAL AGENTS MAY BE

(471) MINGLED WITH THE CEREBRO SPINAL FLUID. Chablbs
A. Ballance, Lancet, 1914, May 30.

A most instructive article, the first part of which is devoted to the
physiology of the cerebro-spinal fluid. The method of and the

388

ABSTRACTS

reasons for carrying out the operation, which consists in the
introduction of salvarsanised serum into the lateral ventricle, is
fully described in the second part of the paper.

R. Dods Brown.

THE CAUSE OF DEATH FROM SUBDURAL INJECTIONS OF

(472) SERUM. Worth Hale, U .S. Hygienic Laboratory Bulletin, No.
91, December 1913.

Hale’s experiments on dogs and cats showed that death from the
introduction of anti-meningitis serum may result from an increase
in intracranial tension, or from the presence in the serum of the
poisonous preservative, tricresol. Tlie danger from tricresol is
much greater and more certain than from increase in intracranial
pressure. He recommends that blood-pressure observations should
always be made when cerebro-spinal fluid is withdrawn, or when
serum is introduced into the meninges. Sophian had found that
the blood pressure was always lowered during injection, and that
the rate of fall was much accelerated by larger quantities of serum
or by smaller amounts introduced too rapidly.

J. D. Rolleston.

ANALYSIS OF BLINDNESS AS A SYMPTOM OF HYSTERIA

(473) T. H. Ames, Archives of Ophthalmol ., 1914, xliii, July, p. 357.

Two cases are recorded here, the first being a girl, aged 26, who
was hopelessly overworked at home, and developed blindness as a
means of escape from the drudgery of the housework. The second
was a man, aged 39, who became totally blind overnight, and came
under observation ten weeks later. His married life had been
unhappy, and his blindness appears to have been the expression of
his desire not to see his wife. An analysis of this case is given,
with some dream interpretations. Both cases recovered.

A Ninlan Bruce.

ON HEREDO-ALCOHOLIO DEGENERATION. (Sulla degeneration©

(474) eredo-alcoolica.) P. Nurzla, Riv. ital. di Neuropat ., Psichiatr. ed
Elettroter ., 1914, vil, p. 106.

Physically heredo-alcoholics are distinguished from other de¬
generates by regular bodily development which does not allow
one to suspect the gravity of their condition. Physiologically they
show a great vaso-motor sensitiveness. As a rule, they are
intelligent. In their affective side and their will the anomalies
are strongly marked, and consist of a violent impulsiveness which
may tend to crime, hardness and coldness, and a tenacious male-

ABSTRACTS

389

volence. Three illustrative cases are reported in women admitted
to asylum for recurrent mania, hysterical psychosis, and dementia
prsecox respectively. J. D. Rolleston.

▲ CASE OF SUPPOSED PROGERIA (PBEMATUBE SENILITY)

(475) IN A GIRL OF EIGHT YEARS. WITH REMARKS. Carl

W. Baud, Boston Med. and Surg. Joum., 1914, clxxi., July 16, p. 107

Progeria is an exceedingly rare condition in which the body is
arrested in its growth, and becomes prematurely the subject of
senile changes, i.e., infantilism and senilism are both present in the
same body at the same time. Progerians pass from delayed child¬
hood directly into a premature old age. The first case was
recorded by Jonathan Hutchinson in 1886, two more were
reported by Gilford in 1904, and a fourth by Variot and
Pironneau in 1910. The present case is a girl aged 8 years,
who has all the appearance of old age. Her parents were
Russian Jews, and she was the eleventh of twelve children. Her
home surroundings were very bad, and she could not be kept at
school on account of the effect of her peculiar appearance on the
other children. A good description is given, together with four
illustrations. A. Ninian Bruce.

CARBON MONOXIDE POISONING IN THE SENGHENYDD. Ivor

(476) J. Davies, Proc. Roy. Soc. Med., 1914, viL, June, p. 219 ; Brit. Med.

Joum., 1914, July 11, p. 57.

The Senghcnydd explosion happened on October 14, 1913, and is
the worst disaster in the history of British mining. The number
of men killed was 440, most of whom were asphyxiated by carbon
monoxide gas. The symptoms, which are duo solely to lack of
oxygen caused by the temporary impairment in the oxygen-carrying
power of the blood, consist of a marked feeling of languor and an
irresistible desire to rest quite regardless of immediate danger.
Headache, tinnitus, palpitation, breathlessness, and weakness of
the lower limbs were also usually present. No mental distress is
found. Apart from injuries, the most marked appearance on the
bodies was the bright pink colour. Cutaneous lesions were found
in some cases over pressure points, e.g., the buttocks, &c., and
peripheral neuritis, possibly also due to pressure, occurred. The
author considers, however, that the cutaneous lesions are true
manifestations of CO poisoning of neurotrophic origin. The
treatment consists of removal to fresh air, inhalation of oxygen,
Schafer’s artificial respiration, and avoidance of the effect of sudden
cold outer air which is liable to produce serious collapse.

A. Ninian Bruce.

390

ABSTRACTS

CHRONIC OCULAR TUBERCULOSIS. NECROPSY FINDINGS IN

(477) A CASE IN WHICH DEATH WAS DUE TO TUBERCULOSIS
OF THE HYPOPHYSIS CEREBRI. F. H. Verhoeff, Joum.
Amer. Med. Assoc., 1914, lxiiL, July 4, p. 13.

A married woman, aged 36, became affected with keratitis in the
right eye three years before death. This subsided after a year,
and the left became similarly affected, the right eye soon becoming
again inflamed. Fundus changes could not be made out on account
of the corneal opacities. Tuberculin reactions were negative.
During her final stay in hospital she became dull and apathetic,
and developed polyuria and polydipsia. There was no sugar or
albumin in the urine. The pulse rate showed extreme variations.
At the autopsy the right lung showed tubercular foci. The
meninges were normal. The pituitary was enlarged to about ten
times its usual volume, measuring 21 mm. by 18 mm. by 15 mm. It
was firmly united with the chiasma, which it had carried backward.
The brain was normal on section and showed no evidence of
tubercle. On section the pituitary was found to have been
converted into a large tubercle of the fibroid type, with a central
caseous centre about 5 mm. in diameter. From the pituitary the
tuberculous process had invaded the chiasma. A description of
the microscopic changes in each eye is given. The author could
only find eight cases of hypophyseal tuberculosis, none of which
were associated with ocular involvement. It is hardly conceivable
that the pituitary lesion could have given rise to the ocular
tuberculosis by way of the optic nerve, because the chiasma was
only slightly involved at death, and there were no foci in the optic
nerve or in the choroid. Probably the ocular and pituitary lesions
were independent of each other, the primary seat being in the
lung. A. Ninian Bruce.

TWO CASES OF ACUTE RETROBULBAR NEURITIS, ASSOCIATED

(478) WITH MARKED ACETONURIA. Joum. Amer. Med. Assoc.,
1914, lxiii., July 4, p. 27.

The first case was that of a girl, aged 84, an exceptionally healthy
child until a few days before examination, when she complained
of not being able to see the Hack board, and of dull frontal
headaches. The fundus revealed no change in the appearance of
the nerve-head or retinal vessels, but an absolute scotoma for red
was present, the fields for white and blue being normal. Nothing
abnormal could be discovered except a mild acetone reaction in
the urine, but no diace tic acid. Under a regulated diet the acetone
disappeared, and a test with a red disc showed no colour defects.

The second case was a man aged 31, married, who suddenly
noticed that the vision of his left eye was blurred, and the sight

ABSTRACTS

391

noticeably impaired. On examination, the discs were found to
be sharply outlined, of normal colour and appearance. The
visual field of the right eye appeared normal for white, blue, and
red; on the left eye an absolute scotoma for red and a relative
for blue were present. A “ very heavy acetone reaction ” was
found in the urine, but no other evidence of disease.

Hysteria was absent in both cases, and it is suggested that
possibly the acetone may be an etiologic factor in cases of retro¬
bulbar neuritis of otherwise obscure origin. At the discussion
it was suggested that such scotomas may represent and interpret
fatigue of the macular region, or an oedema of the optic nerve analo¬
gous to the acute swelling of the eyelids. A. Ninian Bruce.

LABYRINTH ACTIVITY, (fiber die Art der Labyrintht&tigkeit.)

(479) O. Gobbkl, Berl. klin. Wchntchr ., 1914, May 11, 8. 872 and 979.

A paper in which small details are discussed at very great length.
The writer does not hold with Helmholtz’s theory of sound
perception nor with Ewald’s, though it is not quite clear what
his own theory is. He says that there is no guarantee that a soft
note and a loud one of the same pitch are perceived by the same
hair cells. He agrees with Helmholtz in so far as he believes
that low tones are perceived by the apical coil and high tones by
the basal coil of the cochlea. The mammalian maculae show a
great resemblance in structure to the cochlea of birds. From this
he concludes that the macula? are also concerned with sound
perception in mammals. If acoustic function is granted in the
case of the otolith membrane of birds, it probably is the same in
higher forms. The human maculse are probably concerned with
perceptions of very high tones. Noises are probably perceived
by the cristse of the vestibuli. J. K. Milne Dickie.

A8YMB0LY. (Le asimbolie.) A. Mochi, Ratsegna di Studi Psichiat.,

(480) 1914, iv., Gennaio-Febbraio, p. 1.

The author defines asymboly as a disturbance of secondary identi¬
fication. Disturbance of primary identification is known as agnosia.
The latter process of identification includes all the psychical facts
which lead to the complete monosensorial analysis of a perception,
and which may be considered as the exponent of the physiological
phenomena which unfold in the cortical area of a single sense,
e.g., in the case of sight, perception of the colour, shape, size, and
distance of an object and the comparison of such a synthesis with
the optic mnemonic image. Secondary identification includes
those phenomena which produce the image but derived from
other sources, e.g., in the case of sight, auditory, tactile, olfactory,
and verbal images. All physiological and psychical phenomena

392

BOOKS AND PAMPHLETS RECEIVED

which do not belong to this field are excluded. In actual practice
pure clinical cases of agnosia and asymboly are impossible.

Asymboly is divided into two kinds, optic and tactile. These
are discussed here at great length, the article occupying more than
300 pages. A short anatomical account follows the clinical dis¬
cussion, and the difficulty of transferring the more delicate results
of the psychological analysis of perception to the field of anatomy
is pointed out. A. Ninian Bruce.

PSYCHIATRY.

TRAUMA AND GENERAL PARALYSIS. (Traumi e p&ralisi pro-

(481) gressiva.) L. Gatti, Riv. itaL di Neuropat., Psichiatr. td Elet-
troter., 1914, vil, p. 58.

A record of three cases in which pre-existent general paralysis was
aggravated by trauma. In one case it was very probable that the
accident—a fall off a bicycle—was the result of a paralytic attack
rather than the cause of the subsequent disturbances. In each case
the existence of syphilis was established, in one clinically and in
the other two by Wassermann’s reaction. J. D. Rolleston.

SOMATIC DISTURBANCES IN DEMENTIA PRiEOOX. (Uber die

(482) korperlichen Storungen bei der Dementia procox.) Goldstein
and Reichmann, Neurol. Centralbl., 1914, March 16, p. 343.

1. As probably characteristic of dementia pnecox is the combina¬
tion of diminution in the total leucocyte count with relative in¬
crease in lymphocytes, and a high erythrocyte count, and absolute
leucocytosis with hypoglobulia during periods of excitement.

2. In dementia pnecox, the blood picture is influenced by
minimal doses of adrenalin and pilocarpin.

3. The anodal excitability in dementia pnecox is definitely in¬
creased, and in this respect differentiates it from other psychoses.

Increase of anodal excitability is characteristic of spasmophilia,
which is an expression of disturbance of function of the para¬
thyroids : it is probable, therefore, that in dementia pnecox these
glands, at least, are not normal. S. A. K. Wilson.

BOOKS AND PAMPHLETS RECEIVED.

Lohmann, W. “Disturbances of the Visual Functions.” Translated
by Angus Macnab. With 39 illustrations in the text, some in colours.
John Bale, Sons & Danielsson, Ltd., London, 1913. Pr. 15s. net

Rank, Otto. “ The Myth of the Birth of the Hero.” (A psychological
interpretation of mythology.) Authorised translation by Drs F. Robbins
and Smith Ely Jelliffe. ( Nervous and Mental Disease Monograph , No. 18.
New York, 1914.)

“Fifty-sixth Annual Report of the General Board of Commissioners
in Lunacy for Scotland.” 1914

IReview

IReurolog^ anO ps^cbiati^

©rigtnal Hrttcles

THE ALLEGED SENSORY CUTANEOUS ZONE
OF THE FACIAL NERVE OF MAN.

By LEONARD J. KIDD, M.D.

1. Introduction; 2. Evidence of Comparative Anatomy; 3. Anatomical
Considerations ; 4. Clinico-Pathological Considerations ; 5.

Needed Experimental Inquiries ; 6. Conclusions.

1. Introduction.

The teaching that the geniculate ganglion of man sends sensory
fibres to the skin of the external ear, and external auditory meatus,
which was urged by J. Ramsay Hunt 1 in the year 1907, has been
accepted with alacrity by most clinical writers. However, C. K.
Mills 2 has strenuously opposed it; but, as he was specially con¬
cerned with the much larger question of all the sensory functions
attributed to the facial nerve, he did not make out anything like
so damaging a case against what we may call the cutaneous
facialis hypothesis as he could easily have done. There was a
certain amount of plausibility about Hunt’s presentation of the
subject which caused almost all readers of his paper to accept his
teaching at once. Hunt arrived at his conclusion largely from his
studies of herpes auris. The underlying argumentation seems to
have been somewhat as follows:—We have known for many years
(1) that the geniculate ganglion is, in part at any rate, an afferent
root-ganglion, homologous with all spinal dorsal-root ganglia; (2)
that spinal root-ganglia give origin to cutaneous sensory fibres;
therefore (3) it must follow that the geniculate ganglion gives
origin to cutaneous sensory fibres. Of course this does not in the
32

LEONARD .T. KIDD

least follow. Again, herpes is commonly believed to be due to an
acute intlammatory lesion of a dorsal-root ganglion or ganglia; it
seemed, then, reasonable to suppose that an isolated herpes of the
geniculate ganglion might really occur and give rise to a true
geniculate otalgia. Rut, even if we had conclusive proof of the
existence of an isolated geniculate herpes, we should still not be
justified in concluding at once that this otalgia was, even in part,
a cutaneous otalgia. Hunt divided his cases of herpes auris into
several groups, but the most important of these, from the point of
view of the cutaneous facialis hypothesis, are (1) those cases of
herpes auris that occur without facial paralysis, and (2) those that
occur with facial paralysis. Now, if we recall the fact that the
geniculate ganglion of man is a swelling on the course of the facial
nerve, we must conclude at once that there could be no such thing
as a true isolated geniculate herpes without at any rate marked
paresis of the facial nerve. It is certain, then, that all those cases
of herpes auris which are unaccompanied by facial palsy or paresis
are of non-genieulato origin. There is no doubt, however, that
there really are cases of herpes auris with complete homolateral
facial palsy that correspond closely in the distribution of the
herpetic vesicles with Ramsay Hunt’s so-called “ zoster zone of the
geniculate.” I have seen four examples of this variety: in one
there was also present a herpetic eruption on the cutaneous area
of the homolatcral fourth cervical nerve-root. But we lack con¬
clusive proof that these cases are ever purely of geniculate
ganglionic origin. It is interesting to note that in 1910 Mills was
sceptical on this point; thus ho writes:—“The cases of herpetic
inflammation, cervico-occipital, auricular, and facial, which have
been observed in connection with facial paralysis, or with facial
paralysis ami acoustic symptoms, are best explained on the
supposition of an involvement of ganglia other than the geniculate.”
It is greatly to he deplored that we still too often hear or read the
unqualified statement that herpes depends on an acute inflam¬
matory lesion of a dorsal-root ganglion or ganglia. The real truth
is that the lesion is a predominantly ganglionic one, hut there are
often present also neural, radicular, meningeal, and vascular
lesions; and sometimes the neural and the radicular lesions are as
much primary as is the ganglionic affection. We are just as much
in error in describing herpes as a posterior poliomyelitis, as we are
(or were till a few years ago) in calling acute polio-encephalo-

THE ALLEGED SENSORY CUTANEOUS ZONE 395

myelitis simply an affection of ventral horns. In both diseases
we have a brutal, knock-down blow by an acute gross lesion which
irritates, compresses, or strangles every structure which it meets,
whether it be nervous, vascular, lymphatic, or meningeal. In two
out of Head and Campbell’s twenty-one necropsies of herpes there
was present a primary affection of spinal nerves. Clearly, before
we can admit the existence of an isolated geniculate herpes, we
must have the following minimum requirements fulfilled:—We
must have during life a typical case or cases of Hunt’s geniculate
herpes with facial paralysis; necropsy must include a searching
histological examination of (1) the cells of all the afferent ganglia
from the Gasserian to the third cervical, including, of course, the
geniculate, petrosal IX., and jugular X.; (2) of their roots; (3)
of all their issuing auricular branches; and (4) of the membranes
of the brain and spinal cord. And only if all but the geniculate
ganglion and its root and branchee be found to be normal can we
admit the existence of an isolated geniculate herpes. Need I add
that there appears to be no recorded instance of such an obviously
needed thorough pathological examination having been made ?
But let us now begin at the beginning, and ask what comparative
anatomy has to teach us as to the existence of a cutaneous facialis
component in vertebrates.

2. Evidence of Comparative Anatomy.

Not only is there a total absence of any anatomical or experi¬
mental evidence in favour of the existence of a cutaneous facialis
component in mammals, but there is not even any well established
instance of this in any vertebrate class above the cyclostomcs.

In pctromyzon Johnston found 3 that the hyomandibularis nerve
innervates the skin of part of the hyoid segment, but that even so low
in the vertebrate scale as this the dorsal and lateral portions of this
area are being encroached upon by the branches of the trigeminus:
the hyomandibularis certainly innervates the ventral cutaneous
area of this segment. He attributes the facialis innervation of the
skin of the hyoid segment of peiromyzon to the absence of an
operculum. But this can hardly be the real reason, for other non-
operculated forms, such as the selachians, ought to show a facialis
cutaneous component, but yet they do not. In his book 4 Johnston
attempts to explain the matter thus:—“ In forms provided with an

396

LEONA I'D J. KIDD

operculum, tlie operculum is innervated by rami from the V. and X.
nerves, and rami from the V. nerve supply the ventral surface in
the gill region. In cgdoslomrs, where there is no operculum, a
simpler and more primitive arrangement is found. There is a large
cutaneous component in the VII. nerve which is distributed byway
of the post-trematic ramus to the skin of the hyoid segment, just
as in the more caudal branchial segments. The skin of the
corresponding dorsal area, however, is innervated by rami from the
V. nerve. From this it would appear that the hyoid segment had
originally its own cutaneous innervation, and that when the
operculum was formed the component in VII. disappeared, and the
V. nerve supplied the parts of the hyoid segment remaining
exposed.” Sheldon, in his excellent paper 5 on the phylogeny of
the facial nerve and chorda tympani, writes thus, after a reference
to Johnston’s finding in pctromipon : —“In most forms above the
cyclostomes the evidence is strong that the only sensory component
remaining (is., in the facialis) is the visceral, which innervates
mucous surfaces, while the cutaneous sensation for the hyoid
segment is served by fibres from the trigeminal or the vagus
nerves.” He shows that in selachian-s there is a small cutaneous
component derived probably, however, from the trigeminus by an
anastomotic branch from the Gasserian ganglion. In Iclcosts also
there is a cutaneous branch from the Gasserian ganglion. In
amphibia cutaneous fibres may be present, but when they are they
come from the vagus nerve by a communicating branch. Kingsbury,
in his paper on “ The structure and morphology of the oblongata in
fishes,” a writes thus of the spinal V. tract system—which he
accepts as representing the dorsal column of the spinal cord:—
“The exit in amia calm of a small portion of the fibres with the
VII.-VIII. appears to be an exceptional condition,* though constant
in the few brains examined for it.” And on page 23 he writes
“ The spinal V. furnishes a small contingent of fibres possibly in
ganoid's (amia) to the VII.” I have failed to find that anyone has
ever demonstrated the existence of a cutaneous facialis component
in any reptile, bird, or mammal. J. Gordon Wilson, in his paper
on “ The nerves and nerve-endings in the membrana tympani of
man,” refers 7 to “ the teaching of (J. Judson Herrick, that there is

* Evidently he means “ exceptional for yanouls” Other ganoids studied by
him included L( p\do*tcm ossens and aa'puttcr.

THE ALLEGED SENSORY CUTANEOUS ZONE 397

no proof that the geniculate ganglion ever sends general sensory *
fibres to the skin; in all cases where general sensory fibres are
distributed to the skin by branches of the facialis, they either have
a separate root of their own, as in cyclostomes, or else enter the
facialis distal to the geniculate ganglion by anastomosing branches
from the Gasserian ganglion.” And here we may well ask the
question:—If Herrick does not know of general cutaneous facialis
components in any vertebrate above the cyclostomes, where shall we
find a comparative neurologist who knows more about nerve com¬
ponents than he ? Clearly, then, as the comparative neurologist
does not know of a cutaneous facialis component in any mammal,
it behoves the mere clinician to walk softly and ask himself whether
Ramsay Hunt’s teaching will bear close scrutiny. It might, of
course, be urged that mammals, up to man, may after all resemble
cyclostomes in this matter; but though this is just theoretically
conceivable, it can be shown that man certainly does not possess
a sensory cutaneous facialis innervation.

3. Anatomical Considerations.

There are in man at least four possible anatomical routes by
which the skin of the auricle might receive sensory fibres from
the geniculate ganglion, viz:—(1) By the small superficial petrosal
nerve, the otic ganglion, and the auriculo-temporal branch of the
trigeminus; (2) by the communicating branch which the facial
trunk gives to the auriculo-temporal nerve from its temporo-facial
trunk before the latter splits into its three terminal branches; (3)
by the temporal branches of the temporo-facial division which
communicate with the auriculo-temporal nerve; (4) by the com¬
municating branch which the facial nerve sends to the auricular
branch of the vagus nerve. To these four routes Ramsay Hunt
adds the posterior auricular branch of the facial nerve. This
branch is described by almost all anatomists as a purely muscular
branch to the auricular muscles and the occipitalis muscle; but
Valentin describes it as sending cutaneous filaments to the auricle.
It is also to be remembered that the posterior auricular branch of

* Thia term is used by American comparative neurologists to denote true
sensory cutaneous fibres which subserve tactile sensibility: they use the term
“special cutaneous” for those fibres whioh innervate the neuromasts (the
acoustico-lateralis system), i.e., the pit and canal skin-organs of the head, and
the lateral line of the trunk of fishes and aquatic amphibians.

398

LEONARD J. KIDD

the facial nerve communicates with the great auricular branch of
the cervical plexus, so that fibres could pass from the geniculate
ganglion thus to the auricle. On putting all these points to¬
gether we see that (1) a lesion which destroys the geniculate
ganglion will of course interrupt all these five sets of hypothetical
sensory cutaneous facialis fibres; and that (2) a complete lesion
of the facial nerve which involves the chorda tympani, and gives
clinically loss of taste on the anterior part of the tongue with
facial palsy, will interrupt all five sets of cutaneous fibres, with the
possible exception of those which might pass out from the geniculate
ganglion by the small superficial petrosal nerve. In Hunt’s later
paper, 8 published two years after his first one, he figures the sensory
system of the facial nerve of man as he conceived it: the sensor)'
fibres are shaded, and we find that they include the posterior
auricular branch of the facial nerve, and also the proximal end of
the temporo-facial division; clearly, therefore, he intended us to
regard those branches at any rate as constituting the anatomical
paths of his cutaneous facialis fibres. It is necessary here to give
an account of the experiments of both Amabilino and van
Gehuchten, for not only has Hunt mixed them up in a surprising
fashion, but we can also see how he probably came to favour the
temporo-facial division of the facial nerve as at any rate forming
one of the routes for the passage of his sensory cutaneous facialis
fibres.

Amabilino 9 performed two distinct sets of experiments on
adult dogs. In the first group he opened the middle ear and per¬
formed avulsion of the chorda tympani nerve. The animals were
sacrificed after from twelve to forty-six days. Typical Nissl
degeneration was found in about four-fifths of the cells of the
homolateral geniculate ganglion. In the second group of dogs
Amabilino removed 1 cm. of the facial nerve below the stylo¬
mastoid foramen; subsequently no cell changes were found in the
geniculate ganglion. And yet Ramsay Hunt definitely wrote in
1909 * that “ the presence of such sensory fibres (i.e., rising in
cells of the geniculate ganglion) in the facial trunk has been
demonstrated experimentally by Amabilino. These experiments
consisted in cutting the nerve at its exit from the stylomastoid
foramen, and studying the retrograde degeneration in the cells of
the geniculate ganglion; another proof that these cells have a

* Loc . cit., p. 332.

THE ALLEGED SENSOKY CUTANEOUS ZONE 399

common sensory function apart from those subserving the function
of taste. These sensory fibres in the trunk are destined for the
cutaneous distribution of the facial on the external ear (zoster
zone of the geniculate).” But Amabilino failed to (jet the changes
which Hunt says he obtained; and it was van Gehuchten 10 who
did find retrograde chromolytic changes in a very small number of
the cells of the rabbit’s geniculate ganglion subsequently to a
section of the facial nerve at the level of the stylomastoid
foramen. And, further, van Gehuchten concluded that these
ehromolysed cells of the geniculate ganglion give origin to
afferent fibres which pass peripherally by the peripheral muscular
branches of the facial nerve to its mimetic muscles; and he asks
the question: “ Where else could they go ? ” It is obvious that
if Amabilino had really obtained retrograde chromolysis of any
cells of the geniculate ganglion after cutting out a portion of the
facial nerve below the stylomastoid foramen, van Gehuchten
would naturally have quoted this as agreeing with his own
experimental findings, whereas he expressly points out that
Amabilino must have overlooked the presence of ehromolysed
cells, for in the rabbit they are very few in number. Probably
Hunt believed that the number of ehromolysed cells of the
geniculate ganglion found by van Gehuchten in the rabbit corres¬
ponded to about the number of cells which we might expect to
find in the geniculate ganglion of man as the ganglionic centre of
the hypothetical cutaneous facialis fibres. But we know that in
the monkey * about one-third of the medullated fibres of the facial
nerve, distal to the point at which the branches to the posterior
digastric and stylohyoid muscles are given off, are afferent fibres
which are distributed to the mimetic facial muscles. The ex¬
ceedingly small number of these mimetic facial muscle afferent
nerve fibres in the rabbit is perfectly explained by the fact, to
which I referred f in 1909, that in mammals below the Carnivora
and the Primates the mimetic facial muscles are quite in¬
significantly developed in degree. In the next section of this
paper I will show that the temporo-facial division of the human
facial nerve does not convey any sensory cutaneous fibres to the
auriculo-temporal nerve, and thence to the auricle.

* F. H. Edgeworth, Jour, of Anat. and Physiol., 1899, N.S. xiv., p. 124.

t L J. Kidd, Rer. of Neurol, and Psychiatry, 1909, vii., p. 173.

400

LEONARD J. KIDD

4. Clinico-Patholocical Considerations.

In studying the clinieo-pathological aspect of this subject we
have to consider the question of either pain or diminution or
loss of cutaneous sensibility in the area of distribution of the
alleged sensory cutaneous fibres of the facial nerve. It is clear
that the presence of an otalgia confined to Hunt’s zoster zone of
the geniculate ganglion would not of itself prove the existence of
any cutaneous facialis fibres, because the facial nerve may, as
Hunt and others teach, supply sensory fibres to the membrana
tympani, mastoid cells, &c. And, as all the alleged cutaneous
facialis fibres rise in cells of the geniculate ganglion, it would follow
that after a complete extirpation of that ganglion, or a complete
division of its afferent root, the pars intermedia of Wrisberg, we
should have a complete cutaneous anaesthesia of Hunt’s zoster
zone of the geniculate ganglion, to say nothing of other sensory
areas of the facial nerve ; and, further, this post-operative cutaneous
amesthesia would be permanent because functional regeneration
of divided afferent roots does not, as far as we know, ever occur.
Now there is one such operated ease on record, viz., the case of
L. Pierce Clark, operated on by Alfred S. Taylor, reported 11 before
the New York Neurological Society in 1909. The patient had
been previously shown by Clark before the American Neurological
Association in June 1909, five weeks after operation, as a cured
case of Ramsay Hunt’s peculiar form of geniculate otalgia. The
case is entitled : “ The report of a case of tic douloureux of the
sensory filaments of the geniculate ganglion: operation, recovery.”
The patient was a young woman “ whose neuralgic pain was
rather sharply limited to the anterior wall of the external meatus
and a small portion of the skin just in front of the ear, the
essential supply zone of the geniculate to the ear and face, as
described by Hunt.” At the operation Taylor exposed and
identified the facial, eighth, ninth, tenth, and eleventh nerves,
but only the facial, pars intermedia, and the upper fasciculus of
the eighth nerve were divided. And yet, amidst all the well-
deserved rejoicings that followed the recital of this case on this
New York joy-day, in which Ramsay Hunt took part, actually no
speaker asked the question as to what was the post-operative
state of cutaneous sensibility on the auricle, and there is even no
mention whether it was ever tested! Among the personal cases

THE ALLEGED SENSORY CUTANEOUS ZONE 401

recorded * by Hunt was one of herpes occipito-collaris, in which
a complete facial palsy supervened on the fourth day of the
disease. Evidences of facial paralysis and objective sensory
disturbances in the occipito-cervical region were still present at
the time of death, eighty-seven days after the onset of the disease.
Necropsy revealed, among other things, well marked degeneration
of a large number of the fibres of the pars intermedia of Wrisberg.
But clearly this fact does not prove, or even suggest, that the
human geniculate ganglion innervates skin; for the pars intermedia
(the afferent facial root, though it is something more than that)
contains the ascending facialis root-fibres coming from the palate,
tongue, facial muscles, and probably also the membrana tympani
and mastoid cells, &c. And nobody has yet advanced so far as to
be able to pick out from a degenerated nerve-root a particular
fibre, or group of fibres, and say: “This degenerated fibre is a
cutaneous root-fibre, and I prove the truth of my statement by
the following criteria, &c.” Again, we know that the characteristic
sensory disturbance of herpes elsewhere is pain, and only occasion¬
ally do we find any cutaneous anfesthesia associated with it. At
the present stage of our inquiry, then, we may safely conclude
that from the point of view of otalgia, on which Ramsay Hunt
laid great stress, the cutaneous facialis hypothesis breaks down
completely; there is a total absence of proof that otalgia is ever
due to irritation of cutaneous fibres rising in cells of the geniculate
ganglion. And yet it is easy to see that there is really such a
thing as a geniculate otalgia, but that it is always due either to
involvement of deep structures innervated by the geniculate
ganglion or of auricular branches of trigeminus, vagus, or cervical
origin, and is never, even in part, a cutaneous otalgia, unless other
ganglia or their sensory cutaneous branches are affected simul¬
taneously with the geniculate ganglion.

Let us now examine the cutaneous facialis hypothesis from the
side of cutaneous anaesthesia, and notice a few of the recently
recorded cases in which an insignificant degree of hypaesthesia of a
part of the auricle has been found, often only after very careful
repeated clinical testings, in certain cases of unilateral complete
infra-nuclear facial palsy. To begin with, Ramsay Hunt, in his
second paper, discusses f the question of sensory disturbances in

# Loc. cit. y 1907.

t Loc . rtf., 1909, pp. 343, 344.

402

LEONARD J. KIDD

the common form of Bell’s palsy, “ in which the nerve has been
involved in the Fallopian canal between the geniculate ganglion
and the stylomastoid foramen.” In 2 out of 30 such cases
examined by him there was a hypaesthesia of the face on the same
side which needed a most careful testing for its recognition. This
he regarded as “ a functional or physiological derangement of the
fifth nerve ganglion, induced by the motor insufficiency of the
paralysed face." And in 9 out of the 30 cases hypaesthesia
in the concha was demonstrated: there was never any anecsthesia : *
“The tactile sense was merely diminished or obtunded in this
area.” By repeated careful testings Hunt satisfied himself of its
existence. He says he failed to demonstrate any definite changes
of sensibility within the canal. It is to be noted that he offers no
explanation (1) why in 21 out of the 30 cases of complete Bell’s
palsy there was not even any cutaneous hypaesthesia, nor (2) why
there was not in all the 30 cases a complete anaesthesia of the
skin of the concha and interior of the external auditory meatus.
His negative findings prove that the temporo-facial division does
not send any cutaneous sensory fibres to the auricle by way of the
auriculo-temporal nerve. As a matter of fact, if there were any
facialis cutaneous fibres in man, we should find in every case of
Bell’s palsy as complete a cutaneous anaesthesia of its alleged
auricular zone as any clinician ever found on the trigeminus
cutaneous area after a complete Gasserianectomy.

Dejerine, Tinel, and Heuyer record 12 a case of auricular herpes
with facial palsy. There was complete motor facial palsy with
reaction of degeneration; the earliest symptom was right facial
palsy with a perversion of taste-function, and “ with the herpetic
cicatrices were united interesting sensory troubles.” At first
there was almost complete anaesthesia of the meatus, external
auditory canal, all the concha, and the neighbouring parts of the
antihelix. On the lobule, helix, and upper part of the antihelix
sensibility was much diminished. Afterwards there was a marked
hypaesthesia on the hairy scalp behind the ear and in all “the
zone of the posterior auricular branch.” Finally, on the face there
was slight hypaesthesia which diminished on leaving the auricular
region, but could be recognised as far as the neighbourhood of the
median line. The three authors write:—“ Finally, in our case
objective sensory changes show the rOle of the geniculate ganglion

* The italics are mine.

THE ALLEGED SENSORY CUTANEOUS ZONE 403

in the innervation of the ear, skin of scalp, and face.” Then, in
commenting on the teaching of most authors that the sensory
branch of the external auditory meatus is an anastomotic filament
coming from the vagus or glossopharyngeal, they write:—“ Now it
appears, according to observations similar to ours, that it really
comes from the geniculate ganglion.” It is interesting to note
that they admit (contra Hunt and Valentin) that the posterior
auricular branch of the facial nerve “terminates solely in the
muscles (occipital, temporal, and muscles of ear).” They go on
thus:—“ Now, according to our observation, it is incontestable that
this hypaesthesia cannot be attributed to anything but the lesion
of the geniculate ganglion. This idea agrees with the fact
observed by the physiologists that the facial is sensory at its exit
from the stylomastoid foramen (Weigner), and that its section
causes achromatosis of a certain number of the cells of the
geniculate ganglion (van Gehuchten). The posterior auricular
zone therefore seems to receive a certain number of sensory fibres
from the geniculate ganglion.” A reference to their figure shows
that there was marked hypaesthesia over a large part of the second
cervical cutaneous area, and a very slight hypaesthesia over almost
the whole of the trigeminus cutaneous area. And yet they ask us
to believe that these vast cutaneous areas belong solely to the
geniculate ganglion! If their view were correct, we should find
in every case of complete unilateral facial palsy, between its
ganglion and the pes anserinus, a slight hypiesthesia of almost all
the homolateral trigeminus cutaneous area. But, although very
slight sensory changes have often been found in that area in Bell’s
palsy, it is certain that in the overwhelming majority of cases they
are absent. We cannot, then, reasonably accept the interpretation
of Dejerine and his two co-workers that their very slight
hypaesthesia in the trigeminus area was due to “ the hypotonia of
the cutaneous muscles and the consecutive feebleness of the
dermal papillae.” Such hypotonia is present in all complete facial
palsies, no matter at what level of the facial root or nerve-trunk
the maximum intensity of the lesion may happen to be situated.
The three authors actually state that “ the facial hypaesthesia was
not in the area of the trigeminus! ” And yet their figure gives
the slightly hypaesthetic area as reaching almost up to the mid¬
line of the face, and even on the forehead it reaches not far short
of that line; it affects the side of the nose, cheek, temple, and

404

LEONARD J. KIDD

hinder half of the lower jaw, extending there on to the third
cervical cutaneous area. It is clear that, if all this vast cutaneous
area belongs to the geniculate ganglion, all our anatomists and
surgical neurologists have misled us woefully on the question of
the trigeminus cutaneous area. Although one cannot agree with
Ramsay Hunt, that the human facial nerve has any cutaneous
area whatever, yet he at any rate has always claimed but a very
tiny cutaneous zone for the geniculate ganglion.

Souques has recently recorded 13 a case of cervical herpes with
facial paralysis. At the beginning of November 1913 a woman of
53 had intense tinnitus, without vertigo, in her right ear,
with very severe lancinating pains inside the auricle, with irradia¬
tion behind and above it in the parietal region. Three days later
herpes auris and cervicalis (C 2 and C 3 ) on right side; the former
affected the internal and external aspects of the pinna, helix,
antihelix, lobule, and concha; the pinna was red, swollen, and
painful, and the meatus was narrowed by the swelling. In
addition, the herpes encroached upon the face both in front of
and below the auricle: there were also two “aberrant” vesicles
on the lower lip (figured). Twelve days after the onset of the
herpes a complete and total right facial palsy appeared. On
25th November the herpetic eruption was drying up, but very
severe pains persisted in and around the auricle; no objective
disturbances of sensibility could be found either in the auricle
or around it. Souques concludes that the case was one of a
simultaneous affection of the second and third cervical dorsal-
root ganglia and of the geniculate ganglion. He goes on to
describe the cutaneous area of the facial nerve on the auricle,
and yet he makes no comment on the fact that he failed to
demonstrate any cutaneous sensory diminution or loss on that
area.

At the same meeting of the Paris Neurological Society at
which the paper of Souques was read, Laignel - Lavastine
mentioned * that he had lately had the case of a “ man who, as a
sequel of a right-sided cervical and auricular herpes, showed a
right peripheral facial paralysis with a partial reaction of degenera¬
tion. There were herpetic and anaesthetic disturbances in the
concha and external auditory meatus, which territories belong to
the geniculate ganglion; from this he was able, before the appear-
* Herne Xenrol., 1914, May 20, p. 721.

THE ALLEGED SENSORY CUTANEOUS ZONE 405

ance of the facial palsy, to diagnose a participation of the pars
intermedia in the herpes amis.” Again, in discussing the case of
Souques, he says * that in his own case the subjective disturbances
were much slighter than in that of Souques, but that there was
“ a very marked anaesthesia,” which was absent in Souques’ case.
Yet he seems to see no difficulty in concluding that in both cases
the herpes auris was of geniculate origin, in spite of the fact that
cervical herpes was present in both cases, and that part of the
cutaneous innervation of the auricle is of cervical ganglionic
origin, and also in spite of a total absence of objective sensory
changes in Souques’ case.

It is well known that in cases of complete unilateral Bell’s
facial palsy one does occasionally find on examination a very slight
cutaneous hypaesthesia over the whole, or a large part of the
homolateral trigeminus area. Such cases have been recorded by
von Frankl-Hochwart and several other writers, including myself.f
At the time when my paper was written (1909) I believed that
the geniculate ganglion sends sensoi'y fibres to the mimetic facial
muscles; but we know now, thanks to the careful clinical study
by Maloney and Foster Kennedy J on the sense of pressure in the
face, eye, and tongue, that these muscle-afferent nerve-fibres from
the geniculate ganglion are really postural afferent ( non-scnsory ) in
function, and that the algetic afferent nerve-fibres of the facial
mimetic muscles come from or through the Gasserian ganglion. It
is quite untrue that at its exit from the stylomastoid foramen
the facial nerve contains sensoi'y fibres. Let us all grasp the
elementary truth that while all sensory fibres are afferent, all
afferent fibres are not sensory. I am convinced now that, in all
the cases of slight hypaesthesia in the cutaneous area of the
trigeminus nerve in Bell’s facial palsy, either there is present a
coexistent neuritis of the peripheral muscle-sensory fibres which
the trigeminus sends just underneath the skin of the face to the
facial muscles, or else the cutaneous hypaesthesia is psychogenic and
is induced by the action of the clinical examination on a suggestible
patient. Although I had, prior to the early part of the year 1909,
seen about seventy cases of hypaesthesia of the trigeminus
cutaneous area in Bell’s palsy, yet I have not once seen it since

* Loc. cit p. 737.

t L. J. Kidd, Rtv. of XturoK and Psychiatry , 1909, vii., p. 175.

X Maloney and Kennedy, Brain , 1911, xxxiv., September, p. 1.

406

LEONARD J. KIDD

that date. I attribute this fact mainly to our improved and more
intelligently conducted modern sensory testings. One may
mention that Mills refers * to these cases of facial palsy in which
the patients are apparently hypothetic, not only over the entire
face, but sometimes over portions of the neck and throat. He
concluded from his own work that in all these cases the hypothesis
was of a suggested or so-called hysterical character: his cases
comprised a Polish Jew, a Russian Jewess, and a coloured woman.
All these were of a well marked hysterical or suggestible
temperament: one of the cases was an alcoholic man. If we
try to put ourselves in the place of a patient suffering from Bell’s
palsy, who knows nothing of human anatomy beyond what he
himself invents for the occasion, what thoughts pass through his
mind as we cover his eyes, touch his face on the affected side, and
perhaps ask the very suggestive question : “ Do you feel me touch
you ? ” If he be a fairly quick-witted person, he reasons thus:
“ I can’t move the right side of my face, and the doctor asks me if
I can feel on it; clearly he expects me to say I cannot.” And who
can doubt that it is in this way that he is led to say he either does
not feel a touch or that it feels different from the feeling on the
sound left side ? To him it seems only natural that motion and
feeling should go together. Such a suggested response to clinical
sensory tests is all the more likely to lie evoked the more frequently
repeated and the more careful and painstaking be the inquiry.

There can be little doubt that, in many of the published cases
of herpes auris affecting Hunt’s zoster zone of the geniculate,
there has been present a lesion of the cervical ganglia or their
cutaneous auricular branches. The cervical area of the auricle is
much larger than most clinicians realise, and covers a large part
of Hunt’s so-called geniculate zone. We have the exact testimony
of an experiment in favour of my statement. Thus Trotter and
Morriston Davies found 14 that twenty-four hours after section of
the great auricular nerve in a man there was anaesthesia to a
camel’s-hair brush over more than half of the external ear; and they
found that by the use of their “ stroking method ”—which Mills
has found f of great value—there was abnormal sensibility over a
considerable part of the cheek and lower jaw (figured). On the
question of the exact extent of the cutaneous area of the auricular

* Loc. cit ., 1910.

t Loc . cit ., 1910.

THE ALLEGED SENSORY CUTANEOUS ZONE 407

branch of the human vagus nerve there appears to be no satis¬
factory evidence; but it seems probable that in some of the cases
described by Hunt and others as geniculate herpes, in which
vomiting was a prominent symptom, there may have been an
involvement of the jugular ganglion or the vagus roots, with or
without involvement of the auricular branch of that nerve. As to
whether the petrosal ganglion of the ninth cranial nerve of
mammals does or does not contribute cutaneous fibres to the
auricular branch of the vagus, and so to the auricle, we have at
present no exact information. We may now sum up this clinico-
pathological section as follows:—(1) We lack conclusive proof of
the existence of an isolated geniculate herpes; (2) geniculate
otalgia is never, even in part, a cutaneous otalgia; (3) an isolated
complete unilateral infra-nuclear facial palsy never gives amesthesia
of any part of the auricle; such amesthesia would be present in
every case if the geniculate ganglion sent any sensory cutaneous
fibres to the auricle; (4) those cases of Bell’s facial palsy in
which hypjesthesia is found, often only after repeated and highly
suggestible clinical testings, on either the whole or a large part of
the trigeminus and cervical root-areas or on part of the auricle,
are always either due to a coincident sensory neuritis of trigeminus,
cervical, or vagus auricular branches, or else are psychogenic
(i.c., manufactured by the patient’s reasoning suggested by the
clinician’s testing). It was to these, or some of these factors, that
the sensory changes found in the cases by Dejerine, Tinel, and
Heuyer, by Souques, by Laignel-Lavastine, and by Ramsay Hunt
were due, and not to involvement of any hypothetical (and non¬
existent) sensory cutaneous facialis fibres; (5) the afferent fibres
which are contained in the trunk of the facial nerve of man,
rabbit, and monkey are non-sensory: they are purely postural-
afferent in function, and their functioning never rises into con¬
sciousness. The algetic afferent nerve-fibres which are distributed
to the facial muscles of man come from or through the Gasserian
ganglion; it is solely on them that the muscle-pain-sensibility of
the facial muscles depends.

, 5. Needed Experimental Inquiries.

The experimental investigation of the question whether the
mammalian facial nerve has a cutaneous sensory zone may con-

408

LEONARD J. K1I)D

eeivably prove to be difficult unless a fairly large animal be
selected. The subject might be approached in several ways:—
(1 ) An attempt might l>e made to divide all the cutaneous nerve-
filaments that enter the skin of the auricle from its circumference;
if this could he done, it should be followed up a few days later by
histological examination of all the afferent ganglia from the
Gasserian to the third cervical for evidence of retrograde chromo-
lytic changes in some of their cells : the geniculate, petrosal IX.,
and jugular X. would of course be examined ; (2) as it is nearly
certain that the mammalian facial nerve has no cutaneous in¬
nervation, a section of (a) all the auricular filaments of the
auriculo-temporal nerve before it has received its communicating
fibres from the small superficial petrosal nerve, and of (b) the
auricular branch of the vagus before it has received the com¬
municating branch from the facial nerve, and of (c) all the
auricular branches coming from the cervical plexus, would prob¬
ably be found at a later date to have caused degeneration of all
the cutaneous filaments of the auricle; (3) the operation of com¬
plete extirpation of the geniculate ganglion might be attempted:
if it were successful, it would divide all the hypothetical cutaneous
facialis fibres, and we should find later some degenerated fibres on
the cutaneous zone of the auricle described by Ramsay Hunt
as the “ zoster zone of the geniculate ganglion ”; further, we
should find normal nerve-fibres on the auricle both in front of and
behind the area of degenerated fibres; if all the auricular
cutaneous fibres were found to be sound, the cutaneous facialis
hypothesis would be disproved; (4) after a complete division of
the facial nerve just below the geniculate ganglion, i.r., well above
the point of exit of its posterior auricular branch and the com¬
municating branch to the auricular branch of the vagus nerve, we
ought to find degenerated nerve-fibres in part of the skin of the
external ear if, as Hunt suggests, these two nerves contain sensory
cutaneous facialis fibres for the auricle; (5) a section of the
posterior auricular branch of the facial nerve close to its origin
might be performed in order to settle the question whether it is a
purely muscular branch, or whether, as Valentin asserts, it gives
also cutaneous filaments to the auricle. It seems to me very im¬
portant that before any of these experiments are attempted it
should be exactly ascertained what cutaneous or subcutaneous
nerve-filaments are liable to be severed in the performance of the

THE ALLEGED SENSORY CUTANEOUS ZONE 409

various operations; for, unless this precaution be observed, we
might, in some of them at any rate, attribute the subsequent
presence of degenerated fibres on the auricle to the wrong cause.
Of the various experiments here suggested, it seems probable that
the third, fourth, and fifth groups are the most likely to prove
successful in deciding whether there is any cutaneous facialis zone
in mammals. If the geniculate ganglion can be completely
extirpated, it should be possible to trace degenerated fibres to the
membrana tympani, mastoid cells, all the facial muscles, and
possibly also to the lachrymal gland (there is some clinical
evidence that the great superficial petrosal nerve conveys secretory
fibres to that gland). It may quite well happen that the pro¬
fessional experimentalist will think of even better methods of
attacking the question of the cutaneous facialis hypothesis than
those here offered; but in any case a careful experimental inquiry
is greatly to be desired in order to overthrow error and establish
the truth.

6. Conclusions.

1. There is no anatomical or experimental evidence of the
existence of a cutaneous sensory zone of the facial nerve in any
vertebrate group above the Cyclostomata.

2. Clinical studies prove that the human facial nerve has no
sensory cutaneous zone on the auricle.

3. The clinico-pathological evidence brought forward by
Ramsay Hunt and his numerous followers in favour of the
cutaneous facialis hypothesis breaks down completely on a search¬
ing critical scrutiny, as is set forth exhaustively in section 4 of
this paper.

4. It is unknown whether the petrosal IX. ganglion contributes
any sensory cutaneous fibres, by way of the auricular branch of
the vagus nerve, to the auricle.

5. Some of the experimental methods by which the question
of the existence of a sensory cutaneous supply of the mammalian
facial nerve can be tested are outlined.

References.

1 J. Ramsay Hunt, Joum. of Nerv. and Meat. Die., 1907, xxxiv., p. 73.—
“ Herpetic inflammations of the geniculate ganglion.” Also Archives of
Otology, 1907, xxxvi., No. 6.

* C. K. Mills, Joum. Nerv. and Menl. Die., 1910, xxxvii., (a) p. 273, (h) p. 355.—
‘'The sensory functions attributed to the seventh nerve.”

410

ABSTRACTS

3 J. B. Johnston, Morphol. Jahrb ., 1905, xxxi r., p. 185.—“The cranial nerve

components of Petromyzon.”

4 /lid ,—“The nervous system of vertebrates/ 1 1907. London, pp. 107, 108.

6 R. E. Sheldon, Anatomical Record , 1909, iii., p. 593.—“Thephylogeny of the
facial nerve and chorda tympani.”

6 B. F. Kingsbury, Journal of Comparative Neurology , 1897, vii., p. 1.

7 J. Gordon Wii^on, American Journal of Anatomy , 1911, xi., p. 101.

8 J. Ramsay Hunt, Journ . Nerv. and Ment . Die., 1909, xxxvi., p. 321.—“The

sensory sj-stem of the facial nerve and its symptomatology.”

9 R. Amabilino, II Pieani, 1898, xix., 1, 2.—“Sui rapporti del gangiiogenioolato

con la corda del timpano e col facials. Ricerche anatomiche sperimentale.”

10 A. van Gehuchten, “ Anatomie du systems nerveux de Thomme,” VoL 2,1900.

11 L. Pierce Clark and Alfred S. Taylor, Journ. of Nerv. and Ment. Die.,

1910, xxxvii., pp. 242, 243.

12 Dejerine, Tinel, and Hbuyer, Soc. de Neurol, de Paris , 7 Mars 1912;

Revue Neurol., 1912, xx., March 30, p. 466.
ly A. Souques, Revue Neurologique , 1914, Ann. xxii., May 15, p. 625.

14 Wilfred Trotter and H. Morriston Davies, Rev. Neurol . and Psychiatry,
1907, v., p. 761.—“ The exact determination of areas of altered sensibility.”
Also Journal of Physiology , 1909, xxxviii., p. 134.

abstracts.

PSYCHOLOGY.

ON THE ANALYSIS AND INTERPRETATION OF DREAMS
(483) BASED ON VARIOUS MOTIVES AND ON THE THEORY OF
PSYCHO-ANALYSIS. Meyer Solomon, Journ. Abnorm. Psychol.,
1914, June-Sept.

Infantile primitive tendencies are always detectable by dream
analysis, and this applies not only to dreams but to all adult
tendencies and activities; these tendencies are not a priori of a
sexual nature; and it is not only the infantile tendencies, but
still more fundamentally the instinctive tendencies, which we find
as the driving force of all dreams and of all other mental states.
The Freudians have entirely neglected all instincts other than the
sexual instinct. Their broad generalisations with regard to the
role of sexuality in dreams, the neuroses, psychoneuroses, psychoses,
&c., do not ring true, and Freudism must undergo wholesale
modification, especially with respect to the conceptions of psychical
determinism, psychical repression, sexuality, and symbolism.
Psychology and psychoanalysis should be developed not on
sexuality alone, but on man as he really and truly is.

H. de M. Alexander.

ABSTRACTS

411

▲ CONTRAST IN PSYCHOANALYSIS £ THREE OASES. Tom A.

(484) Williams, Jawm. Abnorm. Psychol 1914, June-Sept

Three cases are reported illustrating the author’s belief that a
complete Freudian analysis does not, in itself, lead to a cure;
that a cure may be effected without a complete analysis, provided
the analysis reaches the genetic difficulty; and that readjustment
may be accomplished without any reference to the sexual.

H. de M. Alexander.

PATHOLOGY.

MEDULLARY CAVITIES AND CERVICAL MENINGITIS. (Carttfs

(485) mfedull&ires et mlningites cervicalea. Etnde explriment&le.)
Jean Camus and Qustave Roussy, Rev. Neurol ., 1914, xxii.,
F6v. 28, p. 213.

The authors record the result of a number of experiments upon
eleven dogs. After dividing the occipito-atlantoid membrane,
they injected into the subarachnoid space a mixture of formic acid,
sodium nucleinate, and talc suspended in water. A gradual and
progressive meningitis resulted, followed by small areas of soften¬
ing and ultimate cavity formation in the interior of the cord.
These areas of softening are probably ischemic in origin, and
result from interference with the spinal vessels by the meningitis.
They are often roughly symmetrical, in many places show evidence
of inflammation, and resemble those of true syringomyelia. The
meningitis is of that type known as cervical hypertrophic
pachymeningitis, and is of interest in connection with the
observations of Philippe and Oberthur that there is a pachy-
meningitic form of syringomyelia. A Ninian Bruce.

A STUDY OF THE SATELLITE CELLS IN FIFTY SELECTED

(486) CASES OF MENTAL DISEASE. Samuel T. Obton, Brain,
1914, xxzvi., p. 525.

The fifty cases were selected to form five groups of ten each and
comprised (1) maniacal depressive insanity, (2) dementia praecox,
(3) senile dementia, (4) general paralysis, and (5) alcoholic insanity.
Sections were cut from the following cortical regions: precentral,
postcentral, frontal, temporal and occipital. The number of
satellites was then counted and their distribution by laminae,
Brodmann’s division into six layers being adopted.

The results are tabulated for each case and it is pointed out
that satellitosis cannot be considered to be in any sense indicative
of the type of psychosis, although it has in this series appeared
with more consistent intensity in the maniacal depressive cases
and of much less prominence in dementia praecox. The reaction

412

ABSTRACTS

is much more marked in the deeper cell layers, both in regard to
frequence of occurrence and degree of reaction. The cortices of
the dome, precentral, postcentral, and frontal, seem to show the
reaction with greater intensity than do the temporal and occipital
regions. Age at the time of death seems to play some part in the
occurrence of severe reactions, but cannot be considered the only
factor. The duration of the psychosis bears no demonstrable
relation to satellitosis. A. Ninian Bruce.

A MIOROOEPHALIO IDIOT WITH MALFORMATION OF BRAIN.

(487) Report of a Case. Arthur K. Petbry, Joum. Amer. Med. Assoc.,
1914, lziii., Aug. 15, p. 536.

The patient was the third child of a family of eight, born at full
term, when he weighed about 6 lbs. There was no history of
any miscarriages, tuberculosis, malignancy, or mental disease in the
family. It was noticed that his head was small at birth, but his
condition did not attract special attention until the age of 5. Owing
to family inability to take care of him, he was sent to hospital, being
then 21 years of age. He was found to be an idiot, could neither
walk nor talk, had to be fed, and was unclean. He weighed
Go lbs., and measured 4 ft. 2 in. in height. He showed athetoid
movements of the upper extremities. Mentally he was dull, and
“ in appearance he resembled more closely a monkey than a human
being.” He was very destructive.

The brain was small, weighing 220 gm., and measured 9 cm. from
frontal to occipital poles, and 4 cm. in width. The fissure of Sylvius
was well defined, the posterior limb reaching the great longitudinal
fissure just behind the middle of the superior edge of the cerebrum.
Its course closely resembles that of the normal fissure of Rolando.
A well-defined fissure lies anterior to the posterior limb of the
Sylvian fissure on the left side, and probably corresponds to the
Rolandic fissure. No distinct parieto-occipital, calcarine, or
parallel fissures were found. No corpus callosum was present,
and the anterior horn of the lateral ventricle was absent in the
right hemisphere. The circle of Willis and vascular supply
were normal.

The above points would appear to indicate that this is not
a case of true microcephaly. A. Ninian Bruce.

CLINICAL NEUROLOGY.

ASSOCIATED MOVEMENT OF THE JAW AND UPPER LID:

(488) “THE JAW-WINKINO PHENOMENON.” E. A. Cockayne,
Brit. Joum. Child. Die ., 1914, xi., p. 362.

Cockayne reviews the literature including the case reported by
Sym {v. Review, 1908, vi., p. 337), and reports a personal case in a

ABSTRACTS

413

female infant. The movements were first noted when she was
about a month old. As the baby sucked the right lid was raised
synchronously with the movements of the jaw, and as the jaw
was moved away from the side of the lesion as in grinding the
teeth, the lid was raised. There was slight ptosis of the right
upper lid. The left lid was not affected. There was no history
of a similar condition or of ptosis in the family.

J. D. Rolleston.

PSEUDO - HYPERTROPHIC MUSCULAR DYSTROPHY: TWO

(489) CASES WITH PLATES. A. F. Bernard Shaw, Dublin Joum.
Med. Set ., 1914, No. 512, Aug., p. 116.

Two quite typical cases are described. They were brothers, and
there was no history of any other cases in the family either on
the father’s or mother’s side. Their sister was unaffected. The
knee jerks were absent in both cases, and the Achilles jerks absent
in one and diminished in the other. A. Niki an Bruce.

ACUTE ATAXIA IN CONVALESCENCE FROM MEASLES. (Un

(490) cas d’at&xie aigue pendant la convalescence d’une rougeole.)

R. Morichau-Beauchant, Frey, and Rameix, Bull, et mem. Soc .
mid. H6p. de Parte, 1914, xxxviii., p. 60.

A bov, aged 7 years, about a week after the appearance of the
eruption of measles complicated by broncho-pneumonia, suddenly
developed the following symptoms: paralysis of the tongue and
lower jaw, intention tremors, contractures, exaggeration of
reflexes, adiadococinesis, disturbance of equilibrium, nystagmus,
and transitory retention and incontinence of urine. There were
no psychical troubles, sensory disorders, nor general disturbance.
A month later only a slight degree of nystagmus, slight tremor,
and spastic gait remained, and in another two months there was
only slight exaggeration of the knee jerks. When seen a year
after the onset of the symptoms, the child was perfectly normal.
This case closely resembles that recently reported by Bari£ and
Colombe (v. Bemew , 1913, xi., p. 493). J. D. Rolleston.

ON NEUROFIBROMATOSIS. (Ueber Neurofibromatose.) W. Lier>

(491) Zeiteckr.f. klin. Med., 1914, lxxx., p. 261.

A record of a case of a boy, aged 9£ years, in whom general
neurofibromatosis was associated with dystrophia adiposo-genitalis.
There was no family history. There was bilateral optic atrophy,
and the X-rays showed evidence of a tumour close to the
hypophysis. No previous case has been recorded of the com¬
bination of neurofibromatosis with Frohlich’s syndrome.

J. D. Rolleston.

414

ABSTRACTS

PULMONARY LOCALISATIONS OF THE MENINGOCOCCUS. (Lei

(492) determinations pulmonaires du mlningococque) Q. Loygue,
Paris tne'd., 1913-14, iv., p. 231.

A woman, aged .‘35, in the course of an attack of cerebro-spinal
meningitis, developed acute lobar pneumonia. Meningococci were
found in the sputum as well as pneumococci. Recovery took
place. J. D. Rolleston.

A CASE OF PARAMENINGOCOCCUS OERBBRO SPINAL MENIN-

(493) GITI8. SEROTHERAPY. RECOVERY. (Un cas de m&iingite
c6r6bro spinale k parainlningocoques. Stfrothlrapife. Garrison.)

Brodin and P. Vallery-Radot, Bull, et mem. Soc. mid. Hop. it
Parity 1914, xxxvii., p. 1210.

A girl, aged 18, was admitted to hospital for meningitis, and in
three days received 120 c.c. of antimeningococcus serum. As the
symptoms became worse, the possibility of parameningococcus
meningitis suggested itself, and 40 c.c. of antiparameningococcus
serum were given when the patient was already comatose. Rapid
improvement took place, and after three more injections, or a total
of 155 c.c of antiparameningococcus serum, recovery took place.
The presence of the parameningococcus in the cerebro-spinal fluid
was subsequently shown by Dopter. J. D. Rolleston.

MENINGEAL STATES IN SCARLET FEVER AND SCARLATINAL

(494) URjEMIA. (Les 4tats mlningls dans la scarlatina at l’nrfaiie

scarlatinense.) P. Mauriac and P. Philip, Joum. de Med. de
Bordeaux , 1914, lxxxv., p. 437.

A record of two cases:—

1. A boy, aged 8£ years, in whom scarlet fever had been
mistaken for measles a month previously was suddenly seized
with vomiting and an epileptiform attack involving the left side.
The urine contained much albumin, and the diagnosis of the
epileptic form of nervous unemia was made, which was confirmed
by the presence of a large amount of urea in the blood and
cerebro-spinal fluid. After transitory improvement following
treatment, coma set in. A second lumbar puncture showed the
presence of pneumococcal meningitis which proved fatal. The case
closely resembles one reported by Hutinel (v. llcview, 1909, vii.,
p. 363).

2. A girl, aged 15 years, after a mild attack of scarlet fever
uncomplicated by albuminuria, caught a chill. Acute nephritis
developed, and respiratory unemia rapidly supervened.

J. D. Rolleston.

ABSTRACTS

415

LUMBAR PUNCTURE AS A SPECIAL PROCEDURE FOR CON-

(495) TROLLING HEADACHE IN THE COURSE OF INFECTIOUS
DISEASES. A. Gordon, Therap. Gazette , 1914, xxxviii., p. 392.

Gordon has used this method with excellent results in typhoid
fever, pneumonia, and intluenza. After the ordinary means for
relieving headache had failed, 15 to 20 c.c. of cerebro-spinal fluid
were withdrawn, and if the tension was very high 30 or 40 c.c.
In the typhoid and pneumonia cases several punctures were
necessary, in influenza one or two were sufficient. The cerebro¬
spinal fluid was sterile in all, and the tension was high. Some
showed leucocytosis and others an increase of albumin in the
cerebro-spinal fluid. (Cf. Review , 1913, xi., p. 165.)

J. D. Rolleston.

TYPHOID SPINE AND THYROID OPOTHERAPY. (Espondilitis

(496) tiflca y opoterapia tirdidea.) A. Vit6n, Rev. Soc. Mid. Argentina ,
1914, xxii., p. 282.

The patient was a man, aged 40, convalescent from typhoid fever,
in whom the diagnosis of post-typhoid thyroid insufficiency was
suggested by the absence of any history of gonorrhoea or syphilis,
the febrile, chronic ankylosing character of the process, the X-ray
features of the bony deformity, and the degree of cardiac excitement.

Thyroid opotherapy was adopted, and complete recovery rapidly
took place. J. D. Rolleston.

AN ATTEMPT TO TRANSMIT POLIOMYELITIS BY THE BITE

(497) OF LYPEROSIA IRRITANS. Edward Francis, Joum. Infec¬
tion* Die., 1914, xv., July, p. 1.

Since it has been found that poliomyelitis may be successfully
transmitted from monkey to monkey through the bite of Stomoxys
calcitrans (v. Review, 1913, xi.), the writer thought that possibly
Lyperosia irritans, a blood-sucking fly found in great numbers
in Texarkana during an epidemic in June and July 1913, might
be similarly concerned. These flies were accordingly allowed
to bite rhesus monkeys inoculated with poliomyelitis virus, and
then bite fresh monkeys. But the latter in no case developed
poliomyelitic symptoms. A. Ninian Bruce.

FURTHER NOTE ON THE USE OF CELLULOID SPLINTS IN

(498) THE TREATMENT OF ACUTE CASES OF POLIOMYELITIS.

Frederick E. Batten, Lancet , 1914, clxxxvii., July 26, p. 216.

In 1912 the author recommended the use of celluloid splints in
poliomyelitis ( v. Review, 1912, x., p. 387). He now states that

416

ABSTRACTS

the more he sees of this method, the more is he convinced it is
a good one. Of thirty-two cases of poliomyelitis admitted to
hospital within three months of the onset, twenty-four were
splinted, and it is known that in twenty-one no malposition has
arisen. The splints have proved of greatest service in really acute
cases by keeping the muscles at rest in a position of relaxation,
and have prevented deformity. The advantages of this form of
splint are: (1) it fits the limb perfectly, (2) it is easily applied
and removed, (2) it is light, (4) it is rigid, (5) it will not break
easily, (6) any form of shoe or Wot may be worn over it, (7) it is
cheap, and (8) can be very easily made. The process involved in
making them necessitates: (1) the taking of the “ negative ” cast
of the limb, (2) the making of the “ positive,” and (3) the moulding
of the splint on to the positive. This is fully described.

A. Ninian Bruce.

A PECULIAR UNDESCRIBED DISEASE OF THE NERVES OF
(199) THE CAUDA EQUINA. Foster Kennedy, Charles A Elsberg,
and C. I. Lambert, Amer. Journ. Med. Sci., 1914, cxlvii., May.

Out of eighty-four spinal operations five cases have been met so
alike in their history, clinical findings, and morbid appearances
that the authors have been led to class them together as a definite
clinical and pathological entity.

1. A man, 40 years, eighteen weeks before admission suddenly
experienced severe pain in the small of the back. This pain was
replaced by pain in the right lower extremity which would come
in attacks, and would extend down the thigh and leg to the ankle.
Later he had a burning sensation in the right hip, and the right
leg became weak. Difficulty in urinating developed and the
bowels were constipated.

The right lower extremity was weaker and thinner than the
left; the knee jerks were exaggerated on both sides; ankle jerks
could not be obtained, no clonus, plantar, right extensor, left
flexor. There was diminution of all sensations over the right
side of penis and scrotum, also over parts of the oval region,
buttocks, and lower limbs.

A laminectomy was done and several of the nerves were
observed to be swollen, and of a bluish-red colour. No neoplasm
was found. The affected roots were thoroughly washed with
warm saline solution, and the patient, twenty-seven days after the
operation, stated that he felt perfectly well.

The other four cases reported are essentially similar to the
above one.

In the third and fourth patients the symptoms were pro-

ABSTRACTS 417

gresaive in each for about two years, in the second for about one
year, and in the first for about six months.

A sharp, shooting, burning pain was present in all the cases
from the beginning, and was felt almost entirely in the backs of
the thighs, and in the calves.

Atrophy of the anterior tibial muscles with loss of power of
dorsifiexion at the ankle was a prominent feature in four of the
series; in the exception there was a spasticity of the lower
extremities, which was more marked on the right than on the left
side.

The objective sensory disturbances showed an astonishing
uniformity; in all, the main incidence of the disease had fallen on
the lowest roots of the cauda, the sacral roots were always affected,
and with the utmost severity.

None of the patients gave either a history or indication of
luetic infection. The histo-pathological examination of two of
the cases definitely excluded a tuberculous or syphilitic meningo-
myelitis or neuritis. There was evidence of a chronic degenera¬
tive type of arterio-sclerosis and also intimal proliferation identical
with the reaction encountered in some of the acute infections or
toxic processes.

The degeneration of the nerve fibres and cells in the posterior
lumbosacral roots of the cauda equina appeared to be relatively
recent in origin, and compared to the cord involvement minimal
in severity and extent; the cord degeneration stood out distinctly
as the most affected district.

Such a condition as that described by the authors has been
reported by Marek as occurring in the horse, and was called by
him a neuritis of the cauda equina. The authors believe that
their cases are examples of a true toxic neuritis of the caudal
nerve roots, and is similar to that produced experimentally by
Orr and Rows, who have shown how toxins may travel from the
sciatic and other nerves to the posterior root ganglia, along the
spinal roots, and upward in the cord. D. K. Henderson.

ROENTGEN DIAGNOSIS IN FRACTURES OF THE CRANIUM IN
(500) CHILDREN. Geobge Rosenbaum, New York Med. Joum ., 1914,
c., Aug. 29, p. 414.

Fractures of the skull in young children are very uncommon
because of the elasticity of the cranial bones. They are.best
classified as fractures of the vault and fractures of the base, the
former being caused by direct violence upon the vault, the latter
by extension from a fracture of the vault or by indirect violence.

Two cases are very briefly recorded. The first was a girl,
aged 9 years, who was run over by a waggon and fractured her

418

ABSTRACTS

femur. An X-ray examination also revealed a simple fissure of
the right frontal hone. Recovery after many weeks. The second
case was a girl, aged 8 years, who fell a distance of about 50 feet,
landing on her head. An X-ray examination after death revealed
a fracture of the parietal region of the vault extending into the
middle fossa as far as the sella turcica. A. Ninian Bruce.

THE BOLE OF THE CABOTID ABTEBIES IN THE CAUSATION

(501) OF VASCULAB LESIONS OF THE BBAIN, WITH BEMABES
ON CEBTAIN SPECIAL FEATUBES OF THE SYMPTO¬
MATOLOGY. J. Ramsey Hunt, Amer. Joum. Med. Sci,, 1914,
cxlvii., May.

The importance of obstructive lesions of the main arteries of the
neck (the innominate, common carotid, and internal carotids)
in the causation of softening of the brain is emphasised, and the
routine examination of these vessels is urged in all cases presenting
cerebral symptoms of vascular origin.

Two eases are reported as showing the development of
immediate cerebral symptoms after puncture wounds of the
carotid artery. In both cases there was an absence of pulsation
in the temporal artery of the affected side, showing that the
external carotid artery was occluded. Emphasis is also laid on
the distinct vascular changes in the optic disc on the side of the
injury.

Reference is made to a series of cases of hemiplegia associated
with diminished pulsation of the carotid artery in the neck on the
side of the softening. D. K. Henderson.

SPASMODIC CLOSING OF CEBEBBAL ABTEBIES IN ITS BELA

(502) TION TO APOPLEXY. Alfred Gordon, Albany Med. Annals,
1914, xxxv., p. 423.

The author,from an analysis of fourteen cases, points out that besides
embolism, thrombosis, and hiemorrhage (the classical causes of
apoplectic strokes), there is also a condition which is of hemiplegic
or hemiparetic character, and which is produced not by a material
lesion of the blood vessel, but by such a functional disturbance of
the vessel wall as to interfere with the circulation, and therefore
with the function of the nerve tissue supplied by this blood vessel.

Of these fourteen cases, eight died. Their clinical histories are in
their essentials identical, the chief symptom being a sudden onset
of hemiparcsis, never complete. The number of attacks varied
from one every three or four months to one every two years. All
the attacks were transient. The fewer the attacks the longer
their duration. The briefest time was two minutes, the longest

ABSTRACTS

41$

several hours. All terminated in severe attacks of permanent
hemiplegia. At the autopsy, softenings were found in the internal
capsule and basal ganglia. The ages of the patients varied from
56 to 70.

Of the six patients living all presented intermittent attacks of
apoplectic nature. Four had a great many attacks of a sensory
nature. Two have already entered the period of permanent
hemiplegia. The only explanation possible of these attacks is an
intermittent closing and opening of the cerebral vessels resulting
in local ischaemia. As the disease develops complete occlusion of
the vessels occurs. A. Ninian Bruce.

A FAMILIAL CASE OF SPLENOMEGALIC ANiEMIA WITH

(503) INFANTILISM. F. Pabkes Weber, Brit. Joum. Child. Bit.,
1914, xi., p. 345.

A record of a case of splenomegalic anaemia in a male, aged 17,
who was small and infantile in development. His height was
5 ft. 1 in., and his weight 6 stone 9 lbs. He had no pubic nor
axillary hair, and his penis and testes were small. All the
thirteen children in the family had had a yellow skin at birth,
and haul remained yellow for three to six months after birth, and
another child, a girl, had shown splenomegalic anaemia as well
There was no note of infantilism in any other member of the
family.

The author does not regard the case as one of Gaucher’s
splenomegaly, which is never associated with infantilism, but
rather as one of congenital haemolytic jaundice, in which infantilism
has been recorded. J. D. Rolleston.

EOSINOPHILIA IN CHOREA: A Preliminary Study. Simon S.

(504) Leopold, New York Med. Joum., 1914, c., Aug. 1 , p. 225.

Twenty cases of Sydenham’s chorea were examined. Of these,
ten showed a distinct eosinophilia of from 4 to 16 per cent.
Nine patients showed recurring attacks of chorea, the attacks
varying from 2 to 5; eosinophilia was found in six of the nine
cases. Of these, four had had only one recurrence, and eosinophilia
was only present in one; the remaining five had had from three
to five recurrences, and eosinophilia, ranging from 6 to 16 per
cent., was present in every case.

Eosinophilia is thus present in most recurring cases, especially
if there has been more than a single recurrence, and its absence
may prove of value in cases where the diagnosis is doubtful. Its
presence is in favour of the infective origin of chorea.

A. Ninian Bruce.

420

ABSTRACTS

LEAD POISONING WITH PANALYSIS OF THE EXTERNAL

(505) OCULAR MUSCLES. E. M. Williams, Jo urn. Amer. Med. Assoc.,
1914, lxiii., Aug. 1, p. 403.

A woman, single, aged 36, typesetter for six to eight years, began
to suffer from severe pains in all her limbs, and her leg and arm
muscles became weak. This increased rapidly, and in two weeks
she became confined to bed. Almost all the muscles of the body
seemed weak and wasted. Fibrillary tremors were present in the
thigh and shoulder muscles. There was double toe-drop, no
Rahinski’s sign, no sensory changes, no basophilia, and no blue
line on the gums. There was, however, diplopia on the extreme
lateral field, with a weak right abducens. The patient had often
noticed double vision when working in a poor light.

A. Ninian Bruce.

SOME MODERN CONCEPTIONS OF APHABIA. Donald Cork,

(506) Med. Ckron., 1914, fix., Aug., p. 309.

A brief historical account and summary of aphasia, the views of
Marie and Ddjerine being specially compared with the older
conceptions. A. Ninian Bruce.

SEROTHERAPY WITH MASSIVE DOSES IN TETANUS (Con-

(507) tribution h l’ltude de la s6roth6rapie h dose massive da tlttnos
confirm^.) F. E. Sarrazin, Theses de Parts , 1913-14, No. 280.

Sarrazin recommends the injection of 50-100 c.c. of antitetanic
serum as soon as the diagnosis is certain. The dose should be
repeated next day and even the following days until the con¬
tractures are completely controlled. The intravenous route should
be used by preference.

The thesis contains the histories of twenty cases, three of
which are original: sixteen recovered and four died.

J. D. Rolleston.

WASSERMANN S REACTION IN AORTIC DISEASE. (Contribution

(508) h l’ltude de la reaction de Wassennann ches lea aortiqnea)

I. Moricand, Theses de Paris , 1913-14, No. 404.

Moricanp examined thirty-four cases of aortic disease and found
that the frequency of a positive reaction was as follows: aneurysm,
70 per cent.; incompetence, 50 per cent.; aortitis, 33*3 per cent.;
and multiple lesions, 50 per cent.

In eleven out of seventeen cases in which Wassermann’s reaction
was positive, syphilis had not been suspected, while in four out of
fourteen cases in which the reaction was negative, syphilis was
extremely probable. {Of. Review, 1912, x., p. 192.)

J. D. Rolleston.

ABSTRACTS

421

PRACTICAL STUDY OF THE ALBUMIN IN THE OEREBRO-

(609) SPINAL FLUID IN SYPHILIS. (£tude pratique de 1’albumine
du liquide cdphalo-rachidien chez las syphilitiques.) A Foucque,
Theses de Pam, 1913-14, No. 419.

In the great majority of cases increase in the quantity of albumin
in the cerebro-spinal fluid in syphilis is closely associated with
hyperleucocytosis and a positive Wassermann’s reaction in the
cerebro-spinal fluid. These three signs are certain evidence of
syphilitic involvement of the meninges. Increase of albumin is
the easiest to detect, and not only can its presence be ascertained,
but the precise amount can be tested.

Apart from cases of isolated hyperalbuminosis in old cases of
syphilis, who no longer show any signs of disease {?. Review, 1914,
xii., p. 271), treatment of a syphilitic patient should never be
stopped as long as there is an excess of albumin in the cerebro¬
spinal fluid. The thesis is based on the study of twenty cases.

J. D. Rolleston.

SYPHILITIC REINFECTION AFTER TREATMENT WITH NEO-

(610) SALVAR8AN. (Reinfection syphilitique aprds le traitement par
le ndo-salvarsan.) Milian, Bull, et mim. Soc. mid. H6p. de Parts ,
1914, xxxvii., p. 1207.

A man, aged 26, developed a chancre on the dorsal surface of the
penis in April 1912. Numerous typical spirochaetes were found
in the lesion, and Wassermann’s reaction was positive. He received
five injections of neo-salvarsan in May, and in July, August, and
September was treated with biniodide of mercury and potassium
iodide. Wassermann’s reaction remained positive, so he was
given four more injections of neo-salvarsan in November, and in
December the reaction became negative.

In May 1914 a typical chancre appeared on the left side of the
penis after coitus with a woman who was found to have a
syphilide on the right side of the fourchette,. Wassermann’s
reaction was now positive again in the man and also in the
woman. J. D. Rolleston.

MALIGNANT GANGLIO NEUROMA OF LEFT SUPRARENAL.

(611) T. E. Monro and J. S. Dunn, Glasgow Med. Jovm ., 1914, lxxxii.,
Aug., p. 81.

The patient was a boy, aged 3£ years, who had not been well for
six months. He was very anaemic, and a large, firm mass was
palpable in the region which an enlarged spleen might occupy.
It was considered to be related to the kidney, and an attempt was
made to remove it by operation, during which he died.

422

ABSTRACTS

The tumour was later found to occupy the site of the left
suprarenal body, having apparently developed within the gland.
It was the size of a large orange. The cells present were mainly
ganglionic nerve-cells supported by fibrillar material, in which
it was easy to demonstrate large numbers of naked axis-cylinders.
No myelinated fibres were present. Foci of smaller cells corre¬
sponding to embryonic nerve-cells which form the sympathetic
nervous system in normal development, were also present.

Metastatic deposits were present in neighbouring glands and
in the ribs and bones of the skull. These consisted mostly of
small-celled malignant tissue.

About thirty-six such cases have been recorded, of which six
were malignant. A. Ninian Bruce.

A CASE OF ADDISON’S DISEASE OBSERVED IN 1902, OON-

(612) SIDERED AS CURED. DEATH FROM GASTRIC CANCER
IN 1913. AUTOPS7. (Addisonien observe en 1902. Consider*
comme gudri. Rdtrouvd en 1913. Mort d’un cancer gastrique.
Antopsie.) R Hirtz and R. Debr£, Bull, et mim. Soc. mid. H6p.
de Paris , 1914, xxxvii., p. 1192. Netter, ibid., p. 1203.

A man, aged 39, the subject of chronic alcoholism, presented
typical symptoms of Addison’s disease in 1902, and was treated by
injections of suprarenal extract. Rapid improvement and ap¬
parent recovery took place. In 1904 he was admitted to an
asylum for subacute alcoholism and was then lost sight of till
1913, when he was re-admitted for the same cause, and died a
month later. The necropsy showed carcinoma of the pylorus and
a metastasis in the liver. There were no naked eye changes in
the suprarenals, but microscopic examination showed a cicatricial
lesion in the right suprarenal.

In the subsequent discussion, Netter alluded to a case of
Addison’s disease successfully treated by suprarenal opotherapy
some years ago, and who for" the last three years had been
engaged as a chauffeur. Beyond a pleural rib nothing abnormal
was to be detected on examination. J. D. Rolleston.

TRUE LARYNGEAL SAG FORMATION IN MAN AND ITS

(613) OPERATIVE TREATMENT, (ttber echte kehls&ckbildung
beim menschen und ihre operative Behandlung.) A. Erich,
Beitrdge z. klin. Chir. t 1914, xc., H. 3, S. 619.

There is a median laryngeal sac in certain of the lower apes which
lies in front of the thyroid cartilage and communicates with the
larynx below the epiglottis. The occurrence of such a congenital
sac has never been conclusively shown in man. They are nearly

ABSTRACTS

423

all pathological. Lateral sacs are extensions of the appendicular
sac. They are lined with tubular ciliated epithelium. They may
extend upwards as far as the hyoid or the mucosa of the base
of the tongue. These are not pathological. A pathological
dilatation of the appendix also occurs, due to some obstruction to
expiration. True congenital sacs are easily recognised. They grow
slowly and appear early; they may grow in two directions:

(1) into the ventricular band, causing a swelling in the vestibule;

(2) upwards through the thyro-hyoid membrane.

The writer reports the following case: Woman, aged 30.
Seen first, 6th May 1913. In autumn 1912 became gradually
hoarse with intermissions. Dyspnoea on exertion. At the same
time a swelling appeared in the right side of the neck. On
laryngoscopic examination the right ventricular band was seen to
be swollen to about the size of a cherry. The swelling on the
outside of the neck lay between the thyroid cartilage and the
lower jaw. It was tympanitic on percussion, and when punctured
with a syringe air was drawn off and the swelling diminished
greatly in size. The tumour reappeared in a quarter of an hour.
23rd May 1913, operation on account of dyspnoea. Local
anaesthesia. Incision over swelling in neck. Tumour connected
with digastric by connective tissue. Depressor muscles of hyoid
divided and sac exposed. Sac pierced the thyro-hyoid membrane
by a stalk as thick as the little finger. Opening in membrane
enlarged, and another sac seen inside connected with the larger
one outside. Superior laryngeal nerve anaesthetised with novocain.
Sac dissected out. Opening into ventricle not seen. The tumour
was the size of a hen’s egg, with a constriction at the site of the
thyro-hyoid membrane. The air could not be pressed out, and no
opening could be found. Probably there had been a valvular
opening, as the sac filled up again so rapidly after puncture.

Unlike most other cases, there had been no increased air
pressure to account for its formation. The author believes in
puncture with a hypodermic syringe as a diagnostic method.

J. K. Milne Dickie.

PSYCHIATRY.

PHYSICAL DEVELOPMENT IN THE MENTALLY DEFECTIVE.
(614) (Lo sviluppo flsico nei frenastenici.) L. Ciampi and H. Valdizan,
Riv. ital. di Neuropat ., Ptichiatr. ed Elettroter 1914, vii., p.' 193.

A statistical study based on the examination of 600 cases, aged
from 5 to 14 years, and illustrated by tables showing the
relation of increase in size and in weight to sex, and to the form
of mental defect. J. D. Rolleston.

424

ABSTRACTS

GENERAL PARALYSIS AND PREGNANCY. (Paxalysie gtfninle
(016) et grosses*®.) J. de B. de Lavebqne, Tkiset de Paris, 1913-14,
No. 443.

The thesis contains the histories of seventeen cases, three of which
are original.

The writer’s conclusions are as follows:—

1. Pregnancy is rare in general paralysis.

2. Pregnancy may ocour at any stage of general paralysis, and
appears to accelerate the course of the disease, and sometimes
to aggravate the symptoms.

3. In rare cases there is improvement or disappearance of
the symptoms.

4. Delivery is followed sometimes by aggravation of the
disease, but usually hy a transient remission.

5. Pregnancy as a rule goes on to full term.

6. Labour is very often painless, and is in most cases very
rapid.

7. The infant is usually normal.

8. Abortions, premature births, or births of children with
syphilitic symptoms or malformations are rare.

J. D. Rolleston.

FOCAL SYMPTOMS IN GENERAL PARALYSIS. C. Macpie
(516) Campbell, PsychiaU Instit. of the New York State Nospitalt, 1914.

Q. E. Stechert «fe Co. Price 9 1.26 net.

Nineteen cases are here analysed, both from the clinical and from
the pathological points of view. They are classified into the
following four groups:—

1. Cases of general paralysis with focal symptoms on the basis
of vascular disorders (4 cases).

2. Cases of general paralysis with focal symptoms on the basis
of localised severity of the process of general paralysis; Lissauer’s
atypical general paralysis (6 cases).

3. Cases of general paralysis with focal symptoms of traumatic
origin (2 cases).

4. Cases of general paralysis with focal symptoms which are
correlated neither with vascular disorders nor with localised
severity of the process of general paralysis (6 cases).

It is only within recent years that the introduction of cyto-
logical and serological methods, together with a definite histo-
pathological criterion (Nissl and Alzheimer), have made the
diagnosis of general paralysis at all certain, and even yet it is often
impossible, clinically at least, to differentiate between general
paralysis and cerebral syphilis. Among the cases which specially

ABSTRACTS

425

present diagnostic difficulties is the large group of cases of general
paralysis with focal symptoms. Focal symptoms may be due to
vascular changes, frequently of syphilitic origin, and occurring
before the onset, within the prodromal period, or after the disease
has become established. In regard to cases of localised severity
of the process of general paralysis, the factors which determine
this are quite obscure, and there seems to be no tendency towards
a systemic distribution. Traumatic lesions may precede or follow
symptoms of general paralysis, but the term “ traumatic general
paralysis” is unjustifiable. In the fourth group no anatomical
findings could be found to account for the focal symptoms, and
afford fresh evidence of the difficulty in correlating lesions and
symptoms. A. Ninian Brucb.

DIFFERENTIAL DIAGNOSIS OF GENERAL PARESIS. Adolf
(617) Miybb, Amer. Joum. Insanity, 1914, lxxi., July, p. 61.

By the "diagnosis of dementia paralytica” is meant progressive
parenchymatous syphilis of the brain. The diagnostic problem is
most difficult where we deal with processes also on a luetic basis,
but with a different type of lesion, e.g., the diffuse luetic meningitis
and gummatous processes; the luetic vascular affection of the
smaller vessels; the tabetic conditions with non - paralytic
psychoses, as well as syphilis combined with neurasthenia,
epilepsy, alcoholism, arteriosclerosis, and functional psychoses.

The best evidences of a parenchymatous syphilis are:—

1. The findings in the cerebro-spinal fluid. Historically the
points of importance are—(a) the platinum chloride reaction of
Mott and Halliburton, ( b ) the demonstration of a pleocytosis (with
plasma cells), (e) the demonstration of globulin, (d) the complement
fixation according to Wassermann, (e) the colloidal gold chloride or
Goldsol reaction. In importance these rank as follows— (a)
complement fixation with various antigens, ( b ) the gold chloride
reaction, if it involves the total discoloration of the first five
dilutions, and relative discoloration of the dilutions, 6 , 7, 8 , (c) the
presence of globulin either in the form of the first phase of Nonne-
Apelt or with Noguchi’s butyric acid test or the Ross-Jones test, (d)
the presence of more than ten or twelve cells per c.mm., especially
when there are plasma cells and no leucocytes. A slight pleo¬
cytosis and traces of globulin may also occur in brain tumour.

2. The findings from brain-puncture, of most value in connec¬
tion with the cerebral introduction of curative fluids.

3. The “ cerebral symptom-complex ”; inconclusive, but consists
of speech and writing disorders, tremor, difficulty of co-ordination,
innervation, cerebral attacks, and exaggeration of tendon reflexes,

426

ABSTRACTS

occasionally with ankle clonus. Most of these symptoms occur
also in toxic states, especially bromide intoxications.

4. The “ tabetic symptom-complex,” mostly eye symptoms.

5. Change in mental functions, loss of memory, change of
personality, &c.

6. Combined mental and neurogenic attacks of an apoplectiform
or epileptoid nature.

Next one must try and determine (1) if all the symptoms are
paretic, (2) the chances of remissions, and (3) the localisation of
the process. Here the cerebro-spinal findings are of special value.

A. Ninian Bruce.

WHAT IS PARANOIA? R Stanley Abbot, Amer. Journ. Insanity ,
(518) 1914, lxxi., July, p. 29.

Kraepelin’s conception, as defined in 1904, was that “there is
undoubtedly a group of cases in which delusions are the most
prominent, if not the only symptoms of the disease. In these
cases a chronic, stable system of delusions gradually develops
without any disorder of the train of thought, of will, or of action."
Two years ago he wrote of paranoia as being not a disease process,
but a mental twist, an abnormal development, occurring under
the ordinary stress of life in a person psychopathically predisposed
by internal conflicts and by a mixture of egotism and suspicious¬
ness—the “ paranoid ” constitution.

Bleuler (1906) and Hans Maier (1913) believe paranoia to be
a psychosis in which some complex or group of complexes has for
the patient such strong associated feelings or emotions that the
content of thinking in lines related to the complex is determined
by these affects instead of by facts or logic (Bleuler’s autistic
thinking). Errors thus arise which the patient cannot correct.
Hence, with persistence of the tendency to this affective response
to the complex, whenever anything in the individual or in the
environment arouses associations leading to it, errors are per¬
petuated, new ones are made, and thus delusions are formed,
persist, and develop (Maier’s katathymic delusions). Wishes, fears,
or internal conflicts are what give rise to such complexes. Only
the thoughts and feelings connected with the complexes are
abnormal; all the rest is normal.

A special predisposition, perhaps consisting in constitutional
defect with bad heredity (Krafft-Ebing), a primary disposition to
think with short associations (Friedmann), a special psychopathic
constitution (Kleist, Bleuler, and others), an egotistic and suspicious
personality with internal conflicts (Kraepelin), or an imaginative
personality with lively emotional reactions (Maier), may be the
necessary soil for the development of paranoia. Practically all

ABSTRACTS

427

writers, except Ziehen and his followers, agree on the chronicity
and incurability of paranoia, though a very few recoveries have
been reported.

The author concludes that unless the word be used in a
symptomatic or descriptive sense, paranoia is a psychosis, but not
a disease process. It is neither a pure affect-psychosis nor a
pure ideation-psychosis, but rather a combined associational affect-
ideation-psychosis. It is a continuous self-perpetuating faulty
association of ideas and affects without disturbance of the thinking
or affective or conative processes as such. It is purely functional,
but not related to the manic-depressive or dementia praecox
psychosis, which are ordinarily, though wrongly, called functional.
Hence it does not lead to dementia, and it does not necessarily
have any of the symptoms of the other psychoses except delusions,
which may occur in all of them. Its mechanism is that of
prejudice, but the basal complexes are very intimate and personal
ones, with correspondingly strong and durable effects. This con¬
ception gives us some therapeutic hope, realised in at least
one case. A. Ninian Bruce.

DEMENTIA PRJECOX IN THE EIGHTH EDITION OF
(519) KRAEPELDTS TEXT-BOOK. H. Douglas Singer, Journ. New.
and Afent. Die., 1914, xli., June, No. 6.

In 1902 Kraepelin defined dementia praecox as “a series of
diseased pictures, the common characteristic of which is the
outcome in peculiar states of weak-mindedness.”

In the latest edition the above definition is in the main
adhered to, but Kraepelin now proposes to separate off some types
in which the outcome shows certain differences. This whole
group of disorders is now designated by the general title, "Die
endogenen Verblodungen ” (endogenous deteriorations). The group
is defined as “ a series of diseased pictures, the reciprocal clinical
relations of which are still entirely unclear, but which show the
common peculiarity that they arise from internal causes without
recognisable external occasion, and that, at least in the great
majority of instances, they result in a greater or less degree of
psychic infirmity.” This broad group is then subdivided into
Dementia Praecox and Paraphrenia.

The deterioration in dementia praecox is emphasised as in¬
volving principally the interest and activity, and much stress is
laid upon the character of the sense-falsification and the absence
of coherent relation between them and the patient’s thoughts.

The three types, the hebephrenic, katatonic, and paranoid, have
now been split into eight main forms with a few subdivisions.

1. Dementia Simplex is defined as "an extremely insidious

428

ABSTRACTS

impoverishment and erosion of the entire mental life.” Patients
belonging to this group are slovenly, inattentive, indifferent, shy
and retiring, fretful and irritable, without any very clear or
definite signs of insanity. This disorder is of slow development,
and may lead to extreme deterioration.

2. “Silly” (. Ldppische ) Deterioration. —This group includes a
large number of those cases previously classed as hebephrenia.
Besides the progressive mental deterioration there is marked
desultoriness in thought, feeling, and act. The most striking
disturbances concern the conduct; the acts are often strange,
absurd, and unexplained, more or less impulsive. In 60 per cent,
the onset is before the age of 25.

3. Simple Depressive or Stuporous Deterioration includes “ those
cases in which, after an introductory phase of depression with or
without the manifestations of stupor, there develops finally a
psychic infirmity.” About 20 per cent, of this group are stated
to begin acutely, especially when stupor is present. The mood
is at first anxious and depressed, but later irritable, impulsive
conduct, grimacing, mannerisms, and negativistic tendencies may
show themselves. Some of the cases belonging to this group
closely resemble the depressed form of manic-depressive insanity.

4. Depressive Deterioration with Delusion Formations. —The
onset is similar to that in the previous type, but is more frequently
acute or subacute. In this form the delusions are widely
developed and have a bizarre form.

5. (a) Circular Form. —The onset may be gradual or acute, and
is characterised by subjective complaints and hypochondria, sense-
falsifications, and delusions of a depressive type. Following this
stage of depression there appears one of excitement. The chief
symptoms are the restless, aimless excitement with numerous
impulsive acts. The excitement is one of considerable monotony
and repetition, and finally passes into deterioration. This course
is interrupted by remissions, with marked improvement in 53 per
cent, of cases, and in 14 per cent, such remissions occur several
times.

(b) Agitated type.

6. Katatonia. —This name is now restricted to a group “in
which the peculiar excitement with katatonic stupor controls
the picture.”

The onset is acute in 41 per cent, and gradual in 31 per cent.
In one-third of the cases remissions occur, and in some this may
amount to apparently complete recovery.

7. Paranoid. —In this group the chief symptoms are delusions
and sense-falsifications, and definite deterioration of the dementia
praecox type ensues.

ABSTRACTS

429

There are two sub-types, (a) dementia paranoides gravis and
(6) dementia paranoides mitis.

8. Cases of Speech Confusion .—“The development and course
correspond in general with those of dementia prsecox. They differ
in that the outcome is a state characterised essentially by an
unusually striking disturbance of speech expression, with propor¬
tionately little interference with other mental functions.”

In regard to the etiology of the disease, Kraepelin’s final
conclusion is that it is probably an auto-intoxication. He refuses
to consider the modern views as expressed by Freud and Jung,
in regard to the psychopathology of the disease.

Paraphrenia is the name proposed for a group of cases similar
to those of the paranoid form of dementia prsecox, but differing
in that the affects and will are only very slightly disturbed.

Four sub-types are described:—

1. Paraphrenia systematica.

2. The expansive type.

3. Confabulating form.

4. Paraphrenia phantistica.

D. K. Henderson.

SIMILAR AND DISSIMILAR PSYCHOSIS IN RELATIVES. Charles
(520) Ricksher, Amer. Joum. Insanity , 1914, lxxi, July, p. 133.

The following conclusions were based upon an examination of
the histories of 314 individuals, 61 parents and 62 children, and
191 brothers and sisters from 90 families, in all 151 families.

Similar psychoses occur in about 50 per cent, of parents and
children, and in brothers and sisters in about 66 per cent, of the
eases. The age of onset of the psychosis is, as a rule, earlier in
the child than in the parent. When the father and daughter, or
mother and son, each suffer from dementia prsecox, the difference
in the age of onset is most marked. Idiot children are not found
as often as children with less severe mental disorders. Epilepsy
in this series was transmitted through the fathers to the sons.
The transmission from mother to child is only a very little more
frequent than from father to child. Dementia prsecox is the
most frequent psychosis found in brothers and sisters, and is the
psychosis most frequently found in one child when the brother
or sister suffers from some other mental disorder. Mental disease
is more apt to appear earlier in sisters than in brothers, except
that when dementia prsecox is found in one child and manic-
depressive insanity in the other, the average age of onset is less
in the brother than in the sister, whether the brother suffers from
manic-depressive insanity or from dementia prsecox.

A Ninian Bruce.

430

ABSTRACTS

AN INTOXICA TION P SYCHOSIS ASSOCIATED WITH CIRRHOSIS

<521) OF THE LIVER. Guy H. Williams, Amer. Joum Insanity, 1914,
lxxi., July, p. 149.

Three cases are described, all occurring in men aged 60, 59, and
72 years respectively. They all showed disorientation as to time,
place, and persons. In one case this grew much better under
eliminative treatment, but again became marked when the patient
became toxic. It is impossible to say what the toxic agent was,
but, as cirrhosis of the liver was present in all the cases, it is
suggested that it may have arisen from defective liver metabolism.
There were no autopsies. A. Ninian Bruce.

IS THERE AN INCREASE AMONG THE DEMENTING P8Y-

(522) CHOSES7 Charles P. Bancroft, Amer. Joum. Insanity , 1914,
lxxi., July, p. 59.

The writer feels that while it is demonstrably certain that paresis
has increased during the last twenty-five years, it is by no means
equally certain that an actual increase in the other dementing
psychoses has occurred. A decrease in the dementing psychoses
may be attained by curtailment of the immigration of mental
defectives at the source, restriction of alcoholic indulgence,
prevention of syphilitic infection, stricter segregation of the
feeble-minded, and greater intelligence in entering upon the
marriage relation. A. Ninian Bruce.

A STUDY OF BRAIN ATROPHY IN RELATION TO INSANITY.

(523) A J. Rosanoff, Amer. Joum. Insanity , 1914, lxxi., July, p. 101.

Brain atrophy cannot be precisely measured by brain weight
alone; both the cranial capacity and the brain weight must be
taken into account. The measure which most nearly approaches
a normal constant is that of the average width of the space
between the skull and the brain, the cranio-encephalic space. An
index of this space, and consequently an index of atrophy, may be
obtained by subtracting the cube root of the brain volume from
the cube root of the cranial capacity. The brain volume is
obtained by dividing the brain weight by 1'037, the average
specific gravity of the brain.

The index of atrophy was measured in 452 cases, and it was
found that it slightly increased with age and with emaciation. In
cases of insanity it varied with the clinical group; it is greatest in
cerebral arteriosclerosis, and is greater in general paralysis and in
senile dementia than in dementia prrecox. Mental deterioration,
of whatever nature, goes hand in hand with brain atrophy. An
analysis also showed that the atrophy of the brain in dementia

REVIEWS

431

praecox is not due to age or emaciation, and that, in consequence,
dementia praecox must be a disease associated in some way with
changes in the brain which lead to atrophy.

A. Ninian Bruce.

"Reviews.

THE TRAINING SCHOOL BULLETIN, 1913-14. Published at Vine-
(524) land, New Jersey, U.S.A.

The Training School Bulletin is a small periodical published by the
Training School at Vineland, New Jersey. The Training School
is devoted to the study, care, and training of mentally-defective
children. Private, State, and free patients are admitted to the
school, where they are classified according to their physical and
mental abilities.

The “ Association of the Training College ” is engaged in promot¬
ing the colony idea, and encouraging the foundation, in the various
States, of colonies for the permanent care of the feeble-minded.

The Bulletin contains articles dealing with the study and care
of the feeble-minded at Vineland and elsewhere, many of which
should be of interest to those concerned in the operation of our
own Mental Deficiency Act. Thus in recent numbers there are
several articles on the Binet tests, an article on the de Sanctis tests,
articles on Eugenics, Crime and Mental Deficiency, Moral Defec¬
tives, Laboratory Equipment for an Institution for the Feeble-
Minded, The Montessori System, and reviews of recent literature.

The following extract from the Superintendent’s report with
regard to the founding of colonies indicates the kind of work
which is being done under the auspices of the Association:—“ See
how fast it (the colony idea) has moved at Menantico. The land
was purchased May 5, 1913. The first two boys went into the
portable buildings July 15, 1913. The other buildings are made
of cement blocks, made by the boys, under the direction of the
masons. To-day (April 1914) we have two dormitories holding
twenty-five each, a dining-room and kitchen building, bath house
with hot and cold water, sewer lines and cesspool, rooms for
employees and for mending, and a shop building with pump and
five-thousand gallon water tank fifty feet high. . . . The colony
unit is to be one hundred. With the additional buildings and
equipment for the extra fifty, we shall have provided the com¬
plete unit for $200 per capita.” This includes $5,455 for the
land. W. B. Drummond.

432

BOOKS AND PAMPHLETS RECEIVED

DISTURBANCES OF THE VISUAL FUNCTIONS. Prof. W. Lohmann.
(526) Translated by Angus Macnab. Pp. 185. John Bale, Sons, A Daniels-
son Ltd., London, 1913. Price 15a

Under this title the author has collected a large number of
observations mainly referring to the physiological and psychical
aspect of sight, and thus provides much information on subjects
which are barely, if at all, mentioned in most text-books. The
reader is invited to explore that interesting but very difficult
area, in which vision and its correlated processes meet and give
rise to perception with its widespread associations, and which has,
therefore, attractions both for the oculist and the psychologist

The book is divided into twelve chapters, of which the first
three deal with vision and blindness, while in the fourth the
differences between central and peripheral vision are discussed.
The next three chapters consist of expositions of current views on
disturbances of adaptation and the light sense, and on the colour
sense. The eighth chapter deals with the chromatopsias, and the
remainder with colour hearing, binocular vision, visual disturbances
in disease of the tracts and centres, and memory pictures.

All of the subjects discussed are of great interest, and the
book contains much that will stimulate further investigation:
at the same time it iB somewhat disappointing to find that the
greater part of the book consists of a compendium of the observa¬
tions and opinions of others, with many quotations, Bet down with¬
out much comment either favourable or the reverse. The evidence
is presented, but very little in the way of a judicial summing
up, and the author’s personal opinions are not easy to discover.

For this the inherent difficulties of the subject are no doubt
responsible, and therefore the greater is the credit due to Professor
Lohmann, whose book is the first attempt to present the facts
connected with the most difficult and abstruse aspect of the visual
function in a collected, concise, and easily readable form.

On these grounds alone the present work supplies a long-felt
want, and will be heartily welcomed by all who are interested in
the subjects with which it deals.

The translation and the illustrations are excellent, and the
publisher’s work is of the best, with the exception perhaps of the
very shiny paper. H. M. Traquair.

BOOKS AND PAMPHLETS RECEIVED.

Campbell, C. Macfie. “ Focal Symptoms in General Paralysis ”
(Ptychiat. InstituL of the New York State Hotpitale, New York, 1914.
Pr. 91.26 net).

Lohmann, W. “Disturbances of the Visual Functions.” Translated
by Angus Macnab. John Bale, Sons A Danielsson, Ltd., London, 1913.
Pr. 16a

■Review

IFleurologiP anb ps^cbtatr^

©dginal Erttcles

THE MECHANISM OF PERIODIC MENTAL DE¬
PRESSIONS AS SHOWN IN TWO CASES,
AND THE THERAPEUTIC ADVANTAGES OF
SUCH STUDIES . 1

By L. PIERCE CLARK, M.D., New York City.

Notwithstanding the fact that periodic depressions of a so-called
simple neurasthenic or hypochondriacal character have been
known so long that many special sanitoria have been largely
devoted to their treatment, little effort has been made to make
careful mental analyses of such cases to determine the psychogenic
factors at work in these depressions. So great has been the stress
laid upon somatic causes of disturbed brain metabolism that one
has usually been quite satisfied to search for digestive or circulatory
disturbances in the periodic neurasthenias, and when such physical
disorders were found, as is usually the case, we have been willing
to rest content and forthwith base a treatment upon these facts.

It is not that the line of investigation in neurasthenia has been
necessarily wrong, but that such researches are incomplete, and
do not place us in possession of all the facts. I venture to say
that every case of periodic depression usually has some somatic
disturbance, but I hold it is equally true that in every case there
is just as certainly an abnormal psychic mechanism at work. It
matters little in this or similar studies whether one speaks of this

1 Read before the N. Y. Psychiatrical Soc., June 3, 1914,

L. PIERCE CLARK

4.‘U

particular mechanism as the cause, or merely as a psychogenic
factor in the production of the sequential symptoms of neurasthenic
depression. At present no one would be so bold as to say that
such depressions are really produced by either a somatic disorder
or by mental factors, inasmuch as we are not pardoned in even
considering mind disturbances in terms of brain structure altera¬
tions, much less in terms of remote physical disease. Be that as it
may, I shall undertake to set forth here some analyses of the
psychic mechanisms present in periodic depressions, which facts
seem to me of sufficient moment in our full understanding of such
disorders to warrant our close attention and consideration. Even
though it may ultimately be found that recurrent neurasthenic
depressions of every sort are essentially biochemic, and therefore
essentially somatic and not psychogenic, studies upon the mental
mechanism as entered upon here will not be in vain, as the latter
studies may make plain the more delicate and successive order in
which the somatic causes assault the psyche, the relative order by
which its natural defences are broken down, and finally will give
us definite information concerning the breadth and depth of
subjugation its innate powers have sustained. It will finally
disclose how strong the native trends are, and what chance they
have in making the proper adaptations to a healthy life in future.
Not a few data have already been presented upon a field closely
allied to the one studied here; they are the intramural studies of
the frankest manifestations of the manic-depressive syndrome.
These studies have not only greatly cleared the nature and
pathology of such syndromes, hut they promise therapeutic aid in
a field hitherto considered hopeless so far as obviating recurrent
attacks in such individuals are concerned. It is hoped these
studies upon a simpler type, at the lesser end of the scale of
depressions, may serve similar diagnostic and therapeutic ends.
The work here presented has been prompted not a little by the
psychiatric studies already alluded to, both in this country and
abroad. I venture to hope the inspiration in this study may be
mutual, and the work in future will be fully co-operative.

In presenting such a study of periodic mental depressions, I do
so with the greatest diffidence, for the reason that the cases I
shall present do not suffer that degree of mental dilapidation which
permits one to penetrate the psyche to the depth reached in the
more frankly disordered melancholies. My first case, analysed six

MECHANISM OF PERIODIC MENTAL DEPRESSIONS 435

years ago, when she was 44 years old, had had two depreseive
attacks yearly since 24 years of age, but has been entirely well
since the treatment now finished over five years ago.

In order that this study may be considered in a fair light, I
must say that I shall hold no brief for the somatic symptoms of
neurasthenic depression, as they have been too long uppermost in
the final court of treatment of nervous disorders, and are well
known to all. On the contrary, I shall make argument for the
innate right for neurasthenic depression to be considered on its
own basis of mental pathology, the laws governing which for a
long time have been too lightly held by most of us. The study
will embrace two case-presentations, given as briefly as possible, to
show the mental or dynamic processes operating in each. If it
be shown some time in future that there exists a large and
important physical disorder, such as uterine displacement and
adhesions in the one patient, or a long-standing chronic appendi¬
citis should be proven to be present in the other, the psychogenesis
of the depressions will, to my mind, be none the less true although
the mental mechanisms under study, as being the sole etiologic
factors for the mental state, may be robbed of some of their value.

The first case is that of a woman of 50, who has suffered from
long-standing and recurrent attacks of mental depression of the
neurasthenic type. I first saw her in 1909 in one of her
characteristic depressions, at which time, as a result of the usual
routine treatment of baths, rest, massage, and diet therapy she,
gradually regained a fair state of physical and mental health in
the course of two or three months. At present she suffers from
a similar attack; there is physical fatigue and a great depression
of spirits. She has had fearful dreams and nightmares, after
which she is sleepless and restless for the greater part of the
night. There is a heavy, dull headache, pains in the back, stiffness
of the neck, and a sense of an encircling, constricting band about
the top of the head. Now and then she feels dizzy, nauseated,
has pains about the heart, and a feeling of impending collapse.
All the above symptoms are worse in the morning and gradually
wear off, with the exception of the mental depression, the slowness
of thought and action, the mental indecision, the feeling of
unworthiness, and that she is to lose her mind or become an
invalid, or dependent on charity. It will be shown in the
analysis of the case that many of the above symptoms are more or

4.36

L. PIERCE CLARK

less 8yml)olie representations of wish-fulfilments of death trans¬
lated from the dream state to the waking, conscious life.

Our patient was the fifth child in a family of fourteen, of whom
five are now living. All the brothers and sisters were of the
neurotic temperament, and in fact both branches of the family
stock were of a highly nervous temperament, although of a
different make up than that of our patient. There were no manic-
depressive cases in the family history. As a school pupil our
patient had a good standing in her classes except in mathematics,
which she never mastered. She was of a musical temperament,
lively, and of a sympathetic nature. She lived a very sheltered
life, was much petted and protected by her mother. In brief, she
was of a frankly open type of personality, and gratified herself
freely in a care-free social life. She was very dutiful and obedient,
easily controlled as a child, and always did as her parents wished
in all things. At the early age of 16 she became engaged, and
under the cover of an apparently strong attachment she continued
her social interests to such a thoughtless extent that her engage¬
ment was broken off by her fiance', owing to her own acta. The
engagement was renewed in a year or so by her surrender of a
too free conduct with other young men. She was finally married
at 26 years of age, and her husband died six yearn after.

On her marriage she lived with her mother-in-law for three
years. Her mother-in-law was extremely jealous, calling for our
patient’s best effort in cheerfulness and tact to avoid conflicts.
The mother-in-law always had the patient’s husband call her
“ sister ” rather than mother, and seemed to require his childish
petting and caressing. The father-in-law was a cold, stern man,
and gave his wife little affection. There was an active rivalry in
the affections of our patient’s husband on the part of his mother.
Coupled with this, financial troubles soon began, and all were
required to economise to the utmost. The mother-in-law now
spoke of the lost opportunities of her son’s chance to marry a
much richer girl. Coupled with this stress was the active rivalry
of the husband’s younger brother, who was also closely attached
to him, and considered the patient as an interloper. Even to
this day he has not become reconciled to her having taken his
brother away from the home. This younger brother is still
unmarried, and lives with his mother.

The sexual act in our patient was always painful and extremely

MECHANISM OF PERIODIC MENTAL DEPRESSIONS 437

unpleasant. She seems to have known nothing of the details
of sexual life until she was married. She never spoke to anyone
of the painful or depressive character of the sexual act, not even
to her husband, although she doesn’t doubt that he was fully
aware of how the act affected her, and how she dreaded it.
Although there was no physical difficulty in the act, it was never
pleasurable, and she avoided it as far as possible. She never took
any artificial means to avoid pregnancy. After the sexual act
she felt nervous and very tired and sleepy, but felt no depression.
At the first pregnancy she had a miscarriage before she was aware
that she was really pregnant. After each of the first two abortions
she felt no depression, but within a few days after the successful
and uneventful delivery of the child from the third pregnancy she
felt bad, became depressed without obvious cause, and wanted to
be alone. The next day she had pains in the arms and wanted
them rubbed. She felt sick all over, but there were no physical
signs of illness. She began to weep, thought she was to lose her
mind, and thought of committing suicide, and thinks she would
have attempted it if someone had not stayed constantly in her
room. She didn’t care to have her husband about, and never
asked to have her child with her. This depressive attack, which
she calls her great nervous prostration, disappeared in two months,
but ever since that time she has had depressions every four or five
months of more or less the same character. She usually feels
a slowness of action, hates to make decisions, there is a shaking,
tingling sensation in the arms, the heart beats rapidly, and she
feels as though she cannot live and doesn’t desire to do so. There
is a loss of sleep and appetite, and there is always an aimless,
undefined fear.

To summarise up to and including the depression after the
childbirth: We find a woman of rather superficial mental type,
of a highly sensitive temperament, who, after marriage of a not
very marked love-fixation, had financial and family worries of an
intensive sort, who never had other than painful intercourse
with her husband, with nervousness but no depression after each
attempt of the act, but who, through desire for children and her
feelings of duty to the husband, actually bore a child after the
third pregnancy, at which time she passed abruptly into a deep
and painful depression. Although the husband has been dead
fourteen years, she still has a feeling as though there were some-

L. TIERCE (’IARK

4:58

thing unfulfilled in her life with him, and reproaches herself for
much of her past life with him. The son is viewed lately as
a relic or remnant of the father, and on him she centres her love
and fears. She places on him an over-determined contrition of
spirit, as though to say, “ I brought you into the world, and now
I must see you through it.”

In a more frank review of her depressions she began to search
her childhood for the first faults in character. She reproached
herself because in the physician’s eye and in her own, too, she had
blamed her parents unduly for not rearing her properly, and
because she had cast reflections on her husband for not leaving her
provided for by any life insurance.

In a still franker talk, it was shown that the patient had kept
alive a ghost-fancy of her dead husband, whom she mentally
consulted as regards all her acts and thoughts; that he played a
larger part in her life now' than when living, and when this grew
indefinite the depression was not far off. She now sees she was
so much attached to her mother and older sister that she was
sexually a cold wife, and on the death of the mother, sister, and
husband, she had but a child left as a remnant connecting her with
the past, and now he is engaged and soon to be married. Even
his announced intentions of marriage caused a continued depression
lasting a year.

Still deeper analysis shows that the patient surmised her
painful intercourse with her husband was unnatural, and
that to talk frankly with other women about it would only
make her feel a sense of unworthiness and bring out her defect.
Besides, she thought she could make up for this by being more of
a sweetheart to him, and thus make him foiget she was not all to
him a good wife should be. After each pregnancy there resulted
a conflict between the desire for children for her husband’s sake,
and the feeling that the birth of a living child would disturb the
lover relations, a not uncommon conflict in such cases (reproaches),
the “ ever to court and never to wed ” principle, which was her
ideal of a happy marriage. Whenever she hears that one of her
friends is about to have a child she feels a great pity for her, and
a sort of depression and sadness.

After each abortion there was a sense of reproach to the
patient; she thought it might be her fault the pregnancies did not
go on to term, and she was therefore examined repeatedly by

MECHANISM OF PERIODIC MENTAL DEPRESSIONS 439

physicians to determine that she was blameless. After the third
pregnancy and its successful termination, instead of elation, content¬
ment, &c., she went into a morbid mental depression, disliked her
child and husband, &c., and had grave fears her son wouldn’t live to
grow up, and ever since he was born her fears have been centred
about him and his welfare. In the dream he always falls seriously
ill, but not fatally, nor does he ever die in the dream; being a
remnant of the father this still protects him from the unconscious
annihilation he might otherwise suffer in a more ambitious dream.
She had wished she might avoid all pregnancies in future after
the second abortion.

Apropos of suicide being one of the ways out of her periodic
depressions, we find the following dream of pertinence and interest
in our patient. She dreamed she was in a large building thronged
with all sorts of people from all walks of life, all on different
floors (stratified class society of real life); she finally goes down
a long flight of stairs (sexuality, See.), and there comes upon an urn
placed upon a pedestal near which stands a Japanese, silent and
grave, dressed in black robes (death). After looking long at her,
the Japanese asks her if she wants a picture of herself, and without
waiting for her reply he solemnly takes one from the urn, which
she felt contained her “destiny.” She finds the picture is of
herself, but the upper half of the face is entirely like a beautiful
Japanese, and a confused identity masque-effect is produced.
Consciously, in the waking state, she finally identified this with
“ Madam Butterfly,” which play and opera she has seen very
frequently. It will be remembered when Madam Butterfly finds
her lover has left her, never to return to the old relations, she
commits suicide. Madam Butterfly is the play-opera which
fascinates our patient most, and next comes Shakespeare’s “ Romeo
and Juliet.”

To summarise the case. We have a woman of 50 subject to
periodic depressions for twenty-four years, dating from the birth
of her only child. She led a rather gay, superficial, restricted
child and girl life. She was greatly attached to her mother, but
became engaged at the early age of 16, which engagement con¬
tinued off and on for ten years before marriage. At marriage she
had pronounced family and financial worries. The marriage
relations were avoided when possible, were painful and extremely
wearing to her health; at the third pregnancy a boy was born,

110

L PIERCE CLARK

ami a sharp and marked mental depression ensued. Her child
was an object of dislike—she could not or would not nurse it;
the menstrual period was absent for two years. After a firm
injunction by the surgeon who repaired the laceration, an opinion,
which was concurred in by the family physicians was that she
should have no more children, and the marital relations ceased
thereafter. As is well known, one identifies himself with those
statements of the physician which suit him best or enable him to
do what he wants to do, it being only too frequently a case of a
bribed oracle. Six years after marriage her husband died, leaving
her penniless, with a child to care for. From that time to the
present day she has never been more than six months free from
neurasthenic depression, and its usual host of bodily ills following
in the wake of such a nervous disorder. The depressions are
always brought on by some new life adaptations or adjustments.
First there is the shock, then regression and depression, and
finally reproaches for an unalterable past with the husband, and
finally the reproach is cast back upon the parents for defects in
her bringing up as a child, and in the deepest depression, as at
the childbirth, it finally rested on her own fault, and then deeper
depression and thoughts ensued, and the idea of suicide followed.
The mental mechanism would seem to be a regressive depression
following an incomplete discharge of the libido ; the primary fault
would seem to suggest a homosexual maternal-sister attachment
as shown in the dreams and free associations.

I n every depression she has had since the first great one, there
is always the same mechanism ending in the conflict, “ I would
not l»o having such depressions if I had not had that one at
childbirth, and I wouldn’t have had that if I had not had a child.”
This brings up unbearable wishes and fears in regard to the dead
husband and her living son; then follow the reproaches as to
the unsatisfied and incomplete marital relations, then parental
reproaches, and occasionally, in deepest despair, the reproach that
she is herself, after all, the one great fault, and then suicide
musings enter. As the final note to the case, I would Bay that the
present depression was relieved entirely in three weeks with a far
superior ability at the end to meet life issues than had been
attained by any previous plan of treatment.

To summarise, we have a woman of the open type of personality
who is not able to adapt herself to the new state of maternity.

MECHANISM OF PERIODIC MENTAL DEPRESSIONS 441

While many would call the latter an added bond in the married
state, it really is a new adaptation in life quite different from that
which formerly obtained. If we take into account the difficulty
met in ordinary sexuality, coupled with the mental breakdown
shown here at maternity, we will see how the whole adaptations
required make for a more or less complete severance of the older
or platonic love relations. There was therefore a new adjustment
required which broke the libido attachment that formerly obtained,
hence the shock and regressive depression. All subsequent
upsetting causes have been in the nature of more or less complete
temporary withdrawal of the libido in its larger meaning. Certain
additional facts during the treatment and at its termination
which, unfortunately, cannot be brought out here, proved over
and over again that while the patient is now in a more comfort¬
able and understandable frame of mind than she has ever been
before, there still remain certain primary antagonistic trends to
sexuality which have not been essentially changed, and which
it would seem to be unwise to attempt to alter at this late day
in one who is no longer young and not primarily endowed with
great innate plasticity for adaptations in life. A further develop¬
ment of the hypothesis to cover both cases will be elaborated at
the end of the second case, which I will now briefly set forth.
It is that of an unmarried man of 34 years of age who has had
periodic mental depressions for thirteen years; during this time
seven attacks have occurred, in 1901,1904, 1905,1906,1909,1911,
and the present attack which began in December of last year.

The general characteristics of the different attacks are as
follows: He gradually grows quiet in manner, is disinclined to
meet social demands, sits about the house, and worries in a mildly
anxious manner that he is to lose his job, and that others are
to be promoted above him. In a few days the depression appears,
he loses his appetite, sleeps little, grows more restless and vague
of purpose, at times becomes a little fault-finding, and cannot make
decisions of a simple personal character. His thoughts come
slowly, and finally he thinks he is going to die of insanity or
brain disease, and often expresses a wish that he might contract
some fatal disease like pneumonia or typhoid to end it alL In
the final depth of the depression he lays his hopeless condition
upon the fact that he indulged in excessive masturbation in youth.

The patient is the youngest in a family of four, three of whom

442

L. PIERCE CLARK

are living. There was evidence that the two sisters of the patient
are of relatively the same temperamental make-up as our patient.
The mother, who died eight years ago, suffered for twenty-five
years prior to her death from manic-depressive insanity, with
occasional lucid intervals. The circumstances under which her
mental depression was brought about were as follows: After
marriage the father was unable to support his wife and children,
and the mother took a position as matron in what was then the
Ward’s Island Immigration Hospital. Things went on fairly
satisfactorily until a protest was made to the administrative
authorities of the hospital that her home duties and the rearing of
children were conflicting with her official duties in the institution.
She was then pregnant, and although she remonstrated in the
controversy with her husband as to what was to be done, the
husband suggested and later gave her abortive remedies. From
the time of the abortion there was a sharp depression, an intense
hate toward the husband, and a condition of manic excitement
which lasted continuously, with slight lucid intervals, until her
death. The excitement took the phase of destruction, dilapidation,
and disregard of home conditions, and the mother was practically
maintained as an insane patient in her own home until her death.

One of the first outbursts was on the occasion of her entrance
to her husband’s room when she found one of the children naked
on the floor outside the father’s bed while the father was asleep.
With terrific fury the mother awakened him by throwing a couple
of pailfuls of water on him in bed.

The father’s temperament is designated by his oldest daughter
as being that of a Catholic Puritan, extremely seclusive, and rather
miserly, efficient, one who had never met the obligation of a father
to his family in its broader sense.

The foregoing facts relating to the mother’s mental disorder
are mentioned here as it makes plainer the home setting and
the background of family relationship upon which our patient
developed his depression.

Our patient had a common school education and a two years’
training in the New York City College. He had an open type of
personality, a rather depreciative opinion of himself, was sociable,
generous, little concerned with doubts and scruples in everyday
life, and is fairly capable as a city surveyor, his present employment.

He was always rather fantastical in youth, and has built air

MECHANISM OF PERIODIC MENTAL DEPRESSIONS 443

castles all through life. His mood is very variable, and has been
so since early childhood. He was always affectionate and
demonstrative with his mother, and has always had a very
intensive dislike toward his father.

At 21 years of age he began work as an office boy in a
wholesale coffee house. From earliest childhood he had a great
curiosity with regard to sexuality, and made insistent inquiries
about it. He masturbated from 12 to 14 years of age, and had
normal intercourse at 17, but each time he indulged in this latter
act he was morally shocked, and a slight depression followed. He
returned to masturbation, which act was not fully satisfying, and
he could not bring himself to indulge in normal intercourse. He
then entered on the clerkship as before mentioned. Through an
intense application to work he sought to break off or to diminish
masturbation. He succeeded in stopping the habit for one year,
but during the latter part of this time he also fell in love, was
jilted, and to get square with the irritable depression engendered
he devoted himself more intensely to his work. To repress sexual
thoughts he engaged excessively in athletics, and fancifully thought
he would like to kill himself with work. He finally worked to
the exclusion of all pleasurable enjoyments. He thought being
an office boy was beneath his dignity, and strove to compensate
for this feeling by still more fanciful ambitions in his work. He
thought he would like to die in harness, get control of the entire
coffee trade, and corner the market. After existing for nearly
a year in this exalted mental state, which contrasted so strongly
with the actuality of not being advanced in his work, and in fact
of seeing others promoted over him, a genuine conflict began in
his mind as to how he was to get square with life. He became
a little over-fatigued, dispirited, and anxiously restless, couldn’t
sleep as before, and grew thin. He then gradually began to drink
more and more. Alcohol made him feel more efficient and
deadened the pain of business disappointment. The drinking
produced mild states of desire for inactivity and of depression,
which, when yielded to, were on the whole satisfying and pleasur¬
able. Still there was an undercurrent of irritability which the
alcohol less and less deadened, and besides there was a certain
“ want in the mind ” which the alcohol only the more inflamed.
Drinking was then discontinued, but in a few weeks the stomach
became disordered, there was loss of appetite, and a heavy pain

444

L. PIERCE CLARK

came in the stomach. The whole was found to have nothing to
do with indigestion. He then felt he must take up masturbation
again. The resumption of the habit eased all the old aches and
pains in the stomach, and the irritable depression vanished at
once. In a few weeks, however, masturbation failed of relief.
He felt languid and detached from life. There succeeded headache,
sleeplessness, loss of appetite, and a despair that his occupation
was not a proper field of work for him, and that there was no way
out At the earnest suggestion of his family, who now saw how
miserable he had become, he changed his work to that of
surveying, and studied very hard at both day and night school.
He was then specially coached for the civil service. After the
change of work, and in the light of new ambitions, sexuality
concerned him not at all. Life was worth while once more, and
he passed his service examination very successfully; he then went
into an exalted hypomanic state which lasted for two or three
days of elation, during which he neither indulged in alcohol nor
sexual acts. He then quickly sobered down and went to work;
the work, however, again proved rather disappointing. He was
set at rather menial tasks at first, carrying stakes and acting
practically as a lackey to older men in the service. Then, too,
he started surveying at a season of the year when there was little
to do and the hours of work were short. He felt listless, irritable,
fault-finding, and began masturbating once more, and at the same
time thought of renewing his studies for a better position in the
service. On the day he reluctantly picked up his old books again,
he felt that life after all was hopeless and that there was no way
out—life was a miserable failure. At once he felt a terrific shock
throughout the whole body, something broke in his head, he
became dizzy and fearfully depressed. He saw a doctor, went
to bed, and in a few hours regressed to youthful reminiscences,
and in ruminating upon the causes of his depression finally saw
the cause of his troubles was due to masturbation. In his own
words, "All the occupations were not sufficient outlet for my
ambitions; I felt overactive and beyond their poor possibilities.
I let off some of this excess of feelings in masturbation. I now
see I demanded too much of life, and there was no way out but
for me to break as I did.”

The history of this first attack is a rather tedious but detailed
account of the conscious life; the facts all lay rather near the

MECHANISM OF PERIODIC MENTAL DEPRESSIONS 445

surface, aud were rather easily pieced together in a coherent and
understandable pattern. The real fixed idea that has lain at the
heart of all his several depressions is the reproach for masturbating.
It was found on dream analysis, and by intense research of the
child life, that he had an intense sexual aggression at 7 years
of age toward a little girl friend, for which his mother gave him
punishment, and which, because of the very intense love for the
mother, caused him many sleepless nights and fearful dreams, in
which he awakened crying he “would never do it, no never!”
These renunciatory dreams now and then recur. He now knows
their origin and their significance; the whole childish episode of
sexual aggression which has now been fully recovered to conscious¬
ness was lodged against the habit of masturbation. The idea of
the act was also heavily conditioned from many collateral conscious
sources, such as quack books, supposedly good advice from friends
and relations, various newspaper happenings, certain acquaintances,
whose set habits he knew very well, becoming insane, &c.

Without going into the varied types of the same general
mechanism of the depression, I propose to submit for discussion
a hypothesis of the genesis of depression in terms of the libido
as shown in this case, and which applies equally well to all my
cases of periodic depressions. This second case will be taken as
a paradigm upon which I will elucidate the theory. Our patient
was of the frankly open type of personality, began to show great
sexual curiosity at 6 and 7 years of age, and even made sexual
aggressions at this age. The same were painfully and severely
repressed by the mother punishing the boy. He began masturba¬
tion at puberty in the face of the exaggerated and false knowledge
of its immediate harm and its remote consequences. He tried to
make the next normal sexual adaptation by ordinary intercourse,
but this was a distinct offence against the mother, whom since her
death he has more than once confused with the Holy Virgin. This
sexual adaptation having failed, he reverted to his former sexual
habits, which now proved no longer an adequate outlet, and so he
tried to sublimate the unrequited libido into athletics and his
work. His emotional adaptations proved inadequate for normal
love, and he could not requisition them in the inhibitory process
in the sublimation, consequently the work failed as it could not
be made large enough to fulfil the desires of the growing libido.
Then, too, the clerkship resulted in failure. There was, however,

446

L. PIERCE CLARK

enough strength in the power of adaptation, together with the aid
of the sister, to carry the whole life process on to one more tryout
in adjustment. But the next occupation, as the first, was doomed
to failure, and for the same reasons. A third effort was not
possible; even a reversion to a cruder and simpler outlet of the
libido by masturbation was not even temporarily effected at the
third tryout. The result was a break, a shock, regression,
depression, the reactivation of the prohibition of the mother, and
finally the consciousness of guilt, and then thoughts of suicide or
desire for annihilation. One might ask: But why did he have a
depression ? The inquiry would be equally pertinent about the
shock or the regression, as I believe the whole chain of symptoms
are all but parts of the one great process of failure in the effort at
compensatory sublimation of the libido. One must remember that
the law of the libido requires a continuous attachment or out-
streaming activity, and its withdrawal or cessation is as much an
actual loss to the satisfaction in life as would be the loss of
conscious pleasure shown in the loss of property or other simple
sense gratifications. The feelings of depression indirectly act as
a protective mechanism. Given a faulty adaptation in a manic-
depressive individual in whom a break in compensation occurs,
and the whole reaction which follows a depressive episode is
essentially a conserving process. The libido having been more or
less forcibly or abruptly torn from its customary attachments, it
is permitted to recharge itself in its enforced rest, or, if more
severe, it actively seeks the infantile attachments to the father or
mother, or, when still more severe and the regressions of libidinous
attachment to the living are not sufficient satisfaction to the
patient, he strives for a more perfect union in death with the
parent. The very manner of suicidal attempts to win this wish
fulfilment are most infantile; there is often a refusal of food,
holding the breath, refusal of discharge of faeces and urine, &c.
In many instances the unconscious striving towards death is not
alone an effort to escape the psychic stress and pain of the
depressive episode, nor even a desire of a spiritual union with a
dead parent, but rather a diffuse, general desire to return to the
primal unity of the infinite force of inorganic nature. I believe
this latter phase transcends all sexual content, and approaches in
its make-up the completeness of an organic demand for a return
to the inorganic, or oblivion.

MECHANISM OF PERIODIC MENTAL DEPRESSIONS 447

I believe in many not essentially pathologic depressions the
process may be a superficial regressive depression, but in the
severest grades of sudden severance of the activities of the libido
the whole process, from a shock down to the depths of regression,
self-blame, and suicide, may be so sharp, severe, and sudden as to
carry an individual to instant suicide, or at least to the deepest
mute plane of the melancholic stupor. In some cases it would
seem that the quicker and more rapidly the final stage was reached,
the better the prognosis.

We all know, however, that many of the classic manic-
depressives have slight depressive episodes, not essentially different
from the grand attacks, both before and after their great depression
under upsetting circumstances. However unhealthy the gradual
cessation and continued presence of depressive perturbations may
be considered, I believe it lends an ideal opportunity for making
an analytic reconstruction of the personality, and of the whole
mechanism by which the individual fortifies himself against future
attacks. Cases in which the mental healing is abrupt may be
quite satisfactory and sound clinically, but when one finds such
individuals are even to a casual observer quite unreconstructed,
one cannot help having many misgivings regarding their future.
I believe the early discharge of many such asylum cases of this
type is of positive harm.

I may say, while I am conscious that this report of what I am
pleased to call the mechanism of depression is based on too small
a material for generalisation, I believe it indicates in a manner
the general trend of psychiatric considerations which such cases
demand, and which shall be in terms of a withdrawal or rupture
of the libido, as the modern and rational approach to an intelligent
understanding of the nature of periodic mental depressions.
From a therapeutic standpoint I may say that in all my cases the
relief of the depression has been astonishingly rapid as the analysis
progressed. The transference occurs rapidly and is extraordinarily
strong, so much more marked than in the ordinary psychoneuroses,
and especially the compulsion neuroses. It must be added that
the depression is not solely relieved, but the whole temperamental
adjustment of the depressive individual’s life is so much improved
that many of the patient’s relatives are as much gratified at the
change for the better as the patients themselves.

448

ABSTRACTS

abstracts.

ANATOMY.

THE MORPHOLOGY AND HISTOLOGY OF A CERTAIN BTRTJO-
(626) TORE CONNECTED WITH THE PARS INTERMEDIA OF
THE PITUITARY BODY OF THE OX. Rosalind Wulzen,
Anai. Record ,, 1914, viiL, Aug., p. 403.

Ip the cleft of the pituitary body of the ox be opened, there will
be found almost invariably a mass of tissue attached to the pars
intermedia, but very different from it. This structure is cone-
shaped, and is usually symmetrically placed in the mid-sagittal
plane, one-third or less of the way from the dorsal to the ventral
end of the cleft. Out of 760 cases, only 38 showed no such
structure. The cone differs in colour and consistency from the
pars intermedia. Microscopically its cellular elements resemble
those of the pars glandularis, numerous neutrophile cells being
its most striking feature. It differs from the pars glandularis,
however, through having in a general way finer connective tissue
and smaller acini When this cone, which is very clearly shown
in the figures accompanying the paper, penetrates deeply into the
pars glandularis, the walls of the cavity into which it is so closely
fitted are solidly packed with blood sinuses, thus suggesting an
arrangement for the absorption into the blood stream of secretions
from the cone or pars intermedia. A. Ninian Bruce.

PHYSIOLOGY.

NEW RESEARCHES ON THE FUNCTION OF THE PINEAL
(627) GLAND. (Nouvelles recherches sur la fonction de la glands
pineals.) C. Foa, Arch. Ital. de Biol., 1914, lxl, June 30, p. 79
(1 plate).

FoA. confirms his previous experimental findings in very young
pinealectomised cockerels (v. Review, 1912, x., p. 439, and 1913,
xi., p. 60); no results of any kind occurred in pullets nor in young
female rats. But in young male rats a more rapid somatic
development occurred than in controls of the same age: it reached
its maximum degree about twenty-six to thirty days after opera¬
tion, and then gradually diminished till it equalled that of the
controls: at the period of maximum development the testes also
showed a relative increase of size, which likewise later disappeared.
The testes of operated cockerels and also those of male rats (at

ABSTRACTS

449

this maximum period) show a uniformly more advanced develop¬
ment of all their tissues; the tubules show a larger diameter and
lumen, and contain a larger mass of spermatozoa: the interstitial
tissue is increased, but only proportionately with the overgrowth
of the tubular. Therefore we cannot say to which tissue is due
the greater development of the secondary sexual characters in the
cockerels, and the increased somatic development of the young
male rats. No skeletal changes were found after pinealectomy,
and all the organs of internal secretion were free from any histo¬
logical changes (the pituitary, adrenals, thymus, and thyroid are
specially named). Fok concludes that his experiments tend to
confirm the teaching that the pineal body exercises an inhibitory
action on sexual development. Leonard J. Kidd.

THE PINEAL GLAND IN RELATION TO SOMATIC, SEXUAL,

(528) AND MENTAL DEVELOPMENT. Caret Pratt M‘Cord,
Joum. Anver. Med. Assoc., 1914, lxiii., July 18, p. 232.

The general plan here adopted was to feed very young animals
with minute quantities of pineal tissue, and to record the weight
changes, sexual differences, and, in the case of dogs, increased
mentality. There were used altogether 110 guinea-pigs, 18
puppies, 14 adult dogs, and 16 chicks.

The conclusions were that rapid growth of the body resulted,
but not beyond normal size, and less well-established indications
of precocity of mental and sexual development were found.

A. Ninian Bruce.

THE SUPRARENAL BODIES AND DIURESIS. Douglas Cow,

(529) Joum. Physiol ., 1914, xlviiL, Sept 8, p. 443.

As the result of a number of perfusion experiments on the kidney
of cats, supported by the evidence of carmine-gelatine injection,
the author describes a direct vascular connection between the
suprarenal bodies (medullary portion) and the kidneys. Under
certain conditions adrenalin is poured in appreciable amount
directly into the kidneys from the suprarenal bodies, producing
a diminution in the flow of urine. The suprarenal bodies may
thus be regarded as direct regulators of urinary activity.

A. Ninian Bruce.

GASEOUS EXCHANGE IN THE DECEREBRATE ANIMAL.

(530) Charles G. L. Wolf and T. S. Hele, Joum. Physiol., 1914, xlviii.,
Sept 8, p. 428.

The decerebrate animal responds to carbohydrates and proteins
as does the intact animal. The rise in the total metabolism

ABSTRACTS

4f>0

following the administration of protein is accompanied by a rise
in the non-protein nitrogen in the blood. A. Ninian Bruce.

PSYCHOLOGY.

SOME CASES OF PSYCHOLOGICAL INTEREST FROM PRIVATE

(531) PRACTICE. J. E. Middlemiss, Joum. of Merit. Set., 1914,
July, p. 451.

An account of five cases of psycho-neuroses of varied type, which
were treated by psycho-therapeutic measures, carefully adapted
to the particular case. The author contends that at present no
particular procedure can be looked upon as of paramount importance,
to be used exclusively—for instance, psycho-analysis. He himself
leans towards the use of suggestion, and of an early hypnotic or
hvpnoidal state, but he occasionally tries true hypnosis.

W. D. Wilkins.

PATHOLOGY.

A NEW METHOD OF PRODUCING EXPERIMENTAL LESIONS
( r >32) OF THE NERVE CENTRES. (Sur tine nouvelle mtthode pour
produire des lesions expdrimen tales des centres nerveux.) A.

Bertolani, Rev. Neurol., 1914, xxii., Avril 15, p. 509.

The best way to reproduce experimentally the mechanical effects
of a ruptured cerebral artery is to inject some suitable substance
into the cerebral tissue. The author recommends paraffin with a
melting point of about 38 o -40°. The syringe is heated to 50*, and
the paraffin rapidly injected just above its point of solidification
through a fine needle. The area involved is proportional to the
quantity of paraffin injected.

The advantages of this method are its simplicity, and the
greater chance of the animal surviving the operation. The dis¬
advantage is the difficulty of making the injection in exactly the
desired place. A. Ninian Bruce.

PARAFFIN - WEIGERT METHODS FOR THE STAINING OF
(533) NERVOUS TISSUE, WITH SOME NEW MODIFICATIONS.

Ralph Edward Sheldon, Folia neuro-biologica, 1914, viil, Jan.,
p. l.

A long and very full account of the Weigert method for the staining
of nervous tissue, with a large bibliography. The paper is not
suitable to abstract. A. Ninian Bruce.

ABSTRACTS

451

CLINICAL NEUROLOGY.

THE FOREARM SION. (Le phenomena de l'avant-bras (de L4ri).)

(534) Teixeira-Mendks, Rev. Neurol , 1914, xxii., Mars 15, p. 348.

This phenomenon was first described by Ldri (v. Review, 1913,
xl, p. 432), and consists in flexing the patient’s fingers into the
palm, and the palm on the forearm, using a little force when the
patient’s forearm is observed to flex gradually on the arm.

The author found this sign positive in all normal cases, and
negative ( i.e ., absent or greatly diminished) in organic hemiplegia,
in tabes with cervical cord lesion, and in Huntington’s chorea. It
is thus useful in the diagnosis of organic hemiplegia, and in certain
other cerebral lesions. The results were based on the examination
of sixty-five cases of nervous disease. A. Ninlan Bruce.

ABSENCE OF THE RADIAL REFLEX AND OF THE REFLEX

(535) OF PRONATION OF THE FOREARM, AND CONSERVATION
OF THE REFLEX OF THE BICEPS TENDON FROM LESION
OF THE 6TH CERVICAL ROOT. (Assenza del riflesso radiale
e del riflesso di pronazione dell avambraccio, conservazione del
riflesso del tendine bicipiteo per lesione della 6a radici cervicale.)
Q. Campoba, Riv. ital. di Neurop., Psichiatr. ed Elettroter., 1914,
viL, p. 241.

The above phenomena were observed in a man, aged 39, who
had fallen from a height of about 8 metres. The lower limbs
and left upper limb were not affected, but there were slight
paresis of the right upper limb and severe pain in the right
shoulder, upper arm, and forearm. The X-rays showed a probable
fracture of the body of the 3rd cervical vertebra and a forward
dislocation of the 5th cervical vertebra. Under treatment with
an extension apparatus the pain disappeared in a few days, and
in about three weeks the radial reflex returned.

J. D. Rolleston.

TALALGIA IN DIABETES. (La talalgie au corns de la diab&te.)

(536) M. Blumzweio, Theses de Paris , 1913-14, No. 440.

A record of a case in a man, aged 46, who developed talalgia of
the right foot a year after the first symptoms of diabetes. Both
ankle jerks and the left knee jerk were lost, the right was barely
perceptible. There was a patch of complete anaesthesia corre¬
sponding to and extending beyond the site of talalgia. The skin
of the anaesthetic area presented exaggerated sweating. The
X-rays showed no exostosis or other bony abnormality. No
other cases of talalgia in diabetes haw been recorded.

J. D. Rolleston.

452

ABSTRACTS

GRUBAL PARAPLEGIA FROM EXTRA DURAL SPINAL TUMOUR.
(537) OPERATION. RECOVERY. (Parapllgie crurale par neoplasme

extra-dure-mlrien. Operation. Gu&ison.) J. Babinski, P.

Lec&ne, and J. Jarkowski, Rev. Neurol., 1914, zzii., Juni 30,

p. 801.

A woman, aged 53, midwife, began to notice that she became easily
tired, and experienced abnormal sensations in both legs. This
slowly progressed until both legs became paralysed. Sensation
diminished gradually in both lower limbs, and bladder symptoms
developed. Pain, principally at night and never very violent, was
also present, radiating towards the upper part of the vertebral
column and towards the inferior angle of the right scapula. Later,
sensation liecame altogether abolished from below the line of the
nipples, while the paralysis became complete. The patient was
also much annoyed by involuntary movements of the lower limbs.
The condition was considered to be due to a tumour which
appeared to extend as far up the cord as the level of the fifth or
sixth dorsal segment, and as far down as the ninth dorsal segment.
A laminectomy was performed, and an angiolipoma 11 cm. long
was found in the extradural vascular adipose tissue. The result
was good, sensation returning, and the patient became able to
walk about again. A. Ninian Bruce.

CLINICAL OBSERVATIONS ON NINETY CASES OF ACUTE
(538) EPIDEMIC POLIOMYELITIS. Francis R. Fraser, Amer .

Journ. of Med. Set., 1914, cxlviii., No. 1, July.

In this paper the clinical observations are reported on 90 cases
admitted into the hospital of the Rockefeller Institute, New York.
These cases were admitted during the acute stage only. The ages
of the patients varied from nine months to fourteen years. In
three instances two members of a family were admitted, and in
a fourth instance two cousins living in the same house. In no
case could a predisposing cause be ascertained, but the majority
of the patients came from the same general locality in New York.

No cases were admitted in the pre-paralytic stage, but 5
abortive cases were admitted, and in 22 cases the paralysis increased
after admission to the hospital.

The most common general symptoms were feverishness, drowsi¬
ness or heaviness, irritability or restlessness, and involuntary
twitchings or jerkings during sleep. A temperature that varied
from 101° to 103°, and gradually settled in the course of a few
days, was seen in the majority of cases. A history of localised,
profuse sweating was occasionally obtained, involving the part

ABSTRACTS

453

that subsequently became paralysed, but more common was
profuse general perspiration in the very severe cases. Gastro¬
intestinal symptoms were rarely absent, and vomiting was reported
in 41 cases, and loss of appetite in 22 others. Stiffness in the
neck and back, and pain and tenderness on handling the patient,
were also important symptoms. This tenderness during the acute
stages seemed to be of three degrees, e.g .: (1) hyperesthesia,
(2) pain on mild pressure of the muscles, and (3) such severe pain
that, on passive movements of the limbs, the child would cry out.

This tenderness, as a rule, passed off in a day or two, but
might persist for three or four weeks.

Pain also may be present in the muscles, and a spastic condi¬
tion may be caused due to irritation of the pyramidal tracts
during the healing process of the lesion in the upper part of
the cord.

In regard to paralysis, 31 cases showed involvement of the
muscles of respiration; of these there was paralysis or weakness
of both diaphragm and intercostal muscles in 9, and of these 6
ended fatally. In 3 cases the diaphragm alone was involved
without complete paralysis, and in each instance there lias been
complete recovery in the action of the diaphragm; 19 cases
showed paralysis, complete or partial, of the intercostal muscles,
and of these 3 ended fatally, and 7 recovered entirely.

A very large number of the cases showed involvement of the
facial muscles.

Difficulty with micturition and defsecation occasionally occurs.
Treatment may be divided into three stages: (a) the acute stage
of fever and general symptoms, including the period of onset and
spread of paralysis; (6) the stage of recovery of muscle power;
(c) the stage where recovery in muscle power is as complete as
it is going to be, and the treatment is applied to the residual
conditions of deformities, flail-joints, &c.

The essential thing in treatment, at the present time, is to
prevent crippling and deformities.

Several of the author’s more interesting cases are reported.

D. K. Henderson.

THE USE OF CELLULOID SPLINTS IN THE TREATMENT OF
(539) DISEASES OF THE NERVOUS SYSTEM. G. Wilse Robinson,
Joum . Amer. Med. Assoc , 1914, lxiii., Aug. 29, p. 773.

The author emphasises the advantage of using celluloid splints in
poliomyelitis ( cf.\ Review, 1914, xii., p. 415), describes the process
involved in making them, and points out that they render the
same support and comfort in patients with Charcot’s joints and
in extreme cases of hypotonia in tabes. A. Ninian Bruce.

454

ABSTRACTS

THE GLYCYLTRYPTOPHAN REACTION IN MENINGITIS.

(5-IO) Ralph H. Major and Edmond Nobel, Archives Intern. Med.,
1914, xiv., Sept, p. 383.

The reaction is carried out as follows:—One c.c. of the suspected
cerebro-spinal fluid is placed in a test-tube with an equal quantity
of glycyl-tryptophan, and then 1 c.c. of toluol is added as a pre¬
servative. The mixture is placed in an incubator for three hours.
It is then withdrawn and a few drops of dilute acetic acid added,
and then oversaturated calcium chloride drop by drop. A red
colour is produced if free tryptophan is present. The calcium
chloride solution used should be briskly shaken just before using
to give off free chlorine, and must be added cautiously, as an excess
masks the reaction. The test should be made with various
dilutions with sterile normal salt solution up to 1 to 200.

The reaction depends upon the presence of a proteolytic or
peptid-splitting ferment in the cerebro-spinal fluid in meningitis
which is not usually present in normal cerebro-spinal fluid.

In 12 cases of suspected meningitis, later found not to be
meningeal, the reaction was negative. In 17 cases of true
meningitis, all tubercular except one, a positive reaction was
present, although not always in high dilutions.

The authors think that in this reaction we have another
valuable addition to our diagnostic measures in meningitis.

A Ninian Bruce.

MENINGEAL SYNDROME IN THE COURSE OF CEREBRAL
(041) H&SMORRHAGE. (Syndrome m£ning6 au cours d’une h^morragie
c6r6brale.) L. Levy and Gonnet, Rev. Neurol ., 1914, xxii., Avril
15, p. 505.

In most cases cerebral hemorrhage is not difficult to diagnose. If
the hemorrhage should, however, happen to involve a silent area
of the brain, the diagnosis may become one of great difficulty.

A man, aged 56, did not feel very well on rising one morning.
There was marked occipital headache followed by vomiting,
delirium, and, in the evening, coma. There was no evidence of
hemiplegia, and both plantar reflexes were flexor. The pupils
were contracted, but there was no conjugate deviation of the eyes,
nor paralysis of any of the ocular muscles. Uraemic coma was
suspected, and 500 c.c. of blood were removed. This caused
slight improvement, but the coma soon reappeared, followed by
twitellings of the face and right arm resembling Jacksonian
epilepsy. Later the movements became general, and a right
hemiparesis was found, Babinski’s sign became positive, and the
reflexes on this side were exaggerated. Lumbar puncture gave

ABSTRACTS

455

issue to a slightly yellowish fluid under great tension, and sterile.
The convulsive attacks became more and more frequent, and the
patient finally died in a status epilepticus.

At the autopsy a haemorrhagic focus about the size of an
orange was discovered behind the left interparietal fissure, in¬
volving the second and inferior parietal, and first and second
temporal convolutions, and spreading inwards as far as the
occipital horn of the lateral ventricle. The right hemisphere was
normal. A Ninian Bruce.

UNUSUAL TYPE OF HEREDITARY DISEASE OF THE NERVOUS

(542) SYSTEM. Pelizaeus-Merzbacher, aplasia azialis extra-corticalis
congenita. Frederick E. Batten and Douglas Wilkinson,
Brainy 1914, xxxvi., p. 341.

A familial and hereditary disease of the nervous system is here
described, the symptoms of which resemble disseminated sclerosis,
and in its later stages Friedreich’s disease. It affects chiefly
males, and is transmitted by healthy females. Those affected are
either congenitally diseased or exhibit symptoms in the first
months of life, the progress of the disease being very slow. They
are mentally defective and ataxic, show nystagmus, speech defect,
and defective development, with weakness and spasticity of the
lower limbs. Four cases are described at length.

A. Ninian Bruce.

DISSEMINATED SCLEROSIS WITH CROSSED HEMIPLEGIA.

(543) (Scldrose en plaques (?) avec hlmipldgie alteme.) B. Conos,
Rev. Neurol., 1914, xxii, Feb. 28, p. 226.

A man, aged 39, doctor, in good health, developed suddenly a
partial paralysis of his right third nerve, with left hemiplegia,
together with hemiansesthesia of the left side of his face and
right half of his body. The cerebro-spinal fluid was normal.
There was no history of syphilis, the Wassermann reaction in the
blood was negative, and anti-syphilitic treatment proved of no
avail. Alcoholism and botulismus could also both be excluded.
Nystagmus was present. The condition was considered to be most
likely due to an unusual manifestation of disseminated sclerosis.
The symptoms improved rapidly. A. Ninian Bruce.

ELECTROLYTIC TREATMENT OF LEAD POISONING. W. H. F.

(544) Oxlet, Lancet, 1914, clxxxvii., Oct. 3, p. 848.

The author throws doubt upon the possibility of the removal of
lead from the body in lead workers by means of electrolysis, as
described by Sir Thomas Oliver. He points out that the large

45G

ABSTRACTS

proportion of total current used up by the tissue ions, and the
slow rate of penetration of the ions through the skin, would only
allow of the removal from the superficial layers of the skin of an
amount of lead not exceeding TxWth part of a grain.

Experiments upon rabbits under conditions even more
favourable than in man showed also a consistently negative result.

A. Nlnian Bruce.

MENTAL MANIFESTATIONS IN TUMOURS OF THE BRAIN.

(545) Alford Gordon, Amur. Jour. Med. Set., 1914, cxlviii, No. 2, August

One of the cases here reported presented a most striking
resemblance with paretic dementia, both from the standpoint
of physical and mental manifestations; yet no meningo¬
encephalitis was found, and a tumour was seen in an area not
at all suspected during life.

The second case reported is one of a tumour of the pituitary
body. In this case the diagnosis of paresis was repeatedly
made by competent men.

The third case is one of a tumour situated between the frontal
lobe and insula in the left hemisphere. During life the patient
presented a very marked dullness, apathy, indolence, and extreme
somnolence.

The author feels that mental symptoms are not of any
special assistance in the localisation of tumour growths.

D. K. Henderson.

A PATHOLOGICAL INVESTIGATION OF FOUR CASES OF

(546) PITUITARY TUMOUR. W. Johnson, Lancet , 1914, clxxxvii.,
July 4, p. 24.

The first two cases came to necropsy, the remaining two were
from specimens dated 1883 and 1877 respectively. Three of the
tumours were classified as malignant epithelial tumours without
secondary deposits, the fourth was a malignant columnar-celled
growth with secondary deposits in the lung.

Eye symptoms had been present in the first two cases for
over two years, and pathologically a degeneration was found in
the optic tracts, extending as far back as the primary optic ganglia,
but not into the optic radiations or calcarine cortex. Both cases
also showed that the uncrossed visual fibres tend to occupy the
outer and lower portion of the optic tracts. A. Ninian Bruce.

INFANTILISM. August Strauch, Amer. Jour. Med. Sci. t 1914, cxlvii.,

(547) No. 2, August.

An interesting paper, which cannot be adequately abstracted,
describing various forms of infantilism. D. K. Henderson.

ABSTRACTS

457

METABOLISM STUDIES IN A CASE OF MYASTHENIA GRAVIS.

(548) Theodore Diller and Jacob Rosenbloom, Amer. Joum. of Med.
Set. , 1914, cxlviii., No. 1, July.

It was found that the true cellular or “ endogenous " metabolism
was not normal, as both the uric acid and creatinin excretion were
much lower than normal. Such a finding makes one consider
myasthenia gravis as a disease of deranged muscular metabolism.

In addition, the amount of neutral sulphur excreted in
relation to the total sulphur was below normal.

Finally, 6 3 grams calcium oxide was lost by the tissues in
eight days.

On account of the great importance that the calcium ion plays
in normal muscular action, it is possibly owing to lack of its
utilisation that myasthenia gravis owes its origin, and the changes
observed in the “endogenous” or cellular metabolism may be
secondary to this fact; and as the inorganic ions are necessary for
normal muscular action, it may be that some disturbance in
metabolism in these substances, especially calcium, is responsible
for the muscular symptoms of myasthenia gravis. During muscle
work lactic acid is produced, and it is one of the factors in the
production of fatigue of muscle. “ May it not be that owing to
the fact that the calcium not being utilised normally, the lactic
acid is not neutralised by the calcium, and fatigue, one of the
characteristic features of myasthenia gravis, comes on readily ? ”

D. K. Henderson.

ENGLISH PELLAGRA IN EARLY CHILDHOOD. Charles R. Box,

(549) Brit. Med. Joum., 1914, Aug. 29, p. 397.

The patient was a little girl, aged 1 year and 8 months when a
butterfly rash appeared on her face and lasted from March to
September. It reappeared next spring. She had never suffered
from digestive disturbance, and had never eaten maize. When
seen at 4£ years of age the rash was found on her face, hands, and
knees. Pronounced tremor, with occasional small jerky movements
of the limbs, was present. A. Ninian Bruce.

ATTEMPTS TO TRANSMIT PELLAGRA TO MONKEYS. C. H.

(550) Lavindkr, E. Francis, R. M. Grimm and W. F. Lorenz, Joum.
Amer. Med. Asaoc., 1914, lxiii., Sept. 26, p. 1093.

The authors used 77 rhesus monkeys, 2 Java monkeys, and 3
female baboons. The methods employed were: (1) inoculation of
pellagrous tissues; (2) inoculation of pellagrous fluids and excreta;
and (3) feeding with pellagrous material and spoiled corn meal.
The pellagrous tissues used consisted of filtered extracts of

458

ABSTRACTS

(a) the brain, spinal cord, and membranes from 6 necropsies;

(b) the buccal, thoracic, and abdominal contents, except intestines,
from 1 necropsy; (c) the intestines and faecal contents of 7
necropsies; and (d) the skin from 5 necropsies. Extracts of
these were made with normal saline, and injected intracerebrally,
intraspinally, intraperitoneally, intravenously, or subcutaneously.
The pellagrous fluids used were: (a) blood from 7 pellagrins;
(b) pericardial fluid from 1 necropsy; (c) urine from 4 cases;
(d) faeces from 1 case; and (e) cerebro-spinal fluid from 3
necropsies. The feeding material consisted of (a) sputum from
4 cases: (b) faeces from 2 cases; (c) thoracic and abdominal
organs and contents from 5 cases; and (d) brain, cord, membranes,
buccal, thoracic, and abdominal organs, with contents complete,
from 1 necropsy. The monkeys were exposed daily to the direct
rays of the sun. One hundred and three experiments were
made.

The result was 8 monkeys died, 4 clearly from some other
cause than pellagra; the cause of death in the remaining 4 was
undetermined. With one exception all the remaining monkeys
showed no symptoms of pellagra. A. Ninian Bruce.

SYPHILIS OF THE VERTEBRAL COLUMN: ITS SYMPTOM-
(551) ATOLOOY AND NEURAL COMPLICATIONS. J. Ramsey

Hunt, Amer. Journ. of Med. Set., 1814, cxlviii., No. 2, August

At the present time there are about one hundred well-
authenticated cases recorded in the literature, and the pre¬
ponderance of the cervical localisation has been quite striking.

The pathological lesions consist of exostoses, gummatous
periostitis, and osteomyelitis, with occasional necrosis and
sequestration of bone. The tendency to pus formation is
slight, and “ cold abscesses,” as found in tubercular caries,
apparently do not occur. The greater number of the cases originate
in the tertiary period of syphilis.

Of the 100 cases which the author has analysed neural
symptoms were present in 26, distributed as follows:—

Cervical region -
Dorsal region
Lumbar region -
Sacral region

15 cases.
5
4
2

Of the 26 cases with neural complications, 14 were associated
with symptoms that would indicate a lesion of the spinal cord
corresponding to the level of the bone disease.

In 9 cases the limitation of symptoms to paralysis and

ABSTRACTS

459

paresthesia of one upper or lower extremity indicated a radicular
origin.

In 2 cases of sacral origin the symptoms indicated an
involvement of the strands of the cauda equina.

Four interesting personal cases are reported.

I). K. Henderson.

A CRITICAL STUDY OF LANCE'S COLLOIDAL COLD REACTION
(552) IN CEREBRO SPINAL FLUID. Rogbr I. Lee and W. A.
Hinton, Amer. Joum. of Med. Sci., 1914, cxlviiL, No. 1 , July.

The technique employed is described, and the following conclusions
are come to.

A gold reaction typical for syphilis is nearly constant in cases
of syphilis of the central nervous system.

This test is more delicate than the blood Wassermann reaction,
spinal fluid Wassermann reaction, cell count, and globulin content.

The test has the advantage that it gives a reaction with
pathological spinal fluids due to other causes than syphilis that
is characteristic and easily differentiated from the reaction typical
for syphilis. D. K. Henderson.

OBSERVATIONS ON THE WASSERMANN REACTION. B. A.

(553) Thomas and Robert H. Ivv, Amer. Joum. of Med. Set., 1914,
cxlviii., No. 1, July.

The authors call attention to several factors in technique which
they believe are of importance in securing accurate results. They
plead for the standardisation and uniformity of methods.

D. K. Henderson.

ATROPHY OF THE PELVIS IN INFANTILE PARALYSIS AND

(554) ITS OBSTETRICAL CONSEQUENCES. (Atrophie du bassin
dans la p&ralysie infantile et ses consequences obstdtricales.)
Mllb. G. Schmouchbb, Threes de Paris, 1913-14, No. 411.

Atrophy of the pelvis in infantile paralysis is rare. It is caused
by the same spinal lesions as those which give rise to the motor
and trophic disturbances in the lower limbs. The pelvic deformity
resulting may be bilateral or affect one side only. Dystocia
caused by atrophy of the pelvis is often slight and easily remedied
by application of the forceps; sometimes it is more serious and
necessitates premature delivery; in the severest cases Caesarean
operation is required. The thesis contains the histories of 15
cases, 3 of which are original. J. D. Rolleston.

460

ABSTRACTS

THE RELATION BETWEEN EPILEPSY AND TUBERCULOSIS.

(556) B. Hknry Shaw, Jottm. of Merit. Set., 1914, July, p. 477.

The percentage of epileptics in the Staffordshire asylums is very
high, being 20 8 per cent., as compared with an average for
England and Wales of 12 8 per cent. The tuberculosis death-rate
is also high, being 25*2 per cent., the rate for England and Wales
being 16*6 per cent. The author gives tables to prove that the
connection between a high epileptic ratio and a high tubercle
ratio is very general throughout the country, and he believes this
to be due to an association of the two diseases. He has found
that 83*3 per cent, of his epileptics reacted to tuberculin, whereas
only 33*3 per cent, of non-epileptics did so. His view is that
the great majority of cases of idiopathic epilepsy are due to the
toxaemia of tuberculosis at an early age, kept in check, however,
by the curative effects of the auto-inoculation with tuberculin
occurring during the fits. W. D. Wilkins.

EPILEPSY: A THEORY OF CAUSATION FOUNDED UPON THE
(556) CLINICAL MANIFESTATIONS AND THE THERAPEUTIC

AND PATHOLOGICAL DATA. J. J. M. Shaw, Journ. of Merit.

Sei., 1914, July, p. 398.

This paper is a careful study of the etiology of epilepsy, embodying
much original work, and giving also a full account of other data
bearing upon the theory advanced. The theory is that the
inherent defect in epilepsy is an instability, which may be
hereditary, of the nucleo-proteid elements of the brain and blood.
These nucleo-proteins break down and produce uric acid and other
acid products, and there is a consequent diminution in the
alkalinity of the blood. If this falls below a certain point,
agglutination of the coagulative elements of the blood will occur,
with consequent stasis in the cortical capillaries, cerebral anaemia,
and the production of convulsive seizures and other cerebral
symptoms. Among exciting causes of the seizures are the ingestion
of nucleo-proteins and purins, and the relative sluggishness of the
circulation occurring in early sleep.

The author has demonstrated a greatly increased rate of
agglutination in epileptic as compared with non-epileptic blood.
The action of the bromides is to combine with the nucleo-proteins
and prevent their disintegration. Alkalies naturally increase the
alkalinity of the blood and diminish its coagulability, and have
therefore a beneficial effect. Oxalic acid and ammonium oxalate
have been found by the author to have a marked effect, not only
in diminishing the number of fits, especially the attacks of petit
mal, but still more in curtailing the post-paroxysmal states, and

ABSTRACTS

461

improving the mental condition. Glycerophosphates, including
sanatogen, were found to increase the severity and frequency of
the fits. W. D. Wilkins.

TWO NEUROLOGICAL CASES IN PjEDIATRIO PRACTICE.

(557) M. A. Rabinowitz, Med. Record, 1914, lxxxv., p. 1031.

Case 1.—Syphilitic pseudo-paralysis of the new born. The
right hand became affected at the age of 4 weeks, and a few
weeks later the child did not move any of its limbs. Rapid
recovery ensued under mercurial inunction.

Case 2.—Recurrent multiple neuritis. A girl, aged 9 years,
developed symmetrical paralysis of all four limbs without fever
or much constitutional disturbance. Recovery took place within
a year. A similar attack occurred at the age of 12 years, and
within a year of its onset recovery was almost complete. There
was no history of alcohol, arsenic, or diphtheria.

J. D. Rolleston.

A CASE OF IMPLANTATION OF SUPRARENALS IN ADDISON’S

(558) DISEASE, WITH FATAL RESULT. W. H. Beown, Med. Joum.
Australia, 1914, i., August 8, p. 129.

A man, aged 21, presented the typical symptoms of Addison’s
disease—great weakness, low blood pressure, and pigmentation of
the skin. Very slight improvement followed complete rest and
tuberculin treatment for five months, but such improvement proved
only temporary. It was decided to try the effect of implanting
the suprarenal glands, and this was done into the rectus sheath
two hours after their removal from a girl of 6 years dying from
heart disease following rheumatism. During the first thirty-eight
hours his condition gave no cause for anxiety, but four hours
later his pulse became weak, his pupils dilated, and he became
semi-conscious, dying shortly after. The wound was healthy, but
“it seems clearly the case that the man was poisoned by the
contents of the two suprarenal glands implanted.”

A. Ninian Bruce.

A CASE OF SCIATICA ENTIRELY CURED IN THREE WEEKS’

(559) TREATMENT. Harry Marcus, N.Y. Med. Joum., 1914, c.,Sept
12, p. 520.

The sciatica followed rapid delivery by forceps during eclampsia.
The pain was uninfluenced by iodides, salicylates, massage, and
electricity, and was so severe that the patient would not even
allow her bed to be touched. The treatment consisted in the
injection of a solution of 2£ drams of antipyrine and grs. of
cocaine hydrochloride in 1£ drams of water, first over the

462

ABSTRACTS

external popliteal nerve, and second, into the dorsum of the foot,
sixteen minims were injected each time, and the pain gradually
disappeared. A. Ninian Bruce.

PSYCHIATRY.

THE BIOLOGICAL CONCEPTION OF INSANITY. John Turner,
(660) Joum. of Mmt. Scu, 1914, July, p. 352.

Though many cases of insanity present no obvious pathological
lesions, yet careful examination of such cases will usually show
slight deviations from the normal. The author has found that
the kidneys, liver, heart, and especially the blood-vessels, are all
very commonly affected to a slight degree, the changes being
principally degenerative. It is interesting to note that, in a series
of 235 cases, a patent foramen ovale was found in 16 per cent.

Systematic observation was made of the Betz cells in a large
number of cases, and it was found that in every type of insanity
a varying percentage of the cells presented the features of the
axonal type of degeneration, usually in an early stage. The
percentage was lowest in the general paralytics, viz., 20 per cent.,
and highest in epileptic imbeciles, viz., 60 per cent. The average
for the whole series was 35-40 per cent. The author considers
that the presence of these cells is an index of the inherent
instability of the brain and its consequent liability to insanity.
A series of 50 brains from hospital cases, all presumably sane,
showed 20 per cent, in which there were Betz cells of this type,
but generally to a more limited extent. Gliosis in the subcortical
white matter and subcortical nerve cells were also more frequent
in the asylum series. The author believes that insanity has
always a biological basis, and that if the disordered bodily
functions could be corrected, the mental would also be adjusted.

W. D. Wilkins.

THE REACTION OF MORIZ WEISZ IN MENTAL DISEASES.
(561) (La reaction de Moriz Weisz dans les maladies mentales.) V.

Demole, Rev. Neurol., 1914, xxii., Jan. 30, p, 85.

The technique of this reaction is very simple, and consists in
placing a small quantity of urine in a test-tube and diluting
it with twice its volume of water. Half of this is used as a
control, while to the other half three drops of a one per cent,
solution of potassium permanganate are added. A yellow
coloration denotes a positive reaction, the colour depending upon
the oxidation of urochromogen into urochrome, the normal
urinary pigment. The reaction is, like the diazo-reaction of

ABSTRACTS

463

Ehrlich, found in wasting diseases, in fevers, and in tuberculosis,
and has also been recorded in cases of meningitis, leukaemia,
cancer, and in cardiac and renal disease.

The author examined it in 139 cases of different mental
diseases, and found it transitory in 11, and constant in 10. Two
and a half months later 3 (i.e., 27 per cent.) of the transitory
cases had died, and 6 {i.e., 60 per cent.) of the cases in which the
reaction was constant had died. The reaction bears no special
relation to any particular mental disease, and is to be regarded
as a disturbance of metabolism resulting from the disease. The
appearance of this reaction iu the course of a psychosis is there¬
fore to be regarded as an alarming sign, and its persistence as
grave. A. Ninian Bruce.

SOME OBSERVATIONS ON EARLY NERVOUS AND MENTAL
(562) OASES, WITH SUGGESTIONS AS TO POSSIBLE IMPROVE¬
MENTS IN OUR METHODS OF DEALING WITH THEM.

A Helen Boyle, Joum. of Meat. Set., 1914, July, p. 381.

At present the last person asked to treat an early case of mental
disease is the alienist, and it is not uncommon for the case to have
reached an advanced stage before he is appealed to. Moreover,
there is a large group of cases in which both nervous and mental
symptoms are present, the consequence being that the patient
gets inefficient treatment in one direction or the other according
as he consults an alienist or a neurologist. The authoress urges
that the two specialities should be welded together, and that
physicians should be competent to deal with cases in either group.
Further, that institutions should be established which would treat
both nervous and early mental cases that have not yet reached a
certifiable stage. W. D. Wilkins.

TREATMENT.

THE ROLE OF HYPNOTICS IN MENTAL DISEASES, WITH
(663) INDICATIONS FOR THEIR SELECTION AND EMPLOY¬
MENT. Richard Eager, Joum. of Merit. Sci., 1914, July,
p. 461.

A systematic account of the chief hypnotics used in asylum work,
with their indications and contra-indications. The author lays
stress on the fact that paraldehyde should be avoided in cases
with a tendency to respiratory trouble, on account of its irritant
action, and he recommends sulphonal for use in senile dementia,
accompanied by intractable insomnia. He incidentally compares
the price of the various drugs he mentions. W. D. Wilkins.

464

REVIEWS

■Reviews.

THE MYTH OF THE BIRTH OF THE HERO. A Psychological

(564) Interpretation of Mythology. By Dr Otto Rank (Vienna).
Translated by Robbins and Jelliffe. Pp. 100. (Nervous and. Mental
Disease Monograph Series, No. 18. $1.00.)

Tins book should be read in conjunction with Abraham's “ Dreams
and Myths ” (reviewed in the Review of Neurology and Psychiati'y,
May 1913, p. 291), for the two books complement each other.
Rank makes here an attempt to establish the scaffolding of a
theory of mythology based on individual psychology. For this
purpose he selects one type of myth, that concerning the birth of
heroes, studies in detail a series of well-known ones—from Sargon
to Jesus and (Edipus to Lohengrin—and abstracts the features
common to the series. These features he then compares with
similar traits in the fancies of the individual child on the subject
of birth, and explains them as a glorified expansion of these.

The work is avowedly based on investigations by means of the
psycho-analytic method, and the reader’s judgment is likely to
depend on his attitude towards this method. In any case,
however, it cannot be denied that Rank has furnished here a
number of novel and stimulating hints of considerable value to
those working in this field. The subject also has its importance
for the medical psychologist and psychiatrist, for fancies relating
to childbirth play a part second to none in the pathogenic content
underlying delusions and other morbid mental manifestations.

The translation, which could not have been easy, is quite
adequately done, and we may hope that it will be followed by
translations of Rank's later and more extensive works. The
author has added a number of additional footnotes for the transla¬
tion, dealing with knowledge that has accumulated since the book
was first published five years ago. Ernest Jones (London).

PSYCHOPATHOLOGY OF EVERYDAY LIFE. Prof. Sigmund Freud.

(565) Authorised English Edition, with an Introduction by A. A Brill.
Pp. 342. T. Fisher Unwin, London. Price 12s. 6d. net

This book will be found of interest to all who have studied
psychoanalysis as expounded by Professor Freud. It is an attempt
to apply this method of investigation to all the faulty actions of
everyday life, such as the forgetting of names, mistakes in speech
and in writing, forgetting of resolutions, erroneous carrying out
of actions, and all the numerous little errors which are so apt to
occur in daily life. If a name be forgotten, it is because it is
connected with some unpleasant association which has been
repressed; if one accidentally knocks over and breaks some object

REVIEWS

465

on one’s table, it is to be regarded as evidence that one did not
really care for it, and designed unconsciously this way of removing
it; if one addresses a friend by the wrong name, it signifies that
one would rather be speaking to the friend whose name is
unintentionally used, and so on. In fact, all these actions which
one regards as “ chance ” actions are really not so; they are rather
purposive, although the author may happen to be unconscious of
their true significance. And it is surprising how many little actions
one can remember which may be explained along these lines. But
that the reader will be able to follow Professor Freud to the extremes
to which he carries his argument is quite another question. That
the explanation of many apparently purposeless actions is to be
found in the complex analyses here elaborated is very doubtful,
and although the greatest ingenuity has been used to devise means
of adequately explaining these, it is obvious that many much
simpler explanations have been entirely overlooked. This book,
in fact, accepts no explanation except that based on psychoanalysis.
If it be regarded, however, merely as representing one of the lines
of research along which such problems may be approached, it will
undoubtedly be found of interest.

THE BRAIN IN HEALTH AND DISEASE. Joseph Shaw Bolton.
(566) Pp. 479, figs. 99. Edward Arnold, London. 1914. Price 18s. net.

This volume has been written with the object of elaborating a
scheme of cerebral function which is based on clinico-histo-
pathological proof. Coming as it does after a period when so
many of the attempts to elucidate the function of the brain have
approached the subject from the point of view of abnormal
psychology, it is particularly welcome to have our attention again
directed to the actual structural changes which may be found in
the brain in disease, and their interpretation by correlation with
the clinical symptoms observed during life. The author, in his
preface, points out how “quite recently the psycho-analytical
method of Freud, which is in reality a ‘catch unawares’
application of the ‘ confession and absolution ’ idea to the
ordinary sympathetic case-taking of the hysterical and the
psychasthenic, has introduced a still newer psychological
terminology, but no fundamentally new method. On the other
hand, this method has the great fault of appealing to those
unaware of its strictly limited scope, as a new system of universal
applicability to cases of mental disease, whereas its field of
utility is for practical purposes outside the walls of asylums.”

This work is based upon the personal researches of the author
during the past eighteen years, and he points out that the book is
to be regarded not as a text-book on mental disease, but as a

466

REVIEWS

treatise on general cerebral physiology and pathology. The book
is divided into two parts, the first dealing with cerebral function
in the normal brain, the second with cerebral function in mental
disease.

In the first part a very good description is given of the
geography, histology, and development of the cerebral cortex,
followed by chapters on the localisation of function and on the
human cerebral functions of language, thought, feeling, emotion,
and sentiment.

In the second part all cases of mental disease are divided into
two categories— (a) those classed under the term Amentia, the
subjects of whom “ suffer from a more or less marked grade of
sub-evolution of the brain,” and includes idiocy and imbecility
together with cranks, asylum curiosities, true paranoia, &c.; and
(b) Dementia, the subjects of whom “ suffer from a more or less
marked grade of involution or dissolution of the cerebrum,” and
includes senile, presenile, mature and premature types, general
paralysis, and such kindred conditions, &c. This generalisation
is based upon the fact that “ cases of mental disease exhibit a lesion
of the cortex of the prefrontal region of the cerebrum, which lesion,
in the case of amentia, is of the nature of a true sub-evolution, and
in the case of dementia, is of the nature of a true involution or
dissolution.”

During the last few years we have often felt the want of a
good English text-book on the pathology of the nervous system.
This book, which is limited to the pathology of the brain, fulfils
part of this want. The early chapters on the physiology of the
normal brain are excellent, while the second part, which presents
the author’s own views, are written in a clear and concise manner
which may be easily followed and will well repay perusal. The
book presents much room for thought, and although no references
to literature are given, is a good starting-point for fresh work.
We would recommend it as one of the more recent books which
all workers in mental disease ought to be acquainted with, as
we know of no book in English in which the whole question of
cerebral physiology and pathology is more clearly defined.

BOOKS AND PAMPHLETS RECEIVED.

Binet, A., and Simon, Th. “ Mentally Defective Children.” Authorised
translation by W. B. Drummond. 1914 Edward Arnold, London. Pr.
2s. 6d. net

Henderson, D. K. “ Korsakow’s Psychosis occurring during Pregnancy ”
(Johns Hopkins Hosp. Bull., 1914, xxv., Sept.).

Mercier. “A Text-book of Insanity ard other Mental Diseases.'’
Second edition. Entirely rewritten, 1914. George Allen A Unwin, Ltd.
1914. Pr. 7s. 6d. net

“The Training School,” 1914, xi., Sept.

■Review

TReurologp anfc IPs^cbtatr^

Original Hiticles

THE PYRIDINE-SILVER METHOD. WITH A NOTE
ON THE AFFERENT SPINAL NON-MEDUL-
LATED NERVE FIBRES.

By S. WALTER RANSON, Ph.D., M.D.,

Professor of Anatomy, North-Western University Medical School.

The pyridine-silver method is a modification of the Cajal method
which has recently come into general use in America, and which is
easy and reliable. It was devised as a differential stain for non-
medullated fibres, but has been found to be of use in the study of
a variety of problems. It is being used in a number of laboratories
in the preparation of sections for class use of the spinal ganglia,
sympathetic ganglia, and spinal cord.

An account of the method is given here in the hope that some
of the clinical neurologists, who have more ready access than the
anatomist to fresh pathological material, will use the method in
studying some of the problems for which fresh human material is
absolutely necessary, and for the solution of which the method
is especially adapted. A brief account of the method, and an
enumeration of the purposes for which it has shown itself to be
adapted, will be followed by a brief statement of some of the
results which have been obtained by its use, and an indication of
some of the problems which await solution.

The method was first used in connection with a study of the
structure of the peripheral nerves and published in a paper on
38

468

S. WALTER RAN SON

the “ non-medullated nerve fibres in the spinal nerves ” (Ranson,
1911). The technique as given on page 69 of that paper is as
follows:—

“ The nerve or ganglion is placed in 100 per cent, alcohol, with
1 per cent, ammonia for forty-eight hours (95 per cent, alcohol
with 5 per cent, ammonia will give much the same results, but
seems more likely to bring out the neurilemma nuclei). The
pieces are then washed for from one-half to three minutes (accord¬
ing to their size) in distilled water and transferred to pyridine for
twenty-four hours, after which they are washed in many changes
of distilled water for twenty-four hours. They are then placed in
the dark for three days in a 2 per cent, aqueous solution of silver
nitrate at 35° C., then rinsed in distilled water and placed for one
to two days in a 4 per cent, solution of pyrogallic acid in 5 per
cent, formalin. Sections are made in paraffin, and after mounting
are ready for examination.”

The pyridine-silver method is the only one of the silver
methods which gives a satisfactory stain of the peripheral nerves
and is more reliable than the other methods in almost all parts of
the nervous system, except the peripheral nerve endings. It has
given good results in the study of the cells and fibres of the
spinal ganglia of adult dogs (Ranson, 1912), and of the spinal
ganglia of foetal and new-born rabbits (Huber and Guild, 1913).
It has given “ uniformly satisfactory results" in demonstrating
the developing neurofibrils in Squalus embryos (Neal, 1914).
Used on the spinal cord it not only shows the structure of the
grey substance, including the neurofibrils in the nerve cells, but
it brings out, as does no other method, differences in the structure
of the fascicles of the white substance (Ranson, 1913, 1914). The
method has been successfully used by Black (1914) on the
medulla of the new-born baby, by Chase (1914) on the vagus
nerve of several mammals, by Kuntz (1913) on the sympathetic
plexuses of the intestine, and by Ranson (1912) on regenerating
nerves.

Huber and Guild (1913) have found it possible to use the
method on decalcified material, and thus to stain and cut into
serial sections the entire head of a small animal or embryo. The
details of the method as used by them are as follows:—

“ 1. Adult or young animals and embryos of sufficient size to
admit of injection are injected with ammoniated alcohol solution,

THE PYRIDINE-SILVER METHOD

469

as above described,” i.e., with a solution of 95 per cent, alcohol
and 1 per cent, concentrated ammonia through the arteries; and
the tissues are dissected out, “and placed in the ammoniated
alcohol for from two to four days, depending on the size of the
tissue mass to be fixed.

“ 2. Transfer to distilled water, in which the pieces remain until
they sink.

“ 3. The pieces are then transferred to a 7 per cent, solution of
nitric acid, made with distilled water, in which they remain until
the decalcification is complete; which varies with the age and size
of the tissue block.

“ 4. Wash in distilled water for about one-half hour, the water
being changed frequently.

“ 5. The pieces are then transferred to alcohols of 80, 90, and
95 per cent., to each of which is added 1 per cent, of concentrated
ammonia. A thorough treatment with ammoniated alcohol at this
step seems to us essential; three to eight days, depending on the
size of the pieces.

“ 6. Rinse in distilled water and place for twenty-four hours in ‘
pyridine.

“ 7. Wash thoroughly in distilled water for twenty-four hours,
the water being frequently changed. As the immediate transfer¬
ence of the tissues from the pyridine to the distilled water is
liable to result in a swelling of the tissues, which may lead to a
bursting of the hemispheres, a gradual transference from the
pyridine to the distilled water is recommended.

“ 8. Transfer to a 2 per cent, solution of silver nitrate in distilled
water, in which the tissues remain for from three to five days, in
the dark and at a temperature of about 35° C.

“ 9. Rinse in distilled water, and place for from one to two days
in a 4 per cent, solution of pyrogallic acid in 5 per cent, formalin.

“ 10. Dehydrate thoroughly, beginning with 80 per cent, alcohol.
Acetone may be used to hasten the dehydration, but should be
preceded and followed by alcohol Clear in xylol and embed in
paraffin. A necessary stay in the warm oven, even to forty-eight
hours, to ensure thorough paraffin penetration, does not seem to
affect the stain.

“ The possibility of decalcification combined with preliminary
ammoniated alcohol injection greatly extends the applicability of
the pyridine-silver method. We have found it possible to stain

470

S. WALTER RANSON

half of the head of a six-day rabbit, head and neck of a medium¬
sized frog, head of a small turtle, and so forth. After the injection
with the ammoniated alcohol we have removed the skin and
exposed the brain. Further cutting of the pieces was delayed until
after the decalcification and second ammoniated alcohol treatment.
The paraffin sections may be cut serially, and fixed to the slide by
the water albumen method in the usual way.

“We are aide to confirm Ranson’s statement, and find it
applicable to the method as here modified, namely, ‘ With freeh
pure chemicals, absolutely clean utensils, and a reasonably constant
temperature, this method can be relied upon to give uniform
results.’ ”

The chief advantages of the pyridine-silver method are: (1) It
can be used in a study of the peripheral nerves where the other
silver stains fail to give good results. (2) It is more reliable than
the other silver methods and gives more uniform results. (3)
Larger pieces of tissue can be successfully stained, and the im¬
pregnation is more uniform throughout the block than when the
old Cajal method is utilised. (4) It is a differential stain for non-
medullated fibres having a selective action for these axons, and
staining them much darker than the other elements in the section.
(5) It can be applied to decalcified tissue allowing the staining in
toto, and cutting into serial sections of the entire head of a small
animal or embryo.

With this method it has been possible to demonstrate the
presence of axons devoid of myelin sheaths in many parts of the
nervous system where it had been supposed only medullated fibres
were to be found. It has been shown (Ranson, 1911-12) that
there are even more non-medullated than medullated fibres in the
spinal nerves, and that they are not sympathetic but afferent
spinal fibres with their cells of origin in the spinal ganglia (Fig. 1).
These are the small cells of the spinal ganglia, the single processes
of which are non-medullated and divide dichotomously into fine
non-medullated fibres which run into the peripheral nerve, and
still finer non-medullated fibres which run centralward in the
dorsal root. The number of small cells in the spinal ganglion is
greater than that of the large cells, while the number of large
cells is sufficient to account for all the medullated fibres
(Hatai, 1902). In pyridine-silver preparations of the spinal ganglia
it is very easy to demonstrate the origin of the non-medullated

THE PYRIDINE-SILVER METHOD

471
\

fibres from the small cells and of the medullated fibres from the
large cells.

In addition to the afferent spinal non-medullated fibres there
are also sympathetic non-medullated fibres which enter the nerve
by way of the grey ramus communicans. In a series of longitudinal
sections through a spinal nerve and ganglion in the plane indicated
in the drawing, stained by the pyridine-silver method, it is easy to
follow the sympathetic non-medullated fibres into the spinal nerve
from the grey ramus. At first they run in bundles of considerable
size, which are readily recognised as sympathetic. Most of these

Fin. 1 . —Diagram of a spinal nerve and ganglion to show the
origin of the non-medullated fibres. The small cells of
the spinal ganglia give rise to non-medullated fibres which
divide into peripheral branches extending into the nerve
and central branches running in the dorsal root to the
spinal cord. Sympathetic non-medullated fibres are also
indicated entering through the ramus oommunicans.

bundles turn peripheralward into the ventral or dorsal rami, a few
turn centrally into the dorsal root and spinal ganglion.

The central branches of the non-medullated axons of the small
spinal ganglion cells can be followed through the dorsal root to the
spinal cord (Fig. 2). Here they are seen to separate out from among
the medullated fibres just before the root enters the cord. And,
turning lateralward, they run through the lateral part of the
entering root into the tract of Lissauer (Ranson, 1913-14). These
non-medullated fibres from the dorsal root run in the tract of

472

S. WALTER RANSON

Lissauer for a short distance before terminating in the substantia
gelatinosa Rolandi, which is probably the nucleus of reception of
these fibres. The tract of Lissauer is composed of closely packed
non-raedullated and scattered fine medullated fibres. The fibres
in the tract have for the most part a longitudinal direction, but

4*4.

Fro. 2.—Diagram of the posterior root and postero lateral part
of the spinal cord.—f.c., fasciculus cuneatus; L.t., Lis-
sauer’s tract. The non-medullated fibres of the root are
seen separating out from among the medullated fibres and
running into the tract of Lissauer.

some are seen running horizontally or obliquely forward into the
substantia gelatinosa.

We have in the non-medullated fibres of the spinal nerves,
dorsal roots, and Lissauer’s tract, a system, the function of which
is as yet unknown. It is clear from the nature of the cells of
origin of these fibres in the spinal ganglia that the system is an

THE PYRIDINE-SILVER METHOD 473

afferent system, and it seems probable that its nucleus of reception
is the substantia gelatinosa Rolandi. There is some evidence that
these fibres carry pain and temperature, since they do not enter
the posterior funiculus, but separate at their entrance into the cord
from the fibres that carry the muscle sensations upward in that
funiculus. The fact that the upward course of these fibres in
Lissauer’s tract is very short—not more than one or two segments
at most—is also in favour of their carrying pain and temperature,
since the impulses corresponding to these impressions are known to
enter the grey substance near the level of their entrance into
the cord.

It is obvious that a study of tabetic material would help in the
solution of the problems which are here presented. Do the non-
medullated fibres in the spinal nerves degenerate in tabes, and if
so, early or late? What effect does tabes have on the non-
medullated fibres in the spinal ganglia and in the dorsal roots ? Do
the non-medullated fibres in Lissauer’s tract degenerate in tabes ?
What relation do the non-medullated fibres seen by Nageotte in tabes
bear to these normal non-medullated fibres ? What is the relation of
disturbances of pain and temperature in tabes to the degeneration
of these fibres ? These are some of the problems which should be
investigated, and for the solution of which the pyridine-silver
method is especially adapted. If material from cases of tabes in
different stages of the disease could be secured fresh, i.e., within an
hour after death, there should be no difficulty in answering these
questions. Such an investigation should add something to our
knowledge of the pathology of tabes, and at the same time clear up
the physiology of the varieties of cutaneous sensation.

References.

Black, D. D., 1914. “On the So-called ‘Bulbar’ Portion of the Accessory
Nerve.” AnaL Rec., Vol. 8, p. 110.

Chase, M. R., and Ranson, S. W., 1914. “ The Structure of the Roots, Trunk,

and Branches of the Vagus Nerve.” Joum. Comp. Neur., Vol. 24, p. 31.
Hatai, S., 1902. “ Number and Size of the Spinal Ganglion Cells and Dorsal Root

Fibres in the White Rat at Different Ages.” Joum. Comp. Neur., Vol. 12,
p. 107.

Huber, G. C., and Guild, S. R., 1913. “ Observations on the Peripheral Distri¬

bution of the Nervus Terminalis in Mammalia.” Anal. Rec., Vol. 7, p. 253.
Huber, G. 0., and Guild, S. R., 1913. “ Observations on the Histogenesis of

Protoplasmic Processes and of Collaterals, terminating in End Bulbs, of the
Neuropes of Peripheral Sensory Ganglia.” Anal. Rec., Vol. 7, p. 331.

474

ERNEST JONES

Ktntz, A., 1913. “ On the Innervation of the Digestive Tube.” Joum. Comp.

Xeu/\, Vol. 23, p. 173.

Nkai., H. V., 1914. “The Morphology of the Eye Muscle Nerves.” Joum .
Morph., Vol. 2.1, p. 1.

Ranson, S. W,, 1911. “ Noti-Medullated Nerve Fibres in the Spinal Nerves. M

Amrr. Joum. Anat ., Vol. 12, p. 67.

Ban-son, S. \\\, 1912. “ The Structure of the Spinal Ganglia and of the Spinal

Nerves. ” Joum . Comp. X*nr. y Vol. 22, p. 159.

Ranson, S. W., 1912. “Degeneration and Regeneration of Nerve Fibres.”
Joum. Comp. Xrur. y Vol. 22, p. 487.

Ranson, S. \V., 191.*1. “The Course within the Spinal Cord of the Non*

Medullateil Fibres of the Dorsal Roots.” Joum. Comp. Xettr., Vol. 23,
p. 259.

Ranson, S. W., 1914. “Tlie Tract of Lissauer and the Substantia Gelatjposa
Rolandi.” Am^r. Joum. Aunt., Vol. 16, p. 97-

THE SIGNIFICANCE OF THE UNCONSCIOUS
IN PSYCHOPATHOLOGY . 1

By ERNEST JONES, M.D., M.R.C.P. (Lond.).

Before discussing the question of the importance of the un¬
conscious it is necessary to be clear in what sense one proposes to
use this term, for it is one to which very different connotations
have been attached. There are three principal current uses of the
word “ unconscious,” and mention will be made of each of them in
order.

The first of these, and probably the commonest, is where
“ unconscious ” is regarded as a synonym for “ non-mental.” This
is the general sense in which it is employed in medicine, for
instance, in reference to the “ unconsciousness ” following a brain
injury or the administration of an anaesthetic. Many psychologists
also, notably Miinsterbcrg and Morton Prince, would adhere to
this use of the word. It is plain that this attitude begs the whole
question, by assuming that no mental processes can exist that are
not accompanied by consciousness or awareness. The view held
by most psychopathologists, on the contrary, is that processes
certainly occur, as is shewn by the findings of hypnosis and
psycho-analysis, which present all the attributes of mental ones
except that the subject is not aware of them, and they therefore

1 Read before the Section of Neurology and Psychological Medicine, British
Medical Association, 26th July 1914.

THE SIGNIFICANCE OF THE UNCONSCIOUS 475

call them mental for the simple reason that it is impossible to
describe them except in mental terms; according to this view,
which is here adhered to, consciousness becomes merely one
attribute of mentality, and not an indispensable one. The equating
of “unconscious" with “non-mental” would remove the whole
subject from the field of psychopathology, or of any branch of
psychology, for the other question then involved, that of the
influencing of the mind by non-mental, physical processes, belongs
rather to the field of psycho-physics.

The second conception of the unconscious is difficult to describe
in positive terms on account of its essential vagueness. It might
well be called the “ limbo ” conception, for in it the unconscious is
regarded as an obscure region of the mind, the content of which is
characterised by neglect and oblivion. It is on the whole a
philosophical conception, and has been developed chiefly by such
writers as Hartmann, F. W. H. Meyers, and most recently by
Jung; with some of these writers a mystical element has been
decidedly prominent. According to this view the unconscious
part of the mind is a sort of lumber room to which various mental
processes get relegated when they are in a state of inactivity.
These processes are then usually considered to be of only quite
secondary importance in comparison with conscious ones, and they
are accorded no initiative of their own, or any primary dynamic
functions, being purely of a passive nature.

The third conception of the unconscious is the psycho¬
analytical one, developed by Freud. He divides those mental
processes that are not accompanied by awareness into two groups,
the preconscious and what he calls the unconscious proper, the
latter being the sense in which the term is used in this paper.
Freud’s conception of the unconscious differs sharply from the
preceding ones in that it is a purely inductive one, being built up
step by step on the basis of actual experience without the intro¬
duction of any a priori speculative hypothesis; it may therefore
be called the scientific conception, in contradistinction to the
philosophical one. Instead of starting with any notions, whether
precise or nebulous, of what the unconscious ought to be, he
investigated the actual mental processes that were inaccessible to
his patients’ direct introspection, and which were only to be
reached by means of some technical procedure such as the psycho¬
analytic one. As a result of these investigations, he acquired a

476

ERNEST JONES

gradually increasing knowledge of the nature of unconscious
processes, of their content, meaning, origin, and significance, and
was therefore placed in a position of being able to formulate some
general statements on these matters.

The statement of most fundamental importance, and the one
on which I wish to lay the greatest stress here, concerns both the
origin and the content of the unconscious. It is to the effect that
the existence of the unconscious is the result of “ repression.” By
this is meant that unconscious processes are of such a kind as to
be incompatible with the conscious ones of the given personality,
and are therefore prevented from entering consciousness by the
operation of certain actively inhibiting, “ repressing ” forces. The
incompatibility in question is of a moral order, the word moral
being taken in its widest possible sense. The processes concerned
flagrantly conflict with the moral, social, ethical, modest, or aesthetic
standards that obtain in the person’s consciousness; their very
existence would be intolerable to him, and he automatically
refuses to acknowledge to himself their presence in his mind
In this action of repression only a very small part is played by
the occurrence that may be described as a deliberate conscious
pushing of certain thoughts out of the mind, though this is the
one with which we are most familiar; much more extensive is
the subconscious and automatic keeping apart of the two Bets of
incompatible mental processes.

The unconscious, then, consists of repressed mental material
A second characteristic of it is its dynamic nature. The unconscious
is not a depository for passive material, but a region where the
most active functioning goes on. Unconscious processes are typi¬
cally conative in kind, and may thus be conveniently, and not
inaccurately, described as wishes. These wishes are constantly
striving for gratification, imaginary or real, and it is to this active
striving that the external manifestations of the unconscious are to
be ascribed.

Closely allied to the preceding features of the unconscious is
the third one of its relation to primary instincts. The unconscious
is the part of the mind that stands nearest to the crude instincts
as they are inborn in us, and before they have been subjected to
the refining influences of education. It is commonly not realised
how extensive is the work performed by these influences, nor how
violent is the internal conflict they provoke before they Anally

• THE SIGNIFICANCE OF THE UNCONSCIOUS 477

achieve their aim. Without them the individual would probably
remain a selfish, impulsive, aggressive, dirty, immodest, cruel,
egocentric, and conceited animal, inconsiderate of the needs of
others, and unmindful of the complicated social and ethical
standards that go to make a civilised society. Yet, according to
the findings of psycho-analysis, the results of this refining process
are rarely so perfect as is generally supposed; behind the veneer
of civilisation there remains throughout life a buried mass of
crude primitive tendencies, always struggling for expression, and
towards which the person tends to relapse whenever suitable
opportunity is offered.

In accord, again, with the features just described is the
infantile nature and origin of the unconscious. The splitting of
the mind into conscious and unconscious regions takes place in
the earliest part of childhood life, probably in the first year, and,
as was mentioned above, this splitting is the result of the conflict
between the uncivilised and non-moral endowments with which
we are born, and the inhibiting forces that make for adjustment to
the standards of society. The primordial tendencies are repressed,
and much of their energy is diverted to other, social aims. The
fact that they are not allowed to find direct external expression,
however, does not mean that they are abolished, but that they
are compelled to lead an underground existence, manifesting
themselves only by indirect and tortuous courses. The infantile
character of the unconscious thus persists throughout the whole
of life, giving an added signification to the old saying that the
child is father to the man.

To be correlated with the infantile nature of the unconscious
is the circumstance that it ignores not only moral standards, but
also logical ones. It has, it is true, a logic of its own, but this is
one of the emotions and not of the reason; from the usual point of
view, therefore, it would be called illogical. Just as the fantasy
can overstep the bounds of time and space, so does the unconscious
ignore all reasonable and logical considerations.

The sixth attribute of the unconscious is its predominantly
sexual character. This is only what might have been expected
from the fact that the unconscious is in a state of moral conflict
with the standards of consciousness, for none of the other primary
instincts is subjected to anything like the intensity of repression
that the sexual one invariably is. This attribute stands iq

478

ERNEST JONES

apparent contradiction with the one previously mentioned con¬
cerning the infantile nature of the unconscious, but this contradic¬
tion is easily resolved when we remember the fallaciousness of
the popular belief that would date the sexual instinct from the
time of puberty. Freud and his co-workers have produced
abundant evidence to shew that this instinct is actively operative
long before this time, and probably from early childhood, though
what is called infantile sexuality widely differs from the adult
form, being, like other childhood manifestations, much more
diffuse, tentative, and preliminary in nature. Amongst other
striking differences, two special ones may be briefly mentioned
here: the close association between infantile sexuality and
excretory functions, and the sexual colouring in the child's
relation to its near relatives (the so-called “incest-complex”).
None of Freud’s conclusions has met with more bitter opposition
than the last-named, concerning the normal occurrence of incestuous
fantasies. It was at first met by a blank denial of the facts
themselves. Of late, however, when the facts could no longer be
ignored, more ingenious forms of opposition have been devised.
Jung, for instance, who is familiar with the facts, has formulated
the view that, though these incestuous fantasies unquestionably
occur, they do not mean what they purport to, but constitute merely
a symbol for various ethical ideals, and have no “real,” primary
existence in themselves; according to him, therefore, these uncon¬
scious fantasies possess no dynamic initiative of their own, but are
to be regarded as purely secondary products. The psycho-analytical
view, as against this, is that Jung’s different formulation of the facts
constitutes a distortion and manipulation of them that is dictated
by moral repugnance to a distasteful conclusion.

The preceding description may be summarised in a single
statement: according to psycho-analysis, the unconscious is a
region of the mind, the content of which is characterised by the
attributes of being repressed, conative, instinctive, infantile,
unreasoning, and predominantly sexual. A typical example of
an unconscious mental process, illustrating all of these, would be
the wish of a little girl that her mother might die so that she
could marry her father. The six attributes in question, together
with others not here mentioned, make up a consistent and clearly-
defined conception of the unconscious which is formulated on the
basis of experience that may at any time be tested.

THE SIGNIFICANCE OF THE UNCONSCIOUS 479

The significance of the unconscious, as defined above, for the
science of psychopathology may be discussed under four headings.
In the first place, a knowledge of the content and mode of operation
of the unconscious furnishes us with a key for the understanding
of numerous morbid manifestations that were previously incom¬
prehensible ; it has given us a consistent interpretation of them,
and has revealed the coherent and intelligible structure of them.
Without this knowledge no solution can be found to such problems
as why a given patient has developed this or that particular
delusion, phobia, or other symptom; with this knowledge the
bizarrery and meaninglessness with which we are so familiar in
psychopathology disappear or are replaced by quite other problems.
The reason for this is that all psychopathological symptoms arise
in the unconscious, which is the true seat of the disorder, so that
the investigation of it is of cardinal importance for both pathology
and therapeutics.

In the second place, a knowledge of the unconscious makes
clear not only the meaning of these symptoms, but also the
causation of them. They are, namely, compromise-formations
produced through the conflict between unconscious and conscious
tendencies, and are brought about in the following way. It was
pointed out above that normally a great part of the energy
pertaining to the repressed trends of the unconscious is diverted
to permissible, social aims, a process known as “sublimation.”
This denotes a partial renouncement of the crude pleasures
obtained by indulging in the primitive tendencies that are kept
from consciousness, and a replacement of them by other, more or
less satisfactory, refined ones. Now a great number of people
find it by no means an easy matter to achieve this renouncement,
and are in constant danger of relapsing into the old indulgencies
and gratifications under various circumstances, particularly when
the attractions of the more refined aims flag, as they must do
whenever the mental environment becomes more painful, difficult,
or disagreeable. Then the mental interests and energies are apt
to “ regress ” towards older and more primitive modes of function¬
ing. In this regression, however, they are checked by the
repressing forces on which the original sublimation depended.
In the resulting conflict neither set of forces is entirely successful:
on the one hand the repressing ones manage to prevent a complete
return to the primitive modes of gratification, while on the other

480

ERNEST JONES

they fail in transforming the energies in question into sublimated
activities. A compromise is reached whereby both sets of forces
come to expression, though only in a partial and disguised way;
these compromise-formations are clinically called symptoms, and
constitute the various psychopathological maladies.

As was hinted above, the actual symptoms do not carry their
meaning on the surface, but have to be interpreted and translated
into the language of the unconscious before this can be reached.
To do this a knowledge is necessary of the different mechanisms
by means of which the distortion is brought about that changes
the underlying repressed trend into the manifest symptom; it is
impossible, however, here to discuss the nature of these mechanisms,
such as displacement of the effect, inversion, projection, intro-
jection, transposition, and so on. 1 It can only be said that the
distortion is brought about in perfectly definite ways, and through
the operation of specific factors, which vary in their exact nature
according to the past experiences and mental development of the
individual concerned.

In the third place, the knowledge gained by investigation of
the unconscious bridges over the gap between the normal and the
abnormal by demonstrating that the same processes go on in both,
though the control of the unconscious ones by consciousness is
greater in the caso of the former. Roughly speaking, insanity
presents a picture of the normal unconscious. This matter,
important as it is for normal psychology, does not, however,
pertain to the theme of the present symposium.

Last, but not least, is the remarkable aid that this knowledge
has yielded for the treatment of psychopathological maladies.
Up to the present this has, it is true, been far greater in the case
of the psychoneuroses than in that of the psychoses, such as
dementia praecox, but there it has already proved so valuable that
one is justified in entertaining the hope that further researches
may be profitable from this point of view in the case of the latter
group also. The mode of action of the treatment, in a word, is
that the overcoming, by means of psycho-analysis, of the resist¬
ances that are interposed against the making conscious of the
repressed unconscious material, gives the patient a much greater
control over this pathogenic material by establishing a free flow

For further information on these and allied topics reference may be made
to my 4 ‘ Papers on Psycho-Analysis,” 1913.

ABSTRACTS

481

of feeling from the deeper to the more superficial layers of the
mind, so that the energy investing the repressed tendencies can
be diverted from the production of symptoms into useful, social
channels.

I would conclude these highly incomplete remarks with the
statement that a knowledge of the unconscious furnishes an
indispensable key to the understanding and treatment of psycho-
pathological manifestations.

Hbstracts

ANATOMY.

MAST CELLS IN THE MENINGES OF NEOTUBUS, EASILY
(567) MISTAKEN FOB NERVE CELLS. Paul S. M'Kibbbn, Anal.

Record , 1914, viil, Oct. 20, p. 475.

M'Kibben figures and describes the mast cells which exist in great
numbers in the dura mater of Nectui'us ; they are elongated,
irregular cells, with several long cytoplasmic processes. Thoir
similarity to certain sympathetic nerve cells in shape, size, and
extent, might lead one into serious error. But they differ from
nerve cells in several respects. “ In a study in Amphibia of certain
tissues where sympathetic nerve cells and these mast cells may
occur simultaneously, when methods are used by which it is
impossible to differentiate between the two types of cells, the
value of observations is open to question. In Mammalia a similar
confusion of nerve cells and certain cells of connective tissue is
not altogether impossible.” Leonard J. Kidd.

GANGLION CELLS OF THE NEBVUS TEBMINALI8 IN THE
(568) DOG-FISH (Maatelus Can Is). Paul S. M'Kibben, Joun. Comp.

Neurol ., 1914, xxiv., Oct. 15, p. 437 (6 figs.).

The ganglion of the nervus terminalis of Selachians was found by
Locy (1905) to contain a preponderance of bipolar nerve cells,
with sometimes a few cells having angular outlines and throe
or more processes. M'Kibben, using the intra vitam methylene
blue method, the technique of which he gives, finds that in adults
of Mustelus canis the ganglia of the nerve, ten of which were
once seen, contain multipolar nerve cells: few, if any, bipolar cells

482

ABSTRACTS

were demonstrated. “That the selective action of the methylene
blue has picked out only the multipolar cells and left unstained
the bipolar cells is not impossible but not at all probable.”

Leonard J. Kidd.

SOME FEATURES IN THE DEVELOPMENT OF THE CENTRAL
(569) NERVOUS SYSTEM OF DBSMOONA THUS FUSCA. P. K

Smith, Joum. Morj>hol., 1914, xxv., Sept 20, p. 611 (58 figs.).

This Eastern American Urodde was chosen for study partly because
it was easily available, the eggs during earlier stages are not
pigmented, and the persistence of embryological characters and
the retention of teUodean characters have been noted. Con¬
clusions: “(1) The epiphysis of Desmog-nathus fusca is morpho¬
logically double. The posterior outgrowth forms first; it is
followed by an anterior evagination which forms independently.
As growth proceeds they come to have a common ostium into
the third ventricle. The epiphysis is formed on the second
diencephalic segment. (2) No evidence is found in the cephalic
portion of the medullary plate of divisions to which a segmental
value should be assigned. There are irregularities and folds in
this portion of the medullary plate which are normal but not
constant. The primary fore-brain vesicle becomes secondarily
divided into three segments: the cephalic one is included in the
telencephalon, the other two in the diencephalon. The mid¬
brain vesicle is composed of two segments. These appear at the
same time as the primary vesicle.” Leonard J. Kidd.

THE DEVELOPMENT OF THE ADRENAL GLANDS OF BIRDS

(570) Victor J. Hays, Anat. Record , 1914, viii., Oct 20, p. 451 (8 figs.).

From observations based on embryos and adults of Gallus domcsticus
Hays concludes: “(1) The Anlagcn which give rise to the cortical
substance of birds appear as groups of cells which migrate doreally
from the peritoneal epithelium. (2) The chromaffin substance is
derived from indifferent cells which wander in from the Anlagen
of the prevertebral sympathetic plexuses. (3) The chromaffin sub¬
stance of the glands lies in contact with the venous blood vessels.
The vessels of the arterial system are found almost entirely in the
cortical substance. In general, this is the same condition as Flint
found in the adrenals of mammals. (4) The entire venous system
is derived from the subcardinal veins. Within the glands the
vessels of this system are sinusoidal in character. (5) During the
period in which there is the greatest influx of cells from the Anlagen
of the prevertebral sympathetic plexuses there is also the greatest

ABSTRACTS

483

activity in the development of the vascular systems. It is possible
that the relationship of cause and effect exists between the
simultaneous activity in the development of these distinct systems
of the adrenal glands.” Leonard J. Kidd.

PHYSIOLOGY.

A NEW THEORY OF HEARING. F. P. Sturm, Joum. of Laryngol .,

(571) Jthinol., and Otol., 1914, April, p. 193.

This theory is based on the supposition that the hair-cells of the
organ of Corti respond to sound in the same manner in which the
rods and cons of the retina respond to light, that is, by an actual
process of contraction.

“(1) The hair-cells of the organ of Corti are the end-organs
of the auditory nerve. They respond to the stimulus of sonorous
vibrations in two ways—the body of the cell by contraction, the
sensory hairs by sympathetic vibration.

“(2) The contraction of the cell frees the hairs from the
pressure of the tectorial membrane, which acts as a damper. The
cells contract until they are beneath the level of the reticulate
membrane, whose function it is to prevent this heavy damper from
sinking down upon the contracted cell.

“ (3) Sound vibrations reach any particular hair-cell or set of
hair-cells by means of the fibre or fibres of the basilar membrane
which support them.

“ (4) The so-called ligamentum spirale is in reality a muscle,
and acts as the tensor of the basilar membrane. It is thus able
to not only induce and inhibit paracusis by locking and unlocking
the rods of Corti, but also to produce any degree of tension in
every fibre of the basilar membrane, thus providing what is practi¬
cally an infinite capacity for sympathetic response to sound-waves.”

When a stimulus occurs, and a small part of the basilar
membrane vibrates, the hair-cells at once contract and free the
hairs from the membrana tectoria. The basilar membrane is thus
freed, and the hair-cells can now respond freely to the stimulus.

J. K. Milne Dickie.

THE STATE OF THE VASOMOTOR APPARATUS IN PNEU-

(572) MONIA. W. T. Foster and L. H. and I. Newburgh, Amer.
Joum. Physiol., 1914, xxv., Aug., p. 1.

The writers deny the old proposition that the toxins of
pneumonia specifically injure the vasomotor cells. “Earlier
investigators, using the methods of their day, failed to show in

484

ABSTRACTS

this disease a normal change of blood-pressure upon the stimula¬
tion of nerves afferent to the vasomotor centre. The present
investigation with more perfect methods demonstrates a normal
vasomotor reflex, with almost wholly consolidated lungs, in animals
about to die.” The organisms used for infection were the Pneumo¬
coccus Frdnkel for rabbits, and the Streptococcus mucosus ( Pseudo-
pneumococcus, Pneumococcus mucosus) for rabbits, cats, and dogs.
Conclusion: “Experimental evidence proves that the vasomotor
centre is not impaired in fatal pneumonia.”

Leonard J. Kidd.

OVARIAN EXTIRPATION AND VASOMOTOR IRRITABILITY.

(573) R. G. Hoskins and Homer Wheelon, Amer. Joum. Physiol.,
1914, xxv., Aug., p. 119.

Symptoms of vasomotor irritability, e.g., hot flushes, dizziness,
sweating, and increased pulse rate, which often follow surgical
ovarian extirpation in women of child-bearing age, appear about
the fifth week after operation, occur intermittently many times
a day, and gradually decrease in frequency till they finally cease
in about eighteen months. The writers find that “ovarian
extirpation in dogs results within six to eight weeks in a marked
augmentation in the vasomotor reaction to a standard dose of
nicotine. The reaction to epinephrin is not similarly increased.
These results, in conformity with clinical evidence, indicate that
the operation causes a heightened irritability in the sympathetic
nervous system.” The writers have not yet determined whether
the augmented irritability would ultimately disappear in dogs
as it does in the human species. Leonard J. Kidd.

EXPERIMENTAL OBSERVATIONS ON THE SUPRARENAL
(674) GLANDS WITH ESPECIAL REFERENCE TO THEIR
INTER RENAL PORTIONS. S. J. Crowe and G. B. Wislocki,
Bull. Johns Hopkins Hosp., 1914, xxv., Oct, p. 287.

From the authors’ summary of their experiments on twenty-six
dogs, young and old, the following conclusions are here selected:
(1) In dogs the adrenals are vital organs: it is probably the cortex
which is essential to life; (2) after partial adrenal extirpation
there is cortical hypertrophy, chiefly of the fascicular layer, but
none of the medulla; (3) acute and chronic infections in an
animal with an adrenal insufficiency sometimes cause changes in
the fascicular layer of the cortex, but none in the medulla; (4)
after an “ almost total ” removal of both adrenals, the animals often
have general convulsive seizures, a subnormal temperature, and

ABSTRACTS

485

other symptoms of an acute adrenal insufficiency: sometimes
gradual recovery follows, with subsequent normal growth and
sexual functioning: there is no change in disposition and no
polyuria: weight increases, but not to abnormal extent; (5) no
permanent raising or lowering of carbohydrate tolerance follows
an adrenal insufficiency; (6) transient glycosuria follows operative
adrenal manipulation; (7) there seems to be a definite relation¬
ship between the adrenals and the lymphatic system: the most
striking feature at autopsy of dogs with long-standing adrenal
insufficiency is enlargement of mesenteric and retro-peritoneal
lymph nodes and of the solitary lymph follicles in the intestinal
walls: not infrequently there is also hyperplasia of the thymus.
(There are twelve figures, the coloured ones being specially
beautiful.) Leonard J. Kidd.

PSYCHOLOGY.

MENTAL TENDENCY IN TESTIMONY. Helens Lelesz, Arehiv.
(576) de Psychol ., 1914, May, p. 1.

The writer takes up Binet’s work on intellectual types, and
endeavours by means of a series of experiments devised for this
purpose to find out the comparative frequency of the different
types, and whether any constant effect upon evidence can be traced
to the type. She experimented on 124 persons, of whom 69 were
children. These subjects were shown a picture for one minute,
after which they were required to write an account of it, and also
to answer a series of questions about it. The papers thus obtained
furnished the evidence studied. It was found possible to arrange
them in five groups, corresponding very closely to the five groups
distinguished by Binet. The papers of each group were then
considered from the point of view of their value as evidence, and
certain general statements are made with regard to each group. ,
The practical value of the results, if they are confirmed by
subsequent workers, is that they offer a judge the means of
estimating the value of the evidence of any witness by a study of
the nature and form of the evidence itself.

Margaret Drummond.

A CASE OF HYSTERICAL CONTRACTURE. Charles Odier,
(676) Arehiv de Psychol ., 1914, May, p. 158.

An account of a case of hysterical mutism with subsequent develop¬
ment of talipes, equino-varus, and a stiff leg. The ability to speak
returned after nine months. The stiffness of the leg disappeared

486

ABSTRACTS

under narcotics, but the condition of the foot remained unaffected.
Hence it was thought necessary to divide the tendo Achillis.

The psychological interest of the case consists in the analysis
which shows that both symptoms resulted from psychic traumas,
the mutism being equivalent to a retreat from the world motived
by the death of the patient’s father, to whom she was deeply
attached; and the contracture being the symbolic expression of a
wish rooted in her subconscious life. Margaret Drummond.

PATHOLOGY.

COLLODION OOVBBSLIP8 IN MICROSCOPICAL TECHNIQUE.
(577) (Ooprtogetti di collodion nella technics microscopies.)
G. D’Abundo, Riv. ital. di Neurop ., Prickiatr. ed EletProter .,
1914, vil, p. 296.

The glass coverslips in ordinary use are very fragile and not
sufficiently thin. The writer therefore recommends the substitu¬
tion of collodion coverslips made from a solution composed of
collodion 10 parts, absolute alcohol 5 parts, and sulphuric ether
5 parts.

The transparency of these coverslips is equal to that of glass
ones, and their thickness is considerably less.

J. D. Rolleston.

80MB OF THE HISTOLOGICAL CHANGES FOUND IN TABES.

(678) Frederic H. Thorne, Jou m. of Med. Soc. of New Jertey, 1914.

The material for this paper was taken from nine typical cases of
tabes in all stages of degeneration. The conclusions are that tabes
dorsalis is a degeneration of the spinal cord due to an invasion and
proliferation of the treponema of syphilis. The pia was thickened
in all the cases, usually equally so all round the cord, and extend¬
ing as far up as the pons and optic tractB. There is always a
plasma cell infiltration into the pia, and in the adventitial lymph
spaces of the vessels in the cord substance; this plasma cell
infiltration is intense in the active oases, but scanty in the long¬
standing cases. It is seldom found above the pons. The degenera¬
tion found in the posterior columns is secondary, and is only one
manifestation of the degenerative process. Its cause is obscure.
The glial element in the cord is usually increased both in the grey
and in the white matter. Many focal lesions were found scattered
throughout the grey substance. The ganglion cells of the anterior
horns and of Clark’s column are markedly involved.

The meningitis, pia infiltration, and glia proliferation are
identical with those found in the brain in general paralysis.

A. Ninian Bruce,

ABSTRACTS

487

PARAMENINGOCOCCUS AND ITS ANTISERUM. Martha

(679) WOLL8TMN, Joum. Exp. Med., 1914, xx., p. 201.

The parameningococci of Dopter are culturally indistinguishable
from true or normal meningococci. Serologically, they exhibit
differences in regard to agglutination, opsonisation, and complement
deviation. This, however, is not sufficient to justify their being
placed in a separate class, because considerable variation and
irregularity in tne serum reactions is also found amongst otherwise
normal strains of meningococci. It is therefore best to consider
the parameningococci as merely a special strain of the meningo¬
coccus, and not wholly consistent in itself.

As the distinctions in the serum reactions between normal and
parameningococci are supported by the differences in protective
effects of the monovalent immune sera upon infection in guinea-
pigs and monkeys, it is advisable that parameningococcal strains
be employed in the preparation of the usual polyvalent anti-
meningococcal serum. A. Niki an ‘Bruce.

LOCALISATION OF THE VIRUS AND PATHOGENESIS OF
(580) EPIDEMIC POLIOMYELITIS. Simon Flexnrb and Harold
L. Am 088 , Journ. Exp. Med., 1914, xx., p. 249.

The virus injected into the blood is deposited promptly in the
spleen and bone marrow, but not in the kidneys, spinal cord, or
brain. In spite of the affinity which the nervous tissues possess
for the virus, it is not removed from the blood by the spinal cord
and brain until the choroid plexus and blood vessels have been
injured. An aseptic inflammation, such as may be produced by
an intraspinous injection of horse serum, facilitates and ensures the
passage of the virus to the central nervous organs, and the pro¬
duction of paralysis. When the virus within the blood fails to
gain access to the central nervous organs and to set up paralysis,
it is destroyed by the body, in course of which destruction it
undergoes diminution of virulence.

The histological lesions which follow the intravenous injections
of the virus in some, but not in all, cases differ from those which
result from intraneural modes of infection. In escaping from the
blood into the spinal cord and brain, the virus causes a lymphatic
invasion of the choroid plexus and widespread perivascular
infiltration, and from the latter cellular invasions enter the
nervous tissues. A similar lymphoid infiltration of the choroid
plexus may arise also from an intracerebral injection of the virus.
The histological lesions present in the central nervous organs in
human cases of poliomyelitis correspond to those that arise from
the intraneural method of infection in the monkey. The virus, in

488

ABSTRACTS

transit from the blood through the cerebro-spinal fluid to the
substance of the spinal cord and brain, is capable of being
neutralised by intraspinous injection of immune serum, whereby
the production of paralysis is averted.

The authors consider that infection in epidemic poliomyelitis in
man is local and neural, and by way of the lymphatics, and not
general and by way of the blood. Hence they uphold the belief
that the infect ion atrium is the upper respiratory mucous membrane.

A Ninian Bruce.

PENETRATION OF THE VIRUS OF POLIOMYELITIS FROM
(581) THE BLOOD INTO THE CEREBRO SPINAL FLUID. Simon
Flexner and Harold L. Amoss, Joum. Exp. Med. t 1914, xix.,
p. 411.

It is now generally conceded that the poliomyelitic virus enters
the human body by way of the upper respiratory passages, and in
particular through the nasopharyngeal mucous membrane. Once
within this membrane the virus may pass through the lymphatic
channels of the olfactory nerve to the leptomeninges, where it
reaches the cerebro-spinal fluid, or it may first enter the blood.
It may then pass indirectly by way of the cerebro-spinal fluid to
the interstices of the central nervous system. To reach the
cerebro-spinal fluid the virus must first penetrate the barrier of the
choroid plexus, which requires time. By the inoculation test no
virus was detected in the fluid at the expiration of forty-eight
hours, only small amounts at the expiration of seventy-two hours,
while at the expiration of ninety-six hours the virus had passed
more freely. The virus was still to be detected in the fluid at the
onset of paralysis nineteen days after the intravenous injection.
Pathological conditions of the leptomeninges and the cerebro-spinal
lluid play an important part in the pathogenesis of epidemic
poliomyelitis. A Ninian Bruce.

CLINICAL NEUROLOGY.

CHANGES IN THE OCULO CARDIAC REFLEX UNDER THE
(582) INFLUENCE OF PREGNANCY. (Modifications dn rtfexe
oculo-cardiaque sons l’infinence do la gestation.) M. Garniks

and G. L£vi-Franckel, Bull , et mem . Hoc . m £ d . H 6 p . de Pant ,
1914, xxxviii., p. 252.

As the result of their examination of seventy women in the
seventh to ninth months of pregnancy, the writers came to the
following conclusions. Iu normal pregnancy a sympathico-tonic

ABSTRACTS

489

syndrome is fairly frequent and is formed by the union of three
symptoms, tachycardia, inversion or abolition of the oculo-cardiac
reflex and mydriasis.

These three elements of the syndrome may be dissociated;
thus one may find tachycardia alone, or tachycardia accompanied
by disturbance of the oculo-cardiac reflex without mydriasis,
or disturbance of the oculo-cardiac reflex without tachycardia.

After delivery all these symptoms disappear, but the pupil
is the last to resume its normal condition.

J. D. Rolleston.

HERPES ZOSTER AND MALARIA. W. H. Deadebick, Med. Record,
(683) 1914, lxxxvi, p. 421.

A record of eight cases of herpes zoster in patients aged from 13
to 72 years. Five of the cases were associated with malarial
infection of the sestivo-autumnal form. J. D. Rolleston.

ON THE OCCURRENCE OF A BILATERAL EXTENSOR RESPONSE
(684) IN STATES OF UNCONSCIOUSNESS. C. O. Hawthorne,
Practitioner, 1914, xciii., Sept, p. 330.

The author considers that the association of a bilateral extensor
response with coma does not necessarily mean an organic lesion,
and that coma, however produced, may be sufficient to establish in
the central nervous system the conditions upon which the appear¬
ance of the extensor response depends. He describes four cases of
coma with bilateral responses, the first from morphine poisoning,
the second from delayed chloroform poisoning, the third of toxic
origin, and the fourth from a bullet wound to the head.

A. Ninian Bruce.

CONJUGAL ZOSTER. (Zona conjugal.) C. Audry, Ann. de Derm, et
(686) de Syph., 1914, 6 s4r., v., p. 299.

In December 1913 the wife developed typical zoster involving the
right shoulder, front of the chest in the region of the third
intercostal space, and upper arm and forearm of the same side.
In February 1914 the husband, aged 38, developed zoster of the
right side of the neck, deltoid region, and second intercostal space.

The interest of the case lies in the probability of contagion
(cf. Review, 1912, x., p. 531, and 1913, xi., p. 434).

J. D. Rolleston.

400

ABSTRACTS

MULTIPLE NEUROFIBROMATOSIS OF THE SKIN. (Beitng rur

(586) Kasuistik and Kenntnis der maltiplen Neuroflbromatose der

Haut.) P. H. Schoonheid, Derrnat. Zeitschr., 1914, rxi., p. 610.

A review of the literature and record of a case previously
published in a Dutch journal (r. Review, 191.3, xi., p. 623).

J. L). Rollesto.w

PERSISTENT HEREDITARY (EDEMA OF THE LEGS (MHiROYS

(587) DISEASE), WITH ACUTE EXACERBATIONS. REPORT OF
TWO CASES. J. Phillips, Cleveland Med. Jovm., 1914, xiil,
p. 316.

Case 1. Man, aged 40, with well-marked painless swelling of the
left leg from the knee downwards. It had been present since the
first year of life and had never caused him much inconvenience,
but since the age of 10 years the leg at times became red, swollen,
hot, and tender. The attack would subside in three or four days.

Case 2. His son, aged 6 years, showed a similar condition,
except that the right leg was affected. The swelling had first been
noted when he was four months old. He had had only one
exacerbation which subsided in a few days (cf. Review, 1908, vl,
p. 663). J. D. Rollestox.

ARSENICAL MYELITIS. (Des mydlites ars^nicales.) O. Fon-agtbs,

(588) Theses de Paris, 1913-14, No. 271.

A record of ten cases in patients, aged from 7 to 50 years, in
whom the administration of arsenic, whether in a therapeutical,
suicidal, or accidental manner, was followed by paralysis of the
lower limbs with or without sphincter troubles. In four cases,
two of which were fatal, the symptoms followed injection of
“ 606 ” or “ 914.” J. D. Rollkston.

NOTE ON TWO CASES OF INTRADURAL SPINAL TUMOURS.

(589) D. Dopglas-Crawford, Proc. Roy. Soc. Med., 1914, vii., July
(Surg. Sect.), p. 265.

The first case was a man, aged 37, a dock labourer, who complained
of pain on right side, with weakness of the right leg. The skin
area supplied by the right eighth and ninth dorsal nerves was
hypenesfchetic. The legs were spastic, with double ankle clonus
and double Babinski. As the paraplegia became absolute, and
sphincter troubles set in, a laminectomy was performed, and an
encapsulated fibro-sarcoma was easily removed from the level of
the eighth dorsal nerve. Recovery was rapid and complete.

The second case was a man, aged 55, who gave a long history

ABSTRACTS

491

of recurrent attacks of pain in the left lumbar and inguinal regions.
Occasionally twitching of left leg. His gait became spastic, and
he lost control of his sphincters. There was double ankle clonus
and double Babinski. A laminectomy was performed, and a
myxo-sarcoma was removed. He remained well for two years, when
his old symptoms reappeared, the paraplegia becoming absolute.
As a recurrence was feared, the cord was again exposed, and it was
found that the symptoms were caused by a spur of new bone which
had pressed the cord over to the right side. It was removed, and
he recovered. A. Ninian Bruce.

THE TREATMENT OF TABETIC OPTIC ATROPHY WITH INTRA
(590) SPINAL INJECTIONS OF SALVAR8ANISED SEBUM. (A

Preliminary Report.) George T. Johnson, L. Z. Breaks, and

August F. Knoefel, Journ. Amer. Med. Attoc., 1914, Ixiii., Sept. 5,

p. 866.

Two cases are described. The first was that of a man, aged 35.
The Wassennann reaction was positive. Apart from the absence
of the left knee jerk, there were no other signs of tabes except
the ocular findings. The right vision was 20/70, and the
left 20/200. Pupils showed marked myosis, and the reaction to
light was slight. The fundus showed the nerve heads greyish
white with sharp-cut margins. He was given neosalvarsan intra¬
venously, followed by intraspinal injections of the serum. After
six injections the vision improved a little, the right vision being
20/50, and the left 20/100.

The second case was a man, aged 37. There was right
amaurosis; the left vision was 20/100. Both knee jerks were
absent, Romberg’s sign was present, and there was marked inco¬
ordination of both upper and lower extremities. After similar
treatment to the above case, his vision improved to 20/30, and
he regained his ability to distinguish colour. Severe reactions
often followed the intraspinous injections. A. Ninian Bruce.

EPIDEMIC POLIOMYELITIS. Arthur A. Pim, Brit. Med. Journ.,
(591) 1914, Nov. 14, p. 831.

A very short account of a number of widely separated cases in a
village in Dorsetshire. It is suggested that the infection might
have been distributed by four parents who worked together in a
butcher’s shop, and lived in entirely separate parts of the town.

A. Ninian Bruce.

492

ABSTRACTS

HIGH INCIDENCE OF POST-DIPHTHERITIC PARALY SIS: A
(592) CONTRIBUTION TO THE QUESTION OF THE NEURO¬
TROPISM OF CERTAIN INFECTIVE AGENTS. (GehSufte
post diphtheriache L&hmtmgen; ein Beitrag znr Fnge der Neuro-
tropie gewisser Infektionstoffe.) P. Schuster, Neurol. Centralbl .,
1914, xxxiii., p. 891.

Three persons, the mother, father, and son aged 11 years, fell ill
at about the same time with severe faucial diphtheria. The
parents received 4,500 units each of antitoxin and the boy 1,500.
Each developed well-marked nervous symptoms. The father, six
weeks after the angina, developed panesthesia in the feet and
fingers, followed by weakness of the extensors of the hand, fingers,
and left extensor of the foot, feeble knee jerks, and absent ankle
jerks. The mother, about a fortnight after recovery from the
angina, had transitory difficulty in swallowing, and a few weeks
later developed an unsteady gait, tingling in the feet, ataxia of
the fingers, tenderness of the nerve trunks, absence of the forearm,
periosteal, and triceps reflexes, and absence of tendo Achillis
reflexes. The knee jerks were very feeble. In the son the
symptoms merely consisted of tingling in the feet and absence of
knee and ankle jerks.

Schuster has found only two other examples of familial
diphtheritic paralysis, recorded by Feilchenfeld (v. Review, 1908,
vi., p. 664) and Kayser (ibid., 1910, viii., p. 613) respectively.

He attributes the high percentage of paralysis in a single
family to a special neurotoxic variety of the diphtheria toxin,
and suggests that a similar condition may be present in syphilis.

J. D. Rolleston.

PNEUMOCOCCAL MENINGITIS IN THE SHARPSHOOTERS OF
(593) SENEGAL. (La mtfningite k pneumocoques des tirailleurs
s4n6galais.) W. Dufougbb£, Bull. Soc. de Path. Exot ., 1914, vii,
p. 466.

Pneumonia is a very fatal disease among the black troops of
Morocco. The pneumococcus rapidly invades the system, and has
a predilection for the heart and brain. Sometimes the meninges
are alone affected, and the symptoms suggest epidemic cerebro¬
spinal meningitis or typhus. Intravenous injections of collargol
or electrargol are recommended as treatment. An illustrative case
is recorded in a man, aged 22. The cerebro-spinal fluid was
clear, but contained pneumococci which were also present in
the pus in the cerebral meninges post mortem. There was no
pneumonia. J. D. Rolleston.

ABSTRACTS

493

ASEPTIC ENCEPHALO-MENINGEAL REACTIONS. (Contribution
(694) K l’6tndo dea reactions encdpbalo-m^ningdes aseptiques.) R.

Bourgeois, Theses de Lyon, 1913-14, No. 70.

The term “encephalo-meningeal reactions” is applied to a
syndrome caused by irritation of the neuraxis and its membranes,
but unaccompanied by gross lesions of the meninges or the nerve
centres, and running an essentially mild course. The syndrome
occurs at the onset, during the course, at the end of, and
during convalescence from, infectious diseases and intoxications.
The origin of some cases is unknown, but is probably infective.
The syndrome is found in various other morbid states, such as
trauma, cerebral haemorrhage, and insolation. It may also occur
after intraspinai injection of various substances. The symptomat¬
ology is that of meningitis, but sometimes only one or two
symptoms are present, or the condition may be entirely latent,
and only revealed by lumbar puncture. The lesions found after
death, which is due to the primary infection, are congestion of the
meninges and lesions of the pyramidal cells.

The symptoms are due to microbial toxins and other poisons.

The syndrome may be mistaken for acute meningitis or
tuberculous meningitis. The diagnosis is made by lumbar puncture,
which is also the best treatment. The condition is essentially
curable, and usually leaves no residues.

The thesis contains the histories of fourteen cases, including
three personal ones, in which the primary disease was influenza,
paratyphoid B infection, and trauma respectively.

J. D. Rolleston.

ON METAGHANOBAL AND PREROSEOLAR MENINGITIS IN
(595) SYPHILIS. (Sur la mlningite syphilitique mltachancreuse et
pr6ros6olique.) Lavau, Ann. de Derm, et de Syph., 1914, 5 sir.,
v., p. 280.

A record of nine cases, including one previously published by
Audry (v. Review, 1914, xii., p. 213), in males aged from 15 to 25.
Of these, six showed changes in the cerebro-spinal fluid, viz.,
hypertension, lymphocytosis, increase in albumin, or a positive
Wassermann’s reaction.

The writer’s conclusions are as follows:—

1. Preroseolar meningitis occurred in two-thirds of his cases.

2. It may be manifested only by slight headache. As a rule
it is absolutely latent, and is only revealed by physical, histo-
clinical, and biological changes in the cerebro-spinal fluid.

3. Treatment by arseno-benzol often exaggerates the meningeal

494

ABSTRACTS

reaction, thus giving rise to Herxheimer’s reaction in the meninges
This exaggeration, however, is not constant, and bears no relation
to the intensity of the pre-existing meningeal lesion, being some¬
times absent in severe syphilitic meningitis, and present in cases
with an almost normal cerebro-spinal fluid.

4. Arsenical treatment, especially neosalvarsan, after exaggerat¬
ing the meningeal reaction, constitutes the best treatment for the
condition. Caution is necessary, and in the severe meningitis at the
onset of the secondary period intramuscular injections of mercurial,
salts only should l»e given during the first four or five days.

5. The metachancral meningeal reaction appears clinically in

a relatively high number of cases treated by intravenous injections
of neosalvarsan. Possibly lumbar puncture may favour their
occurrence. J. D. Rolleston.

PROGRESSIVE LENTICULAR DEGENERATION. Williams 6.

(596) Cadwalader, Joum. A mer. Med. Assoc., 1914, lxiii., Oct 17, p. 1380.

Two cases are described. The first case was in a man, aged 18.
The present condition began at 14, while he was at school, and
developed quickly. The symptoms were sluggish movements,
indifferent table manners, drivelling of saliva, dysarthria, and
general lassitude. A diagnosis of myxcedema with multiple
myoclonus was made and thyroid extract given, which caused
great improvement for a time. At 18 he showed a vacant facial
expression, with a more or less constant smile. The muscles
appear good. The most striking features are marked tremors,
rigidity, and a tendency to contractures, all of which are never
absent, although they vary in intensity. There is no Babinski’s
sign, and the liver dullness appears normal. The mental condition
is fairly good.

Case 2 was a man, aged 36. The present condition began at
the age of 16. The tremor at first affected the right side, the
muscular rigidity and plasticity gradually increasing and spreading
to the muscles of the neck, causing tremor of the head, and later
the entire body. About five or six years after its onset the
disease became stationary. Babinski’s sign is negative, and the
liver dullness appears normal (v. Review, 1913, xl, p. 167).

A. Ninian Bruce.

THE CIRCULATORY SYSTEM IN ACEOMEGALY. (L’appareU

(597) circulatoire au conn do l’acromig&lie.) G. Gkelubr, Theses de
Parts, 1913-14, No. 441.

The thesis contains the histories of thirty-eight cases, of which
two are original.

ABSTRACTS

495

The conclusions are as follows:—

1. Cardio-vaseular troubles are frequently noted in acromegaly,
and consist of palpitation, angina pectoris, asystole, and syncope,
vasomotor symptoms (local asphyxia and gangrene of the
extremities, transitory swelling of the hands and feet, and
sweating), and epistaxis.

2. Clinical and radiographic examination shows considerable
hypertrophy of the heart. The arteries are rigid and atheromatous.
The pulse is affected in frequency, rhythm, and force. The blood-
pressure is fairly often increased, and the veins are varicose.

3. Examination of the blood shows a more or less marked
anaemia and slight leucocytosis.

4. Post mortem, the heart is found to be increased in size either
as a whole or in its right side only. This hypertrophy may exist
alone or be associated with sclerotic myocarditis. The pericardium
is fairly often affected.

5. The pathogeny of these cardio-vascular lesions varies. In

some cases it is due to thoracic deformity or to nephritis. In other
cases a pluriglandular theory explains a large number of the
symptoms. J. D. Roi.leston.

THE OOOUBRBNOB OF PELLAGRA IN ENGLAND. R. W.

(598) Willoocks, Practitioner , 1914, xciii., July, p. 106*

After a short account of this disease, the author describes a
typical case in a girl, aged 14, who had practically never been out
of London. She had been employed at a printing establishment,
and had never eaten maize. She had always been well fed and
clothed. A Ninian Bruce.

SUBFASCIAL LIPOMA OF THE FOOT CAUSING SYMPTOMS OF
(599) SCIATIC NEURALGIA. (Un caso di lipoma subfasciale del
piede determinants la sindrome della nevralgia sciatica.) R.
Casali, Gait. d. o*p., 1914, xxxv., p. 705.

A case of obstinate sciatic neuralgia in a man, aged 57, successfully
treated by extirpation of the tumour. J. D. Rolleston.

A CASE OF EXOPHTHALMIC GOITRE SIMULATING ACUTE
(600) OBSTRUCTION. G. M'Call Smith, Lancet, 1914, clxxxvii., Oct.
10, p. 894.

The case is that of a domestic servant, aged 23, who exhibited
symptoms of acute obstruction as shown by fajcal vomiting,

496

ABSTRACTS

abdominal pain, and visible peristalsis, uncountable pulse, and a
temperature of 101°. She did not, however, appear to be so ill
as would have been expected if the symptoms were due to acute
obstruction, and a diagnosis of hyperthyroidism was made, and
operation deferred. She recovered, and two months later presented
typical signs of exophthalmic goitre, namely, exophthalmos, enlarged
thyroid, pulse rate 105, tremor of hands, and general nervousness.

The case is of interest, as severe vomiting, when it occurs, is
usually a terminal symptom of exophthalmic goitre.

A. Ninian Bruce.

TUBERCULOSIS AND EXOPHTHALMIC GOITRE. (Tuberculosa et
(601) goitre exopht&lmique.) P. Ledoux, Theses de Paris, 1913-14,
No. 415.

Although it is well recognised that Graves’ disease may follow
infections such as scarlet fever, rheumatism, measles, and syphilis,
Ledoux maintains that too little setiological importance has been
assigned to tuberculosis. He records four personal cases in which
Graves’ disease developed in the course of attenuated tuberculosis,
and also two cases which developed tuberculosis in the course of
Graves’ disease. J. D. Rolleston.

THYROID OPOTHERAPY IN GYNECOLOGY. (L’opotMrapie

(602) thyroidienn# on gynecologic.) B. Chakhine, Theses de Paris,
1913-14, No. 433.

A record of twenty-nine cases, including two original ones, in
which thyroid opotherapy sometimes associated with ovarian
extract was used in the treatment of the various disorders of
menstruation, uterine displacements, and chlorosis.

J. D. Rolleston.

GUMMATA OP THE THYROID. (Lee gommes syphilitiquea du

(603) corps thyrolde.) R. Beaufils, Theses de Paris, 1913-14, No. 416.

The thesis contains the histories of five cases, one of which is
original.

The writer’s conclusions are as follows:—

1. Gumniata of the thyroid, whether due to inherited or
acquired syphilis, are rare.

2. Clinically they are manifested by hard swelling, dysphagia,
and dyspnoea.

3. They must be distinguished from tuberculous thyroiditis by
heir course and by Wassermann’s reaction.

ABSTRACTS

497

4. In every case of thyroid swelling in which acquired or
inherited syphilis is suspected, treatment should be instituted
in the form of injections of benzoate of mercury with iodide
internally. J. D. Rolleston.

OBBBBBAL SYPHILIS IN THE SECONDARY STAGE. C. B.

(604) Craig, Med. Record , 1914, lzxzvi., p. 422.

A record of two cases of meningitis coincident with a secondary
rash in men, aged 28 and 35, in whom injections of salvarsan and
neosalvarsan respectively produced rapid disappearance of the
headache, the only symptom complained of. The cerebro-spinal
lymphocytosis was reduced, and globulin excess in the cerebro¬
spinal fluid disappeared after treatment. J. D. Rolleston.

SYPHILOPHOBIA. D. W. Montgomery, Med. Record, 1914, lxxxvi.,
(606) p. 464.

A record of a case in a man who, on four separate occasions, owing
to an eruption of herpes labialis, was convinced that he had
contracted syphilis. Finally he developed herpes zoster of the
lumbar region, accompanied by swelling of the inguinal lymph
glands. The true nature of the eruption was explained to him,
and nothing more was heard of his imaginary syphilitic infections.

J. D. Rolleston.

ERRORS IN THE INTERPRETATION OF WASSERMANN’S RE-
(606) ACTION. (Erreurs ^interpretation de la reaction de Wasser-
mann.) P. Ravaut, Ann. de Derm, et de Syph., 1914, 6 s6r., v.,

p. 286.

In undoubted syphilis a positive Wassermann’s reaction is a
definite symptom of the disease. On the other hand, the reaction
may be negative in spite of active cutaneous or visceral lesions.
A negative reaction, therefore, does not exclude syphilis.

The reaction should not play too large a part in the direction
of treatment. One should try to make and keep it negative, but
in old cases of syphilis it is sometimes impossible to change the
reaction. A negative reaction does not by itself allow one to
consider the patient as cured and to suspend the treatment. In
a patient suspected of syphilis a positive reaction should be
regarded as corroborative evidence.

In a patient without a history or signs of syphilis a constantly
positive reaction indicates that syphilis should be sought for.
Apart from syphilis the reaction may be positive, and as it has no
absolute value, does not by itself justify the diagnosis of syphilis.

498

ABSTRACTS

Ravaut records illustrative cases, including examples of positive
reactions in non-syphilitic cases such as lupus, tuberculides, lichen
planus, and psoriasis. J. D. Rolleston.

THE OUTLOOK IN EPILEPSY. William Aldren Turner, Brit.

(607) Med. Joum., 1914, Oct. 17.

In defining the cure of epilepsy some feature other than a time
limit should be introduced, as cases may remit for several years
and then relapse into an incurable state. The mental condition
of the patient is an essential factor. The cured epileptic should
be able to earn his own living, and complete withdrawal of all
sedatives need not be regarded as necessary for this. If the
sedative drug can be permanently withdrawn, without any relapse
of the seizures and with retention of good mental faculties and
memory, the case belongs to the group of cured epilepsy.

The epilepsies of infancy and early childhood form one of the
most unsatisfactory types, as in many cases these arise from
organic focal lesions of the brain. Temporary arrest may take
place about the age of four or five.

The epilepsies of puberty and adolescence are not unfavourable
if the fits be not too frequent, and the mental condition satisfactory.

The late epilepsies are favourable if alcoholism can be excluded,
and organic disease of the brain is absent.

Once dementia sets in the outlook is unfavourable, although
the fits may be kept in abeyance by sedatives.

A. Ninian Bruce.

TETANUS: ITS PREVENTION AND TREATMENT BY MEANS

(608) OF ANTITETANIO SERUM. Alfred MacConkey, Brit. Med.
Joum., 1914, Oct. 10, p. 609.

A very good account along the above lines. The great importance
of recognising tetanus early is emphasised, as by the time the
characteristic symptoms have developed the disease is far advanced.
Premonitory symptoms must therefore be looked for, and these
may be sleeplessness with distressing dreams, temporary giddiness,
violent headache, excessive yawning, anxious expression, tremor of
tongue, profuse sweating, darting pains, and slight jerking may
follow pressure on the flexor tendons. Symptoms such as these,
after a history of possible infection, justify administration of anti-
tetanic serum.

The method of procedure should be: (1) injection beneath the
arachnoid of 3,000 to 8,000 U.S.A. units; (2) injection into a vein
of 9,000 to 16,000 U.S.A. units to flood the system with antitoxin;
(3) injection intramuscularly; and (4) subcutaneously to keep up
the concentration in the blood; and the injections of antitoxin

ABSTRACTS

499

must be continued after improvement has set in. The amount of
phenol in the antitetanic serum as a preservative is not likely to
have any serious consequences. A. Ninian Bruce.

OCULOMOTOR PARALYSIS OF OTITIC ORIGIN. F. H. Westma
(609) cott, Joum. of Laryngol ., Rhinol., and Otol., 1914, Sept.; Lancet ,
1914, Nov. 14, p. 1143.

Paralysis of all the muscles supplied by the oculomotor nerve,
unaccompanied by lesions of the other orbital nerves, is caused by
a lesion of that nerve before its entrance into the cavernous sinus.
The nerve in this part of its course is 2-3 cm. long. It is usually
in this situation that involvement by extension of disease of the
ear occurs. This extension of pathological processes may be direct
through the temporal bone, or through thrombosis of the inferior
or superior petrosal sinus. An interesting case is recorded:—

A woman, aged 29, was seen on 22nd November 1912. On 14th
November she had had a sudden attack of vertigo, but did not fall.
In the evening she had vomiting and diarrhoea. Later on she had
another attack of vertigo, and fell bumping her head. She could not
open her right eye afterwards. She became unconscious, and re¬
mained so for sixteen hours, and vomited during that time. On 21st
November complete paralysis of the oculomotor nerve with ptosis
were present. No proptosis, no pain. The right external rectus
and superior oblique were unaffected. The facial nerve was also
unaffected. The fundus and retinal vessels were normal.
Diagnosis: pressure on the trunk of the oculomotor behind the
orbit. As there was also an intermittent foul discharge from the
right ear, it was examined. The patient was dazed, but would
answer questions. She could hear ordinary voice with each ear.
The right ear contained cholesteatoma. There was no pain in the
ear nor mastoid tenderness. There was ptosis on the right side,
and the right eye was turned downwards and outwards. There
was no ecehymosis nor oedema of the lids. No nystagmus. The
temperature for the next few days was a little raised, pulse normal.
Reflexes normal, Kernig negative. Patient became very drowsy,
therefore operation performed on 24th November. The sinus was
exposed, and pulsated normally. Dura of the middle fossa exposed,
and pulsated feebly. Antrum contained pus and granulations.
An aperture was seen in its roof, from which pus exuded. The
opening was enlarged inwards, and about one drachm of pus
evacuated. The track of the pus was found to extend inwards for
about half an inch. The patient did well till the fourth day, when
she had headache and vomiting. At midnight she had severe
general convulsions lasting half an hour. After this, recovery was

500

ABSTRACTS

alow, but uneventful. The eye condition gradually improved, till
in May 1915 the ptosis had almost disappeared, though there was
still some diplopia. The writer believes that the infection had
worked along the superior petrosal sinus. An analysis of the
literature is given. J. K. Milne Dickie.

A CASE OF PARALYSIS OF THE EXTERNAL RECTUS MUSCLE
( 010 ) DUE TO THE PRESENCE OF AN ABSCESS IN THE APEX
OF THE PETROUS PYRAMID. DEATH FROM BASAL
MENINGITIS. Geo roe Wilkinson, Joum. of Laryngoi, Rhinol.,
and Otol., 1914, xxix., No. 8.

A Bov, aged 8, came complaining of earache on the right side, and
inability to keep the right eye open. A month before the patient
was seen he had been feverish for a few days, after which he began
to have pain in his right ear. He sweated and was feverish. No
sore throat, no ear discharge, no vomiting. Three weeks later he
began to keep his right eye closed, and was deaf in both ears. On
examination the right tympanic membrane was normal, there was
slight mastoid tenderness, and a little swelling in the neck. The
right eye showed a pure external rectus paralysis. Optic discs
normal. No nystagmus. Temperature 994, pulse 96. Para¬
centesis of the right membrane yielded to pus. Lumbar puncture
fluid clear and not under pressure. Mastoid operation performed.
The cells contained gelatinous muco-pus, which yielded a pure
culture of Streptococcus nwcosus. Lateral sinus normal. The
antrum contained no pus. Four days later discharge appeared
from the meatus, and lasted ten days. For several days there was
nothing particular to note except that the boy was abnormally
quiet. Three weeks later the patient developed acute meningitis.
Lumbar puncture fluid turbid, and contained Streptococcus mucosas.
The patient died five days later. Post mortem—purulent basal
meningitis. Collection of pus in the left middle fossa. On strip¬
ping the dura from the petrous a small bit of bone came away from
the tip and disclosed a small smooth abscess cavity which had no
direct communication with the meninges. The carotid was exposed
in its wall for half an inch. The track of infection was along the
cells above and below the Eustachian tube, and along the carotid
artery. The sinus and labyrinth were normal.

J. K. Milnb Dickie.

ABSTRACTS

501

OPTIC NEURITIS WITH SYMMETRICAL LOSS OF THE LOWER
(611) PORTION OF THE FIELD ASSOCIATED WITH DIABETES.

M. S. Mayou, Proc. Roy. Soc. Med., 1914, vii. (Sect Ophthalmol.),
p. 148.

A man, aged 47, complained of loss of vision in lower half of right
eye. The pupils were equal and active, and the Wassermann
reaction was negative. A sector-shaped scotoma occupied the
lower half of the right field, and the right disc showed a well-
marked optic neuritis with a swelling of 5 D. As the antrum was
full of pus a radical operation was performed, but no improvement
followed.

Seven months later pain in the left eye and headache developed.
A definite optic neuritis was found, and a sector-shaped scotoma
below. The right disc showed signs of optic atrophy at this time.

A large quantity of sugar was present in the urine.

A. Ninian Bruce.

PSYCHIATRY.

THE FOLDS OF THE SKIN HAIR IN THE INSANE. (Le pieghe

(612) del cuoio capelluto negli alienati.) Alberto Zilocchi, Ratsegna
di Stvdi Ptichiat., 1914, iv., p. 669.

The author describes a case, and considers that the folds of the
hair of the skin in the insane have a definite pathological signifi¬
cation. This, however, is not to be regarded as an atavism, but
merely as a functional nervous or vascular disturbance.

A. Ninian Bruce.

PRECOCIOUS GENERAL PARALYSIS THREE YEARS AFTER
(613) A CHANCRE TREATED BY “606.” (Paralysis gdndrale
prfcoce trois ans aprds un chancre traits par le “606.”)
G. B. Nowicki, Thiiet de Paris , 1913-14, No. 288.

A man, aged 36, contracted a chancre in 1910 for which he was
treated with four intravenous injections of salvarsan. Within
three years typical symptoms of general paralysis developed. The
case, though rare, is not unique, as similar ones have been recorded
by Ehlers (y. Review, 1908, vi., p. 267); Marchand and Petit {ibid.,
1910, viii., p. 447), and others.

Nowicki holds Gaucher’s view that salvarsan was a pre¬
disposing cause of the general paralysis.

J. D. ROLLE8TON.

ABSTRACTS

r>oj

GENERAL PARALYSIS RAPIDLY AGGRAVATED BT 606.

(614) (Paralysie gdndrale rapidement aggravde par le 606.) J. Bobeix
Ann. desmal. v^ne'r., 1914, ix., p. 521.

A man, aged 35, of nervous temperament contracted syphilis
in 1907. He underwent a regular treatment for four years with
mercury with which potassium iodide was associated during the last
two years. Beyond a roseola and mucous tubercles which occurred
during the first two years no symptoms developed till 1913, when
he became impotent and began to suft'er from gastro-enteritis.

Wassermann’s reaction was found to l)e positive, and he was
given an intravenous injection of 015 neosalvarsan. Three days
later symptoms of general paralysis developed, which were so
much aggravated by a second injection five days after that of the
first that he had to be sent to an asylum (cj. Eeriav, 1914,
xii., p. 154). J. D. Roi.leston.

THE RESULTS OF SPECIFIC TREATMENT IN TABES AND

(615) GENERAL PARALYSIS AT THE SALP2TRI&RE, 1912-1914.
(Etude critique.sur les rdsultats du traitement spdciflque dans les
cas du tabes et de paralysie gdndrale observes b la cliniqne des
maladies nerveuses (Salp6tri6re) en 1912-1913-1914). G. C. J.
Lkoendre, Theses de Paris , 1913-14, No. 417.

A record of thirty-eight cases, the majority of whom had been
kept under treatment for several years. Intravenous injections
of neosalvarsan or enesol (mercury salicylarsenate), and intra¬
muscular injections of hectine were employed. Of twenty-eight
cases of tabes, fifteen showed considerable improvement,ten slight,
and three none. Of five cases of general paralysis, in two the
improvement was very striking, in one very slight, and in two
none. In no case was there a definite arrest of the disease, and
treatment had to be prolonged indefinitely, as return of the
symptoms always followed cessation of treatment.

J. D. Roixestox.

PARESIS PATIENTS TREATED WITH* INTBASPINAL INJEC-

(616) TIONS OF SALVARSANISED SERUM. (A Brief Report.) LB.

Pilsbuby, Journ. Amer. Med. Assoc., 1914, lxiii, Oct. 10, p. 1274.

The results obtained in eleven cases are here described and tabu¬
lated. Six showed improvement in some respect not necessarily
clinical, one is no better, and four are dead.

A. Ninian Bruck.

ABSTRACTS

503

RESULTS OF ONE HUNDRED INJECTIONS OF SALVAR8ANISED

(617) SERUM. C. Eugene Riggs and Ernest H. Hammes, Joum.
Amer. Med. Assoc., 1914, Ixiii., Oct. 10, p. 1277.

The 100 injections were administered to twenty-four cases, and in
all the cases who received over four combined injections the
Wassermann reaction in the blood became negative, except in one
case. Only four of the cases are recorded, but the author states
that the results in paresis have not been so good as in tabes. One
case of syphilitic meningomyelitis in a tabetic developed an aseptic
chemical meningitis after the fourth intraspinal injection, but
recovered and improved. The paper is followed by a discussion.

A. Ninian Bruce.

KORSAKOW’S PSYCHOSIS OCCURRING DURING PREGNANCY.

(618) D. E. Henderson, Johns Hopkins Hasp. Bull., 1914, xxv., p. 261.

Henderson quotes several illustrative cases, including the following
two personal ones:—

1. A woman, aged 31, during the first month of her second
pregnancy, began to suffer from vomiting and rapidly lost weight.
Symptoms of multiple neuritis developed, and she became
depressed, disoriented, and showed a tendency to fabricate.
Considerable improvement occurred under treatment in hospital.

2. A woman, aged 37, whose previous pregnancies had been
normal, had uncontrollable vomiting in her fourth pregnancy, and
during the last two months developed a psychosis characterised
by apathy, forgetfulness, suspiciousness, and later by a pseudo-
hallucinatory state and a tendency to fabricate. There was no
polyneuritis. She was discharged unimproved.

J. D. Rolleston.

THE PSYCHOSIS OCCURRING DURING THE COURSE OP

(619) PERNICIOUS ANAjMIA. G. H. Williams, Joum. Amer. Med.
Assoc., 1914, Ixiii., Sept. 12, p. 936.

Two cases are described in men, aged 52 and 55 respectively, who
showed definite evidence of pernicious ansemia associated with an
abnormal mental condition, which developed during the course of
the disease, and thus was not to be regarded as a final complica¬
tion. The mental signs were lack of orientation, attention, and
appreciation, undue happiness, loss of accuracy for recent and
remote events in one case, and numerous physical signs, such as
parasthesias, diminished sensibilities, vertigo, speech disturbances,
loss of functions of the arms and legs, ankle clonus, unequal
patellar reflexes, Romberg sign, and unsteady gait. The author
considers the condition might best be classified amongst the
intoxication psychoses. A. Ninian Bruce.

504

REVIEWS

■Reviews.

SfcMIOLOGIE DBS AFFECTIONS DU SYSTEMS NERVEUX. Prof.

(620) J. D£j£bine. Pp. xxvi. +1212, avec 560 figures en noir et en couleura,
et 3 planches hors-texte en conleurs. 1914 Masson A Cie., Paris.

Prof. D£j£rine points out in his introduction that this book is a
second edition of the volume which appeared under the same title
in 1900. It then formed part of Prof. Bouchard’s “Traits de
Pathologic gdndrale.” It is now published separately, having been
re-written, extended, and brought thoroughly up to date. It is
written with that charm of style which we are accustomed to look
for in Prof. Dejdrine’s books. The book, however, is of special
value because of the excellence of the illustrations of which two
separate series particularly call for remark. The first of these is
concerned with the relationship between the clinical symptoms and
pathological lesions present in the medulla oblongata, pons, and mid¬
brain. These are represented and explained by a series of diagrams
which consist of two parts, an upper part in which the clinical
symptoms are roughly sketched in, and a lower part in which the
actual lesion is marked out. It is thus possible to see at a glance
the relationship they bear to each other.

The second series consists of a number of large coloured figures
which demonstrate in a remarkably clear manner the paths taken
by various systems or groups of nerves. For instance, in one
figure the whole pathway of the peripheral sensory neurones are
traced out from their distribution in the skin to their termination
in the medulla oblongata; in another the nerve supply to the
bones is shown ; in another the visual fibres and the nerve supply
to the ocular muscles are all represented, and so on. A great
many different colours have been used in these diagrams, and
thus allow the different pathways to be easily distinguished.

The type is large and clear and the paper good. The text
illustrations are carefully chosen and well reproduced. References
to literature are not given. The book, which is large, is one which
may be safely recommended to anyone wishing a good up-to-date
work on the nervous system, and even those who do not read
French will find much of value in the excellence and variety of
the illustrations and diagrams.

THE MUSICAL FACULTY: ITS ORIGINS AND PROCESSES.

(621) William Wallace. Pp. vi.+228. Macmillan A Co., Ltd., London,
1914. Pr. 5a net.

This book deals with the mechanism of the musical sense. Its
aim is psychological rather than musical, and it records in outline

REVIEWS

505

the mental processes concerned with the creation and production
of music. It is a subject which the psychologist has up till now
rather tended to avoid. Music is a spontaneous act of creation.
The gift may be inherent and spontaneous, or it may be an
acquisition deliberately cultivated to such a point as to pass for
genuine creative ability. Music is limited by the absence of any
standard of excellence. In music we have a form of thought,
which, in its evolution, presents marked crises, one large and
spacious period being followed by a new kind of music absolutely
repellent to the adherents of the older dispensation, and the
process becomes repeated when this new style in its turn yields
to its successor. It is interesting to note that the earliest piece
of musical notation extant, known as the Delphic Hymn to Apollo,
is ascribed to the year 278 b.c., and it took the musical faculty
700 years to bring harmony from its embryonic state to the
maturity upon which our modern music is based.

Precocity in the arts is seen in its most highly organised state
in music. No matter how musical the child’s parents may be,
they can do little more than instruct him in technique. He has
to develop himself from within. In the prodigy we find a highly
receptive and sensitive musical faculty, but one which seems to be
largely unconscious. The act of performing is mainly reflex, and
independent of direct thought and concentration. He does not
realise the magnitude of his performance. There is evidently a
hypersesthesia of the sensori-motor tracts when connected with the
reflex-auditory centres, and this tends to become exhausted unless
the tracts and centres are brought into circuit with volitional
centres. The whole problem is elaborated here with great skill
and clearness. The chapter on heredity is most interesting, while
that headed “A Clinical Study” takes the form of a strong
criticism of Nisbet’s “ Insanity of Genius.”

The analysis of the mental acts giving rise to the production
of music, and its effect upon the hearers, is here presented in a
most carefully thought-out manner, which forms a valuable con¬
tribution to musical science, and which ought to give food for
much thought to all those who are interested in the psychological
side of this question.

MIND AND ITS DISORDERS. W. H. B. Stoddabt. Second Edition,
(622) with 74 illustrations. Pp. xvi. +518. H. E. Lewis, London.

Pr. 12s. 6d. net.

Thb first edition of this work, which appeared in 1908, has already
been reviewed in this journal ( v . Review, 1909, vii., p. 219). It
is thus not necessary for us to do more than to draw attention
to the main additions which have been made. The previous three
divisions into normal psychology, abnormal psychology, and mental

506

BOOKS AND PAMPHLETS RECEIVED

diseases have been retained. Most of the chapters have been
altered or added to in some way, while two fresh chapters have
been added to Part II., the first on the “ Psychopathology of the
Freudian School,” where psycho-analysis is briefly discussed and
a list of 200 stimulus words for use by the association method
is given, and the second on “ Anomalies of the Sexual Instinct.”
Part III. has been rearranged in such a way as to establish more
clearly the similarity of the various toxic psychoses.

BOOKS AND PAMPHLETS RECEIVED.

Babinski, J. “Expose des Travaux Scientifiquea.” Masson «fe Cie.,
Paris, 1913.

Boring, Edwin Q. “Introspection in Dementia Praecox” (Amer. Journ.
Psychol., 1913, xxiv., pp. 145-170).

Boring, Edwin Q. “ Learning in Dementia Praecox ” ( The Psychological
Monographs, Psychological Review Publications, 1913).

Flexner, Simon, and Amoss, Harold L. “ Localisation of the Virus and
Pathogenesis of Epidemic Poliomyelitis,” (Journ. Exp. Med., 1914, xx., p. 249).

Flexner, Simon, and Amoss, Harold L. “ Penetration of the Virus of
Poliomyelitis from the Blood into the Cerebro-spinal Fluid ” ( Joum. Exp.
Med., 1914, xix., p. 411).

Flexner, Simon, and Lewis, Paul A. “ Experimental Epidemic Polio¬
myelitis in Monkeys ” (Joum. Exp. Med., 1910, xii., p. 227).

Simpson, Sutherland. “The Motor Areas and Pyramid Tract in the
Canadian Porcupine (Erethizon dorsatus, Linn).” (Quart. Joum. Exp.
Physiol., 1914, viii., p. 79).

Simpson, Sutherland. “The Physiology of the Hypophysis Cerebri”
(N. Y. State Joum. of Med., 1913, Sept.).

Simpson, Sutherland. “The Pyramid Tract in the Red Squirrel
(Sciurus hudsonius, Loquax) and Chipmunk (Tamias striatus, Lysteri )”
(Joum. Comp. Neurol, 1914, xxiv., April, p. 137).

Swift, Walter B. “ A Voice Sign in Chorea " (Amer. Joum. Dis. Child.,
1914, vii., pp. 422-427).

Swift, Walter B. “Further Analysis of the Voice Sign in Chorea”
(Amer. Joum. Dis . Child., 1914, xii., pp. 279-282).

Thorne, Frederic H. “Some of the Histological Changes found in
Tabes” (Joum. of Med. Soc. of New Jersey, 1914).

Turner, William Aldren. “The Outlook in Epilepsy” (Brit. Med.
Joum., 1914, Oct 17).

Wollstein, Martha. “Parameningococcus and its Antiserum” (Joum.
Exp. Med., 1914, xx., p. 201).

The Training School Bulletin, 1914, xi., Oct.

“ Forty-fourth Annual Report of the Resident Medical Superintendent
of the Down District Lunatic Asylum, Downpatrick,” 1914.

“Eighty-seventh Annual Report of James Murray’s Royal Asylum,
Perth,” 1914.

IRevtew

IReuroloGS anfc> IPs^cbiatn?

©riglnal articles

STUDIES IN NEUROLOGICAL TECHNIQUE.—NO.
2: 1 INDICATION AND METHOD FOR THE
USE OF THE ELECTRICAL RE-ENFORCE¬
MENT FOR THE ELICITATION OF THE
ABSENT REFLEXES.

By WALTER B. SWIFT, M.D., Boston, Mass., U.S.A.,

Formerly Assistant to Physicians for Nervous Diseases, Boston City Hospital;
in charge Voice Clinic, Psychopathic Hospital; Instructor in Neuropathology,
Tuft’s College, Medical School, Boston.

At the Atlantic City meeting of the American Medical Associa¬
tion last June I presented in a preliminary note (1)—and as far as
I know for the first time—a new method of reflex elicitation by
electricity. I wish now to amplify that presentation somewhat,
and mention the indications for the use of the method. By
no means do I intend to convey the idea that electricity should
be applied in every case where we try the reflexes, any more
than Jendrassik’s hand grasp should be applied to reinforce the
elicitation of every knee jerk. But there are certain cases of
absent reflexes where “electrical reinforcement” is applicable,

1 “ Studies in Neurological Technique.—No. 1: The Points in Jendrassik’s
Method of Eliciting the Patella Reflex.” Alienist and Neurologist, 1913, xxxiv.,
No. 3, August.

508

WALTER B. SWIFT

and in fact has been proven (1) to be the only method known
for such elicitation. Those cases are few as compared with all
the cases whose reflexes we take, and in just the same way that
the cases are few where the Jendrassik method of reflex
elicitation is applied. In fact, electrical reinforcement need
not be applied as frequently as others, and should be reserved,
as it were, for a last resort. The situation demands this for two
reasons: First, electrical reinforcement should be resorted to
lastly because other methods are good, and in the majority of
cases suffice. Secondly, electrical reinforcement, while sometimes
the only method that meets with success, is nevertheless clumsy,
inconvenient, and takes considerable time.

I should therefore posit that we arrive finally plumb up
against the indications for electrical reinforcement by making
the reflex test in its usual way first; then if absent, secondly try
some convenient method of reinforcement such as relaxation, and
in case of the knee jerk the Jendrassik hand grasp (of course
according to the most approved method (2); and lastly, when
the reflex is still absent, employ this new method—the electrical
reinforcement.

In a word, then, absent reflexes unelicited by the employment
of milder forms of reinforcement, indicate the electrical method.
Many will justifiably feel that a still further limitation is
necessary. When other symptoms call for absent reflexes, such
as advanced cases of tabes, old cases of anterior poliomyelitis,
or other known breaks in the reflex arc, most of us will be
satisfied with the older methods of reinforcement. This would
designate the electrical method as strongly indicated where an
absent reflex stands out as an irrelevant sign, where absent
reflexes seem uncalled for to complete the otherwise unified
details in the picture of our symptom complex—as where it
vitiates our neurological chiaroscuro—or where it alone may
turn a diagnosis. In such, I might almost say sport, cases the
electrical reinforcement is unquestionably indicated. Naturally
those interested in research will broaden this field, as there are
still many problems here unsolved.

In the preliminary report (1) upon the value of using the electric
current in the elicitation of reflex action the technique of that
method was omitted.

Now I wish to present briefly that method of applying

STUDIES IN NEUROLOGICAL TECHNIQUE 509

electricity to various parts of the body in the elicitation of those
reflexes.

In general, it makes little difference in which direction the
current passes as long as it does pass the mechanism that causes
the reflex act; it also makes little difference as to whether that
current is faradic or galvanic. It makes a great difference whether
there is a strong, medium, or weak current. It makes a great
difference whether that current gives pain or not. If pain results
from too strong a current, the reflex elicitation is interfered with
by muscle contractions. These contractions move the leg or arm
away, so that the current is interrupted, or cause such marked
motion that the reflex action cannot be judged.

Therefore the first requisite in the technique of the applica¬
tion of the current is to have it as strong as possible up to the
point of causing pain. Then for the elicitation of the reflexes the
following electrode positions have been found of good service.
Patient seated.

The knee jerk: one electrode under upper leg, the other on
anterior aspect of lower leg, about the middle third. These
positions secure the following advantages:—By placing the
electrode under the leg the operator does not need to hold it, and
is thus left free to handle the other electrode, and to tap for the
knee jerk. The position of the other electrode upon the anterior
aspect of the lower leg (middle third) prevents interruption of
current at the appearance of the reflex, and is convenient for the
single operator.

The ankle jerk may be elicited by placing one electrode upon
the anterior aspect of lower leg (patient kneeling); and the other
electrode pressing gently upon the ball of the same foot. This
allows the action again of a single operator, and prevents inter¬
ruption of current as the reflex appears; and also secures good
pressure for the electrical contact.

For the elicitation of the triceps reflex, place the upper
electrode under the patient’s arm, instructing him to adduct;
and the lower electrode can be held by the operator’s hand upon
the lower arm about its centre.

For the elicitation of the wrist jerk, the upper electrode is
placed low behind the upper arm, and the lower electrode held by
the operator in the hand of the patient.

The writer will gladly receive any reports of success or failure

ABSTRACTS

510

in using this new method of reflex reinforcement, and to any
interested will gladly send reprints of the preliminary report

Summary .—The electrical method of reflex reinforcement is
indicated where reflexes are absent; and where, at the same
time, other methods have failed and that absence is doubled,
irrelevant, inexplicable, or may turn a diagnosis. As for method,
avoid pain, and place electrodes above and below the point of
reflex stimulation, in such a way that reflex action may not
interrupt the current.

References.

(1) Swift, Walter B. “A New Method of Reflux Elicitation.” Preliminary

Note. Juurn . Amtr. Afeef. Assoc. , 1914, Oct. 31.

(2) Swift, Walter B. See No. 1 of this series.

abstracts

ANATOMY.

A RACIAL PECULIARITY IN THE POLE OF THE TEMPOEAL
(623) LOBE OF THE NEGRO BRAIN. Robert Bennett Bean, Anal.

Record , 1914, viii., Nov., p. 479.

The material studied consisted of 127 brains of negro males,
53 of negro females, and 53 of white males (no white females),
and measurements were made on each temporal lobe in two
planes.

The general conclusions are:—The size of the pole of the
temporal lobe is less in the negro than in the white, and less
in the negro female than in the male. The differences are more
pronounced in measurements taken below the hippocampus than
in those which pass through that structure. Hence it is probable
that the hippocampus is larger in the negro than in the white, and
larger in the negro female than in the male. The shape of the
pole of the temporal lobe is different in the two races, being
slightly more slender in the negro, and almost the same size in
the two races antero-posteriorly. The differences are not only
absolute, but also relative to the weight and size of the entire
cerebral hemispheres. A. Ninian Bruce.

ABSTRACTS

511

A NOTE ON THE DEGENERATION OF THE FAS0I0ULU8
(624) CEREBRO-8PINALI8 IN THE ALBINO EAT. S. Walter
Ran SON, Joum. Comp. Neurol., 1914, xxiv., Oct, p. 603.

Thb cerebro-spinal or pyramidal tracts of the rat decussate in
the medulla, and run through the spinal cord in the ventral part
of the posterior columns. They consist of fine and medium-sized
medullated fibres, and of great numbers of non-medullated axons.
The medullated fibres are of cortical origin. The non-medullated
fibres are now proved to be also of cortical origin, since they were
found degenerated in rats in whom all the cortex of the upper and
lateral surfacee of the anterior half of the hemisphere had been
destroyed without injuring the underlying structure. These non-
medullated fibres in the area occupied by the pyramidal tract in
the cord are thus true pyramidal fibres, since they come from the
motor cortex. The method used was the pyridine-silver method
( v. Review, 1914, xii., p. 467). A. Ninian Bruce.

THE COMPARATIVE DISTRIBUTION OF MITOCHONDRIA IN
(626) SPINAL GANGLION CELLS OF VERTEBRATES. E. V.

Cowdry, Amer. Joum. Anat., 1914, xviL, Nov., p. 1 (14 figs.).

Mitochondria occur in the spinal ganglion cells of man, monkey,
guinea-pig, white rat, pigeon, snake, turtle, frog, and necturus, in
which they are characterised by the constancy of their morphology,
distribution, relative amount, and microchemical properties. There
is a reciprocal relation between the amount of mitochondria and
lipoid granules in the spinal ganglion cells of these vertebrates.
The coagulability of the Nissl substance, on fixation, increases
progressively in the gradation which exists between the small
and the large spinal ganglion cells of man, monkey, guinea-pig, and
white rat. A. Ninlan Bruce.

PHYSIOLOGY.

STUDIES ON THE CEREBRO-SPINAL FLUID.-I. INTRODUO-

(626) TION. Harvey Cushing, Joum. Med. Research, 1914, xxxi.,
Sept., p. 1.

STUDIES ON THE CEREBRO-SPINAL FLUID. — IL THE

(627) THEORIES OF DRAINAGE OF CEREBRO SPINAL FLUID,
WITH AN ANALYSIS OF THE METHODS OF INVESTIGA¬
TION. Lewis H. Weed, Joum. Med. Research, 1914, xxxi., Sept,

p. 21.

512

ABSTRACTS

STUDIES ON THE OEREBBO-SPINAL FLUID.—HI. THE PATH-

(628) WATS OF ESCAPE FROM THE SUBARACHNOID SPACES,
WITH PARTICULAR REFERENCE TO THE ARACHNOID
VILLI. Lewis H. Weed, Journ. Med. Research, 1914, xxxi., Sept,
p. 51.

STUDIES ON THE CEREBRO SPINAL FLUID.-IV. THE DUAL

(629) SOURCE OF CEREBRO SPINAL FLUID. Lewis H. Weed,
Journ. Med. Research, 1914, xxxi., Sept., p. 93 (with 6 plates).

II. The observations of previous investigators have, in fairly
definite fashion, established the fact that cerebro-spinal fluid
escapes chiefly by way of the venous system, and to a lesser
extent along lymphatic pathways. No exact pathway of escape
has been agreed upon. The injection methods of past investiga¬
tions have been such that any deductions made from them are
open to adverse criticism. The intravital injection of the cerebro¬
spinal spaces with true solutions, and the subsequent precipitation
of the chemical body in situ, affords a new and satisfactory method
of studying the manner of escape of the cerebro-spinal fluid from
the subarachnoid spaces. For the purpose, solutions of potassium
ferrocyanide and iron ammonium citrate are recommended.

III. The chief method of return of cerebro-spinal fluid to the
general circulation is by a process of filtration through arachnoid
villi into the great sinuses. In addition to the major return of
cerebro-spinal fluid by the arachnoid villi, there is also an accessory
drainage of the fluid into the lymphatic system. This plays a
comparatively insignificant part in absorption, except from the
isolated spinal-subarachnoid space. No evidence was found of the
escape of cerebro-spinal fluid into the cerebral veins or capillaries.
Absorption from the cranial-subarachnoid space is much more
rapid and much greater in amount than from the spinal portion.

IV. Cerebro-spinal fluid appears to be derived from two

sources: (a) the choroid plexuses in the cerebral ventricles; (6)
the perivascular systems of the nervous tissues. No evidence is
afforded by these observations of any absorption of cerebro-spinal
fluid into the cerebral capillaries. Under certain pressure
conditions an extensive injection of the perivascular system
from the subarachnoid spaces can be secured by the ferrocyanide
method. A. Ninian Bruce.

STUDIES ON CEREBRO-SPINAL FLUID.—V. THE DRAINAGE
(630) OF INTRA-OCULAR FLUIDS. Paul Wegefarth, Jovm. Med.
Research, 1914, xxxi., Sept., p. 119 (with 3 plates.).

ABSTRACTS

513

STUDIES ON CEREBROBPINAL FLUID.—VI. THE ESTABLISH¬
ED MENT OF DRAINAGE OF INTRAOCULAR AND INTRA¬
CRANIAL FLUIDS INTO THE VENOUS SYSTEM. Paul
Wegbfabth, Joum. Med. Research, 1914, xxxi., Sept, p. 149 (with
1 plate).

STUDIES ON CEREBRO SPINAL FLUID —VH THE ANALOGOUS
(632) PROCESSES OF THE CEREBRAL AND OCULAR FLUIDS.

Paul Wbgbfabth, Joum. Med. Research, 1914, xxxi., Sept, p. 167.

V. In the process of elimination of the aqueous fluid at the
so-called filtration angle, the fluid gains access to the scleral
sinuses in the lower animals (cat, dog, rabbit) by a passage through
“ pectinate villi,” which are analogous in structure and function to
the arachnoid villi of the cerebral meninges. The process in man
is the same as in lower animals, except that the pectinate ligament
tufts extend in an unbroken chain round the periphery of the
anterior chamber. The large neurones of the retina possess peri¬
cellular spaces which communicate with the aqueous reservoir,
and by means of these communications the waste products of the
cells appear to be in all likelihood eliminated. In the rabbit, and
probably in other animals as well, the ocular and cranial fluids
come into direct contact around the central vessels and in the
tissue of the optic nerve. The anterior chamber can be injected
from the veins after aqueous decompression. Neither the choroid,
ciliary body, nor cornea play any part in aqueous absorption,
whereas the function of the iris in this respect is still a doubtful
problem.

VI. A direct communication between the sinuses of the sclera
and the fluid reservoirs in the canine eye has existed for at least
forty-eight hours without haemorrhage into the ocular cavity. A
direct communication between the superior longitudinal sinus and
the subarachnoid space of normal dogs has remained patent during
observations up to seven days in length, without haemorrhage into
the fluid spaces. Sino-ventricular punctures in the cause of a hydro¬
cephalic kitten were followed by improvement in the animal’s
general condition. No intraicranial bleeding was occasioned by
these punctures.

VII. The almost complete anatomical and physiological corre¬
spondence of the fluid relations in the eye and cranium are pointed
out here, the secretion, the course of the fluid, and the ultimate
return to the major circulation being wholly similar processes.

A Ninian Bkuce.

514

ABSTRACTS

PSYCHOLOGY.

THE BINET MEASURING SCALE OF INTELLIGENCE. Henry
(633) H. Goddard, The Training School Bulletin , 1914, zL, Oct, p. 86.

The use of this scale upon thousands of children proves it to be,
without doubt, the most satisfactory and accurate method of
determining a child’s mental development available. Roughly
accurate results can be obtained by anyone who applies the scale
intelligently, but to determine a child’s mental level with precision
and certainty, the examiner should be an expert in child
psychology, who has gained experience in the use of the tests.
Persons who use the tests should conform strictly to the standard
method of giving them. People who use some of the tests, making
their own modifications or variations of others, are not really
using the Binet scale at all, and have no standard with which to
compare their results. W. B. Drummond.

PATHOLOGY.

PATHOLOGICAL CHANGES IN THE ADRENAL GLANDS. T. R.

(634) Elliot, Quart. Joum. Med., 1914, riii, Oct., p. 47.

The normal adrenal gland of an adult man weighs between
4 and 5 g., and contains from 4 to 5 mg. adrenalin. There is no
proof that the store of adrenalin in the medulla is increased in
any disease. The adrenaliu is lessened in many infective diseases,
but probably not to such a degree as to endanger the circulation.
The greatest loss was observed in examples of afebrile acute cardiac
failure, associated with mental distress in the struggle to live.
The lipoid of the cortex is stored and lost under conditions entirely
different from those which govern the other fats of the body.
It does not disappear in extreme bodily emaciation. The cortical
lipoid vanishes with great rapidity in all acute febrile infections.
There is a tendency for it to appear in excess in chronic renal
disease, especially in conjunction with athero-sclerosis.

A. Ninian Bruce.

CLINICAL NEUROLOGY.

THE BEHAVIOUR OF THE ABDOMINAL CUTANEOUS

(635) REFLEXES IN ACUTE CONDITIONS WITHIN THE
ABDOMEN AND PELVIS. R. R. Smith, Surgery, Gynecology,
and Obstetric», 1914, xix., p. 604.

From examination of 175 cases which came to operation, includ¬
ing appendicitis, acute cholecystitis, pelvic inflammation, ectopic

ABSTRACTS

515

gestation, perforated gastric or duodenal ulcer, and acute intestinal
obstruction, Smith concludes that the abdominal cutaneous reflex
has a distinct though limited diagnostic value in acute conditions
within the abdomen (cf. Review, 1906, iv., p. 582).

J. D. Rolleston.

GENERALISED HERPES ZOSTER. Q. Fernet, Brit. Joum. Derm.,

(636) 1914, xxvi., p. 399.

Man, aged 80. In addition to characteristic lesions of herpes
zoster occupying the areas of the third, fourth, and fifth dorsal
nerves on the left side, there were a very large number of discrete
vesicles scattered over the trunk and limbs, very few, however,
being found below the knees. There were also a few lesions on
the face and scalp.

Recovery was uneventful J. D. Rolleston.

GENERALISED NEUROFIBROMATOSIS (VON RECKLING-

(637) HAUSEN’S DISEASE). Report of a case showing a superficial
resemblance to Hodgkin’s Disease. C. A. Elliot and A F.
Beifeld, Joum. Amer. Med. Auoe., 1914, lxiii., p. 1356.

A record of a case in a boy, aged 16, with no congenital,
hereditary, or familial history. The condition first developed at
about 10 years of age, when “lumps” first appeared in both
cervical regions, and subsequently became generalised. He was
at first regarded as a case of Hodgkin’s disease, but on examina¬
tion, in addition to general lymphadenitis and enlargement of the
spleen, tumours of the skin and nerves and pigment patches were
found.

The writers hold that von Recklinghausen’s disease is closely
related to the status lymphaticus and that the ductless glands
play a part in the production of both. J. D. Rolleston.

MTATONIA CONGENITA (Miatonia congenita.) F. Schwkizer,

(638) Rev. Soe. Mid. Arg., 1914, xxii., p. 637.

An exhaustive monograph, with an account of three original cases
and a table of all the cases on record down to December 1913.

J. D. Rolleston.

NERVOUS FORMS OF MALTA FEVER. (Formas nervioeas de la

(639) melitococcia.) R. V. Barber!, PolieUniea , 1914, ii., p. 929.

Nervous complications in Malta fever are not rare, but compara¬
tively little is known about them. Barberd records four cases.

516

ABSTRACTS

1. Diffuse subacute myelitis in a man, aged 40, ending in recovery.

2. Left spastic hemiplegia in a woman, aged 50, following osteitis
of the frontal and parietal bones. In four months the exostosis
and hemiplegia disappeared. 3. Mixed infection of paratyphoid
B and Malta fever. Headache and double sciatica occurred during
the acute stage, and mental confusion in convalescence. Recovery
in four months. 4. Woman, aged 52. Violent headache, intense
neuralgia, and psychasthenia. Recovery in four months.

J. D. Rollkston.

LATE DEFORMITIES OF THE VERTEBRAL COLUMN FOLLOWING

(640) TRAUMA (HUMMELS DISEASE). (Deformazione tardiva
della colonna vertebrale consecutive a trauma (Morbo di Ktbnmel.)
N. Capriole, Giom. intemaz. di Set. mtd ., 1914, xxxvL, p. 769.

Severe deformity, either in the nature of kyphosis or less
frequently of scoliosis or kypho-scoliosis, may follow after a long
or short interval direct or indirect trauma of the vertebral
column. The pathological change is a rarefying osteitis, especially
of the spongy tissue of the body of the vertebra.

This process very often follows a fracture that has escaped
notice, but in many cases there has been merely a contusion of
the spine. There is little or no probability of complete recovery.

The paper contains the records of fifty-four cases, including an
original one. A bibliography is appended. J. D. Rolleston.

POST-TYPHOID POLYNEURITIS OF QUADRIPLEGIC FORM.

(641) (Polineuritis postlflca k forma quadripllgica.) C. B. Udaondo and
M. M. Casteiots, Rev. Soc. Mid. Arg ., 1914, xxii., p. 851.

A man, aged 22, in convalescence from severe typhoid fever,
developed sensory and motor troubles in all four limbs. The
sphincters were not affected, and the cerebro-spinal fluid was
normal.

Under treatment by injections of strychnine and hot baths
complete recovery took place (cf. Review , 1912, x., p. 336).

J. D. Rolleston.

ACUTE MYELITIS, SECONDARY TO PERIRECTAL ABSCESS,
(643) DEVELOPING A FEW HOURS AFTER SEVERE FRIGHT.

William G. Spiller, Journ. Atner. Med. Assoc., 1914, lxiii., Oct 31,
p. 1546.

A railroad conductor, aged 35, developed a right facial paralysis
after sitting at an open window. Complete recovery took place.

ABSTRACTS

517

Three years later he was attacked by three men in an eating-
house, who tried to rob him. He drove them off, and is certain
he was not injured in any way. Two days later he saw from a
window the man who had assisted him in driving off the robbers,
and noticed suddenly that both legs had gone asleep. They
became numb, and later completely paralysed. A double Babinski’s
sign developed, with absence of both knee jerks, loss of sensation
from a line about two inches below the umbilicus, and incontinence.

At the autopsy pus was found round the rectum with cellulitis
extending as high as the pleura, and involving the nerves to the
spinal cord. The Streptococcus pyogenes was cultivated from it.
The spinal cord showed softening in the lower dorsal and lumbar
regions, and numerous haemorrhages.

It is pointed out that Orr and Rows’ work upon inflammation
of the central nervous system following the infection of the
ascending lymph stream of nerves may explain this case. At the
subsequent discussion the question of fright as a cause of organic
nervous disease was considered, and the possibility that the fright
was not an important factor in producing the cord lesion in this
case. A. Ninian Bruce.

MAGNESIUM SULPHATE IN PURULENT CEREBRO SPINAL
(643) STREPTOCOCCIC MENINGITIS. History of a case complicat¬
ing acute otitis media, complicated by paralysis of external and
internal recti oculi. W. Sohibb Bryant, Boston Med. and Surg.
Joum., 1914, clxxi., Nov. 26, p. 812.

Man, aged 22, was seized with pain in the left ear and slight
deafness. Ten days later he passed into a typhoidal state, with
severe headache, stupor, slight delirium, rigid neck, slight Kemig
reflex, altered Babinski, and descending optic neuritis of the left
eye. Lumbar puncture showed the fluid under high tension,
containing pus and cocci. As he became comatose, with marked
signs of meningitis and double optic neuritis, decompression was
performed with local drainage. He improved immediately. A
cerebral hernia protruded about half an inch, and the cerebro¬
spinal fluid drained freely. He was given as much magnesium
sulphate as possible to combat toxaemia, and by the seventh day all
symptoms of meningitis had entirely disappeared.

Unfortunately infection of the cranial wound followed con¬
tamination of the dressings, and the patient died on the 190th day
from encephalitis and toxaemia. The author claims that this case
lived longer after the onset of the disease than any other case
hitherto reported. A. N. Bruce.

ABSTRACTS

518

ACQUIRED HYDROCEPHALUS DUE TO THE MENINGITIS OF
(644) MUMPS. (Hydrocdphalie acquise par mdnin^ite ourlienne.)

J. A. SicaRD, Jiev. Neurol. , 1914, i., p. 706.

A hoy, aged 15 years, showed well-marked hydrocephalus which
had followed an attack of mumps, complicated by meningitis two
years previously. Lumbar puncture performed at that time
allowed abundant lymphocytosis without any micro-organisms.
The meningeal symptoms soon subsided, but a few weeks later the
boy suffered from headache and vertigo. The gait became spastic,
and hydrocephalus developed. Within the last few months
considerable obesity had set in, being possibly due to a pituitary
reaction caused by the hydrocephalus. This is the first case on
record of hydrocephalus following the meningitis of mumps.

J. D. Rollestos.

INFANTILE PARALY8IS OF THE SMALL MUSCLES OF THE
(645) HAND. W. F. Lk ukield, Med. Jonrn. Australia, 1914, i., Oct 10,
p. 347.

A girl, aged 12, suddenly became feverish, went to bed, and two
days later lost the use of the right hand. The thenar and hypo-
thenar wasted; the fingers could not be moved in any direction,
except for the slightest ilexion of the tips; the wrist could neither
lie flexed nor extended; pronation and supination of the forearm
were very weak; flexion of the forearm was strong, but extension
weak, and the deltoid and muscles of the shoulder girdle were
unaffected. There were no sensory changes. The limb was put
at rest with daily massage, but the only improvement was some
increase of power in the triceps.

The interest of the case is the unusual involvement of the
small muscles of the hand without paralysis of the upper arm.

A. Ninian Bbuce.

LANDRY’S PARALYSIS. Report of & case, with necropsy. Edward
(646) D. Fisher, Joum. Amer. Med. Assoc., 1914, lxiii, Nov. 21, p. 1845.

A boy, aged 15, complained of pain and weakness in the lower
limbs. This increased in severity until they became paralysed,
with loss of reflexes and tenderness over the larger nerve trunks,
but no anaesthesia. This weakness gradually extended to the
upper extremities, with loss of power, which soon became complete
in the hands and anns. This was followed by difficulty in
swallowing, and by complete paralysis of the muscles of the right

ABSTRACTS

519

eye and of the superior oblique of the left eye. He died from
respiratory failure after about six weeks’ illness.

The cord showed intense congestion to the naked eye, but
nothing else. Microscopically there was an interstitial neuritis
of the sciatic nerve and congestion of the anterior horns, without
perivascular infiltration or meningeal involvement. The medulla
oblongata showed involvement of the cranial nerve nuclei and
degeneration of the axis cylinders for a short distance from the
cell body. The whole picture differentiated it from poliomyelitis.
The brain was not examined. No micro-organisms could be found,
and injection of emulsified cord into a monkey was not performed.

A. Ninian Bruce.

•A CASE OF MULTIPLE VISCERAL HYDATID CYSTS (HEART,
(647) BRAIN, KIDNEYS), RUPTURE OF ONE OF THE HEART
CYSTS IN THE LEFT AURICLE. DISCOVERY, POST
MORTEM, OF FREE DAUGHTER CYSTS IN THE LEFT
CARDIAC CAVITIES. INTEGRITY OF THE LIVER AND
LUNGS. (Un cas de cystes hydatiques visclraux multiples
(cqbut, cerveau, reins). Rupture de l’un des cystes du coeur dans
l’oreillette gauche. Constatation h l’autopsie des v6sicules-fllles
libres h l’intdrieur des cavitds cardiaques gauches. Intdgritd du
foie et des poumons.) C. B. Foresti and J. Bonaba, Bull, et
mtrn. Soc. mdd. h6p. de Parity 1914, xxxviii., p. 262.

A girl, aged 17, was admitted to hospital for headache, con¬
vulsions, and complete left hemiplegia. The convulsions and
headache had started five years previously, but the hemiplegia
had been present for only two months. Death from coma
occurred about a month after admission. The necropsy showed
four cysts in the middle portion of the convexity of the right
cerebral hemisphere, including the motor zone. The whole of
the right corona radiata was destroyed. In the left hemisphere
there was a cyst in the occipital region. The cerebellum, pons,
and medulla were not affected.

The cerebral lesions were regarded as embolic, the primary
lesions being situated in the heart. J. D. Rollrston.

A VOICE SIGN IN CHOREA. (Preliminary report.) Waltxb B.
(646) Swift, Amer. Joum. Pit. Child., 1914, vii., pp. 422-427.

FURTHER ANALYSIS OF THE VOICE SIGN IN CHOREA.

(649) Walter B. Swift, Amer. Joum. Pit. Child., 1914, viii, pp. 279-282.

Examination of vocal utterance on the kymograph demonstrates a
fairly constant voice change, consisting of a rise in pitch and

520

ABSTRACTS

increase in intensity, accompanying choreic movements. The
most marked change is in the rendering of the vowel a as in
around. These changes so constantly accompany choreic con¬
tractions as to deserve recognition as a new sign in chorea.

An analysis of twenty cases of chorea, with over 500 obser¬
vations on the voice, show a change of pitch and intensity in
two cases out of three—a change that deserves recognition as a
new sign in chorea—the choreic voice sign.

A. Ninian Bruce.

EPILEPSY AND OEBEBBAL TUMOUR. William Aldrkn Turner,
(660) Brit. Med. Joum., 1914, Dec. 6, p. 969.

Tumours involving the cortex and subcortical white matter of a
cerebral hemisphere may give rise to seizures having features
characteristic of idiopathic epilepsy. These attacks may precede
the onset of the symptoms and signs of intracranial tumour by
many years, and render the diagnosis of the true cause of the
attacks well-nigh impossible. The existence of certain signs,
however, favours the presence of an organic lesion; such are a
well-defined local warning, the presence of some degree of post-
convulsive hemiplegia, inequality of the deep reflexes on the two
sides, unilateral abolition or impairment of the abdominal reflexes,
and, above all, the development of an extensor plantar response.
Eventually, more decided evidence of a destroying lesion is shown
in hemiplegia, hemiamesthesia, hemianopsia, or aphasia, especially
if accompanied by optic neuritis. It is therefore important in all
cases of epilepsy to examine the reflexes and the optic discs from
time to time, especially if a decided change occurs in the character
of the fits, or a new symptom develops. A Ninian Bruce.

TUMOUR OF THE ORUS CEREBRI. John H. W. Rhein, Joum.
(651) Amer. Med. Astoc., 1914, lxiii., Nov. 7, p. 1662.

A girl, 12 years of age, developed gradual loss of power in the
right side of the face and the right arm and leg, with left-sided
ptosis and convulsive seizures confined to the right face, arm, and
leg. Later, paralysis of associated movements of the eyeballs,
upwards, downwards, and laterally, developed. The pupils did not
react to light nor to accommodation. Weakness of the left arm
then occurred, and a double Babinski’s sign was present without
ankle-clonus and with equal and exaggerated knee jerks. Later,
the pupils became unequal. Intense swelling of the nerve-head
and surrounding retina, with a few scattered haemorrhages, was
found. A diagnosis of tumour of the upper part of the pons was
made on the strength of the paralysis of associated movements.

ABSTRACTS

521

At the necropsy a large tubercular mass was found, involving
the left crus cerebri, extending to the upper limit of the pons below
and the basal ganglia above. The internal capsule was somewhat
implicated in its anterior limb, and the optic thalamus in its
anterior third. The focus in the pons extended to the opposite
side to a slight degree.

In a review of the literature only seventeen cases of tumour of
the crus cerebri were found, in which the diagnosis was verified by
autopsy. These are briefly described here. The characteristic
symptoms of such tumours is said to be hemiplegia on the opposite
side to the lesion, associated with oculomotor palsy on the same
side. The close proximity of the two oculomotor nuclei, however,
usually leads to involvement of both third nuclei.

A. Ninian Bruce.

OPERATIVE INTERVENTION IN CYST OF THE LEFT CERE
(652) BEAL HEMISPHERE, WITH A CONSIDERATION OF THE
PREOPERATIVE AND SUBSEQUENT SYMPTOMS. Chablbs
M. Rkmsen, Joum. Amer. Med. Attoc., 1914, lxiii., Nov. 7, p. 1649.

A man, aged 59, seven years previously, suddenly became uncon¬
scious while in the middle of a conversation, and could not remember
the right words to express himself afterwards. Slight improve¬
ment was followed by regression. He was found in July 1913
to be suffering from aphasia, but with no evidence of motor or
sensory changes. He could repeat phrases, and sign his name, and
write from dictation slowly, but not legibly and not spontaneously.
A diagnosis of haemorrhage into the cortex of the angular gyrus
and Broca’s area was made. In March 1914 his blood pressure
was 195 mm., and in addition to his previous symptoms there were
spells of convulsive jerking of the fingers on the right side, with
numbness. The Jacksonian attacks increased, involving the hand,
the forearm, and then the right leg; apraxia, ataxia, and stereog-
nosis developed rapidly. There was no optic neuritis, and the
Wassermann reaction in the cerebro-spinal fluid was negative.
As there was thus evidence of a progressive lesion, he was
trephined and a pale yellow area exposed, which on puncture
proved to be a cyst. About half an ounce of fluid was removed,
which was under great pressure. The brain tissue below was of
quite a jelly-like consistency. There was no cyst wall, and the
wound was closed without drainage owing to the risk of infection.
He made a good recovery, the Jacksouian attacks and dragging of
the right foot completely disappeared, the aphasia diminished
markedly, and the sensory, stereognostic, apraxia, ataxia, and
position-sense disturbances all improved.

A. Ninian Bruce.

522

ABSTRACTS

OTST OF THE PITUITARY GLAND. W. N. Robertson and
(663) E. D. Ahern, Med. Joum. Australia, 1914, i, Oct. 17, p. 372.

A man, aged 28, came to hospital complainiug of severe and
persistent headaches, without vomiting or giddiness, and localised
mainly between the eyes. When 3 years old, he had “slight
infantile paralysis.” Four years ago he had scarlet fever,
followed by a “relapse,” which was diagnosed as meningitis.
This lasted two months, and was followed by severe headaches,
which disappeared after four months. He had had concussion
three times, accompanied by about half-an-hour’s unconsciousness
each time.

On examination he was stunted, being 5 ft. 4 in. in height,
and weighed 11 st. 7 lbs. His apparent age was about 17, and
his build was feminine. Wassermarm’s reaction was negative.
The eye condition was reported as “optic atrophy on both
sides. Marked limitation of visual acuity. Midline bi-temporal
hemianopsia.” An X-ray showed no enlargement of the sella
turcica. A pituitary tumour was diagnosed, and operation was
performed by the nasal route. A pearly cyst was found about
the size of a hazel nut. About one drachm and a half of glairy
fluid escaped on opening the cyst The cavity was gently
curetted, and as much as possible of the sac wall removed with
forceps, the cavity swabbed with iodine, and lightly packed with
gauze. Recovery was uneventful. The headache disappeared, and
although the eyesight has not improved much, he is able to earn
his living as a music teacher. A. Ninian Bruce.

000LU8I0N OF THE POSTERIOR INFERIOR CEREBELLAR
(664) ARTERY. Andrew C. Qillis, Joum. Amer. Med. Assoc., 1914,
lxiii., Oct. 31, p. 1660.

The symptom complex produced by occlusion of the posterior
inferior cerebellar artery is as follows: Sudden onset with
giddiness, and marked tendency to fall to the affected side; no loss
of consciousness; difficulty with swallowing and occasionally with
phonation; loss of appreciation of pain, heat, and cold over part or
the whole of the trigeminal area on one side of the face (usually
the side of the lesion), and a corresponding loss of pain and
temperature sense over the opposite side of the body from the
face down; touch, tactile discrimination, deep pressure, and
muscular sense are intact; paralysis of the sympathetic on the side
of the lesion, causing retraction of the eyeball, contraction of the
pupil, and drooping of the eyelid, and ataxia of the arm and leg,
usually on the side of the lesion. In the course of from two to six

ABSTRACTS

523

months practically all symptoms disappear, other than the sensory
charges, which usually are permanent.

Two cases are here described, the first in a woman, aged 40,
in which the symptoms appear to have been due to thrombosis,
and the second in a man, aged 39. A short discussion of the
paper took place. A. Ninian Bruce.

TOTAL DEAFNESS, ASSOCIATED WITH THE SYMPTOM COM-
(655) PLEX DESCRIBED BY BAkANY IN WHICH COMPLETE
RESTORATION OP HEARING OCCURRED. Robert Barany,
Joum. of Laryngol., Rhxnoland Otol., 1914, Jau.

A girl, aged 20, was seen in May 1911. She had had an acute
inflammation in the right ear in December 1910, which healed up,
but had left some giddiness, pain in the back of the head on the
right side, deafness, and tinnitus. The drumhead was normal,
there was slight tenderness on the mastoid process, and some
nerve deafness. The caloric reaction was present, but impaired on
the right side. There was deviation of the right hand outwards.
The diagnosis of a localised collection of fluid at the cerebello¬
pontine angle was made. Lumbar puncture performed. Three
c.cm. withdrawn. Following upon this the headache on the right
side became much worse. Vomiting continuous, giddiness intense
and persistent, and remained so for six days. Operation per¬
formed : the dura of the posterior fossa was exposed, and over the
region of the internal auditory meatus it was massaged with a
swab. The effect was startling, as headache, giddiness, and
vomiting had disappeared. Before operation whisper and con¬
versational voice was heard at 0 - 25 aud 1 m. respectively. Patient
not seen till middle of August. At that time still quite well,
and hearing had improved. The caloric reaction was still
diminished on the right side. Hearing now for whisper and
conversation 0 75 and 2-3 m. On 29th August the hearing had
become nojmal on the right side, while the left ear was now
becoming deaf. For some days the patient had had headache and
tinnitus on the left side. Within a few days the hearing on the
left side had become reduced to whisper a.c., conversation 19 cm.
Lumbar puncture again performed without effect. Some days
later the dura was exposed on the left side and the symptoms
improved, but the headache returned after a time and was worse
than ever. The dura was then slit, and a blunt instrument was
introduced in the direction of the internal auditory meatus. A
free flow of cerebro-spinal fluid resulted. The headache and
giddiness disappeared, but the patient was totally deaf on the left
side. A year later the patient returned with severe pain behind
42

524

ABSTRACTS

the left ear, giddiness, and tinnitus. Hearing: conversation 5 m.
in the left ear. Deviation of left wrist present. Some weeks
later the patient had improved, so that she could hear a whisper
at 5 m. No deviation of wrist.

The case is not one of hysteria, but can be explained by the
presence of a localised collection of fluid in the cerebello-pontine
angle. The eighth nerve lies in a definite cisterna pontis lateralis.

J. K. Milne Dickie.

CEREBELLAR SYMPTOMS AND CEREBELLAR LOCALISATION,
(656) including kmem&togr&phic observations on cerebellar phenomena.

Charles K. Mills and Theodore H. Wbisbnborg, Journ. Amer.

Med. Assoc., 1914, lxiii., Nov. 21, p. 1813.

The authors emphasise the fact that asynergy is the fundamental
symptom of cerebellar disease, and tabulate their views on cere¬
bellar symptoms as follows:—

Fundamental symptom in cerebellar disease—

Asynergy.

Special symptomatic manifestations of asynergy—
Hypermetry.

Adiadokocinesis.

Tremor.

Symptoms resulting from asynergic efforts—

Asthenia.

Atonia.

Ataxia.

Whether vertigo and nystagmus are cerebellar or vestibular
symptoms must be largely determined by a thorough study of
each case.

In studying the focal symptoms of cerebellar disease, hyper¬
metry, adiadokocinesis, and tremor at times indicate not only the
presence of cerebellar asynergy, but give the clue to the part of
the cerebellum most involved, as when exhibited in the trunk,
head, arms, legs, or eyes. These facts of localisation may be
emphasised by kinematographic investigation and rendered easy to
analyse. They may be tabulated as follows:—

Focal symptoms indicated by localised asynergic movements—
Eye movements.

Attitude and movements of head.

Movements of jaw, face, tongue, larynx, etc. (Distur¬
bances of speech, emotional expression, etc.)

Position and movements of trunk.

Special movements of upper extremity. (Disturbances
in fine movements, including writing.)

ABSTRACTS

525

Movements of trunk and upper extremity (shoulder-
girdle movements).

Special movements of lower extremity.

Movements of trunk and lower extremity (pelvic-girdle
movements).

The question of cerebellar localisation is then discussed. The
authors agree with Rothmann that the cerebellar cortex is
excitable to the electric current, although a stronger current
is required than for the cerebral cortex. The fact that the cere¬
bellum as a whole and in subdivision is concerned with synergy,
indicates that movements in which various parts of the body are
at the same time concerned, cannot be fully represented by a
centre or area for one of the parts. In the human cerebellum
there must be centres for synergically simple movements, and
centres and zones for more and more complex synergic move¬
ments. Each simple synergic movement has, however, its special
cortical representation. The fact that the representation in
certain parts of each hemisphere may be homolateral, contra¬
lateral, or bilateral makes it more difficult to draw an inference
or reach a conclusion as to the localisation of function, and
therefore as to the results of focal lesions. Two diagrams are
given representing the zones and centres of the superior and of
the inferior surface of the cerebellum. Trunkal movements, and
those movements of the limbs which must act with them to
preserve static and dynamic equilibrium, must involve the vermis
in whole or in part. The association involvement of one lateral
lobe in the vermal lesions will be largely determined by unilateral
dysmetric phenomena, the extent of the antero-posterior involve¬
ment of the inferior vermis by the preponderance of asynergy in
either the lower or the upper limbs. A. Ninian Bruce.

A NOTE ON THE INCREASE OF TOTAL NITROGEN AND
(657) UREA NITROGEN IN THE CEREBRO SPINAL FLUID IN
CERTAIN CASES OF INSANITY, WITH REMARKS ON
THE URIC ACID CONTENT OF THE BLOOD. H. M.

Adler, Boston Med. and Surg. Joum. t 1914, clxxi., Nov. 19, p. 769.

One hundred and ten cases were examined. The cerebro-spinal
fluid was examined within twenty-four hours after withdrawal.
Out of twenty-four cases of general paralysis the average total
nitrogen per 100 c.c. was 27 2 mg., with a minimum of 15 5 mg.
and a maximum of 55*3 mg., whereas the normal variations are
from 15 to 20 mg. in 100 e.c. This observation coincides with the
increase in albumen and globulin in this condition. The unclassified

526

ABSTRACTS

dementias included several which showed high total nitrogen
content.

Concentration of uric acid in the blood of insane patients,
however, varies within normal limits.

A CASE OF TETANUS, WITH RECOVERY, TREATED BY
(668) CARBOLIC ACID INJECTIONS. J. T. Fotheringham,
Canadian Med. Assoc. Joum., 1914, iv., Oct., p. 902.

A man, aged 18, wounded the sole of his foot. There was a little
suppuration, and he did not return to work. On the thirteenth
day stiffness of the muscles of the neck and jaw set in, and five
days later he was admitted to hospital. There was no fever, no
convulsions, and no opisthotonus. Lumbar puncture caused general
spasticity and tension of muscles, especially of the limbs, but no
convulsions. He was given, under chloroform, 10 c.c. of antitetanic
serum into the spinal canal. Next day he had very severe
headache. Smears from the wound gave B. tctani. A second
dose of 20 c.c. of antitetanic serum was given under chloroform
16£ hours after the first, and no more. As the headache was so
severe he was given chloral hydrate 10 gr., and pot. bromide
20 gr., four-hourly, and hypodermic injection of one drachm of
pure carbolic acid in one drachm of glycerin. This was injected
alternately into (1) the left pectoral region, (2) the right pectoral
region, (3) the left thigh, and (4) the right thigh, and so on, with
the white cell count taken at the time of each injection. The
parts looked as if local sloughing were going to take place, but
always healed completely, and no carboluria occurred. The
leucocytosis rose rapidly to 24,000. His convalescence was rapid
and uneventful.

Whether the carbolic acid injections aided the recovery is
doubtful, as the case was a favourable one for recovery at any
rate, especially as the symptoms were localised and did not spread,
and the interval between injury and onset of symptoms was
thirteen days. A. Ninian Bruce.

UNFAVOURABLE COMPLICATION FOLLOWING AN INTRA-
(659) DURAL INJECTION OF NEOSALVARSAN. Alfred Gordon,
Joum. Amer. Med. Assoc., 1914, lxiii., Nov. 21, p. 1851.

A man, aged 35, with typical symptoms of tabes dorsalis, includ¬
ing pain in the lower extremities, ataxia, incontinence of urine,
and constipation, and with a positive Wassermann reaction in the
serum and in the cerebro-spinal fluid, improved greatly after one
injection with autosalvarsanised serum. After two months the

ABSTRACTS

527

bladder symptoms returned, and it was decided to give him a
direct intradural injection of neosalvarsan. The solution used
was 6 per cent, of neosalvarsan in distilled water, and as each
drop contained 3 mg. of neosalvarsan, only two drops were injected.
A small quantity of the spinal fluid was allowed to flow out, the
two drops were mixed with this, and then it was all gently returned
to the spinal canal. The patient was placed in Trendelenburg’s
position. Half an hour later severe pain in the lower limbs set
in, followed by vomiting, retention of urine, incontinence of faeces,
and gangrenous patches developed on the sacrum and scrotum.
His condition grew gradually more and more alarming, the pain in
the limbs became agonising, and he died shortly after. There was
no necropsy.

This case strongly contraindicates the direct intradural use of
neosalvarsan. A. Ninian Bruce.

SOME MANIFESTATIONS OF CONGENITAL SYPHILIS. Leonard

(660) Findlay and Madge E. Robertson, Glasgow Med. Joum ., 1914,
vi., Dec., p. 401.

As the result of an examination of thirty-three cases of spastic
diplegia (Little’s disease) at the out-patient department of the Glas¬
gow Children’s Hospital, 45 per cent, showed evidence of congenital
syphilis, as evidenced by a positive Wassermann reaction, while
out of twenty-two cases of mentally deficient and epileptic
children, 60 per cent, also showed similar evidence.

A. Ninian Bruce.

OVARIAN GRAFT IN HYPERTHYROIDISM. (Ingerto ovarico en

(661) el hypertiroidismo.) A. F. Celesia, Rev. Soc. Mid. Arg., 1914,
xxii., p. 843.

A woman, aged 23, was admitted to hospital for Graves’ disease.
After all other treatment had failed, an ovary removed 1 from
a patient at a hysterectomy was grafted into the cellular tissue of
the abdominal wall. At first there was no change in her condition,
but in a month improvement began, and three months after the
operation all the symptoms of hyperthyroidism had disappeared.

J. D. Rolleston.

PSYCHIATRY.

INTRATHECAL TREATMENT OF GENERAL PARALYSIS. E.

(662) Mapother and T. Beaton, Joum. of Mental Set., 1914, Oct., p. 691.

An account of four cases treated by this method, together with a
review of the previous work done in this direction. The authors

528

ABSTRACTS

point out that injection of salvarsan intrathecally has been fol¬
lowed by grave results in many cases, and they have therefore
followed the plan adopted by Swift and Ellis of injecting the drug
first intravenously, and an hour later removing some blood and
injecting intrathecally the serum obtained from it. One of their
four cases deteriorated, and the other three have shown slight
clinical improvement and a marked diminution in the Wassermann
reaction. The authors discuss the view that the sub-arachnoid
space is a closed one, unconnected with the cerebral lymph
channels, and think that to this fact, if it is a fact, may be
ascribed the relative unsuccess of the treatment. The possibility
of spore formation by the spirochaetes, with a consequent latent
period, accompanied by remission of the symptoms, is also discussed.

W. D. Wilkins.

INTRASPINAL INJECTIONS OF NEOSALVARSAN IN TABES
(G63) AND OENERAL PARALYSIS. (Les injections intrarachi-

diennes de neosalvarsan dans le tabes et la paralysis gdnlrale.)

L. Lort at-Jacob and J. Paraf, Bull, et mim. Soc. mid. H6p. de

Paris , 1914, xxxviii., p. 272.

One case of tabes, two of general paralysis, and one case of
tuberculous meningitis in an old syphilitic patient were treated
with intraspinal injections of 3-5 mg. of neosalvarsan. None
showed the slightest improvement, but, on the other hand, the
injection in one case was followed by a gastric crisis and re¬
tention of urine, and in another by severe pain in the lower
limbs. J. D. Rolleston.

THE WASSERMANN REACTION AND THE MALE INSANE.

(664) J. C. Wootton, Joum. of Mental Set., 1914, Oct., p. 679.

An account of an investigation into the reactions of 550 specimens
of serum and 65 specimens of cerebro-spinal fluid. The author
gives a description of his technique, and summarises the results
obtained by previous authors. Of 66 cases of male adult epileptics,
5, or 7’6 per cent., gave a positive reaction, this result comparing
well with that obtained by other observers. In all the cases of
general paralysis that have died since the reaction was observed,
the post-mortem findings have confirmed the diagnosis, and the
author has not had any case of undoubted general paralysis which
has not given a positive reaction. However, there were a number
of cases which had been looked upon as chronic general paralysis,
and which gave a negative reaction. These cases the author
considers to be cases of Eorsakow’s syndrome, or alcoholic insanity.
Further investigations were made of the serum of the relatives of

ABSTRACTS

529

some general paralytics, and a positive reaction was commonly
obtained.

To find the incidence of syphilis among the ordinary chronic
asylum population, 150 cases were taken at random from the male
incurables of some years’ standing, and 8 per cent, gave a positive
reaction, a result which agrees closely with that obtained in the
epileptic series. Lastly, 284 consecutive male admissions were
examined, and of these 31 per cent, gave a positive reaction, but
when general paralytics are excluded, the percentage drops to
12*5 per cent., which is still, however, higher than that obtained
among the chronic patients. W. D. Wilkins.

THE ELIMINATION OF NITROGEN AND URIC ACID IN STATES

(665) OF EXCITEMENT AND STUPOR. (L’eiimin&zione dell’
azoto e dell’ acido urico in stati di ecdtamento e di stupore.)
D. Valtorta, II Manicomio , 1913, xxviii., p. 167.

From examination of thirteen cases Valtorta came to the following
conclusions:—

In states of excitement, maniacal or catatonic, the excretion of
nitrogen and uric acid was more marked than in cases of stupor,
circular or catatonic. The difference between the quantity of
urinary nitrogen and uric acid excreted appeared greater in the
same individual in the passage from the stuporous stage to the
stage of excitement, or vice versa, than in various individuals
suffering from the same affection. J. D. Rollestox.

ANALYSIS OF A CASE OF PS YOH ASTHENIA. Hrxri Flournoy,

(666) John* Hopkins Hosp. Bull., 1914, xxx., Nov., p. 328.

A man, aged 28, suddenly developed the idea he would have to
kill his child. After five months this idea vanished, and was
replaced by the thought of killing himself. An analysis is given
here, in which, amongst other points, the fact that the patient was
going to have a second child whom he could not well afford to
keep, is shown, the change in his fears coinciding with the birth
of the second child. The obsession disappeared as soon as it was
explained to him, although an uneasy feeling towards the children
without fear arises at times when he is depressed.

A Ninian Bruce.

TWO OASES OF ANERGIC STUPOR TREATED WITH THYROID

(667) GLAND EXTRACT. B. S. Bhiday, Indian Med. Gat., 1914,
Nov., p. 429.

As some cases of anergic stupor and melancholia recover rapidly
after an acute physical illness, e.g., erysipelas, Stoddart advises the

530

ABSTRACTS

induction of hyperthyroidism, giving six 5 gr. tabloids of thyroid
extract the first day, then rising by two tabloids each day to the
fourth, then falling by two tabloids daily to the seventh day, at
suitable intervals. Bhiday subjected two cases to this treatment:
one patient was a Brahman, the other a Mussulman. The result
was that thyroid treatment failed to produce any physical illness
or change in their mental condition: but further trial is suggested
by the writer. Leonard J. Kidd.

THE WET PACK IN THE TREATMENT OF INSOMNIA AND

(668) MENTAL DISORDERS. H. Rayner, Joum. of Mental Set.,
1914, Oct, p. 672.

The author endeavours to recover for this method of treatment
a greater measure of popularity than it at present enjoys, so far
as asylum work is concerned, and he traces its disuse, with great
probability, as the result of its being classed by the Lunacy
Commissioners as a form of mechanical restraint. He shows
that its first effect is the production of a cold state, with shivering
and a falling temperature. This is followed quickly by the stage
of reaction, in which the temperature rises and there is profuse
sweating due to dilatation of the cutaneous vessels, with sub¬
sequent sleep. There is probably considerable elimination of
toxins in the sweat. He lays stress on the point that as soon
as the temperature reaches the normal the coverings should be
diminished, as it is not desirable that pyrexia should be produced,
and he adds other practical points to be observed. The author
considers that the use of the wet pack is extremely beneficial,
both in acute delirious mania and in the ordinary acute form, and
also in melancholia and other forms of mental disease accompanied
by insomnia, and he strongly urges the revision of the existing
rules regarding its employment. W. 1). Wilkins.

ON LETHARGY. K. Agadjaniantz, Joum. of Mental Set., 1914, Oct,

(669) p. 620.

An interesting communication which emanated from the troubled
city of Warsaw before the outbreak of hostilities.. Consideration
of two cases of lethargy leads to a discussion of the nature and
etiology of the condition. One case was that of a girl of 18, who
passed into a lethargic state during an attack of measles, remaining
in it for two days. In the second case, that of a woman of 40,
there were frequent attacks, lasting for several hours each. The
physiological changes resembled those of natural sleep, and the
state of consciousness was undoubtedly greatly obscured, the
patients being unable, after the attacks, to remember anything

ABSTRACTS

531

that happened around them during the attacks. The question of
the connection between lethargic attacks and hypnotism and
hysteria is a vexed one. Lethargy is not an independent disease,
but a symptom complex which may occur as the result of the
suggestion of hypnotism or hysteria, but may also occur quite
independently of either. W. D. Wilkins.

THE USE OF SCOPOLAMINE HYDROBROMIDE OB HYOSGINE

(670) IN THE TREATMENT OF MENTAL DISORDERS. A. W.

Daniel, Joum. of Mental Set ., 1914, Oct., p. 611.

An account of the symptoms which follow repeated dosage with
hyoscine. The drug was given in some cases for weeks or months,
and it was found necessary to gradually increase the dose, as
immunity was quickly established. The maximum dosage was
Jjy gr. twice a day hypodermically. Unfavourable symptoms
generally commenced after three or four weeks, and consisted of
rapid emaciation, ataxia, and paresis of various muscles. But by
far the most characteristic symptom was vivid hallucinosis of a
terrifying character, leading to extreme restlessness, agitation, and
aggressiveness. All the symptoms rapidly subsided on withdrawal
of the drug. The author considers that hyoscine may still be
looked upon as a most useful sedative for occasional use.

W. D. Wilkins.

OBSERVATIONS ON CASES OF ENCEPHALITIS. E. F. Reeve

(671) and Geobge A. Watson, Jowm. of Mental Sci. , 1914, Oct., p. 616.

An important preliminary communication concerning some
anomalous cases which have been found to present distinctive
pathological changes in the nervous system, together with clinical
symptoms of a uniform character, but not corresponding exactly
to any generally recognised type. The symptoms consist chiefly
of a rapidly increasing paresis, accompanied in a large proportion
of the cases by gastro-intestinal symptoms, vomiting being
common and often severe. In a few cases there have been
eczematous rashes of the exposed parts. The mental symptoms
were usually suggestive of dementia prsecox. The cortical
changes consisted of a well-marked lesion of the Betz cells, of
which great numbers showed advanced degeneration of a special
type, this affecting also other cells, both of the cortex, the basal
ganglia, and the cord. The diagnosis is at present uncertain, but
there is some resemblance to pellagra, and it may, on the other
hand, be possible that the cases may belong to a form of dementia
pnecox, accompanied by changes of a much more widespread
character than is usually observed. W. D. Wilkins.

532

REVIEWS

THE DETECTION OF ▲ DYSENTERY CARRIER. H. S. Gettings
(672) and Ethel Wald eon, Joum. of Mental Set., 1914, Oct., p. 606.

The patient in question was a female who for four years hid
had daily loose stools, not at all of a dysenteric character.
Her health was otherwise quite good. Bacteriological examina¬
tion of the stools resulted in the isolation of B. dysenteries,
after some preliminary negative attempts, their numbers being
evidently small. On investigation it was found that a number of
other cases could be ascribed with great probability to infection
from this patient. W. D. Wilkins.

■Reviews.

THE MODERN TREATMENT OF NERVOUS AND MENTAL
(673) DISEASES, by American and British Authors. Edited by

William A. White and Smith Ely Jelliffe. Illustrated.

2 vols. 1913. Henry Kimpton, London. Pr. £3 net.

These two immense volumes view nervous and mental diseases
from quite a different standpoint from the usual text-book. The
nervous system is here regarded as a whole, and as inclusive of
the mind. The ordinary text-book is concerned too much with
the details of nervous disease such as disorders of gait, loss of
sensation, &c., to the neglect of the larger problem of the individual
as a whole and his relation to his environment. They are, as it
were, more concerned with the cure of nervous disease than with
its prevention, and nervous and mental diseases offer the widest
possible opportunities for preventive medicine. The book thus
lays great importance upon the psychical side of life, and sets forth
doctrines of nervous and mental hygiene, reconstructive factors in
social organisation, eugenic problems, questions of education and
of heredity, the applications of legal measures in their remedial
bearings, the functions of the hospital in nervous and mental
disorders, and other important points of the above nature. This
work is not addressed to the medical practitioner alone, but
also to the educator, the legislator, the lawyer, the student of
criminology and of dangerous trades, the social worker, and all
those who come intimately in contact with their fellows and are
concerned with their well-being. The aim has been to focus
attention as far as possible upon the processes, to differentiate
between closely related ones, to outline as clearly as possible their
etiology, and show finally how best to overcome and remove the

REVIEWS

533

main features of the disorders. This may be illustrated by a
reference to tabes and general paresis, two diseases generally
olassified separately because they show an entirely different
clinical picture, but the underlying process is the same in both
cases, only in the one case it is the spinal cord which is attacked,
and in the other the brain.

As the result of the attention here paid to the prevention of
nervous and mental disease, the question of l>orderland conditions
is discussed at some length, especially as the psychoneuroses form
a natural avenue of approach to the understanding of the more
profound and widespread disturbances met with in the psychoses.
It is emphasised that the word “ insanity ” should be eliminated
both from medicine and from law, and regarded as a relic of that
time when all brain disorders with predominant mental symptoms
were considered as one disease.

The two volumes of this book are so large and cover so much
ground that considerable time is required for their study. There
are thirty-six chapters in all, each of which is written by a
recognised authority. They are so arranged that any single
chapter may be read independently, and thus the book is of the
nature of an encyclopaedia. The aim of each chapter has been
therapeutics, and only as much clinical and pathological data have
been introduced as to make the diagnosis certain, while chapters
on Buch subjects as diet, massage, &c., have been omitted altogether.
The value of the different chapters varies considerably, some being
treated on very conventional lines, while others are most original
and suggestive. The books will form a valuable addition to all
neurological libraries.

THE INTENSIVE TREATMENT OF SYPHILIS AND LOCOMOTOR
(674) ATAXIA BY AACHEN METHODS. Reginald Haves. Pp.
iv.+64. Baillifere, Tindall A Cox, London, 1914. Pr.3s.6d.net.

In spite of the discovery of salvarsan and neosalvarsan, the use of
mercury for syphilis has in no way diminished, and it is generally
recognised that treatment by salvarsan should be accompanied by
a course of mercury.

Of all the means of administering mercury, inunction is the
best, and the method employed at Aachen is the most satisfactory.
This consists in the inunction of a mercurial ointment by the
bare hand of skilled rubbers under medical supervision, and, in
addition, the use of sulphur water internally and externally. The
method is fully described here, and the advantages which it
possesses over other methods of administration clearly pointed out,
together with a description of the precautions taken to prevent

534

REVIEWS

the occurrence of salivation and gingivitis and other effects
obtained by intensive mercurialisation. The book appears at an
appropriate moment, and should prove of considerable use.

MODERN PROBLEMS IN PSYCHIATRY. Ernesto Lugaro.

(675) Translated by David Orr and R. Q. Rows. With a foreword
by Sir T. S. Clouston. Second Edition. 1913. Pp. vii.+305.
Pr. 7a 6d. net.

We have reviewed the first edition of this valuable work when it
appeared (r. Review, 1909, vii., p. 792). This, the second edition,
does not present any radical alterations. The authors have
taken the opportunity of making a large number of small changes,
including the correction of several errors, typographical and
otherwise, which appeared in the original issue. They are to be
congratulated on the success which has necessitated the issuing of
a second edition.

HYPNOTISM AND SUGGESTION. C. Lloyd Tuckey. Sixth Edition,

(676) revised and enlarged. Pp. xxviii.+431. 1913. Baillifere, Tindall
<fe Cox, London. Pr. 10s. 6d. net.

Six years have now elapsed since the fifth edition of this book
was published, and the author points out how the important
progress made in psychotherapy during the last few years has
induced him to publish this sixth, and probably final, edition.
He is strongly convinced of the importance of psycho-analysis,
and considers that in many obscure cases it may take the place
of hypnotic suggestion, although there is room for both, and
possibly for their combination. We reviewed the fifth edition
fully in an earlier number of this journal ( v. Review, 1907, v.,
p. 577), and will content ourselves with again pointing out that,
for those interested in this subject, Dr Tuckey’s book will be
found an admirable text-book, and should do much to arouse an
interest in the mind of the general practitioner on this subject.

MENINGOCOCCUS MENINGITIS. Henry Hkiman and Samuel

(677) Frldstein. With introduction by Henry Koplik. Pp. xiv.+
313. With 4 plates, 31 figures (2 in colour), and 4 charts. J. B.
Lippincott Co., London. Pr. 12s. 6d. net.

This monograph is founded on a study of cases of meningococcus
cerebro-spinal meningitis which have been treated in the children’s
wards of the Mount Sinai Hospital, New York, and reflects the
methods of study of the symptoms, diagnosis, and treatment in
vogue there. As its purposes are practical, and as it is intended
for the use of students and physicians engaged in clinical work,

REVIEWS

535

only so much of technical detail has been included as can be
carried out with ordinary laboratory facilities.

A short history of the condition is first given, followed by
chapters on the bacteriology, epidemiology, mode of dissemina¬
tion, and pathological anatomy of the disease. The clinical types
are then discussed with the symptomatology, complications, and
differential diagnosis, including chapters on the eerebro-spinal fluid
and laboratory diagnosis. The book concludes with chapters on
prognosis and treatment.

The authors have succeeded in producing a most readable
book. The subject is carefully and systematically studied, each
chapter being followed by a separate bibliography. The chapter
on the mode of dissemination concludes as follows: “ The present
state of our knowledge permits us to state that there is some
evidence, but no conclusive proof, that the meningococcus primarily
invades the blood and secondarily the meninges.” The onset of
blindness from pressure on the optic nerves from the pituitary is
not referred to, with subsequent amelioration of the symptoms
when the pressure is removed. The subject of internal hydro¬
cephalus is clearly explained. The chapter on treatment has been
brought quite up to date, and the different methods of preparing
the sera of Flexner, Kolle and Wassermann, Dopter, and Jochmann,
is described, together with the results of their use. The book
forms a very complete monograph on this subject, the references
to the literature being most useful.

DREAMS. Henri Bergson. Translated, with an Introduction, by
(878) Edwin E. Slosson. Pp. 62. T. Fisher Unwin, London. Pr.
2s. 6d. net.

ON DREAMS. Prof. Sigm. Freud. Only authorised English Translation,
(678) by M. D. Eder, from the Second German Edition, with an Intro¬
duction by W. Leslie Mackenzie. Pp. xxxii. + llO. William
Heinemann, London. Pr. 3s. 6d. net

THE INTERPRETATION OF DREAMS. Prof. Sigm. Freud.
(680) Authorised Translation of Third Edition, with Introduction, by
A A. Brill. Pp. xiL+510. George Allen «k Co., London. 1913.

These books should be read in the above order. Both authors
base their views on the theory that no conscious experience is
entirely lost. According to Freud, “ what seems to have vanished
from the current consciousness has really passed into a sub¬
consciousness, where it lives on in an organised form as real as if
it were still part of the conscious personality.”

Bergson carries this still further; he believes “ that all our
past life is there, preserved even to the infinitesimal details, that we

536

REVIEWS

forget nothing, and that all that we have felt, perceived, thought,
willed from the first awakening of our consciousness survives
indestructibly.” Dreams are the expression of these subconscious,
dormant complexes. Bergson, who does not believe in the
parallelism of mental and nervous activities, considers that all
these memories are packed away in the subconscious mind, under
pressure, like steam in a boiler. He regards the brain as the
organ of attention, whose function is to concentrate the entire
accumulated experience, i.e., memory, upon any sensation, and to
interpret it correctly. Sleep is to be regarded as a condition of
“disinterestedness.” One sleeps to the extent one becomes dis¬
interested, and thus, during sleep, these subconscious memories
throng forth and express themselves as dreams.

Freud analyses the dream at great length. Dreams, being the
awakening of dormant complexes, are transfigured experiences,
and are a manifestation of ordered mental processes. They are
largely the expression of unfulfilled desires. They may be divided
into three classes, according to their relation towards the realisation
of desires: first, those which exhibit non-repressed, non-concealed
desire ; these are best seen in children, where the sleeping ex¬
perience differs very little from the waking experience, and the
dream thus takes the form of the ungratified desires of the day.
Second, dreams may express in veiled form some repressed desire ;
these constitute by far the greater number of adult dreams. Freud
considers that painful experiences tend to be repressed, ie., to
disappear from conscious memory, but persist subconsciously,
and if they reappear as dreams, they usually require a psycho¬
analysis to be understood, i.e., they are concealed realisations of
repressed desires. Third, dreams where repression exists, but
without or with but slight concealment. Such dreams usually are
accompanied by a feeling of dread, which brings them to an end.

The dream work denotes the transference of the dream thought
to the dream content, and thus is not creative; it judges nothing,
it decides nothing, and it develops no new fancies. Four stages
may be traced in this dream work. First, condensation, because
a single dream is representative of many waking experiences.
Second, displacement, by which emotional emphasis is transferred
from its right place in the train of dream ideas to some trivial
element in the dream content, owing to the fact that a psychical
censorship exists, which tends to suppress everything unpleasant
or impossible. Third, dramatisation or figurative imagination; and
fourth, elaboration from the necessity for regard to intelligibility.

Freud’s work on dreams is of great value, and is clearly
explained in these two books, the first of which is an introduction
to the second, where the whole subject is treated at great length.
All the translations have been well done.

REVIEWS

537

OLANDES SUBRfcNALES ET ORGANES OHBOMAFFINES.

(681) M. Lucibn and J. Pabisot. Pp. iv. + 453, avec 100 figures dans le
text©. F. Gittler, Paris, 1913. Pr. Fr. 14

The increasingly important subject of the internal secreting
glands has, within recent years, led to the production of excellent
English ( v . Review, 1913, xi., p. 176) and German ( Ibid ., 1914,
xil, p. 173) text-books on this subject.

We have here the French contribution, where, instead of
including all the different internal secreting glands in one volume,
it has been decided to issue a separate volume for each gland, and
this, the first of the series, deals with the suprarenal glands and
the chromaffine tissue system.

The book is divided into four parts, the first anatomical,
the second physiological, the third pathological, and the fourth
clinical.

The suprarenal glands in man consist of two portions, a cortex
and a medulla. In the first, however, these two portions form
distinct and separate organs, and all stages can be traced between
this and man. Developmen tally, these two portions are found to
have separate origins. The cortex appears to be related in some
way to the reproductive organs, the medulla is part of the
chromaffine tissue system. This system is so called because the
cells stain yellow with bichromate solutions, and such cells always
contain adrenalin. These chromaffine cells are derived from the
same cells which also give rise to the nerve cells of the sympathetic
ganglia, and thus are really part of the nervous system. Most of
them disappear about birth, the medulla of the suprarenals being
the largest remnant.

In Part I. comparative anatomy, embryology, anatomy, and
histology is described. Part II. deals with physiology, and
discusses the effects of removal of one and both suprarenal glands,
the effects of injection of extracts prepared from them, especially
upon the circulatory system and on general nutrition, the action
of adrenalin, the antitoxic functions of the suprarenals, and the
physiology of the accessory glands. Part III. is related to
pathology, and describes, in turn, atrophy, hypertrophy, vascular
lesions, inflammatory conditions, and tumours. Part IV. discusses
suprarenal syndromes in acute, chronic, and inflammatory condi¬
tions, pluriglandular syndromes, and the symptomatology of
suprarenal tumours. It is suggested that the presence of
adrenalin in the suprarenals is of definite medico-legal value in
determining if death has been sudden or slow. The last chapter
deals with suprarenal opotherapy.

The account given here of the suprarenal glands is most
complete, and forms a valuable contribution to the subject.

538

BOOKS AND PAMPHLETS RECEIVED

LEAD POISONING : from the industrial, medical, and social points
(682) of view. Sir Thomas Oliver. Pp. x. + 294. Crown 8vo. H. K.

Lewis, London, 1914. Pr. 6s. net.

This book consists of the lectures delivered by the author at the
Royal Institute of Public Health, and forms an excellent illustra¬
tion of the good which may be done by suitable inspection and
control in reducing an industrial disease.

The book opens with a description of the methods of lead
smelting and of manufacturing red and white lead, and points out
the dangers of lead poisoning arising at various stages. House
painters are next considered, and there seems to be little doubt
that the acute illness house painters suffer from is not always
plumbism, but is the result of the inhalation of vapours given off
by the materials with which the pigments are mixed. Pottery
work is next considered, and a striking contrast is given between
the condition in this country and in Hungary.

Lead may enter the body in food or drinking water, or as
fume or dust, or through the skin; probably most enters by the
alimentary canal. It is dissolved by the hydrochloric acid of the
gastric juice, and is absorbed unless proteid food is being digested
at the same time, when it forms an insoluble albuminate. The
symptoms are pallor, anaemia (basophilia is not constant), blue line
on gums, colic and constipation, headache, loss of vision, and
numerous nervous symptoms, such as weakness of the wrists, with
or without tremor, extensor paralysis, sensory changes, and mental
symptoms. The presence of a positive Wassermann reaction must
not be considered certain evidence of syphilis. The chapter upon
“ what constitutes lead poisoning ” is most interesting, great stress
being laid upon the presence of lead in the urine. The injurious
effects of lead upon pregnancy is clearly shown, and after discussing
treatment, both preventive and curative, the book finishes with
the Factory and Workshop Orders relating to lead poisoning.

BOOKS AND PAMPHLETS RECEIVED.

Bergson, Henri. “ DreamB.” Translated with an Introduction by
Edwin E. Slosson. T. Fisher Unwin, London.

Hayes, Reginald. “ The Intensive Treatment of Syphilis and Locomotor
Ataxia by Aachen Methods.” Raillifere, Tindall & Cox, London.

Kaplan, D. M. “Serology of Nervous and Mental Disease.” W. B.
Saunders Co.

Oliver, Sir Thomas. “Lead Poisoning, from the Industrial, Medical,
and Social Points of View.” H. K. Lewis, London.

Rebizzi, Renato. “ Osservazioni al Progetto di Manicomio per la
Provincia di . . . Utopia” {Annali del Manicomio Provinciale di
Perugia, 1912, vi., Gennaio-Giugno).

Bibliography

ANATOMY.

YAMAKAWA, SHOTARO. Zur Kenntnis der Ventrolateralen Pyremidenbahn
Barnes’ and der Dreikantenbahn Helwegs. Bemerkungen *ur Frege der Leitungi-
bahn im laterelen Markfeld der Olive und in der anterolaterelen Rtickenmarks-
Peripherie. MitteU . a. d. Med. Fakultat d. Kaiserlieh UnivtrtiUU ru Tokyo ,
1913, xi. v Oct. 3, S. 1.

WEED, LOUIS H. Reconstruction of the nuelear masses in the rhombenoephalon.
Anal. Record, 1913, vii., Deo. 20, p. 443.

THOMPSON, C. B. A comparative study of the brains of three genera of ants, with
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LAND ACRE, F. L., and CONGER, A. C. The origin of the lateral line primordia
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HERRICK, C. J., and OEENCHAIN, J. B. Notes on the anatomy of acydostome
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NISSL, FRANZ. Die Grossbirnanteile des Kaninchsns. Arckiv. /. Psychiat. u.
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AGUGLIA, ENG. Le alterazioni nuclear! delle cellule radicolari in seguito a resesione
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KRASSNIG, MAX. Von der Arteria vertebrelis thoracica der S&uger und Vdgel.
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STRANDBERG. Om Musoulus sternalis’ innervation. Upsala Ldkarefbrenings
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PHYSIOLOGY.

MARINESCO and MINE A. Quelques differences physioo-chimiques entre les cellules
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COLLIN. Les relations des corps de Niasl et des neurofibrilles dans la cellule nerveuse.
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NAGEOTTE. Structure des nerfs dans les phases tardives de la dAgAnAretion walleri-
enne. Note additionnelle. Compt. Rena. d. 1. Soe. de Bid ., 1913, lxxv., Dec. 26,

p. 620.

D&IERINE. Le syndrome des fibres radiculaires longues des cordons poctArieurs.
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GASSER and LOB VENHART. The mechanism of stimulation of the medullary centres
by decreased oxidation. Joum. Pharmaed. and Exper. Ther ., 1913, v., Jan.,
p. 239.

GERHARTZ and LOEWY. Uber die H5he des Muskeltones. PJlUger's Arckiv ., 1913,
dv.,S. 42.

CAMUS and ROUSSY. Hypophysectomie et polyurie expArimentales. Compt. Rend.

MUS and ROUSSY. Hypophysectomie et
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CAMUS and ROUSSY. Polyurie expArimentale par lAaions de la base du cerveau. La
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ISCOVESCO Contribution k la physiologic du lobe anterieur de rhypophyse. Le
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CUSHING and GOETSCH. Hibernation and the pituitary body. Proe. Soc. Exp.
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GOETSCH and CUSHING. The pan anterior and its relation to the reproduction
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WERSCHININ, N. Uber die Herzwirkung des Pituitrins. PJluger't Archiv , 1913,
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VOEGTUN, C., and MACHT, D. I. Isolation of a new vasoconstrictor substance from
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OTT, I., and SCOTT, J. C. The effect of animal extracts and iodine upon the volume
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URECHIA and POPEIA. La m4thode d'Abderhalden chez les animaux en dtat de
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ISCOVBSCO. Sur les propri^t4s d’un lipoide (II. Bd.) extrait de la partie eorticale des
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ISCOVESCO. Propri4tds physiologiques d'un lipoide (II. Bd.) extrait de la partie
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PSYCHOLOGY.

MULLER, G. E. Neue Versuohe mit Riickle. ZUch. f. Psychol, 1913, lxviL, S. 193.

HAZAY, O. v. Gegenstandstheoretische Betrachtungen uber Wahrnehmung und ihr
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BALEY, S. Uber den Zusammenklang einer groaseren Zahl wenig verschiedener Tone.
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PIKLER, J. Empftndung und Vergleioh. I. ZUchr. f. Psychol ., 1913, lxviL, S. 277

ACKERKNECHT, E. Uber Umfang und Wert des Begriffes “ Gestaltqualitat.’*
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KATZ, D., and REVESZ, G. Ein Beitrag zur Kenntnis des Liohtsinns der Nachtvogel.
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LASAREFF, P. Das Weber-Feehnersohe Gesetz und die Abhangigkeit des Reizwertes
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BORCELART, H. Beitrage zur Kenntnis der absoluten Schwellenempfindlichkeit der
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TRENDELENBURG, W. Versuohe liber binokulare Mischung von Spektralfarben.
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MINKOWSKI. E. Die Zenkersche Theorie der Far ben perception. ZUchr. f. Sinnes¬
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TRENDELENBURG. W. Eine Beleuohtungsvorrichtung fhr die Anordnung sur
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YERKES, R. M. Comparative psychology in relation to medicine. Boston Med. and
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SZYMANSKI, J. S. Zur Analyse der sozialen Instinkte. Biol. Ccnlralbl., 1913,
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NATZMER, G. v. Zur Psychologic der sozialen Instinkte der Ameisen. Biol. CentrabL,
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SCHILDER, P. Uber das Selbstbewusstsein und seine Storungen. ZUchr. f. d. yes.
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HEILBRONNER, K. Konstitutionelles Wachtraumen. Als Beitrag zur Pathologic
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PATHOLOGY.

CALLISON and MACKENTY. Tumours of the carotid body. Annals of Surg., 1913,
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NOYAK. Uber den Einfluss der Nebennierenausschaltung auf das genitale. Archit
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ABRAMOW and MISCHENNIKOW. Uber die Entgiftung bakterieller Toxine durch
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GYENES and STERNBERG. Ueber eine neue und schnelle Methode zum Nacbweis
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CLINICAL NEUROLOGY.

GBJfERAL—

PARKER, C. H. The nervous system, its origin and evolution. N. Y. Med.
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MOLREN, GEORGE A. Metallic Poisons and the Nervous System. Amer.
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SAUER. Uber das Vorkommen einer Lymphoeytose im Blutbild, insbesondere bei
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TAYLOR, A. S. Conclusions derived from further experience in the surgical
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KENNEDY, FOSTER. Myotonia atrophica. Joum. Amer. Med . Auoe., 1913,
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MORLEY, JOHN. Traumatio intramuscular ossification : its pathology and treat¬
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BOOT, G. W. A case of oongenital myotonia. Joum. Amer. Med. Assoc., 1913,
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BABONNEIX, M. L. La reaction myotonique. (Rev. g4n.) Qaz. desHdp 1913,
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SPINAL CORD—

General.—D’ABUNDO, G. Modificasioni spinali consecutive a lesioni periferiche
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Fracture, Dislocation, Ac* —ROTH, P. B. The treatment of sooliosis. Med.
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Herpes Zoster. —LANG WILL H. G. Does Herpes Zoster ever oocur trau-
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Cervical Rib. —GARDINER, H.— Bilateral cervical ribs. Proe. Roy. Soc. Med.,
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fiplma Bifida. —HOGUET, J. P. Spina bifida. N. Y. Med. Joum., 1913, xcviii.
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Byrlaao-Myelllls.—GARDINER, H.—Case of (?) syringo-myelitio. Proc. Boy.
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Paraplegia. —SHARPE, WM., and FARRELL, B. P. A new operative treat¬
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Tabes Dorsalis.— AUSTREGESILO, A Friihdiagnose der Tabes und der Tabes
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SIEGRIST. Nervoses Fieber bei Tabes dorsalis. MUnch. Med. Wehnschr.,
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OCZB3AL8KI, K. Bin Fall von Kotbrechen bei gastrischen Krisen. Berl.
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KAPLAN, D. M. The “ Wassermann-Fast Tabes a serologic precursor of
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MALONEY, WM. J. M. A. The cure of ataxia. N. Y, Med. Joum., 1913,
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rsllsarelHIs A a ter ter Aewta.—NETTER, ARNOLD. The meningeal form of
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RIVERA, J. E. A Sporadic Case of Acute Poliomyelitis of the Meningeal Typa
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NETTER and RIBADEAU-DUMAS. Les manifestations ohortiformes dans la
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CASSEL. Beitrag sur Heine-Medinschen Krankheit. (Poliomyelitis and
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UFFENHRIMER. Der Stand der Heine-Medinschen Krankheit (epidemischen
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CANBSTRINI, S. Betrachtungen liber die klinisohe Symptomatik der Polio¬
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WACHENHEIM, F. L. Atypical infantile paralysis. N.Y. Med. Joum.,
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SMITH, E. B. Infantile paralysis of early onset, with unusual deformities
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FRAUENTHAL, H. W. The treatment of paralysis of anterior poliomyelitis.
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SAVARIAUD. La paralysis infantile et son traitement. Joum. de Mid. de
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MAUI—

fieiersl.—EDGEWORTH, F. H. On the cerebral symptoms of lobar pneumonis
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GOLDSTEIN, K. Ueber die Storungen der Grammatik bei Himkrankheiten,
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TYLECOTE, F. E. A clinical lecture on some of the cerebral manifestations of
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ENOCH. Bin Fall von schwerer An&mie mit Herdencheinungen im Gehiro.
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ftkmll Imjwry, Ac.— BARRY, C. C. Treatment of depressed fractures of skull st
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Abscess — DUVERGBR, J. Abcds du cerveau d’origine otique; mort brusaue
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Encephalitis.— VOSS, F. Heilung einer Encephalitis bei Otitis media ehron.
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SMITH, E. B. (?) Cerebellar Encephalitis. Proe. Roy. Soc . Med., 1913, vii.,
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Meningitis.— DOPTER, OH. La contagiositd de la mdningite odrdhro-spinale.
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WOLFF and LEHMANN. Ueber einen duroh intralumbale and intraventri*
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GERHARD. Uber Meningitis serosa bei Nasenerkrankungen. Ztschr. f.
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BIBLIOGRAPHY

ROSENBERG, O. Die Pachymeningitis hemorrhagica interna im Kindesalter.
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REISCHIG, L. Bin Fall yon Meningitis pornlenta aseptica nach einem intra-
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ACKER. G. N. Parotitis complicated with meningitis. Amer. Joum. Dis.
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HUMBERT and ALBXIEFF. Contribution k l’dtude de la m^ningite oano^reuse.
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■ydroccphalas.—DANDY, W. E., and BLACK FAN, K. D. An experimental
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■awcrrhage.—HUTINBL. Meningeal Hemorrhage in Childhood. Med. Prets,
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F1TZWILLIAMS, D. C. L. Case of oephalhematoma. Proc. Roy. Soc. Med.,
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Thrombosis.—BURY, JTJDSON S., and STOPFORD, J. S. B. On a case of
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Hemiplegia.—DANA, C. L. The serological tests in cerebral hemiplegia. Med.
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COCKAYNE, E. A. Hemiplegia with very extensive nsevus. Proc. Roy. Soc.
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Facial Paralysis.—ROSENBLUTH, B. Partial facial paralysis due to trau¬
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CASTRO, A. db. Angeborene Fasdalisl&hmung. Neurol. Centralbl., 1913,
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Tmmemrs. —MANN, R. W., and LOUDON, J. Frontal Tumours. Canadian
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BRUNS, L. Die Behandlung der Gehirntumoren und die Indikationen ftir ihre
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GREY, E. G., and EMERSON, L. E. A striking acquirement of visualising
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LAHMEYER. Ein Fall von Geschwulstbildung im Gehirn und in den weiohen
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JOSEFSON. Gehirngeschwulst mit Gesichtshalluzination und Makropsie.
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HuSsA, F. Ein ungewohnlioher Yerlauf einee Kleinhirntumors. Wien. Med.
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OPPENHEIM and KRAUSE. Operative Brfolge bei Geschwillsten der Sehhiigel-
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Jfemrema.—DUSTIN, A. P., and LIPPENS, A. A propos de deux oas de n4vrome
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Myasthenia.— DILLER and ROSENBLOOM. Metabolism Studies in a Case of
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Amaarelle Family Idiocy. —HYMANSON, A. Metabolism studies of amaurotic
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PltmUary Tnmonrs, dte. —FEJ^SR, J. Beitrage xur Diagnose und sur operativen
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HOFFMANN, R. Uber die pernasale ErOffnung der Sella turcioa. ZUckr. f.
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Acromegaly.—REBATTU, J., and GRAVIBR, L. Gig&ntisme eunuchoide. (4 pi.)
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InfhBtlllsm.—ZUNDEL, C. E. Two cases of infantilism. Proc, Roy, Soc. Med. t
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Cerebral Arterlo-gelerosls.—NOUET, H. Syndrome confusionnel an court de
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Apbasla, Ac.—DEJ^RINE and ANDRE-THOMAS. De la restauration du
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LIEHMANN, H. Motorische Aphasia and Apraxie. Monatsch. f. Psychiat. u.
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RAD, v. Uber Apraxie bei Balkendnrchtrennung. Ztschr. /. d. get. Neurol, u.
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SEILER, FRITZ. Ueber einen Fall von reiner Agraphie bei einem an links-
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Pellagra.—COLE, J. W. E. A case of pellagra with insanity. Proc. Roy. Soc.
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OBRBGIA and PITULESCO. La s4ro-r4action d’Abderhalden dans la pellagre.
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HOGG, C. A., MILES, G. E., and LATHAM. O. Cases of Pellagra-like Skin
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ftypbllls.—RICHTER, ED. Kontralnesin zur Therapie der Syphilis. Dermatol.
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RICHTER, ED. Erwiderung auf die Arbeit von Dr Julius Fiirth : “ Die Behand-
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ftalvarsaii.— SIEGRIST, A. Salvarsan gegen die sympathische AugenentzUndung.
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GERBER, P. Die Behandlung der Hals-, Nasen- und Ohrenkrankheiten mit
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WADHAMS, S. H., and HILL, E. C. Results of treatment of syphilis with
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BIBLIOGRAPHY

HEINRICHSDORFF. Bin weiterer Beitrag zur Leberschadigung duroh Sal-
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BRANCH, E. R. Salvarsan in Filariasis. Joum • Trap. Med. and Hygiene,
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MeesalvarsaB.—KERL, WM. Ueber konxentrierte Neoealvarsaninjektionen.
Wien. /din. Wchneehr., 1913, xxvi, Dez. 11, 8. 2976.

SCHUBERT, v. Patientenaerum ala Neosalvaraanvehikel. Munch. Med.
Wchneehr ., 1913, lii., Dez. 30, S. 2911.

RUSH, J. O. Gumma of prostate and bladder. Six intravenous and one
intramuscular injections of salvarsan and twenty-six intravenous injections of
neosalvaraan to patient sixty-six years old. Med. Record, 1913, lxxxiv., Dec.

6, p. 1028.

NEUMAYER. Zur Gabengrosse dea Neosalvaraana. Miinch . Med. Wchneehr .,
1913, lx., Dez. 2, S. 2672.

BAETGE. Behandlung der Malaria tertiana mit Neosalvaraan. Miinch. Med.
Wchneehr „ 1913, lx., Dez. 16, S. 2776.

Waiiennani Reaction.—POST, ABNER. The clinical value of the Wasser-
mann reaction. Boston Med. and Surg. Joum., 1913, olxix., Nov. 27, p. 777.

DUDUMI and SARATZEANO. La reaction de Wassermann en dermatologic.
Annalee de Dermatol, et de Syphiligr., 1913, iv., S. 600.

SAGASTUME. Contribution k l*4tude dea antigfenes artificials dans la reaction
de Wassermann. Compt. Rend . d. 1. Soc. de Biol., 1913, lxxv., Dec. 5, p. 459.

KOLMER, LAUBAUGH, and CASSELMAN. Practical studies on the so-called
syphilis "antigens” with special reference to oholesteriniaed extracts. Ar¬
ea* vee Int. Med ., 1913, xii., Dec., p. 660.

Cerebro-Spinal Fluid.— DONALD, R. A method of estimating numerically and
quantitatively the cells in permanent preparations of cerebro-spinal fluid with
notes on the cell-count of specimens. Folia Haematol., 1913, xvii., Dez., p.
139.

SALIN and REILLY. Origine et passage des anticorpe dans le liquid© cephalo-
rachidien. (Premiere note.) Compt. Rend. d. 1. Soc. de Biol., 1913, lxxv., Dec.
26, p. 635.

RUBENSTONE, A. I. Cerebro-spinal fluid and its diagnostic significance.
H. Y. Med. Joum., 1913, xcviii., Dec. 20, p. 1210.

EICKE. Die Goldreaktion im Liquor oerebroepinalis. Miinch. Med. Wchneehr.,
1913, xlix., Des. 9, S. 2713.

SZECSI. Eine neue Methode zur Untcrsuohung dea Liquor oerebroepinalis.
Deut. Med. Wchneehr ., 1913, lii., Dez. 28, S. 2558.

ASSMANN. Uber das Verhalten der Cerebrospinalflfissigkeit bei isolierten
Pupillenstorungen. Deut . Ziechr. /. Nervenheilk. , 1913, xlix., S. 395.

ZIMMERMANN, A. Einiges fiber Urotropin und sein Verhalten im Liquor
cerebrotpinalis. Ziechr. /. Ohrenheilk. u. f. d. Krankh. d. Luftwege , 1913, xxi.,
S. 185.

EMBDAL AMD FUMCTIOMAL DISEASES—

Epilepsy. —MULLAN, E. H. Epilepsy. (One illuatr.). N. Y. Med. Joum., 1913,
xcviii., Dec. 20, p. 1197.

BALLET, G. Somnambulisms, cpilepsie, tabes. Joum. dee Prat., 1913, xxvii.,
Dec. 20, p. 817.

RAECKE. Ueber antisoziale Handlungen epileptischer Kinder. Arehiv. f.
Peychiat. u. Nervenkr ., 1913, lii., S. 961.

ODDO and CORSY. La myoclonic epileptique. Rev. de Peychiat ., 1913, xvii.,
Oct., p. 397.

SEROBIANZ, N. A. Untersucbungen fiber das Verhalten des Restkohlenstoffs
im Epileptikcrblute. Ziechr. /. d. gee. Reurol. u Peychiat. (Orig.), 1913, xx..
Nov. 26, S. 425.

8 *

BIBLIOGRAPHY

HAHN, R. Assoriationsversuehe bei jugendlichen Epileptikern. Archiv. /.
Psychiat. u. Nervtnkr ., 1913, lit, S. 1078.

VR1T. Ztur Kasuistik opera tiver Epilepsiebehandlung. ArcAiv. /. Psychiat. u.
Nervtnkr ., 1913, Hi., S. 988.

■ysterlm.— ESCHLE. Wesen and Behandlung der Hysterie. Fortsch. d. Med.,
1913, xxxi., S. 1317, 1350, and 1384.

WACHSMUTH, H. Beitrkge zur Fehldiagnose Hysterie. Archiv. /. Psychiat.
u. Nervtnkr 1913, lii.. 8. 993.

STEWART, PURVBS. A oase of hysterical monoplegia following electric shock.
Brit ified. Joum., 1913, Dec. 20, p. 1580.

Mearalgla*—MANN, L. Le traitement rflectrique dee nlvralgies. Archive# c VElect
Mid., 1913, xxL, Dec. 10, p. 519.

Neuritis.—BYRNE8, C. M. Anterior Crural Neuritis. Joum. Nerv. and Menl.
Die ., 1913, xl., Deo., p. 758.

SIEBERT, H. Ueber Neuritis. St Petersburger Med. Ztschr ., 1913, xxxviii.,
Dez., S. 856.

VERCO, J. C. Radicular Neuritis. Australas. Med. Gas., 1913, xxxiv., Oct. 18,
p. 363.

MARCHAND and USSE. Psychopolynovrite au court d une cure de d4mor-
phinisation. L'Bnctgkale, 1913, viii., p. 514.

Neuroses*—THORBURN, WM. The Traumatio Neuroses. Proc. Roy. Soc.
Med., 1913, vii., Not. (Neurol. Sect.), p. 1.

BARRETT, J. W. A oase of Angio-neurosis. Australian Med. Joum., 1913,
ii, Nov. 8, p. 1287.

ORBISON, T. J. The Kinetio Neuroses Mid Psychoses. (2 Illustr.) N. Y. Med.
Joum., 1913, xcriii., Dec. 13, p. 1160.

LIL1ENSTEIN. Psyohoneurosen bei Herzkrankheiten. Archiv f. Psychiat. u.
Nervtnkr., 1913, lii,, 8. 954.

Psychoses*—BONHOEFFER, K. Die Infektions- und Autointoxikationspsy-
chosen. Monatssch. f. Psychiat. u. Neurol., 1913, xxxiv., Des., 8. 506.

LOMER, G. Ein Fall von zirkul&rer Psyohose, graphologisch gewiirdigt (Mit
8 Sohriftproben.) Ztschr. f. d. get. Neurol, u. Psychiat. (Orig.), 1913, xx.,
Nov. 26. 8. 447.

KAUFFMANN, A F. Zur Frage der Heilbarkeit der Korsakowschen Psyohose.
Ztschr. f. d. ges. Neurol, u. Psychiat. (Orig.), 1913, xx., Nov. 26, 8. 488.

KIRCHBERG, PAUL. Psychisohe Storungen wihrend der Geburt. Archiv f.
Psychiat. u. Nervtnkr., 1913, lii., 8. 1153.

Alcoholism, Ac*—Some Medical and Social Aspects of Mental Disease due to
Aloohol: notes of a conference held at the Psychopathic Hospital, Boston,
Massachusetts, before the Legislative Commission on Drunkenness, November
24,1913. Boston Med. and Surg. Joum., 1913, clxix., Dec. 25, p. 929, Ac.

BOUCHACOURT, L. A propos de la depopulation. Sur la neoessite d’entre-
prendre une lutte serieuse oontre l’alooolisme, pour am&iorer la race, et pour
diminuer la mortality infantile. Joum. de Mid. de Paris, 1918, xxxiiL,
Dec. 13, p. 976.

Exophthalmic Goitre, Cretinism, Ac*— MENDEL, KURT, and TOBIAS,
ERNST. Die Basedowsche Krankheit beim Manne. Neurol. Centralhl.,
1913, xxxii., Des. 1, 8. 1477.

MARINESCO, G., and GOLDSTEIN. Syndrome de Basedow et scUrodermie.
Nouv. Icon, de la Salpit., 1913, xxvi., p. 272.

LANGMEAD, F. Some points in the treatment of Graves* Disease, din.
Joum., 1913, xlii., Dec. 31, p. 609.

DAVISON, R. E. Surgical aspects of Graves' Disease. N.Y. Med. Joum.,
1913, xcviii., Nov. 29, p. 1065.

GELLHORN, G. Exophthalmic Goitre and Pregnancy, Amer. Joum. Obstetrics,
1913, lxviii., Dec., p. 1182.

BIBLIOGRAPHY

SCHMAUCH. Die Schilddrtise der Frau und ihr Einfluss auf Menstruation und
Schwangerschaft. Monatssch. f. Oeburtsh. u. Gyndkol ., 1913, xxxviii., Dez.,
S. G62.

WHITE, C. A description of the ductless glands from a case of acute thyroid
enlargement of pregnancy. Joum. Obstetrics and Gyncecol., 1913, xxiv., Nov.,
p. 271.

WILSON, LOUIS B. The Pathology of the Thyroid Gland in Exophthalmic
Goitre. Amer. Joum. Med. Set., 1913, cxlvi., Dec., p. 781.

PLUMMER, H. S. The Clinical and Pathological -Relationship of Simple and
Exophthalmic Goitre. Amer. Joum. Med. Set ., 1913, cxlvi., Dec., p. i90.

BLACKFORD, J. M., and SANFORD, A. H. A Demonstration of a Depressor
Substance in the Seram of the Blood of Patients affected with Exophthalmic
Goitre. Amer. Joum. Med. Sci., 1913, cxlvi., Dec., p. 796.

DAVIDSON, B. Thirty-three cases of thyroid disease. Med. Record, 1913,
lxxxiv., Dec. 20, p. 1113.

BUCKLEY, A. C. The relation of hyperthyroidism to the nervous system.
N. Y. Med. Joum, 9 1913, xcviii., Dec. 6, p. 1112.

PERN, S. Hypothyroidism and its bearing on general treatment. Australian
Med. Joum., 1913, ii., Nov. 8, p. 1287.

HEMMETER, J. C. Hyperthyroidosis of intestinal origin. Joum. Amer. Med.
Assoc., 1913, lxi., Dec. 13, p. 2146.

POGGIO, E. Insufficienza paratiroidea oronica ed innesto di tiroide. Riv. Crit.
di Clin. Med., 1913, xiv., Deo. 6, p. 769.

Tetmaws*—MILLION!, LUIGI. Considerazioni e note sulla terapia del tetano.
Riv. Crit. di Clin. Med., 1913, xiv., Nov. 29, p. 763.

SPECIAL SEMES AMD CEAMIAL MEEVBS—

RttBEL, E. Hemianopisches Ringskotom. Klin. Monatsbl. J. Augenheilk.
1913, li., Dez., S. 706.

TAKASHIMA, S. Seohs Ffclle der komplizierten heredit&r-famili&ren Opti
kusatrophie dee Kindes-alters (Behr.). Klin. Monatsbl. f. Augenheilk., 1913,
1L, Dez., S. 714.

ASCHER, K. W. Zur Frage nach dem Einfluss von Akkommodation und
Konvergenz ituf die Tiefeniokalisation und die scheinbare Grouse der Sehdinge.
Ztschr. f. Biol., 1913, lxii., S. 508.

MOUGEOT, A. Tachycardie paradoxale des hjpertendus et riflexe oculo-
oardiaque. Prog. Mid., 1913, xli., Dec. 20, p. 663.

LOEPER and MOUGEOT. L’absenoe du rdflexe oculo-cardiaque dans le tabes.
Prog. Mid., 1913, xli., Dec. 27, p. 676.

ONODI, L. Uber die rhinogenen und otogenen Lttsionen des Okulomotorius,
Troohlearis, Trigeminus, und Abducens. Ztschr. f. OhrenheUk. u. /. d. Krankh.
d. Luftwege, 1913, lxix., S. 1.

STERLING, W. Ueber die Abduoenaltthmungen reflektorisohen und otitieohen
Ursprungs (Gradenigoeohea Syndrom). Monatssch. f. Psychiat. u. Neurol.,
1913, xxxiv., Dez., S. 668.

ANTON, W. Uber Mlni&reschen Symptomenkomplex. Prag. Med. Wchnsehr.,
1913, xxxviii., Dez. 11, S. 687.

MANGOLD, E., and ECKSTEIN, A. Reflektorische Kontraktionen dee Tensor
tympani beim Mensohen, Internal. Zentralbl. f. OhrenheUk. u. Rhino -
Laryngol., 1913, xi., S. 603.

DENKER, A. Uber die Funktion dee akustischen und statischen Apparates bei
einem Falle von Ageneeie des Kleinhirns. Ztschr . /. Ohrenhetlf. u. f. d.
Krankh. d. Luftwege, 1913, xx}., S. 173.

10*

BIBLIOGRAPHY

XUCKLUIVMIJ8 SYMPTOMS AMD CASES—

DANA, CHARLES L. The Future of Neurology. Journ. Nerv. and Merit. Dit.,
1913, xl., Dec., p. 763.

CLAUDE, H. Defensive Reflexes: their Semeiological and Prognostic Value.
Med. Prett, 1913, xcvi., Deo. 17, p. 664.

ZELIONT. Prooede technique pour l’etude de r4flexe musculaires oonditionnels.
(Premiere com.) Compt. Rena. d. 1. Roe. de Biol., 1918, lxxv., Dec. 26, p. 669.

BlfSRIEL and DURAND. Bur les paralysies respiratoires. (Suite et fin.) Lyon
Med., 1913, cxxL, Nov. 30, p. 885.

BERG MANN, V. Ulcus duodeni und vegeta tives Nervensystem. Berl. klin.
Wchntchr., 1913, L, Des. 22, S. 2374.

Mt)NZER, A. Ueber “ Decentralisation ” psyohischer Krankheitserscheinungen.
Berl. klin. Wchntchr., 1913,1., Dex. 22, S. 2886.

EISLER Radiologisohe Studien fiber Bexiehungen des Nervensystems xur
motorischen Funktion des Magens. MUnck. Med. Wchntchr ., 1913, xlix.,
Des. 9, S. 2734.

REZNICEK. Zur Klinik der posthemiphlegischen Ph&nomene. Dent. Zltckr. f.
Nervenheilk., 1913, xlix., S. 827.

BARENNE, J. G. D. D*. Zur Kenntnis der Allofcsthesie. Monatueh. f.
Ptyckiat. u. Neurol., 1913, xxxiv., Dex., p. 523.

FAVRE. Zur Frage der Dysbasia angiosclerotioa (“ interznittierendea Hinken ”).
DetU. Zltckr. f. Nervenheilk., 1913, xlix., S. 293.

BERTOLOTTI, M. Etude radiologique d’un oas de sol4rodermie. Analogies de
la sclerodermic avec le syndrome ae Proflchet. Nouv. Icon, de la SalpH., 1913,
xxvi., p. 291.

BAGALOGLU and PARHON. Sur un eas de vitiligo k topographie en ceinture.
Nouv. loon, de la SalpH., 1913, xxvi., p. 309.

BOKS, D. B. (Edbme congenital familial des extremites inferieures. Nouv.
loon, de la Salptt., 1913, xxvi, p. 316.

GEELVINK, P. Ueber Hyperphalangie. Archiv. f. Ptyckiat. u. Nervenkr .,
1913, lii., S. 1015.

DZIERZYNSKY, W. Dystrophia periostalix hyperplastioa familiaris. Zltckr.
f. d. get. Neurol, u. Ptyckiat. (Ong.), 1913, xx., S. 547.

FLATAU and STERLING. Uber das Symptom der Subpatellardelle. Neurol.
Gentralbl., 1913, xxxii, Deo. 16, S. 1537.

REUBEN, M. S., and CLEAVER, E. E. Oxycephaly. Arch, of Ped., 1913,
xxx., Nov., p. 820.

LAURAS* G. Les anormaux psyehiques militaires devant la justice. Arckivet.
d'Antkropol. Grim., 1913, xxviii., Dec, 15, p. 881.

PSYCHIATRY.

6IVK1AL PAM ALTSIS—

NONNE. Der heutige Standpunkt der Lues-Paralysefrage. Deut. Zltckr. f.
Nervenheilk., 1913, xlix., S. 384.

SICHEL, MAX. Die progressive Paralyse bei den Juden. Archiv. f. Ptyckiat.
u. Nervenkr., 1913, m., S. 1030.

ORTON, S. F. An analysis of the errors in diagnosis in a series of sixty cases of
paresis. Journ. Nerv. and Ment. Dit., 1913, xl., Dec., p. 779.

ANTHEAUME and PIQUEMAL. Remission consecutive i un ictus epileptiforme
et fc une poussee furonouleuse ches un paralytique general taWtique. L'En-
dphale , 1913, viii., p. 635.

LEVADITI, MARIE, and MARTEL. Traitement de la paralysie generale par
injection de serum salvarsanise sous la dure-mfere cerebrals. Compt. Bend , cf.
1. Soc. de Bid., 1913, lxxv., Deo. 19, p. 567.

BIBLIOGRAPHY

11*

OBREGIA, URBCHIA and POPKIA. Le coefficient ur^^or^toire d’Ambard
dans la paralysie g^n^rale. Compt. Rend. d. I . See. dt Biol., 1913, lxxv., Dec.
19, p. 586.

MARKUS, OTTO. Ueber klinische Diagnoee nnd pathologiaoh-anatomische
Befande bei Paralyse. Archiv. /. Peyehiat. u. Nervenkr., 1913, lii., S. 1116.

DEMENTIA PRJECOX—

TREPSAT. Dessins et Merits d’un dement priooce. L'EnctphaU, 1913, viii., p.
541.

ROSS, ELLISON, L. Some forms of urinary nitrogen affeoted by the adminis¬
tration of desiccated thyroid to dementia precox patients. Archives I fit.
Med., 1913, xiL, Dec., p. 746.

GENEMAIr-

HTSLOP, THEO. B. The Inheritance of Mental Characters. Joum. State
Med., 1913, xxi., p. 705.

PETERY, A. K Some early symptoms of mental disturbances. Med. Record,
1913, lxxxiv., Dec. 20, p. 1123.

DAM A YE, H. Demence consecutive k une psychose prolong^. Rev. de
Ptyehiat ., 1913, xvii., Oct., p. 416.

PIQUEMAL. Syndrome hypooondriaque ches une debile avant simuie un debut
de d4menoe senile. Joum. de Neurol., 1913, xviii., p. 421.

BBSSliSRE, R. Rapports de la paranoia et de la psychose periodique (la
theorie de Speoht). Rev. de Peyehiat., 1913, xvii., Oct., p. 402.

SOHNIZER. Die Paranoiafrage. Ztechr. f. d. get. Neurol, u. Peyehiat. (Ref.),
1913, viii., S. 313.

BIsINON, R. Manic et idiotie. Nouv. Icon, de la Salptt., 1913, xxvi., S. 358.

HOOPER, J. W. D. Homoplastic transplantation of one ovary into a woman
suffering from amenorrhcea associated with insanity. Australian Med. Joum.,
1913, ii., Nov. 15, p. 1297.

JAHNEL, F. Bin Beitrag zur Kenntnis der geistigen Stdrungen bei der
Eklampsie. Archiv. f. Peyehiat. u. Nervenkr., 1913, Hi., S. 1095.

FBRRAND, J., and PIQUEMAL. Delire de persecution avec hallucinations
auditives cauiees par un etat obsedant ohes un cydothymique. Considera¬
tions j^sychiatriques et medioo-iegales. Oaz. dee Hdp., 1913,1

, lxxxvl., Dec. 30,

CHAUFFARD. Sur deux oas de saturnisms. Determinations viscerales,
paralysies fonctionnelles ohes les saturnine. Joum. dee Prat., 1913, xxvii.,
Dec. 20, p. 823.

ROBEY, W. H. The nervous irritability of chronio renal disease. Boston Med.
and Surg. Joum., 1913, clxix., Dec. 4, p. 817.

QENIL-PERRIN, G. La psychiatric olinique dans roBuvre de Felix Pater.
Rev. de Peyehiat ., 1913, xvii., Oct., p. 424.

MERCIER, C. A. The oonoept of Insanity. Proe. Roy. Soc. Med., 1913, vii.,
Nov. (Sect. Psychiat.), p. 3.

SJOBRING, H. Den individualpsykologiska fragestkllingen inom psykiatrien.
Upeala Lakaref&r. F&rhandl., 1913, xix., S. 1.

BIRNBAUM, K. Der Konstitutionsbegriff in der Psyohiatrie. Zteehr. J. d. gee .
Neurol, u. Peyehiat. (Orig.), 1913, xx., S. 520.

TREADWELL, O. F. N. Oonduot of the feeble-minded criminal. Med. Preee,
1913, xovi., Dec. 24, p. 695.

FRIEDMAN, H. M. The criminal’s plaoe in psychiatry. N. Y. Med. Joum.,
1913, xcviii., Nov. 29, p. 1058.

DECROLY. Examen mental des enfants anormaux. Joum. de Neurol., 1913,
xviii., pp. 381 et 401.

12*

BIBLIOGRAPHY

MAAS, S. Psychiatrisohe Erfahrungen mit dam Abderhaldenschen Dialitierver-
fahren. Ztsehr. /. d. gts. Neurol . u. Psychicd. (Orig.), 1913, xz., S. 561.

FRIEDLANDER. A. Ueber die Anwendung pyrogenetiacher Mittel in der
Psyehiatrie. Archiv f. Psychiat. u. Nervenkr ., 1913, liL, 8. 981.

ALZHEIMER, A. 25 Jahre Psychiatric. Bin Ruokblick anlfcsalich dea 25
ifchrigen Jubilfcums von Prof. Dr Emil Sioli ala Direktor der Frankfurter
Irrenanstalt. Archiv f. Psychiat. u. Nervenkr ., 1913, lii. t S. 853.

LUCAS, W. P. Note on aome problema of the adoleecent aa seen in the Psycho-
patbic Hoapital Out-patient Department, Boaton, Maaaachuaetta. Boston Med .
and Surg. •fotim., 1913, clxix., Nov. 27, p. 782.

SOUTHARD, E. E. The Paychopathic Hoapital Idea. Joum. Anver . Med.
Assoc*. 1913, lxi., Nov. 29, p. 1972.

HALL, H. J. Hoapital and Aaylum Workshopa: Some poaaibilitiea of handi¬
capped labour. Joum* Amer. Med. Assoc., 1913, lxi., Nov. 29, p. 1976.

TREATMENT.*

WISZW1ANSKI. Der diagnoetiche und therapeutiache Wert der Nervenmassage.
Ztcchr. /. Physikal . u. JJidi. Therapie , 1913, xviL, S. 738.

POST. Die Nervenpunktlehre von Cornelius und die achwediache Massage. Mtinch .
Med. Wchnschr ., 1913, xlix., Dez. 9, S. 2732.

OBRRNDORF, C. P. The aoope and technique of psychoanalysis. Med. Record, 1913,
lxxxiv., Nov. 29, p. 973.

FRINK, H. W. The Freudian Conception of the Payohoneuroeea. Med. Record , 1913,
lxxxiv., Nov. 29, p. 967.

* A number of raferanoea to papers on Treatment are inolaUed in the Bibliography under
individual dlaaaaaa.

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1913, xiv., 8. 379.

14*

BIBLIOGRAPHY

DITTLER, R , an<l ur>TTllKR t HANS. liber die Aktionssfcrome menschlicher Muakela
bei naturlicher Innervation, nach Untersuchungen an geaunden und kranken
Menschcn. Piiujer s Archiv 1914, civ., S. 251.

FULLE, C. Sulle compensazioni organiche e funziouali della deficienze cerebellari.
Archivio di FtsioL, 1015, xi., Luglio, p. 370.

LEEUWKN, W. S. v. Druckfehlerbericlitigung zu der Arbeit “Quantitative pharma*
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MARTIN, E. G., and LACEY, W. H. Vasomotor reflexes from threshold stimulation.
Amcr. Joum. Physiol ., 1914, xxxiii., p. 212.

EDWARDS, D. J. A study of the anatomy and the vasomotor phenomena of the
sympathetic neivous system in the turtle. Amcr. Joum. Physiol. , 1914, xxxiii.,
p. 229.

GRUBER, C. M. Studies in Fatigue. II. The Threshold Stimulus as affected by
Fatigue and Subsequent Rest. Amer. Joum. Physiol., 1913, xxxii-, p. 438.

NICE, L. B. Thresholds for faradio stimulation of the respiratory reflex and of the
phreuic-diaphragm preparation. Amcr. Joum. Physiol 1914, xxxiii., p. 204.

ASHER, LEON, and PEARCE, R. G. Die sekretorische Innervation der Niere
Ztschr. f. Biol., 1914, lxiii., S. S3.

KENT, A. F. S. Neuro-muscular structures in the heart. Proc. Roy. Soc.. 1914,
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1913, Nov. 15, p. wii.).

ROSENHEIM, OTTO. The galactosides of the brain—I. Bioehem. Joum., 1913, rii.,
Dec., p. 604.

CLAUDE, H., and PORAK, RENE. Sur l'action hypotensive de certains extraits
hypophysaires. Presse Med., 1914, Jan. 10, p. 25.

ABRAMOW, S. Uber die Veninderungen der Hypophyse bei der experimcntelUn
Diphtheric. Virchow's Archiv., 1913, ccxiv., S. 408.

BOUIN and ANCEL. Sur un procede d isolement de la substance active du lobe
posterieur hypophysaire. Compt. Bend, d . 1. Soc. d. Biol., 1914, lxxvi., pp. 62
and 110.

TRENDELENBURG. W. Uber die Beziehung der Nebennieren tur normalen Blut-
druckhohe. Ztschr. f. Biol., 1914, lxiii., S. 155.

PICARD. Ueber Jen Einfluss der Muskelarbeit auf den Cholesteringehalt des Blutea
und der Nebennieren. Archiv. f. Exp. Path, u. Pharm, 1913, lxxiv., 8. 450.

1SCOVESCO. Sur les proprietes d’un lipoide (II. Bd.) extrait de la partie corticale
des capsules surrdnales. Compt. Rewi. d. I. Soc. d. Biol., 1914, lxxvi., p. 510.

JANOSIK, J. Correlations fonctionnclles ontre les capsules surrenales etlesglande*
gonitales. Arch, de Bio/., 1913, xxviii., p. 627.

SMITH, E. V., and BRODEltS, A. C. The iodin content of the thyroid gland, with
especial reference to the pathologic types, and a review of some experimental work.
Journ. Amer. Med. Assoc., 1914, lxii., Jan. 10, p. 113.

MARINE. DAVID. Observations on tetany in dogs. Relation of the parathyroid*
to the thyroid; relation of tetany to age, amount of parathyroid tissue removed,
accessory parathyroids, pregnancy, lactation, rickets, sulphur and diet; relation of
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KEETON, R. W. The secretion of the gastric juice during parathyroid tetany. Amer.
Joum. Physiol., 1914, xxxiii., J an., p. 25.

STOLAND, O. O. The influence of parathyroid tetany on the liver and the pancreas.
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TSCHIRJEW, S. Elektrische Erscheinungen am tierischen Muskcl- und Nerven-
system. Archiv /. Anat. u. Physiol. (Physiol. Abtlg.), 1913, H. V. u. VI., S. 414.

COHN, A. E. The Effect of Morphin on the Mechanism of the Dog’s Heart after
Removal of One Vagus Nerve. Journ. Exp. Med., 1913, xviii,, Dec., p. 715.

COHN, A. E., and LEWIS, T. The Predominant Influence of the Left Vagus Nerve
upon Conduction between Auricles and Ventricles in the Dog. Joum, Exp . Med .,
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BIBLIOGRAPHY

15*

ELIAS, H. Store und Nervenerregbarkeit. Witn. Jdin. Wchnsehr., 1914, xxrii.,
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OHRWALL, H. Oibt ei viauelle Bewegungsempfindungen ? Skand. Arehiv /.
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TIGER8TEDT, CARL, and DONNER, SVEN. Zur Kenntnis der positiven Nach-
schwankung dee Nervenstromea bei niedrigor Temperatur. Skand. Arehiv f.
Physiol., 1913, xxx., S. 309.

PSYCHOLOGY.

SANFORD, E. C. Psychic research in the animal field : Der klnge Hans and the
Elberfcld horses. Amer. Joum . Psychol ., 1914, xxv., Jan., p. 1.

FINKENBINDER. E. O. The remembrance of problems and of their solutions: a
study in logical memory. Amer. Joum, Psychol ., 1914, xxv., Jan., p. 82.

POFFENBERGER, A. T. The effects of strychnine on mental and motor efficiency.
Amer. Journ Psychol., 1914, xxv., Jan., p. 82.

FERNBERGER, S. W. A simplification of the practice of the method of oonstant
stimuli. Amer. Joum. Psychol ., 1914, xxv., Jan., p. 121.

W1LMANNS, KARL Ein Beitrag zur Psychologic der Kinderaussagen vor Gericht.
Vierteljahrs. f. gcrichtl. Med., 1914, xlvii., Jan., S. 102.

MARCUSE, H. Psychische Erregung und Hemmung vom Standpunkt der JodTschen
Psyohologie. Arehiv f. Psychiat., 1914, liii., S. 262.

TAYLOR, G. H. The emotions and their relation to the mind. Austral. Med. Oaz.,
1913, xxxiv., Oct. 4, p. 315.

CRAEMER, OTTO. Zur Psychopathologie der religidsen Wahnbildung. Arehiv f.
Psychiat., 1914, liii., S. 2#6.

BLOCH, E. Die Intelligenzpriifung nach der Methode von Binet>Simon in ihrer
Bedeutung zur Erforschung des Schwachsinns bei Schulkindem. Ztschr. f.
Jugendl. Schwachsinns , 1913, vii., S. 272.

PATHOLOGY.

ROUBINOVITCH and BARBE. Un cas d’ag^n&ie partielle du corps calleux. (2 pi.)
Nouv . Icon. d. 1. Salptt., 1913, xxvi., p. 407.

STEIN, F. W. Die Bedeutung der mehrkernigen Ganglienzellen. Ztschr. f. d. ges.
Neurok u. Psychiat., 1914, xxi. (Orig.), S. 461.

MEYER, OSKAR. Ein besonderer Typus Riesenzellengliom. Frankfurter Ztschr. f.
Path., 1913, xiv., S. 185.

HENRICH, ERNST. Ubcr das diffuse Gliom des Pons und der Medulla oblongata.
Frankfurter Ztschr. f. Path., 1913, xiv., S. 294.

FRANK, A. Uber subependymtre Gliaknoten. Frankfurter Ztschr. f. Path., 1913,
xiv., S. 450.

v. PODMANICZKY. Die faserige Glia bei Arteriosklerose der Kieinhimrinde.
Frankfurter Ztschr. f. Path., 1913, xiv., S. 395.

FISCHER, O. Ein Beitrag zur forensischen Bedeutung der histopathologischen Unter-
suchung des Gehirns. Prager Med. Wchnschr., 1914, xxxix., Jan. 8, 8. 15.

8ARTESCHI, U. La sindrome epifisaria 14 macrogenitosomia preoooe w ottenuta
sperimentalmente nei mammiferi. Pathdogica, 1913, v., Die., p. 707.

LtJTTGE. Uber einen besonderen histologischen Befund aus dem Gebiete der
fruhinfantilen familiftren Erkrankungon des Nervensvstems. Deut. Ztschr. f.
NervtnheUk., 1913, L, S. 30.

MCHLMANN, M. Das Nervenpigment beim Papagei. Virchow*s Arehiv , 1913,

ocxiv., S. 412.

PASTINB, C. Valore dell’estensione spontanea dell’alluce nolle lesioni dalle vie
piramidali. Riv. di Patol. nerv. e ment., 1914, xix., Gennaio, p. 21.

16*

BIBLIOGRAPHY

MARIE, A. Activation de la toxin# t4tanique. Annales de VInstxtut Pasteur, 1914,
xxnii., Jan., 8. 1.

VOLPINO, G. Recherche# ear la culture du virus rabique eelon Noguchi. Prtsse
M, 1914, Jan. 88, p. 79.

CLINICAL NEUROLOGY.

RRNBRAL—

HOWELL, C. M. HINDS. Trauma in relation to oertain aspects of nervous
dis ease . Lancet, 1914, clxxxvi., Jan. 31, p. 302.

JONES, D. W. OARMALT. Gait in nervous disease. Practitioner , 1914, xcii.,
Jan., p. 13.

KAUFFMANN, ELSA. Klinischer und anatomischer Beitrag cur Frage der
Erkrankungen dee Zen tralnervensy terns bei Anfcmie. Arekiv f. Psychiat .,
1914, liii., S. 23.

SCHAFFER, EL Zur anatomischen Wesensbestimmung hereditkrer Nerven-
krankheiten. Deut . Ztschr . /. Nervenheilk.., 1914, L, S. 35.

MINGAZZINI, G. Remarque additionnelle k ma note: “ Sur quelques petite
signes des parities organiques.” Rev. Neurol., 1913, xxi., Dec. 15, p. 668.

WILSON, S. A. KINNIER. A lecture on some oommon errors in the diagnosis
of nervous disease. Lancet, 1913, olxxxv., Doc. 13, p. 1677.

MlfftCW-

SPILLER, WM. G. The relation of the myopathies. Brain, 1913, xxxvi., p. 75.

BRUCE, A. NINIAN. Spinal changes in pseudo-hypertrophic paralysis. Edin.
Med. Jou m., 1914, xiL, Jan., p. 42.

COURTNEY, J. W., and EATON, H. B. A case of myatoma congenita
(Oppenheim). Boston Med. and Surg. Journ., 1914, olxx., Jan. 23, p. 117.

SCUDERI, ALFIO. Su di un caso di atrofia musoolare da intoesioaxione saturnine.
Riv. ital. di Neuropat., Psichiat. ed Elettroter ., 1913, vL, Die., p. 560.

AUSTREGESILO. Sur un oas d’atrophie musculaire chez un n&gre. (1 pi.)
Nouv. Icon. d. 1. Salptt ., 1913, xxvi, p. 430.

•PINAL CORD—

General. —GROBER. Akute bedrohliohe Erkrankungen dee Rtiokenmarks und der
Medulla oblongata. Deut. Med. Wehnsckr., 1914, xL, Jan. 22, S. 161.

CUIFFINI, P. Klinischer und pathologisch-anatomischer Beitrag sum Studium
der Echinokokken des Riiokenmarks und der Cauda equina. Arekiv J.
Psychiat., 1914, liii., S. 174.

KIDD, PERCY, and TOZER, E. A. Combined sclerosis of the spinal oord and
dystrophia adiposo-genitalis (?). Pros. Roy. Soc. Med., 1913, vfl., Dec. (Med.
Sect.), p. 47.

WARRINGTON, W. B. Acute generalised infective paralyses in adults. Liver¬
pool Med.-Chir. Journ., 1914, No. 66, Jan., p. 67.

Fracture, Dislocation, Ac.— BATTLE, W. H. Bullet wound of the spine. A
case of medico-legal interest. Lancet, 1914, olxxxvi., Jan. 3, p. 20.

DESFOSSES, P. Quelques travaux reoents sur la soolioae. Prtsst Mid., 1914,
Flv. 4, p. 98.

NAGEOTTE-WILBOUCHEWITCH. La scoliose par malformation de la
cin^ui&me vert^bre lorobaire et son traitement. Arch, de Mid. des Enf., 1914,
xvii., Jan., p. 34.

ENGELMANN, G. Ueber das Liegendtragen der Kinder und die HMuflgkeit der
Linksskoliosen. Med. Klinik, 1914, xxvii., Jan. 15, S. 41.

Cervical Rib.—HERTZ, A. F., and JOHNSON, W. Cervical rib with marked
vascular symptoms. Proc. Roy. Soc. Med., 1913, vii., Dec. (Clin. Sect.), p. 32.

Spina RlSda.—STONEY, R. A. Spina bifida. Clin. Journ., 1914, xlUi., Jan. 14,
p. 17.

BIBLIOGRAPHY 17*

SCHABNKB. Enuresis und Spina bifida ooculta. Archiv f. Psychiat ., 1914,
liii., S. 43.

PFANNER, W. Ueber einen Fall von Spina bifida ooculta sacralis mit Blasen-
divertikel und inkomplettor UiaohuBflstef. Wien. klin. Wchnschr., 1914, xxvii.,
Jan. 1, S. 12.

Tabes Dorsalis. —FRUGONI, C. Contributo alio studio delle 1 * crisi ematemetiohe
essenziali” e dell 41 osteo-artropatia vertebral©” nella tabe. Riv. crit. di Clin.
Med., 1914, xv., Gennaio, pp. 1, 17, 33.

DENTI, A. Consider&zioni sui riflessi e sul loro andamento nel deoorso della
tabe dorsale. Riv. di Patol. new. e ment., 1914, xix., Gennaio, p. 1.

Poliomyelitis Anterior Acmta. —ROTH, P. B. Report and remarks on a small
epidemic of poliomyelitis occurring in the neighbourhood of Deddington, Oxford¬
shire. Proe . Roy. Soe. Med., 1913, vii., Deo. (Surg. Sect.), p. 47.

BIELHER, M. DE. Maladie de Heine-Medin, considerations relatives k
repidemie de 1911 en Pologne. Arch, de Mid. dee Enf., 1914, xviL, Jan., p. 1.

SUTHERLAND, G. A. Anterior poliomyelitis: paralysis of abdominal muscles;
collapse of lung. Proe. Roy. Soc. Med., 1913, vii., Dec. (Sect. Dis. of Child.),
p. 31.

ENGELMANN, GUIDO. Uber ein an Poliomyelitiskranken beobachtetes
Ph&nomen. Neurol. Centralbl., 1914, xxxiii., Jan. 2, S. 20.

LOVETT, R. W. Principles of the treatment of infantile paralysis. Journ.
Amer. Med. Assoc ., 1914, lxii., Jan. 24, p. 251.

DAVIS, G. G. Treatment of poliomyelitis by operative measures. N. Y. Med.
Journ., 1914, xoix., Jan. 3, p. 4.

WHITMAN, R. Further observations on the operative treatment of paralytic
talipes, oalcaneous and allied distortions. Med. Record, 1914, lxxxv., Jan. 10,
p. 47.

LUST and ROSENBERG. Beitrag zur Aetiologie der Heine-Medinsohen Krank-
heit. (Poliomyelitis acuta anterior.) Munch. Med. Wchnschr., 1914, lxi.,
Jan. 20, S. 121.

DUBOIS, NEAL, and ZINGHER. Experimental Studies in Poliomyelitis.
Journ. Amer. Med. Anoe., 1914, lxii., Jan. 3, p. 19.

Paraplegia.— NORRIE, H. Spastic paraplegia treated by Foerster’s method of
intradural neurectomy. Austral. Med. Gaz., 1913, xxxiv., Oct. 11, p. 339.

MARIE, PIERRE, and FOIX, CHARLES. Sclerose intra-clrlbrale centrolobaire
et symdtrique. Syndrome parapl4gique. Rev. Neurol . f 1914, xxii., Jan. 15,

p. 1.

Tmmomrs.—ROMAN, B. Ein Fall von Hfcmangiom dee Rttckenmarks. Centralbl ,
/. AUg. Pathol., 1913, xxiv., S. 993.

KNAPP, P. C. Two cases of removal of extra-dural tumour of the spinal cord.
Journ. Nerv. and Ment. Dis., 1914, xli., Jan., p. 1.

BRAIN—

General, —RAUZIER and BAUMEL. Tuberculomes multiples du oerveau et des
meninges. Nouv. Icon. d. 1. Salpit., 1913, xxvi., p. 397.

RENTON, J. C. Clinical Lecture on Cranial Cases. Clin. Journ., 1914, xliii.,
Jan. 28, p. 63.

MEYER, W. Dammerxusthnde mit naohfolgender Amnesic bei leiohter Com¬
motio cerebri. Deut. Med. Wchnschr., 1914, xl., Jan. 1, S. 24.

Meningitis* —WARRINGTON, W. B. Intracranial serous effusions of inflamma¬
tory origin. Meningitis or ependymitis serosa—meningism—with a note on
44 pseudo-tumours of the brain.” Quart. Journ. Med., 1914, vii., Jan., p. 93.

HESS, J. L. Leukocyte counts in pneumonia and oerebro-spinal meningitis.
Amer. Journ. Dis. Child., 1914, vii., Jan., p. 1.

BOECKMANN. Ein Beitrag zur Atiologie der Pachymeningitis interna
hemorrhagica. Virchow's Archiv , 1913, ocxiv., S. 380.

18*

BIBLIOGRAPHY

WOHLWILL, FR. Uber Pachymeningitis hjemorrhagioa interna. Virchow 1 1
Archiv , 1913, ocxiv., S. 388.

MANDELBAUM. Verindernngen im Liquor oerebrospinalis bei Meningitis
tuberculosa. DeuL Archivf. bin. Med., 1913, cxiii, S. 92.

SNESSAREFF. Du processus de reparation dans le oerreau. Un cas de
mdningo-encdphalite chronique. (2 pL) Nouv. Icon. cL l . SalpiL, 1913,
xxvi, p. 434.

FISCHER, O. Corticale Gruben als Folgs meningealer Cystenbildung bei
ckronisohen Meningitideu, insbesondere bei der progressiven Paralyse. Zuckr.
/. d. get. Neurol, v. PtychiaL, 1914, xxL (Orig.), S. 451.

Hydrocephalus.—THOMAS, W. 8. Experimental hydrooephalus. Journ. Exp.
Med., 1914, xix., Jan., p. 106.

RITTERSHAUS, E. Zur Frags der Hydrooephalie. ZUchr. f. Jugtndl.
Schioachtinns, 1913, vii, S. 310.

Hsmorrhage.—MACFARLANE, A. Venesection in cerebral haemorrhage, with
report of cases. Med. Record, 1914, lxxxr., Jan. 17, p. 112.

Hemiplegia.—JONES, A. WEBB. Two cases of post-operative hemiplegia.
Lancet , 1914, clxxxvi., Jan. 10, p. 103.

Facial Paralysis.—BALLANCE, C. A Facial palsy following a mastoid opera*
tion treated by nerve anastomosis. Proc. Boy. Soc. Med., 1913, viL, Deo.
(Clin. Sect.), p. 33.

PITRES and ABADIE. H&nispasmes synoindtiques de la faoe lids au dignement
des paupi&res dans les paralysies faciales. (2 pL, 2 fig.) Nouv. Icon. d. 1. SalpiL ,

1913, xxvi., p. 366.

Facial Hemiatrophy.—GRABS, E. Ein Fall von Hemiatrophia faciei progressiva.
Neurol. Cenlralbl., 1914, xxxiii., Jan. 16, 8. 85.

Cerebral A rterlo-Sclerosis.—SCARPINI, V. Sopra un caso d’arteriosderosi
precoce. Rattcgna di Studi Ptichiat. , 1914, iiL, p. 372.

Cerebellar Ataxia.—SPRAWSON, C. A. A family with oerebellar ataxia. Brit .
Med. Journ., 1914, Jan. 3, p. 23.

Amaarotlc Family Idiocy.—BIELSCHOWSKY, M. Uber sp&tinfantile familiare
amaurotische Idiotic mit Kleinhimsymptomen. (16 abb.) Deut. ZUchr. f.
Nervenhcilk ., 1913, 1., S. 7.

Tumours.—ZANELLI, O.-F. Tumeur sons-corticale des lobes prdfrontaux ot du
lobule paridtal infdrieur droit. (3 fig.) Rev. Neurol ., 1913, xxi, Nov. 30,
p. 573.

LAS ARE W, W. Uber eine Stoning der Innervation des N. facialis bei Gesch-
w tils ten der hinteren Sch&delgrube. Neurol. Cenlralbl ., 1914, xxxiii., Jan. 2,
S. 13.

SCHLESINGER, HERMANN, and SCHILLER, A. Uber die Kombination von
Schfcdelhyperostosen und Hirngeschwiilsten. Neurol. Cenlralbl ., 1914, xxxiii,
Jan. 16, S. 82.

COSTANTINI, F. Tumoro della faccia interna dei lobi prefrontali e della parte
anteriore della trave. Riv. di Paid. nerv. e ment., 1913, xviii., Dio., p. 748.

MINGAZZINI, G. Studi sulla semcjologia dei turnon delle varie tone del lobo
temporals. Riv. di Palol. nerv. e ment., 1913, xviii, Die., p. 737.

SPILLEll, WM. G. Some causes of disappointment in operations on brain
tumour. Arner. Journ. Med Sei ., 1914, cxlvii, Jan., p. 29.

CHAMPION, E. Tumour of brain. Australian Med. Journ., 1914, ii, Jan. 3,
p. 1369.

Fit Hilary Tnmears, Ac.—TAYLOR, A. L. A case of tumour of the pituitary
body. Lancet , 1913, clxxxv., Nov. 22, p. 1464.

GOETSCH, E. The pituitary body. Critical review. Quart. Journ. Med.,

1914, vii, Jan., p. 173.

HI a betet Insipid ms.—HERRIN GHAM, W. P. A case of diabetes insipidus.
(Illust.) Lancet , 1914, olxxxvi., Jan. 3, p. 16.

BIBLIOGRAPHY

19*

LEREBOULLKT, FAURE-BEAULIEU, and VAUCHER. Diabbte insipide et
infantilisme. Rdle probablede l'hypophyse. (2pi.) Nouv. Icon. d. 1. Salpit .,

1913, xxvi., p. 410.

ROMER, C. Die Beziehungen zwischen der Funktion der Hypophysis cerebri
und dem Diabetes insipidus. Dent. Med. Wchnschr., 1914, xl., Jan. 15, S. 108.

SIMMONDS. Ueber seknndfcre Geschwiilste des Hirnanhangs und ihre Bezie¬
hungen sum Diabetes insipidus. MUnch. Med. Wchnschr., 1914. lxL, Jan.
27, S. 180.

Dyspltultartsm.—FALCONER, A. W. Three eases of Dy spituitarisin. Ed in.
Med. Jowm., 1913, xi., Deo., p. 487.

Aphasia, de,—FROSCHELS, EMIL. Ueber die Behandlung der Aphasien.
Archiv f. Psychiat., 1914, liii., S. 221.

FROMENT and MONOD. La reeducation des aphasiques moteurs. Lyon mid.,

1914, exxiL, Jan. 25, p. 157.

KLRIST. Aphasie und Geisteskrankheit. MUnch. Med. Wchnschr., 1914, lxi.,
Jan. 6, S. 8.

MEIGE, HENRY. Les dysphasies fonetionnelles. Comment dtudier les b4gaie-
ments. Rev. Neurol., 1913, xxi., Deo. 15, p. 653.

Pellagra.—NILES, G. M. The treatment of pellagra: an optimistio survey of
its present status. Joum. Amer. Med. Assoc., 1914, lxii., Jan. 24, p. 285.

RUBINATO, G. Alcuni casi di pellagra oon sindrome addisoniana. Riv. crit.
di Clin. Med., 1914, xv., Gennaio 31, p. 65.

HUZAR, W Atiologie der Pellagra im Liohte neuerer Forschungen. Wien.

Med. Wchnschr ., 1914, lxiv., Feb. 7, S. 217.

GARRISON, P. E., and MACSEAL, W. J. Pellagra: a summary of the first
progress report of the Thompson-M‘Fadden Pellagra Commission. Joum.
Amer. Med. Assoc., 1914, lxii., Jan. 3, p. 8.

RAINSFORD, F. E. On a fatal oase of pellagra in an insane patient. Lancet,

1913, clxxxv., Deo. 20, p. 1759.

FUNK, CASIMIR. Studies on pellagra. I. The influence of the milling of
maize on the chemical composition and the nutritive value of maize-meal.
Joum. Physiol ., 1913, xlvii., p. 389.

Aehendroplasla.— BEFANI, G. C. Una alienata acondroplasica. Rassegna di
Studi Psichiat., 1913. iii., Nov.-Dec., p. 451.

Syphilis.—RIGGS, C. E. Syphilitic infections of the central nervous system.
Canadian Med. Assoc. Joum., 1914, iv., Jan., p. 9.

MARIE, M. A. Les alienations mentales dites parasyphilitiques. Rev. de
Psychiat., 1913, xvii., Nov., p. 458.

MINTOSH, J., FILDES, P., HEAD, H., and FEARNSIDES. Parasyphilis of
the nervous system. Brain, 1913, xxxvi., p. 1.

RAVAUT, P. Comment d4pister la syphilis nerveuse? Annales de Mid., 1914,
i., Jan., p. 49.

SEQUEIRA, J. H. A clinical lecture on some late manifestations of inherited
syphilis. (IUust.) Lancet, 1914, clxxxvi., Jan. 3, p. 11.

SEQUEIRA, J. H., and FILDES, PAUL. Case of syphilis showing Noguchi's
luetin reaction. Proc. Roy. Soc. Med., 1913, vii., Dec. (Dermatol. Sect.), p. 40.

KRUMBHAAR, E. B., and MONTGOMERY, C. M. Syphilis in the medical
dispensary. Joum. Amer. Med. Assoc., 1914, lxii., Jan. 24, p. 290.

OLITSKY, P. K., and OLMSTEAD, M. P. Precipitation tests in syphilis.
Joum. Amer. Med. Assoc., 1914, lxii., Jan. 24, p. 293.

POST, ABNE R. Mortality of hereditary syphilis. Boston Med. and Surg. Joum .,

1914, clxx., Jan. 22, p. 113.

M'DONAGH, J. F. R. The biology of syphilis. Med. Press, 1914, Jan. 14,
p. 35.

SAUNDBY, R. Syphilitic paralysis of the oesophagus. Brit . Med . Joum.,
1914, Jan. 31, p. 239.

20*

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EMBRY, W. D’ESTE. An address on the pathology of syphilis, especially in
its bearing on treatment. Lancet, 1914, clxxxvi., Jan. 24, p. 223.

BLUMENTHAL, FRANZ. Chemotherapeutische Versuohe mit Quecksilber-
praparaten bei experimenteller Kanincnensyphilis. Ztsehr. /. Immunitdts•
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21*

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23*

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24*

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«miil PAtALVM»~

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giBIVKBAL—

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BENUSSI, V. Die Atmungsaymptome der Luge, Archiv. /. d. ges. PsychoL , 1914,
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CHARON, A. Rhythmus und rhythmiachc Einheit in der Musik. Archiv. f. d. ges.
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JONES, ERNEST. The case of Louia Bonaparte, King of Holland. Joum. Abnom.
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M DOUG ALL, W. Psychology in the aervioe of eugenics. Eugenics Review, 1914,
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PATHOLOGY.

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SPINAL CORD—

Fraet«re, Dislocation, Re.—ROTH, R. E. Spinal curvature. Aualralaaian
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Herpes Easter.—DABNEY, Y. Herpes zoster otious. N. Y. Med. Joum., 1914,
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Spflaa Blflda —TUTYSCHKIN, P. Ein seltener Fall von Spina bifida mit
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BIBLIOGRAPHY

29*

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Facial Paralysis.—ZESAS, D. G. Neuere operative Verfahren zur Behandlung
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Neirtas.—SEQUEIRA, J. H. Multiple neuromata. Proe. Boy. Soc. Med., 1914,
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30*

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Paralysf s Aglttis.—FRIEDLANDER, R. Zur Uebungsbehandlung der Paralysis
agitans. Ztschr. f. Physik . u. dial. Therap ., 1914, rriiL, S. 65.

GREENWALD, I. The supposed relation between paralysis agitans and
insufficiency of the parathyroid glands. Amer. Joum. Med. Scu 9 1914,
cxlvii., Feb., p. 225.

SCHIOTZ, O. Die Besiehungen der BlutdrUsen sur Pathogenese der Parkin -
sonschen Krankheit. Ztschr. f. d. ges. Neurol, v. Psychial ., 1914, xxiii (Orig.),
S. 88.

Tetany.-CURSCHMANN. Zur Frege der “ Bronchotetanie * der Erwachsenen
und ihrer Behandlung mit Kalxium. MUnch . Mid. Wchnschr ., 1914, lxi.,

Feb. 10, S. 289.

SPECIAL SENSES AND CRANIAL NEE YES—

FIRTH, A. H. The pupil and its reflexes in insanity. Joum. MenL Set.,
1914, lx., Jan., p. 82.

GIGNOUX. Paralysis otique du moteur oculaire extern© assooile k l’atteinte du
trijumeau. Rev. hebd. de Laryngol., d'Otol. et de Rhinal. t 1914, xxxr., Feb.,

p. 61.

LANGE, W. Aplasie des Ganglion spirale und des Nervus cochlearis als Ursache
angeborener Taubheit. Archivf. Ohrenheilk. 9 1914, lxxxiii, S. 123.

MISCELLANEOUS SYMPTOMS ANE CASES—

MILLS, 0. K. Neurology at the Reoent (Seventeenth) International Congress of
Medicine. N. Y. Med. Joum., 1914, xcix., Jan. 31, p. 205.

JOLLY, PH. Neuere neurologisohe Arbeiten. (Sammelreferet.) Schmidt's
Jahrbucher d. in - u. ausldnd. ges. Med. 9 1914, lxxxi., S. 9.

TRIES, A. Ueber die Differentialdiapnose abdomineller Erkrankungen auf
Grand yon Symptomen des vegetativen Nervensystems, insbeeondere mit
RUcksicht auf die Erkrankungen der Gallenwege. Mitteil. a. d. Gremgeb. d.
Med. u. Chir. 9 1914, xxvii., S. 389.

COHEN, S. 8. On some angioneural arthroses (periarthroses, pararthroses)
commonly mistaken for gout or rheumatism. Amer. Joum. Med. Sci., 1914,
cxlrii., Feb., p. 228.

THOMPSON, W. G. Occupational diseases. Med. Record 1914, lxxxr.,
Jan. 31, p. 185.

KING, P. Nerves in illness. Med. Press , 1914, oxlviii., Feb. 25, p. 197.

BIBLIOGRAPHY

33 *

CUNNINGHAM, A. T. R. Report of a case of gradual occlusion of the common
carotid artery in the treatment of pulsating exophthalmos. Joum. Amer.
Med. Assoc., 1914, lxin, Jan. 31, p. 873.

GRECO, F. DEL. La psiooterapia eontemporanea. Riv. Ual. di Neuropaiol.,
Psichiat. ed Elettroter., 1914, vii., p. 11.

HEILBRONNER. Selbstanklagen und pathologische Gestfcndnisse. Miinch,
Med. Wcknsch., 1914, lxi., Feb. 17, S. 3&.

PSYCHIATRY.

CKXBIAl PARALYSIS—

ROBERTSON, GEORGE M. The Morison lectures, 1913.—The serum and
oerobro-spinal fluid reactions and signs of general paralysis. Joum. Merit.
Set., 1914, lx., Jan., p. 1.

OBREGIA and PITULESCO. La s&o-reaction d’Abderhalden dans la paralysis
g6n4rale, lepilepsie et les psychoses p^riodiques. Compt. Rend. d. 1. Soc. de
Biol., 1914, lxxvi., p. 316.

MARINESCO, G. De l'emploi des injections do serum salvarsanisl in vivo et
in vitro sous l'arachnoi'de spinal© et o4r6br&le dans le tabes et la paralysie
g4n6rale. Compt. Rend. d. 1. Soc. de Biol., 1914, lxxvi., Fdv., p. 211.

CKISTIANI, A. La cApaoith civile nolle remissioni della Paralisi gene rale
progressiva. Riv. ited. di Neuropaiol., Psichiat. ed Elettroter, 1914, vii.,
p. 24.

D’ABUNDO, G. Sui tentativi di speciali sieroterapie nella paralisi general©
progressiva. Riv. ital. di Neuropaiol., Psichiat. ed Elettroter., 1914, vii., p. 1.

DEMENTIA PRJ2COX—

MELLUS, E. The early diagnosis and treatment of dementia prsecox. Boston
Med. and Surg. Joum ., 1914, clxx., Feb. 26, p. 313.

FANKHAUSER, E. Ueber die somatische grundlage der Dementia precox.
Oorrespondenz-Bl. f. Schtceizer Aerzte , 1914, xliv., Jan., 8. 66.

SCHMIDT. Adrenalinunempfindlichkeit der Dementia prsecox. Miinch. Med.
Wchnschr., 1914, lxi, Feb. 17, S. 366.

STELZNER, H. Die Frtthsymptome der Schizophrenic in ihren Beziehungen
zur Kriminalit&t und Prostitution der Jugendliohen. AUg. Ztschr. f. Psychiat.,
1914, Ixxi., S. 60.

CEIEKAIr-

HUGGINS, R. R. The diagnosis and treatment of puerperal insanity. Amer.
Joum. Obstetrics , 1914, lxix., Feb., p. 244.

BECKER. Die Behandlung der Melanoholie. F&rtsch. d. Med., 1914, xxxii.,
p. 164.

BALLET, G., and GEN1L-PERRIN, G. L’examen clinique du fond mental chez
les dements. Technique d’examen et representation graphique. L'EnctpkaU.
1914, ix., F4v. 10, p. 101.

FARIS, G. T. The management of disturbed mental cases prior to commitment.
Therap. Gaz., 1914, xxxviii., Feb., p. 77.

M'CASKEY, G. W. Insanity occurring in latent Bright’s disease. N. Y. Med.
Joum., 1919, xeix., Jan. 24, p. 178.

FUCHS and FREMD. Ueber den Nachweis proteolytischer Abwehrfermente im
Serum Geisteskranker durch das Abderhaldensohe Dialysierverfahren. Miinch.
Med. Wchnschr., 1914, lxi., Feb. 10, S. 307.

STEDMAN, H. R. The extradition of insane persons. Med. Record, 1914,
lxxxv., Feb. 28, p. 369.

KNOX, HOWARD A. Mental defectives. N.Y. Med. Joum., 1914, xeix.,
Jan. 31, p. 216.

34*

BIBLIOGRAPHY

GWYN, M. K. The Healy puzzle picture end defective aliens. Med. Record ,
1914, lxxxv., Jan. 31, p. 197.

KREUSER. Uber Geistesstorungen im htiheren Lebenaalter und ihre Genesungs-
aussiohten. AUg. Ztechr. f. Peychiat., 1914, lxxL, S. 1.

MORAVCSIK, E. Klinisohe Mitteilungen. AUg. Ztechr . /. Psychiat ., 1914,
lxxL, S. 23.

KLINKE. Arbeiteentlohnung. AUg. Ztechr. f. Ptychiai ., 1914, lxxL, S. 131.

SCHULTZ. BlutuntersuchuDgen als klinisches Hilfsmittel auf psychiatrischem
Gebiete mit besonderer BerUcksichtigung der Prognosenstellung. Monateech.
/. Psychiat. u. Neurol., 1914, xiiv., S. 128.

ROBERTSON, W. FORD. Vaoeine treatment in asylums. Joum. Merit. Sct. 9
1914, lx., Jan., p. 17.

STANSFIELD, T. E. KNOWLES. The villa or colony system for the care and
treatment of cases of mental disease. Joum. Merit. Sci. 9 1914, lx., Jan., p.
30.

GETTINGS, H. S. Dysentery, past and present. Joum . Ment. Sci. 9 1914, lx.,
Jan., p. 39.

JACKSON, D. J. The clinioal value and significance of leuoocytosis in mental
disease. Joum. Ment. Set.. 1914, lx., Jan., p. 5G.

O’DOHERTY, PATRICK. Some features of the recent outbreak of enterio
fever at Omagh District Asylum. Joum . Ment. Sex ., 1914, lx., Jan., p. 76.

TREATMENT.*

CYRIAX, E. F. Die lokale manuelle Nervenbehandlung in Bexiehung xu atonischen
Zustfcnden dec Mastdarms. Ztechr. f. Phyeik. u. Duet. Therap ., 1914, xviiL, S. 75.

TANNENBAUM, S. A. Psychanalysis. N.Y. Med. Joum., 1914, x<rix., Feb. 7, p.
277.

TANNENBAUM, S. A. A consideration of objections to psychanalysis. Med. Record ,
1914, Ixxxv., Feb. 21, p. 338.

HOWELL, W. W. Suggestive treatment in diseases of childhood. Boston Med. and
Surg. Joum.. 1914, clxx., Feb. 12, p. 230.

* A number of references to papers on Treatment are included in the Bibliography under
Individual diseases.

Bibliography

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D'HOLLANDER, F. Recherches anatomiques sur les couches optiques. Le Ntvraxe
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PHYSIOLOGY.

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TSCHERMAK. Die Lehre von der tonischen Innervation. Wien. Jilin. Wchnschr
1914, xxvii., M&rz 26, S. 809.

CREHORE and WILLIAMS. Electric currents in conductors with distributed capacity,
considered in relation to the propagation of the nerve impulse. Proc. Soc/Exd
B iol, and Med., 1914, xi., 35 (352).

36*

BIBLIOGRAPHY

LEGENDRE, R. Disponitif your l’examen microscopique des nerfs vivants ayant leur*
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ELRINGTON, S. Das Verhalten der Retlexerregbarkeit bei Strychninvergiftung und
das “Alien- oder Nichts-Gesetz.'' Ztsvhr. /. ally. Physiol. , 1914, xiv,, S. 115,

FREDERIOQ, H. Disyarition brusque de la conductibilite k la suite d’une compression
prolongee ou progressive s'exen/ant sur lea troncs nerveux. (La loi du “Tout on
Rien” est elle applicable aux fibres nerveuses?) Ztschr. /. allg. Physiol 1914,
xiv., S. 213.

WEYLAND, H. Versucbe fiber das Verhalten von Colpidium Colpodagegenuber
reisenden und lahmenden Stoffcu. Zt&chr. / allg. Physiol. , 1914, xiv., 8. 123.

MARTIN, E. G., BIGELOW, G. H., and WILBUR, G. B. Variations in the sensory
threshold for f&radic stimulation in normal human subjects.— II. The nocturnal
▼ariatiun. Anver. Journ. Physiol., 1914, xxxiii., p. 415.

PILCHER and SOLLMANN. Quantitative studies of vagus stimulation and stropin.
Journ. Pharmacol, and exp. Therap 1914, v., March, p. 317.

PORTER, W. T. On the percentile measurement of the vasomotor reflexes. Jncr.
Journ, Physiol ., 1914, xxxiii., March, p. 373.

PORTER and PRATT. The state of the vasomotor centre in diphtheria intoxiostion.
Amer. Journ. Physiol 1914, xxxiii., March, p. 431.

GALLERANI, G. Funzione respiratoria del nervo depressore di Cyon. Natnra dei
oentri respiratorii bulbari—respirazione periodica—meccanismo d'asione deDa oolina
Archiwo di Fistol., 1914, xii., Nov., p. 1.

GLEY and QUINQUAUD. Contribution h l’etude des interrelations humoralea Arch.
Jnlemat . de Physiol ., 1914, xiv., pp. 152 and 175.

MIRA, F. DE. Sur Pinfluence exerc^e par les capsules surrdnales sur la eroiamnee.
Arch, internal, de Physiol. , 1914, xiv., p. 108.

S^ZARY and BOREL. Recherche des anticorps surrenaux au oours de Pinsufliisnc*
surrdnale. Compt. Rend. d. L Soc. de Biol. , 1914, lxxvi., p. 384.

HARROWER, H. R. The properties of parathyroid extracts. N. F. Med . Jovrn.,
1914, xeix., Feb. 28, p. 420.

PSYCHOLOGY.

JUNG, C. G. Contribution k l’dtude des types psychologies. Arch, de Psychol.,
1913, xiii., Dec., p. 289.

DUBUIBSON, M. Les oscillations sensorielles et les variations de leur frdquenoe tn
fonction de l’intensit^ de Pexcitant. Arch, de Psychol ., 1913, xiii., Dec., p. 300.

MACKENZIE, W. Le probl&me du chien pennant de Mannheim. Arch, de Psychol

1913, xiii., Dec., p. 312.

BANCELS, J. L DES, and CLAPAREDE, ED. Apropos du chien de Mannheim
Arch, de Psychol ., 1913, xiii., Dec., p. 377.

BO VET, P. Un r£ve expliqud. Arch, de Psychol 1913, Deo., p. 380.

KNOX, H. A. Psychological pitfalls. N. Y. Med. Journ., 1914, March 14, p. 527.

PICK, A. Die Psychologie des Erklarungswahns, dargelegt an residuiren Orien-
tierungsstorungen. Monatssch. f. Psychiat. u. Neurol., 1914, xxxv., Marx, 8.200.

BRILL, A. A. Fairy tales as a determinant of dreams and neurotic symptoms N- P*
Med. Journ., 1914, xsix., March 21, p. 561.

MDNZER. Pubertas praecox und psychische Entwickelung. Btrl. kliu . Wchnschr

1914, li., S. 448.

HIRT. Das neue psyoholog. lnstitut an der Universitat Mfinohen. Miinch Med.
Wchnschr ., 1914, lxi., S. 660.

BIBLIOGRAPHY

37*

PATHOLOGY.

M‘CARTHY, D. J. Iron infiltration in the fixed and wandering cells of the oentral
nervous system. Amer. Joum. Med. Sei.. 1914, cxlvii., March, p. 366.

ZIVKRI, ALBERTO. Les m&hodes rapides poor la coloration des fibres k myeline
Coloration simultanta des lipoides oellulaires. Rev. Neurol ., 1914, xxii., Fev. 16,
p. 173.

ZAGOROWSKY, P. Zur Frage von den gegenseitigen Beziehungen zwisohen Nerven-
svstem und Zuckerkrankheit. (Experimentelle-klinisohe Untersnohong.) Zischr .
/ exp. Path. u. Therap., 1914, xv., p. 167-

ZALLA, M., and BUBCAINO, Y. M. Sulla specificity dei fermenti proteolitioi.
(“ Abwehrfermente.”). Biv. di PcUol. nerv. e. merit., 1914, xix., Marzo, p. 66.

PITZORNO, M. Sullo strappo dello soiatico nei Cheloni. Riv. di Patol. nerv. e merit.,
1914, xix., Marzo, p. 105.

HEUBNER, R. Experimented Untersnchungen zur Lehre der Medianekrosen mit
besonderer Berttoksichtigung des Einflusses der Nervi depressores auf sie. Beit. z.
path. Anat. u. z. allg. Path., 1914, lviii., B. 88.

KRAUS, E. J. Die Beziehungen der Zellen des Yorderlappens der menschlichen
Hypophyse zueinander unter normalen Yerhiltnissen und in Tumoren. Beit. z.
path. Anat. u. z. allg. Path ., 1914, lviii., S. 159.

9IMMONDS. Ueber Tuberkulose der Hypophysis. Centralbl. f. allg. Path. u. path.
Anat., 1914, xxv., Marz, B. 194.

KRASNOOORSKI, N. Ein Beitrage zur Muskelpathologie im Kindesalter. Jahrb. f.
Kinderheilk., 1914, lxxix., S. 261.

WILSON, L. B. A study of the pathology of the thyroids from cases of toxic non-
exophthalmic goitre. Amer. Joum. Med. Set., 1914, oxlvii., March, p. 344.

FARRANT, R. The pathological changes of the thyroid in disease. Lancet , 1914,
March 7, p. 680.

CLINICAL NEUROLOGY.

GENERAL—

RACHMANOW, A. Lesions du systeme nerveux dans l’intoxication ver mine use.
Annales de VInstitut Pasteur , 1914, xxviii., Fev., p. 181.

KNAUER, ALWYN. and MALONEY, W. J. M. A. The cephalograph: a new
instrument for recording and controlling head movements. Joum. Nerv. and
Ment. Dis., 1914, xli., Feb., p. 75.

THOMSON, H. P. Recent work on diseases of the nervous system. Prac¬
titioner, 1914, xcii., Feb., p. 240.

NERVE*—

WELTY, C. F. Anastomosis of the facial and hypoglossal nerves for facial
paralysis. Joum. Amer. Med. Assoc., 1914, lxii., Feb. 21, p. 612.

MINGAZZINI, G. La paralysie du nerf musculo-outane. Le Ntvraxe , 1913,
xiv.-xv., Dec., p. 195.

DEJERINE. Paralysies du plexus brachial. Joum. des Prat., 1914, xxviii.,
Mars 28, p. 194.

SOUTTAR, H. S. Nerve injuries in general practice. Clin. Joum., 1914, xliii.,

p. 161.

DELORME, ED. Les anevrismis et les blessures des nerfs en chirurgie de guerre.
Bull, de VAcad. de Mid., 1914, lxxi., p. 275.

MUSCLE*—

PURSER, F. C. A case of amyotonia congenita. Med. Prest, 1914, oxlviii.,
March 25, p. 306.

BIBLIOGRAPHY

DPINU COMD-

General*— CROCQ, J. I je rn« caninme «Iu touiis musculaire des reflexes et de la
contracture. L Eticrphalt, l'Jl4, ix., Mars 10, p. 107.

STKOHL, A. Les reflexes d’automatisme medullaire chez l’homme. Pnw
uud., 1014, Mars 11, p. 195.

WOLLENBERG, G. A. Zur Lahmungstherapie. Berl. klin. Wchnschr ., 1914,
li., S. 548.

I'radvre, DMscadaa* dke*— MEISENBACH, R. O. The correction of the fixed
structural type of the spinal lateral curvature. Journ. Amir. Med. Akc*.,
1014, lxii., Feb. 14, p. 517.

OMBREDANNE, L. Le principe \Y Abbott. Essai d’infcerpretatiou et rtsultato
deja acquis. Presse intd. y 1014, Jan. 3, p. 1.

CALVE, J. Un mot sur la methode d'Abbott. Prrsse tried., 1914. Mars 18,
p. 214.

■erpes Zoster* —ZUMBUSCH, LEO VOX. l T ber Herpes zoster gentralisatui mit
Kuckenmarksveranderungen. Archie J. DtrnmioL u. Suphilis, 1914, cxviii.
<Orig.),S. 823.

Tatie* Dorsalis* —HOLMES, GORDON. The diagnosis of tabes dorsalis. Brit.
Med . Journ., 1014, March 14, p. 573.

HEED, C. R., and PRICE, G. E. Binasal hemianopsia occurring in the course
of tabetic optic atrophy. Journ. Atner. Med. Assoc.. 1914, brii., March 7,
p. 771.

BATES, O., ami STRATHY, GEO. S. The treatment of tabes dorsalis and
general paresis with salvarsan, Canadian Med. Assoc. Journ., 1914, iv.,
March, p. 107.

roltomyelltl* Aa ter lor Acuta.— BATTEN, F. E. Unusual manifestations of
poliomyelitis. Brit. Journ. Child. Dis 1014, xi. t March, p. 97.

NETTER, ARNOLD. Die meningitische Form dcr Poliomyelitis. Monatueh.
/. Kinder he ilk., 1014, xii. (Orig.), S. 555.

CARR, J. W. Case of polio-encephalitis. Proc. Ron. Soc. Med., 1914, vii., Feb.
(Sect. Study Dis. Child.), p. f>8.

FLEXNER, SIMON. Contributions to the epidemiology and pathology of polio*
myelitis. Berl. klin. Wchnschr 1914, li., S. 500.

CLARK, P. F., FRASER, F. R., and AMOSS, H. L. The relation to the blood
of the virus of epidemic poliomyelitis. Journ. Exp. Med., 1914, xix., March,
p. 223.

PIERSON, R. H. Epidemic poliomyelitis and distemper of dogs. Journ. Atner.
Med. Assoc., 1914, lxii., Feb. 28, p. 678.

BOHM, R. Diechirurgisch'OrthopadischeBehandlungderLiihmungen. Berliner
Klinik, 1914, xxvi., Feb., Heft 308.

SCHWARZKOPF, E. Zur Herstellung von orthopfcdischen Miedern und Hilft*
apparaten aus Zelluloid. Prayer Med. Wchnschr., 1914, xxxix., S. 54.

Tutsan*"CLIMBNKO, H. The diagnosis of spinal cord tumours, with report
of two cases. Journ . Amer. Med. Assoc., 1914, lxii., Feb. 21, p. 604.

BABINSKI, J., ENRIQUEZ, E., and JUMKNTIE, J. Compression de la m ocdls
par tumeur extra-dure-mdrieune : paraplegic intermittente, operation extractive.
(2 fig.) Bev. Neurol., 1914, xxii., Fev. 15, p. 169.

SODERBERGH. Nachtrag zu 44 Kinige Bemerkungen fiber die Lokaldiagnose
von Rfickenmarkageschwulsten.” Berl. klin. Wchnschr 1914, li., S. 457.

l»aea«U*Balbar Paralysis.— FRAGNITO, O. Contributo alia casiitica delle
paralisi pseudo-bulbari. Annexli di Ntvrol., 1913, xxxi., p. 229.

BIBLIOGRAPHY

39*

MAIN-

Ceaeral.—RUDOLPH, OTTO. Untersuchungen liber Hirngewicht, Hirnvolumen
und Schfcdelkapazit&t. Beit. z. path. Anat. u. z. aUg. Path., 1914, lviii., S. 48.

MENDEL, KURT. Uber Reohtshirnigkeit bei Rechtshandern. Neurol. Cen -
tralbl ., 1914, xxxiii, M*rz 1, S. 291.

HARTENBERG, M. Lee cbphaleee musculaires ou cellulitiques. Joum. de
Mid. de Paris, 1914, xxxiv., Man 10, p. 187.

Skull, Injury, Ac*—KIRCHNER. Ueber Schfcdelbasisfrakturen mit Beteiligung
dee Warzenfortsatzes. Milnch. Med . Wchruchr., 1914, lxi., S. 544.

Friedreich's Ataxia. —KELLOG, J. H. The first observed cases of Friedreich’s
ataxia in America. Med. Record, 1914, Ixxxv., March 7, p. 431.

Hereditary Ataxia. —VORKASTNER. Ueber heredit&re Ataxie. Med. Klinik,
1914, x., S. 360, 404, 448, et 495.

Hftsseminated Sclerosis. —SIEMERLING and RAECKE. Beitrag zur Klinik
and Pathologic der multiple!* Skleroee mit besonderer Berlicksichtigung ihrer
Pathogenese. Archiv /. Psychiat., 1914, liii., S. 385.

Progressive .Husemlar Atrophy.—BIONDI, G. Su di an caso di leeione trau¬
matica dei segmenti distali del midollo spinale seguita da amiotrofia spinale
progressiva. Riv. Hal. di Neuropatol., Psichiat. ed Elettroter., 1914, vii., Feb.,

Myasthenia. —DAVIS, E. D. Myasthenia gravis, with affection of the larynx and
soft palate. Proc. Roy. Soc. Med., 1914, vii., Feb. (Laryngol. Sect.), p. 63.

Spondylitis.—LUCCHESI, I. Di un interessante caso di spondilosi rixomelica
con sintomi di ipoovarismo ed ipotiroidismo cronici. Riv. erit. di Clin. Med.,
1914, xv., Marzo 7, p. 148.

Meningitis* —CAMUS, JEAN, and ROUSSY, GUSTAVE. Cavite* mddullaires et
rnfaiugites cervical©*. Etude expbrimentale. Rev. Neurol., 1914, xxii, F4v.
28, p. 213.

BARNES, A. E., and KERR, W. S. A case of otitic meningitis and cerebellar
abscess, with recovery. Brit. Med. Joum., 1914, March 14. p. 587.

Encephalitis.— HENNING, S. Ueber seltenere Formen der akuten nichteitrigen
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Monoplegia.— STEWART, PURVES. Farther note upon a case of hysterical
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40*

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42*

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fimill AMD mCTIONAL DIftEA&K£—

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BENON and DENES. Epilepsie infantile et asthlno-manie. Gaz. des H6p.,
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FUNK, CASIMIR. Studien fiber Beri-beri. X. Mitteilung. Experimentelle
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ariCUl SEN8E8 AND CBAJVUL NEBVBft—

SARBO, ARTHUR V. Zur Technik der Pupillenuntersuchvmg und eine nsue,
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NUCEUANEOH8 SYltmNS AND CA8EA—

PRIESTLEY, JOHN. Nervous diseases of elementary sohool-children—Boy»
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GENERAL—

KNOX, H. A. A scale, based on the work at Ellis Island, for estimating mental
defect. Jowm. Amer. Med. Aeeoe ., 1914, lxii., March 7, p. 741.

SIMCHOWICZ, T. La maladie d’Alzheimer et son rapport aveo la dlmenoe
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LAIGNEL-LAVASTINE. Lee dlmences des syphilitiques. Rev. de Peyehiat.,
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KRONFELD, A. Das Erleben in einem Fall von Katatoner Enpgung.
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VALLON, C., and BE 8 SIERE, R. Les troubles mentaux d’origine oocainique
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TRUELLE, V. Troubles mentaux dans la tuberculose. Jowm. dee Prat., 1914,
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SIBMERLING, E, Gynikologie und Psyohiatrie. Monateeeh. f. Qebiirto-
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K0N1G, ELANS. Beitrage zur forensisoh-psyohiairischen Bedeutung von
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DEMOLE, V. La reaction de Moriz Weisz dans les maladies mentalss. Rev.
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ROWS, R. G. The importance of disturbances of the personality in mental
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MEYER, E. Die psychiatrisohe und Nervenklinik zu Kdnigsberg. Arehiv J.
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46*

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TREATMENT. *

BERKELEY W. N. The use of pineal gland in the treatment of certain classes of de¬
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HABERMAN, J. V. Mental healing. An admonition. Journ. Amer. Med. Assoc.,
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LAPENSKY, MICHAEL. t v ber mechaniaohe Bader in der neurologiachen Praxis
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Psyekeannlysf s. — DERCUM, F. X. An evaluation of the payobogenic factors in
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PFISTER, O. Prof. Dr Ernst Durr und seine Stellung zur Psychoanalyse.
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JUNG, C. G. The theory of paychoanalyaia. Psychoanalytic Review , 1914, i.,
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JELLIFFE, S. E. The technique of psychoanalysis. Psychoanalytic Review,
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PUTNAM, J. J. On some of the broader issues of the psychoanalytic movement.
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RENTERGHEM, A. W. van. Freud et son doole. Nouveaux essais psycho-
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LAUMONIER, J. Le “ pansexualisme ” de Freud. Oaz. des H6p., 1914, lxxxvii.,
Mars 19, p. 533.

ASH, E. The law of psychotherapy. Med . Press , 1914, cxlviil, March 25, p.
308.

DOUGLAS, A Further notes on mental suggestion by transference. Practi¬
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* ▲ number of references to paper* on Treatment are included in the Bibliography under
individual d is ea ses .

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47 *

48*

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CLINICAL NEUROLOGY.

GENERAL—

BOXWELL, WBI. Disordered bladder function in nervous diseases. Med.
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NEfttEft—

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mroexes—

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CHERVTN. Btat mental des begues. Optimistes et pcssiinistes. Journ. de
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A PINAL t #M-

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50*

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It RAIN—

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BIBLIOGRAPHY

BAESLACK, F. W. A scro-cnzyme diagnosis of syphilis. Journ. Auier. Mtd,
Am>c. 9 1914, lxii., March 28, p. 1002.

Ml* Arman.— .SPOONER, L. H. The treatment of syphilitic diseases of the
central nervous system by intravenous injections of salvarsan. Boston Mtd
and Stirg . Journ. % 1914, clxx., p. 441.

OPPKN T HKIM, H. Zur Therapie der syphilitischcn Nervenkrankheiten. Btrl
khn. Wchnschr. t IStl4, li., 8. 882.

AYKH, JAMES B. Salvarsauised serum (“ Swift-Ellis treatment”) in syphilitic
diseases of the central nervous system. Huston Med . and Surg. Journ 1914,
elzx., p. 452.

SCHOLTZ, W. Die Heiluug der Syphilis durch die Kombinierte Sslvtrssn-
Quecksilbei behandlung. Dent. Med. Wchtwchr., 1914, xl., S. 845.

GKNNERICH. Nachtrag zu den Beh&ndlungserfolgennach Salvarsanbehsndluug,
Munch. Med. Wchnschr., 1914, lxi., Mars J40, S. 720.

LERKDDE. Die Technik der Sterilisation der Syphilis in der Initialperiode
durch das Salvarsan. Med. Blatter , 1914, xxxvi., April, S. 01 und 77.

GUIARD, F.-F. Labortion de la syphilis par la s&lvarsanotherapie. Journ.
de Med. de Paris, 1914, xxxiv., Avril 4, p. 267.

HABERMANN, RUD. Ueber die Injektion Konzentrierter AlUalvarsanh*uiig«n.
Dermatol. Ztschr ., 1914, xxi., April, S. 324.

NeosAlvariwiH.—-WILE, UDO J. The technic of the intradural injections of neo
salvarsan in syphilis of the nervous system. A preliminary report. Journ.
Amcr. Med. Assoc. , 1914, lxii., April 11, p. 1165.

NELSON, KENT, and HAINES, E. F. Observations of the results of nine
months’ experience with neosalvarsan at the United States Military Prison
Hospital, Fort Leavenworth, Kan. Journ. Amcr. Med. Assoc., 1914, lxii.,
March 28, p. 989.

GRUNBERG, J. Zur Anwcnduug konzentrierter Losuugen von Salvarsan uod
Neosalvarsan. St. Petersburger Med. Ztschr ,, 1914, xxxix., April, S. 90.

Waster man ■ Reaction. —ANDERSON, N. Die Waascrmannsche Reaktion bfi
einem Fallc von durch gangranosen Schanker eingcleiteter Syphilis. Ikrrnld.
Ztschr. , 1914, xxi., April, S. 323.

CRAIG, CHARLES F. Variations in the strength of the Waasermaim reaction
iu untreated syphilitic infectious. Journ . Amcr . Med. Assoc., 1914, lxii.,
April 18, p. 1232.

PISANI ami SAVARE. Colcstcrinemia c reazione di Wassermann nelle
eclamptiche. La (jinccologi* i, 1913, x., Oct., S. 601.

ORKIN, G. Krfahrungen mit dein Sachs’sclien Cholcsterinalkohol* und dem
Lesser’schen Aetberextrakt bei der Wassermann’schen Reaktion. Bert. klin.
Wchnschr ., 1914, li., S. 690.

Luftln Reaction. —KILGORE, ALSON R. The luetiu cutaneous reaction for
syphilis. Journ. Amcr. Med. Assoc. , 1914, lxii., April 18, p. 1236.

Orebro-8pi«al Fluid —MYERSON, A. A. The albumen content of the spinel
fluid in its relation to disease syndromes. Journ. Nerv. and Mcnt. Dis 1914,
xli., March, p. 154.

GENERAL AND FUNCTIONAL DI&EASE*—

Epilepsy* —BYCHOWSKI, L. Ubcr einen Fall von Jacksonscher Epilepsis mit
ungewohnlicbem rontgenographischem Befund. Neurol. Central 1914,
xxxiii., April 1, S. 406.

MAYER. Zur Serodiagnostik der Epilepsie. Miinch. Med. Wchnschr ., 1914,
lxi., 8. 703.

MOMBURG. Ueber Vcrengerung der Carotiden bei Epilepsie. Dent. Mtd .
Wchnschr 1914, xl., 8. 753.

FUCHS. Epilepsie und Luminal. Munch. Med. Wchnschr ., 1914, lxi., S. 873.

BIBLIOGRAPHY

53*

ANTON, G. Die operative Beeinflussung der Entwicklungsstorungen de*
Gehirns, besonders der Epilepeie. Archiv f. Psychiat. u. Nerrenkr ., 1914,
liv., S. 98.

BRI8SOT and BOURILHET. La d&nence chez lee foileptiques. Joum. de
Neurol., 1914, xix., p. 61, 81, et 101.

SMITH, E. B. Some points in the diagnosis and treatment of epilepsy in
childhood. Practitioner, 1914, xcii., April, p. 616.

RBDLICH, E. Uber das Vorkommen epileptischer und epileptiformer Anfiille
bei Tumoren dor Hypophysis cerebri und der Hypophysengegend. Epilepsia,
1914, v., M&rz, p. 1,

BOUCHE, G. Contribution experimental h l’4tude dee convulsions toniques.
Epilepsia, 1914, v., M*rz, p. IS.

TURNER, WM. A. Remarks upon the outlook in epilepsy. Epilepsia , 1914,
v., Marz, p. 40.

VERTES, L. Die symptomatische Behandlung der Epilepeie. Epilepsia , 1914,
v., Marx, p. 47.

(lores.—MAUREL, P. De la choree de Sydenham. Oaz. des H6p 1914,
lxxxvii., Avril21,p. 766.

CATARINCH, J. Huntington’s chorea. Australian Med. Joum.. 1914, iii.,
April 11, p. 1609. ’

—RONNE, H. Einige Falle von hysterischem Gesichtsfelddefekt.
Klin. Monatsbl. f. Augenheilk ., 1914, lii., Marx-April, S. 372.

.Vrarslgls.—RAMOND, F. Neuralgia of the brachial plexus. Med. Press , 1914,
cxlviii., April 8, p. 368.

JOKL, R. H. Uber die Verwendbarkeit des Roob Sambuoi zur Behandlung von
Neuralgien. Prager Med. Wchnschr., 1914, xxxix., April 23, S. 200.

TOBIAS, E. Zur Frage der idiopathischen Interoostalneuralgie. Berl. klin.
Wchnschr., 1914, li., Mai 4, S. 8337

TURAN, F. Ueber periphere Ursachen des neuralgischen Zustandes. Ztschr .
/. Phynkal. u. Dial. Therapie , 1914, xviii., S. 223.

Neuritis.—CAVAZZANI. A. Sulle oosi dette “nevriti apoplettiformi.” Riv.
crU. di Clin. Med., 1914, xv., S. 19a

COOPER, E. A. On the protective and curative properties of certain foodstuffs
against polyneuritis induced in birds by a diet of polished rice. Part II.
Joum. Hygiene , 1914, xiv., April, p. 12.

DERCUM, F. X. The treatment of sciatica. Therap. Qaz., 1914, xxxviii.,
April, p. 237.

Neurasthenia.—ROSS, T. A. The nature and treatment of neurasthenia.
Edinburgh Med. Joum., 1914, xii., April, p. 296.

BARNES, GEORGE E. Affective activity, emotion, as the oause of various
neurasthenie bodily diseases. N. Y. Med. Joum., 1914, xeix., p. 679.

Neuroses.—WILLIAMS, TOM A. What occupation neuroses really are. Med.
Press , 1914, cxlviii., April 15, p. 387.

CLARK, L. PIERCE. Remarks upon mental infantilism in the tic neurosis.
Med. Record, 1914, lxxxv., March 28, p. 553.

SIBBERT, H. Einige Bemerkungen liber die allgemeinen Neurosen.
Monatsschr. f. Psychiat. u. Neurol., 1914, xxxv., April, S. 394.

WEYGANDT, W. Ueber die Anwendung des Dauerbades fiir Psychosen und
NeuroMD. Med. Klinik., 1914, x., April 26, 8. 711.

■*"***£****"V J®* - —NURZIA, PRIAMO. Sulla d.gen.razione er.do-alooolica.
Rtv. i tal. dt NmropatoL, Peichiatr. td Elettroter., 1914, vii., Marto, p. 106.

ROPER. Alkoholiamu* bei Frauen. Dent. Med. Wchneehr., 1814, xl., S. 910.

SCHARNKB. Zur Behandlung de. Delirium tremen*. Munch. Med. Wchneehr.,
1914, lxi., 8. 717.

2u r Behandlung de. Delirium tremeu*. Munch. Med. Wch nechr .,

IM14 In H Q3fi ’

54*

BIBLIOGRAPHY

Exapfetfealaile Coltre, CreiliUa, dkt. —CLARK, O. Exophthalmic nitre y i

clinical manifestation of hereditary syphilis. Joum. Amer . Mid, Auoc. t
1914, liil, April 11, p. 11C7-

AL^UIEK, L. Basedowisxne on ncrrose vaso-motriee (troubles mo-aoUon
avcc c<*ur instable st facilement excitable, dyspeptic nemos*, tremblemeai,
troubles psyahique*). Rev, Neurol 1914, xxii., p. 393.

PKTTAVKL, C. A. Weiterer Be it rag zur pathologiseheo Anatomic dsi Korku
Basedowii. Miileil. it. d. Grenzgeb. d, Med. m. Chir 1914, xxrii, S. 694.

L1KK, E. Zur Fniboperation dee Morbus Basedow. Arehiv. f. Klin. Chit
1914, oiv., S. 1.

GKUMMB. Zur Theorie von Morbus Basedowii, Myxodem, Kreturismoi und
Gebirgskropf, Hyper- und Hypothy reoidismus ? Berl. Win. Wehmchr., 1914,
li. # S. 737.

WAGNER, K. Bemerkungen zu den Beziehungen der Rontfenbehandloof dcr
Ovarien und des Basedow. Wien. Win. Wehruekr ., 1914, xxrii., April 9,
S. 430.

SAJOUS, C. E. ns M. Toxemias in the genesis of hyperthyroidism sad their
treatment. N . IT. Med . Joum., 1914, xcix., p. 724.

Addison's Macao*.—NAKANO. Hfcmochromatoee unter dsm Bilds dss Morbui
Addisonii. Munch . Med. Wehntehr., 1914, lxi., S. 919.

TeUay.—FISCHER, J., and TRIEBENSTEIN, O. Untersuehungen iiber Tetania
und Alterstar. Klin. Afonatibl. f. A ugenhtilk ., 1914, lii., Mtrz-April, S, 441.

TANBERG, A. Ueber die chronische Tetanie nach Exstirpation ron 01. pars*
th> reoidece. Mitteil. a. d. Qrenzyeb. d. Med. u. Chir., 1914, xxrii, S, 575.

Tela a as.—JOFFE, M. Zur Behandlung des Tetanus mit Phenoliajcktionen nach
Bacelli. St Petersburger Med. Zt$chr., 1914, xxxix., Feb., S. 45.

SPECIAL SENSES AND CRANIAL NEB YES—

BERG, V. Ungewohnlich ausgedehnte markhaltige Nerrsnfasern bci hoch-
gradiger Myopie und Amblyopia. Klin . MonaUU. /. Augenheilk 1914, lii,
Marz-April, S. 495.

1GERSUEIMER, J. Ueber Nystagmus. Klin. MonaUbl. f. Au§enktUk. t Mi
lii., Mart-April, S. 337.

JESS, A. Kopfschmerz und Auge. Berl. Win. Wehn$ehr. % 1914, H., & 629.

LAYTON, T. B. Examination of the intornal ear and hind-brain by itimulstion
of the vestibular nerve. Clin. Joum., 1914, xliii., April 6, p. 193.

SCHMIDT, C. J. M. Ein Fall von progredienter Thrombophlebitis dsr Hinainui
nach Otit. mod. acuta. Septische Verlaufsform. Oj*ration nach
Monatsschr. f. Ohrenheilk . u . Lnryngo-Bhinol 1914, xlviii., S. 270.

MIStELLANEBL* SYMPTOMS AND CASES—

NICCOLAI, N. Contribute clinico alio studio delle sindromi epifisaric e funiioni
endocrine. Biv. ciut. di Clin. Med., 1914, xv., S. 241 und 257.

BELING, C. C. A case of dystonia musculorum deformans. Joum. Nerv. and
MetU. Die., 1914, xli., March, p, 148.

LEVIN, H, C. Organic and psychogenic delirium. N. Y. Med. Joum., 1914,
xcix., p. 631.

LEVY, D. J. Etiology and symptomatology of nervousness in infancy. Architet
of Fed., 1914, xxxi., April, p. 270.

EDEN, R., and REHN, B. Die autoplastische Fetttransplantation xur Nturolyiii
und Tendolysis. Arehiv f. klin . Chir., 1914, dv., S. 66.

KRETSCHMER, M. Zur Neuropathie des kindliehen Alters. ZUchr.f. Phptikol.
u. Dmt. Therapie, 1914, xviii., S. 206,

ANTON, G. Ueber familiar# Dysostose beginnend in dsr Gescbleehtsrslfe
(Pubertats-dysostose). Arehiv f. PsychuU. u. Nenwitr., 1914, Ur., S. 76.

BIBLIOGRAPHY

55*

FRANKL-HOCHWART, L. v. Uber die nervtisen Erkrankungen der Taba-
krancher mit besonderer Berttoksiohtigung dee Kindesalters. Med. Blatter,
1914, xxxvi., Mfcrz, 8. 37.

BODE, P. Zur Kenntnis der Ktinstliohen Atmung bei zentraler Atemlahmung.
St Petenburger Med, Zttchr ., 1914, xxxix., April, 8. 86.

FISCHER, H. Bin Fall von Dercumscher Krankheit and seine Beziehangen
zu den Blutdrttsen. MoncUttchr. f. Ptychiat. u. Neurol ., 1914, xxxv. f April,
8. 307.

LISSMANN, P. Zur Behandlung der sexuellen Impotenz. Neurol, CerUralbl .,
1914, xxxiii., April 1, 8. 417.

HEISE, W. Ein Beitrag zur Frage dee aknten Ekzems mit psychischer Atiologie.
Neurol, Centralbl ., 1914, xxxiii., Apri^l6, 8. 499.

COURBON, PAUL. La convoitise incestueuse dans la doctrine de Freud et les
conditions du dtair sexael. L'Encephale , 1914, ix., Avril, p. 346.

ANTON, G. Nachruf auf E. Hitzig anlisslicb der Aufstellung des Hitrig-
Denkmalea in der Hallenser Klinik fUr Geistes- und Nervenkranke. Archiv f.
Ptychiat. u, Nervenkr ., 1914, liv., S. 1.

ANTON, G. Gefahrliohe Menschentypen. Arthiv f, Ptychiat, u, Nervenkr
1914, liv., 8. 89.

ROHDE, M. Zur Frage der BerufsnervoeiUt der Volksschullehrer. Monalttchr .
/. Ptychiat, u, Neurol ., 1914, xxxv., April, 8. 369.

PSYCHIATRY.

GENIKAL PARALYSIS—

FORSTER, E., and TOMASCZEWSKI, E. Untersuchungen uber die Spiroohaete
des Paralytikergehirns. Deut, Med . Wchntchr., 1914, xl., 8. 694.

STODDART, W. H. B. Clinical lecture on the curative treatment of general
paralysis. Med, Prett , 1914, cxlviii., April 1, p. 330.

MAPOTHER, E., and BEATON, T. Intraspinous treatment (Bwift-Ellis) of
general paralysis: a preliminary note on four cases treated by this method.
Lancet , 1914, dxxxvi., April 18, p. 1103.

MARINESCO, G., and MINE A, J. L’emploi des injections de serum salvarsanisd
in vitro et in vivo sous l’arachnoide spinale et o4rdbrale dans le tabes et la
paralysie gdndrale. Rev, Neurol ., 1914, xxii., p. 337.

SIEBERT, H. Ueber progressive Paralyse. St Petersburger Med, Zttchr
1914, xxxix., Jan., 8. 20.

GOLDSTEIN, MANFRED. Adenokarzinom der Hypophyse und progressive
Paralyse. Archiv f, Ptychiat, u, Nervenkr ., 1914, liv., 8. 211.

DEMENTIA PKJECOX—

PELLACANI, G. Rioerohe sulla deviazione del oomplemento nella demenza
preooce. Riv, di Paid . new, e ment ., 1914, xix., Marzo, p. 164.

MA8SELON, REN^. Les voies d’inversion de la dlmenoe prfoooe. VEncephalc ,
1914, lx., Avril, p. 312.

GENERAL—

BRUCE, LEWIS C. The complement-deviation in cases of manic-depressive
insanity. Journ, Ment, Sei ., 1914, lx., April, p. 177.

OBREGIA and PITULESCO. Etude sur les psychoses du cholera. L'EncephaU ,
1914, ix., Mai, p. 39a

DEVINE, HENRY. The clinical significance of katatonio symptoms. Journ.
Ment. Sci ., 1914, lx., April, p. 27&

WILLIGE, HANS. Ueber akute paranoische Erkrankungen. Archiv. /.
Ptychiat. u. Nervenkr , 1914, liv., 8. 121.

PRICE, GEORGE E. A sixteenth - oentury paranoiac. N. Y. Med. Journ.,
1914, xoix., p. 727.

56*

BIBLIOGRAPHY

KNAPP, P. C. The treatment of cases of mental disorder in general hospitals.
Boston Med. and Sun 7 . Joum 1914, dxx., p. 637.

ALLERS, RUDOLF. Ergebnisse stoffwecbxdpathologischer Unterauchungen b*!
Psychosen.—III. Das manisch-depressive Irresein. Ztschr, f t d. get. Neurol,
u. Psychiat. (Ref ), 1914, lx., S. 5S5.

LOMER, GEORG. Initiate Schriftveranderung bei Paralyse. Ally. Ztschr. /.
Psychoit %y 1914, lxxi., S. 195.

ROWS. R. G. The imi>ortancc of disturbances of the personality in mental
disorders. Joum, Ment. &«., 1914, lx., April, p. 192.

AUSTREGESILO and ESPOSEL. Les cenesthopathiss, L'EnctphaU, 1914,
ix. t Mai, p. 425.

REED, ALFRED C. Insanity in China. Boston Med. and Surg. Journ. , 1914,
clxx., p. 572.

FIRTH, A. H. The pupil and its reflexes in insanity. Joum. Ment. Sci , 1914,
lx., April, p. 224.

COURBON, PAUL. L’hallucination tdealgesique. L'KnctphdU, 1914, ix„ Mai,
p. 440.

LOBB, S. Die AbderhaMenschen Fermentreaktionen und ibre Bedetitung far
die Psychiatric. Afonatsschr. f. Psychiat. u. tfeurol., 1914, xxxv., April, S, 382.

STEIN, EMIL. Posttraumatischc Sp&tpsychose oder Dementia arterio-iclerotics.
Pragtr Med. Wchnschr, 9 1914, xxxix., Marz, S. 116,

SKHOTT, Aus der Praxis der Entmundigung wegen Trunksucht. Ally. ZUdr.
/. Psychiat. , 1914, lxxi., S. 213.

WEBER, L. W. Die Fahigkeit zur freien Selbstbestimmung bei der Wahl des
Aufenthaltsortes. Ally. Ztschr. /. Psychiat. t 1914, lxxi,, S. 252.

MULLER, E. Die Kaiser Dotnitian, Commodus, Caracalla und Elagabal, ein
Beitrag zur Prage des Casarenwahnsinns. AUg. Ztschr . /. Psychiat 1914,
lxxi., 5. 271.

STF.MMKR, W. Das Irren- und Siechenhaus Pforzheim nnd seine Ante. AUg.
Ztschr. f. Psychiat. , 1914, lxxi., S. 289.

TRUELLK, V. Geistige Storungen bei Tuberkulosa. Med. Blatter, 1914,xxm,
Marz, S. 49.

TITIUS. Ein Beitrag zur Kasuistik des Stotterm. AUg. Ztschr./. Psychud.,
1914, lxxi., S. 207.

KNOX, HOWARD A. A comparative study of the imaginative powers in
mental defectives. Med. Recordy 1914, lxxxv., April 25, p. 748.

FOSTER, M. H. Methods of examination of illiterates for mental defectives
Joum . Amcr. Med. Assoc., 1914, lxii., April 4, p. 1068.

SIBBBRT, C. Ueber psychiatrische Gutachten vor Gerichi St Petersburger
Med. Ztschr., 1914, xxxix., S. 7.

TREATMENT,*

BUNNEMANN. Worauf beruhen die psychotherapeutischen Erfolge Dubois 1 ? Neurol.
Centralbl., 1914, xxxiii., April 16, S. 496.

KAHANE, H. Die Zwangsvorstellungen und ilire psychieche Therapie. Wien. Hin.
Wchnschr ., 1914, xxvii., April, S. 371.

WILLIAMS, TOM A. A oomtrast in psychoanalysis: three cases. B. Y. Med. Joum,
1914, xoix., p. 672.

• A number of reftrenoes to papers on Treslmeikt are inoluded in the BibUofrsphj and*
individual diseases

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ANATOMY.

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LEIDLER, R. Uber die Anatomic und Funktion des Nucleus Bechterew (Mit 4 fig.).
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PHYSIOLOGY.

TRENDELENBURG, W. Neuere Methoden und Ergebnisse der Hirnphysiologie.
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CAMUS, J., and ROUSSY, G. Polyurie par l&ion de la region opto-pedonculaire de
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DIXON, W. E., and HALLIBURTON, W. D. The cerebro*spinal fluid. II. Cerebro¬
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WEED, LEWIS H. Observations upon deoerebrate rigidity. Joum. Physiol., 1914,
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TRIBE, ENID M. Vaso-motor nerves in the lungs. Joum. Physiol., 1914, xlviii.,
p. 154.

MARTIN, E. G., and STILES, P. G. The influence of curare on vasomotor reflex
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MOGWITZ, G. Uber das Verhalten des sympathischen Nervensystems des S&uglings
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PORT and BRUNOW. Der Einfluss des vegetativen Nervensystems auf das Blutbild.
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HOSKINS, R. G., and WHEELON, HOMER. Adrenal deficiency and the sympathetic
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SWETSCHNIKOW, W. A. Uber die verschiedenen Bedingungen der Adrenalinwir-
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WIGGERS, CARL J. Further observations on the constricting action of adrenaline on
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57 *

BIBLIOGRAPHY

r>s

KLEE. Die Magenforvn bei gesteigertem Vague- und Sympatbikustonus. Jfu>icA.
Med. \Vchnsckr. % 1914, Ixi., Mai 12, S, 1044.

WOLFSOHN, J. M. The normal and pathologic physiology of the visceral nervous
system, with especial reference to vagotomy and aympathicotony. Journ . Amr.
Med. A$soc. f 1914, lxii., May 16, p. 1535.

KURE, K., HIRAMATSU, T., and NAITO, H. Zwerchfelltonos und Nervi Splanchnid
Zentralbl. j. Physiol., 1914, xxviii., 8. 130.

CARLSON, A. J. The nervous control of the gastric hunger mechanism (man, dog).
Amer. Journ. Physiol., 1914, xxxiv., May, p. 155.

FROHLICH, ALFRED. Die Pharmakologie der Hypophysensubstanzen. Wien. Med.
Wchnschr., 1914, Ixiv., Mai 16, 8. 1061.

WULZEN, R, The anterior lobe of the pituitary body in its relationship to the early
growth period of birds. Amcr. Journ. Physiol 1914, xxxiv., May, p. 127.

CA8TELLI, R. Contribution h l’£tude des substances grasses de l*hypophyee humaine.
Archives de Med. exp., 1914, xxvi., Mars, p. 185.

FUNK, CASIMIR. Is polished rice plus vitamine a complete food? Journ. Physiol.,
1914, xlviii., p. 228.

PSYCHOLOGY.

HALL G. STANLEY. A synthetic genetic study of fear. Amer. Journ. Psychol.,
1914, xxv., April, p. 149.

FLETCHER, J. M. An experimental study of stuttering. Amcr. Journ. Psychol.,
1914, xxv., April, p. 201.

CANNON, W. B. The interrelations of emotions as suggested by recent physiological
researches. Amer. Journ. Psychol. , 1914, xxv., April, p. 256.

MOORE, J. S. The articulation of the concepts of normal and abnormal psychology.
Amcr. Journ. Psychol 1914, xxv., April, p. 283.

LAURENS, HENRY. Uber die raumliche Unter*cheidungg-fahigkeit beim Dimmer*
ungssehen. Ztschr. f. Stnncsphy&iol ., 1914, xlviii., S. 233.

GILDEMBISTER, MARTIN. Uber einige Analogien zwiachen den Wirkungenoptischer
und elektrischer Rcize. Ztschr. /. Smncsphysiol ., 1914, xlviii., S. 252.

GILDEMEISTER, MARTIN. Uber die Wahrnehinbarkeit von Lichtlucken. Ztschr.
/. Smncsphysiol., 1914, xlviii., S. 256.

RUTENBURG, D. Uber die Netzhautrcizung durch Kurzdauernde Lichtb litre und
Lichtliicken. Ztschr. f. Sinnesphystol., 1914, xlviii., 8. 268.

JANET, PIERRE. Psychoanalysis. Journ. Abnorm. PsychoL , 1914, ix., April*May,

p. 1.

PUTNAM, JAMES, J. Dream interpretation and the theory of psychoanalysis.
Journ. Abnorm. Psychol ., 1914, ix., April-May, p. 36.

TERM AN, LEWIS, M. Recent literature on juvenile suicides. Journ. Abnom.
Psychol ., 1914, ix., April-May, p. 61.

BENEDICT, A. L. The psychological effect of the fairy story. N. Y. Med. Journ.,
1914, xeix., May 9, p. 925.

M‘DOUGALL, WM. The definition of the sexual instinct. Proc . Boy. Soc. Med.,
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LOEWY, A., and PLACZEK, S. Die Wirkung der Hohe auf das Seelenleben des
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PATHOLOGY.

ORR, D. f and ROWS, R. G. Toxi-infection of the oentral nervous system. Proc. Boy.
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BIONDI, GIOSUE. Degenerazioni primarie ed alterazione postmortali dells fibre
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TORRE, P. la. Alterazioni del retioolo neurofibrillar® endooellulare della intossicazione
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LEVADITI, C., DANULESCO, V., and ARZT, L M<$ningite par injeotion de microbes
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SARTESCHI, V. Sopra le alterazioni del sistema nervoso oentrale nella intossicazione
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PALADINO, G. Le eellnle nerve#® sono element! perenni dell* organismo ? ed il potere
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ISENSCHMID and SCHNITZLER. Beitrag zur Lokalisation des der Wttrmeregulation
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TODDE, C. Ricerehe sulla fundone e sulla atruttura delle ghiandole seasnali masobili
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BONFIGLIO, FRANCESCO. Un metodo rapido per la coloradone delle guaine
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COSTANTINI, B. Osservadoni eliniohe ed anatomopatologiche sulla forma “pro-
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ROSENHEIM, OTTO. The galactoeidea of the brain. II. The preparation of phrenoain
with kerasin by the pyridine'method. HI. Liquid crystals and the melting point of
phrenoain. Biochem. Journ., 1914, viii., April, pp. 110 and 121.

ABELOUS and SOUL A. Sur la repartition de l’azote et du phoaphore dans le oerveau
dm lapin8 normaux et anaphylactisea. D&luctions aur le m&amsme de l’anaphylaxie.
Compt. Bend . d. 1. Soc. de Biol., 1914, lxxvi., Avril, p. 671.

NICHOLS, H. J. Observations on a strain of Spiroeheeta pallida isolated from the
nervous system. Journ. Exp. Med ., 1914, xix., April, p. 362.

CLINICAL NEUROLOGY.

GENERAL—

BOX WELL, WM. Disordered bladder function in nervous disease. Dublin
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VERNET and PETZETAKIS. Le r^flexe ooulo-cardiaque. Gaz. des Hop., 1914,
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AVIRAGNET, DORLENCOURT, and BOUTTIER. Le rlflexe oculo-cardiaque
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DUPONT, L. lUflexe auriculo-cardiaque et auriculo-vaso-moteur. Compt. Bend,
d. 1. Soc. de Biol., 1914, lxxvi., Mai 15, p. 731.

NERVES—

KENNEDY. F., ELSBERG, C. A., and LAMBERT, C. I. A peculiar un-
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LAURENT, O. Les an^vrysmes et les Measures des nerfs en chirurgie de guerre.
Bev. de Chir., 1914, xxxiv., Mai, p. 553.

ZALLA, M. Sui trapianti dei nervi periferici. Biv. di Patol. nerv. e ment .,
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KENNEDY, ROBERT. Experiments on the restoration of paralysed muscles by
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SPINAL CRRR—

General.— VULPIUS, OSCAR. Ueber die Lahmungstherapie an der oberen
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GO*

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Herpes Zoster.—SOUQUES, A. Zona cervical et paralysis facials. (1 fig.) Ret.
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FLEXNER, S., and AMOSS, H. L. Penetration of the virus of poliomyelitis
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CLARKE, J. MICHELL, and LANSDOWN, R. G. P. Intramedullary tumour of
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COLLINS, J., and ELSBERG, C. A. Giant tumors of the oonus and cauda
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BBAIN—

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Abscess,—RYLAND, ARCHER. A case of temporo-sphenoidal absoess in the
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SOLOW1RJCZYK and KARBOWSKI. Zur Kasuistik der Stirnhohleneiterungan
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Angiospasm.—RUSSELL, WM. Phenomena attributable to spasm of cerebral
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Haemorrhage.—GADWALADER, W. B. A comparison of the onset and character
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Hemiplegia.—PANSKI. Uber einige ungewtthnliche Ersoheinungen bai Hemiplegia.
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SAVARIAUD. La maladie de Little at son traitement ohirurgical. Journ. de
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Facial Paralysis.—HARTY, JOHN. Notes on the electrical reactions in facial
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HOKE, E. Tic convulsif als fctiolorisches Moment ftir die Kntstehung der
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DILLKR, T., and MILLER, R. T. The successful removal of a tumour from the
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STERN. FELIX. Die psychischen Stdrnngen bei Hirntumoreu und ihrt Beiie
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ROCCAVILLA, A. Glissi diffusa dell' encefalo e del midollo in bimbo affetto
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PELLACANI, O. Un c&so di sarcomi multipli primitivi dell’encefalo. Riv.
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clxxxvi., May 30, p. 1525.

MOSNY and JAVAL. Le liquid© cephalo-rachidien dans l’it&re (a propos d’une
note de M. Babes). Compt. Bend. d. 1. Soc. de Biol., 1914, lxxvl, Mai 9,
p. 750.

KISCH and REMERTZ. Uber die Oberfl&chenspannung von Serum und Liquor
cerebrospinalis beim Menschen u. iiber die Technik kapillarimetrischer
Messungen. Munch. Med. Wchnschr ., 1914, lxi., Mai 19, S. 1097.

general and functional disease#—

Kpftlepsy. CHIRAY. Sur un cas d’dpilepsie jacksonnienne portantsur le centre
conjugue des mouvements de la t4te et des yeux. Nouv. Icon. d. 1. SalpB
1914, viu, Feb., p. 1.

YAWGER, N. S. Alcoholism and epilepsy, also so-called acute alcoholic epilepsy.
Amcr. Journ. Med. Set., 1914, cxlvii., May, p. 735.

SHAW, B. HENRY. The relation between epilepsy and tuberculosis. Brit.
Med. Journ., 1914, May 16, p. 1063.

JUARROS, CESAR, Tratamiento de la Epilepsia sin bromuros. Revista de
Criminal. psiquiat. y Med.-Legal , 1914, i., Marzo-Abril, p. 177.

SCHULHOF, FRITZ. Ueber die Wirkung des Sedobrols bei Epilepsie. Wien,
klin. Wchnschr 1914, xxvii., Mai 21, S. 701.

YAWGER, N. S. Experience with crotalin at the Oakbourns Epileptic Colony.
Journ. Amer. Med. Assoc., 1914, lxii., p. 1633.

ZALLA, M. La cura dellepilessia con la “Crotalina.” Epilepsia , 1914, v., Mai,

p. 81.

SHANAHAN, WM. T. Why the marriage of defectives should be prevented
when possible. Epilepsia , 1914, v., Mai, p. 94.

HILL, C. BERKELEY. A short analysis of eighty-nine eases of epilepsy. Indian
Med. Oaz. f 1914, xlix., April, p. 136.

BRISSOT and BOURILHET. La ddmence oh ex lea ^pileptiques. Journ. de
Neurol , 1914, xix., Avril 5, p. 121.

BIBLIOGRAPHY

65*

LOBWT, E. Der beutige Stand der Epilepsieforschung. (Kritiaches Sammel-
referat) Btrl. klin. Wchnsckr., 1914, li., Mai 25, S. 982.

Hysteria.—ORMBROD, J. A. The Lumleian lectures on some modern theories
concerning hysteria Lectures I., IL and 111. Lancet, 1914, olxxxvi., pp. 1163,
1233, and 1299.

CALLIGARIS, G. Bur l’anesth&de hystlrique k type longitudinal. Rev. Neurol .,
1914, xxii., Avril 30, p. 558.

HALLERVORDEN, J. Uber eine hysterisohe Pvschose mit alternierenden
Be wusst«einszustbnden. Ztschr.f. d. gee. Neurol, u. Psyckiat ., 1914, xxiv.
(Orig.), S. 378.

Nenrmlgla*— PATRICK, HUGH T. The symptomatology of trifacial neuralgia.
Joum. Amer. Med. Assoc., 1914, lxii., May 16, p. 1519.

TURAN, F. Ueber periphere Ureachen des neuralgischen Zustandes. Ztschr .
/. Pkysikal. u. Didt. Tkerapie , 1914, xviiL, S. 278.

Memrltls. —SOMERVILLE, W. F. The treatment of neuritis by electrical methods.
Bril. Med. Joum., 1914, May 9, p. 1014.

HARRIS, J. F. Brachial nenritis. N.Y. Med. Joum., 1914, xeix., May 9,
p. 932.

HOBSTERMANN. Uber reknrrierende Polyneuritis. Deut . Ztschr. f. Nerven -
keilk., 1914, li., S. 116.

D&IERINE. Les polynlvrites. Joum. des Prat., 1914, xxyiii., Mai 23, p. 322.

CHAUFFARD, A. Nlvrite alcoolique et hepatite alcoolique. Joum. des Prat.
1914, xxviii., Mai 23, p. 325.

Berl-Berl.—SCHNYDER, K. Pathologisoh-anatomische Unterauchungen bei
Expet imeuteller Beriberi (Reispolyneuritis). Arckiv. f. Vcrdauungs-Krankh .,
1914, xx., S. 147.

Neurasthenia -MONKEMOLLER. Die Forensische Bedeutung der Neurasthenic.
Arckiv. f. Psyckiat ., 1914, liv., S. 278.

FOTHERG1LL, CLAUDE F. Treatment of neurasthenia. Practitioner, 1914,
xcii., May, p. 723.

SCHELLONG, O. Zur Bewertung der Neurasthenie-Diagnose nach objektiven
Merkmalen (des gesteigerten Knlereflexes des \ asomotorischen Nach rot ens des
Augenlidzitterns, Zangenzittems, Fingerzitterns der erhdhten Pulsfrequenz).
Ztsckr. f. klin. Med., 1914, lxxx., S. 200.

BINGLER, KURT. Bin kritischer Beitrag zur Frage: 41 Konnen durch myal-
gische Herde in der h&ls- und Schultermuskulatur neurasthenischer Kopfschmerz,
neurasthenischer Schwindel und Migrine verursacht werden?” Neurol.
Centralbl., 1914, xxxiii., Mai 16, S. 619.

Nemroses.—HASKOVBC, LAD. Arret du pouls dans la ndvrose traumatique.
Nouv. Icon. d. 1. Salpit 1914, viL, F4v., p. 55.

Alcoholism, Jte.— MANOILOFF, E. Weitere Untersuehungen Uber chronischen
Alkolismus und Anaphylaxis. Centralbl. f. Bakterxol., Parasitenk. u.
In/ektionskr., 1914, lxxiii., Min, 8. 314.

AMALDI, PAOLO. Le peicoei da alcoolismo nei Manicomi italiani. Riv. Sper.
d* Freniat., 1913, xxxix., pp. 637*651.

SCHARNKE. Zur Behandlung des Delirium tremens. MUneh. Med. Wcknschr .,
1914, lxi., Mai 19, S. 1132.

SCHNEIDER. Zur Behandlung des Delirium tremens. Milnck. Med. Wchnsckr.,
1914, lxi., April 28, S. 930.

Von dkr PORTEN. Zur Behandlung des Delirium tremens mit Veronal. Milnck.
Med. Wchnsckr ., 1914, lxi., Mai 26, 8. 1179.

Exophthalmic Goitre, Cretinism, Ac.—WALTON, ALBERT J. A considera¬
tion of some cases of exophthalmic goitre treated by operation. Lancet , 1914,
clxxxvi., May 16, p. 1387.

LttDIN, M. Die Behandlung der Strumen und des Morbus Basedowii mit
Rontgenstrahlen. Centralbl. f. d. Qrensgeb. d. Med. u. Ckir ., 1914, xviii ,
Mai, p. 205.

66*

BIBLIOGRAPHY

FITZ, R. Certain aspect* of the medical history of exophthalmic goitre. Boston
Med. and Surg. Journ ., 1914, clxx., April 30, p. 675.

ELSNER, H. L. The association of uterine growths with goitre; trpicxl end
atypical exophthalmic goitre. Amer. Journ. Med . Sci., 1914, cxlvil,
p- t>34.

HOLLOS, JOSEF. Die tuberkulose Atiologie der Thyreosen. ZUckr. /.
Tuberkulose , 1914, xxii., Marx, S. 50.

Ksyaaid’s Disease.—MARCHAND, L., and USSE, F. Maladie de Raynaud
transitoire, k localisations peu communes chet one demente. Nonv. Icm. d. 1.
Salpft., 1914. vii., Feb., p. 52.

Addison’s Disease.—NAKANO. Hamochromatose unter dem Bilde des Morbus
Addisonii. Munch. Med. Wchnschr., 1914, lxi., April 28, S. 919.

TUCZEK, KARL. Uber die Beziehungen der Nebennierenpigmentation tut
Hautfarbe. Mit besonderer Borucksichtigung der pigmen tier ten Nebeanieren
tumoren. Beitrdye z. path. Anat. v. z. ally. PcUh., 1914, lviii., S. 250.

Tetanas*—REYNOLDS, W. G. A case of tetanus treated with subcutaneous
injections of carbolic acid : recovery. Lancet, 1914, clxxxvi., May 23, p. 1461

VULLIET, H. L’injection sous-araebnoidienne lombaire de sulfate de magn&ie
dans le traitement du tdtanoa. Rev. mid. d. 1. Suisse Rom., 1914, xxxiv.,
Mars, p. 185.

SPECIAL SENSES AND CRANIAL NERVES—

Nystagmus, Demonstration of cases and discussion on. Proe. Roy. Soc .
Med., 1914, vii., April (Sect, of Neurol., Ophthalmol., and Otol.), p. 1.

IGERSHEIMER, J. Ueber Nystagmus. II. Teil. Klin. Monatsbl. f. AugenheilL,
1914, lii., Mai, S. 668.

McMURRAY, S. Miner’s nystagmus. Journ. State Med., 1914, xxii., May,
p. 303.

NEIDING, M. Die isolierte Lfchmung des N. trigeminus. Neurol. CcrUralbL ,
1914, xxxiii., Mai 16, S. 615.

EWING, HARVEY M. Complete bilateral isolated paralysis of the seventh
nerve developing four months after the primary infection of syphilis. Journ.
Amer. Med. Assoc., 1914, lxii., May 9, p. 1459.

PASSOW, A. Neue Mittel gegen Horstorungen und Ohrgerausche. Med.
Klinik., 1914, x., Mai 3, S. 753.

WALKER, D. H. Aural vertigo. Boston Med. and Surg. Journ., 1914, clxx.,
May 21, p. 791.

ABOULKER, HENRI. Resection du l&ryngd sup^rieur dans la dysphagie des
tuberculeux. Rev. held, de Laryngol., d'Otol., ct de Rhtnol., 1914, xxxv.,
S. 641.

MISCELLANEOUS SYMPTOMS AND CASES—

WARRINGTON, W. B. Acute generalised infective paralysis in adults. Clin.
Journ., 1914, xliii., May 13, p. 296.

WOERKOM, W. van. La cirrhose hdpatique avec alterations des centres
nerveux dvoluanfc chez les sujets d’&ge moyen. Nouv. Icon. d. I SalpR., 1914,
vii., Feb., p. 41.

CARLILL, H. B. Spastic smile with tremor of the upper extremity and
defective articulation. Proc. Roy. Soc. Med., 1914, >ii. ( April (Clin. Sect.),
p. 114.

COURTNEY, J. W. On territorial autonomy in cerebral circulation, and its
rdle in the genesis of symptoms in the psychoneuroses. Boston Med. and
Surg. Journ., 1914, clxx., May 14, p. 745.

CHAUFFARD, A. Les syndromes tdtaniques. Journ. des Prat., 1914, xxriii.,
Mai 2 et 9, pp. 272 et 290.

JOURDANET, P. Le r61e du systerae nerveux dans les dermitee professionnellex
Pressc mtd., 1914, No. 42, Mai 27, p. 402.

BIBLIOGRAPHY

67*

BERTOLOTTI, M. Le syndrome oxydpbalique on syndrome de cranio-
synostoee patbologique. Presse mid., 1914, No. 35, Mai 2, p. 332.

OAUTLBY, E. The nenrotie temperament in ohildren. Clin. Joum ., 1914,
xliiL, May 27, p. 326.

BOURUIGNON, G. Localisation de l’exdtation dans la mdthode dite“Mono-
polaire ” ches l'homme, pdles r4els et poles Yirtnels dans deux organee different*.
(8 fig.) Rev. Neurol ., 1914, xxii., Avril 30, p. 553.

MALONEY, J. M. A. The co-ordination of movement. Joum. Nerv. and Ment.
Dis., 1914, xli., May, p. 273.

MOCHI, A. Le asimbolie. Rassegna di Studi Psichiat ., 1914, iv., Gennaio-
Febbraio, p. 3.

WESTPHAL. Untersuchungen xnr Frage der nervttsen Entstehung peptischer
Ulcera. Dent. Arehiv f. klin. Med., 1914, cxiv., S. 327.

STURSBERG. Zur Kenntnis der nervfisen Erkrankungen bei Leukkmie. Deut.
Arehiv f. klin. Med., 1914, cxiv., S. 292.

CALLIYARIS, GIUSEPPE. Ulteriori ricercbe sullelinee entanee iperestesiobe.
Riv. Sper. di Frenial ., 1913, xxxix., pp. 557-636.

BITTORF. Bin weiterer Beitrag zur Kenntnis der Muskelkrkmpfe peripheren
Ursprungs und verwandter Erscheinungen. Deut. Ztschr. f. Nervenkeilk .,
1914, li., S. 124.

PICK, A. Perseveration und andere Mechanismen als Ursache agrammatiscber
Erscheinungen nebst Bemerkungen uber die Beziehungen des “ Yerschreibens 99
rum “ Versprechen.” Monatsschr. /. Psychiat. u. Neurol., 1914, xxxv., Mai,
S. 407.

MEIGE, H. Un hec-de-lifevre en peinture et quelques remarques sur la con¬
formation des l&vres. Nouv. Icon. d. 1. Salplt., 1914, vii., Feb., p. 57.

MENDICINI, A., and ARTOM, G. Sur le spasme k bascube de 1’orbiculaire des
paupi&res. Nouv. lean. d. I . Salplt. , 1914, vii., Feb., p. 32.

BERTOLOTTI, M. Poly dactylic et t^ratome hypophysaire. Contribution k
I’tStude des influences morphog4n4tiques des glandes k secretion interne sur
l’organog<£ntae. Nouv. Icon. d. 1. Salplt., 1914, vii., Feb., p. 11.

CHE VALUER, P. Sur un oas d’acrodactylopathie hypertrophiante. Nouv.
Icon. d. 1. Salplt., 1914, vii., Feb., p. 3.

SAFFIOTTI, U., and SERGI, S. Sul tempo di reazione remplice nella nevrosi
traumatica e sua importanza nella valuta* ione della capacity al lavoro. Riv.
Sper. di Freniat., 1913, xxxix., pp. 686-695.

NUTT ALL, G. H. F. “ Tick Paralysis” in man and animals. Further published
records, with oomments. Parasitology , 1914, vii., May, p. 95.

PSYCHIATRY.

GENERAL PARALYSIS—

MYERSON, A. Results of the Swift-EUis intradural method of treatment in
general paresis. Boston Med. and Surg. Joum., 1914, clxx., May 7, p. 709.

MEYER, B. Die Stellung der progressiven Paralyse (und Tabes) zur Syphilis
und die Frage ihrer Behandlung. Berl . klin. Wchnsehr., 1914, li., Mai 25,
S. 965.

RUNGE. Salvarsanbehandlung der progressiven Paralyse. Deut. Med.
Wchnsehr., 1914, xl., Mai 14, S. 998.

NONNE, M., and WOHLWILL, FR. Uber einen klinisch und anatomisch
untersuchten Fall von isolierter reflektorischer PupiUenstarre bei Fehlen von
Paralyse, Tabes, und Syphilis oerebroepinalis. Neurol. Centralbl., 1914, xxxiii.,
Mai 16, S. 611.

REMENT1A PRJCCOX—

KAHLMETER, G. Blutuntenuchungen bei einem Fall von Dementia Praecox
mit periodischem Verlauf. Ztsehr. f. d. ges. Neurol, u. Psychiat., 1914,
xxiv. (Orig.), S. 483.

68*

BIBLIOGRAPHY

GESKBAls—

ASTANKOFF, P. Die Phasen der Manic. Arehiv f. PsvchiaL, 1914, lit.,
8. 368.

ITTEN, W. Zur Kenntnis hkmatologiaoher Befunde bei einigen Piyehoeen
Ztschr. f. d. get. Neurol, u. Psychiat ., 1914, xxir. (Orig.), S. 341.

SIGG, E. Versuch einer retroepektiven Diagnostik der aenilen Psy chosen nach
dem Druaeobefunde. Ztschr. /. d. get. Neurol . u. PtychuU ., 1914, xxir. (Orig.),
8. 453.

GOLLA, H. Die Bedeutung der Abderhaldenschen Serodiagnoatik fiir die
Neurologic und Psychiatric. Ztschr. /. d. pea. Neurol . ti. Piychiot, 1914,
xx iv. (Orig.), 8. 410.

EWENS, G. F. W. Insanity from exhaustion. Indian Med. Oat 1914, xlii ,
April, p. 131.

DEVINE, HENRY. The biological significance of delusions. Proc. Boy Soc.
Med 1914, vii., April (Sect, of Paychiat.), p. 89.

KASTAN, MAX. Kriminalitkt und exogene Erregbarkeit bei angeborenen
paychi»chen Defekten. Arckiv /. PsychiaL, 1914, liy., S. 454.

MUNDIE, G. S. The mentally defective. Canadian Med. Assoc . Joum., 1914,
iv.. May, p. 396.

JOUCHTCHRNKO, A. J. Contribution h la question de I’analyae dea procesius
de fermentation dans la payehiatrie et la neuropathologie. Compt. Rend. d. I
Soc. de Biol ., 1914, ixxvi., Avril, p. 609.

ALEXANDER, R. M. Dermatitia exfoliativa In an insane patient N. Y. Med.
Jvum ., 1914, xcix., May 2, p. 876.

SOUTHARD, B. E. Feeble-mindedness aa a leading social problem. Boston
Med. and Surg. Joum., 1914, elxx., May 21, p. 781.

STEDMAN, HENRY R. The art of companionship in mental nursing. Boston
Med . and Surg. Joum., 1914, clxx., April 30, p. 673.

CONSIGLIO, P. Studii di Paichiatria Militare. Riv. Sper , di Freniat., 1913,
xxxix., pp. 792-849.

CAMPBELL, C. MACFIE. The work of the out-patient department of the
Henry PhippB Psychiatric Clinic. Bullet. Johns Hopkins Hosp 1914, xxv.,
May, p. 153.

TREATMENT.*

MAUPKTIT, GEORGES. Lea paycho-ndvrosea hypoaphyxiques. Lear trsitemwi
Pretie Mid ., 1914, Mai 27, p. 401.

DARDEL, M. Lea in jectiona d’oxygfene dans lea maladies nerveusea et men tales. Re*,
mid. d . 1. Suisse Rom., 1914, xxxiv., Mara, p. 192.

Psyefceanalyala.—SOLOMON, M. Psychoanalysis. N.Y. Med. Jou m., 1914,
xcix.. May 9, p. 919.

ENGELEN. Suggestionafaktoren bei der Freudachen Psychoanalyse. Deul. Med.
Wehnschr ., 1914, xl., Mai 7, S. 958.

* A number of references to papers on Treatment are included in the Bibliography under
Individual diseases.

Bibliography

ANATOMY.

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THOMPSON, CAROLINE B. The posterior roots of the mushroom bodies in the worker
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PHYSIOLOGY.

PFEIFER. Experimentelle Untersuchungen uber die Funktion des Thalamus opticus.
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LAPICQUE and LEGENDRE. Presentation de photographies mioroscopiaues montrant
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H08KINS, R. 8.. and WHEELON, HOMER. Parathyroid deficiency and sympathetic
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PSYCHOLOGY.

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70*

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TIOIJY, GUSTAV. Ex peri men telle Analyse der sog. Beaunisschen Wurfel. Ztschr.
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HORSTMANN, W. Zur Psvchologie kontrarer Strebungen. Ztsckr.f, d. get. Ne\ird.
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MUNRO, H. S. The prevention of psychic trauma. Med. Record, 1914, lixn,
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TAITBERT, F. Kants Beziehungen zur Psychologic and Psychiatric, Ztschr.f. d. get.
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LAHY, J.-M. Un vibratcur k regiage dtendu poor lea appareils utilises an ptycho-
phyaiologie experimentale. Journ. dt Pkystal. et fife Path. g4n. } 1914, irii. t
Jan. 15, p. 39.

PATHOLOGY.

ONODI, LADISLAUS. The rbinogenic and otogenie leaiona of the third, fourth, fifth,
and aixth cranial nerves. Joum. Laryngol ., Rhinol ., and Otol., 1914, xxii., Jum
and July, pp. 304 and 300.

WAHL, H. R. Neuroblastomata; with a study of a case illustrating the three tjpn
that arise from the sympathetic system. Joum. Med. Research, 1914, xxx., May

p. 205.

BOBZANI, GIOVANNI. Note cliniche ed anatomo-patologiohe su di un caso di glioma
bulbo-protuberanziale. JRiv. ital. di Neuropatol., Psichiat. ed ElettroUf 1914,
vii., p. 205.

SALMON, A. Sulla patogenesi della oefalea essenziale. Riv. crit. di Clin. Med.,
1914, xv., Giugno, pp. 387 and 401.

DOPTER and PAUKON. La saturation des agglutinines et des pr^dpitine* appliance
h la diffcrenciation du moningocoque et des paramdningoeoquss. Compt. Rend. d.
1. Soc. dc Biol., 1914, lxxvii., Juin 26, p. 157.

8EZARY, M. A. Lee tumeurs de la glande pineals. (Rev. gen.) Qaz. des H6p 1914,
Jxxxvii., Juin 20 et 27, pp. 1141 et 1205.

CIAMPI, L.» and VALDIZAN, H. Lo sviluppo fiaico nei frenastenici. Riv. italdi
Neuropatol ., Psichiat. ed Elcttrotcr 1914, vii., p. 193.

HANDMANN. Ptosis und Cataracta senilis. Bemerkungen iiber die Pathogeness der
Cataracta senilis. Ucut. Ztschr. /. Nervenhoilk., 1914, li., S. 514.

WAGNER, R. Uber Nebennierenkephalin und andere Lipoids der Nebeunisrsurinde
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CLINICAL NEUROLOGY.

general—

GORDON, A. Lumbar puncture as a special procedure for controlling headache
in the oourse of infectious diseases. Therap. Qaz., 1914, xxxviii., Junt, p. 392.

UIVM-

LEVERTY, A. S. A clinical study of traumatic nerve paralysis. Med. Record,
1914, lxxxv., May 30, p. 907.

Mi/*cua-r

AIME, HENRI. Considerations bisto-pathogeniques sur la myotonie atrophi^ue.
L'Encdphale, 1914, ix., Juin, p. 503.

gpnrii cdhd—,

General* —BEKIEL, M. L. Remarques oliniques sur les syndromss bulbaires
supdrieuis. Lyon Med., 1914, oxxii., Juin 7 and 14, pp. 1259 and 1308.
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Berl. klin. Wchnsehr ., 1914, Ii., Juni29, S. 1205.

GADANI, A. Un caso di lesions del cooo midollare daooito. Riv. crit. di Clin.
Med., 1914, xv., Giugno 20, p. 385.

Fracture, Dislocation, Ac.—SEVER, J. W. A report of the scoliosis clinic of
the children’s hospital, Boston. If. Y. Med. Joum., 1914, xeix., June 29, p.
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Herpes Zoster. — ADRIAN, C. Hyperalgetisohe Zonen und Herpes Zoster bei
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71*

Cervical Rib.—DUPRE, B. G., and TODD, T. WINGATE. A transitional typo
of cervical rib, with a commentary. Anat. Record , 1914, viii., June, p. 313.

Myelitis.—HOLDEN, WARD A. A fifth case of acute dissemiaated myelitis with
retrobulbar inflammation of the optic nerves. Archives of Ophthalmol ., 1914,
xliii., May, p. 231.

FLEISOHMANN. Zur Lehre von der Myelitis funicularis. Uber heilbare und
abortive Formen von Myelitis funicularis. Deut. Zlschr. f. Ncrrcnkeilk ., 1914,
li., S. 402.

Tnmonrs.—MAUSS. Ein Beitrag zur chirurgischen Behandlung der Riicken-
marksgescbwulste. Munch, Med . Wchnschr., 1914, lxi., Juni 30, S. 1451.

Poliomyelitis Anterior Acuta.—LEVADITI, C., and P1GNOT, J. La neurono-
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p. 509.

JONES, ROBERT. The surgioal treatment of infantile paralysis. Clin. Joum .,
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Tabes Dorsalis.—BOGGS, THOMAS R., and SNOWDEN, R. R. The intra
meningeal treatment of tabes and cerebro-spiual syphilis. Arch . Int. Med.,
1914, xiii„ June, p. 970.

MALONEY, W. J., M.A. The determinants of tabes. N . Y. Med. Joum., 1914,
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BARKAN, HANS. On the simultaneous occurrence and interrelation of
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BE AIM—

General.—SEWALL, HENRY. Some relations of the brain and of the olfactory
apparatus to the processes of immunity. Arch. Int. Med., 1914, xiii., June,
p. 850.

BLUM. Eine neue Idee sur Beseitigung der Hypertimie des Gehirna und der
inneren Organe. Berl. Klin. Wchnschr ., 1914, li., Juni 22, S. 1178.

Von Beeklliigbansen’s Disease.—LIKE, W. Ueber Neurofibromatose. Ztschr.
f. Klin. Med., 1914, lxxx., S. 261.

Meningitis.—NAPIER, A. D. L. Meningitis in infancy and early childhood.
Australian Med. Joum., 1914, iii., May 9, p. 1549.

F1NKELSTEIN, H. Zur Entstehungsweise seroser Meningitiden bei tuberkulosen
Kinderu. Berl. Klin. Wchnschr., 1914, li., Juni 22, S. 1164.

LAVAN, M. Sur la mdningite syphilitique metachancreuse et preroseolique.
Annates de Dermatol, et de Syphilig., 1914, v., Mai, p. 280.

HUBER. Pneumococcic meningitis and meningismus. Archives of Ped., 1914,
xxxi., May, p. 328.

KRAMER, S. P. Fatal accidents following the injection of antimeningitis serum.
N. Y. Med. Joum., 1914, xeix., June 6, p. 1139.

DARRE and DUMAS. Nouvelle esp^ce de paramJningocoque. Plurality des
parameningocoques. Compt. Rend. d. 1. Soc. de Biol., 1914, lxxvii., Juin 19,

p. 106.

Hydroeepkalns.—v. BLOMBBRG, FREIHERR. Ein seltener Fall von Hydro-
oephalus. Ztschr. f. d. ges. Neurol, u. Psychiat., 1914, xxv. (Orig.), S. 200.

Abscess.—DICK, G. F., and EMGE. L. A. Brain abscesB caused by fusiform
bacilli. Trans. Chicago Path. *Soc„ 1914, ix., March, p. 95.

Disseminated Sclerosis.—FLASCHEN, STAN. Ein Beitrag zur Aetiologie der
multiplen Sklerose. Ztschr. f. exper. Path. u. Therap ., 1914, xiv., S. 253.

DUGE. Ein Beitrag zur Kenntuis der Psychosen bei der multiplen Sklerose des
Gebirns und Ruckenmarks. Deut. Ztschr. f. Nervenheilk., 1914, li., S. 400.

■stmorrbage.—MARIE, PIERRE, aud LEON-KINDBBRG, M. Le coma dans
Tb4morragie c4r4brale. Trepanation decompressive du cote sain. Presse M4d.,
1914, No. 45, Juin 6, p. 429.

Embolism.—WEVER, E. Cerebrals Luftembolie. Beitrage z . Klinik d. Tuber -
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Hemiplegia.—CARRETIEB Entente aigue et bemipiegie. Archives de Mtd.
des Enfants, 1914, xvii., Juin, p. 445.

Monoplegia.—BERLINER. MAX. Uber einen Fall von hysterischen Monoplegia.
TFien. klin. Wchnschr 1914, xxvii., Juni 25, S. 939.

BIBLIOGRAPHY

PtMdo-Balbftr Paralysis.—DEJERINE. Lft paralysis pseudo-bulbaire. Journ .

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Tanaar*.—FRAZIER, C.-H. The cerebro-spinal fluid and its relation to bnin
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HARMS. Uber Hypophysenganggeschwulste. Ein kasuistiacher Beitng.
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Arroasegaly.— LEVY, L., and BOULUD, R. Glycosurie provoqude chei le chien
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Aphasia, — Van GKHUCHTEN and GOK1S, C. Un caa d'aphasie complete

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Van GKHUCHTEN aud Van GORP. Un ca* d'aphasie motrice par leeion du
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STERTZ. L>ie klinische Stellung der amneatischen und transkortikalen motor
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Pella*™.— FRAZER, T. Pellagra with late skin lesions: case report. Journ.
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ALESSANDRINI, G., and SOALA, A. Beitrag zur Atiologie und Pathogeneee
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BABES and JONESCO. Ia reaction d’Abderhalden chez lea pellagreux et cher
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Lead P#l*«aln*.^LINENTHAL, HARRY. The early diagnosis of lead-poisoning
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H A YH UR ST, EMERY R. Critical examination of one hundred painter* for
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Syphilis.—LEOPOLD, OTTO. Uber Nervenaymptome bei friacher Syphilis.
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RUHL, KARL. Zur Technik der Anwendung der Zielerschen 407jjen Kalo
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Salvarsaa.—LUITHLEN, F. Die gefahren der Salvarsantberapie. Thcrap .
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MARTINOTTI, L. Di una particolare propriety del Salvarsan. Suo possibile
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BIND. La s^reuse sous-arachnoidienne en regard de la syphilis. Influence du
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DRKSCH. Salvarsan, mercure et eaux sulfureuses dans le traitement de la
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M'CASKBY, G. W. The autonerosalvarsan treatment of syphilis of the central
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BAUM, O., and HERRENHEISER, G. Chemotherapeutische Versuche mit
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BUBERL. Zur Salvarsanbehandlung des Milzbrandkarbunkles. Munch Mtd.
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BIBLIOGRAPHY

73*

TAEGB. Bine Methode dor schnellsten Darstellung absolut steriler Kochsabz-
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SCHMITT. Die Sal varsantodesfalls und ihre Ursachen mit Beriicksichtigung der
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Neosalvarsan.—CRAIG, C. B. v and COLLINS, JOSEPH. Four yean' experience
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GIRSDANSKY, J. Neoealvarsan in concentrated solution. N. Y. Med. Joum.,
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SEGER, EMIL. Erfahrungen mit Neoealvarsan. Prayer Med. Wchnschr., 1914,
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RtfHL. Ueber Salvarsan und Neoealvarsan, besonders ambulatorisch angewendet.
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Lwetftw Reaction. —NANU - MUSCEL, ALRXANDRRSCA - DERSCA, and
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Wassermann Reaction.—HECHT, H. Zum Wesen der Wassermannschen
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RAYANT, PAUL. Les erreurs d'interprStation de la reaction de Wassermann.

Annales de Dermatol, et de SyphUig., 1914, v., Mai, p. 285.

STERN, M. Zur Theorie und Praxis der Wassermannschen Reaktion. Ztschr.

f. Immunitatsforsch., 1914, xxii. (Orig.), S. 117.

THOMPSON, LOYD. The titration of Wassermann reagents. Arch. Ini. Med.,
1914, xiii., June, p. 904.

STONE, CHESTER T. Sources of error in the Wassermann Technic. N. Y.

Med. Joum., 1914, xcix., June 20, p. 1242.

SOUTHARD, E. E. Statistical notes on a series of 6,000 Wassermann tests for
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PEASE, M. C. The provocative Wassermann reaction. Med. Record , 1914,
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Cerebrw-ftpiMl Field.—GLASER, ARTHUR* Zur ldinisohen Brauchbarkeit
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De CRINIS and FRANK. Ueber die Goldsolreaktion im Liquor cerebrospinalis.

Miinch. Med. Wchnschr ., 1914, lxi., Juni 2, S. 1216.

BOVERI. Eiue neue Reaktion der Zerebrospinalfliissigkeit. Miinch. Med.
Wchnschr ., 1914, lxi, Juni 2, S. 1215.

WECHSELBAUM and DINKELACKER. Uber die Beziehungen der allgemeinen
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SPAT, W. Zur Frage der Herkunft des luetischen Reaktionskoipers in der
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NONNR. Uber die Bedeutung der Liquoruntersuchung fiir die Prognose von
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1914, li., S. 155.

GUTMANN, C. Liquorbefunde bei unbehandelter Friihsyphilis. Dermatol.

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BABES, AUREL A. Le liquide cdphalo-raohidien dans les falmorragies craniennes.
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74*

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CLAUDE, H., PORAK, R., and ROUILLARD, J. Recherche* dt manometrie
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CtKAEBAL AND HNCT10V4L DlftEAHR*—

Epilepsy.—KELLNER. Die arztliche Versorgung der Anstalten fur Schwacb
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Hysteria.—LEVY, P.*E. A propos d'un cas d’hystcrie. Le traitement de*
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H ASCII E - KLUNDKR. Ein Fall von degenerativer Hysteria in engem
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RHEINDORF, A. Hysteroneuraathenie oder cbronisebe appendicitis? Btrl.
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GRIFFITH, J. P. C. Neurotic, psychasthenic and hysterical children. N.Y
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C'fearea*—DRAPER, A. P. The relationship between chorea and rheumatism.
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Xemrllls.—THORN VAL, A. Polyneuritis cerebralis menteriformis (t. Fonkl
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Nemralgla*—CAMP, CARL D. The treatment of trifacial neuialgia by the injection
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p. 1110.

LUCE. Beitrag zur Klinik der Hodeuneuralgie. Dent. Ztschr. /. Nenenheilk.,
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Senrastlseala*—HAIG, A., and OXON, D. M. Deficiency of chloride of sodium in
the etiology of neurasthenia. Med. Record, 1914, lxxxr., June 6, p. 1017

PaycMaae*.—BLOCK, S. A new psychosis. N.Y. Med. Journ., 1914, xcii.,
May 23, p. 1038.

MRRCKLIN, A. Die Psychosen imserer kleinst&dtischen Bevolkerung. Ztschr.
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LUTHER, A. Erblichkeitsbeziebungen der Psycbosen. Ztschr. f. d. gts. Neurol
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AleohallsaSy .PERELMANN, A. De la dipsomania. VEnciphale, 1914, lx.,

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SCHNEIDER. Zur Behandlung ties Delirium tremens. Milnch. Med-
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Kxspbtlialsile Goitre, Cretinism* de. — ABRAHAMS, R. The medical
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SONNE, CARL. Uebt das Antithyreoidin eine spezifische Wirkung gegeniiber
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PLETNEAV, D. D. Ueber den Basedowsyndrom, ein t re tend mit akuten in-
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GOETZKY, F., and WB1HE, F. Uber die Bedeutung der Rpiphysenscbatten
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Telaams. —IRONS, E. E. The treatment of tetanus by antitoxin. Journ. Amer.
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STEVENS, P, A. Treatment of tetanus by subdural injections of magnesium
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Tetany.— BEUMER, H. Das Dialysieverfahren Abderhaldens bei Reohitis und
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MASSLOW, M. Uber Verknderungen der Atmungskurren bei Kindern mit
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BIBLIOGRAPHY

75*

Addison's Mieue.—MUNZER, E. Bin Fall von Morbua Addiionii mit besonderer
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NlftCELUNRiOIIS SYMPTOMS AND CASES—

MAKUEN, G. H. A study of 1,000 cases of stammering 9 with special reference to
the otiology and treatment of the affeotion. Therap. Qaz ., 1914, xxxviii, June,

p. 386.

TURAN, F. Uber die neuralgiache Form der Angina pectoris. IPicn. Med.
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WEICKSEL. Ueber dystrophia adiposo-genitalis, Afiinch. Med. Wckn$chr. f
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AUER, JOHN. The effeot of intraepinal injections of serums, with and without
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RABINOWITZ, M. A. Two neurological cases in pediatric practice. Med.
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ORCHARD, N. G. A case of anorexia nervosa in an infant. Archives of Ptd. %
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R08ENSTERN, J. Uber spasmophile Diathese. Zischr. /. d. ges. Neurol . u.
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TOMASCHNY. Ein Beitrag zur Frage des PUegerunterrichtes. Zischr . /. d.

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SAENGER. Uber Eunuchoidism us. Zteul. Zischr. f. Nervenhcilk., 1914, li., S.
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SPECIAL SENSES AND CRANIAL N EM YES—

BOETERS, OSKAR. Vergleiohende Untersnohungen Uber den Drehnachny*
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PSYCHIATRY.

GENERAL PARALYSIS—

BONHOMME. Les acquisitions recentes dans le domains de la paralysis glntode.

Jfer. Aftrf. de 2a &utue Roto., 1914, xxxiv., Mai 20, p. 338.

RIGGS, C. E. Juvenile paresis treated by the intraepinal injection of salvarsan-
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p. 1888.

COLLIN, A. Quelle est la forme olinique de la syphilis qui aboutit le plus
souvent k la paralysis g4n4rale? Gaz. aes H&p., 1914, lxxxvii., p. 1125.
PASCAL, C. Forme paranoids de la paralysis glnlrale. L'Enctphale , 1914, lx.,
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BANSE, H., and RODERBURG, H. Bcmerkungen Uber die progressive Paralyse
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LAUSCHNER. Die Frage der leichten Lues und der spfcteren Paralyse. Zischr.

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LIND, W. A. T. A case of juvenile general paralysis of the insane. Australian
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DEMENTIA PRRCOZ—

MEGGENDORFER. Uber Syphilis in der Asoendenz von Dementia ptaeoox-
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SIMON, C. E. The Abderhalden-Fauser reaction in mental diseases, with special
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p. 1701.

ROSS, ELLISON L. Metabolism in dementia prseoox. Arch. Int. Med., 1914,
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SCHRODER, M. Todesursachen schizophrener Frauen. Zischr. f. d. ges. Neurol
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GENERAL—

DUFOUR, H. Trois cas de psychoee polynrfvritique ou maladie de Khorsakoff,
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BURR, C. W. Chronic dementi*, cerebellar ataxia and epileptiform convuliioni
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PARHON and ODOBKSCO. Sur un syndrome peycho-endocrimen carseterii*
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WOODBURY. F. The treatment of the insane in the tropics. N.Y. Med
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ROSENTAL, STEFAN. Zur Methodik der Schadelkapazitatsbestimmimg ©it
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FROMMER, K. Ein durch seinen Verlauf und seine Sphtgenesung bsschten-
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KRETSCHMER, E. Wahnbildung und m&nisch-depreasiver 8ymptorakomplex.
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FISCHER, MAX. Berufsgeheimnis und Herausgabe der Krankengeschichten.
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ALBRECHT. Kasuiatischcr Beitrag zur Konstanz der Wahnideen und Sinnw-
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SIEMENS, F. Die Provincial-Heilanstalt Lauenburg in Pommern nsch 25
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LIND, J. E. Diagnostic pitfalls in the mental examination of negroes. N. Y.
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BISCH, L. E. The recognition of mental deficiency. N. Y. Med. Joum., 1914,
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DENDY, MARY. Feeble-minded children. Joum. State Med., 1914, nil,
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JAR RETT, MARY C. The function of the social service of the psychopathic
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SCHLAPP, MAX G. An economic and social study of feeble-minded women.
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TREATMENT.*

LIEBESNY, P. Elektropbysiologische Studien zur Therapie der Lahmungen. Wien.

Med. Wchntchr ., 1914, lxiv., Juni 27, S. 1450.

LAPINSKY, MICHAEL. Tiber mechanische Bader in der neurologiachen Praxii
(hydraulische Massage). Neurol. Ccntralbl., 1914, xxxiii., S. 743.

ZEUNER, W. Pbenoval als Beruhigungsmittel fur die Nerven. ZentralhL f.d.get .
Therap ., 1914, xxxii., Mai, S. 227.

p§ych#*B*Iy»i»«— PUTNAM, JAMES J. The present status of psychoanalytic
Boston Med . and Surg. Joum., 1914, olxx., June 11, p. 897.

CLARK, L. PIERCE. Some nersonal results in psychoanalysis and the future of
psychotherapy. Boston Med. and Surg. Joum., 1914, clxx., June 11, p. 903.
BURROW, T. The psychanalyet and the community. Joum. Amer Med.
Assoc., 1914, lxii., June 13, p. 1876.

HAMBURGER, F. Uber Psychotherapie im Kindesalter. Wien, Med.

Wchnschr 1914, lxiv., Juni 13, S. 1313.

GOTT. Psychotherapie in der Kinderheilkunde. Munch. Med. Wchnschr.,
1914, lxi., Juni 23, S. 1377.

* A number of referenoee to papers on Treatment are inoluded io the Bibliography under
Individual diseases.

Bibliography

ANATOMY.

LEWY, F. H. Beitrag zur Kenntnis der Lymphwege das Gehirns. (Dei Transport in
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MtfHLMANN, M. Uber die cbemisohen Bestandteile der Nisslkorner, Archiv f.
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KRAMER, J. G., and TODD, T. W. The distribution of the nerves to the arteries
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MANOUELIAN, T. Recherche# sur le plexus cardiaque et sur l’innervation de
l’aorte. Annales de VInstilut Pasteur , 1914, xxviii., p. 579.

MANOUELIAN, Y. Remarq ue k propos de l’existence des centres uerveux dans
les organes. Annales de VInstilut. Pasteur , 1914, xxviii., Juin, p. 584.

RUPP, C. Anwendung der Gelatine sum Konservieren und Befestigen mikroskopischer
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PHYSIOLOGY.

WESSBERGE. Variations de poids subies par la substance blanche et la substance
grise du cerveau de cheval immerg^es dans des solutions de NaCl, KC1, et CaCl^.
Compt. Rend. d. 1. Soc. de Biol., 1914, lxxvii, p. 194.

AMANTEA, G. Effetti di compression! circoscritte graduate sulla zona corticale
sigmoidea del cane. Archivio di Fisiol ., 1914, xiL, Marzo, p. 245.

DIXON, W. E., and HALLIBURTON, W. D. Cerebro-spinal fluid.—III. The general
effects of increasing the cerebro-spinal pressure. Joum. de Physiol ., 1914,
xlviii., p. 317.

FOA, C. Nouvelles recherche* sur la fonction de la glande pindale. (Avec une planche.)
Arch. ital. de Biol., 1914, lxi., p. 79.

BROWN, T. GRAHAM. The phenomenon of augmentation of excitability in the
motor cortex. Joum. of Physiol , 1914, xlviii. ( Proc. Physiol. Soc., xxix.).

BROWN, T. GRAHAM. Motor activation of the post-central gyrus. Joum. of
Physiol., 1914, xlviii. (Proc. Physiol. Soc., xxx.).

BROWN, T. GRAHAM. A respiratory tract in the mid-brain. Joum. of Physiol.,
1914, xlviii. (Proc. Physiol. Soc., xxxii.).

BROWN, T. GRAHAM. Note on the functions of the post-central gyrus in the
anthropoid ape. Joum. of Physiol. 1914, xlviii. (Proc. Physiol. Soc., xxxiii.).

BROWN, T. GRAHAM. Studies in the physiology of the nervous system.—XX.
Rhythmic movements as immediate reflex phenomena of compound stimulation
(progression conditioned by antagonistic reflex stimuli). Quart. Joum. Exp. Physiol.,
1914, viii., p. 155 : XXI. Rhythmio movements as successive (or terminal) reflex
phenomena of compound stimulation (progressive conditioned by antagonistic reflex
stimuli). Ibid., p. 193.

78*

BIBLIOGRAPHY

HOFFMANN, PAUL. Uber die Begegnung zweier Erregungen in der Nerrenfaser.
ZUchr. f Bid., 1914, lxiv., S. 113.

DURANTE, L. Contribution k la physiopathologie des nerfs splanchniauee, en rapport
avec la pathog4nie de 1*ulcere gastrique. Arch. UcU. dc Biol., 1914, lxi., p. 112.

MORAT and PETZBTAKI8. Production de la fibrillation doe oreillettee par voie
nerveuse, au moyen de l’excitation du pneumogastrique. Compt . Rend. a. 1. Soc.
de Biol., 1914, lxxvii., p. 222.

OATDA, T. Sul ricambio gaaeoeo dell* eneefalo. Archirio di Fisid , 1914, xiL, Mano,
p. 215.

BERITOFF, J. 8. Uber die Erregungsrhythmic der Skelettmuekeln bei der re-
flektorischen Innervation. ZUchr . /. Biol., 1914, lxiv., S. 161.

BERITOFF, J. S. Die zentrale reziproke Hemmung anf Grand der elektriechen
Erscheinungen am Muskel.—I. Mitteilung. Uber die Hemmungurhythmik bei der
reflektorischen Innervation. ZUchr. f. Biol., 1914, lxiv., S. 175.

HACKER, F. Vereuche uber die Schiohtung der Nervenenden in der Hant. ZUchr .
/. Biol., 1914, lxiv., S. 189.

HACKER, F. Reversible L&hmungen von Hautnerven doroh Sfcuren und Seize.
ZUchr. f. Biol., 1914, lxiv., 8. 224.

WEBER, E. Der Nachweis der durch Muskelarbeit herbeigcfiihrten zentralen

Ermiidung lurch die Veranderung der bei Muskelarbeit eintretenden
Blutverscniebung. Archiv f. And u. Physiol., 1914 (Physiol. Abtlg.), H. iii. u.
iv., S. 290.

WEBER, E. Das Verh&ltnis der Muskelermiidung zur Gehirnermttdung bei
Muskelarbeit. Archiv f. A not. u. Physiol., 1914 (Physiol. Abtlg.), H. iii. u.
iv., S. 305.

WEBER, E. Die Beechleunigung des Eintretens der zentralen Ermiidung bei
Muskelarbeit durch eine kurze Arbeitspause. Archiv f. Anal. u. Physiol., 1914
(Physiol. Abtlg.), H. iii. u. iv., 8. 330.

CLOETTA and ANDERES. Zur Kenntnis der Lungenvasoraotoren. Archiv f. exp.
Path. u. Pharmakol. , 1914, lxxvii., S. 251.

WALLER, W. W. Excitation of the sudo motor nerves of the cat’s foot by oondenser
discharges. Journ. of Physiol., 1914, xlviiL (Proc. Physiol. Soc., xlviii.).

RONCATO, A. Influence du labyrinths non-aooustique sur le d4veloppement de
l'eoorce corebelleues. Arch. ital. de Biol., 1914, lxi., p. 93.

TA8H1RO and ADAMS. Carbon dioxide production from the nerve fibre in a
hydrogen atmosphere. Anver. Journ. Physid., 1914, xxxiv., p. 405.

LILLIE, R. 8. The conditions determining the rate of conduction in irritable tissues
and especially in nerve. Amer. Journ. Physiol., 1914, xxxiv., p. 414.

BAINBRIDGE, F. A. On some cardiac reflexes. Journ. of Physiol. , 1914, xlviii., p. 332.

FUNK, CASIMIR, and SCH0NBORN, E. v. The influence of a vitamine-free diet on
the carbohydrate metabolism. Journ. of Physid., 1914, xlviii., p. 328.

CARNOT and COIRRE. Localisation du brome apr&s son administration therapeutique.
Compt. Rend. d. 1. Soc. de Biol., 1914, lxxvii., p. 197.

HERRING, P. T. The origin of the active material of the posterior lobe of the pituitary
bodv. Quart. Journ. Exp. Physid., 1914, viii., p. 245; the physiological activity
of the pars intermedia ana pars nervosa of the ox pituitaiy quantitatively compared.
Ibid., p. 267.

HILL, R. L, and SIMPSON, 8. The effect of pituitary extract on milk secretion in
the goat. Quart. Journ. Exp. Physid., 1914, viii., p. 103.

HEWITT, J. A. The influence on metabolism of administration of small amounts of
thyroid gland and of anterior lobe of pituitary. Quart. Journ. Exp. Physid 1914,
viii., p. 113; and of posterior lobe of pituitary. Ibid., p. 297.

GARNIER and SCHULMANN. Action des extraits oombin4s de surrtnale et
d’hypophyse poetcrieure sur la s&r4tion urinaire. Compt. Rend. d. L Soc. de Bid,
1914, lxxvii., Juillet 24, p. 388.

ANTONI, N. R. E. Adrenalin und Pupille. Neurd CentralbL, 1914, xxxiii, Juni 1,
S. 674.

BIBLIOGRAPHY

79*

PSYCHOLOGY.

WATT, H. J. Psychological analysis and thsory of hearing. Brit. Joum. Psychol.,
1914, vii., p. 1.

THOMSON, G. H. The aocuracy of the <p (y) process. Brit. Joum. Psychol ., 1914, vii.,
p. 44

HOWARD, R. A note on pictorial balance. Brit. Joum. Psychol ., 1914, vii., p. 56.

CARET,.N, An improved colour wheel. Brit. Joum. Psychol ., 1914, vii., p. 64.

MYERS, C. S., and VALENTINE, C. W. A study of the individual differences in
attitude towards tones. Brit. Joum. Psychol ., 1914, vii., p. 68.

MYERS, C. S. Two cases of synesthesia. Brit. Joum. Psychol ., 1914, vii., p. 112.

VALENTINE, C. W. The method of comparison in experiments with musical
intervals and the effect of practice on the appreciation of diaoords. Brit. Joum.
Psychol ., 1914, vii., p. 118.

HALL, G. STANLEY. A synthetic genetic study of fear. Amer. Joum. Psychol.,
1914, xxv., p. 821.

FOSTER, W. S. On the perseveretive tendency. Amer. Joum. Psychol ., 1914, xxv.,
p. 393.

TITCHENER, E. B. An historical note on the James-Lange Theory of emotion.
Amer. Joum. Psychol ., 1914, xxv., p. 427.

FERNBERGER, S. W. Note on the affective values of oolours. Amer. Joum. Psychol .,
1914, xxv., p. 448.

LELESZ, H. L’orientation d’esprit dans le tdmoignage. (5 fig.) Archives dt Psychol .,
1914, xiv., p. 113.

OD1ER, OH. Apropos d*uncas de contracturehysterique. (2fig.) Archives dePsychol.,
1914, xiv., p. 158.

DEGALLIER, E. Horlogerie et psychologic. Archives de Psychol ., 1914, xiv., p. 202.

REICHARDT. Ueber die Folgen psyobischer Vorg&nge auf Korper und Seele.
Fortsch. d. Med., 1914, Feb. 12 und 19, S. 173 und 215.

BOCCI, B. La psiohe emotive. Rassegna di Studi Psichiat ., 1914, iv., Maggio-Giugno,
p. 393.

HAENEL, HANS. Neue Beobachtungen an den Elberfelder Pferden. Neurol.
Centralbl., 1914, xxxiii., Juli 1, S. 805.

MIDDLEMI3., J. E. Some oases of psychological interest from private practice.
Joum Ment. Sci ., 1914, lx., July, p. 451.

HASS ALL, JAMES C. Constitutional psychopathy in children. Pediatrics, 1914,
xxvi., July, p. 376.

VALLON and FURS AC. La timidity sexuelle au point de vue medicolegal. Archives
cTAnthropol. Criminelle , 1914, xxix., p. 186.

PATHOLOGY.

KRAUS, E. J. Uber einen Fall von pigmentiertem Gliom bei mnltiplen Gliomen des
rechten Seitenventrikels. Zugleich ein Beitrag sur Kenntnis der Pigmentbildung.
Virchoufs Archiv., 1914, ocxvu., S. 121.

MATTIOU, L. Su l’origine della “ Plasmazellen” e la loro nresenza nel sangue
oircolante. Riv. di Patol. nerv. e ment., 1914, xix., Luglio, p. 266.

TODDE, CARLO. Rioerche sulla funxione e sulla struttura delle ghiandole sessuali
maschili nelle malattie mentali. Riv. Sper. di Freniat., 1914, xl., pp. 1-64.

SANGUINETI, L. R. Influenza della sostanze nervine su raccrescimento dei nervi
u in vitro." Riv. di Patol. nerv. e ment., 1914, xix., Luglio, p. 257.

BUSCAINO, V. M. Graisses, sterines et lipoides dans le syst&me nerveux central en
conditions normalee, experimentales et pathologiques. Arch. ital. de Biol., 1914,
lxi., p. 69.

SHINYA, S. Experimentalversuohe Uber Muskeltransplantation mit BerUcksiehtigung
der Innervation von neugebildeten Muskelfasern. Beitrage z. path. Anat. u. z. aUg.
Path., 1914, lix., S. 132.

80*

BIBLIOGRAPHY

SACQUEPEE and DELATE R. Nouveau milieu do culture pour le mrfningoooque et
lea germea voisins. Compi. Rend. d. L Soc. de Biol., 1914, lxxviL, p. 224.

DOPTER and PAURON. Diff^rendation dea paramlningoooques entre eux par la
aaturatiou dea agglutinines. Compi. Rend. d. 1. Soc. de Biol., 1914, Ixxvii., p. 231.

CLINICAL NEUROLOGY.

GENERAL—

GUILLAIN and LAROCHE. La fixation dea poiaona but le syst&me nerveux.
Prog. mid., 1914, xliL, Juillet 11, p. 325.

QUINCKE, H. Uber die therapeutiachen Leiatungen der Lumbalpunktion.
Therap. Mortal* ., 1914, xxviii., Juli, S. 469.

RINDERflPACHER. Die Bedeutung der Lumbalpunktion ftlr die Begutachtung
von Kopfverletzung. Fortsehr. d. Med. , 1914, xxxiL, S. 405.

NERVES—

WOODWARD, CHAD. Injury to the deep branch of the ulnar nerve. Proc.
Roy. Soc. Med., 1914, vii., June (Sect. Study Dia. Child.), p. 151.

MUSCLES—

HERZ, A. F. Three membera of one family Buffering from Myotonia Hyper>
trophic*—the hypertrophic form of Thomsen's diaeaae. Proc. Roy. Soc. Med. .
1914, vii., June (Clin. Sect.), p. 139.

SPINAL CORD—

General.—CAMPORA, GIOVANNI. Aaaenza del rifleaao radiale e del rifleaao di
pronarione dell’ avambraocio, oonservazione del rifleaao del tendine bicipiteo per
leaione della 6» radioe cervicale. Riv. Iial. di Neuropat., Psichiat . cd
Etettroicr ., 1914, vii., Giugno, p. 241.

GOMBEL, TH. Zur Behandlung der apaatiaohen L&hmungen mit der Foerater’*
achen Operation. Berliner klin. Wchruchr., 1914, li., Juli 20, S. 1353.

Spina Bifida.—SMITH, E. B. Spina bifida occulta. Proc. Roy. Soc. Med., 1914,
vii., June (Sect. Study Dia. Child.), p. 147*

NAGEOTTE-WILBOUCHEWITCH. Un caa de spina bifida ooculta, acoliaae par
malformation de la cinquieme vert&bre lombaire. Archive* de M6d. de*
Enfant a, 1914, xvii., Juillet, p. 531.

Tnmoars.— BAILEY, PEAKCK. Painleaa tumours of the spinal cord. Journ.
Artur. Med. Assoc., 1914, lxiii., July 4, p. 6.

BABIN SKI, J., LECENE, P., and JARKOWSKI, J. Paraplegic crurale par
ndoplaame extra-durt-mdrien Operation. Gu4riaon. Rev . Neurol., 1914, xxii.,
Juin 30, p. 801.

Brown-Sequard Symptom-Complex.— DUPR6, HEUYER, and BERGERET.
Syndrome de Brown-S4quard (plaie de la moelle cervicale par balle). Rev.
Neurol., 1914, xxii., Juin 15, p. 741.

Tabes Dorsalis.—VIX. Der heutige Stand der Tabes-Paralyae-Frage. Fortechr.
d. Med., 1914, xxxii., S. 609.

RICHTER, HUGO. Zur Hiatogeneae der Tabea. Vorl&ufige Mitteilung.
Neurol. Centralbl., 1914, xxxiii., Juli 16, S. 882.

SAUVri, L. Lea interventions chirurgicalea dans lea crises gaatriquea du tabea.
Prog. Med., 1914, xlii., Mai 2, p. 206.

DAUWE, F. L’hypers4cr4tion dans lea criaea gaatriquea du tab&s avec eaaai de
pathogenic. Joum. de Neurol ., 1914, xix., Avril 20, p. 141.

EXNER, A., and SCHWARZMANN, E. Gaatrische Krisen und Vagotomie.
Mitteil . a. d. Orenzgeb. d. Med . u. Chir., 1914, xxviii., S. 15.

STEW"ART, PURVES. The diagnosis and treatment of oerebro-apinal syphilis,
including tabes and general paralysis. Brit. Med. Joum. , 1914, May 2, p. 949.

Poliomyelitis Anterior Aenta.—FRASER, FRANCIS R. Clinical observations
on ninety cases of acute epidemic poliomyelitis. Amer. Joum. Med. Set., 1914,
oxlviii., July, p. 1.

BIBLIOGRAPHY

81*

BURNETT, ROBERT. Poliomyelitis. Joum. State Med., 1914, xxii., April,
p. 193.

BATTEN, F. E. Further note on the use of celluloid splints in the treatment
of acute oases of poliomyelitis. (IUu»t) Lancet, 1914, clxxxvii., July 25,

p. 216.

CYRIAX, E. F. The mechano-therapeutics of chronio infantile paralysis (polio*
myelitis anterior acuta). Brit. Journ. Child. Die., 1914, xi., p. 155.

BBAUV—

Cemerml.—WYNNE, F. E. Tubercle of the crus cerebri simulating enteric fever.
Lanai, 1914, clxxxvi., June 13, p. 1676.

STERN, A. Uber eine Schussverletxung des Thalamus opticus nebst Bemerkungen
liber Tractus-Hemianopsie. Neurol. Centralbl., 1914, xxxiii., Juni 1, S. 683.

FULPIUS, Q. A propos d’un cas de syndrome thalamique. Rev. mid. d. 1.
Suisse Rons., 1914, xxxiv., Juin, p. 418.

REIOHARDT, M. Hirn und Korper. B. Das Kdrpertemperatur bei Hirnkrunk-
heiten. C. Die vasomotoriBch-trophischen Funktionen bei Hirnkrankheiten.
Arbeiten a. d. psychiat. Klinik zu Wurzburg, 1914, H. viii., S. 1.

REICHARDT, M. Die physikalischen Eigenschaften und Zustands&nderungen
des Gehirnes und die FliU8igkeit8verhaltniB8e in der Schadelhohle. Arbeiten
a. d. psychiat. Klinik zu Wurzburg, 1914, EL viii,, S. 251.

REICHARDT, M. Uber normale und Elrankhafte Vorgange in der Hirnsubstanx.
Arbeiten a. d. psychiat. Klinik zu Wurzburg, 1914, H. viii., S. 647.

JANICHEWSKY, A. Le rdflexe de prehension dans les affections organiques de
l’enc^phale. (2 fig.) Rev. Neurol., 1914, xxii., Mai 30, p. 678.

Skull Injury, Ac.—SOLIERI, SANTE. Ueber die Stichwunden des Gehirns
von der Schfcdelbasia aus. Arehiv /. Klin . Chir., 1914, ch, S. 153.

Yen Recklinghausen's Disease.—SCHOONHEID, P. H. Beitrag xur Kasuistik
und Kenntni8 der multiplen Neurofibrome der Haut. Dermatol. Ztechr., 1914,
xxi., Juli, S. 610.

Disseminated Sclerosis.—STAMM, CARL. Bin Fall von multipler Skleroee
im Kindesalter. Arehiv f. Kinderheilk, 1914, lxiii., S. 199.

(Cerebellar Ataxia.—BLAUNER, S. A. Hereditary cerebellar ataxia. N. Y.
Med. Joum., 1914, c., July 11, p. 83.

Meningitis.-CLARKE, J. MICHELL, SYMES, J. ODERY, and VEALE, P. J.,
A small outbreak of epidemic cerebro-spinal meningitis. Brit. Med. Joum.,
1914, June 13, p. 1286.

COMBY and CONDAT. M4ningite odr4bro*spinale avec arthrites k mlningo-
ooques. Archives de Mid. des Enfants, 1914, xvii., Juillet, p. 527.

SMITH, W. M. Meningitis in children. Brit. Med. Joum., 1914, May 2,
p. 962.

KERR, CHARLES. Case of chronic primary pneumoooocal oerebro-spinal
meningitis. Edin. Med. Journ ., 1914, xiiL, July, p. 55.

DUFOUGERE, W. La m^ningite k pneumoooques des tirailleurs rfnlgalais.
Bull. d. 1. Soc. de Path. Exotique, 1914, vii., p. 466.

HUMBERT, G., and ALEXIEFF, W. Contribution k l'dtude de la mlninrite
cancereuse. Etude anatomo-clinique. Rev. de Mid., 1914, xxxiv., Janvier,
p. 44.

BARTHELEMY, R. Les hlmorragies mfoingles. (Rev. g4n.) Prog, mid.,
1914, xlii., Mai 8. p. 217.

CLEGG, J. G. A case of orbital oellulitis produoed by ethmoidal sinusitis.
Purulent meningitis. Death. Med. Chron., 1914, lix., April, p. 17.

MILLER, JAMES, and HEWAT, A. FERGUS. A case of tuberculous disease
of vertebras complicated by an extensive acute suppurative meningitis.
Lancet, 1914, clxxxvii., July 25, p. 222.

Abscess.—WILKINSON, GEORGE. A caso of paralysis of the external rectus
muscle due to the presence of an abscess in the apex of the petrous pyramid.
Death from basal meningitis. Joum. LaryngoL, Rhinal, and Otol ., 1914,
xxix., Aug., p. 409.

82*

BIBLIOGRAPHY

DAVIS, H. J. Bilateral temporo-sphenoidal abscess in a girl, aged 16;
operations; recovery. Proc. Hoy. Soc. Med., 1914, vil, June (Otol Sect),
p. (59.

O’lit.—TURNBULL, A. Cerebral cyst without localising symptoms. Brit. Mtd.
Journ 1914, June 20, p. 1350.

PUSSKI\ L. Die operative Entfernung eine Zyste der Glanduk pinealii
A enrol. Centralb/m, 1914, xxxiii., Mai l r $. 5(50.

UffiuorrhAjce. OPPENHKIM, R., and OLKRKT, H. Lea reactions noeningees
au cout'H do Vhemorragie cerchrale latente. Pray. Med . 1914, xlii., Avril 25,
p. na

WIRGMAN, 0. WYNN. Angeioma in cerebellar peduncle: fatal intracranial
hemorrhage. Lancet, 1914, clxxxvi., June 20, p. 174(5.

Aarurl«m. RHElN, JOHN II. W. Aneurism of the vessels of the brain
Journ. Acre, and Mint. Dis., 1914, xli., June, p. 30<J.

Dtplcffln—SAVAKIAUD, M. Little’s disease and its surgical treatment. Med.
Press, 1914, cxlix., July 1, p. 11.

Hrmlpleitlu.—LHEKMITTE, J. Sur quelquea phenomfcnes nouveaux dani
rhemiplegie organique. Scmainc tried., 1914, xxxiv,, Juillet 22, p. 337,

Tumours. —HOWLAND, G. \V. The diagnosis of subtentorial tumours. With
a report of four cases. Canadian Mtd . Assoc. Journ., 1914, iv., July, p. 604.

STRINGER, (l.-H. A case of cerebral tumour involving the fourth ventricle and
causing glycosuria. Journ. Roy. Army Med. Corps, 1914, xxiii., July, p. 08.

v. MALAISE, Hirntumordiagnosen. Munch. Med. Wcknschr., 1914, Ixi, Juli
14, S. 15*52.

ALEXANDER, W., ami l T NOER, E. Heilung eines bemerkenswerten Growbirn-
tumors. Berliner klin. Wcknschr., 1914, li., Juli 27, S. 1408.

NOVAK, JOSEF. 1 eber kunstlichc Tumoren der Zirbeldriisengegend. Wien,
kiin . Wchnschr., 1911, xxvii., Juli 2, 8. 974.

Pituitary Tumours, *tr.—Ill RSUH, OSKAR. Operative Behandlung der Hypo*
physciitumoren. IGni. Mtd. Wcknschr., 1914, lxiv., Juli 4, S. 1519.

EEARNSIDKS, E. G. Diseases of the pituitary gland and their effect on the
shape of the sella turcica. Lancet, 1914, clxxxvii., July 4, p. 10.

JOHNS* >X. W. A pathological investigation of four cases of pituitary tumour.
La nett, 1914, clxxxvii., July 4, p. 24.

lHabtCe* Insipidus.—CAMUS, J., and ROUSSY, G. Diabeteinsipideet polyurie
dite hypophysairo. Regulation de la teneur en eau de Torganisme. Prtsx
Mtd 1914, Juillet 8, p. 517.

Aphasia, Ac. —DURUY. EUGENE. A lecture on localisation of motor and speech
centres in definite areas of the cortex of the brain. Lancet, 1914, clxxxvii.,
July 25. p. 207.

DAVIDENKOF, SERGE. Sur certains troubles psychiques observe dsni
i'aphasie. Rev. At and., 1914, xxii., Jilin 30, p. 806.

Pellagra. —FRAZER, T. Mental and nervous manifestations of pellagra. Mtd.
Record, 1914, Ixxxvi., July 11, p. 05.

WILLCOCKS, R. W. The occurrence of pellagra in England. Practitioner ,
1914, xciih, July, p. 100.

Lend Poisoning.—STAINTHORPE, \V. W. Observations on 120 cases of lead
absorption from drinking water. Lancet, 1914, clxxxvii., July 25, p. 213.

OLIVER, Sin THOMAS. Lead poisoning from industrial and medical points of
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SELLERS, A. Blood changes in lead workers. Journ . Roy. Sanitary Institute,
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Myasthenia-—OOODHART, S. P. Myasthenia gravis. A.Y. Med . Journ.,
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DILLER, THEODORE, and ROSENBLOOM, JACOB. Metabolism studies in
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83 *

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Salvarsan.— WE YGANDT, J. V. K. Klinische und experimentelle Erfahrungen
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TAKAHASHI, AKIRA. Uber das Schicksal von intramuskular und subkutan
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WALDO, F. J. An inquiry into a death after two intravenous injections of
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HOFFMANN. Darf bei weichen Schankergeschwiiren propbylaktisch Salvarsan
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NeosalvarsAn. —DAMANY, P. LE. Injections intra-veineuses de n^o-salvarsan
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BIACH, P., KERL, W., and KAHLER, H. Zur Kenntnis der Veranderungen
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STtJHMER, A. Zur Topographic des Salvarsans und Neosalvarsans. Archtv
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BUNCH, J. L. Salvarsan and neo-salvarsan in the treatment of hereditary
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EuetlB Reaction.— KLAUSNER, E. Die Kutireaktionen bei Syphilis mit
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Wasserniann Reaction. —GRADWOHL, R. B. H. The Hecht-Weinberg reaction
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84*

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BRAUN, P., And MONTLAUR, H. Un« simplification de 1* technique del*
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THOMAS, B. A., and IVY, R, H. Observations on the Wassermann reaction.
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FLETCHER, \VM. The Wassermann reaction in malaria. Lancet , 1914,
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C*erebpo*SplnaI Flmld.— CHAUVET, S. De la pression du liquide cephxlo-
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BOVKRI, P. Di una nuova rearione del li<{uido cefalo-rachidiano. Ifrr. di
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BIONDI, GIOSUE. Lo stato attualc degli studii istologici sui lipoidi del tdatems
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gBNKBU AND FUNCTIONAL DISEASES—

Epilepsy.—SHAW, J. J. M. Epilepsy ; a theory of causation founded upon the
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ABBOTT, E. STANLEY. A case of pure psychic epilepsy. Journ. Nerv. and
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SHAW, B. HENRY. The relationship between epilepsy and tuberculosis,
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KALISCHER, S. Die Retiexcpilepsie und ihre chirurgische Behandlnng.
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BOLTEN, G. C. Ueber Wesen und Beh&ndlung der sogenannten “genuinsn”
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AUSTREGESILO, A., and AYRES, O. Myoclonia et dpilepsie (syndrome de
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GORN f W. Uber Myoklonie, Myoklonus-Epiiepsie und verwandte Kiankheiten.
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PELLACANI, G. Ricerche suila deviazione del oomplemento nelT epUesiia.
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NIKITIN. Ueber den Einfluss der Schutzimpfungen gegen Lyna auf den
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ULRICH, A, Beitrag zur Technik der wirksamen Brombebandlung der Bpilepm*
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BIBLIOGRAPHY

85*

Paramyoeloans.—WILLIAMS, E. M. Paramyoclonus multiplex, including a
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Hysteria.— AMES, T. H. Analysis of blindness as a symptom of hysteria.
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GRANT, J. W. G. Some cases of traumatic hysteria. Lancet, 1914, clrxxvi.,
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ANTONI. Ein Beitrag xur Kenntnis der Dermatosen bei Hysteria. Munch.
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Chorea.—M‘KINNISS, C. R. The value of eugenics in Huntington’s chorea.
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Xearltls.— DAVIES, N. Neuritis: treatment by electricity. Practitioner f 1914,
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DOBROKHOTOW, M. Sciatique radiculaire. Effets th^i^peutiques des bains
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Berl-Berl.— SMITH, F. Beri beri on polyneuritis among British troops in India.
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BRADDON, W. L., and COOPER, E. A. The influence of the total fuel-value
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KING, H. D. The etiological controversy anent beri-beri, with some remarks as
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Nearalgls.—AIMES, A. La n^vralgie spinale de Brodie (pseudo-mal de Pott
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Ll^PINAY, M. de. Las ndvralgies pelviennes d’origine genitale chez la femme
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Mearasthenla.—HURRY, J. B. The vicious circles of neurasthenia. Brit. Med.
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KRONFELD, A. Ueber die psyobologische Entstehung sogenannter Unfall-
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RHEINDORF, A. Hysteroneurasthenie oder chronische Appendicitis ? Berliner
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Nearoses.—GRANT, J. W. GEARY. The traumatio neuroses: some points in
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July, p. 26.

KNEPPER. Rentenaufhebung bei angeblicher traumatischer Neurose. Fortseh.
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LIilVY, P. E. Le traitement des n^vroses par l’eduoation de la volont4. Journ.
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Psychoses.—MOSHER, J. M. The psychosis of adolescence. Albany Med.
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MYERSON, A. A note on the relative weight of the liver and brain in
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Alcoholism, Ac.—LESSEY, Rev. S. S. The management of the male inebriate
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COOPER, J. W. ASTLEY. The care and control of inebriate men. Brit.
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MILLER, H. C. Psychotherapy and the determination of conduct in the
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HARE, F. The management of the male inebriate. Brit. Journ . Inebriety,
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THORNE, GUY. The inhalation of cigarette smoke and its relation to chronic
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Exophthalmic Goitre, Cretinism, Ac.—LEGGETT, W. Mental symptoms
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GLASERFELD, BRUNO. Die Erfolge der operativen Behandlung des Morbus
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BIBLIOGRAPHY

8G<

KEMPNRR, A. Dio bisherigen Erfahrnngen tiber Basedow and JodbwedoT
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MATTI, H. Die Beziehungen der Thymus mm Morbus Rasedowii. Berliner
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SZKL, PAUL. I'eber alimentare Galaktosurie bei MorbusBasedowi. Ww. 11 m,
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FAKKANT, RUPERT. The causation, prevention, and cure of goitre, endemic
and exophthalmic. Brit. Med. Journ. , 1914, July 18, p. 107.

HUCKELL, HOY. A case of myxcedema. Australian Med. Journ., 1914, iii,,
June 20, p. 1610.

3DCARR1SON, R. Nervous cretinism, Proe. Boy. Soc. Med., 1914, vii., Jane
(Sect. Study Die. of Child.), p. 157.

COBH, I. G. A case of hypothyroidism in a mala Brit. Mtd. Journ, 1914,
June 20, p. 1349,

VALTORTA, D. Ricerche urologiohe ed ematologiche in frenastenid am sin-
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1214, xxviii., p. 147.

Tetaawa.—STROHMEYKR. Zur Magnesium be hand lung des Tetanus. MwL
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PARK, WM. H., and NICOLL, M. Experiments on the curative vslue of the
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Tetaay.—MORGKNSTERN, K. Elektrokardiographiscbe Untersuchungen iiher
die Be/dehungen des Herzmuakels zur Spasraophilie (Tetanie) im fruhen
KindeHalter. Ztschr.f. Kinder he ilk ., 1914, xi (Orig.), 8. 304.

SPECIAL IFASE.4 AMD CKANIAL NEB YES—

HANSELL, H. F. Acute double optio nerve atrophy. N. Y. Mtd. Joum., 1914,
c., July 18, p. 128.

BYERS, W. G. M, Tumours of the optic nerve. Journ. Anur. Med. Auoe.,
1914, lxiii., July 4, p. 20.

FRANCIS, L. M. Two cases of acute retrobulbar neuritis, associated with
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GKADLK, H. E. A subjective examination of the papillary reflexes. Archives
of Ophthalmol. , 1914, xliii., July, p. 377.

LOEPER, MOUGBOT, and VAHRAM. Abolition frdquente du rdflexe oculo-
cardiaque chez lea syphilitiques. Prog. Med., 1914, xlii, Avril 4, p, 157.

SMITH, E. B. Congenital defect, sixth and seventh cranial nerves. Proe. Rof
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ZALEWSKI, TEOFIL. Quantitative Untersuchungen iiber den kaJoriechea
Nystagmus. Mona tuck. /. OKrtnheilk . u. Laryngo-Rhinal., 1914, xlviii.,
S. 694.

bArANY, ROBERT. Total deafness, associated with the symptom-complM
described by B^riny, in which complete restoration of hearing occurred.
Journ. Laryngot., Rhinol. and Otol., 1914, xxix., p. 2.

GIANNULI, F. Audimutismo e Centri della parola. Riv • Sper. di Freniat.,
1914, xl., pp. 145-185.

miscellaneous symptoms and cases—

DAVIES, IVOR J. Carbon monoxide poisoning in the Senghenydd explosion.
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SCHUSTER* PAUL. Gehkufte postdiphtherische L*bm ungen; ein Beitoag wr
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ROTHMANN, MAX. Ueber die Ausfallseracheinungen nach Affektionen det
Zentralnervensystems und ihre Rtiokbiidung. Deut. Med. Wchnsehr 1914,
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RAND, C. W. A case of supposed progeria (premature senility) in a girl of eight
years. With remarks. Boston Med. ana Surg. Journ., 1914, clxxi, July
16, p. 107.

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VERCO, W. A. Traumatic paralysis of the leg ooourring during childbirth.
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THOMAS, T. T. Obstetrical paralysis. N. Y. Med. Joum., 1914, c., July 11,

p. 68.

NEUGEBAUER, HANS. Beitrag cur klinik der Vagotonic. Wien , klin.
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M 4 CORD, O. P. The pineal gland in relation to somatic, sexual, and mental
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STERLING, W. Die trophischen, vegetativen Erkrankungen, Missbildungen
und Entwicklungshemmungen des Knochensystems. Ztechr. f. d. gee. Neurol .
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WILHELM. M. Bin Beitrag zu den nervosen Aequivalenten im Skuglingsalter.
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RECKZEH. Ueber die Begutachtung arteriosklerotisoher und konstitutioneller
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MILLER, R., and DAVIDSON, J. A. The nervous oompUcations of varicella.
Brit. Journ. Child. Die., 1914, xi., p. 15.

MOREIRA, J. Notes sur quelques maladies nerveuses et men tales au Brasil.
Joum. dt Neurol, 1914, xix., Mai 5, p. 161.

DAVIDSON, A. Should the teaching of mental and nervous diseases be com¬
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FERON, G. Contribution k l’ltude de l’anisooorie. Joum. dt Neurol, 1914,
xix., Mai 20, p. 181.

COLLIE, Sib JOHN. The necessity for a systematic and oomplete examination
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BERTOLANI, A. Le Paralisi da Fosfato di Creosoto. Riv. Sper. di Freniat.,
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BOYLE, A. HELEN. Some observations on early nervous and mental cases,
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NEUER, A. HeaUng and Training. (HeU und Bildung.) Joum. Ment. Sci. t
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PSYCHIATRY.

CDIIKAL PARALYSIS—

ZIMKIN, J. Versuche sum objektiven Nachweis der IntelUgensbesserung bei
Paralytikern naoh Salvarsantherapie. Neurol. Centralbl., 1914, xxxiii., S. 885.

BEMKNTU PRRCGY—

SINGER, H. D. Dementia nraecox in the eighth edition of Kraepelin’s text¬
book. Joum. Nerv. and Ment. Die., 1914, xli, June, p. 345.

HOLMES, B. The country care of the dementia precox patient. Therap. Oat.,
1914, xxxviii., July, p. 470.

HINR1CHSEN, OTTO. Die Demens der Dementia preoox-Kranken. Corre-
tpondenz BlaU. f. Sehweizer Aerzte, 1914, xliv., S. 577.

LEMEI, N. J. Over de behandeUng van dementia precox. Nedtrlandech
Tijdeeh. v. Oeneeek., 1914, Juli 25, p. 241.

GENERAL—

MOTT, F. W. A lecture on the causes of insanity. Lancet, 1914, clxxxvii.,
July 11, p. 75.

ANSALONE, G. Contribute alia istologia patologica deUe forme atipiche di
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CUNEO, GEROLAMO. Psicosi maniaco-depressiva prodotta da ritenxione di
asoto con Bucoessiva autointossioazione ammoniacale per insufficienza della
funzione ureogenica. Riv. Sper . di Freniat., 1914, xl., pp. 190-222.

ROSENTAL, STEFAN. Zur Methodik der SohLdelkapasitLtsbestimmung mit
Hinsicht auf einen FaU von Hirnsehwellung bei Katatouie. Neurol. Centralbl.,
1914, xxxUi., JuU 1, S. 809.

88*

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VALTORTA, DARIO. L’eliminazione dell’ Azoto e dell’ Acido urico in stati di
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FAUSER. Ueber “passive” Uebertragung der Ferment* von Geisteskranken
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SCHEER, W. M. v. d. Die pathogenetisohe Stellang der Blntdrnien in der
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SHAW, T. OLA YE. A plea for the degenerate. Lancet* 1914, clxxxvi, June
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TURNER, JOHN. The biologioal conception of insanity. Joum. Ment. Set .,
1914, lx., July, p. 351.

SCHROEDER. Einige teohnische Neuerungen in der Dialysiermetbode und die
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EAGER, R. The rftle of hypnotics in mental diseases, with indications for their
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PETRAZZANI-SAGOOZZI. Sullo stato di mente del soldato Augusto Mawtti
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TREATMENT.*

CHARTIRR, M. Lee bains hydrodlectriquee dans le traitement des affections du
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LAPINSKI, M. Uber mechanische B&der in der neurologisohen Praxis. (Hydraulisobe
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WILSON, J. HORNE. Neuro-electricity. The electropathology of disease and
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LAPINSKY, MICHAEL. Uber mechanische Bader in der neurologisohen Praxis.
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HELLPACH. WILLY. Die elektrischen Heilwerte. Kritische Bemerkungen zu
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STERN, F. Erfahrungen mit dem neuen Schlaf- und Beruhigungsmittel Dial-Ciba.
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MAYER, FELIX. Beitrag zur Wirkung eines neuen Sohlafmittels, dee Dial-Ciba.
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SAYER, ETTIB. Mentally defective children and their treatment. Joum. State
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BLEULER. Die Behandlung der moralisch Schwachsinnigen. Correspondenz-Blatt. f.
Schweizer Aerzte , 1914, xuv., S. 202.

Psychoanalysis.—HABERLIN, P. Psychoanalyse und Erziehung. Internal.
Zttchr. f. drztliche Psychoanalyse* 1914, ii., Mai, S. 213.

BLOUSE, HANS. Zur Theorie der Inversion. Internal. Zttchr. f. drztliche
Psychoanalyse , 1914, ii., Mai, S. 223.

HATTINGBERG, HANS VON. Analerotik, Angstlust und Eigensinn. Internal.
Zttchr. f. drztliche Psychoanalyse , 1914, ii., Mai, S. 244.

LONG, CONSTANCE E. Psycho-analysis. Practitioner , 1914, xciii., July,
p. 84.

TELLING, MAXWELL. A plea for the more systematic employment of treat¬
ment by suggestion. Practitioner , 1914, xciii., July, p. 62.

LADELL, R. G. M‘DONALD. Some practical points in connection with the use
of therapeutic suggestion. Practitioner , 1914, xoiii., July, p. 77.

# A number of references to papers on Treatment are included in the Bibliography under
Individual diseases.

Bibliography

PHYSIOLOGY.

LAPICQUE and LEGENDRE. Modifications des fibres nervenses myEliniques pendant
TanesthEsie gEnErale. Compt. Rend. d. U Soc. de Biol., 1914, lxxvii, JuiUet 10,
p. 284.

NAGEOTTE, J. Qnelqnes remarqnes snr la soi-disant alteration de la gaine de
myEline conditionnant nn ohangement de 1’excitabiUtE des nerfs. Compt. Rend. d.
I Soc. de Biol., 1914, lxxvii, JuiUet 10, p. SOI.

CAMUS and ROUSSY. Localisation anatomique des lesions de la base dn cerveau qni

S rovoquent la polyorie ches le chien. Compt. Rend. d. L Soc. de Bid., 1914, lxxvi,
uin 5, p. 877.

CARDOT. Variations des paramfetres de 1’excitabUitE nerveuse en fonction de l’Ecarte-
ment des Electrodes. Compt. Rend. d. L Soe. de Bid., 1914, lxxvii., JuiUet 10,

p. 276.

CLUZET and PETZETAKIS. Etude Electrooardiographique du rEflexe oculo-cardiaque
cbez le lapin. Compt. Rend. d. 1. Soe. de Biol, 1914, lxxvi, p. 837.

BU8QUET, H. Sur un nouveau rEflexe vaso-dilatateur du membre postErieur obex le
chien. Compt. Rend. d. I . Soe. de BioL, 1914, lxxvi, p. 891.

MEYERSON. L'addition latente dans 1’excitabilitE du pneumogastrique. Compt. Rend.
d.1. Soe.de Bid., 1914, lxxvii., JuiUet 10, p. 253.

ABELOUS and SOUL A. L'autolyse des centres nerveux dans la pEriode de sensibilitE
anaphylactique dEmontrEe par la reaction d’Abderhalden. Compt. Rend. d. 1. Soc.
de Bid., 1914, lxxvi., p. 842.

ANDRE-THOMAS and ROUX. Sur les modifications du pouls radial oonsEcutives aux
excitations du sympathique abdominal. (Plexus solaire et ramifications terminales.)
Compt. Rend. a. 1. Soe. de Bid., 1914, lxxvi., p. 85J.

EDWARDS, D. J. Compensatory phenomena in the distribution of the blood during
stimulation of the splanchnic nerve. Amer. Joum. Pkysid., 1914, xxv., Aug. 1,
p. 15.

LAPICQUE and WEILL Sur l’intoxication nerveuse de la solanine. Compt. Rend.
(Ll.Soe.de Bid., 1914, lxxvii, JuiUet 10, p. 291.

BARUCH. SIMON. An apparatus for neurovascular training. Med. Record, 1914,
lxxxvi., Aug. 1, p. 198.

PILCHER, J. D., and SOLLM^N, TORALD. Studies on the vasomotor centre. The
effects of haemorrhage and reinjection of blood and saline solution. Amer. Joum.
Physid.. 1914, xxv., Aug. 1, p. 59; The effects of intravenous infusion of normal
salme solutions, ibid., p. 70.

HOSKINS, R. G., and WHEELER, HOMER. Ovarian extirpation and vasomotor
irritabUity. Amer. Joum. PhyeioL, 1914, xxv., Aug. 1, p. 119.

PORTER, W. T., and NEWBURGH, L H. and I. The state of the vasomotor
apparatus in pneumonia. Amer. Joum. Phytid., 1914, xxv., Aug. 1., p. 1.

GARNIER, M., and SCHULMANN, E. Action de Portrait du lobe postErieur de
l’hypophyse sur la sEcrEtion urinaire. Compt. Rend. d. 1. Soe. de Bid., 1914,
lxxvii, JuiUet 17, p. 335.

ROTH, G. B. Pituitary extract. An examination of some commercial preparations
made from the posterior lobe of the pituitary body. Joum. Amer. Med. Auoe.,
1914, Ixiii., July 25, p. 476.

MACCALLUM, W. G.. LAMBERT, R. A., and VOGEL, KARL, M. The removal of
calcium from the blood by dialysis in the study of tetany. Joum. Exp. Med.,
1914, xx., Aug., p. 149.

90*

BIBLIOGRAPHY

PSYCHOLOGY.

ROSE, GUSTAV. Experimentelle Untersuchungen iiber das topitche Gedichtnk
Ztschr. f. Psychol., 1914, lxix., S. 161.

UEBERMANN, PAUL v. t and KEVESZ, G. Die Binaurale Tonniechnng. Ztschr.
f. Psychol., 1914, lxix., S. 234.

BKN17SS1, V. Die Gestalt wahrnebraungen. Ztsckr. f. Psychol., 1914, lxix., S. 256.

HILGER, WM. Ueber Suggestion. Beeintriichtigt die Suggestion die Freiheit des
Urteils und des Willens? Ztschr. f. Psychotherap., 1914, vi., S. 65.

SCHNITZER, H. Forensischs Psychiatric und Fiirsorgeerziehiing. ZUchr. 1. Psycho¬
therap., 1914, vi., S. 75.

HELL WIG, ALBERT. Zur Psychologic Kinematographischer Vorfuhrungsn. ZUchr.
f. Psychotherap., 1914, vi., S. 88.

MADAY, STEFAN v. Heilung durch Kunstgenuss. Ztschr. /. Psychotherap 1911,
vi., S. 120.

WILLIAMS, TOM A. A contrast in psychoanalysis: three cases. Joum. Abnorm.
Psychol ., 1914, ix., June*Sept., p. 7o.

SOLOMON, MEYER. The analysis and interpretation of dreams based on various
motives. Joum. Abnorm. Psychol., 1914, ix., June-Sept., p. 98.

CORIAT, ISADOR H. Some hysterical mechanisms in ohildren. Joum. Abnorm.
Psychol 1914, ix., June-Sept., p. 139.

JANET, PIERRE. Psychoanalysis (concluded). Joum. Abnorm. Psychol ,, 1914, ix.,
June-Sept, p. 153.

SOLOMON, MEYER. A contribution to the analysis and interpretation of dreams
based on the motive of self-preservation. Amcr. Joum. Insanity ; 1914, Ixxi., July,
p. 75.

FORREST, ERLE D. The physiology of worry. Med. Record, 1914, lxxxvl, Aug. 8,
p. 245.

STUART, D. D. V. Variability in the results of intelligenoe-tests. Joum. Amcr.
Med. Assoc., 1914, Ixiii., July 25, p. 319.

PATHOLOGY.

COLLIN, R. Sur les rapports des expansions ndvrogliquts et doa grains pdrivasculeires
dans les espaces de Robin-Virchow. Compt. Rend. d. 1. Soc. de Biol., 1914, Lxxvi.,
p. 893.

DOPTER and PAURON. La “saturation des bactdriolysines ” appliance i Is
differenciation da mdningocoque et des paramoningocoques. Compt. Rend, d . 1.
Soc. de Biol., 1914, lxxvii., Juillet 10, p. 292.

CLINICAL NEUROLOGY.

tilffIBAL—

WARRINGTON, W. B. Acute generalised infective paralysis in adults. Med.

FARRINGTON, w. Acute gene
Press, 1914, cxlix., Aug. 19, p. 191.

nrsass-

CLAUDE, H. f and LOYEZ, Mile. M. Etude d’un cas d’intoxication saturnine
aveo paralysiee et atrophies musculaires de date ancienne. L'Enctphalt, 1914,
ix., Juillet, p. 30.

DUNN, C. H. Myatonia congenita, with report #f cases. Boston Mid. and Surg.
Joum., 1914, olxxi., July 30, p. 191.

SHAW, A. F. B. Pseudo-hypertrophic muscular dystrophy. (IUustr.) Dublin
Joum. Med. Set., 1914, No. 512, Aug., p. 115.

gPHil CBBJt—

Fmcimrr, Msl#eatl#m, Ac.—RADLEY, J. H. Spinal subluxations. Their
nature and cause. Med. Record , 1914, lxxxvi., Aug. 1, p. 203.

BIBLIOGRAPHY

91*

Tabes Denali*.—WHITE, 0. J. A statistical study of syphilis. The relation of
its symptoms to subsequent tabes dorsalis or general paralysis. Joum. Ainer.
Med. Assoc., 1914, lxiii., July 25, p. 459.

Poliomyelitis Anterior Acnta.— MENCIERE, LOUIS. Paralysis flasque du
membre sup4rieur par poliomydite antlrieure (paralysis infantile). Traitment
orthop4dique et ctururgical. L'EnctphaU , 1914, ix., Juillet, p. 49.

FRANCIS, E. An attempt to transmit poliomyelitis by the bite of Lyperoeia
trritans. Joum. Infect. Bit., 1914, xy., July, p. 1.

Hiematomyella. — BABINSKI. H4matomydie. Joum . dec Prat., 1914,

xxriii., Aoflt 1, p. 487.

Neuroma*—MONRO, T. K., and DUNN, J. S. Malignant gaaglio-neuroma of
left suprarenaL Glasgow Med. Joum., 1914, lxxxii., Aug., p. 81.

RRAO—

Disseminated Sclerosis.—HOLLOWAY, T. B. Peripheral pigmentation of the
oornee, associated with symptoms simulating multiple sclerosis. Amer. Joum.
Med. Set., 1914, cxlviii, August, p. 235.

Amaurotic Family Idiocy.—HUME, W. E. A oase of amaurotio family idiocy.
Review of Neurol, and Psychiat., 1914, xii, p. 281.

Meningitis. —FABER, H. K. A case of tuberculous meningitis complicated by
influenzal meningitis. Amer. Joum. Die. Child., 1914, viii., Aug., p. 150.

Angiospasm.—CORDON, A. Spasmodic dosing of oerebral arteries in its
relation to apoplexy. Albany Med. Annals, 1914, xxxv., Aug., p. 423.

Tumours.—GORDON, ALFRED. Mental manifestations in tumours of the brain.
Amer. Joum. Med. Sei ., 1914, cxlviii., Aug., p. 225.

Pituitary Tumours, Ate. —DUNN, ALFRED. Pituitary disease: a clinical
study of three cases. Amer. Joum. Med. Set., 1914, cxlviii, Aug., p. 214.

Infantilism.— STRAUCH, A. Infantilism. Amer. Joum. Med. Sei., 1914,
cxlviii., August, p. 247.

Aphasia, Ac.—CORE, DONALD. Some modern conceptions of aphasia. Med.
Chron., 1914, lix., Aug., p. 309.

d£j£rINE, J., and PtiLISSIER, A. Contribution k made de In odoittf verbal,
pure, (aveo 8 fig.) LEneiphale, 1914, ix., Juillet, p. 1.

Lead Poisoning —WILLIAMS, E. M. Lead poisoning, with paralysis of the
external ocular muscles. Joum. Amer. Med. Assoe., 1914, lxiu., Aug. 1,
p. 403.

Syphilis. —HUNT, J. RAMSEY. Syphilis of the vertebral column; its sympto¬
matology and neural complications. Amer. Joum. Med. Set., 1914, oxlviii.,
Aug., p. 164.

BOARD MAN, WM. P. Syphilitic heredity and congenital syphilis. Joum.
Out. Bis., 1914, xxxii., Aug., p. 545.

HAZEN, H. H. Syphilis in the Negro. Joum. Amer. Med. Assoc., 1914,
lxiii., Aug. 8, p. 463.

NICOLS, H. J. Observations of the pathology of syphilis. Joum. Amer. Med.
Assoc.. 1914, lxiii, Aug. 8, p. 466.

Salvarsan.*—BEST, WM. H. The use of salvarsan in non-syphilitie diseases.
Joum. Amer. Med. Assoc., 1914, lxiii, Aug. 1, p. 375.

LEREDDE. Les aoddents du salvarsan. M4canisme et prophylaxis. Joum.
des Prat., 1914, xxviii, Aofit, p. 481.

Neosalvarsan.— HARPER, PHILIP. Treatment of yaws by intravenous and
intramuscular injections of salvarsan and neosalvarsan. Lancet. 1914, olxxxvii,
Aug. 8, p. 370.

Luctin Reaction.—PUSEY, W. A., and STILLIANS, A. W. Noguchi’s luetin
test for syphilis. Joum. Cut. Bis., 1914, xxxii., Aug., p. 560.

Wassermann Reaction.— JUDD, C. C. W. A comparison of oholesterinised
and non-oholesterinised artificial antigens in the Wassermann reaction. Joum.
Amer. Med. Assoc., 1914, lxiii, July 25, p. 813.

HIB8CHFBLD, L., and KLINGER, R. Une nouvelle reaction du sdrum
syphilitique: la ooagulo-rtaction. Semaine mid., 1914, xxxiv., Aofit 5, p. 361.

92*

BIBLIOGRAPHY

Uvtkrt RpUal FlaHL—FRAZIER, C. H. The ecrebro-spinal fluidisemblem
in intracranial surgery. Joum. Amer. Mod. Assoc., 1014, briii., July 25,
p. 287.

OKNiKii amd mxmewu iuuiM-

Epilepsy.—STEWART, K. M. The action of adrenalin end epinineon the pupil
in epilepsy. Review of Neurol . and PsychiaL, 1914, iiL, p. 297.

Cfcarau—LEOPOLD, S. 8. Eosinophilia in choree. N. 7. Med. Joum., 1914, a,
Aug. 1, p. 225.

Psyefceee*. —WILLIAMS, GUY H. An intoxication psychosis Meoeisted with
cirrhosis of the liver. Amer. Joum. Insanity, 1914, lxxi, July, p. 149.

ExeplithalMlc Mtre, CreUsiiM, Ac.—HALSTEAD, WM. 8 The significance
of the thymus gland in Graves’ diseas e . Bulletin Johns Hopkins Hasp 1914,
xxv., Aug., p. 223.

MAYO, C. H. Hyperthyroidism: primary and late results of operation. Lancet,
1914, clxxxvii., Aug. 1, p. 301.

SPECIAL 8EMSE4 AN» CEAJflAl MEETEfl—

HORNE, JOBSON. Gun deafness and its prevention. Lancet , 1914, dxxxtiL,
Aug. 15, p. 462.

MlflCELLAMEOl* ITMPTfMfl AMD CAJiEfl—

DAVIDSON, A. J. Pott’s paralysis. Restoration by Albee’s operation. N.Y.

Med. Joum. , 1914, c., July 25, p. 174.

8AVARIAUD. Dee diffc rentes especes de torticolis. Joum. de mid, de Pant,
1914, xxxiv., Aodt 1, p. 603.

BOEHME, G. F. Pedal tic. Med. Record , 1914, lxxxvl, July 25, p. 159.

PSYCHIATRY.

CEIIIAK. PAKALY8I8—

MEYER, ADOLF. Differential diagnosis of general paralysis. Amer. Joum.
Insanity , 1914, lxxi., July, p. 51.

SALMON, THOMAS, W. General paralysis as a public health problem. Amer.
Journ. Insanity , 1914, lxxi, July, p. 41.

DEMEMT1A PEJECDX—

CLARK, 8. N. Atypical inodes of onset in dementia pnsoox. Amer. Joum
Insanity , 1914, lxxi., July, p. 153.

HAURY. La “fausee simulation.” Un ddment preoooe catatoniqueoonvsincu
de simulation de cdcit4 et aocusd de simulation de troubles msntacx.
L'EncipkaU , 1914, ix., Juillet, p. 66.

gEIBlilr-

ROSANOFF, A. J. A study of brain atrophy in relation to insanity. Amer.
Joum. Insanity , 1914, lxxi, July, p. 101.

BANCROFT, CHARLES P. Is there an increase among the dementing
psychoses? Amer. Joum. Insanity , 1914, lxxi., July, p. 59.

TORREN, J. v. n. Depressieve toestandsboelden. Ncderlandseh Tijdschr. r.
Qeneesk ., 1914, Aug., p. 321.

BALLET, GILBERT. A propos de la psyohose hallucinatoire chroniqw.
L'Encephale , 1914, ix., Juillet, p. 79.

ABBOT, E. STANLEY. What is paranoia? Amer. Joum. Insanity , 1914,
lxxi., July, p. 29.

HAGEMANN, J. A. A rhinologic&l aspect of some mental disturbanoes. Med.
Record , 1914, lxxxvL, Aug. 8, p. 250.

WOOD, H. W. The causes of insanity. Boston Mtd, and Surg. Joum., 1914,
clxxi, July 23, p. 156.

RICKSHER, CHARLES. Similar and dissimilar psychosis in relatives. Amer.
Joum. Insanity , 1914, lxxi., July, p. 133.

BARKER, L. F. The relations of internal medicine to psychiatry. Amer.
Joum. Insanity , 1914, lxxi., July, p. 13.

Bibliography

The bibliography in this number is greatly curtailed , since, on account
of the tear, the number of foreign journals reaching this country
is considerably diminished.

ANATOMY.

DUNN, E. H. The pretence of medullated nerve fibre* pasting from the spinal ganglion
to the ventral root in the frog, Bana pipiens. (I fig.) Joum. Comp. Neurol.,
1914, xxiv., Aug., p. 429.

WULZEN, ROSALIND. The morphology and histology of a oertain structure
connected with the pars intermedia of the pituitary body of the ox. Anal. Record,
1914, viii., Aug., p. 408.

SMITH, P. E. Some features in the development of the central nervous system of
Desmognathus fusea. Journ. MorphoL, 1914, xxv., Sept., p. 511.

HERRICK, C. JUDSON. The medulla oblongata of larval Amblystoma. (57 figs.)
Joum. Comp. Neurol., 1914, xxiv., Aug., p. 343.

BIONDI, GlOSUfi. Sulla struttura dei glomeruli della oorteooia oerebeliare. Riv.
itaL di Neuropatol., Psichiat. ed Elettroter., 1914, vii., p. 337.

PHYSIOLOGY.

SIMONELLI, G. Contributo alia oonosoenca delle localiezazioni oerebellari. Riv. di
Patol. nerv . e merit., 1914, xix., Agosto, p. 347.

LONG, F. Sur les d4g4n4resoences asoendantes consecutive* k une lesion de la moelle
oervicale. (6 pi.) Nouv. Icon. d. L Salptt., 1914, vii., p. 61.

PEARCE, ROY G. Effect of vagus stimulation on the blood flow through the kidney
after section of the corresponding splanchnic nerve. Amer. Joum. Physiol., 1914,
xxxv., Sept. 1, p. 151.

ADRIAN, E. D. The temperature coefficient of the refractory period in nerve. Joum.
Physiol ., 1914, xlviii., Sept. 8, p. 453.

WOLF, C. L., and HELE, T. S. Gaseous exchange in the decerebrate animal. Journ.
PhysioL , 1914, xlviii., Sept. 8, p. 428.

PSYCHOLOGY.

PEAR, T. H. The rfile of repression in forgetting. I. Brit. Joum. Psychol ., 1914,
vii., Sept., p. 139.

WOLF, A. The rile of repression in forgetting. II. Brit. Joum. Psychol, 1914, vii.,
Sept, p. 147.

MITCHELL, T. W. The rile of repression in forgetting. III. Brit. Journ. Psychol.,
1914, vii., Sept, p. 154.

LOVED AY, T. The rile of repression in forgetting. IV. Brit. Journ . Psychol.,
1914, vii., Sept., p. 161.

READ, C. The psychology of magic. Brit. Joum. Psychol., 1914, vii., Sept, p. 166,

WINCH, W. H. Some new reasoning tests suitable for the mental examination of
school ohildren. Brit. Joum. Psychol., 1914, vii., Sept., p. 190.

RE AN BY, M. J. The correlation between general intelligence and play ability as
shown in organised group games. Brit. Journ. PsyehoL, 1914, vii., Sept., p. 226.

PERKINS, N. L. The value of distributed repetitions in rote learning. Brit. Joum.
Psychol., 1914, vii., Sept, p. 253.

KOLLARITS, J. Observations de psyehologie quotidienne. Arch, dt Psychol., 1914,
xiv., Aoflt, p. 225.

KOLLARITS, J. Contributions k l’ltude dee rives. AreA. de PsyehoL, 1914, xiv.,
Aoflt, p. 248.

93V

94*

BIBLIOGRAPHY

8AUSSURE, R. d*. Le tamps an general et la tamps Bargsonian an particulier. Arch,
de Psychol ., 1914, xiv., Aofit, p. 277.

GREY, E. G., and SISSON, W. R. An example of dissooiatad personality. Boston
Med. and 5urp. /oum., 1914, olxxi., Sapt. 3, p. 365.

PATHOLOGY.

D ABUNDO, G. Coprioggatti di collodion nella tacnioa microsoopica. Riv. ital. di
Neuropatd ., Psiekiat. ed EleUroUr., 1914, vii., p. 296.

BIONDI, GIOSUE. Lo stato attuala degli studii istologici soi lipoidi dal sistama
narvoso. Riv. ital. di NeuropatoL, Psichiat. ed EleUroUr., 1914, vii., pp. 296
and 356.

NUNNO, R. DE. L’adona del microooooo di Bruoe (melitense) a dalle sue tossina snl
sistama nervoso oantrala a periferico. Riv. di Patol. new. t ment., 1914, xix.,
Agosto, p. 351.

COOPER, E. A. The relations of vitamins to lipoids. Biochcm. Joum ., 1914, Tiii.
August, p. 347.

CLINICAL NEUROLOGY.

GENERA L—

HAWTHORNE, C. O. On the occurrenoa of a bi-lateral extensor response in
states of unconsciousness. Practitioner , 1914, xciii., Sept., p. 330.

KNAUER, ALWYN, and MALONEY, W. J. M. A. The pneumograph. A new
instrument for recording respiratory movements graphically. Joum. New.
and Ment. Die., 1914, xfl., Sapt., p. 567.

MUSCLES—

ROSENBLOOM, J., and OOHOE, B. A. Clinical and metabolism studies in a
case of myotonia congenita—Thomsen's disease. Archives of Int. Med., 1914,
xiv., August, p. 263.

SPINAL COED—

Herpes Lester. —DBADERICK, WM. H. Herpes zoster and malaria. Med.
Record, 1914, lxxxvi., Sept. 5, p. 421.

Paraplegia.— CO YON and BARR£. Paraplegic “type Babinsld” chez un sujet
atteint de maladie de Recklinghausen. Absence de d4g4n4ration seoondaire
des faiscaaux pyramidaux. Nouv. Icon. d. 1. SalpH ., 1914, rii., p. 81.

Tabes.— JOHNSTON, GEORGE T., BREAKS, L Z., and KNOEFEL, A. F.
The treatment of tabetic optic atrophy with intraspinal injections of salvar-
sanised serum. A preliminary report. Joum. Amer. Med. Assoc., 1914, lxiiL,
Aug. 29, p. 866.

WILLIAMS, TOM A. The treatment of tabes dorsalis in the light of its recent
pathology. Med. Press, 1914, cxlix., Sept. 23, p. 327.

Poliomyelitis Anterior Acute. —GORDINIER, HERMON C. Study of a case
of the adult type of poliomyelitis. Albany Med. Annals ., 1914, xxxv., Sept.,
p. 48a

MOORE, J. W. Surgical treatment of infantile paralysis. (20 illust.) N. Y.
Med. Joum., 1914, c., Aug. 29, p. 404.

FLEXNER, SIMON, and AMOSS, H. L. Localisation of the virus and
pathogenesis of epidemic poliomyelitis. Joum. Exp. Med., 1914, xx., Sept. 1,
p. 249.

BRAIN—

Skull Injury, Be.—ROSENBAUM. GEORGE. Rontgen diagnosis in fractures
of the cranium in ohildren. (3 illust.) N. Y. Med. Joum., 1914, c., Aug. 29,
p. 414.

LOFBERG, OTTO. Zur Deckung von Kranialdefekten. Nordiskt Med.
Arkiv. (Kirurgi), 1913, xlvi., pp. 1-13.

Disseminated Sclerosis.—SMITH, H. LYON, and STEWART, T. GRAINGER.
A case of disseminated sclerosis treated by inoculation. Brit. Med. Joum.,
1914, Aug. 22, p. 364.

BIBLIOGRAPHY

95*

Hereditary Ataxia*—WILLIAMS, E. if. Hereditary ataxia. Amer. Journ.
Med. Sci., 1914, cxlviii., Sept., p. 887.

HealaaltU. —BROWNING, CHAS. 0. Report of four oases of what appeared to
be tuberculous meningitis with apparent permanent arrestment. Med. Record,
1914 t lxxxvi., Aug. 22, p. 326.

MAJOR, RALPH H. v and NOBEL, E. The glycl-tryptopban reaction in
meningitis. Archives of ItU. Med., 1914, xiv., Sept. 15, p. 383.

Hydrocephalus.— ROUBINOVITCH and BARBE. Contribution k l’etude de
l’hydroc^phalie interne. L'Enctphale, 1914, ix., p. 1.

Hsemerrhage. —MOTT, WALTER M. Report of a case of cerebral haemorrhage.
Journ. Amer. Med. Assoc., 1914, lxiii., Sept. 19, p. 1028.

Axglespasm.—GORDON, ALFRED. Spasmodic closing of cerebral arteries in
relation to apoplexy. Journ. Nerv. and Ment. Dis., 1914, xli, August, p. 501.

Cerebellans.—TAFT, A. E., and MORSE, M. E. Hemiatrophy of the cerebellum
im a case of late catatonia. Journ. Nerv. and Ment. Die., 1914, xli., Sept.,
p. 553.

Tamoars.—BLAIR, V. P. Treatment of unlocalised intracranial injuries by
drainage through a subtemporal approach. Journ. Amer. Med. Assoe., 1914,
lxiii., Aug. 29, p. 863.

Acromegaly.—ADDA, M. Dystrophies gigantiques sans acromegalic. (3 pL)
Nouv. Icon. d. 1. SalpH, 1914, vii., p. 90.

BERGEIM, OLAF, STEWART, F. T., and HAWK, P. B. A study of the
metabolism of calcium, magnesium, sulphur, phosphorus, and nitrogen in
acromegaly. Journ. Exp. Med., 1914, xx., Sept., p. 218.

HyspfltaUarlsni.—FALCONER, A. W. Further note on a case of dyspituitarism.
Edin. Med. Journ., 1914, xiii., Sept., p. 246.

ANDERS, J. M., and JAMESON, H. LEON. The relation of glyoosuria to
pituitary disease and the report of a case with statistics. Amer. Journ. Med.
Set., 1914, cxlviii., Sept., p. 323.

rellagra.— BOX, CHARLES R English pellagra in early childhood. Brit.
Med. Journ., 1914, Aug. 29, p. 397.

LOWERY, J. R. Pellagra. Med. Record , 1914, lxxxvi., Aug. 29, p. 378.

YOEGTLIN, CARL. The treatment of pellagra. Journ. Amer. Med. Assoc.,
1914, lxiii., Sept. 26, p. 1094.

KOZOVSKY, A.-D. Sur la morphologic du sang dans la pellagre. Nouv. Icon,
d. 1. Salptt., 1914, vii., p. 94.

LAVINDER, C. H., FRANCIS, E., GRIM, R M., and LORENZ, W. F.
Attempts to transmit pellagra to monkeys. Journ. Amer. Med. Assoc., 1914,
lxiii., Sept. 26, p. 1093.

SILER, J. F., GARRISON, P. E., and MACNEAL, W. J. Further studies of
the Thomson-M'Fadden Pellagra Commission. A summary of the seoond
progress report. Journ. Amer. Med. Assoc., 1914, lxiii., Sept. 26, p. 1090.

SILER, J. F., GARRISON, P. E., and MACNEAL, W. J. Introduction to the
second progress report of the Thomson-MTadden Pellagra Commission.
Archives. Int. Med., 1914, xiv., Sept., p. 289. A statistical study of the
relation of pellagra to use of certain foods and to location of domiciles in six
selected industrial communities. Ibid p. 293.

Syphilis.—Symposium on syphilis, with especial reference to its importance in
Massachusetts. Boston Med. and Surg. Journ., 1914, clxxL, Sept. 10,
pp. 401-415.

WILE, V. J., and STOKES, J. H. A study of the spinal fluid with reference
to involvement of the nervous system in secondary syphilis. Journ. Cut. Dis.,
1914, xxxii., Sept., p. 607.

CRAIG, C. BURNS. Cerebral syphilis in the secondary stage. Med. Record,
1914, lxxxvi,, Sept. 5, p. 422.

CORBUS, B. C. A second infection with Spirockceta pallida. N.Y. Med.
Journ., 1914, c., Sept. 5, p. 472.

VARNEY, H. R, and MORSE, P. F. The Abderhalden technique as applied
to the diagnosis of syphilis. Journ. Cut. Dis., 1914, xxxii., Sept., p. 624.

96*

BIBLIOGRAPHY

ROSTAINE, PAUL. Acquired and hereditary syphilis. Meet Prtu, 1914,
cxlix., Sept. 2, p. 244.

A8SINDER, ERIC. Syphilis in the poorer clams: its diagnosis by tbe
Wassermann test and its incidence as demonstrated thereby. Birmingham
Mrd. Review, 1914, lxxvi., Sept., p. 93.

WILLIAMS, C. M. The present stage in the treatment of syphilis. Med,
Recoil. 1914, Uxxvi., Sept. 12, p. 463.

tel varan.—STILLMAN, E. G. The immediate results of mlvanan treatment of
syphilis, as judged by the Wassermann reaction, using a obolesterin-fortified
antigen. Med, Record , 1914, Ixxxvi., Sept. 5, p. 405.

CROWELL, A. J., and MUNROK, J. P. Sal Terse n in the treatment of syphilis
—with special reference to the use of salvaraanised serum in cases of syphilis
of the central nervous system. Med, Record , 1914, lixivi., Sept. 26, p. 543.

LOMMEN, A. H. M. E. Over salvarssanbebandeliug der syphilis. Nedcr
landseh Tijdschr . voor Geneeskunde , 1914, Aug. 29, pp. 525 and 593.

SMYTH, H. C., and PEPPER, G. E. Treatment of syphilis by taWausn in
Dr Steevens’s Hospital, Dublin. Dublin Joum. Med, Sei ., 1914, No, 513,
Sept., p. 183.

Keasalvsrsan.—ASSEN, J. van. Intraveneuse toediening van geconcentreerde
oplossingen van neoealvaraaan. Nederlaruhch Tijdschr. voor Geneukunde ,
1914, Aug. 8, p. 388.

Wmaseraaamm Eearilaa.—MACKINNEY, WM. H. How shall the clinician
interpret the Wassermann reaction? Annals of Surgery, 1914, lx., Sept,
p. 309.

DARLING, I. A., and NEWCOMB, P. B. A comparison of the Wassermann
reaction among the acute and the ohronio insane. Joum . Ntrv . and Afrot
Die,, 1914, xli., Sept., p. 576.

HOPKINS, J. G m and ZIMMERMANN, J. B. Cholesterin antigens in the
Wassermann reaction and the quantitative testing of typhilitic sera. Amer.
Joum, Med, Sci., 1914, exlviii., Sept., p. 390.

STONE, W. J. Comparative Wassermann, Cobra, and globulin tests in syphilis
—with a report of 106 reactions. Med, Record, 1914, Ixxivi, Sept. 26, p. 545.

FUCHS, B. Luesbehandlung and Wassermann. Dermatol. Wchnschr 1914,
lix., Juli 11, S. 831.

Lsftls Reaction.—NOGUCHI, HIDEYO. Practical application of the luetin
test. N, Y, Med. Joum., 1914, c., Aug. 22, p. 349.

MATTIROLO, G., and BOTTESELLE, G. B. Sopra la intradermoreazioncalia
luetina. Pathoiogiea , 1914, vi., Agosto, p. 383.

Cerebre-Splnal Fin Ml.—CUSHING, HARVEY. Studies on the cerebro-ipinal
fluid. I. Introduction. Joum. Med. Research , 1914, xxxi., Sept., p. 1.

WEED, LEWIS, H. Studies on cerebre-spinal fluid. II. The theories of
drainage of oersbro-spinal fluid, with an analysis of the methods of investiga¬
tion. Joum . Med. Research , 1914, xxxi., Sept., p. 21.

WEED, LEWIS H. Studies on cerebro-spinal fluid. III. The pathways of
escape from the subarachnoid spaces, with particular reference to the arachnoid
villi. Joum. Med. Research , 1914, xxxi., Sept., p. 51.

WEED, LEWIS H. Studies on cerebro-spinal fluid. IV. The dual source of
oerebro-spinal fluid. (6 plates.) Joum. Med. Research, 1914, xxxi.,Sept, p. 93.

WEGEFARTH, PAUL. Studies on oerebro-spinal fluid. V, The drainage of
intra-ocular fluids. Joum. Med. Research, 1914, xxxi., Sept, p. 119.

WEGEFARTH, PAUL. Studies on oerebro-spinal fluid. VI. The establish¬
ment of drainage of intra-ocular and intra-cranial fluids into the venous system.
(1 plate.) Joum . Med Research, 1914, xxxi., Sept., p. 149.

WEGEFARTH, PAUL, and WEED, LEWIS H. Studies on oerebro-spinal
fluid. VII. The analogous processes of the cerebral and ocular fluids. Joum.
Med. Research, 1914, xxxi., Sept., p. 167.

DUMAS, G., and LAIGNEL-LAVASTINE. Leo variations de pression du
liquids dphalo-raobidien dans lours rapports avec let Emotions. LEnctphnle,
1914, ix., p. 19.

BIBLIOGRAPHY

97*

6MIBAL Am rvNttmu diseases—

Epilepsy.—M‘KENNAN, T. M. T., JOHNSTON, GEORGE 0., and
HENNINGER, 0. H. Observations on epilepsy, chiefly from an X-ray
standpoint. Joum. Ncrv. and Ment. Dis., 1914, xii, August, p. 495.

MANSON, J. F., and SHAW, A. L. The pituitary gland in epileptics.
Archives of Ini. Med., 1914, xiv., Sept., p. 398.

CNerea*— D’ANTONA, S. Contributo all’ anatomia patologica della oorea di
Huntington. Riv. di Paiol. nerv. e ment., 1914, xix., Agosto, p. 321.

Aleefcellsm, Ac.—SOMERSET, Lady HENRY. The female inebriate. Brit.
Joum. Inebriety , 1914, xii., July, p. L

MJEN, JON A. Sociological aspects of recent legislation in Norway relating to
aloohol and alooholism. Brit. Joum. Inebriety , 1914, xii., July, p. 9.

DAVIDSON, J. A. A plea for the early treatment of the inebriate. Brit.
Joum. Inebriety , 1914, xii., July, p. 19.

AN EX-PATIENT. The psycho-analysis of an inebriate: A record of
experiences and reflections. Brit. Joum. Inebriety , 1914, xii., July, p. 22.

VALLOW, H. Aloohol and tuberculosis. Brit. Joum. Inebriety , 1914, xii.,
July, p. 28.

NEFF, IRWIN H. The modern treatment of inebriety. Boston Med. and Surg.
Joum., 1914, olxxi., Aug. 6, p. 224.

DEMOLE, V. Aloool et delirium tremens. L'EncJphale, 1914, ix., p. 6.

Nearest ben la.—HEAD, GEORGE D. Neurasthenia and tuberculosis. Joum.
Amer. Med. Assoc., 1914, lxiii., Sept. 19, p. 996.

Neuroses.—STERN, ADOLPH. Compulsion neurosis. N. Y. Med. Joum., 1914,
e., Sept. 5, p. 451.

NEUHOF, SELIAN. Clinical investigation of gastric neuroses with vago-
eicitative characteristics. N. Y. Med. Joum., 1914, c., Aug. 22, p. 365.

Fsycbonenroses.—WILLIAMS, TOM A. Quelques considerations sur les
psychonlvroses professionnelles. Pathogenfcee et exemples de traitement.
Nouv. Icon. d. 1. Salptt ., 1914, yIL, p. 108.

FARNELL, FRED. J. The psyohopathic ohild. Archives of Ped., 1914, xxxi.,
Sept., p. 684.

Sciatica.— MARCUS, HARRY. A case of sciatica entirely cured with three
weeks’ treatment. N. Y. Med. Joum., 1914, e., Sept. 12, p. 520.

LLEWELLYN, L. J., and JONES. A. B. Gluteal and crural types of fibrositis:
their relationship to spurious and genuine sciatica. Edin. Med. Joum., 1914,
xiii., Sept., p. 225.

YEOMANS, F. C. Coooygodynia—a new method of treatment by injections of
aloohol. Med. Record , 1914, lxxxvi., Aug. 22, p. 322.

Paralysis Agllaas.—CAMP, CARL D. Paralysis agitans syndrome, with syphilis
of the nervous system. Joum. Nerv. and Ment. 2Rs., 1914, xii., August,
p. 489.

AMlten’s Disease.—BROWN, W. H. A case of implantation of the supra-renals
in Addison’s disease, with fatal results. Med. Joum. Australia, 1914, i.,
Aug. 8, p. 129.

Exophthalmic Goitre, Crelinisnt, Ac. —DICK, J. LAWSON. On some signs
and symptoms of hypothyroidism in sohool children. Lancet , 1914, olxxxvii.,
Sept. 5, p. 644.

ROGERS, JOHN. The course of acquired disessc of the thyroid gland and the
principles which seem to control its progress. Annals of Surgery, 1914, lx.,
Sept., p. 281.

HERTOGHE, E Thyroid deficiency. Med. Record , 1914, lxxxvi., Sept 19,
p. 489.

SFRCIAJL SENSES AND CRANIAL NERVES—

MACNAB, ANGUS. The physiology of vision and fusion (excluding the question
of colour vision). Birmingham Med. Review , 1914, lxxvi., Aug. and Sept.,
pp. 56 and 81.

98*

BIBLIOGRAPHY

WALKER, CLIFFORD B. Further observations on tbe hemiopio papillary
reaction obtained with a new clinical instrument. Joum. Amer . Med. Assoc.,
1914, lxiii., Aug. 29, p. 846.

BASTIAANSK, F. S. VAN B. Hemiopische pupilreactic als diagaoethcb
hulpmiddei. Ntderlandsch Tijdsck . voor (Jeneeskurule, 1914, April, p. 1217.

WKSTMACOTT, F. H. Oculomotor paralysis of otitic origin. Joum Laryngol,,
Khinol. , and Otol ., 1914, xxix., Sept., p. 449.

MARINO, A. A proj>o8ito di una osaervazione fattami dal prof. 0. Bossi nella
relazione di un mio studio sui movimenti di cotivergenza e lateraliti dei muscoli
oculari. Kir, di Patol. tierr. e rnent., 1914, xix., Agosto, p. 372. Risyiosta del
prof. O. Rossi alia uota del prof. A. Marina. Ibid., p. 375.

BRAUN, ALFRED. The functional tests of the static labyrinth in neurologies!
diagnosis. N . Y. Med . Joum., 1914, c., Aug. 22, p. 369.

MHftCBLLANEOUa SYMPTOMS ASM CASES—

GRECO, FRANCESCO DEL. Sui rapporti tra “ immorality ” e “delinquema’’
negl’ individui umani. Kir. ital . di Neuropat ., Psichiat. ed Eletiroter ., 1914,
vii., p. 289.

CHARON, K. t and COURBON, P. Influence du milieu et du travail ror lei
stereotypies. Nouv, Icon. d. I. SalpH ., 1914, vii., p. 103.

MEIGE, H. 4, Souvent femme varie. n A propos du groupe “tres in una” de
M. Paul Richer. (2 pi.) Nouv . Icon. d. I. Salptt ., 1914, vii., p. 120.

PSYCHIATRY.

CiBJVBBAL PARALYSIS—

KAPLAN, D. M. General paresis. N. Y. Med, Joum., 1914, c., Aug. 29, p. 397.

AGUGLIA, EUGENIO. Nota sulla citoarchitettura delle ciroonvoluaonl
rolandiche in un caso di paralisi progressiva (forme motoria). Riv. ital. di
Ncuropatol ., Psichiat . ed Eletiroter., 1914, vii., p. 340.

JACQU1N, G., and LAIGNEL-LAVASTINK, M. Paralysie gdndrale juvenile
avec autopsic. V Enciphale, 1914, ix., p. 22.

RESERAL—

KARP AS. MORRIS J. Kraepelin’s conception of paraphrenia. Joum. Amer.
Med. Assoc., 1914, lxiii., Aug. 29, p. 766.

RING, A. H. The early diagnosis and treatment of manic depression, Boston
Med. and Sury. Joum., 1914, clxxi,, Sept. 3, p. 376.

HENDERSON, DAVID K. Korsakow’s psychosis occurring during pregnancy.
Bulletin Johns Hopkins Hotp 1914, xxv., Sept., p. 261.

WILLIAMS, G. H. The psychosis occurring during the course of pemidoui
anaemia. Joum. Amer. Med. Assoc 1914, lxiii., Sept. 12, p. 936.

SAVAGE, Sib G. H. The feeble minded and their care, Clin. Joum., 1914,
xliii., Sept. 2, p. 545.

BARKER, LEWELLYS F. The relations of internal medicine to psychiatry.
Bulletin Johns Hopkins Hosp+ 1914, xxv., Sept., p, 255.

ROJAS, NERIO A. Homicidio cometido por dos alienados—(Inforine medico¬
legal). Kecista de Criminal ., Psiquiat y Med.-Legal, 1914, i., p. 385.

PETERS, AMOS W. The sterilisation of mental defectives considered from
the physiological standpoint. Med. Record , 1914, lxxxvi., Aug. 29, p. 370.

MAY, JAMES V. Modem peychiatry as related to therapeutics. Albany Med.
Annals, 1914, xxxv., Sept., p. 495.

TREATMENT.*

ROBINSON, O. WILSE, The use of celluloid splints in the treatment of diseases of
the nervous system. Joum. Amer. Med. Assoc., 1914, lxiii., Aug. 29, p. 773.

REID, EVA CHARLOTTE. Ergother&py in the treatment of mental disorders.
Boston Med. and Burg. Joum., 1914, clxxi., Aug. 20, p. 300.

KELLY, T. J. Insomnia. Dublin Joum. Med. Set., 1914, No. 513, Sept., p. 178.

• A number of references to papers on Treatment are Inoluded in the Bibhograpby under

Individual d i s ea ses.

Bibliography

The bibliography in this number is greatly reduced,\ since , on account
of the war , the number of foreign journals reaching this country
is considerably diminished.

ANATOMY.

M'KIBBEN, PAUL S. Mast oells in the meninges of Neotnms and their differentiation
from nerve oells. Anal. Record., 1914, viiL, Oct., p. 475.

M'KIBBEN, PAUL S. Ganglion cells of the nervus terminals in the dogfish
(Mustelus canis). Joum. Comp. Neurol., 1914, xxiv., Oct., p. 437.

RANSON, 8. W. A note on the degeneration of the fasciculus oerebro-spinalis in the
albino rat. Joum. Comp. Neurol ., 1914, xxiv., Oct., p. 503.

DOLLEY, D. H. On a law of species identity of the nucleus-plasma norm for
corresponding nerve oells: the numerical constancy of the nucleus-plasma co¬
efficient of the functionally resting Purkinje cell of the dog species. (6 figs.) Joum.
Comp. Neurol., 1914, xxiv., Oct., p. 445.

HAYS, Y. J. The development of the adrenal glands of birds. Anat. Record, 1914,
viii., Oct., p. 451.

PHYSIOLOGY.

FRAZIER, 0. H., and PEET, M. M. Factors of influence in the origin and circulation
of the cerebro-spinal fluid. Amer. Joum. Physiol., 1914, xxxv., Oct., p. 268.

BROWN, T. GRAHAM. On the ordering of reciprocal innervation. Med. Chron.,
1914, lx., Sept.-Oct., p. 1.

MAONAB, ANGUS. The physiology of vision and fusion (excluding the question of
colour vision). (Oontd.) Birmingham Med. Review, 1914, lxxvi., Oct., p. 117.

ZANDER, EMIL Zur Frage von der Wirkung der extrakardialen Nerven auf den
automatisch sohlagenden Yentrikel, zugleich ein Be it rag zur Lokalisation im
Herzen. Nord. Med. Arkiv, 1915, Aid. IL (lure Medicin), Haft 1-2, pp. 1-6.

WHERLON, H. Extirpation of the testes and vaso-motor irritability. Amer. Joum.
Physiol ., 1914, xxxv., Oct,, p. 283.

CROWE, S. J., and WISLOCKI, G. B. Experimental observations on the suprarenal
glands, with especial reference to the functions of their inter-renal portions, (Illustr.)
Bulletin Johns Hopkins Hosp ., 1914, xxv., Oct., p. 287.

PSYCHOLOGY.

ROGERS, A L, and M'INTYRE, J. L The measurement of intelligence in children
by the Binet-Simon scale. Brit. Joum. Psychol ., 1914, vii, Oct., p. 265.

THOMPSON, E. R. An inquiry into some questions connected with imagery in
dreams. Brit. Joum. Psychol ., 1914, vii., Oct., p. 300.

WATKINS, S. H. Immediate memory and its evaluation. Bril. Joum* Psychol .,
1914, vii., Oct., p. 319.

FLtfGEL, J. C., and M'DOUGALL, WM. Some observations on psychological oontrast.
Brit. Joum. Psychol ., 1914, vii., Oct., p. 349.

100*

BIBLIOGRAPHY

CLINICAL NEUROLOGY.

CiENEEAL—

BROUWER, B. Over dermatomerie, bijdrage tot de kennis der segmentaal-
anatomie en der sensibele geleidang bij den Meneoh. Nederlandsch Tijdsehr.
v . Genecsk ., 1914, H. xii., No. 11 and 12, Sept. 12 and 19, pp. 657 and 742.

SODERBERGH, GOTTHARD. Quelle eat 1 Innervation radiculaire dea muaclea
abdominaux? Nord. Med. Arkiv f 1914, xlvii., Aid. II. (Inre Med.), Hkft 1-4,
pp. 1-7.

MU3CLES—

OBBISON, T. J. Myopathy: with olinical record* of eight caaea comprising
various types. Arner. Journ. Med. Sci., 1914, oxlviii., Oct., p. 560.

OLIVER, PAUL Myoaitia oaaificana following a single trauma. Journ. Arner.
Med. Assoc ., 1914, lxiii., Oct. 24, p. 1452.

MURPHY, JOHN B. Myoaitia. Ischemic myoeitis: infiltration myositis:
cicatricial muscular or tendon fixation in forearm: internal, external, and
combined compression myositis, with subsequent musculotendinous shortening.
Journ. Amer. Med. Assoc. , 1914, lxiii., Oct. 10, p. 1249.

STRAUCH. A. Myatonia congenita of Oppenheim. Amer. Journ. Dis. Child .,
1914, vii., Oct., p. 298.

SPINAL CORD—

Frsetare, Dislocation, Be.—CUMSTON, C. G. Gunshot wounds of the spine.
N. Y. Med. Journ., 1914, c., Oct. 17, p. 754.

Herpes Lester.—PERNET, GEORGE. Generalised herpes zoster. Brit. Journ.
Dermatol ., 1914, xxvL, Oct., p. 399.

W YNTER, W. E. Clinical lecture on herpes. Med. Press, 1914, xoviii., Oct. 7,

р. 372.

ayrlngemyella.—WILDMAN, H. V. Syringomyelia, with report of a case of
Morran’s type of the disease. Med. Record, 1914, Ixxxvi., Oct. 17, p. 672.

Twmeur*.—WILKENS, G. D. Bin Fall von Riickenmarkstumor. Nord. Med.
Arkiv , 1914, xlvii. (Inre Med.), Haft 1-4, pp. 1-10.

ELSBERG, C. A. Laminectomy for spinal tumour. Annate of Surgery , 1914,
lx., Oct., p. 454.

Vra Recklinghausen’s Disease.—ELLIOTT, C. A., and BEIFELD, A. F.
Generalised neurofibromatosis (von Recklinghausen’s disease). Report of a
case showing a superficial resemblance to Hodgkin's disease. Journ. Amer .
Med. Assoc., 1914. lxiii., Oct. 17, p. 1358.

Pollonayelltls Anterior Acuta.—GORDINIER, HERMON C. The study of a
case of the adult type of poliomyelitis and of a case of acute ascending paralysis
of the type of Landry. Journ. Nerv. and Ment. Dis ., 1914, xli., Oct, p. 640.

M‘GOWAN, J. P., and DAWSON, JAMES W. A comparison of the lesions of
the nervous system in distemper of the dog with those of human poliomyelitis.
Archives Int. Med., 1914, xiv., Oct., p. 182.

BRAIN—

General.—SOUTHARD, E. E. The association of various hyperkinetio symptoms
with partial lesions of the optic thalamus. Journ . Nerv . and Ment. Dis.,
1914, xli., Oct, p. 617.

CRENSHAW, H. Localisation of brain lesions. N.Y. Med. Journ., 1914,

с. , Oct 17, p. 765.

LEDUC, STEPHANE. Cerebral electrisation. Archives of the Roentgen Ray,
1914, xix., Oct., p. 160.

THORBURN, WM. The present position of cerebral surgery. Med. Press,
1914, xcviiL, Oct 21, p. 424.

BIBLIOGRAPHY

101*

RHEIN, JOHN H. W. Contusion of the brain. Journ. Nerv. and Ment.
Dis., 1914, xli., Oct., p. 653.

Disseminated Sclerosis. —COLLINS, J., and BAEHR, E. Disseminated
sclerosis : its frequency compared with other organic diseases; its etiology and
pathogenesis; the types and differential diagnosis of the disease ; its course
and treatment. A clinical study of ninety-one cases. Amer. Journ. Med. Set.,
1914, cxlviii., Oct., p. 495.

WILLIAMS, TOM A. Syphilitic multiple sclerosis diagnosed clinically in spite
of negative laboratory tests. Boston Med. and Surg. Journ., 1914, clxxi.,
Oct. 1, p. 526.

Meningitis.— HEIMAN, H. Refractory or so-called “fast” oases of meningococcus
meningitis. Amer. Journ. Dis. Child ., 1914, viii., Oct., p. 307.

Encephalitis. —REEVE, E. F. t and WATSON, GEORGE A. Observations on
oases of encephalitis. Journ. Ment. Sci., 1914, lx., Oct., p. 615.

Abscess.— WRIGLEY, FRANK G. A case of temporo-sphenoidal abscess follow¬
ing chronic middle ear suppuration. Med. Chron., 1914, lx., Sept., Oct., p. 10.

Mssmorrhage.— LEOPOLD, SAMUEL. Spontaneous subarachnoid hemorrhage.
A contribution to the subject of meningeal haemorrhage. Journ. Amer. Med.
Assoc., 1914, lxiii., Oct. 17, p. 1362.

Angiospasm.— BIRT, A. Vascular crises and angiospasm. Canadian Med.
Assoc. Journ., 1914, iv., Oct., p. 858.

Progressive Lenticular Degeneration. —CADWALADER, W. B. Progressive
lenticular degeneration. Journ. Amer. Med . Assoc., 1914, lxiii., Oct. 17,
p. 1380.

Facial Paralysis. —THROCKMORTON, T. B. Bilateral peripheral facial palsy,
with report of case. Journ. Amer. Med. Assoc., 1914, lxiii., Oct. 3, p. 1155.

Aphasia. —WHITE, H. W. The disorders of speech. Public Health, 1914, xxviii.,
Oct., p. 8.

Myasthenia. —SMYTH, R. OSBORN. Myasthenia gravis. A short account of
the disease, with notes on three cases. Dublin Journ. Med. Sci., 1914, Third
Series, No. 514, Oct., p. 241.

Pellagra. —BRENGLE, D. R. Pellagra in Minnesota. Journ. Amer. Med.
Assoc., 1914, lxiii., Oct. 3, p. 1157.

SILER, J. F., GARRISON, P. E., and MACNEAL, W. J. The relation of
methods of disposal of sewage to the spread of pellagra. Archives Ini. Med.,
1914, xiv., Oct., p. 453.

MACDONALD, J. B. Pellagra and its symptoms; the importance of mouth and
gastro-intestinal lesions. Boston Med. and Surg. Journ., 1914, clxxi., Sept.
24, p. 458.

Mongolism. —HULTGREN, E. O. Studien iiber die Httuffgkeit der mongoloiden
Idiotic in schwedischen Anstalten fiir Schwachsinnige und liber die Atiologie
dieser Krankheit. Nord. Med. Arkiv, 1915, Afd. II. (Inre Medicin), Haft 1-2,

pp. 1-10.

Syphilis.—VEEDER, B. S., and JEANS, P. C. The diagnosis and treatment of
“late” hereditary syphilis. Amer. Journ. Dis. Child., 1914, Oct., p. 283.

FORDYCE, J. A. Modern diagnostic methods in syphilis. N. Y. Med. Journ.,
1914, c., Sept. 26, p. 597.

WATTERS, W. H. The modern treatment of syphilis. Med. Record, 1914,
lxxxvL, Oct. 24, p. 711.

M*WALTER, JAS. C. Antimony in syphilis. Med. Press, 1914, xcriii., Oct.
28, p. 448.

102*

BIBLIOGRAPHY

BAKU, H., and WITH, CARL. Recherches sur U modification ftpportee }iftr
Herman et l’erutz k la reaction de precipitation an glycocholate de soudt
spdcialement au point de vue du diagnostic de syphilis. Word. Med. Arkii ,
1915. xlviii. (Inre Medicin), Afd. II., Haft 1-2, pp. 1-62.

fllco»alvar*i%n.—FINDLAY, LEONARD. The use of neoealvaraan in mental
deficiency. Glasgow Med. Joum 1914, lxxxii, Oct., p. 241.

M*UURN, W. J. Observations on the behaviour of neoealvarsan. Botton Mtd.
and Surg. Joum 1914, clxxi., Oct. 1, p. 524.

Lneltn Reaction.—WOLFF, L. K., and ZEEMAN, W. P. C. Over de cutiie-
actie van Noguchi bij lues. Nederlandsch Tijdsch. v . Geneesk., 1914, H.
xu. t No. 13, Sept. 26, p. 811.

SCHIPPERS, J. C. De waarde van de luetine-reactie voor Kinderpraktyk,
Nederlandsch Tijdsch. r. Genet aA., 1914, H. xii., No. 13, 8ept. 26, p. 817.

Wassrriuann Reaction.—WOOTTON, J. C. The Wassermann reaction and the

male insane. Joum. Mental Sci., 1914, h., Oct,, p. 579.

WALKER, I. CHANDLER. The specificity of cholesterin with iyphilitic
serums and of cholestet in-reinforced heart antigen in the Wasaennann reaction.
Archives Int. Med ., 1914, xiv., Oct., p. 563.

ASS1NDER, ERIC. Syphilis in the poorer classes: its diagnosis by the
Wassermann test, and its incidence as demonstrated thereby. (Contd.)
Birmingham Med . Review, 1914, lxxvi., Oct., p. 137.

Orchro ftplnal Fluid.—ROSENBLOOM, JACOB, and ANDREWS, VERNON

L. The potassium content of cerebro spinal fluid in various diseases. Archiea
Int. Med., 1H14, xiv., Oct., p. 536.

(iKNCEAL AXD FUNCTIONAL DISEASES—

Epilepsy.—SEBARDT, CARL. Alkohol und Epilepsie. Klinische Studie.
Nord . Med . Arkiv, 1914, Afd. II. (Inre Medicin). Halt 1-4, pp. 1-26.

TURNER, WM. ALDREN. The outlook in epilepsy. Brit . Med . Joum.,
1914, Oct. 17, p. 665.

Chorea.— SWIFT, W. B. Further analysis of the voice sign in chorea Amer.
Joum. Child . Dis., 1914, viii., Oct., p. 279.

Neuroses.— WILLIAMS, TOM A. The traamatic neurosis. Amer . Joum. Med,
Sci. 9 1914, cxlviii., Oct., p. 567-

BILLSTROM, JAKOB. Ein Fall von traumatischer Neurose bei einer vorher
gesunden Patieutin, durch Symptombildern von sinigen anderen Nenrose*
patienten beleuchtet. Nord. Med. Arkiv, 1914, Afd. II. (Inre Mediein), Haft
1-4, pp. 1-5.

CROTHERS, T. D. Periodicity of the drink neuroses. Med. Record, , 1914,
lxxxvi., Oct. 10, p. 628.

Psychoses* —DRYSDALE, H. H. Juvenile psychosis. Report of a casa Joum
Amer . Med. Assoc., 1914, lxiii., Oot. 10, p. 1283.

GERRIN, MARY L. Impressions of a general hospital nurse beginning work in
the psychopathic hospital (Boston, Massachusetts). Boston Med. and Surg.
Joum., 1914, clxxi., Sept. 24, p. 483.

CHANNING, W. Improved nursing for the mentally ill. Boston Med. end
Surg. Joum., 1914, clxxi., Sept. 24, p. 473.

NUTTING, M. A. The training of the psychopathic nurse. Boston MecL end
Surg . Joum., 1914, clxxi., Sept. 24, p. 473.

GREGG, D. A comparison of the drugs used in general and mental hospitals.
Boston Med . and Surg. Joum., 1914, clxxi,, Sept. 24, p. 476.

BIBLIOGRAPHY

103*

ELIOT, C. W. Remarks at conference on modem development in mental
nursing, Feb. 16, 1914. Boiton Med. and Burg. Journ 1914, olxxi., Sept. 24,
p. 477.

SOUTHARD, E. E. Analysis of recoveries at the psyehopathio hospital.
Boston. 1. One hundred oases, 1912-13, considered especially from the stand¬
point of nuning. Boston Med. and Surg. Journ., 1914, olxxi., Sept. 24,
p. 478.

Berl-Berl.—LITTLE, J. M. Beri-beri. Journ. Amer. Med. Assoc., 1914, lxiii.,
Oct. 10, p. 1287.

DARLING, S. T. The pathologic affinities of beri-beri and scurvy. Journ. Amer .
Med. Assoc., 1914, mil, Oct. 10, p. 1290.

Alcoholism, dtc.—COOPER. J. W. A8TLEY. Proposed legislation for inebriates.
Brit. Journ. Inebriety , 1914, xii., Oct., p. 59.

SHAW, T. CLAYE. The aloohol problem of to-day. Brit. Journ. Inebriety,
1914, xii., Oct., p. 66.

NEILD, T. Chronic alcoholism and reproduction. Brit. Journ . Inebriety,
1914, xii., Oct., p. 71.

WAITE, R. Drink in relation to the poor law. Brit. Journ. Inebriety, 1914,
xii., Oct., p. 78.

CARTER, D. Alcoholism as a factor in disease. Med. Record, 1914, lxxxvi.,
Oct. 17, p. 666.

Tetanms. —MacCONKEY, ALFRED. Tetanus: its prevention and treatment by
means of antitetanio serum. Brit. Med. Journ., 1914, Oct. 10, p. 609.

FOTHERINGHAM, J. T. A case of tetanus, with recovery, treated by carbolic
acid injections. Canadian Med. Assoc. Journ., 1914, iv., Oct., p. 902.

GORDON, M. H. Traumatic tetanus. Lancet, 1914, clxxxvii., Oct. 31, p. 1036.

Exophthalmic Goitre, Cretinism, Ac.—CROOKSHANK, F. G. Exophthalmic
goitre: its pathogeny and treatment. Med. Press, 1914, xcviii., Sept. 30, p. 366.

WALTON, ALBERT J. The operative treatment of exophthalmic goitre.
(Illustr.) Practitioner, 1914, xciii., Oct., p. 511.

MAYO, C. H. The surgical treatment of exophthalmos. Journ. Amer. Med.
Assoc., 1914, lxiii., Oct. 3, p. 1147.

BALLARD, I. W. Hyperthyroidism. Med. Record , 1914, lxxxvi., Oct. 10,

p. 626.

MATLACK, G. T. Goitre, its surgical treatment. Therap. Gaz., 1914, xxxviii.,
Oct., p. 685.

SPECIAL SEMES AND CRANIAL NERVES—

MUSKENS, L. J. J. Labyrinthaire invloed op de oogbewegingen; het
mechanisme der geoonjugeerde deviatie van hootd en oogen. Nederlandsch
Tijdsck. v. Geneesk, 1914, H. xii., Nos. 14 and 15, pp. 893 and 970.

BALLON, D. H. Recent investigations on the semicircular canals and their
olinical applications. Canadian Med. Assoc. Journ., 1914, iv. t Oct., p. 871.

MEIERHOF, E. L Thrombophlebitis of the sigmoid sinus of otitio origin
without local manifestations. Journ. Amer. Med. Assoc., 1914, lxiii., Oct. 17,
p. 1389.

MISCELLANEOUS SYMPTOMS AND CASES—

KANAVEL, A. B. Osteoplastic closure of the trifacial foramina. Journ.
Amer. Med. Assoc., 1914, lxiii., Oot. 10, p. 1245.

BARTON, W. M. Postdiphtheritio paralysis. N.Y. Med. Journ., 1914, c.,
Oct. 3, p. 660.

104 *

BIBLIOGRAPHY

GORDON, ALFRED. Nervous And mental disturbances following castration in
women. Journ. Amer. Med . Assoc., 1914, Ixiii., Oct. 17, p. 1345.

OADELITS, 13. Kn sallaynt form af idioti med karakteristiska utveckling-
sanoinalicr—akrocephalo-syndaktyli. Aord. Med. Arkie , 1915, xlviiL, Afd,
II. (Inre Medeciu), H. 1-2, pp. 1-30.

GETTINGS, H. S.. and WALDRON, ETHEL. The detection of a dywntery
carrier. Journ. Mental Sci., 1914, lx., Oct., p. 605.

AGADJANIANTZ, K. On lethargy. Journ. Mental Sci., 1914, lx., Oct.,

p. 620.

PSYCHIATRY.

CK*K*AL PAIAIWW-

MITCHELL, H. W. General paralysis of the insane. N. Y. Med. Journ., 1914,
c., Sept. 26, p. 605.

MAPOTHKR, E., and BEATON, T. Intrathecal treatment of general paralysis.
Journ. Mental Sci ,, 1914, lx., Oct., p. 591.

PILSBURY, L. B. Paresis patients treated with intraspinal injections of
salvarsauised serum. A brief report. Journ. Amer. Med . Attoe., 1914, Ixiii.,
Oct. 10, p. 1274.

RIGGS, C. E., and HAMMES, E. H. Results of one hundred injections of
ealvarsanised serum. Journ. Amer. Med. Assoc., 1914, Ixiii, Oct. 10, p. 1*277.

M'CLURE, C. W. Intraspinous use of salvarsanised serum. Boston Med. and
Surg. Journ., 1914, clxxi., Oct. 1, p. 520.

iFABKAIr-

EWENS, G. F. W. The meaning of insanity. Indian Med. Gaz., 1914, xlix.,
Oct., p. 377.

BERKELEY-HILL, A. R. A comparison between the mental processes in the
sane and in the insane. Indian Med. Gaz ., 1914, xlix., Oct., p. 382,

OVERBECK-WRIGHT, A. The prevention of mental and nervous diseases.
Indian Med. Gaz., 1914, xlix., Oct., p. 387.

PEEBLES, A. S. M. Ganja as a cause of insanity and crime in Bengal. Indian
Med. Gaz., 1914, xlix., Oct., p. 395.

THOMSON, DAVID G. The presidential address on the progress of psychiatry
during the past hundred years, together with the history of the Norfolk County
Asylum during the same period. Journ. Mental Sci., 1914, lx., Oct., p. 541.

BRILL, A. H., and KARPAS, M. J. Insanity among Jews. Med. Record , 1914,
lxxxvi, Oct. 3, p. 576.

GORDON, ALFRED. Neurologic and psychiatric aspects of railway accident
cases. Consideration of some medico-legal problems. Med. Record , 1914,
lxxxvi., Oct. 24, p. 706.

TREATMENT. *

RAYNER, H. The wet pack in the treatment of insomnia and mental disorder*.
Journ. Mental Sci., 1914, lx., Oct., p. 572.

DANIEL, A. W. The use of scopolamine hydrobromide, or byoecine, in tbs treat¬
ment of mental disorders. Journ. Mental Sci., 1914, lx., Oct., p. 610.

• A number of references to papers on Treatment are included in the Bibliography under
individual diseases.

ffitbUograpb\>

The bibliography in this number is greatly curtailed\ since, on account
of the war , the number of Joreign journals reaching this country
is considerably diminished.

ANATOMY.

BEAN, ROBERT BENNET. A racial peculiarity in the pole of the temporal lube of
the negro brain. Anat. Record, 1914, viii., Nov., p. 479.

COWDRY, E. V. The comparative distribution of mitochondria in spinal ganglion
cells of vertebrates. (14 figs.) Amcr. Journ. Anat., 1914, xvii., Nov., p. 1.

SMITH, P. E. The development of the hypophysis of Amia calm. Anat. Record ,
1914, viii., Nov., p. 499.

PHYSIOLOGY.

WHITE, WM. P. f and TITCOMBE, R. H. Observations on the anterior lobe of the

S ituitary. III. The action of pituitary (anterior lobe) extract on cancer in mice.
ted. Cnron ., 1914, lx., Nov., p. 73.

PSYCHOLOGY.

HAMILTON, G. V. An estimate of Adolf Meyer’s psychology. Amcr. Journ.
Insanity , 1914, lxxi., Oct., p. 339.

SOHN, D. L. The psychic complex in congenital deformity. N. Y. Med. Journ., 1914,
c., Nov. 14, p. 9o9.

CLINICAL NEUROLOGY.

GENERAL—

SWIFT, WALTER B. A new method of refiex elicitation. Preliminary report.
Journ. Amcr. Med. Assoc., 1914, lxiii., Oct. 31, p. 1668.

MUSCLES—

LEON, J. T. Pseudo-hypertrophic paralysis. Proc. Roy . Soc. Med., 1914, vii.,
July (Sect. Study Dis. of Child.), p. 182.

SPINAL CORD—

deaeral.—BERGHAUSEN, OSCAR. Intraspinous medication. N.Y. Med.
Joxtrn., 1914, c., Nov. 21, p. 1006.

Herpes Eoster.— FINLAY, R. C. Herpes zoster following arsenic. Journ. Cut.
Dis., 1914, xxxii., Nov., p. 794.

lOli*

BIBLIOGRAPHY

MjcIIIIh.—KFILEEK, \\\ G. Acute myelitis, secondary to perirectal absceo,
developing a few hours after severe fright. Journ. Amer. Med. A$*or. t 19R
lxiii. , Oct. 31, p. 1518.

Tumoin.- Dort SLAS CRAWFORD, D. Note on two cases of intradural spinal
tumours. I* roc. Jlo//. S<x\ Mrd ., 1914, vii. t July (Surg. Sect.), p. 263.

Paraplegia.— PAS'TIXK, C. Sopra un caso di paraplegia improwisae raorbo di
Pott latente. Jin . di Patof. ntrv. r rnent., 1914, xi.v, Sept., p. 53d.

Poliomyelitis Anterior Acuta.—PIM, ARTHUR A. Epidemic poliomyelitis.
Jiritish Mai. Journ ., 1914, Nov. 14, p. 831.

LITCHFIELD, W. F. Infantile paralysis of the small muscles of the hand.
Med. Journ. of Australia, 11)14, i., Oct. 10, p. 347.

Progressive Muscular Atrophy.—DANA, CHARLES L. A new (familial) form
of progressive spinal myopathy. Journ. Ntrv. and Mrnt . Dis., 11)14, ili.,
Nov., p. i;m.

BBAltf—

Meningitis*— <JORDON, ALFRED. Some features of pneumococcal meningitis.
N. Y. Mid. Journ., 1914, c., Oct. 31, p. 851).

THOMAS. H. M.,and BLACKFAN, K. D. Recurrent meningitis due to lead in
a cliiid of five years. Atiur. Journ. Dis. Child., 11)14, viii., Nov., p. 377.

Ilsrinorrtiage.—(’ORE, DONALD E. Spreading or diffuse sub arachnoid hemor¬
rhage. Clin. Journ., 1914, xliii., Nov. 4, p. 841.

SHUMAN, J. W. Intracranial haemorrhage in the iufaut. with history and
necropsy report of a case. Journ. Amer. Med. Assoc., 1914, lxiii., Nov. 14,
p. 1788.

Thrombosis*—GILLLS, A. C. Occlusion of the posterior inferior cerebellar artery.
Journ, Amer. Mrd. Assoc., 1914, lxiii., Oct. 31, p. 1550.

Cerebellum*—MARKS, HENRY K. On the cerebellar syndrome of Babiuski,
with report of a case. Journ. Nerr. and Meat. Dis., 1914, xlL, Nov., p. 709.

Myasthenia*—M‘KKXDREE, C. A. A case of myasthenia gravis. Journ. Amer.
Mrd. Assoc., 1914, lxiii., Oct. 31, p. 1553.

I yst.— RKMSEN, C. M. Operative intervention in cyst of the left cerebral
hemisphere, with a consideration of the preonerative and subsequent
symptoms. Journ. Amer. Mrd. Assoc., 1914, lxiii., Nov. 7, p. 1649.

ROBERTSON, W. N., and AHERN, E. D. Cyst of the pituitary gland. Med.
Journ. of Australia, 1914, i., Oct. 17, p. 372.

Tumour*—KUTTNER, H. The results of one hundred operations performed on
the diagnosis of brain tumour. Journ. Amer. Med. Assoc., 1914, lxiii., Oct.
31, p. 17 m0.

RHEIN, JOHN H. W. Tumour of the crus cerebri. Journ. Amer. Med
A ssoc. , 1914, lxiii., Nov. 1, p. 1882.

Pituitary Tnmoir. —HALSTED, T. H. Intranasal operation in tumour of the
hypophysis. N. Y. Med. Journ., 1914, c., Oct. 31, p. 870.

CUSHING, HARVEY. The Weir Mitchell Lecture. Surgical experiences with
pituitary disorders. Journ . Amer. Med. Assoc., 1914, lxiii., Nov. 7, p. 1515.

Acromegaly*—BLORE, W. ROY. A case of acromegaly, associated with
glycosuria. Med. Chron., 1914, lx., Nov., p. 92.

Diabetes Insipidus* —FITZ, R. A case of diabetes insipidus. Archives of M
Med., 1914, xiv., Nov., p. 708.

DyspltnitarlHiu.—MATTIROLO, G, Contribute alia conoscenza della distrofi*
ipofiao genitale. Riv. di Palol. nerv. c nu'nt., 1914, xix., Sept., p. 513.

BIBLIOGRAPHY

107*

Pellagra*—LITTLE, E. G. G. Pellagra with akin eruptions, troc. Roy. Soc.
Med., 1914, Tii., July (Dermatol Sect.), p. 288.

HUNTER, G. G., and WILLIAMS, E. H. The widening pellagra zone. Med.
Record , 1914, lxxxvi., Oct. 81, p. 757.

■•agollsm.—MIDELTON, W. J. Mongolism with alopecia. Proc. Roy. Soc.
Med ., 1914, vii., July (Sect. Study Dis. of Child.), p. 184.

Syphilis*—MTNTOSH, JABIES, and FILDES, PAUL. A comparison of the
lesions of syphilis and “parasyphilis,” together with evidence in favour of the
identity of these two conditions. Brain, 1914, xxxvii., p. 141.

SACHS, B.. STRAUSS, I., and KALISKI, D. J. Modem methods of treatment
of syphilis of the nervous system. Amer. Journ. Med . Sci., 1914, oxlviii.,
Nov., p. 693.

STOLL, H. F. The late manifestation of inherited syphilis, with especial
referenoe to arterial disease. Journ. Amer. Med. Assoc., 1914, lxiii., Oct. 31,
p. 1558.

GRULEE, C. G. Laboratory diagnosis in the early stages of congenital syphilis.
Amer. Journ. Med. Sci., 1914, cxlviii., Nov., p. 688.

Wssiensan Reaction.— HEAD, HENRY, and FEARNSIDES, E. G. The
elinioal aspects of syphilis of the nervous system in the light of the Wassermann
reaction and treatment with neosalvarsan. Brain, 1914, xxxvii., p. 1.

TEDDER, E. B., and BORDEN, W. B. A comparison of the Wassermann
and luetin reactions in seven hundred and forty-four individuals. Journ .
Amer. Med. Assoc., 1914, lxiii., Nov. 14, p. 1750.

LUSK, W. C. A case of thrombo-angiitis, whose Wassermann was for a long
time negative, but is now positive. Med. Record, 1914, lxxxvi., Nov. 14, p. 833.

Lvetln Reaction. —SQUIRES, J. W. Noguchi’s cutaneous reaction for syphilis.
Med. Press, 1914, oxlix., Nov. 25, p. 540.

Cerebrospinal Flnid.—MITCHELL, H. W., DARLING, IRA A., and
NEWCOMB, P. B. Observations upon spinal fluid oell count in untreated
cases of cerebro-spinal syphilis. Journ. Nerv. and Ment. Dis., 1914, xli.,
Nov., p. 686.

GENERAL AND FUNCTIONAL DISEASES—

Epilepsy.—CLARK, L. PIERCE. A clinical contribution to the diagnosis of
epilepsy. Journ. Amer. Med. Assoc., 1914, lxiii., Nov. 1, p. 1652.

CLARK, L. P. A personality study of the epileptic constitution. Amer. Journ.
Med. Sci., 1914, cxlviii., Nov., p. 729.

JENKINS, C. L., and TENDLETON, A. S. Crotalin in epilepsy. Journ.
Amer. Med. Assoc., 1914, lxiii., Nov. 14, p. 1749.

Hysteria*—HEFFERNAN, P. Notes on two oases of hysteria in males. Indian
Med. Gaz., 1914, xlix., Nov., p. 427.

Psychoses.—O’MALLEY, MARY. Psychoses in the coloured race : A study in

comparative psychiatry. Amer. Journ. Insanity, 1914, lxxi., Oct., p. 809.

GREEN, E. M. Psychoses among negroes. Journ. Nerv. and Ment. Dis., 1914,
xli., Nov., p. 697.

Nenroses. — MASOIN, M. E. Ncvroses et psychoses d’originc otopathique.
Bulletin de VAcad. Roy. de Med., 1914, xxviii., p. 321.

PARKER, S. M. Neurosis and purpose. Med. Record, 1914, lxxxvi., Nov. 14,
p. 840.

Nearalgla*—HARRIS, WILFRED. Some experiences with aloohol injection in
trigeminal and other neuralgias. Journ. Amer. Med. Assoc., 1914, lxiii., Nov.
14, p. 1725.

108 *

BIBLIOGRAPHY

Tetaau.— DOYEN. Traitemeut du tetanos par lea injectioni intraraohidienna
da serum antitetaniquc a haute dose, suivies de renvcrsemeiit da troac en
position de declivity bulbaire. Compt . Rend. d. L Soc, de BioL, 1914, ixivii,
p. 504.

WALTHER, C. Etiologie et prophylaxie du tetanoe chez les blesses de guerTe,
Presse Mid., 1914, No. 70, Oct 8, p. 042.

Exapfctkalmlc Csllre, frcllitiM, Ac. —FOWLER, R. S. Exophthalmic goitre.
N. Y. Med . Jonm., 1914, c., Nov. 14, p. 949.

SMITH, O, hi'CALL. A case of acute exophthalmic goitre simulating sente
obstruction. Lancet, 1914, dxxxvii., Oct. 10, p. 894.

MOORHEAD, T. O. Treatment of Graves's disease by X-rays. DuUin Journ .
Med. Sci., 1914, Scr. III., No. 515, p. 332.

FRAZIER, C. H. A review of one hundred consecutive operations for goitre,
with ee]>ecial reference to the treatment of hyperthyroidism. Annals of
Surgery, 1914, lx., Nov., p. 583.

M AMOUR!AN, M ARCUS. Our present knowledge of the thyroid gland. With
a preliminary report on a case of thyroid grafting. (Illust.) British Mel
Journ ., 1914, Nov. 14, p. 824.

HPMIAL SENSES ASM iKANUl NUVB8—

MAYOU, M. T. Optic neuritis with symmetrical loss of the lower portion of the
field associated with diabetes. Proc. Roy. Soc . Med., 1914, vil, July (Sect of
Ophthalmol.), p. 148.

HENDERSON, E. E. Rupture of the optic nerve at the lamina cribrosa. Proc.
Roy. Soc. Med., 1914, vii., July (Sect, of Ophthalmol.), p. 158.

WESTMACOTT, F. H. Oculo motor paralysis of otitic origin. Lancet, 1914,
clxxxvii., Nov. 14, p. 1143.

MISCELLANEOUS SYMPTOMS AltB CASES—

FISHER, E. D. Toxic diseases of the nervous system, with report of case*
Med. Record, 1914, lxxxvi., Nov. 14, p. 825.

AUDENINO, E. Studio radiografico delle ossa negli arti paralitici. far. di
Patol. nen\ t meat., 1914, xix., Sept., p. 543.

WILLIAMS, TOM A. Some common errors in neurological diagnosis and
treatment. Med. Press, 1914, cxlix., Nov. 11 and 18, pp. 494 and 516.

RUBENSTONE, A. I. Meningococcic empyema. N. Y. Med. Journ., 1914, c.,
Nov. 14, p. 975.

THOMSON, W. H. Vasomotor disorders. Med . Record , 1914, lxxxvi., Oct. ill,
p. 753.

HELLER, J. A study of one hundred and fifty cases of twilight sleep. Med .
Record, 1914, lxxxvi., Nov. 7, p. 797.

GRANT, Sib JAMES. Nerve block, public health and tuberculosis. iV.L
Med. Journ., 1914, c., Oct. 31, p. 849.

PSYCHIATRY.

general paralysis—

DUNLOP, C. B. The pathology of general paralysis. Amr. Journ. Insanity,
1914, Lxxi., Oct., p. 249.

VIDONI, G. Ricerche sul comportamento del ricambio nella cura della paraliii
progressiva con la tubercolina. Riv. di Patol . nerv. e ment., 1914, xix., Sepi,
p. 537.

BIBLIOGRAPHY

109*

NOGUCHI, HIDEYO. On some of the recent advances in the field of micro¬
biology ; with demonstrations of the pore cultures of various spiroohates, of
the viruses of rabies and poliomyelitis, and of Treponema pallidum in the brains
of general paralytics. Proc. Boy. Soc. Med., 1914, vii., July (occasional
lecture), p. 3.

lEMiim fejwox—

SOUTHARD, E. E. On the topographical distribution of cortex lesion, and
anomalies in dementia pneoox, with some account of tlieir functional
significance. Amer. Joum. Insanity, 1914, lxxi., Oct., p. 383.

KIRBY, G. H. Dementia prsecox, paraphrenia, and paranoia: review of
Kraepelin’s latest conception. Amer. Joum. Insanity, 1914, lxxi., Oct.,
p. 349.

GENERAL—

HASKELL, R. H. Mental disturbances associated with acute articular
rheumatism. Amer. Joum. Insanity , 1914, lxxi., Oct., p. 361.

AUER, MURRAY. The psychical manifestations of disease of the glands of
internal secretion. Amer. Joum. Insanity, 1914, lxxi., Oct., p. 405.

HEFFERNAN, P. Asylum dysentery. Indian Med. Qaz., 1914, xlix., Nov.,
p. 417.

ZILOOOHI, ALBERTO. Le pieghe del cuoio oapelluto negli alienati. Rassegna
di Studi Psichiat., 1914, iv., Sett.-Ott., p. 569.

BHIDAY, B. S. Two oases of anergic stupor treated with thyroid gland extract.
Indian Med. Qaz., 1914, xlix., Nov., p. 429,

CARLISLE, C. L. The translation of symptoms into their mechanism. Amer.
Joum. Insanity, 1914, lxxi, Oct., p. 279.

GORDON, ALFRED. Insanity and divorce. N.Y. Med. Joum., 1914, c.,
Nov. 21, p. 997.

BROWN, SANGER. Applied eugenics. Amer. Joum. Insanity, 1914, lxxi.,
Oct., p. 269.

GRINKER, JULIUS. The neurologic examination of mental cases. Joum.
Amer. Med. Assoc., 1914, lxiii, Nov. 14, p. 1754.

WI LLIAM S L. L. The medical examination of mentally defective aliens: its
scope and limitations. Amer. Joum. Insanity , 1914, lxxi., Oct., p. 257.

MOORE, ROSS. The present teaohing of psychiatry in American medical
schools. Joum. Amer. Med. Assoc., 1914, lxiii., Nov. 7, p. 1643.

GRAVES, W. W. Some factors tending toward adequate instruction in nervous
and mental diseases. Joum. Amer. Med. Assoc., 1914, lxiii., Nov. 14, p. 1707.

SINGER, H. D. The ideal course in psychiatry for medical schools. Joum.
Amer. Med. Assoc., 1914, lxiii., Nov. 7. p. 1644.

BOND, C. HUBERT. Introductory address on the position of psychiatry and
the rdle of general hospitals in its improvement. Lancet, 1914, dxxxvii.,
Oct. 17, p. 935.

SHAW, W. 8. JAGOE. Some generalisations on the scope, construction, and
administration of oentral asylum in India. Indian Med. Qaz., 1914, xlix.,
Nov., p. 424.

JACKSON, J. ALLEN. Need of more state hospitals for the insane. N.Z.
Med. Joum., 1914, o, Nov. 21, p. 1013.

STEARNS, A. W. Out-patient work in the Massachusetts State Hospital for
the insane. Boston Med. and Swrg. Joum., 1914, clxxi., Nov. 5, p. 712.

110*

BIBLIOGRAPHY

TREATMENT.*

Psycb+aaalysls.—BURR, CHARLES B. A criticism of psychoanalysis. Aim.
Journ . Insantty, 1U14, lxxi., Oct, p. 233.

FLOURNOY, HENRI. Analysis of a case of peychaathenia. Bullrtin Johni
Hopkins Hosp ., 1914, xxv., Nov., p. 328.

MILLER, H. CRICHTON. The psychic factor in insomnia. Practitiontr, 1914,
xciii., Nov., p. G20.

• A number of references to papers on Treatment are included in the Bibliofrsphy nadir
individual diseases

Jnbtces.

SUBJECT INDEX.

Page Reference* to Original Article* are indicated by Henry Type Figure*.

Abducbns : vide Nerves, Cranial
Abscess: Otitic Meningitis and Cerebellar,
with Recovery, 158 ; Brain, caused by
Fusiform Bacilli, 216; Brain, 216;
Orbital Brain, and its Operation, 313 ;
in Apex of Petrous Pyramid. Death
from Basal Meningitis, 500; Acute
Myelitis secondary to Perirectal, de¬
veloping a Few Hours after Severe
Fright, 516

Acetonuria : Two Cases of Acute Retro¬
bulbar Neuritis, associated with
marked, 390

Achondroplasia: Does it correspond to
Partial Hypopituitarism? 40; and
Chondrohypoplasia, 41 ; Fresh Con¬
tribution to Study of, 41 ; with Manic-
Depressive Psychosis, 86
Acromegaly : Circulatory System in, 494
Addison’s Disease: in a Boy, with
Calcification of Adrenals with Remarks,
167 ; Defaced Type of, 277 ; Case of,
observed in 1902, considered as Cured.
Death from Gastric Cancer in 1913.
Autopsy, 422 ; Case of Implantation of
Suprarenale in, with Fatal Result, 461
Adiposity: due to a Juxta-Pituitary
Sarcoma, 123: Familial, with Endo-
crinal Disturbances, 124
Adiposo - Genital Sjmdrome : Experi¬
mental Contribution to Hypophy*
sectomy and Genital Atrophy, 64
Adrenal: vide Suprarenal
Adrenalin: Further Observations on
Constricting Action of, on Cerebral
Vessels, 207; Action of, and Epinine
on Pupil in Epilepsy, 287 ; and the
Pupils, 306

Agitans, Paralysis: vide Paralysis

Agitans

Alcohol: Histological Observations on
Nervous System of Progeny of Animals
subjected to Chronic Poisoning, 26;
Effect of Administration of, on

Wassermann’s Reaction, 43; and
Delirium Tremens, 274 ; Experi¬
mental Study of Intruneural Injections
of, 274

Alcoholism : Pathological Inebriety : its
Causation and Treatment (Review), 136;
Measurement of Blood-Pressure in. and
Functional Neuroses, excluding Circu¬
latory Disturbances, 166 ; Heredo-
Alcoholic Degeneration, 3S8
Alkaptonuria : Wassernmnn Re action in
Blood in Cases of, 223
All-or-None Principle : in Nerve, 110
Alzheimer’s Disease : and its Relation
to Senile Dementia, 327
Amaurotic Family Idiocy; Case of, 281
Amblyopia : Unusually Extensive Medul-
lated Nerve Fibres in High Myopia
and, 324

Amyosis : Notes on Sunlight and
Flashlight Reactions and on Con¬
sensual, to Blue Light, 131
Amyotonia Congenita : Case of. 3X4
Amyotrophy, Progressive Spinal: Trau¬
matic Lesion of Distal Segments of
Spinal Cord followed by, 376
Antenna : Familial Case of Splenomegalie,
with Infantilism, 419
Anaemia, Pernicious: Psychosis occur¬
ring during Course of, 503
Anaesthesia : General, Absence of Oculo¬
cardiac Keflex in, 25S
Anarthria : Case of Subcortic al or Pure
Motor Aphasia (Dcjcrine) or, 2o6
Aneurysm : Subclavian, Nervous Symp¬
toms caused by, 71 ; of Vessels of
Brain, 382

Angeioma : in Cerebellar Peduncle.

Fatal Intracranial Hteinori huge, 3X2
Angina: Vincent’s, Local Treatment
with Salvarsan, 81

Angiospasm : Spasmodic Closing of
Cerebral Arteries in its Relation to
Apoplexy. 418

112*

INDICES

A«»rtir 1 >is«\iw: Wa>-*ei maim s Reaction
in, 420

Aphasia : R«*|x>rt of two Cases exhibiting
L<->jons of Special Interest for Loralisu-
lion of, 46 ; Contribution to Study of
Loc alisations in, 47 : Left Prefrontal
tilioma with, 47 : C ase from Lesion in
Lwt Hemisphere in a I^eft-Handed
Individual. (’tossed Aphasia and Dis¬
sociated Aphn.-iu, 82 ; Case of Sub¬
cortical or Pure Motor (l)ejerine)>
or Anarthria (Marie), 260; Articu¬
late Language in Normal Man and
in, 4<>7 ; Cliideally Negative Cases
of, 4*4 ; Some .Modern Conc eptions of,

4 it I

Apoplexy : /*nfr Haemorrhage.

Apraxia : Clioma of Corpus Callosum
and Left Parietal Lolx*: Bilateral,
if if i

Areuate Nucleus : in Man. the Anthro¬
poid Apes and the Microoephalie Idiot,

Argvll Hohertson Pupil : in Absence of
(.eneral Paralysis, Talies and Cerebro¬
spinal Syphilis, 477
Arsenic : Myelitis, 490
Arterv : Constrictmg Act ion of Adrenalin
oil " Cerebral Vessels, ‘207 ; Nerve
Arborisations of Blood-Vessel Walls,
2dl ; 1 list ri hut ion of Nerves to, of

Arm. Clinical Value of Results, 470 ;
Hole, of Carotid, in Causation of Vas¬
cular fusions of Brain, with Remarks
on Certain Features of Symptoma¬
tology, 4IS ; Spasmodic Closing of
Cerebral, in Relation to Apoplexy, 418 ;
Occlusion of Posterior Inferior Cere¬
bellar, 522 ; ride Hemorrhage
AsymWoly : 401

Asystole : Xanthochromia of Cerebro¬
spinal fluid in, 27*2

Ataxia: and Fear, 118; Family with
Cerebellar, 160 ; Case of Hereditary,
with Paramyoclonus Multiplex, 161 ;
Hereditary Cerebellar, 380; Acute, in
Convalescence from Measles, 414 j

Athetosis: Double, Inhibitory Action of [
Ocular Compression on Abnormal |
Movements in Case of, 258 j

Atrophy : Neural, of Muscles of Hand
without Sensory Disturbances, 137;
Muscular, from Lead Poisoning, 220
Atropine : Constant Suppression of
Oeulo-Cardiac Keflex by, 250 |

Auditory Nerve: ride Nerves, Cranial
Auricle: Local Action of Nicotine on !

Dog s Right Cardiac, 63 j

Axon: Differential Stain, Structure of j
Vagus Nerve of Man as demonstrated J
by, 402

Babin ski : “Second Sign” of Organic
Hemiplegia in Hemichorea, and its
Bearing on Organic Nature of Chorea,

260

BnrMus colt cnmmuni*: Brain Abscess
due to, 149

Bar any: Significance for Differential
Diagnosis of Pointing-Test of, 3)9;
Total Deafness associated with
Symptom Complex described by, in
which Comnlete Restoration of Hear
ing oeeurrea, 424

Basedow's Disease: ride Exophthalmic
Goitre

Beehterewhs Nude us: Anatomy and
Function of, 4il3

Beri-lx'ri : Relationship of, to (4Lands of
Internal Secretion, 111; rid* Poly¬
neuritis

Binet Test: of Intelligence, 414
Birth Palsy: Brachial, Conclusions
derived from Farther Experience in
Surgical Treatment of, 78
Blindness: as Symptom of Hysteria,388
Blood : Relation of Virus of Epidemic
Poliomyelitis to, 119: Wassermaim
Reaction in, in Alkaptonuria, 223;
Penetration of Virus of Poliomyelitis
from, into Cerehro-spinal Fluid, 4S8:
Kosinophilia in Chorea, 419 ; Uric Acid
Content in, in Insanity, 424; riU
Leucocytosi8

Blood-Pressure: High Frequency Current
in High, 49; Measurement of, in Alco¬
holism and Functional Neuroses, ex¬
cluding Circulatory Disturbances, 16*i
Bonaparte : Louis, King of Holland.
Case of, 154

Bradycardia: Oculo-Cardiac Reflex in
Normal Subject-8 without, 245
Brain: Anatomical: Parietal Area, 64 ;
Structure of, and Interpretation of
Mental Phenomena in Relation to Lav,
170; of Black Monkey. Relative
Prominence of Different Oyri, 370;
Racial Peculiarity in Pole of Temporal
Lobe of Negro, 510. Pathology : Study
of, Atrophy in Insanity, 430; vidt
Tumour, Ac.

Brown Sequards Syndrome: Transitory.

at Onset of Spinal Syphilis, 261.

Bulb : Alterations of Cells of, in Case
of Dementia Pnecox, 48 ; Syndrome
Hthni-Bulbaire, 78; Sudden Death
from Hemorrhage in Dementia Pra
cox, 170

Bulbar Nuclei: with Special Reference
to Existence of a Salivary Centre in
Man, 106

Bulbo-Pontine Glioma : Case of, 481
Bullet Wound : of Spine, 154

INDICES

113*

Cabbon Monoxide Poisoning : in Seng-
henydd, 389

Cataract: Researches on Senile, and on
Tetany, 320

Catatonia: and its Relation to Manic-
Depressive Insanity, 132; Clinical
Significance of, 278

Cauaa Equina: Glioma of, Report of
Case with Seoondary Gliosis of Spinal
Cord, 121; Giant Tumours of (xmus
and, 375 ; Rare Case of Spina Bifida,
with Subsequent Development of
Symptoms referable to Involvement of
Conus Meduliaris and Epiconus, 375;
Peculiar Undescribed Disease of Nerves
of, 416

Celluloid: Splints in Acute Cases of
Poliomyelitis, 415; in Treatment of
Diseases of Nervous System, 453

Cemesthopathies, 253

Cephalograph: a New Instrument for
Recording and Controlling Head
Movements, 253

Cerebellum: Experimental Researches
on Function of, 60; Embolism, 123;
Abscess, 158; Family with, Ataxia,
160; Hereditary Ataxia, 380; Symp¬
toms and Localisation, 524

Corebro-spinal Fluid: Drop Methods of
Counting the Cells of the, the Relation
of the Cell Count to the Wassermann
Reaction, 333; Urea Content of, with
Special Reference to its Diagnostic and
Prognostic Significance ; a Series of 97
Cases, 82; and Special Method of
Treatment of Essential Epilepsy, 129 ;
in General Paralysis, 169; Albumen
in, in Cases of Mental Disease, 171;
Syndrome of Xanthochromia and
Coagulation en masse of, 221 ; Correla¬
tions of, Examinations with Psychiatric
Diagnosis, 227 ; Aseptic Leuoocytosis
of, with Subacute Meningeal Syndrome
in Course of Cerebral Haemorrhage,
Xanthochromia and Polynucleosis,
271; Prognostic and Diagnostic Value
of Sign of Isolated Hyperalbuminosis
in, 271; Retrospective Sign of Syphilis.
Pure Hyperalbuminosis of, without
Leucocytosis and without Wassermann,
271 ; Xanthochromia of, in Asystolic
Patients, 272 ; Albumen Content of, in
Relation to Disease Syndromes, 318 ;
Colloidal Gold Reaction in, 319, 459;
Method by which Remedial Agents
may bo mingled with, 387; Practical
Study of Albumin in, in Syphilis, 421;
Penetration of Virus of Poliomyelitis
from Blood into, 488 ; Studies on,—I.
Introduction. II. Theories of Drainage
of, with Analysis of Methods of In¬

vestigation. III. Pathways of Escape
from Subarachnoid Spaces, with Par¬
ticular Reference to Arachnoid Villi.
IV. Dual Source of, 512. V. Drainage
of Intra-Ocular Fluids. VI. Establish¬
ment of Drainage of Intra-Ocular and
Intra - Cranial Fluids into Venous

S stein. VII, Analogous Processes of
rebral and Ocular Fluids, 513; In¬
crease of Total Nitrogen and Urea
Nitrogen in, in Certain Cases of In¬
sanity, with Remarks on Uric Acid
Content of Blood, 525.

Cerebro spinal Pressure : 204 ; General
Effects of Increasing, 371
Chagas’ Disease : Nervous Varieties of
New Form of Trypanosomiasis, 41
Chemotherapy : Vital Staining and, 203
Children : Typhoid Cerebro - spinal

Meningitis in, 32; Respiratory Form
of Encephalo-Meningeal Reactions in
Typhoid Fever in, 77; R61e which
Heredity Plays in inducing Epilepsy in,
suffering from Infantile Cerebral Palsy,
120; Addison’s Disease in, with Calci¬
fication of Adrenals, with Remarks,
167 ; Nervous Diseases of Elementary
School, 210 ; Occurrence of Wasser¬
mann Reaction in Serum of, of Poorer
Classes, 272; Epilepsy in, 321, 322 ;
X-Rays in Fractures of Cranium in,
417 ; vide Poliomyelitis, Ac.
Chondrohypoplasia: Achondroplasia and,
41

Chorea: Babinski’s “Second Sign” of
Organic Hemiplegia in Hemichorea, and
its Bearing on Organic Nature of, 350;
Eosinophilia in, 419; Voice Sign in, 591
Chromaffin Tissue: and Suprarenal
Glands (Review), 537
Cinematograph: Observations of Cere¬
bellar Phenomena, 524
Coccygeal Ganglion: Mechanical Stimula¬
tion of Contribution to Physiology of
Sympathetic Nervous System, 207
Cteliac Reflex : Hypotensive, 305
Colchicine : Chronic Palsy of Limbs due
to Prolonged Use of, 324
Colloid: Structure of Nerve Cell, 152;
Gold Reaction in Cerebro-spinal Fluid,
319, 459

Colony System: for Care and Treatment
of Cases of Mental Disease, 172
Congenital : Facial Paralysis, 36;
Hemiatrophy, 122; Goitre, 167;
Syphilis, Manifestations of, 527
Contracture : Considerations on Physio¬
logical Pathology of, 61 ; Mechanism
of Muscular Tonus of Reflexes and of,
252 ; Case of Hysterical, 485
Conus Meduliaris: Giant Tumours of,

114*

INDICES

375; Rare Oase of Spina Bifida, with
subsequent Development of Symptoms
referable to Involvement of, #75
Oord, Spinal: t*ide Myelitis, Tumours, Ac.
Cornea: Contribution to Study of So-
called Pseudo-sclerosis with Changes
in Liver and, 270

Cornu Ammonia: Note on Circulation of,
202

Corpus Callosum : Partial Agenesis of,
209; Glioma of, and Left Parietal
Lobe : Bilateral Apraxia, 266
Corpus Striatum: Phylogenetio Evolution
of, 200 ; vide Lenticular Degeneration,
Progressive

Coverslips : Collodion, in Microsoopical
Technique, 486

Cranial Nerves : vide Nerves, Cranial
Cretinism : Etiology of Endemic, Con¬
genital Goitre, and Congenital Para¬
thyroid Disease, 167
Crista Acustica : Fourth, 22
Crural: Neuritis, 130, 275; Paraplegia
from Extra - Dural Spinal Tumour.
Operation, Recovery, 452
Crus Cerebri : Tumour of, 520
Cyst: Is there a Cystic Variety of
Disseminated Sclerosis? 380; Operative
Removal of Pineal, 382; Multiple
Visceral Hydatid (Heart, Brain,
Kidneys), Rupture of Heart Cyst in
Left Auricle, 519 ; of Left Cerebral
Hemisphere, with Consideration of Pre-
operative and Subsequent Symptoms,
5zl; of Pituitary Gland, 522

Decompression : Sellar, in Case of Pitui¬
tary Tumour, 162

Defectives, Mental: Industries for
(Review), 49; Pineal Gland in Treat¬
ment of, 173 ; Are they Lacking in
Moral Qualities ? 308 ; Mental De¬
ficiency (Review), 330; Physical De¬
velopment in, 392, 423; The Training
School Bulletin (Review), 431 ; Binet
Measuring Scale of Intelligence, 514

Degeneration: Structure of Myelin
Sheath and its Alteration in Secondary,
25

Delirium Tremens: Alcohol and, 274

Dementia Paralytica: vide General
Paralysis

Dementia Prtecox: Alterations of Cells
of Bulb found in, 48 ; Reflexes in, 85 ;
Researches on Genital Glands in,
86; Sudden Death from Bulbar
Haemorrhage in Case of, 170; Meta¬
bolism in, 327 ; Somatic Disturbances
in, 392; in Eighth Edition of Krae-
pelin’s Text-book, 427

Dementia, Senile: Alzheimer’s Disease
and its Relation to, 327

Diabetes Insipidus: Oase of, 163; and
Infantilism, 218

Diabetes Mellitus: Facial Paralysis, 267;
Talalgia in, 451 ; Optic Neuritis with
Symmetrical Loss of Lower Portion of
Ineld associated with, 501

Diphtheria: Post-Diphtheritic Abducens
Paralysis, 33; On Changes in Hypo¬
physis in Experimental, 68; On
Treatment and Nature of, Paralysis,
72; Pathogeny and Symptomatology
of Post-, Polyneuritis, 118; Ocute-
Cardiac Reflex in, 311 ; Case of Hemi¬
plegia in, 314; Changes in Central
Nervous System in Experimental and
Human, 372 ; Organic Hemiplegia of,
379; Intramuscular Injections of
Antitoxin in, 379; High Incidence of
Post-, Paralysis : Contribution to Ques¬
tion of Neurotropism of Certain In¬
fective Agents, 492

Diplegia: Cerebral, Oculo-Cardiac Re¬
flex in, 312

Dipfococcus Crcuwt#: Septicaemia with
Cerebro spinal Localisation, 116

Disseminated Sclerosis : Anatomical Ex¬
amination of Case of, from Dissemin¬
ated Syphilitic Myelitis, 67 ; Is there
a Cystic variety of ? 380 ; with Crossed
Hemiplegia, 455

Diuresis : Suprarenal Bodies and, 449
. Dog: Problem of Thinking Dog of
Mannheim, 208, 208

Dreams : (Review), 535 ; Analysis and
Interpretation of, based on various
Motives, 67, 410 ; Inventonal Record
Forms of Use in Analysis of, 309

Ductless Glands : tide Pituitary, Supra¬
renal, Thyroid, Ac.

Dysentery Carrier : Detection of, 532

Dyspituitarism: Three Cases of, 40;
vide Pituitary, Ac.

Dystonia Musculorum Deformans : Case
of, 314

Ear : vide Hearing, Labyrinth
Electric Shook : Hysterical Monoplegia
following, 45, 161

j Electrical Treatment: for Neuritis, 328
I Embolism : Cerebellar, 123
| Encephalic Puncture: by Orbital Route.
Its Clinical and Therapeutic Indica¬
tions, 123

Encephalitis: in Mumps, 158; Observa¬
tions on Cases of, 531
Endocardium: Directly Excitable Region
in the Human, 63
' Eosinophilia: in Chorea, 419

INDICES

115*

Ependymitis: Serosa or Meningitis—
Meningism, Intra - Cranial Serous
Effusions of Inflammatory Origin.
With Note on “ Pseudo-Tumours ” of
Brain, 114

Epilepsy: The Nature and Treatment
of So>called Genuine, 231; Aotion of
Adrenalin and Epinine on Pupil in,

287

Epilepsy : Spasmophilia and, 44 ; Alter-
nans, 47; Mental Manifestations of,
65; Progressive, Myoclonus, 84;
Cerebrospinal fluid and Special
Method of Treatment of Essential, 129;
Brain of Macrocephalic, 129; Role
which Heredity Plays in inducing, in
Children suffering from Infantile
Cerebral Palsy, 120; Effect on Mental
State of Minor and Major Attacks in.
Insanity, 167; Reflex, of Therapeutic
Origin, 274 ; Changes in Reflexes pro¬
duced by Ocular Compression in, 256 ;
Stoppage of Heart by Oculo-Cardiac
Reflex in, 257 ; Exaggeration of Oculo-
Cardiac Reflex in, 287 ; in Childhood,
321; True Idiopathic, in Children, 322;
and Tuberculosis, 460; Theory of
Causation founded upon Clinical Mani¬
festations and Therapeutic and Patho¬
logical Data, 460; Outlook in, 498;
and Cerebral Tumour, 520

Epinine: Action of Adrenalin and, on
Pupil in Epilepsy, 287

Etiology: of Epidemic Poliomyelitis,
156; of Endemic Cretinism, Congenital
Goitre, and Congenital Parathyroid
Disease, 167

Exophthalmic Goitre: Polyneuritis of
Pregnancy with Symptoms of, 45; in
the Male Sex, 45; and Sclerodermia,
46; Case of, successfully treated with
Milk of Thyroidectomised Woman, 47;
Oculo-Cardiac Reflex in, 254; Relations
between, and Puerperal State, 276;
and Glycosuria, Failure of Pituitary
Opotherapy, 276; Case of, simulating
Acute Obstruction, 495; Tuberculosis
and, 496

Familial Disease : Two Families with
Several Members in each suffering from
Optic Atrophy, 42; Nervous Symptoms
associated with Optic Atrophy of
Familial Type, 43; Adiposity with
Endocrinal Disturbances, 124
Fear : and Ataxia, 118
Forearm Sign, 451

Freud : The Teaching of, and his School,
84; Neuroses and Sexuality, 84; vide
Dreams, Psychoanalysis, &c.

u Friction” : Technique of Nerve Palpa¬
tion by Nerve, 148

Friedreich’s Disease; Sensory Changes
in, 122; First Observed (jases of, in
America, 155

Galactosides : of Brain, 69

Ganglion: Structure of Otic, 22; Study
of, Cells in Sympathetic Nervous
System, with Special Reference to
Intrinsic Sensory Neurones, 302;
Comparative Distribution of Mito¬
chondria in Spinal, Cells of Vertebrates,
511; vide Gasserian

Ganglio-Neuroma: Malignant, of Left
Suprarenal, 421

Gaseous Exchange: in Decerebrate
Animal, 449

Gasserian Ganglion: Tumour of Middle
Cranial Fossa, involving, 217

General Paralysis: Treatment of, with
Sodium Nucleinate and Salvarsan, 48 ;
Suprarenal Apoplexy in, Sudden Death,
85 ; Analysis of Errors in Diagnosis in
Series of Sixty Cases of, 131 ; Serum
and Cerebro-spinal Fluid Reactions
and Signs of, 169; Intraspinal Injection
of Salvarsanised Serum in Paresis, 225,
225; Treatment of, with Salvarsan, 226;
On Attempts at Special Serotherapy
in, 226; Civil Capacity in Remissions
from, 227; Arachnoid Injections with
Serum of Syphilitics in Tabes and, 326;
Treatment of, 327 ; Trauma and, 392;
and Pregnancy, 424 ; Focal Symptoms
in, 424 ; Differential Diagnosis of, 425 ;
Precocious, Three Years after Chancre
treated by “606,” 501; Rapidly
aggravated by “ 606,” 502 ; Results of
Specific Treatment in, at Salpetrifere,
1912-1914, 502; treated with Intra-

K il Injections of Salvarsanised
m, 502, 503 ; Intrathecal Treat¬
ment of, 527 ; Intraspinal Injections of
Neosalvarsan in, 528
Glands: vide Suprarenal, &o.

Glioma; left Prefrontal, with Aphasia,
37 ; of Cauda Equina. Report of Case
with Secondary Gliosis of Spinal Cord,
121; of Corpus Callosum and Left
Parietal Lobe : Bilateral Apraxia, 266;
Clinical and Ana tomo-Pathological
Notes on Case of Bulbo-Pontine, vSl
Glycosuria: Hypophysectomy and Ex¬
perimental, 110; Exophthalmic Goitre
and, Failure of Pituitary Opotherapy,
276; Albuminuria, Polyuria and, caused
by Ocular Compression, 261
Glycyl-Tryptophan Reaction : in Menin¬
gitis, 454

116*

indices

Goitre: Observations and Experiment* » Case of, in Diphtheria, 314, 379;

on, in Brook Trout, 66; Etiology of Late, of Central Origin with Peripheral

Congenital, of Congenital Parathyroid Homolateral Paralysis of Tongue from

Disease, and of Congenital Endemic Cerebral Tumour with Double Localisa-

Cretinism, 167 , tion, 381 ; Crossed, in Disseminated

Cold Reaction: Colloidal, in Cerebro- Sclerosis, 455

spinal Fluid, 319; Critical Study of Heredity: Role played by, in inducing
1-ange‘s Colloidal, in Cerebro-spinal Epilepsy in Children suffering from

Fluid, 459 . Infantile Cerebral Palsy, 1*20; Ataxia

Craves* Disease: ridt Exophthalmic with Paramyoclonus Multiplex, 161;

Goitre On Pedigree showing both Insanity

Grooves; Causation of Large Vascular, and Complicated Eye Disease; Antici*

found on Inner Aspect of Os Parietale, pation of Mental Disease in Successive

203 | Generations, 325; Orel>ellar Ataxia,

Growth : Influence of Adrenals on. 111 I ,*180; Unusual Type of, Disease of

Gummala: of Thyroid, 49ft 1 Nervous System, 455; Persistent

Gynecology : Thyroid Opotherapy in, , (Edema of Legs (Milroy’s Disease),

49ft I with Acute Exacerbations. Two Cases,

I 490

Heredo-Alcoholic Degeneration, 388

H.kmatomykma : Traumatic, 34; Trau- j Hero: Myth of Birth of, 464
matic, without Vertebral Lesion, 265 i Herpes Zoster: Etiology of, in Cerebro-
Hiemorrhage: into Left Supramarginal ! spinal Meningitis, 75; Oticus, 113;

and Angular Gyri, 38; Cerebral, in j (5m, ever occur Traumatieally? 114;

Chronic Myeloid Leuca-mia, 122; j of Dental Origin, 211; in a Patient

Venesection in Cerebral, with Report i with Spinal Cord Syphilis, -11;

of Cases, 160; Sudden Death from j Salvarsan in Ophthalmic, 387; wid

Bulbar, in Case of Dementia Pr.venx, Malaria, 489 ; Conjugal, 489; General-

170; Diagnosis of Cerebral, by Means i ised, 515 .

of Lumbar Puncture, 219; Aseptic j Hiccough: Favourable Action of Ocular
Leueoeytosis of Cerebro-spinal Fluid j Compression on Certain Nervous Mam*

with Subacute Meningeal Syndrome in ; festations, especially, 260

Course of Cerebral, Xanthochromia I High Frequency Current: in Treatment
and Polynucleosis, 271 ; Angeioma in I of High Blood Pressure, 49
Cerebellar Peduncle. Fatal Intra- j Horses : of Elberfeld once more, 111
cranial, 382; Spasmodic Closing of I Hydrocephalus: “ Idiopathic,’’ in iorm
Cerebral Arteries in Relation to of Weber’s Syndrome. R&pid Uj ir ®

Apoplexy, 418 ; Meningeal Syndrome i Lumbar Puncture, 39; Acquired, due

in Course of Cerebral, 454 to Meningitis of Mumps, 518

Hair : Folds of Skin Hair in Insane, 501 I Hyperalbuniinosis; t*idt Cerebro-spina
Hand : Neural Atrophy of Muscles of, I Fluid . ,

without Sensory Disturbances, 1S7 Hyperostoses : Combination of Crania ,

Headache : Lumbar Puncture as Special | and Cerebral Tumours, 218

Procedure for Controlling, in Course Hyperplasia: Nodular,of Liverassocia
of Infectious Diseases, 415 with Brain changes, 26

Hearing : New Theory of, 483 Hypnotics : Role of, in Mental Disease.,

Heart: Local Action of Nicotine on with Indications for their Selec m

Dog’s Right Cardiac Auricle, 63 ; A and Employment, 463

Directly Excitable Region in the Hypnotism; and Suggestion (Kevi /i
Human Endocardium, 63 534

Hemianopsia : Binasal, occurring in Hypophysis ; f'idt
Course of Tabetic Optic Atrophy, 212 Hypopituitarism ;

Hemiatrophy': Case of Congenital, 122; correspond to a ~~- - ,

Case of Progressive Facid, 219 ; Case and Metabolic Studies of a Case o »

of Facial, 267 to Cyst of the Hypophysis, »

Hemiplegia: Two Cases of Tabes com- Infantilism of the Lorain type. ’

plicated by, 72; Two Cases of Post- vide Pituitary, &c. •

Operative, 79; Late, Neosalvarsan, Hysteria : The Bradshaw Lecture »

Death, 164; Pneumonic, 216; and Some of its Aspects, 44Gwe »
Prostatectomy, 266 ; Ocuio-Cardioc Monoplegia following Electric *

Reflex in, ancl Cerebral Diplegia, 312 ; f 45; Psychoanalytic Study ot

Pituitary Body
Does Achondmplasia

Partial ? 40: Clinical

INDICES

Case of, 66; Defects of Field of
Vision in, 323; Psychopathology of,
(Review), 331 ; Analysis of Blindness
as Symptom of, 388; Case of, Con¬
tracture, 485

Idiot, Microckphalic : with Malforma¬
tion of Brain, 412

Impact: Remarks on Histopathological
Changes in Spinal Cord due to Impact.
Experimental Study, 310
Industries : for Feeble-minded and

Imbecile (Review), 49
Inebriety : ride Alcoholism
Infantilism; 456; Hypophyseal, 40; of
Lorain Type due to Cyst of Hypophysis,
Clinical and Metabolic Studies m, 80 ;
Retrogressive, 80 ; Diabetes Insipidus
and, 218 ; Familial Cose of Sp] ieno- I
megalic Anremia with, 419
Infantile Paralysis : ride Poliomyelitis
Infantilism, 456; Hypophyseal, 40;
Retrogressive, 80; Diabetes Insipidus
and, 218

Insomnia: Wet Pack in, and Mental
Disorders, 530

Insular Sclerosis: vide Disseminated
Sclerosis

Iridoplegia : Experimental Production of
Reflex, 62

Ischaemia: Peripheral Neuritis from, 84
Iscovesco’s Experimental Researches on
Lipoids of Organs, 100

“ Jaw-Winking Phenomenon”: Associ¬
ated Movement of Jaw and Upper Lid,
412

Knock-out: Physiological Mechanism of.
69

Kiimniel’s Disease : Late Deformities of
Vertebral Column following Trauma,

Labyrinth : Suppuration, 87; Mem¬
branous, Fourth Crista Acustica, 22;
An Aid to the Study of Inflammations
of the Internal Ear (Review), 135 ; In¬
flammation of, after Injection of Neo-
salvarsan, 164 ; Activity, 391
Landry’s Paralysis : Case of, 265, 518
Langes Colloidal Cold Reaction: in
Cerebro spinal Fluid, 319, 459
Laryngeal fSac: True, Formation in Man
and its Operative Treatment, 422
Lead Poisoning: (Review), 538 ; Mus¬
cular Atrophy from, 220: Critical Ex-

amin&tion of 100 Painters for Evidence
of, 385 ; Observations on 120 Cases of
Lead Absorption from Drinking
Water, 385; with Paralysis of Ex¬
ternal Ocular Muscles, 420; Electro¬
lytic Treatment of, 455
Lenticular Degeneration, Progressive:
Case of, 83, 124, 383, 494 ; Westphal-
Striim pell’s Pseudosclerosis and, 161 ;
vide Liver
Lethargy: 530

Leucocytosis: Clinical Value and Signi-
ficance in Mental Disease, 171 : ride
Cerebro-spinal Fluid
Leukiemia: Cerebral Haemorrhage in
Chronic Myeloid, 122
Lipoids : Isoovesco’s Experimental Re¬
searches on, of Organs, 100; Fats,
Stearines and, in the Normal and
Pathological Central Nervous System,
69

Lipoma: Herpetic Facial Paralysis in
Patient with Symmetrical, 312 ; Sub¬
fascial, of Foot causing Symptoms of
Sciatic Neuralgia, 495
Lissauer: Tract of, and Substantia
Gelatinosa Rolandi, 198
Liver : Nodular Hyperplasia of, associ¬
ated with Brain Changes, 26 ; Contri¬
bution to Study of so-called Pseudo-
Sclerosis, with Changes in Cornea and,
270; Intoxication Psychosis associated
with Cirrhosis of, 430; vide Lenticular
| Degeneration, Progressive
Luetin Reaction : Noguchi’s, in Syphilis,
80, 222

Lumbar Puncture : Case of “ Idiopathic
Hydrocephalus” in form 9 f Weber’s
Syndrome. Rapid Cure by, 39 ; Diag¬
nosis of Cerebral Ha'morrhage by
Means of, 219; Sudden Death follow¬
ing, 318; as Special Procedure for
Controlling Headache in course of
Infectious Diseases, 415
Lung: Vaso-Motor Nerves in, 205;
Hypotensive Action of Pituitary
Posterior Lobe Extract on Circulation
in, 206

Macrocephaly : Brain of, Epileptic, 129
Macro-Genito-Somatic Syndrome: Pre¬
cocious, Experimental Production, 23
Magnesium Sulphate: in Purulent
Cerebro spinal Streptococcic Menin¬
gitis, 517

Maize: Influence of Milling of, on
Chemical Composition and Nutritive
Value of, Meal, 24

Malachite Green: Vital Staining of
Nerve Centres by, 112

118*

INDICES

Malari.i : Herpes Zoster and, 489
Malta Fever: Nervous Forms of, 5 15
Manic-Depressive Psychosis: On the
Mechanism of Some Cases of, 175;
Mechanism of Periodic Mental Depres¬
sions as shown in Two Cases, and the
I hempen tic Advantaged such ‘Studies,
433 ; Achondroplasia with, 86; CaU-
tonic Syndrome and its Relation to,
P12; Complement Deviation in Cases
of, 278

Mannheim : Thinking Dog of, 208
Mast Cells : in Meninges of Neeturus,
easily mistaken for Nerve Cells, 481
Mater, Pia: Clinical Observations on
Tumours of, 38

Measles : ThromUjsis of Cerebral Sinuses
alter, 78 : Acute Ataxia in Con¬
valescence from, 413
Meiostagmine Reaction: in Mental
Disease, 49

Meningitis: Ccrihro-»pinaJ: Etiology of
Herpes in, 74 ; Chronic Forms of
Epidemic, 116; Serotherapy of, 262;
Meningococcus (Review), 534
Parnm* mmjococnU: Case of Fulminating,
313 ; Case of. Serotherapy. Recovery,
414 ; and its Antiserum, 487
Pnntmorocrn/: Primary, 75; in Sharp¬
shooters of Senegal, 492
TuIwch/oh# : with Association of Menin¬
gococcus, 75 ; Differential Diagnosis of
Syphilitic and, in Adult, 116
Typhoid: in Infant, 32; On Meningo-
Typhoid, 76; Respiratory Form of
Encephalo - Meningeal Reaction in
Child, 77

Streptococcic : Case of Tuberculous Disease |
of Vertebra?, complicated by Acute |
Meningitis, 378 ; Magnesium Sulphate
in Purulent, 517 |

Syphilitic: Differential Diagnosis of, and i
Tuberculous in Adult, 116; Basal,
Five Months after Infection, 159;
Preroseolar, 213; On Metachancral
and Preroseolar, 493
After Follicular Tonsillitis, 31; Hyper¬
trophic Cervical, 31 ; Case of Purulent
Aseptic, after Intranasal Interference,

31; Parotitis complicated by, 76; Men¬
ingeal Form of Poliomyelitis, 30, 30;
Meningo-Cerebellar Symptom Complex
in Febrile Diseases occurring in Tuber¬
culous Individuals, 32; Intracranial !
Serous Kflusions of Inflammatory I
Origin. Ependymitis Serosa—Menin-
gism. With Note on ‘‘Pseudo-
Tumours ” of Brain, 114; Otitic, and
Cerebellar Abscess, with Recovery,

158 ; Aseptic Reactions of Meninges
and their Diagnosis, 214, 493; in

Mumps, 214; Cerebral Complications
of Whooping-Cough. With Special
Reference to “Pachymeningitis Pro-
ductiva Interna,” 215; Maladies des
Meninges (Review), 279; Recurrent
Fever and Meningeal Syndrome, 313,
(in Greece, 1912 13), 262, (in North
Africa), 378; Cerebral Rheumatism
explained by Haemorrhagic Meningitis
occurring in Course of Acute Articular
Rheumatism, 262 ; Two Cases of Sup¬
purative Otogenic, with Recovery, 263;
Medullary Cavities and Cervical, 411;
Meningeal States in Scarlet Fever and
Scarlatinal Ura?mia, 414; Glycyl*
Tryptophan Reaction in, 454; Memn-

f eal Syndrome in Course of Cerebral
faMnorrhage, 454; Abscess in Apex of
Petrous Pyramid. Death from Basal,
j 500 ; Acquired Hydrocephalus due to,

j of Mumps, 518

Meningococcus; Tuberculous Meningitis
I with Association of, 75; Pulmonary

! Localisations of, 414; Meningitis

| (Review), 534; vide Parameningo¬

coccus

l Metabolism: in Hypopituitarism with
! Infantilism of Lorain Type, 80; in

I Dementia Prarcox, 327; Studies in

1 Case of Myasthenia Gravis, 457

| Metallic Poisons: and Nervous System,
70 ; ride Lead

; Metatyphoid: Myelitis, 33; vide Typhoid
Microcephalic idiot: Arcuate Nucleus
in Man, the Anthropoid Apes, and the,
51; with Malformation of Brain, 412
i Migraine: Pathology of, 165
I Milroy’s Disease : Persistent Hereditary
| (Edema of Legs, with Acute Exacerba¬
tions. Report of Two Cases, 490
Mitochondria; Comparative Distribution
of, in Spinal Ganglion Cells of V erte*
brates, 511

Moiluscum Gravidarum: vide Neuro¬
fibromatosis M

Monoplegia: Hysterical, following

Electric Shock, 45, 161 ■

Moriz Weisz Reaction: in Menta

Di seases 462

Mumps: Nervous Complications of, in
Child, 117; Encephalitis m, 158;
Meningitis in, 214; Acquired Hydro*
cephalus due to Meningitis of, 518

- Traumatic Intramuscular

Ossification, 29 .

Musical Faculty: Its Origin and Pro¬
cesses (Review), 504
Myasthenia Gravis: Contribution
Pathology, 112; Pathogenesis of, 584 ,
Suprarenal and Pituitary Opotherapy
in, 384 ; Metabolism Studies in, 45/

INDICES

119*

Myatonia: Congenita (Oppenheim),

Case of, 113, 515

Myelin Sheath : Structure of, and
Alteration in Secondary Degeneration,
25; Peculiar Alterations of, in De¬
generating Nerve Fibres, 373
Myelitis : Metatvphoid, and Spinal Cord
Phenomena of Typhoid Fever, 33;
Anatomical Examination of a Case of
Multiple Sclerosis from Disseminated
Syphilitic, 67; Pneumococcal, 378;
Arsenical, 490; Acute, Secondary to
Perirectal Abscess, developing a few
hours after Severe Fright, 516
Myoclonus : Idiopathic Varieties of, 28 ;

Progressive Epileptic Myoclonus, 84
Myopathies: Relation of, 113
Myotonia : Theory of, 71

Name-Forgetting : Three Examples of,
308

Neosalvarsan: Death following Two
Injections of, at Onset of Syphilis,
125; Late Hemiplegia. Death, 164;
Inflammation of Labyrinth after
Injection of, 164 ; Technic of Intra¬
dural Injections of, in Syphilis of
Nervous System, 223 ; Present Status
of, in Treatment of Parasyphilis of
Nervous System, 274; Syphilitic
Reinfection after Treatment with,
421; Unfavourable Complication
following Intradural Injection of, 526;
Intr&spinal Injections of, in Tabes and
General Paralysis, 52S

Nerve Cell: Colloidal Structure of,
152

Nerves, Cranial: Optic: Neuritis with
Acetonuria, 390; in Diabetes 501.

Oculomotor: Notes of a Case of Recur¬
rent Paralysis of, 58 ; Bilateral Palsy
from Softening in each. Nucleus, 154;
Paralysis of Otitic Origin, 499

Abducens: Lead Poisoning with Par¬
alysis of External Ocular Muscles,
420; Paralysis of External Rectus
from Abscess in Apex of Petrous
Pyramid. Death from Basal Menin-

pher&l Distribution of Issuing Fibres,
107 ; Structure of Roots, Trunk, and
Branches of, 109; Structure of, of
Man as demonstrated by Differential
Axon Stain, 302

Nerve Fibre: Degeneration: Structure
of Myelin Sheath and its Alteration in
Secondary, 25

Regeneration: of Medullated Nerves in
Absence of Embryonio Nerve Fibres,
following experimental Non-Traumatic
Degeneration, 152

Nerve Tracts: Tract of Lissauer and
Substantia Gelatinosa Rolandi, 198;
Nervous Terminalis, 201, 202; Pyra¬
mid Tract in Red Squirrel and Chip¬
munk, 370; Degeneration of Fascicul-
ous Cerebro-spinalis in Albino Rat,
511

Nervus Terminalis: in Man and
Mammals, 201 ; in Adult Man, 202;
Ganglion Cells of, in Dog-Fish, 481

Neurasthenia: Analysis of So-called, and
Allied States, 308

Neuritis: Peripheral, from IsohsBmia,
84 ; Anterior Crural, 130, 275 ; Treat¬
ment of, by Electrical Methods, 328 ;
vide Optic Neuritis

Neurofibromatosis, 377, 413; Multiple,
of Skin, 490; Generalised, 515;
Recklinghausen’s Disease, 159, 314;
Incomplete Forms of, 30; Fibrosar¬
coma of Leg on Woman suffering from,
281 ; Clinical Note of Fibroma
Moliuscum Gravidarum, 213, 213

Neuroses: Freud’s Theory of (Review),
330; and Sexuality, 84

Neurotropism : High Incidence of Poet-
Diphtheritic Paralysis: Contribution
to Question of, of Certain Infective
Agents, 492

Nicotine: Local Action of, on Dog's
Right Cardiac Auricle, 63

Nose: Meningitis Purulenta Aseptica
after Intranasal Interference, 31

Nucleinate of Soda: and Salvarsan in
Treatment of General Paralysis, 48;
in Paralysis Agitans, 220

Nucleus Intercalatus: of Stederini, 1

gitis, 500 I Nystagmus, 323 ; Analysis of, 109

Facial: Alleged Sensory Cutaneous tone
of, of Man, 393 ; Congenital Paralysis,

36 ; Syphilitic Paralysis, 81, 273; Oculo-Cardiac Reflex : 254, 255, 374,
Diabetic Paralysis, 267 ; Herpetic 374; Absence of, in Tabes, 29, 260 ; in

Paralysis with Symmetrical Lipo- Graves’ Disease, 254; in Normal

roatosis, 312; Zoster with Trophic and Subjects without Bradycardia, 255 ;

Sensory Changes in Lingual Mucosa, producing Stoppage of Heart, 256 ;

312 Constant Suppression of, by Atropine,

Vagus: Anatomical and Experimental 256; Changes in, in Epilepsy; Stoppage

Study of Peripheral Ganglia: Local- i of Heart by, in Epileptic, 257 ;

isation of Sensory Ganglia and Peri- I Exaggeration of, in Epilepsy, 257;

120*

INDICES

Persistence of, in General Anaesthesia,
258 ; Inhibitory Action of, on Abnormal
Movements inCase of Double Athetosis,

258 : in Patients suffering from Various
Tremors, 259 ; and Paralysis Agitans,

259 ; Frequent Abolition of, in Syphilis,

259 ; Abolition and Inversion of, in
Pseudo-Bulbar Paralysis, 260 ; Favour¬
able Action of, on Certain Nervous
Manifestations, especially Hiccough,

260 ; Glycosuria, Albuminuria, and
Polyuria caused by, 261; in Diph¬
theritic Intoxication, 311 ; in Hemi¬
plegia and Cerebral Diplegia, 312;
Changes in, in Pregnancy, 488

(Esophagus : Two Rare Complications of
Foreign Bodies in, 316
Optic Atrophy: Two Families with
Several Memoers in each suffering from,
42; Nervous Symptoms associated
with, of Familial Type, 43; Binasal
Hemianopsia occurring in Course of
Tabetic, 212; Treatment of Tabetic,
with Intraspinous Injections of
Salvarsanised Serum, 491
Optic Neuritis: Acute Retrobulbar,
associated with Marked Aoetonuria,
390 ; with Symmetrical Loss of Lower
Portion of Field associated with
Diabetes, 501

Ossification : Traumatic Intramuscular,
29

Otic: Ganglion, Microscopic Structure of,

Ovary: Extirpation and Vasomotor
Irritability, 484; Graft of, in Hyper¬
thyroidism, 527

Oxycephaly : and the Oxycephalic
Syndrome, 219

Oxygen : Hypodermically in Nervous and
Mental Diseases, 329

Pancreas ; Weight of, in Insane, 172
Paralysis Agitans: Pathology of, 25 ;
Supposed Relations between, and
Insufficiency of Parathyroid Glands,
220; Nucleinotherapy, 220; Oculo-
Cardiac Reflex in, 259
Parameningococcus : and its Antiserum,
487; tide Meningitis
Paramyoclonus Multiplex: Case of
Hereditary Ataxia with, 161
Paranoia: What is ? 426
Paraplegia: Heredo-Syphilitic {Spastic,
264; Crural from Extra-Dural Spinal
Tumour. Operation, Recovery, 452
Parathyroid Glands : Congenital Disease
of, Etiology of, 167; Supposed
Relation between Paralysis Agitans
and Insufficiency of, 220 ; Tetany and,

277 ; Sympathetic Irritability and.
Deficiency, 307
Parietal Area, 54

Parietal Bone: Causation of Large
Vascular Grooves on Inner Aspect of,
203

Parietal Lobe, 54; Glioma of Left, and
of Corpus Callosum: Bilateral Apraxia,
266

Parotitis : Complicated with Meningitis,
76

Pellagra: Notes on Case of, 244 ; In¬
fluence of Milling of Maize on Chemical
Composition and Nutritive Value of
Maize Meal, 24 ; Pathology of, 168 ;
Zeism or, 168 ; English, in Early
Childhood, 457 ; Attempt to Transmit,
to Monkeys, 457; Occurrence of, in
England, 495 ; ride Maize
Personality: Importance of Disturb¬
ances of, in Mental Disorders, 279
Phobia: Psychopathology of Case of,
Clinical Study, 308

Pineal: Experimental Production in
Mammals of the Precocious Macro-
Genito-Somatic Syndrome, 23; in
Treatment of Certain Classes of De¬
fective Children, 173; Tumours of,
320 ; in Relation to Somatic, Sexual,
and Mental Development, 372, 449 ;
Operative Removal of, Cyst, 382 ; New
Researches on Function of, 448
Pituitary : Anatomy: Analysis of Juxta
Neural Epithelial Portion of, with
Embryological and Histological
Account of Hitherto Undescribed
Part of Organ, 200; Morphology
and Histology of Certain Structure
connected with Pars Intermedia of
Ox, 448

Physiology: Hypophysectomy and

Genital Atrophy, 64; Hvpotensive
Action of Posterior Lobe Extract on
Pulmonary Circulation, 206
Palholoyy: Changes in Experimental
Diphtheria, 68; Histological Re¬
searches in Psychopaths, 69 ; Tuber¬
culosis of, Necropsy Findings, 390
Clinical: Failure of Opotherapy in Ex¬
ophthalmic Goitre and Glycosuria,
276; Opotherapy in Myasthenia
Gravis, 384; Cyst of, 522; vide
Acromegaly, Ac.

Pneumococcus : Hemiplegia, 216 ; mye¬
litis, 378 ; tide Meningitis
Pointing Test: Bdrdny’s, Significance
for Differential Diagnosis of, 209
Poliomyelitis Anterior Acuta : Men in-

f eal Syndrome in, 30; Meningeal
'orm of, 30; Note on Etiology of
Epidemic, 156; Contribution to

INDICES

121*

Epidemiology of, 156 ; Epidemic, 491;
Unusual Manifestations of, 158;
Clinical Observations on 90 Cases of
Acute Epidemic, 452; Atrophy of
Pelvis in, and its Obstetrical Conse¬
quences, 459; of Small Muscles of
Hand, 518; Further Note on Use of
Celluloid Splints in Treatment of
Acute Cases of, 415, 453 ; Contribution
to Pathology of Epidemic, 157 ; Intra-
spinous Infeotionin Experimental, 157;
Attempt to Transmit by Bite of
Lyperosia irritant , 415 ; Relation to
Blood of Virus of Epidemic, 119;
Localisation of Virus, and Pathogenesis
of Epidemic, 487; Penetration of
Virus of, from Blood into Cerebro¬
spinal Fluid, 488

Polyneuritis : of Pregnancy with
Symptoms of Graves* Disease, 45 ; On
Pathogeny and Symptomatology of
Post-Diphtheritic, 118; Scorbutic,
322; Post-Typhoid, of Quadriplegio
Form, 616

Polyuria : from Experimental Lesion of
Optoped uncular Region of Base of
Brain. Regulating Mechanism of
Water-Content of Organism, 204;
Glycosuria, Albuminuria and, caused
by Ocular Compression, 261 ; Ana¬
tomical Localisation in Base of Brain
of Lesions which provoke, in Dogs, 305

Pott*s Disease: Tertiary Syphilitic
Fever and Syphilitic, 163

Pregnancy: Polyneuritis of, with

Symptoms of Graves* Disease, 45;
General Paralysis and, 424; Changes
in Oculo-Cardiac Reflex in, 488:
Korsakow’s Psychosis occurring
during, 503

Prodigy: Arithmetical, 112

Profichet’s Syndrome : Sclerodermia and
its Relations to, 46

Progeria: Case of Supposed (Premature
Senility) in Girl of Eight Years, with
remarks, 389

Prostatectomy : and Hemiplegia, 266

Pseudo-Bulbar Paralysis : Abolition and
Inversion of Oculo-Cardiac Reflex in,
260

Pseudo-Hypertrophio Muscular Dys¬

trophy : Two Cases with Plates, 413
Pseuaosclerosis: Familiar Forms of

Wilson’s Lenticular Degeneration and
Westphal-Strlimpeirs, 161 ; Contribu¬
tion to Study of So-called, with
Changes in Cornea and in Liver, 270
Psychasthenia : Analysis of Case of, 529
Psycho-analysis: of Severe Case of

Hysteria, 66; and Interpretation of
Dreams based on Various Motives, 67 ;

Some of Broader Issues of, Movement,
228 ; and Interpretation of Dreams,
410 ; Contrast in, Three Cases, 411
Psycho-pathology : of Case of Phobia,
308 ; of Everyday Life (Review), 465 ;
Significance of Unconscious in, 474
Psychopaths: Histological Researches
on Hypophysis of, 69
Psychosis : History of Prison (Review),
133; in Typhoid Fever, 48 ; Treatment
of Syphilitic, 170 ; Similar and Dis¬
similar, in Relatives, 429 ; Intoxica¬
tion, with Cirrhosis of Liver, 430 ; Is
there an Increase among the Dement¬
ing ? 430 ; occurring during Course of
Pernicious Anaemia, 503
Psychosis, Korsakow’s: occurring during
Pregnancy, 503

Puerperium : Relations between Exoph¬
thalmic Goitre and, 276
Pupil; Action of Adrenalin and Epinine
on, in Epilepsy, 287; and its Reflexes
in Insanity, 278 ; Adrenalin and, 306
Pyramid Tract: in Red Squirrel and
Chipmunk, 370

Pyridine-Silver Method : With Note on
Afferent Spinal Non-Medullatcd Nerve
Fibres, 467

Reflexes: Indication and Method for
Use of Electrical Re-enforcement for
Elicitation of Absent, 507: Experi¬
mental Production of Iridoplegia 62 ;
in Dementia Pnecox, 85; Mechanism
of Muscular Tonus of, 252 ; Hypo¬
tensive Oeliac, 305; New Vaso-Dilator,
in Dog’s Hind Limb, 306; Contralateral
Oppenheim and Gordon, 311 ; Contra¬
lateral Periosteal, of Arm, 311 ;
Absence of Radial, and of Pronation
of Forearm and Conservation of Reflex
of Biceps Tendon from Lesion of 6th
Cervical Root, 451; Bilateral Extensor
Response in States of Unconsciousness,
489 ; Behaviour of Abdominal Cutane¬
ous, in Reflex Conditions within
Abdomen and Pelvis, 514 ; vide Oculo-
Cardiac

Religion : Psychology of, 307

Retina: Vascular and other, Changes
associated with General Disease, 43

Reviews: (Bickmore) Industries for

Feeble - Minded and Imbecile, 49;
(Nitsche and Wilmanns) History of
Prison Psychoses, 133; (Braun and
Friesner) Labyrinth. An Aid to .Study
of Inflammations of Internal Ear, 135;
(Coopei) Pathological Inebriety: its
Causation and Treatment, 136; (Biedl)
The Internal Secretory Organs: their

122*

INDICES

Physiology and Pathology, 173 ;
(Horncn) Arbeiten aus dera Patho-
logischen Institut der Universitat
Helsingfors (Finland), 228 ; (Hutinel)
Maladies des M6ninges, 279; (Tredgold)
Mental Deficiency, 330 ; (Hitchmann)
Freud’s Theories of the Neuroses, 330;
(Fox and Badger) Psychopathology of
Hysteria, 331; (Goddard) The Train¬
ing School Bulletin, 1913-14, 431 ;
(Lohmann) Disturbances of the Visual
Functions, 432; (Rank) Myth of the
Birth of the Hero, 404; (Freud) Psycho¬
pathology of Everyday Life, 464;
(Bolton) Brain in Health and Disease,
405; (l)6j£rine) S&niologie des Affec¬
tions du Syst^me Nerveux, 504;
(Wallace) Musical Faculty: Its Origins
and Processes, 504 ; (Stoddart) Mind
and its Disorders (Second Edition),
505; (White and Jeiliffe) Modem
Treatment of Nervous and Mental
Diseases, 532; (Hayes) Intensive
Treatment of Syphilis and Locomotor
Ataxia by Aachen Methods, 533;
(Lugaro) Modem Problems in Psychiatry
(Second Edition), 534; (Tuckey)
Hypnotism and Suggestion (Sixth
Edition), 534 ; (Heimanand Feldstein)
Meningococcus Meningitis, 534; (Berg¬
son) Dreams, (Freud) On Dreams,
(Freud) Interpretation of Dreams, 535;
(Lucien and Parisot) Glandes Sur-
renales et Organes Chromaffincs, 537 ;
(Oliver) Lead Poisoning, 538

Rheumatism: Acute Polyarticular,

localised to a Limb affected with
Recent Paralysis of Brachial Plexus,
118; Cerebral, explained by Ha*mor-
rhagic Meningitis occurring in Course
of Acute Articular, 262

Rice: is Polished, plus Vitamine a
Complete Food ? 208

Right-Brainedness : in Right -Handed
Individuals, 383

Rigidity: Observations on Decerebrate,
205

Salivaby Centre ; On the Bulbar Nuclei,
with 8pecial Reference to Existence of,
in Man, 106

Salvarsan: and Sodium Nucleinate in
Treatment of General Paralysis, 48 ;
Local Treatment of Vincent’s Angina
with, 81 ; Have Early Claims been
recognised ? 120; Tabes aggravated
by, 154: Treatment of Syphilitic
Diseases of Central Nervous System
by Intravenous Injections of, 224;
Treatment of Tabes Dorsalis and

General Paralysis with, 226; in Oph¬
thalmic Zoster, 387; Precocious General
Paralysis Three Years after Chancre
treated by, 501 ; General Paralysis
rapidly aggravated by, 502
SalvarsanisSi Serum: in Syphilitio
Diseases of Central Nervous System,
163, 224; Intraspinal Injection of, in
General Paralysis, 225, 22§, 226, 502,
503; Treatment of Tabetic Optic
Atrophy with Intraspinal Injections
of, 491

Satellite Cells : Iron Infiltration in
Fixed and Wandering Cells of Central
Nervous System, 209: Study of, in
Fifty Selected Cases of Mental
Disease, 411

Scarlet Fever : Meningeal States in, and
Scarlatinal Uraemia, 414
Sciatica: Notes on Treatment of, 132;
Case of, entirely Cured in Three
Weeks’ Treatment, 461 ; Subfascial
Lipoma of Foot, causing Symptoms of,
495

Sclerodermia; and Graves’ Disease,
46 ; and its Relations to the Syndrome
of Profichet, 46

Sclerosis, Disseminated : vide Dissemin¬
ated Sclerosis

Scopolamine Hydrobromide: Use of, or
Hyoscine in Treatment of Mental
Disorders, 531
Scurvy: Polvneuritis, 322
Sensation: Nature of Cutaneous, with
Instrument for its Measurement, 374
Septicaemia: Diplococcus crasstM, with
Cerebro-spinal Localisation, 116
Sexuality : and Neuroses, 84
Sinuses : Cerebral, Thrombosis of, after
Measles, 78; Case of Progressive
Thrombophlebitis of Brain, following
Acute Otitis Media, 315
Sleep: Problem of, 267
Skull: Syphilitic Bone Disease of, 125;
Roentgen Diagnosis of Fracture of, in,
417

Spasm: Varieties of Facial, and their
Treatment, 165

Spasmophilia : and Epilepsy, 44
Speech : Relation of Function of, to In¬
tonation, Tone, and Rhythm, 383
Spina Bifida : Rare Case of, with Sub¬
sequent Development of Symptoms
referable to Involvement of Cauda
Equina, Conus Medullaris, and Epi¬
conus, 375

Spirocha'ta pallida: Observations on
Strain isolated from Nervous System,
223; vide Syphilis, Ac.

Staderini: Nucleus Intercalatus of, 1
St Hildegard ; 160

INDICES

123*

Stupor: Elimination of Nitrogen and
Uric Acid in States of Excitement and,
529; Two Cases of Anergio, treated
with Thyroid Gland Extract, 529
Substantia Gelatinosa Rolandi: Tract of
Lissauer and, 198

Suggestion: and Hypnotism (Review),

Suicides: Reoent Literature on Juvenile,
309

Sulcus : Post-Centralis Superior, 21
Suprarenal: Glandes Surr£nales et
Organes Chromaffines (Review), 537
Anatomy: Development in Birds, 482,
Physiology: Activity in Thyroidecto-
mised Animals, 65 ; Action of Thyroid
Extract and of Organic Extracts in
General on Secretion of, 65 ; Influence
on Growth, Ill ; Deficiency and
Sympathetic Nervous System, 206;
Effects of Removal in Guinea-Pigs,
207; and Diuresis, 449; Experi¬
mental Observations with Special
Reference to their Inter-renal Portions,
484

Pathology : Tumour in Cow, 310; Malig¬
nant Gangiio-Neuroma of Left, 421 ;
Pathological Changes in, 514
Clinical : Sudden Death in General
Paralysis, 85; Two Deaths due to
Suprarenal Insufficiency, 221; Virilism
321; Syphilis and, 386; Opotherapy
in Myasthenia Gravis, 384; wae
Addison’s Disease

Sympathetic Nervous System: and
Chronic Trophcedema, 81 ; Anatomy
and Vasomotor Phenomena in Turtle,
109; and Adrenal Deficiency, 206;
Study of Ganglion Cells of, with
Special Reference to Intrinsic .Sensory
Neuron©8, 302; Parathyroid Deficiency
and Irritability of, 307
Synesthesia : Case of, 66 ; Unusual Type
of, 66

Syphilis: Noguchi Luetin Reaction in,
80, 222; facial Paralysis, 81 ; Bone
Disease of Skull, 125; Fever as
Solitary Symptom of Latent, 125;
Tertiary Fever and Syphilitic Pott’s
Disease, 163; Psychoses, 170; Frequent
Abolition of Oculo - Cardiac Reflex
in, 259 ; Transitory Brown-Stfquard’s
Syndrome at Onset of Spinal, 261 ;
Heredo-Syphilitio Spastic Paraplegia,
264 ; Biological Reactions in, of
Central Nervous System, 273; Late,
Facial Paralysis associated with
Chronic Pulmonary, 273 ; Intramenin-
ge&l Treatment of Cerebro-spinal, 315 ;
Tests in Latent and Treated, 386;
and Adrenals, 386: Experimental, of

Central Nervous System in Rabbits,
387; Treatment of Parenchymatous,
by Intracranial Medication, 387 ; of
Vertebral Column, Symptomatology
and Neural Complications, 458;
Cerebral in Secondary Stage, 497;
Manifestations of Congenital, 527;
Intensive Treatment by Aachen
Methods (Review), 533; vide Sal-
varsan, General Paralysis, Ac.

Syphilophobia, 497

Syringomyelia: with Autopsy Findings
in Two Cases, 73; following a Peri¬
pheral Infection, 264; Medullary
Cavities and Cervical Meningitis, 411

Tabes : Intensive Treatment of Syphilis
And, by Aachen Methods (Review),
533; Absence of Oculo-Cardiac Reflex
in, 29, 260; Two Cases, complicated
by Hemiplegia, 72; Report of Case of
Juvenile, 119; Aggravated by “606,”
154 ; Diagnosis of, 154 ; with Unusual
Distribution of Deep-Pain Loss, 155;
Binasal Hemianopsia occurring in
Course of Optic Atrophy of, 212;
Treatment with Salvarsan, 226 ; Intra-
meningealTreatinentof, 315; Arachnoid
Injection with Serum of Syphilitics in,
326; Feminine, Comparative Study at
Bicetre and Salpetnere, 376; Treat¬
ment of Optic Atrophy with Intraspinal
Injections of Salvarsanised Serum, 491;
Some Histological Changes in, 486;
Results of Specific Treatment in, at
the Salpetri^re, 1912-14, 502; Intra¬
spinal Injections of Neosalvarsan in,
528

Talalgia : in Diabetes, 451
Tetanus: Subacute, cured by Antitetonic
Serum, 131; Serotherapy with Massive
Doses in, 420; Its Prevention and
Treatment by means of Antitetanic
Serum, 498; with Recovery treated by
Carbolic Acid Injections, 526
Tetany: in Adult and its Parathyroid
Origin, 277 ; Researches on, and Senile
Cataract, 320

Thrombophlebitis: Case of Progressive,
of Brain Sinuses following Acute Otitis
Media, 315

Thrombosis: of Cerebral Sinuses after
Measles, 78; of Posterior Inferior
Cerebellar Artery, 522
Thyroid: Relation to Antitoxin, 47;
Physiological Activity of Adrenal of
Thyroidectomised Animals, 65 ; Action
of, Extract and of Organic Extracts in
General on Adrenal Secretion, 65;
Observations and Experiments on

124*

INDICES

Goitre (Thyroid Carcinoma) in Brook
Trout, 66; Opotherapy and Typhoid
Spine, 415; Opotherapy in Gynaecology,
496 ; Gummata of, 496 ; Two Cases of
Anergic Stupor treated with Extract
of, 529 ; tide Exophthalmic Goitre
Tongue-Chewing: 155
Tonsillitis : Meningitis after Follicular,
31

Tonus: Functional Relation between
Cortical and Subcortical Centres of, 62;
Mechanism of Muscular, of Reflexes
and of Contracture, 252
Toxin: Further Observations on Influence
of, on Central Nervous System, 252
Training School Bulletin, 431
Transference : Some Notes on, 153
Transvestism, 132

Trauma : Intramuscular Ossification, 29;
Hrematomyelia, 34; Can Herpes
Zoster ever occur from? 114; Haema-
tomyelia without Vertebral Lesion,
265; Lesion of Distal Segments of
Spinal Cord followed by Progressive
Spinal Amyotrophy, 376 ; and General
Paralysis, 392; Late Deformities of
Verteoral Column following, 516
Trophoedema: Chronic, and Endocrino-
Sympathetic System, 81
Trout: Observations and Experiments
on Goitre (so-called Thyroid Car¬
cinoma) in Brook Trout, 66
Trypanosomiasis : Nervous Varieties of

New Form of—Chagas’ Disease, 41
Tuberole: Meningo-cerebellar Symptom
Complex in Febrile Diseases occurring
in Individuals with, 32; of Vertebra
complicated by Extensive Acute
Suppurative Meningitis, 378 ; Chronic
Ocular, Necropsy Findings in Case in
which Death was due to, of Hypo¬
physis, 390; Epilepsy and, 460 ; and
Exophthalmic Goitre, 496
Tumours: Cerebral: Left Prefrontal

Glioma with Aphasia, 37; Clinical
Observations on, of Pia Mater, 38 ;
Changes in Spinal Cord in, of Posterior
Cranial Fossa, 35 ; Defect in Innerva¬
tion of Facial Nerve from, of Posterior
Fossa, 217; of Middle Cranial Fossa,
involving Gasserian Ganglion, 217;
Combination of Cranial Hyperostoses
and Cerebral, 218; Pineal, 320; of
Frontal Region of Brain, 382; Left
Hemiplegia of Central Origin with
Peripheral Homolateral Paralysis of
Tongue from Cerebral, with Double
Localisation, 381 ; Mental Manifesta¬
tions in, 456; Epilepsy and, 520; of
Crus Cerebri, 520 ; Intracranial Serous
Effusions of Inflammatory Origin:

Meningitis or Ependymitis Serosa—
Meningism. With a Note on “ Pseudo-
Tumours ” of the Brain, 114

Pituitary: 39 ; Adiposity due to Juxta-
Sarcoma, 123; Case of, and Sellar
Decompression, 162; Pathological
Investigation of Four Cases of, 456;
ride Acromegaly, Dyspituitarism, Ac.

Spinal: Removal of Intrathecal, from
Lumbar Region of Spinal Cord, 34;
Surgical Treatment of, 35 ; Two Cases
of Removal of Extra-Dural, 265;
Painless, 374 ; Giant Tumours of Conus
and Cauda Equina, 375; Crural Para¬
plegia from Extra-Dural, Operation,
Recovery, 452; Two Cases of Intra¬
dural, 490

Turtle : Study of Anatomy and Vaso¬
motor Phenomena of Sympathetic

Nervous System in, 109
’Tweenbrain : and Midbrain of Reptiles,

201

Typhoid: Cerebro-spinal Meningitis in
an Infant, 32 ; Spinal Cord Phenomena
in, especially Metatyphoid Myelitis,
33; Psychosis occurring in, 48 ; Men-
ingo-typhoid, 76; Respiratory Form
of Encephalo-Meningeal Reactions in,
in the Child, 77; Respiratory Dis¬
orders of Nervous Origin in, 77 ; Post-
Polyneuritis of Quadriplegic Form, 516
Typhoid Spine : Report of Case com¬
plicated t>y Thrombophlebitis of Left
Femoral Vein, 118; Ckwe of, 160, 379;
and Thyroid Opotherapy, 415

Uremia : Meningeal States in Scarlet
Fever and Scarlatinal, 414
Urea: Content of Cerebro-spinal Fluid,
with Special Reference toits Diagnostic
and Prognostic Significance: a Series
of 97 Cases, 82

Uric Acid : Elimination of Nitrogen and,
in States of Excitement and Stupor,
529

Vaccine Treatment : in Asylums, 172
Vagus Nerve : tide Nerves, Cranial
Varicella : Nervous Complications of, 73
Vasomotor: Nerves in Lungs, 205;
Apparatus in Pneumonia, 483 ; Ovarian
Extirpation and, Irritability, 484
Vertebral Column : Tuberculous Disease
of, complicated by Extensive Acute
Suppurative Meningitis, 378 ; Syphilis
of, its Symptomatology and Neural
Complications, 458 ; Late Deformities
of, following Trauma (KiimmeVs
Disease), 516

INDICES

125*

Vincent’s Angina: Local Treatment of,
with Salvarsan, 81
Virilism: Adrenal, 321
Vital Staining: of Nerve Centres by
Malachite ureen, 112; and Chemo¬
therapy, 203

Vitamine: Is Polished Rice plus, a
Complete Food ? 208 ; vidt Ben-beri
Von Recklinghausen’s Disease: ride
N eurofibromatosis

Wasskkmann Reaction : Drop Methods
of Counting the Cells of the Cerebro¬
spinal Fluid—the Relation of the
Cell Count to the, 833; Effect of
Administration of Alcohol on, 43 ; and
its Application to Neurology, 127;
Methods of Increasing the Accuracy
and Delicacy of, 128 ; Positive, after
Forty-six Years of Syphilis, Syphilitic
Varicose Ulcers, 164 ; Technique of,
165; in Blood in Cases of Alkaptonuria,
223 ; Some Observations on Occurrence
of, in Serum of Children of Poorer
Classes, 272; Retrospective Sign of
Syphilis—Pure Hyperalbuminosis of
derebro-spinal Fluid without Leuco-
cytosis and without, 271 ; in Aortic
Disease, 420; Observations on, 459;

Errors in Interpretation of, 497; and
Male Insane, 528

Weber’s Syndrome: Case of “ Idiopathic
Hydrocephalus” in Form of, Rapid
Cure by Lumbar Puncture, 39

Weigert-ral: Counterstain in, Prepara¬
tions, 373 ; Paraffin Methods for Stain¬
ing of Nervous Tissue, with some new
Modifications, 450

Whooping-Cough: Cerebral Complica¬
tions of; with Special Reference to
“Pachymeningitis Productiva In¬
terna,215

Xanthochbomia : Syndrome of, and
Coagulation tn masse of Cerebro-spinal
Fluid, 221 ; and Polyuucleosis, Aseptic
Leucocytosis of Cerebro-spinal Fluid
with Subacute Meningeal Syndrome in
Course of Cerebral Hfemorrhago, 271 ;
of Cerebro-spinal Fluid in Asystolic
Patients, 272

X-Rays: in Fractures of Cranium in
Children, 417

Zeism : or Pellagra, 168

12tj*

INDICES

INDEX OF AUTHORS.

Pay: Rtb retires to OrigauU Articles are indicated hy Heary Type Figwx*.

Ai.rot, E. Stam.ky. What is Paranoia ?
426

AUiin-Delthiel, Raynaud, M., Coudray,
am! Derrien. Meningeal Syndrome in
North African Recurrent Fever, 378
Abrahams, Adolphe. The Analysis of
Nystagmus, ](><J

Abramow, S. On Changes in the Hvjkj-
physis in Experimental Diphtheria, 68
Acker, G. N. Parotitis Complicated
with Meningitis, 76

Adler, H. M. A Note on the Increase
of 1 otal Nitrogen and Urea Nitrogen
in the Cerebro spinal Fluid in Certain
Cases of Insanity, with Remarks on the
Unc Acid Content of the Blood, 522
Agadjaniantz, K. On Lethargy, 530
Agadschanianz. On the Relation of the
Function of Speech to Intonation,
lone, and Rhythm, 383
Ahern, R. D., and Robertson, W. N.

Cyst of the Pituitary (Hand, 522
Alderson, H. E. Herpes Zoster in a
Patient with Spinal Cord Syphilis, 211
Allen, A. R. Remarks on the Histo-
pathological Changes in the Spinal
Cord due to Impact—an Experimental
Study, 310

Am&ndrut, J. (de Laval), and Gendron,

A. (de Nantes). Aseptic Leucocytosis
of the Corebro-spinal Fluid, with Sub¬
acute Meningeal Syndrome in the
Course of Cerebral Hemorrhage.
Xanthochromia and Polynucleosis, 271
Ames, 1. H. Analysis of Blindness as a
Symptom of Hysteria, 388
Amosa, Harold L. A Note on the Eti-
ology of Epidemic Poliomyelitis, 156
A moss, Harold L., and Flexner, Simon.
Localisation of the Virus and Patho¬
genesis of Epidemic Poliomyelitis, 487;

I enetration of the Virus of Polio¬
myelitis from the Blood into the
Cerebro spinal Fluid, 488
Amoss, Harold L., Flexner, Simon, and
Clark, Paul F. A Contribution to the
Epidemiology of Poliomyelitis, 156;

A Contribution to the Pathology of
Epidemic Poliomyelitis, 157

Amoss, Harold, L, and Clark, Paul F.
Intraspinous Infection in Experi-
1 mental Poliomyelitis, 157.

Amoss, Harold L., Clark, Paul F.,and
Fraser, Francis R. The Relation to
j the Blood of the Virus of Epidemic
Poliomyelitis, 119

Andr^-Thomas and Roux, J. C. The
Hypotensive Codiac Reflex, 305
Antoni. Adrenalin and the Pupils, 306
Archambault, La Salle. Report of Two
Cases Exhibiting Lesions of Special
j Interest for the Localisation of Aphasic
Disorders, 36; Contribution to the
Study of the Localisations in Aphasia,
37

Argaud, R. A Directly Excitable
Region in the Human Endocardium, 63
Arian, E. D. The All-or-None Principle
in Nerve, 110

Audry, C. Conjugal Zoster, 489
Audry C., and Lavau. On Preroseolar
Meningitis, 213

Auer, E. M. A Case of Progressive
Lenticular Degeneration, 383
Austregesilo. Scorbutic Polyneuritis,
322

Austregesilo and EsposeL The Cenas*
thopathies, 253 ,

Aviragnet, E. C., Dorlenoourt, H., and
Bouttier, H. The Oculo-Caidiac Re¬
flex in Diphtheritic Intoxication, 311
Ayala. Chronic Trophcedema and the
Endocrino-Sympathetic System, 81
Ayer, James B. Salvarsanised

( 4 4 Swift Ellis Treatment ”) in bvphibtio
Diseases of the Central ifervou
System, 224

Babes, A. Xanthochromia of the
Cerebro-spinal Fluid in Asystob
Patients, 272 ,,

Babinski, Jumentte, and J* 1 *? 1 ™*
Hypertrophic Cervical Meningitis,
Babinski, J., Lecfcne, P., and J* 1 *?,*®* *
J. Crural Paraplegia from Extra-
Dural Spinal Tumour. Operation,
Recovery, 452

INDICES

127*

Bachmacknicoff, Mile. N. Pneumo¬
coccal Myelitis, 378

Bailey, Pearce. Painless Tumours of
the Spinal Cord, 374

Ballance, Charles A. A Method by
which Remedial Agents may be
Mingled with the Cerebrospinal
Fluid, 387

Ballet and Genil-Perrin. Clinical Ex¬
amination of the Mental State of
Dements, 328

Banceis, J. Larguier des, and Claparede,
Ed. The Mannheim Dog, 208

Bancroft, Charles P. Is there an In¬
crease among the Dementing Psycho¬
ses? 430

Bar&ny, Robert. Total Deafness, asso¬
ciated with the Symptom Complex
described by Brirany, in which Com¬
plete Restoration Occurred, 523

Barbe and Roubiuovitch. Partial Agen¬
esis of the Corpus Callosum, 209

Barbera, R. V. Nervous Forms of
Malta Fever, 515

Barnes, A. E., and Kerr, W. S. A Case
of Otitic Meningitis and Cerebellar
Abscess, with Recovery, 158

Basta and Haskovec. Contribution to
the Pathology of Paralysis Agitans,
25

Bates, Gordon, Strathy, George S., and
M ‘Vicar, C. S. The Treatment of
Tabes Dorsalis and General Paresis
with Salvarsan, 226

Batten, F. E. Unusual Manifestations
of Poliomyelitis, 158; Further Note
on the Use of Celluloid Splints in the
Treatment of Acute Cases of Polio¬
myelitis, 415

Batten, Frederick E., and Wilkinson,
Douglas. Unusual Type of Heredi¬
tary Disease of the Nervous System,
455

Battle, W. H. Bullet Wound of the
Spine: ACase of Medico-Legal Interest,

154

Baumel and Margarot. Does Achondro¬
plasia Correspond to a Partial Hypo¬
pituitarism? 40

Bean, Robert Bennett. A Racial Peculi¬
arity in the Pole of the Temporal Lobe
of the Negro Brain, 510

Beaton, Thomas, and Mapother, Edward.
Intraspinous Treatment (Swift-Ellis)
of General Paralysis, 225; Intrathe¬
cal Treatment of General Paralysis,
527

Beaufils, R. Gummata of the Thyroid,
496

Befani, G. C. Achondroplasia with
Manic-Depressive Psychosis, 86

Beifeld, A. F., and Elliot, C. A. General¬
ised Neurofibromatosis (von Reckling¬
hausen’s Disease), 515
Beling, C. C. A Case of Dystonia Muscu¬
lorum Deformans, 314
Beling, C. E. A Case of Amyotonia
Congenita, 384

Benech, J., and Legris, A. A Case of
Early Spinal Syphilis W'ith Bulbar
Phenomena, 211

Benigni, P. The Meiostagmine Reaction
in some Cases of Mental Disease, 49
Benjamins, C. E. Contribution to the
Knowledge of the Membranous Laby¬
rinth. On a Fourth Crista Acustiea,
22

Berg. Unusually Extensive Medullated
Nerve Fibres in High Myopia with
Amblyopia, 324

Bergson, Henri. Dreams (Review ), 535
Berguer, Georges. Psychology of Reli¬
gion, 307

Beriel and Delachnal. Anatomical Ex¬
amination of a Case of Multiple
Sclerosis from Disseminated Syphilitic
Myelitis, 67

Beriel, L. Encephalic Puncture by the
Orbital Route. Its Clinical and Thera¬
peutical Indications, 123
Beriel, L., and Durand, P. Tuberculous
Meningitis with Association of the
Meningococcus, 75 ; Arachnoid Injec¬
tion with the Serum of Syphilitics in
Tabes and General Paralysis, 326
Berkeley, W. N. Pineal Gland in Treat¬
ment of Certain Classes of Defective
Children, 173

Bernhardt. A Further Contribution to
the Subject of Traumatic Hanna to-
myelia, 34

Bernstein, E. P. Brain Abscess due to
t lie Bar if l iff* col i com //i u n i '*■, 159
Bertein, P. On the Incomplete Forms
of Recklinghausen’s Disease, 30
Bertolani, A. A New Method of Pro¬
ducing Experimental Lesions of the
Nerve Centres, 450

Bertoiotti. A Case of Selerodcrmia and
its Relations to the Syndrome of Pro-
tichet, 46

Bhiday, B. S. Two Cases of Anergic
Stupor Treated with Thyroid Gland
Extract, 529

Bickel. Clinically Negative Cases of
Aphasia, 383

Bickmore, A. Industries for the Feeble-
Minded and Iml>ecile (Review ), 49
Biedl, Artur. The Internal Secretory
Organs : Their Physiology and Path¬
ology (Review'), 173
Bien, G. Encephalitis in Mumps, 158

128*

INDICES

Bigelow, Oliver P. The Diagnosis of
(Cerebral Hemorrhage by Means of
Lumbar Puncture, 219
Biondi, G. Traumatic Lesion of the
Distal Segments of the - Spinal Cord,
followed by Progressive Spinal Amyo¬
trophy, 376

Blauner, S. A. Hereditary Cerebellar
Ataxia, 380

Biscons. Diplococcm crassm Septi¬
cemia with Cerebro-spinal Localisa¬
tion, lib

Bloch, M., Foix, and Halle, J. A. Case
of Hemiplegia in Diphtheria, 314
Bloch, M., and Vernes, A. A Retro¬
spective Sign of Syphilis — Pure
Hyperalbuminosis of the Cerebro¬
spinal Fluid without Leucocytosis and
without Wassermann, 271
Blumenfeld, Mile. S. On Suprarenal
and Pituitary Opotherapy in Myas¬
thenia Gravis, 384

Blumzweig, M. Talalgia in Diabetes, 451
Bobrie, J. General Paralysis Rapidly
Aggravated by “ 606,” 502
Boez and Du hot. Transitory Brown-

Sequard’s Syndrome at the Onset of
Spinal Syphilis, 261

Boggs, Thomas R., and Snowden, R. R.
The Intrameningeal Treatment of
Tabes and Cerebro-spinal Syphilis, 315
Boisroux, L. The Relations between
Exophthalmic Goitre and the Puerperal
State, 276

Bolten, G. C. The Nature and the
Treatment of the so-called “Genuine
Epilepsy,” 231

Bolton, Joseph Shaw. The Brain in
Health and Disease (Review), 465
Bolzani, G. Clinical and Anatomo-
Pathological Notes on a Case of Bulbo-
Pontine Glioma, 381

Bonaba, J., and Foresti, C. B. A CaBe
of Multiple Visceral Hydatid Cysts
(Heart, Brain, Kidneys), Rupture of
one of the Heart Cysts in the Left
Auricle, 519

Borel, A. On the Reflexes in Dementia
Praecox, 85

Boschi, Gaetano. A Case of Hereditary
Ataxia with Paramyoclonus Multi¬
plex, 161

Boudon, L., and Laignel-Lavastine.
Adiposity Due to a Juxta-Pituitary
Sarcoma, 123

Bourgeois, R. Aseptic Enoephalo-
Meningeal Reactions, 493
Bouttier, H., Aviragnet, E. C., and
Dorlencourt, H. The Oculo-Cardiac
Reflex in Diphtheritic Intoxication,
311

Box, Charles R. English Pellagra in
Early Childhood, 457
Boyd, E. J., and Rolleston, H. D.
Addison s Disease in a Boy, with
Calcification of the Adrenals, with
Remarks, 167

Boyle, Helen A. Some Observations on
Early Nervous and Mental Cases, with
Suggestions as to Possible Improve¬
ments in our Methods of Dealing with
them, 463

Braude, Morris, and Kuh, Sydney. A
Contribution to the Pathology of
Myasthenia Gravis, 112
Braun, Alfred, and Friesner, Isidore.
The Labyrinth: An Aid to the Study
of Inflammations of the Internal Ear
(Review), 135

Breaks, L. Z., and Johnson, George T.
The Treatment of Tabetic Optic
Atrophy w ith Intraspinal Injections of
Salvarsanised Serum, 491
Brinckner, S. M. Fibroma Molluscum
Gravidarum, 213

Brookover, C. The Nervus Terminalis
in Adult Man, 202

Brown, W. H. A Case of Implantation
of Suprarenale in Addison's Disease,
with Fatal Result, 461
Browning, Carl H. The Technique of
the Wassermann Reaction, 165
Bruce, A. Ninian. The Arcuate Nucleus
in Man, the Anthropoid Apes, and the
Microcephalic Idiot, 61
Bruce, Lewis C. The Complement
Deviation in Cases of Manic-Depres¬
sive Insanity, 278

Bryant, W. Sohier. Magnesium Sulphate
in Purulent Cerebro-spinal Meningo¬
coccal Meningitis, 517
Bu'ia, I. N. Nucleinotherapy in Paralysis
Agitans, 220

Burrow, Trigant. Analysis of so-called
Neurasthenic and Allied States, 308
Buscaino, V. M. On the Functional
Relation between the Cortical and
Subcortical Centres of Tonus, 62;
Fats, Stearines, and Lipoids in the
Normal and Pathological Central
Nervous System, 69

Busquet, H. A New Vaso-Dilator
Reflex in the Dog’s Hind Limb, 306
Buzzard, E. Farquhar. Varieties of
Facial Spasm and their Treatment,
165

Byrnes, C. M. Anterior Crural Neuritis,
130, 275.

Cadwalader, Williams B. Progres¬
sive Lenticular Degeneration, 494

INDICES

129*

Camp, Carl D. A Contribution to the
Study of Hereditary Degeneration,
71

Campbell, C. Maofie. On the Mechan¬
ism of some Cases of Manic-Depressive
Excitement, 175; Focal Symptoms in
General Paralysis, 424

Campbell, Harry. The Treatment of
Syphilis of the Nervous System by
Intrathecal Injections, 163; The Treat¬
ment of Parenchymatous Syphilis by
Intracranial Medication, 387

Campora, G. Absence of the Radial
Reflex and of the Reflex of Pronation
of the Forearm, and Conservation of
the Reflex of the Biceps Tendon from
Lesion of the 6th Cervical Root, 451

Camus, J., and Roussy, G. Hypo-
physectorny and Genital Atrophy:
An Experimental Contribution to tne
Study of the Adiposo-Genital Syn¬
drome, 64 ; Hypophvsectomy and Ex¬
perimental Glycosuria, 110; Polyuria
from Experimental Lesion of the
Ch)to-peduncular Region of the Base
ot the Brain. The Regulating Mechan¬
ism of the Water-Content of the
Organism, 204 ; The Anatomical Local¬
isation in the Base of the Brain of the
Lesions which provoke Polyuria in
Dogs, 305; Medullary Cavities and
Cervical Meningitis, 411.

Cappell, G. Tertiary Syphilitic Fever
and Syphilitic Pott’s Disease, 163.

Carle. Neosalvarsan—Late Hemiplegia
—Death, 164

Carpenter, F. W., and Conel, J. L.
A Study of Ganglion Cells in the
Sympathetic Nervous System, with
8pecial Reference to Intrinsic Sensory
Neurones, 302

Capriole, N. Late Deformities of the
Vertebral Column following Trauma
(Kummel’s Disease), 516

Casali, R. Subfacial Lipoma of the
Foot causing Symptoms of Sciatic
Neuralgia, 495

Casa major, L. Case of Cerebellar
Embolism, 123

Cassirer. A Case of Progressive
Lenticular Disease, 83

Casteigts, M. M., and Udaondo, C. B.
Post-Typhoid Polyneuritis of Quadri¬
plegic Form, 516

Castro, Aloysio de. Congenital Facial
Paralysis, 36

Caux, P. Respiratory Disorders of
Nervous Origin in Typhoid Fever, 77

Celesia, A. F. Ovarian Graft in Hyper¬
thyroidism, 527

Chagas, Carlos. The Nervous Varieties

of a New Form of Trypanosomiasis—
Chagas’ Disease, 41

Charles, J. R. The Pathology of
Migraine, 165

Charon and Courbon. Oxycephaly and
the Oxycephalio Syndrome, 219
Chakhine, B. Thyroid Opotherapy in
Gynaecology', 496

Chase, M. R., and Ranson, S. W.
Structure of the Roots, Trunk, and
Branches of the Vagus Nerve, 109
Chauvet and Fouques. Hypophyseal
Infantilism, 39

Christiani, A. Civil Capacity in Re¬
missions from General Paralysis, 227
Ciuffini. Clinical Observations on
Tumours of the Pia Mater, 38
Ciarla, E. Haemorrhage into the Left
Supramarginal and Angular Gyri, 38
Ciampi, L., and Valdizan, H. Physical
Development in the Mentally Defective,
423

Clapar&le, Ed. The Horses of Elberfeld
Once More, 111; Does the Motor
Verbal Image Exist ? 308
Claparede, Ed., and Bancels, J. Larguier
des. The Mannheim Dog, 208
Clark, Elberd. Regeneration of Medul- ,
la ted Nerves in the Absence of
Embryonic Nerve Fibres, following
Experimental Non-Traumatic De¬
generation, 152

Clark, L. Pierce, and Sharp, E. A. The
Role which Heredity Plays in Inducing
Epilepsy in Children Suffering from
Infantile Cerebral Palsy, 120; The
Mechanism of Periodic Mental Depres¬
sions as shown in Two Cases, and
the Therapeutic Advantages of such
Studies, 434

Clark, Paul F., Amoss, Harold L., and
Flexner, Simon. A Contribution to
the Epidemiology of Poliomyelitis, 156,
157

Clark, Paul F., and Amoss, Harold L.
Intraspinous Infection in Experimental
Poliomyelitis, 157

Clark, Paul F., Fraser, Francis R., and
Amoss, Harold L. The Relation to
the Blood of the Virus of Epidemic
Poliomyelitis, 119

Clarke, J. Michell, and Morton, C. A.
Removal of Intrathecal Tumour from
Lumbar Region of Spinal Cord, 34
Claude and Loyez. Traumatic Haemato-
myelia without Vertebral Lesion, 265
Cockayne, E. A. Associated Movement
of the Jaw and Upper Lid: “The
Jaw-Winking Phenomenon,” 412
Coen, Bernard. A Communication as to
the Causation of Large Vascular

130*

INDICES

Grooves Found on the Inner Aspect of
the Os Parietale, 203
Coghill, G. E. Correlated Anatomical
and Physiological Studies of the
Nervous System of Amphibia, 202
Collins, Joseph, and Elsberg, Charles A.
Giant Tumours of the Conus and
Cauda Equina, 375

Conel, J. L., and Carpenter, F. W. A
Study of Ganglion Cells in the
Sympathetic Nervous System, with
Special Reference to Intrinsic Sensory
Neurones, 302

Conklin, C. B. Typhoid Spine. With
Report of a Case Complicated by
Thrombo-Phlebitis of the Left Femoral
Vein, 118

Conos, B. Disseminated Sclerosis with
Crossed Hemiplegia, 455
Conto. A Case of “ Idiopathic Hydro¬
cephalus” in the Form of Weber’s
8yndrome: Rapid Cure by Lumbar
Puncture, 39

Cooper, J. W. Astley. Pathological
Inebriety: Its Causation and Treat¬
ment (Review), 136

Core, Donald. Some Modem Concep¬
tions of Aphasia, 420
Coriat, Isador H. A Case of Synesthesia,
66 ; An Unusual Type of Synesthesia,
66

Corson-Whyte, E. P., and Ludlum, S. D.
Syphilitic Tests in Latent and Treated
8yphilis, 386

Coskinas, G. S. Recurrent Fever and
Meningeal Syndrome (Epidemic of Re¬
current Fever in Greece during and
after the Two Wars of 1912-13), 262
Coudray, Derrien, Abdin-Delthiel, and
Raynaud, M. Meningeal Syndrome in
North African Recurrent Fever, 378
Coulet, G. Two Cases of Suppurative
Otogenic Meningitis, with Recovery,
263

Courbon and Charon. Oxycephalic Syn¬
drome, 219

Courtney, J. W., and Eaton, H. B. A
Case of Myotonia Congenita (Oppen-
heim), 113

Cow, Douglas. The Suprarenal Bodies
and Diuresis, 449

Cowdry, E. V. The Comparative Dis¬
tribution of Mitochondria in Spinal
Ganglion Cells of Vertebrates, 511
Craig, C. B. Cerebral Syphilis in the
Secondary Stage, 497
Crooq. The Mechanism of Muscular
Tonus, of the Reflexes, and of Con¬
tracture, 252

Crowe, 8. J., and Wislocki, G. B. Ex¬
perimental Observations on the Supra¬

renal Glands, with Especial Reference
to their Inter-Renal Portions, 484
Cushing, Harvey. Studies on the Cere-
bro-spinal Fluid—I. Introduction, 511
Cutting, J. A., and Mack, C. W. The
Intraspinal Injection of Salvarsanised
Serum in Paresis, 225
Cyriax, Edgar F. On the Technique of
Nerve Palpation by Nerve “ Friction,”
148

Cyriax, E. F. and R. V. Mechanical
Stimulation of the Coccygeal Ganglion:
A Contribution to the Physiology of
the Sympathetic Nervous System, 207

Dabney, Virginius. Herpes Zoster
Oticus. A Critical Review, with Re¬
port of a Case, 113

D*Abundo, G. Changes in the Spinal
Cord following Peripheral or Cerebral
Lesions, Isolated and Combined, 120;
On Attempts at Special Serotherapy
in General Paralysis, 226; Collodion
Coverslips in Microscopical Technique,
486

Damaye, H. The Treatment of Syphi¬
litic Psychoses, 170; Treatment of
General Paralysis, 327
Daniel, A. W. The Use of Scopolamine
Hydrobromide or Hyoscinc in the
Treatment of Mental Disorders, 531
Dardel, M. Oxygen Hypodermically in
Nervous and Mental Diseases, 329
Davidson, J. A., and Miller, R. The
Nervous Complications of Varicella,
73

Davies, Ivor J. Carbon Monoxide Poison¬
ing in the Senghenydd, 389
Deaaerick, W. H. Herpes Zoster and
Malaria, 489

Debat and Jacquet, L. Subacute Tetanus
Cured by Antitetanic Serum, 131
Debr£, R., Hints, E., and Netter. A
Case of Addison’s Disease derived in
1902, considered as Cured. Death from
Gastric Cancer in 1913. Autopsy, 422
Decroly and Henrotin, E. A Case of
Motor Imbecility, 163
De Jassy, Parhon, C., and Zugravu, G.
The Weight of the Pancreas in the
Insane, 172

Dejerine, Professor J. Semiologie des
Affections du Systerae Nerveux (Re¬
view), 504

Delachanal and Beriel. Anatomical Ex¬
amination of a Case of Multiple Scle¬
rosis from Disseminated Syphilitic
Myelitis, 67

De Lange. The ’Tweenbrain and Mid¬
brain of Reptilia, 201

INDICES

131*

Demole, V. Alcohol and Delirium
Tremens, 274; The Reaction of Moriz
Weisz in Mental Diseases, 462
Dercum, F. X. A Case of Suboortical
or Pure Motor Aphasia (Dejerine) or
Anarthria (Marie), 266
Derrien, Abdin-Delthiel, Raynaud, M.,
and Coudray. Meningeal Syndrome in
North African Recurrent Fever, 378
Descceudres, Alice. Are Defective Chil¬
dren Lacking in Moral Qualities ? 308
Despujols, B. On the Chronic Form of
Cerebro-spinal Meningitis, 116
Devine, Henry. The Clinical Signific¬
ance of Kata tonic Symptoms, 278
De Vries. A Case of Epilepsia Alternans,
47

De Witt Stetten and Rosen bloom, J.
Clinical and Met&bolio Studies of a
Case of Hypopituitarism due to Cyst
of the Hypophysis, with Infantilism of
the Lorain Type, 80

Dick, G. F., and Emge, F. A. Brain
Abscess caused by Fusiform Bacilli,
216

Diller, Theodore, and Miller, R. T.
Tumour of Frontal Region of Brain,
382

Diller, Theodore, and Rosen bloom, Jacob.
Metabolism Studies in a Case of Myas¬
thenia Gravis, 457

Dixon, W. E., and Halliburton, W. D.
The Cerebro-spinal Fluid.—II. Cere¬
brospinal Pressure, 204; III. The
General Effects of Increasing the Cere¬
bro-spinal Pressure, 371
Donald, R. Drop-Methods of Counting
the Cells of the Cerebro-spinal Fluid—
The Relation of the Cell-Count to the
Wassermann Reaction, 333
Dorlencourt, H., Bouttier, H., and
Aviragnet, E. C. The Oculo-Cardiac
Reflex in Diphtheritic Intoxication,
311

Douglas, R. 0. A Case of Landry’s
Paralysis, 265.

Douglas-Craw ford, D. Note on Two
Cases of Intradural Spinal Tumour,
490

Douglas, Mackenzie, and Funk, Casimir.
Studies on Beri-Beri.—VIII. The Re¬
lationship of Beri-Beri to Glands of
Internal Secretion, 111
Dubois, S., and GuilUin, G. Acute Poly¬
articular Rheumatism Localised to a
Limb Affected with Recent Paralysis
of the Brachial Plexus, 118 ; Abolition
and Inversion of the Oculo-Cardiac
Reflex in Pseudo-Bulbar Paralysis,
260; Syringomyelia following a Peri¬
pheral Infection, 264

Dufouger6, W. Pneumococcal Menin¬
gitis in the Sharpshooters of Senegal,
492

Dufour, H. On Reflex Epilepsy of Thera¬
peutic Origin, 274

Dufour and Legras. Oculo-Cardiac Re¬
flex producing Stoppage of the Heart.
Ventricular Automatism and Auriculo-
Ventricular Dissociation. Ovarian In¬
sufficiency associated with Thyroid
Overactivity. Epileptiform Attacks,
256

Duhot. Syndrome H£mi-Bulbaire, Ac.,
78

Duhot and Boez. Transitory Brown-
Sequard’s Syndrome at the Onset of
Spinal Syphilis, 261

Duhot and Hallez. Exophthalmic Goitre
and Glycosuria, Failure of Pituitary
Opotherapy, 276

Duhot, Pier ret, and Verhaeghe. Peri¬
pheral Neuritis from Ischaemia, 84

Dunn, J. S., and Monro, T. K. Malig¬
nant Ganglio-Neuroma of Left Supra¬
renal, 421

Durand, P. Etiology of Herpes in Cere¬
bro-spinal Meningitis, 74

Durand, P., and Beriel, L. Tuberculous
Meningitis, with Association of the
Meningococcus, 75; Arachnoid Injec¬
tion with the Serum of Syphilitics in
Tabes and General Paralysis, 326

Durupt and Thomas, Anar6. Experi¬
mental Researches on Cerebellar Func¬
tion, 60

Eager, Richard. The Role of Hypno¬
tics in Mental Diseases, with Indica¬
tions for their Selection and Employ¬
ment, 463

Eaton, H. B., and Courtney, J. W. A
Case of Myotonia Congenita (Oppen-
heim), 113

Edwards, D. J. A Study of the
Anatomy and the Vasomotor Pheno¬
mena of the Sympathetic Nervous
System in the Turtle, 109
Elliot, C. A., and Beifeld, A. F.
Generalised Neurofibromatosis (von
Recklinghausen’s Disease), 515
Elliot, T. R. Pathological Changes in
the Adrenal Glands, 514
Elliott, W. M. Some Observations on
the Occurrence of the Wassermann
Reaction in the Serum of the Children
of the Poorer Classes, 272
Elsberg, Charles A., and Collins, Joseph.
Giant Tumours of the Conus and Cauda
Equina, 375

Elsberg, Charles A,, Lambert, C. I., and

132*

INDICES

Keunedy, Foster. A Peculiar Unde¬
scribed Disease of the Nerves of the
Cauda Equina, 416

Elsohing. The Orbital Brain Abscess
and its Operation, 313

Embletpn, Dennis, and Thiele, Francis
H. Methods of Increasing the Accu¬
racy and Delicacy of the Wassermanu
Reaction, 128

Emerson, L. E. A Psycho-Analytic
Study of a Severe Case of Hysteria,
66

Emge, F. A., and Dick, G. F. Brain
Abscess Caused by Fusiform Bacilli,
216

Esposel and Austregcsilo. The Cemes-
thopathies, 253

Euzi&re, J. On Aseptic Reactions of
the Meninges and their Diagnosis, 214

Eversole, E. E., and Myerson, A. Notes
on Sunlight and Flashlight Reactions,
and on Consensual Amyosis to Blue
Light, 131

Fabkk and Petzetakis. Persistence of
Oculo-Cardiac Reflex in (General Anes¬
thesia, 258

Falconer, A. W. Three Cases of Dys-
pituitarism, 40

Farise, C. An Adrenal Tumour in a
Cow, 310

Farrant, Rupert. The Relation of the
Thyroid to Antitoxin, 46
Faure-Beaulieu, Vaucher, and Lere-
boullet. Diabetes Insipidus and In¬
fantilism, 218

Fearnsides, E. G., and Head, Henry;
M'Intosh, James, and Fildes, Paul.
Paralysis of the Nervous System, 126
Feiling, Anthony. On the Bulbar
Nudei, with Special Reference to
the Existence of a Salivary Centre in
Man, 106

Feldstein, Samuel, and Heiman, Henry.
Meningococcus Meningitis (Review),

534

Fenoglietta, Perrero v. On a Case of
Polyneuritis of Pregnancy with Symp¬
toms of Graves* Disease, 45
Ferrari, M. Histological Observations
on the Nervous System of the Progeny
of Animals Subjected to Chronic
Alcoholic Poisoning, 26
Fildes, Paul, and M*Intosh, James;
Head, Henry, and Fearnsides, E. G.
Paralysis of the Nervous System, 126
Fildes, Paul, and MTntosh, James.
The Wassermann Reaction and its
Application to Neurology, 127
Findlay, Leonard, and Robertson, Madge

E. Some Manifestations of Congeni¬
tal Syphilis, 527

Fischer, Walther, and Yokoyama, Yugo.
A Peculiar Form of Nodular Hyper¬
plasia associated with Brain Changes,
26

Fisher, E. D. Present Status of Neo-
salvarsan in the Treatment of Para-
syphilis of the Nervous System, 274;
Landry’s Paralysis, 518
Fleming, Robert A. Notes of a Case of
Recurrent Paralysis of the Third
Cranial Nerve, 58

Flexner, Simon, and Amoss^ Harold L.
Localisation of the Virus and Patho¬
genesis of Epidemic Poliomyelitis, 487 ;
Penetration of the Virus of Polio-
1113 'elitiB from the Blood into the
Cerebro-spinal Fluid, 488
Flexner, Simon, Clark, Paul F., and
Amoss, Harold L. A Contribution to
the Epidemiology of Poliomyelitis,
156 ; A Contribution to the Pathology
of Epidemic Poliomyelitis, 157
Flournoy, Henri. Analysis of a Case of
Psychasthenia, 529

Fofc, C. Now Researches on the Func¬
tion of the Pineal Gland, 448
Foereter. A Meningo-Cerebellar Symp¬
tom - Complex in Febrile Diseases
Occurring in Tuberculous Individuals,
32

Foix, Halle, J., and Block, M. A Case
of Hemiplegia in Diphtheria, 314
Fon-agtes, C. Arsenical Myelitis, 490
Foresti, C. B., and Bonaba, J. A Case
of Multiple Visceral Hydatid Cysts
(Heart, Brain, Kidneys), Rupture of
one of the Heart Cysts in the Left
Auricle, 519

Forster, George B. The Noguchi Luetin
Reaction in Syphilis, 80
Fotheringham, J. T. A Case of Tetanus,
with Recovery, Treated by Carbolic
Acid Injections, 526

Foucque, A. Practical Study of the
Albumin in the Cerebro-Bpinal Fluid
in Syphilis, 421

Fox, Charles D. The Psychopathology
of Hysteria (Review), 331
Francis, Edward. An Attempt to trans¬
mit Poliomyelitis by the Bite of
Lyperosia irrilam , 415
Francis, E., Grimm, R. M., Lorenz, W.
F., and Lavinder, C. H. Attempts to
Transmit Pellagra to Monkeys, 4o7
Francesco, Bandettini di Pog^io. Left
Hemiplegia of Central Origin with
Peripheral Homolateral Paralysis of
the Tongue from a Cerebral Tumour,
with Double Localisation, 381

INDICES

133 *

Fraaer, Francis R. Clinical Observa¬
tions on Ninety Cases of Acute
Epidemic Poliomyelitis, 452

Fraser, Francis R., Amoss, Harold L.,
and Clark, Paul F. The Relation to
the Blood of the Virus of Epidemic
Poliomyelitis, 119

Fraser, J. S. Labyrinth Suppuration: A
Review, 87

Fredericq, L6on. The Local Action of
Nicotine on the Dog’s Right Cardiac
Auricle, 63

Freud, Sigmund. Psychopathology of
Everyday Life (Review), 464; On
Dreams (Review), 535; The Interpre¬
tation of Dreams (Review), 535

Frey, Rameix, and Morichau-Beauchant,
R. Acute Ataxia in Convalescence
from Measles, 413

Friesner, Isidore, and Braun, Alfred.
The Labyrinth : An Aid to the Study
of Inflammations of the Internal Ear
(Review), 135

Frink, H. W. Three Examples of Name-
Forgetting, 308

Frith, A. H. The Pupil and its Reflexes
in Insanity, 278

Froment, J., and Monod, O. Articulate
Language in the Normal Man and in
the Aphasic, 307

Funk, Casimir. Studies on Pellagra.—
I. The Influence of the Milling of
Maize on the Chemical Composition
and the Nutritive Value of Maize-
Meal, 24; Is Polished Rice plus
Vitamine a Complete Food ? 208

Funk, Casimir, and Douglas, Mackenzie.
Studies on Beri-Beri.—VIII. The Re¬
lationship of Beri-Beri to Glands of
Internal Secretion, 111

Gaitz, Sarah. Diabetic Facial Paraly¬
sis, 267

Ganeau and Giroux. Tabes Aggravated
by “606,” 154

Gantz, Mieczyslaw. Two Rare Compli¬
cations of Foreign Bodies in the JEao-
phagus, 316

Garnier, M., and Levi-Franckel, G.
Changes in the Oculo-Cardiac Reflex
under the Influence of Pregnancy, 488

Gatti, L. Trauma and General Paralysis,
392

Gautrelet. The Oculo-Cardiac Reflex,
254

Gauthier, G. On the Spinal Cord
Phenomena of Typhoid Fever, and
Especially Metatypnoid Myelitis, 33

Gebb, H. Salvarsan in Ophthalmic
Zoster, 387

Gendron, A. (de Nantes), and Amandrut,
J. (de Laval). Aseptic Leucocytosis
of the Cerebro-spinal Fluid with Sub¬
acute Meningeal Syndrome in the
course of Cerebral Haemorrhage.
Xanthochromia and Polynucleosis, 271
Genil-Perrin and Ballet. Clinical ex¬
amination of the Mental State of
Dements, 328

Gettings, H. 8., and Waldron, Ethel.
The Detection of a Dysentery Carrier,
532

Gillis, Andrew C. Occlusion of the
Posterior Inferior Cerebellar Artery,
522

Giroux and Ganeau. Tabes Aggravated
by “606,” 154

Glaser. The Nerve Arborisations of the
Blood-Vessel Walls, 251
Gley, E. The Physiological Activity of
the Adrenal of Tnyroidectomiaed
Animals, 65

Gley, E., and Quinquaud, A. Contribu¬
tion to the Study of Humoral Inter-
Relations.—I. The Action of Thyroid
Extract and of Organic Extracts in
General on Adrenal Secretion, 65
Glynn, T. R. The Bradshaw Lecture on
Hysteria in some of its Aspects, 44
Goddard, Henry H. The Binet
Measuring Scale of Intelligence, 514
Goebel, 0. Labyrinth Activity, 391
Goldmann, Professor. Vital Staining
and Chemotherapy, 203
Goldstein and Marinesco. Graves*
Disease and Sclerodermia, 45
Goldstein and Reichmann. Somatic
Disturbances in Dementia Prajcox, 392
Gonnet and Levy, L. Meningeal
Syndrome in the Course of Cerebral
Haemorrhage, 454

Gordon, Alford. Mental Manifestations
in Tumours of the Brain, 456
Gordon, Alfred. The Cerebro-Spinal
Fluid and a Special Method of Treat¬
ment of Essential Epilepsy, 129;
Experimental Study of Intraneural
Injections of Alcohol, 274; Contra¬
lateral Oppenheim and Gordon Re¬
flexes, 311; Lumbar Puncture as a
Special Procedure for Controlling
Headache in the Course of Infectious
Diseases, 415; Spasmodic Closing of
Cerebral Arteries in its Relation to
Apoplexy, 418 ; Unfavourable Compli¬
cation following an Intradural Injec¬
tion of Neosalvarsan, 526
Grabs. A Case of Progressive Facial
Hemiatrophy, 219

Grace, John J. Notes on the Treatment
of Sciatica, 132

INDICES

Oraetz. Spasmophilia ami Epilepsy, 43

Graham, Cecil, ami Harris, Wilfml. A
Cane of Pituitary Tumour and Sellar
Decompression, 162

Grand, Selma, and Soper, Willard B.
The Urea Content of the Spinal Fluid,
with Special Reference to its Diag¬
nostic and Prognostic Significance. A
Series of Ninety-seven Cases, 82

Green wald, J. The Sup|x>sed Relation
between Paralysis Agilans and In-
suthciency of the Parathyroid (Hands,
220

Gregor and Schilder. The Theory of
M yotonia, 71

Gregory, M. S., and Karpas. M. J.
Syphilitic Bone Disease of the Skull,
125

Grellier, G. The Circulatory System in
Acromegaly, 494

Grimm, R. M., Lorenz, W. F., Lavinder,
C. H., and Francis, K. Attempts to
Transmit Pellagra to Monkeys, 457

Guichot, H. Primary Pneumococcal
Cerebro-spinal Meningitis, 75

Guidi, Feruccio. On the Structure of
the Myelin Sheath and its Alteration
in Secondary Degeneration, 25

Guillain, G. Inhibitory Action of
Ocular Compression on the Abnormal
Movements in a Case of Double
Athetosis, 258

Guillain, G., and Dubois, S. Acute
Polyarticular Rheumatism Localised
to a Limb Affected with Recent
Paralysis of the Brachial Plexus, 118 ;
Abolition and Inversion of the Oculo-
Cardiac Reflex in Pseudo-Bui l »ar
Paralysis, 2(50; Syringomyelia follow¬
ing a Peripheral Infection, 284 ;

Guillaumont, B. The Oculo-Cardiac
Reflex in Graves’ Disease, 254

Hada, B. On the Cerebral Complications
of Whooping Cough. With Special
Reference to “ Pachymeningitis Pro¬
ductive Interna,” 215
Hale, Worth. The Cause of Death from
Subdural Injections of Serum, 388
Halle, J., Bloch, M., and Foix. A Case
of Hemiplegia in Diphtheria, 314
Hallezand Duhot. Exophthalmic Goitre
and Glycosuria. Failure of Pituitary
Opotherapy, 276

Halliburton, W. I)., and Dixon, W.
E. The Cerebro-Spinal Fluid.—H.
Cerebro-Spinal Pressure, 204.—III.
The General Effects of Increasing the
Cerebro-spinal Pressure, 371
Hallion, L. The Hypotensive Action of

Pituitary Posterior Lobe Extract on
the Pulmonary Circulation, 206
Handmann and Striimpell. A Contribu-
' tion to the Study of So-called Pseudo-
sclerosis, with Changes in the Cornea
and in the Liver, 270
Hammes, Ernest H., and Riggs, C.
i Eugene. Results of One Hundred
I Injections of Salvarsanised Serum. 503
Harris, Wilfred, and Graham, CeciL
A Case of Pituitary Tumour and
Sellar Decompression, 162
Haskovec and Basta. Contribution to
the Pathology of Paralysis Agitans, 25
Hawthorne, C. 0. On the Occurrence uf
a Bilateral Extensor Response instates
of Unconsciousness, 489
Hayes, Reginald. The Intensive Treats
ment of Syphilis and Locomotor Ataxia
by Aachen Methods (Review), 533
Hayhurst, Emery R. Critical Examina¬
tion of One Hundred Painters for
Evidence of Lead Poisoning, 38o
Havs, Victor J. The Development of
the Adrenal Glands of Birds, 482
Head, Henry, and Fearnsute, t‘
M'Intosh, James, and Fildes, P«L
Paralysis of the Nervous System, l*
Heed, Charles R., and Price, Georg. *
Binasal Hemianopsia occurring
Course of Tabetic Optic Atrophy.
Heiman, Henry, and Feldstem ^
Meningococcus Meningitis (B«™ '
534 , t

Hele, T. S., and Wolf, Charlesitj
Gaseous Exchange in the Decere
Animal, 449 , „. l, k ; s

Henderaon, D. K. KoraakowsP^hnsi
Occurring during Pregnancy, .

Henning-Hounc. SomeOasM J
cal Defect of the Field of \
Henrotin, K., and Decroly. A C

Atw

■MJfr. Babinski'. •£*
Sign ” of Organic Henuplepa n‘»
chorea, and its Bearing on the Organ
Nature of Chorea, 2*0 q„

Herxheimer, G., and Kotn, •
Recklinghausen’s Neurofibroma!

Hesnard and Regis. The Teaching of
Freud and his School, 84 j am «.

Hewat, Fergus A., and MdJ* the
A Case of Tuberculous
Vertebrae, complicated ty j-g

Acute Suppurative Menmp ikon's
Higier, H. Familial Forms of ^

Lenticular Degenerationand t P u< “

Strilmpell’s Pseudosclerosis, m

INDICES

135*

Hinton, W. A., and Lee, Roger 1. A
Critical Study of Lange’s Colloidal
Gold Reaction in Cerebro-spinal Fluid,
459

Hirtz, E., Debr£, R., and Netter. A
Case of Addison’s Disease observed in
1902, considered as Cured. Death
from Gastric Cancer in 1913 ; Autopsy,
422

Hitschmann, Eduard. Freud’s Theories
of the Neuroses (Review), 330

Holmes, A. O. Defaced Type of Addison’s
Disease, 277

Holmes, Gordon. The Diagnosis of
Tabes Dorsalis, 154

Holmes, Gordon M., and Taylor, James.
Two Families with Several Members in
Each Suffering from Optic Atrophy,
42; Nervous Symptoms associated
with Optic Atrophy of the Familial
Type, 42

Hom£n, E. A. Arbeiten aus dem Patho-
logischen Institut der Universitat
Helsingfors (Finland) (Review), 228

Hornowski, J. Two Deaths Due to
Suprarenal Insufficiency, 221

Horton, Lydia H. Inventorial Record
Forms of Use in the Analysis of
Dreams, 309

Hoskins, R. G., and Wheelon, Homer.
Adrenal Deficiency and the Sympa¬
thetic Nervous System, 20b; Para¬
thyroid Deficiency and Sympathetic
Irritability, 307 ; Ovarian Extirpation
and Vasomotor Irritability, 484

Humo, W. E. A Case oi Amaurotic
Family Idiocy, 282

Hunt, J. Ramsay. The Neurol Atrophy
of the Muscles of the Hand, without
Sensory I)isturl>ances, 187 ; the Role
of the Carotid Arteries in the Causation
of Vascular Lesions of the Brain, with
Remarks on Certain Special Features
of the Symptomatology, 418 ; Syphilis
of the Vertebral Column : Its

Symptomatology and Neurol Com¬
plications, 458

Hutinel, Professor. Maladies des

Meninges (Review), 279

Ige9HKImer, J. On Nystagmus, 323
Ivy, Robert H., and Thomas, B. A.
Observations on the Wassermann
Reaction, 459

Jacksox, D. J. The Clinical Value and
Significance of Leucocytosis in Mental
Disease, 171

Jacquet, L., and Debat. Subacute

Tetanus Cured by Antitetanic Serum,
131

Jacquin and Marchand. Progressive
Epileptic Myoclonus, 84
Jarkowski, Babinski, and Jumenti.

Hypertrophic Cervical Meningitis, 31
Jarkowski, J., Babinski, J., ana Lecfcne,
P. Crural Paraplegia from Extra¬
dural Spinal Tumour. Operation.
Recovery, 452

Jefferson, Geoffrey. A Note on the
Sulcus Post-Centralis Superior, 21 ;
the Parietal Area, 54
Jelliffe, Smith Ely. Some Notes on
44 Transference, 153
Job, E. A Case of Typhoid Spine, 379
Johnston, J. B. TheNervus Terminalis
in Man and Mammals, 201
Johnson, George T., and Breaks, L. Z.
The Treatment of Tabetic Optic
Atrophy with Intraspinal Injections
of Salvarsanised Serum, 491
Johnson, W. A Pathological Investi¬
gation of Four Cases of Pituitary
Tumour, 456

Jolowicz. The Treatment of General
Paralysis with Sodium Nucleinate and
Salvarsan, 48

Joltrain, E., and Rouffiac, P. Meningeal
Syndrome of the Poliomyelitis Type,

Joltrain, E., Milian, and Sicard. Death
following two Injections of Neosal-
varsan at the Onset of Syphilis, 125
Jones, A. Webb. Two Cases of Post¬
operative Hemiplegia, 79
Jones, Ernest. The Case of Louis Bona¬
parte, King of Holland, 153; The
Significance of the Unconscious in
Psychopathology, 474
Jonnescoand Laignel-Lavastine. Histo¬
logical Researches on the Hypophysis
of Psychopaths, 69

Jumenti^, Jarkowski, and Babinski.
Hypertrophic Cervical Meningitis, 31

Karp as, M. J., and Gregory, M. S.
Syphilitic Bone Disease of the Skull,
125

Karplus and Kreidl. The Experimental
Production of Reflex Iridoplegia, 62
Kellqg, J. H. The First Observed Cases
of Friedreich’s Ataxia in America, 155
Kennedy, Foster, Elsberg, Charles A.,
and Laml>ert, C. J. A Peculiar Un¬
described Disease of the Nerves of the
Cauda Equina, 416

Kerr, W. S., and Barnes, A. E. A Case
of Otitic Meningitis and Cerebellar
Abscess, with Recovery, 158

136*

INDICES

Kidd, Leonard J. The Nucleus Inter -
c&l&tus of Staderini, 1; Isoovesoo’s
Experimental Researches on Lipoids
of Organs, 100; The Alleged Sensory
Cutaneous Zone of the Facial Nerves
of Man, 393

Kilgore, Alson R. The Luetin Cutaneous
Reaction for Syphilis, 222
Kirby, George H. The Catatonic Syn¬
drome ana its Relation to Manic-
Depressive Insanity, 132
Klotz, Oscar. Syringomyelia: With
Autopsy Findings in Two Cases, 73
Knapp, Philip Coombs. Two Cases of
Removal of Extra-dural Tumour of
the Spinal Cord, 265
Knauer, A., and Maloney, W. J. The
Cephalograph, a New Instrument for
Recording and Controlling Head Move-

vnAn f o

Knowles’, T. E. The Villa or Colony
System for the Care and Treatment of
Qkses of Mental Disease, 172
Kobylinsky, Moissey. The Psychosis
Occurring in Typhoid Fever, 48
Kramer, J. G., and Todd, T. Wingate.
The Distribution of Nerves to the
Arteries of the Arm, with a Discussion
of the Clinical Value of Results, 370
Kraus, H. Fever as a Solitary Symptom
of Latent Syphilis, 125
Kreidl and Karplus. The Experimental
Production of Reflex Iridoplegia, 62
Kuh, Sydney, and Braude, Morris. A
Contribution to the Pathology of Myas¬
thenia Gravis, 112

Ladame. Neuroses and Sexuality, 84
Lafforgue. The Meningeal Syndrome in
Recurrent Fever, 313
Lahy, J. M. An Arithmetical Prodigy,
112

Laignel-Lavastine and Boudon, L.
Adiposity Due to a Juxta-Pituitary
Sarcoma, 123

Laignel - Lavas tine and Jonnesco.

Histological Researches on the Hypo¬
physis of Psychopaths, 69
Laignel - Lavastine and Levy - Valensi.
Glioma of the Corpus Callosum and
Left Parietal Lobe: Bilateral Apraxia,
266

Laignel - Lavastine and Pitulesco.

familial Adiposity with Endocrinal
Disturbances, 124

Laignel-Lavastine and Romme. Herpetic
Facial Paralysis in a Patient with
Symmetrical Lipomatosis, 312
Lagane, L. Typhoid Cerebro-spinal
Meningitis in an Infant, 32

Lambert C. I., Kennedy, Foster, and
Elsberg, Charles A. A Peculiar Un¬
described Disease of the Nerves of the
Cauda Equina, 416

Lange, De. The Phylogenetio Evolution
of the Corpus Striatum, 200
Langwill, H. G. Can Herpes Zoster
ever Occur Traumatically ? 114
Lasarew. A Defect in Innervation of
the Facial Nerve from Tumours of the
Posterior Fossa, 217

Laubry, C. Cerebral Haemorrhage in
Chronic Myeloid Leucaemia, 122
Lavan. On Metachancral and Pre-
roeeolar Meningitis in Syphilis, 493
Lavau and Audry, C. On Preroseolar
Meningitis, 213

Lavergne, J. de B. de. General Par¬
alysis and Pregnancy, 424
Lavinder, C. H., Francis, E., Grimm,
R. M., and Lorenz, W. F. Attempts
to Transmit Pellagra to Monkeys, 457
Leo&ne, P., Jarkowski, J., and Babinski,
J. Crural Paraplegia from Extra-
Dural Spinal Tumour. Operation.
Recovery, 452

Ledoux, P. Tuberculosis and Exoph¬
thalmic Goitre, 496

Lee, Roger I., and Hinton, W. A. A
Critical Study of Lange’s Colloidal
Gold Reaction in Cerebro-spinal Fluid,
459

Legendre, G. C. J. The Results of
Specific Treatment in Tabes and
General Paralysis at the Salp6trifcre,
502

Legras and Dufour. Oculo - Cardiac
Keflex producing Stoppage of the
Heart. Ventricular Automatism and
Auriculo - Ventricular Dissociation.
Ovarian Insufficiency associated with
Thyroid Overactivity. Epileptiform
Attacks, 256

Legris, A., and Benech, J. A Case of
Early Spinal Syphilis with Bulbar
Phenomena, 211

Leidler, R. The Anatomy and Function
of Bechterew's Nucleus, 303

Lelesz, Helfcne. Mental Tendency in
Testimony, 485

Lempert, L. Herpes and Zoster of
Dental Origin, 211

Leopold, Simon S. Eosinophilia in
Chorea, 419

Lereboullet, Faure - Beaulieu, and
Vaucher. Diabetes Insipidus and
Infantilism, 218

Lesier, C., Vernet, M., and Petzetakis.
Changes in the Reflexes Produced by
Ocular Compression in Epilepsy, 256;
Stoppage of the Hoart by the Oculo-

INDICES

137*

Cardiac Reflex in an Epileptic, 257;
Exaggeration of the Oculo - Cardiac
Reflex in Epilepsy. Its Variations
under the Influence of Medicinal and
Toxic Causes, 257 ; The Oculo-Cardiac
Reflex in Patients Suffering from
Various Tremors, 259; The Oculo-
Cardiac Reflex and Paralysis Agitans,

259 ; On the Frequent Abolition of the
Oculo-Cardiac Reflex in Tabes, 260;
Glycosuria, Albuminuria, and Polyuria
caused by Ocular Compression, 261

Leszynsky, William M. Glioma of the
Cauda Equina. Report of a Case with
Secondary Gliosis of the Spinal Cord,
121

Levi-Franckel, G., and Gamier, M.
Changes in the Oculo-Cardiac Reflex
under the Influence of Pregnancy,
488

Levy, L., and Gonnet. Meningeal
Syndrome in the Course of Cerebral
Haemorrhage, 454

Levy, Robert L., and Miller, Sydney R.
The Colloidal Gold Reaction in the
Cerebro spinal Fluid, 319

Levv-Valensi, J. A Case of Congenital
Hemiatrophy, 122

Levv-Valensi and Laignel-Lavastine.
Glioma of the Corpus Callosum and
Left Parietal Lobe: Bilateral Apraxia,
266

Lichfield, W. F. Infantile Paralysis of
the Small Musoles of the Hand, 518

Lidbetter, E. I., and Nettleship, E. On
a Pedigree showing both Insanity and
Complicated Eye Disease; Anticipation
of the Mental Disease in Successive
Generations, 325

Lier, W., On Neurofibromatosis, 413

LifBchitz, Mile. R. Tetany in the Adult
and its Parathyroid Origin, 277

Lloyd, James H. Epilepsy in Childhood,
321

Loeper, M., and Mongeot, A. Absence
of the Oculo-Cardiac Reflex in Tabes,
29

Loeper, Mongeot, andVahram. Frequent
Abolition of the Oculo-Cardiac Reflex
in Syphilis, 259

Loeper and Wiel. Favourable Action of
Ocular Compression on Certain Nervous
Manifestations, especially Hiccough,

260

Lohraann, Professor W. Disturbances
of the Visual Functions (Review), 432

Long. A Case of Aphasia from a Lesion
in the Left Hemisphere in a Left-
Handed Individual: Crossed Aphasia
and Dissociated Aphasia, 82

Lorenz, W. F., Lavinder, C. H., Francis,

E., and Grimm, R. M. Attempts to
Transmit Pellagra to Monkeys, 457
Lortat-Jacob, L., and Paraf, J. Intra-
spinal Injections of Neosalvarsan in
Tabes and General Paralysis, 528
Loumeau. Hemiplegia and Prostatec¬
tomy, 266

Loyez and Claude. Traumatic Heemato-
myelia without Vertebral Lesion, 265
Loygue, G. Pulmonary Localisations of
the Meningococcus, 414
Lucien, M., and Parisot, J. Glandes
Surrenales et Organes Chromaffines
(Review), 537

Ludlum, S. D., and Corson-White, E. P.
Syphilitic Tests in Latent and Treated
Syphilis, 386

Lugaro, E. A Biogenetic Principle, 28 ;
Modem Problems in Psychiatry (Re¬
view), 534

Lyon-Caen, L., and Robin, A. Cerebral
Rheumatism Explained by Haemor¬
rhagic Meningitis occurring in the
Course of Acute Articular Rheumatism,
262

M‘Carrison, Robert. Etiology of En¬
demic Cretinism, Congenital Goitre,
and Congenital Parathyroid Disease,
167

M‘Carthy, D. J. Iron Infiltration in the
Fixed and Wandering Cells of the
Central Nervous System, 209
MacConkey, Alfred. Tetanus: its
Prevention and Treatment by Means
of Antitetanio Serum, 498
M‘Cord, Carey Pratt. The Pineal Gland
in Relation to Somatic, Sexual, and
Mental Development, 372, 449
Macfarlane, A. Venesection in Cerebral
Haemorrhage, with Report of Cases, 160
M‘Intosh, James, and Fildes, Paul;
Head, Henry, and Fearnsides, E. G.
Paralysis of the Nervous System, 126
M‘Intosh, James, and Fildes, Paul. The
Wassermann Reaction and its Applica¬
tion to Neurology, 127
Mack, C. W., ana Cutting, J. A. The
Intraspinal Injection of Salvarsanised
Serum in Paresis, 225
Mackenzie, William. The Problem of
the Thinking Dog of Mannheim, 208
M‘Kibben, Paul S. Mast Cells in the
Meninges of Necturus, easily Mistaken
for Nerve Cells, 481 ; Ganglion Cells
of the Nervus Terminalis in the Dog-
Fish {Mu8telus caiiis), 481
Macleod, C., and Rolleston, J. D. Intra¬
muscular Injections of Antitoxin in
the Treatment of Diphtheria, 379

138*

INDICES

MacPh&il, H. D. The Albumen in the
Cerebro-spinal Fluid in Cases of
Mental Disease, 171

M‘Vicar, C. S., Bates, Gordon, and
Strathy, George S. The Treatment
of Tabes Dorsalis and General Paresis
with Salvarsan, 226

Magaudda, Paolo. The Nervous
Symptoms caused by Subolavian
Aneurysm, 71

Major, Ralph H., and Nobel, Edmund.
The Glycyl-Tryptophan Reaction in
Meningitis, 454

Maloney, W. J. M. Fear and Ataxia,
118

Malone v, W. J., and Knauer, A.
The Cephalograph, a New Instrument
for Recording and Controlling Head
Movements, 253

Mapother, Edward, and Beaton, Thomas.
Intraspinous Treatment (Swift-EUis)
of General Paralysis, 225; Intra¬
thecal Treatment of General Paralysis,
527

Marchand and Jaoquin. Progressive
Epileptic Myoclonus, 84

Marcus, Henry. A Case of Sciatica
Entirely Cured in Three Weeks*
Treatment, 461

Marfan, A. B. Heredo-Syphilitic
Spastic Paraplegia, 264

Margarot and Baumel. Does Achon¬
droplasia Correspond to a Partial
Hypopituitarism? 40

Marie, A., and Morax, V. Effects of
Adrenalectomy on Guinea-Pigs, 207

Marine, David. Observations and
Experiments on Goitre (so-called
Thyroid Carcinoma) in Brook Trout,
66

Marinesco, G. On the Colloidal Structure
of Nerve Cells, 152

Marinesco and Goldstein. Graves 1
Disease and Sderodermia, 45

Marinesco and Noica. Two Cases of
Tabes Complicated by Hemiplegia,
72

Marinesco and Radovici. The Syndrome
of Xanthochromia and Coagulation
en masse of the Cerebro-spinal Fluid,
221

Martin, J., and Rebattu, J. A Case
of Recklinghausen*8 Disease, 159

Matlauschek. Peculiar Alterations of
the Myelin Sheaths in Degenerating
Nerve Fibres, 373

Mauriac, P., and Philip, P. Meningeal
States in Scarlet Fever and Scarlatinal
Uremia, 414

Mayou, M. S. Optic Neuritis with
Symmetrical Loss of the Lower Portion

of the Field Associated with Diabetes,
501

Mendel. On Right-Brained ness in
Right-handed Individuals, 383
Menael and Tobias. Graves’ Disease
in the Male Sex, 45

Meneau. Inflammation of the Labyrinth
after Injection of Neosalvarsan, 164
Mercier, F., and Nobecourt. Respiratory
Form of the Encephalo-Meningeal
Reactions in Typhoid Fever in the
Child, 77

Meyer. Differential Diagnosis of Gene¬
ral Paresis, 425

Middlemiss, J. E. Some Cases of
Psychological Interest from Private
Practice, 450

Milian, Sicard, and Joltrain, E. Death
following Two Injections of Neo¬
salvarsan at the Onset of Syphilis,
125

Miller, James, and Hewat, Fergus A.
A Case of Tuberculous Disease of the
Vertebre, oomplicated by an Exten¬
sive Acute Suppurative Meningitis,
378

Miller, R., and Davidson, J. A. The
Nervous Complications of Varicella,
73

Miller, R. T., and Diller, Theodore.
Tumour of Frontal Region of Brain,
382

Miller, Sydney R., and Levy, Robert L.
The Colloidal Gold Reaction in the
Cerebro-spinal Fluid, 319
Milian. Syphilitic Reinfection after
Treatment with Neosalvarsan, 421
Mills, Charles K., and Weisenburg,
Theodore H. Cerebellar Symptoms and
Cerebellar Localisation, 524
Minet, J. Sudden Death following
Lumbar Puncture, 318
Mira, Ferreira de. The Influence of the
Adrenals on Growth, 111
Missimilly, E. The Nervous Complica¬
tions of Mumps in the Child, 117
Mochi, A. Asymboly, 391
Modern Treatment of Nervous
Mental Diseases, by American
British Authors (Review), 532
Moleen, George A. Metallic Poisons
and the Nervous System, 70
Molhant, M. The Vagus Nerve:
Anatomical and Experimental Study.
Part III. — The Peripheral Vagus
Ganglia: Localisation of the Sensory
Ganglia and Peripheral Distribution
of their Issuing Fibres, 107
Mollet, A. Organic Hemiplegia of
Diphtheritic Origin, 379
Mongeot, A. Constant Suppression of

and

INDICES

139*

the Oculo-Cardiao Reflex by Atropine,
256

Mongeot, A., and Loeper, M. Absence
of the Oculo-Cardiao Reflex in Tabes,
29

Mongeot, Vahram, and Loeper. Fre-

C it Abolition of the Oculo-Cardiac
ex in Syphilis, 259

Monod, 0., ana Froment, J. Articulate
Language in the Normal Man and in
the Aphasic, 307

Monro, T. K., and Dunn, J. S. Malig¬
nant Ganglio-Neuroma of Left Supra¬
renal, 421

Montgomery, D. W. Syphilophobia,
497

Morax, V., and Marie, A. Effects of
Adrenalectomy in Guinea-Pigs, 207
Morestin, H. Fibrosarcoma of the Leg
in a Woman Suffering from Reckling¬
hausen’s Disease, 261
Moricand, I. Wassernmnn’s Reaction in
Aortic Disease, 420

Morichau-Beauchant, R., Frey, and
Rameix. Acute Ataxia in Convales¬
cence from Measles, 413
Morley, John. Traumatic Intramus¬
cular Ossification, 29
Morse, Mary E. Correlations of
Cerebro - spinal Fluid Examinations
with Psychiatric Diagnoses, 227
Morton, C. A., and Clarke, J. MichelL
Removal of Intrathecal Tumour from
Lumbar Region of Spinal Cord, 34.
Mouiz. The Idiopathic Varieties of
Myoclonus, 28

Myers, Bernard. Tongue Chewing, 155
Myerson, A. Contralateral Periosteal
Reflexes of the Arm, 311; The Albumin
Content of the Spinal Fluid in its
Relation to Disease Syndromes, 318
Myerson, A., and Eversole, E. E. Notes
on Sunlight and Flashlight Reactions,
and on Consensual Amyosis to Blue
Light, 131

Neiding and Raimiste. Changes in the
Spinal Cord in Tumours of the Posterior
Cranial Fossa, 35

Netter, Arnold. The Meningeal Form
of Poliomyelitis, 30

Netter, Hirtz, E., and Debr£, R. A Case
of Addison’s Disease observed in 1902,
considered as Cured. Death from
Gastric Cancer in 1913. Autopsy, 422

Nettleship, E., and Lid better, E. J.
On a Pedigree showing both Insanity
and Complicated Eye Disease: Antici¬
pation of the Mental Disease in Succes¬
sive Generations, 325

Neue. Biological Reactions in Syphilitic
Diseases of the Central Nervous System,
273.

Neustaedter, M. A Case of Facial
Hemiatrophy, 267

New, G. B., and Plummer, W. A.
Tumour of the Middle Cranial Fossa,
involving the Gasserian Ganglion, 217

Newburgh, L. H. and I., and Porter, W.
T. The State of the Vasomotor
Apparatus in Pneumonia, 483

Nichols, Henry J. Observations on a
strain of Spirochceta pallida Isolated
from the Nervous System, 223

Niekans, A. On the Pathogeny and
Symptomatology of Post-Diphtheritic
Polyneuritis, 118

Nightingale, P. A. Zeism or Pellagra,
108

Nitsche, Paul, and Wilmanns, Karl.
The History of the Prison Psychosis
(Review), 133

Nob^court and Mercier, F. Respiratory
Form of the Encephalo-Meningeal
Reactions in Typhoid Fever in the
Child, 77

Noble, Edmund, and Major, Ralph H.
The Glycyl-Tryptophan Reaction in
Meningitis, 454

Noica and Marinesco. Two Cases of
Tabes Complicated by Hemiplegia, 72

Nolan, J. N. G. The Recognition and
Treatment of True Idiopathic Epilepsy
in Children, 322

Nonne and Wohlwill. A Clinical and
Pathological Case of Isolated Argyll
Robertson Pupils in the Absence of
General Paralysis, Tabes, and Cerebro¬
spinal Syphilis, 377

Nowicki, G. B. Precocious General
Paralysis Three Years after a Chancre
Treated by “606,” 501

Nurzia, P. On Heredo-Alcoholic Degen¬
eration, 388

Oberndorf, C. P. Slips of the Tongue
and Pen, 309

Obregia, Parhon, and Urechia. Re¬
searches on the Genital Glands in
Dementia Praecox, 86
Odier, Charles. A Case of Hysterical
Contracture, 485

Oliver, Sir Thomas. Lead Poisoning:
from the Industrial, Medical, and
Social Points of View (Review), 538
Oppenheini. Is there a Cystic Variety
of Disseminated Sclerosis ? 380
Orr, D., and Rows, R. G. Further
Observations on the Influence of Toxine
on the Central Nervous System, 252

140*

INDICES

Orticoni, A. The Serotherapy of Cerebro¬
spinal Meningitis, 262

Orton, S. T. An Analysis of the Errors
in Diagnosis in a Series of Sixty Cases
of Paresis, 131 ; A Note on the Cir¬
culation of the Cornu Ammonis, 202;
A Study of the Satellite Cells in Fifty
Selected Cases of Mental Disease,
411

Ott, Augusto. Considerations on the
Physiological Pathology of Contrac¬
ture, 61

Oxley, W. H. F. Electrolytic Treat¬
ment of Lead Poisoning, 455

Pacaud, H. On Meningo-Typhoid, 76

Paraf, J., and Lortat-Jacob, L. Intra-
spinal Injections of Neosalvarsan in
Tabes and General Paralysis, 528.

Parhon, C., Jassy, de, and Zugravu, G.
The Weight of the Pancreas in the
Insane, 172

Parhon and Schunda. A Fresh Contri¬
bution to the Study of Achondroplasia,

Parhon, Urechia, and Obregia. Re¬
searches on the Genital Glands in
Dementia Pnecox, 86

Parisot, J., and Lucien, M. Glandes
Surrenales et Organes Chromatiines
(Review), 537

Pawlow, J. The Investigation of the
Higher Nervous Functions, 27

Pazzi, M. On the Structure of the Brain
and the Interpretation of Mental
Phenomena in Relation to the Law,
170

Pellacani, G. A Left Prefrontal Glioma
with Aphasia, 37

Pemet, G. Generalised Herpes Zoster,
515

Pemet, R. Feminine Tabes. A Com¬
parative Study of Tabes at BicStre and
the Salpetriere, 376

Petery, Arthur K. A Microcephalic
Idiot, with Malformation of Brain,
412

Petit, L. On the Differential Diagnosis
of Syphilitic and Tuberculous Menin¬
gitis in the Adult, 116

Petzetakis. The Oculo Cardiac Reflex
in Normal Subjects, without Brady¬
cardia, 255; Circulating and Re¬
spiratory Phenomena produced by
Ocular Compression, 255

Petzetakis and Fabre. Persistence of
Oculo-Cardiac Reflex in General Antes-
thesia, 258

Petzetakis, M., Lesieur, C., and Vernet,
M. Changes in the Reflexes produced

by Ocular Compression in Epilepsy,
256; Stoppage of the Heart by theOculo-
Cardiac Keflex in an Epileptic, 257;
Exaggeration of the Oculo-Cardiac
Reflex in Epilepsy: Its Variations
under the Influence of Medicinal and
Toxic Causes, 207 ; The Oculo-Cardiac
Reflex in Patients Suffering from
Various Tremors, 259; The Oculo-
Cardiac Reflex and Paralysis Agitans,
259 ; On the Frequent Abolition of the
Oculo-Cardiac Reflex in Tabes, 260;
Glycosuria, Albuminuria, and Polyuria
caused by Ocular Compression, 261 ;
The Oculo-Cardiac Reflex, 374
Philibert. A Case of Typhoid Spine,
160

Philip, P., and Mauriac, P. Meningeal
States in Scarlet Fever and Scarlatinal
Uraemia, 414

Phillips, J. Persistent Hereditary (Edema
of the Legs (Milroy’s Disease), with
Acute Exacerbations. Report of two
Cases, 490

Pierret, Verhwghe, and Duhot, Peri¬
pheral Neuritis from Ischemia, 84

Pilsbury, L. B. Paresis Patients Treated
with Intraspinal Injections of Salvar-
sanised Serum, 502

Pim, Arthur A. Epidemic Poliomyelitis,
491

PitulescoandLaignel-Lavastine. Familial
Adiposity witn Endocrinal Disturb¬
ances, 124

Pizzata, C. Thrombosis of the Cerebral
8inuses after Measles, 78

Plummer, W. A., and New, G. B.
Tumour of the Middle Cranial Fossa,
Involving the Gasserian Ganglion,
217

Poirault, H., and Ramond, F. Zoster
with Facial Paralysis: Trophic and
Sensory Troubles of the Lingual
Mucosa, 312

Porter, W. T , and Newburgh, L. H.
and I. The State of the Vasomotor
Apparatus in Pneumonia, 483
Prel, r. A. Syphilitic Facial Paralysis,
81

Price, George E., and Heed, Charles R.
Bi nasal Hemianopsia occurring in the
Course of Tabetic Optic Atrophy,
212

Priestly, J. Nervous Diseases of
Elementary School Children — Boys
and Girls, 210

Prince, Morton. The Psychopathology
of a Case of Phobia—A Clinical 8tuny,
308

Pussep. Operative Removal of a Pineal
Cyst, 382

INDICES

141*

Putnam, James J. Some of the Broader
Issues of the Psycho-Analytic Move¬
ment, 228

Pychlau. A Case of Graves’ Disease
Successfully Treated with the Milk
of a Thyroideotomised Woman, 46

Quinquaud, A., and Gley, E. Contribu¬
tion to the Study of Humoral Inter¬
relations—I. The Action of Thyroid
Extract and of Organic Extract in
General on Adrenal Secretion, 65

Rablnowitz, M. A. Two Neurological
Cases in Paediatric Practice, 461

Radovici and Marinesco. The Syndrome
of Xanthachromia and Coagulation
en masse of the Cerebro-spinal Fluid,
221

Raff, K. Measurement of the Blood-
Pressure in Alcoholism and Functional
Neuroses, Excluding Circulatory Dis¬
turbances, 166

Raimiste and Neiding. Changes in the
Spinal Cord in Tumours of the Posterior
Cranial Fossa, 35

Rameix, Morichau-Beauchant, R., and
Frey. Acute Ataxia in Convalescence
from Measles, 413

Ramond, F., and Poirault, H. Zoster
with Facial Paralysis: Trophic and
Sensory Troubles of the Lingual
Mucosa, 312

Rand, Carl W. A Case of Supposed
Progeria (Premature Senility) in a
Girl of Eight Years. With Remarks,
389

Rank, Otto. The Myth of the Birth of
the Hero (Review), 464

Ranson, S. Walter. The Tract of
Lissauer and the Substantia Gelatinosa
Rolandi, 198; The Structure of the
Vagus Nerve of Man as Demonstrated
by a Differential Axon Stain, 302; The
Pyridine-Silver Method : With a Note
on the Afferent Spinal Non-Medullated
Nerve Fibres, 467 ; A Note on the
Degeneration of the Fasciculus
Cerebro-spinalis in the Albino Rat,
511

Ranson, S. W. f and Chase, M. R.
Structure of the Roots, Trunk, and
Branches of the Vagus Nerve, 109

Rasoh, C. Syphilitic Basal Meningitis
Five Months after Infection, 159

Ravaut, P. Errors in the Interpreta¬
tion of Wassermann’s Reaction, 497

Ravenna. Aohondroplasia and Chondro-
hypoplasia, 41

Raynaud, M., Coudray, Derrien, and
Abdin-Delthiel. Meningeal Syndrome
in North African Recurrent Fever,
378

Rayner, H. The Wet Pack in the
Treatment of Insomnia and Mental
Disorders, 530

Rebattu, J., and Martin, J. A Case of
Recklinghausen’s Disease, 159

Reeve, E. F., and Watson, George A.
Observations on Cases of Encephalitis,
531

Regis and Hesnard. The Teaching of
Freud and his School, 84

Reich, A. True Larvngeal Sac Formation
in Man, and its Operative Treatment,
422

Reich mann and Goldstein. Somatic
Disturbances in Dementia Praecox,
392

lllOy KJA* JL

r, H. van. The High Frequency
in the Treatment of High

A Case of Brain

Reischig, Leopold. A Case of Meningitis
Purulenta Aseptica after Intranasal
Interference, 31

Remsen, Charles M. Operative Inter¬
vention in Cyst of the Left Cerebral
Hemisphere, with a Consideration of
the Preoperative and Subsequent
Symptoms, 521
Rensselaer,

Current

Blood Pressure, 49
Reynolds, Cecil E.

Abscess, 216

Rezza, A. Effect of the Administration
of Alcohol on Wassermann’s Reaction,
43; The Alterations of the Cells of
the Bulb found in Case of Dementia
Praecox, 48

Rhein, J. H. W. Cerebral Palsies
without Demonstrable Anatomical
Findings, 122; Aneurisms of the
Vessels of the Brain, 382; Tumour of
the Crus Cerebri, 520
Ricksher, Charles. Similar and Dis¬
similar Psychosis in Relatives, 429
Riggs, C. E. Report of a Case of
Juvenile Tabes, 119

Riggs, C. Eugene, and Hammes, Ernest
H. Results of One Hundred Injections
of Salvarsanised Serum, 503
Riquier, Carlo. On the Microscopic
Structure of the Otic Ganglion, 22
Riser, M. On a Case of Fulminating
Parameningococcus
Meningitis, 313
Robertson, George M.

Cerebro-spinal Fluid
Signs of General Paralysis, 169
Robertson, Madge E., and Findlay,
Leonard. Some Manifestations of
Congenital Syphilis, 527

Cerebro - spinal

The Serum and
Reactions and

142*

INDICES

Robertson, W. Ford. Vaccine Treat¬
ment in Asylums, 171

Robertson, W. N., and Ahern, E. D.
Cyst of the Pituitary Gland, 522

Robin, A., and Lyon-Caen, L. Cerebral
Rheumatism Explained by Haemor¬
rhagic Meningitis occurring in the
Course of Acute Articular Rheuma¬
tism, 262

Robinson, G. Wilse. The Use of
Celluloid Splints in the Treatment
of Diseases of the Nervous System,
453

Rolleston, J. D. Local Treatment of
Vincent’s Angina with Salvarsan, 81 ;
The Medical Aspects of the Greek
Anthology, 325

Rolleston, J. D., and Macleod, C.
Intramuscular Injections of Antitoxin
in the Treatment of Diphtheria, 379

Rolleston, H. D., and Boyd, E. J.
Addisons Disease in a Bov, with
Calcification of the Adrenals, with
Remarks, 167

Romaic and Laignel-Lavastine. Herpetic
Facial Paralysis in a Patient with
Symmetrical Lipomatosis, 312

Romer and Viereck. On the Treatment
and Nature of Diphtheritic Paralysis,
72

Rosanoff, A. J. A Study of Brain
Atrophy in Relation to Insanity, 430

Rosenbloom, Jacob,and Diller.Theodore.
Metabolism Studies in a Case of Myas¬
thenia Gravis, 457

Rosenbloom, J., and De Witt Stetten.
Clinical and Metabolic Studies of a
Case of Hypopituitarism due to Cyst
of the Hypophysis, with Infantilism of
the Lorain Type, 80

Rosenbaum, George. Roentgen Diagnosis
inFraoturesof the Cranium in Children,
417

Rosenheim, Otto. The Galactosides of
the Brain, 69

Ross, D. MaxweU. Notes on a Case of
Pellagra, 244

Ross, Ellison L. Metabolism in Dementia
Prsecox, 327

Roth, W., and Herxheimer, G. On
Recklinghausen’s Neurofibromatosis,
377

Rother, C. On Post-Diphtheritic Ab-
duoens Paralysis, 33

Rothig, Paul. On a Counterstain for
Weigert-Pal Preparations, 373

Rothmann. Combined Column-Diseases
of the Spinal Cord, 71; The Significance
for Differential Diagnosis of Bdrdny’s
Pointing-Test, 209; Restitution Phe¬
nomena in Cerebral Palsies in Relation

to Phylogenesis and their Therapeutic
Influence, 268

Rotstadt. The Surgical Treatment of
Cord Tumours, 35

Roubinovitch and BarbA Partial
Agenesis of the Corpus Callosum, 209

Roubinovitch, J., and Soudtere, Reginald
de la. The Oculo-Cardiac Reflex in
Hemiplegia and Cerebral Diplegia,
312

Roufliac, P., and Joltrain, E. Meningeal
Syndrome of the Poliomyelitis Type,

Roussy, G., and Camus, J. Hypophy-
sectomy and Genital Atrophy: An
Experimental Contribution to the
Study of the Adiposo-Genital Syn¬
drome, 64 ; Hypophysectomy and Ex¬
perimental Glycosuria, 110; Polyuria
from Experimental Lesion of the Opto-
peduncular Region of the Base of the
Brain : The Regulating Mechanism of
the Water Content of the Organism,
204; The Anatomical Localisation in
the Base of the Brain of the Lesions
which Provoke Polyuria in Dogs, 305 ;
Medullary Cavities and Cervical Menin¬
gitis, 411

Roux, G. C. Meningitis in Mumps,
214

Roux, J. C., and Andr6-Thomas. The
Hypotensive Cceliac Reflex, 305

Rows, R. G. The Importance of Disturb¬
ances of the Personality in Mental
Disorders, 279

Rows, R. G., and Orr, D. Further
Observations on the Influence of Toxins
on the Central Nervous System, 252

Saint-Marc, Mkaux. Wassermann
Positive after Forty-six Years of
Syphilis—Syphilitic Varicose Ulcers,
164

Sainton. The Oculo-Cardiac Reflex, 374
Salmon. The Problem of Sleep, 267
Salmon, P. Vital Staining of Nerve
Centres by Malachite Green, 112
Santee, Harris E. The Brain of a Black
Monkey (Macacos maurus ): The
Relative Prominence of Different Gyri,
370

Sarr&zin, F. E. Serotherapy with
Massive Doses in Tetanus, 420
Sarteschi, U. Experimental Production
in Mammals of the Pineal Precocious
Macro-Geni to Somatic Syndrome, 23 ;
On the Changes in the Central Nervous
System in Experimental Diphtheritic
Intoxication and Human Diphtheritic
Infection, 372

INDICES

143*

Saunders, P. W. Sensory Changes in
Friedreich’s Disease, 122
Sawyer, James E. H. A Case of Pro¬
gressive Lenticular Degeneration, 124
Sc&rpini, Vincenzo. Sudden Death from
Bulbar Haemorrhage in a Case of
Dementia Prsecox, 170
Schilder and Gregor. The Theory of
Myotonia, 71

Schlesinger and Schuller. On the Com¬
bination of Cranial Hyperostoses and
Cerebral Tumours, 218
Schmidt, C. J. M. A Case of Pro¬

gressive Thrombophlebitis of the Brain
Sinuses following Acute Otitis Media,
315

Schmoucher, Mile. G. Atrophy of the
Pelvis in Infantile Paralysis, and its
Obstetrical Consequences, 459
Schoonheid, P. H. Multiple Neuro¬

fibromatosis of the Skin, 490
Schuller and Schlesinger. On the Com¬
bination of Cranial Hyperostoses and
Cerebral Tumours, 218
Schunda and Parhon. A Fresh Contri¬
bution to the Study of Achondroplasia,
41

Schuster, P. High Incidence of Post-
Diphtheritic Paralysis: A Contribu¬
tion to the Question of the Neuro¬
tropism of Certain Infective Agents,
492

Schweizer, F. Myatonia Congenita, 515
Scuderi, A. On a Case of Muscular
Atrophy from Lead Poisoning, 220
Seringes. Retrogressive Infantilism, 80
Sezary, A. Pineal Tumours, 320;

Syphilis and the Adrenals, 386
Sharp, E. A., and Clark, L. Pierce. The
R&le which Heredity Plays in Inducing
Epilepsy in Children Suffering from
Infantile Cerebral Palsy, 120
Shaw, A. F. Bernard. Pseudo-Hyper¬
trophic Muscular Dystrophy: Two
Cases with Plates, 413
Shaw, Henry B. The Relation between
Epilepsy and Tuberculosis, 460
Shaw, J. J. M. Epilepsy : A Theory of
Causation Founded upon the Clinical
Manifestations and the Therapeutic
and Pathological Data, 460
Sheldon, Ralph Edward. Paraffin-
Weigert Methods for the Staining of
Nervous Tissue, with some New
Modifications, 450

Sicard, J. A. Acquired Hydrocephalus
due to the Meningitis of Mumps, 518
Sicard, Joltrain E., and Milian. Death
following Two Injections of Neo-
salvarsan at the Onset of Syphilis,
125

Siemerling, E. Meningitis after Folli¬
cular Tonsilitis, 31

Simchowicz. Alzheimer’s Disease and
its Relation to Senile Dementia, 327
Singer, C. St Hildegard, 166
Singer, Douglas H. Dementia Priecox
in the Eighth Edition of Kraepelin’s
Text-Book, 427

Smith, C. Morton. Have the Early
Claims of Salvarsan been Realised?
126

Smith, G. M‘Call. A Case of Exoph¬
thalmic Goitre Simulating Acute
Obstruction, 495

Smith, P. E. Some Features in the
Development of the Central Nervous
System of D^^mogimthus fusca , 482
Smith, R. R. The Behaviour of the
Abdominal Cutaneous Reflexes in
Acute Conditions within the Abdomen
and Pelvis, 514

Snowden, R. R., and Boggs, Thomas R.
The Intr&meningeal Treatment of
Tabes and Cerebro-spinal Syphilis,
315

Soderbergh. The Wassermann Reaction
in the Blood in Cases of Alkaptonuria,
223

Solomon, Meyer. The Analysis and
Interpretation of Dreams Based on
Various Motives, 67 ; On the Analysis
and Interpretation of Dreams based on
Various Motives, and on the Theory
of Psycho-Analysis, 410
Somen, H. Physiological Mechanism of
the Knock-out, 69

Somerville, \V. F. The Treatment of
Neuritis by Electrical Methods, 328
Soper, Willard B., and Grand, Selma.
The Urea Content of the Spinal Fluid,
with Special Reference to its Diagnostic
and Prognostic Significance: A Series
of Ninety-seven Cases, 82
Soudi&re, Reginald de la, and Roubino-
vitch, J. The Oculo-Cardiac Reflex in
Hemiplegia and Cerebral Diplegia, 312
Souques, A. Chronic Palsy of Limbs due
to Prolonged Use of Colchicine, 324
Souques and Chauvet. Hypophyseal
Infantilism, 39

Spiller, William G. The Relation of the
Myopathies, 113; Bilateral Oculo-
motorius Palsy from Softening in each
Oculomotorius Nucleus, 154; Acute
Myelitis, Secondary to Perirectal
Abscess, Developing a Few Hours after
Severe Fright, 516

Spooner, Lesley H. The Treatment of
Syphilitic Diseases of the Central
Nervous System by Intravenous Injec¬
tions of Salvarsan, 224

144*

INDICES

Spr&wson, C. A. A Family with Cere¬
bellar Ataxia, 160

Stainthorpe, W. W. Observations on
One Hundred and Twenty Cases of
Lead Absorption from Drinking Water,
385

Steiner. The Production and Histo-
pathology of Experimental Syphilis of
the Central Nervous System in Rabbits,
387

Stern. The Pathogenesis of Myasthenia,
384

Stewart, Purves. A Case of Hysterical
Monoplegia following Electric Shock,
44; Further Note upon a Case of
Hysterical Monoplegia following
Electric Shock, 161

Stewart, R. M. The Action of Adrenalin
and Epinine on the Pupil in Epilepsy,

287

Stoddart, W. H. B. Mind and its Dis¬
orders (Review), 505

Strathy, George S., M 4 Vicar, C. S., and
Bates, Gordon. The Treatment of
Tabes Dorsalis and General Paresis
with Salvarsan, 226

Strauch, August. Infantilism, 456

Striimpell and Handmann. A Contribu¬
tion to the Study of So-called Pseudo¬
sclerosis, with Changes in the Cornea
and in the Liver, 270

Simpson, Sutherland. The Pyramid
Tract in the Red Squirrel (Scmrus
Hudxonianus , Loquax) and Chipmunk
(Tania* striatus , Lysteri), 370

Stum, F. P. A New Theory of Hearing,
483

Sutton, R. L. A Clinical Note on
Fibroma Molluscum Gravidarum, 213

Swift, Walter B. Studies in Neurological
Technique, 507; A Voice Sign in Chorea,
519; Further Analysis of the Voice
Sign in Chorea, 519

Talmey, B. S. Transvestism, 132

Taylor, A. L. A Case of Tumour of the
Pituitary Body, 39

Taylor, A. S. Conclusions Derived from
Farther Experience in Surgical Treat¬
ment of Brachial Birth Palsy (Erb’s
Type), 78

Taylor, James, and Holmes, Gordon M.
Two Families with Several Members
in Each Suffering from Optic Atrophy,
42; Nervous Symptoms Associated
with Optic Atrophy of the Familial
Type, 42

Taylor, James. Vascular and other
Retinal Changes Associated with
General Disease, 43

Terman, Lewis M. Recent Literature
on Juvenile Suicides, 309

Teixeira-Mendez. The Forearm Sign,
451

Teyssien, De. Suprarenal Apoplexy in
General Paralysis: Sudden Death,
85

Thiele, Francis H., and Embleton, Dennis.
Methods of Increasing the Accuracy
and Delicacy of the Wassermann
Reaction, 128

Thomas, Andr6, and Durupt. Experi¬
mental Researches on Cerebellar
Function, 60

Thomas, B. A., and Ivy, Robert H.
Observations on the Wassermann
Reaction, 459

Thome, Frederick H. Some of the
Histological Changes found in Tabes,
486

Tilney, F. An Analysis of the Juxta-
Neural Epithelial Portion of the
Hypophysis Cerebri, with an Embryo-
logical and Histological Acoount of a
Hitherto Undescribed Part of the
Organ, 200

Timme, Walter. The Nature of Cutan¬
eous Sensation, with an Instrument
for its Measurement, 374

Tobias and Mendel. Graves’ Disease in
the Male Sex, 45

Todd, T. Wingate, and Kramer, J. G.
The Distribution of Nerves to the
Arteries of the Arm, with a Discus¬
sion of the Clinical Value of Results,
370

Tredgold, A. F. Mental Deficiency—
Amentia (Review), 330

Tribe, Enid M. Vaso-Motor Nerves in
the Lungs, 205

Trieben8tein, Otto, and Fischer, Johan¬
nes. Researches on Tetany and Senile
Cataract, 320

Tuckey, C. Lloyd. Hypnotism and Sug¬
gestion, 534

Tuffier. Adrenal Virilism, 321

Turner, John. The Biological Concep¬
tion of Insanity, 462

Turner, William Aldren. The Outlook
in Epilepsy, 498; Epilepsy and
Cerebral Tumour, 520

Tutyschkin. A Rare Case of Spina
Bifida, with Subsequent Development
of Symptoms Referable to Involve¬
ment of the Cauda Equina, Conus
Medullaris, and Epiconus, 375

Udaonda, C. B., and Casteigts, M. M.
Post-Typhoid Polyneuritis of Quadri¬
plegic Form, 516

INDICES

145*

Urechia, Parhon, and Obreria. Re¬
searches on the Genital Glands in
Dementia Prseoox, 86

Vahram, Loeper, and Mongeot. Fre¬
quent Abolition of the Oculo-Cardiac
Reflex in Syphilis, 259
Valdizan, H., and Ciampi, L. Physical
Development in the Mentally Defective,
423

Vallery-Radot, P. A Case of Para¬
meningococcus Cerebro-spinal Menin¬
gitis. Serotherapy. Recovery, 414
Valtorta, D. The Elimination of
Nitrogen and Uric Acid in States of
Excitement and Stupor, 529
Vaucher, Lereboullet, and Faure-
Beaulieu. Diabetes Insipidus and
Infantilism, 218

Verde, E. Late Syphilitic Facial
Paralysis associated with Chronic
Pulmonary Syphilis, 273
Verhaeghe, Duhot, and Pierret. Peri¬
pheral Neuritis from Ischaemia, 84
Verhoeff, F. H. Chronic Ocular
Tuberculosis. Necropsy Findings in
a Case in which Death was Due to
Tuberculosis of the Hypophysis Cerebri,
390

Vernes, A. The Prognostic and Diag¬
nostic Value of the Sign of Isolated
Hyperalbuminoeis in the Cerebro¬
spinal Fluid, 271

Vernes, A., and Bloch, M. A Retro¬
spective Sign of Syphilis. Pure
Hyperalbuminosis of the Cerebro¬
spinal Fluid without Leucocytosis and
without Wassermann, 271
Vernet, M., Petzetakis, and Lesieur, C.
Changes in the Reflexes Produced
by Ocular Compression in Epilepsy,
256; Stoppage of the Heart by the
Oculo - Camiac Reflex in an Epi¬
leptic, 257; Exaggeration of the
Oculo - Cardiac Reflex in Epilepsy :
Its Variations under the Influence
of Medicinal and Toxic Causes, 257 ;
The Oculo-Cardiac Reflex in Patients
Suffering from Various Tremors
259 ; The Oculo - Cardiac Reflex
and Paralysis Agitans, 259; On the
Frequent Abolition of the Oculo-
Caroiac Reflex in Tabes, 260;
Glycosuria, Albuminuria, and Poly¬
uria caused by Ocular Compres¬
sion, 261 ; The Oculo-Cardiac Reflex,
374

Viegas, L. On Recklinghausen’s Disease,
314

Viereck and Romer. On the Treatment

and Nature of Diphtheritic Paralysis,
72

Vitdn, A. Typhoid Spine aud Thyroid
Opotherapy, 415

Waldron, Ethel, and Gettings, H. S.
The Detection of a Dysentery Carrier,
532

Wallace, William. The Musical Faculty:
Its Origins and Processes (Review), 504

Walshe, S. J A. H. Case with Com¬
ments. Effect on the Mental State
of Minor and Major Attacks in
Epileptic Insanity, 167

Warrington, W. B. Acute Generalised
Infective Paralysis in Adults, 114;
Intraoranial Serous Effusions of In¬
flammatory Origin. Meningitis or
Ependymitis Serosa — Meningism.
With a Note on “ Pseudo-Tumours”
of the Brain, 114

Watson, George A., and Reeve, E. F.
Observations on Cases of Encephalitis,
531

Watson, George A., and Wiggles worth,
J. The Brain of a Macrocephalic
Epileptic, 129

Weber, F. Parkes. A Familial Case of
Splenomegalic Anaemia with In¬
fantilism, 419

Weed, Lewis H. Observations upon
Decerebrate Rigidity, 205 ; Studies on
the Cerebro-spinal Fluid. —II. The
Theories of Drainage of Cerebro-spinal
Fluid, with an Analysis of the Methods
of Investigation ; III. The Pathways
of Escape from the Subarachnoid
Spaces, *ith Particular Reference to
the Arachnoid Villi; IV. The Dual
Source of Cerebro-spinal Fluid, 511,
512

Wegefarth, Paul. Studies on Cerebro¬
spinal Fluid.—V. The Drainage of
Intra-ocular Fluids; VI. The Establish¬
ment of Drainage of Intra-ocular and
Intra cranial Fluids into the Venous
System ; VII. The Analogous Pro¬
cesses of the Cerebral and Ocular
Fluids, 512, 513

Weil and Loeper. Favourable Action of
Ocular Compression on Certain Nervous
Manifestations, especially Hiccough,
260

Weisenburg, Theodore H., and Mills,
Charles K. Cerebellar Symptoms and
Cerebellar Localisation, 524
1 Westmacott, F. H. Oculomotor Paralysis
of Otitic Origin, 499

Wheelon, Homer, and Hoskins, R. G.
Adrenal Deficiency and the Sympa-

146*

INDICES

thetic Nervous System, 206; Para¬
thyroid Deficiency and Sympathetic
Irritability, 307 ; Ovarian Extirpation
and Vasomotor Irritability, 484

Wiggers, Carl J. Further Observations
on the Constricting Action of Adrena¬
line on Cerebral Vessels, 207

Wigglesworth, J., and Watson, George
A. The Brain of a Macroeephauc
Epileptic, 129

Wile, Udo J. The Technic of the
Intradural Injections of Neosalvarsan
in Syphilis of the Nervous System,
223

Wilkinson, Douglas, and Batten, Frede¬
rick E. Unusual Type of Hereditary
Disease of the Nervous System, 455

Wilkinson, George. A Case of Paralysis
of the External Rectal Muscle due
to the Presence of an Abscess in the
Apex of the Petrous Pyramid—Death
from Basal Meningitis, 500

Willcocks, R. W. The Occurrence of
Pellagra in Englaud, 495

Williams, E. M. Lead Poisoning with
Paralysis of the External Ocular
Muscles, 420

Williams, Guy H. An Intoxication
Psychosis associated with Cirrhosis of
the Liver, 430 ; The Psychosis occur¬
ring during the Course of Pernicious
Anaemia, 503

Williams, Tom A. Tabes with Unusual
Distribution of Deep-Pain Loss, 155;
A Contrast in Psycho-Analysis : Three
Cases, 411

WilmannB, Karl, and Nitsche, Paul. The
History of the Prison Psychosis
(Review), 133

Wilson, S. A. Kinnier. The Pathology
of Pellagra, 168

Wirgman, C. Wynn. Angeioma in
Ct -ebellar Peduncle: Fatal Intra-
cr. *•! Haemorrhage, 382

Wish G. B., and Crowe, S. J.
Exj lental Observations on the
Supi mal Glands, with Especial
Refer* .ce to their Inter-renal Portions,
484

Withington, C. F. Pneumonic Hemi¬
plegias, 216

Wohlwill and Nonne. A Clinical and
Pathological Case of Isolated Argyll
Robertson Pupils in the Absence of
General Paralysis, Tabes, and Cerebro¬
spinal Syphilis, 377

Wolf, Charles G. L., and Hale, T. 8.
Gaseous Exchange in the Decerebrate
Animal, 449

Wollstein, Martha. Parameningoooccus
and its Antiserum, 487

Wootton, J. C. The Wassermann Reac¬
tion, and the Male Insane, 528

Wulzen, Rosalind. The Morphology and
Histology of a Certain Structure con¬
nected with the Pars Intermedia of
the Pituitary Body of the Ox, 448

Yawxjer, N. S. The Mental Manifesta¬
tions of Epilepsy, 66
Yokovama, Yugo, and Fischer, Walther.
A Peculiar Form of Nodular Hyper¬
plasia of the Liver associated with
Brain Changes, 26

Zilocchi, Alberto. The Folds of the
Skin Hair in the Insane, 501
Zugravu, G., de Jassy, and Parhon, C.
The Weight of the Pancreas in the
Insane, 172

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