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REVIEW

NEUROLOGY AND PSYCHIATRY

Editor

ALEXANDER BRUCE

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

Assistant Editors

EDWIN BRAMWELL
M.B., F.R.C.P.E., F.R.S.E., M.RC.P.Lond.

CHAS. MACFIE CAMPBELL
M.B., Ch.B.

VOLUME IV.

EDINBURGH

OTTO SCHULZE & COMPANY
20 SOUTH FREDERICK STREET
1906

"RC32J

1 \ 1
V. ir

EDINBURGH
Print'd br

TURNBULL * SPEARS

Contents

ORIGINAL ARTICLES.

PAG*

Thb Influence of Facial Hemiatrophy on the Facial and other

Nerves. By Sir William Gowera, M.D., F.R.S. . 1

A Second Case of Partial Doubling of the Spinal Cord. By
Alexander Brace, M.D., F.R.C.P.E.; Stuart M‘Donald, M.B.,
F.R.C.P.E.; and J. H. Harvey Pine, B.Sc., M.B., Ch.B. . 6

Paramtocloncs Epxlepticub. By Ernest S. Reynolds, M.D. (Lond.),

F.R.C.P. ..19

Lesions of the Spinal Cord, the Result of Absorption from
Localised Septic Foci, with a Preliminary Note on an
Experimental Research. By David Orr, M.D., and R. G.

Rows, M.D. ....... 26

The Pathology of General Paralysis of the Insane. By W.

Ford Robertson, M.D. . 73, 169, 268

A Study of Some Cases of Delirium produced by Drugs. By

August Hoch, M.D. ...... 83

The Histological Appearances of the Cord and Medulla in a
Case of Acute Ascending Paralysis. By Charles Workman,

M.D., and Walter K. Hunter, M.D., D.Sc. . . . 106

Trypanosomiasis or Sleeping Sickness. By D. G. Marshall, Major,

I.M.S. (Retd.).112

A Case of Chronic Progressive Double Hemiplegia. By E.
Farquhar Buzzard, M.D., M.R.C.P., and Stanley Barnes, M.D.,
M.R.C.P.182

A Case of Muscular Dybtrophy affecting Hands and Feet :
Depression after Exhaustion, with Recovery. By C.

Macfie Campbell, M.B., Ch.B. . . . .192

On Tetanoid Chorea and its Association with Cirrhosis of the

Liver. By Sir W. R. Gowers, M.D., F.R.8. 249

A Case of Cysticercus Cellulose occurring in the Insane.

By H. Egerton Brown, M.D. ..... 272

Lesions of the Left First Temporal Convolution in Relation

to Sensory Aphasia. By William G. Spiller, M.D. . 329

980727

CONTENTS

PAGE

Two Casks of Embryoma in the Frontal Lobb or the Brain.

By B. G. Bows, M.D. ...... 338

The Recognition of Segmental Levels in the Cervical and
Lumbar Enlargements or the Spinal Cord from the
Appearance of the Transverse Section. By Edwin Bram-
well, M.B., F.R.C.P.E., M.R.C.P. LoncL .... 344

The Pathology of a Case of Myelitis Acutisbima ELemorr-
hagica Disseminata. By W. B. Warrington, M.D., F.R.C.P.,
and John Owen, M.B. ...... 401

A Case of ELemorrhage into the Brain and Spinal Cord from
Obliterative Arterial Disease. By W. B. Warrington,

M.D., F.B.C.P., and John Owen, M.B. . . . . 407

The Pars Intermedia or Nervus Intermedius of Wrisberg,
and the Bulbo-Pontine Gustatory Nucleus in Man. By
Dr J. Nageotte ....... 473

The Descending Degenerations of the Posterior 'Columns in
(1) Transverse Myelitis, and (2) after Compression of
the Dorsal Posterior Boots by Tumours. By David Orr,

M.D. ........ 488

The Pathology of General Paralysis. By Dr Hans Evensen 537, 616

On the Frequency with which Certain Signs and Symptoms
occur in Cases of Disseminated Sclerosis before the
Development of so-called Cardinal Signs. By Ashley
W. Mackintosh, M.A, M.D. ..... 601

Precocious Paralysis of the Palate in Diphtheria. By J. D.

Bolleston, M.A., M.D. (Oion.) ..... 608

Types of the Devolutional Psychoses. By Clarence Farrar, M.D. 665

A Case of Partial Doubling of the Spinal Cord. By Purves
Stewart, M.A, M.D. Edin., F.B.C.P.; and Julius Bernstein,

M.B. Lond., M.R.C.S. ...... 729

A Note upon Two Important Points in the Localisation of
Tumours of the Frontal Begion of the Brain. By T.
Grainger Stewart, M.B. Ed., M.B.C.P. Lond. . . . 809

Note on a Case of Juvenile General Paralysis ; Absence of
Stigmata of Congenital Syphilis and of a Family
History Indicative of that Disease ; Very Pronounced
Cerebbo-spinal Lymphocytosis. By Edwin Bramwell, M.B.,
F.R.C.P.E., F.R.S.E., M.R.C.P. Lond.

813

IReview

IReurolog^ anb flbs^cbtatn?

©riginal articles

THE INFLUENCE OF FACIAL HEMIATROPHY ON THE
FACIAL AND OTHER NERVES

By Sir W. R. GOWERS, M.D., F.R.S.

Ik facial hemiatrophy the temporal bone may share the
diminution in size of the bones of the face, and this is shown
by the smaller mastoid process, and also by the smaller
external auditory meatus. The latter fact is of significance,
because we cannot doubt that other bony canals also become
narrowed, and among them the Fallopian canal through which
the facial nerve passes. We can therefore understand that
this nerve may suffer in facial hemiatrophy, as in the three
cases here described. Contraction of the canal may act
directly or indirectly. Manifestly a much slighter degree of
inflammatory swelling of the sheath of the nerve would
impair its function than would be necessary in a canal of
normal size. The diminution in size may also alter the
blood-supply in the sheath and thus dispose to vascular
disturbance. It may conceivably also cause some direct
mechanical pressure or irritation.

Facial hemiatrophy is so rare, that it is impossible that its
connection with the affection of the facial nerve in the following
cases can be an accidental one.

Case I. The first case is that of a young man, 25 years of
age, in whom left-sided facial paralysis came on six years before I

R. OF N. & P. VOI. IV. NO. 1.—A

a ORIGINAL ARTICLES

saw him. It was thought to be due to exposure to cold, but uo
clear history of the onset could be obtained. There was
considerable paralysis of all parts of the face, and he still
could not quite close the eyelids, but late contraction had
restored the symmetry of the face when at rest. There were
slight flickering contractions in the orbicularis palpebrarum.
The electrical excitability of the nerve and muscle had become
that which is common in old cases; in both it was much reduced
to each current, but nowhere was it extinct.

There was distinct atrophy of the bones of the left side of
the face, the frontal, superior maxillary, and malar bones. The
mastoid process was also markedly smaller than the right, and
the auditory meatus was so much less that it would hardly
admit the smallest speculum, while into the right a full-sized
one could be readily introduced.

The facial hemiatrophy had not been recognised before.
The condition of the facial muscles was that which would be
found from a severe neuritis after the time which had elapsed.
But if so, the condition of the canal must be regarded as having
an influence, especially in view of the remarkable features of
other cases.

Case II. A single woman, aged 37, suffered from spams
in the right side of the face, which had commenced three years
before. At first it was slight and seldom, but had gradually
become greater and practically constant. There was distinctly
less movement on the right side. The naso-labial furrow was
much less on the right side, and there was less power in the
zygomatic muscles. Between the movements in the upper part
of the face on the two sides no difference could be seen.
There were frequent short attacks of clonic spasm in the
right orbicularis, occasionally spreading to the cheek. Move¬
ment did not excite them, except contraction of the frontalis,
which always brought on the spasm in the orbicularis. Sensation
in the face, and power in the masseter, were normal. The bones
of the right face were distinctly smaller than in the left. The
difference was least in the lower jaw, but even here was distinct
It was marked in the superior maxillary and malar bones, and
also in the mastoid process. Moreover, the external auditory
meatus was distinctly smaller than that on the left side.

ORIGINAL ARTICLES

Hearing was quite good, but slight tinnitus was present.
Nine months later her condition was almost the same. There
was the same frequent spasm in the orbicularis, but that in the
cheek seemed to be chiefly in the elevator of the upper lip,
occasionally spreading to the zygomatic muscles. The tinnitus
persisted, and was described as a humming, which seemed to be
felt as well as heard.

In this patient, also, the symptoms of slight interference
with the facial nerve were associated with the diminution in
size of the bones. In each case, advice was sought for the
symptoms in the face; in neither had the alteration in the
bones been previously observed. Whatever may be the rela¬
tion between the two, the cases show the great importance of a
careful observation of the bones in all cases of facial paralysis
and spasm.

Case III. The last case is still more remarkable, because other
nerves suffered as well as the facial.

A solicitor, aged 42, came to me in 1903 on account of
left-sided facial paralysis which had come on two years before.
The precise onset could not be ascertained, but the loss of power
was probably not complete and not sudden. It was said to be
accompanied by some chronic twitching of the eyelids. When
seen, there was moderate loss of power in all parts of the face,
but nowhere complete paralysis. There was distinct late over¬
action, causing slight contraction of the zygomatic muscles, and
undue approximation of the eyelids in a smile. Indeed there was
a slight narrowing of the palpebral fissure at rest. He was sent to
me because he was thought to have ptosis as well as facial
paralysis, but the supposed ptosis was really due to the slight
contraction of the orbicularis, and also to the fact that the left
eye-ball and orbit were a little lower in position than the right.
This was due to distinct left hemiatrophy. All bones of the
face were definitely smaller on the left side than on the right,
including the lower jaw and the frontal bone. The condition
had not been recognised, and it was impossible to ascertain when
it had come on. But I had seen him on two occasions before;
first fifteen years, and the second time six years before, each time
on account of troublesome general headache, to which he had long
been liable. On each occasion I examined him carefully, lest

ORIGINAL ARTICLES

there should be any organic disease, and I cannot think I should
have passed unnoticed such a condition. Moreover, on the last
occasion (1897) he complained that he could not hear so well
with the left ear, but no loss of hearing was present, even to high
notes. In 1903, however, he had lost all hearing on the left side r
evidence of a progressive process. Sensation on the face was
normal; so were the masseter and the ocular movements; the
left side of the palate was weak, and the vocal cord was found
by Sir Felix Semon to be moved much less than the other. In
addition to the atrophy of the bones of the face, the left mastoid
process was smaller than the right and the external auditory
meatus considerably reduced in size.

I saw him again a year later (1904). In spite of treatment the
same condition continued. The face was not worse, the deafness
remained complete, sensation in the face was not impaired, but
the masseter seemed a little weaker than the right. The left
side of the palate had become completely paralysed, and so had
the left vocal cord. At times he had some difficulty of swallow¬
ing, lasting an hour or two. His pulse was persistently 116-120.
He frequently woke up at night with a sense of great dyspnoea.
Moreover, there was some wasting of the sterno-mastoid and
trapezius on the left side.

Once more I saw him, a few months later, but he was then
dying of pneumonia, which had come on most acutely, from slight
exposure during a trifling attack of influenza. The pneumonia
was in the left lung, but was beginning to affect the other, and
the heart was rapidly failing. He died a few hours after the
signs of pneumonia were distinct. There had been no marked
change in his symptoms.

The nerve palsies in this case clearly point to narrowing, not
only of the canal for the facial nerve, but also of the foramen
lacerum. Through this pass the spinal accessory nerve (which is
known to supply the palate as well as the vocal cord) and also
the pneumo-gastric and glosso-pharyngeal. Of these, the first
was clearly paralysed and the others were apparently impaired,
and may have promoted his death. I have seen similar
symptoms (including the paroxysmal dyspnoea and frequency of
the heart’s action) from a growth in the temporal bone. In this
patient a growth can certainly be excluded.

It may be thought that a shrinkage of the temporal bone

ORIGINAL ARTICLES

•would enlarge the foramen lacerum, and not narrow it, since it is
situated between the temporal and the occipital bones. But in
the disease we call “ facial hemiatrophy ” the reduction in size is
not of the bones; it is of the bone. It ignores the sutures, and
never opens them. If the shrinkage of the temporal bone,
conspicuous in the smaller size of the mastoid process, reached
the junction with the occipital bone, we should expect also the
adjacent part of this to have suffered, and thus the foramen
lacerum may have been lessened in size. Unfortunately I
omitted to observe the condition of the bone behind the mastoid
process. The foramen is somewhat crossed by bone, separating
the part occupied by the nerves from the rest. In this way their
compression may possibly have been facilitated. 1

It is probable that more than one morbid state is included
under the term “ facial hemiatrophy.” It is a misnomer applied
to such cases as these, especially to the last, in which the bones
seemed to have suffered through a large extent of one half of the
cranium. The condition was “ facial ” only because the general
asymmetry was most readily perceived in the face.

A remarkable fact is the probability that the state was a
real atrophy, and not an arrested development. Not only
was the condition unnoticed six years before, but during this
time slight deafness became complete, and the first symptom of
impairment of other nerves was noticed less than four years before
death.

It is to be regretted that the pathological condition could not
be ascertained, and that the symptoms could not be more
minutely observed and closely watched. But it is well known
how difficult it is to secure scientific facts from cases only seen
in private.

1 Prof. Thane has given me particulars of one instance in which a broad piece
of bone, from the occipital, passed between the jugular part of the foramen and
that for the nerves.

ORIGINAL ARTICLES

A SECOND CASE 07 PARTIAL DOUBLING 07 THE

SPINAL CORD.

By ALEXANDER BRUCE, M.D., F.R.C.P.E., Physician to the
Royal Infirmary, Edinburgh;

STUART M‘DONALD, M.B., F.R.C.P.E., Pathologist to the Royal Infirmary ;

and

J. H. HARVEY PIRIE, B.Sc., M.B., Ch.B., Clinical Tutor in the

Royal Infirmary.

The cord was obtained from a patient, M. A, who died in Juna
1904, at the age of fifty years, from exhaustion and asphyxia
caused by a malignant growth arising from a bronchus in the
right lung, and involving the superior mediastinum as well as
the lung itself. From October 1902 she had suffered from pain
and swelling in the right leg below the knee, and in September
1903 the leg was amputated just above the knee, as the swelling
was found to be malignant. At the post-mortem examination it
was found that there were also some areas of softening in the
cerebrum, but nothing abnormal was noted about the spinal cord,
spinal membranes, or vertebral column.

The woman had been a dressmaker by occupation, and there
was nothing in her previous history or in her family history to
indicate any abnormality of the spinal cord. The cord was being
examined with a view to the localisation of the motor nuclei of
the leg muscles when it was discovered that there was a partial
double formation extending over the upper four sacral segments.

The cord had been fixed in formalin, divided into segments,
embedded in celloidin, and cut into serial sections. For the
purposes of this examination every tenth section was further
hardened in Muller’s fluid and then stained by the Weigert-Pal
method.

The first change is seen in the lower half of L 5, where the
central canal becomes elongated in an antero-posterior direction.

ORIGINAL ARTICLES

extending backwards almost to the periphery in the line of the
posterior median septum. The posterior columns are also very
wide. In the upper third of S 1 this posterior elongation per¬
sists, but it now lies in a narrow wedge of grey matter. This
wedge gradually increases in width; the central canal divides
into two, one division being in the normal situation and some¬
what dilated, the other lying in the middle line near the pos¬
terior periphery. This latter soon ends blindly; the former
then becomes elongated transversely, and a little below the
middle of the segment divides into two canals lying in the same
frontal plane. The anterior median fissure becomes ^-shaped
and persists so till near the lower end of S 4, one central
canal lying opposite the extremity of each limb of the

At the level of the lower division of the central canal the
median posterior wedge of grey matter is distinctly recognisable
as posterior cornu through the presence of gelatinous substance.
Before the lower end of the segment is reached it is being split
into two cornua by the intervention of a median band of white
fibres.

In S 2, although in outward shape still apparently a single
cord, its double nature is more evident. The two outer anterior
and posterior cornua, representing the continuations downwards
of the normal grey matter at higher levels, are (except for the
group of cells on the right side in degenerative reaction) normal

The two inner posterior cornua are perfectly formed, although
nerve roots cannot with certainty be traced into them. On
their outer side there are indications of posterior columns
separated by posterior “ median ” septa from those of the
corresponding outer halves. Between them is white matter
(lateral columns ?) somewhat split up by fissures—attempts at
division of the double cord into • separate entities. There are
two rudimentary inner anterior cornua in contact in the upper
part of the segment, but almost separated below by white
matter which runs uninterruptedly from posterior periphery to
anterior median fissure.

In S 3 the fissures (containing pia mater) in the white
matter between the two inner posterior cornua reach as far
forwards as the inner anterior cornua, but never succeed in
entirely dividing the cord into two parts. The inner anterior

ORIGINAL ARTICLES

cornua are still very rudimentary, but, especially on the left side,
there are a few large, well-formed motor cells, with nerve roots
arising from them, and reaching the surface through the anterior
median fissure. No posterior nerve roots are seen entering the
inner posterior cornua.

In the upper half of S 4 the inner anterior cornua gradually
diminish in size and finally disappear. The white matter
between the inner posterior cornua shrinks till they come into
contact. The anterior median fissure is still ^-shaped; there
are two central canals and two posterior “ median ” septa, one on
each outer aspect of the inner posterior cornua.

In the lower half of the segment the central canals gradually
approach and ultimately join into a single, truly central one ; the
median wedge of grey matter (fused inner posterior cornua) be¬
comes cut off in front from the grey commissure by white matter
(normal posterior columns), and gradually diminishes in width
until it becomes a mere strand in the line of the single posterior
median septum. This finally disappears, and at the extreme
lower end of the segment we have an absolutely normal cord.

At first this duplication resembled very closely that of
Theodor’s case in the appearance and gradual growth of the
posterior median wedge of grey matter; as also in the presence
of two central canals and four anterior and four posterior horns,
while the two cords were still connected. In Theodor’s case,
however, the two cords became separated, while in ours they
always remained united, and before the lower end of the cord
was reached the conditions were again normal, the return
to the single condition being effected in a manner closely re¬
sembling that in which the transformation to a double condition
was carried out.

Steiner has collected thirty-five cases and reported an
additional one of his own. As these have been published
only in the form of a thesis and are not, therefore, generally
accessible, we place here a short synopsis of them.

ORIGINAL ARTICLES

SYNOPSIS OF STEINER’S CASES.

Naii

( 2 )

Mftnget (1095)

Hull

(3)

(4)

Ollirier

( 5 )

Sftndifort

u (6)

Grashuy
[cited by
Reckling-
hausen)

„ (7)

Natorp

( 8 )

Cruveilhier

(9)

Ammon

TaruA (cited
by Reckling-
hausen)

Agk

Part of Cord

Condition of
Vb&txb&s and
Mxmbranis

Condition of Cord

(Anenoe-

phalus

foetus)

—

11 Caput a postica
parte, carne seu
pelle erat detec¬
tum ”

“Qua etiam medulla spin¬
alis erat denuta, quee duplex
oonspiciebatur.”

(Anenoe-
phalus)
v months’
foetus

—

“Amplior multo quam in
aliis foetibus et bifida ad ossis
usque sacri limina conspicie-
batur."

—

Cord appeared in form of
two slender cords, each giving
rise to nerves.

(Anence-

phalus)

Cord consisted of two
small white threads, slightly
rounded posteriorly, flattened
anteriorly, close to each other,
very straight, about the size
of a crow’s quill.

—

Lumbar region

Meningocele

Cord split only by a
" sulcus non admodum pro¬
fundus.”

1st sacral

Sacral hydromenin-
gooele. Splitting
of vertebral arch
of the os sacrum

Cord split in 1st sacral
region, each half being dis¬
placed laterally.

7th oerrical to
6th dorsal

A splitting in the
spinal processes
from the 7th cer¬
vical and 1st dorsal
as far as the 5 th
dorsal

Cord split (but not doubled ).

12th dorsal, 1st
and 2nd lum¬
bar

Splitting through
vertebral processes
from D 12 to L 6,
and bodies from
D 12 to L 2

Cord divided into two
columns by a bony process
from the 12th dorsal ver¬
tebra; each half has a wide
central canal. Duplication
extends as high as 4th ven¬
tricle.

Foetus

Cervical and
upper dorsal

“Fissura spinalis
totalis ”

Cord broader than normal,
and divided into two parts,
each containing a fine canal
which can be followed into the
4th ventricle.

Spina bifida

Division of cord, caused by
the right arch of the lumbar
vertebra, which, instead of
joining with its fellow, reaches
into the middle of the spinal
canal (Merely a splitting of
cord.)

ORIGINAL ARTICLES

Synopsis of Steineb’s Cases— continued.

Name

Aok

(H)

Lenhoss^k

6 months*
foetus

(12)

Ollacher

Chick embryo
of 4 days

(13)

Foh

Man, 76

(14)

FUrstner and
Zaoher

(15)

Reckling¬

hausen

Woman, 31

(16)

Reckling¬

hausen

(Anence-

phalus)

foetus

(17)

Reckling¬

hausen

(18-21)

Reokling-

hausen

Foetuses

Beneke

Part op Cord

Condition op

VlRTSBRJB AND
MRM BRAKES

Condition op Cord

Lumbar enlarge¬
ment

No doubling of ver¬
tebra

Two lumbar enlaigemenW,
with two cords; left fully
developed, right representing
only right half of a cord.
No doubling above or below.
Three anterior and three
posterior roots.

Dorsal region

Medullary tube split into
several parts, normal above
and below.

Lumbar region

Vertebral canal
intact

Cord split for 2 cm. into a
right slender and a left
broad half. Central canal
broadened above splitting.
Doubled in region of split.
In both halves H-formed grey
matter.

As far down as
lowest dorsal

Vertebra and mem¬
branes normal

Lumbar region

No changes in verte¬
bra

Lumbar region

Bony process from
1st lumbar vertebra

“Area medullo-
^rasculosa ”

(Spina bifida) bony
prooess from lower
layer of skin,
through dura into
cord. (Not con¬
nected with verte¬
bra)

4 cases of spina
bifida

Inside same pial sac was a
seoond fullv developed cord,
which gradually compreaea
the first, and finally took its
place. In lowest lumbar, oord
again single.

Cord for 9 cm. divided into
two cylindrical columns, sur¬
rounded by pia, having two
anterior and two posterior
horns each. Inner halves less
perfect than outer. (Figures.)

Bony process from 1st
lumbar penetrating into oord,
and spotting it for 15 cm.
(Cord split, not doubled.)

Cord for 2*5 cm. split by
bony process into a right and
a left cylindrical column, S
mm. thick ; these join again
into a small conus. (Cord
split , not doubled .)

Signs of lateral division of
cord rudiments. (Cord split ,
not doubled.)

Cord split into two asym¬
metrical halves, by intrusion
of a fold of membrane.
(Probably a mere splitting qf
oord.)

ORIGINAL ARTICLES

Synopsis op Steiner’s Casks— continued.

Name

(28)

Bonome

Miura

(24)

. (26,2(5)

Fischer

Kronthal

( 28 )

Rosenberg

o ^ (29)

Steffen

Jakobto

(31)

Feilt

(32)

Braaon

Age

Part of Cord

Condition of
Vertebra and
Membranes

Condition of Cord

2 years

Lower lumbar

Split through dura.
(No spina bifida)

Cord split by layer of con¬
nective tissue. Small pieoe of
cartilage in septum of connec¬
tive tissue. Splitting com¬
mences at peripnery of GolTs
column, where 2nd pair of pos¬
terior horns appears. Gradu¬
ally two coraB form, their
anterior horns medially, their
posterior horns laterally.

53 (trauma)

Dorsal region.
Doublingfrom
2nd lumbar

Cystoid cavity com¬
municating with
central canal.

Cord doubled from 2nd
lumbar ; central canal di¬
vided ; 2nd inner pairs of well-
formed posterior horns; lower
down rudimentary pair of
anterior horns. Gradually two
central canals join, and inner
pair of posterior horns dis¬
appear (Figures).

(2 cases)

Lower cervical
and lumbar
regions

Displacement of ver¬
tebra ; (in one
case penetration
into central canal)

Splitting of cord into two
halves, which spread out mem-
brane-like in region of the
spina bifida.

In an ox

Cord and membranes
had been cut by a
butcher*8 axe

Partial doubling of C0f$L
Along with a transverse
section almost normal, there
was a section of another half
cord.

3 years

Middle dorsal

Spina bifida.

Splitting, with double
central canal. Lower down
cord diminishes into a mem¬
brane-like mass, and still
lower again increases in cir¬
cumference.

6 months

5th lumbar

Fissure in 5th
lumbar. Injury to
bone, divided
vertebral canal

Cord divided by injury.

Lumbar enlarge¬
ment

In lumbar enlargement, at
left side, a formation like a
sand-glass, connected with
medullary substance.

Dorsal and lum¬
bar regions

A secondary cord at ventral
surface, between dorsal and
lumbar regions. Had all the
form of a normal cord.
Further up the two pairs of
anterior horns again unite.

Upper dorsal

Vertebra normal

In grey matter a peculiar
bundle of white substance,
and an extrapial formation of
grey substance, which latter
is described as a rudimentary
partial doubling of the oord.

ORIGINAL ARTICLES

Synopsis op Steiner’s Cases— continued.

Name

Age

Part of Cord

(33)

Turnar

Rabbit

—

(34)

Chian

Lumbar

(36)

flulzer

Child of few

Lumbar region

weeks

Condition of

VrRTKBRA AND j CONDITION OF CORD

Membranes I

| Cord with two o&n&ls, an
accessory anterior horn, and
three anterior noire roots.

Myelo * meningocele.

Total splitting of cord.
Nervous elements well pre¬
served ; central canals absent
Below spina bifida two halves
joined, but cross sections
showed two anterior and four
posterior horns, with their
nerve roots. Central canal
I here doubled.

Myelo - meningocele.
Cartilage mass
penetrating
obliauely into
canal

Doubling, caused by carti¬
lage mass. Between posterior
columns a fissure could be
traced into 4th ventricle,
showing as an open canal in
upper sections of cord. Dia-
stem atomy el ia reached highest
point in 1 umbo-sacral part of
medulla. A complete doub¬
ling of the cord was found
here. (Figures.)

It will be seen from this table that cases 1, 2, 3, 4, and 7
may be put aside as being too imperfectly described to permit
of their real nature being determined.

It has been shown by Van Gieson in his valuable article on
“The Study of the Artefacts of the Nervous System,” in the
New York Medical Journal, 1892, that the cases of Fiirstner and
Zacher (14), Kronthal (27), Jakobsohn (30), and Feist (31) are
cases of artefacts, an opinion with which we agree. Fiirstner
and Zacher’s case showed cord-deformities of the heterotopic
order, with, in addition, a doubling of the cord. These deformi¬
ties, however, seem to have been due to an injury at the autopsy,
and one which was not only sufficient to produce minor dis¬
placement of cord substance, but violent enough, at one place,
to telescope one portion of the cord down over another so as to
double it over a limited space.

Kronthal describes a bruise in the cord of an ox as a con¬
genital malformation. The cord came from a butcher’s shop,
and was at one point, about 1 cm. long, more voluminous than
normal. He remarks that the rest of the cord was “badly

ORIGINAL ARTICLES

damaged by being sawn in two lengthwise,” but it does not
seem to have occurred to him that the “ anomaly ” which he
described was also produced by instruments. As in the previous
case, the figures illustrating the condition are, we think, quite
sufficient proof of the artificial nature of the injury.

Feist describes with thoroughness and detail the topographical
and structural changes in the cord due to bruising, but considers
them pre-formed and as anomalies in the course of the fibres
of the white matter with partial doubling of the cord. The
drawings give an excellent idea of how extraordinarily various
these artificial doublings are. There is an irregular, fragmentary
arrangement of grey and white matter, due to the fusing of
different portions of the cord from consecutive levels.

Jakobsohn’s case is a bruised cord from an acute myelitis,
in which distortions are described minutely and supposed to be
congenital malformations. When a cord has been so thoroughly
knocked to pieces as his illustrations represent, it is difficult to
understand how it can be considered as a malformation, and the
case presented as one of heterotopia.

These, therefore, may be also excluded from the list, along
with that of Steffen (29), which appears also to have been merely
a division produced by injury. Turner’s case (33) (in a rabbit)
is probably, according to Van Gieson, also an artefact, but it
is too shortly described to enable us to form a definite opinion.
In any case, both it and Ollacher’s (12) specimen of splitting of
the medullary tube in a chick embryo may be omitted from
consideration here.

Brasch’s case (32) is of a markedly degenerate syphilitic cord
and seems to us to be of the nature of an artefact or a hetero¬
topia, and not in any sense to be a real doubling of the cord.

When the cases above noted have been eliminated from
Steiner’s list there still remain 22 of his cases to be considered,
and of these 12 (Nos. 5, 6,10, 16, 17, 18, 19, 20, 21, 22, 25,
26) are examples of mere splitting (Zweitheilung—Diastema-
tomyelia) of the cord into two parts. All are associated with
greater or less degrees of spina bifida, and in none of these is
there any evidence of real duplication of the cord.

This leaves only 10 cases of doubling (Doppelbildung—true
Diplomyelia) of the spinal cord of man—Cruveilhier (8), v.
Ammon (9), v. Lenhoss&k (11), Fok (13), Recklinghausen (15),

ORIGINAL ARTICLES

Bonome (23), Miura (24), Rosenberg (28), Chiari (34), and
Sulzer (35), to which may be added Steiner’s own case, that of
Theodor, one reported by von Monakow, and the two cases of
the authors, making 15 in all.

Steiner’s case was in a child of 3^ months with a sacral
spina bifida and meningocele, but otherwise healthy, and with
its functions normal. The central canal was dilated above the
level of the division and surrounded by a thickened capsule,
much as in our first case. The cord was divided from about the
middle of S 1 downwards. In S 2 each cord showed a complete
H-form of grey matter, with nerve roots connected with all eight
horns.

Theodor’s case was a child a week old, with lumbo-sacral
spina bifida and meningocele. The doubling was present through¬
out the lumbo-sacral cord and commenced, as in our second case,
with a posterior wedge of grey matter, and the two cords were
almost completely formed above the level of their separation.
The cords united, separated again, but at the lower extremity
they again became united, but with two central canals, four
anterior and four posterior cornua. The nerve roots came mainly
from the outer halves, but the inner, more dorsally situated
cornua had also both anterior and posterior root connections.

V. Monakow’s case was that of a cyclopic foetus in which
the upper part of the cord was turned back into the skull and
formed the roof of the fourth ventricle, splitting the cerebellum.
Turning down again it entered the spinal cavity and was doubled
in the greater part of its lower course. Higher up one cord
became thinner, transformed itself into one half of a cord, and
blended with the other into a single cord.

Van Gieson, in referring to Chiari’s case, says : “ the absence
of 'drawings and definite details of the deformity renders it
impossible to draw any conclusion as to the real nature of the
changes. . . . (The case would seem to me to look more like a
bruise than a malformation.) ” We are, however, inclined from
the description to think that this is probably a real case of
doubling, although not denying the possibility of the condition
having been produced accidentally, and we therefore class it
along with the cases of Cruveilhier, v. Ammon, Lenhossfek, Rosen¬
berg, and v. Monakow as examples of probable true doubling of
the cord, of which, however, from the descriptions available, it is

ORIGINAL ARTICLES

impossible to be absolutely certain. (In the case of v. Monakow
we have not been able to see the original full account.) We have,
therefore, nine undoubted examples and six probable ones.

Of these we find that 7—the cases of Cruveilhier (8), v.
Ammon (9), Rosenberg (28), Chiari (34), Sulzer (35), Steiner,
and Theodor were related to spina bifida; that in Cruveilhier’s
case a cartilaginous projection from the body of the twelfth
dorsal vertebra, and that in Sulzer’s a similar projection from
the fourth lumbar might have produced a backward pressure on
the medullary tube in an early stage of its formation, and thus
caused a split at a time when the cells were little differentiated,
and each half was capable of forming a more or less perfect
medullary tube.

In two instances, that of Bonome (23) and our first case, the
division has been brought about (or is accompanied) by intrusion
of a fold of membrane between the two parts. In our first case
a V-shaped fold of dura projected in from the front backwards
between the two cords, and some single tags joined this fold with
the posterior layer of the dura.

In Bonome’s cfse the cord was split by a layer of connective
tissue which contained a small piece of cartilage.

The cases of v. Lenhossek and v. Monakow were in foetuses,
and in them and in the cases of Fo&, Recklinghausen, Miura, and
ourselves (2) the bony canal seemed to be quite normal. In the
five last cases the ages of the patients were (Fo&) 76, (Reckling¬
hausen) 31, (Miura) 53, (ours) 31, and 50.

The tracings on the following page, taken from illustrations of
the cases accessible to us, show that whether the separation of the
two cords has been complete or not, the outer cornua are in every
instance the more perfect; the inner, more dorsal cornua being
less well formed. The constancy of this feature, the regularity
of the arrangement of the superadded cornua, and the fact that
in all cases the continuity of the central canals could be traced,
all point to the double cord not being of the nature of a foetal
inclusion. The only satisfactory explanation seems to lie in a
local doubling of the medullary tube. Once this has been
formed it becomes intelligible why the inner cornua are not so
perfectly formed as the outer, which would still represent the
outer halves of the normal tube. But as regards the causation
of the doubling, it must be admitted that we can say very little.

ORIGINAL ARTICLES

Thiodor.

v. Recklinghausen.

SUIiZIB.

Steiner.

MruRA.

ORIGINAL ARTICLES

The simplest explanation would be to suppose pressure acting
either in front or from behind, and in certain cases (Cruyeilhier,
Sulzer, Bonome, and our first case) there are signs of pressure
having acted from the anterior surface. Other modes of doubling
of the medullary tubes, such as kinking, can be conceived, but
there is no evidence of this having been the cause in any of the
cases described.

Finally, in some instances no external cause is evident; the
abnormal development may have been from some inherent
defect in the cells of the medullary tube itself at a very early
period in development, and the doubling affected only the spinal
cord, without exerting any influence on the surrounding meso-
blastic structures.

Description of Figures.

Fig. 1 (x 6) S 1 upper.—Shows the central canal elongated antero-posteriorly
and lying in a narrow septum of grey matter.

Fig. 2 (x 6) S 1 lower.—Two central canals. Wide wedge of grey matter
intruded between the posterior columns; the hinder part shows a
double substantia gelatinosa.

Fig. 3 (x 6) S 2.—Shows normal outer anterior and posterior cornua with
nerve roots in connection. The inner, more dorsal halves have well
formed posterior cornua ; more rudimentary anterior cornua, in contact
behind the anterior median fissure. Two distinct posterior “ median ”
septa. A fissure partly divides the cords where they are united
posteriorly.

Fig. 4 (x 0) S 3.—Well marked x*abaped anterior median fissure. Two small
posterior median septa on the outer side of either inner posterior cornu.
A fissure partly dividing the cords in the middle line posteriorly.
Inner anterior cornua almost separated; the left contains a few motor
cells, from which fibres can be seen passing out by the anterior median
fissure.

Fig. 5 (x 6) S 4 upper.—Outer anterior and posterior cornua distinct;
inner anterior cornua practically disappeared; posterior crushed to¬
gether and their substantiae gelatinosa united. Anterior part of the
posterior columns has been cut off as an islet of white fibres.

Fig. 6 (x 6) S 4 lower.—Single central canal. Merely a small band of grey
matter in the line of the posterior median septum, representing the
fused inner posterior cornua.

OKIGINAL ARTICLES

Errata. —A Case of Localised Doubling of the Spinal Cord.
This Review, November 1906.

Plate 26, Fig. 11, should be Fig. 10, and is upside down.
Plate 27, Fig. 3, should be Fig. 4.

Plate 27, Fig. 4, should be Fig. 3.

Plate 28, Fig. 7, should be Fig. 8.

Plate 28, Fig. 8, should be Fig. 7.

Plate 29, Fig. 10, should be Fig. 11.

Literature.

Steiner. “ Uber Verdoppelung des Rfickenmarks,” Inaug. Distort.,
Konigsberg, 1896.

Theodor. “Ein Fall von Spina bifida mit Doppelteilung des Rficken¬
marks,” Arch, fur Kinderheilk., Bd. xxiv., 1898.

v. Monakow. “ Verhandlung der Naturforscherversammlung,” 1896;
Ref. Neurol. Gentralbl., 1896.

Bruce, McDonald, and Pirie. This Review, Nov. 1906.

Steiner gives the following list of references to the literature :—

v. Recklinghausen. “ Untersuchungen fiber Spina bifida,” etc., Virchovfs
Arch., Bd. 106, 1886.

C. P. Ollivier. “ Traits des maladies de la moelle Ipinifere, Paris, 1837.

Zacchias. “ Qusestiones medic, leg.”

Mange t. “ Theat. anatom.”

Hull. Mem. of the Soc. of Manchester.

Sandifort “ Museum anatomicum academia Lugdun,” Batavae.

Natorp. “ De spina bifida,” Dissert., Berlin, 1838.

Cruveilhier. “ Anatomie patholog.”

v. Ammon. “ Die angeborenen chirurg. Krankheiten des Menschen.”

v. Lenhoesfek. “ Uber eine Zwillingsbildung der Medulla spinalis,”
WocherMatt der Zeitschrift der Wiener Ante, 1868, No. 62.

J. Ollacher. “ Uber einen Fall von partieller Multiplicity des Rficken-
marks in einem 4-tagigen Embryo,” Berickt des naturwissenschaftlichen medizini -
schen Vereins zu Innsbruck, Bd. iv., 1875.

P. F 0 &. Rivist. sperim. di Freniatria e Medic, legale, 1878.

Ffirstner u. Zacher. “Uber eine eigentfimlicbe Bildungsanomalie des
Hirns und Rfickenmarks,” Arch. f. Psychiat., Bd. xii., 1882.

Van Gieson. New York Medical Journal, 1892.

E. D. Bondurant. “ Duplication of the spinal cord as a result of post¬
mortem injury,” The Medical New*, 1894.

R. Benecke. “Ein Fall von unsymmetrischer Diastematomyelie, Fest¬
schrift ffir E. Wagner von seinen Schfilern,” Leipzig, 1888.

A. Bonome. Archive per le scienze vied., “ Di un caso raro di sdoppiamento
parziale del midollo spinale,” Referat. Neurol. Gentralbl., vii., 1888.

Miura. “Zur Genese der Hohlen im Rfickenmark,” Virchoufs Arch., Bd.
117, 1889.

ORIGINAL ARTICLES

D. Fischer. “ Uber die lumbo-doraale Rachischisis mit Knickung der
Wirbelsiiule,” Ziegler’s Beitrdge , Bd. v., 1889.

P. Kronthal. “ Zwei patholog. anatom, merkwiirdige Befunde an Riicken-
mark,” Newol. Gentralbl., 1890.

Siegfried Rosenberg. “ Uber Spina bifida und Diasteraatomyelie,” Dissert .,
Freiburg, 1890.

Steffen. "Spina bifida, Zweiteilung des Riickenmarks. Hydromyelie,”
Jahrbuch fur Kinderheilkunde, 1890.

Louis Jakobsohn. “ Ein Fall von partieller Doppelbildung und Hetero-
topie des Riickenmarks,” Neurol. Centralbl., x., 1891.

Bernhard Feist. “ Ein Fall von Faserverlaufsanomalieen und partieller
Doppelbildung im Riickenmark eines Paralytikers,” Neurolog. Gentralbl ., x.,
1891.

Martin Brasch. “ Ein unter dem Bilde der tabischen Paralyse verlaufender
Fall von SyphiliB des Centralnervensystems,” Neurol. Centralbl., x., 1891.

Aldren Turner. Brit. Med. Joum., 1891.

H. Chiari. “ Uber Veranderungen des Kleinhirns infolge von Hydro-
cephalie des Qroeshirns,” Deutsche med. Wochenschrift, 1891, No. 42.

Paul Sulzer. “ Ein Fall von Spina bifida verbunden mit Zweiteilung und
Verdoppelung des Riickenmarks,” Ziegler’s Beitrdge, Bd. xii., 1893.

PARAMYOCLONUS EPILEPTIOUS.

By ERNEST S. REYNOLDS, M.D. (Lond.), F.R.C.P.,

Senior Assistant-Physician to the Manchester Royal Infirmary,
Physician to the Manchester Workhouse Infirmary.

Cases of paramyoclonus epilepticus are so rare that the following
may be found of some interest:—

Benjamin B. C., aged 44, a plumber, was sent to me on
Oct. 9, 1905, by my friend Dr Alan M'Dougall, the Medical
Superintendent of the David Lewis Epileptic Colony, Great
Warford, Cheshire, and was admitted the same day at the Man¬
chester Royal Infirmary under my care. Dr M'Dougall wrote :
“ He has a daily seizure lasting on an average four hours. His
muscles contract in a way that suggests applications of the
battery. Every subcutaneous muscle seems to be affected by
the spasms. During the attack the patient is unconscious, but
the coma does not seem to be absolute. He has had seizures for
several years. Occasionally he misses a day, more frequently he
has two on the same day. The attack is during the daytime,
usually about the middle of the day.”

History of Illness .—The patient complains of having “ fits,”

ORIGINAL ARTICLES

which commenced with slight seizures while at his work some
eight years ago, and they have increased in intensity and fre¬
quency since. He cannot suggest anything as a cause of the
attacks.

Family Histoi'y .—His father died at the age of 64 and his
mother aged 54, causes of death unknown. He is one of 13
children, 10 of whom are still alive and well. He is married
and has had 7 children, 4 of whom are living. There is no
history of “ fits ” or other nervous affection in the family.

Personal History .—The patient has occasionally suffered from
bronchitis, but apart from this has been healthy. He has never
had syphilis or lead poisoning (he has no blue line on the gums).
He has never taken alcohol in excess; he does not smoke.

Physical Signs and Symptoms.

If no fit is occurring, the patient lies in bed apparently
quietly (except for occasional sudden shock-like movements) and
talks rationally; he is indeed very intelligent. He is a well-
built man, 5 ft. 10 in. in height, and weighs 14 stone 3 lbs.; his
muscular system is particularly well developed. His face shows
in all parts, especially on the forehead, strongly marked folds,
very similar to the “ rugosities ” of the face seen in an old-stand¬
ing case of spastic diplegia of infancy. I am of opinion that
these folds and the general great muscular development are
largely due to the excessive muscular action which is constantly
manifested.

He can get out of bed and walk in a perfectly normal
manner, except of course when a fit is occurring. But if, while
he is lying in bed without his attention being specially diverted,
he is very closely observed, it is noticed that there occur from
time to time, at irregular intervals varying from a few seconds
to perhaps half a minute, sudden shock-like contractions (similar
to single contractions produced by single shocks of an induced
current) of various muscles or parts of muscles in entirely dif¬
ferent parts of the body, either the face, neck, arms, legs, or
trunk. Naturally if the whole of a muscle is affected, a bodily
movement occurs, but if only a part of a muscle, practically no
movement results. So uncertain is it which muscle will contract
after any other, that it is necessary to examine the patient

ORIGINAL ARTICLES

entirely stripped or it might seem for many minutes that no
contractions were occurring. An easy method of noticing these
shock-like contractions is to place the hand on the patient’s
forearm or round his leg or resting on his thigh, when, after a
short interval, the contractions, however slight, will be felt. The
contractions occur on both sides, but not necessarily symmetri¬
cally or synchronously. If the patient is engaged in light con¬
versation the contractions may still go on, but if his attention is
strongly attracted they are perhaps lessened in frequency. There
are no contractions of the muscles moving the eyeballs, but con¬
tractions of the tongue occur (especially during the “ fits ”). The
movements are present during sleep.

The “fit .”—In addition to the above movements which occur
during complete consciousness, the patient has a " fit ” practically
every day, commencing about 10 a.m. and lasting about two
hours. Sometimes he has a second “ fit ” in the evening. The
attack commences with a complaint of headache and drowsiness,
and the patient is then seen to be scratching or rubbing the
right side of the head in a clumsy way, generally with the front
of the right wrist, the hand being hyperextended. Then rapid
irregular clonic contractions of the right fingers and hand occur,
the thumb usually being affected first. This is soon followed by
clonic contractions of all the muscles of the body, each contraction
being sudden and shock-like in character. If watched for a
considerable time the contractions may be seen to affect sym¬
metrical muscles on the two sides, but not synchronously ; but
in the face, neck, and trunk they may be synchronous. It will
be noticed that these sudden movements are similar, but much
more frequent and more marked, to the movements described
above as occurring in the interparoxysmal period. But during
the whole time of the fit there are, in addition, greater and
relatively slower movements ; these are movements of contortion
very similar to the choreiform movements of an old-standing
case of spastic diplegia, and they affect all parts of the body,
face, neck, trunk, arms, and legs, the movements being so marked
that the body and limbs are thrown about in all directions and
the bed-clothes tossed hither and thither; but the patient never
falls out of bed, nor does he bruise himself to any great extent
against surrounding objects, although he has knocked the paint
and broken the plaster of the wall next his bed (which is in a

ORIGINAL ARTICLES

corner of the ward) in a patch about 4 inches square. His face
is thrown into marked contortions, his lips and tongue being also
involved, but he does not bite his tongue. He does not cry out
either at the commencement of, or during a fit, but all the time
grunts and “ snorts ” in a peculiar manner, these noises being
apparently due to irregular movements of the muscles of respira¬
tion and vocalisation; there are no sudden ejaculations of any
kind. At first sight all these large irregular movements and
contortions resemble closely the “grand movements" of the
typical hystero-epilepsy of Charcot, but they are certainly not of
this nature, for they are so largely intermingled with the clonic
contractions described above. Watching the hand and arm, for
instance, the fingers are sometimes extended suddenly, then
suddenly flexed ; sometimes one or two fingers extended and at
the same time the others flexed; whilst at the same time the
whole hand is moved about in various directions by the larger
movements which affect the whole of the upper limb, these move¬
ments being more irregular and slower than the clonic con¬
tractions. At the same time (still watching the arm) quick
clonic movements may be seen in individual muscles or parts of
muscles of the upper arm. And similar appearances showing
large movements and simultaneous quick clonic contractions are
seen in legs, face, neck, and trunk.

During the fit the patient is apparently only partially un¬
conscious. The large irregular movements will occasionally
alter if resisted by the examiner, and he apparently actively
resents such interference. Sometimes also a sharp loud word of
command will cause some alteration; but in a few seconds the
movements continue as before. On some occasions if I say to
him, “ How are you ? ” he will open his eyes, look towards me,
roll his head about awkwardly, and, after an obvious effort,
splutter out the words, “ How do you do ? ” and then recom¬
mence his movements. But as a matter of fact, from close
cross-questioning afterwards, it is quite certain that he is
entirely unconscious during the whole period of the attack.

The fit terminates very gradually, as it began ; the move¬
ments gradually lessen and consciousness gradually returns.
There is no incontinence of urine during the fit. No typical
post-epileptic sleep follows the attack.

True Epileptic Attacks .—During his residence of eight months

ORIGINAL ARTICLES

at the Epileptic Colony, Dr M'Dougall informs me that the
patient had two genuine epileptic fits. While at the Royal
Infirmary he had a true epileptic fit lasting a few minutes on
November 4, in which he bit his tongue, and another short
attack on November 8.

General Nervous System. —As I have already stated, the
muscular system is everywhere well developed, and there is of
course no paralysis. There is nowhere any affection of sensation.
The knee-jerks and teudo Achilles-jerks are present, normal and
equal on the two sides. The plantar reflexes are of the flexor
type; the general superficial reflexes are everywhere normal.
The patient says his memory is gradually failing, but there is no
evidence of any other mental deterioration.

All other bodily organs are healthy and normal. Urine
normal.

Commentary.

Because of the apparently irregular large movements of the
body and limbs and the peculiar contortions of the face, and the
resistance by the patient to any interference during the attack,
and especially because the unconsciousness did not seem com¬
plete, several observers who saw this case declared, and persisted
for some time in believing, that the man was a malingerer. But
the finer clonic shock-like muscular contractions, both during the
fits and in the intervals, quite dispose of this view, and especially
so as some of the clonic spasms only affected parts of a muscle,
a condition which could not by any possibility be simulated.

Similarly the possibility of hysteria may be excluded, not
only on account of the clonic spasms in isolated muscles or parts
of muscles, but because of the occasional occurrence of true
epileptic attacks, and also because of the entire absence of the
usual hysterical stigmata.

Although, as I have noted above, the large irregular move¬
ments were somewhat similar to the “ grand movements ” occur-
ing in the hystero-epilepsy as described by Charcot, yet the absence
of the other typical stages of such attacks and the smaller clonic
spasms of the inter-paroxysmal period sufficiently distinguish the
condition.

These small clonic shock-like contractions similarly exclude
any form of chorea, either Sydenham’s, Huntington’s, or senile;

ORIGINAL ARTICLES

and the unconsciousness during the “ fits,” as well as the genuine
epileptic seizures, enable one to say that this is neither a case of
electric chorea nor of convulsive tic.

Pathology .—The history of this case, taken together with
the impressions conveyed to my mind in watching the move¬
ments, seem to me to be of some little service in determining
the seat of origin of this strange and uncommon affection.

The true epileptic fits which have occurred on at least four
occasions during the last twelve months must, I think, be
ascribed to some affection of the cerebral cortex. The ordinary
daily “ fit ” must also be due to some affection of the higher or
lower cerebral centres, for it is accompanied by loss of conscious¬
ness (certainly not always of the most profound type), and by
the large, irregular, comparatively slow movements so closely
resembling chorea or the choreiform movements of spastic
diplegia that the situation of the lesions must almost necessarily
be in about the same regions.

But to my mind the smaller clonic shock-like movements,
which occur at all times at irregular intervals, can only be due
to some affection of the lower motor neurones of the pons,
medulla, and spinal cord. The sudden contractions of isolated
muscles or even parts of a single muscle, one cannot conceive
to be of cerebral origin. They occur, as I have said, at all
times: during sleep, during the daily “ fit ” (when they are
much worse), or between the “ fits.” The increase of the clonic
movements during the “ fits,” when cerebral control is cut off,
is also easily explained. They occur also without consciousness
being necessarily lost.

In this case, then, the disease seems to be due to an affection,
possibly some slow degeneration, of higher and lower cerebral
centres, and also of the motor centres of the pons, medulla, and
spinal cord.

ORIGINAL ARTICLES

LESIONS or THE SPINAL CORD, THE RESULT OP
ABSORPTION FROM LOCALISED SEPTIC FOCI,
WITH A PRELIMINARY NOTE ON AN EXPERI¬
MENTAL RESEARCH . 1

By DAVID ORR, M.D., and R. G. ROWS, M.D.

In a paper published in the Winter number of Brain, 1904,
while discussing the starting-point and distribution of posterior
column lesions in General Paralysis of the Insane, we referred to
the work which has been done to determine the course of the
lymph stream in the posterior roots and columns, and we stated
that it has been proved by several observers that the lymph
flows in an ascending direction towards the cord.

A reference to this paper (1) will show the reasons for
adopting this view. The object of our present communication is
to bring forward further definite evidence in favour of the theory
that lesions of the spinal cord can be produced by the ascent of
toxines, or in some cases even of organisms, from peripheral foci
of inflammation, either of an acute or a chronic nature.

The series, from which our conclusions have been drawn,
comprises in all eight cases, which are mentioned in the table
below. The lesions were of varying nature and situated in
different parts of the body, and in each case, as a reference to
the table will show, the cord lesion was found to be much more
intense in the segments of the cord corresponding to the nerve
supply of the affected area.

Cass 1. Bedsores; gluteal region ;
more severe on left side; sup¬
puration of right elbow.

Degeneration of the posterior columns and
of the anterior radicular # fibres in the
lumbo-sacral region from Si to L 3;
more intense on the left side and in 4th
lumbar. From D 12 to D 2 there was
nothing worthy of note. Degeneration
again commenced at D 1 on the right
side; the lesion was most marked ill
C 7 and <L and gradually diminished in
the next few segments.

1 An aocount of this research will form the subject of a separate paper. Towards
the expenses of this research we have received a grant from the British Medical
Association.

ORIGINAL ARTICLES

Cask 2. Left brachial neuritis;
staphylococci in the tissues
around the posterior root
ganglia.

Case 3. Bedsores on buttocks and
sacrum; of longer duration on
the right side.

Cask 4 Pelvic cellulitis ; renal
abscesses ; double empyema, of
longer duration on the left
side; abscess in the cervical
muscles ; no peritonitis.

Cask 5. Caries of the 4th and 5th
lumbar vertebrae ; psoas abscess
on the right side. The abscess
cavity became septic two months
before death.

Marked degeneration of the left root-
entry zone and Burdach’s column from
C 8 to C 2 ; maximum in C 7-6 ; faded
gradually from C 6 upwards. Degene¬
ration also present in the lateral region
and anterior radicular zones. Right
half of cord affected similarly, but to a
markedly less extent. There were no
changes in the anterior or posterior
roots.

Lesion most intense on the right side.
Some degeneration of posterior columns
in S 1; maximum at tne level of L 4-3;
diminished gradually in the segments
above this.

Very slight degeneration of the posterior
columns in the sacral region. Much
March i reaction amongst the anterior
radicular fibres of S 4-3-2, especially on
the left side. No changes in the
lumbar cord. Degeneration in the
root-entry zones of D 11-10-9 ; again
a separate lesion beginning in D 5
occupying the same area, more marked
on the left side, and occurring in every
segment as high as C 4. In cervical
region degeneration greatest in C 7-6.

In S 2 a slight lesion of the posterior
columns. This increased in S 1, and
was most intense in L 5-4. Above this
level it gradually diminished. Lesion
much more marked on the right side.

Case 6. Chronic suppuration
the right knee-joint.

of | Degeneration from S1 to the lower dorsal
; region ; most marked in the right

r Bterior columns and most intense in
4-3-2.

Case 7. Chronic suppuration of | Lesion of the posterior columns slight in
the left knee-joint. S 1 ; well marked in L 5-4-3. It ceased

! at D 11 ; most intense on the left side.

: There were no changes in the left sciatic
nerve.

Case 8. Prostatic disease; chronic ! Followed by transverse myelitis at the
cystitis. | level of D 8-9.

An examination of the spinal cords from the above-mentioned
cases has enabled us to confirm the two points insisted on before,
viz. that system degenerative lesions of the sensory protoneurons
always begin at the point where the fibres entering the cord lose
their neurilemma sheath, and spread thence into the posterior

ORIGINAL ARTICLES

columns ; that such lesions in their early stages, and even for a
prolonged period, exist without any appreciable changes in the
posterior roots.

It is now generally admitted that the posterior column
lesions in early Tabes, and in other conditions, such as Diabetes
and General Paralysis of the Insane, are primary, and not
dependent upon any lesion of the posterior roots, or of the
posterior root ganglion cells.

But besides defining the starting-point of these degenerations,
our series of cases seems to show clearly, by the distribution of
the lesions in the cord, that the changes are the direct result of
absorption from some peripheral septic focus. For example, in
Case 1, with bed-sores, which were more severe on the left side,
the lumbo-sacral enlargement showed considerable degeneration,
whereas the dorsal region was almost entirely free. In Fig. 1,
note the greater degree of degeneration on the left side; in Fig. 2
only the centre of the posterior columns shows a few scattered
fibres. Further, in the same case, corresponding to a suppuration
of the right elbow-joint, there was a marked degeneration of the
cervical enlargement, which was more intense on the right side
(Fig. 3). Case 2 exhibited the same localised and limited dis¬
tribution, but on the left side (Fig. 5).

There is evidence, however, that, although the toxines are
carried along the perineural sheath into the corresponding posterior
column, a certain quantity of the toxic lymph spreads along the
loose meshes of the pia mater to the opposite posterior column,
and also in a lateral direction to the adjacent portions of the
cord (Figs. 3 and 5).

Further, we have found that toxins are carried along the
perineural sheath of the motor roots as well, but the resulting
degeneration is never so intense as in the posterior columns.

Homen’s 1 observation that toxins seem to reach the spinal
cord more readily by the posterior than the anterior roots is
interesting in this connection. A possible explanation may be
found in the fact that the posterior roots are nearly three times
as large as the anterior, and can therefore pour a larger quantity
of lymph into the cord in a given time.

The degeneration amongst the anterior radicular fibres, as in
the case of the posterior roots, commences at the cord margin
1 Referred to Brain , Winter 1904.

ORIGINAL ARTICLES

where the neurilemma sheath is lost, and affects only the intra¬
medullary portion. We therefore consider this point just as
vulnerable to the action of toxins ascending in the perineural
lymph stream as the corresponding one on the sensory proto¬
neuron system. From the point where the anterior roots enter
the cord, some of the lymph, instead of passing along the
radicular fibres towards and into the grey matter, diffuses
laterally, and produces a degeneration of the fibres in the
adjacent regions.

There is one other fact to be mentioned, and that is, that
in all our cases we have constantly observed degeneration
amongst the fibres of the anterior commissure, but only in those
segments which exhibit the lesions described above.

The effect of the lateral diffusion of the toxic lymph
referred to above is best seen in Case 2, Fig. 5. From this
case—brachial neuritis of infective origin—it seems highly
probable that this diffusion from the two points of maximum
intensity occurs more readily when the toxins are present in
greater quantities, or when they possess a higher grade of
virulence. We have failed to find evidence of it in milder
degrees of toxicity, such as are associated with bedsores.

Fig. 5 shows the distribution of the lesion in Case 2 as it is
demonstrated by the Marchi method.

The degeneration of the posterior columns began at the point
where the fibres lose their neurilemma sheath, and spread for¬
wards into the root-entry zone. Amongst the anterior radicular
fibres also there was much reaction, which extended from the
cord margin, where these fibres also lose their neurilemma
sheath. In addition, the diagram shows considerable degenera¬
tion around the margin of the cord and along the pial prolonga-
, tions dipping into the lateral tracts.

The degenerations in the anterior part of the cord, although
present elsewhere, have been most clearly seen and followed
even to the cell groups of the grey matter, in the upper sacral
and lumbar regions.

After running up to the cell groups, the degenerated fibres
encircle them, and change their position with them (Fig. 4). For
example, in the sacral region, where the motor cells occupy a
postero-lateral position, the degenerated fibres travel through
almost the whole depth of the anterior cornu to reach them;

ORIGINAL ARTICLES

while at a higher level, where the cells lie more anteriorly, the
Marchi reaction is chiefly confined to this region.

It will thus be seen that there are two paths by which the
lymph enters the cord from the periphery, and two points especi¬
ally open to attack. It is at these two points that we find the
marimnin amount of degeneration of the nerve fibres, while there
is a less severe affection of the fibres in the adjacent regions.

We have recently examined the cord of a case of myelitis,
which occurred in the course of a septic cystitis. The myelitic
focus was situated in the 8th and 9th dorsal segments, and the
distribution of the maximum degeneration suggested strongly to
us that the myelitis was the result of absorption from the bladder.
We found on examination by the Marchi method that the posterior
columns showed most change, while the postero-lateral region was
affected to a somewhat less extent. In each anterior radicular
zone there was a well-defined patch of degeneration. The more
lateral region and the grey matter exhibited only a limited and
scattered lesion.

This case, while it differed setiologically from the others of
our series, is highly suggestive of an organismal infection from
the bladder, because of the distribution of the myelitic patches
in the entry zones of the anterior and posterior roots.

S imilar cases are recorded by Walker in the Lancet for
March 11, 1905. He described three cases in which an acute
ascending paralysis occurred in the course of chronic cystitis,
and suggested as an explanation that the lesion of the cord was
due to an extension of an inflammation along the nerves from
the bladder to the cord. Now, all our observations tend to
show that from any septic focus, wherever it may be situated,
toxins, and in some cases organisms, can ascend to the cord, and
there, for the first time, exert their noxious influence. We do
not think it probable that the resulting lesion of the cord is due
to a direct extension of the inflammatory process, because it is
contrary to our experience to find the peripheral nerves or the
spinal roots affected.

We therefore still adhere to the view which we have expressed
before, that the toxins spread upwards in the perineural sheath
without producing any reaction before the cord is reached. With
the view of testing the validity of the opinions which we have
enunciated in this paper, we have undertaken an experimental

ORIGINAL ARTICLES

research on animals. By means of these experiments we are able
to provide a constant limited supply of toxins in the neighbourhood
of some peripheral nerves or spinal roots. So far, the results
which we have obtained have shown that the reaction produced
in the spinal cord is not a continuation of changes in the
nerves, and also that the lesion in the spinal cord commences at
the two vulnerable points which we have dealt with above.

In conclusion, we have to thank Professor Lorraine Smith for
many suggestions in connection with our work, and for his kind¬
ness in allowing us to carry on the experimental part of our
research in his laboratory at Owen’s College, Manchester.

References.

1. Orr and Rows. Brain, Winter, 1904.

2. Walker. Lancet, March 11, 1905.

abstracts

ANATOMY.

THE DEVELOPMENT OP THE CRANIAL AND SPINAL NERVES
(1) IN THE OCCIPITAL REGION OF THE HUMAN EMBRYO.

G. L. Streeter, Amer. Joum. of Anai., Vol. iv., 1904, No. 1.

The tenth and eleventh cranial nerves are parts of the same
complex, both possessing mixed motor and sensory roots and
ganglia derived from the same ganglionic crest, but during the
process of development the cephalic end of this complex becomes
predominantly sensory and the caudal predominantly motor. This
produces the appearance of two separate portions and has led to
their being considered as two independent structures, the cephalic
being known as the vagus nerve and the caudal portion as the
accessory nerve of Willis. The ninth (glosso-pharangeal) nerve is,
however, developed quite independently of this complex. In the
earlier stages of development (third to fifth week) the ganglionic
crest of the vago-accessory complex is an unsegmented structure
which extends to the level of the third to fifth cervical segment of
the cord, placed on the lateral surface of the latter between the
points of later attachment of the dorsal and ventral roots. As
development proceeds it splits up into several segments, the most
oral and largest develops further and forms the root ganglion of
the vagus (jugular ganglion), the more caudal divisions diminish in
size spinalwards and remain rudimentary. They are represented
in the adult by the ganglion cells which are to be found in the

ABSTRACTS

roots of the accessory nerve. Having developed from the gan¬
glionic crest they give origin to sensory fibres, but these probably
join the vagus trunk, as none such are present in the accessory
nerve. The root ganglia of these cranial nerves do not present a
segmental arrangement. The trunk ganglia of the ninth and
tenth cranial nerves (ganglion petrosum and g. nodosum) are
not connected with the root ganglia of the same nerves when they
can be first identified. They then lie isolated in the mesoderm
immediately under the epidermis and are, in contrast to the root
ganglia, segmentally related to the gill arches. The root ganglion
of ninth nerve (Ehrenritter’s ganglion), like those of the
eleventh, remains rudimentary. The ventral roots of the spinal
nerves develop earlier than the dorsal, and, similarly, those por¬
tions of the cranial nerves which are recognised as motor are
differentiated into fibre path earlier than their corresponding
sensory elements.

The twelfth nerve in young embryos closely resembles the
ventral roots of the adjacent spinal nerves and is segmentally
continuous in the same line with them. The occasional presence
of Froreip’s ganglion suggests that a phylogenetic retrogression has
deprived the hypoglossal nerve of the dorsal root it once possessed.
The dorsal root of the first cervical nerve is similarly often absent.

Gordon Holmes.

ON THE 0LAU8TEUM. (An snjet de l’avant-mur.) Trolard, Rev.

(2) Neurol., Nov. 30, 1905, p. 1068.

Hitherto only one portion of the claustrum has been generally
described, viz. its vertical limb which lies beneath the island
of Reil, but there is in addition a horizontal portion which extends
beneath the putmuen.

The only statements the author offers on the connections of the
claustrum with the rest of the brain have been obtained by macro-
scopical dissection. Some of the fibres which leave it pass into
the corona radiata, others reach the third frontal, the ascending
frontal, the ascending parietal, and the first parietal convolutions.
The anterior fibres appear to join the fasciculus uncinatus, the
posterior the fasciculus longitudinalis inferior.

Gordon Holmes.

THE INFERIOR LONGITUDINAL BUNDLE AND THE CENTRAL

(3) OPTIO BUNDLE. (Le faisceau longitudinal infdrienr et le fais-
ceau optique central) La Salle Archambault, Rev. Neurol.,
Nov. 30, 1905, p. 1053.

This paper is devoted to a description of the central optic tract
based on the examination of pathological specimens by Weigert's

ABSTRACTS

medullary sheath stain. The only origin of the central optic tract
is from the external geniculate body, no fibres come from the
thalamus. At first it does not form a compact bundle, as the
fibres are separated up by the projection fibres which pass between
the basal ganglia and cortex through the region of the retro-
lenticular segment of the internal capsule. Within the temporal
lobe some of these fibres are situated in the external sagittal layer
(“ inferior longitudinal bundle ”), some in the internal sagittal layer
(Gratiolet’s radiations), but in the occipital lobe they all lie in the
external layer and are its only constituent. They terminate in the
lips of the calcarine fissure. In the frontal portion of their course
they are closely intermingled with various systems of association
fibres, which should be carefully distinguished from them.

These observations confirm the work of Flechsig, Probst, Redlich,
and others, that the inferior longitudinal bundle is a projection
and not an association system, and that it, or part of it, represents
the central visual tract. As the older name ‘'optic radiations”
(of Gratiolet) has been applied to another system which is not
part of the visual apparatus, the new term “ central optic bundle ”
is suggested for the geniculo-occipital fibres.

Gordon Holmes.

A CONTRIBUTION TO THE HISTOLOGY AND DEVELOP
(4) MENTAL HISTORY OP THE CEREBELLUM. K. Berliner,

Arch.}, mikr. An., lxvi. 2, 5, 220.

The author considers that the structures described by Denissenko
as “ Eosinzellen,” and which are found in the inner granular layer
of the cerebellum of all vertebrata, are no true cells, but constitute
a special nervous mechanism of the molecular layer of the
cerebellum.

They consist in aglomerations of large and small acidophil
granules between which appropriate methods reveal a network of
very minute fibres.

It would appear that the granules and the network fibrils are
bound together in the acidophil bodies by some sort of ground sub¬
stance to form a more or less continuous structure.

Certain of the axis-cylinders coming up from the white matter
end by dividing into a very fine network surrounding these
agglutinations of fibrils and eosinophil bodies.

It is very probable that the terminations of other neurones end
in these eosinophil bodies, and that the latter are in connection
with one another by direct fibre tracts.

Neuroglia fibrils take no part in the formation of these bodies.
Probably these structures have an important function as an
association and “ schalt ” mechanism.

ABSTRACTS

The maximal development of the cerebellar surface in the latter
half of foetal life and the first month of extra-uterine life in the
human subject, corresponds with the period of rapid disappearance
of the superficial granular layer. It is therefore probable that this
layer is an indifferent cell-forming material which possesses the
power to form not only nerve cells but also glia cells.

F. Golla.

THE RELATION BETWEEN THE OCCURRENCE OF WHITE
(5) RAMI FIBRES AND THE SPINAL AOOESSORT NERVE.

A. H. Roth, Joum. Comp. Ntur. and Psychol., Nov. 1905,
p. 482.

In both the cat and rat there is a sudden increase in the number
of white rami fibres in the ramus communicans of the nerve which
immediately succeeds the lowest root of the spinal accessory nerve,
i.e. considerably above the level of the uppermost obvious white
ramus. It does not follow that the cervical portion of the spinal
accessory nerve actually represents the white rami fibres of the
upper cervical spinal nerves; probably the downward extension
of the vagus nucleus as spinal accessory nucleus has simply dis¬
placed downwards the cell column from which the white rami
fibres take their origin. No demonstration, however, is given of
the presence of such a column in the middle cervical region.

J. H. Harvey Pirie.

THE WIDTH OF THE CORTEX AS A FACTOR IN THE E8TIMA
(6) TION OF THE DEVELOPMENT OF THE BRAIN AND
INTELLIGENCE. (Die Rindenbreite als wesentlicher Factor
zu Beurtheilnng der Entwickelung des Gehirns, etc.) Theodor

Kaes, in Hamburg, Neurolog. Centralbl., Nov. 16, 1905,
p. 1025.

The author has amplified the original observations of Schwalbe,
who was the first to adopt as a criterion of the development of the
intelligence, in addition to observations on the weight of the brain,
estimations of the thickness of the cortex and the relative number
of ganglion cells.

I£aes considers that observations of the width of the cortex in
relation to the developmental history of the various medullated
tracts opens a field which promises great results in the study of
cortical localisation by histological methods.

In this paper the observations made on thirty-two brains are
represented graphically,
c

ABSTRACTS

He claims that his results will, when sufficiently amplified,
afford a basis for an exact knowledge of the relations between
nerve cells and nerve fibres and the development of the intelligence
in normal subjects and the psychoses of pathological brains. The
special activity of individuals who have devoted themselves to
some one branch of thought or muscular exercise should, it is
claimed, be manifest in an anatomical analysis such as has been
undertaken by the author. F. Golla.

THE CEREBRAL CORTEX OF THE DOLPHIN, [n manteUo cere-

(7) br&le del delflno (Delphinus Delphis).] V. Bianchi, Annali di
Nevrol., Fasc. 6, 1904.

After mentioning the lobes, chief convolutions, and sulci of the
cortex of the brain of the dolphin (Delphinus Delphis), the author
describes the arrangement of the layers of the grey matter of the
cortex in different regions of the brain, and of the number and
appearance of the nerve cells in these layers.

The most striking feature, macroscopically, is the small propor¬
tions of the frontal lobes. Almost the whole mass of the brain is
included in the parieto-occipital lobes, the frontal lobes appearing
as thin layers in front of these. The temporal lobes are also small,
and the olfactory lobes are wanting.

Microscopically, it is found that the number of layers in the
cortex, and the number of cells in the layers, varies very much in
the different regions. In the frontal lobes the cells are not
numerous, they have an irregular triangular shape, and few proto¬
plasmic processes. In the parieto-occipital lobes the cells are
more numerous, they are larger, many of them are almost pyramidal
in shape, and they have more processes. In the hippocampal
region the cells may be pyramidal, fusiform, or triangular.

The author then shows the intimate relation which exists
between the neuroglia and the nerve cells; the neuroglial fibres
form both a pericellular and an intracellular network. He saw no
anastomoses between the terminations of the protoplasmic processes
of different nerve cells.

Finally, the author attributes the great stupidity and limited
psychic activity of the dolphin to the poor development of the
frontal lobes—the principal seat of the associative processes—to
the uniformity of the constituent elements of the cerebral cortex
and to the rarity of the giant pyramidal cells. R. G. Rows.

THE STRUCTURE OF THE SPINAL CORD OF THE OSTRICH.

(8) G. L. Streeter, Amer. Joum. of Anat., VoL iii., 1903.

The spinal cord of the ostrich consists of fifty-one segments, each
of which gives origin to a pair of motor (ventral) and receives

ABSTRACTS

a pair of sensory (dorsal) roots. Between the seventeenth and
twenty-first segments the cord is slightly enlarged—brachial en¬
largement, corresponding to the segmental level of the wings;
otherwise it is almost uniform in size and appearance, till the
twenty-sixth segment. Here the lumbo-sacral enlargement begins
and extends to the thirty-seventh segment. Below the latter level
the cord decreases abruptly in size. A peculiarity which the cord
shares with that of all other birds is a separation of the dorsal
•columns in the lumbar region—in the ostrich from thirty-first to
thirty-sixth segments—so that a large fossa appears between them.
This is filled with gelatinous-looking material which on microscopi¬
cal examination is seen to consist of large vacuolated cells, and which
Streeter regards as metamorphosed neuroglia, as similar material
surrounds the whole cord at this level except at the attachment of
the lateral pial ligament. The embryological evidence quoted by
Kolliker is also in favour of this view. The dorsal (grey) commis¬
sure is absent within these segments. At the same level the ventral
fissure is also widened so as to form a ventral fossa. Owing to the
increase of ventral horn cells at the levels of exit of the roots
in the lumbo-sacral enlargement, definite projections (eminentiae
ventrales) are visible on the ventral surface of the cord.

The only other noteworthy peculiarity in the arrangement of
the grey matter of the cord is the existence of isolated masses
of cells in the periphery of the ventro-lateral columns, as have been
described by Lachi and Kolliker in other birds. Six pairs, con¬
taining large nerve cells, are present in the lumbo-sacral enlarge¬
ment on the lateral margins of the cord, and similar but smaller
groups with less well-developed cells are found at the root levels
of the brachial enlargement.

The paper contains no definite information on any of the tract
systems of the white matter of the cord, but as the dorsal columns
do not increase in size cerebralwards, it is assumed that only a
small proportion of their fibres reach the higher centres directly.

Gordon Holmes.

PHYSIOLOGY.

A RESPIRATORY CENTRE IN THE CEREBRAL CORTEZ OF
(9) THE DOC, AND THE COURSE OF THE CENTRIFUGAL
FIBRES WHICH ARISE FROM IT. (Ueber ein Athemcentrum
in der Grosshirnrinde des Hundes und den Verlanf dor
von demselben entspringenden centrifugalen Fasern.) C.
Mavrakis and S. Dontas, Arch.f. Anal. u. Physiol., H. 5 u. 6,
1905, p. 473.

In the brain of the dog these authors have located a small area in
the upper part of the anterior central convolution, stimulation of

ABSTRACTS

which produces definite changes in the respiratory rhythm, un¬
accompanied by any other muscular movements. Beyermann has
described two cortical centres, one in the posterior and the other
in the anterior part of the above-mentioned convolution. Irrita¬
tion of the former, he stated, brought respiration to a standstill,
with the thorax in the position of forced inspiration, while ex¬
citation of the latter produced respiratory acceleration. The
present authors, from their own experiments, believe that there
is only a single centre, and that both these effects can be obtained
by varying the strength of the stimulus applied to it—weak in¬
terrupted induction shocks leading to acceleration of the respiratory
movements, strong shocks bringing these movements to a standstill
If the current was made stronger still, movements of the head were
observed, owing to spread into the neighbouring centre for the
neck muscles.

Having determined the position of the cortical respiratory
centre on each side, they made experiments to find out whether
the centrifugal fibres from that to the centres in the medulla
oblongata were direct (homolateral) or crossed. After a mid-brain
hemisection, stimulation of the cortical centre on the same side
produced no effect on the respiratory movements, while stimulation
of the centra on the opposite side did. If the incision extended
slightly across the middle line, involving the whole of one-half of
the mid-brain and the mesial part of the other half, no effect on
the respiratory rate was produced by stimulation of either cortical
centre. When an incomplete hemisection was made, the incision
not extending quite to the middle line, irritation of both cortical
centres led to the usual respiratory changes.

The cortico-bulbar respiratory tract, therefore, is entirely homo¬
lateral, at least as far down as the level of the mid-brain, and it
lies close to the middle line. Sutherland Simpson.

CENTRAL RESPIRATORY INNERVATION. (Zttr Lehre von der

(10) centralen Atheminnervation.) R. Nikolaides, Arch. f. Anat.
u. Physiol ., H. 5 u. 6, 1905, p. 465.

From experiments performed on rabbits and dogs the author has
arrived at the following conclusions:—

1. In the medulla oblongata is situated a centre which controls
the muscles of ordinary respiration, by ordinary respiration being
meant active inspiration and passive expiration. In addition to
this, the presence of another centre for active expiration must be
assumed.

2. The ordinary respiratory centre in the medulla is acted
upon by a higher centre situated in the posterior corpora quadri-

ABSTRACTS

gemina, destruction of which produces the same effect on the respira¬
tory movements as division of both vagi. Normally this centre
has an inhibitory action on the inspiratory phase of normal in¬
spiration similar to that exercised through the undivided vagi.
Removal of this centre has, therefore, the same effect as division
of the vagus—a slowing and deepening of the respiratory move¬
ments due to an increased prolongation of the inspiratory phase.
This effect is evident even with the vagi intact, but it becomes
much more so if these nerves are divided also. There are thus
two paths through which impulses inhibiting inspiration in ordinary
breathing can be transmitted to the above-named centre in the
medulla oblongata, and there is reason for believing that one of
these can compensate for absence of the other. The result of
division of both vagi in three dogs was a reduction of the respira¬
tory rate to about a third of the normal immediately after the
operation, but at the end of from twenty-five to thirty-five days it
had returned almost to the normal. This return to the normal
rate might be explained by supposing that the higher inspiration
inhibitory tract coming from the centre in the posterior corpora
quadrigemina had vicariously taken on the function of the vagi.

o. Similarly, in the anterior corpora quadrigemina is found a
centre which acts upon the expiratory centre in the medulla
oblongata, so as to inhibit its activity in normal breathing.

4. In various parts of the brain above the medulla oblongata
there have been described, by different authorities, inspiratory
centres, e.g. between the corpus striatum and optic thalamus, in the
floor of the third ventricle, at the junction of the anterior and
posterior corpora quadrigemina, etc. These do not exist. The
respiratory changes on which these statements are based have
probably been brought about by stimulating the inspiratory tract
at different levels in its course from the cortical respiratory centres
to those in the medulla oblongata. Sutherland Simpson.

THE CONTRACTILE MECHANISM OF THE GALL-BLADDER
(11) AND ITS EXTRINSIC NERVOUS CONTROL. F. A. Bain-
bridge and H. H. Dale, Journ. of Physiol., Nov. 9, 1905,
p. 125.

In a series of experiments on dogs the changes in volume of the
gall-bladder were investigated by the introduction into the fundus
of the bladder of a catheter bearing on its end a rubber bag which
was distended with water at a known pressure. The changes in
pressure were recorded by a small Hurthle piston-recorder in com¬
munication with the pressure reservoir. Extensive dissections

ABSTRACTS

were necessary to prevent extraneous pressure on the gall-bladder
by the abdominal walls, diaphragm, and the liver itself. The
abdomen was opened freely, sternum and diaphragm divided,
phrenic nerves cut, and the gall-bladder carefully separated from
the liver. The animal was immersed in warm salt solution, or
protected from cooling by frequent application of flannels soaked
in warm saline and placed over the liver.

The gall-bladder shows rhythmical contractions at the rate of
from 1 -3 per minute. This rhythm is intensified by section of the
splanchnic nerves, by injection of chrysotoxin, and occasionally by
increase of pressure in the gall-bladder.

Stimulation of the right splanchnic nerve produces inhibition
of tone and relaxation of the gall-bladder. Stimulation of the left
splanchnic has either no effect or causes a slight increase of tone
and rhythm, in all probability the result of the general rise of
blood-pressure. The injection of adrenalin into the blood-vessels
has a similar effect to stimulation of the right splanchnic. The
relaxation of the gall-bladder is followed by a gradual after-
increase of tone, for which the improvement of blood-supply is
probably responsible. The contraction of the gall-bladder follow¬
ing stimulation of the splanchnics and injection of adrenalin which
had previously been noted by other observers is really to be
ascribed to the engorgement of the blood-vessels of the liver press¬
ing on the gall-bladder. The right splanchnic nerve, however,
contains some motor-fibres, and their effect can be produced when
the tone is lowered by enfeeblement or stoppage of the circulation.

Both vagi contain motor-fibres to the gall-bladder, the left
being more effective than the right. Stimulation causes increase
of tone and of the rhythmic contractions. The effect is abolished
by atropin.

Anaemia produced by occlusion of the thoracic aorta decreases
the tone. Nicotine, bile-salt, atropin, and amyl nitrite also pro¬
duce relaxation. Pilocarpine and peptone cause apparent contrac¬
tion, but this is solely due to swelling of the liver pressing on the
gall-bladder.

The experiments do not show any contraction of the gall¬
bladder following the application of acid or the products of gastric
digestion to the duodenal mucosa or the biliary papilla, nor any
contraction on electrical stimulation of the biliary papilla, or on
rapid distension of the gall-bladder. The authors, however, state
that they draw no conclusion from this as to the existence of such
reflexes in unansesthetised animals. Percy T. Herring.

ABSTRACTS

THE PARALYSIS OF INVOLUNTARY MUSCLE. Part II. On
.(12) paralysis of the .sphincter of the pupil, with special reference
to paradoxical constriction and the functions of the ciliary
ganglion. H. K. Anderson, Joum. of Physiol., Nov. 9, 1905,
p. 125.

The pupil after excision of the ciliary ganglion or oculo-motor nerve
sometimes becomes smaller than the one which has its nerve supply
intact. Although the sphincter pupillse is paralysed, the muscle
under certain conditions is contracted. Anderson calls this
" paradoxical pupil-constriction," a term corresponding with that
of "paradoxical pupil-dilatation,” in which there is dilatation of
the pupil after section of the cervical sympathetic or excision of
the superior cervical ganglion.

Anderson by experiments on cats excluded the possibility of
there being any nerve fibres from the sympathetic in the ciliary
ganglion, or the possibility of injury to the dilatator fibres in
removal of the ganglion or section of the short ciliary branches
near their origin.

After excision of the ciliary ganglion the pupil of that side is
widely dilated under normal conditions, but if the animal is killed
a few days after the operation the pupil soon after death begins to
contract, and in some hours’ time is tightly contracted, while the
other pupil has dilated. The same effect is produced by dyspnoea
under an anaesthetic, but not so readily as is the phenomenon of
pupil-dilatation after section of the sympathetic; the latter is
easier to produce, and comes on sooner. Local paradoxical con¬
striction of the pupil can be brought about by section of individual
short ciliary branches close to the ganglion.

The probable cause of paradoxical constriction is a primary
increase of excitability of the muscle after paralysis, and some
local stimulation of the sphincter. The latter may be the lack of
oxygen, excess of carbonic acid, or the formation of some substance
such as sarcolactic acid.

In a further series of experiments the oculo-motor nerve was
divided in one orbit, and the ciliary ganglion removed from the
other. In some a slight inequality of the pupils resulted, but did
not persist. There is no evidence of the decentralised ganglion
having any power of sending out augmentor or inhibitory
impulses.

After removal of the ciliary ganglion no fibres degenerate in
the third, fourth, fifth, or sixth nerves, so that the ganglion does
not contain cells comparable with those of the posterior root
ganglia. Removal of the ganglion does not cause lesions of the
cornea. Percy T. Herring.

ABSTRACTS

THE LAWS OF ERGOGRAPHY, A PHYSIOLOGICAL AND
(13) MATHEMATICAL INVESTIGATION. (Let Lois do l’Ergo-
graphie, dtnde physiologique et mathdmatiqno.) J. Iotkvko,
Ann. <F Eledrobiol. et de Radiol ., No. 2, 1905, p. 259.

We have here the first instalment of what promises to be an in¬
teresting and valuable contribution to that growing body of
literature in which an attempt is made to introduce the exact
methods of mathematics into physiology. In an age which has
seen Sir William Ramsay conjure new elements into existence by
mathematical abracadabra, and Professor Thomson lay down the
law to the very constituents of the atoms, the efficacy of the
methods cannot be disputed. The only doubt is whether our
knowledge of physiological processes is sufficiently detailed to
allow of their application. In the introductory part of her paper,
Mile. Ioteyko deals with this question with special reference to
ergograms.

While admitting that our knowledge of the course and result
of movement is not sufficiently intimate for us to predict its law
a priori, the writer nevertheless believes that we may be able to
discover empirically a formula which shall not only serve as a
concise expression of our present knowledge, but also as an
instrument to guide further research.

Every ergogram is a curve, and as such lends itself to mathe¬
matical expression. The equation to a curve is simply such an
expression of the relation between its constituent parts as enables
us to draw the curve. To take a simple example. The curve of
fatigue described by the calf muscle of a frog has been shown by
Kronecker to be a straight line: that is, each contraction differs
from the one which precedes it by the same amount. The equation
to such a curve would be

F n = Yo —

whereby Y n is the height of any contraction, n the number of con¬
tractions which have preceded it, Yo the height of the first contrac¬
tion, and 1) the constant difference. The fatigability of the muscle is
evidently indicated by the constant D, which is characteristic of
each frog, and would have to be determined by experiment.

Ergographic curves are almost never straight lines, hence one
constant is in their case insufficient. But we know that fatigue
may be caused in several ways, c.g. by the using up of the muscle’s
reserves or by the action of toxic products, and by introducing
several constants into the equation we may find it possible to dis¬
tinguish the portion of the total effect due to each of the several
causes.

By far the commonest type of ergogram is that in which the

ABSTRACTS

curve descends rather quickly at first, then continues for some
time almost parallel to the axis of the abscissa, to which it finally
falls more or less rapidly.

The writer points out that hitherto in ergographic studies the
form of the curve has been greatly neglected. The difficulty of
defining it is indeed serious, so much so that Binet and Vaschide
have proposed to substitute for it the height to which the weight
has been raised by the middle contraction. This result would
serve to show whether the initial force has been well maintained,
or has diminished rapidly.

By Kraepelin first, and subsequently by Dr Ioteyko herself,
two elements in the curve have been distinguished, viz. the number
of the contractions and their height, and it has been shown that
the variations of these two factors are not always parallel to one
another.

I. First Attempts at Mathematical Determination .—As these
early attempts did not lead to results of any permanent value, and
as their interest is mainly historical, I shall not attempt to sum¬
marise the methods described.

II. General Equation to the Curve of Fatigue .—The starting-point
of the investigation is the fact established by Mosso, that for the
same individual in the same circumstances the ergogram remains
the same. The best way to demonstrate this fact is to take two
tracings at the same sittiug, sufficient time for the muscle to rest
being, of course, allowed between the tracings. The second ergo¬
gram will be found to be an exact duplicate of the first This
regularity in the curve indicates that some law conuects its
variables, i.e. the time (or abscissa) and the height of contraction
(or ordinate). The problem is to find this relation.

Any fatigue tracing is taken, and the curve formed by joining
the tops of the ordinates is made regular: for this it will be found
that only the slightest possible change is necessary. The normal
type of curve has only one turning-point, i.e. only one point at
which the tangent passes from one side of the curve to the other.
The equation to such a curve is of the third degree. The following is
the equation resulting from general mathematical considerations:—

v = H—at z +bt i —ct

ij being the height of contraction at any given moment, H the
maximum' initial effort (in millimetres), t the time (unit of time = 2
seconds), a, b, c, constants or parameters.

The meaning of this mathematical law is that the ergographic
curve is at any given moment under the influence of three factors
(the constants), one of which, b, tends to raise the curve in propor¬
tion to the square of the time, while the others, c and a, tend to
lower it in proportion respectively to the time itself and to its cube.

ABSTRACTS

The constants have to be ascertained by direct inspection of the
tracing. The operation is obviously an easy one: it involves three
measurements of ordinate and abscissa, which give us three equa¬
tions of the first degree. From these it is a simple matter to
determine a, b, and c. The rest of this section of the paper is
devoted to the working out of an illustrative example.

III. The Place of J. Ioteyko's Quotient of Fatigue. —The
“ quotient of fatigue ” is the ratio existing between the sum of all
the contractions and their number. It is thus the average or mean
of the ordinates. The object of the present chapter is to point out
that the relation of the quotient of fatigue to the time can easily
be obtained from the general equation to the curve.

From the definition of the quotient (Q) and summation of the
series the writer obtains the following result:—

Q = -^ ndt = H — | otf 8 + J bt*—\ ct

rt representing the area, that is to say, the sum from 0 to t
/ o n 1 of the contractions supposed continuous, multiplied by dt f
an interval of time infinitely small.

The quotient of fatigue is thus a quantity strictly linked to the
equation, and as it is a quantity which has a physiological meaning,
we may conclude that the equation itself is closely connected with
physiological characteristics.

IV. Mathematical Characteristics of the Curve of Fatigue. —We
know that for every individual there exists a characteristic ergo-
gram, amount of mechanical work, and quotient of fatigue. We
are now enabled to express the same thing in mathematical language
by saying that for every individual the values of the constants
remain the same. The vague graphical notion of the form of the
curve now becomes definite, seeing that four numbers (viz, H and
the parameters, a, b, c, see equation above in II.) are sufficient
fully to determine it. Individual variations are expressed by
differences in these numbers.

An individual’s curve may be affected in various ways, as by
the ingestion of alcohol, caffeine, and many other substances.
Such alteration means a change in the constants, and it ought to
be possible to find out which of the constants are affected by these
substances, and in what direction. A comparison of the ergograms
of the two sexes, of the right and left hands, etc., may also bring
to light determining mathematical characteristics, and “in all
these cases the differences will be expressed by numbers, which
constitutes the greatest perfection to which a science can attain.”

Margaret Drummond.

ABSTRACTS

THE STRUCTURE AND FUNCTION OF THE TA8TE-BUD8 OF
(14) THE LARYNX. John Gordon Wilson, Brain, 1905,
p. 339.

In the larynx the taste-buds, first described by Verson in 1871,
are found on the laryngeal surface of the epiglottis and the medial
and lateral aspects of the arytenoids. They are usually met with
in groups and never closely packed together as in the tongue.
They are only found in the squamous epithelium and do not
project beyond the surface, but lie in a very shallow saucer-like
depression. Each rests on a broad papilla of dense connective
tissue.

Like that of the tongue, the laryngeal taste-bud has two types
of cell—the spindle-shaped cell and the supporting cell—and also
a flask-shaped cavity in its upper segment.

The spindle-shaped cell extends the whole length of the bud,
terminating in a long fine process reaching down to the connective
tissue of the papilla. Peripherally it is prolonged into a long, fine,
hair-like process projecting into the cavity of the taste-bud. The
evidence in favour of a special sense function of this cell is based,
firstly, on the fact that it colours readily with neurotropic dyes as
opposed to a non-colourability of the supporting cell, and secondly,
on its morphological character.

The second type of cell—the supporting cell—differs in no way
from the corresponding cells in the taste-buds of the tongue.

The mode of ending of the nerves in the taste-buds of the
larynx is very complex. There is a sub-epithelial plexus com¬
posed of both medullated and non-medullated nerve fibres. From
this plexus go to the taste-buds at least two nerve fibres, some
medullated and others losing their sheath at a varying distance
between the plexus and the bud. These fibres divide repeatedly
at the base of the bud and two systems can be made out—those
that break up to form a plexus at the base of the bud with
prolongations within the bud, and those which go more or less
directly round the bud. The latter may branch in the plexus,
but there is no anastomosing of the branches as occurs in the
fibres of the plexus.

In this complex arrangement three groups of nerve fibres are
distinguished—the subgemmal plexus, the intragemmal nerve fibres,
and the perigemmal nerve fibres.

The so-called intragemmal nerve fibres are nerves distributed
to the epithelial cells which lie between the buds.

The subgemmal plexus lies in the connective tissue and may
begin at some distance beneath the bud. It is formed by an
anastomosis of one or more fibres which come from the sub-
epithelial plexus.

ABSTRACTS

The intragemmal fibres arise both from the subgemmal plexus
and directly from the sub-epithelial plexus. They form a branch¬
ing and interlacing network around the cells, and knob-like endings
most marked at the upper third of the bud lying on the cells.

The perigemmal fibres form a plexus of non-medullated varicose
nerve fibres which lie around the bud, forming at the apex a circle
round the pore. They arise from medullated nerve fibres coming
from the sub-epithelial nerve plexus, and losing their sheath before
reaching the base of the bud.

The author has never seen any ganglion cells either in prepara¬
tions by the Golgi method or by vital injection.

The investigations of the author corroborate the statements of
Michelson (91) and Kiesow in demonstrating that taste can be
perceived in the upper part of the larynx. Taste perception was
found to be rapid and sufficiently accurate to differentiate more
or less definitely the four primary tastes, though quantitatively
and qualitatively inferior to the tongue.

The following hypotheses have been advanced to explain the
presence of taste-buds in the larynx: they are a phylogenetic
residue, or else they are organs whose chief function is to
strengthen the reflexes which close the laryngeal cavity during
the passage of food. The author inclines to the view that the
reason for their presence in the larynx must be sought in the
intricate mechanism of deglutition. The most suitable end organ
in protecting the larynx during the passage of food would be one
whose natural stimulus is food. Golla.

PATHOLOGY.

A CONTRIBUTION TO THE PATHOOENB8IS OF PARALYSES
(15) EXPERIMENTALLY INDUCED BY INFECTION WITH
PNEUMOCOCCI. (Bin Beitrag zur Kenntniss der Pathogenese
der dutch Infektion mit Pneumokokken experimentell erzeugten
Paralyses) Luigi Panichi, Arch.f. exper. Path. u. Pharmak.,
1905, Bd. liii., S. 339.

Some of the rabbits exhibited signs of paralysis a few hours after
injection with pneumococci, and soon died. In others the paralysis
(usually of one or more limbs) was delayed, not commencing until
one or more weeks had elapsed after the last injection. In both
the acute and chronic cases some of the nerve cells in the anterior
and posterior horns of the cord showed signs of degeneration—
absence of Nissl’s granules, vacuolation of the protoplasm, excentric
nucleus, and shrinking of the cell, the pericellular space which was
thus enlarged being filled with small round cells.

ABSTRACTS

In the acute cases, haemorrhages in the cord were infrequent,
whereas in the chronic cases small haemorrhages in the cord were
so frequent as to be almost constant. The haemorrhages were
most abundant in the dorsal region, and were more frequent in
the grey than in the white matter, but not more numerous in the
anterior than in the posterior horn. Degenerated fibres were
observed in the peripheral nerves. The haemorrhages were con¬
fined to the cord, there being none in the lungs, intestines, etc.

In one sheep, motor paralysis with anaesthesia of three limbs
commenced five days after injection of the virus. The post-mortem
findings were thickening of the vessels of the pia, and congestion
and haemorrhages in the cervical portion of the cord. A transient
and lesser degree of paralysis was noted in two horses after they
had been repeatedly injected with pneumococci.

The author concludes that the paralyses were the result of
haemorrhages in the cord, and that the latter were due to morbid
changes in the walls of arteries and veins.

W. T. Ritchie.

an experimental research on the anatomical

(16) LOCALISATION OF THE SYMPTOMS OF DELIRIUM
WHICH ARE PRODUCED BY THE TOXINES OF
PELLAGRA. (Ricerche sperimentali sulla localisations
anatomies dei sintomi di delirio da tossici pellagrogeni.)

Carlo Ceni, Annali di Nevrologia, Fasc. 3, 1905.

This is a preliminary note of an investigation on the anatomical
localisation of the symptoms of toxic delirium which are produced
in dogs by the injection of toxins which are derived from some
varieties of Aspergillus and Penicillium, and which give rise to ex¬
citement and convulsions. These toxins are quite distinct from
the other group obtained from Aspergillus and Penicillium, which
give rise to depressing and paralytic symptoms.

The symptoms appear about half an hour after the injection of
the toxines and last for about two hours.

The delirium is accompanied by motor excitement, which con¬
sists of marked tremors all over the body, and of convulsions.
The symptoms vary in intensity with the virulence of the toxine
employed. In these experiments the author has attempted to
localise the seat of disturbance by removing various portions of
the cortex of the brain, and he has arrived at the following
results:—

1. The toxines in pellagra, which possess an exciting and con¬
vulsive power, offer a remarkable elective action on the cortical

ABSTRACTS

centres, while they have no functional action on the centres of the
spinal cord, of the bulb, or of the basal ganglia.

2. These toxines act by irritating and exciting all the cortical
centres, both psycho-motor and psycho-sensory, in a diffuse
manner, without showing any special selectivity for one more
than for another.

3. The whole of the cerebral cortex of the dog, but especially
that of the occipital lobes, is concerned in the production of
this delirium.

4. The motor phenomena would appear to be localised in the
motor zone, employing that term in its strictest sense.

R. G. Rows.

THE PARATHYROID GLANDS IN GRAVES’S DISEASE. By

(17) Laurence Humphrey, Lancet , Nov. 11, 1905, p. 1390.

The object of the author’s inquiry was to ascertain whether there
is evidence of any pathological change in the parathyroids in
Graves’s disease, more particularly in the acutely fatal form of the
disease. A comparison of the acute symptoms in this condition,
with the results of parathyroidectomy in animals, suggests that
some changes might be found.

The parathyroids from four cases of Graves’s disease were
examined. In two cases the parathyroids were extensively in¬
filtrated with fat, which was intruded between the columns of
gland cells, and in part only a few scattered epithelial cells were
left between the masses of fat, which largely replaced the gland
tissue. In the third case there was a lesser degree of fatty infiltra¬
tion of the parathyroids, and the gland cells appeared to be de¬
generating. In the fourth case there was no fatty infiltration; the
protoplasm of the cells was diminished, and their nuclei large and
crowded together. In none of the cases did the parathyroid glands
show any signs of compensatory hypertrophy or any evidence that
they were becoming more specialised and forming colloid.

In addition to those four cases of Graves’s disease, the para¬
thyroids were examined in eighteen cases of death from various
causes. The gland tissue exhibited fatty infiltration in five
cases.

It would be premature without further observations to regard
the partial disappearance of gland tissue in the parathyroid and its
replacement by fat as a pathological feature of Graves’s disease, or
as associated with the severe symptoms in the fatal form of the
disease. W. T. Ritchie.

ABSTRACTS

CLINICAL NEUROLOOT.

THE AFFERENT NERVOUS SYSTEM FROM A NEW ASPECT.

(18) Henry Head, Brain, Part XI., Nov. 1905, p. 99.

THE CONSEQUENCES OF INJURY TO THE PERIPHERAL

(19) NERVES IN MAN. Henry Head and James Sherren,
Brain, Part XI., Nov. 1905, p. 116.

These two papers are the first of a series of communications, each
of which will deal exhaustively with different aspects of a new
hypothesis of sensory innervation. This hypothesis is based upon
the careful observation of a large number of cases of nerve injury
which are here given with all necessary detail Many of these
cases have been watched for a considerable time, during which the
individual phenomena were minutely studied. In addition, and of
equal importance, observations of a most minute and detailed
character have been made on one of the authors (Head), who had,
on April 28,1903, the radial and left external cutaneous nerves of
the left arm cut for the express purpose of observing the changes
resulting from section and repair of cutaneous sensory nerves.
This operation will become a classic, not only for the splendid
observations obtained as a result of it, but also because the opera¬
tion was voluntarily undertaken in the interest of science, entailing
no little risk and very considerable suffering.

When a peripheral nerve, such as the ulnar or median, is cut
at the wrist, alterations in the sensibility of the skin supplied by
the cut nerve at once follows. The following changes can be
made out. In a limited area all sensation in the skin is destroyed.
This area of total analgesia is therefore solely dependent on the
cut nerve for its supply. Surrounding this area is another with a
partial loss of sensibility, and with the character of this impaired
sensation a goodly portion of these researches is taken up. This
area shows the following characteristics: Stimulation by the prick
of a pin is felt more severely than over healthy skin. The pain is
of a more widespread character, and the site of stimulation is not
always accurately localised. The patient cannot tell the two
points of a compass when separated by less than 2 centimetres.
The power of recognising differences in temperature is so far inter¬
fered with that he cannot recognise cold above 22° C. or heat below
40“ C. In considering the peculiarities of this area it is not the
fibres of the cut nerve that show this modified sensibility, but the
fibres of neighbouring nerves that supply certain forms of sensa¬
tion to this impaired area. It is proposed to designate this limited
and altered sensation by the term Protopathic sensibility, while
the additional elements that go to make up normal sensation are

ABSTRACTS

designated Epicritic sensibility. Epicrotic sensibility presents very
well marked and definite qualities, such as greater sensitiveness to
touch, as shown by the recognition of gentle stimulation, as by
cotton wool, the more precise and definite sense of localisation, the
perception of the two points of the compass as distinct when
separated by less than 2 centimetres, and the discrimination of
fine grades of temperature.

Epicrotic sensibility is not only an addition to the protopathic
sensibility, but its presence has a remarkable iuhibitory or modify¬
ing effect upon the protopathic sensibility, inasmuch as the pain
felt by a prick is less severe, and the radiation of the pain and of
cold is much less extensive, than when protopathic sensibility is
alone present.

There is a third form of sensibility, namely, a deep sensibility,
which responds to pressure and to movements of joints. It is
capable of evoking pain when the pressure is excessive or when
a joint is injured. It is best demonstrated in a part where the
skin is totally analgesic owing to division of a purely sensory nerve.
For the reason that it is thus present when the skin is totally
insensitive, it is inferred that the sensory nerves supplying deeper
structures, as the muscles, tendons, bones, and joints, reach their
destination, not by the purely sensory nerves, but by the nerves
supplying the muscles. Support for this inference is found in the
facts that Sherrington has found afferent fibres in the nerves
supplying the muscles, and that section of motor nerves deprives
the muscles and deep structures of all sensation. If an injury
severs the ulnar nerve at the elbow before the muscular branches
are given off, then deep sensibility of certain of the fingers is
destroyed. But if the ulnar is cut at the wrist, then the deep
sensibility of the fingers persists. If at the wrist the injury severs
the tendons as well as the ulnar nerve, then the deep sensibility
of these fingers is lost. Hence it is argued that the fibres supplying
the deep sensibility of those fingers reach their destination by
running along the tendons.

The sensory mechanism in the peripheral nerves is thus found
to consist of three systems: (1) deep sensibility, (2) protopathic
sensibility, (3) epicrotic sensibility. A vast amount of information
is to be gained by studying the phenomena that accompany the
gradual repair of the nerve. There is invariably a very considerable
delay after complete division before sensation begins to be restored,
and the restoration of sensation is pursued in a very orderly
manner. The first sign of recovery is shown by a diminution
in the size of the analgesic area due to the gradual 'spreading over
it of protopathic sensibility. This proceeds until the whole analgesic
area is covered by protopathic sensibility. The time that elapses
from the division of the nerve to the beginning of recovery usually

ABSTRACTS

extends to two or three months, while it may be more than six
months before complete restoration of protopathic sensibility takes
place. After protopathic sensibility has been completely restored,
there is often a pause of two or three months before any sign of
improvement takes place in the epicrotic sensibility. When it does
begin to recover, the first sign is shown in a blurring of the margin
that separates the protopathic sensibility from the normal sensi¬
bility of the skin. There is a simultaneous return of all the
different forms of sensation by which epicrotic sensibility is recog¬
nised—of light touch, of better localisation, of appreciation of finer
grades of temperature, and so on. This recovery is very gradual,
and in most cases takes more than a year to complete. Any
hmurance to the healing of the wound delays the return of the
higher forms of sensation.

If a nerve has been bruised or incompletely divided, it may
fail to conduct impulses, and the resultant loss of sensation may
in the first instance resemble that which follows complete division.
Recovery, however, in such cases pursues a course different from
that which follows complete division of the nerve. Thus at the
end of a period which varies with the extent of the injury, the
sensibility to prick and to light touch return simultaneously, and
as recovery progresses protopathic and epicrotic sensibility return
together. By observing the form of recovery, one can tell whether
the injury has completely severed the nerve or merely injured it

A difference in the distribution of protopathic and epicrotic
sensibility is observed depending partly on the distance of the cut
nerve from the spinal cord. Thus section of a peripheral branch
of a nerve near its final distribution presents a different result from
section of a nerve near its exit from the spinal cord. If the fore¬
arm and hand be divided into a pre-axial (radial) and post-axial
(ulnar) half, it is found that the nerves supplying one of these
halves overlap only to a slight extent the areas supplied by
the nerves of the other half, while the peripheral branches that
supply one of these areas overlap among themselves to a very con¬
siderable extent. Thus section of the internal cutaneous high in
the arm produced an area of total analgesia embracing the greater
portion of the ulnar half of the forearm and hand, while at the
same time the epicrotic sensation was lost over the remaining
portion of the ulnar half of the forearm and hand. This shows
that there is very little overlapping of the nerves supplying the
radial half of the forearm with the field supplied by the internal
cutaneous. Division of one of the two branches of the internal
cutaneous presents a very different result—the overlap being so
great that little or no analgesia results from section of one branch
only.

Injury to the cords of the brachial plexus produces not only

ABSTRACTS

very considerable changes in the sensibility of the parts supplied
by the nerves constituting the cord, but they sometimes show a
great difference in the relationship of protopathic and epicrotic
sensibility compared to what happens in sections of a peripheral
nerve. Here the areas of protopathic and epicrotic sensibility are
nearly co-extensive.

A further difference in the relationship of these two forms of
sensibility is shown when the posterior nerve roots are cut. In
two cases division of several posterior nerve roots resulted in the
loss of protopathic sensibility over an area greater than that of
epicrotic sensibility, that is to say there was an abolition of the
sensation to prick over an area larger and more sharply defined
than that which became insensitive to light touch. Moreover, this
insensibility to prick was accompanied by an inability to appreciate
temperature below 15° C. and above 60° C., although 40® C. and
23® C. appeared definitely warm and cool.

In addition to the description of the three forms of sensibility,
a number of other points bearing on the distribution of the nerves
and on the peculiarities of the various sensations are discussed.
The nerve supply of the forearm as shown by changes in sensation
due to section of separate nerves is compared with the usual
anatomical description. The nerve supply of the leg is studied
from the same point of view. The characteristic features of deep
sensibility, sensations of heat and cold, the compass test, hair
sensibility, hyperalgesia, changes in the skin and nails after injury
to nerves, are all minutely detailed.

The papers are illustrated by a large number of excellent
drawings that show at a glance the areas affected, and a large
number of illustrative cases are given in the text and in the
Appendix. James Mackenzie.

A CASE OF NEURITIS, POSSIBLY ATTRIBUTABLE TO
(20) WORKING WITH ARTIFICIAL MANURES. (Bur un

Cas de Nlvrite du peutdtre & l’Us&ge d’Engrais Artificials.)

Babinski, C. R. Soc. de Neur. de Paris , Jan. 12, 1905.

A symmetrical bilateral paralysis of the extensors of the wrist
and of the proximal phalanges in an agricultural labourer. When
one electrode of a galvanic circuit is placed on the back and the
other on the middle of the posterior aspect of the forearm, closure
is accompanied by abrupt flexion of the hand and fingers, which is
immediately followed by a somewhat slower contraction of the
extensors corresponding. The explanation probably is that the
former group comes within the field of electrical excitation, and is
the first to react, inasmuch as the extensors are deprived of the

ABSTRACTS

stimulating influence of the nerves that supply them, and therefore
react more slowly.

It is possible that the presence of arsenic and lead in the im¬
pure superphosphates which compose the artificial manure with
which the patient has to deal may have been the exciting cause of
the neuritis. S. A. K. Wilson.

MULTIPLE SCLEROSIS IN THE GUISE OF TRANSVERSE
(21) MYELITIS. (Multiple Sklerose unter dem Bilde der Myelitis
transversa.) Morawitz, Munch, med. fPchnschr., Not. 7, 1905,
p. 2170.

The writer records two cases of undoubted disseminated sclerosis
which for a time during their course showed the symptoms of
transverse myelitis. He remarks that, out of the immense variety
shown by cases of disseminated sclerosis in their earlier stages,
only a limited number have been recorded as belonging to this
type, and he gives seven references to other cases.

In one case, that of a farm worker seventeen years old, the
patient suddenly developed, at the age of fifteen, after a chill, a
weakness and numbness of the right side of the body. This passed
away in a fortnight, and left the patient quite healthy till two
years afterwards (June 1902), when he sustained a severe fall
upon the back of the head, followed a week later by a thorough
wetting. Soon afterwards a feeling of weakness and numbness in
both legs appeared and passed rapidly into complete spastic para¬
plegia, the legs being absolutely helpless, the patient unable to
pass urine or faeces, a large bedsore forming, and partial anaesthesia
being present below the level of the ninth dorsal spine. Never¬
theless this condition gradually passed off, and in February 1903
the patient had lost his paralytic condition and presented only
somewhat active reflexes. In May 1903 he was able to resume
light work in the fields. In May 1904 he complained again of
numbness in arms and legs, and on examination again showed
spastic paresis of the lower limbs, with diminished sensibility. By
October 1904 these symptoms had developed into those of an un¬
doubted multiple sclerosis, including double optic atrophy, scan¬
ning speech, intention tremors, and bladder and rectal trouble.

In the other case a man, aged fifty-two, came under observa¬
tion in May 1905, with the history that since 1884 he had suffered
now and then from pains and weakness in the right arm and leg
sufficient to confine him to bed for a month at a time. In January
1904 the weakness of the right leg was very marked, and the left
leg gradually became affected. The weakness increased till he
became unable to move the limbs or voluntarily pass his evacua¬
tions. In May 1905 the lower limbs were rigid, the knee- and

ABSTRACTS

ankle-jerks much increased, the Babinski sign present in both
feet, but there was no affection of the cranial nerves nor of the
fundus oculi. The patient died in August 1905, and the post¬
mortem examination showed grey sclerotic patches scattered
through the cord from the middle of the dorsal region downwards,
as well as in the cerebrum, though there were none in the cere¬
bellum, pons, or medulla. John D. Comrie.

MINOR AIDS IN THE EXAMINATION OF OASES OF BRAIN
(22) DISEASE. (Kleine HilHsmittel bei der Unterauchung von
Gehimkr&nken.) H. Liepmann, Deutsche med. Wchnschr
Sept. 21, 1905.

Liepmann promises a more complete work on the technique of
clinical examination in cases of brain disease, but in the meantime
suggests various methods which enable one to carry an examination
a little further than is frequently done. 1. A patient may react
so little to questions and demands that the physician is in doubt
as to whether there is not a general dulling of consciousness or
marked dementia. If one by means of gesture can bring the
patient to imitate movements, it is obvious that the defect is
circumscribed and not general. 2. Sometimes it is difficult to
determine whether speech is understood by the patient: e.g. a
motor aphasic cannot give verbal answers, and one has to depend
upon his reactions to spoken orders. Here there is a source of
misinterpretation, for a patient whose right-sided hemiplegia is
due to a cortical focuB, especially if aphasic, frequently shows
apraxia in the left hand as well. A false reaction to a spoken
order may depend, therefore, on the apraxia and not on failure to
understand the order. Where apraxia is present, it is not as a rule
general; one must seek out a non-apractic muscle group, and by
the reactions of this group come to a conclusion about the under¬
standing of spoken orders; the muscles of facial expression often
escape the apraxia. Even if the apraxia be general, one can still
get the information sought by using the emotional reactions of
patient; if one ask patient an insulting question or a grotesque
and amusing one, his emotional reaction enables one to determine
how far it is understood. 3. Where the patient cannot read, the
question arises whether it is due to mind-blindness or to a defect
of primary identification or perception. There are various methods
of determining the extent of the visual field, the condition of the
colour sense, visual acuity. If a patient be asked to pick up peas
spread upon his table, and if he fails to pick up those on one side
of the visual field, hemianopia is probably present. The introduc¬
tion of an object of special interest to the patient into his visual

ABSTRACTS

field is also a useful test. Visual acuity can be tested by means
of figures, or by asking the patient to pick up small particles of a
substance. 4. Perseveration in reactions is frequently misleading:
the first reaction of a series is the only one to be used if one be
testing a patient with perseveration for mind-blindness. 5. To test
stereognosis is not enough: one should use a variety of articles of
various texture and surface qualities, and see how far patient can
still elaborate the sensation into a complex idea. 6. To test for
apraxia, the following series of reactions should be examined:

(a) to the order of a simple movement, e.g. to spread out fingers;

(b) to the order of an expressive movement, e.g. to salute; (c) to
the order to demonstrate some purposeful movement, e.g. how one
swims ; (d) to the order to show how one uses certain objects,
e.g. smokes a cigar.

One must include both transitive and intransitive movements,
because the “ agnostic ” who does not recognise objects, e.g. a mind-
blind patient, can clench his fist correctly when asked, but cannot
show how to smoke a cigar.

It is very important to observe the spontaneous behaviour of
apractic patients. C. Macfie Campbell.

LACUNAE AND MYELOPATHIC PARAPLEGIA IN THE OLD.

(23) (Les Parapllgies d’origine lacunaire et d’origine mydlopathique
chez les vieillards.) Lejonne et Lhermitte, Arch. Gin. de Mid.,
Nov. 28 and Dec. 5, 1905, pp. 3009 and 3073.

In the progressive paraplegia that so frequently attacks old people
of sixty years and upward, it seems to be possible to distinguish
two types, differing alike in their pathological features and their
clinical expression. One group connects those forms which are
the result of lacunar disintegration in the basal nuclei—a con¬
dition fully authenticated by Pierre Marie, Ferrand, and Catola—
and which may therefore be described as lacunar paraplegias, and
the other includes the myelopathic paraplegias, due to diffuse
polyfascicular sclerosis.

The former is commonly accompanied by indications of im¬
becility and dementia, is of essentially rapid evolution, and is
based on definitely marked pyramidal degeneration; this involves
the direct and the crossed tracts alike, and is often associated with
some sclerosis in the posterior columns. In the latter category
the explanation of the symptoms is a diffuse and disseminated
sclerosis of the posterior, and more especially of the lateral,
regions of the cord, not at all systematised, or obeying any obvious
law of distribution. The fact that examination of the cords of old
subjects free from all indication of nervous lesions in life often
reveals unmistakable arterial disease, is sufficient to illustrate the

ABSTRACTS

discordance between the alterations of the vessels and the extent
of the sclerosis, and to warrant the use of the term “ polyfascicular
sclerosis ” in. preference to medullary arterio-sclerosis.

As far as the pathogeny of the two conditions is concerned, it is
unwise to speak dogmatically. There seems to be little doubt, how¬
ever, that the systematised pyramidal degeneration of lacunar
paraplegia is consecutive to a process of subacute vaginalitis around
the striate arteries of the basal ganglia, but in the myelopathic
type there does not appear to be any relation between irregular
patches of diffuse sclerosis and perivascular disintegration. The
thickening of the adventitia sometimes met with in the blood¬
vessels round the patches is rather the result than the cause of the
sclerosis. S. A. K. Wilson.

LATENT FORMS OF AFFECTIONS OF THE PYRAMIDAL

(24) SYSTEM (Formes Latentes des Affections du Systems
Pyramidal.) Babinski, C. R. Soc. de New. de Paris, Jan. 12,
1905.

The presence of a single or double extensor response may be the
sole persistent indication of a preceding affection of the pyramidal
tracts, and it may occur in the complete absence of any clinical
evidence pointing to the existence of organic disease. The “ fan
sign ” may be taken to signify that there is some disorder of the
pyramidal system; it is more common in infantile than in adult
hemiplegia, more usual in hemiparesis than in hemiplegia, and
more frequently met with in spinal than in cerebral paralysis.

S. A. K. Wilson.

“BLUE DISEASE”—RETINAL CYANOSIS—HEMIPLEGIA FOL-

(25) LOWING ON WHOOPING-COUGH. (Maladie bleue—Oyanose
de Bitines — Hlmipllgie consecutive & une Ooqueluche.)

Babinski and Toufesco, C. R. Soc. de New. de Paris, Nov. 3,
1904.

A short report of a ten-year-old boy, who at the age of three suf¬
fered from a severe attack of whooping-cough of five months’
duration, in the course of which he had an ictus, remaining un¬
conscious for a quarter of an hour. A left hemiplegia followed.
From that time it was noticed that even when at rest he showed
a bluish coloration of his skin and mucous membranes, a condition
which any exertion markedly accentuated. Examination of the
fundus revealed deep cyanosis of the retina and underlying struc¬
tures, with great tortuosity of the veins, which were of a blue-
violet colour. S. A. K. Wilson.

ABSTRACTS

ATROPHY OF THE CELLS OF PURKDJJE. (Atrophia l&mell&ire
(26) des cellules de Pnrkinje.) Andk6 Thomas, Rev. Neurol.,
Sept. 1905, p. 917.

The author describes the case of & woman, set 54, who had
previously suffered from erysipelas, typhoid, and syphilis. Her
feet had been deformed as long as she could remember [talipes
equino varus], greater on the right side than on the left. For
four years before her death she had developed signs pointing to
an affection of the cerebellum. On examination she had slight
nystagmus on extreme lateral deviation of the eyes. The upper
extremities were normal. The lower extremities were deformed
as above mentioned, and the muscles were hypotonic, though not
wasted. There was marked ataxia of the legs and a tremor
simulating that of disseminated sclerosis. She walked on a wide
base with marked oscillations of the trunk and a cerebellar gait.
Rombergism was present. The knee-jerks were increased, especially
the right, the ankle-jerks were diminished, and the plantar reflexes
were extensor in type. There was no diadococinesia. The post¬
mortem examination revealed no gross lesions. On microscopic
examination the following changes were discovered:—

1. In the cerebellum (stained with Picrocarmine ).—In certain
lamellae, Purkinje’s cells had completely disappeared, while in the
immediate neighbourhood they remained normal.

Where the Purkinje’s cells had disappeared their place was
taken by a thick matting of neuroglia fibrils, which in some places
invaded the molecular and granular layers. In other places there
were a number of neuroglial nuclei which formed a distinct layer
between the molecular and the granular layers.

In the molecular layer, numerous amyloid bodies were found,
and the cells in the granular layer were diminished in number and
stained unequally.

The vessels, the meninges, and the central white substance were
healthy.

2. In the spinal cord .—In the sacro-lumbar region the anterior
horns were diminished in size, especially on the right, with diminu¬
tion of the number of the cells and proliferation of the neuroglia
In the same region there were small foci in which neuroglial fibrils
and amyloid bodies were very numerous, and in which there were
no cells.

The author points out that such changes as were observed in
the cerebellum are by no means rare, and he found them in a case
of tabes and of disseminated sclerosis which he examined subse¬
quently. The changes in the spinal cord resembled in many
features the changes in the cerebellum, and he thinks that they

ABSTRACTS

were probably of the same nature; the spinal changes occurring
in infancy and the cerebellar during the last four years of the
patient’s life. T. Grainger Stewart.

PERIPHERAL POST-PARALYTIC HEMISPASM. (H&nispasme

(27) facial ptaphlrique post-paralytique.) Cruchet, Revue Newro-
logique, Oct. 1905, p. 985.

After reminding the reader of the differences between a tic and a
facial spasm, the writer classifies cases of peripheral facial spasm
into three groups. Firstly, there is primitive facial spasm, which
seems to occur in place of facial palsy and under the same condi¬
tions, but is not followed by paralysis; secondly, there is pre¬
paralytic facial spasm, which precedes an attack of facial palsy;
and lastly, there is the post-paralytic spasm, the commonest variety.
Of this latter, he describes a case in detail.

The patient, a girl of 11 years, had an attack of left-sided
facial palsy four years before. This passed off in three months.
About a year later, a tonic spasm was observed to be present in
the orbicularis oculi, narrowing the palpebral fissure on that side.
This gradually increased in intensity. After two years, clonic
muscular twitchings were observed on the left side of the face,
beginning at the left angle of the mouth, later affecting also the
eye and the chin, and causing a dimple on the left side of the
chin. In addition, emotional movements produced a tonic over¬
action of the muscles on that side.

Cruchet considers his case an example of spasm preceding con¬
tracture. The notes of the case, however, would tend to show
that the two conditions developed simultaneously.

Purves Stewart.

SPASM OF THE RIGHT TRAPEZIUS AND FACIAL TIO.

(28) (Spasme du Trapeze Droit ot Tic de la Face.) Babinski, C. R.
Soc. de Neur. de Paris , July 6, 1905.

In opposition to the views of Pitres and Cruchet, who would limit
the application of tic to abrupt muscular twitches of brief dura¬
tion, Babinski holds that the contraction need be neither brief nor
abrupt, thereby adopting the theory of Brissaud and Meige. The
case reported presented the interesting combination of trapezius
spasm—for some of the movements were such as could not have
been imitated by an effort of the will, and they continued during
sleep—with a true grimacing facial tic, which occurred chiefly,
though not exclusively, in the exercise of such functions as speaking
or swallowing. S. A. K. Wilson.

ABSTRACTS

PERIPHERAL FACIAL HEMISPASM. (Hlmispasms facial pdri-

(29) phdrique.) J. Babinski, Now. Icon, de la Salpttrikre, juillet-
aodt 1905, p. 419.

The patient here described suffered from a bulbar lesion, appar¬
ently bilateral, though more marked on the left side. His chief
symptoms were vertigo, latero-pulsion to the left, a bilateral
extensor plantar response, right-sided combined flexion of leg and
pelvis, paresis of the right vocal cord, left-sided hemiatrophy of
the tongue, and left-sided hemiparesis of the face. This latter
phenomenon was succeeded by a left-sided facial hemispasm.

This hemispasm consisted of a series of brisk twitches, short
and in rapid succession, Anally culminating in a tonic spasm
lasting several seconds, similar to what might be produced by a
series of faradic shocks, gradually increasing in frequency. These
attacks were uncontrollable by the patient, and were more frequent
when he was fatigued. The individual spasms began as fibrillary
contractions, limited to a few muscular fibres at first, and pro¬
ducing deformities which could not be imitated voluntarily on the
healthy side, e.g. puckering of the chin, deviation of the tip of the
nose. Moreover, contradictory facial muscles were often thrown
into contraction simultaneously, e.g. the platysma and the levator
labii superioris, the orbicularis oculi and the frontalis. This
characteristic distinguishes facial hemispasm from facial tic, the
latter being psychic in origin and capable of voluntary imitation.
Hemispasm can persist during sleep, whereas a tic ceases then.

Babinski compares the facial spasm of tic douloureux with that
of facial hemispasm of motor origin, the former being due to irri¬
tation of the afferent limb of the reflex arc, the latter to irritation
of the efferent nerve. Purves Stewart.

SYNERGIC PARADOXICAL CONTRACTIONS FOLLOWING PBRI-
(30) PHERAL FACIAL PALSY. (Contractions “ synergiques
paradoxales ” observes k la suite de la paralysis facials pdri-
phdriqus.) H. Lamy, Nouv. Icon, de la Salp&tribre, juillet-aofit
1905, p. 424.

Under the above title the writer describes the well-known clinical
phenomenon that, in many cases of imperfectly recovered facial
palsy, the patient, when he succeeds in innervating the paresed
side of the face, has imperfect control over the muscles and throws
into contraction others that he had not intended.

Lamy’s patient (who also showed the familiar involuntary
fibrillary twitchings of incompletely recovered facial palsy) was a

ABSTRACTS

man of over 60 years of age who had suffered since childhood from
facial palsy of the right side. The muscles most deficient in
voluntary contraction were the frontalis , zygomatici, and levatores
labii superioris. Yet when he closed the eyes, or still more, when
he closed the eye of the paralysed side alone, all these muscles
above-mentioned were thrown into strong contraction. He there¬
fore terms the phenomenon “ paradoxical synergy,” inasmuch as
the contraction of these muscles is illogical and absurd, for the
frontalis is normally an opponent of the orbicularis oculi.

Lamy recalls a similar involuntary movement of the shoulder
which often accompanies facial movement in cases of facio-
accessory anastomosis. And he would explain the “ paradoxical
synergy ” on the same lines, as being due to innervation of the
frontalis and zygomatici by an abnormal part of the facial nerve,
viz. its orbicularis branch. Purves Stewart.

BLOOD - PRESSURE AND NEURASTHENIA (Blutdruck mid
(31) Neurasthenic.) S. Federn, Wiener med. Wchnschr., Nov. 4,
1905, p. 2157.

In this paper the writer replies to certain critics who have thrown
doubts npon his theory that the symptoms of neurasthenia are
attributable to a constantly heightened blood-pressure. The work
to which the writer chiefly animadverts is contained in papers
by Haskovec ( Wien. med. Wchnschr., Nos. 11-17, for 1905). The
heightened blood-pressure which the writer states that he finds in
neurasthenic persons is referred by him in general to peripheral
irritation of the splanchnic nerves brought about by a condition of
intestinal atony, though he allows that it may be caused by dis¬
turbances of other organs. He adduces no new facts in support of
his theories. John D. Comrie.

HYSTERICAL TORTICOLLIS. (Torticollis hystericus.) Kollarits,
(32) Dent. Ztschr. f. Nervenheilk., H. 5-6, Nov. 1905, p. 413.

Details of three cases of spasmodic torticollis are given, and
references to three others previously described. In all six a
neuropathic heredity was evident, although it is stated that
Jendrassik, who also reported on the second series, found
hysterical stigmata in one only. The direct cause of the torti¬
collis was in (1) tremor of the head; (2) paresthesia in neck;
(3) an insignificant blow which directed attention to the neck.
In none of the six was the spasm confined to the region of the
accessorius; other muscles were always involved, giving rise to

ABSTRACTS

the characteristic co-ordinated movements or spasmodic attitudes.
All had discovered some mode of preventing the spasm, which
they exercised without any expenditure of strength and which
could only have had an auto-suggestive influence. Good results,
though not perfect “cures,” were obtained in three cases by
hypnotism and exercises; one was improved by suggestive
methods; in the other two there was no improvement. The
author concludes that every spasmodic torticollis is a mental
one, and as such, a symptom of hysteria, although possibly a
mono-symptomatic hysteria. The treatment can only be by
suggestive methods.

Some good photographic illustrations of the condition are
given. J. H. Hakvry Pirie.

A FURTHER CONTRIBUTION TO THE PATHOGENESIS OF

(33) EXOPHTHALMIC GOITRE. Alfred Gordon, New York
Med. Joum., 1905, Nov. 4, p. 955.

The author describes a case which he regards as a valuable contri¬
bution to the subject of the nervous origin of exophthalmic goitre,
and especially to its probable origin in the medulla.

A middle-aged woman suddenly noticed that she could not
raise her eyes in the normal manner; on the following day there
was inability to turn the left eye externally. A few days later
prominence of both eyeballs gradually ensued. A week later the
neck became enlarged anteriorly, and at the same time cardiac
palpitation and tremor of the hands made their appearance. On
examination there was found exophthalmos, von Gr&fe’s sign,
goitre, tachycardia, and tremor, with paralysis of the third, fourth,
and sixth cranial nerves, unequally distributed on the two sides.

W. T. Ritchie.

SOME INVESTIGATIONS ON THE NERVOUS MANIFESTATIONS

(34) OF ACUTE RHEUMATISM. F. J. Poynton and Alexander
Paine, Lancet, Dec. 16, 1905, p. 1760.

In this paper, which was read before the Neurological Society of
the United Kingdom, the authors refer in the first place to their
well-known views as to the etiology of acute rheumatism. They
firmly believe that rheumatic fever is a definite disease, and,
further, that the diplococcus rheumaticus which they have
described is a cause of the disease. The authors are of opinion
that they have satisfied Koch’s postulates; on the other hand they
“ have never maintained that this diplococcus was specific except
in so far that it is, in our opinion, the only bacterial cause of a
specific disease."

ABSTRACTS

It remains for those who oppose the view that rheumatic fever
is the result of an infection, to demonstrate some infective cause
and to explain the coincidence that a bacterium which has been
found in the arthritis, endocarditis, pericarditis, subcutaneous
nodules, pleurisy, pneumonia, peritonitis, and nephritis of
rheumatic fever, is able to produce similar lesions in animals.
The diplococcus is found with remarkable constancy in suitably
chosen cases. It is very difficult to discover if looked for in
unlikely places, such as the blood and arthritic exudations. The
nature of the organism is a question of secondary importance as
compared with the question as to whether it is the cause of acute
rheumatism. A specific test has not yet been found for the
organism, but this, the authors maintain, in no way alters their
conclusions above mentioned. The peculiarities of the diplococcus
are then described.

In the second part of the paper the authors summarise their
reasons for believing that rheumatic chorea is a local in/ection of
the nervous system, and that most of its symptoms are the result
of a slight meningo-encephalitis and possibly meningo-myelitis.

1. They have isolated and cultivated the diplococcus from the
cerebro-spinal fluid in four cases of fatal rheumatism, in three of
which there was chorea at the time of death.

2. They have produced twitching movements, arthritis,
endocarditis, and pericarditis by intravenous injections of the
diplococcus into rabbits.

3. They have demonstrated the presence of diplococcus three
times in the cerebral pia mater and once in the brain from cases of
chorea.

4. Also in the brain and pia mater of the rabbit that had shown
twitching movements.

The third section of the paper is devoted to Rheumatic
Meningitis, to which it is to be noted they attach a mark of
interrogation. The case was that of a boy, aged 13, admitted to
hospital with what appeared to be an ordinary attack of rheumatic
fever. Under treatment all pain and swelling had disappeared
within four days. For three weeks uninterrupted convalescence
continued. Then he complained of headache, he was sick, and his
temperature rose to 102-4*. Later he became drowsy and collapsed,
cyanosed and pulseless. On the third day after the temperature
had risen he became unconscious, with fixed dilated pupils and
general muscular rigidity, alternating with flaccidity, and died the
same eveuing. The most probable diagnosis appeared to be
cerebral rheumatism.

At the necropsy made fifteen hours after death, early endocar¬
ditis of the mitral valve with a slight left-sided pleuro-pericarditis
was observed. In no part of the body could any focus of suppura-

ABSTRACTS

tion be seen. A meningitis almost entirely basic in distribution
was found. A good deal of turbid fluid was present, with flakes of
exudation. There was also a general spinal meningitis. Minute
diplococci were found in pus from the cerebro spinal fluid.
Cultures from the cerebro-spinal fluid in bouillon, milk, and
glycerine agar contained a pure growth of the diplococcus. Two
rabbits which were inoculated died in twenty-four hours. The
diplococcus was isolated from the blood, and an intravenous injec¬
tion into a rabbit was followed by an arthritis. The diplococcus
was recovered from the damaged joints. The authors believe that
this organism was the diplococcus rheumaticus, notwithstanding
that they observed capsulation in those obtained from the rabbits’
blood, a feature which they admit has hitherto been regarded as a
distinctive feature of the pneumococcus.

Rheumatic meningitis the authors would place midway
between the slight local rheumatic lesions, which they believe
exist in chorea, and acute fatal rheumatic hyperpyrexia, which
they regard as an acute rheumatic toxaemia.

Edwin Bramwell.

A FURTHER CASE OF HBMIORANIOBIS. (Sur un Nouveau Oas
(35) d’Hemicraniose.) Parhon and Nadjede, Rev. Neur., Nov.

15, 1905, p. 1017.

Two years ago, Brissaud and Lereboullet described a curious
condition of cranial hemihypertrophy, with fronto-parietal and
infra-orbital hyperostosis. In one of their cases the autopsy re¬
vealed the existence, apart from the bony changes already men¬
tioned, of numerous tumours on the under surface of the dura
mater, presenting the histological characters of angiolithic sarcoma.
The condition appeared to be the converse of the facial hemi¬
atrophy of Romberg, the trouble being limited to the distribution
of the fifth cranial nerve, especially its ophthalmic branch, but on
the other hand, it did not correspond to what has been described as
facial hemihypertrophy. Some months later, Parhon and Goldstein
published a case in which an exostosis about the size of a nut in
the right anterior parietal region was found post-mortem to be
associated with a similar growth on the under surface of the skull,
and this in its turn exactly fitted into a depression in another
tumour, of the dimensions of a mandarin orange, which was grow¬
ing from the dura and pressing into the greater part of the motor
area and frontal lobe. The latter was an angiolithic sarcoma. Is
this an instance of one tumour serving as a point do dipart tor
another tumour of a different nature ?

The authors report an additional case, the interest of which is

ABSTRACTS

unfortunately neutralised by the paucity of the clinical informa¬
tion and the absence of all reference to the relation between the
clinical and the pathological data. At the sectio on an old woman
with left hemiplegia, a bony excrescence was found of the size of a
nut, springing from the middle and posterior part of the right
frontal bone, and dimpling neatly into a second tumour of the size
of an orange, which grew from the dura and was burrowing into
the right prefrontal lobe. This latter neoplasm was an angiolithic
sarcoma. The authors are content to record the facts.

S. A K. Wilson.

ON THE QUESTION OF INTENTION TBBMOK IN CHILDREN.

(36) (Zur Kasuistik des Intentionstremors bel Kindera.) Urbach,
Devi. med. Wchnschr., Oct. 19, 1905.

The symptoms of four children showing marked tremor upon
purposive movements are recorded. The first two cases are those
of a brother and sister, aged seven and five years respectively.
Both showed tremors markedly in the hands and feet when an
effort was made, but neither presented any other symptoms except
cramps in the hands and feet, of which the girl complained. On
careful examination her urine was found to contain a discoverable
though small quantity of lead. These two cases of tremor the
writer attributes to lead poisoning, though on careful examination
of the children’s surroundings at home he was quite unable to
discover the source of the lead. The tremors in both children dis¬
appeared in the course of a year. Of other two similar cases that
he records the writer attributes one to probable lead poisoning,
though no lead was discoverable in the urine; while the other he
regards as an example of hereditary tremor.

A large portion of the paper deals with the diagnosis of
tremors generally in children, the conditions discussed as likely to
cause tremor being multiple sclerosis, pseudo-sclerosis, cerebellar
ataxia, tumour of the cerebellum or of the optic thalamus, ex¬
ophthalmic goitre, toxic conditions, hereditary tremor, and
hysteria. John D. Comme.

BBMO-ASYMMETRY OF BULBAR ORIGIN. (Thermo-asymetrie

(37) d’origine bulbaire.) Babinski, C. R. Soc. de New. de Paris,
May 11, 1905.

A healthy man, thirty-five years of age, was suddenly seized with
vertigo and staggering of some fifteen minutes’ duration. The next
day he noticed that the whole of the right half of his body was
colder to the touch than the left, and felt colder. On the next

ABSTRACTS

day a friend remarked that his left eye was smaller than the right,
and the conjunctiva was injected. When examined at the hospital
twenty-four hours later, he was found to present a left palpebral
aperture narrower than its fellow, with enophthalmos and myosis
on the same side: the temperature of the left half of the body
was more than a degree above that of the right, which showed a
marked extent of syringomyelic dissociation of sensation, the face
alone not participating. At the end of three weeks the symptoms
had practically disappeared.

Evidently, then—for the lesion must have been situated in the
left half of the medulla or ponto-medullary region—a bulbar lesion
may give rise to vaso-motor and thermic disturbances of hemiplegic
distribution, without causing an ordinary motor hemiplegia. Such
a disorder may be named thermo-asymmetry. A convenient
test for its demonstration is to immerse the hands in cold water
for a few minutes, and compare the after-effects.

S. A. K. Wilson.

TREATMENT.

OUTLINES OF THE TREATMENT OF MENTAL DISEASES.
(38) (Gnudziige zur Behandlung der Oeisteskrankheiten.) S.

Binswanger (of Jena), Deutsche med. Wchnschr ., March 9,
1905.

In the treatment of mental diseases the physician must keep in
mind the individual reaction: this is especially true in the pro¬
phylactic measures to be taken with regard to children with a
psychopathic disposition. Binswanger accentuates the necessity
of a well-regulated life for these children, and calls attention to
the main points which should guide the physician.

He discusses the treatment of the initial stages of mental
disease, and calls attention to two main groups of phenomena—
the anomalies of mood and the signs of mental fatigue. Where
the patient is boisterous and excited, hospital treatment is impera¬
tive ; where he is quiet and depressed, he may be treated at home,
but only if in good circumstances and on condition that there shall
be sufficient skilled nursing and ample accommodation. In de¬
pressed conditions, with much anxiety, Binswanger recommends
a systematic treatment with opium.

Where patients present a primary blocking of thought with
a want of emotional reactions, one must distinguish between the
beginning of a stupor and the first stage of a severe depression.
In the former, treatment should be stimulating; in the latter,
opium and sedatives are indicated. One must be careful not to

ABSTRACTS

overdo treatment in the stuperous cases—massage, gymnastics,
electricity, hydrotherapy; for in exhaustion and toxic cases, stupor
may pass into excitement, and stimulating treatment must cease
as soon as irritative symptoms appear. In conclusion, Binswanger
makes a few remarks on the general treatment adopted in modern
psychiatric hospitals. C. Magfie Campbell.

BALNEATION ET HYDRO THERAPIB DANS LB TRAITRMENT
(39) DBS MALADIES MENTALE8. B. Pailhas. Rennes: F. Simon,
1905, pp. 146.

This monograph is an example of a very useful practice which
prevails in connection with the French Congresses of Alienists and
Neurologists. A specific subject is selected and a certain in¬
dividual is requested to study it fully and present a report on it
to the succeeding congress. In this way much valuable informa¬
tion on current subjects of interest is obtained, and on subsequent
publication in book form this information is made available to a
much wider circle. The book under notice was presented at the
15th Congress held at Rennes in August last.

From the nature of the subject, not much that is new can be
expected in Dr Pailhas’ treatise. It is, however, a very useful
compendium of the experience of a large number of physicians
who have used hydropathy in the treatment of mental disease.
It appears to be much more extensively used and trusted as a
remedial agent on the Continent than in this country. The reason
for this is not by any means clear.

The first chapter contains a short historical review of the
subject The second gives an exposition of the principles on
which the treatment is based. They are of various orders, physical,
dynamic, chemical, and even biological, but in the main the effect
is due to the temperature of the water employed. In a lesser
degree the mechanical effect of percussion comes into play in some
of the applications. By directly influencing the vascular and
nervous mechanisms in the skin a secondary effect is produced in
the cerebro-spinal and sympathetic centres. On the whole the
effects produced are due to this reaction. The reaction is greater
the more the temperature of the water differs from that of the
human body, and naturally cold water is the principal agent in
obtaining the hydrotberapeutic result Another general principle
enunciated is that the greater the difference of temperature from
the normal the shorter should be the period during which it is
applied. When the temperature approaches the normal the effect
is less and less a reaction, and becomes more and more a sedative
one. It is thus possible to choose the hydropathic means best

ABSTRACTS

suited to obtain a therapeutic result. In this connection it
would have been desirable to have stated the results of scientific
experiments on the effects of various baths on healthy individuals,
as has been done with many drugs.

The third chapter contains an account of the various pro¬
cedures and modes of application of hydrotherapy in the treat¬
ment of mental disease. In this, most space is devoted to
the prolonged luke-warm bath, which is so strongly recommended
by many physicians. It is stated to be easy of application, free
from undue risk, and of great value in calming excitement of all
kinds. Its effect must, however, be carefully watched in each
case. Very hot baths, cold baths, sitz baths, douches, sprays of
high, low, and alternating temperature, foot baths, hot and cold
packs, Russian, Turkish, and medicated baths are all fully described
and the indications for their application given. This information
is of such a nature, however, as to be incapable of condensation,
and to obtain it reference must be made to the book itself.

The fourth is a most useful chapter, as it gives a general review
of the indications for the use of these various remedies in mental
cases of all kinds. At the end a few pages are devoted to the
author’s conclusions. If these are correct, alienists in this country
assuredly do not make sufficient use of hydrotherapy as a means
of treatment. The reading of this short work might do something
to lessen such neglect. The author may be congratulated on
having produced a most readable, interesting, and useful book.

Jas. Middle mass.

THE ANTITHYREOIDIN TREATMENT OF EXOPHTHALMIC
(40) GOITRE. (Zur Antithyreoidin-Behandlung der Basedow’schen
Krankheit.) A Eulenburg, Berl. Jdin. FPchnschr., Fest-Nummer
Carl Anion Euoald, Oct. 30, 1905.

The author reviews the literature of the antithyreoidin treatment
of exophthalmic goitre, and records seven cases he has thus
treated. The initial dose is 10 drops thrice daily. This is in¬
creased to 15 drops on the third day, to 20 on the fifth, and to 30
on the ninth day. From the eleventh to the eighteenth day the
dose is gradually reduced, then the drug is discontinued for a
week, and thereafter it is again given in increasing doses as before.

The conclusion is arrived at that antithyreoidin is of some
value in the treatment of exophthalmic goitre, being mainly useful
in the treatment of symptoms. Some cases are distinctly bene¬
fited, both objectively and subjectively, whereas in other cases the
improvement is either slight and transient or there is no benefit
obtained. W. T. Ritchie,

ABSTRACTS

CONCERNING SURGICAL INTERVENTION FOR THE INTRA-
(41) CRANIAL HEMORRHAGES OF THE NEW-BORN. Harvey

Cushing, Am. Journal of Mod. Set., Oct. 1906.

The author draws attention to the importance of realising the
pathology of the so-called “ birth palsies ” or paralyses of cerebral
origin in new-born children. A large number are due to cortical
injury during birth, and as most of the cases are not immediately
fatal, they are serious only from the distressing late consequences
of the injury. The most common cause is a cerebral vascular
lesion, generally a haemorrhage, which is of venous origin, and
results from the rupture of those venous radicles of the cerebral
cortex which are most weakly supported. It may be due to
traumatism at birth or occur as result of severe strain, as by partial
asphyxiation from severe whooping-cough or convulsions.

Cushing examined a large number of new-born infants post¬
mortem, and found that a considerable percentage had died of
intracranial haemorrhage.

The vessels most commonly ruptured are those ascending over
the cortex and opening into the superior longitudinal sinus from
the mid-cerebral region, where they have no support on leaving
the sulci and fissures to enter the sinus. The cranial moulding
during parturition or when forceps are applied lays considerable
strain on these vessels, and may rupture them where they enter
the sinus.

The primary effusion and thickest part of the clot found in
these cases is generally median, and consequently implicates
primarily and most seriously the centres for the lower extremities.

The effusion is generally limited to one side of the falx, but
may be bilateral as in cases of diplegia.

An early diagnosis is important, and in all cases of doubt
lumbar puncture should be performed, where a history of severe
labour or post-partum asphyxia is given. The fontanelle is often
bulging, and may be so light as to show no pulsation. Convulsions
appear a few days after birth and are often unilateral in character.

Some children become epileptics often showing a Jacksonian
type. Attention is drawn to the importance of recognising these
early haemorrhages, and immediate surgical interference is strongly
advised, so as to prevent them reaching the late consequences of
the haemorrhage, so hopeless to treat medically or surgically. He
records four cases treated by turning down a parietal flap and
exposing the motor areas. The appearances seen were a tense
dura mater, often of a plum colour, which on incision revealed a
large amount of blood-clot. This was washed out, and the wound
closed without drainage.

New-born children stand the operation well. Many of the
cases formerly supposed to be infective in origin are probably due
to haemorrhage. E. Scott Carmichael.

BIBLIOGRAPHY

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ANATOMY

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PHYSIOLOGY

JOHN B. WATSON. The Effect of bearing of Young upon the Body-Weight
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JENNINGS. Papers on Reactions to Electricity in Unicellular Organisms.
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LAPICQUE. Recherches sur l'excitabilite SLectrique de different* muscles de
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CLUZET. Loi d’excitation des nerfs par d^charges de condensateur (suite et fin).
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IOTEYKO. Les lois de l’ergographie, 6tude physiologique et math6matique (suite
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COGGI. Sullo sviluppo del sistema nervoso periferico dei Vertebrati e su di una
nuova claasificazione dei principali organi di senso. Monitors cool, italiano ., No.
10, 1905.

HUBERT RICHARDSON. The Thyroid and Parathyroid Glands. Blakiston,
Son A Co., Philadelphia, 1905.

WILKS. Ambidexterity. Sydney Mayle, London, 1905, 3d.

HERING. Grundziige der Lehre vom Lichtsinn. Engelmann, Leipzig, 1905
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MAURER. Untereuchungen zur vergleichenden Muskellehre der Wirbeltiere.

Fischer, Jena, 1905, M. 20.

RAMStROM. Untersuchungen und Studien fiber die Innervation des Peritoneum
der vorderen Bauch wand. Seitrag zur A not. n. Entwick., H. 89, p. 849.

PSYCHOLOGY

GIMBAL. Les inoendiaires. Ann. Medico-Psychol., No. 3, 1905, p. 353.

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AMENT. Em Fall von Oberlegung beim Hund. Arch. f. d. gesammle Psychol ,
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BOTTI. Ein Beitrag zur Kenntnis der variabeln geometrisch-optiachen Strecken-
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KIESOW. Uber einige geometrisch-optische T&uschungene und ttber sogenannte
11 frei steigende ” Vorstellungen und plotzlich auftretende Anderungen des Gemuts-
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CLIFTON TAYLOR, tlber das Verstehen von Worten und S&tzen. Zeitschr. /.
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NEISSER. Individualist und’Psychose. Hirschwald, Berlin. 1900, M.—00.
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ALT. Gber Melodientaubheit und musikaliaches Falschhbren. Deuticke, Wien,
1906, M. 2.

KERN. Das Wesen des mensehlichen Seelen u. Geisteslebene. Hirschwald,
Berlin, 1905, M. 2.40.

MEDEIROS e ALBUQUERQUE. Que 6 uma emo^ao ? Arch. Brasil . de PsyehicU.
e Neurol, Anno i., N. 3-4, 1905, p. 233.

ROSSI. Dell’ attentions collettiva e sociale. 11 Manicomio, Anno xxL, No. 2,
1905, p. 248.

ANGIOLELLA. Sulla gened biologica del delitto. II Manicomio, Anno xxi, No.
2,1905, p. 219.

STIEK. Fahnenfiucht und unerlaubte Entfernung. Eine psychologisohe, paychia-
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The Feeble-minded Criminal. Leading Article, Lancet , Nov. 25, 1905, p. 1550.
RAYMOND PEARL. Some Results of a Study of Variation and Correlation in
Brain Weight. Journ. Comp. Neurol and Psychol., Nov. 1905, p. 407.

Brain Weights and Intelligence. Leading Article, Bril Med. Joum., Nov. 25,
1905, p. 1415.

JOHN E. ROUSE. Respiration and Emotion in Pigeons. Joum. Comp. Neurol .
and Psychol ., Nov. 1905, p. 494.

PATHOLOGY

ALQUIER. Deux cas d’H6t6rotopie du Cervelet dans le canal rachidien. (Soc.
de Neurol.) Rev. Neurol., Nov. 30, 1905, p. 1117.

KATTWINKEL. Scl6rose £pendymaire en plaques ombiliqu6es. Rev. Neurol,
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GUIZZETTI. Pseudo-corpuscoli cromatici del cilindrasse ? Riv. di Patolog. wn?.
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GARBINI. La struttura e la funzione della ipoftsi in alcune forme gravi, con¬
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1905, j). 449.

LUNDQUIST. Nagra nyare bidrag till kannedomen om nervfibriller, saint
darmed fdrknippade forhaUenden. Upsala Ldkare. F&rhand. , Nov. 23, 1906,

p. 86.

LUGARO. Zur Frage der autogenen Regeneration der Nervenfasem. Neurol
Central^., Dec. 16, 1905, S. 1143.

CLARENCE LOEB. Some Cellular Changes in the Primary Optic Vesicles of
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DIAS DE BARROS. Contribui^ao ao estudo da atrophia variooea das dendrites
das cellulas nervosas medullares do porco domestic© sob a ac^ao da pe^onha
da jardrdca pregui$osa. Arch. Brasil . de Psychiai. e Neurol., Anno L, No. 3-4,
1905, p. 261.

LACHE. Sur le nucldole de la oellule nerveuse—Morphologie. Joum. de Neurol ,
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HOWARD. The relation of lesions of the Gasserian and Posterior Root Ganglia
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OUNIOAL NEUROLOGY AND PSYCHIATRY

GENERAL—

ROXO. No^oes geraes sobre o systhema nervoeo. Arch. Brasil, de Psychiat. e
Neurol ., Anno L, N. 3-4, 1905, p. 289.

BIBLIOGRAPHY

MVSCLES—

LEIR et SONNIOT. Myoclonotonie acquise. Rev. dhygibu el de mid. infant.,
No. 5,1905, p. 569.

MEARA. Myotonia Congenita, or Thomsen's Disease. A case. Arch, of PediaL,
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HECHT. Myoclonus Multiplex. Amer. Joum. of Med. Sci., Dec. 1905, p. 1041.
LECLEKC et SARVONAT. Un nouveau cas de Myasthenia gravis. Rev. de
mid., Nov. 1905, p. 862.

PIBIPIEIAL NERVES—

LEREMROURE Plaies du Nerf Radial au tiers supSrieur de l'Avant-braa.
Thise de Paris, 1905.

ACCHIOT& Un oas de NSvrite du Radial (Soc. de Neurol.) Rev. Neurol.,
nov. 30, 1905, p. 1123.

ESPOSITO. Amiotrofle da trauma nervoso periferico. 11 Manicomio, Anno
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BUMKE. Ueber die secundaren Degenerationen nach Verletzung der ersten
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LORTAT-JACOB et SABAREANU. Les sciatiquee raaiculaires. Rev. de Mid.,
nov. 1905, p. 917.

SPINAL CORD—

FELIX ROSE. Du tonus et dee reflexes dans les sections et compressions supl-
rieures do la moelle. Rousselt, Paris, 1905.

Tabes,— CLAPHAM. A Note on Tabes Dorsalis. Joum . Roy. Army Med. Corps,
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EDGEWORTH. On some anomalous cases of Locomotor Ataxy. Bristol Med.-
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Friedreich’s Ataxia. —LANNOIS et POROT. Le oobut dans la maladie de
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Poliomyelitis Anterior Acata. —GOROVITZ. Du Type Radiculaire sup6rieur
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1905.

MORVAN. Contribution h l'6tude de la Paralysie Spinale ant£rieure aigue de
l’adulte. Thise de Paris, 1905.

FLATAU. Die Poliomyelitis anterior acuta. Konegen, Leipzig, 1906, M. 1.

Chronic Anterior Poliomyelitis.— MOLEEN AND SPILLER. Chronic Anterior
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Syringomyelia. - KETCHEN. Notes on a Case of Syringomyelia. Lancet, Dec.
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WEISENBURG AND THORINGTON. A Case of Syringomyelia, with Double
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Paraplegia. —LEJONNE et LHERMITTE Les parap!5gies d'origine lacunaire et
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Syphilitic Paralysis. —NONNE Ein weiterer Beitrag zur Lehre von der
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Spine.— W. E MAW. A Case of Fracture of the First Cervical Vertebra (the
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DRAIN—

TROLARD Au sujet de l'avant-mur. Rev. Neurol., nov. 80, 1905, p. 1068.
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zentren und Uber den Wechsel der Reizefifekte von aer Gehimrinde aus unter dem
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Meningitis.— MAYER tJber traumatische Meningitis. Speyer und Kaerner,
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Memlplegia. —SOC A. Sobre la hemiplegia dolorosa de origen central. Arch.
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BIBLIOGRAPHY

ERNEST FREY. Beitr&ge but Lehre der posthemiplegisohen Bewegungs-
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EDUARD MULLER. Ueber das Verhalten der Blasenthktigkeit bei oerebraler
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JAMES TAYLOR. A Lecture on Intracranial Tumours. Bril Med. Joum.,
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Injury.—LOUIS MOREL. Trois interventions d’urgence pour fractures du cr&ne
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General Paralysis.—MARIE et PELLETIER. Le mal perforant dans la paralyse
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Cerebellum.—E. W. ROUGHTON. A Clinical Lecture on a Case of Cerebellar
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LERI et LABRE. Forme anorm&le de Maladie Familiale (H6r6do-ataxie
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MENTAL DISEASES—

FAUSER. Zur allgemein Psychopathology der ZwangsrorsteUungen und ver-
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TEGTMEYER. Korsako w'scho Psychose mit weitgehender Besserungder schweren
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FRANCO DA ROCHA. Sobre a psychose maniaco-depreesiva. ~ Arch. Brasil . de
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THALBITZER. Melancholic und Depression. Zeitschr. f. PsychiaL, Nov. 1905,
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BENON. Les troubles psychiques ohes les h4mipl4giques organiques intern6 m.
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D’ORSAY HECHT. A Study of Dementia Prsecox. Jorum. Nerv. and MenL
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SANDRI. La formola emo-leucocitaria nella demenza preoooe. Riv. di Patolog.
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BOURNEVILLE. Contribution a l’etude de la d6mence 6pileptique infantile.
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DROMARD. Considerations patnog6nioue sur le mutisme et la sitiophobie'dea
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KNAPP. Die polyneuritischen Psychosen. Bergmann, Wiesbaden, 1905, M. 4.
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GOTTGETREJu. Beitrag zur Khnik der Kinderpsychosen. Zeitschr. / Psychiat ,
Nov. 1905, p. 769. 4

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Neurol., D6o. 5, 1905, p. 521.

8IDNEY SCHWAB, Psychasthenia : Its Clinical Entity illustrated by a Case.
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EL RlfcGIS. Precis de Psychiatric. Octave Doin, Paris, 1905, 10 fr.

GUI*UAL AND FUNCTIONAL DISEASES—

Cherea* —KING. A Study of Chorea Minor. Canad. PraetiL, Dec. 1905, p. 674.
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Nov. 1905, p. 884.

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S6quard’s Epilepsy. Rev. Neurol, and Psuchiat ., Dec. 1905, p. 776.

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d'h6mipl6gie \6gbro avec hgmiatrophie. (Soc, de Neurol.) Rev. Neurol., nov. 80,
1906, p. 1095.

Hysteria.— BRUNS. Die Hysterie im Kindesalter. Marhold, Halle, 1906,
M. 1.80.

VICTOR DE BRITTO. A propoeito de um caso de coxalgia hysterica. Arch.
Brasil, de Psychiat e Neurol., Anno L, N. 8-4, 1905, p. 295.

KOLLARITS. Torticollis mentalis (hystericus). Deutsche Ztsckr. f. Nervenheilk.,
Bd. 29. 1906, S. 413.

LEON TIXIER. Quelques considerations sur un cas d’aphasie hyst&ique con-
sfcutif & un traumatisme important de la region rolandique gauche. Arch. gin.
de mid., nov. 28, 1905, p. 3028.

Neurasthenia.— STERN. Ueber sexuelle Neurasthenie. Leipzig, 1905, M. 1.50.
Exophthalmic Goitre.— CROUZON. Un cas de maladie de Basedow traits par
le S6rum de mouton EthyroidA (Boa de NeuroL) Rev. Neurol., nov. 80,1905,

p. 1118.

IiAIGNEL-LAVASTINE et THAON. Syndrome de Basedow ches une Goitreuse
avec TrophoBdfeme. (Soc. de Neurol.) Rev. Neurol., nov. 30, 1905, p. 1106.
Rheumatism. — POYNTON and PAINE. Some Investigations of the Nervous
Manifestations of Acute Rheumatism. Lancet, Dec. 16, 1905, p. 1760.
GAUCKLER et RIEDER. Un cas de Rhumatisme Chronique pouvant servir de
type de transition entre le rhumatisme chronique proprement ait et les Arthro¬
pathies nerveuses. (Soc. de Neurol.) Rev. Neurol., nov. 30, 1905, p. 1109.
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f. KinderheUk., B. 42, H. 8-4, p. 258.

alcdidusm, etc.—

ARON AD E. Die Alkoholpsychoeen in der psychiatrischen Klinik zu Freiburg,
1887-1905. Speyer und Kaemer, Freiburg, 1905, M. —80.

SPECIAL SENSES AND CRANIAL NERVES—

HOLDEN. The Early Ocular Signs of Dementia Paralytica. Joum. Nerv. and
Ment Dis., Nov. 1905, p. 718.

ALEX ANDER DUANE. Paralysis of Divergence. Ophthalmology, VoL ii.
No. 1. Oct. 1906.

ZENTMAYER. Paralysis of the Upward Movement of both Eyes. Opklhal-
mo logy , VoL ii., No. 1, Oct. 1906.

ARCHIBALD PERCIVAL. The Diagnosis of Ocular Paralysis. Lancet, Deo. 2,
1906, p. 1612.

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HttBNER. Ueber die psychische und sensible Reaktion der Pupillen. Centralbl.
/. Nervenkeilk . u. PsychiaL, Dec. 15, 1905, 8. 945.

GARHAMMER. Thrombose im Gebiete der Vena centralis retinae. Speyer und
K&erner, Freiburg, 1905, M. 1.20.

STEPHENSON. On some of the Diseases and Injuries of the Eye peculiar to
Children. Brit. Jo urn. of Child. Dis., Dec. 1905, p. 540.

BABINSKI. Hyperexcitabilit6 Mectrique du Nerf Facial dans la Paralysie
Faciale. (Soc. de Neurol.) Rev. Neurol. , nor. SO, 1905, p. 1098.

MISCELLANEOUS SYMPTOM8, ETC —

FRENKEL-HEIDEN. Zur Kenntnis der Psychosen nach Erysipel. Monatssehr.
f. Psychiat. u. Neurol., Nov. 1905, p. S83.

THOMAS et LEENHARDT. Un cas de Commotion M6dullaire avee paralysie
des membres supcrieurs eb integrity absolue des membres inf6rieurs. (Soc. de
Neurol.) Rev. Neurol., nov. 30, 1905, p. 1102.

SAXL. Das 11 Streckphanomen,” ein Beitrag zur Kenntnis der Mitbewegungen.
Neurol. Centmlbl., Dec. 16, 1905, S. 1140.

BALLET et TAGUET. Tic inhibitoire du Langage articul6 datant de l’enf&nce.
(Soc. de Neurol.) Rev. Neurol ., nov. 30, 1905, p. 1101.

GEORGE R. STILL. A Lecture on Habit Spasm in Children. Lancet, Dec. 16,
1905, p. 1754.

KIROFF. Le Signe de Babinski dans la Scarlatine. (Soc. de Neurol.) Ret.
Neurol., nov. 30, 1905, p. 1119.

SOUQUES et POISOT. Origine p6riph6rique des Hallucinations des Membres
Amput^s. (Soc. de Neurol.) Rev. Neurol., nov. 30, 1905, p. 1112.

LIEBMANN. Vorlesung uber Sprachstorungen. Heft 6. Blinder, die schwer
lesen, schreiben und rechnen lernen. Coblentz, Berlin, 1906, M. 2.40.
SCHLESINGER Uber Sensibilitatsstorungen bei akuter lokaler Isch&mie.
Deutsche Ztschr. f. Nevvenheilh., Bd. 29, H. 5-6, 1905, S. 375.

ERB. Zur Kasuistik der intermittierenden ongiosklerotischen Bewegungs-
stbrungen (Dysbasie, Dyskinesie) des Menschen. Deutsche Ztschr. /. Nervenheiuc.,
Bd. 29, H. 5-6, 1905, S. 465.

TKEATMENT*—

DOUMER et MAES. Un cas de Paralysie agitante trfcs am61ior6e par le traite-
ment 61ectnoue. Ann. <TElectrohiol. et de Radiol., No. 5, 1905, p. 620.
CHRISTIAN. Quelques reflexions sur le traitement des maladies mentales.
Ann. Medico-Psychol., No. 3, 1905, p. 408.

HUTCHINSON. The Surgical Treatment of Facial Neuralgia. Bale, Sons and
Danielsson, Ltd., London, 1905, 7s. 6d.

SADGER. Die Hydriatik der Psychosen. Centralbl./. Nervenkeilk. tt. PsychiaL,
Nov. 15, 1905, S. 853.

AUFFRET. Transplantations tendineuses dans le traitement de la paralysie
infantile du membre inferieur. These. Steinheil, Paris, 1905.

BROWNING. Some Useful Principles in the Treatment of Cerebro-Spinal
Meningitis. Pediatrics, Nov. 1905, p, /02.

* A number of references to papers on Treatment are included In the Bibliography under the
individual Diseases.

IRevlew

IReurolog^ anb flteEcbiatn?

Original articles

THE PATHOLOGY OF GENERAL PARALYSIS OF THE

INSANE

By W. FORD ROBERTSON, M.D.,

Pathologist to the Scottish Asylums.

(The Morrison Lectures for 1906.)

Lecture I.

Delivered on 24th January 1906.

I have been led to select the pathology of general paralysis of
the insane as the subject of these lectures, chiefly owing to the
fact that its elucidation has formed the principal object of
research in the Laboratory of the Scottish Asylums during the
last three or four years. There are, however, other reasons for
which it is fitting that I should on this occasion direct attention
to some of the problems connected with this special form of
insanity. General paralysis of the insane, dementia paralytica, or
progressive paralysis, is a very common and important disease.
It appears to be increasing; it is certainly one of the most
terrible maladies that can afflict a human being ; it is fatal, with
rare exceptions, within a few years ; and its etiology and patho¬
genesis, notwithstanding many positive and dogmatic assertions
regarding them, have hitherto been a profound mystery.

In 1904, 1795 persons succumbed to this disease in the
asylums of England and Scotland. In the same year, 49 out of
R. OF N. & P. VOL. IV. NO. 2.— F

ORIGINAL ARTICLES

a total of 262 admissions to the Royal Edinburgh Asylum, or 10*7
per cent., were cases of this disease. In some English asylums
the proportion is even higher. Thus at the Durham County
Asylum it reaches to about 16 per cent. On the continent of
Europe the disease is even more prevalent than in our own
country. For example, at the asylum of Naples, about 30 per
cent, of the patients admitted are general paralytics.

The disease has lately been increasing both in this country
and abroad. For example, the annual mortality from general
paralysis in the Royal Edinburgh Asylum has risen from 25*5
per cent, of the total deaths in the five years 1890-1894, to
31 per cent, in the five years 1901-1905. The total number
of deaths from general paralysis in the English and Scottish
asylums has risen from 1321 in 1894 to 1795 in 1904.

To show the gravity of the disease, it is sufficient to mention
its leading features. These have been summed up by Dr
Clouston 1 in a concise clinical definition, as follows:—“An
organic disease of the cortical part of the brain, characterised
by progression, by the combined presence of mental and motor
symptoms, the former always including mental enfeeblement and
mental facility and often delusions of grandeur and ideas of
morbid expansion or self-satisfaction; the motor deficiencies
always including a peculiar defective articulation of words, and
always passing through the stages of fibrillar convulsion, inco¬
ordination, paresis, and paralysis ; the diseased process spreading
to the whole of the nerve tissues in the body; being as yet
incurable, and fatal in a few years.”

It may be added that general paralysis is a disease of the
rich and the great as well as of the poor. It is by no means
confined to the lower social strata. A few years ago a great
statesman fell a victim to it, and to-day is the anniversary of his
death. Unlike tuberculosis, cancer and many other maladies, it
is a disease about which the public understands almost nothing.
By them it is merged with other forms of insanity, which, even
in this intellectual age, they still look upon as a mysterious and
fatal visitation of a nature entirely different from that of disease
as they comprehend it. Nevertheless, it may be said that if
general paralysis, and the closely allied disease tabes dorsalis, had
been unknown, and were then suddenly to make their appear-

1 Clinical Lecture* on Mental Disease*, 1904.

ORIGINAL ARTICLES

ance and to assume the proportions they now attain in this and
many other countries, the occurrence would certainly be univer¬
sally regarded as one of the most appalling calamities that had
ever visited the human race.

Now, the subject of the pathology of general paralysis is far
too large to be dealt with exhaustively in three lectures, and I
shall not attempt so impossible a task. The time I have at my
disposal I shall devote mainly to giving an account of the
researches recently carried out by my colleagues and myself. 1
shall refer to controversial questions merely in so far as it is
necessary to do so in order to make clear the new position
reached as the result of our investigations.

Before proceeding to give an account of these researches, I
must briefly indicate the present position of authoritative opinion
regarding the pathology of general paralysis. The question
chiefly discussed in recent years has been that of the relation of
the disease to syphilis. Professor Bianchi 1 has well remarked
that three periods may be recognised in the progress of this dis¬
cussion. In the first period it was maintained that general
paralysis is simply a manifestation of syphilis. It was, however,
soon found that antisyphilitic remedies have no beneficial effect,
and consequently the second period was reached in which it was
maintained that the disease is determined, not by the direct
action of the syphilitic toxines, but by a secondary auto-intoxica¬
tion which may follow this action. This was the parasyphilitic
or metasyphilitic period. The third period is the present, in
which there has arisen a feeling of scepticism as to the para¬
syphilitic toxines, the existence of which has never been
demonstrated, and which are indeed entirely hypothetical.
There are still many who hold that the disease is essentially
syphilitic in its origin, but probably most writers on the subject
now dissent from this view, and maintain that there are other
no less potent factors, such as alcoholism, the excessive use of
nitrogenous foods, heredity, etc. “ Parasyphilis in the genesis of
progressive paralysis,” says Professor Bianchi, “ is a neologism
that harmonises with no proven and demonstrable fact. It is.
indeed, the product of a premature induction.”

There is similar difference of opinion as to the exact nature
of the pathological processes initiated by these supposed etiological

1 Annali di Neurologic^ 1902.

ORIGINAL ARTICLES

factors. Some writers maintain that there is what they term “ a
premature involution ” of the cortical neurons, and that all the
other changes are secondary. Others hold that the cerebral
vascular lesions are the first to occur, and that the destructive
alterations in the nervous tissues follow as a consequence. It is
now becoming more and more generally recognised that the
cerebral lesions are dependent upon some form of toxaemia.

The pathological anatomy of the disease, as far as it concerns
the nervous system, has been minutely studied by hundreds of
investigators. The outstanding facts already ascertained are
briefly as follows. The cortical nerve cells show acute and chronic
degenerative changes, which, like the other cerebral lesions, affect
the anterior portion of the brain more severely than the posterior.
The medullated nerve fibres of the brain also show more or less
extensive degeneration. The tangential fibres are, as a rule,
specially involved, though certainly not in all cases. The
neuroglia undergoes hypertrophy and 'proliferation, leading to a
condition of cerebral sclerosis. This morbid process, occurring in
localised areas in the walls of the ventricles, gives rise to the
well-known granulations of the ependyma. The vessels of the
brain constantly show chronic or acute irritative changes in their
walls, marked by increase of fibrous tissue and proliferation of
cellular elements. Special attention has in recent years been
directed to the presence of plasma cells in this situation. These
are angular cells having a granular protoplasm which stains deeply
with methylene blue, but which generally presents a distinct,
comparatively clear area. Their presence is said to be almost
pathognomonic of general paralysis. The pia-arachnoid is always
more or less thickened by inflammatory changes. The spinal
cord commonly shows some degenerated fibres, especially in the
crossed pyramidal tracts and in the posterior columns. Not
infrequently there are well marked tabetic lesions. The cranial
and peripheral nerves are often involved in the morbid process.
Much attention has lately been directed to the presence of
lymphocytes in the cerebro-spinal fluid withdrawn by means of
lumbar puncture. Normally this fluid contains very few cell-
elements. When the existence of other inflammatory conditions
can be excluded, a distinct increase in the number of lymphocytes,
or lymphocytosis, is regarded as an important sign of either
general paralysis or tabes dorsalis.

ORIGINAL ARTICLES

I come now to the researches carried out in the Laboratory of
the Scottish Asylums and at the Royal Edinburgh Asylum. I
shall take them in chronological order, and endeavour to lead
you step by step along the road that has been traversed. Before
the end is reached, I hope to have laid before you such evidence
as will satisfy you that the commonly accepted hypotheses
regarding the pathology of general paralysis are erroneous, that,
notwithstanding the enormous amount of labour that has already
been expended in investigating the disease, the great essential
fact in its pathology has hitherto been missed, and that general
paralysis is an infective disease, as specific in its causation as
tuberculosis, typhoid fever, or diphtheria.

For several years I studied the brains of general paralytics
in the orthodox way, and succeeded only in repeating the obser¬
vations of others. In course of time it became apparent to me
that in studying the cerebral changes I was only examining the
effects of a toxic action, and that the toxines must have their
origin somewhere outside the brain. Further, I was convinced,
then as now, that the syphilitic hypothesis does not account for
the known facts regarding the disease. I therefore endeavoured
to find evidence of the occurrence of a general toxaemia, and to
localise the seat of origin of the toxines. About the same time
Dr Lewis G. Bruce made independent clinical investigations,
having a similar aim. He studied especially the temperature
changes, the condition of the blood, the gastro-intestinal disorders,
and certain reactions of the blood serum. In a paper 1 published
in 1901, he recorded the results of continuous observations made
upon the temperature and leucocytes in individual cases. He
endorsed Dr Macpherson’s opinion that the most characteristic
temperature in general paralysis is a recurrent febrile attack
every one or two weeks. He also ascertained that leucocytosis and
hyper-leucocytosis accompany the rises of temperature, and that
in the third stage leucocytosis commonly occurs from time to time
without any elevation of temperature. He inferred from these
observations that each febrile attack represents the resistive
reaction of the body to some toxic substance, and each inter-
febrile period an intermission when the resistive powers of the
patient have subdued the action of the toxine. He concluded
that general paralysis is a disease directly due to poisoning by
1 Brit. Mtd. Joum., June 29, 1901.

ORIGINAL ARTICLES

the toxines of bacteria, whose point of attack is through the
gastric and intestinal mucous membrane. There was evidence that
the bacillus coli is one at least of the organisms concerned in the
production of this toxaemia. In a paper 1 published at the same
time as that of Dr Bruce, I maintained similar views on the
ground of the results of an examination of the pathological
changes occurring in the alimentary tract iu a series of cases. I
found that there was constantly a severe degree of chronic atrophic
catarrh affecting the stomach or small intestine, or both, and that
the morbid changes appeared to be associated with excessive
development of bactern in the alimentary tract.

Further evidence of the existence of a chronic toxaemia was
found in the occurrence of chronic endarteritis in the extra¬
cerebral vessels. Dr A. Ainslie examined numerous arteries
from various parts of the body and found that the condition was
constant, though irregular in distribution, and that it was often
extremely well marked. About this time another worker in the
Laboratory of the Scottish Asylums, Dr Chalmers Watson *
advanced very similar views regarding the pathogenesis of tabes,
arguing that all we can logically conclude from the fact that a
syphilitic history can be traced in a large number of tabetic
subjects is that syphilis alters the physiological conditions in
such a way as to favour the attack and operation of the actual
cause of tabes and allied conditions.

In 1902, Dr Douglas M‘Rae, Dr John Jeffrey and I com¬
menced a bacteriological investigation of cases of general paralysis
with a view to ascertaining if any facts could be elicited that would
throw light upon the nature of the supposed bacterial toxaemia.
It may be noted here that five Italian observers had previously
made bacteriological investigations in cases of this disease. The
blood, the urine, and the cerebro-spinal fluid were examined by
one or more of these observers, various micro-organisms being
found, but I think it may be said with fairness that no very
noteworthy addition to our knowledge of the pathogenesis of
general paralysis has resulted from their researches. Dr M < Rae,
Dr Jeffrey and I made post-mortem cultures from the inflamed
gastro-intestinal tract, the bronchi, lungs, brain, etc. Among
the numerous organisms obtained there was one which, from the
constancy of its presence in the alimentary or respiratory tract,

1 Brit . Med . Joum June 29, 1901. 2 Brit. Med . Joum June 1, 1901.

ORIGINAL ARTICLES

by its occasional occurrence in the brain and in view of the
ascertained pathogenic characters of the group to which it
appeared to belong, there seemed reason to believe might
have special importance. This was an organism resembling the
Klebs-Loffler bacillus. Cultures of a bacillus of this nature were
obtained from seventeen cases out of twenty examined. In the
remaining three a similar organism was afterwards found in
sections of the alimentary tract. Cultures were obtained from
the brain in four out of seventeen cases. On the grounds of our
observations, we advanced the hypothesis that general paralysis is
the result of a chronic toxic infection from the respiratory and
alimentary tracts, permitted by general and local impairment of
the defences against bacteria, and dependent upon the excessive
development of various bacterial forms, but especially upon the
abundant growth of a Klebs-Loffler bacillus of modified viru¬
lence, which gives the disease its special paralytic character. 1 In
our later investigations. Dr M‘Rae and I have simply been putting
this hypothesis to the test, and every step forward has been
attended with the elucidation of some fresh fact that has
rendered it more probable.

I followed up these bacteriological researches by a histo¬
logical investigation of the supposed infective foci. In a series
of twenty cases of general paralysis I was able to recognise in
the catarrhal exudations in the respiratory and alimentary tracts
a bacillus identical in form and staining reactions with the
organism isolated by cultural methods. In several of the cases
it was present in very large numbers. In the course of these
histological investigations, a filamentous organism having special
characters was observed in five cases, either in the walls of the
bronchi or alimentary tract, or of both. I stated that there were
some grounds for supposing that this organism is a thread form
of the diphtheroid bacillus and that its presence in great numbers
in the lymphatics of the respiratory or alimentary tract represents
a terminal invasion by this bacillus. 2

Dr Shennan and I have made two series of experimental
observations with a view to ascertaining if these diphtheroid
bacilli are capable of producing in lower animals changes in any
way resembling those that occur in general paralysis. We used

1 Review of Neurology and Psychiatry , May 1903.

2 Review qf Neurology and Psychiatry , July 1903.

ORIGINAL ARTICLES

chiefly a bacillus isolated from the bronchus of a case in which
in this situation there was found to be a very abundant invasion
by the filamentous form of the organism. We have made two
series of experiments, but an account 1 has as yet been published
only of the first series, and I shall confine myself to it.

It was ascertained that the organism was non-pathogenic to
guinea-pigs. Intra-pleural injection in a white rat resulted in
death of the animal in five days. Microscopical examination of
the tissues showed that the organism had multiplied at the seat
of injection and had spread to the adjacent pulmonary tissues
and also to the pericardium. The invading organism was be¬
ginning to assume a thread form. Three rats were fed for several
weeks upon bread mixed with unsterilised broth cultures of the
bacillus. After three or four weeks they began to show morbid
symptoms, which gradually increased in severity until the animals
became acutely ill. At first they showed especially slowness
and uncertainty of gait and drowsiness. Later they manifested
distinct motor weakness, marked inco-ordination of movement,
dyspnoea and great drowsiness. One rat was killed with chloro¬
form when it appeared to be moribund. In the other two the
disease was allowed to go on to a fatal termination, which
occurred about two months from the time of the commencement
of the feeding with cultures. Control animals remained healthy.
Microscopical examination of the tissues revealed in each animal
a similar series of morbid changes. There was well marked
catarrh of the alimentary tract in all three, and a similar condi¬
tion of the bronchi in two, accompanied by some catarrhal
pneumonia. The diphtheroid bacillus was found in the catarrhal
exudations, but its detection presented the same difficulties as in
cases of general paralysis. A large proportion of the nerve cells
of the cerebral cortex and spinal cord were markedly degenerated.
The neuroglia, especially in the first layer of the cortex, showed
slight but distinct proliferative changes. There was distinct
increase of the cell-elements in the walls of the cortical vessels,
and also proliferation of the mesoglia cells and of the cells of the
pia-arachnoid.

In the two rats in the case of which the illness was allowed
to go on to a fatal termination, there was extensive invasion by
the filamentous organism already referred to. In one animal the

1 Review of Neurology and Psychiatry, April 1903.

ORIGINAL ARTICLES

threads were found in the lymphatics of the stomach, duodenum,
and ileum, as well as in the liver and in the walls of the bronchi.
In the last named situation this invasion exactly reproduced the
histological picture to be observed in the case of general paralysis
from which the bacillus was isolated. In the other rat this
filamentous organism was found in the walls of the stomach,
duodenum, and ileum, and also in the capsule of the spleen and
in a lymphatic gland. Beyond question these animals present
evidence of the occurrence of many of the morbid processes that
can be recognised in the nervous system of the general paralytic,
but they survived too short a time to make it possible for the
complete histological picture to be developed.

At this stage of the investigation, I summarised the case for
the diphtheroid hypothesis of the etiology of general paralysis in
opening a discussion on the pathology of the disease at the
annual meeting of the British Medical Association, held at
Swansea in 1903. 1

An interesting experimental observation has also been made
by Dr Lewis C. Bruce. He used cultures derived from the
bacillus that was employed by Dr Shennan and myself in our
experiments upon the rats. From time to time in the course of
several months Dr Bruce injected a goat subcutaneously with
these cultures for the purpose of obtaining an immune serum for
therapeutic use. After a time the animal developed signs of
alimentary disturbances. It had been known to lick the spots
at which the injections were made, and probably in this way its
alimentary tract became infected with the bacillus. The animal
became tottering in its gait, and about six months from the time
when the last subcutaneous injection had been made, it had a
seizure closely resembling the congestive attack of a general
paralytic. It rallied to some extent, but died a few days later.
A culture was made from the oesophagus after death, and a
growth of a diphtheroid bacillus was readily obtained. Dr
Bruce kindly sent me the brain and some of the other organs for
examination. The brain shows proliferative changes in the
vessel walls, proliferation of the neuroglia and degeneration of
the nerve cells, but each of these morbid alterations is slight in
degree. Nevertheless, among the proliferating cell-elements in
the vessel walls, several distinct plasma cells have been detected.

1 Bril. Med . Joum., October 24, 1903.

ORIGINAL ARTICLES

I think it is certain that in this case the part of the nervous
system chiefly affected was the spinal cord, which unfortunately'
was not obtained. The condition of the brain indeed corresponds
exactly to that of a case of tabes dorsalis in which mental symptoms
have been absent or only very slight.

In May of last year, Dr M'Rae and I reported the results of
an investigation in which it was sought to ascertain if diphtheroid
bacilli are commonly present in the genito-urinary tract in cases
of general paralysis. We have since extended these observations.
We have ascertained that female general paralytics constantly
suffer from chronic leucorrhoea, and that the discharge always
contains abundant diphtheroid bacilli In three instances the
first cultures made from the discharge have yielded a diphtheroid
bacillus alone. Diphtheroid bacilli are also constantly present
in the urethra of the male general paralytic. Similar organisms
have also been found, but generally only in comparatively small
numbers, in the same situations in a considerable proportion
of cases in which there was no ground for suspecting that
the patient was suffering from general paralysis. In seven
consecutive cases of general paralysis combined with tabes,
we have found the urine to be loaded with diphtheroid
bacilli. We have now obtained a culture of a diphtheroid
bacillus from the brain in nine cases of general paralysis out of
twenty-three from which cultures have been made from this
organ. We have also examined the cerebro-spinal fluid
removed by lumbar puncture from five cases of general para¬
lysis. In the centrifuge deposit, in addition to lymphocytes,
there was always a considerable amount of granular debris, and
among this debris, or within the lymphocytes, we have observed
in three cases bacilli, which have very little affinity for staining
reagents, but which, nevertheless, can not infrequently be recog¬
nised to have the morphological characters of diphtheroid bacilli
We have also examined blood films, staining them by methods
suitable for the detection of diphtheroid bacilli. We have
obtained the blood by a method, already described, which
reduces to a minimum the risk of contamination from the
skin of the patient. In a preparation from one paralytic,
presenting the signs of a slight congestive attack, we have
observed a small group of typical diphtheroid bacilli, with
distinct metachromatic granules.

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Lastly, we have searched for evidence of the presence of
diphtheroid bacilli in the walls of the inflamed cerebral vessels,
using chiefly various modifications of Neisser’s method No
definite results were obtained until last summer, when examin¬
ing sections of a portion of the brain subjacent to a purulent area
in the pia-arachnoid, from which we had obtained a pure culture
of a diphtheroid bacillus. Here we found, in a preparation
stained by Neisser’s method, a small group of faintly coloured,
but still quite definitely recognisable diphtheroid bacilli lying in
the walls of an inflamed vessel.

The occasional presence of diphtheroid bacilli, generally
incapable of taking the stain in the ordinary way, in films of
the centrifuge deposit from the cerebro-spinal fluid, in blood
films and in sections of the brain, raised the question whether
these bacilli were not from time to time gaining access to
the blood circulation, and being rapidly destroyed by phagocytic
and lysogenic actions. Dr M‘Rae and I therefore resolved to
study experimentally the action of the phagocytes and blood
serum upon diphtheroid bacilli isolated from cases of general
paralysis. The flood of light that has been thrown upon the
problem of the pathogenesis of general paralysis and of tabes
dorsalis by putting this hypothesis to the test, I hope to show
in the next lecture.

A STUDY OF SOME OASES OF DELIRIUM PRODUCED

BY DRUGS.

By Da AUGUST HOCH, Bloomingdale Hospital, White Plains, N.Y.,
Instructor in Psychiatry, Cornell Medical School, New York.

Cases of the nature of those here recorded are probably not
very rare. Nevertheless, during my ten years’ service at the
M'Lean Hospital, Waverley, Mass., I have had occasion to
observe only eight, four of which are here presented. But it
seemed to me of some value to establish clearly the delirious
nature of these conditions, to analyse them carefully, and to
compare them with the deliria about which we are best informed,
those produced by alcohol. The excellent monograph by

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Bonhoeffer, 1 a model of clinical analysis, has greatly advanced
our knowledge of delirium tremens and of deliria in general.
The desire was very natural, therefore, to study deliria with a
different etiology in a similar manner. That the writer feels a
great obligation to Bonhoeffer, whose work in part guided his
studies and his conclusions, he desires to express at the
outset.

The drugs to which these deliria were attributed are chiefly
bromides, hyoscine, various true hypnotics, and morphia, and it
is a notable fact that it seems to be of very little consequence
which drug is used; indeed, I have seen one case where
antifebrin seemed to have been the only, or at any rate, the
most important drug. After all, as is assumed in the case of
alcohol, the action of the poison introduced is probably only the
indirect cause; nor does it seem to be the only one, for in¬
sufficient food, protracted loss of sleep, digestive disorders, and
general exhaustion, seem to act as contributory causes. We may
infer this from the fact that such factors are often present, and
that we find occasionally conditions resembling delirious reactions
in manic state, for example, after just such causes have been at
work. Unfortunately it has mostly been impossible to determine
the exact amounts of the drugs taken, and in one case the doses
admitted seemed too small to account for the profound reactions.
Nevertheless, the experience with all such cases cannot leave
any doubt regarding the importance of drugs as an etiological
factor in them.

Case I. Mrs H., aged 51. In the hospital from March 5
to March 28, 1903. The patient had one sister who had the
opium habit. Any other neuropathic traits in the family were
denied.

The patient had never been insane, but since the age of 30
had complained of very severe headaches which occurred at
menstruation, and for years had been in the habit of taking
morphia for them to the extent of l to £ grain a day. She is
said to have been perfectly well in the intervals. For three
months before admission the patient had not menstruated, after
the flow had been scanty for about a year. Two months before

1 Bonhoeffer: “ Die Geistcsstorungcii der Gewohnheitstrinker.” Gustav Fischer,
Jena, 1901.

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admission the headaches again came on, and now became con¬
tinuous ; she took morphia, rising rapidly to a grain a day, but,
it is said, no farther. This was continued until admission, while
in the meantime bromides were added. These, it was claimed,
were not in large doses. The patient had become irritable, and
two weeks before admission she began to get restless, somewhat
apprehensive, and for five or six days before admission she is
said to have been confused and at times dull. For a week she
had not slept and had scarcely taken any food.

On admission the patient appeared restless, evidently heard
voices, but she showed no fear. She was disoriented and used
wrong words. At the morning visit on the following day she
was found with a rather pasty complexion, a heavily coated
tongue, a temp, of 99*2°. Her breath was foul. There was no
eruption on the body. There was no evidence of any palsies;
the movements of the arms were not ataxic, but the gait was
rather staggering. There was a general coarse tremor in the
hands. The reflexes were of normal intensity. She lay in bed
tossing about rather restlessly. Her mood was one of a whining
depression, with some irritability, but no apprehensiveness. She
looked somewhat dull, and her attention could at times be
attracted only with marked difficulty, again quite readily ; but
we were struck with the fact that now and then, even at the
time when we had difficulty in obtaining answers, she made
occasional comments on things which were said in her hearing.
Hallucinations were at times quite prominent; she had spoken
of hearing bells ringing, had seen pictures on the door, her sister
in the pillow, a man in her bed, and she tried to pick imaginary
flies from the bed-clothes. She was completely disoriented;
though she repeatedly called the physician “ doctor,” the nurse
“ nurse,” yet again she miscalled them. Paraphasic turns of speech
were quite marked, as we shall presently show. . For the two
succeeding weeks her condition remained essentially unchanged,
and may be summarised as follows. Sometimes she appeared
dull, even to the extent of soiling herself. Her attention varied :
it either could be easily attracted or this was very difficult, and
she could be pricked with a pin without any reaction. Her
disorientation remained, though shaded off gradually. She
thought she was in New York and other places; again, called
people by wrong names. Her time orientation was very poor.

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Sometimes she related delirious experiences; for example, said
that she had been up the river lately in a boat, or that she had
just been in the woods, where “ some money was tied to a tree,"
and the like. The hallucinations continued, and even became
more marked. She heard voices, reached out her hands to
fancied visitors, talked to the wall, spoke of the girls upstairs
“ who have talked ” about her, and quite marked was the fact
that she picked up imaginary threads from the bed-clothes.
Artificial hallucinations could be produced by rubbing her eyes.
On such occasions she said that she saw “ a fire-place,” “ wood¬
work,” “ shelves,” “ a woman in a blue dress,” “ all sorts of
things.” Reading tests showed fair results at times ; again, she
made glaring mistakes, such as reading “pollies” instead of
“ 1903.” When questioned about events in her life she varied
a good deal, sometimes gave perfectly absurd answers, e.g. that
she was born in ’81 ; again, the answers were apparently
perfectly correct. A few tests to study her ability to retain
impressions (Merkfiihigkeit) yielded results which would make
one think that this was very poor; but the question of attention
was not sufficiently considered at the time, so that we must not
lay too much stress on the results, all the more so since it was
found repeatedly that at the end of an examination she remem¬
bered incidents which had taken place at the beginning of it.
Her talk may be illustrated by the following examples. She
said spontaneously, “ I’ll never see my mother any more; she
has been trying to hold up since she was lost.” And then,
pointing to the nurse, she said, “ This is my mother. Please let
me go. There is nothing for me to stay here. That’s what I
was, freezing. It seems just like she came in the window.”
(What do you mean ?) “ Well, don’t you know there is a store

in front of the bridge that comes right down to a point of lace.
She lived there, or she did when I lived there,” etc. “ Down to
a point of lace ” is evidently a paraphasic turn, a trait which
may be further illustrated by the following samples. “ We were
coming down the ref road ... I can’t tell you where it is, it's
the mostly jardmar, in the mell, mell jar, in the worsted mill
yard.” Or in speaking of Chattanooga, she said, “ Chattanulgo,
Challamutta ”; and on one occasion when she heard a telephone
ringing, she said it was the Chattanooga ringing, or “ You are
the gentleman I not in the grocery store.”

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In general it may be said, as is the case in these patients,
that though the talk showed some shifting of subjects, loosely
connected, it was not that which made it difficult to follow it;
nor was this a very marked trait, as she kept often to the
subject she had chosen fairly well; but it was the fact that she
told of delirious experiences which we knew nothing about, and
the talk was further obscured by the paraphasia.

After the two weeks the patient gradually became perfectly
clear, orientation was excellent, the hallucinations disappeared, and
she talked very naturally. It was all the more striking that with
this clearness she retained for a number of days a belief in some
of her delirious experiences. This was especially striking since
these were so absurd. Thus she claimed that the nurse had told
her that she had'killed a man, and said she knew it was her
husband. She explained that at home her husband discharged a
nurse, and that the latter followed him to the barber shop and
shot him through the thumb. When questioned retrospectively
about the events which had occurred in the hospital, it was found
that the very first part was practically a blank to her, but that
after that she remembered quite a number of things, which,
however, were not put together in anything like a sequence. She
was taken home before she had entirely ceased to believe in some
of her delirious experiences, although she did not at all react to
them.

Case IL Mrs W., aged 30. In the hospital from May 23
to August 3, 1903. Her maternal grandmother was insane for
fifteen years until her death at the age of 60 ; her mother had
repeated attacks of “ nervous prostration,” and one of the mother’s
brothers was an epileptic. A paternal uncle had an attack of
insanity.

The patient herself had “nervous prostration” when 22, a
condition in which she complained of considerable physical weak¬
ness, also of much pain in head and spine, and is said to have
been very “ hypochondriacal." She was in bed for months.
She was married two years after the onset, but only two years
later, t.«. four from the beginning, was she considered really well.

Three months before admission the patient is said to have had
an attack of “ grippe.” She was weak after it, complained of
palpitation, and was considerably worried about it. She had to

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remain in bed, became nervous and irritable, and more and more
worried about her condition. It is claimed that she would some¬
times stare for half an hour at a time. A month before admission
she attempted suicide for the first time, and was henceforth very-
insistent in her attempts. Three weeks before admission there
were occasional spells of mental clouding, and for a week before
admission she had been rambling, noisy, resistive ; finally confused,
untidy, hallucinating, eating almost nothing for some days.

Fortunately we have a good account of the drugs which this
patient received. It must be remembered that she was admitted
on the 23rd of May. From April 1 to 11 she was given
10 grains of bromide at night. From the 11th until the 27th
it was replaced by 18 grains of trional, repeated if necessary.
From April 26 to May 3 she had 60 drops of Tr. hyoscyamus
a day. From May 3 until admission she had regularly, at first
60, then 120 grains of bromide, plus 15 drops of Tr. gelsemium
a day. In addition to that she had, for the week preceding
admission, altogether 2£ grains of morphia and tot of hyoscine.
And finally she was given Tr. passitlora, 5 to 10 drops, every
2 to 3 hours; later, 30 drops at longer intervals.

The patient was admitted with a temperature of 100°, sallow
appearance, foul breath, heavily coated tongue, pulse 100. She
was restless, shouted for her husband, spoke of hearing her
people murdered, of seeing coffins, men with revolvers. She
frequently seemed to pick up things from the bedclothes, and
when questioned said she saw bugs and threads. Her voice was
thick and her talk fragmentary. She was completely disoriented.
At the morning visit her physical state was the same as described.
In addition it was found that there was no tremor, but marked
exaggeration of reflexes, with pronounced ankle clonus, in¬
exhaustible on the right side, exhausted after 10 to 12 motions
on the left. Babinsky absent. She lay in bed quietly, mumb¬
ling something to herself, occasionally calling out, evidently in
response to hallucinations, sometimes picking imaginary things
from the bedclothes. She appeared dull. The mood was indifferent,
there was neither fear nor any evident depression or exhilaration.
It was sometimes very difficult to attract her attention, again
more easy. Sometimes she commented on slight, quite un¬
obtrusive noises, such as a distant train. Orientation was poor.
She said she did not know where she was, did not know the

ORIGINAL ARTICLES

people, but she gave the month as May, the year as 1903,
then 1902. Again, she said she was at her sister’s house, but
frequently called the doctor “ doctor,” the nurse “ nurse.”

Her talk may be illustrated by the following. When asked
how long she had been sick, she said, “ I have been sick eight or
ten weeks—that is if I speak right—now my folks tried to lose
me, they were hunting for me.” (Did you see them ?) “I could
not hear a sound, only her [nurse], and she will kill me ” (no
affect). “ They all say I was afraid because I went to a store on
Tremont Ave. They would not let me have—well, she would
not let me—have anything to do—you remember that [to nurse]
—she can’t find out. I’m growing hazier and hazier—but this
forenoon, well, I’ll tell you what she did. I see her object in it
now. I hadn’t thought of it. I have been moved so often.
We have moved around in the daytime—in the night—we have
moved all around, I don’t know how many things,” etc.

What is not brought out in this sample is her paraphasic
turns, which, nevertheless, were quite marked. Thus she said, in
good connection, “ That is all the satisfaction I can get, and I am
satisfaction.” Or when asked the day, she said, “ I don’t know, I
haven’t seen a map for ages. I am just 8.30 May something.”
Or again, “ Are you the gentleman that’s marrying this house ? ”
Or, “ He make it distinct enough that I would not get
well. Distinct, extinct enough, he made it excitement enough,”
etc.

When asked memory questions she varied, evidently owing to
her variation in responsiveness. She gave her age correctly.
(Have you a child ?) “ Yes, three years ago ” (correct). (Is the

child living ?) “ No, dead ” (incorrect). (How long ago since it

died ?) “ Two years.” (What did it die of ?) “ Still-birth."

(What ?) “ Two years ago the 8th of February.” (What
happened then ?) “ A boy was born to me.” (How long did he

live ?) “ Oh. I was taken sick on the 8 th and he was bora on

the 9th.” (Is the boy living now ?) “ Yes.” (What is his

name ?) She gave it correctly. (Have you ever lost a child ?)
“No” (correct). (How old is your boy?) “33." (No, your
boy ?) “ 3 ” (correct). Then she was asked, “ What is 9 times 15?”
She said 19. (7x13?) “21.” (8x9?) “72.” (16x12?)

“ 72.” (What is the capital of the U.S. ?) “ Boston.” (Capital of
Maine ?) “ 45.” (Capital of Maine ?) “ Capital of Maine ?

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7 5." (What is 75 t) “A number.” Then she was again
asked impressively, and she said correctly, “ Augusta.”

In addition to the hallucinations above described, artificial
hallucinations could be produced by rubbing her eyes. She said
she saw “ a horse-car on the street," “ a post,” “ a white post,”
“ people and a dog.” (What kind of people ?) “ Mostly Chinese

women.” (What colour of dresses ?) “ Mostly white dresses. I

saw a cap just now—all kinds of things, houses and everything
else.” When told to open the eyes she said, “ Now I see a bunch
of grapes.” Asked what she saw on the ceiling, she said, “ Grapes
—single grapes, small and large ones.”

Just as we found in the other cases, this woman made
striking mistakes in her reading.

This condition lasted about 10 days, while the more marked
symptoms gradually faded, the tongue became clean, the reflexes
normal, the orientation became much better, the paraphasia was
slight, the talk was much clearer, but in spite of all this
improvement she continued to believe in the delirious experiences
and for a time hallucinations persisted. Although she finally
cleared up altogether, she held on to some delirious experiences
almost to the end, while at the same time she showed a certain
mental sluggishness.

Case III. Mrs E., age, 43. In the hospital from July 22 to
September 15, 1904. Heredity is denied, and the patient has
never before been insane. A year before admission she had a
good deal of worry. She lost flesh and got weak, slept poorly,
and it is stated that at that time she took a considerable amount
of morphia, but that she had not taken any for three months.
For about three weeks she has felt very exhausted, slept poorly,
complained of many pains, and it is stated that a great many
drugs were then given her, but we were unable to find out just
what. She got steadily worse, finally somewhat confused, and
three weeks before admission she was sent to Boston. There she
had to be looked after, had to be dressed, fed, and gradually
became excited and at times fearful, confused, so that 12 days
before admission she was taken to a small hospital, where she
was dull, untidy, restless, had hallucinations of hearing and vision.

In this hospital she was again given hypnotics, but as has
often been our experience, the guilty physicians are very apt to

ORIGINAL ARTICLES

be exceedingly general in their answers to letters of inquiry about
drugs.

The patient was brought to us in a state of marked dulness
and hebetude; she showed a tendency to keep her eyes closed, was
untidy, her mouth was dry, presented sordes, the tongue was
heavily coated, the breath foul, the pulse rather weak (100).
The internal organs presented no abnormality. The reflexes were
normal. There was no terror. She lay muttering, speaking
indistinctly and thickly, but when her attention was attracted
her talk was much more connected and the voice much less
thick. Sometimes it was easy to attract her attention ; again,
difficult. But it was quite striking that she repeatedly caught
up statements made within hearing and commented on them.
Her train of thought was at times difficult to follow, partly on
account of paraphasic utterances, partly because she spoke of
things irrelevant to the situation. But she kept on the chosen
subject remarkably well. The answers were often quite irrelevant,
evidently because she either paid no attention to the question or
because of her paraphasic turns. We may give a few examples.
When asked what is two times two, she said “ two over ” ; and
again, asked what’s two times two, ‘ that what I said, you would
think I was crazy, a woman of 7 5 to make me marry ” (she had
spoken of that before), “ to be asked why I did not marry such a
woman ” (paraphasia). Then turning to the nurse : “ Florence.
No, that isn’t Florence. I said ‘ put that feather over there,’ and
Florence said, ‘ No, I won’t put that feather over,” etc.

The data of her life were at times given well, again poorly.
She was totally disoriented, miscalled people. Even simple
multiplications were done poorly. Her mood was either
indifferent or somewhat euphoric. Hallucinations were present
and frequent, especially those of hearing, and to a lesser degree
those of sight. Quite striking were the tactile hallucinations, or
tactile and visual combined, which were manifested by her
imaginary picking up objects. Her ability to retain impressions
tested in the ordinary way (given a number of 4 digits to
remember) appeared poor, but here again we must add that such
a test is only of value if the mental responsiveness is taken into
account. Paraphasia was pronounced. Interesting were the
results when objects were shown to her. They were evidently in
part due to a disorder in apprehension, so clearly brought out in

ORIGINAL ARTICLES

Case IV., and quite striking was also the influence perseveration.
The following samples may be mentioned. (Knife.) “ Brick
house.” (Knife.) “ Those are—” (thinking). (Tell me.) “ Knife.”
(Bunch of keys.) “ A key ringer—ringer for keys.” (Watch.)
“ Keys.” (Charm.) “ A charm.” (Spectacles.) “ Those rings which
go on.” (Cuff.) “ Keys, cuff of keys with a key-note in it”
(Pink.) “ Pink.” (Palm leaf fan.) “ Fan.” (Brown book.)
“ Bible.” (Hand-glass.) “ Looking-glass.” (Comb.) “ I don’t know
—that’s my black comb.” (Hair-brush.) “Comb. It’s a hair
brush.” (Closed fan.) “ A fan, a parasol, a very little parasol.”
(Opened fan.) “ A fan, a parasol” (Cuff button.) “ A gold
ring.” (50 cents.) “A quarter.” (25 cents.) “A quarter.”
(50 cents.) “ A quarter.” (5 cents.) “ 10 cents.” (One cent)
“ 5 cents.”

Three days after entrance the attention was attracted with
greater ease, but the paraphasia persisted to a marked degree.
She read very poorly. For example, when made to read “ bats
have proportionately the longest ears and the oddest shaped
noses in the whole animal kingdom,” she read, “ Bates properly
continue the largest earnestly and clearly noses of the kind, of
the innumerable kind.” When she was shown pictures she
showed marked abnormalities, pointed out birds where there
were none, called a piece of bread in the hand of a little child
“ a cucumber squash,” saw “ a lobster claw ” on a piece of paper
which contained only indistinct marks, not at all suggestive of
a lobster claw to a normal person, or she called three lambs
“ three cans ” (paraphasic ?). At that time she was still dis¬
oriented as to place. In regard to time she knew the month
and year, but nothing more. She miscalled persons, but not
consistently. She gave no one a correct name, but called the
doctor “ doctor,” the nurse “ nurse.” The hallucinations con¬
tinued. She heard voices, and still picked imaginary things
from her bed-clothes. In regard to the disorientation, it may be
mentioned that she thought she was at home, or in the house of
a friend. She repeatedly told of delirious experiences.

In a few more days the hallucinations left, she became
perfectly clear and the attention was good, but she still called
the place wrongly, still uttered delirious experiences. Thus she
told of an accident which had happened in which her mother had
been injured, and claimed that the examining physician had been

ORIGINAL ARTICLES

called in and had operated on the mother at her home. Gradu¬
ally she cleared up entirely, not only from her delirium, but
from the condition which had originally led to the giving of
drugs.

Case IV. Amelia G., aged 39. Dressmaker. Admitted
January 11, 1905.

The patient has some psychopathic heredity, and it is said
that she was always of a suspicious nature, was easily frightened,
and inclined to be quite hypochondriacal in the sense of making
a great deal of small ailments. For ten years she complained
much of pain in the neck and head, but on the whole was able
to do her work.

Six weeks before admission she complained more of the pain,
became depressed, despondent, listless ; sometimes she was restless.

Five days before admission she became more depressed, self-
accusatory, and sat for hours without speaking. Soon after this
she began to “ talk queerly,” said people were dead, that she had
killed six little children. She also said that the top of her head
was “ blown up.” She claimed that her mind was gone. At
the same time she showed indications of morbid self-reference,
thought things which were done had a peculiar meaning, and
she fancied that people looked at her. A few days before ad¬
mission, hallucinations began ; she answered voices, and she saw
“red devils crawling over the sister’s jacket,” “a little angel
walking round the rim of her drinking cup.” She was often
seen staring.

For about a week she had eaten very little and had slept
very poorly.

Now, this woman had been given liberal doses of bromides in
the six weeks preceding her admission to the hospital. We
were unfortunately unable to find out the exact doses, but it is
said that she was given a teaspoonful every three hours. The
fact that at entrance she had marked acneform eruption on her
body also supports the supposition that she had been heavily
dosed. Besides these bromides, she was given hypodermic
injections, the nature of which we could not find out.

At entrance the patient showed, as was stated, an acneform
eruption ; the tongue had a heavy brown coat; her breath was
foul. Her gait was somewhat unsteady, resembling that of cere-

ORIGINAL ARTICLES

bellar ataxia. But there was no tremor, the reflexes were
normal The pupils could not be tested on account of lack of
co-operation. She showed marked tenderness and pain over the
joints of the legs, but no swelling. Her urine showed a slight
trace of albumin, but nothing pathological otherwise, except a
very high specific gravity, *1041. Temperature normal. Pulse
and respiration showed nothing of any consequence.

She wandered aimlessly about, presenting the uncertain
movements above described. Her expression was strikingly
empty, but not immobile. She made the impression of being
absorbed in vague thoughts, and very often she did not answer
questions, or what she did say had no bearing on what she had
been asked, but was either a vague allusion to the “ Blessed
Virgin ” or the like, or a repetition of something she happened
to hear, and the result was the same whether complicated or the
most simple questions were asked. But she showed her tongue,
and reacted quickly to pin pricks. Quite striking was an aim¬
less resistance, blind in character, yet without an affectful
background to it, making rather the impression of a tendency to
perseveration, a trait which was later on brought out more
clearly. Interesting is the fact that with this there was at
times a tendency to catalepsy, and above all a marked, though
not consistent, echopraxia, even to tests. It should be noted
that in spite of all these traits she at times occupied herself
with the physician, fumbling aimlessly about his clothes and
the like.

Next day the condition was quite different and remained
different for about a week, after which time it very gradually
shaded into a typical state of manic depressive retardation, which
persisted so long as I observed her. The condition which
developed on the second day, and which we shall presently
describe, was a delirious state, and for some weeks after the
height of it was passed the slight delirious traits persisted,
masking the manic-depressive retardation, so that for quite a
while the case presented considerable difficulties to the correct
interpretation.

During the delirious condition she was at first completely
disoriented as to place, persons, time, even the time of the day.
Whether this had been so on the first day we were unable to
decide. It could now be established, because, in contra-distinc-

ORIGINAL ARTICLES

tion to her state of the first day, she frequently answered
questions, although she had a marked tendency from time to time
to get into a similar staring condition as at first, and even to
become decidedly drowsy. These variations in her responsive¬
ness were quite marked, so that at times it was impossible to
attract her attention. When thus absorbed she did not react to
pin pricks, and, at these times also, it was found that she would
firmly hold on to anything which she happened to have in her
hands, so that it could not be taken away from her except when
it was possible by putting some other object in front of her eyes
to forcibly attract her attention to that. Again, when looking at
anyone, she would follow that person with her eyes when he
moved about. All this made the impression of a peculiar
fascination and perseveration. During this time she lay in bed,
often appearing rather dull. She hallucinated, saw “ staggering
things with long legs,” “ a bird ” in the physician’s hair, “ lots of
children at the end of the hall,” or she saw faces in the transom,
and heard voices. But she had evidently no hallucinations of
touch. Her talk, which was rather scanty, was, however, clear,
and there were only occasional paraphasic turns in it, but these
were distinct. She produced, however, a number of delirious
experiences. She said she had been “ in a dry goods store this
morning,” that she had gone down a long street, and the like.

The mood during all this time was strikingly indifferent, even
when she uttered occasional depressive ideas.

We then made some experiments daily in order to study
more closely the hallucinations, the process of apprehension, and
her ability to retain recent impressions. In all these experi¬
ments the question of mental responsiveness had to be taken
into consideration, so that we also made some tests regarding
this. 1

Let us first consider the hallucinations. Like all the other
cases, this patient showed marked artificial hallucinations, i.e.
when the eyes were pressed upon and she was asked what she
saw, she said, for example, “ a whole pile of black iron rails ”;
later, “I see a little girl of 13 or 14 holding a doll.” (What
kind of dress has she on ?) “ A grey one.” “ I see a baby
carriage.” She also said, “I see a man,” or again, “ It looked

1 Those experiments I made in conjunction with my friend and associate, Dr
8. J. Franz, to whom I wish here to extend my thanks for his assistance.

ORIGINAL ARTICLES

like a yellow suit with brown buttons on it.” As will be
remembered, it was Liepmann who first showed that such
hallucinations could be produced in alcoholic deliria.

When pictures were shown to her the hallucinations were
also very marked, just as had been the case in Mrs H. Thus
in one picture which she first described quite well, she added,
“ and there is a man crawling under the fenceIn another
picture she pointed out a cat in the grass, where there was none.
After having described the essentials of a third picture correctly,
she added, pointing to rather small, indistinct geese, that they
were birds. A small brown chicken she called a squirrel.
Finally she saw “ a big snake and a big green lizard.” (The
picture showed a patch of grass.) When she was shown a fourth
picture she again described the essentials correctly, but when she
came to an indistinct chick she said, “ There is something here
but I can’t see it.” Later she saw “ bugs running up the
shrubbery,” and finally “ a long green snake.” In other words,
the patient began invariably by describing the picture correctly.
That was at a time when her attention was attracted by a new
picture, but soon she began to hallucinate, and as we shall
presently point out, she began to see indistinctly, and when one
watched her further she was very apt to go off, as it were, i.e. to
get into a staring state similar to the one described on the first
day, or she got distinctly drowsy.

That she does not see well we infer from the fact that she
pointed to the chick saying, “ I cannot see that.” However, this
was rather isolated and usually she hallucinated. Some years ago
I had occasion to observe a case of Korsakow’s psychosis quite
early in the course. This man resembled in many ways the
patient under consideration. In that case it was very evident
that he had periods when his vision was very indistinct. He
also hallucinated at times during these periods of indistinctness
of vision ; more often this was not the case. The Korsakow case
differed very markedly from Miss G. by making a much more
natural impression, but from time to time he had peculiar short
spells in which he seemed to wander, would not respond, and
sometimes even his attention could not be attracted for the space
of a minute or so. My attention was first called to this condition
while I was making a sensory examination. He would answer
promptly for a time, then suddenly he could be touched or

ORIGINAL ARTICLES

pricked without making any response. In order to study this
more carefully we applied the following tests. We read to him
columns of thirty-two figures each, among which five threes were
irregularly distributed. He was asked to tap the table every
time he heard a three. He would often allow from one to five
threes to pass unnoticed, on one occasion fourteen in four lines, and
altogether 14 per cent. When this man was shown series of
letters (we used quite large ones) or pictures, he would at times
name or describe them very well. At other times he would say,
“ it's dull,” or “ it's blurred,” or “ it’s going,” or simply, “ I can’t
see it.” Although the most frequent result was that his vision
became merely blurred, he, at times, hallucinated like Miss G.
For example, on one occasion, instead of seeing a letter he said he
saw “ a procession of the Knights of Pythias.” A few times he
also had auditory hallucinations in such periods. Questioned
about these states he said, “ My mind wanders ” ; or again, “ I
get forgetful at those times.” 1 We sec, then, that this patient
had short periods during which his “ mind wandered.” In these,
his attention could at times not be attracted; at other times he
showed a peculiar visual disorder, and with it a tendency to
hallucinations. The analogy with the case of Miss G. is obvious.
The most likely cause of this visual disorder seems to be a dis¬
order of accommodation and fixation. There can be no doubt
but that this indistinctness of vision plays a part in the pro¬
duction of the visual hallucinations, or more correctly, illusions.
The most important part, however, we must admit to be the
mental alteration, namely, the peculiar dipping down to lower
levels of consciousness—if this term may be permitted—a con¬
dition of mental dissociation analogous to dreaming or to the
bypnogogic state, in which hallucinations are also present. And
we all know that in the state preceding sleep our vision becomes
indistinct, as everyone has experienced when trying to read a
book while having difficulty in keeping awake.

We will now return to the case of Miss G., and to the
experiments on the process of apprehension. We wished to see
whether a short exposure of letters or words or pictures was

1 An interesting feature about the case were quite marked variations in the
blood-pressure, distinctly perceived by the touch. But I was never sufficiently
satisfied to declare that they were synchronous with these periods. On one occasion
Dr Amadon established the fact that the fundus, which in the beginning of the
ophthalmoscopic examination appeared normal, later was much paler.

ORIGINAL ARTICLES

snfficient for her to apprehend correctly. We used for that
purpose a small screen of a photographic apparatus, the exposure
of which varied somewhat between one-tenth and one-fourth of a
second. Among seventy tests we found that sometimes we
obtained, even with the shortest exposures, remarkably good
results, which did in no way differ from the normal This was
especially the case with simple letters or with words. At other
times the results were remarkably poor, and again the patient
hallucinated. The influence of the clearness of the object was
evidently of some importance. Thus, when an indistinct bird was
shown, she said, “ I see three cows in a field and a man coming
along with a rake over his shoulder.” Bonhoeffer, in studying his
alcoholic deliria, has pointed out that by means of the sesthesio-
meter we sometimes get normal, again very bad results; in fact,
his findings are perfectly analogous to ours. We may say that,
from time to time, there is a most profound inability to appre¬
hend, but that this is due entirely to the specific delirious
alterations, the dipping down to lower levels of consciousness;
while at other times we obtain normal results.

Somewhat more complicated is the study of the retentive
faculty (Merkfahigkeit). When we gave the patient eight con¬
secutive figures to repeat, she was able to give on an average
about four; a few times, however, she gave seven and six, some¬
times none or only one (nineteen tests). It is possible that seven
and six represent her normal limit.

Other tests were the following. The patient was given
pairs of words—(1) words connected by habitual association,
such as “ bread and butter ”; (2) pairs of words connected by
internal association, e.g. “ head—hair ” ; (3) pairs of words which
were not connected at all, such as “ screen—ball.” After times
varying from thirty seconds to two minutes, thirty minutes, an
hour, or even one or two days, she was given the first word and
had to supply the second. We found that she was unable to
retain words which were not connected, but we made few experi¬
ments with these. Among the words with internal connection
she retained 31 per cent.; among those with habitual associa¬
tions 57 per cent. It was generally found that when she was
able to retain the words for thirty seconds she also could retain
them for much longer periods, and the results with habitual
associations were even strikingly good when she was asked two

ORIGINAL ARTICLES

or three days afterwards. 1 In this connection we may also
mention some experiments with pictures. Three days after she
had been shown certain pictures she was able to pick out
correctly the five shown among twelve. And similar evidence
of her ability to retain impressions was seen from day to day
when questions about incidents of former interviews were asked.
I doubt whether the results would have been the same in
alcoholic delirium, for which Bonhoeffer claims such a memory
defect, although he is not very explicit about it. At any rate,
in view of these results, it seems very questionable whether we
can speak in this case of a memory defect independent of the
general clouding of consciousness. It might very well be that
in alcoholic deliria, which have many points of relation with
Korsakow’s disease, there exists an independent memory defect,
while this is not true in cases here under consideration. Finally,
experiments similar to those recorded in relation with the
Korsakow case were made, i.e. the patient had to tap every
time a three occurred in a column of figures read to her. She
omitted 34 per cent. These tests were made at two different
periods—(1) when the delirious traits were more in the fore¬
ground ; (2) when the retardation was more pronounced. During
the former there were present 16 5 per cent, omissions, and 4*8
per cent, slow reactions ; during the latter, 51*5 per cent, omissions,
and 4 8 per cent, slow reactions.

If we summarise the clinical picture of these drug deliria, we
find in the first place on the physical side invariably a coated
tongue, a foul breath, sordes at times. We also find occasional
slight febrile movements, sometimes unsteadiness of the gait,
increase of reflexes, and some slight, but quite inconstant, tremor.
The speech defect I am inclined to attribute in part to the bad
condition of the mouth, in part to the clouding of consciousness,
because it is very striking how much better these patients speak
when they are aroused. There is no cyanosis and no flushing;
on the contrary, the complexion of these patients appears rather
pasty.

On the mental side we find first of all a certain dulness and
hebetude, so that it is at times difficult to arouse these patients,
while at the same interview it may be quite easy ; and we have

1 These word-pair experiments were made with twelve different word-pairs on five
different occasions.

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repeatedly noted that in spite of a marked dulness, unobtrusive
noises may be commented upon. In harmony with this dulness
is the fact that we often find a certain drowsiness even in the
mildest cases. We shall later return to this.

The most marked alteration is a constant tendency to dip
down to a lower level of consciousness. This seems to me a
more correct formulation than to speak of an attention disorder,
which term is used, for example, for the very different alteration
underlying flight of ideas; although it is to be expected, and
experience actually teaches us, that the lowering of conscious¬
ness which we here speak of should lead to an attention
disorder, as a partial secondary manifestation, which then, of
course, presents itself in a very different setting than that which
produces a flight of ideas. When the consciousness sinks to this
lower level we have a condition somewhat akin to sleep, inasmuch
as there is a general dissociation; spontaneous trains of thought
arise, not connected with the outside world or with reality, very
similar to dreams. At the same time there are hallucinations of
various senses, more especially sight, hearing, and touch. These
hallucinations may be produced artificially by rubbing the eyes;
they are also well observed if the patient is made to describe
pictures or to read. We have seen that the visual hallucina¬
tions, or better the visual illusions, are in part at least due to
an indistinctness of vision which we have reason to attribute to
insufficient accommodation and fixation. However, the essential
factor in the production of these hallucinations is evidently the
general dissociation for which we find an analogy in the hypno-
gogic hallucinations and in dreams, and indeed it seems not
improbable that hallucinations are most frequently produced by
a dissociation of some kind or other.

It should again be emphasised that this, we might almost
say, specific delirious tendency to dip down to a lower level of
consciousness, is but a tendency, and that the patient can usually
be roused, often to strikingly good, connected activity, as was
shown in all our patients, especially well in the tests applied in
the case of Miss G. The paraphasia seems entirely due to the
lack of attention, the inability to concentrated activity as the
result of the specific delirious alteration, as Bonhoeffer has
shown.

The disorientation must also be explained on the ground of

ORIGINAL ARTICLES :

this delirious change, and we have seen that in these drug cases
a memory defect, independent of the specific alteration, can
probably not be made responsible for this disorientation. But
one thing should be mentioned in this connection. We have
been struck with the fact that delirious experiences and delirious
interpretations are held with remarkable tenacity, even during
the convalescent stage, at a time when the patient is otherwise
perfectly clear, and it is not improbable that this peculiar
tendency, from an explanation of which we would refrain, is to
a great extent responsible for the lack of correction which one
would naturally expect in such patients who from time to time
can be aroused to a connected mental activity.

As we have stated, the retentive faculty, or the memory for
recent events as such, is probably not altered independently, and
the same may be said in regard to the memory for old events.

The train of thought shows some characteristics which
resemble those of flight of ideas, and are due, as we have
said, to the incidental attention disorder, while at other times
the connection is retained for considerable periods of time.
What makes the utterances of the patient at times so incom¬
prehensible to us is not this tendency to flighty turns, but rather
the fact that delirious experiences are related with which we
are not acquainted, and it is further made incomprehensible by
the very frequent paraphasic elements.

The mood is often indifferent, but we have seen in one case
a certain euphoria, again a certain whining depression, some
indications of apprehensiveness, but never fear. So far as the
motor side is concerned, we may find a certain restlessness or
disinclination to move, but all this seems incidental to the
essential delirious alteration: as a rule it shows nothing very
pronounced.

We will finally compare with this picture that of the alcoholic
delirium as Bonhoeffer describes it. According to this writer,
this psychosis presents in 80 to 90 per cent, of the cases
the following characteristics. The patient moves about a
good deal, and is constantly occupied. His face is congested,
his expression anxious. Often he shows marked fear. There is
a very pronounced tremor, profuse perspiration. The gait may be
somewhat uncertain, and there is ataxia of speech. We may
add here that he mentions occasional eye muscle disorders,

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which are, however, slight; and, retrospectively, the patients
may speak of double vision.

The patients do not appear dull, and even at the height of
the delirium they can be demonstrated to students, and the
impression made on them is that the patient’s manner of
reaction is not markedly different from the normal; but the
examiner finds that it takes some effort to hold the patient’s
attention. On a more careful examination, Bonhoeffer established
the following. It is possible at any time to force the patient
to a maximum degree of attention which does not differ from
the normal. This may be shown, for example, by experiments
with the sesthesiometer. A conversation with the patient also
tends decidedly to raise his attention to a certain level, but
when he is left to himself there is a constant tendency for the
attention to reach a lower level, at which time the normal train
of thought ceases, and the arising ideas show a marked
tendency to become projected, as it were, as hallucinations.
During an examination, when the attention is raised to a
higher level, hallucinations are very few or totally absent, and
the diminished attention shows itself chiefly by signs which are
very similar to those of a normal inattentive state, such as a
paraphasia similar to the fatigue paraphasia.

The memory for old events is not interfered with, and
simple calculations are done well, as are all habitual tasks ;
but where a concentration is needed, and combinatory efforts are
required, the patient fails. The retentive faculty, however, is
markedly altered. On the ground of these deviations, Bonhoeffer
explains the disorientation which in these cases is very marked.
He also mentions in this connection a decided suggestibility and
a marked tendency to confabulation, which we all kuow so well
from our experience with Korsakow cases. From these
confabulations he justly separates those which arise from
hallucinations.

Bonhoeffer devotes considerable space to the hallucinations.
He raises the question whether central or peripheral causes give
rise to them. Meynert has claimed that in deliria the projection
systems were at fault, and others had found various disorders,
such as amblyopias (Magnan), retracted field of vision (Krucken-
berg), disturbance of colour sensibility (Galezowsky). But
Bonhoeffer points out how, on careful examination, he was

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103

unable to tind any of these changes, except perhaps in colour
vision. He is of the opinion that peripheral changes, if they are
of any consequence at all, have to be given a very subordinate
place in the production of hallucinations. He mentions
casually Mendel’s claim that disorders of accommodation have
something to do with visual hallucinations, but he takes no
position in the matter. In describing the many mistakes which
such patients make in reading, he says, however, that possibly
the difficulty of convergence may partly cause this disorder, since
he obtained better reading with monocular vision. He points
out the well-known fact that the hallucinations in delirium
tremens are apt to be combined, so that entire scenes are
hallucinated ; and he emphasises the frequency of the illusionary
character of hallucinations, which are, after all, frequently a pro¬
jection of the patient’s thoughts. Just as Liepmann, so Bon-
hoeffer found artificial hallucinations produced by pressure on
the eyeball, and hallucinations were also produced by looking
at pictures, or by the reading tests.

Now the deviations from this picture are found either in
complications with other psychoses or with epilepsy; but what
interests us here especially is his description of the more severe
cases. Such patients are more difficult to fix; finer tests cannot
be applied. They are duller. The motor excitement is coarser,
more elementary, the cyanosis is more marked, sweating and
anxiety greater, the speech like that in meningitis. Eye muscle
palsies are more frequent, as are various other paralytic
phenomena. Such cases are very apt to terminate fatally.

If we now compare the two pictures, that of our deliria, and
that of the alcoholic delirium as described by Bonhoeffer, we find,
in the first place, that that which we have called the specific
delirious alteration is present in both. The hallucinations are
the same, and here, as well as there, it is easy to produce
artificially these hallucinations; they are seen when pictures
are described, and the results of the reading tests, e.g. are
practically identical.

But all this we only find by a careful analysis, whereas
superficially the two states differ so much that one would never
be inclined to mistake the one for the other. That is due, in the
first place, to the fact that we find in the alcoholic delirium the
dilatation of peripheral vessels, and a tendency to cyanosis, and

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often evidence of anxiety or fear. The pulse shows more marked
alterations in alcoholic deliria. I am inclined to attribute these
differences to the fact that the alcoholic delirium attacks persons
who are chronic alcoholics, and whose cardio-vascular system,
therefore, shows marked degenerative changes.

A further difference is to be found in the tremor, which is
very marked in the alcoholic states, slight and inconsistent in
the drug deliria.

Above all, however, the general responsiveness of the patient
is different. We have seen that, according to Bonhoeffer, the
alcoholics do not appear dull, and often make a strikingly natural
impression on a casual observer so far as their manner of re¬
action to questions is concerned. In contra-distinction to this,
we find our patients presenting a certain dulness and hebetude,
and it is much more difficult to rouse them than it is to rouse
alcoholic patients. It was a very natural supposition to think
that possibly this greater dulness might be due to a disorder
of apprehension which was added to the delirious alteration, and
it was for that reason that the experiments on apprehension
were made. They showed us that this is not the case. One
might, perhaps, say that we happened to see graver states,
conditions of unusually great intensity, and that the more marked
conditions of alcoholic deliria, such as Bonhoeffer describes, are
quite analogous, but are fatal only for the reason that the cardio¬
vascular apparatus is weak in the alcoholic conditions. That
this explanation is not sufficient, is shown by the marked
tendency to drowsiness even in our mildest case, Miss G. There¬
fore it cannot be merely a question of intensity, but this hebe¬
tude seems to be a special feature of these deliria. For some
reason or other it seems that although a high level of conscious¬
ness can be reached in both kinds of cases, the tendency to sink
to lower levels is greater in the drug than in the alcoholic
deliria.

To a certain extent the fact that the alcoholic patient is
constantly busy may depend upon this same difference. Whether
there is, in the alcoholic states, also a certain elementary motor
excitability, I am unable to say.

We have above mentioned the fact that Bonhoeffer assumes
the existence of a memory defect for recent events in alcoholic
deliria. Our experiments in the drug deliria, although they per-

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105

haps do not allow a general conclusion, speak against such an
assumption for our cases. And we have also stated that it
would not be improbable that alcoholic conditions should present
such a change though it be absent in our cases, because we know
how often alcoholic deliria run into conditions of Korsakow's
psychosis.

There is another symptom which Bonhoeffer mentions, the
nature of which is as yet uncertain, viz. the great tendency to
confabulation which he found in the alcoholic deliria. The
“ confabulation ” which occurred in our cases appeared to be due
entirely to the spontaneous trains of thought which were
analogous to dreams, and which in part were externalised as
hallucinations. We have, therefore, throughout our descriptions,
spoken of the patients “ relating delirious experiences.” The fact
that defects in the retentive faculty seem to have some relation
to true confabulation, would suggest the possibility that the
absence of confabulation and the absence of a defect of this
nature were related; and, conversely, the lack of confabulation
might be used as an additional support for the claim that the
retentive faculty is not interfered with.

We see, then, that although superficially the alcoholic and the
drug deliria are so different that the casual observer would never
be reminded of the one by looking at the other, they have
nevertheless both the same nucleus, i.e. the specific delirious
alteration, which is only marked by certain special features
characteristic of one or the other.

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THE HISTOLOGICAL APPEARANCES OF THE CORD
AND MEDULLA IN A CASE OF ACUTE
ASCENDING PARALYSIS.

By CHARLES WORKMAN, M.D.,

Pathologist to the Glasgow Royal Infirmary ;

and

WALTER K. HUNTER, M.D., D.Sc.,

Assistant Physician to the Glasgow Royal Infirmary.

The symptoms in the following case were apparently those of an
acute ascending paralysis, and from the clinical point of view it
might therefore be regarded as belonging to the group to which
the name of Landry’s paralysis has been given. But the lesion
found on microscopic examination was of the nature of an acute
myelitis, though of somewhat rare distribution; and it would
seem desirable to classify such cases under the term “acute
myelitis ” rather than that of “ Landry’s paralysis,” even though
the paralysis was acute and ascending. Landry’s paralysis, as at
present understood, is not a specific disease with a definite and
known pathological lesion, but rather a grouping of symptoms
which may be produced by various, and sometimes widely different,
morbid conditions. The term, therefore, should only be used to
designate a grouping of symptoms of which the lesion has not
been determined, and for which a more definite designation is not
possible.

The case we have to describe is, unfortunately, not so com¬
plete, either in its clinical history or its pathological report, as it
should be; still, the appearances in the cord and medulla are
somewhat striking, and present a form of myelitis of much
interest and some rarity. And from this point of view alone the
case seems worthy of being put on record.

The patient, a boy aged 16 years, was admitted into Hart-
wood Asylum on July 4, 1904, in a state of stupor, being unable
either to apprehend or answer questions. For some months past
he had been suffering with headaches. He was irritable, apathetic
to most of what was going on round about him, and slow in all
his movements. At times he had delusions. But from the date
of his admission he steadily improved, both bodily and mentally,
and by the month of September he was able to go for long walks,

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107

and seemed to be enjoying life as any ordinary individual. By
this time he was considered perfectly well mentally.

On October 5, in the forenoon, he complained of having
pains in the frontal region of the head. The temperature was
100° F., and the tongue coated with a thick white fur. A dose
of castor oil was given, and by the afternoon the patient said he
felt better. In the evening, however, he was not so well again,
and complained of feeling out of sorts. By midnight the tem¬
perature was 103°, pulse 110, and respirations 30. There
was complaint of headache and of pains in the knees, but physical
examination was negative, except for the presence of a tender
spot in the abdomen in the right iliac fossa. The temperature
remained high all next day (October 6), and by the evening
there was paralysis noted in both lower limbs. The loss of power
was not absolute, as the left leg could be slightly raised and the
toes of both feet could be flexed and extended. There was no
anaesthesia and the reflexes were present. But later there was
complaint of a feeling of discomfort in the throat, localised as
being about one inch below the cricoid cartilage. Articulation
was not affected, and while the breathing was somewhat laboured,
there was no cyanosis. On examining the throat the left tonsil
was seen to be slightly inflamed, but no membrane was visible.
The next morning (October 7) the temperature was normal, but
now all the accessory muscles of respiration were in action and
cyanosis was very evident. Articulation remained unimpaired.
Death occurred suddenly at 3 p.m.

The post-mortem examination was practically negative as
regards naked eye appearances. There was no enlargement of
the spleen and no meningitis. A small capillary haemorrhage,
about an eighth of an inch in diameter, was visible on the floor
of the fourth ventricle on the left side near to the striae
acusticae, but otherwise there was nothing of special note in the
nervous system.

The cord, medulla, and pons were examined microscopically.
They were fixed in formol and stained with thionin and with
haematoxylin and eosin. (Sections were also stained in various
ways to demonstrate if any micro-organisms were present, but
with entirely negative result. Cultures were not taken.)

Throughout the whole length of the cord there was a marked
infiltration of round cells into the grey matter. This was most

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abundant in the lumbo-sacral and dorsal regions, and rather less
in the cervical. The infiltration, moreover, was present through¬
out the whole breadth of the grey matter, but much more dense
at the base of the posterior horn and at the base of the postero¬
lateral aspect of the anterior horns. Indeed, the area of greatest
intensity corresponded closely to the distribution of the anterior
and posterior central arteries. The white matter of the cord was
unaffected, except that the peripheral arteries running through it
showed infiltration into their perivascular spaces, but not into the
tissues beyond that. The vessels of the cord were greatly
dilated, and there were some slight capillary haemorrhages into
the grey matter.

The vessels of the meninges were also congested, but the
infiltration round these was slight in amount and was mostly
confined to the ventral aspect of the cord, near to the anterior
spinal artery, and into the median fissure.

In the lumbo-sacral region of the cord no normal ganglion
cell could be seen in the anterior horns, and even the number of
degenerate cells visible was small. The cells in Clarke's column
were less affected. In the cervical region the infiltration was
not so intense, and there was a proportion of the ganglion cells,
mostly in the lateral groups, practically normal. Many of these
seemed slightly swollen, but their Nissl granules were still
intact and fairly well differentiated. The majority of the cells,
however, were small, pale, and without any granulation ; and
many others had doubtless entirely disappeared. The process of
cell degeneration seemed to be very rapid, for there were very
few cells to be seen in a shape intermediate between the almost
normal cell and the pale cell, with no granulation at alL
Certainly no cells were seen with the dust-like granulation so
typical of a more chronic chromatolysis. Some of the ganglion
cells had apparently been invaded by the infiltrating cells, for
they contained round cells in their interiors, but this was not
a marked feature of the section.

Throughout the whole of the medulla and pons the vessels
were greatly dilated as in the cord, and showed the perivascular
spaces packed with round cells. Otherwise the infiltration into
the grey matter was not nearly so marked as in the cord. In
the lower parts of the medulla (level of pyramidal crossing) the
infiltrating cells were almost entirely confined to what remained

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109

of the anterior horns : there was slight, if any, infiltration into
the grey matter of the twelfth nucleus. Passing up the medulla,
the ganglion cells of this twelfth nucleus were still seen to be
quite normal, with no infiltrating cells round about them. But
the infiltrated area could be traced upwards through the dis¬
appearing anterior horns to that part of the reticular formation
round about the nucleus ambiguus. It seemed to be chiefly
limited to this area, for the olive in front, the twelfth nucleus
behind, and the lateral nucleus externally were all practically
free from infiltrating cells. The ganglion cells of the nucleus
ambiguus showed changes similar to those in the anterior horns
of the cord.

The appearances in the pons were like to those in the
medulla, but the amount of infiltration was rather less in the
former. The infiltrating cells occupied a corresponding area in
the reticular formation, and in the upper levels of the pons they
were seen surrounding the fifth (motor) nucleus. Higher still
(level of third nucleus) the area of infiltration seemed to have
passed inwards, for it was most marked on each side of the
middle line. The rest of the brain was unfortunately not
examined.

The appearances were, therefore, those of an acute diffuse
interstitial myelitis, limited to the grey matter of the cord, with
the inflammatory process passing upwards into the grey matter
of the medulla and pons. It was, indeed, a central myelitis,
not, however, limited to an area round the central canal, for this
part of the cord was comparatively unaffected, but with the
intensity of the infiltration rather towards the lateral parts of
the grey matter.

The process seemed to commence at the lower end of the
cord and to pass upwards, for the infiltration was considerably
more intense in the lumbo-sacral than in the cervical areas, and
still less in the medulla and pons than in either of those parts of
the cord. In the lumbo-sacral region, too, the almost complete
destruction of ganglion cells pointed to that level as being first
affected.

We have already said that this destruction of ganglion cells
in the inflamed area seemed to be very rapid, and this is so, for
the illness did not last more than forty-eight hours, and yet at
the end of that time not a normal ganglion cell was to be found

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in the 1 umbo-sacral enlargement. The absenoe, too, of cells is
various stages of degeneration also suggests an acute process.
The degeneration of the ganglion cells was doubtless due to the
presence of a toxic agent in the circulation rather than to
pressure from the infiltrating cells. It is well known how
quickly ganglion cells may degenerate and disappear under the
influence of certain toxins, and, on the other hand, bow little
they seem affected by the surrounding cells in certain other
infiltrations. The exudation in this case, too, did not seem
sufficiently dense to destroy the ganglion cells by actual pressure,
neither was it specially centred round the ganglion cells.

The limitation of the infiltration to the grey matter of the
cord is somewhat difficult to explain. But infiltrating cells
most often follow the line of least resistance, and this is within
the grey matter; possibly, also, the short duration of the illness
prevented further extension. The area of greatest intensity was
the same throughout the whole length of the cord and the same
on both sides of the cord, though the exudation was invariably
slightly greater on one side than on the other. And the area of
the medulla and pons affected corresponded with the area of the
cord affected, at least if we regard the uucleus ambiguus as the
continuation upwards of the postero-lateral group of spinal cells.
The fifth nucleus also continues upward the nucleus ambiguus
and seventh nucleus cells.

As to the nature and origin of the infection—for the
myelitis cannot be regarded otherwise than as an acute infective
condition—we have little to go on. It is likewise difficult to
determine whether it is of the nature of a septicaemia or a
toxaemia. No micro-organisms could be found in the exudation
after careful staining, and this favours the idea of its being a
toxaemia; but, unfortunately, cultures were not taken from the
throat, blood, or cord, either before or after death. The tonsillitis
suggests the tonsils as the seat of entrance of the virus; and
the possibility of the condition being a manifestation of diphtheria
must also be thought of. Or it might even have beeu poet-
diphtheritic, for in the month of April the patient’s brother had
diphtheria bacilli discovered in his pharynx, and a week or two
later the patient himself had a sore throat with some sort of
exudation on the tonsils. But as he was on board a steamer at
the time, and the steamer did not carry a doctor, no diagnosis can

ORIGINAL ARTICLES

111

be made regarding the nature of the sore throat. But in any
case, as far as we know, the toxin of diphtheria produces no such
interstitial exudation in the nervous system as was present in
this case.

The nearest analogy one can find for this myelitis seems to
be in the cellular infiltrations that are met with in rabies, a
disease probably due to some toxin acting on the central nervous
system.

And so we conclude that in this case also a toxin of some
sort had gained entrance into the circulation, and that it acted
on tissues unusually sensitive to such toxin (the history of the
patient showed a marked neuropathic tendency), producing a
degeneration in ganglion cells, and at the same time determining
the infiltration of round cells, which was such a marked feature
of the case.

In conclusion, we wish to express our indebtedness to
Dr N. T. Kerr, Physician-Superintendent at Hartwood Asylum,
who most kindly placed at our disposal the Asylum record of the
patient’s illness.

Description or Figkjbcb.

Fio. 1.—Low power. Fart of anterior horn of cord, showing dilated vessel
with cellular exudation into the peri-vascular space and into surrounding
grey matter.

Fig. 2 . —High power. Shows a similar vessel with exudation into its peri¬
vascular sheath.

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TRYPANOSOMIASIS OR SLEEPING SICKNESS.

By Major D. G. MARSHALL, I.M.S. (Retd.),

Lecturer on Tropical Diseases in the School of Medicine of
the Royal Colleges, Edinburgh.

The literature ou this subject is now very extensive, and this
article is written with the view of presenting, in a concise
form, a review of our present state of knowledge of this most
interesting disease.

History .—The earliest known description of the disease is
an article by Winterbottom, published in 1803. In 1869,
Guerin described minutely 148 cases occurring in Martinique
during a period of twelve years, the disease having been intro¬
duced into the West Indies by imported African slaves.

The subject attracted little attention (though several cases
occurring in natives had been recorded in this country) until

1900, when, owing to the opening up of trade routes, the
disease, which had formerly been confined to West Africa, spread
to Uganda, and caused enormous mortality among the natives,
especially in the vicinity of the Victoria Nyanza.

In 1903 the epidemic had assumed such dimensions, and
the high mortality caused so much interference with the develop¬
ment of the country, that a Royal Commission was appointed to
investigate the disease, and from this time our more accurate
knowledge of the etiology of the disease may be dated.

Etiology .—It is now generally admitted that the affection
is due to the presence of Trypanosomes in the blood and cerebro¬
spinal fluid.

Trypanosomes were first described as occurring in the blood
of rats by Lewis in 1877. Nepveu described what were appar¬
ently Trypanosomes in the blood of a man in 1895, but the
proof of their connection with sleeping sickness dates from May

1901, when Forde, a colonial surgeon working in British
Gambia, found worm-like bodies in the blood of a patient
suffering from fever. In December 1901 he showed the slides
to Dutton, who at once recognised the parasites as Trypano¬
somes. Later, Dutton found Trypanosomes in the blood of the
European captain of a river steamer, who was suffering from

ORIGINAL ARTICLES

113

atypical fever. The man was sent home and the case carefully
studied in the Liverpool School (1).

In September 1902, Manson, who had seen Dutton’s case in
Liverpool, was struck by the similarity of symptoms presented
by an European lady who consulted him on account of fever
contracted in Africa, and, as a result of repeated examinations,
was enabled to demonstrate the presence of Trypanosomes
in the peripheral blood. This patient died on Nov. 26, 1903
(2), death being preceded by marked signs of lethargy. (Fig. 1
is from a film of this patient’s blood taken in Nov. 1902, for
which I am indebted to Sir Patrick Manson.)

During the last three years about ten other European cases
have been described, including one by Siend and Montier (3),
and recently 1 three cases have been reported (4) as having
occurred in Europeans prior to Manson’s case, the cases terminat¬
ing fatally in 1899, 1901, and 1903 respectively.

At this period (1901-2) numerous observers were inde¬
pendently investigating the disease in Africa, and the Trypano¬
some was not generally accepted as the prime factor in its
causation. In particular the Portuguese Commission appointed
to report on the disease in their own African territory came
to the conclusion that it was due to a diplo-streptococcus which
they found in 80 per cent, of their cases. They apparently
overlooked the presence of Trypanosomes.

In Nov. 1902, Castellani, who was inclined to agree with
the conclusions of the Portuguese Commission, found Trypano¬
somes in the cerebro-spinal fluid of a case, and later, by centri¬
fuging the cerebro-spinal fluid, was able to demonstrate the
presence of Trypanosomes in five out of fifteen cases.

The British Commission, under Bruce, on arrival in Africa
in March 1903, were made acquainted with Castellani’s results,
and pursuing their investigations on the lines indicated by these
results, were enabled to thoroughly work out the part played
by Trypanosomes in the causation of the disease, and in their
report (o) were able to tabulate certain definite statements, the
majority of which are fully corroborated by Greig in the latest
report of the Commission (6), a most valuable addition to our
knowledge of the disease which will well repay perusal.

1 Annal de la Soe . Roy. des Sciences Mid. et Naturell , Brux., f. xiv M 1905.

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ORIGINAL ARTICLES

The statements, which are apparently fully proved by further
investigation, are as follows:—

1. Trypanosomiasis and sleeping sickness are one and the
same disease. The so-called Trypanosomiasis is simply die
preliminary stage of fever.

2. Trypanosomes undoubtedly cause the disease.

3. Trypanosomes are carried by the Glossina Palpalis (Tsetse
fly). No other insects, as Stomoxys or Tabanus, are concerned.

4. The distribution of sleeping sickness and Glossina Palpalis
is identical.

5. The cerebro-spinal fluid of every case of sleeping sickness
taken during life shows Trypanosomes.

6. Trypanosomes are not found in the cerebro-spinal fluid in
any other disease.

7. The peripheral blood in all cases of sleeping sickness at
some time or other shows the presence of Trypanosomes.

Among the very few statements in Bruce’s report which, by
the light of further investigations, are shown to be inaccurate,
the most important is one regarding the function of the Tsetse
fly in the development of Trypanosomes. He stated that in his
opinion the fly acted simply as a carrier, and was not the seat of
development of Trypanosomes. Recent researches (7) have,
however, shown that very rapid development takes place in
the stomach of the fly. See p. 40, and figs. 4 and 5.

In the latest report of the Royal Commission above quoted
(6), Greig, as a result of extended observation and carefully
conducted experiments on animals, makes the following categorical
statements:—

1. The disease is a specific polyadenitis caused by the
Trypanosoma Gambiense.

2. In addition to enlargement of the lymphatic glands, the
blood shows a constant lymphocytosis at all stages of the
disease.

3. Sleeping sickness is the last stage of the disease (Trypano¬
somiasis being simply the preliminary stage). It consists essen¬
tially in a polyadenitis plus signs and symptoms due to changes
in the nervous system. The onset of these symptoms
synchronises with the entrance of the Trypanosomes into the
lymph spaces of the nervous system ; this is accompanied by
a rise of the mononuclear elements in the cerebro-spinal fluid.

ORIGINAL ARTICLES

115

4. Bacterial invasion, chiefly coceal, occurs in some cases, but
only in the very last days of the sleeping sickness stage, and
therefore cannot determine the onset of this stage of the
malady.

Generally, these statements may, in our present state of
knowledge, be accepted as correct; for example, the opinion of the
low pathogenic value of the diplo-streptococcus is confirmed by
Lavaran as the result of a prolonged series of experiments, and
the early affection of the glands with the easy detection of
Trypanosomes in the fluid obtained from them by puncture in the
early stage of the disease has also recently been corroborated by
other observers.

The important practical question—Is Trypanosomiasis
invariably followed by sleeping sickness ?—can only be answered
by the results of further observation and experiment.

The disease in natives is so chronic that only the close
observation of a large number of cases from the first appearance
of Trypanosomes in the blood to termination of the case by
death from sleeping sickness or otherwise is necessary. The
Royal Commission has had several natives under observation
since 1903, but sufficient time has not yet elapsed for a
definite conclusion to be reached. It is, however, certain that in
all the European cases reported, the course of the disease tends
to be more rapid than in natives, and Trypanosomiasis is invariably
followed by death with symptoms of sleeping sickness.

Description of Trypanosomes.

It was formerly thought, and is still held by some, that
T. Gambiense and T. Ugandense, e.g. the Trypanosomes causing
the disease in Gambia and Uganda, were distinct species; but
pending further experiments, by which possibly they may be
differentiated, it may be accepted that they are morphologically
identical, and are one and the same species.

The Trypanosome (see Fig. 1) is 18 to 25 1R. long, by 2 to 2'5 TR_
broad; it consists of a body, flagellum, and undulatory mem¬
brane—the details of structure are well seen in specimens
stained by the Romanowsky method. In the body about the
centre is seen a large mass of chromatin staining red, the macro¬
nucleus ; near the posterior end is a smaller mass, the micro¬
nucleus or centrosome or blepharoplast. From this springs the

116

ORIGINAL ARTICLES

flagellum* about twice the length of the body, which, carried along
the edge of the body with which it is connected by the undulatory
membrane, projects from the anterior end.

When alive the parasite is seen to travel rapidly by a series
of undulatory movements, flagellum first.

Description of the Tsetse Fly (Glossina Palpalis).

In the sub-family Glossina are included about twelve species,
but so far only two are known to be concerned in the propa¬
gation of disease : G. Morsitans and G. Palpalis. The former in
connection with Nagana (or cattle Trypanosomiasis); the latter
acting not only as a carrier, but as a seat of multiplication of the
Trypanosome of sleeping sickness.

Habitat .—Tsetse flies show a marked preference for certain
areas, generally known as “ fly belts,” which are characterised by
the presence of water (rivers, or lakes), with abundance of
shady shrubs in the close vicinity. They are practically never
found except in the “ fly belts ” ; and as the fly will not travel far
from water, these belts are often of very limited extent.

The fly feeds only during the daytime (some species are
said to feed both day and night); the natives know this, and
endeavour to pass through the fly belt, if possible, during the
night.

Appearance of Glossina Palpalis.

This, the darkest of all the Glossina, is about the size of an
ordinary house fly. There are two chief characteristics which in
common with the other Glossina render it easily distinguishable
from other flies as the Stomoxys, which closely resemble it.
These are the position of the wings when at rest and the wing
venation.

The wings, which project slightly beyond the abdomen, are
folded over one another like the closed blades of a pair of scissors.
This position of the wings is not seen in any other flies except
the Glossina.

Wing Venation .—The fourth vein, just before it meets the
transverse vein, makes a distinct bend backwards. This is shown
in Fig. 3, in which for comparison the wing of Stomoxys is also
figured. This venation is absolutely confined to the Glossina.

Plate 6.

Fig. 1.

Fig. 2.

Plate 8.

Fig. f>.

Fig. 0.

ORIGINAL ARTICLES

117

Multiplication of Trypanosomes in the Stomach of the
Olossina Palpalis.

In the previously quoted (6) Report of the Sleeping Sickness
Commission, Gray and Tulloch describe the experiments by which
they showed that the Tsetse fly does not act simply as a carrier.
Figs. 4 and 5 show the appearances in the stomach contents
of a fly twenty-four hours after it had fed on an infected
monkey. At the time of feeding, the monkey’s blood only
showed a few Trypanosomes—one in about six or eight fields—
so that the enormous increase in number is very apparent. It is
also interesting to note the varied appearances presented by the
Trypanosomes. Some simply oval bodies with two nuclei, but no
sign of a flagellum. Others elongated, long and narrow, also with¬
out definite flagellum. Others fully formed, and others again
in the process of multiplication by longitudinal fission. These
appearances closely resemble those found by Novy and MacNeal
in Trypanosomes grown on artificial media.

Koch has recently published (7) a note in which he describes
similar appearances in the stomach of the Tsetse, and suggests
that some of the forms of Trypanosomes are male and others
female, and that the development corresponds in some degree to
that in the sexual form of the malarial parasite.

Pathology.

The changes occurring in the disease have been very fully
described by Mott (8). They are slight and practically con¬
fined to the nervous system. The changes are identical in
Europeans and natives.

Naked Eye Appearances of Brain .—There is often some
flattening of the convolutions; the superficial vessels are injected;
there is increase of the sub-arachnoid fluid, which is cloudy,
giving a ground glass appearance to the membranes. These
conditions are more marked at the base.

If the examination is made shortly after death, smears from
the brain will often show Trypanosomes, but they are rapidly
absorbed after death and are not likely to be found if the
examination is delayed for more than six hours.

Microscopically .—The appearances are those of a chronic
meningo-encephalo-myelitis, the chief feature being a filling of the

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perivascular spaces with large and small mononuclear leucocytes.
There is also some glia cell formation.

The mononuclear infiltration is well shown in Fig. 6, a
section of brain from a very chronic case. In addition to the
small and large mononuclears, there are larger cells—plasma
cells of Marscholko—and large granular cells described by Mott
as “ Morula ” cells.

This appearance, which is not confined to the brain, but is
found in the nerve roots, nerves, and the viscera, resembles that
found in many other chronic nervous affections, as general
paralysis, disseminated sclerosis, etc.; but Mott states he has
seldom found “ Morula ” cells in other forms of nervous disease
except sleeping sickness.

Until recently, little attention has been paid to the other
organs, but Greig has shown in his report that the stomach
invariably presents a remarkable appearance, being studded with
small ulcerating hemorrhagic areas varying in size from a pin’s
head to a pea.

A coloured plate representing the appearance will be found
opposite p. 266 of the report.

Symptoms and Diagnosis.

During life the blood, lymphatic glands, and cerebro-spinal
fluid show distinctive changes. These will be considered before
describing the symptoms generally.

The Blood .—The changes here are :—

I. Increase of mononuclear elements.

II. The presence of Trypanosomes.

I. This is early manifested and persists throughout the
course of the disease ; there is no increase in the total number
of leucocytes, the average count being 8000 per c.mm., but the
polymorphonuclears are reduced to about 30 per cent., with a
corresponding increase in the number of mononuclears.

Until late in the disease there is no marked diminution in
the number of red corpuscles or of haemoglobin.

In natives there is almost invariably an increase in the
eosinophiles to 6 to 8 per cent.; but this has no connection with
the disease, being due to the presence of intestinal parasites.

ORIGINAL ARTICLES

119

II. The Presence of Trypanosomes.

The discovery of Trypanosomes in the blood is often a most
difficult matter, and there is no doubt they are frequently
missed—one writer has stated that finding them in an ordinary
film is “ always more or less a matter of chance.”

The reason for this is that they are usually present in very
small numbers, often not more than two or three in a slide, and
therefore in stained slides may be easily overlooked, or only
found after a protracted search. Much time is saved by using
a low power in the search. The appearance, with which it is
necessary to become acquainted, is shown in Fig. 2.

They are more easily found in fresh blood, as they attract
attention by their active movements.

They are not constantly present in the peripheral blood. This
is one of the most marked features of the disease. Examination
of the blood may show their presence in increasing numbers
up to a certain date, when they suddenly disappear, to reappear
after a period of a few days, or, it may be, several months.

Working on Avian Trypanosomiasis, Novy and MacNeal have
shown (9) that in suspected cases, in which examination with
the microscope failed to show Trypanosomes, they were able to
reveal their presence by cultural methods in 44 per cent.—in
doubtful cases of human Trypanosomiasis, this procedure should
be adopted, in addition to the inoculation of susceptible animals,
as the ape or dog. Guinea-pigs are unsatisfactory.

The Lymphatic Glands.

In a letter read before the Royal Society, 5th May 1904,
Greig stated that, acting on a suggestion of Mott, he had
examined the contents of the lymphatic glands in many cases
of sleeping sickness and invariably found Trypanosomes.

Since then the subject has been more fully worked out, and
it has been proved that examination of the glands in the early
stage is a far more easy method of revealing the presence of
Trypanosomes than examination of the blood. As, while they
are, as previously stated, often present in very scanty numbers
in the blood, they are almost invariably plentiful in the glands.

At first, the glands were excised, but this was found to be
unnecessary. It is quite sufficient to puncture the gland with

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ORIGINAL ARTICLES

an ordinary hypodermic needle, suck up a little fluid, and
blow it out on a slide.

By this procedure, Greig found that often 50-70 per cent,
of the natives in certain districts of Uganda harboured Try¬
panosomes ; while quite recently another observer, working on the
Congo, has by the same means found 80 per cent, of the natives
to be affected.

The Cerebro-Spinal Fluid.

In the later stages of the disease, examination will usually
reveal the presence of Trypanosomes in the cerebro-spinal fluid,
but they are usually in small numbers, and it is necessary to
draw off about 5 c.c. of fluid and centrifuge it

For a week or two before death, careful examination of the
fluid often fails to show them, and it is during this time that
bacteria are found in the fluid. This is an interesting fact,
as Novy and MacNeal have demonstrated by their cultural
experiments that Trypanosomes will not grow in the presence
of bacteria.

The cerebro-spinal fluid also shows, from the earliest stages
of the disease, the presence of lymphocytes—the numbers
rapidly increasing towards the end. In the early stage there
may be about 20 per c.mm., rising to 700-800 in the last
stage.

The symptoms throughout are of a most irregular character.

The incubation stage may be very short or prolonged.
Cases have been recorded in which natives did not manifest
any signs of the disease for eight years after being exposed
to infection ; in Europeans the onset is usually more rapid.

The associated fever is in the early stages also of a most
irregular type ; it may be intermittent or remittent, persistent or
showing periods of high fever, lasting for several weeks, alter¬
nating with irregular periods of apyrexia.

Death may ensue within a few months, especially during an
epidemic, or may be delayed for several years.

The course of the disease may, for practical purposes, be
divided into two chief stages.

A. An early stage (Trypanosomiasis), in which the Trypano¬
somes are present in the blood and lymph glands.

ORIGINAL ARTICLES

121

B. A later stage (sleeping sickness), in which the Trypano¬
somes invade the lymph spaces of the nervous system.

Early Stage .—As before stated, the symptoms in this stage
differ very much in natives and Europeans. In the former,
Trypanosomes may be present in the blood for several years with¬
out producing marked symptoms, while in most of the European
cases recorded the fever due to the presence of the Trypanosomes
has often been manifested within a few weeks or months.

In natives, one of the earliest signs is enlargement of
glands, especially the posterior cervical. This has been long
known among natives. In the old days, slave traders invariably
rejected men from sleeping sickness areas if they presented
enlarged glands.

The other marked features in this stage are:—

The irregular fever, which does not yield to quinine.

Vague pains in the chest.

Intermittent headache, lassitude.

Hurried respiration and quick pulse.

In most Europeans, a curious erythematous eruption tending
to run into circular patches has been noticed.

Localised oedema.

In this stage the diagnosis depends on the finding of
Trypanosomes in the blood and glands, and the resistance of the
fever to quinine.

Later Stage .—Sleeping sickness. The earliest symptoms in
this stage are very vague. They are chiefly a peculiar
arythmical tremor of the tongue, the hands, and upper
extremity. The patient often complains of vague pains in the
limbs and neck. The pulse is quick, 90-120, the respiration
hurried.

The superficial reflexes are unaffected throughout; the deep
reflexes, at first exaggerated, are afterwards lost.

The patient gradually passes into a state of lethargy—at
first there is simply sluggish action of the brain, a disinclination
for exertion of any kind ; as the condition advances the patient
assumes a somnolent condition. From this he is easily roused,
but quickly relapses if left alone. In the last stage there is
generally rigidity of the muscles of the neck with flexure of the
lower limbs, extreme emaciation, which is sometimes masked by
oedema, the skin is rough and dry, power over the sphincters is

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ORIGINAL ARTICLES

loet. Saliva trickles from the corner of the mouth. Death
results from exhaustion. The temperature for some days before
death being usually subnormal.

The mind is usually perfectly clear until near the end, the
patient being conscious of his condition, but occasionally, and
this appears to be more common in Europeans than natives, there
is delirium with maniacal excitement, or epileptiform attacks.

Prognosis. — Time and further investigation alone will
show whether all cases of Trypanosomiasis proceed to the stage
of sleeping sickness, or whether in certain cases, especially in
natives of the endemic areas, a certain immunity is acquired.
So far all European (except two or three still under observa¬
tion) cases of Trypanosomiasis have ended fatally with symptoms
of lethargy, and it may be held that, once the nervous system is
invaded, death is inevitable.

Treatment .—Various drugs, as arsenic, chrysoidin, trypan
roth, methylene blue, have been used with little result. At
present in Africa the intra-muscular injection of arsenic is being
extensively tried.

Better results are promised from the employment of serum
obtained from immune animals. There is scope for further work
in this direction.

Description or Fiodres.

Fig. 1.—Trypanosome in blood film. European case. xlOOO.

Fig. 2.—The same. x250.

Fio. 3.—Shows above, wing of Glossina Pal pal is, with the characteristic
backward bend in the fourth vein. Below, for comparison, wing of
Stomaxys.

Fig. 4. —Stomach contents of Glossina Palpalis twenty-four hours after
feeding on a monkey infected with the Trypanosome of sleeping sickness.
Note enormous number and developmental forms. x&00.

Fig. 6 . —The same, xlOOO, showing irregular forms and one large Trypano¬
some in process of longitudinal division.

Fig. 6. —Shows in centre cerebral blood-vessel surrounded by the mononuclear
infiltration.

The whole of the illustrations have been specially made for this article.

For the slides from which 4, 6, and 6 were photographed, I am indebted to

Capt. E. D. W. Greig, I.M.S. ; 5 and 6 are from photographs by Mr Richard

Muir.

ORIGINAL ARTICLES

123

Literature.

1. “ Note on a Trypanosome in the blood of man.” Dutton, Brit. Med
Journ., September 20, 1902.

2. Brit. Med. Joum., May 30 and December 6, 1903. Brit. Med. Joum.
April 30, 1904. “ The examination of the tissues of the case of sleeping
sickness in a European.” Low and Mott.

3. “ Recherche Back et Histol. dans un cas de maladie du sommeil chez un
blanc.” Sicard and Montier, La Preset Mid., December 13, 1905.

4. Annal. de la Soe. Roy. dee Sciences Mid. et Nat., Brux., f. xiv., 1905.

5. “ Further report on sleeping sickness in Uganda,” by Bruce, Nabarro,
and Greig. Published by Royal Society, November 20, 1903.

6. Reports of the Sleeping Sickness Commission of the Royal Society, No. vi.,
August 1905. Printed for H.M.’s Stationery Office by Harrison & Sons,
London.

7. Deutsch. med. Woch., November 23, 1906.

8. Path. Soc. Transactions, Vol. i., 1900. Brit. Med. Joum., December
10, 1904.

9. Joum. Infect. Dis., Vol. ii., No. 2, March 1, 1905.

abstracts

ANATOMY.

THE MODIFICATIONS OF NERVE CELLS, STUDIED B7 NIBBLE

(42) METHOD. (Lea modifications des cellules neryeuses, dtudiles par
la methods de Nisal.) Ch. Mourre, Arch. gin. de Mid.,
Dec. 12, 1905.

This is a long paper dealing with the normal histology of the
chromophile elements, and the changes in them, in various patho¬
logical conditions, chemical poisonings, toxaemias, etc.

The author concludes that the Nissl granules are unequally
distributed through the cell, and do not constitute an essential
part of it; they are subject, normally, to considerable variations,
which are exaggerated in certain physiological conditions, and
attain their maximum in pathological states. They are easily
altered, but although showing many varieties of lesion, none of
these are specific. David Ora

CHROMATIC PSEUDO CORPUSCLES OF THE AXIS-CYLINDER.

(43) (Pseudo - corpuscoli crom&tici del cilindrasse t) Pietro
Guizzetti, Riv. di Patol. nerv. e ment., F. 10, 1905, p. 473.

The author refers to his observation, three years ago, of these
bodies in a dog’s spinal cord, fixed in sublimate-picric solution and

124

ABSTRACTS

stained by Unua's polychrome blue and Griibler’s orange-tannin
mixture.

The axis-cylinders appeared for some distance completely
coloured by the polychrome blue; other parts were yellow or
reddish, and showed blue or blackish corpuscles. These were
sometimes round, but more usually oval or fusiform, and lay along
the long axis of the fibrils.

After using many fixatives and stains, and employing the
tissues of various animals, the author is inclined to the opinion
that these corpuscles are artefacts, principally on the ground of
the almost absolute impossibility of demonstrating them by other
methods than that detailed in the paper. David Orb.

ON CELL TYPES IN THE SENSORY GANGLIA IN MAN AND
(44) THE MAMMALS. (Tipos Oelularesde los GangliosSensitives
del Hombre y Mamlferos.) S. R. Cajal, Trab. del Labored, de
investig. Biologicas, VoL iv., 1905.

Cajal, in an interesting communication, demonstrates the superi¬
ority of his silver method over all others, and indicates that the
formula used was his second, i.e. the impregnation with silver
nitrate, after previous induration for 24 hours in alcohol abs.
pure, or with the addition of two or three drops of ammonia.
In his preparation, the spinal ganglia of man and the mammals
are found to consist of the following types:—

I. The ordinary monopolar corpuscle, the expansion of which is
arranged in a glomerulus.

II. Multipolar corpuscles having, besides the ordiuary axon,
short, thick dendrites with clubbed ends, which terminate within
the capsule.

III. Multipolar capsules provided with fine expansions, ending
in swellings or spheres of large size.

IV. Fenestrated corpuscles.

Besides these there appear in aged subjects:—

V. Corpuscles torn, ragged, or bristling with irregular
appendices.

VI. Corpuscles strongly stained, showing no neurofibrils—pro¬
bably dying or dead. It will be sufficient for our purpose to notice
two of these varieties, those possessed of processes with clubbed
ends and large spheres; and the fenestrated corpuscles:—

I. Cells provided with processes terminating in capsulated balls.
—Cajal mentions that Huber published in 1896 a note announc¬
ing the discovery in a certain American frog of a corpuscle in the
spinal ganglia having such terminations, but as this observation
was not verified, it was supposed to be either accidental or a
pathological condition.

ABSTRACTS

125

Great was Cajal’s surprise, on applying his silver method, to
find in the ganglia of man a great number of cells which reminded
him of Huber’s observation.

Three varieties are noted:—

1. Having expansions with delicate filaments which terminate
within the capsule.

2. Occurring chiefly in man or large mammals, as the horse
and the ass, and having the terminations outside the capsule.

3. A mixed variety, having both intra- and extra-capsular
expansions.

These cells are rare in the mammal, but common in man,
especially in the plexiform ganglion of the vagus.

II. Probable function of these cells with baU-like appendices .—
What signification are we to attribute to these terminations in
globes ?

Cajal finds this to be a problem of extreme difficulty, and he
insists that this will not be solved until we discover special nerve
arborisations, in contact with these spheres. He offers the sugges¬
tion that the sensory ganglia, in exception to the general rule that
nerve centres are insensible, are provided with a sensory receptive
apparatus, by means of which they can transmit to the cell, and so
to the spinal medulla, any stimulus destined to regulate the
sympathetic iunervation of the blood-vessels.

Fenestrated cells .—It will be within the recollection of readers,
that Cajal, in a recent communique, called attention to certain
fenestrated cells which he found in the ganglia of the 9th nerve of
dogs suffering from rabies.

This he considered to be a pathological condition exclusively
found in rabid dogs. But as the result of a series of experiments
which is still incomplete, he holds the view that these cells are
normal in many mammals, and also, but more rarely, in man.
After describing the various forms these fenestrations take, how
they form loops, apparently sometimes multiplying the roots of
the axon, sometimes appearing at the other pole of the cell, he
suggests that they are homologous with the glomeruli of the
ordinary cells, and that they therefore represent an organ whose
object is to multiply the points of contact with the afferent nerve
fibres. The exploration, he says, which is not yet complete, of the
fenestrated system of the mammals, proves the existence in the
spinal and cranial ganglia of a cell-type whose peripheric proto¬
plasm extends itself in cords and network, apparently to meet the
pericellular arborisation of the different nerves.

These cells are peculiarly rich in sub-capsular or satellite cells,
concerning which Cajal hazards some very interesting opinions.
He combats the idea held by Metchnikoff and others, that these
satellites are simply neuronophagi, emigrated phagocytes, whose

126

ABSTRACTS

sole function is destruction. He inclines to hold that they rather
fulfil an important function in the modelling of the neuron; that
they serve a similar purpose to that of the osteoclast in the build¬
ing up of bone, with this difference, that in place of acting by
erosion, their modus operandi is to stimulate the nutrition and
growth of the neurofibrils, and in this way to determine important
morphological changes in the shape of the body and processes of
the ganglionic cells. It is suggested, in order to account for
the diverse shapes produced during growth and in old age, that
there is in the neuronal protoplasm a species of anti-mitosigenic
substance; that in maturity and in health this substance checks
the mitosis of the satellites, but that in old age or ill-health the
anti-mitosigenic activity diminishes, and the dam, so to speak,
which controlled the satellites is broken; they burst forth, increase
and prosper; they penetrate the protoplasm and excite the neuro¬
fibrils which project outwards to the capsule, and so the peculiar
appearance of the decrepit cells is produced.

All this is pure conjecture, and, as Cajal says, his experiments
are not finished. A. S. Cumming.

ON THE DEVELOPMENT OF THE HIND-BRAIN OF THE PIG.

(45) O. Charnock Bradley, Joum. Anat. and Phys., Vol. xl., 1906,
pp. 133-151.

This forms the second part of a communication, the first instal¬
ment of which has already been noticed in this Review (December
1905). Since 1886, when the late Professor His first called
attention to the occurrence of a “ Rantenlippe ” in the hind-brain
of the human embryo, several workers have expressed opinions,
diverse in character, as to its formation and significance in different
mammals. Some have suggested that a rhombic lip is probably
present in all mammals; others have questioned its existence even
in the human embryo. In pig embryos of nineteen and twenty-
two days, there is no indication of the lip; but in an embryo
15 mm. in length, there is a very decided folding of the dorsal
margin of the alar lamina. Sections across the hind-brain at this
stage bear a marked resemblance to the figures given by His of
a five weeks’ human embryo, but with the difference that there is
none of that flattening of the medulla at the widest part of the
ventricle, which is so conspicuous in man. From the time of its
first appearance, the rhombic lip is best developed in the region
of the lateral recess of the ventricle, where it plays an important
role in the formation of the tuberculum acusticum. It is difficult
to imagine that, in the pig, the lip forms the olivary body, etc.,
in the manner described by His; it seems more probable that

ABSTRACTS

127

the fasciculus solitarius becomes buried as a consequence of the
migration of neuroblasts independent of the formation of the
rhombic lip.

In a 23 mm. embryo there is a feeble development of the
rhombic lip in connection with the cerebellum; but it is not so
great as to lend support to the assumption that it plays more than
a very small part in the formation of the cerebellum. The cere¬
bellum is undoubtedly developed from a pair of lateral Anlagen ;
and its development is such that the question is again raised as
to whether the hind-brain should be considered as consisting of
two brain segments or only one.

In the pig, there is no foramen of Majendie during embryonic
life; and it is very doubtful if the opening exists in the adult.
The opening in the lateral recess of the fourth ventricle, on the
other hand, appears at a comparatively early period. In an
80 mm. embryo, the posterior part of the recess has very attenu¬
ated walls; and in an embryo 100 mm. in length, the epithelium
of the posterior wall has disappeared. In a 150 mm. embryo, the
choroid plexus lies free in the subarachnoid space.

Author’s Abstract.

PHYSIOLOGY.

ON THE GRADATION OF ACTIVITY IN A SKELETAL MUSOLB-
(46) FIBRE. Keith Lucas, Joum. of Physiol n Nov. 9, 1905,
p. 125.

The extent of contraction of a many-fibred skeletal muscle might
be varied by a similarly graded contraction of each individual
fibre, or by the contraction of a varying number of fibres. Most
of the evidence hitherto obtained favours the probability of the
latter explanation. Keith Lucas experimented on the “ cutaneus
dorsi ” muscle of the frog, in which the fibres run parallel, and
can be easily counted and separated into groups. Groups of
muscle fibres were stimulated directly with break induction shocks
varying gradually in strength from minimal to maximal, and the
contractions were recorded by means of a fine lever bearing a
galvanometer mirror and. focussing a beam of light on a moving
photographic plate. After each experiment the muscle used was
fixed and its fibres counted. Ten series of observations are
recorded. A uniform increase in strength of the stimulus does
not give a uniform increase in the extent of contraction, but the
latter increases in definite steps, and the steps in the grade from
minimal to maximal contraction are always fewer in number than
the fibres in the muscle. A movement of the secondary coil of

128

ABSTRACTS

1 mm. is often sufficient to produce a step, and it requires a
subsequent movement through several mm. to produce any further
extent of contraction.

The fibres in a whole muscle must have a wide range of
excitability to the direct stimulus, and the gradation of contrac¬
tion in it depends almost entirely on differences in excitability
between the several fibres. The skeletal muscle-fibre appears to
behave to stimulation like a cardiac muscle-fibre.

Percy T. Herring.

THE LAWS OF ERGOGRAPHY, A PHYSIOLOGICAL AND MATHE-
(47) MATICAL INVESTIGATION. (Les Lois de l'Ergographie, dtude
physiologique et math&natique.) Mile. J. Ioteyko (of Brussels),
Ann. d’Electrobiol. et de Bodied., No. 3, 1905.

V. Physiological Signification of the Constants or Parameters.
Equations containing constants are, of course, in everyday use
in the physical sciences. In them, however, the constants never
vary, once they are established ; in biology, on the contrary, they
are affected by innumerable circumstances. Hence arises the far
greater complexity of the sciences of life.

In the fatigue curve the constants a, b, c of the equation

rj = H — at*+bt 2 —ct

represent the losses or gains in power at the end of a unit of time.
Of these, b being positive tends to raise the curve, the other two,
a and c, being negative, to lower it. The most probable interpreta¬
tion of these parameters, and one which the experiments subse¬
quently described tend to confirm, is as follows. The positive
constant b is attributed to the action of the nervous centres, the
action of which increases in ergographic work to cope with the
paralysis creeping over the muscles. The negative parameters,
a and c, are attributed to processes taking place in the muscle
itself which produce a progressive diminution of the work. This
interpretation is not arbitrary, being based upon our knowledge of
physiological processes.

What does actually take place in a muscle which works to
the point of fatigue? It is generally agreed that a muscle when
fatigued consumes material different from that which it uses when
fresh. When fresh, it draws upon its carbohydrates, the result
being total combustion; any toxins which are produced are small
in quantity, and are immediately consumed by means of the oxygen
of the blood, destroyed in the liver and other glands, or eliminated
by the kidneys. On the other hand, when exercise is prolonged
to the point of fatigue, or there is an insufficient supply of carbo-

ABSTRACTS

129

hydrates, then the albuminoids are consumed, many of the waste
products of which are endowed with a high degree of toxicity. It
is the accumulation of these substances in the organism which has
a paralysing effect upon the muscles. It must not be thought that
the carbohydrates are entirely exhausted before the consumption
of the albuminoids begins; it is more probable that the two processes
overlap, and that the accumulation of the toxic products always
prevents our using up the muscle’s whole stock of reserves.

This being the state of our knowledge before mathematics was
called to our help, the author proceeds with her interpretation of the
parameters.

The two negative constants, a and c, must necessarily correspond
to the two chemical processes taking place in the muscle.

The latter must represent the loss of carbohydrates, seeing
that in all motors the consumption of the combustible is pro¬
portionate to the time. The former, a, will then correspond to the
effect of local intoxication by the toxins. It is very small at the
beginning, but increases very rapidly (being multiplied by the cube
of the time); and these characteristics accord very well with what
we suppose to be the course of action in the consumption of the
albuminoids.

The interpretation of the positive constant b as representing
the action of the nervous centres is based on experiment, Mosso
having established by means of his ponometer the law that effort
increases with fatigue.

The writer now proceeds to examine one or two facts already
established in the light of this interpretation of the constants.
There are cases in which the curve becomes a straight line: in
terms of the equation this would mean that the constants a and b
disappear, the tracing being affected by c (consumption of carbo¬
hydrates) alone. Now, does this correspond with the facts ? As
an example, take a curve given by Mosso (“ La Fatigue,” p. 63;
Eng. Trans., p. 99), which is, if we exclude the two first contrac¬
tions, practically a straight line; we find that this curve is produced
by electric excitation—that is, the action of the nervous centres
(represented by the constant 6) is excluded. Moreover, electric
excitation being painful, the weight used is lighter than usual;
hence we can very well conceive that the demand upon the
albuminoids will not be sufficient to affect the curve, i.e. a will
practically disappear.

As a second example, consider what happens in the case of the
straight line curve given by a frog’s muscle when detached from
the body. Here electric excitation is also used, which accounts for
the absence of b. But as strong electric stimuli may in this case
be used, it is difficult to understand the absence of a. Two facts
are advanced by Mile. Joteyko as supplying the required ex plana-

130

ABSTRACTS

tion. 1. The straight line given by Kronecker as the expression
of fatigue in a frog is found only when the weight is supported
between the contractions; when this is not the case, the curve
approaches a hyperbola. It is quite clear that under the former
conditions the fatigue must be less. 2. The muscles of the frog
differ from those of man in that they can by drawing upon the free
oxygen of the air recover from fatigue, even when they have been
removed from the circulation of the blood. It may then very well
happen that, thanks to this elementary respiration of the fibres,
the potency of the poisons of fatigue is much diminished. Indeed,
the resistance of the fibres of a frog’s muscle to all causes of altera¬
tion—anaemia, poisons, death—is well known, and they may there¬
fore easily offer more resistance than man’s muscles to the poisons
of fatigue.

The rest of this section is devoted to a few general remarks
upon the equation, and to pointing out that the constants are
probably complex in their nature, i.e. due to the action of several
causes acting conjointly.

VI. Alcohol. The second half of Mile. Joteyko’s paper is to be
devoted to the account of a series of investigations devised (1) to
test her interpretation of the parameters, and (2) to analyse the
effect of various agents on the muscles by aid of the parameters.

The first agent investigated is alcohol.

The method of experiment was in all cases the same. The
subject made several ergograms (rhythm, two seconds) at intervals of
one to two minutes. He then rested long enough to allow the
muscles to become completely restored (45 to 60 minutes). Then
after having taken the substance under investigation he again
described the same series of ergograms.

The first substance investigated was alcohol. The experiments
were mainly intended to test the correctness of the interpretation
of the positive constant b, for it is known that alcohol in small
doses has an exciting effect on the nervous centres.

The writer proceeds to give a summary account of the literature
already existing on the ergography of alcohol. An account of her
own experiments follows, the exact figures being given in eight
cases, and reproductions of the tracings in two. The typical
alcoholic curve is found to be longer than the normal curve, but
the height of the individual contractions is decreased. The total
work done is increased, while the quotient of fatigue (the average
of the contractions) is diminished. Individual differences with
respect to alcohol are, however, very great, so that results quite
the reverse of the normal are not infrequently obtained.

The constants of five of the most characteristic pairs of curves
were calculated, and from a comparison of the figures thus obtained
some important conclusions are drawn.

ABSTRACTS

131

The constant b, attributed to the action of the nervous centres,
is found to have increased in four out of the five cases. In view
of our knowledge of the exciting effect of alcohol on the nervous
centres, the interpretation of the one case in which b diminishes
becomes of supreme interest. Here is Mile. Joteyko’s explana¬
tion. The constants are obviously complex quantities; thus a may
be due to the action of several different toxins, any of which may
vary independently of the others; if two, for instance, were to vary
inversely, the parameter as a whole would clearly not be affected.
Now suppose b to be made up of two components b x and J 2 ; let
be the effect of the centres properly so called, and let b 2 be the
action of any toxins, muscular or otherwise, which affect them
during the course of the work. A slight dose of alcohol increases
b v but it is conceivable that it might at the same time so much
diminish b 2 that its effect upon b should be on the whole to
diminish it. Now when we turn to the actual figures to see if we
can find anything which seems to support this hypothesis, we see
that while in the other alcoholic curves a decreases at most to a
third of its former value, in this particular one in which b has
decreased it falls to one-thirteenth. If we suppose then what is
from other considerations very probable, that toxins which have a
paralysing effect upon the muscle have an exciting effect upon the
nervous centres, the explanation offered will be seen to verify
itself.

As has been said, a (action of toxins) diminishes in almost all
the experiments (four out of five). It would appear from this
that alcohol in small doses acts as an aliment, furnishing the
muscle with easily assimilable materials which enable it to con¬
tinue working without calling upon its own albuminoids. If we
admit the peripheral origin of fatigue, this would also explain
the fact that a little alcohol diminishes the sensation of fatigue.

Effect of Alcohol upon the Rhythm .—Maggiora has shown that
an interval of ten seconds between the contractions allows the
muscle to recover entirely from its fatigue, and admits of the con¬
tractions being maintained at their maximum. In the experiments
devised with the view of testing the effect of alcohol on the rhythm,
fatigue was considered to be held at bay if after forty minutes’ work
the curve showed no sign of declining towards the abscissa. When
the work was done with a rhythm of eight seconds, fatigue appeared
about the twenty-fifth minute; when the same experiment was re¬
peated after the absorption of 30 grammes of alcohol, no trace of
fatigue appeared. The effect of alcohol then is to quicken the
rhythm at which work may be done without fatigue.

Explanation .—At first sight it might seem that the most
probable explanation of this fact would lie in the exciting effect of
alcohol on the nervous centres. But a closer investigation seems

132

ABSTRACTS

to show that the action of alcohol as an aliment accounts more
satisfactorily for all the phenomena. In the previous discussion it
was shown that alcohol had generally the effect of diminishing the
parameter a (attributed to the action of the toxins). Now if this
is the case with ergograms written with a rhythm of two seconds,
still more ought it to be the case with those written with a rhythm
of four seconds, which approach complete indefatigability. If the
constants are calculated for a normal curve and for an alcoholic
curve with this rhythm, it is found that in the latter the constant
a is reduced to one-thirteenth of its normal value, while the
constant b is reduced to one-fifth. This result agrees with that of
the experiment quoted above in the first series: the enormouB
diminution of muscular toxins coincides with the apparent absence
of excitation of the nervous centres.

The most notable feature of the alcoholic curve is the enormous
diminution of a. This appears explicable by the action of alcohol
as an aliment, the muscle being enabled thus to refrain from
making use of its albuminoids.

The writer concludes her study by pointing out that her results,
established by the ergograph, agree well with those of Atwater,
Duclaux, and A. Gautier, who, on the strength of their recent
researches, have concluded that alcohol acts as a true aliment and
even as a precious aliment, so long as one does not surpass a
daily dose of 1 gramme per kilogramme of the weight of the
body. Margaret Drummond.

PATHOLOGY.

BACTERIOLOGY OF ACUTE ANTERIOR POLIOMYELITIS. M.

(48) Gbirsvold, Tidsskreft fer den Norske Lageftrining, Oct. 15, 1905.

In the Medicinsk Revue for November 1901, Dra Carl Looft and
H. G. Dethloft gave an account of previous bacteriological
investigations in this disease.

Schultze, in a case, has found the meningococcus (cf. S. Auerbach,
Jahrbuch ,/. Kinderheilk, Bd. 4,1899). F. Harbitz and Biilow-Hausen
found a diplococcus in the spinal fluid of one case examined post¬
mortem (Norsk. Magazin fer Liegevidenskaben , 1898). F. Engel
(Prag. med. Woch., No. 12, 1900) found the staphylococcus albus in
the spinal fluid of a boy who developed acute anterior polio¬
myelitis, but since the boy suffered from a chronic otorrhoea
and an osteo-myelitis of the clavicle, he regards the find as acci¬
dental. Concetti (Rev. Mensuelle des Maladies de I’Enfance, 1900)
has performed lumbar puncture in ten cases of the disease, in
nine of which a bacteriological examination was made. In two

ABSTRACTS

133

cases examined on the second and third days of the disease, the
diplococcus of Talamon-Frankel was found; in one case examined
on the seventh day the meningococcus of Weichselbaum.

Looft and Dethloft described two cases in the paper above
referred to. A diplococcus was obtained from the cerebro-spinal
fluid in both cases. The diplococcus, the characteristics of which
are described in their paper, was like the meningococcus type of
Heubner, or the coccus which Hunter and Nuthall (cf. Lancet ,
1901, p. 1527) call meningococcus, type B.

In the present paper. Dr Geirsvold publishes an examination
of twelve cases occurring during the epidemic which has been
prevalent during the last few months in some districts of
Norway. He has found a diplococcus almost identical with the
coccus formerly found by Drs Carl Looft and Dr H. G. Dethloft.

Characteristics. —Bean-shaped diplococcus or tetracoccus, form¬
ing in bouillon chains 4-6 pairs. Division parallel to long axis of
cocci. At first the growth is delicate, later in transferred
cultures it is more luxuriant; then the colonies are more
viscid.

On serum a delicate growth. Growth also on potato and in
milk, which coagulates after some days.

The coccus is distinctly stained by the usual aniline stains and
is Gram positive. It was not found in large numbers in the
spinal fluid, which nearly always was clear and deposited a
little sediment. The deposit contained mononuclear cells, but
very seldom leucocytes.

For cultivating, one has to use great quantities (1-3 c.c. for
each tube). If cultivating after the tenth or twelfth day after
the beginning of the disease, he very seldom found any growth
of the cocci; but in this case the spinal fluid microscopically
examined showed micro-organisms in fairly large numbers.

The results of the experimental inoculations were:—White
mice subcutaneously inoculated died after twenty-four hours;
paralysis was sometimes noticed. Some other mice were ill
during some days, then they rallied, but after twenty days a
paralysis of the extremities was suddenly discovered. The
paralysis was ascendant, and death occurred after extreme
atrophy of the muscles had appeared. The same symptoms
were noticed in rabbits. A sudden paresis of the posterior
limbs after a long incubation.

The same coccus has also been cultivated from the throats of
patients suffering from acute anterior poliomyelitis, and from
persons living in places where the disease has not yet appeared.
In all these cases the coccus was pathogenic for mice.

Carl Looft.

134

ABSTRACTS

CONTRIBUTION TO THE STUDY OF MENINGEAL TUMOURS.

(49) (Contribution & l’dtude des tumours mdningdes.) G. Roussy,
Arch. gin. de Mid., Dec. 19, 1905, p. 3211.

After giving a description of the morbid histology of three
meningeal tumours, the author discusses the nomenclature of such
growths. He concludes that “ tumours developed from the
meninges, commonly called psammomata, angiolithic sarcomata, or
meuingeal endotheliomata, would be better described as sarcomata
of endothelial type with hyaline or calcareous masses of vascular
origin.” He is of opinion that the concentric bodies so often
found are due to the formation of buds by the proliferation of the
inner coat of the vessels, with a subsequent hyaline or calcareous
degeneration. Stanley Barnes.

THE MECHANISM OF NERVE REGENERATION. (Mecanismo de

(50) la Regeneration de los Nervi os.) S. R. Cajal, Trab. del Lab.
de Investig. Bioldg., Vol. iv., 1905.

Preliminary notes of these results appeared in the June and
September numbers of the Boletin del Instituto de Bacteriologia.

It is well known, says Cajal, that when a peripheral nerve is
severed, and the ends approximated, there appear in the cicatrix
bundles of newly-formed nerve fibres, by means of which eventually
communication is restored. How is the regeneration of the distal
segment effected ?

Cajal recounts at length the history of this great controversy.
After detailing a very full and interesting series of experiments,
which are profusely illustrated, he proceeds to give what he calls
a rational interpretation of the facts.

The act, he says, of severing a nerve-cord, leaving a group of
axons and cells of Schwann absolutely isolated from all central
trophic influence, immediately awakens two defensive mechanisms.
The first, for which the cells of Schwann are responsible, has for
its object the destruction and reabsorption of the useless axon and
myeline, leaving the way free for the new fibres; the second, which
is the work of the axons of the central end, is for the creation and
growth of the embryonal conductors, destined to re-establish com¬
munications. The cells of Schwann acquire great activity and
proliferate enormously, and the greater part of the resulting cells,
after completing the work of absorption, run their protoplasms
together, forming a faintly outlined cylinder sprinkled with nuclei,
the cellular bands of Biingner and Betbe. So that, as pointed out
by Stroebe, the cells of Schwann represent real phagocytes which,
like the leucocytes of the blood, can assimilate fatty particles and

ABSTRACTS

135

can migrate. Cajal agrees with Stroebe in thinking that the
greatest number of the granular interstitial cells of the peripheral
segment are dislocated cells of Schwann. The cellular bands are
found to be well formed within eight days.

What, then, is the function of these cellular bands. Cajal,
who is a strong supporter of the theory of continuity, does not
agree with Biingner, Bethe, and others, that they are destined to
produce new axons on the distal side. He is inclined to think
that they secrete what he calls quimiotactical substances, which
excite amoeboid movements and a budding forth of the new axons,
attracting secretions which draw the young fibres into the spaces
which have been cleared for them. These secretions would be
poured out on the seventh or eighth day, and would act as do the
crystal tubes, full of attracting material, in Pfeifer’s experiments on
the spermatozoids of the cryptogams.

Thus it is seen that the cells of Schwann fulfil two functions:
the first consisting in the destruction of the axon and myeline and
its removal; the second in the production of quimiotactic secretions.
Moreover, that this quimiotasis does intervene has been almost
demonstrated by the ingenious experiments of Forssmann; and to
this attracting influence he gives the name of Neurotropism. A
point in favour of this view is, as has been noticed by Vanlair, and
is well seen in Cajal’s illustrations, the behaviour of the young
nerve-fibres on the proximal side of the wound. A large number
wander from the path, to right and left; some turn backwards, and
indeed they look as if they had lost their way. This happens
before the seventh day, and is accounted for by the fact that the
quimiotactic fluid is not at that time in action. As the fibres
traverse the cicatrix, and approach the other side, their course is
much more regular.

The reason why each nerve-fibre infallibly finds its proper
place is, Cajal admits, not satisfactorily accounted for by either
theory. He holds certain ideas on this question which he will
develop later.

Cajal recurs in this paper to the subject of the satellite cells of
the neurons. The neuron, he holds, is a complete entity only so
far as the function of transmitting impulses goes; but for living,
growth, the formation of branches, etc., it is dependent on the
satellite cells. Between the neuron and its satellites there exists
a sort of mutual association, comparable to the symbiosis of algae
and lichens.

Formula Used .—To 50 c.c. alcohol abs. add 2 or 3 drops of
ammonia. Fix for 24 hours, then put the pieces in nitrate of
silver, 1'50 per 100, in stove at 35* to 38°. Lastly, reduce by the
pyro-formol mixture. As a rule, the pieces are kept under heat
during five or six days.

136

ABSTRACTS

Cajal considers that Marinesco, in his recent paper, has arrived
at conclusions diametrically opposed to those which a calm study
of the preparations should have led him to.

A. S. Cum ming.

CLINICAL NEUROLOGY.

JUVENILE TABES. (Bin Beitrag zor Tabes in jungem Alter [Tabes
(61) Infantilis nnd juvenilis].) W. Lasarew, Neurol. Centralbl., Nov.

1905, pp. 988 and 1047.

The author points out that probably in some of the cases recorded
as juvenile tabes, the diagnosis has not been correct. He criticises
many of the cases published, and states that he has only been able
to find in literature the records of twenty-three undoubted cases.

Affections which are specially liable to be wrongly diagnosed
as juvenile tabes art*: Friedreich’s disease, cerebro-spinal syphilis,
and a form of combined postero-lateral sclerosis, which has been
described by Oppenheim.

The author records a case of juvenile tabes which has come
under his own observation. The patient was a female aged 19 years,
and presented signs of hereditary syphilis (Hutchinson’s teeth, etc.).
The symptoms were of three years’ duration. The knee-jerks were
absent; the Argyll-Robertsou pupils were present; there were
shooting pains in the legs; Rhomberg’s sign was present; and
there was diminished sensation on the trunk of “ root type." The
muscular sense (sense of position) was lost in the legs.

A review of the symptoms in juvenile tabes is added. The
disease begins most frequently between the ages of ten and twenty:
males ami females are affected with almost the same frequency.
In one-third of the cases, bladder symptoms (difficulty in passing
water, and especially involuntary micturition) were the first
indications of the disease. Headache (often simulating migraine)
is another symptom not infrequently met with in early juvenile
tabes; and in a few cases failure of vision (due to optic atrophy)
has occurred as an early sign.

Many symptoms, common in tabes of the adult, occur in the
juvenile form, viz. loss of the knee-jerks, Rhomberg’s symptom,
ataxia, shooting pains, sensory symptoms (analgesia, diminution of
sensation), optic atrophy, changes in the pupillary reflexes, etc.

In conclusion, the author discusses the etiology of juvenile
tabes, and points out the frequency of evidence of hereditary or
acquired syphilis. In the twenty-four cases of juvenile tabes on
which he bases his analysis of symptoms, there was undoubted
evidence that the parents were syphilitic in eleven (the father

ABSTRACTS

137

was syphilitic in seven cases, the mother iu one, both parents
in three). Many of the juvenile patients presented signs of
hereditary syphilis. In two of the cases syphilis was acquired at
a very early age—in one case at the age of five years through
the lass of a prostitute; in the other case at the age of four
months through the kiss of a nurse. In only four cases was there
no evidence of syphilis, hereditary or acquired. Thus there was
evidence of syphilis in 84 per cent of the cases. In the adult,
tabes is much more frequent in males than in females; in juvenile
tabes females are affected as frequently as males, since the
majority of cases of juvenile tabes are due, at least indirectly, to
hereditary syphilis. R. T. Williamson.

OHRONIO ANTERIOR POLIOMYELITIS, WITH THE REPORT OF

(52) A OASE WITH NECROPSY. Moleen, Am. Jaurn. Med. Sei.,
Dec. 1905, p. 1025.

In the case recorded, the condition began suddenly with lameness
in the left foot, followed two weeks later by wasting in the
peroneal region, diminution of Faradic excitability and decrease of
reflexes, the upper limbs, however, remaining unimpaired. Fifteen
months later the face, tongue, and upper limbs (especially the
thumb muscles) showed wasting and fibrillary tremors, and the
reaction of degeneration was present in both upper and lower
limbs. A careful examination of the spinal cord was made after
death, and showed congestion of the small blood-vessels of the
anterior horn, with degeneration of the anterior nerve roots in the
lumbar region and numerous small haemorrhages in the thoracic
and lumbar regions (shown in a plate).

The question regarding the classification of cases of spinal
muscular wasting is very fully discussed, and there are references
to some twenty-three other cases of a similar nature that came to
necropsy. John D. Comrie.

SPINAL HAEMORRHAGE; SOME OF ITS GENERAL PHASES.

(53) William Browning, Medical News, Oct. 7, 1905.

These cases may be classed from an etiological standpoint in
three groups: (1) traumatic; (2) secondary, originating from
tumours, etc.; (3) spontaneous. Anatomically three divisions
may be recognised: (1) epidural; (2) submeningeal; (3) myelic.
The author regards meningeal or even intrameningeal as
unsatisfactory terms.

The epidural venous plexus is the source of haemorrhage in this
locality. Ten cases are cited from the literature, in only three of
which was there a distinct complaint of pain at the onset or sub-

138

ABSTRACTS

sequently. Id 20 cases of myelic haemorrhage, in all but two pain
was present. There seems much less tendency to impairment or
loss of sensation in the epidural than in the myelic form. Girdle
sensation was present in one of the epidural and in five of the
myelic cases. Dissociated sensory loss was not observed in the
epidural cases; the presence of this symptom “can be taken as
prirna facie evidence that it belongs to the myelic form.” The
distinction between the epidural and myelic types is of importance,
for in the former, since the blood tends to collect posterior to the
cord, without spreading up and down to a great extent, there is a
reasonable hope of successful surgical intervention.

The subdural type of subnieningeal hiemorrhage is unimportant
except as a complication, likewise the subarachnoid. The subpi&l
form appears at times independently, these cases closely resembling
hiemorrhage into the cord. Myelic hiemorrhage (hannorrhage
into the cord) is capable of subdivision into several varieties. Of
these, the central or tubular type is considered as almost
synonymous with traumatic, since in traumatic cases the haemor¬
rhage so frequently takes on the elongated form.

The single or focal form of myelic hiemorrhage has been sup¬
posed to correspond to the ordinary form of cerebral haemorrhage.
It is, however, surprising to note that many of the cord cases occur
before the usual period of life for cerebral hiemorrhage. Of 20
tabulated cases treated, only 7 occurred in persons over 45 years of
age. Spinal and cerebral haemorrhages are different processes.
“ Myelic ha?morrhage is not usually a result of the degenerations,
but of the activities of life.” By this the author does not wish to
imply that myelic haemorrhage is directly traumatic, although he
points out the influence of flexion of the spine on the pressure of
the cerebro-spinal fluid as observed on lumbar puncture, and con¬
cludes that this change in pressure must be transmitted to the
vessels. An analytical table of the chief points in the 20 causes of
myelic haemorrhage is appended. Edwin Bramwkll.

▲ CASE OF SYRINGOMYELIA WITH DOUBLE OPTIO NEURITIS.

(54) Weisenburg and Thorington, Am. Joum. Med. Set., Dec. 1905,
p. 1019.

This cawe is recorded fully because of the extreme rarity of optic
neuritis in syringomyelia, the writers having succeeded in discover¬
ing only two other recorded cases of which they give the reference
and an epitome. The present case occurred in a girl of 16, and
the neuritis was so severe as to cause blindness in the right eye
and ability only to count fingers at 10 inches with the left. The
writers refer the optic neuritis to hydrocephalus.

John D. Comrib.

ABSTRACTS

139

DISSEMINATED SCLEROSIS; CEREBELLAR ATBOPHT AND
(55) PSEUDO SYSTEMIC SCLEROSIS OF THE SPINAL OORD.
(Sclerose en plaques; atrophic c6rdbelleuse et sclerose pseudo-
syat&natique de la moelle Ipinidre.) 6 . Catola, Nouv. Icon, do
la Salpel., Sept.-Oct. 1905, p. 585.

The patient was a man of 38 years, and the first noticeable
symptom was trembling of the arms, which appeared five or six days
after the onset of an attack of cholera. Later his legs became
stiff, and eventually the usual symptoms of disseminated sclerosis
made their appearance. There was scanning speech, horizontal
nystagmus, and general intention tremors. Diplopia was present,
but the reaction of the pupils was normal. The gait was ataxo-
cerebellar and spastic, and the reflexes were exaggerated.
Incontinence of urine and faeces supervened, and later delirium,
passing into coma.

The histological examination showed very marked sclerosis of
the pons and cerebellum. In the latter, Purkinje’s cells were much
diminished and there was a considerable increase of neuroglia.
Two small patches of complete sclerosis were present in the sub¬
stantia nigra of Soemmering, but the remainder of the cerebral
peduncles were normal. The median portion of the superior
cerebellar peduncles was atrophied, but the middle and inferior
peduncles were normal. Atrophy was also present in the olives and
in the riband of Eeil. In the cord there was a pseudo-systematic
atrophy, chiefly situated in the antero-lateral columns. There
was considerable thickening of the pia membrane, and the vessel
walls were thickened throughout all parts of the cord, medulla,
pons, and cerebellum. The author thinks that the relationship of
these vascular alterations is causal, and that the cholera was an
etiological factor. It is of interest to note that although the islets
had such an anatomical restriction, the classical symptoms of dis¬
seminated sclerosis were nevertheless present

A. F. Tredgold.

FURTHER OBSERVATIONS ON THE RELATION OF LESIONS OF
(56) THE GASSERIAN AND POSTERIOR ROOT GANGLIA TO
HERPES OCCURRING IN PNEUMONIA AND CEREBRO¬
SPINAL MENINGITIS. Howard, Am. Joum. Med. Sci., Dec.
1905, p. 1012.

The writer records five cases of herpes, out of which three
died, so that the condition of the ganglia concerned was fully
investigated.

In case 1 (pneumonia complicating typhoid fever) there was

140

ABSTRACTS

herpes on the right side of the nose, and, after death congestion,
degeneration of the nerve-cells and infiltration of the connective
tissue with leucocytes were found in the corresponding part of the
right Gasserian ganglion, while the left ganglion was normal.

In case 4 (epidemic cerebro-spinal meningitis), with herpes
of the right side of the face and neck and of the left upper lip,
vestibule of the nose, side of the head, and soft palate, both
Gasserian ganglia and the third right cervical ganglion were post¬
mortem found surrounded by exudate and having their nerve cells
degenerated.

In case 5 (cerebro-spinal meningitis of actinomycotic origin),
with trifacial neuralgia on the right side and herpes on the left
side of the neck, the Gasserian ganglion after death showed no
abnormality, though the right fifth nerve was markedly inflamed.
Marked changes were found in the third and fourth cervical
ganglia of the left side.

Commenting upon these cases, the writer shows the complete
connection between herpetic lesions and ganglionic changes; in
affections of the nerve roots, herpes apparently does not occur
unless the change spreads to the ganglia.

John D. Comrie.

CEREBRAL SYMPTOMS DUE TO ENCEPHALITIS AND THE
(57) RELATION OF THIS DISEASE TO ACUTE ANTERIOR
POLIOMYELITIS. Fred. E. Batten, Trans. Med. Soc. Lond.,
Yol. xxviii., p. 116.

The writer deals with the clinical aspects of certain cerebral cases
in children, which resemble those of infantile spinal paralysis in
various ways. They set in suddenly, usually in summer, as acute
anterior poliomyelitis does ; they run a similar course and show a
like tendency to more or less complete recovery. He regards
them as almost certainly instances of polioencephalitis.

The cases are divided into three groups, according as the
symptoms point to implication of (a) the cerebral hemispheres (P.
superior), ( b ) the cerebellum (P. cerebelli), or (c) the nuclei or basal
ganglia (P. inferior). Folioencephalitis superior may involve any
cortical area. An instance is first given where the frontal region
seemed affected. A normal child of two years and three months
became suddenly ill with convulsions, vomiting, and fever; she
lost her sight, could not sit up, and screamed for hours. After a
week of unconsciousness she came round, but was found unable to
walk or talk, and was dirty in her habits, very troublesome, and
given to screaming. Two cases are then given of girls of three
and five years respectively, in which the Rolandic area seemed

ABSTRACTS

141

implicated. In the next, that of a boy of three years, the occipital
lobe appeared to be the seat of the disease. The child took ill
suddenly with vomiting and drowsiness, followed by a convulsion.
When he regained consciousness two days later his neck was stiff,
and, though he was quite intelligent and his fundus was normal,
he was absolutely blind. He spoke and could stand, but could not
walk. There was no weakness or iuco-ordination of the limbs, and
no ocular paresis. Sensation was unaffected and the knee-jerks
normal; there was no ankle-clonus, and the plantar reflexes were
flexor in type. A month later the child was beginning to see, and
could walk with help; but about that time he began to have
attacks of petit mal. Five months after the commencement of
his illness he was quite well, with the exception of the petit
mal.

Three cases with symptoms of Polioencephalitis cerebelli are
recorded. In the first (girl of 4£), the attack followed whooping-
cough, and began with fever and vomiting. Paresis of both legs
and affection of speech followed, with slight affection of the
sphincters. There was little headache and no loss of conscious¬
ness. Five or six weeks later she could just stand with legs wide
apart, and tended to fall backward; on attempting to walk, the
gait was wildly ataxic. The hands, especially the right, were
feeble, and showed marked inco-ordination. When laughing, the
left side of the face moved better than the right. Ocular move¬
ments good, except slight defect in upward movement of right eye;
no nystagmus; no optic neuritis; pupils reacting well to light.
Articulation somewhat bulbar in character, no aphasia, knee-jerks
equal and active, ankle-clonus and plantar response doubtful.
After admission the child rapidly recovered, and three months
later walked quite well, showing no iuco-ordination.

In the second case, that of a boy of fifteen months, the
symptoms were unilateral. The child lost the power of the left
side and developed rhythmic movements in the arm and leg, with
marked intention tremor and inco-ordination, but no rigidity. He
lost the power of walking; the knee-jerks were present and equal;
there was no ankle-clonus, and the plantar reflexes were flexor.
The eyes and eyesight were quite normal. A week later he could
walk with help, and had only a slight intention tremor in the left
arm. The mother noticed that he tended to hold his head with
the left ear near the left shoulder.

A number of instances of Polioencephalitis inferioi', with
involvement of cranial nuclei, are given.

In the two first, the oculo-motor nuclei seemed involved.
There was an acute onset of ophthalmoplegia, with loss of sight,
followed by partial recovery, so far as the ocular muscles were
concerned, but with permanent blindness. In four other cases

142

ABSTRACTS

there was implication of the seventh, and in one of the eighth
cranial nerve, which, judging by the clinical evidence alone, seemed
to be due to encephalitis of the nuclei.

The writer hopes that if attention is drawn to the symptoms
of polioencephalitis, it may result in further opportunities being
obtained of investigating the pathology of the disease.

John Thomson.

PSAMMOMATA OF THE DURA MATER. (Ps&mmomi della dura

(58) madre.) Esposito, Maniamio , Ann. xxxi., No. 2, 1905, p. 129.

Case was that of a young girl who died in status epilepticus
after long illness, in the course of which symptoms of cerebral
tumour were present. At the autopsy the dura from without
appeared to be absolutely normal. Its inner surface was studded
with small tumours of varying size, many of which had undergone
calcification. Microscopical examination showed inter alia the
following points:—

Tumours appeared to be composed of a more or less dense
fibrous tissue, with numerous lacuna? filled with calcified granules.
At first sight they would have passed for calcified fibromata, but
examination of two tumours, in which the calcareous process had
not advanced so far, showed numerous cavities in the fibrous
meshwork containing nests of small cells of irregular outline, with
a large, central, granular nucleus, and occasional small fusiform
cells, whose extremities were prolonged into the fine fibrils of the
general stroma. The tumour was poorly provided with blood¬
vessels, without proper walls, being rather excavations in the
neoplasmic substance.

The tumour was attached to the tissues from which it arose
by means of a fine peduncle, composed of fibrillar substance. The
free surface of the dura, covering the internal face of the tumours,
appeared to consist of cells of endothelial character, which were
frequently found undergoing hyaline degeneration. The absence
of any trace of inflammation in the adjacent dura mater at once
negatives the idea that the tumours are products of inflammatory
activity.

The author attaches great importance to vascular structure as
a criterion of the sarcomatous nature of a tumour. The tumour
which he observed differs from endotheliomata in the absence of
large flat cells grouped together. Their fusiform cells were
few in number, and the round cells have less of an endothelial
character, while the stroma is much developed and the vascular
supply is scanty.

Under the group of psammomata a number of widely differing

ABSTRACTS

143

neoplasms have been included. The majority of writers regard
psammomata as anpiolithic sarcomata. The author would recognise
three varieties : the endothelioma of the serous coat; the angiohthic
sarcoma; and the third, of which this case is an example, the
calcified fibro-sarcoma. He considers that the purely fibrous
nature of the peduncle and absence of any trace of vascular origin
distinguished these tumours from the growths described by Cornil
and Ranvier as ampullary dilatation of vessel walls (similar to
those normally found in the choroid), with a covering of
flattened, calcified, epithelial cells, the tumour finally becoming
pedunculated. F. Golla.

CONVULSIONS IN TYPHOID FEVER. William Osler, Pradi-
(59) toner, Jan. 1906, p. 1.

The occurrence of convulsions in the course of this fever is one
which has received but little attention. Murdison, in a series of
2960 typhoids, noted convulsions in only six cases. Osier has
notes of eight cases in a series of between 1500 and 1600. These
cases he groups under three heads. In the first place, two cases
had a history of the attack commencing with convulsions. No
symptoms of any kind had been noticed previously. Secondly, in
four cases the convulsions were apparently a manifestation of the
toxaemia during the course of the disease. Thirdly, in the remain¬
ing two cases there were brain lesions to account for the fits, in
one thrombosis of cerebral vessels, in the other tubercular menin¬
gitis. Dr Osier also mentions a case occurring in convalescence.
Of the eases reported, only three died: one of a subsequent per¬
foration, and two of the brain lesions mentioned above. The
prognosis, then, is not very grave.

In Borne of these instances only one convulsion is reported. In
others the convulsions were repeated at frequent intervals. The
character of the convulsions is not described in all the cases. In
some they were apparently epileptiform. Dr Osier’s paper is a
valuable addition to the literature of typhoid fever.

Claude B. Ker.

MYOCLONUS MULTIPLEX: WITH REPORT OF ▲ OASE. Hecht,
(60) Am. Joum. Med. Sci., Dec. 1905, p. 1041.

The writer refers to the great confusion that has arisen with
regard to the nature of this disease, since Friedreich in 1881 first
reported his case of “ Paramyoclonus multiplex,” and criticises the
various theories that have been advanced to account for its patho-

144

ABSTRACTS

genesis. He records in great detail a case which came under his
own observation, and in which alcohol and chloral appeared to be
the only two remedies capable of allaying the spasms.

John D. Comrib.

ON A CASE OF TRAUMATIC HYSTERIA, WITH THE CLINICAL
(61) PICTURE OF AN OPHTHALMOPLEGIA EXTERNA. (Ueber
einen outer dem Bilde einer Ophthalmoplegia externa ver-
laufenden Fall von traomatischer Hysteria.) A. Westphal (of
Bonn), Deutsche med. JFchnschr., June 1,1905.

Patiknt was a miner, aged 46, who after an injury to the head
developed the symptoms of a traumatic neurosis—headache, dizzi¬
ness, quick heart action, vasomotor excitability, increase of me¬
chanical muscular irritability, occasional tremor of the whole body.
His mood was rather dull and hypochondriacal. When admitted
to the psychiatric clinic, he appeared to present a bilateral complete
ophthalmoplegia without implication of the levator palpebrse
superioris or of the muscles of the iris. The paralysis of the eye-
muscles was found to be variable, and under certain circumstances
would partially or completely disappear ; under certain circum¬
stances, and especially when patient was examined by some new
method, the eyeballs were rotated even to their normal extent
When, however, his attention was directed to the examination of
the eye-muscles, he was unable to rotate the eyeballs at all. The
eyeball would return from an excursion, not in an uninterrupted
movement, but with a few halts, before reaching its normal position
of rest. A tendency to pass into contracture was noticed in other
muscles.

The variability of the paralysis under psychic influences led to
the diagnosis of a functional disorder, simulating closely an organic
ophthalmoplegia, such as is found sometimes in late apoplexy
after head trauma, with haemorrhage into the central grey matter.

C. Macfie Campbell.

HYSTERICAL TIC. (Le tic hystdrique.) Pitres et Cruchet, Jcwrn.
(62) de Neurol ., Dec. 20, 1905, p. 541.

The authors hold that tic may be a real clinical manifestation of
hysteria, but exclude from the term certain tics which are merely
added to, or are concomitant with, hysterical manifestations, also
Meige’s rhythmic tics of hysterical subjects.

Two cases are here recorded: one in a woman of 30, where the
spasm, affecting the shoulder, neck, and face, followed on and

ABSTRACTS

145

replaced neuralgias and convulsive crises. After lasting 8 months,
the condition was cured in two sittings by hypnotism. A slight
return 3£ months later, brought on by a dream, was entirely
stopped by suggestion in the hypnotic state.

The second patient, a girl of 14, suffered from hysterical crises,
with hiccough every day at certain hours, for a month ; these dis¬
appeared, but tics of the shoulders, head, and face took their place,
occurring at exactly the same hours each day, and persisted for
6 months in spite of all treatment. Pressure over one ovary
could bring on the tic at other times. The condition ceased
suddenly, coincident with the return of menstruation, but hemi-
anaesthia, which had been present throughout, persisted.

In both cases various actions (fixation of attention, respiratory
exercises, etc.) which modify simple tic had no influence.

J. H. Harvey Pirie.

HABIT SPASM IN CHILDREN. George F. Still, Lancet , Dec. 16,
(63) 1905, p. 1754.

In 100 consecutive cases of habit spasm, Dr Still found “ screwing
of the eyes ” in 47, head-jerk in 30, affection of the upper limb in
22, and of the lower limb in 9. The production of sudden sounds
was noted in 14 cases. The movements were usually strictly
limited to one part at one time, but there was a striking tendency
for one form of spasm to be replaced by another after a number of
days, weeks, or months. Psychical disorders were present in
some cases, usually associated with rather violent movement.
Such disturbances might take the form of the utterance of foul
language, apparently without reason and even unconsciously; of
irritability of temper; or even of definite delusions or hallucina¬
tions.

As regards etiology, 53 cases were girls and 47 boys. The
greatest incidence of the disease was between 6 and 8. Most of
the children were of nervous temperament, and many suffered
from other neuroses, such as talking in the sleep and enuresis.
Most were sharp, responsive, and of quick intelligence. Rheu¬
matism was of more than average frequency in the family
bistory.

As regards local exciting causes, some definite irritation may
be found not infrequently, and should always be looked for, because
its removal, if possible, may stop the spasm. The age incidence
suggests one source of irritation, namely, the outset of the second
dentition. Conjunctivitis, hypermetropia, astigmatism, inflamma¬
tion of the nasal mucous membrane, and perhaps worms may
serve as exciting causes. Mental strain and mental excitement
are important factors.

146

ABSTRACTS

In diagnosis there is not usually much difficulty, but habit
spasm may be mistaken for chorea.

As to treatment, a holiday in the country is often speedily
followed by disappearance of the spasm, but there is a likelihood
of recurrence if the child returns to school too soon. Lessons
should be begun again gradually, and the subjects should be
selected so as to avoid strain or worry. All forms of excitement
and fatigue should be avoided. Late hours are particularly harm¬
ful. Any source of local irritation should be attended to, but
operations ( e.g . for adenoids) may make matters worse. Scolding
or punishment can only do barm. Drugs are only of restricted
value. Arsenic combined with bromide of potassium may do
good. Ergot and valerian have also proved useful.

W. B. Drummond.

ON TWO OASES OF MYASTHENIA GRAVIS. J. Mitchell Clarke,
(64) Bristol Med. Jouiti., Dec. 1905, p. 308.

The author reports two fatal cases :—

The first case was that of a single woman, aged 32, who died
from exhaustion and cardiac failure fourteen months after the
appearance of nasal articulation, which was the first symptom of
the disease. For eighteen days prior to death, dysphagia was so
great she had to be fed by nutrient enemata, oesophageal feeding
having to be abandoned because of the distress caused by the
passage of the tube.

The second case was that of a woman, aged 63, who died
six weeks after the first symptom appeared “ in an access of
dyspnoea.”

In neither case, unfortunately, was there a post-mortem.

The pathological observations of Laquer and Weigert, Goldflarn,
Link, Hodelmoser, and Hun are briefly referred to.

The administration of thyroid extract and the hypodermic
injection of strychnine were accompanied by improvement in the
first case. Edwin Bramwell.

ON THE DISTURBANCES OF MOVEMENT IN INFANTILE
(65) CEREBRAL HEMIPLEGIA, AND ON DOUBLE ATHETOSIS.
(Uber die Bewegungsstbrungen der infantilen cerebralen
Hemiplegia und fiber die “ Athdtose double.”) Lewandowskt,

Deutsch. Zeit. /. Nervenheilk., H. 5-6, 1905, p. 339.

The writer draws a distinction between the contracture of infantile
and of adult hemiplegia. In the latter case the contraction of the

ABSTRACTS

147

muscles can be overcome; they can be stretched, and have a
certain elasticity. In the former the contracture is “ fixed ” ; it is
one of connective tissue rather than of muscle, and its elasticity is
of a different quality. While defect of movement in hemiplegia is
often due to incomplete or complete loss of inhibitory control over
the antagonists, in infantile cases it would appear that some
muscles and their antagonists function normally as a group,
other muscles and their antagonists fail together—an important
distinction. For instance, it is common to find both internal and
external rotation of the arm faulty, both supination and pronation
weak or absent, while flexion and extension at the wrist may both
be strong, etc.

In explaining what is meant by athetosis, the author makes an
elaborate differentiation between athetosis and “chorea” of a
hemiplegic nature. In athetosis there is always a co-existing
hemiplegic paralysis of some kind, whereas chorea occurs with no
disturbance of voluntary movement on that side. Athetosis is
revealed in the attempt at voluntary movement, and it is an inter¬
mittent spasm; whereas voluntary movement does not of necessity
elicit the chorea. An athetotic spasm may be of some duration.
A patient whose hand is passively closed may be unable to open
it for a space. Athetosis is specially characteristic of infantile
hemiplegia, and is to be explained as a disorder of function, and
not of structure. By “ pseudo-athetosis ” is signified the involun¬
tary movements— e.g. of fingers and arm—that occur on the hemi¬
plegic side when a patient is exercising other muscles, as, for
instance, in walking. When the hemiplegic arm is tested, the
patient being at rest, well-marked association movements are seen
in it; but when he is walking, movements more of an athetotic
nature are exhibited.

Four cases of double athetosis are detailed. Double athetosis
is not equivalent to a double hemi-athetosis, but ought to be used
to indicate a special relation between individual parts of the body
and limbs. Movement of one limb entails and is inevitably
succeeded by movement of another. Double athetosis is a general¬
ised association of such movements. The patient may sit for
hours motionless, but when the time comes for him to go to bed,
or when everyone else in the ward is getting into bed, the
psychological moment has arrived, and his first movement is at
once followed by a whole series.

There is little reference to pathological data.

S. A. K. Wilson.

148

ABSTRACTS

ON THE COURSE OF THE RETROGRESSION OF HEMIANOPIC
(66) DISORDERS AFTER PARALYTIC ATTACKS. (Ueber den
Gang der Rdckbildnng hemianopiscber St&rungen nach para-
lytischen An fallen.) A, Pick (of Prague), Deutsche med. Wdvnschr.,
Sept. 28, 1905.

Pick calls attention to a phenomenon which he has observed after
a paralytic attack in cases of general paralysis during the period
of disappearance of a typical homonymous hemianopia. To take
the case of a left-sided hemianopia. When an object was carried
through the normal field (right) into the heiuianopic field, patient
only followed the object as far as the middle line; but when the
object was brought from the left side into the outer limit of the
hemianopic field, the patient immediately looked in that direction,
sometimes regularly, sometimes only occasionally. There are two
ways in which the phenomenon may be explained. The fixation
may be considered as due to an act of attention, and for this to
take place, a certain activity of function of the cortico-retinal
apparatus is necessary. The return of this function is shown by
the reaction to the object brought into the periphery of the visual
field. As the object is carried from the periphery of the hemianopic
field inwards, the patient follows it for a short space, but soon loses
it; the distance increases as the hemianopia improves. The
hemianopia, therefore, seems to clear up from the periphery
inwards. The importance of the factor of attention is seen by the
fact that, while the patient reacts to an object in the periphery of
the hemianopic field, on the other hand, when another object is
simultaneously brought into the periphery of the normal field, the
patient invariably fixates the latter object (? because better seen).

Another explanation of the reaction to an object in the hemia¬
nopic field may be found in the hypothesis that the movements of
fixation, at first completely dependent upon the visual centre,
become in time more automatic, and are handed over to a lower
reflex arc, which passes directly from the primary optic centres to
the centres for the eye-muscles. The phenomenon under discussion
would be then due to the dissociation of voluntary and involuntary
fixation, the latter being carried out by this reflex arc. That
involuntary fixation returns before voluntary fixation has been
demonstrated after operation on the congenitally blind.

It is legitimate to assume that in the early stage of restoration
of the hemianopic field, involuntary fixation first returns, and that
the return of the function of the cortico-retinal apparatus proceeds
from the periphery inwards. C. Macfie Campbell.

ABSTRACTS

149

PSYCHICAL AND SENSORY REACTION OF THE PUPILS.

(67) (Uber die psychische und sensible Reaktion der Pupillen.)

Hubnkr, CentraXbl. f. Nervenh. u. Psych., Dec. 15, 1905, p. 945.

The author examined the condition of these pupillary reactions in
cases of imbecility and dementia praecox, and found them absent
in 75 per cent, of the latter disease, 51 examples being taken.
He noted their absence, however, in 3 normal women over 48
years of age, in whom the normal light reflex was present. In
dementia praecox, both reactions are met with in only 14 3 per
cent, of cases, whereas in all other functional psychoses there is no
impairment of either. In imbeciles and idiots a pupillary response
to psychical and sensory stimuli was rarely awanting. As far as
his experience goes, the author has never seen a return of these
reflexes, although the mental condition of some patients has
undergone a considerable change since it first came under notice.

S. A. K. Wilson.

THE SENSE OF PAIN. (Le sens de la douleur.) Ioteyko, Journal
(68) de Neurologic, oct. 5 et 20, 1905.

Mlle. Ioteyko discusses in this paper the views that are at pre¬
sent held in regard to the sensation of pain. Starting with the
consideration of the production of pain, she accepts the statement
of Richet that it is due to a powerful stimulation of nerve endings.
This is illustrated by the results obtained from the application of
pressure on the back of the hand, when by gradually increasing
the pressure three stages are passed through—a stage of non¬
perception, of perception without pain, and of perception with
pain. By the use of the Alg^simetre of Charon (an instrument
by which the exact amount of pressure that results in pain is
measured), Ioteyko and Stefanowska have found a variation in the
perception of pain in different individuals. In those persons who
are less susceptible to pain, “ pain spots ’’ are less numerous than
in the more sensitive individuals. Different parts of the skin vary
in their sensitiveness. Thus of five regions selected, the region of
the temple is most sensitive ; then follows the anterior surface of
the forearm, the pulp of the ring finger, back of the hand, and the
pulp of the middle finger. Contrary to what is found in regard to
touch, the pulp of the fingers is not highly endowed with sensibility
to pain. Attempts have been made by numerous writers to
differentiate the different kinds of pain, Hahnemann distinguish¬
ing as many as 73. There are, however, points which are sensitive
only to certain sensations, the points for temperature, pain, and

150

ABSTRACTS

touch being anatomically distinct. Frey’s scale of the sensitive¬
ness of different regions shows a wide difference in the sensibility
of the different parts, from the exquisite sensitiveness of the
cornea, to the comparative insensitiveness of the sole of the foot.
In regard to the histological localisation of the four cutaneous
senses, Frey’s views are quoted. According to him the corpuscles
of Meissner respond to pressure ; pain excites directly the free
nervous terminations that are found in the cornea ; while in the
skin these free terminations are situated more superficially than
the organs for pressure. The corpuscles of Kranze serve the sensa¬
tion of cold, while the corpuscles of Ruffini serve that of heat In
regard to the mechanism by which pain reaches the brain, the
different and conflicting views are briefly stated, as also those in
regard to the localisation of the centre in the brain in which the
pain is perceived. No view has yet been expressed that can be
accepted with certainty. In the elucidation of this part of the
subject some interesting observations are quoted concerning the
results of the artificial production of analgesia by chloroform,
cocaine, menthol, etc. From some careful experiments by Ioteyko
and Stefanowska, it is shown that the left side of the body is more
sensitive to pain than the right. In the chapter dealing with the
remote effects produced by pain, some interesting results are brought
together. The effect of pain on temperature is to lower it. The effect
upon the heart is variable, arresting it, slowing it, and in some
instances increasing its rate. The effect of pain upon respiration is
also varied, sometimes slowing the rate, while it becomes more
profound and irregular according to L. Meyer; while Montegazza
found a diminution in the exhalation of carbonic acid. Pain
retards digestion. The facial and other expressions produced
by pain have been a subject of study by numerous observers, and
references are given here to the most important of these. The
sensibility to pain according to sex, age, race, etc., is discussed.
According to Montegazza, the circumstances that increase the
sensibility to pain are a refined sensibility, high intellectual
acquirements, a high degree of civilisation, the feminine sex,
youth, certain degrees of heat, the abuse of coffee, the sudden
transition from pleasant sensations to painful. The discussion
of such questions as the radiation of pain is treated very im¬
perfectly, and many of the most instructive data are ignored.
Thus “ La douleur est sentie en cercle, et souvent aussi on ressent
des ^lancements douloureux. L’irridation de la douleur s’observe
aussi dans les maladies (ndvralgie dentaire, coliques hdpatiques,
coliques ndphretiques) ” is practically all that is said of a very
important part of the subject—a part, indeed, whose proper appre¬
ciation affords the key for the solution of many questions that are
left obscure in this article. The article concludes with a very

ABSTRACTS

151

good bibliography, but some very important papers are not in¬
cluded. In lact some of the best work, and certainly some of the
most original work, has been done by British investigators, but
evidently the authoress is not aware of the far-reaching results
arrived at by such observers as Ross, Sherrington, and Head.

James Mackenzie.

DISTURB AN CBS OF SENSATION IN AOUTE LOCALISED

(69) ISCHAEMIA. (Uber Sensibilit&tsstttnmgen bei akuter lokaler
Isch&mie.) Schlesinger, Deutsch. Zeii. f. NervenheilL, H. 5-6,
1905, p. 375.

The author has been able to examine some cases of cardiac disease
in which blocking of a peripheral vessel has occurred. If such a
case be seen immediately after the circulation is thus locally
cut off, it will be found that there is loss of all forms of sensibility,
deep and cutaneous, beyond the line of the blocking, and more
or less corresponding to the distribution of the affected vessel.
The motor paralysis that occurs is not detailed by the writer, who
remarks on the great physiological interest of this sudden loss both
of superficial and of deep sensation, and their equally sudden return
after the circulation is restored. The explanation seems to rest in
the functional disturbance of nerve endings caused by the acute
ischsemia. S. A. K. Wilson.

BABINSKTS SION IN SCARLET FEVER. (La signe de Babinski

(70) dans la scarlatina.) Kiroff (Soc. de Neurol.), Rev. Neurolog.,
Nov. 30, 1905, p. 1119.

Kiroff found Babinski’s sign on one or both sides in seventeen
cases of scarlet fever, ten of which died. The patients’ ages ranged
from 2 to 27. With the subsidence of acute symptoms the reflex
became normal. In most of the cases the knee-jerks were either
lost or diminished. In some of the fatal cases the sign, which at
first could be easily obtained, became difficult to elicit or entirely
disappeared shortly before death. The phenomenon is attributed
to perturbation of the pyramidal system, which is affected by the
scarlatinal toxines like the heart, the kidneys, and the meninges.
This hypothesis is supported by the same sign having been found
by Kiroff in some severe cases of diphtheria. In further confirma¬
tion of this view, the reviewer can cite four cases of enteric fever
lately under his care in which Babinski’s sign was obtained. The
phenomenon was transient, and was associated with no other sign
of disease of the pyramidal system. J. D. Rolleston.

152

ABSTRACTS

THE “EXTENSOR PHENOMENON.” (Das “Btaeckphtaomen.")

(71) Saxl, Neurolog. Centraibl., Dec. 16, 1905, p. 1140.

A hemiplegic girl with flexed hand and wrist, which she was
incapable of extending voluntarily. She could always do so if she
extended her elbow. The condition seems to be analogous to the
tibialis phenomenon of Strumpell. S. A. K. Wilson.

WORD-BLINDNESS, WITH THE RECORD OF A CASE DUE TO A

(72) LE8ION IN THE RIGHT CEREBRAL HEMISPHERE IN A
RIGHT HANDED MAN; WITH SOME DISCUSSION OF THE
TREATMENT OF VISUAL APHASIA. Charles B. Mills
and T. H. Weisenberg, Medicine , Nov. 1905.

The interesting case here reported is that of a right-handed man—
he ate, wrote, and did by preference almost everything with his
right hand, and was not ambidextrous—who, after a severe
apoplectic attack, supposed to be due to a cerebral haemorrhage,
suffered from left-sided hemiplegia and aphasia. The hemiplegia
improved considerably, but the aphasia, consisting principally in
word- and letter-blindness, persisted. The authors hold that the
speech defect was due to a lesiou in the right side of the brain.
Instances of “ crossed aphasia ” are very rare. Senator in 1904 was
able to collect only eleven cases from the literature.

When the patient was first seen by the authors, a year after
the apoplexy, he was only able to recognise six letters, while after
six weeks’ training he was able to recognise nearly all the letters
of the alphabet. The method adopted was to show the patient a
letter or word, make him pronounce it, pick it out from among
other letters or words and try and picture it.

Edwin Bramwell.

THE CONDITION OF THE FUNCTIONS OF THE BLADDER IN

(73) CEREBRAL HEMIPLEGIA. (Ueber das Verhalten der
Blasenth&tigkeit bei cerebraler Hemiplegie.) Ed. Muller,

Neurolog. Centralbl., Dec. 1, 1905, p. 1101.

It is commonly taught in the text-books that unilateral brain
lesions are not, as a rule, accompanied by bladder trouble, apart
from the familiar incontinence during an apoplectic attack, where
the bladder symptom is ascribed to mental dulness. Bilateral
brain lesions, on the other hand, are more frequently accompanied
by bladder trouble.

ABSTRACTS

153

Muller’s paper claims to show that bladder troubles are a very
frequent accompaniment of ordinary hemiplegia from vascular
lesions, even in the chronic stage, when there is no longer any
question of mental blunting and where sources of fallacy, such as
prostatic enlargement, have been excluded. The disorders of
micturition, however, are slight in degree and varying in intensity.
So much so, that they have to be enquired for by the physician,
inasmuch as the patient rarely mentions them spontaneously. A
moderate degree of “ imperative incontinence ” is the rule, a pre¬
cipitancy which makes the patient hurry to micturate, to prevent
involuntary emptying of the bladder. The degree of bladder
affection is precisely similar to that which occurs so constantly in
disseminated sclerosis.

Similar slight bladder troubles are often noted amongst the
earliest phenomena of cerebral tumours, even where the
intellectual functions are unaffected.

Purves Stewart.

INTERMITTENT CLAUDICATION. (Zur Kasuistik der inter-
(74) mittierenden angiosclerotischen Bewegungsstttrungen [Dysbasia,
Dyskinesia] das Menschen. ) W. Erb, Deutsche Zeit. /.
Nervenheilk, Bd. 29, 1905, p. 465.

The patient, a man of Jewish race, 32 years of age, who
smoked 12 to 15 cigarettes daily, had syphilis three years previously,
for which he underwent three courses of mercurial inunction at
intervals of about a year.

A year before he came under observation, he began to have a
“hot, tired feeling” in the left leg on exertion. This steadily
increased, so that it occurred after slighter and slighter exertion.
The left thigh became affected some time later. On examination,
both femoral and popliteal pulses were equal on the two sides, but in
the left foot neither artery nor pulse could be felt. Under mercury,
iodides, galvanism, hot foot-baths and rest, the patient improved.

Some three years later, the patient again came under
observation. By this time, the right leg had begun to show
symptoms similar to those in the left, i.e. pain on walking, which
passed off on resting. But, in addition, he now complained of
pains in the left upper arm, along its inner side, and frequent
tingling in the left finger-tips. The left radial pulse was much
feebler than the right. The pulse was absent in the left foot, that
in the right foot was much weaker than before.

The occurrence of symptoms in the upper limb, precisely
similar to those in the lower limb, leads Erb to classify the case
under the wider category of “ dyskinesia angio-sclerotica,” rather
L

164

ABSTRACTS

than the more limited one of “ intermittierendes Hinken.” In this
particular case, it is probable that syphilitic arterio-sclerosis played
a part, in addition to excess in tobacco. Yet anti-syphilitic
treatment failed to arrest the disease.

Purvks Stewakt.

HjEMATEMESIS m ORGANIC NERVOUS DISEASES (TABES).

(75) (Haematemeeis bei organischen Nervenerkrankungen [Tabes].)

Alfred Neumann, Deutsch. Zeitschr. f. Nervenheilk., Bd. 29,
1905, p. 398.

The author describes a case of tabes with gastric crises and
frequent attacks of hsematemesis. The vomit usually consisted
of bile-stained fluid with some blood, but occasionally almost pure
blood was brought up. The patient was under observation for
nearly six months. The blood-pressure rose from almost normal
to 160 or 170 mm. of Hg. during the crises, and always to over
200 mm. during the act of vomiting. The bleeding was attributed
to the sudden rise in pressure rupturing larger or smaller vessels
in the gastric mucous membrane—all complications such as ulcer,
cancer, etc., being fairly well excluded. According to Pal, this
rise in blood-pressure is a constant feature of the gastric crises in
tabes; but in 105 cases culled from literature by the author, only
10 were found with hsematemesis. Short digests of these are
given; only in 2 was the symptom a marked one.

J. H. Harvey Pirie.

A CONTRIBUTION TO THE CLINICAL STUDY OF THE

(76) PHARYNGEAL REFLEX. (Contribute alio studio clinico
del riflesso faringeo.) Forli e Guidi, Ann. dell’ Instil. Psickiat.
di Roma , Vol. iv., 1905, p. 75.

The pharyngeal reflex is essentially a movement of elevation and
constriction of the pharynx, and of elevation of the soft palate.

The authors discuss results of various experiments and views
of writers as to the motor supply of the pharynx, and the part
taken by the glosso-pharyngeal nerve in conduction of tactile and
sensory impulses; the majority of physiologists concur that the
sensory function of the ninth nerve is exclusively gustatory. The
sensory functions of the pharynx may be said to be supplied by
the vagus, while its sensorial functions are supplied by the glosso¬
pharyngeal nerve.

The pharyngeal reflex, however, is by no means a constant
phenomenon. The authors examined 98 cases which presented
no nervous lesion. Of these, 63 were above fifty years of age, and

ABSTRACTS

155

35 below. In those below fifty, the pharyngeal reflex was brisk in
42 per cent., weak in 14 per cent., scarcely perceptible in 20 per
cent., and absent in 15 per cent. In those above fifty it was brisk
in 40 per cent., weak in 8 per cent., scarcely perceptible in 20 per
cent., and absent in 31 per cent

The pharyngeal reflex was next examined in numerous
hysterical cases. Kattwinkel has recently examined 104 hys¬
terical cases, and found that the absence of the pharyngeal reflex
bears no relation to the presence of thermal and pain sensibility,
and hence is to be regarded as an interruption of a cerebral reflex
path.

The authors found that in 58 hysterical cases the reflex was
brisk in 13 per cent, weak in 13 per cent., scarcely perceptible in
10 per cent., and absent in 65 per cent. In only one case was
there tactile anaesthesia of the pharynx, and in this, as in all the
others, pain sensation was present. On the other hand, gustatory
sensation was absent or impaired in a large number of cases, and
this is thought to explain the results of Volkman. This author
found that, after section of the glosso-pharyngeal, the pharyngeal
reflex was abolished; whilst after section of the trigeminal, which
indubitably supplies sensory fibres to the isthmus of the fauces,
the pharyngeal reflex persisted.

Kattwinkel and Marie considered that in cases of hemiplegia
the pharyngeal reflex was abolished in 50 per cent, of cases of
right hemiplegia and diminished in 20 per cent., whilst in cases
of left hemiplegia it was absent in 4 per cent, and diminished in
20 per cent. Hence they draw the conclusion that the seat of the
reflex is probably in the right corpus striatum.

The authors examined the reflex in 12 cases of right hemi¬
plegia and 10 of left. They conclude that in the majority of cases
of hemiplegia the reflex obtained by stimulation of the pharynx on
the side corresponding to the hemiplegia is less brisk than that
obtained from the opposite side, and that this is independent of
any appreciable diminution of sensibility. The side affected by
hemiplegia did not appear to have any influence on the results
•obtained. F. Golla.

THE BOLE PLATED BT INTENSE GOLD IN THE PATHOGENY
(77) OF ACBOPATHIES. (Rdle du froid intense dans la patho-
gdnie des acropathies.) Etienne, Arch. g&n. de Med., Dec. 20,
1905, p. 3265.

In the first case the patient was exposed a whole night to intense
cold, and frost-bite supervened, associated with progressive and
uninterrupted sensory phenomena, ending in symmetrical mutila¬
tion of the extremities.

156

ABSTRACTS

In the second, a mechanician noticed on a particularly cold
morning that his uncovered hands had become numb, cyanotic,
and locally asphyxiated. Spasm of the arterioles and dilatation of
the venules were responsible for these symptoms, which disappeared
in summer and returned the next winter. Under the influence of
the spasmodic contractions the radial arteries responded by local
endarteritis obliterans, the result being diminution in the radial
pulse.

In the third case the guard of a snowed-up train was forced to
make a journey of about a mile through chest-deep snow, and a
typical polyneuritis was the result. The transitory arterial spasms
occasioned by the cold so affected the vessels that eventually a
local arterio-sclerosis made its appearance. Under a slightly more
heavy muscular strain than usual a prolonged and painful arterial
spasm occurred, and in the morning the Angers were already black.

Evidently, then, cold may act directly or indirectly, in the latter
case devitalising a part by arterial spasm, prolonged or repeated,
setting up an arterio-sclerosis, and so making local death possible,
insidiously or suddenly. S. A. K. Wilson.

PSYCHIATRY.

A CLINICAL, ANATOMICAL, AND PATHOLOGICAL OONOEP
(78) TION OF THE FOB MS OF IDIOCY WHICH ABE THE
BESTJLT OF MENINGITIS. (Concetto clinico, anatomico, a
patologico, dalle idiozie meningiticke.) G. B. Pblizzi, Rtv.
Sper. di Fren., Vol. xxxi., F. 3-4.

The symptom “ idiocy/’ in its various grades, Ands its pathogenesis
either in a chronic and hereditary intoxication of the nervous
system, which may have acted through some generations, or in a
common inflammatory process of the brain and its membranes.
The degenerative element, however, is not without some influence
on the inflammatory forms.

In the toxic forms the poison acts so as to produce an arrest, a
retardation, or an altered development of the brain without there
being any recognisable pathological process; in the inflammatory
cases it has led to a diminished resistance, which renders the brain
and its membranes exceedingly susceptible to infections and ordi¬
nary pathological processes. It is this special vulnerability which
constitutes the hereditary degenerative substratum of the menin¬
gitic idiocy. These processes may start at any period from the
earliest embryonal stages to puberty, and according to the epoch
at which they arise, to their extent, and to their intensity, they will
produce results which may be grouped as follows: (a) pseudo-

ABSTRACTS

157

hypertrophic forms; ( b ) forms with simple and uniform atrophy; (c)
forms in which the brain tissue has been destroyed in scattered foci

But it is impossible to draw any sharp lines between these
three groups, as it is also between toxic and inflammatory idiocy.

The most important differential characters, from the clinical
point of view, are the motor symptoms. In the pseudo-hyper¬
trophic forms the motor symptoms consist of general convulsions
of an epileptic type; in the atrophic group, of generally diminished
muscular tone; in the third group, of paralytic lesions, almost
always spastic and focal.

The anatomical changes found in the first group consist of an
increase in the volume of the whole brain or of some parts of it;
histologically, there is a great proliferation of the neuroglia, and the
nerve cells are atypical and embryonal.

In the second group the brain is uniformly affected; its volume
is diminished, the convolutions are flattened, but the surface is
smooth and the sulci are regular. Microscopically there is diminu¬
tion in number and volume of the nervous elements, and slight
overgrowth of the neuroglia.

In the destructive forms, scattered cicatricial contractions,
erosions, microgyria, and porencephaly are the prominent char¬
acters. Microscopically, the nerve elements are found to have
almost entirely disappeared in the area affected, and in the other
portions of the brain the changes resemble those of the previous
class.

The atrophic group includes the cases of meningitic idiocy,
properly so called, of microcephalic idiocy, and of hydrocephalic
idiocy. It is with these three that the author deals in this paper.

In the case of the meningitis leading to idiocy, we must assume
that the inflammatory process has spread from the meninges to the
cerebral cortex, and, depending on the extent to which this has
taken place, shall we find a condition of simple meningitis or
meningo-encephalitis. In the latter affection the inflammatory
process penetrates deeply into the brain substance, and consider¬
able portions of the brain may be destroyed by it. But in cases
of simple meningitis, on the other hand, the evidences of injury
may be almost wanting, only a slight thickening of the membranes
being visible, while the cortex shows no microscopical signs what¬
ever. Every degree of injury is met with in the brains of the
meningitic idiots, and their pathological anatomy borders on
a microcephalic condition on the one hand, and on meningo¬
encephalitis on the other hand. Generally the pia is thickened, but
strips from the cortex without tearing it. Sometimes the volume
of the convolutions is normal, but, at other times, they are small,
and this diminution may reach the degree of a true microcephalic
brain. The lateral ventricles are often dilated. The histological

158

ABSTRACTS

examination shows a slight overgrowth of the neuroglia in the
outer layer, a diminished number of small and medium pyramidal
cells, very poor development of the capillary network in the cortex,
and thickening of the adventitia of the vessels. These results are
probably produced by a serous meningitis which interferes with
the nutrition of the nervous structures, and the changes mentioned
are the result. Such a simple meningitis may be started by any
of the ordinary invading organisms. There can be no doubt, how¬
ever, that the different powers of resistance of the subjects, the
neuropathic predispositions, the age of onset, must be important
factors in the determination of the degree of these changes.

Dealing with the pathogenesis of microcephaly, the author
shows that the degrees and variations of the brain in this condition
may be as marked as in all the other classes of idiocy which are duo
to a meningitic process. The brain may be uniformly diminished
in size, or some convolutions may be small and others very much
larger than normal, even to the extent of macrogyria. The two
hemispheres may be unequally affected. There is no type of braiu
which is characteristic of these cases, such as there would be if the
condition were an entity outside ordinary pathological processes.
According to the author, they can be explained only by admitting
some inflammatory pathological process, and that process, in his
opinion, is a serous meningitis.

With regard to those cases in which, together with a small
brain, there is evidence of coarse destructive lesions, it is suggested
that in these, as in all other forms, there has been an inflammatory
process which has diffused from some points of greater intensity,
and that it is at these points of intensity that the loss of substance
has occurred.

Turning next to the pathogenesis of hydrocephalus, the author
first shows that hydrocephalus may be internal or external, active
or passive, true or false. The internal, active, true hydrocephalus
may be acute or chronic, congenital or acquired. It may occur
as a simple condition, with ventricular dilation and with charac¬
teristic alterations of the choroid plexuses and the ependyma, or
it may be associated with macroscopical destructive sclerosis of
the cerebral grey substance, or of the ventricular parietes, with
external meningo-encephalitis and coarse cortical lesions, with
simple external meningitis, and with rickets. Most frequently it
is found with the simple meningitis. The dilatation of the ven¬
tricles must be due to an increased secretion, or to a diminished
absorption.

The examination of recent cases points to an inflammatory
origin, as proved by the diffusely or locally thickened ependyma,
with smooth or nodular surface, and by the thickened and adherent
choroid plexuses.

ABSTRACTS

159

Most cases start acutely with grave cerebral symptoms; then
follow convulsive attacks. Later, the effects of mechanical pres¬
sure appear. The author quotes a case which showed evidence
of an internal, ventricular meningitis, certainly inflammatory, but
with a purely serous exudation. Most authorities now agree in
attributing the condition to an acute infection, probably of gastro¬
enteric origin, which gives rise to a serous meningitis.

Syphilis is also mentioned as possessing a greater importance
in the production of hydrocephalus than of any other form of
idiocy, but that is not to say that it is a factor in every case.

With regard to the relation which exists between rickets and
hydrocephalus, the author holds that rickets cannot directly be
the cause of that condition. But in rickets the general nutrition
of the body is so generally interfered with that the invasion by
organisms is greatly facilitated.

This condition of hydrocephalus is the result of an inflamma¬
tory process of varying nature, which gives rise to functional and
anatomical changes in the tela choroidea, the choroid plexuses,
and the ependyma. But beside these cases associated with simple
meningitis, there are others which show signs of a cerebral sclerosis
or atrophy, combined with a true hydrocephalus. The patients
exhibit all the characters of infantile spastic hemiplegia.

In these, the sclerosis has affected the nuclei at the base of
the brain, and has spread into the hemispheres. The ventricle
on that side on which the nuclei have been attacked is the first
to be dilated, and then the inflammatory process invades the
ependyma and internal meninges on the opposite side and pro¬
duces a similar result Then again, there may be a hydrocephalus
associated with a meningo-encephalitis, in which portions of brain
substance in various situations have been destroyed.

It will be seen, therefore, that intermediate grades between
these three groups are common. Finally, the author admits that
although there may be some lacunae in the chain of facts, there
exist so many clinical, anatomical, and pathological resemblances
between these forms of idiocy as to justify their being grouped
together under the term “ meningitic idiocy.”

R. G. Rows.

THE DEPRESSIONS OF ADVANCED LITE. (Die Depressions-
(79) zust&nde des hfiheren Lebensalters.) R. Gaupp (of Munich),
Munch, med. Wchnschr ., Aug. 8, 1905.

Gaupp gives in a brief manner the results of his analysis of all the
cases of depression occurring in patients over the age of 45 who
were admitted to the Heidelberg cliuic within a period of ten
years. His work was originally intended to form part of a wider

100

ABSTRACTS

scheme started in the same clinic to study the influence of advanced
life upon mental diseases. The results here given are based on a
material of 300 cases of depression, and 51 manic cases who had
also to he included in view of the intimate relationship between
certain forms of depression and manic attacks.

According to the statistics obtained, simple and periodic mania
is more frequent in men than in women; manic-depressive insanity,
with equal development of both phases, is equally common in men
and women ; manic-depressive insanity, with preponderance of the
depressed form, is more common in women than in men.

The course of the cases of manic-depressive insanity was very
varied, the following varieties being seen: one single manic attack,
several manic attacks, several manic attacks with transitory de¬
pression, depressive attacks with rare manic phases, several de¬
pressive attacks, one single attack of depression of this type.
Sometimes the manic attacks tended to become more severe in
advanced life. Acute periodic mania (t.e. one form of manic-
depressive insanity) frequently passed into a hypomanic condition
with mental enfeeblement. It is an open question whether the
latter is not due to associated senile or arterio-sclerotic changes.
“ Mixed states ” of manic-depressive insanity (Kraepelin) frequently
simulated mental deterioration, which the course of the disease
showed, however, to be absent Circular cases were found some¬
times to continue to present in advanced life an alternation of the
same clean-cut pictures, but frequently these became rather toned
down.

In some cases, where the depressive phases were the more
marked, the feeling of subjective insufficiency and retardation were
absent; in one case a state of anxious agitation represented the
depressive phase.

Twenty-nine women and twelve men presented recurrent
attacks of depression without any manic phase. In one group the
attacks were characterised by psycho-motor retardation and a
feeling of insufficiency, and terminated in recovery. These cases
belong, according to Gaupp, to manic-depressive insanity. In a
second group of recurrent depressions the patients were hypochon¬
driacal, anxious, voluble in complaint. The onset was gradual,
the outcome uncertain. Sometimes the patients recovered, some¬
times the depression persisted, and in one case mental deterioration
set in after the second attack. This group is more akin to
Kraepelin's melancholia of the involution period, but the attacks
are usually less severe, of shorter duration, and more amenable to
external influences.

Twenty-six women and twenty-two men presented the picture
of Kraepelin’s melancholia. The question of the nosological
position of this type is complicated by the following facts: Patients

ABSTRACTS

161

may have recurrent attacks of melancholia, and in the intervals
show no defect symptoms; in cases of periodic depression with
onset before the involution period, the later and more severe
attacks may present the symptoms and clinical course of
melancholia.

Gaupp divides his cases of depression arising on an arterio¬
sclerotic basis into seven groups: 1. Chronic depressive dementia,
with death after several apoplectic attacks. 2. A variety of
symptomatological pictures following directly an apoplectic attack
—among others an arteriosclerotic Damraerzustand. 3. Pro¬
gressive development of neurological symptoms (especially aphasic),
accompanied by a paranoid or hypochondriacal trend, and some¬
times with anxious delirious episodes. 4. Cases running a quicker
course, e.g. delirious confusion following a hypochondriacal stage,
and passing into dementia. 5. Several cases presented a series of
attacks {e.g. aphasic) before the development of mental symptoms,
which consisted chiefly in an agitated depression with self-accusa¬
tions. 6. In other cases depression preceded the neurological
symptoms, and it was not easy to say whether the initial depression
was really the expression of an arterio-sclerotic process, and not
an independent condition, complicated later by arterio-sclerosis.
7. Cases with arterio-sclerosis of the coronary arteries presented
episodes of anxiety referred to the heart region, with a permanent
hypochondriacal mood.

Senile depressions varied both in symptoms and in course ; the
mood was usually anxious and hypochondriacal, and the symptom-
complex of a cheerful presbyophrenia was found to be only one
stage in a senile psychosis, and to be usually preceded by anxious
or hypochondriacal periods.

There were thirty-nine cases of atypical depressions, some of
which might be looked on as individual variations due to constitu¬
tional peculiarity; of this nature were cases described by some
authors as “ hystero-melancholia,” “ hystero-hypochondria.” Of
more importance was a group of patients who between 50 and 60
developed, after a short period of hypochondriacal depression, an
acute anxiety psychosis with hallucinations and delusions, con¬
fusion and disorientation, resistiveness, and which frequently
terminated in death through exhaustion, but in some cases passed
into a condition of apathetic dementia, with stereotyped residuals
of emotional gestures.

Gaupp insists on the necessity of keeping these cases separate
from cases of late catatonia; and he isolates another group of
patients who, after an hallucinatory excitement with anxiety,
pass into an emotionally indifferent dementia, with variable ideas
of persecution. These terminal dementias call for further analysis.

He next describes, under the head of “ Depressive Climacteric

162

ABSTRACTS

Excitement with Outcome in Mental Enfeeblement,” a small group
of female patients between 45 and 60 who, after a preliminary
change of mood and general nervousness, developed excited lamen¬
tations, self-accusations, worry for the future, and terrifying hallu¬
cinations, but without clouding of consciousness; during the ex¬
citement there was noted loquacity, distractibility, and flight of
ideas; the course was remittent. Recovery never took place,
although the whole condition gradually simmered down.

The work done by Gaupp must prove a stimulus to the further
study and differentiation of the large groups which have been
established largely under the influence of the Heidelberg school.

C. Macfie Campbell.

■Review

DIE ERKRANKUNGEN DES RUOKENMARKES UND DEE
MED ULLA OBLONGATA. EH. Medulla oblongata. Prof.
Dr E. v. Leyden and Prof. Dr A. Goldscheider, Berlin.
Second Edition. Vienna: Alfred Holder. Pp. 84. M. 2.50.

This work contains six chapters, dealing respectively with pro¬
gressive amyotrophic bulbar paralysis, acute bulbar paralysis,
bulbar paralysis without anatomical change {myasthenia gravis),
pseudo-bulbar paralysis, ophthalmoplegia (chronic progressive, and
acute), and recurring oculo-motor palsy {migraine ophthalmique).

Diseases of the medulla are so varied in their symptoms and
so important from a prognostic point of view that the authors’

S ian of dealing with them in a special section or volume is to be
ighly commended. The work cannot fail to be of real value.
The authors give, within narrow compass, a very readable, wonder¬
fully full, and generally lucid account of all that is known
regarding these affections of the medulla. In some parts, we
think, the arrangement of material might be clearer, notably in
the chapter on ophthalmoplegia, and the addition of more
illustrations and of references to literature would greatly enhance
the value of the work. The letterpress is excellent.

A. W. M.

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Jan. 2, 1906, S. 15.

SCHLESINGER. Ein Fall von doppelseitiger, umschriebener Gesichtsatrophie.
Archivf. Kinderheilk. , Bd. 42, 1906, p. 374.

GOWERS. The Influence of Facial Hemiatrophy on the Facial and other Nerves.
Rev. Neurol, and PsychiaL., J an. 1906, p. 1.

SCHLESINGER. Ein nicht beechnebenes Symptom der Gaumenltthmung
(Anderung der Sprachstttrung im Liegen und in aufrechter KOrpc ^ltung).
Neurol. Centralbl ., Jan. 16, 1906, S. 50.

MISCELLANEOUS SYMPTOMS—

VALOBRA. Difformit6 cong£nitale des membres. Nauv. lean, de la SalpRritre,
sept.-oct. 1905, p. 560.

PARHON, SHUNDA, et ZALPLACHTA Sur deux cas d’achondroplaaie. Nauv.
lean, de la SalpRrilrt, sept.-oct. 1905, p. 539.

168

BIBLIOGRAPHY

PORAK et DURANTE. Les micromdlies oongtaitales. AchoudropUae vraie
eft d ystrophia p&iostale. N<mv. Icon, de U Salpkrtire, sept.-oct. 1905, p. 48L
ETIENNE. Arthropathies nerveuses et rhumatisme chronique. Rev. NeuroL,
d6c. 15, 1905, p. 1137.

feTIENNE. Rdle du Froid Intense dans la Pathog6nie dee Aeropathiea. Arch,
pin. de mid., d6c. 26, 1905, p. 3265.

BRISSAUD ET MOUTIEK. CEdfeme E16phantiasiaue dee membres inffcrieurt,
Ast6r6ognosie, Surdit6, origine centrale de oes troubles. (Soc. de NeuroL) Re*.
Neurol. , d6c. 30, 1905, p. 1204.

PELLETIER et MARIE. Les Membres fantdmes ehes les amputta delimits.
Colin, Paris, 1905.

DUFOUR. Du syndrome ‘"deviation conjugate de la tote et des yeux ” (th6orie
sensorielle). (Soc. de Neurol.) Rev. Neurol ., d£c. 30, 1905, p. 1199.

BYROM BRAMWELL. A Series of Lectures on Aphasia. Lecture L Lancet,
Jan. 13, 1906, d. 71.

LOEWY. M i krographie durch hemiplegischen Anfall wahrscheinlich in folge
auf die Schreibkoordination beschrhnkter Rigiditttt. Monatsschrift f. PsyckiaL %.
Neurol ., lid. 18, p. 372.

TREATMENT*—

ROSS. On the Relief of certain Headaches by the Administration of one of the
Salts of Calcium. Lancet , Jan. 20, 1906, p. 143.

SCHLOESSER. Zur Behandluug der Neuralgien durch Alkoholeinspriteungen.
Berlin, klin. Wock ., Jan. 15, 1906, p. 82.

BERILLON. Des anesth&siques et en p&rticulier de la scopolamine envisages
com me adjuvants k la suggestion hypnotique. Journ. de Neurol ., jan. 5, 1906,
p. 13.

CONTET. Gymnastique medicals et R66duoation. Arch. gin. de mid., d6o. 26,
1905, p. 3283.

LOUYRIAC. De la sympathicectomie dans les nlvr&lgies faciales. Thise. Storok
et Cie, Lyon, 1905.

RICHARD LAKE. A Case of Operation on the Vestibule for the Relief of
Vertigo ; together with a description of the Flap employed in order to obtain a
better view of the parts durmg operation. Lancet, Jan. o, 1906, p. 26.

ADOLF LORENZ. Der Indikationen xur Sehnenverpflaniung. Wien. mod. Wock .,
Jan. 13, 1906, p. 118.

P. Ll BRETON. Treatment of the Results of Infantile Paralysis. Journ. Am.
Med. Ass., Jan. 6, 1906, p. 26.

* A number of references to papers on Treatment are Included In the Bibliography under the
individual Diseases.

IReview

fleuroloQs anb ps^cbiatr^

Original articles

THE PATHOLOGY OF GENERAL PARALYSIS OF THE

INSANE.

By W. FORD ROBERTSON, M.D.,

Pathologist to the Scottish Asylums.

(The Morison Lectures for 1906.)

Lecture II.

Delivered on 26th Janaary 1906.

To-day I wish to deal chiefly with the results of au experimental
enquiry into the action of the living blood and of the blood-
serum upon pure cultures of diphtheroid bacilli isolated from
cases of general paralysis. As explained at the end of the pre¬
vious lecture. Dr M'Rae and I were led to take up this study
because we had reason to suspect that certain indistinct granular
or rod-like bodies observed in the cerebro-spinal fluid, in the
walls of the cerebral vessels, in the blood and in the urine, were
really diphtheroid bacilli that had suffered from the effects of a
lysogenic or solvent action. We have also, however, had in
view the possibility of being able to discover some specific
reaction on the part of the blood or blood-serum of the general
paralytic towards the diphtheroid bacillus, for, if such a specific
reaction were found, it would not only serve to establish our
hypothesis regarding the etiology of general paralysis, but it
R. OF N. & P. VOL. rv. NO. 3. —M

170

ORIGINAL ARTICLES

would at the same time probably furnish a method of serum
diagnosis.

Before entering upon this subject I must clear the way by
describing the morphological and biological characters of the
bacillus with which we have worked. When, in our published
communications, my colleagues and I have spoken of a diph¬
theroid bacillus, we have simply meant a bacillus that has the
general cultural and morphological features and the staining
reaction to Neisser’s method which characterise the Klebs-
Loffler bacillus. The organism that is so abundant in cases of
general paralysis is certainly neither Hoffmann’s bacillus, nor
the xerosis bacillus. It forms acid when grown in glucose
broth, and it also differs from these two species in its morpho¬
logical characters. Now it is laid down by such authorities as
Muir and Ritchie that an organism differing from the diphtheria
bacillus solely in its want of virulence must be regarded merely
as a diphtheria bacillus in*an attenuated condition, and should
be spoken of as such. Neisser and several other authorities
have expressed a similar opinion. We have therefore, I think,
been perfectly justified in provisionally regarding the organism
we have studied as an attenuated form of the Klebs-Loffler
bacillus. In doing so we have left it an open question if the
organism differs in certain essential respects yet to be discovered
from the attenuated form of the Klebs-Loffler bacillus, and is
therefore a special bacillus. Our more recent observations
strongly incline us to the view that it is a special organism;
but, whether this supposition should turn out to be correct or
not, if an organism of this nature is really the essential patho¬
genic agent in general paralysis and tabes dorsalis, as we believe
we have evidence to prove, then surely it is deserving of a
special name. We therefore propose to refer to it as the
bacillus paralyticans.

We have studied very numerous cultures of this bacillus,
and, in a large number of instances at least, we had good
grounds for believing that we were dealing with an organism
that had been exerting a pathogenic action upon the patient
from whom it was isolated. As has been indicated, it has the
general morphological characters of the Klebs-Loffler bacillus.
It is capable of assuming the granular, barred, and solid-colour
forms of Wesbrook. Perhaps its most striking characteristic is

ORIGINAL ARTICLES

171

its polymorphism, and in this respect it would appear even to
exoel at least the virulent form of the Klebs-Loffler bacillus.
When grown upon bynohsemoglobin agar at 37° C., it constantly
shows more or less distinct metachromatic granules in prepara¬
tions stained by Neisser’s method. When grown upon blood-
films it has the same appearance. Cultures upon the ordinary
agar medium very rarely show any metachromatic granules.
Individual strains of the organism differ greatly in regard to
the size of the metachromatic granules they are capable of
displaying. Some have very large granules which, after two
days’ growth of the organism upon bynohsemoglobin agar at the
ordinary temperature, present in Neisser preparations a peculiar
metallic lustre which we have not been able to observe in bacilli
isolated from cases of acute diphtheria. The organism grows
feebly under anaerobic conditions, but, nevertheless, it is capable
of multiplying rapidly with a very limited supply of oxygen.
The appearance of the bacillus paraiyticans varies not only with
the medium upon which it is grown, but also with the tempera¬
ture employed. Strains of the organism which, when grown at
a temperature of 37° C. upon bynohsemoglobin agar, show pro¬
minent metachromatic granules, when cultivated at a tempera¬
ture of 30° exhibit extremely minute granules. This difference
is accentuated if the cultures are made upon blood-films. At
the lower temperature the bacilli may then be entirely devoid
of metachromatic granules.

In old cultures, clubbed and elongated forms are very
abundant. Short threads may often be observed. It is hardly
open to question that the filamentous organism, already described
as having been observed in the tissues, is a special form of this
bacillus. It has been found invading the tissues in four rats
fed, or injected, with cultures of the bacillus, and in one of these
animals the segments of the threads show metachromatic granules
exactly like those of the bacillary form. As a rule, however,
metachromatic granules are not visible. We have endeavoured
to determine the precise conditions under which the thread form
is assumed. There are grounds for believing that this special
morphological character is, in part at least, one that is gradu¬
ally impressed upon the organism by environmental influences,
for, in several instances, the bacillus has shown a strong ten¬
dency to form short threads during the first two or three days

172

ORIGINAL ARTICLES

after having been isolated from the patient, irrespective of the
culture medium employed and at the normal temperature. We
have ascertained that threading is not due to the presence of the
toxic products of the bacillus, to growth at a low temperature, or
to limitation of the supply of oxygen. It appears to be in large
part due to an abnormally high temperature, but also to be
favoured by semi-anaerobic conditions. When the bacilli are
grown upon a blood-film at a temperature of 42° C. in a tube
sealed with hard paraffin, they become attenuated and elongated,
and tend to cohere by their extremities so as to form at first
chains and then distinct filaments. The threading is well
marked in two or three days, but it becomes still more distinct
if cultivation is continued upon a fresh blood-film under the
same conditions. The segments forming the threads generally
show two or three minute metachromatic granules.

In view of the extreme variability of the morphological
characters of this bacillus, it is not to be expected that it should
always appear in the general paralytic in the form with meta¬
chromatic granules. It has indeed been definitely ascertained
that in the living body it is the exception for the bacillus to
present these granules. Even when growing in catarrhal secre¬
tions it shows them only occasionally. When it invades the
tissues it is almost constantly devoid of visible metachromatic
granules. It then generally assumes a simple granular and
often a diplo-bacillary form. This corresponds to the appear¬
ance that the organism tends to take when grown upon the
ordinary agar medium at the normal temperature, or upon a
blood-film at a subnormal temperature. In other instances the
invading bacillus, as already indicated, assumes a thread form,
and this special morphological change is to be attributed in part
at least to the occurrence of pyrexia.

By way of further preface it is necessary that I should say a
word regarding the mechanism of natural and acquired immunity.
Here, as in other departments of progressive science, there is
much conflict of opinion. The facts that bear upon the observa¬
tions I am about to record are, however, few in number and
among those that are pretty generally admitted. When foreign
invaders, such as bacteria, pass through the first line of defence
formed by the skin and mucous membranes, they are normally
engulfed by leucocytes and destroyed by the solvent action of

ORIGINAL ARTICLES

173

certain intra-cellular ferments. Some authorities also attach
importance to the extra-cellular action of similar ferments (that
is to say, to the alexines or complements), and of certain sub¬
stances termed inter-bodies which combine with the invading
organisms. Such in brief is the mechanism of natural immunity.
In acquired immunity, that is to say the establishment of an in¬
creased power of resistance to a particular micro-organism or to
some special toxine, the mechanism is more complicated. In
response to the inimical stimulus the cells of the body, after a
certain interval, produce specific anti-bodies capable of neutral¬
ising the toxines or of combining with the micro-organisms,
which are thereby so affected that they are quickly dissolved by
the alexines. Metchnikoff, in opposition to many other authorities,
holds that this process is, in natural conditions, entirely an intra¬
cellular one, although when the blood is shed and undergoes
coagulation the protective substances soon pass into the blood-
serum. I specially mention this view because certain of the
results we have obtained with the bacillus paralyticans harmonise
with it. Recently, E. A. Wright has shown that the power of
the leucocytes to take up bacteria is dependent upon the exist¬
ence of certain substances in the blood plasma or blood serum,
which he has termed “ opsonins.”

One of the points which we have specially studied is the
phagocytic action of the leucocytes upon the bacillus paralyticans.
The method we have employed is as follows:—

Apparatus, etc., required .—Specimen tubes of 2*5 c.c. capacity (with corks),
carefully cleaned ana sterilised by dry heat. Portable incubator for main¬
taining tubes at temperature of 37° < 5 . Large platinum loop (ring), 4 mm.
in diameter (No. 24 wire). Small platinum loop, 1 mm. in diameter. Bacil¬
lary emulsion prepared by mixing one small loopful of 24-hour culture
(upon bynohsemoglobin agar) of bacillus paralyticans (i.e. a diphtheroid
bacillus isolated from the blood or cerebro-spinaf fluid of a patient suffering
from general paralysis) with 5 ac. of *75 per cent, salt solution in distilled
water. Sterilised vaseline.

Wash and dry dorsum of thumb. Apply absolute alcohol and, after a
minute or so, allow it to evaporate. To the dry surface apply a drop of hot
Bterilised vaseline. Allow the vaseline to solidify and then prick the thumb
through the vaseline with sterilised needle. Place four large loopfuls of
blood in specimen tube, and immediately reinsert cork. Maintain the tube
at temperature of 37° C. After half an hour, remove the clot with the aid of
platinum loop. To the mixture of blood-serum and corpuscles remaining in
the tube, add one large loopful of bacillary emulsion (heated to 37° C.) and
mix. Incubate for time desired (see below), and then, after having stirred
the contents of the tube, make coverglass films of the fluid with the aid of
the small platinum loop. Allow the films, which must be very thin, to dry

174

ORIGINAL ARTICLES

in air, and then fix them for two minutes with absolute alcohoL Stain
with carbol thionin, LOffler's methylene blue, or other suitable s t a ining
reagent.

Two separate actions require to be studied, namely, the
power of the polymorpho-nuclear leucocytes to take up the
bacilli, and the power of these leucocytes to dissolve the bacilli
when engulfed.

The first action was studied in films prepared after incuba¬
tion at 37° C. for thirty minutes (Fig. 1), the second after
incubation for three hours. We have found that the power to
take up the bacilli is extremely variable, both in control blood
and in the general paralytic’s blood. No constant alteration in
this power could be recognised in the latter.

On the other hand, the power to diseolve the bacilli taken
up has, in most instances, been distinctly greater on the part of
the leucocytes of the general paralytic than on that of the
leucocytes of the controls. Bacilli which have not been taken
up by leucocytes remain, with few exceptions, perfectly normal
in appearance after three hours’ incubation. The intra-cellular
changes are, however, within this time always very considerable
(Fig. 2). It would appear that, as maintained by Metchnikoff
to be the general rule, the bacteriolytic action is in this case
essentially an intra-corpuscular one. The dissolving organisms
show a progressive diminution in their affinity for the ordinary
staining reagents (Fig. 3). In the last distinguishable phase of
this bacteriolytic process the organisms appear as faintly tinted
rods, and are generally somewhat attenuated. It is only recently
that we have succeeded in sufficiently perfecting the method of
demonstrating this bacteriolytic action to warrant the making
of comparative observations with it in a series of cases, and
therefore the number of these observations that we cau as yet
record is somewhat small. In films fixed with absolute alcohol
and stained for ten minutes with Loffler’s methylene blue, we
have estimated the percentage of altered bacilli among those
engulfed by the leucocytes. This percentage we term the intro-
corpuscular bacteriolytic index. The following table shows the
results obtained in twelve cases of general paralysis and in six
control cases:—

ORIGINAL ARTICLES

i7a

Intra-Corpuscular Bacteriolytic Indices.

I. General Paralysis.

1. A. (w.). . .77

2. R. (w.) . . .64

3. R. (w.) . . .67

4. K. (w.). . .63

5. C. (w.) . . .78

6. W. (w.). . 70-6

7. S. (m.) . . .86

8. W. (m.) . 64*4

9. A. (m.). . . 43*5

10. D. (m.). . .80

11. G. (m.). . . 65

12. N. (m.). . .51

II. Controls.

1. Y. (w.) Adolescent In¬

sanity . .16

2. I. (w.) Imbecility . 31*5

3. Nurse J. . . . 5*8

4. Nurse H. . .15

5. S. (w.) Adolescent In¬

sanity . . 10*5

6. M. (w.) Adolescent

Insanity . .13

III. Clinical Diagnosis Doubtful.
1. W. (w.) . . .15

We have also studied the bacteriolytic or lysogenic action
of the blood serum upon the bacillus paralyticans. After the
blood has been allowed to stand for twenty-four hours, the
bacteriolytic substances are contained in the serum owing to the
disintegration of the white corpuscles. The elaboration of a
suitable technic by means of which to compare the bacteriolytic
power in different cases has proved somewhat difficult. It has,
however, already been possible to determine in several cases of
general paralysis that the solvent action of the blood serum, like
that of the active leucocytes, was greater than the solvent action
of the serum of a normal person.

After having thus studied experimentally the phagocytic and
bacteriolytic actions of the blood upon the bacillus paralyticans ,
Dr M‘Rae and I endeavoured to ascertain if there was any
evidence of the occurrence of similar processes in the tissues and
body fluids of general paralytics. Every case studied with this
object has given the same answer, an emphatic “ Yes.”

Diphtheroid bacilli, more or less altered by lysogenic action,
are present in great numbers in the catarrhal pneumonic foci
that occur in most general paralytics who die in congestive
attacks (Fig. 4). They are contained chiefly, but not exclusively,
in the leucocytes that fill the alveoli. They have also been
found in the blood stream in the neighbourhood of such pneu¬
monic foci They are also generally demonstrable, sometimes in
great numbers, in the adventitial spaces of the inflamed cerebral

176

ORIGINAL ARTICLES

vessels and in meshes of the pia-arachnoid. Further, they can
be observed in films made from the blood of the living paralytic,
more especially when the patient is in a congestive attack
(Figs. 7). They can also be detected in the centrifuge deposit
from the cerebro-spinal fluid. They may be present in
great numbers in the urine of paralytics, especially during

congestive attacks. If 5 c.c. of the fresh urine are centri-

fugalised, and if films of the deposit are then stained by

Neisser’s method or with carbol thionin, abundant organisms
are generally to be observed. These may be of various kinds,
but in several cases we have found that to all appearance only
dissolving diphtheroid bacilli were present. That this was really
so was demonstrated in a striking way in one of our cases in
which these altered bacilli were abundant in the centrifuge
deposit (Fig. 6). We made cultures from the deposit, and

after 48 hours’ incubation there was on first inspection seemingly
no growth of any kind. On closer examination, however, a
single minute colony was observed. It proved to be a pure
growth of a diphtheroid bacillus. In cases of simple general
paralysis it is unusual to find among the diphtheroid bacilli in
the centrifuge deposit from the urine any that show meta-
chromatic granules. In cases of general paralysis combined
with tabes dorsalis it is, however, different. In all of seven
such cases that we have been able to examine at the Royal
Edinburgh Asylum, Dr M'Rae and I have found abundant living
bacilli with distinct metachromatic granules also to be present.
I shall discuss the significance of these facts in the concluding
lecture.

The experimental study of the action of the living blood
upon the bacillus paralyticans has, however, led to another result
of a different kind. It has taught us how to grow the organism
from the blood and cerebro-spinal fluid of the living general
paralytic. More than four years ago Dr M’Rae, Dr Jeffrey, and
I began to make attempts to grow the bacillus from the blood,
for we felt that it should be possible to do so if the hypothesis
we were testing was correct. Every method that we could
think of has been tried from time to time during these years,
but, until quite recently, all in vain. It is now clear, in the
light of our experimental observations, that we failed to get
cultures chiefly for the reason that we incubated the tubes with

ORIGINAL ARTICLES

17 r

as little delay as possible. By so doing we were really adopting
the most certain method of completing the destruction of the
few living bacilli that might be present. From several cases of
general paralysis we have recently placed fresh blood upon byno¬
haemoglobin agar and allowed the tubes to remain in the cold
for twenty-four hours before incubating them at 37° C. By
thus delaying the incubation, two important ends are attained.
First, the leucocytes are killed and their phagocytic action
therefore abolished; and second, time is allowed for the alexines,
which, with the disintegration of the leucocytes, have passed into
the blood serum, to be destroyed by contact with the dead
organic matter contained in the culture medium. When the
tubes are placed in the incubator the blood has more or less
completely lost its bactericidal properties, and any living
organisms it may contain are able to multiply.

By using this method, or slight modifications of it, we have
succeeded in obtaining pure cultures of a diphtheroid bacillus
from the blood in four cases of general paralysis. The first case
was that of a woman in a congestive attack from which she
recovered. The growth of the bacillus was at first very feeble,
but in sub-cultures it has gradually increased in vigour (Fig. 5).
The second case was that of a woman, also in a congestive
attack, which proved fatal a few days later. In this case only
extremely feeble colonies were obtained. The bacillus was
readily recognised in film preparations, but it was found im¬
possible to obtain a growth in sub-cultures. The third case was
that of a man suffering from general paralysis combined with
tabes dorsalis. The disease was progressing rapidly, but the
patient was not in a congestive attack. In this case also the
growth obtained was extremely feeble, but we still have the
bacillus growing in sub-cultures. The fourth case was one in
which the patient had been a tabetic for some years before he
developed the signs of general paralysis. He was suffering from
a congestive attack which proved fatal three days later. In this
case also the growths were very feeble, but sub-cultures have
been successful. We have on several occasions observed this
initial feebleness of growth in cultures of diphtheroid bacilli
isolated post-mortem from internal organs. There is reason to
believe that it is an effect of the previous bacteriolytic action of
the patient’s blood. In such instances the bacillus, as a rule.

178

ORIGINAL ARTICLES

increases in vigour in successive sub-cultures, but sometimes it
refuses to continue to grow. We have ascertained that a feeble
diphtheroid bacillus can be invigorated by being sub-cultured
upon blood-films.

Dr M'Rae and I have made cultures from the centrifuge
deposit from the cerebro-spinal fluid withdrawn by lumbar
puncture in four cases of general paralysis with negative results,
but in each of these instances the tubes were incubated at once,
and the patients were not suffering from congestive attacks.
Quite recently, two patients suffering from congestive attacks
have been examined in the same way, excepting that the tubes,
after having been inoculated with the deposit, were allowed to
remain cold for several hours. From both we have obtained
pure growths of a diphtheroid bacillus. In the first case the
colonies were numerous and the growth fairly vigorous. In the
other the growth was extremely feeble.

I come next to the observations that my colleague and I
have made with the object of obtaining, if possible, evidence of
some specific action of the blood of the general paralytic upon
the bacillus parcdyticans. I am not quite sure that we can yet
say that we have succeeded, but we have certainly come very
near doing so.

We have tried agglutination tests, using chiefly the technic
devised by Dr M. H. Gordon, and employed by him with some
success in an experimental research with the bacillus diphtheria.
We have, however, failed to obtain results of a distinctive nature.
In our experience the bacilli form clumps so readily, even in
normal blood-serum, that it is difficult to be certain of the
occurrence of any specific agglutinative action in the serum of
the general paralytic.

We have also endeavoured to compare the bacteriolytic
power of the blood-serum of the general paralytic with that of
control cases. As already indicated, we have found it extremely
difficult to devise a serviceable technic, and all I can say at
present is that we have in several instances found the power of
the twenty-four hour serum of the general paralytic to dissolve
the bacillus parcdyticans to be distinctly greater than that of the
serum of a normal individual.

We have had more definite success in estimating the intra-
corpuscular bacteriolytic power. The method employed has

Plate 9.

Fig. 1.

Fig. 2.

■V

ORIGINAL ARTICLES

179

already been described, and the results obtained have been given
in tabular form. If these initial results should be confirmed in
a sufficiently extensive series of cases, the reaction would form
the basis of a method of serum diagnosis of general paralysis.

The results of the researches of Wright, Bulloch, and others
upon the “ opsonic ” action of the blood-serum, suggested to us
that it might be worth while to apply some similar test in this
investigation. We have not, however, used Wright’s technic for
the reason that we had already in use our method of studying
the phagocytic action of the leucocytes, and it readily adapted
itself to the purpose we had in view, namely, to ascertain if the
addition of a definite proportion of the blood-serum of a general
paralytic to normal blood-serum containing active leucocytes
would increase the power of these corpuscles to take up the
bacillus parcdyticans. The blood, the serum of which was to be
tested, was obtained in a sterilised glass tube with capillary ends.
The ends were then sealed by means of heat. After twenty-four
hours the contents of the tube were centrifuged, and the clear
cell-free serum was pipetted off and placed in a sterilised
specimen tube (2*5 c.c. capacity). This tube was then corked
and placed in the incubator. Two tubes of normal blood were
obtained in the way already described, and kept at a temperature
of 37° C. After half an hour the clots were removed. To one
tube, forming the control, there was added one large loopful of
bacillary emulsion (heated to 37° C.); to the other there were
added a similar loopful of bacillary emulsion and one loopful of
the serum to be tested. Both tubes were incubated for 40
minutes. Films were then made from each and stained with
carbol thionin or with Loffler’s methylene blue. The control
and experimental films were compared with regard to (1) the
percentage of polymorpho-nuclear leucocytes containing bacilli,
and (2) the average number of bacilli in each leucocyte.

In a test of this kind there is inevitably a considerable
margin of error, for at least two reasons. First, the result may
be affected by slight differences in the quantity of the bacillary
emulsion added respectively to the control tube and to the tube
•containing the serum to be tested ; and, second, the result may
be affected by slight differences in temperature, as it has been
proved that the power to take up the bacilli is very greatly
lessened by lowering of the temperature even 3 or 4 degrees below

180

ORIGINAL ARTICLES

the normal Every effort has, of course, been made to render
the conditions uniform.

Test IV.

Difference between Experiment and Control.

Percentage of Polymorphs
containing Bacilli.

Aver. Number of
Bacilli in each
Leucocyte

I. General Paralysis —

1. S. (m.) .

+ 38 .

. + 2-2

2. L. (m.)

. + 56

. +3-6

3. A. (m.)

+ 12 .

+ •9

4 D. (m.) .

+ 9*9 .

. + 2-8

5. G. (m.)

. - 5

+ -5

6. W. (w.) .

+ 5 .

. +’5

7. C. (w.)

+ 40

. +4-9

8. & (w.)

-2 .

. +4

9. A. (w.)

+ 13-5 .

. + lo

10. R. (w.)

+ 9 .

. + 3-5

II. Controls —

1. V. (w.) Adolescent Insanity -- 14*8 .

. - 2*9

2. K. (w.)

„ + 33-2 .

. + 2*6

3. F. (w.) Epilepsy .

+ 6

. + 16

4. H. (w.) Adolescent Insanity - 10

. + *3

5. Nurse A. .

+ 7 .

. + 1

6. Nurse S. .

+ 1

- -2

7. Nurse M. .

- 7

- -7

The results obtained are perhaps those that might have been
predicted on the ground of what is already known. Dr Wright,
from his studies upon the subject of opsonic action, has come to
the following conclusion:—“ In one class of infections the opsonic
power with respect to the infecting micro-organisms hardly varies
from day to day, remaining always inferior to that of the normal
blood. In another class of infections, the opsonic power is con¬
tinually fluctuating, the range of variation being very far below
the normal and very far above the normal. These categories of
infections correspond respectively to strictly localised and systemic
infections.” 1 As in general paralysis, there is not merely a local

1 The Lancet , December 2, 1906.

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181

infection, bat a succession of systemic invasions, the disease would
come under the second class, and we should expect to find con¬
siderable variation in the opsonic power of the blood in relation
to the infecting organism. It may be that very high readings
are indicative of stimulation of certain specific resisting
mechanisms, hut this conclusion is hardly warranted by the
results as yet obtained.

Whilst a trustworthy method of serum diagnosis would un¬
questionably be very useful in dealing with suspected cases of
general paralysis, it seems not improbable that more direct
methods of bacteriological diagnosis may become generally avail¬
able. They may already be said to be available in some cases.
There can be little room for doubt that the patient is suffering
from the paralytic toxaemia if diphtheroid bacilli can be grown
from his blood or from his cerebro-spinal fluid, or if they can be
detected in microscopical preparations of the blood or of the
centrifuge deposit from the cerebro-spinal fluid. The presence
in the urine of great numbers of diphtheroid bacilli that have
suffered lysogenic action must, I think, also be regarded as a
positive sign. Lustly, if, in addition to altered bacilli, the centri¬
fuge deposit from the urine shows very abundant diphtheroid
bacilli with metachromatic granules, then the case is one of
tabes dorsalis, or at least will soon manifest the recognised signs
of this disease.

There are still some additional facts that I wish to record,
but they will be more conveniently dealt with when I endeavour,
on the ground of the results of our investigations, to formulate
new and definite conclusions regarding the etiology and patho¬
genesis of general paralysis and tabes dorsalis in the next
lecture.

Discbiptioh or Fioubxb.

Fio. 1 . —Polymorpho-nuclear leucocyte containing two unaltered diphtheroid
bacilli. Experimental observation; normal blood corpuscles and
emulsion of diphtheroid bacilli; incubation for half an hour. Carbol
thionin. xlOOO.

Fie. 1—Polymorpho-nuclear leucocyte containing numerous diphtheroid
bacilli, most of which are altered by lysogenic action. Group of un¬
altered bacilli lying free. Experimental observation; normal blood
corpuscles and emulsion of diphtheroid bacilli; three hours’ incubation.
Loffler's methylene blue. XlOOO.

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Fig. 3.—Drawing of diphtheroid bacilli in films made from mixture of
normal blood corpuscles and emulsion of diphtheroid bacilli after three
hours’ incubation. To show the changes produced in the appearance of
the bacilli by lysogenic action. Above there are shown examples of
unaltered bacilli, below examples of altered bacilli to be observed within
the protoplasm of many of the leucocytes. The organisms to the left
are from a preparation stained by Neisser’s method, those to the right
from one stained with carbol thionin.

Fig. 4.—Group of altered diphtheroid bacilli in alveolus of lung of general
paralytic who died in a congestive attack. Carbol thionin. xlOOO.

Fig. 5. — Diphtheroid bacillus isolated in pure culture from the blood of a
general paralytic suffering from a congestive attack which did not prove
fatal. Two days’ growth upon blood-film. Carbol thionin. xlOOO.

Fig. 6.—Centrifuge deposit from urine of general paralytic in third stage.
Neisser’s method. Shows diphtheroid bacilli considerably altered by
lysogenic action. xlOOO.

Fig. 7.—Leucocyte in blood of general paralytic in a congestive attack.
Loffler’s methylene blue. xlOOO. Shows in the protoplasm a body
which under the microscope can be recognised to be a diphtheroid
bacillus that stains faintly. A pure growth of a diphtheroid bacillus was
obtained from the blood of this patient.

A CASE OF CHRONIC PROGRESSIVE DOUBLE
HEMIPLEGIA

By E. FARQUHAR BUZZARD, M.D., M.R.C.P.,

Assistant-Physician (late Pathologist) to the National Hospital
for the Paralysed and Epileptic;

and

STANLEY BARNES, M.D., M.R.C.P.,

Pathologist to the Queen’s Hospital, Birmingham; late House Physician
to the National Hospital for the Paralysed and Epileptic.

Cases of this condition in an early stage are so comparatively
rare, that it appeared worth while to record an account of one
which recently died in the National Hospital for the Paralysed
and Epileptic. We wish to express our indebtedness to Dr

ORIGINAL ARTICLES

183

Hughlings Jackson for his kindness in allowing us to make use
of this case.

Mary C., aged 53, was admitted to the National Hospital,
Queen Square, London, on July 25, 1902, complaining of
“ hysteria,” laughing at nothing, and loss of power in walking.

Her family history was quite good, there having been no
cases of insanity, fits, or other nervous disease. Her previous
health had always been good before the onset of the present
illness. She had never had crying fits or fainting in childhood,
and although she said that she had never taken regular exercise,
she had enjoyed good health. Menstruation began at the age of
15, and had continued to the age of 43.

The present illness came on gradually after a fall, 10 years
ago, at the age of 43. The patient was playing a game in the
house when she fell down in a sitting position. She felt some
pain in the back for a few days, but when this had worn off she
appeared to have quite recovered. From that date forward
however, she seemed to gradually begin to lapse into her present
condition. The attacks of uncontrollable laughter were the first
symptoms to appear, and they have gradually become more and
more marked with each successive year. At such times, she
says, she does not think of laughable things, nor does she know
at what she laughs: she is conscious all the time of the absurdity
of thus laughing and feels a “ fool ” to do so, but she has not
sufficient control to prevent herself from so doing. In these
attacks she does not feel at all happy, “ as it makes her feel so
stupid.”

She noticed weakness of the legs beginning about two
years ago, and this has gradually progressed up to the date of
admission to hospital. She can still get about without assistance,
but not so quickly as before, and she tires after a very short
walk.

Her speech, too, has altered in character. From her descrip¬
tion, it is evident that in this respect she suffers partly from loss
of ideation and partly from difficulty in pronouncing her words :
like the other symptoms, this has become progressively worse
since it was first noticed.

There has never been any headache or vomiting, nor any
trouble with her eyesight. The sphincters have acted normally
throughout

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On admission, she was a rather short, stoat woman, with dark
hair streaked with grey, and looking a little older than her
years.

Facial Aspect .—As she lay in bed, unaware that she was being
observed, the face was symmetrical and was only noticeable for
some loss of the natural expression. When addressed, the face
lapsed into a much wrinkled and rather stupid-looking smile, in
which the muscles about the angles of the mouth were fully con¬
tracted without a similar contraction in those of the upper part
of the face, so that no change occurred in the width of the
palpebral fissures. There was thus no play of features around
the eyes, and the smile reminded one rather of that of an
imbecile than of that of an amused adult. At times, on merely
asking her an ordinary question— e.g. “ How are you to-day ? ”
—the smile would broaden out to a grin from ear to ear, and she
would give a “ He, haw,” and at once bury her head in the
pillows and shake with laughter. After repeated observations, it
was clear that the laugh was never a quick response to any
question, not so quick as would have occurred in a normal
woman, even when she was obviously prepared to laugh before
she was addressed: the stages of the laugh could always be
followed as they gradually rose to a maximum. When asked
to raise her eyebrows, or perform any other facial movement, she
could do so symmetrically and fully, but the action never had the
normally quick response of the healthy individual All the facial
movements seemed to be awkward and slow.

Attitude on Standing and Walking .—In standing, the back
was always a little bowed, and the head thrown forwards, the
chin rather protruding. The arms were at the sides with the
elbows a little flexed and the hands in a state of general partial
flexion. In walking, she shuffled along with small steps, the feet
being dragged along and sometimes scraping the floor. The knees
were bent in walking, but not so much as usual. The whole
gait had an aspect of stiffness, and although there was no tremor
or propulsion, yet with her almost expressionless face one was
forcibly reminded of Paralysis Agitans in an early stage.

Cranial Nerves. —Smell, taste, hearing, and sight were all
good. There was no contraction of the visual fields, and the
optic discs were normal. The pupils were equal, of moderate
size, and reacted normally to light and on accommodation. There

ORIGINAL ARTICLES

185

were no ocular palsies, and the eyes moved steadily and quickly
in all directions. The tongue could be protruded fully, and was
central; its lateral movements were also fully performed, although
with some awkwardness; when asked to “ waggle ” her tongue
rapidly from side to side, she completely failed to do so, the
resultant movements being slow and exceedingly awkward, and
taking about a second to complete in each direction, whereas
normally the number of such lateral movements possible is about
five a second. In other words, the tongue was very spastic.

There was no muscular atrophy anywhere, and in general the
muscles were well developed. Nowhere was any movement com¬
pletely lost, nor could any difference at any time be made out
between the two sides, but there seemed to be a definite general
weakness of all the movements of the limbs and body, but
perhaps more marked in the extremities of the limbs than in
the proximal groups of muscles. In all cases the weakness was
a slight one, and was accompanied with slowness and some stiff¬
ness of movement, although the joints nowhere showed any lesion.
At no time was any tremor observed, either during movement or
when at rest. There was no inco-ordination of movement anywhere.

There were no subjective or objective sensory disturbances.

Reflexes —

Jaw-jerk exaggerated.

Supinator and other arm-jerks all increased, but equal
on the two sides.

Knee-jerks equal, brisk.

Ankle-jerks equal, brisk, no clonus.

Abdominal absent.

Sphincters normal.

The plantar reflexes showed that condition which has else¬
where been described by one of us under the term “ pyramidal
equilibrium ”—that is to say, when tested with the limb in the
generally flexed position, the plantar response was invariably
flexor, but when tested with the leg and thigh in the extended
position, the stimulus being applied to the outer edge of the sole,
then the plantar response was invariably extensor at first. On
repeating the stimulation at short intervals, the third or fourth
responee and all subsequent ones were flexor, the extensor response
having apparently been exhausted. After a few minutes’ interval,
fresh stimulation would again produce an extensor response.

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There were no trophic disturbances.

Circulatory System .—The poise-rate was 86, pulse regular,,
medium tension, no thickening of the vessel wall. The heart was
apparently normal.

The urine was normal, containing no albumin.

She remained in hospital for four months, during which time
no marked changes occurred. It appeared as though the stillness
slightly increased, but at no time did any marked weakness come
on. The reflexes remained the same.

On November 23, whilst having her breakfast, she suddenly
fell back in bed and died almost immediately. She had had no
previous attack of angina.

Diagnosis .—The chief symptoms of which the patient com¬
plained were “ hysterical ” attacks of laughing and crying, and
difficulty in walking so far as she had been accustomed to do.
These signs, taken in conjunction with her obvious deficiency of
mental concentration, strongly suggested that the whole condi¬
tion was a functional one. It was only on careful and repeated
examination that one could be certain that the movements of the
face and limbs were definitely abnormal. The difficulty chiefly
arose in that the condition was perfectly symmetrical, so that no
differences could be noted between the two sides, and also in that
in no single situation was there anything approaching a complete
lesion. The stiffness of the facial and other movements then
suggested a diagnosis of paralysis agitans, but against this decision
was the fact that there were present none of the usual con¬
comitant signs, such as restlessness, sensations of heat, pains in
the limbs, etc.; the fact that tremors were absent was hardly of
sufficient importance to weigh in the diagnosis.

One sign of spasticity, however, was found which is not
present in paralysis agitans, and which, in our opinion, was
sufficient in itself to negative a diagnosis of any disease in which
the pyramidal tracts are not affected. On several occasions the
plantar reflex was tested with great care, and always with the
same result, an easily exhaustible extensor response being
obtained in the extended position of the limb. It is true that
the tendon reflexes all over the body were brisk, and this was
useful confirmatory evidence of the spasticity; but the degree of
exaggeration of the knee-jerks, for instance, was not greater than
is frequently seen in cases of neurasthenia and other functional

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187

conditions. Further, the superficial reflexes of the epigastrium
and abdomen were absent. Now it has appeared to us that in
cases where the tendon-jerks are increased and the superficial
reflexes of the abdomen are also increased, the condition is likely
to be a functional one: whereas, if with increased knee-jerks the
abdominal reflexes are absent, a diagnosis of spasticity is the
more likely. Therefore these signs in this case, confirming the
evidence of spasticity as suggested by the plantar reflexes, led to
a diagnosis of organic disease involving the pyramidal tracts
symmetrically.

If, now, the spasticity of the legs was dependent upon this
cause, it seemed very probable that the awkwardness and stiff¬
ness of the movements of the face, tongue, and arms were
dependent on the same cause, and that the patient was suffering
from a generalised spasticity of all her motor functions. There
were no signs or symptoms suggesting that any of the sensory
tracts were involved, nor were there any signs of nuclear or
infranuclear lesions. These facts, together with the history of
the onset and the age of the patient, seemed to indicate that the
condition was not disseminate sclerosis. The gradual onset with
steady progression led to the diagnosis that the disease was a
degeneration occurring in the upper motor neurones, and probably
not affecting any other of the main neuronic systems of the
central nervous system.

An autopsy was made twenty-four hours after death, when
rigor mortis was still present. The body was well-nourished and
contained abundant subcutaneous fat. The cranial bones, vertebral
column, and meninges were healthy. The brain and spinal cord,
removed together, showed no obvious signs of disease, but all the
large and medium-sized arteries supplying the former were
extensively diseased, the vertebral and carotid being specially
affected. The smaller vessels running in the pia mater over
the surface of the hemispheres were the seat of numerous
atheromatous patches. There was no evidence of thrombosis
on the surface, and the brain was left to harden before it was
cut for further examination.

The lungs were healthy except for an old scar at one apex.
The heart was moderately hypertrophied, but the cardiac muscle
showed no obvious degenerative change to the naked eye. The
coronary arteries were extensively diseased both at their point of

188

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origin and throughout their course. There was some sclerosis of
the mitral and aortic valves, and also of the first part of the aorta.
The left radial artery did not present any signs of disease.

The liver and spleen were healthy. The kidneys showed
little or no loss of cortex, and their capsules stripped readily.
The pelvic organs were normal. The thyroid, pancreas, and
adrenals were preserved for microscopical examination.

After hardening in formalin, the brain was cut in longitudinal
horizontal sections, but with negative results as far as any growth,
softening, or haemorrhage was concerned. On the other hand,
these sections were remarkable for the appearance produced by
the disease of the penetrating vessels. The large majority of the
arteries, even the smallest, were conspicuous on account of the
rigidity of their walls, and the branches of the perforating
arteries on account of a small patch of discoloration which was
often present in the tissue surrounding them. This gave a
somewhat speckled look to the sections through the internal
capsules and basal ganglia.

Microscopical .—Sections were cut from the Rolandic cortex
and from the internal capsule and stained with logwood and
eosin. They confirmed the naked-eye observations in revealing
very extensive disease of small arterioles with practically no
change in the surrounding tissues. The internal and middle
coats of the vessels were both affected as a rule, and in many
cases the adventitia contained an abundance of small round cells.
Tbe condition of the ganglion cells of the cortex was on the
whole satisfactory, and there was an absence of anything like
chromatolytic changes. On the other hand many of the cells
did not appear to be as large as usual, and it was doubtful
whether the number of Betz cells was up to the average.

Sections of a vertebral artery showed marked thickening of
the intima, with degenerative changes in the media and small-
celled infiltration of the adventitia.

Sections taken from the internal capsule, the pons, the
medulla, and from various levels of the cord, were stained by the
Weigert-Pal method, and all these were remarkable for a definite
sclerosis of the pyramidal tracts throughout their length, and for
the healthy condition of most other systems. In the accompany¬
ing photograph it will be noticed that the fronto-pontine fibres of
the internal capsule are degenerated along with those of motor

ORIGINAL ARTICLES

189

origin, leaving only the posterior third of the capsule intact. The
degeneration of the crossed pyramids could be traced down to
the sacral cord, but the direct pyramidal tracts were not so
markedly affected in sections stained by this method.

Sections stained by the Busch method confirmed the presence
of degeneration in the pyramidal system and enabled one to
observe it in scattered fibres throughout the direct tracts as well.
No other definite systemic degeneration was observed by this
method, although other parts of the central nervous system
presented here and there a few degenerated fibres.

Nissi preparations of the cervical cord presented no abnormal
conditions in the ganglion cells of the grey matter.

Sections of the thyroid gland were examined by Dr Chalmers
Watson, who reported advanced interstitial changes, marked
proliferation of epithelium, extensive disease and calcification of
the middle coats of the vessels, and numerous areas of, mainly,
lymphocytic accumulations.

The consideration of the morbid anatomy of this case forces
us to the conclusion that the condition was a progressive
degeneration of the upper motor neurons produced by a failure
in the supply of nutrition to the central portions of those
neurons, and that this failure of supply was due to the un¬
usually extensive disease of the middle cerebral arteries and their
numerous branches.

We are bound to admit that equally extensive vascular
disease is occasionally met with in cases in which one or more
u strokes ” have been followed by a fatal cerebral haemorrhage or
thrombosis, and it is difficult to explain why one person should
experience recurring attacks of hemiplegia and another suffer
from the chronic progressive ailment of which our case is an
example. At the same time it is conceivable that if the accident
of a gross vascular lesion is escaped in the early stages of a
slowly progressive cerebral arterio-sclerosis, the inactive and
vegetative character of life enforced upon the patient may to
some extent act as a safeguard against the more violent
expressions of the disease.

It may be worth while to point out that the degeneration of
the upper motor neurons in our case differs from that which
obtains in certain other diseases in which the same system is
affected. In Friedreich’s ataxy, in subacute combined sclerosis,

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ORIGINAL ARTICLES

and in lathyrism, for instance, the degeneration of the pyramids
is not seen much above the lower end of the medulla, while in
our case it extends at least as high as the internal capsule. In
the former diseases there is probably a gradual decay of the
peripheral portions of the neurons; in the latter condition a
true, if slow, Wallerian degeneration in a centrifugal direction.

If we were obliged to locate exactly the particular level at
which the starvation-process affects the neuron, we should be
inclined to select that part of the fibre which lies between the
pyramidal cell and the internal capsule, and this for two reasons.
In the first place the cortical grey matter was not obviously
shrunken nor histologically much altered. In the second place,
the centrum ovale is more poorly supplied with blood than the
parts lying immediately above or below it.

Etiology .—Traumatism was the only etiological factor which
could be discovered clinically, but it is clear from the post¬
mortem findings that the essential factor in the causation waa the
intense cerebral arterio-sclerosis ; it is remarkable that although
arterio-sclerosis was specifically examined for clinically, yet no sign
of its presence could be detected in the palpable systemic arteries
or the retinal arteries, whilst the heart gave no clue to the
condition.

Frequency .—From the small number of cases verified by
post-mortem examination and placed upon record, it would
appear that this disease is very uncommon. A diagnosis of
41 primary lateral sclerosis ” used to be very common in the
wards of our hospitals, but more careful methods of examina¬
tion and a wider knowledge of the symptomatology have shown
that a large proportion of these cases were in reality disseminate
sclerosis. At the same time, it is probable that chronic progres¬
sive double hemiplegia occurs with moderate frequency. During
the last four years we have both seen several cases in which tliis
diagnosis was made clinically, but in none of them was a post¬
mortem examination obtained. As compared with disseminate
sclerosis, it is probable that the neuronic degeneration of the
pyramidal tracts is rare, not more than one case of the latter
occurring for forty of the former in hospital practice. In
suggesting these numbers, all cases of pyramidal degeneration
in which the lower motor neurones are also affected have 'been
excluded, for it seems that the conditions are widely different

ORIGINAL ARTICLES

191

in etiology and course; amyotrophic lateral sclerosis tends to
mn its course in about two years, and the more the spasticity,
the more acute the disease; whereas the cases of progressive
double hemiplegia are always very chronic, and as in one of
the cases seen recently, may still be living in fair general health
twenty years after the onset of the disease.

Nomenclature .—The term “primary spastic paraplegia” has
been rejected in that, being a clinical term, it does not sufficiently
define the disease, and also because so many of the oases called
by this term in the past have turned out to be merely early
stages of some other disease, that the retention of the term
is only likely to lead to further confusion. Again, the word
a paraplegia ” is usually taken to mean a paralysis of the lower
extremities, whereas in the condition under discussion, all the
mnscles of the body, including those supplied by the cranial
nerves, become weak and stiff.

“Primary lateral sclerosis,” though a pathological term, is
only a partially diagnostic one, and in any case does not
express that the degeneration is of the neuronic type; it is
a term which might usefully indicate the anatomical deduction
of certain clinical signs, but is not sufficiently definitive as a
name for a disease. And further, in the case we are recording,
the condition is evidently not a primary one, but is secondary
to the vascular disease.

Description or Figures.

Fig. 1 . — Section through internal capsule, showing sclerosis of its anterior
two-thirds.

Fro. 2.—A section from the neighbourhood of the basal ganglia, showing the
diseased condition of the small branches of the perforating arteries.

Fig. 3.—Sclerosis of the pyramids in the medulla.

Figs. 4, 5, and 6. —Bilateral sclerosis of the crossed pyramidal tracts in the
cord.

192

ORIGINAL ARTICLES

A CASE OF MUSCULAR DYSTROPHY AFFECTING
HANDS AND FEET: DEPRESSION AFTER EX¬
HAUSTION, WITH RECOVERY.

By C. MACFIE CAMPBELL, M.B., Ch.B.

The following observation is that of a Russian Jewess, who, at
the age of 31, after a period of privation and ill-health, developed
a condition of depression which made it necessary for her to be
committed for treatment to a hospital for the insane. On
physical examination, patient presented a well-marked muscular
dystrophy which dated back to infancy. The psychosis seemed
to have no relation to the muscular condition; both the dystrophy
and the psychosis presented points of interest; to avoid confusion
the two conditions will be discussed separately at the risk of some
repetition.

Several varieties of muscular dystrophy have been described,
but the various groups are not now regarded as different con¬
ditions, but rather as the same condition with different topo¬
graphical distribution; transition forms and combinations of the
various types are known. The muscular dystrophies as a whole,
however, form a distinct group, opposed to the muscular atrophies
of nervous origin. The main characteristics of the former are
that they usually have their onset in childhood, frequently affect
several members of a family, and are very slowly progressive.
The dystrophy is usually symmetrical, begins as a rule with the
girdles and the proximal muscle groups of the limbs, and only at
a later stage, if at all, affects the muscles of the hands and feet;
fibrillary contractions are extremely rare, and there is no reaction
of degeneration.

D&ierine, in his “ S&niologie du Syst&me Nerveux,” considers
the topographical distribution of the myopathy a most important
element in the diagnosis, but this is not an infallible guide; and
he refers to the observation by Oppenheim and Cassirer (1898)
of a woman, aged 42, with a muscular dystrophy which developed
like a case of muscular atrophy of the Aran-Duchenne type.
D&jerine and Thomas lately communicated (Rev. Neur. t Dec. 30,
1904) the case of a woman in whom the first signs of weakness
of the hand commenced in 1868 at the age of 49. In 1893 she
showed a muscular atrophy of the Aran-Duchenne type, which

ORIGINAL ARTICLES

193

was confined to the upper extremities: fibrillary contractions
were present, but no reaction of degeneration. Patient died in
1899, and microscopical examination demonstrated that the
nervous system was intact and that the case was one of muscular
dystrophy. The following observation is of interest on account
of the extreme degree of atrophy of the intrinsic muscles of
hands and feet, a distribution which has repeated itself in three
members of the same family; while a weakness of the leg
muscles, common to these three, has already shown itself in two
members of a third generation.

Mrs L. S., set. 31; Hebrew ; admitted March 23,1905.

Family History .—No information as to grandparents. The father died
at 50, cause unknown. The mother is said to have had marked atrophy of the
muscles of the hands and a gait similar to the gait of the patient. The muscular
atrophy dated from her infancy, and was not progressive so far as her children
know. She was able to do her housework until she died at the age of 45,
cause unknown. A maternal uncle and two aunts are both said to have been
quite free from muscular atrophy. Patient is one of a family of four. One
brother had some obscure complaint, dating from childhood, and died at the
age of 20. It was impossible to form any clear idea of the nature of his
sickness. One brother (30) is alive and healthy ; there is some hollowing of
the interosseous spaces of both hands, which he himself has noticed, but no
weakness of any of the hand muscles can be made out. He has three young
children ; all seem normal (personally observed).

Patient’s sister , Mrs N. (40), has a marked muscular dystrophy with a
distribution similar to that of the patient; in both hands the muscles of the
thenar eminence show extreme wasting; the short flexor of the thumb seems
to have disappeared completely; the hypothenar eminence is considerably
atrophied ; the interossei are not so much affected ; she gives a fair hand grip*
The muscles of the shoulder girdle are satisfactory and act well; on the left
side, however, the scapula has a slight tendency to leave the chest wall. Both
feet are extremely limp and flabby, and assume the talipes position when
unsupported ; the eole is much hollowed out; the foot can be manipulated
with abnormal ease. She cannot dorsiflex the foot at all, and can only very
feebly flex it. Flexion of the toes is extremely weak, and there seems to be
no power of extension of the toes when that movement is especially tested ;
when walking, however, she is seen to extend the toes somewhat. The gait
is slow and ungainly, the feet (especially the right) drooping outwards as she
lifts them up, and therefore having to be raised rather high. She is unable
to walk any distance without feeling pains in her legs. Notwithstanding this
muscular condition, Mrs N. says that she is in good health and able to do her
own housework. She has borne nine children, none of whom show signs of
muscular abnormality (5 were examined personally).

The patient herself has four children ; all are “double-jointed” in their
fingers. Bennie (9$) shows no muscular weakness or atrophy, nor peculiar

194

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gait. Annie (8) has a peculiar gait, the left foot tending to rub along
the floor ; to obviate this she usually raises the left foot rather higher than
the right, which causes a slightly swaying gait. No marked weakness of the
muscles is made out in testing extension and flexion of feet and toes;
the calf muscles are firm and show neither hypertrophy nor atrophy ; there
is no noticeable weakness in the hand muscles. Sam (5$) has a peculiar gait,
the left foot being raised high and slightly everted. On the left side dorsi-
flexion of the foot is weaker than on the right. No weakness of the hand
muscles can be demonstrated. On the only occasion on which the electrical
reactions were tested, the short flexor of the thumb on the left side gave
a slight reaction to the faradic current, while that on the right gave none even
with a strong current. The first interosseous muscle on both sides failed to
react to a faradic current which gave a marked contraction on an adult. The
first interosseous muscle on both sides gave K.C.C. > A.C.C. Charlie (4) is
said to fall more frequently than other children of his age, but no peculiarity
of gait nor muscular defect could be made out.

The family history is shown in the following family tree

Mother. 2 Aunts, 1 Uncle.

(Myopathy with (No myopathy known.)

same distribution as patient.)

Mrs N., 40.
(Myopathy with
same distribution
as patient.)

Brother. Patient (31).

(Died at 20: no I

myopathy known.) I

Brother (30).

(? Hollowing of
interosseous spaces.)

Bennie (94). Annie (8). Sam (5J). Charlie (4).

(No muscular (Defective gait.) (Defective gait.) (No muscular

weakness.) weakness.)

Patient says that her own muscular condition, like that of her sister, is
oongenital, and has shown no change until about eight years ago, when the
little finger of her right hand began to be slightly flexed. Notwithstanding
the condition of her feet and handB, she was able as a child to join in the
games of her comrades ; she worked well at home and as a domestic, and has
been an efficient housewife until the development of her present psychosis.

Physical State on Admission (March 23, 1906).—Weight, 73£ lbs.; height,
4 ft. 8| ins. Patient presents no other malformation than that depending on
her muscular condition ; she is extremely emaciated, but not anaemic. Her
muscular condition is as follows:—

Superior Extremities .—The hand is of the simian type, the thumb lying
parallel with the other fingers, and the thenar eminence showing extreme
atrophy. When the thumb is abducted there is a marked groove on either
side of the tendon of the flexor pollicis longus. The short flexor of the
thumb seems to have completely disappeared, but an occasional flicker showB
that some of the outer head stili persists. No action of the short flexor can
be made out. Patient is able to oppose the thumb to the little finger, but the
slightest touch is sufficient to separate the two fingers. The palm of the

ORIGINAL ARTICLES

195

hand is hollowed out, and the heads of the metacarpala, especially that of the
index finger, are very prominent, while the tendons of the flexor sublimis
digitorum stand out in relief. When the hand is at rest the small finger, aud
to a less degree the ring finger, are flexed at the first interphalangeal joint;
they can be straightened with very little force, but a slight tenseness of the
tendon is felt; when patient extends her fingers to the utmost the little
finger remains slightly flexed. There is marked wasting of the interosseous
muscles, but patient can separate and bring together her fingers, although
with little force ; fibrillary contractions are occasionally seen. The hypothenar
eminence shows less atrophy than the thenar eminence. No reaction to the
faradic or galvanic current is obtained from the intrinsic muscles of the hand.
The muscles of the forearm and upper arm show a certain reduction in bulk ;
fibrillary twitching is occasionally observed in these muscles. The muscles
are not all equally affected, the deltoid being better preserved and firmer
than the biceps, the biceps than the triceps. Most of the muscles show very
marked irritability on percussion, especially the deltoid, in which muscle
fibrillary twitchings are very prominent. The muscles all act well in
proportion to their bulk, and give normal electrical reactions. The condition
is practically symmetrical on the two sides. The muscles of the shoulder
girdle are all reduced in bulk, but act well; all show marked irritability on
percussion, especially the trapezius.

Inferior Extremities .—Both feet are in the talipes position owing to the
weakness of the muscles of the anterior compartment of the leg. The sole of
the foot is flabby and hollowed out; the heads of the metatarsals, especially
of the first, are very prominent; the first phalanges are dorsifiexed, while
the others are in flexion; the foot is thus slightly similar in appearance to
that seen in Friedreich’B ataxia. On the right side the big toe is adducted
and underneath the second toe. The foot is extremely lax and easily
manipulated ; the least pressure corrects the deformity, but the foot cannot
be brought completely to a right angle with the leg owing to slight retraction
of the tendo Achillis ; this is slightly more marked on the right than on the
left side. The two feet present practically the same condition.

On both sides the muscles of the anterior tibio-fibular compartment show
considerable atrophy. There seems to be no action of the tibialis anticus on
the left side, and only very slight on the right side. The extensor longus
digitorum acts feebly on both sides, while the extensor proprius hallucis acts
well on the left side but feebly on the right side. These muscles show no
irritability on percussion, and give no reaction to the faradic current. The
extensor longus digitorum on the left side gives the reaction of degeneration,
while the other muscles of the same group react normally to the galvanic
current. The other muscles of the lower extremity are very flabby and
reduced in bulk, but act well in proportion to the amount of tissue; they
show marked irritability on percussion, and fibrillary twitching iB sometimes
very well marked ; some of the muscles do not react to the faradic current;
the condition on the two sides is practically the same. The gluteal muscles
are considerably reduced, show very marked irritability on percussion,
fibrillary twitching and fascicular contractions.

Patient’s gait is slow and hesitating, with marked difficulty in turning; as

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ORIGINAL ARTICLES

each foot is raised it droops and turns outward, the toes are slightly extended
as the foot is advanced, the ball of the big toe often rubs along the floor, the
foot is put down in a limp way without any spring.

The abdominal muscles show no weakness. There is a flattening over the
jaw on each side which suggests some atrophy of the masse ter; no weakness
of this muscle can be made out; no definite weakness of the muscles of the
face can be demonstrated, but patient shows her teeth in a stiff and con¬
strained way. With regard to fibrillary twitching, one may repeat that it is
most marked in the muscles of the shoulder and pelvic girdles and of the
proximal segments of the limbs. Often there is a continual flickering over
the surface of these muscles, especially after exercise.

There is no disorder of sensibility, the patellar reflexes are active and
equal; nothing of interest in the thoracic and abdominal organs. Patient
received massage and tonic treatment, and during the summer gradually
recovered her mental and bodily health. In November her weight had risen
from 73£ lb. to 99 lb., the circumference of forearm from 18.3 cm. had
increased to 20.2 cm.; while the maximum circumference of the calf,
previously 23.2 cm., was now 28 cm. The atrophy of hands and feet and
the condition of the muscles of the anterior tibio-fibular compartment were
unchanged. On both sides the flexor longus digitorum gave the reaction of
degeneration and failed to react to the faradic current. Flexion of the feet
was fair, but dorsiflexion almost impossible The other muscles of the body
had recovered their bulk and tone and lost their irritability on percussion,
and it was not possible to say that there was any definite atrophy of these
muscles ; the flattening over the jaw still persisted.

The main points of interest in the above case are the extreme
atrophy of the muscles of the hands and feet, the presence of
fibrillary twitching in the interossei and short flexor of the
thumb, and the reaction of degeneration in two of the atrophied
muscles of the lower extremities; the atrophy has presented
itself in three generations, but in the two members of the third
generation affected it is more limited than in the two previous
generations.

Onset of 'psychosis at the- aye of 31, after severe heemorrhage
(Sept. 1904) and months of privation; sleepless, without appetite,
thought she would die, suspicious and resentful, attempted suicide
(Feb. 1905). On admission (March), quiet, depressed, slow in
spontaneous movements, variable in reaction to orders and questions,
frequently mute, slightly apprehensive and suspicious, no delusions
nor hallucinations, no insight. Improvement during summer;
responded more freely, gained insight. November, apparently
normal; denied memory of some events during psychosis; return of
menstruation.

ORIGINAL ARTICLES

197

There is nothing of interest in the family history except the myopathic
heredity described above ; the description of the brother’s sickness given by
his relatives baffled diagnosis. Patient was bom in Poland in 1873 or 1874 ;
her father was a poor tailor and unable to send patient to school. She
learned at home to read a little Yiddish ; she was apparently of normal in¬
telligence, efficient in housework. Menstruation came on at fifteen without
any disturbance; she worked as a domestic from the age of ten until she
married in 1894 ; she came to New York with her husband in 1895. Her
married life was on the whole rather a struggle, and after the first year or so
there was considerable household friction ; patient seems to have been of a
scolding disposition. She bore four children : Benjamin in 1896, Annie in
1897, Sam in 1899, Charlie in 1901. She nursed her children for four
months, two years, one and a half years, and two years respectively. Patient
was very temperate in her habits. During the summer of 1904 her husband
was sick and unable to work and patient had very insufficient food.

Onset of Psychosis .—In the middle of September 1904, patient, who was
two months pregnant, began to have slight haemorrhage; this persisted for
two weeks, and then one night she had a profuse haemorrhage. A doctor was
summoned and removed a large amount of clot; the haemorrhage persisted
for a week. On the night of the profuse haemorrhage, according to patient’s
later account, 44 1 began to speak—not from my thoughts ; when the blood
came I got weak, and immediately began to speak other words.” She denies
having had any hallucinations. Her relatives cannot give any account of any
strange talk that night Patient says that on the following morning she was
quite sensible again, but had severe headache for a week. During the next
few months patient was quiet, apathetic, and silent. She ate little, was
sleepless, said that she was dizzy, and that something ran round in her head.
She did a little housework, but sat brooding most of the time. She attended
a dispensary and was treated with electricity for her insomnia. Frequently
she reproached her husband bitterly for not supporting her better, and
showed a suspicious attitude towards him and her relatives. When her
husband urged her to accompany him to a doctor, she accused him of paying
the doctor to poison her. On one occasion she tore up a prescription, saying
that it was for poison. She does not give a satisfactory account of these inci¬
dents, and denies such thoughts— 44 Who would poison another ?” According
to her retrospective account of this period, she felt that her mind was becom¬
ing affected : 44 Sick and insane is not good, and it was against my will; I
tried to hold it back, twice a week I went to a dispensary ... my head was
weak, my thoughts were feeble, too feeble for you to understand.” She was
as affectionate as usual to the children, but felt that she must die and that
another wife would rejoice in her children ; she rarely spoke to her friends,
and then resentfully and suspiciously. On February 1 she was found at
night by an open window, and struggled when she was drawn back ; she said
that she was warm and had mistaken it for a door ; she now admits that in
her anger (Zorn) she wished to throw herself out. Next day she was taken
to a hospital in Brooklyn; she scolded her husband vigorously because he
was unwilling to pay for a carriage. In hospital she was quiet and depressed,
sleepless, and wandering aimlessly about; at times she heard a roaring sound

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in her ears. When visited she showed her friends the same resentful be¬
haviour, turning away her head when greeted, answering curtly if at all.
She was discharged March 19 on account of her mental condition ; was un¬
willing to leave and apprehensive of what was going to befall her ; she
lamented loudly. Next day she was taken to the psychopathic pavilion,
Bellevue Hospital, where she continued to maintain the same behaviour.
She there said: 44 1 am entirely buried—I was buried when I had all the
trouble.” (She can give no explanation of this statement, which she does not
remember.)

She was committed to Manhattan State Hospital, and admitted on March
23 to the Clinical Service of the Pathological Institute.

Physical State on Admission. —Patient was much emaciated, but not anaemic
—Hb. 100 per cent. (Sahli), R.B.C. 5,280,000 (twice examined). There were
no anatomical stigmata and no scars to indicate previous disease. The tongue
was moist and coated, showed no tremor. The condition of the internal
organs was satisfactory. No information as to subjective feelings could be
obtained from patient; the cranial nerves showed nothing abnormal, there
was no sensory disorder, and the only motor disorder was that due to the
myopathy described above. The urine contained no abnormal constituents :
Sp. G. 1019, T. 98-6°.

Mental Status .— On admission, patient was quiet, obeyed requests as a rule,
sometimes mildly resisted. When nurse asked her name she replied, 44 My
name is no good.” She lay in bed with a slightly worried, woebegone look,
occasionally sighed and changed her position. She made no spontaneous
remarks, and at first gave no answer to physician’s questions. When urged,
she answered a few questions, occasionally beginning an answer and not
finishing it A long pause frequently preceded her answer.

Are you sick ? 44 1 have been sick, now I am healthy ; let me go ! ”

How old are you ? 44 Thirty-two ” (correct).

Where were you born 1 44 In—in—in— ” (sighs).

Where were you born ? 44 In Europe—in—.”

Although apparently very much depressed she did not admit it, said, 44 1
feel good.” She allowed her chest to be examined only after asking the
physician what he wished to do. When asked to give the right hand she
said, 44 What for?” and did not give it.

She gave very few responses to questions about her sickness ; her grasp of
the environment could not be determined, as she repeated the question with¬
out answering ; she denied that she was insane.

During the next few days patient continually got out of bed in a slow and
deliberate way ; when put back she would resist slightly, but seldom made
any remark. She ate and slept satisfactorily. As a rule she sat in bed with
the most doleful expression and did not answer the physician’s greeting.

On March 25 she refused to enter into conversation with her visitors,
would not take some fruit; when it was pressed upon her she took it from
their hands, laid it aside, said, 44 Lay it down, I’ll eat it later.”

On March 26 she seemed uneasy and distressed during an interview,
squeezed her hands, scratched her head, fumbled with her fingers. She gave
very few answers, but these were spoken quickly, although after a pause ;

ORIGINAL ARTICLES

199

similarly movements in response to orders were executed with fair speed after
an initial pause.

During tedious electrical examinations she complied languidly, only
occasionally protesting; she complied with requests, even when she remained
mute during a whole interview. Patient was allowed up on April 17, and
now sat all day long looking dolefully on the ground. For over a week she
had to be dressed by a nurse, and resisted slightly. All her spontaneous
movements, e.g . at meals, in getting in and out of bed, remained slow.

For several days patient had to be spoon-fed, but during April she ate
well, and her weekly weights were 75, 81, 90, 97 lb.

On April 22 she conversed for the first time with her visitors. On two
previous visits she had spoken not a word. On May 6 when she saw her
child she caressed him, asked many questions about him, talked quickly and
eagerly, asked indignantly why the other children had not been brought; she
asked her husband to take her home, said that all the other patients were
healthy. Although patient talked quickly and with much emotion to her
husband and child, she showed the same woebegone, languid behaviour
and want of response in an interview with physician on the same day.

In May she refused food for some time, and said that she was not worthy
to eat, that she did not work for her food. She now talked a little more
readily, denied any knowledge of her environment. “ You said you are a doctor.
I don’t know what you are.” She continually refused to accept physician’s
statement that she was in an insane hospital, but in June she indignantly
asked her husband why he had put her in an insane asylum. “ I shall never
come out alive.” As her reason for refusing food, she said that she could not
grab food like the others, a quite inadequate explanation. As a matter of
fact, patient had to be brought to table, had to be pressed to eat, and usually
tried to leave the table before the meal was well begun.

In July she smiled for the first time, said that on admission she had been
sick in the stomach, “and I got mixed up in the head.” She denied that she
had been insane. She quickly, however, gained insight and a good grasp of
her environment; she continually importuned the nurses for salts, and
stated that she had not had a movement for two or three weeks ; her bowels
were regular.

In August the hypochondriacal trend had disappeared ; she talked freely
to physician ; took some interest in her environment, knew that it was
summer and that she had come in winter. She said that on admission her
head was all mixed and that at times she still had this feeling : “ All tumbles
around ; I feel weak in the head.”

In November patient was practically well Menstruation returned on the
last day of November, after a year’s absence. When the case was reviewed
with patient she said of her mutism : “ I wanted to speak but couldn’t, it was so
difficult; when I tried to speak I couldn’t open my mouth, I had like a stone on
the head ” She denied any memory of the trip on the steamer from Bellevue
Hospital to Manhattan State Hospital, although in June she remembered it;
she denied any memory of her stay in Bellevue, although she remembered
going there; although she remembered the various visits of her friends in
April, she said that she had completely forgotten the numerous electrical

200

ORIGINAL ARTICLES

examinations of her muscles at the same time ; even when the apparatus was
again used, she denied that she had ever seen it before. The difference in her
memory of the various incidents, if not a mis-statement on her part, possibly
■depended upon their relation to her interests ; the visits touched her closely,
while the examination was merely a bore. This element of personal interest
s eem ed also to explain the marked difference in reaction to a mental examina¬
tion and to a visit from her child. Patient did not remember refusing food,
nor denying that the doctor was a doctor, or the hospital a hospital. She
was still slightly confused as to the physicians whom she had known on the
service, and she denied to her physician that he was the physician who had
examined her previously during her sickness. She maintained that it was
another physician, whom she described as being quite similar in every respect.
Although patient has completely recovered from her depression, she is at
present (December 6) rather loquacious during interviews, and the pleasure
which she takes in her environment is rather exaggerated. A convalescent
ward is certainly preferable in many ways to her previous quarters in the
Ghetto, but she continually refers with enthusiasm to the pleasant environ¬
ment, the music, the charming nurse, the daily walk, the weekly dose of salts ;
she talks with pride of the amount of work she does to help the nurse.
Before her menstruation returned she was delighted to have done with it; on
itB return she was equally charmed. She is still very bitter against her
husband, but her general interests in life seem to be sufficiently normal.

The difficulty of obtaining answers from the patient on
admission, and her defective memory or unwillingness to recall
details after she had recovered, left several points in the case
obscure; patient denied any memory of her admission into the
ward, could on recovery give no account of her mental state on
admission, and when confronted with her statement, “ this is not
a hospital,” and with the record of her refusal of food and in¬
adequate excuses, she had either forgotten them or could not be
brought to explain them further than, “ When one is insane, one
says such things.”

The most marked features of the case were the depression
and general inactivity; movements were slow and languid, and
although her responses were sometimes prompt, they were usually
preceded by a pause and frequently were absent altogether.
The depression was coloured by suspicion and resentment, which,
though of less intensity, were part of her mental equipment
before the onset of psychosis. This resentful mood was probably
reflected in the negative answers of patient, and in her refusal to
accept physician’s statements as to the nature of the environ¬
ments.

In endeavouring to establish the clinical relationships of this

ORIGINAL ARTICLES

201

case to other depressions, one is confronted with the great variety
of the latter. Some depressions are forms of, or incidents in,
other psychoses, alcoholic, epileptic, paralytic, arterio-sclerotic, etc.

Other depressions have a more independent existence. From
the great group of these latter depressions several distinct
varieties have been separated. Kraepelin has endeavoured to
give precision to the clinical features of a group of cases occur¬
ring usually in the period of involution (“ Melancholia ” of the
involution period). These patients present marked agitation and
anxiety and certain delusions of depressing colour, with an other¬
wise normal stream of mentation. The clinical picture of the
present case is quite different from that of this group. Another
group of cases has been brought together by Wernicke under
the name “ affective melancholia ”; the depression in these cases
is distinctly secondary to an unaccountable feeling of inadequacy
with loss of the ordinary interests of the individual The
patients show little spontaneous activity, but no retardation in
response to questions and demands. There is no special tendency
to recurrence in such cases, according to Wernicke.

Kraepelin does not allow this as a separate group, but
includes it along with certain other recoverable cases of
depression in his clinical synthesis of manic-depressive insanity.
These patients (depressed phase of manic-depressive insanity)
present a primary depression, with blocking of thought and psycho¬
motor retardation; as a rule they recover, but the psychosis tends
to recur, the recurrence being liable to take the form of a manic
attack. The onset of the attack does not depend upon external
causes, but upon Borne constitutional tendency; external causes
may, however, precipitate an attack. In the history of the case
recorded above, no history of a previous attack, either of a manic
or depressed type, could be elicited, nor was there any trace of
any periodic alteration of mood. The exhausting circumstances
seem to have acted upon a fairly normal nature and caused a
depression which, however, soon overstepped the limit of the
normal. The depression, the want of spontaneous activity, the
languid responses to questions and orders, were symptoms re¬
calling whe depressed phase of manic-depressive insanity; the
retardation was not uniform, but was frequently broken through
under the influence of her distrustful and resentful mood.
Patient acknowledged no feeling of subjective difficulty at first,

202

ORIGINAL ARTICLES

said that she was “ all right.” The professed memory defect on
recovery is difficult to understand.

In view of the fact that the psychosis came on after an
adequate cause, and that there is no history of any constitutional
tendency, one must hesitate to say that this case belongs to the
same group as those cases of depression where constitutional
tendencies seem all-important and external causes play a merely
subsidiary r61e, and of which one characteristic is the tendency
to recurrence, with a possible substitution of a manic equivalent
for the attack of depression. One can say that patient reacted
to exhausting circumstances with a depression of a type similar
to one that is found in a certain group of recoverable cases, but
0 D 6 cannot go further and conclude that patient has a constitution
which renders her liable to a recurrence of either similar or
“ equivalent ” attacks without adequate cause.

I am indebted to Prof. Adolf Meyer, Director of the Patho¬
logical Institute, and to Dr E. C. Dent, Superintendent of Man¬
hattan State Hospital, for permission to publish the above case.

abstracts

ANATOMY.

THE STRUCTURE OF MOTOR NERVE-ENDINGS IN REPTILES.

(80) (Bur la structure des plaques motrice chez les reptiles.)

Augustin Gemelli, from the monastery of Notre Dame des
Larmes-Dongo (Lago di Como), July 15, 1905.

A short paper gives a preliminary description of the motor nerve-
endings of lacerta viridis and lacerta agilis. The method of
preparation is a modification of Golgi’s osmium-bichromate and
silver process: pieces of tissue 1 cm. in thickness are placed for
half an hour in a mixture of one part of a 1 per cent, osmic acid
solution and eight parts of a 3 per cent, bichromate of potassium,
to which are added a few drops (from 5 to 10 for each 25 c.c.
of the mixture) of a 1 per cent, solution of chemically pure
sulphocyanide of potassium. The pieces are next put into Golgi’s
osmium bichromate mixture for sixty-five to seventy-eight hours,
and then transferred to nitrate of silver solution. The passage of
the tissue through a mixture of bichromate of potassium and

ABSTRACTS

203

acetate of copper, as suggested by Golgi, gives equally good
results.

This method of procedure is claimed to give results different
from those obtained by all previous methods in that only the
neurofibrillse of the nerve and nerve-ending are stained. The
fibrils, for the most part, run parallel in the axis-cylinder, and
only rarely cross one another; on arriving in the motor end-plate
they divide and anastomose freely, forming a very fine network
throughout the ramifications of the nerve-ending. Perroncito and
other observers had found a system of fibrils in the nerve-endings
which were not branches of the medullated fibre, but which
formed a second system outside that of the ordinary nerve fibre.
Perroncito was unable to trace any connection between the two
sets of fibrils. The author finds that very fine fibrils run in the
sheath of Henle with the medullated fibre; on entering the end-
plate they divide and form a network surrounding the network of
the fibrils of the medullated nerve; and the two systems unite with
one another by numerous branches. Percy T. Herring.

18 THE DECUSSATION OF THE TROCHLEAS NERVE COMPLETE

(81) OR PARTIAL 1 (1st die Kreuzung des Trochlearis eine to tale
oder partielle ?) L. Bach, Centraibl. f. Nervenheilk. u. Psychiat.,
Jan. 1, 1906, p. 16.

Bach has previously published his observations that in rabbits,
cats, and apes, and probably also in man, all fibres which spring
from the one trochlear nucleus do not decussate in the anterior
medullary velum, but that a certain number run forwards with the
dorsal longitudinal bundle and join the roots of the oculo-motor
nerve.

This statement was challenged by Bemheimer, and Bach’s reply
is contained in the present paper. He cannot, however, uige any
new facts in support of his view, except that Siemerling and
Boedeker found degenerated cells in both trochlear nuclei in a case
where only the one superior oblique muscle was paralysed.

Gordon Holmes.

LA FAISOEAU EN CROCHET (DE RUSSELL) OU FAISOEAU

(82) OEREBELLO-BULBATRE. A VAN Gehuchten, Nivraxe,
Vol. iii., p. 119.

This tract was first described by Risien Russell as a. part of the
superior cerebellar peduncle which degenerated only on the
opposite side after unilateral lesions of the cerebellum. The name

204

ABSTRACTS

was proposed by him owing to its shape in cross-section, where it
forms the dorsal portion of the peduncle. He was unable to deter¬
mine its origin and described it as joining the fibres of the opposite
peduncle after their decussation.

It has since then been studied by Thomas, Probst, and Lewan-
dowsky, but the descriptions of its course by these authors are not
in agreement on many points.

As the fibres which compose it, or at least some of them,
decussate in the ventral portion of the vermis, Van Gehuchten has
studied in rabbits the degenerations which result from complete
median section of the cerebellum by Marchi’s method. By this
experiment complete degeneration of all the decussating fibres of
the cerebellum was obtained. Those which form the faisceau en
crochet run lateralwards, bend round the superior cerebellar
peduncle and form a narrow layer on its dorsal surface, lying
between it and Gowers’ bundle. Having encircled it they form
a compact bundle in the angle between the corpus restiforme and
the spinal root of the nervus trigeminus at about the level of the
facial nerve. Here the bundle divides into two parts: the one
turns ventralwards and medialwards across the facial nerve and
runs caudalwards in the middle of the substantia reticularis of the
medulla as far as the beginning of the spinal cord; the other,
which remains more dorsal in position, runs caudalwards in the
medial segment of the corpus restiforme, at first between this and
descending vestibular root, and when the latter has disappeared it
occupies a still more median position and can be followed to the
first cervical nerve. Both these tracts diminish in size as they pass
caudalwards, owing to the fact that they give off fibres during their
course. Those that come from the dorsal tract form internal
arcuate fibres which can be followed to the neighbourhood of the
ventral tract. The Marchi method cannot with certainty demon¬
strate their termination, it only reveals the course of the fibres
which are provided with a myeline sheath; but it is probable that
they end in the motor nuclei of the bulb, either in those of the
motor cranial nerves or in the association centres from which
ascending and descending tracts spring.

These tracts are composed of descending fibres, which probably
spring from the roof-nuclei of the cerebellum, though this has not
been yet definitely proved. Nor is it known if all these fibres have
decussated in the cerebellum.

The name tractus cerebello-bulbaris is proposed for the bundle.

Gordon Holmes.

ABSTRACTS

205

METHOD OF STAINING THE NEUROGLIA. (Proc6d6 de eolont-
(83) tion de la nAvroglie.) Sabraz^s et Letessier, Arch. gin. de
Mid., Dec. 19, 1905.

The authors describe the following process for staining the
neuroglia, which they recommend especially on account of its
simplicity, although it is not so selective as the methods of
Weigert and Anglade. Fixation should preferably be carried out
by injection of 10 per cent, formalin into the brain by way of the
orbit, or into the cord by spinal puncture, as soon after death as
possible. At the post-mortem examination thin slices of tissue
are in this case placed in 95 per cent, alcohol. In other instances
the tissues are to be fixed in 10 per cent, formalin, in saturated
watery solution of corrosive sublimate, in a mixture of sublimate
solution and Flemming’s solution, or by means of certain other
fixatives. Pieces are imbedded in paraffin. The staining solution
consists of basic fuchsine 1 gramme, carbolic acid 5 grammes,
absolute alcohol 10 grammes, water up to 100 c.c. The stain
is poured upon the sections fixed to the slide, which is then heated
over a Bunsen burner until vapour rises. The slide is then allowed
to cool a little and the section is rapidly washed with absolute
alcohol and cleared by means of a drop of colourless aniline oil,
which should be allowed to act in the vicinity of a bright light.
After a few seconds the aniline oil is replaced by xylol and the
section is mounted in neutral balsam in xylol.

W. Ford Robertson.

PHYSIOLOGY.

SENSORY CONDUCTION IN THE SPINAL CORD. (Ueber die
(84) Leitung der Sensibilitftt im Rtickenmark.) Max Rothmann,
Berl. klin. Woch., Jan. 1906, Sn. 47 u. 76.

The first part of this communication gives the results of the
author’s investigations into the question of the sensory conducting
paths in the spinal cord of the dog, but the details of the experi¬
ments are not given in this paper. His method was, briefly, that
of combined section, i.e. first to cut the anterior columns at the
level of the first cervical segment; a few weeks later the posterior
columns were sectioned a little lower down ; and subsequently the
lateral columns were divided. The conclusion arrived at is that
no one tract can be regarded as the sole conducting path for any
of the various forms of sensation, and in particular that conduction
is never entirely one-sided in the cord. One path may, probably
does, serve normally to a greater extent than the others, but, if
injured, its functions can be more or less completely taken over

206

ABSTRACTS

by one or more different paths. In detail, the tracts which he
assigns for the conduction of the various forms of sensation
are:—

(1) Touch. —Uncrossed posterior columns and crossed anterior
columns.

(2) Pain. —Lateral columns mainly, anterior columns slightly;
the crossed being more important than the same-sided. Some
conduction may also be possible through the grey matter.

(3) Temperature .—Not ascertained.

(4) Pressure. —Approximately the same as for pain, but no
apparent perception after section of all the long paths in the white
matter.

(5) Muscular Sense .—All three columns of both sides are avail¬
able. The lateral columns are the most important, the posterior
least.

(6) Sense of Position .—Anterior columns. Lateral columns.

The second part deals with the applicability of these results to

man. As pathological processes practically never cause lesions
sufficiently exact from the experimental standpoint, the only com¬
parable cases are a certain number of instances of cord wounds.
Review of some of these shows that extensive restitution of
primarily destroyed sensibility can occur, the perception of pain
and temperature usually returning to a less degree than that of
touch, and all are recovered more slowly and less completely than
the power of movement. When one lateral column is divided,
the other carries stimuli from both sides of the body; false pro¬
jection in the cerebral cortex produces the symptom of allocheiria.

The conditions obtaining in man are very similar to those in
the higher mammals, the chief difference from the dog being—

(1) Touch. —Unsettled whether the two paths are of equal
importance.

(2) Pain .—The crossed lateral conduction is of still greater
importance than the same-sided. The anterior columns have
possibly a slight conducting capacity.

(3) Temperature. —Conduction is mainly by the anterior part
of the crossed lateral column (Gowers’ tract). Restoration by
means of the same-sided tract very incomplete.

(4) Pressure. —Mainly through lateral column of the opposite
side. Also by same-sided lateral column, and possibly by anterior
and posterior columns.

(5) Sense of Position .—Chiefly same-sided, but also crossed.

Through anterior columns mainly, also by posterior part of
lateral columns. J. H. Harvey Pirik.

ABSTRACTS

207

EXPERIMENTAL SECTION OF THE PYRAMIDS IN DOGS AND

(85) APES. (Experimentelle Pyxaxaidendnrchschneidnng beim
Hondo and Affen.) Artur Schuller, Wien, Min. Woch.,
Jan. 18, 1906, p. 57.

Method. —One pyramid was exposed from the front and divided
above the decussation, but it was found that it could not be totally
destroyed without too much injury to neighbouring parts.

Three dogs were operated on. One died from secondary
haemorrhage four days afterwards, the other two remained alive
without disturbance of their general well-being for three weeks;
they were then killed, and the cord and medulla examined micro¬
scopically. In all, the lesion was found entirely limited to one
side.

Full details of the condition in the interval are given. The
general result was confirmatory of the observations of various
previous experimenters, viz. that no disturbance of locomotion
was evident. The touch reflex was more active on the side opposed
to the injured pyramid, and there were certain motor disturbances
most evident on trying a flank-walk. There was no spasticity,
but lateral movements at the hip and shoulder—particularly
adduction—were impaired. Other disturbances could not be
clearly demonstrated.

Two apes were operated on, but in neither was the lesion
entirely confined to one pyramid. Both were kept for three
weeks in the best of health. The extremities of the side opposite
the section were at first quite paralysed, later they were used
merely as supports, and finally took part in forward movements of
the body, but although not used so frequently or so readily as
the other side, even isolated “ single movements ” (Munk) could
be made. As in the dogs, side movements remained parti¬
cularly affected—no power of adduction at the hip and shoulder
returning.

Conclusion .—The pyramidal tracts are the sole conducting
paths of the impulses for single movements, for the isolated carry¬
ing out of which, participation of the motor elements of the cerebral
cortex is indispensable.

Section of one pyramid above the decussation produces loss of
certain of these movements, most clearly seen in lateral movements
such as abduction and adduction of the limbs.

J. H. Harvey Pirie.

EXPERIMENTAL RESEARCHES ON THE DESTRUCTION OF

(86) THE HYPOPHYSIS. (Sulla distruzione dell’ Ipoflsi). Gae¬
tano Fichera, Lo Sperimentale, Jan. 1906, p. 739.

The author gives a very complete critical review of the results
obtained by previous observers from destruction of the hypophysis.

208

ABSTKACTS

He explains many of the discordant results obtained by previous
observers as having been due to imperfections in their operative
methods.

He operated on fowls, as in these animals the hypophysis is
notably developed. By his method, of which he gives a lengthy
description, the pharyngeal wall is detached from the basis cranii,
and the basilar portion of the sphenoid is opened without the
wound communicating with the pharyngeal cavity. The operative
wound is thus limited to an incision passing through the geniohyoid
and mylohyoid muscles, to the partial detachment of the posterior
wall of the pharynx, and perforation of the bony basis cranii.
The hypophysis was completely destroyed by a thermocautery, and
in every case the autopsy was supplemented by a microscopical
examination, to make sure that the destruction had been complete.
The operation is said to be simple and rapid, and occupies barely
20 minutes.

In four cases the fowls survived a total extirpation of the
hypophysis till they were killed some weeks later. The general
disturbances manifested after the operation were in no way charac¬
teristic, and there were no late symptoms, except that in the young
fowls the author thought that there was some retardation of develop¬
ment—a statement made with every reservation. Examination of
all the other glandular organs of the body revealed no abnormality.

Study of the normal hypophysis of the fowl shows a complete
absence of the cells described by Traina in the dog as nerve cells.

The paper is supplemented by a very complete bibliography of
the literature of the hypophysis. F. Golla.

ON A NEW METHOD OF INSCRIBING TRACINGS ON THE
(87) REVOLVING CYLINDER. (Di un nuovo Metodo per in-
scrivere Graflche sul cilindro girante.) Giulio Obici, Riv. di
Patol. nerv. e ment., Dec. 1905, p. 545.

The new method described in this communication is as follows:—
The paper is immersed for a few minutes in the following solution:
water, 100; nitrate of ammonia, 150; yellow prussiate of potash,
5. It is then, while still damp, placed on the metal cylinder,
which is connected with one of the poles of the induced current;
while a steel needle, which takes the place of the usual inscribing
lever, is connected with the other pole. Every time the current
passes, an azure coloured dot or short line is traced by the needle
on the white paper. The cylinder should be covered with tin, or
preferably aluminium, as the chemicals used leave a deposit on
copper, which might in the long-run affect the weight of the
cylinder. When the tracing is removed it should be washed in
water to remove the surplus nitrate of ammonia. It will be

ABSTRACTS

209

rendered clearer by placing it in a bath of water acidulated with

The dots of the tracing will not be equi-distant, for they will
depend on the rate of the movement recorded, and one advantage
of the method is that they thus reveal very clearly differences in
this rate. If the current be made to pass along a fixed needle
also, then a line of equi-distant dots should be obtained, and this
line will serve to correct any apparent alteration of movement
which may really be due to irregularities in the rotation of the
cylinder.

If. a tuning-fork be used as interrupter, then the duration of
the phenomenon investigated will be shown by the number of
dots, and so a Deprez’ chronograph may be dispensed with.

The apparatus, moreover, admits of the interruptions being
made with much greater frequency than is possible with the
ordinary arrangements.

Its advantages are especially great when several tracings have
to be recorded on one paper, as many of the measurements
ordinarily required for the points of departure are rendered
unnecessary. Margaret Drummond.

PATHOLOGY.

▲UTOGBNIO REGENERATION. (Recherche* snr la Rdgdndrescence
(88) aotogdne.) G. Marinksco, Revue neurolog ., Dec. 15, 1905,
p. 1125.

Marinesoo brings fresh evidence in support of the autogenic
regeneration of peripheral nerves. He specially employed Cajal’s
reduced silver method, preceded or not by ammoniated alcohol.
He employed for experiment young or adult animals, and per¬
formed sometimes section of the nerve-trunks, sometimes excision,
sometimes avulsion from the central end.

Union of the proximal and distal segments is not essential for
regeneration of the distal segment. The process of regeneration
is as follows: Embryonic cells appear, derived from the nuclei of
the neurilemma cells. In the protoplasm of these cells fine
granules appear, which later arrange themselves in linear series
within the fundamental protoplasm. These granules become more
and more impregnated with “ argentophile ” substance and have
some resemblance to a muscle fibril, that is to say, being constituted
by coloured particles separated by clear spaces. As the granules
increase in density and the clear spaces become coloured, a nerve
fibre is gradually evolved, which may be completely dissociated
from the common trunk.

No essential difference exists between the regenerative process

210

ABSTRACTS

in the proximal and distal segments, nor between that in the new¬
born and in the adult animaL The only difference is in the degree
of intensity and rapidity with which new fibrils are formed. For
the return of voluntary movements, however, it is essential that
the protoplasmic bands and young fibrils in the proximal segment
be in contact with those in the distal

Marinesco holds that the fact of autogenic regeneration reduces
the neurone theory to its proper value, without necessarily destroy¬
ing it: “ elle r&luit la doctrine des neurones k sa veritable valeur,
sans l’^branler.” Purves Stewart.

THE WAT.LKRIAH LAW. (La loi de Waller.) A. van Gehuchten,
(89) Le Ndvraxe, Vol. vii., p. 205.

The Wallerian law, as originally propounded, contained a positive—
that the portion of a nerve separated from its cell degenerates—
and a negative statement—the portion connected with its trophic
centre does not degenerate. The positive statement has remained
practically unchallenged, and has been but little modified, though
recent researches have taught us more of its nature. In the first
place it has been shown that the loss of excitability of the peri¬
pheral end of a sectioned nerve always precedes the anatomical
changes that can be demonstrated in it. The latter begins with a
swelling and granular appearance of the axis-cylinder, and later,
fragmentation of the myeline sheath occurs. These can be regarded
as true degenerative changes or as disorganisation of the fibre, but
the later proliferation of the nuclei of the sheath of Schwann is
not a degenerative process, but is the first attempt at the reorgan¬
isation of the nerve. This reorganisation can proceed till an
anatomically perfect and an excitable nerve is produced, even
though the part remains unconnected with its trophic cell centre.
This is autogenous regeneration, the possibility of which Van
Gehuchten accepts as an established fact.

The changes, then, which occur in the peripheral portion of a
divided nerve do not represent a degenerative process but a vital
reaction, which is dependent on the life of the nerve, and occurs
only under suitable conditions; it illustrates the potential hyper¬
activity of normal cell life.

Waller’s positive statement can thus be accepted, but the
significance of the word degeneration must be altered; and the
possibility of autogenous regeneration must be considered.

The negative statement of the law, that the central end does
not degenerate, was accepted for long though Mayser and Lorel
demonstrated changes in the central end and in their cells of
origin. Then Nissl by his new method showed how constant
the changes in the cells are, but the results of other workers with

ABSTRACTS

211

this method have been discordant. Van Gehuchten limits the
discassion to the evidence of degeneration that can be revealed by
Marchi’s method in the central portion .of a divided nerve. He
has found that there is but little degeneration of the cell end when
a nerve is carefully divided, but that degeneration is constantly
found when the nerve is tom out. And this degeneration is not,
as has been generally assumed, a retrograde or ascending change,
but it begins in the neighbourhood of the cell and spreads towards
the point of rupture of the nerve. It can consequently not be due
to the trauma. Further, it depends on the intensity of the primary
changes which injury to the nerve sets up in the cell; this is so
slight that the trophic influence of the cell in the fibres is not dis¬
turbed if the nerve is merely divided, but it is great enough to
destroy this trophic influence if the nerve is roughly tom out.
The degeneration of the central end of the nerve sets in later than
that of the peripheral end, though both are due to the same cause,
it. loss of the trophic influence of the cell.

The negative part of the Wallerian doctrine is therefore not
true in certain experimental conditions, though the degeneration
of nerves is always consecutive to an atrophy or other change of
the nerve cells or trophic centres. Gordon Holmes.

A FUR THER CONTRIBUTION TO THE STUOT OF THE ANA-
(90) TOMIOAL BASIS OF SYPHILITIC SPINAL PARALYSIS.
(Bin weiterer Beitrag zur Lehre von der anatomischen Grund-
lage der “ syphilitischen Spinalparalyse.”) D. H. Nonne,
Deut. Zeitsch. f. Nervenhetlk., H. 5-6, 1906, p. 369.

The author refers to a former paper of his in which he maintained
that the symptom-complex known as “ syphilitic spinal paralysis ”
has its origin iu one or other of the following anatomical
conditions:—

(1) A chronic patchy transverse myelitis with ascending and
descending degenerations.

(2) A similar condition combined with a primary pyramidal
system degeneration.

(3) A primary pyramidal system degeneration alone; or

(4) A combined system degeneration involving the posterior
column, the pyramidal system, the direct cerebellar and antero¬
lateral ascending tracta

Together with these changes may be found morbid conditions
of the meninges and blood-vessels.

A case is then cited which was under observation for 13 years,
and finally examined post-mortem. A man, 57 years of age, with
a history of syphilis 30 years previously, had for 3 years experienced
slight difficulty in gait, slight bladder trouble, and occasional pains

212

ABSTRACTS

in the legs. His pupils were small and reacted sluggishly to light.
The other cranial nerves and the upper extremities were healthy.
There was slight spastic paraplegia with hardly perceptible blunting
of sensibility in the skin of the lower extremities. The condition
remained stationary until 13 years later, when the patient died of
pneumonia.

Post-mortem examination revealed a very little patchy chronic
myelitis in the dorsal region of the cord without definite secondary
degeneration, some degeneration in Goll’s tract in the cervical and
upper dorsal region, some degeneration in the pyramidal tracts of
the lumbar region, general thickening of the blood-vessel walls
throughout the cord, chronic endarteritis of the anterior spinal
artery, and slight posterior meningitis of the cervical and dorsal
regions.

Nonne regards the case as one in which a primary combined
system degeneration was associated with a diffuse myelitic affection.

£. Fabquhab Buzzard.

THE FIBRILLAR STRUCTURE IN PROGRESSIVE PARALYSIS
(91) (Uber Fibrillenbilder der progressiven Paralyse. ) K. Schaffkr

(Budapest), Neurol. Centralbl., No. 1, 1906, p. 2.

At the beginning of this article there is a r^sum4 of most of the
literature of the subject.

The author’s work has been done with Bielschowsky’s silver
impregnation method. The areas examined were the auterior and
posterior central gyri, the paracentral lobule, the operculum, the
two frontal convolutions of the convexity, the cortex of sulcus
cruciatus (basal frontal), the first temporal, gyrus angularis, first
parietal convolution, calcarine cortex, and cornu ammonis.

In a medium sized pyramid of the posterior central gyrus the
fibrils of the apical process seem to be isolated, but those of the
cell body form a reticulum which possesses more prominent
trabeculae running through, in direct continuity with certain
fibrils of the dendrites.

Between these prominent threads there stretch finer and paler
ones showing slight swellings at the nodal points. The meshes of
the reticulum are round or polygonal, more elongated towards the
apical process, and gradually merge into its structure.

In the smaller pyramids of the anterior central sulcus the net¬
work stains more faintly towards the apical process. These cells
show the following marked changes: swelling of cell body and
apical process; disappearance of fibrils around the nucleus, which
is deeply stained; the peripheral part of the cell is deeply stained,
and here the remains of the network are only recognised with
difficulty. The protoplasmic processes are absent.

ABSTRACTS

213

In progressive paralysis the stages of degeneration are firstly,
swelling and deep staining of the nodal points of the reticulum
with granularity; the meshes become rounded, the threads of the
network disappear, and the star-shaped nodal points are left.
These then break up into finer granules.

In the large pyramidal cells of the paracental lobule the
dichotomous division of the fibrils running from the apical process
into the cell body is well shown; the finer sub-divisions are lost
in the reticulum. On comparison with cells from the same area in
a normal brain, certain changes are demonstrable. The cell body
may be swollen and the apical process diffusely stained, while the
reticulum is well preserved; or the cell body may be diffusely
stained, while the fibrils are evident elsewhere. Often the inter-
fibrillar substance is deeply stained and the fibrils are disintegrated.
To this one can add a terminal form consisting in complete loss of
the network.

All the areas examined showed changes. The early changes
prevailed most in the central gyri; all the other regions showed a
high degree of alteration. In the region of the operculum the dis¬
integration of the reticulum was more marked than in the other
parts of the central convolutions.

This widespread alteration of the nerve cells is accounted for
by the advanced stage of the disease.

In the anterior cornual cells (cervical) the fibrils of the den¬
drites run parallel to each other. At the meeting point of
dendrites a triangular space is left to accommodate the Nisei bodies.

The fibrils in the processes are massed together, and as they
converge on the cell body they form a thick band passing round
its margin. In the cell body is a wide-meshed network with star¬
shaped nodal points.

The author regards the broad dark band where the apical pro¬
cess meets the cell body as a pericellular network with oblique
meshes. This reticulum appears to end at the point indicated
owing to the cell being cut in section.

The cell is slightly swollen and diffusely stained, constituting
what the author describes as incipient change.

More advanced changes are found in the “ Strangzellen ”; the
fibrils in the dendrites are no longer visible and are reduced to
granules arranged in rows. The cell body shows similar changes,
contains fine granules and certain ring-like structures bound
together to form a few meshes (residues). Such alterations are
found at all levels of the cord. David Orr.

214

ABSTRACTS

ON THE FUNCTION OF DEGENERATE MUSCLES. SECOND
(92) PAPER. TIME OF LATENT EXCITATION. (Sulla Fxm-
sione del Moscoli Degenerati. IP Oommonicazione. Tempo
di eccit&zione latente.) Dr Guido Guerrini, Lo SperimentaU ,
Nov.-Dee. 1905.

This paper gives an account of a series of experiments made by
the writer on the muscles of frogs in a state of fatty degeneration,
with the view of determining the period of latent excitation, and
compares the results obtained with the results of similar ex¬
periments on healthy muscles. Full descriptions of the experi¬
ments and tables showing the numbers obtained are given. A
bibliography is appended.

Chief results obtained. —1. The time of latent excitation is
extraordinarily long in degenerate muscles as compared with
healthy muscles, and increases with the amount of degeneration.

2. Degenerate muscles differ from healthy muscles in that no
connection can be discerned: (1) between the weight and the time
of latent excitation, or (2) between the time and the intensity of
the stimulus, or (3) between the time and the distance between
the electrodes, or (4) between the time and the distance between
the end of the muscle attached to the lever and the nearer
electrode.

3. Fatigue may prolong the period of latent excitation, but the
increase is less in proportion than occurs in healthy muscles, and
appears more in the opening than in the closing contraction.

4. Variations of temperature between 12 and 17 degrees C. do
not affect the results.

The article concludes with a short examination in the light of
these results of (1) the hypotheses which have been advanced tJ
explain the phenomenon of latent excitation, and (2) the theories
which have been formulated to explain the mechanism of muscular
contraction. Margaret Drummond.

MALFORMATION OF THE BRAIN IN HATTERIA PUNCTATA.
(93) (Eine Gehimmissbildung bei Hatteria punctata [Sphenodon
punctatus] ). Ernst Sauerbeck, Nova Acta. Abh. d. k. Leop.-
Carol. deutschen A had. d. Naturforscher, Bd. lxxxv., Nr. 1, 1905,
pp. 1-120, 2 plates and 12 text-figures.

This is an exhaustive and well-illustrated account of a malformed
brain of a Hatteria embryo measuring about 4 cm. from the tip
of the nose to the root of the tail. The length of the head, from
the tip of the nose to the articulation between the atlas and the
occipital bone, was 12 mm. The skin showed a higher grade of
development than that of a normal embryo of about the same size.

ABSTRACTS

215

To the naked eye, the malformation was limited to the head. The
trank and limbs exhibited no abnormality externally, nor did
microscopic examination of them reveal anything either terato-
logic&l or pathological.

The intact head, to the naked eye, showed the following aber¬
rations : (1) There was an evident disturbance in the normal
proportion of the mandible to the upper part of the skull. The
mandible was large relative to the size of the rest of the head,
and also in comparison with the body as a whole. (2) The upper
part of the skull was abnormal, since its anterior portion projected
upwards instead of curving downwards As a consequence, the
whole of the tongue and the teeth were visible from the exterior.
(3) Instead of a bulging in the position of the eye, there was an
in-sinking of the lateral wall of the head. (4) On the dorsal aspect
of the head, and between its anterior and posterior parts, was an
ovoid mass, whose long axis was sagittal. The under surface of
the mass was connected with the roof of the cranium by means
of a broad pedicle.

The whole embryo, after separation of the head from the
trunk, was embedded in paraffin, and sections 20 /i thick were
made of the head in a sagittal direction and of the trunk in a
transverse direction. For purposes of comparison, two normal
embryos were also sectioned.

Concerning the normal embryos, the author says that the
eyes formed almost half of the total mass of the head. The
brain showed a typical five-vesicle condition, and was constructed
essentially to subserve the purposes of the special senses of hear¬
ing, sight, and smell In accordance with the large size of the
eye, the mid-brain formed a very considerable proportion of the
whole brain.

It is difficult to convey an adequate idea of the brain of the
malformed specimen without illustrations. The figures accom¬
panying the article, however, present a very clear indication of
the state of the parts. The author states the characters of the
deformity, in general terms, as being (1) the absence of the eyes,
and (2) an abnormal development of the brain and skull, such as
may be expressed by the word “ hemi-exencephaly.” Of the
whole brain, the medulla alone was contained within the cranium.
The cerebellum, the mid-brain, the diencephalon, and the telen¬
cephalon were discovered in the ovoid mass on the dorsal surface
of the head. This malposition was necessarily accompanied by an
elongation of the neural tube as far forwards as the cephalic flexure.

The most striking peculiarity of the specimen was the per¬
sistence of a kind of neuropore, out of which parts of the brain
had been everted. Or, as the author states, there was a prolapse
of the neural tube comparable, in a manner, with a prolapse of
the uterus. In addition to the neuropore was the persistence

216

ABSTRACTS

of another early embryological condition, namely, a direct hieto*
logical continuity of the wall of the neural tube with the epidermis
of the dorsal surface of the head.

The roof of the fourth ventricle, the medulla, the cerebellar
lamina, the arch of the mid-brain, the infundibulum, and the
floor of the third ventricle were easily recognised as such. But
the epiphysis, the roof of the third ventricle, and the optic chiasma
were either absent or altered beyond recognition.

There was no development of the nervous part of the eye, nor
any trace of the lens. But it is remarkable that sections revealed
a rudimentary external eye (cornea) provided with a conjunctival
sac and a lachrymal gland. The ocular muscles and their nerves
were represented. A considerable proportion of the muscles were
fairly clearly differentiated, but it was not easy to identify the
abnormal muscles with those of a normal eye.

The condition of the primordial cranium and the etiology of
the malformation are discussed.

The communication, according to its sub-title, is a critical
monograph designed as a contribution to a rational teratology of
the brain; and its substance is, briefly but clearly, summarised
in the words : Eversio encephali e neuroporo. Transgressus per-
sistens laminae nervosa? in epidermidem. Anophthalmia duplex
partialis (defectus oculi nervosi et lentis).

0. Charnock Bradley.

CLINICAL NEUROLOOT.

ARSENICAL NEURITIS. (Ueber Arsenic Neuritis.) Franz Conzen,
(94) Neurolog. Centralbl., Jan. 2, 1906, p. 18.

Under this title the author describes the case of a girl, aged
24 years, who was engaged in sewing and preparing furs. Her
previous health was normal. In September 1904 she commenced
this work and had to dip the first, second, and third fingers into
an arsenical solution. In three months she noticed these fingers
easily “went to sleep,” and were blanched, especially in cold
weather, the thumbs and little fingers being normal. She had
no pains in the arms or legs and no digestive or conjunctival
trouble. There was found no pigmentation, no loss of power, and
no muscular atrophy. The two terminal phalanges of the first,
second, and third fingers of both hands were cyanotic, especially
the index finger of the right hand. The skin of the fingers is
shiny and very smooth. The nails in both longitudinal and
transverse directions are strongly furrowed. The nails of the
first and second fingers of both hands, and especially the nail of
the third finger of the left hand, are thickened and stratified.
The colour is a dirty greyish-white. The fingers are very painful

ABSTRACTS 217

on pressure, tactile sensation is normal, and there is marked hyper¬
algesia of the finger tips; both hands sweat profusely.

The author considers that in this case there is a local poison¬
ing by arsenic which is taken in through the uninjured skin. A
photograph of the affected hands is given.

Ernest S. Reynolds.

DIPHTHERITIC PARALYSIS OF THE LEFT HYOGLOSSUS.
(95) (Diphtherische IAhmnng dea linken Hyoglossus.) Hamburger,
Wien. klin. Wchnschr., December 21, 1905, p. 1370.

Hamburger exhibited at the Gesell. f. in. Med. und Kinder-
heilk. in Wien, a boy suffering from diphtheritic paralysis of the
left hyoglossus which was manifested by inability to depress
the corresponding side of the tongue on the floor of the mouth.
The other tongue muscles were intact, but cycloplegia, paralysis
of the palate, and paresis of the legs were present. The case had
received antitoxin. J. D. Rollbston.

FRIEDREICH’S ATAXIA. Wharton Sxnklxr, M.D., New York Med.

(96) /cum., 1906, p. 65.

This short paper is almost wholly concerned with the clinical
aspect of the disease; the few sentences devoted to its pathology
are of no importance. The clinical notes of the thirteen cases
which the author records are in many respects incomplete and
“ataxic,” whilst in one or two instances the accuracy of the
diagnosis seems open to question.

The main facts, so far as they are presented, may be summarised
as follows:—

There was no history of ataxia or allied disease of the nervous
system in the patients’ parents or among their ancestors. The sex
of the patients was about equally divided. The age of the first
appearance of the disease varied between 2 and 21 years.

The first symptom observed was usually an unsteady gait,
though in one or two cases inco-ordination in the upper limb and
hand, or weakness of the back, were noted before the gait seemed
affected. With regard to the reflexes, the knee-jerk was absent in
nine cases, present in two cases, and markedly increased in two
others, whilst the plantar reflex was absent in five cases and
present in eight.

Contractures existed in seven cases. Speech was affected in a
similar number. With respect to eye symptoms, nystagmus existed
in nine cases; vision was as a rule good, but the colour field was
contracted in one case; the pupils were practically normal to light
r

218

ABSTRACTS

and accommodation in all those cases where an examination was
made. In one instance, however, the light reflex was rather slow.

An antero-posterior or lateral spinal curvature was noted in
eight cases. In one case the spine was normal; while in four
there is no record as to its condition. In two of the cases ataxia
seems to have followed a paralytic attack, which overtook one
patient at the age of three and the other at the age of five years.

Harry Rainy.

POTTS’ PARAPLEGIA WITHOUT EITHER LEPTO-MENIN-

(97) GITIS OR COMPRESSION, ETC. (Parapl6gie pottique par
my&omalade, sans leptomdningite ni compression, etc.)
Dupr£ and Camus, Rev. Neurolog., Jan. 15, 1906, p. 1.

A rapidly progressive paraplegia was found post-mortem to have
been caused by Potts’ disease of the fourth, fifth, and sixth dorsal
vertebrae, with a corresponding hypertrophic tuberculous pachy¬
meningitis. There were no meningo-medullary adhesions, no
compression of the cord, no lepto-meningitis; on the other hand,
at the same level as the rest of the disease was a zone of softening
in the cord, with degeneration of the columns of Goll and peri¬
arteritis of radicular vessels. Apparently the morbid process had
established itself in the cord vid the posterior roots and by involve¬
ment of blood-vessels; the clinical symptoms were therefore due
to local myelitis supervening in Potts’ disease.

S. A. K. Wilson.

CEREBELLAR TUMOUR WITH MENTAL SYMPTOMS. (Bin Fall

(98) von Nonbildnng des Klelnhirns mit peychischen Symptomen.)

Kurt Berliner, Giessen. Klinik f. psych, u. nerv. Krankheiten,
Bd. 1, H. 1, 1906,

Dr Berliner gives a careful account of a case of cerebellar tumour
in which mental symptoms appeared early in the course of the
disease, the patient being admitted to the clinic on account of
mental excitement and disorderly and violent behaviour. The
first symptoms were headache and vomiting. Later the gait
became affected, and then visual hallucinations appeared with
profound depression. Amongst other signs and symptoms were
occipital pain and tenderness, papillitis and retinal haemorrhage,
nystagmus and cerebellar ataxia. A prominent feature was almost
continual unrest of the total musculature ; the movements not
being involuntary, unco-ordinated spasms, for, though not in¬
tentional, they could be inhibited, were mentally conditioned, and,
in the author’s opinion, were imperative in character. The patient

ABSTRACTS

219

died on the nineteenth day after admission, and a tumour was
found abutting into and completely tilling the fourth ventricle.
At the time of writing no microscopic examination had been made,
but the tumour was probably gliomatous. On this account
the origin and extent of implication of cerebellum have not
been ascertained. Amongst the psychical symptoms the author
considers that the visual hallucinations, motor excitement, etc.,
are most easily explained as the psychic equivalents of epileptic
attacks. R Cunyngham Brown.

CHOREA AlfD ITS NEURONIC ASPECT. Sir William Gowers,
(99) Phonographic Record of Clinical Teaching and Med. Sc., Aug. and
Sept, 1904, Yol. x., Nos. 8 and 9, pp. 113 and 129.

In an article in two numbers of this journal Sir William Gowers
amplifies a lecture he had delivered previously at the National
Hospital, Queen’s Square. Chorea is defined as a “ derangement
of the nutrition and function of the motor structures of the cerebral
cortex, sometimes one-sided only, often on both, and sometimes
extending to those structures of the cortex concerned in mental
processes.” On the old hypothesis that the nerve impulse pro¬
ceeded from the cell, which served as the battery generating nerve
force, a change in structure of these cells was expected in chorea,
and it was a matter of surprise that no constant changes were
found there. With the rise of the neurone theory, an exposition
of which is given with a description of the facts on which it was
based, it was recognised, however, that the nerve cell was concerned
with maintaining vitality rather than with originating function.
The source of the nerve impulse being referred beyond the cell
to its dendrites, it is reasonable to suppose that in chorea, which
is primarily a defect in co-ordination, the affection may be
dendritic. This affection may be one of nutrition as well as of
function; irregularity, both in time and extent, of dendritic action
would account for most of the motor manifestations of chorea.

The three causal influences that stand out in regard to the
disease are: first, its occurrence in childhood at the time when
the tendency to excessive motor activity is so pronounced;
secondly, the action of powerful emotion, particularly alarm, as
probably deranging, through shock, regular dendritic functioning;
and last, the altered blood state that the disease shares in common
with rheumatic fever.

A series of cases are then described, and the diagnosis between
the condition and habit spasm discussed. Two of the cases had
chorea gravidarum, and the suggestion is made that in pregnancy
the mental state approximates towards that of a child, thus
accounting for the frequency with which pregnancy is found in

220

ABSTRACTS

cases of adult chorea. The association of chorea with the vomiting
of pregnancy and with rheumatic endocarditis is dealt with.

As to treatment, Sir William Gowers recommends absolute
rest, antimony wine, small doses of chloral and antipyretics.
Arsenic has been much overrated, but strychnine is of consider¬
able value towards the end of the attack. Hypodermic medication
is to be discountenanced in the disease. Ernest Jones.

OASE OF MULTIFORM TIC, INCLUDING AUTOMATIC SPEECH
(100) AND PURPOSIVE MOVEMENTS. Morton Prince, Joum.

Nerv. Ment. Dis. t Jan. 1906, p. 29.

The patient was a man, set. 35, who presented a combination of
various tics. Some consisted of ordinary choreiform movements
of the eyelids, face, and arms, while others were more complex
purposive movements. Many of these automatic physiological
movements were remarkable in themselves, but most unusual were
the automatic speech which was interjected in the midst of nearly
every sentence he uttered, and certain purposive movements when
he handled a razor or a knife. When asked whether he had
difficulty in pursuing his occupation, he answered, “Christ, no;

hell-nigger,-,” in an explosive, jerky way, and then quietly

added, “Yes, I have been obliged to give it up.” He had
naturally a nice mind, was well-mannered, well spoken of, and felt
his affliction keenly. He was entirely unaware of what he would
say automatically until the words were actually spoken. The
patient in addition revealed a slight degree of mental infantilism.

From the point of view of diagnosis, it is very important and
significant to note that his tics occurred chiefly when his attention
was directed to prevent them, i.e. they were not of the nature of
mere “absent-minded phenomena.” S. A. K. Wilson.

FACIAL TIC CURED BT SUGGESTION. (Un cas de tic de la face
(101) gudri par suggestion.) Ioteyko, Joum. de Neurol., Jau. 5,

1906, p. 1.

A young woman, 22 years of age, had suffered for eight years from
various and varying facial tics, including rapid blinking or nicti¬
tation, throwing back of the head, twisting of the mouth, frowning,
and general grimacing. All were clonic, with the exception of
the head deviation. She presented in addition a typical mental
infantilism. Treatment by the combined methods of enforced
immobility (Brissaud), respiratory gymnastics (Pitres), and psycho¬
therapy, as well as by other means, was followed by what promises
to be a permanent cure. S. A. K. Wilson.

ABSTRACTS

221

AN UNDE80RIBED SYMPTOM OF PALATAL PARALYSIS.

(102) (Em nicht beschriebenes Symptom dor Qanmenl&hmung.)

Schlesinger, Neurolog. Centralbl ., Jan. 16, 1906, p. 50.

This paper records three cases of palatal paralysis, one accom¬
panying multiple sclerosis, and two present with cerebro-spinal
lues. In all three the peculiarity consisted in the fact that in the
recumbent position the speech was good or quite unaffected, while
as soon as the patient sat up the effect of the paralysis became
evident in the speech. This is explained by the passive position
taken up by the palate bringing it nearer to the back of the
pharynx as the patients lay than when they sat up. In a dozen
other cases .of palatal paralysis examined by the writer, this
peculiarity was not present. John D. Comrie.

BILATERAL CIRCUMSCRIBED FACIAL ATROPHY. (Ein Fall
(103) von doppelseitige umschriebener Qesichtsatrophie.) Alfred
Schlesinger, Archiv f. Kinderheilk., Bd. 42, H. 5 u. 6,
1905, p. 375.

Bilateral progressive facial atrophy is much more rare than the
unilateral form; of the former, only eight cases are on record;
of the latter, more than one hundred. The main features of
Schlesinger’s case are as follows: The patient was a girl aged 10
years; in her fifth year, after an attack of measles, the skin of
both cheeks became thin and discoloured; the wasting extended
gradually to the subcutaneous tissues. After progressing steadily
for about a year the atrophy ceased, and since then the condition
has remained unaltered. The child now presents the following
appearance: She is poorly nourished; the circumference of the
cranium, which is dolichocephalic, is 56 cm. The hair, frontal
region, and orbital ridges display no abnormality. Both cheeks
are deeply sunken, the skin is thiuned, and on palpating from the
mouth there appears to be no fat or connective tissue between the
skin and mucous membrane. The muscles of the face are normal.
When the cheeks are puffed out the atrophic regions bulge in a
balloon-like fashion; on showing the teeth they fall into deep
folds. Otherwise the face and cranium are normal in structure,
the bones not being involved in the atrophic change. There is
facial irritability, but the electrical reactions of the muscles
innervated by the seventh nerve are normal. There is, however,
a slight degree of narrowing of the right pupil and right palpebral
fissure. The noteworthy points of the case are the appearance of
circumscribed facial atrophy in a young person after an infectious
disease, and the entire absence of any neuralgia, etc., pointing to

222

ABSTRACTS

implication of the fifth nerve, while there are evidences of
sympathetic lesion.

Schlesinger shortly discusses the various theories which have
been put forward as to the cause of the condition—trophoneurosis
(Romberg), neuritis of the fifth nerve (Virchow, Mendel), lesion of'
the Gasserian ganglion (Jendr&ssik), progressive aplasia (Bitot and
Lande), local toxin action, bacterial or otherwise, acting on tissues
previously weakened by disease (Mobius)—and thinks that his
case can be most readily explained on the last of these hypotheses.

J. S. Fowler.

THE ABDOMINAL REFLEX IN ENTERIC FEVER. (I riflesai
(104) addominali nelT ileo-tifo.) Ortali, Oazz. degli Osped, October
15, 1905, p. 1303.

Ortali investigated the abdominal reflex in 61 cases of enteric
fever. In the prodromal stage it was present in 21 out of 22
males and in 36 out of 39 females. During the height of the
disease it was completely abolished in 41 severe cases, diminished
short of absolute extinction in 20 mild cases. During deferves¬
cence the reflex became slowly re-established, until in convalescence
it returned to its normal activity. In 3 cases of severe relapse
the reflex, which had resumed its normal condition, underwent the
same changes as in the primary attack. In 2 cases of recrudescence
it became abolished a second time after it had begun to return.
The change in the abdominal reflex was not due to the general
condition, since the other reflexes, superficial and deep, were not
similarly affected. A local cause must therefore be sought. All
organic changes in the muscles, nerves, and spinal cord must be
excluded because of the prompt return of the reflex during the
decline of the disease. The condition must be regarded as due to
a functional interruption of the reflex by direct influence of the
intestinal lesions on the reflex centre in the thoracic portion of
the spinal cord.

Ortali’s observations and conclusions coincide with, but were
made before, the publication of those of Sicard (Presse MtdicaU,
January 11, 1905).

In like manner, prompted by Sicard’s paper, but prior to the
publication of Ortali’s researches, the reviewer carried out investiga¬
tions which will form the subject of a future communication.
His conclusions will be found to confirm and supplement those of
his two predecessors. J. D. Rolleston.

ABSTRACTS

223

APHASIA, HEMTPARB8IS, AND HEMIANESTHESIA IN
(105) MIGRAINE. Jelliffe, New York Medical Journal , Jan. 6,
1906, p. 33.

This is a detailed account of three cases of migraine presenting
unusual accompaniments, though the writer, in commenting upon
them, refers to numerous other recorded cases with similar features
(six references).

In one case, a man of 38 had suffered from chronic migraine
for twenty-three years. The attacks were almost always the same,
consisting of a “fortification” scotoma lasting for half an hour,
and followed by severe headache. For some time these attacks
recurred daily about 11 A.M., but latterly the patient had only
monthly or quarterly visitations. In two attacks there was dis¬
tinct motor aphasia lasting for about five minutes during the stage
of the ocular phenomena. One of these occurred at school, the
other later in life.

In the second case a musician, aged 35, had suffered from
headaches since boyhood. These affected the right side of the
head, and the pain even ran down the right arm, and was accom¬
panied by weakness of the right leg. The attacks were followed
by numbness and pricking in the right leg and arm, lasting often
several days.

In the third case, a youth of 19 was suddenly seized by
inability to write, lameness in the right leg, sickness, and difficulty
in speaking, followed after some time by intense headache. From
this attack he slowly recovered. Subsequently he had another,
with scintillating scotoma, dizziness, and sickness, followed after
some hours by complete unconsciousness and cardiac irregularity,
and later by severe left-sided headache and anaesthesia especially
marked on the right side of the body. From this attack, recovery
was slow but complete. John D. Combie.

GENERAL AND ALMOST COMPLETE RETRO-ANTEROGRADE
(106) AMNESIA, WITH DELUSIONS, ETC., IN A CASE OF
HYSTERIA. (Amndsie r6tro-anterograde glndrale et presque
totale; delire; anesthesia considerable des diverses seuribilitds
chez one hystdrique.) Delacroix and Solaoer, Rev. Neurolog .,
Jan. 15, 1906, p. 6.

The interest of the case lies in the extraordinary degree of retro¬
grade amnesia presented by the patient. Nine-tenths of the
history she gave of herself turned out to be the purest delusions,
so that all she knew of herself and of her past amounted to
exceedingly little. At the same time her anterograde amnesia

224

ABSTRACTS

was evidenced by her inability to learn or understand or assimilate
even the simplest facts. She showed unmistakable stigmata of
hysteria, associated with widespread changes in different forms of
sensation. The authors are unable to say whether the amnesia is to
be attributed to this profound alteration in sensation or to enfeeble-
ment of mental synthesis. S. A. K. Wilson.

FAMILIAL CRETINISM. (Famili&rer Kretinismus.) Jaeger, Giessen.

(107) Klinik f. psych, u. nerv. Krankheitcn , Bd. 1, H. 1, 1906.

Dr Jaeger, after some general observations on cretinism, gives
in this paper a very complete account of the four children, two
brothers and two sisters, of a couple, of whom the father was
a drinker with an alcoholic heredity, and the mother healthy and of
sound stock. The father and mother were blood relations and the
union unhappy. The oldest child, a girl, is a mild cretin; the
second, a boy, a myxoedematous imbecile of exceedingly rudi¬
mentary development; in the third, a boy, the cretinism is
moderately pronounced, and the fourth is as yet (set. 12) com¬
pletely normal in development. The possibility of another father
has been carefully excluded, and the author considers these to be
cases of sporadic cretinism with, as aetiological factors, parental
consanguinity and alcoholism. R Cunyngham Brown.

MATHEMATICAL ANALYSIS OF FATIGUE CURVES AS AN
(108) AID TO DIAGNOSIS IN NERVOUS DISEASES. (L’analyw
mathdmatique des courbes de fatigue comme procddd de
diagnostic dans les maladies nerve uses.) Ioteyko, Joum. de
Neurol, Jan. 5, 1906, p. 7.

This paper presents succinctly some of the results obtained by the
study of ergographic curves and the examination of parameters.
An excellent idea of this line of investigation will be found in the
abstracts of another of Mademoiselle Ioteyko’s papers which have
already appeared in this Review (Jan. and Feb. 1906, pp. 40 and
128). In the present communication, reference is made to her
more recent work on the ergography of sugar and caffeine, and to
the alteration in fatigue curves when the arm is rendered anaemic.
Her results go to confirm her theory of the peripheral localisation
of fatigue. S. A. K. Wilson.

ABSTRACTS

225

PSYCHIATRY.

OH IDIOOY. (Uber Idiotic.) By W. Weygandt, Samml. ewcmgl
(109) Abhandl. aus dem Gebiete der Nerven. u. Geisteskrankheitm,
Bd. vi., 1906.

This paper, consisting of 86 pages, is divided into two parts. In
Part I. the author gives a brief account of some of the chief
clinical and pathological features of the main types of idiocy. He
draws attention to the fact that, although primarily due to arrested
development, there are frequently added to this secondary patho¬
logical changes, resulting in epilepsy, athetosis, chorea, etc. Hence
the need for idiots to be under constant medical care. He urges
the importance of further research in this field, particularly from
a pathological and psychological point of view.

Part II. is devoted to the care of idiots. After referring to
the accommodation for this class in the Middle Ages, provided by
the monasteries, and thence onwards, the author deals more par¬
ticularly with the organised attempts of the nineteenth century.
He has made a tour of most of the institutions in Germany,
Austria, France, and Switzerland, as well as England, and his
description of these is very interesting and instructive. He finds
that in many instances the accommodation provided for idiots on
the Continent is far from satisfactory, not only with regard to
the nature of the buildings and general management, but also
owing to the absence of any expert medical supervision. In
strong contrast to these are the English establishments, all of
which are under efficient medical supervision, and the management
and general arrangements of which are excellent. Finally, the
author discusses the general administrative principles which should
guide one in making provision for this—the lowest grade of amentia.
The article hardly professes to deal with any new matter, but is an
interesting sketch of the chief features of idiocy—especially from
the standpoint of administration. A. F. Tredgold.

ON ACUTE JUVENILE DETERIORATION. (Ueber acute juvenile
(110) Verblddung.) M. Fuhrmann (of Lindenhaus), Arch. f. Psych.,
Bd. 40, H. 3.

Fuhrmann reports fully the cases of three young male patients,
born of alcoholic parents, who developed an acute psychosis
resembling symptomatologically an alcoholic psychosis, but passing
rapidly into dementia.

The first patient was a man aged 28, who shortly before the
onset of the psychosis had shown only a few isolated peculiarities.
The psychosis began abruptly with a condition resembling an

226

ABSTRACTS

epileptic excitement, characterised by extreme anxiety, terrifying
hallucinations of sight and hearing, with consequent ideas of
persecution. The disease quickly progressed, and on the fourth day
there was already a profound disturbance and dissociation of all
mental activity; the picture now was more like an alcoholic
condition—fantastic and varying hallucinations, dreamy grasp of
environment with illusions, incoherence of speech and action,
alternation of terror and euphoria, occasional grim humour
(Galgenhumor)—but there was a much more profound disorder
of the consciousness of the personality than is seen in the similar
alcoholic psychosis. The hallucinations became less marked, the
acute affect disappeared, and the mood became one of stupid
euphoria, and patient in three months was definitely demented.

In the two other patients, aged 25 and 26 respectively, the
psychosis began abruptly with hallucinations of a terrifying char¬
acter, explained by the patients as due to strange influences such
as underground telephones, and leading to conditions of marked
anxiety; the hallucinations were not only of spoken words, but
also of less elaborate nature, e.g. flashes of light, shots, twittering
of birds. There were frequent variations of mood, and intervals
of euphoria in the midst of periods of anxiety and agitation. In
the acute phase orientation, grasp of general relations and stream
of mentation were unimpaired. The whole picture resembled
the acute hallucinatory insanity of the alcoholic; the course, how¬
ever, was very different. Within three weeks the patients passed
into deep stupor and then into dementia, with dull emotional life,
lack of initiative, little reaction to the environment, and almost
complete mutism.

Fuhrmann refuses to group these cases with the deterioration
group of dementia prsecox, because the characteristic mannerisms,
stereotypies, hypochondriacal ideas, catatonic symptoms, etc., are
absent; and also on account of the extremely rapid course of the
disease. He therefore describes them as cases of acute juvenile
deterioration. With regard to the aetiology, he evidently believes
that because the fathers have eaten sour grapes the children’s
teeth may be set on edge, and suggests that the alcoholic colouring
of the clinical picture is due to the excesses of the parents.

C. Macfie Campbell.

SYMPTOMATOLOGY OF CATATONIA. (Zur Symptomatology dor

(111) Katatonia.) Von Leupoldt, Giessen. Klinik /. psych, u. nerv.

Krankheiien , Bd. 1, H. 1.

Dr von Leupoldt describes at considerable length an instructive
case of catatonic dementia praecox. The most prominent feature
whilst the patient, a young man, was under observation was his

ABSTRACTS

22 T

continual and spontaneous naming and enumeration of things in
his neighbourhood, particularly those depending on optical impres¬
sions. He was well orientated and evidenced great sharpness of
perception and clear recollection of past impressions. The naming
was almost always a single and rarely a complex process, without
any logical or associative connection, and further, without any
discoverable dependence on affective disturbance. Elementary
or superficial investigation of the power of attention according
to Ranschburg’s method, revealed no marked defect, but in a more
severe memory test (committing to memory and repeating a page
of a historical primer) showed a rapidly failing aud distracted
attention due to the insurgence of optical impressions, with a
tendency from complex to simple presentations. The compulsion
( Zwang) to name objects was not recognised by the patient as
foreign, had no affective basis, and was thus not imperative in
the strict meaning of the term. At the same time the author
distinguishes this “ naming ” from Ziehen's “ hyperprosexia ” and
Wernicke’s “hypermetamorphosis.” An analogy is next drawn
between this phenomenon and that of the continual handling of
objects frequently observed in cases of dementia pnecox. This
latter is illustrated by clinical notes of another case, in which,
like the first, there was compulsion without any affective basis
or consciousness of the imperative nature of the act. A third
case is mentioned, showing that these phenomena may be equally
present in the paranoid form of dementia praecox, and the conclusion
drawn that the compulsory naming and compulsory touching are
consubstantial. R. Cunyngham Brown.

ON THE PSYCHOLOGY OF CONFABULATION. (Zur Psychology der

(112) Confabulation.) A Pick (of Prague), Neur. Centralbl., June 1,
1905, p. 509.

Pick does not discuss here the contents of the fabrications or
pseudo-reminiscences which in confabulation serve to fill up gaps
of memory; he takes up the question of the psychological basis of
confabulation. The existence of a memory gap is not sufficient in
itself to explain the phenomenon, for in hysterical or simple
traumatic amnesia there may be the memory defect with no
attempt to bridge it with fabrications; and while in some cases
the symptom is only elicited in answer to an embarrassing question
which reveals the defect, in other cases there is a marked tendency
to spontaneous confabulation. The explanation of the pseudo¬
reminiscences on the basis of dream experiences according to
Wernicke is inadequate, as one can by suitable questions influence
the contents in any direction; Bonhoeffer does not exhaust the
phenomenon when he separates the “ confabulations of embarrass¬
ment ” from delirious confabulations, because this only takes into

ABSTRACTS

228

consideration the cases where the patient is forced by questions
to cover the awkward gap in memory, and omits the other cases
where there is a spontaneous inclination to confabulate. Spon¬
taneous confabulation is rarer than responsive confabulation, but
is very well marked in cases where Korsakow’s symptom-complex
comes on immediately after trauma. Pick admits as important
factors in causing the phenomenon the suggestibility found after
trauma, clouding of consciousness, impairment of the critical faculty,
and an increased activity of the imagination. Between the cases
of mere traumatic amnesia and those with fabrications to supply
the gap come cases such as those described by Thorburn after
railway accident, which present pseudo-reminiscences, explained
by him as due to auto-suggestion in a condition resembling
somnambulism. The author quotes a case where a peasant
received a severe blow in a quarrel, and during the next ten days
had attacks of apprehensiveness in which he forgot the quarrel
and gave a false account of the trauma.

According to Pick, in confabulation, images called up by the
suggestion of another person or arising spontaneously are pro¬
jected into the past as memory images; but when we remember
an event, we localise it in time and in a certain environment, and
so the pseudo-reminiscence is provided with a complete background
unconsciously and according to the laws of association and without
the direct volition of the patient. C. Maofie Campbell.

ON THE CLINICAL SIGNIFICANCE OF CONFABULATION. (Zur
(113) klinischen Beurtheilung der Confabulation.) C. Neisser (of
Bunzlau), Neur. Centralbl., Aug. 16, 1905, p. 738.

Neisser calls attention to the fact that in certain cases of
functional psychosis the retrospective falsifications dominate the
picture and give the clinical stamp to the case (Parancesis con-
fabulans): such cases were described by Sander under “ original
paranoia,” but are considered by Kraepelin as a mere variety of
paranoides. Neisser emphasises the fact that in these pseudo¬
reminiscences there is present neither the clouding of conscious¬
ness nor the impairment of the critical faculty which Kraepelin
and Pick regard as important factors in the genesis of confabula¬
tions. The author regards them not as a secondary phenomenon,
but as an independent irritative symptom, and to support his view
cites a case where such pseudo-reminiscences developed acutely as
an independent episode lasting only a short time.

He refers to the fact that in functional psychosis, especially of
a depressive character, a flood of memories may episodically
dominate the picture, and this too he would consider an irritative
phenomenon. C. Macfie Campbell.

ABSTRACTS

22£

ON DEMENTIA PABALYTIOA AFTER TRAUMA. (Ueber
(114) Dementia paralytica nach Unfall.) By G. Reinhold (of
Crefeld), Newr. Centralbl., July 16, 1906, p. 641.

Patient was a man, 40 years of age, with no history of syphilis or
of alcoholic excesses, who, after a fall, in which he landed in the
sitting position, developed in a few months sluggish pupil reaction,
increase of patellar reflexes, unsteady gait. The diagnosis at first
was of a functional disorder due to trauma, but the symptoms
were progressive and about eighteen months after the accident
mental symptoms appeared. Patient showed impaired memory,
had little periods of excitement and confusion, fabricated, and had
hallucinations. One week before death he had an epileptiform
attack. Post-mortem examination disclosed thickening of the pia,
atrophy of the convolutions, hydrocephalus intemus, granulations
of the ventricles, slight atheroma of the aorta.

Neither macroscopical nor microscopical examination showed
syphilitic changes in the brain nor other organs.

The author reviews the opinions of various authors on trauma
as an etiological factor in general paralysis, and considers that
the case recorded was of traumatic non-syphilitic origin.

C. Macfie Campbell.

PHYSIOLOGICAL AND PATHOLOGICAL “SLEEP DRUNKEN
(116) NESS.” (Die physiologische und pathologische Schlaftrunken-
heit.) H. Gudden (of Munich), Arch. /. Psych., Bd. 40, H. 3.

The name “sleep drunkenness” is applied to the state of an
individual in whom the transition from the sleeping to the
waking state is slow and accompanied by a misinterpretation
of the environment and frequently by irresponsible talk and
action; the individual is in a half-dream state, the real world is
only hazily grasped as in a state of drunkenness. Gudden reports
briefly the observations of 18 individuals who presented this
phenomenon ; he groups the observations in four categories.

Group 1 includes 3 cases of physiological “sleep drunken¬
ness ”; this is a quite familiar phenomenon and is illustrated by
the first case, who, when wakened one morning after a very short
sleep, seized the wakener by the throat under the impression
that he was a robber, and held him fast until he wakened up
completely and grasped the situation.

The occurrence of this phenomenon is favoured by fatigue, too
short sleep, uncomfortable position, unfamiliar environment,,
sudden interruption of sleep.

When the normal individual wakens, grasp of environment

230

ABSTRACTS

and capacity for action return together; in “ sleep drunkenness ”
there may be a dissociation. In that case the grasp may return
slowly while the individual has no difficulty in moving or talking,
or he may have quite clear grasp but be unable to either move or
talk for a short time. Two other factors influence this state:
the feeling of discomfort associated with premature or disagreeable
interruption of sleep, and the strength of the impressions received
from the environment before going to sleep. If one fall asleep
after only a cursory impression of an unfamiliar environment,
orientation on awakening is delayed.

Group 2 includes 2 cases of affective “sleep drunkenness,”
which are transition cases to pathological examples of the
phenomenon. Here the ordinary predisposing factors were
accompanied by a certain anxiety due to unfortunate experiences,
and the individuals when roused prematurely from sleep, killed
another person under the influence of their apprehensiveness
before they had grasped the real situation.

Group 3 includes 3 cases which presented the phenomenon in
a morbid degree and for which Gudden suggests the name “ dream
drunkenness ” ( Traumtrunkenheit ).

The individuals were of poor heredity, were subject to terrify¬
ing dreams, and committed homicide in a condition akin to that
of the sleep-walker.

In group 4 are given 9 cases, of which one is from personal
observation, under the heading of “ alcoholic sleep drunkenness.”

In these individuals there was a psychopathic constitution,
and the clouding of consciousness was more profound and more
prolonged than in the previous groups. The condition was to be
distinguished from a pathological condition of intoxication by the
suddenness of its occurrence and the quick return of a clear grasp
of affairs.

The author’s conclusions are as follows:—

1. The most striking sign of “ sleep drunkenness ” is a delay in
the return of grasp of the environment and of capacity for action.

2. The want of definite impressions before going to sleep favours
the appearance of the phenomenon.

3. Previous apprehensiveness is a predisposing factor.

4. The feeling of discomfort that accompanies premature
awakening influences the actions of the individual in the half¬
dream state.

5. Pathological “ sleep-drunkenness,” if not treated with tact,
may be prolonged, and in alcoholics may pass over into the
pathological excitement of the intoxicated.

C. Macfie Campbell.

ABSTRACTS

231

A CONTRIBUTION TO THE SYMPTOMATOLOGY OF DELIRIUM
(116) TREMENS. (Zur Symptomatology des Delirium tremens.)

M. Reichardt (of Wurzburg), Neur. CeniralM., June 16, 1905.

The author has found the following method of use in the
examination of patients with alcoholic delirium. He gives the
patient a large sheet of white paper and asks him what he sees on
it: none of his delirious patients failed to describe a great variety
of objects seen; while in cases presenting a similar picture on a
non-alcoholic basis, e.g. in certain cases of general paralysis, this
simple method failed to elicit hallucinationa

The author considers the phenomenon as pathognomonic for
the alcoholic delirium, and emphasises the fact that hallucinations
can thus be elicited at a time when the patient is clearly oriented,
and shows no hallucinations either spontaneously or on
pressure of the eyeballs, and in cases of mild and abortive
delirium. Its diagnostic importance is considerable in cases not
in hospital and which can only be observed for a short time.

The hallucinations are evidently of central origin, because the
patients may show normal acuity of vision and no peripheral
disorder at the time. C. Macfie Campbell.

PSYCHIATRIC OBSERVATIONS ON A OASE OF MURDER AND
(117) SUICIDE, ETO. (Psychiatrlsche Untersuchung eines Fallas
▼onMord und Selbstmord mit Studies fiber Familiengeschichte
und Brblichkeit.) R. Sommer, Klinik /. psych , u. nerv. Krank-
heitcn, Bd. 1, H. 1, 1906.

Shobtlt before Christmas 1903 a whole family, consisting of a
man, his wife, and three children were found dead or dying from
severe wounds in a small town in Upper Hesse. The wife and
one daughter were already dead, another daughter in a dying
condition, and another severely wounded by an axe found in the
room. The father, a farmer, had shot himself through the mouth
and died two days later. The absence of any apparent motive,
and the impossibility of obtaining any information as to the crime
beyond external evidence and the statement of the youngest
daughter, aged 12, that her father had not done it, and also a
blood-stained letter conveying his farewell to his sister-in-law
(“Liebe Schwagerin, wenn Ihr meine Frau noeh retten konnt,

gebt Euch Miihe, letzten Gruss.—S- X-”), invested the

case with considerable psychological interest. Prof. Sommer has
been at considerable pains to collect evidence bearing on the
crime, and has made an exhaustive inquiry into the personal
and family history of the murderer. From the personal history

232

ABSTRACTS

of the actor, the author was able to establish a morbidly increased
susceptibility (Beeinflussbarkeit); mental depression following,
but out of proportion to, domestic worries; and great motor
excitability, hystero-epileptic in nature; with, as exciting or
suggesting factors, the proposed slaughter of his pigs, and the
smell of blood from some which had been killed on his premises
on the previous day. Investigations into the family history, direct
and collateral, revealed an extraordinary proportion of neuro¬
psychopathies, hystero-epileptic in kind, with a marked tendency
to emotional disturbance. R. Cdnynoham Brown.

TREATMENT.

HAS FORMIC AOID A MUSCULAR-TONIC ACTION 1 (L’Acide
(118) fonnique a-t-il one action toni-musculaire ?) Flkig, Arch. gim.
de mid ., Oct. 31, 1905, pi 2753.

Belief in the therapeutic properties of formic acid has oscillated
between periods of extreme faith to periods when it has been
consigned to utter oblivion. Of late years its virtues have been
vaunted more widely than ever. Kowacs was the first within
recent years who drew attention to the exciting properties of
formic acid upon the motor nervous system, as contrasted with
its merely tonic action (Centralb.f. klin. Med., 1885, p. 543).

Garrigue stated that the formates were able to cure such
diseases as cancer and tuberculosis (“ Maladies microbiennes,
gu^rison de la tuberculose et du cancer ”). He stated that these
salts, when injected into animals, produced both cerebral and
physical activity. Clement, struck by the incessant activity of
ants, tried to establish a connection between the presence of formic
acid and aptitude for work, and he believed that ants owed their
proclivity to work and resistance to fatigue to this acid (Lyon
midical, 3 aout 1903). This author says that formic acid is
remarkable for its tonic action, for its power of raising physical
and moral force, for its influence on arterio-sclerosis, on senile
tremor, and on the other incidents of age, that it preserves youth
and retards the onset of old age.

Huchard (Bull. Acad, mid., 14 mars 1905) partially confirmed
the opinions of Clement, and drew attention to the value of the
formates in cases where one desired to increase the resistance to
fatigue in healthy persons, or in such pathological conditions as
asthenia, anaemia, influenza, asthenic pneumonia, etc., and drew
attention to the diuretic effect of the formates through their action
on the muscular fibres of the vessels.

C. Fleig, in an elaborate memoir (Archiv ginir. de mid., 31 oct.

ABSTRACTS

283

1905), criticises the statements of the above authors, and describes
a large number of his own experiments. These demonstrate that
formate of sodium given in the most varied dose does not modify to
any degree the contraction of non-striped muscular fibres, and he
is forced to the conclusion that formic acid is not a muscular tonic.
Clinical experience shows that the arterial tension undergoes no
modification consequent on the exhibition of formates. Fleig
could not confirm Clement’s statement that the formates had an
exciting or reinforcing action on the heart; but if the dose were
large, certain toxic effects were noted, as diminution in the ampli¬
tude and in the frequency of the heart-beats, as well as a certain
degree of arythmia. When sodium formate was given to patients
suffering from persistent cardiac arythmia, negative results were
obtained.

Clement and other authors were even more positive in their
assertions regarding the effects of formic acid on striated muscular
fibres. The former affirmed that this acid diminished, greatly
retarded, or even entirely suppressed the sensation of fatigue.
Fleig, on the other hand, shows that the idea of it diminishing
the sensation of fatigue is illusory.

In order to determine if formic acid acted peripherally either
on the nerve fibres or on the muscle fibre itself, Fleig has com¬
pared myographic tracings from an animal both before and after
the administration of formic acid. These records were obtained by
the stimulation of a motor nerve or of a muscle directly. All his
experiments showed that it was impossible to determine any
stimulating effect either in muscular force or in resistance to
fatigue after formate of sodium had been administered.

Many experiments proved that formic acid did not produce
muscular stimulation through peripheral action. Nor did myo¬
graphic tracings produced by direct stimulation of the cord show
increased activity after the injection of formates. Neuro-reflex
and cutaneous periphero-reflex contractions were not augmented
under the action of these salts. The brain itself did not react
more than the cord under the action of formic acid, as judged by
the stimulation of certain cortical centres.

Sodium formate was added to the food given to a dog which
was made to do work. The observations showed that the salt
given in very varying doses neither increased the activity of
muscles nor augmented the resistance to fatigue. All these ex¬
perimental results were very clearly opposed to the assertions of
Clement. Fleig goes on to criticise very fully and adversely the
statements of this writer as to the benefits conferred by the
formates as shown in his ergographic experiments. In conclusion,
Fleig states that his observations show that the reputed muscular
tonic action of the formates has not been proved. The only
stimulating effects which formic acid appeared to produce were a
Q

284

ABSTRACTS

certain increase in the appetite, though this exhibited itself in a
very inconstant manner, and an increased diuresis. In the treat¬
ment of certain morbid conditions where asthenia predominated,
the employment of formic acid was equally inconclusive.

W. G. Aitchi 80 n- Robertson.

SOME USEFUL PRINCIPLES IN THE TREATMENT OF
(119) CEREBROSPINAL MENINGITIS. William Browning,
Pediatrics, Nov. 1905, p. 702.

Cerkbro-Spinal Meningitis is receiving a good deal of attention
at present, especially in the American medical papers. Dr
Browning thinks that in most cases definite aid can be obtained
from promptly initiated and systematic treatment He lays
special stress upon:—

(1) Light and fresh air. Epidemics occur chiefly in wintry
and stormy weather. Patients should be placed in bright, well-
ventilated rooms, in sunshine if possible, the eyes being shaded if
there is photophobia.

(2) Quiet The patient must be disturbed as little as possible.
Transportation to hospital, though often necessary, does harm.
Even removal from one room to another may be followed by retro-

r ision. If the room cannot be kept quite quiet, cotton wool may
placed in the ears. The bed should be comfortable, with a
slight incline towards the foot to favour the gravitation of body
fluids away from the head. While changes of position to relieve
pressure and hypostasis are necessary, they should be as few as
possible. During convalescence, too early attempts at rising are
very apt to bring on relapses.

(3) Relief of cerebro-spinal congestion. Warmth to the surface
is of great importance. Hot-air baths, vapour baths, hot bran bags
are useful. Small children may be gently lifted into a bath, but
this should not be done to adults. Temporary benefit may result,
but the patient suffers for the disturbance in the long run. If the
temperature is too high, a cold pack, followed by a warm one, may
be used.

Lumbar puncture is of very limited therapeutic value, but often
relieves vomiting.

Small blisters along the margin of the occipital and temporal
scalp are useful.

Careful nursing is of great importance. Drugs are of very
limited value. Stimulants are often required in the later stages.

W. B. Drummond.

ABSTRACTS

235

THE DIET IN EPILEPSY. A. J. Rosanoff, Joum. of Nerv. and
(120) Mcrd. Bis., Dec. 1905, p. 753.

Reference is made in the first place to Merson’s observations
(West Riding Asylum Medical Report , 1875). Twelve epileptic
patients were kept for fonr weeks on a “ farinaceous diet," while a
similar group were kept on a “ nitrogenous diet.” The effect of
the farinaceous diet was to diminish, that of the nitrogenous diet
to increase, the frequency of the convulsions. In a second experi-
ment the first group of patients were given the nitrogenous, the
second group the farinaceous diet, with the same effect

The author holds that there is good ground for the assumption
that the various manifestations of epilepsy are probably dependent
upon a disorder of nitrogenous metabolism, and upon nothing else,
and that in epilepsy there is a hitch in the process of conversion
of proteid material into urea, abnormal and often violent activity
of the nervous and muscular tissues being necessary for the com¬
pletion of the conversion. Krainsky has produced convulsions in
guinea-pigs by injecting the blood of epileptics. To the periodical
accumulation of ammonium carbonate in the blood, the occurrence
of convulsions has been attributed. Dr Rosanoff considers that it
is not the kind of food, but the absolute quantity of proteid matter,
irrespective of its origin, that influences the occurrence of attacks.

Eleven cases of old-standing epilepsy were kept on five different
diets for several weeks at a time, (a) Regular diet of the hospital,
(5) vegetable diet, (c) diet with insufficient quantity of proteids,
(d) diet with excessive amount of proteids, (e) diet with large
excess of proteids and very deficient in carbohydrates (the dietetic
diet of the hospital). The conclusions arrived at were, that the
effect of a mixed diet differs in no way from that of a vegetable
diet containing the same quantities of proximate principles, that
the quantity of proteids has a decided influence (if it is either above
or below the indispensable minimum the severity of the disease is
increased); when a diet contains a large excess of proteid and
practically no carbohydrates, there is a very great increase in the
frequency of the convulsions with an aggravation in the patient’s
physical and mental condition.

The practical therapeutic deduction from these experiments is
that the patient should receive as large amounts of carbohydrates
and fats (which are capable of replacing the proteids) as he can
assimilate, and the smallest amount of proteids which is compatible
with the preservation of the nitrogenous equilibrium.

Edwin Bramwkll.

236

ABSTRACTS

THE FOOD FACTOR IN THE PAROXYSMAL NEUROSES.

(121) Francis Hark, Practitioner , Feb. 1906, p. 179.

The author argues that the recurrent affections—migraine, asthma,
major epilepsy, and acute articular gout—depend primarily upon
an accumulation of unoxidised or imperfectly oxidised carbonaceous
material in the blood ; and that each paroxysm is a conservative
measure adopted to disperse such accumulation.

Whatever tends to reduce the carbonaceous income or increase
the carbonaceous expenditure of the blood, tends to prevent,
alleviate, or disperse; whatever tends to increase the carbonaceous
income or decrease the carbonaceous expenditure of the blood,
tends to initiate, precipitate, or intensify the paroxysms of
migraine, asthma, and epilepsy.

For the restriction of the carbonaceous intake, the following
regime is advised: (1) Cutting off sugar and all articles containing
it; (2) carefully graduating (by weight) the daily intake of starch-
containing foods, so as to attain the minimum consistent with
adequate nutrition in each individual case; (3) graduating in a
similar manner the intake of fats, if necessary; (4) throwing the
onus of nutrition to a considerably greater extent than previously
on fish, lean meats, green non-starchy vegetables, and gelatinous
soups.

Marked benefit results in most cases, and cure in some cases
of migraine and asthma. In epilepsy the results are less satis¬
factory, but many cases are distinctly benefited and none are
rendered worse.

In certain cases of the paroxysmal neuroses, factors other than
humoral may be dominant in causation, and therefore worthy of
the first consideration in the therapeutic attack.

W. B. Drummond.

ON THE TREATMENT OF NEURALGIAS BY ALCOHOL INJEO-
(122) TIONS. (Zur Behandlung der Neuralgien durch Alkoholein-
spritsungen.) Sghloesser (Munich), Berl. klin. Wochenschr.,
Jan. 15, 1906, p. 82.

The writer refers to a previous paper in the same journal by
Ostwalt (No. 1 for 1906) upon the hypodermic injection of alcohol
for neuralgia, and regarding Ostwalt’s statement that 90 per cent,
of cases yielded excellent results to this treatment, declares that no
case (except those of hysterical or diabetic pains) had left his own
clinique without being cured. He states that they remained well
for six or seven months on an average.

The writer does not describe his method, but promises later an
extended publication of his cases, John D. Comrie.

ABSTRACTS

237

THE INDICATIONS FOR TRANSPLANTATION OF TENDONS.
(123) (Die Indikationen znr Sehnenverpflanzung.) Adolf Lorenz
(in Wien), Wien. med. Woch., 1906, p. 118.

Prof. Lorenz inaugurates in this article a reaction against the
excessive employment of tendon-transplantation. The object of
transplantation is, generally speaking, the equalising of the action
of antagonistic muscles when their normal equilibrium has been
disturbed. Irrational transplantations, however, often result, not
in equilibrium, but in the establishment of a deformity exactly
the reverse of the original condition. In pes calcaneo-valgus, for
example, the transference of both peronei into the tendo Achillis
is apt to result in a paralytic eqnino-varus, which interferes with
progression much more than < the original deformity, while one
peroneus is quite an inadequate substitute for the paralysed
gastrocnemius. In paralytic contractures at the knee it is especi¬
ally necessary to avoid excessive dynamical changes. Transplanta¬
tion of the flexors into the quadriceps in genu flexum, or of the
quadriceps into the flexors in genu recurvatum, will sooner or
later always result in the establishment of the opposite contracture.
Genu flexum is far the commoner, and its conversion into a genu
recurvatum leaves the patient far more helpless than before;
hence transplantation of the flexors into the quadriceps is always
inadvisable.

The treatment of conditions such as those mentioned consists,
according to Lorenz, in correcting the deformity by a plastic
operation, involving, if necessary, division of fasciae, tendons, or
bone, and then in strengthening the weaker muscles by exercises
and massage. In most cases nothing more is required, the over¬
stretched muscles recovering when the tension is thus removed.
In a few cases a transplantation of tendons may be necessary, but
this should only be performed at a second operation several months
after the deformity has been remedied, and when all improvement
has ceased. Transplantation should never be practised till paralytic
changes have ceased to be progressive, lest the reinforcing muscle
should subsequently become involved in the paralysis. Arthrodesis
of the ankle-joint the author has never found to be necessary. In
spastic conditions, transplantation of the contracted muscles un¬
doubtedly diminishes the spasm, probably by removing the irritation
of the tension and not through any alteration in the central inner¬
vation or in the direction of nerve currents. A simple tenotomy,
however, is as effective.

Prof. Lorenz’s assertions refer only to the lower extremity.
He admits that in paralysis of the hand transplantation of tendons
put6 mere correction of deformity entirely into the background.

W. J. Stuart.

238

REVIEWS

■Reviews

KLDHK PUR P8Y0HIS0HB UND NEBVOSE KRANKHBITBN.

Robert Sommer, Prof. a. d. Univer. Giessen, Bd. 1, H. 1, 1906.

Halle a. S.: Carl Marhold.

Advance notices of the appearance in serial numbers of clinical
studies under the editorship of Pro£ Sommer of Giessen, the well*
known author of the “Diagnostik der Geisteskrankheiten ” and
other works, have been for some time before the medical public.
In the introduction to this, the first number. Prof. Sommer gives
an account of the origin and future scope of this “ Klinik.”

The extraordinary accretion to medicine in the last few years
of clinical and psycho-pathological material, resulting from the
rapid development of more exact methods of inquiry, permits
to-day of a more accurate diagnosis and much improved treatment
in neurological and psychiatric practice. For the past ten years
Prof. Sommer has conducted a clinic for nervous and mental
diseases, and has, as readers of his works are aware, directed
particular attention to, and done much to further, exact methods
of clinical investigation in this field. It is, therefore, eminently
fitting that this publication should be conducted under his super¬
vision. Under his guidance a school of diagnosis has been formed
which has already amassed a large body of clinical material, and
with the collaboration of other workers who have been asked to
contribute original studies in neuropathology, this material will be
published in quarterly numbers, each containing five or six separate
articles. Particular consideration is to be devoted to those cases
lying on the borderland between nervous and so-called mental
diseases, to nervous diseases accompanied by mental symptoms,
to those as yet included within the category of functional diseases,
hysteria, neurasthenia, and so forth, and their definition and classi¬
fication more accurately delimited. To the general physician the
early stages of the psychoses and psycho-neuroses are of primary
importance, and if the aim of Prof. Sommer in this direction is
fulfilled and this clinic made to reflect the most modern methods
of examination of elementary mental disorders, it cannot fail to be
of service to many. In this country particularly, where psychiatric
clinics are as yet unfortunately wanting, it should prove most
useful to students and to medical officers of asylums, who on
account of the statutory precautions which hedge in the entrances
to asylums, rarely see cases except in an already advanced, and in
many cases incurable condition, and should to some extent supply
this lack. Naturally the result of a more exact diagnosis should
be improved treatment, and still further the compilation of many

REVIEWS

239

original studies in clinical research must in the end form a valuable
addition to works of reference.

The first number, abstracts of some of the articles of which are
to be found on the other pages of this issue, will be found to con¬
firm the arguments in favour of its support by all workers in this
field. R. CUNYNGHAM BROWN.

GEHX&N TJND RUOKENMARK. Leitf&den fdr das Stadium der
Morphologie and des Faserverlaufs. Emil Vilugkr. Leipzig:
W. Engelmann. 1905. Edinburgh : Otto Schulze & Co.
Price 9 M.

The aim of a text-book on the anatomy of the central nervous
system may be to give a description of its morphology without
regard to its function; or it may treat anatomy as the basis for
the comprehension of function and emphasise the facts which are
already recognised to be concerned in the production of the symp¬
toms of disease, and which may be of use in clinical study.

This small text-book of 180 pages belongs to the former rather
than to the latter class, despite the evident intention of the author
to appeal to students of the function of the nervous system in
health and disease, and the consequent result is that it cannot be
highly praised as a representative of either.

The greater part of it is devoted to the description of the
macroscopical appearance of the brain, and this is often ex¬
cellent. The description and illustration of the complex rhinen-
cephalon is, for example, very complete and lucid, but the rest
of the telencephalon is treated so summarily that one previously un¬
acquainted with its anatomy would gain but little from the perusal
of these sections. The descriptive anatomy of the spinal cord
occupies only half as many pages as have been devoted to the
rhinencephalon; surely an unwarranted utilisation of the space at
the author’s disposal, if his aim were to write a medical anatomy.
Similarly the sections which deal with the cerebellum are occupied
by a description of the morphology of its gyri, to the exclusion of
that of its connections with other parts. This is due to the author’s
aim to make his book merely a guide to the student who has a
brain to dissect; for more detailed information he must seek else¬
where.

Many of the statements in the cortical localisation of function
and on the fibre-connections of the different regions of the brain
cannot be tacitly accepted. The motor centres do not, in all pro¬
bability, extend over the post-central gyrus, nor does “ the greatest
part of the superior frontal convolution ” represent the centre from
the trunk muscles. The weight of evidence is also at present
against the localisation of the auditory word centre in the posterior

240

REVIEWS

end of the first temporal gyrus. Similarly, though all recent
work points to the so-called inferior longitudinal bundle being
the projection system which carries visual impressions to the
calcarine cortex, it is here still described as an association system
between the occipital and temporal lobes. Nor is it generally
accepted that Helweg’s bundle in the upper cervical cord represents
the tractus spino-olivaris, and it is doubtful if the fasciculus sulco-
marginalis is composed of tecto-spinal fibres alone.

Despite these exceptions, the book can be recommended to
those who desire to gain such a knowledge of the structure of the
brain as is possible from macroscopical study alone. It is well
illustrated and contains numerous diagrams.

Gordon Holmes.

THE TEMPERAMENTS. (Die Temperaments, ihr Wesen, ihre
Bedeutung Mr das seelische Brleben, und ihre beeonderen
Gestalt ungen.) Dr Eduard Hirt (of Munich). Wiesbaden:
Bergmann. Pp. 54.

In this work the author gives a short description of that part of
man’s psychical life which is evidenced in the varying play of
excitation and reaction by his movements, demeanour, mien, and
in particular by his changes of manner, the limits of which are
fixed by the temperament. The temperament is a life-long
characteristic of the personality, which often brings about re¬
actions quite independent of the intellect and character of the
individual, more particularly in the extremer states of psycho¬
motor excitement or inhibition to which all are subject. Many
manic and depressive conditions appear to be congenitally
temperamental, the severer ones constituting cases of manic-
depressive insanity.

After some description of the general laws of psychical pro¬
cesses and experiences, the author considers the types of tempera¬
ment, or special forms under which these laws are manifested.
The temperament of the average man-in-the-street is summed up
in an inventory of negative qualities. Of the four main types,
the Phlegmatic is the nearest to the average—a mere step below
the plane of normal psychical energy. Its main characteristic is
a sensory blunting, and marked instances grade into undoubted
morbid apathy. A sub-class is formed of the Pseudo-Phlegmatics,
who have drifted into apathy, often after some attack of over¬
excitement—they are distinguished by the clear insight they have
into their condition, feeling it bitterly; when fully developed, the
condition belongs to the class of manic-depressive diseases.
Others appear to be mild forms of dementia praecox, the symp¬
toms appearing about the time of the normal termination of
mental development.

REVIEWS

241

Contrasted with this type is the Choleric temperament, iras¬
cible, but at the same time tenacious of purpose and masterful.
This includes the distrustful, suspicious egoists who shade off into
paranoid cases, and also the sulky, discontented, bitter people
with periods of reproachful sadness, who also form a transition
type to the manic-depressive condition.

The third type is the Melancholic, sad, weary, and grave, bom
to “ Weltschmerz.” Sub-divisions of this class are—

(a) The self-centred, diffident pessimist.

(b) The conceited melancholic, coming midway between the
melancholic and the choleric type, and varying from the man of
action to the man of introspective thought

(c) The man of moods, alternating between moderate excite¬
ment and shallow ill-humour—the mood blinding the mind to all
real joy and sorrow.

Contrasted with the Melancholic is the Sanguine temperament,
full of the joie de vivre, but flighty and unstable. This type in an
exaggerated form is the slave of momentary impulse, also moody,
but the moods are dependent on some evident outward cause.

Many neurasthenics and neurotics fall into this class, and the
hysterical temperament may also be considered a sub-class of the
Sanguine, its unreliable capriciousness being not hypocritical, but
due to some fundamental defectiveness in the will processes.

This classification may or may not be sufficient, individual
examples will certainly occur to one that would be found difficult
to place in the scheme, but the book is of distinct value as an aid
to the study of the temperaments, an application of which, either
consciously or unconsciously, must be of the greatest value to one
in practice, particularly in dealing with “nervous” or with
borderland mental cases. J. H. Harvey Firir.

242

BIBLIOGRAPHY

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KIRSCHMANN. Normale und anormalo Farbensysteme. Arch. f. yesammte
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GOLDSCHEIDER. Uber die materieUen Ver&nderungen boi dor Associations-
bildung. Neurol. Centralbl., Fob. 16, 1906, 8. 146.

SCHUMACHER. t)ber die Nerven des Sohwanzes dor S&ugetiere und dee
Menschen. mit besond. BeriAcksicht. dea sympathischen Grensstrangee. Holder,
Vienna, 1905, M. 1.20.

LONDON and PESKER. Ueber die Entwiokelung des periphoren Nervensy stems
boi Saugetieren (weissen MSusen). Arch./mikroskop. Anal., Jan. 1906, p. 303.
KAPPERS. The Structure of the Teloootoan and Selachian Brain. Joum. Comp.
Neurol, and Psychol., Jan. 1906, p. 1.

GEMELLI. Sur la Structure de la region infundibulaire des poissons. Joum. de
VAnat. side la Physiol., Jan. 1906, p. /7.

VICTOR BONNEY. A Now and Easy Process of Triple Staining for Cytological
and Histological Purposes. Lancet, Jan. 27. 1906, p. 221.

PHYSIOLOGY

MILLS and WEISENBERG. The Localization of the Higher Psyohic Functions,
with Special Reference to the Prefrontal Lobe. Joum. of Am. Med. Ass., Feb. 8,
1906, p. 337.

SCHITTENHELM. Untersuchungen liber das Lokalisationsvermdgen und das
stereognostische Erkennen. Deutsche Zeit. f. klin. Med., Feb. 1906, p. 562.
BACH. Ueber das Verhalten der motorischen Kerngebiete naoh Ltttion dor
periphoren Nenren und Uber die physiologische Bedeutung der Edinger-
Westphal’schen Kerne. Centralbl. f. Nervenheilk. u. PsychiaL, Feb. 15, 1906,
8. 140.

ALCOCK. The Action of Anesthetics on the Injury Current of Nerve. Joum.
Physiol ., Feb. 5, 1906, p. xxvii.

ELLIOTT. Degenerative Section of the Nerves to the Cat’s Bladder. Joum.
Physiol., Feb. 5, 1906, p. xxix.

F. H. SCOTT. On the Metabolism and Action of Nerve Cells. Brain, VoL xxviii.,
Nos. Ill and 112, 1905, p. 606.

FtiRlfL Recherches exp^rimentales sur l'influence du sel sur le travail. Rev. de
mid., Feb. 1906, p. 136.

BAGLIONI e CURCIO. Rioherche sperimentali sulF arions polare della oorrente
oonstante sui centri nervosi. Zeit. f. ally. Physiol., Dea 1905, p. 613.
BAGLIONI. Ueber das Sauers toffbedurfnis des Zentralnervensystems bei
Seetieren. Zeit.f. ally. Physiol ., Dec. 1905, p. 415.

A. B. MACALLUM and M. L. MENTEN. On the Distribution of Chlorides in
Nerve Cells and Fibres. Proc. Royal Soc., No. B. 516, Jan. 30, 1906, p. 165.
OBICI. Di un nuovo metodo per inscrirere graUohe sul cilindro girante. Riv.
di Paiol. nerv. e ment., VoL x., f. 12, 1906, p. 545.

BIBLIOGRAPHY

243

PSYCHOLOGY

FRANZ. The Time of some Mental Processes with Retardation and Excitement
of Insanity. Am. Joum. of Psyched . Jan. 1906, p. 38.

BROWNE Psychology of the Simple Arithmetical Processes: a Study of
oertain Habits of Attention and Association. Am. Joum. of Psychol, Jan. 1906,

Chamberlain. Acquisition of Written Language by Primitive Peoples.
Am. Joum . of Psychol, Jan. 1906, p. 69.

FERREE An Experimental Examination of the Phenomena usually attributed
to Fluctuations of Attention. Am. Joum. of Psychol., Jan. 1906, p. 81.

C. H. TOWSE. The Kinesthetic Element in Endophasia and Auditory Hallucina¬
tion. Am. Joum. of Psychol., Jan. 1906, p. 127.

LEHMANN. Beitrage sur Psychodynamik der Gewichtempfindungen. Arch. f.
aesammte PsychoL , Jan. 1906, p. 426.

ItODENWALDT. Der Einfluss der milit&rischen Auabildung auf das geistige
Inrentur des Soldaten. MonaUschrift f. Psychiat. u. Neurol ., Jan. 1906, p. 67.
GeRAUD-BONNET. Transmission de pens6e. Rousset, Paris, 1906.

EDWIN ASH. Some Experiments in Hypnosis. Lancet, Jan. 27, 1906, ]X 216.
JOSEPH BELLEI. A Further Contribution to the Study of Mental Fatigue in
School Children. Lancet , Feb. 3, 1906, p. 287.

ZBINDEN. Conception psychologique du nenrosisme. Arch, de Psychol., T. v.,
No. 19, 1906. p. 186.

8CHUYTEN. Sur la validity de renseignement intuitif primaire. Arch, de
Psychol , T. y., No. 19, 1906, d. 246.

GERLING. Die Gymnastik aes Willens. M tiller, Oranienburg, 1906. M. 3.
KASSOWITZ. Allgemeine Biologie. Bd. 4. Nerven und Seele. Perlea, Vienna,
1906, M. 12.

M. F. WASHBURN. A Comparison of Methods for the Determination of
Ideational Type. Am. Joum. of Psychol., Jan. 1906, p. 121.

M'DOUGALL. On a New Method for the Study of Concurrent Mental Operations
and of Mental Fatigue. Brit. Joum. PsychoL, VoL L, Part 4, 1906, p. 436.

PATHOLOGY

SCHOLZ und ZINGERLE. Beitr&ge zur pathologisohen Anatomic der Kretinen-
gehirne. Zeit.f\ Heilk., Feb. 1906, p. 67.

BULLARD and SOUTHARD. Cystic Aplasia of the Cerebral Hemispheres in an
idiot child. Joum. of Med. Research, Jan. 1906, p. 431.

GUERRINI. Sulla funzione dei muscoli degenerati. Sperimentale, Nov.-Dec.
1906, p.797.

PELLIZZI. Della eterotopia della sostansa corticale cerebrate. Ann. de Freni*
atria, Die. 1906, p. 289.

RABA UD. Pathogenic de la pseudenc£phalie (suite et fin). Nouv. Icon, de la
SalpStritre , nov.-d6o. 1905, p. 675.

ROUSSY. Un nouveau cas de soi-disant H6t6rotopie du Cervelet. (Soc. de
Neurol.) Rev. Neurol, jan. 30, 1906, p. 88.

ROBERTSON, W. FORD. The Pathology of General Paralysis of the Insane.
Rev. Neurol, and Psychiat., Feb. 1906, p. 73.

CHARLES WORKMAN and WALTER K. HUNTER. The Histological
Appearances of the Cord and Medulla in a Case of Acute Ascending Paralysis.
Rev. Neurol and Psychiat., Feb. 1906. p. 106.

BORUTTAU. L’Electropathologie dee nerfs amytiliques du poulpe. Blais et
Roy, Poitiers, 1906.

OUNIOAL NEUROLOGY AND PSYCHIATRY

CHA VIGNY. Diagnostic des maladies simulles dans les accidents du travail.
Baillifere et fils. Paris, 1906, 10 fr.

SOMMER. Klinik fUr psychische und nervtise Krankheiten. Bd. 1. Marhold,
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N AEG ELI. Nerrenleiden und Nervenschmerzen, ihre Behandlung und Heflung
duroh Handgriffe. Fischer, Jena, 1906, M. 2.

HELLPACH. Nervenleben und Weltanschauung ihre Wechselbeuehungen im
deutschen Leben von heute. Bergmann, Wiesbaden, 1906, M. 2.

ANTON. Uber der Wiederersatz der Funktion bei Erkrankungen des Oehims.
Monatssckriftf. PtyckiaL u. Neurol., Jan. 1906, p. 1.

V08CLB8-

KUPPEL et MAURICE VILLARET. Asthenias et atrophies myopathiquea
(Itude synth6tique). Arch, gin. dt mid., fSr. 13, 1906, p. 363.

LENOBLE et AUBINEAU. Une vari6t6 nourelle de Myoclonia Congenitale
pouvant 6tre h6r6ditaire et familiale k Nystagmus constant. (Soo. de Neurol.^
Rev. Neurol., jan. 80, 1906, p. 101.

PERIPHERAL NERVES—

RAYMOND et LEJONNE. Polyn^vrite oons6cutire k un Empoisonnement aigu
par r Arsenic. (Boa de Neurol) Rev. Neurol., jan. 30, 1906, p. 79.

ALBERT KNAPP. Die polyneuritischen Psychosen. Bergmann, Wiesbaden,
1906, M. 4.

BRISSAUD et MOUTIER Un cas de Cellulo-nSrrite. (Soc. de NeuroL) Rev.
Neurol., jan. 30, 1906, p. 91.

COMTE. Syndrome Pseudo-bulbaire d'origine N6vritique. (Soa de NeuroL)
Rev. Neurol., jan. 30, 1906, p. 94.

KLEMPNER. Ober Narkoselahmung des N. cruralis und obturatorius. NeuroL
Centi-albl. , Feb. 1, 1906, S. 107.

SCHUTZE. Acute aufsteigende (Landry*sche) Paralyse nach Typhus abdominalis
mit Ausgang in Heilung. Berlin, klin. Woch., Feb. 12, 1906, p. 201.

SPINAL CORD—

A. M. BARRETT. Spinal cord degeneration in a case of Acromegaly with
Tumour of the Pituitary Region. Am. Journ. of Med. Bei., Feb. 1906, p. 246.

Tabes.—LONG et CRAMER Du tabes tardif. Rev. Neurol., fir. 16, 1906,

p. 110.

D. C. GREENE. A study of the larynx in tabes. Boston Med. and Surg. Journ.,
Jan. 25. 1906, p. 97.

Pott's Disease.—DUPRlfc et CAMUS. Parapl6gie pottique par my61omalacie, sans
leptom6ningite, ni compression, 6closion du signe ae BabinskL Rev. Neurol., jan.
16, 1906, p. 1.

ROSSI. Sur la pathogtfnie des alterations m&lullaires surrenant au cours du mal
de Pott. Arckiv de Neurol., d£c. 1905, p. 417.

FAURE. Nourelle method© de traitement des parapl6gies spasmodiques par les
Exercices. Rev. de mid., Feb. 1906, p. 164.

Hydatids. —A. G. OWEN. Record of fire cases of Spinal Hydatid treated by
operation. Inter-Colonial Med. Journ. of Australasia, Dea 20, 1906, p. 644.

Disseminated Sclerosis* —ANDRE-THOMAS et COMTE. Paralysie avec Con¬
tracture des quatre membres. Sclerose en plaques y6rifi6e k Tautopsie. (Soc. de
Neurol.) Rev. Neurol., jan. 30, 1906, p. 86.

Meningitis. —GAUSSEL. La gucrison histologique de la m6ningite o6r6bro*spinale.
Rev. Neurol., ian. 30, 1906, p. 46.

SPRINGTHORPE. Case of Fulminant Coocic Meningitis. Intercolonial Med.
Journ. of Australasia, Dec. 20, 1905, p. 541.

OSBORNE. Treatment of oerebro-spinal meningitis. New York Med. Journ.,
Feb. 17, 1906, p. 325.

Cerebro-Splnal Fluid.— PASH AY AN. Some Notes on the Cerebro-Spinal Fluid.
Med. Record, Feb. 10, 1906, p. 219.

BRAIN—

Tumour. —KNAPP. The results of operation for the removal of cerebral tumours.
Boston Med. and Surg. Journ., Feb. i, 1906, p. 124.

LESZYNSKY. Report of a case of Brain Tumour with Autopsy. New York Med.
Journ., Feb. 8, 1906, p. 235.

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BERLINER, Ein Fall Ton Neubildung des Kleinhirna. Klinikf. psych. u. nerv.
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MOCQUIN. Pseudo-tumeur c6r£brale par empyfeme ventriculaire. Nout. Icon,
de la Sqlpltriere , nov-d6c. 1905, p. 651.

DUPRE et CAMUS. Euphoric dtiirante et Onirisme chez un Phtisiquo. Double
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jan. 30, 1906, p. 90.

Abscess.— H. B. STOLL. Abscess of the Brain with a report of five cases. Am .
Journ. of Med. Sci. t Feb. 1906, p. 223.

Bulbar Palsy. —RAYMOND et OUILLAIN. Un cas de Syringobulbie. Syn¬
drome d‘Avellis au coun d’une syringomy61ie spasmodique. He*. Neurol., jan. 30,
1906, p. 41.

Vascular Lesions. —ERNEST JONES. The Onset of Hemiplegia in Vascular
Lemons. Brain. Vol. xxviii., Nos, 111 and 112, 1905, p. 527.

HOGARTH PRINGLE. Some Notes on Hemorrhage from the Middle Meningeal
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Sclerosl*,— ALFRED W. CAMPBELL. Cerebral Sclerosis. Brain, Vol. xxviii,
Noe. Ill and 112, 1905, p. 367.

General Paralysis. —JOSEPH COLLINS. The Etiology, Prognosis, and Treat¬
ment of General Paralysis. Jan. 27, 1906, p. 125.

KNAUER. Progressive Paralyse. Milnch. med. Woch., Feb, 20, 1906, p. 361.
NlCKE. SyphiBs und Dementia paralytica in Bosnien. Neurol. Centralbl.,
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GIACHETTI. Contribute alio studio della sensibility nella paralisi generale pro¬
gressiva. Riv. di Patol. nerv. e ment ., Vol. x., f. 12, 1905, p. 550.

CONOLLY NORMAN. Multiple Lipomata in General Paralysis. Journ. of
Ment Sci. f Jan. 1906, p. 62.

MARANDON de MONTYEL. L’acoommodateur dans la paralysie g6n6rale.
Journ. de Neurol ., f6v. 5, 1906, p. 41.

Cerebellum.— STRAUSSLER. Zur Kenntnis der angeborenen Kleinhirnatrophie
mit degenerativer Hirnstrangerkrankung des Rlickenmarka. ZeU. f. Heilk., Feb.
1906, p. 30.

WHITEHEAD. Three Cases of Cerebellar Absoess. Journ. of Laryngology. Etc .
Feb. 1906, p. 33.

HRT11. DISEASES—

F. G. CROOKSHANK. Some Notes on the Study of Insanity. Journ. of Ment.
Sri., Jan. 1906, p. 49.

THOMAS DRAPER. A Note on Psychiatric Terminology and Classification.
Journ. of Ment. Sci. , Jan. 1906, p. 75.

1NGEGNIKROS. Nuova clasmfioasione dei delinquent! fondata sulla peicopato-
logia. Ann. di Freniatria, Die. 1905, p. 349.

GATT1E. Lunacy Practice. Simpkm, Marshall, Hamilton, Kent A Co., London,
1906, 2s. fid.

PILCZ. Beitrag zur vergleichenden Rassen-Psyohiatrie. Deuticke, Vienna, 1906,
M 2

J. S. BOLTON. Amentia and Dementia. Journ. if Ment. Set., Jan. 1906, p. 1.
RAINSFORD. Necessity for State Interference on behalf of the Imbecile. Journ.
of Ment. Sci., Jan. 1906, p. 108.

NlCOLAEVICI. Le d6lire dans les maladies infectieusee. Thlse. Jouve, Paris,

1905.

SOMMER. Geistesschw&che bei psyohogener Neurose. Klinikf. pouch, u. nerv.
Krankh Bd. 1, H. 1, 1906, S. 51.

C. H. TOWN. Negative Aspect of Hallucinations. Am. Journ. of Psychol., Jan.

1906, p. 134.

LIEBMANN. Epileptisohe Geistessttirungen. Deutsche Klinik, 1905, Lief. 158,
p. 540.

BONHOEFFER. Die alkoholischen Geisteestdrungen. Deutsche Klinik , lief. 158,
1906,1). 511.

WOLLENBURG. Die Melancholic. Deutsche Klinik , Lief. 158, 1905, p. 493.
PFEIFFER. Ueber das Krankheitbild der * * zirkumskripten Autopsy chose auf
Grund einer Uberwartigen Idee/* Monaisschrift f. Psychiat. u. Neurol., Jan. 1906,
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246

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PICK. Ueber einer weiteren Symptomenkomplex ira Rahinen der Dementia
senilis, bedingt durch umsehriebene st&rkere Hirnat?t>phie. Monatsschrift f.
Psychiat. it. Neurol,. Feb. 1906, p. 97.

DE BUCK et DEROUBAIX. Considerations anatomo-psychologiques sur la
demence prAcoce, Journ. de Neurol ., i&n. 20, 1906. p. 27.

KLIPPEL et LUERM1TTE. Lesions de la Moelle aans la Demenoe PrAcooe. (Soc,
de Neurol.) Rev, Neurol, jan. 80,1906, p. 93.

TIRELLL Perizia medico*lcgale sulle condizioni mentali di Rosa BonettL Ann.
di Fren.iatria.Dio, 1906, d. 820.

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mit Studien liber Familiengeschichte und Erblichkeit. Klinik f psych, u. nerv,
Krankh ., Bd. 1, H. 1, 1906. S. 6.

GEORGE GREENE. Incidence of Tuberculosis in Asylums. Journ, of Menu Scu ,
Jan. 1906, p. 92.

ROGERS. Should the Tuberculous Insane in Hospital be Segregated. Boston
Med. and Stay. Journ., Jan. 18, 1906, p. 62.

6INEKU AND FUNCTIONAL DISEASES—

TILING. Clemens Neisser: Individualist und Psychose. Centralbl. /. Nerven-
htilk. u. Psychiat ., Feb. L 1906, S. 91.

EDWARD COWLES. The Problem of Psychiatry in the Functional Psychoses.
Boston Med . and Surg. Journ, Feb. 1, 8,15,1906.

Epilepsy.—SCHMITZ. AufklErung flir Epileptiker. Hiller, Hanover, 1905, M.—60.
BRA. Recherches neurobiologiques sur l’Epilepsie. Archiv de NeuroL, dec.

1905, p. 469.

ONUF and LOGRASSO. Researches on the Blood of Epileptics. Am. Journ. of
the Med. Set.. Feb. 1906, p. 269.

HOUZEL. De la Saignle dans le mal Apileptique. Preset MSdicale , Jan. 31,

1906, p. 67.

PLAVEC. Kleine motorische Epilepsie. Neurol. Centralbl ., Feb. 1, 1906, S. 111.
LEON TIX1ER Rapport des 6tats anxieux et des 6tats Apileptique*. Thisede
Paris , 1905.

CHOTZEN. Mischzust&nde bei Epilepsie und Alkoholismus. Centralblf. Nerven-
heilk. u. Psychiat ., Feb. 15, 1906, S. 129.

RASCH. Ueber die Anwendung von Geheimmitteln bei Epilepsie (Fallsucht),
Buchh. der Anstalt Bethel, 1906, M.—25.

ALAN M‘DOUGALL. The David Lewis Manchester Epileptic Colony. Journ.
of Ment. Sci ., Jan. 1906, p. 84.

Chorea.—AN DR& BRUEL. Traitement des Chorees et des Tics de l’Enfanoe.
Steinheil, Paris, 1906.

J. SPENCER SHEILL. “Chorea Gravidarum.” Practitioner, Feb. 1906,

Lange tJber ohronische progressive Chorea (Huntington) in jugendlicher
Alter. Berlin, klin. Woch , Feb. 5,1906, p. 153.

Mysterla.—INGEGINEROS. Les prAtendua symptdmes de lliAmiplAgie historique.
Preset mid., fAv. 17, 1906, p. 105.

ETIENNE UlcAre utAro-vaginal phagAdAnique et gangrene cut&nAe de nature
hyBtArique. Rev. Neurol., jan. 30, 1906. p. 62.

DELACROIX et SOLAGER. AmnAsie rAtro-antArograde gAnArale et presque
to tale • dAlire ; anesthAsie considArable des diverses sensibilitAs ches une hystArique.
Rev. Neurol., jan. 15, 1906, p. 6.

Neurasthenia.—DRENKHAHN. Die Nervositkt in friiheren Jahrhunderten und
in unserer Zeit. Seitz & Schauer, Mllnchen, 1906, M. 1.

DETERM ANN. Cber die NervositAt der Jetstseit und ihre BekJ&mpfung.

Speyer & Kaemer, Freiburg, 1906, M.—90.

PETIT. Quelques considerations sur le traitement Alectrique de la neurasthAnie.
Bull, de la Soc. Francaise cf Electrothtr., jan. 1906, p. 18.

LEVY. La cure definitive de la neurasthAnie par la rAAducation. Arch gin. ds
mid., fAv. 6, 1906, p. 321.

FRANCIS HARE. The Food Factor in the Paroxysmal Neuroses. Practitioner,
Feb. 1906, p. 179.

Myasthenia Gravis* —FARQUHAR BUZZARD. The Clinical History and Post¬
mortem Examination of live Cases of Myasthenia Gravis. Brain, VoL xxviiL,
Nos. Ill and 112, 1905, p. 488.

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BOLDT. Ueber emen Fall Ton myasthenischer Paralyse. Monatsschr. f. PsyckiaL
u. Neurol, Jan. 1906, p 39.

CURSCHMANN u. HE DINGER. tJber Myasthenic bei sexualen InfantDismus
nebst unterauchungen liber die layaathsMscke Reaktion. Deutsche M /. klin.
Med., Feb. 1906, p. 578.

ExepMtkalsalc Goitre,— BEEBE. Preparation of a Serum for Exophthalmic

Goitre. Joum. qf Am. Med. Ass., Feb. 17,1906, p. 484.

ROGERS. Treatment of Exophthalmio Goitre by a Specific Serum. Joum. qf
Awl. Med. Ass., Feb. 17,1906, p. 487.

fiTTCIAI. linB AND CDANlAli N8BTCA-

M'DOUG ALL. The Illusion of the “ Fluttering Heart ” and the Visual Functions
of the Rods of the Retina. Brit. Joum. Psychol., VoL i.. Part 4, 1905, p. 428.
CHAILLOUS et PAGNIEZ. Ophthalmoplegic extern© oilatlr&le oongenitale et
h£r6ditaire. Nous. Icon, de la Salpttrtire, nov. -d6c. 1905, p. 666.

DREYFUS. Ueber traumatische Pupillenstarre. MUneh. med. Wodu, Feb. 20.
1906, p. 355.

ALBRAND und SCHRODER. Das Verhalten der Pupille im Tode. Marhold,
Halle, 1905, M. 5.

ADAM. Bin Fall yon Abduzensl&hmnng nach LumbalanAsthesierung. MUnch.
med. Woch .. Feb. 20, 1906, p. 360.

BLEGVAD. Bemerkungen liber Rinne's Verauch sowie liber die Bestimmung
der Perzeptionszeit yon Stimxngabeln. Nord. med. Ark., Afd. 1, H. 2, 1905.
WITTMAACK. tJber experimentelle degeneratiye Neuritis des Htimerren. ZexL
f. Ohrtnheilk., Feb. 1906, p. 161.

RANJ ARD. Le vertigo auriculaire. Thise. Jouve, Paris, 1905.

VON LEUPOLDT. Nachweis der Simulation yon Tsubstummheit duroh
Schreckwirkung auf akustische Raize. Klinik f. psych, u. nem Krankk, Bd. 1,
H. 1, 1906, S. 26.

HUET et LEJONNE. Paralyse facial et h6miatrophie linguale droites ayant
yraisemblablement corame origin© une poM©-#nc4phalite inf£rieure aigue andenne.
Bee. Neurol ., U y. 15, 1906, p. 105.

BAL1NT. Ein Fall yon Fractura baseos cranii mit seltener Nervenlkhmung.
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IISCEIAANEDCS ITMPTtHt-

STEINERT. Neue Beitrkge sur Lehre yon der Muskelatrophie bei supranudearen
Ltthmungen besonders bei der cerebralen Hemiplegie. Deutsche Zext.f. klin. Med.,
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NOICA et AVRAMESCU. Sur la pert© du Sens St£r6ognostique k topographic
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1906, p. 99.

FREDERICK BATTEN. Ataxia in Childhood. Brain, VoL xxriiL, Nos. Ill and
112, 1905, p. 484.

KRAMER. Die kortikale Tastl&hmung. Monatssckrift f. PsyckiaL u. Neurol ,
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VON LEUPOLDT. Zur Symptomatologie der Katatonie. Klinik /. psych, u.
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HUET. Reaction de d6g4n6resoenoe dans le releveur de la paupifere. Ann. <TElec-
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8IMONINI. Exostoses oet6og6niques de dAveloppement Nous. loon, de In
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LAUNOIS et TR&MOLIERES. Exostoses multiples Contribution h l'ltude des
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RUDLER et RONDOT. Scapula alata physiologiques. Nous. Jeon, de la Sal
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AUGUST HOCH. A Study of Some Cases of Delirium produoed by Drugs. Res.
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BERNHARDT: Die Betriebsanfule der Telephonistinnen. Hirschwald, Berlin,

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BTROM BRAMWELL. A Series of Lectures on Aphasia. Lecture IL Lancet ,

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DEBRAT. Aphasia sensorielle aveo hfarianopsie laterals homonjme droits.
Joum. de Neurol. j jan. 20,1906, p. 21.

SYDNEY J. COLE. On Some Relations between Aphasia and Mental Disease.
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HENNEBERG. Ueber unvollst&ndige reine Worttaubheit. Monatsschrift /.
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HENNEBERG. Ueber unvollst&ndige reine Worttaubheit. Monatsschrift /.
Psychdat u. Neurol ., Feb. 1906, p. 159.

1WEATMBHT*—

OSTWALT. Des injections aloooliques an nerveau des trous de la base du cr&ne
dans la n6vralgie facials rebelle. La Preset mid., f6v. 17 et 24, 1906.

JORDAN LLOYD. On Facial Neuralgia and its Curative Treatment by Excision
of the Gasserian Ganglion. Birmingham Med . Rev., Jan. 1906, p. 16. (To be
continued.)

HARVEY CUSHING. On Preservation of the Nerve Supply to the Brow, in the
Operative Approach to the Gasserian Ganglion. Annals qjr Surgery, Jan. 1906,

Norton PRINCE. Head Injuries. Boston Med. and Surg. Joum. , Feb. 15,
1906, p.182.

SACHS. Serious Head Injuries and the Indications for Operative Treatment.
Boston Med. and Surg. Joum., Feb. 15, 1906.

W. N. BULLARD. Indications for Operation in Head Injuries. Feb. 15, 1906,
p. 184.

* A number of references to papers on Treatment are included in the Bibliography under the
Individual Diseases.

IReview

tfleurolog^ mb ]p>s^cbiatr^

Original Erticles

ON TETANOID CHOREA AND ITS ASSOCIATION WITH
CIRRHOSIS OF THE LIVER

By Sib W. R. GOWERS, M.D., F.R.S.

A short outline of the first of the two following cases was given in
my “Manual Dis. Nerv. System,” vol. ii., 1888, p. 656, under the
designation “ Tetanoid Chorea,” and was quoted by Dr Ormerod
in an article (St Barts. Hosp. Rep. 1890) in which he described
a case somewhat similar, with cirrhosis of the liver, a condition
present in both the following cases. They were under observa¬
tion man y years ago, and their record has been waiting for other
facts that might elucidate their mystery, but waiting in vain.
They are now presented in the hope they may direct further
attention to these strange forms of disease.

In the first case the symptoms began in apparent health,
and consisted in changing spasm of a tetanoid character, ulti¬
mately becoming fixed in the extremities, attended with variable
pyrexia and emaciation. It was steadily progressive in course
and ended in death in six months. A careful examination failed
to disclose any organic disease in the nerve centres. Not the
least remarkable feature is the occurrence of analogous affections
in other members of the family, and their association in some,
with cirrhosis of the liver. 1

1 The notea of the case were taken by Dr T. Wilson, Resident Medical Officer,
now Obstetric Physician to the General Hospital, Birmingham.

B. OF N. & P. VOL. IV. NO. 4.— R

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ORIGINAL ARTICLES

The patient was a boy, Sydney M., aged 10, who was
admitted to the National Hospital for the Paralysed and Epileptic
on October 5th, 1886. His father’s brother is said to have
suffered from a similar affection at the age of 16, and to have
recovered after an illness lasting 12 months; a sister of his
father also had “St Vitus’ Dance” at the age of 16, which
lasted 3 months; two children of another sister also apparently
suffered from some form of chorea and recovered. The patient
was the eighth of 16 children, of whom 11 were dead, one
from consumption, the others, it was said, from bronchitis;
his eldest brother 1 was in the National Hospital six or seven
years before, and died from some form of paralysis at the age
of 15. The patient had never suffered from rheumatism. His
symptoms began three months before admission, without any
exciting cause. Clumsiness with his knife and fork first
attracted attention, and the awkwardness in moving the hands
gradually increased; spontaneous movement developed and
affected the legs as well as the arms.

On admission he was found well nourished. His heart was
normal. Constant, slowly changing movements in the limbs and
arms at once attracted attention. A contraction of the zygomatic
muscles caused a continuous smile, now greater on one side, now
on the other. The mouth was usually wide open and the tongue
retracted, but sometimes, by an effort, he could slowly protrude it.
The open mouth was due to spasm in the depressors of the lower
jaw. If told to shut his mouth he pressed the lower jaw up
with his hand beneath the chin, and after a moment or two the
spasm seemed to give way and he closed the mouth easily, but
in about a minute the spasm came on again and lowered the
jaw. The strong retraction of the tongue interfered much with
swallowing, because the tongue was pressed up against the hard
palate; liquids taken into the mouth ran out again, unless the
jaw were raised up; as the jaw began to descend again, he was
able to flatten his tongue sufficiently to allow the liquid to pass
into his throat, but the tongue immediately resumed its rigid
position. This process had to be repeated with each mouthful.

1 He was said, in the history of this patient, to have died in the Hospital. All
efforts to trace the case in the Hospital Records hare failed. In the history of the
sister’s case, to be given presently, he is said to have died at home, some months
after his discharge from the Hospital.

ORIGINAL ARTICLES

251

He seldom tried to apeak, but occasionally managed to utter a
sentence which could be understood, especially in the morning.
The spasm was always less after sleep, and worse as the day
went on. He almost constantly made a low whining sound.

The movements of the eyes were normal, but at times the
balls were rolled upwards. There was much spasm in the neck
muscles, especially at the back, so that the head was almost
constantly bent backwards; there was also strong spasm in the
sterno-mastoids. Occasionally, however, when he sat up in bed,
his back and neck were arched forwards so that his head was
between his knees.

Both arms presented slowly changing tonic spasm, greater in
the left The forearms were usually pronated; the fingers half
flexed at all joints, and the thumb also flexed. From time to
time the spasm increased, and then the elbows became strongly
extended, the arms adducted at the shoulder. Voluntary move¬
ment was interfered with by the spasm to a less extent than
might be anticipated; he could take hold of any object with a
little difficulty. At times the spasm changed so that the fingers
were spasmodically extended; occasionally they were spread out
and moved irregularly in a manner resembling athetosis, now and
then more quickly, but the constant tonic spasm prevented any
actual resemblance to ordinary chorea. It was always increased
by an attempt at voluntary movement, even when this could
be effected.

In the legs there was similar spasm, also a little greater on
the left side. The left foot was in constant strong extension at
the ankle, and inverted; the spasm could not be completely
overcome by passive force. It varied less than in the arms, but
occasionally passed off entirely for a short time. The right foot
presented very little spasm, but at times the leg was extended at
the hip and knee by spasm which came on gradually and slowly
passed away. At the hips the spasm occasionally changed to
flexion, and the leg, still extended, became flexed on the trunk at
an angle of about 60°. The boy was able to walk; the spasm in
the left foot generally prevented the left heel from reaching the
ground, but now and then relaxation of the calf muscles permitted
him to walk naturally. The abdomen was generally retracted
by spasm in the abdominal muscles, distinctly greater on the
left side.

252

ORIGINAL ARTICLES

When the body was spasmodically bent forwards the spine
presented one long curve, with a slight lateral deviation in conse¬
quence of the stronger action of the muscles on the left side.
The knee-jerk could be obtained on each side, but was slight,
apparently from the interference of the spasm. There was no
foot clonus. The plantar reflex was slight, the cremasteric
active; no abdominal reflex could be elicited. Mechanical irri¬
tability of the nerves was repeatedly searched for in the limbs,
but could not be found. Sensation was everywhere normal. He
complained of some pain in the dorsum of the left foot. His
optic discs were normal. His mind seemed unaffected. When
the spasm in the tongue prevented him speaking he would write
down the word he wanted to say, and evidently understood every¬
thing that was said to him. His urine was normal, and so, at
first, was his temperature. When he was asleep the spasm
passed away entirely, except in the calf muscles of the left leg ;
the mouth was closed.

During the first few days after admission a distinct improve¬
ment occurred, but after tbe first week he became rapidly worse.
His temperature rose to 100° and 101°; the spasm had the
same character but was greater, and became as severe on the
right side as on the left. He ceased to speak intelligibly and
became drowsy, and began to pass his urine and stools into the
bed.

On October 16th, attacks of spasmodic difficulty of breathing
came on. When lying moderately quiet, with the usual spasm
of the arms and hands, this would suddenly increase; the mouth
opened so widely that the jaw seemed subluxated, and went back
with a snap when the mouth was closed. As the jaw descended,
the breathing became quicker, and it was seen that the tongue
seemed to be drawn up almost into the throat, so as to impede
the breathing, until relieved by drawing the tongue forward and
forcibly closing the jaw. During the attack the face was flushed
but not livid. Such an attack, lasting half a minute, would
recur every four or five minutes. His temperature rose to 101*6°
and his pulse to 168. The attacks ceased on the application of
a spinal ice bag. Next day he was much quieter, the pulse fell,
but the temperature rose to 102*6°; in the evening the spasms
became very violent.

For the next fortnight the condition continued nearly the same,

Pi atk U>.

ORIGINAL ARTICLES

253

in spite of varied treatment. The temperature continued between
100° and 102°, and he rapidly lost flesh. Severe paroxysms
occurred, in which his respirations were 60 to 80 a minute. The
general spasm continued the same in general character, but that
in the hands became very uniform. Both were generally strongly
flexed at the wrist, the fingers semi-flexed but not forced into the
palm, the thumb adducted, the forearm supinated to its full
degree so that the back of the hand was downwards. The face
presented little spasm, except during the paroxysmal increase,
when his features were distorted. These attacks did not seem
to involve the legs, but the extreme extension of the feet con¬
tinued. The spasm no longer ceased during sleep, but continued
much as when he was awake; it seemed to cause little suffering.

A month after admission, some improvement occurred; he
became able to speak a little. The temperature was generally
about 100°. Emaciation continued; the muscles wasted, but
presented no change of electrical or mechanical excitability. In
the middle of November there was again an increase in the
spasm. The feet were strongly extended at the ankles and the
toee were strongly flexed. The spasm of the trunk was still
flexor; the body bent forwards, and the thighs flexed at the hip,
raising the legs off the bed, so that the patient seemed balanced
on the gluteal region. But after two weeks the spasm again
lessened, and such flexion of the trunk became rare, but the
plantar flexion of the feet and toes increased, so that the sole
became arched. The spasm in the arms continued, but
the flexion of the left wrist became less than that of the
right. During November the temperature varied, sometimes
normal for a day or two, then rising to 102°, 103°, or 104°.
The wasting steadily increased, so that the child was reduced
“ almost to a skeleton,” although a fair amount of nourishment
was taken. During the first fortnight of December the spasm
was definitely less and the temperature was lower, varying from
a little below to a little above normal; occasionally he would
talk a little. On December 17th his cheeks and supramaxillary
regions were found to be swollen and crepitated on pressure,
evidently from air in the cellular tissue. This condition spread
down the left side of the neck to the left axilla and left side of
the chest, but rapidly lessened in the next few days. The
evening temperature was generally 100° or 101°. The boy

254

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became rapidly weaker, ceased to swallow, mucus accumulated
in the chest. On December 22nd the temperature rose to 104°,
and he died, eleven weeks after admission, and about six months
after the commencement of the symptoms. Throughout, his
heart presented no murmur and the urine no albumen. The
position of the legs and arms produced by the spasm during
life continued after death.

A careful post-mortem examination was made, and a
thorough naked-eye examination of the brain, spinal cord, and
membranes revealed nothing abnormal. The heart was healthy.
The cellular tissue of the anterior mediastinum contained air,
which extended in front of the trachea, and down to the sub-
pleural tissue of the left lung near its root, whence it had
evidently escaped. The liver was noted to be “firm, hard,
lobular, light in colour, not greasy, and not staining with
iodine.” (It was evidently cirrhosed, although the significance
of this was not realised at the time.) There had been no jaundice.

Portions of the cortex of the brain, of the spinal cord,
peripheral nerves and muscles, were hardened and examined
microscopically by Dr Wilson, but no deviation from the normal
could be discovered.

Two years later, August 29th, 1888, the boy’s sister,
Charlotte M., aged 15, was admitted, because for nine months
she had been restless and lethargic, with some thickness of
speech and tendency for saliva to flow from the mouth. At the
onset the catamenia, established for eighteen months, had ceased.
She was a heavy-looking girl, with mouth generally open and
lower lip hanging down, easily excited to laughter. The tongue
was rather large, and when protruded had a slight tremulous
movement. There was nothing abnormal in the throat except
some congestion. She was able to walk well, the knee-jerks were
normal; there was no foot clonus, the optic discs were normal, and
no other symptoms were found. At the end of six weeks she was
sent to the Country Branch. But six weeks later, “ choreic move¬
ments ” commenced in the right leg, and extended to the other leg
and to both arms in a fortnight. She was readmitted on January
2nd, 1889. The movements increased during the month before
admission, and for a few days the legs had been drawn up,
flexed at the hip and knee, while her arms were extended and

ORIGINAL ARTICLES

255

raised above her head. Lying thus, there was constant regular
movement of the feet, the heels resting on the bed and the toes
sharply depressed and then raised; at the knees and hips there
were also slight flexor and extensor movements, moving the heels
up and down the bed for an inch or two. Similar rhythmical
movements occurred in the arms at the elbows. The trunk
muscles and those of the neck and head were free, and the face
was still. The tongue now presented no tremor or spasm, and
could be voluntarily protruded.

The movements varied in degree, and could be occasionally
stopped for a few seconds by voluntary effort 1 There was no
tenderness of the muscles or wasting. Passive movements
caused some pain, especially attempts to extend the legs. The
knee-jerks could not be obtained (perhaps from the spasm);
there was no foot clonus.

No derangement could be found in any cranial nerve, pupils,
eye movements, or optic discs. The heart was healthy. The
urine contained Jth albumen (casts are not mentioned). The
temperature was raised, and during the first three weeks it
frequently reached in the evening 103° or 104°. She steadily
lost flesh and became thinner and more feeble. The movements
continued, varying much in degree. At times the forearms
were brought in front of the chest, and moved rapidly in flexion
and extension.

The only medicine which had a marked effect on the move¬
ments was the hydrobromate of hyoscin, but toxic effects
prevented its continuance. On the evening of January 23rd
her temperature was 106‘2° (verified by several thermometers),
reduced to 100° by cold sponging. There was no delirium or
headache, the pulse was 180 and respirations 68, although no
morbid sign was presented by the lungs. The patient became
much more excited, and, apparently in consequence of this, the
movements became less violent. The heart sounds continued
normal, but bronchitic rales appeared. The albuminuria con¬
tinued. Twice again the temperature rose to 106°. Evacuations
were passed into the bed. She died on January 30th, the
temperature rising just before death to 108*4°.

Post-mortem examination revealed no morbid appearance in

1 It is perhaps worth while to point oat how readily and reasonably the
symptoms might have been regarded as “ functional,” i.e. hysterical.

256

ORIGINAL ARTICLES

the membranes of the brain; no sign of tubercle could be
discerned in them. The white substance of the hemispheres was
studded with minute "pits” the size of a pin’s head (the
significance of which is probably small). No other morbid
state could be discovered in the brain. The spinal dura mater
was, in places, adherent to the bone, but was not thickened, and
presented no other morbid appearance; in the lower dorsal
region there was a small extravasation outside the dura mater,
but there was no morbid appearance on its inner surface. The
spinal cord and sections of this in all parts appeared perfectly
normal to the naked eye. The heart was healthy. No sign of
tubercle could be found anywhere. In the lungs there was very
slight hypostatic congestion.

The liver, of normal size, presented the typical appearance
of cirrhosis. Strands of connective tissue enclosed yellow
lobules of various sizes rising above the level of the section.
The tint was found to be due to fatty and granular degeneration
of the cells. The condition of the liver led to careful inquiry
regarding alcohol, but it was found she had never taken it.
There is no record of a microscopical examination.

The case described by Dr Ormerod was that of a boy of 10,
whose symptoms ran their course to death in four months.
They bore considerable resemblance to those of Sydney M.
described above. There was similar tonic spasm, but apparently
it did not present the constantly changing character (which was
so marked a feature and suggested the resemblance to chorea).
The flexion of the fingers was less strong, and attempts to
extend the contracted muscles caused clonic contraction.
Towards the last the flexor contraction of the legs was such
that the knees were beside the chin, a form of spasm which was
only transient in the first case. There was the same irregular
pyrexia, less high. After death a small streak of softening
was found in the outer part of each lenticular nucleus,
presenting only leucocytal infiltration. Two minute spots of
softening, £ inch in diameter, were found in the pons. The
liver was in a state of extreme cirrhosis, fibrous tracts enclosing
lobules prominent on the surface, and many softened by
degeneration. As far as could be ascertained, there was no
reason to think that alcohol had been given to the boy.

ORIGINAL ARTICLES

257

Dr Ormerod quotes from Homdn (Neur. Centralbl., 1890)
a group of three cases in one family, two fatal, in which nervous
symptoms with contractures were associated with cirrhosis of the
liver. They began at 12, 20, and 26, and were far more
chronic in course than those above described. In the two fatal
cases, death occurred only after six and seven years. Extensive
changes were found in the nervous system—adhesions of the
membranes, thickening of the skull, dura mater, and pia mater,
and extensive softening of both lenticular nuclei Hom6n
reasonably assumes inherited syphilis to be the cause of the
morbid state and its manifestations.

In the two cases I have recorded no symptom of inherited
syphilis was noted. The number of deaths in early life may
have been due, more probably, to a tubercular tendency, since they
are said to have been caused by “ bronchitis,” and one death was
from recognised consumption. The probability of inherited syphilis
as the cause of the malady of the nervous system, rests entirely
on the significance of the hepatic cirrhosis, whether or not syphilis
is the only cause of the juvenile non-alcoholic form. Even the
assumption of this causation leaves the direct pathology as
mysterious as before. It is inconceivable, in the first case, and
most improbable in the second, that any coarse morbid process
could have existed and have escaped the careful examination to
which the nerve-centres were subjected. The facts seem com¬
patible only with a blood state as the cause of the symptoms.
The occurrence of benign chorea in distant relatives, though
possibly accidental, seems of similar significance.

But if a blood-state caused the symptoms, the question arises :
Were this and the cirrhosis of the liver the common effects of
one cause, or can the blood-state have been the effect of the
hepatic disease ? Anomalous as the last assumption may seem,
it cannot be hastily dismissed. In connection with the difference
in the character of the symptoms, there is also the association of
the higher fever in the second case with a greater degree of
disease of the liver. Toxic blood-states may be complex in
causation; one derangement of the chemical processes of the
system may induce others, the effects of which co-operate with
the first.

I have been unable to find that any other examples of

258

ORIGINAL ARTICLES

similar disease or a similar association have been recorded during
the last fifteen years, but references to any that have escaped
my notice will no doubt be welcomed by the Editors of this
Review. I hope that the belated publication of these cases may
induce the careful study during life, as well as after death, of
any that may be hereafter met with. The suspicions which
similar nerve symptoms should arouse, may lead to the discovery
of conclusive facts, not only after death, but during life.

THE PATHOLOGY OF GENERAL PARALYSIS OF THE

INSANE

By W. FORD ROBERTSON, M.D.,

Pathologist to the Scottish Asylums.

(The Morison Lectures for 1906.)

Lecture III.

Delivered on 29th January 1906.

General paralysis of the insane, and the obviously allied disease
tabes dorsalis, have in recent years probably given rise to more
discussion than any other morbid conditions that specially
manifest themselves in nervous disorders. There are at least
three special reasons for which it may be said that it is natural
that this should have been so. In the first place, general
paralysis and tabes dorsalis, both on account of their frequency
and of their gravity, are among the most important of all the
nervous diseases that the practitioner is called upon to treat;
in the second place, it may safely be said, even without risk of
contradiction from the most extreme advocate of the syphilitic
theory of the origin of these maladies, that there is very much
regarding them that has hitherto remained obscure; and, in the
third place, general paralysis and tabes dorsalis still rank among
the opprobria of medicine, for all efforts to combat them with
success have hitherto proved unavailing.

In discussing the problem of the etiology and pathogenesis
of these two diseases in the light of the investigations detailed
in the two preceding lectures, I wish, as far as possible, to avoid

ORIGINAL ARTICLES

259

a controversial attitude. My purpose is simply to endeavour to
show that a new and solid edifice can be constructed out of the
bets elicited by my colleagues and myself. A passing critical
reference to the syphilitic hypothesis is, however, unavoidable.
It is the only view of the etiology of general paralysis and tabes
that really conflicts with the one I am going to maintain.
There are many who think it is already thoroughly estab¬
lished, and if this is really so there is no room for any rival
explanation.

As remarked in the first lecture, there can be observed in
the recent literature of general paralysis and tabes dorsalis an
increasing dissatisfaction with the syphilitic hypothesis, and a
steadily growing conviction that the essential etiological factor
has yet to be discovered. The most able discussions of the
question that I am acquainted with are those that are to be
found in the recently published works upon insanity by Professor
Bianchi of Naples 1 and Professor Tanzi 2 of Florence. Professor
Bianchi recognises that syphilis is one of the causes of general
paralysis, but he does not admit that it is the specific etiological
factor. He attaches almost equal importance to alcoholism, and
enumerates also many other predisposing factors. He has
observed several cases in which general paralysis developed
during the secondary stage of syphilis, and this fact, he main¬
tains, is inconsistent with the view that general paralysis is a
tertiary or quaternary syphilitic infection. In common with
several other observers, he has seen cases in which general
paralysis has preceded infection by syphilis. Among numerous
other facts likewise tending to weaken the syphilitic hypothesis,
he mentions that he has observed some cases complicated by
genuine tertiary syphilitic lesions, which quickly disappeared
under antisyphilitic treatment, whilst the paralysis progressed in
the usual way. He emphasises the fact of the essential uni¬
formity both of the clinical picture and of the pathological
anatomy of general paralysis, and, recognising the difficulty in
making such uniformity harmonise with the view that the
disease has numerous different etiological factors, expresses the
opinion that it is possible that it may yet be demonstrated that
these various causes simply prepare the soil for a single intoxica¬
tion, perhaps of a bacterial nature; and in the facts recorded by

1 Trattato di Pnekiatria, chap. xxx. 3 Trattato deUc malattie mentali, chap. xiv.

260

ORIGINAL ARTICLES

my colleagues and myself regarding the evidence of constant
infection by a diphtheroid bacillus, he sees a possible solution of
the problem.

Professor Tanzi, whilst provisionally accepting the syphilitic
hypothesis as the one most strongly supported at the time of
writing, is obviously dissatisfied with it. Few, if indeed any
writers upon mental diseases have displayed so fine a gift of
critical analysis in handling scientific evidence. His examina¬
tion of the question inevitably leaves in the mind of the reader
the conviction that, whether the syphilitic hypothesis is in accord
with fact or not, the evidence upon which it rests is extremely
incomplete and of very doubtful value. He clearly shows the
necessity of invoking other etiological factors. He points to
features of the disease that prove it to be dependent upon the
action of some poison that gradually accumulates and then
becomes destroyed or eliminated. He shows that this poison
cannot be attributed directly to syphilitic toxines, and that
therefore it must be assumed that it results from a consecutive
auto-intoxication. He recognises the unsatisfactory vagueness
of this theory, and refers to the more positive evidence of the
occurrence of a bacterial toxaemia of gastro-intestinal origin,
brought forward in 1901 by Dr Lewis Bruce and myself, as
well as to some observations of Idelsohn upon the defective
bactericidal power of the blood-serum of the general paralytic.

On several occasions, either independently or in conjoint
papers, I have contended that the r61e of syphilis in the etiology
of general paralysis and tabes dorsalis is only that of weakening
the general and local defences, and that these diseases must be
dependent upon an active bacterial toxsemia. The facts that
seem to me to support this view are briefly the following.

Only a small percentage of syphilitics ever become general
paralytics or tabetics. General paralytics have been known to
become infected by syphilis, and it is extremely improbable that
this could occur if general paralysis were essentially a late
manifestation of syphilis. General paralysis may develop during
the secondary stage of syphilis, and this is inconsistent with the
view that the disease is either a tertiary or a quaternary mani¬
festation of syphilis. Numerous cases of general paralysis in
which previous syphilitic infection could be reasonably excluded
have been known to many competent clinical observers. Anti-

ORIGINAL ARTICLES

261

syphilitic remedies, so promptly efficacious iu tertiary syphilis
are useless or even harmful in general paralysis and tabes.
Statistics showing the high percentage incidence of previous
syphilis are quite inconclusive. They leave entirely open the
question of the occurrence of a secondary bacterial infection of
a different nature, predisposed to by the syphilitic infection, just
as tuberculosis is predisposed to by a previous attack of measles.
Some of the arguments used to support the syphilitic hypothesis,
as, for example, that drawn from the fact of the occasional occur¬
rence of conjugal paralysis or of conjugal tabes, would better
support the view that general paralysis and tabes result from a
special venereal infection distinct from syphilis. The syphilitic
hypothesis is devoid of the support of a single fragment of
experimental evidence.

The theory that the toxemia of general paralysis is a
secondary auto-intoxication, directly dependent upon the pre¬
vious action of syphilis, does not accord with the clinical and
pathological facts. These point most conclusively to a struggle
between the defensive forces of the individual, on the one hand,
and an aggressive bacterial foe on the other, and indeed furnish
evidence that places it beyond question that the general para¬
lytic suffers from an active bacterial toxaemia. I have already, in
the first lecture, referred to the evidence in support of this view
brought forward in 1901 by Dr Lewis Bruce and myself. I
have also described how Dr M‘Rae, Dr Jeffrey and I were
led, in 1903, to advance the hypothesis that in the production
of this bacterial toxaemia, which is beyond doubt a mixed
bacterial toxaemia, a diphtheroid organism probably plays a
predominant part, and how Dr M‘Rae and I, continuing to test
this hypothesis, have gradually ascertained fresh facts which
seem to us to warrant the conclusion that general paralysis and
tabes dorsalis are essentially dependent upon infection by a
special diphtheroid bacillus. The chief facts have already been
stated, and it remains for me now merely to summarise the
evidence in support of the conclusion that the bacillus paraly-
ticans is the specific etiological factor in the production of general
paralysis and tabes dorsalis, and to describe the morbid processes
to which it gives rise.

I would have it clearly understood that the question is, in
the meantime, left an open one whether this bacillus is merely

262

ORIGINAL ARTICLES

an attenuated Klebs-Loffler bacillus or an altogether distinct
micro-organism. The decision of this question is not in the
least vital to the argument that it is to follow. At the same
time, I would say that, in my opinion, the evidence bearing upon
the point is such as to render it probable that it will eventually
be determined that the organism is a special one.

The evideuce that this bacillus is the specific etiological
factor in these diseases is, in brief, as follows:—

A bacillus of this nature is, according to the results of our
investigations, present in large numbers in either the alimentary
or respiratory tract, or in both, and in the genito-urinary tract in
all cases of advancing general paralysis. This bacillus has a
thread form which has been found invading the walls of the
respiratory or alimentary tract in five cases of general paralysis.
It can be shown that this organism in its bacillary form invades
the pulmonary tissues in cases of general paralysis, and that it is
commonly the only micro-organism present in large numbers in
the catarrhal pneumonic foci that occur in most of such cases
dying in congestive attacks. A growth of a diphtheroid bacillus
has now been obtained in cultures made from the brain post¬
mortem in ten cases of general paralysis out of twenty-four in
which cultures were made from this organ. Diphtheroid bacilli
exhibiting metachromatic granules in Neisser preparations have
been detected in the fresh blood in one case and in sections of
the brain in two cases. It has been ascertained by experimental
methods that these diphtheroid bacilli in contact with the living
blood are rapidly taken up by the polymorpho-nuclear leucocytes,
and that they may be completely digested in the course of two
or three hours. Bodies exactly corresponding in appearance to
these dissolving bacilli can be detected in the blood and cerebro¬
spinal fluid of the living general paralytic, especially during a
congestive attack. Whilst the fact that most of the bacilli
present are in process of disintegration satisfactorily explains the
long succession of negative results of endeavours to obtain
cultures from the blood and cerebro-spinal fluid, we have, by the
use of special methods, succeeded in obtaining pure growths of a
diphtheroid bacillus from the fresh blood in four cases of general
paralysis, and from the cerebro-spinal fluid withdrawn by lumbar
puncture in two cases. In sections of the brain prepared by
special methods, disintegrating diphtheroid bacilli can be recog-

ORIGINAL ARTICLES

263

used in the walls of the vessels and in the pia-arachnoid in
many cases of general paralysis. The centrifuge deposit from
the urine of the general paralytic, especially during a congestive
seizure, commonly contains abundant diphtheroid bacilli that
have been more or less affected by lysogenic action (Fig. 6). In
seven consecutive cases of general paralysis combined with tabes,
we have found the centrifuge deposit from the urine to contain
not only these altered diphtheroid bacilli, but also living ones
showing distinct metachromatic granules in preparations stained
by Neisser’s method. In such cases a culture of the bacillus can
be obtained from the urine. Experimental infection of three
rats and a goat with diphtheroid bacilli isolated from a case of
general paralysis has resulted in the production of symptoms and
tissue-changes resembling those of general paralysis. Lastly,
there is evidence that the active polymorpho-nuclear leucocytes
of the general paralytic have, as a rule, a greater power of dis¬
solving these diphtheroid bacilli than that possessed by the
normal leucocyte. It would, therefore, appear that the general
paralytic has acquired against these diphtheroid bacilli a certain
degree of specific immunity, by means of which he is enabled to
maintain the struggle against these bacilli, notwithstanding an
otherwise defective local and general power of resistance.

I have next to answer the question, Does the view that this
bacillus is the specific etiological factor in general paralysis and
tabes dorsalis accord with the known clinical phenomena and
the ascertained facts regarding the pathological anatomy of these
diseases ? In my judgment it does. I shall first sketch the
pathogenesis of general paralysis as it appears to me in the light
of the foots that have been ascertained, and afterwards I shall
is a similar way consider the pathogenesis of tabes dorsalis.

The specific bacillus would appear to be conveyed from
individual to individual by contagion, although there are grounds
for believing that less direct methods of infection are not un-
oommon. It is capable of living as a saprophyte at the surface
of the various mucous membranes. There is ample warrant for
the conclusion that, to a person whose general and local defences
egainst bacteria are intact, the bacillus paralyticans is quite
innocuous. It can neither multiply to any important extent
upon a healthy mucosa nor penetrate into the subjacent tissues.
The case is, however, different if the bacillus becomes implanted

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upon the surface of a mucous membrane that has been damaged
in consequence of a long-standing catarrhal process, and more
especially if the general defences of the individual have also
become impaired. In normal conditions, epithelial surfaces, such
as those of the respiratory and alimentary tracts, are protected
from bacterial attack by a delicate layer of mucus, which has
been shown to have not only a mechanical action, but also to be
powerfully bactericidal (Arloing). As the result of certain forms
of prolonged chronic catarrh, the function of the mucous glands
tends to become exhausted ; various saprophytic bacteria, normal
or occasional inhabitants of the mucous tracts, are then liable to
assume a pathogenic r61e. They do so, either in consequence of
their excessive development at the surface of the mucosa and the
absorption of their toxic products, or by actual invasion of the
tissues. In cases of general paralysis a condition of severe
chronic catarrh is constantly present, either in the alimentary or
respiratory tracts, or in both. The mucous glands show marked
signs of exhaustion, and there is excessive development of the
common saprophytic bacteria. There are also good grounds for
believing that the general paralytic, before he manifests signs of
his disease, has suffered some impairment of his general defensive
forces. There is, at least, almost constantly a history of his
having been subjected to conditions that are known to cause such
impairment. There are very numerous inimical forces that may
produce such a condition of impaired local and general defence,
but there are three that seem to have special importance in
relation to general paralysis and tabes dorsalis. They are the
pathogenic agent of syphilis, alcohol, and a too highly nitrogenous
diet.

Syphilis is known to produce a severe drain upon the leuco-
blastic function of the bone marrow, whereby the general power
of resistance must be injuriously affected. It is also known that
it frequently determines the occurrence of chronic inflammatory
lesions of various mucous membranes, more especially those of
the mouth, throat, and respiratory tract In this relation, it is
perhaps not without significance that it has been ascertained that
the spirochaete pallida lodges within various epithelial cells,
including those of the bronchi.

The prolonged excessive use of alcohol, it is now well
established, not only impairs the general power of resistance to

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265

bacteria, but leads to severe morbid changes in the gastro¬
intestinal mucosa.

The prolonged excessive use of nitrogenous foods has also
a disastrous action upon the general power of resistance and
upon the local defences of the mucous membranes, as has lately
been demonstrated by the experimental researches of Dr Chalmers
Watson.

One or more of these three causes of impairment of the
general and local defences against bacteria are almost constant in
the individual history of the general paralytic.

It is upon such damaged mucous membranes that the bacillus
paralyticans is capable of effecting a permanent lodgment. The
organisms multiply in the catarrhal secretion, and also find their
way into the ducts of partially exhausted mucous glands. Such
saprophytic infection may continue for a long time without
leading to any important toxic effects. It is probably only when
the state of the local and general defensive forces is such as to
permit of the bacillus invading the tissues that the paralytic
toxemia becomes of any great intensity. Our more recent
observations have led Dr M'Rae and myself to attach special
importance to the bronchi as a seat of chronic infection, although
there are many cases in which bacillary invasion can be shown to
have taken place from the gastro-intestinal tract. As in the
case of other local infections, a veritable battle is waged between
the attacking organisms, on the one hand, and the defensive
forces of the individual on the other. It is virtually a life anc
death struggle between the bacilli and the polymorpho-nucleai
leucocytes. It is a conflict in which the leucocytes, after a long
succession of victories, are ultimately defeated, for their power of
renewal is limited, whilst that of the bacilli is virtually unlimited,
tf oreover, there is warrant for the belief that in the course of a
struggle of this nature, extending over many years, the virulence
of the bacillus, especially in respect of its power to invade, becomes
gradually increased. Under certain conditions the defensive forces
are temporarily placed at a disadvantage and the bacilli become
more aggressive. At least one of these conditions has been
ascertained experimentally. It has been found that lowering of
the temperature four or five degrees below the normal almost com¬
pletely suspends the power of the leucocytes to take up the bacillus
paralyticans. It is, therefore, reasonable to believe that lowering
s

266

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of the body temperature of the general paralytic is an important
cause of aggravation of the bacillary attack. Local invasion
manifests itself clinically in a congestive attack, characterised
generally by rise of temperature, always by leucocytosis and
aggravation of the mental and bodily symptoms. After a few
days, or a shorter time, the defensive forces, stimulated by the
attack, may gain the upper hand and repel the invasion. The
invaders are locally seized by the leucocytes and other phagocytic
cells and rapidly destroyed. Others are dissolved, not by intra¬
cellular digestion, but by the action of the bacteriolytic ferments
derived from leucocytes that have disintegrated. Large numbers
of the invading bacilli reach the circulation either by way of the
lymphatics, or more directly through the capillary walls. They
may be seen in the blood-stream in the neighbourhood of the
infective foci and also in films made from the patient’s blood.
In the blood, they are likewise quickly seized by leucocytes and
digested; but here, as in the infective focus, it is not always
the leucocyte that wins. There is evidence that very many of
these cells, after partially digesting a number of bacilli, succumb
to the action of the bacillary toxines and disintegrate, or at least
disgorge their captives. The bacilli thus liberated, and others
that have escaped the leucocytes altogether, pass out from the
blood-stream by one or other of at least two ways. One is
through the capillaries of the kidney into the urinary tract, and
the other is through the damaged endothelial lining of the
cerebral vessels into the adventitial spaces and other channels
that constitute the lymph-system of the brain. That micro¬
organisms which have reached the blood-stream are commonly
excreted by way of the kidneys is now a well recognised fact.
That it occurs in this infection has been demonstrated. Why
these bacilli should also be capable in certain cases of penetrating
the endothelial lining of the cerebral capillaries is certainly not
very easy to understand, but that they do so we can show. It
probably depends upon certain special structural features of the
cerebral vessels, as well as upon chemiotactic influences which
direct the bacilli towards the nerve-tissues, with which their
toxines most evidently combine. The disintegrating bacilli lodge
for the most part in the adventitial lymph-channels, but many
also reach the pia-arachnoid and subdural space. Within the
>ymph-channels of the brain, various endothelial and connective

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267

tissue elements exercise a phagocytic action and complete the de¬
struction of the bacilli. These micro-organisms have been seen
within lymphocytes in the centrifuge deposit from the cerebro¬
spinal fluid. The disintegration of the bacilli is attended by the
formation of intense toxines. There is thus a general toxaemia
resulting from the disintegration of the bacilli at the seat of
invasion and in the blood, and an added local toxic action
in the nervous centres, in consequence of the passage of the
partially disintegrated bacilli through the endothelium of the
cerebral vessels. The pathological changes that occur in the
nervous system, already briefly described in the first lecture,
are the result of this general toxaemia and local formation of
toxines.

In some instances a successful repulsion of an invasion is
followed by a prolonged period in which the bacillus is kept at
bay. Clinically this corresponds to a remission. More com¬
monly, however, there is a continuous comparatively slight
absorption of toxines from the infective focus and a succession
of more or less severe invasions, which time after time are
repelled ; in the end, however, the defensive forces are generally
overcome. There is then a fatal congestive attack. General
paralytics may, of course, die in other ways. In patients who
die in congestive attacks there is commonly a more or less ex¬
tensive catarrhal pneumonia. The catarrhal exudation is loaded
with diphtheroid bacilli in various stages of disintegration. In
other instances there is similar invasion from the stomach or
small intestine. If pyrexia precedes death for some days, the
bacillus tends to assume its thread form.

I come now to the subject of tabes dorsalis. That general
paralysis and tabes dorsalis are in some way intimately related
to each other is now so generally accepted that I need not argue
the question here. On the anatomical side, apart from the
systemic lesions of the posterior columns, there is in tabes
evidence of a toxic action in the cord similar to that which
occurs in the brain in general paralysis. There are two types
of cases that especially require to be considered. There are
cases of general paralysis which towards the end develop signs
of tabes dorsalis, or at least show in the spinal cord the early
changes characteristic of this disease, as indeed most cases of
general paralysis do; and there are cases of pure tabes dorsalis

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which, clinically at least, are not complicated by dementia
paralytica.

I think we aTe greatly helped to a right understanding of
this matter by the observations recently made by Drs Orr and
Rows 1 upon the production of tabetic lesions of the cord. They
have found that a systemic lesion affecting the posterior columns
can be produced as a result of absorption of toxines from a peri¬
pheral septic focus, such as a bed-sore, and that there is distinct
evidence that the toxines pass along the perineural sheaths of
the nerves to the spinal cord. The peripheral nerve fibres re¬
main unaffected, being protected by their neurilemma sheath, but
the toxines injure the nerve fibres of the posterior root at the
point at which they lose their neurilemma sheath, that is to say,
as they pass into the cord. This is the vulnerable point of
Obersteiner. They have also shown that the posterior column
lesions in general paralysis, which are simply early tabetic
lesions, start at the same point. These observations of Drs
Orr and Rows, which are founded upon experimental evidence,
as well as upon evidence drawn from cases, have confirmed the
view long advocated by Obersteiner, Redlich, Dr Alexander
Bruce and others, that in tabes dorsalis the systemic lesion
begins where the posterior root enters the cord. In order to
account for these lesions of the posterior root in general para¬
lysis and tabes dorsalis, it is necessary to ascertain the source of
the toxines that produce them. The morbid changes can in
part, but not fully, be accounted for simply by toxicity of the
spinal lymph. A peripheral toxic focus in close relation to the
pelvic retro-peritoneal tissues is also required. In cases of
general paralysis in which tabes supervenes, the toxic lesion of
the posterior roots is, I think, in most cases sufficiently explained
by the passage of disintegrating diphtheroid bacilli from an
infective focus in the respiratory or alimentary tract through
the blood and kidneys. In the urinary tract, further disintegra¬
tion of these bacilli occurs, and the toxines thus produced are
in part absorbed, and, entering the sheaths of the nerves, pass
up the lymph-channels and so reach the vulnerable point of
Obersteiner. In cases of pure tabes, in which there is an ex¬
treme degree of the same systemic lesion of the cord as that
which occurs in almost every case of general paralysis, the

1 Brain , Winter 1904 ; Review of Neurology and Psychiatry, January 1906.

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269

source and nature of the toxines causing this lesion should be
similar to those in general paralysis. In seven consecutive
cases of tabes dorsalis we have found the centrifuge deposit from
the urine to contain abundant unaltered diphtheroid bacilli, show¬
ing distinct metachromatic granules. Dr David Orr has at my
request kindly sent me films of the centrifuge deposit from one
case of simple tabes and from two cases of tabo-paralysis. In
all of these three cases the films also show abundant diphtheroid
bacilli with metachromatic granules. In these ten cases at least
there was therefore what may be termed a diphtheroid cystitis.
Whether this condition is constant in tabes dorsalis or not I
cannot say, but if further observations should confirm the testi¬
mony of these ten cases, then I think we shall be bound to
conclude that in tabes dorsalis there is in the urinary tract an
infective focus comparable to that which occurs in the respiratory
or alimentary tract in general paralysis. The bacilli are invad¬
ing, and therefore produce toxic effects far in excess of those that
result from simple passage of disintegrating bacilli through the
urinary tract. We have had an opportunity of examining only
one case of this kind post-mortem, and this so recently that
there has not been time to make a complete histological examina¬
tion ; but, so far as we have been able to study the case, it bears
out completely the view that in such cases a diphtheroid bacillus
has obtained a hold upon the mucosa of the urinary tract. I
may mention that in this case we readily obtained a growth of
a diphtheroid bacillus from the urine; some weeks later the
patient had a congestive seizure and we obtained a pure culture
of the same bacillus from his blood; the congestive attack
proved fatal, and we again obtained the bacillus in cultures from
the brain. Sections of the bladder show the thread form in¬
vading in characteristic fashion.

There are two supplementary points that I wish to deal with
very briefly. There are probably many who will find a difficulty
in the way of accepting these views in the fact of the frequent
presence of diphtheroid organisms in the alimentary, respiratory,
and other mucous tracts of persons who are not suffering from
general paralysis. I would recall such facts as that the Klebs-
Loffler bacillus in its virulent form may not infrequently be
found in the throats of healthy persons, and that the pneumo¬
coccus, which is the most common cause of pneumonia, can often

270

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be isolated from the saliva of people who are perfectly well. I
have already sufficiently insisted upon the importance of altera¬
tions in the local and general defences as a preliminary to the
pathogenic action of the baciUw paralyticans , and what I have
said should, I think, be a sufficient answer to this objection. It
should also, however, be borne in mind that many of the diph¬
theroid bacilli that occur in other conditions may have much
lower virulence than the micro-organism which we assert to be
the essential etiological agent in general paralysis.

It has lately been shown that many persons who do not,
strictly speaking, suffer from tabes dorsalis, nevertheless show
many of the physical signs of this disease. Dr M'Rae has made
observations which seem clearly to prove that a similar statement
may be made in regard to general paralysis. It is only the
more severe cases of this disease that are commonly recognised.
Very numerous other persons are apparently infected by the
specific bacillus, but resist it successfully, and show only very
slight signs of having suffered from the paralytic toxaemia.

If the etiology and pathogenesis of general paralysis and
tabes dorsalis are such as we assert them to be, how are these
diseases to be combated ? It is obvious that certain measures,
such as are taken in other chronic infective diseases, should be
adopted to prevent, as far as possible, the transmission of the
bacillus to susceptible persons. I do not, however, wish to say
more upon this point at present. Of more immediate interest
is the question whether or not there is any reasonable prospect
of these hitherto incurable diseases becoming amenable to treat¬
ment. On the ground of facts observed, I feel justified in
saying, with considerable confidence, that there is. The general
paralytic defends himself, and often with prolonged success, by
manufacturing specific bacteriolytic anti-bodies, with the aid of
which the invading bacilli are repelled. Such specific anti¬
bodies can be produced in suitable lower animals and used as
therapeutic agents, and it seems probable that with their aid it
may be possible to induce a prolonged remission of the paralytic
toxaemia. If this could be effected at an early stage of the
disease, the damage to the nervous system would be slight, and
the result might legitimately be regarded as a cure. Dr M'Rae
and I have for a considerable time been anxious to attempt to
produce an anti-serum of this kind, but hitherto the difficulties

ORIGINAL ARTICLES

271

ia the way have been insuperable. Thanks, however, to the
energy of Dr Clous ton, who has ever been ready to do all in
his power to facilitate these researches, and whose unceasing
interest in them has been one of the chief encouragements in our
work during the last four years, these difficulties have at length
been overcome. We are, at least, going to give such serum
treatment a trial.

Allow me to make three acknowledgments before I close.
I wish to express my indebtedness to Dr Harry Rainy for the
great trouble he has taken in connection with these lectures,
more especially in regard to the arrangements for the micro*
scopical demonstrations. I have also to thank Dr M'Rae for so
kindly relieving me of all trouble in connection with the laying
out of the microscopical preparations; and, lastly, I desire to
acknowledge my great indebtedness to the General Board of the
Laboratory of the Scottish Asylums, that is to say, to the
superintendents of the Edinburgh, Glasgow, Dumfries, Aberdeen,
Perth and other Scottish Asylums, as well as to the lay members
of the Board, for the facilities they have afforded my colleagues
and myself for the carrying out of these investigations.

Description of Figures.

Fio. 8.—Cell in alveolus of pneumonic lung showing two diphtheroid
bacilli in vacuole. From a case of general paralysis. Death in a
congestive attack. Carbol thionin. xlOOO.

Fig. 9.—Group of diphtheroid bacilli in blood-film taken from a general
paralytic suffering from a slight congestive seizure. Neisser’s method.
xlOOO.

Fig. 10.—Section of brain from a case of general paralysis, showing, in the
adventitial lymph spaces of a cortical vessel, partially dissolved micro¬
organisms, which, in the microscopical preparation, can, in many
instances, be recognised to have the characters of diphtheroid bacilli.
Acidulated methylene blue. xlOOO.

Fig. 11.—Section of kidney from a case of general paralysis. Shows, in a
convoluted tubule, micro-organisms morphologically identical with
diphtheroid bacilli, slightly altered by lysogenic action. Carbol
thionin. xlOOO.

Fig. 12.—Section of bronchus from a case of general paralysis. ShowB the
thread form of the diphtheroid bacillus invading. Carbol thionin. x600
Fig. 13.—Section of bronchus of rat fed for several weeks with bread mixed
with unsterilised cultures of a diphtheroid bacillus isolated from the
bronchus shown in Fig. 12. Shows similar invasion by the thread form
of the diphtheroid bacillus. Carbol thionin. X600.

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ORIGINAL ARTICLES

A CASE OF 078TI0ER0US CELLULOSAE OCCURRING

IN THE INSANE.

By H. EGERTON BROWN, M.D.,

Assistant Medical Officer and Pathologist, West Eoppies, Pretoria.

The following case of cysticercus cellulosse may be of interest,
partly on account of the large number and distribution of tbe
embryos, and partly on account of the rapid progression towards
amentia of the mental state of the patient, directly brought about
by the same.

P., a Kaffir, was admitted to West Koppies, Pretoria, in
October 1901. Physically, he was a fairly developed man and
no evidence of disease was detected. Mentally, he was a simple
dement with occasional outbursts of automatic violence; a
typical example of this very common, or possibly most common
form of mental disease among the native races of this country.
In August 1902 he had two fits of an epileptiform character.
During the last two months of his life it was noticed that a
number of tense elastic swellings had appeared under the skin;
some of these were excised and found to contain typical embryos
of taenia solium. During this time he became rapidly more
demented, and towards the end he bordered on a state of com¬
plete dementia, was unable to converse, took practically no
interest in his surroundings, and was wet and dirty in his habits.
The fits increased in numbers, acuto phthisis supervened, and he
died on October 13th, 1905.

Before describing the pathological appearances, it may be as
well to point out the bearing the condition had on the patient’s
mental state. The epileptiform seizures were evidently not in
the first instance caused by the embryo, although latterly, when
the fits increased in number and severity, these were brought
about without doubt by the cortical irritation of the growing
cysts. As regards the mental state proper, I have the authority
of Dr P. E. Todd, who has studied mental diseases among the
natives for many years, for stating that this common form of
insanity takes the form of a very slowly progressive dementia,
and that it never, unless there be some concomitant pathological
condition, reaches a condition bordering on amentia under eight

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273

to ten years following the onset of the primary dementia. The
depth of the dementia in this case is not to be wondered at
when we consider the large amount of brain substance which has
been destroyed and replaced by the cysts, and it is certain that
one of the commonest causes of amentia, namely destruction of
some of the higher association centres or their connections, must
have taken place. Another point on which I base my opinion
that the great exacerbation of the mental symptoms was directly
dae to the embryos, is the fact that these latter were all recent,
as none of their cyst walls were in any way calcareous.

As regards the mode of infection, the theory of regurgitation
of proglottides of the adult worm into the stomach, followed by
the liberation of the ova by the acid secretion of the stomach, may
be dismissed, as no signs of the adult worm were found either
during life or in the intestines at the autopsy. The more probable
cause was direct ingestion of some ova into the stomach by the
mouth, as the adult worm is of common occurrence among the
natives. (No further cases have occurred in over 200 natives
living under exactly the same circumstances since the above
date.)

Autopsy .—The body was much emaciated, and it was noticed
that lying immediately under the skin were large numbers of
small, tense, elastic swellings, 1 to 1*5 cm. in diameter; these, as
have already been stated, were found to consist of cysticerci,
which on examination showed the typical heads of taenia solium.
On examination of the voluntary muscles, it was at once noticed
that lying between, and in the same direction as the muscular
fibres, were large numbers of the cysts, which in this position
assumed a more elongated form than elsewhere. The pectorals
and deltoids appeared to be the most affected.

On removal of the calvarium, nothing abnormal was detected,
but on cutting through and raising the dura, it was noticed that
the cerebrospinal fluid was in excess, and that several typical
cysts fell away, but four large ones remained firmly attached to
this membrane, the largest measuring 2 cm. in diameter; this
was evidently one of the so-called racemose type. On removal
of the pia-arachnoid, as many as forty cysts fell away, while quite
twice this number remained attached to the membrane; in places
it was noticed that these left small depressions in the cortical
substance; here as elsewhere the cysts were not arranged in any

274

ORIGINAL ARTICLES

definite relation to the blood-vessels. In no place was the
pia-arachnoid adherent to the brain substance.

In the cerebrum, scattered all over the surface were numbers
of the embryo, on the surface of the left hemisphere as many as
seventy could be counted; here and there the cysts stood out
from the surface in such a way as to cause the walls of the
fissures to bulge apart; in others they were deeply embedded in
the cortex, giving the appearance of small dark dots on the
surface. It may here be stated that no one region of the cortex
suffered more than another. On cutting transversely through
one of the hemispheres, it was seen that the cysts occurred in
great numbers, and although they tended to keep towards the
surface, they were still to be found among the basal nuclei. In
the photograph of the above the invaginated heads can be well
seen. The greatest number to be seen in any one of these
sections was twenty-four.

As regards the lateral ventricles, a few cysts were to be seen
deep in the walls, but not projecting into the ventricles proper;
on the left side, however, a very large cyst was to be seen pro¬
jecting well into the ventricular cavity; this was the largest
found in the whole body, and measured quite 3 cm. The
choroid plexuses were free from embryos.

The cerebellum was in the same state as the cerebrum, but
fewer embryos in proportion to its size were to be seen. The
fourth ventricle contained no cysts. There were two large cysts
in the pons, and these could be seen forcing the grey bundles
apart. The medulla contained only one cyst, which was situated
just above the decussation of the pyramids.

The spinal cord was free from cysts. On excising and
making sections of the eye-balls, no cysts were found either
before or behind the retina.

On opening the pericardium, no cysts were to be seen on
the distal surface, but projecting from, and firmly adherent to,
the apex of the heart, one of the racemose type was seen, show¬
ing, as has been pointed out in “ Allbutt’s System of Medicine,”
that this form is probably due to the condition of pressure under
which it grows. On opening the heart, numerous cysts were to
be seen peeping out from between the muscular bands; and in a
place where one of the musculares papillares was cut through,
the whole internal substance of the same was occupied by a cyst.

ORIGINAL ARTICLES

275

The diaphragm, lungs, pleura, kidneys, spleen, liver, and the
intestinal walls were free from embryos. The intestines contained
no tsenidse.

In conclusion, I have to thank Dr P. Everard Todd, Medical
Superintendent, West Koppies, for permission to publish the
above case.

abstracts

PHYSIOLOGY.

DEGENERATIVE SECTION OF THE NERVES TO THE CATS
(124) BLADDER. T. R. Elliott, Joum. of Physiol., Feb. 5, 1906,
p. 29.

The author, working in Langley’s laboratory, found that division
of the inhibitory nerves of the bladder, whether inferior splanchnics
(preganglionic) or hypogastrics (postganglionic), produced in each
case the same effect, viz. diminished size of the viscus and in¬
creased tone of its musculature, and this tone was not, as in the
normal animal, at once depressed by section of the pelvic motor
nerves.

After preganglionic section of the motor nerve ( nervus erigens)
on one side, the half of the bladder affected soon regained tone, and
in the first week inhibition could be shown by stimulation of the
hypogastric of the same side. This inhibition was not affected by
the injection of nicotine, showing that the cell stations of these
inhibitory fibres lie in the inferior mesenteric ganglia. A fort¬
night after section, stimulation of the motor nerve of the other
side caused complete contraction of the whole bladder. This could
not be elicited after the injection of nicotine, and the author thinks
that it is to be ascribed to the outgrowth of preganglionic fibres
from the sound trunk to the decentralised ganglia.

Preganglionic section of both motor nerves paralysed micturi¬
tion, but there was always a good rhythm, which was at once
checked by stimulation of the hypogastrics (inhibitory), and in a
few weeks there was partial recovery. On the other hand, when
the bladder was denervated by picking off the ganglia from its
walls, the result was not the same as when the motor nerve cells
remained; the muscle now lost its rhythm and became immobile,
and did not respond well to faradisation.

Arguing by analogy, the author suggests that the ganglion cells
of the bladder (and other viscera) may correspond to the motor

276

ABSTRACTS

nerve endings of striped muscle, and that section of a motor
nerve to striped muscle may correspond to preganglionic section
in plain muscle. For example, the external sphincter ani muscle
(voluntary) after section of its nerves reacts easily to stimuli, and
exhibits rhythmic movements just as does the bladder after pre¬
ganglionic section of its motor nerves, but not after paralysis of
its motor end organs. Again, nicotine and curare both paralyse
ganglion cells and motor nerve endings, and Langley and Anderson
have proved that the preganglionic nerves of the autonomic system
are functionally interchangeable with the motor nerves to striped
muscle. Sutherland Simpson.

ON THE REACTION OF CELLS AND OF NERVE-ENDINGS TO
(125) CERTAIN POISONS, OHIEFLT AS REGARDS THE RE¬
ACTION OF STRIATED MUSCLE TO NICOTINE AND TO
OURARL J. N. Langley, Joum. of Pliys., xxxiii., 4 and 5,
Dec. 30, 1905, p. 374.

The hitherto generally accepted view that adrenalin and some
other substances act on the nerve-endings of unstriated muscle is
at variance with many of the observed facts. Lewandowsky found
that suprarenal extract had its usual stimulating action on the iris,
eye, and nictitating membrane three weeks after extirpation of the
superior cervical ganglion, and Langley confirmed his observations
and added others of a like nature. Dixon showed that apocodeine
paralysed post-ganglionic nerve-endings and abolished the action
of adrenalin, but not of barium chloride. Langley finds that many
muscles innervated by the sympathetic system react to adrenalin
when the nerve-endings are completely degenerated. The action,
therefore, seems to be neither on nerve-endings nor on plain muscle
directly. Elliott has proposed an explanation in the presence of a
new substance in unstriated muscle, which he calls the “myo¬
neural junction,” and which is the structure stimulated by adre¬
nalin. Langley believes that the substance acted upon by many
poisons is a part of the peripheral cell, and not necessarily the
junction of the nerve with the cell it supplies. The paper is the
outcome of an attempt to solve this question.

Fowls were used for the experiments, and the contractions of
one or both gastrocnemii registered graphically. Injection of
doses of nicotine into a jugular vein always caused contraction of
striated red muscle fibres—the gastrocnemii fibres are chiefly red—
even when their nerve supply has been divided. Where the nerve
supply is left intact, the nerve is paralysed by large doses of nico¬
tine, but the further injection of nicotine still causes contraction
and the muscle responds to direct excitation. The make of a

ABSTRACTS

277

galvanic current causes partial relaxation of the prolonged con¬
traction dne to the nicotine. The injection of curari annuls the
effect of nicotine: the two drugs are antagonistic. This looks
as though they acted on the same protoplasmic substance or
substances.

Langley believes that nicotine combines with one substance,
but with different degrees of completeness, according to the amount
of nicotine present. Each successive act of combination produces
a s tim ulation, but diminishes the excitability. The effect of the
nerve impulse is thus abolished, and when no further combination
can take place the further administration of nicotine also fails to
stimulate.

After complete degeneration of the motor nerves, nicotine gives
even greater effects on the denervated muscles, and the antagonism
of curari is less than usual.

Langley concludes that nicotine and curari act upon the muscle
substance, and not on the axon-endings. They do not prevent
response of the muscle to direct stimulation, so probably act, not
upon the contractile part, but upon some accessory material which
he calls the “receptive substance” of muscle. This receptive
substance presents considerable differences in different muscles
and in different animals. The embryonic muscle protoplasm pro¬
bably forms several receptive substances responsive to different
chemical stimuli. In all cells two constituents at least must be
distinguished—a substance concerned with carrying out the function
of the cell, and receptive substances liable to change, and capable
of setting the chief substance in action. Further, nicotine, curari,
atropine, pilocarpine, strychnine, and most other alkaloids, as well
as the effective material of internal secretions, produce their effects
by combining with the receptive substance, and not by an action
on axon-endings or on the chief substance. The receptive substance
is not developed solely in consequence of nerve union, and is not
confined to the myo-neural junction. Percy T. Herring.

ON THE METABOLISM AND ACTION OF NERVE CELLS.

(126) T. H. Scott, Brain, Autumn and Winter 1905.

The author endeavours in this paper to cast some light on the
function of the chromophile material of the nerve cell by an
examination for the presence of a similar substance in other cells.
As a result he finds that the only other cells in which a substance
is found in the protoplasm, with properties similar to those of the
Nissi bodies, are those which form the strong proteolytic ferments
of secretion, i.e. the chief cells of the fundus glands and the
pancreas.

278

ABSTRACTS

The Nissl bodies have in common with these ferment-forming
cells a large amount of highly organised iron-holding nudeo-
proteid in their cytoplasm, the Nissl substance corresponding in
its characteristics to prozymogen. The neurosomes in nerve cells
are morphologically homologous with the zymogen granules of
gland cells. There has been observed an interdependence between
the amount of Nissl substance and the number of neurosomes,
because activity in nerve cells leads to a diminution in chromo-
phile substance and increase in fuchsinophilous granules (neuro¬
somes).

The nuclei of nerve cells, cells of fundus glands of the stomach
and of the pancreas, resemble one another. There is much resem¬
blance too in their cell action, in that they are all concerned in
controlling changes in px*oteids.

On the above similarities the author concludes that nerve cells
also act by a kind of proteolytic ferment. David Orr.

TJEBEB DIE MATERIALLEN VERANDERUNGEN BEI DEE
(127) ASSOZIATIONSBILDUNG. Prof. Goldscheider, Neurol.

Centralbl Feb. 15, 1906, p. 146.

By association is understood the fact that when several impulses
reach different points of the cortex simultaneously or closely
related in time, the future occurrence of the one impulse may
recall the others independent of the corresponding external
stimulus. It seems that by the association of two impulses the
tracts and fibres situated between the affected centres come to
offer less resistance to conduction than the paths which connect
them with other centres, so that if one of the impulses is again
produced it does not radiate indiscriminately in all directions, but
discharges itself predominantly towards the other centre, which
it stimulates in the same way as did the previous impulse from
the periphery.

There has been hitherto no definite conception of the physical
basis of this process. For a time it was explained by the amoeboid
movements of the dendrites, but apart from the fact that this is
unproven anatomically, no such gross mechanical theory is
acceptable. Our conceptions are better stated in chemical terms,
and then it matters not whether the theory of continuity or of
contiguity of the nervous elements is accepted.

Vital activity, according to Hering, leads to dissimilation of
the protoplasmic molecules, assimilation follows during rest.
Hering’s theory is most easily applicable by the adoption of
Verworn’s Biogen - hypothesis. The Biogen - molecule is an

ABSTRACTS

279

assumed complex chemical combination, in a part of which
dissociation occurs during activity and restitution follows imme¬
diately. But, as Weigert has shown, nature is never content with
merely replacing the loss in such a condition, but attempts to
form an excess. (It is on this assumption that Ehrlich’s
Sittenketten theory rests.)

On the simultaneous stimulation of two related neurones there
is considerable dissimilation, as the activity of each reacts on the
other owing to the spread of the impulses from one into the other;
and if there be a succession of such stimulations, an hypertrophy
of the Biogen-molecules will occur at the points of junction or
contact of the two neurones, and will form a bridge across
which the future discharge of such impulses can more easily take
place.

When a series of cells, as generally happens, is simultaneously
excited, their contact points, with the hypertrophied Biogen
molecules, form a contact-point-line which represents the physical
basis for the facilitated spread of stimuli coming from different
cells. By this means an impulse which reaches the one cell can
easily affect the whole series, and it thus calls up in conscious¬
ness a picture of the associated impressions which were originally
received.

The discharge potentiality of the Biogen-molecules may not be
equal throughout the whole line. Therefrom results defective
memory and association; but by the further hypertrophy of the
Biogen-molecules from repeated stimulation these become more
perfect. Gordon Holmes.

THE PARALYSIS OF INVOLUNTARY MUSCLE. Part m. On
(128) the Action of Pilocarpine, Physostigmine, and Atropine upon
the Paralysed Iris. H. K. Anderson, Joum. of Phys., xxxiii.,
4 and 5, Dec. 30, 1905, p. 414.

Recent investigations do not agree as to the manner in which
pilocarpine, physostigmine, and atropine act on the iris. Anderson
has made a series of observations on the action of each drug when
used separately on the decentralised and denervated muscle of the
iris. The animals employed were cats, the iris being decentralised
by division of the oculo-motor nerve in the cranial cavity, and
denervated by removal of the ciliary and accessory ciliary ganglia.
After decentralisation, pilocarpine produces greater constriction of
the paralysed pupil; physostigmine has less action, but both drugs
constrict it for a longer time. After denervation, pilocarpine gives
an increased and abnormally long contraction; physostigmine,
however, does not stimulate the denervated sphincter. Pilocarpine

280

ABSTRACTS

can act, therefore, on the sphincter muscle substance, but physo-
stigmine on the nerve-ending only.

After imperfect regeneration of an oculo-motor nerve, physo-
stigmine restores the light reflex when it is not detected under
normal conditions ; pilocarpine does not. Physostigmine does not
increase the excitability or conductivity of the ciliary nerves or
ganglia, or of the regenerating oculo-motor nerve. Its action shows
that the impulses are blocked chiefly in the ciliary nerve-endings
during regeneration of the nerve.

The denervated sphincter, after several weeks or months, begins
to respond to physostigmine; and though there is no response to
light, or to stimulation of the ciliary nerves, the action must be
due to a regeneration, the exact nature of which is uncertain.

The nature of nerve-endings is shortly discussed. Pilocarpine
acts on a portion of the sphincter muscle which is not the con¬
tractile substance itself. Anderson suggests the term “ myoneure”
for that part of Elliott’s “ myoneural junction ” which persists in
the muscle after degenerative section of its nerve supply.

Percy T. Herring.

THE LAWS OF EROOGRAPHY, A PHYSIOLOGICAL AND
(129) MATHEMATICAL INVESTIGATION. (Les Lois do l'Ergo-
graphie, 6tude physiologique et math&natique.) Mile. J.

Ioteyko (of Brussels), Ann. d' Eledrobiol. et de Radiol ., No. 4,
1905.

VII. Sugar .—A short account of the ergography of sugar is
given as a preliminary, which shows that there are considerable
individual differences in its effect.

Dr Ioteyko herself experimented with three subjects; in none
of these cases did eau sucn-6 have any influence on the ergogram.
She then experimented again after imposing a fast of twenty
hours. In two cases there was still no result—-an interesting fact,
as it shows that even in these circumstances the liver is still able
to furnish abundant glucose; hence it appeal's that ergographic
fatigue must be due chiefly to poisoning by the products of com¬
bustion, and not to want of combustible materials.

In the third subject the fast took effect, and the administration
of glucose resulted in an ergogram which showed more than double
the amount of work recorded in the ergogram of inanition.

Sugar is known to be an aliment for the muscles, and not to
be an excitant for the centres. Therefore when the constants of
the mathematical equation to the sugar curve are calculated, a
diminution of a and c, which represent respectively the action of
the toxins and the exhaustion of the carbohydrates, ought to be

ABSTRACTS

281

shown. Iu effect this diminution does take place, and hence the
analysis of the curve serves to confirm the interpretation which
has been put upon the constants.

VIII. Anaemia of the Arm .—The effects produced by anaemia
are physiologically just the opposite of those produced by sugar.
As the circulation is stopped, supplies of glucose are not brought
by the blood ; moreover the toxic substances are not removed, and
in the absence of oxygen retain all their harmful force. Hence
ergographic fatigue in anaemia will be distinguished from that with
the circulation by a more rapid exhaustion of the carbohydrates
and swifter progress in the poisoning process.

Four experiments were tried, the anaemia being produced by a
strong rubber band round the middle of the arm.

When the constants of the equations to the curves obtained
are calculated, it is found that H (height of first contraction)
diminishes, while a (action of toxins), b (action of nervous centres),
and c (consumption of carbohydrates) all increase. The diminu¬
tion of H betokens that the available quantity of carbohydrates is
diminished ; the increase of c that their consumption increases.
The increase of a denotes the increased rapidity of the toxic
action. The increase of b, denoting the increased activity of the
nervous centres, is explained by the well established fact that in¬
creased resistance in the muscles acts as an excitant to the centres,
causing them to send stronger stimuli to the periphery.

Hence the behaviour of the constants is again in accordance
with expectation, and the experiment further strengthens the
mathematical theory of the writer.

IX. Caffeine .—The mechanism of the action of caffeine on the
muscles is not certainly ascertained, some writers maintaining that
it acts as an aliment, others believing that it affects the muscles
only through the mediation of the nervous centres. This fact led
Dr Ioteyko to apply her mathematical method to the elucidation
of the caffeine curve.

Her general conclusion from her investigation goes to confirm
the opinion of Parisot, who regards caffeine not as an aliment, but
as an excitant of the nervous system, allowing the reserves of the
organism to be called into play. If, however, the dose be a strong
one, or if a longer period be allowed to elapse between the admin¬
istration of the caffeine and the writing of the ergogram, then the
action is quite different. A phase of paralysis of the centre sets
in, hence the consumption of carbohydrates becomes slower and
more gradual, so that the contractions become lower, but at the
same time more numerous.

X. The Right Hand and the Left Hand .—To simplify the in¬
vestigation only right-handed persons were examined, the condi¬
tions, owing to education, etc., being much more complex in the

282

ABSTRACTS

case of left-handed persons. The distinctive characteristic of the
right hand ergogram, as compared with that of the left, is that the
average height of the contractions is greater. Two carves in which
this characteristic was well marked were chosen, and their con¬
stants calculated. The conclusion arrived at is that the pre¬
dominance of the right side in right-handed people is essentially
muscular, and arises from the fact that on that side a greater
quantity of carbohydrates is available. This fact may easily be
explained by the greater bulk of the muscles, by their more active
circulation, and by their training which enables them to observe
the most economical conditions of labour.

With all these researches very full tables of figures are given,
enabling the reader to reconstruct the curves and also to test the
mathematical work. The average difference between the height of
contraction observed and the height as obtained by calculation is
given in many cases, and never exceeds a millimetre and a half,
while as a general rule it is much less. Reproductions of many
of the curves are also given.

Margaret Drummond.

THE LAWS OF ERGOGBAPHT, A PHYSIOLOGICAL AND
(130) MATHEMATICAL INVESTIGATION. (Les Lois de l’Ergo-
graphie, 6trade physiologique et m&thdmatique.) Mile. J.

Ioteyko (of Brussels), Ann. cPElectrobiol. et de Radiol ., No. 5,
1905.

XI. Accumulation of Fatigue, or Residuary Fatigue. — This
section opens with a pretty full r^sumd of the facts bearing on the
question of the seat of fatigue. Professor Mosso, the inventor of
the ergograph, maintains, in his book on the subject, that fatigue
is nervous in nature. Dr Ioteyko believes, on the other hand,
that muscular fatigue is peripheral in origin. With the view of
establishing her point, she examined the constants in 37 curves,
written by 9 different people, to illustrate “ residuary fatigue."
This means that several curves were written, the interval between
them not being long enough to allow of complete restoration.

A practically constant feature of the curves is a decrease in
the quotient of fatigue ( i.e . the average height of the contractions).
If we accept the theory, first advocated by Hoch and Kraepelin,
that the height is more particularly the function of the muscles,
the number more particularly that of the centres, this in itself
would indicate that fatigue first attacks the muscles.

The constants of all 37 curves being calculated, the writer finds
that the most interesting results are: (1) the increase of a, showing
that residuary fatigue is muscular in origin, and is due to an

ABSTRACTS

283

Accumulation of toxic products in the muscle ; and (2) the increase
of b, showing that the nervous centres, far from showing fatigue,
are, by the very inertia of the muscle, roused to greater activity.
Thus in fatigue the toxic action of the products of combustion
plays a much more important part than does the failure of the
carbohydrates.

It should perhaps be pointed out that the testimony of the
figures is not quite so uniform as the text would seem to assume;
-as a matter of fact, a increases 18 times and b 17 times out of a
possible 28. We may observe, however, that every time but once
they vary in the same direction.

XIL This concluding section is devoted to pointing out a plan
for new researches, and to uiging on all workers the importance
-and far reaching power of the mathematical method inaugurated
by this paper. Thus, to give a single example, the writer points
out that in the different forms of paralysis, medullary, cerebral, or
peripheral, an examination of the constants (especially if the
healthy side can be compared with the side affected) will allow
the seat of the malady to be determined.

Margaret Drummond.

XI) SOME ILLUSIONS REGARDING REST IN ERGOGRAPHIO
(131) WORE; (2) THE MECHANICAL VALUE OF THE MENTAL
REPRESENTATION OF THE MOVEMENT; (3) THE
INFLUENCE OF ORIENTATION ON ACTIVITY; (4) THE
EFFECT OF A STANDING POSITION ON ERGOGRAPHIO
WORE; (5) THE EFFECT OF PRELIMINARY IMMOBILITY
ON THE WORE; (6) ECONOMY OF EFFORT; (7) VARI¬
ABLE EFFECT OF THE SLACKENING OF RHYTHM ON
WORE. Ch. F£r£, Comptes rendus des stances de la SocitU de
Biologic , T. lix. et lx., 1905.

These papers by M. Ch. Fdrd give an account of various series of
experiments made with Mosso’s ergograph.

M. Fdr6 finds that in his own case several influences, which we
would be apt to think might safely be disregarded, affect the ergo-
gram, and that to a considerable degree. Thus markedly different
results are obtained when the orientation is altered. A position
facing east or west is more favourable to work than one facing
north or south. Again, marked affection of the tracings follows an
immobility of the arm previous to executing the work. The arm
was placed in position and kept so for varying times; thereafter
twenty ergograms were written, a minute’s rest intervening
between every two. Five minutes’ immobility increased the work

284

ABSTKACTS

of the first ergogram somewhat, while fifteen minutes decreased it
by about six kilogrammetres. In this second case, however, the
ninth ergogram shows a greater amount of work than the normal
first. After an hour’s immobility no ergogram shows even one
kilogrammetre of work, i.c. they are all lower than the twentieth
ergogram when there is no preliminary immobility. The total
amount of work is greatest after an immobility of ten minutes.
Another series of experiments was tried to find how the positions
of standing and sitting affect the amount of work. Twenty ergo-
grams were written in succession in each position. The figures
obtained show that the standing position favours a greater amount
of work at the outset, but gives rise to more rapid fatigue, so that
the twentieth ergogram standing is not much more than a tenth
of the value of the twentieth sitting. Another very remarkable
series of experiments shows that the mental representation of
writing an ergogram immediately preliminary to the actual per¬
formance of the work may cause so much fatigue that the normal
ergogram cannot be written until the interval necessary for rest
has elapsed.

By another set of experiments the author shows that residuary
fatigue may exist in the muscle even when the ergogram shows no
sign of it. We generally consider that the muscle has been com¬
pletely restored when a second ergogram exactly like the first can
be written. M. Fdrd found that with intervals of rest of fifteen
minutes he could write eight ergograms equivalent to one another,
but the ninth gave only 4 41 kilogrammetres of work instead of the
normal 9 4, while the tenth fell to 0 78. This shows that fatigue
may be masked for a considerable time.

According to Maggiora, ergograpbic work may be prolonged
indefinitely if ten seconds are allowed to elapse between the con¬
tractions. M. F£r4 finds that with this rhythm, total exhaustion
supervenes in times varying, according to the weight, from 51
minutes to 81 minutes 40 seconds.

Further experiments on rhythm show that with a slower
rhythm (15 seconds as compared with 10 seconds) the number of
contractions and the work done decrease, whereas the average
height of the contractions increases. This fact shows that occu¬
pations requiring few movements, but necessitating continuous
attention, may give rise to fatigue just as surely as those which
appear more active.

If the rhythm is slackened still more, the same process goes on
with increased rapidity, the average height of the contractions
beginning to decrease also. When the rhythm is very slow the
attention is periodically relaxed, so that the fatigue must be due
to another factor, namely immobility. On the other hand, if
experiments with slow rhythms are tried when the muscle is

ABSTRACTS

285

already fatigued, then more work results than when it is not.
The influence of the rhythm is thus very variable and complex,
and more investigation is required to elucidate it.

A series of experiments with “ economy of effort,” that is, the
ergogram being stopped as soon as the sensation of fatigue appears,
shows that thus increased work may be obtained without a pro¬
portional loss of time. This is in accord with the fact demonstrated
by Mosso that the first part of the ergogram, though representing
more work than the second part, produces less fatigue in the
muscle. Margaret Drummond.

A FURTHER CONTRIBUTION TO THE STUDY OF MENTAL

(132) FATIGUE IN SCHOOL CHILDREN. Dr Joseph Bellei, of
the Board of Health, Bologna, Italy, The Lancet, Feb. 3, 1906.

The question whether the custom of holding afternoon as well as
morning school is a healthy one for the children is one which it
behoves educational authorities seriously to consider. Dr Bellei
affirms in the most emphatic way that “ the work done by the
children during the afternoon lessons is, on account of the great
mental fatigue that it involves, of no advantage to their instruc¬
tion, but is full of danger to their health.” This conclusion he
arrived at in 1900 as a result of a series of experiments on mental
fatigue during forenoon and afternoon school by means of the
dictation method. At that time the interval for rest was from
12 noon to 12.45 p.m. In 1905 a similar series of experiments
was tried, the interval for rest being then from 12 to 2 p.m. The
results in the two cases are so nearly identical as to show that the
longer period of rest has really no advantage over the shorter.
Moreover, “ the fact that the quality of the school work is almost
the same at 2.45 P.M. and at 3.30 p.m. proves that after three-quarters
of an hour of afternoon lessons the children are so tired that their
work is full of mietakes, and becomes only a little worse after
auother hour of lessons.”

Margaret Drummond.

PATHOLOGY.

PROOF OF THE EXISTENCE OF CHOLINE IN THE CEREBRO-

(133) SPINAL FLUID. (Preuve de l’existence de la choline dans
le liquids cfcphalo-rachidien h l’aide du microscope polarisant.)

J. Donath, Rev. Newrol., Feb. 16, 1906, p. 145.

The contents of the paper are identical with those of a paper by
the same author published recently in the Journal of Physiology,
Yol. xxxiii. No. 3, p. 311.

286

ABSTRACTS

In previous papers the author had tried to show that choline
is present in the cerebro-spinal fluid of patients suffering from
certain degenerative diseases of the nervous system, and in the
cerebro-spinal fluids of epileptics. Choline was supposed to be
present if an alcoholic extract of the cerebro-spinal fluid gave
a precipitate with an alcoholic solution of platinum chloride.
Characteristic crystals could be obtained by recrystallising the
precipitate. It was found, however, that ammonium and
potassium salts, which give similar compounds with platinum
chloride, are always present in the alcoholic extract.

In the present paper a new and more certain method of testing
the cerebro-spinal fluid for choline is detailed. It is based on the
fact that the crystals of choline platinum chloride, if crystallised
out of water, are doubly refracting, whereas the corresponding
potassium and ammonium compounds do not possess this
property. By means of the polarisation microscope one can
therefore distinguish between the crystals of choline platino-
chloride, which show double refraction and chromatic polarisation,
and the crystals of the platino-chlorides of potassium and
ammonium. Whereas the crystals of the latter substances are
not visible with crossed nicols, the crystals of the choline
compound appear bright or coloured in the dark field If now,
by rotating the table of the microscope, the angle of the optical
axis of the crystals with the plane of vibration of the polarised
light is altered, the crystals which were previously bright
disappear from view after a rotation through 45° and reappear
again after a further rotation through 45 s .

By means of this method the author examined the cerebro¬
spinal fluid of 27 cases of progressive paralysis, chronic myelitis,
idiopathic epilepsy, hystero-epilepsy, tubercular meningitis, tabes
dorsalis, syphilitic cephalalgia, etc. In most cases he obtained
positive results. W. Cramer.

RESEARCHES OH THE BLOOD OF EPILEPTICS. B. Onuf and
(134) H. Lograsso, Amer. Joum. of Med. Sciences, Feb. 1906, p. 269.

Several cases were subjected to daily blood examinations for a
long period in order to obtain definite data as regards the con¬
ditions in the intervals and in relationship to the attacks. Many
cases had to be rejected owing to night attacks or other factors
which might obscure the issues. In one case answering all the
requirements no change occurred in the behaviour of the erythro¬
cytes. The leucocyte count showed fluctuations in addition to
those of health. A leucocy tosis may occur before a seizure, but a
grand-mal seizure may occur without a preceding leucocytosis

ABSTRACTS

287

There is no exact parallelism between seizure and leucocytosis,
and an existing leucocytosis may reach its height at different
periods in different seizures. The leucocytosis is, in part at least,
independent of the seizures, and marked rises of the leucocyte
count do not necessarily mean seizures. When the intervals
between seizures are long, the fluctuations of the leucocyte count
are slight and are concentrated around the period of seizure.

Alexander Goodall.

▲ CONTRIBUTION TO THE HISTOPATHOLOOY OF CERTAIN
(135) FORMS OF P8Y0HO8I8 ALLIED TO DEMENTIA PREOOX.
(Contribution a l’histopathologie do certaines formes de
psychoses appurtenant a la Ddmence Prdcoce [Kraepelin].)

De Buck and Deroubaix, Le Nevraax, Vol. vii, F. 2, p. 161.

In the eight cases of dementia precox examined, the authors found
that the principal lesion in the brain consisted of a pigmentary
degeneration, together with a gradual atrophy of the neurones,
which resulted in the complete disappearance of the nervous
elements. The layers of the cortex most affected are those of the
large pyramidal and polymorphic cells.

The neuroglia showed a more or less pronounced reaction,
which, however, bore no definite relation to the various grades
and forms of dementia precox. The vessels were only slightly
affected.

These lesions, the authors suggest, depend on an auto¬
toxic action on a predisposed soil. The auto-toxines act very
much like the exogenous toxines, in that they produce in the
neurones a gradual degeneration which begins as a chromatolysis
and goes on to a complete atrophy and disintegration of the nerve
elements.

From the anatomical point of view, the authors suggest that
dementia precox resembles closely the exogenous toxic psychoses,
and especially that form which is produced by alcohol.

It is also somewhat similar to that which is found in epilepsy,
and in acute delirium and confusional insanity. In the last two,
of course, the lesion is much more acute.

Anatomically, therefore, dementia precox should be included
amongst the toxic parenchymatous cerebropathies, of which it is
one of the chronic forms; while the cases of acute delirium and
of confusional insanity represent the acute forms.

If this view be correct, we may say that the brain behaves like
the other organs of the body, and that toxines acting on it produce
regressive parenchymatous changes, which may be acute or chronic,
and which are not accompanied by diapedesis, by primary neuro¬
glial overgrowth, or by vascular change.

288

ABSTRACTS

If these last-mentioned changes appear, the case must be
placed amongst the organic cerebral lesions, such as meningitis
and progressive paralysis

The authors do not, however, approve of the division of these
dementias into the “ddmences organiques ” and “ d^mences
v&aniques” of Klippel and Lhermitte. They maintain, rather,
that the anatomical changes found prove the unity of certain
nosological groups, which exhibit differences of degree rather than
of kind, and they also throw some light on their aetiology.

Finally, they suggest the following anatomo-clinical classifica¬
tion of the acquired dementias:—

1. Dementia secondary to encephalitis and to new growths

2. Senile dementia.

3. Epileptic dementia.

4. Paralytic dementia.

5. Dementia, the result of exogenous toxines.

6. Acute dementia, acute parenchymatous cerebropathy.

7. Dementia precox, chronic parenchymatous cerebropathy.

R. G. Rows.

THE CONDITION OF MOTOR NUCLEI AFTER LESIONS OF
(136) THE PERIPHERAL NERVES ; AND THE PHYSIOLOGICAL
SIGNIFICANCE OF THE EDINGER-WE8TPHAL NUCLEUS.
(Ueber das Verhalten der motorischen Kemgebiete nach L&sion
der peripheren Nerven und iiber die physiologiscbe Bedeutung
der Edinger-Westphal’scher Kerne.) L. Bach, Ceniralbl. f.
Nervenh. «. Psychiat ., Feb. 16, 1906, p. 140.

Although it is generally recognised that destruction of a motor
nerve leads to the ultimate disappearance of the cells from which
it sprang, it is not an absolute rule; occasionally cells persist
indefinitely after their nerves are cut; on the other hand, if the
nerve be tom out its cells of origin almost invariably disappear.

After destruction or removal of an eye the third nerve nucleus
remains quite normal, and the author contends that it must be so,
as the ciliary ganglion, from which intrinsic muscles are supplied,
is a sympathetic ganglion. As this has, however, been denied, the
author undertook further experiments to prove his assertion.
About seven months after the removal of an eye with a consider¬
able portion of the third nerve, the midbrain was examined by
Weigert’s method, and it was found that the cells which supply
the external ocular muscles were degenerated. In the oral part of
the oculomotor nucleus almost all the cells in the same side had
disappeared, while in the caudal end the loss was chiefly in the
dorsal portion of the opposite nucleus. The Edinger-Westphal

ABSTRACTS

289

nucleus was normal. After a critical survey of all the facts which
can be obtained in the literature on the subject, the author comes
to the conclusion that there is nothing to support the view that
this nucleus is the centre for the sphincter pupillse. Koelliher
was probably right in not including this collection of cell in the
oculomotor nuclei. Gordon Holmes.

CLINICAL NEUROLOOT.

FACIAL PARALYSIS AND HEMIATROPHY OF THE TONGUE.
(137) (Paralysis facials et hlmiatrophie linguale droites ayant
vraisemblablement comrns origins un polioenclphalite inftrleur
aigue ancienne.) E. Huet et P. Lejonne, Rev. Neurolog .,
ttv. 16, 1906, p. 105.

The patient was a girl of 15, who, at the age of 3 years, in the
course of a febrile attack accompanied by convulsions, developed
facial paralysis on the right side. Later, transient ocular weakness
was observed, which passed off under electrical treatment. The
facial palsy persisted unchanged till she came under observation.
It was found to be flaccid in type, but with fibrillary contractions
and occasional paroxysmal twitching of the right labial commissure.
The palsy involved all the facial muscles, most markedly, however,
those supplied by the middle branches of the facial, attacking the
upper fibres less severely, and the lowest fibres least of all. The
tongue was slightly wasted on the right side, but without motor
weakness. The electrical reactions of the face and tongue were
normal. No other cranial nerves were affected, and the limbs
showed no abnormality of motor, sensory, or reflex functions.

The authors consider the phenomenon to be the result of an
old acute nuclear affection—a polio-encephalitis inferior, impli¬
cating the facial and hypoglossal nuclei on the right side. The
sudden febrile onset, with convulsion, supports such a hypothesis.
They consider the fascicular contractions in the paralysed muscles
as due to a degree of irritability in the cells of the facial nuclei.

Purves Stewart.

DU TABES TARDIF. E. Long and A Cramer, Rev. Neurolog., Feb. 15,
(138) 1906, p. 110.

In tabetics of advanced age, we have to recognise two classes of
cases: firstly, “prolonged tabes” in patients who, having presented
the first symptoms of the disease at the ordinary middle period of
life, have survived to old age; secondly, those in whom the disease

290

ABSTRACTS

first attacks the patient in advanced years. This latter class of
“ late tabes ” is the one to which the writers direct their attention.

Out of a series of 46 tabetics, 15 cases, or almost one-third,
commenced after fifty years, aud of these, 5 of them after sixty
years. This proportion is not claimed to be the ordinary one, in
fact it probably exceeds the ordinary figures.

Out of ten cases of tabes where a previous syphilis was
certain or probable, in four cases the syphilitic infection preceded
the first tabetic symptoms by from five to twenty years. In the
other six, the incubation period of tabes was much longer, varying
from 30 to 42 years.

In other cases, again, the lateness of the tabes was explicable
by the lateness of the age at which the syphilis was acquired.

Purves Stewart.

▲ STUDY OF THE LARYNX IN TABES. D. Crosby Green,
(139) jun., Boston Med. and Surg. Joum., Jan. 25, 1906, p. 97.

The author reports the result of recent examinations made by him
in sixty cases of tabes. These were observed with reference (1) to
the proportionate number affected with paralytic and other dis¬
turbances of the larynx; (2) to the nature of such disturbances;
and (3) to the period of their occurrence in the course of the
disease.

1. Out of the cases examined, 15 per cent, presented laryngeal
complications; 10 per cent, showed undoubted paralysis of one or
both vocal cords; 12 per cent, were affected with laryngeal crises,
three of these without evident paralysis of either cord, and in one
the cord moved from the median line in a jerky manner. (This
latter figure is small as compared with that of Dorendorf, of Berlin,
who found 4 per cent, with ataxic movements.)

2. Abductor paralysis was the only form seen. Of 6 cases, 5
were unilateral and 1 bilateral, being complete in 3 and only
partial in 3. In this latter connection the author points out that
partial abductor paralysis should not be diagnosed without
repeated examinations, Bince physiological variations in the degree
of the excursion of the vocal cords are met with. Contrary to
Semon, Dorendorf, and others, he found no case where, owing to
the rapid degeneration of the nerve, a complete recurrent paralysis
followed the abductor paralysis.

In 4 cases, laryngeal crises were associated with paralysis,
while in 3 there was no paralysis. In 1 case of bilateral abductor
paralysis the crises, when of three years’ standing, greatly
diminished in frequency and severity, owing, the author supposes,
to the weakening of the adductors.

ABSTRACTS

201

Differing from others, Dr Green found no case of real disturb¬
ance of laryngeal sensibility.

3. The laryngeal crisis when present occurred among the
earliest symptoms in all his cases, and in two of them (briefly
described), owing to a complaint of spasmodic cough, it led to
the examination of the larynx and the subsequent detection of
the tabes.

He infers that laryngeal paralysis is an early symptom of
tabes, but cannot say at what stage it occurs in the majority of
cases.

The practical conclusion to be drawn from this study is that
tabes as an etiological factor, either of vocal cord paralysis or of
spasmodic laryngeal cough, should never be overlooked.

J. D. Lithgow.

LANDRY'S PARALYSIS AFTER ENTERIC FEVER: RECOVERY.

(140) (Acute aufsteigende [Landry’sche] Paralyse nach Typhus
abdomiualls mit Ausgang In Heilung.) Schutzk, Berlin, klin.
Woch., Feb. 12, 1906, p. 201.

Casks of Landry’s paralysis following enteric fever have been
reported by Leudet, Curschmann, Kummell, Pitres, and Vaillard,
but the complication is a rare one, and is almost invariably fatal.
It is diagnosed from meningo-myelitis and syphilis of the spinal
cord by the absence of sensory symptoms and of muscular atrophy,
and by the retention of control over bladder and rectum; and
from ordinary polyneuritis, by the absence of pains, of electrical
changes, and of muscular atrophy.

Schutze’s patient was a soldier, aged 25, who was admitted to
hospital with a severe attack of enteric fever in which hypostatic
pneumonia and intestinal haemorrhage subsequently developed.
A week after the temperature had become normal he began to
complain of a sense of weariness in the legs. The temperature
rose again to 101°. The urine, hitherto clear, contained a trace
of albumen, and the spleen became again enlarged and tender.
A relapse was at first suspected, but there were no rose spots nor
typical stools. The next day the patient complained of severe
pain along the vertebral column, which was aggravated by touching
or tapping the spinous processes, especially in the lumbar region.
He was quite unable to move his legs or to sit up in bed. Passive
movements revealed a flaccid paralysis of the muscles of the pelvis,
abdomen, and lower limbs. Faradic excitability was preserved,
but was somewhat diminished in the calf muscles of the left leg.
The. knee-jerks were lost on both sides. The plantar, cremasteric,
and abdominal reflexes could be obtained, but were obviously

292

ABSTRACTS

impaired. Except for a small zone of complete anaesthesia on the
back of the light foot, tactile and painful sensation warn quite
unaffected. Slight convergent strabismus was present. The pupils
were equal and reacted to light The conjunctival and corneal
reflexes were present The sphincters were intact.

During the next two days complete flaccid palsy, first of the
right and then of the left arm developed. The electrical reactions
remained practically normal, and, with the exception already
mentioned, there was no impairment of sensation.

On the fifth day the respiration became laboured and there
was occasional Cheyne - Stokes breathing, but these signs of
threatening respiratory paralysis disappeared the next day, when
an ephemeral difficulty in articulation developed. There was no
affection of the palate, lips, pharynx, or eyes, but a slight left
facial paralysis of three days’ duration occurred. After complete
paralysis of the limbs, lasting for six days, power began to return,
first in the arms and then in the legs. Within a week from the
onset of the paralysis, the patient was discharged cured. There
was no evidence or history of syphilis, but he was nevertheless
subjected to mercurial inunction and the administration of potas¬
sium iodide internally for a fortnight before leaving hospital.

J. D. Rolleston.

DISEASES OF THE CONUS TEBMINALIS AND OF THE CAUDA
(141) EQUINA (TJber Erkrankungen des Conus terminalis und des
Cauda Equina.) R. BAlint and H. Benedict (Budapest),
Dent. Zeitschr.f. Nervenheilk., Bd. 30, H. 1-2, p. 1.

Six cases are described in this paper: (1) traumatic injury
destroying the cord from L5 downwards (confirmed by sectio);
(2) primary neuritis (?) of 3rd, 4th, and 5th sacral roots ; (3)
spina bifida, with involvement of parts of the roots of L5, SI, S3,
S4, and S5; (4) aneurism eroding through the sacrum and pressing
on 4th and 5th lumbar and 3rd, 4th, and 5th sacral roots; (5) men-
ingo-myelitis of SI, S3, S4, and S5; (6) neurofibroma of lower
lumbar sacral cord.

Localisation of the lesion in the conus or cauda is not always
easy, except in such cases as Nos. 3 and 4, where the site puts
out of the question an affection of the cord. Irregularities in dis¬
tribution of the sensory and motor disturbances are commoner in
cauda cases than in lesions affecting the conus.

It is noteworthy that in case 4 there were fibrillary twitchings
of the glutei, which, according to several writers, is purely a sign
of a conus lesion, while this was undoubtedly a radicular case.

ABSTRACTS

293

A foil analysis of the urinary, defsecatory, and genital symptoms
is given.

In every instance micturition was of the involuntary automatic
type of childhood, but with more or less residual urine. In no
case was there any real paralytic incontinence. The writers
favour L. R. Muller’s view that the automatic bladder centres are
not in the cord, but in the pelvic sympathetic, but little light is
thrown on the share taken by the lumbar and sacral parts of the
cord in the innervation of the bladder.

Defalcation was quite involuntary, but despite the paralysis of
the sphincter ani there was usually continence. That there is an
automatic centre functionating independently of the spinal cord
and lying in the sympathetic pelvic ganglia, is almost certain.

Little was learnt regarding the seat of the genital centres in
the male, but the two female cases (1 and 2) are of interest. Case
1 had a labour entirely painless; it would therefore seem as if for
the innervation of the body of the uterus (which, according to
Head, is supplied by the lumbar sympathetic) the 5th lumbar
rami were chiefly concerned. The centre for labour pains cannot
be in the sacral cord. As with micturition a spinal centre (in the
lumbar cord) cannot be entirely excluded, but taken in conjunction
with animal experiments it seems probable that such a centre is
confined to the pelvic sympathetic ganglia. Both patients, al¬
though ovulating normally, became absolutely frigid, apparently
from the complete anaesthesia of the lower part of the genital
passages. J. H. Harvey Pirie.

ANALYTICAL EXAMINATION OF THE SYMPTOMS AND ASSO
(142) OIATIONS OF A CASE OF HYSTERIA. (Analytische Unter-
suchungen der Symptoms und Assoziationen ernes Falles von
Hysteric.) F. Rikun (of Rheinau), Psych.-Newr. Wchmchr.,
Nr. 46-52, 1905.

This is an important contribution to our knowledge of the
mechanism of hysterical disorders, and is the result of two years’
observation and analysis of the case recorded.

Patient was a hysterical girl, aged 23, of moderate intelligence
and poor physique, who had had a most stormy life, full of revolt¬
ing sexual episodes; she suffered the first sexual trauma at the
age of 12, while menstruation began at 13. On the death of her
third illegitimate child, she was sent, at the age of 23, to the house
of correction for a year, was then admitted to a refuge for women,
and, owing to depression and suicidal ideas, was admitted to the
hospital for the insane.

294

ABSTRACTS

Physically, nothing objective of any importance was made out,
while patient had a great variety of subjective complaints, which
were the important element in the course of the disease. Among
these latter were severe pain in the side, cough, vomiting, pelvic
and abdominal pains, inability to walk, pain in the ear. Examina¬
tion of the patient in the hypnotic state showed that these symp¬
toms were the representatives in consciousness of subconscious or
submerged complexes of ideas connected with the various painful
episodes of her life. Her persistent vomiting was due to the
frequent associations which led to the submerged complexes,
based on outrages which had at the time caused vomiting or
nausea; patient herself was unconscious of this reason for the
vomiting, as the associations were split off and did not form part
of her conscious system of associations. For a long time milk
produced nausea and was refused, and she herself gave plausible
but superficial explanations: the real ground, as disclosed in the
hypnotic condition, was the fact that during an early outrage in
a barn a pail of milk was spilt; the incident, which in hospital
caused patient to refuse milk, had led by association to this sub¬
merged complex without bringing it to light. In a similar way
Riklin traced the mechanism of the other symptoms, and he shows
how experiences accompanied by deep emotion, and connected,
perhaps casually, with somatic symptoms, tend to be thrust into
the background of consciousness or submerged, and thus remain
as a foreign body or an irritant in the mind, having as their
representatives in consciousness various disconcerting symptoms.
When the hidden sore is touched, although the patient is uncon¬
scious of the mechanism, the conscious life is disturbed by an
unexplained disorder. Under hypnosis the deeper explanation
of the disorder is reached, and the ventilation of the split-off and
submerged complex tends to remove its noxious effect. The con¬
fession of the whole episode enables the patient to digest and
assimilate it, and this justifies the probing of the secrets of the
patient against her will: thus, after the elucidation of the basis
of her disgust for milk, patient lost her repugnance for it. This
gastric complex was one of many physical complexes correspond¬
ing to a well-defined system of split-off complexes.

The analysis of patient’s associations, tested by giving one
word and asking what other word that suggested, showed that
wherever the given word was related to a split-off complex the
reaction was abnormal in time or in other ways. Such abnormal
reactions enable one to come upon the trail of a hidden complex.

In conclusion, the author discusses the associative mechanism
of various forms of hysterical disorders.

C. Macfie Campbell.

ABSTRACTS

295

THE OUNIOAL HISTORY AND POST-MORTEM EXAMINATION

(143) OF FIVE OASES OF MYASTHENIA GRAVIS. E. Far-
quhar Buzzard, Brain , 1905, p. 438.

Dr Farquhar Buzzard has examined post-mortem five cases of
this disease, probably a larger number than has been examined by
any single observer up to the present time. In this paper the
clinical history of these cases and the histological findings are
described in extenso.

It is impossible in an abstract to do justice to this valuable
and interesting communication, which is one of the most important
contributions on the subject which has hitherto appeared, and
must of necessity be carefully studied by all those specially work¬
ing at the pathology of the disease. The author summarises his
conclusions thus:—

Clinical. —(1) That myasthenia gravis is a disease in which the
symptoms are not always confined to the motor system, but may
include others of sensory, mental, or other origin.

Anatomical. —(2) That in all probability it has a definite and
constant morbid anatomy, constituted by the presence of widely
distributed cellular, and sometimes serous, exudations (lymphor-
rhages) in the tissues and organs of the body.

(3) That slight muscle-fibre changes are frequent, and severe
muscular atrophy rare, occurrences in the disease.

(4) That proliferative and degenerative changes in the thymus
gland are frequently, but not constantly, met with.

Theoretical .—(5) That the symptoms of the disease are best
explained by assuming the presence of some toxic, possibly auto¬
toxic, agent, which has a special influence on the protoplasmic
constituent of voluntary muscle, and a less specialised influence
on the function of other tissues.

(6) That the relation of this toxin to the incidence of lymph-
orrhages and to thymic alterations is not clear.

The two very beautiful plates illustrating the morbid appear¬
ances in the muscles are deserving of mention.

Edwin Bramwell.

THE ASTHENIAS AND MYOPATHIC ATROPHIES. (Anthonies

(144) et atrophies myopathiques.) M. Klippel and M. Villaret,
Archiv. Gen. de Mid., Feb. 13, 1906.

The authors make an attempt to show that the whole group of
atrophic and hypertrophic myopathies, myasthenia gravis, Thom¬
sen’s disease, and family periodic paralysis are not only intimately
related but perhaps different manifestations of the same patho-

296

ABSTRACTS

logical process. A study of their paper suggests that they
commenced with this assumption, and then laboriously undertook
the task of giving it some semblance of reality by hunting the
literature for the most atypical examples of each disease, and
pointing out certain points of resemblance to other members of
the group. Such an undertaking might be considered bold if we
were in possession of complete knowledge concerning the origin of
each of these various morbid processes. In our ignorance of the
exact nature of any one of them, we must regard this piece of
work as distinctly premature and unsatisfying. Had Klippel and
• Villaret been content to intimate that, in their opinion, the
diseases mentioned above were all dependent upon some form or
other of disordered muscular metabolism, many observers would
probably not be prepared to quarrel with them.

E. Farquhar Buzzard.

A CASE OF CRURAL MONOPLEGIA, PROBABLY REPRESENT-

(145) ING THE EARLY STAGE OF A UNILATERAL ASCEND¬
ING PARALYSI8 DUE TO DEGENERATION OF THE
PYRAMIDAL TRAOTS. C. K. Mills, Joum. Nero, and Merit.
Dis., Feb. 1906, p. 115.

The case is that of a woman, 50 years old, with a history of
gradually increasing weakness of the right leg. When seen 14
months after the onset, she had moderate paresis of the entire
limb, more marked distally, greatly exaggerated knee-jerk, per¬
sistent ankle clonus, and Babinski response on the right side.
There were no sensory symptoms and no other detectable nervous
affection except (?) a very slight weakness of the right arm, and
increased knee-jerk and muscle-jerks on the left leg. Mills
believes that the case is best explained by degeneration of that
portion of the pyramidal tract which passes from the motor cortex
to the lumbo-sacral cord, and that it is altogether probable that the
disease will advance and involve the arm of the same side and
also the unaffected lower extremity. Reference is made to several
similar observations of unilateral ascending paralysis, due to
progressive degeneration of the pyramidal tracts—confirmed by
autopsy in one case. A. W. Mackintosh.

SEPARATE SENSORY CENTRES IN THE PARIETAL LOBE

(146) FOR THE LIMBS. W. G. Spiller, Joum. Nerv. and Ment. Dis.,
Feb. 1906, p. 117.

Spiller records the case of a man, 38 years of age, who, when ex¬
amined 17 months after being struck over the right parietal lobe

ABSTRACTS

297

with a club, exhibited the following condition: awkwardness and
ataxia but no paresis of the left arm; great impairment of the
sense of position, of the spacing sense and of stereognostic per¬
ception in the left hand, with slight diminution of the sensations
of touch, pain and temperature in this hand ; no affection, motor
or sensory (subjective or objective), in left leg or face or on right
side of body; no hemianopia; patellar reflexes not prompt. Par¬
esthesia had been present since the injury in the left hand, but
had never occurred in left leg or face.

Spiller is inclined to place the lesion in the lower part of the
parietal lobe and he believes that the case shows: (1) that sensation
may be affected from a cerebral cortical lesion, without motor
paralysis; (2) that the sensory alteration may be confined to one
limb, i.e. that the sensory centre for the upper limb must be
distinct from the centres for the face and lower limb; and (3) that
the alteration of the sensations of position and space and of
stereognostic perception is greater from a lesion of the parietal
lobe than is the alteration of the sensations of touch, pain and
temperature. A. W. Mackintosh.

HYSTERICAL STIGMATA CAUSED BY ORGANIC BRAIN
(147) LESIONS. Herm, H. Hoppe, Joum. Nerv. and Ment. Dis., Feb.

1906, p. 101.

Notes of two cases of organic cerebral disease are given in which
hysterical signs appeared. Remarks are made on the “ psychology
of hysteria.” Hoppe agrees with Oppenheim that all the pheno¬
mena of hysteria can be explained by “ an irritable weakness, an
abnormal exhaustibility of function of the brain cortex ”; there¬
fore, “ we may assume that the same protoplasmic changes of the
ganglionic cells which we assume to be present in neurasthenia
are also present in hysteria." “ I assume that hysterical signs
and symptoms which we see accompanying organic diseases of the
brain are the result of organic changes in the ganglionic cells ”—
these changes resembling very closely the conditions found in ex¬
haustion from functional activity, and being produced by such
results of the organic disease as increased intracranial pressure and
circulatory disturbances. The paper deals mainly with purely
“ theoretical considerations ” and assumptions.

A. W. Mackintosh.

A TAXIA IN CHILDHOOD. Frederick E. Batten, Brain, 1905,
(148) p. 484.

The paper deals with ataxia in childhood. The author excludes
from consideration ataxia occurring in association with Friedreich’s
u

298

ABSTRACTS

disease, with tumours or lesion of the cerebellum or mid-brain,
and with certain cases of diphtheritic paralysis. He divides his
cases into three groups—

(1) Congenital cerebellar ataxia .—Cases in which ataxia has
been noted early in life and in which there is a tendency to
gradual improvement.

(2) Acute ataxia. — Encephalitis cerebelli — cases in which
ataxia has suddenly developed after some acute illness in a child
who formerly had been quite healthy.

(3) Progressive cerebellar ataxia .—Cases in which a child has
been healthy till a certain age, and then has gradually developed
ataxia.

Two cases illustrative of the first group are given. Both
children exhibited marked ataxia of gait, which, during the three
years they were under observation, became less and less marked.
There were constant movements of the head and trunk and
marked inco-ordination of the hands. The articulation was jerky
—a very characteristic feature of the disease.

Under the second group five cases are described—two of
which were observed by the author, the remaining three by Dr
Voelcker, Dr L. Guthrie, and Dr Frederick Taylor. In the one
of these which may be taken as typical of the disease, the boy,
who had previously been perfectly healthy, developed measles.
During convalescence he had a series of convulsions followed by
unconsciousness for one week. On recovery he was unable to sit
up in bed without support, and showed the most marked ataxia of
his legs. Three months later he was still very ataxic, but eight
months later he had made some improvement; twenty mouths
after the onset of his disease he showed very little abnormality,
although his mother stated that his moral sense was still perverted.

The case recorded by Dr Frederick Taylor has especial interest,
for it shows that complete and absolute recovery may take place,
so that in adult life the patient is able to undertake and perform
the usual duties of life. A boy aged 4 years was first seen in
1875. He had had whooping-cough three weeks previously. He
had trembling of his limbs and trunk which closely resembled
disseminated sclerosis. In 1878 he had considerably improved,
but his speech was still imperfect. In 1904 he was 33 years old,
and no sign of his former complaint existed. He was an active
and busy man.

Under the third heading, progressive cerebellar ataxia, two
cases are described in which ataxia, starting at the age of 9 and
13, slowly and steadily progressed. The close relationship of this
group to Friedreich’s disease and to hereditary ataxia is recog¬
nised, but the cases recorded differ in many particulars from these
diseases.

ABSTRACTS

299

The pathological evidence for regarding these cases as due to
cerebellar lesions is then discussed. It is shown that changes in
the cerebellum are the most constant feature in this affection,
though such changes are frequently accompanied by other lesions
of, or lack of development in, the cerebrum, pons, medulla, or spinal
cord. It is known that almost complete atrophy of the cerebellum
may exist without giving rise to any symptom, and in explanation
of this fact the author quotes the work of Luciani, who showed
that animals rapidly recover from symptoms produced by ablation
of the cerebellum if the cerebral cortex remained undamaged; but
if the cerebral cortex was injured in the region of the opposite
gyrus sigmoidte, then the symptoms produced by removal of the
cerebellum persisted.

The diagnosis from disseminated sclerosis, quiescent cerebellar
tumour, and hydrocephalus is discussed.

The prognosis with regard to the congenital cerebellar ataxia
and the acute ataxia is relatively good, whereas the prognosis in
the progressive cerebellar ataxia is bad, but some cases of this
latter group run a very prolonged course.

Author’s Abstract.

OOBTICAL TACTILE PABALTSIS. (Die korticale Tactlfthmung.)

(149) Franz Kramer (Breslau), Monatssch. f. Psych, u. Neurol ., Feb.

1906, p. 129.

In this paper the author goes into the question of the relationship
between pure tactile sensation and the other forms of sensibility
(particularly the sense of position and the sense of movement)
with regard to the perception of tri-dimensional form. A number
of cases are detailed in which there were disturbances from cortical
lesions of tactile sensation with more or less affection of other
sensory qualities. One case in particular he regards as a practi¬
cally pure tactile paralysis—the sense of movement was slightly
impaired, the perception of simple touch was perfect, and the power
of localisation was intact, but there was complete failure of the
power of recognising the shape and form of objects. Such loss of
the stereognostic sense he considers due to a disturbance of cortical
association, so that there is failure to combine the successive tactile
pictures coming from the periphery into what becomes a sensation
of form. In other cases the loss may be due to failure to com¬
bine the two dimensional stimuli coming from the skin with the
sense of position of the perceiving fingers. But all such pure
tactile paralyses must always be the result of a superficial cortical
lesion—deeper affections cause in addition (inter alia) disturbances
of other forms of sensibility. J. H. Harvey Pirie.

300

ABSTRACTS

ON THE PRESENCE OF KBRNIG’S SION IN HERPES ZOSTER.

(150) (Sur la presence dn signs de Kernig dans Is zona.) Raymond
Belbeze, Arch. OH. de Mid., Feb. 27, 1906, p. 520.

During the past four years the writer has seen nineteen cases of
herpes zoster; and in examining them, has been on the outlook
for any sign that would give clinical support to the hypothesis
that the disease is of central nervous origin. Pathological evidence
and theoretical considerations are in favour of this view of the
etiology, and the arguments brought forward against it are of little
weight. Of the nineteen cases recorded, two showed an absolutely
definite Kernig’s sign. Both patients were healthy women past
middle life, and in both the eruption was on the abdomen. One of
them at the onset of the disease was suffering from a very severe
and intractable attack of constipation. It was impossible to be
sure that Kernig's sign had not been present before the attack;
but it was observed that it became gradually less marked as the
eruption subsided, and disappeared entirely with recovery. The
writer strongly opposes the theory advanced by M. Amaducei
(U Policlinico, 1905) that Kernig’s sign is the result of a peripheral
irritation acting on a normal centre, on the ground that were the
centre in a normal condition it could not, when stimulated from a
peripheral source, give rise to a pathological manifestation.

Henry J. Dunbar.

BULBAR SYMPTOMS OCCURRING WITH CARCINOMA OF
(151) PARTS OTHER THAN THE NERVOUS SYSTEM, AND
RESULTING FROM INTOXICATION. T. H. Weisenburg,
Univ. of Pennsylvania Medical Bulletin, Jan. 1905.

Cerebral symptoms may occur in persons suffering from carci¬
noma of internal organs. Aphasia, convulsions, hemiplegia, or
monoplegia are commoner than paralysis of cranial nerves and
bulbar symptoms.

Indications of bulbar palsy are the least frequent. Invasion
by microscopic metastases, especially in the pia mater, vascular
changes, and toxic influences are the supposed causes. Weisen-
burg relates the case of a woman, set. 59, who suffered from recur¬
rent carcinoma mammae. Five months before death difficulty in
swallowing was noticed, and chromatolysis was found in the cells
of the nucleus ambiguous and of the dorsal vagus nucleus, and a
lesser alteration in the cells of the nuclei of the glossopharyngeal,
facial, and abducens nerves. The author gives some review of the

ABSTRACTS

301

literature. The abstractor described a comparable case iu this
journal, published after the appearance of Weisenburg’s note.

W. B. Warrington.

SPINDLE-SHAPED ENLARGEMENT OF THE BLIND SPOT
(152) ASSOCIATED WITH CONGESTION OF THE OPTIC DISC.

A. Maitland Ramsay and W. M. Sutherland, Ophthalmic
Review, Jan. 1906.

The authors of this interesting and important paper, while using
Bjerrum’s screen in testing the state of the field of vision in a case
of sympathetic ophthalmia, demonstrated the presence of a vertical
spindle-shaped elongation of the blind spot associated with con¬
gestion of the disc. The condition of the blind spot was deter¬
mined by the same method in five cases in which congestion of
the disc was found with other evidences of sympathetic ophthalmia,
aud in each case vertical spindle-shaped elongation of the blind
spot was found. Reference is made to the normal appearance of
the blind spot as demonstrated by this method. The surrounding
amblyopic zone, which in health shows irregular extensions at the
upper and lower margins where the large vessels pass from the
disc, is described. The figures given show how remarkable is the
change in the shape of the blind spot.

In the normal the vertical diameter is to the horizontal as
6 to 4. In the cases of sympathetic ophthalmia examined, the
horizontal diameter remains unchanged, but the vertical becomes
much increased. In the five cases examined the relative increase
of the vertical diameter is represented by the following figures:
First case, 12 to 4; second, 12 to 4; third, 10 to 4; fourth, 12 to
4; and fifth, 18 to 4.

The opinion of the authors as to the clinical importance of this
change in the blind spot may be gathered from the following
passage in their paper: “ If, then, in a case of infected wound,
or of degenerative change in one eye, its fellow began to give
trouble, no matter how slight, and careful examination showed a
congestion of the disc with characteristic enlargement of the blind
spot, the sign would in our opinion go far to determine the ques¬
tion of the immediate enucleation of the exciter.

The explanation offered for the appearance of this change in
the shape of the blind spot is, that the congestion of the disc and
tuTgescence of the large retinal vessels accentuate and increase
the extensions of the amblyopic zone round the blind spot, which
normally are met with at the upper and lower margins, and thus
the spindle-shaped enlargement in the vertical diameter is
produced. A. H. H. Sinclair.

302

ABSTRACTS

CONGENITAL AND HEREDITARY BILATERAL OPHTHALMO-
(153) PLEOIA EXTERNA (OphthalmopMgie externe bilat^rale
conglnitale et h6r6ditaire.) J. Chaillons et P. Paonikz,
Nouv. Icon, de la Salpit., nov.-d&s. 1905, p. 666.

In this paper, notes are given of four cases of ophthalmoplegia
externa occurring in three generations of the same family. In the
first and second generation, malformation of the anterior part of
the cranium, and immobility of the frontal portion of the occipito¬
frontalis muscle, were found as concomitants of the ocular
condition.

In all four cases the eyes occupied a position of divergence.
The vertical movements were absent, and convergence was only
observed to a very limited degree. Nystagmus was present in all,
and in some corneal opacities were found. The pupil reaction was
normal in all, and accommodation so far as could be ascertained
was normal also.

The first patient had a good hereditary history, but three out
of her seven children had ophthalmoplegia externa, and one of the
three became the mother of a child also affected with the same
condition.

The authors regard the lesions in the cases they describe as
probably nuclear. They affirm that the results of several post¬
mortem examinations in similar cases give support to their view
that a developmental defect in the oculo-motor centres is present
in these cases. A. H. H. Sinclair.

PSYCHIATRY.

A STUDY OP DEMENTIA PRjEOOX. D’Orsay Hkcht (of Chicago),
(154) Joum. of Nero, and Ment. Dis., Nov. and Dec. 1905.

The literature, from Heinroth(1818)to Kraepelin (1904), is briefly
reviewed, for the purpose of pointing out the different phases in
the evolution of this disease picture. Hecker in 1871 contributed
his masterly work on “ Hebephrenia,” the chief features of which he
correlated as follows:—“ Onset in close succession to puberty; the
appearance, alternately, of melancholy, maniacal and confused
states; a speedy psychic decline, with its finality in terminal
dementia, which may be anticipated from the first.” Kahlbaum
followed with his “ Heboidophrenia,” a curable type of “Hebe¬
phrenia,” and later with his classical paper on “ Katatonia.” Tuke
in 1879 referred to the psychic disturbances which developed at
puberty, and led to progressive mental weakness. Clouston in

ABSTRACTS

303

1838 insisted that the essential feature of many adolescent cases
was the tendency toward dementia from the first Hecht then
enumerates in chronological order the contributors whose works
have materially enriched the literature on this subject since 1883.
The latest, the most original, and the most illuminating contribu¬
tion to the study of this series of disease pictures has been fur¬
nished by Kraepelin. With one sweep Kraepelin has correlated
certain maniacal states, depressed states with stupor and catalepsy,
bizarre attitudes with delusions and hallucinations, to form one
comprehensive group, “ Dementia Pnecox,” whose termination is
in a special form of mental reduction. This group corresponds to
the Adolescent Insanity of the English, the Dementia Primitiva of
the Italians, the Jugendirresein of the Germans, the DtSmence
Prdcoce of the French, and the Primary Dementia of the Ameri¬
cans. The general symptomatology of Dementia Praecox with its
clinical types is considered, and brief cases are introduced to illus¬
trate each type. Pathological research has revealed little, hut the
changes noted have been suggestive enough to stimulate still
keener investigation. The prognosis for recovery is better in the
katatonic and hebephrenic than in the paranoid type of the disease.
The existence of a paranoid type as a division of Dementia Praecox
is contested by many. The differential diagnosis from circular
insanity, paranoia, and general paralysis is sometimes difficult,
because of the numerous and varied symptoms which this disease
picture may present. C. H. Holmes.

the TIME OF SOME MENTAL PROCESSES IN THE RETARDA-
(155) TION AND EXCITEMENT OF INSANITY. Shepherd
Ivory Franz, Am. Joum. of Psych., Jan. 1906.

Franz states that this work was undertaken in order to aid in the
solution of the problem, to what parts of the nervous system can
the decreased and increased psychomotor activity found in manic
depressive insanity be referred ? He reviews briefly the clinical
symptoms of this form of insanity, and adds the histories of six
subjects used in his experiments—two normal, two retarded, and
two exhilarated subjects. The experiments deal chiefly with the
time consumed in certain mental processes, and their object is to
determine the amount of slowing in the retarded, and the increase
in ability of the exhilarated subjects. Seven kinds of experiments
were made: (1) the time of rapid tapping; (2) the time of simple
reaction to sound; (3) the time of choice reactions to sound; (4)
the rapidity of reading; (5) the time of discriminating and marking
out letters; (6) the time of adding; (7) the time of discriminating
and distributing coloured cards. Results are grouped by weeks,

304

ABSTRACTS

and the weekly averages are collected into tables. The number of
experiments varied from 5 a week in the tapping-time, to 100 a
day in the reaction-time experiments. Franz concludes that the
exhilarated patients do not show a consistent increase in speed
over the normal or the depressed patients. Therefore the maniacal
state is simply an increased motor diffusion, and not an increased
motor ability. The retarded subjects were slow in the beginning,
but the retardation was not regular throughout the series of
experiments.

In the complex processes the retarded subjects took propor¬
tionately less time than they took for simpler acts. The exhilarated
subjects kept the normal relations. The movements of the retarded
subjects became more rapid after practice. Systematic exercise
will not cure the depression, but it causes improvement by lessen¬
ing the retardation. The habit of slowness may be replaced by an
activity habit developed through exercise. It is probable that
retardation does not come at the beginning of the movement. The
supposition that retardation may be due to a general lowering of
the irritability is unsatisfactory, because it has not been settled
just where this lowered irritability is. C. H. Holmes.

ON BOMB RELATIONS BETWEEN APHASIA AND MENTAL
(156) DISEASE. Sydney J. Cole, Joum. of Meni. Sci., Jan. 1906,

p. 28.

Applying to echolalia the dictum of Wernicke—that the speech-
phenomena of mental disease can often be advantageously regarded
from an aphasic standpoint—the author discusses the aphasic
relations of this well-known psychiatric symptom. He shows in
various ways its relation to failure of understanding for spoken
language, and regards it as commonly indicative of an aphasic
disorder approximating to the so-called “transcortical sensory
aphasia ” of Wernicke (Lichtheim’s “ Type VI.”). Such a disorder,
transient or permanent, may not seldom be observed as one of the
expressions of an insanity. As a transient disturbance it is ob¬
served in acute intoxications (von Monakow), in post-epileptic
conditions (Pick), in epileptic confusional states not obviously
attributable to fits (Raecke), and in other forms of insanity of con¬
fusional type. The author relates a case of insanity in which it
accompanied Jacksonian fits referable to irritation of the motor
area for the right upper extremity. He also illustrates its occur¬
rence in re-evolution after general paralytic seizures. The
occurrence of transcortical sensory aphasia as a permanent con¬
dition is then discussed, with special reference to cases presenting
no coarse focal lesion. Many of these are cases of senile dementia,

ABSTRACTS

305

in which a general diffuse atrophy of the cerebrum has been most
marked in the left temporal region. Abstracts are given of ten of
the most important observations (Pick, Liepmann, Heilbronner,
and others). A similar aphasic disorder, often of slow and in¬
sidious onset, occurs also in dementia following insanity of com¬
paratively early life. Cases of this class, in part assignable to
dementia pnecox, have as yet been little studied, and do not
appear to have been in any instance reported in detail; the author
accordingly gives a full analysis (6 pp.) of a case of presumable
katatonic dementia pnecox, beginning at the age of 20. The
patient, whose age at the time of writing was 63, had for many
years exhibited a condition nearly resembling transcortical sensory
aphasia. Marked automatic echolalia was the most conspicuous
feature. There being nothing suggestive of coarse lesion, the
author suspects a diffuse atrophy predominating in the region of
the left temporal lobe. He reviews the various explanations ad¬
vanced for the production of echolalia, aud inclines to that of Pick,
based upon Hughlings Jackson’s doctrine of inhibition. Certain
phenomena of reading, associated with echolalia, are interpreted
in similar fashion. A bibliography is appended.

Author’s Abstract.

ON THE DISCLOSURE OF FACT BT PSYCHOLOGICAL METHODS.
(157) (Zur psychologischen Tatbestandsdiagnostik.) C. G. Juno (of
Zurich), Centralbl.f. Nervenheilk. «. Psych., Nov. 1, 1905.

The author gives here an example of the practical application of
his association method to criminal psychology. If by association-
tests submerged complexes with unpleasant effect could be diag¬
nosed, it seemed possible by this means to demonstrate the presence
of a complex of ideas related to a crime committed. Jung applied
his tests to a boy suspected of theft, and by means of the reactions
to special words inserted in the series was able to convince himself
of the guilt of the patient, and thus extract a full confession.

C. Macfie Campbell.

EXPERIMENTAL OBSERVATIONS ON MEMORY. (ExperimenteUe
(158) Beobachtungen fiber das ErinnerungsvermOgen. ) C. G. Juno
(of Zurich), Centralbl. f. Nervenheilk. u. Psych., Sept. 1, 1905.

In association experiments with hysterical cases, the author fre¬
quently observed that, when the test word given to the patient
touched upon the dissociated complex of ideas at the bottom of

306

ABSTRACTS

the disorder, the patient frequently failed to react, and then after
some time asked what the given word was. It was demonstrated
that patient had really forgotten the word, this being simply
one instance of the general tendency to submerge an unpleasant
complex.

It is important in treating such cases to learn the content of
the submerged complex; one iudicator of a complex is the long
reaction-time when the word given refers to the complex. In
this article, Jung calls attention to the fact that when one asks
the patient, after the series of associations has been completed,
to give again the same reactions, the patient makes several
mistakes or has forgotten the reaction. He found that the
associations, where the memory of the patient was at fault, were
exactly those relating to the complex. He gives two cases with
complete series of associations to demonstrate this point. The
influence of feeling-tone on memory is clearly demons'rated; an
unpleasant effect leads to increase in reaction-time and to forget¬
fulness of the reaction. Wherever in mental life there is a
submerged complex, we meet the same phenomenon but in different
degrees—the transitory embarrassment of the normal individual,
the “ voluntary ” amnesia of the hysterical, and the blocking in
the catatonic. C. Macfib Campbell.

▲PRAHA IN GENERAL PARALYSIS. (Apraxie bei progressiver
(159) Paralyse.) M. Lewandowsky (of Berlin), Centralbl.f. Nervenh.
u. Psych., Sept. 15, 1905.

Patient was a day-labourer, aged 36, who had suffered from
epileptiform attacks. The psychosis developed in a manner
which suggested at first the diagnosis of catatonia; there were
periods of excitement with hallucinations.

When observed by the author, patient had complete motor
aphasia, contracture of the right arm; patient seemed unable of
his own accord to sit up, raise himself from his chair, walk back¬
wards or forwards. The left arm showed no paralysis, but only
was used in three different movements; these were, to put his
hand behind his ear as if to hear better, to move his hand to his
mouth, and to rub his head with his left hand. The essence of the
disorder seemed to be of the nature of a motor apraxia, and not to
be sufficiently explained by the dementia or by agnosia. In addi¬
tion, patient presented choked disc with fresh haemorrhages. Post¬
mortem examination showed a typical general paralysis.

C. Macfie Campbell.

ABSTRACTS

307

GENERAL PARALYSIS AND TRAUMA. (Paralyse und Trauma.)

(160) C. Gieseler (of Konigsberg), Arch. f. Psych., Bd. 40, H. 3.

After reviewing the opinions of others on the relation between
general paralysis and trauma, Gieseler gives six cases in which the
two were associated (one case with psychical trauma). In only
two of these was the trauma an etiological factor, in the other
cases the association being casual, or the trauma due to the already
existing paralysis. As to the exact role of the trauma he is
cautious, and says that it is improbable that trauma per se can be
a sufficient cause of general paralysis.

C. Macfie Campbell.

THE PUPIL ACCOMMODATION REFLEX IN GENERAL

(161) PARALYSIS. (L’accommodateur dans la paralysie g&t&ale.)

Marandon de Montyel, Joum. de Neurol., Feb. 5, 1906, p. 41.

From prolonged and minutely detailed observations iu the cases
of 140 general paralytics, the author draws the following con¬
clusions :—

1. In any case of general paralysis which has passed through
all the stages of the disease, some abnormality is to be found at
one time or another in the pupil accommodation reflex.

2. In the great majority of cases accommodation in both eyes
is simultaneously and similarly affected, the alteration generally
being in the direction of enfeeblement or abolition.

3. In the first two stages of the disease the tendency is to
enfeeblement rather than to abolition; in the third stage abolition
is the more frequent.

4. In the same patient it is most common to find abolition
following enfeeblement. In rarer cases, when no change occurs in
the abnormality, enfeeblement is twice as common as abolition.
In exceptional cases, exaggeration, enfeeblement, and abolition may
occur in the same patient.

5. In the first stage accommodation is abnormal in 50 per cent,
of cases; in the second stage in 66 per cent. It is exceptional to
find it normal in the third stage, but it may be so.

6. Exaggeration is met with only in the first stage. Different
conditions in each eye occur only in the first and second stage.
In the last stage only enfeeblement and abolition are found, and
the changes are identical in both eyes.

7. Abolition of accommodation, in all probability, is never
produced as a primary condition, but is preceded by enfeeblement.

8. The two changes of enfeeblement and abolition are in direct
ratio to the progress of the disease, but enfeeblement is more
common in the initial stages and abolition in the terminal.

T. C. Mackenzie.

308

REVIEW

■Review

HISTOLOGICAL STUDIES ON THE LOCALISATION OF CEREBRAL
FUNCTION. Alfred W. Campbell, M.D., xix., 360 pp.
roy. 4to, 29 Plates, Cambridge, 1905.

It would be difficult, we think, to speak too highly of this most
important and valuable research. It is a monumental work,
which reflects the greatest credit on Dr Campbell and on British
medicine; it should be carefully studied by everyone who is
interested in the anatomy, physiology, and pathology of the brain,
and in the clinical study of neurology.

In his preface the author states “ that a study of the cortex
cerebri in the normal state constitutes the basis of the present
research, and may be regarded as the corner-stone in the histo¬
logical foundation upon which the superstructure of cerebral
localisation may be reared by workers in other departments.” He
goes on to say: “ that with rare exceptions previous observations
on the structure of the cerebral cortex have been founded on what
may be termed piecemeal work, and that it is plain that observers
have previously baulked an attempt to explore the whole surface
in a comprehensive and complete manner on account of the
magnitude of the task.” He now claims to have accomplished this
undertaking. He has made a collateral comparison of the cell
lamination and fibre arrangement in section after section, and
millimetre by millimetre, over the entire surface of the human
cerebrum. In more than one case he has converted an entire
cerebral hemisphere into serial sections, and has alternately stained
them for the display of nerve cells and nerve fibres.

The material used is divisible into three categories, namely,
normal human, normal comparative, and pathological.

The normal human material consisted of: three cerebral
hemispheres completely examined for both nerve cells and nerve
fibres; three hemispheres completely examined for fibres only;
and two hemispheres partially examined for nerve cells and nerve
fibres.

Six of the above mentioned hemispheres were taken from
persons who died while of unsound mind in Rainhill Asylum. In
anticipating criticism on this point, Dr Campbell makes the
following important statement:—

“ It may be urged that the mere fact of a person having suffered from
insanity is sufficient in itself to condemn the brain as unsuitable material for
an investigation of this description. In reply to this, while I confess on
looking back that I should have preferred that more brains in the series were

REVIEW

309

from individuals free from mental disorder, it is almost needless for me to say
that I should not have continued to employ the insane brain had I not felt
that the objections to its use were based more on sentiment than reality, and
had I not convinced myself from a lengthy experience in the pathological
laboratory attached to Sainhill Asylum that, in a large proportion of cases
dying insane, all the microscopic methods at our disposal will fail to disclose
changes, either in the nerve cells or fibres, which we can refer to their altered
mental condition ; and that in other cases in which the mental disorder is
more advanced or of a graver nature, while we mav be able to discover
alterations in the nerve cells—thanks to the marked advance which has been
made of late years in this province of histology—yet the present state of our
knowledge will not allow us to make any definite declaration concerning
attendant changes in the nerve fibres. And I am able to speak without
reservation of the difficulties which beset the detection of morbid changes in
the nerve fibres in the cerebral cortex, because for several years prior to the
inception of the present investigation I devoted much time to a study of this
subject.”

The normal comparative material included: (1) The right
hemisphere of a Chimpanzee, completely examined for nerve fibres
and partially investigated for nerve cells. (2) The left hemisphere
of a Chimpanzee (another animal), completely examined for fibres
only. (3) The right hemisphere of an Orang, completely examined
for fibres only.

The pathological material consisted of:—two brains from
cases of amyotrophic lateral sclerosis, seven from cases of amputa¬
tion of one or other extremity, three from cases of tabes dorsalis,
and one from a case of old-standing capsular lesion—in all of these
the central convolutions and parietal lobe were examined—and
two cases of old-standing blindness, in which the occipital lobe
was completely examined.

In the Addendum, the histological characters of the cortex of
the brain in the cat, the dog, and the pig are described, and the
functions and homologies of the more important cortical areas are
considered in considerable detail.

With regard to the methods of examination, all the normal
human and the anthropoid brains were hardened in Muller’s fluid
or in Orth’s solution—a mixture of Muller’s fluid and formalin;
after fixation, orthogonal tracings were drawn, showing the exact
disposition of the convolutions and sulci on the various surfaces,
and to confirm the correctness of these tracings the same surfaces
were photographed. In the case of the anthropoid brains a
plaster of Paris cast was always made, and proved of great
assistance in facilitating orientation when the preparations were
ready for microscopic examination.

The hemispheres which were completely examined were first
divided into portions of suitable size for section on the microtome.
The lines of cleavage between the blocks were carefully and
correctly indicated on the original tracings and photographs.
Then the blocks were numbered and placed in separate bottles

310

REVIEW

after hardening in increased strengths of alcohol and imbedded
and cut in celloidin on a Jung microtome. The sections, of a
thickness of 25 /x, were taken at intervals of 1 mm. and preserved
in strict serial order between sheets of paper and subsequently
mounted and stained ; and so, in the case of the central convolu¬
tions, for instance, sections were obtained showing their structure
at about a hundred different levels.

For staining the nerve fibres the method known as that of
Wolters-Kulschitzky was adhered to throughout. The nerve cells
were stained by a J per cent, solution of thionin. By this method,
the author states that “ in spite of the thickness of the sections he
was able to see the Nissl bodies clearly, and, what was more
important for his purpose, the cell morphology and lamination
were shown to perfection.” He adds: “ I cannot too strongly
emphasise the advantage in time-saving and general convenience
secured by the possibility of staining first cells and then fibres in
successive series of large sections, for apart from the obvious
advantage in obtaining a ready comparison between cell and fibre
constituents in given parts, it converts a comprehensive investiga¬
tion of cortical cell lamination from a gigantic and almost im¬
possible task, when small sections are employed, into one of easy
accomplishment."

The enormous labour involved in this research is shown by the
fact (which the author states in a footnote) that the examination
of a whole human hemisphere by this method takes six months for
its accomplishment (whereas to go over it thoroughly in small
blocks would absorb at least two years). When it is remembered
that Dr Campbell has examined no less than three human cerebral
hemispheres completely for both nerve cells and nerve fibres, three
hemispheres completely for fibres only, and two hemispheres
partially for nerve cells and nerve fibres, and in addition a large
amount of normal comparative and pathological material
(enumerated above), the extraordinary magnitude of the work on
which Dr Campbell’s splendid research is based will be readily
appreciated.

The work consists of eleven chapters and an Addendum.

Chapter I. deals with the material and methods of examination;
Chapter II. with general remarks on cell lamination and the
arrangement of the nerve fibres in the cerebral cortex; Chapter
III. with the precentral or motor area; Chapter IV. with the post-
central or sensory area and the intermediate post-central area;
Chapter V. with the visuo-sensory and visuo-psychical areas;
Chapter VI. with the temporal lobe and the auditory areas;
Chapter VII. with the limbic lobe; Chapter VIII. with the
parietal area; Chapter IX. with the intermediate precentral area;
Chapter X. with the frontal and prefrontal areas; and Chapter XI.

REVIEW

311

with the island of Reil. The Addendum includes “ further
histological studies on the localisation of cerebral function; the
brains of felis, canis, and sus compared with homo.”

Each of the chapters devoted to individual parts of the cerebral
cortex comprises: (1) a detailed description of the cell lamination
and fibre arrangements of the special part under investigation ; (2)
a discussion on the functions of the part examined, based upon the
histological characters of the cortex, the results of experimental in¬
vestigation, clinico-pathological data, the teaching of comparative
anatomy, and developmental evidence; (3) a summary of the
author’s histological study of the part of the cortex under discussion
and of his conclusions as regards its function (based on a considera¬
tion of the various data enumerated above); and (4) a very complete
list of references and authorities.

The written description of the histological characters of the
different parts of the human cerebral cortex is illustrated by
twenty-three figures in the text and twenty-five full-sized plates
and legends, and the Addendum is illustrated by four full-sized
plates.

Many of the microscopic drawings of the preparations were
made by Dr A. C. Wilson and are a most important and valuable
feature of the work, showing as they do with the greatest accuracy
and faithfulness the exact cell lamination and fibre structure in
individual parts of the cerebral cortex of man ; for the purpose of
reference and comparison, these drawings will be of the greatest
value to future workers. Most of the photographic work
incidental to the research was done by Mr F. J. Abram.

The microscopic drawings were made by means of the eye¬
piece drawing apparatus of Leitz. Dr Campbell states—and on
this point we entirely agree with him—that perfectly accurate
drawings made in this way are superior to microphotographs.
He claims that “ in the low power drawings the position of every
fibre, at any rate in the outer two-thirds of the cortex, is faithfully
shown, and that in the high power figures the calibre as well as
the relation of the fibres one to another is accurately represented,
and that as regards the cells, size, position, and number are faith¬
fully shown.” All the drawings were made to scale, the low
power ones at a magnification of - 8 ^, the high power at

From what has been stated, it will be seen that Dr Campbell
has described in great and exact detail the histological characters
of the whole cerebral cortex in man, and has figured his results in
a series of most beautiful and accurate microscopic drawings.
Further, the gross results of his research are diagrammatically
represented (so far as it is possible to represent them in a surface
view) in several charts (maps and legends), which are of great
interest and value.

312

BEVIEW

So much as regards the histological observation and matters of
fact.

With regard to the conclusions, as to the physiological functions
of the different areas, which Dr Campbell draws from his histo¬
logical studies and from other data (experimental, clinico-patho-
logical, embryological, comparative, etc.), there is naturally much
room for difference of opinion; many of the author’s conclusions
must in the meantime be regained as suggestions—suggestions of
great value—which will have to be proved or disproved by further
observation. In connection with this part of the work, Dr Campbell
shows a wide acquaintance with the work of previous observers,
an extensive literary knowledge, a keen critical faculty, and a
discriminating judgment. The reading involved and the considera¬
tion required to form a judgment on the numerous points con¬
sidered with regard to function must have been very great.

In the limited space of a review it is impossible to describe in
detail Dr Campbell’s histological findings or to discuss and criticise
the many debatable points involved in his conclusions; but it may
be useful to indicate some of the facts and conclusions which have
a direct bearing upon clinical medicine.

Chapter III. Precentral or motoi' area .—The author confirms
the important conclusion which Sherrington and Griinbaum came
to as the result of electrical stimulation of the brain of the
anthropoid apes, viz. that the motor area is practically confined
to the precentral (ascending frontal) convolution. Both in the
anthropoid apes and in man, Dr Campbell has been able to map
out a histological area which agrees very closely with that which
responds to electrical irritation. The floor (not the lip) of the
fissure of Rolando forms a very definite and constant posterior
limit to this area.

The same area corresponds approximately to the distribution
of the giant or “ motor ” cells of Betz and Bevan Lewis. The
giant cells disappear before the lower extremity of the fissure of
Rolando is reached, and are consequently not found over that part
of the cortex which is regarded as the face area; in this area, how¬
ever, large cells are found which differ from the large pyramidal
cells common to the whole precentral area; they are possibly
special presiding elements.

Strong confirmation of the assumption that in man as well as
in the anthropoid apes the motor area is confined to the precentral
gyrus and its paracentral annex is afforded by the condition of the
ascending frontal and ascending parietal convolution in amyo¬
trophic sclerosis, and in cases of amputation of the limbs.

In two cases of amyotrophic lateral sclerosis (a disease in which
the lesion is limited to the muscular system and the motor system
of neurones) there was a wholesale disappearance of the “ motor ”

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313

cells throughout the normal area of their occupation, and while
there was a co-existent disturbance of other elements in the pre¬
central cortex, the post-central gyrus entirely escaped affection.

With regard to the amputation cases, Dr Campbell states that
in the seven cases which he has examined he has never failed to
find microscopic changes, akin to, if not absolutely identical with,
those to which Marinesco has given the name “ reaction k distance.”
He maintains that “ given a case of section of the nerves supplying
even a single group of muscles, for instance, the extensors of the
foot, it would be quite possible from a careful examination of the
cortex and a study of the resulting “ reaction k distance ” to deter¬
mine the exact distribution of the motor elements, on the integrity
of which, movements of that particular group of muscles depended,
and, by collecting and examining a selected series of similar cases
and collating the results with the findings of the physiologist, the
clinician, and embryologist, we may eventually hope to draw on
the surface of the human brain a detailed map of motor localisa¬
tion, so definite and so exact, that it will not require alteration
and revision at the hands of our successors.” The exact altera¬
tions found in the seven amputation cases which he examined
were as follows:—

“ In two cases of amputation of the leg a short distance below the knee, I
have found,” he says, “changes limited to the upper extremity of the
precentral gyrus and its paracentral annex, in other words to the part which
in the case of the higher ape seems to control movements of the toes and
ankle. In another case of amputation at the knee-joint, associated with great
atrophy of the thigh muscles, the changes extended further outwards, but
numerous cells above the superior annectant gyrus remained intact; the
latter probably govern hip movements. In two cases of amputation of the arm
through the humerus, degenerated cells were found over an extended area
corresponding very closely with Professors Sherrington and Griinbaum’s
experimentally located areas for finger, wrist, and elbow movements ; and in
one of these cases, which was associated with extreme wasting of the shoulder
muscles, a large group of cells lying immediately below the superior annectant
gyrus was affected. In a case of amputation of the hand the changes were
limited to the lowermost part of the last-mentioned area.”

Dr Campbell states that it is impossible to reconcile these
findings with the long list of clinical observations adduced in the
past to support the view that the two central convolutions have
an equal share in the control of volitional movements, and it is
suggested that natural lesions such as cerebral softening, cerebral
tumour, and cerebral trauma, which form the basis of most of
these observations, are only in rare instances sufficiently limited
in their effects to allow of safe judgment on this question; hence
errors have arisen.

He states that the conclusions deduced from clinical observa¬
tions, from experimentation, and from histological investigation,
x

314

REVIEW

are completely in agreement concerning the sequence of representa¬
tion of movement along the course of the motor area.

Dr Campbell argues that the precentral (ascending frontal)
convolution is a purely motor area; he does not agree with those
(Bastian, Munk, and Mott) who think that it is the seat (or a seat)
of the muscular sense, or with those (like the late Dr Ross) who
think that it is a combined sensory and motor area.

Chapter IV. Post-central or sensory area .—The author states
that “ structurally the post-central (ascending parietal) gyrus differs
entirely from the precentral (ascending frontal) gyrus and from
the superior parietal and supramarginal convolutions, and its
definition as a distinctive area is accomplished without the
slightest difficulty. It is not nearly so rich in nerve fibres as the
precentral gyrus, and a most important distinguishing feature is
the presence in the inter-radiary plexus of fibres of even larger
calibre than those seen in the precentral convolution, fibres which
are curious, inasmuch as they run obliquely or at right angles to
the radiating fasciculi. Such fibres recall some met with in known
sensory regions, for instance, the visual, auditory, and olfactory
centres. They are not seen in either the precentral convolution
or the parietal lobe proper, they seem to concentrate themselves
on the Rolandic side of the gyrus, and their curious oblique course
gives rise to the assumption that they are centripetal fibres making
for cells resident in this situation.”

In reference to nerve cells, the lamination differs from that of
the precentral gyrus, first, in showing no true cells of Betz ; and,
secondly, in exhibiting a most pronounced layer of stellate cells;
and it differs from that of the remaining parietal region in contain¬
ing pyramidal cells of larger dimensions.

The largest of these pyramidal cells are smaller than an average¬
sized precentral giant (motor) cell; they are pyramidal in shape,
while the Betz cells are pyriform ; their apical extension process
tapers away more gradually; unlike the typical cells of Betz, these
elements are not found lying in nests or clusters, but are solitary.

That these large pyramidal cells in the post-central gyrus are
sensory is proved by the facts that in amyotrophic lateral sclerosis
(in which the Betz cells are destroyed and atrophied) they are un¬
affected, and that in tabes dorsalis (in which the Betz cells are
unaffected) they are profoundly affected (degenerated and
atrophied).

Dr Campbell argues that this post-central gyrus constitutes the
terminus where the main system of fibres for the conveyance of
impressions pertaining to tactile and allied forms of sensation
primarily impinges.

“ The separate localisation of the various components combining
to produce ‘ common sensation ’ is,” the author states, “ beset

REVIEW

315

with difficulties. However, the view is promulgated here that the
post-central area, like better-known sensory realms, is divisible
into a purely sensory part, to which all impressions primarily pass,
and an investing psychic part. The former occupies the post-central
area proper and, in accordance with ray thesis, its destruction
should lead to abolition of psychic, as well as impairment of funda¬
mental sensory components; the latter covers the intermediate
post-central field and may extend further back in the parietal
direction; its destruction should lead to isolated disturbance of
psychic sensory attributes. Some clinical and pathologic findings
substantiate this view. The fact that fundamental attributes,
such as the simple recognition of touch, pain, heat, and cold, are
only dulled and rarely or never abolished in cases of cortical
lesions, is probably due to the participation of subcortical inter¬
mediate stations in the receptive act.’'

In three cases of tabes dorsalis an examination of the brain
disclosed changes limited to the post-central gyrus, very similar in
character to those which he has described as the result of old-
standing lesions in the internal capsule. The discovery of these
changes Dr Campbell regards as of the greatest possible signifi¬
cance and one of the strongest points which can be advanced in
favour of the view which he advocates, viz. that the ascending
parietal convolution constitutes the terminus where the main
system of fibres for the conveyance of impressions pertaining to
tactile and allied forms of sensation primarily impinges. This
point is of so much importance that we quote the paragraphs
relating to it in full.

“ I have now examined the cortex cerebri in three cases of tabes dorsalis
in somewhat close detail, and in all three I have discovered important changes,
almost gross in character. Having hitherto escaped notice at the hands of
other observers, these changes, in themselves, constitute an interesting addi¬
tion to our knowledge of the pathology of this disease, and would prove a
fruitful topic of discussion in that light. Here, however, I am only concerned
with cerebral localisation, and to this my comments must be restricted. Now,
to my mind, the evidence derived from a study of these cases may be con¬
fidently advanced as stronger than any which has yet been adduced in favour
of the assumption that the cortex of tie post-central gyrus, and it alone, is the
primary terminus or arrival platform for nerve fibres conveying impulses
naving to do with ‘ common sensation ’ ; the data are so clear that they speak
for themselves and need little in the way of introduction. For, just as we
saw, in the last chapter, that amyotrophic lateral sclerosis, a disease confined
exclusively to the muscles and the motor system of neurones, provided a
convincing demonstration to the effect that the resulting cortical changes are
limited in their distribution to what we may in the future call the ‘ precentral
or motor area ’; so we see in tabes dorsalis, a disease which is essentially a
sensory one, and in typical cases exclusively confined to the sensory system
of neurones, just as sharp a limitation of the associated cortical changes to the
opposite bank of the Rolandic fissure, to what we may now designate the
'post-central or sensory area.’ And, conscious as I am that the histo¬
logical findings on which this weighty statement rests will need to be carefully

316

REVIEW

checked and confirmed by others before it can be considered final, I give it in
the firm belief that the portrait received from the microscope is a correct one,
and that the solution of a vexatious problem, which has baffled the neurologist
■for a number of years, is at hand.

“ The limitation of the alteration to the post-central gyrus is the feature of
predominant interest^ but there are several points of minor importance which
arise for consideration in this discussion. The first is that the alterations are
still further limited to a certain part of the post-central gyrus, to the Rolandic
wall and lip, to the field which was mapped out long before this pathological
investigation was thought of, by its possession of a very curious and dis¬
tinctive structure, the field which I nave sometimes distinguished by the
name poet-central area proper.”

Chapter V. The visuo-sensory or calcarine and the visuo-psychic
areas .—Dr Campbell confirms the opinion of previous observers
that the area of cortex characterised by the possession of the
lamina or “ line of Gennari ” is the chief end station of the optic
radiations, and therefore constitutes the cortical centre for the
primary perception of visual sensations. The arrangement of
nerve fibres in this area is absolutely distinctive, and it is also
characterised by a special type of nerve cell lamination. “ Briefly
put, the characters which distinguish the calcarine type of cell
lamination are, first, the almost unique external layer of large
stellate cells usurping the position occupied by the external layer
of large pyramidal cells in other regions; secondly, the existence
of pale-stained zones above and below the uncommonly well-
marked layer of stellate cells, the upper of which marks the
position of the line of Gennari; thirdly, the presence in the
depths of the cortex of the layer of solitary cells of Meynert, cells
which differ from homonymous cells in any other part of the
brain.”

The distribution of this field of cortex (bearing a line of
Gennari) is influenced directly by the calcarine fissure and follows
closely every bend and branch of that sulcus.

The occipital or visuo-psychic type of cortex has decided and
distinctive characters in the central parts of the field, but its exact
distribution is not accomplished without difficulty. It may be
described as a zone of cortex, from T3 to 2 cm. broad, investing
this visuo-sensory area on all sides, that part above the stem of the
calcarine fissure excepted.

In summing up his conclusions on the function of the visuo-
sensory and visuo-psychic areas. Dr Campbell states: “ Convinced
from my histological investigations that two definite and distinct
areas, each bearing a special type of cortex, can be mapped out in
the occipital lobe, I am now satisfied, after a consideration of most
of the recorded work on this subject, that these two fields have
different physiological functions to perform. And joining hands
with those who hold the belief that in the occipital lobe there
exist two distinct cortical centres, one specialised for the primary

REVIEW

317

reception of visual sensations, the other constituted for the final
elaboration and interpretation of these sensations, I would go a
step further and affirm that the area of cortex in the calcarine
region, which I have mapped out and termed visuo-sensory,
represents the exact limits of the first-mentioned centre, while the
investing field, which I have designated visuo-psychic, represents
the precise extent of the second centre .”

In this chapter the important subjects of psychic blindness,
alexia, colour blindness, and optic aphasia are referred to.

Chapter VI. The temporal lobe and auditory areas .—The
author maps out three distinct histological types of cortex in the
temporal lobe. Type 1 is confined in a remarkable manner to the
transverse temporal gyri or gyri of Heschl. The leading features
of this type of cortex are the presence in the radiary zone of
numerous large fibres, the existence of a line of Kaes, and the
general wealth of fibres in all layers; and, so far as the cell
lamination is concerned, (a) the general rich supply of cells, and
(6) the presence of numbers of curious giant cells above the well-
developed stellate layer. Type 2. This forms a broad skirt or
margin to the concealed area above mentioned (transverse gyri of
Heschl), and is almost entirely confined to the first temporal lobe.
Dr Campbell thinks that some part of this cortex spreads on to the
insula and covers parts of the gyrus longus and gyrus posterior
secundus. Type 3. This type covers a very large area and is
contiguous with the “parietal” field, the dividing line between
the two corresponding approximately but not absolutely with the
disposition of the horizontal and occipital rami of the intraparietal
fissure.

Dr Campbell states that the angular gyrus, which is supposed
to possess special functions, does not differ structurally from other
parts of the area. This is a point of special interest.

As regards function, Dr Campbell argues that the area of Type
1 (the transverse temporal gyri of Heschl) probably stands in
relation to the auditory function in the same way as the calcarine
region does to the visual, and is accordingly of prime importance
as a centre for the primary reception of simple auditory stimuli.

He suggests that the only way of explaining the negative
results which Schafer observed after removal of the superior
temporal gyrus is by supposing that his ablation of the superior
temporal gyrus was not quite so complete as he imagined, and that
he left behind part of the transverse temporal gyri of Heschl.

The area of Type 2 he regards as a second centre specialised
for the interpretation and further elaboration of primary auditory
stimuli. Dr Campbell could detect no difference in the structure
of the corresponding areas on the two sides of the brain. “ On the
question,” he says, “of a word-hearing” (does Dr Campbell mean

318

REVIEW

word-seeing) “ centre in the left angular gyrus, histology affords
negative evidence; for although I have subjected both hemi¬
spheres to examination I have been unable to detect any
appreciable difference in the two sides, either in regard to the
arrangement of nerve fibres or nerve cells.”

In this chapter, deafness due to cortical lesions, word-deafness,
amusia, and psychic deafness are considered in some detail.

Chapter VII. The limbic lobe and olfactory area. —The parts
studied in this section include all the constituents of Broca’s
“grande lobe limbique,” viz. the olfactory lobe (excluding the
olfactory bulb and peduncle), the whole gyrus hippocampi (in¬
cluding the cornu ammonis and subiculum, the uncus and lobus
pyriformis), the entire gyrus fornicatus, and other subsidiary
structures. The author states that histology supports comparative
anatomy in suggesting that, in the human brain, the lobus pyri¬
formis must be regarded as the principal cortical centre, although
not the sole one, governing the olfactory sense. Structurally the
cortex of this lobe is not built up on the usual plan, and its chief
distinguishing features are: (a) curious clusters or nests of giant
polymorphous cells which occupy a unique position close beneath
the surface ; (b) a deep succeeding layer of pyramidal cells approxi¬
mately equal to one another in size (S. Ram6n y Cajal’s tassel
cells); (c) a correspondingly peculiar arrangement of cortical nerve
fibres, of which the presence of projection bundles reaching right
up to the zonal layer constitutes a prominent feature.

Dr Campbell does not agree with the view expressed by Ferrier
and Horsley and Schafer that common sensation is centred in the
hippocampal region.

Chapter VIII. The parietal area. —The author applies the
term “ parietal ” to an area which may be briefly described as
covering the precuneus, the superior parietal gyrus, and the
anterior part of the supramarginal gyrus. Structurally its cortex
possesses all the cell laminae of, and a similar arrangement of
nerve fibres to, the “ intermediate post-central ” area, but it differs
in containing a smaller number of special large pyramidal cells
and of large medullated nerve fibres; it is also peculiar in showing
a more perfect reduplication of the line of Baillarger.

To electrical excitation the area is irresponsive, and histology
seems to favour the clinical doctrine that it shares with the
“intermediate post-central” cortex the function of elaborating
complex impressions embodied in the muscular and stereognostic
senses.

Chapter IX. The intermediate precentral area. —The cortical field,
which Dr Campbell terms the “ intermediate precentral ” area, ranges
as a zone between 3*5 and 1 cm. in width, placed after the manner
of a buffer in front of the “ precentral ” area proper and showing

REVIEW

319

an additional extension downwards on to the orbital surface of the
hemisphere. Broadest above, the area becomes constricted at its
middle and then expands again below. It covers the base of the
upper and middle frontal gyri, some of the ascending frontal (that
not coated by the “ precentral ” type), a considerable portion of
the inferior frontal, including the pars basilaris (area of Broca), the
pars triangularis (sometimes), and the pars orbitalis of the fronted
operculum.

Histologically many of the structural characters noted in the
“ precentral ” cortex are repeated; thus, the general depth is pre¬
served, the difference in regard to nerve fibres chiefly affects the
degree of fibre wealth, and save for the giant cells of Betz, the cell
lamination is remarkably alike. These resemblances suggest a
physiological kinship between the two parts. “Having,” he
says, “ regard to the discoveries (1) that this cortex bears a structural
resemblance as well as a topographic relation to the ‘ precentral *
cortex, (2) that the field corresponds in distribution with the area
found excitable in the simian brain by experimenters prior to
Sherrington and Griinbaum, and (3), that its anterior boundary
agrees to a marked extent with the so-called ( sensory projection
centre ’ worked out by Flechsig on developmental lines, the pro¬
position is favoured that it participates in the motor function;
and it is submitted that it may represent a higher centre presiding
over elements in the * precentral area ’ proper, in short, that it is
designed for the execution of skilled, as opposed to crude and
automatic movements.”

In this chapter the subjects of motor aphasia and agraphia
are referred to. In connection with motor aphasia. Dr Campbell
states:—

“ Digressing to consider the localisation of the motor speech centre, it is
submitted that this is probably not so restricted as previously supposed, and
that the forward extension of the “ intermediate precentral ” cortex on the
inferior frontal gyrus may have the same function as the cortex of Broca’s
area. In support of this assumption it is pointed out, in the first place, that
histologically the cortex of all this part of the “intermediate precentral”
area is alike, that is to say, the area of Broca is not distinguishable by any
localised specialisation of structure; and, secondly, that it is a common
matter of clinical experience that a superficial lesion confined to the cortex of
Broca’s area is not wholly effective in the production of motor aphasia ; in
other words, if the disability is to be permanent, the lesion must be deep and
penetrating. The explanation given for the occurrence of complete and
permanent motor aphasia after a deep-seated lesion in the pars basilaris is
that all connections between the ‘ intermediate ’ cortex and tne direct labial,
lingual, and laryngeal centres occupying the lower end of the precentral area
proper—and by the way remaining intact—are severed. Such a lesion there¬
fore produces an effect equivalent to destruction of the whole of the * inter¬
mediate precentral ’ cortex coating the inferior frontal gyrus.”

The author adds that from this and from what we know
regarding motor aphasia it is inferred that the “intermediate

320

REVIEW

precentral ” cortex harbours a sequence of centres for die control
of skilled movements, following the same order, deposited more or
less on the same horizontal level, and connected by commissural
fibres with the series of “primary” centres existing in the
“ precentral ” area.

Chapter X. Frontal and prefrontal areas. —The part of the
frontal lobe uncovered by “ intermediate precentral ” and “ limbic ”
cortex comprises the anterior half of the marginal gyrus, on the
mesial surface of the hemisphere, much of the superior, middle,
and inferior frontal convolutions, on the lateral surface, and their
downward extensions on the orbital face. Dr Campbell states
that, although this expanse is covered all over by cortex showing
a type of fibre arrangement and cell lamination approximately
uniform in character, it is nevertheless possible to split it up
into two fields, the hinder of which forms a skirt to the “ inter¬
mediate precentral” area and will for convenience be called
“ frontal ”; while the anterior, centred on the tip of the frontal lobe,
will be designated “ prefrontal.”

The structural development of the “ prefrontal ” cortex is
exceedingly low. It presents an extreme of fibre poverty; all
its fibre elements are of delicate calibre, and its association
system is particularly deficient. Its cell representation is on a
similar scale. The cortex is also shallow.

The relative paucity of fibres and of nerve cells in the
prefrontal lobe which Dr Campbell shows is very remarkable. It
will be interesting to see whether his observations on this point
are confirmed by subsequent observers.

The feeble structural representation of the “ prefrontal ” cortex
suggests that it is the last portion of the frontal lobe to make its
appearance in the course of phylogeny, and all things considered,
the idea is favoured that its physiological importance as a psychic
centre is over-estimated j the same does not apply to the “ frontal ”
area.

Chapter XL The island of Beil. —The general fibre supply of
the insular cortex is poor, and it likewise contains no cells of large
size. In the adult it is histologically separable into two main
regions, an anterior and a posterior, between which the sulcus
centralis insulae roughly forms a dividing line.

Dr Campbell thinks that “it is probable that the insula is
‘ old ’ in the rank of phylogenesis, and that it plays a more im¬
portant part in primitive mammals than in man and the
higher apes.”

"Histology,” he says, “does not support the view that the
insula is endowed with speech functions. In the cases giving rise
to this conception, an extension of the destroying lesion, either to
the inferior frontal gyrus or to the transverse temporal gyri, is

REVIEW

321

suspected. Clothed by temporal cortex, the posterior insula is
supposed to pertain to the auditory apparatus. Studies in com¬
parative anatomy show a close topographic relation between the
insula and the fissure rhinica, and as the anterior insula contains
elements common to the olfactory area, it may have to do with
the recognition of smell; or in accordance with Gorschkow’s ex¬
periments, its specialised cortex may represent the gustatory
centre.”

In conclusion, we beg to congratulate the author most heartily
on this most laborious and splendid piece of work. We repeat
that it reflects the greatest credit on British medicine, and that it
should be most carefully and thoroughly studied by everyone who
.is interested in the structure and functions of the brain and in the
clinical study of neurology.

The book is excellently printed and got up, in particular the
admirable way in which the microscopic drawings have been re¬
produced deserves to be mentioned. Byrom Bramwell.

822

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MOTT and HALLIBURTON. The Suprarenal Capsules in Cases of Nervous and
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8. Karger, Berlin, 1906, M. 0.75.

anrecuft—

ARMAND-DEULLE et ALBERT-WEIL Syndrome Myopathiaue ches un
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C. MACF1E CAMPBELL A Case of Muscular Dystrophy affecting Hands and
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PBIPIBRU NERVES—

JAMES SHERRAN. The Erasmus Wilson Lectures on the Distribution and
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LAFAGE. Contribution k l’tftude des paralysies ngvritiques de la ooqueluche.
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nmi DISEASES—

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E. L. HUNT. Korsakoff’s Disease. Med. Rec., March 10, 1906, p. 387.

GENERAL AND FUNCTIONAL DISEASES—

Chorea.—GUSTAV0 MODENA. Su di un caso di oorea di Huntington. Annuario
del Manicomia Provinciate di Ancona , Anno iii., Marchetti, Ancona, 1905.

Epilepsy.—SPRATLING. Unrecognised Epilepsy. Joum. of Amer. Med. Ass.,
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PLAY EC. Kleine motorische Epilepsie. Neurol. Centralbl ., Mkrz 1, 1906, S. 207.

■ysteria.—HERM. H. HOPPE Hysterical Stigmata Caused by Organic Brain
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STRUMPELL. Uber das sogenannte hysterische Fieber. Deutsche Ztschr. f.
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DEROUBA1X. Le rire et le pleurer spasmodiques. Joum. de Neurol .. man 5,
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Neurasthenia.— P. C. SMITH. Neurasthenia, Degeneracy, and Mobile Organs.
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GUTHRIE RANKIN. The Treatment of Neurasthenia. Brit. Med. Joum..
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Exophthalmic Goitre* — STRANSKY. Zur Antithyreoidinbehandlung dor
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ftPECIAL SENSES AND CRANIAL NEE YES—

TALMAY. A Contribution to the 8tudy of Pseudoneuritis optica. New York
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p. 604.

WALTER H. HAW. An Attempt to Simplify the Diagnosis of Ocular Paralysis.
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MISCELLANEOUS SYMPTOMS—

SANDBERG. tJber die Sensibilittttssttirungen bei cerebral an Hemiplegien.
Deutsche Ztschr. f. Nervenheilk., Bd. 80, H. 8-4, 1906, S. 149.

C. K. MILLS. A Case of Crural Monoplegia, representing the early stage of a
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ACHARD et RIBOT. Rhumatisme ddormant du c6t£ oppose fc rH4mipl4gie.
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ERB. Ein weiterer Fall von angiosklerotiscner Bewegungsstdrung des Arms.
Deutsche Ztschr. J. NervenheUk. , Bd. 80, H. 3-4, 1906, S. 201.

NEWMARK. A Case of Ascending Unilateral Paralysis. Joum. Nerv . and MenL
Die., March 1906, p. 182.

EGGER et RAYMOND. L’Acroparesthesia. Une lesion du Cordon Postlrieur,

g k>c. de Neurol.) Rex. Neurol. , f6v. 28, 1906, p. 174.

RAEFFNER. Einige Studied liber Refleze, besonders an Hemiplegikem.
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BAUMANN. Ueber den Racnenreflez. Munch, med. Wock. % M&n 27, p. 593.
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Kbrperteil bei Kompression der oberen Teile des Ruckenmarks. Deutsche Ztschr.
/. Nervenheilk. , Bd. 30, H. 3-4, 1906, S. 239.

DEJERINE et NORERO. Epilepsia Spinale vraie et Clonus de la rotule ches une
Hyst5rique anorexigue ayant 6t6 atteinte d’une Hemiplegia gauche actuellement
gu£rie (Soc. de. Neurol.) Rev. Neurol ., f6v. 28, 1906, p. 182.
eEMPNER. Ueber Stdrungen im Augengebiet des Trigeminus speziale des
Cornealreflezes und ihre diagnostische Verwerfung. Berlin klin . Woch.. M&rz 26,
p. 879.

ACHARD et RIBOT. Troubles de la Motility des membres inf6rieurs rappe lan t
oeuz de l’Ataxie C4r4belleuse. (Soc. de Neurol.) Rev. Neurol. , U y. 28, 1906.
p. 198.

CASTEX. Le rSflexe patellaire est independent de la surface du percuteur.
Joum. de Neurol. , mars o, 1906, p. 89.

DARCANNE. Le signe de Kernig dans la paralyse g6n4rale. Joum. de Neurol
mars 1906, p. 91.

BELBEZE. Sur la presence du signe de Kernig dans la sona. Arch. gin. de
mid fey. 27,1906, p. 520.

RUGGLES. Observations on Ganser’s Symptom. Am. Joum. Jnean. t Oct. 1905,
p.307.

THORP. Du vertige voltaique ; Son application au diagnostic des fractures
anciennes du rocher. Gout et Cie, Orleans, 1906.

DOUGLAS BRYAN. Recurrent Herpes Gestationis. Lancet , Feb. 24, 1906,
p. 512.

bRISSAUD et MOUTIER. Cyphose prononc4e ches un tuberculeuz. Nouv.
Icon, de la SalpStriei c, jan.-ffcv. 1906, p. 30.

SfeRIEUX et MIGNOT. Observation clinique d*un oas d’amn6sie retro-antero¬
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LIEPMANN. Der weitere Krankheitsverlauf bei dem einseitig Apraktischen und
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MARCEL NATHAN. Note sur un cas d’Amusie incomplete ches un musician
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HENRI LAMY. Troubles d’Elocution ches un ancien Aphasique. (Soc. de
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328

BIBLIOGRAPHY

POOHHAMMER. Beobaohtungen Uber Etstehung and RUckbiklung trauma-
tisoher Aphasie. Mitteil. aus den Gremgebieten der Med. und Ckir. , Bd. 16, E 5,
1906, p. 496.

OSKAR FISCHER. Uber Makropsie und deren Resiehangen zur Mikrojrraphie,
sowie Uber eine eigentUmliche StUrung der LichtempUndung. Monatssch. f. PsyehiaU
u. Neurol., M&rz 1906, p. 290.

KLEIST. tJber Apraxie. Monatssch. f. Psychiat. u. Neurol ., M&rz 1906, p. 269.
LIEPMANN. Der weitere Krankheitsverlauf bei dem einseitig Apraktisohen
und der Gehirnbefund auf Grund von Serienschnitten. Monatssch. f. Psychiat u.
Neurol., M tin 1906, p. 217.

TREATMENT*—

OPPENHEIM. Psyohotherapeutische Briefe. S. Karger, Berlin. 1906, M. 1.
NEUMANN. Die Heilung der NervoeitKt duroh intelligent Leibeeiucht und
rationalle Lebenshaltung. Borggold, Leipzig, 1906, M. 1.20.

HIRSCHL. Bemerkungen zur Behandlung dee Morbus Basedowii. Wien. klin.
Woch ., M&rz 15, 1906, p. 296.

WHITCOMBE BROWN. The Therapeutic Effects of Mercury in a case of
Tuberculous Meningitis. Lancet , March 24, 1906, p. 825.

ABADIE et DUPUY-DUTEMPS. Hdmispasme Facial© gu6ri par une Injection
profonde d’Alcool. (Soc. de Neurol.) Rev. Neurol., f6v. 28. 1906, p. 197.
KALISCHER. tJber das Schlafmittel Proponal. Neurol. CentralbL , Mttrz 1,
1906, S. 206.

BRUEL. Traitement des chorees et dee tics de l’enfanoe. Steinhefl, Parts, 1906.
J. R. EASTMANN. The Effects of Osmic Acid Injections. Joum. of Am. Med.
Ass., Feb. 24, p. 556.

TUBBY. The Hunterian Oration on Recent Surgical Methods in the Treatment
of Certain Forms of Paralysis. Brit. Med. Joum., March 8, 1906, p. 481.
SPILLER, FRAZIER and KAATHOVEN. Treatment of selected cases of cere¬
bral, spinal and peripheral nerve palsies and athetosis by Nerve Transplantation.
Am. Joum. of Med. Sci. t March 1906, p. 480.

JORDAN LLOYD. On Facial Neuralgia and its Curative Treatment by Excision
of the Gasserian Ganglion. Birm. Med. Rev., Feb. 1906, p. 57.

HOFMEISTER und MEYER. Operierter Tumor des Ganglion Gasserf. Deutsche
Ztschr.f. Nervenheilk., Bd. 80, H. 8-4, 1906, S. 216.

* A number of references to papers on Treatment are Included In the Bibliography under the
individual Diseases.

■Review

IteurolOQS ant> ftescbiatn?

Original articles

LESIONS or THE LEFT FIRST TEMPORAL
CONVOLUTION IN RELATION TO SENSORY APHASIA.

By WILLIAM G. SPILLER, M.D.,

Professor of Neuropathology and Associate Professor of Neurology in the
University of Pennsylvania.

From the Department of Neurology and the Laboratory of Neuropathology
of the University of Pennsylvania, and from the
Philadelphia General Hospital.

The centre for word-hearing in right-handed persons is generally
believed to be in the posterior part of the left first temporal
convolution and possibly of the second. According to Bastian,
the merit of having determined this region belongs to Wernicke,
but Bastian thinks that disturbance (Bastian, “ Aphasia and Other
Speech Defects.” H. EL Lewis, London, 1898) to a very marked
extent of the functions of the visual word centre as a result of a
lesion in the upper temporal convolutions is not so universal as
Wernicke and Dejerine believed. Thus out of sixteen recorded
cases of sensory aphasia in which the lesion was pretty closely
limited to the hinder part of the first, and more or less of the
second temporal convolutions, in only five is any mention of
some amount of word-blindness. In the sixteen cases to which
Bastian referred, motor aphasia existed in six, some paraphasia in
six, aphasia and paraphasia in one, and voluntary speech seemed
to be, but to a less extent, affected in three.

R. OF N. & P. VOL. IV. NO. 5—Y

330

ORIGINAL ARTICLES

Yon Monakow says that so many instances of word-deafness,
resulting from a lesion of the left first temporal convolution in
right-handed persons are recorded, that the relation between this
lesion and the word-deafness cannot be doubted. There are
cases of lesion confined to the left second and third temporal
convolutions with sensory aphasia, and others with a lesion con¬
fined to the posterior part of the left first temporal convolution
without aphasia, and in illustration of the latter statement he
refers to Byrom Bramwell’s Case 10, Brain, 1899 (Yon Monakow,
“ Gehirapathologic,” 2nd edition, p. 929).

Still, word-deafness with destruction of the posterior part of
the left first and second temporal convolutions is not so common
that new cases may be ignored, and the two following cases are
reported to form a contrast with the third, in which destruction
of the left first temporal convolution in a right-handed man did
not cause word-deafness.

Cask I. William Jones, aged 29 years, was admitted to the
Polyclinic Hospital, to the service of Dr Steinbach, May 12,
1901, with the diagnosis of fractured skull. He was struck in
the left temporal region with a base-ball bat. When he was
admitted he had profuse haemorrhage from the left ear, and this
continued most of the night. He has been unconscious since
admission, moves his limbs somewhat, and has tried to get out
of bed, but does not seem to know when anyone is speaking to
him. He is on liquid diet, and only a small amount can be
forced into him. The bowels have been opened by enema.
The temperature is 100 t*> pulse, 60 ; respiration, 14. Haemor¬
rhage from the ear has entirely ceased, and he lies in a semi-
comatose state most of the time.

May 17.—Paralysis, both motor and sensory, has appeared
in the right limbs. The pulse is slow, and more feeble than it
was previously. He is still unconscious, but less restless than
before.

May 18.—He seems to understand some things that are
said to him, but he cannot do more than occasionally mutter a
reply. There is slight motor power in the right leg. The left
eye is inflamed, the right iris responds to light.

May 20.—Paralysis in the right leg is disappearing. He
tries to answer questions, but cannot make himself understood.

ORIGINAL ARTICLES

331

May 22.—He sings occasionally, but cannot make himself
understood; seems to understand some things said to him.

May 24.—His right arm moved to-day; he has twitchings
of the right angle of the mouth, otherwise his condition is about
the same.

May 26.—-He has regained some use of his right arm.

June 3.—A slight twitching of the mouth is noticed on
the right side. He speaks when spoken to, but replies by
meaningless words.

July 6.— Notes by Dr Spiller. —The tic of the right side of
face in its lower portion still continues, and probably is caused by
a large scar on the right side of the neck, extending from the
middle of the clavicle to the mastoid process. The paralysis on the
right side of the body has almost entirely disappeared. His
speech is as follows: “ Well, sir, I know I use to have good. I
can ever do ever know. Yes I have been plenty; I have been
impose; I know where I at, who I not; I would to work to
work plenty plenty.” This is mingled with words that cannot be
understood. All this was in answer to the question of his name.
He does not recognise his name when it is mentioned among
other names. When told to sit up in bed he did so; when told
to lie down, he did so; when told to give his hand he did not
seem to understand; he sat up a second time on command, when
all gestures were avoided. He was probably word-blind.

June 15.—An operation over the posterior part of the left
first temporal convolution was advised. Dr Steinbach made a
horse-shoe shaped incision (base downward) over the temporal
region, dissected the periosteum from the bone, exposing a stellate
fracture; and at the superior border of the squamous portion of
the temporal bone a depression was seen. The patient was
trephined just above the point of depression, and the opening
was enlarged by rongeur forceps to about the size of half a dollar.
The dura was found torn and the brain substance protruding.
The finger, when inserted, entered a large cavity filled with
degenerated brain material and blood-clots.

After removal of this broken-down tissue, the cavity was
irrigated with normal salt solution, and a silk thread was in¬
serted as a drain. At this stage haemorrhage started, and the
cavity was packed with iodoform gauze. The scalp wound was
now brought together and sutured.

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ORIGINAL ARTICLES

June 16.—The patient had a very comfortable day. He
does not show any signs of improvement as yet.

June 17.—He still remains word-deaf. No weakness of the
right side is detected. General condition is good.

June 24.—The wound was re-dressed to-day, and all the
packing was removed. The wound is in an excellent condition.
The patient is allowed to be up.

July 1.—The wound of the scalp has healed nicely, but
there is no improvement in the mental condition of the patient.
He was sent to the Philadelphia General Hospital, July 5th,
1901, and came into the service of Dr Spiller.

His word-deafness persisted unchanged. He occasionally
understood a word here and there in a sentence, and guessed at
the meaning of the rest of the sentence. After he had been in
the nervous wards about a year, he became insane and was
referred to the insane department.

July 17, 1902.—He says he hears people talking to him,
hears the devil and thinks he saw him also, that he jumps at
him and wants to kill him.

July 19, 1902.—He no longer has auditory hallucinations,
but has been unmanageable at times, and very abusive and
violent, has refused to remain in bed, and has wandered about
the grounds, and threatened the nurse several times.

August 25, 1902.—He has delusions of persecution, and
has again shown evidence of hallucinations of hearing, which,
with the visual hallucinations, are especially interesting on account
of the injury of the centre for word-hearing and of the optic
radiations.

I am indebted to Dr Charles W. Burr for the brain of this
patient. An area of sclerosis implicates the posterior part of
the first and second left temporal convolutions and lower part
of the parietal lobe. It extends to the posterior part of the
island of Reil, and to the optic radiations, and may implicate the
latter.

The history in the second case is very brief. The man was
in the service of the late Dr Frederick A. Packard, at the Penn¬
sylvania Hospital, and the brain was given to me by Dr Packard
and Dr Simon Flexner in April 1901. The former wrote that
the man had had Cheyne-Stokes breathing many days before his

Plate 21.

Brain in Can© 111.

ORIGINAL ARTICLES

333

death, and was so deaf that it was impossible to obtain any but
the most meagre history from him, and the deafness had been
long-standing. He had no friends, consequently his former
history could not be obtained.

The greater part of the left first and second temporal
convolutions are sclerotic and the cortex here is extremely
atrophied.

The third case, in contrast to the other two, is very interest¬
ing. The patient was under the care of Dr Herman B. Allyn,
and the clinical notes are from him. I am much indebted to
Dr Allyn for them.

October 14, 1900.—F. R. S., aged 57 years, complains of
painful cramps in his right upper and lower limbs. The leg is
jerked up in flexion and subsequent extension is slow and painful.
His clinical history is as follows:—

On January 28, 1881, he fell in New York in an apoplecti¬
form attack. He recovered with disturbance of speech and
some loss of power on the right side of the body. Four years
ago he had another seizure. He is now partly aphasic, cannot
write without making mistakes, walks with difficulty, and at
times has difficulty in swallowing and in urination; also has
hiccough and vomiting spells.

November 29, 1902.—His condition is about the same as
at the previous examination. His chief complaint is spasmodic
twitching of the leg muscles and weakness of the ankles. He
has diplopia, which is not constant, and difficulty in stepping
down from the sidewalk to the street.

October 21, 1903.—He cannot walk without help. Speech
is no worse. He has been obliged for years to open the anus
with the finger in order to start a stool.

January 7, 1904.—He is weaker and cannot stand, as his
legs bend under him and he does not know where they are when
he is in bed. He has involuntary micturition, and painful spasms
of the right leg.

In reply to questions, Dr Allyn informed me that the patient
was never musical, had always had remarkably acute hearing,
and there were no words he had difficulty in understanding. He
did not swing or drag his right lower limb so long as Dr Allyn
had had him under his observation—about four years. He had

334

ORIGINAL ARTICLES

some loss of power on the right side, and the right ankle was
likely to give way under him and he was liable to fall. He
always shook hands with his right hand. His gait was some¬
what ataxic. He understood all that was said to him, but was
frequently at a loss for a word in speaking, although he could
carry on a conversation, tell anecdotes, and was very entertain¬
ing. When he was fatigued or was not feeling well his speech
became at times muffled and indistinct, so that he would have to

lo no

vTuA- omajI wAo*

. W-t- \a-J> \rs~- '*-*+*}

L>Li. O Vv» w<

Letter written by the patient (Cone 111.).

be asked to repeat. When he had difficulty in saying a word,
he would say, with an air of embarrassment and a slight laugh,
“You know what I mean.” His speech was probably much
worse following his first attack in 1881 than at any time since.
He could write legibly, but rarely did write, and was liable to
misuse words in writing, and therefore had his letters supervised
by a member of the family. In the letter reproduced there are
several mistakes : “ address ” for “ addressed,” “ tabled ” for
“ tablets,” “ troubled " for “ trouble.” He was sound mentally,
had good judgment and reasoning powers, but his memory had
failed somewhat. He read constantly. He was right-handed.

ORIGINAL ARTICLES

335

The microscopical examination shows that the patient had
tabes. The first left temporal convolution is entirely destroyed
and appears as a shrivelled mass of tissue, and the sclerosis
extends to the posterior limb of the internal capsule and to the
posterior horn of the lateral ventricle, and implicates the optic
radiations. The second left temporal convolution is intact, and
the first temporal convolution on the right side is unusually well
developed.

The only explanations that are suggested to me for the pre¬
servation of word-hearing in this case are that the centre for
this function was largely in the posterior part of the left second
temporal convolution, or that the right first temporal convolution
had been unusually well developed during the patient’s entire
life, and was capable of assuming the function of the destroyed
left first temporal convolution.

Some cases in literature give evidence that the right cerebral
hemisphere may sometimes replace the left in the functions of
speech, even in adults.

Freund reports the following case :—

A woman, right-handed, 73 years of age, had apoplexy, and
following this, right hemiplegia and aphasia. Improvement
occurred, and most important was the condition of word-hearing.
She could distinguish between sounds, she understood what was
read to her from the newspaper, she repeated sentences if they
were short and spoken slowly to her. She did not have alexia,
letters were written correctly, and she copied correctly. In
spontaneous writing, and in writing to dictation, or after long
copying, repetitions were frequent. The understanding of spoken
words seemed to be impaired only when she was spoken to
rapidly or in too long sentences, or in unusual words. Right
lateral homonymous hemianopsia and the inability to name
objects seen or touched by her indicated the location of the
lesion.

At the necropsy an area of softening was found in the left
temporal lobe, and had caused much destruction. The lesion
extended to the middle of the occipital lobe posteriorly, and to
about 1£ cm. behind the anterior end of the corpus callosum
anteriorly.

Freund believed that the restoration of word-hearing in this
case is to be explained by the assumption that the right temporal

336

ORIGINAL ARTICLES

lobe functionated in place of the destroyed left temporal lobe.
Wernicke suggested a similar explanation for a case in 1874,
and this view has been held by Pick, Kauders, V. Monakow,
Entzian, and others. (Freund, Neurologisches Cmtralblatt, Oct 1,
1904, p. 914, and Oct 16, 1904, p. 965.)

In the discussion of this case, Sachs, of Breslau, expressed
doubt concerning vicarious action of the right hemisphere in a
person so well advanced in years, and Pick shared the doubt.
Freund acknowledged that the objection was forcible, but because
of the intense destruction of the left temporal lobe he assumed
that the patient had since youth made partial use of her right
temporal lobe in the function of word-hearing.

Bastian reports a case in which the whole of the left superior
temporo-sphenoidal convolution was destroyed, with the exception
of the anterior one-third, 4£ cm. in length. Of the middle
temporo-sphenoidal convolution, the anterior 5 cm. were perfectly
intact; but posteriorly, only a narrow portion of the inferior part
of the convolution remained, and that was in a discoloured and
degenerated condition. The left angular and marginal convolu¬
tions were destroyed. The patient understood what was said
to him and could repeat all simple common words. His spontane¬
ous speech was limited to his name and short affirmative or
negative answers, or short phrases. He understood what he read.
Bastian believed that the destruction had been gradual, and that
a gradual development in the functional activities of the cor¬
responding convolutions of the right hemisphere occurred. This
case had been under observation eighteen years, and there had
never been word-deafness or word-blindness. Presumably tbe
man was right-handed. (“ Aphasia and Other Speech Defects,”
by H. C. Bastian. H. K. Lewis, London, 1898.)

A case is reported by Jolly in which right hemiplegia and
motor aphasia followed an apoplectic attack. Word-hearing for
simple questions was preserved, but complex questions were not
understood. Reading was impossible. The necropsy revealed
destruction of Broca’s convolution, and of the first and partially
of the second left temporal convolutions. Word-hearing in great
measure is said therefore to have been preserved, notwithstand¬
ing complete destruction of the left first temporal convolution,
and Jolly thinks the right hemisphere functionated in place of
the left, although the patient was 73 years old at the time of

ORIGINAL ARTICLES

337

the attack, and lived but a short time after the attack began.
(Jolly, CentralblcUt fiir Nervenheilkunde wnd Psychiatric, Oct. 21,
1899, p. 593.)

The third case that I have reported can not be explained on
the ground that the patient was left-handed, as Dr Allyn is sure
that he was not. There is evidence that in left-handed persons
the speech centres are in the right cerebral hemisphere. In a
case reported by Joflroy, the patient was word-deaf, word-blind,
paraphasic and agraphic, and an area of softening was found in
the middle portion of the right first temporal convolution, with
meningo-encephalitis about it. Only three cases of sensory
aphasia, according to Joflroy (Kussmaul, Touche, Roster), with
lesions in the right side of the brain have been reported, and
Joflroy ’b case makes the fourth. The three cases occurred in
left-handed persons. Joffroy’s patient wrote and ate with the
right hand, and those who had known him had not observed
that he was left-handed. (Joflroy, jRevue Neurologique , Jan. 31,
1902, p. 112.) Mills and Weisenburg have reported a case of
word-blindness in a right-handed man, with the lesion in the
right cerebral hemisphere. (Mills and Weisenburg, Medicine,
Nov. 1905.)

The case of Bloch and Bielschowsky seems to show that a
lesion of the anterior part of the left first and second temporal
gyri may cause word-deafness, and that involvement of the
posterior part of these gyri is not always present when word-
deafness exists. In their patient the hearing of sounds was
excellent, but that of words was completely lost. Reading and
writing were not tested. A haemorrhagic focus was found in the
point of the left temporal lobe, and it extended backwards and
downwards. (Bloch and Bielschowsky, Neurologisches Central-
blatt, Aug. 15, 1898.)

We need more cases of word-deafness from lesions of the
left first and second temporal convolutions in their anterior
portion before we can locate the centre for word-hearing in this
part of the brain.

Probst seems to have shown that the centre for music-hearing
may be in the anterior part of the first left temporal gyrus. A
patient of his had motor and sensory aphasia, she could repeat
only a few words, and these conveyed no meaning, but she could
sing and articulate the words in singing correctly. She recog-

338

ORIGINAL ARTICLES

nised songs with which she had been familiar, and sang them
correctly after some one else, and was able to sing unknown
tunes, but without the notes. (Probst, Archiv filr Psychiatric,
vol. xxxii. No. 2, p. 387.) The anterior part of the first left
temporal gyrus was not implicated in the lesion.

The explanation of the substitutional functioning of the right
cerebral hemisphere applies to motor speech as well as sensory.

A case that Byrom Bramwell reports shows that acute and
complete destruction of Broca’s area, and of the anterior end of
the left island of Reil, in a person who has always been right-
handed, may produce merely a very temporary motor aphasia.
Bramwell believed that in his case the cortical centre in the
right hemisphere corresponding to Broca’s convolution was more
highly educated than it is in the great majority of right-handed
persons, and was able to carry ou immediately the functions of
the left motor-vocal speech centre. According to his views, the
right cerebral hemisphere has more to do with speech than is
usually taught, and the speech centre and speech functions are
bilaterally represented in the brain, but not to the same extent
in each hemisphere.

A somewhat similar case has been reported by Collier, and
probably other similar cases could be found in the literature.
(Bramwell, Brain, Autumn 1898 ; Collier, Lancet , 1899.)

TWO OASES OF EMBRYOMA IN THE FRONTAL
LOBE OF THE BRAIN.

By B. G. ROWS, M.D.,

Pathologist to the County Asylum, Lancaster.

Amongst the very rare tumours which may be found in the
cranial cavity, are the dermoid cysts and the embryomata.
These tumours are more frequently met with in the base of
the skull and in the hypophysis; very seldom have they been
found in the brain itself. Wilms (1), while searching through
the literature on the subject, has discovered only a few cases
which have been recorded by Weigert, Beck, Bonorden,

ORIGINAL ARTICLES

339

Gauderer, Rokitansky, Bruns, Virchow, and Ziegler. Beck
has also described eight cases of embryomata which he found
in the nasal and pharyngeal cavities.

These tumours all resembled each other in containing some
embryonal structures, but their complexity varied very much
in the different cases. The structures which were found included
skin with hair and glands, fat, mucous tissues, ciliated mucous
membrane, cartilage, bone, muscle, and nervous tissue. Beck’s
case contained some thyroid gland substance.

In the course of last year I met with two cases in which an
embryoma was situated in the frontal lobe of the brain.

In the first case the tumour, which was about an inch in
diameter, lay in the mesial portion of the first frontal convolution
of the brain of an epileptic aged 77. This man had been in the
asylum for fifteen years. He had suffered from frequent epileptic
attacks, which left him irritable and sometimes dangerous, but
there had been no symptoms which pointed to the presence of
a tumour in the brain. This tumour was a very simple one,
and contained only epithelium, fibrous tissue, fat, and choles-
terine crystals.

The other tumour was about the size of a hen’s egg, and was
found in the left frontal lobe of an epileptic aged 73. He had
been in the asylum for thirty-eight years. His attacks occurred
about once a month; he was often troublesome for a day or two
before the attack, and excited and confused for two or three days
after, but here again there were no symptoms of cerebral tumour.
Before admission he had been an overlooker in a mill, and while
here he worked, at different times, at tailoring, shoemaking, and
mattress-making. He became demented gradually.

This tumour lay above the pia mater of the orbital surface
of the left frontal lobe. The pia here was much thickened and
had a pearly-white appearance.

The centre of the tumour was occupied by a soft, yellowish-
grey substance, which consisted of fat cells, shed epithelial cells,
and crystalline plates. In its wall were found skin, hair, sebaceous
glands, embryonal blood-vessels, cartilage, bone, elastic tissue,
and muscle.

It will be seen that the embryonal structures which were
present in these two tumours differed very greatly. In the
smaller one there was little more than a layer of epidermis;

840

ORIGINAL ARTICLES

while in the other, structures representing many of the tissues
of the body were found.

Now, the one structure which is present in all the embryomata
is that which is derived from the ectodermal layer, the epidermis.
Wilms ascribes this to the fact that the ectodermal layer is
developed first, and, in fact, may be the only layer which appears
in some of these tumours. Now, in the ovarian dermoids at any
rate, it is usual for all three layers—epiblast, mesoblast, and
hypoblast—to be represented, but the portions which are
developed from the two inner layers may be limited because
of the pressure exercised on them by the surrounding structures
or by their own growth, or because of other abnormal conditions
under which they exist. In some cases they break down and
disappear owing to a haemorrhage into their substance or to
interference with their nutrition.

Bostroem (2), in describing these tumours, has stated that
intermediate grades exist in the complexity of the growths, from
the very simple to the embryomata. The simplest, such as my
first case with just the layer of epithelium, would be called by
him a cholesteatoma. The complexity of the series increases
by the addition of dermal and other structures, until at last
we find growths which contain portions of the skeleton and
representatives of many of the tissues of the body.

Other characteristics which, according to Bostroem, are
shared by all of them, are:—

1. They are all intimately connected with the pia mater,
and the active cells from which the tumour spreads are situated
in that membrane.

2. They are always found in the basal portions of the brain,
and in or near the middle line.

3. They all start in the early stages of embryonal life, i.e.
between the third and fifth week of development.

4. They grow very slowly, and rarely give rise to any
symptoms.

The gradual increase in the complexity of this series of
tumours, together with these characteristics, which are common
to them all, suggest that they must have a similar origin.

Hitherto, as Bostroem says, they have been ascribed to a
penetration, at a very early period of embryonal development,
of a series of ectodermal cells into that layer from which the

ORIGINAL ARTICLES

341

nervous system is developed; it is from these included cells
that the various contents of the tumour are derived. These
included cells must contain potentialities of the various tissues
mentioned above, but their powers of development are limited
by the abnormal conditions under which they exist

No satisfactory explanation of such an inclusion of cells has
yet been offered.

Lustig (3), speaking of the growth of these tumours in the
sexual glands, says they can be logically explained by the theory
of Wei8smann, by admitting that in a germinal cell the reserve
plasm, which is contained in these cells, has accidentally burst
into activity, and has led to the formation of cells which are
very similar to those found in a very early period of embryonic
development, and that from these cells the various tissues con¬
tained in the tumour are derived. He does not offer any explana¬
tion of their occurrence in any other part of the body.

The subject was approached from an altogether different
point of view by Wilms. In his comprehensive work on dermoid
cysts and embryomata, without explaining all the steps by which
these tumours have arisen in all parts of the body, he suggested
the probability of their having sprung from “ wandering germ
cells”

Dealing with ovarian dermoid cysts, after showing that the
theories which have been brought forward to explain their origin,
viz. abnormal pregnancy, irritation or stimulation of some Nisus
Formativus in the membrana granulosa, inclusio foetus in foetu,
are untenable, he says that “ dermoid cysts of the ovary can only
spring from egg cells.”

Again, when speaking of Beck’s cases of tumours of various
complexity—some containing portions of skeleton and of some of
the organs of the body—in the pharyngeal and nasal cavities,
he said that Beck could not decide whether they had sprung
from wandering germ cells, or whether they owed their origin to
a duplication of a series of cells.

Then, with regard to the tumours—ciliated epithelial cysts
and dermoids—in the thorax, he said “ they all may be traced
to a scattering of germ cells in very early foetal life.”

Lastly, when giving his conclusions on the origin of the
teratomata, which grow in the nasal cavities, in the base of the
brain, and in the cranial cavity, he said :—

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ORIGINAL ARTICLES

1. The numerous branchial clefts of the head, the formation
of the mouth, and the projection inwards of the hypophysis, offer
many opportunities to the wandering germ cells.

2. Some of the teratomata may be produced by a duplica¬
tion of a series of cells.

It is evident that although Wilms recognised that these
tumours must have sprung from germ cells, x.e. from the only
cells which are known to possess the potentialities necessary for
such a growth, he made no attempt to explain the wandering of
these cells. In the embryological works of Beard (4), however,
we find a description of the earliest embryonal development in
some of the fishes which throws much light on this phenomenon.
In his investigations on the development of the Raja batis,
Beard has shown that the earliest divisions of the fecundated
ovum do not take part in the formation of an embryo, in fact
the fecundated ovum passes through two series of divisions before
any signs of an embryo appear.

The first series includes ten mitoses, and gives rise to a
structure which Beard states corresponds to one stage in an
alternation of generations, and leads up to the primitive germ
cell The next stage starts from this primitive germ cell, which
divides into two, then into four, and so on through nine mitoses,
giving rise to 512 primary germ cells.

All this has gone on without any appearance of an embryo.
At this stage one of these 512 primary germ cells undertakes
the formation of an embryo, and the other primary germ cells
pass into this developing embryo along the yolk-stalk, which
connects it with the yolk-sac.

This migration begins very early, even before the closure of
the medullary plate, and lasts for only a short time.

It is possible to distinguish these primary germ cells, because
when they are stained with osmic acid or Heidenhain’s iron-
hsematoxylin, the yoke-plates which they contain are coloured a
deep black, and they can thus be easily recognised amongst other
cells.

These cells should find their way to the germinal nidus; but
Beard has found in the Raja batis and in the Pristiurus that in
their migration into the embryo some of them fail to find the
germinal nidus, and they wander into other parts of the body.
In the series of embryos of Pristiurus (5) examined, Beard

ORIGINAL ARTICLES

343

states “that no single embryo was devoid of germ cells in
abnormal places.” In the Raja batis they have been found
in all the organs of the body except the thyroid and thymus
glands.

Further investigations have led Beard to the conclusion that
the capacity to form an embryo is not necessarily limited to one
only of these primary germ cells, but that, for example in the
skate, at least from 8 to 16 primary germ cells possess the
potentialities necessary for such a development. In some
animals, e.g. the armadillo, it seems to be a normal phenomenon
to have more than one embryo developing within a single
chorion.

If two of these cells, possessing the necessary potentialities,
develop at the same time, the result will be that two embryos
will be contained in a single chorion, and we shall have an
example of what are known as “ identical twins.”

But if, instead of producing an embryo, a primary germ cell,
endowed with such potentialities, wanders into the developing
embryo and fails to reach the germinal nidus, it will stray into
some other situation, and may there become encapsuled and
remain inactive, or it may give rise to an incomplete develop¬
ment, owing to the abnormal conditions in which it is placed.

Such has, in all probability, been the sequence of events in
my cases. In each of them a primary germ cell, endowed with
the potentialities necessary for the development of an embryo,
has migrated along the yolk-stalk, has failed to reach the
germinal nidus, and has wandered to the frontal lobe of the
brain, and there given rise to the tumours described above.

Now, although it is so rare to find these tumours in the
human brain, it is by no means rare to discover wandering germ
cells in the brains of fishes. They have frequently been found
by Beard in the brain of the skate, and he has also discovered
one on the spinal cord of a salamander.

The embryological researches of Beard therefore provide a
basis of support for the opinion of Wilms that these embryomata
spring from wandering germ cells, and we are thus enabled to
obtain a clear view of the sequence of events which leads to the
production of the embryomata, in place of the vague and
unsatisfactory hypotheses which have been advanced to explain
the origin of these tumours.

344 ORIGINAL ARTICLES

References.

1. Wilms. “Ueber die Dermoidcysten and Teratome, mit besondecer
Beriicksichtigang der Demoide der Ovarien,” Deutsche* Archiv fur kltnitche
Medicin, Band lv.

2. Boetroem. “ Ueber die pialen Epidermoide, Dennoide and Lipome, und
dar&len Dermoide,” Cmtralblatt fur path. Anat ., 1897, 8. 1.

3. Lustig. Patologia Generate , 1901.

4. Beard. “A Morphological Continuity of Germ Cells as the Basis of
Heredity and Variation,” Review of Neurology and Psychiatry, 1904.

5. Beard. “The Germ Cells of Pristiurns,” Anatomischer Anzeiger,
Band xxi., 1902.

THE RECOGNITION OF SEGMENTAL LEVELS IN THE
CERVICAL AND LUMBAR ENLARGEMENTS OF
THE SPINAL CORD FROM THE APPEARANCE OF
THE TRANSVERSE SECTION.

By EDWIN BRAMWELL, M.B., F.R.C.P.E., M.R.C.P.Lond.

The correlation of clinical symptoms present daring life with
anatomical lesions met with post-mortem necessitates in certain
cases an exact determination, so far as possible, of the segmental
level in the spinal cord from which any section under examina¬
tion has been taken. This result may be arrived at by counting
and marking the nerve roots and segments before the cord has
been subdivided. Unless, however, the dura mater has been
preserved intact so that it is possible to trace the roots from the
point at which they penetrate this membrane to the point at
which they join the spinal cord itself, the delimitation of the
individual segments will be attended with considerable difficulty,
particularly in the lumbo-sacral region.

When the segments have not been numbered and marked
previous to subdivision of the spinal cord, the level of any section
can only be gauged by distinctive characters which that section
may present.

Dr Alexander Bruce, in his “ Topographical Atlas of the Spinal
Cord,” has figured a series of very beautiful photogravures illus¬
trating the special features of the transverse section at the level
of each segment. The cord from which his figures are taken was
the last and most perfect of five which were specially examined

ORIGINAL ARTICLES

34*

for this purpose. The cord was divided into segments by a series
of horizontal incisions passing through it immediately below
the lowest fibres of each entering nerve root. Each segment was
cut into serial sections, of which every tenth was stained in order
to demonstrate the relative arrangement and proportions of the
grey and white matter. “ From the total number of sections
in each segment a selection was made of one which appeared to
be the most characteristic of that segment. Where the transit
in form of grey to white matter in any one segment was so great
that a single section could not be regarded as typical of that
segment (as was the case in the eighth cervical segment), two
sections were chosen.” The sections are reproduced with a magnifi¬
cation of ten diameters. Other sections were stained to show the
arrangement of the nerve cells, but since this subject is beside
the purpose of the present communication, further reference
thereto is unnecessary. Dr Bruce concluded from his research
that although there are minor individual variations which appear
to be mainly dependent upon differences in the shape of the cord,
the “ type of form ” of the grey matter and the type of outline
of the anterior cornu is constant for each segment or for corre¬
sponding parts of segments in different cords. He remarks, how¬
ever, that it is very difficult, if not impossible, to identify in¬
dividual segments in the dorsal region from the 3rd to the 10th
inclusive, although it is possible to tell whether any given section
belongs to the upper part, i.e. from the 3rd to the 6th, or to the
lower, i.e. from the 7 th to the 10 th inclusive.

While engaged in cutting a normal cord for comparative
purposes, it struck the writer that it would be interesting to
examine a series of cords and to illustrate the appearances pre¬
sented by sections taken from identical levels in order to show
the amount of variation that might occur.

In the plate which accompanies this communication, outline
drawings illustrating the shape and size of the transverse section
of six spinal cords at successive segmental levels in the cervical
and lumbo-sacral enlargements are figured. Before proceeding
to refer to these appearances, it is necessary to describe the
method which has been employed.

Method .—The six spinal cords, sections from which are
figured on Plate 22, were removed from subjects free during
life, so far as was known, from nervous disease. In each case

346

ORIGINAL ARTICLES

the cord was obtained from the level of the second or third
cervical segment to the filum terminale, the dura mater being
preserved intact The dura was slit up from top to bottom
both anteriorly and posteriorly and the cord was placed in 10
per cent formalin. A few days later the roots were counted
and a piece of silk attached to the first dorsal, first lumbar, and
first sacral The method adopted in enumerating the roots was
to regard the first small root caudal to the cervical enlargement as
the second dorsal and to count up and donon from this level. The
cord was then divided into segments by a series of transverse
incisions made at the lowermost level of each entering root
Each segment was further subdivided into two equal parts by
a transverse incision passing as nearly as possible through its
centre. For the purposes of the present investigation the lower
half of each segment was used. A horsehair was passed from
above downwards through each piece of cord in the region of
the left anterior horn. The lower halves of successive spinal
segments were thus preserved in series. After hardening in
Weigert’s chrome alum solution and embedding in photoxylin
in the usual way, each individual piece of cord was mounted
on a numbered block, care being taken in each instance to see
that its cephalic extremity was placed uppermost Several
sections were then taken from each block, and one or more of
these were stained by Ford Robertson’s modification of Heller’s
method and mounted. The sections from each segment were
stained and mounted separately in order to avoid all risk of
confusion, and with the same object in view each slide was
numbered as the preparation was completed. In this way one
or two sections were obtained from near the centre of every
segment below the level of the second or third cervical. Careful
camera lucida drawings of certain segments (C4 to D1 and LI
to SI) were then made. The drawings so obtained were photo¬
graphed and are figured on the plate which illustrates this paper.

Before proceeding to refer to the features which characterise
the different levels, two explanatory remarks are necessary. In
the case of Cord I., for instance, there appeared to be 13
dorsal segments, if the first small root caudal to the cervical
enlargement was regarded as D2. It follows that had this
method of enumeration been alone adopted in the case of this
cord, the lumbar segments would have all read one lower than is

•ORIGINAL ARTICLES

347

figured on the plate. On counting the roots from below upwards,
however, the lumbar sections were found to be correctly num¬
bered as here depicted. It would seem, then, that in the first
cord there was an extra dorsal root, or, what is perhaps more
likely, that the whole cervical enlargement was displaced one
segment upwards. For purposes of comparison it was considered
advisable in numbering the segments in the case of this cord to
omit one of the dorsal segments.

A further point to which the attention of the reader is
directed is the transposition of the sections C5 and C6 of
Cord VI., a mistake which was only discovered on examining the
blocks after the drawings had been photographed and the plate
prepared.

Remarks .—The result of this investigation has been to con¬
firm Dr Bruce’s conclusion that there is a type of outline of the
anterior cornu which is characteristic of each segment in the
cervical and lumbar enlargements. Let us now briefly point out
the more prominent features which distinguish the transverse
section each of the levels as represented in the plate.

Cervical 4.—The large size of this section as compared with
the upper cervical segments is characteristic. The anterior horn
is considerably broader than in the segments above this level.
The anterior cornua in sections at this level and at the level of
first lumbar segment are very similar in shape. The size of the
section, the broader posterior horns of the first lumbar, and the
projection into the posterior columns which is produced by
Clarke’s group in the upper lumbar region are, however, points
by which these sections can be readily distinguished. (Cerv. 4,
Cord III.) 1

Cervical 5.—The prominent pointed antero-lateral angle of
the anterior horn is the distinctive feature of this level. The
postero-lateral angle is also pointed—a feature in which thi«
segment differs from the eighth segment—with sections from the
upper part of which (compare Cord V., Cervical 8) it might
perhaps be confounded. (Cerv. 5, Cord I.)

Cervical 6.—The antero-lateral angle is not nearly so promi-

1 The reference in brackets indicates the figure in the plate which most closely
corresponds to the section depicted by Dr Bruce in his Atlas as typical of this
segment. In this work the appearances of the transverse section are described in
greater detail than in the present communication.

348

ORIGINAL ARTICLES

nent as in the preceding segment. A second antero-lateral angle,
as pointed out by Dr Bruce, is characteristic of this level. This
is especially well seen in the sections of Cords V. and VI. Note
once more that Cervical 5 and Cervical 6 of Cord VI. have been
transposed. (Cerv. 6, Cord V.)

Cervical 7.—The square or rhomboidal shape of the anterior
horn distinguishes this level. (Cerv. 7, Cord I.)

Cervical 8.—The concave anterior border is distinctive. In
the upper part of the segment an antero-lateral angle is figured
by Dr Bruce as characteristic (compare Cerv. 8, Cord V.). This
section, however, may be distinguished from the fifth cervical, to
which it bears some resemblance, by its rounded postero-lateral
angle. (Cerv. 8, Cord V. = upper part, Cerv. 8, Cord IV. = lower
part.)

Dorsal 1.—The triangular, somewhat boomerang shape of the
anterior horn is a feature by which this segment may be recog¬
nised without difficulty. In the section from Cord L the anterior
horn approaches in shape the type met with at the level of the
second dorsal. (Dorsal 1, Cord IV.)

Lumbar 1.—At this level, as has been already pointed out,
the anterior horn bean a considerable resemblance in shape to
the fourth cervical segment, from which the section may be dis¬
tinguished by its smaller size, by the greater relative breadth of
the posterior horn, and by the prominent projection which is
formed by Clarke's column. As in the case of the fourth cervical
segment, the first lumbar is to be distinguished from the segments
immediately above it by the greater breadth of the anterior horn.
(Lumb. 1, Cord III.)

Lumbar 2.—The grey matter here assumes the shape of a
narrow goblet. Dr Bruce’s representation corresponds more
closely to Cord V., Lumbar 3, than to any of the sections here
figured from this leveL (Lumb. 3, Cord V.)

Lumbar 3.—The grey matter still retains a goblet shape,
although the cup is one of considerably greater capacity. (Lumb. 4,
Cord V.)

Lumbar 4.—The rounded or hood-shaped anterior horn, as
Dr Bruce describes it, is the striking feature of sections at this
level. (Lumb. 4, Cord III.)

Lumbar 5.—The prominent antero-lateral and postero¬
lateral projections give the anterior horn at this level a resem-

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ORIGINAL ARTICLES

349

blance to a hatchet with a concave catting edge. (Lumb, 6,
Cord I.)

Sacral 1.—The hatchet shape is still seen at this level, but
the cutting edge of the hatchet is now convex. This section is
somewhat similar to the fourth lumbar, from which it may be
distinguished, however, by the acute angle formed by the white
matter of the lateral columns as compared with the obtuse angle
in the case of the fourth lumbar. (Sac. 1, Cord IV.)

abstracts

ANATOMY.

DISTRIBUTION OF THE CELLS IN THE INTERMBDIO-
(162) LATERAL TRACT OF THE SPINAL CORD. Alexander
Bruce, Trans. Roy. Soc. Edin., Vol. xlv., Part 1, 1906.

In a research on the intermedio-lateral tract in the cervico-dorso-
lumbar region of the cord, the author comes to the following con*
elusions:—

1. The intermedio-lateral tract may be defined as a tract
composed of a special series of nerve-cells, situated at the outer
margin of that portion of the grey matter which lies between the
anterior and posterior cornua. These cells are not necessarily
limited to the lateral cornua.

2. Within the spinal cord the tract is found in three regions:
(1) in the upper cervical region as low as C. 4; (2) in the lower
cervical, the dorsal, and the upper lumbar regions; and (3) in the
lower sacral region (below the lower part of the third sacral
segment).

3. It is absent in the cervical enlargement from C. 5 to C. 7
inclusive, and in the lumbo-sacral region from L. 3 to the upper
part of S. 3 inclusive.

4. In that portion of the tract which is at present under con¬
sideration—viz. the second of the above-mentioned divisions—its
component cells are found mainly in two positions: (a) in the
lateral horn proper, or in analogous positions above the level at
which the lateral horn is fully constituted; and (b) along the
margin of that part of the grey matter which is in immediate
relationship to the formatio reticularis, and also among the strands
of the formatio reticularis itself. For convenience of description

ABSTRACTS

360

and. reference these may be distinguished as the apical cells and the
reticular cells.

5. The apical and reticular cell-systems have not a co-extensive
longitudinal distribution.

6. The apical cells are found between the middle of the upper
half of the eighth cervical segment and the lower end of the second
lumbar, or the extreme upper part of the third lumbar segment.

7. The reticular cells are first met with in the lower half of
the second dorsal segment, and have the same lower limit as the
apical series. They are not present in the cervical enlargement.

8. The upper part of the apical cell-series is composed of cells
which are either situated in the white matter at some little dis¬
tance behind the lateral part of the anterior horn, or are applied
more or less closely to the grey matter. In all cases the cells are
distinct from the large motor cells in their position, size, form, and
grouping. No transitional forms are anywhere found between the
cells of the two series.

9. The lateral horn is not fully constituted above the lower
half of the first dorsal segment. This horn is not a transition
from the lateral part of the anterior horn, but is a new and inde¬
pendent formation. It is represented in C. 8 and the upper part
of D. 1 by the outlying cells of the intermedio-lateral tract.

10. The lateral horns of the two sides may show a want of
symmetry in size and form, notably in the lower dorsal and lumbar
regions. In the tenth, eleventh, and twelfth dorsal segments the
apical cells lay in a plane posterior to the central canal.

11. The middle cells described by Waldeyer do not form any
part of the intermedio-lateral tract.

12. The cells of the intermedio-lateral tract vary in size from
12 p to 60 p.

13. The apical and reticular cells could not be distinguished by
any essential difference in their form, size, or structure. Large
and small cells lying in close juxta-position may be present in both
series in any one section. It has not been found that any group
is composed entirely of large or of small cells. Large cells were
relatively more numerous towards the lower end of the tract, but
they were present alike in the apical and in the reticular series.

14. The number of cells in the intermedio-lateral tract is vastly
greater than has hitherto been recognised.

15. The cells of the intermedio-lateral tract do not form a con¬
tinuous column, but occur throughout the tract in groups or clusters.

16. These groups are not symmetrical on the two sides,
although they may present a general resemblance to each other.
There appears to be a larger number of cells on the left side in the
lower cervical and upper dorsal regions. In the tenth dorsal
segment there is a large excess on the right side.

ABSTEACTS

351

17. These groups or clusters vary in size and form and in their
distance from each other.

18. In each segment the cell-groups are arranged in a manner
which may be regarded as characteristic of that segment.

19. The number of groups in each segment is somewhat diffi¬
cult to determine in some cases; generally the number is fairly
equal on the two sides.

20. At the upper and lower extremities of the tract there is a
tendency for the groups to appear suddenly, to rise rapidly to a
maximum, and then quickly to disappear. Towards the centre
of the tract—below the fifth and above the tenth dorsal segments
—the groups are less separated from each other. They rise
slowly, persist for a considerable length, and diminish slowly.
In this region the maximum number of cells attained is never
so great as towards the extremities of the tract.

21. There is a remarkable increase in the number of the cells
in the third dorsal segment. There is a marked transition in the
form of the groups in the middle of the fifth dorsal segment, and
another at the middle of the ninth dorsal segment.

22. The intermedio-lateral tract has a vascular supply largely
independent of that of the motor cells of the anterior cornu.

23. The segmentation of the tract into groups or clusters of
cells is not due to the distribution of blood-vessels or of the root-
fibres, but is probably in some way related to their function.

It is pointed out that the greatest outflow of the sympathetic
fibres from the cord, as indicated by the researches of Gaskell and
Langley, corresponds in a remarkable manner with the position of
the greatest number of the cells in the intermedio-lateral tract.
Eeference is made to the researches of Anderson and Herring and
of Onuf and Collins, with regard to the probability that the inter¬
medio-lateral tract is the source of the fibres of the sympathetic
system.

The paper is accompanied by a graphic chart of the distribution
of the fibres, and by 24 figures illustrating the position and dis¬
tribution of the cells. Author’s Abstract.

PHYSIOLOGY.

ON THE PREPARATION OF OHOLESTERIN FROM BRAIN.

(163) 0. Rosenheim, Jowm. of Physiol., March 1906, p. 104.

THE OHOLESTERIN OF THE BRAIN. M. Christine Tebb, Ibid.,

(164) p. 106.

In the first paper a modification of Biinz’ method for the prepara¬
tion of cholesterin is described.

352

ABSTRACTS

By means of this method human brain substance was examined
for the presence of cholesterin-ethers. The results given in the
second paper confirm Bunz’ statement, that cholesterin occurs as
such in brain and not in the form of ethereal salts.

W. Cramer.

PATHOLOGY.

THE SUPRARENAL CAPSULES IN OASES OF NERVOUS AND

(165) OTHER DISEASES. F. W. Mott and W. D. Halliburton,
Joum . of Physiol ., March 13, 1906.

In this precis of their paper read before the Physiological Society
on January 20, 1906, the authors state that having noticed the
frequency with which atrophy or disintegration of the suprarenal
capsules occurred at autopsies on cases which had died in the
London County Asylums, and looking to the very special relation¬
ship between the nervous system and the medulla of the suprarenal,
they examined the suprarenale in over seventy successive cases in
order to determine if there was any connection between nervous
disease and suprarenal atrophy.

The glands were examined histologically, by Vulpian's colour
reaction with ferric chloride, and also physiologically for adrena¬
line.

In half the cases the glands were atrophied, degenerated, or
disintegrated, but no connection could be traced between such a
condition and the original nervous or mental disease for which the
patient had been admitted to the asylum.

Suprarenal atrophy appeared, however, to be related to the
secondary diseases from which the patient ultimately died, in the
majority of cases where it occurred the patient having suffered
from chronic disease.

The authors state that the observations suggest the possibility
that the fatal termination of chronic diseases may be accelerated
by the lack of suprarenal secretion, and consequent circulatory
depression. A. Dingw all-Fordyce.

POST MORTEM CHANGES IN THE NEUROFIBRILS. (Alterations

(166) cadaveriques des neuroflbrilles.) Lachk, Rev. Neurol., No. 5,
1906.

In this paper the author gives the results of an investigation into
the post-mortem changes of neurofibrils in the nerve cell and in
the peripheral nerve. In the large motor nerve cells the peri-

ABSTRACTS

353

nuclear fibrils are first attacked, and the process gradually spreads
to the dendrites. The change consists of a granular degeneration,
which leads to a complete disappearance of the fibrils. But
with a high magnification it is seen that the fibrils in the dendrites
are also altered, but the granules are- larger and stain more darkly.

In the sensory cells, in the cells of Purkinje, and in the cells
of the polymorphous layer of the cortex, all the fibrils become
affected at the same time. In both cases the degeneration goes on
until the cell is represented by a round mass of amorphous proto¬
plasm, in which lie a few dark grains, or there may remain only
the nucleus surrounded by a thin layer of homogeneous cytoplasm.
The fibrils of the peripheral nerves undergo a process of fragmenta¬
tion and decolorisation. In the spinal cord the granular disintegra¬
tion of the large fibres is very slow.

Finally the author draws attention to two facts, first, that the
changes which take place after death resemble those which occur
when the cell is attacked by a poison during the life of the
organism, and pass through the same stages, viz. alteration of the
protoplasm, then of the nucleus, and lastly, of the nucleolus, and
secondly, that the changes begin in that portion of the cell which
is developed latest

There is, therefore, no essential difference between the granular
degeneration of the intracellular neurofibrils in the cadaver and
the regressive changes of the fibrils when attacked by a toxin.

R. G. Rows.

ON THE DETECTION OF BHIZ0P0D8 IN TWO OASES OF
(167) ACUTE ANTERIOR POLIOMYELITIS. (Ueber den Befond
von Rhizopoden bei zwel Falien von Poliomyelitis acuta.)

Y. Ellermann, Centralbl. /. Bakt., etc., 1. Abt. Originale, 1906,
Bd. xl., H. 5.

In the fluid obtained from two cases of poliomyelitis anterior acuta
by means of lumbar puncture, and with stringent precautions so
as to prevent contamination, the author found bodies which he
regards as rhizopods. When fresh preparations of the fluid were
examined on a warm stage, the parasites presented active amoeboid
movement. In films stained by Leishman’s method, the parasites
were 10-15/* in diameter; each contained a small ring-shaped
nucleus; the cytoplasm was not granular; the pseudopodia were
numerous and terminated in long, slender filopodia. Some of
the parasites appeared to be phagocytic towards lymphocytes,
but not towards erythrocytes. The appearances of the parasites
are shown in two illustrations. W. T. Ritchie.

354

ABSTRACTS

MENINGOCOCCAL PHARYNGITIS AS A CAUSAL FACTOR OF
(168) EPIDEMIC CEREBRO-8PINAL MENINGITIS. (Die Meningo-
coccenpharyngitis als Grundlage der epidemischen Genick-
starre.) A. Ostermann, Deutsche mcd. Wchnschr., March 15,
1906, p. 414.

Meningococci have not hitherto been often isolated from the nose
or naso-pharynx of healthy individuals. Albrecht and Ghon,
examining 15 persons, found meningococci in only one instance,
a father whose child had died of meningitis. Weichselbaum and
Ghon have examined the naso-pharyngeal secretion from a large
number of healthy persons during the recent epidemic of cerebro¬
spinal meningitis in Silesia, but in only three instances did they
detect meningococci; whilst v. Lingelsheim found those cocci in
24 out of 346 healthy persons who were in contact with cases of
that disease.

The author instituted bacteriological investigations on the
upper respiratory tract of the members of six families, in which
there were children suffering from cerebro-spinal meningitis. He
found meningococci in members of each of these families. Of 24
persons examined, the naso-pharynx of 17 harboured cocci, which
were proved by agglutinating sera to be meningococci. Several of
these persons presented naso-pharyngeal catarrh, but usually with¬
out fever, headache, or other sign of constitutional disturbance.
Such persons affected with meningococcal pharyngitis constitute
the chief foci of infection. The upper part of the naso-pharynx is
the favourite site of the meningococci, which were less frequently
detected in the nose or on the tonsils. At a time when there was
no epidemic, the author examined 50 school children and 10 adults,
without once finding meningococci in the naso-pharynx.

The chief prophylactic measures to be adopted when epidemic
cerebro spinal meningitis is prevalent are the closing of schools, or
the detention from school of children living in a house where there
is a case of that disease; the disinfection of sputum, of handker¬
chiefs, and of the patient’s room; and the instruction of the laity
as to the manner in which the infection is propagated.

W. T. Ritchie.

THE PATHOLOGY OP EPILEPSY. John Turner, Brit. Med.
(169) Journal, March 3, 1906, p. 496.

The author holds that epilepsy is a disease occurring in persons
with a defectively developed nervous system, associated with a
morbid condition of the blood, whereby it shows a special tendency
to intravascular clotting; and that the immediate cause of the

ABSTRACTS

355

fits is sudden stasis of the blood stream resulting from the blocking
of cerebral vessels by the intravascular clots.

As regards the features pointing to a defectively developed
nervous system, and which may be regarded as stigmata of de¬
generation, Dr Turner mentions the two following characteristics:
(a) A variety of nerve cell which, as Lugaro, Bevan Lewis,
and others have, pointed out, represents an embryonic form,
and is a common feature of the brains of imbeciles. This
type of cell is moat clearly seen in the Betz cells of the
ascending frontal gyrus, and was observed by the author in 77 per
cent, of his cases of epilepsy. ( b ) The persistence of subcortical
nerve cells, a character first noted by RoncoronA These cells
exist in large numbers throughout life in the lower animals, but
although found in infants they soon, with the growth of the child,
become less, and at adult age few remain. In imbeciles, on the
other hand, they tend to persist, so that at all ages they are met
with in large numbers. They are also commonly seen in the
brains of epileptics. Dr Turner also describes cells in the brains
of epileptics similar to what has been observed in the brains of
dogs after ligature of the cerebral arteries. He lays stress upon
this appearance as indicating a like condition in epilepsy, viz.
stasis of the cerebral circulation.

The characteristic vascular changes which he has observed
consist of hyaline masses, spheres, finely granular clots and fibrine
threads occupying the lumen of the smaller cerebral blood-vessels,
the walls of which, however, present a normal appearance. These
clots he ascribes to the amalgamation of blood plates, as their re¬
action to staining reagents indicates the presence of phosphorus,
and points to the nucleo-proteid character of the clot. That the
clots are not post-mortem changes, is clearly shown by the fact
that proximal to these obstructions are often seen rupture of the
blood-vessel wall and effusion of blood into the perivascular space.

The author ascribes the sclerosis of the cornu ammonis, so well
known a feature of epileptic brains, to the deprivation of the
normal blood supply to this part, as a result of complete or partial
thrombosis of its nutrient vessels, whereby the tissues are, as it
were, starved.

The cornu ammonis is, however, not the only part of the brain
affected by this sclerotic change, for similar features were seen in
the occipital lobe and in the cerebellum.

In support of his contention that the convulsions in epilepsy
are due to the deprivation from the cortical areas of arterial blood
in consequence of the thrombotic obstructions which he has
observed. Dr Turner refers to the well-known Kussmaul and
Penner experiments, in which general convulsions were produced
in rabbits after ligature of the subclavian and innominate arteries;

856

ABSTRACTS

and to an observation of K Hill’s, who produced spasm in himself
by compressing one of his carotid arteries; this author also states
that sudden occlusion of one carotid artery may iu some persons
produce a march of epileptic spasm preceded by an aura.

W. Alpben Turner.

CLINICAL NEUROLOGY.

POLYNEURITIS AS A SEQUELA OF GERMAN MEASLES.

(170) (Polynforite suite de ruWole.) Revilliod and Long,
Arch, de mid. dee enfanie, March 1906.

Sequels of any kind in this usually trivial exanthem are so rare,
that the following case reported by Revilliod and Long is of con¬
siderable interest. A boy, aged eight, had a mild attack of
German measles without any rise of temperature or constitutional
disturbance. The eruption completely disappeared in forty-eight
hours. Ten days later paralytic phenomena developed, which were
at first confined to the lower extremities. His walk became un¬
certain and staggering, and he soon found it impossible to go
upstairs or downstairs, to get into bed without assistance, or even
to rise from the dorsal decubitus into a sitting posture. The trunk
and upper limbs soon became involved, and neuritic pains simul¬
taneously developed. For three weeks the motor impairment
became worse and then began to improve, but the uormal con¬
dition was not regained till the end of two months. The pains
disappeared long before the return of motility. The tendon
reflexes were lost throughout the affection and remained so long
after apparent recovery. There was no definite muscular atrophy
nor reaction of degeneration. Contrary to what is usually found
in motor polyneuritis, paralysis of the trunk muscles was much more
accentuated than that of the limbs, while in the extremities the
proximal muscles were more affected than the distal ones. The
neuritic pains were also more marked at the root of the limbs.
Diplopia, a rare manifestation of polyneuritis, was present for some
days. The child had been kept under careful observation through¬
out his illness, and the writers confidently assert that all con¬
comitant infectious diseases, in particular diphtheria, could be
excluded from the causation of the polyneuritis.

J. D. Rolleston.

TABES, GENERAL PARALYSIS, AND SYPHILIS. (Zur Tabes-

(171) Paralyse-Syphilis-Frage.) Arth. Herm. Hubner, Neurolog.
Centralll., March 16, 1906, p. 242, I. Beitrag.

The author first refers to the rate at which the opponents of
the Erb-Foumier hypothesis have diminished in the past few

ABSTRACTS

S57

years, and mentions the historical account of the subject given in
“ Nonne’s Syphilis und Nervensystem,” 1902, and Erh, Berliner
Jdin, Woch ., 1904. Hiibner’s present researches deal with an inquiry
into these diseases amongst the women of the lower classes in
Berlin. He has had special opportunities in investigating the
police and club statistics of such women. The alleged infrequency
of parasyphilitic diseases among prostitutes is to be accounted for
partly by the loss in professional capacity sustained by those who
acquire syphilis and its consequences—thus diminishing their
apparent numbers through exclusion from the ranks—and partly
by the extraordinary high numbers in statistics, such as Glaser's
of women who had suffered from syphilis so recently as to make
parasyphilis as yet impossible. For instance, if the number of
women infected within five years are excluded from Glaser’s
statistics, the percentage of tabetics amongst those remaining is
more than doubled. Hiibner could find no reliable published in¬
vestigations of general paralysis among prostitutes. He has made
notes in hospital work of 97 prostitutes over the age of 25. Of those
living, 20-9z had general paralysis, 7 - 0% tabes and 85% cerebro¬
spinal syphilis. This total of 32‘9% is twice the percentage seen
in other women under similar circumstances. The proportion of
tabes and cerebro-Bpinal syphilis is 4 times that given by Glaser
and 5*7 that given by Mendel, as these authors have not allowed
for the fallacies above mentioned. In the 41 cases which had been

examined post-mortem, excluding those dying of accident, 58*5%
had general paralysis, 5% tabes, and 24*4% cerebro-spinal syphilis,
or a total of 87 - 9%. By the side of tnese are the figures of
the 150 women, other than prostitutes, that were examined post¬
mortem in the last two years, showing a frequency of general
paralysis 16’7%, tabes 2 - 7%, cerebro-spinal syphilis 4%, or a total
of 23'4%. In 1903,0-3% or the men dying in Berlin were certified
to have tabes, and 017%^ of the women. On adding the cases of
55 living and 38 dead prostitutes to his own list, cases obtained

from the Rummelsburg workhouse, he reaches the conclusion that
42*8% of all prostitutes suffer from parasyphilis.

The next point dealt with is the comparative frequency of
child-rearing in healthy women and in those with tabo-paralysis.
Of 70 cases of general paralysis and 120 of other psychoses, 45‘7% of
the former were sterile and 14*4% of the latter, 5 , 7% of the former
had only abortions compared witn 2*5 of the latter, and 314% of
the former had only full-time children in contrast with 74% of
the latter. The paper concludes with several instructive examples

of syphilitic families and refers to the importance of syphilis in
other conditions, such as deafness, idiocy and defective speech.

Ebnest Jones.

358

ABSTRACTS

SOME FORMS OF TABES SELDOM DESCRIBED. (Binige wenig
(172) beschriebene Formen der Tabes dorsalis.) Michael Lapinsky,
Deutsch. Zeit.f. Nervenheilk ., Bd. m., H. 3 u. 4, 1906, S. 178.

After referring to the classical picture of tabes, one that is
filled in chiefly by afferent phenomena, the author describes at
length five cases that made their appearance with motor signs.
The first of these was a girl of 23, whose father had suffered from
syphilis; her initial symptom was a paralysis of the left leg,
followed a week later by a paresis of the right hand. Subsequently
indubitable signs of tabes developed. The second case, a man of
37, began with weakness of both legs and for some time it was
impossible to be sure that the condition was not one of peripheral
neuritis. The third case, an officer of 28, had suffered two years
previously—seven after infection—with a temporary squint
Weakness appeared in both arms and legs, so that he could no
longer ride or carry out his exercises, but it was accompanied by
pain only after some months. Rombergism was, however, present
early. The fourth, a woman of 45, suffered first from weakness
of the lower limbs, the right, which had wasted £ inches, being
worse than the left. The tendon reflexes were slightly diminished,
electrical reactions normal. The last case, a woman of 30, was
very similar to the fourth. In all five unequivocal signs of tabes
developed.

In reviewing the cases the author points out how misleading
it is when tabes begins with muscular weakness, either of special
groups or widespread, and the likelihood of the condition being
mistaken for a complaint of the peripheral nerves, bony Rystem,
and especially of the joints. It was easy to eliminate functional
disease and affections of the pyramidal tract or of the muscles
themselves. Unfortunately, all the characteristic features of ataxy,
as described by Oppenheim, may fail, as in these cases. Anterior
horn cell affection may be excluded by the variability of the
symptoms, and by their tendency in general to get better. How¬
ever, the author holds it probable that slight chromolytic changes
are present in these cells, analogous to those found after section
of the posterior nerve roots in such experiments as those of
Mott and Sherrington. The other possibility is that the tonus
of the anterior horn cells is diminished, through the lessened
sources of excitation which reach the spinal cord. Similar cases
to those now described are referred to in the writings of Grasset
and Frenkel. The latter mentions a case in which the motor
symptoms had a quite acute onset, but were shown later to be
part of a tabetic affection. Ernest Jones,

ABSTRACTS

359

SYMPTOMS AND TREATMENT OF EXTRA - MEDULLARY

(173) SPINAL NEW GROWTHS. (Zur Symptomatology u. Therapie
dor 8ich im Umkreis des Rfickenmarks entwickelnden Neu-
bildnngen.) H. Oppknheim, Mitteil. arts den Grenzgebieten der
Med. u. Chir., 1906, H. 5, p. 607.

The author records in this paper six cases of extra-medullary
tumours at different levels. The symptoms varied considerably,
but, as a rule, there was an early irritative stage, followed gradually
by paralytic and spastic phenomena, but no marked extension of
the process upwards or downwards accompanying the signs of
increasing local compression. A typical Brown-Sdquard syndrome
developed when the tumour lay laterally to the cord. He finds
also that the level of the tumour may be diagnosed too high when
there is a concomitant meningeal affection. With regard to
differential diagnosis, there is an affection which produces a picture
practically indistinguishable from that of tumour, viz. a localised
spinal meningeal hydropsy. Such fluid collections may result from
narrowing of the spinal canal by caries, or from thickening of the
meninges, and their influence is said even to be occasionally, in
some unexplained manner, quite unilateral. The result of operative
interference in these cases was—one complete recovery (operation
eight years ago); one recovery with paresis from section of nerve
roots; four deaths within a week of the operation.

J. H. Habvey Pirie.

THE PRINCIPAL FORMS OF NERVOUS TROUBLES IN POTT’S

(174) DISEASE WITHOUT DEFORMITY. (Les principals formes
des troubles nerveux dans le mal de Pott sans gibbosity.)

L. Alquikr, Nouv. Icon, de la SalpSt., No. 1, 1906, p. 2.

In grown-up people neuralgic pains almost always, and graver
nervous symptoms frequently, precede by many months the first
sign of spinal deformity. Such symptoms are therefore of the
greatest importance as regards early diagnosis of vertebral caries.
Much difficulty may be experienced in distinguishing between the
effects of involvement of nerve roots, and of the cord itself, but
clinically a combination of both is most common. For want of a
better, the writer adopts a classification depending on the ana¬
tomical position of the disease.

1. Cases with signs of compression of the dorsal and upper
lumbar cord and roots. These show early intermittent girdle
pains, followed by numbness, tingling, and neuralgic pains of the
legs. Next comes spastic paraplegia, gradual in onset or sudden,
complete or partial, equal in both legs or more marked in one.

360

ABSTRACTS

This may be accompanied by sensory disturbance—hyperesthesia
or aneesthesia of the whole body below the lesion, limited above
by a band of girdle anaesthesia. The legs swell, sores develop, and
in most cases there is retention of urine.

2. Cases with root and medullary compression of the filum
terminale and cauda equina. Diagnosis in this group is extremely
difficult unless there is obvious disease of the lumbosacral region.
In every case there is early and severe pain in the legs, usually
resembling sciatica and sometimes unilateral Next appears
flaccid paraplegia with muscular atrophy and incontinence of
urine. Anaesthesia corresponding to the distribution of the lumbar
and sacral roots may follow.

3. Cases with compression of the cervical cord and roots.
Here also pains from pressure on the nerve roots form the first
symptoms. Anaesthesia in the arms, usually of the dissociated
variety, is next noted. Sooner or later flaccid paralysis with
muscular atrophy ensues; and when pressure on the cord develops
this is associated with spastic paralysis of the legs. A certain
degree of ataxia is common. Bowel and bladder troubles are
slight. When the disease is situated high up, symptoms due to
involvement of the medulla are added. Special nerves may be
implicated, e.g. the sympathetic giving rise to disturbances of the
pupil, etc., and the hypoglossal resulting in partial or complete
atrophy of the tongue.

Cases are detailed illustrating the above three groups. The
differential diagnosis is next considered. In neuralgia of
doubtful origin some help may be obtained from the injection
of a local anaesthetic, when more relief will be obtained
in a peripheral than in a root lesion. The result of a lumbar
puncture is negative. The pain of Pott’s disease is aggravated
by walking and movement, and relieved by rest. Flaccid para¬
lysis of the legs may simulate a multiple neuritis or a myopathy.
Spastic paralysis of the legs may closely resemble a transverse
myelitis, especially syphilitic. In cervical disease, with atrophy
and dissociated aneesthesia of the arms, spasticity of the legs, and
slight scoliosis, a diagnosis from syringomyelia is often difficult.
Positive diagnostic signs are, firstly, those common to tuberculosis
anywhere, and a reaction to tuberculin may be of help, although
there are obvious fallacies connected therewith; and, secondly,
those indicating vertebral disease, such as rigidity of the spine
and pain on percussion. Skiagraphy gives comparatively little
assistance. Diagnosis may sometimes be absolutely impossible,
but every case should be investigated with the greatest care on
account of the importance of early treatment.

The article is excellently illustrated with drawings and
photographs. Henbt J. Dunbab.

ABSTRACTS

361

SPONDYLITIS DEFORMANS. (La Spondyloee RhigomOkue; ana-
(175) tomie pathologique et pathog&iie.) Pierre Marie et Andr£
L6ri, Now. Icon, de la Salpet., No. 1, 1906, p. 32.

This disease differs essentially from chronic rheumatic, traumatic,
and other conditions leading to ankylosis, and must be regarded
as a definite, and, moreover, a comparatively common pathological
entity. The cause in most cases is some infective agent, frequently
gonorrhoeal or tuberculous ; but constitutional predisposition and
the effects of chill must also be taken into account. In 1899, L^ri
advanced the theory that the disease was of the nature of an
ossification of the ligamentous structures of the joints affected,
and that this was accompanied or preceded by a rarification of
osseous tissue to which the condition was probably secondary or
compensatory. The spinal column, the shoulders, and the hips are
the usual seats of the disease; occasionally the sterno-clavicular joint
and the knee; and only rarely, and of late occurrence, the other
joints of the extremities. The spine is curved antero-posteriorly,
and the ligaments on the convexity show the most marked ossifica¬
tion. The curve is greatest in the cervico-dorsal region, because
of the weight of the head. The thorax is always more or less
flattened, and frequently also the pelvis. The femora may be
ankylosed either in flexion or extension. In the early stages pain
is constant. In the present article the writers record a case
recently observed by them, and give a full account of the post¬
mortem examination, which fully confirms their previously ex¬
pressed views as to the pathology of the disease. The article is
illustrated by excellent photographs and diagrams.

Henry J. Dunbar.

REPORT ON EPIDEMIC 0EREBR0-8PINAL MENINGITIS IN
(176) INDIA C. J. Robertson-Milne. Pp. 67. Government Print¬
ing Office, Calcutta, 1906.

This report considers the Historical, Clinical, Bacteriological, and
Epidemiological aspects of the subject. Although the fact seems to
have been generally overlooked, Cerebro-Spinal Fever, in both its
epidemic and sporadic forms, has been recognised in India for
almost a quarter of a century, and the records of the disease show
that it is in every way identical with the malady as it has been
observed in other countries. An outbreak in Persia about 1874-5
appears to be the only other recorded occurrence of the disease in
Asia. In India it has most frequently attacked prisoners in jails:
in some of these institutions the disease has prevailed irregularly
2 A

362

ABSTRACTS

for prolonged periods, 593 cases (with 450 deaths) having occurred
from 1881-1901 in a population averaging annually 100,123. No
outbreak of any magnitude has been chronicled in the general
community, although the disease has prevailed widely.

J. H. Habvey Pirie.

THE FUNCTION OF THE LEFT PREFRONTAL LOBE. Charles

(177) Phelps (New York), Am. Joum. Med. Sciences, March 1906.

From a series of 46 cases of left prefrontal involvement which
Phelps reported in the Am. Joum. of Med. Sciences for May 1902,
he came to the following conclusions: (a) " The more absolutely
the lesion is limited to the left prefrontal lobe, the more positive
and distinctive are the symptoms of mental default. ( b ) The
integrity of the mental faculties remains unimpaired with right
frontal lesion, even though it destroys the entire lobe or extends
to the entire right hemisphere. ( c ) Exceptional instances in which
seemingly opposite conditions exist are always reconcilable on
more careful examination, with the assertion of an exclusive control
of the mental faculties residing in the prefrontal region of the
left side.”

He now adds to the former series 11 more cases of similar
nature, and concludes that 57 cases should form an adequate basis
for a positive opinion upon the function of the left prefrontal lobe.
In 3 of these cases the lesion was limited to the left lobe; in 3
more the right lobe was implicated, but to a lesser degree; in 5 the
lesion was limited to the right lobe. He includes in his paper the
history of each case, and the autopsy reports of fatal cases. His
conclusions are that lesions limited to the posterior left frontal
region occasion only motor defect; conjoint lesion of both prefrontal
regions is always attended by meutal decadence ; lesion of the left
prefrontal region alone is always attended by mental decadence;
lesion of the right prefrontal region alone is never attended by
mental decadence. He finds that the small number of cases which
have been reported of left prefrontal lesions having unaffected
minds and right prefrontal lesions with disordered minds are un¬
worthy of credence. In such cases either no detailed history has
been afforded, or the assertions have been found to be incompatible
with the history as stated. C. H. Holmes.

CEREBRAL MANIFESTATIONS OF HYPERTONUS IN SCLEROSED

(178) ARTERIES. William Russell, Practitioner, March 1906.

In this paper the term "sclerosis,” as applied to arteries, is
confined to the uniform and widely distributed thickening of

ABSTRACTS

36-3

arteries due to thickening of both the middle and internal coats.
The condition is quite different from atheroma, although commonly
confused with it. In arterio-sclerosis the arteries retain their
power of contractility—may, indeed, be unduly sensitive to some
of the impressions to which arteries respond. Whilst thickening
of the arterial wall is easily recognised, it is always a question
how much of it is due to permanent tissue increase, and how
much to an excess of the normal tonic contraction of the muscular
coat ? It is to this increase of normal tonic contraction that the
term hypertonics or hypertonic contraction is applied. As to the
cause of hypertonic contraction, the general proposition may be
laid down that deleterious substances of various kinds present in
the circulation cause it. In this paper some of the cerebral
symptoms due to hypertonus in sclerosed arteries are referred
to. The first condition dealt with is the occurrence of hemiplegia,
monoplegia, or aphasia without loss of consciousness. It is pointed
out that the diagnosis lies usually between thrombosis and hyper¬
tonic contraction. The latter, as a cause of the conditions
mentioned, has not been recognised, and yet it is probably more
common than thrombosis. When the condition of the vessel wall
in sclerosis is borne in mind, and when it is recognised that
sclerosed vessels can become markedly contracted, so as to
diminish or almost obliterate their lumen, it is evident that the
condition can as effectually interfere with the nutrition of the
portion of brain supplied by such arteries as if they were
occluded by embolism or thrombosis. There is, however, this
great practical difference, that, whereas the two latter conditions
are permanent, the first-mentioned may be transitory, and can,
to an important degree, be influenced by treatment. The degree
of local spasm varies; in some instances it merely impoverishes
the blood-supply of the part, and the symptoms are correspondingly
slight. If, along with spasm-contraction of arteries, there is a
feebly acting heart, the circulation in the part is necessarily still
more reduced. Cases are given illustrating the foregoing. Other
symptoms, due to this contraction of vessels, are pains in the head
and attacks of giddiness. Another common type of case occurs,
usually in old people, with all the characteristics, mental and
vascular, which commonly accompany senility. These persons
have attacks of restlessness, insomnia, and mental excitement.
In these attacks it is usually found that there is a general
hypertonic contraction of vessels, and that the symptoms pass
off when the vascular condition is relieved.

Author’s Abstract.

364

ABSTRACTS

HEMORRHAGE FROM THE MIDDLE MENINGEAL ARTERY.

(179) J. Hogarth Pringle, Scot. Med. and Surg. Journal, Feb. 1906,
p. 97.

The author records fifteen cases of head injury followed by
hemorrhage from the middle meningeal artery which illustrate
well the difficulties in making an accurate diagnosis and carrying
out suitable treatment in such cases owing to the great variations
in the symptoms produced by the extravasated blood.

Although all fifteen cases were associated with fracture of the
skull, in two of them the tear of the artery occurred on the opposite
side of the skull to the fracture, and were therefore comparable to
the cases which have been recorded of tear of the artery without
any fracture of the skull at all. Pringle’s explanation of the
mechanism in such cases is “ that owing to the violence applied to
the head the elasticity of the skull permits a rapid alteration in its
shape, while the dura mater, less elastic than the bony case, does
not react so quickly and gets lacerated in consequence.”

In three of his cases the main trunk of the artery was injured,
in five the anterior main branch, in three the posterior main
branch, and in four several of the smaller branches.

In only one of the fifteen cases was the typical sequence of
symptoms present, i.e. an initial period of unconsciousness due to
concussion, followed by a lucid interval and finally by a return of
unconsciousness with other symptoms of compression. In eight
cases unconsciousness was present from the first and continued till
death occurred. In only four of the cases was paralysis limited
to the side of the body opposite to that of the head lesion. In nine
cases the patients were able to move all their limbs spontaneously
or alter irritation. In six of the cases there was inequality of the
pupils, and in all these the wider pupil was on the side of the
haemorrhage, while in five of them neither pupil reacted to light
In five cases the pupils were equal and active, in two they were
equal but did not react to light.

In discussing the diagnosis, Pringle draws attention to the fact
that the frequent combination of brain laceration, subarachnoid or
subdural haemorrhage, with extradural haemorrhage, causes great
difficulty. He inclines to the view that laceration and subarach¬
noid haemorrhage more often cause general paralysis from the first,
than extradural haemorrhage. In two of his cases every symptom
usually associated with middle meningeal haemorrhage was absent
till a very late stage. This was explained by a free escape of
cerebro-spinal fluid from the interior of the skull. In one case the
patient remained conscious for four days, till three hours before
death, and in the second for twelve days after the injury. In both

ABSTRACTS

365

cases the clot was over the posterior parietal region, and on the
opposite side of the head to the fracture. Ten of the fifteen cases
were operated on and four recovered. In the fatal cases subdural
haemorrhage and brain injury were present and were apparently
the cause of death. J. W. Struthers.

THE ONSET OP HEMIPLEGIA IN VASCULAR LESIONS. A

(180) Ernkst Jones, Brain , Autumn 1905, p. 527.

This paper—the first of a series—is based partly on a study of the
autopsy records at University College Hospital for sixty-five years,
and partly on a large number of published cases, the individual
accounts of which have been studied by the author. The fallacies
and advantages of this method of approach are considered. It is
shewn that much of the clinical teaching on the subject is based
on tradition and founded on insufficient evidence, and that there is
great need of a large series of cases, the history of which has been
critically studied and the diagnosis verified.

The main conclusions expressed are as follows:—

(1) Rest in bed, and to a greater extent sleep, protect to some
extent against cerebral haemorrhage. This seems to be a more
accurate statement than that rest and sleep predispose to throm¬
bosis ; for, whereas only one-third of the number of haemorrhage
attacks that might have been expected to occur during sleep did
so in fact, exactly the anticipated number of thrombosis attacks
occurred then.

(2) The significance of severe exertion and of time of day has
been over-estimated in the past.

(3) Consciousness is lost at the onset of half the cases of
occluding lesions, and of three-quarters the cases of haemorrhage.
It is transitorily affected in many of the remaining cases. We
have no accurate knowledge as to the depth or duration of the
coma in the various lesions, or its relation to the completeness of
the paralysis. Until these latter problems are decided, it is well to
remember the danger of relying too much on this aid to diagnosis
on account both of :in important group of occluding lesions in
which the onset is apoplectiform, and another group of haemorrhage
lesions in which the onset is quite insidious.

(4) The immediate prognosis is much graver when the onset
is apoplectiform; especially is this so in cases of haemorrhage.
Contrariwise, late cases of hemiplegia due to haemorrhage are less
likely to have suffered from loss of consciousness, and are therefore
the more likely to be attributed to thrombosis.

(5) Intraventricular haemorrhage, which is nearly always
secondary, may not cause loss of consciousness. On the other

366

ABSTRACTS

hand, immediate loss of consciousness as the initial symptom may
be due to extra-ventricular haemorrhage.

(6) The immediate prognosis is much graver in cases of haemor¬
rhage than in cases of occluding lesions. The results of 828 cases
of haemorrhage, 158 of thrombosis, and 273 of embolism are as
follows: over 30 per cent, of the first cases were fatal within
24 hours, half as many of the second, and a quarter as many of
the third; nearly two-thirds of the first patients are dead in a
week, and more than a third of the others. Of 20 cases of each
lesion, 4 haemorrhage ones would survive a month, 5 thrombosis
ones and 9 embolism ones. Most of those that survive two years
are cases of thrombosis.

(7) Of the cases in which blood is found in the ventricles, 60
per cent, die within 24 hours, and 90 per cent, in the first week.
It is not very rare, however, for such cases to live a few weeks.

(8) On the first day the mortality in cases of haemorrhage is
heaviest amongst the younger men; in the next few weeks amongst
the aged women.

(9) There is no indication that either haemorrhage or throm¬
bosis affects one side of the brain more often than the other. A
right-sided lesion was present in 49 89 per cent, of 995 cases of
the former, and 47*2 per cent, of 176 cases of the latter. Of 558
cases of embolism—three times the number in any previous
collection—the lesion was right-sided in 4048 per cent Mathe¬
matically this means that a right-sided lesion in embolism cannot
be much more common than a left one, that it may be either
equally common or much less common. The usual statements to
the last effect are unwarranted at present.

Author’s Abstract.

OLINIOAL STUDY OF HEMIPLEGIA IN THE ADULT. Theodore
(181) H. Wbisenburg, Journal of the American Med. Assoc., Feb. 25,
1905.

This paper is based on the study of 160 cases of hemiplegia, par¬
ticular attention being paid in most of the cases to nine special
points. The conclusions may be summarised as follows:—

1. Heredity. —In 14 out of 109 cases, at least one parent had
suffered from hemiplegia; in one of these cases both parents had.

2. Prehemiplegic Pain. —Seventeen cases out of 109 suffered in
this way. In 12 of these cases the pain occurred within 48 hours
of the stroke; in the other cases at varying periods up to two
years. They were mostly in the upper extremity, in the muscular
tissues and joints. In five of the cases the pain ceased after the
onset of the hemiplegia; in another seven it was mitigated.

ABSTRACTS

367

3. Posthemiplegic Pain. —Of 109 cases, 27 had such pain, 12
had paresthesia, 70 had soreness on the paralysed side; only five
complained of no pain or ache. The largest group was to be cor¬
related with contractures. Pain was commoner in cases where
there were sensory changes.

4. Respiration. —In every one of the 160 cases the author con¬
firmed Hughlings Jackson’s observation that the upper part of the
chest expands most on the paralysed side in quiet respiration, and
least on that side in forced respiration. He points out, however,
that in quiet respiration the chest retracts more on the sound side,
which means that there must be more residual air left in the lung
of the paralysed side. This would account for the greater ex¬
pansion on that side, in order to take in an equal quantity of air
on the two sides.

5. (Edema .—In only two cases was this present to any extent.
In one of them it was widespread on the paralysed side; in the
other case, and in yet a third, a “ succulent hand ” only was present.

6. Vasomotor Disturbances. —Coldness is very common in the
paralysed limbs. One patient did not perspire on the paralysed
side, nor did he sun-tan on that side. Another patient had an
eczematous eruption, limited to the paralysed side.

7. Posthemiplegic Chorea. —No case of choreiform tremor was
observed, but a case with irregular tremor is described and its
pathology discussed.

8. Cerebral Muscular Atrophy. —This was present in every case,
but in very varying degree. It is always more marked in the
upper limb, and usually most in the shoulder or hand muscles.
The usual explanations are quoted.

9. Arthropathies. —One case of Charcot’s painful joint was seen.
On the other hand, the condition described by Marie was very
common. In this there is limitation, and pain on passive move¬
ment, but no redness or swelling. The shoulder-joint is most
often affected in these latter affections, and they are probably due
to the forced immobility plus the pulling on the articulations by
the weight of the paralysed member.

A. Ernest Jones.

SENSORY DISTURBANCES IN CEREBRAL HEMIPLEGIA (Uber
(182) die Sensibilit&tsstflnmgen bei cerebralen Hemiplegien.) Georg
Sandberg (Breslau), Deut. Zeitschr. f. Nervenheilk., H. 3-4,
1906, p. 149.

Op 31 cases examined, the author found 22 with objective sensory
disturbances. The majority corresponded to v. Strumpell’s “ pos¬
terior column type,” i.e. there were disturbances of touch and deep

368

ABSTRACTS

sensibility, while the pain sense and temperature sense were well
preserved. In bulbar lesions all the sensory qualities may be
affected. In five cases with only slight motor weakness there was
marked stereognosis from disturbances of the pressure sense and
sense of movement and position. J. H. Harvey Pibie.

PO8T-HEMIPLEQI0 MOVEMENTS. (Beitrttge nr Lehre der post*

(183) hemiplegischen BewegungstOrongen.) Ernest Fret, Neurol
Centralbl., Dec. 1 , 1905, p. 1104.

The case under notice was one of right hemiplegia with contracture
of the right lower face and upper extremity, the lower extremity
being hypotonic. The left arm and leg were slightly spastic.
Athetoid movements were observed in the right arm and occa¬
sionally in the left. The movements consisted of slow extension
of the arm at the elbow, supination and pronation at the wrist,
and flexion and extension of the fingers. The deep reflexes were
brisk and there was slight ankle clonus on the right side. The
pupils were of moderate size, the right being larger than the left,
and both were inactive to light. The mental condition was one of
apathetic dementia, and this prevented any satisfactory examina¬
tion of the sensory system.

The case came to autopsy and after staining by Weigert-Woller’s
method, frontal sections at the proximal middle and distal ends of
the lesion revealed the following lesions: (1) A somewhat large
focus of haemorrhage in the left optic thalamus which destroyed
the external nucleus and the internal capsule bounding the
thalamus at that spot The fibres connecting the red nucleus
to the thalamus and the lenticular nucleus were also destroyed.
(2) Destruction of the middle and internal nuclei of the thalamus
and of the upper part of the red nucleus. (3) Destruction of
the middle ana outer nuclei of the thalamus. There was slight
degeneration of the fibres in the left crus, in the pons, and in the
pyramidal tracts on the right side of the cord.

After discussing the various opinions which have been advanced
as to the seat of lesions which may give rise to post-hemiplegic
movements, the author draws the following conclusions: (1) That
the post-hemiplegic movements were due to lesions of the thalamus
or hypothalamic region. (2) That the thalamus is a co-ordination
centre. T. Grainger Stewart.

A OASE OF SYRINGOBULBIA, Ac. (Un cas de Syringobulbie,

(184) Ac.) Raymond and Guillain, Rev. Neur., Jan. 30,1906, p. 41.

The interest of the case lies in the association of typical syringo¬
myelic (cord) symptoms with others pointing as clearly to involve-

ABSTRACTS

369

menb of the medulla. These were hemiatrophy of the muscles of
the palate and of the pillars of the fauces on the right side,
together with complete paralysis of the right vocal cord. These
latter conditions constitute the syndrome of Avellis, so called, and
signify paralysis of the internal branch of the vago-spinal nerve.
The fact that in the present instance the facial nerve was intact
would appear to corroborate the view that the vago-spinal and not
the seventh is the principal nerve supply of the palate muscles.

S. A. K. Wilson.

MULTIPLE LIPOMATA IN GENERAL PARALYSIS. Conolly
(185) Norman, Joum. of Ment. Sc., Jan. 1906, p. 62.

The patient was a male, aged 40, who presented well-marked
speech trouble of the general paralytic character, general tremors,
and tabetic symptoms. In addition to the usual mental symptoms
of the disease, he exhibited suicidal tendencies and delusions of
conjugal infidelity. Three tumours presenting the characteristics
of lipomata were discovered in the following sites: angle of
the left scapula, left lumbar region, right side of chest in the
nipple line just above the costal margin.

Four months after admission, synovial effusion in both knee-
joints appeared without known cause, and seemingly suddenly and
painlessly. In six weeks the effusion disappeared rather quickly
leaving the knees apparently normal.

Three months after admission the original tumours had in¬
creased in size and were rather more prominent, while about a
dozen others had appeared on the back, the sides, and abdomen.
These were of various sizes and various degrees of definiteness of
outline. Some were firm and almost fibroid in consistence; others
were soft, and some had edges so ill-defined that they appeared to
be merely local accumulations of subcutaneous fat without any
capsule. Other tumours developed on various parts of the trunk,
the face, neck, arms, forearms, thighs, and legs being exempt.
The patient died a year after admission from exhaustion following
the occurrence of nineteen epileptiform tits in one day. No
autopsy was obtained, but examination of one of the smaller and
more defined tumours revealed a lipomatous structure.

T. C. Mackenzie.

PERFORATING ULCER IN GENERAL PARALYSIS. (Le mal
(186) perforant dans la paralysie gtatoale.) Marie (of Yillejuif) and
Pelletier, Rev. de Psych., Nov. 1905.

Similar conclusions to those of Vigouroux in the preceding article
are arrived at; mechanical causes are an inadequate explanation

370

ABSTRACTS

of the disorder; it is directly associated with a vasomotor dis¬
turbance of nervous origin. In some cases the existence of the
ulcer seemed to have a beneficent influence on the psychosis.

C. Macfie Campbell.

BED-SORBS IN GENERAL PARALYSIS. (Les escarres dans la
(187) paralysis gdndrale.) A. Vigouroux (of Vaucluse), Rev. de
Psych ., Oct. 1905.

The author insists on the fact that all bed-sores have not the same
origin, and refers to certain clinical observations to show that bed¬
sores may be directly related to a nervous lesion—cerebral
medullary, or neuritic. In general paralysis, bed-sores may
develop acutely after an epileptiform or apoplectic attack without
pressure or improper care; in other cases myelitic foci have been
discovered. C. Macfie Campbell.

A PSYCHOLOGICAL CONCEPTION OF NERVOUSNESS. (Oon-
(188) caption psychologique au nervosisme.) H. Zbinden, Arch, de
Psych., Jan. 1906, p. 185.

The nervous state includes such conditions as nervousness,
hysteria, neurasthenia. It is characterised by primary symptoms,
of which fatiguability, anxiety, emotionalism, irritability, and
above all, an exaggerated auto-suggestibility, are the chief; and
by secondary symptoms, such as insomnia, palpitation, asthma,
dyspepsia.

The causes of the nervous state are discussed under three
heads: hereditary, predisposing (education), and determining
(fatigue, worry, disappointment, etc).

The consequences of the nervous state on family, social, and
political life are discussed at some length, and shown to be multi¬
form and far reaching, so much so, indeed, that it must seem an
almost superhuman task to deal with them. Nevertheless the
author does not think the task an impossible one.

The remedy for the evil the author finds in education. At
bottom the nervous state is a psychic disorder. Men become
“ nervous ” because they do not think rightly. As our acts are
the outcome of our thoughts, it follows that a neurotic does not
know how to live. To preserve a nervous equilibrium, one must
learn how to think and how to live. If such an education were
given with the necessary competence from early childhood, the
nervous state would disappear.

In the treatment of disorders arising from the nervous state.

ABSTRACTS

371

the first point is to gain the confidence of the patient. One must
then unravel the disordered train of thought upon which the
symptoms depend. Having thus thoroughly mastered the case,
one proceeds to explain to the patient how his sufferings have
arisen, and when one succeeds in directing his thoughts into
healthy channels, and in encouraging him to expect to be cured,
the secondary symptoms will disappear one after the other. The
main point is, cure the primary symptoms and the secondary will
depart of themselves.

The whole paper extends to over sixty pages, and contains
many valuable suggestions, but scarcely lends itself to satisfactory
summarising. W. B. Drummond.

SPASMODIC LAUGHTER AND WEEPING. (Le rire et le pleurer

(189) spasmodiques.) M. A. Deroubaix, Journal do Neurologic,
March 5, 1906, p. 81.

Most modem writers agree with Bechterew that the reflex
emotional centre is situated in the optic thalamus, but opinions
vary as to the connections of this centre with the cerebral cortex
and with the bulbar nuclei, and as to the course of the fibres
which establish these connections. The writer discusses the views
advanced by various authorities, and records two cases observed
by himself, with an account of the post-mortem findings in one of
them. The first case was that of a coal-miner, aged 67, whose
chief symptoms were—difficulty in walking, swallowing, and
speaking; slight mental deterioration; loss of control of the
sphincters; and frequent attacks of causeless weeping. Examina¬
tion showed—hesitating, shuffling gait; trembling of hands and
tongue; pupils unequal and sluggish; no nystagmus; exaggerated
tendon reflexes; absence of Babinski’s sign, ankle clonus, and
Rombergism; and nothing of note in connection with sensation or
the organs of special sense. The outbreaks of crying were quite
involuntary, and unaccompanied by any feeling of sadness. Any
attempt at a smile was cut short almost before being formed, and
its place taken by weeping. The second patient was a miner, aged
38, with a history of apoplexy followed by left hemiplegia two
years before, and some recent epileptic seizures. He had paresis
of the left side of the face and left arm and leg, with exaggerated
tendon reflexes, but there was no ankle or patellar clonus, and no
Rombergism. He had no control of urine or faeces. His mental
condition was good. He was subject to attacks of weeping exactly
similar to those of the first patient. The chief points determined
post-mortem were: Slight atheroma of the basal arteries; a small
cyst lying between the diverging optic tracts, which had destroyed

372

ABSTRACTS

the corpora albicantia and softened the pituitary body; and ex¬
tensive softening of the right side of the brain, the lenticular
nucleus, the anterior limb of the internal capsule, and all the
white matter of the frontal lobe and central region being destroyed.
The author’s main deductions are: That the cortical centres for
emotional expression are in the frontal and central regions; that
the fibres connecting these centres with the optic thalamus run,
not in the pyramidal tract, but in front of the genu of the internal
capsule, and probably through the corpus striatum; and that a
lesion destroying this connection removes the regulating and
inhibitory influence of the cortical centres on the lower emotional
centre in the optic thalamus, which, being intact, gives rise to
involuntary emotional manifestations, i.e. to laughing and crying.

Henry J. Dunbar.

ON THE ANATOMICAL AND HISTOLOGICAL BASIS OF SO-
(190) CALLED CORTICAL BLINDNESS; ON THE LOCALISA¬
TION OF THE CORTICAL VISUAL AREA AND OF THE
MACULA LUTEA, AND ON THE PROJECTION OF THE
RETINA ON THE CORTEZ OF THE OCCIPITAL LOBE
(Ueber die anatomisch-histologische Gran diage der sog. Rinden-
blindheit and fiber die Lokalisation der cortic&len Seesphere der
Macula lutea und die Projection der Retina auf die Rinde dee
Occipitallappens.) Eugen Wehrli (Frauenfeld), v. Graefes
Arckw ., brii., 2.

In this elaborate and interesting paper the conclusions reached by
Henschen and others regarding the location of the visual areas in
the occipital lobe are subjected to searching criticism. Dr Wehrli
first describes very carefully the brain of a patient who became
suddenly blind after a convulsive seizure with loss of conscious¬
ness. In the right half of each field there was a slight return of
light perception, but not sufficient vision to make the charting of
a field possible. Death occurred about three months after the
onset of blindness. At the autopsy there were found softenings
in both occipital lobes involving the cuneus, gyrus lingualis, gyrus
occipito-temporalis, and praecuneus. Both occipital arteries were
occluded by old thrombi. Dr Wehrli specially emphasises the
fact that at the post-mortem the impression made was that the
lesions were purely cortical. The brain was hardened in formalin
and Muller’s fluid and cut on the microtome in a series of vertical
sections. A very minute description of the naked-eye and micro¬
scopical appearances is given. The case might be quoted as a
classical example of occlusion of the occipital arteries with con-

ABSTRACTS

373

secutive necrosis of the cortex in the area supplied by these
vessels. In regard to cause, localisation, and extent of cortical
softening, this case is therefore exactly comparable with those
recorded by Henschen and others. Owing to the comparatively
short period between the onset of blindness and the death of the
patient, Dr Wehrli claims that in this case there was no time for
the development of secondary degenerations, and therefore the
extent of the original lesion could be definitely determined.

A detailed and thorough examination of the brain revealed that
the supposed purely cortical lesions were not in reality restricted to
the cortex, but that on both sides there was an undoubted primary
lesion of the optic radiations.

In a series of drawings Dr Wehrli shows that, owing to the
depth to which the calcarine fissure penetrates, a lesion on its floor
may very readily produce extensive destruction of the fibres of the
optic radiations.

Cases of supposed cortical lesions causing hemianopsia, as
described by Yialet, Forster-Sachs, Laqueur, and others, are
passed in review, and in all of them Dr Wehrli finds evidence
of the co-existence of lesions of the white matter and optic
radiations. Not a single case, he maintains, can rightly be
used to furnish proof on questions regarding the exact cortical
localisation of the visual area. He considers, in fact, the cortical
lesion relatively unimportant in the production of hemianopsia when
compared with the deeper lesions which affect the optic radiations.

In corroboration of this view he quotes nine published cases of
extensive lesions of the mesial surface of the occipital lobe in which
no hemianopsia was present. In case 7 (Gowers, Lancet, 1879), a
malignant tumour involved the region of the entire cuneus, upper
and middle occipital convolutions, the region of the calcarine fissure
and prsecuneus, and yet there was no hemianopsia. Apparently,
however, Gowers did not see the patient for some months before
death, so that the case loses much of its value as negative evidence.

Commenting on these negative cases, Dr Wehrli summarises
somewhat as follows:—

1. Whether a softening of the occipital lobe shall cause a
hemianopsia or not, depends rather on the number of intact
fibres connecting the cortex with the primary optic centres than
in the position of the softening in the cortex.

2. The optic fibres, relatively few in number, and mixed with
commissural and other fibres, are distributed in fen-like fashion to
the occipital cortex. Few come to any one convolution, and their
destruction, in the case of small defects, is not sufficient to cause
a scotoma.

3. The function of the destroyed projection fibres of the cornea
radiata in cases of extensive softening, and in cases where there is

374

ABSTRACTS

destruction of part of the optic radiations, is taken over by the
adjoining fibres and cortical areas, the connection of which with
the primary optic centres has remained intact. Countless experi¬
ments and a large number of clinical facts support this view.

4. The existence of any sharp projection of the retina on the
cerebral cortex (reproduction of the retina on the cortex) is most
improbable.

Dr Wehrli is not inclined to lay stress on peculiarities of
histological structure as indicative of the visual function being
wholly or chiefly limited to any one small cortical area. He
instances v. Monakow’s experiments on animals, as pointing
to a wide area of distribution for the visual fibres.

With regard to the question of the representation of central
(macular) vision in the cortex, Dr Wehrli naturally opposes the
view of those who hold that the macula is represented in the cortex
by a very small area on the floor of the calcarine fissure. He points
out, apparently with justice, that direct vision of an object is a
function so complex, and involving the co-operation of so many
other cortical areas, e.g. in forming judgments as to size, taste,
smell, uses, and general properties of the object looked at, that its
adequate representation in the cortex would require an area larger
than that needed to represent the peripheral parts of the retina.
He would support v. Monakow’s view that fibres from the macula
spread themselves over the whole visual area.

On the question of whether different segments of the retina are
represented by definite and circumscribed cortical areas, Dr Wehrli
holds the view that attempts to map out retinal areas in the cortex
are quite fanciful.

It is a well-known fact that in cases of double cortical
hemianopsia some restoration of vision almost always takes
place, and the portion of the field restored is usually central
This is interpreted by Dr Wehrli to mean that any intact
neurons are, as it were, pressed into service to carry on the
function of the macula. The failure of restoration of vision in
Wehrli’s own patient is ascribed not to special severity of the
lesion, but rather to the very bad state of the patient’s circula¬
tion, and the degenerative changes in the cerebral vessels.

In his concluding sentences. Dr Wehrli claims to have shown
that purely cortical lesions causing hemianopsia have, so far, never
been observed. Conclusions regarding the exact localisation of the
cortical visual area and the island-like representation of the macula
in the cortex, based on the supposed occurrence of such lesions, do
not therefore rest on any firm foundation of fact.

The article is amplified by a series of plates illustrating the
lesions in the present case, and in a large number of important
cases published by various observers. J. V. Paterson.

ABSTRACTS

375

ISOLATED PALSY FOB LATERAL MOVEMENT OF AN IN-

(191) TERNAL RECTUS MUSCLE. (Isolierte LUimtmg eines
Muskels rectos internus als Seitenwonder.) Oskar Fischer,
Prag. med. Wochenschrift , xxx., No. 49, 1905.

Dr Fischer quotes briefly two cases recorded by Bielschowsky
where the internal rectus of one side failed to act in lateral move¬
ment while convergence was unaffected. He then cites a case
which came under his own observation. Patient, set. 42, a sufferer
for some years from symptoms pointing to multiple sclerosis, was
seized with a sudden attack of giddiness; objects appeared doubled
when he looked to the left, and he had at the same time the feel¬
ing of a sort of jerk or wrench in the left eye. On examination,
a week later, movements upwards, downwards, or to the right were
normally executed, but when an attempt was made to look to the
left the right eye failed to move inwards more than‘25°, while the
left eye, after a moment’s pause, suddenly took up a position of
extreme outward rotation. The patient was at the same time con¬
scious of an unpleasant jerk in the left eye and a crossed diplopia
appeared. With the right eye covered, the left eye moved readily
and smoothly to the left, the right eye behind the occlusion screen
failing to move inwards beyond an angle of 25°. No feeling of
jerk in moving the eye was felt as long as the right eye was
covered. If, on the other hand, the left eye was covered, the
right eye failed as before to move inwards beyond 25°, while the
left eye behind the screen made a sudden movement outwards into
the position of extreme abduction and the patient had the same
sensation of a jerk. Convergence movements were completely
intact, and also when an object near the eyes was moved a little
to the left the right eye was able to assume a position of extreme
inward rotation.

In less than a month the intemus paresis had completely dis¬
appeared. The lesion must have been so placed as to interrupt
the stimulus passing to the internal rectus while leaving intact
the path to the corresponding external rectus. At the same time
the path for the passage of convergence stimuli to the internal
rectus must have been intact. The position of such a lesion is
indicated by a diagram. J. V. Paterson.

A STUDY OF THE OONTRAOTURES IN ORGANIC NERVOUS

(192) DISEASES, AND THEIR TREATMENT. T. H. Weisenburg,
Univ. of Pennsylvania Med. Bull., 1905.

This paper is based upon the study of 500 cases of nervous disease.
The author divides contractures into two great classes, passive and

376

ABSTRACTS

active. By passive contracture he indicates a condition due to
disease of the part, such as joint disturbance, inflammation round
a joint, paralysis of antagonistic muscles, as, for instance, in multiple
neuritis and infantile paralysis, etc. Passive movement of such
contractured limbs is either impossible or very limited in extent,
and the contractures are not influenced by foreign conditions, such
as heat, and do not disappear during sleep or narcosis. Active
contractures are always due to disease of the central nervous
system. Passive movement is always possible, and during sleep
or narcosis the contractures may disappear, provided no structural
changes are present. Passive contracture may become super-
added to active contracture when such structural changes super¬
vene.

In writing of contractures in cerebral diseases he states that
early contracture is only possible if the motor tracts are not com¬
pletely cut off, and that its occurrence warrants one in giving a
better prognosis. Variations from the usual type of hemiplegia
contracture are not infrequent, and one of the most common is
extension of the fingers instead of flexion. This is seen especially
in infantile hemiplegia. In bilateral contractures of cerebral
origin both thighs are invariably flexed. He holds that in adults,
at any rate, such contractures are never due to a unilateral lesion,
as has been mentioned by some members of the French school.
The various forms of contracture met with in Little’s disease and
diplegia, and also in diseases of the spinal cord, peripheral nerves
and muscles, are all analysed and described.

The author mentions some of the various hypotheses which
have been advanced as to the causation of contractures in cerebral
disease, but he does not commit himself to any special theory. The
return of function in the paralysed limbs after destruction of the
pyramidal fibres is, in the author’s opinion, best explained by the
influence of the extra-pyramidal tracts. This view was brought
forward by Rothmann as the result of his experimental research,
and has been supported by the clinical and pathological observa¬
tions of Von Monakow, H. v. Alban, and M. Inf eld. Refer¬
ence is also made to the condition “hemitonia apoplectica” of
Bechterew, or “ hemihypertonia post-apoplectica ” as named by
Spiller, which is due to irritative lesion of the extra-pyramidal
tracts.

The last portion of the paper deals with the treatment of
contractures, and is eminently practical and full of sound
advice.

T. Grainger Stewart.

ABSTRACTS

377

SENSORY APHASIA, WITH RIGHT HOMONYMOUS LATERAL
(193) HEMIANOPIA. (Aphaaie Sensorielle avec hemianopsie
latArale homonyme droite.) Debray, Jawm. de Neur., Jan.
20, 1906, p. 21.

An interesting discussion is added to the description of a case of
sensory aphasia, coupled with right homonymous lateral hemianopia.
The patient was a man fifty-seven years of age, who one day,
when riding a bicycle, was observed suddenly to lose control of it,
and was found, when interrogated by his friends, to be talking
nonsense. There was no loss of consciousness. When examined
later he was seen to present a right homonymous hemianopia.
He understood what was said to him, and could answer simple
questions, could read print and writing, and was able to write
himself. He could not, however, spontaneously express any idea
either in words or in writing, repeating indefinitely a short phrase
without perceiving he was doing so. His speech was frequently
paraphasic, and indeed jargonaphasic.

The lesion was probably located in the subcortical region of the
occipital lobe, destroying the fibres joining the cortex in the
neighbourhood of the angular gyrus to the motor paths and to the
motor vocal centres, as well as those in the area round the
calcarine fissure.

There was not, however, any deviation of the head and eyes,
yet there ought to have been, if Bard's view of the phenomenon as
a sensory reflex is correct, the deviation being due to loss of visual
sensations in the altered portion of the cortex. As the cortical
cells on the lips of the calcarine fissure were probably unaffected
in this case, the fibres uniting them to the centre for conjugate
movements of the head and eyes may possibly have been untouched.

As in many cases of hemianopia, the patient presented the
peculiarity of being able to distinguish differences of light in the
field in which he could no longer discern objects or colours.
According to Bard, the visual sensations of light, form, and colour
may be compared to the cutaneous sensations of touch, tempera¬
ture, and pain, and these modalities of vision depend on the
activity of the cortical cells of the occipital pole. Morat believes
in the existence of homolateral retinal fibres concerned with the
“crude” sensations of light and darkness. According to the
author, all the cells of the occipital lobe are capable of appreciating
the stimulus of luminous waves, whereas those of the occipital
pole are in addition able to distinguish the form and the colour of
objects, because they are more directly in continuity with the
retinal cones constituting the fovea.

Pure hemiachromatopsia and hemiamblyopia are rather the
2 B

378

ABSTRACTS

result of a functional alteration of the occipital cells than of their
destruction. Corroboration of the author’s view would probably
be found in a unilateral complete lesion of the bandelettes. It has
been shown by Ddj&ine and Gialet that hemianopia resulting from
such a lesion is much more complete than that caused by disease
in the occipital pole. S. A. K Wilson.

PHnJPOVIGZ’S SION IK BKTERIO FEVER. (II fdntoma palmo-
(194) plantare di Philipovics nella febre tifoidea.) G. Minciotti,
Qazz. degli Osped., March 25, 1906, p. 376.

Philipovicz, in 1893, described as pathognomonic of enteric fever
an orange-yellow coloration of the palms and soles which occurred
at an early stage of the disease. Subsequent observers showed
that the condition, though not peculiar to enteric fever, was more
frequently found in that disease than in any other. The pheno¬
menon was attributed to a trophic alteration of the epidermis, due
to elimination through the skin of the typhoidal toxines. Though
sensory disturbance in the limbs in the course of enteric fever is
not infrequent, there has hitherto been no record of local pain
being associated with Philipovicz’s sign.

Minciotti’s patient was a woman, aged 26, who, at the end of
the first week of a hitherto uneventful attack of enteric fever, com¬
plained of severe pain and tenderness in the metatarso-phalangeal
region of the left sole. There was no local evidence of inflamma¬
tion, but the part had assumed an intense orange-yellow colour.
The corresponding region of the right foot had a similar, though
less intense, coloration. Spontaneously it was completely pain¬
less, but slight pressure provoked a feeling of discomfort. There
was no sensory disturbance in the hands, but the thenar and hypo-
thenar eminences and thumb of the left palm had a yellowish
coloration. The right palm was not affected. The pain in the
left sole continued to be troublesome for another week, proving
rebellious to all treatment. Spontaneous pain subsequently de¬
veloped in the corresponding coloured zone of the right foot, but
was of moderate intensity and short duration. The coloration
gradually diminished, so that when convalescence was attained no
traces were found in the left hand or right foot. In the left foot
the coloration persisted for a month longer, gradually fading
away pari passu with the sense of discomfort which had succeeded
the more severe symptoms. Minciotti attributes the pain to a
disturbance of nutrition in the terminations of the sensory nerves
in the regions affected, the disturbance being due to weakening of
the cardiac action characteristic of the typhoid infection.

J. D. Rolleston.

ABSTRACTS

379

PSYCHIATRY.

AN ANALYSIS OF INSIGHT IN MENTAL DISEASES. (Zur
(195) Analyse dee Erankheitsbewnsstseins bei Psychosen.) E.

Akndt (of Greifswald), Centraibl. f. Ncrvenk. u. Psych., Oct.

1905, p. 773.

Insight into any disorder is only possible under certain conditions:
there must be unusual feelings and sensations due to the disordered
working of the organ, these feelings must be correctly appreciated
and not distorted or fantastically explained, and there must be a
certain familiarity with the nature of disease.

Sane people do not always have good insight into their
physical condition; the absence of insight of the insane is not
always pathological

Arndt discusses the influence on the presence of insight of
the various psychopathological symptoms, dividing these into
intellectual, emotional, and volitional.

Frequently the very nature of the intellectual disorder, e.g.
the false interpretation and elaboration of changes dependent on
subjective conditions, excludes the possibility of insight. In the
life of feeling, pain is more importunate in its demand for explana¬
tion than pleasure; pain is something external and foreign to the
individual, and insight is more common in conditions dominated
by distressing emotions than in those where the disorder takes the
form of an exhilaration: the latter seems to the patient to belong
to his personality. Volitional disorders not infrequently occur
where the general judgment is fair, and are frequently recognised
as pathological.

The question of insight is apt to be exaggerated from the point
of view of diagnosis, prognosis, and treatment; its value depends
entirelyupon its relation to the various psychopathological elements
in the psychosis. C. Macfie Campbell.

MENTAL CONFUSION. (La confusion mentals.) E. RAgis (of
(196) Bordeaux), Ann. mid. psych., Sept.-Oct. 1905.

RAgis endeavours in this article to trace the clinical picture of
mental confusion, a well-defined group according to the French
school, but one which contains, according to the school of
Kraepelin, cases belonging to quite different groups, some cases
coming under the infective and exhaustion psychoses, others under
dementia praecox. The work of Chaslin has had great influence
on the French school, and R^gis begins with his definition; his
own description of this condition is that it is “a generalised

380

ABSTRACTS

psychosis, characterised by a toxic dulness and torpor of higher
mental activity, sometimes to the extent of its suspension, and
accompanied or not by an automatic dream-like delirium, with
adequate reaction of the general activity and of the various func¬
tions of the organism.” It is essentially a toxic psychosis;
headache is one of the most prominent physical symptoms;
mental torpor and a tendency to dream-like delirium are present,
and either may dominate the picture. The course is variable;
it is the most curable of all the psychoses, but may be fatal; if
it becomes chronic, the typical deterioration is that of dementia
prsecox. While the symptomatological description by Bdgis of
these toxic cases is adequate, he passes by the difficult questions
of their relation to similar cases with no known intoxication or
infection, and of the relation of the chronic cases to the whole
dementia prsecox group. C. Macfie Campbell.

MIXED APRAXIA (TJeber einen weiteren Symptomenkomplex irn
(197) Rahman der Dementia senilis bedinft dutch umschriebene
sttrkere Himatrophic [gemischte Apraxic].) Pick, Monatsschr.
f. Psych, u. Neur., Bd. xix., H. 2.

Prof. Pick describes a case of senile dementia with post-mortem
results. The case presented clinically “mixed” (ideo-motor-i-
purely motor) apraxia and amnestic aphasia with general psychic
enfeeblement. The author comments on the Temporal-lobe-
symptom-complex (Schldfelappenkomplex of Stransky), and shows
that in this case there was no diffuse or general atrophy, the
atrophy being most pronounced in the L. Inf. Par. Lobule and in
the Frontal convolutions of both sides, and to a less degree in the
Temp. Lobes of both sides, most marked in the 2nd and 3rd L.
Temp. The central convolutions of both sides, both Precunei and
Cunei, were intact, and only the L. Lat Ventricle and the 3rd
Ventricle dilated. The author considers that in all probability
the frontal atrophy did not contribute to the apraxia, but occasioned
merely the general mental weakness, and discusses the relation of
the L. Parietal and Temporal atrophy to the apraxia, and the
coincidence of the atrophic areas with Flechsig’s associative centres.

R CUNTNGHAM BROWN.

SLIGHTLY ABNORMAL CHILDREN. (Leicht abnorme Kinder.)

(198) E. Thoma (of Illenan), Ally. Ztschr.f. Psych., Bd. 62, H. 4.

Thoma discusses the neuroses and mild psychotic disturbances
which occur in childhood. He first describes the cerebral neuras-

ABSTRACTS

381

thenia of children, a condition usually due to over-pressure in
school work. The typical symptoms are a general languor and
want of interest, a diminution in mental efficiency, emotional
anomalies; vasomotor disorders are prominent, patient has un¬
pleasant head-feelings. The condition occurs in children with
poor heredity, and runs a favourable, although tedious, course of
several months. The treatment is to regulate the child’s activities
and allow plenty rest. As evidences of a psychopathic disposition,
compulsive ideas and phobias are frequently met with; a pedantic
ecrupulousness in children is very suspicious. It is frequently
advisable to remove such children from their home environment
As for the tics which are so frequent in children, treatment by
suitable gymnastics is recommended; punishment is always
injurious. Among psychotic symptoms are to be regarded the
exaggerated day - dreaming of some children, their wilful
romancing, and some truant episodes. The hysteria of children
is essentially the same as that of the adult, but, owing to its
frequently monosymptomatic appearance, the diagnosis is fre¬
quently difficult; from this point of view various coughs, pains,
twitchings, stuttering, etc., are important. The conditions occurring
in childhood are extremely varied, but almost all point to an
inherited psychopathic constitution. The function of the school
physician in picking out such children, and the necessity of suit¬
able schools and institutions for such children are finally insisted
upon. C. Macfib Campbell.

LATE EPILEPSY IN THE COURSE OF CHRONIC PSYCHOSES.
(199) (Die Sptttepilepsie im Verlaufe chronischer Psychoeen.)

P. Nacke (of Hubertusburg), AUg. Ztsehr. /. Psych., Bd. 62,

H. 5, 6.

The author excludes cases where epileptic attacks developed on a
syphilitic or an alcoholic basis, or where there was a history of
attacks in early life. Epileptiform attacks are not very uncommon
in the acute stage of dementia prsecox, but are very rare in the
case of chronic psychoses, except on the bases mentioned above.
The author reports thirteen cases in some detail He considers
that these attacks are genuine epileptic attacks; they rarely
occur in rapid succession, and were rarely replaced by equivalents
in the form of attacks of dizziness. They came on in the cases
reported from six to fifteen years after admission to the Hospital ;
the interval between the attacks was sometimes several years.
An aura was rarely present; post-epileptic symptoms were the
rule.

Nacke considers the late epilepsy to be one symptom of the

382

ABSTRACTS

psychosis, which has so prepared the soil that the exciting cause,
whatever that be, is able to discharge the epileptic attack.

C. Macfie Campbell.

the DEMENTIAS: PATHOLOGICAL ANATOMY AND PATHO-
(200) GENESIS. (Lee dlmences: Anatomic pathologique at
pathoglnie.) Klippel and Lhermitte (of Paris), Rev. de Psych.,
Dec. 1905.

After some general considerations the authors give an outline of
the cortical changes in the dementias, which they divide into three
groups. In the first group, including the various forms of dementia
prsecox, the vessels are not implicated; there are some changes in
the glia, and the cortical cells, especially in certain regions, snow a
definite form of degeneration. In the second group, the dementias
of the adult, which include a variety of conditions, both the meso¬
dermal and the ectodermal elements are affected as a rule, the
cause usually being some form of intoxication ; in certain dementias
of more endogenous origin only the ectodermal elements may show
changes. In the senile one meets two forms of dementia, which
have both clinical and pathological characteristics; in the one the
degeneration is limited to the ectodermal elements, in the other
the vessels also show a definite reaction.

A number of observations are given, with pathological reports.

C. Macfie Campbell.

TREATMENT.

TREATMENT OF THE TICS AND CHOREAS OF CHILDHOOD.
(201) (Traitement dee Charles et des tics de l’enfiuice.) Bruel,
Thhc de Paris, 1906. Paris: Steinheil.

There is little, if anything, novel in the discussion of the thera¬
peutic measures in vogue for the choreas and tics of childhood, as
presented by the author. Systematic scanning of the literature
has enabled him to specify very numerous procedures, of which
personally there is little evidence of experimental knowledge.
The methods of which most details are vouchsafed are alimentation
and isolation, in association with psycho-motor discipline. In the
chapter, or rather paragraphs, on the rheumatic theory of chorea,
no reference is made to the work of English observers, and an
eclectic position is adopted which scarcely harmonises with recent
advances in our knowledge of the subject.

S. A K. Wilson.

ABSTRACTS

383

DIETETIC TREATMENT IN EPILEPSY. William Aldren
(202) Turner, Practitioner , April 1906.

In a short paper the author reviews the results obtained in the
treatment of epilepsy by modifying the diet, and brings forward a
dietetic formula which has been followed by considerable success in
his hands.

Alt concluded (Zeitschr.f. klin. Med., vol. liiL) that a diet without
meat was the most satisfactory, but that neither a milk diet alone
nor a vegetable diet was as beneficial as their combination.

“ Salt starvation ” has proved a useful adjuvant to bromide
medication in some cases, while in others little benefit has resulted.
The author has recorded in a previous number of this journal (. Rev .
of Neurol, and Psychiat., 1904, p. 793) his experience of the salt
starvation diet of Toulouse and Richet as modified by Balint. He
has recently tested the efficacy of a purin-free diet. Tea, cocoa,
coffee, and all kinds of fish, fowl, and meat (including sweetbread)
are to be avoided. Tripe, neck of pork, and cod-fish may be given,
since they contain only relatively small quantities of purin bodies.
Feameal, malted lentils, potatoes, and onions, although they con¬
tain small quantities of purin bodies, may be given. Milk, eggs,
butter, cheese, rice, macaroni, tapioca, white bread, cabbage, lettuce,
cauliflower, sugar, and fruit are free from purin bodies, and are,
therefore, suitable.

Details of five cases are narrated in which distinct improve¬
ment was noticeable when the patients were placed on a purin-
free diet in addition to a dose of 20 or 30 grains of sodium bromide
at bedtime. In every instance there had been previously a more
or less prolonged course of bromides, with little or no improvement.

The author concludes from these results that “ the elimination
of the purin element from the dietary of epileptics is of great
therapeutic assistance in the treatment of the disease.”

Edwin Bramwzll.

ON BLEEDING! IN EPILEPSY. (De la saigntfe dans le mal tfpilep-
(203) tigue.) Gh. Houzel, Presse Mid., Jan. 31, 1906, p. 67.

The author has had two cases of status epilepticus which he
successfully treated by bleeding. In the first case, breathing had
practically ceased and the respiratory passages were obstructed by
a fine froth. The pulse was imperceptible, there was cyanosis,
and the extremities were cold. Bleeding was practised rather as
a forlorn hope. In a quarter of an hour recovery occurred. The
second case had been in an epileptic condition for four hours

384

ABSTRACTS

when he was bled and immediately recovered. The first case was
a little girl in whom epilepsy would not have been expected; the
second, a boy with marked stigmata of idiopathic epilepsy. In
both cases bleeding stopped the fits, lowered the arterial pressure,
slowed the pulse, and was followed by freedom from symptoms for
several days. Alexander Goodall.

PREPARATION OF A SERUM FOR THE TREATMENT OF
<204) EXOPHTHALMIC GOITRE. S. P. Beebe, Journ. Airier. Med.

Assoc., 1906, Vol. xlvi., p. 484.

THE TREATMENT OF EXOPHTHALMIC GOITRE BT A SPECIFIC
(205) SERUM John Rogers, Ibid., p. 487.

The sera used in the treatment of ten cases of exophthalmic
goitre were obtained after injecting rabbits with the nucleo-proteids
and thyreoglobulin isolated from the thyroid glands of two cases
of exophthalmic goitre. The method of isolating the nucleo-proteids
was described in a former paper by Beebe ( Journ. of Exper. Med.,
Nov. 1905). The globulin was precipitated by half-saturation
with ammonium sulphate, and after filtration and washing the
excess of salt was removed by dialysis. The nucleo-proteids were
included in the mixture injected into the rabbits, because it was
desirable to produce some cytolytic effect on the thyroid gland,
and the globulin because it was hoped thereby to develop an
antitoxine to counteract the toxic symptoms of exophthalmic
goitre. The rabbits were given injections of the two proteids
intraperitoneally at five-day intervals. On the eighth day after
the last injection the animals were bled from the carotid artery.

Ten cases of exophthalmic goitre were treated by subcutaneous
administration of the sera, “ with a result of three apparently per¬
fect cures, three rescued from a critical condition and now
approaching a cure, and the others more or less improved.”

W. T. Ritchie.

REGENT SURGICAL METHODS IN THE TREATMENT OF
(206) CERTAIN FORMS OF PARALT8I8. A H. Tubby, Brit.
Med. Joum., March 3, 1906.

The forms of paralysis chiefly dealt with are those arising from
anterior poliomyelitis, spastic paralysis, and traumatic nerve
lesions. The methods discussed are tendon and muscle trans¬
plantation, arthrodesis, and nerve anastomosis; the results of
tenotomy and of lengthening and shortening of tendons are re¬
garded as too well known to require description.

ABSTRACTS

385

In tendon and muscle transplantation the reinforcing tendon
may be completely divided, and its central end inserted into the
tendon of the paralysed muscle; or the reinforcing tendon may
be split, and only a strip transplanted. In the latter case it is
difficult to obtain functional independence of the strip, while in
both methods the two tendons must be comparatively near one
another. Many of the results are ultimately disappointing, owing
to stretching of the paralysed tendon. A great improvement was
effected by stitching the reinforcing tendon directly to the perios¬
teum, which avoided this stretching, and gave an attachment
experimentally proved to be five or six times stronger. But in
many cases the reinforcing tendon or muscle is too short for this
purpose, hence the value of Lange’s method of prolonging the
tendon by means of silk threads which bridge the gap between
the end of the tendon and the selected point of periosteal insertion.
Four to eight strands of silk are employed, and subsequent
sections show that the silk becomes enveloped and infiltrated
by new tissue, which thickens with use. In this way intervals
of from eight to ten inches have been successfully bridged, and
the most favourable site of insertion can be chosen; thus, in
paralysis of the quadriceps extensor, the hamstrings can be trans¬
planted by means of these silken tendons into the tubercle of
the tibia instead of into the patella. Successful or encouraging
results have been obtained in the various forms of club-foot due
to infantile paralysis; in paralysis of the quadriceps extensor, by
transplantation of the hamstrings, sartorius, or ilio-tibial band;
in dropped wrist, by conversion of the carpal flexors into carpal
extensors; in paralysis of the biceps, by use of a strip of triceps;
and in scapula alata, by grafting part of the pectoralis major into
the serratus magnus. In spastic paraplegia and cerebral diplegia
the technical difficulties are greater and the results less encourag¬
ing. Great improvement has often been secured, but simple
tenotomies are in many cases similarly successful. For tendon
transplantation a preliminary correction of secondary deformities
is essential, and the reinforcing and the reinforced muscles should,
if possible, be synergic. Cases of extensive paralysis should not
be attempted, and a slender muscle like the peroneus cannot be
expected to perform the function of paralysed calf muscles. Re¬
inforcement, by removing the constant stretching, often allows an
apparently paralysed muscle to recover.

Arthrodesis is indicated where a joint is hopelessly flail-like;
it merely aims at restoration of stability, but may be accompanied
by transplantations.

In nerve anastomosis and transplantation an interesting field is
opened up. Experimentally it has been proved that the central
end of an efferent nerve fibre can make functional union with the

386

ABSTRACTS

peripheral end of any other similar efferent fibre. The nerves to
flexor and extensor groups of muscles may thus be interchanged
and will take on their new function, the cortical areas for flexion
and extension also becoming interchanged. Where one central
nerve trunk is made to supply two distal ones, an actual division
of nerve fibres takes place. Regeneration of the muscles supplied
may set in even eight years after atrophy. Very successful cases
of facio-hypoglossal anastomosis for facial paralysis are recorded,
the hypoglossal being preferred to the spinal accessory because
its action is more associated with that of the facial, and less after-
education is therefore required. The obturator nerve has been
called upon to take up the work of the anterior crural, and the
nerves to soleus and gastrocnemius have been transferred from
a paralysed internal to a healthy external popliteal nerve, with
fair success. In some cases considerable power returned, without
return of faradic excitability.

In both tendon and nerve transplantations prolonged sub¬
sequent care and education are required, but the results are
sufficiently encouraging to justify careful trial.

W. J. Stuart.

TREATMENT OF SELECTED OASES OF OEREBRAL, SPINAL,
(207) AND PERIPHERAL NERVE PALSIES AND ATHETOSIS
BT NERVE TRANSPLANTATION. Spiller, Frazier, and
van Kaathoven (of Philadelphia), Am. Joum. of Med. Sciences,
March 1906.

Nerve transplantation in cases of acute anterior polio-myelitis, to
bring diseased peripheral nerve fibres into union with healthy
nerve fibres, gives more advantageous results than tendon trans¬
plantation. If the operation is successful, the function of the
paralysed muscles should be restored. The chief dangers are
delayed union, and overgrowth of connective tissue in the nerve
at the site of operation. The most favourable cases are those in
which the paralysis is confined to a small group of muscles.
Spiller’s case, reported in the Journal of Nervous and Mental
Disease , June 1903, showed some return of power in two months,
and distinct improvement in two years. Hackenbruch, in June
1903, reported two cases in which partial success followed the
insertion of a third of the tibial into the paralysed peroneal
nerve; he reported a third case in which marked improvement
followed the insertion of one-half of the posterior tibial nerve into
the peroneal nerve after one and a half years.

In cases of athetosis the flexors are, as a rule, much more
powerful than the extensors ; for this reason Spiller thought that

ABSTRACTS

387

an attempt to establish an equilibrium by switching off some of
the flexor power into the extensors by nerve transplantation was
justifiable. Frazier operated upon a young man who had shown
violent athetoid movements of the upper limbs from infancy; the
operation consisted in a lateral anastomosis in left arm of the
divided median and ulnar nerves with the musculo-spiral; two and a
half months later there was a distinct return of power in the wrist,
in the flexors of the fingers, and at the elbow, but the movements
were far from normal. Seven and a half months later the im¬
provement was most encouraging. With the partial paralysis due
to operation on the nerves, athetosis had seemed to disappear.
Sensation for touch and pain were present over the front and back
of the forearm, but less acute than in the right forearm; sensation
for touch and pain in the palmar surface of the hand was lost. A
second operation on the same arm consisted in an end to end
anastomosis between the cut circumflex and musculo-cutaneous
nerves (central end of one to the distal end of the other and vice
versa). This was successful, inasmuch as it seemed to ease the
violent contraction of the shoulder muscles.

Frazier reviews the physiological law upon which is based the
operative treatment of palsies by nerve transplantation. He
discusses briefly the best method of effecting anastomosis, and
describes the operative technique. Excellent photographs and
drawings are introduced to illustrate the paper.

C. H. Holmes.

■Reviews

HISTOLOOISOHE UND HISTOPATHOLOOISOHE ARBEITEN
USER DIE GROS8HIBNRINDE MIT BESONDEBEB BE-
BUCK8IOHTIGUNG DEB PATHOLOGISOHEN ANATOMIC
DEB GEISTESKRANKHEITEN. Edited by Franz Nissl,
Professor of Psychiatry in Heidelberg. Vol. i. With 14
plates and 23 illustrations in the text. Jena : Gustav Fischer.
1904. Price 40 M.

This work is the first of two volumes in which Nissl proposes to
publish the results of various cortical studies carried on by him
and his pupils in the laboratory at Heidelberg, and by Alzheimer
partly at Heidelberg, but chiefly at Frankfort. The first volume
is devoted to General Paralysis, and contains two articles embody-

888

REVIEWS

mg the resuite of Alzheimer and of Nissl, who worked at the same
subject independently and on separate material

Alzheimer writes on “ Histological Studies towards the Differ¬
ential Diagnosis of General Paralysis ” (pp. 18-814), and his work
is accompanied by fourteen plates and twenty-three illustrations
in the text.

Nissl follows with an article on “ The Histopathology of the
Cortical Changes in General Paralysis ” (pp. 315-494); he refers
to Alzheimer’s drawings, but reserves his own for the second
volume.

Alzheimer begins by defining his general aim in carrying on
his histopathological researches; he hopes by establishing the
histological characteristics of the various disease-processes to
enable the clinician to define more clearly the limits of the various
disease-groups. General paralysis, with its marked tissue changes,
offers a good starting-point.

The material used was derived from 320 successive autopsies
in the Frankfort asylum; of these, 170 were cases of general
paralysis. The largest section of the work is occupied with the
description of the macroscopic and microscopic changes in general
paralysis, their nature, distribution, and meaning, and the con¬
tribution which this knowledge makes to our clinical grouping of
the cases. The macroscopic changes are first discussed, and then
the histological changes are taken up in detail. The membranes
first receive attention; in every case there is present in the pia
a cellular infiltrate which is not merely perivascular; new forma¬
tion of capillaries is rare. In the cortex the vessels always show
proliferative changes, and there is an increase of vessels in all but
the most acute cases; this much disputed point can be regarded
as settled by the researches here published. In every case there
is diffusely distributed throughout the cortex a perivascular infil¬
trate of pla8inon cells. In the parenchyma itself a rod-shaped
cell is regularly present (Stabchenzelle of Nissl); it is more
picturesquely and accurately called a “ sausage cell,” and is derived
from the vessel wall. Granular cells were not found apart from
focal destruction, and polymorphonuclear leucocytes always de¬
noted secondary infection.

The changes of the nerve-cells in general paralysis are be¬
wildering in their variety; they are probably not meaningless
degenerations, although very difficult of interpretation; in ad¬
vanced cases there is always a considerable disappearance of
nerve-cells.

In that portion of the parenchymatous tissue which our
technique stains very imperfectly, the “nervous grey” of Nissl,
degenerative processes take place.

The glia always shows proliferative changes, and the various

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389

progressive and regressive changes are illustrated by chromo¬
lithographs in which the author’s drawings are admirably repro¬
duced (plates viii.-xi): the staining methods used were mainly
those of Weigert, Nisei, and Bevan Lewis.

The next question taken up is that of the topographical
distribution of the changes in the nervous system, and in this
context he records eight cases presenting focal symptoms without
actual foci of softening or haemorrhage, but with marked severity
of the paralytic changes in circumscribed areas. The clinical
course of such cases is usually spasmodic, the attacks occurring
after long intermissions and leaving the same defect symptoms.

Alzheimer calls attention to the histological changes in the
thalamus, where one finds not only primary changes, but occasion¬
ally also degeneration secondary to the cortical changes; it is a
puzzling fact that the pulvinar is always the region with most
marked degeneration, for it has no known relations to the cortical
regions most affected.

The changes in the cord are next examined. Histologically
one cannot differentiate the paralytic from the tabetic de-

? ;eneration of the posterior columns of the cord; but in the
ormer the endogenous systems are early attacked in opposition
to what occurs in tabes. It is a primary degeneration, and can
not be explained as secondary to vascular changes. This is
important in discussing the essence of the paralytic process.
The distribution of the paralytic disease-process cannot be ex¬
plained by the inflammatory changes ( i.e . “ inflammatory ” in the
sense of a cellular exudate); although in the cortex it does not
follow any known systemic distribution, it is at least much
influenced by the nervous architecture of the cortex.

Histological data do not enable us to demonstrate varieties
of general paralysis corresponding to the usual clinical groups;
Binswanger’s haemorrhagic and meningo-encephalitic forms have
doubtful value.

In the next section (pp. 158-198) the histological differential
diagnosis is discussed between general paralysis and various
syphilitic conditions, arterio - sclerotic brain atrophy, and the
changes in chronic alcoholism and senile insanity. Special
attention is paid to the meningo-gummatous variety of brain
syphilis and to syphilitic endarteritis of the small cortical vessels
(Nissl). In this latter, in contrast with general paralysis, there
is much greater proliferation of the cells of the vessel-walls,
absence of infiltration of the lymph-sheaths (unless there is focal
softening), less destruction of the parenchyma, a different dis¬
tribution of the morbid process, and a greater general tendency to
focal softening.

The last section (pp. 198-292) is the part which is of most

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REVIEWS

value to the clinician, and can be read with much advantage, even
should the earlier detailed pathological discussions be found
difficult of digestion by those who have done little laboratory
work. Here Alzheimer endeavours to correlate his histological
results with the clinical phenomena, and he records a series of
cases.

The importance of a careful detailed psychiatric analysis of
these cases of difficult diagnosis is brought out; the focal
symptoms and associated neurological symptoms are of diagnostic
value, but equally essential are the clinical course, the type of
dementia, the nature of the affect, the interests, the memory
changes, and abnormal mental trend of the patient.

As yet we have, from want of recorded material, no definite
clinical picture to correlate with the syphilitic endarteritis of
the small brain-vessels (Nissl). Through the microscopic isolation
of this pathological process we may hope soon to establish its
clinical symptoms. With regard to arterio-sclerotic dementia, the
author emphasises its existence as a nosological entity, and refuses
to consider it a transition form between alcoholic and senile
dementia; it has definite clinical and pathological characteristics,
is less a cortical than a subcortical affection, and may be described
as an association dementia.

In conclusion, the author mentions certain questions associated
with idiocy that await solution, and points to the limits of our
present knowledge. No one can deny the claim in the closing
sentence that the results of these investigations demonstrate the
value of histopathological work for clinical psychiatry.

In the beginning of the second article of the volume, Nissl
states the question before him thus: Can we, on the basis of the
anatomical examination alone, decide that a case has been one of
general paralysis ? The answer he gives is that in general paralysis
there is a definite histopathological picture.

It is evident that Nissl is treating the same question as
Alzheimer, but his work is in many respects complementary to
that of the latter. Thus Nissl leaves to Alzheimer the detailed
description of the progressive and regressive changes in the vas¬
cular elements while he himself takes up the question of the
nature and origin of the cells in the perivascular infiltrate and of
other mesodermal elements. While he revels in the extremely
detailed analysis of the mesodermal and ectodermal elements in
the paralytic cortex, he does not confine himself to mere mor¬
phology, but discusses in a suggestive and stimulating way the
wider biological and pathological questions involved.

He begins with a short sketch of the development of his own
views on general paralysis. In 1896 he held that general paralysis
is a primary affection of the cortical neurones, and may develop

REVIEWS

391

without any affection of the vessels and with no inflammatory
changes. He now holds that there is an inflammatory process
present, and agrees with Alzheimer that in every case the vessels
are affected and present a perivascular infiltrate. The diagnosis of
general paralysis can be definitely excluded if there is not present
a diffuse plasma cell infiltrate in the cortex.

Before passing to the plasma cells he discusses the nature of the
“ rod cells” ( Stdbchemellen ), to which he first called attention, in the
paralytic cortex; these he now holds to be of mesodermal origin.
In general paralysis, granule cells are, as a rule, absent, unless
there is some hemorrhage or softening; but these elements are of
such importance in the histopathology of the cortex that Nissl
devotes eleven pages (pp. 329-340) to their morphology and histo¬
genesis. These are the epithelioid cells of Friedmann, the
granule cells of other authors ; Nissl calls them mesh-work cells
(Gitterzellen) on account of their morphological features. They
are of mesodermal origin, and are not heematogenous; they are the
phagocytic cells par excellence , and also the elements that fill up
gaps in the tissue due to focal destruction.

The presence of the rod cells and Gitter cells and occasional
plasma cells in the parenchyma, and other facts, have forced Nissl
to give up his old view, that the adventitia of the vessel wall
continues to act as a biological limiting membrane between
mesodermal and ectodermal elements even in pathological con¬
ditions. The hsematogenous elements, however, are kept back
with few exceptions, and the infiltrate remains perivascular and
does not invade the ectodermal tissue. The majority of the cells
in this infiltrate are cells which Nissl was the first to identify with
the plasma cells of Unna. The origin, nature, function, and destiny
of these cells have given rise to an enormous literature, of which
an exhausting and exhaustive review is given (pp. 347-361). This
is followed by an analysis of their morphology (pp. 362-379) and
a general discussion of their diagnostic importance. Nissl holds
that these cells are of hsematogenous origin, being modified
lymphocytes; his opinion is largely based upon experimental
work on the production of tubercle in the animal cortex. He
admits that his conception of plasma cells is unusually broad.
The important characteristic of a plasma cell is, according to him,
that the cell body stains extremely deeply with methylene blue,
the dark substance being not sharply defined granules, but rather
a crumbly substance, between which clearer spaces are to be seen.
The cell body has most morphological importance, the peripheral
arrangement of the nuclear chromatin and the eccentric position
of the nucleus being non-essential. The practical importance of
the demonstration of a plasma cell infiltrate is great, for it enables
the physician, although not an expert pathologist, to definitely

392

REVIEWS

place his case within a certain very limited group of psychoses.
In fact, it usually establishes the diagnosis, for the other conditions
with plasma cells, such as tubercular and carcinomatous processes,
acute and sub-acute forms of encephalitis and certain forms of
idiocy and epilepsy are not liable to lead to confusion; while a
diffusegummatousmeningo-encephalitis presents various histological
points of difference.

With regard to the nerve cell changes, Nissl agrees that the
variety is disheartening, but he suggests lines of experimental
study. He then gives an exceedingly thorough discussion of the
glia question, reviewing the views of Weigert and Held, and
describing in detail the progressive and regressive changes and
the regressive changes in progressively altered cells. He hesitates
to accept all of Held’s views, e.g. his membrana limitans and his
view of the Golgi net, but he is in sympathy with his view of the
glia as a syncitiaJ tissue.

In summing up, he repeats that general paralysis is an inflam¬
matory condition, if the term inflammatory be applied to processes
where, along with progressive and regressive changes in the
parenchyma, there is implication of the vessels in the sense of a
cellular infiltrate; and if one considers the plasma cells of the
paralytic exudate to be of hsematogenous origin. Having dis¬
cussed the inflammatory aspect of the morbid process, he next
turns to the degenerative process which accompanies the former.
He regrets that his method of working on little blocks of tissue
does not enable him to form a definite opinion on the complete
distribution of these changes, and insists on the importance of
studying this distribution in large brain sections.

However great the value of the inflammatory changes from the
diagnostic point of view, they do not explain the morbid process
and the degenerative element. In this context the relation of
general paralysis to various forms of brain syphilis and the
possibilities of various combinations are discussed.

The author finishes with a reminder of our iguorancc of the
essence of the paralytic process; in this context he refers to
the puzzle of his two rabbits and one dog, which presented in
their cortex the typical histopathological picture of general
paralysis.

The book, containing the results of two such accurate observers
as Alzheimer and Nissl, must be regarded as the most complete
and trustworthy presentation of the histopathology of general
paralysis hitherto published. The ideal of histological analysis
accepted by the editor involves the careful scrutiny with the
oil-immersion of every cell and tissue element, and a clear appre¬
ciation of the extent of one’s knowledge of each element. Such
an ideal involves an amount of detailed labour which only a

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393

strong scientific faith makes possible, and it is good to find that
the result of this long-continued research is a contribution to the
subject so stimulating in its presentation, and so far-reaching in its
significance.

The editor is to be congratulated on having had the co-operation
of a publisher who has done justice to the work.

C. Macfik Campbell.

AFPEOTTVTTAT, STJGGE8TIBILITAT, PARANOIA. E. Blkuler,

Prof, of Psychiatry, Zurich. Halle a. S.: Carl Marhold. 1906.

Pp. 144.

The great importance of the affective side of all mental operations,
both in normal and pathological psychology, has of late years
received increasing recognition, and the above very thorough
analysis of affective states with particular reference to paranoia
from the able pen of Professor Bleuler is a valuable addition to the
literature of psychiatry. The author sharply distinguishes affec-
tivity (emotion—feeling—affection) from intellectual processes,
whilst he admits that the separation is purely a theoretical one, as
in actuality every intellectual state or process has its emotional
complement. Certain intellectual states, however, have particular
connection with affectivity, t.g. sensations of muscular tension,
palpitation, hunger, thirst, etc. As regards the vexed question of
pain ( Schmerz , not Unhist), the author himself is not clear whether
it should be regarded as a sensation or a feeling. Probably both.
However this may be, he emphasises the preponderating import¬
ance of affectivity in action, as it “generalises the reaction to
isolated sensory impressions over the whole body and mind, pushes
opposing tendencies out of the way, and decides the range and
force of the reaction.” It is thus the dominating motive power in
conduct, and is, further, in pathological or abnormal conditions,
the source of dissociations and transformations of the personality,
and the origin of certain forms of delirium. Affectivity still
further displays a well-defined independence as contrasted with
intellectual processes, the affective complement of one succeeding
state being frequently carried over to succeeding meutal opera¬
tions. This affective solidarity is also evidenced by the fact that
in childhood the development of affectivity is independent of, and
quite out of proportion to, that of the intellect, so that in patho¬
logical development either the intellectual idiot or the emotional
or moral idiot may result. In this relation the author adverts to
the advantage of classification of individual types, as attempted by
the old divisions into temperaments, sanguine, phlegmatic, and so
on. Attention is next analysed and finally defined as a special
2 c

394

REVIEWS

form of affectivity. In pathological states, affectivity, the author
says, dominates the whole clinical picture. In the organic
psychoses, the emotions are, he maintains, not obliterated as is
commonly affirmed, their elimination being apparent, not real,
depending entirely on loss of exciting intellectual elements.
Similarly with alcoholics and epileptics the emotional elements
persist but are extraordinarily labile, producing a factitious efface-
ment. In idiocy, all variations of affectivity are to be found, just
as in the normal, only with a much wider range, but in dementia
prtecox the affective reactions are largely suppressed. Turning to
suggestibility, Professor Bleuler shows that in result, in their mode
of operation, and in origin, affectivity and suggestion are identical,
suggestion being an affective process and suggestibility merely one
phase of affectivity. The importance of this contention in its
bearing on the phenomena of hysteria and hypnotic suggestion is
obvious. All these considerations naturally lead up to the author’s
examination of the mechanism of paranoia. Concerning the
ground-work of paranoia, and whether in this category many
different conditions are united or not, we are, Professor Bleuler
maintains, still in the dark, but he is convinced, and his arguments
go far to prove, that it is not derived from pathologically altered
affective states, as is widely held. In particular, morbid suspicion
—one of the most constant symptoms—is not an “ affect,” but is
only a secondary effect of intellectual disorders (delusions, etc.).
Neither is there in paranoia a general disturbance of perception or
apperception or of memorial images. Professor Bleuler devotes
considerable space to the discussion of the marked egotism ( Hyper-
tropic des Ich, esjozenti'ischer Charaktcr) so frequently observed in
paranoiacs. None of these features are constant, and even when
present are operative only in a numerically limited part of the ex¬
periences of the subject, and are not spread over the whole field as
they would be if of primarily affective origin. The ego-centric
character of the paranoiac is thus merely the result of the circum¬
stance that in the foreground of his mind there is continually
present an affectively-accentuated idea complex; his delusions
being intellectually and not affectively determined, differing from
the mistakes of the sane only by their incorrigibility. Herein,
however, lies the crux of the whole matter, and though Professor
Bleuler says that this characteristic incorrigibility may rest on
chemical, anatomical, or “functional” grounds, his explanation
throws no light on this supremely important point The whole
question is highly controversial and some of the author’s conclu¬
sions, particularly in this last chapter on paranoia, can only be
accepted with considerable reservation. Nevertheless the book
as a whole will be found in many directions illuminating and in
others highly suggestive. R. Cunyngham Brown.

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CLINICAL NEUROLOGY AND PSYCHIATRY

GKNRRAL—

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6BMUAL AND FUNCTIONAL DISEASES—

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Goitre, with Remarks on the Probable Nature of the Disease. Brit. Mid. Journ .,
April 21, 1906, d. 914.

ROBINSON. On the Relationship between Grave’s Disease and Acute Rheu¬
matism. Lancet, April 14, 1906, p. 1037.

FREUDENBERG. Em Fall von Morbus Basedow, behandelt mit Anti thyreoid in.
Konegen, Leipzig, 1906, M. 1.

STEGMANN. Bemerkungen zur Behandlung des Morbus Basedowii mit Rdnt-
genstrahlen. Wien. klin. Woch., April 19, p. 473.

E. F. CURTIS. The Results of the Surgical Treatment of Exophthalmic Goitre.
Annals of Surgery, March 1906, p. 335.

Acromegaly.— WIDEL, ROY, et FROIN. Un cas d'acrom6galie sans hypertrophic
du corps pituitaire avec formation kystique dans la glande. Rev. de Mid., avril
10, 1906, p, 313.

SPECIAL SENSES AND CRANIAL NERVES—

AXENFELD. Ueber traumatische reflectorische Pupillenstarre. Deutsche med.
Woch. , April 26, p. 663.

DREYFUS. Ueber traumatische Pupillenstarre. MUnch. med. Woch., MSrz 27.
P. 604.

PFLUGK. Tiber die Akkomodation des Auges der Taube nebst Bemerkungen
iiber die Akkomodation des Affen (Macacus cynomolgus) und des Menschen.
Bergmann, Wiesbaden, 1906, M. 3.60.

CANTONNET et TAGUET. Paralysie des mouvements associ&s des yeux et
leur dissociation dans les mouvements volontaires et automatico-r6flexes. Rev.
Neurol ., avril 15, 1906, p. 308.

WILHELM SCHOEN. Das Schielen, Ursachen, Folgen, Behandlung. Lehmanns
Verlag, Munchen, 1906.

HASTINGS. A case of acute middle ear suppuration complicated by labyrinthine
fistula and paralysis of the abducens nerve. Arch, of Otol., Vol. xxxv., No. 1, p. 1.
JOHMANN. Rezidivierende Oculomotoriuslahmung als Komplikation bei Typhus
abdominalis. Deutsche med. Woch., April 19, p. 617.

L. STREET. Motor ocular paralysis as a complication of acute articular rheu¬
matism. New York Med. Jaum ., April 7, p. 712.

DUMARE8T. Des n6vroses et n6vrites du pneumogastrique chez les tuberculeux.
Gainche, Paris, 1906.

MISCELLANEOUS SYMPTOMS—

LENNANDER. Ueber lokale Anaesthesie und fiber Sensibilit&t der Organs und
Gewebe, weitere Beobachtungen. II. Mitteil a. d. Qremgdb., Bd. 15, H. 6, p. 465.
KEMPNER. Ueber Storungen im Augengebiet des Trigeminus speziell des
Comealreflexes und ihre diagnostische Verwertung. Berlin. %lin . Woch., M&rz 26,
p. 379.

GOLDSCHEIDER. KasuLstischer Beitrag zur Lehre von der sensorischen Ataxie.
Neurol. Centra Ibl., April 16, 1906, S. 338.

BAUMANN. Ueber den Rachenreflex. Munch, med. Woch., Mitre 27, p. 598.
KURT MENDEL. Tiber den Fussruckenreflex. Neurol. Centralbl., April 1,1906
S. 293.

LAS ARE W. Uber den Schafer’schen an tagonistischen Reflex. Neurol Centralbl .,
April 1, 1906, S. 291.

BECHTEREW. Uber eine eigentumliche Reflexerscheinung bei Plantarflexion
des Fusses und der Zehen in Fitllen von Affektion des centralen motorischen
Neurons. New'd. Centralbl., April 1, 1906, S. 290.

LOEB. Gutachten Uber Entstehung und Ruckbildung traumatischer Aphasie.
Mitteil a. d. Orenzgeb., Bd. 15, H. 5, p. 495.

ERIC CAMPBELL PRITCHARD. The Training of Nerve Centres in Children.
Lancet , April 21, 1906, p. 1104.

GUTZMANN. Grundzuge der Behandlung nervoser Sprachstorungen. Deutsche
med. Woch. April 19, p. 612.

BIENFAIT. Le traitement des dyspepsias nerveuses et des troubles nerveux
dyspepsiques. Ann. d’ftlectrobiol. et de Radiol., mars 1906, p. 173.

MOREL. Sur les lesions du sinus lateral et leur traitement longitudinal dans es
traumatismes craniens. Arch. gin. de mid., avril 24, 1906, p. 104.

PERS. Ueber chirurgische Behandlung der Ischies. Deutsche med. Woch.
April 12, p. 574.

* A number of reference* to papers on Treatment are Included In th# Bibliography under the
Individual Disease#.

"Review

IReurolog^ artfc fltepcbiatn>

©riginal articles

THE PATHOLOGY OF A CASE OF MYELITIS
ACUTISSIMA HJEMORRHAGIOA DISSEMINATA

By W. B. WARRINGTON, M.D., F.R.C.P.,
and

JOHN OWEN, M.B.

(From the Thompson-Yates Laboratories of the University of Liverpool.)

In the Liverpool Medico-Chirurgical Journal for June 1904, Mr
George Hamilton recorded a case of rapid paraplegia terminating
fatally in four and a half days. The patient, a gentleman aet.
41, was under the care of Mr Hamilton, and seen in consultation
by Dr T. R Glynn and the late Dr Alexander Davidson.

The following are the essential clinical features :—

No history of previous illness was obtained. On October
27th, 1904, the patient took a “ chill,” and felt out of sorts; he
was, however, able to travel up to London. Three days later
Mr Hamilton found him with a temperature of 101° and
symptoms of slight gastric catarrh. He rapidly improved, and
on the 4th November seemed quite well. On the afternoon of
that day, when standing by his dressing-table, he said suddenly,
“ I think I have lost the use of my legs,” and before he could be
got into bed he was completely paralysed from the waist down.
Mr Hamilton found complete motor and sensory paralysis below
the umbilicus. The reflexes were absent, and there was retention
R. OF N. & P. VOL. IV. NO. 6—2 D

402

ORIGINAL ARTICLES

of urine. The same evening there was violent pain in the spine
at the mid-dorsal region. The following day loss of sensation
extended to a higher level; at midnight he became unconscious,
breathing purely with the diaphragm. The left pupil was larger
than the right, and both reacted to light. There was much
difficulty in swallowing. Paralysis of the upper limbs and of
the right side of the face soon followed. The temperature rose
suddenly on the afternoon of the illness, and remained high until
death four and a half days after the onset

An autopsy was made 24 hours after death by Dr Ernest
Glynn, who found no disease in the viscera, the spleen was
slightly enlarged, and its substance diffluent; from it unsuccess¬
ful attempts were made to cultivate micro-organisms. The
brain and spinal cord were hardened in formalin, and after some
preliminary examination Dr Glynn kindly handed the material
over to us for a further investigation.

On cutting across the cord at various levels, masses of
intraspinal haemorrhage were readily seen with the naked eye.
The maximum intensity of the haemorrhage was found at the
lower dorsal region, where the greater part of the cord appeared
to be replaced by a clot; from here to the termination of the
cord there was much haemorrhage. The next chief site was in
the mid-cervical region. Smaller extravasations were seen
scattered throughout the cord and extending as high as the
upper part of the medulla. The membranes appeared normal,
the pia being smooth and glistening, and showing through it the
greatly dilated spinal arteries and veins.

The microscopical findings may be briefly described under
the following headings :—

Distribution of the haemorrhage and vascular changes.

Changes in the vessel walls and their immediate neigh¬
bourhood.

Swelling and necrosis of tissue.

Condition of the nerve elements.

1. Distribution of the Haemorrhage and Vascular Changes .—
The figures 1 and 2 are drawn from low power magnification with
the Edinger projection apparatus, and reproduce the appearance
seen in sections taken from the lumbar and dorsal regions, and
stained by van Gieson’s method. Their inspection shows that

ORIGINAL ARTICLES

408

the haemorrhage followed chiefly the distribution of the anterior
spinal system of arteries, but that the coronal vessels had in
many places ruptured. The extravasation of blood and fluid in
the lumbar region caused a marked dislocation of the ventral
cornua towards the periphery, and in the cervical region had
torn across the base of one posterior cornu at its attachment to
the central grey. Apart from this destruction of tissue caused
by the irruption of blood from the branches of the anterior
spinal system, a distinctive feature shown by the sections was
the great dilatation of innumerable small vessels, not merely in
the grey matter, but scattered over the conducting tracts of the
cord. In the van Gieson specimens these vessels and the
infiltrated surrounding tissue stood out as brilliant red dis¬
seminated areas. Where the haemorrhage was copious, numerous
granules of blood pigments were seen, much of which was
enclosed in large, round, clear cells. In the pia there were
greatly distended arteries and veins, the latter containing many
pigment granules and surrounded by round mononuclear cells;
the vessels in the nerve roots also in many instances were
distended, in other places ruptured.

2. Changes in the Vessel WaUs and their Neighbourhood .—
The structure of the larger vessels was normal, there was no
thickening of their walls, and the acid orcein stain showed the
normal elastica without change in the internal coat; but both in
the pia and around the greatly dilated branches of the anterior
spinal arteries there was infiltration of the surrounding tissue
with round and fusiform mononuclear cells. In the central grey,
when vessels cut in transverse sections could be seen, the peri¬
vascular sheaths were found filled with blood cells and round
cells which also infiltrated the neighbouring tissues. In others,
as in Fig. 3, the lumen of the vessel was bounded by granular
necrotic masses, in which only few formed elements could be
detected, replacing the vessel wall and perivascular space. Out¬
side this again was another zone of necrotic tissue. Changes in
the smaller vessels, on the other hand, presented a characteristic
feature of the histological study of the cord. The bright red
areas seen under the low power in the van Gieson stained
sections were, on more detailed examination, and especially when
studied in hsematoxylin preparations, found to be formed around
small vessels, commonly an arteriole, sometimes with a vein

404

ORIGINAL ARTICLES

(Fig. 4). The walls of these vessels were hyaline and thickened,
in many instances completely obliterating the lumen (Fig. 5).

In some cases thrombi in various stages of formation could
be seen within the vessel. These thick-walled or obliterated
vessels formed the centres of irregular areas composed of swollen
glial fibres, necrotic granular tissue, and infiltrating round and
fusiform cells with varying extent of haemorrhage.

Around some small vessels groups of epitheloid cells were
seen and, rarely, examples of the dissecting aneurysm in which
the intravascular lymph space between the media and adventitia
was filled with blood.

3. Swelling and Necrosis of Tissue .—In many sections,
especially those near to the chief site of the haemorrhage, the
preponderating change was due to the exudation of fluid which
had coagulated into homogeneous glistening masses.

Such masses were often found within the grey matter, entirely
replacing the nervous tissue. This oedematous soaking led to
swelling of the glia, revealed by thickened fibres compressed into
fibrous-looking bands.

In Fig. 1 a large band is seen in the form of an arch
immediately under the dorsal aspect of the grey matter, the
white matter of the dorsal column thus enclosed was found in
various stages of necrotic softening and destruction.

4. Condition of the Nerve Elements .—Whilst at the chief sites of
disease both the cornual cells and nerve fibres exhibited all degrees
of degeneration, these changes were almost entirely limited to the
immediate region of vascular disturbance; beyond these zones,
nerve fibres and nerve cells, studied by the van Gieson, Strobe,
and Nissl methods, were normal in appearance.

The substance of the cord and meninges was carefully
examined for micro-organisms, but none found. The brain above
the medulla was normal.

Remarks .—This is a noteworthy example of the class named
“Acute Disseminated Myelitis”:—vague toxic symptoms followed
by profuse haemorrhagic myelitis distributed over the whole of
the spinal cord, extending into the medulla, and causing death
within five days.

Similar cases are well known, usually following definite
infection; they rarely, however, present so fulminating an onset
or so rapid a course. Sir Thomas Barlow (1), many years ago.

Plate 23.

Fig. 3.

Fig. 5.

</£>

ORIGINAL ARTICLES

405

described a disseminated myelitis which terminated on the
eleventh day of an attack of measles and on the third day from
the first spinal symptoms.

SchifTs (2) patient, with typhoid, died in eighteen hours
from the first appearance of palsy. In both these cases there
was considerable haemorrhage into the spinal cord, but this is not
an essential feature of the disease. In most of the recorded fatal
cases the duration of the illness was considerably over a week.
Acute myelitis has for some years been the object of much
pathological debate; we now only record the findings in a case
carefully examined by modern methods.

It seems probable that most cases of transverse myelitis are
rather examples of primary softening (Myelomalacia) due to
impaired arterial supply, and, in the case of syphilitic disease,
occurring early after the original infection. Williamson (3) has
shown that the thrombosis of blood-vessels found by him was the
primary cause of the softening and haemorrhage, because throm¬
bosed vessels were found far away from the hsemorrhage, many
of the thrombi were clearly of older date than the hsemorrhage,
and marked vascular change sufficient to account for the throm¬
bosis was present; the known limitation of the inflammatory
change to the distribution of one spinal artery, such as occurs in
acute infantile palsy, is, as Batten (4) has recently pointed out,
in favour of a primary thrombotic origin. Findings of this kind
are valuable evidence, and are tests which should be applied to
the interpretation of the microscopical appearances, for histo¬
logically the changes in simple and inflammatory softening may
be identical; “ the evidence of the initial thrombotic lesion
may disappear in the inflammatory change it excites” (Sir
William Gower’s “Manual of Nervous Diseases”).

Bruns (5) considers that etiological considerations can alone
furnish a distinction between these different types of pathological
changes ; it is especially in the cases of acute disseminated
myelitis that the evidence of bacterial or toxic invasion is clear,
that the changes found resemble those produced by experimental
inoculation (Marinesco), and that inflammatory action with
necrotic softening follows the vascular distribution.

Mager (6) lays stress on the observed changes in the vessel
wall, regarding these as an essential and primary expression of
the activity of the virus, according to the nature and intensity

406

ORIGINAL ARTICLES

of which haemorrhage, round-celled infiltration, or simple paren¬
chymatous degeneration may result. Mager, however, considered
the changes in the vessel walls as essentially of the same order
whether they exhibit the characteristic thickening of the intima
of syphilis or not, but of the seven cases described by him the
changes in the intima were found only in the cords of those
patients who had previously been affected with lues. We con¬
sider the changes in the vessel walls so clearly described by
Williamson as occurring in syphilis are not comparable with
those now described by us and frequently met with.

Singer’s (7) cases also were examples of transverse myelitis
in syphilitic subjects, and his conclusion that acute myelitis is
pathologically a myelomalacia resulting from thrombosis in
diseased arteries should refer specifically to that condition
(acute transverse myelitis).

Against Mager’s view of the primary nature of the vessel
change such as we have described in our case, is the fact that
these changes are not found in all cases ; they were absent, for
example, in Purves Stewart’s case recorded in this Journal
(1903), and which pathologically was a disseminated myelitis;
in our case they were only marked in the chief sites of the
disease, being absent in other regions of the cord where vascular
dilatation and perivascular infiltration were present. It is note¬
worthy that they were found only in the smaller vessels, and we
regard them as due in the first place to the intensity of the
toxic virus, and secondly to the necrosing action of the inflam¬
matory oedema. We have seen similar changes in the vessels of
a spinal cord destroyed by the usual fracture dislocation of
vertebrae and which ended fatally in four days. In conclusion,
we think it desirable that further pathological reports should
be published on cases of acute disseminated myelitis and ence¬
phalitis, which diseases at present we regard as being different
in pathogenesis to acute transverse myelitis.

Description of Figures.

Fig. 1 . —Lumbar region stained by van Gieson’s method, showing haemor¬
rhages and cedematous tissue in the dorsal columns, surrounded by a
band of swollen glia, and dislocating the anterior cornua outwards and
backwards.

Fig. 2.— Dorsal region stained by van Gieson’s method, showing hsemor-

ORIGINAL ARTICLES

407

rhages in the distribution of the anterior spinal artery, and also in a
slighter degree from the coronal vessels.

Fig. 3.—Necrotic masses surrounding a blood-vessel at the junction of the
grey and white matter (Leitz, l-12th haematoxylin).

Fig. 4.—Inflammatory focus around vessels in the posterior column (Leitz,
l-8th haematoxylin).

Fig. 5.— Vessels from a haemorrhagic focus undergoing hyaline degeneration,
and showing round celled infiltration, less marked here than in other
preparation (Leitz, l-8th haematoxylin).

Drawings made with the Edinger apparatus and Leitz’ drawing ocular.

References.

1. Barlow. Tram, of Roy. Med. Chir. Soc., p. 77, 1887.

2. Schiff. Archiv.fUr tlin. Med., p. 175, vol. lxvii.

3. Williamson. “Syphilitic Diseases of the Spinal Cord,’ 1899, p. 62.

4. Batten. Brain, p. 376, 1904.

5. Bruns. “ Twentieth Century Medical Practice.”

6. Mager. Ref. in Neurol. GentraJM., p. 455, 1900.

7. Singer. Brain, p. 332 (a), 1902.

Note .—A grant towards the expenses of work in Neuropathology is made to Dr

Warrington by the Scientific Grants Committee of the British Medical Association.

▲ CASE OF HAEMORRHAGE INTO THE BRAIN AND
SPINAL CORD FROM OBLITERATIVE ARTERIAL
DISEASE.

By W. B. WARRINGTON, M.D., F.R.C.P., and JOHN OWEN, M.B.

(From the David Lewis Northern Hospital and Thompson-Yates Laboratories,

University of Liverpool.)

Summary.— Girl, set 25. Apoplexy. Marked unilateral optic
neuritis, endarteritis proliferans, rupture of aneurysm, haema-
toma of one optic nerve sheath, foci of haemorrhagic softening
around obliterated blood-vessels in the spinal cord.

A well-nourished young woman, aged 25, was sent into hospital
on Aug. 15,1905, by Dr Stack, of Wavertree. She was moaning
and crying, and complained bitterly of pain in the head. When
not calling out, she lay in a partially stuporose state.

The history of her illness was that eleven days ago, sitting
at the tea-table, apparently in good health, she cut her
finger. Convulsive movements of the left side of the body
began, and continued for an hour, when she passed into a semi-

408

ORIGINAL ARTICLES

comatose condition, which continued for several days. At the
end of that time she recovered sufficiently to recognise her
friends and talk to them. She complained of much pain in the
back and head, and from time to time relapsed into the semi-
stuporose condition in which she was found on admission to
hospital.

The girl was engaged as a housemaid, but recently had been
doing the work of a general servant, and is said to have been
overworked. No history of previous illnesses could be obtained,
though lately the patient had complained of sore throat, and the
menses had been too frequent

She came of respectable and healthy parents, had several
brothers and sisters in good health, with the exception of a
grown-up sister, who for two years had suffered from fits.

Special enquiry was made as to any evidence of hereditary
or acquired syphilis. The former could probably be excluded,
and there was no evidence of the latter, though a frank state¬
ment from the mother suggested that the risk of infection could
not absolutely be excluded.

State on Admission .—Examination of the body and viscera
showed no signs of syphilis or tuberculosis. The heart was
normal in size ; a faint systolic bruit heard at the apex. Urine
and faeces were voided involuntarily, though from time to time
it was necessary to pass a catheter. The urine was alkaline and
contained a large amount of pus, but no casts. After separating
the pus, only a small amount of albumen remained in the
filtrate.

The pulse-rate varied from 90 to 120 per minute, and the
temperature was slightly subnormal. The ears, throat, and nose
were normal.

Nervous System .—There was marked left hemiplegia, including
the face. The loss of power in the left limbs seemed very com¬
plete, but the patient was unable to aid us in our examination.
We considered that there was also loss of sensation on this side.

The right upper limb and right side of the face moved fairly
well, but the lower limb seemed paretic. Both plantar reflexes
were of the extensor type, the response being more distinct from
the left foot. The knee, ankle, abdominal, and epigastric
reflexes could not be obtained on either side. The wrist-jerk
was, however, present on the right, not on the left side.

ORIGINAL ARTICLES

409

Eyes .—The right pupil was larger than the left; both reacted
to light and accommodation. There appeared to be some
paralysis of the upward and outward movement, but it is im¬
possible to make a precise statement on this point. Particular
interest attaches to the result of ophthalmoscopic examination.

Mr A. Nimmo Walker, of St Paul’s Eye Hospital, noted as
follows:—

“ The right disc was extremely swollen, being best seen with
a + 5 lens, and appeared like a reddish tumour. Its lower
border was not to be defined, but superiorly it formed a prominent
ridge overlapping the superior retinal vein. This was the only
vessel to be seen, and around it was the only comparatively
clear portion of the fundus. The vein was swollen, and ran
vertically downward, apparently behind the swelling representing
the disc. Its companion artery was quite invisible, but on each
side of the vein were small dots of black pigment.

“ The picture was one of intense congestion and exudation
occurring in an eye which had previously suffered from chorio¬
retinitis.

“ Owing to the restless delirium of the patient and the haziness
of the media, it was possible to obtain only fleeting glimpses of
the fundus.”

The left eye showed slight distinct optic neuritis, with some
swelling of the veins and smallness of arteries.

Progress of the Case .—The patient lived for twenty-seven
days, the symptoms remaining stationary. The stupor deepened
into coma, and the temperature rose for a week or so before
death.

Lumbar puncture was performed three times. On the first
occasion, six days after admission, a reddish fluid was obtained,
which was sterile, and showed only red blood-cells with a few
leucocytes. Four days later the fluid was yellowish, and a
week later normal.

Autopsy .—The pyuria was found to be due to a slight
cystitis, there was no disease of the kidneys, and the other
thoracic and abdominal viscera were normal, with perhaps the
exception of a slight mitral stenosis not of recent origin; the
cusps of the valve were quite smooth, a trifle thickened, and
there were no visible vegetations.

Brain .—On removal of the brain a fair amount of yellowish-

410

ORIGINAL ARTICLES

red fluid was seen, and masses of clot along the base of the
brain extended from the pons forward. On the right side the
optic foramen was plugged with clot compressing the nerve, the
left nerve passed freely into its foramen.

The vessels at the base exhibited marked pathological change.
The whole system was dissected away from the brain, and pieces
from the vertebral, basilar, circle of Willis, and cerebral arteries
examined with the microscope. To the naked eye they appeared
as yellowish thickened tubes, and on cross section the diminution
in the size of the lumen was clearly seen.

This thickening was of unequal distribution, adjacent parts
of a vessel being either much diseased or practically free; both
sides suffered equally.

On microscopic examination the thickened vessels showed
well-marked endarteritis proliferans. In some sections the endar¬
teritis produced a uniform thickening; in many others there were
nodes formed by local overgrowth of the intima. Stained by
acid orcein the characteristic reduplication of the elastic lamina
was well seen. No tubercle bacilli were found after the appro¬
priate staining. The change seemed limited to the larger vessels,
the smaller cortical branches appeared normal.

Shortly after its origin the middle cerebral artery divides
into four branches; the most posterior is the parieto-temporal,
which lies under the temporo-sphenoidal lobe. Arising from the
wall of this vessel at its origin from the common trunk on the
right side a small sac the size of a pea was seen. A section was
obtained through the sac and through the two more anterior
branches of the middle cerebral; it was then seen that whereas
the two latter vessels showed marked nodose proliferation of the
intima, the wall of the sac was in places extremely thin, being
represented only by a band of connective tissue. The rupture
of this sac was no doubt the cause of the haemorrhage, and the
arrest of the circulation the cause of the reddish necrotic
condition of the neighbouring parietal and temporal convolutions.
Examination showed that the softening was not, however, con¬
fined to these areas, but affected the island of Reil and part of
the ascending frontal convolution. The basal ganglia and
internal capsule appeared normal to naked-eye examination.

Spinal Cord .—After formalin hardening, on cutting across
the cord, brownish-red irregularly shaped spots could be seen in

ORIGINAL ARTICLES

411

the grey matter at various levels. Sections were stained by the
Van Gieson, Strobe, and acid orcein and haematoxylin methods.
There was found considerable dilatation of blood-vessels through¬
out the whole cord, but no perivasular infiltration or distension
of perivasular sheaths. Small haemorrhages almost entirely con¬
fined to the grey matter occupied areas in the anterior and
posterior cornua, and less frequently to one side of the central
canal. The haemorrhage had destroyed and torn the tissue in
which it occurred without producing much change in the
surrounding neighbourhood. There was no evidence of inflam¬
matory reaction. Within many of these areas of haemorrhage
were seen small vessels, the lumina of which were almost

Fio- 1- Fig. 2.

Small obliterated artery surrounded Thickened arteries in the spinal grey substance,
by an area of hremorrhagic soften- (Leitz, l-12th.)

ing. (Leitz, l-12th hsematoxylin.)

Drawings made with Leitz' drawing ocular.

completely obliterated by thickening of their walls (Fig. 1).
Many of the larger vessels in the grey matter also displayed a
similar thickening of the walls (Fig. 2), but in no instance was
any proliferation of the intima seen such as occurred in the
cerebral vessels. The nerve elements showed little change, but
Marchi and Nissl’s method were not used. The glia was some¬
what thickened in the neighbourhood of the dilated vessels.

Commentary .—Cerebral haemorrhage was diagnosed during
life from the presence of blood in the cerebro-spinal fluid; it
was due to the rupture of a small aneurysm forming on an
artery weakened by the advanced endarteritis proliferans so
characteristic of syphilis. A similar change may be produced
by other infections, notably tubercle, of which a beautiful

412

ORIGINAL ARTICLES

example is figured in Ziegler’s Pathology. Ziegler says that the
nodose form of endarteritis is by no means always due to
syphilis. We refrain from expressing an opinion as to the
causation in our case, though perhaps the chorio-retinitis men¬
tioned by Mr Walker and the history may leave a suspicion
in the mind.

Optic neuritis in cerebral haemorrhage, apart from tumour, is
a rare event. In a discussion at the Ophthalmological Society
in 1881, Sir William Gowers (1) related the case of a child aet.
10, the subject of hereditary syphilis, with marked double optic
neuritis; endarteritis with haemorrhage into the optic nerve
sheath was found post-mortem. A valuable paper by Remak (2)
in 1886 showed that in cases of cerebral haemorrhage with optic
neuritis the bleeding extended into the optic nerve sheath, and
that the neuritis was always more marked on the side of the
lesion. The explanation given was compression of the central
vessel by clot and interruption of the flow of lymph ; this was
doubtless the cause in our case, though we have to regret that
this was not definitely confirmed by microscopical examination.

The appearance of the fundus was remarkable for the intense
red congestion and is one we have not seen before.

The condition, then, of hsematoma of the optic sheath and
its frequent unilateral limitation is one of some clinical import¬
ance.

The mild papillitis on the opposite side cannot be explained
in a similar way: it may have been due to an infective blood
state or to local alteration in the retinal vessels.

The evidence in favour of syphilis as a blood infection pro¬
ducing optic neuritis is very slight. Emile Berger (3) alludes
to such cases and quotes Horstmann, who collected eight cases;
these, however, showed endarteritis.

In the Bpinal cord the findings may be contrasted with those
present in the case of myelitis. The van Gieson specimens show
a superficial resemblance in the distended vessels, areas of
haemorrhage, and the bright red of the swollen glia, but detailed
examination suggests that here the haemorrhages are due to
obliteration of small blood-vessels, for these were found in many
of the haemorrhagic foci; the surrounding tissue had suffered a
local neurosis and showed no signs of inflammatory reaction;
thickened blood-vessels were found elsewhere in non-aflfected

ORIGINAL ARTICLES

413

areas and in the brain; in the vertebral arteries, from which the
anterior spinal arises there was pronounced disease.

Batten (4) quotes the old experiment of Prevost and Cotard,
as showing that hemorrhage may be due to emboli in small
arteries; and Williamson (5) mentions the observations of Lamy,
who, on injecting inert powder, found foci of hemorrhagic soften¬
ing in the grey substance, the region of distribution of end-
arteries.

References.

1. Gowers. Tram. Oph. Soc., vol. i., 1881

2. Remak. Berlin klin. Woch., pp. 828 and 848, 1886.

3. Emile Berger. “ Lea Maladies des Yeux,” 1892.

4. Batten. Brain, p. 376, 1904.

5. Williamson. “On the Relation of Diseases of the Spinal Cord to the
Distribution and Lesions of the Spinal Blood-vessels,” 1895.

Note .—A grant towards the expenses of work in Neuropathology is made to Dr
Warrington by the Scientific Grants Committee of the British Medical Association.

abstracts

ANATOMY.

NOTE ON THE TAENIA PONTIS. Sir Victor Horsley, Brain,
(208) April 1906, p. 28.

The author, in a number of photographs of the brain of the camel,
hippopotamus, and man, shows the position of a bundle of fibres
running antero-laterally along the upper border of the pons, to
which Heule applied the term taenia pontis. It was regarded as
arising in the cerebellum and ending in the pons varolii, but the
exact origin and termination of its fibres was not known.

In this note, two cases of congenital defecitive cerebellum in
the human subject are described, in which this bundle was traced
from a “mass of embryonic grey tissue continuous with that of
the interpeduncular ganglion ” of one side in which it seemed to
arise, to the region of the dentate nucleus of the other side. To
determine the direction of its fibres, the author divided the taenia
pontis in a monkey and traced the resulting degeneration by the
Marchi method. He found that all its fibres between the lesion
and the cerebellum were degenerated, their direction being there¬
fore cerebello-petal, like the other ponto-cerebellar systems in

414

ABSTRACTS

parallel position. The degenerated fibres were followed to the
dentate nucleus of the opposite side, in which they appeared to
end, a few passing inwards to terminate in the roof nuclei

Sutherland Simpson.

A NOTE ON THE TOPOGRAPHICAL ANATOMY OF THE
(209) OAPUT GYRI HIPPOCAMPI Johnson Symington, Joum.
of Anat. and Physiol , April 1906, p. 244.

This part of the gyrus hippocampi is of considerable morpho¬
logical and physiological importance, since it corresponds to the
pyriform lobe of mammals and is the main cortical centre for
smell. Its boundaries and certain markings on its surface have
been investigated with great care by Prof. G. Retzius, who has
described a fissure on its surface which he terms the sulcus
rhinencephalous inferior.

During the examination of a series of adult human brains
hardened in situ by the injection of formol, Symington invariably
found a groove in the position of the fissure described by Retzius,
and by making dissections of the brain in situ , this groove was seen
to be occupied by the anterior part of the free edge of the tento¬
rium cerebelli, a little behind the anterior clinoid process and
external to the third nerve. These relations are most readily
shown by making a median section of the head and then dividing
on each side the upper part of the crus cerebri and removing the
portion of the brain below this cut. By this means the relation
of the free edge of the tentorium cerebelli to the brain is easily
ascertained. On such preparations it will be seen that this edge
passes forwards and downwards from just behind the splenium of
the corpus callosum across the isthmus, uniting the callosal and
hippocampal gyri, and occasionally indenting it It then passes
into the depression between the upper border of the lateral aspect
of the pons varolii and the crus cerebri In front of this it again
comes into close relation with the cerebral cortex, and on the
caput gyri hippocampi corresponds to a distinct longitudinal
depression. The lower part of the caput lies against the dura
mater in the middle fossa of the base of the skull, where the dura
mater forms the outer wall of the cavernous sinus. The upper
part bulges upwards and inwards above the edge of the tentorium
and presents an uneven surface, being marked by the gyrus
lunaris and gyrus ambiens of Retzius and continued backwards
to form the uncus. This depression cannot be regarded as a true
cerebral fissure, but it is of interest as an illustration of the close
relation of the basal portion of the cerebral cortex to the cranial
wall and dura mater. Author’s Abstract.

ABSTRACTS

415

THE RADIX MESENCEPHAT.IOA TRIQEMTNA AND THE
(210) GANGLION ISTHML J. B. Johnston, A natom ischer A nzeiger,
1905, S. 364.

The mesencephalic root of the trigeminus of the vertebrates has
been generally regarded as a motor structure, and it has been
assumed that its fibres spring from the large unipolar cells which
lie along its course. But neither of these assumptions has been
yet proved.

The nucleus magnocellulaiis tecti of the fish brain has been
regarded as the analogue of the nucleus of the upper root of the
trigeminus. The author’s investigations on it were made on the
brain of Scyllium by Weigert’s medullary sheath stain. He finds
that the fibres which form the mesencephalic tract always enter
the brain with the sensory root, quite separate from the motor
fibres. During their course forward they pass beneath the de¬
cussation of the trochlear nerve and the decussatio veli into the
midbrain, where they end chiefly in the fibre layer of the tectum:
it is doubtful if any of them have any cohnection with the nucleus
magnocellularis. In Acipenser, too, he has now recognised the
existence of an ascending trigeminal root, which also ends in the
fibre layer of the tectum and in the torus semicircularis. This
had been previously described by Goronowitsch, but was denied by
Johnston in his monograph on that brain. The tectum is therefore
a primary centre of somatic sensation; this is of interest in view
of the fact that the tectum is regarded as the oldest sensory
centre.

The second portion of the paper refers to the nature and sig¬
nificance of the nucleus, which has been described by Edinger in
all classes of vertebrates, except the mammals, by the name
ganglion isthmi. It was earlier known to Mayser as the Rinden-
knoten, and he recognised that the secondary vagal tract ended
in it It is now known that it is the centre in which the fasciculus
communis, which is the secondary tract of visceral components
from the seventh, ninth, and tenth sensory nuclei terminates, and
it must, consequently, be regarded as the secondary visceral
nucleus.

Finally, attention is drawn to the relation of the cerebellum to
the valvula cerebelli. The latter is met with only in the teleosts
and ganoids, in which the gustatory system is well developed. It
seems probable that the cerebellum proper belongs to the somatic
sensory system, while the valvula cerebelli is part of the visceral
sensory apparatus especially developed in relation to the olfactory
and gustatory senses. Gordon Holmes.

416

ABSTRACTS

CONTRIBUTION TO THE STUDY OF LOCALISATION IN THE
(211) NUCLEI OF THE CRANIAL AND SPINAL NERVES IN
MAN AND IN THE DOC. (Nouvelle contribution & l’ltode
des localisations dans les noyaux des nerfs craniens et
rachidiens chez lliomme et chez le chien.) C. Parhon and
G. Nadejdb, Joum. de Neurol., April 1906, p. 129.

In a case of cancer of the tongue which ended fatally in two years,
and in which at the time of death this organ was almost completely
destroyed and many of the muscles of the sub-hyoid region also in¬
volved, including the sterno-cleido-mastoid, the authors examined
the spinal cord, medulla oblongata, and pons by Nissl’s method,
with a view to determine the positions of the group of cells
affected.

The central group of cells in the anterior horn of the first and
second cervical segments they believe to be the nucleus of the
sterno-cleido-mastoid muscle. This group does not extend into the
third segment. All the cells of the upper part of the hypoglossal
nucleus were atrophied except the anterior group, which showed
signs of recent change, and us the genio-hyoid muscle was known
to have become invaded only towards the end of the disease, this
group they associate with the nerve supply of that muscle.

In the nucleus of the seventh, the group, which they term the
“second ventral group,” is the centre for the posterior belly of digas¬
tric, stylo-hyoid and stylo-glossus muscles, and from a difference
on the two sides they believe the most external cells of this group
to belong to the last named muscle. The anterior belly of the
digastric and the mylo-hyoid they find to be represented in the chief
motor nucleus of the fifth, these being supplied by the mylo-hyoid
branch of the fifth nerve.

These findings in man they have confirmed experimentally in
the dog, and in addition in this animal they have located the
position of the centres for the innervation of the temporal, masseter,
and pterygoid muscles in the motor nucleus of the fifth.

Sutherland Simpson.

RESEARCHES ON THE MINUTE STRUCTURE OF THE NERVE
(212) CELL IN VERTEBRATES. (Ulteriori ricerche sulla intima
Struttura delle Cellule nervose nei Vertebrati.) Rossi, Le
Ntvraxe, April 1, 1906.

This paper is a continuation of the author’s previous work on the
reticulum in the nerve cell. Using Cajal’s and Donaggio’s methods
he can demonstrate, in the spinal nerve cells of vertebrates and in

ABSTRACTS

417

man, two networks, one at the periphery composed of coarse fibrils
intimately connected with each other and preserving in the cell
body the direction of the protoplasmic processes from which they
come; another situated nearer the centre of the cell composed of
very fine fibrils united to form a true network and connected with
the peripheral one. The author’s peripheral network is not
identical with the external reticulum of Golgi.

By using the chloride of gold method he can demonstrate an
endocellular reticular structure resembling that shown by Golgi
with his nitrate of silver method.

This structure is delicate and filamentous, tortuous, and its
elements are of uniform calibre. The filaments anastomose and the
reticulum rather resembles that observed by Apathy in the leech
and by Gemelli in the worm.

The author has not yet come to any conclusion as to the inter¬
pretation to be put upon this appearance. David Orr.

A STUDY OF THE MINUTE STRUCTURE OF THE OLFACTORY
(213) BULB AND CORNU AMMONIS, AS REVEALED BY THE
PSEUDO-VITAL METHOD. With remarks on the plan of
Nervous Structure of Vertebrates in general. John Turner,
Brain , 1906, p. 67.

The author’s method is described by which a differential staining
of the central nervous system is obtained, and extra-cellular neuro¬
fibrils shown. The method is not applicable to cord or spinal
ganglia.

The brain is cut into pieces about 3 mm. thick, and laid on the
flat bottom of an inverted glass capsule, which is placed in a larger
receptacle, surrounded by distilled water, to which has been added
eight drops of formalin. The whole is covered by a glass plate,
and subjected to a temperature of 24°-25° C. for 30 hours. The
pieces are then placed in a stoppered bottle in 15 c.c. of a 1°/ Q solu¬
tion of patent methylene blue (Grubler) containing 12 minima of
lactic acid to each 100 c.c. One or two cubic centimetres of
dioxygen (3% solution of hydrogen peroxide) are added to the stain,
and the bottle kept for five days at the before-mentioned tempera¬
ture. The pieces are then rinsed, and placed in a fresh 10% solu¬
tion of molybdate of ammonium, acidulated with two drops H.CL,
and left for 12 hours; washed under running water all day;
dehydrated in alcohol, passed through chloroform; imbedded in
paraffin, and cut.

The appearances presented by the olfactory bulb of animals
when stained in this manner are then described, and the similarity
2 E

418

ABSTRACTS

of its microscopical features to those of the cerebellum pointed out,
and it is suggested that these organs are homologous.

The structure of the cornu ammonis and fascia dentata are next
described, and an attempt made to homologise their layers with
those of the pallium. It is suggested that the stratum oriens cor*
responds to the fusiform or spindle cell layer; the stratum pyra-
midalum and s. radiatum to the laTge pyramidal layer; the s.
lacunosum (and s. granulosum of dentate fascia) to the second or
small pyramidal layer.

The uniform structure of all grey matter, cortical or central, is
pointed out, and the great importance in the evolution of the
mammal’s brain of the inter-cellular plexus of neuro-fibrils—this
plexus assuming, as one passes from lower to higher forms, an
increasing richness and delicacy.

The features in the development and finer structure of the
vertebrate nervous system which favour the assumption of con¬
tinuity in the neuro-fibrils are briefly discussed, and schemes both
of the reflex arc apparatus, and of the nervous system in general,
on the lines of continuity of neuro-fibrils, are given.

Author’s Abstract.

THE OEANIAL NERVE COMPONENTS OF PETROMYZON.

(214) J. B. Johnston, Morpholog. Jahrbuch., 1906, Bd. 34, S. 149.

This paper deals with the complicated subject of the arrangement
and functions of the cranial nerves of the fishes. Petromyzon
was selected for this study, as it was expected that the condition
in the cyclostomes would throw light on the structure of the
primitive vertebrate head. As only the constitution and dis¬
tribution of the peripheral portions of the nerves are here con¬
sidered, a full abstract of the paper is scarcely possible, but
attention may be drawn to some interesting points in the
conclusions.

Any nerve trunk may be made up of fibres belonging to two
or more different systems. There are five systems represented in
the cranial nerves—general cutaneous, special cutaneous (which
supply the pit organs), visceral sensory, visceral motor, and somatic
motor. The author has succeeded in analysing each nerve into
its separate components. His conclusions are:—

In the arrangement of its cranial nerve components Petromyzon
agrees with other fishes, but has some marked primitive characters.

The facialis contains a general cutaneous component for a
portion of the hyoid segment; these fibres are not represented in
the higher fishes. General cutaneous components are also found
in the glossopharyngeus and vagus, and the dorsal spinal nerves

ABSTRACTS

419

contribute similar components to the epibranchial trunk of the
vagus.

The arrangement of the pit organs and of the rami innervating
them is in general the same as in other fishes, except that those in
the branchial region are innervated by special cutaneous com¬
ponents from the glossopharyngeus and epibranchial trunk.

The visceral sensory component is very small in the facialis,
but large in the glossopharyngeus and vagus.

Large taste organs on the internal surface of the pharynx,
between each pair of gill slits, are innervated by visceral cutaneous
fibres from the glossopharyngeus and from each branchial nerve.

The first two ventral nerves innervate the first three post-otic
myotomes. Only the abducens and the first spinal nerve are
absent. A dorsal nerve is present in each segment beginning
with the nervus ophthalmicus profundus.

A sympathetic trunk and ganglia are present in the head.

Gordon Holmes.

THE CRANIAL AND SPINAL GANGLIA AND THE VISCEBO-
(215) MOTOR ROOTS IN AMPHIOXU8. J. B. Johnston, Bio¬
logical Bulletin , Vol. i, No. 2, July 1905.

Rohde and Hatschek described collections of nerve cells on the
dorsal roots of amphioxus, which they regarded as analogues of
the spinal ganglia of the higher vertebrates.

Retzius, Dogiel, and Heymans and van Stricht, however, failed
to find them, and came to the conclusion that the dorsal roots arise
from intraspinal cells.

The author, by the aid of the intra-vitam methylene blue
injections and by Golgi’s method, has been able to demonstrate
four different classes of cells from which dorsal root fibres take
origin: (1) Bipolar cells, one process of which enters the dorsal
root while the other extends into the opposite half of the cord.
(2) Similar bipolar cells, but their central processes remain on the
same side of the cord. (3) Bipolar cells in the root or trunk of
the nerve, which are probably identical with those described by
Rohde and Hatschek. .(4) Irregular cells, provided with a thick
process which breaks up near the surface of the cord and sends a
fine fibre into the dorsal root. These are probably the fibres
which supply the viscera. Thus only part of the spinal ganglia
are intraspinal.

The greater portion of the dorsal root fibres end in or about
the segment at which they enter; the rest form three tracts in
the dorsal part of the cord, a diffuse mesial tract of fine fibres, a
diffuse lateral tract of coarser fibres, and a compact dorsal tract

420

ABSTRACTS

of coarse fibres. The latter is the earliest representative of the
dorsal columns of the mammalian cord, and it is the first tract to
appear as a definite bundle in the vertebrate nervous system.

The central nervous system of amphioxus resembles in many
particulars that of the lower fishes. Gordon Holmes.

APPLICATION DE LA METHODS DE RAMON T OAJAL (IM-

(216) PRfiGNATION A LARGENT) A L’ANATOMTE PATHO-
LOGIQUE DU OTLXNDRAXE. Thomas, Revue Neurol., March
81, 1906, p. 249.

The author strongly recommends the above method for the study
of the morbid changes in axis-cylinders. The tissues employed
were taken from cases in which there was degeneration of the
pyramidal tracts. The axis-cylinders were greatly reduced in
number, a few only remaining stained black, with or without a
myelin sheath. Some were distorted and swollen, others much
atrophied. Moniliform swellings were common.

David Orb.

ON THE ESTIMATION OF SKULL CAPACITY ON THE CADAVER.

(217) (Ueber die Bestinunung der Sch&delkapazit&t an der Leiche.)

M. Rbichardt (of Wurzburg), Allg. Ztschr. f. Psych., Bd. 62,
H. 6, 6.

Unless the disproportion between the brain and the cavity of the
skull is well marked it is impossible, according to the author, to
say definitely whether the brain is of its normal size, or atrophic
or swollen. The weight itself of the brain is insufficient; the
important question is, whether the brain in relation to the cavity
is too heavy or too light; Reichardt gives in detail his method for
the estimation of skull capacity. C. Macfie Campbell.

PHYSIOLOGY,

THE LOCALISATION OF THE HIGHER PSYCHIC FUNCTIONS,

(218) WITH SPECIAL REFERENCE TO THE PREFRONTAL
LOBE. By Charles K. Mills and T. H. Weisbnburg
(Philadelphia), Joum. Am. Med. Ass., Feb. 1906.

After giving a short history of cerebral localisation from the first
•enunciation of the theories of Gall to the definite localisation of

ABSTRACTS

421

the motor and sensory functions in the middle and posterior part
of the cerebral cortex, the authors go on to point out that Flechsig’s
embryologic researches (1893) demonstrated the existence of
cerebral association areas concerned with intermediate and higher
psychic functions. Since then the subject has evolved in two
directions: (1) in the direction of a more exact delimitation of
areas concerned with primary functions; (2) in the recognition of
sub-divisions of Flechsig’s posterior association area, the concrete
memory field, especially as regards the visual and auditory sub¬
divisions. The authors then give their views as to the higher
psychic functions, and state that they believe that the highest
mental faculties or functions have their material representation in
the prefrontal lobes of the brain, and especially in the left pre¬
frontal lobe. After pointing out the mistake made by Gall and
the old phrenologists that they did not recognise the essential
difference between a fundamental faculty or function and certain
cerebral side attributes or epiphenomena, they state that whilst
the ability to attend, to will, to judge, to compare, to reason, and
to exercise the imagination are fundamental psychic functions,
the exhibition by an individual of pride, of vanity, of friendship, of
combativeness, of piety, etc., is not due to the operation of any
single mental faculty. The fundamental psychic functions are
represented by special centres associated by special tracts, whilst
the latter so-called faculties result from the action of one or several
or many of the regions of the brain. The authors put forward
some of the evidence on which their opinions are based.

A careful study of the brains of notable men has shown the
high development of the prefrontal region, whilst if these are put
alongside of brains of low individual or racial development—as
criminals, imbeciles, negroes, etc.—the difference is marked in the
prefrontal region.

The embryologic researches of Flechsig and the histological
investigations of Campbell show the absence of projection cells and
fibres in this portion of the brain. It is the very last pallium to
appear in the progress of phylogenesis. The authors then point
out that gross and microscopical examination of the brains of
general paretics support in some degree the thesis that the pre¬
frontal portion of the brain is the seat of its highest functions.
They discuss the question as to whether the prefrontal region
is divided into sub-areas or centres, if it be granted that it is the
seat of the highest intellectual functions. After stating how
difficult it must be separating the highest psychic functions from
each other, as they are so interblended in expression, they state
that a clue may be found to their relative position on the higher
psychic region by a consideration of the positions and relations of
the centres of known functions contiguous to the prefrontal lobe.

422

ABSTRACTS

As Broca’s centre is situated just anterior to the centres of articu¬
lation, enunciation, and phonation, the sub-divisions of the so-
called face areas, so speech, being the chief instrument employed in
reasoning, one would expect the psychic centres of ratiocination to
be topographically closely related in position to the centre of
Broca. In the same way, writing, administering to exactness in
thinking, the centres of comparison and judgment may have their
highest development contiguous to the graphic centre. Again,
whilst the motor centres for the limbs and body are in the pre¬
central convolution, the centres for movement of the head and
eyes, especially the latter, are thrust towards and into the pre¬
frontal lobe. Attention and volition have their most marked
physical expression through vision and the position of the head,
and if there are centres for attention and volition, their most
probable situation is in parts contiguous to the centres for move¬
ments of the eyes and head.

The authors then cite the statistics of Phelps, Muller, Schuster,
von Monakow, and others, and point out how they in many respects
support the views here enunciated. Many fallacies, however, are
apt to creep not only into the statistics of mental cases, but also in
the recording of the facts, for many reasons which are discussed by
the authors.

A case of their own observation is recorded in support of their
views. A physician, seventy-one years of age, who till within a
few months of his death carried on his profession, was seen about
two months before death by Dr Mills when his symptoms were all
mental, chiefly exhibited in defects of memory and judgment.
He had no paralytic or sensory symptoms. Shortly afterwards he
was noticed to have a shuffling gait, and later was unable to carry
food to his mouth with any certainty. Then he developed
muscular tremors in his hands and legs like those of paralysis
agitans. He died comatose. His son, a physician, supplied
observations after his death showing that the patient was affected
in his higher psychic functions, in his judgment and powers of
comparison, in his grasp of his work, in his disposition, etc.

At the necropsy the lesion was found to be a left prefrontal
tumour, fleshy in colour, hard in substance, and well defined from
the surrounding tissues. It extended as far back as the knee of
the callosum and the caudatum and anterior extremity of the
internal capsule, but was limited on the surface to the anterior
part of the first, second, and third frontal convolutions. Two
photographs show the extent of the lesion.

William Elder.

ABSTRACTS

423

AN OSMOTIC THEORY OF SLEEP. (TWorie osmotique da

(219) sommeil) E. Devaux, Arch. gin. de mid. April 10, 1906,
p. 903.

Thb author supposes that the cells of the nervous system, parting
in the course of their activity with various molecules of their com¬
position, become more and more greedy for water, which they
attract from the blood. This process continues until there is a
steady flow of serum from the capillaries into the tissues. The
blood in the capillaries thus becomes thick and viscous. The
terminal arterioles become constricted. The flow through the
capillaries becomes very slow. The consequence of this is twofold.
Firstly, a copious nutriment is brought to the cells, which thus are
able to restore their reserves. Secondly, the necessarily diminished
supply of oxygen reduces the sensibility of the cells, hence the
condition—sleep.

The theory is supported by several arguments:—

1. If sleep is due to a flow of plasma from the vessels, the
blood pressure should fall. This is what actually does occur.

2. This fall of pressure is certainly not due to a lowering of
the peripheral resistance, for in that case the pulse-rate would rise,
whereas it falls.

3. If a smaller quantity of blood circulates during sleep, we
should expect to find a diminished secretion of urine. This is just
what does occur.

4. If there is less fluid in the vessels during sleep, there must
be more in the tissues. This seems to be indicated by the tendency
to oedema, as expressed, for instance, in the saying, “ His eyes are
still heavy with sleep.” The duration of imprints made upon the
skin by the pressure of a definite weight for a definite time is
longer when the trial is made during sleep.

5. During sleep, breathing is shallower and the flow of blood
through the lungs is slowed. One would, therefore, naturally
expect a diminished absorption of oxygen. As a matter of fact,
the oxygen absorption is much increased—a fact which may be
explained on the theory that the blood, deprived of so much of its
serum, has become relatively very rich in corpuscles.

6. Lastly, Dastre and Loge have shown, and their observation

has been confirmed by Langlois, that during chloroform narcosis,
massive injections of artificial serum isotonic with the blood serum
are not excreted by the kidneys or other organs of elimination, but
accumulate in the tissues—a striking confirmation of the theory
that during sleep there is a marked osmotic current from the blood
towards the tissues. W. B. Drummond.

424

ABSTRACTS

THE CONDUCTING PATHS FOR PAINFUL AND THERMAL
(220) IMPRESSIONS IN THE SPINAL CORD. (Lea voies de la

sensibility dolorifiqne et csloriflqne dans la moelle.) E. Bertho-

let, Nevraxe, Vol. vii., F. 3, 1906, p. 283.

Bebtholet begins bis paper with an historic review of the previous
work on this subject. All the authors quoted are practically
unanimous in regarding the grey matter of the spinal cord as the
conducting path for the sensations of pain and temperature. The
second part of the paper is devoted to a detailed account of the
experimental work which has led Bertholet to take a different
view to that of former observers. The experiments were performed
on cats and consisted in the production of various hemisections,
three-quarter sections (destroying the grey matter on both sides),
double hemisections, double quarter sections (destroying both
lateral columns), and finally in the destruction of the central grey
matter of the cord itself. The results obtained, briefly summarised,
are as follows: single hemisection did not in any way interfere
with the conduction of heat and pain sense from either side
posterior to the level of the lesion; similarly three-quarter section
caused no interruption of the passage of these sensations; on the
other hand, double hemisection resulted in complete and permanent
loss of heat and pain sense ; double quarter section caused a tem¬
porary loss of painful sensation (this appears to have been a single
experiment only); destruction of the central grey matter was
followed by complete retention of pain sense on both sides.
Bertholet, therefore, concludes that the grey matter is not the
conducting path for painful or thermal impressions, but that it only
serves as a bridge connecting the fibres of the posterior nerve roots
to those of the lateral columns of the cord in which the conducting
strands lie; he believes these to be contained in the tract of Gowers.

E. Hewat Fraser.

ON THE QUESTION OP EXHAUSTION FROM EXCESS OF
(221) FUNCTION. (Beitrag zur Lehre vom Aufbrauch durch Hyper-
funktion.) Lilienstein, Munch, med. Wochenschrift, April 17,
1906, p. 748.

The object of the paper is to supply three instances of the
incidence of disease falling on the part or parts of the body that
had been in a state of functional over-activity.

A girl employed in a typefoundry suffered from plumbism, and
the condition affected not so much the extensors of the wrist and
fingers as the muscles supplied by the ulnar nerve. It was dis-

ABSTRACTS

425

covered that the girl's occupation entailed a constant quick devia¬
tion of the wrist to the ulnar side when she was filing type.

Another girl employed as a telephonist developed neuritis in
the right arm, seemingly attributable solely to continually holding
a heavy receiver in the right hand. The adoption of another
apparatus which did not necessitate the employment of the right
hand was followed by a disappearance of the symptoms.

The third case is not quite so clear, weakness in an arm that
had long since been fractured being conceivably attributable, not
merely to occupation, but also to the consequences of previous
syphilitic infection.

The author remarks on the importance of careful supervision
of all cases of tabes practising Frenkel’s exercises, inasmuch as
some, so far from improving, actually deteriorate when undergoing
the treatment. These are instances of exhaustion from excess of
function. S. A K. Wilson.

PATHOLOGY.

RESEARCHES ON REGENERATION IN PERIPHERAL NERVES.

(222) (Recherches but la R6g6nerescence des Nerfs PdripMriques.)

Marinbsco and Minea, Rev. Neurol ., avril 15, 1906, p. 301.

Bt the employment of Cajal’s new staining method, the writers
had previously come to admit the existence of so-called “ autogenic”
regeneration in peripheral nerves. They did not, however, deny
that the nerve-cell exercises some trophic influence on the axon.
The evidence in favour of autogenic regeneration they classified
under two headings: (1) the presence of newly-formed fibres
within the cell-bodies and in the protoplasmic processes of the
proliferated neurilemma nuclei; (2) the existence of newly-formed
fibres in the peripheral segment of nerves torn from the cord,
together with the anterior roots and the intervertebral ganglia.
The neurilemma nuclei play an important part in the mechanism
of regeneration, not only in the peripheral but in the central
segment.

Cajal, however, in a recent paper, defends the classic Wallerian
theory of regeneration. He describes how in young animals young
axis-cylinders grow out from the central segment, about the
beginning of the second week. These young fibres, devoid of
myelin sheaths, push across the cicatrix and penetrate into the
peripheral segment, in spite of all obstacles which may be inter¬
posed. In immediate]reunion the neurotisation of the peripheral
segment occurs rapidly: where there are intervening obstacles, the
process may require three or four months, or more. The fibres

426

ABSTRACTS

growing from the central end are mostly continuations of the old
fibres, and the increased number of new fibres is due to Y-shaped
division of the old, chiefly in the substance of the cicatrix. Cajal
denies the neuroblastic function of the neurilemma nuclei. He
describes the growing extremity of the young fibre as possessing a
“ terminal ball,” which, if it becomes impacted in one of the tissue-
interstices, may become enormously swollen and enlarged. Cajal
attributes three functions to the proliferated neurilemma nuclei:
firstly, a phagocytic function removing the debris of the old
degenerated fibres; secondly, that of producing guiding or orienting
sheaths, whose function is to secrete and set free a chemiotaxic
substance capable of acting on stray young axones; and, thirdly,
the function of maintaining the nutrition of the young nerve fibres
when they arrive.

Marinesco and Minea have pursued their study of the process
of regeneration, chiefly by experiments on puppies and on young
rabbits. In the main, their observations are corroborative of those
of Cajal above described, but they draw somewhat different
conclusions from the facts.

The existence of new interstitial nerve-fibres and their Y-shaped
branchings, together with the frequency of the terminal balls, most
of which are directed from the centre towards the periphery,
have caused the authors to abandon their original views as to
autogenic regeneration. They now believe that the new fibres in
the peripheral segment are produced by outgrowth and branching
of the fibres in the central stump. Nevertheless, they still
uphold the immense importance of the part played by the neuri¬
lemma nuclei, and maintain that regeneration does not occur
unless in the presence of proliferation of these nuclei, whose
cell-colonies constitute, as it were, the advance-guard of the
regenerative process. Even when the central nerve-cell is
atrophied, by separation of the central segment from the nerve¬
cell, new nerve-fibres can still grow out from the central segment
to the peripheral To Cajal, however, belongs the credit of having
demonstrated the existence of nervous plexuses, microscopically
invisible, which permit the transmission of new fibres from the
central into the peripheral segment. This plexus, they say, has
escaped the notice of the upholders of the autogenic regeneration
theory. If it be admitted that the new nerve-fibres are not bom
spontaneously within the protoplasm of the neurilemma-cells,
Cajal’s next point must, they believe, be conceded, that the fibres
are attracted by the cells, thanks to some chemiotaxic substance
elaborated by them, The authors, however, disagree with Cajal’s
view as to the phagocytic function of the neurilemma-cells, and
believe that phagocytosis is performed by the ordinary phagocytes
of the tissues. Purves Stewart.

ABSTRACTS

427

CEREBRAL SCLEROSIS. CAMPBELL, Brain, Parts 3-4, 1905.

(223)

The author in this paper first discusses the origin of the several
varieties of neuroglial elements in the brain, and the origin of the
cells which have a phagocytic function in cerebral lesions. He
then goes on to consider all the known forms of sclerosis which
occur in the brain.

The first class includes the somewhat rare cases of what is
called “ tuberose sclerosis.” This condition is most frequently met
with in idiots and imbeciles. In most cases there is a history of
epilepsy, and it is almost always accompanied by the rare skin
affection, adenoma sebaceum. In the kidneys, too, it is usual to
find a number of small, hard, white tumours, which are thought to
be endothelial neoplasms.

In the case described by the author the small tumours lay in
the cortex cerebri and the adjacent white matter. They consisted
of a dense network of proliferated neuroglial fibres in which a few
pyramidal and fusiform nerve cells and old neuroglial nuclei were
scattered. In the peripheral portions of these masses some peculiar
tubular glands, lined with columnar cells, were found.

Other small white tumours, probably of endothelial origin, were
seen in close connection with the venules on the ventricular
surface of the basal ganglia.

The origin of these tumours must be attributed to some develop¬
mental anomaly of the central nervous system, which was the
result of some process which became active about the seventh
month of intrauterine life.

This assumption that these tumours are the outcome of some
evolutionary aberration or disturbance, which results in structural
hyperplasia and heterotopia of the grey matter, supports the view
that cerebral sclerosis is almost always a secondary condition.

The term, evolutionary aberration, used in connection with this
condition of tubular sclerosis, may be applied to several other
conditions described by the author. These conditions include:—

1. Hypertrophy of the cerebrum, in which the brain is
uniformly hypertrophied and indurated while the microscopic
architecture is normal.

2. Hemisclerosis, in which there is a diminution in size,
affecting one hemisphere alone, equally distributed, associated
with sclerosis, but unaccompanied by disarrangement of the gyral
or sulcal architecture. On the whole, the nerve cells preserved
their columnar arrangement and their erect attitude, but the cortex
was reduced in depth by quite two-fifths.

3. Lobar sclerosis and microgyria, in which various lobes may
be affected on both sides of the brain.

428

ABSTRACTS

4. Giant cell sclerosis. In this condition there is a heterotopic
anomaly of the nervous system.

The next class includes those cases of cerebral arterio-sclerosis
and colloid sclerosis which are produced by vascular changes.

Lastly, brief reference is made to several of the commoner
scleroses, viz. those met with in general paralysis of the insane,
in senility, in the cornu ammonis in epilepsy, after softenings, in
microgyria, in cerebral syphilis, and in disseminated sclerosis.

R. G. Rows.

HETEROTOPIA OF THE CEREBRAL CORTICAL SUBSTANCE

(224) (Della eterotopia delle sostanxa corticate cerebrate.) G. B.

Pellizzi, Ann. di Freniai., Yol. xv., Fasc. 4.

This is an enquiry into the relation which exists between idiocy
and epilepsy, and heterotopia and other malformations of the
cerebral cortex.

In the case quoted by the author there was a history of rest¬
lessness and irritability from birth, and at the age of four years
definite epileptic attacks began; finally the patient died after a
series of fits.

At the autopsy, the right hemisphere was larger than the left,
especially in the posterior portion, and the convolutions were less
distinct. The right ventricle was much dilated, especially the
occipital horn. In the lower wall of this horn there was a conical
depression which extended down to the pia mater over the occipital
lobe.

The fusiform convolution was diminished in size, and all the
surrounding convolutions were in a condition of microgyria by
sub-division. The pia mater here was thickened and adherent.
A vertical section through the brain exhibited the conditions of
porencephaly, heterotopia of the grey matter, and microgyria by
sub-division. Microscopically, the superficial cortex was very thin
and often interrupted, and it was poor in nervous elements, which
were always small and generally pyramidal in shape.

The heterotopic masses were surrounded by large bundles of
myelinated fibres with normal axis-cylinders; small fibres were
present within them. The arrangement of the nerve cells was
quite irregular, and they were less numerous than normal.

Most of the cells here were globose, and only a few were
pyramidal. Only a few giant cells were seen, and they were badly
formed.

The presence of pyramidal cells in all the heterotopic masses
proved their common cortical origin.

The neuroglia cells were more numerous than normal.

ABSTRACTS

429

Heterotopia of the cerebral grey matter may affect the cortex
or the basal ganglia. In the latter case there may be pedunculated
small tumours on the floor of the lateral ventricles surrounded by
a dense neuroglial layer which is in connection with the sub¬
ependymal neuroglia by the peduncle. This form is met with
chiefly in the brains of idiots, and is associated with disseminated
hypertrophic sclerosis.

It may be present also in the form of small tumours under the
ependyma, and surrounded by it. This condition is found in adults
and old people, and sometimes in general paralytics.

These examples are probably anomalies of development of the
basal ganglia rather than true heterotopias. They are not in any
way connected with idiocy.

Heterotopia of the cortex, however, is in more direct relation
with idiocy, and is often associated with grave forms of atrophic
sclerosis, microgyria from destruction, and porencephaly, and it
may be with microcephaly.

But besides the heterotopias, which can be seen macroscopically,
there may exist others, consisting of a few cells, which can only be
recognised by the aid of the microscope.

In these cases of cortical heterotopia the cells are generally
small and spherical; few are pyramidal. The larger cells are
undergoing disintegration, and the smaller are in a state of
atrophy.

All these forms are the result of some inflammatory process
acting on the brain during embryonal life, before the cortex has
completely separated from the white matter, i.e. before the fifth
month of development.

With regard to the clinical aspect of these cases, it may be said
that idiocy is always present, and epilepsy in the vast majority of
instances.

In the opinion of the author, the epilepsy is due to the dis¬
turbance of the cerebral cortex, a disturbance which may not
consist of macroscopic alterations of the seat of the grey substance,
but rather of histological anomalies of form and arrangement of
the nervous elements, anomalies by which the normal relations
between these elements is completely altered.

R. G. Rows.

SPINAL CORD DEGENERATION IN A OASE OF ACROMEGALY,
(225) WITH TUMOUR OF THE PITUITARY REGION. Albert
M. Barrett, Amer. Joum. of the Med. Sd. t Feb. 1906.

The case reported is that df a woman aged 49, who clinically
presented symptoms of acromegaly with considerable mental

430

ABSTRACTS

change. Under treatment with thyroid considerable improvement
took place, and she recovered so far as to do simple work for about
18 months. She then began to fail, became stupid and drowsy,
and complained of pains in the legs and arms. The knee-jerks,
which were formerly equal and brisk, became lost, and she
gradually passed into a comatose condition and died. At the
autopsy a large tumour was found in the region of the chiasma,
filling up the sella turcica. The tumour was firmly adherent to
the adjacent dura mater, and on histological examination proved
to be a sarcoma.

In the cervical region of the spinal cord, degeneration of the
posterior column was demonstrated both by the Weigert-Pal and
Marchi method.

This degeneration does not correspond to a root degeneration,
but, as the author points out, is similar to that met with in cases
of cachexia and anaemia. The possibility of the degeneration being
associated with the presence of other tumours in the brain is dis¬
cussed, but the author concludes that the form of degeneration
here met with is not that which occurs in cases of cerebral tumour.
The author mentions four other cases of acromegaly in which
degeneration of the posterior column has been recorded.

We quite agree with the careful wording of the title of the
paper, and should be inclined to regard the spinal degeneration as
due to the cachectic condition of the patient and not dependent on
either the acromegaly or the tumour of the pituitary region.

Frederick E. Batten.

CLINICAL NEUROLOOT.

THE DISTRIBUTION AND RECOVERY OF PERIPHERAL NERVES.

(226) The Erasmus Wilson Lectures. James Sherren, Lancet, March
17, 24, and 31, 1906.

In these lectures the distribution and recovery of peripheral nerves
is studied from the clinical standpoint.

The “ exclusive ” supply of the nerve under consideration, that
is, the area to which it alone sends fibres, is first described from
instances of section verified by operation. This is compared with
the “full” supply, obtained from cases in which the nerves
surrounding the area supplied by the nerve whose distribution we
are studying have been divided (method of residual sensibility),
and also as the result of stimulation of the trunk of the nerve.

After division of a mixed nerve, such as the median at the
wrist, there may be no portion of the affected territory over
which the patient cannot appreciate and localise those stimuli

ABSTRACTS

431

commonly called tactile. The stimuli usually employed, a touch
with the finger, a piece of paper or a pencil, appeal to this form of
sensibility to which the name of deep touch was given. The
sharpness of the point of a needle, and all degrees of temperature,
are unappreciated within an area which varies in each patient;
this is spoken of as loss of sensibility to prick. Surrounding this
territory is an area within which the patient is unable to
appreciate light touches with cotton wool and temperatures
between about 22° and 40° C., and fails to discriminate the points
of a pair of compasses when separated to many times the distance
necessary over the corresponding portion of the sound hand.
Failure to appreciate these stimuli is grouped under the term loss
of sensibility to light touch. The loss of sensibility resulting from
division of each nerve is examined under these headings. The
divergent opinions given upon the loss of sensibility resulting from
division of the various nerves is commented upon and explained.
An examination is made of the muscles supplied by the nerve
under examination, and attention is drawn to the mistakes which
so commonly arise from failure to appreciate the extent to which
the movements usually performed by the paralysed muscles can
be produced by others (“ supplementary motility ”).

On these lines, the median, ulnar, musculo-spiral and its
branches, the external and internal cutaneous nerves of the fore¬
arm, the brachial plexus and the roots composing it, the sciatic,
external popliteal, and posterior tibial nerves are studied.

The restoration of sensibility and motility after primary and
secondary suture is next spoken of. It is shown that sensory
recovery follows three well-defined stages. Sensibility to prick is
first restored, the area of loss of sensibility to light touch remaining
as extensive and well-defined as immediately after section of the
nerve. After an interval which varies with the distance from the
periphery and the nerve divided, light touch gradually begins to
be restored, and at the end of the second stage the part is every¬
where sensitive to light touch and all degrees of temperature.
The third stage consists in the perfecting of sensibility which has
been restored. This is tested by the gradual restoration of the
power of appreciating two points.

Muscular recovery follows a definite march, those muscles
nearest the seat of the lesion first regaining voluntary power and
electrical excitability. It is pointed out that in all the cases
watched by the author, irritability to the interrupted current was
found to be present on the date at which return of voluntary
power was first noticed. This is contrary to the usually accepted
teaching.

The evidence on which the doctrine of primary union rested is
examined, and the conclusion drawn that this method of recovery

432

ABSTRACTS

is impossible, and that mistakes have arisen owing to the want of
appreciation of the distribution of the nerves subserving deep
touch and sensibility to prick, and of failure to examine the action
and electrical reactions of the muscles supplied by the injured
nerve, movements such as are usually performed by the muscles
supplied by that nerve being taken as evidence of its restoration.
After primary suture, complete recovery—meaning perfect appre¬
ciation of all sensory stimuli, and the return of voluntary power
and electrical excitability to the affected muscles—is possible, and
recovery will ensue in all cases carefully treated, provided that
suppuration is avoided. No instance of rapid restoration of sen¬
sibility after secondary suture occurred in the fourteen cases
watched by the author, the earliest instance being thirty days after
suture. After secondary suture, recovery, both motor and sensory,
occupies a longer time than after primary, and complete sensory
recovery is unlikely.

The bearing of the clinical phenomena of recovery upon the
theories of regeneration is briefly discussed, and the opinion
expressed that the evidence, so far as it is positive, is in favour of
the formation of the new nerve fibres in situ , and that, even when
it is negative, it discloses nothing against this theory. But union
with the central nervous system is necessary before the develop¬
ment of new axis cylinders takes place. The evidence goes to
show that regeneration is “ peripheral,” but not “ autogenetic.”

Incomplete division is next defined and classified. It is shown,
in opposition to the usual teaching, that a temporary interruption
of continuity of a mixed nerve affects sensation earlier than motion,
and its effect upon sensation is often more enduring. It is only in
instances of injury to nerves, division of which produces no
loss of sensibility, that the effect of the injury appears to fall
wholly on the motor fibres.

Electrical reactions are described, which are considered by the
author to be typical of incomplete division, as met with by the
surgeon. The muscles do not react to the interrupted current, but
react in a striking manner to the constant. There is increased
irritability, the muscles react to a smaller current than those of the
sound side, the contraction, instead of being the long drawn-out,
wave-like contraction seen when the reaction of degeneration is
present, is brisk, though not the sharp twitch given by sound
muscles.

During recovery all forms of sensibility return together from
above downwards, this being in striking contrast to the manner of
sensory recovery seen after complete section of a nerve.

In conclusion, the author maintains that the peculiarities of
sensory loss mentioned in the lectures, and the method of recovery,
are explained by the theory brought forward in conjunction with

ABSTRACTS

433

Dr Head. 1 In this communication the view was expressed that
the afferent fibres in a peripheral nerve could be divided into three
groups—those subserving deep sensibility, the protopathic, and the
epicritic.

The distribution of the various nerves is illustrated, and tables
given of the recovery after secondary suture, and of cases of
incomplete division. Author’s Abstract.

ON TABES DOB8ALI8. The Lumleian Lectures. David Ferrier,
(227) Brit. Med. Joum., March 31, April 7 and 14.

The aim of these lectures is “ to present . . . the evolution of our
knowledge of tabes, its nature and causes, and to indicate the
problems as yet unsolved and on which we need further light.”

After a historical sketch, clinical and pathological, the relation
of the posterior roots to the posterior columns of the spinal cord is
described in some detail, and a diagram is given showing the
constitution of the posterior columns in relation to tabes. The
degenerations, characteristic of tabes in its different stages, are
considered, emphasis being laid on the fact that the medium fibres
of the posterior roots, i.e. the reflex collaterals and the fibres to
Clarke’s column, suffer first and most. Although the tabetic
degeneration would appear to be selective in character, Ferrier
does not think there is satisfactory proof that it coincides precisely
with any of the foetal systems described by Flechsig and others.

According to the most modern research, the essential character
of the tabetic process is a progressive dystrophy or demyelinisation
and ultimate destruction of the nerve fibres, with secondary pro¬
liferation of the neuroglia.

Pathogenesis. —Ferrier passes in review and criticises in con¬
siderable detail the different views regarding the pathogenesis of
tabes: (1) The primary ganglionic origin; (2) the peripheral origin
(v. Leyden and Goldscheider); and (3) the meningitic origin
(Nageotte, Redlich and Obersteiner). His conclusion with regard
to these theories is that “ there is not one which is not open to
several more or less serious objections.” The negative result of
antispecific treatment is against any theory of syphilitic meningitis,
general or special (cf. Marie and Guillain’s theory of syphilitic
affection of the posterior lymphatics); and the lymphocytosis of
the cerebro-spinal fluid cannot be adduced as a conclusive argument
in favour of the meningitis, as the lymphocytosis has been found
in other affections in which meningitis plays no part, e.g. Landry’s
paralysis, herpes zoster, the subacute combined degeneration of
pernicious ansemia. Ferrier himself “is inclined to adopt the

1 Brain, Sommer Number, 1906.

2 F

434

ABSTRACTS

hypothesis of Thomas and Hauser that the essential lesion of tabes
is a dystrophy, similar to that induced by certain toxic agents,
affecting the sensory protoneurone as a whole, and manifesting
itself in degeneration both of the peripheral and central termina¬
tions, of which the intramedullary are the more vulnerable, and
are usually the earliest to exhibit anatomical change. The process,
however, is not confined to the spinal protoneurone, but may
affect, among others, the optic, the sympathetic, and certain motor
neurones.”

“The most probable pathogeny of the tabetic degeneration is
that it is the result of a toxin generated or conditioned by the
syphilitic virus.” Arguments, based on the statistics of Erb and
Hirschl and on other facts, are quoted, which leave in Ferrier’s
opinion “ little room for doubt that tabes and general paralysis are
in all cases syphilitic, and that tabes per se is as much a proof of
syphilis as a gumma of the skin.” The relative infrequency of
tabes among those who have suffered from syphilis is no argument
against the syphilitic origin of tabes, but it suggests that, in addition
to syphilis, there may be some predisposing or other co-operating
causes. Among these, of chief importance is placed fatigue or
over-exertion ; the influence of sexual excess and cold has been
greatly over-estimated; the same is true of neuropathic inherit¬
ance, with tendency to premature decay of nerve elements; in
certain instances—perhaps five per cent—tabetic symptoms have
first made themselves manifest after injuries, but there is no proof
of the efficacy of trauma as a cause of tabes independently of
antecedent syphilitic affection.

In Ferrier’s opinion, then, tabes is most probably due to a
toxin of syphilitic origin. The reason for the special vulnerability
of the sensory protoneurones to this toxin is “ a question for the
future”; it may be found in evolutional or developmental causes,
in peculiarities of the lymph circulation in the posterior roots and
posterior columns, in an elective affinity of certain poisons for
special structures, in the fact that toxins originating in the peri¬
phery ascend to the spinal cord more readily by the posterior than
by the anterior roots (ffomen, Orr and Rows).

It is probable, in Ferrier’s opinion, that the absence of the
neurilemma cells is the cause of the greater proclivity to degenera¬
tion of the intra-medullary terminals than of the other branches of
the sensory protoneurone.

Degenerations, very similar to those of tabes, have been shown
to occur from various poisons ( ef. ergotism, pellagra, lathyrism;
certain inorganic poisons; the toxins of diphtheria, beri-beri, etc.;
certain cachectic states of the system, e.g. diabetes, pernicious
anaemia). The resemblance between these degenerations and those
of tabes “strongly supports” the hypothesis that the tabetic

ABSTRACTS

435

degeneration is due to the action of a toxin of syphilitic origin.
While this is “the most probable pathogeny of tabes,” it is at
present “a pure hypothesis,” and one which has to surmount
many difficulties, notably two: (1) The long interval between the
date of syphilitic infection and the development of tabetic
symptoms. In this connection, Ferrier records the interesting
observation, based on examination of a series of cases, that there
is no lymphocytosis of the cerebro-spinal fluid in the secondary or
tertiary stage of syphilis, i.e. before the actual commencement of
the tabetic process. (2) The fact that the tabetic process, once
begun, is essentially of a progressive character, and postulates a
more or less continuous generation of the poison. To meet these
difficulties, Ferrier suggests that “ in the absence of any living
organism capable of generating the tabetic toxin ’’—and he gives
reasons for concluding that the diphtheroid-bacillary origin of the
tabetic poison (Ford-Robertson) is “ at least not proven ”—“ it may
be that the syphilitic virus under certain conditions so affects
some viscus or gland that in time it develops, and continues to
elaborate, some toxic internal secretion which exerts its noxious
influence ou the nervous system.”

The third lecture deals with the physiological pathology of ataxy
and the tabetic pupil:—

Ataxy.— “ If it is possible to give a satisfactory explanation
of tabetic ataxy by the demonstrable lesion of the centripetal
paths to the spinal, sub-cortical (mesencephalic and cerebellar)
and cortical centres, it would seem unnecessary, with Erb and
others, to ascribe the ataxy to lesion of some hypothetical centri¬
fugal tracts of motor co-ordination.”

Ataxic symptoms, indistinguishable from those of true tabes,
may result from lesion of the sensory nerves alone (c/. pseudo-
tabes from alcohol, diphtheria, etc.), and experimental section of
the posterior roots causes very similar symptoms.

There is no constant relation between the ataxy of tabes and
the extent to which cutaneous sensibility, epicritic or protopathic,
is affected—this form of sensibility may even not be found affected
at all. “ Deep sensibility ” (from muscles, tendons, joints), is more
important: from the result of examination of fifty cases of tabes,
however, Ferrier questions the accuracy of Frenkel’s contention
that, in every case of ataxy, there is a more or less extensive
impairment of the sense of passive movements of the joints.
Sense of vibration of a tuning-fork, frequently impaired or lost
in tabes, is probably dependent principally on the deep sensibility.
Golla has shown that the sense of tonic or tetanic muscular con¬
traction induced by the faradic current is greatly diminished or
totally lost in the ataxic limb, while the sense of minimal or rapid
contraction may be well preserved. That “total interruption of

436

ABSTRACTS

the spinal paths of conscious sensation does not of itself cause
ataxy proper ” is shown by a case of syringomyelia recorded by
Schiippel: the phenomena of functional cerebral anaesthesia and
of sleep-walking point in the same direction.

The general result of this analysis is “that tabetic ataxy
depends on impairment or loss of centripetal impressions of all
kinds, conscious as well as unconscious, and, of these, those from
the deeper structures (muscles, tendons, joints) are more important
than the superficial; and if one may single out one class as more
essential than the others of the complex, I would specify these to
the spinal, sub-cortical, and cerebellar centres.” Kinaesthetic im¬
pressions to these centres are necessary to secure the due co-opera¬
tion of the synergic, antagonistic, and collateral muscles with the
prime movers in any given movement: the constitution and
connections of the spinal and sub-cortical centres provide for
the combined action of these various muscles in our acts, simple
and co-ordinated—“the mechanism is not formed by conscious
activity, it already exists.” Loss of the centripetal impressions,
arising chiefly in the muscles themselves and acting on the spinal
and sub-cortical (cerebellar) centres through the reflex collaterals
of the posterior roots to the anterior cornua and through the fibres
to Clarke’s columns, is the basis of the muscular hypotonia, which
is so largely responsible for many features of tabetic ataxy, e.g., the
attitude, the brusque over-action of the prime movera of the limbs
as in walking, etc. Throughout all the acts of a tabetic with ataxy,
the same purpose runs—“ the attempt, by conscious effort, to make
up for the failure of a self-adjusting mechanism which, under normal
conditions, works better without conscious interference.”

The Tabetic Pupil. —“ A permanent isolated reflex iridoplegia
occurs only in tabes, general paralysis, and as a consequence of
congenital or acquired syphilis.” The pathology of the Argyll-
Robertson pupil is a subject of great difficulty. A review is
given of our knowledge respecting the reflex pupillary arc and
of the various theories which place the lesion underlying the
Argyll-Robertson pupil in the region of the corpora quadrigemina
(e.g., Meynert’s fasciculus retroflexus), in the central grey matter
of the aqueduct of Sylvius, and in the cervical region of the cord
or spinal end of the medulla. Ferrier concludes from this review
that “ though theoretically reflex iridoplegia may be explained by
interruption of certain hypothetical centripetal paths of the light
reflex, no actual pathological changes have as yet been demon¬
strated in the reflex iridoplegia of tabes.”

The investigations of Marina, showing degeneration of the
ciliary ganglia and short ciliary nerves in all cases of tabes and
general paralysis with Argyll-Robertson pupil, are “ of the utmost
importance in reference to the pathology of the tabetic pupil.”

ABSTRACTS

437

The researches of Piltz are of great significance in the same
relation; by irritation of the ciliary nerves experimentally, Piltz
produced irregularities in the outline of the pupil and in its
position very similar to those exhibited in tabes and general
paralysis. The atrophy of the iris, too, as shown by its thin
inner margin, is “ undoubtedly due to affection of the short ciliary
nerves.” In Ferrier’s opinion “ it is difficult to conceive how such
irregularities of the pupils could be produced by any central lesion;
and seeing that they so often precede the reflex iridoplegia of
tabes, the presumption is strong that both phenomena have
essentially the same anatomical basis, namely, degeneration of
the ciliary ganglia and short ciliary nerves.” The loss of dilata¬
tion to sensory or psycho-sensory stimulation may be produced
in the same way. The retention of contraction on accommodation
may be explained by the assumption—in which “ there is nothing
improbable ”—that “ in tabes the ciliary ganglion and ciliary nerves
are so affected that, though they cannot transmit the reflex impulse
of light to the sphincter pupillae, they can readily allow the more
powerful stimulus associated with accommodation to pass through.”
Finally, “ it is probable that the myosis ... is due to degenerative
changes of an irritative character which are going on in the
sphincter.”

Space forbids a more exhaustive review of the luminous details
of criticism which specially mark these lectures: many important
points—not directly arising from the aim of the lectures—are
touched upon, e.g., the importance of thorough treatment of the
primary syphilis and the therapeutic possibilities of the future.
Regarding nomenclature, Ferrier would like—but for their con¬
secration by custom—to discard the terms dorsalis and tabetic,
in favour of tabes simply and tabid; while, in view of “the
essential pathological identity of tabes and general paralysis,” it
“ would conduce to a truer conception of the pathology of these
affections” if we were to call them spinal tabes, cerebral tabes,
or cerebro-spinal tabes, according as the disease affects the spinal
cord, the brain, or both conjointly.

An extensive bibliography is appended.

A. W. Mackintosh.

THE DYSTROPHY OF TABES AND THE PROBLEM OF TROPHIC
(228) NERVES. A Lecture by Sir W. R. Gowers. Brit. Med. Jowm.,
June 2, 1906.

The features and distribution of the arthropathy of tabes were
described and illustrated by examples, and the cutaneous and
other nutritional disturbances were referred to. The term “ tabetic

438

ABSTRACTS

dystrophy ” has been employed, and is a convenient general desig¬
nation to include them all. The risk that the real nature of tabetic
arthropathy may be overlooked is definite, because it is rare even in
tabes, which itself is an uncommon disease, absolutely considered.
Many practitioners meet with only two or three cases of tabes
throughout life, and arthropathy does not occur in more than
10 per cent Following an injury, as it often does, the arthritis
alone may attract attention, but the absence or slightness of pain
should always arouse suspicion. The back-bent knee (genu
recurvatum) must be distinguished from arthropathy. It depends
only on the yielding of the ligaments through the undue strain
occasioned by the unequal and changing support given by the
muscles, whose tendons afford a large amount of support to the
joint. The occurrence of similar dystrophies in congenital defects
of development of the spinal cord was illustrated by a remarkable
case in which they were associated with analgesia in one leg, which
had necessitated amputation of all the toes. The nature of the
case was shown by a huge scar in the lumbar region, where a
long-haired mole had been removed in early life.

Trophic nerves and centres have been widely assumed to
explain such disorders of nutrition. But no direct evidence of
them, or of their loss, has ever been discerned. Is their assump¬
tion necessary ? May not the changes depend on disease of the
nerves of ordinary function ? Trophic nerves were once invoked
to explain muscular atrophy, but this is now known to depend on
disease of the motor nerves and cells. Division of a motor nerve
causes very slow changes in the muscle, with long preservation of
its excitability to voltaism. An artificial irritant, exciting inflam¬
mation of the nerve, causes an irritant degeneration with rapid
granular degeneration of the muscle-fibre, and in a week or two
even voltaic excitability becomes extinct, never to be regained.
This is seen also in some cases of intense polio-myelitis. The
character of the inflammation of the nerve is so invasive as to
spread to the muscular protoplasm, although the nerve-ending is
not in actual continuity with the muscle substance. Thus we have
evidence of an inherent vitality of the muscle, and also that it may
be destroyed by extension to it of an acute change in the nerve.

All other structures (besides the viscera) are under the nutri¬
tional influence of the sensory nerve fibres. The cornea teaches
the same lesson as the muscle. The vitality of the fibres depends
on the ganglion of the fifth. A lesion behind the ganglion seldom
affects the cornea—only when intensely irritant and spreading.
When the ganglion is removed for neuralgia, with strict antiseptic
precautions, the degeneration of the fibres is simple, not irritant.
Yet, during the first fortnight, keratitis occurs with great readiness.
The cornea has lost sensibility, and particles of dust falling on it

ABSTRACTS

439

do not excite movement of the lids to remove them. But if the
lids are fixed together, the cornea is preserved from irritation, and
does not become inflamed. After a fortnight it may be exposed
with impunity, though still insensitive. The nutritional instability
exists only during the changing state of the nerve, and afterwards
the inherent vitality of the tissue maintains its integrity. So in
other tissues, affections of the nerves, as inflammation, renders the
nutrition of the tissues readily disturbed. In some forms of
myelitis an irritant inflammation seems to pass down the posterior
roots, to involve the ganglia and descend the nerves, rendering it
most difficult to preserve intact the nutrition of the skin. Thus
the vital state of the nerves seems to be communicated to the
related tissues, and to pervert their inherent vitality and nutritional
power. The strange perverted nutrition of tabes may be thus due
to the altered vitality of the nerves, which is a certain fact, without
assuming the existence of wholly hypothetical trophic nerves.
Under the influence of the altered state of the nerves (shown by
the defective sensation), a morbid tissue process, however excited,
is perverted, and the perversion persists until ultimately a vast
degree of disturbance is attained. The affection of the joints usually
begins as slight inflammation, often of traumatic origin, and might
subside did not the absence of pain entail the absence of the needful
rest. The altered process goes on in morbid form, until extreme
changes result from a morbid tendency which may be in itself trifling.
So with the cutaneous ulcerations. They will heal if rest is insisted
on in the early stage. The inherent vitality of the tissues is suf¬
ficient, if the deranging nerve state is not supplemented by harmful
physical influences.

It was also urged that the imperfect growth of the bones in
infantile palsies, whether spinal or cerebral, occurs in disease of
such different seat as to be irreconcilable with the hypothesis
of trophic nerves. It is proportioned to the early age at which
the affection occurs, and may be a simple effect of the defective
approximation of the epiphyses due to the palsy and other secondary
local consequences of disease. Author’s Abstract.

PARALYSIS OF THE EXTERNAL BRANCH OF THE SPINAL
(229) ACCESSORY IN TABES. (La paralysis de la branch®
extern® dn spinal dans le tabes.) Mile. Anna Avdakoff.
Rousset, Paris, 1906.

This thesis is based on the study of a case of tabes in the service
of Pierre Marie at the BicStre. The condition in question is
uncommon, or at any rate has been rarely recorded, for in the
whole of medical literature the author has only been able to dis-

440

ABSTRACTS

cover ten other cases. The clinical study of paralysis of the
spinal accessory is complicated by the fact that the sterno-mastoid
and trapezius muscles receive additional nerve supply from the
cervical plexus. The extent of the paralysis of these two muscles
is extremely various: one or both may be affected partially or
entirely, and the condition may be unilateral or bilateral. The
internal branch of the spinal accessory is almost always affected
at the same time, with consequent acceleration of the pulse,
laryngeal paralysis, and difficulties of deglutition. There is
usually also an accompanying paralysis of other nerves. Para¬
lysis of the spinal accessory alone only occurred in four of the
eleven recorded cases: in the other seven symptoms of affections
of other nerves were present, the most important being the optic,
oculo-motor, trigeminal, abducent, glosso-pharyngeal, pneumo-
gastric, hypoglossal, and phrenic. Although exact post-mortem
evidence is wanting, it is almost certain that the paralysis is due
to a chronic meningitis affecting the nerve-roots, and not to a
nuclear lesion. The case recorded by the writer is that of a man
aged 42 years, who acquired syphilis at the age of 25, and had
been suffering from tabes for several years prior to the discovery
of the spinal accessory paralysis. The right sterno-mastoid was
almost completely atrophied, and showed practically no response
to faradic or galvanic stimulation. The right trapezius was in
much the same condition, and there was probably also slight
affection of the left trapezius. A detailed description, aided by
photographs, is given of the effects of the paralysis on the move¬
ments of the head and shoulder and the position of the scapula.
The patient also presented marked eye symptoms and other signs
pointing to involvement of several cranial nerves. Summaries of
the previously recorded ten cases are given, the first being one by
M'Bride published in 1885. Henry J. Dunbar.

ON FIFTY OASES OF INFANTILE PABALY8I8. E. F. Trevelyan,
(230) Brit. Joum. of Children's Bis., April 1906, p. 135.

The majority of cases occurred during the second and third years
of life, and, curiously, girls preponderated largely over boys. One or
both legs were involved in thirty cases, one arm in seventeen, an
arm and leg of the same side in two, and an arm and leg of opposite
sides in one. In six cases of the upper arm type, some of the
small muscles of the hand were affected. Recovery might possibly
be looked upon as complete in two cases, but in the others
it was, as usual, only partial. There was generally a marked
contrast between the extent of the early and of the residual
paralysis. Separate foci of disease could only explain the residual

ABSTRACTS

441

paralysis in at least nine cases. Massage, active and passive
movements, and (if practicable) electrical treatment, are of
service. Careful attention should be given to the prevention of
deformities, especially during the early period of the disease.
Orthopedic treatment, in its various forms, is necessary when
deformities develop. Author’s Abstract.

▲ FAMILY IN WHICH SOME OF THE SION8 OF FRIEDREICH'S
(231) ATAXY APPEARED DISCRETELY. Eric Gardner, Brain,
1906, p. 112.

In this paper the hereditary diseases of the nervous system which
are more or less closely related to Friedreich’s ataxia are discussed.
Starting with the definition of the typical form of Friedreich’s
disease, and with an enumeration of the symptoms by which it is
characterised, the writer reviews several divergent types of nervous
disorder which have been found to occur in the same families with
undoubted cases of typical Friedreich’s disease. They are classed
in three groups, namely those in which the knee-jerk is persistent
or exaggerated; those cases which exhibit symptoms nearly related
to those of Marie’s cerebellar ataxy ; and a smaller group in which
symptoms of muscular atrophy are found in conjunction with those
of ordinary Friedreich.

In addition to the examples quoted from former observers, the
writer has had an opportunity of studying one family which pre¬
sents points of interesting variation from the more ordinary types.
The cases of disease were confined to the female members of the
household, the mother and two of the daughters being affected,
whilst the father and sons escaped. The mother exhibited a fine
and rapid tremor of the hands on voluntary movement. This
tremor was of the same character as that which is seen in dis¬
seminated sclerosis, but it never assumed a serious degree of
development. The eldest daughter suffered from very marked
spastic changes, but was free from ataxia. Her arms and hands
showed a high degree of intention tremor, and both feet were in a
condition of Pes Cavus. The second, third, and fourth daughters
were found to be normal, with the one exception, that none of
them had any knee-jerks. The fifth daughter had no knee-jerks,
the feet showed an early condition of Pes Cavus, and some paresis
of the internal rectus muscles of both eyes was present.

The conclusions to which the author of the paper is led are:
(1) the common type of Friedreich’s ataxy passes almost imper¬
ceptibly through an unbroken series of cases into a form of spastic
paraplegia, in which the consequences of the lesion of the posterior
columns of the cord are overshadowed by those due to implication

442

ABSTRACTS

of the lateral tracts; (2) the latter cases may further exhibit a
combination of involvement of the lateral columns with symptoms
of cerebral defect, thus forming a connecting link with the follow¬
ing type; (3) there is a complex group, provisionally designated
hereditary cerebellar ataxy, which consists of examples of family
disease characterised by inco-ordination of voluntary movements
combined with increased tendon reflexes, ankle clonus, and occa¬
sionally with intention tremor. Some cases included in this group
exhibit ocular changes also, but deformity of the feet occurs with
the greatest rarity, if at all. The writer’s most important case—
that of the eldest daughter—conforms in most respects to the
spastic group, but in addition shows an involvement of centres
which initiate voluntary movements on the one hand, and on the
other exhibits the Pes Cavus of ordinary Friedreich’s ataxy;
whilst the youngest girl appears likely to develop into a typical
case of Friedreich’s ataxia, although she presents, in addition to
the usual symptoms, a paresis of the internal recti.

He therefore dissents from the opinion of those who would
separate Friedreich’s ataxy very sharply from the other forms of
inherited nervous disease, and emphasises the fact that careful
examination of many groups of cases may be expected to demon¬
strate the existence of transition-forms, bridging the gaps that
exist between the more ordinarily recognised types.

Harry Rainy.

SYRINGOMYELIA WITH SENSORY DISTURBANCES OF RADI-
(232) OULAR DISTRIBUTION. (Note sur un cas de syringomyelia
avec troubles sensitifs k topographic radiculaire.) Raymond &
Fran^ais, Rev. Neur., March 31, 1906, p. 283.

The interest of the case lies in the sensory changes, which concern
not merely cutaneous sensations of pain and of temperature, but
also that of the joints and bones, indicating a gliomatous process
in the postero-lateral part of the cord, which in this particular
case extends from the sacral region right up into the medulla.
Nystagmus is rare in syringomyelia (20 times in 200 cases,
Schlesinger). In the case reported it was a marked symptom.
The alteration in sensation was strictly limited to the area from
the second to the sixth cervical roots, inclusive, on both sides; and
it occurred also in the domain of the inferior maxillary nerve on
both sides. The sensation of vibration was completely lost over
the whole of the right arm and shoulder, whereas the defect of
cutaneous sensation was confined to the outer aspect of the limb.
Not a few cases of spastic syringomyelia with a strictly radicular
change in sensation have been already described.

S. A K. Wilson.

ABSTRACTS

443

A CASE OF POST-TRAUMATIC HEMORRHAGE FROM THE
(233) SUPERIOR LONGITUDINAL SINUS WITHOUT FRAC¬
TURE OF THE SKULL: OPERATION AND RECOVERY.

E. Fabquhar Buzzard and J. Cunning, Lancet, March 24,
1906, p. 822.

A man of 25 fell on the back of his head, inflicting a small scalp
wound. For 13 days he complained of constant and increasing
headache; palpation of the skull revealed no abnormality, but
the left abdominal reflex was absent, the left knee-jerk increased,
and there was an extensor plantar reflex on the left side. Intra¬
cranial abscess was suspected. By the 17th day he had become
drowsy, with subnormal temperature and intense headache, worst
on the right side. There was cerebral vomiting, left hemiplegia,
hemianaesthesia, and hemiopia, but no optic neuritis. On trephin¬
ing, a large clot was found below the dura, and bleeding coming
from the superior longitudinal sinus. This was stopped, and the
wound subsequently closed. Four days elapsed before improve¬
ment set in, but recovery was ultimately quite complete. The
skull was a very thick one, and probably a tributary vein had
been torn away at its junction with the sinus.

J. H. Harvey Pirie.

HYSTERICAL FEVER. (Zur Lehre vom hysterischen Fieber.) G. v.

(234) Voss (St Petersburg), Devi. Zeitschr. f. Nervenhetlk., H. 3-4,
1906, p. 167.

HYSTERICAL FEVER. (Ueber das sogenannte hysterische Fieber.)

(235) Ad. v. Strumpell, ibid., p. 281.

In Voss’s paper two cases are described with hysterical attacks
accompanied by “ hysterical fever,” or, more strictly, elevation of
the body temperature ; in both all organic disease was believed to
be excluded. In one case—that of a nurse—the temperature rose
to 104* F. or even 106* F. The pulse-rate is noted once as being
104. During the attacks the skin, of the upper part of the body
especially, became hot and dry, and the mucous membranes were
injected. Simultaneous readings in the rectum and axilla showed
that the temperature curves were parallel, but that of the rectum
was always some tenths (of a degree Cent.) lower. The temperature
is noted as having been taken by an experienced nurse.

In the second case the temperature varied from 101° F. to 103* F.
for several months, the pulse being 90-106. The quantity of

444

ABSTRACTS

urine was large, but otherwise normal. (Edema of the legs and
body occurred for a short time at each menstrual period. A full
list of the literature accompanies the paper.

Striimpell in a short communication restates his conviction
that the existence of the so-called hysterical fever must be
regarded as “not proven.” Very high temperatures, he says, are
suspicious, and unless the measurement has been taken per rectum
by the physician himself with his eye on the patient during the
whole time, deception and fraud cannot be excluded. As regards
long continued slight rises of temperature, he reminds one that
latent tuberculosis, chronic inflammatory conditions, etc., may be
present without recognisable physical signs. He describes several
cases of the first class where, on taking the precaution of measuring
the temperature himself, the “ fever ” at once disappeared, but he
confesses it was not always clear how the apparent high reading
of the thermometer was brought about.

J. H. Harvey Pirie.

A CASE OF CONVULSIVE TIO. (Bur un cas de maladie des Tics

(236) convulsifs.) R. Crtjchet, Archiv . gSn. de mid., May 8, 1906,

p. 1180.

The case is that of a boy of thirteen who had suffered increasingly
from this condition for three years off and on. There was a
neurotic family history, and in his case there had been chorea
(? tic) at the age of seven, with remaining blinking movements.
At ten the tic commenced suddenly with echokinesia after a fright
by a too dramatic storyteller, and very soon the whole body was
affected with the characteristic movements, brusque, frequent,
arythmic, involuntary, irresistible, and subserving no purpose.
With short intervals of improvement they had persisted from that
time. There was also echokinesia and echolalia but no coprolalia.
In Tourette’s original description of the disease the movements are
called inco-ordinate. The author considers this an improper de¬
scription, and would call them rather voluntary movements made
in spite of the will.

The patient’s mental state was one of infantilism, but as
regards causation he is inclined to put down the tic to a primary
instability of the muscles, for some cases of tic have their mental
condition intact, although there is more frequently some defect
which aggravates the condition.

J. H. Harvey Pirie.

ABSTRACTS

445

EXOPHTHALMIC GOITRE. W. Gilman Thompson, N. Y. State
(237) Joum. of Med., April 1906.

A concise and most instructive review of the clinical notes in
forty-three cases is given with the object of “ emphasising the
importance of certain symptoms so commonly ignored in the
description of this disease."

The administration of the Rogers Beebe cytotoxic serum is
briefly referred to: a statement of the theory and results of its
use is given.

Thompson’s conclusions are: “(1) In addition to possessing
the four cardinal symptoms of tachycardia, tremor, enlarged thy¬
roid gland, and exophthalmus, Graves’ disease is subject to
exacerbations which are of a distinctly toxsemic character, with
active fever, acute cardiac dilatation with murmurs, and a variety
of symptoms constituting a definite clinical syndrome ; (2) in some
instances the most toxsemic attacks have been completely checked
by the cytotoxic serum of Dr Rogers, prepared from the diseased
human gland through animal inoculation; (3) in a large propor¬
tion of cases the agency which appears to initiate the acute
toxsemic seizure is some inter-current mild infection, such as
tonsilitis, pharyngitis, bronchitis, influenza, or similar acute
ailment.” C. H. Holmes.

WHAT IS HYPNOSIS 1 W. v. Bbchtkrew (of St Petersburg), Joum.

(238) of Abnorm. Psych., Vol. i., No. 1, April 1906.

The author first gives a short statement of the current views of
hypnotism and of the differences between the school of Charcot
and that of Bernheim; according to the former, hypnosis is an
artificially produced neurosis akin to hysteria, and has three
different stages. According to the latter school these stages are
due to the education of the patients of Charcot’s Clinic; hypnosis
has no relation to hysteria, and is merely sleep induced by sugges¬
tion, and the different stages depend upon the depth of the sleep
and the susceptibility to suggestion. The author favours the school
of Bernheim, while he denies that all the facts can be explained
by suggestion; in one of his patients, where there was no apparent
suggestion, percussion of the tibial tendon threw the patient into
a deep hypnotic sleep. He therefore considers hypnosis “ a special
modification of normal sleep, which can be induced by physical as
well as by psychical means.” There is little difficulty in accepting
those views if one considers individual variations as to the sleep
process, and the facts of natural somnambulism.

C. Macfie Campbell.

446

ABSTRACTS

DISTURBANCES OF BAStJE STHESIA, OR THE SENSE OF PRE8-
(239) SURE. [Lea troubles de la baresth&ie (sensibility k la
pression).] Marinesco, Sem. Mid., Nov. 29, 1905.

The importance and significance of the sense of pressure, as distinct
from tactile sensation, have recently been emphasised by Strumpell,
and in the present paper a welcome addition is made to our
knowledge of the subject. The author tested the sense of pressure
simply by his fingers, although more or less elaborate forms of
apparatus for the purpose have been invented. According to
Strumpell, the sense of touch and the sense of pressure are quite
distinct, inasmuch as in individuals with lax integuments the
latter may be firmly pressed without giving rise to any sensation
at all, until it becomes painful. He is inclined to associate bares-
thesia with the muscular sense, as being a “ deep ” sensation, due
chiefly to stimulation of aponeuroses and periosteum.

Marinesco has based his researches upon the examination of
60 cases, of which 25 were tabetics. In 24 of these baresthesia
was modified, and in every one the sensation of vibration (tested
by a tuning-fork) was diminished also. The actual areas, how¬
ever, in which the alterations occurred, did not always corre¬
spond. He was unable to trace any constant relation between the
defect of baresthesia and the degree of ataxia.

In his cases of paraplegia and hemiplegia, very varying results
were obtained, but the general conclusion seemed to be that
between pallaesthesia, baresthesia, and the muscular sense, close
affinities may be detected. They may very frequently be affected
simultaneously, though sometimes dissociated. Hence they cannot
be considered as identical, however much akin they may be, one to
the other. S. A K. Wilson.

CASE CONTRIBUTION TO THE STUDY OF SENSORY ATAXIA.

(240) (Kasuistischer Beitrag zur Lehre von dor sensorischen Ataxie.)

Goldscheider, Neurol. Cenlralbl., April 16, 1906, p. 338.

A workman, aged 44, a heavy drinker, was admitted for weakness
and tingling in the right leg. The liver was large, but the other
organs healthy. The right leg was weak, especially in the coarse
movements, which were swaying and ataxic. Muscle tonus was
much diminished there. The gait was swaying, and the knee heel
test was performed with difficulty. Skin sensation was normal,
but passive movements were not appreciated and the localising
capacity was much diminished. The right peroneal nerve was
tender. The knee-jerks were diminished, especially the right.

ABSTRACTS

447

No other abnormal signs. The course was as follows. The ataxy
and weakness progressed, as did the changes in the joint sensibility.
Atrophy of the extensor muscles appeared, as did diminution of
the sensibility to pain in the right leg. The right knee-jerk dis¬
appeared, and the left was only just present. In the left leg
slight weakness appeared, with diminution of skin sensibility, but
no change in the muscle sense and no ataxy. Later, slight
tingling appeared in the arms, but no objective signs. Recovery
was fairly complete in three months.

Thus the ataxy was to be correlated with changes in the joint
sense, and not with cutaneous sensibility. Ernest Jones.

OH THE DORSAL FOOT REFLEX. (Ueber den Fussrtickenreflex.)

(241) Kurt Mendel, Neurolog. Ceniraibl., April 1, 1906, p. 293.

Kurt Mendel deals with this reflex, first described by Bechterew
in 1901, and refers to a previous paper in which he demonstrated
that the toe extension normally obtained by striking the dorsum of
the foot was replaced in affections of the pyramidal tract by
flexion of the four outer toes. In tabes, polyneuritis, and polio¬
myelitis no response was present. Amongst later writers is
Graeffner, who, in 116 cases of hemiplegia, found plantar
flexion in thirty-one cases; in twenty-nine of these Babinski’s
sign was present. Kurt Mendel has investigated the sign
in a very large number of cases, with the following results.
In healthy people, and also in functional diseases of the nervous
system, toe extension (dorsiflexion) was the invariable rule. In
cases of poliomyelitis or neuritis no response at all was obtained,
and in such cases the plantar reflex also was absent; in a
unilateral lesion of this nature the normal reflex on the healthy
side thus contrasted with the absence of response on the other.
The following table deals with eighty-five cases of organic
hemiplegia and fifty-nine of paraplegia:—

1 .

2 .

Babinski

Plantar foot reflex
Dorsal „ (normal)

fPlantar „

Dorsal „

Paraplegia,

Hemiplegia.

Thus, of the 144 cases, in forty-eight both Babinski’s and
Bechterew’s signs were positive, in forty-nine both were negative;
in thirty-four Babinski was positive and Bechterew negative,
in thirteen the reverse obtained. In these thirteen cases, some
of which are quoted, the dorsum of the foot reflex was of the
utmost value in establishing a diagnosis. Frequently it was

448

ABSTRACTS

obtained only by percussing the outer half of the foot. Similar
results were obtained in such conditions as Friedreich’s ataxy,
juvenile general paralysis, etc. The author, in conclusion, con¬
siders that the sign is of very high value. Ernest Jones.

ON A PECULIAR REFLEX CONCERNED WITH PLANTAR
(242) FLEXION OF THE FOOT AND TOES IN CASES OF
AFFECTION OF THE CENTRAL MOTOR NEURONS.
(Ueber eine eigentumliche Reflexerscheinung bei Plantarflexion
dee Fusses und der Zehen in Fallen von Affektion dee centralen
motorischen Neurons.) W. v. Bechterew, Neurolog. Centralbl.,
April 1, 1906, p. 290.

A new reflex phenomenon is here described. If the patient’s
foot be fixed, and the toes passively flexed, there occurs a dorsal
flexion of the foot and toes; in marked cases the knee and hip
joints also flex. The plantar flexion of the toes must be carried
out strongly. The phenomenon is easily obtained when present.
It has the same significance as ankle clonus, Babinski’s sign,
Oppenheim’s sign, Bechterew and Mendel’s plantar flexion of the
toes on percussion of the dorsum pedis, etc. It is, however,
present in some instances when these other signs are abrogated
by excessive spasticity. Ernest Jones.

ON SCHAFER’S ANTAGONISTIC REFLEX. (Ueber den Sehttfer’-
(243) schen antagonistlschen Reflex.) W. Lasarew, Neurolog.

Centralbl., April 1, 1906, p. 291.

The author discusses the reflex described by Schafer in 1899. On
gripping the gastrocnemius tightly in normal people a slight
flexion of the great toe and plantar flexion of the foot appears,
due to mechanical shortening of the tendons by the pressure. In
affections of the pyramidal tract, extension of the toes occurs,
which Schafer attributed to a reflex contraction of the antagonists
due to stimulation of the sensory nerves of the gastrocnemius
tendon. The phenomenon is thus of theoretic interest apart from
the clinical importance claimed for it by Schafer as a localising
sign in cases of deep coma.

Lasarew has found the sign present in ten cases within a month,
seven being cases of cerebral hemiplegia and threeof spinal paraplegia.
In the latter cases the appearance of the sign was prompter than
in the former. It signified always a pyramidal lesion. By
careful observation, however, Lasarew demonstrated that the
essential feature in the stimulation was not pressure on the

ABSTRACTS

449

gastrocnemius, but the stroking or pinching of the skin over the
muscle. In other words, Schafers sign is the well-known
extensor response which, as Babinski has shown, can be evoked
by stimulation, not only of the sole of the foot, but also of the leg,
and occasionally even of the thigh. Thus the reflexogenous zone
of the plantar reflex is more extensive than usually supposed.

The reviewer may point out that the sign here referred to was
independently discovered and thoroughly investigated by Gordon,
who originated a full discussion on the subject at a meeting of the
Philadelphia Neurological Society, October 25, 1904.

Ernest Jones.

ON MAOBOP8IA AND ITS RELATION TO MICROGRAPHIA,
(244) AND ON A PECULIAR ALTERATION IN LIGHT PER¬
CEPTION. (Ueber Makropsie und deren Beziehungen zur Mikro-
graphie, sowie fiber eine eigenthiimliche Sttinmg dor Lichtemp-
findung.) Fischer, Momtt. f. Psych, u. New., Bd. xix., H. 3,
p. 290.

The term dysmegalopsia is employed to designate the condition in
which the size of an object is inaccurately appreciated, a condition
which occurs in two differing classes of disease. It is a frequent
phenomenon in hysteria and epilepsy, and it may occur when
there is defect of convergence or accommodation. The under¬
standing of its pathogeny in the latter cases helps to explain its
significance in the former.

The apparent size of an object is estimated by the retinal
impression, as well as by the distance at which we think the object
is situated. Objects of the same size, placed at varying distances,
give us retinal pictures of varying dimensions. We estimate
distance by the innervation we make to converge, as well as by
the effort it requires to accommodate. The nearer an object,
the stronger the impulse required to focus it sharply on the retina;
and conversely the stronger the impulse, the nearer our estima¬
tion of the object’s position. Hence, if for any reason an increased
accommodation and convergence effort is demanded, the condition
is one of micropsia, or mutatis mutandis of macropsia.

On the other hand, in some cases micropsia is associated with
the apparent withdrawal of the object. Alteration of convergence
is followed by dysmegalopsia in all individuals, relaxation of it
producing macropsia and increase micropsia; but the apparent dis¬
tance varies with the individual. This appears to depend on
whether he regards the size of the retinal image or the degree of
muscular effort; hence in micropsia the object may seem to some
nearer, to others farther away.

2 G

450

ABSTRACTS

Dysmegalopsia, similarly, is a question of accommodation. It
is important not to forget that our estimation of an object’s size
and distance is not merely a question of convergence or accom¬
modation. A bright surface appears larger than a dark one; a
vertical line seems longer than a horizontal one; of two objects of
equal length the slenderer seems the longer, etc.; and again, a
large object seems nearer than a small one, a dark object appears
farther off than a bright one, etc. These components have different
values in different individuals, which helps to explain differences
in the appreciation of size and distance, but they are not, in any
case, so essential as the apparatus for accommodation and con¬
vergence.

In the dysmegalopsia of hysteria and neurasthenia, however,
there is apparently no defect of peripheral organs, hence we assume
disturbance of some cortical centre for accommodation. A
hypothesis of this kind is distinctly unsatisfactory, nevertheless,
and the author supports his contention of peripheral disturbance
even in these functional cases by an ingenious series of experi¬
ments on an hysterical subject.

She was a twenty-two-year-old girl, liable to hysterical seizures
of varying duration and typical character, which were associated
with pronounced macropsia, micrographia, and a curious alteration
in light perception whereby everything seemed to be dull grey.

The fact that the micrographia varied exactly with the
macropsia was utilised by the writer in the following way:—
During a period of macropsia a drop of a one per cent, hamatropin
solution was applied to the right eye, and when the patient was
tested two hours later it was found that with the right eye closed
the usual micrographia was obtained; with the left eye closed the
writing was distinctly larger. This was repeatedly observed. In
further experiments by instillation of eserin the converse was
demonstrated; the writing became even smaller when the eserin-
ised eye was employed. It must be obvious, therefore, how fal¬
lacious is the view that some one factor alone is responsible for the
appreciation of size. Many factors come into play, and no one is
negligible. The limitation of the attention in hysteria means that
certain stimuli are not appreciated by the sensorium, and others
therefore produce an unwonted effect. This is no doubt the ex
planation of the secondary micrographia, viz., the concentrating of
the attention on the disturbance of vision, to the exclusion of the
perception of the correcting sensations coming from the muscles.

The dyschromatopsia of the patient must have been of central
origin: elimination of the macropsia by atropin and prisms was
effected, but these failed to produce any change on the former.

S. A. K. Wilson.

ABSTRACTS

451

ON TRAUMATIC IMMOBILITY OF THE PUPIL. (Ueber trau-

(245) matische Pupillenstarre.) Dreyfus, Muench. med. Wochenschr.,
March 27, 1906.

This is a reply to the criticism passed by Kreuzfuchs upon
Dreyfus’s previous article. It consists merely in a contradiction
to several of the facts and opinions stated by Kreuzfuchs, who is
said to have confused loss of sympathetic dilating power with
reflex rigidity, since there is do true reflex on darkening. Dreyfus
also gives references to three further cases of pupil immobility
associated with injury of the spine.

John D. Comrie.

ON TRAUMATIC IMMOBILITY OF THE PUPIL. (Ueber trau-

(246) matische Pupillenstarre.) Kreuzfuchs, Muench. med.

Wochenschr ., March 6, 1906.

The writer refers to the previous article of Dreyfus, and complains
that attention has not been paid to his work upon the dilatation
reflex of the pupil when darkened. His observations were made
upon rabbits with divided fifth nerve and persons whose Gasserian
ganglion had been removed. He has explained why some authors
place the centre for the pupil reflex in the oculo-motor nucleus, others
in the spinal cord, for, he says, the path of the light reflex is by the
pupillary fibres, oculo-motor nucleus, third nerve, and sphincter
pupillae, while the darkening reflex (produced on covering the eye)
runs by way of the fifth nerve, spinal cord, dilatation centre, sym¬
pathetic nerve, and dilator pupillae. Dreyfus’s case he explains
by a destruction of the dilator centre in the cervical cord leading to
loss of tonus in the dilator pupillae, and thus to permanent myosis.

John D. Comrie.

ON TRAUMATIC IMMOBILITY OF THE PUPIL. (Ueber trau-
(247) matische Pupillenstarre.) Dreyfus, Muench. med. Wochenschr .,
Feb. 20, 1906.

This communication is designed to indicate the connection sub¬
sisting between the spinal cord and the pupillary reflex. The
writer states that the third cervical segment is the part of the
central nervous system usually found diseased when the Argyll-
Robertson phenomenon is present, and he gives a brief history and
copious bibliography of the views expressed and researches per¬
formed on this point. He states that, according to Reichardt, as

452

ABSTRACTS

the result of examining thirty-five cords, a characteristic degenera¬
tion affecting a narrow strip of fibres between the tracts of Goll
and Burdach from the second to the Bixth cervical segments is
associated with this ocular sign.

The writer records a corroborative case in which a healthy
man, aged sixty-eight, sustained a severe accident, as the result of
which complete paralysis of the extremities gradually came on,
with death in three weeks. At first the eyes were quite normal,
but, six days after the accident, both pupils were found myotic and
devoid of reaction to light. They were not examined as regards
convergence. Post-mortem the brain was apparently healthy, but
there was a degeneration of the spinal cord extending from the
last up to the third cervical segment, the result of fracture of the
fifth cervical vertebra.

The writer does not attribute every case of reflex immobility
of the pupil to this spinal lesion, but takes into account the possi¬
bility of defects at a higher level in general paralysis, cerebral
syphilis, etc. John D. Comrie.

ON TRAUMATIC REFLEX IMMOBILITY OF THE PUPIL.
(248) (Ueber traumatische refiektorische PupUlenstarre. ) Axenfeld,
Deut. med. Wochenschr ., April 26, 1906.

This paper deals with the production by injuries of a condition of
the pupil in which the light reaction is affected in contrast to
narrowing on convergence.

Three illustrative cases of damage to the optic nerve or iris are
recorded. In one case a man, aged twenty-five, received a blow
upon the left eyeball so severe as to tear the choroid and cause
haemorrhage; sight was but partially impaired, though even nine
months afterwards the light reaction was almost absent, while the
reaction, both consensually and on convergence, remained as good
as in the right eye; since motor apparatus and the reflex arc from
the right eye remained good, it was evident that the defect lay in
the pupillary fibres of the left optic nerve or their distribution in
the affected eye. In the second case, a girl aged five suffered a
crush to the head beneath the wheel of a waggon, resulting in a
fracture with complete paralysis of the left third nerve and contu¬
sion of the right eye shown by a small preretinal haemorrhage.
The result, as regards the right eye, was complete loss of light
reaction, though the consensual and convergent reflexes remained
active. The third case, that of a man struck by a splinter of wood
on the left eyeball, differed from these two; the reaction in the
right pupil was in every way normal, while the left pupil was
slightly oval, remained absolutely unaffected by light, contracted

ABSTRACTS

453

slightly on convergence, and dilated freely under cocaine, thus
showing that there were no adhesions; the visual acuity in both
eyes was normal. In this case the change is attributed by the
writer not to any defect in the optic nerve, hut to a condition
situated in the iris.

Two other cases of damage to the skull, followed by similar
reflex immobility of the pupil, are detailed. In case four, a woman,
aged twenty-five, sustained a fracture of the base with paralysis of
the left external rectus muscle and complete loss of pupil reflex to
light in the right eye, partial loss in the left, with retention of
convergence contraction in both. In case five, a woman, aged
fifty-five, fell upon the right side of the head, double vision result¬
ing, as well as complete loss of light reflex (consensual and direct)
in the right eye, while the left was unaffected. The writer dis¬
cusses the site of the lesion in the last case, disapproves of the
idea that the ciliary ganglion is the reflex centre, and inclines to
the belief that this condition may be due to a selective damage by
concussion of the reflex fibres in the third nerve.

John D. Comrie.

ON IMMOBILITY OF THE PUPIL IN HYSTERICAL ATTACKS.

(249) (Ueber Pupillenstarre im hysterischen Anfall.) Bumke,
Muench. med. Wochenschr., April 17, 1906.

The writer states that any doubt which may formerly have existed
as to the occurrence of this phenomenon in hysterical seizures has
now been quite dispelled by recent observations, to which he gives
numerous references. Nevertheless he states that it does not
occur with great frequency. The high importance of recognising
its possibility is shown by the fact that the condition of the pupils
is sometimes made a test between hysteria and epilepsy.

The writer describes the condition of immobility which may be
met. It is not of the nature of the Argyll-Robertson phenomenon,
but consists in a rigidity of the pupil under every sort of stimulus.
One or other pupil, or both, may be contracted, and in these cases
there is often strong convergence also; or, on the other hand, the
pupil is sometimes moderately or widely dilated.

The natural explanation in the former case is that a spasmodic
condition of the sphincter iridis is present along with the spas¬
modic convergence; but when the pupil is dilated, opinion may
differ as to whether a paralysis of the sphincter or spasm of the
dilator is the cause. In a case of undoubted hysteria showing this
sign, the writer was enabled, by the use of weak solutions of homa-
tropine and cocaine, to decide in favour of a spasm of the dilator
pupillw. John D. Comrie.

454

ABSTRACTS

RECURRENT THIRD NERVE PARALYSIS AS A COMPLICATION
(250) OF ENTERIC FEVER. (Residivierende OculomotoriuslIUi-
mung als Komplikation bei Typhus abdominalis.) Jochmann,
Devi. med. Wchnschr., April 19, 1906, p. 617.

Jochmann records a case of that interesting condition designated
by Mobius recurrent third nerve paralysis, and described by Charcot
under the name of ophthalmoplegic migraine. The patient was a
male, aged 19, whose previous history was as follows. At the age
of 8, left oculomotor paralysis occurred, ushered in by migraine,
and lasted for a week. The next year he had three attacks of
migraine but no paralysis. At the age of 10 he had smother attack
of migraine accompanied by oculomotor palsy of four days’ dura¬
tion. In each of the two following years he had an attack of
migraine without paralysis. At 13 the third attack of paralysis
took place, and like the second lasted only four days. From that
date till the age of 19 he had three attacks of migraine without a
return of oculomotor paralysis. At 19 an attack of migraine
occurred. Diarrhoea and fever set in simultaneously. On the
fifth day complete paralysis of the left oculomotor nerve developed.
On the tenth day the patient was admitted to hospital, where in
addition to the third nerve palsy, clinical and bacteriological evi¬
dence of enteric fever was found. This time the paralysis was of
much longer duration than on each of the three previous occasions,
having not completely disappeared at the end of three months.
The case presented almost all the features described by Mobius as
characteristic of recurrent oculomotor paralysis. The attacks
occurred first in childhood. They were of longer duration than
those of ordinary migraine. There were no visual aura and no
hereditary nor familial history. Jochmann regards the typhoid
infection as the exciting cause of the paralysis, and as responsible
for its unusually long duration. J. D. Rolleston.

PARALYSES OF ASSOCIATED MOVEMENTS OF THE EYES,
(251) AND THEIR SUB DIVISION INTO VOLUNTARY AND
AUTOMATO-REFLEX MOVEMENTS. (Paralysies des mouve-
ments associto des yeux et leur dissociation dans les mouve-
ments ▼olontaires et automatico-rfflexes.) Cantonnkt and
Taguet, Rev . Neur ., April 15, 1906, p. 308.

To two cases gleaned from the literature, the authors add three
fresh examples of paralysis of voluntary conjugate deviation of the
eyes in conjunction with conservation of reflex conjugate deviation.
The lesion is probably somewhere between the cortex and the

ABSTRACTS

455

co-ordinating—supra-nuclear-centre, which is situated, according
to some, in the anterior corpora quadrigemina, according to others
in the nucleus of the sixth nerve itself. S. A. K. Wilson.

DIAGNOSTIC VALUE OF THE POSITION OF THE HEAD IN
(252) CEBEBELLAB DISEASE, ETC. (Sarcome du lobe droit du
eervelet et du pddonde c6r6belleux infdrieur droit. Valour
diagnostique do la position do la tdte. Hypertension cranieuse
avec hypotension rachidienne.) M. L. Laruelle, Rev. Neurol .,
Feb. 28, 1906, p. 204.

The author records the case of a boy whose head was inclined to
the left shoulder and face turned towards the right. Later he
had headache, vertigo, vomiting, and staggering gait. Six weeks
after the abnormal position of the head was first noted, there was
some cerebellar asynergy, some ataxia in all four limbs, double
Babinski sign, indistinct outline of optic discs. Death occurred
in the eighth week, with signs during the last fortnight of pressure
on the right sixth and seventh nerves. At the necropsy a small
sarcoma was found in the right inferior cerebellar peduncle, pene¬
trating the right lobe of the cerebellum.

The case is almost identical with one recorded by Batten
{Brain, 1903). In both the attitude is similar to that produced
in dogs by extirpation of a cerebellar lobe, but on the opposite
side, and in this case the side was only diagnosed when the para¬
lytic involvement of cranial nerves occurred.

J. H. Harvey Pirie.

PSYCHIATRY.

TYPES IN MENTAL DISEASE. W. A. White (Washington), Jcntm.
(253) Nerv. and Ment. Disease, April 1906.

The problem of classification of mental diseases has been considered
from nearly every possible standpoint—etiological, symptomato-
logical, pathological, psychological, and recently from the stand¬
point of natural history, course and termination. Of recent years,
however, the whole tendency seems to have been toward the
creation of distinct clinical entities; with an increasing knowledge
of the complicated functions of the brain, it is natural to expect
that an increasing number of disease processes may be recognised.
The accurate conception of mental disease must be from a broadly
biological viewpoint; types are like species, they have many
transitions and intermediate forms: as examples, the transition

456

ABSTRACTS

forms between dementia praecox and manic-depressive insanity
and involution melancholia, between paranoia and dementia praecox
are mentioned. Primary confusion may occur during the course
of any psychosis: flight of ideas in dementia praecox; Korsakoff
syndrome in paresis and in senility; catatonic rigidity and
negativism in toxic and exhaustive psychosis, etc.—these are all
common examples of the complication of syndromes occurring in
the so-called diseased types. Dementia should be understood to
include only conditions of permanent mental impairment. White
believes that with dementia as a dividing line a satisfactory classi¬
fication can be arrived at until paranoia is reached. He discusses
then the issue which is so commonly raised as to whether or not
the degree of absurdity of a delusion represents a corresponding
degree of judgment defect or dementia in the individual.

Under the non-dementing psychoses he includes (1) infection
exhaustive psychoses; (2) toxic psychoses; (3) manic depressive
psychoses; (4) psychoses associated with other diseases; (5) psycho¬
neuroses; (6) constitutional psychopathies. Under the dementing
psychoses he includes (1) dementia praecox; (2) involution melan¬
cholia; (3) senile and presenile psychoses; (4) paranoia and
paranoid states (not otherwise classified); (5) paresis; (6) psychoses
associated with other diseases.

It is to be understood in such a classification that “non¬
dementing psychoses may produce dementia in an unstable or a
greatly predisposed individual.” “ Dementing psychoses tend
naturally to lead to permanent mental impairment.”

The conclusions and arguments are arranged under five heads,
as follows: (1) The necessity for a broad biological viewpoint in
considering the problems of alienation; (2) the inconstancy and
variability of types of mental disease; (3) the desirability of a
pause in the universal tendency to the analysis of mental
symptoms for the purpose of developing general principles under
which to group results; (4) the suggestion that a great deal could
be accomplished by the study of certain symptom groups apart
from the special diseases which they more or less typify ; (5) the
illustration of what can be accomplished by this method by its
application to the dementia syndrome. C. H. Holmes.

THE RELATION OF THE PSTOHOSES OF THE INVOLUTION
(254) PERIOD TO JUVENILE DEMENTIA (Das VerhJUtnis der
Involutionspsychosen zur juvenilen Demenz.) G. Lomer (of

Neustadt), Allg. Ztschr. /. Psych., Bd. 62, H. 5, 6.

On the basis of twenty-eight cases where the mental disorder
began after 36, and excluding all cases of senile dementia, Lomer

ABSTRACTS

457

makes a comparison of the symptoms met with in psychoses of the
involution period, and those characteristic of juvenile dementia.
The predominance of sexual ideas, and the similarity of the
symptomatology to that of the juvenile psychosis, lead him to con¬
clude that the involution processes and juvenile deterioration pro¬
cesses depend upon the same cause. He suggests that the cause
is a pathological alteration of the secretion of the sexual organs
modified by age and other circumstances.

C. Macfie Campbell.

THE PSYCHOLOGY OF SUDDEN RELIGIOUS CONVERSION.

(255) Morton Prince, Joum. of Abnortn. Psych., Vol. i., No. 1,
April 1906.

Cases of religious conversion are classified by Starbuck into the
volitional type and the type by surrender —sudden cases belong to
the latter class. James believes that individuals possess large fields
of subconscious thought, and in this field an incubation of motives,
deposited by the experiences of life, takes place: finally these
motives reach maturity and burst forth into the conscious life of
the individual.

Prince advances three difficulties in the acceptance of this
theory: (1) if sudden conversion is to be looked upon as a normal
phenomenon, it must be proven that in normal life there is a sub¬
conscious field of sufficient size for the development of the ideas
noted; (2) the experimental demonstration of any particular case
is lacking; (3) there are occasional transitions of results into con¬
sciousness, for which a subconscious incubation is not easy to
demonstrate.

Several cases are cited where attempts have been made to
analyse the subconscious state. The final deductions are—
(-1) that the subconscious mind furnishes emotions rather than
ideas; (2) there is no fundamental difference, except in the con¬
tent of consciousness, between a state of ecstasy with its system
of ideas and beliefs, and an obsession of fear or anxiety with its
system of ideas and beliefs; (3) in other cases of sudden con¬
version the new system of ideas is not an uprush from “co¬
consciousness,” but rather an automatic crystallisation of past
experiences out of the latest consciousness. C. H. Holmes.

A COMMON FORM OF INSANITY. C. A. Drew (Mass.), Med.

(256) Bee., April 28, 1906.

During the year 1903-4 there were admitted to the hospitals for
the insane in Massachusetts 2426 patients; of these, 18‘7 per cent.

458

ABSTRACTS

were classified as dementia prcecox ; 13*1 per cent, as senile
insanity; 11 per cent, as alcoholic insanity; 9‘6 per cent, as
paresis; 5 4 per cent, as imbecility; 3*3 per cent, as epileptic
insanity; 3*1 per cent, as organic brain disease.

Drew believes that dementia praecox is responsible for more
chronic mental cripples than any three forms of insanity combined.
We should be keenly alert then to recognise the danger signals;
we should know its natural course and the prognosis. He
criticises most pertinently the prevailing tendency to include
under dementia praecox certain cases of manic-depressive insanity,
and toxic and exhaustive cases. The percentage which recover
is nearly twice as great among the relapsed cases as among those
never before admitted to the hospital; this should turn our
attention to the possibility of manic-depressive insanity: the
prevalence of the delirium—confusion—stupor complex should at
least suggest the toxic type of insanity; the overlapping of two
diseased types is possible. In 454 cases of dementia praecox
admitted to the Massachusetts hospitals in 1903-4, 16 per cent,
were capable of self-support at the end of a year’s time. Home
environment offers great obstacles; the adolescent, who is idle,
apathetic, irritable, and resistive at home, commonly falls into
line at once among strangers in the routine of a well regulated
hospital.

Drew’s experience coincides with that of Clouston, i.e. that
between the ages of fourteen and fifteen the liability to insanity
is practically nil, that between twenty-one and twenty-five it is
very great; the prognosis of psychosis developing before twenty-
five is fairly good. C. H. Holmes.

A STUDY OF MENTAL DISEASES ASSOCIATED WITH OEBE-
(257) BEAL ABTEBIO SCLEROSIS. Albert M. Barrett, Amer.

Joum. of Insan., Vol. brii., No. 1, 1905, p. 37.

The author states that general paralysis, arterio-sclerotic dementia,
and senile dementia are associated with characteristic changes in
the central nervous system. He cites Alzheimer’s four groups of
cerebral arterio-sclerosis, pure types of which he says are not
common. The characteristic feature of the disease in the cerebral
cortex is its focal occurrence, as compared with the diffuse char¬
acter of the changes in senile brain atrophy and general paralysis,
and the absence of lymphoid-cell infiltration of the vessel-wall
seen in the last-named affection. The patch-like appearance of
nerve-tissue degeneration and its relation to the vessel changes
distinguish it from the more diffuse processes of senile brain
atrophy. In both general paralysis and senile brain atrophy,

ABSTRACTS

459

arterio-sclerosis with its secondary degeneration may be present,
yet it is purely associative.

The author minutely analyses a series of five cases, and sum¬
marises, to put it shortly, as follows:—In three cases there were
superficial evidences of arterio-sclerosis; in four a systolic cardiac
murmur with accentuated second aortic sound; and in one the
heart was enlarged towards the left. Three cases of examined
urine showed nephritis. They were characterised clinically by
progressive dementia—loss of memory being a prominent feature—
and death in coma with or without convulsions.

He very fully describes the familiar vascular changes and con¬
sequent nerve degenerations, and notes that the focal lesions were
never more than 1 cm. in diameter.

He mentions many differential points clinically and etio-
logically, such as “the lack of prominence of delusion, and a
greater degree of insight into his disease in the arterio-sclerotic
case; the history of vascular or similar mental disturbance in
relatives, and a high hereditary taint in general paralysis, yet of
a different nature.”

He admits, however, that the diagnosis clinically from general
paralysis is quite impossible in a case he describes, where there
was a marked arterio-sclerotic brain process, and at the same time
a tabetic-like posterior column disease.

The paper is illustrated by pictures showing characteristic
wedge-shaped sclerosis in cortex and degeneration in spinal cord
in the case with tabes-like symptoms.

Douglas M‘Rae.

ON THE PATHOGENESIS OF SOME IMPULSES. Dr P. Janet
(258) (College of France), Joum. of Abnorm. Psych., Vol. i., No. 1, April
1906.

Janet gives a brief resume of the cases of five patients with marked
impulsions; these differed widely in their nature, the episodic
craving being respectively for drink, food, excessive exhausting
exercise, and self-inflicted pain. The features common to all the
cases were the periodic appearance of the desire, the satisfaction
following its accomplishment, the remorse of the subject and his
good but useless resolutions. More detailed analysis of the cases
demonstrated a prodromal stage, during which the patient for
several days was dominated by a feeling of ennui or depression or
insufficiency; it is these latter feelings which form “ the essential
part of the psycholeptic crisis to which the impulsions are joined
only as accidental phenomena.” The author cites a case in which,
owing to unfortunate associations, obsessing and impulsive ideas

460

ABSTRACTS

of drinking became grafted on a recurrent depression. With
regard to the mechanism of these impulsions, they must be regarded
as an effort of the patient to escape from the primary disorder of
feeling. The error of the patient is in assuming that the same
means will always retain its efficiency, and that there is no other
means of attaining the same end. Therapeutics should be directed
to the cultivation of these other means and to the development of
the internal resources of the patient The gravity of the prognosis
lies in the fact that the primary anomaly of mood is frequently
constitutional and its conditions difficult to determine.

C. Magpie Campbell.

WAS SIND ZWANGSVORGANGE ? Dr Bumke, Sammlung zwcmg-
(259) loser Abhandlung aus deni Gebiete der Nerven- und Geisteskrankheiten,
Bd. vi., H. 8. Carl Marhold, Halle a. S., 1906, pp. 45.

This short paper is a critical examination of the many and varied
phenomena described as imperative processes, obsessions, impulsive
actions, and so on. The author gives a succinct account of the
origins of their classification, beginning with the observations of
Esquirol in 1838, and discusses at some length the respective
claims to priority of their recognition and categorisation of Krafft-
Ebing and Westphal—a point of purely academic interest. The
author shows rightly, however, that great confusion has been
introduced into this question by the opposing ways in which the
term Zivangsvorstelluw/ has been applied by different writers. Dr
Bumke himself endorses the well-known views of Westphal, who,
it will be remembered, cited four chief characteristic features, viz.:
(1) intact intelligence ; (2) absence of any emotional disturbance;
(3) the insuppressive nature of the imperative ideas; and (4) their
recognition by the subject as foreign and absurd. Dr Bumke,
however, defines these phenomena in terms which he considers less
liable to misinterpretation, unfortunately without any perceptible
improvement. These presentations, he says, are never projected
outwardly, a point of considerable differential value, but he
nevertheless affirms that they do occasionally dominate the clinical
picture at the commencement of the severer psychoses. He
therefore dismisses as too sweeping the often-heard statement that
the subjects of obsessive ideas never become insane.

Naturally, as following Westphal, he denies the emotive basis of
those states. Dr Bumke traverses, with perhaps unnecessary
severity, the views of Freud and his followers. The paper
evidences no original work or new point of view, and is a mere
criticism of the hypotheses of well-known authorities.

R. CUNYNGHAM BROWN.

ABSTRACTS

461

ON THE CLINICAL PICTURE OF “ CIRCUMSCRIBED AUTO-
(260) PSYCHOSIS ON THE BASIS OF A MORBIDLY DOMI¬
NANT IDEA.” (Ueber das Krankbeitsbild der “ zirkxun-
skripten Autopsychose auf Grand einer tiberwertlgen Idee.”)

B. Pfeiffer (of Halle), Monatsschr. f. Psych, u. Neur.,
Jan. 1906.

The author reports the cases of two patients where, on the basis
of an emotional occurrence, there developed a paranoic condition
which centred round this episode without influencing the judgment
of patient in other spheres. The delusions of reference and the
retrospective misinterpretation of the past were limited to the
same complex of ideas. These cases are similar to Friedmann’s
cases of mild systematising paranoia (vide Abstract in Rev. Neur.
and Psych., Vol. iii., p. 563). The author analyses the psycho¬
logical mechanism of the disorder, using Wernicke’s sej unction
hypotheses and general terminology. C. Macfie Campbell.

CLINICAL CONTRIBUTION TO THE PSYCHOSES OF CHILDREN.

(261) (Beitrag zur Klinik der Kinderpsychosen.) H. Gottqetreu
(of Munster), Allg. Ztschr. f. Psych., Bd. 62, H. 5, 6.

The author reports the case of a boy of 10 years of age who, two
years after concussion of the brain with transitory delirium, began
to show symptoms of mental disorder. He was restless at times;
at other times he would stand staring at one spot without uttering
a word. His actions were rather foolish and unexplained. He
was admitted to an institution in July 1903, and there he was
noted as having hallucinations both of sight and hearing. He was
rather mischievous at times, sometimes was disinclined to answer
questions, and after a few weeks he talked of being in America,
and thought that the people were speaking American. On succeed¬
ing days he named other places. For several evenings he either
saw or heard his father, and on one occasion was rather astonished
over his father’s presence as the journey was expensive. Patient’s
conduct gradually improved, hallucinations disappeared, and on
November he was discharged recovered. Patient had no memory
for many of the hallucinations, but had satisfactory insight for a
boy of his age. For the treatment of such cases, children’s hospitals
or, if possible, a special division in a psychiatric clinic, would be
preferable to the ordinary institution.

C. Macfie Campbell.

462

ABSTRACTS

TREATMENT.

REGENT EXPERIENCES IN THE STUDY AND TREATMENT

(262) OF HYSTERIA AT THE MASSACHUSETTS GENERAL
HOSPITAL, WITH REMARKS ON FREUD’S METHOD OF
TREATMENT BY “PSYCHO-ANALYSIS.” J. J. Putman (of
Harvard), Joum. of Abrwrm. Psych., VoL i, No. 1, April 1906.

Putman cites in a short and clear manner the main views of
Freud with regard to the mechanism of the dissociation of con¬
sciousness in certain psycho-neuroses; Freud holds that an un¬
pleasant incident, usually of a sexual nature, becomes shut off
from the rest of the personality, acts in a disintegrating way on
consciousness, and that treatment should consist in the recalling
of the details of the incident, and letting the patient react
adequately and thus assimilate the affair. The discovery of the
sore spot or hidden complex is frequently facilitated by Freud’s
dissociation method, aud under hypnosis the patient can be brought
to re-live the paiuful scenes. Freud’s method of treatment, which
consists in recalling the details of painful scenes, seems essentially
different from that of authors like Dubois, who try to cultivate
all associations which lead away from the disorganising element
to a more rational series of associations. Putman criticises Freud’s
theory, and says that it is a mistake to look upon the complex
of the painful incident as a fixed element in the mind; ideas are
not bricks. When Freud makes his patients react adequately to
a long hidden sore, he is merely asking them to associate these old
painful ideas with the elements of a more vigorous and rational
mental state, and therefore his method is essentially “sub¬
stitutive ”; it is important to recognise that Freud’s method is
one of substitution, and that hypnosis is not a necessary element
in the treatment. One can thus avoid recalling to patient’s
memory unnecessary details; having got the essential facts with
or without the aid of suggestion, one should cultivate in the
patient’s mind a truer series of associations. The author gives
briefly four cases which show how, in a general hospital, suitable
suggestive treatment may produce substantial results.

C. Macfie Campbell.

THE RESULTS OF THE SURGICAL TREATMENT OF EXOPH-

(263) THALMIO GOITRE. B. Farquhar Curtis (of New York),
Ann. of Surgery, March 1906, p. 335.

This paper reports the further progress of eighteen previously
published cases of exophthalmic goitre treated operatively by the
author, and records three fresh cases. The only operations re¬
quiring consideration are partial thyroidectomy and extirpation of
the cervical sympathetic nerves and ganglia, ligature of the thyroid

ABSTRACTS

463

vessels being merely a palliative or preliminary operation. In
seven cases he tried sympathectomy, in the hope of avoiding the
mortality from acute thyroidism, but still two deaths occurred
from that condition and one from the anaesthetic. The results of
sympathectomy are fairly satisfactory, but the operation is more
difficult, especially with local anaesthesia, leaves a more disfiguring
scar, and has as high a mortality; the author has, therefore, returned
to thyroidectomy.

Am ong his fourteen cases of thyroidectomy the writer has had
four deaths, all from acute thyroidism. At least eight of the ten
patients who recovered are “ practically cured.” The effect of the
operation on the symptoms is interesting. The exophthalmos is
lessened, though it seldom disappears, and the strained feeling in
the eyes is lost. The remainder of the thyroid is stationary or
diminishes, unless a relapse occurs. The heart’s action generally
becomes slower; in many cases, however, tachycardia persists, but
without irregular or tumultuous action, the feeling causing no
inconvenience. Tremor and nervousness immediately improve,
and the feeling of anxiety completely disappears.

What is the cause of acute thyroidism, which is responsible
for the post-operative mortality? The theory which ascribes it
to absorption of thyroid material from the wound can for various
reasons hardly be accepted. Thus the attacks occur during the
usual course of the disease, apart from operation; any excitement
fright, or worry often brings on an attack; and, lastly, acute
thyroidism occurs as frequently after sympathectomy, or after
operations on distant parts of the body in patients with exoph¬
thalmic goitre, as it does after thyroidectomy. The writer believes
that acute thyroidism is due to a combination of the nervous strain
of operation, the effects of general anaesthesia, the shock of the
operation, and the absorption of toxic material from a minimal
degree of sepsis, quite as much as to absorption of thyroid products.
The risk would be diminished by preliminary rest and medical
treatment, by accustoming the patient to the surgeon and nurses, by
the use of local anaesthesia, and by dividing the operation by per¬
forming preliminary ligation of the arteries. W. J. Stuart.

SERIOU8 HEAD INJURIES AND THE INDICATIONS FOE

(264) OPERATIVE TREATMENT. Sachs, Boston Med. and Surg.

Joum., Feb. 15, 1906.

HEAD INJURIES. Morton Prince, Ibid., p. 182.

(265)

INDICATIONS FOR OPERATION IN HEAD INJURIES. W. N.

(266) Bullard, Ibid., p. 184.

These three papers, which were read at a meeting of the Boston
Society of Psychiatry and Neurology, repay perusal. An addi-

464

ABSTRACTS

tional interest lies in the fact that the subject is approached from
two different points of view, viz. that of the neurologist and that
of the surgeon.

The following, put very briefly, are some of the conclusions.
In Sachs’s opinion:

1. Much more frequent collaboration should take place between
the surgeon and the neurologist in cases of head injury, since, in
his judgment, the difficulty of deciding whether to operate or not
was much greater than the actual operation. He would, apparently,
only leave the decision to the surgeon alone in severe fractures of
the skull, and in clear cases of middle meningeal haemorrhage.

2. In determining the gravity of cases, disturbances of cardiac
and respiratory action, of vesical and rectal control, and the con¬
dition of consciousness were the most important points. The
condition of the pupil reflexes were of no special value m an
operative indication.

3. If the external injury points to one site and the symptoms
to another, both should be considered, the external injury being
attacked first.

4. It is unprofitable to differentiate between concussion, con¬
tusion, and compression; rather find out whether the brain is or
is not tangibly injured, and whether the injury is accessible.

5. In inaccessible cases, simple trephining may be done if
increasing intracranial pressure, unrelieved by lumbar puncture,
is present.

Sachs also complains that cranial surgery has not kept pace
with abdominal surgery, and thinks that surgeons, by improving
their technique, might produce much better results than they do.

Bullard recommends operation in the following cases, unless
special contra-indications exist:—

1. All depressed fractures, and all compound fractures of the
vault, even if linear and without depression.

2. In cases where cerebral symptoms are present, clearly due
to traumatism—

(a) Where unconsciousness comes on after an interval of

consciousness.

(b) Where unconsciousness has lasted for more than twelve

hours.

any previous history of convulsions.

Morton Prince considers that, in the majority of cases of head
injury, only general symptoms are present, and that purely “neuro¬
logical signs” are rare. Consequently, the neurologist can afford the
surgeon very little help. He also emphasises the frequency of
laceration of the brain in severe head cases. Thus, out of 138 fatal
cases examined by Dwight, in only 22 was laceration absent

ABSTRACTS

465

In the discussion which followed, Lund said that the differ¬
ences which exist between the cranial and abdominal contents
were snch that cranial surgery could never be brilliant. Paralysis,
also, might be produced in the course of operation, worse than the
lesion which it was attempted to cure. A. A. Scot Skirting.

THE SURGICAL TREATMENT OF SCIATICA. (Ueber chirurgfeche
(267) Behandlung der Ischias.) Alfred Pers (Copenhagen), Devi,
med. Woch., April 12, 1906, p. 574.

The author believes that the operative treatment of sciatica has
fallen into comparative disrepute owing to the uncertainty of its
results, and this want of success he attributes to the fact that the
usual method adopted is forcible nerve stretching, necessarily
accompanied by injury to the nerve fibres. He recommends that
the nerve should be exposed by the usual incision, but should not
be stretched. It should be freed from any adhesions, and all
reddened connective tissue should be very carefully removed by
means of gauze and forceps from the nerve itself, so that its surface
assumes its proper white and glistening appearance. The nerve is
in this way followed upwards and downwards until normal portions
are reached. The wound is then closed. If improvement sets in
rapidly, it is ascribed to the separation of the adhesions ; if more
gradually, it is because “ changes in the circulation have produced
favourable conditions which have led to the cure of the inflamed
nerve.” In only two cases has the author performed this opera¬
tion, and both were successful, there being no recurrence in from
one to two years.

No doubt many intractable cases of sciatica are due to
perineuritic adhesions, but it seems rather premature when a
writer discusses the value of an operative procedure from a record
of two cases. W. J. Stuart.

■Review

DIE PALPABLEN GEBILDE DES NORMALEN MENS0HLI0HEN
KORPERS UND DEREN METHODISGHE PALPATION.

Part I. Upper Extremity. Toby Cohn, Berlin. Pp. viii. + 216,
with 21 illustrations in the text. Berlin: Karger. Edin¬
burgh : Otto Schulze & Co. 1905. Price M. 5.60.

The student of so-called “Artistic Anatomy” is more or less
familiar with the lines and points of the human body that cor¬
respond with underlying structures, of the exact nature of which
2 H

466

he may be ignorant And the medical student, of course, is
required to give evidence of his acquaintance with so-called
“ Surface Anatomy,” because his ability to recognise pathological
changes in the tissues of the body frequently depends on the
intimacy of his knowledge of the normal, as seen and felt on the
surface. The importance of surface anatomy is abundantly
obvious, and it is regrettable that so little time, relatively speak¬
ing, is devoted to its study. The care with which the embryo
medical dissects out the smallest ramifications of some insignificant
and probably variable blood-vessel might very well be found to be
more profitable were it bestowed on the landmarks of the human
frame as they reveal themselves to the educated finger. Nor need
the student complain of lack of material, for he always has himself
to practise on, and it is indeed remarkable how much information
may be gained from the systematic examination of the various
regions of the body.

There is nothing new in the idea, of course: many of us
acknowledge their indebtedness to such a book as Holden’s “ Land¬
marks, Medical and Surgical.” The volume at present under con¬
sideration, however, is a most elaborate presentation of the structural
details of the body recognisable by touch; and though it is more
than two hundred pages long, it refers solely to the upper extremity.
Of the wisdom of this hunting of minutiae there may be question.
Many of the facts are neither of importance nor of interest, and
many more are absolutely familiar. The author states in his
preface that it is owing to his conviction of the desirability of
being au fait with these details, from the point of view of scientific
massage, that he has undertaken the task, which has occupied four
years. But a judicious weeding out process would, in our opinion,
have enhanced the value of the book. Where so many facts are
aggregated, some indication of relative significance or insignificance
would have been of great service. It is somewhat irritating, too,
to observe the tendency to denote various points by the name of
some observer: e.g. constant reference is made to “ Mohrenheim’s
pit” (the deltoideo-pectoral sulcus), etc. etc. The photographs
which illustrate the text are very unequal: the majority are so
reproduced that they fail to justify their adoption, and constitute
the best argument for the value of accurate drawings. Apart from
these and other minor criticisms, one readily admits the labour
and painstaking zeal that characterise the production. The arm
is divided into regions, anterior and posterior, and each is exhaust¬
ively studied, from skin to bone, and every conceivable structure
that can be felt is enumerated, and its relation to neighbouring
tissues discussed. The book is of such a nature that further
analysis becomes needless: for information regarding any particular
area the original must be consulted. S. A. K. Wilson.

BIBLIOGRAPHY

467

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IReview

IReuroIogE anO flteEcbiatrp

©riginal Hrticles

THE PARS INTERMEDIA OR NERVUS INTERMEDIUS
OF WRISBERG, AND THE BULBO-PONTINE
GUSTATORY NUCLEUS IN MAN.

By Dr J. NAGEOTTE,

Physician to the Bicetre Hospital, Paris (Travail du laboratoire d’histologie
de l’^cole des Hautes Etudes au College de France, et du service de
M. le Dr Babinski, k l’hopital de la Piti4).

Having had occasion to study, by Marchi’s method, a case of
degeneration of the nervus intermedius of Wrisberg in man,
I have been able to determine the exact conformation and
connections of the bulbo-pontine nucleus to which the fibres
of this nerve belong. This nucleus measures about fourteen
millimetres in length; it receives the fibres of the intermediary
nerve only in its middle, most slender part; above and below
it becomes enlarged in order to receive the fibres of the trigeminus
and of the glosso-pharyngeal. In man, when studied in serial
sections stained by the Weigert-Pal method, it presents definite
anatomical characters which make it easily recognised throughout
its whole extent, so that its position can be determined in¬
dependently of its connections with the surrounding parts. The
connections of this nucleus with the intermediary nerve of
'Wrisberg, which, as Sapolini has shown, is continuous with
K. OF N. & P. VOL. IV. NO. 7—2 I

474

ORIGINAL ARTICLES

the chorda tympani, indicate that its function is the reception
of gustatory impressions; conversely, the fact that it receives
a great number of fibres from the trigeminus, seems to me to
prove that the fifth pair contains, in its intra-pontine course,
a gustatory nerve, which is evidently the lingual

In this article I shall describe, firstly, the degeneration of
the intermediary nerve of Wrisberg in the case which I have
observed; secondly, the topography and the myelinic network
of the gustatory bulbo-pontine nucleus in man (making use of
three series of sections, cut millimetre by millimetre, and stained
by the Weigert-Pal method, also of a series stained by carmine
and blue soluble in alcohol, by the method of Mathias Duval).
Finally, I shall compare the results obtained with the views
arrived at by anatomists who have preceded me, and shall state
the observations which corroborate the anatomical and physio¬
logical deductions drawn from study of my sections. This work
will have to be completed subsequently by study of the fine
structure (methods of Nissl and Ramon y Cajal), and by the
researches of comparative anatomy.

A man, aged 36, suffering from cancer of the stomach,
presented, about a month before his death, a right facial
paralysis, which was demonstrated on post-mortem examination
to be caused by a metastatic nucleus as large as a grain of hemp-
seed, situated in the aqueduct of Fallopius immediately below the
geniculate ganglion. The details of the observation having been
lost, I cannot say whether the patient presented any sensory
troubles, but this blank, though important, may be filled up by
what we know of analogous cases, in which there usually exist
localised disturbances of taste.

The facial nerve, as well as the chorda tympani, on being
examined in a series of transverse sections by Marchi’s method,
are found to be completely degenerated below the lesion; the
geniculate ganglion, the extra-pontine portion of the inter¬
mediary nerve and the portion of the facial comprised between
the cancerous nucleus and its emergence from the pons do not,
on the contrary, present any appreciable lesions by Marchi’s
method. But in the interior of the pons the facial presents
manifest traces of retrograde degeneration, and this degeneration
becomes accentuated in proportion as one approaches the nucleus.

Plate 24,

ORIGINAL ARTICLES

475

which contains a great number of degenerated fibres throughout
its whole extent.

As regards the intermediary nerve of Wrisberg, its degenera¬
tion presents a very remarkable distribution. I have just in¬
dicated that its extra-pontine portion would appear to be intact;
in its intra-pontine course, on the other hand, this nerve shows,
by Marchi’s method, a complete degeneration of its fibres. The
aspect of this degeneration is identical with that of Wallerian
degeneration. The line of demarcation between the intact portion
and the degenerated portion is absolutely clear; it is situated
exactly at the point where the root fibres normally lose their
sheath of Schwann as they penetrate into the nerve centres. I
should recall the fact that at this site there exists in every
sensory root a space in which the myeline is paler; as all the
neighbouring sheaths present this modification at the same level,
the result is the formation of a bright line which cuts each root
fascicle in the neighbourhood of its point of penetration. This
line separates the peripheral portion, which is provided with its
sheath of Schwann, from the central portion, which has lost it.
This line has a form which varies in the different fascicles of the
same root: sometimes it is straight, and is situated at the level
of the pia-mater, sometimes it describes a very marked curve, the
convexity of which is directed towards the periphery, so that
each of its extremities being at the level of the pia-mater, its
centre is placed one or more millimetres outside; in this case the
central portion of the nerve fascicle forms a kind of tubercle pro¬
truding outwards, which is capped by the peripheral portion. In
the observation in question these tubercles are degenerated, as is
all the central portion of the fascicles of the intermediary nerve
of Wrisberg, whilst the peripheral portion is spared. This dis¬
tribution is distinctly seen in fig. 1. It is necessary to insist
upon this anatomical detail in order that there may be no doubt
as to the precise point at which the degeneration commences.

The particular mode of degeneration which is here described,
and which is very different from Wallerian degeneration proper,
is not yet known; it seems to me to present a certain interest.
I cannot dwell longer upon its significance in the present article,
which has quite another aim, but it is necessary to state precisely
the general conditions of this phenomena as it is presented to
observation in this case. A sensory root neurone, that is to say

476

ORIGINAL ARTICLES

a neurone with a single prolongation bifurcated in T-form, has
recently undergone, very near the cell, an amputation of the
peripheral portion of its axone. Although the cell has not been
touched, the central part of the axone has undergone an intense
degeneration which, by Marchi’s method, appears only in the
portion of its course which belongs to the central nervous system.
And it should be noted that the conditions of observation are
excellent; the meninges are intact, and in the whole course of the
nerve in question (which has been examined after having been
divided through its whole extent into a series of short lengths)
there exists but the one and only cause of degeneration described
above, that is to say, a nucleus of cancer situated immediately
below the geniculate ganglion. This proves once again that a
section of the peripheral axone, when made very near the cell, is
capable of producing a considerable perturbation in the vitality of
the neurone; in the case in question this perturbation is shown
by a very marked lesion of the central axone, a lesion which is
perhaps only one phase of a total destruction of the neurone. To
this particular mode of degeneration one may give the name of
secondary transcellular degeneration.

A second point is also made evident by this observation, that
is the very great instability (fragility) of the myeline of the
central portion of the root as compared with that of the peri¬
pheral portion. In fact, whilst the former is already completely
degenerated, the latter as yet shows no distinct sign of having
suffered. I have had occasion to observe analogous facts under
other circumstances, in particular in study of root lesions of the
cord associated with cerebral tumours.

Since all the fascicles of the intermediary nerve of Wrisberg
present an intense degeneration from their entrance into the
pons, this case may serve, just as well as if it were one of real
Wallerian degeneration, for investigation of the topography of this
nerve.

Intra-pontine course of the intermediary nerve of Wrisberg.
The fascicles which constitute this nerve, seven or eight in
number, penetrate into the pons between the facial and acoustic
nerves; they lie nearer to the eighth pair than to the seventh.
Their course is somewhat sinuous; they cross the fibres of the
pons, then those of the trapezius, in order to reach the root of the
trigeminal, which they cross obliquely; finally, they terminate

ORIGINAL ARTICLES

477

in a very limited nucleus, which is situated in the prolongation
of the anterior cornu of the crescent, which is formed by
the descending root of the fifth pair. As they approach
the nucleus in which they terminate, they become sub¬
divided into numerous fine fascicles, which are spread out over
the root of the trigeminal, and then converge towards their point
of destination. The nucleus appears in the sections of the
levels under consideration, in the form of one or more small
masses of grey matter, rounded in outline and enclosed in a
mantle of white matter. This formation is clearly marked out
and possesses a characteristic aspect; it extends upwards and
downwards from the point which the fibres of the intermediary
nerve reach in order to become connected above with the fibres
of the trigeminal, and below with the fascicles of the glosso¬
pharyngeal. Figs. 7 and 8 represent the projection of the
nucleus in question on the median plane and on an antero¬
posterior plane; these figures, made with an enlargement of
three diameters, have been obtained by the aid of measure¬
ments taken on a series of transverse sections at a distance
of 1 mm. It will be seen that the zone of entry of the fibres
of the intermediary nerve measures about 2 mm. in breadth.
The superior extremity of the nucleus is situated about 3 mm.
above the superior limit of the zone of entry, and its inferior
extremity descends about 9 mm. below the inferior limit of
this zone, so that the nucleus measures in all about 14 mm.
in length.

Study of sections made by Marchi’s method shows in ad¬
dition that the fibres of the intermediary nerve are not distributed
only in the portion of the nucleus which is reached directly by
the fascicles of that nerve. We find, in fact, a great number
of degenerated fibres which follow an ascending or descending
course in the white matter at the periphery of the nucleus,
fibres which terminate in the superior and inferior regions of the
grey matter. Above, these fibres, which are situated more
particularly within the nucleus, diminish rapidly in number,
and the last of them disappear about 1£ mm. from the superior
limit of the zone of entrance, so that the superior extremity of
the nucleus, which is enlarged, does not receive any fibres from
the intermediary nerve over a space of about 1 mm. Below, the
degenerated fibres diminish less rapidly ; some of them descend

478

ORIGINAL ARTICLES

to 4^ mm. below the inferior limit of the zone of entrance, that
is to say to the neighbourhood of the point at which the gustatory
nucleus enters into intimate connection with the solitary bundle,
as we shall see later.

To sum up, the fibres of the intermediary nerve are distri¬
buted in the gustatory nucleus over an extent of about 8 mm.;
they blend above with root fibres which certainly come from the
trigeminal, and below with other fibres which belong to the glosso¬
pharyngeal. We shall see subsequently also that certain facts
tend to prove the existence of fibres from the trigeminal which
descend along the periphery of this nucleus and which terminate
at various points throughout its whole length. The zones of
distribution of the three gustatory nerves in the interior of
the common nucleus of termination thus largely overlap each
other.

I ought to add that there exist root fasciculi which follow
almost the same course as those of the intermediary nerve
of Wrisberg, and which certainly do not belong to this nerve, or
at least to its sensory part. These fasciculi are of considerable
size ; they are situated somewhat internally to the fibres of the
nerve of Wrisberg, and like them are directed towards the gusta¬
tory nucleus; but instead of resolving into fibres which penetrate
into this nucleus, they pass inside it and become lost in the gTey
matter of the fourth ventricle. The fascicles in the case which
we are studying contain some distinctly degenerated fibres, which
become separated from them in the neighbourhood of the gusta¬
tory nucleus in order to enter into this nucleus. These fibres
evidently belong to the intermediary nerve. But, in addition, it
would seem that even in the pure portion 1 of these fascicles,
there exist a number of fine globules more numerous on the
affected than on the healthy side. It is thus possible that we
have here a retrograde degeneration analogous to that observed
in the facial nerve of the same side. Reasoning by exclusion,
one might suppose that these root fascicles, which I have found
exactly at the same place in the three series of normal sections
studied, represent the vaso-motor roots of the intermediary. In
any case they occupy exactly the same position in relation to
the sensory and the motor roots of the seventh pair (the intermediary

1 i.e. Those fascicles which remain after the degenerated fibres pass off to the
gustatory nucleus.

Plate 26.

Fig. 5.

ORIGINAL ARTICLES

479

and facial proper) as do the fibres arising from the dorsal nucleus
of small cells of the ninth pair in relation to its sensory and motor
portions. Now, we know that Dr Alexander Bruce considers
the dorsal nucleus of the ninth pair to be the origin of the vaso¬
motor fibres of this nerve; this fact would thus constitute a
fresh analogy between the ninth and the seventh pairs. It would
have been interesting to determine experimentally the place of
the nucleus of origin of these problematical fibres by looking for
Nissl’s reaction & distance after extraction of the facial nerve ;
but the only experiment which I practised upon the rabbit with
this intention gave me no results.

Gustatory Nucleus. —We must now study more closely the
topography and the structure of this nucleus.

The gustatory nucleus is situated in front of the sulcus on
the floor of the fourth ventricle, which separates the fasciculus
teres from the acoustic area. We know that, corresponding to
this sulcus on its posterior surface, the grey matter of the floor
of the fourth ventricle forms by its anterior surface a ridge
which projects forwards (dorsal nucleus, triangular nucleus of
the acoustic), and which penetrates somewhat deeply between
Deiters’ nucleus and the formatio reticularis of the pons and
medulla. The gustatory nucleus, which is in the form of a
column, is situated immediately in front of the crest of this
ridge, as if it were a detached portion of it. Above, it
commences to appear at about 2 mm below the termination of
the convolutio trigemini; below, it ceases 3 or 4 mm. below the
origin of the solitary bundle. In its infeiior portion it con¬
stitutes what is now known as the nucleus or gelatinous substance
of the solitary bundle , very exactly represented by Dr Alexander
Bruce in his Topographical Atlas of the Mid and Hind Brain.
In its superior half, it stands in intimate relation to the sensory
nucleus of the trigeminus, from which it has not been differentiated
by the classic writers, although it may be easily recognised in
the good figures of this region given in their treatises. Through
the whole extent of its connection with the trigeminus, the
gustatory nucleus is situated exactly in the prolongation of the
anterior cornu of the crescent described by the descending root.
In all its length the nucleus in question is in very intimate
relationship with that which M. and Mme. D6jerine call the
juxtarestiform body, that is to say the nucleus of Deiters accom-

480

ORIGINAL ARTICLES

panied by descending fibres from the acoustic and by the
internal semi-circular fibres of the cerebellum.

Above, the gustatory nucleus is in connection with the ascend¬
ing (inferior) root of the trigeminus, the fascicles of which skirt
its superior extremity before uniting with the descending
(superior) root.

The aspect of the gustatory nucleus, in transverse sections
stained by the Weigert-Pal method, is very characteristic, and
permits of it being described in two portions. In its superior
three-fifths, it is formed by one or more small rounded masses
of grey matter, surrounded by a layer of white matter; in its
inferior two-fifths, on the contrary, it is broken up into several
irregular portions by white fascicles, which tend to lie in its
centre, and which come from the giosso-pharyngeal (figs. 5 and
6, sections 398, 360, 350, and 337). The first portion of the
nucleus is formed, to begin with, by an enlarged part, which
measures on an average 0 8 mm. in diameter, and which con¬
stitutes about one* third of the total length; below, comes a
very much thinner portion, in which the grey matter hardly
measures 0*1 mm. in diameter, and even seems in certain
individuals to be interrupted in places, the continuity of the
nucleus being in this case established only by its white matter,
which always retains a very characteristic aspect. Finally, the
nucleus becomes swollen shortly before tbe termination of its
first portion, which is marked by the arrival of ascending
bundles from the giosso-pharyngeal. The penetration of the
fibres from the intermediary nerve takes place half in the inferior
extremity of the superior enlargement, half in the narrowed part
which succeeds it. (Fig. 6, sections 326, 314, 302, 278, and
266.) In its second portion the characteristic appearance of
the gustatory nucleus is completely transformed by the penetra¬
tion of fibres from the giosso-pharyngeal. The white mantle
which surrounds the grey matter disappears. The latter is
divided into Bmall areas by the sensory root-bundles of the
ninth pair, some of which ascend into the body of the nucleus
and go to reinforce the peripheral white matter of the inferior
regions of the first portion of the gustatory nucleus (cerebral
prolongation of the solitary bundle), whilst the others assume a
descending direction and go to constitute the solitary bundle
proper. When the solitary bundle is formed (fig. 6 section 302),

Plate 27

Fie;, ei.

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481

the grey matter of the gustatory nucleus surrounds it with an
almost complete ring, which is thicker posteriorly; then the
anterior part of this ring disappears and there remains only a
posterior crescent. Finally, the nucleus, which diminishes
rapidly in size, separates itself from the solitary bundle behind,
in order to plunge into the grey matter of the floor, retaining
its limits perfectly distinct, and terminating in an attenuated
extremity at about half a millimetre from the posterior margin
of the solitary bundle. The remarkable conformation of the
gelatinous substance of the solitary bundle in man, and the termina¬
tion of this nucleus in an extremity which curves backwards has
never been described in detail to my knowledge. This arrange¬
ment, however, is probably constant; I have found it, without
any appreciable variation, in the three series of sections at my
disposal The inferior portion of the nucleus which curves
backwards, and which forms as it were an appendix to the grey
matter of the solitary bundle, is perhaps the vestige in man of
the commissural ganglion of Cajal in rodents.

One might ask, in consideration of the differences of arrange¬
ment which I have described, and in particular of the inverse
relations which exist between the grey matter and the white,
whether the two portions of the gustatory nucleus described
above do not in reality constitute two distinct nuclei, having
different functions. But there exist very serious arguments
against this interpretation. Independently of the morpho¬
logical continuity which is observed between these two forma¬
tions, one must take into account the identical structure of the
grey matter in the two portions. We shall subsequently see
in fact that the form of the myeline network and of the cells
does not change throughout the whole extent of the nucleus in
question. In addition, we find the presence of degenerated
fibres, not numerous, it is true, but very distinct, in points
which already belong to the inferior portion of the nucleus.
So, in my opinion, we must conclude that the gelatinous sub¬
stance of the solitary bundle is nothing but the inferior portion
of the gustatory nucleus.

With regard to the structure of the gustatory nucleus, I
shall merely indicate here the most elementary points. Its
myelinated fibres are very fine and slightly curled, both in the
white matter and in the grey. This results in the formation

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of a felt-work which, seen under low power, has a somewhat
blurred (estompt) appearance different from that of the sur¬
rounding grey mass. This network is slightly less fine in the
inferior part of the nucleus than in the superior part.

The cells, studied in sections stained by carmine, are of a
rounded or ovoid form; they measure from 15 to 20 mm. in
diameter.

From the preceding observation it appears that one part of
the presumed gustatory nucleus is reserved for the termination
of the fibres of the fifth pair ; consequently it may be assumed
that the trigeminus is in itself a gustatory nerve, without neces¬
sarily implying that the sensory functions of the lingual are
related exclusively to the chorda tympani which joins it. The
gustatory nerve then, as a whole, seems to be formed by three
branches leading to the same bulbo-pontine nucleus, one of
which is attached to the fifth pair, another to the seventh, and
a third to the ninth. Amongst the gustatory fibres of this last
pair, some follow an ascending course (cerebral prolongation of
the solitary bundle), whilst others blend with the solitary bundle
proper in order to pass into the gelatinous substance of this
bundle. It is extremely likely that the solitary bundle does
not contain gustatory fibres below the point at which its gelati¬
nous substance terminates, that is to say below the first 3 or 4
millimetres of its course.

I shall not here enter into the discussion of contradictory
opinions of physiologists; I shall confine myself to comparing
with the case which I have just reported a remarkable anatomo-
clinical observation which gives direct evidence of the gustatory
properties of the trigeminus, and which consequently furnishes
the complement of the demonstration which I have attempted.

This observation was reported by Wallenberg. It related
to a patient who had presented anaesthesia in the region of the
left trigeminus along with disappearance of taste on the back of
the left tongue and a left hemiatrophy of the tongue. Autopsy
showed the existence of a tumour affecting the hypoglossal, and
partially the trigeminus; the glosso-pharyngeal and the inter¬
mediary nerve of Wrisberg were spared. From this fact
Wallenberg concluded that taste fibres pass into the trigeminus.
The investigation was very completely carried out by Marchi’s
method. At the level of the knee of the facial, there is detached

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483

from the dorsal angle of the descending root of the trigeminus
an oval piece of gelatinous substance, surrounded by degenerated
fibres, which turn inwards and backwards. After the appear¬
ance of the internal nucleus of the acoustic, it takes its place at
its ventral angle and goes directly into the nucleus of the solitary
bundle. The number of degenerated fibres, at first much greater
than that of the healthy fibres, gradually diminishes ; before the
entry of the glosso-pharyngeal, it has fallen to its minimum and
is limited to some elements which terminate, some at the ventral
margin of the gelatinous substance of the solitary bundle, the
others, after having skirted the solitary bundle, in its dorso-
median portion. Throughout the whole bulbar course of the
solitary bundle, as far as the interior angle of the calamus, there
is a slender gToup of degenerated longitudinal fibres, which unite
the posterior angle of the root of the trigeminus with the antero-
internal margin of the solitary bundle. At the inferior extremity
of the olive these fibres disappear, and there remains in this
region only the descending root of the trigeminus, which goes
down as far as the second cervical.

The oval portion of gelatinous substance surrounded by
degenerated fibres which, to use Wallenberg’s expression,
detaches itself from the dorsal angle of the descending root
of the trigeminus, is very evidently the superior part of the
nucleus described above under the name of gustatory nucleus,
the inferior part of this grey formation, which goes to join
the solitary bundle, being simply the portion of this nucleus
represented in fig. 8 (sections 360, 350, 337, and 326). My
observation thus entirely accords with that of Wallenberg, and
comparison between the two observations, one of which completes
the other, strengthens the conviction that we are here dealing
with a nucleus whose function is the reception of gustatory
sensations in the bulbo-pontine region. We may also, from
comparison of the two cases, draw this deduction, that the
nucleus in question is divided into two territories, the inferior
of which is reserved more particularly for the glosso-pharyngeal,
whilst the superior is common to the trigeminus and the inter¬
mediary ; in the maTgin which separates these two territories,
however, there exists a mixed zone in which the fibres from the
three gustatory nerves blend with each other.

484

ORIGINAL ARTICLES

History .—Such are the conclusions to which we are led by
study of pathological preparations in man, by the aid of Marchi’s
method. It is well to compare these results with those at which
anatomists and experimental physiologists have arrived.

Anatomical study of the bulbo-pontine course of the inter-
mediary nerve of Wriaberg was commenced in 1880 by Mathias
Duval, by the aid of serial sections, stained in carmin and blue
soluble in alcohol, from normal portions of the Cebus ape and of
man. M. Duval has traced the root fibres of this nerve across
the bulbar root of the trigeminus and into “ a small, grey, ovular
nucleus formed by cells of medium dimensions, and which is
nothing but the continuation of the grey sensory column of the
glosso-pharyngeal.” From that connection M. Duval draws the
anatomical conclusion that “ the intermediary nerve of Wrisberg
is one of the fascicles of the glosso-pharyngeaL” M. Duval’s
anatomical description is remarkably exact, but it is incomplete,
for the learned French histologist has not followed the nucleus
in question above the point at which it receives fibres from the
intermediary. Further, we have seen above that it is not the
grey sensory column of the glosso-pharyngeal which constitutes
the inferior extremity of the nucleus of the intermediary, but
a special, very limited nucleus (gelatinous substance of the
solitary bundle) which is situated round the highest portion of
the solitary bundle, and in which only a small part of the fibres
of this bundle terminate. M. Duval’s description is accepted by
Kolliker in these essential points, with the reserve which I have
just indicated with regard to the gelatinous substance of the
solitary bundle.

Roller, soon after, described under the name of the radix
descendens of the gustatory nerve, the cerebral prolongation of
the solitary bundle; according to this writer there are at this
point fascicles which apparently unite with the spinal root of the
trigeminus, and which penetrate into the convolutio trigemini

His, in 1890, while studying the ganglion of the facial in
a human embryo, found that its central prolongation joins the
glosso-pharyngeal in the solitary bundle.

Martin, in embryos of the cat, has traced a bundle which
ascends from the ninth pair to the fifth.

Cramer has described in a more precise way the formation to
which Roller gave the name of descending root of the gustatory

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485

nerve; he has seen a prolongation of the solitary bundle, with
its grey nucleus, which was directed upwards from the point of
the glosso-pharyngeal reflection. The grey matter in question
approached nearer and nearer to the root of the trigeminal, and
ended by blending with the gelatinous substance which accom¬
panies this root. In a word, Cramer distinctly saw the inferior
portion of the gustatory nucleus, but he did not distinguish its
superior portion. Wallenberg is the only writer who, to my
knowledge, has seen this superior portion before me.

Dexter has shown in embryos of the rabbit that the fibres of
the solitary bundle come from the trigeminal, from the acoustico-
facial, from the glosso-pharyngeal, and from the pneumogastric
nerves.

In 1900 Van Gehuchten studied the course of cranial
nerves by the experimental method; he pulled out the facial
nerve in rabbits, and showed, by Marchi’s method, the course
of the fibres of the intermediary. These descend, occupying the
apex of the postero-internal extremity of the trigeminus; then
they penetrate into the solitary bundle, take a place inside the
fibres of the glosso-pharyngeal, and descend to below the point of
entry of the pneumo-gastric. At the level of the point at which
the fibres of the intermediary commence to turn slightly from the
trigeminus, there appears a small bright nucleus, which is situated
immediately in front of and slightly inside the degenerated fibres;
this nucleus is directed lower down into an internal portion, which
is continuous with the dorsal nucleus or the motor small-celled
nucleus of the glosso-pharyngeal, and into an external portion
which is simply the terminal nucleus of the fibres of the nerve
of Wrisberg, and of the glosso-pharyngeal nerve.

Ramon y Cajal, who employed the method of Golgi, describes
in the same way the course of the intermediary. He draws
attention to the fact that these fibres do not present a terminal
bifurcation any more than do those of other nerves which enter
into the composition of the solitary bundle; they are furnished
only with collaterals. This observation agrees well with that of
Van Gehuchten, who has not seen the ascending portion of the
intermediary, but merely a compact group of fascicles which curve
downwards in order to join the solitary bundle.

The distribution is different, at least apparently, in the case
which I have studied, since there very distinctly exists an ascend-

486

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ing portion of the intermediary nerve, the fibres of which ascend
into the nucleus above the point of penetration of the root
filaments. And further, the existence in adult man of an
ascending portion of the solitary bundle, noted by several writers,
seems also in contradiction to the results of investigation in
animal embryos by Golgi’s method. All the histologists who have
employed this method agree in fact in denying the existence of
a terminal bifurcation of roots destined for this bundle. These
fibres simply curve downwards as if they represented only the
inferior branch of the spinal roots, no superior branch existing.
Does the distribution of the fibres in question differ in adult man
from that in the embryo of mammiferous animals ? Is it a question
of age or of species ? Or is the contradiction merely an apparent
one, resulting only from a detail of arrangement of the fibres ? I
cannot answer this at present, but the point appears to me an
interesting one to study.

Finally, I would draw attention to the fact that in man the
fibres of the intermediary descend much less far than in the
rabbit, and that from this fact there would seem to be an ascent
of the gustatory nucleus in the human race.

Description op Figures.

Fig. 1.—Degeneration of the intermediary nerve of Wrisberg; view of its
whole extent; Marchi’s method. Section corresponding to line 6 of fig.
7. The intra-poutine portion of the intermediary nerve alone is dege¬
nerated ; the peripheral portion appears healthy. Retrograde degenera¬
tion of the facial nerve, which is the more marked the nearer it ap¬
proaches to the nucleus of origin.

D, nucleus of Deiters; i.w., intermediary nerve of Wrisberg;
n.g., gustatory nucleus ; o.a., superior olive; P., pyramidal fascicle ;
v., vii., viii., trigeminal, facial, acoustic.

Fig. 2.—Gustatory nucleus above the point of penetration of fibres from the
intermediary. Section corresponding to line a in Fig. 7. Degenerated
fibres passing from the intermediary into the grey and into the white
matter of the nucleus, throughout the whole of its internal aspect
(ascending fibres of the intermediary).

S. c.i., internal semi-circular fibres.

Fig. 3.—Gustatory nucleus at level of point of penetration of the fascicles of
the nerve of Wrisberg (enlarged portion of fig. 1).

T, corpus trapezoideum.

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487

Fig. 4.—Gustatory nucleus below the point of penetration of the fascicles
of the nerve of Wrisberg. Degenerated fibres in its grey and in its white
matter.

P.c.i., inferior cerebellar peduncle.

Fig. 6.—From normal brain. Weigert-Pal method. Section following line
398 of fig. 7.

The gustatory nucleus forms four small rounded grey masses of matter,
enclosed by a crown of white matter ; in front are seen the nucleus
and the descending root of the trigeminus; behind the internal
semi-circular fibres of the cerebellum; to the right of the figure the
facial nerve, to the left the corpus trapezoideum.

Fig. 6.—From normal brain. Weigert-Pal method. Inferior portion of the
gustatory nucleus studied by a series of sections one-twelfth mm. in
thickness, about 1 mm. distant from each other. Section 266 : termina¬
tion of the gustatory nucleus behind the solitary bundle. Sections 266
to 326 : successive forms of the portion of the gustatory nucleus which is
in connection with the solitary bundle (gelatinous substance of the soli¬
tary nucleus). Sections 337 and 350: cerebral prolongation of the solitary
bundle (ascending fibres of the gloeso-pharyngeal). Section 360: the
gustatory nucleus has become connected with the trigeminal, and has
assumed the aspect which it retains through the whole extent of its
superior portion.

Fig. 7.—Projection of the gustatory nucleus on an antero-posterior plane (en¬
largement of 3 diameters). The dotted line represents the area of distri¬
bution of the intermediary nerve of Wrisberg; the grey matter is repre¬
sented in black.

Pig. 8.—Projection of the gustatory nucleus on a vertical and transverse
plane.

Bibliography.

1. Alexander Bruce. “On the Dorsal or so-called Sensory Nucleus of the
Glosso-pharyngeal Nerve, and on the Nuclei of Origin of the Trigeminal
Nerve,” Brain, xxi., 1898.

2. Alexander Bruce. “ Illustrations of the Mid and Hind Brain,” 1892.

3. Cramer. “ Beitrag zur feineren Anatomie der Medulla oblongata und
der Briicke.” Fischer, Jena, 1894.

4. Dexter. “ Ein Beitrag zur Morphologie des verlangerten Markes beim
Kaninchen,” Arch. f. Anat. u. Physiol, (anat. Abth.), 1895.

5. M. Duval. “Recherches sur l’origine r4elle des nerfs craniens,” Joum.
de FAnat., 1880.

6. Van Gehuchten. “Recherches sur la terminaison centrale des nerfs
sensibles p4riph4riques,” Le Ndvraxe, i., 1900.

7. Kolliker. “ Handbuch der Gewebelehre des Menschen,” 6th ed., t iL

8. Nageotte. “Sur la nature et la pathogdnie des lesions radiculaires de
la moelle qui accompagnent les tumeurs cdr^brales,” Rev. Neurol ., 1904.

488

ORIGINAL ARTICLES

9. Roller. “Der centrale Verlauf dee Nervua Gloasopharyngeus,” Arch./,
mikroa. Anat., xix., 1881.

10. Ramon y Cajal. “ Textura del sistema nervioso del hombre y de los
vertebra toe,” t. ii.

11. Sapolini. “ Etude anatomique ear le nerf de Wrisberg et la corde du
tympan,” Joum. de mdd. de BruxeUee, 1884.

12. Wallenberg. “ Dae dorsale Gebiet der spinalen Trigeminuewurzel und
seine Beziehungen zura solitaren Biindel beim Menschen,” Zeitechr. f. Nerven-
heiUc., xL, 1897.

THE DESCENDING DEGENERATIONS OF THE POS¬
TERIOR COLUMNS IN (1) TRANSVERSE MYELITIS
AND (2) AFTER COMPRESSION OF THE DORSAL
POSTERIOR ROOTS BY TUMOURS.

By DAVID ORR, M.D.,

County Asylum Preetwich, Manchester.

The posterior columns of the cord contain, besides ascending
tracts, descending fibres traversing the areas known as Schultze’s
comma, Hoche’s marginal zone, Flechsig’s oval, and the triangle
of Gombault and Philippe. These are now admitted by the
majority of writers to be portions of one continuous tract
(Barbacci, Dejerine and Theohari, Stewart, Flatau), the last three
lying in the postero-median part of the columns, while the first,
pushed outwards in all probability by the gradual formation of
Goll’8 fasciculus, comes in the cervical and dorsal regions to lie
alongside the posterior horn.

Opinion regarding the position of these tracts is unanimous;
but regarding the origin of the fibres composing them, especially
the comma tract, the opposite holds. Some have definitely
asserted that in the comma there are only fibres of exogenous
origin, the descending branches of the posterior roots; others
place their seat of origin in the cord exclusively; others again
think the tract contains fibres derived from both sources.

With a view to determining where the fibres originate, cases
of cord compression, myelitis, compression of the spinal roots by
tumours or meningitis, have been studied. The posterior roots
have also been divided in animals and the cord examined for
degeneration in Schultze’s comma, with negative (Tooth) and

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489

positive results (Oddi and Rossi, Lowenthal, Flatau, Van
Gehuchten, Margulies).

According to Van Gehuchten the descending branches of a
posterior root form a scattered bundle, at first in the immediate
neighbourhood of the posterior horn, but afterwards lying more
internally. After degeneration, the resulting sclerosis is hardly
appreciable. The fibres are short, and never extend downwards
for more than six or seven segments.

In Flatau’s experiments these descending branches lay at
first in the root entry zone, but ultimately. occupied the region
around the anterior part of the median septum and behind the
commissure.

In man also, after compression of the posterior roots, the
comma tract shows descending degeneration for a few segments
(Zappert, Schaffer, Jacobsohn, Hom4n, Laslett and Warrington),
so that we have ample evidence of the presence of exogenous
fibres in this zone.

But a different series of observations shows that the comma
tract contains, in addition to the short exogenous fibres, other
fibres of sufficient length to reach from the cervical region to
the lowest sacral.

After transverse division of the cord by myelitis or injury,
Schultze’s comma is degenerated downwards as far as the lower
dorsal region as a very definite bundle; and the degeneration is
continued into the zones around the median septum, in the
lumbar and sacral cord (Daxenberger, Hoche, Achalme and
Theohari, D&jerine and Theohari, Stewart, Bruce and Muir).

In the descending tract as a whole there must therefore be
long descending fibres of purely endogenous origin, which, judging
from the degree of degeneration in Flechsig’s oval in cases of
cord compression, must in the comma greatly exceed in numbers
the exogenous ones.

Of the endogenous nature of Flechsig’s oval we have
additional evidence from cases of tabes dorsalis in which this
area is always found intact, even in the later stages of the
disease (Bruce, Hom£n, Orr and Rows).

Recently I had the opportunity of examining two spinal cords,
one from a case of Transverse Myelitis obtained through the kind¬
ness of Mr Platt, Surgeon to the Manchester Royal Infirmary, the
other from a case of my own exhibiting Multiple Tumours com-

2 K

490

ORIGINAL ARTICLES

pressing the posterior spinal roots in the dorsal region. The
interest of these two cases consists in the different degree of
degeneration exhibited in the descending tracts of the posterior
columns in a myelitic or endogenous lesion on the one hand, and
by a root or exogenous lesion on the other. It will be seen that
in the latter instance, although such a high degree of root
destruction was present, yet Hoche’s, Flechsig’s, and Gombault and
Philippe’s zones showed a very slight degeneration. Even this
slight degeneration I am not prepared to accept as of the de¬
scending fibres of posterior roots, for in the lower dorsal region
there was a small tumour of the posterior columns growing
inwards from the cord margin, and in addition there were
several myelitic foci on either side of the median septum.
Bearing in mind that the endogenous fibres of Schultze’s
comma pass backwards at this level to gain the septo-marginal
region, one is confronted with the probability that some of
these fibres were implicated in their course.

Case I.—The patient from whom this cord was obtained
developed transverse myelitis on July 26th, 1905, and died
September 12th, 1905.

Marchi’s method alone was used to trace the degenerations.
The entire cord, medulla, and pons were examined. The my¬
elitic focus was found to affect the 8th dorsal and the upper
part of the ninth dorsal segments. The degeneration was most
marked in the posterior columns, the postero-lateral region, and
the anterior radicular zones of the cord. In the grey matter, and
regions occupied by the basis bundles, there was considerable
degeneration, but this was less in comparison with that in the
areas just mentioned.

As the interest in the two cases to be described centres en¬
tirely in the descending degenerations observed in the posterior
columns of the lumbo-sacral region, I do not propose to give the
ascending ones in detail.

Both cerebellar tracts and Goll’s column were completely de¬
generated. The path pursued by the fibres in the former was
that usually given, viz., the postero-lateral, through the inferior
peduncle of the cerebellum, the antero-lateral, by the superior
peduncle. In Goll’s column the fibres were traced into the
gracilis nucleus, where the great majority ended ; but not all, as
a by no means inconspicuous number could be seen to cross by

ORIGINAL ARTICLES

491

the arcuate fibres to the fillet. This confirms the observation
already made by Stewart {Brain, Summer, 1901).

Finally, degeneration was present in a tract occupying the
anterior sulco-marginal region, and was followed into the medulla.
Here, having lost many fibres, it seemed to end posterior to the
inferior olive, and somewhat towards its inner extremity.

Below the myelitis there was descending degeneration. The
crossed pyramidal tracts could be recognised in the lowest
segment of the cord, the direct as far as S s . There was a
very distinct degeneration in the sulco-marginal region as far
as S 2 ; and in the antero-lateral portion of the cord in front of
the crossed pyramidal tract there were many scattered degene¬
rated fibres.

Descending Degenerations of the Posterior Columns.

In the centre of the myelitic focus the whole posterior
column was uniformly filled with Marchi reaction, but a short
distance below this, in the lower part of D®, a rapid diminution
in the extent of the degeneration occurred. The external portion
of each column still showed a dense mass of degenerated fibres,
which at this level took definite shape only in the cornu-com¬
missural angle. In D 10 , however, where the central portions of
the columns showed a very few degenerated fibres, there was a
definite bundle on each side extending from the commissure
backwards to the cord periphery and lying somewhat retracted
from the posterior horn. It will be seen in photo 1 how this
bundle broadens posteriorly, where the fibres are more scattered.
Throughout D u and D 12 the posterior part of this tract (Shultze’s
comma) gradually became more indefinite and receded a little
from the cord margin; and, in the latter segment, Hoche’s
marginal tract first made its appearance as a small band consist¬
ing of a few fibres alongside the posterior extremity of the
median septum.

In L 1 and L 2 the tail of the comma tract gradually dis¬
appeared, the head became ill-defined, and the degenerated fibres
became scattered diffusely in the more central portion of each
column. In L 8 there was no trace of the comma tract, but the
septo-marginal bundle was well defined. The fibres of this tract
lay as a thin band, situated for a short distance along the cord

492

ORIGINAL ARTICLES

margin on either side of the median septum, and spreading
forward on either side of its posterior extremity. In L 4 there
were many scattered fibres in the posterior columns. These were
more abundant in the central parts, and also around the anterior
part of the median septum, as if the head of the comma had be¬
come diffused there. The number of degenerated fibres in the
septo-marginal bundle had increased, and the tract extended
further in a ventral direction (photo 2).

In L 5 (photo 3) one sees how the septo-marginal tract gradually
becomes the central oval of Flechsig. A few degenerated fibres
are still present at the cord margin behind the ovaL In front
of Flechsig’s area there were many degenerated fibres lying close
to the median septum, and extending forwards to the posterior
commissure, where, spreading, they formed a figure of a some¬
what triangular shape, whose apex pointed backwards.

Passing downwards through S 1 and S* (photos 4 and 5), one
found Flechsig’s oval field enlarged by the degenerated fibres at
the cord margin and those behind the commissure passing
respectively forwards and backwards.

Below S* there was a malformation of the cord which
prevented the descending fibres from taking up the position which
they ought to do normally. A mass of grey and white matter,
appearing first just behind the central canal, grew, in the middle
line, downwards into the posterior columns , separating and rotating
them outwards. In this malformation were developed two
rudimentary anterior and posterior horns, until finally the cord
became double, but only for a short distance. The malformation
was continued to the end of the cord as a partial doubling. In
consequence, the triangle of Gombault and Philippe was divided
into two portions, each widely separated from the other. In
these, degenerated fibres were recognisable to the cord extremity
(photo Q).

In Case II. there were Endotheliomata scattered throughout
the central nervous system, one of which was situated in the
right frontal lobe, another involved the crura cerebri and third
nerves, while on the spinal roots of the dorsal cord there were
many (see infra).

The spinal root lesions are alone of interest at present.

For the examination of the lesions, Marchi’s, Van Gieson’s,
and the hsematoxylin and eosin methods were used.

ORIGINAL ARTICLES

493

The tumours of the dorsal cord, situated on both anterior
and posterior nerves, originated in connection with the peri¬
neural sheath, and varied considerably in size; some were round,
others fusiform. The majority totally or almost totally destroyed
the nerves. Others again—though rarely—affected a few
fasciculi only. As a result, one found a cellulifugal degenera¬
tion; and where the sensory roots were involved, a degenera¬
tion of the posterior columns.

In the cervical cord only two, the second and fifth left
posterior roots, were affected; only part of each root had under¬
gone degeneration, so that the root entry zone was only partially
filled with degenerated fibres.

In the dorsal cord the appearances were very different, for
here in every segment from D 8 to D 18 the root entry zone was
filled with degenerated fibres, the result of destruction of the
posterior roots.

Both of these were destroyed in all segments with the
following exceptions: D 8 , in which only the right posterior
root was implicated ; D 18 , only the left.

The anterior roots affected were: in D* and D 4 , the left;
in D 7 , the right one; in D 10 and D 11 , the left; and in these last
two the growth extended into the anterior radicular zone.

In D 8 and D 4 the tumours were large, and had invaded the
lateral portion of the cord from the anterior radicular zone
backwards almost to the posterior horn.

In D 7 a similar condition was present, but the invasion of
the lateral part of the cord was less in depth, and was confined
more to the postero-lateral region.

The degeneration of the posterior columns resulting from
such an extensive root destruction attained very considerable
proportions, and was followed up to the medulla, where the
majority of the degenerated fibres ended in the nucleus
gracilis ; many, however, passed into the nucleus cuneatus.

As in Case I., some of the fibres passed through these nuclei
and reached the fillet by the arcuate fibres; others passed on
into the anterior external arcuate bundle, and were traced round
the ventral aspect of the pyramids to end finally in the restiform
body.

The invasion of the lateral surface by the growth in D 8 ,
D 4 , and D 7 , caused an ascending degeneration of the cerebellar

494

ORIGINAL ARTICLES

tracts. Both were completely destroyed on the left side; bat
only the direct postero-lateral and the posterior part of the
antero-lateral (Gower’s) on the right.

In D u there was a tumour in the posterior columns. This
was small, with its base at the cord margin on either side of the
median septum, and spread ventrally along it for a short distance.
From this point upwards there was a continuous ascending
degeneration as far as the medulla.

Regarding the descending degeneration of the pyramidal
paths, following implication of the crura, it is only necessary to
state that this was more marked in the left C. P. T. and in the
right D. P. T., and was followed to the same levels as in
Case I.

Throughout the cord there was considerable general sclerosis
and vascular degeneration. The sclerosis was more accentuated,
however, in the degenerated tracts—especially in the posterior
columns—and around the cord margin. The vessels and pia-
arachnoid showed a high degree of hyaline thickening, and the
latter in many places sarcomatous infiltration, especially in the
neighbourhood of the tumours.

Descending Degenerations of the Posterior Columns.

As already noted, the root entry zones in the dorsal cord
were filled with degeneration from D* to D 12 (photo 7), but, in
addition, there were lesions in the lower segments of equal
importance.

In D u there was the small tumour already noted at the
posterior extremity of the median septum. This involved not
more than one-eighth of an inch of the segment, in a vertical
direction. In D 7 , D 8 , D®, D 10 , and D 11 there was considerable
degeneration and sclerosis in the region of the postero-lateral
septum as well as round the margin of the cord (photo 7).

In D 7 there was a small myelitic softening situated at the
cord margin just internal to the left posterior root, in D 8 one
on the right side of the hinder third of the median septum, and
several small areas of sclerosis in each column close to the
periphery (photo 8).

In D 12 there were two degenerated and sclerosed patches,
one on either side of the posterior extremity of the median

ORIGINAL ARTICLES

495

septum. The margin of the right column was almost entirely
free from degenerated fibres. There was still some degeneration
with advanced sclerosis around the left postero-lateral septum
(photo 9). In the right root and entry zone there was little
degeneration in comparison with that in the left root, and in
those of the segments immediately above.

On comparing this section with one taken one segment below
the myelitis in Case I., the difference was very marked. Here
there were only a few scattered fibres in the position of Schultze’s
comma tract, thus forming a striking contrast with the well-
defined bundle in Case I. (photo 1).

In the 1st lumbar segment (photo 10) the degeneration in
the root entry zones was much less than in D 1 *, especially on
the right side, and was continuous with that of the entering root.

There was no trace of a comma, and the posterior part of the
columns was free from degeneration with the exception of a few
fibres in the position of Hoche’s marginal zone on the left side. In
all the lumbar segments the posterior roots and entry zones showed
& slight degree of degeneration, which gradually diminished from
above downwards. In L* there was a small sclerotic patch on
the right side of the posterior extremity of the median septum,
while on its left side the septo-marginal tract first made its
appearance as a definite structure.

In L s and L 4 the septo-marginal tract left the periphery, and
in L 6 became Flechsig’s oval. The oval in this case contained
far fewer degenerated fibres than that of Case I., as a comparison
of the photographs from each will show (photos 11, 3, 4); and
lying along the median septum anteriorly there were only a few
degenerated fibres, scattered too irregularly to form a definite
band. This band, stretching forwards to the commissure, was
very definite in Case I.

In the sacral cord the degenerated fibres of this descending
tract rapidly diminished in numbers, but a few could be recognised
in the triangle of Gombault and Philippe, even as far as the lowest
sacral segment.

To summarise the descending lesions in the two cases, we
find in the first many degenerated fibres in Schultze’s comma,
which, becoming diffused about the upper lumbar region, reappear
in very definite tract form in the dorso-median bundles below.
In the second, immediately the gross lesions of the roots ceased,

496

ORIGINAL ARTICLES

on the right side at D 11 , and on the left at D 12 ; the root
entry zones contained only a scanty and scattered degenera¬
tion. No comma tract existed in the right entry zone of D“,
nor in either at L 1 , whereas in D u of Case I. Schultze’s comma
was a prominent structure, especially in its ventral portion.

If, then, in an extensive posterior root lesion, Schultze’s
comma fails to show degeneration, while this is so obvious at
the same level after a myelitis, then we must conclude that by
far the greater number of the fibres of the tract in question are
endogenous.

Extending the same line of argument to the degenerations in
Flechsig’s oval, we have confirmatory evidence of the great pre¬
ponderance of endogenous fibres in the descending tracts, for
numerically the degenerated fibres in Case I. greatly exceeded
those in Case IL

But the presence of the tumour and myelitic softeningB in
the lower dorsal region of the latter case renders it extremely
doubtful if the slight degeneration in Flochsig’s oval was
exogenous. It is much more probable that it consisted of
endogenous fibres intercepted, in the posterior regions of D u and
D u , in their passage from Schultze’s comma to the dorso-median
zones. Naturally, with such lesions, the large majority would
escape and continue their course without interruption, as these
endogenous fibres traverse the columns in the transition from
Schultze’s comma to the septo-marginal zone and Flechsig’s oval
in a very diffused manner.

It appears to me, therefore, that Case II. demonstrates that
the descending branches of the lower dorsal roots do not form
a comma tract in the upper lumbar cord, nor enter Flechsig’s
oval, but pass almost at once into the grey matter.

References.

1. Ach&lme and TheoharL (Cited by Fl&tau: “ Handbuch der path.
Anat. d. Nervensystems,” 1904, vol. ii. p. 964)

2. Barbacci. “Lo Sperimentale,” 1891, p. 386.

3. Bruce and Muir. Brain, 1896, p. 333.

4 Bruce. Brain, 1897, p. 265.

5. Daxenberger. Deutsche ZeUtch.f. NervenheiL, Bd. iv., 1893.

6. Dljerine and Theohari. Joum. de Phyt. et Path., March 1899.

7. Flatau. “ Handbuch der path. Anat. d. Nervensysteme,” 1904, vol. ii.

8. Qombault et Philippe. Arch, de Mdi. Experiment, 1894

marginal

Photo 4.—Case 1

i :o

Plate 31 .

F. O.

Photo 5.—Case 1. S-. Flechsig’s central oval.

Photo 6 .—Case 1. Cord almost completely double.

1 .

•)

Left half of triangle of (tombault and
Philippe.

Original posterior horn.

Original anterior horn.

4. Commissure.

5. Rudimentary anterior horn. | New

6. Rudimentary posterior horn, j formation.

1. Denunon
%

Photo 9. (’ase 2. D 1 * 2 .

1. Degeneration in left root entry zone. 3. Myelitic softenings on each side of jkjs-

tero-median septum.

2 . A few degenerated fibres in right root 4. Degeneration around left postero-lateral

entrv zone. septum.

Photo 10.—Case *2. L 1 . Observe both root entry zones contain only

a few scattered degenerated fibres.

ORIGINAL ARTICLES

497

9. Hoche. Neurol. Centralb., 1896, p. 155.

10. Hom4n. Deutsche Zeitech./. Nervcnheil., p. 24, 1901.

11. Hom6n. “Handbuch der path. Anat d. Nervensys terns,” by Flatau,
etc., 1904, yoL ii.

12. Jacobeohn. Zeitsckf. klin. Med., Bd. xxxvii., 1899.

13. Laalett and Warrington. Brain, 1899.

14. Lowenthal. (Cited by Flatau. See above.)

15. May. Rev. Newr. and Psych., No. 1, 1905.

16. Margulies. Monatsch. f. Psych, w. Newr., 1897.

17. Oddi and Roui. Arch. Ital. de Biolog., 1891, p. 296.

18. Orr and Rows. Brain, winter, 1904.

19. Schaffer. Arch. f. Mikroskop. Anat., 1894.

20. Stewart. Brain, summer, 1901.

21. Tooth. Brit. Med. Joum., 1889.

22. Van Qehuchten. “ Anat. du Syst&me Nerveux de l’Homme,” 1906.

23. Zappert Neurol. Centralb., No. 3,1896.

abstracts

PATHOLOGY

A MALFORMATION OF THE SPINAL CORD APPARENTLY
(268) HITHERTO TJNDE8GRIBED. (Ueber eine bisher anacheinend
nicht beachriebene Miaabildung am Riickenmarke.) A.

Westphal, Arch. f. Psychiat. u. Nervenkrankheiten, Bd. 41, H. 2,
S. 712.

Thu cord was that of a woman of 30, who died with symptoms of
dementia praecox of three months’ duration. There were marked
gluteal and trochanteric bedsores, giving rise to suspicions of some
cord lesion.

The vertebral canal and dura were found normal, as was the
cord down to the level of the upper lumbar region, but the lower
lumbar cord appeared to divide into two parts; one, the left,
larger than the other, but unconnected with any nerve roots.
Serial sections showed first the appearance of unstriped muscle
fibres in the posterior median fissure; these increased in amount
downwards, being at first in continuity with the left posterior
column, but soon becoming separate from the cord. At lower
levels it was found that this left “ cord ” was an elongated cyst lined
with cylindrical epithelium, its wall being formed of circular and
longitudinal bundles of unstriped muscle with some fat, connective

498

ABSTRACTS

tissue, and a few nerve fibres, but no nerve cells. The real cord
contained numerous recent hsemorrhages, and a little way below
the separation of the cyst showed a well-defined doubling. This
began with the appearance of an independent second central canal
on the inner side of one of the anterior horns, and caudalwards
there gradually developed a third anterior and posterior horn, the
former containing numerous motor cells. This condition persisted
to the lower end of the cord.

The cyst was supposed to be a persistent part of the embryonic
proctodeum or neurenteric canal. J. H. Harvey Pirie.

ON THE ACTION OF VENOMS OF DIFFERENT SPECIES OF
(269) POISONOUS 8NAEES ON THE NERVOUS SYSTEM.
V. Venom of Common Krait (Bungarus Coendeue). George
Lamb and Walter K. Hunter, Lancet, May 5, 1906,
p. 1231.

The common krait is a small snake, but its venom is of great
toxicity, the minimum lethal dose being a third of that of cobra
venom. But the symptoms following poisoning with either venom
are almost identical, i.e. there is paralysis beginning in the
skeletal muscles and gradually involving the muscles of respiration,
death being due to failure of the respiratory mechanism.

The venom also acts on the circulatory apparatus much in the
same way as does cobra venom, but krait venom acts in addition
on the vaso-motor centre in the medulla, causing a well-marked
fall of blood pressure, doubtless due to paralysis of the vaso¬
motor centre.

The authors have examined histologically the nervous systems
of four monkeys dying at intervals of 16$, 12,10, and 4$ hours
respectively, after injection of this venom; also the tissues from a
soldier who died a few hours after being bitten by a snake
identified as a common krait The first three monkeys showed
well-marked degenerative changes in the motor ganglion cells
throughout the whole central nervous system. In the fourth
monkey (dead in 4 J hours) there were practically no chromatolytic
changes to be found. With Donaggio’s stain the peripheral nerves of
the four monkeys gave undoubted signs of an early parenchymatous
degeneration. In the human case, as with the fourth monkey, the
histological examination of the central nervous system was
negative; the peripheral nerves, however, were not examined.

Generally the degenerative changes produced by this venom
are similar to those formerly described when dealing with the
venoms of cobra and the banded krait (Bungarus fasdalus).

W. K. Hunter.

ABSTRACTS

499

CLINICAL NEUROLOGY.

ISOLATED TRAUMATIC PARALYSIS. (Ueber isolierte trau-

(270) matische DUunung.) F. Fischler, Neurolog. Centraibl., May
16, 1906, p. 444.

I. Suprascapular Nerve .—This occurrence is one of the rarities
of neurology. The writer lirst describes a case which occurred in
a woman as a result of the strain of stretching to reach a brush that
was fixed outside a window. Immediate pain was felt in the right
shoulder blade. The pain soon disappeared, and no other sensory
symptoms were ever present. Weakness of the arm for outward
movement, particularly in the raised position, was the only symp¬
tom. No atrophy or fibrillary tremors were seen, save in the
supraspinatus muscle. The right shoulder was lower than the
left, and the shoulder blade was displaced 1& cm. outwards and
downwards. External rotation of the humerus was impeded.
The suprascapular nerve did not respond when tested electrically.
The infraspinatus shewed diminished response to both faradism
and galvanism ; qualitative changes could not be established with
certainty, nor could the reaction of the supraspinatus. Recovery
ensued after sixteen weeks.

The diagnosis is discussed and the unusual etiology insisted
on. The writer has found fourteen similar cases in the literature,
seven of which were of traumatic origin; in three of these the
trauma was direct, in four indirect.

II. Right Musculo-cutaneous Nerve .—The patient was a stoker,
aged 30, who, two years before, had sustained an injury on the outer
side of the right forearm in the lower third. The wound was
sewn up, but suppurated, and healed only after five weeks. After
this a pustular eruption appeared on the lower part of the forearm
and lasted a month. Pain continued from the first over the outer
part of the forearm towards the front; it was slight, but was
increased on extension of the forearm. In addition, the patient
noticed a numbness on the outer half of the flexor aspect of the
forearm, extending, when the limb was cold, to the thumb
and first two fingers. Flexion of the forearm was weak, but the
hand and finger movements were normal. On being examined,
the biceps was found a little wasted and obviously weak. Other
than flexion at the elbow joint, no movement shewed any weak¬
ness, except, perhaps, supination. The biceps and brachial is
anticus were flabby, in contrast with the coraco-brachialis and
supinator longus. In the distribution of the cutaneous branch
of the musculo-cutaneous nerve, there was anaesthesia to touch,
hypaesthesia to heat and pain. The periosteal reflex of the radius
was lost on that side. Reduction in response to galvanism and

500

ABSTRACTS

faradism was found in the two affected muscles. An ascending
infective neuritis was diagnosed.

Eleven similar cases of isolated paralysis of this nerve are on
record; five of them were due to trauma, four to neuritis, as in the
above case, and two were of uncertain origin. One of the cases of
neuritis was due to gonorrhoea. The coraco-brachialis frequently
escapes. It is to be observed, as Bernhardt pointed out, that slight
paresis of this nerve may easily be overlooked, as the patient's
work may not be interfered with. Ernest Jones.

TOXIC POLYNEURITIS IN A PHTHISICAL PATIENT. (Toxisdw
(271) Polyneuritis bei einem Phthisiker.) Werthkim Salomonson,
Neuroloff. Centralbl., May 16, 1906, p. 484.

A school teacher, aged 21, was suddenly taken with paralysis of
the lower limbs, and in a few days this was followed by weakness
of both hands. The paralysis was preceded by pains in the calf
and sole for two days. It came on a fortnight after ceasing a line
of treatment for his pulmonary tuberculosis, consisting chiefly in
the administration of phosphoric creasote. He had taken altogether
75 grains of this in seven weeks. The paralysis of the lower ex¬
tremities was intense, and atrophy was present in the peronei and
tibiales. Sensory changes were very inconspicuous. There were
practically no skin changes. Sphincters unaffected. The etiology
of the neuritis is discussed fully. After a perusal of the published
cases, the author is doubtful of the very existence of a true tuber¬
culous neuritis. A fortnight after seeing the above case he came
across an exactly similar one from the practice of the same doctor,
and heard privately that lately seven other cases of polyneuritis
had developed while they were being treated by him with the same
preparation. Although creasote and phosphorus are both in¬
nocuous drugs in fairly large doses, it is possible that, as happens
elsewhere in chemistry, the combination of the two substances
evolves a new body which is a poison to the nervous system.
Lowenfeld published two years ago three exactly similar cases to
the above and attributed them to the taking of phosphoric creasote.
He suggests that the cord may be the part affected, especially as
the motor symptoms are so much in excess of the sensoiy ones.
Chaminer has also collected seven cases, and has no doubt as
to the etiological factor. The cases recorded by Leyden in his
classical work on polyneuritis as being due to phosphorus alone
are quite different in their symptomatology from those referred
to above. Babin ski showed a case last year in which the cause
seemed to be the manure which the man used at his work; he
thought that some contamination of the manure with lead or

ABSTRACTS

501

arsenic might explain the case, but Salomonson suggests that a
derivative of the superphosphates which largely compose manure
might with equal likelihood be the origin of the symptoms.

Ernest Jones.

TABES DORSALIS AND THE KNEE ANGLE PHENOMENON.

(272) (Tabes dorsalis twd das KniewinckelphSnomen.) J. G.

Orschansky, of Charkow, Newrolog. Centralbl., May 1, 1906,
p. 401.

The author recalls the fact that laxity of the knee ligaments is
commonly to be found in tabetics. This may be thus demon¬
strated. In a healthy person who lies supinely it is impossible to
lift a foot if the knee is fixed; in other words, as no hyperextension
is possible, the leg and thigh form an angle of 180*. In many
tabetics the foot can be raised under these circumstances, so that
the leg may form at the knee an angle of even 16-20* with the
bed beneath. This sign is never absent if the tabetic have
ataxy, and corresponds with the more ataxic limb if it is only
present on one side. It is found constantly in infantile paralysis
and occasionally in myelitis, but never in cerebral paralyses.
There is no correlation between the phenomenon and the
appearance of lightning pains, or of other cutaneous sensory
disturbances, but when unilateral it is found on the side on
which the knee-jerk first fails.

Other changes about the knee accompany this phenomenon.
If the thigh be fixed at the knee, the foot can be abducted, so
that the leg and thigh form an obtuse angle. Further, the
patella may be movable up, down, in or out, to an unusual
degree, and it can be lifted from the lower end of the femur to
such an extent that a finger may be insinuated between the two.
The lower border of the patella is often thin and pointed.
Observations similar to the knee phenomenon may be made at
other joints, notably the ankle and elbow.

The phenomenon is doubtless due to the loss of muscle tonus
and the diminution of elasticity of the ligamentous apparatus. It
is possible that the joint changes are of high importance in the
development of the tabetic ataxia. Ernest Jones.

SOME SURGICAL COMPLICATIONS OF TABES DORSALIS.

(273) Anthony A Bowlby, Brit. Med. Joum., May 5, 1906, p. 1021.

The moral of this clinical lecture is that the various complications
are often transitory, and therefore deserve as careful surgical treat¬
ment in tabetic as in other patients. “ Charcot’s disease ” of joints

502

ABSTRACTS

may appear at any stage in tabes. Exceptionally, it is one of the
earliest symptoms; sometimes it sets in twenty years after tabes
is recognisable, and it may show itself at any intermediate period.
The important point is, that the disintegration of the joint
eventually ceases, and that, if the patient is kept at rest and the
joint properly splinted while the destructive process is progressing,
and if displacements are thereby prevented, he may be able to
regain some use of the limb, and, indeed, may be able to dispense
with splints, as the masses of new bone thrown out round the joint
may form a natural splint.

“ Spontaneous fracture ” of hones from slight causes results
from a similar dystrophy of bone. These fractures should be
treated as in healthy people, for in many tabetic patients strong
union occurs, and the tendency to fracture may pass away. Per¬
forating ulcer of the foot may heal, and remain healed if kept
clean and relieved from pressure; abstinence from alcohol is
important in this condition. Other complications, such as gastric
crises and incontinence of urine or faeces, may also be transient;
and eye conditions, for example diplopia, squint, and grey atrophy
of the disc, may cease to become worse.

Too bad a prognosis in tabes should not, therefore, be given;
arrest of the disease may occur at any stage. Improvement of
general nutrition is the main treatment; antisyphilitic remedies
are useless. As many of the complications prove transitory, all
should receive careful and appropriate surgical treatment.

W. J. Stuabt.

MULTIPLE SCLEROSIS: A Contribution to its Clinical Course and
(274) Pathological Anatomy. E W. Taylor (Boston), Joum. of
Nerv. and Merit. Dis., June 1906, p. 361.

The view that multiple sclerosis is a very rare disease in America
is not likely, in the author’s opinion, to stand the test of further
experience, although it is probable that it is less frequent than in
Europe.

“ Some of the apparent reasons for our neglect of the disease in
America may be found in the predominance of out-patient clinics
and the failure to follow cases to their end, with the consequent
lack of autopsy reports. The insistence upon so-called cardinal
symptoms, the neglect to recognise and properly interpret other
obscure signs, the doubtful significance ordinarily attached to
uncomplicated spasticity, and the personal bias in diagnosis, all
account for the infrequency of diagnosis.”

Dr Taylor refers to thirteen cases with autopsy reported in the
American literature, and to these he adds eight which he has per-

ABSTRACTS

503

sonally examined, three of which were studied in Germany. As
evidence of the extraordinary interest which is being taken in
disseminated sclerosis at the present time, the author has been able
to discover eighty papers dealing with this disease in the literature
of 1904 and 1905. In the cases which he has personally examined
he has failed entirely to discover a symmetrical distribution of the
sclerotic patches, except occasionally in what seemed to him to be
a fortuitous way. He adheres to the opinion previously expressed
that the grey and white matter are irrespectively involved. He
was unable to discover that the grey matter formed the slightest
barrier to the progress of the disease. Examination of several
hundred specimens failed to establish any relationship between the
vessels and lesions. The vessel walls often appear quite healthy,
and where they show changes these are probably part of the
general process.

A primary neuroglial overgrowth is held by many as the
initial lesion. Borst holds that the process consists, firstly, in
vessel changes; secondly, in a primary myeline degeneration; and
thirdly, in a compensatory neuroglial overgrowth; and this writer
admits the possibility of development of multiple sclerosis from
a myelitis, as originally suggested by Leyden.

Bielschowsky regards the process as purely inflammatory, both
neuroglia and nerve fibres being simultaneously involved.

E. Taylor’s observations, however, are in perfect agreement
with Muller’s statement that no trace of an inflammatory reaction
is to be seen.

Even though the process is not actually inflammatory with
demonstrable lesions in and about the vessel walls, it is neverthe¬
less both possible and probable in the author’s opinion that the
agent, whatever it may be, that produces the lesions, reaches the
tissues through the blood or lymph channels. He remarks on the
delimitation of the process in the individual patches, and suggests
as an explanation the presence of an agent which spreads from a
central focus until it exhausts itself, This view he thinks is far
more reasonable than the hypothesis of a primary inflammation as
that is usually understood.

Arguments are accumulating against a primary growth of
neuroglia, and among these the frequent lack of evidence of
extensive proliferation of the neuroglia, and the fact that the
nerve roots often show degenerative changes without evidence of
neuroglial proliferation may be cited. A more probable explana¬
tion would appear to be that a toxic agent of unknown character
exists, which has a peculiar chemical affinity for myeline and
possibly also for certain analogous material in the axone. A third
alternative is a simultaneous action of the supposed toxic agent
upon the myeline and the neuroglia, leading, on the one hand, to

504

ABSTRACTS

a destruction of the myeline and coincidently acting as a stimulus
to neuroglial proliferation. “ The sequence of events is, however,
impossible to determine with accuracy.” Edwin Bramwbll.

THE CLINICAL SIGNIFICANCE OF THE 0EBEBBO8PINAL
(275) FLUID. Purves Stewart, Edin. Med. Jowm., May 1906,
p. 429.

The author describes the technique of lumbar puncture and the
characteristics of normal cerebro-spinal fluid. He then considers
the diagnostic data which may be obtained from the examination
of the physical, chemical, bacteriological, and microscopical
characters of the fluid, and finally refers to the therapeutic appli¬
cations of lumbar puncture. In the case of one patient, comatose
from cerebral thrombosis, he obtained normal clear fluid, whilst in
another case with cerebral haemorrhage the fluid was faintly straw-
coloured.

Cryoscopy of the cerebro-spinal fluid has not been of great
practical value.

Guillain and Parant have found in a series of sixteen cases of
general paralysis that if the globulin of the cerebro-spinal fluid was
precipitated by adding a saturated solution of magnesium sulphate
and the clear filtrate boiled, a characteristic precipitate was obtained.

The demonstration of cholin in the cerebro-spinal fluid might
occasionally be of value in diagnosis between hysteria and organic
disease, but the method is somewhat too complicated and technical
for the ordinary clinical observer.

In doubtful cases of tuberculous meningitis, inoculation of the
cerebro-spinal fluid into guinea-pigs may prove of value.

After describing the method to be adopted in the cytological
examination of the fluid, the author recounts his experience in 105
cases of various nervous diseases which he has recently examined.
Whereas in the normal fluid not more than four cells should be
seen, under a magnification of 400 diameters, in the deposit obtained
after centrifuging 5 c.c. of the fluid for five minutes; in certain
diseases this number, as is well known, is greatly exceeded. Thus
there were more than 4 and less thaD 10 lymphocytes in the field
in the following five cases: combined degeneration of pernicious
anaemia (1 case), acute myelitis in syphilitic patients (2 cases),
tuberculous tumour of cortex cerebri (1 case), persistent headaches
of obscure origin (1 case).

In six cases there were from 10 to 25 lymphocytes to the field.
Gumma of the spinal cord, Landry’s paralysis, endothelioma of
spinal cord, cerebral thrombosis with hemiplegia, post-epileptic
visual hallucinations (? syphilitic), old syphilitis + hemiplegia,
functioned type.

ABSTRACTS

505

Moreover in the following conditions from 25 to 400 lympho¬
cytosis, or even more, were presentln each field: G.P.I. (12 cases),
tabes (25 cases), gumma of crus cerebri, gumma of spinal cord,
syphilitic hemiplegia (thrombosis), tuberculous meningitis (2
cases), glioma of corona radiata, posterior hydrocephalus relieved
by operation.

In two cases of epidemic cerebro-spinal meningitis and menin¬
gitis from otitis media, a polymorpho-nuclear leucocytosis of 87.3
and 371 respectively was present. The lymphocytosis of tabes
and general paralysis is uninfluenced by the most energetic anti¬
specific treatment. Syphilis, unless it has actively attacked the
central nervous system, produces little or no lymphocyte increase
in the cerebro-spinal fluid.

Regarding the therapeutic applications of lumbar puncture, the
author points out that the lumbar puncture is often successful in
alleviating the headache of intracranial pressure. Ursemic coma
and convulsions are frequently relieved in a striking way. Re¬
ference is made to spinal anaesthesia.

Four special tables are given of lymphocyte counts in syphilitic
patients without signs of nervous disease (12 cases), in tabes
(25 cases), general paralysis (12 cases), and intracranial tumour
(13 cases). Edwin Bramwell.

TRANSITORY HEMIPLEGIA, WITH NOTES OF TWO OASES.

(276) Hamilton Graham Langwill, Scot. Med. and Surg. Joum.,
June 1906, p. 509.

The author records in this interesting paper the history of two
individuals who suffered from Severn attacks of hemiplegia of
brief duration. “ The patients were males, aged 57 and 71 respec¬
tively." In each patient there occurred a sudden seizure, having
all the features of a typical hemiplegic attack without loss of con¬
sciousness, perfect recovery of motor power following in less than
an hour, while in one case these attacks occurred on several occa¬
sions. In neither instance was there left any trace of motor en-
feeblement.

The author lays special stress on the suddenness of the recovery
and its perfectly complete character. After discussing the possible
etiology of the condition, he comes to the conclusion that the
paralysis was probably a consequence of a localised arterial spasm,
and in this connection refers to two papers, one by Dr William
Russell on “ Cerebral Manifestations of Hypertonus in Sclerosed
Arteries ” ( Practitioner , April 1906); the other by Dr R. A
Lundie, on “ Transient Spasm of the Retinal Artery ” ( Ophthalmic
Review, May 1906). Edwin Bramwell.

2 L

50G

ABSTRACTS

INFANTILE CEREBRAL HEMIPLEGIA; REFLEXES ABOLISHED

(277) IN THE LOWER EXTREMITIES AND LITTLE MARKED
IN THE UPPER EXTREMITIES. (HAniplfeie cdrdbrale in¬
fantile ; reflexes abolis anx membres inftirieura, pen prononefe
aox membres guplrieurs.) Bouchand (de Lille), Arch. Gin. de
Mid., May 15, 1906, p. 1236.

Writers on infantile cerebral hemiplegia describe spasmodic hemi¬
plegia, hemiathetosis, and hemichorea, but scarcely mention forms
where spasticity and abnormal movements are absent, and com¬
pletely ignore the existence of cases in which the reflexes are
abolished. The case here recorded is that of a boy aged ten years,
the subject of left hemiplegia. He had been healthy until six
years old, when he had an illness lasting six weeks, and apparently
of the nature of a meningitis, from which he recovered completely.
Nine months later, however, there was a sudden appearance of
complete paralysis of the left arm and leg. Since that time
considerable improvement had taken place. There had been no
epileptic attacks. On examination he was noted to have deficient
intelligence; marked weakness and arrest of development of the
left arm, and slight of the left leg; but no affection of the face.
The reflexes of the arms were not exaggerated; those of the legs
were absent; there were no contractures. The electrical reactions
of the muscles in both affected limbs were normal. The differen¬
tial diagnosis is indicated, the literature of the subject reviewed,
and probable explanations of the diverse manifestations of the
disease discussed. Henry J. Dunbar.

(278) CEREBELLAR APOPLEXY. Starr, Med. Record , May 12, 1906.

Although this condition is undoubtedly much rarer than cerebral
apoplexy, the writer having found only four cases of cerebellar
disease in 187 cases of apoplexy examined post-mortem, he urges
in this paper the distinctiveness of its symptoms and the import¬
ance of its diagnosis.

Five cases of cerebellar apoplexy are detailed, the symptoms
which they presented in common being vertigo of an extreme
degree at the onset, and remaining to some extent as a permanent
feature; uncertainty of gait and staggering due to lack of balancing
power; an unnatural position of the head at rest; nystagmus,
vomiting, and headache.

The author attaches great importance to diagnosis, because he
believes that cases treated as “ stomach vertigo ” in old people may
be due to this condition, in which case the treatment for apoplexy
is essential. He gives a copious bibliography.

John D. Comrie.

ABSTRACTS

507

INTRAO&ANIAL ANEURISMS. Byrom Bramwell, Clinical Studies,
(279) July 2, 1906, p. 289.

Large intracranial aneurisms are of rare occurrence. In this
paper the author describes in detail and illustrates six such cases.

The following is a brief account of the leading features of the
cases reported:—

Case 1. Large aneurism of the left internal carotid artery;
severe headache, chiefly limited to the right side of the head; com¬
plete loss of sight in the right eye, loss of sight in the temporal
part of the field of vision in the left eye; death from uraemia five
years after the patient was in hospital and nine years after the
first symptoms.

Case 2. Chronic dementia in a woman aged 43; syncopal
attacks; headache; obesity; partial left-sided hemiplegia; diffi¬
culty of articulation and deglutition; progressive stupidity and
drowsiness; death two years and nine months after the symptoms
were first complained of; an aneurism, the size of a small orange
springing from the right posterior cerebral artery, and projecting
into the third and lateral ventricles; softening of the brain tissue
around the tumour; haemorrhagic pachymeningitis.

Case 3. Temporal hemianopsia; mental derangement; symp¬
toms of a cerebral tumour; blindness; mania; gradual and pro¬
gressive hebetude; death; an enormous aneurism of the right
internal carotid within the skull; erosion of the sella turcica;
pressure upon the optic nerves, optic chiasma, and optic tracts;
softening of the brain tissue around the tumour.

Case 4. Aneurism of the basilar artery; meningeal haemor¬
rhage ; immediate coma; death in fourteen hours.

Case 5. Aneurism of the left internal carotid artery; rupture;
convulsion; violent delirium followed by pain in the back part of
the head, stiffness of the neck, and retraction of the head. Second
rupture a fortnight after the first attack; convulsions; delirium;
coma; rapid rise of temperature; death.

Case 6. Aneurism of the right middle cerebral artery; rupture,
attended with sudden pain in the head, and vomiting; gradual
onset of coma and left hemiplegia four hours after the accident;
rapid development of Cheyne-Stokes respiration; death from
failure of the respiration six hours after the rupture.

In the same number the author reports three other cases of
tumour in the same situation, viz. a large tumour of the pituitary
body pressing upon the optic chiasma, a pituitary tumour without
acromegaly, and a syphilitic gumma involving the optic chiasma,
with recovery. Edwin Bramwell.

508

ABSTRACTS

BXTRA-OEBE BELLAS TTJMOUBS. Byrom Bramwell, Clinical
(280) Studies, April 2, 1906, p. 254.

Four cases of tumour in the cerebello-pontine angle are described.
One of these is of especial interest since the patient was operated
upon and a growth of considerable size removed.

The following are some of the details of the case: The patient,
a male, aged 27, when seen in November 1905, stated that for
eighteen months he had been deaf in the left ear, and that soon
after this was first noticed his eyesight became affected. Some
time after this he found that his “ gait ” was unsteady. He had
never had any tinnitus, vomiting, giddiness, or headache, although
he occasionally felt a pain above the eyes. The family history was
unimportant.

On examination it was noticed that he walked somewhat
unsteadily, swaying especially to the left side. The head was
turned slightly to the left, and the left ear depressed slightly
towards the left shoulder. This position of the head might have
been accounted for by a marked lateral curvature of old
standing.

There was complete deafness both to aerial and bone conduction
in the left ear. Well-marked optic neuritis was present, more
advanced in the right eye. There was imperfect fixation on
conjugate movement to the left, and slow, coarse nystagmus on
attempting to keep the eyes in the position of extreme deviation
to this side; lateral movement to the right was attended with
quick nystagmoid jerkings.

Beyond these points nothing abnormal was detected. The
opinion was expressed that there was an intracranial tumour
probably situated in the left cerebello-pontine angle.

The patient was admitted to hospital on December 20th. At
that time his gait was much more unsteady, and in addition there
was a distinct upper neuron paresis of the right side of the face
and some inco-ordination in the left hand.

The patient was subsequently operated on by Mr Cotterill
in two stages. At the second operation on January 9th, 1906,
after the dura had been opened it was found necessary to take
away a large part of the left lateral lobe of the cerebellum in order
to expose the tumour, which proved to be as large as a small hen’s
egg. The growth was removed, and on microscopical examination
proved to be a fibroma. Unfortunately the patient died from
respiratory failure eighteen hours after the operation.

Edwin Bramwell

ABSTRACTS

509

THE MENTAL SYMPTOMS OF CEREBRAL TUMOUR. Phillip
(281) Coombs Knapp, Brain , 1906, p. 35.

In this paper the author has endeavoured to estimate the frequency
of the occurrence of mental symptoms in cases of cerebral tumour
from the clinical study of 104 cases, in which a growth of some
nature was found at the autopsy.

Of these 104 cases, 40 were rejected on account of various
complications, so that the author has based his investigations upon
the study of 64 uncomplicated cases of tumour. In 58 of these
cases (in over 90 per cent.), mental symptoms were noted; but the
author holds that in every case of brain tumour presenting any
cerebral symptoms, some mental symptoms can probably be
discovered by a competent observer.

With regard to the nature of the mental symptoms occasioned
by a growth within the skull, the author found that in 31 cases
there was mental failure and dulness, the patients exhibiting vary¬
ing degrees of languor, somnolence, apathy, mental torpor, failure
of memory, and a general failure of all the mental functions, ending
usually in complete stupor and coma.

Seven cases showed mental confusion and disorientation with
mental failure, loss of memory, irrelevancy in speech, mild mental
wandering, somnolence, and a dazed mental condition.

In 15 cases the mental impairment went on to actual states
of delirium, and, even in some, to mania. Actual hallucinations
and vague and unsystematised delusions were also observed.

Neurasthenic and hysterical states were observed in the earlier
stages of the disease in some cases, but always developed more
marked mental disturbance later on. True, Wizelsucht was not
observed in any of the cases.

In about half of the cases the onset of the mental symptoms
.was early; confusion, mental dulness, somnolence, etc., charac¬
terised the earlier stages; delirium, violence, and profound stupor
the later stages.

The cases examined did not bear out Schuster’s figures with
regard to the more frequent occurrence of tumours in the left side
of the brain, but brought out the fact that in laige growths the
mental change was more marked.

The detailed examination of the actual symptoms in relation
to the site of the growth did not give any support to the theory
which seeks to establish one special psychical centre in the
brain.

The investigations of the cases according to the period of
development of the mental symptoms brought out the fact that in
tumours of the corpus callosum or of the corpora quadrigemina the
mental symptoms were of early development, and that next in
importance, in point of time, come the temporal and frontal lobes,

510

ABSTRACTS

followed by the other regions of the prosencephalon, the optico-
striate region, the hypophysis, and the brain stem. The study of
these cases lends support to the belief that the temporal lobe,
apart from its association with the function of speech, has perhaps
as important a share in the psychical functions of the brain as the
frontal lobe.

Regarding the pathogenesis of the mental symptoms, various
explanations have been brought forward. The mental disturbance
may be due to (1) focal deficit or irritation, or (2) to increased
intercranial pressure, or (3) to the formation of certain toxines in
the brain, either from the new growth itself or by the disturbance
of the circulation caused by the growth.

The author brings out the resemblance between the mental
symptoms usually met with in cerebral tumour and those occurring
in toxic psychoses, but was unable to find any special relation
between the nature of the growth and the character of the mental
disturbance except that in cases of sarcoma the delirious conditions
were more apt to occur.

In conclusion, he points out that the cases he studied reveal
nothing as to the nature or even the existence of toxines, but he
considers that although the situation of the growth is often of
influence in producing mental symptoms, especially in the early
stages of the disease, and probably has an influence upon the
nature of the symptoms, a combination of increased cranial pres¬
sure and the action of toxines is of greater importance, and in
some cases may be the only factor to be considered in the
production of such symptoms. T. Grainger Stewart.

A CONTRIBUTION TO TEE STUDY OF CEREBELLAR TUMOURS
(282) AND THEIR TREATMENT. J. J. Putnam and G. A Water*
man, The Joum. of Nerv. and Merit. Dis., May 1906.

This paper contains reports of four cases of cerebellar tumour and
three cases of tumour in the cerebello-pontile angle. Three of the
cerebellar cases were successfully operated upon, and the remain¬
ing case died before an operation could be performed. Of the
cerebello-pontile cases, one was operated upon and the growth
removed, but the patient died suddenly four days later. One of
the other two cases was wrongly diagnosed, and in the third case
the presence of fits with a sensory aura in the arm led in the first
instance to a diagnosis of tumour of the opposite Rolandic area.
Both these cases show some of the points to be brought out in the
differential diagnosis of such tumours, and further points of interest
in this connection are illustrated by the reports of a case of tumour
in the fourth ventricle and a case of pontine tumour. The authors

ABSTRACTS

511

strongly advocate operative treatment, and condemn the practice
of treating such cases with iodide for long periods; such treatment
never being successful, and often rendering the chances of success¬
ful operation less hopeful. The operations were always carried
out in two stages. The chief danger attending operation is failure
of the respiratory centre. This occurred in two cases: in both
artificial respiration was resorted to, and the patients made a
complete recovery. T. Grainger Stewart.

THE SIGNIFICANCE OF JA0K80NIAN EPILEPSY IN FOCAL
(283) DIAGNOSIS, WITH SOME DISCUSSION ON THE SITE
AND NATURE OF THE LESIONS AND DISORDERS
CAUSING THIS FORM OF SPASM. Mills, Boston Med.
and Surg. Joum ., April 26, 1906.

The writer defines Jacksonian epilepsy broadly as “ monospasm or
hemispasm due to cortical or cortico-subcortical discharge,” but
states that it is by no means true that it is always, or even nearly
always, due to gross lesion of the motor zone.

He records, in the first place, several cases of successful opera¬
tion for tumour, cyst, or gumma of the cortex, in which the focal
diagnosis had been correctly made by observation of the parts
involved in the Jacksonian attack, but the greater part of this
lengthy paper is taken up by an examination of the fallacies which
may interfere with diagnosis. He considers that this symptom
may arise in the following five sets of conditions: (1) Tumours
in other parts of the brain than the motor cortex. The writer
records two cases of this condition produced by tumour in the
cerebello-pontine angle, and quotes two cases of cerebellar tumour
recorded by Collier, in which the symptom is attributed to accom¬
panying hydrocephalus. On the other hand, the writer states that
he has had several cases of parietal tumour involving the motor
area in which Jacksonian epilepsy was not present, ana he believes
that destruction of the sensory cortex and subcortex before in¬
volvement of the motor fibres or cortex gives a certain immunity
from spasm. (2) The symptom may also be due to other lesions
of the motor cortex besides tumours, e.g. depressed fractures,
localised meningitis, meningeal or cortical haemorrhage, focal
encephalitis, or focal necrosis from embolism or thrombosis. He
discusses the diagnosis of these and quotes numerous cases.
(3) Jacksonian epilepsy may occur in toxic and other diseases with
no demonstrable focal lesion of the brain. The writer states that
one of the most striking cases of this symptom that he has seen
occurred in a case of diabetes, while it is also occasionally a sign
of uraemia or of acute alcoholism. (4) Peripheral irritation

612

ABSTRACTS

almost anywhere in the body may cause a convulsive attack, and
this in rarer instances may assume the Jacksonian type. In this
connection the writer records a case due to a fibroma in the palm
of the hand. (5) Jacksonian epilepsy may be simply a part or the
entire expression of a case of idiopathic epilepsy.

Numerous references to the literature of the subject are also
given. John D. Comrik

THE SOMATIC EVIDENCES OF SYPHILIS IN PARETICS.

(284) Winfixld (of Brooklyn), New York State Joum. of Med., May
1906.

There were 241 cases of general paralysis examined from six of
the State hospitals in the neighbourhood of New York. All but
six were males. The reason why more females were not examined
was because the cutaneous evidences of syphilis in women are not,
as a rule, as well marked as in men; consequently it was thought
best not to submit the females to the rigid examination necessary.
All were examined for external evidences of syphilis, irrespective
of any history of the disease: 165 had scars and markings that
were typical of cutaneous syphilis; 76 showed no external evi¬
dences whatever. The hospital histories showed, however, that
28 of the 76 negatives gave an undoubted history of syphilis. If
these 28 are added to the 165 exhibiting evidences of cutaneous
syphilis, there would be 193 out of 241, or about 80 per cent., that
had had syphilis.

Cutaneous phenomena were more common and more pronounced
among the patients confined in the rural hospitals than among
those confined in the metropolitan hospitals. This is explained by
the ease of obtaining treatment at the free hospitals and dispensaries
of a metropolis.

Of those of foreign birth, the greatest number were Germans,
31; Irish, 17; Russian, 8; Italian, 5; English, 4; Austrian,
Hungarian, and Swedish, 2 ; French, Roumanian, Finnish,
each 1.

Concerning the distribution of scars, Winfield states “ 46 had
scars on the penis; 77 had scars on the legs and thighs; 73
showed markings over the trunk; 18 over the arms and hands;
14 had inguinal scars (bubonic) ; 30 had general adinitis; 3 had
mucous patches on the scrotum; 7 had scars and tophi on the
scalp; 4 showed scars and destruction of the lips, nose, and
palate; 20 had nodes along the tibia; 5 showed ptosis, 4 blind¬
ness from optic neuritis, and 2 showed the stigmata of congenital
syphilis. C. H. Holmes.

ABSTRACTS

513

THE SUPPOSED IMMUNITY OF SYPHILITIC ARABS REGARD-
(285) ING GENERAL PARALYSIS. (La Mgende de rimmunitd
d«s Arabes syphilitiques relsttvement It la par&lysie gdndrale.)

Maris, Rev. de Mid., May 10, 1906.

This is a contribution to the question of the relation subsisting
between syphilis and general paralysis, as well as a refutation
of the commonly accepted opinion that general paralysis is not
frequent among the Arabs. The inquiry is based upon the
statistics of the admissions to the Abbassieh asylum for insane at
Cairo, numbering 3600 in ten years. The writer found here that
the general paralytics made up 6 per cent, of the admissions, and
though this is but half the rate for Paris, it is greater than that
found in provincial French asylums. Taking two years from the
middle of the decade, 1900 and 1901, the numbers of Arabs were
respectively 21 and 23 out of totals of 25 and 35 general paralytics
admitted to the asylum. As to syphilis, while its prevalence in
the cases throughout the asylum was only 12 per cent., among the
general paralytics 79 per cent., or about six times as many, were
proved to be syphilitic.

Some interesting facts are also given as to the native treatment
of the insane among the Arabs, and reasons advanced why in
Tunis and Algeria general paralysis appears to be less prevalent
than in Egypt. John D. Comrie.

COMMUNICATION ON THE “ HYSTERIA ” OF ANIMALS. (Mit-
(286) teilungen fiber die “Hysterie” der Tiere.) J. Mainger,
Neurolog. Cenlralbl., May 16, 1906, p. 438.

The literature on this subject is very sparse. This is doubtless
in part due to the attitude taken by most veterinary suigeons to¬
wards the study of the mind in animals. Yet if only from a
theoretic standpoint the cases of hysteria are of great interest,
occurring as they do in minds which are relatively simple. After
a critical review of the literature, Mainger affirms that only five
true cases have been published; most of those labelled hysteria in
animals, even the oft quoted one of Charcot’s, are really cases of
other psychoses. Mainger has personally observed three other
cases which he now publishes.

Gase 1 . Female fox-terrier, aged 2. It suffered first from a
broken pelvis through a horse kick, and limped in the right hind
leg for six months. Then the right fore leg was broken, and later
the dog was twice run over by a bicycle with no ill result One
day when scrambling up a loose pebbly slope, which was too steep
to allow progress, it slipped back in spite of all its efforts, and

514

ABSTRACTS

when reached by its master had first the right, then both hind
legs strongly contracted. This was followed by opisthotonos with
no loss of consciousness. It was unable to stand or move the hind
legs for five minutes, and then unexpectedly recovered power. It
died of poisoning a year later and no changes were found in the
nervous system.

Case 2. Male Bolognese dog, aged 1 Convulsive attacks
occurred not infrequently. These were epileptiform in nature and
were followed by a temporary amnesia, so that the animal would
snap at its master. They were brought on chiefiy by a fear, akin
to agoraphobia, that occurred on the dog being forced to enter an
open space, such as a field. Occasionally exciting episodes, such as
losing its master, being in a crowd of other dogs, etc., would also
induce attacks.

Case 3. Fox-terrier, 18 months old. Attacks occurred until the
age of 2. They consisted in extensor spasm with opisthotonus;
staring eyes; consciousness was retained. They were induced by
anxious moments, such as losing his master or finding himself
the centre of interest of strange dogs. The master, an electrical
engineer, was advised to use farachsm, but this made the dog
worse, invariably inducing an attack.

The psychical origin of the attacks in every case is insisted on
by the author, who then discusses in an interesting way the bearing
of the cases on human hysteria and especially on the treatment of
this. Ernest Jones.

ISOHBMIO MUSCULAR ATROPHY, CONTRACTURES, AND
(287) PARALYSIS. Alex. Hugh Ferguson, Ann. of Surg., April
1906, p. 599.

The changes described are those in muscles, following more or
less complete arrest of their blood supply. A brief r&umd of
the causes, symptoms, pathological anatomy, and course of the
condition is given. Tight splinting was the cause in the two
cases referred to in this article. The sequence of symptoms is
briefly as follows—parsesthesia, pain, cramps, loss of electric
irritability, muscular rigidity, and contractures followed by
flaccidity, and ultimately permanent contractures from muscular
atrophy and overgrowth of fibrous tissue. In both cases operated
upon by the author there was marked flexion of wrist and fingers,
which could not be overcome by any ordinary force; the muscular
bellies, especially of the flexors, were atrophied; and there was
more or less paralysis, with sensory and vaso-motor disturbances.
The operative procedure consisted in free exposure of the con¬
tracted flexors, the bellies and tendons of which were found to

ABSTRACTS

515

be matted together and extremely atrophied, followed by separation
of the adhesions, and lengthening of each of the musculo-tendinoua
structures by one of the ordinary surgical methods. The median
and ulnar nerves were freed and stretched. Finally, sterile olive
oil was poured over the tendons to prevent immediate re-adhesion
and the wound was closed. The post-operative reports show that
complete passive movement and a fair amount of voluntary move¬
ment became possible, the result being a great improvement, though
not by any means a restoration to a normal condition. The nerves
were so shortened and fixed that forcible extension of the limb
would probably have ruptured them. The author thinks that
resection of part of the bones, with consequent shortening of the
forearm, might be a better operation than tendon splicing. Various
references to the literature of the condition are given.

W. J. Stuabt.

ON UNILATERAL L088 OF, AND ON SUBSEQUENT RETURN
(288) OF A LOST KNEE-JERK. (Ueber einseitiges Fehlen und fiber
die Wiederkehr des verschwunden gewesenen knieph&nomens.)

Gaston Wehrung, of Bonn, Newrolog . CentnUbl ., May 1, 1906,
p. 391.

This contribution is based on three cases observed with care in
Westphal’s clinic, and subsequently examined post-mortem.

Case 1. Woman, aged 40. Complaint chiefly was of psychical
and intellectual symptoms. Pupils were unequal and quite fixed.
The left knee-jerk was very active, the right absent, even with
Jendrassik. This condition remained absolutely the same during
the ten months she was under observation. The left limb was
spastic and the right flaccid. Post-mortem, there was found in
the thoracic and upper lumbar region a slight degeneration at the
side of the posterior columns, especially in Westphal’s root entry
zone, on the right side, whilst on the left the corresponding part
was healthy. There was also some degeneration of the pyramidal
columns, most marked on the left side. The clinical signs were
thus explained.

Case 2. Woman, aged 31. Case similarly of paralytic demen¬
tia, with unequal and fixed pupils. Rombergism. No Babinski.
Knee-jerk absent on both sides. After a second attack of right¬
sided paresis, the right knee-jerk returned. The left was also very
slightly observable for a short while. The right knee-jerk was
present till death, four months later. Post-mortem: (a) Van Gieson.
In cervical cord, slight fibrosis in both pyramidal columns. Many
small haemorrhages in right posterior horn. In thoracic cord, best
seen about the middle, is a symmetrical area of degeneration, mark¬
ing out the comma tract. Otherwise no fibrosis worth mentioning

516

ABSTHACTS

in the pyramidal tracts of the thoracic or lumbar cord. Slight
change, equal on both sides, in posterior columns of lumbar cord.
Four or five haemorrhages in posterior horn and Clarke’s column
at the level of the first lumbar segment on the left side. ( b ) Pal-
Weigert Similar to above, (c) Marchi. Recent degeneration in
posterior columns only.

Case 3. Man, aged 38. Also a case of paralytic dementia.
Pupils unequal and fixed. No Rombergism. Knee-jerks and
Achilles-jerks absent. After an attack, which was not followed
by paresis, the right knee-jerk reappeared, and ten days later the
left also. In a fortnight they had again disappeared, but after
another attack, a week later, the right returned and remained
active for two months, failing only two days before death. Post¬
mortem, no changes were found in the pyramidal tracts by any
method, save Marchi. Moderate degeneration of the posterior
columns was found throughout the cord; this, in the lumbar
region, was more marked on the left side, especially in the root
entry zone. By Pal-Weigert staining, the fibres entering Clarke’s
column were seen to be degenerated on the left side, not on the
right.

From a consideration of these cases, and others that the author
reviews from the literature, the conclusion is reached that retention
of the knee-jerks in tabes depends on the escape of the root entry
zones from degeneration, and that their reappearance can occur
only when these zones are not severely affected. Pick’s hypo¬
theses on the subject are discussed, and the one favoured that
assumes disappearance of the knee-jerk to depend on obstructions
in the nerve path, and reappearance on the removal of these
obstructions. Ernest Jones.

DEAFNESS DDE TO HYSTERIA AND ALLIED CONDITIONS

(289) P. M ‘Bride, Edin. Med. Joum., May 1906, p. 391.

The author discusses the subject of deafness due to hysteria and
allied conditions, and points out the difficulty of being sure of the
diagnosis in such cases until the hearing is restored.

In one of the seven cases recorded (No. 3) it was noted that a
tuning fork placed on the vertex was heard less clearly when the
ears were closed. Case 4 had already suffered from hysteria when
first seen, and the subsequent notes showed that the hearing power
returned and went away again on several occasions. Case 7 is
interesting, because it showed a diminution of sensibility of the
auditory canals and tympanic membranes, and also because the
patient stated at the beginning of the examination that the tuning
fork, when placed on the vertex, was heard best by the left ear,

ABSTRACTS 517

whilst at the end of the examination she located the sound in the
right ear.

Dr M'Bride next discusses the literature of the subject, and
quotes Politzer as saying that hysterical deafness is usually con¬
fined to one side, that bone conduction is lost, and that this kind
of deafness is associated with diminished sensibility.

Dench is also referred to, especially with regard to the percep¬
tion of high and low notes—“ Upon one side the upper tone limit
will be found greatly reduced, while the organ of the opposite side
will perceive the highest tones of the scale with ease. On repeat¬
ing the experiment the condition will be exactly reversed, and this
alternation may be repeated several times during the examination.”

According to Oppenheim, as quoted—“Unilateral hysterical
deafness does not interfere with hearing, as a whole, to any great
extent . . . often they are not aware of the deafness . . . bilateral
deafness is usually only a transient phenomenon.”

Boulay and Marc’hadour have described cases similar to those
given by Dr M'Bride in his paper: he gives the following extract,
among others, from their writings:—“But whether the dynamic
trouble occupies the whole scene, or whether it is superadded to an
affection of the ear, it is always possible to track it, for it has from
its beginning a special stamp . . . diminution or absence of sensi¬
bility of the meatus and membrane, disappearance of perception
for high and medium tones, absence of subjective trouble, diminu¬
tion or disappearance of bone conduction ... in hysteria the
central neuron has lost its connection with the peripheral ... a
corollary—the absence of subjective phenomena.”

The author states that he cannot attempt to give a r&umd of
Gradenigo's work, though he considers it the most complete on the
subject: some of the more important points are, however, clearly
noted.

Finally, in investigating one of these cases, Dr M'Bride suggests
the following points as worthy of attention:—

1. Is there any marked discrepancy between the history and

the results afforded by objective examination ?

2. Do the history and manner of the patient suggest hysteria?

3. Do history and results of examination accord with any of

the recognised forms of organic disease ?

4. Is there any evidence of sudden improvement of hearing

when patient is interested ?

5. Do repeated hearing tests give the same result ?

6. Is there any anomaly of hearing ?

He points out, in conclusion, that there is no question of prog¬
nosis in these cases, for the diagnosis itself is only made certain
when there is no longer a question of prognosis—in other words,
when hearing has returned. J. S. Fraser.

518

ABSTRACTS

DEVELOPMENTAL ALEXIA (CONGENITAL WOBD-BUNDNES8).

(290) By Edward Jackson, M.D., Am. Joum. of the Med. Sc., May
1906, p. 843.

This condition was first described by Hinshelwood in 1900. Other
cases have been reported, the number including the author’s cases,
now amounting to nineteen.

The present article describes two cases.

Case A. A girl, set. 11 years, came in April 1900, for headache,
eye-strain, and special difficulty in reading. General intelligence
good. Hesitates and miscalls the larger letters on the test-card,
as much as the smaller ones. Under special tuition at home the
difficulty gradually decreased. February 1900.—She now reads
letters without hesitation. Reads a good deal and enjoys it.
January 1905.—Her ability to read seems quite normal.

Case B. A boy, set. 7 years, brought because his teacher says
“ he cannot see letters either near or far.” After a year at school
he only recognises with certainty O and H. Has full vision with
each eye. Slight hypermetropia. Seems bright and intelligent.
Recommended special tuition at home, and on February 18th he
is said to be making good progress with his reading, and to have
no difficulty with figures.

The writer gives references to, and a brief summary of, the
seventeen previously described cases. He does not seem to be
aware of the cases described by Dr Kerr in his last Report as
Medical Officer to the London School Board, nor those described
by Dr Sydney Stephenson in the “ Reports of the Society for the
Study of Disease in Children,” Vol. iv. W. B. Drummond.

PSYCHIATRY

THE COMING OF PSTOHASTHENIA. G. A. Blumer (Providence,
(291) R.I.), Joum. of Nero, and Ment. Die., May 1906.

Psychasthenia is a condition, not a disease, and its interpretation
should be widely extended. It is an exhaustion, and not a defect
psychosis, although it may be evolved from an inborn weakness
and instability. Symptoms common to this condition are not in¬
frequent in the early stages of paresis, dementia prsecox, manic
depressive insanity, and senile dementia.

Janet makes five divisions based upon the degree of the morbid
mental condition: (1) the simple neurasthenia with physical and
moral depression, but without any accompanying sense of disease;
(2) the patient who feels acutely and suffers from his state of
depression, but shows a tendency to exaggerate and to generalise;

ABSTRACTS

519

(3) one who has crises of agitation and anguish; (4) one who
exhibits tics, phobias, or mental manias; (5) one who summarises
all preceding disorders in obsessional ideas of shame, crime, sacri¬
lege, expressed by crisis or continuously.

Janet makes three divisions according to symptoms into (1)
the motor, (2) the effective, (3) the intellectual fields. Blumer, in
conclusion, refers to the stirring events in psychiatry during the
past ten years; the introduction of the term dementia praecox,
the readiness with which it has been accepted, and its comprehen¬
siveness. He urges that the Americans do not expose themselves
to the criticism of a “ cynical confrere ” over the seas, who says
that in America “ everything is dementia prsecox from idiocy to
general paralysis.” C. H. Holmes.

THE FEELING OF UNREALITY. F. H. Packard (of Boston),
(292) Jou/m. of Abnor. Psychol., June 1906, p. 69.

A brief statement of the views held by previous writers upon the
loss of feeling of reality, introduces the case of an unmarried
woman, set. 34, in a third attack of depression of sudden onset,
who, at admission, sixteen months after beginning of attack, com¬
plained of a feeling of inadequacy, and especially of the feeling
of unreality related to external objects, her body, and personal
identity; this being associated with a belief in, and memory of,
reality. Examination proved no disorder of the primary sen¬
sations. Tests with associations of simple words (nouns with
appropriate adjectives and nouns associated by contrast) led to no
definite results. But upon being given a simple story to read she
found great difficulty in analysing and grasping the point; each
component simple sentence had to be gone over and “ visualised.”
Upon this basis an apperceptive disorder is considered as having
been demonstrated for this group of cases. The lack of prompt
apperception leads to a feeling of lack of familiarity or to the
feeling of unreality. This same line of explanation is brought to
apply to the association and apperception of matters in the
somato and autopsychic spheres of mental activity as well as in
the aldopsychic. G. Y. Rusk.

NATURE OF DEMENTIA PRjEOOX. Walker (Dixmont, Pa.),
(293) New York Med. Jowm., May 19, 1906.

Ik a mental disorder so clearly founded upon original inadequacy
of constitution of the involved organ, one expects to find anomalies
of structure indicative of this defect. Walker finds these abun¬
dantly present in his own cases; imperfectly formed and asymme-

520

ABSTRACTS

trical ears, palatal deformities, and facial asymmetries have been
present in all of his cases.

The mental symptoms are associated, as a rule, with bodily
states which are both significant and explanatory of the nature of
this disorder—poor appetite, loss of weight, anemia, headaches, in¬
somnia, and alteration and perversions of sensibility are among the
bodily symptoms mentioned.

The dementia is the one constant characteristic which unifies
all forms of this disorder, and this implies structural changes
(Cowles). Structural defect is first manifested by functional
failure, and to be able to interpret the early symptoms of func¬
tional failure is of extreme importance in order that errors in
nutritive functions, etc., may be corrected. The histories of several
cases are briefly reviewed, so as to emphasise the important facts
in the etiology, and the recognition of the earliest symptoms of
the disease. Whether manifested at puberty, during adolescence,
or in later adult life, and whether traceable to toxic agents or
influence of stress and exhaustion, dementia prsecox must be
viewed as a representative of a relatively late stago of mental dis¬
order, originating in an inherent defect in the vitality of the higher
brain cells. The apparent recovery in a small percentage of cases
is due to the relatively greater degree of vital endurance of the
brain cells, or to a less marked involvement of the lower vegetative
and organic functions. Under the favourable circumstances of
early diagnosis and treatment, these cases are brought back to
a normal state, because of the greater recuperative energy and
reparative powers.

When once the disease is established it is progressive, and it
leads ultimately to deterioration, which varies from a slight stunt¬
ing of mental development to a reduction as extreme as that which
follows any of the degenerative psychoses. There is no means by
which one may accurately foretell the outcome of a given case.

C. H. Holmes.

DIAGNOSTIC ASSOCIATION STUDIES, SIXTH CONTRIBUTION.

(294) PSYCHOANALYSIS AND ASSOCIATION EXPERIMENT.
(Diagnostische Assoziationsstudien. VI. Beitrag. Psycho¬
analyse und Assoziationsexperiment). C. G. Jung (of Zurich),
Joum. f. Psych, u. Neur ., March 1906.

The author gives the detailed examination of a patient suffering
from a psychogenic neurosis by means of his association method,
and of Freud’s psycho-analytic method. The contribution is espe¬
cially useful as the analysis of the individual associations is
fully given, and the value of the method employed clearly
demonstrated.

ABSTRACTS

521

The patient was a woman of 37, a teacher, who came to
be treated by hypnotism for sleeplessness; in addition, she com¬
plained of inner unrest, impatience, and irritability. At the first
interview Jung was struck by her peculiar manner; she spoke
past him instead of addressing him directly; she made frequent
restless, twitching movements, one of the most characteristic of
which was the abrupt advancing of the lower part of the abdomen;
she said that she felt that she was incurable, would go insane.
Only after strong urging did she confess with much blushing and
evidence of disinclination, as if telling some sexual experience,
that she was unable to go to sleep because of the besetting idea,
which would continually crop up, that she could not sleep, and
would not until she was dead. She was also brought to confess
that she had other obsessions. She denied, and apparently frankly,
any sexual incident in the past. Owing to her condition, an
attempt at hypnotism was not successful; accordingly, Jung
applied his association method in order to get some clue to the
disorder. He records the 100 association words used and the
reactions of patient, and shows how these reactions pointed un¬
mistakably to the existence of an underlying sexual complex. To
those unfamiliar with the method of Jung and his results, the
conclusions may seem unsound and almost fantastic, but his con¬
clusions are the result of a very thorough study of associations,
various parts of which have been published in this journal. The
average reaction time of patient was 2*4s., while a person of her
education would normally have a figure near 1*5. Examining
those reactions which showed marked retardation, more than one
complex was elicited, the most prominent being the sexual com¬
plex. The physician told patient that her obsessions were merely
the distorted expression of an underlying sexual current, and that
she was beset by sexual ideas. Patient denied this earnestly, and
with considerable emotion. In the next interview Jung applied
Freud’s psycho-analytic method, or the method of spontaneous
association; this method consists in merely inducing the patient
to tell without reserve whatever chances to crop up in her mind.
For the first half hour patient gave practically little, but before the
sitting was concluded she had told of an indecent proposal made
to her several years previously; the disclosure was made unwillingly,
after much internal struggle, and was accompanied by the same
gestures as had struck the physician on the first interview.
During three weeks, on alternate days, the interviews were con¬
tinued, and by the end of that time patient had disclosed a fund
of sexual memories dating back to her childhood. In the store of
images thus disclosed, the act of coitus was the most prominent,
and was the centre round which later associations had disposed
themselves. Patient herself had not been conscious of this master
2 M

522

ABSTRACTS

motive at work in her sub-conscious life. The governess had
swept the chambers of her mind clean, but did not know the
nature of the contents of the cellars, nor of the influence of the
latter upon her conscious life. The existence of a psychic trauma
long before puberty in her case confirms Freud’s view of the
great importance of this as a dissociating factor in one’s mental
life.

For some time after these interviews patient was tormented
with obsessions of a sexual character, but later all these obsessions
and the secondary obsessions, which had developed without her
being conscious of their relation to her sexual life, disappeared.
Her sleep was restored, and only occasionally was disturbed
through sexual ideas. Jung sums up as follows: (1) in psycho¬
genic neuroses the complex which is disclosed by the associations
is the cause of the disease (the predisposition being supposed);
(2) the association method enables one to discover the pathogenic
complex, and to shorten Freud’s psycho-analytic method; (3) the
association method shows us that hysterical phenomena and
obsessions may be derived from the one complex; bodily and
mental symptoms are merely symbolical derivatives of the
pathogenic complex. C. Macfie Campbell.

FRAGMENT OF AN HYSTERIA ANALYSIS (Bruchstiick einer
(295) Hysterie-Analyse). S. Freud (of Vienna), Monatschr. f. Psych.

«. New., Oct.-Nov. 1905.

In this communication, with its modest title, Freud does more
than merely analyse the mechanism of the disorder in the case
which he describes; he continually diverges to wider issues, and
with the one case as his text, he gives his general views on the
psychopathology of hysterical and allied disorders. He again
emphasises his belief that a psychic trauma of a sexual nature
before puberty is at the root of the hysterical dissociation; he
traces out through all their subtle ramifications the submeiged
mental complexes and their manifestations, both physical and
psychical, in the conscious life of the individual; he lays stress on
the existence at an early age in the psychical constitution of the
individual of homosexual tendencies, which may not be suspected
by the owner, but which no less modify his reactions. Gestures
and actions of apparently the most trivial import are explained in
their symbolic meaning with reference to subconscious trends and
groups of associations; and dreams are subject to rigid analysis,
and shown to be equally determined, even in detail, by the same
subtle influences.

Freud's interpretations are subtle, far-reaching, and so bold that
they make the reader gasp ; but his strenuous endeavour to push

ABSTRACTS

523

his analysis as far as possible, and to demonstrate universal laws
in what appear the most capricious and evasive aspects of mental
life, is stimulating from the point of view of psychological insight,
and has already given valuable clinical results.

Such work necessitates a most searching investigation into the
sexual elements in our mental constitution, and it is unfortunate
that the author has to spend time in defending this aspect of his
work against those who fail to take a sufficiently serious grasp of
the problems involved. C. Macfie Campbell.

IDIOCY AND A CEREBELLAR LESION. AMELIORATION OF

(296) SYMPTOMS. (Idiotie et lesion clrlbelleuse. Amelioration
des symptomes.) Jules Yoisin, Roger Yoisin, et A Randu,
Arch. G6n. de Mid., May 29, 1906, p. 1365.

When idiocy is associated with cerebellar symptoms it is ex¬
tremely rare for any improvement to take place, and the case
here recorded is therefore of some interest. It is that of a girl
who was not thought to be in any way abnormal until defects of
speech and walking drew attention to her condition. The birth
had been natural, but at the fourth month of intra-uterine life the
mother had received a severe emotional shock resulting in syncope.
On admission to the Salp4tri&re at the age of 7^ years the patient
could only speak one or two words, did not understand what was
said to her, could neither walk nor stand erect, and was generally
helpless. The knee-jerks were diminished. Since then—twelve
years ago—she has steadily improved both physically and mentally.
The intelligence, however, is still poor, and her gait is now
markedly cerebellar; speech slow and syllabic, knee-jerks ex¬
aggerated, and nystagmus present. The writers discuss the
differential diagnosis from hereditary cerebellar ataxia, Fried¬
reich’s ataxia, and disseminated sclerosis. They consider the
condition one of combined lesion of the cerebrum and cerebellum,
dating probably from foetal life, the exact nature of which it is
impossible to determine. Henry J. Dunbar.

TJEBER DIE STIMMUNGSSCHWANKUNGEN DER EPILEPTIKER.

(297) Prof. Dr Gustav Aschaffenburg, Sammlimg zvoangloser
Abhandlungen aw dem Gebiete der Nerven- und Geisteskrankhetien,
Bd. vii., H. 1. Carl Marhold, Halle a. S., 1906, pp. 55, price
M. 1.60.

In this important and extremely interesting paper, Prof.
Aschaffenburg seeks to show that fluctuations in affective tone
form a specific symptom of epilepsy, a symptom which on account of

524

ABSTRACTS

the frequency of its appearance is of the greatest diagnostic value,
and, further, that neither convulsive or vertiginous attacks nor
emotional depression are the cardinal symptoms of epilepsy,
but periodic fluctuations of psychic equilibrium which, according
to the participation of the central nervous system, may lead to
lighter or severer disorders of consciousness, and which may,
but also may not, be accompanied by convulsions. This widened
conception of epilepsy is, of course, of the utmost importance from
its bearing on conduct, and particularly criminal conduct. It will
be remembered that in 1895 Aschaffenburg read a paper,
published in the Archiv. fiir Psychiatric (Bd. xx., S. 955), on
“ Certain Forms of Epilepsy,” in which he described these periodic
fluctuations and, following Hoffmann, who first (in 1862) used the
term “epileptic equivalent,” strongly maintained their epileptic
nature. His observations were mainly made upon dipsomaniacs
under detention and the patients were subject to periodic attacks
of bad spirits, during which they became tired, depressed,
meditated suicide, had impulses to wander and escape, were
fearful and apprehensive without cause, and suffered from head¬
ache, but without either delirium or obvious intellectual disturb¬
ance. Outside the Institution the patients sought to relieve their
depression by recourse to alcohol, which was quickly followed by
stuporous or dazed states (. Dammerzustande ), indistinguishable
from those of epilepsy proper. By a comparison of these results
with those obtained at the Heidelberg Klinik for insane epileptics
requiring compulsory detention, an admittedly circumscribed class,
the author’s opinion that these fluctuations were of epileptic
nature, and may either accompany or replace the classical type of
attack, was corroborated. Prof. Aschaffenburg’s views have been
widely criticised, and on account of the partial nature of his
former material he now, on the basis of extended studies and
with material to which exception cannot be taken, again opens up
the whole question. The two questions which he sets himself to
answer are:—

(1) Are these fluctuations characteristic symptoms of epilepsy ?

and

(2) In what way are they distinguished from similar disturb¬
ances in the psychopathies in general ?

Prof. Aschaffenburg finds the answer to the first question
comparatively easy, and he shows by means of tables, firstly, with
regard to epileptics with convulsive attacks; and secondly, with
genuine epileptics having no convulsions during their observation,
that with the exception of vertiginous attacks, the periodic
fluctuations form the most characteristic feature, the actual
order of frequency in 50 cases investigated, entirely unselected,
being vertigo (74 per cent.), periodic attacks of depression

ABSTRACTS

525

or excitability (70 per cent.), petit mal (58 per cent.), “ fainting
attacks” (44 per cent.), convulsive seizures (42 per cent.),
stuporous states (36 per cent.), wetting beds (28 per cent.), and
impulses to escape or wander (18 per cent.). The striking feature
of these results to which Prof. Aschaffenbuig directs attention is
the place in the list which convulsions take. All doubtful, or
only slightly marked, fluctuations were excluded from the records,
and, as the patients were nearly all prisoners undergoing sentences
for moral and other delinquencies, and thus under constant and
minute supervision, any convulsive seizure, however transitory,
would be bound to come under notice. Thus 70 per cent, of the
total epileptics showed, to quote Prof. Aschaffenburg, marked
variation of emotional tone as epileptic equivalents. These
fluctuations were almost constantly of sudden onset, characterised
subjectively by fear, feelings of impending disaster, of “ internal
irritability,” of nostalgia and a desire to wander, of “ having done
evil,” of the desire, in some cases actually attempted, to commit
suicide, of great difficulty in thinking—never, however, proceeding
to marked disorientation; and, objectively, of delay in reaction¬
time to questions, memorial lacunae, and increase of prison
offences, insubordinate conduct, etc., with, as bodily symptoms
during these periods, pulse acceleration, palpitation, profuse sweat¬
ing, diarrhoea, hemicrania, changes in body-weight, hand-tremor,
dilatation and comparative immobility of pupils, and changes in
the individual’s character, passing off entirely till the next attack.
A point which is barely touched upon, and which should have been
thoroughly investigated, is that of the patients’ subsequent degree
of memory as to the attacks and the occurrences during these
periods. Turning to the second question, that of the differentiation
of the fluctuations from similar states occurring in the course of
other psychopathies, Prof. Aschaffenburg finds this much more
difficult of solution, particularly as between epilepsy and congenital
weak-mindedness, as the conditions are so frequently combined. In
this relation he recalls an instructive case of an imbecile, in whom
the author had diagnosed epilepsy entirely from the periodic
fluctuations, and in whom later classical epilepsy developed. The
whole question is one of great interest, and, from the criminologi¬
cal point of view, of much importance, and it seems probable that
many of the periodic outbursts of temper, vagaries of conduct, and
insubordination characteristic of weak-minded prisoners, are more
easily explicable on Prof. Aschaffenburg’s hypothesis than on any
other. R. Cunyngham Brown.

526

REVIEWS

"Reviews

UEBBR ROBERT SCHUMANNS KRANKHEIT. P. J. Mobius.

Carl Marhold, Halle, 1906, M. 1.50.

This little book is an example of the attempts, frequent at the
present day, to establish a retrospective -diagnosis from the study
of documentary evidence. The writer has carefully analysed all
the Schumann literature, including Litzmann’s recent book on
Clara Schumann, and the letters and diaries it contains. From
these he finds that both Schumann’s parents were “nervous,” that
his only sister died from a severe form of dementia prsecox, and
that all his brothers died during early manhood. As a boy,
Schumann was ambitious, generous, and good-tempered. In his
youth he was distinguished by his artistic talents, and by a
peculiarly feminine cast of temperament. His parents were quite
unmusical, so that Schumann’s musical genius is somewhat of
an enigma. The writer regards it as a sign of abnormal mental
disposition—as the pearl in the shell, for the production of which
the whole must suffer.

During the first twenty years of his life, Schumann had no
serious illness, but after that period, without any apparent cause,
there were occasional attacks, and in his twenty-third year the
disease assumed a graver form. The main symptom was a
condition of unreasoning anxiety. During one night of frightful
mental anguish, which left an indelible mark on all his future
outlook on life, Schumann attempted to commit suicide by throwing
himself out of the high window of his room. In the years
that followed, there were periods of apparently complete recovery,
followed by relapses which gradually became more severe and
prolonged. The symptoms were growing anxiety, moodiness and
depression, odd manners, tendency to remain silent, suspicion,
persistent auditory hallucinations, slow, difficult speech. The
progress of the disease was slow, remittent, but inexorable, ending
in profound melancholia. At his own request, Schumann was taken
to an asylum. There his mental and physical strength gradually
declined, and he died peacefully at the age of 51.

It haB been assumed that the cause of his death was general
paralysis. The writer thinks, however, that this history points
without doubt to a diagnosis of dementia prsecox. One can hardly
say of a man who in the course of an illness extending over

REVIEWS

527

twenty years showed himself a master, not merely as the creator
of exquisite music, but as a writer, a poet, and a critic, who was
an excellent husband, father, and friend, that he was an imbecile.
But dementia prsecox numbers among its victims many who never
come under this designation. Not a few cases of the nervous
weakness of youth belong to this class; after a few years, recovery
seems to have taken place, but a subtle change has been left which
may be evident only to the sharpest eye. Some are recognised as
beihg weak-minded; in others the mental power seems to be
unaltered, but they have lost the gaiety and spontaneity of youth,
their ideals have gone, they are no longer capable of passion, and
are always either tired or very easily fatigued. Between these
Blight forms and the severe cases found in the asylums, there are
many transition stages, and to these Schumann’s case belongs.

By those around him, Schumann’s illness was attributed to
over-work and mental strain. Bat no mental disease, whether
dementia prsecox or paralysis, is caused by mental strain. It is
possible that over-excitement favours the onset of the illness, and
certain that it has a very prejudicial effect on a disease already
established ; but the main or only cause of mental disease is a
certain inherited disposition—an abnormally constituted brain.
Creative work naturally entails fatigue. But if one is tolerably
healthy, the fatigue passes off without harm ; if one is ill, it easily
leads to exhaustion. There is now a prevailing tendency to trace
every disease to some early experience, and if fatigue aggravates
a disturbance, to regard it as the cause. Schumann worked
willingly and joyfully. In his later years he bore work badly,
because he was ill; he was not ill because he worked.

The writer therefore concludes that Schumann’s disease was
dementia prsecox, caused by inherited predisposition, and that
there is no evidence pointing to the existence of general paralysis.

THE JOURNAL OF ABNORMAL PSYCHOLOGY. Editor: Morton
Prince, M.D. Vol. i.. No. 1, April 1906. The Old Corner
Book Store, Inc., Boston, Mass.

There is no doubt that there is room at the present moment for a
journal to represent that department of mental science which the
new bi-monthly, Journal of Abnormal Psychology, proposes to
cover. In the first number the scope of the journal is defined as
being “ primarily intended for the publication of articles embodying
clinical and laboratory researches in abnormal mental phenomena.
. . The field of investigation includes, for instance, such subjects
as hysteria, hallucinations, delusions, amnesias, abulias, aphasias,

528

KEVIEWS

fixed ideas, obsessions, deliria, perversions, emotions and their
influence, exaltations, depressions, habit neuroses and psychoses,
phenomena of hypnosis, sleep, dreams, automatisms, alterations of
personality, multiple personality, dissociation of consciousness, sub¬
conscious phenomena, relation of the mind to physiological processes,
neurasthenic and psychasthenic states.

The journal intends to publish the results of clinical and labo¬
ratory analyses of the phenomena referred to, rather than mere
reports of psychiatric cases. Such analyses should be extremely
helpful and suggestive to psychologists and to those working at
the problems of clinical psychiatry, and should offer valuable hints
in the direction of lines of clinical research. The names of the
associate editors, of whom there are six, warrant the assumption that
the journal will be broad in its interests, and representative of the
various aspects under which these phenomena may be considered.
The first number is one of much interest, and promises well for the
future of the journal. Abstracts from the articles in the first
number are given in the June number of the Review.

C. Macfie Campbell.

GEHIBN UND 8EELE. Vorlesungen von Prof. Dr. med. Paul

Schultz, Univ. Berlin. Edited by Dr Hermann Beyer.

Leipzig: J. A. Barth. 1906. Pp. 189.

At the end of last July, Prof. Schultz died from heart failure, in
the midst of a life full of activity and widespread interests. He
had contemplated for some time publishing these lectures in book
form, but, finding this impossible, he entrusted the task of their
publication to his friend Dr Beyer. The fifteen lectures which
comprise the book make no pretence of original investigation or
conception, are treated in popular scientific fashion, and are of
metaphysical rather than psychiatric interest. This book, whose
author was thoroughly imbued with Kantean idealism, is essentially
a protest against mechanistic theories of the “ soul,” and in par¬
ticular a somewhat belated refutation of what Prof. Lodge has
called the “rudimentary, antiquated, gratuitous, hypothetical, in
some places erroneous and altogether unconvincing” scheme of
materialistic monism formulated by HaeckeL The first three
lectures are largely historical; the succeeding six are concerned
with the phylogenetic development of the nervous system, and the
gradual elaboration and increasing complexity of consciousness and
intelligence; and the remaining chapters treat, in rather superficial
and discursive fashion, of the relation of brain weight to intelli¬
gence, cortical localisation, insanity, hallucinations and illusions,

REVIEWS

529

and hypnosis. To sum up the main argument, mental processes
are not spatial phenomena localised in the brain: brain and mind
are related only in time as parallel psychic processes, and cannot
be causally connected, any reciprocal action between the two
series being invalid, and mutually inexplicable— i.e. the nature of
mind cannot be elucidated by an explanation of the life of
the organism, as it can never be the object of exact scientific
investigation.

The author is thus an orthodox exponent of psycho-physical
parallelism, and though the work is largely outside the field of
psychiatry, it is throughout of considerable philosophic interest.

R. CUNYNGHAM BROWN.

630

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BING. Experimentelles zur Physiologie der Tractus spino-cerebell&rea. Archiv.
f. Anat . u. Physiol., 1906, p. 250.

VELICH. Studien fiber den Einfluss des Nervensystems auf den Puls. Wien,
klin. Woch ., Mai 31, 1906, p. 663.

DAVID FRASER HARRIS and WILLIAM MOODIE. On the Non-Uniformitv
in the Rate of Discharge of Impulses from Cells of the Spinal Cord poisoned with
Strychnine. Journ. Physiol., May 31, 1906, p. 213.

GUIDO GUERRINI. Di una propriety mecc&nica des muscolo che si pu5
chiamare “potenza.” Sperimentcue , Anno lx., f. iii., 1906, p. 415.

BIBLIOGRAPHY

531

PSYCHOLOGY

ALSBERG. Dio Grundlagen des Gedkchtnisses, dor Vererbung und dor
Instinkte. Reinhardt, M line hen, 1906, M. 1.

BA UGH. The Origin of Human Mind. Canadian Practitioner and Review , May
1906, p. 239.

CLAPAREDE. The Value of Biological Interpretation for Abnormal Psychology.
Journ. of Abnormal Psychology, June 1906, p. o3.

PACKARD. The Feeling of Unreality. Journ. of Abnormal Psychology, Juno
1906, p. 69.

WILIBALD A. NAGEL. Observations on the Colour-Sense of a Child, /burn.
Comp, Neurol. and Psychol ., May 1906, p. 217.

PFLAUM. Die individuelle und die soziale Seite des seeliscben Lebons. Berg-
m&nn, Wiesbaden, 1906, M. 1.60.

BUSCHAN. Gehirn und Kultur. Bergmann, Wiesbaden, 1906, M. 1.20.

The Psychology of the Anarchist. Leading Artiole. Brit. Med. Journ., June 6,
1906, p. 1365.

CLAYE SHAW. A Lecture on Mind and Matter. BriL Med. Journ., June 9,
1906, p. 1335.

RAYMOND PEARL. On the Correlation between Intelligence and the Size of
the Head. Joum. Comp. Neurol, and Psychol., May 1906, p. 189.

ROBERT M. YERKES. George Bohn's Studies in Animal Behaviour. Joum.
Comp. Neurol, and Psychol., May 1906, p. 231.

S. J. HOLMES. Death-Feigning in Ranatra. Joum. Comp. Neurol, and Psychol.,
May 1906, p. 205.

PATHOLOGY

ARMAND-DELILLE. Lesions Nerveuses cellulaires produites par le Slrum
n6vro-toxique. (Soc. de neurol.) Rev. Neurol., mai 30, 1906, p. 469.

CATOLA und ACHlJCARRO. tTber die Entstehung der Amyloidkorperchen im
Zentralnervensystem. Virchow's Archiv ., Bd. 184, H. 3, p. 454.

MEDEA. Recherches explrimentales sur la D6g6n6ration et la K6g6n6ration des
Fibres Nerveuses dans la N6vrite parenehymateuse d£g6n6rative. (Soc. de neuroL)
Rev. Neurol ., mai 30, 1906, p. 483.

LUGARO. Osservazioni sui “gomitoli" nervosi nella rigenerazione dei nervi.
Riv. di Patol. nerv. e. ment., vol. xi., f. 4, 1906, p. 170.

PIERCE CLERK. Do Central Tracts of the Nervous System Regenerate T New
York Med. Journ., June 2, 1906, p. 1116.

GUIDO G U ERRINI. Sulla fundone dei muscoli degenerati. Sperimentale, Anno
lx., f. iii., 1906, p. 427.

ASCH. Zur Hypertrophic der quergestreiften Muskeln, speziell des Herzmuskels.
Springer, Berlin, 1906, M. 1.20.

CATOLA. Contribute alio studio dell' anatomia patologica della Malattia di
Parkinson. Riv. di Patolog. ne\'v. e. ment., vol. xi., f. 4, 1906, p. 145.
SPIELMEYER. Zur anatomischen Differential-diagnose der progressiven
Paralyse. Centralbl. f. Nervenheilk. u. Psychiat., Juni 1, 1906, S. 425.

OSKAR FISCHER. Ueber einen eigenartigen Markfasemschwund in der Hirn-
rinde bei Paralyse. Wien. klin. Woch., Mai 31, 1906, p. 661.

CLINICAL NEUROLOGY AND PSYCHIATRY

dENEKAL—

BEN ED IKT. Zur Theorie der typisohen Degenerationskrankheiten dee N erven-
system. Deutseh med. Woch., Juni 26, 1906, p. 1000.

VON LEUPOLDT. Die Untersuchung von Unfallnervenkranken mit Dsycho-
physischen Methodon. Klinik f. psych, u. nerv. Krankk., Bd. 1, H. 2, 1906,
S. 130.

532

BIBLIOGRAPHY

WALLACE WOOD. Cerebral Segmentation : a Now Method of Reading the
Brain. Med. Ree. 9 June 2, 1906, p. 878.

REINHARDT. Arztliche Nervenanalyse (Psychoanalyse). Konegen, Leipzig,
1906, M. 1.

FRANZ FONCK. Radium und NervensyBtem. Georg Thieme, Leipzig, 1906.

RIEGER Untersuchungen liber Muskelzust&nde. Fischer, Jena, 1906, M. 2.

NOICA. Deux fibres atteints de myopathie progressive. Nouv. Icon, dt la
Salpttrtire, mars-avril 1906, p. 151.

PERIPHERAL NERVES—

FREDERICK T. LEWIS. The Mixed Cerebral Nerves in Mammals. Journ.
Comp. Neurol, and Psychol ., May 1906, p. 177.

GELLY, Les troubles norveux j^riph^riques au d6but de la tuberculosa pulmonaire
(thfese). Firmin, Montane at Sicardi, Montpellier, 1906.

JOSEPH STARK. Neuritis in Phthisis. Brit. Med. Joum. 9 June 23, 1906,
p. 1464.

RUDLER. Un cas de neurofibromatose g6n6ralis6e. Nouv. Icon, de la SalpHriert
mars-avril 1906, p. 161.

HAMMERSCHLAG. Ein Fall von neurofibromatose Recklinghausen* sche
Krankheit mit Beteilung des Gehororganes. Monaisschrift f. OkrenheUk ., 1906,
p. 309.

SPINAL CORD—

Tabes.— SIR WILLIAM GOWERS. A Lecture on the Dystrophy of Tabes and
the Problem of Trophic Nerves. Brit. Med. Joum. 9 June 2, 1906, p. 1267.
MOUTOT. Sur la coexistence des lesions syphilitiques tertiares avec le tabes.
Gainche, Paris, 1906.

DEBOVE. Tabes et aneurysme aortique. Joum. de Practiciens, June 9, 1906,
p. 353.

DE BORD YOUNG. Diagnosis of Tabes in the Preataxic Stage, New York Med.
Joum. % June 2, 1906, p. 1131.

VON RAITZ. The Treatment of Tabes Dorsalis. Med. Record , May 19, 1906,

p. 786.

Poliomyelitis Anterior Acuta. — HUET et LEJONNE. Deux cas de Polio*
my61ite antlrieure aigue de l'adulte. (Soc. de neurol.) Rev. Neurol ., m&i 30,
1906, p. 474.

Progressive Muscular Atrophy. —DE BUCK et DEROUBA1X. Notes sur un
cas d'atrophie musculaire progressive. Jouim. de Neurol ., mai 5, 1906, p. 161.

Amyotrophic Lateral Sclerosis. —LEJONNE et LHERMITTE. Un cas de
Sol6rose Amyotrophique h forme anormale avec autopeie. (Soc. de neurol.) Rev.
Neurol ., mai 30, 1906, p. 485.

ROSSI et ROUSSY. Un cas de sclerose latSrale amyotrophique avec d6g6n6ra-
tion de la voie pyramid&le suivie au Marchi de la moelle jusqu’au cortex. Rev.
Neurol ., mai 16, 1906, p. 393.

Myelitis.— W. B. WARRINGTON and JOHN OWEN. The Pathology of
Myelitis Acutissima Haemorrhagica Disseminata. Rev. Neurol, and PsydiuU.,
June 1906, p. 401.

ROSENBEGER u. SCHMINCKE. Zur Pathologic der toxischen Gravidit&ts-
myelitis. Virchows Archiv., Bd. 184, H. 3, p. 329.

Syringomyelia.— ALQUIER et GUILLAIN. Etudes anatomocliniques d*un cas
de syringomydlie spasmodique. Rev. Neurol ., juin 15, 1906, p. 489.

Tumour.— H. OPPENHEIM u. M. BORCHARDT. Ueber zwei F&lle von erfolg-
reich operierter RUckenmarkshautgeschwulst. Berlin. klin. Woch ., Juni 25,

1906, p. 864.

BIBLIOGRAPHY

533

BUM-

Xeiligltti.—GHON, MUCHA, and R. MULLER. Zur Aetiologie der akuten
Meningitis. Centralbl.f. Bakt .., etc. Bd. xli., H. 4, p. 401. Fortsetzung folgt.

F. KR AUSE. Zur Kenntniss der Meningitis serose spinalis. Berlin, klin. Woch .,
Jum 18, 1906, p. 817.

JEHLE. Ueber das Entstehen der Genickstarreepidemie. Wien, klin. Woch

Juni 21, 1906, p. 753. 1

J. S. BILLINGS, Jr. Cerebrospinal Meningitis in New York City during 1904-05.
Joum. of Amer. Med. Assoc., June 2, 1906, p. 1670.

HYBRAM. Contribution k l'6tude de la m6ningite c6r6bro-spinale. Relation
d’une 6pid6mie dans la province d’Oran (Alg6rie). Privat, Toulouse, 1906.

HUNTER. Note on an Atypical Case of Cerebrospinal Meningitis. Lancet , May
26, 1906, p. 1469.

GILLARD. M6ningite tuberculeuse au cours d’une granule polynud6ose
rachidienne. Arch. gSn. de m&d., juin 5, 1906, p. 1421.

E. SCHLESINGER. Der therapeutische und symptomatische Wert der Lumbal-
punktion bei der tuberkulbsen Meningitis der Kinder. Berlin, klin. Woch., Juni
18, 1906, p. 838.

Hemorrhage.— HERBERT J. WALKER. A Case of Meningeal Hcemorrhaire
resembling Hysteria. Lancet , May 26, 1906, p. 1468.

W. B. WARRINGTON and JOHN OWEN. A Case of Hemorrhage into the
Brain and Spinal Cord from Obliterative Arterial Disease. Rev. Neurol, and
Psychuit., June 1906, p. 407.

Hemiplegia,— H. G. LANG WILL. Transitory Hemiplegia, with Notes of Two
Cases. Scot. Med. and Sur. Joum., June, 1906, p. 509.

Tsmoir. —PUTNAM and WATERMAN. A Contribution to the Study of Cere¬
bellar Tumours and their Treatment. Joum. Nerv. and Ment. Die., May 1906,
p. 297*

RAYMOND. Un cas de tumeur du cervelet. Joum. der Practiciens , juin 2,1906,
p. 337.

E. E. SOUTHARD. Case of Glioma of the Frontal Lobe, with Invasion of the
Opposite Hemisphere. Amei\ Joum. Insan., April 1906, p. 561.

CESTAN. Epithelioma primitif du Cerveau. (Soc. de neurol.) Rev Neurol
mai 30, 1906, p. 468. ’*

PtJSCHMANN. Fall von Kleinhirnbriickengeschwulst. Deutschmed. Woch., Mai
24, 1906, p. 836. ?

ALQUIER. Volumineux tubercule cas6ifi6 de la calotte protutarantielle. iStude
anatomo-clinique. Rev. Neurol ., mai 15, 1906, p. 406.

HUGH SMITH and C. C. ELLIOTT. A Case of Cerebral Tumour; Operation •
Recovery. Lancet, June 16, 1906, p. 1688.

Cerebral Diplegia,— DANNENBERGER. ttber die porenkephalische Form der
zerebralen Kinderlfihmung. Klinik f. psych, u. nerv. Krankh., Bd. 1, H. 2, 1906,
S. 100.

General Paralysis.— VORBERG. Dementia paralytica und Syphilis. Deuticke
Wien, M. 1. ’

PLASKUDA. Ein Fall von progressive Paralyse mit gehkuften epileptiforme
Krampfen, etc. Allg. Zcit. f Psychiat., 1906, p. 240.

RAMSAY HUNT. Chronio Progressive Softening of the Brain. Amer. Joum. of
the Med. Sci., June 1906, p. 1020. J

MENTAL DISEASES—

F. W. MOTT. An Address on the Pathological Investigation of the Causation of
Insanity. Lancet, June 2, 1906, p. 1515.

SOUTZO FILS. La psychiatric modeme et l’ceuvre du profeeseur Kraepelin
(suite et fin). Ann. ntfd.-psychol, mai-juin 1906, p. 402.

CLARENCE B, FARRER. Clinical Psychiatry. Amer. Joum. of Insan. April
1906, p. 627. *

PENTA. Die Simulation von Geisteskrankheit. Stubers Verlag, Wiirsburg,
1906, M. 3.50.

VICTOR PARANT. Un article de M. le profeeseur Grasset: “ Demi-fous et
demi-reaponsables.” Ann. mH.-psychol., mai-juin 1906, p. 353.

534

BIBLIOGRAPHY

PHILIPPE et PAUL-BONCOUR. Les Anomalies Montales chez les EcoHsn.
Fdlix Alcan, Paris, 1906, 2 fr. 60c.

tlFFENHEIMER. Die medisinische Psychologic mit Becug auf Behandlungjand
Erziehung der angeboren Schwaohsinnigen. Munch, med. wock Mai 22, 1906, p.
1028.

C. J. ROBERTSON-MILNE. Notes on Insanity with Illustrative Cases.
Indian Med. Oaz.y April 1906.

JOSEF BERZE. Das Prim&rsymptom der Paranoia. Centralbl. f. NervenheiU.
u. Psychiat.y Juni 1, 1906, S. 432.

C. W. HITCHCOCK. A Case of Dementia Prseoox of Medico-Legal Interest
Amer. Joum. of Insan., April 1906, p. 615.

F. X. DERCUM. The Heboid-Paranoid Qronp (Dementia Prmoox). Clinical
Relations and Nature. Amer. Joum. Insan. t April 1906, p. 541.

HERZER. Beitrag zur Klinik der Puerperalpsyohooen* Ally. Zeit. f. Psyckiat,
1906, p. 244.

ALBRAND. Das psychische Verhalten von Geisteskranken im Sterben. AUg.
Zeit. f. Psychiat.y 1906, p. 299.

MAURICE DIDE et ALBERT LEBORGNE. SymptOmee et Unions M&hl-
laires dans la D6mence Pr6oooe oatatonique. (Soc. de neuroL) Rev. Neurol,
mai 30, 1906, p. 479.

BEURMANN, ROUBINOVITCH et GOUGEROT. Les Troubles mentaux dans
la lfepre. Gainche, Paris, 1906.

K6LPIN. Die psychischen Stdrungen nach Kopftraumen. Breitkopf A Hirtel,
Leipzig, 1906, M. 0.75.

MABANDON de MONTYEL. Les Pervers. Joum. de Neurol. , mai 20 et
juin 5, 1906, pp. 181, 201.

TOURRENC. 6tat Mental des Incendiaires. Michalon, Paris, 1906, 2 fr. 50 c.
OIMBAL. Les incendiaires (suite) Ann. mtd.-psychol. , mai-juin 1906 p. 380.
ROUSSET. Un cas d’exhibitionists. Ann. mScL-psychol., mai-juin 1906, p. 394.
T. CLAYE SHAW. Insanity and Murder. Lancet f June 23, 1906, p. 1739.
NOUET. De la Necessity d’exi^er des Connaissances Psychiatriquee pour les
Mddecins des Etablissements Pdnitentiares. Michalon, Paris, 1906, 3 fr.

MOELI. Die in Preussen gUltigen Bestimmungen liber die Entlassung aus den
Anstalten fiir Geisteskranke. Marhold, Halle, 1906, M. 1.20.

ALCOHOL—

IS ADO R H. CORIAT. The Mental Disturbances of Alcoholic Neuritis. Amer.
Joum. of Insan.y April 1906, p. 671.

DANNEMANN. tTber Bewusstseinsverandemngen und Bewegungsstdrung
durch Alkohol, besonders bei Nervdsen. Klinik. f. ptychis. u. nerv. Krankh Bd.
1, H. 2, 1906, 8. 79.

SPECIAL SENSES AND CRANIAL NERVES—

PICK. tJber Hyperfisthesie der peripherischen Gesichtsfeldpartien. Neurol.
Centralbl ., Juni 1, 1906, S. 498.

BRAILLON. Des reflexes pupillaires dans les cardiopathies mitrales. Oaz. da
H6 P .y juin 21, 1906.

NEUMANN. Die otitischen Facialisparesen. Wien. med. Woch. 3 Juni 16 u.
23, 1906. pp. 1234 u. 1306.

MIRALLlk et PLANTARD. Paralysie Facial© double au oours d’une Polynevrite
infectieuse g6n6rali*6e. (Soc. de neurol.) Rev. Neurol. , mai 30, 1906, p. 480.
MASSE I. Un segno premunitorio della paralisi del rioorrente laringeo. Arch
iial. dl laringol.y F. 1, 1906.

GENERAL AND FUNCTIONAL DISEASES—

Chorea* —TRONIBETTA. Lo strapazzo intellettuale e le nevroei (con tribute

all* etiologia della corea). La Clinica Modema, 11 aprile 1906, p. 169.

Sir DYCE DUCKWORTH, Remarks on Chorea considered as Cerebral Rheuma¬
tism. Brit. Med. Joum., June 23, 1906, p. 1464.

Epilepsy.— REDLICH. Bemerkungen zur Atiologie der Epilepsie. Wien. med.
Woch ., Mai 26 u. Juni 2, 1906, p.1074 u. 1147.

BIBLIOGRAPHY

535

Ne«raitkeaUu -MttBIUS. Die Nervoritiit. Weber, Leiprig, 1906, M. 2.60.

ALDER BLUMER. The Coining of Paychasthenia. Joum. Nerv. and Meni.
Du., May 1906, p. 336.

DONLEVY. On Neurasthenia as a Disintegration of Personality. Joum. of
Abnormal Psychol., June 1906, p. 55.

Hfiterli. —HAASE. Cber eine Epidemie yon hysterisohem Laryngismus. Wien,
med. Freest. Juni 3, 1906, p. 1187.

ARSIMOLES. Hysteria infantile arec hallucinations. Qainche, Paris, 1906.

PAUL BLUM. Des Anesthesias psychiqnes ditea Nerreuses ou Hysteria uea
Octave Dorn, Paris, 1906, 6 fr.

'A TUBBY. A Clinical Lecture on Tortioollis, or Wry-Neck.
Brtt. Med. Joum., June 16, 1906, p. 1887.

Amclo-Nearotle «dema.—TRUMAN. A Case of Angio-Neurotio CEdema.

Lancet, June 2, 1906, p. 1685.

NlgCEUUMVg SYMPTOMS—

CLAUDE et LEJONNE. Hypotrophie d’origine bacillaire; troubles de la voie
pyramidale. Nouv. Icon, de la SalphrUre, mars-avril 1906, p. 147.

BOEDER. Zwei Ffille von linkseitiger Abduzensliihmung nach Rfickenmarks-
aeethesie. Munch, med. Woch., Juni 5,1906, p. 1118.

K()NIG. Bleibende Rfickenmarkslahmung nach Lumbal-Anaesthesia. MUnch.
med. Woch., Juni 5, 1906, p. 1112.

OTFRID FORSTER. Die Kontrakturen bei den Erkrankungen der Pyramiden-
bahn. Karger, Berlin, 1906, M. 1.60. J

JULES VOISIN, ROGER VOISIN et A. RENDU. Idiotie et lfeion c6r6belleuse
Amelioration des symptdmes. Arch. gin. de mid., mai 29,1906, p. 1865.

ALFRED GORDON. Atrophy of the Intrinsic Muscles of the Hands due to Lead
Poisoning. New York Med. Joum., June 2, 1906, p. 1125.

MORITZ. Mitbeteilung des Phrenicus bei Duchenne-Erb’scher L&hmunxr. Deutsch
med. Woch., Juni 7, 1906, p. 909.

SOCA. Sur un cas de 4, paralysie de beguilles.” Nouv. Icon, de la Salvitrikre.
mars-avril 1906, p. 17L ^

A. PICK. Bemerkungen zur Pathologie der Akroparasthesie. Berlin, klin. Woch.
Juni 4, 1906, p. 745. 1

HENSCHEN. Zum bulbSren Syndrom: Dissoziation der Sinne in Verbindung
mit cerebellar-ataktischen Stdrungen. Neurol. Centralbl., Juni 1, 1906, S. 502 l

GRASSET. La claudication intermittente des centres nerreux. Rev. Neurol
mai 30, 1906, p. 433. *

LEJONNE et EGGER. Traumatisme cranien. Syndrome vestibulaire. Accidents
m4ning6s c4r6bro-spinaux. (Soc. de neurol.) Rev. Neurol ., mai 30, 1906, p. 470.
ANGELL. Hyptesthesia and Hypalgesia and their Significance in Functional
Nervous Disturbances. Joum. Nerv. andMenL Lie., May 1906, p. 824.

PFISTER. Zur Atiologie und Symptomatologie der Katatonie. Alla. ZeU. f.
PeyckiaL , 1906, p. 275. J

FEILER. t)ber zwei instruktive Falle von Sympathicusneurose und fiber ein bei
denselben aufgetretenes anfallender Symptom. Wien. med. woch., Juni 2. 1906
p. 1130. * 1 ’

BRUMPT. Doigts en Lorgnette au cours d’une A trophic Musculaire Progressive
chez un nhgre du Soudan. (Soc. de neuroL) Rev. Neurol, mai 80, 1906, p. 477.
HANS KAHN. Studien fiber den Schluckreflex. Arch. f. Anal u. Physiol
1906, p. 355. s

JAMES MACKENZIE. Remarks on the Meaning and Mechanism of Visoeral
Pain as shown by the Study of Visceral and other Sympathetic (Autonomic)
Reflexes. Brit. Med. Joum., June 28, 1906, p. 1449. 1

A. PICK. Ueber motionisch-bedingte Mikrographie. Wien. klin. Woch., Juni
21, 1906, p. 757.

HEILBRONNER. Sprachstttrungen bei funktionellen Psychosen mit Ausschluss
der a^hasischen Storungen. Centralbl/. NersenheUk. u. Psychiat, Juni 15, 1906,

BYROM BRAMWELL. A Series of Lectures on Aphasia. Lecture IIL Lancet
June 16, 1906, p. 1671.

536

BIBLIOGRAPHY

TREATMENT—

A. T. SCHOFIELD. The Management of a Nerve Patient. J. & A. Churchill,
London, 1906. 5s.

BRtjGELMANN. Die Behandlung von Kranken durch Suggestion und die wahre
wiwenschaftliche Dedeutung derselben. Eine peychi&trischen Studio. Thieme,
Leipzig, 1906, M. 1.20.

ERTL. VolUtandiger Lehrkurs des Hypnotismus in alien eeinen Phaaen und ver-
wandten Erscheinungen. Fiedler, Leipzig, 1906, M. 2.

MATHIEU et ROUX. Traitement de Thysterie gastrique. Qaz. des Hdp ., juin
12,1906.

POROT. Le traitement arsenical de choree. Oaz. dez H6p ., juin 2, 1906.

ALT. Ernahrungstherapie der Basedow'schen Krankheit. MUnch. med. Woek. t
Juni 12, 1906, p. 1145.

OERLACH. Versuche mit Neuronel bei Geisteskranken. MUncJu med. Wock .,
mai 22, 1906, p. 1017.

LEHMANN. Esai sur l'action therapeutic du radium. Arch. gin. de mid., mai
22, 1906, p. 1801.

ANTONIN CON VERS. De Taction de Tacide formique en mtdecine mentals.
Ann. mid.-psychoL, mai-juin 1906, p. 388.

ESCHERICH. Die Verwendung der Pyozy&nese bei der Behandlung der epi-
demische Siiuglingsgrippe und der Meningitis oerebrospinalis. Wien, klin . Woe A.,
Juni 21, 1906, p. 751.

OSTWALT. On Deep Alcohol Injections in Facial and other Neuralgias and in
Histrionic Spasm. Lancet, June 9, 1906, p. 1605.

WILENS. Heilung hyaterischer Kontrakturen durch Lumball&hmung. Deutseh.
mmL Woch ., Juni 14, 1906, 954.

SCOTT CARMICHAEL. A Plea for Operative Interference in Intracranial
Hemorrhages in the New-born. Scot. Mca. and Sur. Joum ., June 1906, p. 524.

SECOND CONQRES BELQE

NEUROLOQIE ET DE PSYCHIATR1E

(Bruxelles, 39 au 31 aout 1906)

Frialdant* d’Honneur

M. lb Babos van deb Bbuggev M. Vast dbv Hkcttel

Mlnistre de T Agriculture Mlnistre de la Justice

Vlce-Pr6sldenta d'Honneur

M. Btco M. DK Latoub

Gonverneur de la Province de Brabar Dlrecteor gdndral an Ministers de la Justice

Trav&ux Bdenttflques

1° RAPPORTS.—Ces rapports, sn nombre de trois, seront distribute an moins troll semaines
avant la rtanion da Congrks, de manlfere k poavoir Stre attentivement ttndlts par oenz qnl dlslrent
prendre part k la discussion.

Lee questions choLMes pour la session de 1906 sont:

(а) Psychiatbib: Lee ftliOnts dlsslmulateurs.— Rapporteurs: M. le Dr De Moos,
mtdecln en cbef de l'hosplce Gnlslaln, k Gand, et M. le Dr Duchateau, mtdecln de la Malsonde sante
pour femmes, k Gand.

(б) Neurologic: La th5orle du neurone.— Rapporteur: Mile, le Dr Stetavowska,
asals tan te au laboratolre de psychologic de V University de Bruxelles.

(c) Pstchologie : Les test8 mentauz ches lea enfanta— Rapporteurs: M. le Dr Deceolt,
direct ear de 1’Ecole d’enselgnement spiels] de Bruxelles, et M. le Dr BouLEnaEB, mtdedn-edjolnt de
l'Aslle d’alllnls au Fort Jaco k Uccle.

T COMMUNICATIONS DIVERSES.—Une place Importance est rlserrle aux communication*
origlnales sur un sujet qnelconque de nenrologle on de psychlatrle, avec presentation de xnalades, da
plkces anatomiques et microscopiques.

Lea membres qul dlslrent fairs une communication an Congrfes sont prMs d’en envoyer le tttre et
le rlsnml au secrltalre glntral avant le 30 lain 1906.

Lee stances du Congrfes seront comblnees avec la visite d’lnstituts sctentlflqnes et hospitallers.

Des rtductlons de prix seront dtmsndtes sur les chemlns de fer fran^ais.

Le prix de la cotlsation est de 10 francs. Envoyer les adhlsions k M. le Dr Massaut,
secrltalre gtntral, mtdedn directenr de la colonle d’alitnts de Liemeox.

Lee praticlens de toutes nationality peuvent faire partle de ce Congrks; la seule restriction
imposts est rusage d’une des langues nsltees en Belgique.

IReview

WeuroloGE anb flbsscbiatn?

Original Hrtlcle

THE PATHOLOGY OF GENERAL PARALYSIS.

By Dr HANS EVENSEN,

Medical Saperintendent of Trondlijem Lunatic and Criminal Asylum
(Lecture delivered before the University of Christiania.)

Part I.

Macroscopic Examination.

The changes which may be seen, even with the naked eye, in a
post-mortem examination of a case of general paralysis are in
general characteristic, and they have led, as we know, to the
earliest interpretation of its pathology as a chronic arachnitis
(Bayle, 1822), or a chronic diffuse peri-encephalo-meningitis
(Calmed, 1826).

The skull, as a general rule, is thicker and denser than
normally, the diploe having given place to compact tissue.

The dura mater may adhere more closely to the skull than
usual, but the adhesion is seldom so firm as, for instance,
in cases of senile insanity. The membrane is thicker and less
translucent, but as the thickness varies greatly under normal
conditions, it is not easy to pronounce with certainty as to this
matter in each case. The inner surface is generally smooth and
glossy; it may also be rough, or it may display deposits ranging
from a film which is just visible, colourless or reddish, and which

R. OF N. & P. VOL. rv. NO. 8—2 N

538

ORIGINAL ARTICLE

cannot be washed off, to thick, pulpy and highly vascularised
newly-formed membranes, which lie in layers on the top of each
other and are the seat of ha;morrhage. A very large haematoma
of the dura mater is very seldom met with ; it was, perhaps, more
frequent at one time, when treatment could not protect the
patient from injuries in the same degree as now. Occasionally
there are only rusty patches to be seen on the inside, and no
membrane; but on the other hand, the dura mater may not
display any change whatever. Along the middle line it may be
adherent to the pia round the Pacchionian bodies. Occasionally
the latter are larger than usual.

The leptomeninges (pia-arachnoid)—for I agree with Ford
Robertson that it is artificial to distinguish between an exterior
alleged non-vascular membrane (arachnoidea) and an inner
vascular one (pia)—present a very milky aspect and are some¬
what thickened and often distended over the sulci, which are filled
with arachnoid fluid. In itself this fluid is as a rule quite clear,
but seen through the pia it resembles whey. The exudate is not
purulent unless an infection has supervened (most usually
pneumonia). The milkiness is specially evident over the con¬
vexity of the cerebrum and along the vessels, most of all over the
frontal lobe and the front part of the parietal lobe. It may be
so dense that one cannot distinguish the outlines of the con¬
volutions. On the inferior surface of the brain, where the changes
in the membrane are not on the whole very pronounced, it is
most easily seen at the commencement of the Sylvian fissure and
between the pons and the cerebellum. The small vessels in the
membrane are often gorged with blood, but as it is not always
an evidence of the amount of blood supply during life, and may
depend on the mode of death, this circumstance is of minor
importance. Of greater importance is the fact that over a large
extent the pia-arachnoid cannot be detached from the cortex
without bringing some of the latter with it, mainly over the
summit of the convolutions, and especially when the membrane
is not considerably thickened. But here also external circum¬
stances play a part, as the adhesion is more pronounced the more
advanced the post-mortem changes are. The membrane is occa¬
sionally finely granular. The pole of the occipital lobe is, as a
rule, quite free from changes of the soft membrane, and there are
cases where the condition of the membranes, on the whole, does

ORIGINAL ARTICLE

539

not support the assumption of a general paralysis. In other
cases again the occipital lobe is chiefly affected, and it has been
thought that this is particularly the case when the disease
begins with tabes.

The larger cerebral arteries, especially at the base, often
appear rigid, widely gaping on being cut across, and dotted over
with white or yellow spots. These changes, which in general are
looked upon as a sign of senility, setting in at the ordinary age
or prematurely, are not confined to general paralysis. Further,
by cutting across an apparently normal artery one can sometimes,
even with the naked eye, distinguish a fairly uniform thickening
of the inner coat of the artery extending round a greater or
smaller portion of the transverse section, but as a rule it cannot
be decided by the unaided vision whether the vessel wall is
altered or not.

The brain matter itself is generally of somewhat softer con¬
sistence than normally ; it is seldom firmer. The cortex may be
narrowed and its details effaced, being of a uniform reddish-grey
colour or spotted with red. There is, however, so much room
for a subjective estimate in forming an opinion as to the macro¬
scopic appearance, that its practical value is comparatively small.
As long as writers confined themselves to recording the macro¬
scopic results, these conditions had greater attention devoted to
them, and it was quite a common occurrence for the alienist, who
was more accustomed to notice minute differences, to think that
he saw distinct changes where the general pathologist found
nothing to remark. On the line between the cortex and the
white matter, and in the white matter itself, there are sometimes
to be seen pale stripes or spots corresponding to the loss of bands
of medullated fibres (Tuczek), and it has been thought that in
these stripes we have a certain macroscopic sign of general
paralysis. In cases of longer duration the convolutions are dis¬
tinctly narrowed, especially in the front half of the brain, and on
being weighed the brain shows a loss of weight up to several
hundred grammes. This is the case mainly in regard to the white
matter, less so as regards the grey matter. In the atypical forms
especially, the thalami optici are often atrophic.

The shrinkage is also seen in the large increase of arachnoidal
fluid under the soft membrane, but mainly in the ventricles. The
lateral ventricles are especially enlarged. The walls of these, as

540

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well as the floor of the fourth ventricle, are not smooth, but feel
like sand to the touch, at least in some places, or are covered
with small translucent granulations. In the grey matter subjacent
to the central ventricles there may occasionally be seen blood
effusions, which have set in immediately before death, especially
when this has occurred during a paralytic seizure.

Also in other parts of the brain one may meet with slight
haemorrhages or softenings which are visible to the naked eye,
but these are not specially frequent even in cases where there is
a clinical history of apoplectic attacks. They may, of course, be
a consequence of vascular changes which have no direct connec¬
tion with the paralytic process.

Into the question of the state of the spinal cord in paralysis,
especially the common degeneration of the fibre-systems, there
will not be time to enter on the present occasion ; neither shall
I treat of the lesions of the other organs, with the exception of
certain points, to which I shall return later.

The macroscopic picture which is generally seen in cases of
paralysis is not sufficient evidence of this disease, and it may be
absent. The occipital lobe may be most seriously affected;
when in that case paralytic seizures with residual focal symptoms
are the most prominent in the clinical picture, while the mental
decay is less obvious, and increases by fits and starts, and not by
a steady progression, then we have the form to which Lissauer gave
the name of “ atypical paralysis.” There are also, however, other
deviations from the type in which the macroscopic changes are
chiefly restricted to particular regions (the cerebellum, temporal
lobe, etc.).

Microscopical Examination,

therefore, can alone decide the anatomical diagnosis.

Like a red thread through the history of the pathology of
paralysis runs the tendency to class the alterations under the
heading of a simple morbid process. At one time the contest
centred round the question of primary or secondary alteration,
at another the shibboleth was either degeneration or inflamma¬
tion, and this inflammation again was regarded either as paren¬
chymatous or interstitial. The changes especially which the
inflammatory theories underwent during the last century are
reflected in the opinions on the pathology of general paralysis.

ORIGINAL ARTICLE

541

The disagreement begins even with regard to the membranes.
It may be said that the changes here have been the object of
less interest, inasmuch as it has generally been taken for granted,
ever since the time of Bayle, that these throughout display the
ordinary symptoms of a simple chronic inflammation. It is
principally

The subdural newly-formed membranes

round which the battle has raged. As early as 1826, Bayle and
Oalmeil saw in them the issue of a pachymeningitis, an assumption
which is generally attached to the name of Virchow (1856).
Similarly, Huguenin (1877) stands as champion of the opinion
which was first put forward by Prescott Hewitt (1845), that the
primary change was a haemorrhage. According to Ford Robertson,
who has revived the old question, the inflammatory theory does
not hold good. Several of the newly-formed membranes are the
result of haemorrhage in the subdural space, most usually from a
pial vein, without any change in the dura itself. It is the vessels
from the dura mater alone which make their way into the blood
clot, since the surface of the dura mater has most capillaries.
Other new membranes are connected with a widespread morbid
process in the dura mater, characterised by proliferation and
degenerative changes of the surface epithelium, increase of
connective tissue fibres, compression of the vessels, and most
of all by the formation of new capillaries, numbers of which
become obliterated and undergo hyaline changes, partly also
fatty degenerations. In the last case they are easily ruptured,
and the new membrane is generally developed here also from
haemorrhages, which are then numerous and punctiform. These,
however, are not a necessary condition. A somewhat similar
chronic morbid alteration in the dura, which cannot rightly be
called inflammation, occurs also in cases other than insanity.

The majority of the newly-formed membranes give the
impression of comparatively recent formation; some can
scarcely be called membranes at all, but consist for the most
part of fibrine. If the membrane is organised, there are found,
according to Ford Robertson, numerous granules of amorphous
hsematoidin. Mendel, on the other hand, seldom saw debris from
disintegration of red corpuscles, and founded on this fact the
assumption that the membrane was formed previous to the
haemorrhage.

542

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In the pia-arachnoid

also the connective tissue fibres have increased and the endo¬
thelial cells on the surface and along the trabeculae show
alterations similar to those in the dura. Further, the small
vessels are infiltrated (Del Greco, 1891). The new connective
tissue fibres, which are specially met with in the superficial
layer in patches, or uniformly distributed, are generally coarse,
and it is these which cause the thickening of the membrane
(Fig. 1). The newly-formed endothelial cells are sometimes
accumulated in heaps, and thus the aforementioned small
granulations on the surface of the membrane are produced
(L. Meyer, 1862). The membrane is also found to be

Penetrated by numerous smaller cells ,

which have been explained by many as lympho- or leuco-cytes.
I am not able to say definitely whether outside the vessel sheaths
lymphocytes occur regularly and in greater numbers in the pial
tissue in general paralysis, as I have only had the opportunity of
seeing a few cases of paralysis since I began systematically to
study the membranes. According to Ford Robertson, blood
corpuscles are, on the whole, absent. At any rate polynuclear
leucocytes will occur only singly, unless septic processes have
taken place (Nissl). Even regular occurrences of lymphocytes
ought not necessarily to be ascribed to the paralytic process itself;
they might as well be due to the preceding syphilitic infection.
On the other hand, the absence of white corpuscles does not
necessarily exclude inflammation. Those cells which fill the
adventitial sheaths and the immediate neighbourhood of the
vessels are, as will be proved later on, for the greater part not
“ round cells,” although there are lymphocytes among them. In
the brain substance these cells (plasma cells) have undertaken the
task which is generally attributed to the leucocytes in inflamma¬
tions of other regions. Consequently, it ought not to be considered
improbable that they should do so in the pia also under similar
circumstances. Finally, as far as I can see, some of the cells which
lie free in the pial tissue belong to the same group as the
infiltrating cells.

After all, perhaps much is not gained by calling the process
in the pia by the indefinite name of “ inflammation.” But when

ORIGINAL ARTICLE

543

we take into consideration the condition of the vessels, I suppose
we must still maintain the old hypothesis of most authors, that,
as a rule, an exudative inflammation occurs in general paralysis.
On the other hand, Ford Robertson’s opinion is certainly correct
that the process is merely hyperplastic in the similar alterations
which take place in senile insanity, chronic alcoholism,' and
epilepsy. Dupr4 (p. 115) maintains that even here there may
be a meningitis.

Among other forms of cells which (in adults) are not normally
found in the pia, and which may be found in general paralysis,
the “ lattice cells ” ( Gitterzellen ) (Fig. 2) occur rather frequently,
chiefly in areas of blood effusion. They are partly the same cells
which older authors called “ fatty granular cells ” (Kornchen-
zellen ) and epithelioid cells. Juliusburger and Boedecker gave
them the name of “lattice cells” ( Gittemetzzellen ). In the
brain they appear diffusely in haemorrhages and in softenings;
they accomplish their task as scavenger cells by taking up and
carrying away the debris of medullary substance and disintegrating
red corpuscles, and they are temporary substitutes for the
destroyed tissue. The “ lattice cells are par excellence the phago¬
cytic migrating cells of the nervous system” (Nissl). 1 They
cannot at all be said to indicate that there is an inflammation.

The cause of the adhesion of the pia to the surface of the
cortex (decortication) will be found in the condition of the cortex
as well as in that of the pia. The pial vessels are more adherent
in consequence of the increase of the connective tissue fibres in
the adventitia, and of their more intimate connection with the
neuroglia. And also the glial fibres along the surface of the
convolutions are thicker and more numerous (Weigert), and pro¬
bably the cortical substance is softer.

Ford Robertson maintains that the cause of the hyperplastic
and degenerative alterations of the tissue of the membrane is an
altered chemical composition of

The cerebrospinal fluid,

which is said to be effected by the metabolic changes in the brain.

1 In 1900 Nissl considered these cells which he found in the brain substance as
neuroglia cells that had no processes, later on as derived from adventitia (Stroel>e),
or from endothelial cells. In the pia-arachnoid he thinks they may probably be of
autochtonic origin. At all events they are not derived from the blood, as Fried¬
mann maintained. Even what this author called 11 epithelioid cells," derived from
the local tissue cells, were probably chiefly u lattice cells."

544

ORIGINAL ARTICLE

From the vessels of the brain the lymph flows through the
channels of adventitia into the lymph-spaces of the pia-arach-
noidea, and from these into the subdural space and to the dura
mater, according to Ford Robertson’s view. As yet, however,
very little is known about the intracranial lymph circulation.
In this connection it is interesting to know that Mott, Donath,
and others, by chemical analysis of the cerebro-spinal fluid in
general paralysis and other diseases of the brain, have found
cholin, a product of decomposed nervous tissue. Since the intro¬
duction of lumbar puncture the condition of the cerebro-spinal
fluid has been examined with far greater interest than before,
and in general paralysis this method of investigation has proved
specially valuable. The quantity of albumen will be found to
have increased to a much higher degree than in other insanities
(Schaeffer, Babcock). This is especially the case with the serum
albumen (Guillain et Parant), which is not found in the normal
fluid, or at least only in minimal quantities (Sicard). By micro¬
scopic examination of the sediment after centrifuging, the whole
field under the oil immersion will generally be found overcrowded
with lymphocytes, and this result is so constant, and so different
from what is seen in other brain diseases, that it has led to the
use of lumbar puncture for diagnostic purposes. This was first
practised in French cliniques. According to Joflfroy, lympho¬
cytosis is the earliest certain symptom of general paralysis. But
it must not be forgotten that positive reaction may be obtained
from an infective meningitic process and from “ organic ” diseases
of the brain, nay even from preceding syphilitic infection, although
the number of elements will then be small (Nissl). Polynuclear
leucocytes will seldom be found either alone or predominant
Nissl, however, points out that the technical difficulties prevent 8
more accurate analysis of the elements of the cells, and he main¬
tains that a great number of what seem to be lymphocytes turn
out, in successful preparations, to be transitional forms and poly-
morpho-leucocytes. According to Dupr6, the polynuclear leuco¬
cytes have migrated from the vessels and they denote a con¬
gestion of the membranes, while the lymphocytes come from the
lymph sheaths and signify a “ simple serous irritation.”

The microscopic alterations which in general paralysis take
place in

ORIGINAL ARTICLE

545

The intracranial vessels

(from the arteria basilaris to the smaller pial arteries which dip
into the brain substance) are so heterogeneous and vary so much,
not only in different cases but in different vessels in the same
case, that it is very difficult to deal with them collectively.
Only in the cortex itself do the alterations become more alike,
and here they show the aspect characteristic of general paralysis.
As the conditions are less complicated in the cortex, it is best to
commence with it

One of the first conditions noted by microscopical examina¬
tion of the cortex in general paralysis was the infiltration of
arteries, capillaries, and veins by “ small cells.” Calmeil was of
opinion that the small vessels transmitted the inflammation from
the membranes to the brain, and he described the “nucleus¬
shaped corpuscles” found in the vessel sheaths as “ dotted discs ”
(disques ponctuSs). Later on they were simply called “ round
cells,” and were generally regarded as migrated white corpuscles,
although some authors maintained that they originated from the
cells of the vessel wall. The staining methods then used did
not make it possible to recognise the different forms in the infil¬
trations, or to distinguish them from the nuclei of the surrounding
brain tissue. By careful isolation of what seemed to be nuclei,
Ludv. Meyer found (1873) that they were oval cells of the size
of white corpuscles, being composed of opaque protoplasm and
one large nucleus with one, frequently two, nucleoli. They were
not the common cells of the vessel wall. He supposed that by
fusion with the vessel wall and by retrogressive changes they
transformed the capillaries into homogeneous hyaline tubes. Even
the filling up of the lymph-space with nuclei was not considered
characteristic of general paralysis alone; in Mendel’s monograph
(1880) it is said that the same process occurs not only in various
diseases of the brain, but even in its healthy state.

As far as I have been able to discover, the first author who
traced the real nature of these elements was Oppenheim. In
a paper written under his direction (1893), some large cell
formations found in a softening in central syphilis are assumed
to be plasma cells, a form of cells which had been described
by Unna two years before. But possibly Oppenheim meant
those plasma cells which were described by Waldeyer in 1875,

546

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and which later on were called by Ehrlich MastzeUen. To Bhow
the plasma cells in the skin, Unna used the method of harden¬
ing in alcohol, staining with methylene blue, and subsequently
differentiating. As Nisei’s method of staining nerve cells (1894)
is based on the same principle, it gave us at the same time the
means of distinguishing the plasma cells in the cortex. Alzheimer
described and photographed these cells in general paralysis (1897),
but Nissl was the first to identify them as plasma cells (1900).
In the same year my countryman Ragnar Vogt, under Nissl's
direction, undertook to investigate their occurrence. He arrived
at the conclusion that the plasma cells were pathognomonic of
general paralysis. By further examination of 300 cases, Nissl
was able to prove that they were constantly to be found in
general paralysis. Yet some authors maintain that they do
not occur in many pronounced cases; according to Mahaim
they are not found even in 5 per cent. From their descrip¬
tion {e.g. Havet’s), it is however evident that the dissension is
owing to their view of what are to be considered as plasma
cells. In fact, the reproduction of a drawing which accom¬
panied Vogt’s paper, and to which these authors refer, was
quite misleading.

By and by it became evident that the terms in which Vogt
had summed up his results were too categorical, as plasma cells
were also found in brain diseases other than paralysis, as for
instance, in non-purulent encephalitis, in rabies, cerebral syphilis,
and tuberculous meningo-encephalitis, around abscesses and car¬
cinomatous nodules, and sometimes also in the neighbourhood
of softenings. During a visit to the Claybury Laboratory my
attention was drawn to their occurrence in the brain, also in
the sleeping sickness caused by trypanosoma Ugandense, a disease
which shows some resemblance to paralysis in other respects also,
clinically as well as anatomically (Mott). In a case of arterio¬
sclerotic insanity I found a few plasma cells among a great
number of lymphocytes infiltrating the adventitial lymph space
of a large, undoubtedly arterio-sclerotic artery in the cortex.
Mahaim found plasma cells even in intoxication from felix
mas. The fact is generally overlooked that Vogt has also
stated, that according to the occurrence of plasma cells in
other organs, we must expect to find them in several inflamma¬
tions and inflammatory new-growths; he once found them in

ORIGINAL ARTICLE

547

meningitis during tuberculosis. The careful reader of his paper
will notice that according to Vogt’s opinion the plasma cells are
not pathognomonic of general paralysis unless they occur diffusely.
To prevent a narrow view being taken of the results of examina¬
tion of the cortex, Nissl has lately found it necessary to emphasise
the fact that the plasma cells are only one among other signs
of the disease. But this reservation does not impugn the validity-
of the doctrine—No general paralysis without plasma cells.

Unna defines plasma cells as hypertrophic connective tissue
cells in which the granoplasm 1 with amorphous granules has
been excessively developed. At the same time, the other con¬
stituent of the protoplasm, the reticulated spongioplasm, has
diminished from shrinking of the prolongations of the spongio¬
plasm, and the form of the cell has become more rounded, oval,
or cubical. The nucleus is oval and is often excentrically
situated; when suitably stained the coarse chromatin network,
with a row of very large, deeply-stained chromatin granules,
will become apparent. As a rule there is only one nucleus
with a single nucleolus, and this is generally faintly stained,
while the cell-body assumes a deep bluish-black colour, which
makes the cell perceptible at first sight. Frequently, however,
the granoplasm has partly become lost, so that the reticulum
of the spongioplasm appears in one half of the cell, or more
frequently on one side of the nucleus. Thus there will be
an area deprived of granoplasm in the middle of the cell,
and this form Marschalko has declared to be the principal
type of the plasma cell. Although this view, according to
Unna, may not be justified, there is no doubt that the form
described by Marschalko with the unstained area in the middle
is the type which will most easily be recognised. While on
the whole Marschalko laid stress chiefly on the form of the
plasma cells, Unna emphasised their staining property and
proved that where the cells were found in heaps they were
generally polygonal, oblong, or irregularly shaped, often almost
ragged. In addition, the chromatin of the nucleus was always
arranged along the margin in coarse grains (Fig. 7).

Unna came to the conclusion that the plasma cells originated
from the local connective tissue cells, chiefly because they were
never seen migrating. Marschalko was of opinion that they were
1 The single grannies cannot be distinguished.

548

ORIGINAL ARTICLE

emigrated, transformed lymphocytes, because all transitional forms
might be found, from typical plasma cells to small mono-nucleated
cells without any visible cell body, i.e. lymphocytes; he had also
seen plasma cells in the spleen and lymph-glands of a healthy
suicide and in normal animals. According to Almkvist, both
authors are right, because under the name of plasma cells they
deal with different kinds of cells, different even as to their origin.
Later on Pappenheim, who sides with Unna in the question of
origin, found in normal bone marrow large and small lymphocytes
which showed the same morphological and staining properties as
plasma cells. Unna, in objecting to this, says that most probably
they are plasma cells and not lymphocytes. The point is that
fully developed plasma cells can be distinguished without any
difficulty from lymphocytes, the young ones being, on the other
hand, hardly, if at all, distinguishable. According to Unna the
plasma cells' proliferate by amitotic division. The daughter cells
are small, and exhibit a comparatively large central nucleus with
a narrow, uniform, deeply-stained protoplasmic border round it
But plasma cells may also be produced by crumbling down of
the “ reticulum ” of the spongioplasm, and the cells thus formed
have a plasmic border which is irregular in outline as if it were
corroded. This border is easily overlooked, and so the cells may
be mistaken for lymphocytes. This form especially will be found
in what is generally called “small cell infiltration” (Unna).

Further, the plasma cells easily undergo retrogressive changes
which affect their appearance. Marschalko mentions that they
become smaller and more oblong; the cell body becomes less
susceptible of staining, while the nucleus will be deeply stained.
Unna describes what he terms “grossblasige Schaumzellen” which
have lost their granoplasm under the influence of oedema and
of hyaline transformation. In general paralysis T have often
been able to trace the different stages in the development of
what are called fuchsin bodies (“ amyloid ”) from plasma cells,
which break down into granules that are deeply stained by
fuchsin; these granules run together into big lumps, and these
finally fuse into hyaline globules . 1

Considering all this, we cannot expect all authors to mean

1 These must not be mistaken for the globular masses which alcohol extracts
from the myelin sheaths, and which give a gritty surface to preparations hardened
in alcohol.

ORIGINAL ARTICLE

549

the same thing by what they call plasma cells. Thus Alzheimer
found his form of plasma cells not only in the adventitial lymph-
spaces, but scattered freely in the tissue, chiefly round the
nerve-cells; he also described karyokinesis. Vogt adhered to
Marschalko’s description, and therefore excluded all forms which,
staining as plasma cells, did not exhibit the forms pointed out
by Marschalko. This is probably the reason why I have not
so often as Vogt found lymphocytes “in great quantities” in
the adventitia of the cortical vessels in paralysis, at least not
in the small vessels. The typical forms of plasma cells, however,
will always be found in such numbers in this disease that a few
cells more or less will be of no importance. It is not even
always possible to identify each single cell. But if we wish
to form an opinion with regard to the occurrence of the different
cell forms, the first thing required is to use appropriate methods.
In Rehm’s double staining (by methylene blue and alcoholic
fuchsin) we have the means of distinguishing the nuclei of the
plasma cells from those of the lymphocytes. In his account
of the pathological anatomy of insanities, Cramer says that,
by carefully studying alum-hsematoxylin preparations, we can
ascertain three kinds of nuclei in the adventitia-infiltration:
(1) leucocytes, (2) endothelia of vessel- or lymph-sheaths, and
(3) glial nuclei. So far as I can see, the predominant part of
the infiltration consists of plasma cells, and not of the forms
of nuclei just mentioned. I have not even succeeded in finding
lymph-sheath endothelium in intracranial vessels. In the examina¬
tion of cell forms it is of course of little use to employ methods
which give to plasma cells the same appearance as glia nuclei,
endothelium, and leucocytes.

The distribution of plasma cells in general paralysis is quite
characteristic. They surround the vessels in large, dark masses,
so that the vessel wall itself can scarcely be seen; they cluster
densely, like plant-lice upon a young shoot (Fig. 3). In rapidly
progressing cases especially they will be found in the dilated
adventitial lymph-space of almost each vessel in the cortex, also
in the subcortical white matter. During remissions they will
mostly disappear, and in cases with a slow progress they will
chiefly be found in the lymph-sheaths of the larger vessels.
They occur over the whole cortex, in the anterior as well as
the posterior portion of the cerebrum, in the central ganglia, in

550

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the grey matter immediately subjacent to the brain ventricles,
and in the cerebellum—wherever, indeed, a fresh paralytic
process is going on (morbid changes of nerve-cells, degeneration
of medullated fibres, glia hyperplasia). The number of plasma
cells does not seem to be proportional to the degree of alteration
in the meninges, and they may be found even if no alteration
can be detected by the naked eye.

It has been said that the plasma cells might migrate from
the vessels into the tissue. No doubt this sometimes seems to
be so; I have not, however, been able to exclude the possibility
that they may belong to a capillary, whose walls have not been
included in the section, or which has not been stained from
some cause or other. In large vessels they will never be seen
moving inside the walls as long as these are healthy, and if the
tissue has been injured the plasma cells will be found almost
exclusively in the layers subjacent to the adventitia, having
made their way into it from outside. But they will not be
found close to the lumen of the vessel, nor have I seen them
inside it. It must of course be admitted that possibly they do
not assume their typical appearance till they come into the
lymph-space, and therefore cannot be distinguished from lympho¬
cytes in their earlier stages, when they circulate in the blood.
But no elements even resembling lymphocytes will be seen
passing through the vessel wall. On the other hand, if Unna
is right in saying that the plasma cells originate from the local
tissue cells (that is, from adventitia), then it is not quite correct
to apply to them the term exudation.

Along with plasma cells, lymphocytes 1 will be found in the
infiltrations (not often in large numbers according to my experi¬
ence), as well as mono-nucleated leucocytes. Polynuclear leuco¬
cytes occur quite sporadically, in cases where there is no special
reason for their appearance, such as septic infection. Some of
Ehrlich’s so called “ fattened cells ” (“ Mastzellen ”) may also be
found. These cells may be recognised by their markedly granular
cell body; as the nucleus cannot generally be seen, the whole cell
seems to consist of an accumulation of granules, and almost

1 By “ lymphocytes ” is here always meant cell forms with one single round
nucleus, which assumes a somewhat dark tint in Nissl preparations, and whose
protoplasm will be visible merely as grains round the margin ; it will never, at least,
encircle the nucleus entirely. The leucocytes are larger, more slightly coloured, and
mono- or polynuclear; the latter may have different forms.

ORIGINAL ARTICLE

551

resembles an aggregation of micro-organisms. The protoplasm
granules are of different size and somewhat irregularly scattered,
but each single granule may always be distinguished (which is
not the case in plasma cells) ; these granules have great affinity
for basic aniline dyes, and are generally stained metachromatically
(i.e. they take a shade different from that of the staining fluid
which has been used). In staining with Unna’s polychrome
methylene blue (which may be used in the same way as for
plasma cells) they assume a reddish shade ; when Nissl’s method
is used they turn a bluish-black colour. Haematoxylin is not
suitable for their demonstration, and it is better not to embed
the preparation before staining it. The form of the cells may
vary; they are circular as well as flat, angular, and spindle-
shaped. They may be as large as white corpuscles, or larger.
The nucleus is of medium size, oval in shape ; generally it is not
stained, but it may take the colour of the staining fluid. It
has not been definitely ascertained whether the “ mast-cells ”
originate from the local connective tissue cells or from the
leucocytes. Normally they are found in bone marrow, and are
said to increase with age; they also occur in inflammations and
in tumours. As far as we know at present they are of small
importance in the diagnosis of general paralysis.

The nuclei of the adventitia may have increased without any
concourse of other elements. The hyperplastic nuclei often
exhibit strange forms. The cell body contains considerable
pigment in grains or flakes.

The other alterations of the small cortical vessels are not so
constantly found. Sometimes the* endothelial nuclei have dis¬
tinctly increased, and now and then they seem to fill up the
whole lumen; the cell body is very frequently more or less
visible in the Nissl preparations. The vessel wall may have
undergone a hyaline degeneration; but this term is still so vague
that almost every different author applies it in his own sense.
Thus capillaries are said to have undergone “ hyaline degenera¬
tion ” when their walls are thickened and, as it were, swollen;
and the same expression is used about the smallest arteries when
the connective tissue has increased and the structure has become
indistinct. More rarely real deposits of hyaline matter (taking a
bright red stain from eosin) will be found in the vessel wall,
either in the place of the muscular coat, or more frequently

552

ORIGINAL ARTICLE

between the adventitia and media the remnants of the nuclei of
which may still be faintly seen in the hyaline substance. Some
vessels have contracted and seem impervious. Finally, we will
find a number of newly-formed capillaries. According to experi¬
ments in ado in the laboratory of the Psychiatric Clinique in
Heidelberg, the glia cells come forward to give support to the
newly formed capillaries, their cell bodies being permeated by
endothelial cells, which circumscribe the lumen of the new
capillary. The protoplasmic processes from a neuroglial cell to
a vessel do not become channelled, as Mendel imagined. Most
of the new buds from the capillaries, however, make their way, I
think, between the glia cells, not through them.

The large intraci'anial arteries.

The aggregation of plasma cells in the lymph space of the
adventitia may be traced even to the large intracranial arteries.
There will frequently be other alterations here, however, which
are more prominent or which will be found alone. Arterio¬
sclerosis must of course be expected in all aged paralytics; syphilis,
also, has long been thought to favour its appearance at an earlier
age. But we cannot therefore say—as some authors have done
—that general paralysis is the result of combined syphilis and
arterio-sclerosis. Upon this occasion the obviously arterio-sclerotic
alterations are less interesting than the occurrence of Heubner’s
syphilitic arterial disease. Anglade has never found this in
general paralysis. Mendel has not seen more than 2 cases
among 60, and during 14 years Cramer has not been aware
of more than 3-4 well-marked specimens. But it is not
quite clear whether all cases have been examined microscopically.
On the other hand, Straub found this arterial disease in most of
the paralytics whom he examined, and I have also been surprised
to see how frequently it will be found, when carefully looked
for.

Of course this difference of opinion mainly depends upon
what is considered as syphilitic arterial disease. The question,
therefore, is, whether we really have definite signs which enable
us to distinguish between this disease and arterio-sclerotic
alterations. The other “ endarteritic ” processes in tuberculosis,
in chronic ulceration, and after ligature, etc., cannot here be
taken into consideration.

ORIGINAL ARTICLE

553

Even Heubner himself was not of opinion that the arterial
disease which he described was specific in regard to its anatomy,
hut he maintained that the process was connected with syphilis,
and was anatomically different from arterio-sclerosis. He
pointed out that the newly-formed layer had a larger number
of cells, and was irregularly arranged in syphilis, and that there
were no degenerative alterations, especially no deposit of fatty
matter or lime salts. Further, the atheroma generally impli¬
cated only a part of the circumference of the vessel, but extended
over a considerable portion of its length, and would mostly be
found in the larger arteries, while the syphilitic arterial disease
attacked in preference the small and middle-sized arteries.
Generally the muscular coat was not affected by the syphilitic
process, except in the extreme stages, and the infiltration of
adventitia round the nutrient vessels was an accidental occur¬
rence. But according to Heubner the muscular coat was not
much altered, even by arterio-sclerosis, and if so, the form
assumed was usually that of fatty degeneration. The adventitia
was often infiltrated by “ round cells.” In arterio-sclerosis the
elastic membrane became laminated, exhibiting nuclei between
the laminae, and eventually it would split into 4-8 shiny bands.
Also, according to Jores (p. 49), the division of the elastic
membrane is always part of the arterio-sclerotic process, and
besides this, connective tissue will be abundantly found between
the laminae. He says that this splitting will only be found in
syphilitic endarteritis when the endarteritis has developed in
slightly arterio-sclerotic vessels.

Leaving out of the question the vessels which are evidently
arterio-sclerotic ( i.e . vessels charged with fatty matter and lime
salts), the diseased cerebral arteries of large calibre (art. basi-
laris, fossae Sylvii, etc., and their first branches) in general
paralysis present, as far as my experience goes, the following
aspect (Fig. 5). The endothelium does not seem to be altered ;
the nuclei form as usual only one layer. Under the endothelium
may frequently be seen a structure which in its form resembles
an elastic membrane, but which does not give the staining
reaction characteristic of elastin, nor will those remnants of
nuclei be found which in all text-books are called “ fenestra.”
But a little further out in the vessel wall a typical elastic
membrane will be found, which evidently is the original

2 o

554

ORIGINAL ARTICLE

membrane of the vessel. Between this and the endothelia is
a newly-formed layer, consisting of a fibrillar ground substance
and numerous cells. The intercellular substance is, as a rule,
poorly developed, but it may consist of huge bundles of fibres;
these will not generally give the reaction of elastic tissue, but
sometimes they may do so. In preparations stained with the
ordinary stains for nuclei, the nuclei of the newly-formed layer
sometimes resemble endothelial nuclei, sometimes those of
muscle cells, but generally they are unlike both. The elastic
membrane, which will be found in its place close to the muscular
coat, may show its original appearance, but frequently the folds
are not so regular as formerly; the membrane may in part be
quite straight under the newly-formed layer, and in some places
it has taken no staining, so that its circular line looks broken.
In the place where it seems to be least prominent, elastic fibres
have developed, generally on the inside of the membrane, but
sometimes on the side facing the muscular coat. In the elastic
membrane two layers may be distinguished as usual; the inner
layer will be stained a deep red by Weigert’s resorcin fuchsin,
and the outer layer black by Heidenhain’s iron hsematoxylin.
In an early stage of the arterial disease the inner layer is thicker,
as if swollen and about to be split. Between the divided layers
nuclei will appear. It seems as if this splitting of the mem¬
brane, with the appearance of nuclei between the layers, is the
alteration with which the whole process begins, and this might
explain why the condition in the brain vessels just described will
be seen in the arteries only and not in the veins, which, as a
rule, have no elastic membrane. Heubner thought the newly-
formed elastic membrane was derived from the endothelium. In
my opinion, it has its origin in the already existing membrane.
It need not, therefore, be simply a splitting of this membrane,
since the lamins, taken together, may be thicker than the
original membrane. Those sheets or elastic fibres which split
off are liable to retrograde changes, and then they will no longer
give the reaction of elastic tissue. The wavy fibres of the layer
may partly, however, be common collageneous tissue.

The new layer which develops inside the inner lamina of
the elastic membrane projects forward into the lumen, and may
become prominent at a circumscribed spot of the wall, but will
generally follow the whole circumference of the vessel. In

Plate 35 .

Fig. 1.—Considerable thickening of pia arachnoid, with proliferation
of nuclei and connective tissue fibres. /, a collection of fibroblasts,
a, the wall of an artery; in adventitia with immediate surround¬
ings numerous plasma cells. Iheraatoxylon-eosin. Leitz lens 6,
oc. 1.

Fig. 2. —Pia arachnoid. In the lower part a bundle of elastic fibres,
probably belonging to a vessel not in section. On both sides
“ Gitterztllen" (</); some other cells are certainly plasma cells.
/, nuclei of fibroblasts. Hiematoxylon, and then the rosorcin-
fuchsin method of Weigert. Oil immersion A, oc. 1.

Plate 36.

Fig. 3. —Plasma cell-infiltration of a vessel in the cerebral cortex.
In the vicinity spider cells, sending protoplasmic prolongations to
the vessel wall. Bevan Lewis aniline blue black. Lens 6, oc. 1.

Fig. 4. —Spider cells in the outermost layer of the cortex, with dense
network of glia fibres. From a case of juvenile paralysis. The
artery shows no change. Method of Held. Lens 7. oc. 1.

Plate 37-

Fig. 5.—A probably syphilitic cerebral artery; s, newly formed sub-
endothelial layer ; m, muscular coat, considerably narrowed. The
elastic membrane (r) partly interrupted, nearly straightened in
places where the newly formed layer is most developed. On the
opposite side of the artery there are several laminae split off from
the membrane towards the lumen. Heidenhain’s irondnema-
toxylon. Lens 3, oc. 1.

Plate 39.

Fio. 9.—Plasma cells (Marschalko’s type) round a capillary of the
cerebral cortex. Beneath the lowest plasma cell an endothelial
nucleus. Nissl’s method. Oil immersion T 1 *, oc. 4 (1000 > ).

t %

Fig. 10. —Staff cells. One of these is reproduced from a rather dark
copy in order to make the branching cell body more distinct.
Nissl’s method. Oil immersion i 4 *, op. 4.

ORIGINAL ARTICLE

665

general paralysis considerable narrowing or entire obliteration
of the lumen will seldom occur. The layers grow at intervals
and probably very slowly. Several (2-3) layers of different ages
may frequently be distinguished, each of which will be limited
by an undulating line, that marks an elastic lamina which has
been separated at some time or other. On the newly formed
layer thrombosis may take place. Later on the obliterating
masses become vascularised; 3-4 or more new large lumina, each
having a separate muscular coat, may be seen. There are no
traces of fatty or calcareous degeneration.

The muscular coat has not been altered where the subendo-
thelial layer is only very slightly developed, but it will generally
become narrower in the place corresponding to the newly-formed
layer, and in a later stage of the arterial disease the muscular
coat will sometimes become quite wasted.

The adventitia is now and then uniformly thickened, almost
exclusively by increase of the connective tissue fibres, which may
form huge bundles; the elastic fibres have not often increased.
But there need not be any alteration here, even if the newly-
formed layer under the endothelium is somewhat thick.
Frequently, however, the adventitia has been infiltrated by alien
cells, especially in the outer layer, and not unfrequently they
have penetrated to the adjacent parts of the wall in those vessels
where the muscular coat is atrophic, and where abundant elastic
tissue has been developed in the subendothelial layer. In all
likelihood the cells are lymphocytes and plasma cells. The
infiltration of the adventitia is probably more directly connected
with the paralytic process, while the syphilitic vascular lesion
(Heubner) does not in itself relate to general paralysis.

In general paralysis the syphilitic arterial disease will be
found not only in the intracranial arteries, but also in other
parts of the arterial system. In syphilitic individuals without
any trace of mental disease it has been found even a few months
after the infection. The anatomical picture of the arterial disease
seems mostly to indicate a slow and irregular progress with
partial repair, and this fully agrees with the fact that in the
greater number of my cases the lesion did not seem to have
caused any evident disturbance in the function of the vessel.

The reasons for my opinion that the arterial disease just
described is caused by syphilis and not by arterio-sclerosis are:

556

ORIGINAL ARTICLE

first, that the changes resemble those found in the intracranial
vessels in a case of syphilitic brain disease occurring at about
seventy years of age, where no gross alterations of the aorta were
to be seen; secondly, the absence of fatty or calcareous deposits
in the newly-formed layer, even where this was markedly de¬
veloped ; and, finally, because the original elastic membrane was
always recognisable, and was never completely divided into
equally delicate laminae. Even in arterio-sclerosis, however, this
mode of splitting may not always be found. Jn general para¬
lysis the plasma cells will, of course, afford no aid to the
differential diagnosis between the two vascular diseases, as the
vessel may be arterio-sclerotic before the paralysis begins; bat
in arterio-sclerosis alone the plasma cells will never be found
in large numbers.

Nothing definite can be said about the nature of the vascular
changes till further investigations have been made, and we most
be prepared to find that most heterogeneous processes are included
in what we now class under the common name of arterio-sclerosis.

(To be continued.)

abstracts

ANATOMY.

A CONTRIBUTION TO OUR KNOWLEDGE OF THE STRUCTURE
(298) OF THE NERVE CELL. (Oontributo alia conoscensa dells
struttura delle cellule nervose.) Gemelli, Riv. SpertmenL di
Freniatria, Vol. xxxii., Fasc. 1-11, p. 212.

In this paper, which is a preliminary communication, the author
reviews the work already done upon the neurofibrils and proposes
to answer three questions: (1) If long fibrils exist; (2) the
existence and the form of the endocellular reticulum; (3) the
combination of the long fibrils to form an endocellular network or
their independence.

The research when finished will embrace vertebrates as well as
the lower forms of life, and the author recognises the importance
of using one method which will give constant positive results in
all. With this object he has employed a modification of the

ABSTRACTS 557

osmio-bichromate-silver nitrate method, and gives the result of his
observations on worms.

The fibrils which enter the cell from the nerve process are
very fine, and divide into two or three rami, which, uniting with
others, help to form a meshwork. This completely surrounds the
nucleus. In the worm there are no long fibres, all fibrils ending
in anastomosis. David Obr.

0 ADA VERIO ALTERATIONS OF THE NERVE CELLS STUDIED
(299) BT THE METHOD OF DONAGGIO. (Le alterazioni cada-
veriche delle cellule nervose studiate col metodo di Donaggio.)

V. Sgarpini, Riv. Sper. di Fren., Vol. xxxi., Fasc. 3-4.

In this investigation the author examined pieces of the spinal
cords of rabbits, which had been removed from the spinal column
immediately after death, and kept in a damp room at a tempera¬
ture of 15* C.

Fragments about 5 mm. thick were taken every two hours and
placed in fixing fluids. The results showed that no changes of
any importance had taken place in tissues which had been exposed
for twenty-four hours. After a little longer exposure the fibrils,
peripheral and central, had become less distinct and had broken up
into very fine granules. At the same time the nucleus and the
nucleolus had become stained, the cell had lost its processes, and
had gradually become disintegrated.

These changes differ from purely pathological alterations, in
that the contour of the cells had altered; they were uniform
throughout the cell, and when the granular condition was com¬
plete the nucleus was also stained. On the other hand, in patho¬
logical conditions the contour of the cell is preserved, the reticular
fibrils break down before the long peripheral fibrils, and the nucleus
never becomes stained. R. G-. Rows.

ON SOME PRIMARY ALTERATIONS OF THE ENDOOELLULAR
(300) FIBRILLARY RETICULUM AND OF THE LONG FIBRILS
IN THE CELLS OF THE SPINAL OORD. (8u alcune alte¬
razioni primitive del reticolo flbrillare endocellulare e delle
flbrille lunghe nelle cellule del midollo spinale.) V. Scar-
pini, Riv. Sper. di Fren., Vol. xxxi., Fasc. 3-4.

The author first examined the nerve cells of animals which had
been killed by the inhalation of ethyl chloride. The results, as far
as the fibrillse were concerned, were negative.

He then described the condition of the cells of the cord after

558

ABSTRACTS

compression of the aorta. These results varied, of course, with the
duration of the anaemia produced. With an anaemia lasting for
twelve minutes, even if repeated three times, there was very little
departure from the normal. If, however, the anaemia lasted a little
longer than that, the network of fibrils became less distinct, the
fibrils themselves less regular, and some fragmentation could be
seen; vacuolation of the cell also occurred. The fibrils in the
centre of the cell were more affected than those at the periphery.

After an anaemia of three hours, the reticulum had lost its
structure, and the fibrils throughout the cell had undergone a
granular disintegration. With still longer compression of the
aorta, softening of the cord was produced.

Other methods have shown that the chromophile elements of
the nerve cells react to morbid agents more readily than do the
fibrils. If, however, the lesion of the chromophile elements is not
accompanied by much injury to the fibrils, recovery of the cell is
possible, although the function of the cell may have been tempo¬
rarily almost lost; but if the fibrils have been damaged to any
extent, i.e. if they have undergone this granular change, recovery
is impossible. R 6. Rows.

PHYSIOLOGY.

CONTRIBUTIONS TO THE PHYSIOLOGY OP THE JAW-MOVE-
(301) MENTS. (Beitr&ge zur Phyaiologie der Kieferbewegungen)

Riegner, Archiv. f. Anat. und Phys., 1906, p. 109.

This paper deals with the action of the individual jaw muscles
of Macacus Rhesus in supplement of an earlier research by the
same author on the effect produced by drawing upon the jaw
muscles of the human body, carefully isolated after death.
The method employed was to kill the ape with chloroform, and
then to stimulate electrically the muscles, which retained their
full contractility for an hour after death. The action of each
of the seven muscles is shortly given, and found to be in
general accord with the results obtained on the human subject.

John D. Combie.

PATHOLOGY.

CONCERNING DEGENERATION AND REGENERATION OF
(302) PERIPHERAL NERVE-FIBRES. (Sopra la degenerazione e re-
gener&zione [in seguito al taglio] delle fibre nervosa periferiche.)

Carlo Best a, Rivisia SperimentcUe di Freniatria, Vol. xxxii,
p. 99.

From experimental researches, consisting in the division of peri¬
pheral nerves, turning up the central segment and suturing it to a

ABSTRACTS

559

muscle, thereby preventing the reunion of the central with the
peripheral end, the author comes to the following conclusions as
regards the process of degeneration:—All the fibres in the peripheral
segment undergo degeneration. The process commences in the
axis-cylinder, firstly as a swelling, then as a granular degeneration
of the fibrils composing the axon. Then follows a destruction of
the supporting stroma of the axis-cylinder, and, parallel with this,
a proliferation of the cells of the neurilemma. In the place of each
fibre there comes to be formed a protoplasmic thread, rich in
nuclei, which after a time becomes attenuated and is at last reduced
to a mere chain of delicate bipolar elements. The process is
identical in young animals and in adults. The writer has never
seen any migration of leucocytes into the nerve-fibre during the
degenerative process, and believes the phagocytosis to be carried
out entirely by the proliferated neurilemma cells.

In the process of regeneration, the author describes how the
neurilemma cells proliferate within the old fibres and form them¬
selves into bundles of protoplasmic threads running longitudinally.
The lower end of the axis-cylinder of the proximal segment then
becomes attached to one of the newly-formed protoplasmic threads,
and thereby exercising an influence on it, a delicate new axis-
cylinder is laid down in the protoplasmic thread. In this way the
new fibres, though not branches or prolongations of the central
axis-cylinder, are formed under its immediate influence. Besta’a
results therefore support the pluri-cellular origin of regenerated
fibres, whilst he maintains that the central segment exercises a
stimulating influence on the process. Purves Stewart.

ON THE FUNCTIONING OF DEGENERATE MUSCLES. Third
(303) Paper. (Mechanical Work and Potency.) (Sulla Funzione del
Muscoli Degener&ti. Ilia Comunicazione. [Lavoro meccanico
e potenza.]) Dr Guido Guerrini, Lo Sperimentale , May-June
1906.

In this paper Dr Guerrini continues his examination of the
functioning of muscles in a state of fatty degeneration.

Two points have to be considered: (1) The mechanical work
done by the muscle; and (2) The mode in which a muscle raises a
weight to a certain height and there sustains it.

A short account of the work already done by others with
reference to the first point is followed by a description of the
machine which the author himself made use of.

The experiments were made on edible frogs, the gastrocnemius
being the muscle used. The weight employed was one gramme;

560

ABSTRACTS

it was found that heavier weights gave almost exactly the same
total amount of work, though naturally the individual elevations
were less. The number of stimuli was two per minute; slackening
this rate did not affect the tracing, while increasing it was apt to
cause the degenerate muscles to entlr the state of contracture.
Moreover, the author desired not to have phenomena due to fatigue
superposed upon the tracing, his object being to bring about the
material exhaustion of the muscle uncomplicated by the specific
action of those products of muscular catabolism which play so
great a part in fatigue.

Records of twenty experiments follow. They show that the
degenerate muscles, as compared with the normal, give a tracing
in which the ordinates are both shorter and fewer in number.
Moreover, there is in the former case a greater irregularity in the
amplitude of the movements, and the initial rise of the curve is
either wanting or of much shorter duration.

From these facts the following conclusions are reached: (1) That
whilst in normal muscles (sufficient interval being allowed) to
identical stimuli correspond contractions equal in amplitude and
form, in degenerate muscles contractions corresponding to identical
stimuli differ in amplitude and form. (2) Whilst in normal muscles
identical stimuli repeated at short intervals bring about increased
excitability, this does not occur in degenerate muscles. (3) Hence
it appears that whilst in normal muscles the excitability persists
with remarkable constancy, in degenerate muscles it oscillates
between fairly wide limits.

The decrease of mechanical work in the case of a degenerate
muscle is very considerable; thus while one cm. of normal muscle
gives 119 97 cm.-grms. of work, one cm. of degenerate muscle
gives only 74'36.

In order to study the second mechanical property of the
muscle—which in a former paper Dr Guerrini called muscular
potency—the area of the tetanic curve was calculated for normal
and degenerate muscles respectively. The method of experiment
is described, and figures referring to seventeen experiments given.

The results show that the muscular potency of a degenerate
muscle is much less than that of a healthy muscle, the ratio
being 23:79.

In both muscles in the second tetanic contraction the muscular
potency is less than in the first, but whilst in a normal muscle it
decreases to about one-half, in a degenerate muscle it decreases to
about one-fifteenth.

Finally, an examination of the muscular potency represented
by the sum of all the tetanograms shows that the degenerate
muscle possesses barely one-tenth of the potency possessed by the
normal muscle.

ABSTRACTS

561

The paper concludes with a short enquiry into the causes of
the diminution of power of work and of muscular potency shown
by degenerate muscles and with a bibliography of the subject.

Margaret Drummond.

HISTOPATHOLOGIOAL CHANGES OF TEE CEREBELLUM IN
(304) GENERAL PARALYSIS. (Die histopathologischen Ver&n-
derungen des Kleinhims der progressives Paralyse.) E.

Straussler, Jahrbuch fur Psyehiat. und Neurol ., Band xxvii.,
1906.

This is a long enquiry into the changes which are met with in the
cerebellum in general paralysis. Microscopically the evidences of
disease are less prominent than in the cerebrum. The meninges
are not thickened to such an extent, nor do the vessels show so
much change. Microscopically the changes in the meninges con¬
sist of a collection of cells around the vessels in the outer layers,
while in the inner layers there is an infiltration of the tissues.

The alterations in the vessels the author considers to be
secondary.

There is a considerable discussion with regard to the relation
of syphilis to the changes in the vessels, and after stating that the
proportion of cases in which a syphilitic arteritis has been found
varies from 82% in the cases of Straub to 47% in those of Chiari,
and 13'5% in his own cases, he expresses the opinion that syphilitic
alterations in the vessels cannot be accepted as the cause of the
lesions found in the nervous tissues.

The lesions of the nervous tissues consist of a loss of nerve cells
and fibres, which is followed by an overgrowth of the neuroglia,
and a shrinking of the convolutions. Vacuolisation of the nerve
cells is common. The regions of the cerebellum which are most
affected are situated around the semi-lunar sulcus, the lobus cen¬
tralis and the lobus superior arterior, and parts of the inferior
worm, the nodulus and uvula. These lesions are at first limited
to the superficial portions, and only in the advanced stages of the
disease do they attack the deeper convolutions.

With regard to their origin, the author suggests that they are
primary degenerations produced by toxines circulating in the
cerebro-spinal fluid, and, as a matter of fact, it is precisely the
superficial portions, which are most exposed to the cerebro-spinal
fluid, which are most affected. The other changes met with must
be considered as secondary.

Lastly, the author expresses the opinion that, although there
is no close relationship between the intensity of these cerebellar

562

ABSTRACTS

changes and the motor symptoms of general paralysis, they do
sometimes play an important part in the determination of the
clinical picture. R G. Rows.

EXTIRPATION OF THE LOWER HALF OF THE SPINAL OORD
(305) AND ITS RESULTS. (Ueber die Extirpation der nnteren

Hftlfte des Rflckenmarks und deren Folgeerscheinungen.) L.

R. Muller, Deut. Zeitschr. /. NervenheWc., Bd. 30, H. 5-6,

S. 413.

A DOG had its whole lower cord, except the conus terminalis,
removed in three stages up to the level of D 9. After the primary
disturbances had passed off there was automatic emptying of the
bladder and rectum.

Erection and seminal ejaculation were possible with the upper
lumbar cord intact, but not when it was removed.

The dog was killed after two years. Over the hinder part of
the body the skin and hair were then as healthy as over the
normal anterior part. Some pressure sores which had formed
early over the feet had healed. The subcutaneous fat was also as
abundant as elsewhere.

The muscles of the hind limbs were almost entirely fatty ; a
little fibrillary substance could still be seen microscopically. The
muscle spindles were for the great part intact. The bones of the
hind limbs were more rarified than those of the fore. In the
nerves, nearly a third of the fibres still had medullary sheaths,
although these were somewhat granular. Probably they were
fibres from the cells of the posterior root ganglia, which were un-
distinguishable from normal ganglia cells.

In the conus there were no marked signs of secondary degene¬
ration except in the dorso-medial tract. This tract was also affected
in the upper dorsal cord, but no degeneration could be traced into
the cervical region. J. H. Harvey Pirib.

A SERUM REACTION OCCURRING IN PERSONS SUFFERING
(306) FROM INFECTIVE CONDITIONS. Lewis C. Bruce,
Joum. Merit. Sc., July 1906.

The author, having noticed in the course of making observations
upon the opsonic indices of the insane that the serum in many of
the cases agglutinated the red blood corpuscles of a healthy
person, examined the serum of some recent cases of insanity,
and found that the serum of all persons suffering from mania with
confusion, the mania or depression of folie circulaire, katatonia,

ABSTRACTS

563

hebephrenia, and the excitement associated with epilepsy, invari¬
ably gave this agglutinative reaction. Whereas cases of insanity
due to other causes than bacterial infection, such as melancholia
of metabolic origin, systematised delusional insanity, etc., did not
give this reaction.

The writer also observed that the red blood corpuscles of
a patient in whom this agglutinative reaction is present are pro¬
tected against the action, not only of the agglutinine in the patient’s
own blood, but also against the agglutinine in the serum of
another patient.

The substance which causes this agglutinative reaction is
thermostable, and it is not the same substance as the agglutinine.
It also gradually disappears from the serum in some cases—the
reaction may be quite definite in a serum recently obtained from
a patient, while the same serum six hours later will give a very
indifferent reaction.

By means of this test it is possible to divide cases of insanity
into two great groups, infective and non-infective.

H. de M. Alexander.

CLINICAL NEUROLOGY.

TWO BROTHERS AFFECTED WITH PRIMARY PROGRESSIVE
(307) MYOPATHY. ADDITIONAL NOTH (Deux frtres attaints
de myopathia primitive progressive. Note additionnelle.)

Noica, Noun. Icon, de la Salpei., March-April 1906, p. 151.

This article deals with the sensory disturbances present in two
cases of myopathy which had been previously reported. The first
case showed tactile anaesthesia over the whole surface of the body,
with the exception of the head, neck, palms, and soles. There was
also hypoalgesia and delayed perception of pain over practically
the whole of the same extensive area. Sensibility to heat was
diminished, but sensibility to cold was unaffected. The stereog¬
nostic sense, and sight, hearing, taste, and smell were normal. In
the second case the sensory symptoms were less marked but
similar in nature, and although at first the skin of the limbs was
alone affected, the distribution eventually extended until it was
almost identical with that noted in the first patient Examination
of a portion of a cutaneous branch of the anterior tibial nerve
removed during life from one of the patients revealed very definite
pathological changes. The author discusses the relation of the
sensory phenomena and nerve changes to the muscular atrophy,
and although unable to arrive at a definite conclusion, he thinks

564

ABSTRACTS

it probable that the nerve lesion has been snperadded to the
muscular one, and that no etiological connection between the two
exists. Henry J. Dunbar.

ON A CASE OF “ CRUTCH PARALYSIS.” (Sur uncude “pua-

(308) lysis des bdquilles.”) F. Soca, Nouv. Icon, de la Salpit., March
April 1906, p. 171.

This article is based on the case of a soldier, aged 30 years, who,
while recovering from a wound of the right leg, was obliged to
employ crutches to enable him to walk. After a few days of their
use he began to experience tingling and numbness, succeeded by
progressive loss of power in the whole of the right arm. A fort¬
night after the commencement of symptoms, the arm was found to
present the typical signs of musculo-spiral paralysis. On careful
consideration, however, it was discovered that there was indisputable
evidence of affection of the whole brachial plexus, as shown by
paresis of the muscles supplied by the median and ulnar nerves,
and also of the biceps, brachialis anticus, coraco-brachialis, deltoid,
subscapular, pectoralis major and minor, supraspinatus, infra¬
spinatus, rhomboids, levator anguli scapulae, and serratus magnus.
There was also anaesthesia to pain, heat, and cold, with unaffected
tactile sensibility over the whole arm. The accepted theory of the
mechanism of crutch paralysis is that the musculo-spiral nerve is
compressed against the humerus by the direct action of the crutch.
The distribution of the paralysis in this case shows the lesion to be
one affecting the nerve roots—not of the peripheral nerves nor of
the brachial plexus. The cause of this root lesion cannot be direct
compression, and is almost certainly traction, the end of the crutch
acting as a pulley. The author has demonstrated this mechanism
by experiment on the cadaver. The fact that the musculo-spiral
nerve is most affected is probably explained by the direct pressure
of the crutch, a pressure to which the other branches of the plexus
are less exposed. Henry J. Dunbar.

ALOOHOLIO NEURITIS. Coriat (of Boston), Am. Journal of
(309) Insanity, April 1906.

The clinical histories of seventeen cases are given, and some of the
most recent literature on the subject is reviewed at length. The
conclusions concerning the mental disturbances associated with
alcoholic neuritis are as follows:—

With eye muscle palsies, which may be of either central or
peripheral origin, there is often an implication of the higher central

ABSTRACTS

565

neurones, and a consequent delirium, with marked allopsychic
disorientation, or the development of a fabricating psychosis.
Again, peripheral neuritis may be associated with a posterior
column degeneration, and bear a close resemblance clinically to
tabes, or the central involvement may exist by itself, and give
rise to a characteristic terminal disorder. Ordinary peripheral
neuritis is, as a rule, associated with some central disorder. Cole
believes that the central disorders consist in an axonal reaction of
the Betz cells, with a degeneration of their connecting pyramidal
tracts, and a posterior column degeneration similar to that seen
in tabes.

Korsakow’s psychosis may occur without any signs of peripheral
neuritis, and be caused by other factors than alcohol. A delirious
state of very acute onset, strongly resembling delirium tremens,
may occur, and when associated with peripheral neuritis, may show
marked disorientation, poor retention, defective memory for recent
events, and confabulation. The course of the disease is usually
acute, and may end with the motor disorders of a terminal central
neuritis. There is still another type of Korsakow’s psychosis of
acute onset, with isolated neuritic symptoms, which progresses
rapidly to recovery. In true delirium tremens which shades into
a fabricating psychosis, recovery is usually not complete, some
mental reduction follows, or the delirium may subside rapidly
and leave a slowly improving neuritis. If neuritic symptoms
appear during delirium, suggestibility and marked fabrication
are always superimposed.

Another group of cases show a protracted course, and ultimately
exhibit all the clinical symptoms of a central neuritis, i.e. emaciation
with diarrhoea, rigidity, and twitchings.

In the pure acute hallucinosis with neuritis from the start, or
developing later in the course of the disease, the outlook for recovery
is very favourable.

Depressive delirious states of rapid course with or without poly¬
neuritis or a dreamy hallucinatory confusion may exist, always
without fabrications or amnesia. Finally, there are cases resembling
at first an alcoholic deterioration process, exhibiting recent memory
defect, and running a slow course, which show an almost complete
recovery parallel with the disappearance of physical signs.

C. H. Holmes.

TABES AND AOBTIO ANEURYSM. (Tabes et anlvxysme aortique.)

(310) Dkbovx, Journal des Practitiens , June 9, 1906.

This is the account of a case which presented signs indicative of
tabes or of aortic aneurysm. Briefly these were loss of weight,
and gastric crises, lasting over eight years, loss of muscular power,

566

ABSTRACTS

hiccough, abolition of tendon reflexes, slow pupillary reaction to
light, great muscular hypotonus, severe pain down the right arm,
but no shooting pains, no ataxia, no Rombergism.

The writer in passing remarks upon the denial by Babinski,
Vagnez, and others, that pupillary dilatation in cases of aneurysm
is due to compression within the thorax, these writers attributing
it to syphilitic eye changes. Being in a dilemma as to the diagnosis,
he draws attention to the importance of two recent diagnostic
methods, viz. lumbar puncture and skiagraphy. The former dis¬
covered many lymphocytes in the arachnoid fluid, enabling a
diagnosis of tabes to be made, while the latter showed with
certainty a large aneurysmal dilatation of the aorta.

John D. Comrie.

A STUDY OF PARAPLEGIAS FROM RETRACTION IN OLD
(311) PEOPLE. (Etude but les parapl4gies par retraction ches lea
viellards.) P. Lejonne and J. Lheriotte, Now. Icon, de la
Salpit., May-June 1906, p. 256.

Paraplegia from muscular and tendinous retraction due to
chronic myositis in old people has, on account of its close
resemblance clinically to paraplegias of other origin, not received
the attention which it merits. The disease has been to a great
extent confused with chronic rheumatism and with the con¬
tractures following prolonged want of use in paraplegia. It is
essentially a disease of old age, the majority of the cases being
over 75 years, and women are more frequently affected than men.
Although not a necessary etiological factor, confinement in bed
from fracture or other injury, or from weakness, physical and
mental, is an important predisposing cause. The onset of the
disease is insidious, and is usually preceded by vague pains and
cramps in the legs. After a few months the patient is unable to
walk on account of weakness of the legs, and at this stage the
muscles are found to be soft, flabby, giving a brisk reaction to
mechanical stimulation, but not diminished in volume. Atrophy
and retraction follow rapidly, the legs taking up and becoming
fixed in a position of flexion and adduction. The thighs are flexed
on the pelvis, the legs on the thighs, and the feet are extended.
The atrophied muscles feel like tense cords, and are extremely
sensitive to touch, but there is no tenderness along the lines of the
nerve trunks. The muscles of the trunk, neck, and arms, although
atrophied, are not affected by the disease until late on in its course,
and then not to the same extent as the arms. There is no quali¬
tative change in the electrical reactions. The joints are unaffected
except by changes secondary to their position and immobility.
Emaciation becomes extreme, but the intellect remains clear until

ABSTRACTS

567

just before death, which occurs in a few years from the first
symptoms. The differential diagnosis is most difficult in the
early stages. There are many conditions with which it may be
confused, but careful examination will usually make a diagnosis
possible. In particular, the electrical reactions must be thoroughly
tested. The pathology of the condition is described in great detail.
It consists of an atrophy of the muscle fibres accompanied by fatty
and fibrous degeneration and a sclerosis and retraction of all the
tissues of the muscle and tendons. No lesion is discoverable in
the central nervous system or in the peripheral nerves to which
the muscular condition could possibly be secondary.

Henry J. Dunbar.

ON THE PATHOLOGY OF THE EPICONUS MEDULLABIS. (Zur

(312) Pathologic des Epiconus medullaris.) L. Minor, Dent
Zeitschr. f. NervenheiUc., Bd. 30, H. 5-6, S. 395.

The author defines the epiconus as that part of the spinal cord,
including the fifth lumbar and first and second sacral segments
and the epiconus region, as these segments with their nerve
roots.

The present type of epiconus lesion is met with in cases of
poliomyelitis, and the next best in traumatic central hsematomyelia.
In this paper two cases of the former and one of the latter are
described.

The characteristic features are: atrophic paralysis of calf
muscles and peronei, particularly the latter, with steppage gait and
tendency to talipes ; Achilles jerk lost, knee-jerk present and
increased; no affection of sphincters or sensibility.

If the lesion extends into L 4 at all, the glutei and adductors of
the thigh are also affected. J. H. Harvey Pirie.

A CONTRIBUTION TO OUR KNOWLEDGE OF TRAUMATIC

(313) CONUS LESIONS. (Ein Beitrag zur Kenutnis der trau-
matischen Oonus-Ubdoueu.) Fischler, Deut. Zeitschr. f.
Nervenheilk., Bd. 30, H. 5-6, S. 364.

In this paper the author describes two new cases of pure conus
lesions, and reviews some nineteen cases (nine with sectio) from
the literature.

The usual symptoms are: a temporary paraplegia; motility
usually returns early and completely, but sensory disturbances in
the region of the anus, perineum, and external genitals are longer
lawting and may be permanent. Dissociation phenomena frequent.

568

ABSTRACTS

Disturbance of function in the bladder, rectum, and sexual organs
may be temporary or permanent.

The majority of cases follow on falls from a little height, either
on the gluteal region directly, or on the feet first and then on the
back. A pure conus lesion may result without any injury to the
vertebral column. The mechanism seems to be a traction through
the nerve roots of the cauda equina or the conus (where the lumbar
curvature is increased), with tearing of tissue and subsequent
effusion of fluid. Even when there is also damage to the vertebra
this mechanism may act. J. H. Harvey Pirie.

A CONTRIBUTION TO THE STUDY OF AMAUROTIC FAMILY

(314) IDIOCY. F. J. Poynton, J. H. Parsons, and Gordon Holmes,
Brain, 1906, Part 114, p. 180.

The clinical histories of three cases are recorded. All three
children belonged to Jewish families, and no other child was
affected in any of the families. In each of the three cases the
symptoms of the disease came on at about six months of age, and
death occurred when the children were between a year and
eighteen months old. The history and the course of the disease
was typical in each case. The symptoms began with arrest of
development and evidence of general weakness, inability to sit up
without support, or to move about in a normal way, and failure of
vision. Examination showed weakness and slight spasticity of
the limbs, especially of the lower extremities, increase of the
deep reflexes, and extensor plantar responses were obtained in at
least one case. There was also marked mental deterioration,
advancing as the disease progressed to complete idiocy. The
characteristic retinal changes, the frequently described cherry-red
spot at the fovea with a white halo around it, were present iu the
three cases. In two of the cases there was, in addition, optic
atrophy, but the discs of the third case appeared normal.

The central nervous systems of two of the cases were obtained
for examination. There was nothing noteworthy in the macro-
scopical appearance of either brain, except slight wasting of the
gyri, especially in the frontal lobe, and an unnatural firm
consistence of the whole forebrain to touch. The following
methods were employed in the microscopical examination: Nissl’s
and Bielschowsky’s for investigation of the cells, Weigert’s and
Marchi’s for the medullated fibres, and various portions of the
central nervous system of one case were, in addition, stained by
Weigert’s neuroglia method.

The changes found were practically identical in the two cases.
Not a single unaffected cell remained in any part of the central

ABSTRACTS

569

system, in the dorsal root ganglia, or in , the retina. The nerve
cells appeared swollen and inflated, their nuclei, which were often
shrunken, generally lay excentric, and they had, as a rule, almost
disappeared, so that the only part of the cytoplasm which stained
by the basic aniline dyes was a finely granular substance around
the nucleus. The nature of this substance is doubtful; it
resembled a degeneration product, but stained deeply with
haematoxylin, and was not coloured by osmic acid or any of the
fat stains. Many of the larger cells were, in addition, vacuolated.
The cells of the cerebellum were, on the whole, less affected than
those of any other part of the central nervous system. The
neurofibrils were generally normal in the dendrites, even when
these were diseased, and in the peripheral portions of the cells,
but they were, as a rule, broken up in, or had disappeared from,
the centre of the cells. Curious bladder-like appendages, into
which neurofibrils could be traced, were attached to the bases of
some of the cortical cells; they seem to have arisen by the
central constriction of an elongated cell which thus becomes
hour-glass shaped.

There was slight degeneration of the myelinated fibres of all
parts of the forebrain, but it was in no place great. The pyramidal
and cortico-pontine tracts were, on the other hand, considerably de¬
generated, the former especially in the cord. All the other systems
of the brain-stem appeared practically normal when examined by
the Weigert-Pal method. Marchi’s method, on the other hand, re¬
vealed slight diffuse degeneration in all parts of the central
nervous system, greatest in the coarse of the pyramidal and
cortico-pontine tracts. The optic tracts appeared normal in both
cases when stained by the Weigert-Pal method, but in one case
there was recent degeneration visible by Marchi’s method. The
use of the specific neuroglia stain showed that the neuroglial
proliferation was limited to the areas of the degenerating
systems.

The eyes of the same two cases were examined microscopically,
but unhappily the minute histology was complicated by the
presence of post-mortem changes. In one eye of the one case,
which was opened immediately after the autopsy, a minute hole
was found at the fovea, but this could not be demonstrated in the
other eyes which were examined in sections. There was degenera¬
tion of the ganglion cells and nerve fibres of the retina of both
cases, but the cells of the nuclear layers remained intact. The
changes which were visible in the ganglion cells were identical
with those which have been described in the central nervous
system; the cells were swollen, often vacuolated, the tigroid had
disappeared, and the majority of the nuclei lay excentric. There
was also evidence of oedema of the retina.

570

ABSTRACTS

The explanation of the ophthalmoscopic appearances is probably
that the white area around the fovea is due to oedema and the
folding of the retina which results from it, while the dark red
spot at the fovea is merely a contrast appearance.

The conclusions which have been drawn on the nature of the
disease are that it is a primary cell affection, and that the initial
change is disease of the interfibrillar protoplasm, and that the
alterations of the neurofibrils are secondary to this. As regards
its aetiology, there is no evidence of it being merely a condition of
arrested development, and there is nothing to support the hypo¬
thesis that it is due to the action of toxines. It can therefore only
be concluded that the degeneration is due to some inherent bio¬
chemical peculiarity of the protoplasm of the cell which is
inherited. Gordon Holmes.

A PECULIAR FORM OF AMAUROTIC FAMILY IDIOCY. (Ueber
(315) eine besondere Form von famili&rer am&urotischer Idiotie.)

W. Spielmeyer, Neurolog. Centralbl., Jan. 16, 1906, S. 51.

This interesting communication records a form of disease which
apparently has not been previously described. The four cases
occurred in a family of five, the eldest member alone escaping. As
the father contracted syphilis after the birth of the eldest child, it
seems probable that the disease developed on a congenital syphilitic
basis, though there was no clinical evidence or anatomical indica¬
tion of this.

The symptoms began in each case at about the age of six years,
with gradually progressive dementia, and diminution of vision due
to retinitis pigmentosa. The blindness soon became complete in
each case. There were no symptoms of palsy, and death occurred
only from intercurrent illnesses, in each case at the age of
puberty.

The disease is thus distinct from that which is known by the
names of Waren-Tay and Sachs, though it has in common with it
the symptoms of dementia and blindness.

The pathological conditions in the two cases which were
examined were identical. They are referred to only briefly in the
present paper, but will be published more fully elsewhere. There
was universal cell affection throughout the whole central nervous
system; the cells were swollen, the greater portion of their tigroid
had disappeared, and they contained a curious granular deposit
which stained by the fat dyes and frequently contained pig¬
ment. There was, on the other hand, relatively little change in
the medullated fibres and axis-cylinders.

ABSTRACTS

571

From the short account given, the pathological anatomy of this
disease seems to resemble very closely that of amaurotic family
idiocy. Gordon Holmes.

AMAUROTIC FAMILY IDIOCY. (Zur Kasuiatik der Tay-
(316) 8achs’sch6n Krankheit [Idiotismus familiarla amauroticua.])

W. Sterling, Neurolog. Centralbl., Jan. 16, 1906, S. 55.

This paper contains the report of a typical case of amaurotic family
idiocy. A child of Jewish parents came under observation at the
age of eleven months, with the history that since the age of six
months it had ceased to develop both mentally and physically,
and had gradually become peevish and apathetic. There was no
other case in the family.

On examination it was seen that the child was poorly developed
and badly nourished and had well-marked signs of rickets. The
functions of the cranial nerves were undisturbed and the pupils
reacted briskly, though the child was undoubtedly blind and had
been, according to the mother’s account, from birth. Ophthalmo¬
scopic examination revealed the characteristic cherry-red spot,
surrounded by a white halo, in each macular region, and advanced
optic atrophy. The muscles were small but hypertonic, especially
those of the lower limbs. The latter were rarely moved voluntarily,
and their strength seemed to be considerably diminished—they
could not bear the child’s weight. The arms and hands were
stronger, and were almost constantly in apparently purposeless
movement. The deep reflexes were increased, and plantar stimu¬
lation produced extensor responses of the great toes.

As in many of the other cases reported, there was marked
hyperacusis; the child started violently at the slightest noise. A
pronounced feature of the case was the less frequently observed
symptom of automatic purposeless movements, especially those of
sucking, swallowing, and yawning.

There was no pathological examination.

Gordon Holmes.

THE PORENCEPHALIC FORM OF INFANTILE PARALYSIS.
(317) (Ueber die porenkephalische Form der zerebralen Kinder-
UUmmng .) Dr A. Dannenbergkr, Klinik f. psych, u. nerv.
Krankheiten , Bd. 1, H. 2. Halle a. S.: Carl Marhold, 1906.

The author, after a preliminary description of porencephaly, its
pathology and various setiological factors, proceeds to a careful
clinical description of four cases of this form of infantile cerebral

572

ABSTRACTS

palsy, with in one of these an account of the post-mortem results.
The first and the last of these showed clinically the characteristic
8ymptomatological triad of imbecility, epilepsy, and spastic
paralysis, with developmental arrest in the paralysed parts. The
author, however, points out that according to the site of the
cerebral lesion, one or all of these cardinal symptoms may be
wanting, e.g. the spastic paralysis may be replaced by hemi-chorea,
hemi-athetosis, or general chorea or athetosis. In the second case
the diagnosis was open to question, the patient, a boy of eight
years, having a markedly neuropathic heredity, but no history of
birth trauma or post-natal convulsions, and exhibiting later moral
rather than intellectual defect. The patient had no typical
epileptic attacks, these being replaced by larval epilepsy in the
shape of periodic attacks of excitement separated by quiet intervals,
and in place of the spastic paralysis there was only slight com¬
parative weakness of the muscles of the right side. The reflexes
on the right side, though lively, were not pathologically increased.
The diagnosis of porencephaly of slight degree in the neighbourhood
of the motor centres—an admittedly fine diagnosis—is discussed
minutely. The third case was one with marked convulsive
epilepsy and hemiplegia, but with hardly any mental reduction;
and the fourth, a clinically well-marked case, is of interest on
account of the relation of the post-mortem findings, which are
fully discussed, to the clinical picture.

R. CUNYNGHAM BROWN.

ON THE MILIARY DISSEMINATED FORM OF BRAIN SYPHILIS
(318) AND ITS COMBINATION WITH GENERAL PARALYSIS.
(Zur Lehre von der miliaren disseminierten Form der Hindoos
und ihrer Kombination mit der progressiven Paralyse.) E.

Straussler (of Prague), Monatsschr. f. Psych, u. New .,
March 1906.

The formation of miliary gummata is one of the rarest forms of
syphilitic brain disease. In the cases previously recorded the
gummatous formations usually occurred in the middle of a diffuse
syphilitic infiltrative process, while two cases of miliary gummata
on the ependyma of the lateral ventricles are on record. In the
two cases here presented the gummata were situated in the deeper
cortical layers, while the meninges covering the cerebrum showed
no specific syphilitic changes; in one case there was a gummatous
meningitis limited to the cerebellum, and in this region the gummata
extended from the meninges into the brain substance itself. In
both cases the cerebral cortex showed the histopathological features
of general paralysis.

ABSTRACTS

573

The first case was a man of 30, who, after a year’s nervousness,
became shortly before admission excited, talkative, full of plans.
On admission he presented tremor of tongue, lively deep reflexes,
slight deficiency of innervation of the left facial, but no speech nor
pupillary defect; he was euphoric, expansive, restless; after five
months’ residence in hospital, during which his mood varied between
exaltation and depression, he died after a series of epileptiform
attacks. Microscopically the brain showed the characteristics of
general paralysis. In addition there was in the cortex of the
frontal and temporal regions a large number of miliary foci of a
gummatous nature; these were in obvious relation to vessels, had
irregular and ill-defined limits, and were most numerous in the
deeper cortical layers. While in meningo-encephalitis the exudative
process spreads in from the meninges, there was no such relation
in this case. The origin of the miliary gumma consisted in a great
infiltration of the vessel wall with cells of which the great majority
were lymphocytes; obliteration of the lumen took place, the infil¬
trating cells and rod-cells (Stabchenzellen) did not respect the
vessel wall, but penetrated into the surrounding tissue, and regressive
changes in the centre of the focus, with formation of giant-cells,
occurred.

The second case was a man of 64, who, after a cataract operation
three years previous to admission, began to show signs of mental
enfeeblement; he became restless, irritable, disoriented, thought
he was dead. His speech was drawling and scanning; deep reflexes
were increased, there was double ankle clonus; his writing was
unintelligible. He died from catarrhal pneumonia shortly after
admission. The cortex presented the histopathological character¬
istics of general paralysis. In addition there was in the layers of
the small and large pyramidal cells a number of disseminated foci.
The foci in the previous case were always in relation to a vessel
wall; in the second case there was no such relation, the focus con¬
sisting essentially of a central necrotic patch surrounded by an area
of marked glia reaction, and in the later stages infiltrated with a
large number of small round nuclei; no giant-cells were observed.
It is interesting to note that in the central nervous system such a
gummatous formation can arise without implication of the meso¬
dermal tissue, the ectodermal tissue forming the basis of the new
formation.

In both cases in the neighbourhood of the miliary gummata
the paralytic process showed greater severity, as it may do in the
neighbourhood of a glioma, or scar tissue.

Alzheimer, in discussing the histopathological diagnosis of general
paralysis and brain syphilis, refers chiefly to syphilitic meningo¬
encephalitis. The above cases show the existence of a disseminated
form of brain syphilis which is independent of the meningeal

574

ABSTRACTS

changes, and where naturally the diagnostic points referred to by
Alzheimer do not help. The cases reported are of little use for
establishing diagnostic points, inasmuch as the picture was com¬
plicated by that of general paralysis. As to Nissl’s view, that a
meningo-myelitis invariably is found to accompany a meningo¬
encephalitis, the first case makes that statement doubtful, for a
meningo-encephalitis of the cerebellum was present, while the
medulla and upper cervical cord were free; the rest of the cord was
not examined. With regard to the rod-cells of Nissl, these were
extremely numerous in the first case, where the gummata were in
relation to the vessel wall, and much more numerous in the neigh¬
bourhood of the gumma than elsewhere; this does not agree with
Alzheimer’s observation that these cells appear in a much more
isolated manner in brain syphilis than in general paralysis. In con¬
clusion, the author discusses certain relations of general paralysis to
brain syphilis. The nature of the various foci is well illustrated
in the plate which accompanies the article.

C. Macfie Campbell.

REMARKS ON THE .ETIOLOGY OF EPILEPSY. (Bemarkungen
(319) zur Atiologie der Epilepsie.) Emil Redlich, Wiener mcdizin,
Wochnschr., 1906, Mai 26, S. 1074, u. Juni 2, S. 1147.

The author follows Nothnagel in his division of the “ causes ” of
epilepsy into predisposing and exciting. Treatment should aim at
counteracting both these factors, though a practical difficulty is
that the exciting causes are far from constant even in the same
individual. A few of the less well known causes are dealt with
by means of reference to cases observed in the past year. First,
the relation of pregnancy, and especially labour, to epilepsy.
Nerlinger has demonstrated that this connection has been
unduly emphasised in the past because of the confusion exist¬
ing between eclampsia and epilepsy, and that there is certainly
po such thing as a special epilepsy of pregnancy. Nevertheless,
it is not rare for this state to act as an exciting cause, parti¬
cularly in women with special disposition—often hereditary.
Numerous cases are quoted from the literature as evidence of
this, and the experience of many authorities is referred to. Four
cases are briefly described in which setiological action of preg¬
nancy seemed certain. Two of them revealed no other factor,
two suffered psychical trauma at the end of pregnancy. Preg¬
nancy only infrequently gives rise to epilepsy, because the
required disposition is not present as a rule; but if this is there,
pregnancy may light up epilepsy, just as may chorea, tetany,
myelitis, disseminated sclerosis, etc. Two of the above cases

ABSTRACTS

575

had suffered from convulsions in infancy, so that the exciting
action of pregnancy was manifest. Whether the action is
brought about through an infectious process, or via the effect
on the circulation, or through metabolic changes causing the
formation of the toxic products is quite unknown, though the
first is not probable.

The question should abortion be induced arises in these cases,
but the opinion of most authorities is that this should only be
done if the status epilepticus be present.

A fifth case is described in which the attacks began four
months after labour, and a few days after the passage of a
tapeworm. The author discusses whether the labour, the pre¬
sence of the tapeworm, or the use of a helminthintic is the operative
factor. He holds that epilepsy may certainly be induced by the
presence of tapeworms, particularly tsenia nana, though in the
case of tsenia solium the possibility of an autogenous cysticercus
in the brain must be considered. In a sixth case the author
discusses whether a tapeworm was the cause of the attacks or
whether the case entered into a special group of senile epilepsy
characterised by mental disease, and described some six years
ago.

Two further cases are related to illustrate the occurrence of
peculiar attacks of timidity and strangeness during which the
surroundings become suddenly quite unfamiliar. Gowers has
previously described the same condition.

In conclusion, two cases are mentioned which raise the
possibility of vaccination acting as an exciting cause. In both
a secondary infection had taken place. Similar cases have been
previously recorded. Ernest Jones.

ON NON-EPILEPTIC AFFECTIONS OF CONSCIOUSNESS OE
(320) SHORT NARCOLEPTIC ATTACKS. (Uber die nicht epilep-
tischen Absencen Oder kurzen narkoleptischen Anf&lle.) M.

Friedmann, Deutsch. Arch, fur Nervenheilkunde, 1906, Bd. xxx.,
S. 462.

Cases are sometimes seen which differ from nerve giddiness in
having no real disturbance of equilibrium, and from petit mal in
the distinct maintenance of full consciousness; this however
undergoes certain momentary alterations. Up to now these have
been grouped, not as a separate condition, but as a variety of the
affection called by G41ineau Narcolepsy, and previously described
by Westphal under the title, “ Peculiar Sleep States.” It is now
recognised that narcolepsy occurs, not only with larval epilepsy,
but more often in cases of pure epilepsy and other functional

576

ABSTRACTS

neuroses, such as hysteria and neurasthenia. The exact relation
to epilepsy has been much discussed by Lowenfeld, Binswanger
and other writers.

The author describes fifteen cases he has carefully studied
personally, and nine he has discovered in the literature, and deals
fully with the various problems arising in relation thereto. His
chief conclusions are: these short narcoleptic attacks differ from
ordinary petit mal in the incompleteness of the disturbance of
consciousness, the tendency to occur under certain definite con¬
ditions, such as during meals, at work, after excitement, in
sleep, etc. It also differs from epilepsy in producing no ill
effects on either the body or mind. It seems to be commoner
in the female sex. It practically never begins after thirty, and
is not much rarer in children than in adults. In spite of its
comparative innocuousness it is a very troublesome complaint on
account of the frequency of the attacks. These are very constant
in their symptomatology. The eyes turn upwards and remain
fixed, the pupils dilated but reacting; the flow of thought is
arrested, though consciousness is retained; the limbs are motion¬
less and flaccid, or else may automatically continue the movement
they were engaged upon; a sense of oppression is common in the
attack; waking is usually quite complete, no symptoms remaining;
an aura frequently occurs, especially the feeling that “ it’s coming
again.” Paralysis of the limbs is a rare symptom, occurring in
only three of the fifteen cases. The duration of the attack is
usually fifteen to thirty seconds, but not infrequently they last
two or three minutes; in one adult, however, they used to last
half an hour, and in one child two hours. The frequency of
the attacks is their most variable feature, in one case it was as
high as 100 times a day. It was curious to note that an
intercurrent illness prevented any attacks while the patients
were confined to bed. The most difficult question is that of the
aetiology of the condition. Although severe sleep attacks may be
due, as Ballet thinks, to bodily conditions, such as obesity, the
slight ones are certaiuly psychical. The author’s cases could be
sharply divided into the two groups that G^lineau described, the
primary idiopathic cases and the secondary symptomatic cases.
Three each of children and adults of the present cases belonged
to the former group; the rest were either neurasthenics or
hysterics, more often the former. The prognosis is much better
in the secondary cases, the total duration being as a rule from six
to eighteen months. The primary cases are, however, far more
obstinate, and one of those recorded had been in progress for
fourteen years; exceptionally they may recover after a few years.
As to the fear of epilepsy developing, that may be dismissed
in the secondary cases, and in the primary ones it has been

ABSTRACTS

577

recorded only once. Mental shock or distress almost always
precedes the onset of the complaint. Heredity plays some share,
especially in the primary form. A cousin of one of the author’s
cases suffered from the same condition, and in several of the
recorded cases this was so with one of the patient’s parents. Lastly
as to the relation of the condition to allied causes of clouding
of consciousness. Two fundamental features serve always to
differentiate it —-first the clouding affects only the higher func¬
tions of the brain, so that volition in thought is inhibited as in
movement, but automatic movement may persist; secondly the
attacks recur periodically in great numbers. There is a group of
real sleep stateB, which may be called a second type of narcolepsy,
that occurs also in neurasthenia, hysteria, or epilepsy. Again
cases occasionally occur in which the inhibition is confined to
thought, but voluntary movements can be carried out. Two
such cases are described by the author. These three types of
narcolepsy make it imperative to revise our present teaching,
which usually attributes every uncaused disturbance of con¬
sciousness to epilepsy. The attacks now described may also be
confounded with the sudden “ refusals to think ” that arterio-
sclerotics sometimes suffer from, but these last many minutes
or even an hour. Ernest Jones.

PUERPERAL ECLAMPSIA AND PARATHYROID INSUFFICIENCY.

(321) G. Vassale, Society Medico-Chirurgica di Modena, Meeting of 4th
July 1906.

The parathyroid theory of puerperal eclampsia, formulated last year
by the author, on the ground of experimental and clinical observa¬
tions, has since received confirmation — (1) from pathological
observations which have served to demonstrate in persons who
have died from eclampsia morbid changes in, or congenital absence
of, one or two parathyroid glands (Pepere, Zanfrognini); (2) from
additional clinical observations, showing the beneficial effects of
parathyroid treatment in eclamptic convulsions (Zanfrognini,
Stradivari); and (3) from new experimental researches carried
out upon gravid cats and rats (Zanfrognini, Erdheim, Thaler, and
Adler), which have confirmed the conclusion that in latent para¬
thyroid insufficiency there constantly occur in the last third of
pregnancy severe parathyreoprival convulsive phenomena (experi¬
mental eclampsia). The author gives an account of the history of
three gravid bitches, from each of which he this year removed
three parathyroid glands. The animals remained well until the
last few days of pregnancy. In two of them experimental
eclampsia developed about two days before parturition. To

578

ABSTRACTS

one of these animals parathyroidin was given by mouth in
very large doses. The convulsions ceased, and under the
influence of parathyroidin, the administration of which by the
mouth was continued after the cessation of the first convulsive
seizure, the bitch, without suffering from any further convulsion,
gave birth to three pups, which died within three days owing
to want of milk in the breasts of the mother. The second bitch
was not given parathyroid treatment, and about forty hours
after the onset of the first slight attack of tetania parathyreopriva, it
died in a violent convulsive seizure, without having expelled the
foetuses, although these had reached their full term. In the
case of the third bitch, convulsions occurred only a few moments
before parturition. A large dose of parathyroidin was administered,
and the animal succeeded in giving birth to six pups, four of
which it suckled and reared. In the course of lactation it
again had a violent seizure of tetania parathyreopriva, which
was combated by large doses of parathyroidin. Subsequent to
this it remained, like the first bitch, in good health. The urine of
these animals contained albumen (‘05 to T per cent.), the amount
of which kept increasing during the last days of pregnancy. The
albumen disappeared fairly rapidly after parturition. The onset of
experimental eclampsia in these animals was preceded by a period
of oliguria and anuria. The author also points out the clinical
analogy that exists between the disorders of the renal functions in
these animals and those that are to be observed in eclamptic
women. Concerned with the pathogenesis of the renal disorders
of pregnancy, which are of chief importance as determining causes
of the manifestation of a latent parathyroid insufficiency, and,
therefore, of the onset of eclamptic convulsions, there are not only
autotoxic causes, but also mechanical causes (compression by the
gravid uterus), which induce disturbances in the renal blood circula¬
tion and urinary stasis. The author has found that partial occlusion
of the ureters of dogs, upon which a partial parathyroidectomy
has been performed, determines the rapid development of severe
parathyreoprival convulsions, which result in the death of the
animal in from fifteen to twenty hours. It is known that muscular
fatigue and nervous exhaustion are also capable of determining the
occurrence of symptoms of parathyroid insufficiency. It is thus
easy to understand howin primiparae,in whom the mechanical causes,
dependent upon compression by the gravid uterus, are undoubtedly
of greater importance, and in whom also the duration of the labour
is longer, eclampsia occurs more commonly than in multiparse.

Author’s Abstract.

ABSTRACTS

579

PRELIMINARY REPORT OF THE TREATMENT OF IDIOPATHIC

(322) EPILEPSY BY APPENDIOOSTOMY FOR COLONIC IRRIGA¬
TION. La Place (Philadelphia, Penn.), Joum. Am. Med.
Assoc., June 2, 1906.

Epilepsy is but a symptom revealing the reaction of the general
nervous system to some irritation, either as a result of pressure from
injury, or as a result of the accumulation of some toxine.

In the treatment of numerous cases of so-called Idiopathic
Epilepsy, it has been found that the establishment of an intel¬
ligent diet is one of the most important elements.

Metchnikoff states that the colon is a receptacle for refuse
undigested matter; that human life could be sustained in a
more physiological state without its presence.

That the power of absorption by the colon is remarkable may
be shown by the length of time during which patients may be
nourished from rectal feeding alone.

It is reasonable to suppose that from this colonic reservoir
toxic material is absorbed, especially in cases where chronic
constipation exists. Any method, then, which would destroy
this toxine, or prevent its absorption, would contribute toward
lessening the nature and frequency of epileptic attacks. With
this theory in view, La Place has created an artificial fistula at
the beginning of the colon, and directed the patient to flush out
his colon with two gallons of warm water morning and night.
Four cases of similar nature have been treated in this way, and
have shown distinct improvement— i.e. lessening number of
convulsions, causing a more cheerful appearance, and an improve¬
ment in appetite. They have not been operated upon for a long
enough time to be reported in full at present.

C. H. Holmes.

CESSATION OF THE PULSE DURING THE ONSET OF EPILEPTIC

(323) FITS. A. E. Russell, M.D., Lancet , July 21, 1906, p. 152.

The author describes a case of cessation of the radial pulse at the
onset of epileptic fits for three-quarters of a minute or more. He
notes other cases where the same phenomenon has been observed,
and suggests that the cardiac arrest may be the cause of the fits
through the production of cerebral anaemia.

While not attempting to explain all epileptic fits in this way,
the author thinks that such arrest may be much commoner than
is suspected. If observations were made on the pulse at the onset
of fits by those whose work brings them into contact with epileptic
patients in considerable numbers, it would soon be established
whether such cardiac arrest is of occasional or of frequent occur¬
rence. W. B. Drummond.

580

ABSTRACTS

ON HYPERESTHESIA OF THE VISUAL PERIPHERY. (Uber
(324) Hyperaesthesie der peripherischen Oesichtsfeldpartien.) A

Pick, Neurolog. CeniraXbl., June 1, 1906, p. 498.

The author contrasts the careful studies that have been made on
hyposesthesia of the retinal periphery with the absence of interest
displayed in the reverse condition. He refers to a previous com¬
munication of his {Brain, 1903) describing a patient in whom
hyperaesthesia of the retina was due to a pathological prolongation
of the visual impressions. It is known that under normal circum¬
stances attention given to a central object fades gradually into
that given to an object in the periphery; and further, that men
may be divided into two types, according to whether they make
much or little use of their visual periphery. William James says
that women use it more than men. The ease with which the eye
can be focussed so as to bring an important object opposite to the
macula is also of course important in this connection. When the
focussing movements are defective, the effort to retain both the
directly seen and the indirectly seen objects in the field leads, as
Hering has shown, to a doubling or dispersion of attention so that
the central image reaches consciousness with an effort that is
translated as pain. The author mentions the case of a neuras¬
thenic who suffered from obsessions and impulsions, and who com¬
plained of a peculiar extreme visual trouble, saying, “ Too much
streams into my eye.” On closer examination it was noticed that
in fact he did see too much, in that he had a clear perception of
many objects besides the one looked at directly ; this caused dis¬
turbances of attention, as above described, so that the central
vision was disturbed, resulting in pain from the antagonism of the
two sets of images. To the perimeter the field appeared normal.
In another instance, the patient being a peasant girl, the visual
trouble was the starting-point of a severe psychopathic disturb¬
ance. She was extremely shy and timid, and on going to Vienna
soon became greatly distressed by the turmoil of the city, particu¬
larly the electric trams, of which she was terrified. She gave up
work and withdrew into herself. Her visual symptoms were as
follows: when anyone moved on her side he became clearly seen
as though he occupied the centre of the field. This naturally gave
her the feeling of squinting towards him, especially as the same
thing might occur simultaneously on both sides. No ob¬
jective movements were visible; on these occasions, indeed,
the eyes were motionless under conditions when a lateral move¬
ment was expected. This phenomenon occurred only in an out¬
ward or downward direction, not upwards. The field of vision,
repeatedly examined with the perimeter, was remarkably extensive
for both white and colours. The diagnosis of an obsessive im-

ABSTRACTS

581

pulsion was negatived by the coincident divergence of the eyes,
by the condition occurring only with moving objects, and by its
intensity increasing with the number of moving objects.

Pick’s conclusion is that the varying sesthesia of the different
parts of the retina is a protective mechanism whereby the peripheral
objects are excluded to a greater or less degree. This capacity is
only gradually developed, and is not present in children when
their lateral vision begins, at the fifth month.

Ernest Jones.

THE PUPIL REFLEXES IN MITRAL VALVE LESIONS. (Des
(325) reflexes pupillaires dans lea cardiopathies mitrales.)

Braillon, Gazette des Hdpitaux, June 21, 1906, p. 831,

The author first refers to the syndrome, first pointed out by
Babinski and confirmed on all sides since, consisting in the co¬
existence of the Argyll-Robertson sign and a lesion of the aorta.
By its means we are now able frequently to decide whether a
given aortic lesion is due to syphilis or to some other cause, such
as traumatism. It may be regarded as established that when,
through an affection of the centrifugal path, the reaction to light
is abolished, with or without the reaction to accommodation, we
may be quite certain that a chronic syphilitic meningitis is pre¬
sent. This has been confirmed in a striking manner by the study
of the cerebro-spinal fluid in such cases. The author has recently
observed two cases which raise the question of the syphilitic
origin of certain mitral affections. Obs. I. Patient was a man
aged 66. He had double hydrothorax, large, painful liver, oedema
of the lower limbs, rapid, soft pulse, scanty urine, hypertrophied
left ventricle, with the classical signs of organic mitral regurgita¬
tion. The pupils were myotic, reacted feebly to accommodation and
not at all to light. No other signs on examining the nervous
system. He had had a hard chancre and secondaries at the age of
twenty-seven. Obs. II. Patient was a man of 45. Rapid, feeble
pulse, hypertrophy and dilatation of the left ventricle, with signs
of organic mitral regurgitation. There were evidences of old
interstitial keratitis but not of iritis. The pupils were of average
size and regular; they responded feebly to accommodation, but not
at all to light. He had had syphilis badly ten years previously.
His wife was well, but one of her pupils was dilated and responded
neither to light nor to accommodation; a study of the consensual
reflexes showed the integrity of the centripetal path.

Although the cases were not examined after death, there was
no doubt of the diagnosis of an affection of the mitral valve.
Syphilis was probably the cause of this affection, there being no

582

ABSTRACTS

indication in the history of any other factor that might account for
it. The author’s previous researches have shown that Koch’s
bacillus may undoubtedly give rise to tuberculosis of the endo¬
cardium without any characteristic anatomical appearance of this,
so that the specificity of the structure of the endocardium may
mask the specificity of the germ. This may also be the case with
Schaudinn’s spirochaete, and syphilis may be the cause of many
cases of mitral affection that are now unexplained. Albespy’s
observations on the frequency of mitral lesions in tabetics support
this suggestion. Ernest Jones.

THE ABDOMINAL REFLEX IN ENTERIC FE V ER . J. D. Rolle-
(326) ston, Brain, Spring 1906, pp. 99-111.

The paper is based on the study of sixty patients who were
admitted to hospital certified to be suffering from enteric fever.
In forty-five cases this diagnosis was confirmed; the remaining
patients were found to have other diseases. In the former the
abdominal reflex was affected to a varying degree in forty-two
(93 3 per cent.), it was completely lost in thirty-one (68*8 per
cent.), impaired in a greater or less degree short of absolute
extinction in eleven cases (22-2 per cent.), unaffected in three
cases only.

In only three of the fifteen patients who were not suffering
from enteric fever was the reflex affected. The first was a case
of suppurative appendicitis, the second one of acute cancerous
peritonitis, and the third was that of a woman, aged 54, suffering
from lobar pneumonia, in whom the absence of the reflex was
regarded as the result of her age and wrinkled condition of the
abdominal wall. The examination should be made daily through¬
out the disease, as a single negative result is of little value. The
abdominal muscles must be relaxed. Ticklish and apprehensive
patients should have their attention diverted by conversation or
other means.

The best method to elicit the reflex is lightly and rapidly to
stroke the skin of the abdomen with the end of a penholder. The
author adopts Oppenheim’s division of the reflex into a supra-
umbilical and infra-umbilical zone. In enteric fever the infra-
umbilical reflex is the first to disappear and the last to return.
The supra - umbilical reflex may remain active throughout the
disease, or, as more commonly happens, a slight response rapidly
exhausted after a few stimuli may be obtained in the epigastrium
or sides of the abdomen alone, when stimulation of the rest of the
abdomen provokes no response.

The author’s conclusions are as follows:—

ABSTRACTS

583

1. The abdominal reflex is affected in a very large number of
cases of enteric fever, the percentage of cases in which it is
entirely lost exceeding those in which its normal activity is
diminished only.

2. From its absence under 50 being confined to certain nervous
diseases and acute abdominal conditions, notably appendicitis and
enteric fever, the absence of the abdominal reflex in a given case
of continued pyrexia in any patient below 50 is of considerable
diagnostic value.

3. The comparatively transient nature of the affection of the
abdominal reflex in enteric fever is a striking contrast to the more
chronic affection of the knee- and ankle-jerks in diseases associated
with peripheral neuritis, e.g. diphtheria.

4. Return of a lost reflex, and a fortiori resumption of its
normal activity, are a valuable indication of commencing con¬
valescence, and often correspond with lysis and characteristic
changes in the faeces and urine.

5. The objective sign of return of the reflex is often associated
with the return of the subjective feeling of ticklishness normal to
the individual.

6. In reappearance of pyrexia in convalescence, the condition
of the abdominal reflex is a valuable index of the nature of the
pyrexia.

7. No constant relation exists between the condition of the
abdominal reflex and that of the tendon reflexes.

8. The frequency, degree, and duration of impairment of the

abdominal reflex are, as a rule, in direct proportion to the age of
the patient. Author’s Abstract.

ATROPHY OF THE GLANDS AT THE BASE OF THE TONGUE AS
(327) A SIGN OF SYPHILIS. N. B. Potter, Boston Med. and Surg.

Journal, March 8, 1906.

In a study of three hundred cases of various kinds this symptom
was present in about one-half of the patients who exhibited reason¬
able evidence of previous syphilis, and in only about ten per cent,
of cases without satisfactory evidence of previous syphilis. Examina¬
tion by palpation is more trustworthy than by vision.

The tongue, after being protruded as far as possible, is grasped
and held by a hand covered with a towel The region behind the
circumvallate papillae is explored by the index finger of the other
hand, introduced along the dorsum of the tongue. The conclusions
are, that when the papillary glands at the base of the tongue are
normal, syphilis may be excluded, while typical atrophy of these

584

ABSTRACTS

glands in an individual below the age of fifty is indicative of
syphilis. A moderate or slight degree of atrophy is of little
diagnostic importance. C. H. Holmes.

PSEUDO-BULBAS PALSY IN A CHILD. (Paralysie psendobnlbaire
(328) chez un enfant.) Raymond and Lejonne (Soc. de Neur. de
Paris), Rev. Neurol ., April 5, 1906.

The case concerns a boy of 11, who was in perfect health up to one
year ago. His symptoms commenced by slight weakness of the left
leg, followed in a month or two by diarrhoea and spasmodic laughter,
faulty articulation, maladresse of hands, specially on the right. In
March 1906 he presented a double hemiplegia, his movements being
stiff and awkward, but Babinski’s sign was absent. There were in
addition double facial palsy, more pronounced on the left side,
complete paralysis of the tongue, involvement of the motor fifth,
but no palsy of the larynx, and practically no difficulty in
swallowing.

The authors think the condition must be supranuclear, i.e.
pseudo-bulbar, because while the tongue is paralysed, it is not
in the slightest degree atrophied; there are no changes in the
musculature of the body or face, no fibrillary contractions, and
no change in electrical excitability. They do not commit them¬
selves as to its cause. S. A. K. Wilson.

A OASE OF TIO. (Iconographie de l’evolntion d’un cas de maladie dee

(329) tics.) Roubinovttch, Nouv. Icon, de la Salp&tribre, mars-avril
1906.

This paper consists of a brief account of the evolution of certain
tics in a young man twenty-three years old. It is illustrated by
a series of excellent photographs illustrating the convulsive move¬
ments of the patient. S. A. K. Wilson.

INTERMITTENT CLAUDICATION OF THE SPINAL CORD.

(330) (Sur la clandication intermittente de la moelle dpini&re.)
D&J&RINE, Rev. Neur., April 30, 1906, p. 341.

Three cases are quoted of healthy individuals in the prime of life
who are afflicted with intermittent paralysis of one or both legs.
In repose there is no inconvenience, and in two cases where the
symptoms are unilateral, the subjects are not conscious of any
difference between the two legs as far as the muscular power is
concerned. It is only after walking a certain length that they

ABSTRACTS

585

find one or both lower extremities becoming heavy and progressively
heavier, more and more difficult to move, till soon they are incap¬
able of making any movement at all. A rest of a few minutes
suffices for the phenomenon to disappear, and for their natural
power and suppleness to return to the paralysed limbs. If the
patient be examined when in the paralysed state, it will be found
that the reflectivity of his lower limbs is greatly increased, and that
sometimes an actual extensor response is present.

There can be no doubt that the symptoms are analogous to
those of intermittent claudication from arterial disease, because
the pain and weakness occur after muscular exertion or because the
condition disappears with rest; and the facts that there is no
obliteration of the peripheral pulse in the legs, and no cyanosis or
coldness of the skin, are of localising value. The disease may be
either peripheral or medullary, but the absence of the latter
symptoms shows it must be medullary in the cases quoted. In
the great majority of cases syphilis is the cause of the condition,
and antispecitic treatment is urgently called for. The physiological
pathology indicates that the process is one of meiopragia of part of
the spinal cord, that is to say, insufficient irrigation by the blood
stream. The ischaemia produced by exertion reveals itself in
functional insufficiency. S. A. K. Wilson.

INTERMITTENT CLAUDICATION OF NERVOUS CENTRES.
(331) (La claudication intermittente des centres nerveux.) Grasset,
Rev. New., May 30, 1906, p. 433.

In this interesting communication Grasset refers to the article of
Ddj&rine on the same subject in an earlier number of the Revue
Neurologique. He shows that strictly speaking Ddj^rine ought to
have called his paper “intermittent claudication of the anterior
(antero-lateral) part of the spinal cord,” for reasons readily
appreciated.

Grasset emphasises the widespread nature of the lesion that
may cause intermittent claudication, and the possibility of its
occurrence in cerebrum and brain and spinal cord. In the first
case, it reveals itself chiefly by transient amnesia, intellectual
fatigue, and aphasia, often by very incomplete “ strokes,”
momentary loss of consciousness, of orientation, etc. Intermittent
claudication of the mesencephalon is seen in Cheyne-Stokes
respiration, paroxysmal and transient, in vertigo, which may pass
into the syndrome of Stokes-Adams, with epileptiform attacks and
bradycardia, etc. In the spinal cord there may be intermittent
claudication of the posterior cord, indicated by paroxysmal
painful feelings of constriction round the trunk, associated with
pseudo-angina and gastralgia, and possibly akin to the gastric
2 Q

586

ABSTRACTS

crisis of tabetics. The colic of anterio-sclerotics is almost certainly
due to intermittent claudication.

Finally, one may have the ordinary peripheral (muscular)
intermittent claudication, the symptomatology of which is familiar.
Transient panesthesias and crises of acroparesthesia are probably
to be attributed to this condition.

Grasset considers many of the symptoms of tabes have a
similar explanation. S. A. K. Wilson.

A CASE OF TAOTILE APHASIA. (Un cas d’aphasie tactile.)

(332) Raymond and Eggkr (Soc. de Neur. de Paris), Rev. Neurol.,
April 5, 1906.

The patient was a woman 61 years old, with a right brachial
monoplegia of four months’ duration. There was perfect con¬
servation of all forms of cutaneous sensation over the palmar
aspect of the hand, but there seemed to be fairly constant post-
axial localisation when topognosis was tested. There was no
hemianopsia. There was no aphasia, and only occasionally some
verbal amnesia—muscular sense was conserved in its entirety in
the right hand.

When various objects were placed in the right hand, the patient
recognised their forms well enough, and could say whether they
were round or square, thin or thick, large or small, rough or smooth,
etc. Yet in each instance she failed to name the object she was hold¬
ing, whereas the moment she had it in her left hand she could tell
what it was. An orange was described as big, round, hard, rough,
but she could get no further.

The condition is therefore one of pure tactile aphasia, analogous
to word deafness; in the latter case the patient hears perfectly
what is said, but the acoustic impressions do not evoke the images
of the words.

The patient in this instance is not suffering from astereognoeis,
for she recognises the forms of objects, and is not therefore to be
classified with the cases of Tastlahmung described by Wernicke,
since these were not only unable to recognise objects by touch, but
were astereognostic as well. S. A. K. Wilson.

CONTRIBUTION TO THE LOCALISATION OF THE MUSICAL

(333) TALENT IN THE BRAIN AND ON THE SKULL. (Beitragxur
Lokalization des mnsikaHschen Talentes im Gehirn undan
Sch&del.) Auerbach, Arehiv. /. Anat. u. Phyt ., 1906, p. 197.

In this article the writer gives an account of the literature bearing
upon this intricate question, records certain observations of his own,

ABSTRACTS

587

and suggests a series of headings under which future investigations
might be recorded.

Among the most important sets of records were those of
Retzius, who was inclined to associate the mathematical talent
with a strong development of the parietal region, particularly
of the angular gyrus. The brain of Gylden the astronomer, that
of Loven the histologist, and that of Helmholtz, who all possessed
great musical gifts, showed a special development of this part and
of the first temporal convolution. A similar condition was found
in the brain of the violin-virtuoso Rudolf Lenz. In the case of
Naret Koning, first concert-master in the Frankfurt opera, who
possessed an extraordinary ear for music, with great musical
judgment, and whose brain was carefully examined by the
writer, the hinder part of the left upper temporal convolution
and supramarginal gyrus were strikingly developed. Further,
the writer believes that he can observe in musically - gifted
people a special development and roundness of the skull in the
temporal region. He gives eight points to which he thinks
future investigators might direct attention, as well as copious
references. John D. Combie.

PSYCHIATRY.

THE INVESTIGATION OF THE TRAUMATIC NEUROSES BY
(334) PSYCHO-PHYSIOAL METHODS. (Die Untersuchung von
Unfallnervenkranken mit psycho - physischen Method en.)

Oberartz Curt v. Leupoldt, Klinik f. psych, u. new. Krwnkheiten,
Bd. 1, H. 2. Halle a. S.: Carl Marhold, 1906.

In the whole field of neurology there are few, if any, diseases
which occasion more trouble and give rise to more controversy
than the traumatic neuroses. Unfortunately these controversies
are fought out in the full light of day, in legal courts, from which
the medical witnesses have not always emerged with credit.
Almost invariably in these vexatious cases the symptoms offered
by the patients claiming damages are altogether subjective in
character, and for this reason the results of minute psycho-physical
methods of examination, such as are in operation at Giessen under
Prof. Sommer, will, in time, it is to be hoped, furnish objective
and satisfactory data on which to found an accurate diagnosis.
That this has not yet been attained is evident from a perusal of
Dr Leupoldt's careful description of the investigation made in
nine cases of this nature. The methods employed include, in
addition to ordinary neurological examination, the application of
Sommer’s apparatus for the three-dimensional registration of

588

ABSTRACTS

movements to the attitude of the body and its members, to
tremors of the hand and finger, and to “ fright-reaction ” on sadden
noises; ergographic results with Mosso’s instrument; time
reactions; plethysmographic investigations and, on the intellectual
side, tests in reckoning, in word memory according to Ranschbuig’s
plan, in verbal association, and so on. Each of Dr Leupoldt’s cases
was exhaustively analysed and the results are given in extenso
in this paper. In none of these cases does it appear that the tests
employed did more than corroborate a diagnosis previously arrived
at by ordinary methods, except in one case, in which the patient
had been considered a simulator, but after examination was
considered to be affected by “ a particular kind of mental
inhibition ” giving rise to delay in all reactions and, apparently,
incapacity for labour. No more definite diagnosis is given in this
case, and here, as in the others, an inherent difficulty is presented
by the impossibility of separating incapacity from disinclination,
that is, as Dr Leupoldt admits, the subjective elements cannot be
discounted even in these tests. R Cunyngham Brown.

ON THE PUERPERAL PSYCHOSES. (Bin Beitra* zur Lehxe
(335) der Puerperalpsychosen.) A. Munzer (of Heidelberg),
Monaisschr. f. Psych, u. New., April 1906.

Thk author gives the result of his analysis of 101 cases where a
psychosis developed in relation to gestation, the puerperium, or
lactation; the term puerperal psychosis is applied widely to
psychoses arising during any of these periods. The percentage
of puerperal psychoses, estimated in relation to all female
admissions, was 8 per cent., but in relation to the number of
patients who had borne children was 21 per cent. The occur¬
rence of the psychoses in relation to the three main periods
was 19 during pregnancy, 56 in the lying-in period, and
26 during lactation. In discussing the setiological factors,
Munzer agrees with Schmidt, who lays great stress on the
physical exhaustion due directly to child-birth. During preg¬
nancy the placental circulation is a disturbing element in the
general economy of the system. The fact that many authors lay
great stress on the element of infection is in part explained by the
frequent occurrence of fever, which, however, is frequently the
only symptom to suggest infection.

In his series the author found that 56 cases occurred between
the ages of twenty and thirty; the usual period given by
authors as most common is between thirty and thirty-five. Preg¬
nancy psychoses occurred on the average at a later period than
the other forms.

Puerperal psychoses presented a larger percentage of cases

ABSTRACTS

589

with bad heredity than other psychoses; the other setiological
factors were numerous and varied.

As to the nature of the psychoses, 26 were manic-depressive
insanity, 53 were dementia praecox, dementia paralytica occurred
6 times, amentia (acute hallucinatory confusion) also 6, hysteria
furnished 1 case, while in 9 the diagnosis was doubtful. The
cases of dementia prsecox were usually of the catatonic form, and
presented frequently marked depressions. The psychoses in
puerperal cases presented the same features as in the non-
puerperal cases. The amentia presented the identical features
which are found in cases occurring after other exhausting
causes.

The author concludes that we do not know as yet a specific
puerperal insanity, but it is not impossible that further analyses
may discover features special to puerperal cases; the predominance
of depressions during pregnancy is referred to in this relation.

As to prognosis, the cases occurring in pregnancy were the
gravest. The prognosis of puerperal psychoses is the prognosis of
the same psychosis occurring in relation to other factors.

C. Macfie Campbell.

ON THE WANT OF INSIGHT OF ALCOHOLICS. (Zur Lehre von

(336) der Einsichtiglosigkeit der Alkoholisten.) 0. Juliusbubger
(of Steglitz), Monatsschr. f. Psych, u. Neur., Feb. 1906.

In this article the author discusses the grounds of the frequent
inability of alcoholics to recognise the real setiological factor in
their mental disorder. He gives briefly in 25 cases the amount
of money spent in drink, the wages and rent of the patient, and
the reasons given by the latter for his drinking habits. The
importance of the social atmosphere in determining the latter is
most important, and cannot be neglected in any attempt at a
permanent cure; the traditions of the classes from which the
alcoholics are chiefly recruited must be known and combated if
prophylaxis is to be really serious. In view of these factors
Juliusburger emphasises the importance of a purposeful ethical
treatment during detention: the apparent weakness of the
alcoholic has frequently a sociological rather than an individual
explanation. C. Macfie Campbell.

MIXED CONDITIONS IN EPILEPSY AND ALCOHOLISM.

(337) (Mischzust&nde bei Epilepsie and Alkoholismus.) Dr F.
Chotzen (of Breslau), Centrcdbl. f. NervenheUk. u. Psych., Feb. 15,
1906.

The close relationship of epilepsy and alcoholism is well known;
the abuse of alcohol may lead to epileptic attacks, and epilepsy

590

ABSTRACTS

with its symptoms and constitution predispose to alcoholism.
Post-epileptic deliria resemble alcoholic deliria, but the well-
marked affect, the fantastic ideas of persecution, the prominence
of hypochondriacal ideas, the tendency to religious delusions,
and the variable disorientation, are typical of the pure epileptic
delirium. These may, however, be absent, and one may, on the
other hand, in an epileptic meet a simple occupation delirium with
tremor and complete disorientation. As a rule, the epileptic
delirium presents a more varied and changeable picture than the
alcoholic. The author has not seen in a non-alcoholic epileptic a
typical alcoholic picture, but in alcoholics the epileptic attack
may be the precipitating cause of a delirium presenting the pure
picture of the alcoholic delirium. In alcoholic epileptics an acute
hallucinatory condition without the dream-like state of conscious¬
ness of the epileptic, and without the fantastic, anxious delusions,
may be met with. Such a picture frequently takes on, in its
later course, the epileptic features. In one case, neither convul¬
sions nor other epileptic symptoms had been observed. In cases
of recurrent alcoholic attacks with the later development of
epilepsy, the later alcoholic attacks may gradually assume an
epileptic colouring. The anxiety may become prominent, the
orientation extremely variable, with sudden misinterpretation of
environment, abrupt assaults, great irritability, delusions of a
religious content, hypochondriacal delusions. The epilepsy, as
well as the deterioration after successive alcoholic attacks, is due
to the association of arterio-sclerosis. The author discusses the
question whether certain motor phenomena of a catatonic nature,
occasionally met with in alcoholic psychoses, may not in reality
be epileptic symptoms. He records one case of an alcoholic who,
after several convulsions, showed a stupor with negativism, mutism,
abrupt and unexplained actions, with dulling of the sensorium and
absence of the pupil reflex; there was no affect observed; the
epileptic nature of the stupor was seen in the general dulling and
the absence of pupil reflex.

In the second case which he reports, the stupor preceded the
development of epileptic attacks, and the latter were followed by
a delirium. The behaviour of the patient during the stupor was
that of a catatonic.

In a third case, in which nothing in the history indicated
previous epilepsy, the patient had a delirium with hallucinations,
chiefly auditory ; hypochondriacal feelings of varied nature fol¬
lowed, and two days later he showed mutism, sat in stereotyped
attitudes, showed flexibilitas cerea. This gave way to the previous
picture, and in nine days patient quieted down, became quite clear
and had insight.

In a fourth case the course of the psychosis was that of the

ABSTRACTS

591

alcoholic delirium, although the patient in the early stages had
presented a catatonic picture.

In depressive alcoholic psychoses complicated with motor
phenomena, the possibility of a mixed condition with epileptic
features cannot be excluded, and the author suggests a similar
way of regarding several severe psychoses in marked alcoholics
and in traumatic cases. C. Macfie Campbell.

FTSOHIO AND MOTOR DISTURBANCES OAUSED BY ALCOHOL,
(338) IN PARTICULAR AMONGST THE NEUROTIC. (Ueber
Bewusstseinsver&nderungen und Bewegungsstoningen durch
Alkohol besonders bei NervSsen.) Privatdozent Dr Danne-
mann, Klinik. f. psych, u. nerv. Krankheiien, Bd. 1, H. 2.
Halle a. S.: Carl Marhold, 1906.

Under the above rather high-sounding title, Dr Dannemann
describes the case of a man sentenced in 1903 to five years penal
servitude for murder. Briefly the facts relating to his crime are
as follows. The prisoner, set. 21, whilst partially intoxicated,
became involved in a quarrel and received a blow on the nose and
had his ears boxed by a certain S. This was at 10 in the
evening and was soon settled peaceably, prisoner and many others
proceeding to a convenient tavern, without, however, S. the
aggressor. About midnight the prisoner, not obviously drunk,
went home and, passing on his way the home of S., became
suddenly inflamed with anger, hastened home, seized a gun and
ran back to the tavern. Here, in a room crowded with guests,
but from which S. was absent, he discharged his weapon at an
unoffending man, apparently under the impression that he was S.,
wounding him fatally, then fired again, wounding another who
afterwards succumbed, and injuring several others. He was
placed by the authorities under mental observation, and being
found neither insane nor weak-minded, was sentenced as above.
In investigating the case, Dr Dannemann obtained from his
parents a criminal family history, his father and his brother
having been frequently convicted of violent assault, but no
heredity of insanity, epilepsy, or other nervous disease. The
prisoner was stated to have been subject all his life to sudden
accessions of anger, to have stayed out all night and wandered for no
reason at times, and even up to a few months before his crime to
have wet his bed. In 1900 he suffered two severe head injuries
followed by brief unconsciousness. Also, a few weeks before
incarceration, he had violently assaulted another man in a fit of
rage following a quarrel—in this case also a late reaction. Under
observation he was found to be mentally well endowed, normal in
emotional reactions, and apparently of good moral character.

592

ABSTRACTS

Memory for past events was good and also, when first examined,
for the events leading up to and during his homicidal acts.
Later his memory for these last events became confused and his
evidence contradictory. During the whole period of his observa¬
tion he showed no special characteristics of epilepsy, but during
the last few weeks his sleep became disturbed, he suffered from
headache, and was found to be markedly intolerant of alcohoL
Tested by Sommer’s apparatus, marked tremors were observed
even after moderate doses, much more pronounced than in other
normal individuals after prolonged drinking. Also, after com¬
paratively small doses of alcohol, his power of observation and
attention was proved to be unusually deficient. On the grounds
of these observations, Dr Dannemann concludes that the prisoner
was an individual of excitable temperament, psychically abnormal,
and most probably the sufferer from epilepsie larvde. Prof
Aschaffenberg has shown the high percentage of cases of epilepsy
exhibiting alcoholic intolerance, but until it is proved that this is
not shared by any normal individuals, too much stress Bhould not
be laid on this sign, and Dr Dannemann’s hypothesis, though
suggestive, is somewhat unconvincing. R. Cunyngham Brown.

ON THE EXPERT VIEW OF GRIMES COMMITTED DURING
(339) INTOXICATION. (Zur gerichts&rztlichen Beurteilung der im
Rausche begangenen Verbrechen.) R. Gaupp (of Munich),
CentraUbl. /. Nervenheilk. u. Psych., Feb. 1, 1906.

This article is a criticism of the views published by Hoppe in
the January number of the Centralblatt. Gaupp admits the
scientific truth of Hoppe’s attitude towards the phenomena of
intoxication and chronic alcoholism; he joins issue with him on
his practical conclusions. It is the duty of the expert as such
to aid in the carrying out of the laws in the spirit in which they
were framed, and not to run counter to that spirit.

The law has not included intoxication as one of the causes
which reduce the responsibility of the individual, and to put
forward intoxication as removing the responsibility of the indi¬
vidual on the same footing as other conditions of mental disorder
would be to fail to interpret the existing law and would be to
expose the expert to ridicule. The majority of serious crimes
are committed under the influence of drink. It is impossible to
dismiss scot-free such individuals; there are not sufficient institu¬
tions in which they could be treated; the only practical solution
under present conditions frequently is to subject them to im¬
prisonment. C. Macfie Campbell.

ABSTRACTS

593

THE FORENSIC OPINION AND TREATMENT OF CRIMES

(340) COMMITTED BT THE INTOXICATED AND THE CHRONIC
ALCOHOLIC. (Die forensische Beurteilung nnd Behandlnng
der von Trunkenen nnd von Trinkem begangenen Delikte.)

H. Hoppe (of Konigsberg), Centralbl. /. Nervenheilk. u. Psych.,
Jan. 5, 1906.

Hoppe reviews the laws of various countries regarding crimes
committed by individuals either intoxicated or showing the
result of alcoholic deterioration. He insists upon the fact that
alcoholic intoxication is essentially a transitory mental disorder,
and concludes that the responsibility of the individual should
be determined in view of this fact. It is not sufficient to say
that the individual is responsible for causing this mental

disorder—social influences are a potent factor, and the reactions
of various individuals differ. Cramer and Heilbronner recom¬
mend that a physician should decline to give an expert opinion
on the responsibility of an intoxicated person, unless the indi¬
vidual has presented morbid symptoms. Hoppe looks upon
this as a failure to accept one’s scientific responsibility; the
physician should insist on the essentially pathological condition
of the intoxicated. He maintains a similar attitude with
regard to the criminal acts of chronic inebriates. Punish¬
ment in these cases is absolutely fruitless: the prison

is a quite ineffective means of answering the problem.

The author proposes that where a man with a previously
good record has committed a crime under the influence
of alcohol, which he would not have done when sober,

he should be conditionally released if an expert declare him
irresponsible at the time of the crime, but that he should
be bound over to keep the pledge; and that in the event of his
failure to do this, and especially if he should again commit a
misdemeanour under the influence of drink, he should be
liable to serve the sentence for the first offence as well.
Repeated misdemeanours should make him liable to be sent to
an institution for inebriates for an adequate period, at least for
one or two years. C. Macfie Campbell.

ON THE TREATMENT OF CRIMES COMMITTED BT

(341) ALCOHOLICS. (Zur Behandlnng alkoholischer Delikte.) O.

Juliusburger (of Steglitz), Psych.-Ntwr. Wchnschr., April 7,
1906.

The author agrees with Hoppe that the only suitable treatment
for inebriates who have committed misdemeanours under the
influence of drink is to send them, not to prison, but to an inebriate

594

ABSTRACTS

institution. By punishment one gains nothing. He does not
agree with Hoppe’s suggestion as to the practical method of
treating the first offence, but holds that on the first offence the
inebriate should be committed to an institution for treatment.
He emphasises his own views as to the importance of the educa¬
tional and ethical aspects of the treatment of thiB class of
individuals. C. Macfie Campbell.

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sclerose lat^rale amyotrophique. Anh. de Neurol., juin 1906, p. 488.

Paraplegia. —GAUSSEL. 6tude pathogenique de la parapl6gie du mal de Pott

Arch, de mid. explr. , mai 1906, p. 293.

DEJERINE et CAMUS. Un cas de Mai de Pott oervical avec troubles fete
6tendu8 de la Sensibility par M6ningite concomitante. (Soo. de NeuroL) Rjen
NeuroL, juin 30, 1906, p. 560.

CHARLES PETIT et VEILLARD. Paraplegia Spasmodique. Troubles o4r6-
braux. Scl6rose en plaques probable. (Soc. de NeuroL) Rev. NeuroL, juin 80,
1906, p, 595.

BIBLIOGRAPHY

597

PELLIZZI. Paraplegia spasmodic* famigliare e demenza precoce. Riv. Speri -
merit, di Freniatria, Vol. xxxii., 1906, p. 1.

LEJONNE et LHERM1TTE. itude sur les parapl6giea par retraction chez lea
vieillards. Nouv. Icon, de la SalpStriere, mai-juin 1906, p. 255.

Myelomalacia.—RAYMOND et ALQUIER. My£lomalacie incomplete avec
Osteite rarefiante d’un corps vertebral ayant simuie und Compression sub&igue de
la Moelle. (Soc. de Neurol.) Rev. Neurol., juin 30, 1906, p. 581.

Malll pie Sclerosis. —E. W. TAYLOR. Multiple Sclerosis: a Contribution to its
Clinical Course and Pathological Anatomy. Journ. Nerv. and Merit. Die., June
1906, p. 351.

Syringomyelia.—ARCHIBALD CHURCH. Syringomyelia, with Involvement of
Cranial Nerves probably. A Syringobulbia. Journ. Nerv. and Merit. Die., July
1906, p. 454.

RAYMOND et LHERMITTE. Sur un c&s de Syringomy61ie h type douloureux.
(Soc. de Neurol.) Rev. Neurol ., juin 30, 1906, p. 576.

W. B. RANSOM. A Case of Syringomyelia and Adenoglioma of the Spinal Cord.
Jorum. Pathol, and Bacteriol. , June 1906, p. 364.

GILBERT BALLET et MAILLARD. Syringomy61ie h forme anorm&le ? (Soc.
de Neurol.) Rev. Neurol., juin 30, 1906, p. 562.

Conns Lesions.—MINOR. Zur Pathologic des Epiconus medullaris. Deutech.
Ztechr.f. Nervtnheilk. , Bd. 30, H. 5-6, 19&, S. 389.

F1SCHLER. Ein Be it rag zur Kenntnis der traumatischen Conus-l&sionen.
Deutsche Ztechr.f. Neyveuheilk. , Bd. 30, H. 5-6, 1906, S. 364.

L. R. MULLER, tlber die Extirpation der unteren H&lfte des Riickenmarks
und deren Folgererscheinungen. Deutsche Ztechr.f. NervenheUk ., Bd. 30, H. 5-6,
1906,8.413.

MMAIN—

Meningeal HiemorrMage.—APELT. Zum Kapitel der Diagnose des extra- und
intraduralen traumatischen und pachymeningitischen Hama to ma. Mitteil. aus der
Orenzgtb. der Med. and Chir., Ba. 16, H. 2.

Meningitis*—PETERS. Ueber die Entzundung des extraduralen Gewebes des
Riickenmarks bei der Genickstarre. Deutech. med. Woch. , Juli 19, 1906, p. 1151.
WEICHSELBAUM. Moningitis cerebro-spinalis. Wien. med. Woch., Juli 14,
1906, p. 1451.

WILLIAM WRIGHT and WILLIAM ARCHIBALD. Epidemic Cerebro-spinal
Meningitis, with Notes on Recent Cases occurring in Glasgow. Lancet, June 30,
1906, p. 1815.

ALBERT CHARPENTIER. MSningite chronique syphilitique oonjugale. (Soc.
de Neurol.). Rev. Neurol ., juin 30, 1906, p. 550.

RAYMOND et BAUR. Syndrome de M£nifere dfi h une M6ningite de la base.

g -oc. de Neurol.) Rev. Neurol ., juin 30, 1906, p. 584.

ILDESCHEIM. The Prognosis in Posterior Basic Meningitis. Pediatrice, July
1906, p. 431.

Encephalitis*—BREGMAN. Uber eine diffuse Encephalitis der BrUcke mit Aus-
gang in Heilung. Deutsche Ztsckr. f. Nervenheilk ., B<L 30, H. 5-6, 1906, S. 450.
Tnmonr*—THOMAS BUZZARD. A Clinical Lecture on Two Cases illustrating
Points in the Diagnosis of Tumour or other Lesion of the Temporo-Sphenoidiu
Lobe. Ijxrvcet , June 80, 1906, p. 1807.

GEORGE A. MOLEEN. Subcortical Cerebral Gumma Accurately Localised in
the Comatose State : Death ; Autopsy. Journ. Nerv. and Ment. Die., June 1906,
p. 407.

C. T. VAN VALKENRERG. Tumor in der Marksubetanz der motorischen Zone
(Armregion). Zur Differentialdiagnose zwischon kortikalem und subkortikalem
Site des Herdes. Neurol. Centralbl., Juli 1, 1906, S. 594.

LIEBSCHER. Zur Kenntnis der Zystizerkose des Gehirns mit Geistesstfrrung.
Prag. med. Woch., June 28, p. 339.

J. A. MACDONALD. Report of a Case of Brain Tumour. Journ. qf Am. Med.
Ass July 14, 1906, p. 101.

GIORDANI. Sur 1e diagnostic des Tumours de l'Hypophyse par la radiographic.
(Thlee.) Baillifcre et fils, Paris, 1906.

VOLPI-GHIRARDINI. Considerazioni sopra un caso di tumore comprimente la
metk destra del ponte di varolio diagnosticato in vita. Riv. Speriment. di Frenia -
tria , Vol. xxxii., 1906, p. 166.

Abscess*—DUPRE et DEVAUX. Abcfcs c4r4bral; necrose corticate; syndrome
m6ning6. Nouv. loon, de la SalpHriire., mai-juin 1906, p. 239.

598

BIBLIOGRAPHY

Hereditary Cerebellar Ataxia*—RAYMOND et ROSE. H6r6do-ataxie c4ri-
belleuse. (Soc. de Neurol.) Rev. NeuroL , juin 30, 1906, p. 546.

Cerebral Diplegia.—POYN TON, PARSONS and GORDON HOLMES. A Coo-
tribution to the Study of Amaurotic Family Idiocy. Brain , Vol. xxll, No. 114,
1906, p. 180.

Ceaeral Paralysis.—GIUNIO CATOLA. A proposito della patogenesi deDa
par&lisi progressiva e dello spirochaete pallida di Schaudinn-Haunmann. Ris. di
Patol. nerv. e ment., VoL xi., f. 5, 1906, p. 218.

ETIENNE et PERRIN. Arthropathie nerveuse chez un paralytique general
non tabetique. Nouv. Icon, de la Salpitribe , mai-juin 1906, p. 276.

ADAM. Ein Fall progressiver Paralyse im Anschluss an einen Unfall durch elek-
trischen Starkstrom. Allg. Zcit.f. Psychiat ., Bd. 63, H. 3 u. 4, p. 428.

HUGH T. PATRICK. Hereditary Cerebellar Ataxia and General Parem.
Joum . Nerv . and Ment. Die., July 1906, p. 459.

Pellagra.—C. CENI. Sul ciclo biologico dei penicilli verdi in rapporto colT endemia
pellagrosa. Riv. Speriment. di Freniatria, VoL xxxii., 1906, p. 184.

MENTAL DISEASES—

WERNICKE. Grundrias der Psychiatrie in klinisohen Vorlesungen. Thieme,
Leipzig, 1906, M. 14.

HELLPACH. Der Gegenstand der Psychopathologie. Arch. f. d. gesammtePsycho¬
logic, Bd. 7, H. 344, p. 143.

ROSENFELD. 0ber den Einfluss psychischer Vorgiinge auf den StoffwechseL
Allg. Ztit. f. PsifchiaJ. , Bd. 63, H. 3 u. 4, p. 367.

ALBRECHT. Die psychischen Ursachender Melanoholie. Monatssch. f. PsyckiaL
u. Neurol., Juli, p. 65.

ALBRECHT. Manisch-depressiver Irresein und Arteriosklerose. Allg. Ztit. f.
Psychiat. , Bd. 63, H. 3 u. 4, p. 402.

LUGIATO e OHANNESSIAN. La pressione sangoigna nei malati di meote.
Riv. Sj>eriment. di Freniatria, Vol. xxxii, 1906, p. 225.

MARGULIES. Uber graphisch-kmksthetische Hallurinationen. NeuroL Ceu-
tralbl. , Juli 16, 1906, S. 651.

GROSZMANN. The Position of the Atypical Child. Joum. Nerv.and Ment Di*.,
July 1906, p. 425.

BOURNEVILLE et BORD. Types d’idiotie. Cas d’idiotie mongolienne. Rex.
dC hygiene de mldecine infantiles, T.v., No 3, p. 221.

PIUHINI. II ricambio organic© nella demenza precooe. Riv. Speriment. di
Freniatina, Vol. xxxii., 1906, p. 355.

DE-SANCTIS. Sopra alcune varietk della demenza precooe. Riv. SperimenL di
Freniatria , Vol. xxxii., 1906, p. 141.

D’ORMEA. 11 potere riduttore delle urine nei dementi preeoci. Riv. SperimenL
di Freniatria, Vol. xxxii., 1906, p. 79.

ORBISON. Acute Paranoia exhibiting cyclical Relapses. Am. Joum. of the
Med. Sri., July 1906, p. 91.

GREGOR. Ein Beitrag zur Kenntnis dee intermittierenden Irreseins* Allg. Zed.
f. PsycJiiai., Bd. 63, H. 3 u. 4, p. 417.

GEIST. Uber kombinierte Psychosen nebst einem kasuistisohen Beitrag. Ally.
Zeit. f. Psychiat. , Bd. 63, H. 3 u. 4, p. 434.

RAW. Mental Disorders of Pregnancy and the Puerperal Period. Edin. Med.
Joum., Aug. 1906, p. 118.

A. MARIE. La Demence. Doin, Paris, 1906, 4 fr.

J. MOREL. Prophylaxie et traitement des criminels r6cidivistes. Joum. dt
Neurol. , juin 20, 1906, p. 221.

The Alcoholic Craving.

BriL Journ. Inebriety. July
Riv. SperimenL di
ArdLgh.

ALCOHDL—

HARRY CAMPBELL.

1906, p. 5.

FORLI. Sulla polineurite reumatica dei nervi cranici.

Freniatria , Vol. xxxii, 1906, p. 280.

JEAN GALEZOWSKI. Les manifestations oculaires du satumisme.
de mM., juin 26, 1906, p. 1613.

V. HIPPEL. Ueber seltene Falle von Lkkmung der Akkommodation and von
Pupillenstarre. Klin. Monatsblatt. f. Augenheilk ., Juli 1906, p. 97.

TOdTER. Ein Beitrag zur isolierten Blicklahmung nach oben und unten.
Klin. Monatsblatt./. Augenheilk., Juli 1906jx 102.

HAMMERSCHLAG. Behandlung der Trigeminusneuralgie mit Perosmium
S&ure. Arch./, klin. Chirurg ., Bd. 79, H. 4, p. 1060.

BIBLIOGRAPHY

599

FERNAND LliVY. Essai sur 1 m n6vralgies faciales Rousset, Paris. 1906, 5 fr.
JAC06S0HN. Ueber traumatisch-chirorgische Faciahalahmungen. Deutsch. mod.
Woch., Juli 19, 1906, p. 1163.

ALLAIRE Sur deux cas de paralysie faciale protuWrantielle. Ann. <T Electrobiol.
et de Radiol avril 1906, p. 227.

MINGAZZINI und ASCENZI. Klinischer Beitrag sum Studium der Hemi-
atropbie der Zunge supranuklearen Ursprungs. Deutsche Ztschr. f. NervenheUk .,
Bd. 30, H. 5-6, W6, S. 437.

fiimAL AND FUNCTIONAL DISEASES—

Epilepsy.— BUSCHAN. Die Epilepsie. Eonegan, Leipzig, 1906, M. 1.40.

Sir WILLIAM GOWERS.. Clinical Lectures on the Borderland of Epilepsy:
Vertigo. Brif. Med. Joum., July 21, 1906, p. 128.

MORSELLI e PASTORE Le modificazioni qualitative e Quantitative delle
cellule eosinofile nel sangue degli epilettici. Rxv. Speriment. ai Freniatria , Vol.
xxxii., 1906, p. 268.

A. E. RUSSELL. Cessation of the Pulse during the Onset of Epileptic Fits, with
Remarks on the Mechanism of Fits. Lancet, July 21, 1906, p. 152.

BESTA. Ricerche sopra la pressione s&nguigna. II polso e la temperatura degli
epilettici. Riv. Speriment. di Freniatria, vol. xxxii., 1906, p. 306.

RICCI. Studio critico sopra 393 casi di epilessia. Riv. Speriment. di Freniatria,
Vol. xxxii., 1906, p. 291.

FRIEDMANN. t)ber die nicht epileptischen Absencen oder kurzen narko-
leptischen Anfalle. Deutsche Ztschr. f. NervenheUk., Bd. 30, H. 6-6, 1906, S. 462.
Nfxmthenlt.—HUCHARD. The Mental State of Neurasthenic Patients. Paris
Med. Joum , July 1906, p. 91.

CRAMER Die Nervositkt, ihre Ursachen, Ersoheinungen und Behandlung.
Fischer, Jena, 1906, M. 8.

NEVILLE HART. The Nervous Phenomena following Attempted Suicide by
Hanging. Lancet , June 30,1906, p. 1821.

Traumatic Neurasthenia*— WILLY HELLPACH. Unfallsneurosen und Arbeits-
freude. Neurol. Centralhl. , Juli 1, 1906, S. 606.

Hysteria* —DEBOVE Dysarthrie hysterique. Arch. gin. de mid. % juillet 10,1906,
p. 1746.

HENRI CLAUDE Troubles Vasomoteurs de nature Hysterique. (Soo. de
Neurol.) Rev. Neurol., juin 30, 1906, p. 551.

RAYMOND et LEJONNE. Astasie-Abasie fonctionnelle avec association de
phlnomfenes organiques. (Soc. de Neurol.) Rev. Neurol. , juin 1906, p. 564.
FISCHL. Les vomissements ac6ton6miques et lTiysttfrie infantile. Rev. mens, des
maladies de Venfanct, juillet 1906, p. 289.

CHARPENT1ER. D6gen6rescence mentale et hysterie. (Thise.) Durand, Paris,
1906.

8PECHT. Ueber Hysteromelancholie. Centralhl. f. NervenheUk. u. Psyckiat,
Juli 13, 1906, S. 545.

SADGER. Die Hydriatik der Hvsterie und der Zwangsneuroee. Centralhl . /.
NervenheUk. u. Psychiat., Juli 1, 1906, S. 505.

The Tics. —ROUBINOVITCH. Iconographie de revolution d’un oas de maladie des
tics. Novv. Icon, de la Salpitriire , mai-juin 1906, p. 289.

Tetany.— Frankl-Hochwsrt. Die Prognose der Tetanic der Erwaohsenen. Neurol.
Centralhl., Juli 16, 1906, S. 642.

Exophthalmic Goitre.— BERNHARDT. Zur Pathologic der Basedow’sohen

Erankheit. Berlin, klin. Woch ., Juli 2, 1906, p. 905.

SCHULTZE. Zur Chirurgie des Morbus Basedow. Mitteilt. aus der Orensgeb. der
Med. und Chir., Bd. 16, H. 2, 1906.

SAINTON. Les traitements actuels du goitre exophthalmique. Lev6, Paris,
1906.

MISCELLANEOUS SYMPTOMS—

LAMBERT LACK. Headache of Nasal Origin. Practitioner, July 1906, p. 46.
WALTER H. JESSOP. Eye-Strain as a Cause of Headaohe. Practitioner,
July 1906, p. 40.

WILFRED HARRIS. Migraine and Toxsamio Headaches. Practitioner, July
1906. p. 25.

JAMES TAYLOR Intracranial Disease as a Cause of Headaohe. Practiiioner t
July 1906, p. 21.

ROBERT SAUNDBY. Headache of Renal Origin. Practitioner, July 1906,
p. 19.

600

BIBLIOGRAPHY

CAMPBELL THOMSON. The Causation and Treatment of Headaches. Intro¬
duction. PiXLdiUoner, July 1906, p. 16.

LlfcVI. Migraine thyroidienne. Re r. dWygiint ft tit Midecine infantile*, T. v.,
No. 3, 1906, p. 246.

SPIELMEYER. Hemiplegie bei intakter Pyramidenbahn. MUnek. med. Wock,
Juli 17, 1906, p. 1404.

CHOTZEN. Einseitige Tempo ratursteigerung in der gelShmten KttrperhSlfte bei
serebraler Herderkrankung. Miineh. med. WocA., Juli 3, 1906, p. 13u4.
MAUDSLEY. Brachioplegiaof Cerebellar Type and Rhythmical Tremor. Inter¬
colonial Medical Joum. of Australasia, June 20, 1906, p. 302.

NOICA efc AVRAMESCU. Sur deux cas de perte ctu Sens Stlr6ognoet£que k
topographic nerveuse. (Soc. de Neurol.) Rev. Neurol. , juin 30, 1906, p. 692.
LEJONNE et EGGER. H&nianesth&ie d’origine Corticale probable. (Soc. de
Neurol) Rev. Neurol. , juin 30, 1906, p. 571.

JAMES MACKENZIE. Remarks on the Meaning and Mechanism of Visceral
Pain as shown by the Study of Visceral and other Sympathetic (Autonomic)
Reflexes. Brit. Med. Joum., June 30, 1906, p. 1523.

ALFRED GORDON. A further Contribution to the Study of the 44 Paradoxic
Reflex.” Joum. Nerv. and Ment. Die., June 1906, p. 415.

KLIPPEL et MA1LLARD. Un can de maladie de Recklinghausen arec
dystrophie multiples et predominance unilateral©. Nouv. Icon, de la Salpttr&re,
mai-jum 1906, p. 282.

PAUL TOUCHARD. Recherches anatomo-cliniquee sur la Sclerodermic gene¬
ralise©. (Thise.) Steinheil, Paris, 1906.

Aphasia. —DEJERINK L’Aphasie motrioe. La Prem mSdicale , 18 juillet 1906,
p. 453.

DEJERINK L’Aphasio Sensorielle. Presse mid., juillet 1906, p. 437.
KRAEPELIN. tJber Sprachstorungen im Traume. Engelmann, Leipzig, 1906,

M. 3.

BOULENGER. Quelques considerations sur l’ecriture en miroir. Lee troubles
de l’orient&tion et son education. Joum. de Neurol .. juillet 5, 1906, p. 241.
DEJERINE. Considerations sur la soi-disant 44 apnasie tactile." Rev. Neurol .,
juillet 15, 1906, p. 597.

HASKOVEC. Cas particulier dTnfantilisme du Langage chez une femme de 58
ans, survenu aprfcs une attaque d'Aphasia motrice. (Soc. de NeuroL) Rev.
Neurol ., iuin 30, 1906, p. 593.

DEJERIN E. Considerations sur la soi-disant 44 aphasia tactile." (Soc de NeuroL)
Rev. Neurol., juin 30, 1906, p. 553.

Cerebral Localisation.—BONHOEFFER. Ueber die Bedeutung der Jackson'-
schen Epilepsia fur die topische Himdiagnostik. Berlin, klin. Woch , Juli 9,
1906, p. 935.

ANTON. Symptome der Stirnhirnerkrankxmg. Miineh. med. Woch, Juli 3, n.

1289.

DEJERINE et ROUSSY. Le Syndrome thalamique. Rev. Neurol., juin 80,
1906, p. 521.

TREATMENT—

SIR WILLIAM BROADBENT. The Treatment of Sleeplessnem. Practitioner,
July 1906, p. 1.

PAUL PETIT. Zona survpnu k 1'occasion d'une stance de H. F. et gu£ri par le
courant continu. Ann. d' Electrobiol. et de Radiol., avril 1906, p. 232.

NEUMANN. Die Heilung der Nervositat durch intelligente Leibessucht und
rationed© liebenshaltung. Borggold, Leipzig, 1906, M. 1.20.

IDE. Die Behandlung der Neurasthenia aurch das Seeklima. NeuroL Centralbl
Juli 16, 1906, S. 654.

BABINSKI et DELHERM. Sur le traitement de la N6vralgie Faciale par Ice
Courants Voltaiques k intensity 6lev4e. (Soc. de NeuroL) Rev. NeuroL , juin 80,
1906, p. 544.

DETERM ANN. Physikalische Therapie der Erkrankungen des Zentralnerven-
systems inklusive der allgemeinen Neurosen. Enke, Stuttgart, 1906, M. 3.60.

1Re\>iew

IReurologi? anb ps^cbiatr^

©rlglnal articles

ON THE FREQUENCY WITH WHICH CERTAIN SIGNS
AND SYMPTOMS OCCUR IN OASES OF DIS¬
SEMINATED SCLEROSIS BEFORE THE DEVELOP¬
MENT OF SO-CALLED CARDINAL SIGNS.

By ASHLEY W. MACKINTOSH, M.A., M.D., Aberdeen.

Since Charcot emphasised the existence and importance of formes
frustes, or atypical forms of disseminated sclerosis, it has been
recognised that this disease may present for a long period, it may
be many years, none of the so-called cardinal signs, but simply
the features of spastic paraplegia. I have notes of 110 cases of
disseminated sclerosis, including the series of 80 cases on which
a former paper in this Review (Yol. i. p. 73) was based. In 30
cases, which eventually appeared clear examples of disseminated
sclerosis, the cardinal signs were, when the cases were seen at an
earlier stage, either entirely absent, or so doubtful that it was
believed that no diagnostic significance could be attached to
them; at this early stage all appeared to be examples of simple
spastic paraplegia, but it was possible in all to elicit, either from
the histories of the cases or from the “ present condition,” certain
signs or symptoms not belonging to the symptomatology proper
of primary spastic paraplegia. It is believed that an analysis of
the nature and frequency of the most important of these signs
and symptoms may be of interest and also of some value from
the point of view of the early diagnosis of disseminated sclerosis.

R. OF N. & P. VOL. IV. NO. 9—2 R

602

ORIGINAL ARTICLES

Points in the Histories of the Cases.

I. Marked variability or remission of symptoms, 30 cases:—

(a) Leg-paralysis, 25 cases :—

Paraplegia .
Monoplegia .

Hemi paresis .
Unsteady gait

19 cases.

(8) Parsesthesia of legs, especially of feet, 9 cases
(variable objective sensory defect in 2):—

Pains in legs . . . .3 cases.

Attacks of numbness of one half of body . 1 case.
Markedly severe and remittent pain in spine 1 „

(y) Sphincter troubles, 7 cases.

(3) Arm-affection :—

Paraesthesiae, especially about fingers . 11 cases.

Arms weak or shaky

•

. 10 „

Amblyopia.

cases.

Diplopia .

Squint

Vertigo

Speech defect

„ (temporarily “ difficult,
“ indistinct ”).

Epileptiform attacks

case.

II. Paraesthesiae, 23 cases (“numbness,” “pins and needles,”
“ hot or cold feeling,” etc.):—

Arms, chiefly about fingers . 18 cases.

Legs „ feet . . 17 „

Marked cord sensation 4 „

Numbness of trunk . . 2 „

Numbness of half of body . . 1 case.

Pains in limbs, 7 cases (legs 6, arms 3).

Pains in spine, 6 cases (chiefly in lumbo-dorsal region).

III. Arm affection: “weak,” “shaky,” “tremulous,” 12 cases.

IV. Sphincter trouble (apart from constipation), 12 cases:

ORIGINAL ARTICLES

603

either retention of urine or, more often, a tendency to incontinence
of urine: in 6 cases, defective control over bowel.

V. Amblyopia
Diplopia
Squint .

Vertigo .

Speech defect
Epileptiform attacks

14 cases.
7
2
6
3
2

Remarks .—That marked variability or remission of symptoms
—emphasised by Oppenheim, UhthofF, Freund, Buzzard, and
others—is one of the most striking and moBt constant charac¬
teristics of disseminated sclerosis is amply borne out by these
cases. In several, paraplegic attacks occurred again and again,
with apparently complete recovery in the intervals; in a few
cases the paraplegia was accompanied by great or even complete
loss of power over bladder and bowel, which also entirely dis¬
appeared. In most of the cases with sphincter troubles, especially
those in which the troubles were transitory, there was simply
either retention of urine or precipitate micturition or slight
definite incontinence of urine.

There are several interesting histories of temporary
amblyopia; t' as, in one case, sudden complete blindness is
stated to have occurred, first of one eye and then of the other
eye two years later, lasting several months and then completely
disappearing. In about one-half of the cases of amblyopia, the
condition was mainly or entirely unilateral.

Attacks of vertigo were the specially prominent early
symptom in one case. They came on quite suddenly and made
the patient stagger so that he was “ often said to be drunk.”

The frequency of occurrence of subjective sensory disturbances
(parsesthesise, pains) in the early histories of the cases may be
noted. Probably these disturbances are rarely absent in cases of
disseminated sclerosis, although no note may be made of them.
They occur in 93 of my series of 110 cases: parsesthesise in 75
cases, pains in 64. The parsesthesise generally implicated mainly
or solely the distal parts of the limbs (legs 63, arms 53 cases);
they were often strikingly transient and prone to recur, and they
usually occurred early in the history of a case; in a fair number
of cases they were the first symptom noted. The pains affected

604

ORIGINAL ARTICLES

the limbs in 39 cases (legs 35, arms 17). Spinal pain, generally
in the lumbar or lumbo-sacral region, was noted in 26 cases ; in
some the pain was very persistent, and not unfrequently it was
severe; in one of the present series of 30 cases, severe recurrent
attacks of pain in the lower lumbar spine, later tending to shoot
down the legs, were the first and most prominent symptom.

Points in the “Present Condition” of the Cases, before
Cardinal Symptoms Appeared.

I. Gait, unsteady or staggering or ataxic, as well as spastic,
18 cases.

II. Primary optic atrophy, 16 cases, 1 2, not noted 2,
absent 10.

III. Objective sensory defect of legs, specially feet, 14 cases.

Slight defect of sensation of half of body, 1 case.

Stereognostic sense impaired or lost in one hand, 2
cases.

Sensory defect, chiefly algesic, at tips of fingers, 2
cases.

IV. Parses thesiae, 14 cases.

Legs 13, arms 11, trunk 1, girdle sensation 5, pain
in lower spine, 7 cases.

V. Sphincter troubles, 9 cases, chiefly tendency to in¬

continence of urine or precipitate micturition, in¬
continence of faeces in 2 cases.

VI. Diminution or loss of abdominal and epigastric reflexes,

12 cases.

The state of these reflexes is noted in 15 cases
only.

VII. Ocular signs: Pupils unequal, 2 cases.

One pupil sluggish to light, 1 case.

Paresis of external rectus, 3 cases.

Paresis of internal rectus, 2 cases.

Remarks .—In 18 cases (».«. 60 per cent.), an ataxic or un¬
steady element in the gait was noted; in several cases the
degree of unsteadiness was very suggestive of cerebellar trouble;
in 4 cases it was the only objective sign, apart from spastic
paraplegia.

Optic atrophy was present in 16 cases, i.e. 58*3 per cent.;

ORIGINAL ARTICLES

605

mainly or entirely confined to the outer part of disc in 7 cases,
and mainly or entirely unilateral in 4 cases. As a rule the
degree of pallor of disc was not great, but marked atrophy was
present in 2 cases, in which visual acuity was reduced to tv and
'sftnr respectively in the more atrophic eye. In most cases the
visual defect was comparatively slight, although only one case
with optic atrophy is noted to have had V = £. The fields of
vision are recorded in only a few cases; the fields were narrowed
in four (all had optic atrophy), central scotoma was present in
one (discs pale, especially at outer parts), absent in 5 cases (2
had optic atrophy). Of the 14 cases with a history of ambly¬
opia, 9 were found to have optic’atrophy, 2 ? atrophy, 3 normal
discs. In the case already mentioned of sudden complete
temporary amblyopia, first of one eye and then of the other, the
discs were found to be normal In 7 cases with optic atrophy
there was no history of failing vision. In my total series of
110 cases, optic atrophy was noted in 62, ie. 47*27 per cent
Buzzard found it in 43 per cent, Uhthoff in 52 per cent, Byrom
Bramwell in 33*5 per cent. The slightly greater frequency of
optic atrophy in my cases seen at an early stage (53*3 per cent.)
compared with that found in the total series of 110 cases (47*27
per cent.) is probably a mere coincidence. It may, however,
suggest the relatively early incidence of this oondition in dis¬
seminated sclerosis.

External ocular paresis occurred in 5 cases, and there was a
history of transient squint in other two cases.

Objective sensory defect, generally patchy and not amount¬
ing to complete loss, was noted on the legs, especially on the
feet, in 14 cases. In the great majority of cases the loss of pain
sense predominated; it was noted in 12 cases (sense of touch
affected in 5, sense of temperature in 5, sense of passive move¬
ment in 4 cases). In the total series of 110 cases, objective
sensory defect was noted in 47 (i.e. 42*7 per cent.), the legs
being affected in 44, and arms, often very slightly, in 18.

The epigastric and abdominal reflexes were absent in 8,
sluggish in 4, normal in 1, and active in 2 cases; thus 12 of 15
cases, seen at an early stage, showed absence or diminution of
these reflexes. This gives some support to Mtiller's contention
that the loss of the abdominal reflexes is of diagnostic value.

Sphincter troubles and paraesthesise have already been re-

606

ORIGINAL ARTICLES

ferred to. The record of parses thesiae at the date of examination
is incomplete. Among 12 of the most recent and most care¬
fully recorded cases, paraesthesise are noted as present in 11.

The four objective signs specially noted, in addition to
spastic paraplegia, were optic atrophy, sensory defect, unsteady
gait, sphincter troubles. Analysing the 30 cases from the point
of view of the frequency with which one or more of these signs
occurred, we find:—

Spastic paraplegia alone, 1 case.

Spastic paraplegia and one sign, 11 cases (optic atrophy 2,
unsteady gait 4, sensory loss 5).

Spastic paraplegia and two signs, 8.

Spastic paraplegia and three signs, 7.

Spastic paraplegia and all four signs, 3.

The most frequent combinations of two signs were: optic
atrophy and unsteady gait (10 cases), sensory defect and un¬
steady gait (10 cases), optic atrophy and sensory defect (9 cases,
in 2 other cases 1 optic atrophy).

A certain diagnosis of disseminated sclerosis, especially in
the earlier stages, is often difficult or even impossible. One may
doubt whether the present position of our knowledge warrants
the statements of a recent writer (E. W. Taylor, Joum. Nero, and
Ment. Dis. t June 1906) that, since Charcot’s time, “we have
learned that dependence on scanning speech, nystagmus, and
so-called intention tremor is fallacious in the extreme,” and that
Sach’s opinion that the diagnosis of multiple sclerosis should be
made only if the cardinal symptoms are present is “ evidently an
erroneous standpoint.” All will, however, agree with Taylor’s
final words on diagnosis : “ we should continue to lay stress upon
so-called cardinal symptoms, but more upon others almost equally
important but far less conspicuous.” The nature and relative
frequency of some of these subordinate signs in a series of early
cases are shown in the analysis given above. Even in the
absence of all the cardinal symptoms, the diagnosis of dis¬
seminated sclerosis should be entertained as probable, perhaps the
most probable, in a case of spastic paraplegia which exhibits one
or more of these subordinate signs—notably primary optic
atrophy, unsteady gait, sensory defect—and which gives a history
of certain symptoms (paraesthesise, sphincter trouble, amblyopia,

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ORIGINAL ARTICLES

607

diplopia, vertigo), and of variability or remission of one or more
symptoms.

The chief details of the individual cases are given in the
accompanying table.

Remarks .—It will be noted that of the 30 cases, 20 were
females and 10 males; in the total series of 110 cases, however,
59 were males and 51 females.

The age at onset and interval from onset being determined
from the histories, i.e. from the statements of patients, must be
uncertain in many cases, and may be estimated differently by
different observers. As stated in the table, the onset was
between the ages of 19 and 35 (inclusive) in 24 cases—16 cases
between 19 and 27, 8 cases between 30 and 35—below 19
years in 2 cases (15 and 16 years), over 35 years in 4 cases
(37, 42, 42, and 43 years).

Some of the cases, in which the interval from onset is stated
to have been many years, call for special note, in view of possible
error on my part in interpretation of the early symptoms.

Case 1. Twelve years before date of examination, gradual
left-sided hemiparesis occurred, with complete recovery ; “ shortly
after,” diplopia and squint—also quite temporary ; one year later,
gradual right-sided hemiparesis appeared, which also was
transitory ; six years before examination, legs got gradually weak
and stiff and varied greatly, but never completely recovered.

Case 2. Twelve years before examination, gradual paraplegia
occurred, which disappeared entirely and was diagnosed as
functional; there was no other symptom until 1J years before
examination, when the legs got gradually weak and stiff again
and did not recover.

Case 5. Eighteen years before examination there was partial
loss of eight, which completely disappeared; 3 years later,
temporary paresthesia; no other symptom until 8 years before
examination, when legs became weak and numb.

Case 7. During 30 years before examination there were six
or eight attacks of great weakness, stiffness and numbness of legs
and of arms to less extent; no attack lasted longer than a month;
there was complete recovery in intervals until 6 years before
examination.

Case 10. Twelve years before examination there was gradual
weakness, stiffness, etc., of legs, with incontinence of urine ;

C08

ORIGINAL ARTICLES

patient was bedridden for a year; then gradual complete recovery
occurred; later, two slighter attacks of the same character.

Case 19. Twenty years before examination, temporary right¬
sided hemiparesis occurred, lasting 10 weeks and followed by
temporary attacks of weakness of right leg; 4 years later, similar
right-sided hemiparesis with partial loss of vision—also quite
transient; no other symptom till five years before examination,
when gradual weakness, etc., of legs began and did not disappear.

Case 23. Thirty years before examination, sudden temporary
numbness of one half of body occurred, and many similar attacks
followed; 19 years before examination, weakness and numbness
of legs began and never entirely disappeared.

When all due allowance is made for error in estimating the
exact date of onset of such cases, the duration of symptoms in
some of these, taken in conjunction with evidence of later
progression of the disease—as shown inter alia by the appearance
of cardinal signs—must make one hesitate to speak of recovery
from disseminated sclerosis.

PRECOCIOUS PARALYSIS OF THE PALATE IN

DIPHTHERIA

By J. D. ROLLESTON, M.A., M.D. Oxon.,

Assistant Medical Officer at the Grove Fever Hospital of the Metropolitan

Asylums Board.

Since first diphtheritic paralysis was systematically studied, the
occurrence of palatal palsy at an early stage of the disease has
been well known. Trousseau and Las&gue, and many subsequent
writers of the pre-antitoxin era, such as Sann6, Squire, Morell
Mackenzie, and Henoch have recorded illustrative cases. Until
within recent years, however, no mention is to be found of the
significance of the early affection. Some writers, indeed, such as
Ruault, Sevestre, and Martin regard the paralyses that develop
early as the benign forms, in that they show a tendency to be
localised, unlike the late forms which tend to become generalised.
An exactly opposite view is held by Baginsky and Romberg in
Germany, and in France by Yariot, Marfan, Deguy, Berthelot,

ORIGINAL ARTICLES

609

Petit, and Babonneix. These authorities hold that precocious
paralysis of the palate is a mark of malignancy. The present
writer has recently reported some cases that illustrate the truth
of this view. The following remarks are based on observations
made on 1000 consecutive cases of diphtheria that have been
under the present writer’s care at the Grove Fever Hospital
during the oourse of the last four years.

Paralysis of the palate occurred in 162 cases (16*2 per cent.).
The average date of occurrence was towards the end of the third
week (18*3 day among 162 cases).

The term “ early " or “ precocious ” has therefore been applied
to such palsies as developed before the beginning of the third
week. Fifty such cases among the 162 were so termed, the
dates at which they were first observed being as follows:—

Table I. Showing Date of Occurrence of Precocious Palatal Palsy.

5th ‘day

of disease,

2 cases.

6th

3 „

7th

»l

6 „

8th

7 „

9th

7 ,,

10th

5 „

11th

))

7 „

12th

3 n

13 th

6 „

14 th

4 „

The relation of the onset of the paralysis to the subsidence
of acute symptoms is shown in the following table:—

Table II.

Cases.

Palatal palsy noted 3 days before the throat became clean, 4

II II ** » II »

W »» I >» It ,1

„ ,, same day as „ „

Death before disappearance of membrane,

Palatal palsy noted after throat became clean,

Thus in 12 cases the palatal palsy developed before the
throat became clean, in 10 the two events took place on the
same day, in 3 death occurred before the membrane disappeared,

610

ORIGINAL ARTICLES

and in the remaining 25 the palsy arose after the throat had
become clean. Most of the cases presented after the membrane
had left the throat an extensive superficial necrosis of the
epithelium of the tonsils, palate, and uvula, manifested by an
opaque appearance of the mucous membrane which sometimes
took three weeks or more to be completely regenerated. As will
be seen from the following figures, the incidence of precocious
palatal palsy is higher in childhood than in adult life:—

Table III .

Ages.

Cases of Precocious
Palatal Palsy.

Percentage.

0- 5 years

4-5

5-10 „

5-9

10-15 „

4*4

15-20 „

307

20-30 „

This corresponds with

the incidence

of post-diphtheritic

paralysis at the various ages,

as is shown by Table IV.

Table IV. Ages of 238 Paralysis Cases among 1000 Cases of

Diphtheria.

Ages.

Gases.

Percentage.

0- 5 years

26-5

5-10 „

119

26*2

10-15 „

17*9

15-50 „

4*7

No case of precocious palatal palsy was met with above the
age of twenty-nine, though sixteen of the 1000 patients were
above that age, 7 of whom had severe, 4 moderate, and 5 mild
faucial attacks.

The two sexes were almost equally affected, 22 being males
(4 6 per cent.) and 28 females (5*3 per cent.). How frequent
an associate early palatal palsy was of the severe forms is illus¬
trated by the fact that of the 50 early cases 20 died, while
among the remaining 112 cases of non-precocious palatal palsy
there was only one death, due to diaphragmatic paralysis, on the
52 nd day.

The mortality of the total 1000 cases was only 78, or 7 8
per cent.

OKIGINAL ARTICLES

611

The relation of the frequency of precocious palatal paralysis
to the character of the initial faucial attack is shown in the
following table:—

Table V. Showing relation of Precocious Palatal Paralysis to
Character of Initial Attack.

Very severe faucial
Severe faucial
Moderately severe faucial
Moderate faucial .

29 cases = 29'2%
17 cases - 8-8%
1 case - 1-1%
1 case = 0-3%

From this it will be seen that though more frequently found
in the severest cases, precocious palatal palsy occasionally follows
an angina of only moderate intensity. Berthelot’s experience
was similar. Four of his twelve cases were of moderate intensity,
the remaining eight were severe forms. Petit and Deguy, on
the other hand, regard precocious palatal palsy as the exclusive
appanage of severe forms. The severity of the attacks might be
attributed in the majority of cases to neglect of antitoxin treat¬
ment during the first few days of the disease ; in a smaller
number of cases the disease was precociously malignant. The
truth of this statement is borne out by the following table,
which shows that the majority of cases were admitted in the
second half of the first week. Only one of the fifty cases had
received antitoxin before admission to hospital. This was a
child who, after having had small doses of antitoxin at home
on the fifth and sixth days of disease, was admitted to hospital
on the seventh day and died on the eleventh day.

Tabic V. Showing the Days of Disease on Admission

to Hospital.

1st day
2nd „
3rd „
4th „

5 th „

6 th „
7th „
8th „

11th „

0 cases
7 „
10 „
10 „
14 „

1 „

612

ORIGINAL ARTICLES

That the concomitant symptoms were severe is shown by the
following facts. Fatal cardiac paralysis occurred in 19 esses,
the signs of which first developed within a few days of the
palatal affection. One case died of diaphragmatic paralysis on
the fortieth day. Fourteen were haemorrhagic cases, i.e. pre¬
sented purpuric spots, with or without haemorrhages from the
mucosae. Eleven of these were fatal In all but one of the
cases albuminuria was present In 9 it persisted for three
weeks or more. All but 6, or 80 per cent, of the survivors
developed other paralyses, which are classified as follows:
generalised paralysis, 8 cases; ocular paralysis, 14 cases;
labial paralysis, 2 cases. The incidence of further paralysis
among the non-precocious forms of palatal palsy was mnch less.
Sixty-two cases (53 5 per cent.) occurred, only one of which, as
already stated, was fatal.

Among the survivors, cardiac disturbance of some kind
occurred in 14 cases. In 4 it was severe, and was associated
with vomiting. Enlargement of the liver, a very grave sign,
was present in 26 of the 50 cases. Seventeen of the 26 were
fatal.

All the cases received antitoxin, but in spite of the massive
doses which were injected the sequel© were, as a rule, less
marked than in milder cases in accordance with the law
enunciated by the author that the frequency and intensity of
serum phenomena are in direct relation to the size of the dose
and in inverse relation to the character of the diphtherial attack.
Babinski’s sign, which Kiroff has recently noted in malignant
diphtheria, was present in 5, or 51 per cent., out of 9 cases in
which it was sought for. It is noteworthy that, as in KirofTs
cases, the extensor response co-existed with sluggish or absent
knee-jerks. Among the thirty survivors, the duration of the
paralysis considerably exceeded the average, being 43'3 days, as
compared with 24’8 days, which was the average duration of the
palsy in the 112 cases. In 3 cases the palatal palsy was short¬
lived, the duration in each case being six, seven, and eight days
respectively. No other paralyses subsequently occurred in these
cases.

In the majority of cases the paralysis, as is the rule in
diphtheria, was incomplete, and was manifested only by a change
in the voice. Regurgitation seldom occurred at a very early

ORIGINAL ARTICLES

613

stage, except in young children. Inspection of the fauces
showed that the motility of the velum was only slightly im*
paired on phonation. In a few cases the palsy was unilateral,
when it was subsequent to an angina that had been unilateral or
predominant on that side. 1

Diagnosis.

During the first fortnight of the disease, especially during
the second week, the sound of the voice should be tested daily
in all severe cases. The preservation of a clear voice will be
found to coincide with a normal heart, an aheenoe of liver
enlargement, and a good general condition; while a nasal twang
shortly precedes or accompanies the signs of cardiac involvement
and the apathy or restlessness usually associated with it. It is
sometimes difficult to distinguish a nasal intonation from the
thick character of the voice due to faueial cedema and abundant
membrane. As a rule, however, a nasal voice does not develop
till the oedema has subsided.

When regurgitation occurs early in diphtheria it must be
distinguished from that due to mechanical obstruction produced
by hyperaemia and faucial oedema, such as may occur in any
form of sore throat. In diphtheria, though the membrane may
still be present, the oedema has usually subsided by the time
that regurgitation occurs.

Pathology.

Maingault, the writer of the first monograph on diphtheritic
paralysis, attributed the paralysis to a modification of nutrition
of the palate under the influence of inflammation, and compared
the paralysis of the palate to the similar phenomena that follow
inflammation of the bladder and intestines. It was soon pointed
out, however, that local inflammation did not account for cases
of paralysis occurring where there had been no initial angina,
nor for the paralysis attacking other parts than those which had
been the site of membrane, e.g. the eyes. A purely local cause
was therefore set aside in favour of systemic intoxication by
Trousseau. The histological investigations of Charcot and
Vulpian in 1862 in a fatal case of palatal paralysis showed

1 Similar cases were reported by Gubler in 1801, by Gee in 1884, and more
recently by Anbertin and Babonneix.

C14

ORIGINAL ARTICLES

that the motor nerves alone were affected. Later observers,
such as Oertel and Leyden, pointed out that other tissues besides
the nerves were involved. Hochhaus, by his histological ex¬
amination, proved that the morbid anatomy of paralysis of the
palate was mainly an interstitial myositis. This view was
adopted by Baginsky and Romberg, who distinguish early
paralyses (Friihlahmungen) from post-diphtherial palsies. The
former, according to them, arise from disease of the musculature,
which in many ways is analogous to the change in the heart.
Post-diphtheritic paralysis, on the other hand, depends on a
degenerative change in the peripheral nerves, with occasional
affection of the anterior cornual cells. The most elaborate
histological researches yet published on the paralysis of the
palate in diphtheria are those by Deguy, after researches carried
on in Marfan’s laboratory at the Hopital des enfants malades.

Sections of the palate from cases that had died with early
paralysis showed very marked inflammatory lesions. The
presence of a large number of diplococci, both in the leucocytes
and in the thrombosed capillaries of the part, made Deguy
regard the condition as a diplococcsemia superadded to diph¬
theritic intoxication.

From this brief survey it will be seen that recent authorities
agree with the early writers in regarding the affection of the
palate as due to a local change. The extensive superficial
necrosis of the fauces accounts for the unusually long duration
of the paralysis, owing to the long time that elapsed before the
tissues are completely regenerated. A further proof of the
influence of the local inflammation in determining the palsy is
furnished by the fact that ocular paralysis in diphtheria is never
precocious. In the present series of cases it never started before
the beginning of the fourth week, and sometimes was not noted
till the sixth week, although the vision had been tested carefully
at frequent intervals until then.

Summary.

1. Precocious palatal palsy in diphtheria is almost invariably
associated with malignant forms, as is shown by the high
mortality, the association of other grave symptoms during the
acute stage, and subsequent more frequent development of
paralysis in convalescence in the cases in which it occurs.

ORIGINAL ARTICLES

615

2. It resembles the ordinary forms of diphtheritic palsy in its
tendency to be frequently incomplete, and by its higher incidence
among young persons.

3. It is, as a rule, of much longer duration than the palatal
affection which occurs at a later date.

References.

1. Aubertin. Arch. gdn. de med., tev. 10, 1903.

2. Aubertin et Babonneix. Gaz. da H6p., 1902, p. 1285.

3. Babonneix. Nouvelles recherchea sur les paralysies dipht4riques,”
Thise de Parte , 1904.

4. Baginsky. “ Diphtherie und diphtheritischer Croup,” 1898.

5. Berthelot. "De la gravity des paralysies dipht4riques pr4coces,”
Thise de Paris, 1904.

6. Deguy. Rev. mens, da mal de Fenf., juin 1903.

7. Gee. Med. Tima and Gaz., 1864, p. 148.

8. Grancher, Boulloche, and Babonneix in Brouardel and Gilbert’s “ Traits
de m4d., 2nd ed., 1905, art. “ Diphterie.”

9. Gubler. Gaz. mdd. de Paris, 1861, p. 704.

10. Henoch. “Lectures on Children’s Diseases,” New Syd. Soc., 1889,
vol. ii. p. 306.

11. Hochhaus. Virchovfs Archiv, Bd. 124, S. 226, 1891.

12. Kiroff. Rev. Neurol., Nov. 30,1905 ; Abstract in Review of Neurology,
Feb. 1906, p. 151.

13. Mackenzie. “ Diphtheria,” 1879.

14. Maingault. “ De la paralysie du voile du palais k la suite d’angine,”
These de Paris, 1854.

15. Marfan. Bull, et Mem. de la Soc. mdd. da H6j>. de Paris, July 11, 1902 ;
and “ Le 9 ons cliniques sur la diphterie,” 1905.

16. Moynier. “ Compte rendu des faits de diphtheric dans le service de
Trousseau,” 1859.

17. Petit. Rev. mens, da mal de Fenf., iky. 1897.

18. Rolleston, J. D. Practitioner, Nov. and Dec. 1904; Ibid., May 1905 ;
M.A.B. Annual Reports, 1904 ; Review of Neurology, Nov. 1905.

19. Romberg. " Lehrbuch der inneren Med.,” 1906, art. " Diphtherie.”

20. Ruault in " Traite de Med.,” par Charcot, Bouchard, et Brisaaud,
art “Diphterie.”

21. Sanne. " Diphterie,” 1877.

22. Sevestre et Martin in Comby’s "Mal de l’enf.,” tom. 1, 1904, art
“ Diphterie.”

23. Squire in Reynold’s " System,” vol. i, 1866, art. " Diphtheria.”

24. Trousseau. Union mddicale, 1851, p. 471; Gaz. da H6p., 1860, Nos. 1
and 5 ; Clinique mdd., 1st ed., 1861.

25. Variot " La diphterie et la serumtherapie,” 1898.

616

ORIGINAL ARTICLES

THE PATHOLOGY OF GENERAL PARALYSIS.

By Dr HANS EVENSEN,

Medical Superintendent of Trondbjem Lunatic and Criminal Asylom
(Lecture delivered before the University of Christiania.)

Pabt II.

I have dwelt 80 long upon the conditions of the vessels,
especially of the cortical vessels, because they are conclusive
with regard to the anatomical diagnosis of general paralysis,
and upon those of the larger vessels, because they are veiy
frequently somewhat neglected by writers on the subject. I now
return to the lesions of the cerebral cortex.

The neuroglia

has increased much in general paralysis, and this increase will
generally, though not necessarily, keep pace with the destruction
of the nervous tissue. By neuroglia is here always meant all
non-nervous tissue in the cortex outside the vessels. The
biological limit between the tissue of mesoblastic and that of
epiblastic origin is constituted by adventitia, according to
Degenkolb, by the vascular neuroglial net according to Held,
so that all tissue lying outside the adventitia is originated from,
the epiblast. According to the theory of Ford Robertson, a
certain number of elements described by others as the
“ neuroglia ” have developed from the mesoblast, and have their
own special function (“ mesoglia,” as opposed to “ neuroglia ”).

On the cortical surface will be seen a denser felting, mainly
of coarse glial fibres, which may even penetrate into the pia
mater. The filaments do not assume the direction of the
original fibres in such a perfect manner as they do in typical
cases of epilepsy (Alzheimer), and the breadth of the felting
is more variable {Figs. 6-8). The glia fibres 1 may be traced
downwards through the whole of the cortex. Especially along
the vessels they may attain a considerable thickness. Even

1 For daily work the methyl-violet method of Ford Robertson is very well
adapted for staining glia in formalin-hardened preparations. Alcohol should not
be used, as it is apt to destroy the finest fibres.

ORIGINAL ARTICLES

617

in the white matter, plexuses of densely interwoven fibres may
be found.

Corresponding to this rich new formation of glial fibres,
numerous retrogressively altered nuclei will be found in the
outermost layer, recognisable by their shrunken form and deep
staining in Nissl preparations; as a rule, much yellow pigment
adheres to them. The most conspicuous objects in the outer¬
most layer are the large spider cells, with their large pale nuclei,
their distinctly stained and sometimes swollen cell body, and
their numerous prolongations (Fig. 4). They may also be found
in rows along the vessels, and it is now generally admitted that
the protoplasmic processes are in part attached to the vessel
wall by means of conical expansions. One side at least of the
prolongation and the cone is often limited by a coarse glial
fibre, which finally disappears in the glial network round the
vessel, or ends in a fan-shaped termination. Through the whole
cortex there will be seen many unusually large pale glial nuclei,
with one or often several comparatively large nucleoli and a
faintly perceptible protoplasm. Some of the glial cells are mere
monsters, and the cell-body may exhibit the most curious forms,
often resembling indistinctly limited areas, containing several
nuclei (Nissl’s “ Gliarasen ”). Karyokinetic figures will be found
comparatively rarely.

This proliferation of neuroglia seems to take place chiefly
where the morbid processes are going on afresh, either in cases
in which the disease is steadily progressive, or in those in which
there are acute exacerbations during a chronic course ; it will
frequently be absent in slowly progressive cases. Spider cells
have also been found, however, in paralytics who died during
a remission.

The large pale (hyperplastic) nuclei will also be found in
the white matter; besides these there are here many small dark
nuclei resulting from the differentiation of the protoplasma into
glial fibres.

According to the researches made by Raecke, the prolifera¬
tion of glia in the cerebellum occurs chiefly in the molecular
layer—corresponding to the destruction of Purkinje’s cells—
also, but far less diffusely, in the granular layer, and least of all
in the medullary layer.

In 1899 (see reference 51, p. 656), Nissl described as belong-

2 s

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ing to the neuroglia some exceedingly long and narrow nuclei,
occasionally slightly curved, which on a cursory view might
be taken for proliferating endothelial nuolei, the more so as they
generally lie near the vessels. Sometimes the pale nucleus, with
a row of small nucleoli, will alone be seen ; but generally the
cell-body may be perceived jutting out at the poles of the
nucleus; occasionally it will exhibit ramifications (Fig. 10).
These “staff cells'" ( Stdbchemellen ), as Nissl now calls them, are
considered of some importance in the diagnosis of general
paralysis, as they will not be found so profusely in any other
insanity. It is not improbable that these cells for the greater
part are the same as the “ staff-shaped ” nuclei described by
some earlier authors. In 1895, Harald Holm, a Norwegian,
drew attention to the occurrence of these nuclei in masses in
general paralysis (reference, p. 210). Whether they are really
of neuroglial nature is perhaps doubtful. They will often be
found close to the adventitia of the capillaries, and sometimes
they may convey the impression of having something to do
with the development of new capillaries.

The granulations of the ependyma were formerly considered
to be due to a hyperplasia of the surface epithelium. Since
a proper method of staining glia was introduced by Weigert,
they have been found to be caused by proliferation of the
subjacent glial tissue, accompanied by a differentiation of
numerous fibres. The ependyma itself is not thickened, and in
the sections it will often be lost on the tops of the prominences.

As a manifestation of the morbid process in general paralysis
the hyperplasia of glia is generally admitted to be of a secondary
nature. But still, everything is not said in the statement that
owing to the degeneration of nervous tissue, nerve cells, and
medullated fibres, there is nothing left to keep the glia in check.
The fact is that this degeneration is not always followed by
proliferation of glia.

Nerve cells.

With regard to the changes that affect the nerve cells in
general paralysis, most authors, as if of one accord, do not deal
with them minutely, pleading partly that the question is a very
difficult one, partly that as yet no cell disease typical of general

ORIGINAL ARTICLES

619

paralysis has been found. It is no longer believed that the
nerve cells react with a distinct anatomical change to each of
the different kinds of noxious agents, which may disturb the
equilibrium of its metabolism. There is no lack of variety
in the reactions. Indeed, it would be a Sisyphean task to
classify the changes into small groups (E. Meyer). Nissl has
provisionally described eight different cell diseases, each of
which may combine with one of the others; but even this
grouping is not sufficient for all cases. To judge from the
existing literature, however, the clue that leads to the recogni¬
tion of these diseases still seems to remain in the Heidelberg
laboratory. The ideas one could obtain from Nissl’s description
of them gave little more than the impression that the whole
matter was exceedingly intricate. The common reluctance to
grapple with the changes of the nerve cells still persisted.
Since Nissl brought forward his equivalent theory, and since
the artefacts produced by hardening as well as the post-mortem
changes could be accurately recognised, it has no longer been
possible to dismiss the question by saying that the image of the
nerve cell in Nissl’s preparations was an artificial one. It was
then urged that the method was too subtle ; it showed changes
even where no insanity was present. Many pathologists, there¬
fore, still did not make use of Nissl’s staining, but kept to
the old methods, which scarcely showed any result, and still
called all the changes degenerations, which explained nothing.
Others confined themselves to the examination of the large
pyramidal cells, the conditions of which were least complicated,
but which frequently, especially in general paralysis, were not
altered at all. Among the changes here they dealt only with
the chromatolysis, commencing at the centre, which scarcely
made one any wiser. So it was a great relief when the neuro¬
fibrils were found, and attention was diverted from the stainable
protoplasmic portion seen in the tedious Nissl preparation.

But still, the neuro-fibril methods are not very well adapted
for use in anatomo-pathological examinations, and at present the
question of changes in the nerve cells in the Nissl preparation
cannot be evaded. Were it merely for facilitating mutual
understanding it would be of great importance if all could agree
with regard to some definite types of disease. In the following
I refer to those types which Nissl has described.

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In general paralysis the nerve cells are generally very much
changed throughout the cortex, but not to the same extent in
the different gyri, or in the different layers. Sometimes not
a single cell will be found which has not been injured; in other
cases the changes are slight Most frequently the lamination of
the cortex has been preserved ; but the very fact that the
morbid process has disturbed the arrangement of the cells
suggests general paralysis (Nissl).

One of the most common cell diseases, and one that may
most easily be recognised, is chronic alteration 1 (cell sclerosis).
The cell shrinks and becomes darker, and at the same time the
axis-cylinder process and the normally unstainable tracts take on
the staining. The dendrites will be stained to a great extent;
they become narrower and contorted. The contours of the cell
have sharp edges. The nucleus becomes smaller, lengthened, and
angular ; the nuclear contents are so deeply stained that at last
the nucleus cannot be distinguished from the rest of the cell.

Another alteration of the nerve cells which is easily recog¬
nised is the severe form of cell disease. Here the cell becomes
faded, generally from the centre outwards. The cell-body
becomes liquified. What is left of the stainable substance
forms small circles, which are only slightly stained. The nucleus
becomes small and globular ; the nuclear contents are uniformly
stained; the nucleolus becomes small and is removed towards
the wall. The nuclear membrane and the axone show longest
resistance.

Acvle cell disease is not unfrequently met with. Its peculiar
feature is that it attacks all the cells of the cortex simultaneously.
The cell swells and becomes paler. The details are somewhat
effaced, as the neuro-fibril tracts take on staining, and the
chromatin bodies moulder. The prolongations of the proto¬
plasm break down; the axone only shows strong staining.
Later on the cell-body undergoes vacuolation. Even the nucleus
is swollen; it moves closer to the margin of the cell, sometimes
even beyond it; the nuclear contents do not take on staining, so
that the nuclear network and the nucleolus stand out very
clearly.

Of all cell diseases met with in general paralysis, these three

1 There is no connection between acute and chronic cell disease and the acute or
chronic course of general paralysis.

ORIGINAL ARTICLES

621

most frequently occur in a pure form as far as I have seen.
The granular decay and the cell shrinking (Zcllenschumnd) seem
to be less common. But there is scarcely one of Nisei's eight
cell diseases which will not occasionally be found.

The different cell diseases will often be found simultaneously
in the cortex, or even combined in the same cell. Thus an
acute cell disease may occur in a chronically changed cell, so
that the swollen nucleus does not appear round, and the diffusely-
stained cell-body does not look quite pale, etc. Or a chronic and
a severe cell disease may be combined. The combined forms are
perhaps more frequent than the pure types, and they are often
very difficult to distinguish. Further, the same cell disease may
show a different appearance according to the stage of its develop¬
ment. Taking all this into consideration, one cannot but admit
that the examination of nerve cells is a somewhat thankless
task.

It is not easy to form any definite opinion as to which con¬
volutions and which cell layers are most frequently attacked by
these cell diseases. For that purpose a long series of carefully
examined cases is required.

In cases of general paralysis which have lasted for several
years, terminal stages of cell diseases and different forms of cell
destruction will chiefly be found. The cells liquify, are de¬
molished by vacuolation, or destroyed by glial cells, and finally
disappear. Some remnants of the cells may remain, and here
calcareous deposits will appear. These are not stained in the
Nissl preparations. There may also be seen some peculiar
incrustations, which stand out bluish-black in colour. Ultimately
the cell remnants will break down into debris, or there will only
be left a shadow of the cell, which retains its original shape
(ghost cells).

In the cortex, areas may be seen in which scarcely any nerve-
cells are left, and if the decay is irregular the mutual arrange¬
ment of the cells will be disturbed, as has already been mentioned.
The spreading of the non-nervous tissue wherever the nervous
tissue is destroyed will also help to disturb the cellular arrange¬
ment. The rows of cells will not only become more open, but
they will be interrupted. In other insanities where a considerable
decay of nerve cells occurs, the normal order of the cells, with
their tips towards the surface of the convolutions, has been

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preserved, even if the rows have become less crowded. Some¬
thing like this may be seen only in serious forms of arterio¬
sclerosis, as far as I know. Weber, however, relates that he has
seen the same condition in epileptic insanity.

In some places it is chiefly the intercellular fibrillar sub¬
stance, the grey reticulum (“ the nervous grey,” Nissl) which has
been destroyed, so that the cells stand close up to each other.
At first sight it therefore looks as if the cells in the cortex had
increased in number.

The same changes of nerve cells as in the cortex will be found
in the nuclei of the medulla oblongata.

Since Exner’s (1881), and especially since Tuczek’s (1884
researches, we have known that large numbers of

Medullated nerve fibres

are destroyed in general paralysis. In consequence of the total
decay of nervous tissue in slowly progressing cases the cortex
has, in general, shrunk and become narrower.

The disintegration of medullated fibres begins with the tan¬
gential fibres of the surface, which may, however, in some cases
be preserved. It will decrease gradually from the surface of the
cortex towards the white matter. The fibres will be destroyd
in greatest number in the pyramidal cell layer, then in the layer
of the granules (Baillarger’s bundle); but the interradial net¬
work also will become more sparse (Kaes, Mott). Frequently
the myeline sheath only has disappeared, so that the axis-cylinder
is almost bare (Kaes). The waste of fibres is most extensive in
those gyri, which, on the whole, are chiefly attacked; it is almost
always considerable, even in the islands of Reil, and may be
traced in all parts of the brain. The decay will very seldom be
confined to small spots (Siemerling, in the work of Cramer, Bin-
swanger). While all the destruction of medullated sheaths which
is in full activity may be recognised with some accuracy by
Marchi’s method, 1 it is rather difficult to decide in a completed
process whether, if there is no considerable loss, any fibres have
been lost or not. On the one hand the distribution of tangential
fibres is unequal, and their quantity varies with the individual;

1 With regard to the fallaciousness of this method see Nissl (in “ Encyklopadie
der mikroskopischen Technik,” p. 982) and Spielmeyer (“Die Fehlerqnellen der
Marchi’schen Methods,” CtntralblaU. filr Nerv. u. Psych., 1904, p. 757).

ORIGINAL ARTICLES

623

on the other, the method (Weigert’s, bat still more Pal’s modi¬
fications of the same) is not at all mathematically exact. 1 Exner’s
method is, no doubt, more reliable, hut it is “ not suitable for
general use ” (Weigert).

In certain conducting tracts, even in their course into the
spinal cord, secondary destruction of fibres will occur as a con¬
sequence of the focal lesions. As a rule these focal lesions are
not very well marked in general paralysis, as they are due to a
more delicate lesion of the cortex, and they will soon disappear,
unless that part of the cortex is completely destroyed (Lissauer).
It is a well-known fact that the focal lesion, indicated by the
clinical symptoms, may be looked for in vain in the post-mortem
examination. The gross circumscribed lesions, such as haemorrhages
and softenings, exhibit nothing characteristic of general paralysis.

Part III.

Anatomical differential diagnosis.

The tissue-changes of the cerebral cortex, which have now
been described, have all one feature in common: they occur
diffusely, although they may attack certain localities in particular.
The hyperplasia of neuroglia, and for the greater part the de¬
struction of medullated fibres, are the consequences of the
changes of nerve cells; these have most likely been directly
injured by the pathogenic agent, but the changes in themselves
are not characteristic of general paralysis. The only diffuse
anatomical sign which to a certain degree in itself characterises
the process as due to general paralysis, is the infiltration by
plasma cells of the adventitial lymph spaces. It does not seem
very probable, however, that the vascular change is the primary
lesion in the morbid process, as many authors have maintained
(Magnan, L. W. Weber, Koppen, Tschisch, Nageotte, Angiolella,
and others), nor that this change is the source of the alterations
in the nervous tissue. The vessels as well as the nerve cells,
perhaps to some extent even the medullated fibres, may probably
all be directly affected by the toxic agent.

As far as we know at present, the dense aggregation of

1 The preparation is not always evenly penetrated by chrome , or it will be too
far differentiated ; in formalin-hardened preparations the after-hardening in alcohol
has a deleterious effect upon many fibres.

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plasma cells in the lymph space must be considered as a
peculiar inflammatory condition , and in general paralysis this, I
repeat, is diffuse. This is very important with regard to the
anatomical differential diagnosis of general paralysis. The con¬
sequence of this is simply that Klippel’s merely “ degenerative
paralysis ” (which partly is identical with what others call pseudo¬
paralysis), and Binswanger’s transitional forms without inflamma¬
tions, do not belong to general paralysis. It is this sign also
which makes it possible microscopically to distinguish general
paralysis from similar changes in arterio-sclerotic insanity, chronic
alcoholism and epilepsy, and from non-inflammatory forms of
cerebral syphilis, where there are widespread changes without
adventitial infiltrations (Alzheimer, Nissl).

Consequently the opinion can no longer be upheld that the
capillary lesions are alike in both general paralysis and in senile
insanities , and that there are forms of senile dementia which
cannot be anatomically distinguished from general paralysis.
If there is a widespread infiltration by plasma cells, the disease
is a senile paralysis. It is unnecessary here to point out
other distinctive features. According to Alzheimer, senile
paralysis holds a special position, as the inconsiderable pro¬
liferation of neuroglia in this disease is not in proportion to
the extensive decay of nervous tissue. Clinically also there is
some difference from the ordinary general paralysis, as dementia
—not paralytic symptoms—is the most prominent feature of
senile general paralysis.

The insanities in drunkards are often simply called alcoholic.
This is so even in cases in which the clinical symptoms afford
evidence of general paralysis, but in which the usual gross
meningeal changes have not been revealed by autopsy. Several
cases which came under my observation labelled chronic
alcoholism turned out, under microscopical examination, to
be general paralysis. The diagnostic difficulties have induced
several authors to establish an alcoholic paralysis as an inter¬
mediate form. In a previous paper (p. 61) I stated that after
some time the disease will manifest itself either as general
paralysis or as an alcoholic insanity (pseudo-paralysis). I
added, however, that if death occurred before the diagnosis
could be clinically determined, even autopsy could not always
settle the question. This problem, which pathological anatomy

ORIGINAL ARTICLES

625

could not solve at that time (1899), it has now been able to
work out. In alcoholic insanities no inflammatory infiltration
will be found.

Even epileptic fits occurring in general paralysis, especially
in status epilepticus and confusional states, leading to death
within a short time, will sometimes be clinically taken for
epilepsy, while the microscopical examination will prove it to
be general paralysis.

There are, however, some acute and subacute forms of non-
purulent encephalitis , in which the cell infiltration is no longer
the criterion, and then the question must be settled by the
process as a whole, i.e. affected nerve cells, proliferation of
neuroglia, abundance of staff cells, loss of medullated fibres, and
at the same time infiltration of the vessel sheaths and develop¬
ment of new vessels as described above. Special importance
must be attached to the extent of the process. As far as is
known at present the encephalitis is always a circumscribed
lesion. The same distinction will apply to cases of epilepsy and
idiocy caused by encephalitis (Degenkolb, Nissl). From a
clinical point of view these cases will hardly give rise to con¬
fusion. For the same reason some other conditions, in which
plasma cells occur, need not here be taken into consideration.

It is far more difficult, though not impossible, to distinguish
general paralysis from inflammatory forms of cerebral syphilis
(gummatous meningo-encephalitis). Here the same cell forms
will be found in the infiltration, but the process does not seem
to spread over the whole cortex as in general paralysis; it is
most intense in the immediate surroundings of the specific new
growths or surface inflammations. Some convolutions may be
left quite uninjured. If gummata are found it will perhaps be
most correct to call the disease cerebral syphilis, even if it
differs in no other respect from what is commonly seen in an
ordinary general paralysis. It may be, however, that such a
case, which will seldom be met with, represents a combination
of both diseases. According to my opinion, Heubner’s endar¬
teritis belongs to the antecedent syphilis, and does not prove
that the disease in question is cerebral syphilis and not general
paralysis. Along with the syphilitic meningo-encephalitis the
so-called gummatous surface inflammation will always be found
in the meninges of the spinal cord (Nissl); but it is not certain

626

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that this inflammation may not also be found in general
paralysis.

Our next task will be to discuss the

Etiology

of the inflammatory condition. I shall here confine myself to
mentioning the contributions which up to this time pathologists
have made towards the solution of this problem.

It might seem to be an obvious conclusion that the paralytic
changes were immediate consequences of syphilis. Previous
syphilitic infection will be found as often amongst the ante¬
cedents of general paralysis as of extra-cerebral diseases of
undoubted syphilitic origin. It will almost always be found
in juvenile general paralysis, and the possibility of its existence
cannot be left out of account even in cases in which the history
does not affirm it. That paralytics may as a rare exception
acquire recent syphilis does not disprove a previous infection.
At present such a case will not even be accepted as general
paralysis, unless the diagnosis is verified by microscopical
examination. Further, general paralysis may be combined
with lesions which anatomically present themselves as being
of specific syphilitic origin, and on the other hand syphilis
may bring about changes, the anatomical features of which do
not reveal any specific nature.

Against the theory (maintained by Strumpell, Mobius,
Hirschl, and several others) that general paralysis is a simple
after-effect of syphilis, many arguments have been brought for¬
ward: the differences, clinical as well as anatomical, between
general paralysis and ordinary cerebral syphilis, the negative
results of anti-syphilitic treatment, the steadily progressive
malignant course of the disease, and finally the absence of
general paralysis in several localities in which syphilis is a
common occurrence. At all events the said theory would have
to be altered in so far as it maintains that general paralysis is
quite a special form of syphilis.

It must at least be regarded as highly probable that syphilis
is a necessary condition for the onset of general paralysis, just as
poisoning by alcohol is necessary for the appearance of delirium
tremens. Drinking and head injuries which often supervene
c annot be supposed to have any other effect than to provoke

ORIGINAL ARTICLES

627

or accelerate the outbreak; nor can they—any more than
exhaustion (Binswanger)—account for the anatomical picture
of the disease. The changes in the cerebral cortex indicate that
general paralysis is the outcome of intoxication. But if we
desire to discover what then supervenes on the syphilis, and so
gives rise to general paralysis, we must not confine ourselves to
the examination of the brain and the spinal cord. For general
paralysis is not a disease of the nervous system only, although
here the changes are most obvious. The lesions of the other
organs are no mere consequences of the alterations of the brain
and of the spinal cord. The whole vascular system is affected,
the bactericidal properties of the blood have been lost or
reduced (Idelsohn); its auto-virulence has increased (D’Abundo).
The kidneys are not sound (Angiolella); there will be found
abdominal and intestinal catarrh, and very frequently also fatty
liver. Diminution of bone marrow, fragility of bones, degenera¬
tive changes of the ear cartilage, liability to bed-sores, are all
common symptoms. There may be observed fluctuations in the
state of nutrition and temperature, which cannot be accounted
for by the changes in the casual condition of the patient.
There can, therefore, be no doubt whatever that general paralysis
is a general disease. Kraepelin regards it as a general disease of
metabolism, akin to myxoedema, diabetes, dementia praecox, and
other diseases. According to this author, it may have various
sources, but it develops chiefly on the basis of syphilis, and will
in its turn cause the special paralytic changes of the nervous
system.

On account of the pre-supposition that intoxications are the
common basis of insanities, the Italian as well as the younger
Scotch alienists have instituted bacteriological examinations in
paralysis. Of course no weight can be laid upon occasional
infections in the terminal stage, caused by bed-sores, by cystitis
(D’Abundo), or by pneumonia; nor can any importance be
attached to certain post-mortem discoveries of bacteria ( e.g. the
coli bacillus). Cultures have been taken from the urine (coli
bacilli, Grimaldi), from the blood (streptococci, ibid.), and from
the cerebro-spinal fluid (“ bacillus viscosus,” Montesano and
Montesori). The streptococci were not really taken into con¬
sideration as a cause of the disease; the coli bacillus was
considered somewhat more important. Lewis Bruce observed

628

ORIGINAL ARTICLES

that the blood aerum of paralytics manifested an agglutinative
power on the coli bacillus during remissions of the disease, but
not while the paralysis was active, and from this fact he derived
the conclusion that there might exist a causal connection between
this bacillus and general paralysis. E. Raimann, however, stated
that the reaction of the agglutination was too irregular to permit
of any conclusion being drawn from it; according to his experi¬
ments, normal blood serum has an even greater agglutinative
action on the coli bacillus than that of paralytics.

Lately attention has been drawn to the diphtheria bacillus
by the systematic experiments made by Ford Robertson, assisted
by M‘Rae, Jeffrey, and Shennan. They demonstrate that an
invasion of micro-organisms takes place in the mucous membrane
of the respiratory tracts and the alimentary canal, probably
because there is a general as well as a local weakening of the
normal defences. As the resistive powers are weakened, the
parasites will develop a pathogenic action. Coli bacilli as well
as streptococci may be found; but the micro-organism to which
the principal importance is ascribed is a bacillus which resembles
the Klebs-Loffier diphtheria bacillus in all respects except in its
virulence. It can be cultivated from the respiratory tracts in
living paralytics, but not from the blood; after death, pure
cultures can be obtained from the surface as well as from the
muscular coat of the stomach and of the small intestines, from
mouth, bronchi, and lung tissue, sometimes also from the brain,
but probably only when a general blood infection has taken
place. Chiefly by using a modification of Neisser’s method,
the bacillus may be identified in sections of the catarrhal
exudation from the organs mentioned above, except from the
brain. In the lymphatics of the walls of the same tracts
filamentous organisms have been found, which probably are
the bacilli in some form of involution, perhaps occasioned by
the presence of anti-bodies in the serum. Experiments with
anti-diphtheria serum have had no effect. Guinea-pigs have
proved insusceptible to the bacillus. In rats fed on bouillon
cultures the organism produces a fatal disease with symptoms
from the nervous system ; and the anatomical changes of vessels,
meninges of the brain, and neuroglia, as well as those in the
respiratory and alimentary tracts, “ have a distinct resemblance
to those that occur in general paralysis.”

ORIGINAL ARTICLES

629

Ford Robertson, therefore, goes further than to establish the
regular occurrence of a diphtheroid organism in the respiratory
and alimentary tracts in cases of general paralysis in asylums.
Although a parasitic infection might be very dangerous to a
paralytic individual, this bacillus is not merely a parasite.
According to Robertson, general paralysis is the result of a
chronic toxic infection brought on by the invasion of those
tracts by various bacterial forms ; but it is a Klebs-Loffler bacillus
of modified virulence which mainly gives the disease its special
paralytic character.

While I was working in the laboratory of the Scottish
Asylums for some months of the winter of 1903, I had an
opportunity of observing the pure cultivation of this bacillus.
It must be admitted that the bacillus, stained by Neisser’s
method, showed the typical appearance of the Klebs-Loffler
bacillus. Still I cannot help thinking that for the present it
is perhaps advisable not to insist upon the identity of this
diphtheroid bacillus with the true diphtheria bacillus. There
are, indeed, essential features of the life of the diphtheria bacillus
with which we are not familiar; and as long as experiments on
animals have not demonstrated that the poisonous effect of the
diphtheroid bacillus can at all be neutralised by anti-diphtheritic
serum, we are not warranted in identifying the two bacilli. In
my opinion the supposition that the diphtheroid bacillus shares
the responsibility of causing insanity with other bacteria, the
importance of which would thus be quite indefinite, merely
complicates the hypothesis. The only advantage that, perhaps,
may be derived from this supposition, is that the inefficacy of
the anti-diphtheritic serum might be imputed to the mixed infec¬
tion. But we cannot very well imagine more than one active
agent in an anatomical process which is so constant in its
occurrence, and which, in spite of its multiformity, has such
a peculiar character as general paralysis. Finally, this hypo¬
thesis pre-supposes a still unknown factor, which weakens the
natural power of resistance, not only against the attacks of
micro-organisms in general—as by such generalities nothing
definite would be explained — but against this diphtheroid
bacillus in particular.

Now there is nothing to prevent us assuming that this
unknown factor may be syphilis, and Robertson’s hypothesis

630

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would then more easily find favour with those who believe that
the way to general paralysis lies through syphilis. According
to Klippel, the “ inflammatory forms ” described by this author
are due to a “ trivial ” infection, the occurrence of which is also
facilitated by a previous syphilis. But then, again, if a previous
syphilitic infection is necessary, it would be difficult to explain
the fact that in animals the diphtheroid bacillus can by itself
give rise to anatomical changes which resemble those in general
paralysis, all the more so if the bacillus should prove to be
identical with the ordinary diphtheria bacillus, which up till
now has proved innocuous to rats. The chief interest will be
concentrated in these experimental changes, of which only pre¬
liminary communications have as yet been made.

It will be a point of importance to ascertain whether plasma
cells do or do not occur, even if the conditions for their occurrence
might be different in the experimental animals from what they
are in human beings. But even when the results of experiments
in animals harmonise, to a great extent, with the anatomical
picture of general paralysis, it would be premature to conclude
that the processes are identical. In an insane dog, Nisei once
found changes which could not be distinguished from those which
are characteristic of general paralysis.

It is to be hoped that these investigations will be carried
on, and that other pathologists will take them up. Theoretical
criticism is of no value, and the examination of the cerebral
cortex alone is not likely to solve the problem. One thing
ought to be considered an established fact: that the pathology
of general paralysis can only be established by investigations
which are founded on the doctrine that this insanity is a general
disease. Whether one had better search for a micro-organism or
lay stress upon inquiries into the metabolism is a secondary
question. All who trust that one day or other we shall succeed
in bringing psychiatry into line with general medicine have in
general paralysis a field for research in which they may expect
to reap fruit of their labour.

Gentlemen, since general paralysis was established as an
insanity proper, eighty years passed before we learned to make
the diagnosis from the microscopical picture. That this insanity

ORIGINAL ARTICLES

631

has been the first of which we have a pathological anatomy is
due to its frequency, to the fact that its clinical picture is easily
recognised, and to the gross anatomical changes which invite
mimite examinations. That this result has been obtained must,
however, be ascribed chiefly to the fact that so many workers
have taken part in the investigation. It has certainly been of
importance also that contributions to the anatomy of the disease
have come from various sources. Most of the researches have, of
course, been made by alienists, as they almost alone have the
opportunity of studying insanities. The development of psychiatry
lies in their hands, theirs is the duty therefore of working scientifi¬
cally for the profession. An acknowledgment of this duty is
represented by the founding of laboratories for each asylum, or
for several asylums in common. Here the alienist who takes a
particular interest in pathological anatomy may concentrate his
energy on this matter ; here the novice may be instructed. That
these laboratories abroad give admission to foreigners is a great
benefit to those who live far from the centres of culture and
science. I for one have benefited greatly thereby, and I should
not like to conclude this paper without having expressed my
sincere gratitude for the cordiality with which I was met during
my studies at the laboratory of the Psychiatric Clinique in
Heidelberg, as well as at the laboratory of the Scottish Asylums
in Edinburgh. I wish also to emphasise the fact that these
laboratories do not render it unnecessary for the assistant
physicians of the asylums to take part in the anatomical investi¬
gations. This is, in fact, the only way in which it will be
possible for them to keep up their knowledge of the literature
bearing upon this subject. Nobody expects that great dis¬
coveries will be made in this way. It is, however, of great
importance as regards the steady development of this science
that the daily minor work in the laboratory should be carried
out by a sufficient number of investigators. Alienists in general
ought not to consider anatomy as outside their psychiatric train¬
ing, as they have done up till now in this country as well as
abroad. In countries where there are no institutions for the
teaching of beginners in this subject, it is of still more importance
that those who occupy superior positions in asylums should be
able to instruct their assistants in the principles of the subject,
and thus to lay the foundation of their further training. The

632

ORIGINAL ARTICLES

right distribution of the work need not therefore be affected.
What is not actually necessary “ for household use ” may be left
to those who take special interest in pathological anatomy. But
in every asylum it ought to be expected of the assistant physicians
that they should at least be able to make that test of general
paralysis which consists in the demonstration of plasma cells.

References.

1. D’Abundo. La Psichiatria, 1889. Cited by No. 63.

2. Almkvist, Johan. “Beitrage zur Kenntnis der Plasmazellen, ins be -
sondere beim Lupus,” Arch. f. Dermatologic u. Syphilis, Bd. 58, 1901, S. 105,
110 .

3. Alzheim er. “ Ueber die anatomische Ausbreitung d. paralytischen
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4 . -- “ Beitrag z. pathol. Anatomie der Hirnrinde u. zur anat. Grand -

lage einiger Psychosen,” Monatsschr. f. Neurologic u. Psychiatric, ii. S. 82.

5 . -“ Ueber atypische Paralyse,” Monatsschr. f. Psych, u. Neurol., xi.

S. 73.

6. Angiolella. “ Di alcuni problemi sulla paralisi progressiva e dei piu
recenti lavori su di essa,” II manicomio modemo, vol. 10, 1894, No. 3.

7. Anglade. See the discussion on Paralysis at the Brussels Congress, 1903,
Revue neurol., 1903.

8. Bayle. “ Traits des maladies du cerveau et de ses membranes,” 1826.

9. Binswanger. “ Die Abgrenzung d. allg. progr. Paralyse,” Berlin, klin.
Wochenschr., 1894, S. 1103 ; Allg. Zeitschr.f. Psych., Bd. 62, S. 488.

10. _“ Die patholog. Histologie d. Grosshimrindenerkrankung bei

der allg. progr. Paralyse.” Jena, 1903.

11 . -“ Beitrage zur Pathogenese u. differentiellen Diagnose der progr.

Paralyse,” Virchows Archiv , Bd. 154, 1898, S. 389.

12. Boedecker u. Juliusburger. “ Anatomische Befunde bei Dem. parol.,”
Neurol. Centralbl., 1897, S. 774.

13. Bruce, Lewis. “ Clinical and Experimental Observations upon General
Paralysis,” Brit. Med. Joum., 1901, p. 1600.

14. Calmeil. “ De 1a paralysie consid4r4e chez les ali4n4s.” Paris, 1826.

16. Cramer. “ Pathologische Anatomie der Psychosen,” “ Handbuch d.

pathol. Anat. des Nervensystems,” S. 1486, note.

16. Degenkolb. “ Beitrage z. Pathologie der kleinen Himgefasse. Ueber
Vorkommen intraadventitiellen Infiltrate der Rindengefasse bei diffusen Rin-
denkrankheiten,” Allg. Zeitschr.f. Psych., 59, 1902, p. 714.

17. Donath. “Das Vorkommen u. die Bedeutung des Choline, etc.,”
Zeitschr. f. physiol. Chemie, 1903, Bd. 39, p. 526.

18. Dupr4. “Psychopathies organiques,” “Trait4 de pathoL mentale”
(Ballet). Paris, 1903, p. 115.

19. Evensen. “Den kron. alkoholismes kliniske former,” Norsk mag.f.
lasgev., 1899, No. 2.

20. __“Vascular Lesions in Mental Diseases,” Transactions of the

Medical Society in Kristiania, 1901, p. 186.

ORIGINAL ARTICLES

633

SI. Friedmann. “ Zur Lehre, insb. z. pathologischen Anatomie der nicht
eitrigen Encephalitis, Deutsche Zeitschr. f. NervenheiUc., Bd. 14.

28. Qaupp. “ Nenere Arbeiten fiber die prpgieesive Paralyse d. Irren,”
Monatsschr. f. Pysch. u. Neurol 1897, Bd. i. p. 265.

23. Del Qreco. “Sulle alterazioni delle pie meningi cerebrali negli
alienati,” Rivista speriment., voL ivii., 1891.

24. Qrimaldi. R manicomio, 1896, 2-3. Quoted by No. 60.

25. Havet. “ Des lesions vasculaires du cerveau dans la paralysie g4n4rale,”
Bull, de Vacad. de mM. de Belgique , 1902.

26. Held. “ Ueber den Bau der Neuroglia und iiber die Wand der Lymph-
gefasse in Haut and Schleimhaut.” Leipzig, 1903.

27. Heubner. “ Die luetischen Erkrankungen der Hirnarterien.” Leipzig,
1874.

28. Hewitt, Prescott London Med.-Chir. Transactions, vol. xxviii., 1845.
Quoted by No. 26.

29. Huguenin. “ Pachymeningitis int. haemorrh.” In Ziemssen’s “ Hand-
buch,” 1878, xi. 1, p. 384.

30. Idelsohn. “ Ueber das Blut u. deseen Bactericides Verhalten bei prog.
Paralyse,” Arch. f. Pysch., Bd. 31, p. 640.

31. Joffroy and Mercier. “ De l’utilit4 de la ponction lombaire pour le
diagnostic de la paralysie g4n4rale,” Revue de neurol ., 1902, p. 825.

32. Jo res. “Wesen u. Entwickelung der Arterioekleroee.” Wiesbaden,
1903.

33. Kaes. “ Rindenbreite u. Markfaserchwund bei allg. Paralyse,”
Wiener medizin. Wochensckr., 1900.

34 - “ Zur patholog. Anatomie d. Dementia paralytica,” Monatsschr.

/. Psych, u. Near., 1902.

35. Klippel. “ Lea paralysies g4n4rales progressives.” Paris, 1898.

36-“ Histologie de la paralysie g4n4rale.” Congr4s de Bruxelles,

1903, Revue neur., 1903, p. 814.

37. Lissauer. “ Sehhiigelveranderungen bei prog. Paralyse,” Deutsche med.
Wochenschr., 1890, No. 26.

38. - bei Storch. “Ueber einige Falle atypischer progresaiver

Paralyse," Monatsschr. f. Psych, u. Neurol., Bd. 9, 1901, p. 401.

39. Mfthaim . “De l’importance des lesions vasculaires dans l’anatomie
pathologique de la paralysie g4n4rale et d’autres psychoses,” Bullet, ds Vaoaddm.
de mdd. de Belgique, 1901, juli, p. 600.

40. - “L’importance diagnostique des l&ions vasculaires dans la

paralysie g4n4rale,” Ibid., 1902.

41. v. Marschalko. “Ueber die sogenannten Plasmazellen, etc.,” Arch./.
Dermatologic u. Syph., Bd. 30, 1895, pp. 3, 241.

42. “ Die Plasmazellen in Rhinoskleromgewebe, etc.,” Ibid., Bd. 64, 1900,
p. 235.

43. - “Zur Plasmazellenfrage,” Zentralbl. f. allg. Path, u. path.

Anatomie, Bd. 10, 1899.

44. Mendel. “Die progressive Paralyse d. Irren.” Berlin, 1880.

45. Meyer, E. “ Die pathol. Anatomie der Psychosen.” Orth—Festschrift

46. Meyer, L. “ Die allg. progr. Oehirnlahmung eine cnron. Meningitis,”
Charitd-Annalen, 1858.

2 T

634 ORIGINAL ARTICLES

47. Meyer, L. “ Die pathol. Anatomie der Dementia paralytica, 7 ’ Virdum
Archiv, 68, 1873, p. 292.

48. Montesano e Monteeeori. “Ricerehe batteriologiche, etc., 9 Bit. &
PtiodL, Psichiat., Neuropatologia, etc., 1897, 1, 15. Ref. Neurol. Centralbl,
1898, p. 549.

49. Mott “Observations upon the Etiology and Pathology of General
Paralysis,” Arch, of Neurology, 1889, i

50. Nisei. “ Sind wir imstande, a us dem pathoL-anat Befunde die Diag¬
nose der progr. Paralyse zu stellen ?” Monaistchr. f. Psych, u. Neurol^ iv.

51. -“ Ueber einige Beziehungen zwischen Nervenzellenerkrankung

u. gliosen Erscheinungen bei verschiedenen Psychosen,” Arch. f. Psyche, Bd. 32,
H. 2.

52. “Die Diagnose d. progr. Paralyse,” Neurol. Centralbl., Bd. 21.

53. - “ Ueber einen Fall von Geisteas to rang bei einera Hand,”

Centralbl f. Nervenhetlk., 1890, Cfr. Arch. f. Psych., Bd. 33, H. 2.

54. “ Eritische Bemerkungen zu Schmaus : Vorlesungen fiber die pathoL
Anatomie des Rfickenmarks,” Centralbl. f. Nero. u. Psych., 1903, p. 88.

55. -“ Die Bedeutung der Lumbalpunktion,” Centralbl. f. Nero. u.

Psych., 1903, p. 225.

56. Oppenheim. “ Die syphilitischen Erkrankungen des Gehims,” 1903,
p. 113.

57. Orr and Cowan. “ A Contribution to the Morbid Anatomy and the
Pathology of General Paralysis of the Insane,” Joum. of Merit. Sci., 1900,

p. 688.

58. Pappenheim. “ Wie verhalten sich die Unna’schen Plasmazellen zu
Lymphozyten ?” Virch. Arch., Bd. 165 (1900, p. 365), Bd. 166 (1901, p. 424).

69. Raecke. “ Ueber Gliaveranderungen im Eleinhirn bei progr. Paralyse,”
Arch. f. Psych., Bd. 34.

60. Raimann. “Zur Aetiologie der progr. Paralyse,” Wiener klin.
Wochenschr., 1903, No. 13.

61. Rehm. “ Einige neue Farbungsmethoden zur Untersuchung d.
central. Nervensystems,” Munchener med. Wochenschrifi, 1892, p. 217.

62. Robertson, Ford. “ A Text-book of Pathology in relation to Mental
Diseases.” Edinburgh, 1900.

63. Robertson, M'Rae, and Jeffrey. “Bacteriological Investigations into
the Pathology of General Paralysis of the Insane,” Rev. of Neurol, and Psych.,
1903, No. 5.

64. Robertson, Ford. “Histological Evidence of the Presence of an
Organism resembling the Klebs-Lofiler Bacillus in Cases of General Paralysis
of the Insane,” Rev. of Neurol, and Psych., July 1903.

65. - “The Pathology of General Paralysis of the Insane,” Brit.

Med. Joum., Oct 24, 1903.

66. Straub. “ Gefaasveranderung bei allg. Paralyse.” Verb. d. Gesellsch.
deutscher Naturforscher u. Aerzte. Miinchen, 1899. Ref. Neurol. Centralbl .,
Bd. 20, p. 957.

67. Tuczek. “ Beitrage zur Anatomie u. Pathologie d. Dementia paralytica.”
Berlin, 1884.

68. Unna. “ Ueber Plasmazellen, insbesondere bei Lupus,” Monatsschr. f.
prakt. Dermatologic, Bd. 12, 1891.

ABSTRACTS

635

69. Unna. “ Ueber die Bedeutung der PlasmazeUen fur die Genese der
Geschwulzte der Haut,” etc., BerL klin. Wochentchr ■., 1892, No. 49.

70. - “ Plaamazellen,” “ Encyklopadie der mikroak. Technik,” 1903,

ii. p. 1116.

71. Vogt, Ragnar. “Dae Vorkommen von Plaamazellen in der mensch-
lichen Hirnrinde, etc .,” Monatsschr. f. Neurol, u. Psych., 1901, p. 211.

72. Waldeyer. “ Ueber Bindegewebszellen,” Archiv f. mikroskop. AruU.,
Bd. 11, 1876.

73. Weber, L. W. “ Ueber die eogen. gallopierende Paralyse nebat
einigen Bemerkungen uber Symptomatologie u. patbologische Anatomie,”
Monatsschr. f. Psych, u. Neur., Bd. 14, 1903, pp. 374, 460.

74. Weigert. “Beitrage zur Eenntnia d. normalen menachlicben Neu¬
roglia.” Frankfurt, 1896.

Note to References (in Fine).

After this paper had been written (September 1904) the first volume appeared of
41 Hiatologische u. histopathologiache Arbeiten, etc.,” herauagegeben von Franz
Nissl, Jena, 1904, containing: 44 Hiatologische Studien zur Differentialdiagnoee
der progr. Paralyse” by Alzheimer, and “Zur Histopathologic der paralytischen
Rindenerkrankung" by Nissl. As the lecture above rendered was delivered im¬
mediately after the paper was written, there was no time to take advantage of these
important treatises by Alzheimer and Nissl.

abstracts

PHYSIOLOGY.

THE MOTOR AREAS IN THE CEREBRAL CORTEZ OF
(342) DA8YURU8 V1VERRINTJ8. J. F. Flashman, Reports Path.
Lab. of Lunacy Depart., N.S.W., Yol. i., Part 2j

The motor centres in the cerebral cortex of this marsupial, the
“ native cat ” of New South Wales, were investigated by electrical
stimulation in several specimens. The convex surface of the
hemisphere is marked by only one fissure, the sulcus orbitalis,
which is generally simple, but there is occasionally an apparent
bifurcation of its upper end. The posterior branch is, however,
not a true sulcus, but only a groove in which an artery lies.

Movements were obtained only by stimulation of the
posterior lip of this sulcus. With a minimal current the move¬
ment was crossed, but with a slight increase of the current the
limbs of the same side were also affected. The areas for the
various groups of muscles overlap one another to a very large

636

ABSTRACTS

extent, and there are in addition well-marked centres for very
definite associated movements.

The arrangement of the motor centres from above down¬
wards is—leg, arm, the movement of seizing with the month and
claws an object in front and to the opposite side, snarling, and, at
the inferior end of the fissure, the movements of the tongue and
jaw. Gordon Holmes.

PATHOLOGY

DENDRITES AND DISEASES. Sir William Gowers, Lancet,
(343) July 14, 1906, p. 67.

In a lecture delivered at Queen’s Square, Sir William Gowers deals
with some of the remote implications of the neurone doctrine. He
first describes the facts, as given in the current text-books, on which
the neurone theory rests. These are mainly findings in histology.
He regards the continuity of the ultimate fibrillar network of the
dendrites as improbable, and holds that Cajal’s teaching of
“contiguity not continuity” is borne out by observation. The
significance of the fact that neurofibrils never end in nerve cells
has been too much overlooked, yet it disposes of the old view that
the nerve cell is the source of nerve impulse. In speaking of
the contractility of the dendritic terminations, he suggests the
analogy between the hyaloplasm of the fibrils, and that of muscular
fibres. The observations that have been made on dendritic
retraction during hibernation are then referred to, with their
bearing on the theory of sleep. The author claims that the
isolation thus brought about of the higher structures from the
lower structures that continually excite them allows of rest of the
former, so that nutritional renewal may take place, and that this
view is a more satisfactory explanation of the phenomena of sleep
than any other physiological one.

Turning to disease, one may look upon chorea as a nutritional
disturbance of the cortical dendriteB (see Review of Neurology ,
March 1906, p. 219). Paralysis agitans may be looked upon as a
senile dendritic disease. This would explain why researches made
upon the motor cells have been made in vain, and why no degenera¬
tion occurs in the pyramidal fibres. An attack of epilepsy may
be regarded as the passage of a special form of excitation through
the dendritic fibrillae of the cortex with an extension almost
explosive in its rapidity. Again, hysterical hemiansesthesia may
be due to a mechanism similar to that occurring in sleep, so that
the impulses of pain cannot reach those neurones that subserve
consciousness. Ernest Jones.

ABSTRACTS

637

THE NON-OGOURRENOE OF AUTOGENOUS REGENERATION
(344) OF NERVE FIBRES. (Ancora nn’ esperienza contro l’auto-
rigenenudone delle fibre nervose.) E. Lugaro, Riv. di Paiol.
nerv. e ment., 1906, p. 273.

Ltjgaro records the results of experimental observations on three
puppies in which he extirpated the lumbo-sacral portion of the
spinal cord, together with the corresponding spinal ganglia. The
animals were kept alive for periods varying from two and a half to
three months. They were then killed and the nerves of the lower
limbs examined, not only with the osmic acid method but also
by Cajal’s new axis-cylinder process with reduced silver.

He found no evidence of regeneration in any of the nerves,
with the exception of one case, in which five or six myelinated
fibres were present and appeared to be traceable to a spinal
ganglion which happened to have been incompletely removed.

If the proxinial part of the nerves be not extirpated, non-myelin-
ated fibres may appear in the peripheral stump, these apparently
being derived from the sympathetic nervous system. All the new
fibres which arise from the sympathetic ganglia and grow into the
peripheral nerves are non-myelinated. Lugaro also states that re¬
generation of striated muscle may occur autonomically, even when
all nervous influence, cerebro-spinal or sympathetic, is withdrawn.

Purves Stewart.

ON THE DEGENERATION OF NERVE TISSUE. (Ueber den
(345) Abbak des Nervengewebes.) A. Alzheimer (of Munich),

Allg. Ztsehr. f. Psych., Bd. 62, H. 3, 4.

The histological methods which give useful results in the study of
the brain in such organic affections as general paralysis, senile
dementia, arterio-sclerotic insanity, and brain syphilis fail almost
entirely when called on to aid in the histopathological differential
diagnosis of the so-called functional psychoses. A few isolated
tissue changes have been noticed without the subject being much
elucidated: new methods are necessary, and the author suggests
that the subject may be usefully attacked from a new point of
view.

The few facts which we do know of the functional psychoses
which lead to dementia are essentially of the nature of regressive
changes. In view of this degeneration of the nerve tissue, the
products of degeneration, their nature and distribution may prove
to be useful indicators and helps in differential diagnosis. Marchi
degeneration is of rare occurrence and of little help here. On the
other hand, in the deteriorating psychoses there is a considerable

638

ABSTRACTS

increase of fat, especially in the cells of the adventia of the blood¬
vessels. Other products of deterioration occur, but the methods
of fixation and staining commonly employed are inadequate ; new
technique must be elaborated before the chemical and tinctorial
qualities of these bodies can be determined, and their relations to
the parenchymatous and neuroglia elements on the one haud, and
to the vascular system on the other, satisfactorily worked out

C. Macfie Campbell.

THE PATHOLOGICAL APPEARANCES IN A CASE OF AMYO
(346) TROPHIC LATERAL SCLEROSIS, ETC. (Un cas de acMroee
laterals amyotrophic avec dlgln&ation de la voie pyramidale
suivie an March! de la moelle jusqu’au cortex.) Italo Rossi
and D. Roussy, Rev. Neurol., May 16, 1906.

The authors describe the pathological findings in a typical case of
amyotrophic lateral sclerosis. Except for the spinal ganglia, which
were not obtained, the examination was very complete. The nervous
tissues were examined by Marchi, Nissl, and Carmine, and the
muscles by Hematoxylin and Eosin, and Van Gieson. They found
the following lesions:—

1. Recent (Marchi) and old (Weigert) degeneration of the
pyramidal system from the cord to the cortex.

2. Diffuse degeneration of the antero-lateral columns, with the
exception of Gower’s tract and the direct cerebellar tract.

3. Degeneration of the anterior roots in their intra-medullary
course, and of the fourth and fifth dorsal roots of the left side,
with corresponding ascending and descending degenerations.

4. Atrophy of the anterior horn cells of the cord.

5. Degeneration of the fibres of the hypoglossal pneumogastric
and facial nerves, with cellular lesions in the nuclei.

6. Degeneration of the medullary fibres of the cortex and
atrophy of the large pyramidal cells.

7. Atrophy of the peripheral nerves and muscles.

The changes in the large pyramidal cells were often slight
as compared to the extent of the degeneration of the cortical
fibres, which tends to show that amyotrophic lateral sclerosis is
primarily of the pyramidal tracts. The degeneration of the
cortical fibres supported the views of Sherrington and Campbell
as regards the situation of the motor centres in the ascending
frontal convolution, very few degenerated fibres being traced to
the ascending parietal convolution. The changes in the cortex
were limited to the large pyramidal cells and the medullary fibres,
the association fibres being unaffected. Ho degenerated fibres
were found in the corpus callosum. There was also found de-

ABSTRACTS

639

generation in the post-longitudinal bundle in the lower part of
the pons and bulb, a condition which has been previously de¬
scribed, and which does not alter the essentially motor character
of the disease. There was sufficient degeneration in the radicular
fibres of the third and sixth nerves to warrant the authors stating
that they were definitely affected, but no changes were found in
the corresponding fibres of the fourth nerves. Some granular
bodies were found in the ventral part of the direct cerebellar tract
at the level of the second and third cervical segments, but there
were no changes in the cells of Clarke’s column, and the authors
are inclined to think that these degenerated fibres belonged to the
pyramidal system rather than to the direct cerebellar tract itself.
The slight degenerations which they found in the posterior columns
were apparently due to the degeneration of the fourth and fifth
dorsal roots of the left side. Such degenerations of the posterior
roots have been described in a number of cases, and show that in
amyotrophic lateral sclerosis not only may there be changes in the
posterior columns, but also in the posterior nerve roots themselves.
The changes in the posterior columns are analogous to those seen
in cachectic states, but the rarity of the root changes makes the
authors attribute them to accidental peripheral lesions rather than
to a primary process analogous to that seen in the case of the
motor neurone. T. Grainger Stewart.

THE INTERNAL FEATURES OF THE BRAIN OF A MICRO
(347) CEPHALIC IDIOT, SHOWING LACK OF THE CORPUS
CALLOSUM. J. F. Flashman, Reports Path. Lab. of Lunacy
Depart ., N.S.W., Vol. i., Part 2.

This brain was described in a previous part of these Reports as
showing, on macroscopical examination, absence of the corpus
callosum, but a study of sections stained by Weigert’s method
revealed the fact that this designation was incorrect, for a corpus
callosum was really present, though in a very imperfect state.

Besides this, there were apparently two striking abnormalities
in the brain visible to the naked eye. The one was a large
bulging mass in the anterior portion of the base of the brain,
which microscopical examination showed to be formed by the
fusion of the heads of the two caudate nuclei across the middle
line, and covered only by a thin layer of cortex. The second was
a large mass of grey matter situated mesially between the hemi¬
spheres in the position of the anterior part of the corpus callosum;
it consisted of a superficial layer of normal cortical tissue, and a
deeper portion formed by the more or less complete fusion of
masses of heterotopic grey matter, containing but few medullated
fibres.

640

ABSTRACTS

Fonr classes of callosal fibres are described: (1) Fibres uniting
the two frontal lobes which have fused across the middle line, but
these can scarcely be considered as belonging to the callosal
system. (2) Small bundles of fibres which cross the middle line
in the mesial grey mass and are probably true commissural fibres
(3) Undoubted callosal fibres which cross behind this grey mass in
a bundle which probably represents the splenium of the corpus
callosum. A considerable number of these are arranged, before
their decussation, in definite bundles in the dorsal wall of the
lateral ventricles, thus corresponding to the tapetum of the normal
brain. Passing backwards or forwards they bend into the splenium
when they reach it. (4) Fibres from the neopallium traverse the
floor of the lateral ventricles and decussate in the hippocampal
commissure (psalterium). It is interesting that in this case the
callosal and hippocampal commissures are almost continuous, there
is no trace of a septum pellucidum between them.

The two lateral ventricles united across the middle line to form
a single cavity, from which the third ventricle was separated only
by a layer of ependyma which formed its roof. The ventral surface
of the mesial grey mass was covered by ependyma; it must conse¬
quently have developed from the hemispheres. Other interesting
peculiarities are the absence of decussating fibres which could
correspond to the anterior commissure, and the aberrant course of
a bundle of fibres which is assumed to represent the fornix. This
bundle springs from the fimbria, but passes forwards along with
the taenia thalami in the floor of the lateral ventricle, apparently
into the anterior portion of the thalamus.

The only striking defect in the cortex was a paucity in the
number of its cells.

The most important point which the description of this brain
bears on is the nature and origin of the tapetum. As is well
known, Onufrowicz and others have described brains in which
there was no corpus callosum, yet the tapetum was normal, and it
was therefore concluded that the tapetum does not contain callosal
fibres. In this case the tapetal fibres could be so easily followed
into the small remainant of the corpus callosum that the author
believes this view is incorrect. Gordon Holmes.

THE TOXIC CAUSE IN SOME FOAMS OF MENTAL DISEASE
(348) A NEW METHOD OF INVESTIGATION. (La causa tossica in
alcune malattie mental! Nuovo metodo di saggio.) Rkbizze,

Riv. di Patel, nerv. e ment., F. 6, 1906, p. 241.

The author’s researches are not quite finished and he hopes to
publish with more detail very soon. His method consists in the

ABSTRACTS

641

application of leeches to patients suffering from various forms
of mental disease, and subsequent examination of the animals*
nerve cells by Cajal’s method.

After being filled with blood, each animal is allowed to live
24 hours. The experiments have been carefully controlled.

The following cases were examined: early convalescence
from alcohol (2); ordinary amentia (3); pellagrous amentia (3);
general paralysis (1); senile dementia (2); idiocy (5) ; epilepsy (5);
dementia praecox (18). In the nervous system of leeches filled with
the blood of normal individuals, there is a slight diffuse hyper¬
trophy of the neurofibrils forming the reticular network. In
epilepsy during a period of improvement between the convulsions
the neurofibrils were normal, but during the epileptic state they
were atrophied in the cell body and hypertrophied in the axis-
cylinder. The same change was found in general paralysis. In
senile dementia the neurofibrils were extremely atrophied. In
amentia the initial hypertrophy of the neurofibnls was followed
by dissolution into granules. In recovering alcoholics, idiocy, and
dementia praecox, the results were negative.

The author concludes that his investigations support very
strongly the view that many forms of mental disease are of toxic
origin, the result of gastro-intestinal disturbance. The blood of
epileptics is only toxic during the convulsive period. The toxins
may act electively upon the cells of the motor area or diffusely,
in which case these cells react because of increased vulnerability,
the result of some congenital anomaly or alteration sustained in
intrauterine life. After the convulsion, should the toxins persist,
then the other centres being affected, post-epileptic confusion
results.

In senile dementia and in amentia, great importance is attached
to increased growth and virulence of certain germs in the in¬
testinal canaL

In alcoholism especially is this question important, as the
gastro-iutestinal inflammation induced favours overgrowth and
increased virulence of the organisms normally present. The
mental symptoms depend upon the predominance of certain of
these, and in their absence arterio-sclerosis, renal and hepatic
changes may be the only result of the intestinal disturbance.

Another point insisted on is the predisposition to attack or weak¬
ness of the nervous system which results from slight meningitis or
meningo-encephalitis in infancy. These infantile diseases leave
areas of diminished resistance in the cortex prone to break down
under toxic action. Taking this into consideration, the necessity
to ascribe to organisms an elective action is diminished. The author
considers dementia praecox of toxic origin, hut the toxin seems to
be present only in the initial phases of the disease; later on, as

642

ABSTRACTS

in alcoholism, there follows a period in which the symptoms are
the result of the brain lesion already established.

David Orr.

CLINICAL NEUROLOOT.

OGTJLAB CRISES IN TABES. (Orises oculaires et syndromes peeudo-
(349) basedowien d&ns l’ataxie locomotrice.) Haskovec (Soc.de Near,
de Paris), Reti. Neurol., April 5, 1906.

Pel has described as ocular crises in tabes a case of that disease,
in which sudden pain in the eye occurred, with lachrymation,
slight exophthalmos, widening of the palpebral aperture, and ocular
hypotonia. Haskovec reports a similar case in some detail. He
considers the symptoms of exophthalmic goitre presented by his
patient to be due entirely to the affection of the cervical sympathetic
by the tabetic morbid process; a pseudo-basedowian syndrome.

S. A. K. Wilson.

MENTAL DISORDERS IN MULTIPLE SCLEROSIS. (Psychische
(350) Sttirangen bei der multiples Sklerose.) Rakckx (of Kiel),
Arch. /. Psych., Bd. 41, H. 2.

The author first gives a brief r^sum^ of the views of previous
writers, and shows how, with few exceptions, notably that of
Muller, they recognise the large percentage of cases of multiple
sclerosis which present mental symptoms. Several writers refer
to a combination of multiple sclerosis and general paralysis, with¬
out stating explicitly whether typical paralytic changes in the
cortex were accompanied by sclerotic foci, or whether the condition
was one of very widely disseminated insular sclerosis producing a
rather diffuse brain lesion. In both diseases epileptiform convul¬
sions may occur; it is wrong to talk of a complication of multiple
sclerosis with epilepsy, where the epileptiform attacks are due to
the sclerotic foci. The so-called hysterical phenomena must be
looked on as the direct expression of the organic disease, and not
as an incidental complication.

As to the forms of mental disorder which are met with in this
disease, where the mental symptoms occur in an early stage of the
disease the most common forms are depressive and maniacal dis¬
orders with delirious episodes, confusion, hallucinations, and
isolated delusions. The delirious episodes frequently follow epi¬
leptiform or hy8terifonn attacks. The depressive conditions are
frequently associated with head feelings; the maniacal conditions
with a silly cheerfulness and often with great irritability. Where

ABSTRACTS

643

the mental symptoms arise at a more advanced stage of the disease,
expansive delusions with the absurd exaggerations and want of
judgment of the general paralytic are more common.

Among thirty-seven patients observed by the author, thirteen
cases showed marked mental enfeeblement and nine cases showed
other mental disorders. Only in fifteen cases was no mental defect
observed, and in these the disease was not far advanced. In five
cases in the initial stage of the disease there was a simple de¬
pression ; in three cases there was an emotional disturbance with
delirious conditions. In one case, where the disease was already
far advanced, there was a characteristic paranoic condition similar
to that described by other authors. Raecke reports in detail three
of his cases. The first case was that of a sixteen-year-old boy, who
developed attacks of dizziness, episodes of anxiety, a horrible fear
of death, a few hallucinations, impulsive reactions. Hysteriform
conditions, with transitory pareses and aphasia, alternated with
epileptoid attacks of dizziness and sleep. From the very beginning
the memory defect was prominent, and there was great instability
of the emotional tone. Neither nystagmus nor intention tremor
was present; the knee-jerks were normal; speech was slow, stut¬
tering, and abrupt; the gait was staggering; writing was tremu¬
lous. Patient died about nine months after the onset of the first
symptoms. Post-mortem examination confirmed the diagnosis of
multiple sclerosis, there being numerous sclerotic foci in the brain
and cord.

In the second case there was no microscopical examination, but
the neurological symptoms made the diagnosis quite clear. Patient
was a young woman twenty-one years of age, who had a first attack
at the age of twelve years, with paresthesia of the left hand. From
the age of seventeen, when she had influenza with transitory para¬
lysis, patient suffered from epileptiform attacks, which came every
four to six weeks; these attacks were frequently followed by an
aphasic condition, which was also present, but much less marked,
in the free intervals. Fatigue made this aphasia more marked.
In addition to the aphasia there was the early onset of a euphoric
dementia, with later conditions of excitement and confusion.

The third patient was a man twenty-six years of age, who, two
years after the onset of the disease, with pains, impaired gait, in¬
crease of reflexes, nystagmus, and speech defect, with intellectual
enfeeblement and a tendency to confabulate, developed absurdly
grandiose matrimonial schemes. Notwithstanding his dementia,
he took considerable interest in the affairs of the ward, showed
marked personal preferences, and would only discuss his delusions
under favourable conditions. A cursory examination would have
elicited none of his typical ideas, and this perhaps explains how
such a trend may be overlooked. C. Macfie Campbell.

644

ABSTRACTS

ON TWO OASES OF SUCCESSFUL OPERATION FOR TUMOUR OP
(351) THE SPINAL MENINGES. (Ueber zwei FUle von erfolgreieh
operierter Riickenmarkhautsgeschwulat.) Oppenheim and

Borchardt, Berl . klin. JFochenschr., June 25, 1906.

In the first part of the paper a detailed account is given of the
symptoms and course of these cases.

The first case, of a woman aged 33, began in July 1904 with
pains between the shoulder-blades followed three months later
by increasing weakness of the left arm and stiffness of the left leg.
The paralysis of the arm was limited to the hand and finger muscles,
and the left leg showed all the reflex signs of spastic paraplegia,
though the right lower limb was unaffected, save for a diminution
of sensitiveness to pain and temperature. Pain was felt on
pressure upon the sixth and seventh left cervical transverse
processes, but no changes were visible on radioscopy. The
patient declined operation, and in September 1905 was much
worse, the paralysis affecting also the right leg, and the bowels and
bladder having become incontinent; pain, however, was diminished.
The patient was then operated upon, and an intradural fibroma or
fibrosarcoma 3 cm. long was found flattening the cord. Improve¬
ment began upon the day after its removal with disappearance of
the spastic condition and of the Babinski sign. Two months later
she was able to walk.

The second case, of a man aged 49, began in autumn oi
1904 with pains in the back and legs, weakness in the right leg,
and interference with the visceral reflexes. In April 1905 there
was marked paralysis in the right leg, slightly increased knee-jerkB,
ataxia in both legs, and disturbance of all forms of sensation on
both sides up to the seventh rib, together with tenderness to
pressure on the fifth dorsal spine. In March 1906 an exploratory
laminectomy revealed a soft dural tumour at the level of the
fourth and fifth neural rings, in the middle line, and 5 cm. long.
A few days after its removal, pain and spasticity were much
lessened, and the urine was voided normally; two months later
the patient could walk with a stick, and the reflexes and
sensations had become natural.

The second part of the paper gives the surgical details of the
operations, with figures, and Borchardt states the mortality of such
laminectomies at 50 per cent. John D. Comrie.

DISSEMINATED SYPHILITIC ENCEPHALITIS. Albert M.
(352) Barrett, Amer. Joum. of Med. Sciences , March 1905.

The author describes a case of syphilis admitted to Danvers
Asylum, Dec. 11,1904, six months after the initial lesion appeared.

ABSTRACTS

645

The secondaries were well marked at this time. Physically: the
left pupil was larger than right, there was partial ptosis and
external strabismus of the right eye, the knee-jerks were increased,
and there were coarse tremors, especially of the hands. Mentally:
there was amnesia, complete disorientation, and extreme dulness.
A comatose condition ensued, and the patient died Dec. 18, 1904.

Macroscopically: the pia was hazy over the convexity and base,
the third nerve and left middle cerebral were imbedded in an
exudate, and there was both a focal and general meningitis.

Microscopically: the vessels of the pia, and more especially the
veins, showed a proliferation of the intimal endothelium, infiltra¬
tion of sheath with lymphoid and plasma cells, often polynuclears,
and there was more or less mural necrosis of the vessel walls.
The cortex showed both diffuse and focal changes. The former was
manifest in degenerative alterations of the nerve cells, neuroglial
reaction and vascular proliferation with infiltration of the shorter
vessels of the cortex, and extension of the meningitis. Nissl’s
rod cells were everywhere numerous. The focal changes in the
cortex consisted of small areas of granulation tissue, anaemic
necrosis and punctate haemorrhages, and conditions resembling
small, gummata. The changes in the oblongata and cord were
similar, but not so severe. Fibre degenerations were negative.

In its entirety the process is to be considered essentially as a
disseminated syphilitic meningitis. Clinically the case is inter¬
esting as appearing early after syphilitic infection, and anatomically
as being rather a diffuse vascular and parenchymatous condition,
distinguishable from the gummatous type of syphilis on the one
hand, and on the other from the cortical changes seen in general
paralysis. Charles I. Lambert.

STATISTICAL INQUIRT INTO THE ETIOLOGY AND DURA
(353) TION OP GENERAL PARALYSIS AND CAUSES OF
DEATH. (Paralisi Generate Progressiva: Etiologia—Dnrata
—Cause di Morte.) Giuseppe Margaria, Ann. di Fren.,
Yol. xvi., Fasc. 2.

The material for the inquiry was provided in the records kept of
the general paralytics who had died in the Turin asylum during
the last ten years, amounting to 107 women and 349 men.

Etiology .—The disease appears to be on the increase: 49 patients
died from it in the second quinquennial period, as against 42 in the
first. The conditions of industrial life in large cities, with alco¬
holism, prostitution, and syphilis, are important factors.

Most cases of the disease occurred between the thirty-sixth
and forty-fifth years. Two cases occurred between twenty-one

646

ABSTRACTS

and twenty-five, and 4 over seventy. The proportion between
male and female patients was 3*26 :1. The age of commencement
of the disease was the same for both sexes.

56*5 of the patients belonged to the poor classes, and 43 5 to
the well-to-do.

83*8 came from the cities, and 16*2 from the country.

Of 349 male patients, only 13 belonged to the army.

Alcohol was found as a sole cause in 127 cases—109 men and
18 women, or in 27*87 per cent.; and syphilis in 11*46 per cent, of
the men and 11*21 per cent, of the women.

Cases in which syphilis was associated with alcoholism
amounted to 9*43 per cent, for the men and 4*67 per cent, for
the women. Syphilis was thus found in 19*77 per cent, of all
the cases examined.

Duration .—When the cause was alcoholism, death occurred
most frequently between the thirteenth and the eighteenth months,
and the same result was found in the case of syphilis.

The course of the disease depends principally on the degree of
intensity of the intoxication, the association of other causes, and
especially the power of individual resistance.

Causes of Death .—Marasmus is more common in men than in
women—4212 per cent, to 28*03 per cent. Septicaemia—due to
bed-sores—on the other hand, is more common in women—23*36
per cent, to 8 59 per cent. Apoplectiform seizures are slightly
more common in women than in men—12*14 per cent to 11*74
per cent. The reverse holds for epileptiform seizures—men, 6*30
per cent.; women, 4*67 per cent. T. C. Mackenzie.

SYMPTOMS OF FRONTAL DISEASE. (Symptoms der Stirnhirner
(354) krankungen.) Anton, Munch, mcd. fPchnsehr., July 3, 1906,
S. 1289.

With a paired organ like the frontal (pre-frontal) region, abun¬
dantly connected with another paired organ, the cerebellum,
considerable compensation can occur, and the results of injury or
disease may only be recognisable through a quantitative diminution
in activity.

The chief physical signs are disturbance of balance in standing
and walking, almost exactly as in cerebellar disease; change in
character of gait (hypotonus), and loss of fine co-ordination of
movement in the upper extremities. From the proximity of the
motor cortex, pareses and motor aphasia are frequent complications,
and in localised orbito-frontal cases, anosmia.

Abscess, etc., may be present for years unrecognised. In one-

ABSTRACTS

647

sided disease, characteristic psychical symptoms are not evident,
but from involvement of both sides there results a set of symptoms
closely resembling those of general paralysis.

J. H. Harvey Pirie.

SIGNIFICANCE OF JACKSONIAN EPILEPSY IN TOPICAL
(365) CEREBRAL DIAGNOSIS. (Ueber die Bedeutxmg der Jack-
son’schen Epilepsia f&r die topische Himdiagnostik.) K.

Bonhceffer, Berl. klin. Wchnschr., July 9, 1906, S. 935.

The author summarises his past ten years’ experience of Jacksonian
epilepsy. It is a frequent symptom of organic disease of the
central convolutions. In cases of traumatic haemorrhage it is of
gTeat importance as indicating the site for trephining, but several
cases of attacks in alcoholic subjects are given where the main
lesion was found not to be over the motor cortex, but in some
other part of the same hemisphere.

The differential diagnosis of Jacksonian epilepsy from those
cases of genuine epilepsy affecting mainly or entirely one side of
the body, lies chiefly in the different anamnesis, and in the com¬
plete loss of consciousness, usually, though not invariably, present
in the latter. Midway between those two lie genuine epileptic
cases where some other local lesion determines the one-sided
character of the seizures. Here consciousness is generally lost, but
a case is recorded with cerebellar atrophy on the same side as the
fits where this was not the case.

A hemistatus epilepticus is frequently associated with other
signs of cerebral abscess or tumour which may be present. A very
interesting case is given where abscess was diagnosed, but both at
operation and post-mortem there was found only hydrocephalus
interna, with no apparent cause for the localisation of the fits—an
“ idiopathic ” hemiepilepsy. J. H. Harvey Pirie.

ON THE PATHOLOGY OF EXOPHTHALMIC GOITRE. (Zur
(356) Pathologic der Basedow’schen Krankheit.) M. Bernhardt,
Berl. klin. Wchnschr., July 2, 1906, p. 905.

The cases which the author records are, he believes, unique. The
interesting point in the first case lies in the association of the
characteristic symptoms and signs of exophthalmic goitre, with the
presence of bilateral cervical ribs.

The second observation records the simultaneous occurrence of
exophthalmic goitre in husband and wife. W. T. Ritchie.

648

ABSTRACTS

THE THALAMIC? SYNDROME. (Le syndrome thaluuqae.) Dt

(367) J&UNE and Roussy, Rev. Neurol, June 30, 1906, p. 521.

This paper is based on clinical research, supplemented by patho¬
logical investigation, and it contains a lucid and concise statement
of important facts.

The onset of the hemiplegia is usually insidious: there is
seldom, if ever, an actual “ stroke,” or any loss of consciousness.
Voluntary movements on the affected side are relatively well pre¬
served, but post hemiplegic movements, such as hemichorea and
hemiathetosis, are frequent. There is never any hemitremor, but
nearly always a certain degree of hemiataxia. This is revealed in
hesitation and accompanying slight inaccuracy of co-ordination,
but the desired end is always attained. Apparently the ataxia is
not dependent on sensory defect.

In every instance Babinski’s sign is absent; that is to say, the
normal flexor response is obtained. The other cutaneous reflexes
are normal or absent.

Disturbances of sensation are of prime importance. Objective
changes are met with, involving touch, pain, and temperature senses;
the anaesthesia is never absolute, and is more marked peripherally
than centrally. There is usually some failure to appreciate the
niceties of the localisation of touch, delay in recognising stimuli,
some atopognosis, and some widening of Weber’s circles.

Deep sensation is more definitely affected: there is complete
loss of the muscular sense, and sometimes diminution or loss of
pallaesthesia. Astereognosis is frequent, and the sense of weight
and of resistance is equally at fault.

Subjective alterations are very significant; we meet with
paroxysmal pains on the affected side, referred usually to the skin
or to tissues just below it, and radiating throughout the limbs.
Sometimes any touch suffices to evoke them. Associated with the
pains are various paraesthesiae: occasionally there is hyperaesthesia
of the hemiplegic side, sometimes an “anaesthesia dolorosa.” Some
times the pain prevents the patient from moving his limbs,
suggesting a resemblance to what is known as “ akinesia algera.”

Sphincter troubles are not unknown. Vasomotor, trophic, and
secretory disturbances are fairly frequent. Hemianopia may occur
if the posterior and inferior part of the optic thalamus be involved
in the lesion.

Pathological evidence is offered by the authors to show that
the clinical picture which has been sketched is associated with
destruction or alteration in the postero-extemal division of the
external nucleus, together with part of the middle and internal
nuclei and the corresponding fragment of the internal capsule.
The motor defect is in proportion to the extent of the capsular

ABSTRACTS

649

lesion, not of the thalamic. Experiments on apes make it clear
that a local lesion in the thalamus does not affect motility. The
sensory disturbances are obviously the result of thalamic involve¬
ment. S. A. K. Wilson.

REVISION OF THE QUESTION OF APHASIA. THE THIRD
(358) LEFT FRONTAL CONVOLUTION DOES NOT PLAT ANT
SPECIAL ROLE IN THE FUNCTION OF SPEECH. (Re¬
vision de la question de l’aphasie. La troisi&me circonvolution
frontale ne joue aucun rfile special dans la fonction du langage.)
Pierre Marie, La semaine mSdicaie, May 23, 1906, p. 241.

The results, however startling they may appear, to which Professor
Marie feels himself committed, have been obtained by the clinical
and pathological examination of fifty cases of aphasia which have
occurred in his service at Bic6tre.

Marie’s first generalisation is, that in every case of aphasia there
exists more or less pronounced inability to comprehend spoken
language. An aphasic, however Blight be his failing, can never
execute correctly any complicated request. Yet this does not
arise from any word deafness, because if the question he asked
clause by clause, he understands and obeys accurately enough.
It follows that there must be diminution in his intellectual capacity.
According to Marie, sensory aphasia (Wernicke’s) is not the conse¬
quence of destruction of the sensory images of language, because he
does not believe in their existence. Diminution of intelligence is at
the foundation of this form of aphasia. He supports his contention
by a consideration of the question of mimicry. The aphasic’s
descriptive mimicry, by gesture, is often very feeble. Further,
there is commonly diminution in the stock of things learnt by
didactic processes. One of his cases was a chef who made gross
mistakes in the cooking of an omelette. Superficial examination
of cases of aphasia might lead one to suppose that sometimes the
intellect is unimpaired, and this view is supported by the fact that
in aphasics there is exaggeration of the affective reactions. Never¬
theless, careful interrogation and investigation will, Marie believes,
make it clear that defect of intellectual powers is fundamental.

He is not desirous of straining the argumentative value of cases
in which a lesion of the third left frontal convolution was un¬
accompanied by motor aphasia, or cases in which that area of the
cortex was unaffected, yet Broca’s aphasia was clinically manifest.
He agrees, of course, that the two clinical types, motor aphasia
and Rensory aphasia, exist; but he considers the sole essential
difference to be that Broca’s aphasic cannot speak, while Wernicke’s
aphasic can. Both are incapable of understanding complicated
2 u

650

ABSTRACTS

questions. He quotes cases of Broca’s aphasia in which ward
deafness was present, associated with alexia and agraphia (Thorn
and Roux).

His second generalisation, therefore, is that motor aphasia is
sensory aphasia plus anarthria, which anarthria is due to a lesion
of the neighbouring lenticular nucleus. The sole territory, a lesion
of which will produce aphasia, is comprised in the supramarginal,
angular, and upper two temporal convolutions on the left side.
Any lesion in this area will cause aphasia: the degree of the
aphasia will depend on the extent of the lesion. This is merely a
specific instance of a synthetic dogma to which Marie assigns great
importance: the global production of cerebral hemisyndromes by
the lesion of only a portion of the zone from which they arise.
Another instance may be quoted, viz. his belief that there is no
localisation in the internal capsule, and that a slight limited lesion
there produces a slight hemiplegia in face, arm, and leg together.
The degree of hemiplegia depends on the extent of the lesion.

As a result of his study of pathological material, Marie con¬
cludes, and gives anatomical reasons for his conclusions, that—

1. If the lesion be anterior to a transverse line passing through
the fissure separating the third frontal convolution from the
insula, there is neither aphasia nor anarthria.

2. If the lesion be posterior to this line, and bounded by
another passing through the posterior part of the insula and the
posterior extremity of the lenticular nucleus, there is anarthria.

3. If the lesion be posterior to this second line, there is aphasia.

If there be, clinically, Broca’s aphasia from a lesion of the third

frontal convolution, it is because the lesion is not strictly confined
to the cortex, but involves the isthmus of white matter between it
and the lenticular nucleus. S. A K. Wilson.

SENSORY APHASIA: ITS LOCALISATION AND PATHOLOGICAL
(359) PHYSIOLOGY. (L’aph&ale senaorieUe: sa localisation it »
physiologic pathologiqui.) D&tArinb, La press* mSiiesle,
July 1906, p. 453.

This brief contribution is in part an answer to some of the state¬
ments recently made by Pierre Marie, which necessitate a recon¬
sideration of the question of aphasia.

D^jdrine gives a succinct historical rdsumd of Wernicke’s seneoiy
aphasia, mentioning such men as Bouillaud, Broca, Bastian,
Wernicke, by whose labours the present doctrine has been estab¬
lished. It is possible that all have been mistaken, but the
hypothesis is rather overwhelming, although Ddjdrine admires the
tone of conviction with which Marie has written his article.

ABSTRACTS

651

He proceeds to express his astonishment at the way in which
Marie ignores the whole groundwork of the images of language on
which modern theories are based. For Marie they do not exist;
yet every physiologist and every psychologist is cognisant of them.
Ddjdrine regrets that Marie ignores many well-differentiated forms
of aphasia, subcortical and otherwise, and complains that to
attribute so much to mere "intellectual impairment” is quite
inadequate, in view of the point our knowledge of cortical processes
has reached. He emphasises the great and fundamental difference
between word deafness and mental deterioration, and quotes cases,
in his turn, in which not the slightest psychical defect was
discoverable. Disorders of speech are far too specialised to be
explained by such generalisations as Marie offers. “Mental
defect ” of the type described by Marie occurs only when the area
affected is that which contains the images of language, and the
significance of this fact is so obvious that D^rine is content to
let the matter end thus. S. A. K. Wilson.

▲ CLINICAL AND PATHOLOGICAL CONTRIBUTION TO THB
(360) STUDY OF APHASIA (Contribute clinico ed anatomo-
patologico alio studio dell' afosia.) R. Bonfigli, Riv. di
Paid. nerv. e ment., 1006, p. 266.

The patient was a chronic alcoholic who, after a cerebral haemor¬
rhage, was admitted to the asylum at Borne with partial word-
deafness, severe par-aphasic errors in repeating words heard, also
word-blindness, writing from a copy being impossible and spon¬
taneous writing being full of par-agraphic errors, the latter being
somewhat less numerous when writing from dictation. The
autopsy showed two old areas of softening in the left cerebral
hemisphere, the one implicating the cortex and white matter of
the angular gyrus, the other in the posterior fourth of the middle
temporal convolution. The immediate cause of death was a
recent haemorrhage into the lateral ventricle.

The writer discusses the connection between the clinical
symptoms and the appearances found after death. He agrees that
the explanation of the word- and object-blindness, in confirmation
of Bastian’s views, is probably to be found in a destruction of the
occipito-temporal commissure between the visual centre and the
auditory centre, this commissure being interrupted by the lesion
in the angular gyrus. In this particular case the patient could
not be said to have what Dejerine has called the “servile ’’ variety
of writing, inasmuch as even when copying the patient made
“ par-agraphic ” mistakes, and the power of writing to dictation was
not entirely lost He therefore had merely an attenuated form of

652

ABSTRACTS

“ servile ” writing. Bonfigli thinks it probable that there are in¬
dividual differences in different people as regards the cortical
mechanism of words in writing and in reading. In this particular
patient the power of writing to dictation was almost lost. The
greater part of the word-hearing centre having remained intact,
the patient could still write correctly an occasional word to
dictation, whilst in the act of copying he failed completely, being
unable to bring into action the word-seeing centre which in him
was of minor functional importance. It is also of importance to
bear in mind that there are individual differences in the extent to
which the other half of the cerebrum can compensate for a focal
lesion of the speech centres. Purves Stewart.

ON AORAMMATISMTJS AND DISTURBANCE OP INTERNAL
(361) LANOUAOE. (Ueber Agrammatismua und die Stttrong der
inneren Sprache.) E. Heilbronner (of Utrecht), Arch. /.
Psych., Bd. 41, H. 2.

Patient was a young man, aged 19, who one year before admission
received a punctured wound in the left temporal region, followed
by a severe haemorrhage and unconsciousness lasting two weeks.
He was speechless for four weeks, after which he again began to
speak, but with difficulty. For three months there was complete
right-sided paralysis, then some return of movement on that side.
The patient remained in the clinic from June 1902 to September
1903. During the whole of this period patient had an interesting
speech disorder, which showed no change. The author gives the
record of one complete examination of his speech disorder, and
then discusses the symptoms in detail.

Patient showed no difficulty whatever in understanding spoken
questions and demands. He was able to understand written and
printed matter, although he complained that it took him longer to
read the newspaper, and was a little more difficult than pre¬
viously. Patient spoke with some difficulty, and sounds were pro¬
duced only after a considerable latent period. Patient referred to
this as a mechanical difficulty. The most interesting point in his
speech was the presence of Agrammatismus; the French distin¬
guish two varieties—“ negro style with verbs in the infinitive,”
and “ telegraphic style, the phrase being reduced to the elements
necessary for comprehension.” In the present case both these
forms were present; notwithstanding the faulty grammatical for¬
mation the sentences were almost always intelligible. In discuss¬
ing the symptom, Heilbronner first excludes the explanation that,
owing to the difficulty of expression, only the most important words
were brought forth, thus producing a skeleton of normal speech.

ABSTRACTS

653

He refuses this explanation for three reasons: because there was
the same difficulty in writing; because the difficulty was not merely
a difficulty of production, as was shown by the fact that the patient
made errors even in the simple task of giving nouns their correct
article; finally because, when given a few words, he was unable
to compose sentences out of them; he understood the task, was
displeased with his results, but could not produce a satisfactory
result.

Ziehen considers a general intellectual disorder as a necessary
condition of Agrammatismus, and holds that this symptom in an
aphasic means a co-existing mental enfeeblement. In this case
there was no foundation for such an assumption, and Heilbronner
looks upon the Agrammatismus as a symptom of a focal disorder.
He passes on to discuss the anatomical relations of such a lesion.
Sensory aphasics never show the symptom, and in the disappear¬
ance of a sensory aphasia a stage with this symptom has not been
observed, whereas it has been observed during improvement after
motor aphasia. In this context the author refers to a previously
published case of transcortical motor aphasia; the patient, like the
present one, understood speech, could repeat spoken sentences, but
when using the ordinary phrases at his command only rarely
uttered concrete words, while the present patient used these latter
freely, but did not join them together with the usual grammatical
parts of speech. The former patient showed the maximum dis¬
order of the expressive part of the speech mechanism which is
possible without implication of Broca’s area: in the present case
the lesion must be still nearer to the motor centre, and probably
implicates this latter; the implication may be deduced from the
difficulty of expression. A lesion, therefore, in the motor territory,
even leading to Agrammatismus and disorder of internal language,
need not influence the power to find words. In this case, as in Ins
earlier case, Heilbronner does not consider the symptom as a stage
in the regression of a motor aphasia, but rather as an independent
focal symptom, and he holds that the other symptoms leading to
the complete transitory aphasia were merely irritative and owing
to temporary disturbance. The author next passes to the dis¬
cussion of certain symptoms which are usually regarded as an
expression of disturbance of “the internal language.” Owing to
the general mental condition of patient, this disorder was par¬
ticularly easy to define. Patient showed a loss of grasp of the
internal structure of words quite apart from their meaning. While
able to choose the suitable word to express his ideas, and while
able to complete words of which he was given only the initial
meaningless syllable, he was unable to grasp the structure of words
with regard to their letter components. He could pronounce the
individual letters, could pick out letters named and write down

654

ABSTRACTS

letters demanded, but he was unable, if given the component
letters of a word, to put the word together, and could not spell even
simple words correctly. The fact that the erroneous products on
different occasions showed striking similarity points to the import¬
ance of studying not only the disordered function, but also the
incorrect products, to see what are the laws which govern them.
This disorder of the internal language was in striking contrast
with the almost complete absence of paraphasia in the spontaneous
speech of the patient, and with the very slight degree of para¬
graphia which was seen in the spontaneous writing of the patient
In conclusion the author touches lightly the question of the im¬
portance of the motor speech centre for the understanding of
speech, and in this context he emphasises the fact of individual
variation.

The author sums up as follows: 1. Agrammatismus can follow
a trifling motor speech disorder. 2. It may remain stationary for
years, even under favourable conditions. 3. Agrammatismus in an
aphasic is not necessarily associated with mental enfeeblement.
4. Agrammatismus in motor aphasia is a primary defect pheno¬
menon. 5. Well-marked Agrammatismus may co-exist with
practically intact understanding of connected discourse. 6. The
sequels of a light motor speech disturbance can affect more severely
the structure of sentences than the structure of words. 7. As in
the case of Agrammatismus, so with regard to the structure of
words—the disorder is more marked on the expressive side (writ¬
ing) than on the receptive side (reading.) 8. The finding of words
may remain intact notwithstanding Agrammatismus and the dis¬
turbance of the grasp of the internal structure of words. 9. The
laws which determine the nature of the errors made form a suitable
subject for future study. C. Macfik Campbell.

HYSTERICAL DYSARTHRIA. (Dysarthrie Hyst&ique.) Dkbovk,
(362) Arch. GUn. de Hid., July 10, 1906, p. 1746.

The source of this article was a clinical lecture given in respect to
a male patient, aged thirty-two. The characters of his speech
were as follows: The accent was Alsatian, and b’s and d’s were
replaced by p's and t’s. His speech wa3 voluble and nasal, and
could be understood only when delivered slowly. He repeats
words more distinctly than he speaks them spontaneously. There
was no difficulty in naming objects or in writing. He sings and
reads music well; he also draws very well. There were traces of
a right hemiparesis in face, arm, and leg. Still he could thread a
needle and sew with the right hand. The deep reflexes were
slightly exaggerated, but were equal on the two sides. There

ABSTRACTS

655

were no sensory troubles, but lividity of the hands showed that
some vaso-motor defect was present. At times, under the influence
of emotion or of a sudden startling, crises of general trembling
appeared.

The case was then one of dysarthria, of articulatory defect, and
not of aphasia. The decision as to whether that is functional
or organic is not so easily arrived at. A bulbar lesion may be
excluded, for there is no motor trouble with the tongue, lips,
palate, or larynx. There was no physical sign of hysteria beyond
the mental changes; no anaesthesia, hysterogenetic zones, or con¬
traction of the visual field. The patient was very suggestionable,
improvement being obtained by appropriate affirmation. The fea¬
ture most indicative of hysteria was the description written by the
patient of three attacks: it was after the last of these that he was
left with the dysarthria and hemiplegia. The attacks consisted of
trembling, oppression, and several distinctly lyssophobic symptoms.

Ernest Jones.

THE IMPORTANCE OP LUMBAR PUNCTURE IN PSYCHIATRY
(363) AND NEUROLOGY. (Soil' importance della puntura

lombare nella Psichiatria e Nevrologia.) L. Mxrzrachkr,

Riv. di Patol. nero. e merit., 1906, p. 193.

The writer gives an account of the ordinary technique of lumbar
puncture as practised at the Heidelberg clinic. At the outset
of his paper he expresses his surprise that lumbar puncture
has not yet been introduced amongst diagnostic methods in the
Italian clinics of neurology and psychiatry, and laments his failure
to find any references to the subject in Italian medical literature.
Merzbacher’s self-imposed mission of scientific evangelist will
doubtless amuse the Italian neurologists, to whom lumbar puncture
has been familiar both in theory and in practice for some years,
as evidenced by the numerous valuable contributions on the
subject by Italian authors, amongst which we might mention an
article by Pighini (Bivista di Freniatria , 1903, p. 381), which con¬
tains practically all the facts to which Merzbacher now draws
attention, and many more.

The paper is a fair elementary account of lumbar puncture
It re-states a number of familiar facts already established by
neurologists working in the outer darkness of France, of England,
of Italy, and of Germany (outside Heidelberg). Three of the four
illustrations are copied (without acknowledgment) from an article
by Desfosses and Dumont five years ago (La Presse Medicate, 1901,
p. 268). The remaining figure, however, a careful study of three
glass tubes and two pipettes, is apparently original.

656

ABSTRACTS

His chief conclusions are as follows:—Every case of general
paralysis and of tabes shows marked lymphocytosis of the cerebro¬
spinal fluid. In general paralysis there is an excessive amount of
albumin in the fluid; in the case of tabes there is no excess. The
occurrence of syphilis, even without signs or symptoms of disease
of the central nervous system, produces in nine-tenths of cases a
remarkable increase in the number of lymphocytes, the albumin
not being increased. (This statement is not in agreement with the
observations of certain other writers. Thus the reviewer, 1 in a
series of twelve syphilitic cases at various stages of the disease,
found that the increase of lymphocytes was so small as to be
practically negligible.) All forms of meningitis are accompanied
by marked lymphocytosis. There is no form of psychosis in non¬
syphilitic patients which is accompanied by lymphocytosis of the
cerebro-spinal fluid. Lymphocytosis is the earliest and most con¬
stant sign of tabes and of general paralysis of the insane.

Pueves Stkwabt.

PSYCHIATRY.

THE POSITION OF THE ATYPICAL CHILD. W. H. Groszmaxn,
(364) Joum. of Nerv. and Merit. Dis., July 1906.

The public and private schools of to-day are overlooking the
educational needs of a very appreciable fraction of school children.
Educators recognise only the patent cases of idiocy, imbecility,
epilepsy, etc., to the exclusion of about ten per cent of the
total number of children who may be classed as “non-typical,”
or below the “ essential average.” The task of introducing methods
applicable to the child whose mental, moral, and physical condition
is warped, has not been sufficiently investigated.

The “ non-typical ” children are classified as follows:—(1) Con¬
genitally abnormal children ; (2) Congenitally defective children;
(3) Children of rudimental development; (4) Children of arrested
development; (5) Atypical children proper; (6) Pseudo-atypical
children; (7) “ Average,” “ ordinary,” “ typical ” children.

An atypical child is an embodiment of numerous warped
tendencies which continue to deviate from the average to the
abnormal, with increase in age.

The home environment is the direct abettor of the child's
peculiar growth, the parents themselves are frequently abnormal
and they fail to correct their children because their own attitude
is irrational. The beneficial effect which the ordinary school has
upon many children is wholly inadequate to overbalance the effects
of home training.

1 Edinburyh Medical Journal , 1906, p. 429.

ABSTRACTS

657

The private tutor is also a failure in such a home, because his
methods must be modified to comply with the distorted views of
the child’s parents. Such children must be removed into an
environment where perfect harmony and interaction exist between
all influences; rigorous hygienic treatment and the co-operation
of a medical specialist are invaluable. State or municipal institu¬
tions are necessary to obtain this end ; private endeavours can only
indicate the path. From an economical standpoint the results
will warrant the expense, for the atypical child, changed into
a normal man or woman, is a valuable aid to our social structure.
From an educational standpoint nothing can give more promise.

C. H. Holmes.

IRevlew

PSYOOTHERAPEUTISCHE BRIEFS. Prof. Dr H. Oppenheim.

S. Karger, Karlstrasse 15, Berlin, 1906, M. 1.

This is a brochure of forty-four pages in the form of letters supposed
to have been written by Professor Oppenheim to patients under
his care. The letters are really expansions of others actually
written, and they also incorporate advice given orally at con¬
sultations to patients suffering from various forms of functional
nervous disease, which may be included shortly under the terms of
neurasthenia or psychasthenia. The letters are eleven in number,
and each one deals with the treatment of a special variety of
functional nervous disease. They are intended as a guide to young
physicians entering on practice as to how to deal with a very
difficult class of disease, but they deserve to be read and pondered
over by old as well as young. They are written in a quiet,
dignified, impressive style, and each one unveils the course of
treatment that has been adopted, and shows the form of reasoned
suggestion or other method which seems to be most suitable in
each case.

The following are some of the subjects dealt with: a settled
but unfounded conviction of organic brain disease; an eye disease
of psychogenic origin; insomnia and its aggravation by the dread
of the effects of sleeplessness; a dread of the harmful effects of
effort; mental depression and incapacity resulting from an unsuit¬
able marriage; the fears which arise from the discovery of the
existence of an incipient but not necessarily progressive disease of
the spinal cord; the dread of failure of mental faculty in an
artist; vertigo in an aged general, who has become entirely

658

REVIEW

unmanned by the unfounded dread of calcification of the cerebral
arteries; the insufferable egotism of a neurasthenic lady, whose
family had been made to dance attendance upon her during four
years’ rest in bed.

The advice given is so sound and so detailed that it may be
hoped that the letters will be accessible at no distant date to
English and American physicians in their own language.

Alexander Bruce.

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CLINICAL NEUROLOGY AND PSYCHIATRY

GENERAL—

PEARCE BAILEY. Diseases of the Nervous System resulting from Accident
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WILHELM SPECllT. The Clinical Measurements of Fatigue. L Measurement
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MUSCLES—

LENOBLE et AUBINEAU. Une vari£t6 nouvelle de myodome oong£nitak
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ROCHARD et de CHAMPTASS1N. G6n6ralit6s sur le muscle dans ses diver?
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PERIPHERAL NERVES—

P. RUDAUX. N6vrites gravidiques. Aixh. oin. de mid., juillet 81, 1906,
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SPINAL CORD—

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BKAHY—

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MENTAL DISEASES—

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■Review

IKleuroloGS anb fltescbiatrs

Original article

TYPES OF THE DEVOLUTIONAL PSYCHOSES . 1

By CLARENCE B. FARRAR,

Assistant Physician and Director of the Laboratory, Sheppard and Enoch

Pratt Hospital; Assistant in Psychiatry, Johns Hopkins University.

As a foreword to the subject of the Epochal Psychoses, one phase
of which claims our attention in the present discussion, I should
like to refer to several points of view from which the attempt
has been made to interpret forms of insanity in general.

We have heard much of the warfare of the so-called symptoma¬
tology and the clinical methods, and their varying fortunes
are familiar to alL Of necessity the symptomatology method
came first, and until the emancipation of psychiatry from the
blighting control of theology and the uncertain authority of
speculative philosophy was guaranteed, it represented the only
avenue of approach. In its 1 most primitive form the symptoma¬
tology method recognised but very few distinct diseases of the
mind ; these were assumed to be determined by the most con¬
spicuous symptom in the disease picture, and naming this
symptom constituted the diagnosis. Etiology, course, and
outcome of the psychosis were of secondary importance in so far
as the identification of the pathologic condition of the hour was
concerned. To what errors the symptomatology method may

1 Presented at the Toronto Meeting of the British Medical Association, 23rd
August 1906.

R. OF N. & P. VOL. IV. NO. 10—2 X

666

ORIGINAL ARTICLE

lead is shown in the attempt of Las£gue to construct out of his
cUlire de persecution a disease entity from the symptom picture
alone without reference to subsequent course or termination.
Indeed Las£gue expressly stated that he had purposely avoided
taking account of the fate of his patients, declaring that the
disease was characterised and determined by the symptom
complex of a certain stage. It is this view, often unconsciously
followed, which has stood in the way of accurate discrimination
and the deeper appreciation of the nature of mental disease pro¬
cesses even up to the present day.

The beginnings of psychiatric differentiation we nevertheless
owe to the symptomatology method. It furnished the stepping-
stone for the work of Pinel and Esquirol in launching the
modem science, and culminated finally in the masterpieces of
symptomatology psychologic analysis of Wernicke the pilot-
alienist, who died last year.

The clinical method was the outgrowth of the nineteenth
century. It had been discovered that the peripheral appearances,
for example of mental depression or exaltation or of psychic
enfeeblement, such as had stood for the earlier symptomatology
entities, were not sufficient for the determination of individual
diseases, and that indeed these several states might occur in the
most varied conditions, differing widely from each other in
etiology, course, and event. The clinical picture therefore began
to take a biographic perspective of mental diseases. The method
was new and the way beset with diagnostic difficulties, and in
the face of these the extreme conclusion was reached that there
was but one form of mental alienation, the four-stage insanity of
Zeller, of which the conditions of depression, excitement, and
weakness represented only different symptomatology phases.

From this confusion of despair of the possibility of clinical
differential diagnosis there was, however, soon a recovery in the
attempt of distinguished clinicians in various countries to
separate from the chaos of material certain so-called typical
disease forms, taking into account the personal and family
antecedents, the various etiologic factors, the entire course of the
disease, and the fate of the patients.

The clinical method has resulted thus in the setting up of a
number of pathologic types, such as the folic cireidaire of
Falret, or the folic & double forme of Baillarger, the German

ORIGIN AX ARTICLE

667

successor of which is the manisch-depressives Irresein of
Kraepklin ; the Vesania Typica or Katatonie of Eahlbaum,
and the Hebephrenie of Hecker, the former being the natural
successor of the four-stage insanity of Zeller ; the Amentia of
Meynert ; the dimenu pricoce of Morel and Christian, and the
Dementia Prdcox of Kraepelin.

Assuming as it does that the course and outcome are the
determining factors of the psychosis in contradistinction to the
symptomatologic method which looks primarily at the disease
state as it exists, the clinical method has been aptly described
as offering a longitudinal section of disease, while the symptoma¬
tologic method offers only a cross section.

The growth of the clinical method was the best thing in
psychiatry which the nineteenth century had to offer, and it
brought with it sanguine expectations not destined to be entirely
realised.

With the differentiation of certain typical disease patterns
which large numbers of patients were found to fit by observers
widely distributed, the hope was not unnatural that as know¬
ledge accumulated and differentiation became still more accurate,
new and independent forms would gradually be discovered, as
a result of which the great bulk of undiagnosed material would
finally be used up, each case being assigned in the course of
observation to its proper pigeon-hole, each with its label
attached.

There are many who have realised that this psychiatric
millennium is an impossibility, and who, seeing the decline and fall
of previously accepted conceptions of disease entities and their
replacement by others which tend to undergo the same fate,
have become more or less discouraged, just as did the observers
alluded to of the mid-nineteenth century, of ever arriving at
even an approximate classification of mental diseases.

It has been urged against the writers of text-books of
psychiatry that they concentrate their attention upon the
so-called typical cases, leaving the obscure cases to their
obscurity. Of these the attempt has been made to dispose of
many by describing them as mixed forms, intermediate or
transitional forms, allied forms, combined forms, etc., ad
infinitum of the assumed typical forms. By these subterfuges
the clinical method in the strict sense expresses its disappoint-

668

ORIGINAL ARTICLE

ment, and the question of purity and adulteration of psychoses
becomes a serious one. Thus the position of the classification
sceptics is strengthened.

But to classify is not in itself the aim and end of psychiatry.
The excursion of the pendulum has covered fifty years, and there
are signs that the point of the return swing is near. Already
clinicians are taking a broader view of mental pathology than
that which attempts to discover in every patient some definite
disease-form.

This broader view may be described as the biologic method.
It comprehends the advances that have been made by both the
symptomatologic and clinical methods, but its standpoint is less
dogmatic. It looks at diseases of the mind not so much as
stationary or transitory symptom-complexes, nor indeed alone
as protracted manifestations of individual pathologic processes,
it looks rather at the diseased personality in its entirety. It
includes therefore both the symptomatologic and the clinical
pictures and something more. It is neither a cross section nor
a longitudinal section of disease, but embraces both, and takes
the cubic measurements into the bargain.

The biologic method studies personality first and disease
second; and not despairing at the ultimate futility of absolute
clinical differentiation, it turns rather to the minute analysis of
the perverted functions of individual minds, comparing them
with each other point by point, both in health and disease.
Under the influence of this conception, whatever further growth
the symptomatologic and clinical methods are capable of will
proceed to the best advantage.

II.

Turning now to the Epochal Psychoses, we find that they are
a relatively modern product. The symptomatologic classification
of cases of depression as melancholia, and of cases of excitement
as mania , drew no fine distinctions between such conditions
appearing in youth, in adult life, or in old age, and epochal
differentiation did not go beyond the recognition of the terminal
mental reduction of the aged.

But with the clinical observation that the course and out¬
come of psychoses in many points symptomatically similar might

ORIGINAL ARTICLE

669

differ with the time of life, and that the critical periods favoured
the development of particular forms of alienation, there arose the
concepts of the so-called adolescent and climactei'ic insanity. In
the latter the epochal physiologic changes were assumed to stand
in direct etiologic relationship with the mental derangement, and
many varied forms were classed together under the general head
of climacteric insanity which was found not to be limited to the
female sex, but to occur in men as well, at a corresponding or
somewhat more advanced age.

The pathologic mental conditions of the grand climacteric
are not, however, those of the senium proper, and we are thus
accustomed to separate the psychoses of later life into two
groups—the senile and the prdsenile forms, although the distinc¬
tion does not always hold. That the age of the patients is not
the distinguishing factor is shown by the fact that one may show
evidences of senile decay at forty-five or fifty, while a second
passes through an affect psychosis with recovery at seventy.
Esquirol described two cases in the Salpetri^re of maniacal
attacks in women over eighty years old who got well.

The earliest of the devolutional psychoses appear as a rule
about the forty-fifth year, and fixing upon this as a purely
arbitrary boundary we shall have a period of a decade and a half
or two decades during which occur morbid states predominatingly
of a depressive type, many of which recover, and beyond which
appear by preference the conditions with distinctly senile
•colouring.

It is obvious that all the psychoses occurring in the de¬
volutional period are not necessarily of the devolutional type,
and we must distinguish the accidental cases from the epochal.
Under the former heading are to be included those cases which
are known to occur at widely separated ages. For example,
well characterised attacks of maniaco-depressive insanity, with
or without previous phases of illness, may occur within this
period. Isolated cases of late katatonia are also not unknown.
Various intoxication and infection psychoses, the traumatic
neuroses, the different organic and exhaustion states, amentia,
hysteric and epileptic insanity—all of these may occur during
the devolutional period as well as at other times of life.

Of the organic diseases, paresis, which appears in the majority
of cases after a certain length of time following specific infection,

670

ORIGINAL ARTICLE

occurs for the most part during the earlier prime of life. It may,
however, for patent reasons also develop during the devolutional
period, and in such instances is to be looked upon as an accidental
psychosis, not dependent upon the regressive changes peculiar to
the epoch. With the cardio-vascular psychoses the question is
different. Arterio-sclerosis is in the bulk of cases the ac¬
companiment of later life, and the pathologic mental states
dependent upon it are therefore in a sense specific for the
advanced devolutional period.

The insanity of arterio-sclerosis appears under a variety of
forms which seem to be the direct expression of the structural
and nutritional changes in the central organs. On the other
hand nothing is more common in the senile and prasenile types
than that arterio-sclerosis should be present as a complicating
factor without being the sole etiologic agent, and it is sometimes
possible in such cases to trace the influence of the cardio-vascular
condition in modifying the manifestation of the psychosis. But
whether as primary disease or symptom, the separation of the
morbid mental states of arterio-sclerosis constitutes one of the
most important differentiations among the devolutional psychoses.

A second group of cases comprises the involutional sexual
phrenopathies, including perhaps the prasenile persecutory forms
{prasenile Becintrdchtigungsivahn, Kraepelin).

A third form is represented by the presbyophrenia oi
Wernicke.

With the mention of these types we shall pass at once to
the group in which our present interest centres—the devolutional
depressive forms.

First comes the condition of affect-depression known as
melancholia. Various observers have noted that the depressive
psychoses in old people run a somewhat different course and
depart symptomatologically from the depressive states of younger
individuals, and have thus distinguished between the melancholia
of later life and that of earlier years; but this viewpoint has
become most conspicuous through Kraepelin, who draws a hard
and fast line between the two conditions, and reserves the term
melancholia exclusively for the involutional cases.

The melancholia of Kraepelin is still a distinctly wide¬
mouthed receptacle in spite of the fact that the disease-concept
is a very much narrower one than that of the melancholia of tie

ORIGINAL ARTICLE

671

symptomatology school. Kraepelin includes under melan¬
cholia “ all pathologic conditions of anxious depression in later
life, which do not represent phases of other forms of insanity.”
The breadth of the category is adequately expressed in the defini¬
tion. It comprises cases of quiet affect depression (i melancholia
simplex ); active cases with marked apprehensive anxiety ( melan¬
cholia activa vel agitata), which may culminate in raptus melan-
cholicm; and finally, fantastic depressive delusional conditions,
and even continued forms accompanied by depression and ending
in progressive senile deterioration. It is in this broad field of
symptomatologically heterogeneous conditions that we are
endeavouring to discover types which may possibly be clinically
distinct.

As to the relations between melancholia and the depressive
phases of maniaco-depressive insanity, two conditions which
Kraepelin wishes to see clearly distinguished as independent
and individual diseases, there exist unreconcilable differences of
opinion, and there are not a few who are unable to see in
involutional melancholia anything else than one of the manifesta¬
tions of maniaco-depressive insanity, modified, perhaps, by the
time of life. The peculiar ideas of sin, unworthiness, and future
punishment which constitute one of the important symptoms of
the involutional cases, are by no means always present, and may
also be encountered in young individuals. The same is true of
the anxious affect state. Moreover, one of the emphasised
diagnostic criteria of maniaco-depressive insanity or circular
depression, that of periodic recurrence, is not at all uncommon
in involutional depression.

One would doubtless be near the truth in saying that involu¬
tional melancholia represents a condition of psycho-motor and
affect depression, such as may occur at any time of life, and that
its peculiar colouring, by which it unquestionably differs from
depressive cases in earlier life, is due simply to the epoch.
While therefore in these cases we confidently look for certain
symptoms which are much less likely to be in evidence in
younger individuals, and which may be said therefore to be in a
certain sense specific, they are specific nevertheless only in the
sense in which the old man by reason of natural structural and
functional alterations in the central organs acts and thinks
differently from the young adult. Thus, while during the earlier

672

ORIGINAL ARTICLE

and mid years of life the affect psychosis of choice is maniaco-
depressive insanity, and during the later years a more or less
specific form of depression occurs, yet some of the symptoms of
this latter disease are not absent from youthful cases, and
correspondingly, definite attacks of maniac-depressive insanity
are not infrequent in the devolutional period.

The assumed clinical distinctions are rather biologic differences,
and are closely associated with the psychologic metamorphosis
of age. This view is further supported by the facts that in one
instance a well-defined attack of circular depression may appear
for the first time in later life and present the pathognomonic
features of the psychosis—subjective insufficiency with affect
depression, and psycho-motor inhibition,—while in a second case
of maniaco-depressive insanity with recurring depressive attacks,
the later phases may show unmistakable epochal modifications
and take on more or less the complexion of involutional
melancholia.

It is even possible to trace the metamorphosis. Take the fed
of subjective insufficiency of circular depression. The normal
adult lives in tense relation with the objects of his environment,
he maintains himself in a state of ready adaptability, reac¬
tions follow quickly and easily, but nevertheless as a result of
deliberation or at least with conscious approval. If now
the ready succession of the psychic elements be functionally
interfered with and consciousness remain unclouded, a subjective
feel of insufficiency is the inevitable result.

In the patient overtaken in the devolutional period on the
other hand, with his waning relational tenseness and weakening
powers of adaptation, whose reactions are rather those of habit
and custom than of conscious deliberation and logical choice,
under the influence of pathologic depression the subjective in¬
sufficiency becomes subconscious and is reflected in a conscious
uncertainty and insecurity, which are the essential conditions of
the anxious apprehensive states of certain of the devolutional
cases.

Further, the objective symptom of psycho-motor inhibition in
the circular cases is significant not only of a psychosis but of a
time of life as well Psycho-motor inhibition is the outward
expression of the resistance of an habitually active organ to
hindering influences of a functional nature, it is the counterpoint

ORIGINAL ARTICLE

673

of the life of action which straggles to make good, it is analogous
to the brake on the wheels of an engine at full steam. It is
therefore in a sense a positive symptom.

In the old man on the contrary the gauge is low, and the
wheels tend to slacken their speed, so that in the presence of
pathologic depression the effect of the brake is less conspicuous,
although not entirely absent, and there may thus result a condi¬
tion of apparent indifference or even apathy which is characteristic
of a group of devolutional cases. The positive symptom has
been replaced by a negative one.

These observations, while in no wise under-reckoning the
value of the clinical differentiation of epochal depressions,
emphasise nevertheless the biologic consanguinity of these affect
states at different times of life.

III.

In the great group of depressive psychoses of the devolu¬
tional period there are unquestionably various sub-types, if not
distinct clinical forms, and with a view to ascertaining in how
far such a differentiation is justifiable, we have been following
carefully in the Sheppard-Pratt Hospital in Baltimore a number
of the patients belonging to this group.

Our results, which thus far are imperfect, only partial, and
thoroughly provisional, I have summed up very briefly and some¬
what too schematically in the accompanying chart (p. 683). An
absolutely complete representation of the facts in such a chart
would defeat its purpose in making it too wordy and complicated.
In the present instance we have merely seized upon the im¬
portant points as they appeared to us, and emphasised them.
It must of course be understood that these observations are in
an entirely fluent state, and have nothing to do strictly with
what might be spoken of as final conclusions.

A trite remark may nevertheless here be accented, namely,
that in the symptomatologic analysis of cases there is no single
characteristic which is pathognomonic of or limited strictly to
any one disease-type. In the conditions we have been studying
certain symptoms run through them all, although in varying
degrees of intensity, some features being exaggerated in one con¬
dition and inconspicuous in another, while other symptoms on
the contrary are so constant and so pronounced in a given

674

ORIGINAL ARTICLE

disease-state, that taken together they lend a certain provisional
definiteness of outline and colour to the picture.

Our cases have been analysed with regard to about one hundred
and fifty of the more important normal and abnormal elements
of the mental life and physical status of the devolutional period.
In our chart only a very few of the particularly representative
elements have been indicated, and, as will be seen, they concern
exclusively the psychic sphere. Other points will be referred
to in discussing the individual conditions.

IV.

Under true melancholia we have included a fairly definite
and well circumscribed clinical picture, with confines distinctly
narrower than those of the involutional melancholia of
Kraepblin. It comprises cases which previous to the forty-
fifth year are reported to have been mentally sound, but which
during the fifth or sixth decade pass through one, sometimes
two attacks of affect depression lasting one or more years.
Neither sex is spared. In women the psychosis may be
associated with or soon follow the menopause. In such cases
the patient may get well and a number of years later suffer a
recurrence from which she may or may not recover. The
depression is unaccompanied by maniacal phases or symptoms.

Melancholia as here understood is characterised by fairly
normal sensation and orientation, an affect depression which may
lead to odium vitas and suicidal acts, a narrowed egocentric associa¬
tion, thought processes tolerably active within their confined
circle, introspection, self-abasement, auto-accusation, exaggerated
ideas of sins committed, often the unpardonable sin, and of future
damnation. The chief lesion of consciousness is in the idea of
the Ego, and the disease may therefore be designated as an
Autopsychosis. Associated with this primary lesion, somato¬
psychic delusions, expressed as ideas of change and derangement
in the patient’s physical economy, are not uncommon. Con¬
sciousness is blackened by a deep-dyed religiosity ; the patient
is too wicked and vile to be tolerated among men, to be given
food and drink, or even to be seen. He has sinned basely
against his family, against mankind, and against the Most High.
He has violated all the Commandments, his vileness reeks to
heaven, his body will be destroyed by the most exquisite torture,

ORIGINAL ARTICLE

675

and his perjured soul committed to the everlasting flames.
Indeed, to make a realistic comparison, the whole picture is quite
such as a susceptible individual might be expected to have
presented after listening to the sermon of Jonathan Edwards
on “ Sinners in the Hands of an Angry God.”

In all of these beliefs the patient displays a striking
subjective certainty which admits neither of doubt nor of argument.
It is the time of life to be dogmatic, and this tendency is
reflected actively in the psychosis.

The depth of the lesion is shown in the autognosis. Insight
is very defective. The patieut is persuaded that he is in full
mental health—it is his soul which is lost, not his mind. He
would to God it were nothing worse than a disease of the mind,
but conscience convicts him otherwise.

In this condition the feel of subjective insufficiency and
incapacity common in the circular forms is likely to be incon¬
spicuous or absent. The patient may believe himself quite
capable of resuming and carrying on his usual occupation, and
his reasons for not doing so are bound up in his autopsychic
delusions.

The psychic inhibition , which is at the bottom of the sense of
circular subjective insufficiency, is not a prominent symptom in
melancholia vera during the acme of the psychosis, while in the
circular cases it is exactly at the height of the disease that it is
most pronounced. During the prodromal and early stages of
melancholia a mild degree of inhibition is common, and this is
the rule in fact, with all cases of affect depression ; but with the
development of the psychosis and the unfolding of the auto¬
psychic ideas with concomitant egocentric narrowing of con¬
sciousness, the pathologic thought processes tend to become more
and more fixed and habitual, and flow in their limited channels
with the readiness of settled convictions, in the presence of
which psychic initiative and deliberative choice are conceived
not only as futile but unnecessary.

Finally, it is to be noted that in the cases under discussion a
condition of the effect expressed as anxiety or apprehensiveness
is seldom entirely lacking. It may appear only occasionally
and in a mild form, or may reach such a degree of intensity
as to make life very distressing to the patient. This anxiety is
always recognised and understood by the subject as such, and is

676

ORIGINAL ARTICLE

the logical outgrowth of the depressive content of consciousness
with its stamp of absolute subjective certainty. It may be
considered therefore in most cases rather as a secondary symptom
psychologically determined than as a primary manifestation
pathologic per se. The whole situation is perfectly illustrated is
a remark which the physician so frequently hears from patients
of this class—“you too would be worried and afraid and
anxious if you had such thoughts as mine and knew that then
were true" The anxious affect does not depend upon clouding
disorientation, or hallucinosis. It is the natural expression of
the dark thoughts which dominate consciousness, and is strongly
coloured with pathologic remorse.

If now we look at the second group of cases, representing a
condition which for convenience’ sake may be spoken of as
Anxietas Prdsenilis, we find a situation essentially different from
that in melancholia vera. The disease occurs a little later in
life, usually in the sixth or seventh decade, and the great
majority of the patients are women. The morbid process is
deeper-seated and severer, and the outlook decidedly more
dubious. It represents more specifically the regressive changes,
both structural and functional, of later life.

Both primary and secondary sensation are involved, these
terms being used in the sense of the primary and secondary
identification of Wernicke, and a degree of disorientation is
therefore the rule. Fallacious sensation is often present, usually
in the form of sensory misinterpretations, but fleeting isolated
hallucinations of hearing and sight may also occur.

The psychosis is pre-eminently the expression of severe
defect in the power of mental assimilation and adaptation, and
undoubtedly rests upon a considerable diffuse cortical change.
Arterio-sclerosis is a not infrequent complication.

With the diminished power of quickly and correctly
interpreting sensory impressions and reacting to them, there
is born a condition of subjective uncertainty and insecurity, a
sense of strangeness, not-at-homeness of the Ego in the presence
of its environment. We see here a lesion in the relational
sphere of consciousness, or the allopsyche, and in this sense the

ORIGINAL ARTICLE

677

condition may be spoken of as an allopsychosis. To the patient
the surrounding objects of the material world acquire a character
of unnaturalness or even unreality, and this sense of objective
strangeness and unreality may extend to include the patient’s
own body. Thus the Ego finds itself lost and adrift in a sea
of sensory unrealities and misinterpretations. These are
uniformly of a depressive character, determined primarily no
doubt by the dysphoria of organic ill-functioning of the
devolutional period. From the subjective uncertainty and
objective unreality there come fear and vague alarm, an in¬
voluntary and uncontrolled sense of apprehension in the face
of every new impression. In proportion as the affect sphere of
consciousness is active, this cloudy apprehensiveness may
develop into a veritable panic of agonised fear with lively
motor agitation and a tendency to self-mutilation. This status
anxietatis may persist with slight remissions for weeks or months,
and represents the most essential character of the psychosis.

The condition is utterly dissimilar to the anxiety referred
to in connection with melancholia. There the feeling expressed
a dread of awful things to come, clearly conceived and sub¬
jectively certain, complicated with anxious remorse for awful
things in the past of which the patient accused himself of being
the author. The situation was therefore one of apprehensive fear
of the awful certainties of existence. Here, on the contrary, the
feeling is one of dread and anxiety less of the future than of
the present, alarm before the unknown, uncomplicated with
remorse; it is a fear of the awful uncertainty of existence.

A further important distinction between true melancholia
and the condition here described lies in the character of the
content of consciousness itself. In anxietas prdsenilis autopsychic
ideas such as were described in melancholia play no part.
There is no auto-accusation, no self-abasement, no alloistic self¬
blame. Religious delusions with remorse and dread of future
punis hm ent do not enter the scheme. Indeed, in spite of their
uncertainty, patients of this class regularly reply in answer to
questions that they have no particular regrets regarding the
past, and that they have done nothing for which they should
suffer.

The autognoses of the two conditions placed over against
each other well illustrate their differences.

678

ORIGINAL ARTICLE

From the melancholiac we should perhaps get something
like this:—“ I have no complaint to make, I know my condition,
my mind is clear. My body is diseased from my evil life and
my soul is in torment, but I deserve it all, and what I now
suffer isn’t a circumstance to what is still in store for me. I
have been false, unnatural and wicked from my birth, the most
sinful creature alive, and am to be made an example before the
world. It is true. God has revealed it to me through the
voice of conscience.”

From the anxieuse we should have this:—“ I don’t know
what’s wrong with me ; I can’t get right; nothing seems the same
to me any more, and I always have such fears, such awful
anguish. I don’t know what makes it. I never did any one
any harm. I don’t know where I am. I don’t know what to
do, but this is not the right place: I don’t belong here. Don’t
let any one kill me.”

The facial expression of the anxieuse reflects the two chief
elements—psychic uncertainty and fearful apprehension, dis¬
played in the characteristic frontal omega contraction.

With the development of the psychosis the mental horizon
may become progressively narrower. Initiative in thought and
action is nil; all psychomotor activity assumes more and more
the quality of the habitual; the habitual becomes the reflex;
the reflex may become automatic. The laws of inertia hold,
and reflex movements once begun tend to continue. Thus we
get the symptoms of verbigeration and oft-repeated, stereotyped
motions of the body or its members, and these finally may
assume a definite rhythmical form. These movements are
thoroughly characteristic. They arise sometimes as a result of
stimuli from without, at others with no discoverable cause, and
still again from demonstrable processes going on within the
patient’s body. Thus, for example, during a state of severe
anguish the respiratory rate is accelerated, and at the same time
waving or beating movements of hands or arms may appear,
keeping time with respiration; or the patient may utter an
ejaculation of despair to the same rhythm, pronouncing the same
word or phrase with identical intonation time after time with
each respiratory excursion.

The subjective uncertainty and the tendency to reflex
rhythmical expression favour the development of a degree of

ORIGINAL ARTICLE

679

suggestibility such as would be quite foreign to the true melan¬
choliac. Thus in certain cases the automatism of verbigeration
may be interrupted by the observer, and the set phrases of fear
replaced by others at suggestion, even quite contradictory to the
former expressions and out of keeping with the affect tone.
This phenomenon, in which the general bearing and the
countenance reflect uncertainty and anguish, while on the lips
is a phonographically repeated phrase of confidence and joy, is
very striking indeed.

One or two concrete examples of the character of the
rhythmical verbigeration in anxietas prdsenilis may still be given.
They display at the same time perfectly the fundamental char¬
acteristics of the psychosis. One woman in whom the sense of
subjective uncertainty was extremely pronounced, repeated fre¬
quently this phrase over a period of four years,—

“ I don’t know where to go, nor what to do;

Nor what to do, nor where to go,”

giving to the words a chanting rhythm which never varied.

Another female patient, a German, chanted in the same
manner the following:—

“ Ich weise nicht wo ich bin,—

Und wer ich bin.—

Und was ich bin,—

Und wie mir ist,”

During the earlier part of the course of the disease the
anxious affect tone may be fairly constant, merely showing
variations in intensity. Later there appears to be a tendency to
remittance, or indeed an alternation of states , in which periods of
acute anguish with sensory misinterpretation, motor unrest and
rhythmical verbigeration, alternate with intervals of quiet in
which the face is relaxed and the patient lies tolerably motion¬
less, inaccessible, even mute.

Sleep is as a rule very much better with these patients than
with melancholiacs, and the appetite may even be ravenous.

The tendon reflexes are regularly exaggerated, sometimes
greatly so. The pupils are usually small and slightly sluggish.
Temperature is a trifle subnormal, pulse moderately accelerated
in most cases, and the blood pressure elevated. A varying degree
of arterio-sclerosis is common. In some instances a definite

680

ORIGINAL ARTICLE

parallelism can be demonstrated between the intensity of the
anxious effect and the height of the blood pressure, treatment
directed toward lowering the blood pressure and pulse rate also
relieving to a degree the pathologic affect. While therefore in
many instances the connection between cardio-vascular condition
and mental state is unmistakable, yet this does not hold for all,
and in typical cases such as we have been describing, the arterio¬
sclerosis should perhaps be considered only as a complicating
factor.

It is impossible here to outline completely the clinical picture
of anxietas prdsenilis. There will be occasion to recur to the
subject later, and we shall therefore leave it for the present with
this preliminary sketch. It has seemed to us to be clearly dis¬
tinguishable from melancholia proper, although most authors
mention its characteristics, or part of them, only in common
with those of the latter disease. The prognosis is distinctly less
favourable than in melancholia vera.

VI.

There remains to refer briefly to a third form of devolution^
depression which differs in certain essential features from both of
the previously described types. It appears to attack men by
great preference, and in its general character may be described as
an apathetic psycho-motor depression.

Individuals who all their lives have been accustomed to
arduous physical toil, or sometimes close mental application with
the worries of commercial life, and who continue their labours
unmodified or perhaps with increasing responsibilities into their
later years, sometimes sink gradually during the devolutional
period into a state of inertia, indifference, and mild depression,
withdrawing from their usual occupation and becoming taciturn,
unsociable, morose, or even resistively perverse. Occasionally
the onset appears to be fairly sudden after some unusual exertion,
exposure, or worry, when the patient declares that it is of no use
any longer, he cannot keep up the unequal struggle, he has
played his game out, he is used up and done for.

We have to do here undoubtedly with the expression of
accumulated fatigue through years of monotonous labour, with
insufficient variation, recreation, and recuperation. The actual

ORIGINAL ARTICLE

681

situation is often fairly appreciated by the patient himself, and
his autognosis may be tolerably accurate, although his mental
state does not allow him to seek explanations or trace connections
between causes and effects.

In the feeling of subjective insufficiency we see a symptom not
encountered in either of the two forms already described, but
common in the affect depression of circular insanity. To this
latter type, however, the apathetic depression of senescence bears
little resemblance. It presents no suggestion of maniacal
symptoms, either as phases or complications; it shows no vivid
affect, and the psycho-motor inhibition of the circular cases is
replaced by a simple psychic depression. It is not so much a
question of the overcoming and suppressing of a tendency to
action such as would be characteristic of earlier years; it is rather
a more or less complete lapsing of the action impulse altogether.
The change is thus pre-eminently a biologic one, as has already
been suggested; indeed the ensemble in depressio apathetica im¬
presses one as negative, both subjectively and objectively.

Sensory falsifications play little or no part in the development
of the psychosis. At the beginning the patient may entertain
vague ideas of harm befalling him, but they are uncertain and
fleeting, and do not lead to the development of an anxious state.
He may even be mildly self-accusatory in that he upbraids him¬
self for his sloth. For the most part, however, he remains quiet
and uncommunicative, expressing neither hope, nor fear, nor
desire, although commonly enough a mild degree of nostalgia is
present even though not actively voiced.

It is the rule to observe in the condition we are considering a
certain amount of subjective uncertainty. This, it will be remem¬
bered, is one of the cardinal symptoms of anxietas prasenilis.
The setting of this element is nevertheless quite different in the
two psychoses. In anxietas prasenilis the sense of uncertainty is
closely associated with a degree of disorientation and mental
anguish, usually with conspicuous disturbance of secondary
sensation, and unaccompanied by well-marked conscious in¬
sufficiency. In depressio apathetica , on the other hand, sensation
and orientation are usually intact, and the uncertainty is accom¬
panied by apathy instead of anxiety. Indeed, the fundamental
lesion here is in the relational warmth of the Ego to its environ¬
ment, in the patient’s interest in life and its activities and

2 Y

682

ORIGINAL ARTICLE

pleasures; as a result of which, together with a fairly preserved
insight, suicidal tendencies may become manifest, though they
usually lack the energy of execution. Moreover, the failing
interest and weakened voluntary attention bring it about that
mental impressions are faint and easily lost Objects of the
environment are not vividly reflected in consciousness, and it
results that the external world becomes to the Ego to a certain
degree cold and colourless, distant, vague, or unreal. This sense
of distance or vagueness is, however, distinct from the objective
unreality of anxietas prdsenilis. There this symptom was deter¬
mined by misinterpretations with disturbed affect,—a pan-
condition; here it is an element of diminished psychic activity,
—a hypo-condition.

From all of these factors it follows that a certain defect of
memory is seldom entirely missed in patients of this class, shov¬
ing itself chiefly as a disturbance of the recording faculty. Of
this defective recollection of current happenings the patients are
themselves conscious, and it contributes its part to the feeling
of uncertainty before mentioned.

In general bearing the patients are for the most part listlea
and indifferent. Their voluntary movements are few, slow, weak,
without purposeful direction. Their power of initiative and
decision is almost nil. Sleep and appetite are usually fair.
Muscle tone is diminished, and the tendon reflexes are likely to
be weak. Blood pressure and pulse are as a rale low, unless
there be a marked degree of arterio-sclerosis.

The prognosis appears to be relatively good.

VII.

In the foregoing discussion of certain clinical types of the
devolutional psychoses the subject is by no means exhausted.
So far as our material has furnished evidence it has seemed to
us that these types were worthy to be considered separately, but,
as has been said, our results are incomplete and distinctly pro¬
visional. What may be the ultimate relations of these various
forms to each other, and to the senile psychoses proper, as well
as to other possible undifferentiated forms, remains matter for
continued observation.

ORIGINAL ARTICLE

683

Melancholia

Vera.

Anxietas

Prasbnilis.

Deprbssio

Apathbtica.

Character

Autopsychosis

Allopsychosis

Hypopsychosis

Primary Sensation .

Secondary Sensation

Hallucinosis .

Psychic Depression .

Motor Depression .

Affect Depression .

Apathy .

Anxietas .

Subj. Uncertainty .

Autoaccusation

Religiose Delusions

Somatopsychic Dels.

Subj. Insufficiency .

Verbigeration .

Insight .

Poor

! Partial

Fair

Sex . .

Both

Female

Male

Prognosis

Fair

Doubtful

Fair

abstracts

ANATOMY.

AN INVESTIGATION INTO THE STRUCTURE OF THE LUMBO-

(365) SACRAL-COCCYGEAL CORD OF THE MACAQUE MONKEY.

Miss M. P. Fitzgerald, Proc. Roy. Soc., Series B, Vol. lxxviii.,
No. B 523.

The present paper deals only with the section area of the grey and
white substance in the various segments of the 1 umbo-sacral-
coccygeal cord. A further paper is promised on the arrangement
of the cell groups at the different levels, and a comparison with
the human spinal cord. J. H. Harvey Pibie.

THE NEUROGLIA FRAMEWORK OF THE CEREBELLUM. E. E.

(366) Southard, Journal of Medical Research, August 1905.

With a large variety of material and by means of Mallory’s
neuroglia stain the author has sought to modify the hitherto
dominant view of the neuroglia framework of the cerebellum with

684

ABSTRACTS

particular reference to the histogenesis of Bergmann’s fibres. He
presents the total findings in cases of syphilis, ischemia, trauma, and
bacterial infection, and concludes that the tissues of the cerebellum
react in a characteristic way to injury. The Purkinje cell layer is
a point of least resistance along which cleavage may easily occur,
especially in macerating brains; moreover, these cells, together with
their dendrites, suffer the maximum injury in impairment of the
blood-supply or from bacterial infection. Severer injuries destroy
not only the Purkinje cells but also the nerve cells of the granular
layer, the neuroglia, however, persisting and reacting in corre¬
spondence with the nerve-cell degeneration.

The neuroglia reaction is characteristic of the several layers
composing the folia. In the medullary centre the gliosis is a
homogeneous feltwork. In the cortex the regular stratification is
fairly definitely preserved. The Purkinje line of cleavage and
degeneration is replaced with a line of neuroglia cells which
produce numerous fibrils forming three layers—(1) a layer of fine
fibrils lying flatwise to the outer limits of the medullary core;
(2) superimposed and also lying flatwise to the medulla, but at
right angles to the first layer, is another layer of fine fibrils. These
two layers of fibrils parallel the contour of the cortex. (3) The
third layer of fibrils is composed of coarser radial fibrils running
vertically with respect to the medullary centre and passing out to
the pia. These latter radial fibrils (Bergmann’s) are the first to
develop and arise from cells lying in Purkinje level, and not from
cells of the inner layers, as revealed by the Golgi method. An
apparent exception to this is noted in reference to the neuroglia
reaction in a case of syphilitic marginal sclerosis of the cerebellum.
The author’s interpretation of the origin of the radial fibres in the
syphilitic lesion is somewhat confusing and complicates the other¬
wise clearly described picture of the architectonic of the cerebellar
neuroglia. Charles I. Lambert.

SUPPLEMENTARY PROCEEDING OF TEE PYRIDINE METHODS
(367) FOR THE RAPID DIFFERENTIATION OF THE RE-
TIOULUM OF NERVE ELEMENTS. (Procedimento supple-
mentare dei metodi alia piridina per la rapida differenziaxione
del reticolo flbrillare negli elementi nervoei.) Donaggio.
Riv. Sper. di Fren., Vol. xxxii., Fasc. 1-2.

This supplementary proceeding, described by Donaggio, which
may be applied to his 3, 4, and 5 methods, is of value, not only
because it shortens the time necessary for differentiation, but also
because it assists in the demonstration of various morbid changes
met with in human pathological tissues.

ABSTRACTS

685

Although the nucleus and nucleolus are not stained by
Donaggio’s methods when applied to normal tissues, it has been
found that in pathological material the nucleolus becomes differenti¬
ated into two distinct parts, a central portion, which has a pale
blue colour, and a peripheral portion, which takes a violet colour.
Those peripheral masses correspond to the basophile constituents
of the nucleolus described by Levi

This characteristic should be of the greatest value in examining
human pathological material.

The various stages of these three methods up to the end of the
staining process remain as described by the author in an earlier
work, but, now, instead of putting the sections into water for
a few seconds and then into spirit to differentiate, they pass from
the staining fluid rapidly through water and then into an aqueous
solution of pink-salt (1), (one part of concentrated solution of
pink-salt to nine parts of distilled water), for one to five minutes ;
this solution should be made fresh each day, because it deterio¬
rates rapidly.

The sections should then be passed into distilled water, which
is changed several times, and care must be taken to see that the
side of the coverslip opposite to that carrying the sections is
cleansed, in order to avoid any precipitate; they are then immersed
in spirit, and become differentiated in a few minutes. The
length of time required varies with different sections ; from two
to five minutes is generally sufficient.

The spirit should only be used for a few sections.

They are passed into absolute alcohol; then to xylol; and
finally the coverslips are cleaned, and the sections are mounted
in neutral balsam.

The preparations should be kept in the dark.

(1) The author uses a concentrated solution of pink-salt
(ammoniated chloride of tin), which may be obtained from C.
Erba of Milan. Note .—It will be opportune here to correct a
mistake which appeared in the description of method 5 which
was published in the Review of Neurology and Psychiatry,
February 1905. At the end of the second paragraph of page 88 is
the following sentence:—“ Now wash in water, changing it a few
times, for 24 hours, and proceed to embed in paraffin.” This
should read:—“ Now wash in water, changing it a few times, for
two to four minutes, and proceed to embed in paraffin.”

R. G. Rows.

686

ABSTRACTS

PSYCHOLOGY.

ON INSTINCT: A Psycho-Physical Study in Evolution and Dinoln-

(368) tion. W. H. B. Stoddart, Joum. of Ment. Sc., July 1906,
p. 491.

The author maintains (1) that volitional and instinctive move¬
ments are performed by different motor tracts of the nervous
system, the former by the cortico-rubro spinal representative of
the pristine nervous system as it exists in birds, the latter by the
pyramidal system; (2) that the volitional motor system, being
evolved and developed later than the instinctive, is earlier and
more readily affected in mental disorder; and (3) that when the
instinctive motor system is attacked the instincts disappear in
the reverse order of their development, and therefore of their
evolution.

The development of the various instincts in the child is traced
in some detail, and an instructive parallel is drawn between the
stages of dissolution as seen in a general paralytic and the
instinctive stages occurring in childhood.

In conclusion the author shows the importance of distinguish¬
ing between volitional and instinctive acts in medico-legal cases.

W. B. Drummond.

PATHOLOGY.

BETBOGRADE DEGENERATION IN THE SPINAL NEEVE&.

(369) S. "Walter Ranson, Joum. Comp. Neurol, and Psychol ., VoL xvi.
No. 4, July 1906, p. 265.

An experimental investigation on the white rat. After section of
the second cervical nerve it was found that one-half of the cells in
the corresponding spinal ganglion disappeared. This ratio was
found very constant in nine cases. Enumeration showed that
many more cells had disappeared than could be accounted
for in terms of medullated fibres cut at the operation. The
number of fibres in the dorsal root is liable to greater individual
variation, but on an average there was a loss of about 17 percent,
and the dorsal roots seemed more susceptible to degenerative
changes in the young than in adult animals. The degeneration in
the dorsal roots apparently cannot without some qualification be
attributed to the degeneration in the spinal ganglia. The
degeneration of fibres and cells was found not to be progressive but
to be completed before the end of the first two months. A good
bibliography is given along with a short summary of the literature.

J. H. Harvey Pirie.

ABSTRACTS

687

LESIONS OF THE NEURO-FIBRILLARV RETICULUM OF
(370) THE NERVE CELL IN EXPERIMENTAL INANITION.
(Lesioni del reticolo nenroflbrill&re della eellnla nervosa nell’
inanMone sperimentale.) Riva, Riv. Sper. di Fren., Vol. xxxii.,
Fasc. 1-2.

The author has applied the methods of Donaggio to the nervous
tissues of adult dogs in order to study the changes in the neuro¬
fibrillary recticulum which are produced by inanition.

The first dog was kept aliye for 48 days without food during
the winter months. On examination it was found that the re¬
ticulum in the cells of the anterior cornua were profoundly
altered. The fibrils were disturbed and were arranged in vortices
and spirals, and in irregular condensations. Some vacuolisation
was also observed. In other cells, and more rarely, there was a
rarefaction of the network in the centre of the cell, and various
nodosities were present at different points of the reticulum; the long
fibrils formed a marked condensation at the periphery of the cell.

The disturbance was most marked in the anterior cornua,
less in the other cell groups. Vacuolisation was common, and in
many instances the vacuoles were filled with a granular substance.

In the medulla and pons the same type of change was found,
especially in the cells of the motor nuclei. Very little alteration
was present in the cells of the cerebral cortex, and those of the
posterior root ganglia were practically unaffected.

In the other animals experimented on these profound changes
of the reticulum were absent, but many of the cells showed a
marked degree of vacuolisation, even in some of the cell processes.
This vacuolisation did not lead to much change in the surrounding
reticulum.

The results obtained in these experiments suggest that the
reticulum of the nerve cells suffers little injury from inanition
when acting alone, and the more severe lesions, noticed in the
first dog described, depended on the fact that the experiment was
carried out in the winter, and the alterations were therefore the
result of the combined action of cold and inanition.

R. G. Rows.

THE EFFECTS OF THE COMBINED ACTION OF FASTING
(371) AND COLD ON THE NERVE CENTRES OF ADULT
MAMMALS. (Effetti dell’ azione combinata del digiono e del
freddo sui centri nervosi di mammtferi adulti.) Donaggio,
Riv. Sper. di Fren., Vol. xxxii., Fasc. 1-2.

Earlier researches of Donaggio and Fragnito have shown that the
neuro-fibrillary reticulum of the nerve cells of the adult mammal

688

ABSTRACTS

possess considerable powers of resistance to injurious agents. In
the present inquiry the author deals with the changes produced
in the reticulum of the nerve cells by the combined action of
fasting and cold. Neither of the factors, when acting alone,
produces any marked alteration in the fibrils of the reticulum, but.
in animals which have been subjected to their combined action,
marked lesions are constantly found.

In the rabbits examined by the author the cells of the grey
matter of the spinal cord showed much change. In the cells of the
anterior cornua the network was thinner than normal and
intersected by large bands, which were uniformly and strongly
coloured, so that there was no trace of any structure. Sometimes
these bands were scattered throughout the cytoplasm; in other
instances they were localised in the thicker reticulum around the
nucleus; in other cells the meshes were much larger than normal

The cells of the remaining grey matter showed even more
serious alterations. The reticular structure had disappeared, and
was replaced by large bands, often fusiform, running through the
cytoplasm, and sometimes even into the cell processes. The
distribution of these bands was quite irregular.

Similar changes of the endocellular reticulum appeared to a
greater or less extent throughout the whole of the central nervous
system, but the cells of the cerebrum were generally only slightly
affected.

Vacuolisation of the cells, especially of those in the spinal cord,
was frequently present.

Another interesting condition noticed was that, although the
nucleus remained uncoloured, the nucleolus assumed a pale blue
colour in its centre, while at its periphery lay three or four masses,
which sometimes showed a granular structure, but much more
frequently were stained uniformly violet. They correspond to the
peripheral basophile contents of the nucleolus described by Levi
In the nerve cells of the normal animal these masses are not
coloured by the methods employed in this research—the methods
of Donaggio for staining the endocellular reticulum—and their
presence is an indication of some pathological change which allows
them to assume the violet colour. In one rabbit vacuolisation of
the nerve cells was very frequently seen, and it was observed that
they contained some substance in the form of short rods or some¬
times in irregular masses which were similar to those described by
Cajal in the vacuoles found in the nerve cells of animals which
had died of rabies.

It has also been found that various toxines, which by them¬
selves have little effect, can produce serious lesions of the
neuro-fibrillary reticulum when combined with cold.

These researches also suggest that a greater importance should

ABSTRACTS

689

fee attached to the so-called rheumatic causes in the production of
nervous diseases, and further, that the rheumatic cause is able to
exert its influence only when it finds a toxic or infective-toxic
basis on which to act R. G. Rows.

CONTRIBUTION TO THE PATHOLOGICAL ANATOMY OF
(372) PARKINSON’S DISEASE. (Contribute alio stndio doll 1
anatomia patologica della malattia di Parkinson.) Riv. di.
Paiolog. nervosa e mentals, Yol. xi., F. 4, pp. 145-70. Catbla.

The author gives a schematic review of the remote and recent
literature, and appends an extensive bibliography. There is little
agreement as to what constitutes the specific anatomical basis of
this disease. In general the findings have been those of cerebro¬
spinal senility, frequently of an earlier and severer character than
is usual.

The author discusses at length the views held by different
students—a few regarding it as a nervous state without an organic
basis, others esteem it not as a clinical entity but a syndrome.
He concludes with a critical risumi of the more recent neuritic
nnd muscular theories. In the former there is lack of uniformity
in the anatomical findings; in the latter, so far as observed, there
seems to be considerable agreement. He reports two favourable
cases examined in detail by modern methods.

The principal lesions are then described in connection with the
muscles, there being a diffuse and focal increase of the nuclei
which are frequently large and polymorphic, considerable atrophy
of the muscle parenchyma, and practically negative findings in the
neuro-muscular fibres. These changes he regards as occupying the
first place in the anatomical picture and forming the essential
substratum of the malady.

The author reviews the toxic-infective theories held in regard
to mild chorea and Basedow’s disease, and similarly on clinical and
anatomical grounds regards Parkinson’s disease as probably due
to a chronic endogenous intoxication whose specific action may be
on the muscles. Charles I. Lambert.

THE PATHOLOGY OF FOUR OASES OP EPILEPTIC IDIOCY.

(373) Harvey Baird, Journal of Menial Science, July 1906, p. 571.

The author gives the clinical notes and pathological changes found
in these cases, and in his conclusions emphasises certain import¬
ant facts. (1) The gross nature of the lesions in epileptic as

690

ABSTRACTS

opposed to non-epileptic idiocy. (2) The frequency of meningeal
changes, especially of the pia-arachnoid, the constant opacity of
whicn leads him to consider meningitis the primary cause of
epileptic idiocy in many cases. Three of the cases recorded are
supposed to have been due primarily to meningitis in early but
post-natal life, if one can argue from the complexity of the
convolutions; in the remaining case the absence of structures in
the region of the corpus callosum and of sulci in the left frontal
lobe suggests an ante-natal lesion. (3) The larger pyramidal
cells appear to be the last to degenerate. David Orb.

CLINICAL NEUROLOGY.

RHEUMATIC POLYNEURITIS OF CRANIAL NERVES. (Sulla
(374) polineurlte reumatica del nervi cranid.) Forli, JUv. Sper. di
Fren ., Vol. xxxiL, Fasc. 1-2.

The condition of rheumatic paralysis of cranial nerves has been
recognised for a long time, but no agreement as to its pathogenesis
has been reached. It has been considered by some to be a
neurosis, generally hereditary, by others to be secondary to
affections of the ears, by others a real infective neuritis; bat
only recently has the influence of cold been appreciated.

Moebius suggests that it is an infective process determined
usually under the influence of cold. Von Sarbo denies the influence
of cold and of heredity, and attributes the condition to an exposure
of the nerves, due to some anatomical peculiarity of the foramina
through which they pass.

The author describes a case of a railway employee who had
been much exposed to rain and wind, and who developed a lesion
of his 3, 4, 6, 7, 8, and 12 right nerves. The affection came on
rapidly and was accompanied by general malaise, pain, and some
paresis. Syphilis was excluded. The patient recovered rapidly
under antirheumatic treatment. This case was considered to be
a case of multiple neuritis of cranial nerves of rheumatic origin,
due to some infective process developing under the influence of
cold, and attacking the nerves.

R. G. Rows.

PERIPHERAL FAOIAL PALSY, WITH AUTOPSY. (Paralysis
(375) faciale p4riph6rique : autopsie.) Mirall£b, Soc. de Neurol, dt
Paris, July 5, 1906.

The patient was an arterio-sclerotic, who developed a typical right
peripheral facial palsy as the result of a chill, and died rather less

ABSTRACTS

691

than six weeks later of pulmonary congestion, the palsy being still
well marked.

Microscopical examination of the nerve trunk revealed (Marchi)
an intense parenchymatous neuritis, more marked peripherally
than centrally.

In the corresponding nucleus in Che pons (Nisei) the great
majority of the cells were swollen and rounded, with obliteration
of the protoplasmic prolongations; the nuclei of the cells were
distinctly visible and still central, and round them was a pronounced
chromatolysis. The left seventh nucleus was absolutely normal,
as was the nucleus of the sixth on the right side. The cellular
lesion was probably due to a reaction d distance , and the case may
be taken to indicate that no fibres join the facial nerve from the
sixth nucleus. S. A. K. Wilson.

THE NEURITIC TYPE OF PROGRESSIVE MUSCULAR ATROPHY.

(376) A CASE WITH MARKED HEREDITY. Church, Joum. of
Nervous and Ment. Dis., July 1906.

The writer first gives a resume of the leading symptoms of this
disease as stated by Sainton, who collected and scrutinised in
a thesis all the cases published up to 1899. These include a
commonly hereditary nature, commencement usually in the lower
extremities, paralysis of flaccid type not extending above the lower
third of the thigh nor above the proximal part of the forearm,
fibrillary tremors, and frequent disturbances of sensation. Post¬
mortem, there are found interstitial neuritis, degeneration of the
posterior columns of the pyramidal tracts, of the cells in the
anterior horn, and of those in Clarke’s column.

Other cases appearing since those of Sainton are quoted with
references.

Full details are given by the writer of a new case which affords
a most notable instance of heredity, the disease being certainly
present in five successive generations, perhaps apparent in the
sixth, and, according to hearsay, in three prior generations—nine
in alL John D. Comrie.

692

ABSTKACTS

TABES, DURING THE DEVELOPMENT OF WHICH APPEASED
(377) A CHANCRE, APPARENTLY SYPHILITIC. SLOWNESS
IN ANATOMICAL DEVELOPMENT OF THE MEDULLARY
LESIONS. INTENSE PERIPHERAL NEURITIS I N 001
NEOTION WITH AN ARTHROPATHY OF THE KNEE
Verger and de Cardenal, Revue Neurologique, July 15,1906.

The name indicates sufficiently the scope of the case recorded and
the observations upon it. The writers give references to four
similar cases in which a chancre appeared during the course of
tabes. John D. Combos.

THE PHYSIOLOGY OF THE LARYNGEAL CRISES OF TABES.

(378) (Physiologic des crises laryngdes des taWtoques.) Maurice
Faure (Congris de Lille), Revue Neurologique, Aug. 30,1906,
p. 776.

When a particle of mucus passes^" in a normal individual, from the
trachea into the larynx, its presence produces a special effect on the
laryngeal mucosa, and a reflex immediately results in the shape of
a cough or an expiratory “ ahem! ”

For the tabetic, this succession of sensory and motor phenomena
is interfered with: 1st, because the laryngeal mucous membrane is
hypenesthetic or hypoaesthetic; 2nd, because the expulsion reflex
is disordered; 3rd, because there is inco-ordination of the muscles of
respiration.

For these reasons the relaxed diaphragm may be drawn into
the thorax just when it is being expanded by the muscles of inspira¬
tion, or conversely the diaphragm may descend when the thoracic
cage is falling in; in each case there is no change in the volume
and the expiratory effort is annulled. Or the action of the glottis
may be so irregular as to prevent an expiratory column of air from
producing its effect. It is common to observe the reflex cough
determine a series of short, staccato expirations, which have not
been preceded by such inspirations, as will fill the thorax with air,
and are therefore useless.

As a result, the paroxysmal tickling continues, the patient gets
excited, becomes pale and cyanosed, and runs serious risks.

In other cases the whole disturbance is referable to inco-ordina¬
tion of laryngeal muscles in association with anaesthesia of the larynx.
It is obvious that the pathogenesis of these conditions is entirely
analogous to what obtains when bladder and rectum are affected.
Actual paresis or paralysis of the muscles of the larynx, from
peripheral neuritis or from alteration of nuclear cells, may occur,
but this is very infrequent.

ABSTRACTS

693

Muscular spasms in tabes are met with only exceptionally ; they
are brief, harmless, and transient. To designate the condition above
described as one of laryngeal spasm, is certainly inaccurate. In¬
co-ordination, relaxation, atony, abolition of reflexes do not charac¬
terise spasm. Faure advocates the application of the method of
systematic re-education to the larynx and thorax.

S. A. K. Wilson.

PARALYSIS BY COMPRESSION OF TEE PYRAMIDAL TRACT
(379) WITHOUT SECONDARY DEGENERATION. (De la p&ralysie
par compression du f&isceau pyramidal, sans dlgtafration
secondaire.) Babinski, Revue Neurologique (Soc. de Neurol, de
Paris), July 5, 1906.

In this case, reported at length by Babinski, the patient was a
man of fifty-two, who was under continuous observation for two
years previous to his death. His earliest symptoms were slight
difficulty and confusion when speaking, and slight paresis of the
right half of the body. A diagnosis of intracranial vascular
disease with thrombosis was made. Three months later he de¬
veloped several attacks of Jacksonian epilepsy, beginning in the
muscles of the right face, and spreading to the arm and leg. The
difficulty in speech had increased, and the paresis also, resulting
in a mild degree of contracture. There was no headache what¬
ever, no sickness, no optic neuritis. The cutaneous and tendon
reflexes were normal, and equal on the two sides. The diagnosis
was reconsidered, but a cerebral tumour seemed unlikely, yet
more probable than an hysterical hemiplegia; in any case, a
course of thorough antisyphilitic treatment was commenced.

Seven months from the onset of the disease the patient's con¬
dition was obviously worse, but the reflexes remained normal and
the cardinal symptoms of intracranial neoplasm were absent. An
operation, however, was suggested, but refused. At the end of a
year and a half the contracture and weakness were much greater,
the aphasia was more pronounced, but there was no other change,
except double papillitis and slight diminution of visual acuity.

At length, after two years, the patient was operated on, and a
tumour weighing 310 grammes was found attached to the dura
mater over the left psycho-motor area, compressing but not in¬
vading the cerebral substance. Its enucleation was performed
with the utmost facility, but unfortunately the patient succumbed
immediately after the operation. Examination showed the tumour
to be a myxo-sarcoma.

From beginning to end of the illness there was neither head¬
ache nor vomiting, and the reflexes were absolutely normal.
Babinski thinks that compression, as opposed to invasion, of the

694

ABSTRACTS

cerebral cortex produces a clinical picture such as has been de¬
tailed. He ventures to describe the condition as one of “ pseudo-
hysterical organic paralysis,” admitting that in this particular case
there was no intrinsic sign whereby he could distinguish between
functional and organic disease; extrinsic signs were requisitioned
to establish the diagnosia S. A. K. Wilson.

TWO OASES OF TUMOUR OF THE 00RPU8 CALLOSUM. (Deux cas
(380) do tumour du corps calleux, avec antopsie.) Raymond (Congres
de Lille), Revue Ncurologiquc, Aug. 30, 1906, p. 772.

The first patient had a stroke three months before his death.
Immediately after the ictus a general deterioration of his
mental faculties was remarked, in addition to a progressive
hemiplegia and hemitremor, and subsequently a hypoaesthesia
of the same side. At the autopsy a large vascular gliomatous
tumour was found in the anterior two-thirds of the corpus
callosum, spreading into the frontal lobe anteriorly and laterally
into the left centrum ovale. In addition, a second focus of disease
was discovered in the ascending parietal convolution of the left
side. In that hemisphere the tangential fibres of Exner were
atrophied to a considerable extent, and the superior longitudinal
bundle, the occipito-frontal tract, and the cingulum were destroyed.

The second patient did not present any symptom for eight
months beyond special mental disorders; two months before
his death he developed a progressive left hemiparesis, with
great ataxia and anaesthesia on the same side, as well as a left
homonymous hemianopia. A diagnosis was made of tumour of
the corpus callosum spreading into the right optic thalamus, and
at the sectio the posterior third of the corpus callosum was found
to be invaded by a highly vascular sarcoma, which had made its
way into the posterior two-thirds of the right optic thalamus, and
the posterior third of the internal capsule, destroying the thalamic
radiations and the inferior longitudinal fasciculus as well.

The special mental syndrome which the author seeks to attach
to lesions of the corpus callosum consists of eccentricity in manner
and in actions, hiatuses in memory, want of sequence in ideas,
coupled with an apparent conservation of the intelligence.

S. A. K. Wilson.

THE BORDERLAND OF EPILEPSY. Sir William Gowers,
(381) British Medical Journal , July 7, 1906, p. 7.

In this, the first of two lectures, the author deals more especially
with the subject of vertigo. He insists that epilepsy cannot be

ABSTRACTS

695

sharply marked off from functional diseases, and that there is a
borderland of diseases which fades in either direction.

Of the different varieties of vertigo, the only one that in
practice is liable to be confounded with epilepsy is labyrinthine
vertigo. In minor epilepsy the subjective, objective, and motor
vertigo are all in the same direction, and are probably due to
inequality of discharge in the two hemispheres. In aural vertigo
the subjective and objective rotation are usually in different
directions. Both affections have a sudden onset, and both may
have a brief duration, though this is rarer in the case of aural
vertigo. The author lays stress on the fact that consciousness may
be not merely blurred, but momentarily lost, in aural vertigo, and
quotes cases in support of this statement. Again, sight may be
lost in this affection for a few seconds, when consciousness is
retained, still further increasing the resemblance between epileptoid
forms of aural vertigo and minor epilepsy. Another symptom
that is frequently mistaken for an epileptic aura is the sense of
impulsion felt by some patients at the onset of a vertiginous
attack. Although in epilepsy there may be a sense of involuntary
movement, there is never the feeling of being hurled or even struck
to the ground, as by an outside force, that is found in the other
cases; when this occurs it is characteristic of aural vertigo.

Ernest Jones.

LECTURES ON THE BORDERLAND OF EPILEPSY. H. VERTIGO.

(382) Sir William Gowers, Brit. Med. Journal, July 21, 1906, ii.,

p. 128.

In the first lecture the writer had considered the features of aural
vertigo that resembled epileptic symptoms—suddenness, brevity,
loss of consciousness, loss of sight, and the curious sensation of
impulsion downwards as by an external force. In addition, other
cephalic sensations may cause difficulty in diagnosis. In one case
a sudden sensation would appear in one side of the head, seeming
as if it would throw the patient down. In another a sudden sen¬
sation would dart from the back of the neck over all the head,
with a strong sense of impending loss of consciousness. In yet
another there was a feeling of a sudden “ rush ” to the head, and
that consciousness would be lost unless the patient at once sat up.
The relation of these attacks to posture, and their association with
tinnitus, is most significant of aural vertigo, as otherwise they
would often suggest epilepsy. In some instances the attack is
induced iu the sitting posture, and relieved by lying down; in
others the reverse occurs; and sometimes lying on a certain side
is the factor concerned.

696

ABSTRACTS

Another point of resemblance is that aural vertigo, like epilepsy,
may occur during sleep. This fact has no doubt to do with the
alteration in pressure that must occur in the semicircular canals
during the supine posture. When visual and muscular influences
are cut off from the equilibrial centre, as they are during sleep,
impulses still reach it from the semicircular canals, and the com¬
bination of sleep and posture may effect what posture alone cannot.
In this connection the author proffers his opinion that the sensation
of falling through space, so common during sleep, may be due to
contraction of the stapedius, which lowers the pressure in the
canals.

The cephalic sensations just referred to are not the only ones
that may give rise to difficulty in the diagnosis, for they may be
reflected and appear as curious feelings elsewhere in the body, par¬
ticularly at the heart. It is also important to remember that an
epileptic seizure may be ushered in by labyrinthine giddiness,
tinnitus, and vertigo ; still such tinnitus is not pronounced or
persistent.

Aural vertigo and epilepsy, neither of which is a rare disease,
may coincide in the same patient; in addition, the one sometimes
seems to exert an influence on the other.

A more difficult group to classify is what the writer calls
pseudo-aural vertigo. In this, symptoms of labyrinthine vertigo,
of the character seen in no affection except ear disease, exist with¬
out tinnitus or any evidence of organic labyrinthine disease. The
pathology of this group is at present very mysterious.

In the treatment of labyrinthine vertigo the combination of
bromides with gelsemium and hyoscine is suggested.

Ernest Jones.

EPILEPSY WITH UNILATERAL MANIFESTATIONS. (Epilepsia

(383) mit Halbseitenercheinungen.) Bratz and Leubuscher,
Neurol. Centralbl., Aug. 16, 1906, p. 738.

The authors refer to recent writers who support the view of the
organic nature of epilepsy. Heilbronner has shown that the
speech centre is the originating focus of some cases of epilepsy
with speech defects. Redlich has lately revived the old hypothesis
that idiocy, cerebralpalsies of children, and early epilepsy are due to
the same pathological process; this view was based on the numerous
cases of early epilepsy that show either a slight hemiparesis or
asymmetry in the tendon reflexes. The authors have had many
cases with one-sided symptoms, and at the autopsy changes have
been found in the contralateral Ammon’s horn. An example of
this is quoted in detail. The patient was admitted thirteen years
ago, when aged twenty-three. But for one attack in his seventh

ABSTRACTS

697

year, he was quite healthy till sixteen; after this he had fits
weekly. On admission he showed some deviation of the tongue to
the right; five years later it was noted that he fell towards the
left in his attacks. Mental deterioration was rapid and progres¬
sive. Three days before death it was noticed that in a fit his eyes
were turned strongly to the left, although, in a stuporose state
before the fit, they were turned to the right. Clonic movements
occurred much more on the right side than on the left. At the
autopsy the left Ammon’s horn was much shrunken; there were
no other changes. During life the diagnosis lay between hysteria,
epilepsy, and organic brain disease, but was made correctly. The
authors state that bilateral changes in Ammon’s horn are rarely
found except in cases of epilepsy, combined with idiocy. The
origin of these changes is probably to be attributed to foetal
trauma or infection. Ernest Jones.

HEART-NEUROSES AND BASEDOW’S DISEASE. (Herzneurosen
(384) und Basedow.) Fischer, Muench. med. Wchnschr., Aug. 7,
1906.

The writer refers in the first place to the subject of removal of
the thyroid in the treatment of the disease, and recommends the
removal at most of one-half of the gland to begin with. He
recommends, instead of operation, the antithyroid preparation
“ Rodagen ” (derived from the desiccated milk of goats from which
the thyroid gland has been removed).

The paper deals chiefly with cases corresponding to the
“ formes frustes,” which the writer believes are much more
common than is generally supposed. Thus cases diagnosed as
“ neurasthenia,” “ anaemia,” or “ heart-neurosis,” particularly in
women suffering from menstrual disorders, he considers frequently
are of the nature of imperfectly developed Basedow’s disease.
The chief complaint is always irregularity or pain in the heart,
with shortness of breath or faintness. If tonic treatment fails in
these cases, he recommends the trial of two grammes of rodagen
thrice daily, combined with rest. He states that he has several
times seen decrease of the enlarged thyroid under this treatment,
notably in one case where the goitre had lasted over twenty years,
and distinctly diminished after six weeks’ treatment.

John D. Comrie.

698

ABSTRACTS

THE PROGNOSIS OF TETANY IN ADULTS. (Die Prognose der
(385) Tetanie der Erwachsenen.) L. v. Frankl-Hochwabt, Ntmi
CentrcUbl., July 16, 1906, p. 642, and Aug. 1, p. 694.

The prognosis of this affection is usually considered to be very
favourable; thus, of 264 cases of whom the author had hospital
notes, 215 were discharged as cured, 42 improved, and 6 un¬
improved. Extensive experience had suggested, however, to the
author that this opinion might be unduly favourable, owing to the
fact that it leaves out of consideration the tendency of the affec¬
tion to recur. He remarks how rarely such problems are revised
de novo in neurology, but determined so to do in this instance. He
made observations of 160 patients in the past twenty years, and,
by holding a recent inquiry, was able to follow the after-history of
55 of these. The tetania strumipriva and the stomach tetany was
excluded, as our knowledge seems to be on more secure ground in
the case of these. The present cases refer to the endemic tetany
of cobblers and tailors, puerperal tetany, and that due to acute
infectious disease.

The 55 cases, of which an account is given, are divided into
five groups. Group I. includes 7 cases of chronic or repeatedly
recurring tetany. Group II. includes 19 cases in which spasms
were replaced by parsesthesise or cramp feelings. Group 1IL also
includes 19 cases, in which there were no spasms present, and
which had symptoms reminding one of myxcedema. Group IV.
includes 11 fatal cases, death being due to other diseases
Group Y. includes 9 cases that recovered. These groups are
analysed with respect to the variety and situation of the tetany
present, and the frequency with which the symptomatic triad (of
Trousseau, Erb, and Chorstek) occurred. The results of the
inquiry are as follows:—Of the 55 cases, 11 had died at a relatively
early age; of the 44 living, 9 were healthy—about 20 per cent
Over four-fifths of the patients were more or less permanent
sufferers. The prognosis as to recovery is thus very considerably
worse than is usually thought. Ernest Jones.

ANOTHER CASE OF INTERMITTENT CLAUDICATION. (Bn
(386) weiterer Fall von angiosklerotischer BewegungsstSrungen du
Arms.) W. Erb, Deut. Zeit. f. Nervenhettk., Bd. 30, 1906,
p. 201. See this Review, Feb. 1906, p. 153.

The patient was a woman of 57 with diabetes mellitus of two
years’ standing. For about one } T ear she had had smarting pains
in both legs and arms, then some swelling of the legs. In the
right arm there was great smarting, and a feeling as if the right
hand were thicker than the other and unable to be closed properly.

ABSTRACTS

699

There was no visible swelling. After using it much the hand
became somewhat purplish in colour and very feeble, with great
pain in the upper arm. These symptoms passed off on resting.
On examination the heart was found to be hypertrophied, there
was marked arterio-scleroBis; the right radial pulse was completely
absent, although the artery was not especially hard. The brachial
pulse was just palpable, and the artery was very wiry. Pulsation
in the right subclavian was quite good. Blood pressure on the
right 70, on the left 130 mm. Hg. Erb considers the case as one
of typical Dyskinesia angiosklerotica brachii.

J. H. Harvey Pirie.

TWO OASES OF BI TEMPORAL HEMIANOPIA. (Deux cm dTnSmi-
(387) anopie bitemporale.) Galezowski, Soc. de Neurol , de Paris,
July 5, 1906.

Two cases of bi-temporal hemianopia in middle-aged women, of
gradual onset, with pallor of the optic discs and considerable
diminution of visual acuity. Galezowski gives his reasons for
attributing the defect to hypertrophy of the pituitary body,
possibly neoplastic in origin. S. A. K. Wilson.

BLINDNESS OF CORTICAL ORIGIN, FROM DOUBLE HEMI-
(388) ANOPIA. (C4cit6 corticale par double h&nianopsie.) Raymond,
Lejonne, and Galezowski, Soc. de Neurol, de Paris, July 5,
1906.

The patient was an arterio-sclerotic, fifty-seven years of age. On
December 3, 1905, he had a sudden attack of giddiness and
vomiting, and seemed to be impelled towards the left. Seven
days later he had another attack of giddiness, and felt himself
forced towards the right. On December 25 he suddenly felt a
tingling of the whole of his left arm, and a moment later he
became completely blind. On January 4 he began to distinguish
objects again, but on the 6th he had another attack, and remained
more or less comatose till the end of the month. As a result he
became absolutely blind again, but by April he had once more
begun to distinguish objects faintly.

On examination, the field of vision was entirely gone, except
for a minute area round the fixation point in each eye. In this
zone his visual acuity was There was no loss of colour vision;
pupil reactions were normal; and the fundus showed no abnor¬
mality in either eye. A consideration of all the symptoms makes

700

ABSTRACTS

it probable that after the first attack there had been hemianopia,
which did not involve the fixation point, and remained unnoticed
Whenever a lesion occurred in the other occipital lobe, however,
the cortical centre for macular vision was partially involved, and
the blindness became complete. As in a number of published
cases, central vision gradually returned, though not quite to the
normal S. A. K. Wilson.

THE ANTAGONISM OF THE CUTANEOUS AND THE TENDON
(389) REFLEXES IN SPASTIC PARAPLEGIA. (Etude but l’anta-
gonisme des rdflexes cutands et tendineux dans les p&rapldgies
gpaamodiques.) Noica and Marbe, Soc. de Neurol, de Pam,
July 5, 1906.

•

Thirty-eight cases of spastic paraplegia, of various types, were
examined.

In five cases the cutaneous reflexes were normal. In twelve,
some of the cutaneous reflexes were present, others diminished or
absent. To quote one instance: the upper and middle abdominal
reflexes were intact, the lower abdominal and the cremasteric were
absent, the anal reflex could still be elicited, but the gluteal was
not obtained.

In two cases all the cutaneous reflexes were abolished. Evidently
the principle of antagonism is not absolute.

S. A. K. Wilson.

REMARKS ON THE MEANING AND MECHANISM OF
(390) VISCERAL PAIN. Mackenzie, Bril. Med. Joum., June
30, 1906.

This, the last of a series of three papers, deals with the mechanism
by which visceral pain is produced. The writer refers to the
three tissues by which pain is exquisitely felt in the body wall,
viz., the skin, the muscular layer, and particularly the loose
cellular tissue immediately outside of the peritoneum. With
regard to the opinion of some that the viscera are incapable not
only of originating sensations from stimuli, such as cutting, tear¬
ing, or burning, which affect the skin, but even of producing any
sense of pain directly, he adduces the familiar example of a large
enema, which serves to produce severe griping pain, accompanying
muscular contraction of the rectum. This pain originates un¬
deniably in the rectum, but is referred in most people to the
region immediately above the pubis.

This peculiarity of visceral pain in being “referred,” he

ABSTRACTS

701

explains as follows: Constant afferrent impulses pass from the
viscera to the central nervous system, but set up no sensations;
if, however, a morbid process in a viscus gives rise to exaggerated
impulses, these affect neighbouring centres in the spinal cord,
and so sensory, motor, and other nerves connected with this
region of the cord are stimulated. According to the writer, there¬
fore, visceral pain is of the nature of a viscero-sensory reflex,
while the various muscular contractions set up in visceral disease
correspond to viscero-motor reflexes.

Angina pectoris is taken as an example, and the writer
explains its symptoms by reference to his theory. Thus the
pain experienced over the region of the heart and down the arm
is not a direct pain in the heart, but a referred pain in the distri¬
bution of the upper dorsal nerves, which are connected with the
splanchnic nerves of the heart. Similarly the agonising feeling
as if of the breast-bone snapping, or of the chest being squeezed
in a vice, is explained as a viscero-motor reflex, in which the inter¬
costal muscles are thrown into a state of extreme spasm.

John D. Comrie.

ON THE THEORETIC AND PRACTICAL MEANING OF HEAD’S
(391) ZONES IN DISORDERS OF THE DIGESTIVE ORGANS.
(Zur theoretischen tmd pr&ktischen Bedeutung Head’scher
Zonen bei Erkrankung der Verdauungsorgane.) Kast, Bari,
klin. Wchnschr., July 30, 1906, and August 6, 1906.

In two papers the writer discusses the clinical value which can
be assigned to Head’s zones of cutaneous hyperesthesia in con¬
nection with disease of deep-seated organs, after he has examined
some two hundred cases of disease of the abdominal and thoracic
organs with reference to the point.

He found that in many cases the hyperesthesia affected not
only the senses of pain and temperature, as Head found, but also
the sense of touch. In all cases, however, the minimal stimulus
necessary to produce a sensation was the same over the zone as
on the rest of the skin, although the sensation provoked differed
in acuteness. In explanation of this peculiarity, he offers the
analogy that each segment with its splanchnic and spinal nerve*
is tuned to a certain pitch ; the constant reception in the spinal
cord of stimuli from diseased organs, though these are not felt as
pain, produces an effect comparable to loss of pitch, and hence
the change in sensibility. This circumscribed defect in a segment
he regards as a local neurasthenia.

He discusses at some length the question as to whether
sensations of any sort are produced by affections of internal

702

ABSTRACTS

organs, but finally dismisses as untenable the opinion of Lenander,
founded upon his experience of operations done under local
anaesthesia, that the organs innervated by the vagus and sym¬
pathetic nerves are devoid of sensation, except in so far as
damage to and stretching of the parietal peritoneum are
concerned, or in cases where an inflammatory process spreads
from internal organs to neighbouring spinal nerves. He believes
that the hypenesthesia of Head’s zones demonstrates that the
sensations of pain originate in definite organs.

The presence of a hyperaesthetic zone does not necessarily
follow even serious disease of the corresponding organ. Thus in
serious gastric ulcer he repeatedly found the zone absent. Again,
out of twelve cases of gastric cancer only one showed Head’s
zone. The writer does not agree with the suggestion of Willoughby
that the position of an ulcer in the stomach can be determined
by the position of the superficial zone affected. Though the zones
are usually discoverable in appendicitis, they are of little diagnostic
value, since the same areas are affected in catarrh of the small
intestine. On the other hand, the writer believes that the level
of the zones affected is of great value in the indication of the
particular organ at fault when general symptoms like vomiting
and cardiac weakness only are present.

A word of warning is given against mistaking for Head's
zones the sensitive areas of skin found in emaciated individuals
where the skin is stretched over the rib margins and iliac crests.

On the whole, the writer does not attach great value to these
zones as a practical method of clinical examination.

John D. Comrie.

PROJECTION OF PAIN SENSATION FROM THE LOWER TO THE
(392) UPPER EXTREMITY. (Ueber Projektion des Schmerzempfin-
dung von der unteren auf die obere Extremist bei Herd im
Dorsalmark.) M. Lewandowsky, Centralbl. f. Nervenheilk. wd
Psychiat., No. 218, Aug. 1, 1906, p. 593.

The case was that of a young girl with symptoms of localised com¬
pression of the spinal cord. Operation revealed a sarcoma of the
vertebrae, invading the dura, and the sectio 4 J months later showed
a complete transverse softening of the cord at the level of the 4th
dorsal segment.

In the interval there was complete flaccid paralysis of the
lower half of the body. The left leg was quite anaesthetic and the
reflexes lost; in the right there was a little sensation and veTy
feeble reflexes. Strong faradisation of the right leg caused no
pain, but a current which a healthy person could scarcely bear when

ABSTRACTS

703

applied to the left leg for about two minutes then caused severe
pain. But more remarkable than the delayed transmission was
the projection of the pain. It was referred usually to the left arm,
occasionally to the operation wound, but never to the right arm or
any part of the body innervated from below the 4th dorsal segment.
The pain lasted a few seconds, but once elicited, further stimuli of
a few seconds’ duration sufficed to cause it No other form of
H t.imnlfi. tion had a like effect.

There must either have been a “ track-jumping ” in the cord or
(which the author thinks more probable) conduction to the cortex
by a remnant of path coming from the lower extremity, and false
projection outwards from the cortex. J. H. Harvey Pirie.

OBSERVATIONS ON THE 80-0ALLED “ TACTILE APHASIA’

(393) (Considerations snr la soi-disant “ aphasie tactile.”) Dejerine,
Revue Neurologique, July 15, 1906.

The writer records a case with symptoms similar to those of one
regarded by Raymond and Egger as a new type of aphasia and
named by them “ tactile aphasia.” Briefly these consist in the
fact that the patient though able to describe generally the size,
shape, consistence, and temperature of objects placed in one hand,
is incapable of telling their name. This condition, known as
“ tactile paralysis,” was described by Wernicke in 1896, and the
writer protests against the name of tactile aphasia as a misnomer.
These cases owe their failure to name objects to defective informa¬
tion brought to the cerebral centres by the sensory nerves of the
affected hand; while the fact that there is no aphasia is shown by
the ready naming of all objects placed in the sound hand. In all
cases of real aphasia, motor or sensory, according to the writer, the
aphasic person preserves the images of objects in his mind, but
has lost their names. It would therefore be as reasonable, he says,
to call deafness auditory aphasia, or loss of taste gustatory aphasia,
as to apply the name of “tactile aphasia” to such cases. The
illustrative case in the paper is described in full detail.

John D. Comrie.

CEREBELLAR ASYNERGY AND INERTIA. (Asynergie et inertie
(394) ctelbelleuse.) Babinski, Soc. de Neurol, de Paris, July 5, 1906.

The characteristic features of cerebellar disease are titubation,
intention tremor, scanning speech, asynergy, disturbance of kinetic
equilibrium and of diadococinesis, and catalepsy. All these
phenomena may be connected one with the other if we regard

704

ABSTRACTS

the cerebellar mechanism as having two functions, one destined
to insure synergy of movements whose combination constitutes a
volitional act, and the other intended to combat inertia.

Thus intention tremor may be explained by a lack of co¬
ordination among the various elementary movements of the upper
limb, in particular by unharmouious functioning of antagonistic
muscles. The tremor, further, is sometimes associated with abrupt
movements, movements sans mesure. Thus the patient can bring
his hand up to his mouth briskly, but he is usually unable to
arrest the movement just when he wants to; in other words,
he is unable to control the inertia of a moving body.

Again, diadococinesis—the function which permits us to execute
rapidly a succession of volitional movements—consists in an asso¬
ciation of exciting and restraining action, and is intended to
overcome the inertia of the motor apparatus alternately at rest
and in motion. The disturbances of equilibrium are due to the
abolition of diadococinesis, and the scanning speech may legiti¬
mately be attributed to inertia. S. A. K. Wilson.

PSYCHIATRY.

ON K0R8AK0WS SYMPTOM-COMPLEX IN BRAIN SYPHILIS.

(395) (Ueber den Korsakow’schen Symptomencomplex bei Hirnluea)

L. Roemheld (of Hornegg), Arch. f. Psych., Bd. 41, H. 2.

Patient was a woman at the climacterium who, in the spring of
1904, became forgetful and began to fabricate; she had headache
at night, suffered from attacks of dizziness and transitory mental
disturbance, and was apathetic; her gait became unsteady. On
admission (July 1905), there was pain on pressure over the left
side of the skull; pupils were small and sluggish in reaction; the
right side of the face was weak and showed movements of the
nature of a tic, which sometimes even spread to the right arm and
leg. Mentally patient was very apathetic; speech was slow and
hesitating; she was quite disoriented, and had exceedingly poor
retention. In hospital patient had several attacks of fainting and
dizziness; she fabricated with the greatest freedom; the pupils,
which had at first acted sluggishly, after some time became quite
fixed; examination of retina showed choked disc. Treatment by
mercury and by iodide separately was ineffective, but mixed treat¬
ment with injections of iodipin was successful, and patient in two
months made an excellent recovery. On discharge (Nov. 1905)
she showed no mental defect, but had an amnesia for the period
of her illness. She still occasionally complained of headache;
there was no longer inequality of facial innervation; the knee-

ABSTRACTS

705

jerks were equal and the sign of Romberg absent. The eye still
showed choked disc.

Several months later, patient returned on account of attacks of
dizziness, which again yielded to the same treatment. The author
discusses the question whether the cause is to be looked for in the
vascular changes, or in a gumma with increased intercranial
pressure, or in the syphilitic intoxication acting in a manner
analogous to chronic alcoholic poisoning.

C. Macfie Campbell.

ON ATYPICAL ALCOHOLIC PSYCHOSES. A CONTRIBUTION
(396) TO THE KNOWLEDGE OF THE HALLUCINATORY
DEMENTIA OF THE ALCOHOLIC, AND OF ALCOHOLIC
PSEUDO-PARALYSIS. (Ueber atypische Alkobolpsychosen.
Beitrag zur Kenntniss des hallucinatorischen Schwachsinns
der Trinker and der alkoholistischen Pseudoparalyse.)
F. Chotzen (of Breslau), Arch. f. Psych., Bd. 41, H. 2,
pp. 383-481.

In this clinical contribution to the subject of the alcoholic psychoses
the author shows the necessity for defining more clearly the
grounds upon which certain psychoses are called alcoholic, and
the difficulty of differentiating these psychoses from others of
non-alcoholic origin. The difficulty is greatest with various
chronic conditions, but even in the acute conditions the symp-
tomatological differentiation is by no means easy. The acute
hallucinatory condition arising on an alcoholic basis—the “ Acute
Hallucinosis ” of the Germans—is in its typical form a well-defined
picture: auditory hallucinations dominate this picture, hallu¬
cinations of smell and taste are absent, there are no hypochondriacal
complaints, and the outcome is recovery. Such a condition, how¬
ever, may arise without alcohol being an aetiological factor; on the
other hand the symptom-complex, even on an alcoholic basis, may
be complicated on the one hand by hypochondriacal symptoms
without the outcome being different, on the other hand by motor
symptoms, even by marked stupor. Several attacks of acute
alcoholic psychoses may be followed by a chronic psychosis pre¬
senting close similarity with chronic non-alcoholic psychoses. In
addition to the fact that the aetiology, even of the well-defined
alcoholic psychoses, is complicated and obscure, the symptomato-
logical likeness to other psychoses makes the differentiation
extremely difficult. The acute hallucinatory psychosis on an
alcoholic basis is difficult to separate from hallucinatory episodes
belonging to Dementia Praecox. The fact that a chronic paranoic
psychosis has been preceded by such an acute hallucinatory con-

706

ABSTKACTS

dition does not warrant us in calling it alcoholic paranoia, unless
the chronic psychosis presents in itself distinctive features; the
hallucinatory onset may be looked on merely as an episode in a
Dementia Pra-cox development.

The author cites four cases to show the heterogeneous nature
of this group of paranoic conditions of alcoholic origin, and the
difficulty in determining the etiological factors.

He then passes to the subject of the hallucinatory dementia of
the alcoholic, and reports various observations. He starts from
Kraepelin’s description and shows what a variety of cases come
under this head, and how other elements than the alcoholic factor
play an important part. Even the initial deliria which precede
one large group are atypical; the psychoses vary in their
symptomatology and frequently show degenerative phenomena.
Cases belonging to another group are progressive with fantastic
ideas of greatness and of being influenced, but even in these cases
the course and outcome vary; some are closely related to Kor-
sakow’s psychosis. In this group there is not the definite
deterioration of the previous group; recovery is possible.

Alcoholic pseudo-paralysis is not necessarily a combination
of this hallucinatory dementia with the Korsakow symptom-
complex. The picture iucludes, in addition to the mental
symptoms, cerebral focal symptoms due to haemorrhages and
parenchymatous degeneration. Vascular changes and toxic in¬
fluences are both important elements. The various stages in the
development of alcoholic pseudo-paralysis are closely analogous
to conditions met with in the group of infection psychoses, e.g.
stuporous conditions, and conditions of confusion with motor
symptoms. In this context the author refers to a case of a
markedly catatonic psychosis in association with focal brain
symptoms of alcoholic origin with memory and retention dis¬
order. Korsakow’s psychosis may result in a characteristic ter¬
minal condition of paranoid nature, with the delusions limited to
the idea of annoyance by those forming the environment of the
patient.

To sum up: alcoholic pseudo-paralysis may arise from the
association of arterio-sclerosis with alcoholic psychoses ; secondly,
it may develop from the association of the polyneuritic complex
or cerebral focal symptoms with either a late stage of a typical
Korsakow’s psychosis or with other forms related to the infection
psychoses, or to forms of organic vascular brain disease; thirdly,
it may arise from the association of alcoholic focal brain symptoms
with a degenerative megalomanic psychosis, or with “ mania.”

C. Macfie Campbell.

ABSTKACTS

707

MANIC-DEPRESSIVE INSANITY AND ARTERIOSCLEROSIS.

(397) (Manisch-depressives Irresein and Arteriosklerose.) Albrecht,
Allg. Ztsch. f. Psych., Bd. 63, H. 3 and 4.

The writer reports briefly 54 cases of manic-depressive insanity,
in 18 of which ( i.e. 30%) arteriosclerosis was present. This ratio
is considered high because only 40% of the alcoholics showed the
signs of arteriosclerosis. Dementia prsecox gave 10%. Kraepelin
has mentioned the early occurrence of vessel sclerosis in manic-
depressive insanity, and considers that the prognosis is thereby
rendered less favourable. The investigation led to the following
conclusions.

General arteriosclerosis is more frequent and appears earlier
in manic-depressive insanity than in the other non-toxic psychoses
or in those unaccompanied by period fluctuations in the affect.

The causal relation of the vessel disease and manic-depressive
insanity is a double one. In a majority of cases the mental
disorder with its emotionally conditioned variations in blood
pressure and resulting anomalies of nutrition in the vessel walls,
creates an especially favourable ground for the development of
arteriosclerosis.

In a minority of cases the senium, with its accompanying
arteriosclerosis, especially in hereditarily burdened individuals,
furnishes the final conditions for the outbreak of manic-depressive
insanity. G. H. Kirby.

THE HEBEPHRENIC FORMS OF DEMENTIA PR.SGOX. (Ueber
(398) die hebephrenischen Formen der Dementia praecox Kraepelins.)

Klipstein, Allg. Zeitschrift f. Psych., Bd. 63, H. 3 und 4,
p. 512.

The hebephrenia of Kraepelin comprises those forms of dementia
prsecox in which the mental weakness develops either gradually
or with the signs of a sub-acute, rarely acute mental disturb¬
ance ; to be excluded are those forms with well-marked
catatonic states*, as well as those in which there develop with
retention of clearness prominent delusions, which remain for
years in the foreground.

The author’s observations are based on 100 cases; no clinical
histories are furnished. In a majority the onset was between the
fifteenth and twenty-fifth year. The symptomatology of the
chronic sub-acute and acute forms is discussed in detail.

The slowly developing cases show from the beginning the
signs of dementia and further hallucinations, falsifications of
memory, symbolic interpretations and delusions, which are, how-

708

ABSTRACTS

ever, expressed with slight show of emotion and remain un-
systeraatised. Peculiarity in behaviour and queerness of speech
develop rapidly.

The acute and sub-acute cases are divided into (1) simple and
(2) compound forms. Under (1) states of excitement and depres¬
sion are described. In (2) the disturbance of will and feeling are
more strongly expressed, hallucinations and delusions are more
prominent.

Emotional decay, passivity, reduction in active attention, and
defect in concentration are the permanent and fundamental dis¬
turbances which appear in all forms of hebephrenia.

The course may be gradual and even, but is more frequently
fluctuating with remissions and exacerbations. Recovery without
defect has not been observed,

No sharp line exists between the acute and chronic forms, and
the acute disturbances can be considered only as phases in a
fundamentally chronic disorder.

The acute and sub-acute forms of hebephrenia show numerous
transitions to the catatonic variety of dementia praecox, mid the
chronic forms lead over to the paranoid types of dementia praecox.
Kraepelin’s attempt to separate the small group of paranoia from
dementia praecox cannot be supported.

The writer proposes the following tentative grouping within
the department of dementia praecox.

(1) Acute and sub-acute types, with remissions and catatonic
symptoms. Here belong Kraepelin’s catatonic form, and the acute
and sub-acute forms of hebephrenia described by the author.

(2) Chronic types with delusions. Here may be grouped
chronic forms of hebephrenia, Kraepelin’s paranoid form of
dementia praecox, and the small group of paranoia.

G. H. Kirby.

THE HEBOID PARANOID GROUP OF DEMENTIA PR.EOOX—
(399) CLINICAL RELATIONS AND NATURE. Dkbcum (of
Philadelphia), Am. Jowm. of Insanity, April 1906.

It is conceded that the dementia praecox group forms the centre
of discussion among the psychiatrists of to-day. Kraepelin, the
originator of the group, states that the term implies nothing more
than the unfavourable prognosis and the appearance of the disease
in youthful age. There is no sharp dividing line between the
different types (hebephrenic, catatonic, paranoid), and the exist¬
ence of a paranoid type is questioned. Certain depressive and
expansive phases of dementia praecox resemble similar phases in
manic-depressive insanity, but a careful analysis of any given case

ABSTRACTS

709

is commonly sufficient to make the distinction. Hallucinations,
which play such an important role in both phases of dementia
prsecox, play no part whatever in manic-depressive insanity;
confusion dominates the dementia prsecox picture, but is at most
only an incident in the manic-depressive picture. Dementia is
commonly understood to be the most important symptom of
dementia prsecox, but facts do not justify such a position. Dercum
makes a comparison between the reduction of a simple senile
dementia and dementia prsecox. Dementia prsecox is a quantita¬
tive and not a qualitative change—memory, consciousness, orienta¬
tion are seriously affected in senile dementia, but are frequently
preserved to an astounding degree in even advanced cases of
dementia prsecox. Confusion, and not dementia, should be
regarded as the striking feature of at least the earlier stages of
dementia prsecox—completely cured cases probably constitute
a group by themselves, and should be separated from the great
mass of dementias.

The delirium-confusion-stupor complex of such toxines as lead
and alcohol is considered, and the possibility of dementia prsecox
being a toxic disturbance is discussed.

Diem’s twelve cases of simple and uncomplicated dementia are
referred to—in these cases there were no elements of depression
or expansion; no hallucinations, delusions, grimaces, clownism, or
stereotypy; these cases should be considered as true primary
dementias.

Finally, the author discusses briefly Kraepelin’s division of
paranoia, and suggests that the first form be designated as heboid
paranoia; the second form as hallucinatory paranoia; and the third
form as paranoia simplex. C. H. Holmes.

THE TREATMENT OF ACUTE INSANITY IN A GENERAL
(400) HOSPITAL. Brower (of Chicago), Joum. of Am. Med. Assoc.,
July 14, 1906.

The increase in insanity is due to the feverish activity of the age
in which we live; the diminished curability is due to racial
degeneracy, and to the difficulty of securing promptly the scientific
treatment necessary to aid in restoration. One hundred years ago
the insane were considered either as recipients of Divine favour or
as victims of diabolical possession. At the present time, while
insanity has been raised to the dignity of a genuine sickness, our
medical colleges give entirely too little attention to the study of
psychiatry and treatment of the insane. The delays incident to
the commitment and delivery to hospitals for the insane are often
prejudicial to the recovery of these patients.

710

ABSTRACTS

Brower considers home treatment a failure, but has met with
some success during the past thirty years in the treatment of acute
cases in the wards of general hospitals. The “ autotoxic and ei-
haustional ” cases lend themselves particularly well to this plan. The
Weir-Mitchell rest cure is the form of treatment recommended—
particular attention being paid to the general constitution of the
patient, and rheumatism, gout, syphilis, tuberculosis, etc., being
accordingly treated. C. H. Holmes.

TREATMENT.

attempts at treatment of certain oases of ooh-

(401) TRAOTXTRES, SPASMS, AND TREMORS OF THE LIMBS
BT LOCAL INJECTION OF ALCOHOL INTO THE NERVE
TRUNKS. (Esaais de traitement de certains cas de con¬
tractures, spasmes, et tremblements dee membres par l’alcod-
isation locale des troncs nerveux.) Brissaud, Sicakd, Tanon,
Revue Neurologique , July 30, 1906.

Encouraged by the favourable action of deep injections of alcohol
in cases of facial neuralgia and facial spasm, the writers were led
to try the same remedy in cases where the limbs were affected.
They give a reference to previous work on the cranial nerves.

In the first place, they made numerous experiments on the
sciatic nerve of dogs and rabbits to test the effect and limit of
safety in the injection of alcohol into a mixed nerve. Various
strengths of alcohol, from 5 per cent, up to 80 per cent., were
tried. After 80 per cent., the dogs sometimes showed a paresis of
the foot, which, however, disappeared after one or two dayB. On
histological examination, the sciatic nerve showed, forty-eight
hours after the operation, an increased vascularity, and later
degeneration of some of the fibres.

Clinically, in man, the writers used alcohol of 80 per cent,
containing 1 per cent, of stovaine, injecting about two cubic centi¬
metres high up in the course of the sciatic nerve, which lay at a
depth of three to nine centimetres, according to the stoutness of
the individual. Immediately after the injection, coldness and
anaesthesia of the limb, some paresis of the foot, loss of the
Achilles-jerk, and of all spasm or tremor in the limb were the
noticeable features. Later, up to ten weeks after a single
injection, absence of all clonus and of the Achilles-jerk, but no
anaesthesia, paralysis, modification of the electrical reaction, or
trophic changes were observed.

Twelve cases are recorded in which the method was used with
benefit, viz. spasm of the foot of fifteen years’ duration; hemi-

ABSTRACTS

711

plegia with contracture (two cases); hemiplegia with athetosis
(two cases); spastic paraplegia (two cases); paralysis agitans;
pseudo-bulbar paralysis with clonus; and sciatica (three cases).

In later researches the writers had satisfactory results with a
strength of 40 to 45 per cent, of alcohol, but found that the effect
of 20 per cent, lasted only a few days. John D. Comkeb.

CONTRIBUTION TO THE TREATMENT OF BASEDOW’S DIS-

(402) EASE WITH RONTGEN RATS. (Beitrag zur Behandlung
Basedow’scher Krankheit mit RiSntgenstrahlen.) Sklodowski,
Beui. med. Wchnsehr., Aug. 16, 1906.

The writer refers to experiments showing that the application of
X-rays have an effect in causing atrophy of the parenchyma of
organs to which they are applied, and states that Senn was the
first in 1903 to put this to practical use by diminishing the
size of a leuksemic spleen. He gives a reference to cases of Base¬
dow’s disease treated successfully by Gorl through these means.
He gives also a reference to a record of five typical cases of Base¬
dow’s disease similarly treated by Widermann, in which the ex-
ophthalmus and the pulse remained uninfluenced, though the
nervous symptoms abated and the weight was increased.

He gives full details of a well-marked case of his own, in
which for a month the region of the thyroid gland was exposed
one-half on every alternate day from a distance of 20 cm. for ten
minutes at a time to the action of X-rays. At the end of this
time the nervous symptoms had almost disappeared, though the
pulse and exophthalmus remained as before, and the circumference
of the neck increased somewhat. The sweating ceased also, and
the patient felt well and increased greatly in weight.

References are also given to somewhat similar experiences of
von Stegmann and Beck, the latter of whom used the X-rays as
after-treatment in operation cases. John D. Comrie.

THE SURGERY OF BASEDOW’S DISEASE. (Zur Chirurgie der

(403) Morbus Basedow.) Kurt Schultze, Mittheil. aus den Grenzgeb.
der Median und Chirurgie, Juli 1906.

This paper takes the form of a report on fifty cases on which
the writer had operated, the condition prior to and after operation
being fully noted in each case. From his experience of the
disease, he is a strong advocate of surgical treatment. Of the
50 cases, 36 were permanently cured, i.e. 72 per cent, exhibited
no objective or subjective signs of the disease after periods
varying from 1-18 years, and expressed themselves as entirely

712

ABSTRACTS

cured; 12 per cent, were much improved; 2 per cent, remained
in statu quo ; while 12 per cent. died. The operation was the
same in all—thyroidectomy; in no case was ligature of the
vessels or resection of the sympathetic tried.

It is interesting, further, to note that from a table in which
the disease is classified according to the severity, viz. severe,
medium, and mild, the earlier surgical treatment is carried out
the better are the results. Thus, in the first group, the per¬
centage of recoveries was 57, compared to 100 in the third
group and 66 in the second. The mild cases are first treated
by medical measures, i.e. medical means are given a trial, and
continued with until it is obvious that the disease is not
improving, and that prognosis as to operation is getting worse
Of the medical measures he advocates, only two are of real service,
viz. Anthyroidein (Mobius), i.e. blood serum of thyroidectomised
sheep, and Rodagen, i.e. milk of thyroidectomised goats. The
former was used in about 60 cases, and, generally speaking, the
results of its administration were good. The subjective symptoms
were mainly improved, i.e. palpitations, restlessness, sleeplessness,
and mental anxiety were diminished; but a favourable effect was
noticed also in the size of the gland itself, its vascularity decreased,
the eyes became less prominent and the pulse-rate fell. This
improvement, however, was only temporary, as on the first signs
of stopping the drug, all the symptoms returned, and in some
cases were more aggravated. Eulenburg reported 7 such cases,
and gave his opinion of the drug as follows: Its value is limited;
it seems to be only a palliative measure. The results obtained
with Rodagen were much the same in character. It is a bulky
powder, requires to be administered in laige doses, and is not
very stable.

Dr Schultze found that the operation was more successfully
carried out under local anaesthesia, and rapid improvement soon oc¬
curred. Rise of temperature was noticed in some of his cases, but it
soon fell again. He considers it caused by bronchitis, set up by the
mechanical irritation of the trachea, especially if the tumour is a
large one and the trachea displaced. Large vessels are encoun¬
tered, and have to be ligatured in close contact with the
trachea, the mucous membrane of which becomes oedematous, and
consequently the ciliae of the lining epithelium become clogged,
and mucus is allowed to collect in the bronchi After a few days,
however, this passes off. The pyrexia may also be attributed to
the absorption of clots, antiseptics in the wound, and possibly to a
fresh output of the existing secretion in the gland. Tetany and
cachexia were never observed. The cause of death invariably was
due to cardiac failure, and the adoption of local anaesthesia
diminished the percentage mortality.

ABSTRACTS

713

Turning to a consideration of the individual symptoms, we
find that the most constant sign recorded was the enlargement of
the thyroid gland. This was noticed in 100 per cent, of his
cases. It was generally very marked, in some cases being as large
as a foetal head. It was further very vascular, and in many cases a
thrill could be detected by the hand. In half his cases it inter¬
fered with respiration.

The second cardinal symptom, exophthalmus, was found in
92 per cent; it always followed the appearance of the enlarged
thyroid, and only occasionally was it the first sign to be observed.
As a rule it was not very marked, but in the more advanced cases
caused pain, disturbance of vision, and increased secretion of tears.
Both eyes were equally prominent Graefe’s, Stellwag’s, and
Mobius’ signs were noticed in 15, 11, and 7 of the 50 cases. In
only 3 cases were they all noticed together.

The most serious cases were those in which the cardiac
symptoms were most marked. Tachycardia and palpitations
occurred in nearly every case in combination. On three occa¬
sions the palpitations existed without tachycardia. In half of the
cases no organic change could be found in the heart; in the other
half they were only slight, and consisted chiefly of hypertrophy.
(Edema and epistaxis were noted five and seven times respectively.
These symptoms on the side of the heart show best perhaps the
benefits of surgical interference.

Muscular tremors were noticed in 33 cases; they varied in
intensity, and only occurred when the patient was spoken to or
watched. In practically every case they disappeared after thyroid¬
ectomy. Nervous and psychical conditions, e.g. mental depression,
melancholia, mania, headache, etc., were also favourably influenced.

Eighteen cases exhibited emaciation of varying severity. In
a few it constituted a most alarming symptom—one patient lost
14 lb. in twenty-two days. It was generally attributable to
diarrhoea and vomiting. In many cases apathy and general
debility were well marked.

With regard to the technique of the operation and the extent
to which the gland is excised, no mention is made by Dr Schultze.

C. B. Paul.

REPORT OF THE CONGRESS OF ALIENISTS AND NEURO¬
LOGISTS OF FRENCH-SPEAKING COUNTRIES
Held at Lille, August 1906.

At the International Medical Congress of 1889 the section of
Psychiatry resolved to perpetuate itself in an annual reunion of
the alienists of French-speaking countries. Under the auspices of
the Society M^dico-Psychologique of Paris, was then formed this
3 A

714

REPORT OF CONGRESS

annual Congress for the study of the care of the insane, the
interests of the personnel of the public establishments in which
they were detained, of the relationship of the foregoing to the law,
of other aspects of legal medicine, and of the scientific research in
mental diseases. A few years later, Neurology was added to the
subjects of its consideration, and the anatomo-pathologic aspect
became more and more prominent at the meetings; and although
the sections separated for the International Congress of 1900, they
have reunited once more, and really form a firm body containing
most of the leading spirits of France who are engaged in the study
of the diseases of the nervous system.

As pointed out by Professor Grasset of Montpellier in his
presidential address, it is the neurologists who at present are the
chief users of mental measures in the treatment of disease, while
the anatomo-pathology of the brain receives fully as much study
from the psychiatrists. But indeed the two branches are
inseparable.

The gathering has its social functions as well as its purely
business one, and the men are most cordial to strangers, among
whom was the writer. The chief feature is the three reports.

These consist of subjects decided upon at the previous Congress
One is on Psychiatry, one on Neurology, one on Legal Medicine.
The first of these, on the blood in the insane, was made by Dr
Maurice Dide of Rennes, where last year’s Congress was held.
Among the more interesting features he noticed a lowering of the
specific gravity immediately before the fit in epilepsy, with a
rapid return to the normal, and an increased density in dementia]
conditions. During the epileptic fit the potassium salts are
increased, although its alkalinity is decreased. His researches into
modification of coagulability are not sufficiently complete for
definite results, although he often found coagulation to occur in
less than a minute during the stuporose stage of dementia praecox.
while in normal subjects he has always found it to occur in from
eight to ten minutes.

It is to be regretted that no original data of relative acidity
were given, nor of the richness in chlorides. For the latter he
merely quoted certain experiments made along with Stenuit in
1898, when the importance of acidoses and of hyperchloruration
were not appreciated, while he confined himself to adverse criticism
of the technique of Lambranzi, Cappalletti and Lui, and of Charon
and Briche.

Biliary toxaemia is the only malady where the changes of the
haematocytes interest particularly the psychiatrist. The poly¬
nuclear cells are increased at the beginning of toxi-infectious
psychoses and in states of intoxication. Mononcleosis with inver-
tion of the formula is of great diagnostic importance, being

REPORT OF CONGRESS

715

uncommon in general diseases. It occurs in states of depression
and stupor, where the polynuclears may fall to 45 per cent. In
epilepsy, Dide thinks that there is a tendency to a diminution of
polynuclears during the fit and an increase after it. This is in
harmony with the results found in dementia praecox by himself, as
well as by Bruce and Peebles, to whose results Dide attached great
importance. All these data go to show that both epilepsy and
dementia praecox are paroxysmal toxic infections, although
Sabrazes pointed out the discordance between the severe symptoms
and the slight blood changes, while even these disappear as the
malady progresses. He alluded to the causes of error in Ehrlich’s
tri-acid stain and the haemoglobinometer of Gowers. He was sorry
that the large lymphocytes had not been studied, and thought that
Dide’s facts do not at all demonstrate that the blood changes have
anything to do with the psychosis, especially as it is very probable
that the so-called lymphocytes found in tabes, general paralysis,
and other chronic diseases are in reality tissue elements, while the
toxi-infectious nature of tetany is extremely unlikely in view of its
known production by removal of the para-thyroids. To this Dide
replies that in 150 autopsies he never found altered para-thyroids,
though the thyroids were often diseased.

He then turned to the bacteriology of the blood in the insane,
and reported the finding of organisms in a considerable percentage
of patients, although the germs are not pathogenic. This statement
met with much criticism at the hands of Sabrazes and of Maurice
Faure of Paris, who blamed the technique and gave his own results
where only eight cases out of a hundred produced microbes, and
all were proved to arise through faulty technique, with the excep¬
tion of one case of typhoid.

Dide replied that Faure’s research was on dead bodies, and
that he used too small a quantity of bouillon for insemination.
The discussion elicited the failure of any observer to find the spiro-
chaeta pallida in cases of general paralysis.

As to the serum, Dide never found bile in melancholia, as did
Oilbert in the hospitals. In any case the toxicity is experimentally
shown to depend on its rapidity of injection as well as on the relative
weight of the subject. Its increased toxicity in epilepsy alleged by
Carantzine is subject to this critique.

The serum of psychopaths modified the hatching eggs of fowls
more than did that of normal individuals (F^rd).

The bactericidal power has only rarely been found less. Dide’s
experiments incline him to accept the doctrine of poly-morphism.

Turning to serology Dide’s own experiments showed a notable
diminution of alexin in dementia precox and general paralysis.
In not one out of twenty-three cases of the former and four of the
latter did complete haematolysis occur, although the controls shewed

716

REPORT OF CONGRESS

its invariable completeness. He uses this result to explain his
frequent finding of saprophytes in the blood in dementia precox.
He agrees with Bordet in thinking that alexin is of uniform
composition, and that specific differences in its action are accounted
for by “ les seusibilatrices,” i.e. the bodies which resist heat up to
65-70°, which act as "specific mordants” in enabling alexin to
act.

In the analogy which has been often pointed out between the
action of these bodies and that of enterokinase, Dide seeks the
explanation of sitiophobic phenomena, an idea he frankly attributes
to the reading of Pavlow.

Although in dementia precox, Dide obtained hsematolysis with
the procedure of Bordet and Gengon, yet his controls shewed
results very similar, and he inclines to think that sensibilatrices,
like bacteria, are less specific than imagined. He cites the cm
where reaction to the tubercle bacillus occurred in people free
from all other appreciable sign of tuberculoses. To the writer,
this last seems an unhappy example, being given the frequency
of latent tubercular lesions.

With regard to neurolysins and other cytotoxins, Dide merely
resumes some of the known work. The very irregular differences
of reaction even in the same kind of insanity, he attributes to the
variation in the amount of conservation of the undifferentiated
reaction of defence common to all organic cells and its capability
of stimulation even near the end of life. This reaction diminishes
in the following degree; most of all in the acute or subacute
confusional psychoses, next in precocious dementia, and least of
all in general paralysis. These arguments, if valid, do not
support Ford Robertson’s explanation of the pathology of this last
affection. Among the psychiatric conclusions which Dide daws
are the following:—Firstly, that the ddlire of all the infectious
and acute intoxications is one, and should for the future be
described as one. It is the manifestation of a direct attack upon
the thinking cells by toxins conveyed by the blood, and the nature
of the reaction depends much more upon the nature of the cell
than upon the variety of the toxin.

The sub-acute toxic infectious psychoses are not due to the
direct attacks of toxins, but to their indirect influence in
diminishing the anti-toxic function of the host. They are
not specific. Into the next group general paralysis would
fall if Ford Robertson can maintain his position. Its patho¬
geny is the same, plus the alteration of the supporting tissues.
Here the nomenclature of Fournier “ parotoxi-infectious ” and
its connotations is accepted by Dide, who, however, modifies
the doctrine in denying specificity to the processes, thus placing
in the same group general paralysis and dementia prsecoi.
He thinks this latter is a clinical entity, much more on account

REPORT OF CONGRESS

717

of the clinical signs it presents than from its psychic symptoms,
there being other varieties of chronic hallucinatory delire. In this
opinion he differs from Deny, who attaches little importance to the
physical manifestations. Dide looks upon epilepsy as a cyclical
toxaemia, claiming this is proved by the blood changes he has
found. The psychoses of involution are for him secondary to
hepatic and thyroid alterations as well as to the so-called senility
of the brain. But the psychoses of delusional bases are purely
psychological in nature. He looks for rational therapeutics of
insanity to such agents as will powerfully raise the defensive
f unction of the body cells.

The second report was that on the senile brain, made by
Ldri, from the BicStre laboratory. It was rather hastily put
together, but nevertheless embodied results of several years’
research by other workers.

Its chief interest lay in the question of the lacunae and their
pathogeny, which the reporter attributes to parenchymatous
Atrophy in the neighbourhood of small vessels. This conclusion
was strongly contested by Anglade, of Bordeaux, who brought
preparations to show that the pathogeny of the lacunae is similar
to that of the pulmonary cavity, in being due to the necrosis of an
inflammatory area not always in the neighbourhood of a vessel.
The process begins by neo-formation and collection of giant multi-
nucleated arthrocytes of which the protoplasm is visible and
which possess thick processes formed of groups of fibrils. This
stage is followed by disappearance of cells and nuclei and the
leaving merely of groups of fibres forming a sclerosis, which in
turn begins to crumble, leaving a lacuna in the centre. In the
meanwhile, the first stage has been extending at the periphery, and
the lacuna enlarges unless cicatricial limitation occurs, as in the
young. These processes are most easily seen in the cerebellum.
According to Anglade, the worm-eaten appearance so often seen
under the ependyma is similarly produced.

Passing to theoretical considerations, Anglade supposed that
the nerve cells were in a constant state of struggle with the neur¬
oglia, and that eventually the latter triumphed, if not through
disease, at least when old age supervenes. In any case, the pre¬
parations he brought strikingly show this interstitial encephalitic
reaction. L6n, on the contrary, thought that the apparent crowd¬
ing of the neuroglia cells was explicable by the lessened volume
of the brain, his preparations showing that the corpus callosum,
for instance, was diminished fully one half. He denies their
neuronophagic function. He distinguishes between toxic and
inflammatory proliferations. The diffuse form of sclerosis, all
Agreed to be non-uniform, and L4ri thought it always moderate
in amount. The five cases published of miliary sclerosis with
fits of senile epilepsy were alluded to. He is of the opinion

718

REPORT OF CONGRESS

that most of these lesions are due rather to the prolonged actions
of toxins than to simple senile involution.

In support of this, Hussnot, of Bordeaux, stated that the supra-
renals, far from atrophying with the advance of age, were very
frequently adenomatous; and he attributes the arterial scleroses
of old age, and cases of premature senility to the increase of the
secretion of this gland, which has been proved by experiments in
animals to cause arterial sclerosis. The familiar headache, tinnitus;
vertigo, amnesia, passing aphasia, slight apoplexy, not followed by
hemiplegia, were cited, as well as their tendency to relapse an!
complication with pseudo-bulbar symptoms. The danger of mis¬
taking arterio-sclerosis for neurasthenia was not emphasised, and
vice versd, although the rapid fatigability was.

The symptoms of these lesions are usually intermittent, due
to the claudication of the cerebral vessels. Those of the motor
apparatus, consisting generally of slight paraplegias with 'ie
march aux petits pas,” and the dragging or tottering walk of
old age are apt to be confounded with those due to similar diffuse
scleroses in the spinal cord, as Raymond pointed out in quoting
the researches of Lejonne and Lhermitte. Grasset pointed out
that such paraplegics are astonished to find that they can lift the
foot and walk like an ordinary individual when they give their
attention to doing so specifically. The muscular power, too, of
each segment of the limb is perfectly conserved. Anglade, too,
pointed out how often the cerebella contained lacunae, and hov
this fact explained many senile nervous troubles.

These clinical signs differentiate this form from that due to
lesion of the cord and that due to lesions of the cerebral hemi¬
sphere proper. In this polygonal form, as Grasset calls it, the
lesion is due to multiple lesions in the corpus striatum, as the
researches of the Bicctre laboratory have shown. While Lfri to*
generally found the reflex in extension, Anglade stated that he
had always found it in flexion in the slight hemiparaplegia of
the aged.

Meige pointed out the therapeutic importance of this distinc¬
tion, for walking could be retaught to a patient who had lost
nothing but his automatic movements.

Anglade tried to indicate the psychoses corresponding to these
lesions. For him the senile general paralysis was a clinical reality:
it occurred when an intellectual enfeeblement was accompanied by
meningeal lesions, the diffuse scleroses producing a dementia with
maniacal, melancholic, or paranoic excitation with an intermittent
jargon-aphasia and paraphasia, while in general the lacunar lesions
only cause dementia when they affect the cortex.

Regrets were expressed that so little mention was made of the
trembling, the troubles of the sensibility, and the modification of
the reflexes.

REPORT OF CONGRESS

719

Among the miscellaneous communications, great interest was
caused by that of Professor Brissaud on the rdle of traumatism in
general paralysis. The discussion of this occupiod nearly a whole
morning, and numerous classic cases were related, as well as more
recent personal experiences. It is strange that the question that
has been so long decided in Germany should occupy so much
valuable time, for only Vallon dissented from the view that
traumatism was merely an accident, and had no etiological
significance. Indeed, Briand went so far as to ask Brissaud
to change the title of his paper into “general paralysis as a
factor in the production of traumatism,” relating a particularly
striking case of an officer who became a general paralytic immed¬
iately after a fall from one of the dangerous horses he had latterly
been in the habit of riding. At the regimental audit, some weeks
afterwards, it was discovered that this officer had been wasting the
funds in his care by ordering from Spain a horse of extravagant
price, of which the regiment had no need. Brissaud, in all
seriousness, refused to change the title of the paper.

Vallon, in a long, rambling speech, conveyed the opinion that
traumatism could produce general paralysis. He gave no real
facts, and did not even quote, as au analogy, the physiologist’s
experiment, where, after artificial trauma, one cerebral hemisphere
of a dog which had recovered fully from the paralysis thus
induced, became once more paralytic on the injection into the
blood of bacterial toxins, thus showing the increased susceptibility
of traumatised tissues.

In the section of psychiatry, two studies of dementia precox by
Mdle. Pascal, of Ville Evrard, raised questions of clinical import¬
ance in the early diagnosis of this much-disputed affection. She
thinks that characters of their own are shown by the fits which occur
early in dementia precox, and that they are very often mistaken
for hysteria, especially as the same patients often at other moments
exhibit the silly laugh so often called hysterical.

Professor Regis thought that this laugh is rarely absent early
in dementia precox; but he did not agree with Pascal in
thinking that a laugh specially excited by solemn events belongs
to this psychosis; he thought it was due to the obsession of con¬
trast. He thought, too, that not only precocious dements presented
such convulsions but that they occurred in all the psychoses of
intoxication, and were due to toxaemia.

To this Pascal replied that such fits occurred in cases
which showed no mental confusion or other toxic symptoms. To
those who accept as clinical entities neither dementia precox nor
confusion mentals, these arguments will not appear of great value.
But it must be remembered that only in acute attacks of toxemia
does one find such a definite syndrome as the confusion menials,
while precocious dementia—a chronic, slowly-progressing malady

720

REPORT OF CONGRESS

—presents psychic signs of intoxication so attenuated that their
validity is even denied. But when we reflect that in a disease of
definite morbid anatomy so well known as general paralysis, delire
is neither constant nor always takes the same form, running the
gamut between the most exalted grandiose ideas and a depression
even leading to suicide, the polymorphism of the early manifesta¬
tions of dementia precox, and their resemblance to certain phases
of confusion mentale, is no reason for separating into numerous
categories the admirable synthesis which KrapeUn has given to
psychiatry.

Another communication was that in which Williams main¬
tained that traumatic neuroses were merely the products of
unskilful suggestion, direct or indirect, by doctors. In support of
the contention he quoted a railway accident in America, where
out of 200 people (of whom 120 were wounded), only 24 had
traumatic neuroses. All those who happened to fall first into the
hands of Professor Bevan of Chicago were cured at once, while none
of the others were cured until they had received indemnity through
the courts. The means of treatment employed by Bevan were,
in principle, those of Bemheim, though they were more crudely
carried out. Dejerine has used the same in removing what he
calls false gastropathies. Their essence is to neutralise the ideas
fixed in the patients by the unskilful suggestions of other doctors,
either unconsciously created in the course of medical treatment, or
acquired by the patient from a clinical picture (in the air, as it
were), this of course being primarily of medical painting, “ the
so-called auto-suggestion.”

He was not surprised that these considerations had not become
current, in view of the fact that the observations even of an
observer like Babinski, about the so-called stigmata of hysteria, had
not been better received even by neurologists. He accounts for
this by the difficulty the human mind has in freeing itself from
such a suppressed major premise as the authority of a text-book.
He shows how suggestibility is in proportion to ignorance or lazi¬
ness of the critical power, and that in medical matters the laity
fall an easy prey on that account; and in consequence this type of
suggestibility is not a mark of hysteria or neurasthenia. The
difficulty of curing these cases is due to the suffering produced by
an attempt on the patient’s part to modify the false convictions of
which he is a victim ; for change of convictions means change of
personality; and the conservation of the sentiment of the person¬
ality is a means towards self-preservation. Cases are quoted in
support of this thesis; and the practical application of the paper
is to urge the medical profession to counteract the injurious
suggestions of charlatans, with which Williams classes those at
the bottom of the manifestations of traumatic neuroses. As a
first step towards this, he advocates the instruction of the medical

REPORT OF CONGRESS

721

profession in psychology, without which they are quite incapable
of explaining to the laity what is in reality not at all mysterious.

Joire, of Lille, showed an apparatus which he called the
sthenom&tre, by which he claimed to be able to diagnose neuras¬
thenic states through a dynamic influence exerted by the patient
on a very light, finely balanced needle in a glass case. He had
eliminated as causal factors heat, light, and magnetism, and thinks
the deviation is proportional directly to the nervous force of the
subject tested. The general verdict of the members was pas
sdrieux. He also read an exceedingly long paper on simulation by
hysterics, entering into the whole question from the beginning;
but it will be more convenient to discuss this next month, in con¬
nection with the third report (of Leroy), on the responsibility of
hysterics.

The study of hysteria, which has within recent years fallen
into abeyance, after the stimulation it received at the hands of
Charcot and his followers, is again beginning to excite attention in
France; and, indeed, one of the reports decided upon for next year
is on the nature of this psychosis (I use this term advisedly).
It will be reported upon by Claude, who has the unsurpassed
opportunity of the clinic of Charcot’s successor, Professor Raymond,
at the Salpetri&re.

This interest is chiefly due to the progress made by the ideas
of Babinski, who confines the name hysteria to those manifesta¬
tions susceptible of production by suggestion, and removable by
persuasion. He excludes, therefore, such symptoms as polyuria,
cyanotic oedema, and hyperthermia. He claims that misunder¬
stood organic conditions or faulty control of the opportunity for
deception by the patient are responsible for the cases reported.

Tom A. Williams.

{To be continued.)

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HANS FREUD. Nouer Apparat zur Massenfarbung mikrosoopischer Pripewte
von F. Hellige k C o. Z tschr. /. wissen. MUcroskopit ,. Bd. 23, H. z, 1906, S. 197.
WAKELIN BARRETT. The Staining Act: An Investigation into the Niton*
of Methylene Blue-Eosin Staining. Bio-Chemical Jour*., Sept. 1906, p. 406.
HOPPE. Zur Technik der Weigert’schen Gliafarbung. Neurol . Central#..

Sept. 16, 1906,jp. 854.

LOBENHOFFER. Ueber die Ergebnisse der Altmann-Schriddeechen FSrt*-
methode beim Zentralnervensystem. Arch. /. mikros. Anal.. Bd. 68, H. 4, 1906,
S. 491.

PHFBIOLOGT

C. K. MILLS. Cerebral Localisation and the Study of Psychiatry. Ant Mei
Joum. t Sept. 29, 1906, p. 748.

RICHARD. Uberblick Uber den heutigen Stand der Frage nach der Lokilhrtine
in der Grosshimrinde und ihre Anwendung in der forensischen Praia.
Monatsschr. f. Psychiat. u. Neurol ., Bd. 20, H. 3, 1906, 8. 280.

PAGANO. Le funzioni del nucleo caudato. Contribute alia peico-firiologios daik
emozione o all* innervazione centrale degli organi genitali. Riv. di PaL am. t
ment., Vol. ii., fasc. 7, 1906, p. 289.

DRIESCH. Studien zur Entwicklungs-physiologie der BilateraHtat. Ard. f.
Entfciddmujsmechanik d. Organismen, Sept. 1906, S. 756.

JADERHOLM. Unterauchungon Uber Tonus, Hommung und Erregbsikeit.
Arch. f. die gesam . Physiol ., Bd. 114, H. 8-4, 1906, S. 248.

CLUZET. La loi d’excitation des nerfs. Ann. d'ElectrobioL , aoOt 1906, n506*
HOORWEG. Ueber die elektrische Erregung der Nerven und der MuskdiL
A\rh. f. die gesam. Physiol ., Bd. 114, H. 3-4, 1906, S. 216.

FERE. Le precision du monvement sous l’influence des ezoitationa Csmptc
Rend, des Stances de la Soc. de Biol T. lx., p. 377.

TAWARA. Das Reizleitungssystem des Saugetierherzens. Elne anatomiseb-histo-
logische Studie Uber das Atrioventrikularbundel und die Purkinjeschen FSden.
Fischer, Jena, 1906, M. 10.

BOTTAZZI. Ein WarmblutermuskelprSparet das sich fUr Untersuchungen ste-
meinon Muskelphysiologie besondera eignet. Ztschr. f. Biol., Bd. 48, H. 8,lfcri.
S. 432.

PIERACCINI e CENI. II tetano faradioo e la reazione galvano-musculare
studiate nei rapporti col lavoro musculare svolgentisi liberamente nel campo del
lavoro quotidiano. Ric. crii. di Clin. Med., sett. 15, 1906, p. 681.

KttLBS. Experimentelles uber Herzmuskel und Arbeit. Arch. f. Experisust.
Pathol ., Bd. 55, H. 4-5, 1906, S. 288.

HENRICI. Ueber respiratoriache Druckschwankungen m den Nebenhtfhlen der
Nas#, Ztschr. f. Psychol, u. Physiol, d. Sinnescn-aanc, Bd. 41, H. 4, 1906, S. 283.
VON DER vElDEN. Zur Phkrmakoiogie des N ervus Depressor. ArcA. f. Ex¬
periment. Pathol ., Bd. 55, H. 4-5, 1906, S. 223.

ROUX et HEITZ. De l'influence de la section exptrimentale des ndnm vos-
t^rieures sur letat des neurones p£riph£riquee. Nouv. Icon, de la Salpitritrt , VoL
xix., No. 4, p. 297.

PSYCHOLOGY

A. BINET. Cerveau et pens£e. Arch, de Psychol juillet-aodt 1906, pi.
DECROLY et DEGAND. Les tests de Binet et Simon pour la mesure de rintel-
ligence. Aixh. de Psychol., luillet-aoOt 1906, p. 27.

CORNELIUS. Psychologiscne Prinzipienfragen. I. Psychologic und Erkenntni?-
theorie. Ztschr. f. Psychol, u. Physiol, d. Sinnesorgaru , Bd. 42, H. 6,1906, S. 401.

BIBLIOGRAPHY

723

ISADOR H. CORIAT. Experimental Synthesis of Dissociated Memories in
Alcoholic Amnesia. Joum Abnorm. Psychol ., Vol. i., No. 3, 1906, p. 109.
KATZ. Experimentelle Beitrgge zur Psychologic dm Vergleichs im Gebiete des
Zeitsinns. (Schluss.) Ztschr. /. Psychol, u. Physiol, d. Slnnesorgane , Bd. 42, H.
6, 1906, S. 414.

LOHMANN. Ueber Helladaptation. Ztschr. f. Psychol, u. Physiol d. Sinnes•
organs , Bd. 41, H. 4, 1906, S. 290.

HENRY J. WATT. Ueber die Nachbilder subjektiv gleich heller, aber obiektiv
▼erschieden stark beleuchteter Flachen. Ztschr. f. Psychol, u. Physiol, d. Sinnes-
organs. Bd. 41, H. 4. 1906, S. 312.

AUDIFFRENT. De la Sensation et de remotion. Arch. danthropol. mm., T.
21, Nos. 151-153, 1906, p. 481.

PROBST. Les dessins des enfants Kabyles. Arch, de Psychol. t juillet-aoOt 1906,
p. 131.

PICK. Sur la confabulation et ses rapports avec la localisation spatiale dee
souyenirs. Arch, de Psychol. , juillet-aoOt 1906, p. 141.

MAEDER. Contributions h la psycho-pathologie do la vie quotidienne. Arch,
de Psychol ., juillet-aotit 1906, p. 148.

PATHOLOGY

SOUKHANOFF et PETROFF. Un cas de microcSphalie avec autopsie. Le
Ntn'axe, Vol. viii., fasc. 1, p. 1.

GEORG EISATH. Ueber normale und pathologische Histologie der menschlichen
Neuroglia. Monatsschr. f. Psychiai. u. Neurol., Bd. 20, H. 3, 1906, S. 240.
MARINESCO. Quelques recherches sur la morphologic normale et pathologiqun
des cellules des, ganglions spinaux et sympathiques de Thomme. Le Ntoraxe,
Vol. viii., fasc. 1, p. 7.

SCHAFFER. Das Verhalten der fibrillo-retikulfcren Substanz bei Schwellungen
der Nervenzellen. Neurol. Centralbl., Sept. 16, 1906, p. 834.

SAITO. Ueber Dauerverkiirzungen an gelkhmten Muskeln. Ztschr. f. Biol., Bd.
48, H. 3, 1906, S. 340.

MtJNZER. Das Waller’sche Gesetz, die Neuronenlehre und die autogene Re¬
generation der Nervenfosern. Ztschr. f. Heilk. , Bd. 27, H. 8, 1906. S. 297.
EUGENIO RIGNANO. Die centro-epigenetische Hypothese una der Einflusa
des Centralnervensystems auf embryonale Entwicklung und Regeneration. Arch,
f. Enhcicklv.ngsmechanik, Sept. 1906, S. 792.

BABES et MARINESCO. Histologie des lesions exp6rimentelles et pathologiques
des cellules nerveuses surtout des ganglions spinaux. Hirsohwald, Berlin, 1906,
M. 14.

HANS EVENSEN. The Pathology of General Paralysis. Rev. Neurol, and
Psychmt., Sept. 1906, p. 616.

HUGO STALBERG. Pathologisch-anatomische Verknderungen des Gehiras bei
Lepra, Leprabacillen in Gasser schon Ganglion und in die Anatomie und Patho¬
logic der Nervenzellen des Gehirns im Allgemeinen. A'txh. f. Psychiai. u. Nervenk .,
B. 41, H. 3. 1906, S. 809.

BABONNEIX. Les kystes hydratiques du cerveau chez Tenfant. Rev. mens, des
mat. de I'enfance , sept. 1906, p. 385.

BREGMAN. Beitrage zur Pathologic der Varol’schen Briicke. Deutsche Ztschr.
/. Nci'ccnheilL, Bd. 31, H. 1-2, 1906, S. 86.

RUPPEL. Ueber den Diplococcus intracellularis meningitidis und seine Be-
ziehungen zu den Gonococcen. Deutsche med. Wchnschr., Aug. 23, 1906, S. 1866.

CLINICAL NEUROLOGY AND PSYCHIATRY

CEMERAL—

HERM. MEYER. Compendium der Neurologie und Psychiatrie. Speyer k
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EICHHOIIST. Pathologic und Therapie der Nervenkrankheiton. 1. Half to.
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FtlRNROHR. Die Rontgenstrahlen im Dienste der Neurologie. Karger, Berlin*
1906, M. 10.

A. T. SCHOFIELD. Mind in Medicine. Brit. Med. Joum ., Sept. 29, 1906,
p. 765.

The Nose and the Brain. Leading Article. Brit. Med. Joum., Sept 29, 1906*
p. 792.

MARTIN BARR. Physical Training a Factor in Psychological Development.
AT. Y. Med. Joum., Sept. 15, 1906, p7531.

724

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ASCHAFFENBURG. Die Benehungen dee sexuellen Lebens zur Entstehung
von Nerren- und Geisteskrankheiten. Munch, mod. Wchnschr ., Sept 11, 1906,
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T. S. CLOUSTON. The Hygiene of Mind. Methuen k Co., London, 1906,
7». 6d.

MUSCLES—

DREYER. Ueber Skelettveranderungen und Friihkontrakturen bei Dystrophia
musculorum progressiva. Deutsche Ztschr. f. NervenheilL , Bd. 31, H. 1*2, 1906,
8. 147.

VON BECHTEREW. Ueber myopathieche Muskelhypertrophie. DeutscheZtschr.
f. Ntrvtnheilk.y Bd. 31, H. 1-2, 1906, 8. 164.

ROSENBERG. Ueber Myatonia congenita. Deutsche Ztschr . /. Nereenheill ., Bd.
31, H. 1-2, 1906, S. 13a

PEBIPMEBAL NERVES—

CHANOZ. Paralyse radiale par fracture de 1'humerus. Recherche dectrique nr
le nerf mis a nu. Gu6rison malgrl un prognostic dtfavorable. Arch. cTfiled?.
MkL, sent. 10, 1906, p. 659.

HAUCH. Neuritis puerperalis lumbalis peracuta. Bibl.f. Laegety 1906, p. IS.
JABOULAY. Neurofibromatose avec n^vrome plexiforme. (faz.dtsH6p.yMbi
28, 1906, p. 1155.

RONNEACX. Deux cas de zona traitls et gu€ris par 1'effluTation de haute fre¬
quence. Ann. c? Klecti'obiol. et de Radiol., July 1906, p. 498.

OSTERROHT. Herpes zoster ophthalmicus. Marhoid, Halle, 1906. M. —80.

a pinal corns—

JEAN LEPINE. Rapports du rhumattsme chroniquo avec quelques maladies de
la moelle. Lyon Mhd.y sept. 16, 1906, p. 465.

Tabes.— DUBOIS. Sur la coexistence des accidents syphilitiques tertiaires avec le
tabfes. Thise. Storck et Cie, Lyon, 1906.

MARTIN. The Sphincter Reflexes in Tabes Dorsalis and Paresis. Journ . of Sen.
and Ment. DU., Aug. 1906, p. 527.

Progressive Muscular Atrophy. —STIEFLER. Zur Klinik der neuralen Form
der progressiven Muskelatrophie. Ztschr. f. HeUk. , B<L 27, H. 8, ISHB,
S. 219.

Amyotrophic Lateral Sclerosis.— PUSCARTN et LAMBRIOR. Sclerose laten:
amyotrophique avec phenomfenes spasmodiques trfcs accentuls et amyotrophia
accusle des membres suplrieurs. Phlnombnes bulbaires tree marques, march*
rapide, mort. Autopsie. Rev. Neurol. y sept. 15. 1906, p. 789.

Little** Disease.—GLASCOCK. Report of a Case of Little's Disease. N. F. Mei
Journ. y Sept. 1, 1906, p. 433.

Myelitis. —SALLE. Zur Frage liber die Wege der aufsteigenden Myelitis. lu&chi
Ztschr. f. NervenheiU., Bd. 31, H. 1-2. 1906, S. 108.

Eucephalomyelltls. — OTTO MARBURG. Die sogenannte akute Sklerose (En¬
cephalomyelitis periaxialis scleroticans). Deuticke, Wien, 1906, M. 3.

Potts* Disease.—BOSCHI et GRAZIANI. Un cas de parnptegie potfcique. Res.
Neurol., Sept. 15, 1906, p. 799.

Disseminated Sclerosis. — HELLER. Zur Differentialdiagnose zwischen
psychogoner Neurose und multipler Sklerose. Klin. f. psych, u. nerr. Kmnih,
Bd. 1, H. 3, S. 252.

ASHLEY W. MACKINTOSH. On the Frequency with which Certain Signs and
Symptoms occur in Cases of Disseminated Sclerosis before the Development of
so-called Cardinal Symptoms. Rev. Neurol, and PsychiaL, Sept. 1906, p. 601.
CATOLA. Scterose en* plaques et syphilis. Nouv. Icon, de la Salpit Vol. rix..
No. 4, p. 337.

Syringomyelia. — BURR. A Note on the Temporary Disappearance of the
Sensory Symptoms in Syringomyelia. Journ. of Nerv. and Ment. Dis. y Aug. 1W6,
p. 525.

Tnmonr.— GEORG STERTZ. Klinisohe und anatomische Beitrage zur Kssoiatik
der Ruckenmarks- und Wirbeltumoren. Monatssckr. f. Psychiat. u. Neurol.,
Bd. 20, H. 3, 1906, S. 195.

Concussion.— CORNER. Concussion of the Spine, with some Remarks on Concusooc
in general. Lancet , Sept. 22, 1906, p. 784.

Spine.— PONCET et LERICHE. Pathog6nie des ankyloses nKmtan6es et parti-
culiferement des ankyloses vertlbrales. Key et Cie, Lyon, 1906.

LERI. Pathoglnie des ankyloses et particulihrement des ankyloses vertebrales.
Rey et Cie, Lyon, 1906.

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Menlngltls.—WE8TENH0EFFER. Ueber don gegenw&rtigen Stand unserer

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BLAU. Kasuistischer Beitrag zur Meningoencephalitis serosa. Ztschr. f.
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WE8TENHOEFFER Pathologisch-anatomisehe Ergebnisse der obersehlesischon
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WRIGHT. The Rash in Cerebro-spinal Meningitis. Lancet , Sept 15, 1906,
p. 717.

Hsnaorrhage.— MARIE et MOUTIER. Deux cas d’hlmorragie protutarantielle.

Rouv. /con. de la Salpit ., Vol. xix., No. 4, p. 888.

Encephalitis. —LAACHE. Til encefalit-spogsmaalet Norsk. Magaz. f. lAgevid .,
1906, p. 1.

Sin as Thrombosis.— -FRIED. STOCKER A rare case of Thrombosis of the
Cavernous Sinus following Orbital Thrombo-phlebitis. Arch, of Ophthalmol ., Vol.
xxxv., No. 4, p. 373.

YERSIN. Phllbite infootieuse du sinus caverneux. Rev. mid. de la Suisse
Romande , aotit 20, 1906, p. 456.

ST CLAIR THOMSON. Cerebral and Ophthalmic Complications in Sphenoidal
Sinusitis. Brit. Med. Joum., Sept. 29, 1906, p. 768.

Tsnoar. —OGDEN and MATHEWS. A Case of Sarcoma with Secondary Intra¬
cranial Growths in a Child of Five. BriL Joum. Children's Dis. , Sept. 1906, p. 894.
8ALTYKOW. Heilungsvorgttnge an Erweichungen, Lichtungabezirken und
Cysten des Gehims. Arch./. Psychiat. u. Nervenk ., Bd. 41, H. 3, 1906, S. 1053.
Abscess.— PAUSE. Ein Fall von Kleinhirnabscess. Monatsschr. f. Ohrenheilk .,
Bd. 40, H. 8, 1906, S. 589.

TH^VENET et ROUBIER. Abchs extra-duremlriens. Gat. des H6p., sept. 22,
1906, p. 1287.

CIAMPOLINI. Sintomatologie e diagnosi degli ascessi cerebellari d'origine
otitica. Riv. ant. di Clin. Med., sett. 22, 1906, p. 605.

ALFRED WIENER. A Case of Brain Abscess following Traumatism and Acute
Mastoiditis. A Case of Hysteria simulating Brain Abscess after Operation for
Secondary Mastoiditis. Arch, of Otol. % Vol. xxxv., No. 4, 1906, p. 840.
ZEBROWSKI. Zur Kasuistik der otitischen Himabscesse. Monatsschr. f. Ohren¬
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Ht^TTIG. Zur Kasuistik der endokraniellen Komplicationen der Mittelohreiter-
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General Paralysis. —SALMON. Della diagnosi differemriale tra la paralisi pro¬
gressiva e la sifilide cerebrale. La Clin. Modeme, agosto 22, 1906.

RODIET, DUBOIS et PANSIER Les symptdmes oculaires de la paralysie
generate. A rch. de Neurol., aoClt 1906, p. 90.

W. JULIUS MICKLE, ALDREN TURNER, and others. A Discussion on
General Paralysis. Brit. Med. Joum., Sept. 29, 1906, p. 741.

DUCHAMP. Les Troubles oculaires dans la paralysie glnlrale au d6but. Dirion,
Toulouse, 1906, 3 fr.

M. REICHARDT. Ueber Knochenverknderungen bei progressiver Paralyse.
Centralbl. f. Nerv. u. Psychiat., Sept. 15, 1906, p. 705.

MENTAL DlftEABEft—

DIEFENDORF. Etiology of Dementia Paralytica. Brit. Med. Joum., Sept. 29,
1906, p. 744.

D1DE. £tude cytologique, bactfriologiaue et explrimentale du sang chez les
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T. D. CROTHERS. The Insanity of Inebriety. Biit. Med. Joum., Sept. 29,
1906, p. 753.

SERGE SOUKHANOFF. On Hypochondriacal Melancholia in Russian Soldiers.
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C. K. CLARKE, ADOLF MEYER, and F. X. DERCUM. A Discussion on
Dementia Prwcox. Brit. Med. Joum., Sept. 29, 1906, p. 755.

CLARENCE B. FARRER Types of the Devolutional Psychoses. Brit. Med.
Joum., Sept. 29, 1906, p. 760.

MARC HAND et OLIVIER. Diabfete et troubles mentaux. Oaz. des U6p., sept.
6, 1906, p. 1203.

COURTNEY. On the Clinical Differentiation of the Various Forms of Ambula¬
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FRANCO DE ROCHA. La psychose maniaqae depressive. Ann. mid-psyM.,
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MARCUS WYLER. Beitrage zu einem Grundries dee vergleiohendea Irrea-
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ROBERT RENTOUL. Proposed Sterilisation of Certain Mental Degenerates,
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ADAM. Dos Itablissements d’ali6n6s, d'idiots et d*6pileptiques. Du r61© da
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LAQUER. Die artzliche und eraehliche Bebandlung Ton SchwachsmnigaQ
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VERKON BRIGGS. Observation Hospitals or Wards for Early Cases of Mental
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WERNER. Die Versorgung der geisteekranken Verbreoher in Dalldorf. Fischer,
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HOPPE. Ein gang duroh eine modems Irrenanstalt. Marhold, Halle, 1906,
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4BMEBAL AND FUNCTIONAL DIABASES—

Chorea. —VETLESEN. Chorea gravidarum and psychosis. Norsk. Magaz. f.
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MACKEY. A Case of Osteitis Deformans with Huntingdon's Chorea. Lcaat,
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Epilepsy.—THALWITZER. Epileptiker als Autofahrer. MUnch. mod. Wchuehr .,
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GEORG LOMER. WitterungseinflUsse bei Epileptischen. Arch. /. Psyckiei. il
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JULES VOISIN et ROGER VOISIN. Emploi du bromure de potassium dans
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BAUMANN. Ein seltener Fall von hysterischem D&mxnerzustande. Neurol.
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MENDELSOHN und KUHN. Beobachtungen liber kiihmilchfrei Emlhrungbei
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Nenralgfta.—LEO WILLIAMS. Neuralgia and Headache. Clin. Joun., Aug. 22,
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LEWIS S. SOMERS. Nasal Disease and Neuralgia. Joum. Amer . Med. Assoc.,
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I*aralysis Agltans. -KINICHI N AKA. Zur pathologischen Anatomic der P&r&ljni
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Exopktkalmlc Ctltre.—GIFFORD. Ueber ein n mm Augensymptom bei Morbus
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SPECIAL SENSE* AMD CRANIAL NERVES—

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CAVAZZANI. Lesioni spinali e riflessi pupillari. Riv. crit. di Clin. Med., sett.
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WENDELL REBER. A Study of Convergence and its Defects, including an
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SOH1ER BRYANT. The Great Psychical Importance of Ear Disease. Joum.
Nerv. and Mini. Dis ., Sept 1906, p. 663.

EMIL AMBERG. Ear Affections and Mental Disturbances. Joum. Nerv. and
Mint. Die., Sept. 1906, p. 566.

HOLGER MyGIND. Die Paralysis des Muse, crico-thyreoideus. Arch. f.
LaryngoL, Bd. 18, H. 3, 1906, S. 408.

GROSSMAN. Beitr&g zur Lehre von der wechselseitigen funktionellen Beziehung
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S. 463.

GRABOWER. Zur Recurrensfrage. Arch. f. LaryngoL , Bd. 18, H. 3, 1906,
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GEORG AVELLia Neue Fragestellung zur Symptomatologie der Sensibilit&ts-
storungen im Larynx. Arch./. LaryngoL, Bd. 18, H. 3, 1906, S. 472.
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Psyckiat.. Sept. 1906, p. 608.

MISCELLANEOUS SYMPTOMS—

STRASBURGER. Zur Klinik der Bauchmuskell&hmungen, auf Grund eines
Falles von isolierter partieller LShmung, nach Poliomyelitis anterior acuta.
Deutsche Ztschr./. Ncrvenheilk. , Bd. 31, H. 1-2, 1906. S. 52.

CURSCHMANN. Beitrage zur Physiologie und Fathologie der kontralateralen
Mitbewegungen. Deutsche Ztschr./. Ncrvenheilk., Bd. 31, H. 1-2, 1906, S. 1.
HRtJSKA. Ein Fall von Typhus abdominalis mit nachfolgender LAhmung und
Aphasie. Prog. med. Wchnschr., Sept. 20, 1906, S. 487.

LANG. Liihmungen nach Lumbalan&sthesie mit Novocain und Stovain. Deutsche
med. Wchnschr., Aua. 20, 1906, S. 1412.

DA1REAUX. Etude sur les paralyses pneumoniques ches les adultes. Arch. gbt.
de mid.. Sept. 4, 1906, p. 2241.

HERZOG. Ueber das VibrationsgefUhl. Deutsche Ztschr. /. Ncrvenheilk., Bd. 81,
H 1-2 1906 S 96

CHARLES L. DANA. The Question of Protopathic and Epioritio Sensibility
and the Distribution of the Trigeminus Nerve (Third Branch). Joum. Ncrv . and
MenL Dis., Sept 1906, p. 577.

LES EM. Acroparesthesia. A Study of 200 Cases. Med. Rec., Sept. 1, 1906,
p. 337.

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* A number of references to papers on Treatment are included in the Bibliography under the
Individual Diseases.

IReview

UteuroloQS anO fltepcbiatrs

Original Htticle

A CASE or PARTIAL DOUBLING OF THE
SPINAL CORD . 1

By PURVES STEWART, M.A., M.D. Edin., F.R.C.P.,

Physician in charge of Out-Patients at the Westminster Hospital;

Physician to the Royal National Orthopaedic Hospital;

and

JULIUS BERNSTEIN, M.B. Lond., M.R.C.S.,

Assistant Pathologist and Curator of the Museum to the
Westminster Hospital.

The following case of partial doubling of the spinal cord came
under our observation at Westminster Hospital during the summer
of 1904.

Clinical Notes.

The patient, a lad of sixteen, a clerk by occupation, was
admitted to the wards under Dr Purves Stewart, suffering from
tuberculous meningitis. The family history was unimportant.
There was no consanguinity of the parents. The patient had
always been observed to walk a little clumsily, but his general
health had been good and his intelligence quite up to normal.

Three weeks before admission he began to complain of frontal
headaehe, and the bowels were confined; two days before admis¬
sion he began to vomit, and on the day before he came in he
became drowsy and developed incontinence of urine.

When admitted on 22nd August he was semi-comatose, but

1 The pathological part of this paper has already been communicated by one of
ua (J. B.) to the Transaction* of the Pathological Society of London , vol. lriL, to
which Society we are indebted for the use of Figure facing p. 732.

R. OF N. & P. VOL. IV. NO. 11—3 B

730

ORIGINAL ARTICLE

could be roused with difficulty. The optic discs were normal
The pupils were equal and did not react to light. The other
cranial nerves were normal He had no paralysis of any limb.
There was well-marked pes cavus on both sides. The knee-jerks
and ankle-jerks could not be elicited. The plantar reflexes were
of a doubtful extensor type. The temperature was 100° F., and
the pulse 74. The urine was normal.

On 23 rd August, lumbar puncture was performed. The intra¬
thecal pressure was found to be markedly increased. The fluid
was clear, but on microscopic examination showed a large excess
of degenerating lymphocytes.

Aug. 24. To-day (apparently as a result of relief of
intracranial pressure by the lumbar puncture) the patient’s coma
has passed off and he is quite rational The left pupil is slightly
larger than the right, and both of them react sluggishly to light
There is occasional transient inward strabismus of the left eye.
The face, palate, tongue, upper and lower limbs are normal and
symmetrical in their movements. The knee-jerks and ankle-jerks
are still absent

Aug. 25. The patient is again semi-comatose. The pupils
react very sluggishly to light. The ankle-jerks are just present;
the knee-jerks are not elicited. The right plantar reflex is of
extensor type, the left flexor.

Aug. 26. The coma is now complete. No additional paralysis
has developed. There is still occasional transient inward
strabismus of the left eye. The spinal muscles also occasionally
become tonically contracted. There is no head-retraction. Lumbar
puncture withdraws 22 cubic centimetres of clear fluid under
excessive pressure.

Aug. 27. The patient is again partially conscious. The right
eye is fixed in the mid-position, the left occasionally rotates in¬
wards alone.

Aug. 28. The pupils are now dilated and insensitive to light

Aug. 30. The pupils are widely dilated and insensitive. The
veins of the left optic disc are now fuller than normal, but there
is no measurable swelling. The right eye is fixed in the mid¬
position, whilst the left makes occasional inward movements.
The patient is semi-comatose and makes restless movements of
the face and hands. There have been no fits. The knee-jerks
and ankle-jerks are again absent. The plantars are flexor in

ORIGINAL ARTICLE

731

type. The temperature, which since admission has varied from
99° F. to 101* F., is now over 102*2° F.; and the pulse, which
on admission was 80, is now 144.

Aug. 31. Patient died this morning, with a temperature of
105° F.

Remarks.

The diagnosis made during life was that of basal tuber¬
culous meningitis. The history of habitual clumsiness of gait,
together with the presence of pes cavus, suggested the possibility
of a co-existing Friedreich’s ataxy. The absence of the knee-jerks
and ankle-jerks on admission might have seemed to support such
a view, but, three days after admission, the ankle-jerks were
elicited quite distinctly, and we therefore preferred to attribute
the depression of the deep reflexes to increased intracranial
pressure. The presence of the pes cavus therefore remained
unaccounted for.

Pathological Appearances.

4-t the base of the brain there were the usual appearances of
tuberculous meningitis. The spinal meninges were normal.

On opening the vertebral canal a marked bulging of the
membranes in the lumbar region was observed. The theca and
its contents almost filled the vertebral canal. On opening the
theca, its abnormal fulness was found to be due, not to
excess of fluid, but to a bifurcation of the spinal cord, commenc¬
ing at the level of the first lumbar segment and becoming almost
complete in the third lumbar segment, at which level, on transverse
section, the naked-eye appearance was that of two spinal cords,
slightly united at their mesial aspects, each possessing grey and
white matter, with two anterior cornua and one posterior cornu
on each side. Below this level the two cords gradually fused
together again, the dividing fissures becoming progressively
shallower, and the cord ultimately became continuous with
the filum terminale, which was single, though somewhat
thicker than usual.

The cord was fixed in Muller’s fluid. After being divided
into blocks, each segment was cut in paraffin, serial sections
being made of the first lumbar segment, in order to study the
question of the bifurcation of the central canal and surrounding
grey matter.

732

ORIGINAL ARTICLE

The appearances at different levels are shown in Figs. 1 to
11, which were drawn to scale by means of the Edinger projec¬
tion-apparatus, and in the photographs appended.

In the upper part of the first lumbar segment (see Figs. 1
and 2) the appearances are those of a normal cord. Towards
the lower part of this segment, whilst the central canal remains
single, the posterior or grey commissure becomes more diffuse
and bulges backwards towards the posterior columns. Lover
still (see Fig. 2) a smaller canal appears, situated in front and to
one side of the main central canal.

In the upper part of the second lumbar segment the cord is
divided into two almost complete halves (see Fig. 3) by the
deepening of the original anterior and posterior median septa.
Each half-cord possesses a central canal towards its inner
aspect, a complete anterior and posterior cornu, with, at the
outer side, anterior and posterior nerve-roots, and mesially a
mass of grey matter, the downward continuation of the original
grey commissure, spread somewhat profusely around the bisect¬
ing processes of pia mater. Lower still, the two central canals
diverge from each other towards the centres of their respective
half-cords, but never quite reaching the centre on each side.
The mesially situated grey matter assumes the appearances of si
anterior and a posterior cornu on each side of the mesial furrow,
these new cornua becoming separated from the pia mater by a
tract of white matter (see Fig. 4). Meanwhile the separation of
the two half-cords becomes more complete, and each develops an
anterior fissure and a less perfect posterior septum, the two new
anterior fissures being inclined towards each other and towards
the original anterior median fissure, which is now antero-mesial
with relation to each half-cord.

In the third lumbar segment (see Fig. 6) the separation of
the two half-cords is at its maximum. Each has an anterior
and a posterior septum, a central canal, two anterior cornua and
two posterior cornua. The antero-extemal cornu on each side
is better developed than the antero-mesial cornu. The antero-
extemal cornu possesses well-formed nerve-cells, whereas in the
antero-mesial cornu the nerve-cells are small in size and scanty in
numbei-s. Moreover, the anterior nerve-roots are derived only
from the antero-extemal cornua. The two half-cords appear as
‘ if rotated inwards, each on its ov(n long axis, so that the two

734

ORIGINAL ARTICLE

antero-mesial fissures incline inwards towards each other. The
grey matter of the postero-mesial cornua is somewhat diffuse and
broken up by irregular strands of white matter.

Below this level the two half-cords gradually fuse together
again, but in a less symmetrical manner than that in which they
had separated. Firstly, the adjacent antero-mesial cornua
become fused (see Fig. 7), the two postero-mesial cornua being
still separated by white matter, in which is a posterior
septum. There are still two central canals and two
antero-mesial septa symmetrically situated. Lower down,
the two antero-mesial fissures meet to form a single fissure
bifurcated in a Y-shaped fashion on transverse section. One
half-cord then rapidly resumes an almost normal appearance, its
central canal persisting as the true central canal of the lower,
segments. The postero-mesial cornua gradually merge again
into the posterior grey commissure. The other half-cord remains
for a time as an abnormal excrescence of grey matter projecting
laterally from the true {interior cornu. In Fig. 8 the arrange¬
ment of the anterior cornual cells is shown. There is a con¬
striction of the grey matter at the point corresponding to the
position of the original antero-mesial fissure. On both sides of
this constriction there are groups of nerve-cells, the majority
being external to the constriction. At this level the central
canal of this half-cord becomes less distinct and the posterior
cornu disappears (see Fig. 9). The fibres of the posterior root
on this side are more numerous, but in smaller bundles, than
those of the posterior root of the other side.

In the sacral region a small relic of the additional central
canal is still to be made out, situated antero-mesially to the
constriction of the anterior cornu. Even in the coccygeal seg¬
ment there is a trace of an extra posterior septum (see Fig. 11),
situated at the circumference of the cord, about a quarter of the
way round from the true posterior septum.

At first sight this case might appear to be an example of
true doubling of the spinal cord, the central canal of the original
cord bifurcating to correspond to the double organ. But inas¬
much as the nerve-cells in the abnormal parts are for the most
part, if not entirely, situated in the antero-extemal cornua, which
are the homologues of the anterior cornua of the undivided cord,

Plate 40 .

Second Lumbar Segment.
Photograph x li.

Third Lumbar Segment.
Photograph x ]J.

Fourth Lumbar Segment.
Photograph x 1L

Fifth Lumbar Segment.
Photograph x lj,

ORIGINAL ARTICLE

735

and considering also that the posterior roots in the bifurcated
area are in connection only with the postero-external cornua, it
is more probable that the mesial cornua, whether anterior or
posterior, are merely masses of expanded grey matter corre¬
sponding to the grey matter of the commissure higher up. The
expanded grey commissure becomes constricted in the middle by
ingrowth of the anterior and posterior median septa with pia
mater, and strands of white matter come to separate the mesial
cornua from the constricting pia. Moreover, careful examination
of the mesial cornua shows their structure to be abnormally
diffuse, being traversed by strands of white matter. We there¬
fore have to do, apparently, with a bisected cord, not with a true
doubling of the cord.

The literature of this subject has been so recently discussed
by Bruce, M'Donald, and Pirie in their admirable article in this
Review (1906, part i.) that it is unnecessary to recapitulate the
points which they have brought out. We therefore content our¬
selves with recording this case as another example of the type to
which belong the cases recorded by Bruce, M'Donald, and Pirie,
by v. Recklinghausen, by Theodor and by Steiner. In all these
cases, as in our own, the antero-external cornua were better de¬
veloped than the antero-mesial. The posterior roots appear to be
connected in a similar fashion with the postero-external cornua,
the postero-mesial cornua being formed by a diffuse spreading-
out of the grey matter of the posterior cornua.

We would direct attention to the presence of pes cavus in
our case, a condition doubtless associated with the congenital
deformity of the spinal cord.

Description of Figures.

(Drawn to scale with the aid of Edinger'sprojection-apparatus.)

Fig. 1 . —First lumbar segment. The spinal cord is single with a somewhat
dilated central canal. There is some commencing deformity of the grey
commissure in the left side posteriorly.

Fig. 2.—First lumbar segment, lower than the preceding. The grey com¬
missure has increased in area and shows anterior and posterior out¬
growths. On the left side a smaller central canal is present, situated
anterior to the original central canal, which is here smaller than in Fig. 1.
The anterior and posterior nerve-roots are normal in their positions.

Fig. 3—Second lumbar segment. The anterior and posterior septa have
deepened to meet each other, splitting the grey commissure into two ill-

736

ORIGINAL ARTICLE

defined masses, each possessing a portion of the original central caul
The anterior cornual cells and anterior nerve-roots are normally
situated.

Fig. 4.—Second lumbar segment, slightly lower than Fig. 3. The two half-
cords are separated by a constriction containing pia mater. On each
side an antero-mesial septum is seen. Two complete central canals ue
present and the grey matter of the commissure is assuming the
appearance of anterior and posterior cornua, separated from the surface
by a layer of white matter. On the left side, postero-meskllv to file
central canal, there; are a few small nerve-cells. The remainder of the
nerve-cells are in the original anterior cornua.

Fio. 6.—Second lumbar segment, lowest level. Half-cords completely
separated.

Fio. 6.—Third lumbar segment. Two almost complete cords. The outer
portion of each is more complete than its mesial portion. The antero-
extemal cornua contain normally situated nerve-cells. In the antero-
mesial cornua only a few poorly developed nerve-cells occur. Two
central canals. The nerve-roots, anterior and posterior, are associated
with the external cornua only. An antero-mesial septum is present
The two half-cords are rotated so as partially to face each other by their
anterior surfaces. On the right side there is a postero-median septum
and a rudimentary substantia gelatinoea at the tip of the poetem-meshl
cornua.

Fio. 7.—Fourth lumbar segment There is partial fusion of the two halm
anteriorly, the posterior portions still remaining separated. On the right
side the postero-mesial cornua is poorly defined from the postero-eiteml
The central canals are symmetrical.

Fio. 6 . —Fifth lumbar segment The left half-cord is almost normal, with
an anterior and a posterior cornu. Its central canal becomes the main
canal of the lower segments. The right half is still abnormal, its
anterior cornu being constricted at the point where the small cental
canal is present. Traces of anterior and posterior septa still permit on
this side. The area of the posterior cornu is somewhat indefinite. The
posterior root fibres are somewhat scattered. The anterior median
fissure is Y-shaped on transverse section.

Fio. 9.—Upper sacral region.

Fio. 10.—Lower sacral region.

Fig. 11.—Coccygeal segment. The asymmetry is less evident but does not
entirely disappear. The anterior and posterior median septa resume their
normal appearances. Even in the lowest section there is still s true
of an additional central canal. And on the right side, at the circumfer¬
ence of the cord, there is a relic of an additional posterior septum.

ABSTRACTS

737

abstracts

ANATOMY.

THE CELL COLUMNS OF THE ANTERIOR CORNUA OF THE

(404) SPINAL OORD OF MAN. (Les colonnee cellulaires des
comes antlrieures de la moelle 6pinidre de lliomme.) M. et

Mme. DAjebine, Rev. Neurol., July 30, 1906, p. 689.

Dr and Madame Dejerine showed at a meeting of the Neurological
Society of Paris a series of drawings representing serial transverse
and longitudinal sections of different segments of the human cord.
Their conclusions, which will probably be published later else¬
where, along with the exhaustive details of their research, are that
there are great individual variations in the form of the human
cord; that the levels of medullary segments may vary not only
from one cord to another, but in the two sides of the same cord;
that the general contour may show great individual differences,
and that the symmetry of the two halves of one cord is rarely
complete. In spite of these differences, however, the general
characters of different sections are sufficiently constant to allow
of one cord being superposed upon and compared with another,
and of a characteristic type of contour being recognised in the
anterior cornua of each segment or part of a segment.

This conclusion is in harmony with the statement made by the
reviewer in his “ Topographical Atlas of the Spinal Cord.”

Alexander Bruce.

ON THE LOBUS OEREBELLI MEDIANUS. Geist, Neurolog.

(405) CerUraibl., Sept. 16, 1906, p. 855.

In two brains Geist found the vermis separated from the lateral
lobes of the cerebellum by deep furrows. This condition is
regarded by him as an instance of atavism, as the vermis is
phylogenetically the oldest portion of the cerebellum and is in the
lower mammals distinctly separated from the lateral lobes. This was
the only abnormality in the brains; the relative sizes of the different
parts of the cerebellum were normal. Gordon Holmes.

NOTE ON THE RETICULATED STRUCTURE OF THE AXIS-

(406) CYLINDER. (Note sur la structure reticul6e du cylindraxe.)

M. G. Marinesco, Polytechnia, Yol. iii., No. 1, 1906.

From his researches into the mechanism of regeneration of nerve
fibres of the peripheral nerves, Marinesco concludes that there

738

ABSTRACTS

exists in the normal axis-cylinder of peripheral nerves an extremely
fine and slender network, which is rendered more apparent when¬
ever there is a dilatation of its meshes caused by increase of the
inter- and peri-fibrillary substance. The greater the quantity of
liquid absorbed, the more marked does this network become. The
reticulum is pre-formed, and is represented in the regenerating
fibres either in the form of a fine network with oblong meshes, or
in the form of a network which is coarser, on account of the exist¬
ence of primary fibres, which are re-united by slender, delicate
angles.

These conclusions apply also to the structure of the axone and
the axis-cylinder of central neurones. In his experiments Marines©}
found that after section of the cord there was present in the central
end of the divided medullary fibres a network which could be
clearly seen, but which varied greatly in its appearance. Some¬
times, by reason of the increase of the intrafibrillary substance, it
assumes characteristics which give it a marked resemblance to the
network found in nerve-cells. Marinesco’s conclusion is, there¬
fore, that there is no essential difference between the structure of
the neurofibrils in the cell and in the nerve fibres, so that the
anatomical and functional difference which exists between these
two organs must lie elsewhere than in the neurofibrils.

Alexander Bruce.

WEIGERT’S NEUROGLIA STAIN. (Zur Tecknik der Weigert’schra
(407) Gliaf&rbung.) Fritz Hoppe, Neurolog. Ceniralbl., Sept. 16.

1906, p.854.

The author professes to obtain well-stained neuroglia preparations
by mordanting sections of tissue, which have been hardened in
formaline and cut in celloidin, in Weigert’s chrome-copper mordant
for 1 to 3 days at 36° C, and afterwards staining them according to
Weigert’s original directions. Staining of neuroglia in tissue
which had lain for months in 80 per cent alcohol also succeeded
by this method. The advantages claimed for this modification of
Weigert’s method are saving of time, and the fact that other
sections cut from the same block of tissue may be stained by other
methods. Gordon Holmes.

PHYSIOLOGY.

THE DISTRIBUTION OF AFFERENT NERVES IN THE SKIS.

(408) Max von Frey (of Wurzburg, Germany), Joum. of Am. Med.
Assoc., Sept. 1, 1906.

It is agreed by most physiologists that the sensory functions of
the skin are based upon four fundamental qualities, giving sensa-

ABSTRACTS

739

tions of warmth, cold, touch, and pain. Corresponding to these
functions, the nerve supply to the skin must be a fourfold one.
Blix was one of the first who contended that there were terminal
organs of specific function within the skin, whose projection on
the surface was indicated by irritable points; von Frey estimates
that there are on the skin of the trunk and limbs about 30,000
warm spots, 250,000 cold spots, and half a million touch spots.
Reliable determinations as to pain are wanting. Regions are to
be found on every normal skin where one or two of the typical
sensations are wanting— i.e. where cold is felt, but not warmth,
pain, but not touch, etc. Von Frey explains this by the “ irradia¬
tion of stimuli ” (physical and physiologic). By physical irradia¬
tion he means the spreading of irritation over a larger number of
terminal organs than the nature of the stimulus would seem to
demand. By physiologic irradiation he refers to the ability to
discriminate points as separate on the surface of the skin.

In the perception of pressure a distinction must be drawn
between light pressure and deep pressure; light pressure is
appreciated by the skin with its touch points; deep pressure by
terminal organs called “ muscle spindles ” (Sherrington).

Concerning the “ protopathic ” and " epicritic ” systems of
Head, the author says: “It seems for the present, at least, not
necessary to introduce a hypothesis to which existing physiologic
and psychologic data do not lend support.”

C. H. Holmes.

PATHOLOGY.

THE CONDITION OF THE FIBEILLO-RETIOULAR SUBSTANCE
(409) IN SWOLLEN NERVE CELLS. (Das Verhalten der flbrillo-
reticularen Substanz bei Scbwellungen der Nervenzellen.) K.

Schaffer, Neurolog. Centralbl ., Sept. 16, 1906, p. 834.

Primary disease of a nerve cell is characterised by swelling, due to
increase of its interfibrillar protoplasm ; this is seen after injury
to its axis-cylinder, and it is the chief change in amaurotic family
idiocy which may be taken as a type of primary cell disease. The
swelling may be limited to one part of a cell or to a dendrite, but
the axis-cylinder never swells in this way. The author has
availed himself of the greater ease with which intracellular neuro¬
fibrils can be examined in swollen than in normal cells, as there
the fibrils are more definitely separated from one another.

The present descriptions are chiefly from preparations obtained
by Bielschowsky’s method from the central nervous systems of
cases of amaurotic family idiocy. The intracellular fibrils are very
indistinctly visible in normal cells, but when a cell is swollen they

*40

ABSTRACTS

are seen to form a network of polygonal meshes, which are smaller
in the perinuclear zone than elsewhere. Often the trabeculae of
this net can be seen to be continuous in the periphery of the cell
with the thicker strands of the pericellular (Golgi) net; and the
coarser fibrils which spring from the intracellular net and pass
into the periphery of the dendrites also join the pericellular net of
Golgi. Thus Schaffer confirms Bethe’s assertion that the peri¬
cellular net is directly continuous with the intracellular fibrils, a
statement which Cajal in chief disputes on the evidence of
preparations by his own and other methods. Many of the coarser
fibrils of the dendrites can be traced through the cell into the peri¬
nuclear zone, where they branch up and become continuous with
the trabeculae of the intracellular net.

In further advanced stages of degeneration the intracellular
network of fibres becomes disintegrated and its trabeculae
break up into a fine granular debris; but different bundles of fibrils
are found to be differently resistant to degenerative processes, and
the Golgi net may remain intact when the intracellular net has
completely disappeared. Gordon Holmes.

ON DIPLOOOOOUSINTBA0BLLULABI8 MENINGITIDIS AND ITS
(410) RELATIONS TO GONOOOOOI. (Ueber den Diplococcua inta-
cellularia meningitidis und seine Besiehungen zu den Gono-

coccen.) W. G. Ruppel, Deui. mad. fPchnschr., Aug. 23, 1906,
p. 1366.

The numerous attempts which have been made within the last
few years to obtain a protective and curative serum for use in
epidemic cerebro-spinal meningitis have met with little success,
one reason being that the virulence of the cultures which have
hitherto been available has not been sufficiently constant.

Ruppel has now succeeded in obtaining a meningococcus which,
after daily transference to fluid media during a period of five
months, was proved to have acquired a high degree of pathogeni¬
city for animals. Intraperitoneal injection of 1 c.c. of a fluid
culture in dilution of 1:200,000,000 kills a rabbit in 12 to 18 hours.

After inoculation of horses with those virulent cultures, a
serum was obtained, c.c. of which is capable of protecting a
white mouse against one hundred times the minimal lethal dose of
virulent meningococci The serum protects the rabbit against more
than 1000 times the minimal lethal dosa

Although the serum agglutinates not only the homologous
culture of meningococcus but also all other strains of that micro¬
organism, the presence of agglutinins in the serum is no proof of
its protective or curative efficacy.

ABSTRACTS

741

The difference in potency of the immune sera obtained after
inoculation of horses with virulent cultures of meningococcus,
with avirulent strains of the same organism, and with gonococci, is
merely a quantitative one. W. T. Ritchie.

ON THE EXTENSION OF ASCENDING MYELITIS. (Zur Frage
(411) fiber die Wage der auftteigenden Myelitis.) Y. Salle, Devi.

Zeitschrifi f. Nervenheilk., Bd. 31, H. 1-2, S. 108.

An experimental investigation on the paths by which inflammatory
conditions spread up the spinal cord. The lower part of the cord
(in puppies) was exposed, and various irritants, chemical and bac¬
terial, injected directly into the cord in the region of the central
canal. The animals lived from a few hours to several days after
the injection. The results varied somewhat with the irritant em¬
ployed, but in all it was found that the extension was by the blood¬
vessels (both central and coronal), and also largely by the peri¬
vascular lymphatics.

The central canal appeared also to act as a path to some extent,
but, although the lesion in its neighbourhood must have been gross
compared with that which is present in clinical infective myelitis,
its importance seemed slight compared with that of the perivascular
lymphatics. J. H. Harvey Pirie.

THE RESUSCITATION OF THE CENTRAL NERVOUS SYSTEM
(412) OF MAMMALS. G. N. Stewart, C. C. Guthrie, R. L.
Burns, and F. H. Pike, Joum. of Exper. Med., Vol. viii., No. 2,
March 26, 1906, p. 289.

The object of the experiments, which were performed on cats and
dogs, was to gain a knowledge of the condition of the anterior part
of the cord and of the brain centres during total acute anaemia,
and to determine the ultimate limit at, or below which, resuscita¬
tion is possible. Acute temporary cerebral anaemia was produced
by passing ligatures around the innominate (from which both
common carotids and the right subclavian take origin in the cat)
and left subclavian arteries proximal to the origin of the verte¬
bral ; traction on the ligature produced occlusion of the arteries.
Artificial respiration was used.

The phenomena of complete occlusion are characteristic and
constant. The nose and mucosa of the mouth become white as in
death, respiration ceases, the reflexes disappear, and the pupils
dilate, while the heart is but little affected. Observations were
made on the blood-pressure, pulse-rate, respirations, and reflexes

742

ABSTRACTS

during occlusion and following restoration of the cerebral circula¬
tion. For these, which are given in great detail, the original paper
should be consulted.

The eye reflexes disappear very quickly, and a period of high
blood pressure follows the occlusion; this is succeeded by a fall,
then a second rise, and then a slow fall, which is maintained
throughout the period of occlusion. Respiration stops temporarily
(in 20 to 60 seconds) after the beginning of occlusion, and then
follows a series of strong gasps of the Cheyne-Stokes type, after
which it stops entirely until some time (it may be as long as one
hour) after the restoration of the cerebral circulation. The anterior
part of the cord and the encephalon lose all function; no reflexes
are obtainable.

Following the return of blood to the brain, convulsions varying
in severity, of tonic or clonic type, sometimes begin before the full
return of the reflexes, or occasionally the animal may lie quiet from
1 to 3 hours before their onset. These spasms, which are always
present, may terminate in death or in partial or complete recovery.
Transection of the cord stops the spasms below the level of the
section, and hemisection stops them on the side of the section
below its level.

Death, without any return of the reflexes after release of the
cerebral arteries, has followed an occlusion of 7$ min utes. Respira¬
tion has returned after an occlusion of 1 hour. Five animals
recovered completely after an occlusion of 7 minutes or more;
only one animal recovered completely after an occlusion of 15
minutes, and none after 20 minutes. Beyond this period of com¬
plete cerebral anaemia the authors believe that resuscitation is not
possible. Sutherland Simpson.

EXPERIMENTAL CEREBRAL ATROPHIES AND ACCOMPANY
(413) INO CRANIAL ATROPHIES. G. d’ Abundo, AnnaXi di NevroL,
Anno xxiii., f. vi.

From an earlier series of experiments, which were carried out on
cats and dogs twenty-four hours after birth, the author was enabled
to arrive at the following conclusions with regard to the production
of cerebral hemiatrophies: (1) ablation, more or less extensive, of
the vault of the cranium, without injuring in any way the cerebral
substance, does not lead to any hemiatrophy of the brain; (2)
removal of the cortex cerebri down to the white matter produces
cerebral and cranial hemiatrophy, even when the ablation of the
cranial vault is quite limited. In all these cases the cranial
atrophy was considered to be secondary to the lesion of the
corresponding hemisphere.

ABSTRACTS

743

In this paper we find the results obtained by producing similar
lesions of the cortex in both cerebral hemispheres of new-born cats
and dogs.

The result of these experiments was to give rise to a condition
of atrophy of both cerebral hemispheres, together with a cor¬
responding absence of growth of the cranium; and if in any case
one hemisphere was atrophied more than the other, the absence of
cranial growth on that side was also more marked In all these
cases the development of the whole of the body of the animal was
somewhat disturbed, and in those which lived long the condition of
ventricular hydrocephalus appeared. The asymmetry produced if
the operation was done when the animal was thirty days old was
much less than when it was performed twenty-four hours after
birth. In adult animals removal of the vault did not affect the
brain, nor did the removal of the cortex produce any change in the
cranium. In these latter cases the condition of hydrocephalus
“ ex vacuo ” always accompanied the atrophy of the brain.

It is established, therefore, that cerebral morbid processes
which act on the brain in the earliest period of extra-uterine life
have a most important influence on the conformation and on the
development of the hemisphere operated on, and also on the cor¬
responding part of the cranium; that the cerebral lesion determines
the cranial asymmetry; and that the earlier the morbid process acts,
the more serious will be the cerebral and cranial disturbance. It
is probable that the more serious anomalies which are met with in
idiots are the result of morbid processes which were active during
intra-uterine life.

It is necessary also, from the clinical and medico-legal point of
view, to remember that very serious results may follow an injury
to the head in the earliest days of extra-uterine life, and that a
morbid cause which interferes with the normal function of a
cortical zone at an early period, when the brain is developing
rapidly, limits the evolutive potentiality, not only of the cerebral
hemisphere corresponding to the lesion, but also of tbe entire
brain. R G. Rows.

CONCERNING THE EFFECT OF EXPERIMENTAL SECTION OF
(414) THE POSTERIOR ROOTS UPON THE PERIPHERAL
NEURONS. (De l’influence de la section expdrimentale des
radnes postdrieures but l’dtat des neurones pdriphdriques.
Contribution b l’dtude des fibres centrifuges des racines
posterieures.) Roux et Heitz, Nouv. Icon, de la Salpet., July-
August 1906, p. 297.

In the first weeks after section of the posterior roots, the
cutaneous nerves and mixed trunks always show a slight degree of

744

ABSTRACTS

Wallenan degeneration. The same degenerative process affects
the sympathetic, is evident at the third week, and seems to stop
by the eighth and eleventh month. The coarse fibres are pre¬
served ; these only degenerate after ablation of the spinal ganglia.
For studying the changes in the spinal ganglia the authors prefer
the osmic acid and sublimate method, followed by carmine, to
Nisei’s, as the fibres are stained as well as the nerve cells. The
cells were found well preserved, but some fibres, especially at the
central end of the ganglion, were in parts swollen, at others thinned,
with irregularity of outline.

In the ganglionic end of the posterior root the appearances
varied with the date of examination. At the fifth day a certain
number of fine fibres were degenerated, and by the 247th day the
large fibres were thinned, badly coloured, irregular in outline, and
fragmented in places, but not disintegrated into droplets. A large
number of fine fibres were present, giving one the impression of
regenerated fibres.

In the medullary end of the sectioned posterior root very fine
normal fibres were found, and in the ganglionic stump a corre¬
sponding number of degenerated ones which could be followed in
the afferent nerve from the ganglion almost as far as its fusion
with the anterior nerve (fifteenth day, third month). These are
regarded as centrifugal fibres.

At the 382nd day the medullary end showed a very large
number of fine fibres, probably coming from the spinal ganglion
cells.

The authors then proceed to discuss what the influence of
posterior root section is upon the peripheral neurons, and what
deductions can be drawn with regard to the pathogenesis of tabes.

In the cutaneous branches, at the fifteenth day, the degeneration
is of fine centrifugal fibres, but, by the 250th day, medium-sized
fibres are also involved. This is ascribed to a peripheral neuritis
of the Wallerian type, affecting exclusively the fine cutaneous
branches. By the time this neuritis has appeared alterations are
found present in the ganglionic end of the sectioned root, while the
ganglion cells remain normal.

By the end of the first year the peripheral neuritis disappears,
leaving the nerve sheaths empty, while retrograde degeneration of
coarse fibres and fine regenerated fibres can be found.

These latter are prolonged into the medullary stump. Thus
some fibres showed degeneration of both prolongations, Wallerian
of the peripheral end, simple atrophy of the central portion.

Conclusions:—In the posterior roots of mammals there are
myelinated centrifugal fibres, relatively few in number, and mostly
of fine calibre. They pass for the most part into the sympathetic
system, by the rami comm unican tes. A small number pass into

ABSTRACTS

745

the peripheral nerves. At the seventh and eighth months after
root section the cutaneous nerves show Wallerian degeneration,
and to a much less extent the mixed trunks also; the ganglion
cells are normal, and the ganglionic end of sectioned posterior root
shows retrograde degeneration. A year after operation, regeneration
has taken place in the medullary end of the cut root.

The authors recognise the difficulty of drawing a parallel
between experimental work such as theirs and the results of
Toot affection in tabes, and point out many differences, e.g. the
affection of ganglion cells and different type of fibre degeneration
in tabes.

They think that, besides the direct action of meningitis on the
posterior roots, a certain part of the disease may be due to the toxic
influence exercised by the syphilitic virus. This toxic action is
manifested mainly on the sensory proto-neurons and the centripetal
proto-neurons of the sympathetic. David Orr.

NEUROTROPISM AND TRANSPLANTATION OF NERVES. (Sul
(415) neurotropismo e sui trapianti dei nervi.) Lugaro, Riv. di
Patol. Nero, e Merit., F. 7, 1906, p. 320.

In an earlier series of experiments the author observed—after
cutting both anterior and posterior nerves at the same level and
removing the spinal ganglion—that regenerated fibres passed from
the central stump of the anterior nerve into that of the posterior.
This phenomenon might be explained by the theory that the re¬
generative products in the posterior roots diffuse substances which
exert a positive chemotropism on the new axis-cylinders of the
anterior roots and draw them into the empty nerve sheaths. Once
having gained these, the new fibres push their way along the
posterior root as far as the cord surface, but not into its substance.
They infiltrate the pia mater, both outside and inside the point of
root entry, and spread upwards and downwards for some distance
on the cord surface. Before discussing the source of this neuro¬
tropic action, Lugaro refers to the statements of Bethe on polarity
of nerve fibre. The latter admits that all fibres have a certain
polarity, not exercised in the direction of the nerve current, but in
that of the orientation of the fibre from its cell; so that in peri¬
pheral nerves the sensory and motor fibres are traversed by nerve
currents of opposite direction but have the same polar orientation.

In Lugaro’s experiments, therefore, the new fibres in the central
end of the motor nerve find the correct polarity in the central end
of the posterior root, which is separated from its trophic centre,
and so equivalent to the peripheral end of a nerve. The cells of
Schwann’s sheath exert a neurotropic action on the new axis-
cylinders, which allows of their invasion of the posterior root, but

746

ABSTRACTS

directly these cells cease to exist the axis-cylinders are repelled at
the cord margin by a negative neurotropism, and, as above indi¬
cated, infiltrate the pia mater.

As confirmatory evidence of the above observation, the author
conducted the following experiment:—Both seventh lumbar nerve*
were cut outside the spinal ganglion ; this was then removed (both
sides), and the anterior nerve of the right side united to the pos¬
terior nerve of the left side and vice versd. The experiment wa*
successful, and confirmed the views already expressed regarding
the positive neurotropism of the cells of Schwann and the negative
neurotropism of the central nervous system.

To study the behaviour of the axis-cylinders of the cental
nervous system in the presence of Schwann’s cells a piece ofaaatie
nerve was embedded in the brain of the same animal. Examined
by Cajal’s reduced silver method, the embedded nerve showed no
new formed axis-cylinders, thus showing that Schwann’s cells
exercise a neurotropic action on the axis-cylinders of peripheral
nerves which are regenerating, but not on those of the cental
nervous system.

Two questions are now discussed. Can this neurotropic action
make itself felt on a normal nerve enveloped in its normal sheath;
and from where do pieces of nerve embedded close to other nerve*
derive their fibres?

Having embedded pieces from one sciatic close to that of the
other side (same animal), Lugaro found these, at the fifteenth daj,
adherent to the muscle, but not to the normal sciatic. There vie
no sign of penetration by young fibres and the sound sciatic was
quite normal.

At the twenty-sixth day the embedded nerve was found firmly
adherent to muscle, from which non-medullated fibres sprang,
penetrating first the cicatricial tissue, then extending between
Schwann’s nuclei. The sciatic was absolutely normal. The author
concludes, therefore, that embedded nerves do not exert any netuo-
tropic action upon normal nerves in their vicinity. That a process of
auto-regeneration does not take place is shown by the fact that the
fine axis-cylinders entering the embedded nerve are perfectly con¬
tinuous and end in a fine olivary swelling, thus showing them to
be in a condition of active growth and running isolated in a large
collection of chains composed of Schwann’s cells perfectly empty.

To confirm these experiments, Lugaro extirpated the spinal
ganglion with the adjoining part of the posterior root without in¬
flicting the least injury upon the anterior one. Here he found
that the anterior root gave off no axis-cylinders to the stump of
the posterior one.

Even where a degenerated fasciculus of a nerve runs side by
side with a normal one in a common sheath no transverse neuro-

ABSTRACTS

747

tropic action is provoked. Probably neurotropic action is diffused
only from the central end of a divided nerve, and does not influence
normal fibres. Its influence is greatest on the central stump of
divided fibres, which are growing.

Conclusions: —1. Pibres from the anterior root can be continu¬
ous with those of the central stump of the posterior root. 2. They
follow the normal path so long as there are cells of Schwann, then
penetrate the pia mater. 3. The central nervous system exercises
a negative neurotropism on the anterior root fibres. 4. The cells
of Schwann, the origin of neurotropism in the regeneration of
peripheral nerves, do not exert any neurotropic action on the axis-
cylinders of the nerve centres. 5. Transplanted nerves in the
vicinity of a sound nerve, whose sheath is uninjured, have no
action upon it. 6. They become adherent to muscle, and draw
from it nerve fibres which, by neurotropic action, are drawn amongst
the cells of Schwann. David Orr.

RETROGRADE DEGENERATION IN THE SPINAL NERVES.

(416) S. W. Ran son, Jowm. of Neurol and Psychol., Vol xvi., No. 4,
1906.

In this excellent piece of work the author begins with a historical
account of retrograde or ascending degeneration.

The writer collates the results of researches conducted by many
workers under certain headings. These include the changes in
the central end of a divided nerve, in the anterior and posterior
roots belonging to the nerve in question, in the spinal ganglia, and
in the spinal cord, including the anterior and posterior horns and the
posterior columns of the cord. The material from which the his¬
torical part of the work is drawn consists of sixty-nine autopsies
of amputation cases in the human subject, and the experimental
researches on animals of eighteen observers. The author finds,
partly from the work of these other investigators, and partly from
his own experiments on rats, that simple atrophy and also true
degeneration result from nerve section. These changes are seen
in the central end of the divided nerve, in the spinal ganglia, in
the posterior and anterior nerve roots, and in the spinal cord. The
atrophy causes a decrease in size of the nerve fibres, some of which
lose their medullary sheaths, while many of the nerve-cells of the
anterior horn and of the spinal ganglia also undergo atrophy.
The degeneration begins in the central end of a divided nerve
some weeks later than the Wallerian degeneration in the peri¬
pheral segment, but corresponds closely with it in microscopic
characters. This degeneration is limited as far as the fibres in
the nerve are concerned, but it extends into the cord. The

748

ABSTRACTS

anterior cornual cells undergo a certain degree of degeneration,
some of them disappearing altogether, while a considerable and
more constant number of the spinal ganglia cells also vanish.

It is well recognised that there are far more cells in the spinal
ganglia than there are nerve fibres in the posterior nerve roots
corresponding to them; this implies that many of the cells and
probably the smaller ones are not connected with nerve fibres in
the dorsal roots at all. As the result of section of all the fibres
passing to the spinal ganglion of the second cervical nerve in
the rat, the author found that more cells in the spinal ganglion
degenerate than can be explained by the division of the nerve
fibres. In the posterior nerve root after section of the nerve there
was a variable disappearance of fibres, but equalling an average of
1 7 per cent. Ranson notes that the dorsal nerve roots tend to
degenerate more in young than in adult animals.

The statement that the degeneration of the spinal ganglion
cells was constant after section, while the number of nerve fibres
in the posterior nerve roots varied, constitutes an important part
of the paper, although no explanation is offered with regard to the
discrepancy. We are pleased to find that the author corroborates
the statement that the degenerative changes following on nerve
section cease after a period of two months.

The greatest care was taken to prevent any sepsis, during or
after the experimental operations, and in the enumeration of the
nerve cells those cells only were counted whose nucleoli were clearly
seen, a method which should ensure accuracy in counting where
several thousand cells had to be enumerated in each ganglion, and
numerous serial sections had to be examined in reckoning the cells
even in the comparatively small ganglion of the rat. A very
prudent precaution was adopted, namely to take as control
enumerations the same spinal ganglia from animals of about the
same age, but which had not sustained any operation.

Robert A. Fleming.

CLINICAL NEUROLOGY.

COEXISTENCE OF TERTIARY SYPHILITIC LESIONS WITH
(417) TABES AND GENERAL PARALYSIS. (Coexistence d’acd-
dents syphilitiques tertiaires avec le tabes et la panlpit
gdndrale.) Dorleans, Thtee de Paris, 1906.

Dobleans has collected twenty-eight cases in which tabes or
general paralysis was associated with tertiary lesions of the skin,
bones, tongue, eye, brain, and testis.

In nearly half the cases the patients denied or were unaware

ABSTRACTS

749

of the existence of syphilis. The author’s conclusions are as
follows:—

1. The coexistence of tertiary syphilitic lesions with tabes or
general paralysis is not rare.

to*. 2. This coexistence is of interest, because it affords a further
proof of the syphilitic nature of tabes and general paralysis, and
may help to an early diagnosis, and to the establishment of a
rational and efficacious treatment. J. D. Rolleston.

THE RELATION OF SYPHILIS TO LYMPHOCYTOSIS OF THE
<418) CEB EBRO-SPINAL FLUID AND TO THE QUESTION OF
“ MENINGEAL IRRITATION.” (Die Beziehung der Syphilis
zur Lymphocytose der Oerebrospinalllfissigkeit und zur Lehre
▼on der “ meningitischen Reining.”) L. Merzbacher (of
Heidelberg), Centraibl. /. Nervenh. u. Psych., July 1, 1905, May
1, 1906.

In this contribution Merzbacher follows up the work of Nissl
(vide abstract, Rev. of Neur. and Psych., VoL ii. p. 479), who took
a stand against the rather loose pathogenic views of the French
school with regard to lymphocytosis of the cerebro-spinal fluid,
and defined the exact state of our knowledge of the subject. He
said “ to my mind it is not at all definitely established that a
positive cytological result is of necessity due to an inflammatory
process in the meninges.” Merzbacher endeavours to answer two
questions. (1) How far can syphilitic infection produce a lympho¬
cytosis without there being any clinically demonstrated disorder
of the central nervous system and its membranes ? (2) Must every
lymphocytosis in the syphilitic be attributed to the “ meningeal
irritation ” of the French school ?

In order to answer the first question, he examined the avail¬
able material in the Heidelberg clinic, choosing patients with a
definite history of syphilis, but with no organic affection of the
central nervous system.

In 89 7 per cent, of the cases the result was positive. The
number of cells found was much less than that usually found in
cases of tabes and general paralysis. The conclusion is that in
almost all his cases syphilitic infection had led to an increase of
the cell elements in the cerebro-spinal fluid, even in the absence
of any evidence of disease of the central nervous system and of
the meninges.

He begins his attack on the second question by examining
the results of others with regard to a lymphocytosis in cases with
disorders of the pupil movements, but who were neither tabetics
nor general paralytics. He agrees with Bumke that the Argyll

760

ABSTRACTS

Robertson phenomenon as an isolated sign is not necessarily due
to a syphilitic meningitis, but depends certainly on syphilitic
infection. Many cases present this sign who do not later become
either tabetic or general paralytic.

There is no sound reason for explaining the lymphocytosis
which uniformly accompanies the Argyll Robertson pupil by a
local affection of the meninges. The latter is purely hypothetical.
In cases of eye disease of various nature, where there was no
reason to suspect the presence of meningeal disorder, there was
always a history of syphilis in the cases where the puncture gave
a positive result. Similarly in cases of brain tumour, hemiplegia,
paraplegia, and cerebral apoplexy the cases which presented a
lymphocytosis differed from those which failed to do so, not in
local differences of the process, but in the presence of a history of
syphilitic infection. Must one attribute the lymphocytosis in
tabes and general paralysis to the meningitis present ? The lympho¬
cytosis is present and even most abundant at an early stage in
tabes when there is no evidence that there is a meningitis.
Meningitis, according to some, is not always present, and in many
cases it is a purely hyperplastic form (Nissl). In general paralysis
the characteristic plasma-cells so common in the meningeal
exudate are not found in the cerebro-spinal fluid, at least to any
extent Even in tabes and general paralysis it is safer to refer the
lymphocytosis to the syphilitic infection than to the meningeal
changes, although the latter do no doubt play later an important
part in producing the lymphocytosis. Other infections produce
lymphocytosis without there being evidence of a meningeal factor
-—multiple sclerosis, herpes, mumps.

Merzbacher concludes that the theory of meningeal irritation
lacks evidence; he finds the common factor of all cases with
lymphocytosis in the syphilitic infection, which in some way dis¬
turbs that mechanism, which even under physiological conditions
allows some cells to reach the cerebro-spinal fluid.

C. Maofie Campbell.

A OASE OF AMTOTROPHIO LATERAL SCLEROSIS. (Un css de
(419) sclteose laterals amyotrophique.) Puscarin et Lambrior,
Rev. Neurol , Sept. 15, 1906, p. 789.

A record of a pretty typical case in a man of forty. Commenced
in the fingers of the right hand with some numbness, then mus¬
cular atrophy; rapidly extended up the arm, at the same time the
left hand and arm becoming involved. The lower extremities
then became involved, and all were characterised by marked
rigidity and contractures.

ABSTRACTS

751

In less than five months the muscles of the neck, head, and face
were affected; swallowing became impossible, respiration irregular,
and death occurred within seven months of the onset.

Microscopically there was found a marked degeneration and
sclerosis of the crossed pyramidal tract, from the cerebral peduncles
to the sacral cord; the direct pyramidal tract being less severely
involved. There was also some sclerosis of the whole antero¬
lateral columns. There was typical degeneration of the anterior
motor-cells, at its maximum in the cervical enlargement; also of
the hypoglossal, vagus, and facial nuclei.

No light is thrown on the etiology of the condition.

J. H. Harvey Pirie.

TRANSVERSE MYELITIS AS A SEQUELA OF MEASLES. (Un
(420) caso di mielite lombare transversa consecutiva a morbillo.)

Primangeli, II Policlintco, Sept. 9, 1906, p. 1161.

Measles, the commonest of all diseases, is seldom followed by
grave nervous sequelae. Primangeli’s case is of special interest in
that it was that of an adult in whom a circumscribed portion only
of the spinal cord was involved.

A robust countrywoman, aged 25, free from tubercular or
syphilitic taint, had an attack of measles. The eruption was of
short duration, and the febrile period did not last more than six
days. Two days after getting up she was seized with pain in the
lumbar region, radiating to the abdomen and lower limbs. She
had an urgent desire to micturate, but complete retention was
present. The next day spasm of the anal sphincter developed,
and paresis of the lower limbs. The temperature was 102*.

There was diminution of tactile and painful sensibility of the
lower limbs and of the abdomen to a little above the umbilicus.
Some areas of the lower limbs were affected with anaesthesia
dolorosa. Active movements of the legs, which had become some¬
what oedematous, were very limited. There was diminution of
the superficial reflexes, and of the knee- and ankle-jerks. Elec¬
trical muscular excitability was impaired.

The patient complained of girdle pain, and of formication and
numbness in the lower limbs. There were no motor nor sensory
changes in the upper limbs, trunk, or face. After about a week,
complete anaesthesia and flaccid paralysis of the lower limbs super¬
vened, with total abolition of the reflexes and incontinence of
urine and faeces. The muscles rapidly atrophied, the skin became
dry and rough, and in spite of the greatest attention, large bed¬
sores formed on the sacrum and gluteal regions. Cystitis, hypo-

752

ABSTRACTS

static pneumonia, and gastritis subsequently occurred, and the
patient died after an illness of six and a half months.

The autopsy, of which no details are given, revealed softening
and degeneration of the lower dorsal and lumbar cord.

J. D. Rolleston.

A REMARKABLE OASE OF POTT’S PARAPLEGIA. (TJn cas

(421) remarqtuble de parapl&gie pottique.) H. Boschi et A.
Graziani, Rev. Neurol, Sept. 15, 1906, p. 799.

The patient, a lad of sixteen, woke up one morning—having been
perfectly well previously—with tingling and feeling of heaviness
in the lower limbs, and found that they were almost quite
paralysed. There was severe abdominal pain, which, however, soon
subsided and never returned; hypoaesthesia for touch and pain
from waist downwards; and incontinence of urine and faeces. No
pain along the spine, and no elevation of temperature.

When examined by the authors a fortnight later there was
found a slight dorsal scoliosis, and some pain, on heavy pressure,
over the fourth dorsal spine- No pain on movement of the spine.
Voluntary movements of lower limbs very feeble. Cutaneous
reflexes diminished, tendon reflexes more active than normal, ankle
clonus and double Babinski sign.

Hypoaesthesia for touch and pain in the feet and muscular
sense defective in the lower limbs.

Micturition and defsecation as at onset.

The cerebro-spinal fluid contained a few lymphocytes and a
considerable quantity of albumen.

His condition steadily improved, and three months later there
was complete control of the sphincters; the power of movement
was very much better. The reflexes were much as before, although
less removed from normal; Babinski sign still present. The pain
on pressure over fourth dorsal spine was almost entirely gone.

Although a diagnosis could not be made with absolute certainty,
the authors consider that the most probable cause was a limited
Pott’s disease with some associated pachymeningitis.

J. H. Harvey Pirie.

PNEUMOCOCCAL CEREBRO-SPINAL MENINGITIS AND DIA

(422) BBTES. (Mlningite drlbro-spinale h pneumocoques et
diabbte.) Louis-Albert Amblard, Arch. Gin. de Mid.,
Sept. 11, 1906, p. 2319.

This is the record of a case in support of the theory that certain
forms of diabetes are of nervous origin. The patient, a man
aged 55, was admitted to hospital on the tenth day of an acute

ABSTRACTS

753

pneumonia, no crisis having occurred. His urine contained a trace
of albumen but no sugar. In a few days his symptoms had
subsided, but about a week later a rise of temperature and pulse
occurred, accompanied by arthritis of the left wrist. This was
followed by paresis of the right side and other signs indicating
meningitis. The patient died within two days. Immediately after
the onset of the meningitis the urine was found to contain sugar
to the amount of 154 grammes per diem. The autopsy revealed
an unsuspected encysted empyema, a meningitis particularly
marked at the base of the brain, and nothing else worthy of note
except that the pancreas was healthy. The writer considers the
case one of genuine diabetes due either to infective or nervous
influences, and pronounces strongly in favour of the latter on
account of the time of appearance of the sugar, and the history of
the case. Henry J. Dunbar.

THE SENILE BRAIN. (Le cerve&u senile.) Andr£ L£ri, Revue
(423) Neurol , Aug. 30, 1906.

In a r£sum4 the author draws a distinction between old age and
senility—the latter being a pathological condition which may
make its appearance at any age, late or early, and may affect the
organism as a whole or in part

The pathological changes due to senility are of three special
types:—

(1) Atrophic changes in parenchymatous tissues.

(2) Proliferation of interstitial tissues.

(3) Sclerotic lesions in blood-vessels.

The rest of the paper consists of an anatomical and a clinical
study of senility.

Macroscopically the brain is small and atrophied, a change
shared by the meninges and the central nuclei. The grey matter
seems less affected than the white. The ventricles are frequently
dilated and their walls thinned.

Microscopically the nerve-cells are diminished in number, and
show degenerative changes consisting of destruction of Nissl’s
granules, and an increased yellow pigmentation.

These changes closely resemble those due to chronic intoxica¬
tions (alcoholism, uraemia, etc.), and are not peculiar to the senile
brain. The nerve-fibres share in the general atrophy, especially
the tangential fibres of Tuczek, a change comparable to that found
in cases of dementia. The neuroglial cells and fibres are pro¬
liferated to a moderate degree, determining a diffuse sclerosis,
which, however, is most marked in the perivascular areas.

Sclerotic changes occur in the vessels, but vary much, the

754

ABSTRACTS

commonest type being one which involves the whole of the arterial
wall. The vascular lesions determine the local changes which are
met with, such as perivascular sclerosis, miliary haemorrhages, areas
of lacunary degeneration, softening, and cerebral haemorrhage.
Especially typical of senile brain are lacunary degeneration and
what the author describes as the “worm-eaten state,” due to
progressive degeneration of cerebral tissue with neuroglial pro¬
liferation.

Clinically the senile changes find expression in an “ intermittent
claudication ” of the brain—symptoms of which are vertigo, head¬
ache, tinnitus, sleepiness or insomnia, transitory aphasia, and
hemiplegia. Hemiplegia other than transitory as a true senile
condition is not very common, and when found is chiefly due to
lacunary degeneration, and the lower limb is chiefly affected.

Senile epilepsy may occur, and much more rarely paraplegia of
cerebral origin.

The mental condition varies widely from slight changes in
memory, character, and intellectual power to simple dementia,
which, however, is often slighter than appears at first sight—the
patient remaining conscious of his condition for a long time. Signs
of general arterio-sclerosis (cardiac, renal, etc.) are always to be
found associated with the cerebral lesions.

One must always distinguish between mental changes o/’old
age and those which may occur in old age.

The author concludes in favour of senility being the result of
chronic toxic processes. C. M. Hinds Howell,

TWO OASES OF PONTINE HEMORRHAGE. HYPERPYREXIA
(424) RAPIDLY FATAL TERMINATION. (Deux cas dTuhnor-
rhagie protruWrantielle. Hyperthermia Mort rapide.)
Pierre Maris and F. Montier, Noun. Icon, de la SalpSl.y.
July-Aug. 1906, p. 383.

The first case was that of a man aged 86, whose illness began
suddenly with vomiting followed rapidly by unconsciousness. He-
showed a complete left hemiplegia with a certain rigidity of the
right side and turning of the head to the right side. He died two
days later, the temperature shortly before death being 105’4\
Post-mortem an extensive haemorrhage into the right side of the
pons was found. The second case occurred in a man aged 47, who
died the day after the onset of a left hemiplegia associated with
rigidity of all the limbs, more marked on the right side, and
pronounced myosis. The temperature before death reached 109*.
At the autopsy a small haemorrhage on the right side of the pons.

ABSTRACTS

755

was discovered. In a case of hemiplegia with an apoplectic onset,,
a rapid course, and accompanied by myosis and hyperpyrexia, one
should always be strongly suspicious of a lesion of the pons.

Henby J. Dunbar.

DIVER’S PALSY. (La maladie des scaphandriers.) Boinet, Arch.

(425) Gin. de Mid., Sept. 11, 1906, p. 2305.

This is a continuation of a previous article of which an abstract
appeared in these columns {Rev. of Neurol and Psychiat., 1905,
p. 805).

The cases described have been met with amongst the divers
employed in the sponge and coral fisheries of the Mediterranean
for the most part. A number of fatalities, however, have occurred
in the course of salvage operations on the wrecks of sunken vessels
on the French coast.

The illness of divers, like that of caisson workers, is due to too
rapid atmospheric decompression. Both of these form a chapter
in compressed air illness. There have, just recently, been several
fatal cases and a number of cases of incurable paralysis amongst
the divers off the coast of Provence. On account of all these
accidents, which are mostly preventable, it is desirable, the writer
thinks, that the apparatus used by the divers should be properly
inspected, and that prophylactic measures should be enforced.

The clinical history of fifteen cases, of which seven proved fatal,
is given in detail.

In each instance the symptoms appeared after the diver had
ascended, i.e. on decompression. Death in some cases was sudden,
and occurred as soon as the diver reached the deck of the boat.
In other cases the patient passed into a state of coma and died
after a period of hours, or sometimes days. The fatal issue was
usually preceded by “ pains ” in the limbs, and in the case of those
patients who did not die suddenly, by paralysis of the lower limbs
and retention of urine. Paralysis of the arms, when it occurs, is
usually transient. Cyanosis was observed on some occasions, and
r&les indicating pulmonary congestion were heard in the majority
of fatal cases. All the fatal cases are attributed by the author to
too rapid decompression.

Of the non-fatal cases, the typical variety is paraplegia with
sensory disturbances. At the onset of the illness there may be
paralysis of the arms, but this usually passes off rapidly. In those
cases of paraplegia which are permanent, the paralysis becomes
spastic in character. At first there is retention of urine and faeces,
and later on imperfect control of the sphincters. Anaesthesia of
the legs is present, with hyperaesthesia often in the early stages.

756

ABSTRACTS

Many of these cases have been under the care of the author for a
few years, and are regarded as incurable. In rarer cases hemiplegia,
with aphasia, is met with, the latter being sometimes temporary,
but occasionally permanent. The paralysis in one or two instances
takes the form of a monoplegia, either of the arm or leg. A few of
the patients had anaesthesia of the palate.

In accidents due to rapid decompression, ecchymoses under the
skin, often of the chest, are seen.

Haematomyelia is the condition which the author believes to be
the cause of the serious symptoms of diver’s palsy. The lesions
affect the whole of the spinal systems, with the exception of the
anterior horns, and do not pass above the level of the second dorsal
segment. The presence of haemorrhages in the cord has been
verified both by autopsies on the human subject and after experi¬
ments on animals. There are also present in such cases haemor¬
rhages in the spinal meninges. It is believed that the haemorrhages
in the spinal cord are produced in two ways. In some cases the
bubbles of gas liberated in the blood by too rapid decompression
actually cause rupture of the capillaries in the substance of the
cord. In others, haemorrhagic infarction, following embolism of a
vessel of the cord resulting from bubbles of gas, is thought to occur.
The author adheres to the theory of the pathology of the disease
attributed to Paul Bert. Nitrogen is dissolved by the blood in
increased quantity at high pressure, according to Dalton’s law, and
is liberated in the form of bubbles on decompression. In experi¬
ments the formation of these bubbles can be actually watched.
Oxygen poisoning has been suggested as a factor in aetiology, but
the atmospheric pressure is not sufficiently great in diving or in
caissons for oxygen to exert its toxic effect. The air-embolism
theory finds support from the good results of slow decompression and
from the therapeutic action of recompression, followed by very slow
decompression, in cases of illness. One of the author’s patients,
who was the subject of paraplegia, showed a marked improvement
after dives taken at moderate depths and followed by a slow ascent
Slowness of decompression is the basis of true prophylaxis. In
caissons the time given for coming out is, as a rule, three minutes
per atmosphere. In the case of divers, the conditions of work do
not allow of such a long period of decompression. However, the
ascent should be made slowly enough to give at least one minute
per atmosphere. In practice, the divers after descending to a depth
of forty metres (four atmospheres) usually come to the surface in
less than one minute. Such has been the case in all the fatal
cases. The result of this rapid decompression is that bubbles are
liberated in the capillaries of the lungs and central nervous system.
Thus is explained the sudden death, which in certain cases
resembles that due to the entrance of air into the veins. The

ABSTRACTS

757

diving suits in use are often faulty and in bad repair. The supply
of compressed air is consequently irregular and its pressure not
accurately indicated by the manometer. The absence of rigidity in
the old type of suits exposes the wearer to injurious pressure. As
a consequence, it is necessary to send air to him at an excessive
pressure when he is working at the greatest depths. A new diving
suit (Buchanan-Gordon) has been devised to overcome these defects.
The body and arms are protected from pressure by spirals of
metal, and the diver is enabled to breathe air at a pressure nearer
normal.

The author remarks, in conclusion, that better apparatus and a
more rigorous application of prophylactic measures, of which the
chief is slow decompression, would prevent most of the accidents
due to compressed air. Alfred Parkin.

CEREBRAL AND OPHTHALMIC COMPLICATIONS IN SPHENOI-
(426) DAL SINUSITIS. St Clair Thomson, Brit. Med. Joum.,
Sept. 29, 1906.

The author thinks that, if the accessory sinuses of the nose were
systematically examined at all post-mortems which showed intra¬
cranial inflammatory lesions, we should find that a large number
of these was due to suppurative sinusitis.

Observations have shown sinus disease to exist in 30 per cent,
of all post-mortems (Harke, Fraenkel, and others); next to the
maxillary antrum the sphenoidal sinus is most often affected, and
Lermoyez observes “ sphenoidal suppuration is not rare; it is only
its diagnosis which is uncommon.”

Two cases are recorded which have recently come under the
author’s observation.

Case I. Male, age 36, had two years’ history of ear trouble; one
month before admission to hospital had influenza and acute earache.
On admission he gave history of discharge from nose running
chiefly into back of throat, “as long as he could remember.”
Occasionally severe headaches and bad taste in his mouth; the
headache had been chiefly frontal, beginning at 9.30 A.M. and
ceasing at 3.30 p.m. ; recently the headache had been referred to
the lower occipital and left temporal region. The patient looked
very ill, pulse 92, temperature 98‘8, pupils equal and reacting
normally; no vomiting, rigors, or staggering. Left ear showed
a perforation of the membrana with slight non-fetid discharge.
The right middle turbinal was enlarged and there was pus on the
roof of the naso-pharynx on the right side.

The patient did not sleep well, and complained of pain behind

758

ABSTKACTS

the eyes and on the top of his head, and also of a rotten-egg taste
from the back of his nose; he rapidly became dull and irrational.

Operation was decided against as a diffuse meningitis had
already started; later diplopia, left internal strabismus, nystagmus
and deafness developed; the optic discs were slightly hazy. Before
death, facial paralysis was noticed on the right side.

Post-mortem .—Pus in right sphenoidal sinus only. Lining
membrane of this cavity was thickened, purplish, and sodden.
All other sinuses were healthy. Basal meningitis was present,
extending down the spinal cord. The author thinks the infection
must have been through the lymphatics.

Case II. Female, age 16, had pain on the vertex followed by
sickness, shivering, and swelling of the eyelids. A week later the
eyeballs were prominent with chemosis of the right conjunctiva.
Temperature 102*-105° F. No history of nasal discharge or head¬
ache. Stiffness of the neck and backache were next complained
of. On admission to hospital, optic neuritis found to be present.
Ears quite normal. The nose showed pus on the right side in
the middle meatus and olfactory cleft The patient was quite
rational.

The leucocytes numbered 36,000, and the patient had two
rigors within 24 hours of admission. Temperature 106° F. Anaes¬
thetic, right middle turbinal removed and right sphenoidal sinus
opened and scraped; thereafter irrigations of the sinus carried out
twice daily. Later the proptosis and swelling of the eyelids
increased and the sixth nerve was paralysed on the right side
Pus, obtained on incising the conjunctiva, showed a pure
streptococcus.

Post mortem .—No meningitis. Cavernous petrosal and lateral
sinuses all filled with pus. Superior longitudinal normal. Mucous
membrane of right sphenoidal sinus thickened and polypoid. Left
sphenoidal sinus small and contained recent muco-pus.

The author has collected 42 cases in which death occurred
from intracranial complications due to septic infection from the
sphenoidal sinus. A list of these, in chronological order, is
appended to his paper. In 17 meningitis was the predominant
lesion; in 4 thrombosis of the cavernous sinus was the primary
complication; and in 13 there was both thrombosis and meningitis.
There was only one case of brain abscess.

The chief symptom of sphenoidal sinusitis is post-nasal dis¬
charge with anosmia or cacosmia. Unfortunately the discharge
may not always be present, and thus the disease may be over¬
looked unless the middle turbinal be removed and the sinus
washed out.

Pain or neuralgia may be referred to the frontal, occipital, or
temporal regions. Pain deep in behind the eyes is characteristic

ABSTRACTS

759

of sphenoidal disease. The pain may be referred to one or the
other accessory sinuses, and these cavities and also the mastoid
process have, for this reason, been operated on in error.

Sphenoidal sinusitis causes more disturbance of the general
health than fronto-maxillary suppuration.

The bacteriology of these cases is briefly mentioned, and the
paths of infection are given as follows: (a) directly through the
bone; ( b ) by the veins; (c) by the lymphatics. The roof of the
sphenoidal sinus may be as thin as paper or even absent in
places.

The subject of the ocular complications of sphenoidal sinusitis
and their cure by operation, as well as the method of operating on
the cavernous sinus through the maxillary antrum and nose, are
briefly touched upon.

In conclusion, Dr St Clair Thomson urges the necessity of
operation in all cases of suppuration in the sphenoidal sinus, and
of the examination of these cavities in cases of headache, neuralgia,
meningitis, and thrombosis of the ophthalmic vein or cavernous
sinus. J. S. Fraser.

A CASE OF ACROMEGALY WITH A LESION OF THE HYPO-
(427) FHYSI8 AND OF THE SELLA TOROIOA (Un cas
d’acromlgalie avec l&ion de l’hypophyse et de la sells
turcique.) Gaussel, Nouv. Icon, de la Salpit., July-Aug. 1906,
p. 391.

The patient was a man aged 65, who came under treatment for
Bright’s disease and was found on examination to present most
of the symptoms of acromegaly. The feet, hands, and lower jaw
were enlarged, and there was a kyphosis of the upper dorsal region.
The superior maxilla was not hypertrophied and the tongue was
of normal size. He died of uraemia of the pulmonary type. On
examining the brain it was found that there were numerous
meningeal adhesions surrounding the region of the sella turcica.
The pituitary body consisted of a thick pulp occupying the sella
turcica and also a cavity large enough to admit the tip of the
index finger hollowed out in the sphenoid. The pedicle and
the anterior and posterior portions of the gland could not be
differentiated, and only with difficulty were two small fragments
of gland tissue obtained for examination. The pathological process
appeared to be one of adenomatous degeneration and cellular
infiltration. The thymus and thyroid glands, the brain, cord, and
nerves were normal. The case is recorded as further evidence of
the etiological relationship between disturbance of the function of
the pituitary body and acromegaly. Henry J. Dunbar.

760

ABSTRACTS

▲ RARE CASE OF HYSTERIC TWILIGHT-STATE. (Bin seltener

(428) Fall von hygterischem DSmmerziutande.) Waltheb Baumann,
Neurol. Cenlralbl., Sept. 16, 1906, S. 849.

A great number of different pictures, besides the classic form
described by Ganser, are grouped under the title hysteric twilight-
state. Baumann describes a case, in a tram conductor of thirty-
four, who sustained a slight concussion with fractured ribs through
a fall from his tram. Three months later, on his return to work,
psychical symptoms appeared. These were first evident by his
getting lost and being brought home by the police. His state then
and on admission was one of extreme excitement and irritability.
In his house he brandished a sword violently, throttled his wife
after accusing her of infidelity, behaved indecently before his
children, and smashed the furniture. He fancied himself in
various places and emergencies and had numerous visual hal¬
lucinations. He uttered a series of incomprehensible noises, and
was completely disoriented as to time and place. The only
abnormal physical sign was an increase in the knee-jerks. After
two days his speech became occasionally intelligible, but soon
relapsed; it was very stammering. There was tremor of the lips,
but not of the tongue or hands. On the next day he improved
slightly, but intelligence, thought, and attention were greatly
deficient. Expansive ideas were marked; he fancied he was the
Russian ambassador, etc. He remained in much the same con¬
dition for a fortnight, and then a remarkable change occurred
coincidently with his transference to another ward. Practically all
his symptoms disappeared in a day, only to be replaced by typical
signs of hysteria. These were bilateral concentric visual contrac¬
tion for all colours, left-sided hypaesthesia to prick, and over a
smaller area to touch also, a band on the outer side of the left arm
and foot of complete anaesthesia to touch, pain, and temperature;
left-sided ageusia. His intelligence was then intact and remained
so, as did his speech.

The writer discusses the diagnosis between the condition, which
was recognised only after recovery, and G.P.I. and dementia prsecox.
He excludes a remission of G.P.I. by the completeness and perman¬
ence of the recovery in speech and intellect. Ernest Jones.

THE RESPONSIBILITY OF HYSTERICS. (La responsabilitt des

(429) hyst&iques.) Leroy, Rev. Neurolog., Aug. 30,1906, p. 765.

This paper formed the opening of a discussion on the subject at the
French Neurological Congress held at Lille, August 1906. Leroy first
points out that no rigid rules should be established on the subject on

ABSTRACTS

761

account of the great variation found in the disease. At present,
when signs of gross mental change are present, such as anaesthesia,
visual contraction, etc., most experts hold for a diminished re¬
sponsibility, even when the act has no direct connection with the
neurosis. Leroy, on the contrary, maintains that such cases should
be treated entirely as patients and as having complete irresponsi¬
bility. They are cases for an asylum rather than a prison, as
medical treatment is needed for the contraction of the social feel¬
ing that takes place as much as for the contraction of the visual
field. At the same time it may be held that hysterics are
responsible for certain acts and not for others, so that both the
act and the attendant circumstances must be taken into considera¬
tion. Of especial importance are the fugues, thefts, etc., committed
during somnambulism, or when the disaggregation has proceeded
to such a degree as to produce an automatic or secondary state
with evident modifications of character. The most difficult cases
to decide about are those showing the different varieties of twilight-
states. It must be remembered that, owing to their increased
suggestibility, the resistance offered by hysterics to the various
impulsions to which they are subject may be so enfeebled that
they cannot be regarded as in any way responsible in the
sense that the word is used with normal people. In addition to
simple hysteria we have often to deal, in a given case, with degene¬
ration, intoxications, and other complications. In conclusion,
Leroy strongly maintains that the compromise adopted by most
alienists in advocating partial responsibility, a condition which is
not recognised by the law, is irrational and absurd, so that we
should decide always to treat a patient either as completely
responsible or quite irresponsible for his crimes. The feeling of
the meeting, particularly as voiced by Grasset and R^gis, waa in
favour of the scientific recognition of partial responsibility, the
idea to which the law would sooner or later have to conform, but
in the meantime it would be better to treat such cases in the
way Leroy suggests, as being pathological and quite irresponsible.

Ernest Jones.

TRAUMATIC NEURASTHENIA IN THE ARTERIO SCLEROTIC.

(430) (La neurasth&iie traumatique chez les artfrio-sclfreux.) E.

R£gis (of Bordeaux), Joum. de Mid . Lig., Feb. 1906, No. 1.

Rtfois insists on the close relationship between neurasthenia in
general and arterio-sclerosis, and refers them both to a similar
origin, either toxic, infectious, or of the nature of physical or
emotional strain. Of twenty cases of traumatic neurosis examined,
sixteen were men, and these were over forty years of age, and were
3 D

762

ABSTRACTS

definitely arterio-sclerotic. The neurasthenic state in these cases
persisted and tended to become worse. According to the author
the trauma frequently merely elicits the symptoms of a latent
arterio-sclerosis. In cases of traumatic neurasthenia the expert
must pay particular attention to the presence of arterio-sclerosis
as determining the prognosis, and as being an important factor
in the appearance of the neurosis.

C. Mactte Campbell.

TETANY: A REPORT OF NINE OASES. Campbell P. Howard,
(431) Amer. Joum. Med. Sciences, Feb. 1906.

The author gives a series of nine cases of tetany supervening
respectively upon the following conditions:—

1. Gastric ulcer (?); hyperacidity; hypersecretion; male aged 46

2. Dilatation of stomach; male aged 24

3. Dilatation of stomach; hyperacidity; male aged 52.

4 Pyloric stenosis; enormous dilatation of stomach; death;
autopsy —condition probably due to cicatrisation around an old
ulcer; male aged 58.

5. Hyperacidity; dilatation of stomach (?); male aged 18.

6. Dilatation of stomach; male aged 45.

7. Chronic diarrhoea; male aged 24.

8. Rickets (?); male infant aged 6 months.

9. Gastro-enteritis; abscess of scalp; rickets; female infant
aged 3£ months.

Summary of Cases. —Seven were adult males, two were young
infants. Four of the adult cases had definite dilatation of the
stomach, in one case due to pyloric stenosis. Two of the other
cases suffered from hyperacidity of the gastric juice without
evident dilatation, making in all six cases of gastric origin. One
case suffered from chronic diarrhoea, the only adult case of tetany
of purely intestinal origin recorded in America during the last
decade.

All the adult cases had definite prodromata such as numbness,
tingling, etc., and in all the cases the typical spasms occurred, four
being severe, three moderate, and two mild in their intensity.

Trousseau'8 phenomenon was present in five out of six cases
examined for it. Chvostek's sign was positive in four out of six
cases. Erb’s phenomenon was demonstrated in four out of five
cases examined. Albuminuria was present in six out of seven
cases examined. A detailed analysis of the author’s cases is given,
followed by a short review of the work of some of the other
observers who have studied the subject of tetany.

With regard to the pathogenesis of the disease, the author

ABSTRACTS

763

favours the modern auto-intoxication theory. He deals with the
symptomatology, differential diagnosis, prognosis, and treatment in
some detail. He follows most recent authors in advocating lavage
in gastric cases, and surgical interference in suitable cases.
Thyroid treatment should be tried in cases where the action of
the gland appears deficient.

The paper finishes with a tabular analysis of the cases of tetany
in adults and in children occurring in America during the last ten
years. W. E. Carnegie Dickson.

A CASE OF PABALY8I8 OF MOVEMENT UPWARDS AND
(432) DOWNWARDS. (Bin Beitrag zur isolierten Blickltthmung nach
oben und unten.) TOdter (Hamburg), Klin. MonatiblatUr fur
Augenheilk ., August 1906.

There is a great contrast between the frequency of interference
with lateral movements of the globe and the rarity with which
the vertical movements are affected. Theoretically a lesion
causing this latter manifestation may be situated cortically (or
sub-cortically) in the region of the nuclei, in the hypothetical
supra-nuclear centre about the corpora quadrigemina, or peripher¬
ally. First, the author, in the discussion of the problem, dismisses
those cases in which other movements of the eyes are affected,
whether this other symptom is or is not synchronous with the
vertical defect, as being due to some affection of the third nucleus.
Those cases should also be put into a separate category in which
there is congenital defect of upward movement along with ptosis,
for the situation of the lesion with them is most frequently peri¬
pheral—in fact, a muscular anomaly in certain instances, though
in others the fault is in the nuclei. The particular affection with
which Todter has to deal is sharply to be differentiated from either
of these forms.

So far as a cortical lesion is concerned, we are still quite in the
dark; there is no case on record of a paralysis of this nature in
which a cortical lesion has been proved post-mortem; but judging
from analogy, one cannot but suppose that there is a cortical centre
for this movement, though experiments on the lower animals have
not proved very convincing as to its precise situation. Clinically,
it is true, hysterical paralysis of upward and downward movement
has been noted, and the same failure after a head injury with con¬
comitant symptoms pointing to a cerebral situation.

To turn to the hypothetical supra-nuclear centre, several
authors place this in the corpora quadrigemina, while others deny
its existence, and say it is not necessary to postulate any such
mechanism at all. If they are correct, then it is not to be

764

ABSTRACTS

wondered at that paralysis of these movements occurs so seldom,
for the lesion would have to damage the nuclei of the two elevators
(or depressors) of each eye. As a rule, it is both upward and
downward movement which is paralysed; next most frequently
paralysis of upward movement alone; paralysis of downward
movement alone has not been recorded

Clinical observations throw little light on the question of the
inter-relations of movements of the globe and the corpora quad-
rigemina. The symptoms of a lesion affecting the latter are
supposed to be cerebral ataxia and paralysis of eye muscles, but
even these are not necessarily present, and the case may be indis¬
tinguishable from one of cerebellar tumour. When one examines
the records of cases of isolated paralysis pursued to post-mortem
examination it appears that, with one exception, the cases have all
shown a tumour implicating the corpora, or pressure exercised
upon its neighbourhood, especially by the pineal gland. In the
exceptional case of Thomsen the region seemed entirely unaffected.

Close examination of the post-mortem records shows, however,
that much reliance cannot be placed upon the localisation, for it is
not possible to exclude pressure effects or “ Femwirkung.” Be¬
sides that, there are cases also in which there had been no such
symptoms, although the corpora quadrigemina were quite de¬
stroyed by tumour growth. Nor do the results of experiments on
anim als do much to clear up the difficulty. But, looking at the
matter broadly, one is fairly justified clinically in diagnosing the
presence of a lesion about the corpora quadrigemina when one
meets with an acquired isolated paralysis of upward or downward
movement.

In recorded cases the cause has generally been tumour of
one kind or another, much more rarely trauma, haemorrhage, or
“ hysteria ”; accompanying symptoms have in some instances been
conspicuously absent. A difference may be noted according as the
lesion is above the association centre actually or in it. If the former,
reflex movements of the globe are not interfered with, though the
voluntary movements are lost; if the latter, both are alike im¬
possible. Thus in the hysterical cases the patient cannot move
his eyes—let us say—downwards, but if one causes him to fix a
stationary object and then slowly raises his chin, the eyes will
remain fixed upon the object, i.e. the reflex movements are not
impeded.

Prognosis varies greatly according to the situation of the lesion,
but recovery is very rare, to judge from the literature, for Todter
has only found records of three instances. In one of these trauma
was the cause, in the other two there was no certainty as to the
origin.

Todter then proceeds to describe two cases which he had seen

ABSTRACTS

765

at the Breslau clinique. The first was that of a man of 38, who
first complained, in March 1900, of double vision and giddiness,
which continued even when the eyes were shut At that date he
could not, on desire, move the eyes either up or down, but on
making him fix an object and tipping back his head a little degree
of descent of the glance took place. Both eyes were equally
affected, and on attempt to look up nystagmus came on. Lateral
movements and convergence were quite good. Vision was normal,
so was the pupil reaction. The urine contained sugar. He practi¬
cally recovered in a few weeks, and three years later was quite
well. It seemed probable that the cause was a small haemorrhage
implicating the fibres coming to the corpora quadrigemina rather
than the corpora themselves, since there was the decided difference
above indicated between the voluntary movement and the reflex.

The second case was that of a man of 24, who at 17 suffered
from a heart lesion. In October 1902 he became suddenly
giddy and began to see double, but had neither headache nor
vomiting. The left eye stood somewhat higher than the right;
downward movement was somewhat nil, even on vigorous effort;
upward movement quite impossible; there was double vision,
one image standing above the other. The fundus was quite
healthy and lateral movements were not impeded. Next day
diplopia was gone and all movements were quite free. A
year later there was again a little diplopia as before, and limitation
of both upward and downward movements. The day following the
examination the patient died of pulmonary embolism, and the
whole of the nuclear region and of the corpora quadrigemina was
examined with great care, but no haemorrhages or other changes of
any kind could be discovered. The only suggestion is that of a
soft embolus in one of the vessels of the corpora quadrigemina
which had rapidly broken up and been carried away, but it would
be strange if this had occurred twice and left no trace discernible
on microscopic examination.

Todter concludes his paper with a brief account of the case
of an infant of five months with a high degree of ptosis and with
complete inability to turn the globes upwards. The child was in
every other respect quite healthy. The interesting point is that
the father had an exactly similar defect; further back in the
family he did not succeed in tracing it. W. G. Sym.

PARALYSIS OF THE ABDUOENS IN THE 00IJR8E OF OTITIS.

(433) Terson (Toulouse) and A Txrson (Paris), AnndUs tfOculistigue,
July 1906.

The appearance of ocular paralysis in the course of otitis media is
alarming, and highly suggestive of meningitis or sinus thrombosis.

766

ABSTRACTS

But as an isolated symptom, and even when associated with optic
neuritis, its import is not always so serious, and complete recovery
may be hoped for. Such a happy issue occurred in cases recorded
by Gervais, Keller, Styx, Boeme, Valude, and others, and in the
two following under the care of the authors:—

Case I. was that of a girl, aet. 12, with no family or personal
history suggestive of syphilis or tubercle. She had had no illness
apart from ozoena and two attacks of right otitis media. During
the first attack of otitis she had right facial paralysis, which lasted
six weeks. Fifteen months later a second attack was ushered in
with symptoms of acute mastoiditis, but operative interference was
not required in view of the disappearance of symptoms which
occurred along with the onset of otorrhoea on the twentieth day.
With this, however, right abducent paralysis appeared, though
visual acuteness and the appearance of the fundus oculi were
normal. Under treatment by mercurial inunctions and iodide of
potassium the otitis and paralysis improved concurrently, and
were cured three months after the first sign of diplopia.

Case II. A boy, set. 7, having no stigmata of hereditary
syphilis, but whose father was a general paralytic and syphilitic,
suffered from left purulent otitis media, probably of influenzal
origin, and left abducent paralysis, which came on about s fortnight
after the otitis. There was no affection of the fundus or reduction
of vision, nor any mastoid symptoms. Treatment consisted in the
administration of syrup, iodotannic, and recovery was complete.

The possibility of the paralysis being a mere coincidence is
highly improbable, as it always occurs on the same side as the
otitis, and may be associated with optic neuritis, and occasionally
with paralysis of the third and fourth nerves. The origin of the
paralysis may be infectious or reflex. The nuclei of the sixth,
seventh, and eighth nerves are closely related functionally and
anatomically, and through the carotid plexus the sixth may be
reflexly connected with several cranial nerves, and in the walls of
the cavernous sinus it receives a direct communication from the
ophthalmic division of the fifth nerve, and possibly the third nerve.

Such symptoms as blepharo-spasm, nystagmus, and spasmodic
squint, occurring in the course of disease or operative treatment of
the ear, are often doubtless of reflex origin; but a paralysis coming
on some days after the onset of otitis, and disappearing concur¬
rently with the latter, is much more likely to be of infectious
origin. The paths of infection are probably varied. Direct infec¬
tion would be possible in cases of necrosis or tubercular caries of
the petrous temporal at the point where the nerve is in intimate
contact with the bone. Infection along the nervous communica¬
tions of the carotid plexus or localised toxic or necrotic neuritis, at
a distance from the seat of the disease, are all very improbable in

ABSTRACTS

767

the authors’ opinion. By far the most likely method of infection
is along the venous and lymphatic communications between the
carotid canal and its venous plexus and the lymphatic and venous
plexus of the tympanum through the carotico-tympanic canals.
This communication may become more free owing to the absorption
of the bony wall of the carotid canal, thus bringing the carotid
sheath and the tympanic mucous membrane into actual contact.

J. Jameson Evans.

A STUDY OF THE PARALYSES OF PNEUMONIA IN ADULTS.

(434) (Etude sur les paralyses pneumoniques chez les adultes.)

Pierre Daireaux, Arch. Gin. de Mid., Sept. 4, 1906, p. 2241.

The paralyses associated with pneumonia in old people are
invariably hemiplegic, nearly always fatal, and frequently found
to be due to haemorrhage, softening, or local changes, the result of
atheroma. In the adult, on the contrary, various types of paralysis
are found, and recovery can usually be counted on, no matter how
grave the symptoms may appear at the time of onset. During the
acute stage of the disease, hemiplegias alone are encountered,
occurring usually a few days after the commencement, but in
exceptional cases preceding by some days the first appearance of
symptoms of pneumonia, or even not developing till after the
crisis. A right-sided hemiplegia is the more common and is often
associated with aphasia. In some cases hemiansesthesia has been
noted. Although admitting that in many respects the symptoms
in these cases suggest a hysterical origin, the author is of opinion
that they are due to a temporary affection of the meninges over
the Rolandic area, caused by pneumococcal toxins and comparable
to the meningitis known to complicate such diseases as scarlet
fever, typhoid, and mumps.

Following the subsidence of the pneumonia a typical peripheral
neuritis is occasionally noted, the arm on the same side as the
affected lung being usually attacked. These also the writer
ascribes to toxic infection, and not, as has been supposed, to a
direct extension of an inflammatory process from the pleura.
During convalescence, usually some weeks after the attack of
pneumonia, generalised paralyses occur, resembling those following
diphtheria. There is weakness of the legs and arms, and some¬
times involvment of the cranial nerves. The majority of such
cases are undoubtedly due to a polyneuritis, but exceptionally, as
in a case fully recorded in the paper, the symptoms point rather
to a poliomyelitis. With reference to the etiology of the above
conditions the writer emphasises the fact that pneumonia is a

768

ABSTRACTS

general disease and that the paralyses are therefore probably of
toxic origin and similar to those associated with the infectious
fevers. Hsmbv J. Dunbax.

JACKSONIAN AND PSEUDO-JAOKSONIAN EPILEPSY. Yob-

(435) KASTNKR, Berlin. Klin. Gesell, Oct. 9, 1905, xhi., 1321.

A patient was brought to the Nerve Clinic with a history that
convulsive spasms had appeared suddenly in the Ifeft arm, extend¬
ing to the left side of the face and the left leg, and leaving a
sensation of weakness on that side. The patient had acquired
soft chancre in the year 1897, but had previously been healthy.
She stated that three months previously the illness had commenced
with irritation in the left arm, and the hand became weak. Later
a small swelling was removed from the forehead, and, subsequently,
enlargement of the glands on the left side of the neck and in the
axillary region was noticed, and these were also removed On
admission the spasms occurred frequently. They commenced by
clonic convulsions of the flexors of the thumb and fingers of the
left hand, rapidly extending to the left lower facial muscles, and
finally to the ocular muscles. Sometimes the spasm first appeared
in the elbow and extended to the shoulder. On examining the
patient there was found to be definite paresis of the left lower
facial muscles. There was also marked paresis of the left arm and
hand, especially the flexors of the fingers, those muscles which had
been most severely affected by spasm suffering most from paralysis.
The left leg was somewhat weaker than the right, and the extensors
of the fingers, which at first functionated well, became weak. The
fundus oculi appeared to be normal. The glands, which had been
removed from the neck and axilla, proved to be malignant and of
an endothelial character. It seemed probable that the cerebr&l
symptoms were due to a tumour, the position of which could be
ascertained with a moderate degree of certainty. It was thought
that possibly it had not developed strictly in the cortex, but jost
beneath it. The question naturally arose as to whether removal
of the tumour should be attempted, but this was abandoned on
account of the cachectic condition of the patient

Donald Armour.

NOTE ON A BABE POBM OF PSEUDO-JS8THE8IA. (Observe

(436) tion d’une forme rare de pseudoesthdsle.) Mattirolo, Jour*,
de Neurol., Aug. 5, 1906, p. 281.

Pseudo-asthbsia is a false but physiological mental perception of
colour, sound, smell, taste, or touch, having a real objective origin

ABSTRACTS

769

from its own or from one of the other four senses, or being of
purely psychic derivation. Usually only one such anomaly is
present in one patient, but two or more may co-exist. Frequently
there is a reciprocity between two senses, a primary sensation of
one producing always a secondary false perception of the other,
both being indifferently primary or secondary. The condition
cannot be regarded as really pathological, as it exists in normal
individuals and is always found to have been present since early
life. The case recorded is that of a man aged 30 years, a little
nervous and excitable, but perfectly healthy and highly intelligent.
Since childhood certain words had the effect of producing in him
certain gustatory sensations—a state of matters which he had only
gradually realised to be peculiar to himself. He was an Italian,
but had learned French at an early age, and some years later had
acquired a knowledge of German. French and Italian words
produced the false perception equally well, but their German
equivalents had no effect. It mattered not whether he heard the
words spoken, himself uttered them aloud, or merely thought them.
Certain words always evoked particular taste sensations, and when
eating any pleasing article of diet he automatically pronounced in
his mind tne corresponding word, which latter proceeding gave
him a more complete appreciation of the taste of what he was
eating. The word Eusse called up the taste sensation of pears;
admettre, of tomato sauce; Mercredi, of gooseberry ice, etc. Mere
elementary taste perceptions, such as bitter and sweet, were never
produced. The patient’s other senses were unaffected. The writer
would regard the condition as being due either to an association of
ideas originating in childhood and developing unconsciously, or to
a special psychical process of the nature of a hallucination.

Henry J. Dunbar.

ZUR RECURRENSFRAQE. Gra bower, Arch. f. Laryngol ., Bd. 18,
(437) H. 3.

Although the vocal cords assume finally the cadaveric position
after section of the recurrent laryngeal nerve, in a preceding stage
they occupy the median position. This is due to the action of the
cricothyroid muscle. The following case demonstrates the accuracy
of this view. In a patient whose right recurrent was divided
during an operation for thyroid enlargement, shortness of breath
supervened shortly after the operation although the voice remained
clear. After four days the voice became quite hoarse and the
dyspnoea disappeared. The patient was examined a few days
later, when a right-sided recurrent paralysis was found.

With reference to Semon’s teaching that the abductor muscle

770

ABSTRACTS

is the first to be affected, the author believes that this is dae to
this muscle having a smaller mass than the adductors. He says
that clinical experience and experiment confirm this view. In
lesions of the nerve trunk, whether due to a central or peripheral
cause, the nerve elements for both abductors and adductors are
equally affected, but the result is first seen in the case of the
adductors. The author has shown, by making serial sections of
all the intrinsic muscles of the larynx, that the number of the
nerve fibres is relatively and actually fewer in the abductors than
in the adductors, and in this he finds the explanation of the lesser
resistance of the former. W. G. Porter.

A CASE OF “ STAMMERING GAIT.” (Bin Fall von “ Gehstottem. )

(438) E. TrOmner, Neurolog. Centralbl ,., Sept. 16, 1906, S. 857.

The author has in a previous work maintained that stammering
is really a Zwangsneurose of the speech apparatus, the reasons
being the absence of organic findings, the disappearance of the
symptom when the patient is alone, the fact that the stammering is
more marked in ordinary speech than in foreign speaking or in sing¬
ing or whispering, and the influence on the affection of the person’s
conception of his environment. The tics, as defined by Brissaud
and Meige, and hysteric abasia, belong to this same group of
Zwangkinesias. Closer analogies with stammering are found in the
Hamstottern or begaiement urinaire, in which the individual cannot
pass water in the presence of another; but no cases are on record of
a pure stammering motor affection of the limbs. Bruns published a
case of hysteria in a boy with this as a symptom of the condition.
Tromner describes an interesting case of a man, aged twenty-three,
who, for eleven years, had suffered from attacks of the following
nature. On attempting to rise from a sitting posture, or to start
moving from a resting upright posture, he was seized with a cramp
which, beginning in the leg, often spread over the whole body;
these were nearly always on the right side. After a powerful
effort he was enabled to raise his leg, and, once started, went quite
welL The attack was accompanied by a psychical condition akin
to that found in certain cases of obsessive states; the feeling of
distress and fear of not being able to move was in bad attacks
extreme. It was assuaged by turning his head to the right,
stretching his body backwards, and working his arm violently in
the air; he could thus master the difficulty, and relief at once
followed. Of late years the attacks had increased in frequency
and occurred every day. They were always worse when some one
else was present. A short course of hypnotism treatment was very
successful, and for six months the patient has been nearly welL

Ernest Jones.

ABSTRACTS

771

A LECTURE ON HEAD-NODDING WITH NYSTAGMUS IN
(439) INFANCY. George F. Still, Lancet, July 28, 1906.

Dr Still commences by considering the three main symptoms of
the condition—the head-nodding, the tendency to look out of the
comer of the eyes, and the nystagmus. Of 31 cases which had
come under the author’s observation, the variety of the rhythmic
movement of the head was noted in 22. Eleven patients showed
only lateral rotation; six showed only antero-posterior nodding;
four either of these movements at different times; and one the
combined pendulum movement.

Emphasis is laid on the fact, as being of importance in diagnosis,
that the head movement occurs only when the child is sitting with
the head unsupported, and that it ceases therefore when the child
is lying in a cot or leaning the head against the mother’s arm.

An absent-minded stare is frequent in these children, but there
is no ground whatever for regarding this peculiarity as due to petit
mal, and the author has not seen the least tendency to epilepsy of
any sort.

The habit these infants have of looking out of the corner of the
eyes while the face is turned in the opposite direction, and slightly
downwards, is very remarkable and very characteristic.

The nystagmus is characteristic and peculiar in certain re¬
spects, and chiefly in two points. (1) Its unilateral predominance.
(2) Its onset without apparent cause in an infant a few months
old, and its complete disappearance after a few weeks or
months.

As regards the aetiology of the condition, rickets is present in
a large proportion of the cases, but rickets is not an essential factor
in its causation.

The author agrees with Henoch that the irritation of teeth is
the usual exciting cause of the condition:—

“ Its occurrence in rickety children and after the exhaustion of
various illnesses or the shock of an injury, and its very close rela¬
tion to dentition and the exacerbations just when a tooth is in
process of eruption, all suggest that spasmus nutans is a functional
disorder depending upon an acquired or congenital nervous in¬
stability, with some peripheral irritation as an exciting cause.”

Dimness of light has recently been put forward as a cause
of the condition, and the arguments adduced in favour of this
theory are:—

1. The fact that infants with spasmus nutans often live in dark
dwellings.

2. The rarity or non-existence of the disorder amongst the
wealthier and consequently better housed.

772

ABSTRACTS

3. The onset of the disease nearly always daring the dark
months of the year.

4 The analogy with miners' nystagmus, with which there are
known to be associated in rare instances some rhythmical swaying
movements of trunk and head.

The difficulties in accepting this theory are:—

(1) It is quite certain that spasmus nutans may occur in infants
living in well-lighted dwellings.

(2) The disorder is undoubtedly seen chiefly in hospital
practice, but the author has seen it in three cases in private
practice amongst people in comfortable circumstances and
well housed.

(3) The seasonal incidence of the disease is indeed remarkable,
but a consideration of other conditions leads the author to con¬
clude that during the season November to March, there, is some
influence, apart from deficiency of light, which favours the onset of
certain nervous disorders in connection with rickets.

(4) The analogy with miners’ nystagmus does not support
strongly the defective light theory.

As regards prognosis, the author states that “it is probably
safe to give an unqualified good prognosis,” while treatment should
be conducted along general lines, benefit in many cases being
obtained also from sedative drugs. A. Dingwall-Fordyck.

PSYCHIATRY.

ON THE CLINICAL SYMPTOMS, DIAGNOSIS, AND PROGNOSIS
(440) OF AMENTIA (Zur Klinik, Diagnose und Prognose der
Amentia.) W. Strohmayer (of Jena), Monatsschr. /. Psych, u.
Neur., May, June 1906.

Aptkb a short historical sketch the author analyses the cases of
acute hallucinatory confusion received in the clinic at Jena from
1885 to 1902. He starts with a broader group than the amentia
of Kraepelin who, by separating the infection psychoses and
collapse delirium, and by referring other cases to the manic-
depressive or dementia praecox group, has limited the number of
cases regarded as true amentia.

Of the 3000 male admissions in the period used, 40 were cases
of amentia; among 2500 females, there were 90 cases. Of the
130 cases, only 110 could be used, as the others could not be
followed for a satisfactory length of time; in 110 cases the subse¬
quent outcome of the case was ascertained.

Thirty-three cases were of puerperal origin; 40 showed some

ABSTRACTS

773

marked ^etiological factor of somatic nature; in 26 no somatic
cause was made out, but emotional strain played an important
rdle. In 90 per cent, of the cases it was possible to find some
cause responsible for the onset of the disorder; in the total
absence of any exogenous factor the diagnosis of amentia should
be made with care.

Strohmayer gives a clinical picture of the disorder as presented
by his cases. The onset is sometimes abrupt, sometimes preceded
by a variety of subjective disorders; the clinical picture quickly
develops and presents essentially a state of confusion with promi¬
nent hallucinations, transitory delusional elaborations, and general
excitement. When the excitement subsides somewhat the funda¬
mental disorder comes out more clearly, viz. the confusion and
primary incoherence of thought. This incoherence is the most
fundamental and most persistent feature, being well marked even
in the remissions and during convalescence; it may be complicated
by a secondary incoherence due to the influence of the crowd of
hallucinations.

The mood is seldom uniform, but varies quickly and in accord
with the trend of ideas. In 10 cases anxiety predominated
throughout the whole course; these patients were men in ad¬
vanced life. Hallucinations and illusions are prominent and
lead to a complete misinterpretation of the whole situation.
The author had no case similar to that of Weber, where the
hallucinatory element was absent, and the essential features
were primary incoherence, disorientation, perplexity, variability
of mood, and delusions.

Where a secondary incoherence due to the prominent hallu¬
cinations complicates the condition, dream-like states with
complete disorientation result; this form may be described as
acute hallucinatory confusion, while the simpler picture may be
considered simple amentia. Clinical records are given to illus¬
trate these types.

Agitation is a well-marked feature of amentia, and may pass
into frenzied excitement, and this is not infrequent in certain fatal
cases, with emaciation and fever. Agitation may be replaced by
stupor, or the two may alternate. The symptom-complex is com¬
plicated in various ways by the introduction of so-called catatonic
symptoms — verbigeration, mannerisms, stereotypies, mutism,
bizarre attitudes. Stereotypies and negativism were in the cases
of the author more frequent than flexibilitas cerea, echolalia, or
echopraxia. In 50 per cent, of the cases some of these symptoms
were present, and their significance is discussed later.

The course of the disease is remittent, the incoherence being
marked even in the remissions; on recovery, memory of the attack
is poor with many gaps, but it is much better for conditions of

774

ABSTRACTS

hallucinatory stupor than for incoherent and for true catatonic
phases.

Of the 110 cases, 21 died in the hospital, 66 were discharged
recovered or improved, 23 passed into chronic conditions or had
recurrent attacks of a periodic psychosis. The large mortality was
due to the accompanying bodily diseases. Of the cases discharged,
61 were followed: 55 remained healthy and showed no defect;
while of the other six, one developed general paralysis, three died
from a subsequent attack of delirium acutum, two had another
attack of amentia.

The records of the 23 unfavourable cases are briefly given; the
large majority turned out to be cases of dementia prsecox, and this
group included only young patients. In other cases the secondary
dementia was not of the dementia prsecox type. A third group
belonged to the periodic psychoses. Where the patient seemed to
recover and later had an attack leading to the dementia prsecox
deterioration, the remission seldom lasted more than three years;
the lapse of this period without ominous symptoms justifies the
belief that the recovery is permanent.

The prognosis of amentia is very favourable, but one has to
consider that in young people an attack of hallucinatory confusion
may be the beginning of dementia prsecox. Cases with no
adequate setiological factor are specially to be suspected. It is
difficult to differentiate between amentia and the delirious form of
manic-depressive insanity, and therefore the possibility of a second
attack of mental disorder must be kept in mind. The greatest
difficulty lies in the separation of certain cases of hallucinatory
confusion from Kraepelin’s dementia prsecox. In dementia prsecox
the disorder develops more slowly; in the remissions the catatonics
are oriented and alert, and there is not that incoherence which is
so characteristic of amentia. So-called catatonic symptoms occur
in both disorders, and do not make the prognosis of amentia
graver. An unfavourable outcome may sometimes be anticipated,
not owing to the presence of catatonic symptoms, but on account
of the want of harmony between the affective and the intellectual
functions.

The disorder is not common, and formed less than 2 per cent,
of the admissions. C. Macfie Campbell.

ON HYSTEROMELANCHOLIA. (Ueber Hysteromelancholie.) 6.

(441) Specht (of Erlangen), Centralbl. f. Nervenh. u. Psych., July 15,
1906.

Specht maintains the existence of a special form of melancholia
which is based upon the hysterical constitution; he does not use

ABSTRACTS

775

the term hysteromelancholia to denote the appearance of another
psychosis in a hysterical patient, or to characterise the presence of
some hysterical features in the course of a melancholia. He does
not give any clear delineation of the psychosis, but discusses it in
general terms, and criticises the attitude of various authors. It is
wrong to assume that because the patient is exaggerated in gesture
and expression, therefore she is merely coquetting with grief; the
depression is real and often profound.

The occasion for the onset of the psychosis is not necessarily
an acute shock; chronic worry is more important. Where the
cause is a lively emotion, the latter may be joy as well as grief.

Threats of suicide are frequent and prominent, and cannot be
ignored, as the patient may carry out her threat. The psychosis
is as a rule polymorph and variable, but on the other hand it may
show little variation.

Hysterical stigmata may disappear during the psychosis. The
delusions are no more apt to take on religious sexual colouring
than in other psychoses. C. Macfie Campbell.

ON THE SYMPTOM-COMPLEX OF PRIMARY INCOHERENCE
(442) WITH EXCITEMENT. (Ueber den Symptomenkomplex der
primftren Inkoh&renz mit Erregung.) R Fels (of Jena),
Monatsschr. f. Psych, u. Neurol ., May 1906.

Eels reports the cases of three patients presenting incoherence
with excitement, without any of the characteristic symptoms
which would warrant one in associating the cases either with the
manic-depressive, dementia praecox, or amentia group. The in¬
coherence was primary and not secondary to hallucinations,
memory defect, or flight of ideas. The mood showed no constant
anomaly, but was continually varying, and there were long periods
of incoherence without either elation or depression. On this
ground, the diagnosis of manic-depressive seemed unjustifiable;
the cases were not similar in development to the cases described
by Wernicke as confused mania (verworrene Manie). Although
presenting some similarity to cases of amentia, the well-preserved
orientation was in marked contrast with the disorientation of
amentia. Even in the presence of some catatonic symptoms the
diagnosis of dementia praecox was excluded on account of the
absence of defect symptoms and of the age of the patients—40,
34, 46.

With regard to the aetiology, all had bad heredity, and two
were of psychopathic constitution; in the third case rheumatic

776

ABSTRACTS

pains had preceded the onset. In all three cases the clinical
picture had already lasted for more than a year.

C. Macfie Campbell.

A CASE OF HALLUCINATIONS OF PERIPHERAL ORIGIN.
(443) (Bin Fall von peripherentstandener Sinnestansdrang.) C.

Hudovernio (of Budapest), CentralbL f. Ncrvcnk. «. Psych.,
April 1, 1906.

Case of a neuropathic young man of 18, who for some time had
heard sounds, a continuous murmur, an occasional human voice
which spoke out his thoughts; this latter phenomenon caused
patient great distress. There was no history of ear disease.
Examination showed a large amount of wax in the left auditory
canal, and a plug of cotton-wool tightly pressed against the drum.
The symptoms disappeared completely on removal of the wool and
wax. There is no mention of whether the hallucinations were
one-sided or not. C. Macfie Campbell.

THE GREAT PSYCHICAL IMPORTANCE OF EAR DISEASE.

(444) N. S. Bryant (of New York), Joum. of Ment. and Nerv. Di$.,
Sept. 1906.

The author’s attention was drawn to this subject by patients who
suffered from otitis media with tinnitus, reacted to auditory
hallucinations, were treated for the middle ear disease, and the
hallucinations disappeared. He reports such cases with recovery
and refers briefly to several others. The dry forms of otitis media
are the most frequent cause of tinnitus, and are more commonly
associated with psychoses than are the purulent forms. Tinnitus
from the psychic standpoint maybe classified as follows: (l)that
not heeded by patient (largest class); (2) that caused by hypo¬
chondria, neurasthenia, melancholia, etc.; (3) that causing auditory
hallucinations. The hallucinations may be (a) of slight importance,
the patient being conscious of them; (b) “ unconscious hallucina¬
tions ” of no great psychic importance; (c) “ true delusions ” finally
becoming organised. Koppe in 1867 examined 100 insane patients
with the following results: without symptoms pointing to the ear,
20; auditory hallucinations, 77; marked ear disease, 31; tinnitus
aurium, 26. Redlich and Kaufman in 1896 found in the exami¬
nation of 97 insane patients, 29 doubtful, 10 without auditory
hallucinations, 11 normal, 58 with auditory hallucination, 57 with

ABSTRACTS

777

abnormal ears, 26 with tinnitus. Among their cases hallucinations
were most common in paranoia (50) and alcoholic insanity (17).

Bryant examined 36 insane with the following results: 10
doubtful, 4 normal cases, 42 abnormal ears, 5 without hallucina¬
tions, 41 with hallucinations, 27 with tinnitus (not classified
according to disease),

In regard to prognosis, the author believes the prognosis to he
bad for recovery from auditory hallucinations in proportion to the
deafness; in old age the prognosis is particularly had. Unilateral
tinnitus does not have so much psychic influence as bilateral.

In conclusion, the evidence points to some connection between
ear disease and auditory hallucinations other than mere coinci¬
dence ; it is probable that auditory hallucinations in most cases
originate in subjective ear sensations; cure of the ear disease
assists in the convalescence from the psychosis in many cases.
Some cases of insanity appear to be excited by ear disease and
convalescence is delayed by its presence; unilateral hallucinations
are unquestionably due to unilateral ear disease.

C. H. Holmes.

ON HYDROTHERAPY IN MENTAL DISORDERS. (Zur Hydro-
(445) therapie bei Oeisteskranken.) W. Alter (of Lindenhaus),
Ceniralbl. f. Nervenh. u. Psych., May 15, 1906,

Alter answers some criticism by Sanger, who had deplored the
limited use of hydrotherapy in the treatment of the insane, and
recommended a more complicated hydrotherapy than is usually
employed. Complicated hydrotherapeutic treatment is out of place
in a large hospital for the insane ; the treatment must be left to a
large extent to the nurses, and the directions to be given need to
be simple and easily understood.

Hospitals for the insane have usually limited equipment, an
inadequate medical staff, and an insufficient nursing staff.

Alter looks upon the treatment of the excited cases as the
special field for hydrotherapy; rest during the day and sleep at
night are what is aimed at. Complicated packing and any method
which provokes the resistance of the patient and general an¬
tagonism in the ward should be if possible avoided. The packing
of a patient in wet sheets until a reaction is obtained, and then
repeating the treatment, provokes such antagonism and induces
resistance in the patient which leads to dangerous exhaustion.

Warm packs are recommended; vasomotor variation is hindered
by the equable moist temperature, and peripheral irritation being
removed, the patient is in the most favourable condition for the
3 E

778

ABSTRACTS

inducement of peycho-motor calm. The pack in this respect is
more effective than the warm bath. C. Macjte Campbell.

ON THE TECHNIQUE OF OPERATIONS ON THE CENTRAL
(446) NERVOUS SYSTEM. Sir Victor Horsley, Brit. Med. /our*.,
Aug. 25, 1906.

Sir Victor Horsley based his Address in Surgery upon an
analysis of his cases at the National Hospital, Queen Square,
since 1886. He points out that the advance in technique of
the surgical treatment of diseases of the brain and the spinal cord
has been relatively less than the improvement in our knowledge of
the seat and nature of the diseases for which surgical intervention
is useful and necessary. And while correct diagnosis in diseases
of the nervous system is still far to seek, yet, he adds, operative
treatment in such a difficult field is often expected to yield as good
results as relatively easier and simpler work.

He lays stress upon the immense importance to the community
that the study of neurology should be pushed forward by every
means in our power, in order that the earliest commencement of
a tumour of the brain should be determined as certainly as that
of one nearer the surface of the body. He then briefly alludes to
the responsibility of the surgeon in the treatment of diseases of the
central nervous system, and complains that outside of the Queen
Square Hospital surgical treatment is almost universally regarded
as a dernier ressort.

Horsley then proceeds to discuss surgical treatment under two
aspects, viz.: 1. Palliative Surgical Procedures; 2. Curative
Surgical Procedures. He points out that the prominent char¬
acteristic symptoms of intracranial disease, viz. (1) optic neuritis,
which usually ends in total blindness; (2) severe headache and
vomiting, all of which are dependent upon pressure, can be com¬
pletely palliated or wholly removed by making a sufficiently free
opening in the skull and dura mater. Barely will the opening of
the skull alone suffice. This opening should be made preferably
in the basal temporal region of the right side. Should the tumour,
however, directly involve the optic tract, the specially delicate
anatomical structure of the optic tract may prevent the att aining
of this result. In referring to the localising value of the incidence
of the optic neuritis, Horsley lays down the rule, drawn from an
examination of his own cases of intracranial tumour, that the
optic neuritis commences on the side of the lesion. While
admitting some true exceptions to this rule, he argues that some
of the exceptions hitherto described have not been real, for in any

ABSTRACTS

119

given case it is not a question merely of the number of dioptres
of swelling of the disc, but also a matter of the anatomical
changes in the disc, and finally, when first seen the disc on the
side of the lesion may be actually subsiding into decadent con¬
ditions at a time when the opposite disc is rising to its maximal
swelling.

Passing to curative surgical procedures, Horsley says it is
necessary to consider (1) what is the nature of the disease; (2)
what loss or aberration of nerve function it causes; (3) whether,
if the lesion be wholly extirpated, there will be a recovery from
the disorder of function; and (4) whether any loss which may
have been present before operation will be made permanent by
the necessary extirpation of particular regions of the brain.

On points like the last he says a satisfactory opinion cannot
be given until we learn from the cerebral physiologist under what
circumstances and to what extent we can get compensation of
function when various parts of the cerebrum and cerebellum are
destroyed. As regards the cerebrum, from clinical records,
Horsley states that special motor functions, probably the special
senses, and certainly the hemianopic representation of sight,
cannot be restored if the whole of their cortical representation
be removed. The higher sensory representations and the intel¬
lectual functions are not permanently abrogated by the destruction
of any one part of the cerebral hemisphere.

As regards the cerebellum, Horsley is distinctly opposed to the
proposed removal of any part of it for the purpose of reaching a
deep-seated tumour. He advocates the displacement of the
cerebellum, which necessarily involves bruising it, and instances
remarkable recoveries from this bruising. Whether the recovery
is due to restoration of function of the bruised portions or com¬
pensation from the uninjured part, Horsley is unable to say with
certainty, though he believes the former. He therefore concludes
that as much as possible of every portion of the encephalon which
is not absolutely shown to be diseased should be preserved.

Horsley then proceeds to discuss the question of anaesthesia
in operations on the central nervous system, limiting his observa¬
tions to ether and chloroform, as he had never employed the
intraspinal injection of cocaine or stovaine, and has entirely given
•up the combined anaesthesia of morphine with chloroform. He
regards ether as inadmissible as an anaesthetic in operations on
the central nervous system, because it directly causes, besides &
rise of the blood pressure, a notable increase of the blood venosity,
and therefore much additional and troublesome haemorrhage.
Chloroform, per contra , causes a fall of blood pressure with re¬
latively less blood venosity. It therefore does not aggravate the
bleeding, nor embarrass the respiration. It is also attended by

780

ABSTRACTS

practically no after-excitement. Horsley agrees that chloroform
is more dangerous, and that it kills by paralysis of the respiratory
centre, as often or more often than by paralysis of the heart It
is especially in cases of increased intracranial tension that the
danger of respiratory paralysis is greatest Therefore, he states,
the immediate problem is how to regulate the dosage of
chloroform.

Horsley advocates the use of an apparatus for giving known
percentages of chloroform, Vernon Harcourt’a being the one he has
entirely worked with. It is used as follows: Commencing with
the dose at 0*5 per cent., and rising in one or two minutes to
2 per cent., the patient is ready for operation in five to eight
minutes. The amount of 2 per cent is given for about five
minutes before the skin incision and reflection of the flap which
constitutes the maximal pain period of the operation. The bone
is removed at 1 per cent. The dura being a sensitive membrane,
the dose is somewhat raised just previous to its incision. As soon
as the dura is opened the encephalon is dealt with under less than
0*5 per cent, of chloroform in the air respired. The percentage is
raised again to 0*7, or even 1 per cent., for the skin suturing.

Passing to the depressant physiological effects of the general
anaesthetic, Horsley says all operating-rooms should be kept at a
temperature of not less than 75° F.,and the operating-table heated
But, in addition, he is strongly of the opinion that to maintain the
physiological energy of the central nervous system and prevent
shock thereto, it is necessary during all operative procedures on
the skull and its cavity to prevent cooling by radiation from the
brain exposed in the wound. For this purpose the wound should
be constantly irrigated with a solution of 1 in 10,000 sublimate, or
with saline, at a temperature of 115°. An additional use of this
hot irrigation is the arrest of capillary and arterial haemorrhage.

Turning to the subject of haemorrhage, Horsley says that the
first general principle is the recognition of the fact that as few
vessels as possible should be obstructed, this applying as closely to
veins as to arteries. He is opposed to the practice of tying such
main arteries as the carotid to control haemorrhage, owing to
serious and even fatal secondary oedema and softening resulting
therefrom. He thinks nothing is better than the plan of tying all
the arteries around the lesion before extirpating it, beginning the
incision in the brain below and carrying it upwards and towards
the mesial plane.

Horsley points out how remarkably easy it is to arrest capillary
and arteriole oozing from the brain by the simple means of hot
irrigation. For this purpose the temperature of the fluid should
not exceed 115° F., and should certainly not fall below 110° F.

When a lesion is about to be extirpated, and there is reason to

ABSTRACTS

781

expect considerable oozing, or when the brain is obviously turgid
with congestion, Horsley takes advantage of the fact that chloro¬
form causes a marked fall in blood pressure, and has the chloroform
percentage raised for a quarter to half a minute to 1 or 2 per cent
By this means a convenient, proportionate, and temporary anaemia
is induced. The bleeding from veins and sinuses in bone is con¬
trolled by wax plugging ; wounds of the sinuses and Pacchionian
bodies and venous lakes in the dura mater are closed by a fine
lateral suture on a round needle; and the principal veins are
ligatured by passing a round needle beneath them. Venous oozing
can be rapidly controlled by the inhalation of oxygen. This is
done by raising the percentage of oxygen in the anaesthetic at¬
mosphere breathed, by directing a stream of the gas through the air
inlet of the Harcourt regulator.

For the lessening of shock, Horsley always does his brain
operations in two stages, opening the skull first, and then about
five days after opening the dura and removing the lesion. Re¬
garding the influence of the region opened, he finds that if a line
be drawn from the frontal eminences to the occipital protuberance,
more shock results from operations below that line than from
above, and also proceeding backwards from the frontal to the
cerebellar pole of the encephalon. Horsley thinks that the risk of
an operation for decompression is greater if the opening for the
relief of pressure is not made directly over the lesion.

In the treatment of shock, Horsley advocates the use of
inhalations of oxygen in embarrassment of the respiratory centre,
and above all in depression of that centre in the use of strychnine,
•which he, however, adds is a circulatory depressant, and therefore
not to be given too freely.

He thinks that cardiac stimulation is a clinical error. He
relies upon repeated two-hourly nutrient enemata, with a very
small dose of atropine if time presses. In cases of peripheral
vaso-motor paralysis he finds digitalis useful, but stops it on any
acceleration of pulse. He lays stress upon the main principle of
operating on the central nervous system which is the avoidance
and prevention of all conditions which lead to shock—namely,
cooling and mechanical disturbance of the central nervous system.

Concerning sepsis, Horsley points out the proclivity of the
central nervous system to invasion by septic micro-organisms and
the extremely feeble degree of its resisting power. For this
reason he thinks the less drainage employed the better, and that
every effort should be made to close the skin wound as early as
possible.

Horsley ends his address by giving an analysis of his Queen
Square cases which “ brings out in very strong relief the fact that
where the technique of intracranial operations fails most is the

782

ABSTRACTS

treatment of malignant disease.’’ He appends the following table
of 55 tumour cases:—

Cases.

Glioma . 191
Sarcoma . 4 J

Endothelioma

Tuberculous

Gumma

Fibroma

Cysts

Adenoma .
Adeno-sarcoma

. 8
. 4
. 5

Pituitary!

3 /

Recurrence within 2 years, 20.

1 recurrence 3 years later; died of

valvular heart disease. 7 alive
well, longest 5 years.

2 died within 3 months of tuberculous

meningitis. 2 alive well, longest
7 years.

No recurrence.

Ditto.

1 recurrence.

He concludes with the following general deductions on the
question of the surgical treatment of malignant disease of the
encephalon: (1) That operation should be resorted to as early as
possible; (2) the tumour should be, if possible, freely exposed and
examined and extirpated with surrounding tissue; (3) that if it
cannot be removed without undue interference with important or
essential structures, there remains some possibility of the tumour
undergoing retrogression in a certain number of cases.

Donald Ajcmouh.

RESULTS OF OPERATIONS FOR THE REMOVAL OF CEREBRAL
(447) TUMOURS. Knapp, Boston Med. and Svrg. Joum., Feb. 1,1906.

The author, in 1889, had collected 24 cases of operation on tumours
of the brain. In 1891 he added 48 cases to these, making 72
cases, and in 1899 collected 489 cases more. He compares these
three groups with the present collection to see what progress
has been made in the surgical treatment of brain tumour, as well
as to present the general results drawn from the whole collection
of 828 cases. The accompanying tables (Tables I. and II.) show
the results of these operations as reported in 1899, the results in
267 cases collected since, and the total results in 828 cases. The
subsequent tables (Tables III. IV. V. and VI.) show the mortality,
the number of cases not benefited by operation, and the number of
cases in which there was a failure to remove the tumour in each of
the four groups of cases, together with the total results in the 828
cases. The percentages are given, but he confesses that they are
somewhat fallacious. A single case in 1889, when only 24 esses
were recorded, accounted for about 4 per cent., but in 1899 a single

ABSTRACTS

783

case accounted for about one-fifth of 1 per cent The tables show
that in the later cases there has been a diminished mortality as a
result of the operation, and a somewhat greater number of cases
benefited, but Knapp regards this as being due to the improved
surgical technique. He points out that the table showing the per¬
centage of failures to remove the growth is less flattering to the
neurologist than the previous table to the surgeon, in spite of the
number of cases said to have “ recovered.” A study of the recorded
cases confirms him in the belief that most of these simply lingered
on for a time, paralytic, epileptic, or blind, and that in many
instances the growth recurred; that the cases of actual recovery,
that is, of complete restoration to health, are exceedingly few. He
thinks that it is justifiable to operate in suitable cases with the
probability of affording temporary relief, but the possibility of a
complete cure is slight; and the optimistic views, or rather hopes,
so often expressed as to the benefit of operation are hardly justifiable.
He thinks that the claim of the so-called palliative operations to
relieve pressure can be admitted only in about half of the cases,
in which they relieve headache and arrest the progress of optic
neuritis.

TABLE I.

Not

1899.

Recovered* Improved,

improved.

Died.

Not stated.

Total.

Removed

. 76

311

Not found

. 5

130

Impossible

Palliative

Total

. 80

129

135

188

561

1905.

Removed

. 36

160

Not found

Impossible

Palliative

Total

. 36

267

Removed

. 112

Total.

122 78

123

471

Not found

]89

Impossible

Palliative

104

—-

■

—

Total

. 116

205

186

265

828

784

ABSTRACTS

TABLE IL

Not

1809, Recovered. Improved.

improved.

Died.

Not stated.

Total.

Frontal . .

Central . .

192

Parietal . .

Temporal .

Occipital

Cerebellum.

Not stated .

—

■ ■■

Total .

311

1906.

Frontal . .

Central . .

Parietal . .

Temporal .

Occipital

Cerebellum.

Not stated .

•3

...

— ■-

—

■

■ ■

—-■

Total .

160

Frontal . .

Total.

6 3

Central . .

236

Parietal . .

Temporal .

Occipital .

Cerebellum.

Not Btated .

■ ■■ —

- ■ ■

■

— ■

Total .

112

122

123

471

TABLE III.

Percentages op Operative Mortality.

786

ABSTRACTS

TABLE V.

Percentages of Failure to Find the Growth.

1889.

1891.

1899.

1905.

TotaL

Removed . . .

. . 18

265

160

471

Not removed . .

. . 5

115

189

Per cent, failure .

. . 22

TABLE VI.

Percentages of Failure to Remove.

1889.

1891.

1899.

1905.

TotaL

Removed ....

. 18

265

160

471

Not removed . . .

. 6

224

107

357

Per cent, failure . .

. 25

Donald Armour.

CEREBRAL DECOMPRESSION; PALLIATIVE OPERATION IN
(448) THE TREATMENT OF TUMOURS OF THE BRAIN,
BASED ON THE OBSERVATION OF FOURTEEN OASES.

Spiller and Frazier, University of Penn. Med. Bull., Septem¬
ber 1906.

The authors commence their article by a review of the literature,
and refer to cases of simple trephining of bone for the relief of
symptoms of increased intracranial pressure by Annandale, Lister,
Sahli, White, Horsley, Jaboulay, Caton, Paul, MacEwen, Taylor,
Keene, Bruns, Bramwell, Kammerer, Wyeth, Sanger, Albert,
Schlesinger, Putnam, Schultze, Clarke and Morton, Wiener,
Rohmer, von Bergmann, Babinski, Leslie Paton, Risien Russell,
Codman, and Cushing. After a careful study of these cases, and
of the views of the different authors, Spiller considers that the
weight of opinion is decidedly in favour of palliative operations.
The choked disc, headache, vertigo, nausea, vomiting, and to some
extent the convulsions, are all favourably influenced by this
method of treatment. Relief from these distressing symptoms
is by no means to be despised, even though the tumour is not
removable. The relief from many of these symptoms is often
permanent, i.e. during the period the patient may continue to live,
and as the growth of the tumour is not hastened by the palliative
operation, and may be slow, we should be thankful for a means of
relieving the distressing symptoms of intense intracranial pressure.

ABSTRACTS

787

Spiller himself is somewhat sceptical as regards the disappearance
of the Jacksonian convulsions after merely opening the skull and
dura. If the convulsions are very frequent, he is doubtful as to
whether palliative operations can cure focal symptoms. Bruns
thinks that they cannot do this, but the subject is one that has
important bearings. It is probable that a small tumour will cause
more local disturbance if the general intracranial pressure is
increased, not only because the local disturbance is added to the
general pressure, but also because any one part of the brain is
more irritable when the disturbance is general. Spiller thinks,
however, that this is not sufficiently important to prevent pallia¬
tive operation, and advises that this should be done before the
general symptoms become very intense, and especially before optic
neuritis has developed so far that blindness is likely to result.
The apparent unanimity of opinion as regards the effect on
choked discs of opening the skull makes the necessity of this
operation at an early period very evident.

He thinks it is a mistake to regard palliative operation as a
substitute for radical operation. The tumour should be removed
whenever this is possible, and palliative measures are to be con¬
sidered only when the tumour cannot be located, or is too large
for removal, or possibly is a glioma. He thinks that no surgeon
who has had but little experience in operating on the brain should
attempt the removal of a brain tumour, and always insists upon a
specialist in brain surgery operating upon his own cases. He
considers the experience of Horsley as regards atrophy of tumours
as a result of palliative operations to be unique. He himself has
never found other similar cases, nor has he ever experienced any
such result in his own. He has never seen arrest in the growth
of a tumour following the removal of a part, but several times has
seen increase of symptoms result, and hence dreads the partial
removal of a growth, especially if it is a glioma. It seems to him
that the congestion of the tumour and of the surrounding tissue, and
the greater space afforded for the growth of the tumour after partial
removal, favour rapid growth of the remaining portion. He is
convinced that it is better to leave the tumour untouched if only
a part can be removed, especially if the growth is a glioma. He
thinks that the attempt should never be made to remove a glioma,
and yet confesses that there is no way of determining before the
operation that the tumour is a glioma. He thinks it is a question¬
able proceeding to excise the portion of brain protruding through
the opening in cases of palliative operation. He says it may be
thought that the growth of the tumour is arrested by the opera¬
tion : this is possibly doubtful Internal hydrocephalus (meningitis
serosa) or some other lesion may cause the symptoms of brain
tumour, and relief of intracranial pressure may produce great

788

ABSTRACTS

modification or disappearance of them. Spiller’s views, as a result
of his experience and of a study of the literature are: (1) Pallia¬
tive operations should be performed early in every case in which
symptoms of brain tumour are pronounced, and before optic
neuritis has advanced far, especially when syphilis is improbable,
or antisyphilitic treatment has been employed. (2) Partial
removal of a tumour, especially of a glioma, is a questionable
procedure. (3) Palliative operation does not, under ordinary
circumstances, cause atrophy of brain tumour, and probably does
not arrest its growth. On the other hand, it probably does not
hasten its growth. (4) Palliative operation is not to take the
place of a radical operation when the latter can be performed
without great risk to the patient. (5) In some cases the
symptoms of brain tumour disappear almost entirely for a long
time, or permanently, after a palliative operation. This result is
obtained either by relief of intracranial pressure, or by the removal
of some lesion (meningitis serosa, etc.) other than brain tumour.

Frazier considers that the very vascular infiltrating sarcomata
should be classed with the inoperable tumours, and believes that
the expectation of life which remains to the patient would be
greater in the majority of cases after palliative operation. On the
other hand the fibroma, the somewhat definite fibro-sarcoma, and
the gumma of limited dimensions, should be classified as of the
operable group. The size of the tumour as revealed at the autopsy
has no practical bearing at all on the problem. The size of the
tumour at the time when the symptoms first made the diagnosis
possible only should be considered. If it were possible to ascer¬
tain the point from which the tumour took its origin, we should
have some valuable statistics as to the operability of tumours.
The further away the tumour is from the cortex, or the nearer it
is to the base of the brain, the more it approaches the field of
operable growth. He considers that if the statistics are to be of
much value to the surgeon, they should be based on the records
which are made on the operating table, or at the autopsy if the
patient dies as the result of the operation. As with carcinoma of
the stomach, so with tumours of the brain, the greater the number
of the cases brought to the surgeon in the earliest recognisable
stage of the disease, the sooner shall we be able to state with some
degree of accuracy in what percentage of cases there is a reason¬
able hope of being able to perform a radical operation. Frazier
divides the cases in which a decompressive operation may be
required into two classes: (1) those in which there is reason to
believe that the tumour cannot be removed in its entirety; and
(2) where the tumour cannot be localised, and yet the possible loss
of vision, intense headache, and distressing vomiting almost
demand some immediate measure of relief.

ABSTRACTS

789

He thinks that in palliative operations in the cerebellar region,
the usual incision, beginning at the mastoid process, and following
the line of the transverse sinus to the occipital protuberance,
should be replaced by a vertical incision, beginning a little
above the superior curve line, and extending downwards for a
distance of three or four inches. The edges of this wound can be
retracted sufficiently to afford the space necessary to carry out the
subsequent steps of the operation. A much more perfect approxi¬
mation of the wound may be obtained, as the muscles are split in
the direction of their fibres, and not in various angles. If for any
reason a bilateral craniectomy seems advisable, the muscle splitting
operation may be repeated upon the opposite side. He thinks
there is less chance of disturbance arising from the traction on the
pons or medulla if an intervening bridge of bone is left. He has,
failing to find the tumour, in certain cerebellar cases deliberately
removed from a quarter to a third of the cerebellar hemisphere,
and attributes the relief of the pressure in part at least to this.

In all their cases the operation has been confined to one side, and
it was not found necessary to operate a second time for the removal
of the bone on the opposite side. Should this be found necessary,
Frazier considers that the operation had better be performed at two
sittings, seeing that patients with cerebellar lesions are at the best not
very favourable subjects for operative treatment. Taking first those
cases in which the tumour cannot be localised, Frazier thinks that
there are two points in the technique of the operation about which
there may be some difference of opinion, namely, the area of the
brain to be uncovered, and the incision of the dura.

The decompression operation consists solely in the removal of
a portion of the cranial vault, with or without incision into and
removal of a portion of the dura. When there is no guide as to
the situation of the tumour, the operator is free to select any one
of four areas: the frontal, parietal, occipital, or temporal. As
Sanger suggests, it is desirable to give preference to that portion
of the skull beneath which may be said to exist a silent area of
the brain. This is especially true of the right temporal region, so
that, in the absence of any contra-indication, this may be said to
be the region of choice.

Turning then to those cases in which the tumour has been
definitely localised, Frazier agrees that it is impossible to determine
prior to the operation whether the tumour is one suitable for a
radical rather than a palliative operation. He thinks that the
duration of the disease is a guide neither to the nature nor to the
size of the tumour. He thinks that in every instance therefore the
operator should begin the operation with the intention of attempt¬
ing to expose the tumour. He should proceed as for the perform¬
ance of an osteoplastic operation. The flap should be carefully

790

ABSTRACTS

mapped out and reflected, and the usual exploratory measures
adopted. Failing to find the growth, or finding an inoperable one,
the propriety of a decompressive operation is clearly indicated. He
must then determine as to whether he will remove the bone of the
flap, wherever this may be, or close the flap and remove the bone
from the area of choice, namely, over the right temporal lobe. As
to the escape of cerebro-spinal fluid, there are certain observers,
notably von Bergmann, who believe that the beneficial effect of
this operation is largely attributable to the escape of cerebro¬
spinal fluid. It may possibly be difficult to prove or disprove this
idea on theoretical grounds, but in their own experience Spiller
and Frazier have not been able to note any radical difference in
the results between those cases in which the dura was either left
intact, or if incised for exploration, was closed immediately after¬
wards. They consider that the relief, which extends over a period
of months or years, can scarcely be attributed to the escape of a
small quantity of cerebro-spinal fluid from a temporary opening in
the dura. Many consider that the success of the operation depends
upon the establishment of an opening in the dura, as well as in the
skull, it being said that the dura is not elastic enough to stretch
sufficiently when subjected to pressure. Frazier says that the
dura will stretch when the overlying bone is removed sufficiently
to afford adequate relief of tension, as has been demonstrated in
their cases over and over again. He points out that, whatever
else may be said in favour of or against the removal of the dura, it
should be borne in mind that if the dura is removed, and any com¬
plication arises in the repair of the wound, it is more than likely
that a fungus cerebri will develop. He confesses that in the hands
of operators experienced in this field of surgery the danger is very
slight, but thinks that it is questionable whether the removal of
the dura should be resorted to ’as a universal practice. He con¬
siders that if the dura is disturbed at all, the operator should be
content with making a crucial or radiating incision, and in many
cases it may be advisable to reserve this step of the operation until
indication arises for further intervention.

He concludes that the decompression operation offers to the
patient relief from the three cardinal symptoms of cerebral tumour,
headache, nausea, and vomiting, restores vision, and if the lesion is
in the cerebellar fossa, relieves ataxia and vertigo. The oppor¬
tunity to save or restore the patient’s eyesight is one of the
strongest arguments in favour of the palliative operation. With¬
out exception the choked discs subsided in every one of their
cases. The prospect of preserving the eyesight alone therefore
would justify the operation, but no less so the opportunity of re¬
lieving headache. Their results with respect to headache have been
uniformly good. They append a summary of their fourteen cases.

ABSTRACTS

791

SUMMARY OF CASES.

Location of
Lesion.

Cerebrum.

Cerebellum.

Period since Operation.

1 year (operation was
not performed, but
relief of pressure oc¬
curred spontaneously).

7 years.

Cerebellum and 2 years and 7 months.

Cerebrum.

Cerebellum.

Cerebrum.

Cerebellum.

24 years.

2$ years.

1 year and 7 months.
8 months.

Cerebellum.

7 months.

Cerebellum.

Cerebrum.

Cerebellum.

7 months.

24 months.

2$ months.

2 months.

Cerebrum.

—

Cerebellum.

About 3 years.

Besults.

Alive and free from pain.

Almost complete recovery
during 2 or 3 years: pres¬
ent condition unknown.

Alive and free from pain.

Second operation was per¬
formed : tumour found
and removed.

Died 7 months after opera¬
tion.

Alive and free from pain.

Radical operation was per¬
formed 2 months after
palliative operation.

Alive, but little, if any,
relieved.

Improved : death from
tumour about 3 yean
after palliative operation.

Donald Armour.

OPERATIVE TREATMENT OF PURULENT MENINGITIS. (Die
(449) operative Behandlung der eitrigen Meningitis.) Kummkl*

Areh.f. klin. Chir., lxxvii., 1905, 77, 930.

The author considers that the advances which have been made in
the operative treatment of purulent peritonitis, and the fortunate
results that have been obtained in that of tuberculous peritonitis,
make it evident that we are not very far from being able to obtain,
by means of a more active operative procedure than that hitherto
employed, amelioration or cure in the case of disease processes of
the meninges in which formerly nothing could be hoped for. He
refers to the free drainage of the abdominal cavity in cases of

792

ABSTRACTS

septic peritonitis for the purpose of aiding nature in her curative
powers, though it is impossible to remove all the toxic foci, and
thereby attain in a disease which otherwise would certainly run a
fatal course a percentage of cures which is progressively increasing.
In cases of tuberculous peritonitis, the abdominal cavity is simply
opened, with or without removal of the ascites, and yet cures are
obtained without interference with the true primary disease.
Judging from these results, he thinks that attempts should be
made to obtain similar ones in intracranial inflammatory affections
more frequently than has hitherto been done. He thinks that the
small proportion of cases which recover after opening of the skull
for tuberculosis meningitis is due to the miserable condition of the
patients, though after trephining we see a transitory improve¬
ment, due to diminution of the pressure, and shown by a
remission of stupor, liberation of the sensory faculties, and
remission of pain; and he thinks it worth while to endeavour
to obtain these results in the face of an otherwise fatal
malady. He thinks that the cured cases of cerebro-spinal
meningitis reported by Lenharty, in which cure was effected by
lumbar puncture, are in favour of the employment of active thera¬
peutic measures in inflammatory diseases of the cerebral and spinal
meninges. He is of the opinion that in epidemic cerebro-spinal
meningitis, when lumbar puncture fails, free opening of the skull
cap or vertebral column should be performed, as affording a prospect
of a beneficial result. He refers to the cases of circumscribed
purulent meningitis, usually of otitic origin, or complicating frac¬
tures of the skull, which have been benefited by operation. He
also refers to those cases of circumscribed meningitis, with mani¬
festations of a general meningitis, which have been cured by more
or less thorough surgical interference. He refers to cases reported
by Lucca, Witzel, Bertelsmann, and M'Ewan, in which successful
results have been obtained. He then reports at length a successful
case of diffuse purulent leptomeningitis, extending to the cauda
equina, and due to a fracture at the base of the skull, which was
cured by operative treatment. The cranial cavity was extensively
opened on both sides of the occipital bone, so as eventually to
allow of an opening to the vertebral canal. The posterior cranial
fossa was drained. He thinks the result obtained in this case is
decidedly in favour of the opinion of those who advocate active
interference, even in diffuse purulent leptomeningitis. Giissenbaur,
at a meeting of the Vienna physicians in January 1902, stated that
the treatment of meningitis belonged to surgical therapeutics of
the future. Kiimmel thinks that the fact that the possibility of
attaining a cure does present itself, even in severe cases, in which
otherwise there is no room for hope, through extensive opening of
the cranium, must incite us to interfere surgically in the earliest

ABSTRACTS

793

possible stages of inflammatory diseases of the meninges, and thus
endeavour to aid nature in her attempts at cure.

He concludes that the opening must be made as early as pos¬
sible, either in the cranial cavity or the vertebral canal, or even in
both, after meningitic symptoms appear, if we are to save an other¬
wise doomed patient. Donald Armour.

ON FACIAL NEURALGIA AND ITS CURATIVE TREATMENT
(450) BY EXCISION OF THE GASSERIAN GANGLION. Jordan-
Lloyd, Birm. Med. Review , Jan. 1906.

The writer regards instantaneous relief of the agonies of inveterate
epileptiform neuralgia, by a carefully-planned and well-executed
excision of the Gasserian ganglion, as one of the most satisfactory
operations in the whole field of surgical work. He regards the
operation as having passed its period of probation, and thinks that
the remarkable relief the operation brings at once to the almost dis¬
tracted victims of this cruel disorder should make us confidently
advise our patients to accept it. He is careful to distinguish
between the many varieties of facial neuralgia, and defines those in
which the major surgical operation is to be practised. He confines
himself entirely to the consideration of true epileptiform neuralgia,
the neuralgia major, or tic douloureux. While examples of it are
frequently mistaken in the early stages of the disease, the difficulty
can rarely arise when it is well established.

Commenting upon the “ chief features ” of the disease, Jordan-
Lloyd says, with regard to his own cases, that he had twice seen
the trouble begin in the first division, and remain most severe
there throughout; that spasm of the facial muscles had several
times been absent, that there were nearly twice as many females as
males, and that he knows of one case of spontaneous disappearance.
He points out that epileptiform neuralgia is confined to no class,
age, or rank in life. Some of the sufferers are men and women of
the highest intellect and the strictest lives. Others have never
worked hard, except with their hands; and many have lived freely
as regards alcohol and the like. He states that the second
division is most often affected, rarely alone, but usually in associa¬
tion with the third division. In about 25 per cent, all three
divisions are more or less involved together. He points out, as
has been done by all others who have written on the subject, that
the disease is rarely of dental origin, and the extraction of healthy
teeth is a useless and barbarous method of treatment.

He has no suggestions to make as to the nature and pathology
of the disorder, but thinks that it is not improbable that it depends
on a true neuritis, but thinks, too, that there are good reasons for
3 F

794

ABSTRACTS

rejecting the theory that vascular degeneration is the causal
factor. He disposes of the medicinal treatment by pointing out
that only disappointment results from the prolonged administration
of drugs, and regards the right treatment as undoubtedly consist-
ting in operation when once the neuralgia is well established He
seems doubtful as to whether the major operation of ganglion
excision should be performed in the first instance, or only after the
failure of peripheral operations. In operating, he prefers the
patient flat on the back, and obviously in a good light The head
and shoulders may be raised to a half-sitting position, or the head
may be turned well to the side on a simple sand pillow, without
the shoulders being raised. He has tried both positions, and
prefers the latter, when a good overhead light is available. He
very wisely remarks that a Tight which enables you to see precisely
what you are doing is absolutely necessary. There must be no
“ plunging in the dark in the neighbourhood of the internal carotid
artery and the cavernous sinus.” Jordan-Lloyd prefers an osteo¬
plastic flap. He opens the skull by means of a gouge, thinking
that it has many advantages over every other instrument In
stripping off the dura from the base of the skull he uses the
finger, with its pulp towards the membrane, and takes as his guide
the meningeal artery leading to the foramen spinosum. He states
that it is necessary to tie and divide the middle meningeal artery
close to its exit from this foramen, but many surgeons who hare
had experience of this operation will not agree with this statement
He says that the ligature of this vessel is “ the most tricky part of
the operation, and oftentimes taxes the skill and ingenuity of the
operator to the utmost.” He thinks that removal of the anterior
half or more of the ganglion is followed by complete disappearance
of the symptoms for which the operation has been performed He
drains the wound with a small rubber tube, laid in its deepest
part, and brought to the surface through its hinder angle. He
stitches the flap with fine wire or silver wire sutures. He has
had no trouble from necrosis of the bone flap.

In his experience, shock after the operation has never been
serious, and has usually been absent altogether, and the relief of
the painful symptoms has always been immediate and complete.
He removes the drainage tube in forty-eight hours, and has been
struck by the easy recoveries which follow what appears to be so
severe and dangerous an operation. He then passes on to consider
the after consequences of the operation, but his observations differ
in no detail from those of other observers.

He has operated upon eleven cases without a death. All have
been cured of the neuralgic symptoms, and up to the present time
there have been no relapses. The length of time since the
operation has been as follows:—

ABSTRACTS

796

Six years and eight months;

Four years and ten months;

Two years and eleven months;

One year and eleven months;

One year and nine months;

One year and eight months;

Six months;

Four months;

And two others, quite recently.

The average stay in hospital has been a fraction less than twenty-
one days. Four of the cases had been submitted to previous
operations, one to three, one to two, and two to one operation.
The duration of the attacks ranged from two to twenty years,
giving an average of nearly nine years. Of the eleven cases, seven
were females and four males, and their ages were as follows
Three in the fourth decade;

Three in the fifth decade;

Four in the sixth decade;

One in the seventh decade.

The youngest female was forty-six years, and the eldest sixty-
seven ; the youngest male fifty-two, and the eldest seventy-three.
The right side was affected seven times and the left four. All
the males had right-sided lesions, whilst in the females three were
on the right and four on the left side.

Donald Armour.

EXTIRPATION OF THE GASSERIAN GANGLION. (Extirpation
(461) des Ganglion Gasseri) Krause, Deut. Gesell. /, Chir., April 10,
1901, 33.

In the writer’s experience recurrence of symptoms of neuralgia
has frequently occurred after intracranial resection of the two
branches of the fifth cranial nerve, and he considers that by the
radical operation of extirpation of the root of the fifth nerve and
the Gasserian ganglion, in which the risk is scarcely at all in¬
creased, a much more certain result is obtained. He had employed
this procedure in a series of twenty-seven cases. In one case there
was severe collapse, which interrupted the operation, which was
completed four days later, but with this exception the operation
was completed at one sitting. The patients were usually able to
get up on the tenth to the twelfth day, and treatment was dis¬
continued on the eighteenth to twentieth day. In two cases the
difficulty of the operation was considerably increased by thinning
and perforation of the dura mater, which made it necessary to
remove the ganglion in two pieces, but in spite of this he succeeded

796

ABSTRACTS

in removing the whole of the ganglion, with, however, only the
adjacent portion of the fifth nerve. The patient died nineteen
days later from influenzal pneumonia, and on section the perio¬
steum of the base of the skull was found to be abnormally thin.
The second patient in whom this accident occurred, died of col¬
lapse a few hours after the operation (resection of two branches of
the fifth nerve). He performed removal of the Gasserian ganglion
in a series of twenty-five cases, eighteen of women from 30 to 71, and
of seven men from 30 to 72. The right ganglion was removed in
twelve women and four men, the left in six women and three men.
In connection with the immediate results of the operation he
mentions that a delicate woman, who had suffered for years from
chronic nephritis, was collapsed for some hours afterwards. A
man of 72 died six days after in consequence of heart failure. In
this case he had refused to perform the operation on account c>f
the presence of arterial sclerosis and very irregular action of the
heart. Post-mortem the wound was found to be closed, and there
was no pathological change in its neighbourhood, but there was
extensive degeneration of the heart muscle and severe sclerosis.
In four patients, who died within a short time of the operation
from other complications, the wound was found to be healed on
post-mortem examination.

In one case the patient left her bed in eight days with the
wound healed, but death ensued four weeks later from choleste¬
atoma of the brain and its membranes. In no case was a septic
process found post-mortem, and the eye, ear and mouth, in spite
of their proximity to the wound, remained aseptic throughout
Cerebral abscess has sometimes occurred after several months, but
no brain abscess developed in any of the writer's cases, though in
two of them the bony plate became necrotic. In one of these
intracranial resection of the two branches of the fifth nerve was
performed in two sittings, on account of the weakness of the
patient; and in the other there was a considerable amount of
haemorrhage, which was accounted for by the fact that the patient
had been the subject of haemophilia. The necrosis manifested
itself by oedematous swelling of the cutaneous flaps and their
vicinity, especially of the lower eyelid. The wound was enlarged
on the tenth day, and further enlarged on the eleventh, and the
bony plate, which showed on its inner side a covering of fibro-
pus, was removed. The condition of the eye after operation is
important. In some cases, on account of previous peripheral
operations, the closing of the lids was rendered impossible by
facial paralysis. In one case there was complete lagophthalmus.
The Gasserian ganglion was extirpated on August 23, 1895, and
up to the present time, though protective measures only were
employed, the patient has never suffered from inflammation of

ABSTRACTS

797

the eye. In another case keratitis appeared three days after
operation, soon leading to hypopyon, with purulent affection of
the lachrymal sac. He was treated by atropin, lukewarm chloro¬
form water, and a protection bandage, and in spite of the loss of
the influence of the fifth nerve this hypopyo-keratitis subsided.
His investigations throughout proved that the eyes, in spite of
being deprived of the influence of the fifth nerve, recover from
hypopyo-keratitis. Trophic disturbance sometimes occurs. In
one case ulcers were formed twelve days after operation, with
swelling of the adjacent upper lip, which the patient had bitten
with her artificial teeth. The bitten portions were removed, and
in a few days the swelling disappeared. In another case there
was a loss of epithelium on the upper surface of the right side of
the tip of the tongue, with a somewhat more extensive one on the
inner side of the right lower lip. Boracic lotion was employed,
and the tongue healed in five days and the lower lip in nine.
Paralyses of the optic muscles were observed in five cases. In
one the abducens alone was paralysed, the paralysis disappearing
entirely in a few days. Total ophthalmoplegia occurred in a case
in which the operation occupied two and a half hours, owing to
severe haemorrhage. The pupil was only moderately enlarged,
but reacted neither to light nor accommodation. In ten days a
slight degree of functional power was restored in the abducens,
and the pupil had become rather smaller. The paralysis gradually
improved, but severe inflammation of the cornea occurred three
months later. Aphasic disturbances were observed in two cases,
and in one case there were severe brain symptoms, and in this
case there was an extravasation of blood in the right hemisphere.
As regards the results of extirpation, the writer states that none
of the patients whom he has operated upon by this method for
trigeminal neuralgia, however severe, and who are still living,
have up to the present time had a recurrence of symptoms.

Donald Armour.

REPORT OF THE CONGRESS OF ALIENISTS AND NEURO¬
LOGISTS OF FRENCH-SPEAKING COUNTRIES

Held at Lille, August 1906.

(i Continued .)

In his remarkable presidential address, Grasset attributed the
great success of this Congress to the fact that it was a collabora¬
tion of alienists and neurologists who as a rule tended to be

798

REPORT OF CONGRESS

ignorant of one another’s studies, these two branches in general
having been entirely separated, not only by the public, but also in
the eyes of the medical profession. Both study diseases of the
body, and the object of both is to thoroughly understand the
normal and morbid functioning of the nervous system, to safe-
guard society against a progressive invasion by people of abnormal
nervous system, and to cure, or at least to solace, those whose
nervous system is diseased.

This union is typified in the statues at the gate of the
Salp€tri&re of Pinel, who reformed the treatment of the innane,
and of Charcot, who roused enthusiasm for the study of nervous
diseases. Grasset accordingly devoted his remarks to developing
the reasons for which he believed in the unity of the science he
called human neuro-biology. They are three in number: (1) The
same object is studied; (2) the same methods are applied; and
(3) the same end is pursued.

1. Although from the definition of the word only psychic
diseases should be comprised in the study of psychiatry, yet the
psychic functions pertain just as much to the nervous system
as to those of motility and sensibility. Moreover, neurologists
encounter many psychic phenomena among their patients who
have not become insane. Of course Grasset made it clear that by
psychic he meant neither occult nor metaphysical phenomena, but
those merely into which enter thought and intelligence. These,
however, need not be conscious, as say Toulouse, Vaschide, and
Pi&ron. He cited Janet’s work on automatism as proving this.

He believes that, although not yet proved, the neurones which
preside over the very highest faculties, where one finds sensations,
memory, association of ideas, reasoning, and even decision, are not
the same as those ruling the phenomena of the inferior psychism,
such as are shown in dreams, distraction, hypnotism, somnambulic
crises, or in mediumistic trances; that with the latter the actor
plays his rfile or the reader reads his book, while at the same time
with the former he thinks of his fiancee or his financial affairs,
just as with these former neurones Archimedes solved his problem
without interfering with the automatic reaction of the neurones by
which he climbed out of his bath and maintained his equilibrium.

There is no need to enlarge upon “ language ” in this connec¬
tion ; and although Grasset does not go the length of Renauts,
who believes in the pyschic individuality of each cellule, yet it is
evident that psychic functions are too intimately mingled with
other nervous functions to permit of their legitimate separation.
Hence as regards their object, psychiatry and neurology are
indistinguishable.

2. As to their methods, there is no ground for the suspicion
expressed at the Congress of Paris in 1900 that neurologists would

REPORT OF CONGRESS

700

be prevented from thinking anatomically at these reunions; for,
as Gilbert Ballet well expressed it, “ to think anatomically is no
less familiar to psychiatrists.” No one who is abreast of the
anatomo-pathological work being done in the asylums could make
such a statement That they think physiologically upon occasion
is due less to themselves than to the occasion; and Grasset insists
upon the necessity of this manner of thought. As says Lepine, “ to
think anatomically in clinical neurology is superannuated ”; with
Huchard, “one must for the future think and act physiologically”;
and as Albert Robin puts it, “study the diseases of function.”
Of course he does not deny that an anatomical era was a necessary
stage in order to lay the foundation, but he shows that, as regards
the determination of the symptoms of a nervous disease, the
nature of the lesion is very insignificant as compared with its
localisation. No one now says that aphasia is a sign of cerebral
softening, amnesia or embarrassed speech a sign of diffuse meningo¬
encephalitis, paraplegia significative of Pott’s disease, or even that
dissociation of sensibility is pathognomonic of syringomyelia.

Nor should even these anatomical localities be regarded as the
clinical units of which we speak. We shall only escape erroneous
descriptions, or at least connotations, by describing the different
physiological apparatus which are the real organs, and by refrain¬
ing from referring the symptoms we find to the organs as described
by the anatomist. For instance, the tic of the “colporteur” is
meaningless when described in terms of the sterno-mastoid of one
side and the trapezius of the other, that is to say of different parts
of each spinal accessory nerve whose bond of union in the
particular case is the common head-turning centre which controls
them both. One occipital lobe presides, not over the other eye,
but over the function of seeing objects on the opposite side with
both eyes at the same time. The movements of lateral rotation
of the eyes are interpreted in the same way; for although
anatomists describe the two abducens nerves, each with its centre,
yet it is impossible for either of these to act without bringing into
action the opposite abducens. That is to say, the true oculo-motor
apparatus is not either the third or the sixth pair, but one right-
turning nerve and one left-turning nerve for the two eyes. The
physiologist and the clinician pre-suppose their existence; it is
for the anatomist to reveal them. Thus the physiological right
eye is formed by the right half of each eye, and vice versa. Even
the nerves of the anatomist are not physiological units. One
cannot voluntarily innervate the radial or sciatic nerve to the
exclusion of others; the true units are the articulo-motor nerves
and the segmeuto-sensitive nerve. Even the muscles are not
clinical unities. For instance, the scapula is raised by one part
of the trapezius, while lowered by the other; and the movements

800

REPORT OF CONGRESS

produced by the glutei do not correspond to their anatomical
names. But even these do not exist apart; they are merely the
terminal portions of the neuro-motor apparatus of motility. The
units are not in the muscle or the peripheral topography of the
nerves, nor even in the neurones of relays called by the anatomist
the real origin ; but they are seated in the functional centre, that
is the cortex cerebri

Brissaud has well said of the genio-glossus, “a muscle does
not exist: it is an assemblage of fibrils; it is the nerves which
determine its function.”

Thus, the spinal cord, medulla oblongata, cerebellum, pons
Varolii, and brain all disappear as practical entities. There is far
more correspondence between the pyramidal tract and the peri-
rolandic zone than between the anterior and posterior columns of
the spinal marrow. The real complement of the posterior columns
is in the cranium; the real lobes of the brain are not those separated
by the fissures, which are in reality bridges rather than ditches.

Following Claude Bernard, for whom the only science in
medicine was physiology, we should find in neuro-biology a science
of the living being, rather than of the cadaver; and we must cease
to study separately the diseases of the brain, those of the pons and
the cerebellum, those of the spinal cord, and study instead those
of the real organs, i.e. those of the apparatus sensitivo-motor, of the
apparatus of the psychism, that of orientation and equilibrium, of
vision, of hearing, of speech, of circulation, of trophicity, etc.

In each case one must analyse its function in the healthy body,
comprehend the abnormalities it shows, observe after death the
position of the lesion, and thus deduce the r61e of each part of the
nervous system. This method, the only truly fruitful one, is that
of both the psychiatrist and the neurologist, no matter upon which
part of the nervous system effort is concentrated.

3. The third correspondence of these two branches is their end:

(1) to cure, or at least to relieve, those with nervous diseases;

(2) to protect society against such patients; and (3) to advance
science. Thus, both use the same natural agents—water, mineral¬
ised or not; application of heat, etc.: electricity, mechano-therapy
—the same drugs, stimulants, tonics, anaesthetics, hypnotics, etc.;
their antidotes are directed against the same effects or causes; even
psycho-therapy is applied as much by neurologists as by alienists.

Again, the prophylaxis of nervous disease does not differ from
that of insanity. For example, bad heredity must be combated,
family and social surroundings must be rectified, the personal
factor producing neuroses must be regulated— e.g . education, over¬
work, the genital life, the moral habits, professional exigencies,
toxic infections; in this it is impossible to separate the alienist
and the neurologist.

REPORT OF CONGRESS

801

The practical need of their association is felt even by the
magistrates, who, in determination of responsibility, frequently
sununon both to confer upon the case of a criminal.

Finally, above all, for the better understanding of normal man,
each of these workers requires the other. This, after all, is the
chief end of medical science, and each practitioner should consider
himself primarily a student of human biology, for the sick often
teach us to understand the healthy. Philosophers who have
studied psychology in asylums for the insane have understood this,
and latterly have not neglected the precious data furnished by the
non-confmed “ demi-fous,” where they find, ready analysed, the
mechanism of emotion, memory, and association.

But there is another reason which alone suffices to bind firmly
together these now separated parts of the science. This is the
unity of each element which builds up the nervous system.
Although the doctrine of the neurone is no longer a purely
anatomical one, it yet remains as the physiological unit which
alone permits us to explain the phenomena which constitute
nervous activity. Does not the section of a nerve influence not
only its periphery, but also the proximal portion, and even the cell
from which it has grown ? Is not a “ simple ” reflex act almost
unheard of in practice ? For does not the whole neuronal chain
discharge as soon as any one of its constituents is stimulated?
Centripetal action involves centrifugal action, and the latter is
impossible without the former. The so-called psychic functions
are no exception to this rule, and are impossible without move¬
ments or their active inhibition, while these in turn influence the
psyche; so that it is well said, “ sometimes one cries because one
is sad, and sometimes one is sad because one cries.”

Nor are psychic influences confined to the moving of the
so-called “voluntary” muscular system. They influence the
secretions, the circulation, and even the trophicity, none of which
can be called voluntary.

Thus again is shown the impracticability of arbitrarily dividing
into neurology and psychiatry what are indissoluble complements
of the physio-pathology of the nervous system of man, or human
neuro-biology. Tom A. Williams.

{To be continued.)

802

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PH78I0L00T

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BOLOGNI&L Gliori cerebrals tuberose, subependimale in soggetto melanconico.
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CLINICAL NEUROLOGY AND PSYCHIATRY

GENERAL—

BAILEY. Diseases of the Nervous System resulting from Accident and Injury.
Sidney Appleton, London.

PURVES STEWART. The Diagnosis of Nervous Diseases. Edward Arnold,
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POSEY and SPILLER. The Eye and Nervous System. J. B. Lippinoott Co. 26s.
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n* Congrfes beige de Neurologic et de Psychiatrie, Bruxelles, aoOt 1906. Joum.
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MUSCLES—

ETTORE LEVI. Contribute olinioo alia conosoensa del Morbo di Erb-Goldflam.
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MAX KAUFFMANN. Stoffweohseluntersuohungen bei einem Fall von myas-
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804

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PEKIPIBKAL IVBBTBB-

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IPUU €•!»-

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Disseminated Sclerosis. —MARBURG. Die sogenannte akute multiple Sklerae.
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F. T. SIMPSON. A Case of WestphaTs Pseudoeclerods. New York Jded. Jour a..
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WILLIAM G. SPILLER. Syringomyelia, extending from the Sacral Region of
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DRAIN—

ANDRlfc L^RI. Le Cerveau s6nile. Le Bigot frhree, Lille, 1906.

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SIMON FLEXNER. Experimental Cerebro-spinal Meningitis and its Serum
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Tamoar.— RAYMOND. I. Un cas simple de tumeur ae l’enc6phale (Localisation
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ACEWEN. A Case of Cerebral Tumour, giving rise to Jacksonian Epilepsy,
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MAILLARD et M1LHIT. Un cas de tumour clrgbrale avec sommeil. LEn-
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805

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MENTAL DISEASES—

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EMIL AM BERG. Ear Affections and Mental Disturbances. Journ. Nerv. and
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CHARLES MERCIER. Agoraphobia—a Remedy. Lancet, Oct. 18,1906, p. 990.
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L1EFMANN und NETER Ueber Ruhr bei Irren. MUnek. mod. Woek., Okt 23,
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WERNER l>ie Versorgung der geisteakranken Verbrecher in Dalldorff. Fischer,
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EDWIN GOODALL. An Address on the Hospital Treatment of Curable Cases of
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ALCMMUftH—

DAVID FLECK. Inebriety and Mental Weakness. Brit Joum. Inebriety, Oct
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WEBER Aloobol and Old Age. Brit. Joum. Inebriety, Oct 1906, p. 87.
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ISADOR H. CORIAT. Mental States in the Subjects of Alooholic Neuritis.
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MOTT. Alcohol and Insanity. The Effects of Aloobol on the Body and Mind aa
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eUTULAL AMD FUMCTIOMAA DISEASES—

Epilepsy. —VOLLAND. Qebortssttfrungen und EpBepsie. Ally. Zeit.f. PtuckiaL,
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T. DIVINE. A Study of the Mortality from Convulsions in the “ Rickets
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STOWELL. One hundred and three Cases of Epilepsy. Med. Bee., Sept. 29,
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N. B. ROSS. A Note on Peculiar Attitudes in Epilepsy during Sleep. New York
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BARUK. Traitement de l’6pilepsie par les bromures et Hiypochloruration.
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Meiraitheala.—LE CLECH. De la neurasthenic grave d’origine osseuae. Des
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CESARE BIONDI. Sulla Sintomatologia e sulla Patogenesi della neurosi
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HUGH A. MACCALLUM. Gastric Neurasthenia. Brit. Med. Joum., Oct 20,
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BATUAUD. La neurasthenic gdnitale feminine. Maloine, Paris, 1906, 4 fra.
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ZORN. Zur Behandlung der Neurasthenia sexualis. Leipzig, 1906, M.—50.

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LEROY. La Responsabilit6 dee hystSriquee. Le Bigot frferes, Lille, 1906.
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NearalgU. — lAVY. Eseai sur lee nevralgies facialee. Thise. Rousset,
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SPECIAL SENSES AND CRANIAL NERVES—

WEYL. Ueber Nystagmus toxicus. Berlin. Min . Woch., Sept. 17 f p. 1245.

MAX LOWY. Ueber die Schmerzreaktion der Pupillen als ein differential*
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MISCELLANEOUS SYMPTOMS—

R. RICHARD, tiberblick liber den heutigen Stand der Frage naoh der Lokali-
sation in der Groashirnrinde und ihre Anwendung in der forensischen Praxis.
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PONTHIEU. Contribution a l’etude de la pseudo-paralysie rachitique. Thise.
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ESPOSITO. Amiotrofie da trauma nervoso periferioo (cont.). Manicomio ,
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C. K. MILLS and T. H. WEISENBURG. The Subdivision of the Representation
of Cutaneous and Muscular Sensibility and of Stereognosis in the Cerebral Cortex.
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DUPRAY. Section incomplete du nerf cubital avec lesions p&ralytiques et
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JOSEP FEIX. Ueber ein neues Verfahren zur Untersuchung des Patellar- und
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KRONIG. Ein einfacher Kunstgriff zur Erzeugung aes Kniephknomens. Berlin .
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BOTTEMER Le Reflexe crdmastArien chez lea hernieux et k la suite des cures
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CLAUDE et ROSE Etude graphioue du clonus dans les maladies organiquee et
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REISSERT. Beitrag zur Kenntnis der .Lidreflexe. Klin. Mon. /. Augenheilh.,

AND& SOLIRfeNE. Les complications nenreuses des appendicites. Thise.
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HERMANN SCHLES1NGER Ueber die paroxysmelle Tachykardie und ihre
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SOLLIER. La claudication intermittente de la moelle. Preset mid., oct 24,
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GUSTAV MUSKAT. Ueber das intermittierende Hinken. Zeii. f. ortkop&d.
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VOGT. Falle von familigrer Mikrokephalie AUq. Zeii. f. Psychiat., Bd. 63, H. 5.
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Aphasie. Prag. mid. Woch ., Sept. 20, p. 487.

PiERRE MARIE Revision de la question de l’aphasie : que faut-il penser des
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VARJOT et LECOMTE. Un cas de typhlolexia cong^nitale (c4cit4 congdnitale
verbale). Qaz. des H6p., oct. 3, p. 1479.

GUTZMA NN. Untersuchungen Uber die Grenzen der spraohliohen Perzeptionen.
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TREATMENT*—

L. F. BARKER. Some Experience with the 8impler Methods of Psychotherapy
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HUDOVEKNIG. Die Verwendbarkeit des Methylatroprmum bromatum bei
Erkrankungen des Nervensystems. Berlin. Min. Woch., Okt. 15, p. 1868.

* A number of references to papers on Treatment are included in the Bibliography under the
i ndMdoal Diseases.

808

BIBLIOGRAPHY

E. GROSSMANN. Die Behandlung der Ischia* mit perineuraler Kochsair-
infiltration. Wien. klin. Woch., Okt. 18, p. 1254.

LAPPONI. L’Hypnotisme et le Spiritisme. Etude m6dioo-critique. Perrin et
Cie, Pang, 1906, 3 fr. 60.

ZIMMERN. laments d'Electroth^rapie clinique. Masson et Cie, Paris, 1906.
SUDN1K. ifctude clinique de l’induenco de la aur6e de l'onde 61ectrique sur Les
effets moteurs et sensitifg. Ann. cTEUctrobiol. et de Radiol., sept 1906, p. 610.
W. W. GRAVES. The Problem of Localisation in Relation to Head Injuries.
Med. Rec., Sept. 29, p. 483.

MOSCHCO WITZ. The Surgical Treatment of Trigeminal Neuralgia. Med . Rec .,
Sept 29, p. 486.

HAYNES. Gunshot Wounds of the Spinal Cord. New York Med. Joum.. Sept.
29, p. 629.

SPILLER and FRAZIER. Cerebral Decompression. Palliative Operation in the
Treatment of Tumours of the Brain. Joum. of Am. Med. Assoc Sept. 22,
p. 923.

ALLEN STARR. The Present Status of Brain Surgery. Joum. of Am. Med.
Assoc. y Sept. 22, p. 926.

HENKING. Beitrag zur chirurgisohen Behandlung schwerer Occipital- und
Cervicalneur&lgien. St Petersburg, rued. Woch. % Sept. 7 (20), p. 391.

VULPIUS. Misserfolge der Sehnenuberpflanzung. Berlin, klin. WocA., Okt. 16,
p. 1359.

ALT. Ein Beitrag zur operativen Behandlung der otogenen Fazialis-l&hmung.
Wien. klin. Woch., Okt 25, p. 1285.

WEISENBURG. Advances in the Surgery of the Nervous System considered
from the Standpoint of the Neurologist New York Med. Joum.. Oct 13.
p. 732.

F. W. MURRAY. Early Operation in Traumatic Intracranial Hemorrhage.
Annals of Surgcnj , Sept '1906, p. 374.

SHERREN. Some Points in the Surgery of the Peripheral Nerves. Bdiu. Med.
Joum.y Oct, p. 297.

R. T. WILLIAMSON. Recent Successful Results of the Operative Treatment
for Spinal Tumours and Cysts. (Review.) Med. Chronicle , Oct, p. 23.

BOOKS AND PAMPHLETS RECEIVED.

Stewart, Purves. “ The Diagnosis of Nervous Diseases.” Edward Arnold,
London, 1906.

Clouston, T. S. “The Hygiene of Mind” Methuen & Co., London,
1906.

Zimmern, A. “Elements d’£lectroth4rapie Clinique.” Masson et Cie,
Paris, 1906.

Fiimrohn, Wilhelm. “ Die Rontgenstrahlen im Dienste der Neurologies
Karger, Berlin, 1906.

Stelzner, Helenefriederike. 44 Analyse von 200 Selbstmordfallen.”

Karger, Berlin, 1906.

Babes, Victor. 44 Atlas der pathologische Histologie des Nervensystems.”
August Hirschwald, Berlin, 1906.

Haskovec. “Revue v. Neurologii, Psychiatrii, fysikalni a diaeteticke
Therapii.” Prag, 1906.

Rentoul, Robert Reid. 44 Race Culture or Race Suicide.” Walter Scott
Publishing Co., Ltd., London, 1906.

IReview

WeurolOGE anb flbs^cbiatrs

A NOTE UPON TWO IMPORTANT POINTS IN THE
LOCALISATION OF TUMOURS OF THE FRONTAL
REGION OF THE BRAIN.

By T. GRAINGER STEWART, M.B. Ed., M.R.C.P. Lond.,

Assistant Physician to the Metropolitan Hospital, Pathologist to the Nationa
Hospital for the Paralysed and Epileptic.

Amongst the various localising signs presented by tumours of
the frontal lobes of the brain are two to which I would like to
draw special attention. The first is the absence, diminution, or
easy exhaustion of the superficial abdominal reflexes on the side
opposite to the tumour; the second is the occurrence of a fine,
Tapid vibratory tremor in the limbs of the same side as the
tumour.

Both these signs are often present in cases of frontal tumour,
and the diminution of the superficial abdominal reflexes is rarely
absent in any case in which the growth has attained such a
size as to give rise to the general symptoms of intracranial
neoplasm.

Loss or diminution of the superficial abdominal reflexes,
local causes being excluded, would appear to depend on some
affection of the pyramidal system. Such alteration of these
reflexes is seen on the hemiplegic side in cases of hemiplegia,
and on both sides in cases of spastic paraplegia, due to lesions
above the mid-dorsal region. This loss of the superficial
R. OF N. & P. VOL. IV. NO. 12—3 G

810

ORIGINAL ARTICLES

abdominal reflexes is usually associated with an increase in the
corresponding deep reflexes, and the presence of an extensor
plantar response. In cases of cerebral tumour the alteration of the
abdominal reflexes occurs before any change may be noted in the
deep reflexes, or in the plantar response, and has often been
observed to precede the other signs, reflex or motor, of hemiplegia.
It is therefore of value as a localising sign in all cases of cerebral
tumour; but in cases of tumour of the frontal region, where
focal symptoms are often late in appearing, it is of special
service. I have observed it as the first localising sign in several
cases of tumour of the frontal lobes, and I have never known it
to prove fallacious. In certain cases where the intracranial
tension is much increased, or where there is a growth in both
frontal lobes, the superficial abdominal reflexes may be absent on
both sides; but as a rule when this occurs an extensor plantar
response will be obtained on the side contra-lateral to the
tumour, so that any doubt as to the side of the lesion can be
dispelled.

The second sign—tremor in the limbs on the same side as
the tumour—may be observed in both the upper and lower
limbs, but it is more constant and better seen in the arm than in
the leg. It is absent during muscular rest, and is best brought
out by making the patient extend both arms horizontally in
front of him with the palms directed downwards and the fingers
extended. It will then be noticed that the homolateral arm and
hand are in a state of constant fine vibratory tremor in contrast
to the contralateral arm, in which such tremor is absent The
difference between the two hands can be better realised by
placing a palm lightly upon the back of each of the patient’s
hands. This tremor may not be constantly present in any one
ease, but in the great majority of cases of frontal tumour it will
be observed at one time or another. During the past four years
I have had the opportunity of studying at the National Hospital
for the Paralysed and Epileptic more than twenty cases of
tumour of the frontal lobes, and in all of these except two, in
which the patients’ condition prevented examination for this
point, it was present at one time or another. In five cases out
of twenty-two such tremor was observed on both sides, but in all
it was greater and more constant on the side of the tumour. Of
tnese five cases, in which bilateral tremor was observed, in two

TABLE

Side of Tumour.

No.

Nature of
Growth.

Motor Paresis.

Tremor. |

Reflexes.

Case. | Sides.

Face

alone.

Heml-

pareals.

Plantar.

Right

W. M.

right

left

gumma

tremor

.flexor

extensor

* Had occa¬
sional tremor on
left as well.

•Tremor after¬
wards only teen
on left.

•Tremor not
examined for.

* Tremor not
looked for.

* Both lobes
involved.

• Left lobe
more Involved
than right.

Right

A. 0.

right

left

gumma

slight

tremor

flexor

extensor

Right

T. J.

right

left

glioma

tremor

flexor
? flexor

Right

W. M.

right

left

blood cyst

slight

tremor

flexor

Right

C. T.

right

left

glioma

slight

tremor

flexor

Right

J. D.

right

left

carcinoma

marked

tremor

flexor

Right

W. M.

right

left

glioma

marked

slight

tremor

flexor

Right

right

left

glioma

marked

slight

tremor

flexor

Left

E B.

right

left

glioma

tremor

flexor ?
flexor

Left

H.B.

right

left

endothelioma

slight

tremor

flexor

Left

E. R.

right

left

endothelioma

slight

tremor

flexor

Left

E. J.

right

left

glioma

tremor

flexor

Left

E. P.

right

left

fibroma

slight

tremor

extensor

flexor

Left

J. M.

right

left

glioma

slight

N !

extensor

flexor

Left

W. Y.

right

loft

glioma

slight

j 0

' tremor

0 1
N |

extensor

flexor

Left

A. D.

glioma

marked

slight

tremor

1 flexor
flexor

Left

S. B.

S. H.

right

left

sarcoma

marked

marked I 0

0 | 0

0 1
N

extensor

flexor

Left

right

left

glioma

marked

tremor

? flexor
flexor

Both

J. H.

right

left

glioma

tremor

N <
N ?

flexor

Both

right

left

endothelioma

slight

tremor

? extensor
flexor

Abbreviations*. N = natural: 0»ab«ent; - = diminished; -{-»increased.

812

ORIGINAL ARTICLES

autopsy revealed the presence of tumours in both frontal lobes.
This tremor occurs quite independently of paresis of the other
(the contra-lateral) side, and there does not appear to be any
association between them. I have specially looked for similar
tremor in cases of tumour situated in other parts of the brain,
but have never observed it Various forms of tremor and
unsteadiness are not uncommonly met with in association with
cerebral neoplasms ; and although some of them approach the
type I have endeavoured to describe, yet as a rule they lack the
fine vibratory character.

The table shows the condition of the motor system and
reflexes in twenty cases of tumour or gross lesion of the
frontal lobes of the brain. In each instance, except in the two
cases in which tremor was not observed, the condition reported
is that which was found when the tremor was first observed.

These cases were all observed in the National Hospital for
the Paralysed and Epileptic, and I am indebted to the kindness
of the medical staff of the hospital for permission to make use
of them.

It will be seen from the Table that—

(1) Diminution or loss of the superficial abdominal

reflexes was observed on the contra-lateral side
in every case except one (19).

(2) The corresponding plantar reflexes were extensor in

7, doubtful in 4, and flexor in 9, of the 20 cases.

(3) Tremor was noted on the same (homolateral) side

as the tumour in 18 out of the 20 cases.

(4) That it was present on both sides in the 2 cases

(10 and 11) where the growth was limited to one
side, and that it was present on both sides in the
two cases where the growth was bilateral (19
and 20).

ORIGINAL ARTICLES

813

NOTE ON A CASE OF JUVENILE GENERAL PARALYSIS ;
ABSENCE OF STIGMATA OF CONGENITAL SYPHILIS
AND OF A FAMILY HISTORY INDICATIVE OF THAT
DISEASE; VERY PRONOUNCED CEREBRO SPINAL
LYMPHOCYTOSIS.

By EDWIN BRAMWELL, M.B., F.R.C.P.E., F.R.S.E., M.R.C.P. Lond.,
Assistant Physician to Leith Hospital

Since 1876, when the first recorded case of Juvenile General
Paralysis was described by Clouston, 1 a large number of instances
have been reported, while the existence of an important etiological
relationship between syphilis and these cases of general paralysis
occurring in early life has long been recognised. Thiry, for
example, obtained certain or extremely probable evidence of
syphilis, either congenital or acquired, in 43 of 67 cases which he
collected from the literature, while in only 10 of these cases
were there no indications suggestive of that disease. 2 Further, it
is to be remembered that syphilis cannot be absolutely excluded
in the absence of manifestations which might serve for its detec¬
tion, hence it is not improbable, as Thiry remarks, that the
disease may have been present even in some of those cases in
which no evidence of its existence was forthcoming.

The following case, for example, presented none of the
stigmata of congenital syphilis, while an inquiry into the family
history revealed no facts distinctly indicative of syphilis in the
parents; yet examination of the cerebro-spinal fluid showed a
very pronounced lymphocytosis, an observation which must be
regarded as pointing strongly to the syphilitic origin of the
nervous affection.

Record of Cask.

J. K., aged 15^, was seen in the out-patient department of Leith
Hospital on June 26th, 1906. His mother, who came with him, stated that
her son was very nervous and shaky, that his speech was indistinct and his
memory defective.

Previous Health .—The following history was obtained from the patient’s
1 Joum. of Meet. Science, Oct. 1877, p. 419.

* De la Paralytic girUralt progressive dans lajeune Age, p. 87. Paris, 1898.

814

ORIGINAL ARTICLES

mother, a particularly intelligent woman. J. K. was her first child, and was
bora at full time after a comparatively easy labour which did not necessitate
the use of instruments. The patient appeared to be a perfectly healthy child
at birth, and, so far as can be ascertained, did not subsequently suffer from
snuffles, nor was any skin rash noticed. He was breast fed up to the age of
six months. As far as his mother remembers, he cut his first teeth at about
the usual time, and began to walk when he was 16 months old. Although he
was a little backward in beginning to talk, he commenced all of a sudden to
speak correctly without having passed through the stage of baby language, so
that by the time he was two years old he was talking as well as most children
of that age. Measles, followed by bronchitis, when he was between 3 and 4
years old, and scarlet fever seven years later, which appears to have run a
normal course, were the only illnesses from which he had suffered. He went
to school when 5 years of age and remained there until he was 14. He was
always rather backward for his age, and when he left he was only in the
fourth standard.

Present Illness .— The present illness dated from February 1905 (sixteen
months previous to examination), when he was knocked over by a runaway
horse. He was said to have injured his right knee, and to have been
unable to walk in consequence for five weeks, during most of which time
he was confined to bed. There was no evidence to suggest that his head
received any direct injury as a result of the accident. The patient, his
mother stated, had received a considerable 44 nervous shock,” and soon after
the accident he lost his speech for some days. Ever since that time he
had spoken indistinctly. A few weeks after the accident he was observed to
be shaky, while about the same time his memory was noticed to be impaired.
These symptoms seemed to have developed gradually, so that it w-as impossible
to fix any definite date for their onset. His mother stated, however, most em¬
phatically, upon cross-examination, that none of these symptoms were present
before the accident, but that they began to develop almost immediately
after. On two occasions soon after the accident he is said to have
fallen out of bed in what appeared to be a fit. He was uncon¬
scious for a few minutes, but does not seem to have been con¬
vulsed. In April 1906, he had an attack in which for a few minutes he
lost consciousness, and became stiff all over, while his face was very blue.
During the two or three months which immediately preceded our exa¬
mination his condition had been becoming worse. He had been very
irritable and easily upeet, though easily managed. When sent a message
he often forgot what he had been sent for. He was in the habit of
wandering about collecting small pieces of wood, nails, and other odds
and ends with which he filled his pockets. He was rather particular about
his clothes, more so than formerly. He was very careful about his money,
putting every penny he received into a money-box which he carried about
with him and liked to rattle, and nothing would induce him to spend a
penny.

State upon Examination .—The patient’s somewhat stupid, staring, and at
the same time scared expression, at once attracted attention. There was veiy
slight double ptosis and marked wrinkling of the forehead (frontal over-

ORIGINAL ARTICLES

815

action). He was somewhat poorly developed for his age, though not ill-
nourished. There were no distinct stigmata of degeneracy, nor were
there any signs of congenital syphilis. The nose was well formed, the
forehead was not unduly prominent, the cornea of both eyes was quite
clear; there were no scars about the mouth, and the teeth presented none
of the characteristics described by Mr Jonathan Hutchinson. The genitalia
were poorly developed, and there was no trace of pubic or axillary hair.

When spoken to his face showed no expression of responsive intelligence,
and he turned to his mother as if expecting her to answer for him. His
manner was childish, and he was unduly emotional. Although not word-
deaf the patient obviously took a long time to grasp the meaning of a
question. On being told to open his eyes widely he opened his mouth,
and it took a few minutes before he could be made to realise that this
was not what was required of him. He remembered the number of the
house and the name of the street in which he lived, but when questioned as
to the number, names, and ages of the boys who were in his class at school?
his feeble memory was at once apparent. His mother stated that he could
find his way about the streets quite well.

When he spoke there was a great deal of tremor of the face, both of the
lips and eyelids ; his voice was rather high-pitched and monotonous, and his
articulation indistinct and slurring. For hippopotamus, for instance, he said
“hip-popoto-potopos,” while West Register Street was pronounced “Wesh
Regissherr Shhreeshh.” His writing was very tremulous, although when asked
to write his name he spelt it correctly.

Vision seemed to be good, for the patient was able to make out small type,
though when asked to read a simple sentence he did so in such a way as to
leave the impression that it conveyed no meaning to him. The exact acuity of
vision was not tested either with Snellen or Jaeger types. The optic discs
presented a healthy appearance, an observation which was confirmed by Dr
Sinclair, who noted also the absence of any choroiditis.

A watch was heard at several inches from either ear.

As regards the eye muscles, a very slight degree of double ptosis was present,
and associated with this was marked frontal overaction. There was no squint.
The ocular movements, with the exception of convergence, which was not
satisfactory, were unimpaired, and there was no nystagmus.

The pupils were somewhat large and equal (measuring about 6 mm.); they
were regular in outline, were quite immobile to light, and only contracted
very slightly on accommodation. As already mentioned, convergence was
extremely defective.

With the exception of the unsteadiness of the face, which has already been
referred to, nothing abnormal was detected in connection with the other
cranial nerves, excepting for the fact that the tongue was extremely tremulous.

The grasp was rather poor but equal. Both hands were extremely tremu¬
lous, the right rather more so than the left. His mother stated that he was
unable to feed himself with the right hand on account of the shakiness.
When he closed the eyes he missed the tip of the nose by an inch or two with
the right forefinger, whereas with the left he performed this test fairly
accurately. No definite weakness of any group of muscles in either lower

816

ORIGINAL ARTICLES

limb or trank vu detected. He walked somewhat unsteadily in rather a
shuffling manner and with short steps. There was no Rombergism.

The knee- and ankle-jerks were brisk and equal. There was no ankle
clonus. The right plantar reflex was distinctly of the flexor type, while that
on the left aide was noted as “ indeterminate.” No anmethesia or analgesia
was detected. The calf muscles were not analgetic.

There was no defect of micturition so far as could be ascertained.

The heart was not enlarged, the sounds were closed in all the areas, and
the pulse was regular.

The bowels were regular.

The urine contained neither albumin nor sugar.

On lumbar puncture there was no evidence of increased pressure. The
fluid obtained was perfectly clear. A cytological examination showed on two
separate occasions the presence of a very marked lymphocytosis, 180 to ISO
lymphocytes being present in many fields under a magnification of 400
diameters.

Family History .—The patient’s father has been an alcoholic for many
years, and was drinking heavily about the time of patient’s conception. No
history of syphilis was obtained from the mother. The parents, who were
not blood relations, had had five children, of whom two were alive. The
patient was the eldest. Then followed two children who both died at three
months of diarrhoea and vomiting. The next child, who was aged eleven
years, presented on examination no signs of congenital syphilis. The last
child died when three weeks old of diarrhoea and vomiting. There had been
no miscarriages.

It is unnecessary to comment further on the case. The
diagnosis, as will be seen from the above record, was obvious.
Again there was no evidence of syphilis either congenital or
acquired, while lastly the cerebro-spinal fluid obtained by lumbar
puncture showed an excessive lymphocytosis. An additional
point of interest in the case was the circumstance that an
accident had immediately preceded the first symptoms of the
disease which were observed. It is also worthy of note that
the patient’s father was an alcoholic subject, and was drinking
heavily about the time at which conception took place.

ABSTRACTS

817

abstracts

PHYSIOLOGY.

THE FUNCTIONS OF THE CAUDATE NUCLEUS. (Le fonsiom
(452) del nucleo caudato.) G. Pagano, Riv. di Patel, nervosa e
mentale, July 1906, p. 289.

In this paper Pagano gives an account of experimental researches
on the functions of certain sub-cortical and medullary centres,
by his own method of local injections of curara into their
substance. Previous observers, in order to study the functions of
the sub-cortical nuclei, have hitherto been compelled to remove
the superjacent cortex, thereby introducing grave sources of error.
Since stimulation of mutilated brains is bound to lead to incom¬
plete and often erroneous conclusions, Pagano operated on un¬
mutilated animals, setting them at liberty immediately after the
injection of the stimulating substance into the basal ganglia. By
such local stimulation, the normal relations of the parts being
undisturbed, it is possible to observe the effects of local exaggera¬
tion of function. The animals he employed were dogs. No
anaesthetic or narcotic was employed. A flap being reflected from
the scalp, a trephine-hole was rapidly made in the skull in the
region of the post-crucial sulcus of the cerebrum. Then, with a
fine needle, a few drops of a 2% solution of curara were gently
injected, mixed with a small quantity of thionin-blue, in order that
the exact site of injection might afterwards be verified anatomically.
There was no tendency for the fluid to leak through the injection
track if care was taken to wait a few seconds before withdrawing
the needle. The sutures of the scalp wound were rapidly tied
and the animal was at once set at liberty. Pagano gives full
protocols of seven such experiments, and his main conclusions are
as follows:—

1. Excitation of the anterior third (except its extreme tip),
and of the middle third of the head of the caudate nucleus, especi¬
ally in the inner half, produces in dogs an emotional picture having
all the characters of fear, the posture of the body, the play of the
facial muscles, the cardiac, respiratory, intestinal, and vesical signs,
the state of the pupils, the influence of threatening gestures and
especially of sounds, all producing a striking picture.

2. Excitation of the same points, but especially of the middle
third of the head of the caudate nucleus, produces priapism,
occurring immediately after the injection and sometimes persisting
till the animal's death several hours later.

818

ABSTRACTS

3. Excitation of the extreme anterior end of the caudate nucleus
produces a picture of psycho-motor agitation which preserves all the
characters of fear but in addition shows the phenomena of anger.

4. Excitation of the posterior third of the caudate nucleus
produces a complex of phenomena which correspond to those of
anger, especially evident in the facial expression.

5. Excitation of the outer part of the anterior third of the
caudate nucleus produces, besides emotional phenomena, intestinal
and vesical phenomena more marked than those produced from
excitation of other parts of the nucleus.

The above results would tend to show that the caudate nucleus
has a higher physiological significance than has hitherto been
suspected. Pagano emphatically states that the foregoing pheno¬
mena only occur when the irritant is applied directly to the
caudate nucleus itself. If the nucleus be not reached, and the
injection falls on surrounding parts, the above-described pheno¬
mena are not produced. Moreover, if the motor cortex l>e extir¬
pated and time be allowed for degeneration of the pyramidal fibres
to occur, excitation of the caudate nucleus still produces the same
phenomena. He therefore holds that there can be no question of
indirect excitation through the cortex.

Nor can the phenomena be ascribed to diffusion of the fluid from
the caudate nucleus into the lateral or third ventricle. In several
instances he made the injection through the temporal lobe, whereby
the needle avoided altogether the region of the ventricle, yet the
same emotional phenomena resulted. Further, he injected the
fluid in several instances into the lateral ventricle without injuring
the caudate nucleus, but never produced either the emotional
phenomena or the priapism. On the contrary, there were spastic
tremors of the limbs with cardiac and respiratory phenomena,
causing death in about an hour and a half from respiratory exhaus¬
tion. Pagano maintains that the emotional phenomena and the
priapism are directly due to stimulation of the caudate nucleus, and
that there exist in this nucleus centres for the expression of
emotions, and also for the innervation of those vegetative organs
whose activity generally accompanies emotions. He recalls the
observations of other workers, notably those of Ferrier and of
Bechterew, who obtained emotional phenomena by excitation of
the optic thalami and corpora quadrigemina. Bechterew in par¬
ticular considers the optic thalamus a reflex centre for emotional
expression. Pagano has also experimented on the optic thalamus
by his own method of curara injections, and quotes protocols of
two such observations, showing that the emotional phenomena
differed entirely from those resulting from lesions of the caudate
nucleus; there were no phenomena of fear or of anger, the dog
growled and howled in a plaintive fashion, and epileptiform attacks

ABSTRACTS

819

soon appeared, increasing in frequency until the animal’s death.
Pagano considers that the optic thalamus is closely associated with
the visual function. Finally he directs special attention to the
constancy with which erection of the penis is produced by excita¬
tion of a certain limited part of the caudate nucleus.

Pueves Stewabt.

THE SUBDIVISION OF THE REPRESENTATION OF CUTANEOUS
(453) AND MUSCULAR SENSIBILITY AND OF STERE0GN08I8
IN THE CEREBRAL CORTEZ. Mills and Weisenburq,
Joum. of Nerv. and Merit. Dis., Oct 1906, p. 617.

The main object of this paper is to present the following proposi¬
tions : (1) that the cortical representation of cutaneous and muscular
sensibility is independent of motor representation; that it surrounds
the motor zone; and that it is subdivided into a mosaic of centres,
each centre or group of centres being anatomically and functionally
correlated to a motor centre or centres; (2) that every muscle or
group of muscles producing a movement or movements which are
represented by separate centres in the cortex is topographically
related to a segment of the skin which has also a definite cortical
centre, this centre being correlated anatomically and functionally
with the motor centre; (3) that stereognostic representation, like
that of cutaneous and muscular sensibility and of movements, has
also its independent cortical area, and is subdivided after the
manner of the motor and sensory areas. In other words, the areas
of representation of movements and of sensibility and of stereognosis
are separate, and are subdivided into sub-areas and centres.

Evidence for these views is chiefly clinical and pathological.
Apart from many well-known instances of motor and sensory sub-
divisional localisation, the authors direct attention to cases (nine
are briefly abstracted) where there were limitations of anaesthesia
and astereognosis not only to the upper extremity, but to limited
portions of this limb, and especially to the hand and certain of the
fingers. The impairments of sensation present were in several
instances more or less dissociated, certain forms of impairment
being present, and others not, or different forms showing them¬
selves in different parts. It is interesting to note that in four of
the nine cases the impairment and disturbance of sensation were
greater in the fingers towards the ulnar side of the hand, this show¬
ing itself sometimes in two and sometimes in three fingers. The
authors add four more cases, studied in detail by themselves. These
were all cases of cortical disease, and the facts were elicited that
the touch and pain senses were more disturbed distally than proxi-
mally in the fingers and hand; that they were more disturbed

820

ABSTRACTS

(three cases) on the dorsal than on the palmar surface, and that
astereognosis (three cases) was more persistent and decided in the
middle, ring, and small fingers, and the ulnar portions of the hand.
In one case, when the hand and forearm were totally relaxed, the
patient had not the sensation of position and movement when the
fingers were extended, although he recognised position and move¬
ment when the fingers were flexed.

Reference is made to a paper by Russel and Horsley on the
representation in the cerebral cortex of the type of sensoiy repre¬
sentation as it exists in the spinal cord {Brain, April 1906), and
their view that astereognosis is represented all over the motor
cortex is combated. S. A. K. Wilson.

ON THE REPRODUCTION OF NERVE CELLS. (Sur la reproduction
(464) des cellules nerveuses.) Carmelo Ciaccio, Rev. Neurol., Oct.

15, 1906, p. 876.

This question of reproduction of nerve cells is a much debated
one, but most authors hold that once beyond the neuroblast
stage, there is no reproduction on the part of the nerve cells.
After lesions, however, karyokinesis has been noted in various
nerve cells, but it seems never to go on to complete cell division,
and may very probably only be a degeneration of the nucleus.

The author has previously recorded formation of new cells in
the sympathetic system, and in the present paper records a con¬
firmation of his results in the examination of cell reproduction in
the brain of the mouse.

The process he describes is as follows:—Certain cells which
occur chiefly in the outermost and innermost layers of the cortex,
with large oval nuclei and very little protoplasm, are embryonic
in type, and their role is to form new nerve cells. Unsymmetri-
cal amitotic division of the nucleus occurs; complete splitting of
the cell into daughter cells rarely occurs; but one of the secondary
nuclei becomes the nucleus of a future nerve cell, while the others
undergo degenerative processes, and form the cytoplasm. Exactly
how they form Nissl granules and neurofibrils has not been
demonstrated, but some become hypochromatic and others
hyperchromatic.

He holds that he has demonstrated nerve-cell reproduction in
the adult in a manner analogous to that described by Fragnito and
others in the embryo. Cajal discredits this plurinuclear origin of
nerve cells, saying the secondary nuclei are vacuoles wrongly
interpreted, but the author thinks errors of interpretation are much
more likely to be made with the reduced silver method than with
staining by hsematein and nuclear stains.

J. H. Harvey Pibik.

ABSTRACTS

821

the movement of birds after section OF THE POS-

(455) TERIOR SPINAL ROOTS. (Uber die Bewegnng der Vtigel
nach Dnrchschneidnng hinterer Rdckenmarkswurzeln.) Tren¬
delenburg, Arehiv. f. Anatomie u. Physiologic, Phys. Abteilung,
1906, H. 1, 2, p. 1.

After unilateral section of the posterior nerve roots coming from
the wing, no difference is to be observed in the position in which the
wings are held when the bird is standing or walking. The wing
reflexes which are called into action when the position of the bird
is suddenly changed are brisker on the side of the operation, and
wider in range at the beginning; and they can be elicited by
stimuli which are not followed by any response on the normal
side. Resistance to passive spreading of the wing is absent.
Flying is possible, and if the bird is let fall, it uses both wings
to correct itself.

After bilateral section of the same roots the position of the
win^s when at rest is still normal. No attempt is made to correct
unusual attitudes into which they are passively put. Rising from
a sitting or lying position is difficult, and the bird is quite unable
to fly. If it is allowed to fall there is no attempt on the part of
the wings to save it, nor if it is held up by the wings or the tail.

The condition of the wing reflexes indicates that section of the
posterior roots removes a normally present inhibitory action in
the wing area. When the section is unilateral, bilateral move¬
ments of the wings remain normal.

If the posterior roots from one leg are divided the bird cannot
walk or stand at first, but after a time it learns to walk, although
on the operated side the leg is lifted too high, the stride is length¬
ened, and the rhythm of gait is therefore altered. If the section is
bilateral the bird is quite unable to stand, and sits with its feet
spread out in front.

Evidently after bilateral section of the posterior roots from the
limbs, sensory stimuli do not reach higher centres, and after
unilateral section there is no compensatory innervation from the
opposite side, as in the case of the wings. The overaction of the
affected leg is due to the removal of normal reflex inhibitory
influences exercised on muscular action viA the posterior roots, as
well as vid central paths.

If, in addition to the operation on leg roots, the labyrinth is
unilaterally or bilaterally extirpated, compensation becomes im¬
possible. Vision exercises no influence over the resulting ataxia.
Apparently the condition of tone of the wings does not depend on
cerebral influence, for after removal of the cerebrum no alteration
is observable; further, the decerebrate pigeon can attempt to
execute movements of compensation when its posterior roots from
the legs have been divided. S. A K. Wilson.

822

ABSTRACTS

PSYCHOLOGY.

THE SCIENTIFIC INVESTIGATION OF THE PSYCHICAL FACUL-
(456) TIES OH PROCESSES IN THE HIGHER ANIMALS. By

Ivan Pbtrovitch Pawlow, M.D., Professor of Physiology,

University of St Petersburg, Lancet , October 6, 1906, p.

911.

In the Huxley Lecture delivered at Charing Cross Hospital on
October 1st, Professor Pawlow gives a summary of the conclusions
already published with respect to “conditioned” reflexes, and an
account of work in the same direction recently done in his labora¬
tory. The subjects of the experiments were dogs in normal
condition, and the reflex specially studied was the action of the
salivary glands.

A reflex action is a specific response invariably given to a
specific stimulus; a “ conditioned ” reflex is a specific response
which sometimes, but not invariably, follows a specific stimulus.
The problem is to discover the laws which determine the response
or failure of response in the case of a conditioned reflex. To
illustrate: when food is placed in the mouth of a dog the excretion
of saliva invariably follows—this is a reflex action; when food is
shown to a dog, the excretion of saliva sometimes takes place and
sometimes does not—this is a conditioned reflex.

These two classes of action manifestly resemble one another
closely; in both we have primary stimulation of the centripetal
paths and secondary stimulation of the centrifugal paths, with in
both cases the intervention of the central nervous system. The
difference lies in the mode of this intervention, and this difference
has up till now been considered so great as to justify the assignation
of only the one set of actions to physiology, while the other is
reserved for psychology. Professor Pawlow’s endeavour is to
break down this division-wall and to restore to physiology what,
in his opinion, properly belongs to her.

Certain facts which have been ascertained with regard to these
conditioned reflexes have been already published. The chief of
these are:—Every conditioned stimulus becomes ineffective on
repetition, and the shorter the interval between the repetitions the
more quickly is the reflex obliterated. Spontaneous restoration
takes place only after the lapse of one or two or more hours. If a
conditioned stimulus is employed for a somewhat long time—days
or weeks successively—it loses its power altogether; for example,
if a certain kind of food is shown to a dog without being given him
to eat, his salivary glands in time cease to become active at the
sight. Any conditioned stimulus which has been rendered impo-

ABSTRACTS

823

tent may be restored at once by being made to act along with the
unconditioned stimulus.

From these facts it was natural to suppose that the conditioned
reflexes arose from their stimuli being constantly associated with
the stimuli producing unconditioned reflexes. The next step
obviously was to try whether conditioned reflexes could be manu¬
factured. This attempt was crowned with success. It was found
that any stimulus whatever—such as heat, cold, or rubbing applied
to the skin, the ringing of a bell, the sight of an electric light—
could be transformed into a stimulus bringing about excretion
from the salivary glands. The method was simply to let these
stimuli act invariably for a certain number of times along with
the unconditioned stimulus—the placing of something in the
dog’s mouth. The artificial reflexes thus manufactured showed
exactly the same characteristics as the natural ones.

It thus appears that stimuli which always synchronise with
stimuli which give notice of events of importance to the organism
become themselves “ signalling stimuli,” and themselves bring
about the necessary adjustment; and the fact that they cease to
act when they no longer regularly accompany the unconditioned
stimulus is further evidence of the marvellous delicacy of re¬
action which characterises the organism in its relation to its
environment.

The time required to establish conditioned reflexes was next
investigated, and it was found that this bore some relation to the
strength of the stimulus. Thus a temperature of 0‘ or 1° C.
would give a reaction by itself after it had been made to accom¬
pany the unconditioned reflex twenty or thirty times; whereas
a temperature of 4° or 5° 0. gave no reaction after a hundred
repetitions. The same thing happened with respect to 50° and
45* C. respectively.

The attempt was next made to find out the elements of a
stimulus, or, in other words, to discover what amount of differen¬
tiation the nervous system of a dog is capable of. It was found
that if the application of cold to a definite area of the skin has
been made to act as a conditioned stimulus, then the application
of cold to another region of the skin causes secretion of saliva on
the very first occasion. Hence the stimulus of cold generalises
itself over a considerable portion, perhaps even over the whole,
of the skin. The same is true of heat, but not of mechanical
stimulation. Great delicacy of analysis is manifested with
respect to musical sounds; notes which differ by as little as
a quarter of a tone from the note which has been established as
a conditioned stimulus will sometimes fail to give a reaction.

Experiments were also framed with a view to testing for traces
or latent remnants of both conditioned and unconditioned stimuli.

824

ABSTRACTS

Thus a conditioned stimulus was allowed to act one minute or
even two ininntes before the application of the conditioned
stimulus. Conversely, it was not brought into action until the
unconditioned reflex was at an end. In all these cases the artificial
reflex was developed. Indeed, in the case where the conditioned
stimulus acted first, and was separated from the unconditioned one
by an interval of two minutes, an unusually copious excretion of
saliva took place.

The far-reaching importance of these discoveries is obvious.
The bringing of these conditioned reflexes into the domain of law
is undoubtedly a definite step towards that mechanisation of the
central nervous system which every physiologist, as such, is bound
to presuppose. Professor Pawlow rejoices openly in the fact that
by these researches he removes a whole field of investigation from
the baneful influence of psychology. The answers to the questions
which he propounds to nature are delivered objectively ; no trans¬
ference of feelings distinctively human to the animal is possible:
the results are all amenable to the laws of quantity, and the
method is thus evidently in accord with the demands of the most
exact science.

The tendency of the investigation is summed up in the following
remarkable sentence:—

“ Men will possess incalculable advantages and an extraordinary
power over themselves when scientific investigators will subject;
other men to the same external analysis as they would employ for
any natural object, and when the human mind will contemplate
itself, not from within, but from the outside.”

We may, however, perhaps be allowed to remark that in this
contemplation from the outside the whole meaning of the drama
of human life is missed. The play of atoms and molecules in the
human brain is a purely hypothetical construction of science ; the
whole reality of the universe is in the inner world of emotion,
cognition, and conation. Nevertheless every true psychologist
will be grateful for the light which these studies of Professor
Pawlow throw on the outskirts of his subject, and when the
further results which the Professor foresees are given to the
world, he will be prepared to work them into correlation with his
own conclusions derived from a direct study of the laws of
consciousness. Margaret Drummond.

ABSTRACTS

825

PATHOLOGY.

COLLATERAL REGENERATION BY NERVE FIBRILS WITH
(457) CLUB-LIKE TERMINALS IN PATHOLOGICAL AND
NORMAL CONDITIONS; TABETIC LESIONS OF SPINAL
R00T8. (R4g6n6ration collaterals do fibres nerveuses
termin&s par des massnes de croissance, & l’6tat pathologique
et k l’etat normal; ldsions taWtiques des radnes m&iullaires.)
J. Nagbotte, Nouv. Icon, de la SalpUrikre, No. 3, 1906, p. 217.

The author draws attention to two special changes which can be
demonstrated by Ramon y Cajal’s new ammonia-alcohol and
reduced silver method, in the root fibres and in the ganglia of the
posterior roots and their processes in the course of tabes. (1) In
tabes there is moniliform swelling of the axis-cylinders. This
change affects the fibres of the posterior roots from the bifurcation
of the axone near the ganglia as far inwards as the posterior
columns. It involves the large and medium-sized fibres, but
spares certain very fine fibres which probably pre-exist in the root
and become more evident owing to the degeneration of the other
larger fibres. In the anterior roots this moniliform swelling is
found at the level of and below the foci of interstitial neuritis
which Nageotte has described in tabes, but not between this and
the cord. (2) The author has demonstrated that in tabes the
cells of the spinal ganglia and their axones give origin to fine
fi brill®. These fibrill® are exceedingly numerous in advanced
tabes, and they are evidently compensatory to the destruction of
old root fibres. They rise either from the cell body or from
the portion of its axone contained within the peri-cellular capsule,
or lastly from the extra-capsular portion of the nerve fibres.
Those which arise from the cell body frequently remain included
by the peri-cellular capsule. Those which arise from the axis-
cylinder processes of the cells bud off in the manner of colla¬
terals. In advanced tabes these new-formed fibrils frequently
ramify greatly. The fibrils which arise from the cell body and
from the fibrils within the capsule for a time ramify within its
capsule. Eventually they may perforate this, and with the club¬
like processes in which they terminate, they tend to pass from
the ganglion towards the nerve root. In their passage they
undergo numerous tortuosities and ramifications. They all tend
to agree in the presence of rounded or oval, more or less regular
balls, but their most remarkable characteristic is the presence of
a terminal club-like mass contained in a nucleated capsule.
These appear to represent the cones of growth of the embryonic
3 H

826

ABSTRACTS

period of development. The masses vary considerably in shape.
They never show the presence of neuro-fibrillae. They all have
a peculiar tendency to be directed towards the cord. In
incipient tabes they accumulate at the superior pole of the
ganglion. Others pass into the posterior root, but none of them
succeed in crossing any focus of interstitial neuritis, and none
have been traced so far as the posterior columns.

In the grey matter of the cord Nageotte has also traced some¬
what similar club-shaped processes along the anterior margin of
the anterior cornu, and also along the internal margin of the
posterior cornu. The clubs in this instance, however, differ
from tiiose of the fibrils arising from the posterior root ganglia
in the absence of a nucleated capsule.

Nageotte is of opinion that these fibres terminated in clnbs
are due to regeneration for the purpose of replacing destroyed
root fibres. He does not think it probable that the regenera¬
tion is sufficient to restore lost function. He employs the
term collateral regeneration because the new fibres develop after
the manner of collaterals from parts of the neurone nearest the
vital centre, and to distinguish the process from that of terminal
regeneration, which is found in divided nerves. It is probably not
limited to tabes, and is merely an exaggeration of processes which
go on in healthy nervous systems.

The paper is illustrated by a series of beautiful illustrations
of the author’s microscopical preparations.

Alexander Bruce.

EXPERIMENTAL OEREBRO - SPINAL MENINGITIS AND ITS
(458) SERUM TREATMENT. Simon Flexner, Brit. Med. Jour*.,
Oct. 20, 1906, p. 1023.

As tested upon laboratory animals, the Diplococcus intraceliularis
of Weichselbaum is a micro-organism of low and variable patho¬
genicity. Freshly isolated cultures are usually pathogenic for
small guinea-pigs, whereas cultures grown for a period on artificial
media are not. Active cultures injected into the peritoneal cavity
of guinea-pigs often cause death in eight to ten hours; the a nimals
may, however, die in four hours or survive thirty-six hours.

In cases of rapid death from virulent cocci the exudate shows
large, often prodigious, numbers of cocci. The appearances are
indicative not only of preservation of the injected cocci, but are
suggestive of their multiplication. The virulence of the cocci is
proportionate to their resistance to destruction. A relatively
non-virulent strain of the coccus may still be toxic, but has little

ABSTRACTS

827

or no capacity bo resist disintegration, and none for multiplication
in the peritoneum. The peritoneal exudate, after having been
freed from cells by centrifugalisation, still possesses a high diges¬
tive power for cocci, and the exudate, after having been heated
to 58° C. for 30 minutes, has the same digestive power as before on
fresh cultures, and on those heated to 65° C. It therefore appears
that although a measure of the reaction of the guinea-pig is found
in the emigration of leucocytes, the disappearance of cocci from
the peritoneal cavity does not depend wholly upon phagocytosis,
for it Beems probable that the removal of the cocci may be effected
by their self-digestion and by the digestive action of the inflamma¬
tory exudate.

In monkeys, intraspinal injection of cultures produces either
an acutely fatal leptomeningitis or an acute disease from which
recovery usually takes place in three or four days. Monkeys
which survive beyond the second day after inoculation tend rather
to recover than to die. The early disappearance of the cocci from
the spinal canal, early emigration of leucocytes, active phagocy¬
tosis and dissolution of the cocci both within and without leucocytes
are favourable signs; yet the monkey may succumb although cocci
cannot be found in smears nor obtained in cultures from the
inflamed membranes.

A large dose of an active culture is required to cause marked
symptoms in monkeys or to bring about their death from menin¬
gitis, and the author believes that in many of the experiments
no multiplication of the cocci took place.

In monkeys the inflammatory exudate was found chiefly in the
spinal meninges and the meninges at the base of the brain, but the
inflammation was also found to extend into the ethmoidal sinuses
and probably into the nose. Attempts to isolate the cocci from
the nose were, however, unattended with success.

Antiserums were prepared in rabbits, goats, and large monkeys.
The goat proved more satisfactory than the rabbit, and eventually
yielded a serum of marked agglutinative power. Although this
serum, when given intraperitoneally, was capable of protecting
guinea-pigs against the diplococcus, its intraperitoneal injection
failed to exert any beneficial effect upon the monkey. The anti¬
serums made in large monkeys {Macacos nemestrinus) were used
on a series of five smaller monkeys (Macams rhesus) which had
been injected with fatal quantities of the diplococcus. Whereas
the control monkeys all died within twenty-four hours, of those
which received the antiserum four either remained well or
recovered from the disease, and one died nineteen hours after
infection.

In how far the results obtained with guinea-pigs and monkeys
can be applied to the prevention and treatment of cerebro-spinal

828

ABSTRACTS

meningitis in man it is not safe to predict, but experiments dealing
with these important questions are being undertaken.

W. T. Ritchie.

COMPARATIVE STUDIES ON THE LOCAL ACTION OF COCAINE
(459) AND STOVAINE ON PERIPHERAL NERVES. Santesson,
Festsehrift fur Olaf Hammarsten, xv.

The author records the results of a number of experiments under¬
taken to test the relative powers of cocaine and stovaine on peri¬
pheral nerves, motor and sensory. Frogs and rabbits were used
in the investigation, and contradictory results, of which no satis¬
factory explanation could be given, were obtained. The results in
rabbits approximated most closely to the well-known effects of
cocaine and stovaine in man. Microscopic examination of the
treated nerves seemed to show alterations dependent on the action
of the drugs, but other causes, such as the handling of the nerves,
might have produced the changes, which were in any case minimal
and almost without significance. The whole investigation appears
to have been devoid of positive results and to have added nothing
to our knowledge of the action of cocaine or stovaine.

J. W. Strtjthers.

CLINICAL NEUROLOOT.

ASCENDING NEURITIS AND CHRONIC RHEUMATISM. (Ndvrito
(460) ascendants et rhnmatisme chronique.) P. Lejonne and
M. Chartier, Rev. Neurolog., Oct. 15, 1906.

This is the account of a case in which an ascending neuritis of the
nerves of the left arm and chronic rheumatism of the metacarpo¬
phalangeal and inter-phalangeal joints of the same side, followed
on an injury to the terminal phalanx of the middle finger. The
first symptom was excessively severe pain in the fingers, later
spreading to the hand, forearm, and upper arm. Gradually there
followed loss of function and muscular wasting of the hand and
arm. There were no sensory changes and no alterations in the
electrical reactions. The nerves were thickened and tender to
pressure. The symptoms of neuritis preceded the appearance of
the arthritic changes, and only those joints supplied by the affected
nerves were involved. The joints and periarticular tissues were
probably predisposed to the onset of the infective rheumatic pro¬
cess by the loss of trophic influence resulting from the nerve
changes. Henry Dunbar.

ABSTRACTS

829

ON THE CLINICAL ASPECTS OF THE NEURAL POEM OF
<461) PROGRESSIVE MUSCULAR ATROPHY. (Zur Klinik der
neuralen Form der progressive!! Mnskelatrophie.) Stiefler,
Zeitsehr.f. HciUc., 1906, H. 8.

This paper forms a contribution to the literature of that type of
chronic muscular atrophy described first by Charcot and Marie, as
well as by Tooth, and known as the “neural” or “peroneal”
type.

The writer, as the result of thorough investigations into the
subject, discovered 240 cases. Of these 145 occurred on a
hereditary basis, 44 in families of which other members were
affected, while 47 were isolated cases. Thus three-fifths are
hereditary, one-fifth of family occurrence, while one-fifth are
sporadic. The series of cases recorded in this paper (numbering
19) were traced through four generations and were transmitted,
like the cases of other writers, through both men and women.
In this series the proportion of men affected was three to every
one woman; while other writers give an even higher dispro¬
portion.

The usual time of onset the writer found to be in the second
decade of life, and the disease makes but little progress after the
age of 40, while many of the affected persons reach the age of 60
or 70 years. All the cases, save one, showed their first symptoms
in the lower limbs; while the exceptional case, in which the
wasting was first seen in the hands, was further atypical in that it
commenced at the age of 68. In two brothers there were extensive
changes in the bones as well as in the muscles, and the symptoms
of one of these cases are given in full detail.

The paper is illustrated by three plates, and there is a copious
bibliography. John D. Comrib.

A CASE OF LANDRY’S PARALYSIS, WITH RECOVERY.

(462) Wharton Sinkler, Joum. of Nerv. and Ment. Dis., Nov. 1906,
p. 692.

Dr Sinkler reports a case of Landry’s paralysis, with recovery,
in which the bulbar nerves were involved.

He discusses briefly the diagnosis of the disease from multiple
neuritis, poliomyelitis, and spinal paralysis, and notes the different
yiews held on its pathology, and the probability of microbic
origin.

His patient was a healthy man, aged thirty. On the first day
of illness he felt unaccountably tired, and had prickling in the
fingers.

830

ABSTRACTS

Second day, stiffness, difficulty in walking. Fifth day, pain
in calves, no tenderness, weakness in arms and legs. Eighth
day, could walk only with strong support; numbness in hands
and feet, no objective sensory change; pupil and epigastric
reflexes present, abdominal and all deep reflexes abolished.
Tenth day, almost complete paralysis of arms and legs, weak¬
ness of lower face, deglutition unaffected. Twelfth day, weakness
in upper face, difficulty in deglutition Electrical reactions of
muscles normal. Fourteenth day, slight improvement in face.
Twentieth day, improvement in deglutition and power of arms.

The improvement was maintained, and the legs regained

? ower. Two weeks later he sat up, and in six weeks could walk.

hree months later he was in perfect health, but the deep reflexes
were still absent.

Two years later he was still in good health, and the knee-jerks
had returned. D. W. C arm alt Jones.

CONTRIBUTION OF A CASE TO PAL’S TEACHING AS TO THE

(463) VASCULAR CRISES OF TABETICS. (Bin kasuistudwr
Beitrag zu Pals Lehre von Gef&sskrisen bei Tabiker.) MOrchkn,

Neurolog. Cenlralbl., Oct. 16, 1906, p. 940.

The writer records with great prolixity the history and symptoms
of a case of tabes, with a development at a late stage in the disease
of cerebral disturbances. The patient became at times extremely
exhausted and sleepless, and on several occasions had attacks in
which he lost consciousness, and had great irregularity of the
heart’s action, and congestion of the face and head. These
symptoms were found to be much alleviated by doses of digitalis.

According to Pal’s investigations the blood-pressure varies
much in tabetics—falling, for example, during attacks of lightning
pain, and rising in gastric crises; while in high-pressure crises
epileptiform conditions may ensue. Pal further found that
physostigmine, belladonna, and iodine, as well as reflex agencies
like hot hand-baths, served to diminish the tension and relieve
this condition. The present writer believes that the symptoms in
his case were of similar origin, and recommends the use of digitalis,
which benefited it. John D. Comrie.

POLIOMYELITIS ANTERIOR AOUTA AND MENINGITIS OERB-

(464) BROSPINAUS. Tiedemann, Muench. Med. JVocheneekr
Oct. 23, 1906, p. 2095.

The writer discusses at some length with references to recent
literature the relationship existing between encephalitis of th#

ABSTRACTS

831

grey matter, acute poliomyelitis of the cord, and meningitis. He
quotes researches of Striimpell and of Medin, for example, which
show that encephalitis and poliomyelitis may be due to the same
infective process, the latter authority having observed in an
epidemic among children that in some cases the cranial and in
others the spinal nerves were affected. Other observers, as Dauber
and Schultze, are quoted as proving that meningitis may accom¬
pany poliomyelitis acuta; one such combined case of the last-
named writer showed the Weichselbaum-Jaeger bacillus in the fluid
drawn by lumbar puncture.

The writer gives full details of an illustrative case, in which a
factory girl of 17, after a febrile attack lasting some days, and
diagnosed as “ influenza,” became lethargic, suffered from pain in
head, neck, and spine, had optic neuritis and extensive paralysis
of the right upper arm and forearm with R.D., and presented
in her cerebro-spinal fluid a turbidity with great lymphocytosis
and leucocytosM. The patient ultimately recovered, though several
groups of arm muscles remained paralysed and atrophied. The
diagnosis of acute poliomyelitis accompanied by meningitis was
made, and the writer discusses the various features of the case at
length. John D. Comrie.

A CASE OF WBSTPHAL’S PSEUDOSCLEROSIS. Simpson, N.Y.

(465) Med. Joum., Sept. 29, 1906, p. 645.

The writer simply gives the clinical features of the case of a girl,
aged 21, in whom he diagnosed this condition. The chief points
noted were—Hereditary psychoses; weakness and loss of memory
gradually setting in; slow speech ; ataxia, shown by the hands and
in the gait; headaches; increase of the knee-jerks; hypsesthesia,
especially on the left side. The patient still lives, so that the
pathological state is not recorded. John D. Comrie.

THE DIFFERENTIAL DIAGNOSIS BETWEEN MULTIPLE
(466) SCLEROSIS AND THE PSYCHOGENIC NEUROSES. (Zur
Differential diagnose zwischen psychogener Neurose und
multipier Sklerose.) Heller, Klinik. f. psych. «. nerv. Krcmk-
heiien,, Bd. 1, H. 3, 1906.

This paper is intended to demonstrate the value of the technical
methods employed by Dr Sommer, and described in his “ Diagnostic
der Greisteskxankeiten,” in the differential diagnosis between organio
and functional nervous disease in doubtful cases, and takes the

832

ABSTRACTS

form of a careful study of a particular case. The case does not
appear to have been, however, one admitting of much donbt, as on
admission to the Klinik there were present, in addition to a
certain amount of mental reduction, and mentioning only the
more prominent symptoms, the following signs:—increased knee-
jerks, ankle-clonus, spastic gait, staccato monotonous speech,
mystagmus, intention - tremor, and optic atrophy. The main
interest of the paper lies in the author’s analysis of the curves,
recorded by Sommer’s instruments, of the knee-phenomena and
finger tremor. R. Cunyngham Bbown.

SYRINGOMYELIA, EXTENDING FROM THE SAORAL REGION
(467) OF THE SPINAL COED THROUGH THE MEDULLA-
OBLONGATA, RIGHT SIDE OF THE PONS, AND RIGHT
CEREBRAL PEDUNCLE TO THE UPPER PART OF THE
RIGHT INTERNAL CAPSULE (syringo-bulbia). William
G. Spiller, Brit . Med. Joum., Oct. 20th, 1906, p. 1017.

Notes, clinical and pathological, with illustrations, are given of a
case of syringomyelia whose special interest lies in the syringo¬
bulbia and the vertical extent of the lesion. The cavity, beginning
in the lower sacral region, implicates the left posterior horn in the
sacral and lumbar regions: in the thoracic and cervical regions,
both posterior horns and the central grey matter are involved,
the cord being very distorted above the mid-thoracic region. The
lower part of the medulla-oblongata shows a transverse cavity in
each anterior pyramid; the fibres of the right hypoglossus nerve are
completely cut across, thus explaining intense atrophy of the right
side of the tongue ; higher up in the medulla the cavity in the left
anterior pyramid has disappeared. In the pons the cavity is
transverse in the right pyramidal tract; there is partial degeneration
of the right abducens nerve from implication in the cavity, thus
explaining paresis of the right abducens nerve. In the right
cerebral peduncle, the cavity is in the substantia nigra, extending
into the upper part of the crusta. In the lower part of the right
internal capsule the cavity becomes divided, one part remaining
nearer to what will become the knee of the capsule, the other
occupying the posterior part of the capsule and soon disappearing.
The former, at a higher level, occupies the inner segment of the
globus pallidus and outer portion of the internal capsule near the
knee. Still higher, there is a cavity on each side of the knee, one
in the posterior part of the head of the caudate nucleus, and the
other in the anterior part of the lenticular nucleus, connected by
a narrow slit, the cavity in the head of the caudate nucleus extends

ABSTRACTS

833

to within 2 or 3 mm. of the lower surface of the lateral ventricle,
and does not open into the ventricle.

Schlesinger finds that the cavity in syringomyelia has never
been observed above the upper end of the facial nucleus, so that
only the fifth to the twelfth cranial nerves are ever implicated in
syringobulbia, while the involvement of the higher cranial nerves
is caused by complications (e.g., hydrocephalus, tabes, etc.). Spil-
ler’s case shows that these higher nerves might be involved by the
cavity, and that their implication does not necessarily imply a
complicating disorder, although he agrees with Schlesinger that, in
the majority of cases, symptoms in the supply of the upper cranial
nerves point to a complicating lesion. Hoffman’s opinion, that
invasion of the pons in syringomyelia is not more frequently seen
because vital centres are implicated before the cavity extends to
the pons and thereby death is caused, is shown by Spiller’s case to
be untenable, as a cavity may extend a long distance in the
medulla and pons without impairing many cranial nerves.

A. W. Mackintosh.

ON TRANSITORY HEMIPLEGIA IN ELDERLY PERSONS. F. H.

(468) Edgeworth, Scot. Med. and Surg. Joum., November 1906.

This condition is probably due to a temporary spasm of a branch
of one of the cerebral arteries. It can usually be distinguished
from hemiplegia, the result of an organic lesion, by the absence of
the extensor plantar response. The writer records two cases, both
in males—one at 68, the other at 64 years of age. In both clonic
spasm of the affected side preceded the paralysis. The first patient
was subject to temporary mental derangement, and the second had
attacks of clonic spasm not followed by paralysis.

Henry Dunbar.

TWO OASES ILLUSTRATING POINTS IN THE DIAGNOSIS OF
(469) TUMOUR OR OTHER LESION OF THE UNCINATE
REGION OF THE TEMPORO - SPHENOIDAL LOBE. Thomas
Buzzard, Lancet, July 1906.

In this lecture the author records two cases which illustrated the
chief points in the diagnosis of tumour of the uncinate region of
the temporo-sphenoidal lobe. Special attention is drawn to the
presence of “intellectual auree or warnings” in lesions of the

884

ABSTRACTS

uncinate region, a condition to which Qughlings Jackson gave the
name of “ the dreamy state.”

Both cases were very similar in their clinical features, but the
situation and nature of the lesion was determined only in the
second case which came to necropsy. The second case was that of
a woman aged 21, who was first seen in November 1904. Her
family history and previous health were unimportant She had
suffered from attacks of vertigo for two years, and four months
before admission she began to complain of severe attacks of head¬
ache followed later by vomiting and attacks of “loss of mind,”
which were typical examples of the “dreamy state”; she also
suffered at times from a dull aching numbing pain in the right
arm and leg, which would last for a few minutes, and on occasions
she had a similar sensation on the left side. Although the patient
often woke up with a bad taste in her mouth which persisted all
day, there was no taste sensation directly associated with the
psychical attacks.

The examination of the nervous system revealed no organic
signs, and the subjective symptoms passed away while she was in
hospital. A diagnosis of right temporo - sphenoidal tumour was
made.

In November 1905 (one year later) she was re-admitted to
hospital. She had had no more “dreamy states,” but had had
“ feelings of dread,” accompanied by a cold, creepy sensation all
over the body. The headache had returned, and her sight was
affected. At times she had attacks, characterised by feelings of
contraction associated with coldness and numbness, generally on
the right side, but sometimes on the left. On examination, there
was optic neuritis, slight weakness of the left side, with a tendency
to lurch to the left when she walked.

Taste and smell were not lost, and there was no affection of
sensation. The superficial abdominal reflexes were absent on the
left side, otherwise the reflexes were normal

The patient died suddenly in bed.

The necropsy revealed a glioma situated in the right hippo¬
campal gyrus, which was enlarged; this destroyed the uncus and
extended into the inferior horn of the lateral ventricle; its anterior
end infiltrated the lenticular nucleus, but did not destroy the in¬
ternal capsule. The right optic tract and the right crus cerebri,
were compressed and flattened by the growth.

In discussing the cases, attention is called to the “dreamy
states,” the “ taste aura ” present in the first case, and to the loss
of the superficial abdominal reflexes on the side opposite to the
tumour without any alteration of the corresponding plantar reflex.

T. Grainger Stewart.

ABSTRACTS

835

LIMITED AREA OF ANAESTHESIA, EPILEPTIFORM ATTACKS
(470) OF HEMIALGE8IA, AND EARLY MUSCULAR ATROPHY
IN A CASE OF BRAIN TUMOUR. Morton Princk.
Operation by John C. Munro, Jown. of Nerv. and Ment. Dis. t
Nov. 1906, p. 698.

The case was one of cerebral tumour of the left Rolandic area, with
unusual sensory symptoms.

The patient, a girl of 19, suffered from recurrent attacks of
pain beginning in the fingers of the right hand, and gradually in¬
volving the right arm, right side of face and body, and right leg,
and accompanied by spasm of the right arm. In the attacks there
was some disturbance of consciousness, and they were regarded as
epileptiform.

There was an area of slight anaesthesia involving the right face,
neck, and shoulder only. There was weakness and general wast¬
ing of the muscles of the right arm, but the electrical reactions were
normal. The deep reflexes were increased on the right, but there
was no Babinski. There was some headache and nausea, and
double optic neuritis.

The condition progressed, and she became blind, and quite
hemiplegic on the right; the slight tactile anaesthesia involved the
whole of the right arm, and there was complete loss of muscle
sense and stereognosis in it. Babinski’s sign appeared on both
sides.

A diagnosis was made of cerebral tumour of the right cortical
arm area, localised in the post-central convolution, and spreading
forwards into the ascending frontal gyrus, and backwards into the
parietal lobe.

A sub-dural endothelioma was removed from the middle of the
Rolandic area, involving both central convolutions, but not spread¬
ing back. The patient died, and there was no autopsy.

The findings in this case are compatible with the theory that
the post-central gyrus is sensory, and includes both tactile and
muscular senses and perhaps stereognosis.

D. W. Cabmalt Jones.

SEXUAL INFANTILISM WITH OPTIC ATROPHY IN OASES OF
(471) TUMOUR AFFECTING THE HYPOPHYSIS CEREBRI.

Harvey Cushing, Jowm. of Nerv. and Ment. Die., Nov. 1906,
p. 704.

Tumours of the hypophysis cerebri in women often lead to
amenorrhea. Axenfeld has reported certain cases—one of them in

836

ABSTRACTS

a woman who had never menstruated, was sexually undeveloped,
and whose optic discs showed a primary, not a consecutive atrophy.
Dr Cushing has seen a similar case. Abelsdorff has quoted a case
of presumed benign tumour of the hypophysis, in which amenorrhea
preceded other symptoms by ten years.

Two new cases are here described at length.

(1) A girl of 16, who had never menstruated, had undeveloped
breasts and scanty pubic hair. She had small hands and un¬
usually tapering fingers. She complained of headache, pain in the
back, malaise, nausea, vomiting, and imperfect vision. Cranial
nerves and discs were normal.

Later she developed double optic neuritis, severe headache, and
projectile vomiting. She became mentally dull, vision failed till
she could hardly count fingers, and there was general contraction
of the fields, but no bitemporal hemianopia. Craniotomy was
performed and alleviated the symptoms and the oedema of the discs,
but after a further operation the patient died of pneumonia.

Post-mortem .—A tumour containing cartilage cells was found
occupying the position of the tuber cinereum, and projecting into
the third ventricle. It is suggested that this tumour had existed
for years and retarded sexual development by pressure on the
hypophysis, and that the acute terminal symptoms and optic
neuritis were due to its displacement into the third ventricle.

(2) A woman of 26, who had only once menstruated, and
was sexually infantile. She had tapering fingers and some boggi¬
ness of subcutaneous tissue. She complained of headache, failing
vision, and right trigeminal neuralgia. No vomiting. She had
been blind in the left eye for four years; this may have begun
as a temporal blindness. The right field of vision was irregularly
contracted. Both discs were atrophic, especially the left. Smell
was diminished on the right, and the right trigeminal area was
partially ana;sthetic. The axes of the eyes were not always
parallel.

Bilateral craniectomy was performed, with relief of the head¬
ache and neuralgia and some improvement in the sight of the right
eye, with some enlargement of the temporal field and appreciation
of colours on the temporal side hitherto absent; there remains a
nasal hemianopia for colours.

A skiagram shows some shadow with deformity about the sella
turcica.

The diagnosis suggested is a benign tumour, probably con¬
genital, causing amenorrhea by pressure on the hypophysis.

The author regards amenorrhea in a woman, associated with
optic atrophy, as diagnostic of tumour pressing on the hypophysis.

D. W. Carmalt Jones.

ABSTRACTS

837

DIFFERENTIAL DIAGNOSIS OF CEREBRAL DISTURBANCES
(472) OF TOXIC ORIGIN DUE TO ALCOHOL AND TOBACCO
AND TO GENERAL PARALYSIS ACCORDING TO THE
OCULAR SYMPTOMS. (Diagnostic differential des troubles
cerebranx, etc.) A. Rodut and F. Cans, Annales Medico-Psycho-
logiques, Nov.-Dee. 1906, p. 408.

In discussing the differential diagnosis between chronic alcoholism
with delirium and general paralysis, the authors quote a statement
of Magnan that “alcohol can mask, simulate, or cause general
paralysis.” They point out the importance of the eye symptoms
in this connection, grouping these under five heads : (1) Pupillary
changes; (2) alteration in sensibility; (3) aberrations, illusions,
and hallucinations of vision; (4) alterations in the fundus; (5)
visual troubles. In chronic alcoholism the pupils are contracted,
equal in size as a rule, and they have a sluggish reaction to light;
a complete Argyll-Robertson pupil is rare. Inequality of the
pupils occurs sometimes during the acute attack, but is not of
importance.

In general paralysis a difference in the size of the pupils is
found, but is only of importance when associated with other signs.
In this disease there is a progressive change in the reaction of the
pupils, Argyll-Robertson, false Argyll-Robertson, i.e. loss of light
reflex, with diminution of accommodation, and finally, complete
immobility of the pupils. This change may affect the two eyes
differently. Deformities and irregularities of the pupils are present
in both conditions; the eccentric pupil they find commoner in
general paralysis, tabes, and cerebral syphilis.

The authors then discuss the alterations in the sensitiveness of
the eye. They describe a peculiar form of hemiansesthesia of the
cornea in alcoholism, resembling that in hysteria, though not so
complete, and differing in the fact that in the alcoholics reflex
stimulation of tears can be produced by touching the anaesthetic
area, which is not present in the case of hysteria. They then go
on to describe the differences in the hallucinations of sight, etc., in
the two conditions, and give a very full account of the changes in
the fundus of the eye, and the extent to which vision is affected,
and in what particular manner, in the intoxications by alcohol,
tobacco, and general paralysis: and they have remarked that
with atrophy apparent in the fundus there is a remarkable pre¬
servation of sight in the general paralytic, while the extent of the
loss of sight in the alcoholic is not to be explained by the extent
of the changes in the fundus. Duncan Lorimer.

838

ABSTRACTS

KEFLEX EPILEPSY. (Ueber BeflexepUepsie.) Ernst Urbaut-
(473) scHrreCH, Wien. Min. Wocheruchr., Sept. 27, 1906, p. 1160.

The main tenor of the paper is the importance of clearly separating
the two conditions that are confused under this title. On the one
hand we find cases of true epilepsy in which peripheral irritation
bears a relation to the actual attacks, though not to the disease
itself. This condition should be called Reflex Epilepsy. On the
other hand there are cases in which attacks indistinguishable from
those of true epilepsy occur, which are due solely to peripheral
irritation. These should be called Reflex Epileptiform Attacks
(reflektorisch-epileptiforme Anfalle). The author lays great stress
on the significance of nomenclature here, as elsewhere, for even a
physician who is quite aware of the facts is unconsciously in¬
fluenced, if he uses the term Reflex Epilepsy for both conditions,
in the direction of considering both states as epileptic; and that
these are absolutely distinct conditions is insisted on throughout
The differential diagnosis is therefore most important, as the prog¬
nosis and treatment are quite different. Unfortunately, however,
it is frequently extremely difficult, and several cases illustrating
this difficulty are referred to. One of the main distinctions is this
fact: an epileptic always has other evidence of neurosis, both in
his family and his personal history, so that the attacks are only
one element in the case; the epileptiform case, on the other hand,
is perfectly sound mentally, and has no other sign of disease of the
nervous system. The effect of operative treatment on the local
condition is different in the two cases. In true epilepsy the attacks
may be relieved, and may cease for a while; but, on account of the
underlying predisposition, sooner or later they return: frequently
the recurrence is due to some other local irritation. One does not
gather, however, that the author would deprecate local treatment
even in these cases. The effects of this treatment in the epilepti¬
form cases are striking, permanent cure usually resulting. It is
absurd, however, for reasons given above, to label such results
“ Cure of Epilepsy.” Bromide medication, while favourably affect¬
ing most cases of pure epilepsy, has but little influence on the
epileptiform cases. In the treatment of epilepsy the author layB
stress on the importance of careful dieting. He founds this opinion
both on the results of experience and on the view that the intesti¬
nal tract is frequently the source of irritation which—given a suit¬
able predisposition—causes true epileptic attacks. He tries to
correlate this gastric and intestinal irritation with the common
ascending epigastric aura, but only in a far-fetched manner. The
other sources of irritation are referred to at some length, and
several cases described. Ernest Jones.

ABSTRACTS

839

A NOTE ON PBOULIAB ATTITUDES IN EPILEPSY DURING

(474) SLEEP. N. B. Ross, New York Mod. Journal, Oct. 6, 1906,
p. 689.

Attention is drawn to the fact that the low grade epileptic patients
frequently assume remarkable attitudes during Bleep. For instance,
they may lie laterally in such a flexed position that the forehead
is between the knees, and asphyxia may occur. A sitting posture
during sleep is not rare. One patient had for twenty months lain
in his sleep flat on his abdomen. Another slept always with his
head hanging over the side of the bed in a dependent position.
Photographs are given of these different positions.

Ernest Jones.

EPILEPSY AND MIGRAINE. (L’4pilepsie et la migraine.) P.

(475) Kovalesky, Arch, do Neurol., May 1906.

The author reports a case of epilepsy in a woman of thirty-seven,
subject to migraine from the age of eight; the convulsions occurred
at the end of coitus, and were preceded by an aura of a red light.
He holds that in certain cases migraine and epilepsy can be com¬
bined and substituted for each other; this shows their close
relation. Outbursts of fury without reason may be epileptic
equivalents. He emphasises the connection of the fit with the
sexual act C. Macfie Campbell.

SOME OBSERVATIONS ON CONVULSIONS IN CHILDREN, AND

(476) THEIR RELATION TO EPILEPSY. R. O. Moon, Lancet,
Sept 15, 1906.

The author in this paper gives analysis of a second set of 100
cases.

In his opinion “ convulsions in early life may shade off inde¬
finitely into epilepsy or epileptiform manifestations, so that it
becomes often impossible to say where the one stops and the other
begins.”

In about 50 per cent of cases the first convulsion arose
without any obvious cause.

As regards prognosis, there is no marked difference between
the two classes of cases—“ the fact remains that in 200 cases taken
haphazard, carefully investigated and followed up, the prognosis
as to the future moral and mental condition of the child does not
appear to be any better when the first fit is associated with a
reflex cause which can be removed than when it is of idiopathic
origin.” A. Dingwall Fordyce,

840

ABSTRACTS

HTBTERIA FROM THE POINT OF VIEW OF DISSOCIATED
(477) PERSONALITY. M. Prince (of Boston), Journal of Abnormal
Psychology, Oct. 1906.

The author’s object is to study hysteria from the view-point of
dissociated personality, and conversely dissociated personality from
the view-point of hysteria. Hysteria is used to denote the type of
case which shows on physical examination anaesthesia, paralysis,
limitation of the visual field, convulsions, etc., and on mental
examination amnesia, irritability, emotionalism, instability, sug¬
gestibility, etc. In cases of dissociated personality the hysterical
symptom-complex may make up one or more of the phases of the
multiple individual. In order to show more clearly the contrast
in clinical symptoms, 20 cases of dissociated personality are
tabulated according to the number, designation, and origin of
personalities; general health; stigmata; amnesia; memory, and
general character. Upon the analysis of these cases the author
concludes that certain complexes with or without amnesia, which
are commonly known as hysteria, may be regarded as cases of
dissociated personality. They may be considered as phases of
multiple personality if taken in connection with the normal
condition. Hysteria is a manifestation of disintegration, and the
neurasthenic state—one of the stigmata of hysteria—is patho¬
logically a type of dissociation of personality. Conversely, dis¬
integrated personality is no bizarre phenomenon, but in its mild
forms an almost every-day clinical affair, though ordinarily, in
consequence of the absence of amnesia, it passes unrecognised.

C. H. Holmes.

A OASE OF OSTEITIS DEFORMANS WITH HUNTINGDON^
(478) CHOREA Mackey, Lancet , Sept. 22,1906.

The writer merely puts on record a case which showed these two
conditions combined, similar cases having been noted elsewhere,
to which he gives references.

The patient’s memory and intellectual faculties were much
impaired and the speech slurred. The muscular power was
normal, but there was marked inco-ordination of the limbs, lower
jaw, and tongue, and the muscles showed choreiform spasms as
well as fibrillary twitchings. Many of the reflexes were absent.
The bones of the arms, the ribs, and the femora and tibias were
much thickened. There was coxa vara, and one leg was much
longer than the other and considerably bent. The state of the
patient in both respects was getting steadily worse at the time
of writing. John D. Combie.

ABSTRACTS

841

OPHTHALMOPLEGIA INTERNA UNILATERALE, WITH
(479) SPECIAL REFERENCE TO ITS ETIOLOGY AND CLINICAL
SIGNIFICANCE. Edwin Bramwell and Arthur H. H.
Sinclair, Scot. Med. andSurg. Joum., December 1906.

The authors in this paper record six cases of unilateral internal
opthalmoplegia. 4

Case I. A watchmaker, aged 34, unilateral internal opthal¬
moplegia in right eye of three or four months’ duration. Syphilis
six years previously. Argyll-Robertson pupil on left side. No
other indications of nervous disease. Since the symptoms appeared
in the eye which he employed almost exclusively when at his
work, the case might be cited as an instance supporting the
“ Ersatz theorie ” of Edinger. It is quite possible, however, that
the affection of the right eye was merely a coincidence, and that
it was the inconvenience produced thereby in connection with his
very special work which had compelled the patient to seek medical
advice.

Case II. Left internal ophthalmoplegia in a case of cerebral
syphilis.

Case III. An unmarried lady, aged 38, with left internal
ophthalmoplegia. Argyll-Robertson pupil on right side. Absence
of both tendo-Achillis jerks. No history suggestive of syphilis or
further indications of an organic nervous affection.

Case IV. Unilateral internal ophthalmoplegia of several years'
duration in a male, aged 40, an applicant for life insurance, who
presented no further indications of disease.

Case V. A bank clerk, aged 30, with progressive tabes dorsalis.
History of a chancre six years previously. First indication of
present illness was dimness of vision and dilatation of left pupil
eighteen months ago. Accommodation not examined at that time,
but six months later found to be defective in left eye. Pupils
regained normal size, and defect of accommodation recovered from
under anti-syphilitic treatment

Case VI. Left internal ophthalmoplegia of some weeks’ duration
in a married woman. No evident cause, but a history of mis¬
carriages following marriage was suggestive of syphilis.

Unilateral internal ophthalmoplegia may be due to local trauma
when it is almost always associated with dislocation of the lens or
other evidence of injury to the eye. Again, it may follow a general
injury, as in a case reported by Donath. In some cases of third
nerve palsy, dilatation of the pupil and defective accommodation
may persist after the external ocular palsy has been recovered
from. “ Cold ” is probably an occasional cause, as in one of
UhthofTs cases. The very great majority of cases of ophthalmo-

842

ABSTRACTS

plegia interna unilateral persisiens are, however, associated with
syphilis. Alexander has reported twenty-eight cases, in only fonr
of which syphilis could be excluded. Among UhthofFs cases there
are several in which no cause could be detected. All of these
cases occurred in young adults. In all there was a well-marked
neuropathic factor, while in all, with one exception, the disturb¬
ance of vision and mydriasis seem to have disappeared quickly, a
point which may help to distinguish this group from the syphilitic
cases, in the majority of which the symptom appears to be per¬
manent.

The authors point out that the sign may be of importance
in relation to life insurance, since a considerable proportion of
these cases—it is impossible as yet to hazard an opinion as to
the percentage—ultimately develop parasyphilitic affections of the
nervous system. Further, they point out that this is an objective
sign of organic disease of the nervous system which it is possible
to produce artificially, a circumstance which it may be of use to
bear in mind in connection with medico-legal cases.

Schulz concludes, from experimental evidence, that internal
ophthalmoplegia, which is a consequence of an affection of the
ciliary ganglion or short ciliary nerves, may be distinguished
from that which is caused by a lesion on the cerebral side of the
ganglion by the fact that the pupil in the latter case contracts
under physostygmin, while in the former case it fails to do so.
In several of the author’s cases the pupil contracted well under
eserin, an observation which suggests, granting that Schulz’s con¬
clusion is correct, that the lesion in these cases was situated on
the proximal side of the ganglion. Edwin Bramwkll.

INTERMITTENT CLAUDICATION OF THE CORD. (La Olaudiev
(480) tion Intermittente de la Moelle.) Paul Sollier, La Prase
Mtdicale, Oct. 24, 1906, p. 677.

The recent work of D^rine (Revue Neurolog., April 30, 1906) on
this subject is resumed. It will be remembered that D^jdrine has
called attention to the features that distinguish it from the inter¬
mittent claudication described by Charcot, which is due to a peri¬
pheral arteritis. These features briefly are: In the cord affection,
persistence of the arterial pulsation in the lower extremities,
absence of cyanosis, coldness or any vaso-motor trouble, increase
of the patellar and Achilles reflexes with occurrence of Babinski’s
sign, and, most constant of all, presence of bladder symptoms,
usually of the nature of precipitancy; in the muscle affection,
abolition of arterial pulsation in the lower limbs, occurrence of
vaso-motor symptoms, absence of any symptoms indicating a cord

ABSTRACTS

843

lesion. In both instances there are no abnormal symptoms or
signs except following exertion.

Sollier has met with a typical case, and records it at length.
The patient was a man of fifty-four, who had had symptoms for
over seven years. The only special features were the occurrence
of a relapsing diplopia, and the fact that the upper extremities
were affected equally with the lower. Great amelioration was
obtained by mercurial treatment, as is usual in these cases. It is
because the prognosis is graver, and the effect of treatment more
marked, that it is especially important to recognise this group as
distinct from that described by Charcot. Ernest Jones.

THE CEREBRAL ELEMENT IN THE REFLEXES, AND ITS
(481) RELATION TO THE SPINAL ELEMENT. G. L. Walton
and W. E. Paul, Joum. of Nerv. and Mend. Dis., Nov. 1906,

p. 681.

The authors draw attention to the unsatisfactory nature of the
theory that the deep reflexes depend on the integrity of a spinal
arc, inhibited in health by a cortical arc, and allowed to become
over-active when the pyramidal tract is injured.

The paper is based on sixteen cases of lesion of the brain or
cord in which observations were made on the reflexes, and which
led the writers to the following conclusions:—

Both the brain and the cord must play a part in the production
of the deep reflexes. The higher arcs tend to produce a more
subdued, the lower arcs a more violent, reflex. In health the
resultant is a comparatively moderate reflex, varying in individuals
as the cerebral or spinal type predominates. In organic disease,
partial withdrawal of cerebral influence causes exaggeration of the
reflex. The spinal arc cannot sustain a reflex alone, since complete
withdrawal of cerebral influence causes abolition of all reflexes.

Further, the control of the superficial reflexes differs from that
of the deep. They disappear in cerebral disease, and are therefore
controlled by the cerebrum, and they are not increased in pyra¬
midal disease, and are therefore not represented in the cord.

The Babinski response is controlled more in the manner of the
deep than the superficial reflexes.

Of the cases quoted, six were hemiplegias of rapid onset, and
were observed at periods varying from one hour to “some days’*
after they occurred.

In all, the knee-jerk on the paralysed side was diminished or
absent; in two the ankle-jerk of that side was noted as diminished,
in two the abdominal reflex was diminished, and in two Babin-
ski’s sign was obtained.

844

ABSTRACTS

Three cases are quoted in which there was increased deep
reflex on the paralysed side, and in one of them diminished
abdominal reflex was noted.

Two cases of transverse lesion of the cord showed loss of both
deep and superficial reflexes below the lesion, without a true
BabinskL

Two cases of hemiplegia, with well localised lesion, showed
increase of deep reflex in the parts less affected, and diminution
in those most damaged on the paralysed side.

These observations go to confirm the cerebral element in the
deep reflexes. This element accounts for the abolition of reflex
in cerebral disorder, such as epilepsy or chorea, far better than
any theory of “ irritative inhibition.”

Temporary abolition of deep reflex is the rule in apoplexy;
when it is retained, cerebral influence has not been completely
cut off; the writers suggest that the ultimate increase is due to
the uncrossed pyramidal fibres, and is of spinal type.

The work of previous writers on the subject is passed in
review, with special reference to Pandi.

D. W. Carmalt Jokes.

A NEW METHOD OP INVESTIGATING THE KNEE- AND

(482) ANKLE-JERKS. (Ueber ein neves Verfahren xur Untar*
suchung des Patellar- nnd Achillessehnenreflexes.) Fedc,
Wien. klin. Woch., Oct. 11, 1906, p. 1223.

Ik examination of the tendon jerks relaxation of the corresponding
muscles is indispensable. An objection to the usual methods
employed, such as Jendrassik’s, is that patients, especially those
that have been subjected to frequent examinations, involuntarily
make their muscles tense. Feix’s method is to make the patient
adopt the lateral decubitus with the hip- and knee-joints slightly
flexed, and the eyes closed. Complete relaxation of the quadriceps,
extensor, and calf muscles is thus obtained, and the patient cannot
now make tense his muscles without considerable inconvenience to
himself. A further advantage of this method is that both the knee-
and ankle-jerks, and even the gluteal reflex, can be examined while
the patient remains in the same position. J. D. Rolleston.

A SIMPLE DEVICE FOR OBTAINING THE KNEE-JERK. (Bin

(483) einfacher Kunstgriff ror Eneugung des Knie-PhUnomens.)

KrOnig, Berlin. kUn. Woch., Oct. 29, 1906, p. 1421.

In cases where the knee-jerks are difficult to obtain, some patients
are not sufficiently intelligent to carry out Jendrassik's method.

ABSTRACTS

845

Kronig has therefore devised the following method, which, like
Jendrassik’s, is based on the principle of diverting the patient’s
Attention. Directly the doctor says “Now!” the patient is to take
a forced inspiration, and at the same time to look up at the ceiling.
As the percussion of the tendon must exactly correspond with the
inspiration, the tendon must not be tapped until after the word
M Now! ” has been pronounced, otherwise the patient will delay his
inspiration and the jerk will be impeded.

Kronig has carried out this method in some hundred cases and
found it most effective. J. D. Rolleston.

SUBCORTICAL APHASIA (PURE APHASIA). (Revision de la
(484) question de l’apltasie: que faut-il penser des aphasias sons*
corticales (aphasies pares)?) Pierre Marie, La Semaine
Midicale , Oct. 17, 1906, p. 493.

In this paper Professor Marie continues his revision of the question
of aphasia, and deals with the subcortical or pure aphasias. By
this phrase is signified the result of a lesion which does not involve
the cortex, but which interrupts fibres coming from motor, auditory,
or visual centres, and so isolates them from their physiological con¬
nections. Pure word-deafness, pure word-blindness, pure motor
aphasia, may be specified in this group.

1. Pure word-deafness, according to D^j&ine, is the result of
a bilateral lesion of the temporal lobes, but from both the clinical
and the pathological point of view Marie denies the reality of its
existence, for the following reasons:—

He has never seen a clinical case which approaches the condi¬
tion, and the reported cases do not satisfy him. He affirms the
impossibility of its occurrence in a pure form, i.e. without any
concomitant diminution of the intellectual faculties, and with the
other allied speech functions intact. Pathologically, no one of the
published cases bears out the reality of the pure subcortical lesion.
If any of these cases showed slight deafness, the assumption was
made that this was due to a lesion of a cortical auditory centre in
the first temporal convolution, but Marie asserts that such deaf¬
ness is always the result of disease somewhere in the peripheral
auditory apparatus.

He suggests that in the so-called auditory word centre there are
stored up images not of words, but of syllables; that this centre is
therefore an intellectual one, since a complicated intellectual process
would be required to reconstitute these syllables into words; and
he holds that this explains the frequent defect in all forms of
language, however slightly Wernicke’s zone is affected. If a
patient with word-deafness does not understand what is said to
him, it is not because he is deaf to words as words, but because of

846

ABSTRACTS

the defect of comprehension produced by the lesion of an intellec¬
tual (not a sensory) centre.

2. The case is different with pure word-blindness. There can
be no clinical doubt of the existence of cases of pure alexia.
D^j&rine considers the lesion one which destroys the association
fibres uniting the common visual centre (bilateral) to the left
angular gyrus, the centre for the visual images of words.

But the arguments against the existence of this centre (sensory)
are, for Marie, as cogent as those against the existence of a sensory
(as opposed to intellectual) auditory word centre. In addition, the
fact that the faculties of reading and writing are of quite recent
development in the history of mankind militates against the
accepted view.

Pathologically, the essential point to remember is that the
lesion which gives rise to “ pure ” alexia is in an area supplied by
the posterior cerebral artery, not by the Sylvian. Right homony¬
mous hemianopia is therefore of very frequent occurrence in cases
of pure alexia. It is not sufficient for the lesion to involve fibres
from the visual zone: the white matter below the zone of language
must also be implicated. An affection of the lingual and fusiform
lobes in the inferior aspect of the brain will produce “pure"
alexia. On the amount of involvement of the fibres coming from
Wernicke’s zone depends the degree of alexia. Marie is almost
inclined to say that aphasia, clinically, depends rather on the
distribution of cerebral arteries than on the topography of cerebral
convolutions. Pure alexia is really an “ extrinsic aphasia ” : it is
a sort of visual agnosia.

3. Subcortical motor aphasia—or pure motor aphasia—is, ac¬
cording to Ddj^rine, secondary to a lesion which destroys the fibres
uniting Broca’s convolution to bulbar nuclei. The clinical picture
is familiar, and Marie accepts it as of frequent occurrence; its
pathological interpretation, however, is another matter.

According to Marie, these are really cases of anarthria, and the
anarthric is not an aphasic. Broca’s aphasia is aphasia plus
anarthria; and although Ddj&ine maintains that dysarthria or
anarthria is the result of disease of the peripheral speech mechan¬
ism—lips, tongue, palate, etc.—Marie affirms that a patient may
be anarthric without any paralysis of the muscular organs of
phonatioD. His anarthria is a functional disturbance, attributable,
as the author has already endeavoured to prove, to a lesion in the
zone of the lenticular nucleus. Further pathological evidence is
offered to show that Broca’s aphasia is really anarthria plus
aphasia, and a case reported by D^jdrine as one of pure motor
aphasia is re-analysed, and demonstrated to be one of aphasia from
a lesion in Wernicke’s zone plus anarthria from a lesion in the
lenticular nucleus. S. A. K. Wilson.

ABSTRACTS

847

PSYCHIATRY.

THE EARLY DIAGNOSIS AND TREATMENT OF PROGRESSIVE
(485) PARALYSIS OF THE INSANE. (Frfihdiagnose und Behand-
lung der progressiven Paralyse.) Karl Heilbronner, Deutsche
med. Woch., Oct. 4, 1906, S. 1609.

Most of the cases sent to institutions with the diagnosis of early
Gr.P.I. are fairly advanced, as the early symptoms are not suffi¬
ciently studied. One is not justified in making the diagnosis until
both aspects of the disease, the dementia and the paralysis, shew
signs of their presence. At the same time these signs may be so
very faint as to require special investigation directed towards them
before they can be observed. The dementia is much less obvious
in the case of women and children. It often begins in the moral
sphere, so that a previous knowledge of the patient is necessary in
order to detect it. Unmannerliness, disorderly dress, the sudden
appearance of a love for a public-house bar, are all suspicious
symptoms ; at the same time fleeting spasms of remorse or of rage
are often noticed. Amongst the intellectual symptoms, deficiency
in attention, forgetfulness—usually of the continuous amnesia
type—ignorance of simple facts, are prominent. Hypochondriac-
depressive moods, alternating with euphoria, are often noticed.
On the physical side, indication of pyramidal disease, such as
Oppenheim’s and Babinski’s signs, of posterior column implication,
and disturbances of micturition, are to be looked for as shewing
cord affection; and pupil changes, ataxy, tremor, and changes in
facial appearance and in speech, as shewing cerebral affection.
The above are described in an elementary way, and no new points
of view demonstrated by the author. The indications for sending
the patient to an asylum are mentioned. In addition to dangerous
symptoms, other indications are great excitability, expansive deli¬
rium, a hypochondriac condition. Ernest Jones.

SECOND NOTE ON FALSE REMINISCENCE. (Denxi&me note
(486) anr la f&nsse reminiscence.) F£r£ (of BicStre), Joum. de
Neurol ., mars 20, 1906, p. 101.

A casuistic contribution to the study of the phenomenon of false
reminiscence, i.e. the false impression of having already seen, heard,
or experienced things. The first patient was a neurasthenic
woman with paresthesia of the extremities, transitory paralyses
at night, various visual disorders, nocturnal episodes of awaking

848

ABSTRACTS

with a feeling of great anguish. Transitory dimness of vision was
frequently followed by the illusion of having previously seen an
object, t.g., she said to the fishmonger, who had not called before,
“ You showed me yesterday that lobster.”

In the second case, the phenomenon occurred in a man con¬
valescent from grippe; it was associated with a state of fatigue,
and disappeared with the latter. C. Macfie Campbell.

THE POLYNEURITIC PSYCHOSIS AND BERI BERI. (La psychose
(487) polyndvritique et la bdribdri) Nina Rodrigues (of Brazil),
Ann. Mid.-Psych., March-April 1906.

Manson has denied the presence of the syndrome of Korsakow in
polyneuritis, due to beri-beri, and emphasises the absence of memory
defect as a differential point between a polyneuritis of this origin
and a malarial polyneuritis. The author contradicts this view
absolutely, basing his views on observations in Brazil; he reports
fourteen cases, and gives the following conclusions. Korsakow’s
polyneuritic psychosis occurs in polyneuritis caused by beri-beri.
Taking the three forms of Korsakow’s psychosis grouped by Ballet
as amnesic, delirious, confusional, the amnesic form is the most
common. Sometimes the amnesia is much more far-reaching than
the amnesia of Korsakow’s psychosis. Absence of amnesia is not
of differential value. C. Macfie Campbell

MILD FORMS OF DEMENTIA PRJEOOX. (Les formes frustes de
(488) la ddmence prdcoce.) J. Crocq (of Brussels), Journ. de Near.,
April 6, 1906.

The author starts from the heboidophrenia of Kahlb&um, which
consists in a slight reduction in the various mental faculties at
puberty ; the adult does not fulfil the promises of his youth, his
interests and abilities show slight deterioration, but there is neither
delusional formation nor excitement. It is a mild form of Heckeris
hebephrenia. Crocq notes the deterioration in interests, character,
occupation and behaviour of this group. He next reports the case
of a patient with bad heredity, always slightly peculiar, who, at
the age of twenty-nine, showed increased want of balance and
change of character; he became irritable, neglected his business,
was odd, occasionally mute and refused to eat, talked of suicide.
This ill-balanced behaviour was in part precipitated by the failure
of his matrimonial plans.

ABSTRACTS

849

When committed, the main feature was his ready acceptance
of hospital regime, with no desire for any wider sphere of interests ;
he was not depressed, amused himself with the others, and on dis¬
charge he continued to lead an equally limited existence.

Such a case is considered by Crocq to be intermediate between
heboidophrenia and a third form, with short delusional attacks,
from which the patient recovers with comparatively slight defect;
after a series of such attacks the patient gradually descends the
mental scale. As examples of this form he reports the observa¬
tions of two patients with bad heredity and constitutionally
defective. The first had recurrent maniacal attacks, and was
observed during an attack at the age of forty ; he had numerous
absurd delusions. After two and a half months he left the hospital
convalescent, but still showed a paranoic attitude. Unfortunately
the report lacks definition, especially with regard to the differentia¬
tion of the attacks from those of manic-depressive insanity. The
second case had periodic attacks of “ maniacal incoherence ”; on
admission, at the age of forty-six, he was excited, incoherent,
gesturing; made a series of absurd statements. After five months
he left convalescent, and continued to lead an ill-balanced life.

The author does not give any valid reasons for bringing such
cases into the group of dementia praecox, he does not discuss their
relation to the periodic psychoses, nor consider the question of
constitutional mania. C. Macfie Campbell.

MANIO-DEPRESSIYE INSANITY. (De la folie maniaque-dlpres-

(489) sive.) G. Deny (of Paris), Arch, de Neur., July 1906.

In this lecture Deny gives a brief but clear historical account
of the steps which have led to the formation of the clinical group
of manic-depressive insanity. The earliest writers noted the
alternation in certain patients of maniacal and depressed attacks,
but mania and melancholia were regarded as two distinct entities
before the works of the French school showed their intimate rela¬
tion ; this first period closes with the publication in 1851 of Falret’s
first communication on the subject.

The second period is that of the French school; Falret and
Baillarger called attention to cases where the attacks consisted of
more than one phase, a maniacal phase passing into a depressed
phase, and a clear interval either separating the two or following
the depressed phase.

This new clinical entity, which was separated from the classical
mania and melancholia, was called by Falret circular insanity,
while Baillarger named it “ folie & double forme.”

ABSTRACTS

8(0

Kraepelin is the representative of the third or German period.
He called attention to the fact that so-called simple mania, if
followed for a long period, was found to recur; the simple mel¬
ancholia—from which he separated certain depressions in advanced
life and other depressions forming part of a deteriorating psychosis
—also recurred or alternated with periods of excitement.

He therefore brought together simple mania, simple melan¬
cholia, circular insanity, recurrent mania, and melancholia into the
one large group of manic-depressive insanity. Deny justifies the
term manic-depressive not only for recurrent cases with the two
phases, but for all cases; the series of attacks may show pre¬
dominance of one phase, but the other phase may occur later.
Even in the individual attack, symptoms of the opposite phase
appear either faintly indicated, or well enough marked to make it
useful to group the case as belonging to a mixed type. The author
accepts fully Kraepeliu’s views, and defines the psychosis as a
constitutional disorder, essentially hereditary, characterised by the
repetition, alternation, juxtaposition, or coexistence of states of
excitement and of depression; it is a clinical entity belonging to
the large group of constitutional psychoses.

C. Macfie Campbell.

THE FORENSIC IMPORT OF SEXUAL PERVERSITY. (Die
(490) forensische Bedeutung der sexuellen Perversitftt.) J. Salgo
(Budapest), Sammlung zwangloser Abhandhmgen aus den GdtieU
der Nerven- und Geisteskrankheiten, Bd. vii., H. 4, p. 43. Halle
a. S.: Carl Marhold. 1907. Price M. 1.20.

The present paper is confined to an examination of homo-sexuality
and an inquiry into the various legal restrictions placed upon un¬
natural offences, and the practical results of the operation
of these laws. The author reviews the various laws of different
countries, and points out their disparity in this respect; some
countries, notably France and Japan, taking no particular legal
cognisance of these practices. With the exception of Hungary,
however, all countries which do legislate in this matter, punish
only male homo-sexuality and sodomy, and even in Hungary
sapphism is in practice disregarded. In the author’s opinion, the
law stipulates either too much or too little. On the one hand, if
the punishment is intended to enforce sexual congress as entirely
a procreative act, then many other practices should come under
the ban of the law, which as it stands is thus too limited; and on
the other hand, if the general execration of sexual inversion is
rooted in an aversion from their unnatural or abnormal character,

ABSTRACTS

851

the law, in so far as it takes notice of secret vices which do not
violate public decency, oversteps its bounds and infringes private
interests. The author therefore considers that it would be better
if the various articles dealing with homo-sexuality were expunged
from the law and its punishment left—as are already many other
immoral or vicious acts—to social condemnation.

From the point of view of psychiatry Dr Salgd finds nothing
in these phenomena to justify such a term as “ psychopathia
sexualis.” Homo-sexuality may be a symptom, a Teilerscheinung,
of one or other morbid process, but in itself gives no indication of
any type of disorder. R. Cunyngham Brown.

THE REGULATIONS AS TO THE DISCHARGE OF PATIENTS
(491) FROM ASYLUMS IN PRUSSIA. (Die in Preussen gfiltigen
Bestimmungen fiber die Entlassung arts den Anstalten fttr
Geisteskranke.) Professor C. Moeli, of Berlin. Pp. 44. Halle
a. S.: Carl Marhold. 1906.

Professor Moeli furnishes in this short paper an exceedingly
interesting commentary on the working of the provisions made in
the Burgerliches Gesetzbuch with regard to the discharge of
patients from asylums. As the German lunacy laws differ funda¬
mentally from our own, his criticisms of Prussian law are of only
relative interest. Nevertheless the same problems which confront
English medical superintendents are being widely discussed in
Germany, such as, for example, to instance only one or two of
these, the question of the discharge of recovered patients whose
subsequent relapse seems inevitable; the provision of some form
of supervision and after-care of patients having no legal guardians;
and—a difficulty which is naturally much more sorely felt in
Germany than with us—the ill-effects of maintaining criminal
lunatics in ordinary public asylums. These are among the poiuts
ably and temperately discussed by Professor Moeli. His conclu¬
sions are, of course, inapplicable here, with perhaps one exception,
namely, the formation of an after-care association similar to the
German equivalent for our Discharged Prisoners’ Aid Society.
Doubtless if the sphere of operation of the English After-Care
Association could be so widened as to exercise for a prolonged
period some supervision over and personal interest in all rate-aided
patients discharged from asylums, whether requiring pecuniary
assistance or not, their dischaige would be facilitated, and, quite
possibly, the chances of their relapse diminished.

R. Cunyngham Brown.

852

ABSTRACTS

TREATMENT.

POTASSIUM BROMIDE IN EPILEPSY. (Emploi du bro m ine de
(492) potassium dans l’lpilepsie.) Jules and Roger Voisin,
Presse MidicdU , Aug. 25, 1906, p. 541.

The mechanism of the action of bromide in epilepsy is that it is
supposed to take the place of the molecules of sodium chloride,
which are combined with albuminoids. Various adjuncts have been
proposed in its administration. The authors recommend pilocarpin,
and give the following prescription:—

Potassium bromide.
Nitrate of pilocarpin
Syrup of orange
Water

•035

400

600

grammes.

Pilocarpin is useful, because of its diuretic and sudorific action.
“ Dechloridation,” or the reduction of the chlorides, is not always
advisable, however much its worth has been vaunted. The regime
which the authors have found serviceable may thus be indicated:—

10 days of ordinary diet, with 4 grammes of KBr daily;
followed by

10 days of ordinary diet, with 10 grammes of KBr daily;
followed by

10 days on a salt-free diet, and no bromide.

This sudden suspension of the bromide is harmless, for the
latter has soaked the tissues of the organism, and does not disap¬
pear at once from the body. On the other hand, it is a mistake to
suspend the bromide if the patient has previously been on a salt-free
diet. S. A K Wilson.

THE PRESENT STATUS OF BRAIN SUROERY. Allan Stars,
(493) Joum. of Amer. Med. Assoc., Sept. 22, 1906.

Stare regards the present time as a suitable one for coming to
final conclusions in regard to the propriety of operations on the
brain, since it is twenty years since the first operations were per¬
formed. He thinks that it is now more possible to take a broader
and calmer view of the entire subject; to realise the limitations of
such operations; to appreciate their true value, and to determine
with exactness the class of cases in which brain surgery promises
success. He derives his conclusions from an extensive experience
in this field, and does not lay too great stress upon statistics, because

ABSTEACTS

853

he realises that very many cases, both of a favourable and un¬
favourable nature, have not been published.

With regard to the surgical treatment of epilepsy, he thinks
that the cases of epilepsy which are open to surgical treatment are
those in which it can be determined that there is a localised focus
of disease in the brain which acts as a starting-point for irritation,
and thus causes the epileptic attack. Such local foci of irritation
may be produced by an injury to the head not attended by external
evidence of injury. Internal causes, such as a small local inflam¬
mation of the meninges, a plaque of sclerosis in the brain, the
origin of which may be wholly unknown, are capable of producing
epilepsy. He points to experience in the treatment of abscess
and tumour as showing that the necessary cutting of the brain for
the relief of these diseases is liable to result in the production of
gliomatous scar tissue, which subsequently becomes a focus of
irritation, leading to epileptic attacks. He points out that the
essential difference between epilepsy produced by these local
lesions and idiopathic epilepsy consists in the fact that in the cases
open to operation the epileptic fit is usually preceded by a single
kind of aura, either a sensation of numbness in one extremity, or a
hallucination of sight, sound, smell, or taste; or by a sensation of
muscular twitching, which is immediately followed by a localised
spasm, confined at first to one extremity, or to one side of the face,
and extending, if it does extend, in a definite manner to the other
parts of the body. The fit is rarely attended by a loss of con¬
sciousness. He says that such a localised epilepsy, generally
described as Jacksonian epilepsy, is always due to a definite focus
of disease in the brain; furthermore, that this disease is cortical,
and hence accessible to the surgeon; and that, by following the
well-known guides to the localisation of such diseases, it can be
excised, either from the meninges or from the cortex, when these
parts are laid bare. He distinctly states that these are the only
cases of epilepsy which are open to cerebral operation. He points
out that epilepsy is a widespread disease among the community,
one person in five hundred being affected, and in his experience
not more than 2 per cent, of the cases of epilepsy are in any way
open to operation, the other 98 per cent, presenting none of the
characteristic symptoms of localised disease in the brain. He
thinks it is useless to trephine idiopathic epilepsy, even though it
may apparently have been caused by a fall or a blow on the head,
unless the attacks present the characteristics here named. He
thinks the prognosis in the cases of focal epilepsy open to opera¬
tion is not so favourable as was at first anticipated; even when a
focus of disease can be excised from the brain, or a plaque of
adherent meninges loosened or taken away. Some cicatrix is
inevitably left, and this too often remains as an adequate focus for

854

ABSTRACTS

the recurrence of the epilepsy. In only about 20 per cent, of the
patients operated upon has permanent cure been the terminal
result. In many cases relief for a certain time has followed the
operation, but after one, two, or three years these patients have
returned with a renewal of the symptoms, and second and third
operations have not been followed by permanent cure. Such
unfavourable results might possibly lead to the conclusion that in
the majority of these cases of focal epilepsy the operation should
be refused. But, as Starr points out, it is often found that the
focal epilepsy is the first symptom of the growth of a tumour, or
the development of a cyst in the cortex of the brain, and a careful
study of the histories of the cases of brain tumour reveals the
surprising fact that in many of them focal epilepsy was the
earliest sign of the development of the disease. He says that it is
therefore imperative to operate in these cases of focal epilepsy as
soon as the diagnosis is made: (1) because of the possible relief of
epilepsy; and (2) for the possible discovery of a more serious and
fatal disease, which is just commencing.

He reports operations performed for the relief of epilepsy of a
focal nature in about sixty cases. In a few of these relief by
operation was found to be impossible. In about one-fifth a
permanent cure was obtained. In the remainder the epilepsy
recurred, and was in no way affected by the operation. He
concludes as a result of his experience, that the operation of
trephining in epilepsy is of very limited application, and is only
to be recommended in a few selected cases, which present the
necessary guides to both physician and surgeon.

Turning to the surgical treatment of abscess of the brain of
traumatic origin, he thinks that they should be operated upon early,
when located in parts of the brain which produce definite cerebral
symptoms. In cases of fracture of the skull, or concussion, followed
within two or three weeks by the development of symptoms sug¬
gestive of abscess, Starr says that it is imperative to trephine, even
though the indications are purely those of a surgical kind, there
being no localised cerebral symptoms; for there are many districts
of the brain, disease of which does not produce known effects.

Patients with abscess of the brain, developed subsequently to
chronic otitis media, should be operated upon as early as it is
possible to make a diagnosis. He thinks the diagnosis of abscess
of the brain is comparatively simple in cases in which the usual
causes have preceded the development of surgical symptoms.
Headache, vertigo, vomiting, slow pulse, marked change in the
mental state, sensations of dulness and hebetude, slowness of
thought, irritability of temper, defective memoiy and depression,
tenderness of the head to percussion, irregular pupils, and optic
neuritis, constitute sufficient evidence of a cerebral complication.

ABSTRACTS

855

When meningitis occurs, as a rule lumbar puncture will reveal
au increased number of leucocytes in the cerebro-spinal fluid,
together with the existence of micro-organisms. He therefore
regards lumbar puncture as an important means of differential
diagnosis between meningitis and cerebral abscess. He regards
the examination of the blood also as a means of diagnosis, for a
sudden and great increase in the leucocytes is an indication of a
cerebral complication, and the leucocyte count in meningitis is
usually higher than that in abscess. Starr holds that as soon as
the diagnosis of cerebral abscess is made under any circumstances,
it is imperative to operate; and while the percentage of recoveries,
from the nature of the case, is at present only about 60 per cent,
in the statistics that he has collected, including about 500 cases,
yet he holds that there is every reason to believe that in cases
which are diagnosed early, and operation undertaken as soon as
the diagnosis is made, the percentage of recoveries will be much
greater.

Turning to the surgical treatment of tumours of the brain, he
thinks that in cases in which the diagnosis of brain tumour is
made early from the general symptoms, together with the special
localising signs, operative interference is warranted; but that in
the far larger number of cases in which localising signs are absent,
operation promises nothing. He refers to the statistics published
by Knapp, which the author of this article has already reviewed in
the last number of this journal, and finds that they are quite in
accordance with his own experience. He thinks that, even though
the number of lives saved is a small one, it is our duty to study
every case with our minds fixed on the question of possible
surgical relief. He thinks that palliative operations for the relief
of symptoms are justifiable, although he quotes two cases in which
they did not succeed.

Referring to the surgical treatment of cerebral haemorrhage, he
thinks that it requires a large amount of courage to suggest an
operation on the head of a patient who is comatose from an
apoplexy. He refers to the fact that Harvey Cushing has applied
successfully in hospital cases the test of the condition of the pulse
tension, in order to determine the need of surgical intervention to
prevent death. When the blood pressure rises steadily to 250 mm.,
measured on the Riva Rocci apparatus in a case of apoplexy, and
coincidently with this rise a very slow pulse, falling to 50 a
minute, we may say that the case will be fatal. He thinks that
in such a case we are justified in resorting to surgery. The object
in view is to relieve the intracranial pressure. This is done by
turning down a large bony flap, or making a large fenestrum in
the skull, irrespective of any attempt to find or remove the clot.
The best place to open is over the motor area on the side opposite

856

ABSTRACTS

to the paralysis, as in some cases the clot may be found there.
The dura should be exposed and divided. If the clot is on the
surface, it will then be seen. If the clot is within the brain, the
brain will bulge, and division in the depth of a fissure may succeed
in reaching and evacuating the clot. Even if the clot is not found
and removed, the relief of the intracranial pressure stops the
alarming symptoms, and recovery is much hastened, as Cushing's
cases have proved. The pulse tension falls as soon as the skull is
opened. The pulse becomes more rapid, Cheynes-Stokes respira¬
tion ceases, and consciousness soon returns. The operation thus
offers life in a formerly hopeless condition. He refers to Cushing’s
operations in cases of haemorrhage in the new bom, and thinks
that any measure for their relief is justifiable. He thinks that
Cushing’s success in these cases warrants us in urging on all
obstetricians the duty of considering this operation in asphyxiated
infants. It is they who see these cases, and if they can be per¬
suaded that delay in them is dangerous, and the prospect of
relief is good, the percentage of idiocy and hemiplegic epilepsy
will be reduced.

He refers to the cases of cerebral haemorrhage, in which hemi¬
plegia, aphasia or hemianopsia, develop slowly after an injury, and
do not come to their height for three or four days, as another class
of case open to trephining. A lumbar puncture will reveal bloody
cerebro-spinal fluid. The symptoms may increase and threaten
life, as shown by the slow pulse, Cheynes-Stokes respiration, and
increasing blood pressure; or they may come to a standstill, leav¬
ing the patient permanently incapacitated. In either case suigical
treatment is indicated.

He refers to a successful case, operated on in 1889, and many
other cases, which have been equally successful, since then.

Passing on to the surgical treatment of imbecility, due to
microcephalus, he refers to the operation of craniectomy, for
allowing an increased expansion of the brain. In spite of many
operations, reported in many lands, he says that the subsequent
history of these cases has demonstrated conclusively that no
marked mental improvement ever follows this operation. It is
evident that the microcephalus is not the cause of the imbecility,
but the imperfect and rudimentary development of the brain,
which does not grow in proportion to the rest of the body, pre¬
vents the normal expansion of the skull over a normally growing
brain, and leads to an early closure of the fontanelles. He says
that the slight improvement which in some cases has appeared to
follow the operation, in no way differs from a corresponding
improvement in [patients equally affected, and equally trained,
who have not been operated upon. For this reason he no longer
recommends any operation on the head in cases of idiocy, im-

ABSTRACTS

857

facility, hemiplegia, and epilepsy, dating from childhood, and
states that these operations have no effect whatever on the painful
condition so often associated with these conditions, namely,
athetosis. Donald Armour.

THE SUBOIOAL TREATMENT OF TRIGEMINAL NEURALGIA.

(494) Being a Study of the Cases of Recurrence after Operative
Treatment, with Suggestions as to the Best Methods of
Obviating Post-Operative Recurrence. Moschcowitz, New
York Med. Bee., Sept. 29, 1906.

Moschcowitz shortly reviews the pathogenesis of trigeminal
neuralgia. He points out that there is no agreement in the views
of the numerous observers as regards the pathology of the disease,
and classifies the changes that have been found under two
headings:—

1. Those that have been found in the peripheral nerves.

2. Those that have been found in the Gasserian ganglion.

1. The following are the various pathological changes found in
the peripheral nerves by various writers:—Dana: an obliterative
endarteritis, but no changes in the nerve elements. Putnam: an
endarteritis and a general fibrosis. Horsley: a sclerosis, with a
shrunken epineurium, probably due to an active congestion and
oedema in the early stages. Schweinitz and Rose: an obliterative
endarteritis, with the axis cylinders swollen or shrunken, and
occasionally absent, the myelin sheaths swollen, the sheaths of
Schwann swollen and markedly rich in nuclei. The endoneurium
was increased, particularly in the neighbourhood of the blood
vessels. The changes resembled those of a chronic neuritis, and as
they were more marked at the periphery than at the centre, Rose
assumed that the lesion was an ascending one. Krause’s examina¬
tion of nerve trunks, obtained by evulsion, showed only occasionally
a thickening of the nerve sheaths, and nothing else.

2. The following are the pathological changes that have been
found in the Gasserian ganglion by various observers:—Rose: a
thickening of the interstitial connective tissue, and irregularity in
the formation of the ganglionic cells. He regards the disease as a
chronic inflammatory process. Horsley has found no more
degenerative changes in the ganglion than could be accounted for
by the age, condition, and habits of the patient. Antonio d’Antona
found a sclerosis of the ganglion. Krause found no sclerosis or
endarteritis, but only degeneration of the ganglionic cells and nerve
fibres. He regards the origin of the disease as being in the
Gasserian ganglion. Moschcowitz thinks that the argument that

3 K

858

ABSTRACTS

the disease is a neuritis can probably be negatived, because, with
the exception of the symptom of pain, trigeminal neuralgia presents
none of the symptoms and physical signs of any other well-
recognised neuritis, such as anaesthesia, paralysis, or the electrical
reactions. Frazier thinks that, from our present knowledge, there
are two or three distinct types of trigeminal neuralgia, one in
which the lesion is primarily a neuritis of the peripheral branches,
.which subsequently may or may not extend to and invade the
ganglion; another, in which a primary lesion first appears in the
ganglion; and a third, in which the lesion is neither in the ganglion
nor its branches, but in the central nervous system. The lesion
may be of a degenerative type, an interstitial neuritis, or
a neoplasm.

Spiller, from the examination of ten Gasserian ganglia removed
by Keen, describes his findings as follows:—

“ The lesions in the Gasserian ganglion, in the more advanced
cases of tic douloureux, consist of large swollen medullary sheaths,
swollen axis cylinders, atrophied fibres, empty nerve sheaths,
nerve bundles, in which the nerve elements have been destroyed
and only connective tissue is left, atrophied ganglion cells, cells
faintly stained, and sclerosed blood-vessels, in some cases even
without a lumen.”

Moschcowitz points out that all the observers quoted above have
regarded the pathological changes as primary, and in direct
setiological relation to the disease. Assuming, then, that many
of the changes which they describe have actually occurred, he
thinks we cannot accept their findings as primary, because all the
pathological changes can be easily accounted for as secondary
products. These secondary influences might be classified as
follows:—

1. Rough handling of the nerve or ganglion, as a result of the
necessary manipulations in the course of the extirpation.

2. Incomplete preservation of the ganglion after removal.

3. The age of the patient.

4. Ascending changes in the nerve or ganglion as the result of
previous peripheral operations.

He refers to the researches of Monari, Schwab, and Coenen, as
showing the possibility of this. These observers had examined five
ganglia, in cases where no previous peripheral operation had been
performed, and found the ganglia were entirely normal. Billroth,
Hutchison, and Cushing have found no changes in the ganglion
or nerve.

Moschcowitz suggests that trigeminal neuralgia may possibly
be accounted for by assuming some variety of vasomotor disturb¬
ance. He therefore classifies it with such diseases as Raynaud's
disease, intermittent claudication of Erb, erythromelalgia, etc..

ABSTRACTS

859

although he confesses that this theory cannot be proved by
definite pathological or physiological evidence. He regards ex¬
tirpation of the Gasserian ganglion as a symptomatic cure, and as
the treatment of trigeminal neuralgia has resolved itself into the
relief of pain, the simplest operation that could be devised would
be one which would prevent unnecessary impulses from passing
into the brain—in other words, neurotomy. He refers to the first
neurotomy, done in 1748 by Schlichting, and others by Louis in
1766, and Viellart in 1768. He refers to the disappointment
following the operation for neurectomy, which was a direct
development of the first proceeding. He refers to the various
operations for attacking the branches of the ganglion at their exit
through the foramina at the base of the skull. He says that these
operations have been found wanting, because of the frequency of
recurrence of the malady in a large percentage of cases, and says
that, as in neurotomy and neurectomy, the cause of the relapse has
in every instance been due to regeneration 'f the divided nerve.
He thinks that these operations at the base of the skull are merely
neurotomies and neurectomies, performed at a higher level, and
that the relapses are not to be wondered at. He then refers to
Thiersch’s operation of evulsion of the nerve (neurexairesis), brought
forward in 1889. Recurrences were as frequent after this method
as before. The idea of attacking the intracranial portion of the
fifth nerve was first suggested by Mears in 1884, who, however,
never performed it After operations by Rose, who used the
pterygoid route, and Horsley, who in 1891 divided the intracranial
root of the fifth nerve, ganglionic extirpation was placed on a firm
footing by Hartley and Krause. Moschcowitz refers to the com¬
paratively high mortality, which he apparently arrives at from
cases collected some years ago. He regards the results in a very
large percentage of all operative recoveries as excellent He refers
to instances of recurrence reported by Friedreich, Garr^, Parmenter,
Sapejko, Schwartz, Marchant and Hebert and Perthes. He thinks
that on account of these recurrences after complete extirpation of
the Gasserian ganglion the operation is not based on a correct
principle. He further thinks that he is justified in coming to the
following conclusions regarding the Hartley-Krause operation:—

1. The operation is attended by a very high mortality.

2. It undoubtedly gives the greatest number of complete
recoveries.

3. Occasionally, though rarely, recurrences have been met
with after this operation, even in competent hands.

4. The relapses are due to a regeneration and reunion of the
divided nerves.

He concludes his article by advocating the plugging of the
foramina after section of the nerve with fine celluloid, such as is

860

ABSTRACTS

used in photographic films. This suggestion is merely a modifica¬
tion of one made by Abbd, who used rubber tissue as an inter¬
vening medium. Moschcowitz also suggests thin flat gold buttons,
provided with suitable sized shanks, for insertion in the foramina.
He then refers to the intraneural injection of osmic acid, which
has been so warmly advocated by Murphy, and points out that in
the majority of cases a recurrence follows sooner or later.
Moschcowitz sums up the treatment of trigeminal neuralgia in the
following conclusions:—

1. Eliminate any possible setiological factors, such as tumours,
carious teeth, antral disease, malaria, syphilis, etc.

2. Determine accurately the nerve branch or branches in¬
volved.

3. The operation should be performed as near to the periphery
as possible.

4. The operation should be performed early. This is important,
because the earlier the case, the more chances there are that a
peripheral operation will be of benefit.

5. Whatever the character of the operation may be, the
dominant principle must be the prevention of regeneration of the
affected nerve.

More specifically, the operation may be classed under two
headings, peripheral and central.

6. He believes that if the above principles in the treatment of
trigeminal neuralgia are carried out, the operation of extirpation of
the Gasserian ganglion will become entirely unnecessary.

Donald Armour.

SOME POINTS IN THE SUKGERY OF THE PERIPHERAL
(495) NEBVES. James Sherren, Edin. Med. Joum., Oct. 1906, p. 297.

A number of problems are here discussed, and tables of cases
referring to each are appended. The first question concerns the
methods available to restore continuity to a divided nerve, the
ends of which cannot be brought into apposition. These methods
fall under five groups:—

1. Nerve transplantation, the gap being filled by a portion of
nerve derived from another source. Wliere the source is the
patient or another human being, the results are good, perfect
recovery being not infrequent; this is the ideal operation. Where
the nerve is from an animal, the results are worse, the piece of
nerve apparently dying instead of merely degenerating ; only one
out of sixteen cases was completely successful, and six were
partially so.

ABSTRACTS

861

2. Flap operations, a portion of the nerve being turned down
or up. Though not without successes, this method is not
encouraging.

3. Provision of an artificial path for regeneration. Usually
strands of catgut are used for the bridge, the nerve ends and
catgut being sometimes surrounded by a tube of decalcified
bone, or other material, to prevent adhesions. This method
gives results equal to those of transplantation of animal nerve.

4. Utilisation of neighbouring nerves. Here there are two
varieties: (1) Nerve crossing, where the sound nerve is com¬
pletely divided, and its central end united to the peripheral
end of the injured nerve. (2) Nerve anastomosis, where only
some of the axis cylinders of the sound nerve are divided and
employed. The latter variety practically is the only pne suitable
for traumatic cases. Nerve anastomosis may be central , where the
whole of the sound nerve or a slip from it is inserted into the side
of the injured nerve; or distal, where the whole or part of the
peripheral end of the injured nerve is inserted into the sound
nerve, or attached to a slip of it. Of twelve cases of anastomosis
all but two showed improvement.

5. Shortening the limit by resection of bone. This is rarely
justifiable.

The second question considered in the article is the treatment of
facial paralysis by nerve crossing or nerve anastomosis. The spinal
accessory or the hypoglossal may be employed, and in none of the
cases collected has some voluntary movement—in many cases
very complete—failed to return. The chief difficulty is the
tendency for facial movements to be associated with those of the
trapezius or tongue, according to the nerve used; but dissocia¬
tion of the movements has now occurred in a number of cases,
the hypoglossal having given the better results in this respect.
Transverse incision into the nerve and suture into it of the peri¬
pheral end of the facial seems to be the operation of choice. As
a rule, improvement does not begin for four or five months, and
requires several years for completion, massage and electricity
being meanwhile used as may be necessary.

These successes naturally suggested operation on cases of
paralysis of central origin, such as infantile paralysis. The
results in suitable cases are distinctly encouraging. The best
operation seems to be complete division of the affectkl nerve, and
end to end suture to a flap raised from a sound nerve. If the
affected nerve, however, be small, it is sufficient to suture it into
a slit in the reinforcing nerve. W. J. Stuabt.

862

ABSTRACTS

FAILURES Df THE TRANSPLANTATION OF TENDONS.

(496) (MLuerfolge der Sehnenfiberpflanziwg.) Oscar Vulpius,
Berlin, klin. Wochenschr., No. 42, 1906.

The ill-successes attending such operations are chiefly to be
attributed to the selection of unsuitable cases. The more limited
the paralysis existing, the greater is the prospect of success; for
the more antagonistic the action of the muscle employed is, the
greater is not only the mechanical disability, but the strain thrown
on the central nervous system in accommodating its functions.
If the available muscles are paretic, either from previous polio¬
myelitis or atrophy of disuse, they may not be capable of replacing
those actually paralysed, but in course of time become stretched
and useless. In such cases implantation of tendons on bone is the
preferable operation. One difficulty in ensuring success of trans¬
plantations lies in determining beforehand the degree of usefulness
or capacity of recovery of the available muscles.

In quadriceps paralysis the results of operations are wonder¬
fully good. In deltoid paralysis tendon transplantation is contra¬
indicated. Arthrodesis gives better results. With regard to the
forearm the great risk is of over-correction, and transplantation to
correct extensor paralysis of the hand is useless if, as may easily
happen, limitation of flexion and of the finer movements of the
fingers results.

In the paralysis associated with poliomyelitis transplanta¬
tion operations must await the termination of the disease and its
ultimate effects on the muscles implicated. In the case of
progressive muscular dystrophy, however, Vulpius considers that
transplantation of tendons is not contraindicated during the course
of the disease, if for instance during a pause in its advance one
can secure for the patient an improvement in locomotion for the
space of a few years.

In spastic affections of children associated with mental weak¬
ness, such cases as show paralysis of bladder or rectum, spastic
paralysis of the srms or athetosis are best left unoperated on.

In operative procedures care must be taken to avoid in the
restitution of one function the complete abolition of another, as
for instance by transplanting both peroneal muscles. From the
point of view of nerve function it is better to use a whole muscle
than to split it. Great care must be taken to ensure the preserva¬
tion of tone in the transplanted muscle; too great or too slight
tension will result in atrophy. Rest must be sufficiently prolonged
after operation to procure firm union of the sutured tendona
Massage and exercises are subsequently of prime importance to
avoid stiffness and to assist the development of the nervous
accommodation. L C. Peel Ritchie.

REPORT OF CONGRESS

86S

REPORT OF THE CONGRESS OF ALIENISTS AND NBURO-
LOOISTS OF FRENCH-SPEAKING COUNTRIES

Held at Lille, August 1906.

( Continued .)

The third report, that on the responsibility of hysterics, was
prefaced by its author, Leroy of Ville Evrard, with the quotation
of the various definitions of this neurosis. Those of Pitres,
Bemheim, Babinski, and Janet were considered, but the reporter
neither selected one, nor gave a precise definition of what consti¬
tutes hysteria. The physiological theory of Sollier, however, was
not cited. As a consequence, the report becomes an attempt to
appreciate the responsibility of subjects showing manifestations
considered to indicate a morbid condition hitherto so vague as to
escape definition. It is only just to add, however, that Leroy
attempts to separate from pure hysteria such conditions as mental
degeneration and intoxications.

The unsatisfactoriness of this want of precision led the Con¬
gress to seek for a report which will enable them to focus the
manifold ideas regarding the definition and nature of hysteria, and
it may be advisable to defer an analysis of the views on this
subject until Claude has presented his report at Geneva.

Given then this ill-defined condition, is any modification of
responsibility entailed thereby ? This will depend upon two
points: (1) the patient, as regards antecedents and physical signs,
and (2) the peculiarities of the crime committed. As to the
patient, Leroy considers that even slight attacks of paralysis,
contracture, or somnambulism, are more serious than syncope with
constriction of the throat; and he thinks that a considerable
anaesthesia of general, special, or visceral senses indicates grave
psychic trouble tending towards double personality.

Quite as important is it, in a medico-legal examination, to
appreciate the degree of suggestibility, of aboulia, or of amnesia.
A patient showing these symptoms should often be deemed
irresponsible for an act which in itself seems to have been dictated
by motives that are perverse though not irrational. The respon¬
sibility in such cases is qualified as “ modified ” by most experts,
but Leroy considers that such subjects are diseased, and are there¬
fore completely irresponsible on account of their true mental
inferiority, which entails atrophy of the altruistic or social feelings
along with a restriction in the breadth of apperception. For him
confinement, when indicated, should be in an asylum, not in
prison, as well in the slight cases as in the grave hysteria which
no one disputes.

864

REPOET OF CONGRESS

In the second place, however, the characters of the act often in
themselves show the patient to have been at the time irresponsible,
even although physical examination may show the stigmata to be
slight, while on the other hand an avowed hysteric is not irrespon¬
sible for every act he commits. To give such people a bill of
indemnity to the detriment of public order is not only inexpedient
but inexact.

What conditions, then, indicate irresponsibility t Those acts
committed when the subject is under the influence of hallucina¬
tions, or of delusional ideas, or is in an ecstatic or agitated state, even
when these are merely transitory and more or less abortive; for in
the opinion of Leroy, these states are substitutions for convulsive
fits, and are the only true hysterical delires. Of course the actions
committed during somnambulism are judged in the same way.
A theft, a murder, or a flight is here dictated by a fixed idea, of
which the patient is the automatic plaything. To the so-called
“ second state,” which is merely a prolonged somnambulism, the
same considerations apply. The two personalities may have
entirely different mental content, and be different characters. In
judging of responsibility, one must be very careful to see that the
act has really been committed during the “ second state."

This is the explanation of many of the lies of hysterics. Leroy
agrees with Pitres in saying that Huchard and Legrand du Saulle
were mistaken in attributing to simulation phenomena of this kind
simply because they could not explain them. As Janet has clearly
shown, the hysterical consciousness is sometimes so vague that
dream states are mistaken for reality, and vice versd, while the
distinction between yesterday and to-morrow is seldom clear.
First one image predominates and then another, and hence the
untruthfulness; for the hysteric is not am inhibitory creature.
His images eventuate in action; impulsion arising in misconception
is the foundation of a crime.

But mythomania, as Duprd calls a morbid tendency to lying,
is often fully conscious and intentional, and springs chiefly from
the desire to create an impression. It is an infantile characteristic,
not outgrown in ontogenetic evolution, which has been arrested
in its march towards the summits of accuracy and precision of
thought, popularly represented as truthfulness. What appears at
first sight an unequivocal simulation will often be discovered to
be in reality merely the product of a morbid fancy brooding over
some imaginary situation, suggested perhaps by a sensational
journal or some prurient acquaintance. The most familiar and
striking, because the most easily understood example, is furnished
by the periodic change of fashion in methods of suicide. Rigorous
application of this very simple principle explains much of the
seemingly intentional mendacious simulation of hysterics.

REPORT OF CONGRESS

865

Several interesting cases were cited in support of this. One
of a haunted house, taken from Grasset on “ Spiritualism before
Science,” was particularly striking as a mixture of hallucinations
and trickery. Another case of automatic writing with alleged
revelations, taken from Esoaud de Messieres, was attributed to
purely subliminal phenomena without trickery, and several accusa¬
tions of rape were quoted in support of this contention. The
distinctive characters of auto-accusation—apparent lucidity with
a wealth of detail, the likeliness of the crime and the invariability
of its recital—were supported by numerous cases varying from
frank hallucinations to evident simulation.

The deterministic explanation of the mechanism of such cases,
with its corollary of complete irresponsibility, was vehemently
combated by Grasset, who adhered to the old doctrine of modified
responsibility, which in judicial practice should not connote a
lighter punishment For him, the basis of responsibility is nor¬
mality of the neurones, and as it is impossible to draw a fixed line
separating mankind into two classes, entirely healthy and entirely
morbid, it follows that there is a vast category of more or less
inferior, though not totally irresponsible individuals, who yet
cannot be held accountable to the full degree for their actions, and
that it is the duty of the expert to appreciate to what degree they
should be responsible to the law for such actions. But as criminals
of this class cannot logically be placed in prison, and as they are
not sufficiently insane to require detention in a lunatic asylum, it
is urgently necessary to create special prison asylums. Society
will thus be guarded against these half-insane people, while at the
same time it is treating their deficiencies. The principle does not
differ from that of isolation of cases of plague, small-pox or cholera.
In this view Grasset was supported by Duprd and R^gis. The
latter urged that limi tation of responsibility should not mean a
shortened period of incarceration, since experience has shown that
though a long term has sometimes benefited, a short sentence
only aggravates a tendency to crime, so that the individual is not
benefited, and society continues to suffer from his misconduct.

With regard to whether the simulations should be diagnosed as
due to hysteria or to a fully conscious and voluntary effort, there
is no certain criterion, for indeed, deliberate deception alternates
with the work of unconscious fixed ideas. Williams urged, how¬
ever, that in either case no deterrent is so powerful (and in this
respect the hysteric does not differ from the normal), as a fore¬
knowledge of the unpleasant results to oneself which an anti-BOcial
act entails, and to mitigate this unpleasantness is to loosen the
social curb just with regard to the individuals to whom it is most
necessary on account of the insufficiency of their own inhibitory
power. The “impulsiveness” of the worse - than - savages who

866

REPORT OF CONGRESS

terrorised Liverpool was restrained as soon as these scoundrels
understood that a determined Chief of Police inflicted upon them
the cat-o’-nine-tails; and such a stimulus differs only in degree
from that exercised over the young girl who has not lost the power
of preventing her hysterical attacks by the presence of some one
who she knows will not hesitate to use such drastic measures as
the “cold water cure.” To lose sight of these principles is to
deprive these unfortunates of their very best incentive to good
conduct; for to pity and coddle is the very worst method of
building a self-reliant character, and it is emphatically the lack
of character and self-control that is the source of these patients’
troubles. It is only when such social incentives fail to produce
good conduct that mental alienation is constituted ; and it follows
that as society deprives itself of these incentives, in that propor¬
tion will mental alienation increase among such suggestible sub¬
jects. The “antiquated, common - sense ” legislation in Great
Britain has escaped the social danger of departing from this point
of view, from which in France and America innumerable medico¬
legal subtleties have of late caused a divergence, the result of
which is manifested by the enormous increase in crimes of violence
committed by impulsive degenerates in those countries.

It was to the complication with mental degeneration that
Duprd attributed most of the crimes of hysterics. Hysteria itself,
in his view, eventuated rather in a fit than in an action foreign to
the moral make-up of the patient. This is well illustrated by the
fact that there is no authenticated case of a crime committed
during hypnosis 1 at the instigation of the suggestioner. If the
subject is urged to overstep the simulacrum of the act suggested,
he responds by his typical fit. To this doctrine it may be objected
that while a crime will not be committed out of harmony with the
moral content, yet the extreme suggestibility of these subjects
renders that moral content very susceptible to modification, and
also renders an education towards criminality relatively easy.
But at the same time it must not be forgotten, as Raymond has
clearly pointed out in connection with the fugues, that every
manifestation of an epileptic is not necessarily due to that con¬
dition ; nor is the theft, the flight, or the arson of the psychasthenic
necessarily a manifestation of that neurosis. Indeed, he and
Janet have emphasised the fact that the fixed ideas of the
psychasthenic do not eventuate in action, but, as in the case of
Macbeth, they oscillate, “ letting I dare not wait upon I would.”
Raymond distinguishes the hysterical impulsions by their secondary
amnesia, which disappears if the second state returns, whereas
they resemble the impulsions of degenerates in originating in fixed
ideas, of which in the latter, however, the subject is always fully

1 Babinski holds that hypnosis is merely a highly exaggerated hysterical state.

REPORT OF CONGRESS

867

conscious. From the impulsions of alcoholics it is very difficult to
disassociate hysteria; for such neurotic subjects have generally a
strong appetite for intoxicants, and are particularly susceptible to
their influence, which often, indeed, determines temporary states
of mental disequilibration, which may eventuate in crime.

The character of the act, as in the preceding examples and in
epilepsy and dementia prsecox, generally permits one to detect the
factor to which it is due, and hence to say how far it is due to
disease. It is to this duty that the intervention of the physician
should be confined, however difficult he may find it to so limit
himself. He is called merely as a medical expert, and it is
not his province to determine the fate of the patient from a social
point of view ; that is the duty of the Court, and the expert who
allows his opinions to be coloured by considerations not belonging
to his specialty arrogates to himself a function to which he has no
right.

According to Leroy, actions which may be distinguished as
hysterical are: (1) those which are due to the extreme suggesti¬
bility of the subject, which makes him the plaything of an influence
such as a dream, a hallucination, or some outside agency; (2) those
which are accomplished in the “ second state,” that is, where the
everyday ego is unconscious of the act; (8) those which are due to
instantaneous reaction to emotion, along with difficulty in stopping
an action already commenced, the subject being for the time truly
inaocessible to restraint exercised by himself or by others; (4)
hysterical actions show in a marked way strange, romantic,
mysterious, dramatic, sensational, bizarre characteristics, and are
very often accompanied by naivete and a crass want of foresight.

Tom A. Williams.

■Reviews

ATLAS DBS PATHOLOGISCHEN HISTOLOGIE DES NERVEN-
STSTEMS. m. Lieferung. Histologie des lesions exp4ri-
mentelles et pathologiques des cellules nerveuses surtout des
ganglions spinaux. V. Babes et G. Marinesoo. Berlin: Aug.
Hirschwald. 1906.

This fasciculus of the valuable Atlas edited by Dr Babes is devoted
to the demonstration of new data regarding the fine structure of
nerve-cells and the changes which their component elements
undergo in various conditions of intoxication and infection, and

868

KEVIEWS

after injury to the axis-cylinder. It contains an introduction
dealing with recent work regarding the fine structure of the nerve
cell, and the relationship of the chromatic and the achromatic con¬
stituents to each other and to the neuro-fibrillae. It contains also
a brief remmA of the more important recent views regarding the
distribution of the neuro-fibrillse within the cell. It is to be
regretted that the limitations of space have made this introduction
somewhat too concise. Nine beautifully executed chromo-litho¬
graph ic plates, containing sixty-four figures, show the fine changes
in normal nerve-cells, in nerve-cells which have been poisoned by
such substances as morphine, arsenic, snake venom, tetanus toxin
and rabies, and also motor-cells and cells of the posterior root
ganglia after section of nerves. The illustrations demonstrate
with great clearness the remarkable changes which take place not
only in the chromatic granules, but also in the neuro-fibrillse, and
in the nucleus and nucleolus. An indication is given of the reason
for the hitherto insufficiently explained fact of the displacement
and extrusion of the nucleus during the process of chromatolysis.
The authors show that in certain cases, after section of the nerves,
there is a peculiar localised swelling of the reticulum in part of the
cell, which appears to be in such a position as to mechanically dis¬
place the nucleus towards the side of the cell.

As a demonstration of the recent work on the morbid changes
in the nerve-cell, the figures leave little to be desired.

Alexander Bruce.

THE DIAGNOSIS OF NERVOUS DISEASES. Purvks Stewart,

M.A, M.D., F.R.C.P. London: Edward Arnold. 1906.

Price 15 s,

We have nothing but praise for this book, which it is our pleasant
duty to review. The author has approached the diagnosis of
nervous diseases from the clinical standpoint, “avoiding abstruse
details of purely theoretical interest,” and we heartily congratulate
him upon the success which has attended his efforts. The two
first chapters contain a clear and concise account of the chief
anatomical and physiological points which are of importance to
the clinician. The illustrations in these chapters are deserving of
special mention; two diagrams which represent the most recent
views as to the course of the motor and sensory tracts, are especially
instructive. In the third chapter the author describes the method
of case-taking which he is in the habit of using. Succeeding chap¬
ters deal with coma, fits, involuntary movements, aphasia, disorders
of articulation, the cranial nerves, pain and other abnormal subjective
sensations, abnormalities of sensation, organic motor paralysis,

REVIEWS

869

recurrent and transient palsies, incoordination, postures and gaits,
the trophoneuroses, reflexes, and affections of the sympathetic. In
the last three chapters, hysteria, electro-diagnosis and electro¬
prognosis, and the cerebro-spinal fluid are considered. The excel¬
lence of the half-tone reproductions is a pleasing feature of the
work. In conclusion, we may say that the book is admirably
adapted to meet the wants of the physician who wishes to obtain
in comparatively small compass an up-to-date knowledge of the
diagnosis of nervous diseases which will prove of real service to
him in practice. The book will also be read with interest and
profit by those who have especially applied themselves to the
study of the diseases of the nervous system.

Edwin Bramwell.

OUTLINES OF COMPARATIVE LUNACY LAW. (BeitrBge zu
einem Grandma des vergleichenden Irrenrichtes.) Dr Jur.
Marcus Wyler, pp. 182. Halle a. S.: Carl Marhold. 1906.

At a time like the present when various amendments to our
lunacy laws are under consideration, such as the certification and
detention of the victims of alcohol and drug habits, the insertion
of clauses permitting the extra-asylum treatment of cases of
incipient insanity, the formation of university clinics in psychiatry,
and the establishment in England and Wales of the family-care
system, a small pandect of the lunacy laws of all countries cannot
but be of great value to medical men and others interested in
these matters.

Dr Wyler is not a medical man, but is a jurist who has con¬
tributed many articles on this subject to various Continental
journals, and, with the exception of Part III. of this book on the
“ State Supervision of the Insane,” the whole of the present work
has appeared in the Psychiatrisch-Neurologische Wochcnschrifb
during the year 1905. Part I. deals with the “ Legal Basis of the
State Care of the Insane,” and describes the essential features of
the various legal enactments and stipulations concerning the
insane in all European states and America. Wide divergences
exist, and a perusal of this and the subsequent parts shows the
force of what Dr Wyler pointed out in an able precis published in
the British Medical Journal of 13th January 1906, that English
law, by its confusion of poor law and lunacy law and its combina¬
tion of public and private law, differs from that of almost every
other country.

In Part II the principal administrative forms as defined by
law, the public and private asylums, and the family-care system.

S70

REVIEWS

are examined and compared. The whole matter is, of course, re¬
garded solely under its legal aspect, and it seems possible that a
certain ambiguity of law and laxity of procedure which the author
deplores as present in certain countries is of positive advantage to
the patients by permitting a greater freedom of medical treatment
In this connection it is of interest to note that in the author's
judgment it is very doubtful whether certain states which have
adopted the family-care system are legally justified in doing so.
Dr Wyler’s book differs from the distinguished work of Hermann
Reu88, published in 1888, on the lunacy laws of Europe and North
America, in that the latter described the various legal require¬
ments in their geographical order, whereas Dr Wyler collates the
information as to the several states under their proper categories,
thus avoiding repetition and facilitating reference. The whole
work, though small in bulk, must represent an immense amount of
labour on the part of its author; and as it contains the essential
features of the lunacy laws of Europe, and a complete list of refer¬
ences to the statutes at large of the several states, will be found
indispensable to the student of comparative lunacy law.

R. CUNYNGHAM BROWN.

A WALK IHBOUOB A UODE&K ASYLUM. {Bin Qu| durch

eine moderns Irrenanstalt.) By Dr H. Hoppe, of Konigsberg.

PP- 75, with 16 plates. Halle a. S.: Carl Marhold. 1906.

Price M. 1.60.

After many years’ service in public asylums, Dr Hoppe seeks in
the present work to give an account of the inner life— die
Geheimmisse —of a modem asylum. The book takes the form of
a personally conducted tour through the Provincial Asylum of
Galkhausen, between Cologne and Diisseldorf, and is particularly
addressed to the lay public in the hope of allaying many fears and
misconceptions about asylum treatment even to-day widely enter¬
tained. As, however, the construction and management of
asylums in Prussia differs in many particulars from our own, this
careful and intimate account of the Galkhausen Asylum will be
found of much interest to both medical and lay readers in this
country. The author opens by giving a brief historical account of
the treatment — or rather, ill-treatment — extended to the un¬
fortunate insane in the eighteenth and the beginning of the nine¬
teenth centuries, ensuing upon the then current misconceptions of
the nature of insanity, and the great changes which subsequently
extended all over Europe, initiated by Conolly’s abandonment of
mechanical restraint.

REVIEWS

871

From the administrative point of view the prominent features
of the virtual revolution so brought about have been the careful
classification of the patients according to the degree of liberty
which might safely be permitted them, and, following upon this,
the practical emancipation of great numbers of the insane.
Although initiated by an Englishman, this movement for the
granting of the greatest degree of liberty to the insane compatible
with public safety has in Great Britain lagged far behind that of
other countries, so that we have to-day only one institution in
occupation—that at Kingseat near Aberdeen—at all correspond¬
ing to the village-asylums of Germany. Of these village-asylums
Galkhausen affords a very good example, for the details of which
readers are referred to Dr Hoppe’s interesting description. The
various detached houses which compose the institution are, as is
usual, classified into closed, semi-closed, and open houses, and Dr
Hoppe says that experience has taught the directors the error of
timidity with regard to placing patients in the open houses. The
beneficial influence of increased liberty is most marked, "the
quarrelsome elements become peaceable sociable beings, the dis¬
contented grumbler ceases to complain, and the idler in restraint
turns out as diligent a worker as the ordinary free man.” Even
in the closed houses, not only has mechanical restraint been
entirely abolished, but the cellular system is hardly ever employed,
rest in bed or the prolonged warm bath being substituted. With
regard to the latter, the patients—presumably those who cannot
endure the restraint of clothes—remain for hours, or days, and in
some cases for weeks, day and night in the bath, almost invariably
to the patient’s great improvement “ Das Dauerbad,” Dr Hoppe
says, “ bildet den besten Ersatz der fruheren Tobzelle.”

Dr Hoppe sorrowfully admits that the family-care system is
not in practice at Galkhausen, not through any lack of recognition
of its value, for this is, he says, undoubtedly the ideal form of the
care of the insane, but simply because, and in this his opinion
coincides with many others, the family-care system is best
prosecuted in the form of autonomous colonies.

Dr Hoppe’s brochure is well illustrated with photographs and
plans, and ought not only to serve its purpose of reassuring the
friends of insane persons as to the care experienced in modern
asylums, but probably indicates the trend of asylum construction
and management of the insane in other countries.

R. CUNYNGHAM BROWN.

872

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AHATOMY

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Erg&nzungsheft, 1906, 8. 179.

PHYSIOLOGY

CHARLES 8. SHERRINGTON. The Integrative Action of the Nervous System.
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OSK AR VOGT. Ueber stmkturelle Himoentra, mit besonderer Berucksichtigung
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EBSTEIN. Ein Beitrag zur Lokalisation an der Gehiraoberfl&che. Klinii f.
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MAXWELL. Chemical Stimulation of the Motor Areas of the Cerebral Hemi¬
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LIE BEN. Zu Lehre von den Beziehungen der Groeshirnrinde zu den Pilomotem.
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WEBER. Einwirkung der Groeshirnrinde auf Blutdruck und Organvohunen.
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ENGELMANN. Zur Theorie der Contractflit&t. Reimer, Berlin, 1906, M. 1.
ALBERTONI. Contribution h la connoissance de repuisement de l’activit6 de
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ROUVIERE. Atude sur le d6veloppement phylogfoique de certaines muscles
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WM. SUTHERLAND. The Nature of Chemical and Electrical Stimulation.
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GEMITZ und W1NTER8TEIN. Ueber die Wirkung erhfihter Temperatur auf
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LUSSANA. La funzione dei canali semi-ciroolari. Riv. Sperimenl di Frtniatru z,
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KITAGAWA und THIERFELDEN. Ueber das Cerebron. III. Mitteil. Hoppe -
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PANELLA. Le nucl6one et l'eau du cerveau chez les animaux h jeun. Arch
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BURNETT. The Influence of Temperature upon the Contraction of Stripe
Muscle and its Relation to Chemical Reaction Velocity. Joum. Biol. Chem.
Oct 1906, p. 195.

MOBIUS. Ueber den physiologischen Schwachsinn des Weibes. Marhold,
Halle, 1907, M. 1.50.

PSYCHOLOGY

DUPUREUX. L’application de la recherche des tests mentaux de Binet chez
les enfants des 6cofea comm unales de Gand. Joum . de Neurol , nov. 5. 1906,
p. 555.

MEYER. Rausch und ZurechnungsfShigkeit. Archf. Psychiat ., Bd. 42, H. 1,
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LAPPONI. Hypnotismus und Spiritismus. Elischer, Leipzig, 1906, M. 4.
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f. Psychiat ., Bd. 42, H. 1, 1906, S. 194.

KATZ. Versuche liber den Einfluss der “ GedJtahtnisfarben” auf die Wahr-
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A. BABEL. Anomalies observes dans les rapports sociaux. Ann. mSd.•psychol .,
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HANS ABEL&. Ueoer Naohempfindungen im Gebiete des kin&sthetisohen und
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PATHOLOGY

PURVES STEWART and JULIUS BERNSTEIN. A Case of Partial Doubling
of the Spinal Cord. Rev. Neurol, and Psychiat.. Nov. 1906, p. 729.
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KAUFFMANN. Zur Pathologie des Stoffwechsels bei Myasthenia. Zentralbl.f.
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EIMIGEK Beitrtfge zur Kenntnis der Gefttssver&nderungen in der Gehimrinde
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MEDEA. Contribute alio studio delle fini alteraxioni della fibra nervosa (fenomeni
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6ALLI. Lesioni del reticolo neurofibrillar© endocellulare in mammiferi adulti
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SCARPINI. Sulle alterasioni delle oellule nervoee dell’ ipetermia sperimentale
studiate con i metodi di Donaggio. Riv. Speriment di Freniatria , VoL xxxii,
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GOUREWITCH. Contribution h. l’ttude de la resistance du r&eau fibrillaire des
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Freniatria , Vol. xxxii, f. 3-4, 1906, p. 926.

HASSLAUER. Die Mikroorganismen bei den endokr&niellen otogenen Kompli-
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KUTSCHER. Ein Beitrag sur Agglutination der Meningoooccen. Deutsche mecL
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GOSIO. Circa il reperto fenolico nolle culture di taluni aspergilli e peniriHi.
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MARI NEBCO. Du r61e des cellules apotrophiques dans la r6g6n6reecence
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MARINESCO et MINEA. Pr6cocit£ des ph£nom&ne« de r6g6n6reecenoe dec
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tentacolare di Helix pomatia. Biblio. Anal., Bd. 15, f. 5, 1906, d. 259.
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1'exportation du labyrinthe de l'oreille. Arch . ital. de biol., Vol. xlvi, 190, p. 156.

OLINIOAL NEUROLOGY AND PSYCHIATRY

GENERAL—

EICHHORST. Pathologie und Therapie der Nervenkrankbeiten. Urban und
Schwarzenberg, Wien, 1907, M. 9.

WM. CAMPBELL POSEY and WM. G. SPILLER. The Eye and Nervous
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MEYER. Compendium der Neurologic und Psychiatric. Speyer und Kaeraer,
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HtJBNER. Zur Lehre von der Lues nervosa. Bert klin. Wchnschr ., Nov. 5,

1906, S. 1448.

OPPENHEIM. Nervenkrankheit und Lektiire; Nervenleiden und Erriehung.
die ersten Nervositttt des Kindes&ltera. Zweite Auflage. S. Karger, Berlin,

1907, M. 2.

GAUPP. Der Einfiuss der deutsohen Unfallgesetsgebung auf den Verlauf des
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8PINAL CORD—

Tabes* —WAYNCOP. Crises gastriques au d6but du tabee et crises gastriqnee en
dehors du tabes. {This*.) Rousset, Paris, 1906.

FRENKEL. L’ataxie tabetiquo. See origines, son traitement par la reeducation
des mouvements. F61ix Alcan, Paris, 1906, 8 fr.

Myelitis.— EBSTEIN. Myelitis acuta (post influens&m ?), Heilung. Klinii f.

psych, u. nerv. KranJth ., Bd. 1, H. 4, 1 906, S. 278.

Fractnre Dislocation.— BEVERLEY WELFORD. Fracture-Dislocation of the
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Disseminated Sclerosis. — AUSTREGESILO e GOTUZZO. Tree oasoe atypicos
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p. 127.

Syringomyelia. —GRAMEGNA. La radioterapie della siringomielia. Nota di
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1906, p. 717.

Landry’s Paralysis.— WHARTON SINKLER. Case of Landry’s Paralysis with
Recovery. Joum. Nerv. and Meni. Di*., Nov. 1906, p. 692.

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875

Lumbar Puncture. —MORELLI. Esame del liquido oefalo-rachidiano. Valore

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MINOT. Le Diagnostic prlooce do la syphilis nerveuse par la ponction lombairc.
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BKAISI-

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LINDEMANN. Sind die Stoinkohlengruben die Verbreiter der Qenickstarre ?
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Hemiplegia*—F. H. EDGEWORTH. On Transitory Hemiplegia in Elderly
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HARVEY CUSHING. Sexual Infantilism with Optic Atrophy in Cases of
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HUGH E. JONES and THURSTAN HOLLAND. Demonstration of an
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Abscess*—PERCY GOLDSMITH. Some Unusual Cases of Frontal Sinus Suppura¬
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DUFAYS. Accidents c6r£braux graves au oours d’une mastoidite chronique
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FuNCHI NAKA. Eine seltene Erkrankung der Pyramidenbahn mit spastischer
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General Paralysis* —VALLET. Contribution h l*6tude dee remissions dans la
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BOUCHAUD. Un cas de main de pr&Licateur chez un par&lytique g6n6ral. Rev.
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KARL L1EBSCHER. Die cytologisohe und ohemische Unterauchung des Liquor
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WASSERMANN. Ueber das Vorhandensein syphilitischer Antistoffe in der
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Cerebellum*— HONCK. Ueber die Rolle des Sympathicus bei der Erkrankung
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ALCOHOL, ETC.

BIANCHI. L'alcool e la malattie del sistema nervoso. II Tommasi , Anno 1,
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ROBERT JONES. Mental Degradation the Result of Alcohol. Amei\ Journ.
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MAURICIO DE MEDEIROS. Notas de urn anti-alcoolista. Arch. Brasil, de
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MENTAL DISEASES—

R. S. WOODWORTH. Psychiatry and Experimental Psychology. Amer. Journ .
Insan., Vol. lxiiL, No. 1, 1906, p. 27.

CLARENCE B. PARKER. Clinical Psychiatry: Clinical Demonstrations. Amer.
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ALAN RIGDEN. Presidential Address concerning the Insanity of Child-birth.
Brit. Med. Joum., Nov. 10, 1906, p. 1253.

BOSC. Diabfete et troubles mentaux. Rev. de Psychiat. , oct 1906, p. 416. ^
MOREIRA et PEIXOTO. Los maladies mentales dans les climats tropScaux.
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HENRIQUE ROXO. Perturbacoes mentaes ligadas & arterio-scleroee. Arch.
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FINCKH. Die psychisohen Symptome bei Lues. Centralbl. f. Nervenheilk. v.
Psychiat Nov. lo, 1906, S. 865.

CHARLES RICKSHER. A Review of the Mental Symptoms accompanying
Apoplexy. Amer. Joum. Insan., Vol. lxiii., No. 1, 1906, p. 55.

DE C LfcRAM BAULT. Sur un caa de d&ire collectif oh figure un paralytique
g6n6r&i Ann. m&L-psychol., nov.-d6o. 1906. p. 878.

RODIET et CANS. Diagnostic differential des troubles cdrtibranx d’origin©
toxique dus h l’aloool et au tabac et de la paralysie g6n£rale, d’aprhs les symptfinss
oculairea Ann. mSd.-psychol. , nov.*d6c. 1906, p. 408.

PIGH1NL II ricambio organico nella demensa preoooe. Riv. Speriment di
Freniatria, Vol. xxxii., f. 8-4, 1906, p. 513.

FAUSER. Zur Kenntnis der Melancholia. CentrcUbLf. Nervenheilk. u. Psychiat,
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BODROS. De la prtitendue dfimenoe des persdcut^s. (Thhe.) Michalon, Paris,
1906, fr. 1.75.

8CHAIKEW1CZ. Ueber Geisteskrankheiten im russisohen Hear wahrend des
russisch japanisohen Krieges. Centralbl. /. Nervenheilk. u. Psychiat, Nov. 15,
1906, S. 872.

STIEDA. Ueber Geisteskrankheiten im russisohen Hear wfihrend des ntssueh-
japanischen Krieges. Centralbl. f. Nervenheilk. u. Psychiat , Nov. 15, 1906,

LUG1ATO e CHANNESSIAN. La pressione sanguigna nei znalati di mente.
Riv. Speriment. di Freniatria , Vol xxxii., f. 3-4, 1906, p. 787.

IBBA. Citolisine termolabili e coctostabili nel sangue dei psioopaticL Riv.
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PODESTA. Hkufigkeit und Ursachen der Selbstmordneigung in der Marine im
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GRASSET. Les Devoirs et les Droits de la Soci6t6 vis-h-vis des alidnds. Blais et
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PIGH1NI. La criminalith negli stadi iniriali della “ demensa precooe." Riv.
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8CHN1TZER. Moderne Beh&ndlung der Geisteskranken. Harm. Walther,
Berlin, 1906, M. -50.

HOCQUET. Des sorties provisoires k titre d’essai. Contribution h la thtra-
peutique des maladies mentales. (Thlse.) Michalon, Paris. 1906, fr. 2.50.
GUSTAVO ARMBRUST. 0 tratamento physico da obesiaade. Arch. BrasiL de
Psychiat . t Neurol ., Anno 2, N. 2, 1906, p. 16/.

GRASSET. La psychoth6r*pie totals ou suptrieur. Rev. de Psychiat, oct 1906,

&5RPERE. Deux asiles de Saint-Petersbourg. Rev. de Psychiat f oct 1906,
p. 412.

ADAM. Des dtablissement* d’ali^uds, d’idiots et d’Spfleptiquea. Du rfile du
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p. 421.

GENERAL AND FUNCTIONAL DISEASES—

Epilepsy. —WEICHARDT und PILTZ. Experimentelle Studien in die Eklamptte.
Deutsche med. Wchnschr ., Nov. 15, 1906, S. 1854.

CENI. Nuove rioerohe sulla natura dei prindpi toasid eontenuti nel riero di
sangue degli epilettiol Riv. Speriment di Freniatria, VoL xxxiL, f. 8-4, 1906,

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di Freniairia , VoL xxxii, f. 3-4, 1906, p. ol8.

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BESTA. Significato e frequenza delle manifestazioni emilaterali noil' epilessia
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BERNHARDT. Be it rag zur Lehre vom Status hemiopilepticus. Berl. klin.
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HOPPE. Die Beziehungen dor Bromwirkung zum Stoffweohsel dor Epileptiker.
Neui-ol. Ceniralbl ., Nov. 1, 1906, S. 993.

Neurasthenia. —STEKEL. Die Uraachen der Nervoeitat. Knepler, Wien, 1906,
M. 1.

6ERHARDT. Die Differentialdingnose der nervdaen Herzstdrungen. Klinik
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FKANCAIS. L'apepsie dans les nlvroses. Arch. gin. de mid., oct. 30, 1906,

p. 276lT

■ysterla.—HENRIQUE ROXO. Hysteria. Arch. Brasil, de PsychiaL e Neurol. t
Anno 2, N. 2, 1906, p. 139.

ROUBY. Lourdes und die Hysterie. Frankfurter Verlag, 1906, M. —50.
INGEGNIEROS. Le langage musical et ses troubles hyst6riques. F61ix Alcan,
Paris, 1906, 6 fr.

GOLDB'LAM. Ein Fall von hysterisohem Fieber. Neurol . Ceniralbl. , Nov. 1,
1906, S. 978.

Tetany.—MARCO ALMAGIA. Sul rapporto tra sostanza nervosa centrale e
tossina del tetano. Sperimeniale , Anno 60, f. 5, 1906, p. 654.

Tranmatlc Neurasthenia.—ALESS1. Nevrosi traumatico in un arterioeclerotioo.
CRnica mod. t oct. 17, 1906, p. 493.

GIGLIOLI. Alcune considerazioni a propoeito delle traumato-nevrosi. Riv. crit .
diclin. med Nov. 10, 1906, p. 722.

Aiglo-searoies.—ERNEST DO RE. On Cutaneous Affections in Various Diseases,
with especial Reference to Certain Angio-neuroses. Brit. Jaunt, qf Dermatol .,
Oct. 1906, p. 354.

SPECIAL SENSES AND CRANIAL NERVES—

ONODI. Beitrfige zur Lehre der durch Erkrankung der hintersten Siebbeinselle
und der Keilbeinhohle bedingten Sehstdrung und Erblindung. Berl. klin.
Wchnschr Nov. 19, 1906, S. 1514.

BOUCHAUD. Un cas d’ophtalmoplegie unilateral©, to tale et complete aveo
c6cite du m£me cOte. Joum. de Neurol ., nov. 6, 1906, p. 649.

BLOCH. Ueber willkurliche Erweiterung der Pupillen. Deutsche med. Wchnschr. 9
Nov. 1, 1906, S. 1777.

KUTNER. Abnorme ErschOpfbarkeit der Lichtreaktion der Pupille (Asthenische
Lichtstarre). Ceniralbl. f. Nervenheilk. u. Ptychiat ., Nov. 1, 1906, S. 825.
BfiRIEL. Un cas de paralysie faciale obst4trioale spontan6e. Rev. mens, des mal.
de Venfance, nov. 1906, p. 603.

JULIUS DO NATH. Die SensibilitKtastttrungen bei peripheren Geeichtalkh-
mungen. Neurol. Ceniralbl ., Nov. 16, 1906, S. 1039.

MOSSI. Otite scl6reuse bilat£rale ; surdit4, vertiges. Traitement par les ponctions
lomb&ires. Rev. hebd. de Lanyngol., Nov. 17, 1906, p. 693.

FERDINANJDO MASSE!. Ueber die Bedeutung der ° Ansesthesie dee Kehlkopf-
eingangs” bei den Recurrenslahmungen. Berl. klin. Wchnsehr. t Nov. 19, 1906,
S. 1512.

ROSENBACH. Gibt es bis jetz eine Ausnahme von der Regel, dass bei iutensiver
Affection der Nil recurrentes vagi di Abduktoren der Stimmbknder frfiher
Funktionsstorungen ziegen als die Adduktoren. Berl. klin. Wchnschr ., Nov. 12,
1906, S. 1460.

DEGE. Zur Aetiologie der Lkhmung des Nervus laryngeus inferior. Berl. klin .
Wchnschr ., Nov. 5, 1906, S. 1446.

GEORGE L. RICHARDS. Two Case3 of Abductor Paralysis. Brit. Med. Joum. f
Nov. 17, 1906, p. 1374.

878

BIBLIOGRAPHY

■imwulajvmto iym wh —

HENRY SMURTHWAITE. Headache: Pathological Conditioiis of the Middle
Turbinal a Cauaal Factor. Brit. Med. Jounu. Nor. 17,1906, p. 1368.

HUGO LUKACS. Spasmus progrediens (Torticollis mentalis). CentralbL /.
Nervtnkeilk. u . Psychiat., Not. 1, 1906, S. 829.

MICHAEL LAPINSKY. Die Zustand dor Reflexe in paralysirten K&rpcrtheUen
bei totaler Durchtrennung des Rlickenmarkea. Arek f. Psychiat , Bd. 42, H. 1,
1906. 8. 65.

WALTON. The Cerebral Element in the Reflexes and its Relation to the Spinal
Element Joum. Nerv. and Menl. Du., Not. 1906, jd. 681.

80UQUES. Aphasie motrice sans lesion de la troisieme ciroonTolutton frootale.
Bull, et Mfm. de la Soc. mfd des H6p . de Paris, oct 19, 1906.

VON MAYENDORF. Ueber eine direkte Leitung vom optbchen sum binfc-
thetischen Rindenzentrum der Wort- und Buohstabenbuder. Wien. Hin.
Wchnsckr Not. 8, 1906, 8. 1336.

VON MONAKOW. Aphasie und Diachisis. NeuroL CentralbL , Not. 16,1906,

a 1026.

TMATMKNT*—

EBSTEIN. Einige Bemerkungen sur Behandlung der syphilitischen Erkra jiku pgcn
des Nerrensrstems. Klinik fi ntycA. a. nerv. Krankk ., bd. 1, H. 4, 1906, 8. 284.
MULTAVIDI. Die Macht des Hypnotismus im Dienste des Mensohen. Verisg
Meteor, Dresden, 1906, M. 2.

FEDOR KRAUSE Die operatire Behandlung der Hirn- und Rttckenmarks-
tumoren. Wien. med. Preset , Nr. 46, 1906, 8. 2376.

LAVAL. Beitrtfge cur operatiTen Freilegung des Bulbus venae jugulam.
Arek /. OhrtnAtUk, Bd. 69, H. 3-4, 1906, 8.161.

* A number of references to papers on Treatment are included In the Bibliography under the
IndlTftdnal Diseases.

BOOKS AND PAMPHLETS BEOETVED.

Eichhorst, Hermann. Pathologic and Therapie der Nervenkrankheiten.
Urban und Schwarzenberg, Berlin.

Magelssen. Norway as a Winter and Summer Health Resort.
Kriatiania, 1906.

Posey and Spiller. The Eye and Nervous System. J. B. Lippineott
Co., Philadelphia and London, *1906.

Wilson. Anatomy of the Calamus Region in the Human Bulb. Journ.
Anat. and Physiol ., 1906.

Scbiefferdecker. Neurone nnd Nenronenbahnen. Barth, Leipzig.
Determann. Physikalische Therapie der Erkrankungen des Zentral-
nervensystems, inklusive der allgemein Neuroeen. F. Enke, Stuttgart, 1906.

Babinski. Ma conception ae l’Hyst4rie et de l’Hypnotisme. Dunne,
Chartres, 1906.

So inner, Robert. Klinik fur psychische und nervose Krankheiten,
Bd. 1, H. 4. Marhold, Halle, 1906.

Mobius. Uber Scheffel’s Krankheit Marhold, Halle, 1906.
Lewandowsky. Die Funktionen des Zentralennervensystems. Fischer,
Jena, 1907.

Mott, Haliburton, and Edmunds. Regenention of Nerves. Proc. Boy.
Soc., VoL 78, 1906.

Mott. The Microscopic Changes in the Nervous System in a Case of
Chronic Dourine or Mai de Coit, and Comparison of the Same with tho*e
found in Sleeping Sickness. Proc. Roy. Soc., VoL 78, 1906.

Mott. Alcohol and Insanity. Adlard & Son, London, 1906.
Oppenheim. Nervenkrankheit und Lektiire. Nervenleiden und Er-
ziehung. S. Karger, Berlin, 1907.

Sherrington. The Integrative Action of the Nervous System. Charles
Scribner’s Sons, New York, 1906.

Arch. Brasil, de Psychiat., Neurol, e Scienciat Affine, Nos. 2 e 3, 1906.
Rio de Janeiro.

Jnbtces

Page references to Original Articles are indicated by heavy type figures .

SUBJECT INDEX.

Abscess ; vide Brain I

Abdncens: Paralysis of, in Otitis, 765 j
Accommodation; vide Pupil
Achilles-Jerk ; vide Reflexes
Acromegaly: Spinal Cord, Degeneration
in, 429; with Lesion of Hypophysis
and Sella Turcica, 759
Acropathies : Intense Cold in Pathogeny
of, 155

Afferent Nervous System from New As¬
pect, 47

Alcohol: Ocular Symptoms due to, 837 ;
Injections in Neuralgias, 236 ; in Con¬
tractures, Spasms, and Tremors of
Limbs, 710; vide Neuritis
Alcoholism: Want of Insight in, 589 ;
Mixed Conditions in Epilepsy and,
589 ; Psychic and Motor Disturbances
in, 591; Crimes committed during
Intoxication, 592, 593 (2); Atypical
Alcoholic Psychoses, 705 ; Hallucina¬
tory Dementia in, 705 ; Pseudo-Par¬
alysis of, 705 ; Delirium Tremens, 231
Alexia: Developmental, 518
Amaurotic Family Idiocy, 568, 570, 571
Amnesia: Retro-anterograde in Hysteria,
223

Amphioxus: Cranial and Spinal Ganglia
and Viscero-motor Roots in, 419
Amyotrophic Lateral Sclerosis, 750 ;
Pathology of, 638

Anaesthesia, Limited Area of, in Brain
Tumour, 835

Aneurisms : Intracranial, 507 ; Aortic,
and Tabes, 565

Aphasia : Word-Blindness, 152, 518 ;
Treatment of Visual, 152 ; Aphasia in
Migraine, 223; and Mental Disease,
304 ; Lesions of Left First Temporal
Convolution and Sensory Aphasia,
329 ; Sensory Aphasia, with Right
Homonymous Hemianopia, 377 ; Tac¬
tile, 586, 703 ; Revision of Question,
Third Left Frontal Convolution does
not play Special Rdle, 649 ; Localisa¬
tion and Pathological Physiology of

Sensory, 650; Clinical and Patho¬
logical Study of, 651; Agrammatis-
mus and Disturbance of Internal
Language, 652 ; Hysterical Dysar¬
thria, 654 ; Alexia, 152, 518; Sub¬
cortical (Pure), 845 ; vide Apraxia,
Amnesia

Apoplexy: Cerebellar, 506

Apraxia : in . General Paralysis, 306 ;

Mixed, 380
Arsenical Neuritis, 216
Arteries : Hypertonus in Sclerosed, 362 ;
Hemorrhage from Middle Meningeal,
364 ; Hemorrhage into Brain and
Cord from Obliterative Disease of, 407
Arterio-Sclerosis: Mental Diseases asso¬
ciated with Cerebral, 458 ; Manic-
Depressive Insanity and, 707; Trau¬
matic Neurasthenia in, 761
Ascending Paralysis, 828 ; Cord and
Medulla in, 106 ; vide also L&ndry’s
Paralysis

Asthenias and Myopathic Atrophies, 295
Asynergy : Cerebellar, and Inertia, 703
Ataxia: in Childhood, 297; Sensory, 446
Athetosis, Double, 146 ; Nerve Trans¬
plantation in, 386

Atrophy: Myopathic, and Asthenias, 295;
Experimental Cerebral and Cranial At¬
rophies, 742 ; of Muscles in Tumours of
Brain, 835

Autogenic Regeneration ; vide Regenera¬
tion

Axis-Cylinder; vide Nerve

Babinski Sign ; vide Reflexes
Baraathesia, Disturbances of, 446
Basedow’s Disease; vide Exophthalmic
Goitre

Beri-Beri, Polyneuritic Psychoses and,
848

Birds after Section of Posterior Spinal
Roots, 821

Bladder, Functions of, in Hemiplegia,
152 ; Nerves of, in Cat, 275
Blindness: of Cortical Origin, from

*79

880

INDICES

Double Hemianopia, 699 ; Anatomy of
Cortical, 372 ; vide Hemianopia

Blood, in Epilepsy, 286

Blood Pressure and Neurasthenia, 58

“ Blue Disease,” 54

Brain : Anatomy : The Claustrum, 31;
Histology of Cerebellum, 32 ; Width
of Cortex in Estimation of Develop¬
ment, 33 ; Cerebral Cortex of Dolphin,
84 ; Hind-Brain of Pig, 126; Histology
of Cerebral Cortex, 887 ; the Taenia
Pontis, 413 ; Caput Gyri Hippocampi,
414 ; Radix Mesencephalica Trigemina
and Ganglion Isthmi, 413; Olfactory
Bulband Cornu Ammonis, 417; Estima¬
tion of Skull Capacity on Cadaver, 420;
Nervus Intermedius of Wrisberg and
Bulbo-Pontine Gustatory Nucleus, 478;
Neuroglia Framework of Cerebellum,
683; Lobus Cerebelli Medianus, 787 ;
vide Nerve Tracts

Physiology : Respiratory Centre in Cere¬
bral Cortex of Dog, 35 ; Central
Respiratory Innervation, 36; Experi¬
mental Section of Pyramids in Dogs
and Apes, 207; Experimental De¬
struction of Hypophysis, 207; Separate
Sensory Centres in Parietal Looe for
Limbs, 296 ; Edinger - Westphal
Nucleus, 288; Organic Changes in
Development of Association, 278 ;
Localisation of Cerebral Function, 308;
C holes ter in of Brain (2), 351 ; Function
of Left Prefrontal Lobe, 362 ; Cortical
Visual Area and Macula Lutea, 372 ;
Projection of Retina on Cortex of
Oocipital Lobe, 372; Localisation of
Higher Psychic Functions, and Pre¬
frontal Lobe, 420; Motor Areas in
Cerebral Cortex of Dasyurus Viverrinns,
635; Functions of Caudate Nucleus,
817; Cortical Representation of Cutane¬
ous and Muscular Sensibility, 819

Pathology : Medulla in Acute Ascending
Paralysis, 106 ; Malformation of Brain
in Hatteria Punctata, 214 ; Hetero¬
topia of Cortical Substance, 428 ;
Cerebellum in General Paralysis, 561 ;
Brain of Microcenhalic Idiot, showing
lack of Corpus Callosum, 689; Senile
Brain, 753

Clinical : Minor Aids in Examination of
Brain Disease, 52; Miliary Dissemi¬
nated Brain Syphilis, 572 ; Symptoms
of Frontal Disease, 646; Pontine
H«morrhage, 754 ; Lesion of Uncinate
Region of Ternporo Sphenoidal Lobe,
833 ; Ocular Symptoms in Toxic Dis¬
turbances due to Alcohol and Tobacco,
887; vide Encephalitis, Tumours,
Cerebellum

Brain Surgery : Present Status of, 852
Bulbar Paralysis: Pseudo-Bulbar Palsy
in Child, 584

Bulbar Symptoms from Intoxication,800;
Thermo-Asymmetry, 62

Caisson Disease, 755
Catatonia: 226

Cauda Eauina, Diseases of, 292
Caudate Nucleus, Functions of, 817
Cerebellum : Histology of, 32 ; Neuroglia
Framework of, 683 ; Lobus Cerebelli
Medianus, 737 ; Asynergy and Inertia
in Disease of, 703; Atrophy of, 139;
Haemorrhage, 506; in General Para¬
lysis, 561 ; Idiocy in Cerebellar Lesion,
528 ; Position of Hoad in Disease of,
455; vide Tumours, Atrophy of Cells
of Purkiuje, 55.

Cerebral; vide Brain
Cerebro-Spinal Fluid: Choline in, 285;
Clinical Significance of, 504 ; Relation
of Syphilis to Lymphocytosis of, 749 ;
Lumbar Puncture in Psychiatry and
Neurology, 655 ; Lymphocytosis in
Juvenile General Paralysis, 813
Cholesterin of Brain (2), 351
Choline in Cerebro-Spinal Fluid, 285
Chorea: its Neuronic Aspect, 218;
Tetanoid, Associated with Cirrhosis of
Liver, 249; of Childhood, Treatment
of, 382 ; Osteitis Deformans with
Huntingdon's, 840

Cirrhosis of Liver, Association with
Tetanoid Chorea, 949
Claudication ; vide Intermittent Claudi¬
cation

Confabulation : Psychology of, 227 ;

Clinical Significance of, 228
Consciousness: Non-Epileptic Affections
of, 575

Contractures in Organic Nervous Dis¬
eases, 375

Conus terminalis: Diseases of, 292;
Pathology of Epiconus Medullaris,
567 ; Traumatic Lesions of, 567
Convulsions in Typhoid, 143; in Child*
run and Relation to Epilepsy, 839
Corpus Callosum: Lack of in Brain of
Microcephalic Idiot, 689 ; Tumour of,
694

Cortex ; vide Brain

Cortical Blindness : Anatomy of, 372

Cretinism : Familial, 224

Crural Monoplegia : 296

Deafness due to Hysteria, etc., 516
Degeneration: of Nerve Tissue, 637;
Retrograde, in Spinal Nerves, 558,
686, 747

INDICES

881

Delirium: produced by Toxines of
Pellagra, 45 : by Drugs, 83
Delirium Tremens, 231
Dementia Paralytica ; vide General
Paralysis

Dementia : Pathological Anatomy, 382 ;

Hallucinatory, in Alcoholics, 705
Dementia Praecox : 302, 519 ; Certain
Forms of Psychosis allied to, 287 ;
Hebephrenic Forms of, 707 ; Heboid
Paranoid Group of, 708; Mild Forms
of, 848

Dendrites and Diseases, 636
Development of Cranial and Spinal
Nerves of Human Embryo, 30
Diabetes: and Pneumococcal Cerebro-
Spinal Meningitis, 752
Digestive Organs : Head’s Zones in Dis¬
orders of, 701

Diphtheria : Precocious Paralysis of
Palate in, 608; Paralysis of Tongue, 217
Disseminated Sclerosis: 139, 502; in
Guise of Transverse Myelitis, 51;
Frequency of Certain Signs and Symp¬
toms, 601; Mental Disorders in, 642 ;
Diagnosis from Psychogenic Neuroses,
831

Disseminated Syphilitic Encephalitis,
644

Dissociated Personality: in Hysteria,
840

Diver’s Palsy, 755

Donaggio’s Method : Changes in Nerve
CelTwith, 587

Ear Disease, Psychical Importance of,
776

Eclampsia: Puerperal, and Parathyroid
Insufficiency, 577

Edinger-Westphal Nucleus, Physiologi¬
cal Significance of, 288
Encephalitis: Cerebral Symptoms due to,
140 ; Relation to Acute Anterior Polio¬
myelitis, 140 ; Disseminated Syphili¬
tic, 644

Enteric Fever: Convulsions in, 143;
Abdominal Reflex in, 582; Philopo-
vict’s Sign in, 378 ; Recurrent Third
Nerve Paralysis in, 454; Abnormal
Reflex in, 582

Epiconus Medullaris ; vide Conus
Epilepsy : Etiology of, 574 : Pathology
of, 854 ; Pathology of Epileptic Idiocy,
689 ; Blood in, 286; Borderland of,
696; in course of Chronic Psychoses,
381 ; Vertigo in, 694 ; with Unilateral
Manifestations, 696; Variations of
Mood in, 523; Cessation of Pulse
during Onset of Fits, 579; Peculiar
Attitudes during Sleep, 839; and
Migraine, 839; Mixed Conditions

and Alcoholism, 589; Reflex Epilepsy,
838 ; Relation to Convulsions in Chil¬
dren, 839 ; Jackson aud Pseudo-Jack¬
sonian, 768; Significance of Jacksonian,
511, 647 ; Paramyoclonus Epilepticus,
19; Non-epileptic Affections of Con¬
sciousness, 575 ; Diet in, 235, 883 ;
Bleeding in, 388 ; Potassium Bromide
in, 852; Treatment by Appendicos-
tomy, 579

Ergography, Laws of, 40, 128, 280,
282; Rest in Ergographie Work,
283; Mechanical Value of Mental
Representation, 283; Effect of Stand¬
ing Position on, 283; Effect of Pre¬
liminary Immobility on, 283 ; Eco¬
nomy of Effort, 283 ; Effect of Slacken¬
ing of Rhythm, 283; Influence of
Onentation on Activity, 283
Exhaustion from Excess of Function, 424
Exophthalmic Goitre: Parathyroid
Glands in, 46; Pathogenesis of, 59 ;
Heart Neuroses and, 697 ; Antithy-
reoid in Treatment of, 65; Serum Treat¬
ment of (2), 384, 445 ; Surgical Treat¬
ment of, 462, 711 ; Pathology of, 647;
Treatment with Rbutgen Rays, 711
Eyes: Paralysis of Associated Move¬
ments—Voluntary and Automatic-Re¬
flex Movements, 454

Face : Hemiatrophy of, 1; Tic of, 56,220;
Peripheral Hemispasm of, 57 ; Syner¬
gic Paradoxical Contractions following
Palsy of, 57; Bilateral Circumsoribed
Atrophy, 221; Facial Paralysis and
Hemiatrophy of Tongue, 289; Peri¬
pheral Facial Palsy, 690
Fatigue : Laws of Ergography, 40, 128,
280, 282 ; Fatigue Curves in Diagnosis
of Nervous Diseases, 224 ; Mental
Fatigue in School Children, 285; vide
Ergography

Fever : Hysterical (2), 443
Fonnio Arid: Muscular-Tonic Action
of, 232

Freud’s Method of Treatment in Hys¬
teria, 462

Freidreich’s Ataxia, 217, 441
Frontal Lobes ; vide Brain

Gall-bladder, Contractile Mechanism
and Extrinsic Nervous Control, 37
Ganglia : Lesions of Gasserian and Pos¬
terior Root Ganglia aud Herpes, 139 ;
Cranial and Spinal in Amphioxus,
419 ; Excision of Gasserian in Facial
Neuralgia, 793 ; Extirpation of Gas¬
serian, 795

Gasserian, vide Ganglia

General Paralysis: Pathology of, 73,

882

INDICES

169, 966, 537, 616; Histopatholoricad
Changes of Cerebellum in, 661; Fibril¬
lar Structure in, 212; with Miliary
Disseminated Brain Syphilis, 672 ;
Etiology and Duration of, 645 ; Trauma
and, 229, 307, 813 ; Tabes, Syphilis,
and, 356; Supposed Immunity of
Syphilitio Arabs to, 513; Somatic
Evidences of Syphilis in, 512, 748 ;
Ocular Symptoms in, 837 ; Apraxia in,

306 ; Pupil Accommodation Reflex in,

307 ; Multiple Lipomata in, 369 ; Per¬
forating Ulcer in, 369 : Bed-Sores in,
370 ; Cerebro-spinal Lymphocytosis in
Juvenile, 818; Early Diagnosis and
Treatment of, 847; Juvenile General
Paralysis, 813

German Measles: Polyneuritis as Sequela
of, 356

Glands: Parathyroid Insufficiency in
Eclampsia, 577 ; Atrophy of, in Syphi¬
lis, 683

Graves's Disease, vide Exophthalmic
Goitre

Habit Spasm in Children, 145
Hallucinations of Peripheral Origin, 776
Head-Nodding and Nystagmus in In¬
fancy, 771

Haemorrhage: Surgical Intervention for
Intra-cranial, 66; Spinal, 137 ; from
Middle Meningeal Artery, 364 ; into
Brain and Cord from Obliterative
Arterial Disease, 407 ; Post-Traumatic,
from Superior Longitudinal Sinus, 443
Haematemesis in Organic Nervous Dis¬
eases, 154

Head: Position of, in Cerebellar Dis¬
ease, 455

Head Injuries: 463; Indications for
Operative Treatment (2), 463
Head's Zones: in Disorders of Digestive
Organs, 701

Heart-Neuroses and Basedow’s Disease,
697

Hemialgesia: Epileptiform Attacks of,
in Brain Tumour, 836
Hemianesthesia in Migraine, 223
Hemianopia: Retrogression of, after
Paralytic Attacks, 148 ; Right Homo¬
nymous Lateral, and Sensory Aphasia,
377; Blindness of Cortical Origin from,
699; Bi-Temporal, 699
Hemiatrophy: of Face, 1; of Tongue,
289

Hemicraniosis, 61
Hemiparesis in Migraine, 223
Hemiplegia; following Whooping-Cough,
54 ; Infantile Cerebral, 146 ; Functions
of Bladder in Cerebral, 152; Chronic
Progressive Double, 182; in Vascular

Lesions, 365; Adult, 366: Sensory
Disturbances in Cerebral, 367; Post-
Hemiplegic Movements, 368; Transi¬
tory, 362, 505, 833; Infantile Cere¬
bral, 506

Hemispasm: Peripheral Post-Paralytic,
56 ; Peripheral Facial, 57
Herpes Zoster: Lesions of Gasserian and
Posterior Root Ganglia in, 139;
Kernig’s Sign in, 300
Heterotopia of Cerebral Cortical Sub¬
stance, 428

Huntingdon’s Chorea with Osteitis De¬
formans, 840

Hydrotherapy in Mental Diseases, 777
Hyperesthesia of Visual Periphery, 580
Hypertonus in Sclerosed Arteries: Cere¬
bral Manifestations of, 362
Hypnosis: What is it ? 445
Hypoglossus: Diphtheritic Paralysis of,
217

Hypophysis Cerebri, vide Pituitary Body
Hysteria: Traumatic, resembling Oph¬
thalmoplegia Externa, 144; Hys¬
terical Tic, 144; Retro-anterograde
Amnesia in, 223; Symptoms and
Associations of, 293; Stigmata caused
by Organic Brain Lesions, 297; Hys¬
terical Fever (2), 443; Immobility of
Pupil in, 453; Treatment of, at Mas¬
sachusetts General Hospital, 462;
Freud’s Method of Treatment by
“ Psycho-Analysis,” 462 ; “ Hysteria* #
of Animals, 513; Deafness due to,
516 ; Hysteria Analysis, 522 ; Hysteri¬
cal Dysarthria, 654: “Twilight-State,”
760 ; Responsibility of Hysterics, 760;
“Stammering-Gait,” 770; Hystero-
melancbolia, 774 ; From Point of View
of Dissociated Personality, 840

Idiocy : 225 ; Forms which rosult from
Meningitis, 156; Amaurotic Family,
568, 570, 571 ; Pathology of Epileptic,
689 ; In Cerebellar Lesion, 523
Impulses : Pathogenesis of Some, 459
Intantilo Cerebral Hemiplegia, Disturb¬
ances of Movement in, 146
Infantile Paralysis: 440; Porencephalic
Form of, 571

Infantilism with Optic Atrophy in
Tumour of Hypophysis Cerebri, 835
Innervation : Central Respiratory, 36
Insanity, vide Mental Diseases and Psy¬
chiatry
Instinct, 686

Intermedio-lateral Tract, Nerve Cell of,
349

Intermittent Claudication: 153 ; 698 ;
of Spinal Cord, 584 ; 842 ; of Nervous
Centres, 585

INDICES

883

Insanity: Cysticercus Cellulosse in, 272 ;
Mental Processes in Retardation and
Excitation of, 303 ; Common Form of,
457; vide Mental Diseases
Insular Sclerosis, vide Disseminated
Sclerosis

Ischemia: Muscular Atrophy in, 514;
Sensation in Acute, 151

Jaw-Movkmrnts : Physiology of, 558
Juvenile Dementia, 456

Kernig's Sim : in Herpes Zoster, 300
Knee Angle Phenomenon in Tabes, 501
Knee-Jerk, vide Reflexes
Korsakow’s Symptom-Complex : in Brain
Syphilis, 704

Landry's Paralysis: 106 ; 829; after
Enteric, 291, vide also Ascending
Neuritis

Larynx: Structure and Function of
Taste-buds, 43; in Tabes, 290;
Laryngeal Crises in Tabes, 692; Zur
Recurrens Frage, 769
Laughter, Spasmodic, 371
Light Perception, Peculiar Alteration in,
449

Lille, Report of Congress at: 713 ; 797 ;
868

Lipomata in General Paralysis, 369
Localisation: of Cerebral Function, 308 ;
of Cortical Visual Area, 872 ; of Macula
Lutea, 372; in Nuclei of Cranial and
Spinal Nerves, 416 ; of Higher Psychic
Functions, 420; of Musical Talent in
Brain and on Skull, 586
Lumbar Puncture: in Psychiatry and
Neurology, 655; vide Cerebro-spinal
Fluid

Lunacy Law, 869, vide Mental Diseases

Macropsia and Micrographia, 449
Macula Lutea, 372
Manic-Depressive Insanity, 849
Measles: Transverse Myelitis as Sequela
to, 751

Megrim, vide Migraine
Memory: Experimental Observations on,
305

Meningeal Artery: Haemorrhage from,
364

“ Meningeal Irritation," 749
Meningitis: Diplococcus Intracellularis
Meningitidis and Gonococci, 740;
Experimental, 826 ; Meningococcal
Pharyngitis in Epidemic Cerebro¬
spinal, 354 ; Epidemic Cerebro-spinal
in India, 361; Diabetes and Pneumo¬
coccal, 752; Poliomyelitis Anterior
Acuta and, 830; Idiocy resulting from,

156 ; Treatment of, 234 ; Serum Treat¬
ment of, 826; Operative Treatment
of, 791

Mental Diseases: Pathological Anatomy
of, 287, 387; Toxic Cause in some
Forms of, 640; Pathogenesis of some
Impulses, 459 ; Types in, 455; Mental
Symptoms in Cerebellar Tumour, 218 ;
Idiocy and Cerebellar Lesion, 523;
Mental Symptoms associated with
Cerebral Arterio-sclerosis, 458, 707 ;
Mental Symptoms in Multiple Sclero¬
sis, 642 ; Epilepsy in Course of Chronic
Psychoses, 381 ; Slightly Abnormal
CMldren, 380 ; Amentia, 772; Acute
Juvenile Deterioration, 225 ; Psychoses
of Involution Period and Juvenile
Dementia, 456 ; The Dementias, 383 ;
Depressions of Advanced Life, 159 ;
Manic Depressive Insanity, 849 ; Hys-
tero - melancholia, 774 ; Coming of
Psychasthenia, 518 ; Mental Con¬
fusion, 379; Circumscribed Autopey-
chosis on Basis of a Morbidly Dominant
Idea, 461 ; Atypical Alcoholic Pys-
choses, 705; Polyneuritic Psychoses,
848 ; Relation of Aphasia and, 304 ;
Insight in, 379 ; Mixed Apraxia, 380 ;
Affectivity, Suggestibility, Paranoia,
883 ; “ Zwangsvorange,” 460 ; Feeling
of Unreality, 519; Pseudosesthesia,
768 ; Primary Incoherence with Ex¬
citement, 775 ; Hallucinations of Peri¬
pheral Origin, 776 ; False Reminis¬
cence, 847 ■; Diagnostic Association
Studies, 520 ; Psychical Importance
of Ear Disease, 776 ; Clinic for (Re¬
view), 238 ; Forensic Import of
Sexual Perversity, 850 ; Discharge of
Patients from Asylums in Prussia,
851; Outlines of Comparative Lunacy
Law (Review), 869 ; Treatment, 63,

. 64; of Acute Insanity in General
Hospitals, 709 ; Hydrotherapy in,
777 ; Walk through a Modern Asylum
(Review), 870; vide General Paraly¬
sis, Dementia Pnecox, Psychiatry,
Psychoses.

Methods : of Staining Neuroglia, 205;
Pseudo-vital Method, 417 ; rtamom y
Cajal’s Silver Method applied to Axis-
Cylinders, 420 ; Changes in Nerve
Cells by Donaggio’s Method, 657 ;
Pyridine Methods for Differentiation
of Reticulum of Nerve Elements, 684 ;
Weigert’s NeurogliA Stain, 788

Method of Inscribing Tracings on Revolv¬
ing Cylinder, 208

Microcephalic Idiot: Brain of, 639

Micrographia: Relation to Macropsia,
449

884

INDICES

Migraine: Aphasia, Hemiparesis and
Hermansestnesia in, 228; and Epilepsy,
88ft

Monoplegia, Crural, 2ft0
Multiple Sclerosis, vide Disseminated
Sclerosis

Muscles: Activity in Skeletal Muscle-
fibre, 127: Function of Degenerate
Muscles, 214 ; Tonic Action of Formic
Acid, 232; Reaction of Striated
Muscle to Nicotine and ( urari, 276;
Paralysis of, Involuntary, 89, 27ft ;
Functioning of Degenerate, 559
Muscular Atrophy: Ischaemic, contrac¬
tures and Paralysis, 514; Neuritic
Type of Progressive, 691; in Brain
Tumour, 835

Muscular Dystrophy affecting Hands
and Feet, 192 ; vide Myopathy
Musical Talent: Localisation of, 586
Myasthenia Gravis, 146, 295
Myelitis: Transverse, simulating Mul¬
tiple Sclerosis, 51; Pathology of
Myelitis Acutissima Hemorrhagica
Disseminata, 401; Descending De¬
generations of Posterior Columns in
Transverse, 488 ; Extension of Ascend¬
ing, 741 ; Transverse, as Sequela of
Measles, 751

Myoclonus: Multiplex, 143; Epilep-
tious, 19

Myopathy : Primary Progressive, in two
Brothers, 563 ; Asthenias and Myo¬
pathic Atrophies, 295; Muscular
Dystrophy affecting Hands and Feet,

192

Narcoleptic Attacks, 575
Nerves: Decussation of Trochlear Nerve,
203; Wrisherg’s Intermediary Nerve,
478 ; Distribution of Afferent Nerves in
Skin, 73S ; Localisation of Nuclei of
Cranial and Spinal, 416 ; Motor Nuclei
after Lesions of Peripheral, 288 ; Zur
“ Recurreusfrage,” 769 ; Motor Nerve
Endings in Reptiles, 202 ; Cranial
Nerve Components in Petromyzon,
418; to Cat's Bladder, 275 ; Trophic
Nerves, 437 ; Consequences of Injury
to Peripheral, 47 ; Mechanism of Re¬
generation, 134 ; Autogenic Regenera¬
tion, 209 ; Retrograde Degeneration
in Spinal, 688, 747 ; Wallerian Law,
210 ; Influence of Facial Hemiatrophy
on, 1; Distribution and Recovery of
Peripheral, 430 : Paralysis of External
Branch of Spinal Accessory in Tabes,
439 ; Rheumatic Polyneuritis in
Cranial, 690; Paralysis of Abduoens
in Otitis, 765 ; Recurrent Paralysis of
Third Nerve in Typhoid, 454 ; Diph¬

theritic Paralysis of Hypogfassns, 217 ;
Local Action of Cocaine and 8tovaine
on Peripheral, 828; Neurotropism and
Transplantation of, 745; Surgery of
Peripheral, 86C

Nerve Cells: Structure of, 416, 556;
Cell types in Sensory Ganglia, 124;
Modifications by Nissl’s Method, 123 ;
Alterations by Donaggio’s Method,
557 ; Metabolism and Action of, 277;
Reproduction of, 820; Reaction to
Certain Poisons, 276 ; Atrophy of
Cells of Purkinje, 55 ; Morbid Condi¬
tions of Endocellular Fibrillar Reti¬
culum, 557, 687, 739; Reaction to
Fasting and Cold, 687

Nerve Fibres: Reticulated Structure of
Axis Cylinder, 737 ; Chromatic Pseudo¬
corpuscles of Axis - cylinder, 123;
White Rami Fibres and Spinal Ace«-
sory Nerve, 33; vide Regeneration
and Degeneration.

Nerve Ftorils: Fibrillar Structure in
Progressive Paralysis, 212; Post¬
mortem Changes in Neuro-fibrils, 352;
Club-like Terminals in Collateral Re¬
generation, 825

Nerve Palsies: Nerve Transplantation in,
386

Nerve Roots: Yiscero-motor, in Amphi-
oxus, 419; Effect on Peripheral Neu¬
rons of Section of Posterior, 743;
Movements of Birds after Section of
Posterior Spinal Roots, 821 ; Tabetic
Lesions of Spinal, 825

Nerve Tracts : Cranial and Spinal Nerves
in Occipital Region, 30; Inferior
Longitudinal Bundle and Central
Optic Bundle, 31; Faisceau en
Crochet, ou Faisceau Cer4bello-Bul-
b&ire, 203; Sensory Conduction in
Cord, 205 ; Paralysis by Compression
of Pyramidal, 693

Nerve Transplantation in Nerve Palsies
and Athetosis, 386

Nervous Diseases: Diagnosis of (Review),
868

Nervous System: Action of Snake
Venoms on, 498 ; Resuscitation of
Central, 741; Technique of Operations
on Central, 778 ; Atlas of Pathological
Histology of (Review), 867

Nervousness: Psychological Conception
of, 370

Neuralgia: Treatment by Alcoholic In¬
jections, 236; Facial, treated by Ex¬
cision of Gasserian Ganglion, 793, 795;
Surgical Treatment of Trigeminal,
857

Neurasthenia: and Blood-Pressure, 58;
Traumatic, in Arterio-Sclerotics, 761

INDICES

885

Neuritis, possibly due to working with
Artificial Manures, 60 ; Arsenical, 216 ;
Alcoholic, 664; Rheumatic Poly¬
neuritis of Cranial Nerves, 690 ; Neur-
itic Type of Progressive Muscular
Atrophy, 691; Peripheral Neuritis in
Tabes, 692 ; Ascending and Chronic
Rheumatism, 828

Neuroglia: Framework of Cerebellum,
688 ; Methods of Staining, 205, 788
Neuroses: Food Factor in Paroxysmal,
286; Psycho-Physical Methods in
Traumatic, 587; Heart-Neuroses and
Basedow’s Disease, 697; Diagnosis
between Multiple Sclerosis and Psy¬
chogenic, 881

Neurotropism and Transplantation of
Nerves, 746

Nuclei : of Cranial and Spinal Nerves,
416; after Lesions or Peripheral Motor
Nerves, 288

Nystagmus : and Head • Nodding in
Infancy, 771

Occipital Lobe9, vide Brain
Ocular Movements: Isolated Palsy for
Lateral Movement of Internal Rectus
Muscle, 375 ; Paralysis of Movement
Upwards and Downwards, 763 ; Para¬
lysis of Associated Movements, 464 ;
Paralysis of Abducens in Otitis, 765;
vide Ophthalmoplegia
Ocular Symptoms: m Toxic Cerebral
Disturbances and in General Paralysis,
837

Oculo-motor Nerve, Recurrent Paralysis
of in Typhoid, 464

Ophthalmoplegia : Hysteria with Clinical
Picture of External, 144; Bilateral,
302 ; Interna unilateral, 841
Optic Disc: Congestion of, with Spindle-
Shapes Enlargement of Blind Spot,
301

Optic Tracts: Inferior Longitudinal
Bundle and Central Optic Bundle, 31
Osmotic Theory of Sleep, 423
Osteitis Deformans: with Huntingdon’s
Chorea, 840

Otitis : Paralysis of Abducens in, 765

Pain: Sense of, 149; Meaning and
Mechanism of Visceral, 700 ; Head’s
Zones in Digestive Disorders, 701 ; Pro¬
jection of Sensation from Lower to
upper Extremity, 702
Palate: Precocious Paralysis of, in
Diphtheria, 608; Undescribed Symptom
in Paralysis of, 221

Paradoxical Contractions following Palsy
of Face, 57

Paramyoclonus Epilepticus, 19
Paralysis: Cord and Medulla in Acute
Ascending, 106; Anatomy of Syphilitic
Spinal, 211 ; Undescribed Symptom of
Palatal, 221 ; Cortical Tactile, 299 ;
Surgical Methods in, 384 ; Infantile,
440; Isolated Traumatic, 499 ; “Crutch”
Paralysis, 564; by Compression of Pyr¬
amidal Tract, 693; of Pneumonia in
Adults, 767

Paralysis Agitan6: Pathological Anatomy
of, 689

Paraplegia: Lacunar and Myelopathic,
53; from Retraction in Old People,
566 ; Cutaneous and Tendon Reflexes
in Spastic, 700

Parathyroid Glands in Graves’s Disease,
46

Parietal Lobes, vide Brain
Parkinson’s Disease, vide Paralysis Agi-
tans

Paroxysmal Neuroses, Food Factor in,
236

Pellagra: Delirium produced by Toxin es
of, 46

Peroneal Form of Muscular Atrophy, 829
Petromyzon : Cranial Nerve Components
of, 418

Pharyngitis, Meningococcal, in Epidemic
Cerebro-Spinal Meningitis, 354
Philipovicz’s Sign in Enteric Fever,
378

Pituitary Body: Experimental Destruc¬
tion of, 207 ; Tumour of, 429 ; Tumour
of with Infantilism and Optic Atrophy,
835

Pneumonia: Paralyses of, 767; Paralyses
induced by Pneumocoocic Infection, 44;
Pneumococcal Cerebro Spinal Menin¬
gitis, 752

Poliomyelitis Anterior Acuta: Bacteri-
ology of, 132; Relation to Encephalitis,
140 ; Rhizopods in, 353 ; and Cerebro
Spinal Meningitis, 830
Poliomyelitis Anterior Chronica, 137
Polyneuritis: as Sequela of German
Measles, 356 ; Toxic, in Phthisical
Patient, 500 ; Rheumatica in Cranial
Nerves, 690; Psychoses in, 848 ; vide
Neuritis

Porencephaly, 571
Post-Hemiplegic Movements, 868
Pott’s Paraplegia, 218, 369, 752
Pressure, Sense of, 446
Progressive Muscular Atrophy, Neural
form of, 691, 829

Pseudo-Sclerosis: Westphals, 831
Pseudo-Systemic Sclerosis of Cord, 139
Psychastnenia, 518

Psychiatry: Observations on Case of
Murder and Suicide, 231; Lumbar

886

INDICES

Puncture in, 655 ; Position of the Aty¬
pical Child, 656 ; vide Mental Diseases
Psychic Functis ; on Localisation of
Higher, 420

Psychological Conception of Nervous¬
ness, 370

Psychological Methods: Disclosure of
Fact hy, 305

Psychology : Scientific Investigation of
Psychical Processes in Higher Animals,
822 ; of Sudden Religious Conversion,
457 ; Psycho Analogies aud Associa¬
tion Experiments, 520
Psychoses : Epilepsy in Chronic, 381; of
Children, 461; of Involution Period,
456; Puerperal, 58S ; Types of Devo-
lutional, 666 ; vide Mental Diseases
Pulse: Cessation of, during onset of
Epileptic Fits, 579

Pupil: Psychical and Sensory Reaction
of, 149; Accommodation Reflex in
General Paralysis, 307 ; Traumatic Im¬
mobility of (3), 451 ; TVaumatic Reflex
Immobility of, 452; Immobility of
in Hysteria, 453 ; Reflexes in Mitral
Yalve Lesions, 581
Purkinje, Atrophy of Cells of, 55
Pyramidal Tracts : Latent Forms of Affec¬
tions of, 54; Unilateral Ascending
Paralysis due to Degeneration of, 296 ;
Experimental Section in Dogs and
Apes, 207 ; Paralysis by Compression
oL 693

Pyridine method for Differentiation of
Reticulum of Nerve Elements, 684

Ramon y Cajal’s Method applied to Axis-
cylinder, 420
“Recurrens Frage,” 769
Recurrent Third Nerve Paralysis in
Typhoid, 454
Reflex Epilepsy, 838

Reflexes: Cerebral and Spinal Elements
in, 843 ; Babinski’s Sign in Scarlet
Fever, 151; “ Extensor Phenomenon,”
152; Pharyngeal, 154 ; Abdominal, in
Enteric, 222; Dorsal Foot, 447 ; Peculiar
Reflex in Affection of Ceutral Motor
Neurones, 448; Schafer’s Antagonistic,
448 ; in Infantile Cerebral Hemiplegia,
506; Unilateral Loss and Subsequent
Return of Knee-Jerk, 515 ; Abdominal
Reflex in Enteric, 582 ; in Spastic Para¬
plegia, 700; Abdominal Reflex in
Frontal Tumours, 869; New Method
of Investigating Kuee and Ankle-Jerks,
844 ; Simple Device for obtaining
Knee-Jerk, 844

Regeneration: in Peripheral Nerves, 134,
209, 210, 425, 430, 558, 637

Reptiles, Nerve-Endings in, 202

Respiration: Cortical Centre in Dog.
35; Central Respiratory Innervation.
86

Retina: Projection on Cortex of Occipital
Lobe, 372; Hypenesthosia of Visual
Periphery, 580

Retinal Cyanosis, 54

Reviews: Die Erkrankungen dee Riicken-
markes und der Medulla Oblongata,
162 ; Klinik fur psychische und nervbee
Krankheiten, 238 ; Gehim und Rticken-
mark, 239; Die Temperamente, 240;
Localisation of Cerebral Function,
308 ; Histology of Cerebral Cortex, 387 ;
Affectiritat, ouggestibilitat, Paranoia,
393 ; Palpablen Gebilde des normalen
menschlicnen Korpers, 465; Robert
Schumann’s Disease, 526; Atlas der
pathologischen Histologie des Nerven
Systems, 867 ; Diagnosis of Nervous
Diseases, 868 ; Outlines of Comparative
Lunacy Law, 869; Walk through a
Modern Asylum, 870; Journal of Ab¬
normal Psychology, 527; Gehim und
Seele, 528; Psychother&peutischeBriefe,
657

Rheumatism: Nervous Manifestations of
Acute, 59; Polyneuritis of Cranial
Nerves, 690; and Ascending Neuritis,
828

Scarlet Fever: Babinski Sign in, 151

Sciatica: Surgical Treatment of, 465

Sclerosis: Cerebral, 427 ; vide Dissemi¬
nated Sclerosis

Sensation : Thermo-Asymmetry of Bul¬
bar Origin, 62; in Acute Localised
Ischaemia, 151; Rare Form of Pseudo-
iEsthesia, 768 ; Disturbances of Barae-
thesia, 446; Representation in Cortex,
819

Sensory Ataxia, 446

Sensory Areas in Disorders of Digestion,
701

Serum Reaction in Persons suffering from
Infective Conditions, 562

Serum Treatment: in Exophthalmic
Goitre (2), 384; of Cerebro - spinal
Meningitis, 826

Sexual Perversity, Forensic import of
850

Skin: Distribution of Afferent Nerves
in, 738

Skull: Estimation of Capacity of, 420

Sleep : Osmotic Theory of, 423 ;
Peculiar Attitude in Epilepsy during,
839

“ Sleep Drunkenness ": 229

Sleeping Sickness, lit

INDICES

887

Snake Venom, Action on Nervous
System, 498

Spasmodic Laughter and Weeping, 871
Sphenoidal Sinusitis, Cerebral and Oph¬
thalmic Complications in, 757
Spinal Accessory Nerve: White ranli
F.bres and, 83 ; Paralysis of, in Tabes,
4^9

Spinal Cord : Anatomy : Structure of
in Ostrich, 84 ; Recognition of Seg¬
mental Levels from Appearance of
Transverse Section, 844 ; Distribution of
Cells in Intermedio-Lateral Tract, 349;
Lumbo - Sacral - Coccygeal Cord in
Macaque Monkey, 683; Cell Columns
of Anterior Cornua, 737
Spinal Cord: Physiology : Sensory Con¬
duction in, 205 ; Paths for Painful and
Thermal Impressions, 424
Spinal Cord : Pathology : Partial
Doubling of, 6, 729 ; in Acute

Ascending Paralysis, 106 ; Degenera¬
tion in Acromegaly, 429 ; Descending
Degenerations of Posterior Columns in
Transverse Myelitis and Compression
of Dorsal Posterior Roots by Tumours,
4B8; Malformation of, 497; Extirpa¬
tion of Lower Half of, 562;

Spinal Cord : Clinical : Lesions from
Absorption from Localised Septio
Foci, 25 ; vide Conus Terminalis and
Various Diseases of
Spondylitis Deformans, 861
Suprarenal Capsules in Nervous and
other Diseases, 352

Syphilis : Tabes, General Paralysis and,
856, 512, 561, 748 ; Milianr Dis¬
seminated Brain Syphilis and General
Paralysis, 572 ; Atrophy of Glands at
Base of Tongue in, 583 ; Korsakow’s
Symptom-Complex in Brain, 704;
Relation to Lymphocytosis of Cerebro-
Spinal Fluid, 749 ; Syphilitic Spinal
Paralysis, 211
Syringobulbia, 368 ; 832
Syringomyelia : with Double Optic
Neuritis, 138 ; with Sensory Disturb¬
ances of Radicular Distribution, 442 ;
Extending from Sacral Region to
Upper Part of Right Internal Capsule,
832

Tabks : 433 ; Juvenile, 186 ; Heemate-
mesis in, 154 ; Late, 289 ; Larynx in,
290 ; General Paralysis, Syphilis and,
856; Forms Seldom Described, 858 ?
Dystrophy of, 487 ; Paralysis of Spinal
Accessory in, 439 ; and Knee Angle
Phenomenon, 501; Surgical Compli¬
cations of, 501; and Aortic Aneurism,

565 ; Ocular Crises in, 642; Chancre
in, 692 ; Peripheral Neuritis and
Arthropathy of Knee in, 692 ; Largyn-
geal Crises in, 692 ; Co-existence of
Tertiary Syphilitic Lesions with, 748 ;
Lesions of Spinal Nerve Roots, 825;
Pal's teaching as to Vascular Crises in,
830

Tactile Paralysis, 299
Taste-buds of Larynx, 43
Temperaments (Review), 240
Tendon-Jerks, vide Reflexes
Tendons: Indications for Transplants
tion of, 237 ; Failure in Transplanta¬
tion of, 862

Tetany : 762 ; Prognosis of Adult, 698
Tetanoid Chorea, 249
Thalamic Syndrome, 648
Thalamus, a co-ordinating Centre, 368
Thermo-Asymmetry of Bulbar Origin, 62
Tic: 584 ; Facial, 56 ; Hysterical, 144 ;
Multiform, 220; Facial, cured by
Suggestion, 220 ; of Childhood, Treat¬
ment of, 382 ; Convulsive, 444
Tobacco, Ocular Symptoms due to, 837
Tongue: Hemiatrophy of and Facial
Paralysis, 289 ; Diphtheritic Paralysis
of, 217

Torticollis: Hysterical, 58
Transplantation of Nerves; 386 ; 745
Trapezius, Spasm of Right, 56
Trauma: Dementia Paralytica after, 229;
and General Paralysis, 307 ; 813; Con¬
sequences^ of Injury to Peripheral
Nerves, 47 ; Isolated Paralysis due to,
499 ; and Pupil (3), 351
Tremor: Intention, in Children, 62; in
Frontal Tumours, 809
Trypanosomiasis, 112
Tumour: Brain : Mental Symptoms of
Cerebral, 509; Anaesthesia, Attaoks
of Hemialgesia and Early Muscular
Atrophy in, 835 ; Meningeal, 184;
Pituitary, 429; 835; Psammoma of
Dura Mater, 142; Cerebellar, 218;
510; Extracerebellar, 508 ; Localisa¬
tion of Frontal, 809; Embryoma of
Frontal Lobe, 838; Corpus Callosum,
694 ; Temporosphenoidal Lobe, 838;
Results of Operation for Removal of,
782 ; Palliative Operation in, 786
Tumour: Spinal Cord : Extra-Medullary
New Growths, 859; Descending De¬
generations of Posterior Columns after
Compression of Dorsal Roots by, 488;
Operation for Tumour of Spinal
Meninges, 644
Typhoid Fever, vide Enteric

Vascular Lesions, Hemiplegia in, 365

888

INDICES

Venoms: Action of, on Nervous System,
498

Periphery, 680

Wallsrian Law, 210
Weeping, Spasmodic, 371
Weigerts Neuroglia Stain, 738
Westphal’s Pseudo-sclerosis, 831
Whooping-Cough: followed by
plegia, 64

Wrisberg, Nerve of, 473

Hemi-

INDICES

889

INDEX OF

Albrecht. Manic-Depressive Insanity
and Arterio-soleroeia, 707
Alquier. Nerrous Troubles in Pott’s
Disease, 359

Alter. Hydrotherapy in Mental Dis¬
orders , 777

Alzheimer. Degeneration of Nerve Tissue,
687

Amblard. Pneumoooocal Oerebro-spinal
Meningitis and Diabetes, 752
Anderson. Paralysis of Involuntary
Muscle, 39, 279

Anton. ISymptoms of Frontal Disease,
646

Archambault. Inferior Longitudinal
Bundle and Central Optio Bundle, 81
Arndt. Insight in Mental Diseases,
379

Aschaffenburg. Variations of Mood in
the Epileptic, 523

Auerbach. Localisation of Musical Talent
in Brain and on Skull, 586
Avdakoff. Paralysis of External Branch
of Spinal Accessory in Tabes, 439.
Axenfeld. Traumatic Reflex Immobility
of Pupil, 452

Babes and Marinesco. Atlas of Patho¬
logical Histology of Nervous System
(Review), 867

Babinski. Neuritis, possibly due to
Working with Artificial Manures, 50 ;
Latent Forms of Affections of Pyramidal
System, 54 ; Spasm of Right Trapezius
and Facial Tic, 56 ; Peripheral Facial
Hemispasm, 57; Thermo-Asymmetry
of Bulbar Origin, 62 ; Paralysis by
Compression of Pyramidal Tract, 693 ;
Cerebellar Asynergy and Inertia, 703
Babinski and Toufesco. “ Blue Disease,*’
Retinal Cyanosis, Hemiplegia follow¬
ing on Whooping-Cough, 54
Bach. Decussation of Trochlear Nerve,
203; Motor Nuclei after Lesions of
Peripheral Nerves, 288
Bainbridge and Dale. Contractile
Mechanism of Gall-bladder and its
Extrinsic Nervous Control, 37
Baird, Harvey. Pathology of Epileptic
Idiocy, 689

Balb&e. Kernig’s Sign in Herpes Zoster,
300

3 M

AUTHORS.

BAlint and Benedict Diseases of Conus
Terminalis and Cauda Equina, 292
Barnes, Stanley, and E. Farquhar Buz¬
zard. Chronic Progressive Double
Hemiplegia, 188

Barrett Spinal Cord Degeneration in
Acromegaly, with Tumour of Pituitary
Region, 429; Mental Diseases associ¬
ated with Cerebral Arterio-Sclerosia,
458; Disseminated Syphilitic Ence¬
phalitis, 644

Batten, Fred. E. Cerebral Symptoms
due to Encephalitis; Relation of
Disease to Acute Anterior Poliomyelitis
140 ; Ataxia in Childhood, 297
Baumann. Hysteric Twilight-State, 760
Bechterew, W. v. What is Hypnosis ?
445; Peculiar Reflex in Affection of
Central Motor Neurons, 448
Beebe. Serum for Treatment of Exoph¬
thalmic Goitre, 384

Bellei. Mental Fatigue in School
Children, 285

Benedict and Bklint Diseases of Conus
Terminalis and Cauda Equina, 292
Berliner. Histology and Developmental
History of Cerebellum, 32 ; Cerebellar
Tumour with Mental Symptoms, 218
Bernhardt. Pathology of Exophthalmic
Goitre, 647

Bernstein, Julius, and Purves Stewart.

Partial Doubling of Spinal Cord, 729
Bertholet. Conducting Paths for Pain¬
ful and Thermal Impressions in Cord,
424

Besta, Carlo. Degeneration and Regenera¬
tion of Peripheral Nerve Fibres, 658
Bianchi. Cerebral Cortex of Dolphin, 34
Binswangor. Treatment of Mental
Diseases, 63

Bleuler. Affectivity, Suggestibility, and
Paranoia (Review), 893
Blumer, G. A. Coming of Psychasthenia,
518

Boinet Diver’s Palsy, 755
Bonfigli. Aphasia, 651
Bonhoeffer. Jacksonian Epilepsy in
Topical Cerebral Diagnosis, 647
Borchardt and Op^enheim. Operation
for Tumour of Spinal Meninges, 644
Boschi and Graziani. Pott’s Paraplegia,
752

890

INDICES

Bouchand. Infantile Cerebral Hemi¬
plegia, 506

Bowlby, Anthony. Surgical Complica¬
tions of Tabea Dorsalis, 601
Bradley, O. Charnock. Hind-Brain of

Pig, 126

Braiilon. Pupil Reflexes In Mitral Valve
Lesions, 581

Bramwell, Byrom. Intracranial Aneur¬
isms, 507 ; Extra-Cerebellar Tumours,
508.

Bramwell, Edwin. Recognition of Seg¬
mental Levels in Cervical and Lumbar
Enlargements of Cord from Appearance
of Transverse Section, 344; Juvenile
General Paralysis, 813
Bramwell, Edwin, and Arthur H. H.
Sinclair. Ophthalmoplegia interna
unilateral, 841

Bratz and Leubuscher. Epilepsy with
Unilateral Manifestations, 696
Brissaud, Sicard and Tanon. Treatment
of Contractures, Spasms and Tremors
by Local Injection of Alcohol into
Nerve Trunks, 710

Brower. Treatment of Acute Insanity in
a General Hospital, 709
Brown, H. Egerton. Cystioercus Cellu¬
lose in the Insane, 373
Browning, William. Spinal Hemor¬
rhage, 137; Treatment of Cerebro-
Spin&l Meningitis, 234
Bruce, Alexander. Distribution of Cells
in Intermedio-lateral Tract, 349
Bruce, Alexander, Stuart M*Donald, and
J. H. Harvey Pirie. Partial Doubling
of Spinal Cord, 6

Bruce, Lewis C. Serum Reaction in
Persons suffering from Infective Con¬
ditions, 562

Bruel. Tics and Choreas of Childhood,
382

Bryant. Psychical Importance of Ear
Disease, 7?6

Buck, J. de, and Deroubaix. Histo-
pathology of Certain Forms of Psy¬
chosis allied to Dementia Procox, 287
Bullard. Operation in Head Injuries,
463

Bumke. Immobility of Pupil in
Hysterical Attacks, 453; “Zwangs-
vorgange,” 460

Burns, R. L., Stewart, Guthrie, and Pike.
Resuscitation of Central Nervous
System of Mammals, 741
Buzzard, E. Farquhar. Myasthenia
Gravis, 295

Buzzard, E. Farquhar, and J. Cunning.
Pest-Traumatic Haemorrhage from
Superior Longitudinal Sinus without
Fracture of Skull, 443

Buzzard, E. Farquhar, and Stanley
Barnes. Chronic Progressive Double
Hemiplegia, 183

Buzzard, Thomas. Diagnosis of Tumour
or other Lesion of Uncinate Region of
Temporo-sphenoidal Lobe, 833

Cajal, S. R. Cell Types in Sensory
Ganglia, 124 ; Nerve Regeneration, 134
Campbell, Alfred W. Localisation of
Cerebral Function (Review), 308
Campbell. Cerebral Sclerosis, 427
Campbell, C. Macfie. Muscular Dys¬
trophy affecting Hands and Feet, 193
Camus and DuprA Pott’s Paraplegia, 218
Cans and Roaut. Diagnosis of Cerebral
Disturbances of Toxio Origin and
General Paralysis by Ocular Symptoms,
837

Cantonnet. Paralysis of Associated
Movements of Eyes, 654
C&rdenal, de, and Verger. Tabes, 692
C&tolk. Disseminated Sclerosis, Cere¬
bellar Atrophy, Pseudo-Systemic
Sclerosis of Cord, 139; Pathology of
Parkinson*8 Disease, 689
Ceni, Carlo. Anatomical Localisation of
Delirium produced by Toxines of
Pellagra, 45

Chaillons and Pagniez. Bilateral Oph¬
thalmoplegia Externa, 302
Chartier ana Lejonne. Ascending Neu¬
ritis and Chronic Rheumatism, 828
Chotzen. Mixed Conditions in Epilepsy
and Alcoholism, 589; Atypical Alco¬
holic Psychosis, 705

Church. Neuritic Type of Progressive
Muscular Atrophy, 691
Ciacco, Carmel lo. Reproduction of Nerve
Cells, 820

Clarke, J. MichelL Myasthenia Gravis,
146

Cohn, Toby. Die palp&blen Gebilde des
normalen menschlichen Korpers (Re¬
view), 465

Cole, Sidney J. Aphasia and Mental
Disease, 304

Conzen. Arsenical Neuritis, 216
Coriat. Alcoholic Neuritis, 564
Cramer and Long. Late Tabes, 289
Croeq. Dementia Procox, 848
Crucnet. Peripheral Post-Paralytic

Hemispasm, 56 ; Convulsive Tic, 444
Cruchet and Pitres. Hysterical Tic, 144
Cumming, J., and E. Farquhar Buzzard.
Haemorrhage from Superior Longi¬
tudinal Sinus without Fracture of
Skull, 448

Curtis, B. Farquhar. Surgical Treat¬
ment of Exophthalmic Goitre, 462
Cashing, Harvey. Surgical Intervention

INDICES

891

for Intra-cranial Haemorrhages of New¬
born, 66; Sexual Infantilism with
Optic Atrophy in Tumour of Hypo¬
physis Cerebri, 835

D'Abukdo, G. Experimental Cerebral
Atrophies and Accompanying Cranial
Atrophies, 742

Daire&ux. Paralysis of Pneumonia in
Adults, 767

Dale and Bainbridge. Contractile
Mechanism of Grail-Bladder and its
Extrinsic Nervous Control, 87
D&nnemann. Psychic and Motor Dis¬
turbances caused by Alcohol, 591
Dannenberger. Porencephalic Form of
Infantile Paralysis, 571
Debove. Tabes and Aortic Aneurysm,
565 ; Hysterical Dysarthria, 654
Debray. Sensory Aphasia, with Right
Homonymous Lateral Hemianopia, 377
D6jerine. Intermittent Claudication of
Spinal Cord, 584; Sensory Aphasia,
its \ Localisation and Pathological
Physiology, 650 ; “ Tactile Aphasia,”
708

D6jerine, M. et Mme. Cell Columns of
Anterior Cornua of Spinal Cord, 737
D4ierine and Roussy. Thalamic Syn¬
drome, 648

Delacroix and Solager. Retro-antero¬
grade Amnesia, etc., in Hysteria, 223
Deny, G. Manic-Depressive Insanity,
849

Deroum. Heboid Paranoid Group of
Dementia Pnecox, 708
Deroubaix. Spasmodic Laughter and
Weeping, 371

Deroubaix and de Buck. Histopathology
of Certain Forms of Psychosis allied to
Dementia Praecox, 287
Devaux. Osmotic Theory of Sleep, 423
Donaggio. Pyridine Methods for Rapid
Differentiation of Reticulum of Nerve
Elements, 684 ; Effects of Combined
Fasting and Cold on Nerve Centres, 687
Donath. Choline in Cerebro-spinal
Fluid, 285

Dontas and Mavrakis. Respiratory
Centre in Cerebral Cortex of Dog, 35
Dorleans. Co-existence of Tertiary
Syphilitic Lesions with Tabes and
General Paralysis, 748
Drew. Common Form of Insanity, 457
Dreyfus. Traumatic Immobility of
Pupil (2), 451

Dupre and Camus. Pott'9 Paraplegia,
218

Edgeworth. Transitory Hemiplegia in
Elderly Persons, 838

Egger and Raymond. Tactile Aphasia,
586

Ellerman. Rhizopods in Acute Anterior
Poliomyelitis, 358

Elliott. Degenerative Section of Nerves
to Cat’s Bladder, 275
Erb. Intermittent Claudication, 153,
698

Esposito. Psammomata of Dura Mater,
,142

Etienne. Intense Cold in Pathogeny of
Acropathies, 155

Eulenburg. Anti thyreoid in Treatment

of Exophthalmic Goitre, 65
Evensen, Hans. Pathology of General
Paralysis, 537 , 616

Farrar, Clarence B. Devolutional
Psychoses, 665

Faure, Maurice. Laryngeal Crises of
Tabes, 692

Fedem. Blood-Pressure and Neuras¬
thenia, 58

Feix. Method of Investigation of Knee-
and Ankle-Jerks, 844
Fels. Symptom-Complex of Primary
Incoherence with Excitement, 775
F6r6, Ch. Rest in Ergographic Work,
Mechanical Value of Mental Repre¬
sentation of Movement, etc., 283;
False Reminiscence, 847
Ferguson, Alex. Hugh. Ischemic Mus¬
cular Atrophy, Contractures, and
Paralysis, 514

Ferrier, David. Tabes Dorsalis, 433
Fichera. Experimental Destruction of
Hypophysis, 207

Fischer, Oskar. Isolated Palsy for
Lateral Movement of Internal Rectus
Muscle, 375; Macropsia and its Rela¬
tion to Micrographia, and Peculiar
Alteration in Light Perception, 449 ;
Heart Neuroses and Basedow’s Disease,
697

Fischler. Isolated Traumatic Paralysis,
499 ; Traumatic Conus Lesions, 567
Fitzgerald. Lumbo - Sacral - Coccygeal
Cord of Macaque Monkey, 683
Flashman, J. F. Motor Areas in Cere¬
bral Cortex of Daayurus Viveninus,
635 ; Brain of Microcephalic Idiot,
showing lack of Corpus Callosum, 639
Fleig. Muscular-Tonic Action of Foraio
Acid, 232

Flexner, Simon. Experimental Cerebro¬
spinal Meningitis and its Serum
Ireatment, 826

Forli. Rheumatic Polyneuritis of Cranial
Nerves, 690

Forli and GuidL Pharyngeal Reflex,
154

892

INDICES

Francos and Raymond. Syringomyelia
with Sensory Disturbances of Radicular
Distribution, 442

Fraukl-Hochwart. Prognosis of Adult
Tetany, 698

Franz, S. I. Time of Some Mental Pro¬
cesses in Retardation and Excitement
of Insanity, 308

Frazier and Spiller. Cerebral Decompres¬
sion, 786

Frazier, Spiller, and Van Kaathoven.
Treatment of Nerve Palsies and
Athetosis by Nerve Transplantation,
886

Freud. Hysteria Analysis, 522
Frey, Ernest. Post-Hemiplegic Move¬
ments, 368

Frey, Max von. Distribution of Afferent
Nerves in Skin, 788

Friedmann. Non-Epileptio Affections
of Consciousness or 8hort Narcoleptic
Attacks, 575

Fuhrmann. Acute Juvenile Deteriora¬
tion, 225

Galkzowskl Bi-temporal Hemianopia,
699 ; 777

Galezowski, Raymond, and Lejonne.
Blindness of Cortical Origin from
Double Hemianopia, 699
Gardner, Eric. Family in which Signs
of Friedreich’s Ataxy appeared Dis¬
cretely, 441

Gaupp. Depressions of Advanced Life,
159 ; Crimes committed during Intoxi¬
cation, 592

Gaussel. Acromegaly, with Lesion of
Hypophysis and Sella Turcica, 759
Gehuchten, A. van. Faisceau en Crochet,
208 ; The Wallerian Law, 210
Geirsvold. Bacteriology of Acute An¬
terior Poliomyelitis, 132
Geist. Lobus Cerebelli Medianus, 737
Gemelli. Structure of Motor Nerve-
endings in Reptiles, 202 ; Structure of
the Nerve Cell, 556

Gieseller. General Paralysis and Trauma,
307

Goldscheider. On Organic Changes in
Assoziationsbildung,” 278; Sensory
Ataxia, 446

Goldscheider and Leyden. Diseases of
Cord and Medulla Oblongata (Review),
162

Gordon, Alfred. Pathogenesis of Exoph¬
thalmic Goitre, 59

Gottgetreu. Psychoses of Children, 461
Gowers, Sir W. R. Influence of Faoial
Hemiatrophy on Facial and other
Nerves, 1; Chorea and its Neuronic
Aspect, 219 ; Tetanoid Chorea and its j

Association with Cirrhosis of the Liver,
M9; Dystrophy of Tabes and Problem
of Trophic Nerves, 437 ; Dendrites and
Diseases, 686 ; Borderland of Epilepey,
694, 696

Grabower. Zur Recurrenafrage, 769
Grasset. Intermittent Claudication of
Nervous Centres, 585
Graziani and BoschL Pott’s Paraplegia,
752

Green, D. Crosby. The Larynx in
Tabes, 290

Groszmann. Position of the Atypical
Child, 656

Gudden. “ Sleep Drunkenness,'’ 229.
Guerrini. Function of Degenerate
Muscles, 214, 559

Guidi and ForlL Pharyngeal Reflex,
154

Guillain and Raymond. Syringobulbia,
868

Guizzetti. Chromatic Pseudo-Corpuscles
of Axis-Cylinder, 123
Guthrie, C. C., Stewart, Burns, and
Pike. Resuscitation of Central Ner¬
vous System of Mammals, 741

Halliburton and Mott Suprarenal
Capsules in Nervous Diseases, 352
Hamburger. Diphtheritic Paralysis of
Left Hypoglossus, 217
Hare, Francis. Food Factor in Paroxys¬
mal Neuroses, 236

Haskovec. Ocular Crises in Tabes, 642
Head, Henry. Afferent Nervous System
from New Aspect, 47
Head, Henry, and James Sherren. Con¬
sequences of Injury to Peripheral
Nerves, 47

Hecht Myoclonus Multiplex, 143;

Dementia Prwcox, 302
Heilbronner. Agrammatismus and Dis¬
turbance of Internal Language, 652;
Progressive Paralysis of Insane, 847
Heitz and Roux. Effect of Experimental
Section of Posterior Roots upon Peri¬
pheral Neurons, 743

Heller. Multiple Sclerosis and the
Psychogenic Neuroses, 831
Hirt, Eduard. The Temperaments (Re¬
view), 240

Hoch, August Delirium produced by
Drugs, 83

Holmes, Gordon, F. J. Poynton, and
J. H. Parsons. Amaurotic Family
Idiocy, 568

Hoppe, Fritz. Weigert's Neuroglia
Stain, 738

Hoppe, Herm. H. Hysterical Stigmata
caused by Organic Brain Lesions, 297;
Treatment of ; Crimes committed by

INDICES

893

Alooholic, 598; Walk through a
Modern Asylum (Review), 870
Horsley, Sir Victor. The Tania Pod tie,
418; Technique of Operations on
Central Nervous System, 778
Houzel. Bleeding in Epilepsy, 383
Howard. Relation of Lesions of Gas¬
serian and Posterior Root Ganglia to
Herpes occurring in Pneumonia and
Oereoro - spinal Meningitis, 139 ;
Tetany, 762

Hiibner. Psychical and Sensory Re¬
action of Pupils, 149 ; Tabes, General
Paralysis, and Syphilis, 856
Hndovernig. Hallucinations of Peri¬
pheral Origin, 776

Huet and Lejonne. Facial Paralysis and
Hemiatrophy of Tongue, 289
Humphrey, Lawrence. Parathyroid
Glands in Graves 1 Disease, 46
Hunter, W. K., and George Lamb.
Action of Snake Venoms on Nervous
System, 498

Hunter, Walter K.. and Charles Work¬
man. Cord and Medulla in Acute
Asoending Paralysis, 106

Iotbtko. Laws of Ergography, 40,128,
280, 282; Sense of rain, 149; Facial
Tic cured by Suggestion, 220 ; Mathe¬
matical Analysis of Fatigue Curves in
Diagnosis of Nervous Diseases, 224

Jackson, Edward. Developmental Al¬
exia, 518

Jaeger. Familial Cretinism, 224
Janet, P. Pathogenesis of some Impulses,
459

Jelliffe. Aphasia, Hemiparesis, and
Hemianaesthesis in Migraine, 223
Jochmann. Recurrent Third Nerve Par¬
alysis in Enteric Fever, 454
Johnston, J. B. Radix Mesencephalica
Trigemina and Ganglion Isthmi, 415;
Cranial Nerve Components of Petro-
myion, 418; Cranial and Spinal
Ganglia and Viscero-motor Roots in
Amphioxus, 419

Jones, A. Ernest. Hemiplegia in
Vascular Lesions, 865
Jordan-Lloyd. Facial Neuralgia treated
by Excision of Gasserian Ganglion,
798

Juliusburger. Want of Insight in
Alcoholics, 589; Treatment of Crimes
committed by Alcoholics, 598
Jung, C. G. Disclosure of Fact by
Psychological Methods, 305; Experi¬
mental Observations on Memory,
305; Diagnostic Association Studies,
520

Kaathovkn, Van, Spiller, and Frazier.
Treatment of Nerve Palsies and
Athetosis by Nerve Transplantation,
386

Kaes, Theodor. Width of Cortex in
Estimation of Brain Development and
Intelligence, 38

Rest. Head’s Zones in Disorders of
Digestive Organs, 701
Kirotf. Babinski’s Sign in Scarlet Fever,
151

Klippel and Lhermitte. The Dementias,
382

Klippel and Villaret, The Asthenias
and Myopathic Atrophies, 295
Klipstein. Hebephrenic Form of De¬
mentia Pracox, 707

Knapp, Philip Coombs. Mental Symp¬
toms of Cerebral Tumour, 509; Re¬
sults of Removal of Cerebral Tumours,
782

Kollarits. Hysterical Torticollis, 58
Kovalesky. Epilepsy and Migraine, 839
Kramer, Franz. Cortical Tactile Par¬
alysis, 299

Krause. Extirpation of Gasserian Gan¬
glion, 795

Kreuzfuchs. Traumatic Immobility of
Pupil, 451

Kronig. Device for Obtaining Knee-
Jerk, 844

KiimmeL Operative Treatment of
Purulent Meningitis, 791

Lachb. Post-mortem Changes in Neuro¬
fibrils, 352

Lamb, George, and W. K. Hunter.

Action of Snake Venoms on Nervous
* System, 498

Lambrior and Puscarin. Amyotrophic
Lateral Sclerosis, 750
Lamy. Synergic Paradoxical Contrac¬
tions following Peripheral Facial Palsy,
57

Langley, J. N. Reaction of Cells and
Nerve-endings to Certain Poisons, 276
Langwill, H. G. Transitory Hemiplegia,
505

Lapinsky. Forms of Tabes Seldom
Described, 358

La Place. Treatment of Idiopathic
Epilepsy by Appendicostomy for
Colonic Irrigation, 579
Laruelle. Position of Head in Cerebellar
Disease, etc., 455

Lasarew. Juvenile Tabes, 186; Schafer's
Antagonistic Reflex, 448
Lejonne and Chartier. Ascending Neu¬
ritis and Chronic Rheumatism, 828
Lejonne and Huet. Facial Paralysis and
| Hemiatrophy of Tongue, 289

894

INDICES

Lejonne and Lhermitte* Lacunar and
Myelopathic Paraplegia in the Old, 58 ;
Paraplegias from Retraction in Old
People, 566

Lejonne and Raymond. Pseudo-Bulbar
Palsy in a Child, 584
Lejonne, Raymond, and Galezowski
Blindness of Cortical Origin from
Double Hemianopia, 699
L4ri, Andr£. The Senile Brain, 758
L£ri, Andr4, and Pierre Marie. Spondy¬
litis Deformans, 361

Leroy. Responsibility of Hysterics, 760
Letessier and Sabrazes. Method of
Staining Neuroglia, 205
Leubuscher and Bratz. Epilepsy with
Unilateral Manifestations, 696
Leupoldt, Curt yon. Catatonia, 226 ;
Investigation of Traumatic Neuroses
by Psycho-Physical Methods, 587
Lewandowsky. Disturbances of Move¬
ment in Infantile Cerebral Hemiplegia;
Double Athetosis, 146 ; Apraxia in
General Paralysis, 306 ; Projection of
Pain Sensation from Lower to Upper
Extremity, 702

Leyden ana Goldscheider. Diseases of
Cord and Medulla Oblongata (Review),
162

Lhermitte and Klippel. The Dementias,
382

Lhermitte and Lejonne. Lacunar and
Myelopathic Paraplegia in the Old, 53 ;
Paraplegias from Retraction in Old
People, 566

Liepmann. Minor Aids in Examination
of Brain Disease, 52

Lilienstein. Exhaustion from Excess of
Function, 424

Lograsso and Onuf. Blood of Epileptics,
286

Lomer. Relation of Psychoses of Involu¬
tion Period to Juvenile Dementia, 456
Long and Cramer. Late Tabes, 289
Long and Revilliod. Polyneuritis as
Sequela of German Measles, 356
Lorenz. Transplantation of Tendons, 237
Lucas, Keith. Gradation of Activity in
Skeletal Muscle-Fibre, 127
Lugaro. Non-Occurrence of Autogenous
Regeneration of Nerve Fibres, 687 ;
Neurotropism and Transplantation of
Nerves, 745

Maingbr.* 41 Hysteria’ 1 of Animals, 513
Marbe and Noica. Cutaneous and
Spinal Reflexes in Spastic Paraplegia,
700

Margaria, Guiseppe. Etiology and Dura¬
tion of General Paralysis, 645
Marie. Supposed Immunity of Syphilitic

Arabs regarding General Paralysis, 513;
Aphasia : Third Left Frontal Convolu¬
tion does not play Special R61e in
Function of Speech, 649; Subcortical
Aphasia, 845

Mane, Pierre, and Andr6 L6rL Spondy¬
litis Deformans, 361

Marie and Montier. Pontine Haemor¬
rhage, 754

Marie and Pelletier. Perforating Ulcer
in General Paralysis, 369
Marinesco. Autogenic Regeneration, 209;
Disturbances of Baresthesia, or Sense
of Pressure, 446; Reticulated Struc¬
ture of Axis-Cylinder, 737
Marinesco and Babes. Atlas of Patho¬
logical Histology of Nervous System
(Review), 867

Marinesco and Minea. Regeneration in
Peripheral Nerves, 425
Marshall, D. G. Trypanosomiasis or
Sleeping Sickness, 113
Mattirolo. Rare Form of Pseudo-

aesthesia, 768

Mavrakis and Dontas. Respiratory
Centre in Cerebral Cortex of Dbg, 35
M‘Bride, P. Deafness due to Hysteria,
etc., 516

M 4 Donald, Stuart, Alexander Bruce, and
J. H. Harvey Pirie. Partial Doubling
of Spinal Cord, 6

Mackenzie, James. Visceral Pain, 700
Mackey. Osteitis Deformans with
Huntingdon’s Chorea, 840
Mackintosh, Ashley. Frequency of
Certain Signs and Symptoms in Dis¬
seminated Sclerosis, 601
Mendel, Kurt. Dorsal Foot Reflex, 447
Merzb&cher. Lumbar Puncture in

Psychiatry and Neurology, 655 ; Rela¬
tion of Syphilis to Lymphocytosis of
the Cerebro-spinal Fluid and to the
Question of 44 Meningeal Irritation,"
749

Mills, C. K. Crural Monoplegia, 296;
Jacksonian Epilepsy in Focal Diag¬
nosis, 511

Mills and Weisenburg. Word-Blindness,
Treatment of Visual Aphasia, 152;
Localisation of Higher Psychic Func¬
tions, 420 ; Cortical Representation of
Cutaneous and Muscular Sensibility,
819

Milne, C. J. Robertson. Epidemic
Cerebro-Spin&l Meningitis in India, 361
Minciotti. rhilipovicz’s Sign in Enteric
Fever, 378

Minea and Marinesco. Regeneration in
Peripheral Nerves, 425
Minor. Pathology of Epiconus Medul-
laris, 567

INDICES

895

Mirall6e. Peripheral Facial Palsy, 690
Mobius. Robert Schumann's Disease
(Review), 626

Moeli. Discharge of Patients from
Asylums in Prussia, 851
Moleen. Chronic Anterior Poliomye¬
litis, 137

Montier and Marie. Pontine Haemor¬
rhage, 754

Montyel, Marandon de. Pupil Accommo¬
dation Reflex in General Paralysis, 307
Moon. Convulsions in Children and
their Relation to Epilepsy, 839
Morawitz. Multiple Sclerosis in Guise
of Transverse Myelitis, 51
Morohen. Pal’s Teaching as to Vascular
Crises of Tabetics, 830
Moschcowitz. Surgical Treatment of
Trigeminal Neuralgia, 857
Mott and Halliburton. Suprarenal
Capsules in Nervous Diseases, 352
Mourre. Nerve Cells, studied by Nisei's
Method, 123

Miiller. Functions of Bladder in Cerebral
Hemiplegia, 152; Extirpation of Lower
Half of Spinal Cord, 562
Miinzer. Puerperal Psychoses, 588

Nacke. Late Epilepsy in Chronic
Psyohoses, 381

Nadjede and Parhon. Hemicranioeis,
61; Localisation in Nuclei of Cranial
and Spinal Nerves, 416
Nageotte, J. Nervous Intermedius of
Wrisberg and Bulbo-Pontine Nucleus,
473 ; Collateral Regeneration by Nerve
Fibrils with Club-like Terminals, 825
Neisser. Confabulation, 228
Neumann. Haemateraesis in Organic
Nervous Diseases, 154
Nikoiaides. Central Respiratory Inner¬
vation, 36

Nissl, Franz. Histology of Cerebral
Cortex and Pathological Anatomy of
Mental Diseases (Review), 387
Noioa. Primary Progressive Myopathy
in Two Brothers, 563
Noica and Marbe. Cutaneous and
Tendon Reflexes in Spastic Para¬
plegia, 700.

Nonne. Anatomical Basis of Syphilitic
Spinal Paralysis, 211
Norman, Conolly. Multiple Lipomata
in General Paralysis, 369

Obici. Method of Inscribing Tracings
on Revolving Cylinder, 208
Onuf and Lograsso. Blood of Epileptics,
286

Oppenheim. Extra - Medullary Spinal
New-Growths, 359

Oppenheim. Psychotherapeutic Letters
(Review), 657

Oppenheim and Borchardt. Operation
for Tumour of Spinal Meninges, 644
Orchansky. Tabes Dorsalis and Knee
Angle Phenomenon, 501
Orr, David. Descending Degenerations
of Posterior Columns in Transverse
Myelitis and Compression of Dorsal
Posterior Roots by Tumours, 488
Orr, David, and R. G. Rows. Lesions
of Spinal Cord, Result of Absorption
from Localised Septic Foci, 25
Ortali. Abdominal Reflex in Enteric
Fever, 222

Osier, William. Convulsions in Typhoid,
143

Ostermann. Meningococcal Pharyngitis
in Epidemic Cerebro-spinal Meningitis,
354

Owen, John, and W. B. Warrington.
Pathology of Myelitis Acutisaima
Haemorrhagica Disseminata, 401 ;
Haemorrhage into Brain and Cord from
Obliterative Arterial Disease, 407

Packard. Feeling of Unreality, 519
Pagano. Functions of Caudate Nucleus.
817

Pagniez and Chaillons. Bilateral Oph-
tnalmoplegia Externa, 302
Pailhas. Baths and Hydrotherapy in
Treatment of Mental Disease, 64
Paine and Poynton. Nervous Manifes¬
tations of Acute Rheumatism, 59
Panichi. Pathogenesis of Paralyses in¬
duced by Infection with Pneumococci,
44

Parhon and Nadjede. Hemicraniosis,
61; Localisation in Nuclei of Cranial
and Spinal Nerves, 416
Parsons, Poynton, and Gordon Holmes.

Amaurotic Family Idiocy, 668
Paul and Walton. Cerebral Element in
Reflexes; its Relation to Spinal
Element, 843

Pawlow. Psychical Faculties or Pro¬
cesses in Higher Animals, 822
Pelletier and Marie. Perforating Ulcer
in General Paralysis, 369
Pelizzi. Forms of Idiocy due to Menin¬
gitis, 156; Heterotopia of Cerebral
Cortical Substance, 428
Pers, Alfred. Surgical Treatment of
Sciatica, 465

Pfeiffer. Circumscribed Autopsychosis
on Basis of a Morbidly Dominant Idea,
461

Phelps, Charles. Function of Left Pre¬
frontal Lobe, 362

Pick. Retrogression of Hemianopio

896

INDICES

Disorders after Paralytic Attacks, 148;
Psychology of Confabulation, 227;
Mixed Apraxia, 880; Hyperesthesia
of Visual Periphery, 580
Pike, F. H., Stewart, Guthrie, and
Burns. Resuscitation of Central
Nervous System of Mammals, 741
Pitres and Crochet. Hysterical Tic, 144
Pirie, J. HL Harvey, Alexander Bruce,
and Stuart M‘Donald. Partial
Doubling of Spinal Cord, 6
Potter, N. B. Atrophy of Glands at
Base of Tongue as sign of Syphilis,
588

Poynton and Paine. Nervous Manifes¬
tations of Acute Rheumatism, 59
Poynton, Parsons, and Gordon Holmes.

Amaurotic Family Idiocy, 568
Primangeli. Transverse Myelitis as a
Sequela of Measles, 751
Prinoe, Morton. Multiform Tic, 220;
Psychology of Sudden Religious Con¬
version, 457 ; Head Injuries, 468 ;
Journal of Abnormal Psychology
(Review), 527 ; Limited Area of Anaes¬
thesia, etc., in Brain Tumour, 885;
Hysteria from Point of View of Dis¬
sociated Personality, 840
Pringle, J. Hogarth. Haemorrhage from
Middle Meningeal Artery, 864
Puscarin and Lambrior. Amyotrophic
Lateral Sclerosis, 750
Putnam, J. J. Hysteria in Massachusetts
General Hospital, 462
Putnam and Waterman. Cerebellar
Tumours, 510

Rahsay, A. Maitland, and W. M. Suther¬
land . Spindle-Shaped Enlargement of
Blind-Spot with Congestion of Optic
Disc, 801

Ranaon,S. Walter. Retrograde Degenera¬
tion in Spinal Nerves, 686, 747

Raymond. Tumour of Corpus Callosum,
694

Raymond and Egger. Tactile Aphasia,
586

Raymond and Fran^ais. Syringomyelia
with Sensory Disturbances of Radicular
Distribution, 442

Raymond and Guillain. Syringobulbia,
868

Raymond and Leionne. Pseudo-Bulbar
ralsy in a Child, 584

Raymond, Lejonne, and Galezowski.
Blindness of Cortical Origin, from
Double Hemianopia, 699

Raecke. Mental Disorders in Multiple
Sclerosis, 642

Rebizzi. Toxic Cause in Mental Disease,
640

Redlich, EmiL Etiology of Epilepsy,
574

R4gis. Mental Confusion, 879; Trau¬
matic Neurasthenia in Artario-Seler-
oeis, 761

Reichardt Delirium Tremens, 231;
Estimation of 8kull Capacity on
Cadaver, 420

Reinhold. Dementia Paralytica after
Trauma, 229

Rendu, A., Jules Voisin, and Roger
Voisin. Idiocy and Cerebellar Lesion,
523

Revilliod and Long. Polyneuritis as
Sequela of German Measles, 856
Reynolds, Ernest 8. Paramyoclonus
Epilepticus, 19

Riegner. Physiology of Jaw-Movements.
558

Riklin. Symptoms and Associations of
Hysteria, 298

Riva. Neuro-fibrillary Reticulum in
Experimental Inanition, 687
Robertson, W. Ford. Pathology of
General Paralysis of Insane, 78, 169,
258

Rodrigues. Polyneuritic Psychosis and
Beri beri, 848

Rodut and Cans. Diagnosis of Cerebral
Disturbances of Toxic Origin and
General Paralysis by Ocular Symptoms,
887

Roemheld. Korsakow’s Symptom-Com¬
plex in Brain Syphilis, 704
Rogers, John. Serum Treatment of
Exophthalmic Goitre, 384
Rolleston, J. D. Abdominal Reflex in
Enteric Fever, 582; Precocious Par¬
alysis of Palate in Diphtheria, 666
Roeanofl. Diet in Epilepsy, 235
Rosenheim. Preparation of Cholesterin
from Brain, 351

Ross. Peculiar Attitudes in Epilepsy
during Sleep, 839

Rossi. Structure of Nerve Cell in Verte¬
brates, 416

Rossi and Roussy. Pathology of Amyo¬
trophic Lateral Sclerosis, etc., 688
Roth. White Rami Fibres and Spinal
Accessory Nerve, 33

Rothmann, Max. Sensory Conduction
in Spinal Cord, 205
Roubiuovitch. Tic, 584
Roussy. Meningeal Tumours, 134
Roussy and D6jerine. Thalamic Syn¬
drome, 648

Roussy and Rossi. Pathology of Amyo¬
trophic Lateral Sclerosis, etc., 688
Roux and Heitz. Effect of Experimental
Section of Posterior Roots upon Peri¬
pheral Neurons, 748

INDICES

897

Rows, R. G. Embryoma in Frontal
Lobe, 388

Rows, R. G., and David Orr. Lesions of
Spinal Cord, Result of Absorption from
Localised Septic Foci, 88
Ruppel. Diplococcus Intraoellularis
Meningitidis and its Relations to
Gonococci, 740

Russell, A. E. Cessation of Pulse during
Onset of Epileptic Fits, 579
Russell, William. Cerebral Manifesta-
tions of Hypertonus in Sclerosed
Arteries, 362

SABRAZfcs and Letessier. Method of
Staining Neuroglia, 205
Sachs. Head Injuries and Operative
Treatment, 463

Salgd. Forensic Import of Sexual Per¬
versity, 850

Salle. Extension of Ascending Myelitis,
741

Salomonson, W. Toxic Polyneuritis in
a Phthisical Patient, 500
Sandberg. Sensory Disturbances in
Cerebral Hemiplegia, 367
Santesson. Local Action of Cocaine and
Stovaine on Peripheral Nerves, 828
Sauerbeck. Malformation of Brain in
Hatteria Punctata, 214
Saxl. Extensor Phenomenon, 152
Scarpini. Nerve Cells studied by Don-
aggio’s Method, 557 ; Endocellular
Fibrillary Reticulum and Long Fibrils
in Cells of Spinal Cord, 557
Schaffer. Fibrillar Structure in Progres¬
sive Paralysis, 212; Fibrillo-Reticular
Substance in Swollen Nerve Cells, 789
8chlesinger. Sensation in Acute Local¬
ised Ischaemia, 151; Palatal Paralysis,
221; Bilateral Circumscribed Facial
Atrophy, 221

Schloesser. Treatment of Neuralgias by
Alcohol Injections, 236
Schiiller. Experimental Section of Pyra¬
mids in DogB and Apes, 207
Schultz, Paul. Gehirn und Seele (Re¬
view), 528

Scliultze, Kurt. Surgery of Basedow’s
Disease, 711

Schutzc. Landry’s Paralysis after
Typhoid, 291

Scott, T. H. Metabolism and Action of
Nerve Cells, 277

8herren, James, and Henry Head. Con¬
sequences of Injury to Peripheral
Nerves, 47

Sherran, James. Distribution and Re¬
covery of Peripheral Nerves, 480; Sur¬
gery of Peripheral Nerves, 860
Sicard, Brissaud, and Tanon. Treatment

of Contractures, Spasms, and Tremors
by Looal Injection of Aloohol into
Nerve Trunks, 710

Simpson. Westphal’s Pseudo- Sclerosis,
831

Sinclair, Arthur H. H., and Edwin
Bramwell. Ophthalmoplegia interna
nnilaterale, 841

Sinkler, Wharton, Friedreich’s Ataxia,
217 ; Landry’s Paralysis, 829
Sklodowski. Treatment of Basedow’s
Disease with Rontgen Rays, 711
Soca. “ Crutch Paralysis,’’ 564
Solager and Delacroix. Retro-antero¬
grade Amnesia, etc., in Hysteria, 223
Sollier, Paul. Intermittent Claudioation
of Cord, 842

Sommer. Psychiatric Observations on
Case of Murder and Suicide, 231;
Klinik fur psychische und nervose
Krankheiten (Review), 238
Southard. Neuroglia Framework of
Cerebellum, 683

Specht. Hystero-melancholia, 774
Spielmeyer. Amaurotic Family Idiocy,

570

Spiller, W. G. Separate Sensory Centres
in Parietal Lobe for the Limbs, 296;
Lesions of Left First Temporal Con¬
volution in Relation to Sensory
Aphasia, 329 ; Syringomyelia, 832
Spiller and Frazier. Cerebral Decom¬
pression, 786

Spiller, Frazier, and Van Kaathoven.
Treatment of Nerve Palsies and Athe¬
tosis by Nerve Transplantation, 886
Starr, Allan. Cerebellar Apoplexy, 506;

Present Status of Brain Surgery, 852
Sterling, W. Amaurotic Family Idioqy,

571

Stewart, G. N., Guthrie, Burns, and Pike.
Resuscitation of Central Nervous
System of Mammals, 741
Stewart, Purves. Clinical Significance
ofCerebro-Spinal Fluid, 504; Diagnosis
of Nervous Diseases (Review), 868
8tewart, Purves, and Julius Bernstein.

Partial Doubling of Spinal Cord, 729
Stewart, T. Grainger. Localisation of
Tumours of Frontal Region of Brain,
309

Stiefler. Neural Form of Progressive
Muscular Atrophy, 829
Still, George F. Habit Spasm in Chil¬
dren, 145 ; Head-Nodding with Nys¬
tagmus in Infancy, 771
Stoddart. Instinot, 686
Straussler. Cerebellum in General Para¬
lysis, 561; Miliary Disseminated Form
of Brain Syphilis and General Paralysis,

572

898

INDICES

Streeter, G. L. Cranial and Spinal
Nerve* in Occipital Region, 30; Spinal
Cord of Ostrich, 34
Strohmever. Amentia, 772
Striimpell. Hysterical Fever, 443
Sutherland, W. M., and A. Maitland
Ramsay. Spindle-Shaped Enlarge¬
ment of Blind-Spot with Congestion
of Optic Disc, 801

Symington, Johnson. Topographical
Anatomy of Capat Gyri Hippocampi,
414

Tanon, Brissaud, and Sicard. Treatment
of Contractures, Spasms, and Tremors
by Local Injection of Aloohol into
Nerve Trunks, 710

Taylor, R. W. Multiple Sclerosis,

Tebb, M. Christine. Choiceterin of

Brain, 351

Tereon. Paralysis of Abducens in Otitis,
765

Thoma. Slightly Abnormal Children,
380

Thomas, AndrA Atrophy of Cells of
Purkinje, 55 ; Ramon y Cajal's Method
in Pathological Anatomy of the Axis-
cylinder, 420

Thompson, W. Gilman. Exophthalmic
Goitre, 445

Thomson, St Clair. Cerebral and Oph¬
thalmic Complications in Sphenoidal
Sinusitis, 757

Thorington and Weisenburg. Syringo¬
myelia with Double Optic Neuritis,
138

Tiedemann. Poliomyelitis Anterior
Acuta and Meningitis Cerebro-spinalis,
830

Todter. Paralysis of Movement Up¬
wards and Downwards, 763

Toufesoo and Babinski. * 1 Blue Disease, ”
Retinal Cyanosis, Hemiplegia following
on Whooping-Cough, 54

Trendelenburg. Movements of Birds
after Section of Posterior Spinal Roots,
821

Trevelyan, & F. Infantile Paralysis,
440

Trolard. Claustrum, 31

Tromner. “ Stammering Gait,” 770

Tubby, A. H. Surgical Treatment of
Paralysis, 384

Turner, John. Pathology of Epilepsy,
354 ; Structure of Olfactory Bulb and
Cornu Ammonia, as revealed by
Pseudo-Vital Method, 417

Turner, W. Aldren. Dietetic Treatment
in Epilepsy, 883 I

Urbach. Intention Tremor in Children,
62

Urbautschit8ch. Reflex Epilepsy, 838

V ass ale. Puerperal Eclampsia and
Parathyroid Insufficiency, 577
Verger and de Carden&l. Tabes, 692|
Vigouroux. Bed-Sores in General
Paralysis, 370

Villaret and Klippel. The Asthenias
and Myopathic Atrophies, 295
Villiger Emil. Gehim und Riickenmark
(Review), 239

Voisin, Jules, and Roger. Potassium
Bromide in Epilepsy, 852
Voisin, Roger, Jules Voisin, and A.
Rendu. Idiocy and Cerebellar Lesion,
523

Voisin, Jules, Roger Voisin, and A.
Rendu. Idiocy and Cerebellar Lesion,
523

Vorkastner. Jacksonian and Pseudo-
Jacksonian Epilepsy, 788
Voss, G. v. Hysterical Fever, 443
Vulpius, Oscar. Failures in Transplanta¬
tion of Tendons, 862

Walker. Dementia Praecox, 519
Walton and Paul. Cerebral Element in
Reflexes, its Relation to Spinal Ele¬
ment, 843

Warrington, W. B., and John Owen.
Pathology of Myelitis Acutissima
Hemorrhagica Disseminata, 401 ;
Haemorrhage into Brain and Cord
from Obliterative Arterial Disease,
407

Waterman and Putnam. Cerebellar
Tumours, 510

Wehrli. Cortical Blindness, etc,, 372
Wehrung, Gaston. Unilateral Loss and
Subsequent Return of & Knee-Jerk,
515

Weisenburg, T. H. Bulbar Symptoms
with Carcinoma of Parts other than
Nervous System from Intoxication,
300; Adult Hemiplegia, 366 ; Con¬
tractures in Organic Nervous Diseases,
375

Weisenburg and Mills. Word Blindness,
Treatment of Visual Aphasia, 152;
Localisation of Higher Psychic Func¬
tions, 420 ; Cortical Representation of
Cutaneous and Muscular Sensibility,
819

Weisenburg and Thorington. Syringo¬
myelia with Double Optic Neuritis, 138
Westphal. Traumatic Hysteria resem¬
bling Ophthalmoplegia Externa 144;
Malformation of Spinal Cord, 497
Weygandt. Idiocy, 225

INDICES

899

White, W. A. Types in Mental Disease,
455

Williams, Tom A. Report of Congress
of French Alienists and Neurologists,
718, 797, 863

Wilson, John Gordon. Taste-buds of
Larynx, 48

Winfield. Somatic Evidences of Syphilis
in Paretics, 612

Workman, Charles, and Walter E.
Hunter. Cord and Medulla in Acute
Ascending Paralysis, 106
Wyler, Marcus. Outlines of Comparative
Lunacy Law (Review), 869

Zbindkn. Psychological Conception of
Nervousness, 870

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